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Legislative Assembly","@language":"en"}],"DateAvailable":[{"@value":"2018-05-17","@language":"en"}],"DateIssued":[{"@value":"[1955]","@language":"en"}],"DigitalResourceOriginalRecord":[{"@value":"https:\/\/open.library.ubc.ca\/collections\/bcsessional\/items\/1.0367835\/source.json","@language":"en"}],"FileFormat":[{"@value":"application\/pdf","@language":"en"}],"FullText":[{"@value":" PROVINCE OF BRITISH COLUMBIA\nNinth Report of the\nDEPARTMENT OF HEALTH\nAND WELFARE\n(HEALTH BRANCH)\n(Fifty-eighth Annual Report of Public Health Services)\nYEAR ENDED DECEMBER 31st\n1954\nVICTORIA, B.C\nPrinted by Don McDiarmid, Printer to the Queen's Most ExceUent Majesty\n1955\n it ;fc \u00ab Office of the Minister of Health and Welfare,\nVictoria, B.C., January 7th, 1955.\nTo His Honour Clarence Wallace, C.B.E.,\nLieutenant-Governor of the Province of British Columbia.\nMay it please Your Honour:\nW& The undersigned has the honour to present the Report of the Department of Health\nand Welfare (Health Branch) for the year ended December 31st, 1954.\nj| ERIC MARTIN,\nMinister of Health and Welfare.\n Department of Health and Welfare (Health Branch),\nVictoria, B.C., January 7th, 1955.\nThe Honourable Eric Martin,\nMinister of Health and Welfare, Victoria, B.C.\nSir,\u2014I have the honour to submit the Ninth Report of the Department of Health\nand Welfare (Health Branch) for the year ended December 31st, 1954.\nI have the honour to be, f\u00a7\n\u2022 Sir' f '\nYour obedient servant,\nG. F. AMYOT, M.D., D.P.H.,\nDeputy Minister of Health.\n DEPARTMENT OF HEALTH AND WELFARE\n(HEALTH BRANCH)\nHon. Eric Martin -\nMinister of Health and Welfare.\nSENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF\nG. F. Amyot, M.D., D.P.H.\nJ. A. Taylor, B.A., M.D., D.P.H. -\nG. R. F. Elliot, M.D., CM., D.P.H,\nA. H. Cameron, B.A., M.P.H. -\nG. F. Kincade, M.D., CM. -\nC. E. Dolman, M.B., D.P.H., Ph.D., F.R.C.P. -\nW. S. Maddin, B.A., M.D., CM. - - -\nA. J. Nelson, M.B., Ch.B., D.P.H. -\nJ. H. Doughty, B.Com., M.A.\nR. Bowering, B.Sc.(CE.), M.A.Sc. -\nT. H. Patterson, M.D., CM., D.P.H., M.P.H. -\nMiss M. Frith, R.N., B.A., B.A.Sc, M.P.H.\nF. McCombie, L.D.S., R.C.S., D.D.P.H. -\nR. H. Goodacre, M.A., C.P.H. - -\nMiss D. Noble, B.Sc.(H.Ec), C.P.H. - - -\nC. R. Stonehouse, CS.I.(C) -\nC. E. Bradbury -------\nDeputy Minister of Health and Pro-\nvincial Health Officer.\nDeputy Provincial Health Officer and\nDirector, Bureau of Local Health\nServices.\nAssistant Provincial Health Officer\nand Director, Bureau of Special\nPreventive and Treatment Services.\nDirector, Bureau of Administration.\nDirector, Division of Tuberculosis\nControl.\nDirector, Division of Laboratories.\nDirector, Division of Venereal Disease Control.\nConsultant in Epidemiology.\nDirector, Division of Vital Statistics.\nDirector, Division of Public Health\nEngineering.\nDirector, Division of Environmental\nManagement.\nDirector, Division of Public Health\nNursing.\nDirector, Division of Preventive\nDentistry.\nDirector, Division of Public Health\nEducation.\nConsultant, Public Health Nutrition.\nSenior Sanitary Inspector.\nRehabilitation Co-ordinator.\nE. R. Rickinson\nDepartmental Comptroller.\n TABLE OF CONTENTS\nGeneral\u2014 Paoe\nThe Province and Its People _ :2L 11\nThe Health of the People 12\nThe Organization for Public Health Services 12\nOther Major Developments and Activities 14\nReport of the Bureau of Local Health Services 16\nHealth-unit Organization and Development 17\nAdministration 19\nCommunity Health Centres 21\nHome-care Programmes 22\nResident Physicians' Grants 26\nSchool Health Services 26\nThe Health of the School-child 31\nTable I.\u2014Physical Status of Pupils Examined, Showing Percentage in\nEach Group, 1947-48 to 1953-54 31\nTable II.\u2014Physical Status of Total Pupils Examined in the Schools for the\nYears Ended June 30th, 1950-54 32\nTable III.\u2014Physical Status of Total Pupils Examined in Grades I, IV,\nVII, and X for the Years Ended June 30th, 1953-54 32\nTable IV.\u2014Summary of Physical Status of Pupils Examined, According\nto School Grades, 1953-54 32\nTable V.\u2014Physical Status by Individual Grades of Total Schools, 1953-54 33\nTable VI.\u2014Number Employed and X-rayed amongst School Personnel,\nif 1953-54 . 33\nm Table VII.\u2014Immunization Status of Total Pupils Enrolled, According to\nIf School Grade, 1953-54 33\nDisease Morbidity and Statistics 35\nTable VIII.\u2014Notifiable Diseases in British Columbia, 1950-54 (Including Indians) 40\nTable IX.\u2014Notifiable Diseases in British Columbia by Health Units and\nSpecified Areas, 1954 41\nReport of the Division of Public Health Nursing 42\nStatus of Service 42\nOS Public Health Nursing Consultant Service I 43\nPublic Health Nursing Training % 45\n|| Local Public Health Nursing Service 46\nGeneral 48\nReport of the Division of Environmental Management 50\nA. Nutrition Services 50\nConsultant Service to Local Public Health Personnel 51\nConsultant Service to Hospitals and Institutions 52\nConsultant Service to Other Government Departments 53\nOther Activities 5 3\n|\u00a7 B. Sanitary Inspection Services 54\nMilk 54\n:M Food Premises 55\nLocker Plants 56\nSlaughter-houses 56\nMeat Inspection 56\nM Industrial Camps 56\nSummer Camps 57\nfS Schools 57\nPlumbing 57\n7\n L 8 BRITISH COLUMBIA\nReport of the Division of Environmental Management\u2014Continued\nB. Sanitary Inspection Services\u2014Continued\nRodent Survey\t\nGeneral Sanitation\t\nC Civil Defence Health Services\nHospital Disaster Plans\nEmergency Medical Supplies\nEmergency Blood Service\t\nStudy Forum\t\nTraining\t\nGenera]\t\nD. Employees' Health Service\t\nPlanning\t\nService | 61\nRecords 62\nSurveys and Other Activities g\nj? Policy 62\nE. Health-care Research Project 6!\nReport of the Division of Preventive Dentistry \t\nPrevention\t\nDental Personnel 71\nGeneral I 73\nReport of the Division of Public Health Engineering 74\nWater-supplies i 74\nSewage-disposal 75\nStream Pollution\t\nSiell-fish j\nSwimming and Bathing Places\nTourist Accommodation \"\nFrozen-food Locker Plants \"\nGeneral\t\nReport of the Division of Vital Statistics\t\nRegistration of Births, Deaths, and Marriages\nDocumentary Revision\t\nMicrofilming of Documents\t\nAdministration of the \"Marriage Act\" ;^- \"\nRegistration of Notices of Filing of a Will\nCertification Services\t\nDistrict Registrars' Offices !'\nGeneral Administration ~\nStatistical Section . -\nCancer Registry \"\nTable I.\u2014Number and Percentage of New Cancer Notifications by Site\nand Sex, British Columbia, 1954 - 51\nTable II.\u2014Number and Percentage of Reported Live Cancer Cases by\nSite and Sex, British Columbia, 1954\n52\nTable III.\u2014Cancer Notifications by Sex and Age-group, British Columbia,\n1954 '2\nTable IV.\u2014Live Cancer Cases Reported by Sex and Age-group, British\nColumbia, 1954 ji '2\nPopulation Characteristics of the People of British Columbia - J\nPopulation in British Columbia by Age-group 1901-54 9\nBirth and Stillbirth Rate ____ |g 5| 8\nPrincipal Causes of Mortality in British Columbia - 5!\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 9\nPage\nReport of the Division of Public Health Education 95\nLocal Health Educators 95\nIn-service Training 95\nfMaterials 96\nPublications and Publicity 97\nStaff 98\nReport of the Health Branch Office, Vancouver Area 99\nBuildings - 99\n|j\u00a7 Personnel 99\nFaculty of Medicine, University of British Columbia 100\nVoluntary Health Agencies 100\nGeneral 101\nNational Health Grants 102\nAcknowledgment 108\nReport of Division of Laboratories 109\nTable I.\u2014Statistical Report of Examinations Done during the Year 1954, Main\nLaboratory 110\nTable II.\u2014Statistical Report of Examinations Done during the Year 1954,\nBranch Laboratories 111\nIfi Tests for Diagnosis and Control of Venereal Diseases 111\nTests Relating to Control of Tuberculosis 112\nSalmonella-Shigella Infections 112\nOther Types of Tests ^. 113\nBranch Laboratories 115\nGeneral Comments 116\nReport of the Division of Venereal Disease Control 117\nIntroduction 117\nTreatment 117\nEpidemiology . 117\nSocial Service ! 118\nEducation : | 118\nGeneral 119\nReport of the Division of Tuberculosis Control\u2014 120\nDeaths from Tuberculosis by Place of Death, 1945-54 120\nAdmissions to Tuberculosis Institutions, 1945-53 120\nNew Cases of Tuberculosis by Year of Notification, 1947-54 121\nSanatorium Accommodation 122\nAge Distribution in Sanatorium 122\nNational Health Grants 123\nRecalcitrant Patients 124\nControl of Tuberculosis 125\nReport of the Rehabilitation Co-ordinator 126\nRehabilitation 126\nReport of the Accounting Division 127\n Ninth Report of the Department of Health and Welfare\n(HEALTH BRANCH)\nFifty-eighth Annual Report of Public Health Services\nYEAR ENDED DECEMBER 31st, 1954\nG. F. Amyot, Deputy Minister of Health and Provincial Health Officer\nDuring 1954 the events and trends in public health in British Columbia were, for the\nmost part, encouraging. It was possible to effect certain improvements in the organization\nand administration of the service. There was no dramatic outbreak of disease to disturb\nthe course of events.\nThe General section, immediately following, describes in summary form the major\ndevelopments which took place throughout the year and the situation at the year's end.\nThe later sections describe in greater detail the programmes and activities of the various\nservices which constitute the Health Branch.\nThe Deputy Minister of Health is grateful to all those persons and agencies who\nhelped to maintain and improve the service. Other departments of Government, professional groups, voluntary agencies, private citizens, and employees of the Health Branch\nall contributed to make this a year of progress. To them the Deputy Minister extends his\nsincere thanks. The Deputy Minister also wishes to direct special attention to the\nassistance given by the Department of National Health and Welfare. Throughout this\nAnnual Report, there is repeated reference to the National health grants and the part\nthat they have played in improving public health services in British Columbia. Although\nit is not possible to describe all the benefits that have resulted from this far-reaching\nFederal programme, the Deputy Minister wishes to express his gratitude to the Federal\nauthorities, not only for the financial aid, but also for their co-operation in helping to\nadminister the programme.\nGENERAL\n|| A. H. Cameron, Director, Bureau of Administration\nTHE PROVINCE AND ITS PEOPLE\nThe area of British Columbia is approximately 366,000 square miles. The population, according to the mid-year estimate, is 1,266,000, an increase of 36,000 over the\n1953 population. Over the Province as a whole, this gives a population density of 3.5\npersons per square mile, which is the second lowest among the Provinces of Canada.\nHowever, the greatest concentration is in the southern and particularly the south-western\nsections, with almost one-half of the total population of the Province living in the metropolitan areas of Greater Vancouver and Victoria-Esquimalt. With more than 72 per cent\nof the people residing in urban areas (metropolitan areas and communities with populations of more than 1,000), British Columbia ranks with Ontario among the Provinces of\nCanada in having the highest proportion of urban residents. Approximately 15 per cent\nof British Columbia's population is 60 years of age and over. The Canada-wide figure\nfor the same group is only 11 per cent.\n11\n L 12 BRITISH COLUMBIA\nTHE HEALTH OF THE PEOPLE\nAlthough health has, or should have, much broader implications, than the mer\nabsence of disease and infirmity, it is usual to report on the health status of any group 0f\npeople by reporting in terms of death rates, causes of death, and sickness experience\nAccording to the Director of Vital Statistics, British Columbia's crude death rate for\n1954 was 9.6 deaths per 1,000 population. This was the lowest rate experienced since\n1939, and, in view of the increased proportion of older people in the population to-day\nit represents a considerable improvement. Heart-disease, cancer, intracranial lesions of\nvascular origin, and accidents were again the four leading causes of death, as they have\nbeen for some time.\nThe Director of Local Health Services reports a decrease in the total incidence oi\nnotifiable disease. The decrease in respect to the volume of poliomyelitis was particularly\ngratifying. On the other hand, infectious hepatitis was on the increase and enteric infections of the shigella-salmonella group continued their upward trend. The minor communicable infections, such as chicken-pox, measles, mumps, pertussis, and rubella,\naccounted for approximately two-thirds of the total notifiable disease. With reference\nto school-children, the Director of Local Health Services states that this group is in good\nphysical condition clinically but stresses the need for increasing the proportion of children\nimmunized against the major communicable diseases such as diphtheria and smallpox,\nBecause of the advent of antimicrobials and the advances in chest surgery, the\nDirector of Tuberculosis Control states that it is now possible to cure tuberculosis. The\ndeath rate from this disease has declined markedly since 1946, when streptomycin was\nintroduced. In 1954 it was 9.3 per 100,000, as contrasted to 57.4 per 100,000 for 19ft\n(These rates include the Indian population.) Although there has not been such a sharp\ndecline in the morbidity rate, it is gratifying to note that fewer cases have been found, in\nspite of increasing efforts to locate them. |\nThe Director of Venereal Disease Control states that the total number of venereal-\ndisease cases reported in 1954 was lower than in previous years. However, non-specific\nurethritis remains a problem requiring special attention.\nTHE ORGANIZATION FOR PUBLIC HEALTH SERVICES\nIn British Columbia the two large metropolitan areas, Greater Vancouver and\nVictoria-Esquimalt, operate their own city health departments. Although these do not\ncome under the direct jurisdiction of the Provincial Health Branch, they receive substantial\nfinancial assistance from it and co-operate closely with it. Throughout the remainder oi\nthe Province, public health service is provided by health units. (A health unit is defined\nas a modern local health department staffed by full-time public-health-trained personnel\nserving one or more population centres and the rural areas adjacent to them.)\nOriginal plans, made some years ago, called for the formation of seventeen such\nhealth units. It is most encouraging to be able to report that sixteen of these are now\ncompletely organized and in operation. Only the Gibsons-Howe Sound area has not\nattained health-unit status, although even here full-time public health nursing and sanitary\ninspection services are in operation. It is also encouraging to note that only one of the\nsixteen units was without a full-time medical director at the end of the year. On the other\nhand, the shortage of public health nurses continued to be a most discouraging problem\nOnly by employing some nurses who lacked postgraduate training in public health was\nit possible to maintain service to the public.\nThe metropolitan health services (Greater Vancouver and Victoria-Esquimalt) and\nthe Provincial health services together reach practically every citizen of the Pro*\nExcluding Indians, for whom services are provided by Federal authorities, the percent**\nof the Province's population receiving public health service at the end of 1954 from'\nsources named were as follows:\u2014\nI\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 13\nSource of Service Per Cent\nCity health departments of Greater Vancouver and Victoria-\nEsquimalt 47.1\nProvincial health units 49.3\nNon-health-unit areas (public health nursing and sanitary\ninspection districts) 1.9\nTotal 98.3\nThe staffs of the health units\u2014that is, the \"teams\" of public health physicians,\nnurses, sanitary inspectors, and related workers\u2014provide direct to the public a generalized\nservice. Supporting these \" teams \" and serving the public through them are certain\nProvincial specialized services which, for economic or other reasons, cannot be established\nand maintained locally. Important among these specialized programmes are the services\nrendered by the Divisions of Tuberculosis Control, Venereal Disease Control, and Laboratories, which comprise the Bureau of Special Preventive and Treatment Services.\nAt the year's end the Division of Tuberculosis Control was providing 788 treatment-\nbeds in its four institutions\u2014Willow Chest Centre and Pearson Tuberculosis Hospital, in\nVancouver; the Vancouver Island Chest Centre, in Victoria; and Tranquille Sanatorium,\nnear Kamloops. In the Division as a whole there were approximately 730 employees.\nThese staff members served not only the institutions mentioned above, but also Divisional\nheadquarters and the clinics, both stationary and travelling, which are operated in strategic\nparts of the Province. Because renovations at Tranquille Sanatorium had made extra\nbeds available, it was possible to close Jericho Beach Hospital, in Vancouver, at the end\nof October. This was desirable, and even necessary, because the building, a temporary\nstructure built by the armed forces during World War II, had become very difficult to\nmaintain and operate economically.\nThroughout the year the Division of Venereal Disease Control continued to use the\nold and inadequate building on Laurel Street, Vancouver, as its headquarters and principal\nclinic and treatment centre. (It is anticipated that the new Provincial Health Building,\nnow nearing completion, will provide more modern quarters long before the next Annual\nReport is written.) Other clinics were operated at the following locations: Victoria,\nNew Westminster, Vancouver (City Gaol, Juvenile Detention Home, Girls' Industrial\nSchool, and the Metropolitan Health Committee's Health Unit No. 1), Oakalla Prison\nFarm, Prince Rupert Gaol, and Prince George City Gaol. Two changes in the administrative organization are examples of co-operative planning. The Victoria Clinic, which\nwas formerly a self-contained subsection of the Division of Venereal Disease Control,\nhas now been placed under the immediate administrative management of the Division of\nTuberculosis Control's Vancouver Island Chest Centre. The New Westminster Clinic\nhas become closely integrated with the Simon Fraser Health Unit, whose staff have\nassumed responsibility for case-holding and treatment of venereal-disease patients. The\nstaff of the Division consisted of approximately thirty full-time employees and several\npart-time employees. Drugs, free of charge to the patient, were again made available\nto all private physicians for the treatment of venereal disease. In order that the drugs\ncan be dispensed locally to private physicians, supplies are placed in health units\nthroughout the Province.\nThe year's end once again found the Division of Laboratories operating its headquarters and main laboratory in the old wooden houses on Hornby Street, Vancouver.\nThis Division has suffered more acutely than any other part of the public health service\nfrom lack of proper accommodations over a period of many years. It is gratifying to\nreport, therefore, that the Division of Laboratories will move to modern, properly designed\nquarters reasonably early in 1955 when the new Provincial Health Building is completed.\nBranch laboratories were operated throughout 1954 at Victoria and Nelson. However,\n L 14 BRITISH COLUMBIA\nthe one-person branch laboratory at Prince George, which had been in operation forf011r\nyears, was closed after the end of March. For the Division as a whole, the Director of\nLaboratories reports that there was little change in the work-load. A decline in total\nnumber of tests performed was offset by increases in many of the more time-consumfe\ntypes of tests. The staff of the Division numbered approximately forty-seven. AH but\na very few of these work in the main laboratory in Vancouver.\nOther specialized services are provided by the Divisions of Public Health Nursing\nPublic Health Engineering, Preventive Dentistry, Environmental Management, Vital\nStatistics, and Public Health Education. All of these provide consultative service to the\nstaffs of the health units, and some of them, the Division of Public Health Nursing\nparticularly, have large responsibilities in recruitment and placement of personnel. The\nDivisions of Public Health Engineering and Vital Statistics also have responsibilities in\nproviding service direct to the public. There were no major changes in the organization\nof these six Divisions during 1954.\nTTiere were, however, three important changes contemplated or actually effected in\nthe central consultative services of the Health Branch. The first of these was the appointment of a Consultant in Epidemiology. Dr. A. John Nelson, former Director of the\nDivision of Venereal Disease Control, assumed this position in April, 1954, and has\nalready done much to meet a long-felt need in communicable-disease control. During\nthe first year the entire salary and travel expenses of the Consultant will be paid from\nNational health grant funds, which will also meet part of the costs during the following\ntwo years. |\nThe second was the appointment of a Provincial Co-ordinator of Rehabilitation in\nSeptember. This development was the result of an agreement between the Province and\nthe Federal Department of Labour, which share in paying the salary and expenses of the\nCo-ordinator. The new appointee is Mr. C. E. Bradbury, former Rehabilitation Officer\nin the Division of Tuberculosis Control. His first report appears later in this volume.\nThe third major change is the proposed appointment of a Technical Supervisor of\nClinical Laboratory Services. Although the salary will be derived from the National\nhealth grants, the British Columbia Civil Service Commission has been asked to conduct\na recruiting competition in accordance with the Commission's usual procedures. It is\nhoped that an appointment will be made early in the new year. The Technical Supervisor will take an important part in effecting the proper use of the Laboratory and\nRadiological Services Grant to strengthen and develop clinical laboratories, particularly\nthose in rural hospitals throughout the Province. I\nAM of the foregoing describes briefly the organization for public health services as\nprovided by the official agencies\u2014the Provincial Health Branch and the two metropolitan\nhealth departments. Supplementing these official agencies, British Columbia's voluntary\nhealth agencies continued to provide much-needed services. Although the Provincial\nGovernment has not yet considered it desirable or necessary to enter these specialized\nfields on an operational basis, it provides considerable financial support through the\nHealth Branch. Because the headquarters of most of the voluntary agencies are in Vancouver, the Assistant Provincial Health Officer has the responsibility of effecting proper\nliaison and co-ordination. This close tie between the official health agency and the\nvoluntary groups has done much to prevent misdirection of energies and duplications\nor omissions in services.\nOTHER MAJOR DEVELOPMENTS AND ACTIVITIES\nDuring 1954 there was encouraging progress in the construction of much-needed\naccommodation for laboratories, offices, clinics, and treatment services. At the end of\nthe year the general structure of the Provincial Health Building on Tenth Avenue near\nWillow Street in Vancouver had taken form, although it was anticipated that it wo*\ntake several months' more work to make the building ready for occupancy.\n DEPARTMENT OF HEALTH ANtfWELFARE, 1954 L 15\nConstruction of the Poliomyelitis Pavilion was undertaken on the grounds of the\nPearson Hospital, of which it will form an administrative sub-unit. Although last year's\nReport expressed the hope that the new pavilion would be ready to receive patients by\nthe summer of 1954, it is now known that the building will not be ready for occupancy\nbefore February, 1955. Designed for the care of convalescent poliomyelitis cases, it\nwill relieve the general hospitals\u2014particularly the Vancouver General Hospital and the\nRoyal Jubilee Hospital in Victoria\u2014so that those institutions may be better able to care\nfor acute cases.\nThe Federal Hospital Construction Grant is being used to assist in the construction\nof both the Provincial Health Building and the Poliomyelitis Pavilion.\nNew community health centres were completed at Oliver, Nanaimo, New Westminster, and Vancouver, and construction was undertaken at Ladner and Revelstoke.\nPlans were being made for similar developments in Keremeos, Rossland, Penticton, and\nCloverdale, and for further construction in Vancouver, fi In each case the Federal and\nProvincial Governments have assisted the local community in the cost of construction.\nThe National Hospital Construction Grant has provided the Federal contribution, and\nservice clubs and voluntary agencies have given material assistance with the local\ncontribution in some cases.\nAt Smithers and Nakusp the public health nurses were provided with much-improved\noffice and clinic accommodation by the Provincial Government which made space available in the Court-house in those centres. An improvement was also effected for the\npublic health nurse at New Denver, where a building was renovated to provide a small\nbusiness office and a larger separate clinic.\nAt Nelson more spacious accommodations were made available on a rental basis\nfor use as clinics and offices. When these quarters were being altered and renovated to\nsuit them for their new role, health-unit staff members themselves assisted materially by\nbuilding the necessary cupboards, counters, and similar interior fittings.\nIn the field of personnel administration an important change was made in April,\n1954, when Mr. P. M. Nerland, former personnel assistant in the Division of Tuberculosis\nControl, was appointed as personnel officer for the Bureau of Special Preventive and\nTreatment Services. This change extended the personnel officer's responsibilities to the\nDivisions of Venereal Disease Control and Laboratories as well as the Division of\nTuberculosis Control. Since the headquarters and main operational centres of all three\nDivisions are located in Vancouver, it is sound to have their personnel administration\nunder the control of one official. Information in respect to numbers of positions, employees on staff, and related matters of establishment control has been placed on a firm\nbasis.\nIn February, 1954, an Employees' Health Service for Provincial Civil Servants in\nthe Victoria area was placed in operation with the appointment of Mrs. Evlyn Dalman\nas industrial nurse. The Health Branch had earlier participated in planning with the\nCivil Service Commission and the Department of Public Works, both of which have an\ninterest in the Service. During this first year of operations the salary and expenses of\nthe industrial nurse have been derived entirely from the National health grants, which\nwill continue to share the cost for the next three years. The programme is supervised\nby the Health Branch's Director of Environmental Management. His report, which\nappears later in this volume, provides details of the new service.\nHealth-unit personnel and senior officials of the Health Branch were again fortunate\nin being able to add to their professional knowledge by attendance at the Public Health\nInstitute. At the 1954 meeting, which was held in Vancouver from April 20th to April\n23rd, the chief speaker was Miss Ruth Gilbert, Assistant Professor of Nursing Education,\nTeachers College, Columbia University. Miss Gilbert's six lectures on mental hygiene\nwere of deep interest and value to all members of the staff.\n L 16; BRITISH COLUMBIA\nREPORT OF THE BUREAU OF LOCAL HEALTH SERVICES\nJ. A. Taylor, Director\nAny health department functions primarily to promote and maintain ideal maxim\ncommunity health, thus ensuring optimum conditions for ideal maximum individual heato\nThis can only be accomplished adequately and efficiently through properly orffimizJ\nhealth services at the municipal level, staffed with sufficient numbers of trained personnel\nto co-ordinate community action toward that goal. Health services at the provincial\nlevel foster and support those local health services at the municipal level, and the various\ndivisions ProvincMly serve in a consultative and advisory capacity to the staff within\nthe local areas. Provincial health service is designed, therefore, to contribute to local\nhealth service, and all programmes are planned Provincially to flow through local health\nservices to the people who are to be served.\nAs the year ends, it is possible to record the progress and, conversely, the lack of\nprogress toward meeting community health needs throughout the Province. On the asset\nside can be recorded such items as:\u2014\nA gradually increasing growth of home-nursing programmes.\nThe development of more adequate prenatal clinics.\nAn improvement in the consultative pediatric clinics throughout the whole\nof the Province.\nAn increase in the cancer diagnostic and consultative clinics in the Province.\nAn improvement in the services of the child guidance clinics.\nAn increase in the number of community dental clinics.\nAn increase in the number of diagnostic X-rays of hospital in-patients.\nA fortuitous decrease in the incidence of poliomyelitis.\nThe development of a consultative epidemiological service to assist in the investigation of disease outbreaks.\nA complete revision of the programme of School Health Services.\nA research study of hospital admissions as a basis of inquiry into morbidity\ncauses.\nThe development of a Provincial Government Employees' Health Service,\nwhich also serves as an industrial health-programme pilot study.\nThe development of a sanitary inspector training programme to provide additional trained staff for recurring vacancies.\nThe promotion of an annual meeting of representatives of Union Boards of\nHealth.\nThe construction of additional community health centres.\nOn the other hand, certain hindrances and lack of progress can be seen in:\u2014\nA serious shortage of public health nurses, creating vacancies in nursing districts in health units, and preventing opening of new nursing districts in\ngrowing communities.\nThe resignation of the Assistant Director of the Division of Public Health\nNursing.\nA difficulty in recruiting sufficient dentists to develop the complete programme\nof Regional Dental Consultants.\nThe resignation of the public health physician in the Skeena Health Unit, an\nthe lack of success to date in recruiting a replacement\nA marked increase in the incidence of infectious hepatitis in many commiHUu \u2022\nA gradually increasing annual incidence of enteric infections of the salmofle\nand shigella type.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 17\nAt this time it is also possible to enumerate some of the points requiring study and\ninvestigation if the health needs of the people of the Province are to be entirely fulfilled.\nAmongst these points are:\u2014\nA thorough evaluation of present public health practices, particularly in the\njII field of public health nursing, to ensure that effective use is being made\nof existing staff and, where possible, to redistribute the load on that staff\nso that they may adequately handle other tasks.\nThe continuation of studies into disease morbidity to determine bedside nursing-\ncare needs throughout the Province.\nRefinements in the programme of maternal and child hygiene.\nA further study toward a more complete programme of industrial hygiene.\nAn approach toward a more favourable recruitment of public health nurses.\nThe planning of a programme of vaccination for poliomyelitis as a possible\ncontrol of that disease.\nA study of methods of control of infectious hepatitis, possibly through the distribution of gamma globulin as a prophylactic and therapeutic measure.\nAn attempt toward decreasing the incidence of enteric infections.\nf|r A study of opinions on tuberculosis infectivity to co-ordinate the ideas of field\npersonnel with the specialists in tuberculosis.\nThe organization of postgraduate refresher training for staff members serving\ncontinuously over periods of years.\nHEALTH-UNIT ORGANIZATION AND DEVELOPMENT\nThe Bureau of Local Health Services has had as its major function to encourage\nand stimulate the development of adequate health units throughout the Province to raise\nthe standard of health services in the Interior parts of the Province to the level of those\navailable in the larger metropolitan areas. Originally, seventeen such health units were\nplanned, sixteen o^ which have now come into being. Only the Gibsons-Howe Sound\narea is not completely organized. Even in this area some progress has been made, with\nthe addition of a full-time sanitary inspector this year to augment the services provided\nby the two public health nurses. It has not yet been decided whether this area would\nbe better served through union with the North Shore Union Board of Health or through\norganization of an entirely separate unit with its own public health physician as Medical\nDirector. The growth of the area, as further development of the Pacific Great Eastern\nRailway progresses, will be a factor in determining the decision. In the meantime the\npeople in this area are fairly adequately served by the aforementioned staff, supported by\nprivate physicians acting as part-time Medical Health Officers in the populated centres\nwithin the area.\nIt was also possible during this year to recruit a young physician interested in public\nhealth to become full-time Director of the Peace River Health Unit, thereby restoring\nto that unit its full complement of staff for the first time in two years. This physician\nwill probably undertake postgraduate study in public health within a year.\nThe physician employed as Medical Director of the Skeena Health Unit expected to\ndepart on postgraduate study in public health during September, but suddenly reversed\nhis decision in favour of returning to the private practice of medicine. While another\nqualified public health doctor had been located to replace the departing candidate, last-\nminute changes in his immigration plans from England rendered this impossible. This\nunit has, therefore, been operating without the services of a Medical Health Officer and\nSchool Medical Inspector since September, and all attempts to recruit a replacement\nhave been fruitless.\nIt is of some value to contemplate the development that has taken place in local\nhealth services over the past five years, since National health grants came into being, as it\n L 18 f BRITISH COLUMBIA\nserves to illustrate the impact that these health grants have had in accelerating the growth\nof local health services. The major growth has occurred outside the metropolitan health\nareas, which already had fairly extensive health-department coverage prior to 1948, The\nAajor need at that time was for the development of full-time local health units for the rest\nof the Province as a method of offering equal health services to all citizens, irrespective of\ntheir place of residence. It is interesting, therefore, to compare the local health services\nsituation, excluding metropolitan areas, in 1947, prior to National health grants, with that\nin 1953 after National health grants had been in operation for five years:\u2014\n111 1947 ' 1954\nNumber of health units 6 16\nNumber of health-unit directors 5 15\nNumber of public health nurses 98 141\nNumber of sanitary inspectors 6 31\nNumber of dental officers 5\nNumber of health educators g 1\nNumber of health-unit clerks 6 35\nThe costs of development within local health services have shown significantly pro-\nportionate increases, but comparison does show the very fortunate situation that local\nareas occupy, from the point of view of the amount requested from them toward financing\nof the total programme. It is readily seen that the greater proportion of the increase in\nlocal health services has originated from the contributions provided by National health\ngrants, with a proportionate increase by the Province and a lesser amount by local\ngovernments.\nExpenditures for Local Health Services, Exclusive of\nMetropolitan Areas\n1947 1954\nProvincial S $331,922.00 $598,789.00\nLocal 121,078.00 163,199.00\nFederal 240,588.00\nTotals $453,000.00 $1,002,576.00\nEstimated per capita 1.00 1.561\nInclusion of Dental Costs\nProvincial $331,922.00 $598,789.00\nLocal 121,078.00 212,624.00\nFederal 328,473.00\nTotals $453,000.00 $1,139,886.00\nEstimated per capita 1.00 1.781\n1 Based on population of 640,670.\nIn 1947 the per capita cost for local health services was approximately $1, but*\nchanging economic trend has increased this to the degree that the per capita cost, outside\nmetropolitan areas, has risen to $1.56. \u00a7 |\nLocal health services within the metropolitan areas of Greater Vancouver and\nVictoria-Esquimalt continue to make substantial progress during the year. While ties6\nservices operate somewhat independently of the direct supervision of the Health Brancn,\nthey, nevertheless, maintain a very excellent co-operation, and participate in the annual\nPublic Health Institute and the bi-annual Health Officers' meetings. Financial assistance\ntoward their operation has been continued on the same basis throughout the year as id\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 19\nprevious years, any increases in costs being absorbed by the municipalities themselves.\nA table briefly indicates the present situation as far as these financial contributions are\nconcerned, indicating the amounts involved in assistance toward metropolitan health\nservices:\u2014\nMetropolitan Health Services, Inclusive of Dental Costs\nProvincial $175,504.00\nFederal 152,440.00\nLocal 1,173,116.00\nTotal $1,501,060.00\nPer capita 2.53 x\n1 Based on population of 594,130.\nAs a result of this, the per capita cost of metropolitan health services can be shown\nto be $2.53, which, coupled with the previously mentioned per capita figure, shows a total\nper capita cost over the whole Province of $2.14.\nAs health units develop, there is less need and less opportunity for experienced\npersonnel to move to new locations to assume new appointments. Thus, staff are\nbecoming more permanently fixed in their present locations. This offers definite advantages, but raises the question of provision of opportunities for further advancement in\nnewer developments in public health and clinical medicine. Thus, study is being given\ntoward provision of some type of refresher courses for those members of the staff who\nhave given continuous service over periods of years, and who would gain particularly\nfrom instruction in newer developments in public health administration, public health\npractice, and clinical medicine.\nADMINISTRATION\nAdministration of the Bureau of Local Health Services has continued to function\nthroughout the year as it has in the past, guided by two advisory groups, namely, The\nLocal Health Services Council, composed of Divisional Directors, meeting weekly, and\nthe Medical Health Officers' Group, composed of all the full-time Medical Health Officers\nthroughout the Province, meeting bi-annually.\nThe Local Health Services Council has continued to act as an informed central\ncommittee in all phases of local health services, so that each member is kept acquainted\nwith developments in the field, while continuing to suggest alterations and modifications\nof existing policies and programmes. The work which was commenced some two years\nago on a manual of recommended procedures, a policy manual for local health services,\nhas progressed very slowly, but is being continued with the hope that it can be completed\nshortly. ^\nIt is probably from the Medical Health Officers' group that the major recommendations for changes in Departmental programmes and policies originate, and the meetings\nof this group have become increasingly valuable each year, particularly as more stability\noccurs within the ranks of the Health Officers and they become better acquainted with\nthe needs in promotion of efficiency and adequacy of their services.\nOne major development resulting from their deliberations this year was the complete revision of school health services. The need for changes in the school health\nservices programme had been discussed repeatedly at meetings of the Medical Health\nOfficers' Group, without tangible results, until the work was delegated to a sub-committee,\nwhich brought in a report which was thoroughly discussed at the April meeting, thereby\nprompting final recommendations. A more complete review of this revision will be\nfound in the section of this report dealing with School Health Services. Arising from\nthe work of the committee, however, has been a Standing Committee on School Health\n L 20 \u00bb \u25a0 \u2022 \u25a0 \u25a0 BRITISH COLUMBIA\nServices, which will continue to carefully examine school health programmes from time\nto time in order that they may be kept as practical as possible.\nAnother Standing Committee of the Health Officers' Group\u2014that dealing with\ncommunicable-disease control\u2014has as its primary function the study of regulations and\ncontrol measures, so that effective revision of regulations is maintained in keeping with\nepidemiological knowledge of the spread factors. During the year this sub-committee\nhas studied the recommendations presented by the Department of National Health and\nWelfare designed to promote uniform reporting of notifiable diseases across Canada,\nPrincipally, these recommendations indicate a desire to bring reporting more in line with\npractical experience, and to omit those minor conditions which are very infrequently or\nsporadically reported, and in which little, if anything, can be gained in attempted control,\nIt had been planned to have a Dominion-Provincial conference on these recommendations in the late fall of the year, but this has now been postponed until early spring, when\nan opportunity will be provided to air the opinions of the various Provinces toward the\nproposed change in uniform reporting. The sub-committee is headed by the newly\nappointed Consultant in Epidemiology, who will probably represent this Province in the\nconference deliberations.\nApart from these two accomplishments, the Medical Health Officers' Group has\nserved to bring a number of other problems up for consideration and has prompted the\ndrafting of swimming-pool regulations, which are designed to detail standards which\nshould be followed in construction of swimming-pools in the various communities. The\npreliminary work in this connection has been undertaken by the Director of the Division\nof Public Health Engineering, assisted by advice from Health Officers and one or two\nPhysical Recreational Directors from the University of British Columbia.\nIn addition to this accomplishment, other items which have received consideration\nduring the year is one rather controversial subject dealing with tuberculosis infectivity\nand interpretation of positive bacteriological cultures and smears. It was evident that\nthe varying opinions could not be thoroughly aired at any meeting of the Medical Health\nOfficers' Group, and consequently another sub-committee was struck to go into this\nsubject and bring forth definite recommendations for next year's meetings.\nA number of other items have received attention in discussion, such as health-unit\nbudgets, health-unit administration, milk legislation, standards for private hospitals, and\nfoster-home placement. At previous meetings an outline of a pamphlet detailing the\nduties and responsibilities of Union Boards of Health had been thoroughly discussed,\nmodified, and accepted. During the year this pamphlet was circulated to the various\nUnion Boards of Health throughout the Province, from whom suggested alterations or\nadditions in the material had been requested. The South Okanagan UMon Board of\nHealth presented one or two proposed changes, but the pamphlet was well received by\nthe remaining Union Boards of Health! The South Okanagan Union Board of Health,\nhowever, did feel that there would be considerable merit in an annual meeting of representatives of Union Boards of Health, and has been seeking some means of organization\nfor that purpose. Departmentally, it had been suggested that one of the possible approaches might be through the Union of British Columbia Municipalities, which, at its\nannual fall convention, mi^ht be able to arrange an opportunity for representatives of\nUnion Boards of Health to convene informally for discussion. Toward the end of tte\nyear it was possible to pursue this suggestion further with the executive secretary of the\nUnion of British Columbia Municipalities, with the result that an informal meeting of\nrepresentatives of Union Boards of Health was convened in October in Victoria during\nthe Union of British Columbia Municipalities Convention. There was exceptionally\ngood attendance and opportunity for thorough exploration as to the value of an annri\nmeeting of that type, with the result that a committee was struck to investigate ways and\nmeans of meeting annually at the same time as the Union of British Columbia Municipalities Convention. That committee is drafting proposals in anticipation of the ft*\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 21\nformal convention of Union Boards of Health to be held in Prince George in October,\n1955. The Health Branch, Department of Health and Welfare, was pleased to co-operate\nin this matter, since it is felt that it will provide an excellent opportunity for discussion\nof common inter-unit problems and for future planning in health-unit administration.\nCOMMUNITY HEALTH CENTRES\nThe plan, brought into being three years ago, to provide financial assistance toward\nconstruction of more adequate office and clinic accommodation for local health services\nhas continued to demonstrate its value as more and more communities co-operate in the\nplan. The proposals originally advanced were that the provision of a community health\ncentre should be originated in the community, either by the municipal authorities or by\nsome service club, to spark a drive to raise community funds for that purpose. Following this, a formal request was to be made for Provincial and Federal assistance through\nProvincial grants and National health grants toward construction of the building. During\n1954 four new community health centres were completed, construction got under way\non three more, and planning was under way in six other communities.\nIn Oliver a community health centre committee was organized to plan the construction of a sub-office for the South Okanagan Health Unit to provide office accommodation for the two public health nurses and clinic space for the various clinical services.\nAfter much initial organization, it was possible to raise the local share, assisted by the\nBritish Columbia Tuberculosis Society and the British Columbia Cancer Society. These\nfunds, coupled with the Provincial and National grants, were used to complete construction of a well-appointed spacious building that will serve all community health services,\nboth official and voluntary, in that area for many years to come. This building was formally opened by the Minister of Health and Welfare in September.\nPast reports have recorded the considerable effort that has been made toward construction of a Nanaimo Community Health Centre to house the headquarters of the\nCentral Vancouver Island Health Unit. The financial arrangements reached during the\nyear permitted construction of the greater portion of the building, leaving certain space\nincompleted until additional financing can be arranged. The completed quarters indicate\nthe degree of planning that has gone into this building to provide facilities for all the\ncommunity health needs of that municipality, co-ordinating all health programmes,\nofficial and voluntary, under the one roof. Here again the British Columbia Tuberculosis\nSociety, the British Columbia Cancer Society, the British Columbia Branch of the Canadian Arthritis and Rheumatism Society, the British Columbia Branch of the Canadian Red\nCross Society, and other agencies have assisted financially and are provided with space in\nthe building for their local operations. This building was also opened formally by the\nMinister of Health and Welfare during September.\nThe addition to the headquarters of the Simon Fraser Health Unit in New Westminster attained completion during the year. This large new double-storied structure\nprovides excellent accommodation for the health unit on the ground floor and for the New\nWestminster Stationary Tuberculosis Clinic on the second floor. This released space in\nthe older building, which now houses the Welfare Branch, so that there is complete consolidation of all three related services in the one building. It was formally opened by the\nMayor of New Westminster in the early summer. jj|\nThe City of Vancouver has participated in this building programme with the construction of two community health centres to house two of their area health units. These\nwill be definite assets to the health-unit administration in Vancouver, where operations\nhave been conducted for a considerable number of years in old renovated accommodation\nwhich was no longer suitable for the increasing clinic requirement and staff needs. First\nof these two was formally opened by the Minister of Health and Welfare in December.\nWhile these definite accomplishments reflect a credit upon the construction programme, the need for its continuity is evidenced in the fact that continual planning is going\n L 22 BRITISH COLUMBIA\nforward for community health centres in other areas. The construction of one serves\na concrete example of accomplishment in a community, thereby creating a desire fe\nsimilar health-department buildings in another community. At the moment, plans ^\nbeen completed and excavations commenced for sub-offices at Ladner and Revelstoke\nwhile plans are going forward for other sub-offices in Keremeos, Rossland, and Penticton\nand an addition to the headquarters office at Cloverdale. Three others are planned, also\nfor the Greater Vancouver area.\nThe very definite contribution that is being given to this programme by the British\nColumbia Tuberculosis Society, the British Columbia Cancer Society, the British Co-\nlumbia Branch of the Canadian Red Cross Society, and other voluntary agencies must be\nmentioned. While the Provincial grant and the National health grant provide a considerable part of the financing, it is, nevertheless, not always easy for the community to raise\nthe local share, which is often more than one-third of the total cost. To fill this breach\nthe contributions from these voluntary associations have aided materially in attaining the\nfinancial goal, which, otherwise, might have been most difficult. Their assistance in this\nprogramme has been much appreciated locally and is gratefully acknowledged by the\nHealth Branch.\nIn addition to the new housing that has arisen through this programme, reference\nmust be made to the accomplishment in certain communities through provision of more\nsuitably appointed accommodation in local Court-houses by the Provincial Government\nIn both Smithers and Nakusp, accommodation has been provided for the resident public\nhealth nurse more in keeping with her service as a health worker. In both instances this\naccommodation is more ideally located, more spacious, and provides room for the clinic\nas well as the nurse's offices. I\nIn New Denver, a change in offices also occurred with the removal of a building\nformerly on school property to a new location across the road from the school. The\nbuilding was placed on a more solid foundation and the interior renovated to provide a\nsmall business office for the resident public health nurse and a larger separate clinic room.\nWith headquarters in Nelson, the Selkirk Health Unit, which came into being last\nyear, was able to negotiate, on a rental basis, new accommodation to house the staff more\nadequately and provide space for their numerous clinic operations. Much credit is due\nthe local staff in this case, who did so much individual labour toward providing the necessary counters and cupboards, utilizing lumber provided through the Provincial Health\nBranch for that purpose. The renovations of the space were completed to the specifications of the staff, so that the whole arrangement was designed to fit their needs for the\npresent and for some time to come. I\nThe most pressing accommodation needs are in relation to the East and West Koote-\nnay Health Units at Cranbrook and Trail. The staff of both these units are operating out\nof cramped, poorly designed, and inadequate offices. The situation, in so far as Cranbrook\nis concerned, may be answered by the construction of a new Court-house now being\nplanned by the Provincial Government. Space for the health unit, designed in consultation with the staff to fit their present and future needs, is included. Some discussion has\ngone on in Trail toward the possibility of a community health centre under the form*\nplan of joint financing, but it would seem to be dependent upon the acceptance of the\nconstruction as a project by some service club. With a service club to spearhead community organization, it may be possible to arrange local financing to permit construction\nof an ideal community health centre. The Director of that health unit was continuing to\ninvestigate the possibilities as the year came to an end.\nHOME-CARE PROGRAMMES\nThere is an ever-increasing demand for home nursing-care programmes in certain\ncommunities throughout British Columbia. In large part, this demand originates from\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 23\nthe excellent progress that has been shown by the Vernon plan, originally set up to\nprovide home care to convalescent patients discharged from hospital earlier in order to\nrelease hospital beds for more acute cases, and thus demonstrate that a home-care programme could provide an economic saving to the community in obviating the construction\nof additional hospital space to provide additional beds. Since the patient could only be\nadmitted to the service from hospital by the attending physician, the service could be\nconsidered an extension of hospital care to the home. The public health nurses within the\nhealth unit were prepared to give nursing care in the home on an hourly basis, while a\nhousekeeping service was also available to patients requiring home help. For both\nnursing and housekeeping service, a small daily charge was to be made.\nIt is now possible to compare two annual periods during which the programme has\nbeen in continuous service, and to report that there has been a gradual increase in the\nscope of the service. It has been ably demonstrated, however, that the success of the\nwhole programme is dependent upon co-operation of medical staff, hospital staff, patients,\nand public health staff in fostering emphasis upon the service, so that patients are discharged from hospital to their homes under the programme. In one period of the year\nwhen there was little emphasis to that end, there was a definite lowering in the numbers\nserved and it was only when emphasis was again placed on the programme that it became\nmore widely used and further accepted.\nAs the year was drawing to a close, the demands upon the service were becoming so\ngreat that consideration was being given to the addition of another public health nurse to\nthe health-unit staff, in order that dispersal of the case load among a greater number of\nnurses could be undertaken.\nIn a period from January to August, 1953, each patient on nursing care had an\naverage of 5.6 visits to save 14.3 hospital-days, or one visit every 2.6 hospital-days saved.\nIn the same period in 1954, each patient had 6.6 visits to save 14.7 hospital-days, or one\nvisit every 2.3 hospital-days saved. In other words, in 1954, patients requiring nursing\ncare have needed more visits more closely spaced, indicating that possibly a more acute\ntype of nursing care has been required.\nIn the same period in 1953, each patient on housekeeping service required 42.5\nhours of housekeeping care to save 10.0 hospital-days, or 4.3 hours of care per hospital-\nday saved, as compared to 51.4 hours of care to save 14.5 days in 1954, or 3.5 hours\nof care per hospital-day saved.\nRegarding time of public health nurses, the visits were slightly less lengthy in the\nover-all in 1954 than in 1953, requiring 22 minutes, of which 14 were service, in comparison with 25 minutes, of which 14 were service, the reduction being confined mainly\nto travel. Each of three public health nurses averaged 361 minutes or about 6 hours\nper month given to this service in 1953, compared to 402 minutes or 6.7 hours per month\nin 1954. Comparative tables for these two periods are shown as follows:\u2014\nJanuary to January to\nAugust, 1953 August, 1954\nPatients receiving nursing care only 54 60\n:|g Patients receiving housekeeping services only 7 17\nPatients receiving both nursing care and housekeeping services 12 7\nTotals - 73 84\nNursing visits 370 439\nNursing visits per patient 5.6 6.6\nHousekeeping visits 196 257\n JL 24 BRITISH COLUMBIA\nHospital-days saved\u2014\nBy nursing 773 881\nBy housekeeping 69 246\nBy both 177 119\nTotals 1,019 1,246\nTime of public health nurses' travel minutes 3,863 3,651\nTime of public health nurses' service minutes 5,274 5,991\nTotals minutes 9,137 9,642\nAverage time per public health nursing visit for\ntravel minutes 10.4 8.3\nAverage time per public health nursing visit for\nservice minutes 14.3 13.7\nTotals minutes 24.7 22.0\nHousekeeping hours 807.5 1,234.75\nHospital-days saved\u2014\nPer patient receiving nursing care only 14.3 14.7\nPer patient receiving housekeeping services\nonly 10.0 14.5\nPer patient receiving both nursing care and\nhousekeeping services 14.8 17.0\nAverage number of hospital-days saved per patient on the home-care programme 14.0 14.8\nCosts\nCost from January to August, 1953 $1,851.46\nHospital-days saved 1,019\nCost per day $1.82\nCost from January to August, 1954 $2,034.04\nHospital-days saved 1,246\nCost per day $1.63\nTotal cost from January, 1953, to August, 1954 $4,869.63\nHospital-days saved 2,849\nCost per day $1.71\nThe cost of the service deserves special mention, since, during the initial stages of\nthe study, in the period from November, 1951, to May, 1952, it amounted to $4 per\nday. Since then, costs have been reckoned on a different basis, with the result that during 1953 the cost per day was shown to be $1.82. Experience with the plan and better\norganization have brought a further decrease, so that the cost per day during 1954 has\nbeen estimated to be $1.63. These figures are significant when compared with the hospital per diem cost of $11.35. Apart from this economic advantage, there has been the\nadditional fact that the service has increased the facilities of the Vernon Jubilee Hospital\nto the extent of 5.2 beds in continuous use during 1954, as compared to an increase in\n1953 of 4.3 beds. It demonstrates very ably that a properly organized and supervised\nhome-care programme can provide economic advantages to the community and service\nindividually to the patient.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 25\nThe publicity attendant with this programme has promoted desire for similar programmes in other communities. However, it must be recorded that a considerable portion of home-care nursing is presently being provided by the public health staffs throughout British Columbia, and that careful study and investigation are necessary before new\nplans are introduced for additional services, either on an official basis through health\nunits or on a voluntary basis through the Victorian Order of Nurses. In Nanaimo this\nsituation had to be faced a year ago when community request for Victorian Order of\nNurses service was considerable. Community organization resulted in the adoption of\nsuch a programme in Nanaimo, and Victorian Order nursing service was originated and\nis now operating throughout the city. It has substantiated itself during the year of operation and will be continued into the future, with consideration toward extension to neighbouring areas with the employment of additional staff.\nIn the Municipality of Saanich, considerable local demand for bedside nursing care\nwas presented to the Municipal Council through a local branch of the Women's Institute.\nThe Council, agreeing to the request in principle, turned the matter over to committee\nfor investigation, which committee studied the possibilities of obtaining the service\nthrough the Victorian Order of Nurses or through their official health department, the\nSaanich and South Vancouver Island Health Unit. After discussions with their local\nMedical Health Officer and the Health Branch, Department of Health and Welfare, as\nwell as officials of the Victorian Order of Nurses, a decision was made to recommend\nto the Council provision of the service through the health department, with financing by\nan increased local contribution of 10 cents per capita. For this amount, the Health\nBranch, Department of Health and Welfare, agreed to employ the services of an additional public health nurse, provide transportation, and pay operational costs, but the\nprovision of service would be allocated uniformly through the total staff of public health\nnurses. The service has been in operation since July, and has been able to meet satisfactorily all the needs referred to it. In actual fact, the addition of the programme has\nnot created any additional work load as far as the public health nurses are concerned,\nand would seem to indicate that the volume of home nursing was already being adequately\nmet before the formal acceptance of the programme was engineered. It is possible,\nhowever, that the initial introduction of the programme has not presented all the demands\nthat may have to be met, and a continued study of the programme is going to be required\nto determine the requirements that the service will have to face.\nA programme of home nursing and housekeeping care has been in effect in the\nCity of Kelowna for some years, operating quietly with very little publicity and yet\nsatisfying the needs of that community. More recently the City of Penticton has become\ninterested in a visiting nurse programme, through the Hospital Board, which has been\nstudying the reports on the service from the Vernon Jubilee Hospital. That Board has\nset up a committee who are investigating the possibilities and are seeking advice and\nguidance from senior members of the North Okanagan Health Unit, as well as officials\nof the Health Branch, Department of Health and Welfare. It has been suggested to the\ncommittee that they should discuss the proposals most carefully with the medical staff\nof the hospital and investigate to ensure that some of the potential cases are not already\nreceiving service.\nAdditionally, similar requests have been received from organizations in the Courtenay area and Powell River. Any plans in those communities would be modelled along\nthe plan introduced in the Municipality of Saanich, requiring an increased contribution\non the part of the local area toward financing of the service. In each case the committees\ninvestigating the possibilities have been advised to inquire very carefully to be sure that\nexisting needs are not being met and to make certain that it is not housekeeping services\nthat are being required rather than nursing services. In so many communities the opinion\nis voiced that home nursing service is required, when actual investigation reveals that it\nis more likely housekeeping assistance that is required for the convalescent patient or\n L 26 BRITISH COLUMBIA\nthe chronically ill pensioner. It is possible to set up both within the community, as ha\nbeen &o capably demonstrated in Kelowna and Vernon over the past few years, p\nquently the demands on the housekeeping service are greater in number and motepreT\ning than the demands on the nursing service. It behooves any community contempt\nlatin\nsuch a departure to make careful study to ascertain the community needs, since it is not\nadvisable to tie up professional nurses, when they are in such short supply, for services\nwhich can actually be provided by efficient housekeepers.\nRESIDENT PHYSICIANS' GRANTS\nFor some years the Health Branch, Department of Health and Welfare, has cooperated with the Department of the Provincial Secretary in supervision of a programme\nof grants-in-aid to resident physicians, which is designed to encourage physicians to take\nup residence in remote communities and to provide service on a periodic schedule of\nvisits to neighbouring communities which are not sufficiently large enough in themselves\nto support a physician. The amount of the grant was based upon a definite formula of\ngrants on a sliding scale, proportionate to the population density and distances to be\ntravelled. As the organization required a degree of intimate negotiation with practising\nphysicians, it was felt that it could probably better be handled entirely through the Health\nBranch, Department of Health and Welfare, and, as a result, the whole programme was\nturned over to that Department during the past year. |\nNo essential change has been effected in the method of administration, with each\nphysician under the grants being required to present a report, on a quarterly basis, of\nthe services provided, following which a quarterly payment of the grant is rendered,\nAt present, grants are being paid to some seventeen physicians to provide medical care\nto some thirty rural locations of the Province. During the year, negotiations were conducted under the plan on behalf of the communities at Atlin and Telegraph Creek, as\nwell as communities on the Queen Charlotte Islands. |\nIt was possible, toward the close of the year, to reorganize the service in so far as\nAtlin was concerned, as the Red Cross Society assumed responsibility for the operation\nof a Red Cross Outpost Hospital, under the jurisdiction of the resident Red Cross nurse,\nThe resident physician's grant continued to play a part, however, through provision of\nregular periodic visits from physicians at Whitehorse to Atlin, on a twice-a-month schedule, to see patients referred by the resident nurse to them for consultation. In this way,\nthis grant serves to meet, at least in part, the medical-care needs of these remote communities.\nSCHOOL HEALTH SERVICES\nHealth is a primary objective of modern education. A recent report has stated:\n\"An educated person knows the basic facts concerning health and disease\u2014works to\nimprove his own health and that of his dependents\u2014and works to improve community\nhealth.\"\nEvery school has tremendous opportunities to promote the health of its pupils and\nof its community. From early childhood to early adulthood, most children are enrolled\nin schools and are under the supervision of school staffs for a substantial part of the day,\nfor approximately half the days of the year. The conditions under which they live io\nschool, the help which they are given in solving their health problems, the ideals of\nindividual and community health which they are taught to envisage, and the information\nand understanding that they acquire themselves as living organisms are factors wW\noperate to develop attitudes and behaviour conducive to healthy, happy, and successtu\nliving. In all of its efforts the school must consider the total personality of each studefl\nand the mutual interdependence of physical, mental, and emotional health. Policies m^\nbe organized toward development of a school health programme which recognizesi tw\nthe total health of the total child and his total life situation is the prime objective ot any\nschool health programme.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 27\nWith this in mind, the scope and aims of school health services have been the subject\nof much discussion at meetings of public health physicians, who, employed as health-unit\ndirectors, are charged with the responsibility of providing school health services within\nthe community health services programme under the Union Boards of Health operating\nthe health units. From these discussions it was apparent that there was a unanimous\ndesire for some revision of existing school health services programmes to promote\nuniformity throughout the Province, assess the present services, and to reorganize the\nprogramme to provide the maximum service to the pupils and the teachers, while\nutilizing to the best advantage the professional staffs involved. I\nA sub-committee of the Health Officers, set up under the chairmanship of the\nDirector of the North Okanagan Health Unit, studied the present programme. They\nrecommended a revision of the programme, outlining in the beginning the objectives\ndesired, which were as follows:\u2014\nTo inspire the pupils with the desire to be well and happy.\nTo discover early any physical or emotional defect the pupils might have.\nTo secure their correction to the extent that they are remediable, and to assist\nthe pupils to adapt themselves to any irremediable handicap they might\nhave.\nTo protect the pupils against preventable and communicable disease and\navoidable physical defects by providing effective public health control\nmeasures throughout the school and community.\nTo impart effectively to the pupils scientifically accurate health knowledge.\nTo foster attitudes in the pupils which will cause them to conserve and promote\ntheir own health in an intelligent manner.\nTo see that the physical aspects of the school are maintained at a level which\nwill allow the students to do their best work, and to see that no defects\nare present which will affect the health of the pupils and teachers.\nIt was recommended that in order to work toward these objectives, certain services\nshould be given to the schools within their school area. Routine medical examinations\nshould be done in some of the grades, but because it is not possible to set a uniform\nnumber of grades to be examined throughout the Province, due to the great variation in\nthe number of school-children in the different areas, an order of priority is suggested as\nfollows:\u2014\n(1) Grade I, preferably before the child starts school and with a parent present.\n(2) Referred pupils from any grade. -fl IP P-\n(3) Pupils previously found to have serious defects, if the defects are not\nknown to have been corrected.\n(4) New arrivals from whom a medical record is not available.\n(5) Grade VII or X.\n(6) Grade IV.\nThe committee went on to emphasize the value of a teacher-nurse conference in\nstating that the nurse should hold a scheduled discussion with every classroom teacher\nabout the children in his, or her, register at least once and preferably twice every year.\nThe first conference should be very brief, held as soon after school opens in September\nas practical, and is for the purpose of telling the teacher about any of the pupils in the\nclass who may have specific health or emotional problems. The purpose of the second\nconference, which should be delayed until the teacher knows her pupils well, is to get the\nnames of those pupils that the teacher feels might have specific or emotional problems\nthat could be aided by the school health service. It is suggested that the conference will\nbe most acceptable if it is held during school-hours, not in the hearing of the students,\nand that both nurse and teacher use a \"guide\" as a basis for their discussion.\nWhen a teacher, from the physical appearance or action of a child, suggests that he\nor she should not have returned to school after an illness, the school medical service\nshould examine the child at the request of the teacher and recommend appropriate action.\n L 28 BRITISH COLUMBIA\nIt was recommended that heights and weights should be taken and recorded ve\nvision testing of all pupils should be done yearly, and that audiometer testing should?\ndone on children in any grade who are referred by their teacher as having possible hear' \u00b0\ndefects. It was proposed that the school medical service endeavour to interest the teac?\nand older pupils in the taking and recording of the yearly heights and weights, and *\ndoing the yearly vision testing and incorporating these procedures into the lessons htm\ntaught on health subjects, on the basis that they could serve as practical exercises. Wher\nthe vision testing was done by the teacher, the nurse should recheck all pupils showin\nless than 20\/20 vision in both eyes. \u00b0\nIt was further recommended that, where equipment is available, the school health\nservice should attempt to have every student receive a miniature X-ray just prior to\nleaving school. Mass tuberculin testing was not recommended as a routine, but this\nprocedure was reserved for those pupils where there was a specific indication. It was\nsuggested that the school health service should advocate and encourage yearly miniature\nX-raying of all School Board personnel who come in contact with pupils and advocate\ncompulsory pre-employment X-rays and compulsory re-X-raying of all such school per-\nsonnel every two years.\nA suggested policy of supervision of students taking part in the more major form of\nschool athletics was proposed, as follows:\u2014\n(1) Students should be required to present to the school a consent form signed\n4 by a parent before they may participate in major athletics.\n(2) The health records of all students participating in major athletics should\nbe screened by the nurse.\n(3) Students whose records show a history of illness, or for whom there are\nno records, should be requested to bring a note from their family physician\nor be seen by the School Medical Officer before taking part in major\nathletics.\nIt was proposed that a programme of immunization against diphtheria and tetanus\nand vaccination against smallpox should be carried out and should include as a\nminimum:\u2014\n(a) Checking individual records and immunizing all who need it in Grades I,\nV, and X, on receipt of consent from the parents.\n(b) Immunizing all new pupils who need it, in any grade. S. J|\n(c) When local needs and availability of staff make it possible, this minimum\nprogramme may be increased by immunizing pupils other than in the\ngrades mentioned above.\nA complete reorganization of the basis of grading the physical condition of pupils\nwas recommended, utilizing letter symbols as follows:\u2014\nA\u2014no observable defect.\nAp\u2014a physical defect which has not yet appreciably affected the pupil's health.\nAe\u2014an emotional defect which has not yet appreciably affected the pupil's\nhealth. *\nBp\u2014a physical defect which is affecting the pupil's health to a moderate degree.\nBe\u2014an emotional defect which is affecting the pupil's health to a moderate\ndegree.\nCp\u2014a physical defect which is affecting the pupil's health to a marked degree.\nCe\u2014an emotional defect which is affecting the pupil's health to a marked\ndegree.\nDp\u2014a physical defect of such a nature that the child is unable to fit int0 tlie\nstandard school system.\nDe\u2014an emotional defect of such a nature that the child is unable to fit int0 *\nstandard school system.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 29\nThe referral of pupils by their teachers to the school health service was to be actively\nencouraged. The quotation \" team concept\" appears to offer the most fruitful approach\nto this aspect of the school health programme. The \" team \" might well consist of teaching\npersonnel (teacher, principal, inspector), health personnel (nurse, doctor, specialist),\nparent, and family physician. The teachers should be considered the key persons in the\n\" teams \" because of their special opportunity of recognizing the earliest manifestations of\nthe deviation from normal in their pupils. The school health programme cannot be considered to be complete if the teaching personnel do not take a full and active part in it.\nThe particular role of the teacher should be:\u2014\n(1) Check and report to the nurse any physical and emotional deviations from\nnormal in her pupils.\n(2) To be aware of, and to supervise in the school, the activities of those of\nher pupils with defects that might require special care or particular first-aid\nmeasures.\n(3) To apply minor first aid to her pupils and to report other than minor\ninjuries or illnesses to the parent at once.\n(4) To exclude from the school any child suspected of having a communicable\ndisease.\n(5) To be responsible for seeing that pupils who become ill are returned to\ntheir homes in a suitable manner.\n(6) To impart to the pupils \"health knowledge\" which will cause them to\nadopt a scientific attitude toward the conservation and promotion of their\nhealth.\n(7) To foster attitudes in the children which will cause them to make intelligent\n\" health \" decisions.\n(8) Where possible, to weigh, measure, and test the vision and hearing of all\npupils as a practical part of the lessons in health.\nA referral should not be considered complete until the school medical service has\nreported its finding and actions to the referring teacher.\nIt was recommended that the school health service should actively promote good\ndental practices, and where a good dental service is not available through the health unit\nit should encourage the formation of community dental clinics in every way possible.\n^Recommendations were made that home visiting should be considered an integral\npart of school health services, and should be arranged primarily for those children who\nare repeatedly absent due to ill health, and those children referred by their teacher if it\nseems that this would be helpful. The parents may be visited at their home or asked to\ncome to the school or health-unit office, depending on individual circumstances. Home\nvisits in the case of suspected or confirmed communicable disease should not be considered a routine part of the service offered, but should be made mainly where a visit would\nappear to contribute toward prevention of spread of the disease through the community.\nConsideration was given to the physical education programme in the schools, and it\nwas proposed that the school medical service take a keener interest in the programme, in\nbecoming acquainted with the various physical activities carried on under that programme.\nIt was felt that some knowledge of the accepted degrees of physical activity at various\nlevels of growth should be obtained to determine what participation should be expected\nby children in the various grades. The sub-committee is to give further study to this phase\nof the school health programme with a view to providing standard recommendations.\nThe complete revision, following acceptance by the Health Officers' Group, was\nforwarded to the Department of Education for its consideration, as it was desired to\nframe a programme consistent with the views of educational personnel as well as health\npersonnel. The revision was reviewed in detail with officials of the Department of\nEducation and accepted by them, with the suggestion that they should be presented to\n L 30 BRITISH COLUMBIA\nthe School Inspectors throughout the Province. Outlines of the revision were then f\nwarded to each of the Health Unit Directors, who, in their capacity as School Medii\nInspectors, were asked to get in touch with the School Inspectors and outline the pr0pos i\nto them, finally approaching the various school principals in each health unit. In additio\nofficials of the Health Branch, Department of Health and Welfare, are to meet with ft\nSchool Inspectors as a group at their next gathering to discuss the whole school m.\ngramme and to deal with any questions and comments presented.\nFrom all this, it is hoped to evolve a school health programme uniformly acceptable\nto both Departments which can be presented to the School Boards as the best that is\npossible for the pupils attending the various schools. It is the first time that a complete\nrevision of the programme has originated with the staffs expected to carry out the work\nand it is hoped that it will be a practical programme designed to meet the needs of pupils'\nteachers, parents, and school medical personnel.\nSome criticism has been levelled at the present methods of vision testing in the\nschools, which the British Columbia Optometrists' Association feels overlooks certain\ndefects, particularly of muscle imbalance. The association has argued that testing with\nthe Snellen Chart alone will always leave something to be desired, and that improved\nmethods of testing with telebinocular equipment should be introduced into the schools of\nthe Province, which testing could be interpreted by the optometrists themselves, who now\nhave members located in nearly every part of the Province. In defence of the Snellen\nChart method of vision testing of school pupils is presented the argument that it is merely\na screening tool, the same as all other phases of the medical examination programme,\nand that it possibly may overlook some few cases, but, on the other hand, is serving its\npurpose of selecting the maximum number of pupils requiring further specialized examination. While there has been nothing new forthcoming in research into this matter, and\ninformation presented to the Department has continued to recommend the Snellen Chart\nas an adequate screening tool for vision testing, it was felt that further inquiry might be\nindicated. The matter was, therefore, referred to the Ophthalmological Section of the\nBritish Columbia Medical Association, who are investigating methods of vision testing\nin the Vancouver schools to determine their efficacy, or otherwise. A report from that\nsection is awaited to determine whether changes should be made in the vision-testing\nprogramme within the school medical service.\nDuring the year the Department of Education established committees to bring forth\nrecommendations of minimum standards for schools which would serve as a guide for\nSchool Boards and architects in designing new schools. The Health Branch, Department\nof Health and Welfare, was approached to bring forth recommendations in regard to\nschool lunchrooms, medical and first-aid rooms, heating and ventilation, lighting, washroom facilities, toilets, water-supply, and sewage-disposal. A committee, composed of\ndivisional directors within the Bureau of Local Health Services, was assigned to this\ntask, completing its report within the designated time to be forwarded to the Department\nof Education, following which an opportunity was presented for discussion with committees set up within that Department, and the general recommendations of the report\naccepted. The Department of Education plans now to bring all the recommendations\nfrom the various requested participants together into a text of recommended standards\nWhich will be circulated to school medical personnel, School Inspectors, School Boards,\nand architects, so that each may know what standards of construction can be proposed\nas acceptable to the Department of Education. It is anticipated that this project will be\nreleased for distribution shortly. |tr.\nWithin the sections of this Annual Report dealing with dental health services,\nnutrition services, sanitation services, and health education will be found reference to\nother services relating to the school health services programme. It must again be\nemphasized, however, that much of the public health service supplied as community\nhealth service has a direct bearing on the school health services, from which it canno\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 31\nbe entirely divorced as the school-child is duly influenced by conditions within the\ncommunity itself. .\n\u00a5 \u00a5 THE HEALTH OF THE SCHOOL-CHILD\nThe major objective of the school health programme is to promote optimum health\nfor the school-children throughout British Columbia, and it seems desirable in an annual\nanalysis of the school health programme to attempt to determine whether the health of\nthe school-child has been benefited thereby. So many features affect physical status, it\nis difficult to determine any definite reason for minor fluctuation in the health of the\nschool-child, since it is difficult to find a satisfactory measure of health status. Over the\npast four years the analysis of the health of the school-child has been based on immunological status, physical status, and morbidity figures of notifiable diseases. In the absence\nof a better measuring tool and for the purposes of comparison, it is probably advisable\nto carry out the same analysis this year for school-children as a group.\nThe school health programme operates within the academic year, so that the analysis\nis based on the programme from September, 1953, to June, 1954, during which school\nhealth services were provided in the 1,033 schools included in the eighty large school\ndistricts and the twenty-five small school districts. Enrolled in the grades examined were\n194,920 school-children, a further increase again over the enrolment for previous years.\nOut of the 194,920 enrolled in the grades examined, only 52,814 (27.1 per cent) received\nmedical examinations, a figure which is admittedly low but is explainable by the fact that\nspecial attention is being proffered to those referred by screening methods, whether those\nscreening methods consist of ancillary devices, such as the Wetzel Grid or teacher-nurse\nconferences. An examination of the results of the medical examinations by grades\nreveals a much more reassuring situation in the fact that 82.9 per cent of the pupils in\nGrade I were examined, which is as it should be, concentrating attention on the child\nentering school. Usually this was done with the parent present and was productive of\ngreater results as the parents endeavoured to ensure the child's complete preparation to\na new phase of development and education. In the later grades, screening methods were\nused to select the pupils most likely in need of physical examination. The results are\npresented in detail in the various statistical tables.\nTable I.\u2014Physical Status of Pupils Examined, Showing Percentage\nin Each Group, 1947-48 to 1953-54\nAcademic Group\nPercentage of\nPupils, A Group1\nPercentage of\nPupils, B Group2\nPercentage of\nPupils, C Group8\n1947-48 .\t\n1948-49\n1949-50\t\n1950-51. _i\t\n1951-52...:\t\n91.7\n93.3\n93.4\n93.1\n93.5\n93.0\n92.6\n7.8\n6.4\n6.5\n6.8\n6.4\n6.8\n7.3\n0.5\n0.3\n0.1\n0.1\n0.1\n1952-53\t\n0.2\n1953-54\t\n0.1\n1 A Group: A, Ad, Ae, and Ade categories.\n2 B Group: Bd, Be, and Bde categories.\n8 C Group: Cd, Ce, and Cde categories.\n L 32\nBRITISH COLUMBIA\nTable II.\n-Physical Status of Total Pupils Examined in the Schools\nfor the Years Ended June 30th, 1950 to 1954\n1949-50\n1950-51\n1951-52\n1952-53\nTotal pupils enrolled in grades examined\t\nTotal pupils examined\t\nPercentage of enrolled pupils examined 1\t\nPhysical status\u2014percentage of pupils examined\u2014\nA\t\nAd\t\nAe\t\nAde\t\nBd\t\nBe\t\nBde\t\nCd \t\nCe\t\nCde\t\n128,724\n45,049\n35.0\n38.8\n52.5\n0.8\n1.3\n5.6\n0.1\n0.8\n0.1\n154,517\n46,028\n29.8\n34.4\n56.3\n0.7\n1.7\n5.8\n0.1\n0.9\n0.1\n1953-54\n161,408\n42,401\n26.3\n36.5\n54.2\n0.8\n2.0\n5.4\n0.2\n0.8\n0.1\n186,912\n52,296\n28.0\n33.6\n57.2\n0.6\n1.6\n5.8\n0.1\n0.9\n0.1\n0.1\n52,814\n27.1\n36.2\n53.6\n0.7\n2.1\n6.1\n0,1\n1.1\n0.1\nTable III.\u2014Physical Status of Total Pupils Examined in Grades I, IV, VII, and\nX for the Years Ended June 30th, 1950 to 1954\n1949-50\nTotal pupils enrolled in grades examined I\nTotal pupils examined \t\nPercentage of enrolled pupils examined\t\nPhysical status\u2014percentage of pupils examined\u2014\na :\t\nAd\t\nAe \t\nAde ...\nBd\t\nBe\t\nBde\t\nCd .\t\nCe \t\nCde ._ ...\n41,688\n30,515\n73.2\n38.8\n53.3\n0.6\n1.0\n5.6\n0.1\n0.5\n0.1\n1950-51 | 1951-52\n1952-53\n56,491\n36,468\n64.6\n34.8\n56.3\n0.6\n1.7\n5.5\n0.1\n0.8\n0.1\n0.1\n58,930\n33,118\n56.2\n36.7\n54.7\n0.7\n1.7\n5.2\n0.1\n0.8\n0.1\n70,222\n38,273\n54.5\n34.9\n57.1\n0.5\n1.4\n5.1\n0.1\n0.7\n0.1\n0.1\n1953-54\n73,616\n39,995\n54.3\n37.7\n53.1\n0.7\n2.1\n5.3\n0.1\n0.9\nTable IV.\u2014Summary of Physical Status of Pupils Examined,\nAccording to School Grades, 1953-54\nTotal\nPupils,\nAll\nSchools\nExamined in Grades\nGrade\nI\nGrades\nII-VI\nGrades\nVII-IX\nGrades\nX-XIfl\nTotal pupils enrolled in grades examined\t\nTotal pupils examined\t\nPercentage of enrolled pupils examined B\nPhysical status\u2014percentage of pupils examined\nA\t\nAd\t\nAe __\nAde\t\nBd\t\nBe : '\nBde \t\nCd\t\nCe\t\nCde i\t\n194,920\n52,814\n27.1\n36.2\n53.6\n0.7\n2.1\n6.1\n0.1\n1.1\n0.1\n26,577\n22,029\n82.9\n34.8\n55.7\n0.8\n1.6\n6.1\n0.1\n0.8\n0.1\n99,369\n13,847\n13.9\n32.8\n54.1\n0.8\n2.1\n8.5\n0.1\n1.4\n0.1\n0.1\n44,994\n10,651\n23.7\n39.8\n50.6\n0.8\n3.1\n4.2\n0.1\n1.3\n0.1\n23,98(1\n6,287\n41.9\n50.3\n0.4\n2.3\n4.2\n0.1\n0,7\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 33\nTable V.\u2014Physical Status by Individual Grades of Total Schools, 1953-54\nAll\nSchools\nGrade\nI\nGrade\nII\nGrade\nm\nGrade\nIV\nGrade\nV\nTotal pupils enrolled in grades examined\t\nTotal pupils examined\t\nPercentage of enrolled pupils examined\t\nPhysical status\u2014percentage of pupils examined\nA \t\nAd\t\nAe\t\nAde\t\nBd\t\nBe\t\nBde\t\nCd \t\nCe I\t\nCde \t\nGrade\nVI\n194,920\n26,577\n22,765\n19,533\n19,550\n19,222\n52,814\n22,029\n3,126\n3,172\n4,339\n1,710\n27.1\n82.9\n13.7\n16.2\n22.2\n8.9\n36.2\n34.8\n29.2\n25.3\n40.7\n30.6\n53.6\n55.7\n57.0\n60.7\n47.5\n55.6\n0.7\n0.8\n1.0\n0.5\n0.8\n0.6\n2.1\n1.6\n2.5\n1.5\n2.3\n2.4\n6.1\n6.1\n8.7\n10.2\n7.2\n9.1\n0.1\n1.1\n0.1\n0.8\n0.1\n1.3\n0.1\n1.3\n0.1\n1.3\n1.4\n0.1\n0.1\n0.2\n0.3\n0.1\n0.2\n0.1\n0.1\n18,299\n1,500\n8.2\n36.0\n51.1\n0.9\n1.7\n7.4\n0.2\n2.4\n0.3\nGrade\nVII\nGrade\nVIII\nGrade\nIX\nGrade\nX\nGrade\nXI\nGrade\nxn\nGrade\nxm\nTotal pupils enrolled in grades examined\t\nTotal pupils examined\t\nPercentage of enrolled pupils examined\t\nPhysical status\u2014percentage of pupils examined\u2014\nA :\t\nAd\t\nAe\t\nAde\t\nBd\t\nBe \t\nBde\t\nCd\t\nCe\t\nCde\t\n17,073\n15,029\n12,892\n10,416\n7,413\n5,479\n8,270\n1,316\n1,065\n5,357\n582\n307\n48.4\n8.8\n8.3\n51.4\n7.9\n5.6\n41.7\n30.6\n36.2\n41.9\n39.7\n45.9\n50.1\n54.5\n49.1\n51.2\n46.6\n40.7\n0.9\n1.0\n0.6\n0.3\n1.2\n1.0\n2.8\n4.5\n3.4\n2.4\n1.5\n2.3\n3.3\n6.5\n7.9\n0.1\n2.4\n3.4\n0.1\n0.6\n8.2\n9.4\n1.1\n2.7\n2.4\n0.7\n0.1\n0.1\n0.1\n0.2\n0.1\n0.2\n0.1\n\t\n0.2\n672\n41\n6.1\n43.9\n48.8\n4.9\n2.4\nTable VI.\u2014Number Employed and X-rayed amongst School Personnel, 1953-54\nTotal\nOrganized\nUnorganized\nNumber employed _. .\n1\n8,803 7,584\n4,560 4,050\nI\n1,129\nNumber X-rayed \t\n510\nTable VII.-\n\u2014Immunization Status of Total Pupils Enrolled,\nAccording to School Grade, 1953-54\nTotal\nPupils\nEnrolled\nby Grades\nPercentage Immunized\nSmallpox\nDiphtheria\nTetanus\nTyphoid\nB.C.G.\nTotal, all grades \t\n194,920\n26,577\n22,765\n19,533\n19,550\n19,222\n18,299\n17,073\n15,029\n12,892\n10,416\n7,413\n5,479\n672\n61.9 69.4\n65.9 75.7\n64.1 76.3\n65.5 75.2\n64.3 76.2\n67.0 76.1\n67.2 72.9\n60.2 63.3\n55.6 59.8\n50.4 55.6\n55.7 59.6\n51.5 53.0\n51.7 50.8\n50.6 ! 48.7\n29.4\n53.6\n43.5\n34.9\nt* 29.9\n27.8\n28.0\n19.6\n14.6\n12.8\n13.1\n10.4\n11.6\n11.0\n2.3\n1.7\n1.6\n1.8\n2.2\n2.2\n2.4\n2.8\n2.4\n2.1\n3.2\n3.5\n4.5\n5.4\n0.1\nGrade 11\nGrade II\t\n0.1\n0.1\nGrade III\n0.1\nGrade IV..\n0.1\nGrade V.\n0.1\nGrade VI\n0.1\nGrade VII\n0.1\nGrade VIIL.\t\n0.1\nGrade IX\t\n0.1\nGrade X\n0.1\nGrade XI....\nGrade XII..\nGrade XIII...\n L 34 BRITISH COLUMBIA\n' An analysis of these tables is revealing, since it becomes evident from Table I th\nthe physical status of the school-children as shown by the medical examination presel\nthem in good physical condition clinically. Somewhat over 92 per cent of the Jl\nare in A Group, with a lesser number, 7.3 per cent, in B Group, and 0.1 per centl\nC Group. While these results show well over 90 per cent of the school-children in safe\nfactory physical condition, nevertheless an examination of the table will show that there\nhas been a decrease of 0.4 per cent in that group, as compared to the year previous\nwith a concomitant increase in the number in the B Group.\nIn Table VII is shown the immunological status of the school-children in the grades\nexamined, indicating that a majority of the pupils (more than 60 per cent of each group)\nwere immunized against such major communicable diseases as diphtheria and smallpox\nmaintaining their immunity status throughout their school-life. Actually it would k\ndesirable to have a somewhat better picture than this, since it is argued that at least\n75 per cent of the population should be immunized against these diseases if epidemics\nare to be avoided. There is, therefore, a definite need for increased activity in the im-\nmunization clinics throughout the schools of British Columbia. There have been diphtheria cases recorded in British Columbia every year, and, during this year, again a rate\nof 0.5 per 100,000 population is evidenced, indicating the very necessary need to main-\ntain diphtheria immunization throughout the total school population at an extremely\nhigh level.\nThere has been a definite increase in the percentage immunized against tetanus\n(29.4 per cent, as compared to 21.6 per cent a year ago) and in the number immunized\nagainst typhoid fever (2.3 per cent, as compared to 0.08 per cent a year ago). This is\nexplainable by the fact that a combined diphtheria-tetanus toxoid is now being distributed, immunizing pupils against tetanus as well as diphtheria. It can be anticipated!\nthere will be a continued upswing in the percentage immunized against tetanus in\nfuture as this practice is continued. This is desirable, since in periods of disaster it i\nan advantage to have a high proportion immunized to tetanus as a protective measure,\nThe higher figure in typhoid fever immunization is entirely due to the campaign that was\norganized in the spring of the year as a protective measure in' the face of potential\nserious flooding. While the climate favoured a slower run-off, preventing the occurrence\nof flooding conditions, nevertheless protective measures against typhoid and paratyphoid\nfever had been undertaken and is reflected in the immunological status of the school-chili\nThe incidence of communicable diseases is a third method of gauging the health ol\nthe school-child, since a considerable majority of these occur in childhood. Fromi\npoint of view, the health of the school-child during 1954 could be stated to be vastly\nimproved, since there was a definite decrease in the volume of incidence of such childhood infections as chicken-pox, conjunctivitis, measles, mumps, rubella, scarlet fever,\nand septic sore throat. It must be recognized, however, that many of these, such as\nchicken-pox, measles, mumps, and rubella, recur with a cyclic periodicity in epidemic\nproportions as new susceptible groups enter the school, and it is likely that during 1$\nthe Province was on the downward phase of one of those cycles.\nPoliomyelitis showed a marked decrease during the year, with a rate of 16.7 p\n100,000 population, compared to the rate of 64.0 per 100,000 the previous year, ft\nincidence of poliomyelitis is receiving special attention, with study of the age-specific\nattack rates as planning goes forward for the use of poliomyelitis vaccine in future p\nas a possible control measure toward this dreaded infection. Diphtheria continued to\nshow its usual annual incidence, although in few numbers, but it emphasized the vigils\nthat must be exhibited toward control through immunization. The comparisons beW* J\nyears in so far as notifiable diseases are concerned may be studied in detail in Table vm\nFrom the report of the Division of Preventive Dentistry can be gathered infofl^\nrelative to the dental health of the school-child. The health status, dentally, should^\nconsidered as an additional factor influencing the total health of the school pup\nAt\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 35\nthis stage of development in preventive dentistry in this Province, maximum concentration is directed toward the dental examination of Grade I pupils and encouragement\ntoward remedial treatment, as indicated. Concurrently, an active campaign of dental-\nhealth education explains to parents and children ways in which dental health may be\nimproved. '\u25a0<{\nOn the whole, during the academic year 1953-54, the health of the school-child\ncan be considered satisfactory, with certain reservations. Physically, the child continues\nto show a high standard of physical status, and a somewhat higher level of resistance to\ncommunicable infections, but there is a marked need for improvement in the immunity\nstatus of the school population and further concentration on efforts toward improved\ndental health. # W * ^ ifp^\nf DISEASE MORBIDITY AND STATISTICS\nPrevious reports over the past three years have mentioned the National Sickness\nSurvey, in which British Columbia, in common with the other Provinces, co-operated\nwith the Department of National Health and Welfare on the collection of information\nconcerning the illness experience of the population, the amount and kinds of health\nservices received, and the volume of expenditure, either directly or through insurance, for\nthose services. At the eighty-seventh annual meeting of the Canadian Medical Association, convened in Vancouver during June, 1954, the Deputy Minister of National Health\nreviewed some of the statistics which have been presented in the five special compilations\nreleased to date, based on the information gathered during the Sickness Survey. It\nwas indicated that Canadians as a whole, in the year of the survey, 1950-51, spent\n$675,000,000 from public and private sources for health care, of which almost\n$375,000,000 came directly from families, or from them through insurance plans.\nAllowing for adjustments in the survey data, it was estimated that consumer payments\nfor physicians' services amounted to about $118,000,000, or an average of $26 for each\nfamily. As far as could be told from the data, the amounts spent per family increased\nsignificantly as income increases but do not go up as the size of the family increases;\nrather, larger families spend less per person on all items of health care. Regional variations in average family expenditures are even more striking. It is estimated that families\nin British Columbia spend on an average of about $100 each for all items, with those in\nQuebec, Ontario, the Prairie Provinces, and the Maritimes spending successively smaller\namounts. Preliminary survey data showed that an estimated 2,000,000 visits were made\nto out-patient departments by just under 5 per cent of the population. Such visits\nrepresented about 8 per cent of the total of home, office, and clinic calls. Even considering that out-patient facilities are not evenly distributed, there were only minor\nregional variations around this proportion, with the exception of British Columbia where\nthe proportion was about 12 per cent.\nIn reviewing the illness experience of the population, the Deputy Minister of\nNational Health indicated that Canadians on the average suffered an illness or disability\nsufficiently serious to interfere with their normal activities for 11.9 days, including an\naverage of 5.6 days in bed at home or in the hospital. These same Canadians reported\na grand total of 51.4 days of \"complaints,\" which may or may not have interrupted\nnormal activities. Viewing this from another aspect, it implies that out of every 100\nCanadians 20 had no \"complaints\" whatever during the year, 22 reported some symptoms\nof ill-health but not serious enough to interfere with their usual activities, 10 were prevented from carrying on such activities but not confined to bed, and 48 were confined\nto bed, at home or in hospital, for one or more days.\nFurther study of the illness experience is under way, from which it is hoped to\npublish national estimates of some ninety diseases and conditions, or groups of conditions,\ncausing illness. Of the preliminary evidence, it appears that over one-half of all the\ndiseases reported in the survey (54 per cent) can be grouped under diseases of the\n L 36 BRITISH COLUMBIA\nrespiratory system. In fact, the common cold and influenza represented no less tha\nper cent of all the diseases reported. The second largest group, diseases of the digef\nsystem, involved only 8 per cent of the total illness, followed by infective parasi&T\neases (6 per cent) and accidents, poisoning, and violence (5 per cent). These *\ncategories included about 75 per cent of all reported illnesses. In analysing the voir\nof medical services, the Deputy Minister of National Health indicated that nearly thT\nout of every five Canadians did not see a physician in the home or office during the ye*\nOnly one out of three visited the physician's office at least once, one out of five received\none or more home calls, and one out of twenty attended hospital out-patient clinics. A\nmight have been expected, older persons had a higher rate of physicians' calls. Those\nover 65 years of age, both male and female, received 2.5 calls per person, compared with\nabout 2 calls for those between 25 and 64 years and about 1 call for children under 15\nyears. Persons 65 years of age and older represented 7.8 per cent of the population\nwhich received 18.9 per cent of all the home calls. Higher-income groups, for example\nappeared to have received on an average of 4 calls per family. The home and office call\nrates were highest in British Columbia, 2.1 per person, compared to a national average\nof 1.6. | There was wide variation in the ratio of home to office calls, as learned from the\nfact that the proportion of home calls to total home and office calls was 45 per cent in\nQuebec, 31 per cent in the Maritimes, 18 per cent in British Columbia, and 16 per cent\non the Prairies, indicating that such variations cannot be due to chance, but must have\nspecific reasons. Some of these obvious reasons are differences in geography, communication, and transportation, but perhaps more significant is the unequal development of\nhospital bed capacity and the presence or absence of hospital and medical-care insurance,\nIt is apparent from this that a great wealth of information has been unearthed in the\nNational Sickness Survey, and that much more data are to be available as the study continues. As this additional information becomes available, it will be possible to relate it\nmore directly to British Columbia, so that some information can be gained on the medical-\ncare needs of the Province as a whole.\nThe disease morbidity picture in British Columbia over past years has shown it\nthere is a considerable proportion that should be more thoroughly investigated, with a view \\\nto control on an epidemiological basis. Increases in certain infections, such as poliomyelitis and shigellosis, have resulted in some epidemiological investigation which\nindicated that more intensive study was desirable. Thus, during the year, a Consultant I\nin Epidemiology was appointed, as mentioned in the report of the Bureau of Special\nPreventive and Treatment Services. As a result of this appointment, it is hoped it\nmore thorough study of the notifiable diseases will occur, with special attention being ]\nconcentrated on suggestions of follow-up, as guidance to the various health-unit directors,\nparticularly in respect to disease-carriers in specific conditions. Much groundwork was\nlaid during the year as this new service became organized, and in the future a specific\nreport dealing with disease morbidity and epidemiology will be presented as a separate\nfeature.\nBritish Columbia, in 1954, experienced a decrease in the total incidence of noting\ndiseases, with a rate of 2,424 per 100,000 population, which is the lowest of the past ft\nyears, as evidenced in Table VIII. In effect, this can be credited to the lowered incite*\nof practically all notifiable diseases, with the exception of infectious hepatitis and t j\nshigellosis-salmonellosis group. Particularly gratifying was the decrease in the vop\nof poliomyelitis experienced throughout the Province this year, in contrast to the m\ntionally tremendous incidence of the year previous. As a matter of fact, the lowe\nincidence at 211 cases per 100,000 population was extremely fortuitous, asthef^\nmyelitis facilities of the Province were severely taxed by the load of patients stw u\ntreatment from the previous years. If another heavy case rate had occurred, theh0SL\nwould have laboured under undue circumstances in endeavouring to accommodate ac\nill patients\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 37\nAs it is, credit must be given to the larger hospitals in Vancouver and Victoria for\nthe exceptional job performed in conversion of space to accommodate the patients\nadmitted. Had conditions warranted, the Vancouver General Hospital and the Royal\nJubilee Hospital in particular were prepared to make further sacrifices to handle an\nincreased volume of cases.\nFortunately, the situation will not have to continue, as the construction of a poliomyelitis pavilion, on the grounds of the Pearson Tuberculosis Hospital, now nearing completion, will provide accommodation for the long-term poliomyelitis patients requiring\nlengthy specialized treatment in resuscitators, thus relieving the load on the acute hospitals\nto permit them to assume the responsibility for acute care of the early stages of the illness.\nIt can be readily realized that these facilities in these large cities are exceedingly necessary\nfor the larger number of patients which are evacuated to those centres where they may\nobtain the specialized medical and nursing treatment so vital to their welfare at the onset\nof their illness. The easement on space will be a relief to those physician-nurse teams who\ngave so unstintingly of their time and skill. The case fatality rate of 2.8 for 1954 is a\nreflection of the capable treatment provided poliomyelitis patients by the hospitals,\nphysicians, and nurses. As a basis of comparison, the table that follows shows the trend\nthat has occurred in the case fatality figures in those years in which poliomyelitis was\nmost heavily reported, if A-\nPoliomyelitis Case Fatality Rates\nYear\nCases\nDeaths\nCase Fatality Rates\nPer Cent\n1927 \t\n182\n37\n20.3\n1928 \t\n102\n19\n18.6\n1929 \t\n43\n13\n30.2\n1930\t\n34\n8\n23.5\n1931\t\n42\n11\n26.2\n1947\t\n313\n12\n3.8\n1952\t\n584\n37\n6.3\n1953\t\n787\n26\n3.3\n1954\t\n211\n6\n2.8\nIt must be recorded that the improved case fatality rates over recent years may in\npart be due to improved reporting of cases, in which an undue number of non-paralytic\ncases of low fatality influenced the fatality rates. On the other hand, a major factor in\nthe improvement can be stated to be the improved methods of treatment prevailing generally throughout the Province. \u00b1\nIn a large measure, credit for the low case fatality rate belongs also to the Royal\nCanadian Air Force Air-Sea Rescue Unit, which has provided evacuation transportation\nof patients from Interior points to the larger treatment centres. This service, which has\noperated so successfully and effectively for the past three years, has been a valiant aid\nin the fight against poliomyelitis by accepting air-evacuation trips on exceedingly short\nnotice under all types of weather conditions. In addition, a medical officer from the\nAir-Sea Rescue Squadron has continued to serve on the Poliomyelitis Committee in\nVancouver, which serves to supervise the plans for handling of poliomyelitis patients\nwith respect to their evacuation, acute treatment, and ultimate rehabilitation. This Committee had its origin during the epidemic of 1952, but has continued to function as the\npoliomyelitis incidence has remained unduly high ever since.\nAssistance has also been forthcoming from the British Columbia Foundation for\nPoliomyelitis, a voluntary agency supported mainly through the efforts of the Kinsmen's\nClubs throughout the Province. Their campaign for funds was well oversubscribed,\nwhich fortunately assists materially in providing major equipment in some cases, additional physiotherapists for rehabilitation services in other instances, and in assistance\ntoward the vital question of research. For some few patients this agency has been able\n L 38 BRITISH COLUMBIA\nto provide financial assistance for treatment where no other sources of financial aidco\nbe obtained; without the Poliomyelitis Foundation, such patients might have remain\ncrippled for life because of financial inability to obtain complete treatment and rehaft\ntation services.\nDuring the year, considerable publicity was aroused from the field trial being co\nducted in the United States toward the use of poliomyelitis vaccine as an effective Z\nphylactic in the control of this infection. At the outset it had been decided to concen\ntrate the field trials in the United States, and that all poliomyelitis vaccine manufactured\nby the Connaught Research Laboratories in Canada would be turned over to the US\nPublic Health Service for its use. Field trials were commenced in the United States in\nthe early spring, and as they progressed it became evident that there would be some supply\nof poliomyelitis vaccine surplus to their needs, which resulted in an offer being made to\nsupply a quantity to Canada for distribution to the Provinces for use on an additional\nfield-trial basis.\nAs it was late in the spring before this information became available, decision as to\nits administration in British Columbia had to be carefully weighed on the basis of a\nnumber of complicating administrative factors, which resulted in the choice to forgo\nany participation in the field trial as far as this Province was concerned. It was felt that\nthe information that would be obtained from the more intensive trials in the United States\nunder ideal administrative conditions would be of more value than a hasty participation\nunder less ideal conditions here. Consequently, plans were laid toward obtaining polio-\nmyelitis vaccine for administration to specific groups in 1955, following on the report\nof the field trials conducted by the U.S. Public Health Service throughout the United\nStates. Financial arrangements were completed to permit the purchase of available\nquantities so that the production of the vaccine by the Connaught Research Laboratories could get under way.\nThe attempts at control of poliomyelitis remained, therefore, with the prophylactic\nadministration of gamma globulin. New criteria for its use were established, however,\nto permit injections only to household contacts between the ages of birth and 30 years,\nor who are pregnant, whereas the previous year it had been confined to administration\nof family contacts who were 16 years of age or less, or who were pregnant. It was definitely recommended that such prophylactic injections should be given within three days\nfollowing diagnosis of the original case, since gamma globulin is of no value after clinical\nsymptoms of the disease have appeared. The available supply did not permit of widespread community prophylaxis or an attempt at immunization of household contacts to\nsuspect cases.\nToward the end of the year it became evident that the quantities of gamma globulin\nwere improving to such an extent that the Dominion Council of Health, at its last meeting\nin Ottawa, proposed extension of its use as a prophylactic for measles, infectious hepatitis, hypogammaglobulinemia, and for expectant mothers exposed to rubella. Recommendations toward that extension have been proposed to each of the Provinces, and tk\nsubject is under active consideration in British Columbia by the Committee on Communicable Disease Control as the year ends. Some careful consideration will have to\nbe given to the terms under which it will be permitted to be used in respect to infectious\nhepatitis, since this is a disease that is very definitely on the increase. During 1953 a\ncase rate of 64.1 was recorded as much the highest to date, but this has been exceeded\nfurther during 1954, when the case rate reached 96.4. This infection, vile in nature,\noccurs most commonly amongst children and young adults, who seem to be most sitf-\nceptible. The infection tends to affect the largest numbers in the autumn and ear?\nwinter, the degree of severity varying from individual to individual. It is known ttt\ngamma globulin does confer a certain protective quality to the infection, and it is argnf\nthat its administration to at least familial contacts might serve to materially reduce *\nincreasing annual incidence. Before another year has passed, it is felt this prophp1\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 39\nmaterial will be available for that purpose, and the next report may produce some evidence of its effect, f }$\n\u2022Another major blemish on the notifiable-disease record of the Province during 1954\nwas that of enteric infections of the Shigella-Salmonella group, which have continued to\nshow a materially upward trend. Bacillary dysentery and the Shigella type was reported\nin the case of 605 persons, to provide a case rate of 47.8 per 100,000 population. This\nis a further upward trend in a condition which has been consistently increasing over the\npast four years. It had been indicated in previous reports that this might be anticipated,\nparticularly in infection caused by Shigella sonnei, and further comment on this specific\ninfection may be noted in the Division of Laboratories section of this Report. With\nrespect to salmonellosis, almost the same incidence of typhoid fever (Salmonelli typhi)\nwas recorded, with a case rate of 0.9 per 100,000 population, as compared to 0.8 per\n100,000 population in 1953. Sporadic cafces were reported in widely separated parts\nof the Province, with the exception of the Skeena Health Unit, which reported five cases\namong members of the Indian population. Among this same group, and in the same\narea, were the majority of the cases of paratyphoid fever, although additional cases of\nparatyphoid were located along other coastal communities, both on the Mainland and\non Vancouver Island, to create a significantly higher case rate for this disease (2.8 per\n100,000 population for 1954, as compared to 1.8 per 100,000 population in 1953).\nOther Salmonella types of infection remained on about the same level as on previous\nyears, with a case rate of 13.7 per 100,000 population.\nThis whole field of enteric infection needs some future investigation, and it is one\narea of epidemiological investigation which is to occupy the services of the Consultant\nin Epidemiology, in an endeavour to set up complete carrier registries, so that the most\nlikely source of infection can be kept track of and movement from place to place recorded\nto the degree that local health services can be advised. Control of disease-carriers offers\none aspect of action toward reduction in the increasing incidence.\nThe Division of Laboratories section of this Report has made mention of the three\ncases of botulism which occurred among Indians, contracted from fish products. The\nDivision of Laboratories has made special study of botulism in Canada over many years,\nand is recognized as an authority adequately investigating all cases.\nWhile the incidence of diphtheria continues to remain low, with a case rate of 0.5\nper 100,000 population, nevertheless the fact that cases do occur is a reflection on total\nimmunization to this infection. As a matter of fact, a reference to the section of this\nReport dealing with School Health Services indicates that only about 69.4 per cent of\nall school-children are thus protected. This, coupled with the fact that the large adult\npopulation has probably ignored suggestions for booster immunizations, indicates a\npotentially susceptible situation in which opportunities for a diphtheria epidemic are\nprobable. Intensification of the immunization programme does seem indicated.\nTetanus occurred in the case of one person; here again the need for administration\nof tetanus antitoxin to traumatic patients does seem warranted, while the tendency to\ninclude tetanus immunization with others, as is the present trend, is exemplified.\nPlans have been made this year, as in previous years, for special studies of epidemic\ninfluenza if it should occur in epidemic proportions. The Department of National Health\nand Welfare sought to have all reporting promptly, while opportunity was provided for\ntyping of submitted specimens in the Laboratory of Hygiene at Ottawa. However, the\nrate at 6.2 per 100,000 population was not significant, and this situation did not require\nspecial attention.\nMinor communicable infections, such as chicken-pox, measles, mumps, pertussis,\nand rubella, continued to exact a toll throughout the year, accounting for approximately\ntwo-thirds of the total notifiable diseases. These infections do seem to be uncontrollable,\nand it is exceedingly doubtful whether all cases are reported in any case. It had been\nhoped that the matter of reporting them would be the subject of discussion during the\n L 40\nBRITISH COLUMBIA\nmeeting of Federal-Provincial epidemiologists, but unfortunately that meeting did\nmaterialize and is now postponed into the forthcoming year. ol\nThe notifiable diseases are reported weekly by the Medical Health Officers to ft\nDivision of Vital Statistics and are presented in the statistical tables that follow, show*6\nthe totals and case rates for the past five years, and listing the incidence by health unit\nthroughout the year.\nTable VIII.\u2014Notifiable Diseases in British Columbia, 1950-54\n(Including Indians)\n(Rate per 100,000 population.)\nNotifiable Disease\n1950\nNumber\nof\nCases\nRate\n1951\nNumber\nof\nCases\nRate\n1952\nNumber\nof\nCases\nRate\n1953\nNumber\nof\nCases\nActinomycosis\t\nBotulism .\t\nBrucellosis\t\nCancer -3\t\nChicken-pox\t\nConjunctivitis\t\nDiphtheria\t\nDysentery\u2014\nAmoebic\t\nBacillary (Shigella)\t\nEncephalitis, infectious\t\nHepatitis, epidemic\t\nInfluenza, epidemic\t\nLeprosy\t\nMalaria\t\nMeasles I\t\nMeningitis\t\nMumps\t\nPertussis\t\nPoliomyelitis\t\nRubella \t\nSalmonellosis\u2014\nTyphoid fever\t\nParatyphoid fever\t\nUnqualified\t\nStreptococcal infections\u2014\nErysipelas\t\nScarlet fever\t\nSeptic sore throat\t\nPuerperal septicaemia\t\nTetanus\t\nTrachoma\t\nTuberculosis\t\nTularaemia\t\nVenereal disease\u2014\nGonorrhoea ,\t\nSyphilis (includes non\nspecific urethritis \u2014\nvenereal)\t\nChancroid\t\nVincent's angina\t\nTotals\t\n1\n22\n3,125\n5,001\n280\n63\n1\n189\n1\n46\n460\n5,648\n15\n8,634\n1,740\n73\n7,935\n11\n35\n152\n36\n871\n183\n1\n1\n5\n1,828\n3,579\n630\n6\n0.1\n1.9\n274.6\n439.5\n24.6\n5.5\n0.1\n16.6\n0.1\n4.0\n40.4\n496.3\n1.3\n758.7\n152.9\n6.4\n697.3\n1.0\n3.1\n13.4\n3.2\n76.5\n16.1\n0.1\n0.1\n0.4\n160.6\n314.5\n55.4\n0.5\n18\n2,850\n6,671\n374\n5\n253\n90\n11,033\n2\n6,269\n30\n5,835\n1,134\n92\n2,288\n18\n7\n149\n38\n4,146\n300\n8\n1,662\n3,301\n568\n48\n1.6\n247.2\n578.5\n32.4\n0.4\n21.9\n7.8\n956.9\n0.2\n543.7\n2.6\n506.1\n98.4\n8.0\n198.4\n1.6\n0.6\n12.9\n3.3\n359.6\n26.0\n0.7\n144.1\n286.3\n49.3\n4.2\n12\n3,366\n6,266\n346\n11\n1\n102\n2\n212\n548\n2\n8,227\n33\n7,088\n976\n594\n1,986\n30\n8\n109\n26\n4,163\n536\n2\n3\n1,411\n3,057\n541\n19\n1.0\n281.0\n523.0\n28.9\n0.9\n0.1\n8.5\n0.2\n17.7\n45.7\n0.2\n686.7\n2.7\n591.6\n81.4\n49.6\n165.8\n2.5\n0.7\n9.1\n2.2\n347.5\n44.7\n0.2\n0.3\n117.8\n255.2\n45.2\n1.6\n40,572\n3,565.2 I 47,189 I 4,092.7 39,677\n3,312.0\n1\n5\n2,785\n6,869\n193\n8\n1\n588\n4\n789\n808\n1\n1\n7,646\n42\n8,071\n717\n787\n1,095\n10\n23\n83\n24\n2,220\n206\n1\n2\n13\n1,494\n1\n2,969\n691\n11\n26\nRate\n0.1\n0.4\n226.4\n558.4\n15.8\n0.6\n0.1\n47.8\n0.3\n64.1\n65.7\n0.1\n0.1\n621.6\n3.4\n656.2\n58.3\n64.0\n89.0\n0.8\n1.8\n6.7\n1.9\n180.5\n16.7\n0.1\n0.2\n1.1\n121.5\n0.1\n241.4\n1954\nNumber\nof\nCases\n1\n3\n7\n3,600\n6,085\n64\n7\n605\n47,8\n1\nai\n1,220\n96.4\n78\n6,2\n6,572\n47\n3,548\n1,096\n211\n832\n11\n36\n173\n21\n1,355\n179\n1\n4\n1,434\n1\n2,668\n38,185\n56.2 784\n0.9 36\n2.1 12\n\"3,104.4 \\!0M\\&i\nRate\n0.1\n0,2\n0,5\nim\n480.6\n5,1\n0,5\n519,1\n3,7\n65,7\n2,8\n13,7\n1,7\n1071\n14,1\n\"II\n0,3\n113,3\n0,1\n210.7\n61i\n2,8\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 41\nON\nCO\n<\nfa\n<\no\nw\nHH\nfa\nHH\nu\nfa\nfa\nQ\nco\nH\nH-1\nB\nH\nfa\n<\nfa\nfa\nfa\no\nfa\no\nO\ni\nCO\nHH\nH\n\u00bb-h\nCO\nfa\nCO\ni\nfa\nCO\nfa\nfa\nfa\n<\nfa\nH\nO\nX\nfa\nfa\nfa\n3\nQDUlAOJd;\nouBuia^i-;Buiiji^i\npUBISJ JSAnOOUBA\nJO JSBOO JS9M\njsboo isaAV\npUBHUBj^[\nXbuq;oo^[ ;s9Ai\njo pJBog uoiun\njrBunnbsa-BiJopiA\n39WTUiuioo iftlBdH\nUBjirodoijapi J3A\n-uoouba J9JB9JO\npuBjsi jaddn\njasBJj: jaddfi\nCO\ncd\n\ni\u2014*\ncd\nJ JSBg\npuBjsj jQAnoo\n-UBA IBHU33\nooqiJBO\nXJBpunog\nIBJOX\nCD\n09\na\no\nCO\nIO\n!0\nISO\nt \u2022\u00bb\n'co\nOcO\ncm cm\nooovo rf\nvoovco on\ncm\nCM IrH\nNO\n\nCOON !CM\nON\nCO\nVO\noot-\u00bbon ien ! 'i-i\nO CO\nivooo th cm\nco\nO\nco (vo m^tON irnoN\nf* !CM ,\"Sf I Tf\ni*-\" ! ! CM\n\"<*rH\nm\noo\nOS\no\ncm\n00\ncm\nco co ON v> On fO\nvo t-\"\u00ab3- vo\nVO rH\ncm\nOOn\n00^\"\nic*\niO\n!CM\n'CM\nCM\nr-\n00\ncm\nr\u00bbCMV\u00a9TtcOV\u00a3>rHrM\nc- >r> r-i oo oc vo m\nr-l \"^t ONCS r-l\nof\nfM*- CM i CO CS CS \u00bb\/-> V> CO\nI''* C-VOrHrH\n! ! CN\nvo\n5\nTf\n!CO\nI CM\nrH t~- ! 00 CM CN CO \u00ab0 00\nrH 00 !VO TtONr-I^J-\nICO rH\nrHrHTfr\nON ON\nOs\nvo\nCO\n00\n\u2022n\no\nvo\nrH | CO CO f- CO 00 VO ^ Tf\nv* |IO \nCO CM\nvo\n00\no\nrH\nvo\nVOCOCM\no\nrf-Tj- oo \u00abn\nCM CM\nCO\n!OV>\nIVOrH\n!CM\nCO\nvo\nCM\nOtJ-O^\nrj- CMrH\no\nr* CM\nICO\nTfrH\n\u00bb\u00abo\nco\nicoo-^-JO\n\u00aboco\nCO\nCO\nCM\nCM\nmcM ON rococo\n\"CMCM\nICO\noo\nCO\nlONt-*\nll>rH\n1 r-t\n00 00 CO CO Th vo vo vo 00 r-*\niTfCM f- OS rHrH\n1 rH r-t i-i\nvo com^-\nrHln\nTf\nI\nt\nIt-CM\n1 oo\n1 y*\n\u00abn \"<* CM On (S 00 ON CO O !\ni\u00bbn o oovorHcs\n1 CM rH !\nrH fMrHON\nvo\ni i\ni i\ni t\ni co r~- o >*o rt t> \u00abn'\nooovo o\nvqo vo\nCOVD\nlOOOCSr~OCVOrHf>J\ncsr-t-,Nt\"^i-o\\rHco\ncs >n mocMoo\nivoco\nICOC-\n\u2022r-t IT) ON rH \u25a0^,\ncM\u00abnr-\nCOrH\nMH.\nOco\nCM CM\nVO\nCOrH\nooovo\nVOONCO\nVOrH\nCM\nTl-CM\nOs i\u2014(\nNO\noo\nvo\nVO\n00\nCM\noo\nCM\nON\nvo\no\nCO\nCO\n\u20221\u2014(\nco\no\nCJ CO\nIsl\n+\u2022> \u2022*-\u00bb 3\nO O C\n2 fl\nco\no\nOn-n\nCOrG\nIH >H\nOh 55\nco\nT? O *\u00bbh *r!\nCO _\"-H \"H\n*H !\nCO\nCO\n^PQfavJUUQQ\nc\u00abr2 co \u00abS -jh ' co\nfa g &5C S I 3 S3\n<2 o\ns o\nftfco\no\n>\n\u20222'81\no >^S\na2g\nHfaP\nCO\na\no\n\u2022\u00bbH\nu\n\u00abH\nCJr-H\u00ab\u00bbH\na O. ca\n2'St:\n5? ^ O\n\u00a3Wto\nCO\ncd\no\nlH\nrG\n G\nOhG\n\n\u2022\u00bbH\n\u00bbH\nHH>\nu\nG\no\n\nG\nG\ncd\nrG\nO\nG\na>\na\nJh\no\n\u00abM\no\nH>J\ncd\nV\n>H\n L 42 BRITISH COLUMBIA ^\nREPORT OF THE DIVISION OF PUBLIC HEALTH NURSING\nMonica M. Frith, Director\nThe Public Health Nursing Division forms part of the Bureau of Local Health\nServices. The Division not only provides public health nursing personnel for assignment\nto local health services, but also assumes responsibility for the technical supervision oi\nthe public health nursing programme in order that the best type of public health nursing\nservice may be available to the people of the Province. As most nursing districts have\nnow been incorporated into health units, with the senior nurse or supervisor assuming\nresponsibility for the direct supervision of the public health nursing staff, it is now po$.\nsible to direct more attention toward the provision of public health nursing consultative\nservices to the local health units. By assisting the staff to analyse their specialized pro-\ngrammes in relation to local need, time, and staff available, better public health nursing\nservices may be developed in each area within the framework of Provincial policy, The\nDivision has been active in recruiting nurses to the staff, arranging for new appointments\ntransferring nurses within the service, and in planning for both in-service and postgraduate training for members of the public health nursing staff.\nSTATUS OF THE SERVICE\nThe population of the Province continued its upward trend, with the younger age-\ngroups showing the greatest increase. Accordingly, the demand for public health nursing service has continued to increase as the emphasis of the service has been directed\ntoward the health of the expectant mother, infant, pre-school and school-age child,\n111 Although it may be shown clearly that there is need for larger numbers of public\nhealth nurses on the staff in order to keep pace with the rising population, it has not been\npossible to increase the number of public health nurses in the field largely because of the\nlack of available qualified public health nurses.\nAt the close of the year there were positions for 141 nurses on the staff. This\nincludes 4 positions in central administration, 1 public health nursing co-ordinator wi\nthe Division of Tuberculosis Control, 1 resident nurse, and the remainder of the positions\nare allocated to local health services and include 6 supervisors, 14 senior nurses, and\n110 staff public health nurses.\nBecause of the difficulty in recruiting nurses, it was not possible until this year to\nfill four of the new positions established last year in such locations as the Saanich and\nSouth Vancouver Island Health Unit, Coquitlam in the Simon Fraser Health Unit,\nWilliams Lake in the Cariboo Health Unit, and Nanaimo in the Central Vancouver Island\nHealth Unit. t\nTwo new positions were created this year to assist with the development of home\nnursing-care programmes in the Saanich and South Vancouver Island Health Unit and\nin the Vernon area of the North Okanagan Health Unit. The nursing establishment at\nQuesnel in the Cariboo Health Unit was increased from one and one-half to two nurses.\nResident nurse positions at Atlin and Telegraph Creek were transferred to the Heai\nBranch from the Provincial Secretary's Department. Both these positions were vacant\nand increased the recruitment problem. However, in October a Red Cross Outpost\nHospital was opened at Atlin, so that this centre no longer required a resident nurse.\nTahsis., on Vancouver Island, was assisted with the organization of a part-time p*\nhealth nursing service.\nThe Division suffered a serious loss when Miss Margaret Campbell, Assistan\nDirector, resigned to join the World Health Organization after having given faithful an\ncompetent service with the Department over a period of twelve years. Miss Camp*\nhas not yet been replaced, so that the public health nursing administrative staff We\nincreased their responsibilities by accepting additional duties. 1\n 1\u00a7| DEPARTMENT OF HEALTH AND WELFARE, 1954 L 43\nBecause of the shortage of qualified public health nurses, it has been necessary to\naccept certain unsatisfactory conditions in order to make a maximum of service available\nto local health units utilizing existing personnel, as illustrated below:\u2014\n(1) It has been necessary to employ nurses without public health nursing training to fill positions which normally require persons well trained in this\nfield of work. These nurses provide only a minimum service to the community and at the same time increase the supervisory problems for the\nalready heavily burdened senior nurses and supervisors. Twenty per\ncent of the field staff do not have the required training.\n(2) Qualified public health nurses have been accepted for employment on the\nbasis of their availaMlity, fulfilling at least part of the community need.\nFor example, two married nurses are working four days rather than five\neach week, because they are the only public health nurses available for\nappointment.\n(3) Qualified and experienced public health nurses with married status are\nemployed in large numbers in the most desirable districts, thus forcing\ninexperienced single nurses to accept the more difficult rural postings.\nDuring the year there were forty-two new appointments made to the staff. In addition, eight nurses were reappointed to the service following the completion of the public\nhealth nursing course at university. The situation with regard to recruitment of nurses\ncompleting the public health nursing course at the University of British Columbia seems to\nbe similar to last year, as only two nurses could be interested in joining the service. The\nremainder of the qualified staff are recruited from outside of the Province or from married\npublic health nurses and residents of communities in which vacancies occur. There were\nthirty resignations from the staff. Of this group, twenty-two were married nurses who\nreturned to their homes, four nurses resigned to be married, and six left for employment\nelsewhere. In addition, fifteen nurses received leave of absence to complete their public\nhealth nursing training at university. Seventeen nurses were transferred within the\nservice, while one nurse transferred from the Division of Tuberculosis Control to the\npublic health nursing field staff.\nAs qualified public health nurses are required for placement in sub-centres of health\nunits and as no suitable applicants are available for appointment, it has not been possible\nto fill the vacancies at Hope in the Upper Fraser Valley Health Unit, Greenwood in the\nWest Kootenay Health Unit, Salmon Arm in the South Okanagan Health Unit, Burns\nLake in the Cariboo Health Unit, and the public health nursing position at Kitimat.\nOcean Falls public health nursing service has not yet been established for the same\nreason. When it is necessary to close a sub-centre, emergency public health nursing\nservices are provided by the remaining public health nursing staff.\nDuring the year the nursing situation was relieved to some extent by an adjustment\nin the nursing salaries. However, the salary levels do not yet compare favourably with\nthe salaries of the nurses on the staff of the Metropolitan Health Committee in Vancouver,\nwhich also recruits trained public health nurses. It is not expected that satisfactory\nnumbers of qualified public health nursing staff will be available for placement in rural\npublic health nursing positions until a further adjustment takes place.\nPUBLIC HEALTH NURSING CONSULTANT SERVICE\nUnder the direction of the Bureau of Local Health Services, the staff of the Division\nof Public Health Nursing plan together to assist with the development of the public\nhealth nursing service on a Province-wide basis to fit in with accepted standards of public\nhealth nursing.\nFrom information collected each year, a critical analysis is made of the case load\ncarried by each public health nursing member on the staff in order to determine the work\n L 44\nBRITISH COLUMBIA\nload, the need for staff, or reassignment of duties. Thus the numbers\u00bb Evidenc* Presen New Westminster and PoweU River School Districts, and North Okanagan, South Okanagan, Upper Fraser Valley, and Central Vancouver Island Health Units.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 69\nIn two Provincial health units, in some clinics of the Greater Vancouver Metropolitan Health Committee, in New Westminster and Powell River, 4,189 Grade II pupils\nwere examined, and 29.8 per cent of these were not in need of dental treatment at the\ntime of examination. Of these pupils, 1,159 received treatment at these clinics, and it\nis interesting to note that dental treatment for the average Grade II 7-year-old of Greater\nVancouver and New Westminster (presumably previously treated in Grade I) required\n1 hour 56 minutes.\nIn Grade III and the senior grades, 13,991 children were examined (11,457 in\nVictoria), and 42.9 per cent of these did not require treatment at the time of examination.\nPreventive Dental Services in Health Units\nWithin the four health units providing full-time preventive dental services, it is noted\nthat of the pre-school children examined during the past school-year, the percentage not\nrequiring dental treatment at the time of examination was 22.7 per cent, which compares\nfavourably with 14.4 per cent the previous year. Six hundred and ninety-two pre-school\nchildren (72.9 per cent of those requesting this service) received complete dental treatment, and 930 parents of pre-school children were interviewed at the chairside. This past\nyear the average time to rehabilitate these children was the lowest yet recorded in each\nage-group. Nevertheless, the standard of service to these children without doubt improved during the year, since 42 tooth surfaces were restored for every tooth extracted,\nand in the two previous years this figure was 19.2 and 22. ^\nAmongst the Grade I pupils of the three health units in which full-time preventive\ndental services were offered to this group, 14.3 per cent of those examined were not in\nneed of dental treatment at that time, which also compares favourably with 11.5 per cent\nthe previous year. In 1950-51, the first year of these services, of those children treated\nby the health-unit clinics, 78 per cent had never before visited a dentist, but the next year\nthis percentage had been reduced to 58 per cent, and in 1953-54 it was only 44 per cent.\nIn none of these three health units has it been possible to carry out extensive pre-school\ndental-treatment programmes. The above reductions are, therefore, attributable to educational activities and the co-operation of the family dentists.\nThe average number of tooth surfaces restored for Grade I children has not decreased\nduring 1954. Since the number has not increased to any significant degree, despite the\nuse in the latter years of diagnostic X-rays, a slight reduction in the incidence of dental\ndisease in those areas is possibly indicated. Moreover, it is noted that the average time\nrequired to provide complete dental treatment for these children during the past year is\nvery significantly lower than that previously recorded. Extraction rates are also lower\nthan ever before, and the ratio of twenty-seven tooth surfaces restored to every tooth\nextracted stands as the highest yet recorded within these services for this group of\nchildren. Amongst the 1,054 Grade I pupils receiving complete dental treatment within\nhealth-unit preventive dental services, only one permanent tooth was extracted.\nIn summary, it may be stated that, during the past three years within the health units\nwherein full-time preventive dental services have been provided, there is clear evidence of\nincreasing pre-school dental care being attained through the family dentists and perhaps\nsome indication of a slight reduction in the incidence of dental caries.\nApproximately three-quarters of the costs of full-time preventive dental services in\nthe Provincial health units have been met through National health grants. The balance of\nthe costs of these services has been borne by the Boards of Trustees of the school districts\nin receipt of these services.\nCommunity Preventive Dental Clinics\nIn addition, a further 3,983 children (pre-schools and pupils of Grades I, II, and\nHI) received complete dental treatment through forty-seven community preventive dental\n L 70 BRITISH COLUMBIA\nclinics which operated during the 1953-54 school-year. A further ten clinics commenced\nin the fall of 1954, so that at the close of the year no less than fifty-seven such clinics were\norganized and in which fifty-eight different dentists were co-operating on a part-time basis\nIn some of these larger clinics four or five dentists are providing service within the one\nclinic, whilst in other instances a single dentist may be providing service to a number of\ndifferent clinics. %\nDuring the past school-year it is noted that 633 pre-school children received all\nnecessary treatment through these clinics, 1,030 Grade I pupils, 356 Grade II pupils, and\n157 Grade III pupils. Classification of the remaining 1,804 children within these groups\nawaits further reports from some of the clinics.\nFrom the clinics which have at this time forwarded complete reports of their activities during the past year, it is noted that of 456 pre-school children enrolled in the clinics,\nonly 38 were not in need of treatment (8.6 per cent), of 837 Grade I pupils only 34 (4.1\nper cent), of 232 Grade II pupils only 16 (1.4 per cent), and of 114 Grade III pupils\nonly 1 (0.9 percent). \u00a7\nRecords for these children show that complete dental treatment for the average preschool child required 1 hour 13 minutes of dental time, and for the average Grade I pupil,\n2 hours 13 minutes. There were 183 Grade II pupils who had presumably received\ncomplete treatment the previous year included in clinics in their second or later year of\noperation. These children required an average of 1 hour 23 minutes of dental time. In\ncontrast, 49 Grade II pupils of clinics in the first year of operation (it is not known if\nthese children had previously received dental treatment or not) required an average of 1\nhour 48 minutes of dental time. Of the Grade III pupils, records are available of 90\nchildren treated in clinics in their third or later year of operation. These children had\npresumably received dental treatment the year previously and on an average required only\n1 hour 18 minutes of dental time. In contrast, 24 Grade III pupils whose previous treatment history is unknown on an average required 2 hours 10 minutes of dental time.\nNow that it is planned to organize the majority of the dental preventive-treatment\nservices in the health units through community dental clinics, the records which are\nrequired to be maintained by these clinics have been carefully reviewed. In some cases\nit has been possible to simplify the records with the hope that the accuracy of their\ncompletion will be improved. In other cases, new records, one summarizing the activities\nof the clinic during the previous school-year, have been introduced. A standard form\nof application has also been prepared, and by the completion of which the sponsoring\nagency may request approval for their proposed programme either newly commenced or\ncontinuing to the next school-year.\nIt will be recalled that a few years ago few of these clinics were organized and were\noften located in areas without the benefit of the full-time services of a health-unit\ndirector. With the rapid expansion in the numbers of these clinics throughout the Province and the appointment of fifteen health-unit directors, a measure of decentralization of\nadministration is now advisable. Several changes in policies relating to these clinics have\ntherefore been introduced.\nFirst, all correspondence relative to such clinics within health-unit areas will in\nfuture be directed through the respective health units and not direct to this Division as\nheretofore. Also, monthly clinic reports will be retained in the future by the health unit\nand not submitted to this Division. Similarly, requests for authorization of such clinics\nto commence or continue into the next school-year will need to be submitted through and\ncountersigned by the health unit and are required to be accompanied by a rather detailed\ndescription of the dental educational programme concurrently planned by the community.\nfinancial grants-in-aid to these clinics have been made available through National health\ngrants. to\n DEPARTMENT OF HEALTH AND WELFARE, 1954 l 71\nPreventive Dental Services in Metropolitan Areas \u00a7\u00a3\u25a0\u25a0\u25a0;\nFinancial grants-in-aid have continued to the dental services administered by the\nBoards of Trustees of the School Districts of Greater Victoria and New Westminster and\nby the Greater Vancouver Metropolitan Health Committee. A significant proportion of\nthe financial aid to Greater Vancouver during the past year has been made available\nthrough National health grants, which have also provided to that area during this period\nan additional dental X-ray unit and the necessary equipment to open two further dental\nclinics.\nFinancial aid has also been provided through a National health grant toward the cost\nof equipment and operation, since 1951, of a most effective full-time preventive denM\nservice operating within Powell River and district.\nIn summary, therefore, it may be recorded that in the public schools of this Province\nit is estimated that approximately 27,000 Grade I pupils were enrolled during the school-\nyear 1953-54. In the communities where dental rehabilitation was available to the Grade\nI pupils through either full-time preventive dental services or a community preventive\ndental clinic, more than 19,000 pupils were enrolled in the schools. Of these children,\nmore than 16,000 were dentally examined. Of these, 25.3 per cent were not in need of\ndental treatment at the time of their examination, at least 15.2 per cent visited their family\ndentist, and more than 38.1 per cent received dental treatment through the available\nservice. Therefore, a total of at least 78.6 per cent of the Grade I pupils who received a\ndental examination are known to have been dentally fit at the time of their examination\nor were subsequently restored to dental health. This total represents more than 46.6 per\ncent of all the Grade I pupils who were enrolled in the public schools of this Province\nduring the past school-year.\nDENTAL PERSONNEL\nDuring the past year the number of deaths and retirements within the dental profession was appreciably less than the average for the past ten years. As a result, as at\nSeptember 30th, 1954, the ratio of population to dentists (including those practising\nunder a temporary permit) was one dentist to every 2,009 persons. This is a marginal\nimprovement over the ratio on the same date in 1953, but one which is not anticipated\nwill be maintained.\nHowever, of the total of 615 dentists practising in British Columbia at this time, only\n190 are located outside the metropolitan areas of Greater Vancouver, Greater Victoria,\nand New Westminster. For the remainder of this Province there is regrettably only one\ndentist to every 3,111 persons.\nDental Services in the Rural Areas\nOf the smaller communities of the Province previously without a resident dentist and\nyet of sufficient size to require the full-time services throughout the year of an energetic\nyounger dentist, few, if any, now remain without dental services. During the past year\nthis Division arranged for two younger dentists to visit on a continuing schedule some\ntwenty smaller communities of this Province without a resident dentist. These two\ndentists are in no sense employees of the Health Branch. Rather, this Division acts solely\nas an agency which introduces them to various communities desirous of their services.\nA set of this Division's transportable dental equipment is on loan to these dentists. When\nthey visit a community, they agree to provide two sessions each day, five days of the week,\nto an organized preventive dental clinic for the younger children. Outside of clinic hours\nthese dentists provide services to older children and adults on a private-practitioner basis.\nOn a somewhat similar basis, arrangements have also been concluded during the past year\ntor dentists to make regular visits to the communities of McBride and Fort St. James from\n BRITISH COLUMBIA\nL 72\nnear-by larger centres. Tahsis and Zeballos are now visited at intervals of six months,\nand Tofino at yearly intervals.\nNotwithstanding the success achieved in the field of providing dental services to the\nsmaller and more remote communities of this Province, there remains an acute shortage\nof dentists outside of the metropolitan areas. Of the twenty-three dentists who newly\nregistered in this Province in the summer of 1954, only eight located outside the metropolitan areas, which is a better ratio in this regard than has been achivcd during the past\nfive years. The situation provides no grounds for complacency, when it is remembered\nthat 48 per cent of the population of this Province resides outside the metropolitan areas.\nFurthermore, during the past year five dentists moved from the rural to the metropolitan\nareas, whilst only one gave up practice in a metropolitan area to move to a rural\ncommunity.\nThe Dental Health Committee of the British Columbia Dental Association is being\napproached with the suggestion that they arrange for a survey outside the metropolitan\nareas, to be carried out so that some indication may be gained as to which communities\nare in need of additional dentists at this time. This information will then be made available to newly graduated dentists and others, so that they may be encouraged to locate in\nthese communities. It is suggested that the task is now to endeavour to attract additional\ndentists to some of the communities now with resident dentists so that increased dental\nservices to the people of the rural areas may be achieved.\nDental Faculty\nAt this time no announcement has yet been made which would indicate that the\nestablishment of a Dental Faculty at the University of British Columbia is to-day any\nfurther advanced than one year ago.\nThroughout the year a committee of the Council of the College of Dental Surgeons\nof British Columbia has met with officials of the University and others interested in the\nestablishment of a Dental Faculty. It would appear that whilst all are agreed as to the\nneed of a Dental Faculty in this Province at this time, nevertheless the major deterrents\nthe provision of the necessary funds. When approval is granted, it is unlikely that the\nplans could be completed, the necessary buildings erected and equipped, staff engaged,\nand the courses arranged in a period significantly less than two years. A further four years\nwould then elapse before the graduation of the first class of dental students and likely of\ndental hygienists. Even if the period of waiting were no longer than this six years, it is\nconfidently forecast that it will be most unlikely if the ratio of population to dentists,\nespecially in the rural areas of this Province, does not steadily worsen from the already\nmost unsatisfactory ratios pertaining to-day. The lack of available dental services in the\nareas of this Province outside the largest cities is to-day discouraging. This situation will\nlikely further deteriorate until a Dental Faculty at the University of British Columbia is in\noperation and additional dentists are trained. J|\nBritish Columbia Dental Association\nThroughout the year the most pleasant relations and co-operation between this Division and the Dental Health Committee of the British Columbia Dental Association have\ncontinued.\nEarly in 1954 the association, with some financial assistance by a National health\ngrant arranged for two selected members of the Vancouver Pedodontia Study Club to\nvisit four centres in the Interior of the Province. Some of the latest advances in children's\ndentistry were demonstrated to the dentists residing in these areas. The reception by the\ndentists of these demonstrations was enthusiastic. It is hoped that it will be possible next\nyear tor the local dental societies themselves to arrange for further visits and demonstrations by these or other specialists in the practice of children's dentistry.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 73\nIn the coming year the association hopes to arrange a full day's dental-health conference on the day prior to its annual meeting. It is planned that this conference will be\nprimarily organized for the dentists co-operating on a part-time basis within the community preventive dental clinics, and also for representatives from the lay organizations\nsponsoring these clinics and the full-time preventive dental services of this Province. For\nthe dentists, demonstrations in the latest techniques of children's dentistry will be included,\nand for the lay representatives there will be lectures and demonstrations on how they may\nhelp the children of their community prevent dental disease. To both groups it is planned\nto present a symposium entitled | Dental Disease or Dental Health in British Columbia,\"\nin which will be discussed the programmes of this Province, whereby it is hoped that\ndental disease may be very significantly reduced, if not eliminated. It is planned to have\nDr. J. Knutson, Chief, Division of Dental Public Health, United States Public Health\nService, to act as moderator to this symposium and also present an address to both groups\nat luncheon.\nGENERAL\nAt the commencement of this report, some of the difficulties of accurately recording\nprogress in the field of dental public health were indicated. Although some success in\nthis direction has been reported, plans are now being formulated whereby next summer\nthis Province will likely be the first to institute a new system of obtaining one or more\nstatistically reliable dental-health indices. The most helpful co-operation of a university\nin Eastern Canada is anticipated in this regard, and plans to implement this new procedure\nare now under preparation. These indices, it is hoped, will, when compared to similar\nfindings in future years, accurately portray the dental-health conditions in this Province\nand, we trust, the improvement in dental health attained by the programmes of this\nDivision.\nThree other major activities are foreseen for the coming year. First, it is anticipated\nthat the effectiveness, especially through their educational activities, of the community\npreventive dental clinics will be considerably increased through the assistance they receive\nfrom the regional dental consultants. Second, it is anticipated that a number of communities during the coming year will commence fluoridation of their water-supplies.\nThird, it is hoped that it will be possible to encourage even more dentists to locate in the\nrural areas of this Province.\nIt is therefore hoped that during the coming year dental disease will be further prevented and dental efficiency prolonged through the organized efforts of this Division, the\ndental profession, and the communities of this Province.\n BRITISH COLUMBIA\nL 74\nREPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING\nR. Bowering, Director I\nThe Division of Public Health Engineering functions within the framework of the\nHealth Branch, as part of the Bureau of Local Health Services. Professional public health\nengineering is being practised when the physical environment is controlled indirectly or\ndirectly for the protection and improvement of the health and comfort of man, by controlling'the forces and materials of nature for the benefit of the human race.\nEngineering in public health involves the planning of procedures and policies; the\nreview of the design of structures, equipment, and facilities; the investigation of conditions; and the control of natural forces\u2014all for the purpose of affecting the physical\nenvironment for the protection and improvement of the public health. The Division of\nPublic Health Engineering employs registered professional engineers who are trained for\nthat part of public health work which is directed toward the solution of problems in water-\nsupply, sewerage, waste collection and disposal, and the control of the environment in\nthe prevention of communicable diseases. Communicable diseases may often be prevented by employing engineering principles and techniques based upon the application of\nsanitary science.\nPublic health engineering problems tend to increase simultaneously with increasing\npopulation density and with the steady increase of industrialization throughout the Province. In addition, with the increasing wealth of the Province, improved living standards\nhave resulted in an increased demand for water and sewerage services in many of our\ncommunities. In order to cope with the numerous diversified problems involved in\npublic health engineering, three fully trained public health engineers, with postgraduate\ntraining, are on the staff of the Division, one of whom is employed under National health\ngrants.\nWATER-SUPPLIES\nThe Division is responsible for reviewing plans for extensions, alterations, and\nconstruction of waterworks systems. The \"Health Act\" requires that all plans of new\nwaterworks systems and alterations and extensions to existing waterworks systems be\nsubmitted to the Minister for approval. A careful study of these plans, together with\ninspections on the site in many cases, is one of the major duties of the Division. The\nDivision also keeps a check on new materials used in the waterworks-construction field.\nDuring the year thirty-eight plans, in connection with waterworks construction, were\napproved and eleven plans were provisionally approved. As well as approving plans,\nengineers from the Division visit various waterworks systems in the Province from time\nto time for the purpose of checking on sanitary hazards and giving advice and assisting\ngenerally in the improvement of waterworks systems.\nThere are very few water-treatment plants in British Columbia, owing to the fact\nthat in British Columbia most sources of water provide satisfactory water for domestic\nconsumption without expensive treatment. In many cases only bactericidal treatment is\nrequired, and a number of chlorinators have been installed to provide this treatment.\nIn several cases filtration equipment should be provided to take care of seasonal increases\nin turbidity. In this connection, some study was made during the year on the problem\nof the water-supply at Tranquille Sanatorium. This water is good most of the year,\nbut owing to slide conditions on the watershed the water can become very turbid at times.\nIt has been felt for some time that there is a need for better training of operators of\nwaterworks equipment, particularly water-treatment equipment. Some of the chlorinating\nequipment, for example, could be better operated if the operators had some sort of training It was felt that the number of operators that would desire training might be too\nsmall to warrant a short course in British Columbia. Contacts were made with the\ntraining section of the United States Public Health Service and the State of Washington,\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 75\nand it is now arranged that waterworks operators will be invited to short courses in\nWashington State, f Several invitations were sent to waterworks operators this year. Also,\nin connection with the American Waterworks Association, some investigation has been\nmade of methods of certifying waterworks operators.\nThe regular frequent sampling of water from public water-supply systems is the\nresponsibility of the local health unit. The Division of Laboratories performs the bacteriological examinations of the samples. Copies of all laboratory examinations are sent\nto the Division of Public Health Engineering, where they are recorded under the proper\nplace-name. In this way a constant check is kept on the bacteriological quality of the\nwater served in British Columbia.\nIn addition to the bacteriological examination of water, there is some need for\nchemical examination of water. At present the Health Branch does not operate a laboratory for doing these chemical analyses. For this service, reliance is placed upon the Public\nHealth Engineering Division of the Department of National Health and Welfare, which\noperates a laboratory for chemical analyses of water. It is recommended that when the\nnew Public Health Building is opened in Vancouver, a laboratory be set up for the\nchemical analysis of water and sewage.\nThe Division receives a number of inquiries each year concerning private water-\nsupplies. These are referred to local health units, whenever local health units exist.\nA considerable amount of advice is given by mail and occasionally by visit.\nIt is gratifying to note that, in keeping with the normal trend, there have been no\nknown water-borne epidemics resulting from the use of public water-supplies in British\nColumbia this year. The fact that there has been no evidence of water-borne illnesses in\nour Province over the past several years indicates, to a certain extent, the care being taken\nby the various water authorities to provide a safe water for the citizens of British\nColumbia. This record, however, should not be allowed to bring about a feeling of complacency because the bacteriological quality of a number of water-supplies could be\nimproved through more efficient operation of the chlorinating equipment. The Public\nHealth Engineering Division stands ready to assist any water-supply authority with respect\nto water-supply problems such as chlorination or filtration.\nSewage-disposal\nThe Division of Public Health Engineering has the responsibility of reviewing plans\nfor extensions, alterations, and construction of sewerage systems. The | Health Act\"\nrequires that plans of all new sewerage construction be approved before construction\nmay commence. During the year twenty-two approvals were given in connection with\nsewerage-works and thirteen plans were approved provisionally.\nStudy of the plans for approval includes the study of profiles and plans of appurtenances, so that a good standard of sewerage-work is constructed. Study also includes\ntreatment-works, if any, and studies of the receiving body of water, in order to determine\nthe degree of treatment required. One of the villages of the Province which built an\nentirely new sewerage system this year was the Village of Sidney, located on Vancouver\nIsland. One of the areas of Vancouver Island that has long been in need of a clean-up\nis the Gorge area in Greater Victoria. Work undertaken this year by the Municipality\nof Esquimalt and the Municipality of Saanich has removed a considerable amount of\nseptic-tank effluent from the Gorge water.\nPlans for the building of a sewage-treatment plant for the Colquitz Mental Home\nwere prepared this year. Next year, when this plant is brought into operation, another\nfairly large source of contamination will have been removed from the Gorge watershed,\nlhe Gorge waters will still receive contamination from unorganized territory, such as\nView Royal area and portions of the Colquitz River drainage-basin and the Municipality\n^anich, until such time as adequate sewerage systems are constructed.\n BRITISH COLUMBIA\nL 76\nIt was mentioned in the 1953 report that the Vancouver and Districts Joint Sewerage and Drainage Board had published a report on the ultimate disposal of sewage\nfrom the Greater Vancouver area. The organization needed for the implementation of\nthis report has not yet been formed. However, all approvals for new outfalls in the\nGreater Vancouver area will now be made conditional, until such time as the communities concerned have decided to accept or reject the report's recommendations regarding\norganization.\nThe problem of the unorganized urbanized area is still a major one as far as lack\nof sewers is concerned. Some studies were made to determine costs of sewers in one of\nthese areas, View Royal, during the year. However, unless such an area wishes to form\na sewerage'district voluntarily, there appears to be no way by which it can be sewered.\nA study was made during the year which indicated that in almost every case when\na city or a village had reached a population density of 4 persons per acre, a start, at\nleast, on the construction of sewers had become necessary. The study revealed that of\nthe thirty-four cities in the Province, excluding Vancouver, twenty-three have sewerage\nsystems and eleven do not. The average population density of the sewered cities is 6\npersons per acre. The average population density of the eleven unsewered cities is 1.4\npersons per acre. The population density of the most densely populated unsewered city\nin British Columbia is 3.2 persons per acre.\nAs far as villages are concerned, there were forty-nine communities in the Province\nincorporated as villages. Fifteen of these, with a population density average of 3.2\npersons per acre, have at least a partial sewerage system. The average of the population\ndensities of the remaining thirty-four is 2.5 persons per acre. Of the thirty-four, eleven\nare having frequent sewerage troubles now. The average population density of these\neleven villages is 3.2 persons per acre. Most of the unsewered villages that are not\nhaving trouble now have a population density below 2 persons per acre. These studies\nreveal that the need for sewers can be largely determined by the population density,\nalthough other factors, such as topography, type of soil, and relative ease of disposal,\nhave a bearing. In some cases it was found that the cost of building an adequate septic-\ntank type sewage-disposal system for each residence was not much less than that of\nbuilding a sewerage system for the whole community. There is need for more research\nin the economics of disposal of sewage in small communities.\nThe question of sewage-disposal for private homes comes generally under the direction of local health services. However, the plans and specifications are provided by the\nDivision of Public Health Engineering. Also, advice is given to local health services\nregarding private sewage-disposal problems. This year some time has been spent by the\nDivision in the redesign of our standard septic-tank plans. The research that has been\ncarried on in the past few years, both in North America and Europe, has been studied\ncarefully, and, as a result, a new booklet on sewage-disposal for private dwellings and\nisolated institutions and schools will be published early in 1955.\nThe Division also gives advice and reviews plans of sewage-disposal systems for\nschools. There is still need for research in order to determine the discharge characteristics\nof sewage from schools on a per pupil basis. The Division also provides consultative\nservice regarding sewage-disposal problems for the Government institutions.\nThe percentage of the population of British Columbia served by sewers is fairly\nhigh, being over 50 per cent, but there are still many communities where sewerage systems\nare needed. The continued growth of the Province will necessitate the building of sewage-\ntreatment plants in communities which formerly disposed of sewage by dilution. Some\ncost figures for treatment plants were prepared and given to health-unit directors, where\nrequired Constant education of the public is necessary in order to have them realize\nthe need for essential sewerage services.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 77\nSTREAM POLLUTION\nOne of the items that has been dealt with by the Division of Public Health Engineering is stream pollution. Although stream pollution may be a part of the sewage-disposal\nproblem and a part of the water-supply problem, it is felt that it is important enough to\ndiscuss under a separate heading. j|\nStream pollution is caused by discharge of sewage and industrial wastes into surface\nwater. These discharges may have quite diverse effects on the receiving body of water\nbecause of the extreme variations in the type and strength of the wastes and the quality\nand volume of the receiving bodies of water. The net result of such discharges, however,\nmay make the water less desirable and less useful.\nThe extent of stream pollution in the Province is not extensive at present, as there\nare only a few instances where waste discharges have affected down-stream water-users.\nHowever, it is recognized that adequate control should be established in order to prevent\npollution, rather than to wait until it becomes a problem and then try to reduce it.\nThe Health Branch has had general legislation for the control of municipal wastes\nfor a number of years. Control of pollution by sewage under this legislation has made\nit possible to prevent the discharge of sewage from affecting communities in lower\nstretches of streams and rivers. In addition to the Health Branch, other departments of\nGovernment have legislation for the control of industrial wrastes. The legislation is of\nvery general nature and is utilized by each department to protect its special interest. As\nthese interests involve such diverse things as fish, navigation, public water-supplies, and\nirrigation, it is not surprising that different interpretations of the general Acts or legislation are made by each department.\nIn the administration of stream-pollution legislation, an effort is usually made to\nobtain the opinions of officials of all departments which are interested in the specific discharge before a decision is made. This seems the best possible arrangement under the\ncircumstances, but there are a number of disadvantages. An industry is not required to\nhave its waste facilities approved prior to construction; consequently, if a problem arises\nafter operations commence, the solution involves the more difficult matter of alteration\nrather than prevention. Sometimes the most restrictive recommendation is liable to be\nadopted by the group, as there is no one person to decide on the relative value of the\nsuggested requirements. However, as far as public health is concerned, the activities of\nthe Health Branch have prevented the discharge of wastes into streams from becoming\na major health problem. Representatives from the Division have attended a number of\nconferences on individual stream-pollution problems during the year. The control of\npollution depends to a great extent on co-operative effort and public interest. Both of\nthese are objectives of the British Columbia Natural Resources Conference, which is\nconcerned with all the natural resources of the Province.\nDuring the last two annual conferences a special panel on pollution has been considering water, air, and land pollution. All the members of the Division have taken part\nin the preparation and presentation of papers for this special panel. The three papers to\ndate include one on water-pollution control, one on air pollution, and one on a summarization of the Pollution Panel's findings. In order to arouse as much public interest\nas possible in this problem of pollution, the Panel gave wide distribution to reprints of\nthe summarization. ' w W\nAlso, during the year the Director of the Division was elected Chairman of the\nPacific Northwest Pollution Control Council, a council set up informally, with representatives of the Pacific Northwest States, Alaska, and British Columbia, to study all phases\nof stream pollution peculiar to the Northwest. It is felt that in British Columbia, with\nthe co-operation of the other agencies interested in stream-pollution prevention, and with\nimproved methods of administering stream-pollution control, serious pollution of streams\ncan be kept to a minimum.\n BRITISH COLUMBIA\nL 78\nDuring the year a study of the waste problem created by the discharge of wastes\nfrom a vegetable- and fruit-canning factory in the Interior was made. Plans showing how\nthe waste problem could be solved were prepared and presented to the cannery in question. It is felt that during the coming years more attention will have to be paid to this\ntvne of problem.\nThere are still no large pulp-mills located on our Interior streams. If any are built\non such locations, great care will have to be taken to see that the best possible means of\nwaste treatment is used.\nIn summary, stream pollution has not become a serious problem, except in a few\nisolated instances! With the increasing industrialization of the Province, it could become\na very serious problem, unless sufficient steps are taken now to prevent it. It appears\nthat placing all classes of stream pollution under one jurisdiction might be the best way\nof achieving this result.\nSHELL-FISH\nThe Division of Public Health Engineering has the responsibility of enforcing the\nShell-fish Regulations. The inspection of shucking plants and handling procedures now\ncomes under the jurisdiction of local health units. There are six local health units that\nhave one or more shucking plants under their jurisdiction. Reports are made on uniform\nrecords issued by this office. The Department of National Health and Welfare also has\nan interest in shell-fish control, since it has to approve certificates for export purposes.\nThe Provincial regulations are such that any shell-fish produced in the Province, in conformity with the regulations, will conform with the requirements of the Department of\nNational Health and Welfare.\nOysters produced commercially in British Columbia are grown on leased ground.\nApplications for all new leases and applications for renewal of existing leases are forwarded to this Department for approval. Any ground found unsuitable for production\nof shell-fish for public health reasons will not be leased. In some areas a pollution survey\nof a proposed oyster lease can be made relatively easily, but in others a considerable\namount of survey work is necessary. There were twenty-eight certified shucking plants\nin operation in 1954, of which twenty were family operations. The certification must be\nrenewed annually. There are fourteen shell-stock shippers certified as well. Lists of\ncertified shucking plants and shell-stock shippers are forwarded to the Department of\nNational Health and Welfare, which, in turn, forwards this to the United States Public\nHealth Service. This makes it possible for American importers to know if shell-fish\ncome from certified plants and shippers. | A\nThe matter relating to shell-fish toxicity is one that is still before the Pacific Coast\nShell-fish Committee. Following a recommendation of this Committee in 1953, the West\nCoast of Vancouver Island was opened for the taking of clams and mussels after a closure\nof eleven years. Assaying of clams by the laboratory of the Department of National\nHealth and Welfare, in co-operation with the Federal and Provincial fisheries and health\nagencies, was continued in 1954. There have been no deaths due to the ingestion of\ntoxic shell-fish in British Columbia since 1942.\nSWIMMING AND BATHING PLACES\nA considerable amount of time was spent during the summer in consultation work\non swimming-pools. The health units also spend a considerable amount of time studying\nswimming-pool sanitation. In 1954, under the chairmanship of the Director of Public\nHealth Engineering, a Swimming-pool Regulation Committee was set up. This Committee has prepared a draft set of swimming-pool regulations. . Following the third draft,\ncopies were sent to each health unit for comments. It is hoped that these regulations wifl\nbe enforced early in 1955. There is still a good demand for the paper that was prepared\nseveral years ago on suggested requirements for swimming-pools. These suggested\nrequirements should supplement the regulations when they are promulgated.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 79\nTOURIST ACCOMMODATION\nThe Director of the Division is one of five members of the licensing authority for\ntourist accommodation. Inspection of tourist camps, auto courts, etc., is done on the\nlocal level by the sanitary inspector. The reports of the sanitary inspectors are coordinated by the Division of Public Health Engineering, and recommendations for or\nagainst licensing are made to the British Columbia Government Travel Bureau. There\nare over 1,300 hcensed tourist camps in the Province at the present time, and the work\ndone by the Health Branch has a considerable effect in producing a fairly high standard\nof tourist accommodation. Three licences were cancelled on health grounds in 1954.\nThe star rating of tourist camps is not done by the Health Branch, but it is done by\ninspectors employed directly by the Travel Bureau.\nThere appears to be an increasing demand on the part of the public for tenting and\ncamping space. The Parks Division of the Forest Service has provided a number of\ncamping-sites throughout the Province. These do not come under the licensing requirements of the Travel Bureau. However, the local health units provide some inspection\nand consultation services to the persons in charge of such camping-sites. The Division\nalso, upon request, offers consultation advice with regard to sanitation in parks.\nThe requirement that tourist accommodation must be licensed has had an excellent\neffect in the prevention of nuisance to tourist camps. The local sanitary inspector has\nbeen able to visit a tourist-camp site before construction and give the owner advice on\nwater-supply, sewage-disposal, and other environmental health problems.\nFROZEN-FOOD LOCKER PLANTS\nUnder the regulations governing the construction and operation of frozen-food locker\nplants, plans of all new constructions of locker plants must be approved by the Deputy\nMinister before construction may commence. The Division studies the plans and recommends approval where such is indicated. Approvals were given to three locker plants\nduring 1954. One locker-plant operator was charged in Court and found guilty of violating the Frozen Food Locker Plant Regulations.\nIn the review of locker-plant plans, care is taken to see that the required rooms\nnecessary for a locker plant are planned for, and care is also taken to see that the refrigeration equipment is adequate to maintain the temperatures required in the regulations.\nPeriodic inspection of the locker plants is made by the local sanitary inspector.\nGENERAL\nThe Division of Public Health Engineering provides a consultative service to other\ndivisions of the Health Branch and to local health units on any matter dealing with engineering. This entails a considerable amount of work and of travel. During the year\nmost of the health units were visited at least once. During these visits the various problems requiring engineering for their solution are examined in the field. The position of\nChairman of the British Columbia Examining Board for sanitary inspectors' examinations is usually filled by this Division. Papers on public health engineering subjects were\npresented during the year by members of the Division to the Annual Institute for Public\nHealth Workers in British Columbia, the Municipal Engineering Division of the British\nColumbia Engineering Society, and the Pacific Northwest Pollution Control Council.\nThe continued expansion of the economy of the Province will lead to more and\nmore public health engineering problems. It is the intention of the Division to foresee\nthese problems and make plans for their reasonable control so that proper recommendations may be made for adoption by the Government and by local health services for\nadequate control of the environment.\n BRITISH COLUMBIA\nL 80\nREPORT OF THE DIVISION OF VITAL STATISTICS\nJ. H. Doughty, Director\nTwo main types of service are provided by the Division of Vital Statistics to the\ngeneral public and to other branches of Government. On the one hand, the Division\nperforms the functions of civil registration, and, on the other, it renders statistical service\nto all sections of the Health Branch. The Division is made responsible by Statute for the\nadministration of the \"Vital Statistics Act,\" the ^'Marriage Act,\" and the \"Change of\nName Act,\" as well as several sections of the \" Wills Act.\" Statistical services comprise\nthe preparation of detailed analyses regarding births, deaths, marriages, stillbirths, adoptions, divorces, and of other data stemming from the registration function, as well as providing extensive statistical service required for the administration of other divisions of the\nHealth Branch.\nA record high was reached in 1954 in the number of birth certificates issued by the\nVictoria Office. As noted in the previous year, the demand for birth certificates was\nheaviest in the month of June, when 4,334 were supplied, being an increase of 20 per\ncent over the previous all-time high of June, 1953. The demand remained heavy during\nthe summer months, commencing a decline in September. It is evident that there is an\nincreasing awareness on the part of the general public of the value and convenience of\nhaving a birth certificate readily available at all times. Wallet-sized laminated birth\ncertificates have become extremely popular, even on behalf of new-born babies. As\nrecently as ten years ago, few birth certificates were issued at the time the birth was registered, but at the present time at least one certificate is issued at the time of registration of\nalmost every birth. Many parents purchase both a parchment certificate and a laminated\ncertificate at the time of filing the birth registration.\nThe central office issued over 43,000 birth certificates during the year, which was\nmore than double the number issued during 1950. The issuance of death certificates\nshowed a slight increase over the previous year, while the issuance of marriage certificates\ndeclined very slightly. The total of all revenue-producing certificates issued during the\nyear by the Victoria office amounted to 51,800. Revenue-producing searches increased\nto 32,500 from the 30,500 for the previous year. In addition, 25,854 non-revenue\n(current) searches were made, plus 5,500 free searches for other Government departments. A new record was also established for revenue collections by the Victoria office.\nThese amounted to $55,500, compared to the previous high of $53,246.\nREGISTRATION OF BIRTHS, DEATHS, AND MARRIAGES\nCurrent Registrations\nThe registration of births, deaths, and marriages has been a statutory requirement in\nthis Province since its creation in 1872. Many changes have been made in the form and\ncontent of registrations in the ensuing years as the system developed and new needs\nbecame manifest. The fact that to-day the Province has a well-developed and smoothly\noperating registration system is due as much to the continued modification that has been\nits history as it is to the underlying stability it has enjoyed. An unbroken series of registrations of births, deaths, and marriages, dating back to the first year of the Province's life\nand earlier, is available for immediate reference in meeting the many needs such records\nserve. The key to this entire sequence of registrations is a new index system which has\nrecently been completed. The index is now strictly alphabetical by year of event, and\nProvince-wide, regardless of where or when the registration was filed.\nI The registration of marriages and deaths has proved to be a simpler matter than\nbirth registration from the administrative point of view, although there are problems\npeculiar to each series. The responsibility for registering a marriage rests with the clergy-\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 81\nman or Marriage Commissioner solemnizing the ceremony, and the registration is a\nstraightforward record of the event. The responsibility for filing death registrations is\nplaced upon the undertaker or other person who disposes of the body. Because of its\nvery nature, being a record made concerning a person after his demise, the death registration is more prone to contain errors which the Division attempts to discover and rectify.\nAn important part of the death registration is the Medical Certificate of Cause of Death,\nand because of the multiplicity of diagnoses and the need for interpreting these in terms\nof the International Statistical Classification of the World Health Organization, a large\nnumber of follow-up queries are required. |\nThe development of an adequate system of birth registration has presented different\nproblems. For many years following the inception of civil registration in 1872, the\nProvince was a vast sparsely settled region with many difficulties of transportation. Confinements usually took place in the family home, and in many instances without the\nbenefit of medical care. While the responsibility for the filing of birth registrations has\nalways been with the child's parents, there was not a great incentive for them to fulfil\ntheir duty until the popularization of birth certificates in comparatively recent times.\nThese factors account for the lack of completeness and accuracy of birth registrations in\nearlier years. However, the growth of population, combined with a tremendous improvement in transportation facilities, the high proportion of births which now occur in institutions, and the increased demand for proof of birth have now resulted in a very high level\nof birth registration. The reporting of births by the hospital in which these occur and also\nby the attending doctor provides an adequate cross-checking system for bringing to\nattention registrations which are outstanding for longer than the period allowed by law.\nWhile little difficulty is presently encountered in obtaining completed birth registrations from parents, there continues to be a certain lack of understanding of the legal\nimportance of a birth registration and the documents which may later be required t& be\nissued from it. Although efforts are continually being made to simplify the content of\nregistration forms and to provide concise instructional material for the guidance of\nparents, it is necessary to initiate numerous inquiries in order to obtain answers to items\nwhich have been omitted or to which incorrect answers have obviously teen given. Such\nsteps are essential and in the public interest if the quality of registration is to be maintained\nat a high level.\nDelayed Registration of Births\nMost applications for delayed registration of birth continue to come from persons\nbom before the year 1920. The delayed-registration picture appears to be changing\nsomewhat in that first-class evidence is becoming increasingly rare, while verifications\npieced together from assorted fragments of evidence are more frequently presented. It is\nnot surprising that most persons having Class A (that is, first-class) evidence in their\npossession have now been registered.\nThe continued high level of delayed-registration work appears to have two explanations. In the first instance, it is to be expected that more time will be taken to effect\nregistration in the cases where each piece of evidence is produced as the result of considerable research and exchange of letters. Secondly, it is evident that fewer applicants now\nbecome discouraged and discontinue their efforts to obtain registration. Previously there\nwere relatively a large number of incompleted applications in the Division's files. The\nGuide to Delayed Registration of Birth, introduced last year, together with several other\nvariations in approach to the problem, appears to have been helpful.\nThe verification material on file continues to be valuable. There is a small but\nsteady flow of fresh material into these records. Verification material consists mainly of\nphysician's notices of birth, hospital reports of birth, school returns of newly enrolled\nPupils, baptismal records, and miscellaneous records of institutions which are no longer\nui operation. The information provided from these sources is generally of first-class\nvalue as supporting evidence for delayed registration of birth.\n BRITISH COLUMBIA\nL 82\nDuring the last few months the Tabulation Section has been preparing punch-cards\nin order to provide an index to the sixty-one volumes of physicians' and nurses' notices\nof births in our verification files. This particular set of notices relates to the early m\nof the century for which many applications are received. When this index becomes\navailable the work of searching for such a record will be greatly simplified, and it will\nbe of assistance to the public in locating evidence m support of an application for a\ndelayed registration of birth. The punch-cards for this mdex are now complete, and it\nis hoped to tabulate the index sheets during the next few months.\nA new edition of the Guide to Delayed Registration of Birth is now in print. In\nresponse to constructive suggestions from interested sources, a few minor changes have\nbeen made. It is hoped that the new pamphlet will present inquirers with a clearer\npicture of the problem and of the steps they should take to obtain a delayed registration.\nContinued co-operation has been received from the Indian Commissioner for British\nColumbia and from the Indian Superintendents in obtaining delayed registrations for\nthose Indians whose births were not previously registered.\nDOCUMENTARY REVISION\nVital-statistics records are subject to continual change to accommodate new information resulting from adoptions, legitimations, divorces, changes of name, alterations\nof Christian name, and corrections of error made at the time of registration. These\nchanges are handled by the Documentary Revision Section of the Division. This Section\nis also charged with registering the orders of adoption and divorce transmitted from the\nSupreme Court Registries and the processing of applications for legal change of name.\nThe number of adoption and divorce orders received during 1954 increased to 1,248\nand 1,614 respectively from the 1,103 adoptions and 1,574 divorces registered during\nthe previous year. In addition, 144 notations of divorces granted in the Supreme Court\nof British Columbia at Revelstoke, Nanaimo, Vernon, Rossland, Princeton, and Cranbrook prior to April, 1935, were placed on marriage registrations. This is part of a\nprogramme designed to complete the records for divorces granted prior to the 1935\namendment to the \" Vital Statistics Act\" which required that all divorces be registered\nwith the Division. Alterations of given or Christian name numbered 296, while 386\nlegal changes of name were accepted. In addition, 215 applications for legitimation of\nbirth were investigated and accepted.\nIt has been discovered that in the earlier years of registration there were numerous\ninstances of duplication in the registration of births. This problem was overcome a\nnumber of years ago when the Division began matching incoming birth registrations with\na corresponding physician's notice of birth or an entry in the returns of births submitted\nby all hospitals. Since this procedure was instituted, no registrations have been accepted\nwithout a corresponding notification or an adequate explanation as to why none was\navailable. As the existence of duplicate registrations is apt to lead to confusion, steps\nhave been taken to search the birth records for the years in which it is known duplications\noccurred and to cancel them whenever found.\nSteady progress was made on the correction and revision of Indian vital-statistics\nregistrations. The records of several Agencies, covering the period 1917 to 1946, inclusive, were reviewed, and many hundreds of corrections made. In addition, many delayed\nregistrations of Indian births were accepted, as well as legitimations and alterations of\ngiven name. This long-range revision project is aimed at raising the standard of Indian\nregistrations to that enjoyed by the white population. Many difficulties have been\nencountered Some of these stem from the fact that registration of Indian vital statistics\nwas on a voluntary basis until 1943, while others arose from the lack of appreciation by\ninaians ot the value and significance of accurate registration, and from the completion\nof Indian registration by well-meaning but misinformed persons.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 83\nEfforts have been made to ensure greater continuity and accuracy in the names and\nbirth dates used by Indian children by popularizing the use of birth certificates and by\nchecking enrolment records of children attending school for the first time during the\ncurrent school-year. In the 1953-54 school term, returns were submitted by 178 schools,\nof which 44 indicated that there were no Indian pupils entering school for the first time.\nOut of a total of 1,233 new pupils, the births of only 22 were found to be unregistered,\nalthough in 749 cases the birth particulars which had been supplied on entering school\ndid not agree with the related birth registrations.\nH Since the preparation and subsequent checking of school returns constitutes an\nonerous task for school-teachers, Indian Superintendents, and this Division, an experiment\nwas made in September, 1954, to determine whether satisfactory results could be achieved\nby requiring the production of birth certificates by children upon enrolment. Results of\nthe experiment are encouraging, but it is too early to make a full assessment of its\neffectiveness.\nLiaison visits have been made to the Indian Commissioner's office as well as to the\noffices of several Superintendents in the field. This function is generally carried out by\nthe Inspector of Vital Statistics during the course of his inspection of registration offices,\nand affords the Division direct contact with the Agency offices, as well as the opportunity\nto provide technical instruction in vital-statistics procedures to the Agency staff.\nMICROFILMING OF DOCUMENTS\nThe photographing of registrations of births, deaths, stillbirths, and marriages on\nmicrofilm was continued on a weekly basis. In this way the Dominion Bureau of\nStatistics is furnished with copies of all registrations, from which are prepared the\nstatistical tabulations required for National vital statistics and for the National index of\nbirths, deaths, stillbirths, and marriages. In addition to the photographing of current\nregistrations, all registrations upon which notations have been made resulting from adoptions, divorces, changes of name, and other types of documentary revision were rephoto-\ngraphed and the amended images splices into the appropriate rolls of film. As in previous\nyears, miscellaneous projects were undertaken in order to bring up to date the filming of\nspecial files, verification material, and other documents. Several sets of baptism and\nmarriage registers, loaned by various churches, were microfilmed and the books returned\nto their owners. The Division is grateful for the co-operation extended by the churches\nin this connection.\nADMINISTRATION OF THE \" MARRIAGE ACT \"\nThe administration of the \"Marriage Act\" is a major responsibility of the Division\nof Vital Statistics. This Act covers all phases of the Province's jurisdiction over the\nsolemnization of marriage and the legal preliminaries thereto. The main duties of the\nDivision under this Act relate to the issuance of marriage licences and the vesting of\nindividual ministers and clergymen with the authority to solemnize marriages in British\nColumbia. The Division also appoints Marriage Commissioners for the purpose of\nsolemnizing the civil marriage ceremony.\nBecause of the legal importance of the marriage contract and of the qualifications\nwhich are required of the parties to the intended marriage, marriage licences are issued\nonly by specially appointed persons known as \"issuers of marriage licences.\" This provision, which restricts the issuance of marriage licences to a limited number of specially\nappointed persons, is one of the several safeguards written into the \"Marriage Act\" as\na protection to the public. It is the duty of the issuer of marriage licences to be reasonably\nsatisfied that the persons seeking a marriage licence are properly qualified before he may\nissue the marriage licence.\n BRITISH COLUMBIA\nL 84\nThe sections of the Act providing for the registration of ministers and clergymen\nfor the purpose of solemnizing marriage in this Provmce are also intended as protection\nof the public against the performance of marriages by fraudulent or unauthorized individuals The Act provides that before registration is granted, the denomination to which\nthe clergyman belongs must fulfil certain requirements regarding continuity of existence\nand must have established rites and usages respectmg the solemnization of marriage.\nThis legislation in various forms is common throughout the Canadian Provinces.\nAlthough all of the larger religious denominations have been granted recognition pursuant to the \"Marriage Act\" many years ago, splinter groups and newly created denominations continue to seek recognition.\nTwo new religious groups were granted recognition during the year, while inquiries\nwere received from eleven other groups who wish to obtain the privilege of solemnizing\nmarriages for their clergymen.\nAll current marriage registrations are checked against the roll of authorized clergymen, and this year it was gratifying to find that no marriages had been solemnized by\nministers who were not properly authorized. This fact underlines the effectiveness of\nthe legislation and its value to the public.\nApplications for an order permitting remarriage, pursuant to section 47 of the\nI Marriage Act,\" numbered fifteen in 1954. Most of these applications were in respect\nto couples who had previously been married to each other, were subsequently divorced,\nand who then wished to remarry each other.\nREGISTRATION OF NOTICES OF FILING OF A WILL\nSince 1945, when an amendment was made to the \" Wills Act,\" making it possible\nfor a person to file a notice with the Director showing the date of execution and the\nlocation of his will, over 23,000 notices have been filed as part of the records of the\nDivision. During 1954 over 4,100 wills notices were received and filed. The use made\nby the public of this facility has increased with each succeeding year.\nCERTIFICATION SERVICES\nOnce again there has been a major increase in the volume of requests for certificates\nand other forms of certification received by the Division. Although the year 1953 was\nthe previous peak year in this connection, the 1954 applications exceeded 1953 by fully\n10 per cent. On many occasions throughout the year almost 300 separate applications\nfor certification were received on a single day. Each application must be processed\nthrough the cash register, a search must be undertaken to locate the original registration\non file with the Division, the desired certificate must be prepared, the accounting procedures attended to, and the outgoing document dispatched in the mail. Many applications request priority service, alleging that the documents are required for Court purposes,\nfor immigration purposes, for travel to the United States, and other urgent needs. Every\neffort is made to clear all applications routinely within the space of two business-days,\nand priority attention is given to the special requests as far as possible. However, the\ntremendous increase in the number of applications received and the limitations of space\nin the central office, coupled with the fact that the records vault is located some 3 miles\naway from the general office, make it increasingly difficult to handle this work with the\ndesired speed and efficiency.\nEff<\u00a3ts are continually being made to improve and refine forms and procedures used\nin the office m order that accurate certifications may be produced with a minimum of\ndelay Toward the end of the year it was found that a more even flow of work throughout the week could be obtained by a revision of the system whereby the weekly returns\nor registrations are submitted from the district offices at Vancouver and New Westminster.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 85\nDISTRICT REGISTRARS' OFFICES\nRegistration Districts\nNo changes were made during the year in the number or location of the district\noffices. However, it was found that the District Registrar at Alert Bay, because of the\nnature of his other duties, was required to be absent for long intervals, thus inconveniencing the public in obtaining marriage licences. Accordingly, it was deemed advisable\nto appoint a local business-man as Marriage Commissioner and issuer of marriage licences\nfor the Registration District of Alert Bay, to act during the absence of the regular District Registrar. 4-\nInspections\nThe Inspector of Vital Statistics visited forty-seven offices and sub-offices during\nthe year. These covered Vancouver Island, the Sechelt Peninsula, the Fraser Valley,\nthe Okanagan Valley, Revelstoke, Cariboo District, Prince George, the Prince Rupert\nDistrict, the Queen Charlotte Islands, and the Peace River District extending as far north\nas Fort Nelson.\nVisits were also made to the Vancouver, North Vancouver, and New Westminster\noffices and to thirteen Indian Agencies. The purpose of these visits is to check the procedures being carried out in the district offices and to ensure that the registration system\nis working satisfactorily at the local level. The Inspector usually finds it expedient to\nmake contact with the doctors, clergymen, undertakers, hospital personnel, and health-\nunit personnel in the areas visited.\nIn districts where Government Agents and Sub-Agents hold the District Registrar\nappointment, very little direction is needed with respect to vital-statistics work. However, a closer supervision of procedures is required in those offices where there is a more\nrapid turnover of personnel.\nThe success of the entire registration system is contingent upon the efficiency of\nthe District Registrars in collecting and transmitting vital-statistics registrations to the\ncentral office. It is again gratifying to report that the District Registrars have maintained\na very high standard in the performance of their duties. This is especially appreciated\nin view of the fact that, apart from the Vancouver and Victoria offices, which are under\nthe direct supervision of the Division, the District Registrars have other important duties\nto carry out.\nAt the close of the year there were ninety offices and sub-offices operating in seventy-\none registration districts. Thirty-eight of the offices are located in Government Agencies\nor Sub-Agencies, while in twenty-three other districts Royal Canadian Mounted Police\npersonnel hold the appointment of District Registrar. In eight other offices the appointment is held by other Provincial Government employees, in seven offices by Municipal\nClerks, and in fourteen offices by private individuals, including Game Wardens, Postmasters, Stipendiary Magistrates, and a Canadian Customs Officer. In addition, there\nis a Marine Registrar located at Vancouver, and eighteen Indian Superintendents who\nare ex officio District Registrars of Vital Statistics for Indians only.\nVancouver Office\nThe vital-statistics office in Vancouver was established as an integral part of the\nDivision and withdrawn from the Government Agency in 1949. Owing to the fact that\napproximately two-fifths of the total registrations for the Province are received by that\noffice, it plays an increasingly important part in the successful administration of the\nDivision's activities. The personnel employed in the Vancouver office have as their sole\nresponsibility the provision of vital-statistics services.\nThe number of registrations received during the year showed a slight decline. However, there was again a substantial increase in the revenue transferred to the central office,\n BRITISH COLUMBIA\nL 86\nindicating a marked increase in the number of requests for certification which could only\nbe issued from the Victoria office. Most of these were for plasticized birth certificates,\nThe volume of incoming and outgoing correspondence again increased during the\nvear Many birth registrations are submitted by mail, and many letters must be written\nback to the parents eliciting correct answers to various items on the registration forms.\nThe office was extremely hard pressed on several occasions during the year due to\nstaff changes and shortages. Because of the nature of registration work, new employees\nneed considerable in-service training before they are able to carry out their duties in a\nroutine manner.\nI GENERAL ADMINISTRATION\nNo major changes were made in the administrative organization of the central office,\nalthough a number of adjustments were made in the assignment of duties with a view to\nimproving the flow of work. As far as possible, the general office and the Mechanical\nTabulation Section have been organized on a production-line basis, but this plan cannot\nbe followed entirely because of the several important phases of the Division's responsibilities which require individual and specialized attention. Hence, while the checking and the\nprocessing of incoming registrations, the filing of routine applications for certificates and\ncertified copies, and the operation of the Mechanical Tabulation Section have been\ndeveloped along co-ordinated systematic lines, separate specialized units have been\nassigned to handle such matters as legitimations of birth, fraudulent and improper registrations of birth, applications for delayed registration, the licensing of ministers and\nclergymen under the | Marriage Act,\" applications for change of name, special statistical\nrequests, and other items requiring special attention.\nThe most serious problem in day-to-day administration is the shortage of working\nspace in the central office. The fact that the registrations, which are the basis of most of\nthe Division's work, must be located in a separate vault several miles from the central\noffice is most unfortunate. This arrangement considerably impedes the efficient operation\nof the Division. It is now possible to retain in the central office not more than the last two\nmonths' returns of current registrations. Experience has shown that the greatest reference\nis made to registrations during the first several years of their existence. The problem thus\ncreated has been met as far as possible by the use of microfilm in the central office, but\nthis is much less satisfactory than having the original records available, and for many\npurposes, such as the posting of notations, corrections, and supplementary documentation,\nresort must be had to the originals. In addition, it has now been found necessary to transfer many thousands of wills notices and many other special files to Topaz Avenue vault.\nThe space problem has become so acute that the Index Section of the office is completely allocated, with no room for the indexes of subsequent years. Careful investigations\nhave been made of alternative methods of reproducing such bulky material as indexes with\na view to the conservation of space, but no satisfactory method has yet been discovered.\nThe frequency of amendments to vital-statistics indexes, due to changes of name, adoptions, and the filing of delayed registrations, has thus far made any method of photographic or microfile indexing impractical.\nThe 1954 Session of the Legislature saw the passage of the \"Anatomy Act,\" which\nprovides for the custody and control of cadavers for use in the advancement of anatomical\nstudy. The administration of the \"Anatomy Act\" rests with the Deputy Minister of\nHealth, with power to appoint persons to carry out the administrative duties involved. In\norder to make the operation of this Act as simple and as convenient as possible to all\nparties concerned, it was agreed that the District Registrar of Births, Deaths, and Marriages at Vancouver was best able to provide the facilities for the administration of this\nAct. The responsibility for recording and filing of all information required by the Act was\ntherefore vested with the District Registrar at Vancouver.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 87\nThe amendment to the \" Marriage Act,\" which was passed at the second session of\nthe 1953 sitting of the Legislature, and which provided for the registration of marriages\nperformed according to Doukhobor custom, has now been in operation for over one year.\nTo date no Doukhobor couples have taken advantage of the privilege of registering their\nmarriage in accordance with this amendment.\nSTATISTICAL SECTION\nIntroduction\nDuring the last few years there has been a considerable change in emphasis with\nrespect to die work conducted by the Statistical Section. Formerly, the major duties of\nthis Section concerned the preparation and analysis of statistics derived from registrations\nof births, deaths, and marriages. While the need for obtaining additional information\nrespecting the health status of the people was recognized, little was available statistically\napart from that which could be inferred from death registrations. However, while\ncertifications of cause of death still provide the largest single group of health statistics,\nseveral other sources are being used to advantage by the Statistical Section.\nComprehensive statistics on tuberculosis and venereal disease are prepared from the\ncase reports of the Divisions of Tuberculosis and Venereal Disease Control on a current\nbasis. Statistics on cancer treatment and follow-up are produced on behalf of the British\nColumbia Cancer Institute, and statistics on the incidence of this disease are collected\nthrough a Province-wide cancer notification system. Statistics are also compiled with\nrespect to those communicable diseases which by law are notifiable to the Health Branch.\nThrough the use of an expanded form of the Physician's Notice of Live Birth and\nStillbirth, much useful data are being derived and analysed regarding the health of our\nnew-borns and the factors surrounding birth. The Division also supervises the Crippled\nChildren's Registry, and from it produces valuable statistics concerning infants injured\nat birth and those congenitally malformed, as well as children who are victims of crippling\ndiseases. In 1953 the field of mental-health statistics was entered for the first time by the\nDivision with the extension of the punch-card system to cover the records of the Mental\nHealth Services. During the present year the first detailed annual tabulations were run\nfor the Mental Health Services, and further analysis of the data which are accumulating\nwill yield much of value in the field of mental health.\nAnother important source of morbidity data was being utilized for the first time in\n1954. The Division began processing the claims records of the British Columbia\nEmployees' Medical Services and thereby made available for morbidity-statistics purposes\nthe sickness experience of over 16,000 of our population.\nWhile the data from the several sources referred to above have limitations, their\nvalue is considerable, and there is good reason to expect an improvement in quality and\nextent as the various systems are more completely developed and utilized.\nStaff-training\nPostgraduate training in biostatistics was completed by a staff member this year at\nthe University of Toronto. On his return he assumed research duties in the Vancouver\noffice of the Division, thus making available for the first time the services of a trained\nbiostatistician in that area. Another member of the Statistical Section completed a\nsummer course in biostatistics at the Virginia Polytechnic Institute. These courses of\ntraining were made possible by National health grants. fBll\nDivision of Vital Statistics Special Reports\nDuring the year the Division commenced the issuance of a series of special\nstatistical reports on matters of public health interest. These reports are intended to\n BRITISH COLUMBIA\nL 88\nserve as a channel of information to the Public Health administrative staff and field staff\nrespecting data collected and analysed in the Division which are not released in Annual\nReports of the Health Branch, the Annual Reports of the Divisions of Tuberculosis\nControl and Venereal Disease Control, or the Annual Report of Vital Statistics. It {\nhoped that through these non-periodic reports pertinent data will be made readily avail-\nable to those who can make use of them. To date five such reports have been issued, and\ntheir reception has been encouraging.\nFollowing are brief summaries of the important features of the reports released\nduring 1954:\u2014 .\nReport No. 1, entitled \"Deaths by Suicide m British Columbia, 1949-1953,\" indicated that the suicide rate in the Province was higher than that for any other Province of\nCanada. For the period covered, the rate was from two to two and one-half times higher\nthan that for the remainder of Canada. The high rate has existed for a considerable time\nand has shown no sign of decline. The rate for Vancouver City was almost double that\nfor the remainder of the Province, but when suicides by gas poisoning were excluded, the\nrates for the two areas were almost the same. The suicide rate was highest amongst\nwidowed and divorced persons and lowest for single persons. About three times as many\nmales committed suicide as females, and the age-groups from 40 onward showed much\nhigher rates than did the age-groups under 40.\nReport No. 2, entitled \"Health Unit Statistics in British Columbia, 1953,\" continued\nthe series which started in 1952 with a report covering Health Unit Statistics for 1948-\n1951. The report consists of a series of tables showing births, stillbirths, and deaths by\nage and cause for the Indian and non-Indian populations of each health unit, as well as\ntuberculosis cases and venereal-disease notifications for the total population in each\nhealth unit.\nReport No. 3, entitled \"Statistics on Poliomyelitis in British Columbia, 1953,\"\nwas drawn up at the request of the Consultant in Epidemiology. It was based on the\nindividual epidemiological reports submitted for all poliomyelitis cases. The report\nshowed that while the case rate in the 1953 epidemic was higher than in 1952, being 64.0\nper 100,000 population as compared to 48.8, the death rate was down from 3.1 in 1952\nto 2.1 in 1953. The case fatality rate for paralytic poliomjielitis was considerably higher\nin 1952 than in 1953, being 10.0 per 100,000 population in the former year, as compared\nto 5.4 in 1953.\nReport No. 4, entitled \"Accidental Deaths in British Columbia, 1950-1953,\" presented an analysis of the accident mortality picture in this Province. It was compiled as\na follow-up to the Symposium on Accidents which was held at the 1954 Public Health\nInstitute, and which created considerable interest. The report revealed that British\nColumbia has a rather high death rate from accidents, the average rate during 1950 to\n1953 being 119.3 per 100,000 males and 39.6 per 100,000 females. The rates for the\nremainder of Canada were 78.0 and 30.4. Since 1921 the annual rate in British Columbia has been exceeded only once by the rate for another Province. While the death rate\nfrom motor-vehicle accidents in British Columbia is comparable to that for the remainder\nof Canada, the rates for the other major accidental causes\u2014namely, accidental injury by\nfall, drowning, transport accidents other than motor-vehicle, and poisoning\u2014are considerably higher in this Province. A final table in the report presented data on accidental\ndeaths in each health unit and metropolitan area of the Province.\nReport No. 5, entitled \"Cancer Morbidity and Mortality in British Columbia, 1953,\"\nset forth data on cancer cases reported to the Division during 1953 and on cancer deaths\nregistered in that year. For reported cancer cases, including those for which first notification was received after death, 36 per cent of male cases and 30 per cent of female cases\nwere shown as being of the digestive system. The next most important site for males was\nthe respiratory system, and for females, the breast. The genitalia were the third most\nimportant site for both males and females, and the skin fourth. Among both males and\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 89\nfemales, cancer of the digestive system accounted for the greatest proportion of cancer\ndeaths namely 45.2 per cent for males and 37.3 per cent for females. Another 17 per\ncent of male cancer deaths resulted from cancer of the respiratory system and 11 per cent\nfrom cancer of the genital system. Amongst females, 22 per cent of the cancer deaths\nwere due to breast cancer and 18 per cent to cancer of the genital system.\nStatistics for the Mental Health Services\nThe new statistical system which this Division inaugurated in 1953 for the Mental\nHealth Services saw its first full year of operation during 1954*Certain minor improvements were made during the year, and by the end of the year the routine established\nappeared satisfactory in all respects. For the first time the tabulations required for the\nstatistical tables of the Mental Health Services Annual Report were produced by this\nDivision from the punch-card records.\nThe Division is continuing to co-operate with the Mental Health Services in the\ndevelopment of further statistical measures which will be of assistance in the operation\nof those Services.\n:jf Morbidity Statistics\nReference was made in the 1953 report to the negotiations which were under way\nbetween this Division and the British Columbia Government Employees' Medical Services\nwith a view to obtaining morbidity statistics from that organization. An agreement has\nnow been arrived at whereby the Division will process the claims records of the Employees'\nMedical Services on a co-operative basis. The Division will provide monthly and annual\ntabulations relating especially to financial and administrative statistics in return for the\nprivilege of compiling and using the morbidity statistics which are also obtainable from\nthe records. The information is transmitted to the Division in coded form, with the\nexception of the medical diagnoses. Coding of the diagnoses is carried out by the trained\nmedical coders of the Division. The Division has also undertaken to produce from the\npunch-cards the annual receipts required by the subscribers to the Medical Services for\nincome-tax purposes.\nA noteworthy feature of the system which has been developed is that an up-to-date\nset of population punch-cards is being maintained covering all persons embraced by the\nplan. This will provide a basis for computing specific morbidity rates for the various types\nof illness and for specific groups within the insured population.\nAdditional releases were received during the year covering information obtained from\nthe National Sickness Survey of 1950^-51. These reports presented regional estimates of\nfamily expenditures for health care and National estimates of the volume of sickness.\nVancouver Statistical Office\nThe Vancouver statistical office extends the statistical services of the Division to all\nallied agencies of the Health Branch situated in and around Vancouver. Therefore, much\nof the staff's time was spent in liaison and consultant duties. With the addition of a\nbiostatistician during 1954, a more complete consultant service was made available.\nThe consultant services were extended principally to the Provincial Epidemiologist\nand to the British Columbia Cancer Institute. However, considerable time was spent with\nthe Greater Vancouver Metropolitan Health Committee in a consultant capacity in connection with a review of their records and statistical services. To date, the Child Welfare\nUimc records have been under discussion and a study started in order to evaluate the\nusefulness of the medical data on these records. In addition, the office was represented\non the Committee on the Infections of the New-born and the Committee for the Eve Study\nfor Pre-school Children. %\nThe Crippled Children's Registry, which was organized in 1952, is supervised almost\nentirely by this office of the Division of Vital Statistics. This Registry was organized to\n L 90 <#?\u25a0 BRITISH COLUMBIA gJK VM\nacquire a knowledge of the extent of crippling diseases in children and to assist problem\ncases in the low-income groups. In order that the Registry may facilitate the care of the\nchild in the low-income group, it is necessary for it to have knowledge of all agencies\nworking with crippled children. Much work was done in this regard during 1954 with\nvoluntary health organizations, such as the Junior Red Cross, the Canadian National\nInstitute for the Blind, the British Columbia Cerebral Palsy Society, the Polio Foundation\nand the British Columbia Crippled Children's Society. Also during the year the records\nof the Registry were abstracted onto punch-cards in the Victoria office of the Division\nthus making available more complete listings and statistical analyses of the case load oi\nthe Registry. At the end of 1954 there were approximately 4,600 case-histories in the\nRegistry, with an average of 150 cases being added monthly.\nClose co-operation exists between the Vancouver office and the Division of Tuberculosis Control in connection with both the record forms and the statistical reports of that\nDivision. The annual statistical report on tuberculosis is reviewed each year with a view\nto increasing the utility of the data presented. A major change in certain phases of the\ntuberculosis record system has been proposed by one unit of the Division, and it has been\ndecided that the recommended system be placed on a trial basis in that unit. The Vancouver office will collaborate with the Division in assessing the merits of the proposed\nsystem and in dealing with any changes that may be necessary in the manner of collecting\nthe required statistics.\nConsiderable time was spent with the Mental Health Services in developing their\nnew statistical system as outlined elsewhere in this report. A great deal of the preliminary\nwork and the planning of the statistical tables for the Annual Report of Mental Health\nServices was carried out by the Vancouver office. It is intended to further extend this\nwork in 1955 to provide for machine-run statistics covering the resident population.\nThrough the co-operation of the Vancouver General Hospital, members of the statistical staff were permitted to attend medical lectures and rounds in subjects which were\nof particular interest.\nSpecial Studies\nA number of special studies and assignments were undertaken during the year on\nbehalf of other Divisions of the Health Branch. Some of these studies involved special\ntabulations and analyses of the punch-cards already on file in the Division, while others\nwere made from original records. Several of the more important assignments are\ndescribed briefly hereunder.\nA questionnaire regarding features of hospital accommodation and facilities was\ndrawn up and distributed to the patients and staff at Pearson Hospital. The purpose of\nthis questionnaire was to elicit the comments and opinions of both patients and staff of\nthe Province's most modern tuberculosis institution for the benefit of future planning\nand hospital administration. The completed questionnaires were returned to the Division of Vital Statistics, and the results were analysed and synopsized for the use of the\nsenior staff of the Health Branch.\nIn the latter part of the year, work was commenced on a study into the true cost of\nthe 1953 poliomyelitis epidemic to the population of British Columbia. A full assessment of this cost is considered to be valuable information in planning future policy to\ndeal with the effects of this disease. \u00a5\nFrom the contact investigation reports of the Division of Venereal Disease Control,\nquarterly contact indices were prepared for each year from 1947 to 1953, inclusive.\nA routine has been established whereby these indices will be reported routinely to the\nDivision of Venereal Disease Control henceforth.\nStatistics for the Annual Report of the Crippled Children's Registry were tabulated\nfor the first time from the punch-cards which the Division has been accumulating from\nthe Registry. In addition, three sets of indices on the case load of the Registry were\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 91\ntabulated according to various attributes of the children registered. These indices have\nproved to be of considerable value in the work of the Registry.\nAssistance was given to the Division of Public Health Dentistry in connection with\nthe statistics of the fluoridation study carried out during the year. Assistance was also\nriven to the Division of Environmental Management respecting food-study analyses.\nSpecial work was undertaken for the Division of Tuberculosis Control in assessing\nthe results of B.C.G. vaccinations. A special mortality analysis, covering a fifteen-year\nperiod, was also prepared for this Division. An alphabetical index of all known tuberculosis cases on Vancouver Island was tabulated for the Vancouver Island Stationary\nClinic. Other classified listings of known cases of tuberculosis in this same area were\ncompiled.\nCANCER REGISTRY\nSince the year 1932 cancer has been a reportable disease in this Province and a\nProvince-wide reporting system has been operated by the Health Branch. The purpose\nof this reporting is to make possible the provision of up-to-date data on the cancer problem in the Province and to make these data available to the medical profession and other\nagencies interested in cancer. Reports of new cases are received from private physicians,\nthe British Columbia Cancer Institute, general hospitals, and from pathology laboratories. Death registrations are also used as a source of reporting cases which are not\nknown prior to death.\nIt has been recognized for some time that the Division has not enjoyed a full measure of success in obtaining complete reporting of all cancer cases diagnosed. However,\nconsiderable efforts have been made to attain a better quality of reporting, and the\nincrease of over 20 per cent in the number of cases reported during 1954 is almost\ncertainly an indication of better reporting, rather than a sudden increase in the incidence\nof this disease.\nPreliminary figures showed that during 1954 there were 3,600 new cases of malignant neoplasm reported in the Province. Amongst males 305.7 new cases were reported\nper 100,000 male population, and amongst females the rate was 276.8.\nThe following tables show the malignant neoplasms reported during 1954 classified\naccording to site, age-group, and sex:\u2014\nTable I.\u2014Number and Percentage of New Cancer Notifications1\nby Site and Sex, British Columbia, 1954\nSite\nMale\nFemale\nTotal\nNumber\nPer Cent\nNumber\nPer Cent\nNumber\nPer Cent\nDigestive system-\nGenital system\n567\n231\n317\n2\n303\n130\n146\n124\n42\n15\n48\n29.4\n12.0\n16.5\n0.1\n15.7\n6.8\n7.6\n6.4\n2.2\n0.8\n2.5\n428\n329\n196\n439\n51\n74\n44\n29\n26\n22\n37\n25.6\n19.7\n11.7\n26.2\n3.0\n4.4\n2.6\n1.7\n1.6\n1.3\n2.2\n995\n560\n513\n441\n354\n204\n190\n153\n68\n37\n85\n27.6\n15.5\nSkin_\nBreast\n14.2\n12.3\nRespiratory system-\n9.8\nLymphatic and haematopoietic tissue\n5.7\nUrinary system\n5.3\nBuccal cavity\nBrain\n4.3\n1.9\nEndocrine glands\n1.0\nOther and not stated-\n2.4\nTotals\n1,925\n100.0\n1,675\n100.0\n3,600\n100.0\n\t\n1 deludes 1,593 cases reported for the first time at death.\n L 92\nBRITISH COLUMBIA\nTable II.\u2014Number and Percentage of Reported Live Cancer Cases\nby Site and Sex, British Columbia, 1954\nSite\nMale\nNumber\nPer Cent\nSkin\t\nGenital system\t\nBreast\t\nDigestive system\u2014\nBuccal cavity\t\nRespiratory system-\nUrinary system\nLymphatic and haematopoietic tissue.\nEndocrine glands\t\nBrain\t\nOther and not stated\t\nTotals.\n300\n124\n1\n160\n110\n97\n88\n48\n7\n12\n24\n971\n30.9\n12.8\n0.1\n16.5\n11.3\n10.0\n9.1\n4.9\n0.7\n1.2\n2.5\n100.0\nTable III.\u2014Cancer Notifications1 by Sex and Age-group,\nBritish Columbia, 1954\n(Age specific rates per 100,000 population.)\nMale\nFemale\nTotal\nAge-group\nNumber\nAge\nSpecific\nRate\nNumber\nAge\nSpecific\nRate\nNumber\nAge\nSpecific\nRate\n(W 9\n14\n12\n31\n53\n120\n243\n529\n595\n245\n83\n10.8\n14.2\n38.5\n59.2\n146.8\n396.1\n945.2\n1,577.9\n2,713.8\n9\n8\n25\n114\n231\n257\n416\n376\n165\n74\n7.3\n10.0\n30.1\n116.9\n300.6\n460.8\n857.8\n1,212.7\n1,937.1\n23\n20\n56\n167\n351\n500\n945\n971\n410\n157\n9.1\n10-10\n12.1\n?fU?Q\n34.2\n^n_\/iQ\n89.3\n40-49\n221.3\n426.9\n60-69\n70-7Q\n904.6\n1,413.1\n80 and over\nNot stated\n2,336.7\n,\nTotals\n1,925\n305.7\n1,675\n276.8\n3.600 1 291.5\n1 Includes 1,593 cases reported for the first time at death.\nTable IV.\u2014Live Cancer Cases Reported by Sex and Age-group,\nBritish Columbia, 1954\n(Age specific rates per 100,000 population.)\n0- 9\t\n10-19\t\n20-29\t\n30-39\t\n40-49 U\n50-59\t\n60-69\t\n70-79\t\n80 and over.\nNot stated \u201e\nAge-group\nMale\nNumber\nTotals.\n971\nAge\nSpecific\nRate\n7\n5.4\n7\n8.3\n18\n22.4\n40\n44.7\n69\n84.4\n137\n223.3\n233\n416.3\n292\n774.4\n93\n1,030.1\n75\n154.2\nFemale\nNumber\n5\n6\n21\n88\n180\n163\n257\n185\n63\n68\n1,036\nAge\nSpecific\nRate\nTotal\nNumber\n4.0\n7.5\n25.3\n90.2\n234.2\n292.3\n529.9\n596.7\n739.6\n12\n13\n39\n128\n249\n300\n490\n477\n156\n_143_\n2,007\nAge\nSpecific\nRate\n4.7\n7.9\n23.8\n68.4\n157.0\n256.2\n469.1\n694.2\n889.1\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 93\nPOPULATION CHARACTERISTICS OF THE PEOPLE OF\nBRITISH COLUMBIA\nIn previous years' reports, various features of the population composition of this\nProvince have been reviewed. A knowledge of the population structure is of considerable\nimportance to public health, since it has a direct bearing on the problems and programmes\nwhich are the concern of public health workers. \u00a7\nThe population of British Columbia continued to increase during 1954, and the\nmid-year estimate, provided by the Dominion Bureau of Statistics, placed the total\npopulation at 1,266,000. This represents an increase of 36,000 over the 1953 population and is the largest increase since 1948. The Province's population has now increased\nby 8.6 per cent since the 1951 Census, only slightly more than the national increase of\n8.5 per cent. For the population under 5 years of age, there has been a 13.9-per-cent\nincrease since 1951, and for the population 5 to 9 years, inclusive, a 19.6-per-cent\nincrease. In the older age-groups, for males 60 years of age and over, the population has\nincreased only 3.7 per cent since 1951, but the female population at these ages has\nincreased by 9.5 per cent.\nAs the table below shows, since 1901 there has been a steady decrease in the pror\nportion of the population which is in the age-group from 15 to 44 years, and a steady\nincrease in the number over 65. While the total population in the Province was seven\ntimes larger in 1954 than in 1901, there were only five times as many in the 15-44 age-\ngroup in 1954. The number in the 65-and-over age-group has increased more than\nthirtyfold, and that in the 45-64 age-group more than tenfold.\nPopulation in British Columbia by Age-group. 1901-54\n(In thousands.)\nYear\nAge-group\n0-14 Years\nNumber\nPer Cent\n15-44 Years\nNumber\nPer Cent\n45-64 Years\nNumber I Per Cent\n65 Years and Over\nNumber\nPerCent\nTotal\nNumber\nPer Cent\n1901\n1911\n1921\n1931\n1941\n1951\n1954\n44.5\n24.9\n91.2\n23.2\n149.5\n28.5\n171.1\n24.6\n175.1\n21.4\n304.4\n26.1\n356.3\n28.1\n105.8\n239.3\n260.9\n325.0\n376.3\n501.2\n524.6\n59.2\n61.0\n49.7\n46.8\n46.0\n43.0\n41.5\n23.9\n53.3\n95.8\n160.0\n198.4\n233.5\n245.5\n13.4\n4.5\n2.5\n13.6\nS3\n2.2\nIS.3\n18.4\n3.5\n23.1\n38.1\n5.5\n24.3\n68.1\n8.3\n20.1\n126.1\n10.8\n19.4\n139.6\n11.0\n178.7\n392.5\n524.6\n694.2\n817.9\n1,165.2\n1,266.0\n100.1*\n100.0\n100.0\n100.0\n100.0\n100.0\n100.0\nSource: Census of Canada, 1901 to 1951. Figures for 1954 are Dominion Bureau of Statistics estimates.\nBIRTH AND STILLBIRTH RATE\nThe preliminary birth rate for 1954 was 25.3 per 1,000 population, a decline from\nthe record rate of 25.8 established in 1953.\nThe stillbirth rate per 1,000 live births was 11.0 in 1954, a slight decline from the\n1953 figure of 11.8, thus establishing the lowest rate yet recorded, p\nPRINCIPAL CAUSES OF MORTALITY IN BRITISH COLUMBIA\nIt has been mentioned earlier in this report that the Statistical Section is taking\nincreased advantage of the sources of morbidity data that are open to it. However,\nmortality statistics continue to yield valuable information regarding the health status of\nthe people of the Province. Whereas morbidity statistics are still rather sketchy, mortality\nstatistics are much more complete and represent the most reliable comprehensive data\nwhich can be derived at the present time. The following discussion of mortality during\n L 94 BRITISH COLUMBIA\n1954 is presented with the realization that it by no means gives a complete picture of\nstate of health of the population. Nevertheless, it furnishes a useful indication 0f f\nprogress which is being made in public health and of problems which remain to be fa d\nThe crude death rate for 1954 was 9.6 deaths per 1,000 population, the lowest r t\nexperienced since 1939. In view of the ageing of the population which is known to h*\noccurred since that time, this low rate represents a considerable improvement in fr\nlife-span.\n\u00a7 The same four causes took the greatest toll of lives this year as for some time\nnamely, heart-disease, cancer, intracranial lesions of vascular origin, and accidents. These\ncauses were responsible for 71.7 per cent of all mortality during the year. The mortality\nrate from heart-disease was down slightly this year, from 361 deaths per 100,000 population to 350, the lowest rate since 1951. Over 72 per cent of the deaths from heart-\ndisease in 1954 occurred as a result of arteriosclerotic heart-disease including coronary\ndisease. This represents over one-quarter of the deaths from all causes combined, thus\nmaking it the most important single cause of death. Myocardial degeneration caused\n12 per cent of the deaths from heart-disease, and hypertensive heart-disease 7 per cent.\nThe cancer death rate was up slightly to 164 per 100,000 population from the 1953\nrate of 156. Slightly over 13 per cent of the cancer deaths occurred as a result of stomach\ncancer. The lung was the site in 12 per cent of the deaths, the large intestine in 10 per\ncent, and the breast in 9 per cent. Cancer of the prostate accounted for 6 per cent of all\ncancer deaths, and cancer of the pancreas another 6 per cent.\nThe rate of deaths from vascular lesions declined from 106 to 101 per 100,000 in\n1954. Almost 60 per cent of these deaths occurred as a result of cerebral haemorrhage,\nwhile 28 per cent were due to cerebral thrombosis and cerebral embolism.\nThe accidental death rate was down sharply from 80 per 100,000 in 1953 to 64 in\n1954. One-quarter of the accidental deaths resulted from motor-vehicle accidents, 18 per\ncent from injury by fall, and 11 per cent from drowning.\nThe death rate from pneumonia was 39 per 100,000 population, as compared to the\nrate of 35 for 1953. The rate of deaths from diseases of early infancy declined to 32 in\n1954 from the rate of 36 in 1953. J|| Jf I\nThe lowest infant and maternal mortality rates ever known in this Province were\nrecorded in 1954. Preliminary figures indicate an infant death rate of 23.7 per 1,000 live\nbirths and a maternal mortality rate of 0.4 per 1,000 live births. Comparative rates for\n1953 were 27.1 and 0.6 respectively.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 95\nREPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION\nRaymond H. Goodacre, Director\nPerhaps the most encouraging trend observed during 1954 was an increasing awareness on the part of public health personnel that the Division of Public Health Education\nprovides a professional service that is not merely limited to the effective utilization of\naudio-visual aids and the writing of press releases.\nThe Division's role in the organizing of the Annual Public Health Institute, the\npublic health programme of the Eighth British Columbia National Resources Conference,\nand the development of certain records are but three tangible examples reflecting a more\ndiscriminating type of request for service.\nIt was not possible to complete the programme scheduled for the year, due to a\nshortage of staff which reached its peak during the last quarter. Nevertheless, the following review of the year's work appears to indicate a reasonable degree of progress toward\nthe objectives of the division.\nLOCAL HEALTH EDUCATORS\nFour years ago, in 1950, two local health educators were placed in the field\u2014one in\nthe Central Vancouver Island Health Unit, with headquarters in Nanaimo, the other in\nthe Victoria-Esquimalt Health Department. During the past two years the latter has\nbeen on a leave of absence serving with the World Health Organization in Sarawak and\nFormosa in an advisory capacity. He has now returned to the Victoria-Esquimalt Health\nDepartment upon the termination of his appointment to resume his duties, which will\nagain be shared by the Saanich and South Vancouver Island Health Unit.\nThe health educator in Nanaimo continued to effect a liaison between the unit and\nthe teachers through interpretation of health-unit services and familiarization with the\naudio-visual aids maintained by the Division of Health Education.\nConsiderable emphasis this year was, however, directed toward the commemoration\nof Nanaimo's one hundredth birthday and the part played by the public health services in\nthat area. This event was highlighted by a | flier\" type of presentation of the unit's\nfacilities which was distributed widely to all communities served by the Central Vancouver\nIsland Health Unit. i| W W f\nIN-SERVICE TRAINING\nAs mentioned in last year's report, 1954 marked the first year in which the Division\nassumed primary responsibility for organizing the Annual Public Health Institute. As the\nInstitute is an in-service type of training for the field staff, members of the Local Health\nServices Council continued to act as an advisory council to the Division. This year's\nsession was held at the HoteJ Georgia in Vancouver during the week following Easter,\nApril 20th to 23rd. The Health Branch was fortunate in securing Miss Ruth Gilbert,\nAssistant Professor of Nursing Education with Columbia University's Teachers College,\nto provide a series of six lectures in mental hygiene. These talks were especially valuable\nin that they were skilfully directed not merely to the public health nurses, but to all staff\nfrom the health-unit director to the clerk. ||f\nThe remainder of the programme was devoted to a series of topics highlighted by a\nsymposium on safety designed to show health-unit personnel their roles in accident prevention in the home, the school, industry, and in recreation. Inasmuch as accidents still\nconstitute the leading cause of death between the ages of 1 and 39 years, this presentation\nwas considered to be especially timely.\nArrangements for orientation of new staff members and visitors were continued\nduring the year. One health-unit director and the recently appointed Rehabilitation Coordinator were provided with the complete orientation process, whereas only selected\n L 96 BRITISH COLUMBIA\norientation was arranged for visitors to the department. Among the latter were M\\\ngration training teams whose members are gathering information on this Province's nUbr\"\nhealth and hospitalization services, prior to posting to various points in Europe. \u00b0\nMATERIALS \u00a7\nThe Department of National Health and Welfare convened the Fifth Federal\nProvincial Conference on Health Education in Ottawa, May 26th, 27th, and 28th\nCalled every two years, these meetings serve to bring together representatives in health\neducation from all ten Provinces and from the Federal Government's counterpart, Information Services Division. One of the most significant developments arising from this\nConference was a long-awaited decision regarding the controversial subject involving\nsale of health pamphlets.\n9|| In previous reports it has been mentioned that two booklets basic to maternal- and\nchild-health programmes throughout Canada have been in short supply. These are the\nCanadian Mother and Child and Up the Years from One to Six. It has now been decided\nthat Provinces will receive a quota of each of these items, and that the same free distribution basis will apply to the Dental Health Manual and the Backward Child. However\nthese publications will also be available at a nominal cost to the public through the\nQueen's Printer in Ottawa.\nAlthough this decision was not received with favour by Provincial representatives,\nthe disadvantages of the new distribution system are outweighed by the guarantee that\nsufficient copies of these materials will at least be available, a situation that has not\nexisted for the past three or four years. The one disheartening feature of the system is\nthat although the announcement was made in May, this Province has not yet received\nits annual quotas.\nThe effects of short supply of the Canadian Mother and Child have not been felt\nas strongly as they might have been, due to the existence of a series of twelve postnatal\nletters distributed to mothers through local health services. These have now been completely revised and issued under a new format, together with a series of inserts dealing\nwith accident prevention for the infant.\nToward the latter part of the year a project involving the expenditure of funds from\nthe Maternal and Child Health Grant was submitted to the Department of National\nHealth and Welfare to cover the cost of books selected to serve as a basic library for\nhealth units and their branch offices conducting prenatal classes. The purpose of the\nlibrary is considered to be twofold. First, it serves as a readily available depository for\nselected reference texts used in organizing and maintaining classes, and, second, nurses\nwithout public health training whose paediatric background is perhaps less broad than\nis desirable will have an opportunity to develop their own knowledge and understanding\nof child care.\nAlthough this next item may not in itself be of profound significance, it is one more\nreflection of the trend toward increasing recognition and acceptance of professional health\neducation by the field staff. During the fall the suggestion was raised by one of the\nhealth units that all records requiring the signature or concurrence of parents should be\napproved by this Division. Heretofore, there has been some criticism of the wording on\nsome forms which is felt to have provoked resentment on the part of the public. Although\nsome health units have requested this type of service in the past, it is encouraging to note\nthat the latest suggestion applies to forms common to all local health units.\nObtaining reference journals and texts for loan to health units has always been a\nproblem. \u00a7 One library may, of course, borrow from another through the mter-hbrary\nloan system common to both Canada and the United States. However, since media\npublications are not numerous, they have often been difficult to obtain on a loan basis.\nNevertheless, the Victoria Medical Society library has continued to make available I\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 97\nfacilities wherever possible. In return, partial assistance to the libraiyiis being effected\nthrough the provision of duplicate copies of journals to which the Health Branch sob-\nscribes.\nToward the latter part of the year, word was received from the University of British\nColumbia's bio-medical library that Journals and books would now be available on loan\nto health-unit personnel. A system has been developed to enable efficient utilization of\nthese facilities, including the anticipated introduction for a photo-print method of reproduction for use with articles contained in journals that are not available on loan.\nThe Health Education library was augmented as the result of a most welcome\ntransfer of the Department of Education's reference material on alcohol and alcoholism.\nTogether with books and references currently maintained by the library, these additions\nconstitute the most readily accessible source for use by Government departments.\nIn addition to the new safety leaflets mentioned previously, revision of the dermatitis\nseries and the Physician's Reference Manual were effected in co-operation with the\nDirector of the Division of Venereal Disease Control and the Assistant Provincial Health\nOfficer respectively; another in the New Zealand dental-health poster series was reproduced in quantity; and the booklet \u00a7 Information and Rules for Patients Applying for\nAdmission to Tuberculosis Institutions\" was rewritten in conjunction with the Division\nof Tuberculosis Control. Other service connected with the Division of Preventive\nDentistry will be found in that report.\nAlthough there was marked decrease in the number of new films suitable for purchase, thirty-four new and duplicate items were added to the central film library.\nShowings to almost 100,000 people reveal that maternal and child care was the most\npopular topic, followed by mental health, dental health, sanitation, nutrition, and safety.\nAs listings maintained by the Division remain in relatively the same proportions, it is\ninteresting to note that in 1953 mental-health films topped the list, whereas in 1952\ndental health outstripped all other in terms of film showings.\nPUBLICATIONS AND PUBLICITY\nDuring the year the Government completed organizational plans designed to allow\neach department to include a display on its services at the recently opened British Columbia building located on the Pacific National Exhibition's grounds in Vancouver.\nIn conjunction with a Vancouver display firm the Division developed an exhibit\nillustrating the many preventive health services that are organized on a health-unit basis\nfor mothers, school-children, and the community in general.\nAlthough the display was well received, several modifications are anticipated with a\nview to enhancing its attraction value as a medium for public education at a time when it\nis competing for attention with other exhibits in the building.\nAt the February, 1954, session the subject of people as a resource was dealt with\nfor the first time during a British Columbia Natural Resources Conference. Two papers\u2014\none a discussion of the waste of human resources and the other on conservation\u2014were\npresented, together with an outline of the history and origin of British Columbia's population. For the 1955 Conference, the executive has suggested that the story of people be\npresented from the public health approach.\nAs a result, the Public Health Committee, chaired by the Director, has organized\na programme embracing two major topics, namely, the relationship betjveen public health\nand human resources, which outlines the economic and social importance of public health,\nand the relationship between public health and the natural resources. The latter is\ndesigned to demonstrate that although the development of natural resources has been\neneficial to the health of the people in general, this same development has also created\new problems both to the public at large and to the workers employed to develop the\nresources.\n L 98 BRITISH COLUMBIA\nJfc Following an analysis of the monthly staff bulletin to local health services person\nentitled \" News and Views,\" the suggestion was raised with Local Health Services Coun i\nthat this publication was not being utilized as extensively as it might. At the time it wa\nnoted that a publication of this type might serve as an in-service training medium rathe**\nthan merely a channel for instructions and changes in procedure, for which it wa'\noriginally developed some twenty-five years ago. s\nAs a result of further discussion, News and Views has evolved into an in-service\ntraining medium serving three distinct functions. In the first place it continues to provide\na channel to the health units through which instructions and similar information may be\nforwarded from the Health Branch. Secondly, original articles and reprints regarding\nrecent developments in the field of public health are selected for the staff by their counterparts in central office, and, thirdly, News and Views serves as a central source of information pertaining to programmes submitted by one unit which are potentially useful to other\nunits undertaking similar programmes. This third function is especially significant in\nview of the fact that the lines of communication between the health units and central\noffice are well established, whereas they are not well defined between one unit and\nanother.\n--|i STAFF ' -s|'\nThe Division continues to experience a mobility in staff, due to difficulties encountered in both recruiting and retaining suitably qualified personnel. Although leave of\nabsence was granted to the most recently appointed health education assistant for the\npurpose of securing a master's degree in public health at Columbia University under\nNational health grants, no suitable applicant has been found to fill the vacancy created\nby the resignation of another member whose six years' service terminated in September.\nThis latest unsuccessful recruiting experience appears to confirm the belief that\nsuitable applicants are not readily available at the present salary offered, and that potential\ncandidates are being drawn to related fields which, although requiring similar qualifications, provide a more satisfactory remuneration. It is to be hoped, therefore, that the\ncurrent salary negotiations will prove sufficiently fruitful to enable the recruitment of\nacceptable personnel in order to meet the increasing demand for this Division's services.\nI\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 99\nREPORT OF THE HEALTH BRANCH OFFICE, VANCOUVER AREA\nG. R. F. Elliot, Assistant Provincial Health Officer\nThis year has been an active one in all phases of the work of the Vancouver area\noffice of the Health Branch, in charge of the Assistant Provincial Health Officer. The\nlatter is responsible for the Bureau of Special Preventive and Treatment Services, liaison\nwith voluntary health agencies in Vancouver, and the administration of National health\ngrants to British Columbia.\nThe Bureau of Special Preventive and Treatment Services includes the Divisions\nof Laboratories, Tuberculosis Control, and Venereal Disease Control. The Assistant\nProvincial Health Officer is primarily concerned with matters of policy respecting these\nDivisions, including co-ordination between these services, as well as between them and\nthe local health services. A detailed review of the work of each Division, which has been\nsubmitted by the Director, follows this report. Consultants in public health nursing and\nin nutrition, who have been seconded to the Vancouver area by the Bureau of Local\nHealth Services, are located in the office of the Assistant Provincial Health Officer. Also\nhoused within this office is the Vancouver office of the Statistical Section of the Division\nof Vital Statistics, and the usefulness of this policy continues to grow each year.\nBUILDINGS\nThe construction of the new Provincial Health Building in Vancouver, mentioned in\nthe 1953 Annual Report, is progressing in a satisfactory manner and will, in all likelihood,\nbe ready for occupancy around July or August of 1955.\nDuring 1953 it will be recalled that poliomyelitis reached an all-time high in the\nProvince of British Columbia. It became apparent that if this Province experienced a\nsimilar epidemic in the near future, hospital facilities for the proper care of these patients\nwould be taxed. Planning was quickly undertaken, and a new wing at the Pearson\nTuberculosis Hospital on West Fifty-seventh Avenue, Vancouver, is being constructed to\nmeet this need. This wing will offer the most modern facilities available for the treatment\nof post-poliomyelitis cases and will accommodate some fifty patients. The type of patient\nto be hospitalized in this wing will be either the long-term type or the patient who on\ntransfer from an acute general hopsital will receive early rehabilitation prior to transfer\nto the Western Society for Rehabilitation for more active rehabilitation.\nPERSONNEL\nDuring the year the responsibilities of the personnel officer of the Division of Tuberculosis Control were increased, and he became the personnel officer of the Bureau of\nSpecial Preventive and Treatment Services. This has been a most forward step as the\nappointment has co-ordinated and stream-lined personnel policies not only in the three\nmajor divisions of this Bureau, but has been of great assistance to those voluntary health\nagencies with which the Health Branch has a direct working relationship.\nDuring 1954 the former Director of the Division of Venereal Disease Control was\nappointed Consultant in Epidemiology and seconded to this Bureau. The Consultant in\nEpidemiology has given valuable assistance in the control of outbreaks of salmonellosis,\nshigellosis, etc., and has also brought forward valuable information relative to the statistical approach to poliomyelitis. The work of the Consultant in Epidemiology in the field\nof tuberculosis is being developed, and one looks forward in future years to a close\nanalysis from a statistical and epidemiological view-point of many of the programmes in\nthe Health Branch. This appointment has done much to strengthen the services of the\nHealth Branch.\ns\n L 100\nBRITISH COLUMBIA\nDuring 1954 one of the consultants in public health nursing, who has special to'\ning in child and maternal health, was attached to this office. This arrangement will\nresult in a much closer relationship between the Local Health Services and the work of\nimn^oii'ToH orrp.nr'ip'c in Vnnrrmvp.r rp.snonsihlp for the carp, nf th<* ci^V r.u\\iA r\nspecialized agencies in Vancouver responsible for the care of the sick child. In partic\nular, the work of the Crippled Children's Registry and the newly opened Health Centre\nfor Children in Vancouver will be more closely integrated with public health nursing at\nthe local health-service level.\nThe work of the consultant nutritionist attached to this office from Local Health\nServices continues to prove the value of having this consultant located in Vancouver\nDetailed information regarding this work is given earlier in this Report, in the Nutrition\nService section, Division of Environmental Management.\nFACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA\n| As mentioned in the 1953 Annual Report, the very satisfactory working relationship\nwith the Dean of the Faculty of Medicine, University of British Columbia, and in\nparticular with the heads of the Departments of Paediatrics and Preventive Medicine\ncontinues to expand.\nDuring the year a most valuable refresher course was organized by the Department\nof Paediatrics, University of British Columbia, for public health nurses of the Provincial\nHealth Branch and the metropolitan areas of Vancouver and Victoria.\nVOLUNTARY HEALTH AGENCIES\nThe voluntary health agencies located in the City of Vancouver which receive grants\nfrom the Provincial Government continue to receive close supervision, and once again it\nis felt that the programmes of these organizations are sound and the money invested in\nthem by the people of this Province, through the Provincial Government, is well spent.\nHf The activities of the British Columbia Cancer Foundation, the Western Society for\nRehabilitation, and the Canadian Arthritis and Rheumatism Society (British Columbia\nDivision) are outlined separately in this report. In general, however, the Assistant\nProvincial Health Officer has actively participated in the programme-planning of these\norganizations, and a most amicable relationship has existed. Budgets are reviewed with\ngreat care, and it is felt that economy is being practised in a satisfactory manner.\nIn addition to these organizations, limited attention was given to the Vancouver\nPreventorium, British Columbia Poliomyelitis Foundation, British Columbia Tuberculosis Society, Canadian Red Cross Society, John Howard Society, Cerebral Palsy Association, Canadian Cancer Society (British Columbia Division), Alcoholism Foundation,\nMultiple Sclerosis Society, and other similar organizations related to health matters in the\nProvince of British Columbia.\n*\nDuring the year, visits were made to many of the larger hospitals in this Province\non Departmental matters, such as co-ordination of the Provincial biopsy service and\nrequests for assistance from the National health grants.\nBritish Columbia Cancer Foundation\nThis organization, named as the agent of the Provincial Government for the treatment and control of cancer in this Province, made forward strides in its programme.\nFunds are provided by the Cancer Control Grant of the National health grants and by\nthe Province of British Columbia on an equal basis to pay the operating expenses o\nthe main diagnostic and treatment centre, known as the I British Columbia Cance\nInstitute,\" and the nursing home, both located in Vancouver, and of the consultativ\nand diagnostic clinics located throughout the Province. These consultative clinics n\noperate at ten centres in the Province.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 101\nThe diagnostic and treatment centre of the British Columbia Cancer Foundation\nat the Royal Jubilee Hospital in Victoria continues to provide a needed and expanding\nservice.\nLate in 1954 a start was made upon the construction of a new 28-bed nursing home\nadjoining the British Columbia Cancer Institute in Vancouver. This is a much-needed\ndevelopment, since the present nursing home is an old converted home, and besides being\ninadequate in size, it is also a definite fire-hazard.\nWestern Society for Rehabilitation\nAs pointed out in previous reports, this organization continues to give leadership\nto all of Canada in this field, in addition to supplying unexcelled rehabilitation services\nto the people of British Columbia.\nThe additional 20 beds and 15,062 square feet of diagnostic, treatment, and outpatient facilities mentioned in the 1953 report were opened in January of 1954, and are\nadmirably meeting the needs of increasing rehabilitation requirements in this Province.\nCanadian Arthritis and Rheumatism Society\n(British Columbia Division)\nThe travelling consultant service mentioned in the 1953 report is functioning in\na satisfactory manner.\nMobile physiotherapy service is given from the treatment centres listed in the 1953\nreport, bringing the advantage of home care to at least seventy-five communities throughout the Province. In all areas medical and lay committees give practical and financial\nsupport.\nThe staff consists of forty-nine, including a medical director, research director,\nthree medical consultants, one nurse, two occupational therapists, twenty-seven physiotherapists, two social workers, one driver, and four research and record stenographers.\nA shortage of physiotherapists delays the programme and increases its cost.\nThree research projects are being conducted under the auspices of the Canadian\nArthritis and Rheumatism Society\u2014one at the Department of Biochemistry at the\nUniversity of British Columbia on the basic aspects of rheumatism and arthritis, one\non rheumatic fever and heart-disease, and one on rheumatoid arthritis. These are\nsupported by the National Public Health Research Grant.\nAlcoholism Foundation of British Columbia\n|J The Alcoholism Foundation of British Columbia mentioned in the 1953 report has\nbecome active in its responsibilities, and early in the new year should see the development\nof a programme based on out-patient and rehabilitation services. This is a voluntary\nhealth agency, but the board of trustees of the Foundation has Provincial Government\nrepresentation from the Attorney-General's Department, Mental Health Services of the\nProvincial Secretary's Department, and from both the Health Branch and Welfare Branch\nof the Department of Health and Welfare. Jl-\nGENERAL\nThe research programme related to narcotic addiction continues to function with\nsupport from National health grants and the Attorney-General's Department of this\nProvince. At this time there is a brief prepared by the Community Chest and Council\nin the hands of the Provincial Government recommending establishment of a programme\ntor the treatment of narcotic addiction in this Province, with particular emphasis on\nrehabilitation. It is possible that some of the funds now being used for research should\n L 102\nBRITISH COLUMBIA\nbe diverted to a pilot rehabilitation programme, and, at the same time, research could h\ncarried on jointly with rehabilitation in this centre. De\n1 This most frustrating problem of narcotic addiction is, of course, a problem through\nout the world, but with the University of British Columbia taking the responsibility fo\nthe direction of this research project, it is felt that some progress toward the eventual\nsolution in this Province will be made.\nIn the field of poliomyelitis this office continues to act as the co-ordinator of all\nthe agencies concerned. To date in 1954 the problem has been easily handled. ||\nhowever, imperative that once again recognition be given to the outstanding co-operation\nreceived from the Royal Canadian Air Force in carrying out mercy flights in the evacuation of poliomyelitis patients to Vancouver. In addition, the work of the British\nColumbia Poliomyelitis Foundation and the Poliomyelitis Committee of the Vancouver\nGeneral Hospital is sincerely acknowledged. 'j*\nGamma globulin was once again made available on a somewhat less restricted basis\nthan in 1953 due to an improved supply. Plans are now being made for the use of\npoliomyelitis vaccine in 1955.\nNATIONAL HEALTH GRANTS\nGeneral\nThe total amount of funds available to British Columbia for the fiscal year 1954-55\nis $4,210,444, excluding the Public Health Research Grant, which is allocated in Ottawa.\nThe increase of approximately $360,000 from the previous year is largely due to an\nincrease in per capita amount under the Mental Health and Laboratory and Radiological\nServices Grants, to substantial increases in the Medical Rehabilitation and Child and\nMaternal Health Grants, and to an increase in the amount revoted under the Hospital\nConstruction Grant.\nThe General Public Health Grant was increased by $123,000 as the result of a\ntransfer of $83,000 from the Cancer Control Grant, $10,000 from the Tuberculosis\nControl Grant, and $30,000 from the Laboratory and Radiological Services Grant. The\nProfessional Training Grant was increased by the transfer of $5,000 from the Tuberculosis\nControl Grant.\nAdministration\nThe various opportunities provided during the year for personal discussion with\nofficials of the Department of National Health and Welfare of problems arising in connection with the National health-grants programme undoubtedly contributes to the\nsatisfactory administration of the grants. Also of assistance is the revision of the\nNational Health Grants Program Reference Manual, which was received this year.\nOne of the provisions of the National health grants is that not more than 75 per cent\nof any grant may be committed for continuing services, and in this connection some\ndifficulty was experienced when the submissions for 1954-55 were under consideration\nin Ottawa. This applied particularly to the General Public Health Grant, and it was\nnecessary to make certain adjustments and recommendations in regard to several submissions. Steps have been taken to ensure that the situation does not recur.\nDuring the year the Federal auditors have visited several of the general hospitals\nparticipating in the biopsy service and admission X-ray programmes to review their\nrecords and corresponding claims. Where any discrepancy occurred, action was immediately taken to rectify it. As a result, the hospitals are aware of the need for accurate\nrecords in connection with any assistance received from National health grants.\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nGrants Received for the Year Ended March 31st, 1954\nL 103\nTotal expenditures for the year ended March 31st, 1954, were $2,617,625 or 68\nper cent of the total available, as compared with $1,986,279 or 45 per cent of the total\ngrants available in the year ended March 31st, 1953. This increased use of the National\nhealth grants is due to an increase in expenditures under each of the original grantor\nIt should also be noted that these increased expenditures offset the small expenditures\nunder the three new grants for Laboratory and Radiological Services, Medical Rehabilitation, and Child and Maternal Health; only about 10 per cent of each of these grants\nwas expended, due to various difficulties encountered in the utilization of the new grants.\nDetailed figures are given in the following table:\u2014\nComparison of Amounts Approved and Actual Expenditures with Total Grants\nfor the Year Ended March 31st, 1954\nGrant\nTotal Grant\nApproved\nAmount\nPer Cent\nActual Expenditures\nAmount\nPer Cent\nCrippled Children\t\nProfessional Training\t\nHospital Construction r~\nVenereal Disease Control\t\nMental Health\t\nTuberculosis Control \u2014\nPublic Health Research -_\nGeneral Public Health\t\nCancer Control\t\nLaboratory and Radiological Services\nMedical Rehabilitation\t\nChild and Maternal Health\t\nTotals\t\n$43,612\n72,612\n1,497,340\n43,612\n518,779\n347,585\n26,251\n699,000\n209,781\n339,400\n42,877\n34,849\n$23,312\n53,198\n1,416,934\n43,612\n503,468\n329,317\n26,251\n678,998\n196,276\n50,373\n8,510\n12,050\n53\n73\n95\n100\n97\n95\n100\n97\n94\n15\n20\n35\n$3,875,698\n$3,342,299\n85\n$21,850\n50,323\n886,495\n43,612\n469,734\n275,714\n22,626\n618,582\n187,226\n33,162\n4,140\n4,161\n50\n69\n59\n100\n91\n79\n86\n88\n89\n10\n10\n12\n$2,617,625\n68\nThere was a definite improvement this year in the position of British Columbia in\nrelation to all Provinces. Excluding the Public Health Research Grant, the percentage\nof funds allocated was 86 per cent in British Columbia, as compared with 79 per cent\nfor all Provinces. Similarly, the amount expended in British Columbia was 67 per cent\nof the total available, as compared with 60 per cent for all Provinces. For the previous\nyear ended March 31st, 1953, the percentage for British Columbia was lower than the\naverage for all Provinces both with respect to funds allocated and the amount expended.\nCrippled Children's Grant\nAssistance is being given this year to three branches of the Cerebral Palsy Association of British Columbia, namely, Greater Vancouver, Vancouver Island, and Fraser\nValley. Although these branches operate independently, co-ordination is achieved\nthrough the Provincial organization. It is expected that through the leadership being\ngiven by the Chairman of the Cerebral Palsy Association of British Columbia, Dr. Donald\nPaterson, a satisfactory Provincial programme for the care of cerebral palsy children will\ngradually evolve. # jfe\nThe Crippled Children's Registry is becoming increasingly important. The number\nof cases registered and the number of agencies registering cases have both increased\nwiring the past year. In addition, the Registry is being used as a co-ordinating unit for\nthe care of children by supplying information as to the facilities available and giving\nassistance in planning care for children who are registered. Some assistance has also\nheen given in regard to the rehabilitation of children whose handicap has been treated\nmedically to the maximum degree.\nThe Western Society for Rehabilitation and the Health Centre for Children continue\nto receive assistance under this grant. #\n L 104\nBRITISH COLUMBIA\nProfessional Training Grant\nThe number of persons completing training under all projects during the calend\nyear 1954 was thirty-two. In addition, seventy-seven persons have taken courses varvif\nin length from a few days to three or four weeks. Funds for this training have been\nprovided by other grants in addition to the Professional Training Grant.\nIncluded in the short-course group are forty-five public health nurses who attended\na refresher course in paediatrics given in Vancouver by the staff of the Department of\nPaediatrics, Faculty of Medicine, University of British Columbia. Ten members of the\nnursing staff of the Provincial Division of Tuberculosis Control attended two other short\ncourses for nurses, namely, the Nursing Service Administration Institute and the\nRehabilitation Nursing Institute. I\nI Assistance is being continued this year toward the training of public health staff and\nthe staff of general hospitals, as well as training in specialized fields such as medical\nrehabilitation, tuberculosis, mental health, and psychiatric social work.\nHospital Construction Grant\nThe Hospital Construction Grant for 1954-55 increased only slightly over 1953-54,\nThe amount available is $1,610,391, including $1,055,187 revoted from the accumulated\nunexpended funds from previous years. If\nAlthough the number of projects for construction of general hospitals initiated during\nthe current fiscal year has remained comparatively small, the need for new construction\nhas not yet been met and there are still a number of projects to be undertaken. Construe*\ntion has commenced on a combined Child Guidance Clinic and Day Hospital for the\nProvincial Mental Health Services, for which assistance is being requested under this\ngrant. Since 1951, when provision was made for assistance in the construction of\ncommunity health centres, approval has been given to twelve such projects, which has\nresulted in greatly improved accommodation for the local health services in these areas.\nVenereal Disease Control Grant\nThis grant is on a matching basis, and the total amount is therefore paid to the\nProvince, as expenditures by the Province on venereal-disease control are considerably\nin excess of the amount of the grant. The standard and extent of service given during\nthe year 1948-49 are being maintained.\nAs all services for the control of venereal disease in British Columbia are provided\nby the Provincial Government, the annual report of this Division, which appears in\nanother section of this Health Branch report, constitutes the report made on the use of\nthis grant.\nMental Health Grant\nThe Mental Health Grant is devoted principally to projects presented by the\nProvincial Mental Health Services, Department of the Provincial Secretary. The policies\nestablished in previous years have been continued with little change. ||\n3f All units of the Mental Health Services have been benefited by the provision of both\nstaff and special equipment for the therapeutic programmes. The developments in certain\nunits and services are particularly interesting.\n|\u00a7|| The surgical centre in the Crease Clinic is now functioning in a very efficient\nmanner, and through the services provided by the consultants in neuro-surgery, general\nsurgery, and orthopaedic surgery, these special needs of the mentally ill are satisfactorily\nmet. ;^||: |j|j| [ ,\nThe reactivation programme for the continued-treatment patients of the Province\nMental Hospital has been increased in scope because it has contributed greatly to tlie\nwell-being of the withdrawn type of patient. Closely associated with this programme\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 105\nhave been efforts to introduce occupational-therapy services to wards where formerly the\ntreatment programme was handicapped by their lack. In this connection special note\nshould be made of the new shop for the West Lawn Building of the Provincial Mental\nHospital at Essondale.\nThe care of the tubercular mentally ill will shortly be greatly enhanced by the\nopening of the North Lawn Building, Provincial Mental Hospital, Essondale, where\nfacilities to treat this group of patients will be centralized. In anticipation of the opening\nof this new unit, projects have been submitted and approved to provide equipment for\nthe X-ray Department, the ward surgeries, and the Occupational Therapy Department.\nThe equipment is now on order and the suppliers have commenced deliveries.\nThe over-all programme of The Woodlands School in caring for the mentally\ndefective child has been continued. Special mention should be made of the project to\nprovide for the establishment of a physiotherapy department here. This is considered\nto be a very significant development for the rehabilitation of the child in whom cerebral\npalsy and mental retardation are associated.\nThe mental-health research programme at the University of British Columbia has\nagain received support. This year the research project on narcotic addiction in British\nColumbia received special emphasis. It is expected that the neurophysiological studies\nthat have been pursued for several years in connection with the neuro-surgical procedure\nof lobotomy will be concluded next year.\nCommunity education in mental health has been enhanced by the sustained efforts\nof the British Columbia Division of the Canadian Mental Health Association. This group\nhas also sponsored and developed a volunteer service for the Provincial Mental Hospital,\nCrease Clinic, and Home for the Aged, Essondale. The British Columbia Division of the\nCanadian Mental Health Association receives a portion of its funds from a Mental Health\nGrant project.\nWith funds provided under this grant in 1948-49 the University of British Columbia\nset up a programme for postgraduate training in clinical psychology. During the past\nthree years the University has gradually taken over the cost of this programme until this\nyear, when all costs were completely absorbed by the University. Assistance is being\ncontinued to the psychiatric services in the Vancouver General Hospital and Royal\nJubilee Hospital, Victoria, and the mental-health programmes in the Cities of Victoria\nand Vancouver.\nTuberculosis Control Grant\nThis grant is similar to those for Mental Health and Venereal Disease Control in\nthat the majority of the tuberculosis services are provided by the Provincial Government,\nand the largest proportion of this grant therefore is used by this government department.\nDetailed information regarding these services is given in the report of the Division of\nTuberculosis Control, which appears in a later section of this Health Branch Report.\nPublic Health Research Grant\nThe investigation of ABO foetal-maternal incompatibility is the subject of a new\nresearch project approved this year. This study is being carried out by members of the\nstaff of the Department of Paediatrics, University of British Columbia, in co-operation\nwith the Red Cross blood transfusion service and the Department of Pathology,\nVancouver General Hospital. fi\nOne research project was completed this year, namely, the investigation of schistosome dermatitis in British Columbia lakes. This work was under the direction of\nDr. J. R. Adams, Department of Zoology, University of British Columbia, and preliminary\nreports indicate that a satisfactory method has been determined for eliminating the\nproblem. The final report is now in preparation and will be available shortly.\n L 106 BRITISH COLUMBIA\nGeneral Public Health Grant\nThe transfer of $123,000 to this grant from the Laboratory and Radiological\nServices, Cancer Control, and Tuberculosis Control Grants was required primarily f0\nthe procurement of gamma globulin, the purchase of equipment for the treatment of\npoliomyelitis, and the purchase of poliomyelitis vaccine. Arrangements were made this\nyear whereby the cost of equipment purchased for the treatment centres at the Vancouver\nGeneral Hospital and the Royal Jubilee Hospital, Victoria, would be borne jointly by\nNational health grants, British Columbia Hospital Insurance Service, and the British\nColumbia Poliomyelitis Foundation; in previous years National health grants have\nassumed a larger proportion of the costs.\nUnder an approved project, three third-year medical students from the University\nwere again employed during the summer months in health units, to the satisfaction of all\nconcerned. Considerable interest in this development has been displayed by the directors\nof the health units where students have not yet been placed, and requests have been\nreceived from some of these units for the placement of students next year.\nAll phases of the general public health programme carried on by the local health\nservices staff continued to receive assistance from this grant. Detailed information in\nregard to these services is given earlier in this Report, in the report of the Bureau of\nLocal Health Services. Assistance was also continued to the Metropolitan Health\nCommittee of Greater Vancouver and the Victoria-Esquimalt Board of Health, ft\nCancer Control Grant\nThe operations of the British Columbia Cancer Foundation, which are financed\njointly by this grant and matching Provincial funds, are outlined earlier in this report, in\nthe section on Voluntary Health Agencies.\nThe number of examinations done under the Provincial biopsy service has steadily\nincreased since the inception of the service. The average number of tissue examinations\nper quarter referred under the biopsy request form was 2,792 in 1951; the average\nnumber per quarter for the first nine months of 1954 was 4,833. These figures do not\ninclude biopsy examinations originating in the hospital having pathologists on their staff,\nbut the number of these examinations has also increased. The quarterly average number\nof all biopsy examinations was 9,660 in 1953 and 10,888 for the first nine months\nof 1954. |\nProvision is made under this grant and matching Provincial funds for the operation\nof a cytology laboratory at the British Columbia Cancer Institute, Vancouver, where\nspecimens may be examined free of charge. The volume of work done in this laboratory,\nwhich is under the direction of the Director, Pathology Department, Vancouver General\nHospital, has also increased greatly. There were 6,581 specimens examined in 1952,\n8,272 in 1953, and 8,948 during the first nine months of 1954.g\nLaboratory and Radiological Services Grant\nPlans for the appointment of advisory councils to the Provincial Health Branch\nwith respect to laboratory services and to radiological services have been presented to the\nCanadian Medical Association (British Columbia Division), and it is hoped that the\nplans will be finalized within the next two or three months. One of the primary responsibilities of these two councils will be to review and assess requests for assistance under\nthis grant. Pending the appointment of these councils, only immediate and obvious needs\nhave been considered, and, as a result, the utilization of this grant has been restncted.\n^ The plan for the development of improved clinical laboratory services in tm\nProvince was approved by the Department of National Health and Welfare, but in\nimplementation of this plan has been delayed pending appointment of the advisory\ncouncil mentioned above. In order to ensure proper direction of the programme,\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 107\nplan provides for the services of consultants as well as a technical supervisor of laboratory\nservices.\nAssistance under this grant has been given to the Trail-Tadanac Hospital toward\nthe establishment of a pathology department in order to meet the need for this type of\nservice in this area. In addition, the pathology department will assist in raising the\nstandard of medical care in this area through the educational benefit derived from the\nevaluation of surgical tissue, and it will also result in improved correlation of the cancer\nwork performed in this region.\nMedical Rehabilitation Grant\nReference was made in the 1953 Annual Report to the appointment under the\nCrippled Children's Grant of a person well qualified in the field of logopaedics and the\npossibility of the establishment of a training programme in logopaedics at the University\nof British Columbia. Provision for this programme was transferred to the Medical\nRehabilitation Grant this year. In addition to the satisfactory development of the speech-\ntherapy programme at the Western Society for Rehabilitation, a course is being given\nthis year at the University under the Faculty of Arts which, it is hoped, will eventually\ndevelop into a complete training programme in logopaedics.\nApproval was given this year to the establishment of a pilot plan at the Glen and\nGrandview Hospitals, Vancouver, to assess the nursing services for convalescent and\nchronic patients, with emphasis on the medical and social rehabilitation and self-care\nof patients. The project has been designed:\u2014\n(1) To determine whether the provision of adequate rehabilitative measures\nto an unselected group of nursing-home cases would result in:\u2014\n(a) Better utilization of nursing-home beds by permitting recate-\ngorization of some cases to boarding-home status or even home care, and\nso easing the shortage of nursing-home beds by permitting a more rapid\nturnover rate.\n(b) Easier nursing of cases who must remain in nursing homes.\n(c) Increased happiness and comfort of the patient.\n(2) To determine whether the results obtained by rehabilitative measures\njustify the added costs.\nPreliminary organization of this plan has been undertaken, but no results are available\nas the plan is not yet in full operation. ||\nThe recent appointment of a Provincial Co-ordinator of Rehabilitation under the\nprovisions of the agreement between the Federal and Provincial Departments of Labour\nwill materially assist in the development of a rehabilitation programme for the Province,\nincluding the most effective use of funds available under this grant.\nChild and Maternal Health Grant\nThe child and maternal health services in this Province are an integral and important\npart of the general public health programme carried on by the staff of the local health\ndepartment, and this grant is being used to strengthen and expand this phase of the\ngeneral programme. I\nIn January of this year a well-trained public health nurse on the staff of the Metropolitan Health Committee of Greater Vancouver was seconded to the Health Centre for\nChildren to provide a liaison service between these paediatric services and the general\npublic health services. All discharges, both in-patient and out-patient, from the Health\nCentre for Children are referred to the liaison nurse, who keeps the public health nurse\nm the field informed. This programme of closer co-operation between the paediatric\nservices of the Vancouver General Hospital and the general public health services in the\nGreater Vancouver area and adjoining municipalities is gradually developing, and it will\n L 108\nBRITISH COLUMBIA\nundoubtedly result in improved care of these children as well as promoting a better under\nstanding between the various children's services and the private physician.\nEquipment for the care of premature infants has been purchased under this grant\nthis year for nineteen general hospitals. In addition, a copy of the book published bv\nthe American Academy of Paediatrics, which deals with the standards and recommenda-\ni* \u201e i :*\u00ab1 s-.^\u00ab.si r\\f i-ie\u00bbvi7_1-%rvn\"i infcmtc wsic ciityiVIipH trv oil V\u00bb\/^o*,.U~i_ - , .,\ntions for hospital care of new-born infants, was supplied to all hospitals outside the\nVancouver and Victoria areas. I\nACKNOWLEDGMENT\nValuable assistance and co-operation have been received from officials of the\nDepartment of National Health and Welfare, the Provincial Health Branch, the Department of the Provincial Secretary, particularly the Provincial Mental Hospitals Staff, and\nthe Commissioner and staff of the British Columbia Hospital Insurance Service.\nHarmonious working relationships exist with the city health departments of Vancouver and Victoria, the voluntary health organizations, and general and specialized\nhospitals.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 109,\nREPORT OF THE DIVISION OF LABORATORIES\nC. E. Dolman, Director\n' In the annals of this Division, 1954 will be chiefly memorable as the last full year\nof occupancy of the Hornby Street quarters by the central laboratories. Ever since the\nestablishment of the Provincial Laboratory in 1931, its output and responsibilities have\noutstripped its accommodation and resources. This situation should be alleviated by the\nmore spacious quarters planned for the Division in the new Provincial Health Building\nin Vancouver, which is now nearing completion.\nFor the first time in many years, a decline of about 10 per cent must be reported in\nthe total number of tests performed at the central laboratories. However, the actual workload underwent little change, since there were substantial increases in many of the more\ntime-consuming types of work; for example, cultural examinations for M. tuberculosis,\nfor the Salmonella-Shigella groups of organisms, and for gonococci, and bacteriological\ntests of water and milk samples. On the other hand, the greatest reduction in numbers\ninvolved the sero-diagnostic tests for syphilis, certain of which may be speedily performed.\nIn view of the numerous changes in technical staff, and of the fact that for some months\nwe were unable to replace several who had resigned, the year was no less onerous than\nits predecessors. The work of the central laboratories is summarized in Table I, corresponding figures for 1953 being supplied for purposes of comparison.\nThe branch laboratories at Victoria and Nelson showed similar declines in total tests\ndone, again mainly reflecting the diminishing significance of syphilis as a public health\nproblem. The work done in these two branches, and in the Prince George branch for\nthe first three months of the year (after which this branch was closed), is shown in\nTable II. The combined total for branch laboratories was around 55,000 tests, and the\nDivision as a whole carried out nearly 400,000 tests.\n L 110\nBRITISH COLUMBIA\nTable I.\u2014Statistical Report of Examinations Done during the Year 1954\nMain Laboratory\nOut of Town\nAnimal inoculations\t\nBlood serum agglutination tests\u2014\nTyphoid-paratyphoid group\t\nBrucella group\t\nPaul-Bunnell\t\nMiscellaneous\t\nCultures\u2014\nM. tuberculosis\t\nSalmonella and Shigella organisms\t\nC. diphtherias\t\nHemolytic staphylococci and streptococci\nN. gonorrhoea\t\nMiscellaneous\t\nDirect microscopic examinations\u2014\nN. gonorrhoea\t\nM. tuberculosis (sputum)\t\nM. tuberculosis (miscellaneous)\t\nTreponema pallidum\t\nVincent's spirillum\t\nIntestinal parasites\t\nMiscellaneous\t\nSerological tests for syphilis\u2014\nBlood-\nPresumptive Kahn\t\nStandard Kahn ,\t\nQuantitative Kahn\t\nComplement fixation\t\nV.D.R.L\t\nV.D.R.L. quantitative\t\nCerebrospinal fluid\u2014\nComplement fixation\t\nQuantitative fixation\t\nCerebrospinal fluid\u2014\nCell count\t\nProtein\t\nColloidal reaction\t\nMilk-\nStandard plate count\t\nColi-aerogenes\t\nPhosphatase\t\nWater-\nStandard plate count\t\nColi-aerogenes\t\nIce-cream\u2014\nStandard plate count\t\nColi-aerogenes\t\nPhosph atase\t\nCottage cheese\u2014Standard plate count\t\nUnclassified tests\t\nTotals \t\n242\n5,144\n1,825\n1,127\n26\n9,364\n4,849\n1,575\n1,035\n1,154\n4,933\n9,499\n1,663\n28\n27\n235\n736\n14,428\n2,493\n262\n6,929\n26,288\n682\n834\n15\n266\n683\n846\n3,259\n3,242\n1,991\n6,361\nMetropolitan\nHealth Area\n167\n205\n5,472\n4,810\n2,170\n27\n9,260\n7,564\n7,154\n2,392\n7,845\n1,159\n20,070\n7,063\n2,922\n410\n219\n1,117\n893\n41,368\n5,635\n635\n14,690\n67,755\n1,691\n1,665\n59\n285\n1,243\n1,815\n1,781\n1,773\n1,389\n928\n1,595\n238\n238\n234\n89\n132\nTotal in 1954\n447\n10,616\n6,635\n3,297\n53\n18,624\n12,413\n8,729\n3,427\n7,845\n2,313\n25,003\n16,562\n4,585\n438\n246\n1,352\n1,629\n55,796\n8,128\n897\n21,619\n94,043\n2,373\n2,499\n74\n551\n1,926\n2,661\n5,040\n5,015\n3,380\n928\n7,956\n238\n238\n234\n89\n299\nTotal in 1953\n464\n11,212\n7,071\n2,937\n88\n17,476\n9,808\n14,917\n3,011\n6,516\n2,350\n25,221\n15,765\n4,912\n234\n225\n978\n1,867\n139,947\n21,868\n2,057\n26,734\n27,938\n2,727\n87\n710\n2,063\n2,775\n3,732\n3,707\n2,568\n931\n7,168\n140\n140\n124\n72\n210\n112,208\n225,990\n338,198\n370,750\nI\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 111\nTable IL\u2014Statistical Report of Examinations Done during the Year 1954,\nBranch Laboratories\nPrince George\nNelson\nVictoria\nAnimal inoculations\t\nBlood serum agglutination tests\u2014\nTyphoid-paratyphoid group\t\nBrucella group \u2014\t\nPaul-Bunnell\t\nCultures\u2014\nM. tuberculosis\t\nTyphoid-Salmonella-dysentery group\t\nC. diphtheria ~\nHsmolytic staphylococci and streptococci..\nN. gonorrhoea\t\nMiscellaneous j\t\nDirect microscopic examinations\u2014\nN. gonorrhoea\t\nM. tuberculosis (sputum)\t\nM. tuberculosis (miscellaneous)\t\nTreponema pallidum\t\nVincent's spirillum\u2014\t\nIntestinal parasites\t\nSerological tests for syphilis\u2014\nBlood-\nPresumptive Kahn\t\nStandard Kahn\t\nQuantitative Kahn\t\nComplement fixation\t\nv.d.r.l\t\nV.D.R.L. quantitative\t\nCerebrospinal fluid\u2014Complement fixation.\nCerebrospinal fluid\u2014\nCell count\t\nProtein\t\nColloidal reaction\t\nMilk-\nStandard plate count I\t\nColi-aerogenes\t\nPhosphatase\t\nWater-\nStandard plate count j\t\nColi-aerogenes\t\nAlkalinity \u2014 , \t\nUnclassified tests- \t\nTotals.\n234\n215\n215\n94\n142\n900\n566\n114\n176\n231\n326\n233\n202\n483\n49\n3,337\n27\n1,163\n18\n5\n50\n72\n1,019\n1,005\n354\n36\n748\n17\n312\n102\n85\n3,055\n700\n2,001\n2,001\n383\n20\n566\n5,871\n100\n10\n88\n314\n18,942\n787\n162\n1,381\n382\n313\n313\n355\n1,234\n1,234\n1,234\n1,353\n1,353\n92\n\/*79\n10,216\n44,945\nGrand total, 56,061.\nTESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES\nThe continuing low incidence of syphilis in this Province is reflected in a lesser\nnumber of blood specimens sent in for sero-diagnostic tests. This trend also reduced\nthe number of confirmatory tests which needed to be carried out on specimens giving\npositive or doubtful reactions with the preliminary test. Apart from these factors, which\nlie outside the Division's control, a significant reduction in the work of this section was\nmade possible by official adoption of the V.D.R.L. (Venereal Disease Research Laboratory) test, in place of the presumptive and standard Kahn tests. This change was made\nduring the summer, after its desirability had become apparent to both this Division and\nto the Division of Venereal Disease Control. Exhaustive comparisons involving many\nthousands of blood specimens, and extending over about two years seemed to bear out\nthe claims of the Venereal Disease Research Laboratory of the United States Public\nHealth Service, that the V.D.R.L. test, which it has sponsored, is superior in specificity\nand sensitivity to the Kahn tests. Substitution of this single microscopic precipitation\ntest for the presumptive (screening) and standard (diagnostic) Kahn tests has eliminated\na considerable amount of repetition. Other advantages include less glassware-cleaning\nand less dependence upon a highly integrated team of technicians, whose efficiency could\nbe so easily hampered by the absence of any one person. The reduction in numbers of\n L 112\nBRITISH COLUMBIA\nthe Kolmer-Wassermann complement fixation test, reserved for confirmatory purpose\nas before, can be ascribed solely to the diminished incidence of syphilis. S\nCoincident with this change-over in methods, the Division introduced a combined\nrequisition and report form, of a type which has been used successfully in several other\nProvinces. Adoption of this type of form has appreciably reduced the time spent by\noffice staff in a particularly tedious task. The desirability of introducing these changes\nwas generally acknowledged at the 1953 meeting of Provincial laboratory directors in\nOttawa, and it is gratifying to record that such major innovations were accepted unreservedly by the local medical profession.\nIn October the central laboratories began a participation in the seventh in the series\nof regular surveys of sero-diagnostic procedures performed by the various Provincial\nlaboratories throughout Canada, which has been supervised every year or two by the\nLaboratory of Hygiene, Ottawa. There is good reason to feel confident that our performance of the standard procedures on 100 selected specimens sent us from Ottawa will\nagain prove very satisfactory.\nThe importance of gonorrhoea as a public health problem has not declined to the\nsame degree as in the case of syphilis. Around 25,000 microscopic examinations for\ngonococci were carried out in the central laboratories during the year\u2014a high figure when\nit is borne in mind that such tests, in contrast to the blood-testing situation for syphilis,\nare seldom requested routinely by physicians. Cultural examinations for gonococci\nincreased by nearly 20 per cent, thus giving the transport medium, described in the 1953\nAnnual Report, ample opportunity to prove its worth.\nTESTS RELATING TO CONTROL OF TUBERCULOSIS\nLaboratory tests for M. tuberculosis, especially cultures, continued to mount. This\nupward trend, which has now persisted for over twenty years, has always been a major\ncause of anxiety and difficulty to this Division. The infectivity of the specimens, the\ntime-consuming nature of the tests, the necessity to hold cultures under observation for\nseveral weeks, and the maintenance of a supply of guinea-pigs are among the factors\nwhich have recurrently created problems.\nOver the years the changing emphases in the programme of the Division of Tuberculosis Control all seem to have entailed a heavier load of laboratory work. First there\nwas a broadening of case-finding activities; then came the demand for more sensitive\nmethods of detecting the presence of tubercle bacilli, for example, by culturing stomach\nwashings; and now cultures of sputum are almost routinely desired as a means of following and assessing the rapid improvement in the patient's condition which may be induced\nby modern therapeutic agents. Yet this Division can safely claim to have met these\nchallenges, and to have contributed as indispensably to the declining mortality from\ntuberculosis as it has done to the diminished incidence of syphilis.\nSALMONELLA-SHIGELLA INFECTIONS\nFor several years successive annual reports of this Division have drawn attention to\nthe unduly high excreta-borne infection hazard in this Province. These warnings seem to\nhave been fully justified in the light of the 1954 record, which has been exceeded only in\n1946. In that year post-war conditions encouraged poor standards in public eating-\nplaces, and a mobile overcrowded population grew careless over personal hygiene, in\n1954 there were roughly 240 instances of salmonellosis, almost double last year's figure,\ninvolving fifteen different Salmonella types. There were sixteen cases and carriers or\nS. typhi, while over 120 cultures, or roughly one-half of the total, were identified as\nS. typhi-murium. These two types are mentioned because the former is responsible to\nan especially severe and prolonged form of salmonellosis (classically known, of coursj^\ntyphoid fever), as well as being particularly prone to give rise to water-borne or ^ '\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 113\nborne epidemics, while the latter is very liable to become established in animals, domestic\nor wild. Indeed, several other Salmonella types, isolated each year in the Division, have\nbeen implicated elsewhere as frequent causes of human infection due to % animal reservoirs.\" In Alberta a similarity of Salmonella-type distribution among men and domestic\nanimals, especially poultry, has been reported. But in British Columbia there is little\nevidence that the unduly high incidence of salmonellosis in recent years has been other\nthan man-to-man conveyed. I\nIn Shigella infections the possibility that animals may serve as reservoirs need not\nbe seriously considered. |j Poor standards of personal hygiene, and sometimes of community sanitation, must therefore be held responsible for the disconcertingly high total\nof nearly 600 cases of shigellosis identified in 1954, which is an even higher figure than\nthe 1953 record. Fortunately, about 98 per cent of these infections were due to the\nrelatively benign Shigella sonnei, or the consequences might have been far more serious.\nThese cases of shigellosis developed all over the Province, mostly as small, scattered,\nintra-familial episodes. But there were some larger outbreaks, one at Campbell River\nbeing particularly widespread. While it may be hoped that 1954 was a peak year, it is\nlikely that for many years to come this sort of pattern will recur.\nIn some instances, in co-operation with the Consultant in Epidemiology and the\nlocal health-unit director, the source and mode of spread of an outbreak could be deduced.\nThis was true, for example, of two episodes in which S. typhi-murium and 5. bareilly\nrespectively were involved. The first outbreak followed a banquet at a naval training\nestablishment, and the second affected a working party of gaol inmates. In other\ninstances, notably an outbreak of intestinal trouble at Ceepeecee, no casual microorganism could be isolated from the many faeces specimens submitted.\nA brief account can hardly convey the extreme pressure under which this section\noperated during most of the year. It must suffice to add only that the maximum incidence\nof these excreta-borne infections almost invariably coincides with the summer vacation\nperiod, when our staff is depleted and new-comers are being trained.\nOTHER TYPES OF TESTS\nBacteriological Analyses of Milk and Milk Products and Water\nThere was a notable increase, of more than one-third, in the numbers of milk samples\nsubmitted to the central laboratories for standard plate counts and coli-aerogenes tests.\nSome of this increase was attributable to absorption of the Prince George branch\nlaboratory work after the first quarter of the year. Another factor was the introduction\nof light-weight shipping containers, which lowered the air express charges and also\nsimplified the packaging and refrigerating procedures. In addition, it appears that health\nunits throughout the Province are making real efforts to apply this type of sanitary bacteriology as co-operatively and effectively as possible. Still more can be done in this\ndirection, and the Division is anxious to develop further this aspect of its activities, both\nin Vancouver and in the Victoria and Nelson branch laboratories.\nExaminations of ice-cream and cottage-cheese samples from the Greater Vancouver\nmetropolitan area almost doubled in number. This is a gratifying trend because it indicates a growing realization that milk products are no less important than milk itself as\npotential vectors of infection. Moreover, such tests relate essentially to prevention, and\nthough they may seem less dramatic than post hoc investigations, they should carry a\ngreater appeal to community intelligence.\nMilk or milk products were the suspected vehicles in several episodes of miscellaneous nature, including a few cases of acute brucellosis. In one clear-cut case, Brucella\nabortus was isolated from the blood-stream of a raw-milk consumer in the Kootenays.\nThe foregoing general remarks apply equally to bacteriological analyses of drinking-\nwater supplies. As the Province's sparsely inhabited areas become populated, every\n L H4 BRITISH COLUMBIA\nprecaution to secure safe water-supplies will be justified, in view of the already discu\nSalmonella-Shigella situation. There was an increase during the year of nearly 10\nthe\nhealth unit seems to be working quite well. BSE !2 \u00b0Cal\ncent in coli-aerogenes tests of water samples. Very few water samples now reach th\nlaboratories from private parties, and the system of referring such requests to the\nBacterial Food Poisoning\nApart from the occasional implication of foodstuffs as vehicles for Salmonella infections, there were various staphylococcal food-intoxication episodes. In addition, early in\nNovember another instance of fish-borne Type E botulism was identified with the cooperation of the Department of Bacteriology and Immunology at the University and the\nWestern Division of the Connaught Medical Research Laboratories. Three young Indian\nwomen were made ill, and one died, after eating salmon-egg cheese. This delicacy is\nmade by kneading a mass of salmon-eggs, which have been washed in a running stream\novernight, suspended in a gunny sack. Apart from a period in the smoke-house, the\neggs are in no way subjected to heat, so that conditions are conducive to the elaboration\nof botulinus toxin. This is the fourth outbreak of Type E botulism in British Columbia\nin the last ten years, all of them due to uncooked fish or fish products.\nAt the very end of 1953 there were two occurrences of Type A botulism, whose\ncircumstances were reported in the Canadian Medical Association Journal for September,\n1954. Home-bottled corn on the cob caused two fatalities at Grand Forks, while home-\nbottled spinach was responsible for two mild cases at Rock Creek. These outbreaks\nillustrated that mere boiling of such foodstuffs in the course of processing does not ensure\ndestruction of the remarkably heat-resistant spores of Type A botulinum bacilli. The\nimportance of the pressure-cooker in this respect is not yet sufficiently realized.\nDiphtheria\nCultural examinations for C. diphtherue showed a further sharp decline. This\napparently reflects less rigid institutional policies with regard to routine throat swabbing\u2014\na justifiable change of attitude in view of the present very low incidence of diphtheria and\nthe high degree of community protection conferred by immunization with toxoid. However, the diphtheria bacillus has by no means vanished from our midst, and a few cases\nwere identified during the year.\nIntestinal Parasites\nThe central laboratories experienced an increase of nearly 40 per cent in requests\nfor microscopic examinations for intestinal parasites. This upward trend may be due\nlargely to the population influx from diverse parts of the world. At any rate, a broadening\nvariety of infestations is being encountered, and we must obviously be prepared to identify\nthe rarer and more exotic types of parasites. A few specimens of animal tissues (moose\nand deer) were received, showing evidence of infestation with parasitic species nonpathogenic to man. .\nSeveral requests reached us for skin-testing materials for detection of trichinosis ana\nechinococcosis. Both these types of infestation are known to be endemic in certain\nregions of the Province, and alert physicians and health officers should bear this in mind.\nWe were able to supply these antigens free of charge through the courtesy of the\nLaboratory of Hygiene, Ottawa, the only proviso being that we should have a brief outline\nof the case concerned and a report on the reaction obtained.\nFungus Infections ' ]m.\nOver the past few years local doctors have shown greater awareness of fungus in actions. Mycological procedures are now being carried out often enough to warrant\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 115\nseparate listing in Table I, instead of being included, as heretofore, under \"Miscellaneous\" headings. Most requisitions to date have involved the commoner ringworm infections of skin and hair, but Candida albicans has also assumed considerable importance\nfrom the widespread use of antibiotics which inhibit bacterial species normally suppressive\nto this fungus. A few inquiries reached us during the year about certain rarer fungal\nconditions, such as blastomycosis and histoplasmosis. From one hospital patient, with\nmultiple intractable abscesses of obscure aetiology, Cryptococcus neoformans was isolated,\nprobably for the first time in this Province. All signs point to further expansion in activities under this heading.\nVirus Infections\nThe need to develop a virus diagnostic section has become increasingly evident.\nComparatively little could be done in this connection until supplies of standardized\nantigens became available for detection of specific viral antibodies by complement-\nfixation tests. Since the Virus Section of the Laboratory of Hygiene, Ottawa, began\nsupplying such antigens a year or two ago, the central laboratories have offered a limited\nrange of facilities in this field. Reagents are now on hand for performing complement-\nfixation tests on specimens from patients suspected of influenza, Newcastle disease,\nmumps, smallpox, vaccinia, lymphocytic chorio-meningitis, psittacosis, Q fever, Rocky\nMountain spotted fever, and certain of the encephalitides.\nTo be reliable, these tests should be performed on paired specimens (usually blood,\noccasionally cerebrospinal fluid)\u2014one taken during the acute phase and the other during\nconvalescence\u2014and our attitude has therefore been that there is seldom much purpose in\ncarrying out the test unless both such specimens are available. Another prerequisite has\nbeen an undertaking to supply the laboratories with a brief case-history on each patient.\nOnly thus can this Division (which does the tests) and the Laboratory of Hygiene (which\nsupplies the reagents) hope to correlate the clinical and laboratory data, and hence to\ndetermine the specificity of such tests and the suitability of the reagents.\nDuring 1954 nearly 100 complement-fixation tests for various viral infections were\ncarried out in the central laboratories. Positive findings were obtained in a few instances\nof influenza and mumps meningitis. These tests have been listed for the first time under\na separate heading in Table I.\nActual isolations of viruses cannot possibly be attempted in the present quarters.\nAdequate provision has been made in the new building for work of this type, and it is\nhoped that in the near future a well-trained medical virologist can be engaged to develop\nthis important section of the Division's future activities.\nBRANCH LABORATORIES\nAs already indicated, the work of the branch laboratories declined slightly during\nthe year, chiefly because of reduced demands for sero-diagnostic tests for syphilis.\nClosure of the branch laboratory at Prince George, which was foreshadowed in last\nyear's report, took effect after the end of March. The decision was based on four years'\nexperience of the operation of this one-person laboratory, which shared quarters occu-*\npied by a full-time health unit, and concerned itself mostly with bacteriological tests of\nmilk and water supplies. The experiment was terminated reluctantly, on the grounds\nof relatively high costs per test, inability to provide satisfactory staff replacements, and\nunproved transportation facilities between the Prince George area and Vancouver.\nA new type of metal picnic basket was located, which could be packed with a plastic\nmaterial cooled in the refrigerator so as to maintain milk and water samples at satisfactory\ntemperatures during transit, and arrangements were made with an airport taxi sendee\nfor prompt pick-up of these containers. Almost all the laboratory equipment at Prince\nueorge was transferred to Vancouver for immediate or future use. The bacteriologist,\nwho had been stationed there for nearly two years, was transferred to Nelson, after\n L 116 BRITISH COLUMBIA\nspending the summer gaining experience in the central laboratories. The changes we\neffected smoothly and no adverse consequences have been noted. re\nAfter serving at the Nelson branch laboratory for over a year, the bacteriolo^i\nand technician there were both replaced late in the summer and returned to the cento\nlaboratories. In October two technicians from the Victoria branch laboratory at th\nRoyal Jubilee Hospital spent a few days in Vancouver, in order to familiarize themselves\nwith the V.D.R.L. test prior to its adoption in Victoria.\nGENERAL COMMENTS\nIn July proposals for reclassification of technical-staff positions, made by the Director to the Civil Service Commission some time ago, were officially approved. Their chief\nintents were to rectify certain anomalies in existing classifications, to provide higher\nsalary ranges for technical staff with more advanced academic qualifications, and to\nrecognize that many years of specialized experience may for certain positions be a worthy\nsubstitute for a university degree.\nThese changes should appeal particularly to male applicants for prospective vacancies in technical or professional categories. As the time approaches for transfer of the\nDivision's headquarters to the new building, the desirability of recruiting a few first-class\nmen to public health laboratory work becomes even more pressing than before. A predominantly female staff has done admirable work throughout the twenty-three years of\nthe central laboratories' existence, and women will certainly continue to carry out a high\nproportion of these types of work. But the Division simply cannot undertake the desirable broadening of its programme in such directions as, for example, virology, mycology,\nand public health chemistry until it has built up a larger nucleus of responsible people\nanxious to make a permanent career for themselves in this field. Hitherto we have been\nperforce too dependent upon young women, who carry out the procedures assigned to\nthem competently and faithfully, but whose ambitions usually and naturally lean in other\ndirections, so that their average stay with the Division is barely long enough to justify\nthe time spent in training them. At present, apart from the Director, there are only two\nmale bacteriologists among a technical and professional staff numbering thirty-three.\nEvery effort must be made to rectify this imbalance.\nThese remarks require immediate qualification by praise for the selfless devotion\nto duty displayed in their respective spheres of supervision by the Assistant Director,\nMiss D. E. Kerr, and all her senior colleagues. One of this group, Miss Mabel Malcolm,\nwho retired on superannuation at the end of September, conspicuously exemplified those\ncharacteristics which have contributed so much to building the Division's present enviable reputation despite heavy odds. Miss Malcolm had served as a senior bacteriologist\nin the Provincial Laboratories since their establishment on Hornby Street in 1931. In\nfact, long before then she had been mainly responsible for the public health work done\nat the Vancouver General Hospital laboratory. Engaged by that hospital as a stenographer in October, 1917 (at a salary of $55 per month), she was shown how to do\nWassermann tests on her second day of duty. Although Miss Malcolm soon became\nproficient in the performance of all the accepted techniques, throughout her thirty-seven\nyears of service she never lost her special interest in the sero-diagnostic tests for syphilis,\nand became an authority in this field. Her record will be hard to match.\nThe Division's relations with the medical profession have never been better. Very\nsatisfactory co-operation has also been enjoyed with health units and other divisions of\nthe Provincial Department, as well as with representatives of the Greater Vancouver\nMetropolitan Health Committee and of the Department of National Health and Welfare.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 117\nREPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL\nW. Stuart Maddin, Director\nINTRODUCTION\nDuring this past year the total number of venereal-disease cases reported in the\nProvince showed a decline as compared with previous years. Early syphilis, including\nthe secondary stage, has continued to be a clinical rarity. Late syphilis and prenatal\nsyphilis, as reported to this Division, have also shown an appreciable decline. On reviewing the other forms of venereal disease an increase was noted in the total number of\nreported cases of chancroid; however, these cases were found to be mainly among\nmariners and other persons entering the port of Vancouver.\nTREATMENT\nThis Division continued, as in the past, to overtreat gonorrhoea patients with massive\ndoses of penicillin, and the results to date have shown that such treatment has been\nsuccessful in preventing concomitantly acquired syphilis. Prior to the adoption of this\novertreatment schedule, authorities reported a small percentage (3 per cent) of patients\ncontracted syphilis along with their gonorrhoea.\nA clinical survey is now under way to determine the usefulness of a newer long-\nacting form of penicillin; it is hoped that with the addition of this therapeutic modality,\nresults in the treatment of a sizeable group of promiscuous offenders will be enhanced.\nAfter observing the decrease in the patient case loads in the New Westminster and\nVictoria clinics, several changes were made. The facilities of the Victoria clinic, which\nwas previously set up as a separate treatment unit, were incorporated in July, 1954, into\nthe Vancouver Island Chest Centre, 2345 Richmond Road, Victoria, B.C. The New\nWestminster clinic has now become a part of the Simon Fraser Health Unit programme in\nthat the unit staff have assumed responsibility for case-holding and treatment of V.D.\npatients. The economy effected by these changes has in no way detracted from the\ndiagnostic or treatment services offered to the public in either of those communities.\nIn co-operation with the Welfare Branch, the Division has continued to provide\nservice to the Juvenile Detention Home and the Girls' Industrial School. The number\nof clinics at Oakalla Prison Farm has been increased in order to render a more\ncomplete and effective screening of the gaol population for venereal disease. Because of\nthe V.D. problem which prevails both at Prince Rupert and Prince George, clinics have\nbeen continued at the city gaols in both of these centres.\nFree drugs are still supplied to all private physicians for the treatment of venereal\ndisease. A supply of drugs is made available to all health units throughout the Province\nin order that drugs can be dispensed locally to the private physician.\nThis Division has continued to receive excellent co-operation from private physicians\nand other agencies within the Province in regard to the matter of reporting clinical cases\nof venereal disease. Private physicians are continuing to avail themselves of the consultative services furnished by the Division. j\nEPIDEMIOLOGY\nEpidemiological methods employed by the Division continue to be a most important\nfactor in the suppression of venereal disease. With the further education of the private\nphysician as to his place and importance in the over-all programme, it is hoped venereal\ndisease will become a minor problem in the general health programme of the Province.\nEpidemiological workers have altered some of their interviewing techniques. Greater\nemphasis is being placed on the initial interview, both as a means of educating the patient\n L 118\nBRITISH COLUMBIA\nwith venereal disease and in securing from him sufficient data to enable workers to tr\nthe contact in the shortest possible time. ace\nThe modified programme of speed zone epidemiology was recently reviewed b\nmembers of this Division and showed that a higher percentage of contacts could h\nbrought in for investigation and treatment within the first seventy-two hours. Th'6\nnewer concept has completely revised our older and previously described method. B\nThe Vancouver City Gaol clinic continues to function as a most important part of\nour programme. Treatment at this clinic is offered to all patients who present clinical\nevidence of disease or who are known to be promiscuous.\nThe Indian Health Service, Department of National Health and Welfare, reorganized\nits staff in the field, which has enabled them to accept increased responsibility toward\ntheir V.D. patients. In the month of June a serologic survey was made among Indians\nemployed in the Sardis hop-yards, with a member of our staff assisting in this work.\nA statistical analysis of this survey will be completed in the near future.\nDue to increased case-reporting in certain areas of the Province, this Division has\nfound it necessary to supply, temporarily, a specially trained epidemiological worker to\naugment the existing services at the local health-unit level.\nSOCIAL SERVICE\nCounselling on a casework basis continued to be given by the social worker at the\nVancouver clinic, and during the year 778 patients were interviewed as part of their\ntreatment for a venereal disease. This was a decrease from the previous year in the\nnumber of patients interviewed. Again this year the department was without social-work\nStaff for a three months' period.\nThe clinic social worker's evaluation of the capacity of individual patients to modify\npromiscuous behaviour showed much the same pattern as in the previous year. Approximately two-thirds of the patients interviewed were people who utilized the discussion with\nthe social worker to gain some insight into their difficulties. The remainder were patients\nwith repeated infections whose promiscuity was a reflection of their casual way of life.\nIn the current year there was an increase in the proportion of patients whose behaviour\nwas symptomatic of some more basic personality problem, 29 per cent being so classified\nthis year, as against 22 per cent in the previous year. For those patients the counselling\ninterview was an opportunity to sort out their problems and make a start at seeking some\nsolution to them.\nIn addition to the routine interviewing of patients following treatment, the clinic\nsocial worker participated in a study project undertaken in the Division to investigate the\nproblem of recidivism in venereal disease. A detailed sociological analysis was made of\nthe case histories of seventy-seven patients treated at the Vancouver clinic between February and July, 1953, who came within the definition of a repeater patient. Information\nfor the case-histories was obtained by the clinic social worker in an interview with each\nof the patients included in the study. Although the interview appeared to the patient to\nbe spontaneous, it had been carefully standardized by the author of the study in co-operation with the clinic social worker and the Provincial Supervisor of the Social Service\nDepartment of the Division, in order to give specific information about the life of the\nrepeater patient. The social worker experienced very little difficulty in enlisting the\nco-operation of the patients in the study project, and each interview lasted about one hour.\nAs in previous years, the clinic social worker took part in the training programme in\nvenereal-disease control, arranged for the student-nurses, public health nursing students,\nsocial-work students, and other professional personnel.\nEDUCATION\nThe policy with regard to public health education has continued to function as m\nprevious years. On occasion we have been called upon to assist other branches o\nGovernment in the matter of venereal-disease education.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 119\nLectures by members of the staff of the Division of Venereal Disease Control have\nbeen given to student-nurses at Vancouver General, St. Paul's, Royal Columbian, and\nEssondale Hospitals, as well as to the fourth-year medical students at the University of\nBritish Columbia. In addition to this, practical experience is provided by the Vancouver\nclinics to undergraduate nurses of the Vancouver General Hospital. A similar and more\nconcentrated programme is provided for students taking the public health nursing course\nat the University of British Columbia. Certain members of the nursing staff of the Indian\nHealth Service were afforded an orientation period at the Division during the year.\nThe following articles were written and published during the course of the year:\u2014\n(1) \"Challenging Trends in Venereal Disease Control,\" by Drs. Ben Kanee\nand A. John Nelson. Published in the American Journal of Syphilis,\nGonorrhoea and Venereal Diseases, September, 1954.\n(2) \" Observations on the Applied Epidemiology of Gonorrhoea,\" by Drs.\nA. John Nelson and D. O. Anderson. Published in the Canadian Journal\nof Public Health, September, 1954. J**\n(3) \" Recent Advances in Venereal Disease Control,\" by Dr. A. John Nelson.\nPublished in the Canadian Nurse, March, 1954.\n(4) I Syphilis Today,\" by Drs. W. S. Maddin and A. John Nelson. Published\nin the Vancouver Medical Association Bulletin, July, 1954.\nGENERAL\nThe Federal Government has continued its grant to this Division. From this grant,\nfunds were made available to the bio-medical library, University of British Columbia, for\na proportion of the operating costs and the purchase of up-to-date literature on venereal\ndisease.\nMr. D. O. Anderson, a University of British Columbia medical student, was attached\nto the Division during the summer period in the capacity of epidemiology worker.\nA research project undertaken by Mr. Anderson at this time was supervised by Dr. A.\nJohn Nelson, Consultant in Epidemiology to the Health Branch. This project was also\nused to fulfil the thesis requirements for the degree of Doctor of Medicine at the University. During this period Mr. Anderson collected data dealing with one of the major\nvenereal-disease control problems, that of the repeater patient. The project was completed in all detail in the spring of 1954, and the final thesis will serve as a very excellent\nguide in the future management of the repeater problem.\nSpecial appreciation should be extended this year to the Ontario Department of\nHealth, Division of Venereal Disease Control and Central Laboratory, for the services\nthey have provided this Division in respect to the Treponema pallidum immobilization\ntest for selected patients.\nIt is our wish to express appreciation for the services and co-operation of the Division\nof Laboratories, Division of Vital Statistics, and Division of Public Health Education.\nIn addition, the Division is most appreciative of the co-operation extended by the\nVancouver City Police, the Royal Canadian Mounted Police, the British Columbia Hotels\nAssociation, the Liquor Control Board, Indian Affairs Branch of the Department of\nCitizenship and Immigration, the Armed Forces Disciplinary Control Board of the United\nStates, 13th Naval District, and the American Social Hygiene Association.\n JL\/ 1 jL\\J\nBRITISH COLUMBIA\nREPORT OF THE DIVISION OF TUBERCULOSIS CONTROL\n. F. Kincade, Director\nSince the inception of tuberculosis-control programmes our energies have b\ndirected mainly toward two objectives\u2014the finding of cases and their treatment oT\nthe years our attention has been chiefly focused on the saving of lives as reflected thro\/h\nmortality rates. This was natural when, at the outset of this campaign, tuberculosis was\nthe leading cause of death. Treatment was paramount because it was realized that through\ntreatment lives could be saved, and in bringing the disease under control through treatment, the spread of tuberculosis to the rest of the population would be controlled, Case-\nfinding was a necessary adjunct to successful treatment, because early diagnosis gave more\nhope of successful treatment.\nThat we have been successful in the treatment of tuberculosis is now very evident\nand with the advent of antimicrobials and the advances in chest surgery we are now able\nto cure tuberculosis. This is reflected in the falling death rates, which have declined\nprecipitously since 1946, when streptomycin was first introduced. Although we do not\nas yet have the perfect antimicrobial, the present agents used in combination are proving\nmost effective. How successful we have been is evident from the following table, which\nshows the reduction in deaths from tuberculosis in hospitals and other institutions.\nDeaths\nfrom Tuberculosis by P]\nlace of Death, 1945-54\nPlace of Death\n19541\n1953\n1952\n1951\n1950\n1949\n1948\n1947\n1946\n1945\nGeneral hospitals.. \t\n34\n45\n16\n7\n42\n44\n17\n16\n45\n96\n16\n23\n76\n83\n20\n33\n96\n80\n25\n41\n88\n143\n26\n45\n81\n143\n27\n49\n108\n189\n24\n53\n127\n175\n21\n63\n105\nSanatoria \t\n164\nMental institutions - - \t\n27\nHomes\t\n60\nTotal deaths \t\n102\n119\n180\n212\n242\n302\n300\n374\n386\n356\n1 Preliminary figures only (excludes Indians).\nAdmissions to Tuberculosis Institutions, 1945-53\n1953\n1952\n1951\n1950\n1949\n1948\n1947\n1946\n1945\nFirst admissions.-. ..\t\n557\n985\n56.5\n566\n989\n57.2\n541\n926\n58.4\n526\n928\n56.7\n547\n973\n56.2\n486\n814\n59.7\n546\n898\n60.8\n534\n851\n62.7\n611\nTotal admissions ._ \t\nPercentage, first admissions\t\n889\n68.7\nBetween 1945 and 1953, although the total admissions to sanatoria increased from\n889 to 985, the deaths in that group reached their peak in 1947 with 189 deaths, but\nin 1954 there were only 45 deaths.\nBesides the saving of lives, the results of treatment have had other beneficial effects\nin that many patients are now treated following discharge from sanatorium for prolonged\nperiods of time and are rendered non-infectious. This has markedly reduced the infection in the community and greatly lessened the hazard of tuberculosis to the population\nat large. ll\nThere were 118 deaths from tuberculosis during 1954, for a rate of 9.3 per 100,000.\nThis includes Indians and is a preliminary figure only. This is a drop from 17.9 in 1*>\nand 57.4 in 1946. During the past three years the mortality rate has been falling oy\nabout one-third each year. Of 118 deaths in 1954, 84 were in males and 34 in females,\nand the rates were 13.0 and 5.5 respectively, showing that the male mortality rate l\nover twice as high as the female. Moreover, out of 84 male deaths 61 were in m\nover 50 years old and represent 72.6 per cent of the total male deaths.\n DEPARTMENT OF HEALTH AND WELFARE, 1954\nL 121\nOn the other end of the scale, only three deaths from tuberculosis in 1954 were\nrecorded in the other than Indians under 20 years\u2014two in the 1-4 age-group and one\nin the 10-19 age-group. In 1953 there were no tuberculosis deaths in the 10-19 age-\ngroup. Formerly tuberculosis was a leading cause of death in late adolescence.\nDuring 1953 an analysis of the length of treatment of discharged cases following\nfirst admission showed that of 546 cases discharged 39 (7.1 per cent) were treated\nunder one month, 76 (13.9 per cent) were treated one to four months, 137 (25.0 per\ncent) were treated four to eight months, and 114 (20.8 per cent) were treated eight to\ntwelve months. ^\nTherefore, 366 or 66.8 per cent of new cases were treated in sanatorium under one\nyear and 46 per cent of new cases were treated less than eight months.\nThe improving situation has also led to a lessened demand on the treatment-beds,\nas will be shown later, with the result that where previously it was necessary to discharge\npatients from sanatorium earlier than we would have desired, it is now possible to treat\nthem as long as necessary in sanatorium.\nThe tremendous improvement in mortality from tuberculosis has not been paralleled\nby a similar decline in the morbidity rate. However, there has been a marked improvement in this situation in recent years, with fewer cases found in spite of increasing effort.\nThe success of case-finding is in direct ratio to the energy expended in the intelligent application of certain accepted principles in the epidemiology of tuberculosis.\nAlthough with the introduction of the miniature X-ray film it became possible, theoretically, to examine the total population, selectivity has been exercised in concentrating on\ncertain groups where from experience it was known tuberculosis could be expected to\nexist. Special emphasis has always been placed on examination of contacts of known\ncases, of certain groups of workers whose occupation showed a high incidence of tuberculosis, of certain social groups, and of those suffering from lesions associated with\ntuberculosis. Selection is also on the basis of age and economic status.\nThe following table will clearly demonstrate the reduction in morbidity:\u2014\nNew Cases of Tuberculosis by Year of Notification, 1947-54\n19541\n1953\n1952\n1951\n1950\n1949\n1948\n1947\nActive\t\nQuiescent\t\nActivity undetermined\t\nTotal\t\nTotal tuberculous\n668\n179\n482\n182\n621\n208\n699\n185\n847\n1,437\n664\n1,501\n829\n1,383\n804\n1,688\n694\n185\n998\n246\n8552\n163\n929\n224\n879\n1,699\n1,242\n2,202\n1,018\n2,108\n1,153\n2,616^\n1 Preliminary figures only.\n2 The active cases are estimated, as figures are available for the second six months only in 1948.\nThe peak of new cases discovered was in 1947, when 2,616 new cases were found\nin 180,000 persons examined. In 1954, 1,437 new cases were found in 347,018 persons examined. This was an increase of 14,418 persons examined in 1954 and an\nincrease of approximately 65,000 persons examined over two years ago. During this\npenod between 1947 and 1954 the number of new cases that could be classified as active\ndecreased from 1,153 to 847. Therefore, it can be shown that in spite of increased\nsearching, morbidity from tuberculosis in British Columbia is showing a marked\nreduction.\nIt is becoming increasingly difficult and more costly to find new tuberculosis cases\nas *e situation improves. On the basis of 40 cents for each miniature X-ray, it will be\nseen that the direct cost of detecting an active case of tuberculosis is about $700. Howler, the indirect costs would add considerably to this figure. At what point the yield\n0 new cases makes it impractical to continue case-finding by this method is not yet\n L 122\nBRITISH COLUMBIA\napparent, but it is generally agreed that this point is not yet reached. The saving throu r,\nearly detection, with removal of infection in the community, is undoubtedly greater th\nthe costs of later treatment and the spread of infection. It is obviously better to find 7\nactive case at the cost of $1,000 than to treat several that might develop from this souk?\nat an estimated cost of $15,000 per case. ce\nSANATORIUM ACCOMMODATION\nThere has been a marked change in the picture as regards sanatorium accommodation and, indeed, a much-lessened demand on the beds. This has undoubtedly been\nbrought about by two factors\u2014the modern treatment of tuberculosis and the decreased\nnumber of new cases found.\nIn the first ten months of this year there were 790 applications for admission to\nsanatorium, compared to 799 for the first ten months of 1953 and 804 in 1952, actually\nvery little change. However, discharges showed a marked increase, with 840 discharges\nin the first ten months of 1953 and 929 in the first ten months of 1954. At the time of\nthe opening of Pearson Tuberculosis Hospital there were approximately 200 patients\nawaiting admission to our institutions. At this time last year the waiting list had been\neliminated, except for elective cases. It became apparent that the Division was in a\nposition to close certain unsatisfactory sanatorium beds, and plans were laid for the\nevacuation of Jericho Beach Hospital. This took place at the end of October.\nAt the present time it has been possible to abandon all the temporary accommodation\nwhich was once occupied, namely, St. Joseph's Oriental Hospital, the temporary addition\nat Willow Chest Centre, and Jericho Beach Hospital. The opening of Pearson Tuberculosis Hospital provided 264 beds, but simultaneously we closed 164 beds in the\nVancouver area, hence there was a net gain of 100 beds. With the closing of Jericho\nBeach Hospital, having a capacity of 91 beds, one might say that Pearson Hospital\nrepresents a replacement of the temporary accommodation that was being operated in\nVancouver. However, in the meantime, with the renovation at Tranquille Sanatorium,\napproximately 60 extra beds became available at that institution this spring. With a\ncomplement of 833 beds, there are available 70 more beds than before the opening of\nPearson Hospital.\nA census of the sanatorium patients has again been made as of October 31st this\nyear, and this emphasizes the fact that the problem of tuberculosis in the older person\nis increasing.\nAge Distribution in Sanatorium, October 31st, 1954\nAge-group\nMales\nTotal\nPearson\nWillow\nVictoria\nTranquille\nFemales\nTotal\nPearson\nWillow\nVic-\ntoria\nTranquille\nOrand\nTotal\n0- 4\t\n5- 9\t\n10-14\t\n15-19\t\n20-24\t\n25-29 \t\n30-39\t\n40-49\t\n50-59\t\n60-69 \t\n70-79 \t\n80 and over\t\nTotals\n1\n13\n30\n37\n66\n79\n96\n95\n48\n15\n5\n11\n12\n21\n30\n33\n39\n15\n8\n3\n5\n3\n14\n11\n8\n6\n4\n1\n480\n174\n55\n5\n4\n5\n7\n6\n7\n12\n1\n1\n5\n9\n18\n26\n31\n49\n43\n17\n5\n47\n204\n1\n3\n20\n33\n47\n75\n30\n17\n8\n3\n2\n8\n9\n16\n30\n10\n7\n3\n2\n1\n2\n3\n7\n9\n12\n6\n1\n239\n85\n2\n3\n6\n9\n4\n1\n7\n14\n16\n24\n16\n4\n3\n1\n2\n88\n1\n4\n33\n63\n84\n141\n109\n113\n103\n51\n17\nOut of 719 patients in sanatorium, 284 were age 50 or over; that is, 39.5 percent\nwhich is an increase over 32.3 per cent in 1952 and 35.1 per cent in 1953. Thera\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 123\nof males to females in the total sanatorium population has not changed and remains at\n2 to 1, but males to females over 50 years are in the ratio of 8.5 to 1. In 1953, 26.6 per\ncent of the admissions were for persons over 50 years. On the other hand, this group\nrepresents 39.5 per cent of the total population of the sanatoria. Of the male sanatorium\npopulation, 52.9 per cent are over 50 years of age, an increase from 45.6 per cent in 1952\nand 48.2 per cent in 1953. Of the 262 admissions of persons over 50 years of age, only\n38 were females, there being six times as many males as females admitted in the older\nage-groups. Females over 50 years represent 12.5 per cent of female population, and\nthis is an increase from 8.6 per cent in 1952.\nThe increase of the older age-groups in sanatorium is due to several factors, as\nfollows:\u2014\n(1) Increased emphasis on case-finding in this age-group has uncovered many\ncases.\n(2) Advances in medical and surgical treatment have made it possible to offer\nhope to these people through active therapy.\n(3) Availability of beds has made it possible to admit and retain this group\nof people, where formerly it was necessary to give priority to the younger\nand more treatable patients.\nHowever, there is an increasing concentration of older persons in our institutions\nfor whom little can be done either in the matter of curing their disease or in vocational\nrehabilitation. They must be cared for, and because many have no adequate domicile,\nthey must be retained so that they will not become spreaders of disease, which would\noccur if allowed to return to inadequate surroundings.\nIt was shown earlier that the problem of tuberculosis is shifting from the younger\nto the older age-groups: 60.1 per cent of deaths are in persons 50 years and over and\n39.5 per cent of those under treatment in sanatorium are over 50 years of age. This has\nconsiderable economic significance. Obviously fewer young people are developing tuberculosis and fewer are dying of it. It used to be that the disease affected persons in their\nmost productive years, and meant a great loss to the country through loss of production.\nIncapacitation of the bread-winner while the children still needed support and longer\nperiods of disability than under modern therapy placed many families on social assistance.\nAs the disease shifts to the older age-groups, while it does create problems in chronic care,\nit is alleviating many of the problems connected with the disease in the younger groups\nand should prove less of a burden on the economic structure of the country.\nNATIONAL HEALTH GRANTS\nThe amount available in the Tuberculosis Control Grant for the present fiscal year\nis slightly higher than last year at $351,213. At the present time $313,632 has been\nassigned to various projects, practically all of which have been approved.\nIn 1953-54, 94.7 per cent of the grant was approved for expenditure in the amount\nof $329,317. Because of the fact that some of the equipment was not delivered and other\naccounts were not submitted before the cut-off date, this was only utilized to the extent of\n$275,714, which was 79.3 per cent utilization. However, this was an increase from 65\nper cent utilization in the previous year.\nIn this the seventh year of National health grants, a continuing pattern in their use\nbecomes apparent. About 85 per cent of the money is committed to continuing projects\nand is distributed as follows:\u2014 I\n(1) Provision of antimicrobials, $70,500.\n(2) X-ray survey programme, $120,000. This provides for payment of hospital admission X-rays, both large and small, together with the operating\ncosts of all the miniature equipment outside of our institutions and clinics.\n(3) Rehabilitation, $26,756. W\n L 124 BRITISH COLUMBIA\ni\u00a7(4) Provision of staff, $87,293. There are twenty-nine positions n *H\ntwenty-four of these being in the Division. Pr\u00b0viaed,\nOver the years a great deal of this money has been spent on the installation of oh\nroentgen X-ray equipment for admission X-ray purposes, but this need has been far 1\nmet, and at the present time only one or two units a year are being added. Simik l\nmuch money has been spent on equipment for the institutions and the clinics of th'\nDivision, but this need seems to have been largely met, because in the present year ih\ntotal for new equipment in this grant amounts to only $29,150. In fact, the total f \u00b0\ncompletely new projects is only $1,000 more than this figure. ' 0r\nIt will be seen that the Tuberculosis Control Grant plays an important part in case-\nfinding, treatment, and rehabilitation. In actual expenditure, vocational rehabilitation\nrepresents less than 10 per cent of the total grant, but it has enabled us to build up an\neffective service, and the total project is supported by these funds. It was possible to\nreach our objective of having three rehabilitation officers\u2014one in each of our major\nsanatoria with the necessary clerical assistance\u2014earlier this year, but this staff has now\nbeen reduced to two rehabilitation officers through the resignation of our Director to\nassume duties in a broader field. It is hoped that when a suitable candidate becomes\navailable, we shall again have a complete staff in this department.\nIt has also been possible through National health grants to provide most of the antimicrobials that are used both for in-patient and out-patient care, and, of course, this is the\nmost important single factor in the control and treatment of tuberculosis at the present\ntime. Besides this, most of the staff provided, and much of the equipment is directed\ntoward, the treatment of the patient.\nNational health grants have also made the admission X-ray programme possible and,\nbesides having provided the equipment, continue to pay the costs of the operation. In\n1953, 78,740 miniature X-rays were taken on patients admitted to hospital. In the\nsmaller hospitals using their own equipment, an additional 11,251 X-rays were taken\non large films. In those hospitals where photoroentgen equipment has been installed,\n27,120 out-patients were also examined. In these hospitals there has been an increase in\ncoverage of about 10 per cent in 1954, and approximately 65 per cent of hospital admissions are now X-rayed. All told, in 1953 there were 105,860 miniature films taken and\n24,511 large films taken in these hospital surveys.\nRECALCITRANT PATIENTS |f\nFor many years there have been regulations providing for the forcible admission of\ninfectious cases of tuberculosis to institution if they are proving a public health menace\nand refusing treatment. During the time there was a bed shortage for cases seeking\nvoluntary admission it was not thought advisable to use these powers provided to control\nrecalcitrants. However, with the improving bed situation during the past year, action has\nbeen taken for such cases, and they have been forcibly committed to institutions\u2014three\nof these to Tranquille Sanatorium and one to Shaughnessy Chest Unit. For the most part,\nthese patients have been co-operative, but one case proved difficult from a point of view\nof security and management. Moreover, several prisoners from Oakalla under sentence\nwere transferred to Tranquille for treatment against their wishes, and again the problem\nof management proved very difficult.\nIf the regulations for forcible admission to institution are applied more broadly, l\nbecomes apparent that the problem of security and care for these patients will becoin\nincreasingly difficult, and if we are to continue this programme and large numbers\npersons are committed, we must be prepared to provide special accommodation a ^\nindeed, to employ special types of staff whose training would be somewhat simiia\nthat provided at Essondale or Oakalla.\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 125\nIn the past these cases have been sent to Tranquille because barred rooms are available there. However, these are very limited in number, and as this programme expands,\nit will be necessary to provide this type of accommodation in all unite where special\nsecurity measures must be enforced. It would appear that eventually the bulk of these\ncases would be amongst the chronic offenders, such as drug addicts and alcoholics, where\nlittle co-operation from the patients while in institution can be expected. Moreover, with\nthe need to provide special security accommodation and close supervision of these\npatients, it would appear that the cost of looking after this type of patient would be\ngreater than the cost for ordinary patients.\nCONTROL OF TUBERCULOSIS\nThe control of tuberculosis in this Province is a co-ordinated effort and involves\nFederal, Provincial, and municipal authorities. The Federal authorities are charged with\nthe responsibility for the control of tuberculosis amongst Indians and have also assumed\nthe responsibility for the treatment of war veterans. One is happy to relate that the\nclosest co-operation exists among these groups. Our programmes of control and treatment are similar, and our exchange of services and information leaves little to be desired.\nWithin the Provincial authority the closest co-operation between the Division and local\nhealth services must,be maintained to produce the highest degree of integration of these\nservices. While the units of the Division are responsible for the patients while under\ntreatment and for their follow-up examinations when these patients are outside of institutions, their supervision rests with the local health organization. To deal intelligently\nwith these patients and to advise them on the basis of the findings of the tuberculosis\nclinics, it is therefore essential that the field-workers be kept fully informed and in possession of all the essential information that is pertinent to the case. This becomes even\nmore important when such large numbers of patients are continuing treatment in their\nhomes with antimicrobials after discharge from sanatoria.\nAlthough it is realized that vast amounts of information are constantly being sent\nout to the health units and that close liaison is maintained through co-ordinating nurses,\nthere are sometimes oversights and misunderstandings that are annoying and should be\navoided if at all possible. Of course, the exchange of information is a two-way street,\nand only if all of us keep this total picture in mind and realize how many workers are\ninvolved in the complete rehabilitation of a patient can the maximum co-ordination of\nour efforts be achieved.\n L 126 BRITISH COLUMBIA\nREPORT OF THE REHABILITATION CO-ORDINATOR\nC. E. Bradbury\nREHABILITATION\nRehabilitation of the disabled is a subject which merits increasing considerat'\nfrom all segments of our population. Certainly, more and more, it is occupying the sob?\nattention of those responsible for the planning of community health programmes. In J\nlast two decades particularly, the rapid advances of medical knowledge, the applicatio\nof improved public health measures, and the increase in hospital facilities are responsible\nfor hundreds of our people being alive to-day who, fifty years ago, would have died\nTo-day, with our knowledge and developing skills, we can offer hope for a useful and\nproductive life to many of those who, even twenty-five years ago, would have been beyond\nthe scope of rehabilitation.\nAccidents and disease continue to take their toll, and thousands of victims are left\nwith physical disabilities. Some, of course, are still beyond our present knowledge and\nskill, but it has been estimated that with co-ordinated rehabilitation service 80 percent\ncould become productive and live relatively normal, useful lives. It no longer is considered sufficient to save lives. Our society must face the challenge of giving meaning and\npurpose to the life which is saved.\nThe Health Branch has been active in rehabilitation since April, 1949, when a\nrehabilitation service was organized in the Division of Tuberculosis Control, the only\ndivision of the Health Branch which maintains active-treatment beds. In May, 1954, the\nTuberculosis Rehabilitation Service was expanded, and two rehabilitation officers were\nadded to the staff. Integrated rehabilitation services, which include vocational counselling, pre-vocational training and academic instruction, occupational therapy, and post-\nhospital vocational training and placement guidance are now offered to patients in all\nsanatoria.\nThe Health Branch has continued its interest in the problems of those in our Province\nwho are handicapped because of a disability, and on April 15th, 1954, the Honourable\nEric Martin, Minister of Health and Welfare, signed the Co-ordination of the Rehabilitation of Disabled Persons Agreement. The Co-ordination of Rehabilitation Agreement,\nby which it is better known, is a grant made available to the Provinces by the Federal\nDepartment of Labour through which each Province can share up to $15,000 per annum\non a matching basis to pay the salaries and expenses of a Provincial Rehabiliation Coordinator, and to cover certain other expenses attendant on the organization and administration of a rehabilitation co-ordination service.\nAs a result of formal competition conducted under the auspices of the British\nColumbia Civil Service Commission, the Minister of Health and Welfare, on September\n16th, 1954, announced the appointment of a Provincial Co-ordinator of Rehabilitation\nwho is directly responsible to the Deputy Minister of Health. It is the duty of the Provincial Co-ordinator to assist in securing the co-operation and active participation oi\nother departments of the Provincial Government, the services of which contribute to a\nrehabilitation plan. He also is charged with the responsibility of co-ordinating the work\nof those agencies, public and private, which, on the Provincial and local level, aid in tne\nrehabilitation process, and to stimulate the interest of labour, management, and other\ngroups and individuals in the community. . .\nAs this Annual Report of the Health Branch is being prepared for publication,\nplanning goes forward for the effective co-ordination of presentiy existing services contributing to the rehabilitation process. The assistance and counsel of the other interested departments of the Government have been solicited, and effective liaison has bee\nestablished. The Health Branch, in embarking on this new programme, is ^at\u00a3ul\nthe participation of the senior officials and the staffs of the Welfare Branch, the JJep*\nments of Education and Labour, the Provincial Secretary's Department, and the w\nmen's Compensation Board. Mention must also be made of the various private age\nin British Columbia, too numerous to cite individually, who have exhibited a keen in\nand a ready willingness to support the Health Branch in this expansion of its service\n DEPARTMENT OF HEALTH AND WELFARE, 1954 L 127\nREPORT OF THE ACCOUNTING DIVISION\nE. R. Rickinson, Departmental Comptroller\nThis being the first report of the Accounting Division of the Department of Health\nand Welfare to be included in the Annual Report of the Health Branch, it was thought\nthat it would be very informative to all concerned to outline the actual function of the\nAccounting Division.\nThe Accounting Division of the Department of Health and Welfare was first formed\nin 1944 under the Department of the Provincial Secretary, and in the following year transferred to the new Department of Health and Welfare. Since that time it has carried out\nthe accounting services for both Departments. Throughout the years since the formation of the Accounting Division, a steady process of centralization of payment of accounts\nhas taken place, thus reducing the accounting details for the field offices. A complete\ncentralization of payment of accounts is now in force for the Health Branch.\nThe various functions of the Division may be summed up briefly as follows: Control of all expenditures, processing of accounts, preparation of payrolls, collection of\nschool district and municipal assessments for health services carried out by the Branch,\nas well as preparation and finalization of the Health Branch annual estimates of revenue\nand expenditure. Other duties include the accounting for all Federal health grants,\npreparation and analysis of statistical data, inspection of mechanized equipment, records\nof operation, and complete running costs of every vehicle within the Branch.\nIn order to assist the personnel of the Health Branch offices to become more\nacquainted with the requirements of the Accounting Division and in particular for ready\nreference for new staff members, an accounting manual is presently being prepared by\nthis Division, and it is hoped that this will be ready for distribution early in the coming\nfiscal year.\nThis Division wishes to extend its thanks to all members of the Health Branch for\ntheir very fine co-operation during the past year.\nHereunder is a chart showing percentagewise the distribution of the gross expenditure of the Health Branch for the fiscal year 1953-54:\u2014\n L 128\nBRITISH COLUMBIA\n100%\n90,\n80,\n70\n60\n50\n40\n30\n20\n10\n0\n\u00bb\u25a0\u2022\u25a0\u25a0'\u2022*\u25a0>- '\u25a0\u00bb\u2022\u00bb.\n... -V . \u2022.-.T\n\/\u2022\u2022\u2022* '. * ,'-\n\u2022 \" ' '\u2022\u2022 \".* '\/\n\u2022 \u2022\n\u2022 * \u2022\n1.5% RESEARCH, TRAINING etc\n\u2022 2. 1 V. D. CONTROL\n\" 2.9 ADMINISTRATION\n\"3.0 LABORATORIES\n-3. 1 VITAL STATISTICS\n1 CANCER, ARTHRITIS,\n-7.9 CRIPPLED CHILDREN,\nREHABILITATION, etc.\n23. 1 LOCAL HEALTH SERVICES\n56.4 T. B. CONTROL\nVICTORIA, B.C.\nPrinted by Don McDiarmid, Printer to the Queen's Most Excellent Majesty\n1955\n610-1054-3261\n","@language":"en"}],"Genre":[{"@value":"Legislative proceedings","@language":"en"}],"Identifier":[{"@value":"J110.L5 S7","@language":"en"},{"@value":"1955_V02_04_L1_L128","@language":"en"}],"IsShownAt":[{"@value":"10.14288\/1.0367835","@language":"en"}],"Language":[{"@value":"English","@language":"en"}],"Provider":[{"@value":"Vancouver : University of British Columbia Library","@language":"en"}],"Publisher":[{"@value":"Victoria, BC : Government Printer","@language":"en"}],"Rights":[{"@value":"Images provided for research and reference use only. For permission to publish, copy or otherwise distribute these images please contact the Legislative Library of British Columbia","@language":"en"}],"SortDate":[{"@value":"1955-12-31 AD","@language":"en"},{"@value":"1955-12-31 AD","@language":"en"}],"Source":[{"@value":"Original Format: University of British Columbia. Library. Law Library. J110.L5 S7","@language":"en"}],"Title":[{"@value":"Ninth Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-eighth Annual Report of Public Health Services) YEAR ENDED DECEMBER 31ST 1954","@language":"en"}],"Type":[{"@value":"Text","@language":"en"}],"Translation":[{"@value":"","@language":"en"}],"@id":"doi:10.14288\/1.0367835"}