{"http:\/\/dx.doi.org\/10.14288\/1.0059502":{"https:\/\/open.library.ubc.ca\/terms#identifierAIP":[{"value":"e26a5297-5687-49b0-9d09-2a16c72aeb4d","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider":[{"value":"CONTENTdm","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/alternative":[{"value":"PROVINCIAL BOARD OF HEALTH.","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/isReferencedBy":[{"value":"http:\/\/resolve.library.ubc.ca\/cgi-bin\/catsearch?bid=1198198","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/isPartOf":[{"value":"Sessional Papers of the Province of British Columbia","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/creator":[{"value":"British Columbia. Legislative Assembly","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/issued":[{"value":"2016-03-22","type":"literal","lang":"en"},{"value":"[1918]","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO":[{"value":"https:\/\/open.library.ubc.ca\/collections\/bcsessional\/items\/1.0059502\/source.json","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/elements\/1.1\/format":[{"value":"application\/pdf","type":"literal","lang":"en"}],"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note":[{"value":" PROVINCE OF BRITISH COLUMBIA\nTWENTY-FIRST ANNUAL REPORT\nOP THE\nPROVINCIAL BOARD OF HEALTH\nINCLUDING\nSIXTH ANNUAL REPORT OP MEDICAL INSPECTION OP PUBLIC SCHOOLS AND\nTHE PORTY-PIPTH ANNUAL REPORT OP VITAL STATISTICS\nDEPARTMENT POR THE YEAR ENDING\nDECEMBER 31ST, 1917\nAND\nPROCEEDINGS OP THE SECOND MEETING OP MEDICAL OFFICERS OF HEALTH\nOF BRITISH COLUMBIA HELD IN VANCOUVER, B.C.,\nSEPTEMBER 12TH AND 13TH, 1917\nPRINTED BY\nAUTHORITY OF THE LEGISLATIVE ASSEMBLY.\nVICTORIA, B.C.:\nPrinted by William H. Cbllin, Printer to the King's Most Excellent Majesty.\n191S. Provincial Board of Health,\nVictoria, B.C., April 1st, 1918.\nTo His Honour Sir Frank Stillman Barnard, K.C.M.G.,\nLieutenant-Governor of the Province of British Columbia.\nMay it please Your Honour:\nThe undersigned has the honour to present the Twenty-first Annual Report of\nthe Department of Public Health for the year ended December 31st, 1917.\nj. d. Maclean,\nProvincial Secretary. REPORT\nOF THE\nPROVINCIAL BOARD OF HEALTH.\nProvincial Board of Health,\nVictoria, B.C., February 12th, 1918.\nDoctor the Honourable J. D. MacLean,\nProvincial Secretary, Victoria, B.C.\nSir,\u2014I have the honour to submit the Twenty-first Annual Report of the Provincial Board\nof Health being for the year 1917.\nBefore proceeding to lay the facts before you concerning the activities of the Board during\nthe past year I would respectfully request your consideration of a change of the time for the\npresentation of the Annual Report. Under our present regulations we are obliged to present\nthe annual report at the meeting of the Legislature. In this Province the practice has been for\nthe Legislature to meet about the second week in January. \"Under the circumstances it is difficult\nfor the Department to present a report in a way that would permit of analysis of the returns\nreceived from the different sections of the Province. We have been obliged, as regards the Vital\nStatistics Branch, to note annually that returns have not been received from certain outlying\ndistricts; this not because of any fault on the part of the officials at these points, but owing\nto distance and uncertainty of the mail service. If the year embraced in the report was made\nto terminate the end of June, then our reports, particularly of the Vital Statistics Branch and\nthe Medical Inspection of Schools, could be dealt with much more fully, comparisons made with\nthe returns of the former year, and benefits noted. As it is, first, our returns are not complete,\nand, second, sufficient time is not allowed for other work in connection with them than their\ncompilation for the report. The practice in the different States in the United States and in the\nother Provinces of Canada is to allow sufficient time from the beginning of the year to permit\nof a proper analysis of the facts submitted by the officials in the different departments.\nI am very much pleased to say that reports of the health conditions during the year 1917\ndeal more with the work which has been done along educational lines rather than a report of a\nseries of epidemics. The health of the community has been exceptionally good. There have\nbeen no alarming reports during the year, yet such conditions may not continue. It is consequently better to be always prepared to act promptly in the matter of preventive measures in\nany emergency which may arise. Your Board recognizes the importance of this fact and are\ndevoting their efforts to the promotion of the interest of the public at large In health matters.\nThe time seems to be most opportune for stimulating the attention of the public to the teachings\nof the Board of Health. The universal enforcement of health regulations by the military\nauthorities upon the troops in their charge and the beneficial results that have been obtained\nhas brought forcibly home to the people the fact that the health authorities are not faddists\nwhen they say that disease can be prevented. Our troops have been living under conditions\nwhich in normal times would not be tolerated in any community. They have been subjected to\nintense physical strain, irregular hours, irregular meals, and insanitary conditions of living, yet\nby the strict enforcement of sanitary measures and the insistence upon inoculation against disease\nresults have been brought about that have demonstrated conclusively the truth of the teachings\nof the health authorities, and has done more to rivet the attention of the public in a short time\nthan could have been accomplished by another quarter of a century of patient teaching under\nnormal conditions. With these results before us we have been able to direct the attention of\nthe people to and to have awakened a lively interest in health questions. We were first shown\nby the rejection of men presenting themselves for service that there was unfortunately a very\nlarge percentage of men unfit for military service owing to physical defects. Secondly, we were\nshown that the health of the men who were accepted was much better under the enforcement\nof military health regulations, when the man was living under the highest pressure of effort,\nboth mental and physical, than it would have been under previous conditions in civil life. G 6 British Columbia 1918\nConsideration of these aspects of health-work has naturally led the people to a serious\nconsideration of the influence of the individual as regards his relation to the community and\nhis environment, and as regards the efforts that he must make individually to help in prevention\nof disease by attention to personal hygiene and education of himself and others in the idea of\nprevention of disease as distinct from its cause. The Department has taken advantage of the\nchange in public opinion and is endeavouring in every way possible to provide information\nthrough societies by way of distribution of pamphlets, the enforcement of recording of contagious\ndiseases, and by endeavouring to enlist the active interest of the medical profession in the health\npropaganda. With this object in view a meeting was called of the Medical Health Officers for\nthe discussion of health subjects and to listen to papers read on pertinent subjects. The meeting\nwas held in Vancouver in September, 1917, the sessions lasting for two days, and the interest\nmanifested by those who attended was very gratifying. The Department feels under a very\ngreat obligation to the members who presented their papers, and particularly to President\nWesbrook, of the University of British Columbia, for the great interest he took and the assistance\nhe gave towards making the meeting a success.\nOne of the first results that we have obtained from this meeting, which is particularly\ngratifying to the Department, is the increased interest manifested by the members of the\nprofession in their work, and particularly so as regards the reports of the conditions in their\ndistricts. The reports have been much fuller and the comments made more general, making\nthe reports differ very much from those that we previously received, which as a rule were more\nof a record of cases that had occurred. Causes are discussed and suggestions made.\nI have also -to acknowledge, with appreciation, the increased interest which has been taken\nin the question of health and the activities of the Board by the members of the Women's\nInstitutes. They have evinced a very serious and earnest desire to co-operate with the Board,\nand I had the honour to meet and address the institute on three different occasions on health\nmatters. The members of the institute expressed a desire to keep in touch with the Board and\nto further health interests in the localities by giving the matters their personal attention.\nThe health of the Province for the year has been very satisfactory; so much so as to cause\nvery favourable comments from those who are acquainted with the returns made by our Health\nOfficers.\nMeasles.\nDuring last year I had to deal at some length with the history of an epidemic of measles\nwhich occurred at the end of the year and was continued on into 1917. The greatest number\nreported was from the City of Victoria\u2014some 3,000 cases in the city and the districts around.\nWe cannot emphasize too strongly the fact that measles is the most prevalent and one of the\nmost infectious of diseases, and one, from a health point of view, that is the most difficult to\ndeal with. Unfortunately the public look upon measles as a very minor trouble, and their chief\nconcern seems to be, when an epidemic does come, for all their children to have it and get it\nover with. This is very much to be regretted, and it is to be regretted that the general public,\nand even physicians, discount the seriousness of the disease. The danger lies not so much in\nthe effect of the attack itself upon the child, but with the troubles that follow it, such as\nbronchopneumonia, eye and ear affections, and deaf mutism.\nInfantile Paralysis.\nSome concern was felt during the latter part of the summer, when reports of cases of\ninfantile paralysis began to come in, in view of the great epidemic in the Eastern States in\n1916. Fear was expressed that it had come to the West and that we would suffer proportionately\nas they had done. Fortunately the number of cases reported did not exceed those we might\nexpect according to the number of population; in fact, thirty-seven cases in all were reported,\nthirty of which were in and around Vancouver. Prompt measures were taken by Dr. Underbill,\nMedical Health Officer in Vancouver, and with the knowledge we have of his efficient management no alarm was felt as to the outcome.\nSmallpox.\nDuring the past year there were a larger number of cases of smallpox reported as compared\nwith 1916. In 1916 there were seven cases, as against sixty in 1917. The increase was accounted\nfor by an epidemic at Grand Forks, forty-eight cases being reported. The cases were mild, with\nno deaths. It originated from one of the logging camps south of the border. Grand Forks, as 8 Geo. 5 Provincial Board of Health. G 7\nthe gateway for the Boundary country, has always been susceptible to slight epidemics. There\nwere ten cases reported from the City of Vancouver; eight of these occurred during the early\npart of the year amongst stevedores and was due to infection from a ship from the Orient.\nThese cases were severe, of the confluent type, and resulted in fatalities. Prompt measures were\ntaken by Dr. Underhill, Medical Health Officer of Vancouver City, and the disease was confined\nto the eight cases. There was one case reported in North Vancouver and one in Victoria City.\nThe presence of smallpox led to some agitation on the question of vaccination, anti-vaccina-\ntionists entering a protest as regards its enforcement. I would point out, however, that while\nwe have enjoyed particular immunity from smallpox, yet at the same time this immunity is\nleading to carelessness in carrying on vaccination in the children, and when an epidemic does\narrive the results will be unfortunate. That such an epidemic is possible and liable to be of a\nserious character is shown by the nature of the eight cases referred to above that were imported\nfrom the Orient.\nTuberculosis.\nTuberculosis is not hereditary; not Incurable; it is contagious; it is preventable; and\nunder certain conditions curable. The recognition of these facts, for they are facts, has been\nbrought about by the careful study of the disease, by a careful study of the different methods\nof treatment, and will form a basis for the work undertaken by the Provincial Board of Health\nin its efforts to combat the disease. This question was discussed in our last Annual Report,\nand I am pleased to say that, under the direction of the Honourable the Provincial Secretary,\nDr. MacLean, greater efforts are to be made for the future.\nThe sanatorium which was established at Tranquille has been doing splendid work, but this\nwork is handicapped by the fact that they have been overloaded with advanced cases, with a\nresult that accommodation is lacking for the early and curable cases. Dr. MacLean proposes\nto use local hospitals throughout the Province as centres for the handling of the cases in their\nimmediate vicinity. The Government will increase the per capita grant to hospitals for these\ncases to $1 per day. Hospitals will be required to provide one-tenth of their bed accommodation\nfor advanced cases. Tuberculosis is a reportable disease, and provision is to be made for the\nreporting of all cases by the medical men, to whom a small fee will be allowed for the work.\nA travelling Medical Officer of Health is to be employed for the work of supervision and to act\nas a consultant for the local Medical Officers of Health. There is to be established, with the\nco-operation of the Dominion Government, another sanatorium in the Province. This will be\nprimarily for the care of the returned soldiers suffering from tuberculosis, but will ultimately\nrevert to the Province. An effort will be made to stimulate public interest in the matter and\na general campaign of education carried on. The expectation is that the public will be fully\nimpressed with the fact that the disease is contagious, but more especially that it is preventable.\nDoubtful cases will be noted and can be kept under observation, and the beds of the sanatorium\nwill be kept for cases in the early stages that, under sanatorium treatment, can be cured.\nThe danger of infection from tuberculosis is much greater during childhood, and I would\nstrongly recommend the advisability of concentrating as far as possible our efforts in guarding\nour children and to assist the child-welfare movement which is being organized in British\nColumbia. I would suggest that the School Boards of British Columbia, particularly in the\ncities, establish open-air school-rooms for weakly and pre-tubercular children. The establishing\nof such school-rooms is long past the experimental stage, and the results obtained from treatment\nby this means of such children in the Eastern schools are such as to justify an immediate\nadoption of the same plan in British Columbia.\nVenereal Diseases.\nThe wastage of life in this war is rousing the public conscience in all nations to an extent\nwhere a solution has to be found for many of the cases which have been productive of serious\nloss of life and more particularly of efficiency in our population. Tuberculosis has been actively\ndiscussed by the people, but a false sense of modesty, false inasmuch as the health of the people\nis so fatally affected, has in the past prevented public attention being directed to the ravages\ncaused by venereal diseases. Those who have closely studied the spread of such diseases point\nout that it is necessary, if widespread relief is to be obtained, for the public to be made to\napprehend the imminence of the danger. The Governments in the different countries are acting\nin the matter, and while, as yet, there has not been arrived at a basis for conformity of action, G 8 British Columbia 1918\nyet I would recommend to your serious consideration the conclusions arrived at by the Committee\non Public Health of the Conservation Commission of Canada, which committee is of the opinion\nthat legislation should be enacted providing for:\u2014\n(1.) Registration of cases without name and address:\n(2.) Public registration and isolation of recalcitrants:\n(3.) Free treatment for all who apply for it:\n(4.) Free bacteriological and blood tests:\n(5.) Supervision of mental defects:\n(6.) The administration of the plan by a Dominion body through or in co-operation with\nProvincial Boards of Health.\nIn the recommendation made by the Royal Commission appointed by the Government of\nGreat Britain I would especially recommend to your attention their recommendation for \" The\nnecessity of educating the public to the gravity of the effect of the disease by securing the\nconstant assistance of voluntary agencies engaged in prevention and rescue work.\" Such work\nhas been begun in British Columbia, and I would especially mention and recommend the work\nof the Life Conservation League of Victoria City. This League has evinced an active interest\nin the matter, and through the press, the pulpit, and public meetings is endeavouring to arouse\npublic conscience to the gravity of the situation.\nWater.\nA very important question came before the Board during the past year affecting- the water-\nsupply of the City and District of North Vancouver and the City of Vancouver and adjoining\nmunicipalities, which get their water from the same sources. In 1905 reservations were placed\nupon the watersheds by the Government reserving all alienated lands within the bounds of the\nwatersheds. Unfortunately alienations had been made previous to this by lumber and mining\ncompanies. Their holdings had lain dormant until the last year, when they began active\noperations. As they were in possession of certain portions of the watersheds, the Board of\nHealth was asked to take such measures as would safeguard the water-supply. Conferences\nwere held with the Government and as a result arrangements were arrived at. Regulations\ngoverning the companies working on the watersheds were issued, an Inspector was appointed,\nand every effort was made to safeguard the health of the community. From the measures taken\nthere is no doubt that this will be done, but I beg leave to suggest that the whole question of\nthe watersheds for the Burrard Peninsula be dealt with as a whole; that a Water Board be\nestablished along similar lines to the present Sewerage Board of Vancouver, having control of\nthe watershed, the supply and the distribution of the water.\nDuring the year plans for the following were examined and approved :\u2014\nSewerage plans: Vancouver Trunk Sewer, Trail, and B.C. Sulphite Co., of Howe Sound.\nWater-supplies: Revelstoke and Trail.\nCemetery-sites: Okanagan Mission, Squamish, Fort George, Duncan, and Mapes.\nThree hundred and eighty-five doses of typhoid vaccine, 1,280 vaccine points for vaccination,\nand 658,000 units of antitoxin were distributed.\nWork for the Provincial Laboratory was done for us by the laboratory of the Vancouver\nGeneral Hospital, and I have to thank Dr. Mullin, who is in charge, for the very full reports\nwhich we received of the work that he did for us. The Provincial Laboratory was not in use\nowing to the fact that we had been unable to secure the services of a bacteriologist, and also to\nthe fact that the Honourable the Provincial Secretary had under consideration a rearrangement\nof this work.\nWe append a table showing returns made by Medical Health Officers of cases of contagions\nin the different parts of the Province. I am also incorporating reports from the Vital Statistics\nBranch, Sanitary Inspection, Hospitals Inspection, and the School Report. The matters more\nparticularly in connection With these inspections are dealt with in the reports.\nI would commend to your favourable notice the great interest which is taken iii the work of\nthe Department by all the members of the staff.\nI have the honour to be,\nSir,\nYour obedient servant,\nH. E. YOUNG, M.D.,\nSccretarg, Provincial Board of Health. 8 Geo. 5\nProvincial Board of Health.\nG 9\n1\ns\n\u2022sqiuaa\n \u2022 \u25a0 \u25a0 -t>3\t\nCl\n\u25a0sas-BO\n - \u25a0 ... . .... ... |\n- -CO O CO \u00a3N \u25a0rH -00m \u2022 \u00a9 01 00 \u25a0 \u25a0*\"* -\u00abH -laiOHCM 'tOOiS \u2022 \u25a0--\u2022# \u2022 \u25a0 O -* \u2022 \u2022 -IO\n I- *-* \u2022 - rH CO \u25a0\u25a0 rt \u2022 \u25a0 tH - rt \u25a0 OI \u25a0 CO rt \u25a0 \u2022 -\u25a0 i-H \u25a0 \u2022 \u2022 *-\n\u25a0 \u25a0 \u25a0 ' rH -\u25a0\u25a0>!\u25a0 .... ...](.\nCH .\nS3\n3\n\u25a0sq-^a-Q\n\u2022ses-eo\n \u25a0 - \u25a0 * ...\n'\u2022 '\u25a0 '\u2022 '\u2022 '\u25a0 - \u25a0 '\u2022 '\u25a0 ..'.'.... -\n r-t (M \u25a0 \u2022 \u25a0 -*\n\u2022sq^aa | .:::::;:::_:::::.:::::::::::::::::::::::::::::\n-\n'S3SBQ (^ ,HH \u25a0 \u2022 \u25a0 \u25a0 -HOOM -fM .-1 \u25a0 - '. *\u00bb rt H -3J \u2022 - \u25a0 \u25a0 -i-H -(MM . . . .(Mi-( \u25a0 - \u25a0\n 2-3 \u25a0\u2022 \u25a0 .... . .\nB\n\u2022sq^eaa\n\u2022- ;\u2022:: i i i; I \u25a0! i \u2022 i -i M \\,\\;;;.;;;.!\";;; i li i M i;i; i i-j j.i\n-\n\u2022S3S130 j : rt :::;:::::::::::::;:::: ; : ; : : : : . . : : : : : ; : : : : : :\ni \u25a0 \u25a0 \u2022 \u2022 \u2022 * - \u2022 \u25a0 \u25a0 '...'.....'.\t\n-\n\u2022sq^eacr\nmMMMMNMMMMMMMMMMMMmMMmMM\n\u25a0sase^)\na \u00a32\ncc 5\nta *J\nH\n\u25a0sq^aa\nM N =; h i\" M M h M M :r 'r i i !* M M i! 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Young, M.D.,\nSecretary, Provincial Board of Health, Victoria, B.C.\nSie,\u2014In presenting the Seventh Annual Report pertaining to the work of sanitary inspection\nfor the year ending, I beg to preface it by reminding you of the fact that this branch of the\npublic health service was the first to suffer in man-power through war conditions, and as each\nmember of the staff removes the vacancy still remains as such, in the hopes of an early termination of the great conflict, when it is presumed that the staff may regain its original strength.\nMuch extra time and labour has been pressed upon the remnant left to carry on the service: in\nthe meantime industrial development has made such strides, as predicted in my last report, that\nto-day there are 100,000 people employed outside of the cities and in what has been fitly termed\nthe vast \" outdoors \" of British Columbia. The larger part of these new industries are located\nnear tide-water on islands or inlets, many of them off the regular traffic routes. For reasons\nalready given the sanitary welfare of these numerous industrial camps has not received the\ndesired attention during the past two years, although in the Interior sanitary-inspection work\nhas been attended to by the Provincial police, who are ex-officio Sanitary Inspectors. Complaints\nhave been numerous and reference made in the press, one editorial of a widely circulated \" daily \"\npointing out most emphatically that in view of the expansion taking place some more adequate\nmeasure of sanitary welfare for logging and other camps is imperatively necessary. This is\nundoubtedly true, and is further emphasized by the records of the large city hospitals, which\nshow that the majority of typhoid and other infections come from the outside districts, where\nconditions are conducive to the spread of infection. Through the efforts of the Honourable the\nProvincial Secretary means are being provided whereby a thorough and persistent campaign will\nbe taken up for enforcing the regulations dealing with such conditions.\nAmong the numerous new industrial enterprises under way and in contemplation, mention\nshould be made of what promises to be the largest pulp and paper mills in the world, located at\nPort Alice, Quatsino Sound. Others have been brought into operation at Port Mellon, Swanson\nBay, and Ocean Falls. The Powell River plant is operated at capacity limit, and the B.C.\nSulphite Co., at Howe Sound, are enlarging to double present capacity. A large number of\ncopper and zinc properties are being developed at different points, whilst the logging industry\nis only limited by labour procurable. Spruce and fir to the amount of $50,000,000 has been\ncontracted for by the Munitions Department, in addition to an increased commercial demand.\nSpace forbids enumerating to any extent the tremendous development going on, and I have\nmerely mentioned facts to show the necessity of providing means and waysi to protect and\npromote health conditions at the points selected for the industrial camps in unorganized territory,\nwhere no governmental supervision exists beyond the nearest Provincial constable or Government\nAgency, sometimes one or two days' travel distant. However, the men behind these large enterprises are shrewd enough to recognize the fundamental value of selecting sanitary sites for the\nhousing of their employees. The Powell River Townsite is a good sample of such foresight.\nThe larger the enterprise the less trouble for our Inspectors in enforcing the Provincial regulations. With few exceptions, the small and medium-size camp operators, employing from 10 to\n100 men, are the most difficult to convince of the necessity of observing sanitary regulations.\nThe greatest outstanding feature to the credit of all employers operating camps with kitchen\nand bunk-houses is the fact that without exception the food provided is the best obtainable and\nwithout stint. In the past we have not had occasion to give much credit for the manner of\nhousing and other comforts provided to employees in the small camps. In future a greater\nconsideration in that respect will be demanded. Another need for all camps is educational\npamphlets dealing with the increasing prevalence of syphilis, also the value of typhoid prophylactic inoculation, and for the rural settlements similar literature or posters for the attention\nof parents, guardians, and school-teachers in reference to prevention of common ailments common G 12 British Columbia 1918\n s\t\nto children; and again I would respectfully suggest that an amendment be made to the \" Land\nAct,\" prohibiting the registration of any subdivision for townsite or residential purposes until\nthe approval of the Provincial Board of Health has been obtained. The lack of such is shown\nin the almost insurmountable insanitary conditions of several of our newer towns established\nduring the late boom. Such an amendment would prevent \" history repeating itself \" in that\nrespect; furthermore, our sister Provinces and States have adopted such legislation. The State\nof California provides that all land sold or subdivided for residential use must be provided with\npure water-supply, facilities for sewage-disposal, graded streets, lanes, and approved sidewalks.\nDuring the early part of 1918 the service of this Department was invoked for the purpose of\nprotecting a community from the serious endangering of a water-supply through the inefficiency\nof a supposedly well-designed and built septic system used for the drainage from a large institution. One fatal case of typhoid had already occurred. Upon investigation it was found, first,\nthat the septic action of the tanks had been nullified by the lack of grease-traps; second, no\nprovision had been made for rest and clean-outs; third and worst feature was the fact that\nthe outlet from tanks was straight to a fresh-water stream used by neighbours for domestic\npurposes. The first and second defects were remedied in the usual manner, and a well-laid\nsub-irrigation system adopted for the discharge, the old discharge-pipe being removed entirely.\nThe results have been very satisfactory.\nAt Vernon during the past few years the residents of a splendidly improved farming\ncommunity have been subject to a nuisance caused by the periodical removal of sludge from\nthe tanks of a sewage plant owned by the city. The Government was petitioned and the\nmatter was placed with this Department for attention. Arrangements were made with the\ncity authorities that I should be on hand during the next clearing operation. This was done,\nwith the results that by suggested minor changes in equipment and method the nuisance has\nbeen eliminated 90 per cent, and the cost of operation likewise reduced, the results being much\nappreciated. Details of this work are on file and would be good reading to any one interested\nin the varied angles of sludge-removal.\nDuring the early part of last summer the Municipalities of Armstrong and Spallumcheen\ncomplained to the Board in regard to a very offensive odour arising from Otter Lake. The Water\nRights Branch were also appealed to. Mr. F. W. Groves, C.K., and the writer made a joint\nsurvey of the lake and its sources. The nuisance or annoyance was found to be caused by\ndecaying algse known as Hydrus fwtitus, its presence causing a very offensive smell. The lake\nis shallow and sluggish. As a remedy it was suggested that the outlet of the lake be cleared\nto promote action and a small quantity of bluestone, 1 to 10,000 parts, be used in those portions\nof the lake where the growth of alga? is noticeable.\nDuring last September a serious outbreak of typhoid occurred in a logging camp in the\nCrowsnest country; total number of cases, 20; fatal, 6. As soon as notified, this Department\ninspected the camp and at once condemned the site as insanitary. Repeated visits have been\nmade by the Provincial police under instructions from the Provincial Board of Health to see\nthat the camp is not used again under -the old conditions. From investigation made it appears\nthat one of the employees had suffered from typhoid fever in an adjoining State a year ago.\nThe general conditions of the camp were insanitary, no fly-screens provided or any disinfecting\nprecaution being thought of, manure allowed to accumulate, and everything was favourable for\nthe propagation of the greatest typhoid-carrier, the fly. There were several sources of good\nwater available, but the poorest, was most convenient and that was the choice.\nThe question of the contamination of watersheds and sources of water-supply of the Cities\nof Vancouver and North Vancouver has assumed an immediate importance owing to the fact\nthat timber limits lying in the watershed area are being worked and mines are to 'be developed.\nThe enforcement of regulations for the protection of the water-supply will throw an increased\nresponsibility on your staff.\nIn the fish- and food-canning supervision by this Department I regret to say that the recent\nexpected big year was to many canners a disappointment. The sanitary conditions of these establishments on the lower part of the Mainland Coast have been satisfactory except in an isolated\ncase.\nThe salmon-canneries located on the Nass and Skeena Rivers, Rivers Inlet, Smith Inlet,\nand Johnstone Strait were visited during the early summer per regular steamer. The general\nsanitary conditions were found to be good. A few requests were made where needed regarding 8 Geo. 5 Provincial Board of Health. G 13\nbunk-houses and conveniences. The regulations in reference to the disposal of fish-offal has not\nso far been rigidly enforced owing to the fact that the majority of them are isolated, and also\nthe purchase of the necessary machinery to handle the offal is at this time impossible owing to\nwar conditions. There are two responsible companies contemplating the erection of fish guano\nand oil plants to serve these northern canneries just as soon as conditions permit. In the\nmeantime we are demanding that many of the existing offal-chutes be extended in order to\nprevent the accumulation of fish-offal upon the foreshore which may be exposed at very low\ntides. There have been many complaints of abominable odours caused by the careless disposal\nof offal at the northern canneries. There is no necessity for such, and we are endeavouring to\nsee this annoyance abated without hardship to the canners or fishermen. Were it not for\nprevailing abnormal conditions in securing material and labour for such work, drastic action\nwould be taken.\nOn the Lower Fraser River inspection visits were made to the following canneries: Scottish\nCanadian, Lighthouse Cannery, Gulf of Georgia, Steves-ton Cannery, Columbia Cod. Storage,\nImperial Cannery, Phoenix Cannery, Britannia Cannery, Gosse-Millard Cannery, Colonial\nCannery, Richmond Cannery, Great West Cannery, Vancouver Cannery, also Nanaimo Cannery\nand Great Northern Cannery on Burrard Inlet. The strict enforcement of our regulations\ngoverning canneries and the hearty co-operation given by the cannery-men has brought about\nalmost perfect methods in the handling of this important food staple, so much so as to elicit\nmost favourable comments from tourists and experts visiting these canneries.\nThe automatic handling of the fish by machinery is gradually bringing about an ideal\ncondition of sanitation as regards the preparation of the salmon for the market. The machines\nInstalled are most ingenious, almost human in their perfect work, cutting, washing, slicing, and\nfilling into solderless sanitary cans under the closest scrutiny of skilled artisans.\nColouring or chemical artifices* have never been introduced into the salmon-canneries of\nBritish Columbia. In the past 'season our work in this direction was curtailed to some extent\nowing to the launch acquired from the Forestry Department needing extensive repairs. Lack of\nlabour and material necessary for such work was not readily available owing to existing war\nconditions. The difficulty is now being overcome, and through the agency of this long-needed\nequipment the Department will be in an improved position to cope with the increasing demands\nfor sanitary supervision in cannery and other industrial camps and settlements scattered along\nthe 5,000 mile coast-line of this Province.\nDuring August complaints were heard in reference to the insanitary conditions existing at\nsome of the fruit and vegetable canning and evaporating plants of the Okanagan Valley. In\nmany instances I found the complaints justified. Toilet and lavatory arrangements provided\nfor the employees were insanitary and inadequate. This was my first visit, and in justice to\nthe managers it is only fair to say tht my inspection was welcomed, and nearly every one\nexpressed a wish to carry out any official suggestions which would promote efficiency and\nimprove the comfort of the employees. Most of these plants are located within municipal\nlimits, but the local authorities are inclined to think the Provincial Board of Health should\nexercise a supervising control in so far as sanitary conditions are concerned where food products\nare prepared for Provincial and export consumption. I beg to suggest the formulating of suitable\nregulations governing these establishments similar to those used for the salmon-canneries, which\nhave been found to work in a highly satisfactory manner.\nOur flies show inspection reports and correspondence on the following establishments:\nGraham Evaporating Co., Armstrong; Graham Evaporating Co., Vernon; Dominion Fruit Cannery, Vernon ; Western Canning Co., Kelowna; B.C. Evaporating Co., Kelowna; Independent\nFruit Cannery, Peachland; Western Canners Co., Ltd., Penticton.\nThe total number of employees approximate some 800; 20 -per cent, women, 50 per cent,\nboys and girls, 10 per cent, white skilled mechanics, and 10 per cent. Oriental. The past fruit\nseason has been very successful in the great Okanagan Valley for growers and canners alike.\nSeveral large canning and preserving plants are expected to be built to take care of the increased\ncrop expected during the coming season.\nDuring the early part of the past summer complaints were lodged with this Department\nregarding insanitary and inadequate conveniences and lack of drinking-water for employees at\nthe Shaud Works, on James Island. Several special visits were made, and it was found that\nthe company had already recognized the needs and was taking practical steps to remedy the G 14 British Columbia 1918\ngrievance (since completed). This concern employs several hundred men and is gradually\nbuilding up a model town. A very competent first-aid man is continually on the works and\nspecial facilities provided for quick medical attendance in case of accident.\nComplaints have recently been lodged regarding water-pollution at several seaside summer\nresorts well patronized by Vancouver and New Westminster citizens. These places will have\nour attention before the coming season.\nIn reference to the requirement of provision of first-aid in industrial camps, I find that the\nsmaller camps are the principal offenders in their neglect of such provision. There is a great\nimprovement in this respect, however, since we have been able to avail ourselves of the services\nof the Provincial police as Sanitary Inspectors in the outlying districts. A complete list of the\nexisting camps has been supplied by a careful canvass of the different police districts, and also\nthrough the courtesy of the Forestry Department, who supplied us with a list of the logging\ncamps. Under the present system of reporting by the police we are able to keep in touch with\nall new camps and to give immediate attention to complaints.\nThe operators have shown a great willingness to carry out all suggestions offered, and the\nprovisions of section 2 of \" An Act for the Protection of Workmen engaged in Industrial\nOperations \" are being observed to a much greater extent than formerly. The section referred\nto is as follows :\u2014\u25a0\n\" 2. Every employer of labour directly or indirectly operating any mine, camp, construction-\nwork, or industry employing more than thirty persons, and being situated more than six miles\nfrom the office of a medical practitioner, shall at all times maintain in or about such industry\nor works at least one person possessing a certificate of competency to render first aid to the\ninjured, and shall also provide a good and sufficient ambulance box or boxes.\"\nI would recommend that the above, in so far as requiring the provision of an ambulance-\nbox, should apply to railway-trains and also to steamers on inland waters. The importance of\nantiseptic treatment of even slight wounds and of other first aid in cases of emergency is now\ngenerally recognized. Many thousands of dollars compensation, the Workmen's Compensation\nBoard's statistics will show, might be saved by preventing blood-poisoning and other serious\nconsequences by the proper use of \" first-aid services.\"\nIn conclusion, permit me to remind you that the office files will show that the work of this\nbranch of the Department has been carried on in a systematic manner and the varied conditions\ndealt with as presented, and I am pleased to be able to say that without exception most courteous\ntreatment is accorded to our Inspectors wherever their duties call them.\nI have, etc.,\nFbank DeGbey,\nChief Inspector.\nHOSPITAL INSPECTION.\nVictoria, B.C., February 1st, 191S.\nH. E. Young, M.D.,\nSecretary, Provincial Board of Health, Victoria, B.C.\nSib,\u2014In submitting for your consideration the Fifth Annual Report on Hospital Inspection\nin British Columbia, I am pleased to say that no serious event has occurred in hospital circles\nhere to mar the report of the capable management shown during the past year.\nThe following licensed private hospitals have 'been periodically inspected and any changes or\nimprovements suggested have been carried out:\u2014\nArnold Maternity Home (Matron, Mrs. M. Arnold), 316 Robson Street, Nelson, B.C.\nBent Sanatorium (Matron, Mrs. E. Bent), 245 Fenwick Avenue, Cranbrook, B.C.\nBritannia Hospital (Superintendent, Dr. Burke), Britannia Beach, Howe Sound, B.C.\nBass Maternity Home (Matron, Mrs. M. C. Bass), 2625 Prior Street, Victoria, B.C.\nBute Hospital (Superintendent, Mrs. M. E. Johnson), Bute and Robson Streets,\nVancouver, B.C.\nBell Nursing Home (Matron, Mrs. L. Bell), 756 Cloverdale Avenue, Victoria, B.C.\nConvalescent Home (Matron, Miss E. O'Brien), 67 Wellington Avenue, Victoria, B.C.\nCoquitlam Hospital (Superintendent, Dr. Sutherland), Port Coquitlam, B.C. 8 Geo. 5 Provincial Board of Health. G 15\nCorbman Maternity Home (Matron, Mrs. E. Corbman), S55 Eleventh Avenue East,\nVancouver, B.C.\nDown Maternity Home (Matron, Miss Rose Down), Battle Street West, Kamloops, B.C.\nEast Kootenay Hospital (Superintendent, Dr. Garner), Jaffray Street, Fernie, B.C.\nGrandview Hospital (Superintendent, Dr. E. Hall), 1090 Victoria Drive, Vancouver, B.C.\nHandley Maternity Home (Matron, Mrs. J. Handley), 1218 Queen's Avenue, Victoria, B.C.\nHarbour View Sanatorium (Matron, Miss E. M-cLeash), 370 Second Avenue East, North\nVancouver, B.C.\nImpey Maternity Home (Matron, Mrs. M. A. Impey), 243 Eighth Avenue West, Vancouver, B.C.\nKitsilano Private Hospital (Superintendent, Miss Annie Scott), 2494 Third Avenue\nWest, Vancouver, B.C.\nLonsdale Private Hospital (Matron, Mrs. M. D. Schultz), 1900 Lonsdale Avenue, North\nVancouver, B.C.\nMoore Nursing Home (Matron, Mrs. E. Moore), Baker and Falls Street, Nelson, B.C.\nMore Maternity Home (Matron, Mrs. C. More), 949 Fisgard Street, Victoria, B.C.\nMcGuffie Maternity Home (Matron, Mrs. M. A. McGuffie), 628 Columbia Street, Kamloops, B.C.\nMcKenzie Nursing Home (Matron, Mrs. F. McKenzie), 1781 Second Street, Victoria, B.C.\nRutherford Maternity Home (Matron, Mrs. E. Rutherford), 2321 Shakespeare Street,\nVictoria, B.C.\nRoadley Nursing Home (Matron, Mrs. L. Roadley), 360 Battle Street, Kamloops, B.C.\nRoy-croft Private Hospital (Matron, Miss Roycroft), 1036 Haro Street, Vancouver, B.C.\nRoss Convalescent Home (Matron, Miss E. G. Ross), 1145 Faithful Street, Victoria, B.C.\nSalmon Maternity Home (Matron, Mrs. A. Salmon), Garden Avenue, Cranbrook, B.C.\nSouth Vancouver Private Hospital (Superintendent, Mrs. Jane Webb), 129S Fifty-first\nAvenue, South Vancouver, B.C.\nSkelland Nursing Home (Matron, Mrs. E. Skelland), 2316 Lee Avenue, Victoria, B.C.\nSt. Luke's Home (Superintendent, Sister Francis), 309 Cordova Street, Vancouver, B.C.\nSunnyview Sanatorium (Superintendent, Dr. Irving), Powers Addition, Kamloops, B.C.\nToniley Maternity Home (Matron, Miss L. Tomley), 129 Twenty-second Avenue West,\nSouth Vancouver, B.C.\nVictoria Private Hospital (Superintendent, Miss J. B. Archibald), 1116 Rockland\nAvenue, Victoria, B.C.\nWest End Hospital (Superintendent, Miss H. G. Tolmie), 1447 Barclay Street, Vancouver, B.C.\nWitt Maternity Home (Matron, Mrs. A. C. Witt), 1845 Forty-sixth Avenue East, South\nVancouver, B.C.\nWinters Nursing Home (Matron, Mrs. M. Winters), 1020 Harwood Street, Vancouver,\nB.C.\nImproved means of fire-escape and protection for every hospital and safer repositories for\nmedicines or drugs have 'been persistently advocated with gratifying results. One sanatorium\n(Neal Institute) has closed its doors through lack of patients, and one convalescent home has\nclosed for the same reason. Four private maternity hospitals have voluntarily closed through\nthose in charge having tendered their services for hospital-work overseas. Three new licences\nhave been granted and a number of applications considered, but not granted owing to lack of\nnecessary qualifications on the part of the applicant or to the premises not being suitable. One\nlicence has been temporarily suspended. A number of illegal so-called maternity or lying-in\nhomes have been suppressed in various parts of the Province, demonstrating the necessity of\nconstant vigilance in carrying out the provisions of the \" Hospital Act Amendment Act.\"\nThe large public institutions, being under control of a Governing Board, with two of the\nmemibers representing the Government, are not subject to the same inspection visits except for\nspecific reason. A cordial co-operation exisits, however, and much valuable information furnished\nfor the purpose of tracing infection sources in the outlying districts.\nThe following Government-aided charitable and public institutions were visited:\u2014\u2022\nSt. Paul's Hospital, Vancouver, B.C.\nAlexander Orphanage, Vancouver, B.C. G 16 British Columbia 1918\nChildren's Aid Society, Vancouver, B.C.\nMonastery of Our Lady of Charity, Vancouver, B.C.\nSalvation Army Maternity Home, Vancouver, B.C.\nProvidence Orphanage, New Westminster, B.C.\nSt. Mary's Hospital, New Westminster, B.C.\nOrange Orphans' Home, New Westminster, B.C.\nQuamichan Boys' Protectorate, Quamiehan, V.I., B.C.\nSt. Ann's Orphanage and School, Nanaimo, B.C.\nSt. Joseph's Hospital, Victoria, B.C.\nThe existing war-time conditions have brought to these institutions increased burdens\nwithout a corresponding increase in income. Indeed, it is a marvel how exceedingly well these\nhomes are managed in the face of such depressing conditions which they have to meet, especially\nin view of the extra calls upon the societies who volunteer their services in assisting such\ncharities.\nI have, etc.,\nFbank DeGbey,\nChief Inspector.\nMEDICAL INSPECTION OF SCHOOLS.\nVictoria, March 22nd, 1918.\nHon. J. D. MacLean,\nProvincial Secretary, Victoria, B.C.\n-Sik,\u2014I beg leave to submit the Report of the Medical Inspection of Schools which has taken\nplace during the past six months. There has been a break in the continuity of the work of the\nDepartment. In 1916 the matter was up before yourself as to the continuance of the inspection\nof schools, and it was decided at the time not to proceed for the time being, pending Investigation.\nIn 1917, however, I was instructed to begin the inspection again, and the consequence is that\nthe report submitted is only for the latter part of the year 1917. The practice heretofore had\nbeen for the examination to be made once during the scholastic year, and while the appointments\nof the medical men were made in September it was not possible, owing to the lateness of the\nseason, in many of the outlying districts to have the inspection made. The consequence is that\nonly one-half of the schools have been reported, and the other half will be inspected during the\nspring term. These reports will not be received until the midsummer. But when these reports\nare received it will enable us to make a full report for the year September, 1917, to September,\n1918, by embodying the reports already received with those which will be received within the\nnext few months.\nI have, in my Report for the Board of Health, suggested to you the advisability of having\nthe annual report of this Department issue at midsummer on account of the difficulty of receiving\nthe returns at the beginning of the year in time for presentation in the House. Should this\nsuggestion be adopted it would not only benefit us in our report of the Vital Statistics Office, but\nespecially so in our report on schools.\nI would beg leave to suggest that the Inspection of Schools Branch of the Department be\ncontinued and a further effort be made to interest local associations in the work. 8 Geo. 5 Provincial Board of Health. G 17\nIt is the intention in Great Britain and in the United States to concert the attention of all\ndepartments upon child-welfare and to reduce infant mortality, and this Department hopes that\nby co-operating with the central portions of this country that we may take our part in this\nnation-wide movement. To accomplish results, however, it will he absolutely necessary that all\nlocal organizations, more especially Women's Institutes, will lend their efforts to the furthering\nof the movement. It is the intention of the Department to make an especial appeal to the\nmedical men who are doing the work to endeavour to appreciate its importance, to advise with\nthe Department, and more particularly to work in conjunction with the parents in an endeavour\nto render effective an educational campaign.\nI would also suggest for your consideration a recommendation to the School Boards of the\nestablishment of open-air school-rooms for weakly and pre-tubercular children. The work already\ndone along these lines has been so satisfactory that I feel justified in urging the adoption of\nsimilar methods in British Columbia.\nI beg leave to submit a detailed report of the work done by the Department, and also copy\nof a report from the Inspectors of the different schools.\nI have, etc.,\nH. E. Young,\nSecretary, Provincial Board of Health.\nSCHOOLS INSPECTED.\nRural and Assisted Schools.\nSchools inspected: 1916, 331, at a cost of $5,653.82; 1917, 129, at a cost of \u00a72,112.75.\nSchools not inspected: 1936, 117; 1.917, 367.\nPupils inspected: 1916, 7,945; 1917, 3,518, a decrease of 4,427.\nCost of inspection per pupil: 1916, 71% cents; 1917, 60% cents.\nPercentage of defects : 1916, 78.50; 1917, 75.64, less 2.86.\nMedical Inspectors: 1916, 28 Medical Inspectors; 1917, 82 Medical Inspectors.\nMedical Inspectors: 1916, S9 reports from the Medical Inspectors; 1917, 35 reports from\nthe Medical Inspectors.\nGraded City Schools.\nCities, 35. 1916: Reported, 27; not reported, 6. 1917: Reported, 14 ; not reported, 21.\nPupils inspected: 1916, 25,254; 1917, 22,564, a decrease of 1,690.\nHigh Schools.\nHigh schools, 38. 1916: Reported, 19; increase of 181 pupils inspected. 3917: Reported,\n16; increase of 54 pupils inspected.\nRubal Municipal Schools.\nMunicipalities: 1916, 2S; reported, 22; not reported, 6. 1917, 27; reported, 12; not\nreported, 3.5.\nPupils inspected: 1916, 10,469, a decrease of 1,093; 1937, 9,012, a decrease of 1,457. G 18\nBritish Columbia\n1918\nHIGH\nName of School.\nMedical Inspector.\nSchool Nurse.\nV\no\ns\ncu\n'ft\nfa's\nd\n.5\nci\n\no\nOJ\nOl\nQ\nei\n0)\nn\n~h *>\nd B\na '3\n^ \"rt\ns> \u00a3\no\ncu\nP\n*f\n\"o\nB\nCD\n42\no\nbo\nNo report 1917.\n102\n62\n52\n99\n58\n52\n1\n2\n2\nCumberland\t\nNo report 1917.\nW. Truax\t\n1\n3\n1\n1\n7\n1\nEnderby\t\nKamloops \t\nM. G. Archibald\t\nNo report 1917.\nW. J. Knox\t\n1\n4\n1\n4\n14\n12\n1\n1\n8\n1\nl\n8\n1\n4\n4\n30\n74\n91\n120\n296\n110\n28\n50\n56\n22\n2\n3\n8\n2\n7\nNo report 1917.\nR. H. Post\t\n79\n91\n160\n327\n110\n30\n50\n56\n26\nMat.squi\t\nVV. F. Drysdale\t\n6\nE. H. McEwen\t\n16\nNo report 1917.\nc\nPrince Rupert !\t\nJ. C. Cade\t\nJ. W. Coffin\t\n3\nNo report 1917.\n3\nVancouver:\nGirls \t\nBelle H. Wilson\t\n387\n750\n297\n290\n203\n223\n170\n287\n1\n6\n22\n16\n8\n14\n8\n12\n3\n10\n4\n1\n4\n2\n2\n13\n13\n\/F. W. Brydone-Jack. )\n\\ Mrs. M. P. Hogg- f\nPupils not examined.\nL. 0. Griffin .. \t\n3\nH. Bone\t\nNo report 1917.\nGRADED CITY\n370\n425\n358\n375\n4\n3\n1\n6\n4\n5\n8\n24\n22\n2\n2\n2\n18\n6\n17\n13\n2\n8\n14\n20\n24\n1\n2\n6\n1\n1\n5\n1\n1\n8\n17\n7\n8\n20\n10\n38\n5\n21\n7\n15\n71\n62\n21\n7\n16\n16\n29\nKamloops \t\nM. G. Archibald\t\n67\nW. J. Knox \t\n17\nG. H. Tuthill\t\n233\n120\n156\n416\n297\n725\n327\n391\n316\n222\n112\n152\n407\n289\n679\n296\n355\n268\n11\nNanaimo :\nW. F. Drysdale\t\n20\nMiddle Ward\n97\n119\n106\n74\nNew Westminster:\nE. H. McEwen\t\n16\n4S\n\u201e \t\n54 8 Geo. 5\nProvincial Board of Health.\nG 19\nSCHOOLS.\na\ncu\ncu\nQ\na)\no\nra\ncs\n3\nTJ\ncu\nGO\n,3\nta\nH\n1\nio'\n21\n1\n1\n11\n2\nHH\n'o\nO\n24\n2\n15\n5\n1\n7\n30\nOther Conditions, specify\n(Nervous, Pulmonary, Cardiac\nDisease, etc.).\n\u00a3\n0)\n1\n3\n6\nft\n\u00a3\ni\no\nd\ns\nAcute Fevers which\nhave occurred\nduring the Past\nYear.\nCondition of\nBuilding. State\nif crowded, poorly\nventilated, poorly\nheated, etc.\nClosets. State\nif clean and\nadequate.\nGood\t\nYes.\nVery poorly ventilated and badly\nheated ; entirely\ninadequate to the\nnumber of pupils\nWell ventilated\nand heated\nGood\t\n2\nSmallpox, 23\t\n6\ninadequate for\nthe pupils.\n3\nWood and cement.\nGood... .y. \t\nFair\t\nAll in good condition\nGood\t\nVentilation improved\nAdequate in all\nrespects\nSatisfactory\t\nFairly good. Ample room\n12\nMeasles, 1\t\nYes.\n28\nGood.\n35\nYes.\n90\n39\n1\n47\n44\nChicken-pox, 25; scarlet\nfever 1 ; mumps, 46\n31\n23\n1\n1\nCardiac, 1; nervous, 1\t\nBoils, S\t\n*>\nGood\t\nGood.\n4\n2\n2 cement pit,\nclean.\ni\n4\n4\n24\n21\n15\n17\n8\"\n84\n42\n65\nChicken-pox, 1; diphtheria, 1\nGood.\nSCHOOLS.\n68\n192\n21\n120\n58\n84\n215\n138\n414\n90\n92\n71\n10\n2\n67\n40\n29\n36\n28\n3\nYes.\nAmple air-space;\nwell ventilated\nand heated\nExcellent, modern\nSatisfactory\t\nFair \t\nClean as plans\nand construction of building allow\nYes.\nChronic Bronchial catarrh, 7;\ncardiac, 4\nCardiac lesions, 2 \t\n1\n1\n8\n3\n1\n3\nChicken-pox, 35; whooping-cough, 2; measles,\n86\nDiphtheria, 3 ; chicken-\npox, 4\nDiphtheria, 1; chicken-\npox, 1\nMeasles, 1 ; chicken-pox,\n17; pertussis, 9\nChicken-pox, 3; pertussis, 4\nChicken-pox, 24; scarlet\nfever, I\nChicken-pox, 25; scarlet\nfever, 1; mumps, 46\nGood in 1-6 div.\nPoor in 7-8 u\nGood.\n1\n1\n3\n4\n7\n21\n31\n31\n9\n9\n150\n2\nGood\t\nHeart murmur, 7; infantile\nparalysis, 1; talipes, 2; chorea,\n1\n3\n39\n47\n5\n44\nYes. G 20\nBritish Columbia\n1918\nGRADED CITY\nName of School.\nNew Westminster.\u2022-Concluded:\nRichard McBride\t\nLord Lester\t\nLord Kelvin.\t\nQueensboro\t\nPrince Rupert:\nBorden Street\t\nKing Edward.\nSeal Cove.,\nRevelstoke:\nCentral .,\nSelkirk .. .\nRossland:\nCentral\t\nCook Ave \t\nSandon\t\nVancouver:\nAberdeen\t\nAlexandra\t\nBayview\t\nBeaconfield\t\nCecil Rhodes\t\nCentral\t\nCharles Dickens \t\nChildren's Aid\t\nDawson\t\nFairview\t\nFlorence Nightingale .\nFranklin\t\nGeneral Gordon\t\nGrandview\t\nHastings\t\nHenry Hudson\t\nKitsilano\t\nLaura Secord\t\nLivingstone\t\nMacdonald\t\nModel\t\nMount Pleasant\t\nNelson\t\nRoberts\t\nSeymour\t\nSimon Fraser\t\nStratheona \t\nMedical Inspector.\nE. H. McEwen.\nJ. C. Cade (acting).\nJ. H. Hamilton.\nJ. W. Coffin ..\nW. E. Gomm .\nSchool Nurse.\nW. Brvdone-Jack )\nH. Wilson )\nW. Brydone-Jack. ... I,\nH. Wilson j\"\nW. Brydone-Jack I\nP-Hogg \/\nW. Brydone-Jack\t\nP.Hogg\t\nW. Brvdone-Jack \u25a0>\np. Hogg r\nW. Brydone-Jack \\\nH. Wilson \/\nW. Brydone-Jack\t\nH. Wilson\t\nW. Brydone-Jack\t\nH. Wilson\t\nVV. Brydone-Jack |\nH. Wilson \/\nW. Brvdone-Jack\t\nP. Hogg\t\nW. Brydone-Jack\t\nH. Wilson.\t\nW. Brvdone-Jack\t\nP. Hogg\nW. Brydone-Jack. .\nP- Hogg\t\nW. Brydone-Jack,..\nP- Hogg\t\nW. Brydone-Jack...\nH. Wilson\t\nW. Brvdone-Jack...\nP- Hogg\t\nW. Brydone-Jack...\nP. Hogg\t\nW. Brydone-Jack...\nH. Wilson\t\nW. Brydone-Jack...\nH. Wilson\t\nW. Brydone-Jack. .\nH. Wilson\t\nW. Brvdone-Jack...\nH. Wilson\t\nW. Brydone-Jack...\nH. Wilson\t\nW. Brydone-Jack...\nH. Wilson\t\nW. Brvdone-Jack...\nH. Wilson\t\nW. Brvdone-Jack...\nH. Wilson\t\nW. Brydone-Jack...\nH. Wilson\t\nW. Brydone-Jack...\nH Wilson\t\nM. A. McLellan\nA. Jeffers\t\nM. A. McLellan. j\nA. Jeffers '\nM. Cruickshanks i'\nM. Ewart..\nE. G. Breeze }\nM. Ewart X\nM. Cruickshanks \/\nA. Jeffers I\nE. G. Breeze \/\nM. A. McLellan.\nM. A. McLellan. )\nM. Ewart f\nM. Ewart ]\nA. Jeffers \/\nA. Jeffers |\nM. Cruickshanks 1\nM. A. McLellan. !\n\u25a0}\nA. Jeffers j-\nA. Jeffers \\\nM. Cruickshanks (\nM. A. McLellan. )\nM. Ewart I\nM. A. McLellan\nA. Jeffers 1\nM. Cruickshanks t\nM. Ewart 1\nM. Cruickshanks \/\nA. Jeffers )\nM. Cruickshanks t\nM. Ewart \\\nM. Ewart..\nA. Jeffers .\nE. G. Breeze...\nM. A. McLellan\nE. G. Breeze...\nM. Ewart\t\nE. G. Breeze...\n348\n261\n315\n86\n390\n216\n42\n334\n526\n242\n176\n344\n509\n274\n122\n831\n593\n629\n168\n347\n467\n420\n458\n409\n308\n328\n362\n497\n639\n602\n837\n489\n494\n306\n203\n328\n216\n30\n285\n458\n230\n188\n355\n433\n268\n176\n726\n479\n530\n192\n2S3\n478\n460\n375\n349\n288\n302\n329\n464\n505\n537\n741\n479\n463\n644\n5\n52\n1\n41\n30\n26\ni\n32\n6\n42\n6\n59\n4\n20\n2\n12\n7\n67\n4\n60\n1\n55\n2\n33\n6\n42\n2\n45\n1\n25\n8\n67\n7\n61\n3\n10\n2\n17\n2\n26\n5\n68\n3\n40\n1\n45\n5\n54\n9\n91\n2\n58\n9\n88 8 Geo. 5\nProvincial Board of Health.\nG 21\nSCHOOLS.\u2014Continued,\n121\n73\n50\n189\n112\n169\n49\n46\n140\n151\n92\n52\n81\n110\n124\n118\n148\n180\n188\n121\n157\n202\nOther Conditions, specify\n(Nervous, Pulmonary, Cardiac\nDisease, etc.).\nNervous, 2 ; pulmonary, 2 ; cardiac, 1; anaemia, 1; otitis\nmedia, 1\nNervous, 2 ; pulmonary, 2 ;\nBrights, 1\nNervous, 1; ansemia, 1\t\nAbsence left palate, 1\t\nCleft palate, 1; osteo-myelitis,\n1; myocarditis, 1\nCardiac, 2\t\nCardiac, 2\t\nVaccinated,\n2\nVaccinated,\n1\nVaccinated,\nVaccinated,\n1\nVaccinated,\n2\nVaccinated,\nlung, 1\nVaccinated,\n1\n\\ accinated,\nVaccinated,\nung, 12\nVaccinated,\nlung, 6\nVaccinated,\n2\nVaccinated,\n2\nVaccinated,\n4\nVaccinated,\n2\nVaccinated,\nVaccinated,\n3\nVaccinated,\n12\nVaccinated,\nVaccinated,\n1\nVaccinated,\nVaccinated,\nlung, 1\nVaccinated,\nVaccinated,\n1\nVaccinated,\nlung, 1\nVaccinated,\nlung, 9\nVaccinated,\nlung, 8\nVaccinated,\nlung, 5\n72; cardiac, 5; lung,\n66; cardiac, 4 ; lung,\n25 ; cardiac, 7\t\n30; cardiac, 6; lung,\n63; cardiac, 7 ; lung,\n115 ; cardiac, 8;\n29; cardiac, 2; lung,\n14; cardiac, 7\t\n168; cardiac, 19;\n94; cardiac, 10;\n72; cardiac, 9; lung,\n56; cardiac, 2 ; lung,\n75 ; cardiac, 4 ; lung,\n53; cardiac, 7; lung,\n45 ; cardiac, S\t\n63; cardiac, 7; lung,\n53; cardiac, 6 ; lung,\n40; cardiac, 1\t\n66; cardiac, 5; lung,\n50; cardiac, 3\t\n66; cardiac, 13;\n44; cardiac, 5\t\n49; cardiac, 8; lung,\n193; cardiac, 13;\n84; cardiac, 13;\n41; cardiac, 11;\n135 ; cardiac, 8 ;\nAcute Fevers which\nhave occurred\nduring the Past\nYear.\nScarlet-fever, 1; chicken-\npox, 1; tonsilitis, 1;\nT. B. spine, 1\nTonsilitis, 1; chicken-po.x,\n6 ; measles, 2 ; influenza, 1\nChicken-pox, 2\t\nWhooping-cough..\nWhooping-cough..\nCommunicable diseases in children of\nschool age in Vancouver City:\u2014\nChicken-pox 287\nDiphtheria 21\nMeasles 67\nMumps 493\nScarlet fever 32\nWhooping-congh 51\nInfantile paralysis 3\nCondition of\nBuilding. State\nif crowded, poorly\nventilated, poorly\nheated, etc.\nGood\t\nAdequate, fairly\nheated and ventilated\nAdequate, well-\nheated and ventilated\nAdequate, well-\nheated and ventilated\nGood.\t\nSatisfactory\t\nGood [.'.['.\nClosets. State\nif clean and\nadequate.\nYes.\nGood.\nYes. G 22\nBritish Columbia\n1918\nGRADED CITY\n\u25a06\n..\nu\nd\nc\na\nte,\nIs\na\nbib\ns\n-\u2014 ti\nIT\nrt =\nName of School.\nMedical Inspector.\nSchool Nurse.\nBj\ng*\n\nciS\n5\na\no\nA\n>\ntc\n^ rt\n\u00a3\na\n=jjjj\nOJ\n>\n\n1\n8\n1\n1\n2\n1\n7\n5\n2\n1\n2\n2\n1\ni\ni\n3\n2\n1\n2\n5\n3\n3\n5\n8\n2\n5\n3\n4\n5\n2\n5\n4\n4\n1\n7\n6\n4\n8\n10\n1\n1\n\"i\ni\nT\n\"i\n1\n1\n2\n1\n1\n1\n3\n1\n8\n7\n7'\n2\n4\n6\n6\n9\n4\n5\n27\n1\n2\n8\n1\n1\n2\n1\n2\ni\n1\n2\n10\n9\n6\n5\n6\ne\ni\n7\n1\n6\n2\n2\n2\n4\n4\n2\n1\n14\n3\n2\n1\n7\nl\n2\n5\n2\n6\n9\n8\n4\n30\n8\n2\ni\n2\n2\n3\n2\n4\n1\n14\n7\n14\n5\n\"l\n1\n2\n2\ni\n3\n1\n1\n2\n2\n1\n3\n2\n6\n2\n1\n1\n1\n4\n1\n1\nli\n15\n5\n3\n2\n5\n2\n9\n3\n1\n1\nS\n3\ni\n2\n2\n\t\n5 8 Geo. 5\nProvincial Board of Health.\nG 23\nSCHOOLS. \u2014Concluded.\nH3\nCU\nCU\nH\nI\no\nCU\n\"cu\n0\n03\n3\n\u25a0a.\nbo\nil\n13\n63\n20\n2\n1\n1\n4\n'o\nO\n8\n2\nOther Conditions, specify\n(Nervous, Pulmonary, Cardiac\nDisease, etc.).\n.9\n3\nO\n6\ncu\nft\n\u00a3\nK\nO\n&\nbo\nd\njg\n1\n1\nAcute Fevers which\nhave occurred\nduring the Past\nYear.\nCondition of\nBuilding. State\nif crowded, poorly\nventilated, poorly\nheated, etc.\nClosets. State\nif clean and\nadequate.\n95\nVaccinated, 64; cardiac, 8; lung,\n6\nMeasles and chicken-pox\nMeasles and chicken-pox\nMeasles and chicken-pox\nGood\t\n14\n2\nV\nYes\n80\n\"2'\n76\n4\n1\nSCHOOLS.\n116 3\n7 ....\n7 ....\n4 ....\n4 ....\n8 ....\n2 ....\nEczema, 1; uncleanliness, 7 ;\nhronchitis, 2; heart-trouble,\n5 ; wax in ears, 4 ; rhinitis, 1;\nthickened nasal septum, 3\n2\n2\nChicken-pox, 40; measles,\n3 ; mumps, 1; diphtheria, 2\nGood\t\nYes.\n12\n8\nUncleanliness, 1; pulmonary, 1;\ntuberculosis, 1; wax in ears,\n1 ; rhinitis 1\n20\n19\n\"\n9\nScarlet fever ; mumps, 1\n53\n2 7\n1 3\n3\n.. 4\n.. 4\n.. 3\n.. 1\n.. 1\n.. 1\n'.'. \"b\n.. 1\n.. 10\n.. 10\n2 ....\n3\n4\n29\n4\nGood.\n18 ..\nGood\t\n34 ..\n5\n6 ..\nYes.\n10 ..\n3 ..\n3 ..\n3 ..\n.\n9 .\n21 ..\n12 ..\n9\n2\n3\n2 . .\n5\n1 ....\n2\n5\n13\n1 ....\n4\n14 ..\n4 ..\n\" \t\n9 ..\n3\n10\n50\n8 ....\n5\n18\n1 1\n2 1\n1 ....\n22\nChicken-pox. 27\t\nChicken-pox, 10 ; whooping-cough, 2\nChicken-pox, 15\t\nGood\t\nYes.\n12\n24\n2 1\n1 ....\n2\n3\n10\n8\n2 ....\n6 ..\n5 ..\n2\n1\n2\n2\nMeasles and chicken-pox\n15 ..\n.. 1\nLame from infantile paralysis, 1\nYes.\n2 ..\nGood\n6 ..\n- \u2022\nYes.\n5 ..\n4\n7 ..\n.. 1\n7 1\n2 ....\nCretin, 1\t\n4 ..\nBad\t\nGood..\n28\n3\n9\n23\n7 ....\nWhooping-cough, 5;\nmumps, 1\nMumps, 1; chicken-pox, 2\n3 ...\n10\n13\n3* ... G 24\nBritish Columbia\n1918\nRURAL MUNICIPALITY\nName of School.\nMaple Ridge.\u2014Concluded\nHaney\t\nYennadon\t\nHaney, Superior....\nMaple Ridge, Senior\nMaple Ridge, Junior.\nHammond\t\nMatsqui:\nAberdeen \t\nBradner\t\nClayburn \t\nDunach\t\nGlenmore\t\nJubilee\t\nMount Lehman\t\nPeardonville\t\nPoplar\t\nRidgedale\t\nOak Bay:\nMonterey\t\nWillows \t\nPitt Meadows:\nPitt Meadows\t\nRichardson\t\nPoint Grey:\nEburne\t\nMagee\t\nLord Kitchener\t\nShaughnessy\t\nQueen Mary.\t\nKerrisdale\t\nSaanich:\nKeating\t\nMackenzie Avenue...\nRoyal Oak\t\nNorth Dairy\t\nCraigflower\t\nCedar Hill\t\nCadboro Bay\t\nTillicum Road \t\nSaanichton\t\nProspect\t\nSaanich, West\t\nGordon Head\t\nStrawberry Vale ....\nTolmie\t\nVancouver, North:\nLynn Valley-\t\nKeith Lynn\t\nCapilano .\nNorth Star\t\nVancouver, South:\nLord Selkirk\t\nTecumseh\t\nCarleton\t\nMedical Inspector.\nG. Morse .\nR. H. Port.\nF. T. Stainer..\nG. Morse\t\nAndrew Lowrie .\nC. D. Holmes\nE. A. Martin.\nL. O. Griffin .\nSchool Nurse.\n64\n17\n27\n25\n61\n32\n61\n57\n17\n23\n7\n46\n27\n19\n45\n278\n147\n40\n16\n248\n122\n224\n157\n187\n52\n119\n75\n123\n72\n14\n26\n33\n17\n55\n37\n167\n34\n35\n85\n460\n54\n15\n17\n25\n57\n29\n57\n62\n12\n13\n38\n24\n11\n245\n139\n31\n12\n243\n96\n221\n154\n181\n45\n80\n16\n49\n30\n43\n343\n167\n34\n35\n85\n525\n458\n1\n5\n11\n104\n67 8 Geo. 5\nProvincial Board op Health.\nG\nSCHOOLS.\u2014Continued.\n4 .\ncu\nCD\nH\na)\no\nCD\nCD\n0\n\u25a0a\nB\nci\n3\nCD\n50\nt.\n.CS\n*c\na\n3\n'o\n0\nOther Conditions specify*,\n(Nervous, Pulmonary, Cardiac\nDisease, etc.).\nCJ\n1\na\nd\n_bxi\nft\no\n\u202250\na\n3\nAcute Fevers\nwhich have occurred\nduring the Past\nYear.\nCondition of Building. State if\ncrowded, poorly\nventilated, poorly\nheated, etc.\nClosets. State\nif clean and\nadequate.\n33\nDiphtheria, 2; mumps, 15\nGood\t\n9\n8\n1\n4\n3\n8\n12\nDiphtherial; mumps, 2;\nwhooping-cough, 7\n14\n4\n1\n1\n2\ni\n3\n9\nYes\n3\nTubercular bone, 1; bronchitis, 1\n2\n1\n2\nGood\t\n3\n1\nWhooping-cough, 10\t\n1\n4\n3\n1\nGood\t\n2\n3\n7\n136\n24\n11\n1\n4\n1\n2\n3'\n73\n14\nWhooping- cough, 10;\nchicken-pox, 1\nGood. ...\n8\n79\n15\n4\n12\n11\n12\n8\n2\n9\n3\n4\n5\n4\n29\n17\n19\n33\n21\n32\n2\n5\n1\n1\n2\n3\nNervous, 1; cardiac, 4; pulmonary, 1 ; orthopaedic, 1;\nskin, 1\nCardiac, 3; nervous, 1 ; pulmonary, 1 ; skin, 1 ; nephritis, 1\nNervous, 1 ; cai'diac, 3 ; skin, 1;\northopaedic, 1\nNervous, 3; cardiac, 4; pulmonary, 2; orthopaedic, 4\nNervous, 1; cardiac, 2 ; skin, 1;\npulmonary, 2 ; orthopaedic, 4\nCardiac, 6 ; pulmonary, 2 ; orthopaedic, 1; skin, 2\n9\n2\n4\nChicken-pox, 6; scarlet-\nfever, 2\nScarlet fever, 4 ; measles,\n3; chicken-pox, 1; influenza, 3\nScarlet fe\\ er, 2 ; tuberculosis, 1; measles, 9,\ntyphoid 1; mumps, 3\nScarlet fever, 1; mumps,\n24; chicken-pox, 2\nChicken-pox, 25; measles,\n2 ; scarlet fe^er, 1\nChicken-pox, 23; scarlet\nfever, 25 ; measles, 6\n16\n36\n4\nExcellent, ventilation improved\nOvercrowded in\nDiv. II.\nSmall building\novercrowded\nGood except Div.\nIII. overcrowded\nGood\t\n\u00bb\n44\n34\n49\n18\n2\n2\n\"\n32\nMeasles\t\nMeasles and chicken-pox\nMeasles\t\nMeasles ; diphtheria, 1..\nMeasles\t\nMeasles\t\n20\n1\nin order.\n(W\n\u00bb \t\n29\n21\nCatarrh of throat, 1 ; eczema, 1\n1\n2\nNo water supply..\n12\n4\n4\n2\n3\n2\n3\n12\n4\n1\n1\n1\n50\n23\n23\n13\n1\n2\n10\nNo water supplv..\nGood\t\nNo water supply..\n14\nMeasles\t\nMeasles\t\nMeasles\t\nMeasles; chicken-pox;\nmamps\nMeasles and chicken-pox\nMeasles and chicken-pox\nMeasles and chicken-pox\nMeasles and chicken-pox\nMumps, 33; chicken-pox,\n24; wrhooping-cough, 2\nMeasles, 7; mumps, 1;\nchicken-pox, 1; whooping-cough, 1\nMeasles, 2 ; mumps, 5 ;\nchicken-pox, 6; scarlet\nfever, 1\n10\n19\n4\n14\n1\n125\nInfantile paralysis, 1; acne, 3 ;\ncatarrh, 1; eczema, 11; otorr-\nhcea, 1 ; defective speech, 1;\nstammering, 1\nYes.\n55\nIS\n19-\n\" \t\n21\n382\n339\n282\n4\n16\n7\nNervous, 1; pulmonary, 1; cardiac, 4; anaemia, 10; unclean, 1\nNervous, 2; pulmonary, 3; cardiac, 9 ; anaemia, 5 ; unclean,\n4\nPulmonary, 2; cardiac, 3;\nanaemia, 1\n6\n13\n9\n3\n8\n9\n13\n3\nLighting fair \t\nit ....\nGood,\nn G 26\nBritish Columbia\n191S\n1\nRURAL MUNICIPALITY\nName of School.\nMedical Inspector.\nSchool Nurse.\n<5\n\"3\nu\nc\n\nQ\n2\n1\na\no\n\"Eo\na;\nCJ\nty\nOl\n18\n12\n11\n20\n6\n15\n7\n1\n2\n13\n6\nti\nOS\nCD\nX\nV\n>\nO\na>\nCJ\nft\n17\n8\n12\n12\n6\n12\n5\n1\n8\n2\n.-, ci\ncS.5\n\u00a3 H=\nBjj\nCJ CD\nCD\nCD\nB\n5\n12\n9\n22\n5\n11\n8\n1\n2\n16\n4\n3\n'o\nc\nCD\n\"d\n\nCD\na\nB\nCD\nCJ\nCD\no\n1\nbo\n_c\n'E\nrt\nCD\nX\nCO\nCJ\nCD\nCJ\n0\n1\nrt E\nCj fD\n\u25a0i&\nCD\nCD\nCJ\nO\n1\nCO\n*d\n'0\nB\ncd\n-d\n<\n1\n0\nH\n*d\nCD\nbo\n\u25a0a\n92\n15\n20\n25\n49\n18\n41\n11\n12\n8\n10\n112\n21\n15\n279\n8\n8\n23\n52\n8\n9\n43\n13\n20\n38\n35\n14\n103\n22\n20\n28\n24\n11\n33\n39\n9\n11\n76\n23\n66\n14\n20\n15\n9\n41\n59\n40\n13\n25\n35\n150\n103\n23\n39\n13\n42\n33\n8\n8\n18\n42\n12\n67\n70\n89\n13\n18\n23\n44\n15\n40\n9\n8\n7\n9\n113\n19\n11\n260\n8\n8\n13\n50\n7\n8\n41\n13\n20\n37\n32\n11\n100\n18\n18\n26\n23\n9\n22\n38\n9\n10\n72\n22\n66\n11\n18\n15\n9\n38\n55\n39\n12\n22\n33\n150\n100\n17\n36\n9\n41\n22\n8\n6\n17\n38\n12\n60\n66\n47\nFife\t\n4\nW. Truax\t\n\"i\"\n1\n1\n1\n3\nT\n1\n3\n2\n1\ni'\n1\n1\n1\n5\n3\nD. Black\t\n4\nC. Ewart \t\n9\n1\nMrs. Campbell\t\n13\nD. Black\t\n1\n1\n1\n4\n3\n3\n28\n6\n2\n12\n2\n4\n3\n24'\n9.\nHappy Valley\t\nL. Broe \t\nMiss McTaggart ..\n27\n3\n2\n\"i\"\n1\n13\n9\n4\nT. J. McPhee\t\nMiss C. Collishaw7.\n65\nHat Creek..\nH. D. Leitch\t\n1\nHeffley Creek\t\nH. H. Murphy\t\nRobert Elliott\t\n9\nHedley . . \t\n4\n2\n3\n3\n1\n5\nHillier\t\n1\nJ. C. Elliott \t\n3\n1\n1\n2\n1\n3\n5\n4\n4\nP. W. Turner\t\n2\n1\n\"i\ni\n2\n5\nD. Black\t\n14\nNo report 1916-17.\nRobert Elliott\t\n3\n1\n2\n1\n4\n6\n9\nD. McCaffrey\t\n1\n1\n6\n2\n1\n2\n2\n'0\nLangford\t\n5\n5\n4\n1\n5\n3\n\"i\"\n3\n2\n9\n2\n3\n2\nm\nH. R. Fort\t\n2\nJohn Nay \t\nMrs. Campbell\t\n5i\n3\ni\n1\n2\n2\n11\nD. Black \t\nl\ni\ni\n4\nNanaimo Bay\t\nT. J. McPhee\t\n\"s\n2\n1\n2\ni\n6\n7\n12\n1\n2\n1\n1\n2\ni\n6\n2\n2\n9\nRobert Elliott\t\n2\n2\n2\nMrs. Campbell\t\n3\nNorth Bend\t\nH. R. Fort\t\n4\n5\n10\n1\n3\n1\n1\ni\ni\n10\n1\n2\n1\n8\nNorthfield\t\nT. J. McPhee\t\n4\n6\nOlalla\t\nRobert Elliott\t\nOtter Point\t\nW. D. Calvert\t\n2\n3\n1\n6\n2\n3\n10\n20\n50\nD. McCaffrey ....\n20\n2\n3\n2\n1\n2\nG. R. Baker\t\n1\n1\n3\n1\n2\n3\n3\n1\n2\n3\nSt. Elmo..\nJ. C. Elliott . ....\n3\n1\n3\n3\n1\n1\n3\n3\nMrs. Campbell\t\n8\n3\n1\n1\n3\n4\n2\n1\n1\n7 8 Geo. 5\nProvincial Board of Health.\nG 29\nSCHOOLS.\u2014Continued.\n\nl-H\n35\nii\n7\nCM\n8\n32\n6\n31\n7\n6\no\n35\n24\n12\n21\n17\n1\n22\n2\n16\n11\nlie\na\nc:\n42\n3\n16\n8\n1\n2\n48\n4\n19\n6\n104\nIO\n\u00a9\n-.\n34\n4\n10\n4\n1\n48\n4\n16\n7\n100\n<2\nc\n<5\n39\n4\n15\n6\n2\n1\n45\n6\n11\n2\n110\n|\n63\n26\n21\n4\n10\n53\n9\n22\n26\n217\n00\n8\n72\n9\n29\n5\n6\n1\n33\n11\n19\n5\n162\n33\n44\n41!)\nOh\n09\n55\n18\n14\n16\n1\n69\n12\n30\n10\n168\n46\n36\n450\no\n5j\n102\n16\n23\n14\n7\n1\n74\n51\n31\n5\n164\n61\n42\n580\n92\n23\n68\n31\n11\nC-l\ncs\n99\n15\n36\n12\n13\nCO\ncc\n85\n27\n35\n18\n11\nH*\ncr.\n42\n23\n11\n3\n1\n32\n9\n11\nii\nc.\n23\n.37\n18\n1\n12\nC:\n24\n21\n19\n7\n6\n3\n53\n7\n45\n17\n224\n92\n36\n664\n*c?\nO\nhi\n974\n258\n386\n162\n104\n8\n1,040\n234\n430\n211\n2,952\n763\n671\n8,193\n54.11\nWhooping-cough\t\n14.33\n21.44\n9.00\n5.77\n0.44\n38\n6\n11\n98\n29\n4\n13\n3\n102\n30\n6\n11\n6\n155\n53\n24\n80\n10\n237\n86\n60\n724\n130\n23\n39\n10\n258\n124\n63\n822\n113\n24\n10\n11\n105\n66\n51\n648\n108\n13\n45\n11\n188\n04\n47\nB61\n72\n14\n34\nIS\n167\n62\n47\n470\n35\n14\n20\n36\n228\n140\n49\n622\n57.77\n13.00\nPurulent infection and septicaemia\t\n23.9\n11.72\nPneumonia \t\n164.00\n76.30\n22\n274\n26\n280\n22\n812\n19\n260\n24\n277\n16\n243\n20\n261\n47\n408\n37.28\n* Bronchopneumonia does not appear to have been segregated until 1908 ; consequently the average is for 10 and not 18 years.\nRe cancer: The following statement is self-explanatory. The total number of deaths, 24S,\nis 6.36 of all deaths and 0.65 per thousand of population.\nVictoria Division .. ..,\t\nNew Westminster Division\nNanaimo Division\t\nBeatou Croup\t\nAlberni Group\t\nAshcroft Group\t\nFairview Group\t\nVancouver Division\t\nTotals\t\nMale.\n128\n120\n28\n33\n61\n14\n9\n23\n4\n3\n7\n5\n5\n10\n3\n2\n5\ni3\n'7\n20\n61\n61\n122\n248\nRe tuberculosis: Deaths from tuberculosis, all forms, are shown below,\nbeing 10.6 of all deaths and 1.08 per thousand of population.\nTotal deaths, 413,\nMale.\nFemale.\nTotal.\n39\n27\n10\n19\n5\n5\n38\n111\n18\n17\n7\n9\n4\n3\n31\n70\n57\n44\n17\n28\n9\n8\n69\n181\nTotals\t\n254\n159\n413\nReference to both tuberculosis and cancer is made elsewhere. G 36 British Columbia 1918\nThe following information is presented as a comparative statement re the ages of decedents\nfor the years 1916 and 1917 :\u2014\n1916. 1917.\nUnder 1 year 601 587\n1 to 2 years 121 S2\n2 to 5 years 108 107\n5 to 10 years 70 76\n10 to 20 years 104 154\n20 to 30 years 29S 329\n30 to 40 years 451 473\n40 to 50 years 486 451\n50 to 60 years 450 456\n60 to 70 years 413 461\n70 to 80 years 348 341\n80 to 90 years 175 158\n90 years and up 22 18\nAge not given 37 28\nAge and sex not given 2\nTotals 3,686 3,721\nIn the above figures the still-born are not included with deaths under one year. There were\n201 still-births reported in 1916 and 175 in 1917.\nIn connection with the above, it is worthy of note that, notwithstanding the heavy showing\nof infant mortality in each year, if we take the columns of each year, from infancy to 39 years,\nthe totals are respectively 1,753 and 1,808, whilst the columns from 40 to final age returns stand\nrespectively 1,933 to 1,913. This shows a wonderful evenness and calls attention to the longevity\nof the people of the Province. From the age of 60 years up, we have 958 in 1916 and 978 in 1917.\nIn compiling this report we have, necessarily, been compelled to scan the annual reports of\nthis Department for several years back. Whilst so engaged we chanced upon a paragraph in the\nreport for 1914 : \" Another piece of work undertaken and almost completed has been the arrangement and placing in alphabetical order of all the returns received by this office since 1872. The\ndocuments from each district have been gathered together and bound, so that what belongs to\nVictoria, or any other place, may be found by itself under its proper year and letter. The undertaking entailed no little labour, but the results certainly justify the course pursued.\" The staff\ntakes it for granted that all persons are entitled to rejoice when they have successfully accomplished an important undertaking. In this case the end of the task is so near that we announce\nits completion, and hold all returns duly placed under their respective districts and arranged in\nalphabetical order.\nIn the same report we find allusion to church registers. The different denominations have\ngenerally responded cheerfully, and for their co-operation we take this occasion to thank them;\nyet the greatest is still behind. Arrangements have finally been made whereby we have had\nplaced at our disposal the records of the Church of England antedating the Oregon award by\nseveral years. With these documents duly classified and arranged, it is held that the Province\nof British Columbia may with pride compare records with any Province in the Dominion of\nCanada.\nRe the matter of vital statistics of the Indians of British Columbia : Up to the year 1916\nthe registration of births, deaths, and marriages among Indians received no recognition at the\nhands of this Department, section 3 of the \" Vital Statistics Act\" preventing such registration :\u2014\n\" 3. The provisions of this Act shall apply to every person resident within this Province,\nwhether such residence be permanent or temporary, and shall apply to all races and nationalities\nexcept persons who are Indians within the meaning of the Act of the Dominion Parliament\nrespecting Indians.\"\nIn 1914 the Department of Indian Affairs at Ottawa took the matter up with the Government\nof this Province and urged amendment of our Act to the end that Indians should receive the same\nrecognition under the Act as that accorded all other peoples. After considerable correspondence,\nwhich need not be introduced here, extending over a period of two years, a compromise was 8 Geo. 5 Provincial Board of Health. G 37\neffected, and the following amendment to the Act was made in 1916 and became a part of the\nlaws of the land:\u2014\n\" 2. Section 3 of the ' Vital Statistics Act,' being chapter 81 of the Statutes of 1913, is hereby\nrepealed, and the following is substituted therefor:\u2014\n\"'3. (1.) The provisions of this Act shall apply to every person, of whatever race or\nnationality, resident within this Province, but shall not, except as herein provided, apply to the\npersons who are Indians within the meaning of the Act of the Dominion Parliament respecting\nIndians.\n\"'(2.) For the purpose of compiling statistics of births, deaths, and marriages of such\nIndians, the Registrar may accept returns to be made monthly by the respective Indian Agents\nin the Province, and such returns shall be kept separate and apart from the other returns\nauthorized or required by this Act, and shall be made according to the forms specially prepared\nby the Registrar.' \"\nFrom and after the passage of the amendment everything was done in regular order; the\nfirst thing, naturally, was the appointment of the various Indian Agents as Registrars, etc., for\nIndians only, as follows:\u2014\n\" Provincial Secretary's Office,\nOctober 26th, 1916.\n\" His Honour the Lieutenant-Governor in Council has been pleased to appoint the undermentioned Indian iVgents to be Registrars under the ' Marriage Act,' and District Registrars of\nVital Statistics, for Indians only :\u2014\nName. Agency. Address.\nAV. R. Robertson Cowichan Duncan.\nC. A. Cox West Coast Alberni.\nR. E. Loring Babine Hazelton.\nIvor Fougner Bella Coola Bella Coola.\nJohn F. Smith Kamloops Kamloops.\nR. L. T. Galbraith Kootenay Fort Steele.\nH. Graham Lytton Lytton.\nChas. C. Perry Nass Prince Rupert.\nPeter Byrne New Westminster New Westminster.\nJ. R. Brown Okanagan Vernon.\nThos. Deasy Queen Charlotte Masset.\nW. S. Simpson Stikine Telegraph Creek.\nW. J. McAUan Stuart Lake Fort Fraser.\nIsaac Ogden Williams Lake Lac la Hache.\nW. M. Halliday *.. Kwawkewlth Alert Bay.\"\nSpecial forms were printed, all necessary books and other supplies furnished and forwarded\nto the different agencies, in addition to which the Indian Department at Ottawa notified its\nvarious agents by circular letter of the amendment to the Act, etc., closing the letter with the\nfollowing paragraph:\u2014\n\" You will therefore receive instructions from the Registrar of Births, Deaths, and Marriages,\nfully instructing you in your duties as Registrar, and I am to inform you that the Department\nconfirms your appointment as such and will be glad if you will endeavour to carry out any\ninstructions that may be sent you by the Provincial Registrar.\"\nWhilst the foregoing work was under way, our \" exchanges \" were closely watched in the\nhope that something bearing on Indian vital statistics might appear. The most pertinent coming\nunder observation contains the following:\u2014\n\" It has been generally believed that the white man's civilization was inimical to the red\nman. ... It seems now that these conclusions were without basis in fact, and that the\nrace is really Increasing nearly as fast as the white race.\"\nIf such a condition has been rendered possible on one side of a national 'boundary-line, there\nis every reason to believe that it can be done on this side, and that the line itself will never\nrise and say: \" Thus far shall civilization of the Indian come, and no farther.\" G 38 British Columbia 1918\nIn justification of the position assumed in the foregoing paragraph, we must be permitted\nto quote from the Annual Report of the Department of Indian Affairs. Therein is found that:\u2014-\nBritish Columbia has an Indian population of 25,399\nBritish Columbia has land under crop, acres 11,603\nBritish Columbia has produced grain, roots, bushels 567,528\nBritish Columbia has produced hay, tons 24,847\nRepresenting a total value of $598,329\nOntario, the premier Province, has an Indian population of 26,162\nOntario has land under crop, acres 16,1S0\nOntario has produced grain, roots, bushels - 495,767\nOntario has produced hay, tons 31,958\nRepresenting a total value of $506,648\nBritish Columbia standing above her nearest competitor by $91,681. And her Indian\npopulation is treated as a negligible quantity.\nIt may be urged that this trifling critique is out of place, but the facts tempted me and I\nwandered.\nThe reports from the Indian Agents as a whole are not satisfactory. In some cases the\nAgents have evidently taken considerable trouble, even gone out of their way, to comply With\nthe instructions issued from this office, whilst others (particularly Okanagan and Williams\nLake) have ignored the business entirely\u2014no notice of any kind having been received for the\nwhole year. In other cases, instead of reporting monthly, as per their instructions, the Agents\napparently await the accumulation of a batch sufficiently large to fill an envelope before attempting to forward the documents to this office. However, this is only the first year, and hope\nstill lives.\nThe following is a brief summary of the returns as received:\u2014\nBirths 144\nDeaths 310\nMarriages 67\n\/ \t\nTotal 521\nTotal registrations made for the year, 521 for a population of 25,399, the number given in\nthe Report of the Department of Indian Affairs for 1915. The deaths exceed the births by 160,\nand we have record of only 67 marriages. Evidently there is a laxness somewhere which must\nbe overcome.\nThe cash receipts for the year amount to $1,430.15, being $225.65 in excess of 1916.\nCertificates issued for military purposes, as nearly as can be arrived at, stand between\n4,000 and 5,000. The number is assumed because the offices in Victoria and Vancouver together\nhave issued 3,455, to which must be added what was issued by the different District Registrars.\nThe above certificates are issued free of charge.\nThe various forms of tabulated statements used in last year's report have been retained and\nsome new ones introduced.\nLetters received and dealt with in 1917, 4,590; notices received of marriage licences issued,\n2,864; notices of births received from physicians (for Victoria Division only), 1,038. Whilst on\nthis topic it may not be out of place to point out that, in addition to the regular work, the staff\nhas in the last four years indexed, classified, and arranged in alphabetical order returns of births,\ndeaths, and marriages numbering 184.525 lines.\nI have the honour to be,\nSir,\nYour obedient servant,\nM. MILLER,\nDeputy Registrar, Births, Deaths, and Marriages. 8 Geo. 5\nProvincial Board of Health.\nG 39\nBIRTHS, 1917.\nMining Division.\nAinsworth\u2014\nKaslo\t\nArrow Lake\u2014\nNakusp ...\nAtlin\u2014\nAtlin\t\nAshcroft\u2014\nAshcroft\t\nAlberni\u2014\nAlberni \t\nBella Coola\u2014\nBella Coola\t\nCariboo\u2014\nBarkerville\t\nFort George\t\nTete .laune Cache\t\nClayoquot\u2014\nClayoquot\t\nClinton \u2014\nClinton\t\nFort Steele\u2014\nCranbrook \t\nFernie\t\nGreenwood\u2014\nGreenwood\t\nGrand Forks\u2014\nGrand Forks\t\nGolden\u2014\nGolden\t\nKamloops\u2014\nKamloops\t\nLiard\u2014\nPorter's Landing ....\nLardeau\u2014\nBeaton\t\nLillooet\u2014\nLillooet\t\nNicola\u2014\nNicola\t\nNelson\u2014\nNelson \t\nNew Westminster\u2014\nNew Westminster.. .\nBurnaby \t\nChilliwack\t\nOutside\t\nNanaimo\u2014\nNanaimo\t\nAlert Bay\t\nComox\t\nLadysmith\t\n)yoos\u2014\nFairview\t\nOmineca\u2014\nHazelton\t\nFort Fraser\t\nPortland Canal\u2014\nStew-art\t\nPeace River\u2014\nFort St. John\t\nHudson Hope\t\nPouce Coupe\t\nQuesnel\u2014\nQuesnel\t\n150-Mile House\t\nQuatsino\u2014 %\nQuatsino\t\nQueen Charlotte-\nQueen Charlotte City\nRevelstoke\u2014\nRevelstoke\t\nSimilkameen\u2014\nPrinceton.. \t\nSlocan\u2014\nNew Denver... \t\nSlocan City Division \u2014\nSlocan City\t\nStikine\u2014\nTelegraph Creek\t\nCarried forward\nRegistrations in 1917.\n3\n18\n21\n5\n21\n8\n1\n9\n69\n98\n*7\n47\n2\n35\n119\n258\n85\n63\n196\n160\n7\n88\n37\n43\n21\n1\n3\n12\n13\n6\n11\n64\n16\n14\n5\n1\nFemale.\n11\n6\n4\n17\n19\n11\n34\n7\n105\n34\n30\n18\n154\n1\n1\n223\n75\n71\n179\n150\n11\n78\n44\n16\n11\n1\n2\n7\n14\n3\n68\n11\n15\nSex not\ngiven.\nTotal\nRegistrations.\n1917.\n24\n14\n7*\n35\n40\n16\n55\n16\n137\n203\n81\n77\n40\n303\n1*\n3\n5\n70\n226\n481\n160\n134\n375\n310\n18\n166\n81\n37\n17\n2*\n5*\n19\n27\n9\n4\n19\n122\n27\n29\n7\n3,501\n26\n25\n2\n16\n34\n15\n2\n79\n13\n3\n18\n161\n243\n97\n81\n41\n326\n9\n8\n55\n235\n438\n210\n143\n303\n205\n61\n60\n12\n31\n9\n7\n12\n129\n11\n25\n3\n2\n1,581\nBirths in 1917.\n13\n3\n2\n7\n15\n4\niii\n8\n1\n4\n50\n82\n34\n33\n20\n100\n1\n1\n23\n170\n67\n44\n132\n70\n23\nIS\n3\n1\n1\n10\n9\n51\n14\n8\n6\n1,287\nFemale.\nSex not\ngiven.\n7\n4\n4\n8\n12\n9\n3i\n7\n1\n4\n54\n77\n26\n28\n10\n104\n1\n1\n2\n20\n82\n152\n58\n52\n122\n106\n7\n56\n33\n31\n1\n14\n6\ni\n6\n9\n1\n2\ni\n49\n7\n12\n2\n1\n1,228\nTotal Births.\n1917. 1916.\n20\n7\n6*\n15\n27\n13\n50\n15\n104\n159\n60\n61\n30\n204\n1*\n2\n3\n49\n162\n322\n125\n96\n254\n125\n56\n32\n9\n1*\n2\u00bb\n16\n18\n4\n4\n13\n100\n21\n20\n7\n1*\n2,516\n21\n19\n2\n12\n26\n12\n2\n70\n11\n3\n13\n118\n198\n74\n63\n35\n249\n304\n141\n99\n224\n261\n24\n168\n49\n40\n10\n7\n26\n5\n5\n11\n105\n9\n19\n2\n2\n2,722 G 40\nBritish Columbia\n1918\nBIRTHS, 1917\u2014iConcluded.\nMining Division.\nBrought forward.\nSkeena\u2014\nPrince Rupert\t\nAnyox\t\nTrail Creek\u2014\nRossland\t\nTrail \t\nTrout Lake\u2014\nTrout Lake\t\nVernon\u2014\nVernon\t\nVancouver\u2014\nVancouver City\t\nNorth Vancouver City\t\nNorth Vancouver District..\nSouth Vancouver\t\nWest Vancouver\t\nPoint Grey\t\nUnorganized\t\nRichmond\t\nVictoria\u2014\nVictoria City\t\nCowichan\t\nEsquimalt..\"\t\nOak Bay\t\nSaanich\t\nWindermere\u2014\nWilmer.\t\nYale-\nYale \t\nTotals 4.\nRegistrations in 1917.\n105\n3\nFemale.\n1,691\n74\n4\n192\n1,424\n1,246\n74\n56\n21\n13\n251\n229\n2\n6\n73\n49\n39\n27\n71\n76\n517\n478\n49\n53\n36\n44\n22\n22\n94\nS3\n7\n15\n19\n16\n4,479\nSex not\ngiven.\nTotal\nRegistrations.\n1917.\n179\n7\n67\n162\n418\n2,670\n131\n34\n480\n8\n122\n66\n147\n995\n102\n80\n44\n177\n9,450\n1916.\n181\n97\n100\n166\n40\n579\n16\n139\n86\n154\n1,106\n101\n62\n53\n194\n21\n20\n9,840\nBirths in 1917.\nMale.\n1,287\n82\n3\n21\n70\n165\n1,064\n63\n17\n197\n1\n46\nSO\n62\n381\n37\n* 29\n18\n56\nFemale.\n62\n4\n18\n64\n944\n42\n10\n193\n5\n38\n21\n62\n35\n32\n15\n60\n12\n11\nSex not\ngiven.\nTotal Births.\n1917.\n2,516\n144\n7\n39\n134\n2,008\n1,992\n106\n136\n27\n34\n390\n421\n6\n11\n84\n116\n51\n72\n124\n131\n744\n836\n72\n86\n61\n50\nS3\n45\n116\n150\n19\n21\n22\n14\n6,994\n7,475\n1916.\n2,722\n65\n91\n* December returns not received. 8 Geo. 5\nProvincial Board of Health.\nG 41\nDEATHS, 1917.\nMining Division.\no\na .\n\u2022- d\n- t,\n1J\nJj on\n1.9\nu\n2\n2\nfH\nCS\n.\nO\no\no\neo\n1\n|\nOJ\no\nm\no\nHH\nc\n4\n1\ncl\n0)\nO\n\n\u00a9\nB\n0\nH3\nOl\nAinsworth\u2014\nArrow Lake\u2014\nAtlin\u2014\nAtlin\t\n1\nAshcroft\u2014\n3\n3\n1\n1\n3\n1\n1\n2\n2\n1\n1\n4\n1\n2\n4\n1\n1\n1\n2\n3\n2\n1\n1\n1\nAlberni\u2014\n1\n2\nBella Coola\u2014\nCariboo \u2014\n1\n1\n5\n3\n2\n1\n1\n2\n1\n1\n2\n1\nClayoquot\u2014\nClinton\u2014\n1\n16\n42\n13\n9\n1\n12\n2\n4\n9\n2\n5\n2\n19\n3\n29\n104\n24\n24\n9\n100\nFort Steele-\n2\n7\n7\n3\n3\n1\n4\n4\n1\n1\n1\n4\n2-\n1\n4\n5\n22\n2\n1\n2\n22\n5\n22\n1\n2\n2\n31\n5\n14\n2\n4\n1\n15\n5\n9\n4\n2\n3\n1\n1\n4\n5\n4\n1\nGreenwood\u2014\nGrand Forks-\nGolden\u2014\nKamloops\u2014\n13\n18\n9\n1\nLiard\u2014\nLardeau\u2014\n3\n6\n22\n74\n212\n47\n47\n147\n114\n11\n84\n24\n31\n21\n9\n1\nLillooet\u2014\n1\n1\n1\n9\n15\n3\n8\n12\n1\n12\n3\n2\n1\n1\n1\n5\n7\n30\n5\n23\n11\n4\n16\n2\n3\nT\n3\n14\n38\n1\n3\n18\n15\n1\n14\n2\n7\n1\n2\n1\n4\n13\n20\n*y\n19\n11\n1\n8\n1\n9\n5\n1\n1\n1\n12\n34\n4\n6\n25\n10\n1\n7\n21\n7\n6\n25\n9\n1\n4\n11\n1\n11\n5\n2\n2\n4\n\"i'\n\"i'\ni\ni\n4\n11\n72\n146\n24\n25\n130\n60\n8\n63\n9\n22\n18\n5\n3\n1\n6\n34\n97\n11\n12\n50\n89\n3\n20\n16\n9\n7\n4\n5\n17\n106\n243\n35\n37\n180\n99\n11\n83\n25\n31\n25\n9\n3\nNicola\u2014\nNelson \u2014\nNelson\t\nNew Westminster\u2014\nNew Westminster\t\n17\n44\n10\n10\n33\n17\n4\n4\n7\n1\n5\n2\n1\n4\n2\n1\n7\n6\n\"i*\n6\n3\n5\n1\n2\n1\n9\n12\n1\n4\n5\n2\n4\n18\nOutside\t\nNanaimo\u2014\nNanaimo\t\n\"a\n1\n2\n2\n4\n1\n5\n1\n1\n9\n1\n4\n9\n2\n1\n7\n2\n2\n1\n2\n1\n1\n1\nOsoyoos\u2014\nOmineca\u2014\ni\n1\nPortland Canal-\nPeace River\u2014\n1\ni\ni\ni\ni\n2\n3\n195\n2\n1\ni\n1\n1\n2\n4\n3\n1\n5\n30\n5\n11\n2\n1032\n1\n2\n1\n10\n7\n9\n2\n485\n3\n4\n5\n2\n5\n40\n12\n13\n4\n1517\n4\n14\n2\n1\n10\n42\n16\n10\n5\n1425\nQuesnel\u2014\n150-Mile House\t\n1\n1\nQuatsino\u2014\n1\n1\n3\n4\n1\n146\nQueen Charlotte-\nQueen Charlotte City ..\nRevelstoke\u2014 '\nRevelstoke\t\nSimilkameen\u2014\n1\n14\n1\n1\n1\n284\n1\n3\n1\n1\n2\n2\n1\n59\n6\n1\n3\n1\n183\nl\n4\n1\n3\n1\n3\n1\n2\n1\nl\nSlocan\u2014\n36\n1\n1\n52\n22\nSlocan City Division\u2014\nCarried forward...\n164\n171\n127\n49\n4\n21\n44 G 42\nBritish Columbia\n1918\nDEATHS, 1917\u2014 Concluded,\nMining Division.\n\u2022cl\nJs\na .\n\u2014 c\n.\" *-\u25a0\nll\nJH ***\n\u00a3 *=\u00bb\n1-s\n0\n1\nCO\nOI\no\nin\nio\no\ncc\n***!\nOH\nr-l\n\u00a9\nO\nCO\nt-\n9\n\u00a9\nOH\nO\nHH\n\u00a9\ncc\nV\n\u00a9\nCO\no\n5h\n5\nCJ\n\"Hi\n\u00a9\no\n\u00a9\nCO\nb\nrt\n9\n\u00a9\nio\no\nHH\n\u00a9\nrt\n9\no\nCO\no\n\u00a9\niO\nrt\nV\no\no\nHH\n\u00a9\nCO\nrt\n\u00a9\nCO\no\nHH\no\ns-\no\">\n\u00a9\n\u00a9\no\n\u00a9\nCO\n49\ng\nS\nrt\ng\n4\na\nCH\n*\u00a3c\n2\n\n\u25a0&\nO\nc\nX\n\u00a9\n0\nH\n1517\n4\n63\n1\n31\n33\n2\n85\n1307\n58\n12\n88\n4\n29\n30\n21\n476\n33\n26\n15\n39\n4\n18\n3896\ncd\n\u00a9\nHH\n0\nH\n1425\n2\n52\n45\n40\n146\n1240\n36\n11\n112\n4\n38\n33\n32\n533\n36\n26\n19\n40\n5\n12\n3887\n\u00a9\nB\nO\n.c\nHH\nw\nBrought forward ..\nStikine\u2014\n284\n36\n52\n22\n59\n146\n195\n2\n14\n183\n9\n164\n6\n171\n2\n6\n127\n44\nSkeena\u2014\n14\n1\n4\n10\n^\n1\n7\n1\n1\n2\n1\nTrail Creek-\n1\n2\n3\n1\n5\n1\n10\n177\n4\n1\n9\n\"i\"\n2\n5\n37\n3\n4\n6\n4\n1\n6\n163\n5\n1\n5\n1\n4\n3\n4\n54\n6\n1\n9\n6\n5\n1\n1\n1\n1\n1\n19\n25\n2\n64\n810\n28\n8\n50\n2\n17\n20\n17\n279\n27\n18\n8\n23\n4\n15\n2514\n1\nTrail \t\nTrout Lake\u2014\n2\n1\n2\nVernon\u2014\n12\n273\n13\n2\n27\n1\n8\n3\n3\n89\n3\n1\n3\n9\n3\n24\n1\n5\n3\n28\n1\n2\n3\n28\n4\n4\n6\n49\n5\n1\n5\n8\n100\n3\n2\n2\n1\n10\n157\n9\n3\n3\n1\n7\n2\n3\n61\n4\n11\n160\n6\njo\n8\n103\n6\n1\n12\n3\n49\n1\n1\n4\n2\n5\n1\nVancouver-\nNorth Vancouver\t\nNorth Vancouver Dist..\nSouth Vancouver\t\n84\n7\ni2\n1\n4\n5\n3\n1\n2\n1\n1\n1\n1\n8\n1\n4\n12\n1\n1\n12\n4\n2\n11\n2\n4\n3\n3\n40\ni\n1\nVictoria-\n56\n5\n3\n8\n1\n461\n56\n5\n5\n2\n9\n35\n3\n2\n2\n3\n4\n\"i\n1\n1\n20\n1\nWindermere\u2014\n1\n1\n1\n2\n1\n2\n329\n1\n1\n473\n3\n2\n451\n3\n8\n456\nYale-\nYale \t\n2\n762\n1\n341\n1\n158\n18\n2\n28\nTotals\t\n82\n107\n76\n154\n175 8 Geo. 5\nProvincial Board of Health.\nG 43\nMARRIAGES, 1917.\nGroom and Bride same Denomination.\nDenomination.\nAdventist\t\nAgnostic\t\nAnglo-Catholic\t\nAtheist\t\nBaptist\t\nBrethern\t\nBuddhist\t\nCalvinist\t\nCambellite\t\nChristian\t\nChristian Brethern\t\nChristian Baptist\t\nChristian Science\t\nChristadelphian\t\nChurch of God \t\nChurch of England\t\nConfucian\t\nCongregational\t\nInternational Bible Student.\nJewish\t\nCarried forward...\nNumber of\nMarriages.\n4\n1\n2\n1\n45\n9\n2\n1\n1\n7\n6\n1\n4\n1\n1\n1\n11\nDenomination.\nBrought forward\nLatter Day Saints\t\nLutheran\t\nMennonite\t\nMethodist\t\nNone\t\nNot given\t\nNon-Sectarian\t\nOrthodox\t\nOrthodox (Greek)\t\nPenticostal tt... .\nPresbyterian\t\nProtestant\t\nReformed Episcopal\t\nRoman Catholic\t\nSalvation Army\t\nTheist\t\nUniversalist..\t\nTotal\t\nNumber of\nMarriages.\n1\n89\n]\n209\n3\n6\n1\n1\n8\n1\n366\n28\n2\n368\n8\n1\n1\n1,591\nGroom and Bride of different Denominations.\nGroom.\nBride.\nNumber of\nMarriages.\nGroom.\nBride.\nNumber of\nMarriages.\nChurch of England...\nBaptist\t\nBible Student\t\n30\n1\n2\n1\n8\n1\n2\n11\n68\n1\n1\n2\n1\n112\n5\n45\n 293\n2\n1\n8\n3\n6\n4\n 24\n3\n2\n4\n1\n 10\n1\n1\n 2\n2\n3\n2\n1\n 8\n1\n34\n4\n2\n4\n6\n163\n1\n12\n227 337\nBrought forward\nPresbyterian\u2014Con. ..\n227\n49\n1\n1\n3\n33\n1\n1\n7\n1\n5\n1\n5\n1\n4\n6\n2\n1\n1\n1\n1\n1\n2\n22\n1\n1\n1\n12\n19\n3\n13\n2\n38\n7\n2\n61\n2\n1\n1\n2\n7\n123\n337\nMethodist \t\nNone\t\nNot given\t\nM\nGreek Orthodox\t\n..\nRoman Catholic\t\nTheosophist\t\nBaptist\t\nii\nMethodist \t\nProte\n316\nNot given\t\nI.\nChurch of England\t\n,\nMethodist\t\nNot given\t\nChurch of England\t\nMethodist\t\nChurch of England\t\nRoman Catholic\t\nii\nChurch of England\t\nMethodist\t\nRoman Catholic\t\nChurch of England....\nPresbyterian\t\nRoman Catholic :\nRefoi\nSpirit\nLutb\nmed Episcopal..\n30\n3\n3\n.\n,,\nChurch of England ...\nDisciples of Christ\t\nDutch Reformed\t\nLatter Day Saints ....\nMethodist\t\n,,\nRoman Catholic\t\nChurch of England\t\nAnglo-Catholic\t\nBaptist\t\nt|\nii\nMeth\nii\nc\n\t\nxlist\t\n75\nBaptist\t\nChurch of England....\nEvangelican\t\n,,\n,,\nChristian Science\t\nChurch of England\t\n\u201e\nLatter Day Saints\t\n,,\nCarried forward.\narried forward.\n764 G 44\nBritish Columbia\n1918\nGroom and Bride of different Denominations\u2014Concluded.\nBrought forward\nMethodist\u2014Con\t\nBaptist.\nBuddhist.\nChristian.\nChristian Science .\nCarried forward.\nBride.\nJew\t\nNot given\t\nPresbyterian\t\nProtestant\t\nQuaker\t\nRoman Catholic\nChurch of England.\nMethodist\t\nPresbyterian\t\nQuaker\t\nRoman Catholic\nAdventist\t\nBrethern\t\nChristian \t\nChristian Science\t\nChurch of England.\nCongregational\t\nLutheran\t\nMethodist ,\nPresbyterian\t\nProtestant\t\nRoman Catholic\nSalvation Army... .\nChristian\t\nMethodist\t\nAdventist\t\nBaptist\t\nChurch of England.\nLutheran\t\nMethodist\t\nPresbyterian\t\nReformed Episcopal\nRoman Catholic\nSpiritualist\t\nUniversalist\t\nBaptist\t\nChurch of England.\nCongregational\t\nMethodist\t\nNumber of\nMarriages.\n1\n1\n79\n2\n1\n23\n1\n1\n1\n1\n16\n3\n2\n24\n15\n2\n13\n1\n1\n1\n1,111\nGroom.\nBrought forward\nTheosophist\t\nUnitarian.\nAdventist\t\nAmerican Epis. Ch...\nAnglo-Catholic\t\nBrahmin\t\nBrethern..\t\nCatholic Apostolic...\nChurch of Ireland\t\nConfucian\t\nDunker\t\nEpis. Ch. of Scotland.\nFreethinker\t\nLiberal\t\nMaterialist\t\nMennonite\t\nMoriron\t\nNondescript\t\nOrthodox\t\nQuaker\t\nSalvation Army\t\nSocialist\t\nUndenominational..,\nUniversalist\t\nRoman Catholic .\nBride.\nChristian Spiritualist.,\nMethodist\t\nChurch of England\t\nLutheran ,\nMethodist\t\nPresbyterian\t\nMethodist\t\nChurch of England..\nPresbyterian\t\nCongregational\t\nChurch of England..\nChurch of England..\nChristadelphian\t\nMethodist\t\nLutheran\t\nPresbyterian\t\nChristian Friends.. .\nPresbyterian\t\nNone\t\nLutheran\t\nPresbyterian\t\nPresbyterian\t\nChristian\t\nMethodist\t\nChurch of England..\nMethodist\t\nChurch of England.,\nMethodist\t\nAdventist\t\nBaptist\t\nChristian\t\nChurch of England...\nCongregational\t\nGerman Evangelical..\nGreek Catholic\t\nInter. Bible Student.\nLutheran. \t\nMethodist \t\nNone\t\nPresbyterian\t\nProtestant\t\nQuaker\t\nNumber of\nMarriages.\n2\n1\n1\n1\n1\n1\n1\n1\n1\nJ\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n10\n1\n1\n1\n1\n9\n23\n2\n35\n4\n1\nTotal 1,270\nBridegroom and Bride same denomination 1,591\nGrand total 2,861 8 Geo. 5\nProvincial Board of Health.\nG 45\nPRELIMINARY TABLES SHOWING BIRTHS FOR DIVISIONS.\nAshcroft Group.\nAshcroft\t\nBarkerville\t\nFort George\t\nTete Jaune Cache\t\nClinton\t\nLillooet.\t\nQuesnel \t\n150-Mile House\t\nYale\t\nTotals\t\nFaii-view Group.\nFairview\t\nGreenwood\t\nGrand Forks \t\nKamloops\t\nNicola\t\nPrinceton\t\nVernon\t\nTotals\t\nBeaton Group.\nBeaton \t\nCranbrook \t\nFernie\t\nGolden ,\t\nKaslo\t\nNakusp\t\nNelson\t\nNew Denver\t\nRevelstoke\t\nRossland\t\nSlocan\t\nTrail\t\nTrout Lake\t\nWilmer\t\nTotals\t\nVictoria Division.\nVictoria City\t\nCowichan\t\nEsquimalt\t\nOak Bay \t\nSaanich\t\nTotals\t\nNanaimo Division.\nNanaimo City\t\nAlert Bay\t\nComox\t\nLadysmith\t\nTotals\t\nNew Westminster Division.\nNew Westminster City\t\nBurnaby\t\nChilliwack\t\nOutside\t\nTotals\t\nVancouver Division.\nVancouver City\t\nSouth Vancouver\t\nPoint Grey\t\nNorth Vancouver City\t\nNorth Vancouver District\t\nWest Vancouver\t\nRichmond\t\nUnorganized\t\nTotals\t\nJan.\nFeb.\nMar.\nApril.\nMay.\nJune.\nJuly.\nAug.\nSept.\nOct.\nNov.\nDec.\n1\n1\n1\n2\n4\n1\n1\n1\n1\n2\n2\ni\n6\n3\n4\n4\n4\n5\n4\n5\n4\n6\n1\ni\n2\ni\n1\n2\n5\n2\n4\n1\n2\n1\n3\n4\n1\n3\n1\n3\n1\n2\n3\n1\n3\n2\n2\n12\n14\n7\n1\n1\n2\n1\n1\n4\n1\n5\n5\n12\n13\n11\n8\n10\n16\n10\n13\n14\n14\n2\n5\n10\n2\n6\n4\n5\n7\n4\n3\n4\n5\n6\n7\n14\n4\n5\n5\n3\n1\n2\n7\n3\n6\n5\n14\n7\n1\n5\n6\n4\n1\n14\n15\n24\n11\n16\n23\n20\n12\n28\n21\n19\n1\n2\n5\n6\n4\n2\n3\n7\n6\n7\n6\n1\n4\n1\n3\n4\n3\n1\n2\n2\n20\n25\n24\n25\n15\n16\n36\n85\n28\n29\n41\n32\n2\n43\n67\n69\n54\n57\n76\n59\n79\n85\n73\n1\n1\n1\n2\n8\n10\n8\n5\n7\n20\n14\n10\n8\n11\n7\n14\n13\n14\n13\n16\n14\n16\n21\n16\n9\n6\n1\n4\n5\n2\n1\n1\n2\n4\n6\n1\n3\n3\n4\n4\n1\n1\n3\n3\n1\n1\n1\n1\n1\n3\n2\n4\n8\n21\n9\n15\n2*2\n15\n9\n29\n11\n17\n1\n2\n1\n1\n1\n3\n1\n2\n3\n5\n1\n11\n7\n9\n13\n13\n11\n12\n4\n6\n4\n9\n1\n3\n3\n2\n4\n3\n4\n4\n6\n7\n2\n1\n4\n1\n1\n5\n9\n15\n18\n4\n6\n7\n12\n11\n19\n14\n14\n1\n20\n1\n2\n2\n3\n5\n2\n2\ni\n48\n70\n87\n58\n65\n69\n88\n73\n99\n58\n68\n16\n45\n58\n62\n59\n63\n102\n86\n65\n59\n88\n51\n6\n4\n8\n8\n7\n5\n5\n8\n12\n6\n3\n2\n8\n1\n7\n3\n7\n6\n9\n7\n9\n2\n2\n3\n5\n1\n5\n4\n3\n1\n2\n4\n3\n3\n4\n3\n10\n8\n6\n12\n16\n11\n17\n19\n21\n2\n57\n76\n86\n16\n83\n84\n130\n116\n84\n20\n87\n124\n78\n11\n26\n20\n18\n17\n23\n27\n21\n19\n2\n2\n1\n1\n2\n1\n6\n9\n18\n17\n11\n11\n9\n5\n11\n13\n15\n1\n7\n5\n7\nD\n5\n4\n4\n3\n28\n6\n4\n5\n40\n3\n24\n40\n43\n44\n34\n33\n37\n46\n38\n6\n11\n23\n28\n38\n32\n24\n20\n40\n43\n26\n31\n5\n11\n9\n7\n12\n13\n12\n8\n15\n13\n12\n8\n9\n3\n10\n5\n8\n5\n7\n8\n6\n16\n19\n3\n18\n18\n24\n22\n32\n22\n\u25a0 24\n20\n83\n20\n29\n22\n14\n49\n53\n69\n77\n85\n63\n59\n82\n83\n80\n44\n92\n148\n146\n178\n200\n185\n164\n149\n294\n205\n203\n8\n26\n36\n29\n42\n38\n43\n30\n30\n45\n38\n25\n1\n9\n5\n9\n9\n9\n10\n6\n8\n8\n10\n1\n3\n13\n10\n6\n12\n11\n12\n5\n14\n7\n12\n5\n2\n2\n1\n4\n2\n3\n1\n1\n2\n4\n2\n2\n2\n11\n8\n11\n19\n10\n9\n9\n11\n9\n14\n13\n1\n3\n9\n8\n2\n8\n7\n5\n3\n5\n252\n65\n133\n231\n219\n250\n282\n268\n233\n204\n381\n278\nTotals.\n50\n15.\n8\n3\n18\n4\n22\n61\n204\n49\n21\n291\n749\n2\n104\n159\n30\n20\n7\n162\n20\n100\n39\n7\n134\n744\n72\n61\n220\n9\n125\n322\n125\n96\n254\n797\n2,003\n390\n84\n106\n27\n6\n124\n51\n2,796 G 46\nBritish Columbia\n1918\nPreliminary Tables showing Births for Divisions\u2014Concluded.\nAlberni Group.\nAlberni \t\nAnyox\t\n*AtIin\t\nBella Coola\t\nClayoquot\t\nFort Fraser\t\nHazelton\t\n*Fort St. John....\n*Hudson Hope , ..\nPouce Coupe\t\n^Porter's Landing.\nPrince Rupert ..\nQuatsino\t\nQueen Charlotte..\nStewart\t\n*Telegraph Creek.\nTotals.\nGrand totals.\nJan.\nFeb.\nMar.\nApril.\nMay\nJune.\nJuly.\nAug.\nSept.\nOct.\nNov.\nDee.\n2\n3\n2\n'l\n4\n4\n1\n1\n2\ni\n3\n2\n2\n1\n5\n2\n4\n2\n'2\n1\n1\n3\n2\n'2\n3\n4\n1\n2\n2\n2\nu\n4\n3\n2\ni\n3\n3\n2\n5\n1\n4\n4\n1\n2\n2\n2\n2\n6\n15\n1\n1\n14\n9\n14\ni\n7\n3\n2\n27\ni\n36\n11\n14\nio\n'5\n15\n6\n9\n24\n26\n23\n28\n19\n22\n25\n36\n24\n136\n368\n673\n611\n602\n646\n668\n670\n563\n812\n716\n629\n27\n7\n9\n32\n1\n2\n16\n1\n144\n4\n13\n1\n278\n6,994\n* No returns received for December. 8 Geo. 5\nProvincial Board of Health.\nG 47\nPRELIMINARY TABLES SHOWING DEATHS FOR DIVISIONS.\nJan.\nFeb.\n41\n5\n4\n4\nMar.\nApril.\nMay.\nJune.\nJuly.\nAug.\nSept.\nOct.\n27\n3\n2\n1\n3\nNov.\nDec.\nTotals.\nVictoria Division.\n44\n1\n3\n3\n2\n53\n2\n2\n1\n61\n31\n4\n1\n1\n2\n40\n3\n3\n5\n37\n3\n2\n3\n28\n2\n4\n6\n41\n5\n2\n3\n45\n1\n'i\n2\n87\n2\n1\n1\n6\n52\n0\n4\n3\n2\n476\n33\nOak Bay\t\n26\n15\n89\n53\n54\n39\n15\n's\n51\n45\n40\n51\n49\n36\n5\n3\n7\n3\n47\n63\n589\nNanaimo Division.\n9\n5\n2\n10\n2\n9\n3\n10\n4\n3\n9\n1\n7\n2\n6\nii\n2\n9\n4\n7\n2\n9\n7\n2\n6\n4\n2\n4\n9\n1\n1\n5\n3\n99\n11\n83\n25\n16\n24\n17\n23\n19\n19\n22\n18\n12\n18\n14\n16\n111\n11\n1\n6\n1\n5\n4\n139\n' 218\nVancouver Division.\n132\n16\n2\n8\n2\n2\n1\n89\n9\n5\n5\n2\n2\n140\n6\n2\n5\n2\n1\n4\n3\n163\n19\n1\n3\n19\n42\n128\n6\n4\n2\n2\n1\n111\n3\n1\n7\n5\n2\n116\n11\n2\n2\n1\n1\n3\n136\n85\n7\n6\n2\n4\n104\n65\n5\n5\n6\ni\n6\n1\n95\n6\n2\n1\n2\n128\n4\n6\n6\ni\n107\n5\n5\n1\n'2\n1\n1,307\n88\n29\n58\n12\n4\n30\n21\nTotals\t\n162\n112\n143\n31\n6\n3\n19\n129\n89\n106\n145\n121\n17\n2\n5\n13\n1,549\nNew Westminster Division.\n25\n5\n3\n18\n16\n2\n4\n8\n15\n4\n5\n11\n20\n4\n2i\n15\n1\n5\n13\n19\n4\n2\n11\n15\n1\n1\n15\n22\n3\n1\n17\n29\n2\n5\n15\n243\n85\n37\nNew Westminster (outside)\t\n180\nTotals\t\n51\n30\n2\n2\n1\n59\n35\n45\n1\n2\n34\n36\n32\n43\ni\n2\n2\n5\n5\n3\n4\n17\n2\n2\n11\n37\n51\n495\nAshcroft Group.\n1\ni\ni\n'2\n1\n9\ni\n1\n2\ni\n2\ni\ni\ni\n2\n3\n2\n'i\ni\n2\n3\ni\n2\ni\n'2\n4\ni\n2\n1\ni\n1\n1\n4\ni\n11\n2\n16\n10\n3\n5\n4\n150-Mile House\t\n5\nYale\t\n18\n3\n5\n12\n3\n3\n6\n12\n3\n8\n35\n5\n5\n3\n8\n7\n3\n4\n3\n3\n'4\n5\n1\n3\nio\n2\n1\n5\n22\n9\n7\n74\nFairview Group.\n2\n1\n2\n29\n1\n7\n42\n5\n3\n6\n14\n6\n1'\n8\n6\n8\n1\n14\n1\n8\n1\n2\n1\n16\n3\n9\n3\n2\n3\n13\n2\n1\n4\n1\n9\n11\ni\n2\n13\n's\n1\n2\n2\n5\n'2\n4\n32\n32\n155\n17\n85\n43\n3\n2\ni4\n9\n4\ni\n38\n32\n23\n28\n17\n44\n24\n16\nBeaton Group.\nii\n2\n7\n1\n10\n3\n3\n3\n1\n5\ni\nii\n1\n3\n6\n'5\n3\n'2\n7\n10\n1\n3\ni3\n3\n4\n3\n'2\n3\n28\n1\n1\n2\n9\n2\n1\n4\n5\n6\n4\n3\n1\n12\n1\n3\n3\ni\ni\n'2\n6\n1\n5\n2\ni\n3\n2\n1\n23\n3\n11\n'i\n8\n2\n2\n3\n2\n32\n9\n12\ni\n1\n'4\n6\n11\ni\nio\n1\n4\n3\n6\n6\n10\n2\n8\n7\n1\n1\n4\n15\nj\n2\n6\n1\n3\n5\n1\n10\n106\n31\nTrail\t\n33\nTotals\t\n60\n33\n34\n46\n61\n40\n32\n42\n39\n41 G 48\nBritish Columbia\n1918\nPreliminary Tables showing Deaths for Divisions\u2014Concluded.\nAlberni Group.\nAlberni \t\n*Atlin\t\nBella Coola\t\nClayoquot\t\nFort Fraser\t\nHazelton\t\n*Fort St. John \t\n*Hudson Hope\t\nPouce Coupe\t\n* Porter's Landing\t\nPrince Rupert\t\nAnyox \t\nQuatsino\t\nQueen Charlotte\t\nStewart. ....\n^Telegraph Creek .\nTotals\t\nGrand totals\t\nJan.\nFeb.\nMar.\nApril.\nMay.\nJune.\nJuly.\nAug.\nSept.\nOct.\nNov.\nDec.\n3\n2\ni\n2\n3\n1\n1\n1\n2\n1\n1\n1\ni\n4\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1\n2\n4\n2\n2\n2\n1\ni\n2\ni\n3\n2\n3\n1\n4\n'5\n'7\ni\n5\n2\n1\n\"i\n7\n'6\ni\n6\n2\n3\n8\n2\n5\ni\n2\n16\n2\n1\n5\n'2\n13\n14\n12\n8\n12\n11\n16\n9\n16\n4\n13\n390\n315\n376\n361\n334\n322\n275\n259\n274\n349\n295\n346\nTotals.\n16\n1\n11\n1\n9\n25\n63\n1\n2\n5\n3\n4\n* No returns received for December. 8 Geo. 5\nProvincial Board of Health.\nG 49\nMARRIAGES, 1917.\nNumber of Marriages.\nVictoria Division\u2014\n 382\n 16\n 19\n 14\n449\n112\n1,394\n279\n44\n2,278\nFairview Group\u2014 Cone hided.\n 41 2,278\n 16\nAlberni Group\u2014\nAtlin\t\n 66\n IS\n 15\nNanaimo Division\u2014\n 63\n 6\n 74\n 218\n 28\n 15\n 1,191\n 8\n 5\n 3\nVancouver Division\u2014\nFort St. John\t\n 7\n 97\n 12\n 58\n 38\n 3\n 4\n 3\n 4\n 61\n 1\n 164\n 4\nBeaton Group\u2014\n 34\n20\n 1\n 107\nAshcroft Group\u2014\n 61\n 8\n 2\n 16\n 1\n 2\n 3\n 6\n 3\n 32\n 40\n 10\n 6\n 5\n 83\n 7\n150-Mile House\t\nTrail ...\n 30\n17\nYale\t\nFairview Group\u2014\n 3\n 26\n 15\n 41\n, 3\n 23\nTotal\t\n 2\n 2,861\nBridegroom and Bride born in same Country.\nAustria 9\nCanada 562\nChina .* 4\nDenmark 1\nEngland 238\nFinland 12\nFrance 2\nGalicia 3\nGermany 5\nGreece 2\nHolland 1\nHungary 1\nIreland 15\nItaly 24\nJapan : 11\nCarried forward 890\nBrought forward 890\nNewfoundland I\nNew Zealand 2\nNorway 8\nPoland 2\nRoumania l\nRussia 6\nScotland 891\nServia l\nSweden 25-\nUnited States of America 296\nWales l\nNot given 2.\nTotal - 1,32* G 50\nBritish Columbia\n1918\nMARRIAGES, 1917\u2014Continued.\nBridegroom and Bride born in different Countries.\nPlace of Birth.\nEngland.\nTotal\nAustralia\t\nBritish West Indies.\nBarbadoes\t\nCeylon\t\nChannel Islands .\nEast Indies\t\nTotal.\nScotland.\nArgentina\t\nAustralia\t\nBohemia\t\nCanada \t\nChannel Islands\t\nChina\t\nDenmark\t\nEgypt\t\nFrance\t\nGermany .,\nIreland\t\nMexico\t\nNewfoundland\t\nNorway ,\nPoland\t\nPortugal\t\nRussia\t\nScotland\t\nSouth Africa\t\nSweden ,\nSwitzerland\t\nTasmania\t\nUnited States of America\nWales\t\nNot given\t\nNumber of\nMarriages.\nCanada \t\nEngland \t\nUnited States of America\nCanada \t\nEngland\t\nScotland\t\nCanada \t\nUnited States of America\nAlaska\t\nAustralia\t\nCanada \t\nChannel Islands\t\nEngland\t\nIreland\t\nNew Zealand\t\nSouth Africa\t\nSwitzerland\t\nUnited States of America\nWales\t\n1\n173\n1\n1\n2\n1\n1\n3\n22\n1\n3\n1\n1\n1\n3\n66\n1\n4\n1\n1\n52\n7\n2\nI\n1\n65\n1\n53\n8\n2\n1\n1\n16\n2\n29\n18\n(t\n1\n6\n1\n..\nUnited States of America\n6\nTotal\t\n61\nPlace of Birth.\nGibraltar...\nIsle of Man.\nIndia\t\nTotal.\nEngland .\nCanada .\nUnited States of America\nNumber of\nMarriages.\nCanada.\nAustralia\t\nAustria\t\nBelgium\t\nChannel Islands\t\nChina\t\nDenmark\t\nEngland \t\nFinland\t\nFrance \t\nGermany\t\nIceland\t\nIreland\t\nItaly\t\nNewfoundland\t\nNew Zealand\t\nNorway \t\nRussia\t\nScotland\t\nSouth Africa \t\nSweden\t\nSyria ,\t\nUnited States of America\nWales\t\nNot given\t\nTotal.\nAustria\t\nCanada \t\nDenmark\t\nUnited States of America\nWales\t\nUnited States of America\n9\n6\n1\n1\n2\nUnited States of America\n3\nTotal\t\n22\nTotal\nAustralia\nCanada \t\nEngland\t\nFinland\t\nFrance\t\nGermany\t\nIceland \t\nIreland \t\nItaly\t\nJapan \t\nNorway\t\nPoland\t\nRussia\t\nScotland\t\nServia\t\nSouth Africa .\nSweden\t\nSweden..\nTotal.\nCanada\t\nDenmark\t\nEngland\t\nFinland\t\nHolland\t\nIceland \t\nIreland \t\nNorway\t\nRussian Poland. \t\nScotland\t\nUnited States of America\n2\n1\n1\n1\n2\n126\n1\n2\n16\n1\n2\n1\n1\n2\n76\n1\n5\n1\n152\n8\n1\n3\n198\n68\n1\n4\n2\n6\n3\n1\n1\n3\n1\n3\n19\n1\n1\n11\n1\n4\n1\n1\n1\n1\n1\n1 8 Geo. 5\nProvincial Board of Health.\nG 51\nMARRIAGES, 1917\u2014Concluded.\nBridegroom and Bride born in different Countries\u2014Concluded.\nPlace of Birth.\nNumber of\nMarriages.\nPlace of Birth.\nGroom.\nBride.\nGroom.\nBride.\nMarriages.\nCanada \t\nUnited States of America\nWales\t\n3\n2\n1\nFrance \t\n5\n2\n..\n.\n1\nUnited States of America\nTotal\t\n6\n.\n2\nTotal\t\nEngland\t\nUnited States of America\n4\n2\n2\nTotal\t\n8\nSwitzerland\t\nUnited States of America\n1\n,,\n2\n2\nI\n1\n1\n1\nTotal\t\nNew Zealand\t\nUnited States of America\n7\n\t\n5\n1\nEngland\t\n1\nStraits Settlements\t\nItaly\t\n1\nCanada \t\nEngland\t\nFrance\t\nHungary\t\nUnited States of America\n2\n1\n1\n1\n3\n1\nAustria\t\nCanada \t\nEngland\t\n14\n5\n1\nScotland \u25a0.\t\nUnited States of America\n8\nTotal\t\n29\n6\n1\n7\nUnited States of America\n14\nTotal\t\n9\n1\n4\n1\n1\n1\n1\nEngland\t\n5\nUnited States of America\n8\nTotal\t\n7\n40\nNote.\u2014Grand total, 2,861. G 52\nBritish Columbia\n1918\nCAUSES OF\n6\nS3\nS\nca\nCJ\n6\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nS\nit\n\u25a0e\nB\n5\n9\nN\nO\nea\nm\no\nHH\n5 to 10 years.\nl\nVICTORIA DIVISION\u2014VICTORIA CITY.\nI.\u2014General Diseases.\nM.\nft\nM.\nF.\nM.\nF.\nM.\nF.\n8\n1\n1\n\"%\n9\n1\n10\n14\n2\n1\n18\n20\n28\n1\n1\n1\n28a\n29\n30\n1\n1\n30A\n34\n34A\n37\n39a\n39b\n390\n39d\n40\n41\n42\n43\n44a\n44b\n45\n45a\n45b\n46\n1\n47\n48\n60\n1\n50A\n51\n52\n54a\n1\n56\n61\nII.\u2014Diseases of the Nervous System.\n1\n1\n6lA\n1\n61b\n1\n63\n64\n1\n1\n68\n69\n71\n3\n1\n1\n77\nIII.\u2014Diseases op the Circulatory System.\n77a\n78\n78a\n1\n79\n1\n79a\n79b\n....\n79c\n79d\n80\n81\n82 8 Geo. 5\nProvincial Board of Health.\nG 53\nDEATH, 1917.\ndt\nOJ\n\u00a9\nCM\no\no\nI-H\nCJ\n>,\n\u00a9\nCO\nO\n\u00a9\nCM\nci\n3\no\n-Hi\nO\n\u00a9\nCO\noj\nea\n*H%\no\nio\no\nHH\no\nH*\nS\n0\nCO\nO\nO\niO\nCO\nca\nCJ\n0\n0\n0\nco\nE\nci\nCJ\n>.\ns\n0\nHH\nO\nCO\nB\nci\nCJ\nO\nCJ\nO\nO\nCO\nt3\nE\nfin\n3\na\nc3\nO\na'\n9\n\u25a0a\nM\nO\nc\nCJ\nbo\n-***\nCJ\n0)\nr-G\n.\u00a3*\n0\nH\ng\n\"be\nHH\nO\nB\ny,\nCJ\n02\ncc\na\n*ci\nOJ\n1\n0\nH\nM.\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n1\n3\n1\n1\n1\n1\n30\nF.\n1\n1\n1\n1\n1\n5\n2\n4\n1\n1\n2\n6\n3\n1\n1\n1\n6\n...... H\n1\n1\n2\n2\n1\n3\n8\n3\n1\n1\n1\n4\n3\n5\n2\n2\n39\n1\n1\n1\n1\n3\n5\n2\n2\n1\n1\n2\n2\n1\n1\n1\n1\n1\n1\n1\n1\n.....\n1\n1\n1\n1\n1\n1\n1\n1\n7\n4\n1\n1\n\"2\n1\n3\n1\n2\n3\n1\n3\n1\n2\n2\n1\n1\n1\n2\n1\n1\n1\n8\n4\n6\n4\n15\n1\n8\n1\n6\n1\n4\n1\n1\n2\n1\n1\n1\n2\n2\n1\n1\n1\n1\n1\n9\n1\n1\n1\n1\n2\n1\n3\n1\n1\n3\n4\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n5\n1\n1\n1\n1\n1\n1\n3\n1\n1\n2\n3\n1\n1\n2\n1\n1\n1\n1\n1\n\u2022\n1\n1\n3\n1\n1\n2\n1\n9\n5\n1\n1\n1\n1\n1\n1\n3\n1\n1\n1\n4\n4\n1\n4\n1\n\"i\n1\n14\n2\n23\n7\n1\n1\n1\n1\n4\n1\n3\n3\n1\n11\n6\n1\n1\n1\n1\n3\n6\n1\n2\n2\n1\n3\n1\n1\n1\n2\n2\n1\n1\n1\n1\n3\n1\n1\n1\n1\n1\n6\n2\n1\n1\n1\n1\n1\n\"i\"\n3\ni\n3\n3\n\"i'\n2\n2\n13\n1\n8\n1\n1\n1\n1\n1\n3\n2\n4\n2\n1\n6\n1\n1\n4\n5\n2\n1\n1\n1\n1\n3 G 54\nBritish Columbia\n1918\nCAUSES OF\nd\n.2\n1\n55\nca\nD\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nea\n9\nCJ\n\"0\nB\nP\nI\nCM\nO\ntH\nca\n9\n10\nO\nea\n5 to 10 years.\n89\nVICTORIA DIVISION\u2014VICTORIA CITY.\u2014Continued.\nIV.\u2014Diseases of the Respiratory System.\nM.\nF.\n2\nM.\nF.\nM.\nF.\nM.\nF.\n90\n91\n5\n2\n\"2'\n1\n1\n92\n92a\n92b\n920\n2\n1\n1\n92d\n1\n92e\n92p\n92o\n1\n93\n94\n96\n98A\n102\nV.\u2014Diseases of the Digestive System.\n103\n103a\n104\ni\n2\n1\n105\n2\n1\ni\n108\n109\n109a\n1\n111\n116\n117\n117a\n118\n118a\n118b\n118c\n1\n1\n1\n1\n119\nVI.\u2014Non-venereal Diseases of Gexito-urinary System and Annexa.\n120\n122\n126\n129\n130\n135\nVII.\u2014The Puerperal State.\n137a\n138\n141A\n141b\n142\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\n146\nIX.\u2014Diseases of the Bones and Oroans of Locomotion.\nX.\u2014Malformations.\nXI.\u2014Diseases of Early Infancy.\n8\n5\n1\n1\n12\n7\n1\n4\n4\n1\n151\n1\n8\n4\n163C 8 Geo. 5\nProvincial Board of Health.\nG 55\nDEATH, 1917'\u2014Continued.\noo\nE\nei\nCJ\n>t\nO\n.\n\u00a9\nO\n\u00a9\n90 and upwards.\nB\nCJ\n>\n\"Si\nO\nB\nCJ\nCJJ\nCJ\nV,\nCJ\nCO\nti\nHO\n\u25a0ea\no\nB\nCJ\nt*.\n\"be\no\nB\nX\nCO\nCO\nB\nci\nOJ\no\n\"ea\no\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nft\nM.\nft\n1\nM.\nft\nM.\nF.\nM.\nF.\n2\nM.\nft\nM.\nft\nM.\nF.\n5\n2\n6\n2\n1\n1\n6\n14\n3\n6\n1\n1\n3\n1\n3\n1\n2\n2\n2\n16\n1\n2\n1\n1\n1\n4\n1\n1\n1\n1\n1\n1\n1\n5\n2'\n1\n1\n1\n\"i\"\nl\n\"i\"\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n2\n1\n1\n1\n1\n3\n1\n1\n1\n1\n1\n1\n2\n1\n1\n3\n1\n1\n3\n1\n3\n1\n1\n1\n3\n2\n6\n1\n1\n4\n3\n1\n1\n1\n4\n1\n1\n.\u201e.\n1\n1\n2\n1\n1\n2\n1\n1\n1\n1\n3\n1\n9\n2\n1\n1\n1\n2\n1\n1\n1\n1\n2\n2\n1\n4\n1\n\t\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n16\n1\n1\n1\n3\n1\n2\n1\n4\n1\n4\n2\n1\n3\n1\ni\n1\n1\n1\n5\n3\n1\n1\n20\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n5\n1\n9\n5\n1\n1\n12\n7\n1\ni\n1\n4\n4\n13\n1\n1\n8\n4\n2\n20\n11\n1 G 56\nBritish Columbia\n1918\nCAUSES OF\no\nto\na\n.2\n1\n5\n\"ffi\nB\nO\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\ns\n3\ns\nrt\ncu\nCM\nO\noj\nca\n9\nio\nO\nHH\n\u00a9a\n5 to 10 years.\n154\nVICTORIA DIVISION\u2014VICTORIA CITY.\u2014Concluded.\nXII.\u2014Old Age.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n155\nXIII.\u2014-Affections produced by External Causes.\n157\n167\n1\n169\n172\n173\n174\n1\n175\n1\n187\nXIV.\u2014Ill-defined Diseases.\n187a\n53\n36\n6\n2\n7\n5\n6\n6\n32a\n40\n41\n42\n45a\n45 b\n51\n77a\n79a\n79b\n81a\nPurulent infection and septicaemia\t\nTuberculosis of the lungs\t\nTuberculosis of spine\t\nCancer and other malignant tumours of the stomach, liver\t\nCancer and other malignant tumours of the peritoneum, intestines, rectum .\nCancer and other malignant tumours of the female genital organs\t\nCancer of prostate\t\nCancer of bronchial glands\t\nExophthalmic goitre\t\n113\n151\n152a\n153a\nVICTORIA DIVISION\u2014COWICHAN.\nI.\u2014General Diseases.\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nCerebral hsem.orrh.age, apoplexy\t\nIII.\u2014Diseases of the Circulatory System.\nMyocarditis \t\nMitral regurgitation\t\nMitral regurgitation complicated hy nephritis.\nAneurism . \t\nIV.\u2014Diseases of the Respiratory System.\nPneumonia.\nPleurisy\t\nV.\u2014Diseases of the Digestive System.\nCirrhosis of the liver\t\nVI.\u2014NON-VENEREAL DISEASES OF GeNITO-URINARY SYSTEM AND ANNEXA.\nUremia.\nXI.\u2014Diseases of Early Infancy.\nCongenital debility, icterus, and sclerema.\nAtelectasis\t\nPremature\t\nXII.\u2014Old Age.\nSenility . 8 Geo. 5\nProvincial Board of Health.\nG 57\nDEATH, 1917\u2014 Continued.\nt\ncS\n\u00ab\n>\u00bb\no\nCJ\no\ne\nrt\nV\nt*l\no\nCO\no\no\nu\nrt\nSI\no\n^*J\"\no\no\neo\nCJ\no\nIQ\no\no\nca\n9\n\u00a9\n\u00a9\no\n\u00a9\nio\nca\n\u00a9\no\n\u00a9\n\u00a9\nci\n9\n\u00a9\nCO\nO\no\nCO\nt.\nea\nCJ\n\u00a9\n\u00a9\n-S\ns\n*g\nCi\nE\nPh\n\u25a08\nC\nei\n\u00a9\n\u00a9\na*\n3\n*5JD\no\nc\nto\n<5\nTotal by Sexes.\ne\nCJ\n>\no\na\nCJ\nCO\nCo\nQ\n*ei\nHH\no\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n2\nF.\n2\nM.\n6\nF.\n1\nM.\nF.\n2\nM.\nF.\nM.\n8\n1\n1\n1\n2\n3\n1\n2\n2\n1\n1\n1\n1\nF.\n5\n1\n13\n1\n1\n1\n2\n1\n1\n1\n1\n1\n9\n1\n1\n3\n1\n1\n1\n1\n2\n1\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n2\ni\ni\n6\n3\n3\n1\n1\n1\n1\n1\n2\n29\n1\n1\n38\n18\n33\n3\n1\n23\n1\n1\n2\n1\n8\n6\n25\n15\n21\n16\n34\n20\n32\n18\n17\n1\n3\n1\n5\n279\n197\n476\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n2\n3\n2\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\ni\n1\n1\n2\n1\n2\n1\n1\n1\n1\n1\n1\n1\nl\n2\n%\n1\n1\n1\n1\n1\n1 G 58\nBritish Columbia\n1918\nCAUSES OF\nd\nto\nc\n.2\nIt\na\n<5\nrt\nO\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nh\nrt\nOj\nu\nOJ\n0\nCM\nO\no5\nrt\nOJ\nSi\nHO\nc\nCM\no\no\n169\nVICTORIA DIVISION\u2014COWICHAN.\u2014Concluded.\nXIII.\u2014Affections Produced by External Causes.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n172\n3\n1\n14\n28\n34\n40\n77a\n78a\n79\n80\n81a\n105\n113\n169\n169\n170\nVICTORIA DIVISION\u2014ESQUIMALT.\nL\u2014General Diseases.\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nIII.\u2014Diseases of the Circulatory System.\nIV.\u2014Diseases of the Respiratory System.\nV.\u2014Diseases of the Digestive System.\n1\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\n1\nXII.\u2014Old Age.\nXIII.\u2014Affections produced by External Causes.\n1\n\t\n\t\n\t\n\t\n1\n\t\n28\nvictoria division\u2014oak bay.\nI.\u2014General Diseases.\n\u00bb\n42\n44a\n64\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n78\nIII.\u2014Diseases of the Circulatory System.\n81A 8 Geo. 5\nProvincial Board of Health.\nG 59\nDEATH, 1917\u2014Continued.\nrt\nOJ\n8\nO\no\no\nCO\no\no\n5\n9\n\u00a9\nO\n\u00a9\nCO\nea\n\u00a9\no\n\u00a9\nOJ\no\n\u25a0to\no\no\n\u2022o\no5\nE\nrt\nO\no\no\nCO\nrt\nv\n\u00a3\n\u00a9\nei\n9\n\u00a9\n\u00a9\no\n\u00a9\n00\n\u25a0a\nci\nc\nci\n\u00a7\nAge not given.\nCJ\nX\nCJ\nCO\n>,\n*3\no\nH\nB\n9\n>\n\u20225\no\nX\nCO\noj\nX\nHH\nca\nCJ\na\nla\no\nH\nM.\nF.\n1\nM.\nF.\nM.\n1\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n2\n1\nF.\n1\n\t\n3\n1\n1\n-IL\n1\n1\n~\n-777.\n2\n1\n6\n777.\n2\n2\n4\n1\n4\n1\n3\n\t\n\t\n\t\n27\n6\n33\n1\ni_\ni\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n2\n4\ni\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\ni\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\ni\n1\n2\n1\n18\n1\n1\n1\n2\n1\n2\n4\n4.\n1\n2\n1\n4\n1\n2\n1\n2\n8\n26\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1 G 60\nBritish Columbia\n1918\nCAUSES OF\nd\nto\n\u00a9\n1\ns\n\"So\na\n3\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.\na\nV\n9\na\nrt\nCM\no\nei\n\u2022u\n>>\nin\no\nCM\na\nc\no\n96\nVICTORIA DIVISION\u2014OAK BAY.\u2014 Concluded.\nIV.\u2014Diseases of the Respiratory System.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n102\nV.\u2014Diseases of the Digestive System.\n119\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n126\n150\nX. \u2014Malformations.\n1\n1\n1\n153A\nXL\u2014Diseases of Early Infancy.\nStill-born\t\n154\nXII.\u2014Old Age.\n2\n1\n24\n39a\n40\n41\n42\n45\n77A\n79a\n79b\n80\n84A\n85\n90\n92\n92a\n104\n113\n115\n120a\n151\n151b\n153a\nVICTORIA DIVISION\u2014SAANICH.\nI.\u2014General Diseases.\nWhooping-cough\t\nTetanus, neonatorum\t\nCancer of neck\t\nCancer and other malignant tumours of the stomach, liver\t\nCancer and other malignant tumours of the peritoneum, intestines, rectum\t\nCancer and other malignant tumours of the female genital organs\t\nCancer and other malignant tumours of other organs, and of organs not specified.\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nCerebral haemorrhage, apoplexy\t\nIll,\u2014Diseases of the Circulatory System.\nMyocarditis ,\nChronic valvular disease\nMitral regurgitation\t\nAngina pectoris\t\nHodgkin's disease\t\nHaemorrhage\t\nIV.\u2014Diseases of the Respiratory System.\nChronic bronchitis.\nPneumonia\t\nLobar pneumonia..\nV.\u2014Diseases of the Digestive System.\nDiarrhoea and enteritis (under 2 years)..\nCirrhosis of the liver\t\nOther diseases of the liver\t\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\nUremia.\nXL\u2014Diseases of Early Infancy.\nCongenital debility, icterus, and sclerema..\nNon-assimilation of food\t\nPremature\t 8 Geo. 5\nProvincial Board of Health.\nG 61\nDEATH, 1917\u2014Continued.\nei\na\no\nCM\n\u00a9\nO\nc4\nB\n\u00a9\neo\no\no\nCM\nrt\nV\no\no\no\nCO\nei\ncu\no\nO\n\u00a9\nei\n\u00a9\nCD\nO\nO\nea\n\u00a9\no\n\u00a9\n\u00a9\n*-\nei\n9\n\u00a3\no\n\u00a9\nea\nCJ\n\u00a9\n\u00a9\no\no\n00\nci\nlie\n&.\n9\n1\nrt\no\na\ns\n\u2022&\no\nc\nfcD\n\u00ab*i\nOJ\nX\nCO\n>>\n*\"\"*!\nO\nH\nB\nHH\nO\nB\nX\nCJ\nCO\nCO\n.g\na\nla\no\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n2\n3\n6\n2\n8\n7\n15\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n3\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\ni\n1\n1\n1\n1\n1\nl\n1\n1\n1\nl\n1\n1\n1\n1\n1\n1\n1\nl\nl\ni\nl\n1\n1\n1\n1\n2\n2\n2 G 62\nBritish Columbia\n1918\nCAUSES OF\n6\n&\n\u00a9\nei\no\nea\n\"S\n%\no\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nUnder 1 year.\nrt\n\u00a3\nCM\nO\nTO\nei\no>\n\u00a9\nCM\n\u00a9\no\n154\nVICTORIA DIVISION\u2014SAANICH- Concluded.\nXII.\u2014Old Age.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n169\nXIII.\u2014Affections produced by External Causes.\n189\nXIV.\u2014Ill-defined Diseases.\n4\n5\n1\n1\n....\n1\nNEW WESTMINSTER DIVISION\u2014NEW WESTMINSTER CITY.\nL\u2014General Diseases.\n9\n1\n20\n2\n20A\n28\n1\n1\n30\n1\n30a\n34a\n37\n39a\n40\n41\nCancer and other malignant tumours of the peritoneum, intestines, rectum\t\n44\n50A\n63A\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\n1\n1\n1\n67\n68A\n1\n1\n71\n1\n77a\nIII.\u2014Diseases of the Circulatory System.\n78\n79\nIV.\u2014Diseases of the Respiratory System.\n1\n1\n1\n98a 8 Geo. 5\nProvincial Board of Health.\nG 63\nDEATH, 1917\u2014Continued.\ni\n\u00a9\nCM\np\n\u00a9\noj\nCJ\n\u00a9\nCO\nO\n\u00a9\nCM\n5\nCJ\n*>)\n\u00a9\no\n\u00a9\nCJ\n\u00a9\nio\nO\n\u00a9\nOJ\niC\nei\nCJ\n\u00a9\n\u00a9\nO\nHH\n\u00a9\nio\nca\n\u00a9\no\no\n\u00a9\n70 to 80 years.\noj\n\u00a9\n\u00a9\no\nI\n-o\nt-\ns\nPh\nTi\nB\nea\n\u00a9\n\u00a9\nd\nCJ\n'&\u00a3\nHH\no\nQ\nbo\n\u25a03\nTotal by Sexes.\nB\n'Si\nO\na\ncj\nCO\n\u00a3\nca\nCy\n\u00ab\n1\nO\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n2\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\n1\n3\n1\nF.\n2\n3\n1\n1\n1\n1\n1\n1\n1\n3\n1\n2\n1\n2\n1\n2\n1\n4\n3\n5\n4\n\t\n23\n16\n39\n1\n1\n1\n1\n4\n1\n10\n1\n1\n1\n3\n1\n1\n4\n1\n1\n2\n1\n1\n1\n4\n1\n17\n1\n4\n1\n1\n2\n2\n2\n2\n1\n1\n1\n7\n2\n3\n1\n1\n1\n1\n1\n1\n1\n1\nI\n1\n1\n2\n1\n'\"i\"\n1\n1\n1\ni'\n2\n1\n2\n1\n1\n1\n2\n1\n2\n2\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n'\"e\"\n9\n8\n2\n2\n4\n3\nl\n1\n1\n2\n6\n7\n8\n1\n1\n1\n6\n1\n3\n2\n1\n1\n3\n\"b\n3\n1\n1\n1\n1\n*k\n2\n12\n16\n1\n3\n1\n2\n2\n3\n1\n1\n1\n1\n\"i\n1\n3\n1\n2\n3\n1\n3\n3\n1\n10\n4\n3\n1\ni\n2\n1\n1\n1\nl\n3\n2\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n2\n1\n2\n1\n4\n5\n1\n2\n1\n1\n1\n0\n1\n1\n1\n2\n1\n2\n1\n4\n4\n1\n1\n1\n1\n1\n1\nl\n1\n2\n1\n1\n1\n1\nl\n1\n'\"i\"\n1\n1\n1\n1\n1\n\" i'\nl\n1\nl\n1\ni G 64\nBritish Columbia\n1918\nCAUSES OF\n102\n103\n103a\n105\n108\n108a\n109\n110a\n110b\n110c\n113\n117\n118\n119\n120\n120a\n122\n126\n131a\n132\n137\n137a\n140\n142\n145\n160\n151\n151B\n153a\n153b\n153c\n154\n157\n159\n165\n169\n169a\n170\n174\n185\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nNEW WESTMINSTER DIVISION\u2014NEW WESTMINSTER CITY.\u2014Concluded.\nV.\u2014Diseases of the Dioestive System.\nUlcer of the stomach \t\nOther diseases of the stomach (cancer excepted)\t\nHemorrhage of bow-els \".\t\nDiarrhoea and enteritis (2 years and over)\t\nAppendicitis and typhlitis\t\nAppendicitis (gangrenous)\t\nHernias, intestinal obsti uctions \t\nIleocolitis\t\nIntussusception\t\nAbscess of the liver\t\nCirrhosis of the liver\t\nSimple peritonitis (non-puerperal),\t\nOther diseases of the digestive system (cancer and tuberculosis excepted) .\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\nAcute nephritis.\nBright's disease.\nUremia.\nOther diseases of the kidneys and annexa\t\nDiseases of the prostate\t\nPyonephrosis\t\nSalpingitis and other diseases of the female genital organs.\nVII.\u2014The Puerperal State.\nPuerperal septicaemia\t\nInduced abortion \t\nFollowing childbirth (not otherwise defined)..\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\nGangrene\t\nOther diseases of the skin and annexa..\nM.\nIX.\u2014Diseases of the Bones and Organs of Locomotion.\nToxic Absorption (osteomyelitis)\t\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t\nXI.\u2014Diseases of Early Infancy.\nCongenital debility, icterus, and sclerema..\nNon-assimilation of food\t\nStill-born \t\nPremature\t\nHaemophilia neonatorum\t\nXII.\u2014Old Age.\nSenility .\nXIII.\u2014Affections produced by External Caus\nSuicide by hanging or strangulation\t\nSuicide by firearms\t\nOther acute poisonings\t\nAccidental drowning\t\nTraumatism in logging camp and sawmill.\nTraumatism by firearms\t\nTraumatism by machines\t\nFractures (causes not specified). \t\nOther external violence\t\nF. 8 Geo. 5\nProvincial Board of Health.\nG 65\n- DEATH, 1917\u2014Continued.\n|\n5\n3\n5\nB\nCJ\n>\n'So\np\na\nX\nCO\nei\n9\n\u00a9\nCM\nP\n\u00a9\n20 to 30 years.\nu\nc3\nCJ\n\u00a9\no\nHH\n\u00a9\nCO\nLi\nei\nCJ\n>>\n\u00a9\niO\np\n\u00a9\nei\n9\n\u00a9\np\n\u00a9\n\u00a9\nu\na\no\nCO\no\n\u00a9\nei\n\u00a3\no\nCO\noj\n\u2022e\nE\nei\na\n1\nrt\ns\nd\n9\n\"\u00a3c\no\nc\nOJ\nSB\nTotal by Sexes.\nJ\nci\nCJ\ni\nP\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n1\n1\n1\n2\n2\n1\n1\n3\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n\u00bb1\n1\n1\n2\n1\n1\n1\n1\n9,\n1\n1\n5\n1\n1\n7\n1\n1\n1\n1\n1\n2\n1\n2\n1\n1\n1\n2\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n4\n7\n4\n1\n1\n2\n11\n3\n6\n18\n7\n1\n1\n1\n2\n2\n1\n1\n1\n1\n1\n1\n4\n4\n1\n1\n2\n1\n1\n1\n1\n1\n3\n1\n1\n1\n1\n5\n1\n1\n1\n1\n1\n2\n1\n22\n8\n10\n5\n16\n14\n21\n17\n15\n5\n12\n13\n8\n8\n3\n2\n-\n~\n777.\n4\n146\n97\n243 G 66\nBritish Columbia\n1918\nCAUSES OF\nd\na\nS\nCAUSE OF DEATH.\n$\n3\nQJ\nrt\n9\nei\n9\nen\nei\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\n9\nT3\nCM\nO\n\u00a9\n\u00a9\nO\nO\nD\nH\nCM\nm\nNEW WESTMINSTER DIVISION\u2014BURNABY,\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nI,\u2014General Diseases.\n5\n27\n32A\n39a\n42\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\n64\n71\n1\n1\nIII.\u2014Diseases of the Circulatory System.\n77a\n79a\n79b\n79c\nIV.\u2014Diseases of the Respiratory System.\n91\n1\n92a\n1\nV.\u2014Diseases of the Digestive System.\n104\n1\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n119\n1\nX.\u2014Malformations.\n150\n2\nXI.\u2014Diseases of Early Infancy.\n15lB\n1\n1\n2\n153 a\nXIII.\u2014Affections produced by External Causes.\n157\n169\n1\n175\n9\n1\n2\n1\n40\n51\n64\n68\n71\n77a\n78\n79\nNEW WESTMINSTER DIVISION\u2014CHILLIWACK.\nI.\u2014General Diseases.\nLeprosy \t\nTuberculosis of the lungs \t\nCancer and other malignant tumours of the stomach, liver .\nExophthalmic goitre\t\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nCerebral haemorrhage, apoplexy ..\nOther forms of mental alienation .\nConvulsions of infants\t\nIII.\u2014Diseases of the Circulatory System.\nMyocarditis\t\nAcute endocarditis\t\nOrganic diseases of the heart. 8 Geo. 5\nProvincial Board of Health.\nG 67\nDEATH, 1917\u2014Continued.\n10 to 20 years.\nE\nci\nCJ\n\u00a9\nCO\np\n\u00a9\nci\n9\n\u00a9\nh*i\nP\n\u00a9\nCO\nea\nV\n\u00a9\nIO\np\n\u00a9\nea\nCJ\ns\np\n\u00a9\nio\nc3\nOJ\n\u00a9\nP\n\u00a9\n\u00a9\nCJ\n\u00a9\n00\np\n\u00a9\n80 to 90 years.\n90 and upwards.\nB\n'&\np\nB\nCJ\nbe\n<\n*\nCJ\nCO\n*\u00ab\n\"o\nH\nB\n'&\nP\na\nX\nCJ\nCO\nHO\nHH\nca\nCJ\nn\n.\u25a0\u00ab\np\nH\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n1\nF.\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n2\n1\n1\n2\n2\n1\n3\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n3\n1\n1\n4\n1\n1\n1\n2\n1\n1\n2\n1\n1\n3\n1\n1\n1\n2\n2\n1\n1\n2\n1\n1\n1\n2\n3\n1\n3\n3\n2\n1\n1\n3\n4\n3\n1\n24\n11\n35\n1\n2\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n1\n5\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1 G 68\nBritish Columbia\n1918\nCAUSES OF\n6\nfe\nd\n.2\nn\n5\n*\n1-\nO\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nu\nei\n>*\n0J\na\np\nu5\nrt\nCM\nO\nrt\n9\no\n(M\n5 to 10 years.\n91\nNEW WESTMINSTER DIVISION\u2014CHILLIWACK.\u2014Concluded.\nIV.\u2014Diseases of the Respiratory System.\nM.\nF.\n1\nM.\nF.\nM.\nF.\nM.\nF.\n92\n97a\n103a\nV.\u2014Diseases of the Digestive System.\n1\n105\n1\n120\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n150\nX.\u2014Malformations.\n1\n1\n1\n1\n151\nXL\u2014Diseases of Early Infancy.\n153a\n1\n154\nXII.\u2014Old Age.\nSenility '.\t\n169\nXI11.\u2014Affections produced by External Causes.\n170\n175\n175a\n178a\n5\n5\n1\nNEW WESTMINSTER DIVISION\u2014OUTSIDE.\nI.\u2014General Diseases.\n1\n10\n20\n1\n28\n1\nCancer and other malignant tumours of the peritoneum, intestines, rectum\t\n41\n45A\n46\n61\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n64\n67\n68\n69\n1\n71\n1\n1\n1\nIII.\u2014Diseases of the Circulatory Syste.m.\n77a\n1\n78\n1\n79b\n79c\n85a 8 Geo. 5\nProvincial Board of Health.\nG 69\nDEATH, 1917\u2014Continued.\nt\u00bb\n%\n\u00a9\nCM\nO\nO\nDD\nei\n9\n\u00a3\nO\nHH\n\u00a9\noj\nei\nCj\n\u00a9\nhh\nP\n\u00a9\nCO\noj\nca\nCJ\n\u00a9\nio\np\nHH\n\u00a9\noj\nca\n\u00a9\n\u00a9\np\n\u00a9\nIO\noj\nci\nCJ\n\u00a9\np\n\u00a9\n\u00a9\nci\n\u00a3\no\n\u00a3\ncc\nCJ\nCJ\n\u00a9\n\u00a9\no\no\n00\noj\n-p\n\u00a3,\nca\np,\nC\nca\ns\nB\nCJ\n'So\n^>\np\nCJ\nbe\n<\nTotal by Sexes.\nc\nCJ\n>\nHH\nP\nG\nX\nCJ\nCO\noj\nJ\nHH\nCi\nCJ\ne\n\"ci\nJ-ff\np\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n2\n2\n1\n\u20229\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n2\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n5\n1\n1\n3\n5\n2\n2\n3\n1\n1\n3\n25\n12\n37\n1\n2\n1\n3\n10\n2\n1\n2\n1\n1\n1\n2\n2\n1\n1\n2\n1\n1\n3\n2\n2\n1\n1\n2\n1\n4\n14\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n6\n1\n3\n4\n3\n1\n1\n1\n4\n1\n3\n2\n1\n15\n3\n4\n2\n1\n1\n4\n5\n2\n4\n1\n2\n1\n1\n1\n1\n3\n3\n1\n4\n1\n2\n1\n9\n1\n1\n1\n1\n1\nI\n1\n1\n2\n1\n1\n1\n5\n9\n1\n1\n2\n1\n1\n5\n2\n1\n4\n1\n1\n1\n1\n1\n3\n1\n1\n1\n1\n1\n2\n1\n1\ni\n1 G 70\nBritish Columbia\n1918\nCAUSES OF\n91\n92\n92a\n92b\n92c\n94\n97a\n103\n104\n105\n106\n108\n109\n110a\n113\n118\n119\n120\n120A\n126\n137\n139\n151\n151a\n152a\n153a\n153b\n159\n167\n169\n169a\n170\n171a\n174\n175\n185\n186\n187a\n189\nCAUSE OF DEATH.\n{After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nNEW WESTMINSTER DIVISION\u2014OUTSIDE. -Concluded.\nIV.\u2014Diseases of the Respiratory System.\nAcute bronchitis..\t\nBronchopneumonia\t\nPneumonia\t\nLobar pneumonia\t\nBronchopneumonia following whooping-cough .\nHypostatic pneumonia\t\nPulmonary congestion, pulmonary apoplexy...\nPulmonary embolism\t\nOEdema of lungs\t\nSuppurative tonsilitis\t\nV.\u2014Diseases of the Digestive System.\nOther diseases of the stomach (cancer excepted)\t\nDiarrhoea and enteritis (under 2 years)\t\nDiarrhcea and enteritis (2 years and over)\t\nAnkylostomiasis ....\t\nAppendicitis and typhlitis\t\nHernias, intestinal obstructions\t\nEnterocolitis\t\nCirrhosis of the liver\t\nOther diseases of the digestive system (cancer and tuberculosis excepted).\nVL\u2014Non-venereal Diseases of Genito-Urinary Syste.m and Annexa.\nAcute nephritis..\nBright's disease .\nUremia..\nDiseases of the prostate.\nV1L\u2014The Puerperal State.\nPuerperal septicaemia\t\nPuerperal phlegmasia alba dolens, embolus, sudden death...\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t\nXL\u2014Diseases of Early Infancy.\nCongenital debility, icterus,and sclerema.\nAccident of labour\t\nAtelectasis '.\nStill-born\t\nPremature\t\nXII.\u2014Old Age.\nSenility.\nXIII.\u2014Affections produced by External Causes.\nSuicide by firearms\t\nBurns (conflagration excepted)\t\nAccidental drowning\t\nTraumatism in logging camp and sawmill\t\nTraumatism by firearms\t\nTraumatism by falling tree\t\nTraumatism by machines \t\nTraumatism by other crushing (railroad, landslides, vehicles, etc.).\nFractures (causes not specified)\t\nOther external violence\t\nXIV.\u2014Ill-defined Diseases.\nDropsy\t\nCause of death not specified or ill-defined. 8 Geo. 5\nProvincial Board of Health.\nG 71\nDEATH, 1917\u2014Continued.\nei\n\u00a9\nCM\nO\n\u00a9\nc\nrt\nP\n\u00a3\n\u00a9\ni\nrt\n\u00a9\no\n\u00a9\nCO\nci\n\u00a9\nio\np\n\u00a9\nHtl\nca\n\u00a9\n\u00a9\n\u00a9\niO\nca\n9\n\u00a9\np\n\u00a9\n\u00a9\noj\ncl\n.CJ\n\u00a9\nX\nP\nO\nI\u2014\nei\nCJ\n\u00a9\n\u00a9\nP\n\u00a9\nCO\n-p\nPh\n\u25a0a\nB\no\n\u00a9\nd\nCJ\n>\n'bo\np\n<\nCJ\nCJ\nCO\nHP\n*ci\nP\nH\nB\nCJ\n\"Si)\nHH\nP\nS\nX\nCJ\nCO\n5\nHH\nei\nCJ\n0\n*3\n0\nH\nM.\nF.\nM.\nF.|\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n6\n3\n1\nF.\n\"'5'\n1\n1\n1\n1\n1\n2\n1\n1\n2\n11\n1\n4\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n4\n1\n2\n2\n1\n1\n1\n1\n1\n2\n2\n1\n2\n1\n\"i\"\n1\n1\n1\n2\ni\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n1\n6\n1\n1\n1\n1\n2\n2\n2\n1\n1\n1\n1\n1\n1\n3\n1\n3\n1\n1\n2\n1\n1\n3\n1\n2\n2\n1\n3\n4\n6\n5\n1\n1\n2\n2\ni\n1\n2\n1\n1\n1\n1\n3\n1\n1\n1\n1\n1\n2\n3\n1\n1\n4\n1.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n2\n3\n1\n1\n1\n20\n1\n2\n6\n2\n18\n6\n15\n3\n16\n3\n20\n5\n5\n6\n5\n3\n130\n50\nISO G 72\nBritish Columbia\n1918\nCAUSES OF\np\nis\n1\na\nCJ\n3\nB\nrt\nO\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nm\nei\n9\n9\na\nP\nei\n9\nCM\n\u00a9\n2 to 5 years.\noj\nei\nCJ\n\u00a9\np\nio\n1\nNANAIMO DIVISION\u2014NANAIMO CITY.\nI.\u2014General Diseases.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n8\n1\n1\n1\n1\n9\n28\n39a\n39b\n40\n42\n47\n1\n50\n50A\n54a\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n61\n1\n61A\n64\n71\n1\n1\n77a\nIII.\u2014Diseases of the Circulatory System.\n78\n79\n79a\n81a\n81b\n87\nIV.\u2014Diseases of the Respiratory System.\n89\n1\n90\n91\n1\n1\n92\n1\n2\n92A\n98a\n102\nV.\u2014Diseases of the Digestive System.\n104\n1\n108\n113\n114\n117\n119\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n120A\n137\nVII.\u2014The Puerperal State.\n141A\nXL\u2014Diseases of Early Infancy.\n151\n2\n1\n3\n1\n152a\n153a\n1\n154\nXII.\u2014Old Age.\n159\nXIII.\u2014Affections produced by External Causes.\n169\n175\n182 a\n186\n1 8 Geo. 5\nProvincial Board of Health.\nG Ti\nDEATH, 1917\u2014Continued.\nd\nCJ\n\u00a9\nOJ\np\n\u00a9\n4\n>>\n\u00a9\nCO\np\n\u00a9\nOJ\noj\n1\n\u00a9\n***\np\n\u00a9\noj\nei\nCJ\n\u00a9\np\n\u00a9\nhH\n2\no\n\u00a9\n\u00a9\np\nS\noj\nei\nCJ\n\u00a9\nP\n\u00a9\n\u00a9\noj\ni\n9\n\u00a9\nCO\n\u00a9\n\u00a9\nrt\ncu\n\u00a9\n\u00a9\no\n1\nV\n3\n\"s=\np-\nB\n**C\nc\nci\n8\nQ\nCJ\n'&\np\nP\nCJ\nbo\nCJ\nX\nCJ\nCO\nho1\nP\nH\nc\nOl\n'5\np\na\nCO\nj\nci\nCJ\na\n*3\np\nH\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\n2\n1\n4\n2\n1\n4\n1\n1\n2\n2\n2\n3\n1\n2\n8\n1\n1\n1\n1\n1\n1\n2\n1\ni\n1\n1\n'i'\nl\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n1\n2\n1\n1\n1\n2\nl\nl\nl\nl\n2\n4\n2\n1\ni\nl\n1\n1\n3\n1\n1\n1\n1\n4\n1\n6\n1\n1\n1\n1\n8\n1\n1\n1\n1\n1\n1\n1\n1\n1\n4\n1\n1\n1\n1\n1\n1\n1\n2\n2\n2\n2\n1\n1\n6\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\nl\n1\n1\n1\n1\n1\n1\n1\n5\n1\n1\n1\n1\n1\n4\n1\n1\n1\n2\n3\n1\n1\n1\n1\n2\n1\n9\n1\n2\n1\n3\n1\n1\n5\n1\n1\n1\n3\n1\n1\n1\n1\n1\nSI\n1\n1\n2\n1\n1\n1\n2 G 74\nBritish Columbia\n1918\nCAUSES OF\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.\n1\n1\n\"Eo\nI\no\nrt\n9\n9\n\u20226\n3\nCM\n\u00a9\nrt\n\n\"be\np\na\ny.\nCO\nei\n9\n\u00a9\nOJ\np\n\u00a9\noj\nC3\nCJ\n\u00a9\nCO\np\n\u00a9\nOl\nE\nei\nCJ\n\u00a9\n\u25a0*\n.P\n\u00a9\noj\nCJ\n\u00a9\nio\np\n\u00a9\ns\nci\nOJ\n>,\n8\nO\n\u00a9\nE\nei\n\u00a9\nP\nO\n\u00a9\nE\nci\nCJ\n\u00a9\nCO\np\n\u00a9\nei\n9\n\u00a9\n\u00a9\np\n\u00a9\nCO\n\u25a0p\ng\nP.\nP\n-P\na\nci\n\u00a9\n\u00a9\nci\n\"bB\nP\nbo\n<\nTotal by Sexes.\nHP\nca\nCJ\na\n*\u00ab\np\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n3\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n6\n6\n7\n4\n8\n7\n7\n4\n10\n6\n=\n2\n2\n60\n39\n99\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n2\n1\n1\n1\n3\n1\n1\n1\n8\n3\n11\n1\n2\n2\n1\n1\n1\n2\n1\n1\nT\n1\n1\n2\n2\n4\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n1\n1\n3\n3\n3\n1\n1\n1\n2\n1\n1\n3\n1\n1\n1\n1\n2\n1\n2\n1\n3\n1\n1\n1\n3\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1 G 76\nBritish Columbia\n1918\nCAUSES OF\n6\nX\n%\n1\nCJ\n%\ni\n6\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nei\n9\n>>\nta\n\u00a9\na\nei\n9\n(M\nO\n1\ns\nlO\n\u00a9\nCM\nE\nei\n9\n\u00a9\nO\nlO\n117\nNANAIMO DIVISION\u2014COMOX.\u2014 Concluded.\nV.\u2014Diseases of the Digestive System.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n119\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n120 a\n137a\nVII.\u2014The Puerperal State.\n142\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\n153A\nXI,\u2014Diseases of Early Infancy.\n1\n154\nXIL\u2014Old Age.\n160\nXIII.\u2014Affections produced by External Causes.\n165\n168\n169\n169a\n171a\n173\n175\n181\n182\n185\n189\nXIV.\u2014Ill-defined Diseases.\n2\n2\n1\n2\n1\n9\nNANAIMO DIVISION\u2014LADYSMITH.\nI.\u2014General Diseases.\n1\n28\n1\n64\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n70\n1\n77a\nIII.\u2014Diseases of the Circulatory System.\n89\nIV.\u2014Diseases of the Respiratory System.\n91\n1\n2\n2\n1\n92\n93\n108\nV.\u2014Diseases of the Digestive System.\n1\n119\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa. 8 Geo. 5\nProvincial Board of Health.\nG 77\nDEATH, 1917\u2014Continued.\noj\n5\ns\n\u00a9\nOJ.\n\u00a9\n\u00a9\noj\nca\nCJ\n\u00a9\nCO\np\n\u00a9\nOl\noi\nci\nCJ\n\u00a9\n-ci\no\n\u00a9\nCO\noj\nca\n3\n\u00a9\np\n\u00a9\nH*l\noj\nel\n9\n\u00a9\n\u00a9\nP\n\u00a9\nio\n>>\ng\np\n\u00a9\n\u00a9\noj\nca\n9\n|\no\n8\nca\n9\n8\nO\n\u00a9\nCO\n**o\n\u00a3\nei\nis\nPh\nB\n\u25a0a\nB\nca\n\u00a9\n\u00a9\n'Sb\np\nCJ\nbo\n<\nTotal by Sexes.\nSex not given.\nTotal Deaths.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\nF.\nM.\nF.\nM.\nF.\n:m.\nF.\nM.\nF.\nM.\nF'\nM.\nF.\n1\n1\n1\n1\n1\n1\n...... ..\n1\n1\n1\n1\n1\n2\n1\n1\ni'\n1\ni\ni\n1\n1\n2\n1\n1\n1\n3\n10\n1\n7\n1\n1\n1\n1\n4\n1\n2\n1\n1\n1\n1\n1\n2\n5\n2\n1\n1\n1\n1\n2\n10\n1\n1\n4\n1\n1\n1\n1\n7\ni\n1\n2\n1\n4\n1\n1\n1\n10\n1\n2\n11\n1\n16\n4\n4\n4\n6\n3\n5\n2\ni\n1\n1\nl\n3\n63\n20\n. , 83\n1\n1\n1\n1\n3\n2\n2 ..\n1\n3\n1\n1\n1\n4\n2\n1\n1\n2\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1 G 78\nBritish Columbia\n1918\nCAUSES OF\n\u00a9\nfe\n.2\nCJ\nCAUSE OF DEATH.\nei\n9\nei .\n3\nGJ\n\u00ab\n9\n(After the Bertillon Classification Causes of Death, Second International\nU\nCM\nm\nrt\nDecennial Revision, Paris, 1909.)\njo\nO\no\n\u00a9\n6\nP\n*-\"\n(M\nin\nNANAIMO DIVISION\u2014LADYSMITH.\u2014'Concluded.\nVII.\u2014The Puerperal State. \u2022\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n137\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\n145A\nX.\u2014Malformations.\n1\nXL\u2014Diseases of Early Infancy.\n153 a\n1\nXIII.\u2014Affections produced by External Causes.\n169\n1\n1\n6\n1\n1\n2\n2\n-\n~\n1\n20\n28\n30\n41\n64\n68a\n70\n71\n77a\n78\n79\n81\n1)1\n92\n104\n108\n109\n118\n150\n153a\n153b\n153c\nBEATON GROUP\u2014CRANBROOK.\nI.\u2014General Diseases.\nTyphoid fever\t\nPurulent infection and septicaemia\t\nTuberculosis of the lungs\t\nTubercular meningitis\t\nCancer and other malignant tumours of the peritoneum, intestines, rectum.\nOther tumours (tumours of the female genital organs excepted)\t\nAddison's disease\t\nIL\u2014Diseases of Nervous System and Organs of Special Sens:\nLocomotor ataxia\t\nCerebral hemorrhage, apoplexy..\nParalysis from bite of wood tick..\nConvulsions (non-puerperal)\t\nConvulsions of infants\t\nIII.\u2014Diseases of the Circulatory System.\nMyocarditis\t\nAcute endocarditis\t\nOrganic diseases of the heart .\nDiseases of the arteries\t\niv.\u2014Diseases of the Respiratory System.\nBronchopneumonia..\nPneumonia\t\nAsthma\t\nV.\u2014Diseases of the Digestive System.\nDiarrhoea and enteritis (under 2 years)\t\nAppendicitis and typhlitis\t\nHernias, intestinal obstructions\t\nOther diseases of the digestive system (cancer and tuberculosis excepted)..\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t\nXL\u2014Diseases of Early Infancy.\nStill-born \t\nPremature\t\nInjury by forceps at birth. 8 Geo. 5\nProvincial Board of Health.\nG 79\nDEATH, 1917\u2014Continued.\nei\n9\n>>\n\u00a9\n>\nIfS\nO\n-\u2022*=\nCM\nm\n3\n0J\no\n\u00a9\n169\nBEATON GROUP\u2014 CRANBROOK.\u2014Concluded.\nXIII.\u2014Affections produced by External Causes.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n173a\n174\n8\n8\n2\n1\n2\n1\n1\nBEATON GROUP\u2014FERNIE.\nI.\u2014General Diseases.\n1\n6\n1\n1\n8\n3\n1\n1\n1\n20\n28\n40\n42\n45\n50\n1\n56a\n56b\n61\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n1\n1\n70\n71\n2\n2\n77a\nIII.\u2014Diseases of the Circulatory System.\n78\n78b\nIV.\u2014Diseases of the Respiratory System.\n1\n1\n1\n\"i*\ni\n1\n1\n1\nV.\u2014Diseases of the Digestive System.\n4\n4\n1\n1\n1\n1\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n131\n137\n150\nVII.\u2014The Puerperal State.\nX.\u2014Malformations.\n2 8 Geo. 5\nProvincial Board of Health.\nG 81\nDEATH, 1917\u2014Continued.\nei\nOJ\n\u00a9\nCM\nO\n\u00a9\nOD\nei\n\u00a9\nCO\no\n-iO\n8\nci\n9\n\u00a9\n-si\np\n\u00a9\nci\n\u00a9\nio\np\n\u00a9\nOJ\nE\nci\nCJ\n\u00a9\n\u00a9\np\nO\nio\noj\n9\n\u00a9\np\nO\n\u00a9\nca\nCJ\n\u00a9\n00\np\n\u00a9\nea\nOJ\n\u00a9\n\u00a9\np\n\u00a9\n00\nca\n*S\nPh\nB\n-P\nP\neS\n\u00a9\n\u00a9\nd\n\"bo\n\"p\nC\nCJ\nto\n\u2022>3\nTotal by Sexes.\nB\n9\n\"bo\np\np\nCJ\nCO\nHH\nei\nCJ\na\n\u25a0\"ei\np\nM.\nP.\nM.\n1\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n1\n1\nF.\n1\n1\n1\n2\n1\n4\n1\n3\n2\n5\n2\n4\n1\n2\n29\n19\n48\n3\n1\n1\n1\n6\n1\n1\n2\n7\n1\n4\n1\n1\n6\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n2\n2\n2\n1\n1\n1\n1\no\n1\n1\n2\n1\n1\n2\n1\n4\nI\n1\n1\n3\n1\n1\n2\n1\ni\n1\n1\n1\n2\n1\n2\n1\n1\n1\n2\n1\n1\n1\n5\n1\n3\n1\n1\n2\n2\n1\n1\n1\n1\n1\n2\n2\n4\n3\n1\n1\n1\n4\n9\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n2\n1\n2\n1\n2\n1\n2\n2\n2 G 82\nBritish Columbia\n1918\nCAUSES OF\n\u00a9\nfe\n5\nrt\n\u00a3j\n(*\u00bb\nei\n5\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nrt\n9\n\no\n9\n<\nTotal by Sexes.\np\nCJ\n'bo\np\nP\nCJ\nCO\noj\njP\nei\na\n*ei\np\nH\n1\n1\n8\n3\n1\n9\n3\n32\n1\n1\n1\n140\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\n5\n3\n1\n8\n1\n3\n32\n1\n1\n1\n2\n4\n1\n1\n9\n1\n1\ni\n1\n1\n1\n14\n1\n2\n1\n0\n1\n1\n1\n12\n1\n22\n17\n5\n2\n9\n6\n3\n3\n1\n3\n3\n104\n36\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n10\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n2\n1\n-\n1\n9\n1\n1\n1\n\"T\ni\n1\n1\n1\n1\n4\n1\n3\n3\n1\n1\n1\n1\n1\n1\n2\n1\n4\n1\n3\n2\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\ni\n1 1\nG 84 British Columbia 191S\nCAUSES OF\nc?8i g* Classification No.\nCO J.\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nei\n9\n0J\n-g\nc\np\nBO\nS-\nei\n9\nCM\nO\ni-\nri\n9\nLO\n\u00a9\n\u25a0M\n5 to 10 years.\nBEATON GROUP\u2014 KASLO.\u2014Concluded.\nXI.\u2014Diseases of Early Infancy.\nM.\nF.\n1\nM.\nF.\nM.\nF.\nM.\nF.\nStill-born \t\n1\nXIII.\u2014Affections produced by External Causes.\n1\n1\n1\n1\n34a\n44a\n50a\n64\n79a\n117\n119\n151B\nBEATON GROUP\u2014NAKUSP.\nI.\u2014General Diseases.\n1\nII.\u2014Diseases of Nervous System and Organs of Sfecial Sense.\n<\nIII.\u2014Diseases of the Circulatory System.\nV.\u2014Diseases of the Digestive System.\nVI.\u2014Non-Venereal Diseases of Genito-urinary System and Annexa.\nXI.\u2014Diseases of Early Infancy.\n1\n1\n1\n\u2014\n7\n8\n24a\n24b\n28\n30\n40\n46\n50\n5*2\n54A\n56a\n61a\n64\n69\n71\n77a\n78a\n79\n79a\n79b\n82\nBEATON GROUP\u2014NELSON.\nI.\u2014General Diseases.\n2\n1\n1\n1\n1\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n1\n1\nIII.\u2014Diseases of the Circulatory System.\n1 8 Geo. 5\nProvincial Board of Health.\nG 85\nDEATH, 1917\u2014Continued.\ni\n\u00ab\n9\n\u00a9\n0\n\u00a9\nei\ni\n\u00a9\nCO\no\n\u00a9\nCM\n9\n\u00a9\n-*\nO\n\u00a9\nCO\na\nCJ\n\u00a9\n\u00a9\n\u00a9\n-*\nci\n9\n\u00a9\n\u00a9\no\n\u00a9\nd\nO\nI*-\nO\ns\ni\nei\n\u00a9\n00\nO\nO\nct\n\u00a9\n\u00a9\nO\n00\nei\nft\na\nc\n\u00a9\n\u00a9\ne\no\nc\n\u25a0bo\nTotal by Sexes.\nc\nCJ\n'bb\np\np\nCJ\nCO\nO\np\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n1\n2\n1\n1\n1\n1\n2\n1.\n1\n1\n4\n1\n5\n2\n2\n5\n2\n1\nr\n~\n20\n4\n24\n1\ni\n1\ni\n1\n1\n1\n1\nl\nl\n1\n1\n1\n1\nl\nl\n1\n1\n1\nl\n1\n1\n1\n2\n1\n1\n4\n4\n8\n1\n1\n1\n1\n2\n1\n1\n4\n1\n1\n1\n1\no\n1\n3\n1\n1\n1\n1\n2\n1\n1\n1\n1\ni\n1\n1\n2\n1\n1\n7\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n9\n1\n1\n3\n1\n1\n2\n2\n1\n1\ni\n2\ni\ni\ni\ni\ni ' \u2022\n1\nG 86 British Columbia 1918\nCAUSES OF\np\np\np\nH\nCJ\nS\nei\n0\n89\n91\n92\n94\n97a\n102\n108\n104\n108\n110a\n113\n120\n120a\n137a\n140\n150\n151\n153A\n153B\n154\n160\n167\n169\n173\n175\n178a\n186\n187a\n189\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nei\n9\no>\nei\nC-l\nP\noj\nj-\nca\ns\nICC\np\nCM\n5 to 10 years.\nBEATON GROUP\u2014NELSON.- Concluded.\nIV.\u2014Diseases of the Respiratory System.\nM.\n2\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nV.\u2014Diseases of the Digestive System.\n1\n1\n1\nVI.\u2014Non-venereal Diseases of Genito-Urinary System and Annexa.\n1 \u2022\nVII\u2014The Puerperal State.\n1\nX.\u2014Malformations.\nXI.\u2014Diseases of Early Infancy.\n1\n1\n3\n1\n1\n1\nStill-born\t\nj\\II.\u2014Old Age.\nXIII.\u2014Affections produced by External Causes.\n1\n1\nXIV.\u2014Ill-defined Diseases.\n\u00ab9\n8\n1\n4\n2\n3\n1\n28\n29\n6lA\n79\n79A\n92\nBEATON GROUP\u2014NEW DENVER.\nI.\u2014General Diseases.\n\u2022\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n1\nIII.\u2014Diseases of the Circulatory System.\nIV.\u2014Diseases of the Respiratory System. 8 Geo. 5\nProvincial Board of Health.\nG 87\nDEATH, 1917\u2014Continued.\nSh\nca\nCJ\nj*.\n\u00a9\nCM\nP\n\u00a9\nea\nCJ\n>>\n\u00a9\nCO\np\n\u00a9\nc-l\nin\nci\n9\n\u00a9\nHH\nP\n\u00a9\nci\nCJ\n\u00a9\n1C3\nP\n\u00a9\nci\n9\n\u00a9\n\u00a9\np\n5\n0)\n\u00a9\np\n\u00a9\n\u00a9\nci\nOJ\n\u00a3\np\n\u00a9\nci\n9\n\u00a9\n\u00a9\np\nHH\n\u00a9\nOO\n-P\nei\n\u00a3.\nB\n\u25a0P\nP\n\u00a9\n\u00a9\nB\nCJ\n'ft\nP\nP\nCJ\nto\n<\nCJ\njc\nCJ\ncc\nH=\n*c?\nP\nH\nc\nCJ\n\u2022a\nHH\nP\nX\nCJ\nCO\noj\nHP\n-in\n>\n\u00a9\no\nlO\n169\nBEATON GROUP\u2014REVELSTOKE\u2014Concluded.\nXIII.\u2014Affections produced by External Causes.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\nF.\n175\n186\n186a\n11\n3\n1\n2\n1\n20\n28\n30\n61a\n62\n64\n77a\n78a\n79a\n78b\n110a\n117\n151\n153a\n169\n186\nBEATON GROUP\u2014ROSSLAND.\nI.\u2014General Diseases.\nPurulent infection and septicaemia\nTuberculosis of the lungs\t\nTuberculous meningitis\t\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nCerebral tumor\t\nLocomotor ataxia\t\nCerebral haemorrhage, apoplexv .\nIII.\u2014Diseases of the Circulatory System.\nMyocarditis\t\nEndocarditis following rheumatism\nMitral regurgitation.\t\nDilatation of heart\t\nIV.\u2014Diseases of the Respiratory System.\nPneumonia\t\nCapillary bronchitis\nPleurisy \t\nOSdema of lungs\t\nV.\u2014Diseases of the Digestive System.\nEnterocolitis , \t\nSimple peritonitis (non-puerperal) .\t\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\nOther diseases of the kidneys and annexa\t\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t\nXL\u2014Diseases of Early Infancy.\nCongenital debilitv, icterus, and sclerema..\nStill-born\t\nXII.\u2014Old Age.\nSenility.\nXIII.\u2014Affections produced by External Causes.\nAccidental drowning\t\nOther external violence .\nXIV.\u2014Ill-defined Diseases.\nIll-defined organic disease . 8 Geo. 5\nProvincial Board of Health.\nG 91\nDEATH, 1917\u2014Continued.\n9\n\u00a9\nCM\no\n\u00a9\no5\nrt\n9\no\nCO\no\no\n(M\nrt\n9\n\u00a9\no\n\u00a9\nCO\nrt\n\u00a9\no\n\u00a9\n9\n\u00a9\n\u00a9\nO\n\u00a9\niO\nu5\n9\n\u00a9\n\u00a9\n\u00a9\n\u00a9\nei\n9\n>>\n\u00a9\nO\n\u00a9\nei\nV\no\n\u00a9\no\n\u00a9\nCO\nft\nG\nrt\nS\n\"So\no\nc\no\nX\n9\n02\n~ei\nI\nP\nCJ\n>\n'bo\np\nX\nCJ\nCO\noj\n.C\nCJ\na\n*ce\np\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n0\n6\n3\n1\n2\n1\n1\n1\n30\n10\n40\n\"i\"\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n2\n1\n\"i\"\n1\n4\n2\n1\n1\nI\n5\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n\" i'\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n1\n2\n1\n1\n2\n1\n5\n1\n5\n4\n3\n1\n1\n1\n1\n19\n12\n31 G 92\nBritish Columbia\n1918\nCAUSES OF\no\"\nfe\nG\n.2\n'\u25a0\u00a3\nd\n\u00a9\ns\n*3*j\ns\n5\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\n9\n9\nTS\nC\nei\no\nu\nei\n9\niO\no\n\u25a05-1\n5 to 10 years.\n64\nBEATON GROUP\u2014SLOCAN CITY.\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n91\nIV.\u2014Diseases of the Respiratory System.\n1\n120a\nIV.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n153a\nXL\u2014Diseases of Early Infancy.\n1\n1\n1\n20\n28\n45\n50\n92\n94\n102\n104\n151b\n153a\n153b\n153c\n169\n169a\n173\n181\nBEATON GROUP\u2014TRAIL.\nI.\u2014General Diseases.\nWhooping-cough followed by nephritis and convulsions\t\nPurulent infection and septicaemia\t\nTuberculosis of the lungs\t\nCancer and other malignant tumours of other organs, and of organs not specified.\nDiabetes\t\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nConvulsions of infants\t\nIII.\u2014Diseases of the Circulatory System.\nOrganic diseases of the heart .\nAngina pectoris\t\nIV.\u2014Diseases of the Respiratory System.\nAcute bronchitis\t\nPneumonia\t\nPulmonary congestion, pulmonarj apoplexy..\nV.\u2014Diseases of the Digestive System.\nUlcer of the stomach\t\nDiarrhcea and enteritis (under 2 years).\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\nVIL\u2014The Puerperal State.\nPuerperal embolism.\nXL\u2014Diseases of Early Infancy.\nNon-assimilation of food.\nStill-born\t\nPremature\t\nDifficult parturition\t\nXIII.\u2014Affections produced by External Causes.\nAccidental drowning\t\nTraumatism in logging camp and saw-mill.\nTraumatism in mines and quarries\t\nElectricity (lightning excepted)\t\nOther external violence\t\nXIV.\u2014Ill-defined Diseases.\nCause of death not specified or ill-defined\t 8 Geo. 5\nProvincial Board of Health.\nG 9J\nDEATH, 1917\u2014Continued.\n10 to 20 years.\nCJ\n\u00a9\nCO\no\n\u00a9\nCJ\n\u00a9\np\n\u00a9\necj\n40 to 50 years.\n15\na\n9\n\u00a9\n\u00a9\np\n\u00a9\nirj\n60 to 70 years.\nci\nCJ\no\nCO\nP\n\u00a9\n9\n\u00a9\n\u00a9\np\n\u00a9\n00\n*p\nei\nP.\n\u20223\nB\nca\n\u00a9\n\u00a9\nG\n09\n*s>\n0\n0\nbo\n<;\nTotal by Sexes.\nB\nCJ\n\"bo\n\"p\np\nX\nCO\nHP\nCJ\na\n*rt\nP\nH\nM.\nF.\nM.\nF.J\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n4\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\ni\n2\n1\n1\n1\n1\n1\n1\n1\n1\nl\n2\n1\n2\n1\n1\n1\n3\n2\n1\n1\n1\n3\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\no\n2\n1\n1\n1\n1\n1\n1\n1\n9\n2\n2\n1\n1\n1\n2\n1\n5\n3\n1\n5\n1\n1\n1\n8\n25\n33 G 94\nBritish Columbia\n1918\nCAUSES OF\np\n1\nrt\n(gj\n*55\nci\na\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nUnder 1 year.\n1 to 2 years.\n2 to 5 years.\n3\n9\nO\no\nIO\n163\nBEATON GROUP\u2014TROUT LAKE.\nXIII.\u2014Affections produced by External Causes.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n189\nXIV.\u2014Ill-defined Diseases.\n64\nBEATON GROUP\u2014WILMER.\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n79\nIII.\u2014Diseases of the Circulatory System.\n96\nIV.\u2014Diseases of the Respiratory System.\n39a\n50\n79\n79a\n81\n91\n92\n97a\n98a\n137\nALBERNT GROUP\u2014ALBERNI.\nL\u2014 General Diseases.\nDiphtheria and croup.\nCancer of the bladder .\nDiabetes \t\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nCerebral haemorrhage, apoplexy\t\nIII.\u2014Diseases of the Circulatory System.\nOrganic diseases of the heart.\nFatty degeneration of heart..\nDiseases of the arteries\t\nIV.\u2014Diseases of the Respiratory System.\nBronchopneumonia\t\nPneumonia \t\nPulmonary haemorrhage\nOZdema of lungs\t\nVII.\u2014Tub Puerperal State.\nPuerperal septicemia\t\nXL\u2014Diseases of Early Infancy.\nNon-assimilation of food\t\nXIV.\u2014Ill-defined Diseases.\nCause of death not specified or ill-defined\t\nALBERNI GROUP\u2014ATLIN.\nI.\u2014General Diseases.\nAlcoholism, acute. 8 Geo. 5\nProvincial Board of Health.\nG 95\nDEATH, 1917\u2014Continued.\nca\n9\n\u00a9\nen\np\n\u00a9\nrH\np\nci\n9\n\u00a9\nCO\np\n\u00a9\n30 to 40 years.\nci\nCJ\n\u00a9\nio\np\n\u00a9\n50 to 60 years.\n60 to 70 years.\nei\n9\n\u00a9\n00\np\n\u00a9\n80 to 90 years.\n90 and npwards.\nci\nCJ\n'bo\np\np\nCJ\nbo\n<\nTotal by Sexes.\nB\n'bo\np\nP\nX\nCO\na\n\u25a0ci\np\nH\nM.\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n\u2022\n.F.\nM.\nF.\nM.\nF.\nM.\n1\n1\nF.\n1\n1\n1\n1\n1\n2\n9\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n4\n4\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\ni\n1\n1\n1\n1\n1\n2\n1\n3\n3\n1\n1\n1\n1\n1\n2\n1\n1\n2\n1\n1\n1\n1\n1\n9\n7\n16\n1\n1\n1\n1 G 96\nBritish Columbia\n1918\nCAUSES OF\n6\nfe\ng\n.2\n\"rt\n\u00a9\neg\nM\ns\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nei\n9\n0)\n\u2022a\nB\nei\n9\nCM\n\u00a9\na\n>o\n\u00a9\nCM\nrt\n09\n\u00a9\n\u00a9\nIO\ni\nALBERNI GROUP\u2014BELLA COOLA.\nI.\u2014General Diseases.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n41\n77a\nIII.\u2014Diseases of the Circulatory System.\n109\nV.\u2014Diseases of the Digestive System.\n120a\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n169\nXIII.\u2014Affections produced by External Causes.\n1\n1\n79\nALBERNI GROUP\u2014CLAYOQUOT.\nIII.\u2014Diseases of the Circulatory System.\nALBERNI GROUP\u2014FORT FRASER.\nI.\u2014General Diseases.\n1\n77\nIII.\u2014Diseases of the Circulatory System.\nX. \u2014Malformations.\nXIII.\u2014Affections produced by External Causes.\n1\n1\n175\n178a\n1\n1\n1\n28\n40\nALBERNI GROUP\u2014HAZELTON.\nI.\u2014General Diseases.\nTuberculosis of the lungs\t\nCancer and other malignant tumours of the stomach, liver\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nOedema of brain\t\nCerebral haemorrhage, apople.xy 8 Geo. 5\nProvincial Board of Health.\nG 97\nDEATH, 1917\u2014Continued.\n9\nO\nCM\n\u00a9\n\u00a9\nrt\nO\nO\no\nCM\nei\n9\nO\n*\u00bb#\nO\no\ng\nQJ\nO\nIO\no\n\u00a9\n-C-H\noj\nci\nCJ\n\u00a9\n\u00a9\np\n\u00a9\nci\nCJ\n\u00a9\np\n\u00a9\n\u00a9\n\u00a3\n09\nO\n00\no\n-w\no\nei\n9\nO\n\u00a9\n\u00a9\n\u00a9\nCO\n\u25a03\na\nft\nG\na\nrt\n\u00a9\n\u00a9\nc\na;\n'So\nc\nG\nbo\n\u2022<\na)\nm\n2\no\nH\na;\n\"So\no\nG\nX\ntU\n\u25a0\u00a3\nei\n9\no\nH\nM.\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM. .\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n1\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n2\n1\n1\n1\n1\n1\n1\n3\n1\n1\n2\n9\n1\n3\n1\n1\n2\n1\n1\n10\n1\n11\ni\n1\nl\n1\nl\n1\n1\n1\n1\nl\n1\n1\n1\n4\n9 G 98\nBritish Columbia\n1918\nCAUSES OF\nd\nfe\n.2\nCJ\nm\n5\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nei\nCU\n\u2022a\nG\nrt\ncu\n>.\nCM\nO\n-4J\nei\n9\niO\nc\nCM\n9\n\u00a9\nO\nlO\n77a\nALBERNI GROUP\u2014HAZELTON.\u2014Concluded.\nIII.\u2014Diseases of the Circulatory System.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n79\n79a\n79b\n93\nIV.\u2014Diseases of the Respiratory System.\n120a\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n126\n142\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\n150\nX.\u2014Malformations.\n1\n1\n1\n152a\nXL\u2014Diseases of Early Infancy.\n169\nXIII.\u2014Affections produced by External Causes.\n173\n175\n178a\n186\nXIV.\u2014Ill-defined Diseases.\n1\n4\n1\n1\nALBERNI GROUP\u2014POUCE COUPE.\nI.\u2014General Diseases.\n1\n117\nV.\u2014Diseases of the Digestive System.\n187\nXIV.\u2014Ill-defined Diseases.\n1\nALBERNI GROUP\u2014PRINCE RUPERT.\nI.\u2014General Diseases.\n45\nCancer and other malignant tumours of other organs, and of organs not specified .\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n66 S Geo. 5\nProvincial Board of Health.\nG 99\nDEATH, 1917\u2014Continued.\n3\n\u00a9\nCJJ\no\n\u00a9\nca\nCJ\no\nCO\np\n\u00a9\nCJ]\n3\n\u00a9\nHH\no\n\u00a9\n9\n\u00a9\nio\np\n-in\n\u00a9\nhC\n5\nCJ\n\u00a9\n\u00a9\np\n\u00a9\n5\n9\n\u00a9\np\n\u00a9\n\u00a9\nca\nCJ\n\u00a9\nCO\np\no\nci\nCJ\n\u00a9\n\u00a9\np\no\nCO\n-p\nc\nci\nPH\nP\n-P\nP\nci\n\u00a9\n\u00a9\n'bo\np\nB\nCJ\nbo\n<\nTotal by Sexes.\nB\nCJ\n'bo\no\nM\nCJ\nCO\nci\nCJ\na\nla\np\nH\nMi\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF'\nM.\nF.\n1\n1\n1\n1\n1\n1\n3\n1\n3\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\ni\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2 \u2022\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n5\n4\n6\n1\n1\n1\n18\n7\n25\n'\n1\ni\n1\n1\n1\n2\n1\n1\ni\n1\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n1\n3\n1\n2\n1\n1\n3\n1\n1\n4\n1\n1\n1\n\" i'\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n2\n1\ni\n1 G 100\nBritish Columbia\n1918\nCAUSES OF\nd\nfe\n3\nri\no\n\u00a3\nrt\n5\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\na\nC\nP\n5\nCM\nO\nT-H\noj\ns\n>>\nC\n5 to 10 years.\n79a\nALBERNI GROUP\u2014PRINCE RUPERT.\u2014Concluded.\nIII.\u2014Diseases of the Circulatory System.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n79b\n81\n8lA\n81B\n1\n91\nIV.\u2014Diseases of the Respiratory System.\n1\n92\n1\n93\n97a\n1\n1\n104\nV.\u2014Diseases of the Digestive System.\n109\n114\n119\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n1\n120a\n145\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\n1\n2\n1\n150\nX.\u2014Malformations.\nXL\u2014Diseases of Early Infancy.\n1\n151\n151c\n1\n1\n152 a\n153a\n1\n1\n1\n153b\n153c\n153d\n1\n159\nXIIL\u2014Affections produced by External Causes.\n169\n169a\n170\n171a\n173\n175\n180\n189\nXIV.\u2014Ill-defined Diseases.\n10\n4\n1\n1\n1\nALBERNI GROUP\u2014ANYOX.\nXL\u2014Diseases of Early Infancy. 8 Geo. 5\nProvincial Board of Health.\nG 101\nDEATH, 1917\u2014Continued.\nrt\n\u00a9\n(M\nO\n\u00a9\na\n9\n\u00a9\nCO\n\u00a9\n\u00a9\nCM\ns\n9\n\u00a9\nO\no\nCO\nei\n9\n>i\no\nlO\no\n\u00a9\nP\nc3\n01\n\u00a9\n\u00a9\np\n\u00a9\nirj\nea\nCJ\n>i\n\u00a9\np\no\n\u00a9\nC\nei\nCO\n\u00a9\nX\nP\no\nCJ\n\u00a9\n\u00a9\no\n\u00a9\nCO\n\u25a0\u00a7\nca\nS\ng.\nei\n\u00a9\n\u00a9\nS\nfe.\n'B\np\np\nCJ\nbo\n01\n\u25a0Jl\n>,\njp\nj\np\nr*\nB\n'&\nP\nP\n0)\nCO\noj\nHP\nHH\nca\no\na\n*ci\np\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n1\n1\n1\n2\n1\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\ni\nl\n1\n1\n1\n1\n1\nl\ni\nl\n2\n1\n1\ni\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n2\n1\n1\n1\n3\n2\n1\n5\n2\n1\n1\nl\n7\nl\n1\n1\n1\n1\n1\n1\n1\n1\n13\n1\n1\n1\n2\n8\n1\n3\n1\n3\n1\n1\n5\n1\n1\n1\n2\n52\n11\n1\nl G 102\nBritish Columbia\n1918\nCAUSES OF\n7\n35\n78 a\nALBERNI GROUP-QUEEN CHARLOTTE.\nI.\u2014General Diseases.\nScarlet fever\t\nDisseminated tuberculosis, specify organ\t\nIII.\u2014Diseases of the Circulatory System.\nEndocarditis following rheumatism\t\nXL\u2014Diseases of Early Infancy.\nPremature \t\nXIV.\u2014Ill-defined Diseases.\nCause of death not specified or ill-defined\t\n6\nfe\n.2\nei\n9\n\u00a3\nei\no\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.\nrt\no>\n>>\ns\np\na\nCD\nCM\nO\nei\n9\nIO\nO\n5 to 10 years.\n79\nALBERNI GROUP\u2014QUATSINO.\nIII.\u2014Diseases of the Circulatory System,\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n169a\nXIII.\u2014Affections produced by External Causes.\n172\n178A\nALBERNI GROUP\u2014STEWART.\nXIII.\u2014Affections produced by External Causes.\nTraumatism by fall.\nExposure\t\nALBERNI GROUP\u2014TELEGRAPH CREEK.\nI.\u2014General Diseases.\nAnaemia, pernicious\t\nXIII.\u2014Affections produced by External Causes.\nAccidental drowning\t\nXIV.\u2014Ill-defined Diseases.\nCause of death not specified or ill-defined\t\n28\n35a\n52\nASHCROFT.\nL\u2014General Diseases.\nTuberculosis of the lungs .\nTuberculosis not specified..\nAddison's disease\t\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nConvulsions of infants\t 8 Geo. 5\nProvincial Board of Health.\nG 103\nDEATH, 1917\u2014Continued.\na\no\nOl\n\u00a9\n\u00a9\ns-\n\u00ab\n9\nO\nCO\nO\n\u00a9\n(M\n09\n\u00a9\no\n\u00a9\nCO\na\n>>\n\u00a9\n>o\no\n\u00a9\na\n9\n\u00a9\n\u00a9\n\u00a9\n\u00a9\n1\n\u00a9\no\no\nCD\na\n09\n\u00a9\nCO\no\n\u00a9\nei\n9\n\u00a9\n\u00a9\nO\no\nCO\n\u25a0-\u00a9\na\nei\n\u00a9\n\u00a9\na\n'So\no\n\u00a70\n\u25a05\nTotal by Sexes.\nbo\nO\nM\n9\nw\nrt\nOJ\nQ\n\"rt\n~o\nH\nM.\nF.\nM.\nF.\n1\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n1\n1\n1\n1\n1\n777.7.\n1\n1\n9\nl\ni\ni\ni\nl\n1\n1\nl\n1\n1\ni\nl\n1\nl\n6\n5\ni\n1\n2\n1\nl\nl\nl\nl\n2\nl\n3\n3\n1\n1\n2\n1\n2\n2\n1\n2\n2\n4\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1 G 104\nBritish Columbia\n1918\nCAUSES OF\nd\nc\n.2\n\u00a7\nS\na\nO\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\ns-\na\n9\n\u25a073\n5\na\n9\n>*->\nCM\n\u00a9\n9\nc\nrt\n\u00a9\no\nlO\n78b\nASHCROFT.\u2014Concluded.\nIII.\u2014Diseases of the Circulatory System.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n89\nIV.\u2014Diseases of the Respiratory System.\n1\n1\n91\n170\nXIII.\u2014Affections produced by External Causes.\n174\n175\n2\n1\n109\nBARKERVILLE.\nV.\u2014Diseases of the Digestive System.\n120 a\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n\t\n28\nFORT GEORGE.\nI.\u2014General Diseases.\n77a\nIII.\u2014Diseases of the Circulatory System.\n91\nIV.\u2014Diseases of the Respiratory System.\n1\n92\n92a\n94\n110\nV.\u2014Diseases of the Digestive System.\n1\n1\n152a\nXL\u2014Diseases of Early Infancy.\n169\nXIII.\u2014Affections produced by External Causes.\n170\n187\nXIV.\u2014Ill-defined Diseases.\n1\n189\n1\n1\n4 8 Geo. 5\nProvincial Board of Health.\nG 105\nDEATH, 1917\u2014Continued.\na\n9\n\u00a9\n\u00a9\n\u25a0 \u00a9\na\n>\n\u00a9\n\u25a0o\no\n\u00a9\nto\nt~\nrt\nqj\n\u00a9\n\u00a9\n\u00a9\n\u00a9\noj\nc3\nCJ\n\u00a9\nt**-\nP\n\u00a9\n\u00a9\n5\nCJ\n\u00a9\nCO\nP\n\u00a9\noj\nca\nCJ\n\u00a9\n\u00a9\np\n\u00a9\nCO\nrg\ng\np.\n-p '\np\nci\n\u00a9\n\u00a9\np\nCJ\n'bo\no\nB\nCJ\nbo\n<\nTotal by Sexes.\nci\nV\nbo\np\ncj\n03\nei\nCJ\na\np\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1\n1\n2\n2\n1\n4\n3\n7\n2\n4\n2\n1\n1\n22\n9\n1\n1\n1\n1\n1\n1\n1\n1\n1\n9\n1\n1\n4\n1\n2\n1\n4\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n\"i'\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1 G 112\nBritish Columbia\n1918\nCAUSES OF\n6\nfe\n\u00a9\na\nCJ\nCAUSE OF DEATH.\n09\na\n1\n9\na\n9\nrt\n5\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\n9\n73\nCM\nO\n\u00a9\nCM\n\u00a9\no\nIO\nGREENWOOD.\u2014Concluded.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nXL\u2014Diseases of Early Infancy.\n152A\n1\n2\n1\n1\n153a\n153B\nXI11.\u2014Affections produced by External Causes.\n169\n1\n173\n1\n28\n40\n54A\n61a\n64\n78b\n79a\n92\n92a\n92b\n104\n109\n110a\n117\n151\n151b\n153a\n165\n171a\nGRAND FORKS.\nI.\u2014General Diseases.\nMeasles\t\nTuberculosis of the lungs\t\nCancer and other malignant tumours of the stomach, liver .\nAnaemia, pernicious\t\nAlcoholism, acute ,\t\nII.\u2014Diseases of the Nervous System.\nMeningitis, typhoidal\t\nCerebral haemorrhage, apoplexy..\nIII.\u2014Diseases of the Circulatory System.\nCardiac dropsy\t\nChronic valvular disease..\nIV.\u2014Diseases of the Respiratory Syste.m.\nBronchopneumonia\t\nPneumonia\t\nPneumonia following measles\t\nPneumonia-hypostatic\t\nPulmonary congestion, pulmonary apoplexy .\n-Diseases of the Digestive System.\nDiarrhoaa and enteritis (under 2 years).\nHernias, intestinal obstructions\t\nEnterocolitis\t\nSimple peritonitis (non-puerperal)\t\nVI. \u2014Non-venereal Diseases of Genito-urinary System and Annexa.\nNephritis following scarlet fever\t\nXL\u2014Diseases of Early Infancy.\nCongenital debility, icterus, and sclerema..\nNon-assimilation of food\t\nStill-born .\"\t\nXIIL\u2014Affections produced by External Causes.\nOther acute poisonings\t\nTraumatism by falling tree. 8 Geo. 5\nProvincial Board of Health.\nG 113\nDEATH, 1917\u2014Continued.\n10 to 20 years.\n20 to 30 years.\nCJ\n\u00a9\n>*\np\ns\n40 to 50 years.\noj\nol\nCJ\n\u00a9\n\u00a9\np\n\u00a9\nice\n3\ns\n\u00a9\nJJ-\np\n\u00a9\n\u00a9\n70 to 80 years.\nCJ\n\u00a9\np.\np\n\u00a9\nCO\n90 and upwards.\n'be\np\nCJ\nbo\ni\n9\n5\na\nQJ\n(M\nO\n9\nlO\nO\n(M\n50\nrt\n9\n\u00a9\nO\nlO\n157\nKAMLOOPS.\u2014Concluded.\nXIII.\u2014Affections produced by External Causes.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n159\n166\n1\n1\n1\n1\n1\n167\n169\n173\n175\n175a\n186\n186a\n1\n189\nXIV.\u2014Ill-defined Diseases.\n7\n5\n4\n3\n2\n2\n1\n30\n56\n77a\n79\n81a\n91\n92a\n170\n172\n173a\n175\nNICOLA.\nI.\u2014General Diseases.\nTyphoid fever\t\nTubercular meningitis..\nAlcoholism, acute\t\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nTumour of brain\t\nIII.\u2014Diseases of the Circulatory System,\nMyocarditis\t\nAcute endocarditis\t\nOrganic diseases of the heart.\nAneurism\t\nEmbolism and thrombosis....\nIV.\u2014Diseases of the Respiratory System.\nBronchopneumonia .\nLobar pneumonia...\nVI.\u2014 NON-VENEREAL DISEASES OF GENITO-URINARY SYSTEM AND ANNEXA\nAcute nephritis\t\nXIIL\u2014Affections produced by External Causes.\nTraumatism by firearms\t\nTraumatism by fall\t\nTraumatism by railway construction\t\nTraumatism by other crushing (railroad, landslides, vehicles, etc.).\n20\n41\nPRINCETON.\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nMeasles.\t\nPurulent infection and septicemia\t\nCancer and other malignant tumours of the peritoneum, intestines, rectum .\nIV.\u2014Diseases of the Respiratory System.\nLobar pneumonia\t\nV.\u2014Diseases of the Digestive System.\nDiarrhoea and enteritis (2 years and over)\t\nXL\u2014Diseases of Early Infancy.\nNon-assimilation of food\t 8 Geo. 5\nProvincial Board of Health.\nG 117\nDEATH, 1917\u2014Continued.\nCJ\n>l\no\np\n\u00a9\noj\nca\nCJ\n\u00a9\np\n\u00a9\nci\n\u00a9\n*H\nP\n\u00a9\nCO\nCJ\n\u00a9\nica\np\n\u00a9\nHtl\nci\n\u00a9\n\u00a9\np\n\u00a9\nin\nei\n\u00a9\np\ns\nE\nca\nCJ\n\u00a9\nCO\np\n\u00a9\nca\nCJ\n\u00a9\n\u00a9\np\n\u00a9\nCO\n-P\nci\nTj\nci\n\u00a9\n\u00a9\np*\nCJ\n'be\nHH\nP\nP\nbe\n<\nTotal by Sexes.*!\nB\nCJ\n'bo\nHH\nP\na\n\u2022A\nCO\n\u00a3\nei\nCJ\na\n\u25a0Jd\np\nEh\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n3\n1\n1\n2\n3\n1\n1\n1\nF.\n1\n1\n1\n1\n2\n5\n1\n1\n2\n1\n1\n3\n1\n2\n1\n1\n1\n1\n4\n1\n1\n1\n1\n4\n1\n1\n3\n9\n13\n18\n13\n12\n'\n16\n3\n9\n4\n14\n7\n2\n1\n1\n100\n55\n155\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n2\n1\n1\n1\n1\n1\nI\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n2\n3\n1\n2\n3\n1\n1\n1\n11\n6\n17\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1 G 118\nBritish Columbia\n1918\nCAUSES OF\nd\nfe\no\nei\nep\n6\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, i909.)\nCJ\n-p\nei\nCJ\nCM\nP\n2 to 5 years.\n5 to 10 years.\n154\nBEATON GROUP\u2014REVELSTOKE\u2014Concluded.\nXII.\u2014Old Age.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n169\nXIII.\u2014Affections produced by External Causes.\n1\n\t\n\t\n\t\n\t\n\t\n\t\n1\nVERNON.\nI.\u2014General Diseases.\n1\n10\n20\n28\nTubercularnieningitis\t\n30\n34a\n37\n40\n44a\n\"i\n46\n47\n60\n50a\n53\n54a\n61\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\n1\n6lA\n63\n6SA\n1\n64\n71\n1\n1\n76\n1\n77a\nIII.\u2014Diseases of the Circulatory System.\n78\n78a\n79\n79a\n88\nIV.\u2014Diseases of the Respiratory System.\n1\n1\n92\n1\n1\n92a\n102\nV.\u2014Diseases of the Digestive System.\nl\n1\n103\n1\n108\n1\n1\n117\n120\nVI.\u2014Non-venereal Diseases of Genito-urinary System and Annexa.\n134\nVII.\u2014The Puerperal State.\n137 8 Geo.\nProvincial BOh^rd of Health.\nG 119\nDEATH, 1911\u2014Continued.\n\u25a0vj\nel\n9\n\u00a9\nCM\n\u00a9\n\u00a9\na\n9\n\u00a9\nCG\no\no\nCM\nto\na\n\u00a9\no\n\u00a9\nCO\na\n9\n\u00a9\nc\nQ\nCO\na\n9\n>>\nO\n\u00a9\nc\n\u00ab\no\nQ\nO\n\u00a9\nrt\n0)\no\nCO\n\u00a9\n\u00a9\n9\n\u00a9\n\u00a9\n\u00a9\n\u00a9\n\u25a0TJ\na\n&\n\u00a9\n-\u00a9*\nq\nrt\n\u00a9\n\u00a9\nd\n0)\n'5)\no\n0J\nEn\n9\nX\nQ)\nCO\ns\n'ci\nO\nH\n\u00ae\no\nA\n9\nJ\nrt\nQ\no\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\n2\n2\n1\n2\n1\n1\n3\n2\n1\n1\n1\n1\n1\n5\n7\n12\n2\n6\n1\n2\n1\n1\n1\n1\n1\n1\n\"i\ni\ni\ni\ni\ni\n2\n3\n1\n13\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n3 G 120\nBritish Columbia\n1918\nCAUSES OF\nd\nfe\na\n.2\nrt\no\nS\nJj\nQ\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nJ-.\nei\nCJ\nCJ\n-p\nB\nei\nV\nP\nHH\noj\nci\nCJ\nira\nP\nca\nIH\nca\nCJ\n\u00a9\np\n150\nVERNON.\u2014Concluded.\nX.\u2014Malformations.\nM.\nF.\n1\n1\nM.\nF.\nM.\nF.\nM.\nF.\n151\nXL\u2014Diseases of Early Infancy.\n1\n1\n1\n251B\n153a\n154\nXII.\u2014Old Age.\n159\nXIII.\u2014 Affections produced by External Causes.\n170\n172\nTraumatism by fall\t\n173\n176\n178a\n6\n6\n2\n1\n3\n3\n1\nVANCOUVER CITY.\nI.\u2014General Diseases.\n5\n6\n1\n1\n1\n1\n7\n1\n\"i\n2\n8\n1\n1\n2\n1\n9\n1\n10\n14\n1\n1\n20\n2\nTuberculosis of the lung's (Asiatic)\t\n2\n28a\n29\n1\n3\ni\n1\n30\n3\n3\n2\n2\n2\n3\n1\nn\nCancer and other malignant tumours of the stomach, liver\t\n41\n45\n45B\n46\n47\n1\n50\n51\n52\ni\n1\n54a\n1\n56\n56a 8 Geo. 5\nProvincial Board of Health.\nG 121\nDEATH, 1911\u2014Continued.\na\n9\n\u00a9\no\n\u00a9\nco\"\n9\nO\no\n\u00a9\nCM\nCO\na\n9\no\no\n\u00a9\nCO*\n\u00a9\no\n\u00a9\nCO\ni.\na\n>i\no\n\u00a9\n\u00a9\no\na\n\u00a9\no\n\u00a9\n\u00a9\n70 to 80 years.\nro\na\n9\no\n\u00a9\no\n-1-3\n\u00a9\n00\n73\na\na\n\u00a9\nc~.\nOJ\n'So\no\nIU\nbe\n<\nTotal hy Sexes.\na\n>\n\u00a9\nX\n9\nw\na\n9\nP\nH\no\nH\nM.\nF.\nM.\nF.'\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\ni\n1\n1\n1\n1\n1\n7\n1\n3\n2\n2\n3\n4\n4\n3\n3\n3\n7\n3\n5\n6\n7\n1\n1\n1\n3\n54\n31\n85\n1\n1\n1\n1\n2\n1\n3\n1\n1\ni\n1\ni\n1\n1\n3\n5\n9\ni\n3\n1\n1\n1\n1\n9\n33\n\"'3'\n15\n5\n1\n1\n5\n1\n1-1\ni\n2\n1\n19\n67\n1\n1\n14\n5\n2\n1\ni\n5\n19\n1\n1\n2\n1\n1\n1\n2\n13\n7\n15\nI\n3\n2\n10\n2\n1\n1\n2\n1\n2\n1\n28\n4\n100\n1\n1\n1\n1\n1\n1\n1\n2\n2\n3\n29\n1\n1\n1\n1\n1\n10\n1\n1\n1\n2\n1\n1\n1\n1\n1\n2\n4\n1\n3\n4\n1\n35\n10\n2\n1\n1\n1\n10\n2\n1\n1\n2\n2\n1\n3\n1\n2\n3\n1\n10\n1\n2\n1\n1\n4\n8\n3\n2\n2\n2\n7\n2\n2\n2\n3\n2\n2\n1\n2\n1\n18\n9\n15\n6\n1\n19\n1\n1\n1\n1\n3\n1\n1\n3\n2\n3\n3\n1\n1\n2\n1\n1\n. 1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n, 1\n1\n2\n3\n3\n3\n1\n1\n4\n1\n1\n1\n2\n2\n1\n1\n21\n2\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n7\n1\n1\n1\n3\n1\n2\nU\n3\n2\n1\n1\n6\n1\n1 <} 12\nBritish Columbia\n1918\nCAUSES OF\n61\n6lA\n63A\n63 b\n63c\n64\n6Sb\n69\n71\n77\n77a\n78\n78a\n78b\n79\n79a\n79b\n79c\n79d\n79e\n79f\n79g\n80\n81\nSlA\n81B\n82\n84A\n84b\n85\n87\n89\n90\n91\n92\n92a\n92b\n92c\n92d\n92e\n93\n97a\n97b\n97c\n97d\n102\n103\n103a\n103b\n104\n105\n108\n109\n110\n110a\n111\n113\n114\n115\n117\n117b\n118\n118a\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nVANCOUVER CITY.\u2014Continued.\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nMeningitis (Asiatic)\t\nCerebro-spinal meningitis\t\nAcute anterior poliomyelitis\t\nOedema of brain\t\nTumor of brain\t\nCerebral hemorrhage, apoplexy...\nParalysis without specified cause .\nCerebral thrombosis\t\nCerebral abscess\t\nEpilepsy\t\nConvulsions of infants\t\nOtitis media\t\nIll,\u2014Diseases of the Circulatory System.\nPericarditis\t\nMyocarditis\t\nAcute endocarditis\t\nEndocarditis, following rheumatism.,..\nCardiac dropsy .,\t\nOrganic diseases of the heart (Asiatic) .\nCardiac paralysis\t\nChronic valvular disease\t\nAortic insufficiency\t\nFatty degeneration of heart\t\nMitral regurgitation\t\nCardiac dilation\t\nCardiac embolism ,\t\nAngina pectoris\t\nDiseases of the arteries\t\nAneurism\t\nArterio sclerosis\t\nEmbolism and thrombosis\t\nLymphangitis\t\nHodgkin's disease.\t\nHaemorrhage\t\nIV.\u2014Diseases of the Respiratory System.\nDiseases of the larynx\t\nAcute bronchitis\t\nChronic bronchitis\t\nBronchopneumonia\t\nPneumonia\t\nLobar pneumonia\t\nPneumonia hypostatic \t\nCapillary bronchitis \t\nBronchopneumonia, following infected fracture of hip\t\nPneumonia following measles.\t\nPleurisy\t\nPulmonary congestion, pulmonary apoplexy\t\nAsthma\t\nPulmonary abscess\t\nPulmonary hemorrhage\t\nPulmonary embolus\t\nSeptic pneumonia\t\nOther diseases of the respiratory system (tuberculosis excepted).\nOEdema of lungs\t\nV.\u2014Diseases of the Digestive System.\nUlcer of the stomach _.\t\nOther diseases of the stomach (cancer excepted)\t\nHemorrhage from bowels\t\nDuodenal ulcer\t\nDiarrhoea and enteritis (under 2 years)\t\nDiarrhcea and enteritis (2 years and over)\t\nAppendicitis and typhlitis \t\nHernias, intestinal obsti uctions\t\nOther diseases of the intestines\t\nEnterocolitis\t\nAcute yellow atrophy of the liver\t\nCirrhosis of the liver\t\nBiliary calculi\t\nOther diseases of the liver.\t\nSimple peritonitis (non-puerperal)\t\nPeritonitis, gastric ulcer perforated \t\nOther diseases of the digestive system (cancer and tuberculosis excepted)..\nSeptic peritonitis\t 8 Geo. 5\nProvincial Board of Health.\nG 123\nDEATH, 1911\u2014Continued.\nca\nCJ\n\u00a9\nCM\nP\n\u00a9\n5\n\u00a9\nCO\np\n\u00a9\nCM\nci\n\u00a9\np\n0\nCO\nci\nCJ\n\u00a9\n10\np\n0\nei\nOJ\n\u00a9\n\u00a9\n0\n\u00a9\n60 to 70 years.\nci\n\u00a9\nCO\n0\n\u00a9\n1\n\u00a9\n\u00a9\nP\n\u00a9\nOO\noj\nci\nP.\nc3\n\u00a9\n\u00a9\nd\nCJ\n'be\nP\nB\nCJ\nCJ}\n\u00ab!\nTotal by Sexes.\nd\nbe\n0\nCJ\nOS\n\u00a3\nei\nCJ\nO\n*ci\np\nH\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\nF.\n1\nM.\n1\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\n4\n1\n1\n3\n7\n36\n2\n2\nF.\n2\n6\n1\n1\n1\ni\n1\n1\n2\n1\na\n5\n3\n1\n1\n2\n2\n7\n1\n1\n1\n8\n1\n17\n3\n2\n1\n2\n2\n2\n32\n5\n5\n2\n8\n2\n3\ni\n3\n1\n8\n1\n1\n6\n2\n1\n1\n3\n3\n53\n5\n1\n4\n1\n1\n2\n9\n1\n1\n53\n13\n6\n6\n5\n2\n11\n3\n1\n9\n2\n1\n\"2\n2\n1\nio'\n1\n1\n6\n14\n4\n5\n7\n1\n1\n6\n3\n1\n\"i\ni\n4\n3\n2\n4\n2\n1\n6\n3\n3\n85\n2\n18\n1\n11\n1\n4\n1\n1\n\"i\n1\n1\n8\n1\n2\n5\n1\n1\n1\n8\n1\n1\ni\n1\n2\n1\n2\n1\n2\n2\n2\n1\n1\n1\n7\n2\n1\n8\n18\n15\n3\n1\n2\n6\n1\n....\n1\n1\n8\n1\n2\n1\n1\n4\n1\n1\n2\n1\n2\n1\n2\n1\n6\n1\n1\n9\n1\n24\n1\n1\ni\n3\n1\n5\n2\n1\n6\n5\n6\n2\n2\n1\n3\n2\n1\n1\n2\n1\n1\n1\n2\n2\n1\n8\n2\n1\n1\n7\n1\n1\n1\n1\n1\n1\n1\n19\n44\n10\n4\n1\n1\n1\n1\n1\n1\n\"'3'\nii\n12\n9\n3\n1\n1\n'\"i\"\n3\n1\n\"T\n'\"a\"\n3\n1\ni\n1\n4\ni\n1\n6\n2\n1\n1\n1\n5\n4\n2\n3\n1\n1\n1\n2\n1\n2\n1\n1\n1\n1\n2\nS3\n2\n2'\n2\n1\n2\n...\n5\n1\n1\n2\n2\n11\n3\n1\n1\n2\n56\n25\n7\n1\n1\n2\n1\n1\n1\n1\n1\n2\n3\n1\n1\n1\n3\n1\n1\n1\n2\n11\n8\n2\n1\n1\n11\n1\n7\n9\n1\n1\n1\n5\n2\n1\n1\n3\n1\n1\n1\n1\n1\n2\n1\n1\n4\n1\n2\n1\n1\n2\n1\n2\n1\n1\n1\n1\n1\n1\n1\n3\n1\n1\n3\n2\n17\n11\n2\n1\n1\n1\n4\n1\n15\n1\n2\n1\n1\n1\ni\n2\n3\n2\n1\n2\n3\n2\n7\n3\n1\n14\n2\n1\n1\n12\n1\n2\n1\n1\n1\n3\n\"2'\n1\n5\n2\n1\n2\n2\n1\ni\n1\n3\n1\n4\n2\n2\n1\n1\n1\ni\n1\n1\n1\n5\n1\n1\n2 G 124\nBritish Columbia\n1918\nCAUSES OF\nfe\n119\n120\n120a\n122\n124\n126\n130\n181\n133a\n133b\n135\n137\n137a\n137b\n138\n139\n140\n141a\n141b\n141c\n141d\n141k\n142\n145\n150\n150a\n151\n151a\n151B\n152a\n153a\n153b\n153c\n153d\n155\n156\n157\n158\n159\n160\n165\n167\n168\n169\n169a\n170\n172\n174\n175\n182\nVANCOUVER CITY.\u2014Continued.\nVI.\u2014NON-VENEREAL DISEASES OF GENITO-URINARY SYSTEM AND ANNEXA.\nAcute nephritis (Asiatic)\t\nBright's disease \t\nUremia\t\nOther diseases of the kidne}fs and annexa\t\nDiseases of the bladder \t\nDiseases of the prostate\t\nDiseases of the uterus\t\nCysts and other tumours of the ovary\t\nParenchymatous nephritis\t\nCholecystitis\t\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nVII.\u2014The Puerperal State.\nPuerperal hemorrhage ;...\nPuerperal septicaemia\t\nPuerperal infection following miscarriage\t\nEclampsia\t\nPuerperal albuminuria and convulsions ,\t\nPuerperal phlegmasia alba dolens, embolus, sudden death..\nFollowing childbirth (not otherwise defined)\t\nPneumonia following childbirth\t\nIncomplete abortion\t\nFollowing Cesarotomy\t\nEctopic pregnancy\t\nPuerperal fever\t\nVIII.\u2014Diseases of the Skin and of the Cellular Tissue.\nGangrene\t\nOther diseases of the skin and anne.xa..\nIX.\u2014-Diseases of the Bones and Organs of Locomotion.\nDiseases of the joints (tuberculosis and rheumatism excepted) \t\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t\nHemorrhage neonatorum\t\nXL\u2014Diseases of Early Infancy.\nCongenital debility, icterus, and sclerema.\nAccident of labour\t\nNon-assimilation of food\t\nAtelectasis\t\nStill-born \t\nPremature \t\nUmbilical hemorrhage\t\nMelena neonatorum\t\nXII.\u2014Old Age.\nSenility ,\nXIII.\u2014Affections produced by External Causes.\nSuicide by poison\t\nSuicide by asphyxia\t\nSuicide hy hanging or strangulation\t\nSuicide by drowning\t\nSuicide by firearms . \t\nSuicide by cutting or piercing instruments\t\nOther acute poisonings\t\nBurns (conflagration excepted)\t\nAbsorption of deleterious gases (conflagration excepted)\t\nAccidental drowning\t\nTraumatism in logging camp and sawmill \t\nTraumatism by firearms\t\nTraumatism by fall\t\nTraumatism by machines\t\nTraumatism by other crushing (railroad, landslides, vehicles, etc.).,\nHomicide by firearms\t 8 Geo. 5\nProvincial Board of Health.\nG 12c\nDEATH, 1911\u2014Continued.\nCJ\n\u00a9\np\n\u00a9\noi\nei\n\u00a9\nCO\np\nHH\n\u00a9\nCM\nu\nei\nCJ\n\u00a9\n**l\np\n\u00a9\n40 to 50 years.\noj\nei\n\u00a9\n\u00a9\nP\n\u00a9\nire\n60 to 70 years.\noj\nei\nCJ\n\u00a9\nCO\nP\n\u00a9\nci\nCJ\n\u00a9\n\u00a9\np\n0\nCO\nV\nea\na\n-p\n\u00a9\n\u00a9\nB\nCJ\n*s>\np\nB\nCJ\nbe\n\u25a0*-**\nTotal by Sexes.\nc\nCJ\n\"be\np\nB\ncj\nin\noj\n-P\nci\nCJ\nft\nli\np\nM.\nF.\nM.\n2\n1\n1\nF.\n1\n1\n1\nM.\n1\n1\nF.\ni\n1\nM.\n1\ni\nF.\n1\n\"3'\nM.\n6\n1\n5\nF.\n\"i'\nM.\n4\n1\n5\nF.\n\"i\n3\nM.\ni\n5\nF.\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\n16\n5\n21\nF.\n5\n3\n8\n3\n1\n21\n8\n2\n29\n3\nl\n1\n1\ni\n1\n2\n2\n3\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n3\n5\n1\n3\n1\n1\n2\n2\n2\n2\n2\n1\n4\n1\n2\n1\n4\n2\n1\n1\n1\n3\n5\n1\n1\n3\n1\n1\n1\n1\n1\n2\n1\n2\n2\n1\n2\n2\n1\n2\n2\n1\n1\n1\n2\n1\n1\n1\n2\n1\n1\n5\n6\n9\n6\n2\n4\n2\n4\n1\n43\n19\n......\n11\n2\n12\n1\n5\n5\n41\n22\n1\n16\n9\n84\n1\n6\n1\n1\n1\n3\n1\n4\n2\n5\n2\n1\n3\n1\n3\n2\n2\n2\n1\n6\n6\n6\n8\n2\n18\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\ni\nl\n'\"2\n1\n1\ne>\n2\n1\ni\nl\n1\n4\n3\n1\n1\n1\n1\n3\ni\n1\n1\n7\n6\n3\n1\n2\n1\n1\ni\n1\n1\n1\n2\n1\n4\n9\n12\n1\n1\n3\n1\n3\n1\n1\n2\n1\n1\n1\n20\n1 G 12G\nBritish Columbia\n1918\nCAUSES OF\np\n*HH\na\n_p\nci\nCJ\neg\nci\nQ\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nUnder 1 year.\nca\nCJ\nCM\nP\n3\n>.\nire\nP\nCM\nei\nCJ\n\u00a9\np\n182a\nVANCOUVER CITY.\u2014Concluded.\nXIII.\u2014Affections produced by External Causes\u2014Concluded.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nK.\n182b\n186\n1\n1\n1\n186a\nShock \t\n186b\n1\n187a\nXIV.\u2014Ill-defined Diseases.\n15\n189\n15\n9\n14\n1\n14\n152\n121\n13\n30\n30a\n32a\n40\n42\n54A\n62\n63a\n64\n77\n77a\n78\n79a\n79b\n79c\n81\n90\n91\n92\n92A\n92b\n103\n110a\n120\n120a\n126\n137\n150\nSOUTH VANCOUVER.\nI.\u2014General Diseases.\nTyphoid fever\t\nScarlet fever\t\nTuberculosis of the lungs\t\nAcute miliary tuberculosis\t\nTubercular meningitis\t\nTubercular peritonitis\t\nTuberculosis of spine\t\nCancer and other malignant tumours of the stomach, liver\t\nCancer and other malignant tumours of the female genital organs ,\nAnemia, pernicious\t\nIL\u2014Diseases of Nervous System and Organs of Special Sense.\nLocomotor ataxia\t\nAcute anterior poliomyelitis\t\nCerebral hemorrhage, apoplexy ..\nParalysis without specified cause .\nEpilepsy.\nConvulsions of infanta \t\nIII.\u2014Diseases of the Circulatory System.\nPericarditis ....\nMyocarditis \t\nAcute endocarditis \t\nChronic valvular disease\t\nCardiac dilation\t\nOardiao sclerosis with rupture.\nDiseases of the arteries\t\nIV.\u2014Diseases of the Respiratory System.\nAcute bronchitis\t\nChronic bronchitis\t\nBronchopneumonia\t\nPneumonia\t\nLobar pneumonia\t\nHypostatic pneumonia.\nV.\u2014Diseases of the Digestive System.\nOther diseases of the stomach (cancer excepted).,\nEnterocolitis\t\nVI.\u2014NON-VENEREAL DISEASES OF GENITO-URINARY SYSTEM AND ANNEXA.\nBright's disease \t\nUremia.\nDiseases of the prostate\t\nVII.\u2014The Puerperal State.\nPuerperal septicemia\t\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t 8 Geo. 5\nProvincial Board of Health.\nG 12\nDEATH, 1911\u2014Continued.\nv\n'be\no\nc\nX\na\n9\n\u00a9\nCM\nO\n\u00a9\na\n9\n\u00a9\nCO\n\u00a9\n\u00a9\nOl\na\nOJ\n\u00a9\no\n\u00a9\nCO\na\n9\n\u00a9\n\u00a9\n\u00a9\na\n9\n\u00a9\n\u00a9\nO\ni5\na\n9\nO\no\n\u00a9\n\u00a9\nrt\n9\n\u00a9\n00\no\n\u00a9\na\n&\n\u00a9\n\u00a9\no\n+j\na\nF\na\nrt\no\n\u00a9\nd\n0)\n'be\no\nCU\n\u00ab3\nTotal hy Sexes.\nrt\nOJ\nft\no\nH\nM.\nF.\nM.\nF.\n1\nM.\n2\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n2\n1\n5\nF.\n1\n3\n1\n1\n1\n1\n1\n1\n2\n1\n1\n2\n2\n7\n1\n1\n1\n1\n1\n1\n3\n1\n112\n1\n45\n3\n16\n49\n51\n105\n72\n109\n44\n109\n51\n68\n35\n26\n23\n3\n2\n1\n33\n810\n497\n1307\n1\ni\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n\"T\ni\ni\n2\n1\n1\n1\n1\ni\n2\n1\n3\n5\n1\n1\n7\n1\ni\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\ni\n1\n2\n1\n1\n1\n4\n1\n1\n1\n1\n9\ni\ni\n1\n2\n1\n3\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n3\n1\n1\n1\nI\n.\n1\n1\n1\n1\n2\n1\n1\n1\n2\n1\n1\n2\n1\n3\n1\ni\n1\n1 G 128\nBritish Columbia\n1918\nCAUSES OF\np\nto\nB\n_p\nei\nCJ\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\n3\n\u2014\n-p\nD\nei\nCJ\nCM\nP\nci\nCJ\nIO\np\nCM\nCJ\n\u00a9\no\n152a\nSOUTH VANCOUVER\u2014 Concluded.\ni\nXI.\u2014Diseases of Early Infancy.\nM.\n\"\u00bb\n3\n1\nF.\n1\n3\n2\nM.\nF.\nM.\nF.\nM.\nF.\n153a\n163b\n153c\n154\nXII.\u2014Old Age.\n159\nXIII.\u2014Affections produced by External Causes.\n169\n1\n175\n186\n1\n4\nIS\n9\n1\n1\n1\n2\n2\n40\n41\n42\n63a\n66\n77A\n79a\n81\n91\n92\n92a\n92b\n151\n152a\n153 a\n153b\n158\n169\n175\nVANCOUVER DIVISION\u2014POINT GREY.\nL\u2014 General Diseases.\nCancer and other malignant tumours of the stomich, liver\t\nCancer and other malignant tumours of the peritoneum, intestines, rectum.\nCancer and other malignant tumours of the female genital organs\t\nII.\u2014Diseases of Nervous System and Organs of Special Sense.\nPrimary lateral sclerosis of spinal cord.\nParalysis without specified cause\t\nIII.\u2014Diseases of the Circulatory System.\nMyocarditis \t\nCardiac rupture following ulceration..\nDiseases of the arteries\t\nIV. \u2014Diseases of the Respiratory System.\nAcute bronchitis\t\nBronchopneumonia\t\nPneumonia\t\nLobar pneumonia\t\nHypostatic pneumonia.\n-CEdema of lungs\t\nVI.\u2014NON-VENEREAL DISEASES OF GENITO-URINARY SYSTEM AND ANNEXA.\nUremia.\nX.\u2014Malformations.\nCongenital malformation (still-births not included)\t\nXL\u2014Diseases of Early Infancy.\nCongenital debility, icterus, and sclerema..\nAtelectasis\t\nStill-born\t\nPremature\t\nXIIL\u2014Affections produced by External Causes.\nSuicide by drowning\t\nAccidental drowning\t\nTraumatism by other crushing (railroad, landslides, vehicles, etc.).. 8 Geo. 5\nProvincial Board of Health.\nG 129\nDEATH, 1917\u2014Continued.\na\n-OJ\n\u00a9\no\n\u00a9\n9\n\u00a9\nC\n\u00a9\n55\nii\na\n9\n\u00a9\no\n\u00a9\nCO\n40 to 50 years.\nCJ\n\u00a9\ncp\np\n\u00a9\n\u25a0ca\na\n9\n\u00a9\no\n\u00a9\nto\na\n09\n\u00a9\no\n\u00a9\nto\nrt\n9\n\u00a3\no\n\u00a9\n00\na\nIs\np\na\n\u00a9\n\u00a9\nd\nQJ\n\"So\n\u00a9\n\n'a\no\nB\nX\nCJ\nm\noj\nH=\nrt\nCJ\nft\nIs\np\nIH\nM.\nF.\nM.\n1\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\n1\n1\n1\n3\nF.\n1\n1\n2\n3\n1\n3\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n3\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n1\n1\n1\n1\n1\n2\ni\nl\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n2\n2\n2\n1\n1\n1\n1\n1\n1\n1\n2\n1\n1\n1\ni\nl\n1\n1\n1\n1\n1\n1\n1\ni\nl\n\u25a0j'\nl\nL\n1\n1\n5\n2\n7\n2\n1\n1\n1\n1\n5\n1\n1\n1\n4\n2\n1\n1\n8\n1\n4\n4\n2\n4\n1\n5\n1\n1\n28\nso\n58 G 132\nBritish Columbia\n1918\nCAUSES OF\n6\na\no\n'a\no\n5\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\na\n9\nm\na\n9\n\n\"5b\np\nbo\n<\nTotal by Sexes.\nej\n'a\np\nB\nX\nCJ\nin\nei\nCJ\nQ\n\"ei\nP\nE-*\nM.\n1\nF. '\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\np\nM.\n1\nF.\ni\n1\n1\n1\ni\n1\n1\n1\n1\n1\nl\nl\ni\n1\n1\n1\n1\n1\n'\n1\n1\n1\n1\n1\n1\n1\n1\n- 1\n1\n2\n1\n1\n1\n1\n1\n1\n1\n2\nl\n1\n1\n8\n4\n12\n1\n1\n1\n1\n-\n1\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1 G 134\nBritish Columbia\n1918\nCAUSES OF\n6\nft\na\n.2\n\u00ab\n9\ns\na\n6\nCAUSE OF DEATH.\n(After the Bertillon Classification Causes of Death, Second International\nDecennial Revision, Paris, 1909.)\nB\na\n9\no\na\n\u25a0o\n\u00a9\nu\na\n>>\n\u00a9\no\nto\n137a\nEclampsia\nAtelectasi\nStill-born\nBurns (co\nAccidenta\nTraumati\nTraumati\nTraumati\nInjuries b\nOther ext\nVANCOUVER\u2014OUTSIDE.\u2014 Concluded.\nVIL\u2014The Puerperal State.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n152a\nXL\u2014Diseases of Early Infancy.\n1\n153a\n1\ny\n167\nXIII.\u2014Affections produced by External Causes.\n169\n169a\n170\n173\n176\n186\n1\no\n1\n8\nWhooping\nInfluenza\nTuberculc\nTubercula\nII\nMeningiti\nRICHMOND.\nL\u2014General Diseases.\n1\n1\n28\n20\n1\n1\n61\n.\u2014Diseases of Nervous System and Organs of Special Sense.\n1\n64\n77a\nMyocardi'\nEndocard\nChronic v\nPne union\nHemorrha\nOther diss\nSimple pe\nVI.-\nBright's d\nIII.\u2014Diseases of the Circulatory System.\n78a\n92\nIV.\u2014Diseases of the Respiratory System.\nV.\u2014Diseases of the Digestive System,\n1\n1\n117\n120\n-Non-venereal Diseases of Genito-urinary System and Annexa.\n1\nXL\u2014Diseases of Early Infancy.\n1\n157\nSuicide b\nAccidenta\nOther ext\nCause of c\nXIII.\u2014Affections produced by External Causes,\n186\nXIV.\u2014Ill-defined Diseases.\n1\n2\n1\n3\n1\n1 8 Geo. 5\nProvincial Board of Health.\nG 135\nDEATH, 1917.\nCO\nS-\nei\nCJ\n\u00a9\nP\n\u00a9\n20 to 30 years.\nci\n\u00a9\np\n\u00a9\nCO\nCJ\n\u00a9\np\n\u00a9\nCJ\n\u00a9\nID\nO\n\u00a9\noj\nrt\nCJ\n\u00a9\nP\n\u00a9\n\u00a9\nrt\n\u00a9\n:o\np\n\u00a9\ntH\n\u00ab\n\u00a9\n\u00a9\nP\n\u00a9\nCO\n90 and upwards.\na\nCJ\n'5j\no\nrp\n*CJj\nCJ\nX\nCJ\nUl\ni>,\nXI\n\u25a0rf\n~p\nH\ne\nCJ\n'Sa\np\nX\nCJ\nm\noj\nHS\nci\nCJ\nft\nHH\nP\nH\nM.\nF.\nM.\nF.\n1\nj\\l.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\nM.\nF.\n1\n1\n1\n1\n1\n1\n1\n1\n2\n2\n1\n3\n1\n1\n1 1\n1\n1\n1\n1\n3\n1\n1\n2\n1\n1\n1\n1\n1\n1\n4\n3\n1\n1\n2\n1\n4\n1\n3\n!>\n17\n4\n21\n2\n2\n1\n1\n1\n1\n3\n1\n1\n1\n1\n2\n1\n3\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\n1\ni\n1\n1\n1\n2\n1\n1\n1\n1\n2\n1\n1\n1\n1\n1\n1\n2\n2\n1\n1\n1\n2\n9\n1\n1\n1\n5\n5\n1\n1\n1\n1\n2\n1\n1\n1\n2\n2\n1\n2\n4\n1\n1\n1\n4\n20\n10\n30 8 Geo. 5\nProvincial Board of Health.\nG 137\nSECOND MEETING\nOF\nMEDICAL HEALTH OFFICERS OF\nBRITISH COLUMBIA\nHELD at\nLABOUR TEMPLE, corner Homer and Dumsmuir Streets, Vancouver, B.C.\nSEPTEMBER 12th and 13th, 1917.\nUnder the authority of Doctor the Hon. J. D. MacLean, Provincial Secretary.\nMEDICAL OFFICERS OF HEALTH.\nPresent\u2014\u25a0\nDr. J. E. H. Kelso Edgewood.\nDr. Isabel Arthur Nelson.\nDr. Mi Callanan Barkerville.\nDr. H. W. Keith Enderby.\nDr. J. P. Cade Prince Rupert.\nDr. A. G. Price Victoria.\nDr. F. Stainsby Field.\nDr. H. C. Wrinch Hazelton.\nDr. R. W. Large Port Simpson.\nDr. J. H. Hamilton Revelstoke.\nDr. S. Petersky Lucerne.\nDr. G. H. Tutill Merritt.\nDr. H. L. Turnbull South Vancouver.\nDr. O. G. Ingham Nanaimo.\nDr. W. F. Drysdale Nanaimo.\nDr. G. deB. Watson Burnaby.\nDr. F. T. Underbill Vancouver.\nDr. S. O. McEwen New Westminster.\nDr. W. E. Newcombe North Vancouver.\nF. F. WESBROOK, M.D, LL.D.,\nPresident, of the University of British Columbia.\nSecretary to the Meeting :\nH. E. YOUNG, M.D.,\nSecretary, Provincial Board of Health, Victoria, B.C.\nWednesday, September 12th, 1917\nMorning Session,\nThe Convention was opened at 9.30 a.m., Dr. F. T. Underbill presiding.\nThe Chairman: Ladies and Gentlemen,\u2014I think we may call this meeting open and\ncommence our programme. Personally, I would like to offer you all a very hearty welcome to\nVancouver; and while I am very glad to see you, I should have been still more pleased had\nthere been a fuller attendance. G 138 British Columbia 1918\nThere are one or two points which I would like to emphasize. The first is, that those who\nrise to speak will kindly give their name and place of residence, so that the stenographer can\nkeep a proper record. Secondly, we desire to have a free and open discussion on all subjects\nand any amount of criticism\u2014hit as hard as you like\u2014we want to learn, and we can do so at\na meeting of this kind.\nYou will probably have noticed that no provision is made for any entertainment. It was\nthought that under the conditions in which we are now living such a proceeding might not be\nquite in place. However, the freedom of Vancouver, in so far as we can give it-\u2014outside of the\nPolice Court\u2014is open to you. The hospitals will be glad to see you; also the Health Department ; for, while we are ashamed of our building, we have the material there if only we had\nproper space for it.\nDr. Young has kindly organized this meeting, and I will therefore ask him to be good\nenough to open it officially.\nDr. H. E. Young (Secretary, Provincial Board of Health) : Mr. Chairman, Ladies and\nGentlemen,\u2014As you know, some two or three years ago we undertook a programme of holding\nannual meetings of the Health Officers of the Province, and had, in 1914, a very successful\nmeeting, and it looked as if we were launched on a programme that would be of very material\nbenefit to the Medical Health Officers, and also to the public in general. The matters that we\nwished to discuss were those, of course, which loomed very large in the Province, and in many\ncases we had no precedents to guide tis. The conditions in the Province are such that these\nmatters have to be met just as circumstances warrant. Unfortunately, following that meeting,\nwar was declared, and, as a result, general disorganization of our staff in the Provincial Board\nof Health. Our men left\u2014there have been some 200 members of the medical profession who\nhave gone from British Columbia\u2014and it was not thought advisable, under existing conditions,\nthat we should continue the meetings at the time. However, war seems to be a fixed condition,\nand probably we might be pardoned now if we were to say, if there is anything in the expression,\nthat business should go on as usual; and taking everything into consideration, and also the fact\nthat in the near future, or we hope in the near future, there will be a cessation of the war and\nother problems will arise, such as immigration to the Province\u2014we may be disappointed, but I\nfeel that people in general are optimistic on this point, and in order that we may be able to\nmeet these conditions, we thought it advisable to resume these meetings, and I have asked\ndifferent members of the Medical Health Officers to give us papers.\nThe programmes which you have before you show that I have made a very good selection\nin the choice of the men from whom we are to have papers. The intention of their papers is to\nregister their views and the results of their experience in the practice of the profession, but the\nchief thing I wish to bring about is the promotion of a discussion of these papers; to get an\nexpression from those of you who are here to-day, coming from widely scattered points in the\nProvince and to whom at times important questions arise which you have to decide without the\npossibility of your being able to get advice.\nThe Provincial Board of Health wishes the Medical Officers to feel that the Department is\nback of them in enforcing the requirements and regulations. When we come down to ultimate\nresults, it is a matter of education\u2014the people must be educated. It is difficult to enforce\nregulations when the enforcement interferes with the daily habits of the people or their personal\nliberty. They must be taught that they are individual members of a community, and that the\nhealth of the community depends entirely upon concerted action, and that the point of infection\narising from one person neglecting to carry out regulations may result in serious epidemics and\ndisorganization of business and death among the people of the community as a whole.\nI propose to continue to carry out as far as possible the distribution of literature along these\nlines, and we hope that those who are reading their papers during the sessions will consider they\nare contributing a great deal towards the publication of pamphlets which will go toward the\neducation of the people; and great benefits will be derived from active co-operation, and from\nthe knowledge of the individual that what we are asking them to do is for their own benefit.\nI look forward with a great deal of pleasure to listening to these papers and to the discussion\nof these questions.\nI wish to thank Dr. Underbill for the splendid co-operation he has given me in the arrangements for this meeting, and also for kindly taking the chair. 8 Geo. 5 Provincial Board of Health. G 139\nThe Chairman : As Dr. Young has said, I hope there will be a free discussion of all these\npapers. I would ask those who are reading to read as distinctly as possible, and also any one\nspeaking to a paper to speak slowly and distinctly, and not to be disconcerted if any one asks\nthem to speak up. The idea is for every one to hear what is being said.\nThe first paper is on \" Child-welfare,\" by Dr. Isabel Arthur, of Nelson, B.C.\nCHILD-WELFARE.\nBy Isabel Arthur, M.D, Medical Health Officer, Nelson, B.C.\nMr. Chairman, Ladies and Gentlemen,\u2014It is a great pleasure for me to be here this morning.\nI was very much pleased to be asked to read a paper on this subject, but with the medical\ninspection of schools taken up by Dr. Brydone-Jack, and the infectious diseases by some one else,\nit left me another field entirely, not altogether medical, to go into, because I think \" child-welfare \"\nincludes a great deal that is not medical.\nThere is nothing else around which so much centres on or which so much depends as on\ntbe child. It is the possibility of the nation, the hope of the future. It comes into the world\nhelpless, born in all kinds of places and in all kinds of conditions, without any choice as to\nwhat these conditions are. One is born in poverty, another in luxury; one in the palace, another\nin the slums; one in the home of luxury, refinement, and education, another in surroundings of\nvulgarity and ignorance.\nWith life begun in such different circumstances it is hard to know just how far individual\nresponsibility extends, but we must have individual responsibility, for without it we can have no\nlaw or order, and law and order are the essentials of civilization.\nIn order to try and equalize conditions and put all children in as good a position as possible\nto begin life, much time has been spent, and never before has the welfare of the child been so\nmuch before the mind of the State. This is in the right direction, but we are a long way from\nhaving it before the mind of the State as it should be. The child is the asset of tbe State, and\nall conditions should be arranged as far as possible to get the best results from that child. It is\na business transaction, and results are what we are looking for in all business transactions.\nWe do not want inferior products turned out that may answer the purpose, but as perfect a\nthing as can be produced\u2014something to be proud of; something with stability and quality, that\ncan be used for the purposes of development and advancement and for the protection, if need\nbe, of the State to which it belongs.\nChild-welfare is such a complex subject and has so many phases that it is difficult to know\nwhere to begin or where to end. The physical development of the child is so closely connected\nwith its mental and moral development that one cannot be separated from the other, and so in\ndiscussing its welfare many things which do not seem to be physical must be taken into account.\nA child whose mental and moral development is taking place in unhappy or uncongenial circumstances has not the same choice to develop physically as one whose surroundings are pleasant\nand happy. Neither has a child who has a taste for certain lines of work and is forced into\nanother line which he dislikes as good a chance of physical development, as the mental is in\nsuch close relationship to the physical that without harmony of the two the best results cannot\nbe obtained.\nIt would seem that there should be very close harmony between the education department\nand the medical, for the real welfare of the child can hardly be considered from the physician's\npoint of view without taking into account its school-life, hours of study, hours of play, and many\nother things that come directly under tbe education department. Hence this paper is not all\nmedical. We all realize that the physical well-being of. the child is of the utmost importance.\nWe must have the healthy child, and how to get that is our first thought, and we must begin at\nthe beginning.\nIn order to have the healthy child we must have healthy parents, so that the care of the\nchild is prenatal. Some one said, when asked the proper time to begin the education of her\nchild, \" One hundred years before its birth.\" That has a great significance. \" Do men gather\ngrapes from thorns or figs from thistles? \" is a very pertinent question in this regard. Do we\nget the fit from the unfit? This is the thought that should be before the mind of every one\ninterested in the welfare of the child. It does seem as if we begin at the wrong end in dealing\nwith many problems. We allow things to occur and then try to treat results. Now is the time G 140 British Columbia 1918\nto get at the cause, and unhealthy parentage is the cause of many conditions found in the child.\nWe know that all kinds of tendencies are passed from parent to child, even unto the third and\nfourth generation\u2014tendencies to wrong habits of thought as well as to right habits of thought\nand action. This is law\u2014inexorable law; and although we may disregard it, it prevails just\nthe same.\nWhen we want first-class wheat we plant first-class seed, and we get what we aim for.\nThis is true all through nature, and in developing the resources of nature the fact is often taken\nInto account. Not so in the human family, though. I asked the Registrar the other day if there\nwere any restrictions on marriage. He turned up the book, and all the restrictions I could find\nreferred to age. Well, I find no fault with that\u2014it is wise, perhaps; but is that all? What\nabout the man of mature age that is a drunkard or a drug-fiend, or an idiot or a degenerate of\nany kind, or the man who has gone far into the country of tbe prodigal son, and who has wasted\nhis substance and his health in riotous living, or who has acquired disease in any way and is\ndevoured with it; can he get a marriage licence and no questions asked? Oh, yes! Why spoil\nthe romance of life for him? He has been sowing his wild oats, and now he must settle down\nand become a respectable citizen. There is a lovely sweet girl with whom he is in love\u2014why\ninterfere? Let all the earth keep silent! and let this dreadful tragedy be enacted; and all\nthrough the years the tragedy, never ending, follows that innocent girl and her children. The\nshame and injustice is appalling. \"Honour thy father and thy mother,\" says the good Book;\nbut how can the child honour the parent who has bequeathed to it a heritage of ill-health or\nevil tendencies? Too much silence has been our fault; mock modesty and a foolish idea that\ncertain things must not be spoken about have led to fearful results. The world has not always\nbeen fair to the child. It has allowed it to start out with a handicap, and in our cart-before-\nthe-horse style we try to remedy the result. We will look after these children; we will see\nthat the schools have medical and dental inspection; we will improve sanitation and have good\nwater-supplies, and make everything tend towards health. What nonsense! Why ever allow\nthem to happen? If we can't prevent people from acquiring disease, we can at least prevent\nthem from passing it on to innocent children.\nMy first thought, then, in child-welfare would be restriction of marriage licences. Any one\ncontemplating entering into matrimony should be compelled to undergo a strict physical examiiia-\ntion by a capable and conscientious physician, and be required to have a certificate of good health\nfrom that physician before a licence could be issued. \" Oh, yes! \" some one says, \" but money\nwill buy anything; it won't work.\" Quite true, it will not work if doctors are going to stoop\nto a low enough plane to be bribed, but we like to think of doctors occupying a higher place;\nand, besides, they know the result of marriages of the unfit and unclean, and if they cannot be\ncounted on to protect innocent women and children, God pity us all.\nNow, as perhaps never before, we need healthy children to take the place of those fallen\nin the war, and quality will count much more than numbers in this replacement, and careful\nattention must be given along every line tending to the conservation and elevation of human life.\nWhen the child comes into the world the problem of taking care of it begins, and was there ever\nsuch ignorance in regard to any other subject? The delusion that maternity brings with it the\nknowledge of how to do this is fast disappearing, and none too soon. The whole cry of to-day\nIs for skilled workers, people trained to do their work. All trades and professions call for\ntraining for and knowledge of the particular branch of work undertaken. But what about young\nmotherhood? The young girl marries and in the course of time finds herself a mother without\never having had a word of instruction or how to perform the duties of motherhood, and to give\nthat child the attention and training it should have in order to make it into the best class of\ncitizen it is capable of being. All the girl has is her own intuition and love for her baby, and\nshe has to depend on getting advice from very incapable people in many cases, and the result\nis that her whole care of the child is experimental. The pity of it is that it results in a terrible\nwastage of human life, often of the best type, that might have been saved through the knowledge\nof some of the ordinary rules for the care of the child. Not only must she know the way to\ntake care of it physically, but she must understand that that child is not all physical. She must\nrealize that it is not an absolutely new thing that she can train in any way she chooses; while\nit is true that training does a great deal in the forming of the child's habits and preparation for\nits life, it is also true that that child has a disposition and traits of character that no amount\nof training can entirely overcome. It has tendencies to good or bad habits, a predisposition to 8 Geo. 5 Provincial Board of Health. G 141\ncertain lines of conduct, tendencies to contract or resist disease, and a general make-up that is\nentirely bis own; and surely it requires a great deal of knowledge, tact, and ability to mould\nand form that little personality and direct it along right lines, with wisdom enough to know\nwhen to develop and when to suppress. Truly some training is necessary for this great undertaking, for great it certainly is. But she gets none. She learns as she goes on and the child\nis always there to practise on.\nHow many young mothers know how to feed a baby properly if the natural food for some\nreason or other is lacking? The more the baby cries the more food it gets, and the more food\nit is given the more the baby cries. And so it goes on from bad to worse, until both mother\nand baby are physical wrecks. If by any good fortune the child survives, it often takes years\nto recover, and in many cases it never recovers altogether. This lack of knowledge of the proper\nway of feeding children does not end with babyhood. Indulgence is one of the crimes of our\nday. It begins in babyhood and goes all through life. The child must not be denied anything.\nIt likes candy ; therefore it niust have candy, and plenty of it. Whatever the grown-up members\nof the family eat the baby must eat too, and the result is that tbe child is taking food quite\nunfitted for its digestion, and containing tbe wrong proportions of the different substances\ncontained in food. For instance, many mothers do not know that meat and milk should not\nbe given at the same time. Perhaps they have learned the fact, but if so they do not know\nthe reason why, and so do not act on it. The child gets all the meat at once; it usually wants\na good deal; and, of course, nearly all children have plenty of milk.\nThere is also a great deal of irregularity in feeding the child. The pantry is open to it at\nall times of the day, and the result is that when the regular meal-hour comes it is not hungry.\nIt should be taught that the time to eat is at the regular meal-hour, and that it must eat slowly\nand masticate its food thoroughly in order to get a proper amount of saliva mixed in with the\nfood to help to digest the starch contained in that food. To do this it is necessary to have plenty\nof time for meals. I don't know how a child can do this if the time allowed is only one- hour;\nbut of course it can't, and so we preach one thing and make conditions so that the child must do\ntbe opposite. One hour and a half is the very shortest time that should he given at the noon\nhour, for that is the principal meal of the large majority of children, and they should not have\nto \" bolt\" it and run. It would seem as if it would be a very wise thing to have a course for\nthe \" teen\" age girl along lines that would train her for the duties and responsibilities of\nmotherhood, a course that would give her an idea\" of the amount of food to be given to a Raby\nand the proper length of time in between feedings, ahd the importance of regularity; tbe age\nwhen the child might be given solid 'food, and so on; also some instructions on clothing, so that\nthey may know when a child has enough on and not too much. Too much clothing is a very\nfrequent mistake, even more common than not enough. They should also be taught about tbe\nimportance of sleep, fresh air, sunlight, and many more every-day facts.\nThe home-work problem, too, comes in when dealing with the welfare of the child. Play\nis as necessary to its development as work, and if the hours after school are filled with work,\nwhen can it get its play? Either play or sleep must be sacrificed and both are absolutely\nessential. It seems as if for many years the child should be able to get all its instruction in\nschools, and that the rest of the time should be spent in other ways. We should try to make\nconditions so that this may be accomplished. Even in high schools it seems as if the amount of\nhome-work boys and girls are required to do is enormous. It is not the fault of the teacher;\nit is our system that is at fault. I think we are trying to fit round pegs into square holes and\nsquare pegs into round holes, trying to make the child develop along lines where it has no-\naptitude, instead of along the lines it likes. What we want to do is to fit the child for living,\nso that it may do well its life-work, whatever it may be, and to give it a sound mind and a healthy\nbody, so that it can perform its tasks with ease and pleasure.\nSleep is a very essential thing for the child, and its importance should be kept constantly\nbefore the minds of parents. Who has not seen little children from the ba'by-in-arms stage up\ndragged out at night to all sorts of things\u2014picture-shows, concerts, and even dances being well\npatronized. There is no objection to these things in themselves, only the child should not be\nthere. It should be asleep, but the idea that the child must have the same as the grown-ups\nis becoming far too prevalent. How can any one think that night is the proper time to take a\nthree- or four-year-old child to anything? By that time the child is ready for bed; development\ngoes on so fast in the little body and mind and so much waste material has been thrown off that G 142 British Columbia 1918\nit is in no fit condition to have more heaped upon it; but the mother must be amused, the child\nmust be amused, and so out they go. Of course, this does not amuse the child; it only tends\nto tire and weaken it, and helps to place it later amongst the physically unfit. The child is very\neasily amused in reality, and if left to itself it shows this at every turn. Give it space and a\nfew simple toys that it can \" do \" things with, and then it will have real amusement and real\nbenefit. But the fault lies with the parents. The child is the toy of the household. We think\nwe are amusing it when we are gratifying our own selfish desires. We like to see the child\ndressed up; we like to see it doing smart things; and so with wrong ideas of tbe whole child-\nnature we bring it up with wrong ideas of living and of the world it lives in.\nA child whose whole idea of amusement and whose whole thought is of self, nothing but\nthe material does it know anything about, and 'who is to blame? It has been brought up on\nexcitement and amusement; it began when it was a baby; never a quiet moment did it have.\nWhen it was in its cradle it was rocked; when in its carriage it was shaken; if on any one's\nknee it was jumped up and down, then tossed into the air to land no one knew where, and\nthumped and patted, dandled till one became dizzy watching the performance. Tbe child is\nformed the same as any grown-up person, and I don't believe we would enjoy all this diversion.\nIt may be pleasant to be tossed into the air, but none of us are anxious to try it. The child\nshould be kept quiet with as little. handling as possible. It should have the use of its arms\nand legs and be allowed to use them freely, and should be allowed to develop itself. Gymnastic\nexercises for it given by some one else are not required. Nature takes care of all that, and all\nthat is necessary is for it to be allowed to develop in nature's own way, but no such good luck!\nAs it grows older our modern civilization seems to demand still more excitement for it. When\nChristinas or a birthday or any special occasion arrives, every one, father, mother, sisters,\nbrothers, friends, and relatives, all conspire to give it a good time. The good time usually\nconsists in working it up to the highest pitch of excitement; everything is piled on it; toys\nof every description, and never-ending, are there for a surprise, until it is so tired and worn out\nthat there is no pleasure in anything for it. The day usually ends in its doing something very\nnaughty, and the parents cannot understand how it can act so when every one was so good to it.\nOne feels sorry for the child with too few toys and too little attention, but tbe child with too\nmany toys and too much attention is more to be pitied. Too few people understand the simplicity\nand beauty of child-nature. The simplest thing amuses them; expense and costliness are quite\noutsjde its grasp, and we only flatter our own vanity when we heap costly things on it. All this\nis wrong, absolutely wrong. We must 'bri*ug up the child so it will develop into the capable man\nor woman, strong in body and in mind. With so many of our best men gone we must have\nhealthy and capable men for the future, or what will be the result? The past we have nothing\nto do with now, but we must strive to be the guardians for the health and welfare of the future.\nThe moving pictures figure so strongly now in the life of every child that it has become a\nreal factor in its welfare. I have no objections to moving pictures for the child, provided the\npicture shown is of the proper kind and it is taken at the right time to see it. It is such a\nsplendid opportunity to put such wonderful things before the child's mind, that there seems no\nreason why anything else should ever be allowed. I think all health authorities should take a\ngreat interest in the moving pictures, with the idea of getting things put on that are of an\neducative value, things that will not cause nerve-strain and mental exhaustion, and give the\nchild a wrong idea of life.\nNot long ago I went to the moving-picture theatre to see Hall Caine's story \" The Deemster \"\nput on. It is a tragedy from beginning to end; the place was filled with children; all ages\nwere there, from the baby in arms up. When a terrible quarrel occurred between two men, a\nsmall child near me said: \"What are they doing?\" The answer was: \"They are trying to\nkill each other, dear.\" Yes, just tbe simple little thing of murder and tragedy. A most fitting\nsubject for the child to see! Is that the right thing to put before the child's mind? I do not\ncriticize the play, but I do criticize the fact that children were allowed to see such things. Not\nonly does it see tragedy, but even worse. It often has phases of life put before it that cannot\nhelp putting into its mind ideas that lead later on to loose habits of thought and action, suggestive\nthings, that surely lower the standard of living; and lower standards of living tend to lower\nthe race in every way, physically, mentally, and morally.\nThe child suffers a great handicap from the suppression of its natural curiosity to know\nthings. All life and its problems are before it, and these problems are before the child-mind very 8 Geo. 5 Provincial Board of Health. G 143\nearly. It seems to be a prevailing idea that a child's questions should be ignored or answered\nwrongly. It is true that its questions cannot always be answered, but in cases like that the\nreason for not answering them should be fully explained, and whenever possible the proper\nanswer should be given. What difference if it does take a little time; there is always time for\nanything you want to do, and you never can spend time in a better way. The child with the\nalert, active mind is the one we want to develop, and in order to get tbe best results we must\nsatisfy its desire to know the reason why. The whole child-life is \"Why?\" And when it is\nbrushed aside with a \" Don't bother me,\" there is something suppressed in that child which is\ninvaluable. Then, too, it will often do a wrong thing because it does not understand, and very\noften a good explanation of the reason why certain lines of conduct are wrong will do it more\ngood than a whipping. Not that I think whipping should be done away with altogether, but one\nshould be very sure who is to blame before it is given. The child never forgets an injustice,\nand I think most of us carry in our inmost minds the remembrance of some perhaps very small\nthing for which we were punished when we did not deserve it. It has left a scar and a feeling\nof resentment. We must be just to the child, first and, foremost. By that, I do not mean\nindulgent, for often the most unjust parents are the most indulgent.\nSo much harm could be prevented by frankness between the parent and child. The parent\nshould explain the dangers that may beset it and give it a chance to avoid them. The child does\nnot know much about the dreadful diseases in the world, so we should be fair and square enough\nto warn it in time. Prevention is better than cure, even if a cure can be effected, which is not\nalways the case. The child who goes out into the world unwarned and ignorant, and, not\nknowing, who is led astray, has the right to ask its parents \" Why? \" You have only to walk up\nand down the streets in any city at night to see things that appal you. Young girls unescorted\nand dressed in a style altogether beyond their years and means trying to make themselves look\nattractive. Their mothers have never warned them; they have gone their own way from childhood, and many a girl that might have been innocent and healthy, a credit to society, is lost to\nall good, simply because her mother was careless. If parents only recognized their responsibility\nto the children and were frank and just enough to warn them, society would have fewer outcasts\nand much less disease to deal with. Not only does the girl need a guiding hand, but the boy as\nwell. Many people forget that the boy has a hard row to hoe, perhaps even harder than the girl.\nHe is allowed liberty because he is a boy, simply because results can not occur the same as in a\ngirl. They forget that there can be awful results, far-reaching and degrading, resulting in loss\nof health and things that make life worth living. We are allowing the children the liberty of\nthe adult without the knowledge of adult life to protect it. It is often blase when it is sixteen,\nnothing left for it to know. Home-life is ceasing to be a factor in our civilization; too many\nattractions outside. The home must come into its own again; it is essential for the bringing-up\nof the child.\nFor the welfare of the child I would suggest singing. It is good for it, mentally, morally,\nphysically, and spiritually. I wonder if the statement that the Canadian child is lacking in\nmusical taste is true. If so, it is largely because it has been ignored as a national asset. Singing\nshould be national. Almost every one can sing if he or she gets the opportunity, and the opportunity should be given to every one. Not that every one should be trained especially to sing, but\nmusic should have a very prominent place in every school and in every home. Singing makes\na better child. It develops its lungs and puts into that child a something that is indefinable, but\nwhich we have all felt and which we all know. \" The man that hath not music in himself, nor\nis not moved with concord of sweet sound, is fit for treasons, stratagems, and spoils.\" Let us\ntry to put into every child's mind the memory of sweet song; let us have music as a necessary\npart of tbe development and training. No crimes are committed with songs on the lips; song\nis tbe accompaniment of joy and happiness, brave deeds, and noble impulses, and to me seems a\nmost necessary thing in the full development of the child nature, which we all know is very\ncomplex, and which must be considered on all its sides; and, while not forgetting the physical,\nwe must remember that it depends to a very large extent on the development of its other nature,\nmental, moral, spiritual, and testhetic. We are not developing merely the animal, but something\nmade in the image of God, and so this many-sided problem must be faced; and it is the study\nof a lifetime how to make the world a good place for the child to live in; how to fit the child to\nlive as a child first, then as an adult capable of performing in the best way the various duties\nof life. We don't want the child just to be good; we want it to be good for something. Too much cannot be said in favour of our public schools, and every advance made is of\nincalculable value. Although children are born in all kinds of conditions, here at last they are\non an equal footing; here there are neither rich nor poor, high nor low, no class distinction.\nThey are all children together with the same instincts, tbe same love of play, the same everything.\nHere is where the child gets his chance, rich and poor alike, and so everything tending towards\nthe betterment of the school is well worth while. It is coining about that the bodily development\nis considered as important as mental development. We are realizing that the mind must exist\nin a healthy body to give the best results. There is a great deal to be done yet, for we have not\nyet reached the point where all may get attention free of charge if necessary. Many a child still\nhas to bear tbe hardships incident to defective teeth, enlarged tonsils, the existence of adenoids,\nand many more diseases that react upon its mental improvement. Probably the greatest problem\nthat the Medical Inspectors of Schools in towns and outlying districts have to meet is the\nimpossibility of getting the teeth attended to. Dentistry is very expensive, and it is simply\nimpossible to have teeth attended to when there is a large family. It is not much use to send\nthe notice to the parents, \" This child 4s in need of dental attention,\" when you know quite well\nthere is not money enough to buy food and clothing. It almost seems as if the old saying,\n\" Where ignorance is bliss, 'tis folly to be wise,\" would fit here. We are all looking forward\nto the time when we will have dental inspection as a necessary part of our school-life. So many\nills are put down now to diseased teeth that one has to keep very sane in order not to become\nquite panicky when yon see hundreds of children with diseased teeth, and you wonder if they\nreally are all going to the bad.\nThere is one thing in connection with teeth that I would like to say, and I will give an\nexample of what I mean. A boy aged about eight years was found to have no teeth, either above\nor below, on either side, beyond the canine teeth. When asked what happened to bis teeth, he\nsaid that a doctor in a certain Prairie town had pulled them. \" They were aching,\" he said,\n\" and the doctor thought they might as well come out.\" \" Was there not a dentist in the place? \"'\nwas asked the boy. \" Oh, yes,\" was the reply, \" but the doctor always pulled our teeth.\" Yes,\nhe pulled them all right, six-year molars and everything else. He made a clean job of it, but if\nbe had seen the misshapen jaw I am sure he would not be very proud of his work. That child\ndid not get any teeth for years. It is true this was worse than is usually found, but too often\nthe six-year molars are pulled, and not often by dentists either, so I feel like criticizing the\nmedical profession on this point. The six-year molar is the most important tooth in the mouth;\nit is the key of the arch, and should be saved whenever possible.\nGoitre is one thing I see no hope for. It is very prevalent in Nelson; ISO cases were found\nin our schools last year, and there are probably as many more in children under school age and.\nadults. No bad results have occurred from it. It seems to be all of the simple kind, but it is\nvery disfiguring, to say the least, and any theories or knowledge of its cause would be very\nwelcome.\nIn concluding, let me thank you for the privilege accorded me of reading this paper and for*\nyour kind attention.\nDiscussion on Dr. Arthur's Paper.\nMr. Biker (Nelson) : I wish to congratulate Dr. Arthur on her very capable and very\nbroad view-point expressed in her paper. While I am only here as a layman, practically, among*\na crowd of doctors, I feel tempted to have nothing to say; but I can give you my view-point..\nI might say, with regard to the curriculum in our schools, I think this subject might be\nincluded. Another salient point is that we have tbe future in our hands, and we ought to be-\nable to handle that. How many of us as parents warn our children of the conditions they have-\nto face? This is rather an important point.\nI would like to hear more with regard to the question of goitre. I believe we have an awful,\nlot in our town; this disease is very prevalent in the higher altitudes, and I believe about\n90 per cent, is found in the altitude between 10,000 and 15,000 feet. I would like to hear more\non that.\nDr. Petersky: First I want to congratulate Dr. Arthur on that paper. I think it is the-\nmost important paper on the programme. In my experience I have found that the ignorance*\nof the people in this Province is appalling. To illustrate that: I had a little child in my care,,\nthe son of the Stipendiary Magistrate, who is supposed to be a man of judgment, and when food! 8 Geo. o Provincial Board of Health. G 145\nwas kept from this child for twenty-four hours, this man said he wasn't going to have that baby\nstarved. After he saw the attack was cut short, he did have tbe grace to apologize.\nWith regard to the inspection of schools, I have inspected schools in a country district\nprincipally around the Cariboo, and I find teachers as a rule\u2014though some of them are polite\nto us\u2014they think we are a blamed nuisance coming and interfering with their work. That is\nthe way they look at it. The average teacher is just as ignorant as to why schools are inspected;\nthey didn't read the pamphlet sent out by the Government, and not a teacher was conversant with\nit until I carried out the system adopted afterward, of giving them one week's notice, telling\nthem it was their duty to read it as a teacher, and they had certain duties to perform for the\nSchool Inspectors, such as examining the youngsters' eyes, and they could find out certain things\nwhich would come under their notice, such as a limp, or curvature of the spine, and it was their\nduty to look after such things as well as the education of tbe child. They think they have only\nto teach that two and two make four, etc. I think the Health Department ought to take that\nup and make the teachers realize that this is a very important branch of their work, and they\nmay treat the School Inspector with a better spirit.\nThen you take the average mother; that is a point to which I have given some thought, and\nalthough the general public limit their powers by making the laws of health, etc, I think the\naverage mother should have a certificate that she has the education to fit her for her position.\nFor instance, she should know enough about cooking not to poison her husband, and she should\nknow enough about mixing various formula? of milk in case it is necessary, and also know what\ndisturbances may be caused in tbe stomach.\nPersonally, I haven't any children yet, but if I have I shall consider I have to put in my\ntime to look after them; and as to entertainments, one of the parents\u2014fortunately there are\ntwo\u2014will have to stay home to look after the youngsters. I would not trust a child of mine\nto any nurse. In some cases children are left in the charge of women who drink, and what can\nbe expected of the children if they have such a nurse for an example?\nIt in all very well for us to get together here and read papers as to what we ought to do,\nbut how are we going to get people to believe we are.not faddists and not carried away by our\nimpulses ?\nDr. Arthur suggested singing. I might carry that point a little further, and say any innocent\namusements that will occupy their time; and for the parents, I think it should be made compulsory in the high schools and Normal Schools particularly that teachers should be obliged to\ntake first aid and should be taught to respect the Medical School Inspector.\nDr. Vrooman (Medical Superintendent, Tranquille Sanatorium) : I think Dr. Arthur's paper\ndeserves much praise. I do not wish to take up much time on this question of \" child-welfare,\"\nbut there is one suggestion I should like to have taken into account\u2014that is, the education of\nthe parent. The parent cannot be educated by the physician, except partly. A great deal has\nbeen done in this city by the Child-welfare Committee, the Babies' Hospital, etc.; incalculable\ngood is being done. Why not extend that beyond the City of Vancouver? Why not extend it\ninto the rural districts by the appointment of nurses who will go to the rural districts and\neducate the mothers? We are not educating the mothers by making laws; it is a woman's\ninfluence with a woman that counts. A sympathetic nurse can do more than a medical man,\nand I think one suggestion arising out of Dr. Arthur's paper is that nurses be appointed for the\nrural districts in British Columbia.\nMrs. Clark: May I ask a question as to the point about goitre? It is a prevalent idea that\nwater has something to do with it. I had an examination made of Vancouver water, and a\nphysician said it would be advisable to give my children a small quantity of lime-water each\nday, and I did so; but very few mothers know about that, and many have asked me if the lack\nof lime did not cause goitre.\nThe Chairman: I was going to ask Dr. Young to give statistics on goitre later on.\nDr. F. W. Brydone-Jack: I had great pleasure in listening to the paper this morning,\nparticularly the non-medical side of \" child-welfare \" ; and then again the practical application\nwith regard to dentistry, the prevalence of goitre, and the education of the parents.\nIn connection with the education of teachers, I think that could be arranged in Normal\nSchools by having lectures given on \" child-welfare \" by some doctors at some time suitable to\nthe principals of the colleges.\n10 G 146 British Columbia 1918\nIn connection with the child-welfare movement, when down East this summer I saw the\nwell-organized plan in Toronto. Whenever a child is born its birth is registered, and the Mayor\nsends a card of congratulation, telling of its value to the State. This contains a pamphlet of\nsix pages describing methods of feeding, and illnesses, etc. It has twenty-eight child-welfare\nclinics, and a staff of nurses doing prenatal work in these child-welfare classes, and then the\nvisiting of the school-children. In connection with births in -the public wards of tbe hospitals,\nit is almost compulsory that these matters be attended to. Dr. Brown has charge of this work\nfor the City Health Department in Toronto, and also the present head of the work in the\nChildren's Hospital there. When a mother leaves the public ward she has to take the child to\nthe child-welfare clinic once a week for measurement, weighing, diet. etc. If the mother neglects\nto do this\u2014at the present time they can almost compel her to do it\u2014they take the matter up in\nthe Courts as a mother being neglectful of the child. But the majority of women take the\nchildren to the clinics without any trouble.\nI think in New York there are about fifty-seven clinics, in Montreal twenty-eight, and they\nare spreading all over the country here. In Toronto they call them infant-welfare clinics, but\nthey are child-welfare clinics because they look after children up to school age, and many\ndefects which are found usually in children after entering school are in this way remedied before\nthey come to school, because most of the defects found, as you know, in school-life should have\nbeen remedied two or three years before the child came to school.\nDr. Stanier (Medical Inspector of Schools, Oak Bay) : I was much interested in Dr. Arthur's\npaper, and I hope she will let me have a copy of it, as I would like to take it home. Of course,\nby the very nature of that paper, it is sketchy. What I think would do a good deal of good would\nbe something along the line of fiction, giving more intimate details of the bringing-up of children.\nThere is no more popular book than \" Helen's Babies \" to show that a child should not bring\nup its parents. I think many of the clever writers to-day would be able to write something that\nwould be humorous and well read by many mothers who are perfectly willing to know something\nabout children, but do not like to be educated in the strict child-welfare way; but ranch that\nis informing could be introduced into a work of fiction, that perhaps would take up the first\nyear of a child's life, or perhaps up to two or three years of age, and, later on, the school-life.\nNine out of ten children born, I think, are born healthy, even if tbe parents are comparatively\nunsound; if properly fed and looked after the first year, they will grow up strong and healthy\ncitizens and overcome tendencies to disease if properly handled during the first year or two.\nWhat the last speaker said about clinics is important, but I would like to see something written\nalong the line of fiction, and I am sure it would be a book widely circulated and read.\nI haven't time this morning to criticize much, and there is very little to criticize. With\nregard to teeth, I have seen a number of young children with their milk-teeth practically gone.\nThere is a theory that the sticky white flour is responsible for it, or eating sugar at night. About\nthe only instructions I give to parents about these things is not to let a child eat sugar after\nsupper, or to thoroughly clean the teeth after doing so. I know the use of sticky, fine white flour\nproduces decay and tends to disease much more than we are aware.\nDr. A. G. Price (Medical Health Officer, Victoria) : I think we ought to be congratulated on\nhaving the opportunity of listening to such a valuable paper on \" child-welfare,\" so very full\nfrom beginning to end. It is only twenty-four hours ago that I was attending a meeting at\nVictoria, where we are starting late, but we are starting a child-welfare campaign. I only wish\nthis meeting had taken place a few days before or our meeting a few days after, so that I might\nhave had the advantage of this excellent paper. It is so very full that to touch on all the points\nwould be impossible in the time given, but one point I am rather interested in and would like to\ntouch on is the prenatal child. I do not think that enough importance is placed upon this point.\nOnly the other day I had a letter from Dr. Plastings, of Toronto, asking for information about\nthe child-welfare movement in Victoria. I gave bim the information, but finished up by saying,\n\" You have got hold of the wrong end of the stick\u2014you must get at the prenatal end.\" If you\nlook through the statistics of the different cities\u2014I know Victoria better than any other city\u2014\nyou will find an enormous death-rate among children under one year old, due to still-births,\npremature births, and malformations at birth. I can tell you, out of 101 or 105 of the infant\ndeaths under one year old in Victoria last year, I think seventy-five were from prenatal causes\u2014\nstill-births, premature births, and malformations which we are in our present state of knowledge\nnot able to account for. We know this; that maternal impressions are carried on to the offspring. 8 Geo. 5 Provincial Board of Health. G 147\nFor illustration: In one case where a baby was expected in about five months' time, the mother\nwas in a crowd, and a man came up and drove his elbow in her chest and made a dent and a red\nmark. The baby was born with that dent and red mark. It is a deep dent which with a little\nexcitement gets red. Another case, just for illustration, is this: An expecting mother came to\nme with a little boy who had been rolling a hoop and had fallen on the hoop and cut his lip.\nShe was in dreadful distress lest her baby should have a split lip. I laughed at her, to prevent\nher having the impression, but when the child did arrive it had a split lip in the same place where\nthe older child had been cut by this hoop. I know of another case, where a butcher was lifting\na piece of meat from a hook, and the hook fell and tore his face in a horseshoe cut. His wife\nat one time had broken her finger at the top joint. Three of their children had no top joint to\nthe finger, and two girls had a horseshoe mark on tbe face.\nMental defects are carried down in the same way, and it is most important, I think, when\ninfants are on the way, that expecting mothers should have some instructions. I would say\nthat girls before leaving school should be given some instruction on how to live at that time, both\nmentally and physically. I come across many cases where the unfortunate mothers are out at\nwork\u2014husbands are ne'er-do-wells and the women are working for their daily bread. What can\nyou expect to see in the offspring? I think this question should be brought up very fully.\nThere is one book I advocate in Victoria; I got it from the Provincial Department; it is\npublished by the Metropolitan Life Insurance Company, and given away free, called \" The Child.\"\nIt first gives the prenatal treatment; the mother, her treatment; and the treatment of the child\nfrom tbe first, its feeding, etc. It is a very small book, but I have advocated that it be placed\nin every public school in British Columbia, in Canada, and in the British Isles. It is a most\nuseful book, and unless you give the mother something to read she will forget what you tell her.\nI wish to thank Dr. Arthur for her excellent paper.\nA delegate: I think we should congratulate ourselves on having Dr. Arthur here, opening\nup new phases of child-weifare. In our schools, if we were in touch with the boys and girls on\nthe fundamental principles of life, when they get out to work, they would have this knowledge\nto guide them, and I think a great many of you will agree with me that if this were done a great\nmany diseases and imperfections in our children would be eradicated. The State would not be\ncalled upon to keep these children and we would be a better nation. To my mind this is the\nfundamental principle that we should carry out.\nMrs. Clark: I was convenor of the better-babies contest a few years ago, and we found a\ngreat lack of little pamphlets to distribute to the mothers. We were absolutely dependent on\nthe Metropolitan Life for our literature, and we have thought since it would he an advantage\nto have the Provincial Government publish some little pamphlets to be distributed at such a\ntime, when so many mothers and babies are congregated together.\nDr. Young: Our intention is to distribute as much literature as possible. The baby contest\nin the Province was a new feature, and there is now a pamphlet pertaining particularly to these\npoints under publication which will be distributed very widely, especially through Women's\nInstitutes.\nNow, in reference to goitre, I found when I went into this some two or three years ago, in\nconversation with medical men, the question of goitre came up, and I took the matter up at the\ntime, and called it to the attention of the Medical Inspectors, asking them to pay particular\nattention to it; and from their reports during the years 1915 and 1916\u2014unfortunately our\ninspection was not carried out during the past term\u2014but up to the beginning of the last school\nterm there were 1,633 cases of goitre on the school reports. This is not by any means the number\nof cases in British Columbia, but a report simply of the children of school age; and it was very\nalarming. It was not confined to any one district in British Columbia ; I found it from the north\nto the south and from the coast to the east border. Through the Okanagan the percentage of\ncases was probably much higher than in the other districts of the Province. I took the matter\nup with the medical profession in general, and asked the Victoria Medical Association and also\nthe Vancouver Medical Association to conduct some investigations along these lines; and the\nVancouver n^ssociation kindly took the matter up at my suggestion aud appointed a committee;\nand I had an interim report from them, saying later in the season they expected to be able to\ngive further data with reference to the matter.\nIn the course of investigations I found not only humans affected, but animals, very much\naffected. I took it up with Dr. Haddon, of Agassiz, and he confirmed this; and Dr. Tolmie, G 148 British Columbia 1918\nDominion Veterinary, asked me about it. and I gave him some figures I had. and he agreed that\nit was very alarming. He informed me that the existence of goitre amongst animals was so\nserious that it meant a very great economic loss, and he was asking the Department at Ottawa\nfor sufficient funds to conduct an investigation.\nThe percentage of cases among the population of our Province is probably not greater than\nwe should expect in a Province like British Columbia, where we have a shifting population.\nFollowing the knowledge I obtained in the reports, I wrote the Medical Inspectors and asked for\ntheir views, and they are agreed as to its prevalence; but unfortunately, owing to the carelessness of the profession, they did not pay any particular attention to the matter other than the\nfact that they regretted the condition, but I got what information I could from them with regard\nto their private practice.\nThere does not seem to be any consensus of opinion as regards its source or origin. The\ntheory of water-inspection was applied generally to the Province, as we are a mountainous\ncountry and the source of our water is glacial, snow-water. Whether it is microbic or not, I\nhope to be able to ascertain. It is a matter to which the profession should give particular\nattention. It is alarming. There seems to he after puberty a decrease in the number of cases.\nWe are not peculiar in the existence of goitre here, but probably in its distribution. In other\ncountries and in the East they have these epidemics of goitre from time to time, and I wish tbe\nmedical profession would keep this in view and try to arrive at some solution and advise tbe\nDepartment.\nMr. Biker: I believe we have localized within the District of Nelson over 400 cases in\nadults and children. Here, in my opinion, is a specially localized field, and I think, when an\ninvestigation is being made, we should have some investigation in.Nelson, as we have so many\ncases.\nDr. Wrinch: I think we should be able to obtain some concrete results from this conference,\nwhich should be made as valuable as possible. With regard to disseminating information to the\nyoung, I have been pondering on that question for a moment after listening to this very full\npaper, and I wondered if it was sufficient to instruct the high-school pupils on questions of sex,\nmaternity, etc.. also on diseases. Would it not be possible to use our present organization of\nschool examiners to speak upon these all-important matters to both sexes during adolescence\nand early adult life? I fear it would not be sufficient to wait until the children are in high\nschool, because a great number do not attend high school\u2014a large proportion do not; we must\nreach them earlier. Could not some arrangement be made whereby children could be taken by\nthe Health Inspectors in the Senior and Junior Fourth classes before they scatter, taking the\nboys and girls separately and lecturing to them as to the evils to which they are liable? It is\nvery important that they should be taken separately and that the instruction should be given\nby medical teachers and not by school-teachers.\nIn order that the information should be along the right lines and as carefully condensed as\npossible, perhaps the Department, by means of a little committee called together, could arrange\na pamphlet of instructions to be given to Health Inspectors, outlining a course, so as to make\nthe teaching uniform. These are just suggestions that have occurred to me as possible, whereby\npractical results along these lines could be obtained.\nDr. Isabel Arthur (replies to discussion) : I think the greatest difficulty that I have found\nis to get the people to hear any papers or lectures on this subject. Several times I have advertised that I would give a talk on certain matters. When the time came I would look at my\naudience and I would not see a person there that I wanted to be there; that is, people who\nshould be there were not there, and the people who were there already knew. I think it would\nbe a very good idea if the Medical Health Officers were to publish in a weekly paper an article\non \" Child-welfare.\" It would not be a* very hard matter to write a small article each week,\nand in that way get a great deal of information before the public.\nAs to the question of teeth, I have found in examining the schools that the Chinese boys\nand girls seem to have better teeth than our boys and girls, so I presume it has something to\ndo with the food; whether it is sugar or not I do not know, because I do not know whether\nor not the Chinese are sugar-eaters.\nAbout the difficulty between Medical Inspectors and teachers: I have not found any difficulty\nalong that line. I think one has to give tbe teachers credit for being very reasonable and rational S Geo. 5 Provincial Board of Health. G 149\nin their treatment of the Medical Inspectors. I have not found the teachers in the schools I have\nhad anything to do with anything but reasonable and rational, and they do everything I ask them\nto do.\nI think the suggestion that a pamphlet be prepared by the Government as to teaching in the\nschools, public and high, is a very good one, and I think it would be a very good way to get the\nknowledge before the children.\nThe Chairman: Ladies and Gentlemen.\u2014I have received a communication which I will\nread. (Reads communication from Dr. McKay Jordan.)\nNote.\u2014It is moved and seconded that it be laid on the table.\nTbe Chairman: It has been moved and seconded that this be laid on the table. All those\nin favour say \" Aye.\" Contrary, \" No.\" The motion is carried unanimously.\nThe Chairman: I will now call on Dr. B. D. Gillies for his paper.\nDr. Gillies's Paper.\n(The Provincial Board of Health regrets that they have been unable to get a copy of\nDr. Gillies's paper at the time of going to press. They have, however, included in this report\nan account of the discussion on the subject-matter of \"Mentally Defective Children.\")\nDr. Margaret Pitcairn Hogg (of Victoria) : I have listened with a great' deal of pleasure\nto Dr. Gillies's paper. This subject is of particular interest to me, and I think there is a crying\nnecessity in British Columbia that some institution should be formed for these people. I was\nResident Medical Officer in such an institution near London, which supplied the needs of all\ntbe schools of the London County Council and several counties. We took these children from\nthe age of about four or five, before they reached the school age, and kept them until they were\nsixteen, segregating boys and girls in different houses. They all attended school and each child\nhad individual training. I think some provision should be made to show that they should not\nbe allowed to go into the world to swell the army of unemployable. We have 2,000 acres entirely\nrun by the boys from our schools. In British Columbia, where there is so much waste land, i:\nwould be a splendid thing for these children and adults to 'be put on a large farm and properly\ntrained, as Dr. Gillies so aptly puts it, and keep them in proper associations as far as possible.\nDr. Turnbull (South Vancouver) : I wish to speak in appreciation of the paper by Dr.\nGillies, and to say that the points as uttered in his paper express my opinion very clearly in\nalmost everyparticular. During the last year I think I have had seven cases come to me, most\nof them in families who have little of this world's goods, with some of the members of their\nfamily mentally deficient. Three of these cases could only be sent to Westminster Asylum, and\nthat is not very satisfactory. Three were children; I scarcely think that is a proper environment for them. In two cases the mothers were dead and there were no friends to take them.\nWe tried sending one to the Salvation Army for a time, but it didn't work out very well. The\nidea of a farm seems to me the proper idea. The Provincial Government, I believe, has had\nthis under consideration for some time. I myself have written them, but they said they were\nunable to see their way now to do this, but I think they intend to take some steps in the\nnear future regarding this matter.\nDr. J. H. McDermot (Vancouver) : I just wanted to speak on one phase of the subject\nthat Dr. Gillies did not bring in in his paper. We have enjoyed the paper very much, I am\nsure, and, as pointed out, there are a great many things we do not know; but there is one point\nthat I think has not been touched upon very-much, and that is the border-line cases as they\nappear in our schools.\nSome little time ago there was some question as to establishing classes for mental defectives,\nand I tried to collect some data from tbe teachers, asking for the children in their classes. There\nwere quite a number of names handed in, and I took each one of these pupils and examined them.\nWe found there were more backward children than actually mentally defective children, and the\ntrouble was due in many cases to defective tonsils and adenoids, and when these cases were\nproperly treated a great many of these pupils came back to the class and kept up in the way\nthey should be going.\nWhen these children were eliminated the number of mental defectives in our city was found\nto be too small to institute a special class for them. Of those children who are left, they are\nin some cases children of alcoholic parents and of people who should not be at large, as far as\nwe can make out; at auy rate, they should not inflict such progeny on the community, and the G 150 British Columbia 1918\nquestion is, how is this, thing to be controlled? I would like to hear from Dr. Gillies something\nalong that line.\nMr. Biker: I wonder if there is anything in the view-point of the number of children in a\nclass in school? In some cases there are forty-five or fifty pupils in a class. How is it possible\nfor a teacher to attend to that number if 20 per cent, are backward children?\nDr. Stanier (Victoria) : Victoria City has a class supposed to take care of mentally defective\nchildren, but there is no compulsion to take them out of a regular class and put them into this\nclass for instruction. No doubt the education is much better carried out along the kindergarten\nlines than along ordinary rules,, and I think it would be well to establish a farm colony. I find\nthe trouble is the parents are often mentally defective also, and you have great difficulty in\nconvincing them that their offspring are not right. It is, upsetting the class, having such children\nin it, and I think some compulsion should be brought about; it should not be optional with the\nparents whether the child be sent to school or to the class for mentally defectives, or the farm\ncolony.\nDr. Fetersky: I am very glad the last paper has taken up that point. I think it is a most\nimportant point. I think this is up to the Health Department. TTie teacher should be made to\nreport children who stay more than two terms in one class. There should be an investigation\nby a medical man to find whether the child is mentally defective or not. If the child is mentally\ndefective, it should be removed to a special school or institution where the others are in the same\nfix and the grades are standardized. In other words, it creates the environment Dr. Gillies\nspoke of. There are some boys and girls who have a tendency to be mischievous, and if put\namong thieves they become thieves. 1 think we should take this matter up; it seems to me\nthe Provincial Government are neglecting the Health Officers' Department shamefully in a way.\nYou cannot make the ordinary layman see that it is important.\nDr. F. W. Brydone-Jack: It gave me great pleasure to listen to Dr. Gillies's paper.\nPersonally, I want to see action on this sooner than on anything else that may be brought up\nhere. In Vancouver we have twenty-four children attending the mentally defective classes.\nThere are in addition about fifty in Vancouver who should be attending them. We cannot get\nenough teachers to handle them; the School Board has not seen its way to appointing a sufficient\nnumber to handle the whole feeble-minded proposition in Arancouver; but in regard to sending\nchildren to the class, the Municipal Inspector has the power of defining the school which any\nchild shall attend, and if we report to him that a certain child in a certain school is mentally\ndefective be can tell the parents that he assigns the child to this class, and the law supports\nhim. We have only given that power in a few occasions, as we haven't enough teachers to look\nafter the number we have here.\nI think the educational authorities can look after the education of the feeble-minded children\nup to the age of twelve or thirteen years. After that they become a harder problem to deal with.\nAfter girls get to that age, we from time to time have them in the Law Courts for having been\ntaken unfair advantage of by men; we had two or three cases last year, and a case the other\nday, and it is up to us to look after these children. The only way to protect them is to put them\ninto an institution such as Dr. Gillies has suggested. We can teach them manual training and\ndomestic science and make them self-supporting, but they should have constant supervision. In\nthe Old Country they find turning them loose in the world is wrong, because they do not attempt\nto remain employed and become criminals. We could keep them in a colony farm, where they\ncould be self-supporting. At the present time they are turned loose on to the community at\nsixteen or seventeen and they become troublesome, and may later become criminals. A number of.\nparents have approached me and asked if it could not be arranged to have the Government take\ncharge of their children; they know they cannot handle them, and want Government control,\nas that is the only way of looking after them properly.\nWhen in Toronto in July I had a talk with Dr. McMurchie, mentioned by Dr. Gillies,\nregarding the farm-colony control of these children, and she suggested that m British Columbia\nwe should start in a small way, say in a good-sized house having eight or ten girls under a\nsuitable matron, and then, as the fund increased, more buildings, and then have the farm-colony\nprinciple.\nMrs. Clark: Speaking for the Local Council of Women in Vancouver, this question has\nbeen of vital interest to us for some years, particularly since the beginning of tbe war, and last\nJune we had a very able paper, and a resolution went forward asking that such an institute 8 Geo. 5 Provincial Board of Health. G 151\nas mentioned be established in British Columbia, not for the Dominion, but one for our own\nProvince.\nDr. B. D. Gillies (replies to discussion) : I do not think we should leave these children or\nthrow them on the public at the age of sixteen. This is especially the time we want to have\nhold of them. They are ready then to go out and propagate and everything else, and just carry\non what we are trying to control; and it is most essential that the Government should have\npermanent control of these people. We make them self-supporting; they are self-supporting in\na proper environment, but they should be kept under control.\nThere are a lot of things that one could have touched on, but it was utterly impossible\nfor me to have prepared a paper of that character. I know it was deficient in many respects.\nI cannot deal with the method of organization of caring for these cases, but if we have a place\nwhere we can treat them, we will find out those deserving of such treatment.\nI wish to thank you for the way in which you have received the paper.\nDr. Turnbull: I would like to make a resolution\u2014that the Medical Health Officers and\nMedical Inspectors draft out and present a resolution that the Government should take steps to\nmake some arrangement along this line.\nThe resolution was seconded and carried unanimously.\nThe Chairman: I will now call upon Dr. Stanier for his paper.\nVnVCCINATION.\nBy F. T. Stanier, M.D, CM, Medical Inspector of Schools, Oak Bay, B.C.\nMr. President and Gentlemen,\u2014I believe I am called on to read a paper on that threadbare\nsubject, \" Vaccination,\" because as Inspector of Schools in Oak Bay Municipality I was fortunate\nenough to have a Board of School Trustees sufficiently enlightened to take my suggestion during\nthe recent outbreak of smallpox, and under the \" Health Act,\" section 7, subsection (11), compel\nevery pupil attending either to be vaccinated or procure a certificate of exemption before they\ncould be admitted to the school.\nThe Victoria Medical Society had previously passed a resolution that the fee should be $1.\nThe children were told to apply to their own medical men and were given three weeks. Toward\nthe end of that time I attended at the schools and vaccinated a few who had no doctor who\nbrought their dollar with them, and a few more who wished to be vaccinated but had no dollar.\nThe conscientious objectors numbered more than I expected, noticeably among the poorer and\nmore ignorant parents, many of whom were worked up by the usual extravagant letters to the\npapers by objectors who quoted horrible instances of infection; all of which occurred at remote\ntimes and places, and were past disproof, but not without influence.\nI found that the giving of certificates of successful vaccination was not being carried out,\nand not to make too much fuss I examined many who had been vaccinated and had not got\ncertificates, and in doing so I was struck with the many different ways vaccination and the\nafter-treatment of the sores is done, and this paper is a plea for uniformity in this little operation.\nOne man makes four marks, another three, and another only one. One doctor puts on a\nshield, another a great thick dressing of cotton wool, and a third neither washes the arm nor\nputs on any covering. It is immaterial whether vaccination is done on the leg or the arm (one\npretty little maid showed me her thigh\u2014\"We put it here in France,\" she said), but four, or at\nleast three marks and an after-treatment that allows them to go unbroken through the vesicular\nand pustular stage are essentials of successful vaccination.\nTo cut this paper short, I will tell you the method I employ and the reason. The subject\nis then open for discussion.\nThe child is instructed to be clean and have clean underclothes. I wash the site chosen with\nplain water and a piece of absorbent cotton and dry it with absorbent. This, of course, is no\nmore than burning a joss-stick to surgical cleanliness; but I ask you, if you took a thousand\nhealthy, clean children and pricked the three marks without vaccine, how many would become\ninfected? I next squeeze out the vaccine in three places, if the arm is fairly large, in a triangle,\ntwo above the insertion of the deltoid and one below. On a thin arm three vertically in that\nneighbourhood at least 1% inches apart. Then with a sharp-pointed needle that can be sterilized\nin a spirit lamp flame make about eight or ten very superficial stab punctures on each mark\nand lift the epidermis with each puncture. It is quite painless, much quicker than scarifying, G 152 British Columbia . 1918\nmuch surer to take, as no blood is drawn and very much less danger of immediate secondary\ninfection. There is no waiting until it dries. The clothes are pulled down and out goes tbe\npatient.\nI tell them it must he kept dry until the scab comes off. The only dressing allowable is a\npiece of soft linen sewn inside the sleeve of the undershirt. Almost any dressing more than this\nwill cause the pustule to sweat, soften, and' break down into an open ulcer, with liability to\nsecondary infection; and, worst of all, the protective serum that is grown under that hard scab\nwith the intention that it should be absorbed into the system in sufficient quantity to give\nprotection (for that reason at least three marks) is discharged in the dressing, and though the\nscars remain to show vaccination, that patient has very little more protection against smallpox\nthan the unvaccinated, and if an epidemic occurs goes to swell the statistics against the value\nof vaccination.\nThe method described has been used for some time in the military camps in Toronto with\na more elaborate antiseptic preparation of the arm. I have no doubt many of you have tried\nit and can endorse my claim that it is easy, quick, sure, and painless; and if no dressing is\npermitted, the scabs allowed to harden, and the serum formed in the vesicles to be absorDed,\nthe protection afforded will-be much greater than obtains with the present haphazard methods.\nThis little operation and its results are seen by the public from start to finish, and when\nyou are asked, \" Why does Dr. S. only make one mark and put a thick dressing on it?\" it is not\ngoing to add to the professional amenities or the public confidence to explain your theory. For\nthat reason, if this meeting sees fit to endorse this, or any better, method of vaccination, I should\nlike to move that a memorandum of some uniform procedure be seut to the medical societies for\ndiscussion and adoption.\nDiscussion on De. Stanier's Paper.\nDr. A. G. Price (Victoria) : In opening the discussion on this vast subject, I feel like one\nplunging into the ocean, rough on the surface and filled with submarines underneath, because it\nhas been a subject which for years has been under discussion by the general public\u2014the subject\nof vaccination. But I do not need to plunge into the ocean. I have to thank Dr. Stanier for\nthrowing out two lines\u2014as I am in the sea\u2014to rescue me from getting into the deep. These\nare, first, the law in relation to compulsory vaccination; second, the methods of procedure in\nvaccination; and I will try to connect these two.\nThe section referred to is section 7, subsection (11) ; that section states that all children\nattending public schools shall be vaccinated or shall give a certificate of exemption. This law,\nunfortunately, is not enforced. Why is it not enforced? Because of the second part, as to\ngiving a certificate of exemption under the conscience clause, where the parent of a child may\ncome and say that he objects to vaccination under conscientious scruples. A man told me: \" I\ndon't care a rap about my oath, but I am not going to have something injected into my child.\"\nNow, that man was both ignorant and immoral\u2014immoral because he did not care about his oath,\nand ignorant because he did not take pains to find out just what it meant. About 80 per cent, of\nthe parents are anti-vaccinationists. It is either a case of ignorance or prejudice because they\nare proud. They are ignorant in that they have not given any time to study the matter and\nhave heard the tittle-tattle of other people, and are carried away with the rubbish you see\nissued by the anti-vaccinationists. They judge the case before they bear it. They have made\nup their minds that so-and-so didn't get smallpox and were not vaccinated, and what is the\nuse? They are prejudiced and they are proud. Some people say: \"We are Britons. We do\nnot submit to our liberty being taken.\" The word \" compulsion \" is much against the feelings of\na Briton. But in a case of this kind, if they can only be educated in this matter and can\nunderstand more about the uses and the protective properties, they would waive their idea of\nlost liberty and have their children vaccinated. With the conscience class that is in the Act\nwe will never be able to compel children to be vaccinated. The law should be passed that\nthey should be vaccinated or produce a certificate from the parents.\nWe now come to the method which Dr. Stanier mentions. I, am afraid it is due to wrong\nmethods that a great many anti-vaccinationists have some ground to stand on. I am afraid\nthere are a host of medical men\u2014I do not say so in this country, but I am speaking now of\nmy own country, Ireland\u2014I remember when we started vaccination as students a good many\nyears ago, we were shown into a large room in the vaccination institution of the City of 8 Geo. 5 Provincial Board of Health. G 153\nDublin, and we would have perhaps fifty children down one side of the room and an equivalent\nnumber on the other. One lot of children had been vaccinated the week before; the others\nwere the \"new children to be vaccinated. As you probably know, Dublin is a very poor city,\nand the mothers would come out the same as though they were going to church to have their\nchildren vaccinated; they would put on their best clothes or borrowed clothes, and no idea\nof asepsis at all. All stood there together\u2014children brought from anywhere. It is hardly an\nexaggeration to say that in some cases we had to look for their arms under the dirt. I am\nafraid in these cases it would not be simply a scratch on the arm without having some washing\nor some antiseptic used first, but the worst of the performance was we would take the serum\nfrom one arm, with no question as to health, and walk across the room and stick it into the\narm of a child on the other side. They would come back in a week's time, some with bad\narms, but we did not see them after a fortnight's time. This is an extremely bad method, and\nthe anti-vaccinationists had some grounds to stand on, because they would say: \" We are\ninoculated with impure vaccine and the children have bad arms.\" That is quite true, and the\nmothers were not told how to treat the arms. .\nIn order to safeguard ourselves, I think we should be very very particular about the\nasepsis of the arm. We should be particular also in telling the parent how to treat them\nafterward. First of all, if you do not tell the parent how to treat it, and if you do not cover\nit with something, they will look upon it as a mere scratch and continually look at it, finger it\nwith dirty fingers, and you have trouble before the week is up.\nAs far as antiseptics go, I never used antiseptics that will remain on the skin, but I always\nswab the section with ether or alcohol. That completely evaporates and leaves no antiseptic\nbehind which may destroy the activity of the vaccine virus; but it is better to always use\nthorough washing before scratching the skin.\nThen, as to the number of marks you put on, I think there, again, circumstances alter the\ncases. Efficient vaccination I think requires three marks, but you might come across a very\nsmall child, with an arm so small that there is not room for three marks on the arm, unless\nthey are all in a line, and they would ta.ke up the whole length from the elbow to the shoulder\n\u2014very emaciated arms. I think, in a case like that, efficient vaccination with one or two marks\nwill continue for a year or two or three years, and after that they should be revaccinated when\ncoining to school age. If you can put on three, that is the English number\u2014four are required\nnow\u2014all the better; but I do not think it is wise to make four marks on a child whose arm is\nso small.\nAs to the putting-on of cotton-wool, I always scorch a piece of cotton-wool, hold it to the\nbre until is charred, and put it on with three pieces of sticking-plaster. I do not,put it on thick.\nSticking-plaster must not encircle the arm; but this impresses the mother that a surgical\noperation has been performed, and also keeps it clean; it also protects it from being scratched\nor knocked in any way while the child is about. You also tell the mother not to look at that\nmark under three or four days. You also tell her under no circumstances to get it wet, for if\nit is wet the wool, of course, turns to a poultice and softens the skin, and you have a much\nworse arm. The heating of the wool can be obviated by not getting too much wool on and\ntelling the mother not to put heavy clothes on the child.\nIf there could be some uniform method of conducting the little operation it would be a very\nadvisable thing, because I am afraid there is a great deal of diversity in methods and other\nneglect, sometimes for the asepsis, and we have inflamed arms, and the parents object very\nmuch to vaccination, and they have a foundation to stand upon in that case, so that it helps\nto swell the crowd of anti-vaccinationists.\nDr. Brydone-Jack: In our public schools not more than 10 per cent, have been vaccinated,\nand I think it is getting worse every year. If smallpox should come along we would have a\nbad time, the same as they did in Montreal, where they had many deaths when smallpox came\nupon them. I think it would be well to make them produce a certificate of successful vaccination\nor produce a certificate from a Magistrate under the protection clause.\nDr. Large (Port Simpson) : We have to consider that a great many people say of the\nefficacy of vaccination as they say of the efficacy of many other things, \" Well, we have been\nfree from epidemics in the past and do not think we will have them now.\" I have been here\nfor about twenty years in the medical profession and have vaccinated quite a number, but I\nbave vet to treat a case of smallpox. While we referred to the Montreal epidemic, there were G 154 British Columbia 1918\ntwo things to be considered\u2014lack of vaccination and proper precaution to isolate these cases.\nA great many people firmly believe in vaccination, but say there is so little risk of smallpox\nspreading under the stringent regulations at present that conditions have altered, and when it\ncomes to a question of putting three or four scars on the arm, they object very strongly to that,\nunder the present conditions.\nDr. Isabel Arthur: I think the only way is to have an epidemic and every one will be\nvaccinated. In our town a few years ago we had an exndemie of chicken-pox, so it was reported,\nand at last some one conceived the idea of smallpox. Children were in the schools\u2014I found it\neverywhere\u2014they were not ill; but some symptoms appeared like smallpox in several cases\u2014\nmany did not. In the whole course of the epidemic there was no case in which there was\nsecondary fever, aud there were no deaths. I vaccinated many children who had certificates\nof conscientious scruples against it, and I would rather in that case have had the disease than\ntbe vaccination and its attendant results. If that is smallpox it is changed materially, and we\nought to destroy all the information we have in the text-books on smallpox, because that wasn't\nlike anything I had heard of.\nDr. Petersky: I didn't intend speaking on this paper at all, but a few remarks of Dr.\nLarge brought me to my feet. Every one of us who believes in vaccination is, I take it,\nvaccinated. Personally, as a Medical Health Officer, I believe in the various health laws I am\ncalled upon to perform. I believe in the theory of vaccination; if I did not, I would not attempt\nto carry out the Vaccination nlct. I believe in it so thoroughly that I have a feeling, if I heard\nof any smallpox around in the community in which I am living, I would immediately be\nvaccinated myself, as it gives me a feeling of tranquillity, and these little scars are nothing;\nyou might fall down and cut yourself aud have a scar for life, and look what the other scars\ndo. Any medical man who has followed the theories of bacteria and vaccination in general\ncannot help but believe in the theory of immunity. I think this conscientious objection should\nbe entirely eliminated from the Act.\nThe Chairman: I would like to give you a warning. We are going to have an epidemic\nof smallpox with 30 to 40 per cent, of deaths some day. I was brought up amongst smallpox.\nWe have had nine officially reported cases of Asiatic smallpox with three deaths this year in\nthe City of Vancouver; some of the patients said they bad been vaccinated, but they had no\nscars or marks. The disease was brought in on a boat from the Orient. This is not the first\ntime we have had this form of smallpox in Vancouver. Where you have an organized .Health\nDepartment you have some opportunity of dealing effectively with this or any other disease,\nbut where the Health Department is small and inefficient it is not so easy.\nSome time we will have smallpox in this country if the people are not protected by\nvaccination. We tried several years ago to carry out the Vaccination Act in this city, but owing\nto the furor created by the anti-vaccinationists, and thanks to the conscience clause, the attempt\ncame to nothing. To prove that the Act was worthless, I opened vaccination stations in ten\npublic schools and only 200 children were vaccinated. I do believe, however, that if the\nprovisions of the conscience clause were enforced and a statement properly sworn before a\nNotary required of the objectors, we should find very few conscientious objectors. Probably the\nreal objection to vaccination is that the parents do not like the trouble involved by the sore\narms consequent to the operation. I have never seen any of these certificates; the parents\nusually send word to the school that they object. I want to see the certificate required by the\nconscience clause insisted upon, and then we shall see almost universal vaccination.\nDr. Stanier (replies to discussion) : I thank you for supporting me in my opinion regarding\nsmallpox. I have not seen any, but I have only to read statistics of former epidemics. Sometimes you have a mild chicken-pox epidemic that doesn't mean much, but I am thoroughly\nconvinced if smallpox gets loose in unvaccinated communities you will have a serious state of\naffairs.\nReads clause 15 of the Vaccination Act as follows: \" It is now deemed necessary, and is\nhereby ordered, that teachers in public schools and high schools or colleges shall require a\ncertificate of successful vaccination from each child attending at such school or college, or a\ncertificate that such child is at that present time insusceptible to vaccination. The certificates\nshall be presented on demand to the teacher or other proper authority.\"\nIn enforcing that Act. or that clause, the school trustees or municipal authorities have\ndiscussed it, and in some places they have been ignorant and thrown it down, but in Oak Bay they 8 Geo. 5 Provincial Board of Health. G 155\nhad their own children vaccinated and brought that clause in. I do not know that we are so\nsuccessful as we might have been.\nDr. Price, I think, has missed my point of view\u2014he wants to leave it optional. I maintain,\nwithout three marks, you will not have sufficient serum generated. If you can get it in one\nmark, it has to be the size of a 50-cent piece, aud then you have a great, big, ugly scar. I have\nnot seen an arm so small that you could not put three marks on, 1% inches apart. That makes\nan arm about 4 inches long from the upper to the lower part. I am firmly convinced that at\nleast three marks are necessary to manufacture that quantity of serum.\nThese children I vaccinated were clean and not slum children. There is no objection to\nusing an ordinary antiseptic to clean off the arm, but the point I wanted to make was that this\nmethod of vaccination, which just lifts the epidermis with the point of a needle, was quite\neffective, and while it might take a little longer to take, it has been found rapid and efficient\nby the military authorities in Toronto, and it is painless. The children do not mind this form\nof vaccination, as they do not realize about the af tertake.\nI do not know that there is any other point worth mentioning. I think I have answered all\nthe questions that were asked.\nThe Chairman: That brings us to the conclusion of our morning session. We meet again\nat 2.30 this afternoon. I have taken up the question of a committee on resolutions. You will\nremember we had one four years ago to draft out various resolutions that were suggested, and\nDr. Young has asked that the following constitute such committee: Dr. Large, of Port Simpson;\nMr. Biker, of Nelson ; and Dr. Stanier, of Victoria.\nThe meeting then adjourned at 12.30 till 2.30 p.m.\nAfternoon Session.\nThe Convention resumed at 2.30 p.m., Dr. AVrinch presiding.\nThe Chairman: I shall have to ask your kind assistance in helping me to obtain order in\nthis very large -assembly. I know you will kindly overlook any irregularities or such matters\nas might be expected in one who has been so long out of civilization as I have, and give me your\nkindest assistance in carrying on the meeting.\nI will now call upon Dr. Underbill\u2014I do not suppose he would like me to call him the father\nof the health of the Province, but one of the senior health-men of the Province\u2014who is to give\nus a paper on the \" Control of Infectious Diseases.\"\nCONTROL OF INFECTIOUS DISEASES.\nBy F. T. Underhill, F.R.C.S, M.R.S.I, D.P.H, Medical Health Officer, Vancouver, B.C.\nMr. Chairman, Ladies and Gentlemen,\u2014The subject upon which I have been asked to address\nyou\u2014namely, the \" Control of Infectious Diseases \"\u2014is one which opens up a vast field of thought\nin which there are many diverse views and much room for controversy and speculation. It is\nnot, however, my intention to approach this subject from the academic point of view, but rather\nas a Medical Health Officer who has to deal with it from the mere sordid and practical standpoint.\nI may, perhaps, be pardoned if I cite the difficulties of my own city by way of illustration.\nIn the first place, there is the question of cases of an infectious nature in transients. These are\nalways an unknown quantity, and as they are usually to be found in hotels and rooming-houses,\ntheir opportunities for spreading infection are greatly increased. Three or four years ago, when\nimmigration was at its height, this problem was not by any means an easy one to handle, and\nfrequently the accommodation at the Vancouver General Hospital was taxed to its limit. As\nmany of these cases developed a day or so after arrival in the city, it suggests that the patient\u2014\nif an immigrant\u2014must have had the particular disease in its early stages at tbe time of his\nexamination by the Quarantine Officer prior to bis entry into Canada, and I am of the opinion\nthat the medical inspection of immigrants at the port of entry should be much more rigid and\nthorough.\nI feel very strongly that this inspection should be carried out during the voyage\u2014not by\nthe physician employed by the transportation company, but by a Dominion Medical Inspector\u2014\nand that special attention should be paid to tuberculosis, mental deficiency, and specific diseases.\nThis is especially true with regard to tuberculosis, and it is brought home to us forcibly when\nwe are compelled to provide for persons who have been in the country possibly only a few months. G 156 British Columbia 1918\nIn preparing some data for Dr. Peter Bryce, who is giving a paper in Ottawa at tbe annual\nmeeting of the Canadian Public Health Association, I found that of 468 cases of tuberculosis\nreported to my department during the years 1914 and 1915, forty-nine were immigrants, none of\nwhom had been in Canada more than two years and many only a few months. Under the\nquarantine regulations these persons should have been returned to the country from whence they\ncame, but owing partly to the war and partly to the fact that there is no properly organized\nsystem for handling these cases, nothing was done and they were allowed to remain\u2014a menace\nto our citizens and many of them becoming a charge on the community.\nWhen the war is over this question of immigration will become a live one again, and it is\ntime for us to prepare for it, making our laws more stringent and by enforcing those we already\nhave, and not wait until we are compelled by pressure of circumstances to take action. We do\nnot want disease-ridden people from other countries, for it is unfortunately true that we have\nmore than sufficient of our own.\nIt seems to me that, looking at the question from a national standpoint, the foregoing is the\nfirst essential in the control of infectious diseases, and granting it would be possible by these\nmeans to prevent the entry of disease into the country, the question would then become one of\neradication rather than control. In this no real progress can be made until the problem is\napproached in a much broader manner. At the present time every city and municipality makes\nits own by-laws, and either does or does not enforce them, as the case may be. Of what avail\nis it to have effective control of diseases in any city when they are allowed to rage unchecked\non its very borders?\nI feel very strongly that the only proper way to handle this problem, and indeed all public-\nhealth problems, is by centralizing tbe authority governing the question. I am of tbe opinion\nthat there should be a Federal Minister, or Deputy Minister of Public Health, in order to properly\ngovern immigration and inter-provincial relations. Each Province should also have a Minister,\nand public-health matters should be placed on a firmer basis and given the consideration which\ntheir importance warrants\u2014free from politics and undue municipal influence. I have only\ntouched very briefly upon this phase of the question, but would like very much to have it\ndiscussed freely.\nHaving now given you my main idea regarding the broad principles of the control of infectious diseases, we come to the method to be adopted in the particular city of municipality, and\nagain I must crave your indulgence if I describe to you the procedure in vogue in my own\ndepartment. In the first place, there must be ready and willing co-operation between the medical\nmen and the Health Department, and I am glad to be able to relate that this very gratifying\ncondition obtains in Vancouver. The doctors show a commendable readiness to notify the\nFumigation Officer directly their diagnosis is made in the more serious diseases\u2014and in the\nminor ones also\u2014when they are found out. Iii addition to the doctor, the parents and the\nschools are required to notify my department of any cases of which they may have knowledge,\nso that while we may get three notices of tbe same case, we are almost sure to get one.\nIn almost every case of scarlet fever, diphtheria, and smallpox, the patient is removed to\nthe hospital for treatment, and the bouse is placed under temporary quarantine and fumigated,\ntbe suspects or contacts being kept under observation until the Incubation period of the particular disease has'elapsed. When the patient remains at home the house is placarded with\nthe name of the disease, and strict quarantine maintained until recovery, when thorough fumigation with formaldehyde is carried out and the clothing and bedding is disinfected by means of\na steam sterilization.\nNo quarantine is imposed in the minor diseases, such as measles, whooping-cough, chicken-\npox, etc, but children suffering from any such disease or living in a house where disease is\npresent are rigidly excluded from school until all danger of imparting infection is passed, when\na certificate is issued from my department permitting the principal of the school to readmit them.\nConsiderable attention is paid to the disinfection of school-rooms. The procedure I have\nadopted is the burning of all loose papers, etc, the washing of desks with some antiseptic\nsolution, and the liberation of formaldehyde gas. There is, of course, considerable controversy\nas to the efficacy of this latter precaution. I am not prepared to go into tbe pros and cons of\nthe matter from a prophylactic point of view, but we must remember that we are dealing with\nthe public, who are never satisfied unless they can smell a disinfectant, and it is our duty to 8 Geo. 5 Provincial Board of Health. G 157\nsatisfy them that every reasonable precaution has been taken. Personally. I am of the opinion\nthat the essential details in all fumigation are plenty of soap and hot water and elbow-grease,\nthe burning of all papers, rags, etc, and tbe use of limewash. This is the method upon which\nwe place the most reliance.\nTo return for a moment to the subject of placarding houses: About two years ago the\nProvincial Board of Health instituted a system of placarding houses for the minor diseases, the\nplacard bearing the name of the disease and warning all persons to keep away. I found that\nthe effect of this was not what was intended, for people objected to having their houses labelled\nfor measles or mhmps, and the result was that the cases were not reported.\nA great step forward in handling infectious diseases has just .been effected by the setting-\naside of observation wards at the Vancouver General Hospital. There is a large number of\npeople in Vancouver living in hotels and rooming-houses, and a great influx on boats and trains,\nand frequently a case of sickness occurs amongst these people in which it is impossible to make\na definite diagnosis offhand. This difficulty has had to be met in the past either by using private\nwards or by placing a whole ward under quarantine, which for obvious reasons was inconvenient\nand undesirable. To overcome this difficulty a number of small cubicles have been erected at\ntbe hospital in which doubtful cases may be segregated for observation until a diagnosis can be\nmade, when they are removed to their proper ward and the cubicle disinfected.\nWith regard to diphtheria, we have now got the situation well in hand, and there is no valid\nreason why there should be a single death from the disease, provided the doctor is called in time.\nFree antitoxin is supplied by the city without any restriction whatever. The attending physician\nmay, by giving a receipt to the City Druggist, obtain all he requires, and usually gives an\ninjection as a precautionary measure, however doubtful the case, while awaiting the result of\nthe bacteriological examination of the swab. Sterile swabs are also provided free of charge,\nand all the doctor has to do is to send the swab to the laboratory at the Vancouver General\nHospital, where it is examined free. Everything is made as easy as possible, and the result is\nto be noticed in the very gratifying reduction in the number of cases and the percentage of\ndeaths.\nThe Vancouver General Hospital has now established as a routine measure the taking of\nswabs from all children admitted, for whatever cause, and by this means eleven carriers of\ndiphtheria were discovered during 1916. ivltogether twenty carriers were found in the city\nduring that year, and isolated until recovery\u2014none of them showing the usual clinical symptoms\nof the disease.\nI regret that we have not been as successful in the handling of measles and whooping-cough\nas with diphtheria. It is an unfortunate fact that few parents realize the seriousness of these\ndiseases and their complications in young children. During the year 1916 there were thirty-\nseven deaths from broncho-pneumonia amongst children under the age of one year in Vancouver,\nand there is little doubt that many of them were the result of insufficient care during measles\nor whooping-cough. These two diseases, which are so lightly regarded among the laity, are\nresponsible for SO per cent, of the deaths from acute infectious diseases in this city, and yet\npeople wilfully and criminally expose their babies to measles, though possibly not whooping-\ncough, in order to save themselves a little trouble later on.\nTyphoid fever, of course, depends very largely upon the water-supply and sanitary arrangements in vogue in the particular community. In Vancouver we have a water-supply which is\nthe equal of if not superior to that of any other city in the world, and since 1910, when the\nproblem of sewering the entire city was undertaken in a systematic manner, the number of\ncases of typhoid has shown a steady reduction year by year. In 1910 there were 265 cases\nreported and twenty-seven deaths; in 1916 there were thirty cases reported and three deaths,\nand as all but six of these were traced to outside sources, it may be said the typhoid-fever is\nnon-existent in this city; and it may be safe to deduce that this happy state of affairs is due\nto the vast improvement effected in general sanitary conditions.\nOn the subject of tuberculosis I hope to say a few words at the conclusion of Dr. Vrooman's\npaper. The eradication of this disease is one of the greatest tasks that has yet been faced by\npublic-health authorities, and it is one which is becoming more and more important every year.\nIn Vancouver\/ in 1914 the death-rate from this disease was 1.1 per 1,000 of population; in 1915\nit was 1.35; while in 1916 it rose to 1.57, an increase of over 50 per cent, in three years. .Something must be done soon. More drastic legislation, if necessary, must be passed by the Govern- G 158 British Columbia 1918\nment. We must be prepared to spend money, and in addition there must be a greater awakening\non the part of the public to the dangers of the situation.\nI have not touched on poliomyelitis, as that is the subject of a separate paper by Dr. Carder,\nwho has had exceptional opportunities for studying the disease; neither have I dealt with\nvenereal diseases, deeming that it would not properly come within the scope of a paper of this\nnature, being too large and important a matter to be dismissed with a few sentences.\nIn conclusion, I have tried to bring forward in a concise manner the salient points in the\ncontrol of infectious diseases, not so much as one who speaks with authority, but rather in the\nhope that my remarks may induce some helpful discussion, for I am of the opinion that the\nresultant good would be far more lasting and beneficial to all than the reading of a purely\nacademic paper, however learned or profound; and I venture to say that all of us who hold\npublic office are glad of an opportunity to have a good grumble at things as they are and air\nour views as to bow they should be.\nThere are times when the problems which confront a Medical Health Officer loom strangely\nlarge, and he feels that be is standing alone and is frequently unable to get the support even of\nbis committee, which he feels he has a right to, and an occasion like this is an opportunity not\nto be missed.\nThere are many other matters of great importance in connection with public-health work\nthat I would be glad to speak upon, but as they do not come within the scope of this paper I\nwill bring my remarks to a. close.\nDiscussion on Dr. Underhill's Paper.\nDr. A. G. Price (Victoria) : Coming from the smaller city, the Capital City on the Island,\nI take the liberty of opening this discussion ou infectious diseases, following the paper by my\nfriend Dr. Underbill. I would like to have heard Dr. Underbill for another half-hour, because\nhe has had vast experience in Vancouver in the suppression of epidemic diseases. I am only a\nshort time iii office in Victoria, but I happen to have come in at a time when there was a severe\nepidemic of measles, which took all of my exertions to suppress\u2014I leave it to you with what\nsuccess.\nDr. Underbill mentioned they did not quarantine for measles or chicken-pox. Well, in\ncases of very prevalent epidemic, I thought it better to step in and quarantine, as measles is\nnot a case you can treat in isolation hospitals when it comes to 2,000 or 3,000 cases such as we\nhad in Victoria, and we have to have it attended to, of course, in the houses.\nI have had some experience in England in an epidemic of measles. One municipality would\nhave them quarantined and another would not. Where they were quarantined there were no\ndeaths, and where they did not quarantine there were six deaths. I found that where they were\nnot quarantined the mothers allowed their children to, go out on the street at the end of one\nweek or so, and the result was bronchial pneumonia. We keep them in sixteen days in Victoria\nfrom the commencement of the rash. The result was that out of about 2,500 cases we went\nthrough almost without a death until at the very end two very small children under one year of\nage died of pneumonia. The weather was very severe at the time, and I put down the non-fatality\n\u25a0of the epidemic to the harshness of our quarantine, because we kept the children in and the\nInspectors went down to see that the parents complied with the order.\nWhile the disease is a minor one, the sequel is severe in the case of chicken-pox. I think\nit ought to be notified, because there is such a danger among parents of mistaking a case of\nsmallpox for chicken-pox. I tell you a case in point. We had a case of smallpox last March\nin Victoria. The lady who developed it was at a hotel in Victoria. We traced it from Tacoma\nwithin the period of incubation; we communicated with Tacoma and found a great deal of\n\u25a0chicken-pox prevalent, but no smallpox. I have since seen the Health Officer in Tacoma, and\nfound that there was a considerable amount of smallpox there since then. Were some of these\n-cases smallpox? A very mild case of smallpox may be mistaken for chickenpox, and for that\nreason I would advocate that it be notified.\nThere was a case only a month ago in Victoria. I watched the patient in the Isolation\nHospital and it turned out to be chicken-pox. Then I had the history of that. We had the\ncase stopped in the Quarantine Station, but they allowed, against my protest, seventy-five steerage\npassengers to land at Victoria off that boat. I did all I could to prevent it, but it was left in the\nhands of the Dominion authorities. This happened to be a very severe case of chicken-pox; but\nI think measles and chicken-pox should be notifiable. 8 Geo. 5 Provincial Board of Health. G 159\nI was glad to hear Dr. Underhill mention diphtheria as being a disease of less severity than\nit used to be. I remember a friend of mine lost three children in one week from this disease.\nWe have bad a good many cases of diphtheria this year in Victoria, but no deaths in the hospital,\nwith the exception of one Chinese who was found in Chinese quarters in an advanced stage and\nwho died a few minutes after being brought to tbe hospital.\nIn that case we always take the house and quarantine and thoroughly disinfect it; have\nthe walls whitewashed or limewashed down to prevent the spread. I am glad to say now we\nhave no infectious diseases of any kind in Victoria. Of course, we have some cases of tuberculosis, but no acute infectious diseases at present; and I hope and trust, to come back to the\nvaccination question, that we will have vaccination and will not have this terrible epidemic of\nsmallpox which, according to Dr. Underhill, we are in danger of having.\nDr. Vrooman (Tranquille Sanatorium) : I think Dr. Underbill's paper calls for congratulation to him on the report he gives on the health situation in the City of Vancouver, and the fact\nthat such a disease as typhoid has been reduced to a minimum, and other diseases to such a\nsmall number that they can be controlled so well. There are one or two points that I would like\nto touch upon in Dr. Underbill's paper.\nDr. Underhill stated that about 10 per cent, of the arrivals in Canada were sufferers from\ntuberculosis. My own figures show a little higher proportion. I find 10 per cent, of the\nadmissions to the sanatorium are people who have been in Canada one year or less; 15 or 18\nper cent, two years or less. These people bad come to Canada for their health, most of them\ngiving a history of tuberculosis in England or the Old Country. The only way that can be\ncontrolled is by following out a scheme such as Dr. Underhill outlined that these immigrants\nshould be examined on shipboard or before leaving England.\nDr. Montezambert several years ago advocated that immigrants to this country should be\nexamined before leaving the Old Country by appointees of the Immigration Department to see\nthat they are not suffering from chronic infectious diseases, such as tuberculosis in particular.\nAfter the war there will be an influx of people to take care of, and practically all such cases\nwill come to British Columbia because of the climate.\nAnother important point has reference to notification of tuberculosis. It is not notified.\nThe reason for that is partly apathy on the part of the medical profession and sympathy for\ntbe patients. Dr. Underhill will agree with me that he is notified about a number of deaths in\nVancouver in a year. I notify him of any patients arriving, any advanced cases at the sanatorium, but there are many cases not notified by any medical practitioner. That applies also to\nVictoria. This point should be considered and provision should be made to notify open cases of\ntuberculosis. From a health point of view it is the open cases we are concerned in\u2014not from a\ntreatment point of view, but from a health point of view. It is quite true we have not adequate\naccommodation to look after them, but you cannot even keep track of them unless you know,\nand I have followed the history of some of these cases and learned how they moved around\nunknown to the Health Department, and it should be strongly emphasized that to control\ntuberculosis it must be notified to the Health Officer, because the medical profession in this\nregard are careless.\nMr. Biker: I am very much interested in this question. I have been in a great measure\nin touch with the medical faculty in England and they have a great idea of the climate of\nBritish Columbia. The medical men in England are exploiting it against us, and if the percentage\nis 10 per cent, of the cases that arise we are just treating that number here at our own expense.\nAnother point struck me; that is in regard to smallpox and chicken-pox. It is a matter of\nopinion regarding whether it is smallpox or chicken-pox. The Medical Health Officer of the\ndistrict should be supported and not ridiculed. The patient should be protected, but we have to\nprotect the public health, and to this end the Health Officer should be supported.\nDr. Hepworth: There is one point I was interested in\u2014that is, if one child in a family\ntakes measles, should the rest of the family, or the children who have already bad measles, be\nkept at home? Supposing there is a family of six children, five have had measles, and one has\nthem, are we to keep the rest out of school?\nI have had a fair amount of experience in these epidemics, and I find the disease spreads\nbefore they know they have got it. Measles will spread before the rash is developed. I have\ntaken the stand that if there are four or five children, three of whom have had it and two\nhave not, I have kept at home those who have not had it and allowed the others to go to G 160 British Columbia 1918\nschool. Am I right or wrong? There is one thing about measles; I don't pay much attention\nto them; they are not reported, anyway.\nAbout tuberculosis: I want to hear Dr. Vrooman's paper to-morrow. I have had dozens\nof people who do not feel well, and if I take their temperature and find it 99% for three days,\nthat is all I want. If he has closed tuberculosis you let him out, but it may open up in a week\nafter he gets into the country. You have to watch four or five days; no doctor living can make\na diagnosis of closed tuberculosis in one day. I had a case the other day where one fellow said\nhe could hear something and another did not; we found enlarged glands. He has tuberculosis\nthat may open up at any time. This tuberculosis is rather a big question, I think. We had two\ncases of tubercular meningitis this spring; they died; and we had three or four other cases of\ntuberculosis. The trouble is most patients will not allow you to do what you want to do. If\nyou want to take their temperature every three or four hours for three days, they say \" No \" ;\nand if you do not diagnose the case right away they go to some one else.\nThen there is the question of infectious diarrhoea. I did not hear tbe question brought up,\nbut I would like to give a slight history of it. I have been eight years in Steveston as Health\nOfficer, and I think I lost five cases of whatever you like to call it; I call it acute intestinal\ninfection. This year three deaths; sick in the morning and dead at night\u2014lasted about six\nhours, or perhaps a little longer. There ought to be some method of dealing with this. Who\nis going to control it? Suppose your municipality will not help you, who is going to do it?\nI can get no help where I have been. This is the first year they have not cleaned out a ditch,\nand there were three deaths from this disease, and only three deaths in eight years before.\nA. boy took sick one morning in one house, and I was sent for at 9 o'clock at night and he\ndied at 11. Another boy in the same house got sick and lived. A baby got sick with it a\nshort distance away; two others got sick and one died; two others got sick and got well.\nHow are you going to control it? It seems to me a pretty hard thing to control and there\nought to be some method of doing it. To me it has been one of the worst bugbears I have had.\nDr. Petersky: Dr. Hepworth has brought up a certain question that I have had in mind,\nbut didn't know where I was going to get it in, and I think it comes under infectious diseases;\nthat is the difficulty of carrying out the control of infectious diseases in the country. You who\nare in the city have the people trained and the teachers trained, but it is different in the country.\nYou go in there and attempt to interfere with what they have been doing for forty years. The\nHealth Officers are unfortunately dependent on the police of the Attorney-General's Department,\nwho act as sanitary officials. If the doctors cannot do anything the police never do anything.\nThey seldom do anything, even if the doctor wants them to. Now, the district I am in at present,\nthe police officials are paid $75 a month, and it is usually given to a returned soldier. If he finds\nout he can get $150 as a brakesman he resigns, and we don't try to check them up much for fear\nthey will resign.\nI think measles should be quarantined. I think anything should be quarantined that is\ninfectious, and if it were in my power even scabies would be quarantined. The last place I was\nin I got the people trained, but in this place there is no training done yet. I think the cities\nare very fortunate; they have Health Inspectors of their own; and all they have to do is tell\nthe Inspector and he can call a man up. If I do that, why I am in quite a practice there. I\nthink the Health Officer should be a civil servant, independent of any private income. I think\nthat is a weak point in this Province. He should be given a living wage so that he would not\nhave to practise, and be could look after a larger territory and things could be done properly.\nWhen I left the last place I was in I registered a solemn vow that I would never be a Health\nOfficer again. Unfortunately, or fortunately\u2014I don't know which\u2014Dr. Young prevailed upon\nme to take it again, and now I suppose I will get into a jackpot; but I agree with Dr. Hepworth\nthat in these country places where the people do not back you up it is pretty difficult. I think\nit is an educational campaign in sanitation as well. People are more concerned with commercial\nlife, and we have to depend on the commercial part of it, and that is where the whole trouble lies.\nThe Chairman: The discussion is taking a little bit of a side-track; will you kindly, as\nfar as possible, keep the discussion to the lines of the papers?\nDr. Hepworth : I want to make one point: Our police officials are ex-offlcio Sanitary\nInspectors ; they are more interested in collecting a road-tax or a poll-tax to make their department pay. I think the Health Department and the Police Department should be segregated, 8 Geo. 5 Provincial Boarb of Health. G 101\nbecause they will not see a dead cow in a ditch 5 yards away, but they can see anything half\na mile away if they are going to collect a fine. I cannot get any sanitary work done in my\ndepartment.\nDr. Young: No doubt in the matter of infectious diseases the Medical Plealth Officers have\nbeen handicapped from the fact that there is no adequate machinery in the different municipalities in the Province. We have endeavoured to overcome this as far as possible. The millennium\nmay come some day, and we will then have in each district a Medical Health Officer enjoying\na generous salary ; but with tbe population of 400,000, which is a very large estimate, spread\nover 400,000 square miles, the Government cannot be expected to reach as yet the millennium in\nmedical-health matters. We are doing the best we can, and regarding Dr. Petersky's complaint\nand Dr. Iiepworth's complaint about the police, they have a very large territory to cover; but\n1 have made arrangements this year with the Attorney-General's Department for a very definite\nco-operation in health matters by the Provincial constables. The sanitary regulations have been\nconsolidated and printed, and copies are being furnished to the Provincial -police, who are\nrequested to act as sauitary officers and take an active part in the work, and not force the\nMedical Health Officer to be prosecutor as well as Medical Officer. Forms will be provided\nfor them to fill out, and the policemen can make reports to the Provincial Board of Health Office\nin Victoria, and we can have co-operation through the headquarters of the Health Department\nwith the Medical Health Officers. We hope to relieve the resident Medical Health Officer of\nthe onus and responsibility attached to a man in private practice where the duty conflicts with\nhis personal interests.\nThe Chairman: I am glad that relief is going to be afforded; we will be glad to hate\nfurther discussion along the lines of the paper on the control of infectious diseases.\nDr. Isabel Arthur: There is one question i would like to ask. In our neighbourhood there\nis a sanatorium and these patients come into Nelson from time to time and sleep in the hotels,\nand there are a great many complaints about this. I would like to know whether this is tbe\nright thing for them to do.\nWith regard to the other infectious diseases, such as measles, mumps, chicken-pox, and\nwhooping-cough, I think only the patient should be quarantined. It is too hard to quarantine\nthe whole family for these diseases, and it is not necessary, and the Provincial Board of Health\nhas sent out notices that children from these families may be allowed to go to school.\nIn many of these diseases we have used moving-picture slides, asking the people from the\nscreen that children with these diseases should not be allowed in these shows, and this has been\nfound very efficient.\nDr. McEwen (Medical Health Officer, New Westminster) : With regard to the question of\ntuberculosis, where a death has been reported to the Health Department, what precautions are\ntaken as to disinfection or what methods are taken to prevent the spread from that case?\nDr. Stanier (Victoria) : There are two points Dr. Underhill raised: One is the case of\ninfectious diseases in transit. The cases that come in here most generally are from the Old\nCountry, landing at Halifax. There are not many cases coming through Williams Head. They\ncontinue at the different cities until they land in British Columbia, and as they cannot go any\nfarther without jumping into the water they remain here. Unless these cases are stopped before\nthey get to Halifax, and there is a more systematic inspection, we are going to have them here.\nWe can look after our own local infectious diseases, except tuberculosis. In Victoria there is\none place for tuberculosis, and that is Chinatown. There is nothing done there for closed\ntuberculosis. I think about 50 per cent, of the Chinese are tubercular, and I think 90 per cent,\nof the cases in Victoria originate in Chinatown. Unless we can get at the root of that field we\ncannot eradicate our local tuberculosis.\nDr. Underhill (replies to discussion) : Dr. Flepworth asked me some questions. There are\nsome of the points that I certainly am not going to answer. I think possibly Dr. Hepworth and\nDr. Petersky have not realized the duties of Medical Health Officers at all. One thing is sure,\nwhen a medical man is in doubt or does not want to make a diagnosis he sends for the Medical\nHealth Officer, and it is up to the Medical Health Officer to make a bluff; if he says it is smallpox, it is smallpox; it doesn't matter whether it is or not. You have to take this responsibility\non yourself and decide what has to be done and to do the best you can.\nl] With regard to the outbreak of measles in Victoria, that is a unique situation. If you can\ncontrol 1,000 cases of measles, you do mighty well, for these cases are not all reported\u2014make no\nmistake about that.\nRegarding chicken-pox, this is quarautinable, but unless smallpox is prevalent we do not\nnecessarily placard for it.\nRegarding tuberculosis, Dr. Vrooman is going to tell us how to diagnose tuberculosis\nto-morrow; I don't know anything about that myself, but he told me in confidence he was\ngoing to tell us how to do it. Regarding deaths from tuberculosis, I would sooner disinfect\nfor tuberculosis than for almost any other disease, and every precaution is being taken regarding\nthe house and everything sterilized if possible.\nChinatown raises a big question. That is one black spot in Vancouver. We have a Chinese\nhospital where all the Chinese tuberculosis cases go that belongs to Chinatown. I think we have\nmuch more air and more windows in Chinatown here than in most places, but it needs daily\ninspection.\nMEDICAL INSPECTION OF SCHOOLS.\nBy F. W. Brydone-Jack, M.D.J CM, Chief Medical Inspector of Schools, Vancouver, B.C\nThe present terrible war brings. home to us with great clearness the necessity of the\nconservation of the life and the resources of our nation. A nation's place in the world is\ndetermined by the combination of virility, intelligence, and the numbers of its people. This\ncombination can be attained in varying degrees, depending on the extent to which a nation is\nwilling to adopt and enforce the principles of hygiene.\nThe department of hygiene with which we are particularly interested is that dealing with\nthe child. We recognize its outstanding importance, for we know the child is the source of the\nnation's man-power, and that upon a healthy childhood depends the health, vigour, and mental\nalertness of the adult.\nThe following are a few figures bearing on health: In Vancouver in 1916, Gl babies in every\n1,000 died before reaching the age of one year. Nine and one-tenth per cent, died from acute or\nchronic indigestion, due to improper feeding. In 1916, 2,680 children were born. Therefore\nVancouver alone needlessly lost 243 babies during that one year. Germany, in 1915, recognizing\nthe importance of babies, enforced a comprehensive system of infant-care. The mother received\nantenatal care. An adequate supply of milk was assured for the child from birth to six years\nof age. Germany estimates that she has saved sufficient babies that by 1921 there will be more\nbabies in that country than there would have been without a war, and she has obtained that\nresult in spite of the fact that in many parts of the country there has been a fall of 50 per cent,\nin the birth-rate.\nMedical inspection of schools was adopted in Great Britain in 1907, in consequence of public\nopinion following the alarming percentage of unfits among the men attempting to enlist at the\ntime of the South African war. There has been considerable improvement since school medical\ninspection was inaugurated, as the following figures show:\u2014\nNumber of Recruits rejected for the British Army per 1,000.\n1909 299.04\n1910 295.42\n1911 246.50\n1912 223.77\nThe figures for this great war are as yet unobtainable, but the corresponding figures are\nstated to be much better.\nA scheme of child hygiene should be comprehensive. It should concern itself with the\nprenatal care of the mother and the care of the child from birth to adult life.\nThe child-life may be divided into three periods:\u2014\n(1.) From birth to two years of age\u2014infancy.\n(2.) From two to five years of age\u2014the pre-school age.\n(3.) From six to eighteen years of age\u2014the school age.\nThere is no hard-and-fast line between these ages, and it would seem foolish to have three\nseparate organizations each dealing with but one period of the child's life, and yet this has been\nthe case in many cities, resulting in much confusion and overlapping. 8 Geo. 5 Provincial Board of Health. G 163\nGenerally, throughout Great Britain, one authority\u2014the education authority\u2014has. entire\ncontrol of child hygiene. In New York City the Bureau of Child Hygiene, a division of the\nBoard of Health, exercises a similar control. The same control by the Board of Health is\nexercised in Montreal, and since July 1st of this year has been adopted in Toronto. Previously\nin Toronto the Board of Health did the prenatal work and the work among infants, while the\nBoard of Education had charge of the medical inspection of school-children. Much has been\nwritten for and against the control of medical inspection of school-children by the education\nauthorities. To me it seems that where there is a well-organized and a comprehensive organization for child hygiene one authority should have complete control, but where health organization\nis difficult or impossible to complete, as in small towns, then a separate control of the medical\ninspection of school-children by the education authority may be vastly superior in results.\nIn British Columbia the control of medical inspection of schools is vested in the Provincial\nBoard of Health, but it has been made the duty of the local education authority\u2014the Board of\nSchool Trustees\u2014to enforce the \"Schools Health Inspection Act\" and to provide funds, the staff,\nand the equipment. The School Board is therefore particularly interested in that phase of child\nhygiene which applies to the school-child. Usually this work has been called \" school medical\ninspection.\" This title expresses very well the results so far obtained. From now on what is\nrequired is not school medical inspection, but school medical service. Such a service is concerned\nwith the detection of physical defects and the more important work, that of obtaining treatment\nfor the conditions found. The control of contagious and infectious disease, the hygiene of the\nhome, the proper heating, lighting, ventilation, and sanitation of the school, adjustable seats,\nthe curriculum, good blackboards, proper size reading-type, character of the writing materials,\nschool lunches, regular exercises, etc, are factors which the medical service must have constantly\nin mind in order to prevent as far as possible the child's acquisition of disease or defects in the\ngrind for an education.\nA thorough physical examination is of the utmost importance. A great deal of criticism and\ndissatisfaction has been caused by the extremely superficial manner in which children have been\nexamined in many American and Canadian cities. For instance, in Toronto the law called for\na thorough examination, including the heart and lungs, but insisted that no clothing could be\nloosened without first obtaining the consent of the parent. Such consent was very rarely asked,\nand as a result 95 per cent, of children were only examined in regard to eyesight, teeth, and\ntonsils. No wonder people could not understand why the Medical Inspector did not find the\ncrooked back, the deformed arm or leg, the weak heart, or the lung-trouble. New York recognized\nthis weakness and has for the last two years been inviting parents and attempting to thoroughly\nexamine children. This thorough examination is not done every year, but only in the first, third,\nand sixth school-year. In the other years it is of vital importance to have a specially trained\nnurse test tbe eyesight, see the teeth and throats, and estimate the general health of every child,\nso that a child needing attention may be referred to the school doctor for examination without\ndelay. In this the interest and co-operation of the teacher is essential, because it is the teacher's\nopportunity to be with the child day in and day out, being thereby enabled to detect immediately\nany child's departure from its normal average health. Toronto is to inaugurate such a system\nwith the opening of the schools in September. There is no reason to fear the results, for this\nsystem has been working very satisfactorily in Great Britain since 1907. In Japan also the\nthorough physical examination is recognized as the most satisfactory.\nN.B.\u2014In regard to the thoroughness of the physical examination, Vancouver was the pioneer\nin North America aud still holds first place.\nIn making the physical examination the following procedure should be followed:\u2014\n(1.) The parent should be invited at a definite time.\n(2.) The child should be stripped to the waist in privacy and stockings and shoes\nremoved. With female children a towel should be draped over the shoulders and\nchest for the sake of modesty.\n(3.) A nurse should always be present\u2014to prepare the child, assist in the examination,\nand to make notes.\nUnder these circumstances when a defect is found its nature can be very easily demonstrated\nto the parent. It can be found at once what is possible in regard to treatment, and arrangements\ncan be made for the medical service to obtain treatment for the child if the parents are poor. G 164 British Columbia 1918\nIf it is impossible for the parent to be present at the examination, then a sealed notice of the\ndefects found should be sent. The nurse should visit the home within two weeks, and in any\ncase it should be the aim of the nursing department to know within a month what steps the\nparents have taken in regard to treatment, though this time is often too short when a nursing\nstaff is small as compared to the many duties it is expected to perform.\nnln alteration in the school curriculum will be the treatment required for children suffering\nfrom certain defects. These children will be grouped in special classes called auxiliary classes.\nSuch a class as the open-air class is required for the thin, weak, sickly, and the pre-tuber-\nculous children. An ordinary class-room with all the windows open, with movable desks and\nfolding cots, is all that is required. Sometimes the flat roofs of schools are utilized when the\naccommodation in the school is limited. Some of these rooms are heated, some are not. The\nchildren must wear special clothing and must have an adequate rest period. The children\nimprove more rapidly in health and weight when a good lunch is served. For tuberculous\nchildren open-air classes should be formed in sanatoria. A child with open tuberculosis should\nnot be permitted to attend the open-air class intended for ill-nourished and amende children.\nAuxiliary classes are also required for the deaf, the blind, the semi-blind, children with\nspeech defect, and for crippled children. It is estimated that 2.8 per cent, of tbe children of\nSt. Louis have speech defects. Boston is tackling this problem in a sensible way, having what\nare called speech-improvement classes. During the past year 333 children were collected from\neighteen school districts and instruction was given by five teachers to nineteen different groups\nof children. The improvement in articulation is most pronounced. Another interesting class\nin Boston is that for semi-blind children. Twenty-two children having a vision of not less than\none-tenth normal were gathered together and receive special instruction. The type of tbe books\nis large and most of the teaching is oral. Seven classes were formed from the twenty-two,\nthough most of the instruction is necessarily individual.\nAnother type of auxiliary class is that for mentally retarded children. At least one child\nin every hundred is so affected. The best results are obtained toy attempting to give an education\nto those only that may profit by it. Children up to the age of ten or twelve may be taught in\nmixed classes in local districts, but afterwards the boys and girls should go to separate classes\nwhere more time can be given to domestic science and manual training. Mixed classes of the\nolder mentally retarded children are not as easily disciplined nor do they progress as rapidly as\nthe separate classes. Boston has fifty-five classes with an enrolment of 815; the older girls are\nsent to a six-room centre which forms a higher school; the older boys are treated similarly.\nTransportation is provided by the city.\nIn regard to treatment of physical defects, there are at the present time three methods\nusually employed\u2014by private physician, when the parent can afford it, and when not, by school\nclinics, and hospitals.\nLet us examine first the method followed in England to obtain treatment for school-children.\nThe following extracts from the 1914 Report of the Medical Officer of the Board of Education for\nthat country will give a clear idea of what is being accomplished:\u2014\n\" There is no more hopeful feature of the work of the school medical service than the fact\nthat many of the most fruitful activities are of the nature of voluntary undertakings on the part\nof local education authorities. The Board's system of medical grants, graduated according to\nthe efficiency of the arrangements made, has done much to reinforce local enterprise and lighten\nthe burden of local expenditure. Under the ' Education (Administrative Provisions) Act, 1907,'\nthe initiative in regard to treatment schemes remains with the local education authority, and a\nconsiderable proportion of the cost is borne by the local ratepayer.\n\" In 1914. out of 317 education areas in England, 266 had some form of treatment in school\nclinics. Treatment was provided for:\u2014\n(1.) Minor ailments in 204 clinics.\n(2.) Dental defects in 130 clinics.\n(3.) Defective vision in 195 1\n(4.) Provision of spectacles in 165 j refraction-work clinics.\n(5.) Enlarged tonsils and adenoids in 83 clinics.\n(6.) Ringworn (X-ray) in 6S clinics.\n\" In 1914 there were 179 school clinics. 8 Geo. 5 Provincial Board of Health. G 165\n\" The school clinic still maintains its position as the most generally suitable institution for\ndealing with children suffering from remedial defects, for the following reasons:\u2014\n(1.) There are the advantages of complete control.\n(2.) Arrangements are easily made to suit the convenience of doctors, teachers, and\nchildren.\n(3.) Complete supervision of the treatment in all branches is possible.\n(4.) Clinics can be held in positions easily accessible.\n(5.) Follow-up work is readily arranged and accomplished.\n\"Clinics for Minor Ailments.\u2014The treatment is simple; it can often be done by a nurse\nacting under medical direction. Cases do better as they can be treated in school more frequently\nthan they are at home. In 1912 (Warrington), 1,490 children lost 57,793 attendances owing to\nminor ailments, an average loss of 38.8 attendances. In 1914, on account of daily treatment, the\naverage loss was reduced to 27.2.\n\"The treatment of these conditions is essentially the work of the school nurse. The\nunsuitability of hospitals for carrying out treatment of this nature is generally recognized;\nthe staff have not the time to devote to the supervision that is required, nor to tbe daily\nroutine of treatment. Neither can the parents of the class, for the benefit of which these institutions are supposed to exist, afford the time or the means entailed in paying repeated visits to\nthe hospital.\n\" Clinics for Defective Vision.\u2014Ten per cent, of children require treatment for defective\nvision. One hundred and ninety-five authorities are having clinics, and in addition to the\nprescribing of spectacles, have entered into contracts for the provision of spectacles at cheap\nrates.\nWork done by part-time ophthalmic surgeons 9S\nWork done by whole-time ophthalmic surgeons 4\nWork done by staff of school medical service 74\nWork done by contributions to hospitals 37\nSpectacles provided by authorities 165\n\"There is dental treatment in 130 education areas. There are 200 dentists, fifty-one being\nfull time, sufficient to treat 375,000 children.\n\" Clinics for Enlarged Tonsils and Adenoids.\u2014Of all the remediable defects of school-life,\nenlarged tonsils and adenoids are the most neglected and show the lowest proportion to have\nreceived adequate treatment, in spite of their prevalence and their marked disabling effect on\nhealth. The number of authorities making provision for operative treatment is small, only\neighty-three. The reason for this is that in many areas tbe work is undertaken by voluntary\nhospitals without charge.\nNumber of authorities S3\nWork done by doctors not on school staff 24\nWork done by school medical staff 7\nWork done by hospital staff 57\nWork done at school clinics 30\n\" Care Committees.\u2014The development of the scheme of treatment has involved a corresponding increase in the work of following up. Every large school or group of schools has a School\nCare Committee, and the work of those committees is co-ordinated by a staff of paid organizers\nemployed by the London County Council. Care Committees are also concerned with the provision\nof meals and the after-care of children, with the work of juvenile employment, and with attendance at evening classes. Leavers are interviewed as far as possible and endeavours are made\nto find suitable employment.\n\" Results of the Work of the London School Medical Service, 1914.\n\" During the year 84,500 reinspections were made. Of all the children found defective, 50 per\ncent, were treated by the time the first reiuspection was held. Of those children suffering from G 166\nBritish Columbia\n1918\nailments for which tbe Council bad made special provision, 62 per cent, of the cases were dealt\nwith under the Council's scheme.\nTreated and\ncompletely\ncured.\nCured\nnaturally oi*\nwithout\nTreatment.\nTreated but\nnot completely cured.\nNot treated\nand requiring\nTreatment.\nRefraction \t\nEar, nose, and throat\nTeeth \t\nAll cases\t\n56.1\n53.3\n48.9\n51.3\n6.8\n17.7\n10.2\n15.3\n12.2\n4.4\n5.9\n8.6\n24.9\n24.8\n35.0\n24.8\n\" In 1912 only 39 per cent, were treated under the Council's scheme.\n\"The following table shows the percentage of children obtaining treatment from (A) tbe\nfamily physician; (B) under the Council's scheme; (C) at other hospitals or institutions:\u2014\n.\n(A.)\nPrivate\nDoctor.\n(B.)\nUnder\nCouncil's\nScheme.\n(C.)\nAt other\nHospitals and\nInstitutions.\n3.1\n17.6\n7.4\n74.3\n50.7\n58.9\n56.1\n6.2\n22.6\n31.7\n33.7\n21.2\n27.1\n22.7\n66.7\nTotals\t\n13.6\n56.2\n30.2\n\"The high percentage (74.3 of the whole) who get their refraction done under the Council's\nscheme shows what a need has been met by the facilities for treatment arranged by the Council;\nvery few cases needing refraction (3.1 per cent.) or cases of operation for adenoids and tonsils\n(7.4 per cent.) are able to arrange for treatment privately.\n\" The medical treatment scheme adopted by the London County Council combines the advantages of a hospital service and a school-clinic service. During 1914, 294,026 children were\nexamined and 101,432 were found to require treatment. In March, 1915, the education authority\ncontributed to 12 hospitals, providing for 26,184 children, and to 30 other forms of institution,\nproviding for 72,012 children, the total number of centres being 42, providing for 9S,996 children.\n\" Under these agreements the Council pays to tbe hospital or institution the sum of \u00a350 a\nyear for each doctor, surgeon, or anaesthetic working on one half-day a week, and pro rata for\neach half-day a week so worked. In addition, a capitation payment is made of 2s. for each\nmajor ailment treated in respect of eye, ear, nose, throat, and teeth, and for X-ray treatment\nof ringworm a capitation fee of 7s. is paid. A dentist working half-time on five sessions a week\nis paid \u00a3200 a year.\n\" There are three types of centres:\u2014\n\"(1.) Hospitals.\u2014The time of the clinics is arranged to suit the convenience of the hospital.\nDoctors and assistants are appointed by and are under the control of the Hospital Board and\ndevote tbe whole of the time for which they are paid by the Council to the work of dealing with\nthe children referred by the Council.\n\"(2.) Centres provided by Medical Practitioners' Committees, who provide and maintain the\ncentre. These centres are under the administrative control of the Council. The medical staff\nare selected by the Council from names supplied by the Medical Practitioners' Committee and\nare paid for the time given to the clinic. The Council sees to the supply of patients and to the\nfollowing-up of those under treatment. It also equips the centre with the necessary apparatus.\nA nurse employed in the Public Health Department of the Council is provided to attend the\nclinic and to assist the doctors in the treatment of refraction cases, ringworm cases, and ear,\nnose, and throat cases requiring operation.\" 8 Geo. 5 Provincial Board of Health. G 167\nMedical Treatment in New York.\nNew York has had medical inspection since 1897. It was found that only 6 per cent, of\nphysically defective children obtained treatment by tbe use of the postal-card notification system.\nBy the appointment of school nurses for follow-up work in the homes in 1908 it was possible in\n1909 to have 83 per cent, of the defects treated. It was felt by the Bureau of Child Hygiene that\nthe test of the value of school medical inspection was the character and the results of tbe\ntreatment obtained by the children.\nIn order that the existing need for more facilities for treating the children might be met,\nand that the character of treatment given and the adequacy of results might be under control,\nthe department obtained in its 1912 budget funds for the establishment of clinics under the\nBureau of Child Hygiene, exclusively for the treatment of school-children. Nineteen clinics were\nformed for nose, eye, ear, and throat service, for refraction, for dental work, and for contagious\neye-diseases. At five of these clinics operations for adenoids and tonsils are performed. Operative\ncases are kept for twenty-four hours and a list of doctors on call is kept handy in case any\nuntoward symptoms are noted. The clinics are open daily from 1.30 to 5 p.m., except Saturdays,\nwhen they are open from 9 a.m. till noon. Nose and throat operations are performed in the\nmorning from 10 a.m. to 1 p.m.\nMany of the defects from which the school-child suffers should have been prevented or\ndetected and treated before entry to school. It is felt in England, in New York, and in Toronto\nthat the best and the most logical way of reducing the number of school-children with physical\ndefects is to examine them and treat them in the pre-sehool age. Toronto now has twenty-two\nchild-welfare centres at which this examination for the pre-school child is done, in addition to\nthe usual infant and milk depot work. New York maintains fifty-nine such centres and Montreal\ntwenty-eight. It is estimated that one child-welfare centre is required for every 20,000 people.\nAs a rule, a doctor attends a centre for a half-day once a week. The centres are conducted in\npolice stations, Y.M.CA.'s, Y.W.CA.'s, and in settlement houses and in schools. Inasmuch as the\npublic already own the school buildings, and as a school building is the centre of a district, it\nhas been suggested that schools should be used for the child-welfare centres. This could easily\nbe arranged on Saturday mornings. It seems that more and more responsibility is being given\nto education bodies. This is not surprising, for we now appreciate that education does not simply\nconsist in teaching the school-child the three R's, but it includes the education of people of every\nage in everything which can improve our national well being\u2014truly an enormous task.\nIn the preceding pages I have endeavoured to give an idea of the important features of a\nschool medical service. We in British Columbia are young in the work and there is much that\nwe will have to develop. We have made a good start, however, and it is my earnest hope that\nBritish Columbia will maintain the lead she has set Canada.\nDiscussion on Dr. Brydone-Jack's Paper.\nThe Chairman : This is a very important phase of work, and in order to have it more fully\ndiscussed there were three asked to prepare discussions. I will ask Dr. Isabel Arthur, of Nelson,\nto open the discussion.\nDr. Isabel Arthur: I was much pleased to know what Dr. Brydone-Jack said about treatment. The treatment is the main point of medical inspection. There is not much use in sending\nnotes unless they can be followed up by treatment. That is the reason medical inspection does\nnot work out the way we hoped it would. This is being done in the large centres in the States,\nand in small towns and rural districts of 6,000 and 7,000 people there is no equipment in the\nschools and no treatment given. It very often is not done at all, and medical inspection therefore\ndoes not get the desired results.\nThe Medical Inspectors in the rural districts are usually physicians who have other work\nto do, and they do not give up their time especially to that work. They do not get enough\nremuneration and do not spend their time. They have no nurse to help them and the remuneration is so small they cannot take the time to do this thoroughly. That is where our medical\ninspection falls down, and I hope some time to See medical inspection under the Government and\nMedical Inspectors paid to give up their whole time to medical inspection of schools; then and\nonly then we will have good results from this work. G 168 British Columbia 1918\nDr. E. H. McEwen (Medical Inspector of Schools, New Westminster) : Mr. Chairman,\nLadies and Gentlemen,\u2014I feel very much like the man who never made a public speech before,\nand when he was asked to make one he had a friend prepare it for him. Through some mischance he did not get time to memorize it and so he had some notes. When be started to deliver\nhis speech, he said: \" Ladies and Gentlemen,\u2014Of course, this is entirely extemporaneous; of\ncourse, you will understand it is entirely an extemporaneous speech. Hang it, I don't know\nwhat to say next, because I can't find the place.\" So if I cannot find the place in my notes I\nknow you will forgive me.\nI was asked by Dr. Young to take part iu this discussion, but being away from the city\nI did not receive it in time; I did not know until to-day what Dr. Brydone-Jack was going\nto say.\nNow, in the first place, I would like to express publicly my thanks to Dr. Brydone-Jack\nfor the assistance he has given me personally in the school-work since I have been in New\nWestminster. Fie has always been most obliging and has done his utmost to give me assistance\nin the work. I have been in the schools in New Westminster for the past six years, and, outside\nof one year before that, when I was in a country district, I had no experience whatever as to\nhow to handle these things, and his assistance has been invaluable, and I want to publicly express\nmy appreciation of that fact.\nIn the next place, with regard to country work, some have spoken of the difficulties in\nconnection with that. One of the greatest blessings you can have in doing school-work is a\ngood nurse; that is more than half the battle, and you haven't that blessing iu the country at\nall, and you cannot keep in touch with the various patients that you run across. I think there\nshould be some provision made by municipalities in general to appoint a nurse to give her whole\ntime to country districts, and also some arrangements regarding her transportation from school\nto school before they can expect to get results from the country.\nNow, in tbe city work, we find the nurse clinches all the suggestions made by the School\nMedical Inspector. In all cases where w7e send out notices they are followed up by our nurse,\nand she stays with them and persuades them, whether they wish to be persuaded or not. that\nit is best to have the case attended to. As a result, we have bad a great many treatments on\nthese suggestions.\nWith regard to the teachers, I have been greatly blessed, and have bad good support from\nthe teachers. Of course, there are exceptions; you cannot always find all of the lady teachers\nespecially who will meet you in exactly the right way and follow up your suggestions as you make\nthem, but, ordinarily speaking, they do the second time, at any rate, and I must say I have had\ngood support from the teachers.\nNow, with regard to this morning's paper, there was some mention made by Dr. Gillies that\nthere were a number of cases sent to the asylums. Tbe trouble, I believe, we must get to the\nbottom of in school-life and before school-life. We cannot teach the present generation\u2014those\nin tbe asylums and those who should be\u2014we cannot control them; but these children growing up,\nwe have a certain amount of control over them, and that control should begin before the ordinary\ndays of school-life.\nI am in accord with Dr. Brydone-Jack that we do not begin early enough, and it should be\nunder one authority, and school-work and the pre-school work in training the child. We see\nso many examples in school-work of those who should have been attended to before the child\ncomes to school; it is pretty well on by the time we get them under our control. We should\nprepare that child for its future' life. They come to school to learn the three R's; sometimes\nthey get to high school and learn algebra and trigonometry, etc.; but the average child has\nfinished his education before he reaches high school, and they are going to settle down and\nbecome fathers and mothers of future families. How many of these children know the first\nthing about themselves and the proper care of themselves, the proper care of the wife, or the\nhusband, and the proper care of the children? I guarantee that a great proportion of them learn\nthrough a very bitter school, and I think we ought to try to accomplish the better education\nof the child-life on the lines of practical living. I think it is neglected in our present school-life.\nDr. Brydone-Jack has spoken about thorough examination in the schools. It is either that.\nor nothing; that is to say, I do not think it is much use giving a superficial examination of the\nchest and passing it up. I am sure Dr. Vrooman will bear me out in that, that there are few 8 Geo. 5 Provincial Board of Health. G 169\ncases of tuberculosis found in a superficial examination of school-children. I remember one case\nsent to Tranquille; we discovered a small patch in the chest, and then we found two or three\nplaces in the lung, and 1 discovered that after repeated examinations, and I only discovered about\none-third of the whole thing. How much less could it have been discovered in a hurried examination of children in a school?\nHe has mentioned that it should not be \" medical inspection,\" but \" medical service.\" I think\nthat is the crux of the whole question. We have started in a small way in New Westminster.\nThe nurse occasionally gets stuck and asks me for help, but she practically handles the whole\nthing herself, and much practice is making perfect. She is doing a great deal of good in our\ncity in a great many minor cases; ringworm, small cuts and bruises, and minor injuries are all\nhandled in our school offices.\nWe hope to have a dental clinic established next year. We probably would have had it this\nyear, only the money was not provided in the estimates, and it was left till after Christmas.\nWe hope for great things after Christmas in starting our dental clinic.\nRegarding tonsils and adenoids, it is all done by private physicians. We have followed up\nthese cases particularly during the past few years. Parents have been visited, and the fact\nbrought home to them that it was a necessary thing for the child that these cases should be\nattended to. In cases where they were absolutely destitute I have attended to several cases,\nand the result is we have quite a number of operating cases to the credit of the school-work.\nThat brings us to the backward children. The class of backward children has been greatly\ndecreased hy attention to that side. This is only one phase of the subject, but it is a very\nimportant one.\nThere is another difficulty, as Dr. Arthur mentioned, regarding thorough examination of\nthe child. Most certainly, where the medical man has no medical nurse to assist in the dressing\nand undressing of the children he has his hands full, and a good many of us cannot manage it.\nI think it is almost impossible to give them a thorough examination, although it is a most\ndesirable thing.\nThe Chairman : I hope we all appreciate the fact that we are here to learn and to educate.\nThe Government has called together, or the Health Department, this Convention, and they wanted\nour experience, and our views\u2014our difficulties as well as our successes\u2014that they might better\norganize the work to improve the service. We have had a paper and discussion by those carrying\non this work in the larger centres of our Province, but the work is going on in a lesser degree,\nas far as it is able to go on, in the smaller centres, and we would be glad to hear from any of\nthose who are carrying on the work in the smaller centres.\nDr. Petersky: As a man who has had .experience only in rural districts, I think the\nConvention has ail idea now that I have only had difficulty in my work. I have not found\ngreat difficulty; I have gotten out of difficulty. I think this Convention is a place to bring\ndifficulties to.\nWith regard to the schools, I mentioned the teachers were not quite what they should be.\nI have got through examinations and had the teachers act as nurses for me, and they were quite\nwilling to do it, but you have to use a certain amount of tact. Once in a while you come across\none you can't do anything with.\nI want to take issue with Dr. Arthur on one point; I think she has said the money expended\nin country schools is wasted, practically, because there is no treatment. I find in my experience,\nparticularly in dental work, and the eye, ear, nose, and throat, a certain percentage were\nattended to\u2014not as promptly as in the cities, but the parents usually make trips to Vancouver\nor Victoria for other purposes, and take the youngster along and have it attended to at the\nsame time. Usually I tell them if there is one man who can do it better than another. I think\nit is in the country where they attend to those things. You people who think you have all the\ncancer cases in the city, I would like to tell you that it is the country that acts as a feeder to\nthe city. We are like a big railway company providing the passengers along the railway for the\nmain line. Cases we cannot handle ourselves we send to the cities. We know the people better\nthan you do in the cities, and sometimes the parents will apologize to me for not having these\nthings attended to more promptly; but I know when I examine the children next year I find\nthese teeth attended to, and probably other ones fixed up. Of course, some are not attended to\nat all. In the city you can get things done better and the teachers understand these points\nbetter, but we do not get the best teachers in the country because the salaries are not so good. G 170 British Columbia 1918\nDr. Isabel Arthur: I did not intend to say that money was wasted in the country schools,\nbut that medical inspection could not be so efficient without following it up by treatment in every\ncase. It is quite true many many children are treated from notices sent home. I find a large\npercentage of the children have been treated in these cases, but there is always a certain\npercentage of children who cannot be treated, whose parents have not the money to pay for the\ntreatment, and if they cannot be given medical attention, the medical inspection cannot be as\nefficient as if it were carried further.\nDr. Brydone-Jack (replies to discussion) : In regard to a certain amount.of education on\nhealth matters in the schools, last year we had \" little mother \" classes conducted by the girls\nin Senior Fourth class. They received a course of instruction from about the first of April to\nthe end of June. They were taught to look after babies and the general principles of feeding,\nand were given instructions such as would fit them to look after children to a certain extent\nwhen they grew up and became mothers.\nThere is some difficulty in rural districts as to examinations. That is why I emphasized\nhaving tbe parents present, because they could assist you and you could talk to them direct.\nThe Victorian Order of Nurses will also assist when called up in medical-inspection work.\nIn regard to treatment, of course it is difficult here at the present time. In England they are-\nhaving travelling dental clinics, travelling refraction clinics, rural school nurses, etc, and I think\nthe Provincial Board of Health has that under consideration; it is simply a matter of time when\nthey get it here.\nThe Chairman : Dr. E. B. Carder, of Vancouver, will now give his paper on \" Poliomyelitis.\"'\nPOLIOMYELITIS.\nBy Dr. E. D. Carder, Vancouver, B.C.\nHistory.\nIn 1840 the first description of poliomyelitis as a definite entity was given by Heine, an\northopedic surgeon, in a monograph on the surgical aspect of paralytic conditions of the lower\nextremities in children, but containing a clear-cut description of the onset and acute stage.\nIn 1890 Medin published the first good clinical account of acute poliomyelitis based upon\nthe extensive Swedish epidemic.\nSmaller epidemics were reported from year to year, but no important additions to the\nexisting knowledge of the disease were made until 1905, when Wickman, also studying Swedish\nepidemics, developed the epidemiology of the disease and its pathology, and described for the\nfirst time the abortive type. His exhaustive studies demonstrated conclusively the contagious\nnature of the disease. There remained, then, the problem of finding the infective agent.\nIn 1909 independent observers in Vienna, Paris, and New York succeeded in experimentally\nproducing the disease in monkeys and in transferring it from one monkey to another. The\ninfectious agent, according to Flexner, is a minute micro-organism which passes through the\nfinest filter and can be demonstrated under the highest-powered microscope only, the difficulties\nattending its artificial cultivation and identification being such as to make useless the ordinary\nbacteriological tests for its detection. It resists freezing, is destroyed by temperature of 50 C,\nwithstands glycerine and y2 Per cent, carbolic, but destroyed by H,02.\nOn the other hand, Rosenow, of Rochester, recently investigating a series of cases there\nand in New York, isolated a polymorphous streptococcus from the throat, tonsil, and central\nnervous system of poliomyelitis cases. This organism appeared to grow large or small, according\nto the medium used, even after passing through a Berkefeld filter. Using the organism in its\nlarge form, paralysis was consistently produced by intracerebral injections in rabbits and in\nmonkeys. He suggested that the small filterable organism which has been generally accepted\nas tbe cause of poliomyelitis may be the form which this streptococcus tends to take under\nana?robic conditions in tbe central nervous system, while the larger and more typically streptococcic forms which other investigators have considered contaminations may be the identical\norganism grown large under suitable conditions.\nHowever, three other investigators, Geo. Mathers, Nuzum, and Herzog, of Chicago, made\nsimilar claims for a gram-positive micrococcus which they bad obtained from tissue of the\ncentral nervous system, tonsils, mesenteric glands, and from the cerebro-spinal flued by lumbar-\npuncture during life. These organisms injected into monkeys produced definite clinical and 8 Geo. 5 Provincial Board of Health. G 171\npathological poliomyelitis. This micrococcus, too, occurred in small and large forms, regarding\nwhich they point out the similarity to the virus of rabies which presents Itself in a large form,\nthe negri bodies, and in the small punctiform granules which pass a filter. Whether this\norganism is a. secondary invader (perhaps analogous to the streptococcus in scarlet fever) which\nin culture may become more or less closely associated With the independent virus of poliomyelitis, or is Itself the cause of poliomyelitis and capable of existing in filterable and non-filterable\nforms, is a problem demanding still further experiment and study.\nMode of Invasion.\nThe virus exists constantly in the central nervous organs, on the throat, tonsils, and nasal\nmucosa, and intestinal secretions of persons suffering or convalescing from the disease. It\noccurs less frequently in other internal organs, but has not been detected in the general circulating blood of patients. It is found also in the mucous membrane of the nose and throat of\nhealthy persons who have been in contact with cases of poliomyelitis, who thus may act as\ncarriers and convey tbe disease to others. This distribution applies to abortive cases as well\nas to the frankly paralyzed ones.\nFrom experiment and observation it is accepted that the entry of the virus is through the\nupper respiratory mucous membrane, and likewise the exit is by the ordinary secretions of the\n\u25a0 nose and throat, and, after swallowing these, by the intestinal discharges. The fact that the\ndisease has a distinctly characteristic seasonal prevalence\u2014constantly reaching its maximum\nduring the late summer and early autumn\u2014is in marked contrast to the more common diseases\ngenerally believed to be transmitted by direct contact and to find access to the body through\nthe respiratory tract, e.g., scarlet fever, measles, diphtheria, etc, which usually are most prevalent in winter and spring. This summer prevalence has suggested the idea of transmission by\ninsects, but the case against insects has failed up to the present. The house-fly or other insect,\nhowever, can conceivably become contaminated and mechanically convey the poison; therefore\ntheir exclusion from poliomyelitis patients should be religiously carried out.\nIt is generally accepted, then, that poliomyelitis is a human-borne contagious affection, the\nportal of entry for the virus being the upper respiratory tract\u2014tbe uaso-pharyngeal mucous\nmembrane in particular. The infection can be carried by' active and by passive carriers, of\nwhom abortive and unrecognized cases are probably most important. The virus is resistant\nand, being protected by mucous secretions, can become attached to clothing, bedding, etc, to\ndomestic animals and insects, and can be ground into dust and conceivably disseminated by\nwind. It has been found on the mucous membrane of the throat in a patient five months after\nthe onset of the disease.\nPathology.\nThe virus, as we have said, seems to enter the body via the naso-pharyiix\u2014through the\nlymphatics of the upper nasal cavities which are in direct communication with the meninges.\nThis view is strengthened by the anatomical findings. The earliest change in the nervous system\nis a hypei'Eemia and the collection of numbers of small mononuclear cells in the lymph spaces\nsurrounding the meningeal blood-vessels. These lymph spaces are anatomically processes of\nthe arachnoid spaces, and the lymph in them is in communication with the cerebro-spinal fluid.\nThe blood-supply of the cord is derived from these meningeal vessels, and as the pathological\nprocess advances this perivascular infiltration follows along the vessels as they enter the cord\nfrom the meninges. A cellular exudate then surrounds the outer wall of the vessel, while it is\nalso probable that there is some effect, either toxic or mechanical, on the intimal lining of the\nvessels, for haemorrhages, minute or extensive, are frequent findings, and one of tbe prominent\nfeatures of most cases is the extensive oedema. These three factors, then, cellular exudate,\nhaemorrhage, and oedema, all of them dependent on vascular change, may be regarded as the\nprimary reaction of the nervous system to the virus of poliomyelitis.\nThe importance of the vascular system in determining the nervous lesions explains the fact\nthat the cervical and lumbar enlargements of the cord are most affected, and that the anterior\nhorns of the grey matter are more involved than the posterior, for these are the regions of the\ncord to which the blood-supply is most abundant.\nIt has been suggested that the process by which the vascular lesions affect the nerve-cells\nmay be a mechanical one. Now, it is impossible to deny the fact that the virus may exert some\ndirectly toxic action on these cells; nevertheless, in many ways the clinical and anatomical G 172 British Columbia 1918\npictures are readily explained by the circulatory disturbance and the exudate. On such\nhypothesis the damaging effect can result in part from the direct pressure on the nerve-cells\nof haemorrhage, oedema, and exudate. There is also the additional factor of anaemia following\nthe constriction of the blood-vessels by the same merchanism. On account of this pressure and\nana;mia the nerve-cells degenerate. If the haemorrhages are absorbed soon enough the cells\nrecover their function. If, on the other hand, the anosmia and pressure have been prolonged\nor excessive, tbe nerve-cells go on to complete necrosis.\nThe same sequence of vascular changes and subsequent degeneration of nervous elements\nis found, though to a much less degree, in the brain, medulla, and pons. The same, too, in the\nposterior root ganglion\u2014i.e., vessels entering the ganglia, with degeneration and necrosis of the\nnerve-cells. The suggestion has been made that these lesions in the sensory ganglia account\nfor the pain which occurs so constantly in the acute stage of the disease. The changes found\nin other organs are less striking, but practically as constant\u2014viz, changes in the lymphoid\ntissue throughout the body and in the liver. So that the disease must be regarded as a generalized process affecting parenchymatous organs, lymphoid tissue, and most particularly the nervous\nsystem.\nClassification.\nThe study of any disease is simplified if the various clinical forms can be grouped together\ninto a few definite types. In poliomyelitis, hi which we have a pathological process which may\nextend through brain, medulla, pons, spinal cord, and spinal ganglia, or which may be localized\nin any part of the system, the signs aud symptoms may be very diverse; hence the difficulty is\nreadily appreciated.\nPassing over the various elaborate and detailed classifications, the simplest and best from the\nclinical point of view seems to me to be that of Peabody and Dochez, as follows:\u2014\n(1.) Abortive cases\u2014in which no paralysis occurs:\n(2.) Cerebral cases\u2014those rare cases in which involvement of the upper motor neurone\nwith resulting spastic paralysis is the chief characteristic:\n(3.) Bulbo-spinal cases\u2014the great majority of cases, comprising all those with lesions\nin the lower motor neurone and flaccid paralysis.\nThis classification is not absolute, of course, because many cases are not purely of one type,\neither anatomically or clinically.\nSusceptibility.\nChildhood is essentially the age which is most susceptible, though adults are not immune.\nIn the New York epidemic of 1907, 89 per cent, of the cases were under five years. Both sexes\nare equally liable, and social status seems to be unimportant; moreover, those attacked are\nusually hitherto perfectly healthy children, though other diseases, measles, etc, are often\nmentioned as predisposing causes. Whether the greater immunity of adults is to a non-specific\nresistance which develops naturally with maturity without reference to previous exposure or\nInfection, or is specific and acquired, from previous unrecognized infection with virus of poliomyelitis, is a matter of speculation, though our admission to-day of abortive cases, until recently\nunrecognized, indicates a greater general susceptibility than .has been generally thought.\nPoliomyelitis is one of the infectious diseases in which immunity is conferred by one attack,\nwhether of the abortive or paralytic type.\nThe protective substances do not appear in the blood until about two weeks after the onset,\nand have been detected as long as thirty years after an attack. If 1 c.c. of such a serum be mixed\nwith 1 c.c. of the active virus (which is merely a filtrate of a 5-per-eent. salt sol. suspension\nof the spinal cord of an infected and paralysed monkey)\u2014if these be mixed in a test-tube,\nIncubated for two hours, refrigerated overnight, and then injected intracerebral!}* into a monkey,\nthe animal is protected and does not develop poliomyelitis.\n\u2666\nCourse and Symptoms.\nIn most typical cases of poliomyelitis the course of the disease is fairly constant. The\nincubation period averages eight to ten days. Following the incubation period and preceding\nthe onset of paralysis, there is in the vast majority of cases a period marked by prodromal\nsymptoms. These are at times of such a mild and fleeting character that they may be entirely\noverlooked, and there is. too, a small number of cases in which the acute stage with paralysis 8 Geo. 5 Provincial Board of Health. G 173\nseems really to be the first clinical manifestation. The duration of the prodromal symptoms is\non the average one to three days. The severity is variable, and it is a generally accepted fact\nthat the severity of these symptoms bears no relation to the extent or the course of the disease.\nThe prodromal period has until recently received little attention from clinicians, but now,\nin the light of our present knowledge and our hopes for a therapeutic control of the disease,\nassumes an unexpected prominence. It is during this period that we must isolate and quarantine\nif such measures are to be efficacious, and it is only in the prodromal period before an extensive\ndestruction of nerve-cells has taken place that we can ever hope to make treatment efficient..\nThis, therefore, is the most important stage in tbe course of the disease, for on its recognization\ndepends the possibility of controlling the infection.\nThe most constant symptoms of this period are : Fever ; drowsiness ; irritability ; hyperesthesia ; pain, both spontaneous and that produced by passive motion; weakness of a limb or\ngroup of muscles; gastric symptoms, e.g., nausea and vomiting (which rarely becomes persistent) ;\nconstipation or diarrhoea seems to be immaterial. That is to say, the common history is that\nof a previously healthy child taken suddenly ill during the summer or early fall with fever, a\nmoderate gastro-intestinal disturbance, pain in the head, back, or legs, and often becoming quickly\ndrowsy. On physical examination there is stiffness of the neck with resistance to flexion; the\nKernig manipulation of the legs and the passive motions are painful; the child is irritable and\nwants to be left alone.\nA clinical picture which is suggestive in the presence of an epidemic, but which otherwise\nshows very little of specific diagnostic value. What other methods of diagnosis can we call to\nour assistance? The blood examination. Peabody and Dochez, of the Rockefeller Institute,\nsay:\u2014\n\" In the prodromal period, while the total leukocyte count varies within the normal, there\nis a tendency towards the upper limits, i.e., more cases showed counts well above the usual\nextremes than below. There is, too, a definite polymorph leukocytosis, while the lmyphocyte\npercentages are distinctly below the usual figure. After the onset of paralysis there is a constant\nand well-marked leukocytosis, 20 to 30,000. There is also a constant, increase of 10 to 15 per\ncent, in the polymorphs, and as constant a decrease of 10 to 15 in the lymphocytes. The other\nforms of leukocytes show no abnormalities.\"\nThe Spinal Fluid.\nWithout going into details, I will present the findings of the Rockefeller Institute in sixty-\nnine cases on this point, briefly and dogmatically :\u2014\nFluids : Clear, a few slightly opalescent.\nPressure: Normal or slightly increased (unsatisfactory because patients were usually\ncrying children).\nCell-count: Increased at first 35 to 990 per cm, gradually decreasing as the case\nprogresses. In some few instances there were polymorphs, but usually at all times\nwere from SO to 100 per cent, mononuclears.\nGlobulin: Low at first, but increases during second and third week, then gradually falls.\nReduction of Fehling's is present and usually prompt. Because the blood picture and the\nspinal-fluid examination seem also to lack specific diagnostic features, it would be wrong to\nconclude that they are of no assistance, because, taken in conjunction with the history and the\nclinical symptoms, frequently the diagnosis can be made.\nTbe acute stage is arbitrarily considered as the period between the onset of tbe paralysis\nand the disappearance of tenderness on spinal flexion. Fever is not a characteristic of this stage\nand has usually markedly subsided. Pain is a constant feature, and in general may be said to\nbe spontaneous pain\u2014pain caused by manipulations or tenderness to pressure of tbe muscles.\nThere are some cases in which stupor is a marked early symptom. To these the term cerebral\nhas often been loosely applied, but not accurately, because the paralysis accompanying has been\nof the lower neurone flaccid type, and they must be classified as bulbo-spinal. The paralysis is\nand has been the prominent feature. In the vast majority of cases (the bulbo-spinal type) it is\na flaccid or lower neurone variety involving muscles or groups of muscles rather than limbs or\nareas; the distribution is quite unsystematic.\nAs to the relative frequency of various muscle groups, statistics show that in the great\nmajority of cases muscles of one or both legs are affected, and in nearly 50 per cent, of cases\nthe paralysis is limited to ths legs. In the upper leg the quadriceps is most often paralysed. G 174 British Columbia 1918\nIn the lower leg the anterior group of muscles, i.e.. peroneals, flexors of foot, and extensors of\ntoes. Extensive leg paralyses are frequent, but complete and permanent paralysis is not the\nrule. In the arm the shoulder-muscles, more especially the deltoid, are most often involved.\nIt is the general observation that the proximal muscle groups are more apt to be paralysed than\nthe distal, and that after paralysis the distal recover more quickly and certainly. Paralysis of\nthe spincters is very rare. Many have bladder disturbances, requiring catheterization, but this\nis a transient condition and probably analogous to that seen in the febrile conditions.\nPractically all cases dying of poliomyelitis without complications die of respiratory failure,\ndue to paralysis of the intercostals and diaphragm. Tbe phremic nerve arises from a large\nnumber of roots from the 3-, 4-, and 5-cervical segments, and possibly this accounts for the fact\nthat the action of tbe diaphragm is so rarely interfered with. , Bulbar paralysis\u2014most commonly\nthe cranial nerve affections form part of a general process in which the cord is simultaneously\naffected, though occasionally bulbar paralyses may occur alone. The facial nerve is that most\noften found, though it is suggested that slight attacks of poliomyelitis may be a frequent\nunrecognized cause of strabismus.\nThe greater number of fatal cases comes under the heading of rapidly progressive cases,\nshowing the symptom complex known as Landry's paralysis, i.e., an ascending paralysis involving\nfirst the legs (or arms and legs), intercostals, arms, neck, and diaphragm.\nCerebral Cases.\nJust a few words as to cerebral cases. In 1SS5 Strimpell first called attention to the\nanalogy between certain forms of cerebral paralysis in children and poliomyelitis. He analysed\ntwenty-four cases, nineteen of which were below the age of four years. The onset was sudden,\nand there was an initial stage with fever, vomiting, and convulsions; then followed a hemiplegia,\nor a monoplegia of arm or leg or an ataxia without paralysis. There was no atrophy of muscles,\nno reaction of degeneration, and reflexes were usually exaggerated.\nIn 1S9S Medio during the Swedish epidemic noted three cases with fever, drowsiness,\nconvulsions, spastic hemiplegia, and exaggerated reflexes. In two of these the sixth cranial\nnerve was also paralysed, thus forming a connecting-link between the spinal and cerebral forms.\nThus there are some cases, rare it is true, in which the pathological lesion is in the brain itself,\nand in which the clinical manifestations suggest a disturbance of the upper motor neurone. On\nthe other hand, there are some facts which, assuming such a classification, are not easily\nexplained.\n(1.) In spite of the fact that monkeys are usually inoculated with serum intracerebrally,\nthe paralyses are always spinal and not cerebral.\n(2.) With the tremendous increase in the incidence of poliomyelitis during tbe past few\nyears and its more general recognition, it is remarkable there has not been a corresponding\nincrease in the number of cerebral eases reported.\nLastly, the abortive type of case. These are the cases of poliomyelitis which do not develop\nparalysis. They are believed to contribute at least 50 per cent, of the total. They are just as\ntruly and dangerously poliomyelitis (from the contagious standpoint) as the frankly paralytic\ncases, except that the nervous system has been spared. The blood-serum of abortive cases\nneutralizes the virus in vitro just as does the serum of paralysed patients, and the spinal-fluid\npicture is similar. The symptoms, apart from the paralysis, are similar and need not be\nrepeated here.\nPrognosis.\nPrognosis in poliomyelitis is a complicated problem. We are asked to foretell:\u2014\n1st. In the preparalytic stage, whether paralysis will occur.\n2nd. When it does occur, will it advance?\n3rd. How much residual paralysis.\n4th. Question of life and death.\nAs to the first, it is impossible to tell by any symptoms or signs whether paralysis will or\nwill not occur, though twitchings and convulsive movements in the muscles have been cited as\nindicating the area affected.\nAs to the second, will it advance? As a rule, the initial paralysis is maximum and final,\nbut there are enough examples of delayed involvement to make anticipation of further paralysis\njustified up to the seventh or eighth day. . 8 Geo. o Provincial Board of Health. G 175\nAs to the question of life or death: In a general way we may say the mortality has varied\nin epidemics from 6 to 25 per cent. In younger children the outlook is better than in older ones\nand adults. But such statistics are of little help in the presence of a given case of poliomyelitis,\nfor this reason: In poliomyelitis there is a peculiar element of chance not present in other\ninfectious diseases\u2014viz, the accident of the lesion destroying the phrenic and intercostal centres\nsimultaneously, an accident which is always fatal.\nIn most acute infections we regard death as due to a toxaemia which overwhelms the body\nand interferes with its functions until finally some organ, usually the heart, weakens and fails.\nBut in poliomyelitis, while in some few instances death is due to a complication, usually bronchopneumonia, ordinarily tbe toxaemia is a negligible quantity and death is essentially a mechanical\none due to paralysis of the muscles of respiration. It occurs most often on the fourth or fifth\nday of tbe paralysis.\nTreatment.\nWhatever the future may bring forth, we to-day have to admit that there is no specific\ntherapy by which the onset of poliomyelitis may be warded off, the paralysis prevented, or the\nresolution of the inflammatory process and consequently return of function hastened.\nThe problem of treatment is, then: First, to prevent the spread of the disease; second, to\ntreat the symptoms; third, restore muscular efficiency; and, fourth, to prevent and correct\ndeformities.\nFirst: Prophylaxis. The incubation period is probably about eight days. The infectivity\nis unknown, but has been arbitrarily fixed at less than six weeks. It is spread by personal\ncontact, though there may be other contributing causes at present unknown. Admitting that\nowing to unrecognized abortive cases and carriers effective preventive measures are difficult, we\ncan only at present demand the following:\u2014\n(1.) All suspected and recognized cases must be reported:\n(2.) Patients are to be isolated for six weeks just as carefully as we do scarlet fever,\nfor instance, with windows screened, animals excluded, etc.:\n(3.) All discharges, naso-pharyngeal and intestinal, to be destroyed:\n(4.) All contacts quarantined or at least under observation for two weeks after last\nexposure:\n(5.) Regulation or prohibition of intimate congregation of children.\nSecond: During tbe acute stage absolute rest in bed is an essential; thus will the damaged\ncord have the best chance for repair.\nCold sponging is inadvisable, tending to cause increased congestion of the central nervous\nsystem. The value of an ice-bagto the spine is also doubtful. These cold applications cause\nan increase of pain.\nConstipation should be avoided and the child must not be allowed to forget to urinate;\ncatheterize if necessary, for there may be at first some loss of bladder irritability.\nPain is the most prominent sypmtom demanding attention. This is most often due to passive\nmotion, thus indicating the necessity for care and gentleness in handling the patient.\nHeat, dry beat, wrapping the limb in cotton, etc, is a simple method of alleviating.\nImmobilizing by splint or sand-bag is helpful.\nOpiates may be necessary and should not be withheld from children because, unlike adults,\nthey cannot voice their demands.\nContractures and deformities occur early from the pull of unaffected muscles and the overstretching of injured ones if great care is not taken. Dropped foot is perhaps the commonest,\nso a cradle should be used to support the bedclothes and the foot kept at right angles. Sandbags may be used or light apparatus. The danger of restraining apparatus is that the limb\nmay be kept too quiet and prevent active efforts to use the muscles at a time when motion\nshould he encouraged. A good rule is to apply the apparatus at night only and leave the limbs\nfree to move during the day. The phase of convalescence begins with the disappearance of\ntenderness and lasts from one and a half to two years, after which the condition has become\nmore or less stationary.\nThe pathologic condition at this stage is that the haemorrhagic myelitis is subsiding, the\nperivascular infiltration is being absorbed, cells are resuming their function, and the clinical\nmanifestations of these processes is expressed by what we term \" spontaneous improvement.\" G 1.76 British Columbia 1918\nThis is the period when the problem arises as to when the case ceases to be a medical one and\ncomes in the sphere of the orthopedist. A too early resort to surgery and mechanical methods\nmay cause the patient to rely too much on these and cease developing his muscles to their\nutmost, while, on the other hand, it is unfair to postpone the assistance of the orthopedist until\ndeformities have occurred.\nAt this stage Lovett, of Boston, favours ambulatory treatment, i.e., the patient is permitted\nto be up and about, insisting strongly, however, on the avoidance of fatigue. His general rule as\nto apparatus at this time is that it is to be used if the patient cannot stand without It, or if in\nstanding or walking a position of deformity is assumed, because deformity leads to stretching of\nsoft parts, and, if persisted in, to permanent bony changes.\nThe therapeutic measures to be used locally are massage, electricity, heat, and muscle-\ntraining. Massage is used only after all tenderness has disappeared, and then very gently and\nbriefly. Its proper use retards muscular atrophy and promotes muscular tone; more than this\nmust not be expected of it. Its overuse is responsible for much barm. Electricity has done more\nharm probably than good; he does not advocate it. Muscle-training, however, is the measure of\ngreatest value at this stage. Muscle-training attempts to force an impulse from brain to muscle,\nto enable it, if possible, to open up new paths around affected centres in the cord. It is based\non the fact that as a rule the entire nervous control of a given muscle is not wiped out as a\nwhole, but only in part. It is universally agreed that one voluntary effort on the part of the\npatient is worth a dozen passive movements made for him. One should not forget that overstretched muscles are placed at a disadvantage, and that fatigue and overtreatment by massage\nand exercises are detrimental factors of the highest importance.\nThe third stage is called the stationary stage, and begins about two years after the onset.\nThe dominant requirements of this stage are operative, and are, first, the correction of deformity,\nand, second, operations to improve functions.\nJust a word now as to drugs and specific treatment:\u2014\n(1.) Urotropin has been used more or less extensively as a therapeutic measure. However,\nwhen we stop to consider that in urinary conditions-it has no antiseptic effects except in an acid\nmedium, we cannot expect it to show much germicidal activity in the cerebral-spinal fluid, which\nis alkaline. Its use, I think, has been discontinued.\n(2.) Adrenalin was advocated by Meltzer, of New York, though both the Rockefeller\nInstitute and the Health Boards of New York discredited it. He injected % to 1 c.c. of a\n1.000 sol. intraspinally every four hours for several doses. His reasoning, however, was\ninteresting even if not convincing. Tie said: \" Any inflammatory focus is surrounded by\nzones of hyperemlc exudation and oedema. Experimenting on rabbits' ears, he found that\nan injection of adrenalin caused the zones of exudation and oedema to disappear completely\nfor some time and reduced the inflammatory swelling to a small focus in the centre. The\npathological condition of the cord in poliomyelitis is a similar one; the procedure is harmless,\nat any rate; therefore, if the same effect can be produced even temporarily, it is worthy of\ntrial.\"\nOrdinary blood-serum has been used injected intraspinally from parent to child. Horse-\nserum in the form of antitoxin likewise, but with no definite results. Lumbar-puncture is\nadvocated, particularly in those cases showing signs of pressure or prolonged stupor, with\napparent good effect symptomatic-ally. Serum from convalescent patients\u2014even those recovered,\ntwenty-five to thirty years\u2014is used, and does seem the logical procedure. It contains protective\nbodies which, as we have noted, will neutralize the virus when mixed in vitro in certain proportions, and will effectually prevent the experimental production of the disease in monkeys. The\ndifficulties are, of course, the limited quantity to be obtained from convalescent human patients.\nIt is injected intraspinally after the withdrawal of a certain quantity of cerebral-spinal fluid,\njust as is done in meningitis, and repeated at intervals.\nA suggestion has been made by Wells, of Chicago, that the injections should be given intravenously, reasoning that the lesions in the cord are essentially perivascular infiltrations, and\nalso that the lesions are not confined to the nervous system, but involve various other tissues\nand organs (lymph-glands, etc.). Moreover, .a much greater quantity of serum containing the\nnecessary antibodies is thus introduced to the patient.\nSumming up, then, our knowledge of the disease, we must admit that our position in regard\nto poliomyelitis, its prevention, its diagnosis, and its treatment, is unsatisfactory to-day. Never- 8 Geo. 5 Provincial Board of Health. G 177\ntheless, with the study and investigation that is being devoted to it, we can with assurance\nexpect in the near future a scientific solution of the problem; a solution which will include a\npractical and reliable diagnostic test for the detection of clinical cases and carriers; a rational\nscientific cure of the disease itself; and, thirdly, what in view of the character of the disease\nand the early disastrous effects is much more important, a means of conferring artificial\nimmunity against it.\nDiscussion on Dr. Carder's Paper.\nDr. R. E. McKechnie (Vancouver) : I have listened with much pleasure to Dr. Carder's\npaper and must congratulate him on it. It is very comprehensive and he has brought the\nsubject up to date. There is very little that can be added to what he has read to us. The\n, only unsatisfactory thing about it is, there are so many indefinite things as to the nature of\ntreatment, etc, but the paper is a particularly good one and thoroughly up to date, and Dr.\nCarder is to be congratulated on his resume of the subject. My first acquaintance with it, the\nfirst case I ever saw occur in practice, was a relative of mine. 1 cannot say that I recognized\nit at that time, because I had known the youngster from the time I was a youngster myself;\nshe is about my own age and still living.\nDr. Carder gives three types\u2014one cerebral type; this was the cerebral type. The second\ncase was diagnosed in Montreal General Hospital by Dr. Stewart in 1890, the same year Dr.\nCarder quotes the authority giving the first thorough description of the disease. Of course, no\none had any idea as to whether it was an infectious disease or not. The case was in one of the\ngeneral wards, and subsequently I saw other cases in the general wards.\nIn my own practice, in the ten years, or a little more, that I was in Nanaimo District I saw\nsome five cases\u2014no two cases in any one year\u2014and that shows no infection occurred in those\ncases. Since I have been in Vancouver I have seen several cases, but as my work is largely-\nsurgical I do not run into it so much, and I fancy our climate is a good climate or we would\nsee it more often.\nIn discussing the virus or germ that causes this disease, there is something which makes\nus think of goitre. We have heard of the transmission of goitre through drinking-wells, and in\nthe District of Lillooet we find the sheep and dogs have goitre, so we find the production of\ngoitre is, like the production of poliomyelitis, from a certain virus. There is a similarity between\nthe two\u2014the germ that produces the virus, which produces one, passes through a filter the same\nas goitre virus; both can be cured by heat; neither by cold, so there is a little similarity. I\nwould like to see that one of the subjects for your next meeting for the study of goitre in British\nColumbia.\nThere is one point in Dr. Carder's paper which he brought out very nicely; that is the\npartial theory of the cause and symptoms in these cases. It is the mechanical theory, and to\nmy mind is the correct one. Many of these cases are recognized by symptoms of paralysis.\nIn more than one case the child was found paralysed when first noticed. That brings me to\na ease I have in the hospital at this moment. A man was being hoisted out of a mine in a\nbucket with several other men and there was a beam that had to be passed where men were\nsupposed to duck their heads. This was the tallest man in the bucket and he could not bend,\ncould not miss the beam. He was struck on the head and there was a sharp twist and fracture\nof four cerebral vertebrae. He was paralysed in both arms and both legs when he came to the\nhospital. The censory columns are not much injured because he has complete sensation. There\nis some little injury, the same as in poliomyelitis; but his anterior columns got the brunt of\nthe damage, the same as occurs in poliomyelitis cases. Here is where the similarity comes in\nbetween poliomyelitis and a traumatic case. The result in each case will depend on the number\nof nerve-cells which are absolutely destroyed, the number of nerve-cells partially destroyed that\nlater will die, the number that have been partially injured and will recover, and tbe number\nthat have not been hurt at all; and that all happens in a traumatic case almost immediately,\nand in a poliomyelitis case almost immediately. You have to direct your treatment to the\nconditions which already exist. Medicines are not going to do any good. Your first duty will\nbe to combat the present condition, treating symptomatlcally only, and later on you will come\nto the mechanical and mental treatment of the case. Dr. Carder has emphasized the fact that\ndeath in this case is mechanical, the same as in traumatic cases.\n12 G 178 British Columbia 1918\nt\nOne of the most valuable assets in treating these cases is optimism. A doctor who is not\noptimistic ought to be put out of the profession. When you have a long-drawn-out case like\npoliomyelitis, it is going to take a great deal of optimism.\nThe most valuable therapeutic agency is volition; that is, for the will to work to make the\nmuscle work. One attempted move is worth a dozen passive movements. That is the most\nimportant part in the early stage of the case. In dealing with children two or three years old,\nyou cannot impart much optimism to a youngster of that age, but you probably can to the\nmother or the nurse in attendance, and this will help to cure the condition. In older children\nand in adults you can impress the importance of this on them and so make them help to cure\nthemselves.\nAnother important point Dr. Carder emphasized was the danger of overdoing your exercises,\nthe danger of fatigue. You can eat too much meat or too much bread; you can overdo almost\nanything, and you cau overdo exercises. Take the case of poliomyelitis, where you have some\nnerve-cells whose vitality is in the balance, you can overdo the exercises. You have to use your\nbest judgment in working along those lines. Following that, if the case is left alone, you will\nhave contractures; one set of muscles has been paralysed, but the opposing set is still active,\nand you will have contractures. If you go to the military annex hospital you will see them\nworking with patients along these lines, not cases of poliomyelitis, but of injury to the nerves\nby military wounds, and such a line of treatment will be used here.\nI have not touched on the important discussion at all, but purely the Department of Health\naspect of the doctor's paper; I leave that to the others. His paper covers much of what I have\nbeen enunciating here and much of what was in my mind.\nDr. Stanier: I cannot add anything at all to Dr. Carder's most exhaustive paper on the\nscientific aspect, but I can speak from a personal point of view. I think it was in the fall of\n1911 I had an epidemic of this in the Victoria District. It was a long, hot, dry summer, when\nwe could expect something of that kind. Perhaps that obviates the growth of that particular\ndisease, the same as we get spinal-meningitis cases after a cold, wet winter.\nIt must have been about September 15th; I had been camping, and a case occurred that\nhad not been diagnosed on the other side of the bay, about three miles away, a young chap\nabout twelve, and he was dead by the time the doctor arrived. I did not see the case at the\ntime and was not paying much attention to it, as I had been on my holidays. The next thing\nI heard was that a dog was paralysed in the hind quarters, and then my own setter came in\ncompletely paralysed in the hind quarters. Shortly after that I was out shooting and I was\nseized with a violent pain around the loins and lower spine, and I could not get back to town;\nI remember the agony of that day. The paralysis occurs, of course, much more frequently in\nyouth, but I was not tbe only adult case. I cannot to this day stand any great strain, on account\nof weakness in the spine.\nDr. Carder says about 50 per cent, are abortive cases. I was m Toronto about two years\nago and I was told they considered ninety-eight cases of meningitis occurred for two that were\nrecognized, because the symptoms were not definite enough. This is the case in poliomyelitis;\nonly when it gets into the nervous system is it recognized.\nAs regards treatment, my case was diagnosed, a doctor was in attendance. I realized I was\nseriously ill, terribly constipated, and wanting to lie down\u2014very tender and not much use of\nmy legs. Continued heat was the only thing that could be done to relieve it. I can understand\nthat now, since bearing the description of the vascular changes.\nAs regards the effects, a boy came into my office the other day; he was about six or seven\nyears old; he had this when an infant, and he has now practically complete paralysis of the\nbiceps and triceps of the forearm, and hand cannot be used. I took an X-ray, and have tried\nto restore the muscular condition, but he is liable to dislocation on account of the loose condition.\nI am putting his arm in a rectangular splint. I find that massage is decidedly a good thing, but\nshould be only mild in the early stages.\nDr. Carder (replies to discussion) : The hour is late, and I do not think there is anything\nI can add, except perhaps to draw attention again to what I tried to emphasize in the paper.\nThere is a tendency to want to do something too early, probably against their own better judgment. That is one point that should be carefully considered. Absolute rest is essential, and,\nbetter still, immobilization; do not be afraid to put a cast on or a splint. I think in New York\n100 children are practically encased in plaster. And immediately after the plaster cast is applied 8 Geo. 5 Provincial Board of Health. G 179\nthe pain eases and the children are quite happy. Absolute rest is therefore essential. In time\npassive movements should be encouraged, and you can encourage the child to move, because, as\nstated, it is better than passive movement, but to do this too soon only causes damage to the\nnerve-cells and increases the irritation. It has been suggested that even four or five months\nshould elapse before massage is applied.\nThe Chairman: That concludes the programme for to-day. To-morrow morning we have\nsome exceedingly interesting matter and a discussion of the question of tuberculosis.\nThe Convention adjourned at 5.30 to 9.30 to-morrow morning.\nThursday, September 13th, 1917.\nMorning Session,\nDr. F. T. Underhill in the chair.\nThe Chairman: I will call this meeting to order. We have a long and very important\nprogramme before us to-day, and we have first this morning the question of tuberculosis, in\nwhich we are all interested in this Province. I am not going to take up time and I will simply\nask Dr. Vrooman to read his paper. By the way, discussion will be opened by Dr. Wesbrook,\nand then we will ask Dr. Walker and Dr. Proctor to speak to this paper.\nDr. Young: Dr. MacLean received a letter this morning from Mr. Harris, Secretary of the\nVancouver Association for Promoting Speech of the Deaf. (Reads letter.) If occasion will\nwarrant during the day I will phone the office aud we may be able to have some talk on this\nvery interesting subject.\nDr. Vrooman then read his paper on tuberculosis.\nTUBERCULOSIS: HOW SHALL IT BE HANDLED IN BRITISH COLUMBIA?\nBy C H. Vrooman, M.D, CM, Medical Superintendent, King Edward Sanatorium,\nTranquille, B.C.\nIn 400 b.c. Hippocrates wrote concerning tuberculosis: \" The greatest and most dangerous\ndisease and the one that proved fatal to the greatest number was the consumption.\" So that the\nproblem we are considering is one which has afflicted the human race for many thousands of\nyears. Hippocrates' description of the long-drawn-out illness of an advanced case of consumption is wonderfully accurate. In other medical writings of this time there is distinct evidence\nthat the medical men of ancient Greece believed in the contagiousness of consumption. Yet it\nwas only in 1882, thirty-five years ago, that Robert Koch discovered the tubercle bacillus, and\nwe have since that time been able to make great progress in the study of the pathology of\ntuberculosis. As our present methods, both of treatment and prevention, rest on tbe essential\npathology of tuberculosis, it is necessary before considering those subjects to briefly review our\npresent-day knowledge of the pathology.\nTo quote again from the father of medicine: \" I look upon it as being a great part of the\nart to be able to judge properly of that which has been written. For he that knows and makes\na proper use of these things would appear to me not likely to commit any great mistake in the\nart.\" Out of the volumes that have been written on tuberculosis certain conclusions now appear\nto have been reached, based upon accurate scientific observation and experiment. With Hippocrates' admonition in mind, let us examine briefly some of these conclusions and apply them to\nour present needs.\nThe tubercle bacillus is the most ubiquitous parasite the human race has to contend with.\nIt is so widespread, both in man and animals, that there is no doubt that we all, before reaching\nadult years, become its unwilling host, and the most of us without doubt remain the host of\nliving tubercle bacillus during the rest of our days. It is then only because of the high immunity\nwe have developed as a race to this parasite that only about 10 to 15 per cent, of us become\nclinically ill with tuberculosis. The rest of us accommodate the invader like the Allies did the\nGerman spies in the pre-war days\u2014without knowledge, care, or suspicion; but to carry our\nanalogy still farther, these same spies may, when in sufficient numbers, and at a time when\nour defences are least prepared, lead an invasion that may as suddenly overwhelm our organism\nas the Germans did Belgium in 1914. It will be readily seen that being infected with the tubercle\nbacillus does not necessarily mean that one is ill with tuberculosis and requires treatment. If G 180 British Columbia 1918\nthat were so, 90 per cent, of the.white race would require treatment. It is only when the\ninfection is sufficiently massive to produce symptoms that we speak of a person being ill with\ntuberculosis.\nChronologically, the earliest tuberculosis encountered is the bronchial-gland tuberculosis of\nchildren. The researches of Shon* and others show that the most common mode of entrance\nis by inhalation, and tbe setting-up of a small focus of infection in the lungs. This primary\nfocus generally heals, but the bronchial glands draining the area become infected, and if the\ninfection is sufficiently massive we may have developed the well-defined clinical symptoms of\nbronchial-gland tuberculosis. There is no doubt, as shown by the experiments of Ravenalf and\nothers, that the bronchial glands may be infected from the intestinal tract, and that the ingestion\nof infected food may cause glandular tuberculosis without lesion in the intestines. The balance\nof evidence seems to be in favour of the hypothesis that most infection is conveyed by inhalation\nof tubercle bacillus, either in dust or moist droplets, eliminated by open cases of consumption.\nThe chief means, then, for the spread of tuberculosis is the advanced and open case. Bovine\ntuberculosis may be, undoubtedly, conveyed by milk, and is the cause of a great deal of bone,\njoint, skin, and intestinal tuberculosis in children, but it is rarely a cause of pulmonary tuberculosis. Not more than one-twelfth of all the tuberculosis that has to he dealt with is due to\nbovine origin. In a country like British Columbia, where cows are kept well tested, the bovine\ntuberculosis originating in this Province must be exceedingly small.\nAge of Infection.\u2014About 15 per cent, of children are infected the first year of life, about\n50 per cent, the first five years, and SO per cent, are infected the first fourteen. While the\nmortality is comparatively high during the first two years, after that, from two to fifteen years,\nthe mortality from tuberculosis is comparatively low, and during this period it is tbe milder\nforms of tuberculosis that we have to deal with. The mortality starts to rise at fifteen and\nmaintains a high level until about forty, when it drops again.\nBronchial-gland Tuberculosis in Childhood.\u2014Bronchial-gland tuberculosis in children may be\ndivided into three classes:\u2014\nFirst: Those in which the primary infection is small and the general resistance large. The\nbody-tissues react well to the invader; all the defences are ou the alert; and there is a rapid\nformation of fibrous tissue around the infected gland, and the parasite is promptly walled off.\nThese children probably never have any symptoms, and the effect of this small invasion is, on\nthe whole, good for the organism, as there is developed a certain immunity to subsequent invasions.\nThere is also developed the well-known hypersensitiveness to the various tuberculin reactions\u2014\nVon Pirquet's, Moro's, etc. Though a person may never develop any clinical symptoms, this\nhypersensitiveness continues throughout life. It might be as well to emphasize this point, as\nthere is a tendency sometimes to give undue weight to a positive skin reaction. A positive Von\nPirquet always signifies infection at some time with the tubercle bacillus, but it is so delicate\nthat it may be produced by an exceedingly small focus well healed and doing no harm to the\norganism.\nSecond: Those in which there is a moderate invasion the tissues react fairly well, but a\nnumber of glands become involved. There are little, if any, clinical evidences of infection.\nThere is for a time a \" biochemical 'balance \" established between the host and the parasite.\nAt any time, though, that this biochemical balance is disturbed there is a multiplication and\na renewed activity of the parasite until we have the third type.\nThird: By reason of a continuous or massive infection, or because the biochemical balance\nis disturbed by the disease, such as measles, whooping-cough, etc, or bad living conditions, we\nmay have what is the most frequent type of early clinical tuberculosis in children from two to\nfourteen.\nAllow me to quote a description of these cases from a recent article:+ \" Clinically, these\nchildren present histories which are fairly typical. In these histories one may or may not be\nable to trace the source of infection. If the parents are of average intelligence, however, one\ncan trace the source of infection in a very much larger percentage of cases than is possible in\nolder individuals. Quite naturally, of course, one would hunt this source of infection in the\nimmediate family of the patient. Failing there, one is often able to find it in the close vicinity\nof the patient's home.\n* Shon A The Primary Lung Focus of Tuberculosis in Children. Trans. E. Barty King. 1016.\nf Rave'nal. M. P. Jour.* A.M.A, 1016, LNVI., 613.\n% Gekel. W. A. Arch. Int. Med, 1017, Vol. XX, 32. 8 Geo. 5 Provincial Board of Health. G 181\n\" Coming to the history of the case itself, we find that, on close questioning, the parents will\noften say that the child has stopped growing, or does not seem to gain in weight. Along with\nthis the parents will notice that the child does not have the energy that other healthy children\nhave, and does not have the same inclination to play. The child tires easily, is apt to be irritable\nand cross. The appetite is slightly below par and is often capricious. There may or may not be\nsome digestive disturbance. Often, however, constipation is noted, possibly due to the lack of\nexercise on the part of the child. Sometimes these children will have night-sweats, and the\nmother on close questioning will recall that the child has been feverish in the afternoons. There\nmay or may not be a slight cough, which is hacking and unproductive. If tbe child is going to\nschool, the teacher will often complain that he is inattentive and does not seem to keep his mind\non his school-work. Occasionally one will be able to obtain a history of a pleuritic pain. As\nwill be noticed, most of these symptoms are constitutional symptoms which may be present in\nother conditions, such as chronically diseased tonsils, middle-ear disease, and other cryptic\ninfections. Undoubtedly many of these little patients have had their tonsils removed in the\nbelief that this was the cause of the constitutional condition.\n\" On physical examination one finds a child that is slightly undernourished, apt to look\npasty, slightly anaemic, and not seldom stunted in growth. If there are diseased tonsils or\nmiddle ears present, there may be a slight enlargement of the cervical glands, which, however,\nare not necessarily tubercular. If there are decayed teeth, one is apt to find a similar enlargement of the submaxillary glands. Inspection very often reveals a slight or sometimes marked\nenlargement of the superficial veins of the chest, both anteriorly and posteriorly. The mobility\nof the chest-wall on respiration is seldom retarded, and is usually equal on both sides. There\nare very rarely evidences of any retraction. A careful percussion of the interscapular region\nwill occasionally reveal a slight change in the note. Often after tbe fifth or sixth year one\nnotices a slight diminution of resonance over the right apex, anteriorly and posteriorly, which\ndoes not necessarily indicate any underlying pulmonary disease. There are usually no evidences\nof pleuritic adhesions. Auscultation will give a positive D'Espine sign, very rarely any rales,\noccasionally friction-sounds at one base or the other. Along with the slight change of percussion\nto be found after the fifth or sixth year, one begins to notice a slight increase in the intensity\nof the breath-sounds over the right apex as compared with the left. This discrepancy between\nthe apices is found from this age on, and may be considered normal.\n\" On observing such a patient for another week or two, one will find that the Von Pirquet\nreaction is positive in a very large percentage of tbe cases. The pulse is unstable, even when\nthe child is kept quiet, ranging in the evenings from 110 as high as 140. The temperature will\nalso he unstable, sometimes showing marked amplitudes, at other times showing evening rises\nto 99.2, 99.4, and 100 Fahr, and even higher. On prolonged observation over a period of months\none notices, further, a flat-weight curve. Even on a carefully selected diet the weight of such\nchildren often remains stationary as long as a year before there is any increase.\"\nThis type of bronchial-gland tuberculosis in children is particularly amenable to treatment,\nand it is for these children that we should have our open-air schools and special sanatorium\npavilions. By the early discovery and treatment of these cases many well-marked cases of\npulmonary tuberculosis will be prevented from developing in later life. In other words, put\nthese children under such conditions that their health is kept above par, and these infected and\ncaseous glands will be enclosed in such a tough sheath of fibrous tissue that there will be little\ndanger of them breaking down under the stress of early adult life. A man's immunity to\npulmonary tuberculosis is to a large extent dependent on the strength of the fibrous capsule\nwhich walls off the infection received in childhood.\nPhthisis Pulmonalis.\u2014As pointed out before, the most of our eases of pulmonary tuberculosis\nshow themselves between the ages of fifteen and forty-five. The parasite gained its entrance in\nchildhood, and it lived a secluded and quiet life in the bronchial glands until the opportunity\narose for it to multiply and replenish itself at the expense of the tissue and often the life of the\nhost. That the infection of tuberculosis may occur from without in adults is deemed impossible\nby some, and all investigators admit it is most difficult to infect adults from without, and then\nonly by massive and continuous dosage. Phthisis pulmonalis in adults is, in most cases, caused\nby infection from within. The point that pulmonary tuberculosis develops from reinfection from\nwithin, and not by infection from without, has an important bearing upon preventive measures. G 182 British Columbia 1918\nWhether a person develops pulmonary tuberculosis from these enlarged and infected bronchial\nglands is more or less due to the occurrence of what might be called the accidents of life. As\nKrause puts it:* \"The development of tuberculosis disease from old benign tubercle depends\nlargely on -whether the patient gets a cold, rows a race, or becomes pregnant at the wrong time.\"\nOne man may carry through life a chain of enlarged solerosed glands that never give him\nany trouble. Another may only have a few, but situated close to a bronchus; its wall may\nbecome softened, due to inflammatory changes produced by an acute attack of influenza, and it\nmay ulcerate .into the bronchus. The infectious caseous material is aspirated into the alveoli,\nand the practitioner is often surprised to find an attack of influenza developing into a tuberculous\npneumonia. It is not within the scope of this paper to deal with the varied forms of pulmonary\ntuberculosis. Fortunately the great percentage of secondary infections are not so gross as to\ninvolve a whole lobe in a few days. The onset is generally insidious, only small areas being\ninvolved, and the patient at this time responds most readily to. the treatment.\nThe absorption, though, of the products of the tubercle baccilli does cause definite symptoms,\nand the diagnosis, when made early, often means life to the patient, while delay in the diagnosis\nfor six or twelve months without proper treatment often spells death.\nIt would be straying from my subject to go into the details of early diagnosis, but I would\nlike to emphasize that diagnosis in most cases can be made by symptoms alone. Physical signs\nmerely tell the extent of the disease. Slight cough, fever without discoverable cause, slight,\nbut continuous, loss of weight and strength, anorexia, and indigestion\u2014with these symptoms\ntuberculosis should always be excluded by a careful examination of the lungs. A history of\nhaemoptysis clinches the diagnosis without examination. An examination which shows a few\nmoist rales after cough at either apex means in 95 per cent, of cases pulmonary tuberculosis and\ntbe patient should be treated as such. The occasional non-tuberculous case that would be treated\nis negligible in comparison with the number who would get treatment in the early stages if this\nsimple rule were followed. It does not require exceptional skill to diagnose clinical tuberculosis,\nbut it does require careful and prolonged examination. It is perfectly appalling the mistakes\nthat some, otherwise good, practitioners make simply because of lack of care in regard for the\nessentials. There is scarcely a month passes in which I do not have a patient give me a history\nof a frank haemoptysis in which some practitioner has not told the patient it was due to a\nhaemorrhage from the throat, or were assured afterwards that the lungs were all right.\nHaemoptysis, unless due to some readily diagnosed other cause, such as mitral stenosis, always\nmeans active tuberculosis, and should be so treated whether there are any physical signs in\ntbe lungs or not.\nHaving traced our infection by the bronchial glands and shown how in early adult life this\nmay under suitable conditions cause clinical pulmonary tuberculosis, it is not my purpose to\nfurther describe the many different forms that may develop. It will be readily seen, though,\nthat a case is not always incipient because the onset of symptoms were of recent origin. Many\ncases are advanced when they first consult a physician. The terms incipient, moderately\nadvanced, and far advanced have rather to do with extent of disease when symptoms are first\nObserved and have no significance as to the time of onset. The proper classification, though, has\na great bearing upon the prognosis and time required for treatment.\nCases that are incipient when discovered will sometimes, in spite of treatment, steadily\nprogress and become far advanced and then become arrested. Advanced cases, with an apparently hopeless attack, will suddenly under proper treatment, and sometimes under most improper\ntreatment, become quiescent, and the patient may be able to resume an almost normal working-\nlife for a period of years. It is because of this that I hold no institution should be labelled a\nhospital for hopeless cases, and the proper function of all institutions caring for tuberculosis\nis to treat all cases who are ill. Such institutions should have wards arranged so that far-\nadvanced and bed patients could be segregated from those who are not confined to bed. The\nprognosis and course of a case of pulmonary tuberculosis is varied so much by periods of\nquiescence and of exacerbation that in this more than any other disease we must exclaim with\nHippocrates, \" Experience is fallacious and judgment difficult.\"\nHaving thus reviewed briefly some of the facts known in regard to infection and pathology\nof tuberculosis, it remains for us to consider that most important of our problem\u2014viz, prevention.\nOn paper the problem looks simple enough.\n* Krause, A. K. Am. Review of Tb, 1917, Vol. I, 65. 8 Geo. 5 Provincial Board of Health. G 183\nFirst: To put all in healthy environment, with good housing and proper food, which are\nessential preliminaries to good habits. This is a basic economic question and its discussion\nwould carry us somewhat far afield. It may, though, be stated that any agency which tends to\nremove poverty, bad living conditions, and drink is going to help to remove the curse of the\nwhite plague.\nSecond: To recognize the disease early and put patients in the best possible circumstances\nto promote cure.\nThird: To guard the community against the dangers associated with the advanced cases.\nIt is the two latter portions of the problem that we are more immediately concerned with\nin this discussion, and the paper simplicity of the problem somewhat disappears as the different\nactivities involved in their complete solution are examined. To recognize the disease early means\nboth education of general public and medical profession. And it means the provision of sufficient\nsanatorium accommodation where these patients may learn how to cure themselves.\nTo guard the community against the open infectious cases means, first, that these open cases\nshall be known to the Health Officer, and, when known, that he shall be able to keep them under\nadequate supervision either in hospitals or under safe conditions at home. The Health Officer\nwho reports his community free of tuberculosis merely because cases are not reported to him\nby the medical practitioners is burying his head, ostrich-like, in the sands of ignorance. The\nco-operation of the practitioner can and must be secured, and the surest way to gain this\nco-operation is the knowledge by physicians that by notifying their cases real help will be given\nin the care of the patient and that the community will be benefited. The general practitioner\nis the backbone of the medical profession, and he is always ready to co-operate in any movement\nto benefit the health of his patient or the welfare of the community.\nThe headquarters of any campaign in any community against tuberculosis must- be the\nestablishment of a tuberculosis dispensary in charge of a specially trained dispensary nurse.\nThe dispensary nurse should be the accredited agent of the Health Department, and her duty\nwould be to actively search for cases of tuberculosis. She would keep under supervision all\nknown open cases. When an advanced case was discovered she would arrange for the examination of all contacts, particularly children. She would arrange for the proper institutional care\nof all diagnosed as requiring that care. Her duty would be multifarious, but, in short, she\nwould be the adviser and friend of all those afflicted with tuberculosis. The dispensary would\nbe the clearing-house, and while part of the activities of tbe Health Department, it would be\nnecessary to have the medical part of the work under the supervision of a physician having\nspecial knowledge of tuberculosis. This means that supervising the various dispensaries in the\nProvince there would be a Tuberculosis Officer. It may be objected that dispensaries are all\nright for the larger cities, but how about the rural communities? There is to my mind no reason\nwhy there should not he dispensaries in the rural communities, but in the rural communities\nthe work would be widened to embrace all health matters.\nIt would be useless to establish dispensaries unless there were hospital beds where patients\ndiscovered might be treated. It should then be laid down as a basic principle that all general\nhospitals should provide special wards for the advanced cases of tuberculosis in their community.\nIt is quite true that in British Columbia all hospitals have to provide some beds for tuberculosis,\nbut the number is ridiculously small. They are generally the poorest wards in the hospital, and\nin place of encouraging patients to be treated there the hospital authorities discourage them in\nevery way possible. To provide anywhere near adequate accommodation for the tubercular\ncases requiring treatment there should be in British Columbia hospital and sanatorium beds\nequal at least to tbe annual death-rate from tuberculosis\u2014viz, about 400. That would mean\nproviding at Tranquille about 250 to 300 beds. The most of the beds at the sanatorium would\nbe reserved for those likely to benefit by treatment, not necessarily all incipient cases, but\nmoderately advanced and advanced cases, who have a chance to get well. There would necessarily have to be beds for advanced incurable cases, as not all are going to do well, and it is\nnot possible to send every advanced dying case to their home hospital. It would mean seventy-\nfive beds in Vancouver, thirty-five beds in Victoria, and forty beds divided among the other\nhospitals of tbe Province. In these hospital beds would be treated the open case awaiting\nadmission to the sanatorium, and the advanced incurable case who wished to be near their\nfriends during their last days. G 184 British Columbia 1918\nIn charge of the various dispensaries and acting as consultant to the various hospitals should\nbe a Provincial Tuberculosis Officer. His work would be to supervise and co-ordinate the various\nanti-tuberculosis efforts, to act as consultant to the dispensaries and hospitals. His services\nshould be available free to general practitioners in the diagnosis of suspicious cases. It must be\nrecognized that very few practitioners have had the opportunity of obtaining special knowledge\nin regard to the diagnosis and treatment of pulmonary tuberculosis. It is only of recent years\nthat medical students have been given the opportunity to study early cases of pulmonary tuberculosis in sanatoria or special hospital wards. This, then, would be the scheme:\u2014\nFirst: To establish in the various centres of British Columbia tuberculosis dispensaries\nunder charge of a specially trained nurse. This would be the central bureau. Cases would\ncome here for diagnosis, advanced cases sent to suitable hospitals, cases who might be benefited\nsent to the sanatorium, predisposed children kept under supervision, patients discharged from\nthe sanatorium would report here for re-examination, etc.\nSecond: The provision at once in this Province of beds for the special care of pulmonary\ntuberculosis equal to the death-rate\u2014viz, 400.\nThird : In charge of the dispensaries and acting as consultant specialist, a Chief Tuberculosis\nOfficer.\nThis scheme is no experiment; it was first originated by Sir Robert Philip, of Edinburgh,\nand has been adopted in the British Isles as the best scheme in both rural and urban districts\nfor handling the tuberculosis problem. That it is effective is shown by the fall of the death-\nrate in the communities where it has been tried. In 1900 the death-rate in England was 19 per\n10,000; in 1910 the death-rate from tuberculosis was reduced to 14.3 per 10,000. The most\nmarked reduction has occurred in the communities where the most thorough methods have been\nadopted.\nStill more striking comment upon the success of these methods was made recently by\nDr. Hermann M. Biggs,* of New York, after a recent visit both to England and France to\ninvestigate the effect of war upon the incidence of tuberculosis.\nDr. Biggs says: \" For many years in England an active anti-tuberculosis campaign has\nbeen carried on, and there has been a steadily and constantly decreasing death-rate from the\ndisease. The death-rate from pulmonary tuberculosis there is now about 1 per 1,000 of the\npopulation, as compared with 1% in New York State and 3 in France. England has the lowest\ntuberculosis rate of any of the great countries of the world. In contrast to England, France\nhas done practically nothing before the war for the prevention of tuberculosis. Such antituberculosis movements as had been taken were local and sporadic in character and were solely\nthe result of private initiative. The sanitary authorities had never taken official cognizance\nof the disease, and notification of it is not required in France even now. There had been no\nprovisions for institutional care either of early or advanced cases, and but few dispensaries.\n\" At the beginning of the war there were only 1,000 sanatorium beds in the whole of France\nfor tuberculosis, and these were in private institutions. There was no provision for the care of\nadvanced cases, excepting as they were received in the general wards of the general hospitals.\n(You will recall that this method of care was prohibited more than twenty years ago in New\nYork City.)\n\" The death-rate from tuberculosis in France has been continuously high, and especially high\nin the cities, and has decreased slowly and but little. For the whole of France before the war\nit was nearly 3 per 1,000, and in many of the cities is was much higher. In some cities, as, for\nexample, in Havre, the death-rate last year was more than three times that of New York City,\nand the tuberculosis death-rate alone of Havre was equal to 40 per cent, of the total death-rate\nfrom all causes in New York City.\n\" The results, as I said, are exactly what one would have anticipated\u2014the development of\ntens of thousands of cases of tuberculosis among the troops. By the end of December, 1915,\n86,000 soldiers had been returned to their homes with active tuberculosis disease. In February\nof this year it was estimated that about 150,000 had thus been returned, and more are constantly\nbeing discharged for this cause.\n\" The history in France has been repeated, I believe, from such data as are obtainable, in\nAustria, Hungary, and Russia, and to a less extent also in Germany. England alone has not .\nsuffered to any great degree, and this is because, first, of the low prevalence of tbe disease in\nBiggs, H. M. Am. Review of Tb, 1917, Vol. I, 8 Geo. 5 Provincial Board of Health. G 185\nthe civil population of England previous to the war; second, because the army was mobilized\ndeliberately, and careful physical examinations were made, and those applicants who had\nsuspicious histories or signs were excluded; and, third, because the English troops live under\ndistinctly better conditions at the front than do the French, because as a nation they are fond\nof fresh air and outdoor life.\n\" The contrast between the present situation with reference to the tuberculosis problem as\nit exists in England and as it exists in France is most striking and instructive. France has\nsuffered from the war infinitely more than England has thus far. Still Great Britain has raised\nan army of over 5,000,000 men, and no new or serious tuberculosis problem has been created.\nFrance, on the other hand, has a problem of such magnitude that it threatens even the future\nvitality and economic development of the French people. In England the tuberculosis problem\nhas been efficiently met before the war; in France, on the other hand, practically nothing had\nbeen done. It is not, therefore, because measures for the prevention of tuberculosis are wanting\nor inefficient that tuberculosis has become such a serious problem in so many European countries,\nbut it is simply because the well-tried measures have not been applied, both before and since the\noutbreak of war, in an efficient way.\"\nThis surely is sufficient evidence that it is our patriotic duty to protect the health of the\npeople by a properly organized anti-tuberculosis campaign. The results of inadequately handling\nthe problem, or leaving the matter to private effort, is well illustrated by Dr. Biggs's report of\nthe appalling conditions in France at the present time. As a result of his report legislation has\nbeen recently passed in New York State making it compulsory for every county having a population of 35,000 to provide hospitals or sanatorium beds for the treatment of tuberculosis equal in\nnumber to the death-rate in that county from tuberculosis. It is the imperative duty of this\nProvince to adopt such well-tried measures as have proved effective in England and other\ncountries. Let us cease trifling with this problem, and let not future generations reproach us\nthat they knew but did not act. With our splendid climate, our uncrowded cities, and our young\nprosperous people, there is no reason why we should allow the matter to drift until we have\nthe enormous problem upon us that they have in some of the older countries of the world.\nTo carry on any effective campaign against tuberculosis in this Province means the expenditure of a large amount of money. It is'much more than can be done by private philanthropy.\nPrivate philanthropy has been the pioneer, but it is now time the Province should act upon the\nknowledge already gained.\nPublic health is a purchasable commodity. Let the public understand that, once and for\nall time, and there will be no objection to the Province preserving for the people that which\nmoney cannot restore to them when lost.\nDiscussion on Dr. Vrooman's Paper.\nThe Chairman: I am sure we have all listened to this paper, this very valuable and \u25a0\ninstructive paper, on the question of tuberculosis which Dr. Vrooman has so ably put before\nus, and we are particularly struck by the fact that for once we are running down some method\nof prevention; but I am not going to speak on this at the present time; I wish to call on\nPresident Wesbrook to open the discussion. I would also ask all those who take part to give\ntheir names and places of residence so that the stenographer may take it down, and also speak\non one side of tbe room, or in front here, so that all can hear.\nDr. Wesbrook: Mr. Chairman, Ladies and Gentlemen,\u2014I wish first of all to congratulate\nmyself and all of you upon having had the privilege of listening to Dr. Vrooman's paper. It is\nemphatic; it is clear; it does not advocate new and untried methods; it is a vindication of the\npractices which have been adopted, first, from a financial standpoint, and, secondly, backed up\nby Government in many countries of the world. Dr. Vrooman quoted Dr. Hermann Biggs a\nnumber of times. Dr. Biggs did more, I think, for municipal health, particularly in regard to\ntuberculosis, than any other one single individual in the world so far as I know. You may recall\nthat in the early nineties, in order to get the people educated on tuberculosis and in order to\nstimulate an interest, sputum examinations were begun by the New York Health Department.\nThey were made free. I remember at the time many people who had made themselves skilled\nin this kind of work used to protest against the city doing it for nothing, because it would\ninterfere with the practice of medicine in that regard and interfere with fees. As a result of\nthat, however, gradually the people and, still harder to do, the profession were educated as to G 186 British Columbia 1918\nthe economic and social importance of tuberculosis. We in the profession for many years had\nbelieved that every place in which medicine entered was holy ground, and that nobody was\ncapable of understanding it unless he were a medical man. Gradually in New York they were\nable, through this publicity, to locate tuberculosis that otherwise would not have been located,\nand finally to make it a reportable disease, which completed the census of tuberculosis. That\nis the kind of thing that Dr. Vrooman is advocating for us here. Very aptly, I think, he pointed\nout the peculiar nature of tuberculosis, referring to its pathology and to its chronicity ; to the\nfact that the tubercle bacillus had a double effect, one of stimulating tissue-growth, the growth\nof ordinary tissue, and of connective tissue, and when in large quantities at present it has a\ncapacity of breaking down tissue. Now, these two processes are going on all the time, and the\ntreatment of tuberculosis is based upon that; that is, the building-up of the system and giving\nnature a chance to wall in the infection. However, the tubercle bacillus is a long-lived bacillus.\nIt is extremely resistant; it has in its envelope a very resistant material, and it may remain\nalive, if not actively growing, for months and for years. Now, this proves a hardship\u2014at least,\nmakes the difficulties greater of dealing with tuberculosis ; but, ou the other hand, it gives\na chance to save the individual, if not whole, at least to save him if we find out in time that\nhe has tuberculosis.\nDr. Vrooman pointed out very clearly to us that every one of us has at some time been\nstruggling with tubercular bacilli in smaller or larger numbers. When the test first came out\nit was very discouraging to find that it was of value only in children, and we all reacted on\nthis test after we got to a certain age. I was reminded, as he read his paper, of what I heard\nOsier say one day. Simon Flexner, before he went to Philadelphia and before he went to\nRockefeller Institute, used to be at Johns Hopkins, and he was conducting an autopsy in order-\nto find out the cause of death where the patient had died of something else than the diagnosis..\nAt the time it was not thought it was tuberculosis; they didn't know what it was. It was a very\ninteresting case. but. as Kipling says, that is another story; it was published later. I happened\nto see the first autopsy as the lungs were being examined, freely cut into, an old place\u2014I forget\nwhether it was calcified; I don't know; but while Flexner was conducting it Osier said: \" Oh,,\nwe all have them.\" Well, that was very startling at that time. There were very few people-\nwho would have been as frank about it as Osier was; b*ut that was true; they had to struggle\nwith the tubercle bacilli, and in hundreds of autopsies on adults you will find a very high\npercentage\u2014perhaps you placed it too high. Dr. Vrooman\u2014well, it is probably safe; and you\nwill see evidences of a struggle with tubercular bacillus. Now, that gives us our chance, while\nit makes for us also a very difficult problem, because you never could know when the battle has\nbeen won. It makes it all the more important, however, that we should have early diagnosis;\nand in order that Dr. Vrooman's plans, which are admirable, should be successful, it means that\nearly diagnosis must be made, and it means that those who are capable of making them should\nbe available.\nNow, the physicians in this room are probably not very different from the physicians\nthroughout the world, and in my experience probably not over 3 or 4 per cent, of the ordinary\npractising physicians, or physicians as they run, do make\u2014I don't say they can't make, but\nthey do not make diagnoses of incipient cases in many instances which come before them. Now,\nfor Heaven's sake, we in the profession ought to be able to make a diagnosis long before the\npeople on the street can. We don't want any curbstone diagnosis, across-the-street diagnosis.\nTemperatures, night-sweats, loss of flesh, cough, haemorrhage\u2014some of these things, the laity\ncan make a diagnosis under those circumstances. Now, we don't give ourselves or the patients\na chance if we don't do it. 1 know that great pressure is brought to bear upon the physicians;\nwhen a patient suspects that he has tuberculosis and goes to a physician, he is afraid; but if\nsomebody will just take a good look at him, possibly look at his tongue and pat him on the back\nand say, \" You are all right,\" that patieut is very happy\u2014used to be; but remember now that\nwith this new axiom, that public health is a purchasable commodity, the people are taking a\ngreat interest in health and tbe principles which underlie it, and we are expected to be able to\nexplain our problems in their language and to justify our decision. Now they are beginning\nto realize that when they go into a doctor's office to be examined for tuberculosis they may be\nstripped, and that an examination is to take some time; and many of them know about X-rays,\nsome of them know about tuberculin, and they all know about the use of the stethoscope, percussion, and all that kind of thing. Now. it is no wonder that the people who are engaged in 8 Geo. 5 Provincial Board of Health. G 187\nthe practice of medicine, and who have to deal with all of these branches, in certain of them are\nnot expert. Now, I have a reason for speaking on this. I believe very much in Dr. Vrooman's\nidea. I believe that we should have the best possible expert in the service of the Government at\nthe head of this tuberculosis movement. I don't believe, however, that we need local ones; and\nthis war has upset all of our calculations. Before the war, as Dr. Vrooman has pointed out,\nexperts on tuberculosis were extremely scarce, and now with the lighting-tip of these cases, due\nto exposure and to bad physical conditions\u2014because we have them in Canada as well as in\nFrance. We haven't any 400,000 or 500,000 as Biggs estimates for France, but we do have a good\nmany cases which have escaped tbe attention of the examiner for overseas service, and have been\nlighted up since. We do not sleep so many people in an underground hut; we believe in fresh\nair, and have gone in for outdoor exercise, and so on, as Dr. Vrooman has pointed out; but we\nhave an increase in tuberculosis, and it seems, as a war measure alone, any nation might well\nspend, and it would be real economy, a great many thousands, hundreds of thousands, millons\nof dollars, because every soldier, potential soldier, who is.kept fit in this way is a decided asset.\nThat is equally true of these times.\nNow, to get back to the point to which I was referring to a minute ago: Why would it not\nbe possible\u2014I don't know whether Dr. Vrooman could do it if he had more assistants\u2014and I am\nable to say that be needs more assistants. He didn't know I was going to say that, but I say-\nit now; I have been up there and he does need more assistants. That ought to be arranged so\nthat all of us could avail ourselves of his special knowledge. Why wouldn't it be possible, say,\nto begin in Victoria, Vancouver, New Westminster, and some of these other places, and have\nDr. Vrooman, or other experts if we have them, begin a little dispensary clinic. It would do two\nthings\u2014you would get a lot of cases if it were advertised, we could bring in a lot of cases we\ndidn't know about; on the other hand, if the profession would co-operate, we would be getting\na good many other people around us who are experts in this. I don't know whether Dr. Vrooman\ngets them or not; I suspect that he gets a good many cases sent up to him which might have\nbeen diagnosed as incipient cases a good many months and, in some cases, years before he gets\nthem. Now, that is true in other dispensaries. It is true all over in every place that I know\nanything about; and I do think that we are going to save ourselves money; we are going to\nsave the country many lives, we are going to save a great deal of suffering if we can get these\ndiagnoses made earlier.\nI believe in the idea of the district nurse. I wish I could have had a chance yesterday of\ndiscussing the paper on \" Medical School Inspection.\" I am a very great believer in it. Yon\ncan't sit around, doctors can't, and wait for patients to come to them. The city has to go out\nand seek the sick, and there are many ways of doing this. The chief way perhaps is school\ninspection, and that will not be efficient unless it is seconded by visiting nurses. Very often the\nabsence from school of a child will give you a clue to some illness that you would not otherwise\nhave found, particularly if you are able to send your nurse out to the home and see about it.\nNow, that is a good thing in the city; it is a more necessary thing really in the country. Now,\nI would like to speak most enthusiastically and to speak at some length, but I think perhaps\nsome of us in talking about these matters will suggest to Dr. Vrooman, or may directly ask him\nquestions; and I think that Dr. Young, who got this meeting up. is to be congratulated that\ntuberculosis, always an important matter and during tbe war a very important matter, was so\nstrongly featured on this programme, and I think it is a great privilege that I am allowed to be\nhere and have an opportunity of getting back again into touch a little with the work of public\nhealth, which meant so much to me for such a long time. I thank you. (Applause.)\nThe Chairman: Dr. R. E. Walker.\nDr. Walker: Mr. Chairman, Ladies and Gentlemen,\u2014I would just like to add a word in\npraise of the very excellent paper which Dr. Vrooman has communicated to us to-day. His wide\nexperience on this subject always makes anything that he may say instructive, and it carried\nwith it belief on the part of these who may have the privilege of hearing him. In his remarks\nDr. Vrooman mentioned several points which to me, as a general practitioner, were particularly\ninteresting. Firstly, with regard to bronchial-gland infection which Dr. Vrooman mentioned,\nI think that very few practitioners fully realize the frequenecy and the importance of bronchial-\ngland infection in children. So many children are brought to the practitioner complaining\u2014the\nparents say they are not up to tbe standard, they are below par, they are run down; and very\noften, I think, the general practitioner is satisfied with this diagnosis; he does not investigate\nI G 188 , British Columbia 1918\nthe case thoroughly, and they are allowed to drift along by themselves with a drink of tonic or\nsomething of that kind; but a true diagnosis of the case is often not made.\nWhen I was in Eastern Canada not long ago I visited several of the tuberculosis clinics that\nwere conducted by the various cities there, and I was much struck by the thoroughness with\nwhich these children are examined and a true diagnosis come to. All the children admitted to\nthese clinics are given a tubercular test, and then they are X-rayed, and great reliance is placed\non the taking of the X-ray. If the disease is active, in Toronto and Montreal both, they have\nvery excellent sanatoriums close to the city where these children are placed. The Toronto one\nis quite an extensive institution, and they are kept there for varying periods; they are given\nsuitable treatment, and open air classes are conducted, open-air schools are conducted with these\nchildren in attendance, and the result is very satisfactory in connection with that. I think, if\nthe general practitioner were more alive to the fact that bronchial-gland infection is so frequently\na case of sickness of an indefinite character in children, we would get much better results than\nwe do.\nThen, again, Dr. Vrooman stated, with regard to pulmonary tuberculosis, that often the\ndisease can be diagnosed from clinical symptoms alone. In this 'I quite concur. I think it is\nmuch easier for an inexperienced practitioner; that is, one inexperienced in making physical\nexamination and diagnoses of incipient tuberculosis from clinical symptoms than it is from the\nphysical examination; and in this connection I would like to draw attention to what I have\nfound. We have heard Dr. Vrooman say that patients have frequently told them that their\ndoctor said there was nothing wrong with them; that is, nothing wrong with their lungs. Well,\nI find that patients place an undue reliance on the physical examination. The stethoscope is a\nsort of mysterious instrument to them, and they come into your office and they consult you, and\nall they want is an examination. They come in and they don't want, very often\u2014don't want\nto be questioned. The first thing they want to do is to strip off their clothing and have their\nchest examined; and no matter what you may say to them or what you may think, you may tell\nthem that they are tubercular, but if, unfortunately, at the same time you tell them that you\nhave not been able to get any physical signs, as perhaps an inexxierienced man\u2014when I say\ninexperienced, a man who is not expert\u2014he is not able to get physical signs, that Is about all\nthey pay attention to ; and you may assure them that they are tubercular, but if you incautiously\nsay at the same time that you have not been able to get any physical signs, anything wrong in\ntheir lungs, they go away quite happy and satisfied that they haven't got consumption, as they\ngenerally call it. So that I think more caution should be exercised in telling patients what the\ncondition of their lung is; that is, if the doctor does not find physical signs, be should be very\ncareful at the same time to impress upon them that, although the physical signs are not there,\nor that he cannot detect them, still they are tubercular. He should certainly impress upon them\nthat they have tubercular trouble in the lungs, although it is not to his ear or under his\nexamination discernible.\nWith regard to the question of the immunity of England from tuberculosis, I happen to have\nread\u2014I think it was an article by Dr. Biggs, whom Dr. Vrooman quoted, and he suggested in\nthis article that the immunity of. England from tubercular trouble was purely the result of\naccident, in this: that many years back it bad been the custom for indigents to be placed in\nworkhouses and poorhouses; long before the tuberculosis was recognized as an infectious disease,\nlong before it was even diagnosed, these unfortunate persons soon became indigent and were\nplaced in infirmaries. In this way segregation of advanced cases was made long before it was\nconsidered necessary to separate them they were separated, perhaps to the detriment of a good\nmany of the other patients in the infirmaries, but it had a good effect on the community at\nlarge; and it is to this segregation, at first purely by accident, that England now is so immune\nfrom tubercular trouble.\nThis, I think, has an important bearing on the whole question, for although this very\nsegregation was extended, it shows, it teaches us a very important lesson, that we might learn\nthe value of segregating advanced cases; and my own opinion is that all advanced cases should\nbe treated in hospitals. I do not think that any advanced cases can be properly treated in their\nown homes, because when they become advanced they are more or less helpless, and no matter\nbow well they understand, how well they may be taught the necessity of taking care of their\nsputum, and that kind of thing, when they are very sick they become careless, and their friends\nbecome careless, aud I don't think that you can ever treat an advanced, open case of tubercular 8 Geo. 5 Provincial Board of Health. G 189\ntrouble anywhere but in hospitals. I think that that is a very important thing indeed, because\nit is through these advanced cases that the infection of tubercular trouble is being largely spread\namong the children and the non-infected persons in the community.\nWith regard to the question of dispensaries, I think that is, of course, an excellent plan.\nIt is a plan that is being adopted everywhere. There may be some difficulty in the country\ndistricts. The idea that suggested itself to me was that possibly, through the aid of the\nVictorian Order of Nurses, we might get some assistance. I know I have found these ladies\nconnected with this organization of inestimable value in general work. They are well trained,\nthey seem to have been selected very wisely, and are as a rule a very intelligent, able body of\nwomen; and in the country districts I think possibly their services might be enlisted in connection\nwith visitation, home visitation of tubercular cases, as suggested by Dr. Vrooman. I thank you,\nMr. Chairman. (Applause.)\nThe Chairman: Major Proctor will now speak on this subject.\nMajor Proctor: Mr. Chairman, Ladies and Gentlemen,\u2014I will only occupy a very few\nmoments. I want to add my testimony to the great pleasure with which I have listened to\nDr. Vrooman's admirable address on this subject. Dr. Vrooman has given you in his paper the\ntheory of this subject. I know something about Dr. Vrooman's work and practice. He is too\nmodest a man, of course, to tell you what excellent results he is getting and the work he is\ndoing, at Tranquille. I know I have thought that sometimes, as one who has been interested for\na long time in this work, that part of the indifference of tbe general public\u2014yes, and even of\nthe medical profession\u2014has arisen from the idea they have of the apparent hopelessness of\ndoing very much with a tubercular patient, an idea which is absolutely erroneous, au idea that\nis almost cruel. I should like to tell you, along the lines that I have heard a moment ago, of\nthe excellent work that is being done up there at Tranquille by Dr. Vrooman and his staff.\nI think that every Health Officer who has the interest of the general public at heart should\nknow. Out of twenty-five cases that went there, and who were afterwards discharged as cured\nfrom that institution\u2014a small institution, an institution that has been struggling along against\ngreat odds, the want of the necessary money\u2014it cost, that batch of twenty-five patients, it cost\nabout $6,000 to look after them and discharge them as cured; and from the date when these\ntwenty-five patients were found, who were discharged as cured and whose cure cost $6,000, they\nhad earned some $65,000 in wages since their discharge. That, I think, ladies and gentlemen, is\na result worth talking about; it is a result worth knowing. (Applause.)\nThis war has taught you and me a great many things. It has taught us, I think, perhaps\nabove everything else, the value of physically fit people among those of us who have been talking\nabout health problems for several years. We have been talking about tuberculosis, and we\nthought we might be accused of driving a bobby almost to death. I think, ladies and gentlemen,\nthat this war has absolved us from that charge; and you know that is of supreme value to\nyou and irie to-day as a nation to be a physically fit people, and no money that is spent in that\nway I think is money wasted. I find that since this war started, and since it has gone along\nand we have seen in the papers from time to time the huge amount of money that it is costing\nus to finance this war, although we have not been able to convince our Governments that they\ncould spare the money to properly look after the indigent tubercular subject. Now, in our\nDominion I think we now realize, ladies and gentlemen, how well spent that money would have\nbeen.\nNow, I am not going to keep you, because the hour is getting late, but Dr. Vrooman's paper,\nof course, points to a practical model of what is to be done. It resolved itself into two phases\u2014\ntreatment, which I do not intend to go into, he has gone into that so well; and the prevention\nwhich is the important thing. The care of advanced consumption, which, of course, is dangerous\nconsumption, is of pre-eminent importance, as has been shown by Dr. Wesbrook, Dr. Vrooman,\nand Dr. Walker. We physicians see a good deal of advanced consumption. I see a good deal\nof it in this city; unfortunately, up to date there is no proper means of handling such a case.\nSuppose we have in this city, as we have, indigent consumption. We know their home; we have\nno means of taking bold of that man to handle him and put him into an institution and keep him\nthere. I could give you instance after instance of what happened. Not so very long ago, about\na year ago, an advanced consumptive was discharged because he wanted to go; he wouldn't\nremain any longer in our hospital up here, the Vancouver General. He spent the next succeeding\nfive months in being a waiter in one of your restaurants in this city. Then when he got too sick G 190 British Columbia 1918\nto carry on he returned again to the Vancouver General Hospital, ncvnd that, ladies and gentlemen, for that we have absolutely no means of handling it to-day, handling that problem. Another\ncase that I saw this week has been in two sanatoria in this Province. He returned because he\nwouldn't stay there. We had no power to keep him. He refused absolutely to go to the\nVancouver General Hospital. Now, that is the important thing. We want a place where we can\nkeep subjects of that type, where they can keep them in a ward. The result is he is staying\nwith many others in a rooming-house in this city, infecting others with the same trouble. That\nis a problem that confronts us, and it is one of the most serious kind.\nWe had a clinic in this city, a clinic that -was established years ago by the enthusiasm and\nthe interest of the women of our city, a clinic that I think has shown excellent work; and the\nproblems that present themselves to those who attend that clinic are many and varied. I must\nnot talk too much, but I just want to say this: Take, for instance, a case we sent up to Dr.\nVrooman at Tranquille. the mother of a family. The mother goes there; perhaps she is an\nadvanced case ; I have two families of that kind where the work of these households is being\ncarried on in both these instances by girls, children of fourteen and fifteen. Those children are\nhousekeepers; there is no money to do.any thing else. They are living in the same surroundings\nand under tbe same conditions as the mother who has been to the sanatorium, and perhaps died;\nand they have no present facilities for doing anything else; and yet those children will be the\nvery ones who will develop this disease if they are not placed in proper surroundings, if they\ndon't have to go to work, if they are not able to get the proper food that they require, and the\namount of fresh air. I believe there is a movement on foot in this city, and I may be able to\ntell you it may\u2014I don't know that it will be, but it is talked about being undertaken, under\nwhich in this city a children's institution for suspect and others who have tuberculosis, the kind\nof people who will develop tuberculosis if they are not particularly looked after. The trouble\nwith meetings of this kind, the trouble with papers of this kind, ladies and gentlemen, is that\ntoo often a remarkable paper like Dr. Vrooman's is listened to with delight by everybody present,\nbut nothing practical results. Now, what I should like, if possible, would be that you should\nauthorize the Chairman of this meeting, say, to appoint a small committee to bring in recommendations to be sent to the proper legislative authorities, the recommendations being a result\nof what you have listened to here, with the hope that something practical may be the result of\nthe delightful paper and the presentation of the subject such as you and I have listened to from\nDr. Vrooman this morning. (Applause.)\nThe Chairman : Ladies and Gentlemen.\u2014We may congratulate ourselves on having with us\nto-day the Provincial Secretary and Minister of Education, Dr. J. D. Mac-Lean. I know he is\nwith us in his interests as a medical man with regard to this subject, but I think he will go\nfarther still and make the best endeavour to get the necessary money to carry on this warfare\nwhich is being carried on by Dr. Vrooman against the white plague. I will ask Dr. MacLean\nif be will kindly say something on this subject now.\nDr. MacLean: Mr. Chairman, Ladies and Gentlemen,\u2014I assure you that it indeed affords\nme a very great deal of pleasure to be present here to-day, and the pleasure is enhanced owing\nto the fact that you are discussing the problem in which I have always been very greatly\ninterested, and that is the problem of tuberculosis and the prevention of this disease.\nBefore taking up any discussion on the question, I wish on behalf of the Government to\nthank the men and the women who have come here at a sacrifice of time and energy to discuss\na question of this kind. It speaks well for your loyalty to the Province, and it speaks well for\nyour interest in the future welfare of the Province that you have come here in such numbers,\nmany of you at considerable expense; and we all know, those of us who have been engaged in\nthe practice of medicine, that time away from your office is absolutely money lost; so that 1\nsay that yon are to be congratulated for the sacrifice that you have made in this connection.\nNow, I do not appear before you to-day at all as an expert on the question of -tuberculosis.\nAs probably some of you know, for the last ten years I have been engaged in the general practice\nof medicine in a rural community, or at least a community which was largely rural, and tbe\nquestion of turberculosis as it affects rural districts, of course, came largely before my mind and\nto my attention, and it seems to me that it is in the rural districts, in tbe outlying districts, that\nthe problem is the greatest. Those of you who have practised medicine in the outlying districts\nrealize the difficulties under which the general practitioner labours. For instance, you get a case\nof tuberculosis. You have a small hospital, probably anywhere from ten to twenty beds, and to 8 Geo. 5 Provincial Board of Health. G 191\nbegin with, the hospital authorities are not very anxious to take your patient in, for the simple\nreason that if the news gets spread abroad that there is a tubercular patient in your hospital,\nwhy the other patients in the neighbourhood, who would naturally go to that institution, do not\nwant to go; consequently the hospital authorities\u2014and this is not because they are not convinced\nof the seriousness of a case of tuberculosis, but from purely financial considerations. A hospital\ncannot be conducted without money, and if you have your patient in there, a tubercular patient,\nthe majority of people are afraid to have a patient go into that hospital; consequently the problem\nis a very difficult one there. And in addition to that you have the fact that it is so difficult to\nconvince the people that there is a case of tuberculosis in their family. Various considerations\narise, most of which are uncalled for. They seem to think, the average individual, that there\nis some kind of disgrace attached to the fact that there is tuberculosis in the family. These are\ndifficulties which have to be met in the outlying districts.\nI was particularly pleased with Dr. Vrooman's paper, and the particular feature that\nappealed to me in it was the entire practicability of the paper. Tbe suggestions that he made\nwere not purely theoretical suggestions; they were suggestions that are absolutely carried out\nin private practice, in the practice of medicine in this Province. And I was particularly pleased\nwith it for another reason, and that is that it went very much along the lines of the suggestion\nand the ideas of the Health Department in Victoria and myself, in discussing what could be\ndone, and what should be done, or what might be done in the fight against this disease. I say\nit was very much along the lines that we happened at Victoria to consider wise. However, I do\nnot wish at all to take any credit away from Dr. Vrooman for his very excellent paper, and\nwhile we have many of the ideas that he has, he has succeeded in systematizing and in placing\nthem in a practical light which will be of very great assistance to us in our endeavours to have\nsome solution toward the working-out of this very great problem.\nNow, I wish to assure the medical men and women who are in attendance here to-day, and\nthe others of the audience who are interested in this work, that we in Victoria are deeply\ninterested iu this question of public health, and, in particular, in the question of the preventiou\nand spread of tubercular disease. You know it is rather a large question, and you know that\n\u25a0Governments are traditionally slow in moving, and you will have to take all that into consideration when you are looking for some results, or for results of this meeting, as suggested this\nmorning; but I wish to assure you that we are seriously intending to grapple and are grappling\nwith this question to-day, and laying out plans in order that we may be able to do something\ntowards preventing the spread of this disease. It has always struck me as being rather remarkable that a disease like scarlet fever, say, or smallpox, how all the forces of Government, whether\nmunicipal or Provincial, when a case of scarlet fever appears in the community, all the forces\nof the Government are directed in one way, and that way is to segregate that case of scarlet\nfever, to prevent the spread of the disease; but in a case of tuberculosis in the community,\nwhich statistics show is many many times more deadly, very many more deaths from tuberculosis\nthan there even begins to be from scarlet fever, the cases of tuberculosis walk around to spread\nthe disease to and menace continually their associates, and yet nothing is done. So the great\n-question to my mind, the great problem to my mind, is the question of arousing the public to\nthe very great danger of having those active cases of tuberculosis walking around pur streets.\nI do not wish to say any more, Mr. Chairman; I wish to thank you for the invitation to\nbe present here this morning and to make a very few brief remarks. I do not wish to take\nup time which can be very much better occupied in listening to those who have a real practical\nknowledge and a working knowledge of the subject under discussion. I thank you. (Applause.)\nThe Chairman: Ladies and Gentlemen,\u2014This subject is open for discussion, for general\ndiscussion; but I warn you that the time is getting on, and we have two more important papers,\nand we have yet to have an address from Dr. MacLean to be delivered later on. He has just\n\u25a0spoken a few words on the subject of tuberculosis. Now, I hope any one who wants to speak\nwill get up and speak quickly on the point, and distinctly.\nDr. MacLean: Mr. Chairman, I wish to correct your reference to the address that 1 was\nto give. Those of you who have been engaged in the practice of medicine realize how oftentimes the very best plans that you may make will go wrong; and, while I am not engaged in\nthe practice of medicine now, I am engaged in work that is fully as jealous of one's time as the\npractice of medicine, so, as they say when they get in a hurry in some meetings, we will have G 192 British Columbia 1918\nto take the paper that I was to have given to-day as read; so that if you were expecting any\nparticular paper from me, I am very sorry that I have not been able to give the time and\nattention to the preparation of such a paper.\nThe Chairman: Any further discussion on this subject? Any of you who wish to say\nsomething, do not delay.\nDr. Wesbrook: I don't wish to speak twice, Mr. Chairman; but something has occurred tome, and that is that I failed in my talk before to express appreciation of the wonderful work that\nDr. Vrooman is doing; and I wonder how many of tbe Health Officers and medical practitioners\nand others who are here to-day have visited that institution. I would like to suggest that that\nis one very good way of seeing modern tuberculosis work; and we have it, as you have gathered\nto-day from skiagraphs exhibited here, we have it in this Province in as up-to-date fashion as we\ncould wish.\nI would like also to suggest that when Dr. Vrooman closes the discussion, if he will kindly\ndo so, he will tell us a little something about the special tuberculosis school which is being run\nat Saranac, just a few words, because some of us may wish to avail ourselves of Dr. Vrooman's\nhelp, and I hope we all will do that; and some of us may wish to get a little further expert\ninformation, and he can tell us all these various particulars.\nW. J. E. Biker, CE. (District Engineer, Nelson) : I, like Dr. Wesbrook and others who\nhave spoken previously, congratulate myself on hearing such a very explicit paper as we have\nhad this morning. I would like to elicit from Dr. Vrooman a few practical points on the living\nconditions of the people. I am speaking as a layman and as an engineer, therefore I hope you\nwill bear with me. I feel rather out of my atmosphere with so many doctors present, but the\nliving conditions of the people must have something to do with tuberculous cases. I come from\nthe Upper Country; I work up at Nelson, District Engineer for the Government, and my work\ntakes me a great deal into the mining and logging camps. Now, particularly mining: I would\nlike to ask Dr. Vrooman if be has any percentage of the cases that come under his control that\ncome from mining camps in this Province, because in camps I have noticed buildings from 18 to\n24 feet long and 6 feet high at the eaves, from thirty-two to thirty-six men sleeping in one room,\nand with very little ventilation at that. There was another point I would like to ask, and that\nis this : The immunity that England finds herself in from tuberculosis, is it entirely due to\nthe methods that have been used in attacking this disease, or is it in some measure due to the\nimproved sanitary conditions? Those are points that I would like to hear Vrooman on.\n(At. this point Dr. Wrinch substituted in the chair.)\nThe Chairman: Is there any other discussion? There are some who wish to hear from\nDr. Underhill.\nDr. Underhill: I think, Mr. Chairman, as the time is getting on, I can add nothing more\nto what has already been said, but the only question I would like to ask Dr. Vrooman, in\nanswering the remarks on his paper, is to deal with surgical tuberculosis, the methods and the\nmeans he would adopt for dealing with this question. I think that is something that is of great\ninterest to all of us, especially at tbe present time.\n(Dr. Underhill resumes the chair.)\nThe Chairman: If there is no further discussion I will ask Dr. Vrooman to reply.\nDr. Vrooman: Mr. Chairman, Ladies and Gentlemen,\u2014I wish to thank you for the very\nkindly way that my paper has been received. There is nothing in it but what you will find in\nthe literature on tuberculosis for the last five years. I have tried to give you what are the well-\nestablished views, and my hope is that it may have some practical effect. In reference to a\npoint raised by Dr. Walker, the patients are too ready, I quite admit, to say there is nothing\nwrong. I have had patients in and out of my office in the sanatorium, coming there and telling\nthe other patients that I ea'id there was nothing wrong with their lungs, when I told them,\nthough not definitely, that they had tuberculosis, but not much. This has happened more than\nonce at the sanatorium, so I quite realize that it is going to happen many times in private\npractice, and it means that we have to be careful.\nI would like to hear mention the good work that has been done by the ladies of Vancouver\nin connection with the tuberculosis clinic. It has been a pioneer and it is leading tbe way.\nThe only difficulty they have laboured under with regard to it is the lack of money. They have\nonly had one tuberculosis nurse in Vancouver when they should have had three, and they haven't\nhad any place to put the patients when they discovered them; but they have done good work, S Geo. 5 Provincial Board of Health. G 193\nthey have helped us in the sanatorium, they have helped to look after cases here, and I cannot\npay too high a compliment to the ladies and the nurses who have been in charge of the clinic.\nNow, I only hope that the work will be extended much farther.\nDr. Proctor referred to tbe incorrigible patient. We have to handle these in a special way,\nand New York handles them in a special way; they have a special place for them on one of\nthe islands in the East River, a special hospital where the incorrigible patient who will not\nstay in the sanatorium, who will not obey the rules while in the sanatorium\u2014there is a small\npercentage of these anywhere; and in New York City it is recognized, and they have established\na separate institution for that purpose where they are committed by a Magistrate, those who\nare absolutely incorrigible, and most of them are drunkards and absolutely careless. They are\ncommitted, and they are allowed privileges only under conditions of good conduct. I think for\nthat class something like that will have to be done, because there is a small percentage of what\nyou might call indigent drunken, open cases of tuberculosis.\nThe problem that Dr. MacLean has mentioned of the rural districts is a considerable one.\nThe smaller hospital can hardly handle tuberculous cases, and that is the reason why I say\nthat the sanatorium at Tranquille will still have to handle a certain number of advanced cases,\nbecause these rural hospitals cannot under many circumstances take them in. It is only in the\nlarger centres like Vancouver and Victoria where they would have the separate hospital.\nI was very glad to hear also that the Government is now going to act. We hope to see\nthat the action means the voting of a large sum of money to be devoted to this purpose. That\nquotation was from Dr. Biggs, that health was a purchasable commodity, and if the Government\nof British Columbia wishes to purchase immunity from tuberculosis, well, they can purchase it,\nand I hope to see that they will do so.\nI do not think that the public are fully aroused on this question. If I might be allowed to\nmake an observation\u2014because perhaps I come in contact with the public in some ways more\nthan the medical practitioner, and they express their feelings\u2014if I might decide my own profession, right in the family the public are even more aroused on this question than the medical\nprofession or tbe Government. That is my own observation, but I believe that it is correct.\nThere is a standing invitation for all practitioners of the Province to visit the institution.\nToo few have availed themselves of it. We will make yon welcome if you come and stay a day\nor a week; we will try and fix you up; and we will give you any opportunity you wish to study\ntuberculosis there, what we can do, show you what we are doing.\nThe Saranac School has been recently established. It is called the Trudoff Outdoor School\nin memory of that great pioneer in America, Doctor Trudoff, who established the first sanatorium\nin America. In memory of him they have built that Trudoff School, which is under the direction\nof Dr. Baldwin, probably tbe leading man on tuberculosis in America, and they conduct tests in\nthe schools for six weeks dealing with the tuberculosis problem, and my assistant, Dr. Gilchrist,\nhad the privilege of attending that school this summer,, and I have greatly profited; he profited\nby it and I have profited a great deal through him in the teaching of the methods that he learned\nat that school; and if any of you can afford to do so, even if you cannot spend six weeks, if you\nwill spend a week at Saranac in visiting their improvements, you will find them all royal fellows\nthere. The tuberculosis specialists are only too ready to give you everything as accurately as\npossible, if you wish to learn. And even if you cannot go to the school, if you are in Eastern\nCanada and would visit Saranac and see some of the methods there, and visit the laboratories,\nyou would see something that is being done and get a glimpse of some of the problems that come\nup there. They are doing a good deal of research-work that is being done.\nIn reply to Mr. Biker, in reference to the effect of mining, we do get quite a proportion of\nminers. I haven't got any figures here\u2014not so much among coal-miners, although we do get\nsome coal-miners; but, of course, the dust of the quartz-mine is more irritating and more apt\nto set up tuberculosis. I think that living conditions in the camp may have something to do\nwith those symptoms.\nIn reference to Dr. Underbill's question as to surgical tuberculosis of children, I have a\nvision\u2014I don't know whether it will ever be realized\u2014of seeing an institution at Tranquille\nwhich will handle all forms of tuberculosis, surgical or otherwise; that we will have there an\ninstitution that we can both give the open-air treatment, and can give, if necessary, surgical\ntreatment to children under practically what is the best kind of conditions, such as they have\nin Saranac. We haven't taken any of these, but they do, and they do exceedigly well under\n13 G 194 . British Columbia 1918\nsanatorium conditions after they have received the necessary surgical treatment. The doctor\njust gives you a glimpse of what you need, .and in thanking you for the way you have received\nmy paper, I hope that it will give you that, and that something may come of a practical nature\nfrom it; that we will do something for these sufferers from tuberculosis. I could keep you all\nmorning telling you of pathetic cases, but I am not going to, any further. I thank you, ladies\nand gentlemen. (Applause.)\nThe Chairman: The next paper, \" The Laboratory in Relation to Public Health,\" by Dr.\nWesbrook, President of the University of British Columbia. Evidently some special privilege\nattaches to being the President of the University, as he is able to find a substitute. Many of us\nwould desire the same thing when we are called upon to write a paper, but Dr. Wesbrook will\nkindly introduce the substitute for this paper.\nDr. Wesbrook: I feel, Mr. Chairman, very much like a pretender. I have been very much\nembarrassed by the fact that my name should have appeared as the reader of this paper, but\nyou have given me the privilege of explaining. At the time Dr. Young was getting up the\nprogramme he wanted a paper of this kind, and I volunteered; but just shortly after the arrangement was made a man who was very much better able to give it than I, a man who is in that\nwork and has been in that work for a good many years, decided to come to this Province, and\nhas assumed directorship of the pathological laboratories of the Vancouver General Hospital and\nis responsible for the teaching of bacteriology in the University this year. This is a composite\narrangement which is, I hope, not cutting through the lines of co-operative work which in the\nUniversity we will be free to undertake. If I might, in the opening of the discussion, speak to\nthis, I will be glad to do it. This, you will observe, is also taking another privilege; that is,\ninviting myself to discuss Dr. Mullin's paper.\nDr. Mullin returns to Canada ; he has made a place after a good many years in the States.\nDr. Mullin is a graduate of Toronto University in Arts and Medicine, worked there in the public\nhealth as assistant to Dr. John Amyot, whom you know is another of those who are mixed up in\nthe war. In parentheses I might say that Dr. Amyot and his three sons are all at the front at\nthe present time. He had, too, I think, to misstate tbe ages of some of these sons in order that\nthey might go. Dr. Mullin has practical experience in the Toronto General Hospital as a member\nof the hospital staff, was interne there\u2014or house officer, as we call it\u2014and also at Kingston,\nthe Hospital for the Insane. Then he spent\u2014well, a number of years in Minnesota in the\nUniversity of Minnesota and in the State Board of Health. Dr. Mullin and I were associated\ntogether, I think, for nine or ten years, and he was my successor as director of the Minnesota\nState Board of Health laboratories. He has had a very wide experience in pathology and in\nbacteriology, and I regard it as very fortunate indeed that you are able to get his services in\nthis Province. He will speak to you upon this problem of the laboratory in relation to public\nhealth, and if I may crave the privilege. I should like to discuss it and certain things which arise\nout of it, later. I shall ask, if I may, Mr. Chairman, Dr. Mullin now to give his paper.\n(Applause.)\nTHE LABORATORY IN RELATION TO PUBLIC HEALTH.\nBy R. H. Mullin, B.A, M.B, LjU*soratory Director, Vancouver General Hospital.\nWithin the present generation medicine has become a highly specialized science, due to the\nrapid advances that have been made through scientific methods. No longer is it possible for a\nsingle individual who used to be called the family physician to be familiar with all methods\nwhich are employed in the various branches of medicine. This family physician has been\nsupplemented by groups of individuals whose work is more or less restricted to one particular\nbranch, and who are known as specialists in that branch, so there are surgeons, internists,\ngynecologists, etc. Not only has there been specialization in these various branches, but each\nbranch has become further specialized into the clinical and laboratory science.\nDuring the process of this specialization a comparatively new science has developed\u2014namely,\nthe science of public health or public medicine. It is necessary to differentiate clearly between\nthe practice of public health and the practice of private health if an adequate idea is to be\nobtained of public-health laboratories. Private health is what is more commonly known as\npractice of medicine, is essentially individualistic, and is an attempt to cure an individual of\nsome disease for his own particular benefit, without regard to the bearing it may have upon the\ncommunity as a whole. Public health, on the other hand, deals with community health and 8 Geo. 5 Provincial Board of Health. G 195\nwelfare, and seeks to promote this by the prevention of disease, and by devising methods for\nthe promotion of the welfare of the community as a whole. In the one, individuality and cure\nare the predominating notes, while, in the other, community and prevention.\nIt is not so very long ago that public-health workers were selected without regard to previous\ntraining from the ranks of practising physicians; now it is becoming realized that for the\nsuccessful practice of this profession trained specialists are necessary. Just as in tbe development of the practice of medicine the necessity of trained laboratory workers soon became\napparent, so, too, in the practice of public health this side of the science is becoming recognized.\nIt is necessary to differentiate between a public-health laboratory and a clinical laboratory, and\nto appreciate that the two are essentially different, and that it is not necessary that a good\nclinical-laboratory man must be an equally good public-health laboratory man. The two services\nare just as different as are public and private medicines.\nThe function of public-health laboratories may be briefly stated to be: (a) To assist in the\nprevention and control of disease; (6) to devise means for adding to the comforts of community\nlife; (c) research; (d) education. The laboratory-work in the prevention and the control of\ndisease falls naturally into three subdivisions\u2014control of communicable diseases, supervision of\npublic water and milk supply, and the investigation of foods and drugs. In some communicable\ndiseases it is possible to demonstrate the infectivity of individuals by laboratory methods, and\nso determine that such individuals are a menace and danger while taking part in a community\nlife. It is also possible in certain of these diseases to determine when individuals who have been\ninfected cease to be a menace, and so accurate means are afforded for determining the time at\nwhich they may be permitted to resume their community activities. The laboratory may also\nprovide certain biologic products which may be used to artificially immunize individuals in\nthe community, so as to decrease the probability of their being infected; also to effect a cure\nwhen infection has occurred. This class of laboratory-work is accomplished in what is called\na diagnostic laboratory. Of recent years it has become more generally appreciated that this\ndiagnostic-laboratory work should be undertaken in close association with field investigation in\ncommunicable diseases, so that there is gradual development in different localities of what are\ncalled bureaus or departments of communicable disease, in which both field and laboratory\ninvestigations are made in order that all of the information related to a particular epidemic\nmay be in one branch of the service.\nThe scope of the work of a diagnostic laboratory may be broadly stated to be all laboratory-\nwork that can be of any service in the control of communicable diseases. This is naturally\nlimited to such of these diseases as have a known causative agent, but there should be no\nlimitation as to the character of the examination that should be made where this agent has been\nidentified, provided only that the examination will indicate the presence of infected individuals\nor assist in preventing the spread of the disease. From a legal point of view a communicable\ndisease is one that is reportable, but in some instances it may be advisable for the laboratory\nto go beyond this limitation, especially where, as in the venereal diseases and cancer, the danger\nis great. It might well be said that the work of health laboratories should be limited only by\nthe lack of money the public will provide through their governing bodies for maintenance.\nUsually the routine work consists in making examinations of exudates and tissue in cases of\nsuspected tuberculosis; exudates from the nose-and throat in cases suspected of carrying\ndiphtheria both for diagnosis and release from quarantine; the preparation of materials for the\nShick test to determine susceptibility of individuals to diphtheria (especially children and\ninmates of institutions where epidemics of this disease are apt to spread) ; the blood, stools,\nand urine from suspected cases of typhoid fever or its allies and the preparation of typhoid\nprophylactic; spinal fluid from suspected cases of cerebro-spinal meningitis and poliomyelitis;\nexudates and tissue from suspected cases of anthrax, actinomycosis, blastomycosis, leprosy, etc.;\nbrain of man or the lower animals in suspected cases of rabies, and giving the Pasteur treatment\nto people who have been exposed; necessary examinations for cholera, plague, and other diseases\nnot at present frequent in this community.\nIn the supervision of public water and milk supplies the laboratory-worker can be of the\ngreatest service, since it is possible by constant supervision to illuminate the danger of conveying\ninfection by either of these two routes. Here, too, there should be a close association between\nfield and laboratory investigations if the greatest good is to be obtained. If safety is to be\nassured, frequent laboratory determinations and field investigations should be made, since at G 196 British Columbia 1918\nany time accidents may happen which result in either water or milk becoming infected, aud thus\naffording a source from which a very great number of cases of certain of these communicable\ndiseases may arise.\nThe food and drug laboratory is concerned principally with the adulteration of foods and\ndrugs. An extension of the use of such a department might be made, especially in the direction\nof infant-feeding, and the determinations usually undertaken in hospital laboratories in nutrition\nexperiments. This side of the public-health laboratory has not as yet received the consideration\nand appreciation it deserves.\nIn attempts to add to the comforts of community life, problems arise which require laboratory\nsolution, especially from an engineering point of view. Most of these problems have to do with\nthe disposal of wastes in a sanitary way. so that they will be neither offensive to the senses nor\ncapable of acting as a source from which communicable diseases may arise.\nEnough has been said to indicate that a public-health laboratory is not a single entity, but\nis comprised of a number of units, all differentiated, but with points of contact between certain\nof the units. It should better be known as public-health laboratories. Many different problems\nare presented, with all of which it is impossible for one individual to be familiar. It must\nbe appreciated, therefore, that just as in other sciences, and so in public-health laboratories,\nspecialization has occurred to a very considerable extent.\nHowever, no matter how great the specialization, each has functions in addition to the\npublic service which they fulfil. These other functions are research and education, although in\nmost organizations the greatest amount of stress is laid on the public-service function of the\nlaboratories. These other two functions should never be lost sight of, and their importance is\ndifficult to overestimate. Unfortunately, it usually happens that most public-health laboratories\nare undermanned, so that all the time and energy of the workers is absorbed in the service\nfunction, leaving the other two sadly neglected.\nThere are certain elements that are necessary for successful and efficient work in any of\nthese various laboratory branches of public-health activities. As already indicated, the work\nis highly technical and specialized, and, as such, demands the service of well-trained, full-time\nworkers if accuracy and reliability of results are to be assured. The idea that a recent graduate\nor an office-girl is, ipso facto, qualified to do laboratory-work in any branch is surely passing,\nand the importance of receiving dependable results from experienced workers is becoming\nappreciated and demanded. In the beginning of development the number of such workers need\nnot be great, as it is possible to obtain men who are sufficiently qualified to oversee various\nbranches until expansion demands an increase of the force. Adequate quarters should be\nspecially designed and equipped with a view to carrying on the work so as to produce a maximum\nof results with a minimum expenditure of energy. Efficient clerical and laboratory assistants\nwill always prove an economy. These laboratories should be so situated, geographically, that\nthey are of easy access, so that the least possible delay will occur in making reports to physicians\nand health officials. Transportation facilities will have considerable bearing on the location of\nthe laboratories, since the mails must be depended upon for delivering of specimens. Where the\nterritory to be covered is of considerable extent and the population scattered, branch laboratories\ncan be maintained in the larger centres of population. When emergencies demand quick action\nor the character of the work necessitates investigation on the spot, \" travelling laboratories \" may\nbe sent out with au investigator to satisfy the immediate needs.\nAll of these features point to the necessity of providing an adequate budget for the proper\nsupport of the needs of the laboratories. One health department has for its motto, \" Public\nhealth is a purchasable commodity.\" This surely means two things: First, that it can be\npurchased; second, and equally important, it must be bought. The private individual who\nattempts to obtain something for nothing, or for very much less than its face value, is usually\nlooked upon as a grafter or a crook. Should a community expect to obtain a valuable commodity\ngratis or at less than a fair price? It has truly been said that \"The public health is public\nwealth.\" which should indicate these two are closely interrelated. The service rendered should\nbe free to the individual, but supported by the community (and where possible to obtain\nphilanthropic funds) and under governmental control at least in part, so that the results obtained\ncan be legally applied to effect reform. No successful health-laboratory work can be carried\nout on a fee basis for each examination, collected either from the patient or the community, 8 Geo. 5 Provincial Board of Health. G 197\nsince such a practice places a natural reluctance, from a financial consideration, to taking full\nadvantage of all the services that can be rendered in limiting an epidemic.\n. There are other essentials upon which the success of a public-health laboratory depends.\nSince public health is a group science dealing with groups of individuals by groups of workers,\nit is necessary that an active and hearty co-operation should occur among all concerned. In\norder to obtain such co-operation it is necessary for the laity and physician to understand what\nthe objects and methods of public-health workers are. Since the science is comparatively new,\nthere is a large amount of education necessary to this end. It must be appreciated that the\nfunds for the support of health activities come more or less directly from the governmental\nbodies. It is usually only through pressure from their constituents that the individual members\nof such governing bodies can be made to see the necessity of adequately providing funds for the\nwork. The education of the public is therefore necessary if satisfactory advance is to be made\nin public-health laboratory work, or, in fact, any other public-health activity.\nThe public-health laboratory is closely related to a variety of people. In the first place,\nit should be intimately associated with the health department of the community, since it is\nthe latter that is clothed with the police power necessary for the application of tbe results\nobtained in the laboratory for the control of some particular community disease. It is related\nto the units of the population, particularly the practising physician, and each individual family,\nsince in many cases the duration of quarantine is dependent upon laboratory findings. Where\ngroups of people are collected together in hospitals, charitable institutions, schools, etc, the\nlaboratory is of particular use, since in such institutions communicable diseases find a greater\nopportunity to spread. On account of the education that is so necessary at present, a teaching\nfunction is added to the ordinary laboratory function, and in this way the laboratory is brought\ninto close association with the teaching institutions, such as the public or high schools and\nuniversities.\nIn determining the organization of a laboratory it must be recognized that it is impossible\nto lay down an absolute rule which can make all laboratories exactly the same. Each one has\nto meet the particular needs of the particular community in which it happens to be. If,\nhowever, recognition is taken of the relation of a laboratory to the health department, to the\nhospital, and to the university, it should be possible to develop a single institution which will\nadequately serve the needs of each, and so prevent the duplication of equipment and workers,\nwhich is sure to occur when each of these three different contributing parties attempt to establish\nlaboratory-work restricted to their particular needs. Where such a co-operation exists and can\nbe fostered, it is possible to avoid many of the petty jealousies and friction which invariably\narise when different groups of workers approach each other at the border-line of their work.\nDiscussion on Dr. Mullin's Paper.\nThe Chairman: Now the discussion, and I think Dr. Wesbrook asked the privilege of\nopening the discussion, so I call upon him first.\nDr. Wesbrook: Mr. Chairman, Ladies and Gentlemen,\u2014I feel as if I had been doing a great\ndeal more than my share of the talking this morning. Dr. Mullin's paper is clear and to the\npoint, and he has shown the various lines of service which a public-health laboratory is able to\ngive to the people. In his modesty he failed to tell you that he has been the bead of a laboratory\nthat covers practically all these things, the State Board of Health Laboratory of Minnesota, of\nwhich he was chief; and he was a member also of the University of Kingston. This laboratory\nwas inaugurated and was made an integral part of the University of Minnesota. It had a Pasteur\nInstitute for the treatment of those who had been exposed to rabies. The first year of its\noperation it treated 212 people. I think it was the 242nd case in which fatal results occurred,\nand I think that they have had none since. They must have treated from 1,200 to 1,500 people\nby this time. That is not an important matter in British Columbia yet, but we never know\nwhen it will be.\nAs bearing upon what the Provincial Secretary and Minister of Education said a few minutes\nago, that it is the spectacular cases which appeal to the public; that is, speaking of scarlet fever\nand of tuberculosis, the stimulus that is given to public activity and, if necessary, public expense\nwhen a thing like scarlet fever appears. I can say the same thing about cholera. I was in\nGermany one time engaged in research-work at Marburg under Karl Bruncker, when they had\na case of cholera in a little community about three or four miles outside of this town. The G 198 British Columbia 1918\nmanoeuvres of the troops for that year were to be held about three weeks later, and 12,000 troops\nwere to be assembled there. I remember what I felt like at night when I discovered\u2014we were\nnotified at about 11 o'clock that we had cholera iu the community. I think I was the enly\nEnglish-speaking person left in that community by noon the next day. It was part of my duty,\nbecause I had already worked for three years on cholera, and I acted as a volunteer assistant,\nand three of us carried out all the necessary measures for the prevention of the disease. We\nonly had sixteen cases and four deaths, so I think we did very Well. We had sixteen pure cultures\nfrom these sixteen patients, though, in a very few hours, so that We can see what the stimulus of\ncholera did\u2014in 1894 this was. In 1892 Hamburg had its particular lesson.\nNow, to give you an experience from rabies: We got $5,000 to run that institution for the\nfirst year. It was part of the public-health laboratories there. We were able to treat 212 cases.\nEverybody was afraid of rabies. The doctors and the people knew so little about it that we\ncould have got any amount of money we wanted for that, but we couldn't get it for water; we\ncouldn't get it for tuberculosis; we couldn't get it for measles and all those other diseases,\nalthough the deaths from measles at that time were greater than the deaths from smallpox,\nalthough smallpox was quite prevalent, but it was of the very mild type. The people apparently,\nmany of them, would rather have smallpox than be vaccinated; but they had to change their\nmind shortly afterwards, as it was said yesterday.\nNow, there were other features of the work; they had engineers, chemists, bacteriologists,\nand a new trained specialist and epidemiologist. The work was here before, but the name was\nborn just recently. We were speaking of field laboratories; we wouldn't examine specimens of\nwater sent up by an analyst, somebody -who didn't know whether the water was to blame or\nnot. If there were a question of that kind came up, in the public interest we would send a\ntravelling-laboratory man, and a travelling specialist sometimes, and sometimes a chemist and\na bacteriologist, and the engineer. Well, I won't go into this thing further, except to extend a\nlittle what Dr. Mullin was saying and give you the idea that he had this in charge. I will say\nthis, and I think this is a public lesson we get out of it: It is particularly hard for us in the\npioneering stages of our different communities, owing to the fact that this is a huge Province\nand the population is relatively small, and we are as yet scientifically in the pioneering stage;\nbut we do not deny ourselves automobiles, and I think we shall have air-ships pretty soou. We\nhave the best hotel in Canada, supposedly, in this town\u2014the most expensive one, anyway.\nWe haven't denied ourselves these things in our pioneer days; now, why shouldn't we have tbe\nthings that are most essential, because in public health and public wealth, as Dr. Mullin has\nsaid, we would be conserving our cheapest asset. Now. in order to conserve this, there are a\nlot of people required for which our social, aud economic conditions as yet make no provision.\nA consulting engineer (several of them for competition) in waterworks in this Province\u2014I mean\nthe sanitary engineer\u2014would starve to death if it were left for individuals to employ him. A\nchemist devoting himself in some way to a line of public-health work would be equally called\nupon to live at his own expense. The medical profession cannot\u2014their patients are not yet\ntrained to believe in it to a sufficient extent\u2014the laboratory-man in medicine cannot make a\nliving, so that from a number of public bodies it becomes necessary to define certain groups of\npeople. Amongst them every city ought to have, as Victor Bond, of the University of Michigan,\nsays, a forensic institute; you should have a medical man ; you should have chemists ; we should\nhave physiological chemists; we should have other experts, and particularly so that when an\nautopsy is beld, if it is held by a man who is trained to do that work, just the same as we go\nto a trained surgeon; we should have them\u2014there is one group of the forensic institute. I won't\ngo into it further, but I think I have made my question plain. Then you have a group of public-\nhealth experts, of which Dr. Mullin has told us; then we have the group of diagnostic experts,\nnot for the purpose of preventing disease, but for the purpose of suggesting a cure. Nowadays\nyou can make sections of the tumours, and these are examined whilst the surgeon is working.\nYou need blood-clots; you need analyses of stomach contents; you need people to study the\nmetabolism of a particular patient to see on what dietetic treatment he shall be put, or to see\nwhat is wrong inside\u2014see why he is not working right. You need all those, and we need\nsanitary engineers, as I have said. Now, how are we going to get them; how are we going\nto provide for them? The \u2022 Provincial Government needs public-health laboratory facilities;\nVancouver needs public-health laboratory facilities; and in some places they separate the water\nbranch from the public health, but it need not be done. It just depends on who is going to be 8 Geo. 5 Provincial Board of Health. G 199\nboss of the job, whether it is the sanitation, whether it is to be sanitation from an engineering\npoint of view or engineering from a public-health point of view. There are no difficulties in it.\nAs Dr. Mullin said a little while ago. you are not going to have two organizations that are\nexactly alike. Personnel, after all, is what counts rather than system.\nNow, we can't get all of these things at once here; but the Vancouver Flospital is short of\nfunds\u2014and, by the way. the Vancouver Hospital Laboratory should not be ruu on the basis of\nfees to be collected at the time. (Applause.) It should not rest on that basis. Suppose a\npatient in the hospital, when he is ill, you make an examination of him; if you charge him for\nthat examination you are practically precluded from making a whole lot of other examinations\nafterwards. He may prove to be a very difficult case, and he may prove to be a very instructive and educational case; aud suppose you want to examine him every fifteen minutes day\nafter day, you can't charge him or some one else for each one of these examinations. I am\ngetting off the track; that is just an aside. But ultimately a group of men should be brought\ntogether, consisting of bateriologists. chemists, physiologists, pathologists, engineers, and\nvarious other people, for the carrying-on of the public service. Now, if that cannot be paid out\nof the fees from patients, if it cannot be paid by municipalities employing experts when they\nneed them\u2014here is another aside\u2014you know they usually get into all sorts of difficulties because\nit costs from $5,000 to $10,000 to have experts, and after they get into difficulties they spend\n$100,000 in getting out; and they do that under the stress of an epidemic of typhoid fever or\ncholera, or something of the kind. But these have to be provided. Now, you can get them one\nat a time until you have got your group. You can get them, for instance, in this Province by\nthe Provincial Government, the Provincial University, the Municipality of Vancouver, and\nvarious other municipalities, all co-operating. You see, it is public money after all, and I do not\nbelieve, personally, that you ought to gather certain problems together and leave other problems\nabsolutely untouched, because as soon as you get a little bunch of people together they all get\ninterested in the same problem, they alUtackle it, and they leave everything else undone.\nThe function of a university is to teach a course, to teach what is known now. It is just\nas much its function to add to that knowledge, because all knowledge would stop if everybody\nconfined himself to teaching; in fact, that is the most important thing. It should be done\nwithin the university; it should be done without the university; it should be done in co-operation\nwith every existing official organization in the Province. It is the people's money which is\nbeing spent and we should give the largest return to the people. In addition, it should have\nexperts, and it must have experts, for if the Province is not going to get the best experts in\nits university it had better keep out of the business altogether. Those experts ought to be\navailable also for the purpose of giving advice and suggestions, undertaking investigations and\nresearches, the result of which could be available for the different departments of Government.\nIt seems to me that that should be apparent to everybody.\nNow, I want to make one thing quite clear: The university has nothing to do with administration or legislation or politics, and the moment it oversteps that\u2014the best State university in\nthe United States, the University of Wisconsin, made that fatal mistake once. It was called\nupon to investigate the health of the city in every way, and it did make a magnificent job.\nNow, what happens? After you have made a diagnosis and a prognosis and suggested treatment, it is very easy to bold the patient's nose and make him swallow a pill. Now, that is a\nGovernment job; it is not the university's job, and the university only gets into trouble whenever it begins to connect principles and men, to connect men with principles. It must keep\naway from that. Now, I think we can make this start; I think we have got a start with this\nbig movement. We have only one here now; that man is Dr. Mullin, and he has indicated to\nyou that public health has four specialties. He has his own special duties and desires. Now,\nif we can get that group started, it seems to me that a Provincial university is the logical basis\nfor the beginning of that; ultimately we will have a group which will not only take care of the\nwork, but it will train other workers in that line.\nNow, we have been getting impatient in the university at the present time to start a\nmedical school, but we have all seen that in public health we need special training. Vancouver\nis an important town ; there is no public-health laboratory nearer than Toronto or McGill, and\nas far as I know these are the only ones existing in Canada. We can only start that and, when\nthe time comes, a medical school, and the private practice should be practically related to that,\nthis question of public health, and we could have here built up in this community a medical G 200 British Columbia 1918\nschool out of the bigger foundation of a public-health organization. That lies in the future,\nbow far we do not know; but we ought to provide for immediate needs as best we can, and we\nought to conserve our money so that every public body contributes its quota and co-operates\ninstead of competes. That seems to me to be the practical outcome of this paper this morning,\nso far as we can directly apply it.\nI know that Dr. Young is quite in sympathy with such ideas. I know that the Hon.\nProvincial Secretary, Dr. MacLean, is in sympathy with such ideas. I know that Dr. Young\nhas the matter in hand with the authorities of the Vancouver General Hospital here; but one\nman, aud he has to be very very efficient in the one line, cannot spread himself over all of\nthese things for long and give satisfaction to himself and to the community. I believe that that\nis one of the things in which we might co-operate, and in which perhaps the university might\nbe the focusing-point. The same kind of thing is being undertaken, I might say, although this\ndoes not bear on the subject, in a number of other lines. In agriculture, for instance, at the\npresent time there is close co-operation between the Provincial Department, the Dominion\nDepartment, and the University; and we hope that that will be true of forestry and of mines\nand of fisheries, and that will make us really of some practical, as well as potentially practical,\nvalue to the community which has supported, and had the courage to support, a Provincial\nuniversity during war-time. When we are getting impatient it is most comforting to know\nthat the people of this Province had the courage, anyway, to start, a university during wartime ; and it seems to me that by this time it should be started, because it is the day of the\nexpert, anyway, chronologically, and the war has made it doubly of the expert, and we cannot\nget along very much longer without training and using the expert in this Province more than\nwe have, but we will so use it in industry, in social and other life, the way we have been using\nits products for pleasure and for comfort.\nNow, I apologize for having wandered from the subject, Mr. Chairman. It is always a\npleasure to speak to people who are interested in the same subject which has interested me for\nso long; and I always find that whenever I speak of the university here, people are so interested\nand so kind that I am inclined to transgress, and I hope that I shall be forgiven; and I can\nassure you that every member of the staff and those on the executive and governing body of\nthe university are almost anxious to be of the utmost possible service to the Province as a\nwhole, and to do their share in national and Imperial problems which w e are now facing.\n(Applause.)\nThe Chairman : We shall be glad to have discussion by any one else on the subject. I\nthink we have always got some light from this kind of paper. I say some light, but I should\nsay a great deal of light, a great deal of instruction. Speaking for myself, I certainly have;\nI can see great possibilities opening up as the result. Any further discussion? We will be\nglad to hear from any one.\nDr. Hepworth: Mr. Chairman, Ladies and Gentlemen: I might say a few words from the\nstandpoint of the general practitioner. This laboratory diagnosis is a thing that we cannot\nget along without, but I think the subject has been pretty well taken up. The question is, if\nyou want to make a laboratory diagnosis, who is going to pay? Is it the municipality or is\nit the doctors? I have had so many cases where I have had to foot my own bill to make the\ndiagnosis, where the people themselves cannot afford to pay; that is the trouble. That is\none poiut that I found out about that. Many a time I have had certain cases where\nI wanted to do it and have had to pay $3 or $2. Lots of patients cannot afford to\npay for that. When I send a patient to the Vancouver General Hospital I have to pay\nthis $2. Well, if he pays me $2 he thinks he has paid me plenty, and all I can ever get out\nof him is about $3. It may cost me actually a lot more, and the question is, is there any\nmethod of getting the municipality to foot some of these bills? As far as laboratory diagnosis\ngoes, why there is no question of the necessity of having one. Last year I wanted to get a\nBabcock milk-tester, and I went to Dr. Underhill to get some information from him about it;\nbut I couldn't get any one to put up the $10 for it. I had no power to force them to give\nme a Babcock milk-tester. What is the good of Health Officers if you cannot get anything\ndone. It is all very fine to have all this theory and all this talk and paper, but we want\npractice; we want the stuff while we are working; that is when we want it. I tell you it is\nright at home we need it; and when you cannot get anything done, what are you going to do?\nThey haven't spent a 5-cent piece on sanitary measures in my town this summer, and I had no 8 Geo. 5 Provincial Board of Health. G 201\npower to spend any money. As to this laboratory diagnosis, I had four or five cases that\nrequired laboratory diagnosis and they haven't any money to pay for it. The Council have no\npower to do it; so, if they are going to do anything, we want it for practice; we don't want it\nin theory; we want to get it done. I think the municipality in certain cases would pay some,\npossibly the Province would pay some, but here I have had all kinds of cases that required\nlaboratory diagnosis and I cannot get it done; and I think Dr. Wesbrook took the proper point\non that, that you cannot get the people to put up anything; you cannot get your municipality\nto do anything; but I think that some time the Province will begin to see that they should\ndo these things.\nThe Chairman: Any discussion on this paper? If there is no further discussion I will ask\nDr. Mullin to reply.\nDr. Mullin: I don't think I have anything to say.\nThe Chairman: Nothing further; then that completes the programme for this morning.\nWe will meet at half-past two and continue the work of the Convention. As you know, there is\njust as good work before us as we have had previously, so if you meet promptly at half-past\n2 the Convention will resume.\nThe Convention thereupon took a recess until 2.30 p.m.\nAfternoon Session.\nThe Convention resumed at 2.30 p.m. pursuant to adjournment.\nThe Chairman: Well, ladies and gentlemen, we will call this meeting to order and have\nthe last session. The first paper is \" Milk in Relation to Public Health,\" by Dr. A. G. Price,\nMedical Health Officer of Victoria. I call on Dr. Price for his paper. (Applause.)\nMILK IN RELATION TO rUBLIC HEALTH.\nBy A. G. Price, M.B, B.Ch., Medical Health Officer, Arictoria, B.C.\nThe use of cow's milk as a food, especially for the nourishment of infants, and the fact that\nthe composition of milk furnishes so excellent a culture medium for bacteria, and is so fitted for\nthe conveyance of germs \"of infectious diseases, places milk in the forefront among matters of\nhygiene which must be considered and studied by Health Officers with a view to the maintenance\nof public health.\nIn considering the milk-supply to cities and towns or rural districts, it is necessary to\nconsider the milk in three stages\u2014namely, milk with the producer, milk with the retailer, and\nmilk with the consumer. In other words, milk in the farm, milk in the dairy, and milk in the\nhome.\nLet us first consider milk in the farm. Ideal milk within the udder of the healthy cow should\nbe sterile. It is found, however, that the milk-ducts and teats of a perfectly healthy cow always\ncontain bacteria. No doubt these come there through infection of residual milk by bacteria from\nthe exterior of the udder.\nThe anatomical location of the udder pre-eminently lends itself to the collection of microorganisms from the cow's hoofs, from the skin, and from the ground on which the cow lies.\nFlies lighting on the teats, and the hands of the milker too, are means of contamination by\nmicro-organisms. It is therefore impossible to collect milk free from bacteria; even collected\nunder the very best circumstances, fresh milk is computed to contain about 500 micro-organisms\nper c.c, while the average number of micro-organisms in milk collected in the ordinary way and\nas sold to the public has been estimated at not less than 400,000 per c.c. Although it is practically impossible to procure fin absolutely sterile milk from the cow, yet it should be the aim\nof every producer to collect milk from his cows under the most favourable conditions for\nprocuring the purest milk possible.\nIt is with this object in view that legislation is made for the guidance and education of\nproducers endeavouring to produce pure milk, and for the punishment of those who neglect\nprecautions against contamination. The latest amended \"Contagious Diseases (Animals) Act\"\n\u25a0of this Province is one which eminently strives for procuring of milk under the best conditions, G 202 British Columbia 1918\nstress being laid upon sanitary conditions of stables, the care and health of the cows, the\ncleanliness of the dairies and utensils, and the health and cleanliness' of the milkers; the\npremises, stables, and cows being classified into three grades A, B, and C. Mark you, it is not\nthe milk which is classified, but the premises and cows, with the assumption, and rightly so,\nthat the better and cleaner the premises and cows, the better and purer the milk. Stress is laid\nupon the freedom of cows from disease, especially from tuberculosis. No milk is permitted to\nbe sold from diseased cows, and such cows must be slaughtered.\nThe subject of cattle-diseases directly communicable from the cow to man through milk is\none which can only be briefly touched upon now. It is one which, if at all adequately treated,\nwould occupy more time than is alloted to the reading of this paper. Foot-and-mouth disease,\nscarlet fever, vaccinia, and tuberculosis are among the diseases which affect cattle and which\nare communicable to man either in the same or in a modified form.\nThe question of the conveyance of tuberculosis to man from the cow by means of milk is one\nof the greatest importance and one which has been extensively investigated by bacteriologists.\nOwing to the morphological and pathogenic difference between the bacillus of bovine tuberculosis\nin the cow and bacillus of tuberculosis in the lungs of man, discussions and differences of opinion\narose as to the identity of the two types. The bovine type is shorter than that found in man\nand it grows less actively in artificial media. The difference in pathogenic qualities of the bacilli\non certain animals is marked. Bovine bacilli injected into a rabbit was found to kill the rabbit\nin a few weeks, while the human type of bacilli injected caused but mild disease and did not kill\nthe rabbit for six months, and occasionally failed to kill the rabbit at all. Attempts made to\ninfect cattle with the human type of bacilli for the most part have failed; while infections of\nhuman beings with the bovine type have been proved beyond doubt. Koch, realizing these\nmorphological and pathogenic differences, attributed such differences to the environment and\nnature of the infected subject rather than to the infecting agent.\nI quote the following conclusions of the Royal Commission on Tuberculosis given in their\nreport: \" There can be no doubt but that in a certain number of cases the tuberculosis occurring\nin the human subject, especially in children, is the direct result of the introduction into the\nhuman body of the bacillus of bovine tuberculosis, and there also can be no doubt that in the\nmajority at least of these cases the bacillus is introduced through cow's milk.\"\nThe following facts are conceded: Bovine tuberculosis is communicable to man; bovine\ntuberculosis affects especially young children, causing abdominal tuberculosis; pulmonary tuberculosis in adults is often traceable to abdominal bovine tuberculosis in childhood.\nKeeping the above facts in view, it is plain to see of what great importance as a factor in\nthe suppression of human tuberculosis is the prevention of the consumption of milk from cows\naffected with tuberculosis.\nThe \"Contagious Diseases (Animals) Act\" demands the periodic examination of all cows\nfor tuberculosis and forbids the sale of milk from affected cows ; and thus, together with sanitary\nrules and regulations applicable to stables, legislates for the production of milk in as pure and\nwholesome condition as possible.\nSo far we have considered the milk as secreted and extracted from the cow with a view to\nmaintaining its purity at the source. Let us now consider the milk from the time it leaves the\nstable till it reaches the consumer. The protection of milk from contamination and its preservation during this period, whether it be long or short, is of equal importance from a hygienic\naspect as the production of milk under sanitary conditions in the stable.\nThe rapidity with which micro-organisms increase in milk is very great under favourable\ntemperatures. Kept at freezing-point the bacterial increase is not appreciable, but kept at a\ntemperature 86\u00b0 Fahr.' for twenty-four hours it was found that a sample of milk at first containing 30,000 micro-organisms per c.c. at the end of this time gave a count of 14,000.000,000\nof bacteria per c.c. It is evident, therefore, that in order to prevent the increase of bacteria in\nmilk, the milk should be cooled as soon as possible after collecting and kept at a temperature\nnear the freezing-point.\nFurthermore, in order to prevent the increase of bacteria, additional micro-organisms must\nbe kept from entering the milk from the atmosphere, from dirty utensils, and from water used\nin washing same. Milk, therefore, after cooling should be placed in covered containers which\nhave been efficiently washed and sterilized by means of steam or boiling water. It is best to\nplace milk in glass bottles immediately after cooling. Keeping of milk in metal cans longer than 8 Geo. 5 Provincial Board of Health. G 203\nis absolutely necessary is inadvisable, nor under any circumstances should milk be placed warm\nin a can in which it is to remain for any length of time. Milk is a fluid which readily absorbs\na metallic taste from the can in which it is contained, and especially so if the milk is warm.\nStrict regulations are laid down'by the \"Contagious Diseases (Animals) Act\" as to the\nconstruction, the cleansing, and,the keeping clean of dairies and utensils where milk is kept\nfor the guidance of tbe dairymen and the safeguarding of the health of the public. It is\nnecessary that Health Officers should inspect dairies and inspect them frequently and efficiently.\nMany dairymen are uneducated as to what aseptic cleanliness means, and they do not realize\nthe necessity of such cleanliness; they are apt to show gross ignorance or carelessness in matters\nof milk hygiene unless continually reminded or instructed, or even threatened with punishment\nfor neglect.\nLet us now consider the milk in the home. The consumer may have procured milk from\nhealthy cows under best conditions of stable and dairy, from a producer or vendor who fully\nconforms to milk regulations under frequent inspection of Health Officers; yet illness from\nmilk-born germs, diphtheria, typhoid fever, scarlet fever, or diarrhoea may occur in the home.\nThe illness is reported, the suffering family places the blame on the milk-vendor, the dairy or\nfarm from which the milk has come. The dairy is visited, a sample of milk taken and examined\nand found to be good; then the cause of illness is put down as \" undetermined.\"\nWhen diphtheria, typhoid, or diarrhoea occurs in a household, I make it my first duty to\nexamine the larder or place where the food and milk are kept before making inquiries as to\nwhence the milk has been procured or examining the dairy or store. In 00 per cent, of cases\nI find that the milk is kept in a place or in such a manner as to invite contamination and growth\nof germs.\nIt is well known that the diphtheria bacilli, the bacilli of typhoid, and the various microorganisms which are the cause of infantile diarrhoea grow freely in milk; they are not indigenous\nto milk, but they are implanted in the milk from outside sources. Every precaution may be\ntaken by Acts and regulations, by inspections of stables, and supervision of dairies to prevent\ncontamination of milk, but all to no avail if the milk in the home is exposed to the access of\ngerms of disease.\nSome years ago, while engaged in practice in Ireland in a town which at that time had no\nsystem of sewers other than cesspits, an epidemic of diphtheria occurred. In one house where\nfour children had diphtheria the milk was kept in an open pan on a window-sill in close proximity\nto a dirty toilet to which flies had free access. In another house where there were three cases\nof diphtheria a broken drain ran under the floor of the larder where the milk was kept, the\ndrain leading direct to the cess-pit. In another house nine children visitors were affected with\ndiphtheria; all the children had partaken of milk from the same stock; on investigation it was\nfound that a cesspit had been recently emptied in close proximity to the milk-house in which\nthe milk had been exposed and beside which the cow had been milked. From past experience\nI have come to the conclusion that diphtheria is produced by infected milk more than by any\nother cause. Some time ago I had occasion to examine a dirty mixture of milk and water taken\nfrom pools on tbe concrete floor of a room where milk was kept; microscopical examination\nrevealed bacteria identical in appearance with diphtheria bacilli.\nThe germs of typhoid fever are supposed to he more frequently carried by water than by\nother means, but is it not possible or probable that in the majority of sporadic cases of typhoid\nthe germs of the disease may have been carried by the house-fly or by other means to milk and\nhave thus been transmitted to the patient?\nI recollect some years ago, in a neighbouring town to where I lived, a sudden epidemic of\ntyphoid occurred; there were some fifty cases, all of which were traced to infection from one\ncase occurring at an unsanitary dairy which supplied milk to the families affected. We know\nthat the typhoid bacillus grows rapidly in milk, and it therefore behoves Health Officers to be\nextra careful in the supervision of milk-supply with a view to prevention of contamination when\ncases of typhoid fever exist in their district.\nThe proper care of milk in the home is only to be accomplished through education of the\npublic. Many householders.are ready to place the blame for illness occurring in the families\nupon outside, supposed, insanitary conditions, while they overlook their own negligence and\ncarelessness, or in many cases ignorance. G 204 British Columbia 1918\nThe study of hygiene, and especially the subject of the transmission of diseases, should be\ntaught in all public schools of the Province, and simply worded bulletins on the subject should\nbe distributed. It is beyond the powers of Health Officers to personally attend to milk in the\nhomes in a city. The Health Officer can only supervise the milk in the farms and in the dairies;\nfurther his influence cannot go to prevent milk-contamination except through education. The\nimportance of the supply of purest milk, not only to the homes but to the mouths and stomachs\nof children, is a matter which cannot be overrated.\nUp to a few years ago the principal cause of deaths among infants in cities of Eastern\nCanada was summer diarrhoea, second to which was immaturity and still-births (a matter needing\ninvestigation, but one outside the scope of this paper). The death-rate of children in Eastern\ncities is considerably higher during the months of July, August, and September than other\nmonths, whilst the death-rate of adults is highest during winter months. Statistics show that\nin these cities the child deaths in summer were due principally to diarrhoea, and that since,\nduring the last few years, more rigid milk regulations have been made and enforced with the\nobject of supplying pure milk to children, the infant death-rate from diarrhoea has fallen, and\nwe now find that prenatal causes, premature and still-births are the leading causes of infant\nmortality.\nThere is still vast room for improvement. Diarrhoea should be one of the least frequent\ncauses of infant deaths in these cities. In the City of Vancouver in the year 1916 the deaths\nfrom infantile diarrhoea numbered only seven, while in Victoria City there was only one death\nfrom this cause, or about one per thousand births. While in a more eastern city in 1912 seventy-\nnine deaths of infants from digestive trouble per thousand births occurred, and in 1915 in the\nsame city twenty-eight infants per thousand births died from the same cause. These records\nshow a satisfactory condition of milk-supplies in Vancouver and Victoria, if we judge the purity\nof the milk-supply according to the absence of diarrhoea.\nIn New York the National Commission on Milk Standards, which met in February of this\nyear, laid particular stress upon the grading of milk by bacterial counts, advocating that the\ncontrol of milk-supply for the community should be based primarily on this system.\nThe Commission stated that the fundamental objects of grading milk are:\u2014\n(a.) To aid in making safe for human consumption all milk which can be legally sold\nfor drinking purposes:\n(6.) To distinguish between classes of milk which, while all are safe, are of different\ndegrees of excellence in respect to cleanliness:\n(c.) To provide means by which the consumer can make intelligent selection of the kind\nof milk he wishes to purchase:\n(d.) To encourage demand for clean milk, thereby rewarding efforts of clean-milk\nproducers.\nThe Commission proposed that milk be graded into A, B, and C classes. A grade milk must\ncontain less than 10,000 bacteria per c.c.; B grade, less than 1,000,000 bacteria per c.c.; C grade,\nany number over 1,000,000 bacteria per c.c. A and B grades to be used for food raw, while\nC grade be used for food only after cooking.\nThe Commission further stated that in establishing the bacterial standards for a city it is\nimportant to take into consideration the necessary age of the milk, the distance it is hauled,\nand the methods employed in hauling, in addition to the sanitary condition of the milk at its\nsource. This latter finding of the Commission appears to me to be an acknowledgment of the\nfaultiness of the bacterial-count standard previously advocated.\nIf the bacterial standard were a system to be relied upon for the supply of pure milk, it\nwould he unnecessary to consider the sources of milk-supply. On the other hand, if the source\nof the milk-supply be sanitary aud the storing and hauling be under best conditions, then the\nbacterial-count standard is unnecessary.\nIt appears to me that bacterial count is useful in proving the age or impurity of milk, but\nthat it is too lengthy a proceeding and too impracticable in making frequent and quick examinations to be satisfactory for regulating the milk-supply of cities. It takes several days to make\ncultures for bacterial count. A sample of milk taken from a dairy one day, and another sample\ntaken from the same dairy another day, may vary considerably in bacterial counts. It would\nbe impossible, owing to the time required, to grade milk every day by bacterial-count standard,\nand there would be no guarantee that a dairy which supplied grade A milk a week ago was\nsupplying the same grade to-day. 8 Geo. 5 Provincial Board of Health. G 205\nFor the guaranteeing the purest milk-supply, it appears to me that the best method of\nprocedure is that which is followed in this Province\u2014namely, strict attention to the cleanliness\nof the source, the keeping and delivery of milk, and to the cleanliness and health of the cattle\nand milkers. Bacterial counts are unnecessary.\nIn England, Scotland, and Ireland the \"Contagious Diseases (Animals) Acts\" are very\nsimilar to that of this Province. They order the registration of cow-keepers and dairymen, the\ninspection of cattle, cow-sheds, and dairies, and direct sanitation of same and cleanliness of\nmilk-stores and utensils, hut they do not consider bacterial count.\nThus far we have treated the subject of raw milk and bacteria and have considered the\nmethods best adapted for the procuring a raw milk in as pure a condition as possible. We have\nseen that, in spite of all precautions taken, raw milk still contains bacteria. These bacteria,\nhowever, are not of pathogenic type, they are bacteria which cause acidification, curdling, and\ndecomposition. We have seen that under suitable temperatures the process of decomposition is\nrapid. We must therefore consider the methods of preservation of milk. There are three\nmethods\u2014that dependent on low temperature, which inhibits the growth of bacteria; that\ndependent on high temperature, which kills the bacteria; and that which depends on the addition\nof antiseptics to the milk. Germs will not grow in milk held at freezing temperature; for this\nreason all milk in dairies and the homes should be kept at a temperature as near freezing as\npossible. This is not feasible in the homes of the poor, who have not refrigerators; we therefore must advocate for them pasteurization of milk. Pasteurization of milk is simply the\nheating of milk to a temperature of 150\u00b0 Fahr. for half an hour and then rapidly cooling. This\nprocess kills pathogenic germs without appreciably affecting the nutritive qualities of the milk.\nConsumers of milk, especially mothers of children, should learn the methods of pasteurizing milk\nand carry them out in their own homes. The purchasing of pasteurized milk from dairies is not\nsatisfactory unless the dairies are specially licensed and supervised daily.\nTo completely sterilize milk it is necessary to raise the temperature to boiling-point and to\nrepeat the boiling on several successive days. The process of boiling, though rendering milk\nabsolutely safe, has its drawbacks; it alters the taste, destroys the fine emulsification of fat,\ncoagulates the lactalbumin, and renders casein less easy of digestion.\nThe lower temperature in pasteurization does not appreciably affect the digestibility or\nnutrient properties of milk. Preservation of milk by the addition of antiseptics, such as salicylic\nacid, boric acid, formalin, or peroxide of hydrogen, should be prohibited both in the dairy and\nin the home as an injurious adulteration.\nThe nutrient value or richness of milk is usually determined by an estimation of the\npercentage of butter-fat and solids not fat. Boards of Health in most municipalities demand\nthat all milk sold shall contain 3.25 per cent, butter-fat and 8.5 per cent, solids not fat. In\nsetting such a standard of richness it appears that no account is taken of the breed of cattle\nsupplying the milk. The milk of the Holstein cow will seldom give 3 per cent, butter-fat, while\nthe Jersey cow usually gives as much as 5 per cent. Keepers of Holstein cows as a rule keep\nJersey cows and mix the Jersey milk with the Holstein milk in order to make up the deficiency\nof butter-fat in the latter. This is a wrong policy, especially where the feeding of infants is\nconcerned. The milk of the Holstein cow with its smaller fat-globules is more digestible with\ninfants than Jersey milk, while the mixture of the two milks is found to be less digestible than\nJersey milk alone. Far better would it be if the standard of butter-fat were designated to each\nbreed of cow and permission granted to sell Holstein milk as Holstein milk although it contains\nonly 3 or even 2.75 per cent, butter-fat. Holstein milk, though lacking in butter-fat, contains\nthe necessary casein and solids and is more suitable for infants.\nSamples of milk from various dairies and milk-vendors in a city should be frequently tested\nfor butter-fat and for solids not fat; a deficiency in the quantity of solids indicates the addition\nof water, while tbe quality of solids will show whether foreign substance has been added; there\nis no fraudulent adulteration of milk which cannot be discovered by careful examination.\nIf central milk-distributing stations were instituted in all cities, all milk-vendors bringing\ntheir milk daily to one of these stations where the milk would he checked and samples taken for\nexamination, such a scheme would go a long way towards a satisfactory settlement of the pure-\nmilk question; it would prevent adulteration and would be the -means of bringing the best milk\nto the consumer; it would make the work of the Health Officer easier of accomplishment, but\nwould probably raise the price of milk to the consumer. In the City of Victoria by-laws will shortly be in operation which will demand inspections,\ngrading, and registration of all dairies and farms supplying milk and the licensing of all milk-\nvendors selling milk in the City; but no steps have yet been taken towards the institution of\ncentral milk-distributing stations.\nIn conclusion, I may say that milk is the first, the most perfect, and perhaps the most\nuniversally used of all foods, and yet the most dangerous. It therefore behoves all Health\nOfficers to untiringly endeavour to procure and maintain the purest possible milk-supply in their\nrespective cities, municipalities, or rural districts by frequent inspection of all farms and dairies\nsupplying milk, by education of farmers and dairymen along sanitary lines, not withholding\nprosecutions where there is persistent neglect of sanitary precautions.\nAnd, lastly, toy education of the public, the consumers of milk, as to how to keep milk to\nthe best advantage in the interests of their own health and in the interest of the preservation\nof child-life.\n(At this stage Dr. Wrinch took the chair.)\nDiscussion on Dp, Price's Paper.\nThe Chairman: The paper will now be open for discussion by any one present. I would\nask that in the interests of all who are in the hall, and especially on account of the disturbing\nnoises of the street outside, which are inevitable, you will come forward to the front and then\nyou can more readily face those that are here and be heard by them in the discussion. The\ndiscussion is to be opened by Dr. Proctor, also by Mr. McDonald. Live Stock Commissioner.\nDr. Proctor: Mr. Chairman, Ladies and Gentlemen,\u2014I did not know that I was to be the\nfirst to discuss this excellent paper which we have just listened to ; but we have had a very\nfine resume of the whole subject, from the dairy to the consumer, and dealing with the question\nof bovine tuberculosis. It is now known that bovine tuberculosis is not the proper name at\nall; it is definitely transmittable to man, and the Government of this Province deserve all sorts\nof credit for the powerful and efficient way in which they have insisted on the examination.\nIt means the outlay of a great deal of money for the systematic testing of our cattle for\ntuberculosis, but as a result to-day I think there is very little milk reaching our people from\nnon-tuberculin-tested cattle. It would be interesting for us to know just how much bovine\ntuberculosis is existing among our children ; but I am satisfied, if this work is continued, as I\nthink it will be, that that will be very much eliminated, as it has been eliminated already.\nI had the privilege some year ago of being on a Milk Commission in this Province. I had\nthe privilege of working with Dr. Paton, and I hope that we accomplished some good for the\nProvince, but we certainly learned a great deal ourselves\u2014I learned a great deal myself.\nWe found that the problem of the milk-supply of our people was not as simple as it appeared.\nIt is somewhat in the nature of a chain from the dairy right to the consumer, aud there are\nseveral important elements in that chain. First of all,, there is the system in this Province\nunder which these dairies are grouped and the cleanliness of the supply safeguarded. We found\nin the Province in those days dairies of different types. Some dairies' were a credit to the\nProvince, some were not; and we usually found that where they were not it was the result\nof absolute ignorance on the part of the dairymen as to what was necessary to ensure a good\nmilk-supply. They were all willing enough to do it if they only knew how, but they didn't,\nseem to have any conception of the danger from the fly and from having the manure-heap close\nto the dairy. At any rate, they seemed to be quite glad to do it when they were told; but\nthere were certain dairies, as I said, that were\u2014and I am sure they are different since\u2014very\nmuch in want of cleaning out.\nThen the question of transportation of that milk\u2014that is, of our milk-supply in this city;\nI am not sure that it is true of Victoria or any other city\u2014has not grown right into the facilities\nof the city, and the transportation is a simple matter; but in this city, at any rate, it comes\nfrom a long distance. I dare say you know that a very large proportion of your milk-supply\ncomes from south of the boundary, from Washington; and I know one of the grievances of\nthe dairymen iu this Province was. in the line of milk-supply here, that while the dairymen in\nthis Province were subject to all sorts of inspection which it was hard for them to live up to,\nhard to live up to all the rules and regulations, we had no right to go into the State of Washington and inspect their dairies and penalize them if they were not up to the scratch. That\nwas a grievance. 8 Geo. 5 Provincial Board of Health. G 207\nIt is a comparatively simple matter, of course, in the winter-time to keep milk that has\nbeen properly cooled at the proper temperature; but it is a very different thing in the hot\nmonths of the summer. I dare say maiiy of you have been up here in Chilliwack on the main\nline of the Canadian Pacific Railway and the railways to the south of us, and you have seen\nmilk-cans on the platform which have stood out after being cooled; perhaps there is something\nthe matter with the time-card, tbe train has been late, and that can is standing out in the\nsunshine and getting thoroughly well heated, and then jogged along, and there is no attempt\nmade at cooling until it reaches the city. These I tell you are some of the difficulties we found\nout when I was on that Commission. Then the milk reaches the city. One of our recommendations\u2014I am glad to see it is one of Dr. Price's, because it is one I am thoroughly in favour of\nIn regard to having an efficient milk-supply\u2014is that this city and every city ought to have a\ncentral milk depot. Now, under our present system, inspectors of milk, and that statement is\ntrue to-day, get samples from tbe different dairymen. I believe that every man who sells\nmilk in the city should be forced to bring his milk to a central depot, and there) the City\nInspector should be for the purpose of examining that milk to keep that milk up to standard,\nor have it thrown out in the gutter; and a few examples of that character would very soon,\nI think, convince these people that it does not pay to bring the milk in in an impure state.\nI believe, further, that, having arrived at the central depot and having had the seal of the\n-city or the Province placed on that milk, the distribution of that milk in the city should be\nundertaken by the city. I dare say some of you know that discussion has been going on for\nsome time on the price of milk. You have heard about that. A good deal of the blame for the\nincreased cost of milk was laid at the door of everybody having to keep up a staff to distribute\ntheir own milk. Well, ladies and gentlemen, there is one thing more than another that the\nGermans have taught us, and that is on the subject of organization. What we want in this\nquestion of our milk-supply is better organization to reduce the cost to the consumer.\nAnd then Dr. Price has brought very well before you what happens to the milk when it goes\ninto the home. It is not much use haying the dairyman all right, having the transportation\ncompany put ice in its cars and keep them clean and free from anything that might contaminate,\nwithout permitting them to stand out on platforms, and then reaching the central depot with\nevery proper precaution, and the milk leaving there absolutely right and guaranteed, if you are\ngoing to have filthy conditions in the homes of the people, such as just described to you by\nDr. Price in a home of that kind. That, ladies and gentlemen, is the result of uncleanliness on\nthe part of these mothers who are feeding that milk to their children. They simply do not\nknow. It seems to me it would be a very fine thing if every girl in our schools, rather than being\ntaught the number of bones they have in their body, which is not particularly important or\nnecessary for them to be taught, they should be taught something about the proper care of milk\nand the dangers of it; and I am sure that could be done, because it is the result of ignorance,\nand no mother who loves her child would possibly feed milk to It that came, as Dr. Price said,\nfrom milk in a pan 6 inches from the toilet. That is incomprehensible; they absolutely do not\nknow. That, I think, is what we want. I think if we educate our people, our dairymen, to\ntbe great importance of taking care of this milk when they buy it, then I think that the\nmagnificent result in the infant mortality would be greater even than it is now.\nOne thing before I sit down. I am a very firm believer in pasteurized milk. You know\nthe price of pasteurized milk was put up to us by the committee. This pasteurizing of milk\ncreates a sort of feeling with the dairymen all along the line that it does not make any difference\nhow dirty it is; if it is pasteurized it will be all right, anyway. Well, even under the most\nperfect conditions you cannot be quite sure. Pasteurizing is an easy thing to do and it. does\nnot alter the chemical contents of the milk, and I believe very strongly in it. Indeed, if there\nis a lack of protection in other directions, it makes doubly sure.\nWhile I am speaking of pasteurization, I might say this: that we found they had two\nmethods, one they called the flash method, and another method which is no good at all. It should\nbe done, and can only be done to be efficient, by the Holbein method. That is the only efficient\nmethod of pasteurizing. That is the method described by Dr. Price.\nThe Chairman: Mr. McDonald.\nMr. McDonald: Mr. Chairman, Ladies and Gentlemen,\u2014I am very glad of the opportunity\nof being here to take part in this discussion on our milk-supply. I had the pleasure of being\npresent at a previous meeting where we talked a good deal about tuberculosis. As has been G 208 British Columbia 1918\nmentioned by Dr. Trice, we have now aii amendment to the \"Contagious Diseases (Animals)\nAct\" ; that is, an amendment of that part of tbe Act relating to our dairies and milk-supply.\nI have brought a number of copies with me, I think I have just twenty; but I should like to\nhave you take a copy, and any of you who want a copy, if we are short of them, I will be glad to\nsend one to you.\nNow, since the last meeting of Medical Health Officers a good deal of progress has been made\nin regard to the testing of cattle for tuberculosis and the control of that disease. We have not,\nhowever, made the progress that I had hoped we would be able to make owing to lack of money,\nand also lack of a sufficiently large staff. It has been difficult at times; I am trying to convince\nthe powers that be that we need more money than we are getting. The year previous to this\none I wanted to get $50,000 for the work, and succeeded iu getting $10,000, after a desperately\nhard fight put up by the dairymen themselves. Dr. Proctor paid a compliment to the Government on the work that had been accomplished; I also wish to compliment the dairymen for the\nstand they have taken iu regard to this work. Now, we have heard from different individuals\nsome opposition to the test, and we have seen a number of letters in the press. That position,\nhowever, does not represent by any means the general opinion of our dairy-farmers. And, after\nall, the progress that has been made is due to a large extent to the manner in which they have\ngotten behind the work and supported it.\nI just wish to state that in recent conventions of the British Columbia dairymen they have\npassed strong resolutions endorsing the work, without a single dissenting vote. In spite of the\nfact that, with these people assisting us, we haven't been able to prosecute the work as vigorously\nas we should have liked, about three years ago we were finding\u2014less than three years ago\u2014two\nyears ago we were finding in the vicinity of Vancouver, in a considerable area of the district\nsupplying the milk, 15 per cent, of reactors. At tbe present time we are finding 4 per cent, in\nthese same herds, and, better still, the great majority of these cases are in the incipient stage,\nshowing that the fact that we had got that 4 per cent, is largely due to the fact that we did not\nprosecute the work as vigorously as we should have done; that is, we have not followed it up\nas rapidly. What I would like to do would be to retest the herds in which we find even a single\nreactor, within three months, in order to get the animal that may have the disease in the incubation stage before the disease has evolved to the point where it may be transmitted to other\nanimals in the herd. Now, if we can only do that, we are getting where we can control the\nsituation very nicely. And I will confess that the results that we are getting now are much\nbetter than I had expected, in view of the method in which we have carried on the work.\nJust at this time, too, I am going to take the opportunity of referring to the matter of meat\nfrom carcasses of reacting animals being sold for human consumption. Periodically we find a\nlot of agitation carried out from differed sources regarding that question. Now, we do allow\nmeat from the carcasses of reacting animals to be sold for human consumption, provided it\npasses a severe and rigid inspection. That inspection is more rigid than the most rigid meat\ninspection carried ou anywhere else in the world. In order that you may be sure that you are\ngetting good meat free from disease, I would suggest that the best practice would be that, where\nyou can get it, you should buy the meat from the carcasses of reacting animals, because only\nmeat that is fit for human consumption from that source finds its way into our meat market.\nI am presenting that problem in rather a peculiar manner, but the common argument that we\nmeet is that milk from an animal that is unfit'for human consumption indicates that the carcass\nwill be unfit for human consumption. Now, we don't say that milk from all of these animals\nthat we condemn as reactors is unfit for human consumption. We know that much of it is\nabsolutely free from tuberculosis, but we have got no method, no practical method, of determining\nwhether or not the milk from certain cows is not likely to contain\u2014well, contain the germ, rathe tubercle bacilli, while in many cases it may. The bacteriological test for tubercular bacilli\nis not very simple\u2014or, at least, it is a little more difficult than the ordinary bacteriological\ntest of milk; and sometimes we might find germs present in certain tests, while in other tests\nthe milk from the same cow might appear to be free. And then, too, we believe we are safe\nin assuming that in the majority of these cases sooner or later that animal will reach the stage\nwhere it will be positively dangerous as a milk-producing animal; and not only that, but that\nanimal is spreading the disease to other animals in the herd, or may do that; and I hope, at least\nin discussing this question, in setting forth the reasons why we should have tuberculin-tested\ncattle, you will not fail to mention the economic side of it, as well as the public-health standpoint. 8 Geo. 5 Provincial Board of Health. G 209\nI believe that one of the reasons we have made the progress that we have made here, and that\nwe have secured the sympathy and the support\u2014I should not say sympathy, but the support\u2014\nof the dairymen, is that ever since I have had charge of the work I have at least tried to point\nout that the dairyman could not afford from an economic standpoint to have a diseased animal\nin his herd, otherwise he is likely to feel that he is bearing the whole load, that he is paying\nthe bill for public health; whereas, if he is brought to look at it from a broader standpoint\u2014and\nmost of us do not look at it from that broader standpoint\u2014he is going to take more kindly to\nwork of this kind.\nSince I came here this morning it occurred to me that we might have arranged rather an\ninteresting side-trip up to P. Burns's abattoir, and I thought that at the time, as we had brought\nover this week quite a large number of reactors to be slaughtered at P. Burns's abattoir, it\nwould have been very interesting and instructive to have arranged, immediately following this\nConvention, to have had these animals slaughtered in order that you might have an opportunity\nof making a study not only of these diseases in our cattle, but also the inspection or the method\nof inspection carried on at P. Burns's abattoir. Unfortunately, P. Burns's abattoir is the only\nplace for the inspection of reacting animals where there is meat inspection in British Columbia.\nWe are working under rather a peculiar system in Canada and the United States; that is, it\nis assumed that if we are exporting meat outside of the Province, in the United States outside\nof the city, it must be inspected. That is, if we are selling it to somebody else we must give\nthem a good article; if we are using it at home it doesn't make any difference how badly diseased\nit is, it is all right for our home consumption.\nAt the previous meeting of the Medical Health Officers I advocated the institution of public\nabattoirs, municipally owned and operated abattoirs. Now, there are some difficulties in the\nway, but it seems to me that the only solution of this inspection is that we have municipally\nowned abattoirs where Government Inspectors or municipal Inspectors will be stationed. It\nis impracticable under present methods to inspect every little product at the slaughter-house,\nand probably it would be to-day in the field or the bush, particularly if it happens to be\nflooded with tuberculosis or some other disease. Some of the diseased portions remain there\nand the remainder of the carcass is brought into town and sold for human consumption. Now,\nif there is any doubt in the minds of any person regarding this meat inspection or the sale of\nthis meat, the advisability of its sale, I would be very glad to hear from you, and I would be\nvery glad to have a full expression of your opinion. In the inspection that is carried on where\nthe animals are sent to P. Burns's abbatoir, there is some inspection, they are slaughtered\nunder Federal Inspectors; but where they are slaughtered elsewhere, it is under the supervision\nof our own Provincial Inspectors.\nThe question of pasteurization has been referred to you, and this is a question which we\nalways have at a conventional gathering of dairymen and those interested in the milk question\u2014\nquite an argument or discussion. There are different phases of pasteurization, as has been\npointed out. There are things to be said in its favour, and there are other things to be said\nagainst it. Pasteurization as it is carried on commercially is not perfect pasteurization. Now,\nwe might say here that pasteurization will solve the problem, but when we go to the dairyman\nhe says that be cannot sell perfectly pasteurized milk, due to the fact that you cannot secure\nperfect pasteurization without destroying your cream-line,' and the dairyman cannot sell milk\nwithout the cream-line; that is, unless there is cream on the milk, unless the cream rises, the\ncustomer does not want it, because the majority of customers pay a great deal more attention\nto the cream-line on the top of the bottle than the dirt on the bottom of it. Under commercial\npasteurization the nearest we can get to complete pasteurization is 98 per cent, of efficiency.\nNow, that is up to the present time the very best pasteurization in commercial plant, and you\nwill understand that a great deal of it is going to fall away below that in efficiency. You are\nleaving, then, a certain percentage of your bacteria in your milk, and you may be leaving\npathogenic forms in a field more favourable for their development than was the milk before\npasteurization. Personally, I would not care to use pasteurized milk; that is, if I thought\nthe milk was dirty, filthy, and was compelled to use it, then I would waut to pasteurize it of\ncourse; but I would not want any one else to use it, and in our own home we do not use\npasteurized milk, but endeavour as far as possible to get a good wholesome supply of whole\nmilk, raw milk produced under sanitary conditions.\n14 G 210 British Columbia 191S\nI am leaving certain other phases of the subject of pasteurization to Dr. Wesbrook, if he\nwill be kind enough to discuss them, as Dr. Wesbrook understands the point to which I refer\n\u2014namely, the influence that pasteurization may have on the food value, particularly the food\nvalue for infants.\nA short time ago in the Pacific North-west there was what was known as the Pacific Northwest Dairy Milk Inspectors' Association, which to my mind is the most influential associationn,\nthe most influential factor in the matter of milk-supply of the North-west. You will remember\nthat a year ago, or a little over a year ago last spring, we held the convention of that association\nin Vancouver. Although I was the only Canadian member in the association, the association was\nkind enough to hold its convention here in Vancouver. I regretted that we did not have more of\nour consumers and more of our Medical Health Officers present. I know that many of our\nmunicipalities are pretty hard up, and Victoria, although the distauce was very short, after due\nconsideration decided that they could not afford to send their Medical Health Officer over 'to\nVancouver to attend that convention; and we cannot expect other cities farther removed, more\ndistant, to send their Medical Health Officers, although I think all who were present will agree\nthat it was a very excellent convention. In promoting that association we hoped to be able to\naccomplish certain things in co-ordinating milk inspections, and a few of us gathered together\nin Seattle decided that it might be advisable to bring in dealers, purchasers, and consumers into\nour convention, give them associate membership, in order that we might have the benefit of their\nadvice and opinion, because if a certain group of men engaged in a certain line are all working\ntogether, and alone so to speak\u2014say, for example, a group of Medical Health Officers\u2014they may\noverlook some point which perhaps a man engaged in another line of work might think of; and\nwe have found the advantage to be far greater than we ever anticipated. Outside of our\nassociation\u2014at least, from that association subsidiary associations have been formed, and I\nhope that we will be able to have conventions of all our Medical Health Officers from the Province\nof British Columbia. The next convention will be held in Spokane.\nDr. rroctor referred to milk coming from south of the boundary-line. I believe at the\npresent time that we are not having any milk coming from the State of Washington, although\nat the time he was acting on that Milk Commission there was a very large amount of it coming\nfrom the State of Washington; and. by various means, that was shut out by the municipalities\nenforcing regulations which they were empowered to draft under the \" Milk Act,\" requiring\nthe same inspection that we were enforcing in British Columbia. The Province was not able\nto do it, but the Province was able to give the municipalities power to do it, although we could\nnot do it ourselves\u2014at least, our department could do nothing in the matter.\nAnother point mentioned, that of a central milk inspection station, has just recently been\nadopted by the City of Tacoma. I don't know just how it is working ont, although I have no\ndoubt it will prove quite satisfactory. This is a very big question, and I am sorry that I have\ntransgressed so much on the time, but it is a question in which I am very deeply interested;\nand I hope to hear further, and especially if you have any opinions contrary to those I have\nexpressed, I would be very glad to have you express them, as it would be of assistance to us in\nour work. (Applause.)\nThe Chairman: The paper is open now for further discussion. Dr. Wesbrook's name has\nbeen suggested as one having information on this. May we hear from Dr. Wesbrook?\nDr. Wesbrook: Mr. Chairman, Ladies and Gentlemen,\u2014Some of you have been more than\nkind in listening to me. I have been talking too much this morning and had not expected to\nspeak this afternoon, but to sit here and learn. There are a good many things that are of\nimportance to us which have been brought up in the most excellent paper which has been\npresented and the discussion which has followed. I was glad that the reader of the paper laid\na special emphasis upon the important factors in the production, handling, and distribution of\nmilk from the time it left the cow until the time it came to the consumer. Dr. Proctor added\nto that, and Mr. McDonald told us about the inspection for tuberculosis. Those are the factors\nthat are important in the handling of milk. It was expressed at one time by a colleague of\nmine in a literal way, which exactly corresponds with what the reader of the paper said:\nSince milk is an excellent medium for bacteria, and since temperature is a factor iu the\ngrowth\u2014a Provincial factor at least\u2014and since it is ordinarily taken from the cow in a very\ncareless way so as to allow the milk to be polluted, you might express the needs literally as I\nhave said, something like that; it means handling it quickly, cooling it at once, and, of course, 8 Geo. 5 Provincial Board of Health. G 211\ncleanliness is the most important. Now, those are the important matters in the handling of\nmilk.\nAbout its production, we have had quite a bit of discussion to-day, and they have all pointed\nout the difficulties in the handling of milk. We know here that it is not a matter of getting\na milkman and going out and picking out a cow from which you want your milk, picking out the\nperson who is to milk the cow and keeping him under medical supervision, and the cow under\nveterinary supervision, and the railroad, and the man that drives the milk-wagon, and various\nother things; that is not everything, for if you have to do things on a large scale, particularly as\nthe milk-supply for a large city comes from a great distance\u2014Dr. Proctor tells us it will come\ninto the City of Vancouver in a good many instances from across the border. Now, take a place\nlike New York, you must remember that they draw for their milk-supply from the country halfway to Chicago. When they get an epidemic of typhoid in New York which is supposed to be due\nto typhoid, they make an investigation of conditions on the farm; they investigate the people on\nthat farm where the milk was produced, and that may be anywhere from 50 to 250 miles\ndistant, or perhaps 500 miles, more or less, distant, so these are things which we have to\nrecognize. Now, can we get any one single fool-proof proposition that is going to safeguard\nus? And that brings us to the point of pasteurization. Now, that is the nearest thing that we\ncan do. We have already seen the difficulties of pasteurization. We have seen that under\ncommercial conditions only about 98 per cent, of the non-spore-beariug bacteria are killed.\nHowever, that is pretty good; aud that is only under the very best conditions. You have heard\nabout holding the milk at a certain temperature, the flash method, where they shoot it through\na tube, where it goes through very fast; but apparently to secure good results you must hold\nit at this temperature, and since it is important that the milk should not be too high, it must\nbe held at that temperature longer than it would need to be held if it were higher.\nNow, the difficulties you have iu pasteurization have been mentioned; here are a few more:\nIn addition to the one that milk which is rotten\u2014I use the word advisedly, I think\u2014in addition\nto the belief that rotten milk can be made all right by pasteurization, we have this fact: that\nafter pasteurization your milk is more likely, if it is kept too long or in bad condition, to be\nvery problematical as to its condition than if it had not been pasteurized.\nNow, the common bacteria in milk are those which sour the milk and produce lactic acid.\nLactic acid is in itself antiseptic, and that again which the reader of the paper gave us, if these\nbacteria were largely lactic baeteria they would not harm you particularly. Most of the bacteria\npassed through by this process, but you leave in the spore-bearing, putrefactive bacteria, and the\nfermentation in pasteurized milk is much greater than the bacterial fermentation in unpasteurized\nmilk; that is, you get all the bacteria which putrefy and which rot, which form spores, and they\nare left in there, and although they may be relatively few in number, if you don't keep it very\ncold and don't keep it too long it may be all right; but the curds you get on that kind of milk\nare quite different from the cheese-curds you get from your lactic acid, so that you might just\nas well be eating rotten meat as drinking rotten milk.\nNow, that brings me to the idea that in all cases where it is at all possible milk ought to be\nexamined where it is brought from, so that everybody should know how old it is, because even\ncertified milk where perhaps you don't get over a hundred bacteria, which is supposed to be the\nmost desirable milk, milk for which you pay probably 20 cents a quart, if you keep it it will be\nall right. Now, another thing about pasteurized milk, to which Mr. McDonald referred\u2014and it\nis like what Dr. Adam Shortt said about politics and other affairs the other day at the University\nClub. We are not faced with a clear-cut decision usually in our lives, as to what is quite right\nand what is quite wrong. It is usually between one thing which seems to be a little more right\nthaii another, or the choice between a minor and one that is greater. So it is with your milk.\nI have indicated here some of the difficulties of pasteurization. Here is the other way: As yet\nwe don't know, we haven't data enough, in my opinion, to say whether pasteurized milk contains\nall the things that are desirable for young children. Now, take the matter of growth, we are\nlearning a great deal about vital statistics, aud we know these are things that are present in\nthree food products that heating in a great many instances will eliminate\u2014but I think that\ncan be taken care of; but I am on the side of pasteurization; although they can be taken care\nof as we go along by special conditions, which will give us something raw\u2014it may be a vegetable\nproduct\u2014which will look after these things. We have sometimes scurvy right here. We don't\nhave to go to the North Pole to get scurvy, and we have to look out in getting at the vegetable G 212 British Columbia 1918\nproducts or other things. However, from my personal examination, like Mr. McDonald, I should\nprefer to have a milk that is produced from a cow that has been tested for tuberculosis and\nfound free of tuberculosis, and retested again in three months, so that if it had the incipient\nbacilli I would like to know that these few bacilli had been grown from a real case of infection;\nand, secondly, that that cow should be inspected for other conditions besides tuberculosis. We\nmust not think, when a cow is pronounced free of tuberculosis, that it may not have other things\nabout it which may be harmful. Thirdly, I should like to know that that milk is handled by\npeople who have been medically inspected. (Applause.) Now, that is very important. However,\nI am transgressing somewhat. I would like to say a few things about milk epidemic, that is\nimportant; and then I should like to know that it was so handled by that healthy person that\nhe did not get cow-manure or any other objectionable things in it. It is not so many years ago\nthat the Germans startled us by having one of their number report the number of tons of\ncow-manure that went into Berlin in one year. We might as well look those things squarely\nin the face. Fortunately we are not so susceptible as a cow to many diseases, but we might\nas well face some of these things. Then I should like to know that it had not been milked in a\ndusty place, that the cow had been washed out; if it had been milked by milking-machine, that\nthe milker's hands were clean. Fie need not have on a whole white-duck suit, and he need not\nmilk in an operating theatre. That is where the milk used to cost so much, certified milk cost\nso much, they thought all these things were necessary; but if you just keep the dust out, keep\nyour bands clean, keep the teats of the cow clean, and keep your milking-utensils clean, we have\nfound now that certified milk can be produced very reasonably; and I feel quite sure that\nDr. Underhill\u2014I hope he will show us some samples of the very good milk that has been\nproduced in Vancouver under his supervision. I think that we may say that we have a very\ngood milk-supply in Vancouver, as a general rule. I know, before selecting my milkman, I\nasked Dr. Underbill's advice. There is no use having expert opinion if you don't avail yourself\nof it. Now, these are the things I want to know; and then I would like to have that milk\ndelivered to me, if I could, with not more than, say, 1,000 bacteria per cubic centimetre in it.\nThen if I don't know enough to take care of it after I get it, that is my business. I don't think\nany of the Government men or municipal Inspectors can follow the milk into the home. I think\nup to that point we should have inspection, but it must be co-operative inspection, co-operative\nin this sense\u2014or international inspection\u2014if it is going to be efficient. Now, I hope I have made\nthis thing clear. I believe that pasteurization is the nearest thing to give us what I called,\nusing a rather crude expression, fool-proof, something that the most mediocre brain can keep.\nNow, about these diseases, we are not specific about these things. I am sure that the writer\nof the paper will not wish us to infer that the flies carry diphtheria from the toilet into the milk.\nThey don't. They may carry diphtheria or typhoid or other things from a human source or\nfrom an intermediate source, like receptacles, to other people, but you don't find that bacilli are\nin toilet-rooms or in a pan, you find them in people's throats and noses. Sometimes, when you\ndon't suspect it, you find it in the case of people who have had the disease, or in the case of\npeople who have not been suspected at all of having it, who carry it.\nNow, this idea of carrier is pretty general in application. I might tell you of one\u2014I think\nDr. Mullin ran this investigation\u2014we had one time there a case of diphtheria in the vicinity of\nthe university, along the east side; well, what should you do when you are having an epidemic\nof any disease? Every case should be reported at once by the physician to the Medical Health\nOfficers. In that report it should be; then the Medical Health Officer goes out and he finds out\na number of things, the water-supply of the patient, where he was for awhile, for particularly in\ntyphoid cases you want to know what he was doing for weeks; you don't want to know what he.\nwas doing to-day, you want to know what he was doing for weeks, where he was infected; you\nwant to know his milk-supply. Well, these men came in and they said that it was the milk-\nsupply where they detected the presence of bacteria. And in this case he was the best milk-\ndealer in the City of Minneapolis, and he got a very black eye, and it was very very unfortunate,\nbecause he should have been encouraged in every way; but those were the facts. What did we\ndo about it; what did Dr. Mullin's colleagues do about it? Did they go and examine samples\nof the milk? No; they went out to that man's dairy and they took swabs from the noses and\nthroats of everybody who had to do with the milk, and they found a Swede there who had only\nbeen in the country for a few weeks, but he was a good carrier, and be had diphtheria in his\nthroat and nose. He may have talked or he may have sung or he mayliave sneezed, or something 8 Geo. 5 Provincial Board of Health. G 213\nof that kind, over the milk. Anyway, that was the dairy. You see, it must carry down to actual\nobservations. How can you theorize when you cannot get any further? You are supposed to\nbegin the theorizing when you cannot find out anything more. In a case of typhoid fever, in\nthe same way you find the cows don't have typhoid fever. You can't get typhoid fever from a\ncow, you can't get it from any mysterious source; you get it from the individual who carried\nthe typhoid. \" Typhoid Mary \" is perhaps more historical than anybody else. Now, they didn't\nknow what to do with it. She .seemed to have all these bacilli in her system, the typhoid bacilli.\nThat is not her fault, but it is her misfortune, and somebody else's. They had ber on the island\nfor quite a number of months; there was no legal machinery to hold her. She might just as\nwell have all her boxes and her hands full of bonds so far as the community was concerned.\nShe is supposed to have been the cause of twenty-two different typhoid outbreaks.\nThey found on a Russian estate some years ago a woman who was a typhoid-carrier, and had\nbeen for seventeen years, and she had 'been distributing typhoid; she had been the cause of\ntyphoid outbreaks for a number of times because she was in the dairy of that estate. Now, as\nsoon as anybody gets diphtheria or anybody gets typhoid, and you find one of these people in\na dairy, you have got to get control, cut that dairy off for the time being; then you have got\nto segregate that person and cut him off in the meantime until you have examined everybody\nelse in the whole household and the whole establishment, until you find out by this examination\nthat they don't have diphtheria or that they don't have typhoid. That is where you are getting\nmilk that is not pasteurized, and you ought to do it, anyway; you ought to do it, it is good\nbusiness from a public-health standpoint. So it is with your tubercular bacilli; as Mr. McDonald\npointed out, the main factor involved in tuberculosis was not perhaps the question of public\nhealth, because perhaps a different person\u2014I mean you have a number of percentages\u2014there\nare only a limited number of percentages of those cases in which you cannot find the tubercular\nbacilli of the bovine type. Of course, there is another disease group, where you find children\ninfected in infancy; there may have been a change from the bovine type to the human type, but\nnobody can prove it. There is no conjecturing about it; but the main consideration is of the\ncow only. You cannot afford to have tuberculous cattle; they don't produce as much milk, and\nif they are beef animals they will not as a rule take on beef so fast; and, furthermore, he gets\nhis whole herd infected; and we have seen to-day that it is to his interest to get rid of\ntuberculous cattle, and if he does that then we will be safe.\nNow, you see, in all these cases we must keep quite clearly in mind that there are definite\nspecial methods for finding out these things. You do not examine a sample of milk for the\ntubercle bacillus, you go and see if you can find the cow that is tuberculous. You don't examine\nthe milk to see if there is any typhoid in the milk, you go and find out whether there is a case\nof typhoid, or whether the man who is handling the milk or his wife is sick with typhoid, or\nwhether, where the case is water, for the purposes of dilution or perhaps for domestic use, it\nis on a farm where they have typhoid, and you go and examine the individuals to see whether\nthey have diphtheria in their mouths or noses, diphtheria bacilli; and that is the reason that\nmedical inspection of the people who handle the milk is very very important. But as a last\nsafeguard it seems to me that we will be driven to pasteurization, but not pasteurization, as the\ndoctor intimated, in the unscientific commercial way that the commercial man sees it. We will\ncome to have city pasteurization. We will probably come to have a city system, because you\nmust not blame the producer now for the high price of milk\u2014alone, I mean ; you must not\nblame the producer alone for the high price of milk, for that producer only gets half of what\nyou pay for his milk; but if you are going to insist on each one of us having a separate milk-\nwagon driving up to his door and then driving off a quarter of a mile before he reaches his\nnext customer, when right across here there is another milk^wagon doing tbe same kind of\nthing, that is not economy. That has been pointed out. We have had it up before; I think\nwe were discussing this at the food-control meeting yesterday. Mr. McDonald, I think it was,\ntold us that they are getting so particular now in certain places, competition is so keen that\nthey have a separate milk-wagon going down one side of tbe street and he is not allowed to\nrun across to the other side with a can of milk; he just takes care of those houses in that row,\nand there is another one for the other side. Now, that is what German economy can do; but\nwe can flatter ourselves that we have a very much better supply than Germany has, just the\nsame, because we have been trying to educate the people with meetings of this kind. G 214 British Columbia 1918\nNow, this is not a small problem. It is going to cost you more if you are going to have this\nkind of milk; but we heard this morning that health was a purchasable commodity, and we still\nhope to get from Mr. McDonald, if he would tell us his opinion, that not only is this the one\narticle that contains all the things needed by everybody, but that after all, even at the present\nhigh price, it is the cheapest food that we can buy; so that makes it. I think, one of the most\nimportant things with which we have to deal, and that is the reason that co-operation is so\nnecessary; and T hope that before we get through the organization will advocate pasteurization\nof milk, as being such an important article of food which should be used by everybody, a great\ndeal more than it is.\nI beg your pardon, Mr. Chairman, but this is an important matter and I was carried away,\nas I am so liable to be when I get interested. (Applause.)\nMr. McDonald: Mr. Chairman, if I may be allowed just a word in regard to this question\nthat Dr. Wesbrook referred to;. there is in our office, if any of you have time to read it\u2014I\nhaven't yet had the time to read it thoroughly\u2014a report from the Wisconsin Experiment Station\nwhich shows the work they have carried on, that the vegetable oils do not contain the principles\nof this growth that is contained in these other things. It may be that some one present has read\nthis report. I just glanced over it hurriedly.\nThe Chairman : Is there any other member who would like to discuss this paper?\nDr. Petersky: Mr. Chairman, Ladies and Gentlemen,\u2014All this theorizing about milk will\nnot help me in my work. As we all know by this time, I am in the country. What I want to\nknow is how to get pure milk in the community under my jurisdiction; that is my particular\ndifficulty. The same information that you get here can be obtained by reading the papers of\nothers. I have learned a great deal by hearing these papers, but what I am going to carry away\nfrom this Convention is this: that everything in public health is a purchasable commodity,\nanyway, and pure milk is one, and it all comes down to a question of money. Now, just to give\nyou a little illustration in our community: The milk comes along in a baggage-car to the town,\nand if the train is late the milk is spoiled before it gets there. The result is that condensed milk\nis used. Now, we have all heard about the infant mortality, and I believe in providing cow's\nmilk where infants can progress favourably. Now, what are you going to do there? You all\nknow what is said about using condensed milk. Condensed milk contains carbohydrates which\nare very bad for infants. Now, we are up against it there. The merchants, however, say:\n\" If you pay me more for the milk I will get it transported specially in a box of ice.\" In other\nwords, you will have to pay freight on the ice as well as the milk. And what do those people\ndo? They absolutely refuse to pay another cent for that milk, and as a result I have had some\nbabies there with diarrhoea, the mothers have been unable to get them what they wanted. I gave\nthem modified cow's milk ; that is what I prescribed. Where are they to get the milk? The milk\ncame in one day, the train was late, and the milk was spoiled before it got there, and the merchant\nrefused to take it. As a result there was no food for that child unless they used condensed milk,\nand I had to condemn it. Well, you are up a tree.\nYou were saying it would be a good idea to have a central milk depot, that the city shall\ndeliver. I say, why not the Government deliver to communities of a certain size. If you want\nto have the babies live there is a way to do it. Then, on the other hand, that brings us down\nto that question, if it were going to mean a difference of life and death for their babies they\nmight be willing to pay an extra 10 cents a quart which they absolutely refuse to pay there.\nNow, as regards the milk after it goes into the home, if I may be permitted to disagree with\nDr. Wesbrook, I say no, by all means, it is not our own business. It is all right for Dr. Wesbrook\nand for men who know when they have good milk in their homes; but these ignorant people,\nand we find, I might say, over 90 per cent, who don't know what to do with it when they do get\nthe milk in the home, they should get that education that we have been talking about all day\nyesterday with respect to child-welfare, and so on, as to what to do with their milk. If they don't\nknow what to do with it, I don't see that they should be allowed to simply lie down and die.\nI think that is one of our duties a# Health Officers and the duty of the Health Department to\nteach these matters. That brings us back again to the high-school girls getting lectures on\nthat point. Now, if the Chairman will allow me to mention that subject, although it is not on\nthe paper\t\nThe Chairman: You will not be long? 8 Geo. 5 Provincial Board of Health. G 215\nDr. Peterskjv No, just for a moment. I just want to call your attention to the question\nof food inspection by us. The Health Officer in the country is supposed to be a check on all\nthis. They-have to examine the carcasses. Now, what do I know about meat inspection?\nI might do a post-mortem perhaps, and know a little about pathology. Now, I was called in\na particular case, and I read through my \" Health Act\" thoroughly, aud found that I had the\npower to condemn, under the \" Health Act,\" that which I thought was unfit for human consumption ; and this particular carcass, I did not attempt to use a medical expression, the symptom\nalone, but tbe symptom complex of the whole case; in other words, I tried to use my bead.\nI found one man that sold meat was notoriously a man that was very, very severe and would not\nundersell to anybody else, and he sold it so cheaply that it aroused my suspicion. And then the\ncarcass itself. I had never examined meat before; well, I simply told the sanitary officer\u2014the\nProvincial policeman\u2014I said: \" I wouldn't eat it, and I don't see that anybody else should.\"\nWell, the meat was condemned. I had to leave that place for a few days, and some sea-lawyer\nadvised him to send a sample to the Department for analysis, and that they would put it over\nme. I saw the letter; it arrived the day that I came back, and the Provincial police showed\nme: \" This sample contains actinomycosis and the carcass is unfit for human consumption.\"\nAnd the Government Inspector was sent up to examine the herd. Now, that shows you what\nwe are up against in the country. Another thing: Meat is sold in some places the day that it\nis killed, and it was always with fear and trembling\u2014there was no other way of getting it\u2014\u25a0\nI eat that meat myself.\nNow, I take it that this Convention wishes that all the problems that we have and that have\nbeen discussed here should be looked into, as they are not easy to get over. (Applause.)\nDr. Underhill: Mr. Chairman, Ladies and Gentlemen.\u2014We have heard the scientific side\nof the milk question, but we poor Medical Health Officers have another side\u2014the practical side\u2014\nand that is what I want to deal with at the present moment. It is always instructive to meet\na man who can give us a paper such as Dr. I'rice has given us to-day, and I wish to congratulate\nhim upon his achievement. Looking at the matter from the practical side, I cannot see of what\nuse it is to have laws if they are not carried into effect. The Acts of British Columbia relating\nto milk are plain and straightforward, and it is the duty of all of us to see that they are put\ninto practice. I regret to say, however, that they are not put into practice.\nNow, Mr. McDonald has taken the sting out of what I wanted to say, because he has honestly\nsaid that he has neither the money nor the Inspectors necessary to properly carry out his work.\nNow, just keep that in mind. Don't run away with the idea that all the herds in British\nColumbia are tuberculin-tested to anything like the extent they ought to be, for they are not.\nI am simply stating facts\u2014facts that I can prove; and Mr. McDonald can bear me out. It is\nquite true that they want money; it is quite true that they want Inspectors; that is not my\nbusiness. My business is to see that the milk-supply of the City of Vancouver is from tuberculin-\ntested herds, and I say it is not. There may be a small percentage, but it should all come from\ntuberculin-tested herds. We hear that the farmers object. They may have a good reason for\nobjecting, but I am not speaking from their point of view; I am speaking clearly from the point\nof view of the Health Officer who has the care of the milk in this city to-day. Dr. Wesbrook was\nperfectly correct in stating that we have a very excellent supply of milk here, but it would never\ndo for any Health Officer to sit down and be content with anything. (Applause.) Therefore, if\nthe Health Officer is doing his duty, he has always got a kick, always a grunt, coming; he\nshould have in this business. Every one else is kicking at him, and he should have an opportunity\nof returning that kick. Now, the \" Milk Act\" here is all right; I don't object to it, but it is\nthe manner in which it is enforced that I object to.\nDr. Price mentions the sterilization of utensils. That is a very excellent thing; I think\nthey should be sterilized, but, like most other things, when you come down to actual practice it\nis not carried out\u2014it is simply played with. Why is it neglected? Because the farmers and\ndairymen don't know what they are doing. Of course, there are good, bad, and indifferent\nfarmers, .as there are good, bad, and indifferent men in every branch; this is not intended as\na reflection upon them, but I am telling you what we must face as Medical Health Officers.\nWe may imagine that these utensils are sterilized, but they are not. They can't be sterilized;\nthe farmers haven't got the machinery to sterilize them, and they haven't got the system to\nsterilize them. G 216 British Columbia 1918\nNow as to the question of the classification of dairy farms: What has classification done in\nthe past ? It is a\u00bb puzzling phrase. With all due deference to Mr. McDonald, I say it is an\nabsolute farce. Every farm that does not come into Class A or B is in Class C Class C is the\nultimate quantity; you cannot get down any further, and so to save the face of the farmer they\nput his farm in Class 0. You might as well call it Z or anything else. I don't know that we\nhave any milk coming from Grade B farms. Of course, they may have altered recently from\nwhat they used to be.\nTwo or three years ago I brought this matter to the attention of the Secretary to the\nProvincial Board of Health, and he seemed very much exercised about it. The Inspector has\ngone to tbe farms and graded the animals, but not the dairies. Now, Mr. McDonald will tell\nyou that there is a gentleman appointed for that purpose\u2014to examine the dairies. Is that\ncorrect? Is there any gentleman appointed to inspect dairies?\nMr. McDonald: You mean municipal dairies?\nDr. Underhill: No, outside dairies; I might use the word \" farm.\"\nMr. McDonald: We have got no Inspectors.\nDr. Underhill: You have got no Inspectors? I thought you had one for that particular\npurpose.\nMr. McDonald: Well, his duties do not take him over this whole thing.\nDr. Underhill: What I mean is that the Veterinary Inspectors should inspect those dairies.\nWell, it comes to the same thing, that there is no practical dairy inspection of the farms. I may\nhave used the word wrongly there; I was not thinking of city dairies, I was thinking of the\nsource of supply. The fact is, from my point of view, there is no true inspection of these farms,\nand the classification, taking into consideration the condition of some of the farms, is not\nequitable. It is not fair to the good man who has an excellent farm that he should be classed\nwith a very indifferent man.\nNow, as to the milk in the home: Since the introduction of the bottle there has been\ncomparatively little trouble in keeping the milk good in the home. In the old days, when the\nmilk was carried round in bulk, it frequently happened that the utensils placed for its reception\nby the householders were anything but clean; consequently the milk would not keep and the\ndairymen got the blame. To a great extent this has now been done away with, but there is a\ngreat deal to be done yet in educating our people as to how to take care of the bottled milk.\nWell, to speak the truth, I have had some difficulty in my own house, and if you have difficulty\nthere you may expect to find the same conditions prevailing generally. The bottle of milk is\nbrought in from the cooler and a certain quantity taken out of it for immediate use; the bottle\nis forgotteu and is left often in the warm kitchen, and then after a while taken back to the cool\nreceptacle. It Is this change of the milk from one temperature to another that is so detrimental.\nIf it was kept at an even temperature there is no doubt that it would keep much better.\nWith regard to infectious diseases, inquiries are made in every reported case as to the dairy\nfrom which the milk is obtained; by this means, should it be shown that the same dairy is\nsupplying milk in several cases, it might be possible to trace the disease back to its source.\nI would recommend my brother Health Officers also to keep tab on the milk-supply in cases of\ninfectious diseases.\nWith regard to diseases carried by milk, I believe that impure water had a great deal to do\nin the past with many of our tuberculosis cases, or typhoid cases particularly, possibly through\na drain on the farm leaking into the water-supply which was used for washing out the cans\u2014\nor possibly for adulterating the milk. Now, however, that the milk is being purchased from the\ndairies on the butter-fat basis by weight, there is not the same temptation to adulterate it.\nPasteurization I simply look upon as a means to cover up dirt. That is my personal opinion\nabout it. Samples of milk are taken from the dairies at frequent intervals for bacterial examination, and it sometimes happens that the count in a particular sample is especially high. A special\ninspection of the dairy is at once undertaken on the assumption that the milk may have beeii\ncontaminated at the dairy. Samples are taken at different points of the machinery and examined\nfor bacteria, and the cause of the trouble may thus he located. This is one of the most important\nduties of a Health Officer, to find out the point of trouble and see that it is corrected; and this\nis where the bacterial examination of milk is especially useful.\nA question has been asked with regard to milk coming from Washington. Some time ago\nwe were getting about 3,000 gallons a day from that State. Now, I have inspected many of these 8 Geo. 5 Provincial Board of Health. G 217\ndairy-farms personally, and I wish I could say that ours compare favourably with them, but they\ndo not. In addition to that, the milk received from there conformed with all the regulations of\nthis city. The herds were tuberculin-tested by competent men and the certificates were produced\nto my department, and I wrote to the State Board of Health of Washington and obtained a list\nof veterinarians who were authorized to apply the test. It does not matter whether the milk\ncomes from Washington or China as long as it is all right. At the present time I don't think\nthere is any milk coming across the border, only a little cream.\nAll these things have a bearing on economic conditions. You have to be very careful in\nputting your Acts into force, because if they are enforced too stringently the milk may be\ndiverted to other uses; the farmers may send it away for cheese or butter, and as far as I\nknow there is no inspection made of milk for that purpose. I do think that if you lay down\nregulations that are too stringent, you have always before you the question of a milk famine,\nfor which we should be to blame.\nThere are many other little points that I might touch upon, but I think it unwise to prolong\nthis discussion further, and will simply say that I am glad to have been here and to have heard\nsuch an excellent paper.\nMr. McDonald: I think I should be allowed a word or two. I might say that to my mind\nwe have in British Columbia provided a more healthful-milk supply than they have in any other\nProvince of Canada. Now, I can say that without any fear of successful contradiction; and I too,\nperhaps, am somewhat optimistic in my work. If I wasn't optimistic they would have me over\nin Westminster in the \" bug-house \" before very long. However, Dr. Underhill may have left\nthe impression quite unintentionally that there is no inspection of dairies to speak of. Now\",\nthere is inspection of dairies, and our Inspectors\t\nThe Chairman: Excuse me, may I ask you to confine yourself as closely as possible to\nanswering the matters connected with this paper which Dr. Underhill raised. I think he said,\nnot the dairies, but the farms.\nMr. McDonald: That is what I am referring to.\nThe Chairman: All right, thank you.\nMr. McDonald: Yes, and the farm dairies, if you wish to put it that way; and I have the\ngrades of these dairies, they are coming in there every day. Dr. Underhill also said that there\nwas no limit to the fllthiness of milk in Class C Now, Class C reads thus: (reading). Class C\nis a very good milk as milk goes.\nThe Chairman: I think we have all enjoyed this discussion, and we might prolong it almost\nindefinitely, and still to profit; but I think that at this stage we will have to ask that any one\nwho wishes to go further into it will bring on a resolution asking Dr. Young to bring it up at\nthe next session of the Medical Health Officers, so that we can get more on this line.\nA member: I would like to know if there is any other subject\t\nThe Chairman: In fairness to the other subjects on the programme, I think we must close\nthis discussion. There is lots more to be said, but there are two other papers on the programme,\nso unless you insist on the resolution I should ask Dr. Price to close the discussion.\nDr. Price: Mr. Chairman, Ladies and Gentlemen,\u2014I was very much flattered by the amount\nof discussion which my paper has brought forward, and in view of the time taken up in that\ndiscussion, all I have to say is to thank you for listening so patiently to the paper, and I think\nI have derived great benefit from the discussion that has been brought forward. I do not intend\nto make any further reply, because the time is getting on and we have some excellent papers\nto follow. (Applause.)\nThe Chairman: There are two other subjects on our programme this afternoon, both of\nthem of great interest. The first is \" Rural Sanitation,\" by Mr. W. J. E. Biker, District Engineer,\nNelson, B.C. The discussion on this paper will be introduced by Mr. A. G. Dalzell, City Engineer.\nRURAL SANITATION.\nBy W. J. E. Biker, A.M.Can.Soc.CE, District Engineer, Water Rights Branch, Nelson, B.C.\nMr. Chairman, Ladies and Gentlemen,\u2014Public health or the science of living together in\nlarge communities with comparative immunity from disease is, when analysed, simply a matter\nof education. I think you will agree with the statement that it is the chief function of a medical\npractitioner, and particularly of a Medical Health Officer, to solve problems, and to obtain not\nonly a solution, but the best solution considered from all points of view. G 218 British Columbia 1918\nThe effectiveness of the Medical Health Officer in the fulfilment of his duties is very largely\ndependent upon the support given to him from headquarters, but more particularly from members\nof his own profession in the education of the public to proper policies of sanitary administration.\nTo be a success the doctor holding such a public position must have the collective support and\nadvice of his profession. In other words, I maintain it is \" up to you \" on every possible occasion\nto educate the public mind regarding the simple function of living, in order that we may not be\na menace to ourselves or those around us. To illustrate: Most people wash their faces to suggest\ncleanliness, unless they are indifferent or wish to be regarded as abandoned characters. Would\nit not be possible to introduce precisely the same feeling, that there is want of propriety in not\nattending to or keeping perfectly sanitary all the domestic .offices that are essential to the health\nof individuals as well as communities?\nThe need of community co-operation has grown more and more urgent with greater concentration of population, and with the development of conditions in America similar to those which\nhave existed in Europe for between one and two centuries. Such undertakings as water-supply,\ndrainage, sewerage, prevention of pollution of our streams, town-planning, park-developments,\nand particularly sanitation or hygiene, are all accomplished much better under united or centrally\ndirected effort.\nIt is no longer right for apy unit, be it a community or an individual, to disregard the rights\nof others. We must not lose sight of the sovereignty of the State or the fundamental requirement that individual communities, as well as persons, must give way to the common good and\nthe ultimate need of the most good to the most people. Many of you may say: \"But what has\nall this to do with a Medical Health Officer?\" To illustrate the point, I will digress into\npersonalities for a moment. Some of you may not have given the matter a great deal of thought,\nbut as members of an old-established, honourable profession each one of you exerts an influence\nin your community which is second to none in that community, and particularly so in matters\nrelating to health. In fact, you have under your control (in a very great measure) the health\nof the people within your area, and whether the contributory surroundings of the people are\nsanitary or unsanitary is a matter that is up to you for mitigation. Therefore, I say you are\nthe custodians of a very noble trust, and have the power within your grasp of ruling or guiding\nthe majority. Since all our laws and institutions receive their sanction by the ruling majority,\nyou, gentlemen, in so far as sanitary legislation is concerned, are therefore the motive power of\nthe people.\nIt is the boast of science that its only quest is truth, and that in its pursuit the inductive\nmethod of research is never departed from. The average lay mind has become so accustomed\nto accepting as truth whatever bears the scientific label, and as valid whatever conclusions are\nalleged to have been reached by the process of induction, that it is now a comparatively easy\nmatter for any of you to wield this potential asset for the good of the people. In other words,\nto inculcate in the people the simple study of cause and effect as it might be applied to living.\nUpon whom rests the responsibility of the contagious infections or epidemic diseases that\nquietly take their toll of human life? Who can be blamed for permitting many of the preventable\ndiseases to thrive in this enlightened age? Is it the Governments, the municipal authorities, or\nthe people themselves?\nA Province or State may start out with the best intentions in the way of legislative enactments to protect the public health. This is simple, for none but the framers of health laws\nreally know what they signify; hence there arises no antagonism to their enactment. The\ntrouble or cause of these laws not becoming a real factor in any community is, in many cases,\nthe lack of adequate financial appropriation. The average sum available per capita per annum\nfor the enforcement of health regulations for cities having a population of 25,000 or more is\nonly about 30 cents. In looking over the estimates of the Province for the ensuing year, one\nfinds an appropriation of $50,708 for public-health administration, or. worked out on a per capita\nbasis (on an assumed population of 400,000). a little over 12% cents per head.\nSecondly, the officers in charge of such administration have to go about the country almost\napologizing for causing any trouble, and in fear and trembling of the political pull that Jones\nor Smith (whom they have just reported) may use against them when opportunity offers. I\nspeak this to the shame of all political persuasions, both here and elsewhere, and add, without\nfear of contradiction, that no 'efficient public-health administration caii be formed unless, in the\nfirst place, you can secure men who are capable of acting above personal interest, and, secondly,\ngive them adequate protection and continuity of service to make it worth while. 8 Geo. 5 Provincial Board of Health. G 219\nThe status quo of the sanitary problem in this Province to-day can fittingly be compared to\nthat of England prior to her acquiring a dense population. The laws governing the public health\nwere and still are good, and gave to the officials all the power necessary, with what result?\nSewage-disposal, the unrestricted pollution of the rivers and streams, increasing death-rate, and\nother factors took such a toll of the best lives in their midst that finally arrested the attention\nOf Parliament to the issue, resulting in the appointing of a Royal Commission to deal with the\nquestion of sanitary legislation. This Commission has been in existence for seventeen years,\nand the expense and results of the findings of this tribunal have cost England millions of pounds\nsterling. Now comes the point to be made, and surely we are able to draw something from their\nexperience. We are still in the initial stages of development, and I take this opportunity of\ngoing on record, in September, 1917, to the effect that we in this room have it within our power\nto save British Columbia and its future administrations from the condition that Great Britain\nfound herself in when she appointed her Royal Commission for the protection of public health.\nOver there, through bitter experience, they have learned that sanitation almost amounts to a\nreligion, and even at this time, when we are fighting for our very existence, they are debating\nthe advisability of creating a new portfolio to be named the Ministry of Health.\nI do not propose to detain you with figures, but give to you a problem to work out for\nyourselves. How many of us nave conceived the value of a human life in actual dollars and\ncents, the producing and earning power of that life to the State, to the community, and to the\nhome that has cradled it? Taking as an index to our attitude towards the various administrations of the people the actual cash set apart for those administrations, we find that more value\nis placed on a stick of timber than on a human life. For forest-protection we spend on an\naverage $1.25 per capita per annum, as compared with about 12y2 cents per capita for the\npreservation of human life.\nThese opening remarks may have the appearance of being very dogmatic, but my justification\nfor the thoughts just given is drawn from twenty years' experience in sanitary engineering, and\nfor fifteen of those years it was my duty to administer and be daily iu touch with problems\nregarding the public health.\nThe Honourable the Minister and Dr. Young have, no doubt, placed in your hands the new\nSanitary Regulations, which, coupled with the \" Health Act,\" completely cover your sphere of\noperations. The appropriation of $50,708 is unquestionably inadequate to obtain results, except\nin a small degree, particularly so in view of all the problems with which this Department has\nto cope. However that may be, I want to make an appeal to you on behalf of the people of\nthis Province, that the laws you have to administer and the problems under your control are\nquestions apart from the remuneration you may receive. Therefore it will be observed that the\none thing needed is a policy which has for its object a common ground on which we can all work\nfor the same ends\u2014viz, the public health.\nSo much for general statements. I now desire to cover a few practical points on rural\nsanitation, the betterment of which enlists at all times my sympathy. My work of the last six\nyears as District Engineer in the Lands Department has been spent in the East and West\nKootenay Districts, and has necessitated at intervals stays in mining, logging, and construction\ncamps. While every courtesy and hospitality has been shown me, the sanitary condition of\nthose camps to me is a thing quite apart. There are no figures to prove or disprove the statement that I believe between 30 and 40 per cent, of the population in the Kootenay District live\nunder camp conditions. No doubt many of you remember having a1 hurried call to some of those\ncamps and, being unable to get back, stayed the night under usually very respectable conditions.\nWhy? Being the doctor and a visitor, the foreman or superintendent gave up his room or his\nbed for yon. But drift into one of these camps as an ordinary individual, when the space for\nvisitors is limited, and what do you find? A low bunk-house with no ventilation, down each\nside of the room a row of double-deck bunks made of boards covered with hay that has probably\nnever been changed since the place was built, blankets that in places are stiff with body-\nperspiration, finally being compelled to double up with a man who has worked and slept in\nhis underwear for weeks without change, and perhaps not had a bath since he was last in town.\nI have seen in a log shack 24 x 26 x 6 feet high at the walls as many as thirty-two to thirty-six\nmen sleeping. Imagine how refreshed you feel each morning on rising. (Have any of you\nassociated our increasing death-rate from tuberculosis with the overcrowded conditions of\ncamps?) Anyway, you live through it, and with the strength you have left you struggle off to G 220 British Columbia 1918\nthe cook-house. If in summer, you find it impossible to enjoy the food because of the millions\nof flies. You may want a drink of water. It is kept in an open galvanized pail near the door,\nwith a tin dipper hung just above. Under average conditions the privy is placed near the cook\nand bunk houses, quite close in, usually of the open type, and flies simply have a great time\nchasing each other from here to the cook-house.\nWhat do you find regarding the disposal of offal, kitchen waste, slops, etc.? You find that\nthe cook is true to type, designed on the lines of least resistance, and finding room for this\nmaterial not an inch farther than he can throw it from the kitchen door-step, or it may by\nchance arrive in a pigsty adjoining the kitchen, and it may not. Section 60 of the \" Health Act\"\nsets forth that the Health Officer shall in every year in April or May inspect the sanitary\ncondition of these camps, also the water-supply.\nThe above is a very serious state of affairs, true as it is, with only a few exceptions, and\nthe following suggestions are given for your consideration:\u2014\n(1.) The cook is the chief regular offender in camp. Why not have him registered and\nmake him, under penalty of dismissal, responsible for the sanitary condition of\nthe camp? h! printed set of regulations could be got up to cover all the essential\npoints.\n(2.) Log cabins should not be built to house more than from ten to twelve men, and\nshould be provided with iron camp-beds with spring mattresses.\n(3.) All habitable buildings to be whitewashed at least once in every year.\n(4.) Fly-screens for all windows and doors in cook and bunk houses.\n(5.) Waste, offal, empty cans, slops, and all debris to be removed daily (and kept until\nremoval in a covered receptacle), to be finally disposed of by burning.\n(6.) Stables or privy to be at least 100 yards distant from the camp.\n(7.) Bath-room or shower an essential.\n(8.) Good water-supply, and where possible piped into the buildings.\n(9.) Earth-closet to be of approved design to exclude flies.\nCamps for this purpose may be divided into two classes, permanent and temporary,\ndistinguishing permanent camps as those having been built over twelve months.\nMany other points may suggest themselves to you, but in starting a progressive movement\nwhich attacks established custom, it is first necessary to convince the interested parties that\nyou seek their co-operation and help. On the other hand, some one may be tempted to say:\n\"Why not enforce the law?\" On this point, as in the majority of cases in health matters, the\nactual letter of the law is for our guidance, to be used with great discretion and enforced only\nas a last resource. It is often worth while spending a whole day with some men in convincing\nthem that you are working in their interests, because, once convinced, you have a booster for\nyour cause.\nIn support of the better-camp movement, it is only necessary to state that it has made\npossible the Panama Canal, and at this moment, in France and on the Allied fronts it is preserving daily more lives than the guns of the enemy are destroying.\nPollution of Streams.\nThere is an old saying that \" constant dropping wears away a stone \" ; likewise, the constant\npollution of our streams destroys their usefulness. It is a significant condition to observe that\nthe three most scientifically advanced nations in the world, England, France, and Germany (by\nthe standard of present knowledge), allowed the incipient pollution of their streams to overtake\nthem, until it finally became so intolerable that vigorous campaigns costing millions of dollars\nwere instituted to mitigate the evil. England seems to have suffered most in this regard,\npresumably by virtue of her possessing more inhabitants to the square mile.\nWith the exception of a few small streams, we are in a very favourable position in this\nProvince (providing we realize our present opportunities) for keeping the streams free from\nserious pollution. If we are to preserve the amenities of our streams, a very careful and\nsystematic scheme will have to be evolved, enlisting the aid of the greater part of the population.\nThe Royal Commission of Great Britain has had this problem under consideration for a\ngreat number of years, and its conclusion, as set forth in the 1912 report, is as follows:\u2014\n\"We are satisfied that rivers generally, those traversing agricultural as well as those\ndraining manufacturing or urban areas, are necessarily exposed to other pollutions besides 8 Geo. 5 Provincial Board of Health. G 221\nsewage, and it appears to us, therefore, that any authority taking water from such rivers\nfor. the purpose of water-supply must be held to be aware of the risks to which the water\nis exposed, aud that it should be regarded as part of the duty of that authority, systematically\nand thoroughly, to purify the water before distributing it to their customers.\n\" Apart from the question of drinking-waters, we find no evidence to show that the mere\npresence of organisms of a noxious character in a river constitutes a danger to public health\nor destroys the amenities of the river. Generally speaking, therefore, we do not consider that\nin the present state of knowledge we should be justified in recommending that it must be tlie\nduty of a local authority to treat its sewage so that it should be bacteriologically pure.\"\nIt must be conceded that the conclusion of the Commission is sound in principle, since under\naverage prevailing conditions water-purification rather than sewage-purification affords a better\nsafeguard of the public health in the state of present knowledge. It also has financial considerations, since water-purification is not only more reliable, but is also cheaper under the average\nconditions.\nIt is necessary to consider the future as well as the present regarding stream-pollution, for\nsince it is a question of degree there is a limit to the permissible dilution of sewage. It is\nperfectly obvious that as civilization advances and the population of the Province increases\nthere can be no longer any streams of original purity. On the other hand, if the system of\ndischarging crude sewage into our streams, without realizing the \" limits \" of such a system,\nthe Board will have to face a condition which has cost Great Britain millions of pounds sterling.\nThe writer was very much interested in this whole problem in England, and it has been\nwith increased interest that he has noticed a gradual change of opinion by all the leading experts\nin their attitude towards the dilution method. In this regard, it is only necessary to quote\nDr. A. C. Houston, Chief Water Examiner of the Metropolitan Water Board of London, and\nDr. T. M. Drown in his special report of the Massachusetts State Board of Health, wherein is\nstated in reference to sewage-polluted waters: \" It would be necessary to drink half a gallon\nat once of the waters under test in order to get as much nitrogen and carbon as is contained in\na single medicinal dose of strychnine, which is acknowledged to be one of the most energetic\nof recognized poisons.\" At the same time, both the above authorities are advocates of \" clean\nrivers,\" but have brought themselves through their research-work to look more favourably upon\nthe dilution method of disposal, and to take advantage in point of economy of the many intermediate procedures of this system. To apply the above reasoning to British Columbia resolves\nthe problem into what is the actual safe \" degree of dilution.\"\nThe Chicago drainage-canal, constructed under and with the approval of the Illinois State\nBoard of Health, was established on the legal limit of 3% cubic feet of river-water per second\nto dilute the sewage of each 1,000 persons connected with the sewers. This limit has been\ncriticized and was probably too low for the crude sewage of a city which has such a large\nproportion of manufacturing wastes in its sewage-flow as is the case of Chicago. For a city\nwithout such wastes it might be termed a fair limit. Generally speaking, without prior treatment a dilution of 4 cubic feet per second per 1,000 persons is a reasonably close figure for crude\nsewage, although undoubtedly there are many local factors which have a bearing on the complete\ndilution and may be said to establish a range as wide as from 3 to 7 C.F.S.\nSuch simple pre-treatment devices as \"screens\" and \"sedimentation-tanks\" in certain cases\n(other conditions being equal) may reduce the standard to 2.5 C.F.S. per 1,000 persons. One\nvery large factor in reducing the standard, in so far as the majority of our large streams are\nconcerned, is: \" Owing to the rivers having their feeders come from high altitudes, many of\nwhich are glacial-fed, the water is the year round very cold, therefore strikingly unfavourable\nto all biological activities of bacteria, worms, and other organisms which operate to decompose,\ndigest, or oxidize the organic and mineral matters in sewage.\"\nFish Requirements.\nData are somewhat meagre as to the amount of dissolved atmospheric oxygen which is\nrequired in streams to protect major fish-life. In the lower Elbe near Hamburg it is stated\nthat a margin of dissolved oxygen during the ordinary summer periods falls as low as 20 per\ncent, and the figure in the lower Thames is understood to be about 30 per cent. G 222 British Columbia 1918\nFuture Requirements.\nWhile a firm believer in tbe dilution method of sewage-disposal within controlled limits as\nroughly outlined above, it is the part of wisdom to only approve such designs for sewer systems,\nso that if filtration, screening, or other pre-treatmeuts are not needed at the outset, they can be\nadopted as conveniently as possible in later years, without involving pumping-stations or the\nabandonment at too great sacrifice in works already undertaken. In the initial stages of the\ndevelopment of the Province this feature should have full consideration. The writer has been\nin touch with many cases in England where, through the recasting of the regulations by the\nRoyal Commission, authorities or municipalities had to face problems which involved the loss\nof present works, or resort to expensive pumping in order to obtain the fall necessary to install\nadditional treatment-works for securing an effluent equal to the new standard set by the Commission. Therefore, from what has been said, it will be seen that the consensus of expert\nopinion based on present knowledge has aimed at the conclusion, \" That it is proposed now to\ntake full reasonable advantage of dilution \" and to safeguard the future by so arranging the\nworks that a more complete treatment and higher standard of effluent may be secured when and\nas required.\nIt must not be understood from the preceding remarks that sewage is the only contributory\nfactor in the pollution of our streams. I venture to tell yon that in 09 per cent, of our preemptions that have streams running through them the farmer has erected his buildings to\ninclude the stream iu his barnyard, and in scores of cases under my observation the pigsty,\ncorrals, and manure-piles are actually on the creek. The farmer is not to blame for this state\nof affairs. As usual, you find him built on the lines of least resistance, inasmuch as bis stock\ncan secure all the water they require with little attention. You have in sections 42, 43, 44.\nand 47 of the new Sanitary Regulations all the authority you need in handling these cases.\nHave you also thought of manufacturers' trade refuse, sawmills, lead, zinc, and copper\nmines or refineries, all of which come under this head and require attention? It will take a\nnumber of years to round out each district, because it will be necessary to quietly accumulate\ndata or sanitary survey of the streams, in order to be able to deal with existing pollutions,\nand when this is accomplished it will only be a matter of keeping in touch with proposed\ndevelopments.\nThe Board in the near future will have to set up a standard of effluent from sewage-works,\nwhich they will allow to be discharged into the streams, and at the same time provide means\nof inspection to see that such standards are lived up to. In this connection I would suggest\ncloser co-operation between the officials of other departments and the Health Department. For\ninstance, there are Engineers iu the Public Works and Water Rights Branches, Fire and Game\nWardens, Pre-emption Inspectors, Assessors, policemen, etc, all of whom are travelling round\nthe country, who could easily report ou stream-pollution, providing they are circularized as to\n\u25a0what to look out for and given a simple standard post-card report form to fill out.\nDisposal of Liquid and Solid Domestic Refuse in Rural Areas.\nI know of no other phase of rural sanitation that directly affects the health of the population\nmore than the one just named, nor one that is capable of creating more dissatisfaction if badly\nadministered. *- It is a subject on which great difference of opinion exists, even amongst those\nwho are supposed to know. Therefore, a few suggestions on which a future meeting could be\ncalled may not be out of place.\nThe new regulations, sections 59 to 63, will serve as a guide only to your actions in this\nmatter, and I earnestly desire to prevail upon you to \" go slow \" until the time arrives that each\none of you perfectly understands the policy of the Department. I very much doubt my ability\nto focus the true position on this subject, and therefore ask your indulgence if the salient features\nare not made quite clear. The majority of experts in sanitation have accepted the following as\na guide :\u2014\u25a0\n(1.) In towns and populous places, where sewers and public water service are available,\nthe use of dry closets of any kind is inadvisable, on grounds of both health and\neconomy.\n(2.) In sparsely populated rural localities, where sewers and public water service do\nnot exist, the use of dry closets of improved kind (preferably those in which dry 8 Geo. 5 Provincial Board of Health. G\nearth is used) is generally to be preferred to that of water-closets, especially for\nthe smaller houses. In such places the closet can be placed at a sufficient distance\nfrom the house not to cause a nuisance if neglected, and the contents can be\ndisposed of on tbe laud.\n(3.) The intermediate case of a rural parish or urban district containing a closely built\nvillage, or built-up areas adjoining cities but not under city administration, with\nthe balance of the district partly agricultural or mountainous, is often difficult to\ndeal with iu the absence of sewers or water-supply, as many houses may have little\nor no space for the proper placing of a closet or septic tank and the disposal of\ntheir contents, although the majority of houses may have sufficient space for these\npurposes. \u00abIn the circumstances, there is usually strong local opposition to the\nprovision of water-supply, sewers, or public scavenging, since I believe, in the\npresent state of the law, the cost of such works has to be spread or levied over\nthe whole contributory district and paid for by ratepayers who receive no direct\nbenefit from them.\nIt would assuredly help the rural sanitary problem if it were possible to assess portions of\na district pro rata according to benefits received.\nThe introduction of a public water service in a village without sewers undoubtedly aggravates\nsewage nuisances by increasing the volume of waste water. Also, the connecting of house-drains,\nespecially if conveying water-closet contents, to highway drains not constructed or suited for\nconveying sewage is a source of nuisance and pollution of streams. The Board seem to have\npinned their faith to the septic tank with surface or subsoil irrigation, and there is little doubt\nof this procedure making good in the majority of cases. But, at the same time, I doubt the\nexpediency of such a method with a well on the same lot or even on adjoining lots. Again, this\nmethod would fall down completely ou a clay soil and ultimately become a great nuisance.\nTherefore, enough has been said to show that the best regulations it is possible to frame have\nlittle or no finality in them, and, if enforced, would work a hardship on some one. It would\nalmost seem that each case is a law unto itself, calling for the resolving of a few practical points,\nand even with the greatest scope given yon, cases will arise that will be beyond satisfactory\neconomical solution.\nWhile on the subject of methods in dealing with human excrement and waste, I cannot\nimpress upon you too strongly: \" That whatever system is evolved, you cannot allow excreta\nor stable manure to be exposed to the atmosphere in the vicinity of dwellings, because of the\nbreeding of flies.\" The ordinary house-fly is one of the most active agents known to modern\nsanitary science as a conveyer of the germs of disease. Many of you will no doubt recall and\nhave personally watched how the rising curve of the summer death-rate follows the curves of\nflies and heat. Case after case under your own observation has proved the relationship of the\nfly to the toll from this seasonal prevalence of intestinal diseases, typhoid, dysentery, and the\nfatal summer diarrhoeas of infancy. But I find myself travelling on thin ice, since this is more\nin your sphere of work. However, notwithstanding, we have an urgent need of stimulating and\nstrengthening at home our machinery for the conservation of the public health, and especially\nis this true at this time of those activities concerned with the protection of infant and child\nlife. In this regard. I recommend for your perusal the Delineatoi for September, in which\nappears a cleverly inspired article entitled. \" Save the Seventh Baby, or How the Fly Kills Him,\"\nby C E. Terry, M.D. A \" swat-the-fly \" campaign inadequately serves the purpose and has no\nbearing on the root cause of the evil. Let us eliminate exposed excreta and manure-piles, which\nare the breeding-grounds of flies, and you have in that'one action eliminated 95 per cent, of the\nfly problem. Statistics in the United States go to show that between 60 and 70 per cent, of\ninfantile mortality can be directly attributed to the fly in his capacity of germ-carrier; also,\nthe birth-rate of the different warring nations is estimated to be from 30 to 50 per cent, of\nnormal times.\nI respectfully suggest that we make an attempt to enlist the sympathy and help of all the\nwomen's organizations in British Columbia. To this as well as other phases of preventive\nmedicine, for once you have the ladies convinced, I know of no other factor in our social or\neconomic life that is half so powerful. G 224 British Columbia 1918\nHouse Plumbing.\nAll cities of any importance in the Province have plumbing by-laws, but how many take the\ntrouble to see that they are effectively carried out, and why? Because it costs money to have\nthis done. In consequence, the only safeguard agaiust sewer-gas being admitted into dwellings\nis at the mercy of the plumber, who usually secures his work on competitive bids, and who is\nusually more interested in the few dollars he can make (often at the expense of the work) than\nin the matter of the public health. You will certainly do a good thing by urging the cities in\nyour areas to have all plumber's work inspected and made to pass a water-pressure test. Cases\nhave come to my attention where soil-pipes (which, under the present system of house plumbing,\nventilate the sewers) finish through the roof below the upper-story windows. Also, the joints\nin same above the water-line are usually carelessly made. Again, what protection is there in\nthis system against the housewife cleaning out the toilet and wash-basin traps and leaving them\nunsealed, in complete ignorance that by so doing sewer-gas is admitted to the dwelling? Or take,\nfor instance, houses that are empty, or even temporarily empty for about three months, during\na hot, dry spell such as the one we have lately experienced, and you will find the water in all\nthe traps to sinks, wash-basins, and toilets evaporated below the sealing-point, thereby ventilating the sewers into a closed house, all the furniture and hangings, in many cases, becoming simply\nsaturated with sewer-gas.\nThere is no doubt in my mind that the single-trap system, as is the practice in British\nColumbia, is not the best one to adopt. It may be the least expensive, but surely this is not all.\nIn its place I suggest the double-trap system, or what is termed the intercepting trap, with\nmanhole. This has been statutory law in England for many years, and has to its credit not\nonly the prevention of sewer-gas to dwellings, but it also gives access by inspection to the drains,\nenabling the location of stoppages and the clearing of same by rodding.\nThe time has arrived in certain towns in the Province when, in letting or selling a house,\na Sanitary Inspector's certificate as to its habitable and sanitary condition should be just as\nmuch an essential as the clear title.\nGentlemen, I am afraid that this paper is getting too long, and it has not been possible to\ntouch on the subjects of water-supply, contamination of wells, scavenging, dust-removal, \"public\nbathing-pools, recreation-grounds, building by-laws, etc, all of which fill an important place in\nthe chain of a sanitary regime. However, it is impossible to recount here all the detailed functions of sanitary reform. Suffice it to say at this time: \" We have gained accurate knowledge\nof the nature of many diseases and the modes in which they are spread\u2014a knowledge based on\nobservation and statistical research. It remains then for those who have that knowledge to\nawaken and educate the public opinion to the importance of hygienic requirements. The State\nhas realized its responsibilities and we have a sound body of sanitary legislation, not perfect\nindeed, but comprehensive and workable; we have central and local boards responsible for the\ndue carrying-out of the law, and in every district in the Province we have a qualified Medical\nOfficer of Health charged with the sanitary welfare of his community. In short, the Province\nhas taken medicine into its service, and availed itself in a small measure of expert advice on\nsanitary engineering.\"\nFinally, to summarize, we want co-operation and a higher standard of efficiency in the\nadministration of public-health laws :\u2014\nFirst: In improved camp conditions.\nSecond: Prevention of pollution of our streams.\nThird: Better disposal of our liquid and solid domestic refuse in rural areas.\nFourth: Regulations to dispose of the fly problem.\nFifth: Enforcement of the laws in regard to securing better house plumbing.\nSixth: The people of this Province are looking to you to guide them, and your responsibility cannot be side-tracked.\nSeventh: I look forward to the time in the very near future when the Province will\nbe divided into administrative public-health districts, with a full time Medical\nHealth Officer in charge, who will act under and be responsible to the central\nboard in Victoria.\nI realize that I may have aroused in some of you resentment, inasmuch as the suggestions\ncontained in this paper call for guidance in duties of an engineering character. As stated at 8 Geo. 5 Provincial Board of Health. G 225\nthe beginning, this guidance should be forthcoming from headquarters, and I have no doubt\nit will be if you send along your troubles. I also have to suggest that every Medical Health\nOfficer in the Province be provided with a copy of Dr. Poore's book on \" Rural Hygiene.\" which\nis one of the best books I have perused on this subject.\nI now leave you with a plea to make the year 1918 and successive years banner years in the\nreduction of our death-rate, which can be realized only by steady, painstaking effort. Personally,\nyou have my sympathy, and again repeat: \" It is up to you.\"\nDiscussion on Mr. Biker's Paper.\nThe Chairman : The discussion will be opened by Mr. Dalzell, City Engineer.\nMr. Dalzell: Mr. Chairman, Ladies and Gentlemen,\u2014I presume that the hour is so late that\ntbe discussion will be very limited, so I will try to be very brief. I congratulate the reader of\nthe paper on the excellent way in which he has presented this subject. There are a great number\nof civil engineers in the Province\u2014or were. I might say that I understand that a third of them\nare on active service; but the civil engineers who practise in this Province have not, many of\nthem, been trained or had much experience in sanitary work, and of those whose training has\nbeen in the older countries, it seems to me remarkable that so little advantage has been taken\nof experience of that kind in the older countries, and that you are beginning here where England\nand Scotland began years and years ago in many of your regulations. For instance, the Bell trap\nhas been absolutely prohibited in the Old Country for years. It is a commercial output here\nand in common use. Dwellings in basements are prohibited, and where they exist in the Old\nCountry they are regulated; but here in your new apartment-bouses you make the regulation\nthat there shall be no suites in the basement except the janitor's. Why the poor janitor should\nbe put into the basement, when he surely requires greater protection than any other person in\ntbe building from the dust and from the chance of getting tuberculosis\u2014but there are in this\ncity modern apartment-houses which in that respect, in the accommodation for the janitors and\nin certain sanitation in the basements, would not be tolerated in any ordinary town in the older\ncountries, and a great deal I think must be done, as the reader of the paper has said. We have\nto depend upon you as Medical Officers, and the medical profession especially, to do the educational work. As I said, the engineers who are responsible for a great deal of work that is\ncarried out have not, many of them, been trained in sanitary work, and they are not heard or\nattended to as a medical would be. Take one instance, in one ward in this city: A fourth of\nthat area is a muskeg swamp. Now, it is absolutely impossible that that ground will ever be\nfit for human dwellings to be put on, as we regard it in modern sanitation, but yet is has been\npermitted, and I can only imagine that this was because the surveyor who surveyed that ground\nin the first place had no idea of the sanitary significance of land of that description. But I do\nthink this: I am optimistic in this respect, that I believe Canada is going to see in a very few\nyears a tremendous influx of population, and that it is up to us, and up to the medical profession\nespecially, to so try to provide legislation that some of the mistakes that have been made in this\ncity in the last ten years shall not be repeated. If, for instance, we find in a city like this\ndwellings situated in a place which is unfit for human residences, why should we allow another\ncity to take up the same land? And yet I take it that is what has happened at Prince Rupert.\nI am told that half the area of Prince Rupert is muskeg, and I don't think that any ground of\nthat description is fit ground for human dwellings to be erected on. I could give reasons.for it,\nbecause I have had a little experience in this city in that respect; but it is these points that\nwe want the medical men to impress, to prepare for the next influx of population into this\nProvince, which I feel is sure to come very soon, and it will come very rapidly. We want to\navoid the mistakes which the older countries have made, and try to so learn, so prepare, that\nit won't cost us thousands or possibly millions of dollars to remedy the mistakes whiph, by taking\nthe observation and experience of other countries, we might avoid.\nI congratulate the writer on his paper and am glad that he is a member of the Provincial\nstaff. I am sure, if we have more men of that description, many of these mistakes that I\ndeplore, and that I think will be costly in the future, will be avoided. I thank you. (Applause.)\n(At this point Dr. Wrinch occupied the chair.)\nThe Chairman: Ladies and Gentlemen,\u2014Even at this late hour I want your indulgence\nwhile I call your attention to some points in the paper. I might say that while the writer of\ntbe previous paper was complimented on having an optimistic view-point, I would hardly be able\n15 to compliment the writer of the present paper on having an optimistic view-point; but I am\nnot one who has much experience in relation to mining camps; in fact, I never knew anything\nabout mining, except what I saw in the papers, until I came to the Province some years ago,\nbut since coming to the Province, in the northern part a mining district has been opened up.\nI don't know whether I heard the right definition of a mine the other day, but it was rather\nprecise and pointed\u2014a hole in the ground and a liar on top. Of course, I wouldn't say that\nall of our mines are of that nature. I want to say that while the mines in the Kootenay and\nBoundary Districts may be such as the writer of the paper describes, the only two mines that\nI know of that are mining\u2014beginning to operate in any kind of permanent form\u2014the camps\nare not in the shape he has described. I would not like it to go forth from this meeting that\nour mines are all of that description, or the camps are all of that description that have been\nstated here. I have in mind one mine that I went to visit. There they were supplied with\nbunk-rooms which were furnished with single-beds, iron frames; the bunk-houses have shower-\nbaths and hot and cold water, and I have seen tbe miners come right from the work and go to\nthe bath-houses, take their shower and go back to their room; and it is most convenient and\nappropriate. They have ventilation in the rooms in the mines\u2014these two mines\u2014and the camps\nand bunk-houses are ventilated, and certain of them are fumigated; water is piped into their\nbuilding. The closet\u2014at least, one of them\u2014is made of a large box receptacle for a number of\nhouses. At certain times, frequently, that box is hauled out and burned and a new one put in\nits place. That is only just another view-point, another feature which I would like to show,\nif there is any question about it, that there is that kind besides the other one.\n(Dr. Underhill then took the chair.)\nThe Chairman: Any further discussion on this paper? I will call on Mr. Biker to reply.\nMr. Biker: It is so late, and I feel that we have had a rather long session this afternoon,\nso that I don't want to discuss any point at length. I did not intend to put forward that I\ncondemned all the mining camps. That was far from my view-point. The point I tried to put\nforth was to have better camping-ground and better conditions for living in our camps than we\nhave in the majority of cases. Thank you very much.\nThe Chairman: The next paper is \" Vital Statistics,\" by Mr. Miller, Deputy Registrar of\nBirths, Deaths, and Marriages, Victoria, B.C,\nVITAL STATISTICS.\nBy Munroe Miller, Deputy Registrar of Births, Deaths, and Marriages, British Columbia.\nMr. Chairman,\u2014A few days since I was directed by the Secretary of the Board of Health,\nH. E. Young, Esq, M.D, to prepare a paper or report on the \" Vital Statistics of British\nColumbia,\" to be read on this occasion before the Medical Health Officers of our Province.\nNot being a professional man, simply one of the staff in a department in which all members\nof the medical profession should take a deep interest, allow me to make the assertion that the\ndirection \"to prepare\" has been obeyed; yet, let it be granted that when it comes to my turn\nto \" read,\" and I find myself surrounded by the very foremost men and women of our commonwealth (actual participants in and contributors to the success of the meeting), a still small\nvoice admonishes me, \" You are in the company of distinguished strangers.\" Immediately self-\nreliance vanishes, and the position of that great factor of success, when fortified by a familiarity\nwith the subject, is succeeded by one of extreme diffidence.\nTbe task assigned me being statistical may, to many, prove dull and anything but entertaining, particularly at this stage of our proceedings when many are tired, yet, when presented\nalmost as a critique by one who is not given to speaking \" smooth things,\" it may be possible to\nso arouse the combativeness of hearers as to secure at least trifling attention.\nTbe Vital Statistics Department of British Columbia has control of returns and registrations\nof all births, deaths, and marriages happening within our Province. The figures to be presented\ncover the first six months of the year 1917, and will be dealt with in order of births, deaths, and\nmarriages.\nThe returns of births come under two separate headings, delayed and current, which by our\nsystem of indexing is made perfectly plain. For the purpose of showing how necessary and 8 Geo. 5 Provincial Board of Healtfi. G 227\nimportant a thing it is to have prompt registration, figures for each year, from 1913 to June,\n1917, will be cited:\u2014\n1913, registrations 11,088, of which 9,199 were current.\n1914, \u201e .. 10,418, \u201e 8,754\n1915, \u201e 10,516, \u201e 8,558\n1916, \u201e 9,S39, \u201e 7,475\n1917, \u201e 4,798, \u201e 3,889\nTotal 46,659, \u201e 37,875\nA difference in four years and a half between delayed and current of 8,784.\nPermit me here to make an explanation, and at the same time lodge a complaint against\nmembers of the medical profession\u2014under our Act the parent shall within sixty days register\nthe birth of a child. Many are perfectly ignorant of the law and have the idea that registration\nis effected by the doctor, and so suffer the matter to go by default.\nBy section 15 of the Act the doctor is required to notify the District Registrar of the district\nin which the event took place of the birth of a child to John Brown and (maiden name of mother)\nSusan Smith. This, however, is not registration.\nHere is the ground of complaint: The doctors do not make the reports and the Department\nis in perfect ignorance of many births that may have taken place.\nNow, to show the bearing: Every ninety days the notices of births received are compared\nwith the registrations effected, checked, and delinquent parents are, by mail, provided with a\nblank form, and requested to register the birth and save themselves the penalties provided by\nthe Act. This plan is followed by all Registrars in the Province.\nAllowances must be made for people who leave the country, etc, and who cannot be located.\nLet us allow 5 per cent.; 8,784 who are not registered, less 5 per cent, leaves 8,345. Let us be\nliberal; at least 8,000 of the births have never been reported by the doctors, and of which events\nthe Department had no knowledge whatever\u2014a very palpable offence, or clear case of absent-\nmindedness, neither of which can be condoned. To show, in order to explain: Where we have\nhad notice from physicians, and where the people have moved away, by mailing notices and\nforms we have had registrations effected from all portions of the United Kingdom, France,\nvarious Provinces of the Dominion, and nearly all the leading cities of the United States. Had\nnotices never been given, registration would have been lost.\nRegistration of births may be by some considered a matter of trifling importance, but any\nsudden or violent activity in the real-estate market or winding-up of estates, such as we have\nlately passed through, where validity of titles were affected by lack of registration, has had\nan awakening effect; but when we add to that the demand for certificates of registration\noccasioned by the present war, in order that women and children may be enabled to establish\ntheir identity before being able to secure their allowances, then the result is, truly, brought\nforcibly home.\nThe Department must have the co-operation of the physicians. They must give notice of\nevery birth, whether premature, still-born, or congenitally deformed so as to prevent living, and\nthe Department must be held responsible for the registration of births by enforcing the provisions\nof the Act against all offenders.\nAs nearly as possible, following are returns of births for the different localities specified for\nthe first six months of the year:\u2014\nVictoria 514\nNanaimo 258\nNew Westminster 469\nAlberni 151\nBeaton to Nelson 237\nNew Denver to Wilmer 192\nAshcroft 76\nFairview 399\nVancouver City 1,124\nSouth A'ancouver 237\nNorth Vancouver City 58\nNorth Vancouver District 18 Point Grey 47\nRichmond 71\nWest Vancouver 3\nUnorganized 35\nTotal 3,889\nThe total includes premature and still-born.\nRe Death Returns.\u2014Total number of deaths, 2,088, including still-births. Of this number,\nincluding still-births, under one year were 383, being 9.84 of all births and 98.48 per 1,000 of\nbirths. Deaths, up to five years, including still-births, 485, being 23.22 of all deaths and 232.27\nper 1,000 of deaths. Almost one-quarter of all deaths are under five years of age.\nA pertinent question is, What makes the rate so high? We enjoy, almost, immunity from\ndiseases of the digestive system peculiar to children, there being only eleven deaths reported\nfrom summer complaints. The answer can be found in deaths of children under one year of\nage under the following headings :\u2014\nCongenital malformations 33\nCongenital debility, icterus, and sclerema 22\nPremature 49\nStill-born S4\nTotal 188\nNine per cent, of all deaths and 38.85 per cent, of all classed under infantile mortality.\nThe three principal divisions, Vancouver, Victoria, and New Westminster, are responsible\nfor:\u2014\n75 out of 84 still-births.\n196 \u201e 299 under one year.\n271 \u201e 383\nThe figures show that 70.75 of deaths under one year occur iu the congested centres. Why\nshould it be so? The Health Boards are untiring in their efforts to better sanitary conditions\nand put forth every effort to make life worth living; but there is a subtle something abroad\nwhich thwarts their efforts. Plainly, is the pace at which we travel in cities so fast that the\nvirility of parents becomes undermined to such an extent that they are rendered physically unfit\nto become fathers and mothers, or has a natural life been abandoned for a scientific one, thus\nmaking a class the legend on whose banner does not read \" Be ye fruitful, multiply, and replenish\nthe earth\"?\nIs the time ripe for changing our school curriculum? Shall we teach the coming generation,\nas far as we are able, what life is, and that nature not only provides, but inflicts a penalty on\nall who violate physical laws? Or shall we make it a law of the land that all persons shall,\nby examination, prove their fitness to enter into the holy bonds of matrimony? Perhaps too\nmuch time has been given to this particular line of vital statistics, but all foundations must be\nwell and truly laid.\nBy way of finale re infant mortality, allow me to interpolate; in round numbers, registered\nand unregistered, we have lost 500 children under five years during the first six months of the\nyear.\nLet us be sordid enough to view this matter from a financial angle, for, after all, it does\nseem that he makes the best argument who can show that his plan will result in a handsome\ncredit balance. Let us consider the children a source of natural wealth. It is asserted that\nevery child born represents a value to the State of $1,000. At the rate we are moving our\nannual loss in this one source of natural wealth is close upon $1,000,000.\nWhy not give the whole matter a business turn and endeavour to save one-half the loss by\nproviding funds with which to secure proper supervision and institutions for treatment of\nchildren? I do not mean to deprive parents of their little ones, but to provide inspection, etc.\nA little further\u2014save one-quarter of what is now a complete loss, and we have an annual gain\nof $250,000 in one source of natural wealth.\nI have been impelled to these remarks by reading the estimates of revenue and expenditure\nof our Province for the year ending June 30th, 1918. Therein I find every source of natural 8 Geo. 5 Provincial Board of Health. G 229\nwealth carefully guarded by officials provided by the Government. Even wild game is capitalized\nat $700,000\u2014that amount at 6 per cent, will yield $42,000 per annum; and the Game Wardens'\nDepartment costs $41,300 to maintain, the chief end and aim of the whole branch being to\ngratify man's lust for the destruction of helpless creatures, so that he may be amused, gratified,\nand provided exercise.\nIf there be any analogy between preservation of wild game and the conservation of infant-\nlife, why should we not ask for the sum of $15,000 per annum from the Government for the\npurpose pointed out? The subject is worthy of more elaboration than time and this occasion\nwill permit at my hands, but the hope is indulged that members of the medical profession will\ndeem it worthy of consideration. Here is a fulcrum\u2014provide the lever. In the end, if successful, untold numbers will rise up and call you blessed.\nIf our fair Province is to remain for ever the personification of \" Sleepy Hollow,\" perhaps\nwe should be content and still hug the delusion that \" whatever is, is right\" ; but the world is\nmoving, other countries are making gigantic strides for the betterment of child-life, and we\nmust keep abreast, or expect reproach.\nI have here a tabulated statement which shows the number of deaths in each division as\nwell as the age (approximately) at death, together with the percentages of all deaths belonging\nto each particular age. Should any one feel interested the document is at hand for inspection.\nIn the beginning of this paper the co-operation of physicians was asked. It seems to me\nthat no better place could be chosen than this to bring home my reasons. In returns of deaths\nthe following immediate causes have been assigned:\u2014\nHemorrhage of Lungs.\u2014Man was shot. A case of homicide.\nHaemorrhage and Shock.\u2014Man's skull and legs fractured toy rolling log in lumber camp.\nParalysis of Respiratory Organs and Heart-failure.\u2014The cause was undoubtedly quite\nsufficient, but under what heading shall it be classed?\nFracture of Base of Skull.\u2014How did it happen?\nBronchitis.\u2014Respiratory failure. One, actually, want of breath.\nConvulsions of Infants.\u2014Twenty-four deaths. Cause of convulsions not explained. In one\ncase return reads \" Convulsions following measles.\" Under diseases of the respiratory system\nninety-five deaths were returned, of which seventy-eight were reported under various forms of\npneumonia without specifying what induced immediate cause of death.\nInduced Abortion.\u2014It is not explained whether it was the last resort of the physician to\nsave the patient's life, or whether the patient was endeavouring to save her reputation, and as\na last expedient called in the physician to save her life. Immediate cause should be explicit\nand nothing left to conjecture.\nIii short, not to particularize, the immediate causes of death assigned are, in many cases,\nmade in such a careless manner that a compiler of tabulated statements is frequently compelled\nto throw up his hands in despair. Let us pass on.\nDeaths from Cancer (All Forms).\u2014This disease is on the increase. One can hardly say\nrapidly, yet so surely as to merit serious consideration. For instance, for the first six months\nof the year we have had 132 deaths resulting from cancer, seventy-five males and fifty-seven\nfemales. On looking back it is found that deaths from cancer stand in this light: 1914, 195;\n1915, 221; 1916, 259; 1917 (first six months), 132, being 6.32 of all deaths, and rate of 0.34\nper 1,000 population.\nTuberculosis.\u2014In considering this disease, it may be well to consider it for a series of years,\nshowing deaths and population for each year from 1906.\nEstimated\nPopulation Deaths from\n1,000 in Even Tuberculosis.\nNumbers.\n1906 283,000 178\n1907 304,000 243\n1908 325,000 180\n1909 346,000 137\n1910 367,000 172\n1911 392,000 316\n1912 432,000 368 G 230 British Columbia 1918\nEstimated\nPopulation Deaths from\n1,000 in Even Tuberculosis.\nNumbers.\n1913 492,000 422\n1914 495,000 403\n1915 395,000 425\n1916 383,000 367\n1917 383,000 (6 months) 220\nFor comparison: The year 1911 has a nearer estimated population (392,000) to 1917\n(383,000) than any other; still, the population of 1911 was greater than 1917 by 9,000, yet\nwe will use the figures as they are. In 1911 there were 316 deaths from tuberculosis, or 0.80\nper 1,000. For the first six months of 1917 (population estimated at 383,000) there were 220\ndeaths, or a rate per 1,000 of 0.57. If we for a moment compare 0.80 for twelve months (1911)\nand 0.57 for the first six months of 1917, the increase stands out prominently.\nNow for detail; for the first six months of the year. Tuberculosis pays no respect to age,\nand its victims may be found from the cradle to those who have exceeded the allotted span. To\nillustrate: Our present returns show 6 under 1 year; 8, 1 to 2 years; 7, 2 to 5 years; 21\ninfantile, or 9.50 per cent, of all deaths from tuberculosis. The remainder\u2014199\u2014comprise all\nages from 5 to 79, plus 1, age not given; 90.45 per cent, of deaths from tuberculosis, and taken\nas a whole\u2014220\u2014show 10.53 per cent, of all deaths. Further: 23.63 per cent, of deaths from\ntuberculosis occurred among Orientals.\nIt is found that the nativity of decedents total up as follows: British Columbia, 35;\nOrientals, 52; Italians, 6; U.S.A., 6; Germany and Austria, 5; other Provinces of the Dominion,\n37; Norway and Sweden, 7; Great Britain, 42; various countries, 30; total, 220. Of the total,\n185 were born outside the Province, and of those born outside 139 had resided in British\nColumbia for a period exceeding three years. The document containing this information is\nready for inspection.\nIn returns of marriages we have from various offices in the Province the following:\u2014\nAlberni 54\nBeaton 125\nAshcroft 26\nFairview 120\nVancouver City 560\nNorth Vancouver City 18\nNorth Vancouver District 3\nPoint Grey 22\nRichmond \u25a0 \u2022 \u2022 - 1\nSouth Vancouver 47\nWest Vancouver 3\nNew Westminster City 70\nBurnaby 0\nChilliwack 8\nNew Westminster (outside) 36\nNanaimo -7\nAlert Bay -1\nComox 12\nLadysmith 5\nVictoria City 180\nOak Bay u\nEsquimalt 8\nSaanich 14\nCowichan \u00b0\nShowing a total of 1,368 for six months, as compared with 3,169 for tbe whole of last year\na falling-off at the rate of 443 per annum. 8 Geo. 5 Provincial Board of Health. G 231\nDiscussion on Mr. Miller's Pj*s.per.\nThe Chairman: We have heard this excellent paper. Any one wishing to discuss it, we\nwill be very glad to hear their remarks.\nDr. Price: Mr. Chairman, Ladies and Gentlemen,\u2014It affords me great pleasure to congratulate Mr. Munroe Miller on his remarkable and excellent paper on this subject, and especially\nfor the way in which he treated a subject in which I am very much interested; that is, the\ninfantile birth-rate, especially the cause, the prenatal causes, of still-births, of malformation,\nand of premature birth. These are all, as you know, registrable in this Province. In England,\nin Ireland, we never register still-births. I think that is a mistake. I think we are doing the\nright thing in this Province to bring these to the notice of the Registration Department, but\nBlr. Miller put it in words, well-chosen words which no one can use better, explaining\u2014it is a\nvery difficult subject to touch upon\u2014these prenatal causes of infant mortality. And 1 think this\nis a subject which requires a very great deal of attention. The idea is prevalent in families that\nfamilies should not be more than a certain number, and, unfortunately, I know of many cases\nwhere there is one child, and the second one is an accident, and there was never a third. Now,\nin the present state of this country, where every man is wanted\u2014and every girl baby is wanted,\ntoo\u2014it is a crime, a crime which is unspeakable, that these things should happen.\nI am speaking from experience. I come from a country\u2014Ireland\u2014where it is part of the\nreligion of that country that babies should be born into the world; it is part of their religion.\nIn that country I practised for many years; I do not recollect a still-born child in my place,\nand I have seen hundreds of babies into this world. True, there were instances of premature\nbirths, but the number in that country was so small in comparison to British Columbia that the\nonly way I could account for it was that the religion of the people of the country had something\nto do with the full-time birth of the child. It is a very difficult subject to speak of, but Mr. Miller\nhas put it so well and so clearly that I really need add no more to it, but to congratulate him\non the way he put it. But infant mortality is, counting still-birth, counting these other causes,\nappalling In British Columbia; but it is no more than other countries, when we count natural\ndeaths among infants. I do not think the rate is any more in this country than any other. Real\ninfant mortality of children is not very great. Now I leave that subject, and condole with\nMr. Miller upon the careless way in which we medical men\u2014I take the fault to myself\u2014fill up\nthese death certificates.\nI have the pleasure of calling upon Mr. Miller regularly once a month, and I wish here to\nexpress my appreciation of the courtesy with which he always receives me and the wonderful\nway in which he always has statistics ready, and which at any moment I can get from him,\nbecause I report monthly in Victoria the vital statistics of the city. Well, I can't help saying\nthat our death certificates are filled up in a most careless way, and it is certainly annoying to\nhim and very trying to him to have them filled up in this way; and I would suggest taking\nup his suggestion that medical men, both practitioners and others, should be more careful in\nthe filling-in of the cause of death in these certificates. True, I think the certificate is wrongly '\ndrawn up. There are three small lines, a space at the bottom of the certificate; one, primary\ncause; and then, was an operation performed, and then the immediate cause. In case of some\ndiseases I do not till up the two lines. If it is tuberculosis, I simply put tuberculosis down;\nI do not fill up, as some people do, neurasthenia, or stoppage of breath, or something like that.\nThat is unnecessary. We simply fill in the primary cause. I think there is room for discussion\non that; there is room for improvement in the form of the death certificate, and I think that\nis a question that should be taken up by a meeting of the statistical officers to alter that certificate. I believe strongly in collecting the statistics of the country correctly.\nNow as regards cancer: I am taking rather a special interest in the number of deaths from\ncancer which have recently occurred in this country, and I think, from what I gather from\nstatistics, that cancer is running a very close race with tuberculosis, and it is a neck-and-neck\nrace, and I think that we are not studying nearly sufficiently the subject of cancer in its many\nforms. We are doing good work for tuberculosis, but we are to do that work and we are not\nto leave the other work undone; and I think there is quite a lot to be done in the study of\ncancer. It is extraordinary how very prevalent it is becoming.\nNow, again, about the number of tuberculosis cases, and the reference made to the fewness\nof cases in Great Britain: Well, I know, having lived in Great Britain, that we are dumping\nour cases out in this country, and great care should be taken in the examination for the admission G 232 British Columbia 1918\nof people into this country. I know when I came I was put into a queue with a lot of others,\nand I was not very strong at the time, and my wife and children were passed by. Oh, they are\nall right, no examination whatever of any kind. Well, I know to a certainty within the last\nfortnight a man who came from England in an advanced state of tuberculosis. How he got\nthrough\u2014well, it has been carelessness on the part of the examining officer. I think that is a\nmatter which ought to be taken up. We really do not want British Columbia to be a dumping-\nplace for consumptives. I think that is all I have to say, except to congratulate Mr. Miller on\nthe excellence of his paper. (Applause.)\nThe Chairman: Are there any others who wish to make remarks? If you will permit me\nto speak from the chair, as time is getting late. I want to congratulate Mr. Miller on many of\nthe things he has spoken of. I very much regret that there is not a larger attendance of the\nmedical men here, because he is speaking words of wisdom on a matter that is most interesting\nto Medical Health Officers\u2014that of vital statistics.\nOne point particularly attracted my attention; that is the large number of still-births\noccurring here. In 1916, for instance, there were 119 in the City of Vancouver. I feel certain,\nhowever, that a great many cases of still-births occur throughout the Province that are not\nreported. My early experience in this particular city of ours was that many of the still-born\nwere buried in the back yards, one reason for that being that the funeral expenses would be too\ngreat. This matter was taken up, and we arranged that for a nominal fee of $1, on the production of a doctor's certificate, the burial would be taken care of at the cemetery. Since then we\nhave had far more notified to the Department.\nI regret that births are not notified as they should be. It is impossible for Mr. Miller or\nany one else to keep the vital statistics of this Province, which are so important to ourselves at\nthe present time, and also to future generations for comparative purposes. I regret that some\nmachinery cannot be evolved to settle this important question, and to bring the people to realize\nthe necessity for reporting births.\nWith regard to the certificates of death: I feel most strongly ou this point. On the form\nnow in use there is a list of diseases which are not supposed to be accepted by the Registrar, and\nyet which are constantly being certified as the cause of death by the medical men. Personally,\nI think that the remedy is in the bauds of the Registrar himself. I have a note here of a number\nof these instances taken from the death certificates, such as convulsions, gastritis, asthma, heart-\nfailure, and so on, which have apparently been accepted at tbe Registrar's office and no prosecution has been undertaken. I deplore this very much. The method we pursue in my department\nis, when such a case arises, we immediately get in touch with the medical man responsible and\nget from him the correct cause of death. We cannot correct the death certificate, but we can\ncorrect our vital statistics. The medical men are far and away too loose and too careless.\nI quite agree with Dr. Price in his remarks regarding the form of death certificate, and\nwould like to inform him that this matter was taken up in 1899 and on numerous occasions since\n'by the Medical Associations of A'ancouver, New Westminster, and Victoria, and they all agreed\non a form. I think it is a very excellent one, but it has never been adopted. I would like to\nsee a different form from the one at present in use. However, that is a matter we can leave\nin Mr. Miller's hands.\nCancer is certainly increasing. Out of a total of 1,097 deaths in 1916, there were S7 deaths\nfrom cancer in this city, and I notice from the statistics that they are increasing from year to\nyear.\nI thank Mr. Miller for what he has brought to our attention to-day. Mr. Miller will reply.\nMr. Miller: Ladies and Gentlemen,\u2014It seems to me that I haven't anything to reply. I feel\nflattered at the reception I have received. As to the form and as to the mode and method\nadopted by Dr. Underhill,, I see how there happens to be a difference between his reports and\nmine. 1 take the reports we have received. He calls in a physician for the purpose of the\nCity of A7ancouver and has him correct it the way it ought to be. When I once receive that\ndocument I dare not let it out of my hands. I cannot send it back for correction; and if I\nwrite to the physician recommeuding him to make a correction on the cause of death, I cannot\nchange the original document, but I must underline in red ink that such-and-such a correction\nis requested and authorized. You see, the thing becomes difficult; and then, as far as the\nmachinery of the law goes, British Columbia has always been a kind of patriarchal institution 8 Geo. 5 Provincial Board of Health. G 233\nand had a great love of the people; under the dominion and control of the Government from\nOctober, 1872, to date, as far as I know and believe, there never has been a prosecution\nundertaken for violation of the registration law.\nDr. Young: Mr. Chairman, I am not going to speak in reference to the paper. This winds\nup the proceedings of the Convention, and I am sorry that the majority of the members are\nnot here to allow me to express my great appreciation of the attendance and the great evidence\nof the interest which the members of the Convention have taken in the proceedings. I have to\nthank those who have very kindly prepared and read their papers here. I do not think that any\nof us who have attended here regret the time that it has taken. The papers have been excellent.\nThey have been prepared by those especially interested in the subject which they have undertaken to deal with. They have presented views modern and up-to-date, and they have contained\nmany very valuable suggestions, which I hope will be acted upon by the profession, and I know\nwill be acted upon by the Department. It is the intention to collect all these papers, together\nwith a report of the discussions that have taken place upon them, and to publish them in the\nAnnual Report of the Department; but they are so good that it is my intention to print them in\npamphlet form immediately (Applause), accrediting each to the author, and to add to the paper\nthe discussion; and I hope to have the pleasure shortly to send to the authors a sufficient number\nfor themselves, and also to distribute to the profession in general copies of the proceedings of\nthis Convention.\nI want further, Mr. Chairman, to be allowed to move a vote of thanks to yourself for the\nable manner in which you have presided at our meetings, and also personally to thank you for\nthe great interest you have taken, and also the great assistance you have been to me in making\nthis Convention a success. You have shown a great deal of interest, as I know personally, in\nhealth matters, and your activity has been a great help, especially when it is manifested in this\nthe largest centre of population in the Province, and an incentive to tbe Provincial Board of\nHealth. I have much pleasure, ladies and gentlemen, in moving a vote of thanks to Dr.\nUnderhill for his presiding at the meeting. (Applause.)\nDr. Vrooman: Mr. Chairman, I have great pleasure in seconding Dr. Young's motion of\nthanks to Dr. Underhill for his able conduct of the meeting.\n(Dr. Wrinch in the chair.)\nThe Chairman: It has been moved and seconded that a vote of thanks be tendered to Dr.\nUnderhill for the valuable services which he has rendered on the occasion of this Convention.\nNow, if you are all in favour of that, will you manifest it again, please? (Applause.)\nThe motion was carried unanimously.\nDr. Underhill: Ladies and Gentlemen,\u2014I thank you for the kind manner in which you\nhave spoken. I know I have always taken a great interest in this matter of public health.\nSometimes I speak rather quickly, too fast, without due consideration to the seriousness of the\nsubjects we are discussing, but if I have occasioned any harm or inconvenience I am sorry for it.\nGentlemen, I thank you very kindly for your reception of my little efforts here.\nVICTORIA, B.C.:\nPrinted by William H. Cullin, Printer to the King's Most Excellent Majesty.\n1918.\n16","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/hasType":[{"value":"Legislative proceedings","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/identifier":[{"value":"J110.L5 S7","type":"literal","lang":"en"},{"value":"1918_V02_02_G1_G233","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/isShownAt":[{"value":"10.14288\/1.0059502","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/language":[{"value":"English","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/provider":[{"value":"Vancouver : University of British Columbia Library","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/publisher":[{"value":"Victoria, BC : Government Printer","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/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","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/source":[{"value":"Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/title":[{"value":"PROVINCE OF BRITISH COLUMBIA TWENTY-FIRST ANNUAL REPORT OF THE PROVINCIAL BOARD OF HEALTH INCLUDING SIXTH ANNUAL REPORT OF MEDICAL INSPECTION OF PUBLIC SCHOOLS AND THE FORTY-FIFTH ANNUAL REPORT OF VITAL STATISTICS DEPARTMENT FOR THE YEAR ENDING DECEMBER 31ST, 1917 AND PROCEEDINGS OF THE SECOND MEETING OF MEDICAL OFFICERS OF HEALTH OF BRITISH COLUMBIA HELD IN VANCOUVER, B.C., SEPTEMBER 12TH AND 13TH, 1917","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/type":[{"value":"Text","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/description":[{"value":"","type":"literal","lang":"en"}]}}