{"http:\/\/dx.doi.org\/10.14288\/1.0348190":{"https:\/\/open.library.ubc.ca\/terms#identifierAIP":[{"value":"05427079-dbab-4a87-b73d-043ba0a804a8","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider":[{"value":"CONTENTdm","type":"literal","lang":"en"}],"http:\/\/purl.org\/dc\/terms\/alternative":[{"value":"DEPARTMENT OF HEALTH AND WELFARE, 1952","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":"2017-06-05","type":"literal","lang":"en"},{"value":"[1953]","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO":[{"value":"https:\/\/open.library.ubc.ca\/collections\/bcsessional\/items\/1.0348190\/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\nSeventh Report of the\nDEPARTMENT OF HEALTH\nAND WELFARE\n(HEALTH BRANCH)\n(Fifty-sixth Annual Report of Public Health Services)\nYEAR ENDED DECEMBER 3 1st\n1952\nVICTORIA, B.C.\nPrinted by Don McDiarmid, Printer to the Queen's Most Excellent Majesty\n1953  Office of the Minister of Health and Welfare,\nVictoria, B.C., January 14th, 1953.\nTo His Honour Clarence Wallace, C.B.E.,\nLieutenant-Governor of the Province of British Columbia.\nMay it please Your Honour :\nThe undersigned has the honour to present the Report of the Department of Health\nand Welfare (Health Branch) for the year ended December 31st, 1952.\nERIC MARTIN,\nMinister of Health and Welfare. Department of Health and Welfare (Health Branch) ,\nVictoria, B.C., January 14th, 1953.\nThe Honourable Eric Martin,\nMinister of Health and Welfare, Victoria, B.C.\nSir,\u2014I have the honour to submit the Seventh Report of the Department of Health\nand Welfare (Health Branch) for the year ended December 31st, 1952.\nI have the honour to be,\nSir,\nYour obedient servant,\nG. F. AMYOT, M.D., D.P.H.,\nDeputy Minister of Health. DEPARTMENT OF HEALTH AND WELFARE\n(HEALTH BRANCH)\nHon. Eric Martin -------      Minister of Health and Welfare.\nSENIOR PUBLIC HEALTH ADMINISTRATIVE STAFF\nDeputy Minister of Health and Provincial Health Officer.\nDeputy Provincial Health Officer and\nDirector, Bureau of Local Health\nServices.\nAssistant Provincial Health Officer\nand Director, Bureau of Special\nPreventive and Treatment Services.\nDirector, Bureau of Administration.\nG. F. Amyot, M.D. -      -      -      -\nJ. A. Taylor, B.A., M.D., D.P.H.\nG. R. F. Elliot, M.D., CM., D.P.H.\nA. H. Cameron, B.A., M.P.H.     -\nG. F. Kincade, M.D., CM.   -----      Director, Division of Tuberculosis\nControl.\nC. E. Dolman, M.B., D.P.H., Ph.D., F.R.C.P.\nA. J. Nelson, M.B., Ch.B., D.P.H.      -     -\nJ. H. Doughty, B.Com., M.A.      -\nR. Bowering, B.Sc.(CE.), M.A.Sc   -\nDirector, Division of Laboratories.\nDirector, Division of Venereal Disease Control.\nDirector, Division of Vital Statistics.\nDirector, Division of Public Health\nEngineering.\nT. H. Patterson, M.D., CM., D.P.H., M.P.H. -     Director, Division of Environmental\nManagement.\nMiss M. Frith, R.N., B.A., B.A.Sc., M.P.H.\nF. McCombie, L.D.S., R.C.S., D.D.P.H.    -\nR. H. Goodacre, M.A., C.P.H. - - -\nMiss D. Noble, B.Sc(H.Ec), C.P.H. - -\nC. R. Stonehouse, CS.I.(C)\nDirector, Division of Public Health\nNursing.\nDirector,   Division   of   Preventive\nDentistry.\nConsultant, Public Health Education.\nConsultant, Public Health Nutrition.\nSenior Sanitary Inspector.  TABLE OF CONTENTS\nGeneral\u2014 page\nThe Population and Its General Composition  11\nThe Health of the People  11\nPublic Health Services and Their General Organization  12\nLocal Health Services_\nTuberculosis-control\n  13\n  13\n  14\n  14\n  16\n  16\n  17\n  18\nProblems of Alcoholism and Narcotics Addiction  19\nVenereal-disease Control\t\nEnvironmental Management..\nHealth Education\t\nVital Statistics\t\nLaboratory Services\t\nPublic Health Engineering..\nNational Health Grants\t\nProvincial Health Building\t\nVoluntary Health Agencies\t\nRed Cross Blood Transfusion Service\t\nReport of the Bureau of Local Health Services-\nAdministration\t\n19\n20\n20\n21\n23\n25\n27\nCommunity Health Centres     27\nHome-care Programmes     28\nResident Physicians' Grants     29\nSchool Health Services     3 0\nDisease Morbidity and Statistics     31\nTable I.\u2014Incidence of Notifiable Diseases in British Columbia  (Including\nIndians)\t\nTable II.\u2014Table Showing Cases of Notifiable Diseases in British Columbia\nExpansion and Development-\nPersonnel Changes\n36\nby Health Units and Specified Areas for the Year 1952  37\nReport of the Division of Public Health Nursing\u2014\nPresent Status of Service  38\nTable I.\u2014Comparison of Provincial Public Health Nursing Staff Changes\nduring the Period 1943-52  39\nPublic Health Nursing Training  39\nRecords Committee  40\nPublic Health Nursing Consultant Service  41\nLocal Public Health Nursing Service  41\nService Analysis  43\nTable II.\u2014Comparison of Time Spent by Public Health Nurses in Specified\nActivities as Indicated by Time Studies in 1949, 1950, 1951, and 1952____ 43\nTable III.\u2014Breakdown of Amount of Time Spent in Home-visits and Office\nby Percentage of Total Time on Duty as Shown in Time Studies, 1949,\n1950, 1951, and 1952  44\nCivil Defence  44\nGeneral  44\nReport of the Division of Environmental Management  46\nA. Report of the Nutrition Service\u2014\nConsultant Service to Local Public Health Personnel  48\nConsultant Service to Hospitals and Institutions  49\nCo-operative Activities with Other Departments and Organizations  50 BB 8\nBRITISH COLUMBIA\nReport of the Division of Environmental Management-\nB. Sanitary Inspection Services\u2014\nFood-control\t\n-Continued\nPage\n  51\n  51\n  52\n  52\n  53\n  5 3\nSanitary Inspection of Hospitals  53\nEating and Drinking Places_\nFrozen-food Locker Plants__\nSlaughter-houses\t\nMeat Inspection\t\nHorse-meat\t\nHousing..\nFarm-labour Housing-\nSummer Camps\t\nSchool Sanitation-\nPlumbing-\nC.\nD.\n  53\n  54\n  54\n  54\n  55\nGarbage and Refuse Disposal  55\nPest-control  55\nGeneral Sanitation  56\nIndustrial Hygiene  56\nCivil Defence Health Services  57\nReport of the Division of Preventive Dentistry\u2014\nDental Health or Dental Disease  59\nPrevention  60\nDental Personnel  63\nGeneral  65\nReport of the Division of Public Health Engineering\u2014\nWater-supplies\t\n  66\n  67\n  68\n  68\nTourist Accommodation  69\nGeneral  69\nSewage-disposal__\nStream-pollution\nShell-fish\t\nReport of the Division of Vital Statistics\u2014\nRegistration of Births\t\nRegistration of Deaths\t\nRegistration of Marriages\n  71\n  72\n  72\nDocumentary Revision  73\nAdministration of the \" Marriage Act\"  73\nAdministrations of Sections 34 to 40, Inclusive, of the \" Wills Act\"  73\n  74\n  74\n  75\n  75\n  75\n  76\n  76\n  77\n  77\nRegistration of Vital Statistics amongst the Indians\t\nRegistration of Vital Statistics amongst the Doukhobors .\nEffect of Old-age Security Legislation\t\nSurvey of Division\t\nGeneral Office Procedures\t\nMicrofilming of Documents\nDistrict Registrars' Offices and Inspections-\nInspections\t\nStatistical Services\t\nReorganization of Record System in Division of Tuberculosis Control  79\nCancer Registry  80\nTable I.\u2014Number and Percentage of New Cancer Notifications by Sight and\nSex, British Columbia, 1952  80 DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 9\nReport of the Division of Vital Statistics\u2014Continued pAGE\nTable II.\u2014Number and Percentage of Live Reported Cancer Cases by Sight\nand Sex, British Columbia, 1952     81\nTable III.\u2014Cancer Notifications by Sex and Age-group, British Columbia, 1952\n(Age Specific Rates per 100,000 Population)     81\nTable IV.\u2014Live Cancer Cases Reported by Sex and Age-group, British Colum\nbia, 1952 (Age Specific Rates per 100,000 Population)..\nThe People of British Columbia\t\nMortality and the Ageing Population\t\nMortality in Terms of Life-years Lost..\n  81\n  82\n  82\n  84\nChart.\u2014Specified Cause of Mortality as a Percentage of Total Deaths and as\na Percentage of Total Life-years Lost, British Columbia, 1952  86\nReport of the Division of Public Health Education\u2014\nLocal Health Educators  87\nMaterials\t\nConsultative Service\t\nIn-service Training\t\nPublications and Publicity.\nStaff.\t\n  87\n  8 8\n  89\n  89\n  90\n  91\nFaculty of Medicine, University of British Columbia  91\nVoluntary Health Agencies\t\nCivil Defence\t\nGeneral\t\nNational Health Grants\t\nAcknowledgment\t\nReport of the Health Branch Office, Vancouver Area-\nBuildings ..\n92\n93\n93\n94\n99\nReport of the Division of Laboratories\u2014\nTable I.\u2014Statistical Report of Examinations Done during the Year 1952,\nMain Laboratory  101\nTable II.\u2014Statistical Report of Examinations Done during the Year 1952,\nBranch Laboratories  102\nTests for Diagnosis and Control of Venereal Disease  102\nTests Relating to Tuberculosis-control  103\nGastro-intestinal Infections and Bacterial Food Poisoning  104\nOther Types of Tests  106\nBranch Laboratories  106\nGeneral Comments  107\nReport of the Division of Venereal Disease Control\u2014\nTreatment\t\nEpidemiology,.\nSocial Service-\nEducation\t\nGeneral\t\nReport of the Division of Tuberculosis Control-\nNational Health Grants\t\nTrends in the Treatment of Tuberculosis\u2014\nDeath Rates\t\nTuberculosis in Older Persons,\nX-ray Programme\t\n108\n109\n110\n110\n111\n113\n114\n114\n115\n115 BB  10\nBRITISH COLUMBIA\nReport of the Division of Tuberculosis Control\u2014Continued\nTravelling Clinics\t\nNew Cases\t\nSocial Service\t\nNursing\t\nGeneral\t\nPage\n116\n116\n117\n117\n119\n\u25a0\n\u25a0 Seventh Report of the Department of Health and Welfare\n(HEALTH BRANCH)\nFifty-sixth Annual Report of Public Health Services\nYEAR ENDED DECEMBER 31st,  1952\nG. F. Amyot, Deputy Minister of Health and Provincial Health Officer\nIn accordance with the practice of previous years, this Report's General section,\nprepared by Mr. A. H. Cameron, Director, Bureau of Administration, presents a relatively\nbrief summary of the year's activities, events, and trends which appear to be the most\nsignificant in their effect on the public health. Much of the summary is a digest of the\nmaterial submitted by other officials.\nThe latter part of the Report, beginning on page 23, consists of sections prepared\nby senior Health Branch officials in charge of the various bureaux, divisions, and services.\nThese contain more detailed information.\nGENERAL\nTHE POPULATION AND ITS GENERAL COMPOSITION\nThe final count of the 1951 Census placed the population of British Columbia at\n1,165,210. This figure, correct at June 1st, 1951, represented an increase of 42 per cent\nover the population counted in the 1941 Census. This truly remarkable growth has continued during the year and a half since June 1st, 1951.\nThe population has also continued to age. While the total population of British\nColumbia rose 42 per cent between the census years, the increase in individuals 60 years\nof age and over was 64 per cent. British Columbia has a greater proportion of older\npeople than has Canada as a whole.\nBoth of these factors\u2014the growth and the ageing\u2014have a most important bearing\non public health services.\nTHE HEALTH OF THE PEOPLE\nA general indication of the health of the people may be given by some observations\non death rates, causes of death, and sickness experience. For the school-age population,\nthere are also some revealing facts concerning physical fitness, immunization status, and\ndietary habits.\nIn 1952 the crude death rate was 9.8 per 1,000 population, excluding Indians.\nA hasty conclusion might be that this was no improvement over the rate of 9.8 recorded\nfor 1942. However, when consideration is given to the fact that the proportion of older\npersons in the population has greatly increased during the period 1942-52, it represents\na dramatic improvement.\nHeart disease, cancer, and vascular lesions of the central nervous system again\naccounted for the greatest number of deaths in 1952. Over 64 per cent of all deaths\noccurring in the Province were due to these three causes. It is important to note, however, that these may not be the most important causes of death. If consideration is given\nto the ages at which the deaths occur and the number of anticipated years of life which\n11 BB 12\nBRITISH COLUMBIA\nhave been lost through the deaths, these three causes, usually occurring among older\npeople, lose some of their relative importance and drop to third, fourth, and seventh places\nrespectively. Conversely, diseases of early infancy and accidents assume much greater\nimportance and rank first and second in terms of \" life-years lost.\"\nIn the non-Indian population, the death rate from tuberculosis showed a further\ndecline in 1952 and the infant mortality rate showed a slight but statistically nonsignificant increase over the rate for 1951. The maternal death rate remained constant\nat 0.6 per 1,000 live births.   (As recently as 1940 it was approximately five times greater.)\nThe general sickness experience is indicated by the fact that the notifiable diseases\nwhich were reported during 1952 were somewhat less in number than they were in the\nprevious year.\nHowever, the number of cases of poliomyelitis was much greater than it had ever\nbeen before. The incidence was almost twice as great as it was in 1947, which, until\n1952, was the year of greatest incidence. Although Kimberley and the Penticton area\nsuffered the largest number of cases, no part of the Province was spared entirely.\nAn opposite trend may be reported in respect to influenza. During 1952 the\nincidence of this disease was very much less than it was for 1951.\nThe minor communicable infections so common to childhood\u2014chicken-pox, measles,\nmumps, and rubella\u2014comprised the bulk of the diseases reported and accounted for\npractically two-thirds of the total. They were recorded in approximately the same proportion as in previous years.\nStreptococcal infections maintained a fairly high incidence. Extremely mild in\nnature, they occurred most frequently on the Coast and in the Kootenay District.\nWhooping-cough continued the downward trend observed last year. Although this\nwas gratifying, there is still an undue prevalence of this infection and a need to maintain\nthe efforts to provide early and repeated immunization.\nThe number of cases of cancer reported was again greater than that for the previous\nyear. There has been a slight increase over the past two years, but the rate is still lower\nthan it was in 1949.\nThere was a reduction in the number of new cases of tuberculosis discovered. However, it is interesting and important to note that the proportion of older persons, particularly older males, occupying beds in tuberculosis sanatoria is increasing.\nThe venereal diseases displayed a slight reduction in the number of new cases\nreported. The use of penicillin has had a dramatic effect in controlling these diseases and\nin making infectious syphilis a clinical rarity.\nPhysical examinations of school-children have revealed that, as in previous years,\nthe vast majority\u2014more than 90 per cent\u2014are in good physical condition clinically.\nA large proportion\u2014well over 75 per cent\u2014have been immunized against such major\ncommunicable diseases as diphtheria and smallpox, and a smaller proportion have been\nimmunized against scarlet fever, whooping-cough, and typhoid fever. Dietary studies\nindicate that the three chief deficiencies in the children's diet are milk, a Vitamin D\nsupplement, and foods rich in Vitamin C. In their routine duties among pre-school and\nGrade I children, dental officers noted that dental disease is widespread.\nPUBLIC HEALTH SERVICES AND THEIR GENERAL\nORGANIZATION\nThe people of British Columbia are provided with official public health and preventive medical services by field-workers stationed throughout the Province, institutions,\nclinics, laboratories, and special consultants. These official services are strengthened and\nsupplemented by the physicians and dentists in private practice and by the voluntary\nhealth agencies whose services are well co-ordinated with those of the Provincial and local\nhealth departments. DEPARTMENT OF HEALTH AND WELFARE, 1952\nBB 13\nLOCAL HEALTH SERVICES\nBritish Columbia's two largest population centres, Greater Vancouver and Victoria-\nEsquimalt, are served by their own health departments. Although these do not come\nunder the direct jurisdiction of the Provincial Health Branch, particularly in so far as\nday-to-day administration is concerned, they receive substantial financial assistance from\nthe Provincial Health Branch and take an active and co-operative part in over-all Provincial planning and service.\nIn the remainder of the Province, local health services are provided by Provincial\nGovernment personnel who, although they receive guidance from senior Health Branch\nofficials and consultants, are responsible to their own local boards of health. Each local\nhealth department or health unit, as it is officially known, provides service to a defined\ngeographical area, including both rural territory and one or more population centres. At\nthe end of 1951 thirteen such health units were officially organized and in operation.\nDuring 1952 two other areas, in which there had been public health services for many\nyears, became fully organized as health units. These were the South Central Health Unit\nin the Kamloops area and the Boundary Health Unit in the Surrey-Delta area. The\npresent fifteen health units, together with the metropolitan services of Greater Vancouver\nand Victoria-Esquimalt, provide an almost complete coverage of the Province. The only\npopulated areas in which there are not officially organized full-time services are the\nKootenay Lake district (Nelson and surrounding territory), the Squamish-Howe Sound\narea, the Municipality of Oak Bay, and the McBride district. It is hoped that it may be\npossible soon to include these in the health-unit organization.\nThe percentage of the population receiving public health service at the end of 1952\nWas:  PerCent\nCity health departments of Greater Vancouver and Victoria-\nEsquimalt  48\nProvincial health units  47\nNon-health unit areas (public health nursing and sanitary inspection districts)     3\nTotal.\n98\nDuring the school-year 1951-52 preventive dental services operated continuously\nin five health units and, during some months of the year, in two other health units. Seven\nhundred and fifty-two pre-school children and 1,506 Grade I pupils received complete\ndental treatment. Six new clinics for younger children, with chair-side services provided\nby local resident dentists, were opened during 1952. This raised the total of such clinics\nto nineteen. Sets of transportable dental equipment have been made available to private\ndentists in order that they may extend their services to communities which have no\nresident dentists. Communities benefiting by this arrangement are Merritt, Slocan City,\nGanges, Kitwanga, Hazelton, Usk, Tahsis, Greenwood, and Edgewater. In each of these\ncases the dentist agreed to devote at least a part of his time to work in community clinics\nfor younger children.\nTUBERCULOSIS-CONTROL\nIn May, 1952, the newly constructed Pearson Tuberculosis Hospital in Vancouver\nwas opened. This hospital, in its present state, contains 264 beds, although definite\nconsideration is being given to the construction of another section which will provide an\nadditional 264 beds.\nStructural alterations at Tranquille Sanatorium were completed near the end of the\nyear.   These alterations made 50 additional beds available in that institution.\nThe increases in beds noted above were partly offset by the closing of a ward at the\nWillow Chest Centre.   This ward, known as T.B. 1, was located in a frame annex which BB  14\nBRITISH COLUMBIA\nmust be moved or demolished to allow for other construction in that area. The net\nincrease in beds was also reduced slightly by the discontinuance of certain other accommodations which were deemed unsatisfactory.\nHowever, the serious situation with respect to the shortage of beds, which had existed\nfor many years, was very much improved. At the year's end it appeared that sanatorium\ncare could be provided to those persons on the waiting list which had been compiled on\nthe basis of the most urgent needs. This should not be taken to mean, however, that there\nwill no longer be a waiting-list, nor that there is no need of further construction to provide\nadditional beds. There are undoubtedly many persons who should be given sanatorium\ncare, but whose names, in the past, have not appeared even on the waiting-list because\nof the serious shortage of beds.\nThere was an expansion of the chest X-ray service provided by equipment stationed\nin general hospitals and community health centres at strategic locations throughout the\nProvince. X-ray equipment was installed at five additional centres, bringing the total to\nthirty-nine, exclusive of those operated directly by the Division of Tuberculosis Control.\nVENEREAL-DISEASE CONTROL\nThe number of venereal-disease cases reported for 1952 was slightly smaller than\nthat for 1951\u20143,647 compared with 3,916. Infectious syphilis has become a clinical\nrarity, and late syphilis has also shown a marked decline. The over-treatment of\ngonorrhoea patients with penicillin has continued to be the practice of the Division of\nVenereal Disease Control with a view to aborting early syphilis and appears to have been\nof real importance in reducing the number of new cases of syphilis. However, the number\nof new cases of non-specific urethritis is not diminishing, and the treatment of this condition remains an unsolved problem.\nAlthough penicillin is the greatest single factor in the control of venereal diseases,\nthe epidemiology programme of contact-tracing, case-finding, and related activities holds\na strong second place. The Division has continued to strengthen its services in this field\nof endeavour.\nIn February, 1952, Dr. C L. Hunt, who had directed the Division for several years,\nrelinquished his appointment because of the demands of his private practice of medicine.\nIn view of his outstanding services as Director of the Division and as Health Branch\nrepresentative on several important standing committees, it is fortunate for the Division\nand the Health Branch as a whole that he has agreed to continue serving on a part-time\nbasis as consultant in internal medicine. Dr. A. John Nelson, a highly qualified physician\nwho had previously served with the Divisions of Venereal Disease Control in British\nColumbia and, more recently, in New York State, returned to accept the dual appointment of Director of the Division and Consultant in Epidemiology.\nENVIRONMENTAL MANAGEMENT\nThe descriptive but new and sometimes misunderstood term \" environmental management \" refers to the public health programme and activities designed to meet the\nhealth needs of the adult in his total environment at work, at home, and at play.\nImportant parts of the programme are nutrition, sanitation, occupational health, chronic\ncare, rehabilitation, public safety, problems of addiction, and, particularly in this era of\nworld history, those health services included in the civil-defence organization.\nDuring the past year the Chief Sanitary Inspector and the two Nutrition Consultants,\nwho had previously operated somewhat independently within the Bureau of Local Health\nServices, were included as members of the Division of Environmental Management. In\naddition, a member of the Provincial civil-defence staff was attached to the Division to\nassist in the programme of civil-defence health services. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB  15\nIt is perhaps unfortunate that civil defence has been such an important problem\nduring the whole of the relatively short history of the Division of Environmental Management. Since his appointment as head of the Division, the Director has been required to\ndevote what would, under normal conditions, be a disproportionate amount of his time\nto civil-defence planning as it relates to health services. In consequence of this, the\nprogress which he desired in certain other areas of his over-all programme has not been\nachieved. For example, the programme of industrial hygiene remains limited in scope\nand consists largely of investigations of special problems referred to the Division from\ntime to time.\nThe staff of the Nutrition Section of the Division was brought up to strength in July\nby the appointment of a Nutrition Consultant particularly experienced in institutional\nfood services. This new staff member filled a position which had been vacant for\nseveral months.\nThe Nutrition Section continued to co-ordinate and direct rat-feeding demonstrations\nin schools throughout the Province. Reports from teachers and public health nurses\nindicate that these demonstrations, conducted in eighty-six schools outside Greater Vancouver, have resulted in definite improvement in the diets of many children.\nDietary studies consisting of analyses of food records of school-children were conducted in four areas and very generally confirmed the findings of like studies conducted\nin sixteen other areas since 1949.\nThe Chief Sanitary Inspector reports that laboratory samples of pasteurized milk\nreveal improvement over previous years on a bacteriological basis.\nIn respect to eating and drinking places, there were only four complaints received\nduring the year. In addition, two requests were received from the Liquor Control Board\nfor the examination of licensed premises. Much of the improvement is probably attributable to the classes which have been conducted for food-handlers.\nThe regulations governing the construction and operation of frozen-food locker\nplants were more rigidly enforced during the year. As a result, two plants discontinued\noperations and other plants, which were deficient in certain respects, instituted remedial\nmeasures.\nThe annual licensing of slaughter-houses continued to be a co-operative procedure\non the part of the Department of Agriculture and the Health Branch. The Recorder of\nBrands, Department of Agriculture, issues a licence only after the applicant has submitted\nan inspection certificate completed by the Medical Health Officer. This procedure, to\nwhich there was strict adherence during 1952, has proved most beneficial.\nAs the result of a survey of food-handling and related practices in general hospitals,\nthe British Columbia Hospital Insurance Service agreed that local health-service personnel\nshould continue their supervisory work in this field of activity.\nIn the matter of school environment, there has developed a close liaison with the\nDepartment of Education and local school authorities. Health unit directors, in their\ncapacity of school medical officers, and the Division of Environmental Management have\nparticipated with educational authorities in planning new schools and in evaluating the\nfacilities of those already constructed.\nThe Chief Sanitary Inspector is the British Columbia representative on the Technical\nAdvisory Committee on Plumbing Services to the National Research Council. In this\ncapacity he has become thoroughly familiar with the Recommended National Plumbing\nCode and has taken part in planning which, it is hoped, will soon result in a Provincial\nCode and a model municipal plumbing by-law.\nPublic health authorities in several parts of the Province instituted stricter policies\nin the matter of garbage and refuse disposal. There was a trend to replace the primitive\nmethod of dumping in ravines, etc., by trench-and-fill methods. n) BB  16\nBRITISH COLUMBIA\nIn the civil-defence programme, the health-unit directors throughout the Province\nare now recognized as the local directors of Civil Defence Health Services. Plans for\ncivil-defence organization in hospitals have been distributed to the majority of strategically\nimportant hospitals throughout the Province. The inventory of hospital beds and emergency hospital facilities has been revised, and the record of all available physicians,\nnurses, and technicians has been maintained.\nTwenty-eight first-aid stations have been established at strategic locations, and each\nhas been provided a large training kit to be used by the volunteer members. (It is\nimportant to note that a first-aid station in the civil-defence meaning of the term, consists\nof more than 150 persons, including physicians, dentists, and nurses.)\nCivil Defence Health Services have been instrumental in providing first-aid classes\nthroughout the Province, and large numbers of trainees are participating. These supplement the courses conducted by voluntary organizations and the training provided to\nschool students.\nA plan of mutual aid between the State of Washington and the Province of British\nColumbia has been developed. However, some details of this plan require further\nclarification.\nHEALTH EDUCATION\nHealth education is the responsibility of all public health workers and is probably\nthe basic and most important method of improving the health of the people. Included\nin the meaning of the broad term are education of the public, pre-service and in-service\ntraining of staff members, and the provision of information and consultative services to\nother organizations and agencies concerned with health matters. Because almost all staff\nmembers undertake educational activities daily, only a few random examples can be\nmentioned here.\nInstruction of mothers at child health conferences (\" baby clinics \"), instruction of\nfood-handlers at work and in formally organized courses, and the information and advice\ngiven by the public health nurses during their home-visits exemplify the daily routine\nactivities of the field-staff personnel throughout the Province. More formal lectures are\npresented to both lay and professional groups by senior officials of the Health Branch\nproper as well as by local health-service personnel.\nIn the field of in-service training, special mention must be made of the annual Public\nHealth Institute which was held in Victoria from April 14th to 17th. Designed particularly for the benefit of local public health personnel from all parts of the Province, it was\nalso attended by senior Health Branch personnel and divisional directors. The chief\nspeaker was Dr. Jennie Rowntree, Director of the School of Home Economics, University\nof Washington, who gave a series of lectures on nutrition in public health. Senior Health\nBranch officials, members of the field staff, and carefully selected representatives of other\nagencies participated in the remainder of the well-rounded programme.\nThe Division of Public Health Education, whose staff members have undertaken\nformal postgraduate training in this field, provides the consultant services of specialists.\nThe Division and the Health Branch as a whole suffered a severe loss when Mrs. Kay\nBeard resigned at the end of October. Mrs. Beard was the first professionally trained\nhealth-education specialist in British Columbia and was largely responsible for the development of the Division since its organization in 1945. Her position as head of the\nDivision was filled by Mr. R. H. Goodacre, a member of the Division's staff. Mr. Good-\nacre, whose earlier academic training had gained him the Master of Arts degree in\nsociology and anthropology, received his later public health training at the University of\nToronto.\nVITAL STATISTICS\nThe Division of Vital Statistics continued to have two main functions, concerning\n(a) statutory duties (administration of the \" Vital Statistics Act,\" the \" Marriage Act,\" DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  17\nthe \" Change of Name Act,\" and certain sections of the \" Wills Act\") and (b) statistical\nservices (the provision of data regarding births, deaths, and marriages, and the carrying-\nout of the statistical requirements of all other divisions of the Health Branch).\nThe Director reports that the current registration of births is virtually complete,\nexcept in isolated cases in remote regions of the Province and in the case of the Sons of\nFreedom sect of Doukhobors. The bulk of applications for delayed registrations was\nagain concerned with persons born before the year 1920. This indicates that the registration coverage has been much more complete during the last thirty years than during\nprevious periods.\nThe registration of deaths is also virtually complete, except in isolated localities of\nthe Province.\nIndian Superintendents are doing much to encourage the practice of obtaining birth\ncertificates for new-born children as well as for the older members of Indian families.\nThe results have been very gratifying, and it is reasonable to believe that the registration\nof current births is virtually complete. The recording of Indian marriages is likewise\nsatisfactory. However, the registration of deaths among the Indian population still\npresents difficulties. Largely because the registration of vital events of Indians was on\na voluntary basis until 1943, there is a deficiency in respect to the earlier years. The\nIndian Commissioner for British Columbia and his Superintendents have made determined\nefforts to improve this situation. As a result, many delayed registrations were completed\nand filed.\nThe Division completed its work on the data compiled by the enumerators of the\nNational Sickness Survey, which was undertaken in 1950, and submitted to the Department of National Health and Welfare a comprehensive report covering all aspects of the\nsurvey in British Columbia.   The data are now being tabulated in Ottawa.\nIn 1951 a revised form of the Physician's Notice of a Live Birth or Stillbirth was put\ninto use. During 1952 the first tabulations of data reported on this form were made. As\nthe series builds up, much valuable information on the circumstances surrounding births\nwithin this Province will be forthcoming. However, it is still too early to draw any conclusions from the analyses of these tabulations.\nAt the request of the Provincial Secretary's Department, the Division reviewed the\nexisting record and statistical system in use in the Mental Health Services. As a result\nof the recommendations, a revised system and service, in which the Division will participate, will be put into effect in April, 1953.\nDuring the past several years the Division of Vital Statistics has taken a leading part\nin evaluating and reorganizing the record system in use in the Division of Tuberculosis\nControl. Included among the important changes have been the appointment of a trained\nMedical Records Librarian to the staff of the Division of Tuberculosis Control, the complete review and revision or discard, where indicated, of medical-record forms, the institution of new procedures for the control of records, and the appointment of a permanent\ncommittee, consisting mainly of medical personnel, to advise on the use which should be\nmade of the statistical material which is gathered.\nLABORATORY SERVICE\nDuring the first six months of the year the Division of Laboratories consisted of the\ncentral laboratory in Vancouver and four branch laboratories at Victoria, Prince George,\nNelson, and Kamloops. In July, however, the Division discontinued the subsidy under\nwhich the Kamloops branch laboratory operated because Kamloops officials could not\nprocure satisfactorily qualified staff.\nThe total tests performed by the Division approached 410,000. Approximately\n345,000 of these were carried out in the central laboratory in Vancouver. The branch\nlaboratories at Victoria and Prince George showed roughly the same turnover of sped- BB  18 BRITISH COLUMBIA\nmens as in 1951. In the case of the Nelson branch laboratory, however, there was an\nincrease in turnover from about 9,000 tests in 1951 to almost 15,000 tests in 1952. It\nshould be noted that this was accomplished without increasing staff and in spite of the\nfact that a complete change of staff occurred during the summer.\nThe total sputum and miscellaneous specimens admitted for direct microscopic\nexamination for the tubercle bacillus declined slightly from the 1951 figures, but the\nnumber cultured increased by 20 per cent. This exemplified the increasing demands\nwhich are placed upon the Division\u2014demands which are most difficult to meet in the\npresent extremely unsatisfactory and crowded accommodations.\nOver 8,000 stool specimens were cultured for organisms of the Salmonella and\nShigella groups. This represented an increase of approximately 25 per cent over the\nfigure for 1951. More than 300 strains were isolated, some for the first time in British\nColumbia.\nThe number of bacteriological tests on milk and water samples was about the same\nas that for 1951. Close co-operation between the Division of Laboratories and local\nhealth-service personnel, especially Sanitary Inspectors, will undoubtedly improve the\nsupplies of water, milk, and foodstuffs in general.\nPUBLIC HEALTH ENGINEERING\nThe marked increase in industrialization created many public health engineering\nproblems and the expansion of local health services brought to light others which required\npublic health engineering knowledge and procedures for their solution.\nThe \" Health Act \" requires that all plans of new waterworks systems and alterations\nor extensions to existing systems be submitted to the Deputy Minister of Health for his\napproval. The Division of Public Health Engineering has the responsibility of reviewing\nsuch plans. During 1952 thirty-three plans were approved. In addition, many waterworks plants were visited for the purpose of checking on sanitation hazards and assisting\ngenerally in the improvement of the systems. Although many water-supply systems should\nbe better protected from contamination than they are at present, simple chlorination will\nprovide reasonable protection in most cases. However, chlorinating equipment requires\nmaintenance and intelligent operation if it is to give satisfactory service. Unfortunately,\nthese requirements are not recognized in all cases.\nThe \" Health Act\" also requires that plans for sewerage construction receive official\napproval before construction is undertaken. Eleven such plans were approved during\n1952. It is pleasing to report that the Municipality of Saanich undertook construction\nof its new sewerage system. By the end of the year some of the homes in the municipality\nwere connected to the system.\nIn view of the changes in standards and the growth of Vancouver and surrounding\nmunicipalities, the Vancouver and Districts Joint Sewerage and Drainage Board undertook\nstudies of its sewage-disposal system. A firm of consulting engineers was employed, and\nit is anticipated that the new plan will be finalized during 1953.\nAlthough approximately 55 per cent of the population of British Columbia is served\nby public sewerage systems, much remains to be accomplished in a number of urbanized\nareas in both organized and unorganized territory. At present there are both financial\nand legislative difficulties preventing more rapid progress.\nStream-pollution, caused by the discharge of municipal and industrial wastes into\nsurface waters, does not present an alarming problem at the present time. There are only\na few cases in which waste discharges have affected down-stream water uses. However,\nit is recognized that controls with a view to prevention are preferable to corrective\nmeasures instituted after the problem has arisen.\nProcedures for enforcing the shell-fish regulations have now become fairly well\nestablished.   Inspection of shucking plants and handling procedures has been made the DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  19\nresponsibility of local health services.   Reports are submitted on standard forms issued by\nthe Division of Public Health Engineering.\nTourist camps, auto courts, etc., are inspected by the Sanitary Inspectors of local\nhealth services. The reports are co-ordinated by the Division of Public Health Engineering, and recommendations for or against licensing are made to the British Columbia\nGovernment Travel Bureau. It is felt that this procedure has had a marked effect in\nproducing a good standard of tourist accommodation. At the end of 1952 there were\napproximately 1,300 licensed tourist camps in British Columbia. Eight licences were\ncancelled on health grounds in 1952.\nPROBLEMS OF ALCOHOLISM AND NARCOTICS ADDICTION\nBoth of these problems received increased attention during the year.\nThe John Howard Society and other groups presented to the Minister of Health and\nWelfare briefs concerning the problem of alcoholism, and several additional meetings and\ndiscussions were held. Although a variety of proposals have been advanced, it is felt that\nfurther specific action in respect to this very difficult problem should not be taken until\nthe findings of the Liquor Inquiry Board have been made known.\nThe problem of narcotics addiction was brought under active discussion as the result\nof a report prepared by the Health and Auxiliary Division of the Community Chest and\nCouncil of Vancouver. The gravity of this problem is increased by the fact that a satisfactory solution cannot be evolved by any single organization or agency. Many committees have been established at the local, Provincial, and National levels, and the problem\nhas also been discussed at the Dominion Council of Health by the Deputy Minister of\nHealth for British Columbia. Notwithstanding the recognized difficulties and complexities, it appears that some progress has been made through the co-operation of all interested\ngroups in the Province.\nNATIONAL HEALTH GRANTS\nBy May, 1952, the National health-grants programme had been in operation for four\nyears. A review of the records reveals that British Columbia has made good use of the\nfunds in establishing new health and hospital services and in extending already established\nservices\u2014the purposes for which the grants are intended. There is no doubt that the\npeople of the Province have benefited materially by improvements made possible under\nall ten of the grants (Crippled Children, Professional Training, Hospital Construction,\nVenereal Disease Control, Mental Health, Tuberculosis Control, Public Health Research,\nHealth Survey, Cancer Control, and General Public Health).\nThe total allocation to British Columbia for the fiscal year 1952-53 is $4,417,957,\nexcluding the Public Health Research Grant funds, from which are not specifically allocated to the Provinces. This amount is larger by almost $1,500,000 than the amount for\nthe previous year. The increase is due almost entirely to an actual increase of almost\n$90,000 in the Mental Health Grant and the inclusion of those portions of the Hospital\nConstruction Grant which were unexpended in 1948-49 and 1949-50.\nAlthough accurate data for the calendar year ending December 31st, 1952, are not\nreadily available, the trend is revealed by the data for the fiscal year ending March 31st,\n1952. In that fiscal year British Columbia actually used\u2014that is, spent\u2014slightly more\nthan 85 per cent of the total funds available. This compares very favourably with the\nfigure of 69 per cent for Canada as a whole and with the figure of 59 per cent for British\nColumbia for the previous fiscal year.\nAlthough the Assistant Provincial Health Officer, in his report which appears elsewhere in this volume, gives specific examples of important uses to which the grants have\nbeen put, special mention should be made of the \" Survey of the Health Services and\nFacilities in British Columbia in Existence on December 31, 1948.\"   Conducted by the BB 20\nBRITISH COLUMBIA\nAssistant Provincial Health Officer under the provisions of the Health Survey Grant, the\nsurvey was finalized during 1952 and the report, including recommendations, was submitted to the Department of National Health and Welfare in March. Later in the year\nprinted copies were given wide distribution to interested individuals and agencies in\nBritish Columbia and elsewhere on this continent. It is important to note that this health-\nsurvey report does not necessarily represent the views nor policy of the Government of\nBritish Columbia. The report and its recommendations constitute the thinking of administrative officials of the Health Branch, Provincial Department of Health and Welfare.\nPROVINCIAL HEALTH BUILDING\n(Proposed Administration, Clinic, and Laboratory Building,\nVancouver)\nPublic health officials, as well as others deeply concerned in the matter, had hoped\nthat this Annual Report for 1952 could contain the statement that construction of the\nproposed administration, clinic, and laboratory building in Vancouver had been undertaken. For many years the need for such a building has been very great. Many architectural plans have been drawn and then discarded or modified, several sites had been\ninvestigated, and numerous administrative problems have been encountered and solved.\nDuring the earlier part of 1952 it seemed that the actual construction would at last be\nundertaken. An admirable site had been selected and arrangements to transfer the deed\nof the property to the Province had been made; the required funds had, for the most part,\nbeen appropriated; architectural plans had been finalized and plans for such features\nas lighting and heating had been almost completed; test-holes had been dug to determine\nthe type of foundation required. By the summer all phases of the planning had advanced\nto such a degree that tenders were about to be called.\nIt was, therefore, a great disappointment and, in the opinion of public health officials,\na serious blow to public health services that a change in policy resulted in the postponement, once again, of further action. It was intimated that construction might be undertaken during the coming fiscal year. Administrative and professional personnel of the\nHealth Branch expressed the fervent hope that this tentative proposal will indeed be put\ninto effect.\nIn the meantime, services which have a fundamental importance in maintaining the\nhealth of the people must continue to operate under physical conditions which are actually\ndangerous. The Division of Laboratories, located in four converted and obsolete wooden\nhouses on Hornby Street in Vancouver, is the most seriously affected. Working in these\nmuch overcrowded accommodations, the personnel are in danger of becoming infected\nfrom the bacteriological specimens with which they must work. The fire hazard and the\ndanger of structural collapse are great. Second only to the Division of Laboratories in\nthe gravity of this housing problem is the Division of Venereal Disease Control. Only\ngood fortune can account for the fact that the Vancouver General Hospital, which owns\nthe ancient wooden structure in which the latter Division is located, has not yet made use\nof the site for its own building programme.\nIt should be understood that the disappointment resulting from one postponement of\nconstruction was not related to any ordinary desire merely to possess new and more\nadequate quarters. \" Disappointment \" is probably a too conservative word. \" Fear \"\nwould be more appropriately applied\u2014fear for the health and safety of the employees\nand fear for the efficient conduct of the public health service.\nVOLUNTARY HEALTH AGENCIES\nIt is pleasing to report that the close co-operation between the official health services\nand the major voluntary health agencies has been maintained.   Serving as Health Branch DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 21\nrepresentatives on the governing bodies of these agencies, Health Branch officials have\nassisted in developing balanced programmes and eliminating duplication of services.\nDuring 1952 two new voluntary health agencies\u2014the Multiple Sclerosis Society and\nthe Cerebral Palsy Association\u2014were established. Both were urgently required, and\nboth were given financial assistance from the National health grants.\nThe British Columbia Cancer Foundation received financial assistance to pay the\noperating expenses of its Cancer Institute and Nursing Home, in Vancouver, and its\nconsultative and diagnostic clinics throughout the Province. These moneys consisted of\nfunds derived from the National health grants and equal amounts provided by the Provincial Government through the Health Branch. The new clinic building of the British\nColumbia Cancer Institute was opened in October. Included among its most modern\nradiotherapy equipment is the third cobalt 60-beam therapy unit to be put into operation\nanywhere in the world.\nDuring the year the Western Society for Physical Rehabilitation changed its name\nto the \" Western Society for Rehabilitation.\" The deletion of the word \" physical \" indicates the trend of this society to interest itself in all aspects of rehabilitations. It has\nbecome evident that larger accommodations are required, and plans for construction have\nbeen initiated.\nDemands of local communities were largely responsible for further expansion of the\nprogramme of the Canadian Arthritis and Rheumatism Society (British Columbia Division) . At the end of the year this society was operating seven diagnostic and treatment\nclinics in larger cities throughout the Province. From these clinics, mobile physiotherapy\nservice was provided to fourteen other communities. Treatment-rooms were established\nin eight other cities, and from these centres another fourteen communities received the\nmobile physiotherapy service.\nThe British Columbia Tuberculosis Society maintained its active and most welcome\nsupport of the tuberculosis-control programme. Important among its contributions was\nthe provision of a new truck and generator for the mobile X-ray service of the Division\nof Tuberculosis Control.\nAlthough service clubs are not ordinarily considered to be voluntary health agencies,\nseveral of these organizations gave valuable assistance in the construction of community\nhealth centres and in the provision of equipment.\nRED CROSS BLOOD TRANSFUSION SERVICE\nDecember, 1952, marked the end of the sixth year of operation of this service in\nBritish Columbia. During all of these six years the Service has faced a too constantly\nrecurring problem\u2014an insufficient supply of blood. It is most important that two principles be understood: First, the Service makes blood and blood plasma available at no\ncost to the recipients in their times of need, which may be grave; second, the human body\nis the only source of blood-supply for this purpose\u2014blood cannot be produced synthetically. Therefore, it must be obvious that, if the great benefits are to be maintained, donors\nmust appear voluntarily in large numbers at the Service's well-organized clinics. During\n1952, as in previous years, these blood-donor clinics were held at frequent intervals in\nmost population centres throughout the Province.\nThe Provincial Government, through the Health Branch, continued to give financial\nsupport to help the organization in defraying general maintenance costs in clinics and\noffices and in meeting extraordinary transportation charges. It is regretted that delay in\nconstructing the Provincial Health Building has prevented the provision of adequate\naccommodations for the Service's blood-processing depot in Vancouver. A commitment\nto provide such accommodations was included in the agreement between the Canadian\nRed Cross Society and the Provincial Government when the service was inaugurated. BB 22\nBRITISH COLUMBIA\nThe year 1952 was marked by the gratifying progress in many, if not all, fields of\npublic health endeavour and also by some distressing experiences, including a poliomyelitis epidemic. In both the happier activities related to programme-planning and\nadministration and the hectic procedures required in emergencies, the Deputy Minister of\nHealth received firm support from all of those to whom he turned for assistance. Other\ndepartments of Government, professional groups, and voluntary agencies gave unlimited\nco-operation. Personnel of the Health Branch again displayed their loyalty to the Service.\nTo all of these, the Deputy Minister tenders his sincere gratitude.\n\u25a0 DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 23\nREPORT OF THE BUREAU OF LOCAL HEALTH SERVICES\nJ. A. Taylor, Director\nPrevious Reports have recorded that one of the major functions of the Health Branch,\nDepartment of Health and Welfare, should be stimulation toward the development of\nfull-time local health services. The term \" local health services \" denotes public health\nservices at the municipal level, embracing public health nursing and environmental sanitation, and is closely allied with the services in tuberculosis-control, venereal-disease\ncontrol, laboratories, environmental management, vital statistics, public health engineering, and public health education, which, although administered by separate divisions, are\ninterpreted to the community by the field staff in local health services.\nBasically, the ideal type of full-time local health service has been found to be most\nefficiently administered through a health unit, in which a number of municipalities unite\ntheir Local Boards of Health into a Union Board of Health which employs qualified public\nhealth personnel to render public health services to their communities. At the same time\nan opportunity is afforded the district School Boards to transfer their school health services\nto the Union Board of Health and to appoint the staff of the health unit to direct those\nservices for the future. Those municipalities and school districts which have taken this\naction, to unite their community and school health services under a Union Board of\nHealth, have developed a uniform basic public health administration, not only for the\nentire unit area, but which, because of consultation and supervision through the Health\nBranch, is co-ordinated with all the similar services throughout the Province.\nIn the beginning the division of the Province into potential health-unit areas was\narbitrarily decided by officials within the Health Branch, and a degree of persuasion\nwas necessary to induce Municipal Councils and School Boards to participate in the\norganization of the first few units. Once the initial units became established, however,\nthey served to demonstrate this type of administration so well that demands for formation\nof other units exceeded the available personnel. It became necessary to accept the\nrequests on a priority basis and to establish health units as qualified personnel were\nrecruited.\nThe prime goal in the Bureau of Local Health Services has been toward the complete\norganization of local health services for the entire Province. It now appears likely that\nthat goal will become attainable shortly, since only two areas in the Province remain to\nbe organized to complete Provincial coverage. Negotiations are proceeding, and it is\nhoped that these areas will be organized into health units sometime in 1953. With the\norganization of those two areas and the reorganization of one or two older units the goal\noriginally planned twelve years ago will have been attained. The establishment of that\ncomplete basic public health service will permit development of additional services in\nsuch related fields as public health dentistry, mental hygiene, morbidity studies, bedside\nnursing, industrial hygiene, geriatrics, and so forth.\nADMINISTRATION\nNo particular administrative changes occurred within the Bureau of Local Health\nServices during the year. The Division of Environmental Management, which became\nestablished toward the end of the previous year, commenced to develop the planned\nservices, and a separate report of these is submitted for the first time.\nThe central committee known as the \" Local Health Services Council,\" which was\nestablished two years ago to provide for consolidation of administration within the Bureau\nof Local Health Services-, continued to function satisfactorily. This body was established\nto function on the Provincial level in much the same way as the health-unit staff on the\nlocal level. Such unification provides a better co-ordinated administration. In effect, the\nfunctions of this body are as follows:\u2014 BB 24\nBRITISH COLUMBIA\nTo become an informed central committee on all phases of local health services,\nso that each member is kept acquainted with developments in the field.\nIt is hoped that, possessed with this information, each member during\nfield-trips will be able to discuss, in generalities, service other than those\nof his own division.\nTo study existing policies and programmes, to suggest improvements and\nmodifications.\nTo develop a manual of recommended procedures for local health services,\ndivided into sections for the guidance of each branch of the service.\nTo study, develop, and recommend new policies and programmes for presentation to the Deputy Minister of Health for his consideration as the future\npolicy of the Department.\nThe major task continues to be the compilation of a reference or policy manual,\nwhich will outline and enumerate the functions and responsibilities of the various divisions\nand personnel within the Bureau of Local Health Services, so that the responsibilities of\neach division will be enumerated clearly for the future.    Work has been going ahead\nthrough the year on this job, with sub-committees being set up and assigned to study and\nrecommend the content and character of the various sections involved.    Progress is\nbeing made, but it will still be some time before the manual becames a reality.\nIn addition to the administrative guidance supplied by the Local Health Services\nCouncil, additional suggestions and advice are sought from the full-time Medical Health\nOfficers, who convene bi-annually with the directors of divisions and senior officials of\nthe Health Branch. At these meetings, convened in March and September, an agenda is\ndrafted on the basis of topics recommended by the Medical Health Officers dealing with\npoints which they would like to discuss. A review of the subject is introduced by one\nmember for thorough discussion so that uniform handling of the problems and services\nwill prevail throughout the Province. At the same time existing policies and programmes\nare analysed from time to time so that the recommendations of the field staff may be\nconsidered in framing changes in existing services and development of new ones. At the\nsame time, where legislation seems necessary, the Health Branch has a degree of advice\nfrom those individuals concerned with the local administration of that legislation so that\nit is primarily designed to be as practicable as possible. The spring meeting, as usual,\nconvened during the annual Public Health Institute, and the guest speaker at that Institute,\nDr. Jennie Rowntree, discussed various points in relation to nutrition on the basis of\nquestions raised by individual Health Officers.\nFormerly, Dr. L. Ranta, who was assistant to the Dean of Medicine, University of\nBritish Columbia, had been appointed as an active member of the Health Officers' group.\nHe attended all conferences in a technical capacity. During the year his resignation was\nreceived when he transferred his employment; at the same time Dr. J. Mather became the\nfirst Professor of Public Health and Preventive Medicine in the Faculty of Medicine at\nthe University and was invited to assume the position vacated by Dr. Ranta. At his\ninitial meeting with the group in September, Dr. Mather presented a review of the trends\nin teaching preventive medicine to undergraduate medical students, and outlined the\nproposed manner in which this will be handled in the Faculty of Medicine at the University\nof British Columbia. In relation to the question of teaching public health to undergraduate medical students, a plan was discussed with Dr. Mather whereby some orientation could be provided to those students through direct contact with existing public health\nservices. At present it is proposed that they gain this field experience by trips to the\nspecialized divisions of the Department of Health and Welfare located in Vancouver and\nin study of the services provided in the metropolitan health services in that city. At the\nsame time, consideration is being given to the provision of summer internships for those\nstudents indicating a preference for public health as their likely future medical career.\nIt is planned to accommodate three such students by employing one in each of three DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 25\nselected health units. The plan was tried on an experimental basis during this past year\nwhen one student was appointed to assist in various phases of public health during the\nsummer months. It proved so successful that it is felt advisable to further the experiment\nas proposed. In this way it is hoped to inculcate some interest on the part of undergraduate medical students in public health practice as one of the specialties in medicine.\nIt offers one means toward increasing the potential number of public health physicians\nthat will be available in future years and may aid in overcoming the recruitment problem,\nwhich has been the major hindrance encountered to date in the expansion of local health\nservices.\nEXPANSION AND DEVELOPMENT\nIn the last Annual Report, mention was made that negotiations toward the establishment of health units for the Kamloops area and the Surrey Delta area were proceeding\nsatisfactorily, and that they would likely come into being in 1952. This prediction\ndeveloped as forecast. The Municipality of Surrey joined its Local Board of Health with\nthat of the Municipality of Delta to originate the Boundary Union Board of Health in\nJanuary. Subsequently, School District No. 37 (Ladner) and School District No. 36\n(Cloverdale) transferred their school health services to that Union Board and became\nactive members of the Board, to be followed later by the Municipality of Langley and\nSchool District No. 35, thereby completing the original proposals in relation to the establishment of that unit. This was one of the units which had been long delayed, awaiting\nrecruitment of a qualified public health physician to complete the formal establishment\nof the service. During the waiting period graded steps were taken toward organization of\nthe unit as public health nurses were appointed, followed by Sanitary Inspectors, so that\nmuch of the unit service was functioning prior to the finalization of the organization under\nthe Union Board of Health.\nAnother area which had been long on the priority list was Kamloops and district, in\nwhich desires for health-unit services had been expressed as much as eight years ago.\nHere again component units of the service were introduced in the persons of public health\nnurses and Sanitary Inspectors, so that it merely meant the recruitment of a qualified\npublic health physician as director to bring about the finalization of unit development.\nThis became possible early in 1952, when the necessary formal by-laws and resolutions\nby the respective Councils and School Boards resulted in the establishment of the Union\nBoard of Health to initiate the health-unit service. This area selected the name \" South\nCentral Health Unit \" to designate the service in an area which includes the City of\nKamloops, the City of Merritt, the Village of North Kamloops, the Village of Lytton, the\nVillage of Ashcroft, the Village of Lillooet, and the communities of Bralorne, Clinton,\nBarriere, and Blue River, situated in School Districts Nos. 24, 25, 26, 29, 30, and 31.\nThis brings to fifteen the number of health units operating throughout the Province,\nin addition to the metropolitan services in the centres of Vancouver and Victoria. There\nremain two areas which, in the original planning, were designated as potential health\nunits; namely, one in the Kootenay Lake district with headquarters at Nelson and the\nother in the Squamish-Howe Sound area. During the year certain negotiations were conducted in both districts, which solicited information from Councils and School Boards\ntherein indicating their desire for complete health-unit services. It is anticipated that it\nwill be possible to take steps early next year to finalize health-unit development in the\nKootenay Lake area, while the addition of sanitary-inspection services in the Squamish-\nHowe Sound area, coupled with its consolidation with the North Shore health service,\nwill handle that situation.\nIn the original planning of the Upper Fraser Valley Health Unit it was proposed\nthat the Union Board of Health in that area should include the Municipality of Sumas,\nthe Municipality of Matsqui, the Village of Abbotsford, and School District No. 34. For\nsome years this has not been possible as there has been certain resistance toward expan- BB 26 BRITISH COLUMBIA\nsion of the health unit to include those areas. However, during the year, as a result of\nfurther discussions, School District No. 34 (Abbotsford) approved the proposals and\ntook formal steps to transfer their school health services to that Union Board of Health.\nThere remains completion of negotiations with the municipalities to finalize the expansion\nof the unit which it is hoped will become possible in the very near future.\nThe selection of the nomenclature for health units usually has been based on a local\ngeographic basis rather than on any particular city or municipality. The Prince Rupert\nHealth Unit has been the one anomaly, but during the year the Union Board of Health in\nthat area corrected this by formally changing it to the Skeena Health Unit, which more\nproperly designates the area over which the Union Board of Health has jurisdiction.\nThe local health services within the metropolitan areas of Greater Vancouver and\nVictoria-Esquimalt continued to make substantial progress during the year. While these\nservices operate somewhat independently of the direct supervision through the Health\nBranch, they nevertheless maintain a very excellent co-operation and participate in the\nannual Public Health Institute and the bi-annual Health Officers' meetings. There have\nbeen some negotiations proceeding in the Greater Victoria area toward consolidation of\nthe services provided through Victoria-Esquimalt health service and the Saanich and\nSouth Vancouver Island Health Unit. Sub-committees from both Union Boards have\nbeen meeting periodically to discuss the feasibility of uniting under one Union Board of\nHealth. The Health Branch would endorse such consolidation toward a more completely\nintegrated service for the whole of the Greater Victoria area. It is not felt that it would\nimpair quality or quantity of service already being provided in the separate units, and it\nis evident from the results in the Simon Fraser Health Unit, where an essentially metropolitan service united with a semi-rural service under one Board, that such union is\nfeasible and justifiable toward economic efficiency in operation.\nConsiderable study was given to the financing of metropolitan health services to\ninvestigate the proportion being borne by the various levels of government\u2014municipal,\nProvincial, and Federal. As a result of this study, some readjustments were proposed and\npresented to the senior Medical Health Officers for discussion with their Boards. The\nproposals recommended an increase in the Provincial grants in all cases, with some\nreadjustment in the Federal proportion, involving a decrease in one instance and increases\nin a few others. This results in equitable distribution of grants for all metropolitan areas\non a uniform basis, thereby eliminating some of the inequalities previously evident. At\nthe same time it takes into consideration the expanding population, augmenting the\nfinancing to provide for the necessary expansion of service to handle the larger demands.\nThere remain two areas of the Province with only a part-time health service in which\nit would be recommended that full-time public health services should be introduced. One\nof these is in the Municipality of Oak Bay, which at present is operating under a school\nnurse and part-time Medical Health Officer. It is felt that the best interests of this area\ncould be served through consolidation with the Victoria-Esquimalt health service, together\nwith the employment of additional full-time staff within the municipality. The Health\nBranch is prepared to provide additional substantial grants to encourage development of\nsuch a programme. The other area in which the need for full-time service is most evident\nis in School District No. 58 (McBride). There has been a very voluble demand on the\npart of the School Board and all organizations in that community for introduction of this\nservice. However, to date, it has not been possible to recruit a qualified public health\nnurse to initiate public health nursing services in the area, this service being the preliminary to inclusion of the school district within one of the existing health units. While\nevery effort was been made to locate such a person, unfortunately it is not an area to\nwhich a new graduate can be attracted, and progress is dependent upon the ability to\nlocate a person interested in pioneering the service in a new area. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 27\nPERSONNEL CHANGES\nGreater stability in the ranks of public health physicians was noted during the year,\nas only one resignation occurred while four new appointments became possible. In order\nto open the Boundary Health Unit, the Director of the North Okanagan Health Unit was\ntransferred to Cloverdale to introduce and organize the service. The replacement within\nthe North Okanagan Health Unit, after only a few months' service, resigned toward the\nend of the year. The Director of the Skeena Health Unit is being transferred to become\nDirector of the North Okanagan Health Unit as the year ends. A new appointment to\nthe Skeena Health Unit is being made with the recruitment of a physician formerly\nemployed in public health service in the State of Mississippi. The South Central Health\nUnit was supplied through the appointment of a qualified public health physician formerly\nengaged in a similar category in the Province of Alberta.\nThe Directors of the Cariboo and North Fraser Valley Health Units, who were on\nleave of absence pursuing postgraduate study toward a Diploma in Public Health at the\nSchool of Hygiene, University of Toronto, returned to their appointments in the spring.\nFour present directors\u2014namely, the Acting Director of the Cariboo Health Unit, Director\nof the Simon Fraser Health Unit, Director of the South Okanagan Health Unit, and the\nDirector of the Peace River Health Unit\u2014departed on postgraudate training on September\n1st. Readjustments were made to handle the vacancies during their absence. The\nDirector of the Division of Venereal Disease Control is carrying an part time as Acting\nDirector of the Simon Fraser Health Unit, while a new appointee became Acting Director\nof the South Okanagan Health Unit, and a new appointment was made to assume the\ndirection of the Peace River Health Unit.\nThese appointments and transfers have been planned to provide additional trained\npublic health physicians during 1953, who can be utilized to permit development of new\nhealth units as previously outlined.\nCOMMUNITY HEALTH CENTRES\nAs a result of the proposals advanced by the Health Branch last year to assist\nfinancially toward the construction of suitable health-unit accommodation, definite\nprogress is now being made toward improvement in the over-all community health-centre\nsituation in many areas of the Province. During the year Kelowna City Council undertook the construction of a community health centre to house the central offices of the\nSouth Okanagan Health Unit in a modern, suitably appointed single-story structure on a\nsite facing Okanagan Lake. The financing is handled jointly through municipal, Provincial, and Federal Government participation, although the major share has been borne\nby the municipality. This building was occupied during December, 1952, and provides\nmuch more suitable office and clinic accommodation than was available for the unit in\nthe past, bringing the clinical and administrative phases of the service together under one\nroof for the first time in its long history.\nIn Enderby the Lions Club undertook a project to construct a sub-office of the North\nOkanagan Health Unit to provide accommodation for the resident public health nurse in\nthat area. This was entirely a service-club project in which almost all the construction\nwas done by members of the club on the basis of financing provided through Provincial\nand Federal community health-centre construction grants. Clinic quarters were provided,\nwhile separate offices for the nurse and Sanitary Inspector were made available. The\nbuilding was officially opened on December 14th.\nThis is the first time that there has been suitable accommodation of any sort available for the public health nurse in Enderby and is a credit to the Enderby Lions Club for\ntheir foresight in undertaking its construction.\nThe third community health centre came into being in Kamloops, where a Health\nand Welfare Building was constructed by the Provincial Government, assisted by National BB 28 BRITISH COLUMBIA\nhealth grants. This is a modern two-storey structure, in which the Health Branch is\nhoused on the ground floor, with somewhat smaller quarters accommodating the Motor-\nvehicle Branch, while the second floor accommodates the Welfare Branch. These are\nextremely well-appointed quarters and answer a long-felt need for office and clinic space\nin a community in which health services had been housed in old garages and old houses,\nentirely unsuitable for either efficient administration or the operation of clinics. This\nbuilding became available for occupancy early in September and is now fully in use by\nthe appreciative staff.\nThe renovation of a school building in Coquitlam was undertaken under the grant\nformula to provide quarters for the sub-office of the Simon Fraser Health Unit in that\narea. It also provides, for the first time, the consolidation of administrative and clinical\nphases of the public health service under one roof, while accommodating the recently\norganized dental services in that unit.\nDuring the year numerous discussions were engineered by the Director of the Central\nVancouver Island Health Unit in an endeavour to further the plans for construction of\na community health centre for the headquarters of that unit in Nanaimo. It was found\nnecessary to modify the original plans considerably to bring the estimated cost in line\nwith possible available funds. At the same time some thought has to be given to provision of suitable property by the City of Nanaimo, while the interest of some organization\nto spark the necessary community fund-raising campaign must be sought. Continued\ninterest in the proposal has been evidenced, and efforts will be made locally to further\nthe negotiations toward completion.\nInterest in similar projects is evidenced from Haney, New Westminster, Oliver, and\nVancouver, in which new space or enlarged space is very necessary. All have obtained\ninformation concerning the grants available, the sole remaining hurdle being contingent\nupon the provision of the local share of the financing under the grant formula.\nIn addition to these community-sponsored constructive efforts, in certain instances\nwhere new Government buildings were under way, space has been provided for local\npublic health services. This occurred in new Court-houses at Chilliwack and Courtenay,\nin which the headquarters of the Upper Fraser Valley Health Unit and the Upper Island\nHealth Unit, respectively, have become housed. Similarly, smaller Government buildings\nat Terrace and Williams Lake provided sub-offices for the Skeena Health Unit and the\nCariboo Health Unit respectively. It would be preferable to have community health\ncentres to house the health departments wherever possible, but in these instances, where\nan opportunity presented itself and the problem of accommodation was most severe, it.\nwas felt prudent to accept space within Provincial Government buildings. It is recognized, however, that this leads to a misinterpretation of the service as being a Provincial\nGovernment service which is an entirely erroneous impression.\nThe most inadequate housing of the entire Province exists in the East Kootenay and\nWest Kootenay areas, where the three units\u2014namely, the East Kootenay, Kootenay\nLake, and West Kootenay Health Units\u2014operate from overcrowded offices, never properly planned for efficient administration. The need for new offices in each case is most\nurgently recognized, but no community interest in construction of community health\ncentres is evidenced.\nHOME-CARE PROGRAMMES\nThe pilot study into a home-care programme which was organized in Vernon under\nan Advisory Committee with supervision by the North Okanagan Health Unit operated\nfor about a four-month period, from December, 1951, to March, 1952, according to\nplan. During the period April 1st, 1952, to October, 1952, no patients were admitted\nto this service, in consequence of the fact that records indicated no unprecedented demand\non hospital beds during those summer months. It was felt advisable to review the results\nof the study before giving any consideration to further continuation of the programme. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 29\nConsequently, several separate approaches were made to assess the programme. Firstly,\nMrs. Pringle, Inspector with the British Columbia Hospital Insurance Service, made\na separate study of the service from the hospital point of view, while the Assistant Director\nof Public Health Nursing, who had specialized in medical-care plans, made a study from\nthe public health point of view. Finally, the reports of these two separate investigations\nwere reviewed for discussion with the Advisory Board. It was fairly evident that the\nprogramme had been a success within the limitations of its permissible operation, as outlined in the original proposals. It was felt that much of this resulted from the guiding\ninfluence of the senior public health nurse in the North Okanagan Health Unit, who acted\nas administrator of the Vernon Home Care Service.\nDuring the initial four-month period forty-eight patients were admitted to this service\nfrom the Vernon Jubilee Hospital, which, it is estimated, saved a total of 267 hospital-\ndays, as follows: 178 hospital-days saved by nursing service, 41 days by housekeeping\nservice, and 48 days by nursing and housekeeping service combined. The actual financial\nsaving, based upon a difference of the hospital home-care service at $4.22 per day and\nthe cost of a hospital bed at $11.35, indicates a total of $1,969.99 for the four-month\nperiod.\nIt was felt that the service would be of more value to the hospital and the community\nif the boundaries to which it was confined were extended, and if the period over which it\nwas possible to provide service could be lengthened beyond the designated fourteen days.\nActing upon these and other recommendations, the Advisory Committee modified the\nplan to extend the scope of the service and decided to continue, as from October, 1952,\non a yearly basis, with a review to be undertaken periodically to determine whether it is\nfulfilling a community need and overcoming a hospital problem.\nThis is the only test plan operating in the Province, since the proposals for two other\ntrial plans in New Westminster and Parksville did not materialize. It is deemed advisable\nto carry on in the one area for a further extended period rather than duplicate similar\nservices elsewhere experimentally. Once the advantages and disadvantages of the present\nprogramme can be determined, it may then be possible to extend the service to other\nareas of the Province, contingent upon there being sufficient available nurses to permit it.\nDuring the year three or four requests for the services of the Victorian Order of\nNurses were relayed to the Department, from such areas as Nanaimo, Duncan, Castlegar,\nand Saanich. The merits of introducing this service were discussed with officials of the\nVictorian Order of Nurses, during which it was pointed out that the advisability of establishing this service alongside the service of the official agencies is subject to some query.\nIt is questioned whether it is not an economic drain, apart from the administrative duplication, to provide for administrative offices and duplication of nursing visits, often in the\nsame direction and sometimes even to the same home, on the same day, when possibly\none nurse could have handled both calls on a single visit. It is therefore suggested that\nan increase in the nursing strength of the official agency might feasibly handle this\nproblem on a less costly basis than the introduction of another separate service. The\ndecision, however, rests with the municipalities concerned, since the decision to bear the\nmajor share of the financing of the additional service must be theirs.\nRESIDENT PHYSICIANS' GRANTS\nIn collaboration with the Department of the Provincial Secretary, the Health Branch\nsupervises a programme of grants-in-aid to resident physicians, which is designed to\nencourage physicians to take up residence in remote communities and to provide service\non a periodic schedule of visits to neighbouring communities which are not sufficiently\nlarge enough in themselves to support a physician. Such a system of grants has been in\noperation for a number of years, based upon a definite formula of grants on a sliding scale\non the basis of population and distances to be travelled.   At present, grants are being paid BB 30 BRITISH COLUMBIA\nto some thirty-one physicians in thirty-one rural locations of the Province. During the\nyear the grants were subject to review, when the physicians were contacted to indicate if\nany change in their status had occurred which would permit cessation of a grant. Thus,\nif the volume of practice had increased, or if the physician was sufficiently busy to justify\nthe employment of an assistant or engagement of a partner, it was felt the grant was no\nlonger necessary.\nDuring the year two new areas were brought into the plan, involving the communities\nof Sayward and Sooke. It must be emphasized that any one grant is nominal in amount,\nsince it is not expected to provide for the full support of the physician; it is merely an\nadjunct to assist the community, which assumes the major responsibility of attracting the\nphysician and paying for the services rendered.\nSCHOOL HEALTH SERVICES\nSchool health services are concerned with the medical and preventive health features\naffecting the growth and development of a school-child. While attention is focused upon\nthe mental, emotional, physical, nutritional, and immunization status of the pupil, the\ninfluence of the school environment is taken into consideration to ensure that such factors\nas heating, lighting, ventilation, and sanitation conform to the requirements of healthful\nliving.\nIt must again be recorded that concentration toward ideal school health accomplishes\nlittle unless similar healthful influences prevail throughout the community. In other\nwords, it is not possible to separate school health services as a distinct and definite entity\napart from community health services, since the school-child is a member of the community and influenced by conditions within the community. Thus the changing trends\nin school health administration toward its transfer to Union Boards of Health seem\njustifiable, since then the school health services become integrated with the community\nhealth services, in which the same staff is handling, with continuity, the problems of the\nindividual from infancy to adulthood.\nAs in previous years, the physical examinations of school-children have revealed the\nvast majority of them to be in good physical condition clinically, somewhat over 90 per\ncent physically fit. In addition to the excellent physical status of the average British\nColumbia school-child, the majority of the pupils, well over 75 per cent, are immunized\nagainst such major communicable diseases as diphtheria and smallpox, maintaining their\nimmunity status throughout their school-life. A significantly smaller proportion of the\nschool population is immunized against scarlet fever, whooping-cough, and typhoid fever,\nwhich is understandable as administration of these antigens is governed by the vagaries\nof disease incidence, particularly since the immunity so conferred is somewhat less\npermanent.\nOther services falling into this category, such as preventive dental services, nutrition\nservices, sanitary-inspection services, and public health education services, have made\nprogress during the year. While they cannot be entirely separated, since one is to some\nextent related to the other, a separate review of the essential components will be found\nin the individual reports of the divisions dealing more specifically with those phases of\npublic health programme.\nDuring the fall meeting of the Medical Health Officers a review of school health-\nservice programmes was undertaken. It was evident that there were modifications of the\nservice from unit to unit, and it was suggested that a study should be undertaken to determine whether these modifications would become policy acceptable to the Health Branch\ngenerally. It was pointed out that any modifications should have the approval of the\nHealth Branch so that, in turn, the Department of Education can be kept advised on the\nscope of the school health services being provided throughout the Province. Thus an\noutline of the existing school health services in each unit has been requested so that the DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 31\nHealth Branch may make a complete review of all existing services presently provided\nand determine the recommended programme Provincially for the future. This is deemed\nadvisable, since it is agreed that all services should be reviewed periodically so that\nprogress may be recommended lest the service stagnate to a routine situation.\nDISEASE MORBIDITY AND STATISTICS\nThe communicable-disease regulations, which were introduced in their revised form\nin January, 1951, were brought up for review during the fall meeting of the Medical\nHealth Officers. After a full year of experience it was noted that there were one or two\nminor changes necessary. It was proposed that a standing committee on communicable\ndiseases should be established to deal with periodic revision of the communicable-disease\nregulations in order that they be consistent with the latest scientific knowledge and disease\nexperience.\nA morbidity study or sickness survey, which was carried on from October, 1950,\nthrough to October, 1951, in co-operation with the Department of National Health and\nWelfare, has so far provided no results. At present the information which was garnered\nacross the nation is being correlated in Ottawa, and some preliminary information should\nbe released shortly. It is still felt that this would be of considerable significance in\nguiding the recommendations for future medical and nursing-care programmes.\nResults from the tests made on the practicability of caramel lozenges containing\ndiphtheria toxin as an effective method of reinforcing diphtheria immunization of schoolchildren and young adults have not yet been released. The method of oral immunization\nheld promise of distinct advantages over the present parenteral method, but the results\nare dependent upon some long-term investigation, involving termination of immunization\ntitres in blood samples of test volunteers. The results of the study are still being assessed,\nbut some indication of the usefulness of the lozenges will be available shortly.\nDuring 1952 the total recorded notifiable diseases in British Columbia were somewhat less than in the previous year, but comparable with the figures for other years,\nindicating that 1951 was a somewhat exceptional year due to the marked incidence of\ninfluenza. This is evident in the rate of 3,311.9 per 100,000 population for 1952, compared with the rate of 4,092.7 for 1951.\nThe incidence of influenza was a great deal lower, with a rate of 45.7 per 100,000\npopulation for 1952, compared with the rate of 956.9 during 1951. In this connection,\nmention should probably be made of the fact that some discussions are being held relative\nto experimental studies on the value of influenza vaccine. A study was carried out in\nOttawa during the winter of 1952, but the incidence of influenza in Ottawa during the\nperiod of study was too small to permit drawing any valid information. It is now proposed\nthat further studies be planned during the early months of 1953, during which season\ninfluenza is usually anticipated. From the results of a series of studies across the nation in\nthe various Provinces, it is hoped to garner information concerning the possible value of\ninfluenza vaccine as a preventive.\nThe most serious situation, in so far as the morbidity picture is concerned, was\noccasioned in poliomyelitis, since British Columbia registered the highest incidence of\nthis disease ever recorded in the Province. A rate of 49.6 per 100,000 population for\n1952 was almost twice as high as the previous high year in 1947, and considerably higher\nthan the normal annual average figures of 10.0 per 100,000 population. The incidence\nwas particularly high in midsummer in Kimberley, while in the early fall, when the\nKimberley incidence was decreasing, there was a high proportion of cases reported from\nthe Penticton area. Although these areas were especially heavy sources of cases during\n1952, no area or section of the Province was altogether spared.\nPoliomyelitis seems to engender a measure of community panic whenever it becomes\nreported, in spite of assurance that it is fatal to proportionally few and that residual BB 32 BRITISH COLUMBIA\nparalysis remains in only a small number. In this particular disease a considerable\nmeasure of public health education is necessary to allay public fears and to acquaint\npeople with the true situation.\nIn the Kimberley area the epidemic seemed to be particularly virulent, as there was\na considerable incidence of bulbar cases. The local health services in that area, under\nthe direction of Dr. W. G. Watts, in co-operation with the hospital and medical profession,\nwere able to accomplish adequate supervision of the epidemic until late in August, when\nadditional nursing personnel were requested to relieve the hospital nurses who had been\nputting in long overtime hours without rest. It was possible to fly in nurses from the\nBoundary Health Unit and the Simon Fraser Health Unit, both of whom loaned public\nnurses to the East Kootenay Health Unit to permit them to work in the Kimberley\nHospital to relieve that hospital staff. At the same time, Dr. A. J. Nelson, epidemiologist,\nand Miss Fern Primeau traveled to the Kimberley area to confer with Dr. Watts and his\nstaff in an attempt to gain information on the epidemiology of that outbreak. It should\nbe mentioned that the control of poliomyelitis is very difficult from the point of view that\nthe epidemiology of the means of transmission has not been definitely established. In\nKimberley an epidemiological study was carried out to see if the distribution of the cases\nbore any relation to water, milk, or sewage-disposal. The entire City of Kimberley is\nfurnished with water from one source, and investigation showed the water-supply was\nnot involved as examination of the water at Kimberley was consistently satisfactory. The\nmilk was supplied by two dairies, and a study of the milk situation did not show a predominance of cases in any one dairy. In so far as sewage-disposal was concerned, there\nseemed to be no differentiation between areas served by sewage-disposal systems and\nthose relying upon septic tanks. The activities of the patients for the previous two weeks\nindicated that every case was related in some way to the swimming-pool, and there were\na number of familial infections, some in families and some in neighbours. Normally such\na high degree of familial infection is not found in connection with poliomyelitis.\nThe physicians in the area indicated that the last real epidemic of poliomyelitis in\nthat area was in 1928, and it had always been considered a polio-free area. As the area\nwas apparently so free, thus an accumulation of susceptibles had apparently been built\nup, and it was felt that the daily congregation at the swimming-pool had led to a rapid\ndissemination of infection among these many susceptibles.\nSpecimens were taken of excretory and blood samples for investigation by the\nLaboratory of Hygiene in Ottawa, and subsequently some Coxsackie virus was isolated\nfrom at least one specimen. This further complicates the picture, since Coxsackie virus\nis the creator of symptoms similar to poliomyelitis, but is less serious. There is always\nsome question as to whether this may not be present separately or coincidental with the\npoliomyelitis epidemic. Unfortunately, it is not easy to differentiate between the two\nclinically, and a definite diagnosis often can only be established after drawn-out laboratory\ninvestigations are completed and the epidemic is reviewed in retrospect.\nThe situation in Kimberley began to abate during September, with only the odd\nsporadic case remaining, but there was an immediate upswing in incidence in the Penticton area, wherein occurred an unduly heavy load of serious paralytic cases. Here\nagain the staff of the South Okanagan Health Unit, under the direction of the Medical\nHealth Officer, Dr. Donald M. Black, co-operated with the hospital and medical authorities to exercise such control measures as were possible. The hospital staff is to be\ncommended for the long hours of overtime performed in carrying out an abnormally\nheavy load of duties, while the public health nurses likewise investigated contacts and\nsuspected cases around the clock while introducing quarantine and isolation measures in\nthe protection of the public generally. Subsequently, in Penticton, where a heavy fly\nnuisance was evident, spraying of the community, with particular attention to garbage-\nreceptacles and garbage-dumps, was carried out.    Whether this had any effect on the DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 33\nepidemic is conjectural, but it was a fortunate coincidence that with the abatement of fly\npopulation, the incidence of poliomyelitis exhibited a parallelism.\nThe incidence in the Squamish area also became evident late in the year, where,\nalthough there was an unduly heavy number of cases, the number exhibiting paralysis was\nfew, and the disease was much milder than in the two other areas. There was a considerable degree of community unrest in this instance, particularly as school-children from\nneighbouring industrial communities were transported into Squamish for high-school\neducation. There was much conjecture as to whether schools should not be closed as\na control measure to prevent spread to these other communities. Subsequently, Dr. A. J.\nNelson, epidemiologist, visited Squamish to meet the Medical Health Officer, Dr. L. C.\nKindree, and the public health nurse, Miss L. Crane, to review the epidemiology of the\nepidemic and to interview community groups in an endeavour to allay their fears. As the\ndisease in Squamish was so mild, there is some query as to whether this may not have\nbeen actually a Coxsackie-virus epidemic rather than a poliomyelitis epidemic, and certain\nspecimens were being investigated along those lines.\nThe various local health services are to be complimented on the manner in which\nthey have handled the heavy loads of additional work placed upon their shoulders during\nthe poliomyelitis season, particularly the public health nurses, who put in so much overtime\nwithout respite. At the same time the Health Branch is desirous that the valiant assistance\nof the Royal Canadian Air Force be recorded, particularly the officers in charge of the\nAir-Sea Rescue Squadron operations, Squadron Leader John Young and Air Commodore\nGordon. These officials were extremely co-operative in answering any request and provided emergency air transportation, without restriction, placing personnel and aircraft,\nstaffed with a medical officer, whenever an emergency flight was required to evacuate\npoliomyelitis patients from isolated parts of the Province to hospitals, where facilities and\nmedical personnel were available for more complete treatment. Many of these flights\nwere undertaken in night hours under storm conditions, and no such service could have\nbeen obtained from any other source. The Department is indebted to the Department of\nNational Defence for this co-operation, and particularly the individuals above mentioned.\nIn Vancouver a poliomyelitis committee, composed of medical specialists and public\nhealth administrators, was set up to recommend a treatment follow-up of these cases\nbrought in to Vancouver, or diagnosed in Vancouver, and hospitalized there. The experience gained by that committee and by public health officials is now being studied, and it\nis planned that meetings of the two groups will be organized to pattern control measures\nand recommended treatment for future years. At the same time it is hoped that some\nplanned details can be pre-arranged relative to transportation of patients, cases requiring\ntreatment in respirators, and so forth. In the interim all respirators are to be completely\noverhauled for use, if required in future.\nThe bulk of the reportable diseases is composed of the minor communicable infections so common in childhood. There has been recorded the same proportion of chicken-\npox, measles, mumps, and rubella as in previous years. Their aggregate total accounts\nfor practically two-thirds of the number of notifiable-disease cases reported.\nDuring 1952 streptococcal infections exhibited a fairly high incidence comparable\nwith the high incidence recorded in previous years (a rate of 347.5 for 1952, as compared\nwith 359.6 for 1951). This incidence has been observed with some interest, as it is\nevident that it has been of extremely mild nature, with extremely few complications and\nlittle, if any, secondary familial spread. The incidence has been marked on the Coast\nand in the Kootenays, but occurred to a degree generally throughout the Province.\nA downward trend in the number of cases of whooping-cough noted last year has\nbeen continued (81.5 per 100,000 population in 1952, as compared to 98.4 per 100,000\npopulation in 1951). This, while a gratifying result, still indicates an undue prevalence\nof this infection and emphasizes the need for continued endeavours to provide early and\nrepeated immunization as a preventive. BB 34 BRITISH COLUMBIA\nIn respect to salmonellosis, the same incidence of paratyphoid fever was recorded\n(0.7 per 100,000 population, as compared to 0.6 per 100,000 population in 1951), but\ntyphoid fever almost doubled (2.5 per 100,000 population, as compared to 1.06 per\n100,000 population in 1951). These cases have been recorded, in the most part, amongst\nIndians, particularly in the Prince Rupert area and in the Alert Bay area, which is not\nsurprising when one realizes that the level of sanitation and personal hygiene amongst\nthis population is so primitive. It is felt that immunization against the enteric infections\nshould be commenced on a wide scale amongst Indians, while every endeavour should be\nmade to improve their household and community sanitary environment, if adequate\ncontrol is to be complete. There is inherent danger always as long as they act as a reservoir of infection, with sporadic spread to other citizens to be anticipated from time to time.\nFor the first time in many years the actual clinical reporting of salmonellosis-shigellosis infections parallels the laboratory reports; thus it seems evident that the measures\nadopted jointly by the Division of Laboratories and the Division of Health Units are\nfinally yielding results in correlating the laboratory reports and the notification of clinical\ncases. This is most desirable if an epidemiological follow-up is to be of future value.\nIn some respects this result probably stems from the development of adequate full-time\nhealth services throughout the whole Province and is a corroboration of the fact that full-\ntime health units promote more thorough health measures toward protection of the health\nof the people of British Columbia.\nEpidemic hepatitis (jaundice) displayed a somewhat higher incidence, with a rate\nof 17.7 per 100,000 population in 1952, as compared with a rate of 7.8 per 100,000\npopulation in 1951, and a rate of 4.0 during 1950.\nWhile no cases of botulism were reported during the year, apparently one fatality,\nalmost certainly due to botulism, should be mentioned. This occurred late in September\nin a male resident of a small community near Fernie, whose hospitalization and treatment\nwas provided in a neighbouring Province. A detailed report of this case will be found\nin the report of the Division of Laboratories, outlining the source of the infection, and the\nresults again incriminating home-canning measures.\nWhile two cases of malaria were recorded during the year, these were not infections\narising in British Columbia, but were reported as developing in individuals recently\nreturning from tropical residence. It seems apparent that they obtained their initial\ninfection outside the country, but symptoms did not occur until they had returned to\nBritish Columbia, resulting in their being reported as new cases.\nThe number of cases of cancer reported increased again (with a rate of 281.0 in\n1952, compared with 247.2 in 1951, and 274.6 per 100,000 population in 1950). The\ndisease has increased slightly over the past two years but is still somewhat lower than the\nrate of 315.0 in 1949.\nComments on the venereal-disease and tuberculosis incidence will be found in the\nreports of these separate divisions.\nTwo cases of tetanus were recorded, indicating again that opportunity for this infection prevails throughout the Province, and that traumatic injuries may have this serious\ncomplication. One of these cases, in the person of a farmer on Vancouver Island, required\nconsiderable quantities of tetanus antitoxin to overcome his infection, a considerably costly\ntherapeusis as compared with the few cents involved in immunization. Fortunately, with\nthe triple antigens now being used, more and more of British Columbia's citizens are\nbeing immunized against the possibilities of tetanus infection.\nThe table showing the rates for the various notifiable-disease incidence for the past\nfour years, for comparison, are shown in Table I, page 36, while a complete list of the\nnotifiable diseases as reported from the various health-unit areas of the Province, by\nMedical Health Officers, is recorded in Table II, page 37. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 35\nFinally, in line with morbidity, mention should probably be made of the study which\nhas been going on this year into the question of \" swimmer's itch.\" Under National health\ngrants a project was arranged in 1951 which has been carried on during 1952, permitting\na team from the Department of Zoology, University of British Columbia, to investigate\nthe cause and possible prevention of \" swimmer's itch,\" which has been reported as\nprevalent in Cultus and Okanagan Lakes particularly.\nThis condition of \" swimmer's itch \" is caused by a parasite which lives part of its\nlife-cycle in snails and is found in the lake-waters during the summer months. As the\nswimmer emerges from the water and the skin becomes dry, the small larva, of the\nparasite penetrate beneath the skin-surface, causing an initial sharp prickling sensation,\nthe intensity varying according to the number of larva, or cercaria. present. Later small\nred macules appear when each parasite had penetrated the skin. These macules usually\ndevelop into papules. Subsequently, these disappear and the condition clears up. However, re-exposure to the waters will recreate the same symptomology once again.\nSpecifically, the investigation has been conducted into searching for the cercaria. in\nspecimens of the waters, study of the snails, and recommendations as to possible control\nmeasures. It seems apparent that if the swimmers dry their bodies entirely with towels\nupon emergence from the water, there would be less evidence of the condition. In order\nto control the parasite cercaria., however, application of chemicals to the waters is evidently necessary, possibly copper sulphate. However, this may create undue problems\nfor fish reproduction, and therefore, such control measures must be carefully investigated\nin order to gauge the dosage which might prevent the incidence of \" swimmer's itch \"\nwhile, at the same time, allowing the fish to reproduce normally. BB 36\nBRITISH COLUMBIA\nTable I.\u2014Incidence of Notifiable Diseases in British Columbia\n(Including Indians)\n1949\n1950\n1951\n1952\nNotifiable Disease\nNumber\nRate per\nNumber\nRate per\nNumber\nRate per\nNumber\nRate per\nof\n100,000\nof\n100,000\nof\n100,000\nof\n100,000\nCases\nPopulation\nCases\nPopulation\nCases\nPopulation\nCases\nPopulation\n1\n0.1\n1\n0.1\n1\n0.1\nBrucellosis (undulant fever)\t\n16\n1.4\n22\n1.9\n18\n1.6\n12\n1.0\n3,509\n315.0\n3,125\n274.6\n2,850\n247.2\n3,366\n2S1.0\n7,370\n661.6\n5,001\n439.5\n6,671\n578.5\n6,266\n523.0\nConjunctivitis.-    .\n287\n25.8\n280\n24.6\n374\n32.4\n346\n28.9\nDiphtheria\t\n12\n1.1\n63\n5.5\n5\n0.4\n11\n0.9\nDysentery\u2014\n1\n0.1\n1\n0.1\nBacillary (shigellosis)    .\n23\n2.1\n189\n16.6\n253\n21.9\n102\n8.5\n1\n0.1\n1\n0.1\n2\n0.2\n10\n1.0\n46\n4.0\n90\n7.8\n212\n17.7\nInfluenza, epidemic. .  \t\n47\n4.2\n460\n40.4\n11,033\n956.9\n548\n45.7\n1\n0.1\n2\n0.2\n1\n0.1\n2\n0.2\n10,765\n966.3\n5,648\n496.3\n6,269\n543.7\n8,227\n686.7\n18\n1.6\n15\n1.3\n30\n2.6\n33\n2.8\n4,314\n387.3\n8,634\n758.7\n5,835\n506.1\n7,088\n591.7\nPertussis.   \t\n214\n19.2\n1,740\n152.9\n1,134\n98.4\n976\n81.5\n225\n20.2\n73\n6.4\n92\n8.0\n594\n49.6\nRubella \t\n567\n50.9\n7,935\n697.3\n2,288\n198.4\n1,986\n165.8\nSalmonellosis\u2014\n17\n1.5\n11\n1.0\n18\n1.6\n30\n2.5\n1\n0.1\n35\n3.1\n7\n0.6\n8\n0.7\nOther....   \t\n95\n8.5\n152\n13.4\n149\n12.9\n109\n9.1\nStreptococcal infections\u2014\n32\n2.9\n36\n3.2\n38\n3.3\n26\n2.2\n102\n491\n9.2\n44.1\n183\n871\n16.1\n76.5\n300\n4,146\n26.0\n359.6\n536\n4,163\n44.7\n347.5\nScarlet fever-\t\n1\n0.1\n1\n0.1\nTetanus\n3\n0.3\n1\n0.1\n2\n0.2\n2\n0.2\nTrachoma    \t\n9\n0.8\n5\n0.4\n8\n0.7\n3\n0.3\n4\n2,202\n0.4\n197.7\n160.6\n1,828\n1,662\n144.1\n1,411\n117.8\nVenereal disease\u2014\n3,833\n344.1\n3,579\n314.5\n3,301\n286.3\n3,057\n255.2\nSyphilis (including non-spe\ncific urethritis\u2014venereal).\n859\n77.1\n630\n55.4\n568\n49.3\n541\n45.2\n3\n0.3\n6\n0.5\n48\n4.2\n19\n1.6\nTotals\t\n35,036\n3,145.1\n40,572\n3,565.2\n47,189\n4,092.7\n39,677\n3,311.9 DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 37\n<\nW\nPi\n<\nQ\nm\npa\nP^\no\nZ\n<\no_\nH\nZ\nD\nH\nX\nn\nS\n5\npj\no\nu\na o->\npq\n<\nw\nCO   w\nw\n<\nW   Pt\nco\nQ\nw\npa\nH\nO\nPh\no\nU\no\nz\no\na\nw\n\u25baJ\nM\nH\nw\ni-i\n0-\na>\n\u2022o\nV\n<g\n'o\no,\n\u2022o\n!\nc\n.g\n<_\na\n9DUIAOJJ\nm\nc\n\u2022r-\nr^ i> Tf\nm \"Tj- o\nO ro t-\nin\nr-\nro\n00\npuEjsj i-AnoDue^v\nJO JSEOO )S_AV\n:   ] co th\n1        1   i            :w\nvo   ;   jh       j   i cs\ns\nJSE03\nIS-M pUEraiEJAJ\n;   ; o\\   ;\nCO     1 co\nt-   1\nr-csvo       \\   \\ ^     THrHcoii       ij       |   ;   ;   {\ncs\nXeu_joox ls_A^\nTH        j   O\n! r-\n1 CS\no\nVO CO O CO\n\u25a0<*   CS   TH   \u2022*\nCO TH\n2\n\u00bbn\n\u00a9\nipiE_H\n;o pjEog uoiun\nJIEUimbsg-EpopiA\ni    ! \"t Os\n\\rt rt\n: r-\nth m\nTfr\nco th o m co O       irt\n00            OS   TH            \"H;\nH            VO\nm      \u00bbn t- \u00a9\nTH   ON\nrt\nOv\nin\noo\nCS\na.H!Ui__o3\nmiE_u uEjnodonaj^\nJ.AU03UEA J-1E3JO\n1 m th\n! \u25a0*\n1 CS\nCO\nm>HtO\\M\/.mrN      cScSO\\      r*    l \u2022**\u25a0\nr-          ^rcscsr-r-               m            ioo\ncn     c- w h cs                                 \u00abs\nCS          TH                                                                              j  th\"\ni\n|\nOv\nm\ncs\noo\"\npuEisi jaddn\nTH         j   f-   tH   OS\ni m   :    i ^ r) oo o m o\\        lit-      csoorsi:        i:        :    ;    :    :\n!           |;immTt^.cS           !!                          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OS        m th        -rt\n1       1   1 cn                                 :\nI tJ-    I\n| t-    1\nX-J_ET[ aeu-JOO}}\n1    i co    1\n;    ; rs    ;\nICO              (OOTHVOmOvVO          tH\ni SO        V~t CS         rH\nTf CS     1     !           1\nCO       j\n00\nCO\nxqsiuienbs\n\u25a0\u2014punos 3A.OH\n:    ! as    :\n!   jo.   :\nSO    \\\n1    : ov th th co co r-\n1    j 00                  CS (S\nCS O O     1     1           1\nTH   CS        1\n!\n1^\nOv\nCO\n\/_BU-.00;_I }SE_f\n!       ! 00 T-i TH              \\ tH\nth i-i    i th       so Xr~ Os ro\nin\ni r^   i   i       i\n1 CS     1     |\nCO\n5\npuEisj jaAnODUEA.\nJEJJU-3\nrH\nm rt\nOs CS\n1 cs ^\nooo   ir thovocmw     cscscs\n(Sh     Ifi        Os Os        th\nOOOH       1\nth m\ncs\nj   ; ^\nas\nooqiJEQ\n(N  t-i\nCS tH\ncs\ncn\nthOthOCSvoc^io-h         th\nH^      m      rt m in rt\nrt        th th        (N\nTH               TH   CN   SO\nCS CS\n1-1\nr-\nCO\n00\nAJEpunog\n! fS tf\n! Os rf\nI CS\nCS    TH\nr- o\nTH   CS\nCO CO CO tH SO CO\nth     co \u00abn cs vo\nOO         (N                H\n\"Tj\"               TH    CO    00\nSO vo\nin\n\u00a9\nCO\nCS\nF1\u00b0X\nca so so so th      Hr.O(snt\u00bbMt-\u00ab\u00ab)voTt,vo      o oo o.     >o vo m ts co     r-Tt      r- r- \u25a0**\u25a0 o.\nth SO SO  rt  rH                  OOCS          TH \"<f          rl fO CO  t^ 0\\ M          CO          O          CS CO VO                         mm          IflTtONH\nco cs co                               cs m      cs      o o\\ m o^                \u00bbh           i#-)r-<                cs th      \u00a9 co th\neo\"vo                                                        oo       o            th                                        Tt                  th            rn\nr-\nr-\n\u00ab?\nOs\ncn\nGO\n_>\n3\ni-\n4\n>\na.\n(j.\nc\nc\nX\nc\nP\nI\na\nL\nX\nc\n(\nI\n4\n%\nX\ni\nc\nI\n1\n\u00a3\n1\nI,\nh\ng E\n_\u00ab<\nQ\n_\n-\na\n<J\n-I\nj\nc\nc\nB\n1\n\u2022 c\n-1\nI\nc\n\u25a0c\n0,\nc\n_\u2022\nc\ns\n}\ns\n3\ni\na.\ns\nC\na\n5\n1,   V\nI\n5\ntC\na\nH\nC\nt\n.\nc\nc\nc\nc\n1\nV\nI\n1\ni\n1\nA.\nS\n11\n.2 -\na.\n>\n\u2022C\nc\n1\n>\nB\nI- u\n\u25a0\u00bb 0\np-\nr\n1\n0\nt>\nu\na\nS-\nO \"5\n00\ne\nc\nu\n\u00a3\n\\\nc\n1\/\n1 L\nX\n\u2022. c\nc\no_\n>\na_\na\nI. r\nt\nc\nB\nt\n|\n!\n11\nH\n>\nu\nc\n\u00a3\n1\n_\n1\n\u25a0i\n|l\nU   C\n>\nI\n0\na.\nj-\n4\nC\n4\nG\n4:\n>\u2022\nc\n(C\nT\n0\nC\nE\n4\n|\n[\ni\nCO\nt_j\ng\n>\n1\nM\no\nH BB 38 BRITISH COLUMBIA\nREPORT OF THE DIVISION OF PUBLIC HEALTH NURSING\nMonica M. Frith, Director\nThe Public Health Nursing service continued its steady development through the year\n1952. This service is available to 98 per cent of the population of British Columbia, in\nspite of the fact that no new districts were organized this year. The remaining 2 per cent\nof the population not receiving direct service is scattered along the coast of the Province\nand in very rural Interior points.\nPRESENT STATUS OF SERVICE\nTo maintain the standard of service, it was necessary to add Public Health Nursing\npersonnel at six centres in order to give more adequate coverage and to keep pace with\nthe rapid growth in population. In 1949 the ratio of public health nurse to population\nwas one public health nurse to 4,000 people. In spite of increased numbers of public\nhealth nurses on the staff, the ratio of public health nurse to population is now 1:5,000.\nIt was recommended by Haven Emerson, in his book \" Health Units for the Nation,\" and\nby the National Organization for Public Health Nursing that a public health nurse serve\nnot more than 5,000 people where a generalized public health programme is carried. If\nthe public health nurse is to give health guidance and bedside care, it is recommended\nthat the ratio be one nurse to 2,000 people. Because of the scattered population in rural\nBritish Columbia, which necessitates a considerable amount of travelling, and because\nthe generalized public health nursing programme includes some nursing care, the former\nratio of one nurse to 4,000 population should again be attained if a good quality of service\nis to be maintained.\nThe six centres where public health nurses were added are as follows: Nelson, where\na senior nurse was appointed for the first time; Boundary Health Unit, where two nurses\nwere added, one at Langley and the other at Cloverdale; Central Vancouver Island Health\nUnit at Nanaimo; Upper Fraser Valley Health Unit at Chilliwack; and the West Kootenay\nHealth Unit at Trail. These appointments were made possible with funds obtained from\nNational health grants. The Federal Government, through the Department of National\nDefence, this year appointed a qualified public health nurse, who had formerly been on\nthe Provincial staff, to serve in the area formerly carried by the staff of the Saanich and\nSouth Vancouver Island Health Unit. It is hoped that additional nursing personnel can\nbe added next year to the following: Central Vancouver Island Health Unit, at Duncan\nand Port Alberni; South Okanagan Health Unit, in the Penticton-Oliver area; North\nFraser Valley Health Unit, at Haney; and Upper Island Health Unit, at Courtenay. The\nMcBride public health nursing service will be opened as soon as a qualified public health\nnurse is available for appointment.\nSince the inauguration of the National health grants in 1948, twenty-three areas have\nbenefited from financial assistance, which enabled the organization of new public health\nnursing districts or the addition to the numerical strength of the Public Health Nursing\npersonnel in districts where services had already been established.\nDuring the year thirty-eight appointments were made to the Public Health Nursing\nstaff. Of this group, seven were married public health nurses who were able to accept\npositions in their own communities; seven nurses returned to the staff following completion of the public health nursing training at university; seven were public health nurses\nrecruited for placement; while the remaining fifteen were registered nurses without public\nhealth nursing training.\nThere were thirty-one resignations, including nine members of the staff who\nundertook to take public health nursing training at university. Six registered nurses\nresigned and did not go on for further training.   Ten public health nurses resigned for DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 39\nmarriage and family reasons, four left to take positions outside the Province, while one\npublic health nurse transferred to the Division of Venereal Disease Control, and one\njoined the public health nursing staff of the Department of National Defence in British\nColumbia.\nFourteen public health nurses transferred within the service. Three senior-nurse\npositions were involved. Table I shows a comparison of the staff situation over the last\nten-year period. It is interesting to note that the percentage of staff turnover is 12 per cent\nlower than last year and 8 per cent lower than the ten-year average.\nTable I.\u2014Comparison of Provincial Public Health Nursing Staff Changes\nDURING THE PERIOD 1943-52\n1943\n1944\n1945\n1946\n1947\n1948\n1949\n1950\n1951\n1952\n52\n37\n71\n17\n12\n8\n56\n33\n59\n13\n11\n9\n64\n48\n75\n22\n16\n10\n77\n88\n117\n42\n27\n19\n98\n65\n65\n37\n11\n17\n111\n52\n46\n24\n14\n14\n115\n94\n82\n41\n28\n25\n121\n81\n67\n332\n313\n174\n123\n98\n76\n45\n36\n171\n129\nTotal staff changes1 \t\nStaff turnover (per cent)-\n83\n64\n38\nResignations\t\nTransfers   \t\n31\n14\n1 Includes appointments, resignations, and transfers.\n2 Returning from university included.\n3 Leaving for university included.\n1 Exchanges included.\nThe trend toward stability of the Public Health Nursing staff has certain advantages\nin providing continuity of public health nursing service. However, it is interesting to\nnote that 24 per cent of the public health nurses have married status, and are unable to\ntransfer to other positions because of family responsibilities. These nurses tend to live\nin the larger population centres, and thus it becomes necessary to place the single public\nhealth nurses, who frequently have less experience, in the single-nurse districts. It is\npointed out that the percentage of nurses without public health certificates on the staff\ndropped from 14 per cent in 1951 to 10 per cent in 1952. This is probably due to the\nlarger number of married nurses who are qualified as public health nurses and who have\nreturned to the service.\nPUBLIC HEALTH NURSING TRAINING\nNational health grants have proved to be of great assistance in providing an\nopportunity for training suitable nurses for the public health nursing field. Each year\na limited number of nurses without formal preparation in public health nursing are being\ntaken on the staff, placed in districts under close supervision, and given the opportunity\nof gaining some experience in the public health nursing field before taking the required\ncourse at university. During the past four years twenty-eight nurses completed university\ncourses in public health nursing and became fully qualified members of the staff, with the\nhelp of bursaries made available through National health grants. Twenty-one per cent\nof the present qualified staff public health nurses received their public health nursing\ntraining in this manner.\nDuring 1952 nine nurses, who had been on the staff, enrolled in the basic university\npublic health nursing course, with assistance from National health grants. The freedom\nof choice of a Canadian university giving a recognized programme in public health nursing\ntends to assist recruitment to the public health nursing service in this Province. This year,\ncandidates are at the University of British Columbia, McGill University, and Dalhousie\nUniversity. Seven qualified public health nurses returned to the staff following completion\nof the public health nursing course. Since these nurses have had a period of employment\non the staff prior to their university course, they complete their public health training BB 40 BRITISH COLUMBIA\nbetter equipped to fill public health nursing positions than the nurse without previous\npublic health nursing experience. Thus it has been possible to place these nurses in areas\nwhere a greater degree of independent judgment is required of the nurse.\nIn order to improve and maintain the quality of service provided by public health\nnurses, it is necessary to have well-trained senior and supervisory nurses. Through the\nhelp of National health-grant money it was possible for one of the senior nurses, Miss\nJanet Pallister, to enrol in the course in public health nursing supervision at McGill\nUniversity.\nThe heavy programme of in-service training for nurses without public health qualifications has continued this year, as 40 per cent of the new staff do not have all the\nnecessary preparation for the public health work. A planned orientation programme is\nprovided for these nurses similar to the field-work experience given to nursing students\nfrom the University. This orientation programme usually is given in the district where\nthe nurse is appointed for service. However, the required training period throws an\nadditional burden on the senior public health nurse, who must assume responsibility for\ntraining and supervising so that a minimum service to the community can be provided.\nField-work facilities were provided for twenty-one public health nursing students\nfrom the University of British Columbia in January and May. During the year a student\nfrom the public health nursing supervision course at McGill University was given a\nmonth's experience on an advanced level in the South Okanagan Health Unit.\nObservation periods have again been provided by the local Public Health Nursing\nstaff for undergraduate nurses from St. Joseph's Hospital in Victoria, the Royal Inland\nHospital at Kamloops, and the Royal Columbian Hospital at New Westminster. It is\nhoped that this introduction to public health nursing will encourage more nurses to enter\nthis special branch of nursing.\nIn-service education is being carried on continuously in each local area. This year\nthe study groups were reorganized in certain areas in order to make the boundaries\ncoincide with those of the health unit. Study groups select topics which will assist them\nin carrying out the public health programme. For example, a group may study the\nphysiology and hygiene of pregnancy before initiating a series of mothers' classes in\na district which was not given this service before. The study groups also provide an\nopportunity for the nursing staff to make their wishes known through their official organization, the Public Health Nursing Council, which meets annually at the Institute.\nOnce again at the annual Institute a full day's programme was devoted to public\nhealth nursing. This provided an excellent opportunity for members of the staff to\npresent papers on pertinent subjects related to public health nursing. The panel on public\nhealth nursing supervision was excellent, as well as the papers on new trends in maternal\ncare, the family of the tuberculosis patient, and vision-testing. The Public Health Nursing\ngroup look forward to more opportunities for group meetings of this type.\nRECORDS COMMITTEE\nAs the result of recommendations, made by both study groups and individual members of the staff, regarding revisions of various record forms and the use of records, a\nProvincial Records Committee was set up, advisory to the Local Health Services Council.\nThe Committee's function is to study and make recommendations regarding the record\nsystem and the use of the individual forms, with a view to reducing to a minimum the\namount of clerical and professional time required to achieve the maximum service. The\nCommittee consists of Public Health Nursing personnel from Central Office, senior nurses\nfrom the Fraser Valley, and the Director of the Division of Vital Statistics. To date the\nCommittee has accomplished a great deal of valuable work in revising records and\nreorganizing procedures. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 41\nPUBLIC HEALTH NURSING CONSULTANT SERVICE\nPublic Health Nursing Consultant service is available to local health services to\nassist with the development of the generalized health programme. However, the activities\nof the Public Health Nursing Consultant have undergone considerable change as health\nunits developed throughout the Province and as less time was required for the organization of new districts and the direct supervision of nursing staff. As senior and supervisory nurses became available locally, the responsibility for the supervision of the nursing\nstaff was transferred to a local level.\nDuring the year the work of the Public Health Nursing Consultant has been clarified\nin relation to the present type of service. Consultant public health nurses have had\nspecial preparation in public health nursing by reason of well-rounded experience and\nuniversity preparation in a special field of public health nursing. To facilitate the use of\nthe Public Health Nursing Consultant service, the Province has been divided into four\nregions, with one Consultant responsible for service in the generalized programme in each\nregion. Specialized help is available for mental hygiene, maternal and child care, and\npublic health economics.\nConsiderable progress has been made during the year in the field of mental hygiene,\nwith the assistance of the Consultant in Mental Hygiene. A policy was established concerning the relationships of the Child Guidance Clinic and the Public Health service. The\nposition of the Public Health staff in relation to the Social Welfare Branch workers in\ndealing with local situations and referrals to the clinic has been set forth. This year there\nhas been an increased use of clinic facilities as well as an improvement shown by the public\nhealth staff in screening and follow-up of cases.\nAs the maternal and child health programme embraces the total field of child care,\nbeginning with the expectant mother, the Consultant in this specialty is in a position to\noffer assistance to local services to help them evaluate the various activities being carried\nout in this field of work. She guides the development of new services within the framework of the generalized public health service. During the year a number of districts\ncommenced \" parentcraft classes \" for the first time. The Consultant assisted with the\npreparation of technical material for mothers' classes, child health conferences, and\nhome-visits.\nThe Assistant Director of Public Health Nursing has specialized in the field of public\nhealth economics. She is particularly interested in the nursing aspects of medical-care\nprogrammes. She was able to render valuable assistance in analysing the home-care\npilot study in operation in the North Okanagan Health Unit at Vernon. Recommendations were made to increase the effectiveness of this plan in order to meet the needs of\nthe community more adequately.\nSpecial assistance is available to the Public Health Nursing staff in the field of tuberculosis through the Public Health Nursing Co-ordinator assigned to the Division of Tuberculosis Control, Vancouver. On request, through the Bureau of Local Health Services,\narrangements may be made for a field-visit.\nThrough the senior epidemiology worker at the Division of Venereal Disease Control,\nassistance is available to the Bureau of Local Health Services to guide the field staff in\nthe development of the public health nursing aspects of the venereal-disease programme.\nLOCAL PUBLIC HEALTH NURSING SERVICE\nBecause the scope of the public health nurse is not always understood, the following\nhighlights may give some appreciation of the work of the public health nurse in the district.\nAn average public health nurse on the Provincial field staff in British Columbia serves\na population of about 5,000 people. Generally, she lives in a rural area in the largest\npopulation centre in her district and may travel within a radius of 20 to 90 miles to serve BB 42 BRITISH COLUMBIA\nthe people in the surrounding area. Although the public health nurse usually drives to\nthe various centres in her district, she sometimes finds it necessary to use other methods\nof transportation, such as train, chartered aeroplane or boat. This is necessary if she is\nto serve Interior points and scattered isolated communities on small islands and along the\nCoast.\nThe public health nurse supervises the health of about 1,000 school-children. They\nusually attend two large schools and eight or ten one- or two-room schools, which the\npublic health nurse visits on a regular schedule. She inspects those children not seen by\nthe doctor and visits in the children's homes to explain physical or behaviour difficulties\nto the parents. She assists the parents to obtain the care needed for the child. For\nexample, following preliminary tests at school, there may be indications that the child\nneeds further eye examination. If the parents are unable to pay for this examination and\nglasses, the public health nurse has the case referred to an agency which will arrange for\nthe necessary treatment and correction. At the school the public health nurse advises on\nlunch programmes and assists the teacher with her classroom instruction by providing\nher with the latest scientific health information and frequently with teaching aids, such\nas films, posters, and pamphlets. She watches over the environment and general sanitation of the school. She is for ever watchful of the development of communicable diseases\nand skin infections. She arranges for chest X-ray and immunization clinics as indicated.\nThe teacher is given assistance with first-aid procedures. During the year 68,143 school\npupils were examined by the public health nurses, while assistance was rendered to School\nHealth Inspectors with 31,060 medical examinations. A total of 47,371 conferences\nwas held with teachers, 43,824 with pupils, and 9,382 with parents. In all, 34,462\nvisits were made to homes by public health nurses, to interpret to parents health matters\npertaining to the school-child.\nEach public health nurse supervises about fifty persons with tuberculosis, their\nfamilies and contacts, and regularly arranges for chest X-rays for them with the travelling\nclinic. Depending upon local facilities, arrangements are made for chest X-ray surveys,\nusing the miniature X-ray units in local hospitals or the Mobile Chest X-ray Survey Unit.\nA total of 18,595 visits for supervision of tuberculosis cases and contacts was made.\nThe public health nurse organizes and attends about five child health conferences\nper month. During the year, child health conferences were used to the advantage of\n42,383 infants and 32,537 pre-school children. In addition, home-visits for infant supervision is an extensive part of the programme, particularly in those areas where a scattered\npopulation makes clinics impractical. A total of 31,256 infant-visits and 31,099 preschool visits were made to homes for general health supervision.\nHealth supervision is offered the expectant mother through home-visits and at\norganized classes in which the mother is given the opportunity of learning to prepare\nherself and her family for the new arrival. A total of 12,221 visits was made to expectant\nmothers, while 12,150 visits were made to the mother in the home within six weeks of\nthe birth of the baby.   Pre-natal clinics or classes showed an attendance of 895.\nThe public health nurse further assists in the communicable-disease control programme by organizing and operating immunization clinics at strategic areas throughout\nher district. There were 8,734 persons completing the series of injections for protection\nagainst whooping-cough, 12,593 for diphtheria, 11,942 for tetanus, 1,472 for typhoid,\nand 25,162 were vaccinated against smallpox, while 398 were given B.C.G. vaccination\nagainst tuberculosis.   In all, a total of 107,796 inoculations was given.\nSanitation, particularly in the home, diet, and general health practices are stressed\nby the public health nurses in dealing with adults. The public health nurses made 24,771\nvisits to adults.\nA modified home nursing-care programme is carried in most districts as the public\nhealth nursing service is the only community nursing service in rural areas.   The public DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 43\nhealth nurse renders nursing care in the home in an emergency and teaches someone in\nthe home to carry out routine care under her supervision. Demonstrations of nursing-care\nprocedures, the baby-baths, and preparation of the formula are part of the programme, as\nwell as short-term treatments and hypodermic injections. Kelowna, in the South Okanagan Health Unit, continues to carry a full bedside nursing programme, while at Vernon,\nin the North Okanagan Health Unit, a pilot study on home care offers a full bedside\nnursing service in a selected area. One nurse works half-time to assist in carrying out the\nnursing-care programme in the Saanich and South Vancouver Island Health Unit.\nHome-visiting is an important part of the service, as indicated by the 88,824 homes\nwhich were visited by the public health nurse during the year.\nThe activities of public health nursing have expanded as more facilities for diagnosis\nand treatment become available on the local level. There has been increased activity as\nthe result of cancer clinics, children's or.hopa.dic travelling clinics, child guidance clinics,\nand arthritis programmes. Therefore, it becomes necessary to modify the programme to\nmeet the changing needs in local areas.\nSERVICE ANALYSIS\nIn a constant effort to improve the quality of the public health nursing service so\nthat it is rendered in the most efficient and economical manner, a critical analysis of the\nservice should be made by statistical methods. This year the Public Health Nursing staff\nagain submitted studies showing the time spent on the various activities as well as details\nof their case-loads for analysis. In this way it is possible to determine how much time\nis being devoted to certain services and make changes to provide a more efficient service.\nAs a result of study of the case-loads of the various public health nurses, recommendations\nwere made for additional personnel or for rearrangement of service loads.\nTime studies submitted by 113 nurses in May, 1952, were analysed and compared\nwith the results of similar studies during the past four years. Table II shows the percentage of time spent on various activities as demonstrated by time studies during the\nfour-year period 1949-52, while Table III sets forth in detail the percentage of time spent\non home-visits and office activities.\nTable II. \u2014 Comparison of Time Spent by Public Health Nurses in Specified\nActivities as Indicated by Time Studies in 1949, 1950, 1951, and 1952\nActivity\nNov., 1949\nMay, 1950\nMay, 1951\nMay, 1952\n100.0\n17.4\n7.3\n18.1\n28.5\n6.1\n18.3\n3.7\n1.7\n4.2\n100.0\n17.2\n7.1\n17.3\n24.4\n5.2\n17.6\n4.4\n6.8\n9.8\n100.0\n16.1\n7.8\n20.11\n23.3\n6.1\n17.4\n6.1\n3.1\n6.4\n100.0\n18.1\n8 3\n20.4\nOffice, total   -\t\n22.0\n6.4\n17.6\nMeetings.  \u2014 \u2014\t\n3.7\n3.52\n7.4\n1 This includes 2.3 per cent spent on sickness survey.\n2 This includes 0.5 per cent spent on health classes. BB 44\nBRITISH COLUMBIA\nTable III.\u2014Breakdown of Amount of Time Spent in Home-visits and Office by\nPercentage of Total Time on Duty as Shown in Time Studies in 1949, 1950,\n1951, and 1952.\nActivity\n1949\n1950\n1951\n1952\nHome-visits\u2014\n0.5\n3.2\n1.0\n3.0\n3.1\n1.9\n1.7\n0.3\n2.4\n0.5\n3.4\n1.1\n3.0\n4.2\n1.9\n1.7\n0.2\n1.3\n0.5\n3.7\n1.4\n3.0\n4.2\n1.7\n2.0\n0.2\n3.4\n0.6\n4.8\nPostnatal\n1.6\n3.2\n4.3\nNursing care\t\n2.2\n2.0\n0.2\nOther                      \t\n1.5\nTotals   \t\n17.1\nO)\nC1)\nO)\n17.3\nC1)\nC1)\n20.1\n5.4\n2.1\n7.4\n20.4\nOffice\u2014\nClerical-professional\u2014\n6.0\n2.3\n7.7\nTotals\t\n15.1\n4.8\n8.6\n13.5\n5.8\n5.1\n14.9\n3.3\n5.1\n16.0\n3.4\n2.6\nTotals\n28.5\n24.4\n23.3\n22.0\n1 Data not available for these years.\nThe percentage of time spent in schools has increased appreciably over last year,\nwhile the percentage of time spent at child health conferences is continuing the gradual\nupward trend. The percentage of time spent on home-visits has increased, particularly\nwhen it is realized that 2 per cent of the figure 20.1 per cent shown in 1951 was devoted\nto sickness-survey visits, leaving 17.3 per cent on home-visits in connection with the\npublic health programme.   It is hoped that this favourable trend will continue.\nIt is noted that the amount of nursing care in the home has been gradually increasing,\nas shown in Table III. However, since the time studies were completed in May, 1952,\nthe streptomycin programme has been assumed by the public health nurses. This entails\ntwo injections per week to be given to certain tuberculosis patients living at home, over an\neight- to twelve-month period. This has increased the volume of nursing care considerably and has added a heavy load to the public health nurses, who are now giving an\naverage of 7.4 per cent of their time in excess of the regular working-day.\nCIVIL DEFENCE\nMiss M. Campbell, Assistant Director, Public Health Nursing, continued to serve on\nthe Advisory Committee on Civil Defence Nursing of the Registered Nurses' Association\nof British Columbia. She attended the Western Civil Defence Health Services' Regional\nConference at Regina in May and reported on the activities of nurses in civil defence in\nthis Province.\nIn December, 1951, an apportunity was offered to a limited number of registered\nnurses to attend an instructors' course in the Nursing Aspects of A.B.C. Warfare. Among\nthe group taking the course were eleven members of the Public Health Nursing staff.\nThese nurses subsequently taught the course to approximately 500 graduate nurses in\ntheir own districts.\nGENERAL\nPublic Health Nursing personnel from the Central Office have continued to act on\na number of Provincial committees. These include Red Cross Nursing, the Junior Red\nCross Crippled and Handicapped Fund, Sub-committee of the Nursing Curriculum, DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 45\nPublic Health Nursing, Labour Relations, and Educational Policy Committees of the\nRegistered Nurses' Association of British Columbia, and the Advisory Committee to the\nUniversity of British Columbia School of Nursing.\nVisitors included Miss Mona Wilson, Director, Public Health Nurses, from Prince\nEdward Island, and Miss M. Bathgate, Public Health Nursing Officer of the Ministry of\nHealth, London, England.\nThe year 1952 has seen the public health nursing programme expand and develop\nin a continuous effort to keep pace with current problems. In the future it is hoped that\nmore time will be available to assist with the growing volume of work in cancer-control,\ngeriatrics, arthritis, alcoholism, and drug addiction. Tribute should be paid to the public\nhealth nurses, who, in accepting the challenge of public health nursing have adapted themselves to changing conditions and carried out their duties in spite of many difficulties. BB 46 BRITISH COLUMBIA\nREPORT OF THE DIVISION OF ENVIRONMENTAL\nMANAGEMENT\nThomas H. Patterson, Director\nThis Division, recently formed within the Bureau of Local Health Services, is making\na report for the first time in the Annual Report of the Health Branch. It is therefore felt\nthat although the formation of the Division was announced in the 1951 Report, a further\nword of explanation of its scope should be included in this Report.\nIn 1948 a survey of the health services and facilities in British Columbia was carried\nout, and in the report of this survey it was recommended that an additional division be\nformed which would encompass not only several new services, but some of the established\nservices as well.\nOriginally it was the intention of the Health Branch to form a Division of Industrial\nHygiene to meet the growing need for a service that could deal with the many health\nproblems related to the occupations of people in the Province. However, as the time\napproached when the Health Branch found itself in a position to establish this service, the\nconcept of industrial hygiene was changing.\nThe trend was away from concentration on the problems of the worker in solely the\nplace of his employment. Specialists in the field of industrial hygiene were recognizing\nthe fact that it was not enough to deal with the individual adult at work, to the exclusion\nof all his other activities and interests. All the factors of his total environment at work,\nat home, and at play were equally important and needed to be taken into consideration.\nTo continue dealing with these factors in an unrelated and separate manner was to follow\nthe dangerous practice of over-specialization.\nRecognizing this trend, the Health Branch took steps to form a division which would\nhave responsibilities across the whole scope of adult health, dealing with nutrition, sanitation, occupational health, chronic care, rehabilitation, public safety, problems of addiction,\nand the development of civil-defence health services. In order to avoid the impression\nthat industrial hygiene alone would come within the division, the name of \" Environmental\nManagement\" was adopted.\nPrior to the formation of this new Division, two services were operating independently\nwithin the Bureau of Local Health Services. These services were those offered by the\nNutrition Consultants, Miss D. Noble and Miss L. Gadbois, and by the Chief Sanitary\nInspector, Mr. C. R. Stonehouse, and have now been included as sections of the Division\nof Environmental Management. They, therefore, are under the immediate direction of\na trained and experienced public health physician. The inclusion of these services in one\ndivision will serve to integrate or co-ordinate them to a greater degree.\nThe Nutrition Consultants, of which there are two, are responsible for providing\nconsultant service to public health personnel throughout the Province on all matters of\nnutrition as it relates to the public health programme. This includes the provision\nof technical information and recommendations as to methods of nutrition education and\ndirect assistance with local studies or projects. The Consultants also offer to evaluate\nthe local problems and findings which result from studies carried on in local nutrition\nprogrammes.\nThe Nutrition Consultants also provide a consultative service, at the request of\nhospital administrators and directors of other institutions, on all phases of institutional\nfood service related to the technical problems of nutrition and quantity food-handling.\nThe Consultants maintain contact with other Government departments and voluntary\nagencies whose programmes are related to the field of nutrition education. This assists\nthe Consultants to keep informed regarding new developments in this particular field.\nThe sanitation programme provides the consultative service of the Chief Sanitary\nInspector and deals with all matters related to environmental sanitation. DEPARTMENT OF HEALTH AND WELFARE, 1952\nBB 47\nThe field of sanitation is very broad, and new problems arise daily for the members\nof the field staff who are the Sanitary Inspectors in the health units throughout the\nProvince. The Chief Sanitary Inspector deals with requests for advice on all sanitation\nmatters. The questions which the Sanitary Inspector may receive concern sanitation of\nmilk production, dairies and farms, or the handling and distribution of milk in restaurants\nand private homes, the safety of public and private water-supplies, garbage-disposal\nsystems, food-handling in restaurants and other public eating-places, living conditions in industrial camps, tourist camps, and hotels, frozen-food locker plants, and\nslaughter-houses.\nThe Chief Sanitary Inspector is required to keep abreast of new developments in the\nfield of sanitation and to promote new approaches in dealing with sanitation problems,\nas well as being able to evaluate the present services being carried on in health units.\nHe is also required to maintain close contact with other Government departments which\nhave interests in food production, such as the Department of Agriculture, and through this\ncontact plan to co-ordinate the services of these department to operate for the benefit of\nall concerned.\nCivil Defence Health Services have been organized largely under the direction of the\nHealth Branch of the Department of Health and Welfare. This is the logical place for\nresponsibility in developing this service, as the Health Branch has representatives in\nthe persons of directors of health units, located strategically throughout the Province. The\nDeputy Minister of Health acts as an adviser to the Provincial Civil Defence office on all\nhealth matters, and it was therefore considered advisable that one medical officer in the\nHealth Branch should be made responsible for maintaining contact with the office of\nthe Provincial Civil Defence Co-ordinator. The Director of Environmental Management\nwas assigned this responsibility, and during the year a member of the Provincial Civil\nDefence staff was attached to the Health Branch for the purpose of assisting the Director\nof the Division of Environmental Management in dealing with the Civil Defence Health\nServices programme for the Province.\nThe Industrial Hygiene Service is at present very limited, for only the Director of\nEnvironmental Management has any special qualifications in this field. A few specific\nproblems concerning industry have, however, been referred to this Division during the\npast year, and limited steps have been taken to deal with the problems as they arise.\nHowever, this part of the programme will eventually be developed to provide a consultative as well as investigatory service to industry in dealing with all phases of the health\nof workers.\nIt is the intention of the Division, in developing this programme, to promote health\nservices, consisting of industrial nurses and physicians, on a full- and part-time basis for\nindustries already established and being established in British Columbia. It is realized\nthe Government cannot provide actual service of this nature, but it can materially assist\nby informing industry of the benefits of such services and of the type and quality of\nservices available or required.\nRehabilitation and care of the chronically ill are two problems which are now being\ndealt with on the basis of study and discussion by organizations and persons throughout\nthe Province of British Columbia who are interested. When definite plans are agreed upon\nto deal with these problems, they will be included in the programme of environmental\nmanagement.\nThe problems of alcoholism and drug addiction have also recently come under very\nactive consideration, and it is expected that early in 1953 definite steps will be taken to\ndeal with these matters.\nLastly, in co-operation with the Department of Public Works, the Civil Service\nCommission, and the Health Branch, a proposal has been made for the formation of an\nindustrial nursing service for the Provincial Government employees located in the Parlia- BB 48 BRITISH COLUMBIA\nment Buildings, Victoria. There is no doubt that the need for this service has been\nrecognized for some years, especially by the Health Branch, whose doctors and nurses\nhave been called upon from time to time to administer health and medical service to the\nemployees. Unfortunately, however, this assistance is not always available from members\nof the Health Branch at the time that it is required. The establishment of an industrial\nnursing service for Government employees would not only fill a definite need, but would\nalso serve as as an example to private industry of the value of establishing such services.\nA.   REPORT OF THE NUTRITION SERVICE\nThe year 1952 marks a decade since the establishment of a Nutrition Service with\nthe Provincial Department of Health. During this ten-year period there has been a steady\ngrowth in the variety and extent of nutrition consultant service provided. Numerous\nstudies of the variety of foods eaten by families in this Province have served to define more\nclearly common problems toward which the nutrition-education programme must be\ndirected. Every effort has been made to develop the consultative services and methods\nof nutrition education which have proven most effective in meeting these needs.\nConsultant Service to Local Public Health Personnel\nA review of activities during the past ten years reveals a steady increase in the amount\nand type of consultative services requested and provided to local public health personnel.\nThe service of the Nutrition Consultant in providing technical information and advice,\nassistance in studying food habits, and developing effective methods of education is\navailable to all members of the local health unit.\nThe Nutrition Consultants visited a number of health units during the year in order\nto meet with the staff and assist them in dealing with problems of their own area. Visits\nto health units were arranged to coincide with a regular staff meeting, where it is possible\nto review the latest information on nutrition and provide advice regarding local problems.\nDuring the additional time spent in health-unit areas, the Nutrition Consultant met with\nsocial workers to discuss food selection for low-income families and School Cafeteria\nCommittees, or other groups, as requested by the health-unit staff.\nRat-feeding Experiments\nAn important responsibility of the Nutrition Consultant is that of advising and\nassisting public health personnel in developing more effective methods of nutrition education. One of the most effective methods during 1952 has been the rat-feeding experiment.\nThese experiments were conducted in eighty-six schools outside of Greater Vancouver\nduring the year.\nThe rat-feeding projects are planned co-operatively by public health nurses and\nteachers as a school health project. Directions for conducting the experiments, arrangements for shipping and cages, and general guidance is provided from the Nutrition Service.\nDuring the first four weeks, one pair of rats is fed a variety of foods recommended in\nCanada's Food Rules, and the other pair receive such foods as soft drinks, white bread,\ncake, and candy. After about four weeks the difference in weight, appearance, and\ndisposition between the two pair of rats is readily noted by the children.\nTeachers and public health nurses were asked to assist in evaluating the effectiveness\nof the experiment by reporting on the results obtained in their area. Detailed reports\nwere received from all areas. A summary of the reports revealed that the rat-feeding\nproject stimulated a greater interest in the study of foods among the children in the\nclassroom. In most areas this interest was carried over to the parents in the community.\nThe majority of the experiments were displayed at Parent-Teacher meetings or during\nParents' Day at the school. In some areas the rats were used in exhibits in community\nstore windows.    Seventy-five per cent of the teachers and public health nurses reported DEPARTMENT OF HEALTH AND WELFARE, 1952\nBB 49\nthat there were definite indications of improvements in the children's diet as a result of\nthe experiment.\nThe rat-feeding experiments in British Columbia were possible only through the\nexcellent co-operation of the staff of the Animal Nutrition Laboratory at the University,\nwho showed a continual interest in the projects and have supplied all the rats required\nfor the experiments.\nDietary Studies\nDietary studies among school-children, another method of nutrition education, has\nproven effective in conjunction with the rat-feeding experiments. The studies are valuable\nin providing information about the food habits of the community and in directing attention\nto dietary deficiencies. The information provided from a dietary study serves in a tangible\nway to arouse interest and point out problems to parents and children.\nThe Nutrition Consultants assisted local health units with these studies by analysing\nthree-day food records of school-children in four areas of the Province during the year.\nThe results obtained from these studies were very similar to those found in sixteen\nother districts of the Province studied since the first survey of this type late in 1949. In\neach area it was found that the three chief deficiencies in the children's diet were milk, a\nVitamin D supplement, and foods rich in Vitamin C. It was also noted that the majority\nof the children consume liberal amounts of meat, bread, potatoes, and sweet foods, such\nas cake, candy, and soft drinks. In view of these findings it continues to be an important\nobjective of nutrition education in this Province to inform people of the need and value\nof milk, a Vitamin D supplement for children, foods rich in Vitamin C, and to encourage\nthem to include adequate amounts of these foods in their daily meals.\nOther Services\nAnother major problem related to nutrition is that of obesity, which is recognized as\none of the serious health hazards of to-day. The association of obesity with many serious\nphysical impairments and an increased death rate is evident from numerous studies. In\nview of this, considerable time was spent studying methods and compiling materials that\nwill assist public health personnel in their educational efforts to inform the public of the\ndangers of being overweight and the rational approach to lasting weight-control. Several\ndiscussions were held with a group of overweight people during the fall, and this provided\nan opportunity to study methods of assisting with weight-control. Further study and\nassistance in this field is planned for the coming year.\nConsiderable assistance regarding low-cost meal-planning was requested by local\nhealth and welfare personnel. The current prices of essential food items were studied,\nso that it was possible to offer practical suggestions regarding economical food-purchasing.\nAs new schools were constructed with lunchroom and kitchen facilities, there were\na number of requests for information on equipment requirements for lunch-supplement\nor complete-meal programmes, economical methods of preparing food at school, and\nlarge-quantity recipes. This type of information was compiled for public health personnel\nin several areas, and, when possible, schools wishing assistance were visited during trips to\nhealth units.\nConsultant Service to Hospitals and Institutions\nIn September arrangements were made, in co-operation with the British Columbia\nHospital Insurance Service, to extend the institutional consultant programme to include\nhospitals where information and advice concerning the food service is requested. To date\nthree hospitals have received this service, and a number of other hospitals have requested\na visit during the coming year. The assistance requested from hospitals concerned the\nreduction of food costs and improvement of the over-all food service.    The Nutrition BB 50 BRITISH COLUMBIA\nConsultants are working closely with representatives of the British Columbia Hospital\nInsurance Service in developing this consultant programme to hospitals.\nInstitutions which received a consultant service during the year include Oakalla\nPrison Farm, Young Offenders' Unit, New Haven, the British Columbia Cancer Institute,\nand the Marpole Infirmary.\nAt the request of the Warden, a comprehensive study was made of the food service\nat the main kitchen of Oakalla and the kitchens of the Women's Gaol and Young\nOffenders' Unit. As a result of the study, a number of recommendations concerning the\nkitchen layout and meal service in each of the three buildings were made in a report to\nthe Attorney-General's Department. The per capita food consumption was analysed for\nOakalla, Young Offenders' Unit, and New Haven. Where necessary, recommendations\nwere made concerning the reduction or increase of various groups of foods to improve\nthe general diet.\nA study was made at the Marpole Infirmary to assist in determining the number of\ntrained cooks and other kitchen staff required in that institution.\nCo-operative Activities with Other Departments and Organizations\nMonthly meetings were held with nutritionists from the University of British\nColumbia, Metropolitan Health Committee, the Vancouver School Board, Home Service\nDepartments, and other agencies to review programmes and work together on common\nproblems. One project of this group was the complete revision of the booklet \" Family\nMeals.\" Copies of the revised edition were distributed to health and welfare personnel,\nWomen's Institutes, teachers of home economics, and other key groups. Following this\ninitial distribution, requests for the booklet have been numerous, and there are many\nindications that the booklet is proving to be of practical assistance to families.\nA second project of the group was the compilation of a list of low-cost food\nallowances for various age-groups. This material was submitted to the Bureau of\nEconomics and Statistics for use in compiling the quarterly cost of food budget for various\nareas of British Columbia. The list was also useful in providing assistance to the Welfare\nBranch for studies relating to the cost of food for individuals and families.\nConsultant service was provided to the Department of Education regarding\nequipment requirements and kitchen layout for school cafeterias. Assistance was also\nprovided to the Home Economics Division of this Department relative to nutrition\neducation in home-economics courses. The Nutrition Consultant met with teachers of\nhome economics at Summer School to discuss nutrition-education methods.\nThe co-operation of the Junior Red Cross in organizing the sale of apples in a\nnumber of schools in the Province as a practical project in nutrition and dental-health\neducation is most commendable. Through arrangements of the Provincial director of this\norganization, local Junior Red Cross groups in all larger centres of the Province may now\ndevelop the apple-sales project in their school.\nThe objectives and activities of the public health nutrition programme were outlined\nin talks to public health nursing students at the University, student-nurses in hospitals,\nsocial workers, and teachers of home economics. Various phases of the nutrition\nprogramme were outlined in talks presented to the Canadian conventions of the Dietetic,\nPublic Health, and Home Economics Associations this year.\nB.   SANITARY INSPECTION SERVICES\nSanitary inspection is carried out by local health services in accordance with the\npolicies set by the local Union Board of Health and under the direction of the Medical\nHealth Officer. The Sanitary Inspectors' activities include the following: Inspection of\nall food-handling establishments; supervision of milk as delivered to the consumer;\ncollection of milk samples for bacteriological analysis and performance of field tests; DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 51\ninspection of housing, particularly industrial, tourist, and summer camps; inspection of\nschools; collection of water samples for chemical and bacteriological analysis and advice\non private and public water-supplies; inspection of plumbing installations and private\nsewage-disposal systems; advice on insects and rodent-control; and otherwise carry out\na programme of community sanitation under the direction of the Union Board of Health.\nThe Division of Environmental Management provides an advisory and consultive\nservice to the local Medical Health Officer and Sanitary Inspector. Local programmes are\nevaluated. The Director performs liaison duties with other Government departments and\nindustrial and trade organizations. He conducts special investigations in areas outside\nthe boundaries of established full-time local health services.\nFOOD-CONTROL\nMilk-control\nThe quality control and licensing of milk vendors is the responsibility of the\nmunicipalities under milk by-laws. The grading of the producers' premises, the health\nof animals, and the licensing of dairy plants is the function of the Department of Agriculture. The Health Branch continues to act as the liaison between these two bodies and\nto provide an advisory service on matters relating to bacterial quality and the control\nof the products as it is delivered to the consumer.\nRepeating the procedure used for the previous year, an evaluation of laboratory\nreports on samples of pasteurized milk from all points throughout the Province submitting\nsamples to the central laboratory leads to an interpretation that the bacterial quality of\npasteurized milk this year betters that of previous years. Allowable limits are 50,000\nbacteria per cubic centimetre. The average for this year is 13,000 per cubic centimetre,\ncompared to 22,000 per cubic centimetre for the previous year.\nAmongst the problems referred to this Division were the following:\u2014\n(1) An attempt to continue the export of milk to Alaska.\n(2) Proposals to fortify fresh fluid milk by the addition of vitamins.\n(3) The distribution of milk in packaged cartons, which in some cases would\nbe contrary to good milk-handling practices.\nThree municipal by-laws were reviewed prior to submission for the required approval\nof the Lieutenant-Governor in Council.\nThe co-operation which exists between the Department of Agriculture and the\nDepartment of Health and Welfare is reflected by the number of joint meetings which were\nheld, our attendance at the Dairy Branch Inspectors' meeting, and our participation in the\nUniversity Extension training course for dairy-plant workers conducted by the Dairy\nBranch.\nEating and Drinking Places\nThe low incidence of complaints in this category continues. Four complaints were\nreceived during the year. Two requests were received from the Liquor Control Board\nfor the examination of licensed premises.\nContinued improvement in eating- and drinking-place sanitation is attributed to\nfood-handling instruction classes, including food-handling techniques and the instruction\nof food-handlers in those diseases likely to be spread through improper food-handling\nmethods. Instructional classes for food-handlers have now replaced the former practice\nof physical examinations of persons employed in this industry. This Department informed\nlocal health services accordingly that emphasis should now be placed on food-handling\ninstruction.\nThe Peace River Health Unit presented an interesting survey on the inspection\nof eating-places, and in summary fifty-eight premises were placed in the following\ncategories:\u2014 BB 52 BRITISH COLUMBIA\n(1) Seven premises were awarded a perfect score on two semi-annually scored\ninspections.\n(2) Thirty premises showed improvement.\n(3) Thirteen new premises were scored only once.\n(4) Seven premises remained stationary, with no improvements noted.\n(5) One premises was scored as having retrogressed during the year.\nFrozen-food Locker Plants\nThe locker-plant industry is comparatively new, commencing in this Province in the\nlate 1930's, and has been of immense value in the field of food preservation, particularly\nto the rural dwellers during the war years. While the frozen-food locker plant has been\nof most value to the agricultural areas, it has nevertheless extended to the urban areas for\nthe convenience of quantity purchasers, hunting enthusiasts, and for quick-freezing service\nto the owners of home-freezing storage units.\nFacilities and services available to the public have been expanded by the recent\nadvent of frozen-food suppliers catering to the owners of home freezers. It is possible\nin the coming year that package-storage units may be installed in markets and groceterias.\nAt the request of the Frozen Food Locker Plant Association, regulations were passed\nin 1947 governing the construction and operation of frozen-food locker plants. These\nregulations primarily provided for the approval of plans of proposed construction, the\nprovision of equipment and sanitary facilities, the compulsory sharp freezing of food prior\nto storage, and the cutting and wrapping of meat by the plant operator. Since the passing\nof the regulations, and particularly during the past two years, there has been a hesitancy\nin some quarters to submit plans for the required approval. There have also been requests\nfor exemption from providing the required quick-freezing facilities and the cutting and\nwrapping requirement. During the year the regulations were more rigidly enforced due\nto requests for such enforcement from the Frozen Food Locker Plant Association, the\nDepartment of Agriculture, and the Game Commission. As a result of action taken, two\nplants have discontinued operations. Other plants with deficiencies instituted remedial\nmeasures.\nIn the Fraser Valley five health units pooled their inspection reports in the form of\na survey of the plants in that particular locality.\nPlans of four new premises were approved during the year.\nSlaughter-houses\nThere is an arrangement, on behalf of local health services, with the Department\nof Agriculture whereby, before the annual slaughter-house licence is issued by the\nRecorder of Brands, an applicant for a licence must submit an inspection certificate\ncompleted by the Medical Health Officer. This arrangement is in its third year of\noperation and has been an asset to local health services in improving slaughter-houses\nthroughout the Province.\nThe number of licences issued in 1951 dropped, compared to the number of licences\nissued in 1950, prior to the arrangement, indicating that poor or unsatisfactory premises\nfailed to obtain the required approval of the Medical Health Officer in 1951. In 1952\neighty-two licences were issued, compared to seventy-three in 1951, an increase of nine.\nFifteen of the 1952 licences were issued to new operators, indicating that seven of the\n1951 licence-holders either failed to qualify in the continuing improvement programme\nof slaughter-house construction and maintenance or that they decided to discontinue\noperations. Of the eighty-two licences issued in 1952, no less than nineteen of the\napplicants failed to enclose the Medical Health Officer's inspection certificate with the\napplication, although the certificate was requested at the time the application forms were\ndistributed. In all instances the licences were held in abeyance until the inspection\ncertificates were completed. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 53\nThe appreciation of the Health Branch is extended to the Department of Agriculture\nfor the co-operation given in this programme of slaughter-house improvements.\nMeat Inspection\nSeveral inquiries were made concerning the possibility of a Provincial meat-inspection\nservice. Again, as in previous years, such inquiries were relayed to the Department of\nAgriculture, as it is a matter related to veterinary services and diseases of animals. Until\nthe present, meat inspection was confined to Federal inspection of meat entering the\nProvince, the Federal inspection of animals slaughtered in the Province primarily intended\nfor export, and the inspection of meat by the City of Vancouver.\nExamples of interest in meat inspection are as follows:\u2014\n(1) An inquiry from the West Kootenay Health Unit on behalf of the local\nbutchers for inspection \" so that poor grade or diseased meat would not\nbe sold.\"\n(2) A letter from the secretary of the South Okanagan Union Board of Health\nstating in part that \" there is an immediate need of compulsory meat\ninspection, especially in the Okanagan Valley . . . that Provincial\nlegislation should be introduced as soon as possible.\"\n(3) A resolution by the Okanagan Valley Municipal Association requesting a\nmeat-inspection service for the protection of both the consumer and\nfarmer.\n(4) A resolution from the City of Kamloops \" unanimously endorsing the\nresolution of the Okanagan Valley Municipal Association.\"\nDuring the year the Cities of Penticton and Kelowna passed meat-inspection by-laws,\nproviding for the inspection of animals slaughtered within their municipal boundaries.\nConcern was expressed on the sale of non-inspected meat in the unorganized territory\nadjacent to these municipalities. The Municipality of Richmond passed a meat and fish\nby-law during the year.\nThe British Columbia Cattle Growers' Association expressed itself as being in favour\nof meat inspection.\nHorse-meat\nThe sale of this product gained momentum in 1951, continuing into 1952. However,\nthe quarantine restrictions imposed on meat imports to the Province during the year\ncurtailed this enterprise considerably, and no revival has occurred since the lifting of the\nquarantine restrictions.\nSanitary Inspection of Hospitals\nAs a result of inquiries from the Division of Consultation and Inspection of the\nHospital Insurance Service, a survey was conducted on food-handling and related sanitation practices in hospitals. The conclusions reached from this survey were discussed with\nthe Hospital Insurance Service, and the decision reached that local health services should\ncontinue their supervisory practices, thus relieving the Hospital Insurance Service of any\nnecessity of entering this field of activity. Any information desired by the Division of\nConsultation and Inspection could be obtained through the Department of Health and\nWelfare or the health-unit offices at any time it was desired.\nHousing\nIndustrial Camps\nThis phase of housing sanitation included the usual number of inquiries for copies of\nthe regulations, questions concerning the interpretation of the regulations, and complaints.\nThe Cariboo Health Unit, an area from which complaints have originated possibly in\ngreater number than any other area in the past, has reported as follows:  \" Several indus- BB 54 BRITISH COLUMBIA\ntrial developments, logging, lumber, and construction camps throughout the unit have\ndemonstrated first-class industrial sanitation. The companies have constructed their\ncamps with an eye to both health and comfort and have eliminated the ' roughing it' as\ncommonly associated with new developments.\"\nIn February, 1951, the Regulations Governing the Sanitary Control of Industrial\nCamps were amended to allow special permission to contractors to have trailer accommodation on construction projects. Three such permits were issued early in the year\nin connection with housing on the trans-mountain oil pipe-line, but were cancelled in\nAugust pursuant to unfavourable reports in respect to overcrowding by the use of\ndouble-tier bunks. By arrangement between the contractors on the project and the\nBuilding Trades Council, all double-tier bunks in trailer accommodation will cease\nJanuary 1st, 1953. A similar type of accommodation provided by the Department of\nPublic Works, to a limited extent, has also proved unpopular and has been discontinued.\nThe Aluminum Company of Canada project, the largest construction job in progress\nin the world to-day, was visited on separate occasions by the Director of the Division and\nChief Sanitary Inspector. The accommodations and other facilities were found to be well\nbeyond the preliminary construction stage, and in most places the accommodations were\nof a satisfactory quality or better, with but occasional minor deficiencies. At the time of\nthe visits approximately 1,050 men were employed on the Kitimat smelter and townsite\nproject, 1,200 on the Nechako Dam operation, and 3,000 on the Kemano power-house\nand transmission-line construction.\nFarm-labour Housing\nAn evaluation of housing in connection with the small-fruit growers in the Fraser\nValley, which was commenced by the Matsqui-Sumas-Abbotsford Public Health Service\nin 1951, continued into 1952. The evaluation was conducted in co-operation with the\nDominion-Provincial Emergency Farm Labour Committee, Director of Land Clearing\nand Extension, Department of Agriculture, and the Growers' Association. Earlier\nstandards for this seasonal type of housing were revised through joint meetings with the\nGrowers' Association and endorsed by that group. The revised standards were distributed\namongst the growers by the Department of Agriculture and were used as a guide for the\nSanitary Inspectors' inspections before and during the harvest season.\nAt the request of the Department of Agriculture, the housing of fruit-pickers in a\nsection of the Interior came under a cursory review during the harvest season, with the\nadded request from the Department of Agriculture that the matter be further reviewed in\n1953.\nSummer Camps\nThe endeavour to make as complete a coverage of summer camps as possible, as\nrequested by the Welfare Institutions Licensing Board, resulted in an increase in the\nnumber of inspections. Fifty-six camps were inspected this year, compared to forty-nine\nin 1951. The reports were reviewed and summarized, with the indication that compliance\nwith standards, prepared by this Department and endorsed by the Welfare Institutions\nLicensing Board and British Columbia Branch of the Canadian Camping Association,\nshowed improvements compared with the sanitary environment of 1951.\nSchool Sanitation\nThe Division of Environmental Management was stimulated by the School Medical\nInspectors to obtain a close liaison with the Department of Education. The School\nMedical Inspectors requested the privilege of reviewing school plans prior to construction\nand also asked that items of interest to them be inserted in the proposed manual on school DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 55\nrequirements contemplated by the Department of Education. The Division circularized\nthe School Medical Inspectors, inviting their individual suggestions and comments.\nIncluded amongst the items commented upon were fire protection, plumbing, heating,\ngrounds, buildings, classrooms, ventilation, health services, lunchrooms, sewage-disposal,\nlighting, water-supplies, toilets, and washrooms. These were tabulated and submitted to\nthe Department of Education.\nThe school environment C. 6 report form, introduced for use of School Medical\nInspectors in the school-year 1945-46, has been the official report form since that time,\nalthough there have been deviations by several School Medical Inspectors in submitting\na short supplemental form. This year 250 C. 6 reports were received, compared with 360\nin 1950-51, 295 in 1949-50, 334 in 1948-49, 421 in 1947-48, 411 in 1946-47, and\n371 in 1945-46. A complete compilation of the reports of each school-year was prepared\nfor a study by a committee on school environment appointed at the semi-annual meeting\nof health-unit directors and for discussion with the Department of Education.\nThe decided increase in the numbers of inquiries from the Department of Education\nin respect to school environment has reflected a closer liaison between the local school\nauthorities and the health-unit officers, particularly in the selection of school-sites,\nimproved water-supplies, improved sewage-disposal and food-handling facilities.\nPlumbing\nThe fact that the Provincial representative on the Technical Advisory Committee on\nPlumbing Services to the National Research Council is from the Health Branch has\nafforded us the opportunity of becoming most familiar with the proposed revisions to the\nRecommended National Plumbing Code. The first draft of the National Code was\ncircularized to the manufacturers, Plumbing Contractors' Association, municipal and\nProvincial departments of government during the year. It was possible to prepare concurrently a draft for the oft-requested Provincial Plumbing Code. It is therefore proposed\nthat a model municipal plumbing by-law, incorporating the technical features of the\nNational Code and proposed Provincial Code, be made available to municipalities which\nhave been inquiring for some years for such a model by-law. When the proposed\nProvincial Code and proposed model municipal by-law have been completed, the\nstandards will be uniform in all respects. It will be acceptable to the manufacturers\nof fixtures and supplies and to the British Columbia Branch of the National Association of Plumbing and Heating Contractors, and will require less restrictive plumbing\ninstallations than hitherto possible under existing standards or practices.\nGarbage and Refuse Disposal\nIt has been noted in reports of various Union Boards of Health that stricter policies\nwere advocated and implemented in disposal methods in order to minimize rodent\ninfestation and indiscriminate dumping of garbage and refuse. The tendency is to replace\nthe primitive method of dumping in ravines, etc., by that of trench and fill methods.\nFrom various unorganized communities, requests have come for Provincial assistance\nin the maintenance of disposal-grounds and institution of trench and fill practice.\nIn many municipalities as well as unorganized territory the usual arrangement to\nobtain disposal-sites is to have Crown land set aside for disposol purposes. It is the\nconcensus of interested executive bodies that regulatory control or specific standards be\ninvoked upon the land leased or reserved for garbage- and refuse-disposal purposes.\nPest-control\nMosquito-con trol\nRequests for assistance in control measures by way of grants from the Health Branch\nwere practically negligible during the year.   It has been recognized that the efforts toward BB 56 BRITISH COLUMBIA\nthe elimination of mosquitoes are best accomplished in local areas by local organizations.\nWhile health units are in a position to provide the necessary advice on eradication\nmeasures, both the Federal and Provincial Departments of Agriculture provide advisory\nservices in this field.\nRodent-control\nThe co-operation extended to the Department of National Health and Welfare by\nthe collection of ground-squirrels, marmots, and domestic rodents (rats) and their\nectoparasites and submission to the Laboratory of Hygiene continues.\nIn the collection of ground-squirrels and marmots the survey was confined to that\nparticular area in which evidence of plague was found in 1950.\nThe metropolitan area of Vancouver and the Victoria-Esquimalt Union Board of\nHealth both extended their rodent-control activity to the collection of specimens and\nsubmissions to the laboratory. With definite advantages to this local contribution to the\nsylvatic-plague programme, it is proposed that health units be equipped to do the dissection\nprocedures and macroscopic examinations, and thus augment the existing programme.\nGeneral Sanitation\nComplaints and inquiries in this category resulted in investigations or considerations\nwith respect to the following: Ventilation in an electric-welding shop; odours from pulp\nplants and in oil-refineries; sanitary facilities at beaches in unorganized territory; mill\nnoises allegedly contributing to ill-health; the sterilization measures employed in the\nmanufacture of upholstered articles and mattresses; use of approved or non-approved\nliquids in dry-cleaning processes; thermo-vaporizers for use in insect-control and other\nmatters of varying natures.\nC.   INDUSTRIAL HYGIENE\nEarly in the year a visit was made to the orchard areas of the Okanagan area to\ninitiate an investigation of hazards related to agricultural insecticide spraying procedures.\nIt was learned that large quantities of a very dangerous insecticide had been used during\nthe previous year, and that similar or large amounts of the same substance were expected\nto be used in 1952. Because this insecticide (Parathion) had proved so effective in\ncontrolling insect damage, and as there was no other insecticide capable of giving\nequivalent results, there was no practical possibility of preventing its use.\nWith the co-operation of representatives of the Provincial and National Departments\nof Agriculture and staff of the North and South Okanagan Health Units, steps were taken\nto emphasize the dangers of handling Parathion and educating operators regarding safety\nmeasures. However, several cases of Parathion poisoning did occur during the year's\nspraying operation, but fortunately no fatalities occurred among the patients.\nThis co-operative study resulted in the inclusion of a medical representative in the\nOkanagan Spray Committee deliberations held in October. Medical evidence of the\ntoxicity of Parathion and information regarding the availability of an effective but less\ntoxic alternative insecticide led to the exclusion of Parathion from the 1953 Spray\nCalendar.\nAn investigation was made of welding conditions existing on one of the special naval\nship-building projects in Vancouver. Several of the welders were experiencing considerable discomfort and some disability during this operation. The major cause of this\ncondition was related to the extreme difficulty encountered in providing adequate ventilation. Improvement has, however, resulted to the extent that the symptoms of illness\nare no longer being encountered on this project. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 57\nD.   CIVIL DEFENCE HEALTH SERVICES\nThese services continued to develop throughout the Province. The directors of\nhealth units were recognized by all the voluntary and professional health agencies in the\nProvince as the local Directors of Civil Defence Health Services, working in co-operation\nwith the regional and area Civil Defence Co-ordinators.\nFollowing the development of the Civil Defence Health Services Manual, the Civil\nDefence Health Services Planning Group of the Department of National Health and\nWelfare provided plans for civil-defence organization in hospitals. These plans or hospital\ndisaster-kits, as they are termed, were distributed to most of the key hospitals. This plan\nis quite detailed and requires considerable time to implement, however, several hospitals\nare making progress in this matter.\nTwenty-eight first-aid stations were located strategically throughout the Province,\nand the National Civil Defence Office provided each station with a large training-kit to be\nused by the volunteer members of each station. A word of explanation regarding the\nfirst-aid station might serve to demonstrate the magnitude of this step, in that a first-aid\nstation could be said to be similar to a military casualty-clearing station. The civil-\ndefence first-aid station consists of over 150 persons, including physicians, dentists, and\nnurses.\nThe inventory of hospital beds and emergency hospital facilities throughout the\nProvince was revised and brought up to date. A census of all available physicians, nurses,\nand technicians in British Columbia is also maintained.\nAlthough training in first aid is the direct responsibility of the Training Section of\nthe Provincial Civil Defence Office, it is also considered a health matter, as the greatest\ndemand for first-aid trained personnel will be made by the Civil Defence Health Services.\nBesides the regular first-aid training classes being carried on by the St. John Ambulance\nAssociation and the Red Cross, special civil-defence first-aid classes have been organized\nthroughout the Province, and large numbers of trainees are participating in these courses.\nA very progressive step has been taken by the Department of Education by the inclusion\nof first-aid training in the regular curriculum of the schools of British Columbia; therefore, large numbers of young people trained in first aid will soon be available to deal\nwith civil disaster as well as common emergencies.\nThe Health Branch, along with all other branches of Government in Victoria, is\norganizing to deal with any disaster that might strike the Parliament Buildings during\nworking-hours, and in that respect has appointed a Departmental Warden to work in\nco-operation with the Chief Civil Defence Warden for the Parliament Buildings. During\nthe past year twenty members of the Victoria staff of this Department have received the\nbasic civil-defence training being offered by the civil-defence organization of Victoria City.\nThree physicians in British Columbia received special training at an A.B.C. Warfare\nMedical Aspects Course offered at Camp Borden, Ont, by the National Office of Civil\nDefence during 1952. These physicians are an addition to those who had already\nreceived similar training during the previous year. It is hoped that eventually this type\nof training will be made available to a larger number of physicians in this Province.\nEighty-nine British Columbia nurses received special training in the nursing aspects\nof A.B.C. warfare to qualify themselves as instructors in this subject. Since receiving\nthis training, these instructors have held classes in their own localities throughout the\nProvince and have been responsible for extending this training to a very great number\nof nurses, preparing them for their participation in Civil Defence Health Services activities.\nUp to November of 1952 we were aware of 3,403 nurses who had received this training.\nAs a result of two meetings with civil-defence officials from Washington State, a plan\nof mutual aid has been developed between that State and the Province of British Columbia.\nAll the details of integrating the civil-defence services between the State and the Province BB 58 BRITISH COLUMBIA\nhave not been entirely worked out, but considerable progress has been made in this\nrespect.\nA Western Civil Defence Health Services Regional Conference was held in Regina,\nSask., in May of 1952, attended by representatives of Civil Defence Health Services from\nManitoba, Saskatchewan, Alberta, and British Columbia. The purpose of this meeting\nwas to discuss problems that had been encountered by the various Provinces in developing\nthese services and to make recommendations to the Department of National Health and\nWelfare in developing a uniform type of Civil Defence Health Services across the nation.\nThis type of meeting both in Canada and the United States has proved of great value in\nunderstanding the problems which arise in developing this type of service in which so few\npersons have the necessary experience.\nA Civil Defence Liaison Officer was appointed by the Office of the Provincial Civil\nDefence Co-ordinator and attached to the Health Branch to assist in the development\nof Provincial Civil Defence Health Services. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 59\nREPORT OF THE DIVISION OF PREVENTIVE DENTISTRY\nF. McCombie, Director\nThe primary purpose of the Division of Preventive Dentistry is to assist the people\nof this Province to improve their dental health by all and every means available.\nThis objective is not the sole prerogative of this Division. Also deeply concerned\nin such an endeavour are all those persons serving in the field of public health. Many of\nthese workers have for years appreciated the ill effects of dental disease, especially as it\naffects the children. Many members of the medical and teaching professions are also\naware of the urgent need for improvement in this regard and look for guidance as to how\nit may be attained. Workers in the field of social welfare have for many years appreciated\nthat improved facilities for dental care, especially for the children of parents in receipt\nof social assistance and those in the Industrial Schools, would be desirable. Some Boards\nof Trade and similar organizations, especially in the smaller and more remote rural\ncommunities, are deeply concerned about the lack of adequate facilities for dental treatment in their respective areas. Boards of School Trustees, who for many years in the\nmetropolitan areas pioneered in the provision of school dental services, are becoming\nincreasingly insistent that similar services be provided in the rural school districts.\nVoluntary organizations, such as Parent-Teacher Associations, Women's Institutes, and\nJunior Red Cross, have been and are to-day taking most active steps in the same\nendeavour; namely, to improve the dental health of the people, especially the children,\nof this Province.\nAlso, most interested in this endeavour are the senior members of the dental\nprofession and many of the far-thinking membership. They are deeply and sincerely\nconcerned about the dental ill-health of large segments of the population. They are\nindeed conscious of their responsibility to safeguard the dental health of the people by\nreason of the authority delegated to them by the \" Dentistry Act \" of this Province.\nIt therefore becomes the responsibility of this Division to correlate, to advise, and,\nin some cases, to stimulate all these groups so that their respective endeavours may\nproduce the best possible results. In addition, in some fields it is desirable that this\nDivision take direct action. To carry out these functions, this Division at all times keeps\nitself aware of the success and sometimes failure of action taken in this field in other\nProvinces of this country and in other countries of the world.\nDENTAL HEALTH OR DENTAL DISEASE\nThe optimum condition of the oral cavity is the presence of the natural dentition\nunmarred by the ravages of dental disease. The next choice, which regrettably too\nmany persons to-day accept as the ideal, is the condition in which dental disease has\noccurred but has been subsequently eliminated by successful treatment. The third still\nless desirable or efficient choice is the removal of the diseased natural dentition and\nthe provision of artificial substitutes.\nSome leading research-workers to-day claim that all dental disease is entirely\npreventable. Arguable though this statement may be, it is certain that preventive\nmeasures have now been proven which can and will reduce the incidence of dental disease\nto an insignificant fraction of that which is occurring to-day in this country and in this\nProvince.\nHowever, though this situation may be slowly improved in the years to come, and\nmaximum efforts must be devoted to this end, it is to be appreciated that to-day enormous\nsuffering is prevalent due to the widespread incidence of dental disease and the subsequent\ndental ill-health. In the routine duties of dental officers in health units during the past\nyear, again was noted the terrible extent of dental disease, even amongst the youngest\nchildren.   It was noted that the average 3-year-old already required three tooth surfaces BB 60 BRITISH COLUMBIA\nto be restored; the average 4- and 5-year-old, five to six tooth surfaces; the average\n6-year-old, seven to eight tooth surfaces; and the average 7-year-old, nine tooth surfaces\nneeded restoration so that those children could be made free of active dental disease.\nAt the rate preventable dental disease is presently occurring in this Province, only\napproximately one-third of the people can possibly at the present time receive adequate\ndental treatment. Therefore, it is nothing but realistic to appreciate at this time that\nto improve the dental health of the people of this Province, not only must every effort be\nmade to reduce the incidence of dental disease and the consequent need for treatment,\nbut also that the facilities for dental treatment, by properly and adequately trained\npersonnel, must be increased.\nPREVENTION\nHowever, the best possible state of dental health (the natural dentition free from\ndental disease) and the most economic solution to the provision of adequate dental-\ntreatment facilities are both attained by the prevention of dental disease. Therefore,\nfirstly will be reviewed the progress in this field which has been achieved during the\npast year.\nIt is without any doubt that the dissemination of knowledge as to how dental\ndisorders may be prevented will be most rapidly accomplished by the appointment within\nlocal health departments of full-time dentists who are especially well qualified in preventive and children's dentistry. It is pleasing, therefore, to be able to report that within\nGreater Vancouver, New Westminster, and Victoria all such appointments were filled\nat the commencement of the school-year 1952-53. Also, this year the Board of Trustees\nof the Powell River School District were successful in filling a similar appointment.\nIn addition, by means of a Federal health grant and additional grants-in-aid by this\nDepartment, a further clinic has been made possible in the Municipality of Burnaby.\nToward the end of the year, arrangements were completed for a dental clinic to be added\nto the Vancouver Health Centre for Children. This clinic will also provide dental care\nfor children under treatment by the Western Society for Rehabilitation.\nFor the first time it may be reported that at the commencement of the present\nschool-year all school dental services within this Province had adopted a preventive\nprogramme. Dental-health education and concentration of attention in restoring to\ndental health the younger children, especially pre-school, kindergarten, and Grade I, is\nnow universally adopted. To achieve this desirable state of affairs has required the\nwithdrawal of dental treatment by school dental services to children of older age-groups\nwhose parents are in receipt of social assistance. Responsibility for the provision of\ndental treatment for such children now rests squarely with welfare departments. However,\nin co-operation with officials of the Provincial Welfare Branch, proposals for the early\nintroduction of a service to meet the needs of this group have been prepared by this\nDivision.   It is hoped that authority will be possible for its inauguration at an early date.\nHowever, efforts to attract applications from suitably qualified dentists to fill\nappointments with local health units were not too successful during the year. In all, four\nresignations were accepted from dentists holding such appointments, all for varying\npersonal reasons. However, during the year two most suitable candidates have joined\nthe staff of this Division. They have first tried the field of private practice, and, though\ntherein successful, have made the change; their early resignation is therefore not anticipated. In addition, one of the most outstanding of the recruits to this Division during\n1951 proceeded this fall on bursary to postgraduate training in public health dentistry to\nqualify for a master's degree in public health. In all, whilst at the close of 1951 it was\npossible to record seven such appointments with local health units, at the close of 1952\nonly four of these appointments are filled. It is to be noted that during 1952, at the time\nthat this Division was endeavouring to attract recruits from the ranks of new graduates\nfrom the Dental Faculties, salaries were very significantly lower than those being offered DEPARTMENT OF HEALTH AND WELFARE, 1952\nBB 61\nby the Metropolitan Health Committee of Greater Vancouver. This situation has now\nchanged, and better recruitment from this group is hoped for in the coming year. Nevertheless, some thought has been given as to how the dentists of this Division with full-time\nappointments may serve to the maximum advantage and to making the duties as attractive\nand as satisfying as possible. With this in mind, two experiments are now in operation.\nIn one health unit an additional dentist has been engaged on a part-time basis to increase\nthe clinical dental services available in that area. In another health unit the full-time\ndental director is acting as dental consultant to an adjacent health unit. He will\nendeavour to encourage dental-health educational activities and to stimulate the coverage\nof the whole health unit by Community Dental Clinics for Younger Children, in which\nresident private dental practitioners are co-operating.\nHowever, during the school-year 1951-52 preventive dental services operated\ncontinuously in five health units, in which the service was provided to fourteen school\ndistricts, and during some months of the year in two other health units to an additional\nfive school districts. Seven hundred and fifty-two pre-school children were restored to\ndental health\u2014that is, received complete treatment\u2014and they, and in most cases a parent,\nwere instructed in the prevention of dental disease. One thousand five hundred and six\nGrade I pupils similarly benefited. In the five health units which operated continuously\nthroughout the year, 61 per cent of the Grade I enrolment requested the service and\na further 11 per cent made arrangements with their family dentist. Of those requesting\nthe service, 91 per cent received complete treatment. In all, in these Grade I classes\n67 per cent of the children were restored to dental health either by the family dentist or\nthe dental director of the health unit. The urgent need for this type of service was\nrevealed by the fact that of these children no less than 81 per cent had never before\nvisited a dentist. That the dental directors of these health units were truly most interested\nin preventing dental ill-health and saving both foundation and permanent teeth is shown\nby the fact that amongst the pre-school children, on an average, twenty-six tooth surfaces\nwere restored for every foundation tooth that was extracted, and for Grade I pupils\napproximately thirteen tooth surfaces were restored for every tooth extracted.\nTo improve further the standard of clinical service provided by dental offices with\nlocal health units, two further experiments are being undertaken. The routine diagnosis\nand early dental lesions by use of X-rays has long been accepted as desirable, especially\nin any programme of prevention. However, previously no dental X-ray equipment\nsufficiently transportable to be used in the outlying areas of a health unit as well as in\nthe central dental clinic had been seen by this Division. Such a unit has now been\ninspected, purchased, adapted for use with the transportable dental equipment of this\nDivision, and dispatched to a health unit for field trials. In addition, the lack of\ncompressed air and suction for operating the saliva ejector have been appreciated as\nitems regrettably not available when the dental operator was using the transportable\nequipment. A light-weight air-compressor which, by means of a simple adapter, it is\nclaimed, can meet both of these needs is similarly undergoing trials with another health\nunit.\nDuring the past year the number of community dental clinics for younger children\nwherein co-operate local resident dentists continued to increase. Six new clinics were\ninaugurated, bringing the present total to nineteen. Two of the largest programmes which\nhave commenced during the year have been in Prince Rupert and Dawson Creek. Tribute\nis sincerely paid to the lay committees sponsoring and organizing these clinics throughout\nthe Province. It is interesting to note that during the fiscal year 1951-52 no less than\n1,874 children were restored to dental health through these clinics.\nEducational Aids\nTo aid those providing preventive dental services, and indeed many others, to\naccentuate their teachings of how dental disease may to-day be prevented further, audio- BB 62 BRITISH COLUMBIA\nvisual educational aids have been provided. It is encouraging to note the increasing use\nof this material. For example, during the past year more than 15,000 persons viewed\ndental-health films which were made available by the central film library of this Branch.\nThis is an increase of over 50 per cent above the previous year. In addition, health units\nwith full-time preventive dental services have been provided with sets of six dental-health\nfilm-strips as an endeavour to encourage the use of this aid. Previously, of course, these\nfilm-strips were available, but it was necessary for a health unit to order the film-strip in\nadvance from the central film library.\nFurthermore, during the year was reviewed the most excellent dental-health\neducation material issued by the New Zealand Department of Health. Two of its film-\nstrips appeared to have excellent possibilities as additional items for this Division. The\nNew Zealand Department of Health has most generously offered to reprint copies modified\nfor use with the film-strip projectors used in this Province. In addition, the same\nDepartment most graciously gave permission for one of their dental-health posters\nto be reprinted for distribution within this Province.\nThroughout the year were received routinely copies of all pamphlets in this field,\nmade available by the Department of National Health and Welfare. It is, however, to be\nrecorded that the supply of this material is often unfortunately sporadic, which thereby\noften delays the meeting of requests submitted to this Branch and not infrequently makes\nit impossible to meet such requests in full.\nAs a further example of widespread sources of such material reviewed and made\navailable by this Division, it may also be noted that during the past year a very excellent\ndental-health pamphlet published by the Dental Board of the United Kingdom has been\ndistributed by this Branch.\nThe extensive programme of rat-feeding experiments carried out in the schools during\nthe past year is reported in detail in the report of the Nutrition Services of this Branch.\nHowever, this Division takes cognizance of the fact that this programme also provides a\nmost excellent means of dental-health education. It is to be explained that the \" poor \"\ndiet fed to the rats also is one which will encourage dental disease, whilst the \" good \" diet\nis equally favourable to the maximum degree of dental health.\nAlso, as a practical approach to changing the habits of children away from\ndecay-producing sweet beverages, two limited experiments were conducted with the sale\nof a 6-ounce container of vitaminized apple-juice. Its sale would appear to be assured\nby these experiments (if this item could be economically marketed at a competitive price).\nHowever, some doubt in this regard unfortunately exists at the present time.\nFluoridation\nUntil very recently the generally accepted and practical means of preventing dental\ndisease could only provide some hope that any widespread improvement in dental health\ncould only be anticipated in the years to come, after personal habits had changed\nsufficiently.\nHowever, during the past years this Division has constantly kept under review the\nrapidly accumulating evidence relating to the artificial fluoridation of communal water-\nsupplies which are naturally deficient in this regard. Therefore, during this year it became\nour carefully considered opinion that the evidence in favour of such procedures had\nadvanced to the degree when a change of policy by this Department should be considered.\nTherefore, the policy of this Department is now amended to read as follows:\u2014\n\" In communities where the artificial fluoridation of the public water-supplies could\nbe a practical procedure and the procedure has the full approval of the local health\nauthorities and others responsible for the communal health, and in the light of evidence\nnow available, local authorities are now strongly urged and recommended to adopt this\nprocedure, but having first submitted their plans for so doing to this Department for\napproval. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 63\n\" However, in so doing, this Department feels that it must be fully appreciated that\nthe evidence clearly shows that the fluoridation of water-supplies must be considered an\nadjunct to other existing methods of reducing dental decay and not a procedure to be\nadopted in lieu thereof.\n\" Furthermore, since any community undertaking fluoridation will be in a position to\nmake valuable contribution to the scientific data now available, and also in order to prove,\nin the years to come, to the citizens of the community the value of this procedure, it is\nstrongly recommended that the dental defects of at least representative samples of the\nchild population should be periodically recorded, beginning with a pre-fluoridation\nsurvey.\"\nThe importance of this means of prevention must be fully realized. This procedure,\nit is now believed, if used along with other preventive dental measures, offers for the first\ntime real hope that within the foreseeable future dental disease may be controlled to the\ndegree that dental treatment can be made available to all persons so needing.\nIt will be one of the major projects of this Division during the coming year to ensure\nthat there is available to public health personnel, members of the dental and medical\nprofessions, and other interested citizens various types of material accurately describing\nthe advantages of the first method so far discovered whereby one of the major dental\ndiseases may be successfully controlled other than by individual co-operation. It is to\nbe appreciated that no widespread action to fluoridate communal water-supplies may be\nanticipated immediately. Such will not be the case until sufficient people understand the\nadvantages and the entire absence of disadvantages of this procedure. To assist people\nto become aware of these facts, now undisputed by qualified research-workers in this\nfield, will be the object of this Division.\nJunior Red Cross\nFor their co-operation in practical dental-health education, and for their considerable\nand most productive efforts in this field, we would extend our congratulations to the Junior\nRed Cross of this Province. Largely, if not entirely, through the energetic work of the\nProvincial Director, Miss Margaret Palmer, a practical programme of dental-health\neducation is now being carried out in many of the schools of this Province by members\nof the Junior Red Cross. As a practical and positive approach to the dictum \" eat less\nsweet foods,\" apple sales in the school have been organized. Arrangements have been\nmade whereby apples in quantity have courteously been made available at lower than\nretail cost to local groups of Junior Red Cross in the Greater Vancouver and Vancouver\nIsland areas and, at the close of the year, to any such groups of the larger communities\nof the Province. It is hoped that as greater experience in the administration of this\nprogramme is attained that these facilities will be made available to every community\nthroughout the Province. It is to be realized that the sale of apples is not considered by\nJunior Red Cross as an end in itself, but as a positive approach and adjunct to dental-\nhealth education carried out concurrently.\nDENTAL PERSONNEL\nDuring 1952 in this Province the over-all ratio of population to dentists remained\nalmost identical to that of 1951; namely, one dentist to approximately 2,000 persons.\nAs at January 1st, 1952, the ratio in this Province was better than in any other Province\nin Canada. However, the considerable discrepancy between the ratio of dentists to\npopulation in the metropolitan areas compared to that existing in the rural areas became\neven more apparent after the 1951 Census of population. It is now revealed that within\nthe areas of Greater Vancouver, Victoria, and New Westminster there are located close\nto 400 dentists, who provide a ratio of one dentist to approximately 1,450 persons.   The BB 64 BRITISH COLUMBIA\nremainder of the Province\u2014that is, more than 50 per cent of the total population\u2014is\npresently served by only 176 dentists, providing a ratio of one dentist to approximately\n3,350 persons. However, some small encouragement may be taken from the fact that,\nthis year, of the twenty-two newly registered dentists, six located in the rural areas. Three\nyears ago, of the new dentists that year, one located outside the metropolitan area, and\nthe year previously, none. Nevertheless, it must be clearly understood that if the present\nmaldistribution is to be corrected, significantly more than 50 per cent of the dentists\nentering this Province to practise each year must be encouraged to locate outside the\nmetropolitan area.\nDental Hygienists\nAs an endeavour to increase the effectiveness of the present dental personnel within\nthis Province, rules and regulations for the licensing of dental hygienists were prepared\nby the College of Dental Surgeons of British Columbia, with the assistance of this Division,\nand subsequently approved by the Lieutenant-Governor in Council. However, it is to\nbe reported that this year only one dental hygienist has applied for registration. Nor is it\nanticipated that this auxiliary body will in any way assist the dentists of this Province\nsignificantly to increase their services to the people until additional facilities for the\ntraining of dental hygienists are established within Canada. At present, to provide for\nthe 5,000-odd Canadian dentists, only one school for training dental hygienists exists in\nCanada, and this plans each year to graduate only ten students. It is suggested that\nrightful consideration might well be given to the establishment of a school for training\nhygienists within the University of British Columbia, and possibly as a precursor to the\nDental Faculty.\nDental Faculty\nDuring the past year we are informed that the Senate of the University has given\nconsideration to the report of the committee it had previously established to investigate\nthe need for a Dental Faculty in this Province. It is understood that the President of the\nUniversity reports that the University is interested in the organization of a Faculty of\nDentistry and in the provision of graduates in dentistry to serve the people of this Province.\nAlthough the Unhjersity is still in the process of organizing a Medical Faculty, and because\nthere is some limited relationship between the work of these two faculties, it is recommended that action on the Faculty of Dentistry should be postponed until the Faculty of\nMedicine is fully established. It may also be recorded that the Council of the College of\nDental Surgeons of British Columbia and the British Columbia Dental Association are\ngiving active consideration as to how they may best assist in the early establishment of\nthe faculty.\nIt cannot be too strongly stressed that until a Dental Faculty is established within\nthis Province, needless suffering from dental disease will, of necessity, be the lot of many\nof the people and especially many of the children of this Province.\nDental Service to Persons in Receipt of Social Assistance\nDental services available to children of parents in receipt of social assistance has\nfor a long time been a subject of serious concern to this Division. During the year 1951\na report on this subject and a suggested programme were prepared. It would now appear\nthat with certain agreed minor clarifications the suggested programme is acceptable to\nofficials of the Welfare Branch presently responsible for advice in this field. It is hoped\nthat the implementation of this programme may be authorized at the earliest possible\ndate so that such children as are now restored to dental health by the school preventive\ndental services will not then lapse into subsequent gross dental ill-health through the\ninability of their parents at that time to meet the costs of dental treatment provided by\na private practitioner. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 65\nDental Services in Rural Areas\nAlthough, as revealed above, the number of dentists presently practising in the\nsmaller communities of this Province cannot in any way be considered as satisfactory,\nsome improvement in this regard can be noted during the past three years. The degree\nof improvement is, however, not such that activities in this field may be relaxed, but\nrather reveals that further and renewed activities and possibly fresh approaches to this\nproblem must be made.\nSets of transportable equipment during the year were forwarded to Merritt, Slocan\nCity, and Ganges so that dentists may now regularly visit these communities. In addition,\na further set of equipment is on permanent loan so that a dentist may visit Kitwanga,\nHazelton, and Usk. For visits of three to four weeks' duration further sets of transportable dental equipment have also been loaned to dentists visiting Tahsis, Greenwood, and\nEdgewater. In all the above cases the dentists agreed to co-operate at least part of the\ntime with Community Clinics for Younger Children, which were most successfully\narranged by local organizations.\nAlso as an endeavour to encourage dentists to reside in the rural areas, grants-in-\naid have been authorized this year to two dentists who are located in communities\npreviously without a resident dentist.\nBritish Columbia Dental Association\nAgain it is indeed pleasing to be able to report that throughout the year the closest\nliaison has been maintained with, and the fullest co-operation has been given by, the\nDental Public Health Committee of the British Columbia Dental Association. It is\nfurther a pleasure to record that as an indication of the high esteem that this Committee\nhas now earned across Canada, and due to the personal attributes of its Chairman, Dr.\nA. Poyntz was this year elected by the Board of Governors of the Canadian Association\nas Chairman of the Dental Public Health Committee of the National Association.\nSincere acknowledgment is also made of the co-operation of the editor of the British\nColumbia Dental Association News Bulletin and the Provincial editor of the Journal of\nthe Canadian Association, who have both assisted considerably in making known to the\ndental profession the activities of this Division and the facilities which it offers.\nTo encourage that dental treatment for children be provided by private dental practitioners to a greater degree, and that treatment be of the highest standards, the Vancouver\nand District Pasdodontia Study Club has worked extremely hard. To list all their\nactivities in this field would be a lengthy process. However, in addition to their activities\nin Vancouver, they have also conducted demonstrations in Victoria and in Penticton.\nIt is hoped that, in the year to come, arrangements will be completed for individuals of\nthis group to visit the more remote centres of the Province, therein also to encourage and\nassist the resident dentists in the practice of children's dentistry. For their co-operation\nin this and other fields, this Division records its sincerest apprecation.\nGENERAL\nThe object and purpose of this Division has been explained; namely, to endeavour\nto improve the dental health of the people of this Province.\nThe two major fields of activity during the past year have been described. In the\nfield of prevention the outstanding importance of the early fluoridation of water-supplies\nhas been drawn to your attention.\nTo increase the dental services available to people of this Province, it is heartening\nto note that a Dental Faculty within the University of British Columbia this year has been\naccepted in principle. It is to be fervently hoped that all possible assistance will be\nprovided so that its establishment may be made possible at the earliest practical date. BB 66 BRITISH COLUMBIA\nREPORT OF THE DIVISION OF PUBLIC HEALTH ENGINEERING\nR. Bowering, Director\nThe specialized field in public health, in which engineering principles and techniques\nbased upon biological data are employed in the practice of public health, constitutes the\nfield of public health engineering. It deals essentially with the control of the environment, with those modifications and protective and preventive measures that have been\nfound desirable or necessary for providing optimum conditions for health and well-being.\nThis involves a wide range of activity, as engineering methods can be useful in solving\nmany diverse problems in public health. The Division of Public Health Engineering\nfunctions as a part of the Bureau of Local Health Services, even though many of its\nactivities are on a Provincial rather than a local level or responsibility.\nThe industrialization that has been going on in British Columbia during the past\nyear, if continued, will create more and more public health engineering problems. Also\nthe expansion of the local health services has brought to light many public health problems\nwhich require engineering for their solution. It has not been possible to deal adequately\nwith all the problems that have come to light to date with existing personnel, and increasing difficulties in accomplishing all that should be done are anticipated if there is no\nincrease in staff and the expansion of the Province's industry and population continues.\nStaff changes during the year consisted of the return of Mr. R. Bowering to the\nposition of Director and the resignation of one public health engineer. The vacancy\ncreated by this resignation remained at the end of the year because of the lack of applications from suitable candidates for the position.\nWATER-SUPPLIES\nThe Division has the responsibility of reviewing plans for extensions, alterations, and\nconstruction of new waterworks systems.\nThe \" Health Act\" requires that all plans of new waterworks systems, alterations,\nand extensions to existing systems be submitted to the Health Branch for approval. One\nof the major duties of the Public Health Engineering Division is the review of these plans.\nA large amount of waterworks construction was carried on during the year. A total of\nthirty-three plans were approved in connection with waterworks construction. The\napproval of plans requires, in some cases, visits to the field and, in some cases, consultation with consulting engineers and municipal authorities.\nIn addition to the approval of plans, a large number of the waterworks plants in the\nProvince were visited for the purpose of checking on sanitary hazards and assisting generally in the improvement of waterworks systems.\nMany water-supply systems should be better protected from contamination than\nthey are present. Simple chlorination will provide reasonable protection in most cases.\nA number of water-supply systems have been equipped with suitable equipment during\nthe past ten years, and thus have the means of improving the bacterial quality of the water.\nChlorinating equipment requires maintenance and intelligent operation procedures in\norder to give satisfactory service. Unfortunately, in many cases these requirements are\nnot recognized, and, consequently, expensive equipment is often providing inferior service.\nImprovements in this situation could be obtained if more advice regarding the operation\nof equipment could be given to the operators and owners. In most cases the local\nSanitary Inspector does not have sufficient engineering knowledge to assist in this regard.\nAt present all these plants cannot be visited more frequently than once in two to three\nyears by qualified sanitary engineers.\nAlso, there are other problems in the maintenance and operation of a waterworks\nsystem which cause sanitary hazards. More frequent visits to the waterworks systems\nin the field would be of much value in overcoming these problems. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 67\nThe local health units are responsible for the regular frequent sampling of water\nfrom public water-supply systems. The Division of Laboratories performs the examinations of the samples. In this way a constant check is kept on the quality of water\nserved to the public of British Columbia.\nAt the close of the year there were no water systems in the Province to which fluoride\nwas being added. It is felt that during the coming year there will be some fluoridation\nplants installed in the Province. For all practical purposes there are no fluorides present\nin the natural water-supplies of British Columbia. A number of consultations were held\nwith waterworks operators and local water authorities regarding fluoridation, and in one\nor two instances estimates of the cost were prepared. Regulations for the control of\nfluoridation and other forms of water treatment are becoming more and more a necessity,\nand these will be prepared during the coming year.\nThe Division receives a number of inquiries each year concerning private water-\nsupplies. It is customary for the Division to refer the person inquiring to the local health\nunit. In many cases the local health unit refers to this Division technical problems that\narise in regard to private water-supplies. In addition, standards for well construction\nand treatment are provided to the local health units.\nSEWAGE-DISPOSAL\nThe \" Health Act \" requires that plans of all new sewerage construction be approved\nby the Minister of Health before construction may commence. During the year eleven\napprovals were given. In the case of the larger cities, such as Vancouver and Victoria,\nthe submission of plans of all extensions has not been insisted upon owing to the fact\nthat these cities have excellent engineering staffs, and owing also to the fact that the\nreview of plans from these larger cities would be too time-consuming. In the above\ncases the over-all schemes and standards have been approved. Also, where a new\noutfall is planned, or where any major change in the sewerage system is contemplated,\napproval is sought and given in the usual way.\nOne of the municipalities in the Province, the Municipality of Saanich, that has been\nunsewered even though highly urbanized in some areas had construction crews working\nthroughout the year on the building of their new sewerage system. By the end of the year\nsome of the homes in the municipality were connected.\nThe Vancouver and Districts Joint Sewerage and Drainage Board has been making\nstudies toward the ultimate disposal of sewage from Greater Vancouver. The present\ndevelopment of sewerage in Greater Vancouver has followed a report prepared about\nforty years ago. In view of the changes in standards, and in view also of the type of\ngrowth of Vancouver and surrounding municipalities, it has been felt that a new plan\nshould be formed to guide the sewerage programme for the coming years. A firm of\nconsulting engineers was employed to do this. Several conferences were held with the\nconsulting engineers and with members of the staff of the Vancouver and Districts Joint\nSewerage and Drainage Board in connection with the proposed master plan. This plan\nshould be finalized during 1953.\nAbout 55 per cent of the population of British Columbia is served by public sewerage\nsystems. There still are, however, a number of urban areas that are badly in need of\nsewerage systems.\nDuring the past year a number of villages in the northern part of the Province had\npreliminary plans of sewerage systems prepared by consulting engineers. These villages\nwere all visited, and the plans for the sewerage systems were reviewed in the field. One\nof the difficulties that the villages have is financing of sewers. Only three organized\nvillages in the Province have sewers.\nIn addition to the organized municipalities, there are a number of urbanized areas\nin the unorganized territory.    In some of these, nuisances are constantly arising because BB 68 BRITISH COLUMBIA\nof lack of sewers. While it is possible for these areas to provide sewerage systems for\nthemselves on a voluntary community basis, it is felt that some legislative machinery\nshould be prepared by which sewerage systems could be built and maintained without\nthe consent of the majority of the property-owners in the area in those cases where\nimproper sewage-disposal methods create a health hazard to adjoining communities.\nSTREAM-POLLUTION\nStream-pollution is caused by the discharge of municipal and industrial wastes into\nsurface waters. These discharges can have quite diverse effects on the quality of the\nreceiving body of water because of the extreme variations in the type and strength of the\nwaste and the quality and volume of the receiving bodies of water. The net result of\nsuch discharges, however, makes the water less desirable and less useful.\nThe extent of stream-pollution in the Province is not alarming at present as there\nare only a few instances where waste discharges have affected down-stream water uses.\nHowever, it is recognized by most that adequate controls should be established in order\nto prevent pollution rather than to wait until it becomes a problem and then try to\nreduce it.\nThe Health Branch has had general legislation for the control of municipal wastes\u2014\nsewage\u2014for a number of years. The control of pollution by sewage under this legislation\nhas not been perfect, but it has been possible to prevent the discharge of sewage from\naffecting communities in lower stretches of streams and rivers.\nA number of departments in addition to the Health Branch have legislation for the\ncontrol of industrial wastes. This legislation is of a very general nature, and is utilized\nby each department to protect its special interest. As these interests involve such diverse\nthings as fish, navigation, public water-supplies, and irrigation, it is not surprising that\ndifferent interpretations of the general Acts of legislation are made by each department.\nIn the administration of stream-pollution legislation, an effort is usually made to\nobtain the opinions of officials of all the departments which are interested in the specific\ndischarge before a decision is made. This seems the best possible arrangement under\nthe circumstances, but there are a number of disadvantages to it. These include:\n(1) The industries are advised of problems after they exist, and are thus not able to plan\nintelligently to prevent the problem; (2) the basic data necessary for a reasonable decision are seldom available, and no department has the technical staff able to spend much\ntime on such work; (3) individual decisions do not necessarily follow a pattern as there\nis no over-all policy for the Province; (4) the most restrictive recommendation is liable\nto be adopted by the group as there is no one person to decide on a relative value of the\nsuggested requirements. It is hoped that in the coming year a basis for a more reasonable administration of stream-pollution problems can be evolved by the interested departments so that these disadvantages can be eliminated.\nRepresentatives from the Division sat in on a number of conferences on individual\nstream-pollution problems during the year. Some progress was made, but because of the\ndifficulties already mentioned, the results were not too encouraging.\nA meeting of the Pacific Northwest Pollution Control Council was attended. This\nCouncil is a voluntary organization, made up of a representative from each State or\nProvince in the Pacific Northwest. The ideas obtained and the standards developed at\nsuch meetings should prove useful in improving stream-pollution control in the Province\nin future.\nSHELL-FISH\nThe administrative procedures for enforcing the shell-fish regulations have now\nbecome fairly well established. The inspection of shucking plants and handling procedures now come under the jurisdiction of the local health unit. Reports are made on\nuniform forms issued by this office.   The Department of National Health and Welfare DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 69\nalso has an interest in shell-fish control since they have to approve licences for export\npurposes. The Provincial regulations are such that any shell-fish produced in the Province in conformity with the regulations will automatically conform with the requirements\nof the Department of National Health and Welfare. A number of new shell-fish leases\nwere forwarded to this Division for approval. All of these were found to be in unpolluted\nareas and therefore approved. There still are some areas in the Province where shell-fish\ncannot be produced owing to local pollution. These areas include portions of Ladysmith\nHarbour, the tide-flats at the south end of Nanaimo Harbour, and the upper reaches of\nVictoria Harbour, including the Gorge and Portage Inlet.\nThe matter relating to shell-fish toxicity is still before us. It is felt that during 1953\nsome decision must be made with regard to keeping closed or reopening at least portions\nof the west coast of Vancouver Island for the taking of clams and mussels. Assaying of\nclams by the laboratory of the Department of National Health and Welfare in co-operation\nwith Federal and Provincial fisheries and health agencies was continued during 1952.\nIt was not possible to find any correlation between the seasons and the amount of toxicity.\nThis year's sampling and assaying were done in areas where the toxicity was known to\nbe high.\nTOURIST ACCOMMODATION\nThe Director of Public Health Engineering is one of the five members of the\nLicensing Authority for Tourist Accommodation. Inspection of tourist camps, auto\ncourts, etc., is done on the local level by local Sanitary Inspectors. The reports of the\nSanitary Inspectors are co-ordinated by this Division, and recommendations for or against\nlicensing are made to the British Columbia Government Travel Bureau. There are about\n1,300 licensed tourist camps in the Province at the present time, and the work done by the\nHealth Branch has had a considerable effect in producing a fairly high standard of tourist\naccommodation.    Eight licences were cancelled on health grounds in 1952.\nThe requirement for licensing of tourist accommodation has had an excellent effect\nin preventing nuisances. Where information has been received by a local Sanitary\nInspector that a tourist camp was to be built, he has been able to visit the owner and\nadvise him on his water-supply and sewage-disposal problems in many cases before\nconstruction commenced.\nGENERAL\nOne of the duties of the Division of Public Health Engineering is providing a consultative service to other divisions of the Health Branch and to the local health units on\nany matters dealing with engineering. This entails a considerable amount of work.\nDuring the year all of the health units except one were visited at least once. During these\nvisits the various problems requiring engineering for their solution are examined in the\nfield.\nConsultative services also require a considerable amount of office work. For\nexample, the seven frozen-food locker-plant plans that were approved during the year\nwere all carefully studied as to refrigeration requirements, etc., by this Division.\nThe Division has also played a part in civil-defence work. Two meetings were\nattended during the year for the purpose of arranging for the best use of public health\nengineers and Sanitary Inspectors in civil-defence work. This work will continue into\nthe next year.\nThe position of Chairman of the British Columbia Examining Board for the Sanitary Inspectors' examinations was again filled by this Division. This involved organizing\nthree days of examinations and marking a number of papers. Valuable assistance was\ngiven in this work by members of the Victoria City health department.\nSeveral meetings were attended in connection with the proposed new plumbing\nregulations. BB 70 BRITISH COLUMBIA\nThere is one field in which it is felt this Division should be active but finds it impossible owing to the lack of staff. This is in the preparation of at least preliminary plans\nwith cost estimates of building water-supply systems or sewerage systems in unorganized\nterritory. There are a number of unorganized communities in the Province where some\nnon-official agency, such as a Board of Trade, wishes to get information regarding the\nbuilding of a public water-supply system or a public sewerage system. In these cases\nthere are no local funds available for employing a consulting engineer to do the work that\nwould lead at least to an estimate. It is felt that the provision of such a service would lead\nto an increase in the number of sewerage systems in the Province.\nIt is anticipated that the industrial expansion that the Province has enjoyed during\nthe past year will continue. This will lead to more and more public health engineering\nproblems. If these problems are seen in advance and plans made for their reasonable\ncontrol, there is no reason why the environment during the expansion period should not\nbe improved rather than become a greater hazard to the public health. It is the intention\nof this Division to try to anticipate these requirements and the controls needed for the\nfuture so that proper recommendations may be made for the adoption by the Government\nof adequate regulations and programmes. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 71\nREPORT OF THE DIVISION OF VITAL STATISTICS\nJ. H. Doughty, Director\nThe two main functions of the Division have remained unchanged. These are\ndivided between (a) statutory duties and (b) statistical services. The former comprise\nthe administration of the \" Vital Statistics Act,\" the \" Marriage Act,\" the \" Change of\nName Act,\" and certain sections of the \" Wills Act.\" The latter consist of providing\nstatistical data regarding births, deaths, marriages, and other phases of the Division's\nactivities, and also of carrying out the statistical requirements of all the other divisions of\nthe Health Branch.\nIt is interesting to note that although the number of births recorded in 1952 remained\napproximately the same as the previous year, the number of birth certificates issued by the\nVictoria office increased quite sharply, reaching a peak during August. Birth certificates\nissued through the Victoria office numbered 32,360, as compared with 26,566 in 1951\nand 20,271 in 1950. There were 3,706 marriage certificates issued and 5,307 death\ncertificates. Revenue-producing searches numbered 30,138, while 19,179 non-revenue\nsearches were made, in addition to which 6,097 searches were made free of charge for\nother Government departments.\nThe revenue received by the Victoria office reached an all-time high with collections\nof $48,966, an increase of almost 10 per cent over the previous year, which in itself was\nthe peak year up to that time.\nREGISTRATION OF BIRTHS\nCurrent Registrations\nThe registration of births has attained a level at which it may be stated that there is\nvirtually no lack of recording, except in isolated cases in remote regions of the Province\nand with the Sons of Freedom sect of Doukhobors. In a very limited number of cases,\nmothers enter hospitals under assumed names for the births of illegitimate children and\nthen disappear before filing registrations.\nApplications were received from a small number of persons who requested that\nregistrations filed in a prior period be cancelled owing to fictitious information having\nbeen supplied originally. Investigations of each case showed than an ill-advised effort\nhad been made to protect the interests of an illegitimate child. In several cases the mother\nhad been unmarried at the birth of her child and attempted to conceal the truth of her\nplight by supplying a fictitious name as that of the child's father. In other instances,\nchildren were born to married women after a period of separation from their respective\nhusbands and yet the mother had falsely recorded the husband as being the child's father.\nThere was no indication that these actions were attempts at deliberate fraud for financial\nor other such reasons.\nSince a great deal of credit for complete and prompt registration of births is due to\nthe splendid co-operation of the medical profession and hospital staffs in supplying birth\nnotifications to the various district registrars, the appreciation of the Division is hereby\nexpressed to them for the services rendered.\nGratitude is also expressed to the Regional Director of the Department of National\nHealth and Welfare for assistance rendered in cases involving investigations.\nDelayed Registration of Birth\nThe bulk of applications for delayed registrations was again confined to persons\nborn before the year 1920, indicating there has been a much more thorough coverage of\nregistration during the last thirty years than existed before. BB 72 BRITISH COLUMBIA\nThe payment of Federal old-age security pensions and the lowering of the age-limit\nfor eligibility for Provincial old-age pensions has increased the number of applications\nfor birth registrations and for certification among this older age-group, and it is reasonable\nto believe that this increased demand will be sustained.\nThe Division continued to be active in its search for material which could be used\nfor supporting evidence in conjunction with applications for delayed registrations. As\na result, some important additions, in the form of baptismal records, were made.\nThe Division has continued to be guided by the Schedule of Minimum Standards of\nEvidence acceptable in the filing of delayed registrations of birth, which schedule was\nlaid down at the Dominion-Provincial Conference on Vital Statistics in 1944, and which\nis uniformly adhered to by all Provinces of Canada. In effect, this schedule requires that\nthe registrar have documentary proof of a good quality before he accepts an application\nfor a delayed registration. The necessity of good supporting proof is often not understood by the applicants, who, if they are the parents, feel that no one is in a better position\nthan they are themselves to assert that the birth did take place at the time and place stated.\nThe insistence of the registrar on adequate documentary proof is, of course, a most vital\nfactor, since the whole value of birth certificates as legal documents proving the facts\nstated thereon would be undermined if persons were permitted to file a registration at will.\nThe volume of delayed registrations received was somewhat higher than that for\nthe previous period, but it is reasonable to believe that this situation was caused by the\ndemand of actual and potential applicants for the new old-age security pension. It is\nexpected that the number of such registrations should soon commence to show a decrease\nas the recording for the period involved becomes reasonably complete.\nREGISTRATION OF DEATHS\nThe registration of deaths is likewise virtually complete, except in isolated localities\nof the Province. As with the other series of registrations, a system of cross-checking is\nused as a means of ensuring against loss of records during the period between their original\npreparation and the time of processing in the Division.\nOne gap in the recording of deaths stems from the inability of the Division to register\ndeaths when bodies are not recovered. Particularly does this apply to drownings, although\nother circumstances may cause destruction or loss of bodies. In such cases, proof of the\nfact of death is generally obtained by orders of presumption of death issued by the Court,\nbut a death registration cannot be made for such cases. While this procedure satisfies\nvarious requirements for proof of death, it does not provide for statistical information on\nthe cause of death.\nREGISTRATION OF MARRIAGES\nThe responsibility for registering a marriage rests with the person solemnizing the\nevent; namely, the officiating clergyman or Marriage Commissioner. This method of\nobtaining marriage registrations has proven very satisfactory over a period of many years\nand is the method generally used in other Provinces and countries.\nMarriage registers are provided free of charge to clergy and Marriage Commissioners.\nThese are returned to the Division periodically in order that they may be checked against\nthe indexes of registrations filed with the Division. If it is thus ascertained that an event\nhas been unrecorded, steps are promptly taken to obtain a registration.\nMarriage registrations are also checked to ensure that the marriage has been solemnized by a duly registered minister or clergyman, or Civil Marriage Commissioner, as\nrequired by the \" Marriage Act.\" Occasionally, marriages are discovered which, through\nignorance or inadvertence, have been performed by an unregistered clergyman. Where\npossible, steps are immediately taken to secure validation of the marriage. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 73\nDOCUMENTARY REVISION\nIt will be appreciated that there are many circumstances which may cause changes\nin the personal records of any individual. For example, when given names and (or)\nsurnames are changed, adoptions, or dissolutions of marriage are ordered by the Courts,\nerrors in information originally supplied are detected, etc., it becomes necessary to amend\nthe registrations involved in order that they may reflect accurate and up-to-date\ninformation.\nIn order to ensure that the number of future changes will be kept to a minimum, all\ncurrent registrations processed in the Division are carefully scrutinized to guard against\nobvious errors and omissions which might later cause hardship to the individual and\nadditional work in the central office in making amendments. It will be readily seen,\nhowever, that the accuracy of much of the information given on a registration can only\nbe checked by the informant or other members of the family.\nAll registrations which have been amended are immediately remicrofilmed and the\nindexes amended accordingly.\nADMINISTRATION OF THE \" MARRIAGE ACT \"\nApplications were made by four religious groups during the year for recognition\npursuant to the terms of the \" Marriage Act\" for registration of their ministers. Of\nthese, one group was granted recognition, one was refused, and the remaining two were\nin the process of completing documentation at the year's end.\nIn addition, inquiries were made by thirteen other groups, who were advised of the\nrequirements to be fulfilled before their ministers may solemnize marriage. There has not\nbeen a clear indication whether or not any of these groups will pursue the matter beyond\nthe first inquiry.\nOrders permitting remarriage, as required by section 47 of the \" Marriage Act,\"\nwere approved in fourteen cases.\nIn eight instances where marriages had been solemnized in good faith but the\nofficiant had been unregistered at the date of marriage, validations were ordered as provided in the \" Marriage Act.\"\nForm M. 1, Application for Registration of Minister or Clergyman, was revised in\na simplified form and placed in the field.\nADMINISTRATION OF SECTIONS 34 TO 40, INCLUSIVE,\nOF THE \" WILLS ACT \"\nNearly 15,000 notices showing the location of the last will of the respective testators\nhad been filed as at December 31st, 1952. Legislation requiring the Division to receive\nand file such notices was enacted in 1945. Although the response from the general public\nwas slow for the first several years, there has been a great increase in the number of\nnotices filed within the last few years. During 1952 there were 3,989 notice filed by\nthe Division, as compared with 2,700 in 1951, while 2,200 were received in 1950 and\nonly 1,500 in 1949.\nNotices are indexed as rapidly as received, so that searches made will include the\nmost recently filed documents.\nAs was envisioned at the commencement of this service, a problem is developing\nregarding a means of identification due to repetition of like names in the index. The\nDivision has attempted to overcome this by providing a form of notice which embodies\ncertain identifying personal particulars and encouraging its use. However, since there\nis no statutory obligation to furnish these details, many notices are received with very\nlimited identifying information. Ultimately, a portion of these will cause difficulty to the\nDivision and to the executors of estates in making positive identification of testators. BB 74 BRITISH COLUMBIA\nAlthough this is an undesirable situation, it appears that the remedy lies in some statutory\nchanges being made with respect to the preparation and submission of wills notices.\nREGISTRATION OF VITAL STATISTICS AMONGST THE INDIANS\nCurrent Registrations\nEfforts are continuing to be made to familiarize the Indian population with the value\nof accurate registration of vital statistics. It is apparent that the Indian Superintendents\nare doing much to encourage the practice of obtaining birth certificates for new-born\nchildren as well as for the older members of families. The laminated type of plastic\ncertificate is particularly serviceable to Indians as its durability withstands the rigours\nof the nomadic life followed by such a large group of these people.\nResults of policies formulated and carried out during the last several years have been\nvery gratifying, and it is reasonable to believe that registration of current births is virtually\ncomplete.   The recording of marriages is likewise satisfactory.\nThe registration of deaths still presents difficulties, due partly to lack of good transportation facilities in many areas settled by these people and by their indifference toward\nthis convention of the white man, from which they can see no immediate benefit. An\neducational campaign in this respect is being carried on with the various chiefs by the\nIndian Superintendents, who attempt to explain the true meaning and importance of\nregistration to them. Progress is slow, however, and in all probability many years will\nelapse before Indian death registration is quite satisfactory.\nDocumentary Revision\nThe project of checking, revising, and reindexing Indian registrations filed during\nthe period from 1917 to 1946, inclusive, was continued throughout the year.\nComparisons are made between original records within the Division and Indian\nAgency copies of the same documents. Where discrepancies are discovered, further\ninquiries are made and, when necessary, the registrations are corrected.\nOne hundred and thirty-one schools submitted reports for the 1951-52 term, of\nwhich eleven indicated that no Indian children were enrolled for the first time. A total\nof 1,197 pupils attended school for the first time, and records of these children showed\na high percentage of discrepancies. In many cases the information supplied by the\nparents to the schools was found to be inaccurate and amended accordingly in the school\nrecords. In other instances the submission of the report enabled errors to be traced in\nregistrations, and action has been taken to correct them.\nProgress on this project was unfortunately retarded due to several changes of the\npersonnel involved and to an unusual amount of minor sickness of the staff.\nDelayed Registrations\nSeveral important additions to verification material were obtained and have proven\nuseful in completing applications for delayed registrations.\nThe Indian Commissioner for British Columbia has made a determined effort,\nthrough his Superintendents, to clear up the known cases of unregistered births. As\na result, many registrations were completed and filed. Attention will continue to be\ndirected toward the elimination of this deficiency, which was largely caused by the registration of vital events of Indians being on a voluntary basis until 1943.\nREGISTRATION OF VITAL STATISTICS AMONGST THE DOUKHOBORS\nCurrent Registrations\nLittle difficulty was encountered in the attitude of most Doukhobors toward registration of births. However, the Sons of Freedom remained adamant in their refusal to file\nregistrations. DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 75\nIt appears that those Doukhobors who do not oppose registration are making use of\nthe facilities for the recording of vital events, while no effective means has thus far been\ndiscovered for obtaining registrations from those who denounce the practice of registration\non religious grounds.\nThe field representative carried on his activities until he voluntarily resigned near\nthe end of the year in favour of other employment. After making a careful study of the\nvalue of continuing such a service, it was considered that the gains which had been\nanticipated during the last several years had largely been achieved, and that it would be\nan opportune time to discontinue this appointment.\nExhibit at Nelson Fall Fair\nThrough the efforts of the Deputy District Registrar at Nelson, an interesting exhibit\non vital statistics was set up at the fall fair which was held in Nelson in September. The\nexhibit depicted by a series of posters some of the forms and certificates used by the\nDivision and explained the purposes of each. A brief illustration of the statistical services\nprovided by the Division was also included.\nThe experiment was unique in that it was the first exhibit of this type to be displayed\nat such a function in British Columbia. A good deal of public interest was aroused,\nparticularly centring on delayed registrations of birth, concerning which many inquiries\nwere received shortly after.\nEFFECT OF OLD-AGE SECURITY LEGISLATION\nAs had been anticipated, the introduction of this legislation has caused a noticeably\nhigher volume of certification than was experienced previously. Although direct verification of birth of each applicant is the primary object of most persons, the lack of a birth\nregistration usually leads to the more indirect method of proving age by information\nshown on marriage certificates, baptismal certificates, etc. There has therefore been\na heavier demand for certificates of this type than existed formerly.\nSURVEY OF DIVISION\nIn August the firm of Kellogg & Stevenson carried out a survey of the Division.\nThis included a review of the organization of the Division and personnel allocation, duties\nand responsibilities, routines and methods.\nGENERAL OFFICE PROCEDURES\nThis is the fourth year since the Division introduced a multi-part form for the\nprocessing of applications for certification with the minimum of delay. The combined\nform provides (a) the cash-register receipt, (_.) the reply to the applicant, (c) the working copy of the application for internal office use, (d) cross-index file, (e) suspense cash\nledger, and (\/) file copy recording all steps in the transaction. Several reprints of the\noriginal form have been made since its introduction, and slight changes have been made\nwith each print. A further reprint was made this year, embodying some additional\nrefinements aimed at an increased rate of production.\nA continual assessment is made of forms and procedures, with a view to maintaining\nand increasing efficiency. Apart from the form specifically outlined above, several others\nwere simplified and reprinted during the year.\nThe Division laboured under extremely serious conditions of overcrowding and poor\nfacilities for most of the year. This was caused by a tremendous increase in volume of\ncertification within the last ten years and the undertaking of additional duties and responsibilities, which in turn had necessitated some increase in staff. During that period there\nhad been no increase in office space.    However, during November certain changes were BB 76 BRITISH COLUMBIA\nmade which increased the amount of space available to the Division and provided some\nmeasure of improvement.\nThe year 1952 was a period of unprecedented changes of staff and absences due to\nillness. Several persons resigned or transferred in favour of more gainful employment.\nRecruitment of satisfactory replacements was exceedingly difficult. In most cases a\nperiod of several weeks elapsed between the date when the vacancy occurred and the\ndate when the successor reported for duty. Furthermore, several replacements in the\nlower-level positions proved unsatisfactory during their probationary period of employment and were dismissed. One member of the staff retired on superannuation in\nSeptember.\nThe frequency of minor illnesses considerably aggravated the problems created by\nstaff changes. There were many occasions during the year when the normal work-flow\nwas maintained under the utmost difficulties, which taxed the resourcefulness of the\nsenior staff. However, through the outstanding co-operation of the section heads, there\nwere only few periods when the issuance of certificates was delayed more than a day or so.\nMICROFILMING OF DOCUMENTS\nAll current registrations of births, deaths, marriages, and stillbirths were photographed on a weekly basis, the records for all previous years having been done in a prior\nperiod. Amendments to registrations, caused by adoptions, divorces, name changes, etc.,\nwere photographed currently, and the amended images spliced on to the appropriate rolls\nof film.\n(a) 250 complete files re change of name applications.\n(b) 8,000 files of adoption orders and supporting documents (1920 to 1951,\ninclusive).\n(c) 1,400 files of dissolution and nullity of marriage (1935 to 1951, inclusive).\n(d) 3,300 notices of change of name (1941 to 1951, inclusive).\n(e) Miscellaneous medical and institutional records concerning births.\nA separate project of photographing 806 large blue-prints of water and sewer\nsystems was carried out for the Division of Public Health Engineering.\nDISTRICT REGISTRARS' OFFICES AND INSPECTIONS\nChanges in Registration Districts\nWith the opening of the new Court-house in Courtenay, the Government Agency\nwas transferred from Cumberland to Courtenay. Accordingly, the Vital Statistics Registration Districts of Cumberland and Courtenay were redefined and consolidated into one\nregistration district, the Registration District of Courtenay. This change enabled the\nDivision to relieve the Royal Canadian Mounted Police detachment at Courtenay with\nthe appointment of a District Registrar and Marriage Commissioner, and to turn over the\nrecords to the Government Agency.\nThe Royal Canadian Mounted Police headquarters have continued to press their\nrequests to be relieved of vital-statistics duties in certain areas. Therefore, in addition\nto transferring the Courtenay office, five other district offices have been transferred from\npolice offices. These offices include Campbell River and Chemainus, which are now\nhandled by the Village and Municipal Clerks respectively; the Hope office, which has\nbeen transferred over to the local Stipendiary Magistrate and Coroner; and the Haney\noffice, which has been taken over by a private individual. Also, the office at Teslin,\nYukon Territory, was closed out and no replacement made as it is felt that the few\nregistrations received do not warrant the continuance of an appointment in that district.\nWith the opening of the Kitimat area, it was felt that a representative in that district\nwould be desirable.    Accordingly, the local Stipendiary Magistrate was appointed a DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 77\nDeputy District Registrar of Births, Deaths, and Marriages and a Marriage Commissioner\nfor the Registration District of Prince Rupert, with location of office at Kitimat.\nAs pointed out in the section on Registrations of Vital Statistics amongst the\nDoukhobors, the special Deputy District Registrar working amongst the Doukhobors in\nthe West Kootenay area resigned his position, effective October 31st, 1952. At the time\nof writing, a successor has not been appointed.\nINSPECTIONS\nThirty-two offices and sub-offices, covering Vancouver Island, Powell River,\nSquamish, Fraser Valley extending as far as Hope, and the Okanagan area extending to\nRevelstoke, were visited by the Inspector of Vital Statistics during the year.\nIn addition, instructional visits were made to seven Indian Agencies. Visits were\nalso made to the New Westminster, North Vancouver, and Vancouver offices.\nIn those offices where the duties were transferred from the Royal Canadian Mounted\nPolice\u2014namely, Campbell River, Hope, Chemainus, and Haney\u2014the Inspector was on\nhand to arrange the transfer of duties from the police officers and to instruct and familiarize the new incumbents with the various procedures, forms, etc., which a district office\nmust follow and use in order to operate in an efficient manner.\nA visit was also made to Nelson to close the office of the special Deputy District\nRegistrar for Doukhobors and to take inventory of that office.\nAt the close of the year there were ninety-one offices and sub-offices in seventy-one\nregistration districts, one less than the previous year because of the consolidation of the\nCourtenay and Cumberland Districts.\nThirty-seven of the offices are Government Agencies or Sub-Agencies, while\ntwenty-three of the offices are operated by Royal Canadian Mounted Police personnel.\nSix more offices are operated by Village or Municipal Clerks, nine offices by Provincial Government employees, and sixteen by private individuals, including merchants,\npostmasters, Stipendiary Magistrates, Game Wardens, and a Canadian Customs official.\nSTATISTICAL SERVICES\nThose services rendered by the Division in its capacity of statistical workshop for all\nvital and public health statistics continued throughout the year at a steady pace. Not only\nwere there numerous routine compilations of data, which became more extensive during\nthe course of the year, but there was also a wide range of requests for a variety of statistical\ndata, received not only from other Health Branch services, but from other Governmental\ndepartments, both Provincial and Federal, and the general public.\nThrough the use of funds made available under National health grants, it was\npossible for one member of the research section to proceed to the University of Minnesota for postgraduate work in biostatistics, and for another to attend a one-week institute\non public health statistics and administration held at the University of Michigan. The\nvalue of such postgraduate training in equipping the staff to meet the requirements of the\nexpanding public health services is very great.\nThe current year saw the completion, on the Provincial level, of the National\nSickness Survey, with the submission to the Department of National Health and Welfare\nof the data compiled by the enumerators and of a comprehensive report covering all\naspects of the survey in British Columbia. The survey was undertaken in 1950 as a joint\neffort between Federal and Provincial Health Departments. The data collected during\nthis survey are presently being tabulated at Ottawa, and the first analyses are anticipated\nin the near future. The statistics which will be forthcoming should prove to be a valuable\nsource of information and interest to all persons concerned with the health of the\npopulation. BB 78 BRITISH COLUMBIA\nThe first tabulations of the data reported on the revised Physician's Notice of a Live\nBirth or Stillbirth form, which was put into use in 1951, were made during the year.\nAlthough it is still too early to draw any conclusions from the analytical study of these\ntabulations, as the series builds up, much valuable information on the circumstances\nsurrounding births within this Province will be forthcoming. The information is also\nbeing used in connection with infant-mortality studies, and a punch-card has been drawn\nup and put into use which correlates information from the physician's notice, the birth\nregistration, and the death registration.\nEarly in the year the Division was requested by the Provincial Secretary's\nDepartment to review the existing record and statistical system in use in the Mental\nHealth Services, with a view to making recommendations which might lead to improvements in the processing and utilization of mental-health statistics. A preliminary survey\nwas carried out, and from the information gathered, a number of suggestions were made.\nIt was agreed that certain statistics should be transferred to punch-cards, to be processed\nby the Mechanical Tabulation Section of this Division. It is intended that the new\nservice, which is planned to commence by April, 1953, will provide not only the statistics\nrequired for the planning and operation of the expanding mental-health programme in\nthe Province, but will also supply that information required by the Dominion Bureau\nof Statistics in its compilation of institutional statistics on the national level.\nImportant changes were made in the system of notifiable-disease recording, with a\nview to making the statistics more readily available and of greater use. The work of this\nsection was heightened greatly during the year because of the serious poliomyelitis\nepidemic. A complete record was kept of every poliomyelitis case reported, and during\nthe height of the epidemic an up-to-the-minute picture of the situation was available at\nall times.\nMuch of the work of the statistical section is routine in nature, but this work covers\na wide range. Following is a listing of some of the routine activities carried out by the\nstatistical section:\u2014\nWeekly:\u2014 !\nStatistics on notifiable-disease incidence by health-unit areas.\nStatistics on notifiable-disease by age and sex.\nPoliomyelitis incidence by sex and location (during poliomyelitis season).\nMonthly:\u2014\nListing of cancer incidence for each health unit.\nListing of newly reported cases of tuberculosis.\nListing of newly reported cases of venereal disease.\nStatistical report of notifiable-disease incidence by health-unit areas.\nStatistical report of notifiable-disease incidence by age and sex for major cities\nin the Province.\nStatistical report and analyses of births, deaths, marriages, stillbirths, and other\nvital-statistic registrations.\nStatistical report and analyses of vital statistics for Greater Vancouver.\nStatistical report and analyses of vital statistics for Greater Victoria.\nStatistical report and analyses of venereal-disease incidence.\nQuarterly:\u2014\nStatistical summary of vital-statistics registration.\nStatistical summary of tuberculosis morbidity and mortality.\nStatistical summary of venereal-disease notifications.\nStatistical summary of venereal-disease contact investigation report.\nStatistical summary of tuberculosis and veneral-disease incidence by health-unit\nareas. DEPARTMENT OF HEALTH AND WELFARE, 1952\nBB 79\nAnnually:\u2014\nCompilation of annual reports on:\u2014\nVital statistics.\nInfant mortality.\nPhysician's Notice of Live Birth and Stillbirth.\nCompilation of statistical data for:\u2014\nAnnual Report of the Division of Tuberculosis Control.\nAnnual Report of the Division of Venereal Disease Control.\nAnnual Report of Medical Inspection of Schools.\nAnnual Report of Environmental Sanitation.\nAnnual Report of Food Consumption within Provincial Gaols.\nAnnual Report of Notifiable-disease Incidence.\nAnnual statistics on:\u2014\nPopulation, births, stillbirths, deaths, tuberculosis, and venereal disease for\neach health unit.\nREORGANIZATION OF RECORD SYSTEM IN DIVISION OF\nTUBERCULOSIS CONTROL\nIn 1948 the Division of Vital Statistics was requested by the Medical Director of the\nDivision of Tuberculosis Control to make a study of the tuberculosis record system.\nThe work was undertaken shortly thereafter and has been carried on largely by the\nVancouver office of the Division of Vital Statistics. When the project was planned, it\nwas organized as a survey to investigate changes which could be recommended in the\ntuberculosis record system to make it more effective. However, as the work progressed,\nit became apparent that this was a continuing project and could best be carried out with\nthe Vancouver office acting in an advisory capacity to the Division of Tuberculosis\nControl. The problem has three distinct phases: the completion of the individual\npatient's record, the actual record forms in use, and the statistics compiled from these\nrecords.\nOne of the first problems tackled was the manner of completion of the individual\npatient's record, and it was recommended by the Division of Vital Statistics in 1950 that\na trained medical-record librarian be attached to the Division of Tuberculosis Control to\nbe in charge of all records within the Division. This suggestion was implemented in\nSeptember of 1951, and since that time improvement has been noted in all the medical\nrecords. Much work still remains to be done in the supervision of the recording\nprocedures in the various units of the Division, and in the compilation of a manual of\ninstructions covering all the records in the Division.\nAt the time the survey was commenced, there were 156 different medical records in\nuse in the Division. Not all of these forms were in current use in every unit, but very few\nof them had been declared obsolete. With the appointment of the records librarian, these\nwere all reviewed in consultation with the statistician in the Vancouver office. Forty-two\nof the numbered tuberculosis records have now been declared obsolete. Eighteen new\nrecords have been added after consultation with the various medical and nursing staffs.\nThree new procedures have been established in connection with records. (1) All revisions or new records are being circularized through the various sections of the Division\nof Tuberculosis Control for comments and suggestions before they are finalized. Most of\nthe new records are being multilithed so that modifications can easily be made. These\nwill be reviewed for printing at regular intervals. (2) Each section has been supplied\nwith a register of all numbered record forms now in use in the Division of Tuberculosis\nControl. (3) All sections are estimating their record requirements for a six- or twelvemonth period, and the requisitions for these orders are checked through the Vancouver BB 80\nBRITISH COLUMBIA\noffice.   A consolidated order for the printing of records is now placed with the Queen's\nPrinter at one time instead of more frequent individual requisitions as in the past.\nThe statistics being compiled for the Division of Tuberculosis Control have been\nunder critical discussion several times. The annual statistical report of the Division has\nbeen reviewed, and, as a result, certain tables have been deleted in the light of changed\nprocedures, some tables have been added, and certain other tables have been redesigned\nin the interests of simplicity and clarity. However, the general subject-matter covered by\nthe statistical report has not been materially altered. It is the feeling of both the Division\nof Vital Statistics and the Division of Tuberculosis Control that greater use might still be\nmade of the statistical material which is gathered within these Divisions. In view of this,\nit was recommended that a Medical Record Committee, consisting mainly of medical\npersonnel, be appointed on a permanent basis. This Committee has been appointed and\nis available to the medical-records librarian and to the Division of Vital Statistics in an\nadvisory capacity in connection with technical problems of the record system. The\nappointment of this Committee is considered to be of major importance in further\ndeveloping the record system in the Division of Tuberculosis Control, and should result\nin better planning and utilization of statistics on tuberculosis in this Province than has\nbeen possible in the past.\nCANCER REGISTRY\nCancer was made a notifiable disease in this Province at the request of the medical\nprofession in 1932, and since that time it has been the responsibility of this Division to\npromote and establish the complete reporting of this disease. The purpose of this\nreporting is to make possible the provision of up-to-date data on the cancer problem in\nthe Province, and to make these data available to the medical profession and other\nagencies interested in cancer. Although the term \" cancer \" is almost universally used\nby the layman to refer to any malignant growth, technically the term refers only to a\nspecific type of malignant growth. In order to remove any doubts which might result\nfrom inaccurate terminology, Form A-7, used for reporting cases of this disease, was\nrevised to read \" Report of Malignant Neoplasm \" instead of \" Report of Cancer \" as\nformerly.\nDuring 1952, 3,366 new cases of malignant growths were reported, of which 1,944\ncases were reported alive and 1,422 cases reported for the first time at death. The\nfollowing tables show the malignant neoplasms reported during 1952 classified according\nto site, age-group, and sex:\u2014\nTable I.\u2014Number and Percentage of New Cancer Notifications1\nby Site and Sex, British Columbia, 1952\nSite\nMale\nFemale\nTotal\nNumber\nPer Cent\nNumber\nPer Cent\nNumber\nPer Cent\n624\n191\n271\n1\n265\n126\n138\n42\n28\n13\n124\n34.2\n10.5\n14.9\n0.1\n14.5\n6.8\n7.6\n2.3\n1.5\n0.8\n6.8\n374\n338\n171\n374\n28\n54\n25\n34\n22\n10\n113\n24.1\n21.9\n11.1\n24.4\n1.8\n3.5\n1.6\n2.2\n1.4\n0.7\n7.3\n998\n529\n442\n375\n293\n180\n163\n76\n50\n23\n237\n29.6\n15.7\nSkin    \u2014       \t\n13.1\n11.2\nRespiratory system i \t\n8.7\n5.3\n4.9\nBrain and central nervous system \t\n2.3\n1.5\n0.7\n7.0\nTotals       \t\n1,823\n100.0\n1,543\n100.0\n3,366\n100.0\n1 Includes 1,422 cases reported for the first time at death. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 81\nTable II.\u2014Number and Percentage of Reported Live Cancer Cases\nby Site and Sex, British Columbia, 1952\nSite\nMale\nFemale\nTotal\nNumber\nPer Cent\nNumber\nPer Cent\nNumber\nPer Cent\nSkin      \t\n260\n109\n188\n1\n125\n79\n91\n11\n13\n8\n51\n27.8\n11.6\n20.1\n0.1\n13.4\n8.4\n9.7\n1.2\n1.4\n0.9\n5.4\n164\n258\n140\n311\n19\n38\n5\n18\n11\n5\n39\n16.3\n25.6\n13.9\n30.8\n1.9\n3.8\n0.5\n1.7\n1.1\n0.5\n3.9\n424\n367\n328\n312\n144\n117\n96\n29\n24\n13\n90\n21.8\n18.9\n16.9\n16.1\n7.4\n6.0\nRespiratory system. \t\nLymphosarcoma     \t\nBrain and central nervous system._\t\n4.9\n1.5\n1.2\n0.7\nOther and not stated\t\n4.6\nTotals              \t\n936\n100.0\n1,008\n100.0\n1,944\n100.0\nTable III.\u2014Cancer Notifications1 by Sex and Age-group, British Columbia,\n1952 (Age Specific Rates per 100,000 Population)\nMale\nFemale\nTotal\nAge-group\nNumber\nAge\nSpecific\nRate\nNumber\nAge\nSpecific\nRate\nNumber\nAge\nSpecific\nRate\n0- 9  \t\n12\n9\n29\n37\n99\n257\n524\n549\n248\n59\n10.0\n11.3\n35.0\n41.4\n125.3\n426.9\n888.1\n1,577.6\n2,883.7\n16\n9\n29\n94\n193\n268\n363\n383\n142\n46\n13.9\n11.6\n33.3\n98.5\n273.4\n493.6\n753.1\n1,372.8\n1,797.4\n28\n18\n58\n131\n292\n525\n887\n932\n390\n105\n11.9\n10-19.\t\n11.5\n20-29 \t\n34.1\n30-39   \t\n70.9\n40-49 \u201e     \t\n195.2\n50-59 \t\n60-69  ... .\n70-79\u2014. \u2014 \t\n458.5\n827.4\n1,486.4\n2,363.6\nTotals  \u2014 \u2014 \t\n1,823\n296.9\n1,543\n264.2\n3,366\n281.0\n1 Includes 1,422 cases reported for the first time at death.\nTable IV.\u2014Live Cancer Cases Reported by Sex and Age-group, British\nColumbia, 1952 (Age Specific Rates per 100,000 Population)\nMale\nFemale\nTotal\nAge-group\nNumber\nAge\nSpecific\nRate\nNumber\nAge\nSpecific\nRate\nNumber\nAge\nSpecific\nRate\n0- 9 _\t\n4\n7\n16\n21\n61\n137\n263\n263\n113\n51\n3.3\n8.8\n19.3\n23.5\n77.2\n227.6\n445.8\n755.7\n1,313.9\n5\n5\n25\n68\n153\n191\n236\n209\n73\n43\n4.3\n6.5\n28.7\n71.3\n216.7\n351.7\n489.6\n749.1\n924.1\n1\n9       !           3.8\n10-19\u2014    \t\n20-29    \t\n12\n41\n89\n214\n328\n499\n472\n186\n94\n7.6\n24.1\n30-39\t\n48.2\n40-49. .        \t\n50-59\t\n60-69 \t\n143.0\n286.5\n465.5\n752.8\n1,127.3\n936\n152.4\n1,008\n172.6\n1,944\n162 3 BB 82 BRITISH COLUMBIA\nTHE PEOPLE OF BRITISH COLUMBIA\nIn last year's Report, certain highlights from the preliminary reports of the 1951\nCensus of the population were commented upon and the remarkable population increase\nwas noted. The final census count for British Columbia placed the population at\n1,165,210 as at June 1st, 1951. Since that time there has been a continued increase, as\nevidenced by Family Allowance records, birth and death statistics, and other measures.\nWith the further analyses of the data derived from the 1951 Census of Canada, a clearer\npicture of the population structure in this Province is available, and it indicates that\nBritish Columbia has a population structure which, in some aspects, is considerably\ndifferent from that of the rest of Canada.\nA study of the age-grouping of the Province's inhabitants reveals that 53 per cent\nof the population is 30 years of age or over, compared to only 46 per cent in this age-\ngroup for all of Canada. On the same basis, the age-group 60 years and over constitutes\n16 per cent of the Provincial population and only 11 per cent of the Canadian.\nIn the last ten years there has been a marked increase in the population 60 years\nof age and over. This age-group has increased by 64 per cent, from 110,504 persons\nin 1941 to 181,674 in 1951. During this same period the Canadian population in this\nage-group rose only 36 per cent. The marked increase in this Province's proportion of\nolder population points up the fact that British Columbia may expect in the future an\nincrease in general mortality rates due to this ageing factor alone.\nBritish Columbia maintains a rather unique position in the nation's population\npicture with regard to the marital status of its inhabitants. Married persons account for\n50 per cent of the total population, the single-status group for 44 per cent, the remainder\nfalling into the widowed and divorced categories. By comparison, only 45 per cent of\nthe total Canadian population are married, while, on the other hand, 50 per cent are\nclassified as single.\nAlmost one-quarter of the nation's divorced persons are shown to reside in this\nmost westerly Province. This population is, on the average, three times greater in its\nproportion to the total population of the Province than is the case for the rest of Canada,\neither Provincially or Nationally.\nThe percentage of widowed persons within the population is practically constant\nthroughout Canada, being 5 per cent of the total population.\nIt is interesting to note that in 1951 the married group included a larger proportion\nof the population in both British Columbia and Canada than was the case a decade ago.\nAlthough the percentage of males has remained in approximately the same proportion\nin Canada between census years\u2014namely, 51 per cent\u2014that of this Province has\ndecreased from 53 per cent in 1941 to 51 per cent in 1951.\nThe spectacular growth in population experienced in British Columbia between the\ncensus years of 1941 and 1951 is of great consequence to those dedicated to the task of\nguarding the health and welfare of its people. Not only has the population increased\nby 42 per cent, from 818,000 in 1941 to over 1,165,000 in 1951, but also it has continued\nto age, and this has intensified many of the problems which must be met by the health\nand welfare agencies. The figures highlight not only the necessity of increased facilities\nfor health-care and preventive measures, but also give some indication of the changing\nemphasis which public health programmes must envision.\nMORTALITY AND THE AGEING POPULATION\nThere has been little change in the death rate in British Columbia over the past ten\nyears. The crude death rate per 1,000 population, excluding Indians, in 1952 was\nidentical with the figure of 9.8 recorded in 1942. Although there is no actual decrease,\nas evidenced by this rate, upon closer examination of the conditions under which such\ndeaths took place, it actually represents a much more dramatic improvement in the DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 83\nmortality experience of the population. During this ten-year period the number of older\npersons in the Province had been increasing faster than the total population. This ageing\nof the population tends to result in a higher death rate, since the specific death rate for\nthe older ages is naturally very high. For example, while the over-all death rate in 1952\nwas only 9.8 per 1,000 population, the group 60 years of age and over had a specific rate\nof 43.2 (that is, there were 43.2 deaths for every 1,000 persons in the population of the\ngroup 60 years of age and over). This group, with its relatively high death rate, has\nincreased in numbers by 64 per cent in the past ten years, whereas the total population\nhas increased only 42 per cent. The effect of this ageing can be demonstrated by computing what the over-all death rate would have been in 1952 if the population had had\nthe same proportions in each age-group as it had in 1942. Under such conditions there\nwould have been only 9,946 deaths in 1952, but actually 11,426 deaths did occur. Thus\nthe crude death rate would have been only 8.5 per 1,000 population, when in fact it was\n9.8, as previously stated, the difference between 8.5 and 9.8 being due solely to the ageing\nof the population.\nHad it not been for the remarkable improvements made in the death rate at virtually\nall ages during the past decade, the over-all death rate in 1952 would have been 11.3\nper 1,000 population instead of the 9.8 rate actually recorded. For example, the death\nrate in the population under 60 years of age was 4.3 ten years ago, whereas it was only\n3.5 per 1,000 population in 1952.\nThe three leading causes of death\u2014heart-disease, cancer, and vascular lesions of the\ncentral nervous system\u2014continue to exact the greatest toll of lives in British Columbia.\nThis year 64 per cent of all deaths occurring within the Province were due to these three\ncauses.\nDiseases of the heart accounted for 4,291 deaths in 1952, with a rate of 366.8 per\n100,000 population, an increase over the 1951 total of 4,053, with a rate of 355.8.\nAlmost 38 per cent of all deaths were attributable to heart-disease, 1 per cent more than\nlast year. Of the total deaths falling within this category, 85 per cent occurred in the\nage-group 60 years and over. This again points up the problem presented by the steady\naccretion to the population of older age-groups within the Province.\nCancer caused 1,824 deaths in 1952 with a rate of 155.9, an increase over the figures\nfor the last two years. In 1951 this disease claimed 1,718 lives with a rate of 150.8 per\n100,000 population, which was a decrease from the 1950 rate of 154.5. Once again the\ngreatest proportion of deaths from this cause occurred to persons 60 years of age and\nover, 71 per cent of all cancer deaths being attributable to persons in this age-group.\nDeaths from vascular lesions of the central nervous system, which, with the\nintroduction in 1950 of the Sixth Revision of the International Statistical Classification\nof Diseases, Injuries, and Causes of Death, has come into greater prominence as a leading\nfactor in mortality, maintained its position as the third leading cause of death. There\nwere 1,149 lives claimed by this cause in 1952, compared with 1,174 in both 1951 and\n1950, with corresponding rates per 100,000 population of 98.2, 103.1, and 105.9\nrespectively. Although a steady decline has been experienced over the last three years,\nit is here also that a very large proportion of deaths occurred in the older age-groups.\nDuring this year 87 per cent of the total deaths took place in the age-group 60 years and\nover, and 64 per cent, 70 years and over.\nThe mortality rate for accidents has shown only slight change this year over last.\nThe average for the ten-year period 1942-51 was 76.9 per 100,000 population, whereas\nin 1952 it was 75.6. The leading cause of accidental deaths was motor-vehicle accidents,\nwhich took 197 lives, a 12-per-cent reduction over 1951 when 223 lives were lost.\nAccidental falls came next, claiming 163 lives, with 59 per cent of these occurring in the\nage-group 70 years and over. The transport accidents, other than motor-vehicles,\nclimbed considerably this year to the third leading cause for accidental deaths, 118 in all. BB 84 BRITISH COLUMBIA\nSeveral bad aircraft accidents contributed greatly toward this rise. Ranking fourth were\ndrowning fatalities, of which there were 104. This is 7 more than in 1951. The three\nage-groups which accounted for 47 per cent of all accidents were 70 years of age and\nover, which featured in 19 per cent; the 20-29-year group, in 15 per cent; and the\n30-39-year group, in 13 per cent.\nA further dramatic decline in tuberculosis mortality occurred in British Columbia\nduring 1952. A comparison with the year 1942 shows a decline of 66 per cent in the\ndeath rate from this cause over the past ten years. In 1942 the death rate for tuberculosis\nin the non-Indian population was 45.9 per 100,000 population, whereas in 1952 it was\nonly 15.6.\nThe infant-mortality rate in the population excluding Indians showed a very slight\ndecrease this year over 1951, declining from 24.5 to 24.4 per 1,000 live births.\nThe birth rate decreased slightly from 23.5 per 1,000 population in 1951 to 23.1\nin 1952. The rate of maternal deaths per 1,000 live births remained constant this year\nat 0.6, thus retaining the spectacular improvement made during recent years. Only\ntwelve years ago, in 1940, the rate was 2.8 per 1,000 live births, or approximately five\ntimes greater than it presently stands.\nThe epidemic of poliomyelitis which swept the Province during the year has had, as\nwould be expected, a most adverse effect on the mortality experience from this disease.\nA total of 38 such deaths was recorded, with the rate per 100,000 population of 3.2.\nThese deaths were concentrated in the age-groups 0 to 14 and 20 to 49 years of age.\nDeaths in the younger age-group accounted for 63 per cent of the total deaths and the\nlatter for 37 per cent.\nAttention is directed to the fact that the numbers of deaths and the death rates\nreferred to in the foregoing paragraphs are preliminary only for the year 1952, and may\nbe revised slightly when final counts have been made and checked, and interprovincial\nadjustments have been made on a basis of residence.\nMORTALITY IN TERMS OF LIFE-YEARS LOST\nThe most commonly used measure of the severity of mortality from various causes\nis the crude death rate, which is merely a statement of the number of deaths which have\noccurred from each cause of every 100,000 persons in the population. Occasionally, for\ncomparative purposes, an age-adjusted rate is used, which eliminates the bias which\nresults when two populations being compared do not have identical age and sex composition. But neither of these measures takes into account the age at which the deaths occur.\nThus a death at age 70 counts just as much as one at age 10, yet few people would deny\nthat the death at age 10 is a much greater loss than the one at age 70.\nParticularly in public health, which is dedicated not to the prevention of death, but\nto the prevention of untimely or premature death, it is desirable to have a measure of the\nforce of mortality, which takes into account not only the number of deaths, but also the\nages at which those deaths occur. Such a measure has recently been evolved in several\nforms, and one computation is known as the \" life-years lost under age 70.\" It is a very\nsimple and straightforward measure. With the average life-span approaching 70 years,\nit is possible to subtract the age at death from 70 and say that the difference is years of\nlife lost. For example, if an individual dies at age 10, he loses 60 years of life; if he dies\nat age 55, he loses 15 years of life. For each cause of death these amounts are summated,\ngiving the total years of life lost through premature death.\nWhen the force of mortality is measured in terms of life-years lost under 70, the\nrelative importance of the various causes of death changes radically. The accompanying\ngraph shows the force of mortality from the more serious causes, first, when measured as\na percentage of total deaths and, second, when measured as a percentage of the total\nlife-years lost under age 70.   It can readily be seen that when only the number of deaths DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 85\nfrom the various causes are counted, the three most serious causes\u2014diseases of the heart,\ncancer, and vascular lesions of the central nervous system\u2014account for 37.6 per cent,\n16.0 per cent, and 10.1 per cent respectively of total mortality. However, in terms of\nlife-years lost, these three causes drop to third, fourth, and seventh places respectively,\nand accounted for only 13.5, 10.8, and 3.3 per cent of the loss of life through untimely\ndeaths. The importance of diseases of early infancy and of accidents in causing\nuntimely deaths also become startlingly apparent.   These two causes resulted in 19.5 and\n18.1 per cent of all life-years lost under 70, yet they constituted only 3.4 and 7.7 per cent\nrespectively of total deaths.\nThe foregoing discussion on mortality is presented because death rates constitute one\nimportant criterion of the health of the population. However, it is well recognized that\ndeath statistics alone do not purport to give a complete assessment of the health of the\npeople. Many diseases are of a long-term nature, and others result in varying degrees\nof permanent injury or disability, and the effect of these factors must be measured in\nother ways than through mortality statistics. BB 86\nBRITISH COLUMBIA\n\u2022SPECIFIED CAUSES OF MORTALITY SHOWN AS A PERCENTAGE OF TOTAL DEATHS\nAND AS A PERCENTAGE OF TOTAL LIFE YEARS LOST,  BRITISH COLUMBIA,   19S2.\nPER CENT OF TOTAL DEATHS\nI I\nDISEASES OF HEART\nCANCER\nVASCULAR LESIONS\nACCIDENTS\nRESPIRATORY\nDISEASES\nDISEASES OF EARLY\nINFANCY\nTUBERCULOSIS\nCONGENITAL\nMALFORMATIONS HI  1-4\n37.6\nDISEASES OF EARLY\nINFANCY\nACCIDENTS\nDISEASES OF HEART\nCANCER\nCONGENITAL\nMALFORMATIONS\nRESPIRATORY\nDISEASES\nVASCULAR LESIONS\nTUBERCULOSIS\nPER CENT OF TOTAL LIFE YEARS LOST*\n19.5\n*  Under age 70 0 5 10\n**  Includes Bronchitis, Influenza,  and Pneumonia\n20\nPER CENT DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 87\nREPORT OF THE DIVISION OF PUBLIC HEALTH EDUCATION\nR. H. Goodacre, Consultant\nAs a professional field of specialization in public health, health education is, of\ncourse, still in its infancy, suffering at times inevitably from growing-pains. And yet it has\nmade remarkable progress during its short life of a decade or so. An eclectic discipline,\nhealth education has been fortunate in being able to draw upon allied fields of education,\npsychology, sociology, advertising, and even propaganda (in its true sense) for its fundamental principles. Although the methods and aims of each field may differ, they\nnevertheless pertain basically to processes of learning and changes in behaviour, each\nmaking use of theories developed by the other.\nJust as advertising attempts to direct the consumers' thoughts and attitudes toward\nthe eventual purchase of a particular product, health education attempts to improve habits\nand attitudes of the people toward improving their health. Thus the goal and method of\nattaining that goal in advertising may differ from that in health education, but both are\nattempting to induce first the learning and then a change in behaviour.\nLOCAL HEALTH EDUCATORS\nHealth education is nothing new\u2014it has been done by mothers, teachers, and the\nfamily doctor for hundreds of years, and in public health by public health nurses, Sanitary\nInspectors, and health officers.\nThe term \" health educator \" may be confusing, for the health educator does the\neducating only indirectly. Because of his specialization in educational methods, the health\neducator is in a position to co-operate with other public health staff in making their health\neducation more effective. In essence, he is an enabler, a catalyst. The professional\nhealth educator is \" the man behind the man behind the gun,\" as it were.\nIn 1950 two health educators were placed in the field\u2014one to serve the Victoria-\nEsquimalt Health Department and Saanich and South Vancouver Island Health Unit,\nand the other to serve the Central Vancouver Island Health Unit.\nDuring this time their assistance in planning and co-ordinating programmes of health\neducation, in addition to their guidance on leadership to the staff and community on\nmatters concerning health education, has received rewarding acclaim.\nNo attempt is made by the Division to induce the placement of a health educator in\na health unit, since it is felt that first the request should originate from the staff of a unit,\nand, second, for the development of a successful programme, the health-unit staff must\nhave a good understanding of the functions of the local health educator and an earnest\ndesire to work with a specialist in this field. Throughout the year continuous attention has\nbeen given to explaining the functions of the local health educator through Local Health\nServices personnel.\nAt the present time, however, the Division has not been able to fulfil the requests\nmade by two health-unit directors last year to have a health educator attached to the staff\nof their units.   This is due largely to the inability to recruit suitable personnel.\nAs the situation now stands, there is only one health educator in the field, the other\nfrom the Victoria-Esquimalt Health Department having been granted a two-year leave of\nabsence to take a position at Sarawak, Borneo, with the World Health Organization.\nMATERIALS\nTo assist the field staff in their educational programmes, the Division maintains\ncentral libraries of films, film-strips, and books, in addition to supplies of posters and\npamphlets. BB 88 BRITISH COLUMBIA\nSince the dissemination of information alone is not considered to be health education,\nbut merely the first step in the educational process, constant efforts are being made to\nensure that field staff realize that films, film-strips, and pamphlets are aids in teaching and\nnot ends in themselves.\nTo further this end, catalogues of available materials are constantly being revised for\nthe guidance of the staff in the selection of appropriate materials. At the beginning of\nthe catalogue of films and film-strips now under complete revision will appear hints for\nthe most effective use of these media. During the year the film library was augmented to\ninclude 208 films and 143 film-strips. Requests for films continue to increase, with the\ngreatest demand for films on personal health, primarily dental health, with sanitation,\nnutrition, and mental health following in that order. Approximately 120 films have been\ndistributed each month, with a monthly audience varying from five to fifteen thousand.\nThe total audience for the year 1952 was slightly under 90,000 people.\nDuring the past six months it has become increasingly difficult to obtain the free\nliterature on which the Division has had to rely in order to enable the field staff to continue\neffective health-education programmes. This problem, common to several other Provinces, was discussed at a Federal-Provincial Conference for Health Education, called by\nthe Department of National Health and Welfare for the first time in three and one-half\nyears. Inasmuch as the majority of literature distributed in this Province originates from\nthe Information Services Division of the Department of National Health and Welfare, the\napparent budgetary problems existent with that organization are having a residual effect\nupon the present health-education programmes in British Columbia. It is quite possible\nthat this Division will be required to produce a portion of its own materials should there\nbe no improvement in the availability of material from free sources.\nAt this same Conference, held on November 13th, 14th, and 15th, the Federal\nGovernment's consideration of a move to charge for certain health pamphlets was\nunanimously opposed by the Provincial representatives. It was felt that the Federal\nGovernment should continue the practice of producing free literature, inasmuch as it is\ngenerally more economical for a central agency to produce materials en masse for\ndecentralized distribution.\nDuring the year this Division arranged for the production and printing of a nutrition\nbooklet entitled \" Family Meals,\" compiled by a group of British Columbia nutritionists\nand home economists, and a dental poster reprinted through the courtesy of the New\nZealand Department of Health.\nCONSULTATIVE SERVICE\nOne of the major functions of this Division is to provide, on request, consultative\nservice on matters concerning public health education to local public health services, to\nother divisions, and to other organizations.\nIn this connection, visits were made to a number of health units during the year to\ndiscuss with respective staffs their local programmes in health education and, in some\ncases, to assist in planning specific projects. It has not been possible to provide complete\nconsultative services to the field staff, since the shortage of Divisional staff has decreased\nthe opportunities for field-trips. Nevertheless, throughout the year, advice was given by\ncorrespondence to local health services on various phases of health education, including\nfall fairs, annual reports, planning talks and materials for co-operative play groups and\ndiscussion groups.\nAs in the past, requests from persons living in areas supplied with public health\nservice were referred to local public health staff. Where the request was of an unusual\nnature, the Division endeavoured to supply the local public health personnel with the\nnecessary information. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 89\nConsultative service to other divisions has been chiefly in the field of evaluation of\nmaterials suggested for distribution to the public. At the request of the Department of\nNational Health and Welfare, draft copies of a number of pamphlets, including a revised\nedition of The Canadian Mother and Child, were evaluated. In each case the comments\nof persons representing the various groups, both lay and professional, were obtained and\nsummarized.   A similar service was provided for divisions within the Provincial service.\nIN-SERVICE TRAINING\nAs in past years, the most extensive in-service training project during the year was\nthe Public Health Institute, held in Victoria from April 14th to 17th. The guest speaker,\nDr. Jennie Rowntree, Director of the School of Home Economics at the University of\nWashington, gave a series of lectures on nutrition in public health. Her talks were most\nvaluable in that they presented a practical and sound philosophy regarding nutrition\nteaching, which was of value to everyone in public health.\nA member of the Health Education Division acted on the Institute Planning\nCommittee. In addition, the Division prepared a display of library books available to\nthe field staff, which resulted in many requests for books on loan. The local health\neducator from the Central Vancouver Island Health Unit, who has prepared a large\nnumber of displays, arranged a group of her exhibits for the benefit of the field staff.\nIt has since been possible to arrange for the loan of some of these exhibits to other health\nunits. An evaluation of the Institute programme was again undertaken through the use\nof a questionnaire, designed by this Division. The results of the questionnaire were most\nvaluable in planning for the 1953 Public Health Institute, which will be held in Vancouver.\nThe orientation course for new members of the professional staff in the central office\nand for new health-unit directors was continued during the year. Orientation was\narranged for three health-unit directors, one dentist, one nutritionist, one statistician, one\nresearch assistant, and a civil-defence liaison officer.\nAlthough health-unit directors receive copies of the two public health journals\npublished by the American Public Health Association and the Canadian Public Health\nAssociation, both health officers and Sanitary Inspectors indicated a desire to see the\nother journals, for which they felt individual subscriptions were not warranted. As a\nresult of these requests, the Division has inaugurated a system by which selected medical\nand sanitation journals are circulated to medical officers and Sanitary Inspectors for their\nperusal and information.\nPUBLICATIONS AND PUBLICITY\nOne of the great problems facing the field of health education is the evaluation of\nmass media in education. Falling within the category of mass media is B.C.'s Health, the\nmonthly bulletin of the Health Branch, which is designed to inform the general public\non Provincial, local, and voluntary agencies' services, in addition to its function of\nproviding simple, sound advice with respect to different aspects of public health.\nEndeavouring to evaluate continually the effectiveness of this publication is the\nHealth Branch Public Relations Board, which, combined with its activities concerning\npublic relations and publicity of the Health Branch, guides both the content and approach\nof B.C.'s Health.\nOrganized in April by the Minister of Health and Welfare's public relations officer\nand members of this Division, the Board compiled during the year a written policy\ncovering the purpose, content, approach, and readership of B.C.'s Health, which is being\nfollowed now, not as a directive, but as a flexible guide. A valuable outcome of the\nBoard's discussions was the decision to extend distribution of this bulletin to the various\nhouse organs throughout the Province in order to reach ultimately a wider readership. BB 90\nBRITISH COLUMBIA\nSTAFF\nIn the area of recruiting, this Division is by no means alone in its difficulties.\nNevertheless, the problem will become acute if the desired expansion of service is to be\nrealized. In 1952 two of the staff resigned, including Mrs. Kay Beard, the Consultant,\nwho had been with the Division since its inception. It will be indeed a challenge to uphold\nthe reputation of the Division which Mrs. Beard acquired during her six years of valuable\nservice, both to the Health Branch and to the field of health education.\nIf the programme of the Division is to be extended, it will be necessary to augment\nthe present staff of three in the Division's central office and one in the field. To date\nthere has been a definite problem in recruiting suitable applicants, since potential candidates are obtaining positions in other fields, notably that of teaching, which, from a\nmonetary point of view, are more rewarding for the qualifications required.\nHealth education is a field in which results are not immediately apparent or\nmeasurable in dollars and cents. However, when the time arrives when salaries are\nsufficient to draw desirable applicants, the Division will be in a better position to work\ntoward its goal of a Province-wide programme of health education both in the schools\nand in the community. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB 91\nREPORT OF THE HEALTH BRANCH OFFICE, VANCOUVER AREA\nG. R. F. Elliot, Assistant Provincial Health Officer\nThis year has been an active one in all phases of the work of the Vancouver Area\noffice of the Health Branch, in charge of the Assistant Provincial Health Officer. The\nlatter is responsible for the Bureau of Special Preventive and Treatment Services, liaison\nwith voluntary health agencies in Vancouver, and the administration of the National\nhealth grants to British Columbia.\nThe Bureau of Special Preventive and Treatment Services includes the Divisions of\nLaboratories, Tuberculosis Control, and Venereal Disease Control. The Assistant\nProvincial Health Officer is primarily concerned with matters of policy respecting these\nDivisions, including co-ordination between these services, as well as between them and\nthe local health services. A detailed review of the work of each Division, which has been\nsubmitted by the Director, follows this report.\nThe work of the voluntary health agencies and the activities under the National\nhealth grants are reported herein.\nThe Vancouver office of the statistical section of the Division of Vital Statistics\ncontinues to operate in the same location as this office, and to be a most useful development. The use made of the Division of Vital Statistics, not only by the divisions of the\nBureau of Special Preventive and Treatment Services, but by the voluntary health\nagencies in the Vancouver area, continues to grow.\nBUILDINGS\nThe year 1952 saw the completion and opening of the first half of the Pearson\nTuberculosis Hospital, which houses 264 patients. This development has certainly done\nmuch to solve temporarily the problem of the shortage of hospital beds for patients\nsuffering from tuberculosis in this Province.\nPlans for the second building mentioned in the 1951 Report, however, did not\nprogress as had been hoped.\nSeveral times during 1952 it did appear that construction would be well under way\nbefore the end of the year, but circumstances beyond the control of this Bureau have\nprevented the commencement of this most important construction; in fact, all that can\nbe said is that the buildings housing the Divisions of Venereal Disease Control and\nLaboratories are merely one year older and in a much more decrepit and dangerous\ncondition. The remarks found in the 1951 Report are worthy of study to those seeking\nmore information regarding this deplorable and disgraceful situation.\nFACULTY OF MEDICINE, UNIVERSITY OF BRITISH COLUMBIA\nAn extremely close working relationship continues with the Dean of the Faculty of\nMedicine, University of British Columbia, and in particular with the heads of the\nDepartments of Pediatrics and Preventive Medicine. These two departments are of extreme importance in our expanding public health programme, and without this understanding and support, public health will not advance in this Province in the manner the people\ndeserve. This Province is fortunate in having physicians in charge of the Departments of\nPediatrics and Preventive Medicine at the University of British Columbia who are most\nunderstanding and co-operative in all the mutual health problems and programmes, both\npresent and future, that are an integral part of the Provincial Health Branch. This\nprogramme of co-operation and assistance between the Medical Faculty and the Health\nBranch is still expanding. BB 92 BRITISH COLUMBIA\nVOLUNTARY HEALTH AGENCIES\nThe voluntary health agencies located in the City of Vancouver which receive grants\nfrom the Provincial Government continue to receive close supervision, and once again it\nis felt that the programmes of these organizations are sound and the money invested in\nthem by the people of this Province, through the Provincial Government, is well spent.\nDuring 1952 this Province saw the development of two new voluntary health\nagencies; namely, the Multiple Sclerosis Society and the Cerebral Palsy Association.\nBoth agencies were urgently required. Not only was financial assistance given from\nNational health grants, but time was also spent by the Assistant Provincial Health Officer\nin discussing problems and programme-planning with the officials of these two newer\nagencies.\nThe activities of the British Columbia Cancer Foundation, the Western Society for\nRehabilitation, and the Canadian Arthritis and Rheumatism Society (British Columbia\nDivision) are outlined separately in this report. In general, however, the Assistant\nProvincial Health Officer has actively participated in the programme-planning of these\norganizations, and a most amicable relationship has existed. Budgets are reviewed with\ngreat care, and it is felt that economy is being practised in a reasonably satisfactory\nmanner.\nIn addition to these organizations, limited time was given to the Vancouver\nPreventorium, the Greater Vancouver Health League, and other similar organizations\nrelated to health matters in the Province of British Columbia.\nDuring the year frequent visits were made to all major hospitals in the Vancouver\nand Victoria areas on Departmental matters, such as the co-ordination of the Provincial\nBiopsy Service and requests for assistance from the National health grants.\nBritish Columbia Cancer Foundation\nThis organization, named as the agent of the Provincial Government for the\ntreatment and control of cancer in this Province, made forward strides in its programme.\nFunds are provided by the Cancer Control Grant of the National health grants and by\nthe Province of British Columbia on an equal basis to pay the operating expenses of the\nmain diagnostic and treatment centre, known as the \" British Columbia Cancer Institute,\"\nand the nursing home, both located in Vancouver, and of the consultative and diagnostic\nclinics located throughout the Province. These consultative clinics now operate at nine\ncentres in the Interior of the Province.\nThe diagnostic and treatment centre of the British Columbia Cancer Foundation\nwhich was opened last year at the Royal Jubilee Hospital in Victoria continues to provide\nfor a needed and expanding service.\nThe year 1952 was marked in October with the opening of the new clinic building\nat the British Columbia Cancer Institute. The clinic was built by voluntary funds and is\nadjacent to the Vancouver General Hospital. This treatment centre is second to none in\nCanada and houses the most modern radiotherapy equipment available, including the\nthird cobalt 60-beam therapy unit in the world.\nWestern Society for Rehabilitation\nThis voluntary health organization in the field of rehabilitation continued to expand.\nIt is interesting to note that during the year the name was changed to \" Western Society\nfor Rehabilitation,\" the term \" Physical\" being deleted. This procedure indicates the\nnature of the expanding facilities that are available here, since this centre actually is more\nand more encompassing all aspects of rehabilitation. The increasing responsibilities of\nthis agency during the year necessitated the appointment of an assistant medical director,\nan additional brace-maker, as well as other staff. DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 93\nThe outbreak of poliomyelitis which the Province experienced this year will bring\nadditional demands on this centre, since it is the only service in Western Canada which\noffers satisfactory rehabilitation services.\nThe Canadian Arthritis and Rheumatism Society continues to have its medical\nbranch housed at the Western Society for Rehabilitation, where treatment for arthritis\nis given on both an in-patient and out-patient basis.\nAt the present time it is quite apparent that more space is urgently required, and\nactive expansion plans are now under way. It is hoped that these plans will materialize,\nand, furthermore, that the majority of rehabilitation services for the Province will be\ncentralized here; in a field as highly specialized as rehabilitation, it is of paramount\nimportance that the skilled personnel, who are few in numbers, and the expensive\nequipment be centralized if our programme in rehabilitation is to advance to the full\nbenefit of the people of this Province.\nCanadian Arthritis and Rheumatism Society (British Columbia Division)\nFurther expansion has taken place during 1952 in this voluntary health agency\nlargely as the result of the demands of the local communities. There are at present seven\ndiagnostic and treatment clinics, located at Victoria, Nanaimo, Vernon, New Westminster,\nNorth Vancouver, and two in Vancouver, and from these clinics mobile physiotherapy\nservice is given to fourteen additional communities. There are also treatment-rooms\nand mobile physiotherapy services in eight other cities\u2014Kamloops, Salmon Arm, Penticton, Kelowna, Trail, Nelson, Cranbrook, and Mission\u2014and mobile physiotherapy\nservice from these cities is given to another fourteen communities, in four of which there\nare limited treatment-room facilities.\nThere are forty persons now serving this agency, including a medical director, two\nassistant medical directors, twenty-two full-time physiotherapists and one half-time, two\northopaedic nurses, and tv\/o social workers. A shortage of physiotherapists still exists\nand has delayed expansion somewhat.\nCIVIL DEFENCE\nThe heavy responsibilities that fell on this office in previous years relative to civil\ndefence were removed somewhat with the appointment of a medical officer in charge of\ncivil defence in the central office in Victoria. A fair amount of time is, however, still\ntaken up in lectures on A.B.C. warfare; the groups lectured are, in the main, the\nnursing-school at the Vancouver General Hospital and the Vancouver Civil Defence\nSchool.\nGENERAL\nDuring the year considerable time was spent by the Assistant Provincial Health\nOfficer as Vice-Chairman of the Council of Practical Nurses under the \" Practical Nurses\nAct \" passed in 1951. The matters which were discussed were primarily concerned with\nthe writing of the regulations under this Act. Early in 1953 it should be possible to have\nthese regulations passed and the actual operations of the Act brought under way.\nThe year was also marked by attention being paid to the increasing problem of drug\naddiction in this Province, which was originally brought under active discussion in 1952\nfollowing a report by the Health and Auxiliary Division of the Community Chest and\nCouncil, Vancouver. Drug addiction is not only a serious problem, but it is also a difficult\none due to the fact that no satisfactory solution can be brought about by any single\norganization. For example, both the Health and Welfare Branches of this Department,\nthe Mental Hospitals under the Provincial Secretary's Department, and the Attorney-\nGeneral's Department are all closely concerned in this problem at a Provincial level. BB 94 BRITISH COLUMBIA\nMany committees at the local, Provincial, and National level have been established\nregarding drug addiction, particularly as it pertains to this Province. It has also been\nactively discussed by the Deputy Minister of Health for this Province at the Dominion\nCouncil of Health. It appears at this time that all interested groups in British Columbia\nare co-operating in this most important problem, and that some progress toward at least\npossible solutions is being made.\nSeveral meetings were attended relative to the problem of alcoholism in this Province\nand particularly in the Vancouver area. The John Howard Society and other Vancouver\ngroups presented briefs to the Minister of Health and Welfare. It is felt that any positive\ndecision regarding future steps in this matter will likely await the findings of the Liquor\nInquiry Board which has been appointed by the Provincial Government to study all\naspects of the problem of alcohol.\nA satisfactory screening committee for admissions to the School for the Deaf and\nthe Blind, particularly related to the deaf child, was established and is functioning\nsmoothly, following discussions between the Department of Education, Greater Vancouver Metropolitan Health Services, interested specialists in this field in the Vancouver area,\nand the Health Branch, Department of Health and Welfare.\nDuring the year this Bureau saw the appointment of Dr. A. John Nelson as Director\nof the Division of Venereal Disease Control and consultant in epidemiology. Dr. Nelson\nworked very extensively not only in the field of outbreaks of intestinal disease, but more\nparticularly has been of great assistance during the recent summer when the number of\ncases of poliomyelitis rose to an all-time high. At this time special tribute should also\nbe paid to the Royal Canadian Air Force, who gave great assistance to this Branch in the\nevacuation of poliomyelitis cases from the various points in the Interior to the Vancouver\nGeneral Hospital.\nDuring the year three members of this Bureau participated in a series of in-service\ntraining lectures for the 1,600 transit operators of the British Columbia Electric Railway\nCompany on the Lower Mainland. The subject that was dealt with was \" Human Relations, Job Satisfaction, and Personal Well-being in the Transit Business.\" It was felt that\nit was not only most valuable to the British Columbia Electric Railway Company, but\nalso to the members of this Bureau.\nNATIONAL HEALTH GRANTS\nGeneral\nThe total amount of funds available to British Columbia for the fiscal year 1952-53\nis $4,417,957, excluding the Public Health Research Grant, which is allocated in Ottawa.\nThis represents an increase of $1,494,807, which is due almost entirely to an increase of\n$89,655 in the Mental Health Grant and an increase of $1,379,445 in the Hospital Construction Grant. The latter is the result largely of the inclusion of the unexpended portions of this grant for 1948-49 and 1949-50.\nAs it was found in September that the Professional Training Grant was almost completely allocated, an amount of $5,000 was transferred to this grant from the Cancer\nControl Grant. There was no actual decrease in the funds available for cancer as the\namount of $5,000 was transferred from that portion of the Cancer Control Grant for\nwhich no matching Provincial funds are provided.\nAdministration\nEarly in the year the Department of National Health and Welfare assigned Dr. R. B.\nJenkins to act as their liaison officer in British Columbia with regard to the National\nhealth-grants programme. Dr. Jenkins is a member of the staff of the Department of\nNational Health and Welfare located in Victoria.    It is felt that this type of liaison is DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 95\ngood, and that mutual benefit and understanding have resulted from his visits to various\nagencies and institutions receiving assistance from the National health grants.\nIn February the Assistant Provincial Health Officer spent three days in Ottawa\nreviewing with officials of the Department of National Health and Welfare all submissions\nfor continuing assistance in the year 1952-53. This was an excellent plan and no doubt\ncontributed materially to the approval of these submissions being received much earlier\nthan in previous years.\nEfforts to reduce the amount allocated for continuing projects for 1952\u201453 were\nreasonably successful with regard to both government and non-government agencies.\nIt is now recognized by these agencies that the amount allocated for continuing projects\nmust be controlled if sufficient funds are to be available for new or extended services.\nGrants Received for the Year Ended March 31st, 1952\nThe figures given in the following table indicate that considerably greater advantage\nwas taken in this Province of the National health grants in the year ended March 31st,\n1952, than in previous years. Total expenditures were $2,481,398 or 85 per cent of\nthe total grants, as compared to $1,701,011 or 59 per cent of the total grants available\nin the year ended March 31st, 1951. These increased expenditures are largely due to\nthe increase in expenditures in the Mental Health, General Public Health, and Hospital\nConstruction Grants. Under the Hospital Construction Grant alone there was an expenditure of $1,078,708.\nComparison of Amounts Approved and Actual Expenditures with Total Grants\nfor the Year Ended March 31st, 1952\nGrant\nTotal Grant\nApproved\nActual Expenditures\nAmount       Per Cent\nAmount\nPer Cent\n$43,218\n55,596\n1,098,708\n43,218\n428,961\n368,135\n7,482\n33,320\n645,953\n206,478\n$16,362    |        38\n43,885              79\n1.078.708     1         98\n$14,679\n38,277\n1,078,708\n43,218\n347,669\n280,886\n7,217\n532,907\n137,837\n34\n69\n98\n43,218\n386,928\n365,505\n7,482\n100\n90\n99\n100\n92\n88\n100\nMental Health  \t\n81\n76\n96\n596,347\n182,035\n82\n67\nTotals    -\t\n$2,931,069\n$2,720,470    |        93\n\u2022       I\n$2,481,398\n85\nThe figures for British Columbia also compare favourably to those for all Provinces.\nExcluding the Public Health Research and Health Survey Grants, the percentage of funds\nallocated was 93.8 per cent in this Province, as compared with 85.6 per cent for all\nProvinces. Similarly, the amount expended in British Columbia was 85.6 per cent of\nthe total available, as compared with 68.9 per cent for all Provinces.\nPresent Status\nThe National health-grants programme is now well established, with the result that\nit may be expected maximum use will be made this year of these funds in so far as circumstances relating to the individual programmes will permit. As a result of the experience\ngained during the past four years, certain policies have been adopted both at the Federal\nand Provincial level, which have facilitated the planning and implementation of projects.\nGeneral information regarding the distribution of each grant is given in the following\nsections. BB 96 BRITISH COLUMBIA\nCrippled Children's Grant\nA new department under this grant is the provision of assistance for the programme\nfor cerebral-palsied children, which is being worked out under the auspices of the Cerebral\nPalsy Association of British Columbia. The objectives of the association are to promote\ndiagnosis, treatment, education, and welfare of cerebral-palsied children and to provide\nan environment in which the cerebral-palsied children may have the opportunity for the\nbest possible adjustment and development of personality, including occupational training\nand opportunity for employment.\nFacilities are provided at the Western Society for Rehabilitation at a nominal rental,\nand the latter organization has also assisted in many other ways to get the programme\nfor cerebral-palsied children established on a firm basis. To date, assistance from the\nNational health grants has been only for the services of technical personnel.\nThe Registry of Crippling Diseases in Children has shown steady progress this year.\nCrippled children are now registered routinely by the local health services, who consult\nwith the family physician before submitting the registration, and all new-born with congenital malformations or birth injuries are automatically registered by the Provincial\nDivision of Vital Statistics. A technical medical committee representing the various\nspecialties concerned is available for advice in particular cases. A definite working\nliaison has been established with the local hospitals, the Provincial School for the Deaf\nand the Blind, Child Guidance Clinics, and The Woodlands School, and private agencies,\nsuch as the Junior Red Cross, Canadian National Institute for the Blind, and the Cerebral\nPalsy Association of British Columbia. There are definite indications of increasing use\nbeing made of this Registry.\nOther assistance given under this grant was similar to that given in previous years.\nProfessional Training Grant\nThe number of persons completing training under all projects during the calendar\nyear 1952 was thirty-two, and total expenditures made in regard to this training were\n$75,516.29. In addition, fifteen persons have taken short courses, varying in length from\na few days to two or three weeks.\nAssistance is being continued this year to six members of the staffs of general\nhospitals to cover their expenses in connection with the extension course in hospital\norganization and management given by the Canadian Hospital Council. An additional\nsix persons who enrolled this year are being given similar assistance.\nTwo short courses of the in-service training type were given. Under the auspices\nof the Registered Nurses' Association of British Columbia and the School of Nursing,\nUniversity of British Columbia, a workshop on tests and measurements was held from\nJuly 15th to 18th, inclusive at the University. Dr. L. Heidgerken, Associate Professor\nof Nursing Education, Catholic University, Washington, D.C., was the workshop director.\nThe enrolment was forty-six, which was larger than anticipated. Tangible evidence of\nthe success of this project is the fact that the Provincial instructors' group is continuing\nthe study of evaluation throughout the winter months. One aim of this continuing study\nis to effect some standardization of evaluation procedures (including grading of tests)\nin the schools of nursing in the Province.\nDr. MacDonald Critchley, Dean, Institute of Neurology, London, England, visited\nthe British Columbia Mental Health Services the end of May. Conferences were held\nwith the Directors of Research and of Neurology, and a lecture and clinic on Huntington's chorea was presented to the assembled medical staff of the Mental Health Services.\nDr. Critchley's visit was considered most worth while in stimulating the staff and in giving\nthem access to new developments in Great Britain. Provision for this training was made\nunder the Mental Health Grant. department of health and welfare, 1952 bb 97\nHospital Construction Grant\nDuring the past four years there has been a gradual accumulation of continuing\nhospital-construction projects due to the length of time required for construction to be\ncompleted. In order to meet the claims anticipated this year, it was necessary to have\nthe amounts unexpended in 1948-49 and 1949-50 added to the grant for this year. This\ncarry-over of funds is one of the provisions of this grant. Although the total grant for\nthis year is $2,478,153, there is actually therefore no increase over previous years.\nAssistance under this grant has been given this year toward the construction of\nhealth centres in local communities, provision for which was made last year. Areas which\nhave taken advantage to date of this provision are Victoria, Maillardville-Coquitlam,\nKamloops, Enderby, and Kelowna, in addition to the new building planned for the Provincial Health Branch in Vancouver. Only a portion of the cost is provided under this\ngrant, the remainder being provided from Provincial and local funds.\nVenereal Disease Control Grant\nThis grant is on a matching basis, and the total amount is therefore paid to the\nProvince, as expenditures by the Province on venereal-disease control are considerably\nin excess of the amount of the grant. The standard and extent of service given during\nthe year 1948-49 was maintained.\nAs all services for the control of venereal disease in British Columbia are provided\nby the Provincial Government, the Annual Report of this Division constitutes the report\non the use made of this grant.\nMental Health Grant\nThe Mental Health Grant is of benefit primarily to the British Columbia Mental\nHealth Services, Department of the Provincial Secretary. The majority of projects are\ninitiated under the Director of the Mental Health Services, who also reviews all proposed\nprojects which will be administered by other departments or agencies.\nThis year was one of gradual expansion of existing services rather than one of new\ndevelopments. Last year a consultant in neurosurgery was appointed to the British\nColumbia Mental Health Services, and this year consultants in general surgery and in\northopaedic surgery were added.\nAn additional study being undertaken by the Neurophysiological Research Unit,\nwhich is located at the University, is the investigation of abnormal electroencephalograms\nin relation to psychopathology.   Other services have similarly expanded.\nThe University of British Columbia, the mental-hygiene programme in the Cities of\nVancouver and Victoria, and the psychiatric services in the Vancouver General Hospital\nagain received assistance from this grant.\nTuberculosis Control Grant\nThis grant is similar to those for Mental Health and Venereal Disease Control in\nthat the majority of the services for tuberculosis are provided by the Provincial Government, and the largest proportion of this grant therefore is allocated to these services.\nDetailed information regarding these services is given in the Report of the Division of\nTuberculosis Control.\nTwo services for tuberculosis out-patients were discontinued this year. Under the\nhome-care project, housekeeping assistance was provided in selected homes of tuberculosis\npatients to make it possible to discharge patients earlier from hospital and to prevent the\nbreakdown and readmission of patients, thereby partially relieving the acute shortage of\nbeds in British Columbia. As this was originally a short-term project, and as the opening\nof the Pearson Tuberculosis Hospital would alleviate considerably the shortage of beds,\napproval was not given for continuation of this service during the current year. BB 98 BRITISH COLUMBIA\nThe occupational-therapy service for tuberculosis out-patients, which was conducted\nby the Metropolitan Health Committee of Greater Vancouver, was discontinued on June\n30th, 1952. It was felt by officials of the Department of National Health and Welfare\nthat the project did not truly meet the requirements of the National health grants.\nThe administration of streptomycin to tuberculosis patients in the home, which was\nformerly done by the Victorian Order of Nurses in the Greater Vancouver and Victoria\nareas, has been assumed by the local public health nurses. The purpose of this project\nwas to commence treatment on patients awaiting admission to hospital. The number of\npatients requiring home treatment was greatly reduced with the opening of the Pearson\nTuberculosis Hospital.\nPublic Health Research\nApproval was given to a study of the antibiotic and hormonal control of tuberculosis\ninfections in order to endeavour to obtain a more effective form of chemotherapy than is\nnow available for the treatment of tuberculosis. This research, which is not yet fully\norganized, is under the direction of the head of the Department of Biochemistry, University of British Columbia, in co-operation with the Provincial Division of Tuberculosis\nControl.\nThe two projects approved last year, \" Investigation of Schistosome Dermatitis in\nB.C. Lakes \" and \" Control of Skin Infection in the Newborn,\" were continued this year,\nand progress is being made.\nHealth Survey Grant\nThe report \" Survey of the Health Services and Facilities in British Columbia,\nDecember 31, 1948,\" which was required under the provisions of this grant, was submitted\nto the Department of National Health and Welfare in March, 1952, and tabled in the\nHouse of Commons on July 2nd, 1952.\nGeneral Public Health\nThe General Public Health Grant increased only $19,060 this year, and such increase\nwas due to the variable factors governing the allocation of the total amount voted by the\nFederal Government. The principle of having the government and non-government\nagencies absorb a proportion of the long-term recurring expenditures had its widest\napplications to the services provided under the General Public Health Grant. However,\nthe saving in funds thereby effected made possible further expansion of local health\nservices. Detailed information in regard to these services is given in the section of this\nReport on the Bureau of Local Health Services.\nApart from local health services, assistance was given this year to the Provincial\nSchool for the Deaf and the Blind toward the purchase of dental equipment in order to\nestablish at the school a dental clinic, which will be operated by the Metropolitan Health\nCommittee of Greater Vancouver. Fifteen incubators were supplied to general hospitals\nto facilitate the care of premature infants. Assistance was also given to the Multiple\nSclerosis Society to enable the medical adviser to conduct a survey to determine the incidence of multiple sclerosis in this Province.\nCancer Control Grant\nThe operations of the British Columbia Cancer Foundation, outlined earlier in this\nreport under the section \" Voluntary Health Agencies,\" and the Provincial Biopsy Service\naccount for approximately 75 per cent of total expenditures under this grant. In addition,\nover $50,000 was allocated from Federal and Provincial funds for the purchase of equipment for the new addition to the British Columbia Cancer Institute and the Victoria\nCancer Clinic. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB 99\nThe Provincial Biopsy Service remains an integral part of the cancer-control programme and continues to be most satisfactory to all concerned, as well as extremely\npopular with the practising physician. In addition to the biopsy service, which is chiefly\nconcerned with the diagnosis of solid tissues, the service for diagnosis of cells in fluids is\nstill available on the same free basis to the patient. This service, which is known as the\n\" Cytological Service,\" is carried out at the Vancouver General Hospital.\nThis year three registered nurses will complete their training at the British Columbia\nCancer Institute as radiotherapy technicians, under funds supplied jointly by this grant\nand the Canadian Cancer Society (British Columbia Division).\nACKNOWLEDGMENT\nValuable assistance and co-operation have been received from officials of the Department of National Health and Welfare, the Provincial Health Branch, the Department of\nthe Provincial Secretary, particularly the Provincial Mental Hospitals staff, and the\nCommissioner and staff of the British Columbia Hospital Insurance Service.\nHarmonious working relationships exist with the city health departments of Vancouver and Victoria, the voluntary health organizations, and general and specialized hospitals,\nwith all of whom this office has been in contact during the year. BB  100 BRITISH COLUMBIA\nREPORT OF THE DIVISION OF LABORATORIES\nC. E. Dolman, Director\nThe Provincial Laboratories commenced operations as a distinct organization in\nthe late summer of 1931, so the year under review marks their coming-of-age.\nTwenty-one years ago, when the then Provincial Board of Health assumed full\nresponsibility for providing public health laboratory facilities in British Columbia, temporary headquarters for the work were established in two converted frame houses on\nHornby Street, Vancouver. Over the years, two adjacent houses were taken over and\nadapted to the Division's needs, and behind the resulting row of four conjoined, tumbledown buildings, a large hut was erected during 1952. Despite persistent efforts to secure\npermanent quarters more worthy of, and better suited to, the importance of its work, the\nDivision remains in what may be described as unsafe, unhealthy, uneconomical, and\ntotally unsatisfactory shacks. Indeed, perhaps the most unforgettable feature of 1952\noperations will prove to be the frequent conferences regarding a proposed new building;\nthe many hours spent on detailed plans by the Director, Assistant Director, and other\nsenior staff members; and the indefinite postponement once again of a project whose\nfulfilment had seemed at last within reach.\nThe total tests performed by the Division approached 410,000, of which roughly\n345,000 were carried out in the central laboratories. This figure is practically unaltered\nfrom last year, but a changing distribution of tests, and trials of many new procedures\nnot included in monthly or annual totals, entailed a considerably heavier work-load. The\nclassified totals of tests done in Vancouver in 1952 and the comparative figures for 1951\nare set forth in Table I. Similar data for the branch laboratories at Victoria, Nelson,\nPrince George, and Kamloops are summarized in Table II. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  101\nTable I.\u2014Statistical Report of Examinations Done during the\nYear 1952, Main Laboratory\nOut of Town\nMetropolitan\nHealth Area\nTotal in 1952\nTotal in 1951\n137\n4,636\n1,516\n768\n88\n7,764\n2,198\n1,597\n776\n147\n7,488\n5,105\n1,743\n32\n8,155\n5,828\n16,196\n2,741\n6,054\n1,308\n22,523\n5,410\n3,099\n250\n181\n587\n1,166\n105,319\n17,911\n2,110\n18,060\n133\n1,794\n96\n539\n1,350\n1,865\n1,741\n1,741\n1,404\n857\n1,770\n152\n152\n152\n63\n57\n284\n12,124\n6,621\n2,511\n120\n15,919\n8,026\n17,793\n3,517\n6,054\n1,959\n26,758\n12,993\n4,288\n278\n225\n757\n1,740\n142,071\n25,324\n2,842\n26,368\n188\n2,845\n131\n827\n2,171\n2,936\n3,225\n3,225\n2,394\n857\n7,015\n152\n152\n152\n63\n117\n598\nBlood serum agglutination tests\u2014\nTyphoid-paratyphoid group \t\nBrucella group..  \t\n12,204\n6,203\n2,208\n69\nCultures\u2014\nM. tuberculosis-\u2014     \t\nTyphoid-Salmonella-dysentery group  \t\nC. diphtheria; _ \t\n13,631\n6,426\n26,433\n4,516\nN. gonorrhea;  \t\n6,352\n651\n4,235\n7,583\n1,189\n28\n44\n170\n574\n36,752\n7,413\n732\n8,308\n55\n1,051\n35\n288\n821\n1,071\n1,484\n1,484\n990\n1,661\nDirect microscopic examination\u2014\n_V. gonorrhoea;   \t\n26,837\n14,694\n3,862\nTreponema pallidum   _\t\nVincent's spirillum   ...  \t\n351\n267\n756\nSerological tests for syphilis\u2014\nBlood-\n135,740\n25,517\nQuantitative Kahn  \t\n4,064\n26,271\nV.D.R.L _\t\nCerebrospinal fluid\u2014\n2,769\nQuantitative fixation   \t\nCerebrospinal fluid\u2014\n176\n1,084\nProtein   \t\n2,155\n2,774\nMilk-\n3,231\n3,231\n2,474\n894\nWater\u2014\n5,245\n7,041\nIce-cream\u2014\n191\n191\n191\n60\n176\nTotals   \t\n99,743\n245,279\n345,022\n345,238\nPROVINCIAL.   LIBRARY*\nVICTORIA. 8. & BB  102\nBRITISH COLUMBIA\nTable II.\u2014Statistical Report of Examinations Done during the\nYear 1952, Branch Laboratories\nKamloops1\nNelson\nPrince\nGeorge\nVictoria\n34\n44\n7\n1\n36\n15\n81\n495\n106\n32\nBlood agglutination\u2014\n460\n115\n85\nCultures\u2014\n102\n242\n246\n1,987\nTyphoid-Salmonella-dysentery group \t\n\t\n607\n2,045\n2,045\n528\n10\n101\n106\n23\n118\n264\n669\n15\n9\n11\nDirect microscopic examination\u2014\n754\n779\n5,300\n119\n5\n5\n4\n9\n46\n\t\n175\nSerological tests for syphilis\u2014\nBlood\u2014\n21,092\n1,427\n7,157\n84\n\t\n\t\n1,806\n347\n588\nCerebrospinal fluid\u2014\u25a0\n19\n11\n13\n85\n103\n1,511\n1,485\n482\n49\n1,331\n4\n430\n667\n683\n2\n562\n61\n421\n546\nMilk-\n42\n43\n40\n4\n122\n5\n984\n984\n984\nWater\u2014\n1,006\n1,057\nUnclassified tests\n762\n14,581\n2,729\n46,000\n1 Kamloops totals to September 30th, 1952, only.\nTESTS FOR DIAGNOSIS AND CONTROL OF VENEREAL DISEASES\nAs usual, slightly over two-thirds of all tests done in the Division were concerned\nwith the detection or exclusion of syphilis and gonorrhoea. But this high proportion, in\nterms of actual tests reported, does not reflect a similar preponderance of time spent on\nwork under this heading. In fact, a cost-accounting analysis recently carried out in the\ncentral laboratories by the Director and Assistant Director indicates that rather less than\none-third of total \" work units \" are devoted to these tests.\nThe number of blood specimens sent in for sero-diagnostic tests increased by around\n6 per cent. However, this does not signify any rising incidence of syphilis. It is more\nlikely due to a combination of factors, such as the natural increase in the population, the\ngrowing advocacy of such blood tests as part of a routine health examination, and the\nrequirement of a blood test under premarital legislation of certain States, or United States\nimmigration regulations. This supposition is borne out by the fact that the numbers of\nsupplementary sero-diagnostic tests did not increase correspondingly.\nGrowing concern has been felt over the possibility that the presumptive Kahn test\nwas not invariably a satisfactory screening procedure; that although supposedly hypersensitive, it might occasionally yield a false negative reaction. Since all Provincial laboratories in Canada agreed some years ago to adopt the presumptive Kahn test for routine DEPARTMENT OF HEALTH AND WELFARE, 1952 BB  103\nscreening, the question was referred by the Director to the Technical Advisory Committee (of the Dominion Council of Health) on Public Health Laboratory Services, which\nmet in Ottawa in December. The matter was thoroughly debated, and appropriate\nmeasures will be taken. At the same time some attention was given by the Committee to\nthe allegedly increasing discrepancies between the results of the standard Kahn and the\nKolmer-Wassermann complement-fixation tests. By far the most complete details on\nboth these questions were furnished by this Division. Perhaps it should be emphasized\nthat these doubts do not point to any decline of technical proficiency, but rather to\nserological peculiarities of certain groups nowadays subject to test. Discrepancies are\nespecially prevalent among blood specimens from infants at birth, from Venereal Disease\nClinic patients under penicillin treatment, and from apparently healthy adults convalescing\nfrom certain types of febrile illnesses. Such patients furnish a much higher proportion\nof the total specimens subjected to these serological tests than in former years.\nThere is little likelihood of serious errors of technique building up in a large sero-\ndiagnostic laboratory in Canada. Apart from the meticulous attention to detail which\ntraditionally characterizes such departments, there is the constant checking by physicians\nand by venereal-disease control authorities, who are usually quick to notice serious disagreement between clinical and laboratory findings. Additional valuable safeguards are\nthe periodic sero-diagnostic surveys, and the system of supplying standardized reagents,\narranged by the Laboratory of Hygiene, Department of National Health and Welfare.\nThe sixth in the series of sero-diagnostic surveys was launched in November. In future\nyears some attempt might well be made to include the branch laboratories to some extent\nin these surveys. Their much smaller turnover of specimens, and their liability to assign\nthis type of work to comparative novices, warrants less confidence in the accuracy of\ntheir reports.\nTESTS RELATING TO TUBERCULOSIS-CONTROL\nAlthough the total sputum and miscellaneous specimens submitted for direct microscopic examination for M. tuberculosis declined slightly from the 1951 figures, the\nnumber cultured increased by 20 per cent. In the past three years cultural examinations\nfor M. tuberculosis have more than doubled. This rapid increase reflects not only widening recognition of the greater sensitivity of cultural methods over direct microscopy, but\nalso the application of more stringent criteria for diagnosis and release of tuberculous\npatients. Here then, as in many other fields, the public health laboratory is faced with\ndemands for more exacting techniques because of, rather than despite, a declining incidence of the disease in question. Institutions with adequate reserves of accommodation,\nof supplies and equipment, and of staff might well thrive on such paradoxical situations.\nBut only professional laboratory-workers can fully appreciate how much extra work and\nworry results from developments of this type in the painfully restricted circumstances\nbesetting this Division. The insidious parasitic habits of the bacillus M. tuberculosis,\nwhich exposes its handlers to many infection hazards, may be partly related to its slow\ngrowth on artificial nutrient media. This in turn necessitates incubation of cultures for\nat least eight weeks before being finally reported negative and discarded, and their\ninspection meanwhile at regular intervals. Mere inspection of hundreds of culture-tubes,\nstacked high on trays filling several incubators, perched on precious bench space in hopelessly cramped small rooms, is in itself quite a staggering task. When due consideration\nis also given to the special treatment required in preparing specimens for culture, it\nbecomes apparent that the trend toward routine cultural examination of suspected\ntuberculous material cannot be light-heartedly accepted. The branch laboratory at\nVictoria has, to lesser degree, suffered similarly.\nOn the whole, private physicians and the staff of the Division of Tuberculosis Control have shown sympathetic appreciation of the laboratory services rendered them under\n_ BB  104 BRITISH COLUMBIA\nsevere handicaps. The arrangements described in the 1951 Annual Report, whereby\nthe Division of Tuberculosis Control undertook to relay positive laboratory reports on\npatients under its jurisdiction to the appropriate officials, worked fairly efficiently, with\nfew exceptions, and to some extent lessened the pressure on the office staff in the\nLaboratories.\nExcellent co-operation was displayed by Tranquille in restoring the supply of guinea-\npigs for animal-inoculation tests. The supply was cut off altogether for the first several\nmonths of the year owing to an unidentified epizootic, followed by ringworm, affecting\nthe Tranquille guinea-pig colony. During this period, emergency inoculations only were\nperformed, using animals begged or borrowed from various local sources. By the time\nshipments of healthy pigs could be resumed, it had been decided to abandon the two\nrodent-infested, draughty annexes hitherto used as animal-rooms in favour of concrete\nquarters of smaller capacity, erected adjacent to the new hut. These factors account for\nthe total animal inoculations during 1952 amounting to around 300, only one-half of the\n1951 figure.\nGASTRO-INTESTINAL INFECTIONS AND BACTERIAL\nFOOD POISONING\nOver 8,000 stool specimens were cultured for organisms of the Salmonella and\nShigella groups, an increase of roughly 25 per cent over 1951 and double the 1949 figures.\nThe total number of Salmonella-Shigella strains isolated in the central laboratories\nduring 1952 exceeded 300. Of these, about 170 were Salmonella., a figure only slightly\nabove that for the previous year. Two types, S. California and S. heidelberg, appeared\nin this Province for the first time; indeed, the former type (isolated from a nurse at the\nProvincial Mental Hospital) had not previously been recognized in Canada. S. heidelberg\nwas first isolated in Canada in May, 1951, from poultry in the neighbouring Province\nof Alberta, and in July of the same year the first human isolation was made in that Province. In September and October, 1952, a small outbreak of gastro-enteritis occurred\namong children on an Indian reserve at Powell River. Six of the cases yielded S. heidelberg by stool culture. About the same time a case of Salmonellosis due to S. heidelberg\nwas identified in a Vancouver butcher. This sort of situation should provide a happy\nhunting-ground for the epidemiologist.\nAlthough the number of Shigella isolations was less than half that of 1951, the total of\n133 was still more than double the average prevailing prior to 1950, in which year an outbreak of bacillary dysentery at a girls' camp in Howe Sound, identified by the Laboratories\nas due to Sh. sonnei, proved a troublesome source of widespread infection subsequently\nin various parts of the Province. A very similar situation developed again in July, 1952,\nat a girls' camp in the same area. Although this time the outbreak was smaller, twenty-\nsix children yielded Sh. sonnei by stool culture. The original source of infection was\nprobably a child admitted to the camp while suffering from a mild attack of dysentery.\nVery few secondary cases occurred owing to the stringent measures instituted, but more\ncareful screening of applicants for the camp might have averted the second episode of\nthis nature within two years, and the reservoir of unidentified carriers of Sh. sonnei may\nwell have been enlarged as a result of the incident.\nAttention should also be drawn to the unduly high number of isolations of S. typhi\n(the typhoid fever bacillus), which reached a total of 26\u2014-a figure exceeded only twice\nduring the preceding decade (33 in 1944 and 28 in 1947). These cases and carriers\ninvolved several small groups living in widely separated areas. S. paratyphi A, rarely\nfound in Canada, was isolated from a sailor who probably acquired the infection at a\nport of call en route from the Orient. But, for the most part, it must be assumed that\na wide variety of Salmonella types, as well as Shigella flexneri and Sh. sonnei, are now\nmore or less indigenous to British Columbia, and that their presence will be revealed with DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  105\na frequency roughly proportional to the prevailing levels of community sanitation and\npersonal hygiene. Hence it is not surprising that these intestinal infections displayed\na high incidence among Indians and their contacts. The Skeena and Central Vancouver\nIsland Health Units were especially heavy sources of positive specimens during 1952,\nbut no area or section of the community was altogether spared.\nThe importance of the healthy or convalescent carrier in spreading these infections\nhas been stressed in previous Reports. The distribution of such carriers is uneven and,\nfor any given group, rather unpredictable. But the desirability of routinely examining\na stool specimen at least once annually from food-handlers employed in public eating-\nplaces, or from persons closely associated with milk or water supplies, was exemplified\nby the isolation of a strain ofS. typhi-murium from a dietitian, and of a strain of Sh. sonnei\nfrom another food-service employee, at the University, while S. derby was isolated from\na Greater Vancouver Water Board employee. Of a total of 693 apparently healthy\nUniversity food-service employees tested thus, over the period 1946-52, no fewer than 8,\nor 1.15 per cent, have yielded Salmonella-Shigella organisms. Again, of 1,485 Greater\nVancouver Water Board employees, over a similar period, 6 were carrying Salmonella\norganisms (including S. typhi in two instances); that is an incidence of 0.34 per cent.\nAmong nearly 1,000 specimens received from food-handlers employed at the Kitimat\nAluminum Company project, only 2 Salmonella carriers were detected, but even an\nincidence of 0.2 per cent is a disturbing figure in terms of the harm such persons can do\nunwittingly. If more than a single specimen had been examined from each individual,\nno doubt the percentages quoted above would have been higher.\nThe foregoing comments should not be construed as advocating a greatly stepped-up\nprogramme of stool-culturing. Indeed, the Laboratories already receive more of these\nspecimens than can be satisfactorily handled in present circumstances. Faeces examinations are especially time-consuming and intricate, so that any large increase in then-\nnumbers entails a disproportionately heavy burden. In 1952 the enteric department of\nthe Laboratories would have faced an intolerable situation had the new hut not become\navailable just before the incidence of these infections reached their seasonal peak. But\nwhen proper permanent quarters finally become available, it is hoped these routine tests\non food-handlers may be extended. Meanwhile the conscientiousness and skill which\nresult in the provision of this information by the Laboratories might sometimes, with\ngreat advantage to the public, be better matched by those to whom it is reported.\nBacterial food-poisoning episodes were mostly of Staphylococcal type, and unspectacular.\nOne fatality due almost certainly to botulism should be recorded. Late in September a male resident of a small community near Fernie ate some fish fillets which had been\nhome-pickled a few weeks previously. The fish, fresh trout caught by the man himself\nin a near-by river, was stored in the refrigerator until enough had accumulated to fill\nseveral jars. It was then made into patties, dipped in egg and cracker crumbs, \" thoroughly fried,\" placed in the jars with sliced onions, and a hot vinegar and salt-water\nmixture poured on. The jars were then sealed without further heat treatment. The\nhousewife had used this family recipe for many years, but had frequently disposed of jars\nof fish thus prepared because they had gone bad. The lid of the particular jar whose\ncontents her husband consumed was apparently not tight. Within a few days he developed, in succession, nausea and vomiting, marked constipation, ptosis, inability to\nswallow, double vision, extreme dryness of the tongue, and retention of urine\u2014characteristic features of botulism. He died in a Calgary hospital eighteen days after the fatal\nmeal. The post-mortem findings were consistent with his physician's diagnosis of botulism, and not of bulbar poliomyelitis, which had been proposed by consultants. As seems\nusual in such episodes, all the remaining contents of this particular jar were destroyed.\nFrom a companion jar of trout sent to the Laboratories, a toxin-producing culture of BB 106 BRITISH COLUMBIA\nClostridum botulinum, type E, was eventually isolated in the Western Division of Con-\nnaught Medical Research Laboratories and the Department of Bacteriology and Immunology, University of British Columbia. This was the fourth isolation of CI. botulinum,\ntype E, accomplished in Vancouver. Fish products have been involved in all four\ninstances. Three of these botulism episodes have affected a total of six residents of\nBritish Columbia, of whom five died. The fourth instance occurred in Alaska, where\nfive natives who became ill after a feast of uncooked beluga flipper were fortunate enough\nto recover. Roughly one-half of all known isolations of this unusual micro-organism\nhave to date been made in Vancouver. Its predilection for fish is a baffling problem for\nfurther research.\nOTHER TYPES OF TESTS\nBacteriological tests on milk and water samples totalled about the same as in 1951.\nA number of bacterial counts on cottage-cheese samples were made on behalf of the City\nof Vancouver, supplementing the tests started in the previous year on ice-cream samples.\nTwelve new boxes for shipping iced samples of milk and water were procured during\nthe year and put into circulation in various parts of the Province. A recent cost analysis\nof the central laboratories' activities has revealed that bacteriological tests concerned with\nthe sanitation of milk and water are relatively expensive when computed on a \" per unit \"\nbasis. There is good reason to believe that over the years the close co-operation between\nthe Laboratories and the field-workers, especially the Sanitary Inspectors, will bear fruit\nin terms of better supplies of water, milk and milk products, and indeed in the general\nsanitation of foodstuffs.\nAs usual, many bacteriological examinations of water-supplies from trains and other\ncommon carriers were performed on behalf of the Public Health Engineering Division,\nDepartment of National Health and Welfare. The same department requested us to make\na survey of the effectiveness of various procedures used in the cleansing of meat-blocks\nin certain Government establishments. An extensive laboratory investigation was made\nby Mr. Shearer on many swab samples brought in over a period of several months by\nrepresentatives of the above-mentioned Department, and his findings formed the basis\nfor a report prepared for internal distribution by that Department.\nCultural examinations for C. diphtheria? showed an appreciable decline, reflecting\nthe low incidence of diphtheria in the Province during 1952.\nBRANCH LABORATORIES\nThe branch laboratories at Victoria and Prince George showed roughly the same\nturnover of specimens as in 1951. The Nelson Laboratory, however, increased its turnover from about 9,000 tests to over 14,500 tests, a notable performance considering that\nthere was no increase in staff, and that during the summer a complete change of staff\noccurred. The Kamloops Laboratory experienced a recurrence of its chronic difficulties\nin procuring staff satisfactorily qualified to carry out public health laboratory tests, and\nin July the subsidy was withdrawn.\nEach of the other three laboratories was visited at least once during the year by one\nor other senior staff member. Experience is confirming the view repeatedly expressed\nthat the eventual solution to the branch-laboratory problem in this Province must be the\nestablishment of two or three centres staffed and equipped by the Division itself. The\nNelson Laboratory has been particularly successful, and no difficulty is anticipated in\narranging for suitably qualified personnel from the central laboratories to serve a period\nup there. During the year Miss Handlen, laboratory assistant, resigned to be married\nand was replaced by Miss R. Schoeps. Miss M. Yeardye, bacteriologist, was replaced\nby Miss D. Done, since the former, for purely personal reasons, preferred to return to the\nVancouver Laboratories. By suitably arranged overlapping, no dislocation resulted from\nthese changes. DEPARTMENT OF HEALTH AND WELFARE,  1952\nBB  107\nA short-term survey of swabs from restaurant utensils and dishes and from glasses in\nbeer-parlours was launched by the Prince George Branch Laboratory in co-operation\nwith the Cariboo Health Unit. It was felt that sanitation in eating and drinking establish-\nlishments in that area was of a low order and that bacterial counts might furnish convincing evidence to the authorities of the low level of prevailing standards. Mr. Shearer\nvisited Prince George to help make suitable arrangements from the laboratory standpoint\nfor this survey.\nGENERAL COMMENTS\nThe accommodation of the central laboratories continues to give rise to deepest\nconcern. A very serious situation might well arise if plans for new and larger fire-proof\nquarters for the laboratories are further deferred. The already-mentioned provision of\na hut provided some measure of temporary relief to those who moved into it, but left\nundiminished the risks and discomforts endured by those in the older buildings. The hut\nitself is far from ideal in many respects for laboratory work, but this is not the fault of\nthose responsible for its erection, and a note of appreciation is due to Mr. Pendygrasse,\nof the Department of Public Works, who did his best for us.\nDuring part of May and June Miss V. G. Hudson, senior bacteriologist, received\na Professional Training Grant under the Federal health grants for attendance at a refresher\ncourse on enteric bacteriology, given at the Laboratory of Hygiene, Ottawa. In September Miss M. Yeardye, bacteriologist, attended a similar course under the same arrangements, on syphilis serology. On her return from the Nelson Laboratory, Miss Yeardye\nwas thus well equipped to assume supervision of the Kahn-testing department.\nIn September the Director attended the annual meeting at Estes Park, Colorado,\nof the International Northwest Conference on Diseases in Nature Communicable to Man.\nIn December he attended the annual conference in Ottawa of the Technical Advisory\nCommittee on Public Health Laboratory Services to the Dominion Council of Health.\nAs a member of a sub-committee of this group, nominated at last year's conference to\ninvestigate the costs of public health laboratory work, he assisted in compiling a report on\nthis important question. Following the Ottawa conference, the Director attended the\nannual meeting in Quebec of the Laboratory Section, Canadian Public Health Association,\nwhere he presented papers on \" Salmonella-Shigella Infections in British Columbia \" and\non \" The Classification of Clostridium botulinum, type E.\"\nAt the September meeting of health officers, held in Victoria, reports were presented\nby the Director on the costs of distributing biological products and specimen outfits, and\non methods of eliminating wastage in these items. Assurance of co-operation was\nreceived from the health-unit directors, and beneficial results are already apparent. The\nsystem of orientation visits to the Division by new personnel in the Provincial Department\nof Health has also assisted in promoting better understanding of the Laboratories' objects\nand difficulties.\nIt is fitting to close with a note of appreciation of the very fine spirit displayed by the\nwhole staff of the Division, despite all difficulties encountered. This is very largely due\nto the excellent example shown by the senior members, among whom Miss D. E. Kerr,\nAssistant Director, should again be selected for special commendation. BB 108 BRITISH COLUMBIA\nREPORT OF THE DIVISION OF VENEREAL DISEASE CONTROL\nA. John Nelson, Director\nDuring the year the number of venereal-disease cases reported in the Province\ncontinued to show a slight decrease\u20143,647 in 1952, compared with 3,916 in 1951.\nInfectious syphilis has now become a real clinical rarity; only 34 cases were reported\nas of December 31st, 1952. Late syphilis, as reported to this Division, has also shown\na marked decline.\nTREATMENT\nThis Division continued to overtreat gonorrhoea patients with massive doses of\npenicillin, thereby aborting any possible concomitantly acquired syphilis. This over-\ntreatment schedule appears to be of real importance in reducing the number of new cases\nof syphilis in this Province, as elsewhere.\nAn important numerical change worthy of mention concerns the number of cases of\ngonorrhoea that were treated and diagnosed by the private physician of this Province.\nPrivate physicians treated more cases of gonorrhoea than the clinics of the Division of\nVenereal Disease Control.\nPrenatal syphilis continued to show a decrease in the number of new cases reported.\nIn fact, this is the first report in which it could be stated that the number of new cases\nof prenatal syphilis was falling with the same rapidity with which the new cases of acquired\nsyphilis are being reported to this Division.\nQualified specialists are still employed by the Division to act in a consultative\ncapacity on the various problems that arise in treating venereal disease. This consultative\nservice is extended to all physicians who need such services throughout the Province.\nDue to the decrease of the patient-load in the various treatment clinics, there was a\nreal attempt made to discontinue certain services, but at the same time not sacrifice the\nservices to the patients.\nFree drugs were again made available to private physicians. In some cases where it\nwas necessary to alter the type of antibiotic used, because of allergic manifestations,\nalternate drugs were supplied. The policy of this Division was not altered with regard\nto supplying the directors of all health units with the drugs so that they can be dispensed\nlocally to the private physicians.\nThe consultant in medicine to this Division continued to interest himself with the\nproblem of non-specific urethritis. The number of cases falling into this category did not\ndiminish, and as yet no satisfactory diagnostic criteria have been established to classify\nthis troublesome condition. The treatment of non-specific urethritis still remains an\nunsolved problem.\nThe Vancouver clinic and the New Westminster clinic maintained the same hours of\nservice as in previous years, in spite of the decrease in the number of new patients\nreporting. This service is still considered to be sufficiently important to allow no change\nat the present time.\nDuring the year, clinic and treatment facilities continued to operate at the following\ncentres: Victoria clinic; Vancouver City Gaol; Prince Rupert and Prince George City\nGaols; Greater Vancouver Metropolitan Health Committee, Health Unit No. 1; Male\nand Female Oakalla Prison Farm; Girls' Industrial School; and the Juvenile Detention\nHome.\nThere was a decline in the new cases of chancroid, although a number of these were\ndiagnosed and treated by the Division. The majority of such cases were found among\nmariners entering the port of Vancouver, and there was no evidence of increased spread\nof this infection among the general population. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  109\nEPIDEMIOLOGY\nAlthough the greatest single factor in the control of venereal disease is penicillin,\nepidemiology is the other very essential weapon for a complete armamentarium in any\nhealth programme. It is felt that such epidemiological programmes were responsible\nindirectly for the steady decline in the reported incidence of venereal disease, both in this\nProvince and nationally.\nThrough continued efforts to find new cases, it should be possible to reduce further\nthe rate of venereal-disease infections in this Province and maintain a steady decline in the\nreported incidence of the disease.   The Division is now pursuing such a course.\nThe epidemiology section is constantly seeking new methods and tools to assist\npublic health workers engaged in case-finding and case-holding, and thereby make their\nprogrammes more effective. The techniques used in eliciting the necessary information\nfrom contacts are undergoing certain changes which should make such measures more\neffective.\nConsultations on epidemiology are available to all local health units through the\nepidemiological section of the Division. During the past year two field-visits were\nrequested\u2014one for the purpose of studying the problem presented by venereal disease\narising from alleged bawdy-house activity and the other for consultation on epidemiological\nprocedures.\nDuring the year a diagnostic centre was established in the down-town Vancouver area\n(Metropolitan Health Unit No. 1). The establishment of such a unit proved most\nhelpful, both in case-finding and in case-holding. This new unit provides clinic service\nevery day from 11 a.m. to 1 p.m. for the purpose of interviewing male patients and making\ndiagnostic tests for gonorrhoea. Treatment is offered to these patients on epidemiological\ngrounds or clinical evidence of infection.\nThe epidemiology section works in close liaison with the private physician and is thus\nable to interview contacts and follow up patients with unsatisfactory serologic reports\nwhich appear on the confidential lists obtained from the Provincial Laboratory. This\ntechnique has been beneficial to both the private physician and the Division of Venereal\nDisease Control. The epidemiology worker at the Vancouver City Gaol examination\ncentre has been particularly effective, and the services rendered have been most worth\nwhile. Through an interview on radio station CKMO (police broadcast), this worker\nwas able to make known the activities of this centre.\nThe Indian Health Service is assuming the largest part of the responsibility for\ncase-finding and follow-up of the British Columbia Indians. During the past summer\nmany Indians were concentrated in the hop-yards, and this proved to be advantageous\nto this section because many former patients were located and follow-up examinations\nwere thus possible.\nThis Division continued to explore the facilitating processes, maintained constant\nvigilance over potential community trouble spots and made every effort to suppress the\nspread of venereal disease.\nVancouver was again visited by a representative of the American Social Hygiene\nAssociation, and the report made by this trained representative showed a marked improvement in the conditions existing in the city compared with the previous visit of one year\nago. Much of the information obtained from such a survey was of value to the Division\nbecause it pointed up conditions which are frequently not drawn to our attention.\nThe Director of the Division of Venereal Disease Control was invited to attend the\nannual convention of the British Columbia Hotels' Association. The subject of his\naddress to their representatives was entitled \" The Facilitation Process in Hotels and\nRooming-houses.\"\nThe senior epidemiology worker presented a paper on \" Venereal Disease Epidemiology \" to the public health nurses at the Institute held in Victoria. BB  110\nBRITISH COLUMBIA\nSOCIAL SERVICE\nThe activity of the Social Service Section was curtailed during the year when the\ncase-worker in the Vancouver clinic was given extended sick-leave, and no replacement\nwas available for three months. During this period specific problems were dealt with on\nan emergency basis by social-work staff from the Division of Tuberculosis Control.\nHowever, in the first eleven months of 1952 there were 733 interviews of patients carried\nout by the Social Service Section.\nContinued use was made of the rating scale devised in 1951 to get a general picture\nof the kind of people who were reporting to the Vancouver clinic for treatment. An\nanalysis of the ratings for the twelve-month period from July, 1951, when the rating\nsystem was instituted, to June, 1952, indicated that about half the patients interviewed\nneeded help in solving some of the more basic problems that were facing them. In this\ngroup were the older adolescents who were in conflict over sexual behaviour, and who,\nout of curiosity and lack of knowledge, were seeking solutions in promiscuous sexual\nactivity. It was interesting to note the number of new immigrants in the young adult\ngroup who had not adjusted to their new environment and had become infected with a\nvenereal disease because they were susceptible to the only kind of female companionship\navailable to them; namely, the casual street pick-up. These patients responded well to\nthe counselling interviews, but the lack of community resources to which they could be\ndirected for more wholesome recreational outlets was a handicap in working with them.\nIn addition to those patients who could utilize personal counselling, there was a\nfairly large group who seemed to drift from place to place, and job to job, and whose\npersonal relationships, including their sexual ones, were all on a casual basis. Although\nmost of these individuals could be helped to co-operate in the treatment plan, they had\nno incentive to change their promiscuous behaviour pattern because it met their particular\nneeds.\nBecause of lack of staff, no specific studies were undertaken by the Social Service\nSection during the year.\nEDUCATION\nThe Division of Health Education has the major responsibility for health-education\nprogrammes and activities and shares this with the Division of Venereal Disease Control\nin the case of lay education. Education directed to professional groups remains the\nprime responsibility of this Division.\nMembers of the Division presented a total of 177 lectures during the year. Lectures\non the methods of control of the venereal diseases were given to the following: Student-\nnurses at all the main training-schools in the Province, students at Essondale, practical-\nnursing students, student-barbers, and students in the foods department at the Vocational\nSchool. In addition, practical experience, as well as regular lectures, was provided to\nstudent-nurses from the Vancouver General Hospital.\nLectures were also given to students in various other fields, including medical students\nat the University of British Columbia Medical School and residents of the Vancouver\nGeneral Hospital.\nFortnightly meetings were held in the Divisional headquarters for all attending\nphysicians, at which time lectures were given by members of the consulting staff on various\naspects of venereal disease. The consultant syphilologist presented a lecture entitled\n\" Present Treatment Status of Syphilis and Gonorrhoea\" at the Vancouver General\nHospital refresher course for general practitioners held in November.\nThere was a continuation of the programme of talks to youth groups, which was\nestablished in 1950. Speakers were provided upon request to HI-Y groups in Vancouver\nschools and to youth groups at the Y.W.C.A. Groups addressed during the year were\nthe Britannia and King Edward HI-Y's and the GAI-Y groups at the Y.W.C.A.   A talk DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  111\nwas also given at the Girls' Industrial School. As a result of a meeting with representatives\nfrom the Greater Vancouver Health League and the First Aid Attendants' Association,\nlectures on the venereal diseases and films on the subject are now being presented to each\nclass of first-aid trainees.\nThe following is a list of articles written and published and papers presented by\nvarious members of the Division:\u2014\nArticles written and published:\u2014\n\"Undiscovered Case\u2014the Problem\"  (the March issue of B.C.'s Health),\nDr. C. L. Hunt.\n\" Community Responsibility and Venereal Disease \" (the First Aid Attendant,\nofficial magazine of the Industrial First Aid Attendants' Association of\nBritish Columbia), Dr. C. L. Hunt and Dr. A. John Nelson.\n\" Progress in Venereal Disease Control \" (published in the Vancouver Medical\nBulletin), Dr. A. John Nelson.\n\" Co-operation Key to Control in Venereal Disease \" (the Tuberculosis Society's\npublication Your Health), Dr. C. L. Hunt and Dr. A. John Nelson.\nPapers presented:\u2014\n\" Some Considerations in Public Health Control of Gonorrhoea,\" presented by\nDr. A. John Nelson to the annual meeting of the Canadian Public Health\nAssociation.\n\" Co-operation between Police and Health Departments in Venereal Disease\nControl,\" presented by Dr. A. John Nelson at the annual conference of the\nPacific Coast International Association of Law Enforcement Officials.\n\" Present Status of Premarital Blood Testing,\" presented by Dr. A. John Nelson\nto the Provincial Council of Women, New Westminister group.\nAn exhibit was presented by the Division at the North Vancouver Kiwanis Annual\nFair and Trade Exhibition.   The theme was \" Corky the Killer.\"   The exhibit was well\nreceived and created interest.   Literature was distributed, questions answered, and blood\ntests were offered to the public.   Pictures of the exhibit were published in the British\nColumbia Tuberculosis Society's magazine Your Health.\nGENERAL\nThe year was marked by anticipation that some clear-cut policy would be enunciated\nwith regard to more satisfactory headquarters and clinic space for the Division; apparently\nplans have again met with delay. This is indeed unfortunate because it is possible that\nin the not too distant future the present space may become untenable due to its physical\ncharacteristics. There is also the possibility that it may soon be required by the Vancouver\nGeneral Hospital for its building programme.\nDuring the year Dr. A. John Nelson was appointed Director of the Division. Dr.\nNelson had previously been with this Department and left to become associated with the\nDivision of Venereal Disease Control in the State of New York. Besides being Director\nof Venereal Disease Control, Dr. Nelson is also consultant in epidemiology to the Health\nBranch, and it is felt that this is a most satisfactory arrangement.\nDr. W. Stuart Maddin, following three years' postgraduate training in syphilology\nand dermatology, under the National health grants, returned late in the year as physician\nin charge of clinics. Dr. Maddin's specialized knowledge and ability will be most\nvaluable to this Department.\nDr. C. L. Hunt, the former Director, is now employed on a part-time basis as\nconsultant in internal medicine.\nNational health grants continue to prove extremely useful in assisting the Division\nto maintain its ever-expanding services, as well as in affording opportunities for\npostgraduate training of medical and nursing personnel.\n_ BB  112 BRITISH COLUMBIA\nFunds from these grants were made available to assist in the operation of the British\nColumbia Medical Centre Library, where up-to-date literature on venereal diseases is\nmaintained. The Divisional Director is an active member of the management committee\nof this library.\nThe Division is most appreciative of the co-operation and help extended by various\ngroups and agencies who have contributed so much to the success of the venereal-disease\ncontrol programme. Special mention must be made of the Vancouver City Police, the\nRoyal Canadian Mounted Police, the British Columbia Hotels' Association, the Liquor\nControl Board, and the Indian Affairs Branch of the Department of Citizenship and\nImmigration.\nIn addition, special appreciation is expressed to the Division of Laboratories, without\nwhose ever-willing services and co-operation this Division would find it difficult to\nfunction, and also to the Division of Vital Statistics for the helpful advice and assistance\nso freely given at all times. DEPARTMENT OF HEALTH AND WELFARE, 1952 BB 113\nREPORT OF THE DIVISION OF TUBERCULOSIS CONTROL\nG. F. Kincade, Director\nProbably foremost in our minds at the time of the last annual report was the\nreduction of the waiting-list and its eventual elimination through the opening of the\nPearson Tuberculosis Hospital in May, 1952. This opening so markedly reduced the\nwaiting-list that at the present time there are less than fifty people waiting for beds in our\nProvincial sanatoria.\nThe remodelling at Tranquille Sanatorium was completed, and, as a result, fifty\nadditional beds were made available near the end of the year. When these beds are\navailable and the Pearson Hospital is finally staffed and working to full capacity, the\npresent waiting-list will undoubtedly be eliminated.\nHowever, it should be pointed out that the present waiting-list is from a highly\nselected group, and undoubtedly additional cases could benefit from a sanatorium regime\nor should be in sanatorium for the protection of others. If these standards for admission\nwere applied, the expansion of Pearson Hospital to its eventual capacity of 528 beds\nwould undoubtedly be required.\nOne of the biggest jobs in the Division during the past year was the setting-up of\na personnel section and the clarification of staff complements to cover all the activities\nof the various units so that this phase of the work would be put on a sound basis. This\nwas a long and painstaking procedure and, when applied to almost a thousand members\nof the staff, represented a great deal of work and detailed study. During the critical\nperiod in the spring when a large number of appointments and transfers were necessary\nwith the opening of Pearson Hospital, this work was greatly retarded by the resignation\nof the first personnel assistant. However, with the appointment of the present personnel\nassistant the organization has come along rapidly. It is expected that when the\npersonnel section is properly organized and the office routine set up, the personnel\nassistant will be able to devote considerable time to the investigation of office procedures\nand organizational work.\nAs forecast in the last annual report, the two largest sanatoria have now the services\nof trained administrative assistants. The purpose of these positions is to relieve the\nmedical superintendents of all that part of the work directly related to business so that\nthe superintendents may confine most of their attention to the gradually expanding\nmedical organization necessary for the treatment of tuberculosis. The administrators,\nhaving had formal instruction and experience in hospital management, should improve\nfurther efficiency in our sanatorium operations.\nNATIONAL HEALTH GRANTS\nNational health grants continue to be of great assistance to the Division. To date\n$294,000 has been allocated of the $370,329 made available by Ottawa. Approximately\n58 per cent of this amount is being used in continuing projects, but new and improved\nservices were also provided under these grants.\nThe X-ray services were expanded with the installation of photoroentgen equipment\nat Burnaby Hospital, University of British Columbia Health Service, Mission Hospital,\nDawson Creek Hospital, and Abbotsford Hospital. Additional darkroom installations\nare being provided for three health units. Equipment was provided this year to complete\nthe furnishing of the pathology laboratory at Tranquille and the departments of respiratory\nphysiology and physiotherapy at the Willow Chest Centre. A project is now being\nconsidered for the modernization of the X-ray department at Tranquille.\nApproval has been obtained for the expansion of the admission X-ray programme\nto the smaller hospitals in the Province.   At the present time this service is provided only BB  114 BRITISH COLUMBIA\nin those hospitals large enough to warrant the provision of photoroentgen equipment.\nIt is now planned to pay all the smaller hospitals $2 for each chest X-ray taken on\nadmission, using their own equipment.\nAssistance continues to be provided for postgraduate training. During the year one\ndoctor completed his training and returned to the Division. At the present time three\nnurses and one doctor are receiving postgraduate training, and a project is being submitted\nfor the training of a second physician. One of the staff is taking a course as a medical-\nrecord librarian and will return to the Division in that capacity. Funds are available for\nshort courses for senior personnel, and two members of the staff took such courses during\nthe year.\nThroughout the various units of the Division eighteen members of the staff are being\npaid through National health grants.\nPlans are being made for the expansion of the rehabilitation programme by providing\nrehabilitation officers for both Tranquille and Pearson, and expansion of the physiotherapy service by providing a part-time physiotherapist at Tranquille.\nThe project to provide P.A.S. and streptomycin was enlarged to provide isoniazid\nas well.\nApproval was not received for the continuation of the out-patient occupational\ntherapy nor the home-care service in the Vancouver area. The payment for streptomycin injections in the home was also discontinued.\nTRENDS IN THE TREATMENT OF TUBERCULOSIS\nIn reporting the work of the Division of Tuberculosis Control the changing concepts\nin the treatment of this disease should be pointed out. From the extensive studies that\nhave been made through the use of streptomycin and P.A.S., it is now evident that\nresistance of the tubercle bacillus to streptomycin can be, to a great extent, controlled by\nits combination with P.A.S. and its use in smaller dosages over long periods of time.\nWith the fear of resistance removed, it is now possible to treat and control tuberculosis\nin over 75 per cent of cases without resistance developing and without toxic effects on\nthe patient. This has greatly broadened the use of these drugs, and it is now felt that\nif a patient needs treatment for tuberculosis, he should have antimicrobial therapy.\nWhere formerly patients were treated from three to six months, they are now being\ntreated from one to two years and even longer with these drugs. The addition of isoniazid\nto the armamentarium has further broadened the attack against tuberculosis, so that\nmedical cures can frequently be expected.\nWith the advances in chest surgery and refinements in techniques, pulmonary\nresections are commonplace and, in fact, may soon outnumber surgical collapse procedures. Where formerly we hoped for arrest of the disease, we now strive for\neradication. This new approach, while offering great hopes to patients, is also stimulating to those who conduct their treatment. However, it does put the treatment of\ntuberculosis on a highly technical plane and requires extensive investigation of patients\nwith modern equipment. Nevertheless, there is no doubt that when patients are treated\nin this way the relapse rate will be greatly reduced.\nDEATH RATES\nThe death rate from tuberculosis in 1951 continued to decline, and a rate of 18.4\nper 100,000 was recorded for the other-than-Indian population, as against 21.7 the\nprevious year. The final corrected death rate for 1951 for the total population was\n24.8, as against 27.2 in 1950. Since 1946 the annual number of deaths has been exactly\ncut in half, from 576 to 288. This reduction in mortality continued in 1952, there being\n214 deaths, compared with 288 in 1951.   This was chiefly due to a considerable reduction DEPARTMENT OF HEALTH AND WELFARE, 1952 BB  115\nin Indian and Oriental deaths.   The mortality rate in 1952 for the total population was\n17.9 per 100,000, as against a rate of 24.8 for 1951.\nWhile the tuberculosis death rate for British Columbia approximates the death rate\nfor Canada and is reasonably satisfactory considering the rate of reduction, there is one\narea in the Province where the death rate for other than Indians is three times that of the\naverage. This indicates the need for a concentrated effort in that area. It is pleasing\nto report that discussions have already been held and plans are being laid for a special\neffort in that area.\nTUBERCULOSIS IN OLDER PERSONS\nFor some time the problem of tuberculosis in the older person has given some\nconcern. From the annual reports it will be seen that the incidence of tuberculosis in this\ngroup is becoming more apparent, and that the death rate by age specific groups is higher\nthan in other groups. However, it should be pointed out that for the older persons the\ndeath rate is falling, as in the younger age-groups. It is also apparent that this problem\nis more serious among the older male patients than among the older females. This is\nconfirmed by an analysis of patients in sanatoria at the present time. As of October 20th\nof this year a spot survey was made, and it was shown that 552 beds were occupied by\nmales, while 286 were occupied by females\u2014a ratio of almost two to one for the males.\nOf the 552 male beds, 252 or 45.6 per cent were occupied by persons 50 years of age and\nover. Of the 286 female beds, 24 or 8.6 per cent were occupied by persons in these\nage-groups. In all there were 276 persons, 50 years of age and over, occupying 32.3\nper cent of the total of 838 beds. In view of the fact that 24.4 per cent of the admissions\nin 1951 were for patients 50 years of age and over, it is apparent that these people tend\nto accumulate in sanatoria. The trend in admissions is also interesting because in 1947\nthis group represented only 16.7 per cent of the admissions. From this it is apparent\nthat special consideration must be given to this problem by this Division.\nThe first consideration that presents itself is in respect to accommodation. Is a highly\ndeveloped medical service required to treat this type of patient or would ordinary convalescent care be sufficient? Is there any justification in restricting this type of patient\nto a strict sanatorium regime, when most of them have little hope of cure and have, for\nthe most part, already received the maximum benefit from sanatorium care? In any\nevent it is apparent that tuberculosis in the older person is becoming one of our greatest\nproblems, and closer study of this problem than has been given in the past must be\ncarried out.\nX-RAY PROGRAMME\nAt the time of the last annual report it was pointed out that the work of the mobile\nsurvey unit would need critical review to determine a future course in this matter. The\nwork for 1951 was analysed, and as a result of this analysis it was shown that this was\nnot an expensive undertaking compared to other methods, and that the yield in cases\nfound was very satisfactory. The cost of 42 cents an examination compared favourably\nto the rates paid to hospitals for miniature films, and the case-finding rate of 2.2 cases\nper thousand compared favourably with other clinics. It was therefore recommended\nthat this service be continued, particularly where it reached into areas that otherwise\ncould not be covered.\nIt was also decided that the mobile X-ray programme should be on a continuous\nbasis. This Division is grateful to the British Columbia Tuberculosis Society for providing\na new truck and generator, which should enable us to carry out this work in every part of\nthe Province. There was an unavoidable delay in starting this work in the fall due to\nnon-delivery of equipment, but it was undertaken, and the unit continued to work in the\nLower Fraser Valley until the end of the year. At the first of the year it will be available\nfor work on Vancouver Island, and it is expected that the summer season will be devoted BB 116 BRITISH COLUMBIA\nto work in the Interior. It has been asked that all areas of the Province submit their\nrequests for use of this equipment so that the itinerary can be planned. Once this is\nestablished, it is hoped that a pattern can be developed so that the unit may move\ncontinuously throughout the Province each year, it being understood, of course, that it\nwill not visit those areas that have been supplied with photoroentgen equipment.\nIn spite of a great deal of effort, the results from admission X-ray surveys have not\nbeen as good as was anticipated this year, although there was an improvement over the\nprevious year, there being 47,793 admission X-rays during 1952, as against 28,700 in\nthe previous year. It is to be hoped that this showing will improve because the programme is backed by all the official organizations connected with hospitals, particularly\nthe British Columbia Hospital Insurance Service, which has taken an active interest in\nthis work and is attempting to stimulate the hospitals to make a better showing. The staff\nof the Division must take every opportunity to promote this work and point out its\nadvantages both to the staff of the hospitals and to the patients. When some of the\nlarger hospitals are approximating 90 per cent examination of admissions, it is difficult\nto understand why in smaller hospitals, where the organization is less complicated, similar\nresults cannot be achieved. However, it is encouraging to note that most hospitals, where\nrequested, have co-operated very well in the examination of out-patients. While the poor\nshowing in respect to admissions is to be regretted, it must be remembered that it is of\nconsiderable importance that this examintaion was made available for out-patients.\nEncouraged by the Chilliwack experiment, where an organizational plan for\ncanvassing the population to have chest X-rays at the survey unit in the hospital was\ncarried out, the British Columbia Tuberculosis Society is considering provision of an\norganizer to expand this work to other centres in the Province. In this way it is hoped\nthat all of the centres with photoroentgen equipment will be organized along the same\nlines as Chilliwack, and that a continuous survey at each centre will be carried out.\nCredit should be given here to the members of the Junior Red Cross of Chilliwack, who\ngave splendid co-operation.\nIn 1952 there were 212,742 X-ray films taken in the clinics of the Division, general\nhospitals, and health units, as against 202,000 in 1951.\nTRAVELLING CLINICS\nIt is pleasing to report that the district work of the Division through travelling clinics\nis now on a more satisfactory basis. Because additional staff was made available through\nnew appointments, medical consultants are now able to accompany the travelling clinics\non their visits to the various areas. This has long been desired, and its accomplishment\nmakes for the provision of a better medical service and the promotion of closer relations\nbetween the Division, the health units, and the practising physicians.\nWhen consideration is given to the fact that a third of our known cases, or\napproximately 5,000 persons suffering from tuberculosis, are scattered throughout the\nsmaller centres of the Province, and that their follow-up and supervision must be carried\nout by the travelling clinics and the field health service, it can be seen that the provision\nof the necessary services is a considerable task.\nNEW CASES\nThe number of new cases discovered during the year amounted to 1,387. This was\na reduction and was partly due to changes in the system of notification whereby cases\nwhich are healed on diagnosis are not included in the central index of known cases but\nare followed by public health personnel on a referral basis. However, over and above\nthis there was an actual reduction in the number of new cases in 1952, but the extent of\nthis reduction is difficult to estimate. The new cases, broken down into racial groups,\nshow the following:   Indians, 256;  other than Indians, 1,131;  and into age-groups:\u2014 DEPARTMENT OF HEALTH AND WELFARE, 1952\nBB 117\nIndians\u2014\n0-4\t\n_____    31\n5-9\t\n_____    48\n10-14\t\n     36\n15-19\t\n_____    32\n20-24\t\n     24\n25-29 \t\n13\n30-39\t\n     21\n40-49\t\n     14\n50-59\t\n_____    14\n60-69\t\n       4\n70-79\t\n_____    12\n80 and over\t\n       7\nNot stated\t\nOther than Indians\u2014\n0-4\n26\n5-9\t\n___    17\n10-14\t\n___    12\n15-19\t\n___    26\n20-24\t\n___    47\n25-29\t\n___    58\n30-39\t\n.__    99\n40-49\t\n__ 109\n50-59\t\n___ 106\n60-69\t\n___ 103\n70-79\t\n___    61\n80 and over\t\n___    14\nNot stated\t\n___    12\nThe sources of reporting of new cases during the year were as follows:\u2014\nStationary clinics:   Tranquille, 10; Vancouver, 419;  Victoria, 48;  and New\nWestminster, 81.\nTravelling clinics: Interior, 52; Coast, 50; Island, 19; and Kootenay, 43.\nReported from outside the Division of Tuberculosis Control, 665.\nSOCIAL SERVICE\nDuring the year there was almost a complete change in the personnel of the Social\nService Section, but in spite of this a full complement of workers was maintained, and the\nSection is now fully staffed.\nA new policy of referral of patients was established, and is working out most\nsatisfactorily. Instead of waiting for a crisis to develop before a patient is referred to the\nSocial Service Section, it has become routine where social-work staff is available for all\nnewly admitted patients to be visited by the ward social worker soon after admission.\nThe purpose of this introductory visit is twofold\u2014to acquaint the patient with the kind of\nhelp that is available to him from the Social Service Section and to give the social worker\nan opportunity of getting to know something about the patient as a person and how he is\nresponding to the pressures that are part of a long-term disabling condition. In all the\nwork on the wards the closest team relationship is maintained with the doctors, the nurses,\nthe rehabilitation officer, and other allied workers in order to achieve the common goal,\nwhich is to help the patient accept his tuberculosis and fight it effectively with the weapons\nwhich are available to him in the hospital setting.\nThe home-maker service, instituted in 1948 under National health grants to provide\nhousekeeping assistance in select homes of tuberculosis patients, was discontinued in\n1952. The purpose of this service was to assist in relieving the acute shortage of beds\nexistent at that time. It was designed as a short-term project, and discontinued because\nit was felt that the opening of the Pearson Hospital would relieve the shortage.\nNURSING\nIn preparing the report on the nursing services for the past year, there does not seem\nto be a great deal in the general picture that can be considered as entirely new, but steady\nprogress has been made toward maintaining standards and improving services to the\npatients. The time seems opportune, therefore, to review the changes and developments\nthat have entered into the reorganization and expansion of the nursing services during the\npast decade.\nFour factors that stand out as a basic part of the nursing organization are as\nfollows:\u2014 BB  118\nBRITISH COLUMBIA\n(1) The educational programmes for tuberculosis nursing at the undergraduate\nand graduate levels.\n(2) In-service education for orientation of new staff, both auxiliary and professional nursing personnel. An article was prepared on the programme\nat Tranquille for publication in The Canadian Nurse.\n(3) Review and subsequent standardization of procedures and isolation\ntechnique to arrive at uniformity for the various institutions throughout the\nDivision. This is important because lack of uniformity, among institutions\nor among wards, can result in confusion.\n(4) Studies made toward developing patient-centred care, which included staff\nquota requirements and demonstrations and experiments with the team\nnursing plan.\nUnder the team plan, assignments are based on patients' needs rather than ward\nduties; for example, a group of patients is assigned to a professional nurse who is\nresponsible for their total nursing care, including the supervision of the duties done for\nthem by auxiliary personnel, aides, and orderlies. General staff nursing, done under this\npattern, is proving satisfactory from two standpoints: (a) Better over-all care for the\npatients, and (b) greater satisfaction for the staff nurse. However, it should be pointed\nout that successful implementation of the team nursing principle is dependent on three\nimportant requirements:\u2014\n(1) Adequate numbers of well-prepared staff who are physically and professionally able to carry full responsibility for a group of patients and direction\nof auxiliary staff members.\n(2) A proper proportion of professional and auxiliary staff in relation to the\npatient quota and volume of nursing service requirements.\n(3) Convenience of physical layout of ward, patients' rooms and service areas,\nand adequate equipment.\nMuch planning, organization, and staff education are still necessary before the team\nnursing plan can be implemented successfully in the various institutions of this Division.\nNevertheless, actual experimentation with the plan has progressed to the extent that the\nDivision's nursing service was invited to present a demonstration on team nursing to\nthe Western Canada Institute for Hospital Administrators at the workshop which was\narranged by the School of Nursing at the University of British Columbia for the nurse\nrepresentatives to the Institute.\nAdditional factors that have a direct bearing on the nursing service are as follows:\u2014\n(1) The need for review and subsequent revision of practices and policies on\nsuch routines as charting. Elimination of time-consuming and repetitive\nroutines would tend to make more time available for the nurse to spend at\nthe bedside or in consultation with co-workers, allied workers, relatives,\nand patients in the interests of better care and understanding of the\npatients.\n(2) Instruction for orderlies: The setting-up of a basic course of instruction\nand demonstration on essential procedures would strengthen and improve\npatient-care.   Implementation would be at the local level.\nTeaching Programmes\nAs in previous years, a variety of teaching programmes were undertaken to provide\ninstruction in tuberculosis nursing. The majority of nursing students were undergraduates from Mainland hospitals. These students spent five weeks with the Division.\nA lesser number from Victoria hospitals attended classes for one week in Vancouver and\nthen returned to Victoria for clinical experience. DEPARTMENT OF HEALTH AND WELFARE,  1952 BB  119\nThe teaching programme also included practical-nurse students and public-health-\nnurse students, who undertook courses or attended programmes planned to provide\nexperience.\nThe number and types of programmes were similar to those conducted in the previous\nyear.\nThe Pearson Hospital, the Jericho Beach Hospital, the Willow Chest Centre, and\nthe New Westminster Chest Clinic are all being used for student experience.\nGENERAL\nAt this time, mention must be made of the splendid co-operation among parts of the\nthe Division and of the excellent relations with other departments of Government. The\nDivision of Tuberculosis Control must depend on a great many agencies to carry out its\nprogrammes and to conduct its day-to-day business. It is therefore gratifying to be able\nto state that every assistance possible has been extended to this Division.\nWith other organizations, such as the Indian Health Service, the closest and most\ncordial arrangements for mutual assistance have been maintained. The British Columbia\nTuberculosis Society, as in the past, has been a tremendous force in the campaign against\ntuberculosis. The work of the Preventorium Board is also noteworthy in that it provides\nthe facilities, not available within the Division, for the treatment of tuberculous children.\nPlans are at present under way for the expansion of the Preventorium from forty to eighty\nbeds.\nTo all these and many other organizations who assist in this work, the Division,\ntherefore, records its sincere appreciation.\nVICTORIA, B.C.\nPrinted by Don McDiarmid, Printer to the Queen's Most Excellent Majesty\n1953\n770-153-9352 ","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":"1953_V03_07_BB1_BB119","type":"literal","lang":"en"}],"http:\/\/www.europeana.eu\/schemas\/edm\/isShownAt":[{"value":"10.14288\/1.0348190","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":"Seventh Report of the DEPARTMENT OF HEALTH AND WELFARE (HEALTH BRANCH) (Fifty-sixth Annual Report of Public Health Services) YEAR ENDED DECEMBER 31ST 1952","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"}]}}