"78418b7c-f0b9-429c-a259-48a096f172e7"@en . "CONTENTdm"@en . "PUBLIC HEALTH SERVICES REPORT, 1959"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1198198"@en . "Sessional Papers of the Province of British Columbia"@en . "British Columbia. Legislative Assembly"@en . "2017-09-06"@en . "[1960]"@en . "https://open.library.ubc.ca/collections/bcsessional/items/1.0355720/source.json"@en . "application/pdf"@en . " PROVINCE OF BRITISH COLUMBIA\nSixty-third Annual Report of the\nPublic Healdi Services\nof British Columbia\nHEALTH BRANCH\nDepartment of Health Services and Hospital Insurance\nYEAR ENDED DECEMBER 31st\n1959\nStar\nPrinted by Don McDiarmid. Printer to the Queen's Most Excellent Majesty\nin right of the Province of British Columbia.\n1960 Office of the Minister of Health Services and Hospital Insurance,\nVictoria, B.C., February 24th, 1960.\nTo His Honour Frank Mackenzie Ross, C.M.G., M.C., LL.D.,\nLieutenant-Governor of the Province of British Columbia.\nMay it Please Your Honour:\nThe undersigned has the honour to present the Sixty-third Annual Report of\nthe Public Health Services of British Columbia for the year ended December 31st,\n1959.\nERIC MARTIN,\nMinister of Health Services and Hospital Insurance. Department of Health Services and Hospital Insurance (Health Branch),\nVictoria, B.C., February 24th, 1960.\nThe Honourable Eric Martin,\nMinister of Health Services and Hospital Insurance,\nVictoria, B.C.\nSir,\u00E2\u0080\u0094I have the honour to submit the Sixty-third Annual Report of the Public\nHealth Services of British Columbia for the year ended December 31st, 1959.\nI have the honour to be,\nSir,\nYour obedient servant,\nG. F. AMYOT, M.D., D.P.H.,\nDeputy Minister of Health. O\nI-H\n5.\nN\nr-H\nZ\n<\no\nO\nSI\nu\nz\n<\nffl\na:\nH\n<\nS\nu\n1\nri\n&\nE PS\n1\n55\n> >\ns a\nPhI/3\ni\na\n\u00C2\u00AB*h o\n__\u00C2\u00B0\na\no\n0 O\nd\no\nta\nM\no\nU 1\n't\nOJ\no w\nBI 5\nft .a\nrH \u00C2\u00B0J\nS 3\nO a.\nCCS\n\u00E2\u0096\u00BAJ.\nhH\nO\n.fl\n\u00E2\u0080\u00A2a\nV\n'.E\"3\n\u00E2\u0096\u00A0s.a\n-O\ncu\ntH\n1)\na\n_o\ncn\nT3\nU\ns\u00C2\u00A7\nh\nc\n>\n>\ns\nOJ\np=,\ng<\n\u00C2\u00AB\nM\nL J\nQ\nZ\n<\ni/)\ng w\n\u00C2\u00A3 <->\nifi K\n3 5_\nl<\n*H\nPh 0.\n___\n<\npq\n3\nz\no\ng\n\"33\no\nS3\nCfl\nas\nu\nPh\nO\npt.\nW\nH\nto\nHH\nz\nI-H\n3\ncn\n2\n1\nP -\n<\nPH\no\n&\ni\nO\na\n>\n\"\u00E2\u0096\u00A03\nt-i\nCO\n'3\n1\n\"0\n\u00C2\u00A9trl\na \"Is\nO cd\nll\nDivision of\nPublic Health\nEducation\nu\nDh\n-a\n\"3\nB\na\n3\na\nO w\npq\nH\n<\n3\nu\no\nH\nOh\nz\npq\nQ\n1\nrf.\nS\nc\n\u00C2\u00AB\n1\na\n\u00E2\u0096\u00A0S\no\n0)\nif\na Dq\n.2 \u00C2\u00AB\nX\n'3\n0\n*-\u00C2\u00BB\n\"3\na\nMH\nem\n.2\nCO\nH\noZ\nOS\n'S ca\n\u00E2\u0096\u00A0rt\na*\n.g\n\"3\nV\n*Sffi\n11\nB.JS\nb\nO\na\no\n'58\n.5 a\n3\nrs i\nu\nas\nu\nu\n0\ns\n>\nS\na\nc\n3\na\nra\nO\nra\nPh The Department of Health Services and Hospital Insurance consists of\nthree branches\u00E2\u0080\u0094the Health Branch, the Branch of Mental Health Services,\nand the British Columbia Hospital Insurance Service. Each of these is headed\nby a Deputy Minister under the jurisdiction of the Minister of Health Services\nand Hospital Insurance.\nThe chart on the other side of this page deals only with the Health Branch.\nFor convenience of administration, the Health Branch is divided into\nthree Bureaux. The Deputy Minister of Health and the Bureaux Directors\nform the central policy-making and planning group. The Divisions within\nthe Bureaux provide consultative and special services. The general aims of\nthe Deputy Minister with his headquarters staff are to foster the development\nof local health services, to provide advice and guidance to those local health\nservices, and to provide special services which cannot, for economic or other\nreasons, be established on the local level. Included in these are the special\nservices provided by the Divisions of Tuberculosis Control, Venereal Disease\nControl, Laboratories, Vital Statistics, Public Health Engineering, Public Health\nEducation, etc.\nDirect services to the people in their communities, homes, schools, and\nplaces of business are provided by \" local public health personnel.\" These\nfall into two broad groups. In the metropolitan areas of Greater Vancouver\nand Victoria-Esquimalt, they are members of the city and municipal health\ndepartments, which, in these two cases, do not come under the direct jurisdiction of the Health Branch. (However, they co-operate closely with the\nHealth Branch and, through it, receive substantial financial assistance with\nservices from the Provincial and Federal Governments.) Throughout the\nremainder of the Province the \" local public health personnel\" are members\nof the health units (local health departments), which are under the jurisdiction\nof the Health Branch. A health unit is defined as a modern local health department staffed by full-time public health trained personnel serving one or more\npopulation centres and the rural areas adjacent to them. Outside the two\nmetropolitan areas mentioned above, there are seventeen such health units\ncovering the Province from the International Boundary to the Prince Rupert-\nPeace River areas. TABLE OF CONTENTS\nGeneral Statement\nBureau of Administration-\nBureau of Local Health Services\nBureau of Special Preventive and Treatment Services\nVoluntary Health Agencies\t\nNational Health Grants\t\nDivision of Public Health Nursing\t\nDivision of Public Health Engineering\nDivision of Preventive Dentistry\t\nDivision of Occupational Health\t\nSanitary Inspection Service\t\nNutrition Service\t\nPage\n_ 9\n_ 12\n_ 14\n_ 30\n30\n. 33\n. 39\n. 45\n. 49\n. 55\n. 59\n. 61\nDivision of Vital Statistics 63\nDivision of Public Health Education 70\nDivision of Tuberculosis Control 72\nDivision of Venereal Disease Control 79\nDivision of Laboratories 81\nReport of the Rehabilitation Co-ordinator 87\nAccounting Division 91 Sixty-third Annual Report of the Public Health Services\nof British Columbia\nHEALTH BRANCH\nDepartment of Health Services and Hospital Insurance\nYEAR ENDED DECEMBER 31st, 1959\nG. F. Amyot, Deputy Minister of Health and Provincial Health Officer\nA comparison of the above title with that of previous years shows that there\nwas a reorganization of the Department during 1959. The Department of Health\nand Welfare ceased to exist and the Department of Health Services and Hospital\nInsurance came into being. This reorganization did not cause any change within\nthe Health Branch itself, but it combined in one department public health, mental\nhealth, and hospital insurance services.\nThis Report deals with the Health Branch and its public health services and\nconsists largely of sections written by the heads of the bureaux and divisions.\nDetails of the year's events and trends are presented in those sections. Some general\nobservations are as follows:\u00E2\u0080\u0094\nAREA AND POPULATION OF THE PROVINCE\nThe population increased by some 26,000 during 1959, reaching approximately\n1,570,000. According to preliminary figures, the birth rate was again down slightly\nfrom the record of 1957 and the death rate was at its second lowest point in nearly\ntwenty-five years. The infant mortality rate in 1959 was the lowest ever recorded.\nBritish Columbia's relatively high birth rate is making it necessary to devote an increasing amount of time to maternal and child health programmes.\nThe proportion of British Columbia's population over 60 years of age is higher\nthan it is in other Provinces. This makes it necessary to give particular attention to\nthis group also.\nIn area, the Province is approximately 366,000 square miles, but the metropolitan areas of Greater Vancouver and Victoria-Esquimalt contain about 45 per\ncent of the population. Although there are cities and communities of significant size\nthroughout the remainder of the Province, there are also vast areas which are only\nsparsely populated. Great travel distances are, therefore, an important factor in the\nprovision of public health services, Nevertheless, these services were available to\npractically every citizen in British Columbia in 1959, as they have been for a number of years. Calculations based on the non-Indian population show that approximately 45 per cent of the population were served by the two metropolitan health\ndepartments and almost 55 per cent were served by the Provincial health service.\nThe Federal Government provides services for the treaty Indians.\nTHE HEALTH OF THE PEOPLE\nMost of the deaths that occurred during 1959 were caused by heart disease\n(343.8 per 100,000), cancer (148.8 per 100,000), intracranial lesions of vascular AA 10 PUBLIC HEALTH SERVICES REPORT, 1959\norigin (103.9 per 100,000), and accidents (66.2 per 100,000). The death rate\nfrom suicides was 11.0 per 100,000, which was almost the same as it was in 1957\nand 1958.\nMotor-vehicle accidents were responsible for 33 per cent of the accidental\ndeaths reported, falls 16 per cent, drownings 12 per cent, and fires 8 per cent.\nAccidental deaths are responsible for a disproportionate number of years of\nlost life because most such deaths occur among young people.\nThe maternal mortality rate per 1,000 births has remained unchanged for four\nyears at 0.4. Deaths of infants under one year, however, continued to decrease,\nbeing 24.7 per 1,000 live births in 1959, compared with 27.6 in 1958 and 28.3 in\n1957.\nThe death rate from tuberculosis continued to drop, standing at 3.7 per\n100,000, compared with a rate of 4.5 the year before.\nPoliomyelitis killed fourteen. This has not been exceeded since the major outbreak of 1953, when twenty-eight people died.\nAlthough no epidemics occurred, several of the more important communicable\ndiseases were reported with increased frequency this year. Paralytic poliomyelitis\nwas reported 132 times. This has not been exceeded since 1955, when there were\n143 cases. In 1958, only twelve notifications were received.\nAlthough there was little change in the total number of cases of venereal\ndisease, early infectious syphilis increased despite the most intensive efforts at\ncontrol.\nThere was a marked increase, too, in the number of reported Salmonella infections, with over 350 cases reported by local health services. This disease was\nfatal to six persons (three infants and three male adults).\nThere were only two outbreaks of bacterial food poisoning\u00E2\u0080\u0094one following a\nchurch dinner, the other in an armed forces' mess.\nOther infectious diseases with an increased incidence were infectious hepatitis,\nwith 907 cases reported, contrasted to 558 the year before, and streptococal infections, including septic sore throat, scarlet fever, etc., with 4,563 cases, compared\nwith 1,270 in 1958.\nSixteen cases of typhoid and paratyphoid fever were reported this year, which\nis fourteen less than the year before.\nAgain this year there were no confirmed cases of diphtheria in the Province.\nOTHER MAJOR EVENTS AND TRENDS\nA further improvement in accommodations for the staff of local health units\nwas brought about. Seven communities completed construction of health centres\nduring the year, five communities had centres under construction, and eight others\ntook planning action. Since 1951, when the present policy of providing Provincial\nfunds and National health grants to supplement the local funds was introduced,\nforty-three community health centres have been constructed. In recent years, funds\nfrom voluntary health agencies have given material assistance.\nThe use of anti-tuberculous drugs and surgery has enabled the Division of\nTuberculosis Control to reduce still further the number of sanatorium beds in\noperation. Even more important from the public health standpoint, the availability\nof beds has made it possible to take patients out of the community as soon as they\nhave been diagnosed and so reduce the spread of infection. The new methods of\ntreatment of tuberculosis have also increased the amount of care each patient can\ngive himself. This has improved the rehabilitation process and has also resulted in\nsubstantial reductions in staff. GENERAL STATEMENT\nAA 11\nThe tuberculosis institutions also effected economies in the operations of their\nclinical laboratories, dietary, housekeeping, and accounting departments, and janitorial services.\nThe policy in respect to tuberculosis surveys has changed. Until recently it\nwas considered desirable to take a chest X-ray of each member of the population.\nTuberculin testing has now been combined with the chest X-ray as a survey method.\nThis has led to a reduction in the number of X-rays taken, particularly in the younger\nage-groups.\nThe physical condition of school-children was good. In the Grade 1 group,\napproximately 80 per cent of the pupils received physical examinations. About 85\nper cent of those examined were in good physical condition. In the higher grades,\nin which examinations are given only to those referred because of some suspected\nproblem, the findings were also good.\nThe immunization status of the school population improved over that of previous years. One of the more encouraging developments was the trend toward a\nhigher immunization status of pupils in the more advanced grades.\nIn the important field of home nursing care, all health units were providing this\nservice on a short-term demonstration basis during 1959. The experience showed\nthat the development of a more complete home-care service can be brought about as\npersonnel become available.\nClose liaison with the voluntary agencies, the professional groups, and the\nother departments of Government was maintained during 1959. The Deputy\nMinister of Health is grateful for the co-operation of these groups, whose services\nare so valuable in meeting the health needs of the people of British Columbia. The\nDeputy Minister also wishes to thank his fellow public health workers for their help\nin all parts of the Health Branch. AA 12\nPUBLIC HEALTH SERVICES REPORT, 1959\nREPORT OF THE BUREAU OF ADMINISTRATION\nA. H. Cameron, Director\nThe Bureau of Administration consists of the administrative offices, the Division of Vital Statistics, and the Division of Public Health Education, which are\ngrouped together because they serve all other parts of the Health Branch. The Division of Vital Statistics and the Division of Public Health Education have separate\nreports elsewhere in this volume. The Bureau Director is a member of the Health\nBranch's central policy-making, planning, and administrative group and is concerned\nparticularly with non-medical administration. Some important features of the\nyear's experience in this field are as follows:\u00E2\u0080\u0094\nPERSONNEL\nThe table below shows the number of regular full-time positions in the various\noffices, divisions, and services of the Health Branch at the end of 1959 compared\nwith the number at the end of 1958.\nOffice, Division, or Service\nLocation\nPositions 1\n1958\n1959\nVictoria \t\nVancouver. \t\n36\n26\n61\n16\n18\n59\n1\n14\n159\n228\n10\n7\n10\n4\n56\n293\n36\n24\n61\nDivision of Venereal Disease Control \t\nVancouver.. _ \t\nVancouver \t\n16\n17\n59\nDivision of Tuberculosis Control\u00E2\u0080\u0094\nHeadquarters \u00E2\u0080\u0094\t\nNelson \t\n1\n17\n151\n212\n8\nNew Westminster Stationary Clinic . \t\nMainland Travelling Clinics\u00E2\u0080\u0094\t\nIsland Travelling Clinic \u00E2\u0080\u0094\n7\nVancouver \t\n10\n4\n58\n306\nTotals \t\n998\n987\n1 These figures show the number of regular full-time positions. There were vacancies in various sections\nfrom time to time. In addition, there were some part-time positions.\nParticular attention is directed to the reduction in the number of positions at\nPearson Hospital. This was largely the result of the new policy of allowing certain\npatients to take care of many of their own needs with a view to increasing their progress in rehabilitation. The report of the Division of Tuberculosis Control, which\nappears later in this volume, provides greater details.\nThere was also a significant reduction in the number of positions at the Willow\nChest Centre. This reduction was brought about through studies in the effective\nutilization of staff.\nThe increase in the number of positions in Local Health Services is largely the\nresult of increases in population.\nACCOMMODATIONS\nIn a co-operative effort to provide the Deputy Minister of Mental Health and\nhis headquarters staff with offices geographically separate from the Provincial Mental\nHospital, plans were made to complete the seventh (top) floor of the Provincial\nHealth Building in Vancouver. It is hoped that the construction work will be com- ADMINISTRATION\nAA 13\npleted early in the new year. The Health Branch looks forward to this close association with the Deputy Minister of Mental Health as a means of improving still further\nthe good relations with the Mental Health Services.\nBecause of the increase in poliomyelitis cases, there was a danger of overcrowding in the Poliomyelitis Pavilion. Some patients there require three types of bulky\nequipment\u00E2\u0080\u0094ordinary hospital bed, rocking bed, and respirator. To alleviate this\nspace problem, plans were made in co-operation with the Department of Public\nWorks to erect a temporary storage building connected to the Pavilion. At the\nyear's end, construction was about to be undertaken. It was anticipated that the\nbuilding could be erected in a few weeks.\nTRAINING\nIn-service training and academic training enable the Health Branch staff to\nprovide up-to-date professional, technical, and administrative services to the public.\nNational health grants again aided various members of the Health Branch to undertake postgraduate training at universities and to attend short-term courses. In 1959\nsixteen employees completed professional training, fifteen commenced training, and\nsixteen attended short-term courses. (These figures do not include training provided\nto personnel of hospitals, the Mental Health Services, and other health agencies.)\nNational health grants provided funds for a refresher course for Medical Health\nOfficers in January of this year. The grants also enabled the Health Branch, in\nconjunction with the Mental Health Services, to sponsor a Mental Health In-service\nEducation Institute for fifty public health nurses in October.\nWeekly meetings of headquarters staff and monthly meetings of local health\nunit staffs enabled Health Branch personnel to discuss current problems and to keep\nabreast of new programmes both at the local and divisional level. The Annual\nPublic Health Institute, this year held in Victoria in April, also served to maintain\na high standard of public health knowledge. The principal speaker was Dr. J. F.\nMcCreary, Dean of Medicine, University of British Columbia.\nNATIONAL HEALTH GRANTS\nThe Assistant Provincial Health Officer, who is stationed in Vancouver, holds\nthe prime responsibility for the administration of the National health grants programme under the direction of the Deputy Minister of Health. However, the Director of Administration, who is stationed in Victoria with the Deputy Minister of\nHealth, must maintain an active interest in the programme and serve as an adviser\nto the Deputy Minister in connection with it. There were no major changes in the\nprogramme during 1959. The report of the Assistant Provincial Health Officer,\nwhich appears later in this volume, gives details of the 1959 experience.\nRECIPROCAL AGREEMENTS (TUBERCULOSIS)\nIn 1959 reciprocal agreements for the care of tuberculosis patients were continued with Alberta, Saskatchewan, Manitoba, Ontario, and Quebec. The reciprocal\nper diem rate with all these Provinces was raised to $8.\nThe number of British Columbia cases which were accepted by the other Provinces in 1959 was nineteen (Alberta, seven; Saskatchewan, four; and Ontario,\neight). The number of patients from other Provinces receiving care in British\nColumbia in 1959 was only five (Alberta, three; Manitoba, one; and Quebec, one).\nBy the end of the year the number of British Columbia patients cared for in other\nProvinces had decreased to nine, and only two patients from other Provinces were\nbeing cared for in British Columbia. AA 14 PUBLIC HEALTH SERVICES REPORT, 1959\nREPORT OF THE BUREAU OF LOCAL HEALTH SERVICES\nJ. A. Taylor, Director\nORGANIZATION AND DEVELOPMENT\nThe term \" local health services \" denotes public health services at the municipal level, embracing public health nursing and environmental sanitation, and is\nclosely allied with services in tuberculosis control, venereal disease control, public\nhealth laboratories, occupational health, vital statistics, public health engineering,\npublic health dentistry, and public health education, which, although administered\nby separate divisions, are provided to the community by the field staff in local health\nservices. Basically the ideal type of full-time local health services has been found\nto be most efficiently administered through a health unit in which a number of\nmunicipalities unite their local Boards of Health into a Union Board of Health,\nemploying qualified public health personnel to render public health services to their\ncommunities. At the same time, an opportunity is afforded the district School\nBoards to transfer their school health services to the Union Board of Health and to\nappoint the staff of the health unit to direct those services for the future. Those\nmunicipalities and school districts which have taken this action have developed a\nuniform basic public health administration, not only for the entire unit area, but\nwhich, because of consultation and supervision through the Health Branch, is coordinated with all similar services throughout the Province.\nIn the beginning, plans were laid for the provision of seventeen health units\nthroughout the Province, which, together with the metropolitan areas in Vancouver\nand Victoria, provided for full-time health service for almost all populated parts of\nBritish Columbia. Once these became established, the basic framework of public\nhealth administration was set up, on which additional services and programmes\ncould be added as the industrial and population growth of the Province indicated\nand the changing pattern in public health needs warranted. This has now occurred\nexcept in the Gibsons-Howe Sound area, where full-time health unit service remains\nto be organized. Requests from the Municipal Councils and School Boards for that\narea indicate that they desired this to occur at an early date, and some study has\nbeen under way to determine what would be the best type of administration for\nthat area. It is not sufficiently large enough in itself to warrant a health unit, and\nit should become attached to an already existing health unit. From the point of\nview of transportation, the best approach administratively would be to have it\nbecome part of the North Shore Health Unit; some preliminary negotiations in that\ndirection have been conducted, but considerable further study of the proposal has\nto be made.\nIn the Greater Victoria area, the administration of public health services is\nprovided through three different administrations\u00E2\u0080\u0094namely, the Victoria-Esquimalt\nHealth Department, the Saanich and South Vancouver Island Health Unit, and the\nOak Bay Health Department. On numerous occasions, consideration has been\ngiven toward development of a larger administration patterned along that existing\nin the Greater Vancouver area, where a metropolitan health committee co-ordinates\nthe numerous separate administrations. Renewed interest in such a proposal arose\nduring this past year when the Greater Victoria School Board indicated dissatisfaction with the administration of school health services through three separate bodies,\nand suggested that they be transferred to a single health unit, as permitted under the\nPublic Schools Act. Negotiations were recommenced for study of the metropolitan LOCAL HEALTH SERVICES\nAA 15\nset-up and are being continued into the new year in the hope that some unanimity\nmight be obtained to provide for it.\nThe Metropolitan Health Services in the Greater Vancouver area has maintained pace with the growth of the area and has increased the scope and quantity\nof its services to fulfil the health needs there. An employees' health programme\ncame into being with the establishment of an occupational health section under the\ndirection of an occupational health physician. As the year ended, the municipality\nof Richmond was indicating an interest in the establishment of a complete full-time\nhealth service for the municipality, and was investigating the possibility of employing\nits own full-time Medical Health Officer to direct that service.\nWithin the Provincial health units, some administrative readjustments became\nnecessary through resignations and transfers of health unit directors. At the\nbeginning of the year the Director of the Central Vancouver Island Health Unit\nresigned to accept an appointment as Chief, Division of Epidemiology with the\nDepartment of National Health and Welfare. The vacancy thus created was filled\nthrough the transfer of the Director of the West Kootenay Health Unit, who assumed\nthe appointment. The resulting vacancy in the West Kootenay Health Unit was\nfilled through the placement of a public health physician who had recently completed\ntraining in the School of Public Health at the University of Montreal.\nA vacancy which had existed for many months in the Selkirk Health Unit,\nwith headquarters at Nelson, was overcome when a recruitment programme directed\na public health physician into that position. The same recruitment programme\nobtained the services of another trained and qualified health unit director to assume\nan appointment in the Skeena Health Unit, with headquarters at Prince Rupert,\nresulting from the resignation of the former director to return to the private practice\nof medicine.\nThe North Fraser Health Unit, with headquarters at Mission, which had been\noperating without a director at the beginning of the year, was in that state again at\nthe end of the year, when the director employed through the spring and summer\nresigned to take the position of director of occupational health with the Metropolitan\nHealth Services at Vancouver. A replacement is being sought for him through a\nrecruitment programme organized to enlist some new physicians to take up appointments in anticipated vacancies within the next few months.\nLeave of absence was granted to the Director of the Peace River Health Unit,\nwith headquarters at Dawson Creek, to undertake postgraduate training in public\nhealth at the School of Hygiene, University of Toronto. It was not possible to restaff\nthat position, but it was possible to arrange for the Assistant Director of the Cariboo\nHealth Unit to take on the position as Acting-Director, Peace River Health Unit,\nduring the absence of the incumbent. Assistant positions in the Boundary and Central Vancouver Island Health Units, one of which was a vacancy and one new, were\nable to be filled also. This meant that the vacancy in the Central Vancouver Island\nHealth Unit was replaced, and the newly created position of Assistant-Director in\nthe Boundary Health Unit became operative. Unfortunately the newly created\nAssistant-Director position in the Cariboo Health Unit did not even get a chance to\nfunction as reorganization within the Peace River Health Unit denied that opportunity.\nGRANTS TO RESIDENT PHYSICIANS\nBecause of the sparsity of population in certain parts of this mountainous\nProvince, numerous small communities situated in remote areas are often unable to\nobtain medical care since there hardly seems to be a sufficient volume of therapeutic\nneed to attract professional interest or to provide sufficient remuneration to a AA 16 PUBLIC HEALTH SERVICES REPORT, 1959\nphysician. In an attempt to assist in this problem, a programme of grants-in-aid to\nresident physicians was organized to encourage physicians to take up residence in\nremote communities and to provide service on a periodic schedule of visits to the\ncommunities not sufficiently large enough of themselves to warrant a resident\nphysician. The amount of the grant is based upon a definite formula designed on\na sliding scale, inversely proportionate to the population, and directly proportionate\nto the distances to be travelled. The grant in itself, therefore, is not large, but does\nserve to reimburse the physician to some extent for out-of-pocket expenses incurred\nin providing the necessary medical supervision to the ill members of the community.\nThe community itself is expected to assume some responsibility to ensure that the\nnecessary office space and facilities are provided to the physician to meet his needs.\nThe physician must present a report on a quarterly basis to the Health Branch outlining the services he has provided. During the year, grants were continued to\ntwenty-one physicians in the administration of medical care to thirty communities.\nOne area of the Province considerably involved in the question of medical care\nwas Stewart, where, as a result of industrial shut-down, it became difficult for the\ncommunity to continue to attract a physician. As some likelihood of employment\nreturned, it was deemed desirable to provide a grant-in-aid to encourage the physician to stay in Stewart. It is evident that if he left, then the hospital might have to\nclose its doors, and the community would be left without either hospital or medical\ncare. An increase in the grant to the physician was undertaken and has been maintained for somewhat longer than was anticipated, since an uplift in employment has\nnot materialized to the degree that was anticipated.\nThe City of Greenwood has also suffered from inability to attract a resident\nphysician and for some years has been dependent upon periodic visits of physicians\nfrom Grand Forks. Recently a young well-qualified practitioner became resident\nthere, and the former grant-in-aid was re-established to encourage continuation of\nhis stay. In addition to providing services to Greenwood itself, he has undertaken\nregular schedules of visits to neighbouring communities, notably Beaverdell, where\na mine is in operation, and where an additional grant-in-aid is available for his\nservices to that area. It is hoped that a sufficient volume of practice can be located\nto maintain his professional interest since lack of medical care in this area has been\na long-felt health need.\nResidents in communities north of Kamloops in the North Thompson Valley\nhave had to travel long distances to obtain medical care, and steps have been under\nway on numerous occasions by residents in those communities to encourage a\nphysician to become established among them. The most central location seems to\nbe Clearwater, and physicians have tried from time to time to establish themselves.\nFor one reason or another, no one physician has remained for any length of time^\nbut in the fall of the year a new physician was attracted to the location and a grant-\nin-aid for that area became established. It is hoped that he can be induced to\nremain as a resident physician to satisfy the needs of the area in the provision of\nadequate medical therapy.\nSCHOOL HEALTH SERVICES\nEvery school has tremendous opportunities to promote the health of its pupils\nand of its community. From early childhood to early adulthood, most children are\nenrolled in schools and are under the supervision of school staffs for a substantial\npart of the day, approximately half the days of the year. The conditions under\nwhich they live at school, the help they are given in solving their health problems,\nthe ideals of individual and community health which they are taught to envisage, LOCAL HEALTH SERVICES\nAA 17\nand the information and understanding that they acquire of themselves as living\norganisms are factors which operate to develop attitudes and behaviour inducive to\nhealthy, happy, and successful living. In all of its efforts, the school must consider\nthe total personality of each student and the mutual interdependence of physical,\nmental, and emotional health. Policies must be organized toward development of\nthe school health programme, which recognizes that the total health of the child and\nhis total life situation become the prime objective of any school health programme.\nIt is not possible, of course, to segregate school health services entirely from\ncommunity health services, since the school pupil is a definite member of a family\ngroup in the community. On the other hand, the health of the school-child can be\na direct reflection of the community health, since the pupil spends a greater portion\nof his daily life in the community than as a dweller in the school. Indeed, his\nexperiences during his informative years as an infant and preschool child may prove\nan asset to his educational progress, in the measure of mental, emotional, and\nphysical development available to him in a healthful environment.\nThe school health programme must be correlated with the other health programmes of the community generally, but at the same time must concentrate certain\nspecialized services toward the child, to which the main considerations must be\nhealth services, health guidance, health instruction, and school environment. In\nthis, the classroom teacher and the public health nurse predominate, since close\ncollaboration between them can materially aid the child in the greatest need of professional attention. A conference between the teacher and the nurse must serve as\nthe basic framework and can often suffice to determine the people requiring need,\nand the solution to that need. In other instances, the support of the parents, the\nfamily physician, and the school physician, in consultation with others, will be\nrequired. The public health nurse is the link between the school and the home in\nthis field.\nImprovements in school health services are continually sought for schools. The\npresent programme is the result of study and inquiries that have gone on over many\nyears in analysing the objectives and the results of the programme. Pilot studies\nhave been encouraged in many of the health units in the interests of devising newer\napproaches. One of these was a long-term study into height-weight relationships\nas an index of the health of the school pupil, which originated initially through a\nstudy of the Wetzel Grid in the school health services of the Central Vancouver\nIsland Health Unit, which was continued in the study of a growth period developed\nfrom an analysis of more than 10,000 records available from the past twelve years'\nprogrammes. The former director of the health unit sparked the new study and was\nencouraged in this by the Professor of Paediatrics in the Faculty of Medicine at the\nUniversity of British Columbia. It was also aided by the Director of the Division\nof Vital Statistics, who personally and through use of graphs provided analysis of\nthe charts in preparation of the primary graphs. The departure of the Director of\nthe Central Vancouver Island Health Unit did not close this study, since in his position as Chief of Epidemiology in the Department of National Health and Welfare\nhe has maintained his interest and has had available the consultative services of\npaediatricians and nutritionists in evaluation of the proposed graphs. The paediatricians urge that the information be given thorough consideration in preparation for\npublication, since they feel that the materal available from the years of recording\nprovides a background of exceeding value in determining the relationship of height-\nweight figures as an index of health. Collaboration between the interested parties\nis maintained, therefore, although progress is slow because of the separation of the\ncollaborators by distance. AA 18 PUBLIC HEALTH SERVICES REPORT, 1959\nThe need for development of a community mental-hygiene programme is definitely reflected in the repeated representations made for consultative services for\nemotional problems in children. The Health Officers' council has urged that these\nservices be provided, and the various branches of the Mental Health Association\nhave made similar requests.\nThe Metropolitan Health Services for Greater Vancouver has pointed the way\nin its organization of a Division of Mental Hygiene which devotes its major attention to children. Similar approaches are desirable for other areas of the Province.\nConsultations have been held with the Mental Health Services Branch to determine\nwhat action can be taken toward providing a solution to the need, if only in part;\nsimilar negotiations in that direction are being planned, in which it is hoped a coordinated approach between the Mental Health Services Branch and public health\nservices can be evolved in initiation of some measure of community mental hygiene.\nIn many of the schools there are mental-hygiene counsellors available to the teachers\nwho, through special training in the mental-hygiene programme in the Metropolitan\nHealth Services, are qualified to provide counselling services to the teachers and the\npupil. It would seem that more of these are desirable in an endeavour to fulfil the\nneed for handling pupil emotional problems.\nCertain refinements and improvements in the design of a hard-of-hearing programme became possible when a qualified physician specializing in otology was\nappointed to the Health Centre for Children in Vancouver. Under his guidance a\nhearing-testing programme in schools is being reorganized and a travelling clinic\nhas been developed. Considerable assistance in this came from National health\ngrants and the British Columbia Foundation for Child Care, Poliomyelitis and\nRehabilitation. Speech therapists are available to assist in speech therapy for those\nchildren requiring help through that type of service. Originally, hearing-testing\nwas planned for each health unit, using audiometers purchased some years ago.\nImprovement in the design of audiometric equipment has occurred since then, and\nduring this past year it was possible to supply a smaller type of audiometer known\nas \"Otochek\" in somewhat greater numbers; the use of these provides promise of\nan augmented hearing-testing programme. Screening of the pupils requiring this\nfiner testing will be on referral through the teacher-nurse conference, in addition to\nsuch referrals as may be directed by the family physician or by the parent. Routine\naudio-metric testing of entire classrooms is not a feature of the service.\nExaminations and reports of environment by the sanitary inspectors attached\nto the health units are carried out annually. In these fields, investigation of the\nwater-supply, sewage-disposal, school lighting, ventilation facilities, safety features,\nfire protection, and building construction are all evaluated in a report which forms\npart of the report presented to the School Board, indicating where improvements\nand alterations in the school plan are desirable in the interests of the health of the\nschool pupils and staff. The school population continues to advance at its normal\nrate, and new school buildings are required. These more recently designed buildings\nare eminently superior to the older buildings, indicative of the trend to better\ndesigning, better lighting, and more suitably accommodated schools.\nIt does not seem desirable to enumerate in detail all the programmes within\nthe health field that have a bearing on the school health programme; therefore,\nreferral to the numerous sections of this Annual Report dealing with public health\nnursing services, dental services, nutrition services, sanitation services, vital statistics, and health education will round out the pattern that has a bearing on the health\nof the school-child. LOCAL HEALTH SERVICES\nAA 19\nTHE HEALTH OF THE SCHOOL-CHILD\nThe school health programme operates within the academic year, so that this\nanalysis of the health of the school-child is based on the programme from September, 1958, to June, 1959, during which school health services were provided in the\n1,147 schools included in the eighty-two school districts and the twenty-five small\nschool areas. The increase in the school population is reflected in a further increase\nin the number of children enrolled in the grades examined in the schools during\n1958/59, there being 279,040 children this year, compared with 272,499 the previous year; this represents a 2.3-per-cent increase in the number of pupils registered\nin the grades examined. In those grades, 38,174 pupils were examined\u00E2\u0080\u0094only 13.7\nper cent of the children in those grades. This is an 11-per-cent decline from the\nprevious year, when 42,947 children were examined, and is a further indication of\nthe decline in the volume of routine physical examinations. On the other hand,\nthere was an increase in the number of Grade I pupils examined. Table I shows\nthat 25,394 (79.5 per cent) of the 31,953 children enrolled in Grade I received\nexaminations; last year, only 75.7 per cent were given this service. This examination occurs at a transition period in the child's life when they are entering school\nfor the first time, and is usually conducted with the parent present and is therefore\nproductive of greater results when the parent endeavours to prepare the child for\nschool. In later grades, screening methods are adopted solely as a selection for\nmedical attention. In the elementary grades, somewhere between 3 and 6 per cent\nof the pupils were selected for extensive examination, and in the high-school grades\nthe volume of medical examinations continued to be based on selectivity and showed\na consistent decrease.\nAs could be anticipated, there was a considerable amount of examination\nrequired of children enrolled in special classes, which include classes for mentally\nretarded children. Twenty-four per cent of the enrolment required examination.\nIn other types of classes there was also need for concentration of medical examinations, when 56.2 per cent of the children so enrolled were given complete\nexaminations.\nThe results are presented in detail in the various statistical tables.\nTable I.\u00E2\u0080\u0094Summary of Health Status of Pupils Examined According to\nSchool Grades, 1958/59\nTotal\nPupils,\nAll\nSchools\nExamined\nin Grades\nSpecial\nClasses\nItem\nGrade\nI\nGrades\nII-VI\nGrades\nVII-IX\nGrades\nX-XIII\nOther\nTotal pupils enrolled in grades examined\n279,040\n38,174\n13.7\n84.5\n10.9\n3.8\n1.8\n0.8\n0.2\n0.3\n0.1\n0.1\n0.2\n31,953\n25,394\n79.5\n85.1\n10.6\n3.7\n1.4\n0.7\n0.2\n0.2\nC1)\n(T)\nC1)\n139,174\n7,109\n5.1\n82.8\n12.2\n3.7\n2.5\n1.0\n0.2\n0.3\n0.1\n0.1\nC1)\n65,236\n2,976\n4.6\n87.1\n9.2\n3.1\n2.0\n0.4\n0.3\n0.1\n0.1\n39,088\n1,296\n3.3\n89.7\n9.0\n1.8\n0.3\n0.8\n0.1\n0.1\n1,923\n462\n24.0\n52.4\n18.6\n11.3\n16.7\n4.1\n2.6\n9.1\n0.4\n0.6\n10.2\n1,666\n937\nPercentage of enrolled pupils examined ...\nPercentage examined with minor or no\nphysical, emotional, or menta! defects ..\nPercentage of pupils examined having\nspecified type and degree of defect\u00E2\u0080\u0094\n56.2\n80.9\n12 6\nEmotional 2 .... . ...\n7.4\n1 9\nPhysical 3 \t\n0.1\n0.6\nMental 3 .\n0.3\n02\n5 0\n1 2\n1 Less than 0.1 per cent. AA 20\nPUBLIC HEALTH SERVICES REPORT, 1959\nTable II.\u00E2\u0080\u0094Health Status of Total Pupils Examined in Grades I, IV, VII, and X\nfor the Year Ended June 30th, 1959\nTotal pupils enrolled in grades examined.\nTotal pupils examined..\nPercentage of enrolled pupils examined\t\nPercentage examined with minor or no physical, emotional, or\nmental defects\t\nPercentage of pupils examined having specified type and degree\nof defect\u00E2\u0080\u0094\nPhysical 2\t\nEmotional 2 \t\nMental 2\t\nPhysical 3\t\nEmotional 3 \t\nMental 3\t\nPhysical 4\t\nEmotional 4\t\nMental 4\t\n1 Less than 0.1 per cent.\n101,231\n29,509\n29.2\n85.0\n10.6\n3.5\n1.5\n0.7\n0.2\n0.2\nC1)\nC1)\nC1)\nTable III.\u00E2\u0080\u0094Health Status by Individual Grades of Total Schools, 1958/59\nItem\nAll\nSchools\nGrade\nI\nGrade\nII\nGrade\nIII\nGrade\nrv\nGrade\nV\nGrade\nVI\nGrade\nVII\nTotal pupils enrolled in grades examined.\n279,040\n38,174\n13.7\n84.5\n10.9\n3.8\n1.8\n0.8\n0.2\n0.3\n0.1\n0.1\n0.2\n31,953\n25,394\n79.5\n85.1\n10.6\n3.7\n1.4\n0.7\n0.2\n0.2\nO)\n28,925\n1,910\n6.6\n86.4\n10.8\n5.4\n4.0\n1.1\n0.2\n0.3\n0.2\n0.1\n0.1\n28,276\n1,279\n4.5\n81.5\n14.6\n4.5\n2.0\n1.4\n0.3\n0.4\n0.1\n27,897\n1,673\n6.0\n79.1\n13.8\n2.6\n1.9\n0.6\n0.2\n0.3\n0.2\n0.1\n27,019\n1,104\n4.1\n86.2\n12.0\n2.7\n2.1\n1.1\n0.2\n0.2\n27,057\n1,143\n4.2\n80.5\n11.3\n2.7\n1.6\n0.8\n0.3\n0.2\n0.2\n24,734\n1,631\n6.6\n88.5\nPercentage of enrolled pupils examined-\nPercentage examined with minor or\nno physical, emotional, or mental\nPercentage of pupils examined having\nspecified type and degree of defect-\n8.7\nEmotional 2. - \u00E2\u0080\u0094 \u00E2\u0080\u0094\n2.6\n2.5\n0.5\n0.3\n0.1\n0.1\n0.1\n0.1\n0.1\nItem\nGrade\nVIII\nGrade\nIX\nGrade\nX\nGrade\nXI\nGrade\nXII\nGrade\nXIII\nSpecial\nClasses\nOther\nTotal pupils enrolled in grades examined\n20,959\n581\n2.8\n82.3\n11.2\n4.1\n2.4\n0.5\n0.3\n0.2\n19,543\n764\n3.9\n87.7\n8.8\n3.3\n0.5\n0.3\n0.3\n16,647\n811\n4.9\n89.4\n9.0\n1.4\n0.4\n0.5\n0.1\n12,583\n306\n2.4\n88.2\n7.8\n2.6\n0.3\n1.0\n8,886\n173\n1.9\n87.9\n11.6\n2.3\n\" 2.3\n972\n6\n0.6\n100.0\n1,923\n462\n24.0\n52.4\n18.6\n11.3\n16.7\n4.1\n2.6\n9.1\n0.4\n0.6\n10.2\n1,666\n937\nPercentage of enrolled pupils examined...\nPercentage examined with minor or\nno physical, emotional, or mental\ndefects. - \t\nPercentage of pupils examined having\nspecified type and degree of defect\u00E2\u0080\u0094\n56.2\n80.9\n12.6\n7.4\n\t\n1.9\n0.1\n0.6\n\t\n0.6\n0.3\n0.2\n5.0\n\t\n\u00E2\u0080\u0094 _\n1.2\n1 Less than 0.1 per cent. LOCAL HEALTH SERVICES\nAA 21\nTable IV.\u00E2\u0080\u0094Immunization Status of Total Pupils Enrolled, According to\nSchool Grade, 1958/59\nTotal\nPupils\nEnrolled\nby Grades\nSmallpox\nNumber\nPer\nCent\nDiphtheria\nNumber\nPer\nCent\nTetanus\nNumber\nPer\nCent\nPoliomyelitis\nNumber\nPer\nCent\nTotal, all grades..\nGrade I _\nGrade II\t\nGrade III \t\nGrade IV\t\nGrade V \t\nGrade VI _.\nGrade VII\t\nGrade VIII\t\nGrade IX...\t\nGrade X\t\nGrade XI\t\nGrade XII\t\nGrade XIII _.\nSpecial classes\t\nOther \t\n279,040\n31,953\n28,925\n28,276\n27,897\n27,019\n27,057\n24,734\n20.959\n19,543\n16,647\n12,583\n8,886\n972\n1,923\n1.666\n194,170\n24,944\n22,346\n20,441\n18,925 I\n19,888 |\n20.996 |\n16,174 I\n12,167 |\n13,164 |\n10,921 |\n7,000 |\n4,852 |\n429 |\n1,149 |\n774 I\n69.6\n78.1\n77.3\n72.3\n67.8\n73.6\n77.6\n65.4\n58.1\n67.4\n65.6\n55.6\n54.6\n44.1\n59.8\n46.5\n206,662\n27,421\n24,299\n22.769\n20.857\n20.237\n21,728\n17,577\n13,548\n13,589\n10.855\n6,451\n4,768\n413\n1,040\n1.110\n74.1\n85.8\n84.0\n80.5\n74.8\n74.9\n80.3\n71.1\n64.6\n69.5\n65.2\n51.3\n53.7\n42.5\n54.1\n66.6\n181,886\n27,277\n24,144\n22,604\n20,463\n19,337\n18,887\n14,048\n10,113\n8.826\n6,823\n4.213\n2,872\n240\n941\n1.098\n65.2\n85.4\n83.5\n79.9\n73.4\n71.6\n69.8\n56.8\n48.3\n45.2\n41.0\n33.5\n32.3\n24.7\n48.9\n65.9\n242,383\n25,819\n24,994\n25,112\n24,873 |\n24,224 |\n24,176 |\n21,507\n17,925\n17,149\n14,716 |\n11,106 |\n7,599 I\n734 |\n1,370 I\n1,079 j\n86.9\n80.8\n86.4\n88.8\n89.2\n89.7\n89.4\n87.0\n85.5\n87.8\n88.4\n88.3\n85.5\n75.5\n71.2\n64.8\nA study of these tables is somewhat revealing, since they indicate that the\nphysical condition of even selected pupils is at a fairly high standard, as 84.5 per\ncent of those examined exhibited either minor or no physical defect. In the Grade\nI group, where routine physical examination is pursued to the extent that approximately 80 per cent of the pupils enrolled receive examination, 85 per cent of those\nwere in good physical condition. Thereafter, only referred pupils were given intensive medical examinations because of some suspected medical reason, yet a high\npercentage of those examined were found to be in good physical condition. It is\nthus evident from these tables that there is some justification for the change that\nhas occurred in the school health programme in the calculation of routine physical\nexamination for all pupils. Certainly, if only a small proportion of those selected\nfor reason of possible physical defect are medically or emotionally impaired, it\nbecomes obvious that the great majority of the pupils enrolled must enjoy a fairly\nhigh standard of normal physical health.\nIt is axiomatic that there should be a higher proportion of pupils in the special\nand other classes likely to have defects of one kind or another, since these classes\nare designed for pupils unable to cope with normal school situations. In Table III\nit becomes evident that these pupils, already handicapped, exhibit the greatest proportion of physical defects (23.1 per cent), emotional defects (24.5 per cent), or\nmental defects (36.0 per cent). It is possibly a commendable reflection on the\nefforts being made in the existing educational system to provide educational advantages for these children, especially when it is seen that 10.2 per cent are classified\nas having a major mental condition (4). The painstaking patience required of\nteachers in these grades in endeavours to promote some degree of learning is a\ncredit to them.\nThe amount of mental and emotional trauma in the regular grades in school\nis now being revealed by the newer classification of health status of the pupil adopted\nover the past four years; it permits comparison of this year's experience with past\nyears. In the last report, the total amount of emotional and mental defect was\nsomewhat significantly higher than in previous reports, but for the present year of\nreporting it is almost constant. It is likely that experience with the classification\nand its use are promoting a more uniform interpretation, and such constancy can be\nanticipated as an average trend; this will bear study in future reports when comparisons can be pursued further. AA 22 PUBLIC HEALTH SERVICES REPORT, 1959\nCertainly there does not now seem to be any higher proportion of mental or\nemotional disturbance between grades. The figures apply to children selected for\nexamination for reasons of mental or emotional instability; it becomes evident that\nthe proportion is not too alarming. It should be noted also that the pupil seems\nable to adjust to the school programme without any undue upset, maintaining a\nfairly constant emotional equilibrium throughout.\nThe immunization of the school pupil has improved this year over that of previous years. It is evident from Table IV that the majority of the pupils (over 65\nper cent in each category) have become immunized, the greater proportion against\npoliomyelitis. The opportunities presented through education of parents and children presenting themselves for poliomyelitis immunization has possibly had some\neffect in promoting an increase in immunization for other diseases; the greater use\nof multivalent vaccines is an added factor. Certainly this is the case in immunization to tetanus, in which the addition of tetanus toxoid to diphtheria toxoid has\nprompted a greater increase in the numbers immunized against that disease.\nPossibly the most encouraging development in the immunization picture is the\ntrend toward a higher immunity status for the pupils in the more advanced grades;\nthe greater the proportion of immune graduates, the better the protection of the\nentire community.\nThe greater proportion immunized has also been reflected in the pupils enrolled\nin special classes, but, nevertheless, further improvement there is possible. Certainly, these children, already crippled by defect or mental trauma, should be adequately protected against communicable infection.\nBecause of changes occurring in the method of reporting, it is not possible to\ngive the same reflection on the effect of communicable diseases on the health of the\nschool-child. The minor communicable infections so common to childhood, such\nas mumps, measles, rubella, and chicken-pox, are no longer reported on a routine\nbasis, and figures are no longer available for comparison with previous years. This,\nhowever, is not too serious since these minor communicable infections are prone to\noccur cyclically every four or five years in a peak incidence, falling in numbers as\nan immune population develops. They do not display serious complications and,\naside from creating a volume of school absenteeism, do not occasion serious defects\non the health of the average school-child. It is the major communicable infections\nthat are of more serious importance in so far as child health is concerned, and it is\nevident that during the past year the school-child was exposed to an increase in\nthese.\nScarlet fever and streptococcal sore throat took their toll in sickness when an\noutbreak of streptococcal infection was prevalent during the spring. The high incidence of scarlet fever (a rate of 244.5 per 100,000 population) and streptococcal\nsore throat (a rate of 46.1) is the highest experienced in the Province since 1952;\nit is difficult to explain why this should occur, since, in general, the use of antibiotics\nand chemo-therapeutic drugs over the past few years has reduced the volume of this\ntype of infection. It is possible that a change in the virulence of the organism is a\nfactor, but study will be necessary to determine if such is the case. In general, the\noutbreak was mild and did not create the complications formerly associated with\nthis infection; nevertheless, it did make inroads in the school attendance figures,\nand no doubt there will be a few pupils left with cardiac complications. One of the\nmost serious sequela, of streptococcal infections is rheumatic infection, which may\ntake several different forms, including rheumatic fever, rheumatic carditis, and so\nforth. It is well established that rheumatic infections follow infections of the\nhaemolytic streptococcus, usually developing within one to five weeks after a sore\nthroat. The exact nature of the disease process is not established; the most prob- LOCAL HEALTH SERVICES\nAA 23\nable theory is that it is an allergic reaction. Antibiotics have only limited usefulness\nin the treatment of the actue stages, but are very useful in preventive recurrences to\nwhich these patients are prone. The prophylactic antibiotics presumably assert\ntheir influence by protecting the patient from further attacks of streptococcal infection which might again aggravate the rheumatic condition and lead to permanent\ncardiac damage. The best prophylactic antibiotic is penicillin, administered daily\nby mouth or as a monthly injection. It is recommended that after an established\nattack of rheumatic fever the person should receive antibiotic phophylaxis until\nhe is 18 years of age, or at least for five years. A rheumatic fever prophylaxis programme has been introduced in this Province on a trial basis in four of the health\nunit areas. Seventy-seven cases of the condition are not receiving prophylaxis, and,\nbased on the information available from the administration of the programme to\nthose seventy-seven cases, the desirability of including the whole Province is being\nstudied. The study is going forward under the leadership of Health Branch officials,\nin consultation with a committee of the British Columbia Division of the Canadian\nMedical Association; financial support for the programme is forthcoming from\nNational health grants, which provided the money for the purchase of the necessary\ndrugs. It is an additional service designed for the protection of the health of the\nschool-children in which age-group rheumatic infections are more likely to occur.\nPoliomyelitis showed an increase this year over more recent years; a rate of\n8.4 per 100,000 population was the highest since 1955, being about ten times as\ngreat as that of the previous year. About one-quarter of the total cases occurring\ninvolved school-children, and four of the thirteen deaths were among that age-\ngroup. While this is serious enough, the situation might have been considerably\nworse except for the well-organized poliomyelitis immunization programme carried\non amongst school-children over the past four years.\nA change in reporting of poliomyelitis alters comparisons to some degree,\nsince only paralytic poliomyelitis is now being reported as such, whereas the other\nconditions that cause associated symptoms without paralysis are classified under\naseptic meningitis. It is not possible to make any comparisons in that connection\nwith previous years, since such conditions were unreported previously. Nevertheless, the fact that eighty-two cases of aseptic meningitis occurred this year is of\ninterest in any study of the health of the school-child.\nInfectious hepatitis is also a creator of school absenteeism and a factor influencing school health. There was an increase in this condition during the year,\nwith a rate of 57.8 per 100,000 population, to cause a greater proportion of illness\nthan in any year since 1955.\nOne significant situation is the record of a second year with no cases of\ndiphtheria, again a reflection of the efficacy of the immunization programme.\nCOMMUNITY HEALTH CENTRES\nThe proposal advanced through National health grants to encourage construction of community health centres by provision of grants has certainly promoted a\nchanged situation throughout the Province in so far as accommodation for the\nvarious health unit offices is concerned. To date, forty-three community health\ncentres have been constructed under the sharing grant, and more are being added\nyearly. Indeed, such is the demand for grants for this purpose that priority lists have\nhad to be established, accepting requests as planning is commenced; for the past\nthree years the list has had to be carried over into subsequent fiscal years, since it\nwas impossible to complete all the construction requested in any one current year. AA 24 PUBLIC HEALTH SERVICES REPORT, 1959\nUnder the proposal originating with the National health grants, it was planned\nto provide a designated grant for a specified square footage of office and clinic\naccommodation, up to a maximum, providing an equivalent amount was granted\nProvincially and municipally. Latterly, it became accepted that in addition to the\ngrants available through the senior governments, grants from voluntary health agencies could be added to aid in the financing and might be considered part of the local\nor municipal contribution; therefore, grants from the British Columbia Tuberculosis\nSociety, the British Columbia Division of the Cancer Society, the British Columbia\nDivision of the Canadian Arthritis and Rheumatism Society, the British Columbia\nFoundation for Child Care, Poliomyelitis, and Rehabilitation, and others have contributed materially toward the cost of construction of the various health centres. In\nrecognition of contributions from the voluntary health agencies, the building, in\naddition to providing office and clinic space for the official health agencies, has been\nproviding workrooms and meeting-rooms for the voluntary health agencies. By this\nmeans a community health centre then becomes a focal point for all community\nhealth services, both official and voluntary, and promotes co-ordination of those\nservices in the interest of community health generally.\nSince the introduction of the programme, costs of construction have increased\nmaterially, and there has been some agitation over recent years for an increase in\nthe amount of the National and Provincial share of the costs. While it would be\npossible under the National health grants to increase the National contribution\ntoward construction, it is nevertheless tied to the sharing principle. From the Provincial point of view, it is felt that to alter the financial contribution at this time\nwould be breaking faith with those earlier communities initially participating in the\nplan. For that reason, plus the fact that there are a sufficient number of demands\nfor the grants, has come a decision to maintain the grant formula as originally set.\nDuring this past year newly constructed community health centres were opened\nat Williams Lake and Burns Lake in the Cariboo Health Unit, at Smithers in the\nSkeena Health Unit, at Dawson Creek in the Peace River Health Unit, at White\nRock and Whalley in the Boundary Health Unit, and at Port Alberni in the Central\nVancouver Island Health Unit. As the year closed, construction was well under\nway on community health centres at Quesnel in the Cariboo Health Unit, at Creston\nand Kimberley in the East Kootenay Health Unit, at Kitimat, and in South Vancouver. In addition, planning of community health centres was well under way at\nGolden, Michel, and Field in the East Kootenay Health Unit, Ladysmith in the\nCentral Vancouver Island Health Unit, and Coquitlam in the Simon Fraser Health\nUnit, while negotiations for community health centres were being conducted at\nAbbotsford in the Upper Fraser Valley Health Unit, Nelson in the Selkirk Health\nUnit, and Princeton in the South Okanagan Health Unit.\nDISEASE MORBIDITY AND STATISTICS\nComparisons in disease incidence which have been made in recent years have\nto be considerably altered this year, since an agreement between the Provinces and\nthe Department of National Health and Welfare has resulted in a change in reporting; this has resulted in dropping of the reports on the minor communicable\ninfections and some change in reporting in the volume of major communicable\ninfections. In so far as the minor communicable infections are concerned, it was\nfelt that since the reporting was inaccurate and since there was little that could be\naccomplished in control, it did not seem prudent to continue to process the figures\nwhen nothing was being done about them, or with them. Consequently, routine\nreports on the incidence of chicken-pox, conjunctivitis, measles, mumps, rubella,\ntrachoma, and Vincent's angina were removed from the list of notifiable diseases. LOCAL HEALTH SERVICES AA 25\nThese conditions, in past years, have accounted for a considerable volume of the\ntotal notifiable diseases each year; their removal, and the inclusion of diarrhoea of\nthe new-born, unspecified dysentery, staphylococcal food poisoning, aseptic meningitis, and pemphigus neonatorum, alters the comparisons that can be made between\nthe disease incidence this year and the disease incidence in past years. However,\nin order that there may be some comparison, certain figures have been extracted\nfrom the notifiable reports of the past four years in an endeavour to arrive at some\nconclusions on the disease pattern of the Province this past year in relation to that of\nprevious years. As the new methods of reporting are featured in future compilations, comparisons will become more pertinent. Nevertheless, in spite of these\nreservations it becomes evident that the disease experience of the Province for 1959,\nwith a rate of 1,037.1 per 100,000 population, is the highest for the past five years\nfor comparable conditions. A higher incidence of salmonellosis, hepatitis, scarlet\nfever, streptococcal sore throat, and poliomyelitis contributed to this. A major\nfactor for the upward trend was the marked increase in scarlet fever and streptococcal sore throat, in which the disease incidence was the highest for the past five\nyears, and, as a matter of fact, for scarlet fever was the highest since 1952 and for\nstreptococcal sore throat for a considerably longer period. It is difficult to explain\na rate of 244.5 for scarlet fever and 46.1 for streptococcal sore throat in the face of\nadvances that were being made with antibiotics in the control of these infections. It\nis possible that a changing virulence of the organism or development of a new strain\nis rendering the antibiotic drug innocuous, and further increases in this disease can\nbe anticipated. Fortunately the incidence was confined to the spring months of the\nyear and was sufficiently light in its clinical manifestations to preclude the development of serious complications. While it created an increase in the amount of school\nabsenteeism, the modification adopted a few years ago in quarantine regulations\nresulted in contacts being able to continue their normal activities without prolonged\nundue restriction.\nThe amount of infectious hepatitis, with a rate of 57.8, is a definite increase\nover the incidence in the past three years, although somewhat lower than the 1955\nrate of 62.6. This condition is the cause for some alarm, since it can be a factor in\nchronic liver disease; for that reason, some efforts at control are exercised through\nthe distribution of immune serum globulin as a prophylactic measure.\nGastro-intestinal infections due to salmonella showed an upward trend (a rate\nof 22.6 to the highest figure for the past five years). The amount of infection due\nto this organism has shown a consistently upward trend each year, and it can be\nanticipated it will go even higher as the number of carriers resulting from these\ninfections is equivalently increased from exposure to the disease. Food-borne\noutbreaks arise through improperly prepared food, especially meat pies or roast\nfowl, or food prepared by a person who is a recognized mild case of the infection,\nor a convalescent carrier. Controls can be introduced by exercising exclusion of\ninfected persons from food-handling in occupations involving care of young children, in searching for unrecognized mild cases and convalescent carriers among\ncontacts, and by proper cooking of all foodstuffs derived from animal sources and\nprotection of prepared food against rodent or insect contamination.\nRelated to the numerous infections resulting from species of salmonella are\nthose definitely due to human transmission in the form of typhoid and paratyphoid\nfever, caused by specific types of salmonella\u00E2\u0080\u0094namely, Salmonella typhi and\nSalmonella paratyphi. These were somewhat less numerous this year than in past\nyears, with a rate of 0.3 per 100,000 population for typhoid fever and 0.8 per\n100,000 population for paratyphoid fever. This represents a desirable situation, AA 26 PUBLIC HEALTH SERVICES REPORT, 1959\nand one which it is hoped can be further improved with improvements in sanitation and adequate control over known human carriers.\nAnother form of gastro-intestinal infection which has occasioned concern in\npast years is bacillary dysentery, due to and caused by the various forms of shigella\norganisms. In this Province the most common type seems to be that due to Shigella\nsonnet, which has been the agent creating a number of summer-camp outbreaks,\nresulting in the disease being spread through many parts of the Province. It was\nanticipated that an increase would occur as a result of that spread, and such was\nthe case following certain summer-camp outbreaks. It is noted that a decrease in\nthe volume of infection occurred this year in a rate of 21.4 per 100,000 population,\ncompared with 60.6 for the previous year; however, this year's experience was\nnevertheless sufficiently high to warrant the prediction that the volume of infection\ncan be anticipated to be maintained at about the consistent rate for a number of\nyears, since unrecognized mild cases and convalescent carriers will continue to serve\nas sources of infection.\nReporting of poliomyelitis was affected by the change in reporting of notifiable diseases generally, since it was decided that only poliomyelitis cases exhibiting\nparalysis would be designated as true poliomyelitis, and therefore notifiable, while\nall cases formerly classified as non-paralytic poliomyelitis would be shown as aseptic\nmeningitis. This change meant that case rates occurring this year would hardly be\ncomparable with case rates of previous years until the figures had been corrected\nby deletion of the reported non-paralytic cases; consequently, in this year's report\ncertain changes will be observed in the figures shown for previous years to permit\nthat comparison to be made.\nIn this Province, immunization for poliomyelitis was offered on a restricted\nbasis in 1955, when vaccine was first made available in Canada. During that year,\nvaccine was administered to 49,000 children in the age-group 5 to 7 years, inclusive;\nfrom that experience it was very clearly demonstrated that the vaccine conferred a\ndefinite protection. In latter years, as the vaccine became available in larger quantities, immunization was extended to cover all children, and in the years 1956 to\n1958 immunization was concentrated among pre-school and school-age members of\nthe population. In 1959 this preventive measure was extended to include adults\nup to 40 years of age. In addition, in 1959 a combined quadruple antigen became\navailable in which immunization to diphtheria, pertussis, tetanus, and poliomyelitis\nwas associated in a single solution. Some evidence of the volume of immunization\nto poliomyelitis provided in the past year is evidenced in the fact that 604,050 cc.\nof poliomyelitis vaccine and 164,400 cc. of D.P.T. poliomyelitis vaccine were distributed to local health services throughout the Province. This indicates that, in\nassociation with the immunization programme conducted during the preceding four\nyears, a considerable proportion of the population had received the benefit of protection through immunization to poliomyelitis. Nevertheless, the disease incidence,\nwhich had been showing a downward trend for each of the previous three years,\ntook a sudden upsurge during last year, with 132 cases being established, for a case\nrate of 8.4 per 100,000 population. It was, of course, a well-established fact that\neven if the immunity status had been complete for the population as a whole, it\nwould not promote absolute immunity. In the majority of immunological procedures there remains a small percentage of persons unable to obtain a sufficient\nantibody response to the antigen to attain complete protection to the disease. This\nwell-known truth, garnered from immunization experience over many years, is\napplicable also to poliomyelitis. It was evident, then, that, in spite of the excellent\nimmunization coverage, a certain proportion of disease could be anticipated. This,\ncoupled with the fact that there remained a definite core of unimmunized persons, LOCAL HEALTH SERVICES\nAA 27\nmade it not too disturbing to have some increase in the incidence, but it was certainly disquieting to have it attain a rate ten times that for 1958 and five times the\none established for 1957. Further epidemiological study will be required to determine if there are any related factors that may be in association with the features\ncreated.\nMortality from paralytic poliomyelitis was increased also, with the death of\nfourteen of the patients. The fact that the case fatality rate of 10.6 is less than\nthat of 25.0 established in 1958 is no particular credit, since, actually, the few cases\nthat occurred in that year influenced the rate decidedly, as is evident from comparison with the rates for the years preceding.\nPoliomyelitis Case Fatality Rates, British\nColumbia\nYear\nParalytic\nCases\nDeaths\nCase\nFatality\nRate\n1953.. \t\n439\n107\n143\n37\n25\n12\n132\n26\n6\n3\n3\n3\n14\n5.9\n1954 \t\n1955 \t\n1956\n5.6\n2.1\n8.1\n1957 .\t\n1958 .. \u00E2\u0080\u0094.\t\n25.0\n1959 \t\n10.6\nThe virulence of the outbreak creating so many paralytic cases and so many\ndeaths prompted a desire on the part of physicians, and relatives, to have the patients\nobtain the most effective medical care available; this meant that a vast majority\nof the cases required evacuation to major medical centres in Vancouver and Victoria.\nIn such a situation the facilities of the Royal Canadian Air Force were of tremendous\nsupport, since its Communication and Rescue Flight at Sea Island undertook evacuation flights under all types of adverse conditions to expidite the transfer of exceedingly ill patients from inland hospitals to the larger city centres. The quality of\nmedical care provided by numerous individual physicians and the efficient evacuation services have probably had their influence on the case fatality rate, since there\nis little doubt that without them the rate would have been significantly higher.\nIn a review of the poliomyelitis situation, some consolation must be derived\nfrom the fact that it might have been much more serious. It seems fairly evident\nthat without the concentrated immunization programme of the past five years, the\nProvince would probably have suffered an exceptionally severe epidemic. The\npublic health staffs attached to the various health units in the urban and rural\nareas have performed yeoman duty in conducting concentrated immunization programmes, and they deserve much credit for the protection conferred on the public.\nThey have been ably assisted, however, by numerous groups, not the least of whom\nhave been the British Columbia Division of the Canadian Medical Association and\nthe individual physicians. The British Columbia Foundation for Child Care, Poliomyelitis, and Rehabilitation gave unstintingly of funds and lay assstance, thereby\naiding in the supply of personnel and equipment to promote a more capable organization of clinics. National health grants undertook to defray half the costs of the\npoliomyelitis vaccine, and in so doing contributed $80,000, thereby helping to make\na greater quantity of vaccine available for the conduct of the clinics. The prevention\nand treatment of poliomyelitis can be a consumer of time and money, requiring the\nservices of many people; on the other hand, prevention in this one disease alone\ncan reap untold benefits to individuals, to families, and to the whole community. AA 28\nPUBLIC HEALTH SERVICES REPORT, 1959\nAn exceedingly bright feature of the disease morbidity picture was a repetition\nof the absence of diphtheria from the table of recorded illnesses, since, for the second\nconsecutive year, diptheria has failed to record a single case. While the disease\nhas been occuring in very few numbers over recent years, it is nevertheless gratifying\nto have it entirely absent. This situation can be maintained if the immunization\nstatus of the population can be kept at a high level.\nTable V.\u00E2\u0080\u0094Notifiable Diseases in British Columbia, 1955-59 (Including Indians)\n(Rate per 100,000 population.)\nNotifiable Disease\n1955\nNumber\nof\nCases\nRate\n1956\nNumber\nof\nCases\nRate\n1957\nNumber\nof\nCases\nRate\n1958\nNumber\nof\nCases\nRate\n1959\nNumber\nof\nCases\nRate\nBotulism \t\nBrucellosis\t\nCancer \t\nDiarrhoea of the newborn \t\nDiphtheria\t\nDysentery, amoebic \t\nBacillary...\t\nUnspecified \u00E2\u0080\u0094\t\nEncephalitis, infectious ...\nFood poisoning\u00E2\u0080\u0094\nStaphylococcal intoxication \t\nSalmonella infections...\nUnspecified \t\nHepatitis, infectious\t\nMalaria\t\nMeningitis, viral or\naseptic\u00E2\u0080\u0094\nDue to polio virus\t\nDue to Coxsackie virus.\nOther and unspecified ...\nMeningococcal infections.\nOrnithosis. _. \u00E2\u0080\u0094\t\nPemphigus neonatorum.\u00E2\u0080\u0094\nPertussis \t\nPoliomyelitis, paralytic ....\nRabies in man \t\nScarlet fever \t\nStreptococcal sore throat \u00E2\u0080\u009E\nTetanus\t\nTrichinosis..\t\nTuberculosis \t\nTularsemia\t\nTyphoi d fever \t\nParatyphoid fever\t\nVenereal disease\u00E2\u0080\u0094\nGonorrhoea. _\t\nSyphilis (includes non-\ngonorrhceal urethritis,\nvenereal) _\t\nOther (chancroid)\t\nTotals\t\n13\n3,556\nC1)\n8\n2\n293\n(!)\n2\n(!)\n92\n(!)\n841\n1\n(!)\n(!)\n(1)\n(!)\n1,683\n143\n757\n352\n4\n1,414\n40\n2,508\n765\n7\n1.0\n265.0\nC1)\n0.6\n0.2\n21.8\nO)\n0.2\nC1)\n6.8\nO)\n62.6\n0.1\nO)\nO)\nf1)\n3.6\n4\n3,115\nC1)\n1\n342\nC1)\n9\n(!)\n187\nO)\n343\n1\nC1)\n(J)\n(*)\n45\nO) I (*)\n125.4\n987\n10.6\n56.4\n37\n645\n26.2\n171\n0.3\n105.4\n3\n1,331\n1\n0.6\n32\n3.0\n32\n186.9\n3,442\n57.0\n763\n0.5\n6\n0.3\n222.7\nC1)\n0.1\n24.5\n(a)\n0.6\nO)\n13.4\n0)\n24.5\n0.1\n(^\nO)\nO)\n3.2\nO)\n70.6\n2.6\n46.1\n12.2\n0.2\n95.2\n0.1\n2.3\n2.3\n246.1\n54.6\n0.4\n3\n2\n4,150\nC1)\n5\n4\n132\n(x)\n1\nO)\n259\nO)\n393\n1\nO)\nO)\nP)\n35\n13\nO)\n941\n25\n12,537\n934.2 | 11,497\nI\n822.1\n325\n115\n2\n1,355\n6\n10\n3,806\n748\n2\n12,333\n0.2\n0.1\n279.1\n0.3\n0.3\n8.9\nO)\n0.1\n(O\n17.4\nC1)\n26.4\n0.1\nC1)\nC1)\nC1)\n2.4\n0.9\nC1)\n63.3\n1.7\n21.8\n7.7\n0.1\n91.1\n0.4\n0.7\n256.0\n50.3\n0.1\n1\n2\n4,103\nC1)\n6\n936\n0)\n2\nC1)\n292\nO)\n558\n2\n(!)\nO)\n25\nC1)\n1,427\n12\n1\n1,098\n172\n1\n2\n1,092\n22\n3,426\n582\n3\n0.1\n0.1\n265.7\nC1)\n0.4\n60.6\nf1)\n0.1\nC1)\n18.9\nC1)\n36.1\n0.1\n(\u00C2\u00BB)\nC1)\nO)\n1.6\nO)\n92.4\n0.8\n0.1\n71.1\n11.1\n0.1\n0.1\n70.7\n0.5\n1.4\n221.9\n37.7\n0.2\n6\n3,968\n53\n1\n336\n62\n9\n355\n3\n907\n3\n23\n56\n31\n1\n3\n680\n132\n3,839\n724\n3\n1,160\n4\n12\n3,353\n545\n6\n829.4\n13,773 | 877.2 | 16,283\n0.4\n252.7\n3.4\n0.1\n21.4\n3.9\n0.6\n0.5\n22.6\n0.2\n57.8\n0.2\n1.4\n3.5\n2.0\n0.1\n0.2\n43.3\n8.4\n244.5\n46.1\n0.2\n73.9\n0.3\n0.8\n213.5\n34.7\n0.4\n1,037.1\n1 Not notifiable prior to 1959.\nIn any study of morbidity and mortality rates, some consideration must be\ndevoted to the annual toll created by accidents, not the least of which must be the\nvolume of traffic accidents. The collaboration commenced with the Motor-vehicle\nBranch was maintained during this past year, and agreement reached, following a\nnumber of meetings, whereby the British Columbia Division of the Canadian Medical Association would organize a set of minimum physical standards which would\nbe adjudged as basic to the refusal of a driver's licence. A committee of that associa- LOCAL HEALTH SERVICES AA 29\ntion gave the matter some study, and at the annual meeting of the association in\nOctober approval was attained on a set of recommended standards modelled after\nthose approved by the American Medical Association. The Health Branch continued to provide medical consultative services to the Motor-vehicle Branch in\nreview of medical-examiner reports on applicants for driver's licences. As the new\nstandards come into effect, it is anticipated that the amount of review should be\ndecreased, since it is anticipated the individual physicians will be guided by the\nprinted regulations directed to their attention by their own association. There\nremains a considerable need for further review of the problem. Study is being set\nup in the Department of Preventive Medicine, Faculty of Medicine, at the University\nof British Columbia into the relationships of traffic accidents in children, in which\none of the health unit directors will be granted leave of absence to assist. The Division of Vital Statistics and the consultant in epidemiology plan to review the situation\nfurther, in the hope that some recommendation may be forthcoming to assist the\nMotor-vehcile Branch in a decrease of the volume of traffic mortality occuring in the\nProvince, which during 1959, caused 304 deaths, more than all those occurring\nthrough communicable diseases together. AA 30 PUBLIC HEALTH SERVICES REPORT, 1959\nREPORT OF THE BUREAU OF SPECIAL PREVENTIVE\nAND TREATMENT SERVICES, VANCOUVER\nG. R. F. Elliot, Director\nThe headquarters of the Bureau of Special Preventive and Treatment Services\nis in the Provincial Health Building, situated at 828 West Tenth Avenue, Vancouver.\nTwo of the three Public Health Branch divisions included in this Bureau\u00E2\u0080\u0094the Divisions of Laboratories and Venereal Disease Control\u00E2\u0080\u0094also have their headquarters\nand their major facilities in this building. The other division in the Bureau\u00E2\u0080\u0094the\nDivision of Tuberculosis Control\u00E2\u0080\u0094has its headquarters in the Willow Chest Centre,\nwhich adjoins the Provincial Health Building. Its major facilities are in this centre\nand at Pearson Hospital, situated at 700 West Fifty-seventh Avenue, Vancouver.\nThe Poliomyelitis Pavilion is an integral part of the Pearson Hospital.\nThe Bureau Director gives general direction to the activities of the divisions\ncomprising it and integrates their services with local health services and other public\nhealth activities in the Province. In addition, he has responsibility for liaison with\nthe various voluntary health agencies in the Province to promote the integration of\ntheir services with the general public health programme.\nThe relationships with the Faculty of Medicine, University of British Columbia,\ncontinue to be eminently satisfactory; during the year the Assistant Provincial\nHealth Officer was appointed a Professor of Preventive Medicine on a part-time\nbasis.\nADMINISTRATION\nThe major objective in administration is the provision of consistently high\nstandards of services at the least possible cost. This requires continual assessment\nof programmes and methods. During the year several significant innovations\nresulted. A programme of progressive patient-care was introduced. It is expected\nto improve the effectiveness of treatment and rehabilitation of tuberculosis patients,\nwhile affording a substantial reduction in operating costs. Other changes which also\nafforded the twofold benefits of maintaining a high standard of service at reduced\ncost occurred during the year. They included an integration of clinical laboratory\nservices at Willow Chest Centre and Pearson Hospital; a modified basis of operation\nin the dietary, housekeeping, and accounting departments at Willow Chest Centre;\nand an improved organization of janitor services at the Provincial Health Building.\nNo material administrative changes occurred in the Divisions of Venereal\nDisease Control and Laboratories.\nThe former Director, Division of Venereal Disease Control, completed graduate\nstudies in epidemiology at the University of Minnesota and returned to duty in\nAugust. He has assumed full-time responsibility as consultant in epidemiology.\nThe Personnel Officer returned in May from graduate studies in administration at\nthe University of British Columbia.\nVOLUNTARY HEALTH AGENCIES\nAs indicated above, the Bureau of Special Preventive and Treatment Services\nworks closely with voluntary health agencies. In this section a brief outline is given\nof the activities during the year of those agencies receiving direct financial aid from\nthe Provincial Government. It might be mentioned at this point that each of these\nagencies plays a vital role in the maintenance and development of public health SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER AA 31\nservices in the Province. That their contributions have been so valuable to the\npublic health service is in very large measure attributable to public-spirited individuals in the community who provide leadership to these agencies.\nAlcoholism Foundation of British Columbia\nThe demand for treatment services during 1959 was at a high level: 406 new\ncases were admitted to treatment, 85 cases re-entered treatment, and 197 other\npersons sought information about problem cases and services available. A total of\n5,715 therapeutic interviews were carried out, and 292 group meetings were held.\nThese services severely taxed the clinical facilities of the foundation, particularly in\nview of the staff reductions found necessary in late 1958 to ward off a budget deficit.\nIt became necessary during the year to drop the ancilliary services provided in the\nProvincial Mental Hospital and the Haney Correctional Institute; however, the\nservices in the Oakalla Provincial Gaol were maintained.\nThe rehabilitation residence was used to good advantage during the year, particularly to assist patients who reside outside of the Vancouver metropolitan area.\nA total of 108 patients were admitted, for an average stay of eighteen days.\nRecent statistical studies indicate that alcoholism is increasing in British Columbia at an alarming rate (approximately 2,000 cases per year), and partially to meet\nthis situtation the foundation greatly stepped up its preventive education programme\nin 1959. Institutes were held in several outlying areas; a School of Alcohol Studies\nwas held at the University of British Columbia; and the programme of publications,\nfilms, and talks was stepped up.\nA great deal of economic and human waste is created by the problem drinker\nin business and industry. To assist employers with this vexing and little-understood\nmatter in industrial health, the foundation has prepared its \"Alco-Plan for Business\nand Industry,\" a programme designed to help employers discover early cases of\nalcoholism and bring them to treatment.\nThe foundation is constantly striving to give more and better services to the\npeople of this Province and has plans for expansion that will be implemented as soon\nas funds are available.\nBritish Columbia Cancer Foundation\nSince 1949 the British Columbia Cancer Foundation has been the official agency\nfor the diagnosis and treatment of cancer in the Province.\nDuring the past year the number of consultative cancer clinics was increased\nfrom twelve to thirteen, by the establishment of a clinic at Dawson Creek.\nGood progress was made in the extension of facilities at the British Columbia\nCancer Institute in Vancouver, the largest unit of those operated by the foundation.\nThis building programme, when completed, will provide new permanent quarters\nfor the cytology department, the diagnostic X-ray department, the social service\ndepartment, and enlarge the capacity of the boarding home from 36 to 56 patient-\nbeds. It is expected that extension of the radiotherapy department will provide\naccommodation for a second Cobalt 60 unit during 1960, and for another super-\nvoltage unit during 1961.\nOperating expenses of the foundation's cancer-control programme are provided\nfrom National health grants, Provincial Government funds, and fees from private\npatients.\nBritish Columbia Medical Research Foundation\nDuring the past year the British Columbia Medical Research Institute changed\nits name to British Columbia Medical Research Foundation. Its constitution was\nrevised in order to modify its programme in the light of recent changes in the type of AA 32 PUBLIC HEALTH SERVICES REPORT, 1959\nsupport which is most urgently needed by our medical scientists. Originally the\ninstitute operated its own laboratories, in which speicalized facilities were made available for use by physicians and surgeons wishing to undertake research projects. As\nthe Medical Faculty of the University became more firmly established, however, the\ntrustees of the institute decided that a significant improvement in over-all efficiency\nwould be achieved if responsibility for the operation of its research facilities was\nturned over to the University. This was done on January 1st, 1959. The research\nprojects formerly carried on in the institute are now operating efficiently in a new\nlaboratory which has been built, with the aid of funds donated by the institute, as\nan addition to the Medical School Building at the Vancouver General Hospital.\nUnder its new constitution the foundation will make grants to support the work\nof medical scientists in any institution in the Province, without restriction as to the\nbranch of medical science or the specific disease or diseases with which the projects\nare concerned. By maintaining a high degree of flexibility and by concentrating on\nthose types of support which the scientists themselves feel are not adequately covered\nby existing private and governmental agencies, the foundation hopes to be able to\nmake a contribution to the productivity of medical research in British Columbia\nwhich will be large in relation to the actual amount of money distributed. During\nthe six months which have elapsed since the new constitution was adopted in June,\n1959, the foundation has already made a total of nine research grants in support of\nprojects in a wide variety of fields.\nCanadian Arthritis and Rheumatism Society (British Columbia Division)\nOne objective of the Canadian Arthritis and Rheumatism Society is the prevention of crippling and disability from rheumatic and arthritic disease. Good\nprogress is being made toward achievement of this objective. Through education,\npersons with such disease are being persuaded to seek proper medical advice early\nin the disease. This education programme, coupled with provision of adequate\ntreatment facilities, is proving effective. An assessment of about 3,200 cases closed\nin 1958 revealed that 80 per cent showed improvement; about four-fifths of this\nnumber were in the under-65 age-group.\nThe physiotherapy service continued to be provided to all large and most\nsmaller communities in the Province. The continuity of this service is disrupted\nonly when it is not possible to find staff replacements. The service of the occupational therapist travelling in the vehicle van proved so valuable in 1958 that all of the\nagency's treatment units south of Clinton were revisited in 1959. This occupational\ntherapist visits homes at the request of the family physician and, working in conjunction with the unit physiotherapist, does a functional assessment of patients,\nmakes working splints and self-help aids, and assists in home adjustments as\nnecessary.\nAs a result of the research programme, the techniques for serological diagnostic\ntesting are made available to physicians throughout the Province where such service\nis not available in hospital laboratories.\nThe treatment programme for arthritics has been established on a basis of cooperation with hospitals and physicians. Medical consultative service and special\ndrugs are also provided at the request of the family physician. In 1958, 66 per cent\nof all patients referred were treated as out-patients, and the remainder as in-patients.\nStatistics for the first nine months of 1959 indicate that the number of patients receiving treatment will remain at about the same level as in 1957 and 1958, when they\nnumbered about 67,000.\nEach year the society offers a refresher course to other physiotherapists and\noccupational therapists. Also, physicians, interns, and nurses are given lectures and SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER AA 33\ntours as an integral part of their training through the annual Canadian Arthritis and\nRheumatism Society lectureship. The lecturer in 1959 was Professor J. H. Kell-\ngren, Professor of Rheumatology and Director, Rheumatism Research Centre, Manchester University, Manchester, England.\nNarcotic Addiction Foundation of British Columbia\nThe past year has been the first in which this agency has had a treatment programme operating for a full year. In the first eleven months a total of ninety-seven\npersons\u00E2\u0080\u0094seventy-four men and twenty-three women\u00E2\u0080\u0094were interviewed with a view\nto treatment. As of November 30th, 1959, there were seventy patients\u00E2\u0080\u0094fifty-two\nmen and eighteen women.\nResidence facilities for four male patients were established on December 1st,\n1958. Twenty patients were treated in these facilities in the succeeding twelvemonth period. All patients were on this programme on a voluntary basis; eighteen\nwere drawn from the community and two from Oakalla Prison Farm.\nSince practically all patients who present themselves for treatment are currently\naddicted, there is a great need for withdrawal services. An adequate level of such\nservices is not yet available, although the foundation does endeavour to provide such\nservices as an integral part of its therapeutic programme.\nResearch is an essential part of an adequate narcotic addiction control programme. Statistical data are being compiled which will contribute to research.\nSince its inception, the foundation has sought to stimulate the interest of com-\nmuniy agencies in the social, recreational, and occupational fields, since such\nagencies may be expected to contribute especially to the rehabilitation of ex-addicts.\nThere was encouraging increase of interest demonstrated by such agencies during\nthe year.\nG. F. Strong Rehabilitation Centre\nIn last year's report it was observed that in 1958 there had been the greatest\nutilization of the centre since its inception in 1949. The statistics for 1959 and\nestimated statistics for 1960 indicate that this high level of utilization is to be maintained. To date there has been a slight decline in the occupancy of non-nursing beds\nand in the number of work units (half-days of service per patient), but this has been\noffset by an increased number of admissions and discharges and an increase in the\nenrolments in the children's programme.\nIn the cerebral palsy programme, which is entirely an out-patient service, there\nhas been an increase of 6 per cent in patients on the active list (273 as at December\n31st, 1958, compared with 290 as at September 30th, 1959). Further increases\ncan be expected. Related to this increase has been the establishment of a third\nacademic-school room in the centre, which, like the other two schoolrooms, is staffed\non a full-time basis by the Vancouver School Board.\nNATIONAL HEALTH GRANTS\nDr. Jean Webb and Dr. W. J. Connelly of the Maternal and Child Health Division, Department of National Health and Welfare, visited Vancouver in November\nto discuss various programmes and research projects being conducted in the child\nand maternal health field. Considerable benefit is derived from visits of Department\nof National Ffealth and Welfare personnel, since opportunities are presented to\nreview assistance which may be available to this Province under the National\nhealth grants. AA 34 PUBLIC HEALTH SERVICES REPORT, 1959\nThe total amount of funds available to British Columbia for 1959/60 was\n$6,056,144, being an increase of $727,433 over that appropriated for 1958/59.\nThis excludes the Public Health Research Grant, which is administered in Ottawa.\nOf the $5,328,711 available for the year ended March 31st, 1959, 79.1 per cent\nwas expended, as compared to 74.6 per cent for the previous fiscal year. The total\napproved for specific expenditures for 1958/59 was 91.4 per cent for British\nColumbia, compared to 80.2 per cent for all Provinces.\nCrippled Children's Grant\nThe total funds allocated to this grant were $47,221. The speech and hearing\nprogramme of the Health Centre for Children was transferred from the Child and\nMaternal Health Grant to this grant, with assistance being provided for the purchase\nof equipment and toward personnel. The Cerebral Palsy Associations of Greater\nVancouver and Lower Vancouver Island and the cerebral palsy unit at the Children's Hospital continued to receive support. Short-term postgraduate training\nassistance was also provided to four members of the Cerebral Palsy Association of\nBritish Columbia to attend a staff-training workshop which was sponsored by the\nCerebral Palsy Section of the Canadian Council for Crippled Children and Adults.\nProfessional Training Grant\nThe allocated funds, amounting to $47,221, were expended early in the year,\nand it was necessary to transfer a further $1,500 from the Laboratory and Radiological Services Grant in order to meet the increased requests for training. Continued assistance was given to trainees of the Canadian Hospital Association extension course for hospital administrators and medical records librarians, and these\ncourses are continuing to prove to be of considerable benefit to the hospitals and\nthe trainees. Provincial health, metropolitan health, and hospital personnel also\nreceived short-term postgraduate and university training.\nHospital Construction Grant\nConstruction of general hospitals utilized almost 84 per cent of this year's\ngrant. Community health centres and mental hospitals each received about 7 per\ncent. By the end of 1959 the total grant of $1,679,218 for the 1959/60 fiscal year\nwas fully committed.\nVenereal Disease Control Grant\nThere was a slight increase in the amount allocated to this grant, which is on a\nmatching basis, with the total funds being paid to the Province. Expenditures by\nthe Province on the venereal disease control programme are considerably in excess\nof the grant.\nThe report of the Division of Venereal Disease Control appears in another\nsection of this Health Branch Report.\nMental Health Grant\nThe Mental Health Grant was allocated $657,347, and $56,975 was transferred to it during the year. The Mental Health Services Branch submits most of\nthe projects and, as in previous years, the bulk of the assistance was used to provide\nstaff and technical equipment for the mental-health institutions operated by the\nProvince.\nThis year saw the admission and infirmary unit of the Home for the Aged\n(Valleyview Building) completely equipped and opened for the care of patients. SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER AA 35\nIn an attempt to overcome shortages of professional staff for mental-health\nservices institutions, bursaries for professional training were increased in number.\nThere are six psychiatrists, ten social workers, six registered nurses, and three\nclinical psychologists undergoing training, who will be returning to the Mental\nHealth Services Branch in 1960.\nAssistance to the psychiatric services of the Vancouver General Hospital and\nthe Mental Hygiene Division of the Metropolitan Health Committee of Greater\nVancouver continued along the lines already established. Assistance was continued\nto the course for training senior school counsellors sponsored by the Vancouver\nSchool Board. The newly established programme of the Epileptic Division of the\nBritish Columbia Society for Crippled Children was assisted for the first time.\nProjects to assist the research programmes at the Department of Neurological\nResearch and the Department of Pharmacology, University of British Columbia,\nwere continued.\nTuberculosis Control Grant\nFunds allocated to this grant amounted to $374,661, with a further $10,000\nbeing transferred to the grant during the year to meet increased requirements.\nContinued provision was made for equipment for health units and general hospitals, vocational training for patients, payment for special out-patient investigations\nin general hospitals, and to antimicrobial therapy. Special tuberculosis surveys\nwere conducted throughout the Province, and assistance was continued for specialized tuberculosis training for staff members of the Division. The Princess Margaret\nChildren's Village received funds toward personnel in its important tuberculosis\nservices.\nThe majority of the tuberculosis services are provided by the Province, and the\nlargest portion of the grant is used by the Division of Tuberculosis Control of the\nHealth Branch.\nDetails of the activities of the Division of Tuberculosis Control are reported\nin another section of this Health Branch Report.\nPublic Health Research Grant\nTwo research studies were completed this year. One was conducted by the\nDepartment of Biochemistry, University of British Columbia, on the determination\nof human blood patterns and metabolism of adrenal steroid hormones. The other\nproject was carried out by the G. F. Strong Laboratory of Medical Research on the\nnatural history of hypertension in man. One new research study was commenced\nby the Department of Geology and Geography on multiple sclerosis, and a new\nproject was undertaken by the Department of Pathology on the fundamentals of\nconnective-tissue metabolism.\nGeneral Public Health Grant\nThe general public health programme as carried on by the local health services\nof the Province received continued assistance, and detailed information regarding\nthe programme appears in the early part of this Health Branch Report.\nA rheumatic fever prophylaxis pilot project was commenced whereby oral\npenicillin was supplied to patients in four health unit areas within the Province.\nA good response has been received from the practising physicians in the areas\nconcerned.\nThe Metropolitan Health Committee of Greater Vancouver received continued\nsupport toward personnel and for the purchase of dental and photographic equip- AA 36 PUBLIC HEALTH SERVICES REPORT, 1959\nment. Air-pollution control equipment was also supplied to the Metropolitan Health\nCommittee of Greater Vancouver for its concentrated control studies.\nEquipment was provided to the British Columbia Division of the Canadian\nArthritis and Rheumatism Society for use in its treatment services at Terrace.\nA second food service institute for hospital cooks was held at the Prince\nGeorge Hospital and was conducted by the British Columbia Hospital Insurance\nService and the Health Branch. Approximately twenty-five staff members attended\nfrom various hospitals throughout the Province.\nFunds for the purchase of Salk vaccine for the extended poliomyelitis immunization programme within the Province were provided under this grant. Vaccine was\nmade available to all persons under the age of 40 years within the Province, and\nconsiderable publicity and voluntary assistance was given to this most important\naspect of public health.\nThe glaucoma clinic which has been established at St. Joseph's Hospital,\nVictoria, in 1959, received support toward personnel and for the purchase of\nequipment.\nAssistance toward the summer student internship programme whereby medical\nstudents are assigned to health units and divisions within the Health Branch continued to receive favourable response.\nThe three research studies which were being conducted by the Faculty of\nMedicine, University of British Columbia, were completed.\nCancer Control Grant\nAssistance was provided for the training of radiotherapy technicians at the\nBritish Columbia Cancer Institute, and short-term postgraduate training was provided to personnel in the cancer-control field. Provision was made for the purchase\nof a replacement Cobalt source and also for accessories for an X-ray unit which had\nbeen transferred to the institute upon the closure of Tranquille Sanatorium.\nThe major portion of funds allocated to this grant, which are matched by\nProvincial funds, were used for the operation of the British Columbia Cancer\nFoundation.\nThe cytology examinations which are carried out under the Director of Pathology, Vancouver General Hospital, continued to show a marked increase, there\nbeing 47,328 specimens examined during 1959, compared to 35,000 in 1958.\nLaboratory and Radiological Services Grant\nThe allocation to this grant was increased to $772,000; during the year\n$278,608 of this amount was transferred to other grants.\nLaboratory Services\nThe regional laboratory services continued to expand. The appointment of a\npathologist for the Okanagan Valley was finalized this spring, and a regional laboratory was set up to serve hospitals in that area. This made a total of four regional\nlaboratories in this Province, which provided service for twenty-five hospitals which\nhad no such service before this plan was instigated.\nThis past year twenty-three medical laboratory technologists completed the\ncourse given in the University of British Columbia Medical School Building at the\nVancouver General Hospital. The larger hospitals benefited from the increased\nnumber of trained technologists available, but vacancies still occurred in several\nsmaller laboratories in outlying districts.\nThe Laboratory Advisory Council continued to play an important role in guiding the planning for improved diagnostic facilities. The Technical Sub-committee SPECIAL PREVENTIVE AND TREATMENT SERVICES, VANCOUVER AA 37\nof this Council met on several occasions to discuss laboratory equipment for which\ngrants were requested. The Technical Supervisor of Clinical Laboratory Services\nwas frequently called upon by administrators and technologists for advice regarding\nnew equipment and new laboratory procedures.\nRadiological Services\nThe Radiological Advisory Council this year continued to develop and expand\nits studies into radiation hazards and their control. Through the results of a Provincial survey they recommended that there be instituted some form of training for\nX-ray technicians, and, with the aid of Federal health grants, developed and conducted two refresher courses for fifty-six technicians from all parts of the Province.\nThrough the office of the Technical Adviser, the council acted as a clearinghouse for information on all matters pertaining to X-ray, developed a standardized\nform for institutions when ordering X-ray equipment, set up standards for equipment in hospitals of various bed capacities, and, while not an employment agency,\nmade attempts to assist hospitals looking for X-ray staff. All hospital-construction\nplans are now cleared through this service as far as they affect the functioning of the\nX-ray department.\nInstruments have been acquired to carry out radiation surveys of all X-ray\ninstallations in the Province. Working through the Director of Occupational Health,\nthis service will cover also all industrial installations.\nIt is planned for 1960 that the Technical Adviser will make an on-the-spot\nsurvey of hospitals covering the fields of (1) radiation protection, (2) the X-ray\nmachine and its maintenance, (3) darkroom and its equipment, (4) technician technical problems, and (5) administration and film marking and filing problems in\nthe department.\nThe Radiological Advisory Council has continued to review and approve\napplications for grants toward the purchase of X-ray equipment. This past year\ntwenty-four applications were approved, with a total value of $115,838.67.\nMedical Rehabilitation Grant\nIncreased assistance was provided to the G. F. Strong Rehabilitation Centre\nfor its expanding services of physical rehabilitation. Postgraduate training was\nreceived by a member of the staff of the centre to visit a cerebral palsy centre in\nEdmonton to review materials being used for making braces and splints.\nThe traumatic surgical unit at the Vancouver General Hospital continued to\nreceive support under this grant for personnel in connection with investigations into\ncauses of injuries and for studies on the question of rehabilitation of injured people.\nThe Health Branch operates a rehabilitation service for adult patients who are\ndisabled by illness. Individual patients are helped in obtaining various medical,\nsocial, and vocational aids toward their best possible rehabilitation. The rehabilitation team consists of a medical consultant, a rehabilitation co-ordinator, and an\nemployment officer seconded from the National Employment Service. The salary\nof the medical rehabilitation consultant is provided by this grant.\nThe programme was extended to include patients in the Pearson Poliomyelitis\nPavilion who require prosthetic equipment and other medical aids. These are\nsupplied through the G. F. Strong Rehabilitation Centre upon referral to the Rehabilitation Service and funds for payment of such items are provided through the\ngrant.\nThe medical consultant maintains a constant liaison with those responsible for\nactual physical rehabilitation treatment of patients referred from the rehabilitation\nservice and acts in an advisory and consultative capacity to the Health Branch on\nthe over-all programme. aa 38 public health services report, 1959\nChild and Maternal Health Grant\nFunds allocated to this grant amounted to $157,660, with a further $20,992\nbeing transferred during the year in order to meet requests for equipment for the\nMetropolitan Health Committee of Greater Vancouver for its prenatal classes and\nfor the extension of the Provincial local health services programme for child and\nmaternal health care.\nContinued support was given to the Health Centre for Children toward personnel and the purchase of equipment. Members of its staff also received short-\nterm postgraduate training in connection wtih the research studies being carried out\nin the Health Centre for Children.\nThe child health programme at the University of British Columbia continued to expand and received support toward personnel and the purchase of equipment and supplies.\nThe British Columbia Co-ordinating Council for Child Care, which was established a few years ago to review the facilities and possible closer integration of children's hospitals in the Province, was granted funds toward travel for members of\nthe Council, personnel, and supplies. The remainder of the expenses for this\ncouncil are met by the British Columbia Foundation for Child Care, Poliomyelitis,\nand Rehabilitation.\nContinued assistance was provided for the nursing services in the child and\nmaternal health programme in the Provincial health units.\nDuring the year one research study on new-born infants was completed and\none new project on methods of respiratory function testing in the new-born infant\nwas commenced at the Health Centre for Children.\nThe Registry for Handicapped Children continued to receive support. The\nprogramme remains much the same as that outlined in the 1955 report, with an\naverage of 200 cases being reported each month. PUBLIC HEALTH NURSING A A 39\nREPORT OF DIVISION OF PUBLIC HEALTH NURSING*\nMonica M. Frith, Director\nThe Division of Public Health Nursing functions as part of the Bureau of Local\nHealth Services. It performs a dual role through its administrative and consultative\nfunctions. The Division is responsible administratively for maintaining a high\nstandard of public health nursing performance on a local level through the recruitment, placement, training of public health nurses, and through the provision of\ntechnical assistance, consultative help, and guidance to assist the public health\nnurses in providing service as efficiently as possible.\nThe Division works closely with other health agencies, such as the Vancouver\nMetropolitan Health Committee, Victoria-Esquimalt Health Department, Oak Bay\nHealth Department, and voluntary agencies, such as the Victorian Order of Nurses,\nto co-ordinate the use of health facilities and resources and thus avoid overlapping\nor duplication of public health nursing services.\nClose co-operation between the Indian Health Services, Department of National Health and Welfare, has resulted in integration of services so that official\nhealth agencies in British Columbia, including metropolitan health services, now\nprovide approximately one-sixth of the health services for Indians, the largest\namount in Canada.\nTo provide a high standard of care, public health nurses must receive adequate\ntraining, and the Division therefore works closely with educational institutions to\nassist with the development of training facilities. This includes the various schools\nof nursing and the University of British Columbia.\nDuring the year seven new public health nursing positions were set up to provide additional service to certain health units in the Province which had experienced\nincreased population growth and service needs. These included Central Vancouver\nIsland at Qualicum and Nanaimo, South Central at Kamloops, North Fraser at\nHaney, Cariboo at Prince George and Williams Lake, and Boundary at Langley.\nThree of these positions were provided for by National health grants.\nThere are 186 public health nursing field positions in local health units, plus\na resident registered nurse at Telegraph Creek; one occupational health nurse,\nParliament Buildings, Victoria; one consultant public health nurse located in Vancouver, with one consultant public health nurse and the Director, Public Health\nNursing located in Victoria. In addition, there are eight part-time nurses serving\non a regular basis in areas where it is not possible to employ full-time public health\nnursing field staff.\nPUBLIC HEALTH NURSING ADMINISTRATION AND\nCONSULTATION\nEach year the Division undertakes certain studies to evaluate the services being\nprovided by the public health nurses on a local level.\nThese include a case-load analysis of each public health nurse's district to\ndetermine the work load and progress being made. From a review of the case loads,\nit is possible to determine the need for adjusting the public health nurse's district.\nThis might show a need for additional nursing assistance or alternatively an extension of the territory. A population guide of 5,000 is considered the maximum for\n* Unless otherwise indicated, this report concerns the services provided by public health nurses under the\njurisdiction of the Provincial Health Branch, and does not include the services provided by the metropolitan\nhealth departments of Greater Vancouver, Victoria-Esquimalt, and Oak Bay. AA 40 PUBLIC HEALTH SERVICES REPORT, 1959\nwhich a public health nurse should provide a generalized health service. In many\nof the rural districts the population is scattered and travel distances great, so that it\nis necessary for the public health nurse to serve a smaller population in order to\nprovide the same standard of service as in the more populated districts. Accordingly, every effort is made to keep the size of the public health nurse's district such\nthat she can give the services needed in the community.\nA time study is done annually to determine how much time is being spent by\nthe public health nurses in various activities. This information provides data to\ndetermine costs of the various services and at the time time provides a useful tool\nfor local public health nursing staff to use in evaluating the services being provided.\nThe study shows trends in the use of time and may point out the need for certain\nadjustments. For example, a need for more clerical or health unit aide assistance\nmay be shown if too much time is being spent on non-professional activities. During the past five years these studies have shown a 3.5-per-cent reduction in time\nspent in non-professional clerical work, which can be attributed to the provision of\nmore clerical assistance. Similarly, a reduction of 3.2 per cent of the nurse's time\nin professional recording in the same period can be attributed to improved record\nsystems and office routine. The studies have indicated an upward trend in time\nspent on direct services, with a reduction of time in travel, in the office, and in\novertime.\nThe study of the results of the teacher-nurse conferences, which are part of the\nschool health programme, was also done to determine the extent to which the public\nhealth nurses are meeting their objectives, and the results this year showed an\nimprovement over last year's study.\nFrom these studies, as well as from other reports received from local health\nservices and from actual visits to the health unit, it is possible to evaluate the\nservice programmes being offered and to make recommendations regarding nursing\nneeds. The public health nursing consultants visit the health units twice a year to\ngive guidance and assistance to the staff.\nDuring the year there were a considerable number of changes of staff required\nto provide continuity of service. This involved replacements of supervisors, senior\nand staff public health nurses. As a result, there were fourteen transfers, while\nfifty-four new appointments were made. This year the Division was fortunate to\nrecruit the largest number of qualified public health nurses to date, and, even so,\nthere were not sufficient numbers to fill all the vacancies. However, of the new\nappointees, only 6 per cent did not have full public health qualifications and the\nmajority, or 57 per cent of the remainder, had received their public health nursing\ntraining in British Columbia. There were forty-two resignations, of which 42.8 per\ncent were registered nurses without full public health qualifications who decided not\nto take the public health nursing university training. Forty-five per cent of the\nresignations were qualified public health nurses resigning for reasons of marriage\nor family, and a very small group, amounting to 12 per cent of all resignations, left\nthe service to take other positions or to travel.\nThis year the Health Branch was fortunate to have 94 per cent of the public\nhealth nurses with full public health nursing qualifications. This was the highest\npercentage of qualified public health nursing staff that the Health Branch has had\nfor a number of years. It is hoped that this favourable trend will continue.\nTo help the public health nursing staff make the best use of time, certain other\nactivities are carried out by public health nursing consultants. This includes an\nactive public health nursing records committee, which meets under the chairmanship of a public health nursing consultant to review and revise public health nursing\nrecords and instructions with a view to simplification. The public health nursing PUBLIC HEALTH NURSING\nAA 41\nconsultants contribute to the Policy Manual, and many new sections were added\nand revised this year. The Nursing Care Policy Committee has been set up to draft\na new section for the Policy Manual. The consultant in Vancouver continues to\nrepresent the Division in Vancouver and act as a public health nursing adviser and\nliaison with voluntary and official agencies.\nAssistance was given the Provincial Civil Defence Co-ordinator in planning\nand conducting courses of training in civil defence for nurses in British Columbia.\nThis included a one-week programme designed for nurses teaching home nursing,\nand assistance with a similar training programme for directors of nursing in small\nhospitals, being planned for next year. Assistance is given in the selection of\ncandidates for special courses for nurses given at the Civil Defence College at\nArnprior, Ont.\nTRAINING PROGRAMMES\nAs public health nursing is becoming increasingly complex, it is important that\nthe public health nursing staff have a high degree of training. In addition to registration as a nurse, the public health nurse must qualify by securing a diploma or\ncertificate in public health nursing, or a degree in nursing majoring in public health\nnursing from a recognized university.\nAs it has not been possible to obtain sufficient nurses with these qualifications,\nit has been necessary to take a limited number of registered nurses on staff who\ndo not have this university training. These nurses are employed as public health\nnursing trainees on the understanding that they will complete the university programme at an early date if they prove suited to the work. Eleven public health\nnursing trainees were granted educational leave of absence and National health\ngrant bursaries to assist them in completing the required course, after completing a\nsatisfactory period of service in a health unit. Nurses accepting financial assistance\nare required to serve in any district as required in the service for a period of two\nyears. Nine nurses returned this year from university after completing the diploma\ncourse on National health grants and were placed in areas where recruitment is\nusually difficult.\nThe provision of field experience for nursing students is an important contribution toward the training of nurses. During the year forty-one students of the\nUniversity of British Columbia were placed in health units for periods of time\nranging from two weeks to one month, while three students were accepted for a\nmonth of field work from the University of Alberta. One student from McGill\nUniversity spent a month in the Upper Fraser Valley Health Unit, obtaining experience in public health nursing supervision and administration.\nA one week's institute sponsored by the Registered Nurses' Association of\nBritish Columbia and directed by one of the public health nursing consultants, for\ninstructors of nurses from the training-schools in British Columbia, provided assistance in planning for the field observation and was an excellent opportunity for\nnursing instructors to receive an orientation to the public health nursing field. This\nyear a new experience record form and report has been introduced so that all\nundergraduate students will now complete the same report.\nField work for undergraduate nurses is gradually being extended so that all\nnurses have a minimum observation period of four days in a health unit. Eighty-\nseven students from St. Joseph's Hospital and the Royal Jubilee Hospital in Victoria\nhad experience with the Saanich and South Vancouver Island Health Unit; fifteen\nstudents from the Royal Inland Hospital had experience with the South Central\nHealth Unit; and thirty-two Royal Columbian students were with the Simon Fraser\nHealth Unit in Coquitlam and Boundary Health Units. The Simon Fraser Health AA 42 PUBLIC HEALTH SERVICES REPORT, 1959\nunit, in addition, provided four- to five-week periods of experience for ten practical-\nnurse students from the Canadian Vocational Institute in Vancouver.\nAs public health nursing supervision involves preparation beyond that required\nfor staff public health nurses, it is our plan to have all supervisors and senior nurses\ncomplete courses designed to give special training in public health nursing supervision and administration. Two supervisors attended the University of Toronto\nSchool of Nursing and completed the diploma course, while two others are now on\neducational leave of absence completing similar programmes at McGill University.\nIn-service education included a one-week institute on mental health, planned\nwith the co-operation and assistance of the Mental Health Services Branch and\nDr. J. S. Tyhurst, Professor in Psychiatry, University of British Columbia Medical\nSchool. The programme was designed to help the public health nurses learn new\nskills in interviewing techniques, make better use of the Mental Health Centre\nfacilities, and to assist them to deal with certain problem situations found in families.\nPlans are under way for local institutes to be held in all health units so that the\ninformation received in this institute is to be disseminated to all members of the\npublic health staff.\nLOCAL PUBLIC HEALTH NURSING SERVICE\nThe public health nursing programme is developed on a local level to meet\nthe health needs of the community following an accepted standard of service. In\naddition to the 191 public health nurses in the Provincial Health Department on\nstaff at the end of the year, other official health agencies employed a total of 200\npublic health nurses to provide service in other parts of the Province. This included\nthe Metropolitan Health Committee serving the Greater Vancouver area, the Victoria-Esquimalt Health Department, the Oak Bay Public Health Nursing Service,\nand the City of New Westminster, which forms part of the Simon Fraser Health\nUnit. The Indian Health Services provides public health nursing service on reservations not served by Provincial health units or the Metropolitan Health Committee.\nIn addition to the above, a voluntary agency, the Victorian Order of Nurses, supplements the public health nursing programme in the larger cities and rural municipalities through the provision of home nursing care and other selective services.\nThe Victorian Order employs fifty-nine full-time nurses. At the end of the year\na total of 449 full-time public health nurses were employed in public health nursing\nactivities in this Province. These nurses work closely with occupational health\nnurses, employed privately in some industries, and with certain nurses in hospitals,\nto provide continuity of public health nursing service in local communities.\nThe public health nursing programme, except in the two metropolitan centres,\nis similar throughout the Province and provides a generalized health service designed\nto meet the health needs of all members of the family. Every effort is made for all\npublic health nursing organizations to follow policies which are worked out on a\nProvincial basis so that a similar standard is attained throughout British Columbia.\nCertain health programmes are directed toward specific age-groups where\nspecial needs are known to exist. The public health nursing service therefore includes health education for expectant parents through individual instruction and\ngroup classes. Parents receive anticipatory guidance at child health conferences\nand in home visits on the physical and emotional development of the child in order\nthat the child will reach its health potential. .Assistance is given in providing\nresources for the correction of defects and medical care as indicated. Specific\nservices, such as immunizations against preventable diseases such as smallpox,\ndiphtheria, poliomyelitis, typhoid fever, tetanus, and whooping-cough, are pro- PUBLIC HEALTH NURSING AA 43\nvided at child health conferences, schools, and at special clinics. During the past\nyear a considerable amount of time was spent in organizing and conducting special\npoliomyelitis immunization clinics for all persons up to 40 years of age. A continuous health supervisory programme is carried on in the schools to assist in the\npromotion of health among the school-age children. An increased emphasis is\nbeing placed on the mental-health problems, and public health nurses are giving\nincreasing attention to obtaining help for children needing psychiatric guidance.\nIn Provincial health unit areas there has also been an increased interest shown\nin establishing home nursing-care services to meet the need for professional nursing\ncare in the home as provided on a part-time visiting-nurse basis by public health\nnurses on the staff of local health units. This programme has been increasing\ngradually since 1947, when the first health unit in the South Okanagan at Kelowna\nintroduced a visiting home nursing service under medical supervision as part of\nthe generalized health service. This nursing-care service was part of a plan for\nhome care which would assist certain types of patients to receive professional\nnursing care at home and also have the benefit of a \" home-maker \" service which\nprovided visiting part-time housekeepers. Thus many persons receive care at\nhome rather than in an expensive institutional setting. Acute, chronic hospital beds,\nas well as other types of institutional care, have been reduced by the use of this type\nof service. Although there has been a lag in the establishment of organized home-\nmaker or housekeeping services, nine centres now have established the special\nnursing-care service. These include Kelowna and Penticton in the South Okanagan\nHealth Unit, Vernon in the North Okanagan Health Unit, Ladner and Langley in\nthe Boundary Health Unit, Courtenay and Powell River in the Upper Island Health\nUnit, and Qualicum in the Central Vancouver Island Health Unit, which was established this year. Arrangements are being completed to start a similar service in the\nSouth Central Health Unit at Kamloops and in the Upper Island Health Unit at\nCampbell River.\nAll health units are providing limited home nursing care on a short-term and\ndemonstration basis, so that the addition of the special nursing-care programme can\nreadily be carried out with an adjustment of the public health nursing districts.\nAs part of the regular public health nursing programme, 9,265 nursing-care services\nwere rendered during the year. This is in addition ot 13,148 nursing injections of\nstreptomycin provided for tuberculosis patients to enable them to live at home\nrather than remain for treatment in a tuberculosis sanatorium.\nAreas which are interested in the special nursing-care service can arrange with\nthe local health unit to have this service by agreeing to pay an additional assessment\nof 10 cents per capita. Nursing-care service is then provided within the framework\nof the public health nursing service. The public health nurses are then assigned\nslightly smaller districts so that they can assume the additional nursing-care programme. Public health nurses usually serve a population of around 5,000 persons,\nand it is possible at the present time to provide complete public health nursing\nservice, including the special nursing-care service, in an area of around 3,500\npersons. By having each public health nurse assume the nursing care required in\nher area, it is possible to provide the nursing-care service efficiently at a minimum\ncost as travel time and duplication of service are avoided. All nursing-care services\nare given on the written order of the private physician. Service is provided during\nthe regular working-day, and special arrangements are made to provide service on\nweek-ends and holidays by the employment of week-end \" relief \" nurses. In this\nway the public health nurses are able to maintain their regular work schedule as no\ntime off is required to compensate for overtime or week-end work. jM. 44 PUBLIC HEALTH SERVICES REPORT, 1959\nNo charge is made to the patient for the service given. Every effort is made\nto teach the patient or family to carry out nursing procedures so that the patient\nbecomes self-reliant as soon as possible. Whenever possible, patients are asked to\ncome to the health centre for care, in order to help in rehabilitating patients so that\nthey become useful members of the community as soon as possible.\nDuring the year 11,710 nursing-care services were provided in the nine areas\nwhich have the special nursing-care service. From an analysis of the first eight\nmonths of nursing care, records show the following types of care have been given\nas shown by the percentage of the total number of visits: Injections, 70.6 per cent;\ngeneral care, 18.6 per cent; enemas, colostomy irrigations, 1.4 per cent; catheterizations, 2.3 per cent; massage, rehabilitation, inhalations, remove sutures, dress\nwounds, cancer dressings, etc., 7.1 per cent. Approximately 8 per cent of the total\nspecial nursing-care services were given in the health centre, with the balance in\nthe home.\nIt is anticipated that this nursing-care service will continue to grow. PUBLIC HEALTH ENGINEERING AA 45\nREPORT OF THE DIVISION OF PUBLIC HEALTH\nENGINEERING\nR. Bowering, Director\nThe Division of Public Health Engineering is concerned with the specialized\nfield in public health wherein engineering principles and techniques are employed in\nthe practice of public health. The major fields of work of the Division will be discussed under seperate headings.\nWATER-SUPPLIES\nThe Division is responsible for reviewing plans for extensions, alterations, and\nconstruction of waterworks systems. The Health Act requires that all plans of new\nwaterworks systems and alterations and extensions to existing systems be submitted\nto the Health Branch for approval. The careful study of these plans, together with\ninspections on the site in many cases, is one of the major duties of the Division.\nDuring the year seventy-nine plans in connection with waterworks construction were\napproved or provisionally approved. This compares with seventy-one plans in 1958.\nIn addition to approval of plans, waterworks systems in the Province are visited\nfrom time to time for the purpose of checking on sanitary hazards and assisting generally in the improvement of waterworks systems.\nGenerally, in British Columbia the water-supply sources are good and expensive treatment of the water is not usually required. Where treatment is required,\nchlorination is the usual method. Over 80 per cent of the population of the Province uses water protected by chlorination. There are only three domestic water-\nsupply systems in the Province where the water-filtration method is used.\nBy the end of the year 1959 there were seven communities fluoridating the\nwater, some using sodium silico fluoride and some using sodium fluoride. Reports\nare received regularly with respect to the amount of fluoride added to the water,\nthe amount of water used, and reports on testing of the water for fluoride. There\nhave not been any major problems involved in adding fluoride within the required\ndegrees of tolerance. Fluoridation plants are visited from time to time for the purpose of checking on their operations.\nThe local health units are responsible for the regular frequent sampling of the\nwater from public water-supply systems. The Division of Laboratories performs\nthe examination of the samples. The Division of Public Health Engineering offers\nconsultative advice on the interpretation of samples to the health units. During the\nyear the policy of having the Division of Public Health Engineering screen all requests for chemical analyses of water was changed to allow for direct contact of\nthe health units with the Division of Laboratories.\nEach year the Division receives a number of inquiries concerning private water-\nsupplies. These are referred to local health units. A considerable amount of advice\nis given by mail and occasionally by visits. Also, when visiting health units, public\nhealth engineers consult with local health unit officials on various water-supply\nproblems.\nNo known water-borne epidemics resulting from the use of public water-\nsupplies were reported during the year. This fact is evidence of the care being taken\nby the various water authorities to provide a safe water-supply for the citizens.\nThis record can only be maintained by constant vigilance on the part of the local\nhealth authorities and engineers of the Division. In order to assist further the efforts\nof local water authorities to have better-trained people operating the waterworks AA 46 PUBLIC HEALTH SERVICES REPORT, 1959\nsystems of the Province, it is the hope of the Division that during the next year a\nshort school for waterworks operators will be held in the Province. This school may\nbe organized in co-operation with the American Waterworks Association.\nOne problem that is a serious one as far as water quality is concerned is the\nuse of combined irrigation and domestic water-supply systems. The bacteriological\nquality for irrigation water does not need to be as good as that for domestic water.\nWhere the systems are combined, the cost of treating the whole volume of irrigation\nwater just to protect the water used for domestic purposes is very high. This problem continued to receive study by the Division.\nSEWAGE-DISPOSAL\nThe Division has the responsibility of reviewing plans for extensions, alterations, and construction of sewerage systems. During the year sixty-four approvals\nwere given in connection with sewerage work. This compares with fifty-six approvals in 1958.\nStudy of plans for approval includes the study of profiles and plans of appurtenances so that a good standard of sewerage work is constructed. Also, the study\nincludes treatment-works, if any, and studies of the receiving body of water in order\nto determine the degree of treatment required. During the year a considerable\nnumber of small sewerage systems were constructed for subdivisions by subdividing\ncompanies. This type of sewerage systems usually require a small sewage treatment plant. When the subdivision is built in a municipality, it is the policy to have\nthe municipality request the approval.\nDuring the year a by-law for the construction of sewers failed in the Municipality of Saanich. In the Municipality of Vernon a by-law for the rehabilitation\nof the sewage and treatment plant, which is now overloaded, also failed.\nDuring the year the Village of Fruitvale had a complete sewerage system built.\nThe treatment provided here is a two-stage waste-stabilization pond. During the\nyear a considerable amount of sewerage construction was carried out in Nanaimo.\nWhen this construction is finished, there will be no disposal of raw sewage into the\ninner harbour.\nThere are now nine installations of sewage lagoons or waste-stabilization ponds\nin British Columbia. This method of sewage treatment is mainly used for smaller\ncommunities and provides a reasonably good sewage-treatment service at relatively\nsmall cost. The design criteria are becoming more uniformly developed each year.\nSTREAM POLLUTION\nThe general problem of stream-pollution control is one of the major items dealt\nwith by the Division of Public Health Engineering. Stream pollution is caused by\nthe discharge of sewage and industrial wastes into surface water. These discharges\nmay have quite diverse effects on the receiving body of water because of the extreme\nvariations in the type and strength of the waste and the quality and volume of the\nreceiving body of water. The net result of such discharges, however, may make the\nwater less desirable and less useful.\nAt the present time there are no pulp-mills discharging waste into fresh water\nin British Columbia. However, a pulp-mill is now under construction on the Columbia River. The company's plans are to take the best steps possible to prevent\nserious harm to the river. Control of pollution by sewage under legislation presently\nin existence has made it possible to prevent the discharge of sewage from affecting\ncommunities in lower stretches of streams and rivers. In addition to the Health PUBLIC HEALTH ENGINEERING\nAA 47\nBranch, other departments of government have had legislation for control of certain\ntypes of pollution. This type of control has not been sufficient to prevent all types\nof pollution, and for this reason the Pollution-control Board was established to take\ncharge of this problem in the Lower Fraser River Basin. During the year, communities of the Okanagan Valley requested that the authority of the Pollution-\ncontrol Board be made to extend to the Okanagan Valley. It is possible that this\nmight be done by 1961.\nTHE POLLUTION-CONTROL BOARD\nThe Pollution-control Board, which was set up late in 1956 to control the discharge of waste into the Lower Fraser Basin, requires a considerable amount of\nwork by the Division of Public Health Engineering. The administration of the Act\nis the responsibility of the Minister of Municipal Affairs. The Pollution-control\nBoard consists of three Civil Servants, one former Civil Servant, and three members\nfrom the Greater Vancouver area. Under the Act, responsibility for technical\nadvice is laid upon the Health Branch. The Director of Public Health Engineering\nacts as secretary of the Pollution-control Board and as technical adviser to the\nBoard.\nThe area over which the Pollution-control Board has jurisdiction is the Lower\nFraser Valley below Hope, together with the contiguous salt-water areas, including\nBoundary Bay, Roberts Bank, Surgeon Bank, Burrard Inlet, and Howe Sound.\nDuring the year nine permits for discharge of waste were issued. These permits\nwere made valid for only five years, during which time it is believed that adequate\nstudies of the capacities of the area to receive pollution, together with studies of\nexisting discharge into the river, would be made. It is intended to proceed with\na fairly detailed study of all outfalls into the river under the jurisdiction of the\nPollution-control Board during the year 1960. It is hoped that by the end of the\nyear 1960 standards will be prepared for discharge of waste into the waters covered\nby the Pollution-control Board.\nThe most important permit issued by the Pollution-control Board is the one\nthat permits the Greater Vancouver Sewerage and Drainage District to build a\nsewage-treatment plant on Iona Island. During the year 1959 plans for a considerable portion of the work were completed, and a large amount of construction will\nbe done during 1960.\nDuring the year the Greater Vancouver Sewerage and Drainage District attempted to lower the bacterial pollution in English Bay by the installation of a\ntemporary comminuter and sewage chlorination plant on the outfall discharging into\nEnglish Bay. The purpose of this was to make it possible to open the Vancouver\nbeaches for the year 1959. Studies of the effects of this operation showed that this\ntreatment had significantly lowered the bacterial count, and it became possible for\nthe beaches to be reopened for the summer of 1959. It is probable that this method\nof temporary treatment will be carried out until the Iona Island treatment plant is\nready. At such time the sewage presently discharging into English Bay will be taken\nto the south side of the city by tunnel and treated in the Iona Island sewage-treatment\nplant. This will result in greatly improved conditions on the English Bay beaches.\nDuring the year, plans for the sewage-treatment plant for West Vancouver were\ncompleted and approved. Much of the construction will take place in 1960.\nA large number of samples were taken through the co-operation of the local\nhealth units from Burrard Inlet and the Fraser River. It is intended that this programme be intensified in 1960. It is expected that the work of the Pollution-control\nBoard will occupy a considerable amount of time of the Division of Public Health\nEngineering for many years to come. AA 48 PUBLIC HEALTH SERVICES REPORT, 1959\nSHELL-FISH SANITATION\nThe Division of Public Health Engineering has the responsibility of enforcing\nthe Shell-fish Regulations. Inspection of shucking plants and handling procedures\nnow comes under the jurisdiction of local health units. There are six local health\nunits that have one or more shucking plants within their area. Certificates of compliance are issued to owners of shucking plants that comply with the regulations.\nStudies are also made of the shellfish-growing areas, as all applications to lease\nareas for shellfish-culture purposes have to be approved by the Health Branch.\nPractically all the oysters produced commercially in British Columbia are grown on\nleased grounds. In one area a considerable study was made during 1959 to see\nwhether or not a pulp-mill was contaminating a shellfish-growing area with coliform\nbacteria. No evidence was found that such was the case.\nThere is complete co-operation between the Provincial Health Branch and the\nDepartment of National Health and Welfare with respect to the shell-fish industry.\nThe Department of National Health and Welfare has the responsibility for approving\nshell-fish operations where the product is sold outside of the Province of British\nColumbia.\nWith respect to paralytic shell-fish poisoning, the area that was closed for the\ntaking of clams was reduced in size during the year. However, a considerable area\nstill remains closed, and reports indicate that the toxicity is lessening.\nIn view of the difficulty of obtaining samples from certain areas of the Province,\nit was decided to have several paid samplers pick up samples in some of the out-of-\nthe-way parts of the Province. This programme had just commenced by the end\nof the year.\nGENERAL\nThe Division of Public Health Engineering provides a consultative service to\nother divisions of the Health Branch and to the local health units on any matters\ndealing with engineering. This entails a considerable amount of work. During the\nyear all of the health units were visited at least once. During these visits the various\nproblems requiring engineering for their solution are examined in the field.\nThe work entailed by the Frozen Food Locker Plant Regulations has now been\ngreatly reduced, there being only two approvals of locker plants during the year\n1959.\nThe position of Chairman of the British Columbia Examining Board for Sanitary Inspectors was again filled by the Director of the Division. Eight persons\nreceived certificates in sanitary inspection during the year.\nThe Director served as a member of the Advisory Committee on Health, which\nis a sub-committee of the Associate Committee on the National Building Code of\nthe National Research Council of Canada.\nTwo members of the Division attended the first International Conference on\nWaste Disposal in the Marine Environment, held at Berkeley, Calif., in July, 1959.\nThe staff of the Division was increased by one public health engineer during\nthe year, which has made it possible to extend the operations of the Division. PREVENTIVE DENTISTRY\nAA 49\nREPORT OF THE DIVISION OF PREVENTIVE DENTISTRY\nF. McCombie, Director\n\" In one African tribe an attack of dental caries is considered sufficient grounds\nfor divorce. If one of the children has decayed teeth, he is forbidden to eat from\nthe family pot.\" So reports a recent editorial of the British Medical Journal.\nOn the North American Continent, the United States Public Health Service\nstates: \"Dental decay is recognized as man's most widespread chronic disease.\nFew persons escape. No special stratum or age group is immune. If everyone\nwho needed dental care wanted it, there would not be enough dentists to provide it.\nThe current progressive accumulation of dental disease is a heavy national burden\u00E2\u0080\u0094\npainful, costly, and disfiguring.\"\nYet, in the United States, there are approximately half as many dentists again,\npro rata, as there are to-day in British Columbia. In Canada it is reported that\nmore than $100,000,000 is being spent each year on dental treatment provided by\ngeneral dental practitioners. The average child leaving school in British Columbia\nhas, of his or her twenty-eight permanent teeth, already twelve teeth which are\ndecayed, missing, or filled.\nThe tragedy is that to-day the vast majority of dental disease, especially dental\ndecay, is so largely preventable.\nPREVENTION\nThe preventive dental services throughout the Province have continued to\nstrive, and it is believed with some measure of success, to decrease the present high\nincidence of dental disease.\nSome details of the clinical aspects of the preventive dental services during the\nschool-year 1958/59 are shown on Table I below.\nTable I.\u00E2\u0080\u0094Full-time Preventive Dental Treatment Services in British Columbia,\nShown by Local Health Agency, School-years 1953/54 to 1958/59\nO'O\n8-8\nu 3\nc/jTj\niu C\nO-h\ni- i_\naJ Y,\nJD--\nES\n3 .\nZQ\nPreschool Children Dentally\nCompleted\nGrade I Pupils\nSchool-year\na\n2 S\nt/.W\n_h_ M\n\u00E2\u0080\u00A2a .5\n'c.'S.'o\nSES\n\" 0-3\nQUw\n(1)\nRequiring No\nq Treatment\n\u00E2\u0080\u0094' when\nExamined\nb_\nC\n'\u00E2\u0096\u00A03 it.\n__ En\n*_ \",\u00C2\u00A3\n\n3=3 a\n60\nm a\n2-1\nQJ \u00E2\u0080\u0094' _r\nJD.B 3\nSS 3\nZDcl\nO c aj\nt_P\ncjW ft\n? C E\n\u00C2\u00AB\u00C2\u00BB.\na.'oU\nas\nvx\ o\nx) o-o\n04 .1)\n\u00C2\u00A3 \u00C2\u00ABa\nIh U O\nOQU\no\u00C2\u00A30-o\n_-ao a\nass Oh\n^ QJ \u00E2\u0080\u0094 "Legislative proceedings"@en . "J110.L5 S7"@en . "1960_V02_19_AA1_AA91"@en . "10.14288/1.0355720"@en . "English"@en . "Vancouver : University of British Columbia Library"@en . "Victoria, BC : Government Printer"@en . "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"@en . "Original Format: Legislative Assembly of British Columbia. Library. Sessional Papers of the Province of British Columbia"@en . "Sixty-third Annual Report of the Public Health Services of British Columbia HEALTH BRANCH DEPARTMENT OF HEALTH SERVICES AND HOSPITAL INSURANCE YEAR ENDED DECEMBER 31ST 1959"@en . "Text"@en . ""@en .