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THE LIBRARY 




THE UNIVERSITY OF 
BRITISH COLUMBIA 



Gift of 

King's Printer 



.»-,-». «^.. ._»-_„ 



IESL .t* Na._i: 

THE LIBRARY 

jniversity o sh Cofurni 

ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 2 



APRIL, 1935. 



No. 2 



TO THE PROVINCIAL PUBLIC HEALTH NURSING STAFF. 



NEVER before has the nurse had an opportunity such as that which 
is opening to-day for the Public Health Nurse. For years we have 
been thankful that she kept from slipping backward — to hold her own and 
to make the slight forward step which enabled her to retain her hold was 
all that could be expected. 

Rut at last we know that she can go forward! The social problems 
of our Province are being searchingly examined; experiments will be 
made, but not in a haphazard way — each step will be checked. The 
sound work which has already been accomplished by the Public Health 
Nurse and Physician in the Health Centres will provide the control in the 
new community welfare experiments. The nurse will find an outlet for 
all her energy, and to-morrow she will see the fulfilment of all her dreams 
and ambitions. 

May you receive from the Easier Refresher Course all the stimulus 
and encouragement you are looking for and return to the tasks awaiting 
you which you will at length be able to number as faits accomplis. 

Sincerely yours, 

MABEL F. GRAY, 

Assistant Professor of Nursing, The University 
of British Columbia. 



TABLE OF CONTENTS. 



Page 



A School Nurse's Day-dream. By Jennie Hocking, R.N. 



Remarks from Fernie. Jbsy \\ . F. Seymour. liJN , .» 

Story of Five Years at Keremeos. By B. G. Thomson. R.N <> 

Ladysmith and District. By E. G. Allen. R.N 7 

Dental Problems of the Day. By M. A. Twiddy, R.X S 

Discussion Groups for Mothers. By 10. M. Carruthers, R.X 10 

Ixka.meep Indian Reserve. By Rita M. Malum. R.N 11 

An Attempt at Stock-taking. By Mary E. Grierson. K.N 14 

" Fresh Fields and Pastures New." By II. Kilpatrick, R.N 1.1 

" Some Reflections." By I). E. MacKenzie, R.N 17 

First Impressions in Revelstoke. By Agnes Thorn, R.N 18 

A Sikh Well-baby Clinic. By Annie S. Law. R.N 21 

Work in Sayward. By Edith M. Walls. K.N 23 

Vernon. By E. E. Martin. R.N 24 

Popularity and the Three C's. By G. Homfray. R.N 2."i 

The Problem of Teeth in Children. By I). E. Tate. K.N 2(i 

The Generalized Public Health Nurse. By E. Lowther, R.N 27 

Nelson's Health Problem. By Kathleen Gordon. R.N 2<S 

Medical Relief. By Beryl McPherson, R.N 31 

Public Health in Westbank. By Grace Hill, R.N 32 

Rain or Shine? By Muriel Upshall, R.N 33 

Mental Health i.\ our Schools. By P. Charlton, R.N 34 

Toxoid. By M. K. Smith. R.N 35 

Organizing the Nursing Services of a Health Unit. By Bertha Jenkins. R.N... 36 
Progress of Public Health in Ka.m loops. 1925-35. By Olive M. Garrood. K.N. 3* 



A SCHOOL NURSE'S DAY-DREAM. 

Miss " S." stopped into her car one day 
And sped to the West-side School away. 
Her aim to weigh and measure a class 
And see if all could the eye-test pass. 
The road was clear and the air was great. 
Miss " S." she travelled at quite a rate. 
Got there at ten forty-six. I'd say — 
Recess, and all the children at play. 
Thought to herself, while they have their fun 
I'll park out here and enjoy the sun. 

Miss " S." was tired and the sun was warm. 
Her eyes they closed after one big yawn. 
Far in the distance she heard a sound 
Like muffled footsteps from all around. 
Still nearer and nearer came the tread 
So our nurse raised up her drowsy head : 
She looked and saw a most wondrous sight. 
Thousands of nurses in blue and white. 
Behind them stretched for miles and miles 
Doctors and dentists, and all with smiles. 

They said. " We've cars, equipment, and cash. 

Tone diagnoses for every rash. 

Hospitals, clinics, glasses, shoes, 

And pasteurized milk for everyone's use. 

A law has been passed and health is free — 

We're to hand it out unsparingly. 

Let's now remedy ev'ry defect. 

Quarantine even a ' cold ' suspect. 

Our job is to make the whole world well. 

When you need our help just ring this bell." 

She woke to lind though the bell was gone. 
Quite loud in her ears still rang its song; 
Playtime was over and school went in. 
Miss " S." jumped out with her usual vim: 
She weighed and measured and tested eyes, 
Thought of her dream with a little sigh. 
They needed an army, and she but one, 
To see that some healthy work was done ; 
Though results she got were to be admired. 
'Twas the "left undones " that made her tired. 

Jennie Hocking, 

Baanich. 



:; 




NORTH OF TUE PEACE RIVER. 

Four years of public-health work in this new section of the Peace 
River Block — and what is there to show for it? I'm afraid not very 
much. When I look around, I wonder what I have been doing! 

Of course, it is not a whole-time job, as much of my time has to be 
devoted to the little Red Cross outpost hospital, which is run in conjunc- 
tion with the public-health work. 

All the same, 1 don't feel satisfied. And now the time lias come to 
move the outpost farther north across the Beatton River to a still more 
newly opened-up district, where the settlers are particularly isolated 
from doctor and hospital by bad hills and lack of roads. 

And so we have just moved over. The people this side of the river 
are delighted to have a nurse, and the little hospital, which they built 
themselves, getting out the logs, and giving their labour. 

But regarding the advance of public-health work, I foresee the same 
obstacles — poverty, indifference, and superstition. 

The standard of living over here is decidedly low. I am confronted 
right away by the problem of over-crowding, lack of right feeding, lack 
of good water, lack of adequate sanitary arrangements, and most serious 
of all, lack of desire for better conditions. And I might almost add — 
lack of time! 

They need so much that my little bit of public-health work seems 
just a " drop in the ocean." 

More and more I realize that public opinion has to be functioning 
well in advance before there can be much reform work done. 

However, I am not really as pessimistic as 1 sound, for 1 find that 
there is a very " alive '' Women's Institute functioning in this district, 
through which I hope to do great things. I know it will give me a good 
backing and be very helpful. 

Nor do I really blame the settlers for their apparent indifference to 
health matters. On the contrary, I admire them tremendously for most 
things. Many of them are putting up a brave light against existing 
adverse conditions. Necessity is showing herself the "mother of many 
inventions." It is the country of ' ; home-mades." So much is home- 
made, from pickles and rugs to threshing machines and looms for weav- 
ing. The only two threshing machines over here were made from a patient 
collection of scrap iron of all sorts. The cylinder was made from a log 
and cleverly cut to requirements by hand. Of course the foundation is 
the faithful old Ford car that brought the family in, so optimistically, 
two or three years ago. The tires, cut and sewn together, are used for 
belts in a most ingenious manner. 

So these people, who work so hard and so courageously trying to 
help themselves, are undoubtedly worth helping. Therefore, with the 
backing of the Public Health Department, I am ready to put forth fresh 
effort in this new district and to go on hoping that some seed may bear 
fruit some day. 
^^*' M. Claxtox, B.N., 

Cecil Lake, B.C. 
4. 



REMARKS FROM FERNIE. 

1 have spent eight years in Pernie — -years of depression, relief, and 
upheaval. During my first year I drew up a programme and kept to it 
more or less faithfully, realizing that a programme of this sort must of 
necessity be more or less elastic. 

During the last few years I have felt that doing the work which 
seemed most needed was the better way of dealing with the situation. 
Here we have more than fifty per cent, of the people on relief and a large 
foreign population. All service clubs, churches, and private individuals 
have done splendidly in meeting conditions and aiding in emergencies 
as they arose, but " building for the future " has seemingly had to give 
place to " scraping for the present," and that may not be such a catas- 
trophe either as some imagine. 

Through the grey skies of depression it has often been difficult to 
remember to look for the silver lining which is essentially a part of the 
dark cloud, but I really think 1 do see it and can give a concrete outline 
of it. 

Out of 500 children in the Public Schools only nineteen are under- 
weight, and in more than fifty per cent, of these cases the cause is not 
due to relief rations. Whenever needed our children have had appendix 
and tonsil operations as well as other surgical and medical treatments 
in hospitals. Our district has taken care of its handicapped children 
and sent them to the Solarium, the School for the Deaf and the Blind, or 
helped them in their homes. 

We have provided clothing where most needed, infants' layettes, milk 
for malnourished and sick children, also for newly-confined mothers, 
and no children have had to come to school in even the very worst weather 
insufficiently clad and shod. 

A great deal of emergency dental work has been done, and I do not 
worry nearly so much about the lack of attention to first teeth, as the 
second set seems to take care of itself in a truly marvellous manner. 
I find that the child of foreign parents, particularly the Italian, has 
a better tooth structure than the Anglo-Saxon has. 

Our pupils are clean, healthy, happy, wonderfully free from infec- 
tious diseases, of good physique, self-reliant and eager, and I really think 
that the years of depression have helped to give them a better idea of 
real values in life than the former years of prosperity ever did. 

In fact, I have faith in our young people, and feel that mentally, 
morally, and physically they will rise to their •responsibilities in life and 
will be worthy of our respect and admiration as good healthy honourable 
citizens, and that is the best that can be expected of them, and the best 
return they can make us for our efforts to help and guide them. 

Winifred E. Seymour, R.X., 

Ftrnie, B.C. 



THE STORY OF FIVE YEARS AT KEREMEOS. 



It is with pleasure I have read the articles published at intervals in 
our monthly bulletin and written by other nurses in the Province. 

The monthly bulletin is always of greal interest to me. It interests 
me to read about the various diseases, especially contagions, which crop 
up at intervals, wondering at the same time how soon we may expect 
n case and thanking God that so far we have escaped. 

When I came here live years ago 1 had lots of ambition and was full 
of altruism and high ideals. I still retain my ideals. I have lost a greal 
deal of altruism, and the only ambition I have Left is to attempt to teach 
common-sense in regard to health and to try to get people to give the 
same square deal to us that we are trying to give to them. 

Of material things there was very little to work with right from the 
beginning. I was not here long before I noticed that touching the 
pocket-book was a very sensitive procedure. There was some excuse for 
this in that the purse has been rather fiat these last five years. 

I had to make the best of conditions as they were. We at least had 
the minds of the people to work on, and as human psychology has always 
been a subject of all absorbing interest to me, I found this approach 
rather easy. 

I decided to present health in simple, easily understood, straight- 
forward facts. I have tried never to use any elaborations or fanciful 
phrases and always to present the truth. I have read with care all the 
articles published by the Vancouver Health League. They appealed to 
me for their reasonableness and straightforward presentation of facts. 
1 have quoted from these and have given them to those who were par- 
ticularly interested or appreciative to read; 

My health talks to the school children have been prepared mostly 
from the Ilygeia; these talks have been of interest and have, I believe, 
borne a little fruit. This fall, I happened to be very busy on the district 
in September and missed giving a health talk. The teachers kept saying 
" When are you going to talk to us? " 

Practical demonstrations are done in the home. We make mustard 
plasters and linseed poultices, prepare enemata and bowel irrigations, 
give bed baths and babies' baths, make feeding formulas, keep tab of 
the baby's weight, review feedings month by month, and review the health 
rules for the pregnant mother. 

We have some splendid nurses among our mothers. I encourage the 
use of clinical thermometers. Most of the mothers can read a ther 
mometer well. It is the only guide 1 we have to complete recovery from 
minor illnesses, which often become serious if neglected. We have 
learned to realize that time is saved by putting a child 'to bed when it 
first shows a temperature and keeping him there until he is normal. 
This also isolates him somewhat and retards the possible spread of 
infection. A high temperature does not seem to send the mother into 
a " fit." She is calm and wants the matter looked into. Hashes and 
other abnormal conditions are conscientiously reported. We administer 
cod liver oil from November 1 to May 1. 

G 










We have formed the habit of using mineral oil and laxative foods in 
case there is a chronic appendix which might be irritated into an acute 
one if drastic purgatives were used. 

We see to it that we get our daily vitamin in our food — Vitamin A 
in milk, Vitamin B in coarse cereals, Vitamin C in tomatoes. All these 
things are normal every-day affairs, like getting breakfast. 

I must confess there has been no spectacular accomplishment. I do 
think we have made a beginning. There is a glimmer of health con- 
sciousness in the minds of the people. I know these people so well, too 
well maybe, which may account for some of the altruism petering out. 

We have been terribly handicapped by not having a resident physi- 
cian nearer than thirty-two and forty-five miles. Since the Iledley Mine 
opened we have a Medical Health Officer at Hedley, eighteen miles of 
splendid road. He is going to look after us and has in mind a health 
contract for the people consisting of a small monthly payment for each 
family. I have every reason to believe that this scheme will materialize. 
It gives the people such a sense of security to have some one who will 
come in case of illness. What this means to me, no one can guess. 

Dr. Wride has only been known to us a short time, but we have all 
acquired the greatest confidence in him, as he has already proven himself 
up-to-date, conscientious, businesslike, and gracious. 

B. Thomson, R.N. 



LADYSMITH AND DISTRICT. 

I entered hospital for my training as a nurse nearly eleven years 
ago with the idea and intention of caring for the sick. I have seen many 
benefit from this care to the extent of being restored to permanent good 
health; others much improved, and sufficiently cured to enjoy a normal 
life. There were still some who paid repeated visits to the institution. In 
so many instances it was plainly lack of knowledge that had led to the 
breakdown of their " physical resistance " — perhaps through contact with 
a sick person, neglect, or carelessness on the part of the person affected. 
I began to feel that surely there must be another side to sickness, that 
of prevention. 

After graduating, I spent three years working with the knowledge I 
had acquired and then decided to train for a Public Health Xurse. 

During the past three years which I have spent as School Nurse for 
above districts, ten in all, I have many times witnessed the fruits of 
preventive work. The parents and the public, in general, appreciate the 
advice of the Public Health Nurse, and especially the early visits or 
inquiry when the child is absent from school. Recently when I inquired 
on the first morning of absence, a mother said " that is what I call 
service," and so I explained to her that the early check-up meant a whole 
lot more for both the pupil and the contacts. 

In this community the people are very proud of having Public Health 
Service and, in the vast majority of cases, will assist in the check of 

7 




epidemics by the early reporting of sickness in the family. They ask for 
advice as to whether Mary should stay at home because Johnny has a 
"rash." The parents are very eager to learn the explanation of the 
length of incubation periods regulating the quarantine periods, and are 
interested to learn the present-day methods regarding quarantine and 
isolation under supervision. 

Preschool and Infant Welfare Clinics are held twice monthly here, 
and the follow-up work is chiefly done when visiting the homes for other 
reasons. Much more should be done but the school work is the major 
factor, and I feel that it is better to be thorough in one branch of the 
service rather than attempt too many things, some of which only have 
to be dropped later as the work expands, as it does in all its branches. 

People are becoming more clinic-minded all the time, realizing the 
benefits received rather than the disgrace that used to be felt if they 
were asked to attend one. Several advanced cases of tuberculosis in our 
midst have made it much easier to approach the people in regard to the 
care for and the carefulness necessary in this disease. 

Goitre is not so prevalent here, but in all instances where the tablets 
have been suggested for the children the parents have signed the slip of 
paper and paid the fifteen cents asked for to help cover the cost. 

Last June scarlet fever found its way into one family. Also in 
November another child became ill, but in each case we were happy to 
report no further trouble. In January of this year there was a case of 
rubella in the third grade which spread only to a pre-school brother and 
a girl who was assisting in the home during the mother's visit to hospital. 
The family consisted of six children. I cannot say this of whooping- 
cough, unfortunately, as we have had quite a few cases, but all suspicious 
coughs are being isolated and I think a severe epidemic will be prevented. 
The cases are mild but the weather has been so cold and wet that the 
children have not had the chance to recover out-of-doors in the sunshine. 

The best Avay to reach the hearts of the people is to take an interest 
in their children, and we have accomplished much. They are proud of 
their schools and are extending the courses annually. 

Emily G. Allen, R.N., 

La di/ '.smith, B.C. 






DENTAL PROBLEMS OF THE DAY. 

To the many expressions of impressions on depressions, as a School 
Nurse, I would like to add some observations in regard to the dental 
condition of individuals who must neglect the repair of their teeth in 
order to have the immediate necessities of life. Such people visit the 
dentist only when in extreme pain or when general health is seriously 
threatened. 

I have found that dentists are very generous in treating urgent cases 
referred to them, but it is impossible for them to treat all the needy ones. 

8 




Hence every day one meets in both school and home many cases of 
neglected teeth. 

" The dentist says I have five to be extracted and eight to be filled. 7 ' 
" It would cost thirty dollars to fix np another young girl's teeth." These 
are examples of the many reports from dentists when children go to them. 

When trying to get the consent of a mother to get Mary's tonsils out, 
she replied, " I think her trouble comes from bad teeth rather than her 
throat." On looking at the teeth I agreed with the mother. Many 
months have elapsed and neither teeth nor tonsils have had attention and 
Mary remains a thin anaemic-looking girl. 

Practically all prenatal cases among people with a small income need 
dental care. We are reminded that they need extra milk in the diet and 
foods that give additional vitamins. Plow are these expectant mothers 
to get such " extras " as foods and dental care? Surely pregnancy brings 
enough discomforts without the unnecessary suffering that carious teeth 
can give. 

When a doctor examined a child of five, who was acutely ill, he could 
find no cause except many bad teeth. The child had not had sufficient 
milk and cod liver oil. It has been observed that small children who have 
had plenty of milk and cod liver oil have good teeth. But there are 
hundreds who cannot provide these for the children. 

In school, one sees very few children whose parents pay any attention 
to the deciduous teeth. Hence there are scores who have these sources 
of infection in their mouths. 

It is heart-breaking to inspect the permanent teeth of children. Over 
100 of the 911 inspected (nnder sixteen years of age) have from one to 
five or six large cavities. There are likely many small ones besides which 
are not easily seen in the school examination. Some forty of this group 
have had from one to four of the permanent teeth extracted. 

There are only about a dozen in the group who have perfect and 
complete sets of teeth. Hundreds need treatment by the dentist for 
cleaning, straightening, etc. In answer to " have you seen your dentist 
this year?" one often gets the reply, "No, I haven't had toothache yet." 

The famous Sir William Osier once said, "There is not one thing 
in preventive medicine that equals month hygiene and the preservation 
of the teeth." Prevention! That is a heart-breaking word in these days 
when so little of it can be practised. 

While it is generally conceded by all doctors and dentists that 
neglected teeth causes many ailments, it seems to me to be unkind to tell 
people of the dangers of such neglect when they can do nothing about it 
themselves. This teaching only adds " fear of losing health " to the many 
anxieties they already have. He who has health has hope and he who has 
hope has everything. 

We so need dental clinics for small municipalities. Here is hoping 
we have one .soon. 

M. A. Twiddy, R.X., 

Penticton, B.C. 

i) 



DISCUSSION GROUPS FOR MOTHERS. 



It has been stated that the education of parents can be accomplished 
through the schools, by means of the children. Consequently, when in 
health education classes, certain facts relating to hygiene are emphasized, 
and when in home economics budgeting and food values are studied 
minutely, it is often with the hope that these messages will be carried 
home to " mother and father." To parents this second-hand method of 
obtaining a modern education must at times prove embarrassing. 
Approaching adult education from the standpoint of health, there are 
many problems to be considered. It is difficult for doctors and nurses 
to keep up with the fast changing trend of medical science, while for the 
" lay " person it is practically impossible to weed out truth from untruth 
from magazines and newspapers. 

For two years now we have held regular discussion groups for 
mothers, and they have proved to be a happy solution for these problems. 
Not only are they useful as a method of educating " mother," but also 
serve as a means of keeping the nurse well informed. In order to guide 
the groups profitably the nurse must gather all the information she 
possibly can on the topic for discussion. We organized in this way: A 
message was sent home through the school children and through the 
Parent-Teachers' Association inviting all mothers interested in a " dis- 
cussion group " to meet in the nurse's office. The response was fairly 
gratifying and the attendance since then has varied from four to twenty- 
four, but, in all, about fifty different mothers have availed themselves of 
the opportunity to meet and discuss their problems. 

The mothers selected from a given list the following topics for 
discussion : — 

(1.) " The Job of Being a Parent." 

(2.) " Cod Liver Oil and Concentrates Now on the Market." 

(3.) "Colds — Cause and Prevention." 

(4.) "The Power of the Spoken Word." (This meeting was con- 
ducted by Mrs. Jennie McDonald, of Cowichan.) 

(5.) "Children's Parties and Christmas Presents." 

(6.) " Nutritive Value of Dairy Products." (Address given by Miss 
Pepper, of Dominion Department of Agriculture.) 

(7.) "Nervous Breakdowns." (A review of the book by that name 
written bv Dr. Wolfe.) 

(8.) "Tuberculosis." 

(9.) "Cancer." 
(10.) "Posture." 

Each meeting was opened by an address (so far this duty has fallen 
on the nurse, as the mothers are backward) followed by questions and 
discussion relating to the subject, Sometimes, however, other topics are 
introduced into the informal discussions. Connected with the mothers' 
group, we have a library of periodicals, namely " Hygeia " and " Parents," 
and the mothers seem grateful for the opportunity of thus broadening 
their health knowledge. Now, also, they are asking that the addresses 

10 



which were preliminary to each discussion be printed and distributed to 
the members. 

These discussions have entailed a great deal of preparation, but I 
feel that it has been well worth the effort, for not only has it been a 
method of self-education, but also it has been a very forceful way of 
presenting the principles of health education. 

Eileen M. Carruthers, R.N., 

Nanaimo, B.C. 



INKAMEEP INDIAN RESERVE— OLIVER DISTRICT. 

How many of you have an Indian Reserve attached to your district? 
And who does not find the work thereon one of the most interesting parts 
of your entire programme? 

When I first came to Oliver two years ago, having had no former 
experience with Indians, I looked with some few T qualms towards the 
Reserve. Like the average British Columbian, I had given only a passing- 



Tooth-brush drill, Inkameep Indian Day School. 

thought to the Indian in our midst. Few of us realize that a brief 200 
years ago Indians of this Province were monarchs of all they surveyed. 
The present year finds the red man closely hemmed in by our complex 
machine-age era, How to develop him and fit him for our modern life is 
at present a big problem. 

In his primitive state the Indian responded to the natural impulses. 
He hunted when hungry and loafed when full. Their primitive wants 
were few and easily satisfied. The Indian women knew how to care 

11 



for hides. From tliem she made much of the clothing for her family — 
clothing thai was not only durable for hard wear but line and beautiful 
as well. Shelter was a small worry. The nomadic urge is strong within 
(he Indian and, though we now have them more or less restricted to the 
Reserves, one finds them frequently roaming back and forth, "visiting,'" 
they call it here. In our efforts to remould the red man, we would do 
well to remember thai 1 hough he buys canned milk, store clothes, cheap 
jewellery, and the radio brings modern jazz to his lowly dwelling, his 
ancient habits are very much with him. lie has really advanced only a 
fraction of an inch from his primitive ways. 

Dealing with an Indian Keserve from a Public Health Xurse's 
standpoint, I find, gives one plenty of opportunity to cope with difficult 
problems. I believe we are very fortunate here in having a day school 
rather than a residential school. The relationship is closer and one 
finds that much of the teaching carries over. Health lessons are neces- 
sarily very elemental when one remembers that most of the children 
have previously never seen a tooth-brush, a bath-tub was unheard of. and 
a balanced diet beyond the limits of imagination. 

Very excellent co-operation from the teacher of the school has over- 
come many difficulties. Finally, each child possessed a tooth-brush and 
we practised cleaning our teeth assiduously. Formation of a Junior 
Red Cross with an active health committee gained much interest among 
the children, Henry, aged eighteen, acting as the solemn chairman of 
the meetings. The meetings are held when the nurse visits the schools. 
At this time she is a special speaker and stresses some one of the health 
rules as the necessity arises. Last term a number of lessons in first aid 
were given. In this the pupils showed marked adaptability. The local 
Boy Scout leader, who was present at a demonstration of work put on for 
school closing exercises, assured me that the 1 Indian children put his 
scouts to shame. 

Many of the Indians on this Reserve suffer from the eye disease. 
Trachoma. The Indian Department specialist on Trachoma, Dr. Wall, 
first visited this district about three years ago and diagnosed many 
cases. Since that time copper citrate live per cent., supplied by the De- 
partment of Indian Affairs, has been used as a preventive treatment. 
This measure carried out regularly at the school has shown good results. 
Many of the older people suffer from badly impaired vision and some 
from blindness, no doubt due to Trachoma. 

In visiting the homes 1 find it most important to establish a friendly 
footing. The Indian is slow to accept one as a friend, but, once estab- 
lished, his faith is implicit. My experience has shown demonstration to 
be much the best method of teaching. The women, and there are often 
several in one household, crowd around and watch every move. Most 
of the younger ones are \ovy willing to follow instructions re child care. 
but are sometimes dissuaded by their parents and grandparents who 
think babies should never cry. The result is difficulty in establishing 
anything approaching a regular routine. 

12 



The majority of the Indian women keep their infants clean and, 
although some still stick to the native mode of dress, many have accepted 
the modern method and make quite respectable garments, too. One of 
the dirtiest squaws on the Reserve was persuaded to keep her baby 
beautifully clean when I sold her a complete second-hand layette for 
twenty-five cents. She was so proud of those clothes, partly because she 
had paid for them, I think. 

Illegitimacy is fairly common and does not seem to arouse much 
concern. The child is taken into the home and looked upon with as 
much favour as any other member of the family. The father of one 
illegitimate child was known to be a white man. This seemed so appal- 
ling to me that T wrote the Indian Agent about the case only to find that 
the Department could not do anything about it as the girl was over age 
and, as the agent remarked also, " unfortunately, this is not by any 
means an isolated case in this Province.'' 

The Department of Indian Affairs supplies certain standard drugs 
for distribution. Important among these is cod liver oil. Through 
the co-operation of the school teacher, cod liver oil has been fed daily 
to all children attending school during the winter months of the past 
two years. Their health record shows that this has been of great benefit. 

I found it very difficult to persuade mothers to feed cod liver oil to 
the younger children — mostly because the children showed a distaste 
for it and the mothers would not carry on the treatment. This was over- 
come when we got a supply of malt extract and cod liver oil. Perhaps 
the actual content value is not quite so high but one can be quite sure 
the children take it. Many of them, toddlers and pre-schools, come 
running to the car when the nurse visits asking for " malt, malt." Diets 
are poorly balanced and ran to meat, fish, and bread principally. Al- 
, though the Indians on this Reserve raise huge herds of cattle, most of 
them like to buy canned milk. Some families have been persuaded to 
keep one cow for milking and to feed more milk to the children. 

Most of the houses are badly built, run down, overcrowded, and 
poorly ventilated. Some of the women are fairly clean housekeepers 
but the majority are careless and dirty. One who was especially dirty 
acquired a great love for l^sol and asked for it continually. " Bad 
smell ; make clean," she said, and could scarcely be persuaded that her 
shack needed a thorough scrubbing. Open windows were under dis- 
cussion until this winter, when two little girls in different families de- 
veloped pneumonia. Both families were greatly impressed with results 
of fresh air treatment prescribed. 

Tuberculosis is an ever-present problem here. The Indians are 
fairly well informed about the disease and very frightened of it as it 
accounts for a high percentage of deaths. Daring the summer months 
the use of tents and sleeping outdoors is stressed, but winter, with its 
crowded quarters and prevalent colds, usually leaves a mark. 

One might discuss work of the Reserve on and on indefinitely. I 
hope I have touched upon a few points of general interest. The Indian 
will be an ever-present factor in our affairs for years to come. Thanks 

]3 



to his adaptive and imitative faculties, he himself is making a valiant 
effort to adapt himself to our modern parade. Surely our chief aim in 
this special branch of our work is to help develop the Indian into a 
healthy, respectable, self-supporting citizen. 



Rita M. Maiiox, R.N. 



AN ATTEMPT AT STOCK TAKING. 

Another Nurses' Bulletin; another opportunity to learn of other 
nurses' achievements and a stock-taking of one's own district's two 
years' efforts. 

The stock-taking of public health nursing of a district is a bit diffi- 
cult ; one is not always sure what is profit and what is loss. It is not 
possible to add up the forward changes in attitudes toward prevention 
of disease and the building up of positive health. Nor can one be sure 
of just the amount of prejudice and the lack of understanding of the 
health ideals that are still existing in the community, so the compiling 
of a list of the concrete advances in this work of necessity leaves out 
much. 

While one can count the percentage of children in the schools im- 
munized against diphtheria (sixty-four per cent, in these two districts, 
plus numbers of pre-school children), it is not possible to tabulate the 
harm that may come to the remaining thirty-six per cent, who are not 
thus protected from that disease. 

The fact that half of the schools are receiving milk for their under- 
nourished, paid for by the School Board, can of a certainty be placed on 
the credit side, the value being greatly increased by the willingness and 
understanding of the Board in supplying this service. 

The iodine tablet treatment supplied by the School Board of eight 
schools is resulting in a marked decrease of simple goitres among those 
pupils. The other nine schools not given this privilege must be added 
to the losses for that. 

Tests for vision defects and the acquiring of needed glasses by 
a. number of pupils, financed by the Parent-Teacher Associations, School 
Boards, and other organizations, we gladly mark up. Also the thirty 
odd children likewise equipped through the parents' efforts, with distinct 
benefit to them all. 

But the non-success thus far of any arrangement for much-needed 
dental clinics looms large on the debit side. Only a few dozen cases 
have been given dental care through societies paying and the kindness 
of one dentist in giving one afternoon a week for free work for a few 
months. Of course there have been numbers taken care of by the 
families, but many still are in need of dental treatment. 

The decrease in the percentage of underweights in the schools, on 
the whole, in spite of the hard times, can, we feel, be placed with the 
gains, although the degree of malnutrition may not be evident for a time. 

14 






le requests lor well-baby clinics and more diplitlieria " toxoid 
clinics we add to the right side, even though the plans have not been 
completed for them yet. Also, the eagerness of the mothers of infants 
to receive the mothers' advisory letters from the Department of Health. 

Realization by many parents of the necessity of the protective foods 
in the diets of the family and the more general use of cod liver oil with 
the understanding of its properties, is a distinct advance, one feels, while 
there is still much to be done there. 

The reporting by many of the parents of the symptoms of com- 
municable diseases much overbalances the failure of some of the others 
to do so. To which, we add the spoken appreciation of a Municipal 
Council of the health service given, particularly in communicable disease, 
although there was a rather prolonged epidemic of mild scarlet fever just 
recently. 

The clouding of the spirit of independence in many, through the 
receiving of relief, darkens the page. It is a direct about-face with some, 
a. Aveakening of the morale, worse than many other epidemics, one fears. 

In spite of shortened budgets, the lighting and other facilities have 
been much improved in some of the schools, though in three schools there 
is much overcrowding. 

But the " stock '' still contains the backing and assistance of the 
Department of Health, the proven scientific aids for the prevention of 
disease, even aids to improve the salesmanship of these same as refresher 
courses for the salesmen. Belief in these " wares " too is a valuable asset. 

Mary E. Griersox, K.X., 

Mission, B.C. 



" 17 T-? 



FKESH FIELDS AND PASTURES NEW." 

There is always an element of excitement about something new and 
unknown, and our anticipation ran -high as our supervisor, one of our 
students, and myself, in answer to an invitation received from the resi- 
dents of Kapoor, started out to investigate the possibilities of adding 
this settlement to our already large Cowichan District. 

To reach this little-known place we had to travel about twenty miles 
from Duncan through Shawnigan before branching off on the unsettled 
ten-mile stretch through the Victoria watershed area, along the shores of 
Sooke Lake. 

Once before we had partially explored this area, but had been re- 
pulsed by the many signs promising fines and imprisonment to any who 
contaminated or even trespassed on this forbidden land. We had heard 
of the " impassable " road, but we found it even better than many roads 
we traversed daily in our regular routine of work. 

Although there had been a light fall of snow a few days previously 
which blanketed the ground, one could easily imagine the beauties of 
this virgin forest, through which we travelled, on and on. At last in 

15 



the distance we saw great clouds of smoke belching heavenward. As we 
reached the crest of a hill, we saw below us a valley in which lay the 
object of our quest — Kapoor. This spot, as you may or may not know, 
is a small village around a lumber mill, owned partially by Kapoor 
Singh, a native of India, and situated in the mountains, between Gold- 
stream and Shawnigan Lake. 

Leaving our trusty car, we followed a faint path down a long hill 
toward the mill. All about us were logged-off barren hills, dotted with 
uii] tainted houses, typical of many other logging camps in our district. 
We proceeded a little uncertainly until we came across an East Indian, 
of the Sikh clan, piling lumber. He directed us with a wave of his arm 
to the school. We were secretly pleased with this gesture, for at least 
he knew who we were. We guessed that this man must have at one 
time lived in some part of our Cowichan area. 

Walking along the railway track, we saw upon our right the Union 
Jack waving in the breeze. This betokened the school. Up we climbed 
and reached the green-painted school-house, where the teacher greeted 
us warmly and wanted us to get to work at once among her twenty 
pupils. After gathering some necessary information from her we went 
on our way to find the official trustee in the mill office. He, in turn, 
mistook our initial survey for a professional call and was very anxious 
that the work in this district should be undertaken immediately. 

This little village has a population of one hundred and seventy-five 
people, comprised primarily of whites, East Indians, and Japanese, the 
latter two races predominating. The homes are clustered about the mill 
in little groups, according to nationality. Our guide, the trustee and 
company official, explained to us his attempts to maintain some semblance 
of sanitation by insisting that each house be built some distance from its 
neighbour. In order to get even this idea across, the danger of fire had 
to be used as the excuse. Owing to the mixed population to be found 
in most logging centres, with each race maintaining their individual 
native customs and each reluctant to relinquish these for our modern 
new-world principles of hygiene and health, the problem of sanitation 
becomes a baffling one. This difficulty may only be overcome by educa- 
tion and understanding. 

Most of the company business is carried on through Duncan, and it 
is from this centre that medical aid is sought. We found that even the 
doctor is called only when it is considered absolutely essential. Further- 
more, even though the school was established three years ago, the pupils 
have never been medically examined. Here is, therefore, a very fertile 
held indeed, and we fairly yearned to begin work at once. 

After discussing the situation from all angles with the company 
official, we found that the nurse from Langford Lake would have only 
fourteen miles to travel to reach Kapoor School, while we would have 
thirty miles, so we decided to submit the question to our local committee. 
with a view to the matter being officially reported to the Provincial 
Medical .Health Officer for his consideration and decision. 



16 




As we departed, after partaking of tea at the home of the trustee, 
we felt that whoever undertakes this field will receive the heartiest 
co-operation from the people in Kapoor in solving the many problems 
which this most interesting district presents. 

II. Kilpatrick, K.X., 

Duncan, B.C. 



" SOME REFLECTIONS." 



"' Engineers are prone to talk of the efficiency of modern machines. But no 
machine has ever been constructed that is so efficient as man himself. Where can 
we find a pump as perfect as the human heart? If the boss treats it right it stays 
on the job for more than 000,000 hours, making 4,320 strokes and pumping iifteen 
gallons an hour. We have no telegraphic mechanism equal to our nervous system ; 
no radio so efficient as the voice and the ear ; no camera as perfect as the human 
eye : no ventilating plant as wonderful as the nose, lungs, and skin ; and no elec- 
trical switchboard can compare with the spinal cord. Isn't such a marvellous 
mechanism worthy of the highest respect and the best care? " — Floyd Parsons. 

The physical being of the average man does not obtrude itself upon 
his notice, in health. Only pain or discomfort brings it to his attention. 
This is, upon merely aesthetic grounds, a very great pity. The conscious- 
ness and pride in the perfect order of the human mechanism would, if 
present in every person, make for a dignity of thought and a care for 
the body which would approximate the perfect health attitude. This 
brings up the ideal of the modern public health, which is so practicable 
and lends itself so well to education and demonstration. 

It is the office of the Public Health Xurse to begin this education. 
Necessarily it is slow at first. It takes more steam to start a cold loco- 
motive than to run a moving one along miles of track. Ours is the 
struggle to begin this motion, in order that we all may benefit by the 
momentum it will one clay gain. Alone on our districts we have the 
scant satisfaction of knowing that, in our struggle, other nurses meet 
with our difficulties. We find that time well spent for education, a 
reluctant mother convinced of some sane method is regarded by many 
as so much wasted time. We all have found that we have spent time, 
teaching, only to find that the person on whom we have spent the time 
has little or no comprehension of our aims, or meaning. Nevertheless, 
some of our lore always sticks, making further work easier. It is 
encouraging also to notice that, judging from writings of earlier nurses 
in Public Health, we now meet with a response and an intelligence that 
would have seemed miraculous to them. 

Beginning with the prenatal and carrying on up to the cold, cold 
grave we teach, teach, and teach with the idea of getting every one to 
maintain their health and to realize the dignity and responsibility 
entailed in maintaining a happy and well-running bodily mechanism. 

D. E. Mackenzie, R.N., 

Qualicum Beach, B.C. 



FIRST IMPRESSIONS IN REVELSTOKE. 

We sometimes hear it said that first impressions are lasting — well, 
my first impressions of Revelstoke will not soon be forgotten. As the 
old-timers aroimd town are saying, " The worst winter and most snow 
since '92." My first impression was snow — and more snow, and now, 
almost three months later, it is still snow, and measles. 

Revelstoke has more than its share of Nature's grandeur and natural 
beauty. Lying in the lovely Columbia Valley, it- is surrounded by lofty 
mountains and majestic peaks. We are on the very threshold of the 
Canadian Rockies. 

My thoughts on stepping off the train on January 6th were, " What 
a fairy-land of snow " — mountains snow-clad, trees snow-laden, and 
a flurry of soft feathery flakes falling and floating to a blanket-covered 
snowy soft earth. To me, coming from Vancouver where the rain had 
almost excelled itself in a recent record-breaking downpour, the snow 
was a new experience and rather a pleasant one. 

Sometimes we are initiated gradually into our new life and environ- 
ment, but the elements of Nature descended upon us with vengeance in 
this little mountain town, and January, 1935, goes down in history as a 
record month with a snow-fall of seventy-two inches in two days, and 
about ten feet in the month. 

Imagine being a newcomer to the district and ploughing through six 
and seven feet of snow making home visits. The people of the town were 
most sympathetic in their attempts to assure me I was seeing Revelstoke 
at its worst, " but just wait until the spring comes." April is almost 
here, and we are still waiting for spring to come and for five feet of 
snow to go. 

May I take this opportunity of writing a word in appreciation of 
the splendid work accomplished by my predecessor, Miss Amy Lee, who 
organized the work here. To pioneer in public health is not easy. There 
are obstacles to overcome, prejudices to break down, old ideas and cus- 
toms to abolish, organizing and planning to be done, but Miss Lee has 
laid a sure foundation that will not easily be shaken. She has won the 
confidence of the people and has proved to them in a most practical way 
the worth of a school health programme. 

An enlightened public opinion is needed to make health work in the 
schools effective, and the people in Revelstoke are becoming increasingly 
" health-minded " and the school nurse is considered just as necessary 
now as the school teacher. The health programme in this community 
has been almost entirely confined to school work. "Under the following 
headings I will try to give an account of our programme. 

Personnel. — One Medical Health Officer, one Public Health Nurse, 
one high school (155 pupils), two public schools (520 pupils). 

School Plant.- — Daily inspection of basements, hand-washing facili- 
ties, drinking-water faucets, and toilets. 

Health Inspection and Examinations. — A yearly examination by the 
School Doctor, and a monthly inspection in each grade to determine the 
general cleanliness and health of the children. 

18 



During January I weighed, measured, tested eyes, and sent health 
reports home to the 520 public school pupils. In February the high 
school pupils were weighed, measured, and eyes tested. During the 
present measles epidemic a daily inspection is done in each grade, spend- 
ing the morning in one school and the afternoon in the other public 
school. 

Follow-up Work. — It is here that the Public Health Nurse has the 
best channel through which a contact may be made between the home 
and school. It is the responsibilitj^ of the parents to have defects cor- 
rected, but it is our responsibility to explain to the parents the nature 
of the defect and why it should be corrected. 

Co-operation between the home and the school is vitally important 
in the school health programme. The most effective means of winning 
this co-operation is by a home visit. I find defects followed by a personal 
visit likely to be remedied far more speedily than those followed up by 
only the health report or a telephone call. 

During the months of January and February about seventy-live 
home visits were made, and I found the mothers always appreciative for 
the visit and anxious to discuss the health report of "Johnnie'' or 
" Alary." 

x\lready ten pupils have had eye defects attended to and are now 
wearing glasses. Eight have promised to visit their eye specialists 
during the Easter vacation to have their present glasses checked. About 
forty-five children have visited their dentists in the past two months. 

I am hoping in the near future that a medical and dental fund will 
be established by the School Board to enable indigent parents to have 
defects remedied. 

Underioeights. — In one public school we have six per cent, under- 
weight; these are children more than two pounds below the standard 
weight, and in the other school twenty-three per cent, underweight. The 
difference in the two schools is very likely due to the large number of 
Italian children in one school whose parents are on city or Provincial 
relief. These children are weighed monthly and a record-card sent home 
showing the gain or loss as the case may be. Each teacher is given a list 
of her underweights, and the percentage of underweights in each grade is 
worked out and the list posted. We have keen competition between 
the various grades as to which class has the smallest number of under- 
weights. During February eighty-five per cent, of underweights gained 
more than one pound. 

Milk in the Schools. — About three years ago the local chapters of 
the I.O.D.E. and the Women's Auxiliary to the Canadian Legion spon- 
sored the supplying of* milk to children not gaining in weight, under- 
weights, children whose parents are on relief, or mothers' pension, and 
poor families. Other children wishing to take milk pay 50 cents per 
month. At present over one-third of our school children are drinking 
milk at recess. 

I think this health project is perhaps the most worthwhile activity 
carried on in Kevelstoke. The results cannot be evaluated in dollars 



ID 



and cents. In these days oi* hard times the children are always the 
greatest sufferers, and a child underweight starts life handicapped and 
may later become a social and economic liability to the community. 

Health Education. — Health teaching has become a definite part of 
my programme. Every two weeks a health story is given in grades one 
to four, and a forty-live minute health lesson in grades live to eight. 

We have also commenced tooth-brush drills in the lower grades, and 
these have proved very popular as well as instructive and amusing. 

In grades live and six we have recently had a poster competition 
between the two public schools. I gave a health lesson, " The Unman 
Machine and Its Fuel," and following this the children worked out their 
own ideas for a good dinner poster. The competition was very keen as 
to which class and school would produce the best poster. 

1 have two classes a week in first aid, one in each school to grade 
seven boys, and two a week in home nursing and Little Mothers' League 
to grade seven girls. 

We are conscious of the need for greater education along health and 
prevention lines in our community, and our greatest hope lies in the 
rising generation. If we can put our gospel of good health and preven- 
tion of disease across to our children we have gone far in the promotion 
of health practices in our community. 

Communicable Disease. — This community has been remarkably free 
from epidemics of any kind for the past ten years. I think there has 
been one case of diptheria in three years, consequently the people are 
not very enthusiastic about toxoid and prevention of diphtheria. I have 
found that the majority of people here have never heard of toxoid, and 
those who have think it is a serum. 1 have taken every opportunity of 
explaining what toxoid is and what it does and it is one of the ambitions 
of my life to organize in the near future a toxoid campaign for the ini- 
munization of our preschool and school children. I may say that the 
three doctors here are most co-operative and willing to support the 
campaign. 

And now conies my sad tale of woe. We arc 1 at the present time 
at the peak of a measles and German measles epidemic. Having had no 
previous measles epidemic here for ten years it was virgin soil for the 
spread of this most infectious virus. 

We had two or three adult cases of German measles in January, 
but not until the middle of February did one case crop up in the 
schools. This was in grade one, and was diagnosed by the doctor as 
German measles. The contacts from this case were inspected daily 
after seven days, and a brother developed what turned out to be the real 
measles. The brother was in a different school and the damage was done 
there. For the past three weeks all class-rooms have been inspected daily 
and contacts sent home on the seventh day. Having the two kinds it- 
has been almost impossible to be certain of tin 1 incubation periods and 
even the doctors have differed as to whether some cases Were severe 
German measles or a light case of measles. Fortunately the measles 
have been of a light nature and so far no complications have developed. 

20 



The epidemic has caused quite a sensation in town, and many people 
still hold the old-fashioned idea that the schools should be closed. It 
is discouraging- to see the havoc the epidemic has caused in our school 
attendance. About ninety per cent, are absent in grades one and two, 
and thirty per cent, in the older grades. At the present time there are 
160 absent in the two public schools. 

With weather conditions so bad the walking is difficult, 185 cases 
have been visited. It means miles of plodding through snow and slush 
but at the end of a busy day arriving home at six p.m. tired and weary, 
it gives a great deal of satisfaction to know that perhaps due to your 
words of advice and warning of the dangers of complications, some child 
may be saved from mastoiditis, bronchial pneumonia, or defective vision 
— yes, it is worth while. 

Clinics.— No clinics have been organized in this community, but I 
think the time is ripe to start prenatal and well-baby clinics. Oh, for time 
to do all the things we would like to do. There is so much to be accom- 
plished and the days slip by so quickly. I have organized a prenatal clinic 
and had hoped to hold the first clinic about the middle of March. How- 
ever, owing to the disruption caused by the measles epidemic the opening 
has been postponed and we hope to commence in the first week of April. 
The hospital has kindly loaned us one of their rooms, and we have about 
twenty expectant mothers lined up to attend. 

I feel nothing very spectacular in the way of public health is being 
done here. We are doing our best, sowing the seeds of good health, pre- 
vention and the preservation of health, hoping that some of the seeds are 
taking root, and that our Canadian boys and girls will reap the harvest 
that will bring new possibilities of health and happiness and efficiency for 
mankind. 

As public-health nurses and teachers it is our privilege to help in 
a] tplying the knowledge we possess daily in our own lives and to help 
forward their application in the lives of those with whom we come in 
contact. 

And so with the hope of spring in our hearts we go forward knowing 
that the snoiv will go, and measles epidemic will some day burn itself out, 
and the triumphs of public health will bear the fruit of human happiness. 

Agnes Thom, R.N., 

Rerelstoke, B.C. 



A SIKH WELL-BABY CLINIC. 

There is a Sikh settlement not far from Duncan where there are a 
number of native babies. It seemed a fitting time and place to establish 
;i well-baby clinic. Since there are no other public buildings available, 
the primary school-room is used, with the kind permission of the School 
Board secretary. The clinic is held after school hours, from three till 
five o'clock. 



21 



At quarter to three the nurse approaches the school, baby-scales 
under one arm and a large sheet of cardboard under the other. As she 
walks up the board walk she meets an anxious mother who has been 
pacing up and down in front of the school with a seven-month-old babe 
in her arms. The mother looks as if she had stepped down from an 
Indian picture, with her wide-flowing silk trousers and picturesque sari, 
or head-veil. 

"Oh, nursu, you weigh bibi to-day?" she asks eagerly. Reassuring 
her, the nurse enters the school and arranges the scales on the table. 
The piece of cardboard she hangs on the wall; on it are pasted brightly- 
coloured vegetables and fruits, cut out from magazines. This is the 
nurse's interpreter. 

The little Indian mother has followed and hovers at the door, 
chattering in Punjabi with the school children who have gathered to 
watch. The nurse asks her to be seated and begins to unwrap the 
baby. Two shawls come first, then two rainbow-coloured, hand-knitted 
sweaters; next a knitted bonnet with a round pom-pom on top; lastly 
long multi-coloured stockings. His outer clothing removed, baby is now 
ready and is lifted to the scales, where he howls lustily. 

"Bus, has," cries the mother, snapping her lingers above the baby, 
as she watches the weights going on. Baby has only gained one ounce 
in a week. 

What has he been eating? Mother-milk? Anything else? Cow-milk, 
some time little bit potato. " Cereal ' ; she does not understand, but 
"mush " brings a smile of iov from her. The chart is brought into use; 
she recognizes vegetables by picture if not by name. She is told when 
and what to feed her baby and is given a book on infant-feeding. Though 
the majority of mothers know only a few words of English, the fathers 
can generally speak and read it with ease. 

Xext comes a mother with a sixteen-month-old baby who has had 
nothing but breast-milk since birth, with a few arrow-root biscuits once 
in a while. The child can barely sit up by himself and the mother is very 
worried. " Nursu, bibi sick/' 

The nurse has a difficult task. She calls to one of the school children. 
A little girl, with long glossy black hair and sparkling black eyes, answers 
eagerly. There is nothing she likes better than airing her newly acquired 
English. 

The nurse finds exactly what the child is getting, then tells the 
mother exactly what the child should get. "Cod -liver oil'' is the most 
difficult thing for her to grasp. The little interpreter herself does not 
understand. Fortunately the nurse has a small sample bottle of cod 
liver oil in her pocket. This is produced, and though the bottle is not 
recognized, at least the smell is, and all are smiles once more. The mother 
departs happily, and the nurse wonders to herself how many of her 
instructions will be carried out. She knows from experience how often 
baby is not given his proper food because " he no likee." 

99 



And so they come and go. Each day the nurse repeats the same in- 
structions, and though they are not all carried out immediately, eventu- 
ally the mothers come to realize how important proper diet is. And as 
they see their babies gaining under the new regime more than before, so 
they tend to do more what they are told. 

Time passes quickly and as the last mothers walk down the stairs, 
chattering and laughing in their soft native voices, with their toddling 
babies clinging to their trousers, the nurse glances out the door to see 
the sun sinking behind the near-by hills. She gathers up her cards and 
prepares to depart. The clinic is over. 

Annie S. Law, R.N., 

Duncan, B.C. 



WORK IN SAYWARD. 

It is with much pleasure that I submit a brief outline of the work in 
Say ward. The work goes on much the same as we are only a very small 
family. Visiting schools, child-welfare visits, prenatal and postnatal 
visits are the chief things ; I do bedside nursing sometimes, and dressings, 
etc., and helping out people who cannot get out. Sometimes I can get in 
touch with the doctor of the Columbia Coast Mission and can then carry 
out treatment till we can get the patient out, or till they are strong 
enough to travel to Vancouver if they need further treatment. 

During the last few years there have been very few changes. Some 
families have gone out owing to the lack of transportation to and from 
school, the distance being too great for the small pupils to walk especi- 
ally in the winter. Other pupils have gone out to high school, having 
passed their entrance here. 

This last winter has broken all records for Sayward. Altogether we 
have had over eleven feet of snow. In January it was impossible to get 
out because of the snow. Then, owing to the warm winds and rain there 
were floods when the river rose. In some places the water went into the 
rural mail boxes on the road, over four feet high. Just when the snow 
was at its worst, a small child, aged seven years, died. She had a serious 
operation in September. She had been home for several weeks, running 
around and even took part in the school closing concert at Christinas. 
After Christmas she seemed to gradually get weaker and died just after 
the heavy snowfall. Tt took several men six hours to dig a trail a little 
over a mile long. The next day several more men and teams broke the 
road as far as the cemetery and store about four miles from their home. 
So they were able to get the little one buried. 

The health of the pupils seems to be very good in Sayward. There 
have been no epidemics. So far there have been very few colds in spite 
of the bad condition of the weather and roads. 



Edith M. Walls, R.N 



23 



VERNON. 

There are many subjects that J might mention in connection with my 
health work here in Vernon. I have decided to take " Practical Nursing 
in the Home " as my topic. 1 shall attempt to show what I have done in 
that line, and mention some of the things that I hope to do. 

I have for some years given talks, from time to time, on " Home 
Nursing " to groups of high school girls. This year I am giving a series 
of talks to quite a large group of members of the Women's Institute on 
" Practical Nursing in the Home." When I have finished these talks I 
hope to give similar ones in the Ukranian community hall near here. 
I try to make these talks as interesting as possible and listeners are 
urged to ask questions as we go along. 

These practical nursing talks are outlined as follows : — 

First talk: Health in the home. This includes cleanliness, ventila- 
tion, sanitation, flies, food, elimination, clothing, care of teeth, rest, recre- 
ation, etc. 

Second talk: Signs of sickness, as temperature, pulse, respiration, 
general appearance, tongue, cough, bowels, urine and how to measure it; 
pain, chills, etc. 

Third talk: Care of the patient, including cleansing bath, care of 
mouth, changing sheets, moving a bed patient, back rest, etc. 

Fourth talk: Feeding the sick, which includes preparation of food 
for patients on liquid and soft diets. 

Fifth talk: Treatments show how to prepare a hot fomentation, how 
to give an inhalation, how to make a mustard plaster, a linseed poul- 
tice, etc. 

Sixth talk: Communicable diseases, method of spread, signs, isola- 
tion, care of hands, discharges, linen, etc. 

Seventh talk: Emergencies and slight ailments, as poisoning, bleed- 
ing, fractures, dislocations, apparent drowning, etc. 

Eighth talk: Prenatal and maternity care. 

Ninth talk: Infant care. 

Tenth talk: Feeding infants, preschool and school children. 

This comprises the outline of these talks which we add to when 
necessary. 

On the thirtieth of this month the Women's Institute arc holding 
their annual " Bird-house " competition in the Scout Hall. In connec- 
tion with this there are exhibits of drawings, clothing, and woodcraft 
entered by the school children. Included in the school' exhibit are health 
posters, health books, health projects, and essays on " The Care of the 
Baby " by the girls of the Entrance Classes. 1 am giving a general, prac- 
tical demonstration on that day, showing substitute appliances that may 
be used in any home. This demonstration illustrates part of my talks on 
" Practical Nursing in the Home " and will, I hope, be as successful as the. 
last one that I gave in the Scout Hall. 

Elizabeth E. Martin, R.N. 

24 



POPULARITY AND THE THREE C'S. 



" A man, be the Heavens ever praised, is sufficient for himself. Yet 
where ten men are united in love, they are capable of being and doing 
what ten thousand would fail to do. Infinite is the help man can yield 
to man." — Carlisle. 

" We love our Health Centre and we are proud of it." Such were 
the words that greeted me when I first arrived in Duncan. Naturally 
they made a strong appeal and I could not resist the desire to delve about 
for the reason and this is what 1 discovered. 

Cowichan Health Centre has just reached the stately age of 15 years. 
Yet when one looks back over the accumulation of records, one realizes 
that, like many other Public Health endeavours, it was started by a little 
band of workers who struggled against considerable opposition and mis- 
understanding. They, too, in the early days were confronted with the 
problems that confront every pioneering district to-day and yet their 
work has grown far beyond the fondest dreams of the original Com- 
mittee, and at the same time the community now boasts and points with 
pride to " Its " Centre. 

What are the winning points of this successful endeavour? Let us 
consider them only from a very local point of view, and examine what 
seem to be the three most important factors of popularity. 

First, the Committee. Members are staunch and courageous of char- 
acter. Undaunted they are, possessing in no ordinary degree the gift of 
inspiring all. At the same time they stand " united in love " — capable 
of being and doing what ten thousand singly would fail. They back up 
the work, giving courage and sympathetic understanding to all problems 
as they arise. Truly such a little group of health missioners is out- 
standing — for with high ideals they set out to conquer the unknown and 
return victorious to be acclaimed by one and all. 

Secondly, co-operatiox — always co-operation, a spirit of comrade- 
ship and good-will existing between the medical, dental, and teaching 
profession, besides all the others with whom one comes in contact, a 
spirit which has been helpful in establishing that permanency and trust 
which makes the Health Centre an integral part of the community. 

Thirdly and of equal importance, that instillation, deep into Hie 
hearts of the people of the feeling of confidence. To have the public 
feel free at any time to share their troubles and to be assured of a sym- 
pathetic and understanding hearing. One's best friend is one that will 
serve in time of trouble. " Infinite is the help man can yield to man." 

To all the younger nurses, pioneering in virgin territory, let it be 
a comfort to you to know that as years roll by (and not so very many 
at that) triumph and success awaits your endeavours. Many valiant 
attempts prove to be apparent failures. Be not discouraged — foresee the 
value of the earliest and always the hardest work — thai of laying the 
foundation. Here in Cowichan we are now benefiting from the early 



>gles, and to-day we meet our people who cannot sing loudly enough 
their praises of the work. Thus popularity and its relationship to the 
three C's. Yon too can have all three. 

Geraldine Homfray, R.N. 



THE PROBLEM OF TEETH IX CHILDREN. 

The teeth being formed in utero, are therefore influenced by pre- 
natal conditions, and are influenced unfavourably by all adverse condi- 
tions in the first six to eight years of life. When the permanent teeth 
are being formed such conditions as rickets or other deficiencies in vita- 
mins or infections diseases as measles determine whether or not the 
child will have a healthy set in later life. 

Heredity, of course, plays some part. The most common error into 
which parents fall is that they consider deciduous teeth may be neglected, 
as they fall out sooner or later. Rut the presence in the mouth of tem- 
porary teeth until the eruption of the permanent teeth is also necessary 
for proper development of the permanent teeth, and their proper place- 
ment or position in the dental arch. A perfect dental arch certainly 
influences well being and appearance. 

The teeth being bloodless structures must have proper care expended 
on them so that caries may not develop. This care consists in : — 

(1.) Properly balanced diet. 
(2.) Mechanical care. 

(a.) Proper brushing. 

{b.) Removal of tartar by the dentist. 

Wlien caries develop it is impossible to say what course an infection 
will take. It may either be localized or break through the protective 
mechanism of the body and give rise to such profound disturbances as 
endocarditis, pericarditis, arthritis, and rheumatic fever, etc., through 
which, not only life itself, but the efficiency of the individual and his oi- 
lier value to society are endangered. 

Too, the care of the teeth should be of great concern to bodies con- 
trolling education — for a neglected month means retardation and waste 
of money devoted to education. 

No child can devote attention to his school work nor exercise his 
mental powers properly when suffering from dental infection. His 
behaviour, present or future, may also be influenced by such infec- 
tions; and, as such, should be of interest to our law-enforcing bodies. 



Dorothy E. Tate, R.N. 



2G 



THE GENERALIZED PUBLIC HEALTH NURSE. 

Once again the time has come around for us to do our bit by con- 
tributing an article for the yearly issue of the Public Health Nurses' 
Bulletin. 

I have chosen as my subject the Generalized Public Health Nurse, 
as I feel that I am qualified to write on this subject. 

The generalized public health nurse should know her district with 
its peculiarities and potentialities. She must study the different types 
of people and work she contacts, gain the support of the communities as 
well as the co-operation of all public health and welfare organizations, 
both official and voluntary. The work of the public health nurse is cer- 
tainly neither uninteresting nor dull, as it deals with life itself, for one 
must be prepared to be mother confessor to all her flock, as well as carry 
out the usual duties attendant on such a position. 

This requires a patience and tolerance, only acquired after much 
experience. The generalized public health nurse comes in contact with 
the family in all its different aspects, both health and social. One very 
important factor of this work is the prenatal care and advice. This 
phase of the programme is established to protect the mother and to pro- 
mote the development of a stronger and better race of children — the citi- 
zens of the future. This training of mothers is very gladly accepted and 
the results are becoming more and more evident as time goes on. With 
the help of the Well Baby Clinics, it is gratifying to know that condi- 
tions arising from malnutrition and ignorance are gradually becoming 
a thing of the past and the child is thus prepared to meet the demands 
of school and future life with a much more satisfactory physical and 
mental development than would otherwise have been the case. 

During the school years one phase of the work that requires unre- 
mitting watchfulness is that of communicable diseases. By a little detec- 
tive work it is generally possible to trace the disease to its source. These 
cases, when found, should be isolated, thus preventing them from spread- 
ing the disease and causing hardship, not only to parents, but to teachers 
and other pupils as well. The general health of the child is carefully 
watched and instructions given to the parents when necessary. 

In visiting the homes, one often meets problems of an upsetting nature 
which a public health nurse will see and recognize as being remedial. By 
her interest and sympathy she is able frequently to suggest some means 
of help. For instance, one mother living in a rather isolated spot and 
being so much alone, got discontented; as a result her general outlook 
on life was disturbed. I advised her to attend a sewing class. She did 
so and now has a better outlook on life. This is one small example of 
the many ways a public health nurse can be of help to her families. 

The co-operation of the different societies is of great value and help 
to the Public Health Nurse, and again, diplomacy in contact is an 
essential. 



27 



The Public Health Nurse should feel " A friend in need is a friend 
indeed." So as we said at the start, the life of a Public Health Nurse 
is neither uninteresting nor dull. 

Elizabeth Lowtiteu, R.N., 

North Vancouver Health (Hit. 



NELSON'S BEALTB PROBLEM. 

The present school term has been an eventful one and has demon- 
strated in many ways to the Nelson public the value of Public Health 
work. 

We commenced the term under a cloud because of v the distant 
rumblings of poliomyelitis which was gradually creeping our way. xVs 
the disease became prevalent in the State of Washington, the people of 
Nelson were notified through the press, that travelling between the Koote- 
nays and the State of Washington should be confined to business and that 
children should on no account visit in Spokane. 

On the eve of school opening (August 31) a case of diphtheria, was 
reported. The patient returned from a. visit to a near-by town and 
arrived home with a sore throat. The family was quarantined a few 
hours after arrival in Nelson. 

The month of September was well over, the weather much cooler, and 
our fear of a poliomyelitis epidemic was subsiding when our first case was 
reported (September 24). The patient was a preschool child and medical 
attention was not obtained until the damage was done and one limb was 
paralysed. Parents thought the child was suffering from rheumatism. 

There was general alarm and the public practically demanded a ban. 
Members of the medical association met and the Medical Health Officer 
closed the two schools which members of the family had been attending. 
The city council and school board met with the Medical Ilealth Officer. 
Members of both bodies were well aware of the value of preventive work 
and a motion to engage three nurses to assist in the supervision of school 
health was unanimously passed. The meeting weighed the advantages 
and disadvantages of schools remaining open. The medical profession 
felt that if schools were closed it would be almost impossible to keep a 
check on the situation. If all absentees could be visited by nurses im- 
mediately it was likely that medical advice would be obtained in the early 
stages. 

This supposition proved to be a fact in two cases at least. An 
absentee was visited on September 27. The nurse, visiting, found the 
child irritable and worried looking. Temperature was elevated, pulse 
was very rapid. Intestinal upset was present. The mother thought it 
quite unnecessary to have medical advice and explained to the nurse that 
the child had " Stomach Flu." The nurse however prevailed upon her 



to call their doctor. The child was taken to the hospital, a lumbar pu 
ture done and the diagnosis of poliomyelitis confirmed. 

On September 29 a child was excluded from school because of a sore 
throat and elevated temperature. The home was visited by a nurse 
during the early afternoon and swabs were taken. Membrane and typical 
odour were present. The mother was advised to call her physician but 
refused to do so and was asked to reconsider. She was approached by 
the nurse again that evening and finally consented, explaining that a 
quarantine would inconvenience them very much. When the doctor 
called the membrane had been removed and the throat was in a bleeding 
condition. The nose and throat swab were positive but the parents 
refused to accept the diagnosis or to co-operate by having the child given 
anti-toxin or by observing quarantine regulations. Quarantine was en- 
forced by the Police Department. 

With the appearance of diphtheria the public became genuinely 
alarmed. Feeling ran high so that it was deemed wise by the Medical 
Health Officer to declare a ban (eptember 29-October 9). Schools, 
churches, theatre and other meeting places were closed and parents 
ordered to keep children in their own yards. 

The teachers co-operated in a splendid manner and visited each home 
explaining to parents the health service which was at their command and 
reported back to the nursing service any cases of illness encountered on 
their visits. 

No further cases of either poliomyelitis or diphtheria were reported 
during the week of the ban, but because of new cases reported the follow- 
ing week the Medical Health Officer again declared a ban in force which 
was in effect until October 20. 

During this period much was learned regarding the eccentricities of 
human nature. Many of the people who demanded a ban in the first 
place wearied under its restrictions. Parents found it difficult to keep 
children from congregating. Children living in apartments had nowhere 
to play except in the streets. Merchants felt that business was curtailed 
and they were therefore "out of pocket." Beer-parlour operators were 
particularly bitter and interviewed the council regarding their rights. 
Experience taught us that at most it was impossible to foresee the diffi- 
culties which might arise when a ban is declared. 

It would require considerable space to outline each case but the 
following tables will give a picture of the situation. 

Poliomyelitis. 



Case 
1 



o 
o 



G 



District Date 

Nelson.. Sept. 24 

Procter.. Sept. 25 

Nelson Sept. 27 

Nelson Oct. 12 

Nelson Oct. 17 

Nelson Nov. 5 



Age Remarks 

preschool Left leg paralysed 

school no paralysis 



adult., 
school. 



77 



20 



The cases of poliomyelitis appeared sporadically. Their were no 
deaths and only one case where paralysis ensued. All cases received the 
serum of blood from immune persons. It was impossible to establish 
any source of infection, in no instance was there more than one case in 
a family. 

Dr. Meekison's paper which was sent out by the Department of 
Health was invaluable to the nursing service. 



Diphtheria. 

Fam. District Case Date Age Remarks 

1 Nelson 1 Aug. 31 School 

2 „ „ pre-school carrier 

3 Sept. 1 ad nit 

4 „ 2 school 

2 Nelson 5 „ 29 school 

3 Vmir 6 Oct. 13 adult 

4 Ymir 7 ,, 15 „ died 

5 Nelson 8 ,,17 school 

11 „ 20 school 

6 Nelson 9 „ 18 pre-school 

12 „ 21 ad nil 

7 Ymir 10 „ 18 adult 

8 Nelson 13 „ 22 school 

There were ten cases of diphtheria in Nelson and three from Ymir. 
One death occurred from Ymir, the patient having been ill for some time 
before entering the hospital. Contact and cases were carefully inter- 
viewed and history taken but here again it was impossible to establish a 
satisfactory source of infection. Cases appeared here and there through- 
out the city. It was believed that the cases were the result of a carrier. 

Following the outbreak of poliomyelitis and diphtheria we had an 
epidemic of septic sore throat which Lasted until the early part of Decem- 
ber. There was membrane present in many of the cases and many of the 
cases were diphtheria suspects until swab reports could be obtained. The 
temperature in most cases was much higher than usually found in 
diphtheria (103°-104°). 

January was a comparatively quiet month but with February came 
a " Flu " epidemic which has given us much cause for worry because of 
the complications — mastoiditis, rheumatism, sinus, and eye infections. 

There have been eight mastoidectomies performed as a result of this 
epidemic and on one day 20% of the school population was absent owing 
to illness. 

Routine work has suffered rather badly, but we are confident that 
with health conditions in schools gradually improving we shall be able 
to complete our year's work. 

Kathleen Gordon, R.X. 

30 






MEDICAL RELIEF— WITH REFERENCE TO ITS EFFECT 

ON MORALE. 

The situation which here demands consideration is not that of the 
state of those who are on relief, and the medical care given to them. 
They receive this, either upon demand or on the recommendation of the 
Public Health Nurse. This care includes all the incidental care any 
one might require, maternity service, extraction of teeth, and free medi- 
cines. There is, however, another section of the population which is on 
low income, in some cases no more than that of the relief standard. To 
these, sickness is a major calamity, from a financial point of view. 
Naturally they receive required attention from the doctor, regardless of 
their ability to pay; but if they, the recipients of this care, have the 
independence that demands the payment of bills they hesitate to incur 
them when their ability to pay is doubtful. The few dollars that are 
needed, to make the quite necessary but not urgent visit to the doctor 
or dentist, are so often earmarked for food and clothing that the visit is 
never made. Never, until the dark night when little Willie is ill indeed, 
when a health visit is no longer in question, prevention is too late, and 
an emergency is declared to exist. 

Here, when little Willie is so sick, is where the pressure is exerted. 
The family ideal of the moral grandeur of never owing goes, goes phut, 
in fact. Naturally. The only human and tenable position the family 
can take is to get all the care for little Willie that he needs. But when 
Willie is recovering, on naps, and cod-liver oil the bills come in ; cold 
thinking takes the place of emotionalism. They discover that they 
would have been better off on relief? They are right. They would. 

On low income the man with illness in his home has his choice. He 
may: — ■ 

(a.) Do without medical aid. The nurse will call once and advise 
a doctor's care. She can do no more, being unable in every sense of the 
word to suggest treatment or medication. 

(&.) Call the doctor. Have him do everything that he finds neces- 
sary, and run the corollary accounts of nursing and drugs. If he has 
the independence that he should he has to pay, for his own self-respect; 
but, on low income, most people feel an eventual resentment for these 
expenses, when obviously, their neighbours on relief have no such worries. 

(c.) Go on relief. This may involve lying to the investigator, and 
understating his resources; quitting the small job he has, in order to 
qualify. This course gives him absolute security in the event of accident 
or illness. Gently and insidiously he begins to believe in Santa Clans, 
and the law of equivalent return becomes the myth. 

It may be argued that the cause of these people on low income needs 
less attention than that of the really poor, and that such people are not 
found in great numbers. My contention is, that such people are the 
custodians of the morale of this Province. The better off have never 
been tried, those on relief have been tried too hard in the economic 
struggle. It is the man on low income who shows us the national temper. 

31 



In view of this the public health nurse is delighted when anything 
towards a general contributory health insurance scheme is advanced. 
Such a scheme will be a powerful factor in saving this pioneer country 
from decadence, without its proper interval of civilization between these 
two states. 

Beryl McPherson, R.N., 

Coombs, Y.T., B.C. 

PUBLIC HEALTH IX WESTBANK. 

The day previous to the opening of the Schools in Westbank and 
Peachland in September, 1934, Dr. Ootmar, our M.H.O., telephoned from 
Kelowna across the lake and warned me that we would have to watch for 
signs and symptoms of poliomyelitis developing. There had been some 
cases in Spokane, and with the traffic back and forth across the line we 
would be exposed, lie instructed me to find out if any of the teachers 
or children had visited there during the summer vacation, and if so have 
them quarantine themselves for two weeks. On making a tour of all the 
schools I found that neither teachers nor pupils had been there, so the 
schools were duly opened. Now, Westbank is situated on the west side 
of Okanagan Lake. The lake is about 4 miles wide and 85 miles long, 
and the only way people can get to Kelowna from Westbank, or vice 
versa, is by a ferry that plies between the two places. This ferry runs 
every hour, the first one leaving Westbank at 8.30 a.m. and the last at 
8.30 p.m. The people of both places have often wondered if a bridge 
could not be built across the lake, especially when the}' arrive two 
minutes late for the ferry and have an hour to sit there and contem- 
plate. Well, this same ferry proved to be of great benefit when some 
cases of poliomyelitis actually did develop in Kelowna. Dr. Ootmar 
enlisted the help of the Provincial Police in checking up on all cars from 
across the line. The ferry wharf proved to be an excellent checking 
place, as it is a continuation of the main highway. The parents were 
advised of the seriousness of the situation, and to keep their children 
and themselves away from any homes where there was sickness. Most 
of them complied with the doctor's instructions. However, there is 
always someone who doesn't understand why they should comply with 
these regulations. One Sunday morning a family in Kelowna decided 
they would go to Westbank to visit some friends. Now this family had 
been in contact with someone who had developed poliomyelitis. Before 
night, Dr. Ootmar found out where this family had gone. He telephoned 
to the Public Health Nurse, and had her send the family home at once. 
The family which they were visiting was quarantined for two weeks, as 
two of the children were attending school, but fortunately no cases 
developed. Dr. Ootmar and the Public Health Nurses kept a strict 
vigilance over the district, and through the local papers kept the people 
posted on the latest developments, and while they realized the serious- 
ness of the situation, this kept them from getting panicky. 

(trace Hill, K.N., 

Westbank, B.C. 

32 



RAIN OK SHINE? 

The weather plays a very important role in the attendance at the 
Well-Baby Clinic. Immediately on rising every Tuesday morning the 
nurse looks out of the window to see what the weather man intends to 
give that day. Heavy rain means a small clinic, probably only mothers 
with cars will attend; and if the sun is shining a good attendance is 
expected. Where there are four rainy Tuesdays in one month it is very 
discouraging. 

In 1920 a Well-Baby Clinic was started here. It was first held 
monthly, but it was soon discovered that that was not sufficient so it was 
held weekly which has been the case ever since. At first just one nurse 
was in attendance, but it was soon found that it was almost too much for 
her so the school nurse was given permission by her Board to assist each 
week. In May, 1931, a preschool clinic held at the same time was in- 
augurated which demanded another assistant. Now the school nurse is 
responsible for the preschool children and the district nurse for the 
babies. A voluntary worker, who is very interested in the work, weighs 
the babies, which is a tremendous advantage as the nurse can devote her 
time to giving advice. 

The members of the local committee take turns in serving tea to the 
mothers and arrowroot biscuits to the children. They have assumed this 
responsibility ever since the beginning. This gesture of hospitality is 
appreciated greatly, especially on a cold day or if the mother has some 
distance to walk. Another value of this arrangement is that the members 
of the Committee come into direct contact with the work. 

The clinic is essentially a weighing station. Any conditions sus- 
pected such as feeding problems, rashes, etc., are referred to the family 
physician. This has been found to be more satisfactory in an industrial 
town of this size, rather than having a medical man in attendance. The 
latter was given a trial during the first year. Some of the doctors asked 
the mothers to attend the clinic in order to keep check of their child's 
weight, thereby helping them to regulate the formulae. 

The clinic is held in the Canadian Legion Building which is almost 
in the centre of the city. The room is set up each week for clinic, one 
end set aside for the babies and the other end for the older children. An 
I.O.D.E. organization presented the clinic with baby scales and the school 
scales are used for the pre-school children. A large table in the centre 
of the room, covered with a sheet, is used bv the mothers dressing 
and undressing their babies. The table method is much preferred with 
the majority rather than using their knees. Ordinary wire waste paper 
baskets are available to hold the clothes, thus preventing them from 
falling on the floor or touching those of their next-door neighbour. 

Much interest is shown in the different health posters that decorate 
the grey walls. Some of the pictures on the posters are even used to 
induce the four-year-old to stand on the scales. The table with health 
literature draws the attention of the mothers, many pamphlets pertaining 
to other phases of health are taken home for the use of the other members 
of the family. 

33 



The toys that are supplied for the preschool children to play with 
certainly act as a good means of bribery. Mothers often relate stories 
to the effect that her small son begged to come to clinic to play with the 
toys. In watching the children play the nurse gains some knowledge as 
to the mental development. Some children show quite a creative ability. 
Imprints of the children's feet are made by means of applying a liquid 
preparation to the soles of the feet, then an imprint is made on a piece 
of drawing paper. This gives a fair idea as to the condition of the arch. 

Before each new term, for the past three years a special preschool 
clinic has been held for those six-year-old children starting school. The 
school nurse gives the usual school inspection, thus getting acquainted 
with the child. They were weighed and measured and imprints of their 
feet taken. The members of the nursing committee serve tea. At the 
last clinic three fathers brought their sons, then stayed to listen to the 
doctor's informal talk. At each clinic one member of the medical 
profession has given a very interesting talk on some health problem, 
especially pertaining to the six-year-old child. The stores in town very 
kindly loaned sample clothing. Health literature was also distributed. 

Some gratification was felt when at the last clinic the majority of 
the children had either attended the baby or pre-school clinic. Also the 
number of underweights and defects found were much less than that 
found at any other clinic. The best record for attendance was attained, 
seventy-five percentage of the beginners were present. 

A branch of the town clinic is held in the Chinese Mission in China- 
town once a month. The majority of the mothers cannot speak English, 
but we talk with them by means of an interpreter. The wife of the 
Chinese missionary has kindly consented to act in this capacity. A 
number of Chinese posters have been sent from China, all nicely printed 
on rice paper. The children are taught health drills to teach them some 
of the rules of health. If you want real comedy watch a dozen Chinese 
children between the ages of two and six years do the handkerchief drill. 

Due to the generosity of one of the local organizations, cod liver oil 
was supplied to the families on relief who have babies or children 
requiring it. 

Each year shows an increase in the attendance at the Well-baby and 
Preschool Clinics. 

Muriel Upshall, R.X., 

Nanaimo, B.C. 



MENTAL HEALTH IX OCR SCHOOLS. 



Some time ago, when discussing our health programme with a physi- 
cian he said, " Mental hygiene is being sadly neglected in the schools." 7 
I have thought a great deal about this remark, and have decided that he 
was right. 

We strive to instil good physical habits in the child so that he will 
have a good chance to develop a strong, healthy body. We also spend a 

34 



great deal of time striving to have physical defects corrected. Are we 
doing as much for the mental health of our children? 

We often see a teacher giving a great deal of extra instruction to 
" Johnny " who does not understand fractions, but, if on the other hand 
" Johnny " is one of those pupils who has a good degree of intellectual 
capacity, but is shy, retiring, and over-sensitive, and does not mix or 
play with the other children, is extra time given to him going to help 
him adjust himself to daily life? 

Dr. Geo. Davidson, of Brandon Mental Hospital, writes, " Most of 
our mental disorders are due to bad mental habits, and if these bad habits 
are left uncorrected then one sees difficulties setting in during later life." 
In summing up the article from which the above is taken he points out 
the need of 1st: recognizing mental abnormalities in children; 2nd: in 
preventing the development of these abnormalities and correcting them ; 
3rd : in proper handling of children who already show these abnormalities. 

A writer to Mental Hygiene regards fear and speed as two of the 
greatest mental health hazards. Fear in a child very often leads to 
queer or objectionable conduct. In speaking of speed, Miss E. de V. 
Clarke, Supervisor of Mental Hygiene, Toronto, says, " The school super- 
visors require speed of teachers, they in turn hold the stop-watch, so to 
speak, on the child. Educators have assumed that the way to speed in 
performance of school work is to force the pupil to hurry — he must learn 
things by a certain date, and the child who cannot learn fast enough is 
certainly out of luck. A great many times the nervous system of both 
child and teacher cracks under the strain." How often we have seen 
this happen ! 

To have and maintain good mental health in children lies with the 
parents and teachers. Most habits are formed before school age, so the 
greater responsibility rests with the parents. The teacher should be 
able to recognize these habits and correct them. She should also avoid 
overstraining the mind of the child. As Public Health Nurses Ave can 
do our part by being the link between the home and school, and smooth ,/ 
out many a conflict that might arise between mothers and teachers. 



P. Charlton, K.N 



z 



') 



Armstrong, B.C. 



TOXOID. 



A campaign for immunization in Saanich is conducted along novel 
lines — in that no campaign is attempted. With this community, the 
usual drive for vaccination or inoculation is accompanied by a vigorous 
counter-drive against them — organized by members of the Anti-Vaccina- 
tion and Anti-Vivisectionist Leagues, etc. Consequently, it has been 
found that the best method of procedure is to work with as little pub- 
licity as possible — and as quickly as possible. 

Our recent campaign for diphtheria immunization was conducted in 
this way. A definite schedule for clinics was arranged, and explanatory 

35 



pamphlets issued to every school child. These were signed by the parents 
who wished the treatment given and collected as quickly as possible. 
The first dose was then given immediately. Clinics were conducted in 
all the schools by the Medical Health Officer. The nurse for each school 
was present to round up the children and to record doses. 

The response was particularly gratifying. Approximately five hun- 
dred children — school and pre-school — were immunized. In a few cases 
some discomfort was experienced — but none serious. All the children were 
checked by the school nurse, home visits being made where necessary. 

The Health Department feels that the success of the method is 
largely due to general health teaching. Throughout the year the school 
nurses introduce the subject of immunization to parents while visting 
them to check absentees or illness, etc. The discussion is casual but 
informative. A prejudice based on ignorance and fear can often be elimi- 
nated by a simple explanation of procedure and purpose. We have found 
that the best method of combating anti-vaccinationists is to avoid the 
appearance of argument — but to be prepared to offset inaccurate state- 
ments by a disinterested presentation of actual figures. Those for 
Saanich — compiled by the nurses personally — have been particularly 
valuable in these interviews. 

M. K. Smith, R.N., 

Saanich Health Centre. 



ORGANIZING THE NURSING SERVICES OF A HEALTH UNIT. 

In any nursing service where there is more than one nurse in a dis- 
trict, proper organization of the work is important. This organization 
should be planned with a view to giving the maximum amount of service 
to the district with a minimum amount of overlapping. It is also neces- 
sary to plan with a view to giving variety of work, or generalized nursing, 
together with adequate off-duty time for the nurses. 

Having these objectives in view, the reorganization of the work at 
Saanich was undertaken. 

A survey of the district over a period of three or four weeks produced 
the following data: — 

(1.) There are eighteen schools in the district, three of which are 
high schools, three large seven-roomed schools, and the remaining ones 
from four rooms to one, mostly in the outskirts of the district. 

(2.) The larger schools are in one part of the district where the 
greater part of the population reside, and so is a seven-roomed high 
school. The schools in the outlying districts are as far as 10 and 12 
miles from the central ones — a point which had to be considered when 
planning a specific and equitable district for each nurse. 

.(3.) The ever-present question of bedside nursing had also to be 
taken into consideration, and, like all districts, this phase of the work in 
Saanich is a variable quantity — running in spurts. 

36 



sequence, the schedule for nursing and school work was 
drawn up as follows, and has, with few exceptions, worked out very 
well :— 



Nurse No. 1 



I 



Definite Schools. 

.Monday a.m. 
.Mondav p.m. 
.Tuesday a.m. 
.Tuesday p.m. 



Nurse No. '2\ 
Nurse No. 2 J 
Nurse No. 3( 
Nurse No. l) 
Nurse No. 8\ 
Nurse No. 1) 
Nurse No. 2 J 

Monday a.m Nurses Nos. 1 and 2 

Monday p.m Nurses Nos. 2 and 3 

Tuesday a.m....Nurses Nos. 1 and 3 
Tuesday p.m.... Nurses Nos. 1 and 2 

and so on all week. 



Emergency Work. 
Nurse No. 3 Monday a.m. 

Nurse No. 1. Monday p.m. 

Nurse No. 2 Tuesday a.m. 

Nurse No. 3 Tuesday p.m. 



Nurse No. 3 
Nurse No. 1 
Nurse No. 2 
Nurse No. 3 



The school schedule is inflexible, and any nurse not being" able to 
visit her particular school on the scheduled a.m. or p.m. is substituted by 
the nurse in charge. 

Notices were sent to each school at the beginning of the term indi- 
cating the schedule for the coming year, as follows : — 

" Prospect Lake School — Schedule for Visits of School Nurse. — Every 
Tuesday a.m. and Friday p.m. 

" If the regular nurse is unable to visit, another nurse will make the 
call. 

"(Signed) 

" School Nurse." 

The nurse gets to the school at 8.45 a.m. to arrange re-entry of pupils 
who have been absent, etc., and 1 p.m. for afternoon calls. Arrangements 
for M.H.O. examinations are made in advance, and invitations are sent 
to parents to attend if desired. 

But, you ask, what about the disorganization of this schedule in the 
stress of extra nursing? It may seem unreasonable that the one nurse 
on call can handle all the emergency calls if she has two or three obstet- 
rical cases to attend. At one time during this year we had five confine- 
ment cases on the go, and each nurse was able to handle a case along 
with her school-work. It meant that home and school visiting was post- 
poned until the afternoon or next morning, but it was done, and 
admirably too, while all emergency calls were handled by the nurse in 
charge. 

The high schools are visited once a week. All M.H.O. examinations 
were done during the first month of the school term. This enables the 
school studies to be uninterrupted by medical inspections for the whole 
of the term. Sex education talks were given to both boys and girls 
immediately following the medical inspection. 

37 



It is understood that all emergency calls to both high schools and 
elementary schools are answered by either the nurse " on call " or by the 
supervising nurse. 

Time off for the nurses is arranged with a view to the convenience 
of the nursing schedule as well as to the nurses. Each nurse takes suc- 
cessive week-ends off, as follows : First week and from Friday night to 
Sunday night, followed by a week-end on duty, with a p.m. off during 
the week as the school schedule permits. The next week-end starts at 
noon on Saturday and continues to Sunday night. In this way the 
weekly p.m.'s are compensated. Night duty during the week is taken 
consecutively turn about, which amounts to one night in three being on 
call, or two nights a week. 

This off-time schedule is also inflexible, which enables each nurse 
to plan ahead for her off-duty time. 

Apart from the school schedule, around which this work seems to 
revolve, the nurse in charge manages to address public meetings, and 
feels gratified to know that all Women's Institutes and some of the 
Parent-Teachers' Associations have been addressed about the work of 
their Health Unit. This is the most effective way of breaking down any 
prejudice and of getting to know the people of the district . . . and 
doing educational work. 

This programme has now been in operation for nearly a year, and 
there has been no necessity for changes, which leads to the hope that as 
we are able to do more in the district we will be able to fit the extras 
into the schedule without disrupting the basic scheme. 

Bertha Jenkins, R.N., 
Supervisor, Health Department, Saanich. 



PROGRESS OF PUBLIC HEALTH IN KAMLOOPS, 1925-35. 

The Kamloops Red Cross Society was responsible for the Public 
Health Service being started in the year of 1922. Miss Thorn, the Red 
Cross District Nurse, began the first school work in the City of Kamloops. 
During this early stage of the pioneering work the nurse spent her time 
between bedside nursing and school work. It was then that the founda- 
tion was laid for the advancing educational work that is being done 
to-day, which is now under the auspices of the School Board and City 
Council of Kamloops. i 

From all accounts it was very difficult for these early nurses. Later 
in 1925 Miss Fisher was in charge. I found an interesting annual report 
of hers to which was attached a Dental Survey Report, showing the 
deplorable condition of the children's teeth at that time. She states in 
her report that : — 

Children examined, 731 ; children with defects, 636, or 87 per cent. ; 
children with permanent defects, 183, or 66 per cent. 

She also says in her appeal to the School Board for a Dental Clinic 
(which was never granted) that " This work is necessary for the physical 

38 



and mental welfare of the children, and will undoubtedly result in 
improved general health conditions in the whole community, for children 
with healthy mouths are less subject to acute infectious diseases." It 
must have been quite a misfortune to the public-health work when Miss 
Fisher resigned at the end of her first year of efficient work. 

However, she was followed by a most capable and competent nurse, 
Miss Janet Campbell. She carried the banner of progress and also laid 
many good bricks to the foundation of public-health work. She was able 
to gain the confidence of the parents and children and was so able 1o 
break down many old prejudices. 

The Red Cross Well-baby Clinic was established after the war. 
Hundreds of mothers have received the skilled advice given at these 
clinics. A great deal of credit is due to these nurses who ploughed the 
rough places, and built the firm foundation on which it has been possible 
to carry on with the progressive work of public health. 

The mere fact of the improved condition of dental hygiene will show 
what has been done by the education of tin 1 parents and children in our 
clinics and schools. For instance, the following figures may convey to 
your mind the improvement in the dental health of our school children : — 

Defective teeth (permanent and temporary) : 1925, 87 per cent.; 1935, 
20.70 per cent. 

Defective teeth (permanent): 1925, (>(> per cent.; 1935, 10.13 per 
cent. 

One can see at a glance what education has done: First, by preven- 
tion, the building-up of general health and hygiene; second, by early 
dental treatment. 

Miss Fisher also stated that goitre was very prevalent in 1925. 

Goitre in all schools: 1925, 32.5 per cent.; 1935, 10.(5 per cent. (/"" 

This condition has been overcome by the addition of iodine, using 
iodine tabloids which are provided by the generosity of the Imperial Order 
of Daughters of the Empire. These are given to all children who show 
the slightest symptoms of enlarged thyroid glands. 

There are no early figures showing the precentage of infected tonsils 
and defective vision, but it is interesting to note that we have only 4.57 
per cent, of all children needing the preventive operation for the removal 
of infected tonsils. 

Now I would like to dwell on the all-important subject of good vision. 
When 1 took this position in 1927, I was amazed to find the number of 
children with defective vision. After many years of talking, persuasion, 
and patiently waiting, I am now pleased to say that we only have twenty- 
seven children needing glasses, 3 per cent. Last year 60 per cent, of all 
defects were corrected. 

It has been possible to have many of these defects corrected through 
the kindness and skill of our doctors and dentists. Then, too, through 
our Junior Red Cross Society, which was organized in 1929. The first 
year we held a bazaar in the Lloyd George School which realized $183. 
We sent a baby to the Queen Alexandra Solarium for one year. The 
following year we held a Junior Red Cross " Primrose" Tag Day, and 

39. , 



have continued to do so annually since that time. Altogether we have 
collected $713.50; and eighty children have benefited from this fund. 

Our school population has certainly increased. Pupils: 1925, 731; 
1935, 1,105. 

The Junior High School was opened in 1929. Since that time it has 
been possible to carry out a much more advanced educational programme. 
During that year we gave our first toxoid treatment as a prevention of 
diphtheria. At that time we immunized 10 per cent, of our public-school 
children. We have given this treatment annually since. Now the follow- 
ing percentages of children are protected: — 

Lloyd George, 19.78 per cent. ; Stuart Wood, 61.40 per cent. ; High 
School, 10 per cent.; all schools, 19.27 per cent. 

We also hold pre-school clinics for the immunizing of this group. 
Unfortunately very few parents avail themselves of this opportunity. It 
seems so difficult to make them realize that diphtheria is one of " The 
Pour Horsemen of Death," and " that between 00 to 75 per cent, of the 
deaths from diphtheria occur in the age group under five years.'" — (Dr. 
Amyot, North A T ancouver.) 

Certainly the children are healthier and have fewer defects than when 
Miss Fisher made her report ten years ago. 

The following comparisons of malnutrition will give an idea of what 
the correction of defects has done to improve the physical health of the 
children : — 

1925. 1935. 

Per Cent. Per Cent. 

Stuart Wood School.... 20 19.19 

Lloyd George 30 20.20 

High School 27 Junior High 11.17 

All schools 25 17.85 

Surely these figures speak for themselves and the prophecy that Miss 
Fisher made, that " The physical and mental welfare of the children will 
undoubtedly result in improved general health conditions when these 
defects are corrected," has come to pass. 

We have had no epidemic this past year or any infectious cases what- 
soever. It is now over four years since we had a case of diphtheria in 
Kamloops. We are most fortunate in having the support of our Rotary 
Club, which supplies our schools with between 400 and 500 quarts of milk 
a year for the underweight and children who stay for lunch. Our local 
Red Cross Society provided on an average 5,000 quarts of milk to the 
homes yearly, also 75 bottles of cod-liver oil. 

The public is realizing more and more that in the twentieth century, 
medical work is preventive. Thus positive health is offered to all who 
will avail themselves of it. It is given freely and willingly and yet so 
many pass it by and are content with old ways, traditions, and ideas. 

This education is offered from the prenatal stage to High School. 
During this school age we Public Health Teachers have such wonderful 
opportunities of sharing our knowledge and experience. Especially inter- 
esting is it to form the Little Mother League classes and teach these 

40 



young girls in Grade VII I. the true meaning of reproduction, the care 
and training' of the mother and babe. Indeed, we seem to tread on holy 
ground when we come to the threshold of these young minds; as Mr. Ira 
Dilworth, of Vancouver, said once: "We must come in great humbleness 
and wait with great patience, for we are on the threshold of the greatest 
of all mysteries, the human mind." Yes, indeed, how little we know of 
or understand the human mind. 

What is the human mind? " It is the voice of the universe made 
articulate. It is the voice of the soul." (Lesson help for Teachers.) 
Should we then not listen more intently to this voice of the universe, 
and keep our minds young and ever advancing so that there is a greater 
bond of sympathy between us? For, as Leonardo da Vinci says : " Learn- 
ing maketh the soul young, it decreases the bitterness of old age. Gather 
then wisdom, gather sweet fare for thine old age. Little knowledge 
imparts people with pride, great knowledge imparts humility." 

So again we take up our banner of progress and fight not with arms 
of war and destruction, but with wisdom, knowledge, and humility, for 
the positive health and happiness for all nations. 

Olive M. Garrood, R.N. 



VICTORIA, H.C. : 
Printed by Charles I<\ Kankiki.d, Printer to the King's Mosl Excellent Mnjesly. 

1935. 



-11 



ssN.„: 

MESL_dBBrNo.. 

THE LI8ftAR\ 
University Of 81 issued by the 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. f 1^ JUNE, 1936. No. 3 




EDITORIAL. 

MOST of the Public Health Nurses of this Province are familiar 
with the letter-head of the Department of Health, on which 
comes the yearly request to " send in your article for the Bulletin, 
dear Nurse, as soon as possible"; and most of us are also familiar 
with the rumpled heads and wracked brains which inevitably follows 
this yearly request. 

It is therefore a source of continual wonder to me that the articles 
which finally appear are so original and well prepared, and proves 
conclusively that as we live up to our calling of being able to fashion 
things out of nothing when working against terrific odds in the field, 
so we also can produce readable articles at the eleventh hour. 

The interesting feature about this Bulletin, now that it is com- 
piled, is that it will be available for distribution in time for the various 
conventions for which Vancouver is to be host and which we are 
being privileged to attend. We have the opportunity through the 
Provincial Health Officer, who makes these yearly Refresher Courses 
available to each of us, and the benefit we derive from these visits 
will be shown in our work as the years go by. 

As this volume goes out, therefore, may we echo the words of 
our new King when he ascended to the Throne : " May we be worthy 
of the heritage that is ours." 

B. J. 



TABLE OF CONTENTS. 



Page. 

Hocking, Miss J. — A Saanich Sonnet 3 

Allen, Miss E. G. — Ladysmith and District 4 

Arnould, Miss J. M. — Demonstration Area 5 

Chodat, Miss I. — Coombs and District 7 

Claxton, Miss M. — Transportation North of Peace 9 

Cunningham, Miss N. — Baby-welfare, Fort St. John 10 

Dunn, Miss N. E. — Dental Clinics, Peace District .•>. 12 

Garrood, Miss 0. M. — Correcting Defects, Kamloops 14 

Gordon, Miss K. — " An Impossibility becomes a Reality " 16 

Gowen, Miss M. — Peachland-Westbank 18 

Grierson, Miss M. E. — Mission and Maple Ridge 19 

Grindon, Mrs. A. F.— " Selling Public Health " 20 

Hardy, Miss M. — Control of Communicable Diseases 22 

Homfray, Miss G. — Advertising Public Health 23 

Jenkins, Miss B.— " Relax " 24 

Kilpatrick, Miss H. — " A Day in a Logging Camp "__ 26 

Law, Miss A. S. — " Personality in Public Health " 29 

Mahon, Miss R. — " First Aid in the Peace " 30 

Martin, Mrs. E. — Dental Work in Vernon 31 

Miles, Miss M. — " Tuberculin Tests in a City School " 33 

Morris, Miss M. — The Child-guidance Clinic 35 

McMillan, Miss I. — " Emancipation of Children's Play-clothes " 37 

Seymour, Miss W. E. — Fernie's Progress 38 

Smith, Miss M. R. — " Why Nurses go Grey " 39 

Tait, Miss C. — Chilliwack Rotary Dental Clinic 40 

Tate, Miss D. — " An Open Letter " 42 

Thom, Miss A. — -Health Pursuits in Revelstoke 44 

Thomson, Mrs. B. — Keremeos and District 46 

Twiddy, Miss M. A. — " Progress " 47 

Upshall, Miss M. — " Mighty Oaks from Little Acorns Grow " 48 

Walls, Mrs. E. M. — Sayward 52 

Wilkie, Miss D. W. — -Esquimalt Rural Nursing Service 52 

Yaholnitsky, Mrs. P.—" The District Nurse's ' Soft Job ' " 53 

Cull, Dr. J. S. — Health Services under the Larger Unit of Administration 56 



;aanich sonnet. 

Have you seen Dr. Young's little column each month 
Of the blessed events in our midst? 
Walter Winchell himself with his very best hunch 
Couldn't ever foretell such a list! 

The old stand-bys are there who produce every year, 
Almost all of the Spring's blushing brides, 
Though the lads of the Fleet many miles are from here, 
They have added their quota besides! 

Even people whose youngest are almost through school 
Have their name on the baby-list now, 
We should visit each one, but with programmes so full 
For a time we just couldn't see how. 

We started a clinic for pre-schools and babes, 
Every month in a hall it was held; 
With a Doctor and Nurse, snowy gowns and the scales, 
And a rattle for infants who yelled. 

Now the first afternoon was all spent on just three, 
And the Doctor said, " Waste of my time." 
At the second just one — what the Doc said to me! 
Well, the next month the number was nine. 

Twenty babies and mothers, some sisters and brothers, 
A father who carried a twin, 

Our last clinic discovered, said they'd bring the others, 
Sure the Doctor was almost all in. 

Dr. Young's little column so bad doesn't look, 
And the blessed events seem more blest, 
When we find more than half in the new clinic book, 
Its good fun to go after the rest. 



Note. — The above was inspired by the true story of a clinic we started in one 
part of the District last December. In six months the attendance has increased 
from two or three to over twenty. 

Jennie Hocking, 

Saanich Health Dept. 



PUBLIC HEALTH, LADYSMITH AND DISTRICT. 

This district comprises a rather extensive school programme; 
there are nine schools (752 pupils) taken care of and, with the excep- 
tion of the local high-school pupils (99) , the youngsters are all weighed 
and inspected each month, weight-cards being given to all pupils 
10 years of age and under; this brings in the first five grades. The 
local high-school pupils are weighed and inspected twice a year and 
as occasion demands. 

I find the weight-cards a valuable contact between pupil and 
nurse; any constant loss of weight or resistance to gain is found in 
this way, and I feel it has much to do with the lessening of colds, as 
the old stand-by, cod-liver oil or its equivalent in some form is being 
looked upon with a real usefulness ; also early and regular bed-time 
habits on school nights is stressed as a most important factor in 
keeping up the avoirdupois. This system is put up to the pupil for 
trial and together we check up the result. 

With the exception of the receiving class and new pupils, the 
annual medical examination has been discontinued at our local schools, 
it being felt that demands were being met by the Public Health Nurse, 
in whose responsibility lies the referring to the Medical Health Officer 
or private physician of defects noted for correction. 

I feel that much can be accomplished with home-school visiting. 
The importance and method of the check of contagious diseases can 
often be better stressed when entering the home for another reason; 
the mother's mind is not so distracted as when fighting a hazard and 
she listens with interest, discussing points that have been misunder- 
stood by her. 

We were fortunate this year in having dental work done of 
which we were sadly in need. Sixty-eight clinics were held to cover 
the work of the public school; could this branch become an annual 
work, much time and expense would be saved. I think a system of 
raising funds towards the cost might be covered in the same way as 
the public interest in the school sports fund. 

Our Grades V. and VI. girls recently had the honour of bringing 
home the shield for the Girls' Choir at the Nanaimo Festival ; this 
shield has previously been carried by a group for four successive 
years. Great credit was due the teacher who trained them, and I feel 
she was also assisting in the aid of the health programme, since 
without one we cannot have the other. 

The six districts taken care of in this territory have from one- 
to four-roomed schools, the greatest distance being 16 miles north- 
east of here. A system of hiring transportation was in vogue when 
I came here ; this was satisfactory, with the exception of considerable 
waste of time, as it meant a wait for either the driver or myself when 
I had finished at the school, also a double journey was covered. 
Later on I purchased a car, the Department making an allowance 
towards its upkeep, and I am now using the car full time as satis- 

4 



factory work could not be carried on here without means of trans- 
portation. I make it a rule as often as possible to call on an absentee 
the first day from school. 

We are proud of the fact that we have had control of scarlet 
fever three times within the past three years, each case not spreading 
beyond inception. 

Well-baby clinics are held twice a month and we have infants 
that do us credit. Just now there are twins that chose January of 
this year for their birthday, and owing to the long spell of severe 
weather I have kept up a Monday morning visit with the scales. 
Bobby has already outgrown his shirt and with his shortened sleeves 
he greets me with a stretch quite pugilistic; Betty is the dainty 
maiden and both are behaving as infants should. 

Travelling Tuberculosis Clinics are held three or four times a 
year and the response is good from those whom we suggest a check-up ; 
other clinics are held at intervals. 

This district has suffered considerably from the decline in mining 
activities during the past few years, but we are hopeful, however, 
of some change in conditions with the assistance of a logging company 
becoming interested in our locality. This is a most beautiful spot 
for scenery and climate. 

E. G. Allen, P.H.N. , 

Lady smith, V.I. 



PUBLIC-HEALTH WORK IN A DEMONSTRATION AREA. 

The first year of public-health work in the Sumas-Matsqui-Abbots- 
f ord Demonstration Area has been one of intense interest. It was my 
first venture into work of this kind and it was the first public-health 
work to be done in the area. In the schools of Matsqui and Sumas 
there had been no medical examination of pupils for five years or more. 
I arrived in the area only a week after the demonstration had been 
begun under Inspector P. H. Sheffield, and my first meeting with the 
M.H.O., Dr. McDiarmid, after reporting a case of measles, was not 
encouraging, when he stated that there had not been an epidemic of 
measles for several years, and if a case or two had appeared in the 
district, nothing could prevent its spread. 

The first task was to learn the geography of the district, which 
comprises 94,644 square miles, exclusive of Huntingdon Village and 
Straiton (unorganized territory) , giving us both highland and lowland 
and many rough, hilly roads to travel. The Inspector took me to the 
schools and introduced me to each of the forty-seven class-rooms in 
such a way that any fear the children might have had of a School Nurse 
was completely dispelled. The attendance at many of the schools was 
low, due to an absence of parents and, in some instances, of pupils at 
the hop-yards. The hop-yards brought our first problem. A few cases 



of measles seemed to have originated there and as the people returned 
to their homes cases began to appear in all parts of the district. How- 
ever, epidemic proportions were reached in only one school. Then 
chicken-pox appeared and the odd case of whooping-cough. 

One of our principal difficulties has been to educate the public to 
the need for isolation of infectious cases. When some children were 
sent home from school with chicken-pox or measles, the parents did 
not hesitate to take them visiting over the week-end. By addressing 
meetings of women in all parts of the area, by explanation, persuasion, 
and occasional threats, we managed to convince the public that children 
sent home from school with one of the diseases should be kept home. 

By Christmas-time the fear of an epidemic seemed to have van- 
ished. At that time we had only a few cases of rubella in the district, 
and it appeared that the New Year would see us free from prevent- 
able diseases. We had not reckoned with the Christmas festivities, 
however. 

A few parents seemed unwilling to keep their children home from 
the Christmas-tree entertainments and by the middle of January 
rubella was rampant. The attendance of pupils at school was greatly 
reduced and for a period of two months nearly 25 per cent, of the 
teaching staff were away with rubella. During the epidemic twelve 
cases of scarlet fever appeared in different areas, necessitating a thor- 
ough check-up of all absentees and suspects ; 244 visits were made ! 

Last October a medical examination of 1,485 children was begun 
and at the same time Dr. Quinn was engaged to make a dental survey 
of the pupils. These examinations have been productive of much good. 
The medical examination brought the pupils' defects to the attention 
of their parents. The dental survey revealed such an astonishing per- 
centage of defective teeth that a dental clinic became imperative. The 
clinic was begun in January. Two dentists at Abbotsford work four 
one-half days each week and two dentists at Mission work two one- 
half days each week. Because many of the pupils are brought to 
their school in buses, it was necessary to convey children to the dental 
clinic by means of the same buses. From ten to twelve pupils are 
brought in each morning to Abbotsford. They are taken to the Inspec- 
tor's office, where they do school-work, read library books, and other- 
wise employ their time usefully while awaiting their turn in the 
dentist's chair. At Mission five or six pupils are left in each dentist's 
office on the mornings when the clinic is operating. 

These activities have been received with great appreciation by the 
people of the area. Many times parents have said how pleased they 
were to know that sanitary conditions have been improved by the 
installation of paper towels and toilet-paper, which formerly was sup- 
plied to only three or four schools in the whole district. Poor drainage 
systems which were contaminating wells have also been promptly 
attended to. A number of undernourished children have been sup- 
plied with milk and have shown marked improvement. Every day, 
by telephone or by letter, requests are made for visits to the homes 



of pupils who are ill, and the public seems to be heartily in accord with 
the work that is being done. The home-visits are extremely impor- 
tant in an area such as this, where so many families on small holdings 
are on relief. Many of them hesitate to call a doctor because of their 
inability to pay him. In many cases I have been able to point out 
the need for immediate medical attention in critical cases. 

Without the friendly assistance and support of the people of the 
district the results we have been able to achieve would have been 
impossible. The help and co-operation of Inspector Sheffield and 
Miss Robertson, of the demonstration staff, have been invaluable and 
my work has been considerably simplified by the elimination of four 
School Boards. The Women's Institutes, Parent-Teacher Associa- 
tions, and the Welfare Association have given whole-hearted assis- 
tance. The doctors have always been ready with advice and assistance 
in emergencies. The hospital staff, under the kindly supervision of 
Miss Archibald, have helped in so many ways. The Municipal Coun- 
cils, too, have given support and assistance that has been invaluable. 
Altogether, the help and support that has been forthcoming from the 
people of this area have been most encouraging and bring convic- 
tion — if that were necessary — that public-health work is certainly 
worth while. 

J. M. Arnould. 



COOMBS AND DISTRICT. 

Coombs, Hilliers, and Errington Districts have been under my 
care since August 1st, 1935, but it has not taken me until the present 
time to realize that the advice which we were given during our Public 
Health Course — namely, " that one must not be discouraged if the 
results of one's efforts are slow in coming to notice ; that one must be 
satisfied to reach a single objective at a time " — is not to be taken 
lightly. 

I admit that at times I have been rather downhearted. Parents 
have been rather difficult when approached concerning the adminis- 
tration of vaccine or toxoid to their children. My authority in certain 
school-nursing matters has been questioned. Criticisms have had to 
be dealt with tactfully yet firmly. But I have had very fine co-opera- 
tion from my local Nursing Committee, and I am not at all discouraged. 
I feel that I have gained the confidence of the people in the district, 
and am sure that all my efforts to reach the main objective of public- 
health nursing are not in vain. 

The programme carried on is a generalized one, the most impor- 
tant phase being school-nursing. Each school is visited twice a week, 
with a view to checking up on absentees. The teachers have been 
co-operative indeed, reporting any rash, headache, or other symptoms 
at once. There has been one case of German measles and two of 
chicken-pox in the schools, but these have been isolated in time to 



prevent any spread of the infection. As the nearest hospital is 30 
miles away, and as most of the people in the district are in very hard 
circumstances financially, correction of diseased tonsils and adenoids 
has been rather difficult to secure. We are very fortunate indeed to 
have the services of a dentist in the district twice a month, and it is 
most encouraging to find parents doing their best to afford dental 
treatment for their children. The Women's Institute has been very 
helpful in supplying suitable school clothing for the children of larger 
families. A Little Mothers' League branch has been formed here 
and all school-girls over 10 years of age have -attended the classes. 
The mothers have been very appreciative of this service for their girls. 
The Little Mothers, in their turn, have shown deep interest and will- 
ingness to learn " How to save the babies." The boys, of course, 
must not be left out, so I have started to take first-aid classes with 
them in connection with the Canadian Junior Red Cross branches here. 
All the school-children are weighed and examined once a month, par- 
ticular stress being laid on regular gaining of weight. > The poverty 
of the district, along with the ignorance of mothers in matters of diet 
and good home-management, is greatly to blame for several cases of 
malnutrition. However, I am succeeding in making the children 
" weight-conscious," and this, with the addition of a few helpful hints 
to parents and the use of current health-literature, is proving success- 
ful in clearing up the condition. 

Pre-school children and infants are visited once a month and 
examined. It is one of my chief ambitions to start a pre-school and 
infant clinic here. But several factors appear to prevent me from 
carrying on. It is about 12 miles from one end of the district to the 
other. The only means of transportation is by car, and cars are so 
few and far between and volunteers are so scarce that it is impossible 
for mothers to bring their small children to a central clinic. But I am 
doing the next best thing. I am starting a weighing-station in each 
of the three districts, once a month. The first one we have just had 
proved quite successful. The idea is being met with much favour 
from parents. The prenatal work is being carried on by home-visiting. 

I have several things in view for the coming year. Perhaps I 
may be able to go ahead with the idea of a pre-school and infant clinic. 
Certainly I am not going to give it up as a hopeless business. I would 
like to take classes in home-nursing and hygiene. All the school- 
children are anxious to have instruction in first-aid to the injured, 
and they shall have it. I would like to meet with parents, perhaps 
once a month, to discuss health matters of common interest. There 
is much to be done, and I am full of hopes that, in the coming months, 
my programme may become more and more complete. I am sincerely 
thankful for the wonderful encouragement and help I have had from 
Dr. Young, for, without that, the way would have been much more 
difficult. 

So again I say I am not discouraged or yet disappointed ! If the 
future of public-health nursing in this district holds as much oppor- 

8 



tunity as the past has revealed, all will be well and our objectives will 
certainly be reached! 

I. C HOD AT, 

Coombs. 



TRANSPORTATION NORTH OF THE PEACE. 

The means of transportation for the Public Health Nurse has 
always, I believe, been a bit of a problem, especially in a rural district. 

The question is how to get the nurse conveyed to and from her 
work, be it patients, schools, clinics, etc., with the least possible expen- 
diture of money, of her time, and of her energy. 

There are, of course, many ways she may travel — from aeroplane 
to snow-shoes — but not all equally practicable. The means of trans- 
portation has to be suitable to local conditions, and usually the cost 
of maintenance is of vital importance. 

If it is financially possible, of course, a small car is the ideal; 
that is, when climatic and road conditions are equally possible. 

I have now worked north of the Peace River for five years, and 
have travelled to my patients and to very scattered schools, etc., in 
very many different ways. 

At first there was the old Ford car, lent to the nurse " for the 
duration " (of the car !) . " Eliza " was a faithful old car, even if not 
much to look at. She certainly lacked many things that the average 
car is expected to possess; but she had a wonderful engine (so every 
one said) and a very willing spirit, and altogether a nice disposition. 
Many a time she was left in a mud-hole or astride a stump while I 
journeyed on to my patient on foot; but she was useful on the roads 
and saved much time. The horse was used for the trails and more 
difficult trips, and during the many months of the year when " Eliza " 
was snowed up or laid off on account of mud. Of course, she was an 
expense to run, with gasoline at 50 cents a gallon; very shaky and 
bumpy to ride in; also draughty after the glass in her wind-shield 
was bumped out, and dreadfully noisy, but there were many regrets 
when she finally gave up the ghost. Her engine now saws wood in 
Fort St. John, while her body, converted into a sort of buggy, is pulled 
around by horses ! How the mighty have fallen ! 

After the demise of the car I stayed steadily with the saddle-horse, 
varied by " Shank's Mare," except when I was fetched to a patient, 
when I travelled in a diversity of rigs — from a stone-boat to a dog- 
sleigh, including a hay-rack, a grain-box wagon, a home-made cutter, 
a comfortable heated caboose, a bob-sleigh, and many others. 

Generally speaking, the roads have improved in the last few years, 
making transportation easier ; but there are still parts of my district 
almost impossible to get at, except in winter, on account of the 
muskegs. The steep hills with their winding, precipitous roads pre- 

9 



sent a very real obstacle to easy and safe travelling, especially after 
a Chinook, when the surface becomes glare-ice. Taking a patient to 
a hospital over such a hill is quite a difficult procedure and requires 
real team-work. 

At one time, transporting an old lady with a dislocated shoulder, 
we made a safe journey down an icy hill by several men going ahead 
early in the morning with picks and cutting a groove in the ice to 
take the sleigh runners at the most dangerous points, while another 
man riding a steady sharp-shod horse was hitched on behind the sleigh 
to act as an anchor and hold it from swinging around. It was rather 
a perilous ride, but, fortunately, the patient was the least concerned 
of the party, and we reached the bottom safely and thankful. The hill 
on the south bank of the river was less icy and more easily navigated. 

Riding horseback when the temperature is very far below zero 
is a cold business, and then, if time permits, I prefer to walk. 
At present I am considering training my two dogs to pull me on a 
light toboggan. With such a small team I could not expect to go far 
or over bad trails, but they might manage my hundred pounds on good 
trails, and it would be decidedly warmer than perched up on a horse. 

Of all the many ways I have travelled to visit a patient, perhaps 
the most unusual (and undignified) was on hands and knees. 

Hearing that there was a sick child on the other side of the lake, 

1 left my unshod horse at the house I was visiting; I proceeded to 
walk the odd half-mile or so across the ice, as advised, instead of going 

2 or 3 miles around. For some little way out from the shore the ice 
was comfortably covered with snow, but out in the wind-swept centre 
it was plain well-polished ice and I found myself sitting down suddenly 
every few yards. Finally, in desperation, I took to my hands and 
knees and crawled across the lake nearly to my patient's door. 

Surely there are many ways for a nurse to travel her district ! 

Muriel Claxton, R.N., 

Cecil Lake, B.C. 



BABY-WELFARE, FORT ST. JOHN. 

Baby-welfare work has its basic principles that apply in any 
conditions, but which must be adjusted to the local surroundings. 
This has been impressed upon me in this field of work here in Fort 
St. John. 

Fort St. John, in the Peace River Block, is what might be called 
one of the last pioneering districts. This area is sparsely populated, 
with log cabins miles apart. Most of the inhabitants are farmers 
who left their land in the Prairies to try to make a living in this new 
country. The average length of their residence here is about four 
years. Needless to say, the homesteads are not very well developed 
and the farmers are far from rich. Fort St. John, consisting of a 

10 



row of false-fronted stores, log hotel, post-office, and a few dwellings, 
is the centre of this district north of the Peace River. 

We are fortunate in having two doctors, one a resident physician 
and the other the Indian Agent, and a very well-equipped Roman 
Catholic hospital. The doctors visit the outlying districts only in a 
case of emergency, and the people, because of the long distances, do 
not come in for medical attention. We are trying to bridge this gap 
through the efforts of the Peace River Health Unit. Baby-welfare 
work is an important branch of this programme. 

Owing to the fact that these homes are scattered and travelling 
conditions are poor — horses being used many months of the year — it is 
impossible to visit all the babies each month ; thus the establishment 
of baby clinics was imperative. The Women's Institutes of the vari- 
ous districts proved a great help in the organization of this work. 
They were appealed to and took up this work eagerly and as one of 
their projects. This enthusiasm or community spirit, by the way, 
seems to be the main characteristic of these people. On this trait 
much of the success of the clinics depends. The farmers will go miles 
to the pie social ; any community event, however simple, seems to have 
a great attraction for them. 

As it was not convenient for the doctor (who was to attend these 
clinics) to leave Fort St. John, the clinics had to be started as weighing- 
stations. It is hoped that a doctor will be in attendance at future 
clinics when the snow is gone and the trips to the outlying districts 
can be made in one day instead of several. 

The day that the first clinic was held the thermometer registered 
25 degrees below zero. Luckily, this was warmer than it had been 
for several weeks, when it had been ranging between 40 and 60 below 
zero. Even in this cold weather the mothers and children bundled up 
and came by the cutterf ul to the church hall where the clinic was held. 

The routine of the clinic is much like that of any other baby clinic, 
with its weighings, measurings, and advice. The value of cod-liver 
oil was preached and this food was dispensed to babies where it was 
impossible for the families to provide it. Orange and tomato juice 
were spoken of, but as oranges and tomatoes are unobtainable here 
in the winter, and in season are so expensive, turnip-juice has to take 
the place of these in many cases. Canned juices are too highly priced 
for general use. 

The babies are, on the whole, very healthy, and mothers are 
healthy from an outdoor and thus more normal life. The babies are 
given a good start in the prenatal period and are helped through the 
first months by breast-feeding. Isolation cuts down the danger of 
infectious disease tremendously. To reduce this danger to its mini- 
mum, however, the idea of vaccination and toxoid inoculation is being 
introduced. The vaccination-work has started and toxoiding is being 
planned for the near future. 

In regard to pre-school work, much of the time is spent on food 
problems. The families in many cases do not realize the importance 

11 



of a properly balanced diet for the children. For example, it will take 
much work to teach them that vegetables should be grown in large 
enough quantities to be available throughout the winter. The defects 
found in this group, such as tonsils and teeth, will, we hope, be taken 
care of in the various school clinics. 

The Health Unit has been functioning comparatively few months 
and infant-welfare work is just being established in this northern 
area. Since development in every line of community education is 
important, not only to the community itself, but also to the firm foun- 
dation of the unit, infant-welfare work as a branch of health education 
is not to be ignored in this district, where a great deal of work must 
be done to bring the ideas of preventive medicine to the people's minds. 

Norah Cunningham, R.N., 

Fort St. John, B.C. 



ON ORGANIZING DENTAL CLINICS IN THE PEACE RIVER 

BLOCK. 

A phone-bell broke the silence on one of Victoria's glorious August 
mornings in the middle of my summer vacation. Dr. Plenderleith, 
Business Administrator of the new Peace River Health Unit and Offi- 
cial Trustee of the district, wished to see me at his office at the Depart- 
ment of Education. Orders were to return to duty and organize dental 
clinics throughout the Peace River Block. 

Two dentists were coming from the Coast for two months' duty. 
There are children scattered over a country that sadly lacks communi- 
cation; perhaps one rural mail weekly and one phone in a district 
which must serve a very wide territory; transportation is always 
difficult ; some of the districts and people I knew well, of others I had 
had only a bird's-eye view from passing in a car ; every child must see 
the dentist and only two months in which to do the work — such were 
the thoughts that went through my head. 

It was to the women of the Block that I turned for help. We are 
fortunate in having many well-organized Women's Institutes and other 
interested groups of citizens. They are to be congratulated on the 
splendid way they helped, not only by devoted service, but by the 
money collected in voluntary donations of 25 cents given to defray 
expenses. 

The southern districts of the Block were zoned into five centres 
and we worked in empty shops, hotel lobbies, and schools, etc. Com- 
mittees of women with their conveners were arranged for. Three 
members were on duty all day. They relieved each other, one member 
staying on till her relief knew how to do her job. One woman was 
secretary, another looked after the sterilizing and the instruments, 
and the third after the wants of the dentist and children. They also 
arranged that the staff was housed and fed. All equipment was 

12 



brought from Vancouver. The nurse in "charge had to see that the 
clinic was set up and that supplies were on hand, including water, 
which is always a problem in this district, and also to supervise the 
various work being done by the women each day. She must also see 
that the children had transportation, and in many cases go after them 
herself. I found that my Chevrolet roadster would manage fourteen 
children with a little scientific packing in the rumble-seat. The pro- 
gramme for the next day had to be gone over to see that all would 
run smoothly. 

Dr. Coghlan and Dr. Currie, our two overworked dentists, were 
marvellous with the children, many of whom had never seen a dentist 
and who were not, at their first sight of the man with his instruments, 
very much in love with him. However, they always left good friends, 
and in some of the difficult cases with an odd dime. There was only 
one child in the entire area that the dentists were unable to work on. 

The following story was heard one day : Dr. Coghlan, who was 
working on a badly decayed 6-year molar of a rather nervous 8-year- 
old boy, said : " Now I am going to work in that nice little nest and 
drive out all the little bugs." " Oh," replied the child, " then I can 
run away in the nurse's big car " (it happened to be Dr. Cull's Ford 
V-8 — his idea of a big car) , " so they won't get in again." 

It is of interest to note that the children of some of the districts 
had very bad teeth, and yet in some of the most isolated spots the 
teeth of the children were found to be in very good condition. Chew- 
ing on hard moose-meat may have something to do with having good 
teeth. It is thought that some chemical in the water may account for 
the bad teeth in certain areas. 

The work in the northern district was done at the schools, about 
the same amount of work being covered in both north and south areas. 
I think that the conservation of the strength of and the nervous strain 
on the dentist should be thought about. Sleeping in strange beds 
every night, setting up and unpacking the clinic, and miles of travelling 
over bad roads, often after eight hours of hard work, should be care- 
fully thought of by the organizing head. 

In our most isolated places Mahomet had to go to the mountain. 
School districts nesting in the fertile valleys of the Peace River and 
surrounded by foot-hills were visited by boat. With Dr. Cull, Medical 
Health Officer, dentist, nurse, the school-children's examinations and 
dental work were done at the same time. Space does not permit me 
to go into the details of this very interesting trip. 

Kelly Lake, outside of the Block, was reached by motoring 70 
miles through Alberta in the snow, the party consisting of Dr. Cull, 
the dentist, and the nurse. It was finished up with a 10-mile drive 
over muskeg in a wagon that possessed no springs. We arrived at 
10 p.m. at the home of Mrs. Ward, graduate of St. Michael's Hospital, 
Toronto. Mrs. Ward is doing our school-work there and her husband 
is the school-teacher. Unfortunately, the wire announcing our arrival 
had not been delivered. The house was in darkness when we arrived, 

13 



and most women who had a home consisting of one room would have 
been quite upset had they to provide extra sleeping accommodation 
for one woman and three men. Not so Mrs. Ward — she was kindness 
itself, and soon had hot coffee and a lovely meal set before us. Bed- 
rolls were made ready and we were happy and warm and soon to sleep. 
I would like my readers to meet Mrs. Ward, who is doing such mar- 
vellous work among the half-breeds and Indians. She is the only white 
woman in that particular area, but keeps the future of a new country 
always Before her and sees the beauty of Nature and good in every- 
thing; a somewhat difficult philosophy to attain in a hard pioneering 
country conquering the last trails of the North-west. 

The urgent need of this work to be done was well known to Dr. 
Young, Provincial Health Officer, the situation having been presented 
to him professionally, privately, and by an interested public. We have 
him to thank for making this great work possible. 

The results of the clinic are many, and the good work can already 
be seen. 

(1.) This year there has been a marked improvement in the 
attendance of the school-children, this fact being brought to my atten- 
tion by the teachers themselves. 

(2.) The children are taking more interest in the care of their 
teeth. 

(3.) The nurses have not to contend with the child crying with 
toothache, miles from help in 40-below-zero weather and snow-drifted 
roads. 

(4.) The people feel that something, to the most quite beyond 
their reach, was accomplished by the dental clinics for the children. 

(5.) It made a pathway for the staff of the Peace River Health 
Unit to carry out prevention and health to greater goals. 

N. E. Dunn, R.N., 

Supervisor of Nursing, Peace River Health Unit, 

Rolla, B.C. 



SOME WAYS AND MEANS OF CORRECTING PHYSICAL 
DEFECTS AMONG THE SCHOOL-CHILDREN 

OF KAMLOOPS. 

After writing so many articles for our Public Health Bulletin, 
one finds it difficult to continue annually with something of interest. 
However, I will tell you something of what we are trying to do to 
reduce our physical defects. Most of the parents who can afford to 
have these defects corrected now take the necessary measures. They 
are realizing, as never before, the far-reaching effects of the neglect 
of defective tonsils, teeth, vision, etc. 

Six years ago I organized a Primrose Tag Day, the proceeds of 
which were used for our Dental and Medical Fund. This fund had 

14 



been used for the purpose of having defects corrected, of children 
whose parents have found it impossible to do so owing to unemploy- 
ment. We formed an advisory committee to look after the finances, 
also to whom I could refer names of children needing treatment. My 




Some babies attending Well-baby Clinic at Kamloops. 

committee investigates every case most carefully. The children from 
the Lloyd George and Junior High Schools have assisted on our Tag 
Days; also we have had donations given to us, amounting to $100, 
roughly speaking. Altogether we have collected for this fund $788.71 




Some mothers and babies attending Well-baby Clinic at Kamloops. 

15 



and have given assistance to ninety-eight children. Most of the 
defects corrected have been defective teeth and vision. This year 
alone we have corrected 64 per cent, of the defects. In 1925, 66 per 
cent, of the school-children had defective permanent teeth; in 1936 
this was reduced to 10 per cent. Our school population is just over 
1,000 and there are only ten children who need glasses. Most of these 
children have parents who can afford to buy them. Some day I hope 
we shall have 100 per cent, good vision. 

In 1925, 32 per cent, of the children had goitre ; in 1936 this was 
reduced to 5 per cent. For several years the Imperial Order of the 
Daughters of the Empire have provided us with iodine tabloids for all 
children showing any sign of goitre. I am pleased to find that this 
year twenty-five of our high-school pupils have shown very marked 
improvement, owing to the continued treatment which they have 
received during the past five years. Toxoid treatment has been given 
continuously since 1929 to the school-children. We have 62 per cent, 
of our children protected from diphtheria, and also hold a pre-school 
clinic and usually treat twenty children annually. 

It is quite a grief to me that parents do not realize the benefits 
that are offered them free of charge. However, it is only by educa- 
tion that we can hope to build the future health of our race. 

Olive M. Garrood, R.N. 



"AN IMPOSSIBILITY BECOMES A REALITY." 

I think that I am just beginning to realize how much planning and 
thinking and talking and scheming is necessary before anything really 
worth while is accomplished. So many things around us which are 
functioning smoothly in our day, things which we take for granted 
now, have taken hours of careful study, and have had very perilous 
trips through the sea of public opinion. 

It is over three years ago that we first mentioned to the people 
of Nelson the necessity of a pre-school and school dental clinic. Fully 
realizing ourselves the appalling dental conditions which existed in 
our community, we tried to convey to the public the need of dental 
work and to interest people in a clinic, the purpose of which would be : 

(1) Education of parents and children as to the need of dental work; 

(2) operative work for children of the indigent and near-indigent 
families. 

However, a dental clinic was an impossibility. It was not just 
that we sensed the fact, but we were definitely told that it was. 
" It would cost too much." " It couldn't be organized so that it would 
work." " A dental survey had been done before and nothing was 
accomplished as a result of it." 

And so each year we talked and planned and schemed. The need 
of dental work was becoming greater as the period of depression 
lengthened. The dentists co-operated to the best of their ability, but 
there seemed little to offer except extractions. Many of the children 



16 



had so many teeth extracted that they were unable to masticate their 
food properly. There were so many abscessed teeth and more than 
a few cases of acute rheumatism, which our doctors told us were due 
to infections of the mouth. There were so many swollen painful faces 
and so many notes from parents explaining that children were absent 
from school on account of toothache. 

Dr. Young brought a ray of hope to our midst when he visited 
us last June and addressed a very representative meeting, explain- 
ing to those present the need of dental work and offering material 
assistance. 

When the fall term commenced we felt that it would be wise to 
concentrate all of the time which we could spare from routine work 
on the organization of a dental clinic. We talked to the Women's 
Institute, the Gyros, and the School Board. Our first real assistance 
came from the Nelson Women's Institute, when early in November they 
voted money for the purpose of carrying on a dental survey. 

Dr. Walley, a local dentist, was appointed to do the examinations, 
and it was one of the most interesting and conscientiously done pieces 
of work I have ever seen. The children were carefully examined and 
findings charted on the dental charts provided by the Department of 
Health. When the examinations were completed we heaved a sigh 
of relief, feeling that our work was nearly over. 

However, we found ourselves faced with the problem of compiling 
a statistical report which would convey something to our public, and 
we found that the hours spent on the statistical end of the survey 
almost outnumbered the hours spent in actual examination. 

We were not the least surprised at the results obtained. Doctors, 
dentists, and Public Health Nurses the Province over realize the 
appalling need for dental work. The public, however, was surprised. 
On the whole, people were aroused and genuinely interested. The 
local press devoted considerable space to the printing of statistical 
reports. Parents received cards with tooth-defects charted. 

The School Board members became interested, and after the 
matter was discussed from every angle they voted that $1,200 be 
included in the estimates for the purpose of organizing and carrying 
on a dental clinic. 

The Provincial Board of Health obtained the sum of $306 per year 
from the Department of Education toward the salary of a dentist 
and donated the sum of $1,000. 

We are planning to commence work this fall. A committee has 
been chosen to obtain equipment and work out a policy for our dental 
clinic. 

In reviewing the situation, it is gratifying to note that a dental 
clinic which seemed well-nigh an impossibility a short time ago is 
now well on its way to becoming a reality. 

Kathleen Gordon, 

Nelson, B.C. 

17 



PEACHLAND-WESTBANK. 

Four months have passed since I was transferred to the Peachland- 
Westbank District. In that time I feel that I have learned something 
of the people, their needs, living conditions, educational background, 
and religious doctrines. 

A generalized nursing service is required, so the many phases 
of the work must be considered and developed, each as an integral 
part of a public-health programme adapted to the needs of this 
community. 

Prenatal instruction forms a good foundation for future health- 
teaching. In most cases the patient is confined in hospital at Kelowna, 
but some infants are born at home. 

Infant-welfare and pre-school teaching is well received. Most 
of the mothers are anxious for advice and willingly bring their children 
to weighing-stations. This month we hope to have Dr. Ootmar, of 
Kelowna, with us at a well-baby clinic in Westbank. 

With the splendid co-operation of the teachers the school-work 
is well begun, but there is yet much to do. Simple goitre is very 
prevalent amongst the school-children and with the consent of the 
parents we hope soon to give preventive iodine at school. Plans, too, 
are under way'to form branches of the Junior Red Cross this fall. 

When Dr. Lamb and Dr. Kincade visited our district during the 
first week in May, 155 of the 179 school-children were given the tuber- 
culin test. Ten showed local reaction after the first dose and three 
after the second. Five of the total were Indians. At this time 
thirty-two pre-school children were tested and all found to be nega- 
tive. Of the twenty-three young adults, including teachers, twelve 
showed positive reactions. In the near future Dr. Kincade plans to 
follow up this test with physical and X-ray examinations of those 
reacting to the tuberculin test. This survey has stimulated a com- 
munity interest in the present campaign against tuberculosis. 

Bedside-nursing is necessary in a number of cases. Very often 
through this branch of the work interest is created in the nursing 
programme and those who were at one time antagonistic become loyal 
supporters of the nursing service. 

First aid is frequently required, as we have no resident doctor 
in Westbank and the hourly day ferry service to Kelowna is discon- 
tinued at night. 

The Indian reserve presents problems of its own. Superstition, 
old Indian customs, and a little knowledge of modern theories present 
rather serious difficulties. As an example, there is the Indian girl 
who had heard there were people ill at Westbank. When I visited 
her home she asked if every one was well, for she said : " You might 
bring the germs to us." An Indian lad with lobar pneumonia and a 
history of tuberculosis was seriously ill and refused to go to hospital, 
so was of necessity nursed on a very draughty floor. Yet the younger 
generation is beginning to accept a higher standard of health and will 

18 



seek advice and co-operate to a certain extent. Tuberculosis is the 
greatest problem of the reserve. Those suffering from the disease 
are undoubtedly infecting others. Yet what is to be done? 

Sanitation, the disposal of refuse, safeguarding the milk-supply, 
etc., are vital problems of this rural area. 

In Westbank and Peachland the general attitude towards public 
health is good. A splendid foundation has been laid by nurses who 
were here in previous years. With the hearty co-operation of physi- 
cians, teachers, members of the local Board, and other organizations, 
we hope to progress steadily, although slowly at times, towards our 
goal of good health for all. 

Mary Gowen, B.Sc. 



MISSION AND MAPLE RIDGE DISTRICTS. 

The " mills of the gods " seem to be grinding a little less slowly. 
One wonders how much faster public-health projects would be carried 
out if the " times " were as good as in the 1920's — with public interest 
aroused as it is to-day. Difficult times seem to be necessary to impress 
people in general — those who are impressed — with the advantages and 
need of preventive and scientific measures in the building of positive 
health. 

Undoubtedly there is keener health-consciousness among the laity 
than there was ten years ago. There is also a greater appreciation 
of the authorized services available to the public and an increasing 
demand for them. 

The information on health measures that has been given to people 
by press, air, across platforms, and in the homes is reaping a measure 
of harvest. In spite of the number on relief budgets and the larger 
number on small wages, there are fewer underweight children than 
there were before the " depression." Also there are in this field a 
smaller percentage of pupils absent from school because of illness 
other than communicable diseases or accidents. 

As an example of public awareness, many have remarked at 
Father and Son banquets, " in almost every case the son was the 
better man of the two " (physically) . They gave the credit to im- 
proved athletics and the greater attention to diet and hygiene, by 
which the sons have benefited. And, again, the very few times one 
hears of convulsions during baby's teething period these days as com- 
pared to those of mother's day, and the almost universal use of 
cod-liver oil for babies instead of teething-powders. While one less 
seldom hears that " Johnny's father and uncles had weak eyes or 
bronchitis " given as a reason for neglecting Johnny's need of glasses 
or medical care. 

These districts have had rapid growth in school attendance. 
There has been an increase from 1,700 pupils to 2,400 in the past 
three or four years in the nineteen schools in an area of about 240 

19 



square miles of occupied land. In addition to the natural growth in 
receiving classes, many have come from the big city and the Prairie 
Provinces to our fair valley. 

Unfortunately, the past winter's routine health-work has been 
hampered by communicable diseases, chiefly rubella and influenza, but 
with one good result : many people realize and state that there should 
be two Public Health Nurses here. This good luck, I really believe, 
may come in the near future. 

There were " repeat " diphtheria-toxoid clinics in the one large 
centre which were well patronized. There have been inquiries for 
others as well. 

Anti-goitre tablets are still being given to the pupils up to the 
sixth grade in eight schools. These are supplied by the School Board. 
Very few cases of enlarged goitre are found in these schools. Milk is 
also supplied by the Board to under-privileged children in these 
schools. 

In addition to the four regular chest clinics held here by Dr. Lamb 
annually, a tuberculin-test survey is being conducted at present by 
this Travelling Medical Health Officer among the Japanese. There 
have been seven " new " active cases among their young men in the 
past eighteen months. The hope is that further clinics will soon be 
held for the rest of the population. These surveys are a great advance 
in preventive medicine. 

There is also need for the application of mental-hygiene principles 
in our schools, where large numbers of children are almost surely 
going to find their social adjustments difficult in the coming years. 
We hope to do something along this line in the near future. 

E. Grierson, 

Mission and Haney. 






" SELLING PUBLIC HEALTH " IN THE KELOWNA 

RURAL DISTRICTS. 

The problem confronting every Public Health Nurse working in a 
rural area is that of " reaching " her public and placing her wares 
before them so successfully that they will co-operate with interest in 
her efforts to develop a public-health consciousness. 

I will endeavour to present as briefly as possible some educational 
methods used to attack this problem in the Kelowna rural districts, 
a farming area of scattered communities of some 3,600 people, 
embracing sixteen different nationalities. 

The continuous health education of the individual by personal 
contact in the home and school is, of course, second nature to the 
Public Health Nurse. Personal contacts in clinics also come in this 
category, but the more intimate personal relation established by the 
home-visit has been found invaluable, because parents will have con- 

20 



fidence in and listen to some one they know personally who is obviously 
interested in the welfare of themselves and their children. 

Education of the public in the mass has been attempted by means 
of lectures given to many different types of organizations and gather- 
ings — by health exhibits, by health talks in the schools, and by the 
wide and free distribution of suitable health literature. 

The annual School Health Cup competition staged between ten 
rural schools has been an educational force of a somewhat different 
nature, arousing keen interest among school trustees, teachers, parents, 
and children in the health conditions in their own schools. The graded 
results, embracing every phase of personal hygiene, school sanitation, 
interest in and response to health education, are fully written up by 
the School Nurse in an annual topical report, in which she also endeav- 
ours to present in an educative and interesting manner every phase 
of public-health-nursing activity carried on in the communities and 
schools. 

This report (which has grown through the years to a mimeo- 
graphed booklet of some twenty-one pages) is sent to representative 
school trustees and other key people in the districts, and is dis- 
cussed at the annual meeting of the Kelowna Rural Schools Health 
Association. 

Personal interest in child-welfare work has been aroused locally 
by enlisting the aid of Women's Institutes and other interested persons 
in the organization and operation of well-baby and pre-school clinics. 
Clinic work in general has been a prominent feature of the develop- 
ment of the educative, preventive, and curative programme of public- 
health nursing in the rural areas, as the summary of results at the 
end of this article will show. All clinics are attended by the Public 
Health Nurse; those of a preventive nature and well-baby clinics by 
the district Medical Health Officer. Such clinics held in their own 
districts are an effective means of coming into personal touch with 
rural residents. Well-baby clinics especially, where refreshments are 
served by the Women's Institutes, are really pleasant social and educa- 
tional gatherings. 

Results of Health Education. — The result of seven years of inten- 
sive personal and mass health education has been seen in the response 
of parents and teachers to requests from the Health Service for con- 
sent to active immunization of school and pre-school children against 
scarlet fever, diphtheria, and smallpox; to goitre treatment in the 
schools, and, most recently, to tuberculin-testing of school-children. 
Too much appreciation cannot be given to those teachers in the rural 
schools who have placed before their classes the need for such protec- 
tive treatments, and have themselves administered iodine for simple 
goitre prophylaxis, standing behind the Health Service with valuable 
moral support in their own school-rooms. The teachers have also 
impressed continually upon the children under their care the need for 
personal hygiene, and brought before their School Boards the need for 

21 



necessary improvements in school sanitation pointed out by the School 
Health Service. 

Some of the practical results of health education may be summar- 
ized as follows : — 

(1.) Ninety per cent, of 700 rural school-children in ten rural 
school districts actively immunized against diphtheria, or Schick 
negative ; 50 per cent, of 380 pre-school children on register actively 
immunized against diphtheria. 

(2.) Eighty-eight per cent, of rural school-children vaccinated 
against smallpox; 48 per cent, of 380 pre-school children on register 
vaccinated against smallpox. 

(3.) Simple goitre reduced in three years in the schools from 66 
per cent, to 25 per cent., due to the administration of iodine by the 
teachers with the consent of parents. 

(4.) Ninety-six per cent, of 736 school-children tested with the 
tuberculin test with the consent of parents. 

(5.) Gradual improvement in school hygiene and sanitation as 
shown by the increasing percentage of points gained yearly by indi- 
vidual schools in the School Health Cup competition. In 1932 the 
lowest school gained 54.4 per cent, of possible maximum ; in 1935 the 
same school averaged 75 per cent, of a possible grading of 1,200 points. 

(6.) One hundred and thirty-two rural well-baby and pre-school 
clinics, sponsored by Women's Institutes, at which 876 children made 
1,265 attendances. 

(7.) Four hundred and eighty-nine free clinics of various types, 
preventive and curative, at which 3,691 adults, school-children, pre- 
school children, and infants made 8,526 attendances. 

On consideration of the above summary of results, it would seem 
that methods used to " sell public health " to residents of the Kelowna 
rural districts during the past seven years have resulted in a greatly 
increased interest in and understanding of public-health aims and 
objectives. 

Anne F. Grindon, R.N., 

Kelowna Health Unit. 



CONTROL OF COMMUNICABLE DISEASES. 

Last May two cases of chicken-pox from one family developed in 
two class-rooms of Grade I. and two pupils. Previously, when this 
happened, I inspected classes frequently, excluding any further cases 
which developed on school-days, and, if I could not contact the parents, 
hoped that nothing would happen over the week-end. This time, 
however, I expected the contacts of these cases to develop the disease 
on days which included Thursday, a school-sports day; Friday, the 
May Day Festival; Saturday, the children's ball; and the Sunday. 
There were seventy-five contacts and it was a big task to notify the 
parents of those children personally. I decided to make use of the 

22 



mimeograph equipment at the school and notified the parents by forms 
which were delivered by the children who were contacts. Eight cases 
of chicken-pox developed during the holiday, but each one was recog- 
nized in the initial stages and no other cases developed from contact 
with those eight cases. Instead of being alarmed, parents were 
extremely co-operative and pleased that they had discovered the 
disease at the first symptom and that they had prevented other chil- 
dren from contracting it. 

Since then I have distributed mimeographed information occa- 
sionally, stating what diseases are likely to occur, describing the 
symptoms, and giving instruction about the procedure if anything 
develops. Parents are always notified if there is known contact at 
school or anywhere else, and if a family contact is excluded, the 
mimeographed form is also given as part of the instruction at the 
home-visit for further reference. 

After a year's experience with this method I find that parents are 
grasping knowledge of the diseases and are co-operating splendidly. 
Class-room inspections, etc., are continued, but are not as profitable 
as before. 

It is gratifying to have parents realize that a cold may be the 
beginning of a communicable disease and to have their co-operation at 
that stage in the development of, for example, measles. I now con- 
sider these forms an indispensable part of the education and control 
of communicable diseases. 

M. Hardy, 
School Nurse, West Vancouver, B.C. 






ADVERTISING— A PUBLIC-HEALTH NECESSITY. 

In speaking of advertising public health, let us dwell for a moment 
on the word " advertise." What does it mean? According to a text 
on " Modern Business," advertising is an announcement to the world, 
telling the people what it has to offer. It is an invitation to get 
acquainted. If it is successful it is a contact that opens the way to 
permanent friendship, for it radiates friendly fellow-feeling. 

Let us apply this to public health. By means of advertising it, 
we are giving the public an opportunity to be better acquainted with 
our work, we are making contacts, we are paving the way to per- 
manent friendships, and we are radiating friendly fellow-feeling. 

One can readily see why people, being acquainted with any par- 
ticular type of work, and therefore possessed of a greater understand- 
ing of its value, will rally to the cause. Equipped with knowledge 
of public health, people will put forth a good deal more effort mentally 
and physically to support it, and it is that added support that we 
are striving for. 

Advertising is a form of education. In all phases of life the 
task of education must go on year after year — repeating the same 

23 



processes. For instance, the multiplication table may not change, but 
there is always an army of new pupils who need to learn it, and some- 
times an army of old pupils who have forgotten it and need to learn 
it again. Repetition is necessary to assure a permanent place in the 
memory. Every Public Health Nurse knows how very true this is. 
In health it is necessary to repeat the same lesson over and over again. 
If we advertise the lesson we are employing only one more way of 
putting it across and forming a permanent place in the mind of 
a person. 

Again, advertising is a tremendous force in the life of a people. 
It is a vital factor in the building-up of any enterprise. Look, for 
instance, at magazines, newspapers, sign-posters, neon lights. A man- 
ufacturer cannot afford to let the public forget his products for one 
moment. So it is with public health. One must constantly strive 
to keep the value of this work ever before the public eye. 

Moreover, advertising is a force made to overcome barriers of 
inertia. By this one does not mean that we are displeased with 
health conditions in our Province. Far from it, but in almost any 
work there is room for improvement and any effort put forth to 
further this improvement is of great value. By advertising public 
health we can mould public opinion by changing old habits and beliefs, 
by planting new ones, and by overcoming prejudices, and hence lay 
the foundations for a healthier future. 

We are the lights of public health. Let us not hide our lights 
under bushels. 

Geraldine Homfray, B.A.Sc, R.N. 



" RELAX." 

In this accelerated day of hectic dashing back and forth from 
case to case, from school to school, from confinement to confinement, 
from rubella case to rubella contact, the art of relaxation is almost 
lost. It is typical of human nature that sight is lost of the things 
most needed and which are closest to hand. Relaxation is one of 
these near-by remedies — and how we need to make use of it! 

While physical relaxation is a matter of will-power, a matter 
of just stopping occasionally to get some extra sleep, mental relaxa- 
tion seems to be more elusive, and to a group of nurses it seems 
hardly necessary for me to emphasize the value of this capacity for 
which most of us long and which few have achieved. 

In my humble opinion, however, the ideal way to relax is to have 
outside interests — anything that will take us away from nursing and 
things that " pertain thereto " — either a Hubby or a Hobby! I have 
not tried the former, but I can certainly vouch for the benefits and 
pleasures of the latter. 

A hobby, so I have found, is a path by which one may wander 
to green fields far removed from the sick and their troubles ; where 

24 



for hours at a stretch one can create fascinating objects out of 
materials, and exhibit them later for the pleasures of others. For 
instance, take china-painting, photography, drawing, etching, garden- 
ing, leather, wood or copper work — any of them will lead you off 
into another world of enjoyment entirely apart from the nursing 
sphere. A change is as good as a rest, so they say! 

These side-lines, or lanes, lead to the development of unthought-of 
talents, and are not to be compared with various forms of exercise 
and sports, such as horseback riding, tennis, etc., that lead to nothing 
but physical prowess. Not that exercise is being condemned in this 
article — far from it; but it is being contrasted by the satisfaction 
which a creative urge produces and the tangible results which ensue. 
After all, it is an achievement to be able to produce unusual gifts 
for various members of the family at Christmas-time, and the 
emergency gifts for Aunt Susie's birthday or sister's wedding! 

Being a group of nurses — and women — I don't suppose many 
of you have ever considered photography as an outlet; and yet it is 
true that most of the outstanding work on exhibition in photographic 
salons is the work of women. 

This particular hobby is one of the most fascinating escapes 
from Mrs. Jones and her family troubles. To shut oneself up in a 
dark room and watch the miracle of a picture develop before one's 
eyes is really a thrill. Besides which, when the world and everything 
in it is viewed with the one idea of getting interesting pictures out 
of it, it is surprising what one sees ! Then, too, the casual snapshot 
of a scenic spot will produce a pictorial effect suitable for exhibition 
if the right portion is picked out and enlarged — the enlarging process 
being the most intriguing phase of the whole art. One could go on 
indefinitely with the latent possibilities of this particular hobby, 
especially when the secrets of colour effects and filters, shadows and 
angles, worm's-eye and bird's-eye views are explored. 

The value of china-painting is more self-evident because all 
women have a sneaky regard for nice china, and the pride of being 
able to exhibit china of one's own painting at any tea-party is quite 
justifiable. 

Drawing and etching too. No, it's no use saying, " I never 
could draw a straight line at school," because you really don't know 
what you can do until you try. I have proved that theory over and 
over again, even to drawing and painting! 

And so I leave the subject for your consideration. By all means 
dig up something different to do in your spare time that will take 
you far enough away from nursing or social-service work and give 
you a new zest with which to attack your evening's activities. 

Bertha Jenkins, 

Saanich Health Dept. 



25 



" A DAY IN A LOGGING CAMP." 

Tuesday comes around again and preparations are made to pay 
the weekly visit to the logging camp across the lake. Having filled 
my nursing-bag with all manner of things, I also arm myself, on 
clinic days, with those cumbersome baby-scales — frame, tray and all. 

The first problem is to persuade the worthy boatman to be ready 
to start on time. Having located this elusive person, we repair to 
the launch, which is probably tied up at the store float. We then 
go aboard hoping that the engine will start .and, what is more 
important, will keep going until we have covered the 7 miles up and 
across the lake. 




uiUi.lHSSBHEiHiHHHIHMHHHHflHHIHKBBHI 
Camp Six, Cowichan Lake. View 1. 



We start our journey and, if the weather is calm, one can settle 
down to enjoy the scenery for about an hour. The lake, which lies 
east and west, is about 18 miles from Duncan, on Vancouver Island, 
and runs for about 22 miles. From the water's edge the mountains 
soar high above. Numerous bare patches, where other logging camps 
have been located, show up on all sides. Away in the distance, snow- 
capped mountain-tops are clearly visible against the sky. 

Slowly we chug up the lake, passing the big lumber-mill on our 
right, until we pass between two tiny islands, and there in front lies 
Camp Six. The accompanying snapshots may give some idea of 
the setting. The general impression is of a collection of many 
weather-beaten frame buildings clustered about the narrow shore, 
with numerous float-houses oozing out over the lake. 

Here in this restricted area live about ninety families, with about 
200 men working in the woods several miles from camp. The houses, 
which are typically lumber-camp abodes, are dotted here, there, and 

26 



everywhere. The office, store, and cook-house, as well as numerous 
bunk-houses and homes, are built on floats which must be hauled in 
or out as the lake rises or recedes. Woe betide the dwellers if they 
neglect to push their homes out as the water falls, for they must then 
maintain their existence at a most uncomfortable angle. Furniture, 
dishes, and even the linoleum on the floor will slide. Such homes 
are delightful in summer, but when the winter winds come the sensa- 
tions are not at all pleasant, for, even after getting back along the 
floating walk to dry land, one continues to feel that monotonous 
motion of a water-tossed boat. 




Camp Six, Cowichan Lake. View 2. 

The first objective is the one-roomed school set in its " play- 
ground " between the many stumps. The thirty-five children are 
examined monthly or more often if necessary, and informal health 
talks are given. They are encouraged to show any ailments to the 
nurse, and all of these, even to the most infinitesimal scratch, are 
seriously treated. 

The order of the day then is to visit any school absentees in their 
homes. If it is thought necessary, the cases are referred to the doctor, 
who pays a regular visit to the camp on Tuesday afternoon. After 
this it is usually time for lunch and this may be procured in the 
cook-house. 

Every two weeks, from 1.30 to 3 p.m., a well-baby clinic is held 
in the home of the school-teacher. Here the babies are weighed 
and advice is given on general care and diet. On the alternate 
Tuesdays, or after the clinic is concluded, the afternoon is spent in 
making more home-visits. Such calls will include prenatal or post- 
natal work, infant or pre-school care, tuberculosis instruction, or, 

27 



in reality, anything or everything that can be done to further our 
programme of health education. 

Sometimes there is the difficulty of language, for it is quite a 
cosmopolitan community, with Finns, Swedish, and Mid-European 
peoples predominating among our " new Canadians." This, however, 
is overcome by object-lessons or patient explanations, or, if these fail, 
an interpreter may be located. 




Camp Six, Cowichan Lake. View 3. 

All are very anxious to learn, particularly if the subject is the 
care of the new baby. This seems tangible to them, and such instruc- 
tion forms a solid footing for a further entrance into the family 
for some other reason. 

After a busy day of winding in and out by the very numerous 
footpaths and of walking " the ties," supper is enjoyed. The evening 
is spent in visiting about until the doctor is ready for the return 
journey — probably about 8 or 9 p.m. 

28 



With many a joke about the faulty boats, we climb aboard and 
are carried down the dark lake until we see around the point the 
welcome lights of the mill and the homes of Youbou. 

Heather Kilpatrick, B.A., B.A.Sc, R.N., 

Youbou, B.C. 



" PERSONALITY IN PUBLIC HEALTH." 

What do we mean by the term " personality " ? The dictionary 
defines the word as " personal existence or identity " or " distinctive 
personal character." We all know that neither of these definitions 
is adequate. " Personality " includes these and many more shades 
of meaning indefinable in even the best of dictionaries. It embodies 
our character and inherited mental make-up and is influenced by 
our every-day environment. The reaction of people we meet is their 
reaction to our personality. 

How important, then, is the development of an attractive per- 
sonality in our daily life, but how much more is it in public health. 
For public-health workers, be they doctors, nurses, or teachers, are 
virtually meeting the public constantly. The words " public health " 
embody this very thought; for it is the public to whom health is 
brought and taught every hour of the day or night, whenever the 
opportunity arises. 

It is therefore absolutely essential that all contacts with the 
public should be pleasant and should be forerunners of further 
contacts. A pleasing personality creates a good impression. Such 
a one will be asked again and again for advice and will be sought 
out on many occasions. 

A person who will make a good impression on the public does 
not mean a person who has a great flow of small talk. The ability 
to talk well is very useful, but it should be used with discrimination. 
A good talker is not uncommon, but a good listener is a much rarer 
person. Most people want to talk, but few want to listen. Perhaps 
if public-health workers would keep this as their motto they would 
achieve far more as regards their contacts in their work. 

Character also comes with personality. A person may be charm- 
ing to meet, but unless one feels that there is character behind that 
charm, one soon forgets or grows tired of that person. The public 
will have no confidence in a weak personality, no matter how charm- 
ing. People want to feel the strength of will and purpose that should 
be found in a person to whom they will listen and obey. 

Trustworthiness is the very backbone and foundation of per- 
sonality. If a person is consistently reliable, mediocre work may be 
forgiven. Deception may seem the easier way out of a difficulty, 
but, applying an old tag, " You may deceive some of the people all 
of the time, and all of the people some of the time, but you cannot 

29 



deceive all of the people all of the time " ; so why not save any trouble 
and be truthful always. 

Were a personality to include all these — charm, character, trust- 
worthiness — workers in public health would gain the confidence, 
friendship, and co-operation of their people far more easily and 
quickly than by any other means. 

Annie S. Law, B.A., B.A.Sc, R.N. 



" MY FIRST FIRST AID IN THE PEACE RIVER 

DISTRICT." 

Early September saw the establishment of our Health Unit here. 
I had only been at Pouce Coupe (I was staying there temporarily 
until I would be able to get to my own district over a river from 
which the bridges had been washed out) when I was asked to make 
a quick inspection for contagion over six schools within a radius of 
25 miles. Aside from a general sense of direction, I had a very hazy 
idea of where these schools were, and at that time also I had very 
little idea of what muddy Peace River roads are really like. So I 
packed up my little kit and set out on what was booked for a two-day 
trip. 

I shall spare you the details of the journey — that is not what 
I really set out to write about. Suffice it to say that I have found 
out after six months here that difficulties of travel and road conditions 
are the most popular topics of conversation. Everybody always has 
one better to tell, and I stored up a few treasures of anecdotes of that, 
my first trip of any length, that still make material for a brilliant 
participation in any bout of this nature. 

On the second afternoon out, about 3 p.m., I arrived at and 
inspected the last school on my list. Duties over and school dismissed, 
the teacher and I sat chatting over her desk. She wanted to know 
all about the new Health Service, and I was especially interested 
to find out the best road — if any best road existed — back to town. 

Glancing at her casually as we conversed, I suddenly saw a huge 
black spider enter her ear. Controlling an exclamation of horror, 
I asked her to sit still for a minute and let me have a look at her ear. 
I thought she might become frightened if I mentioned spider, so she 
sat there rather cool and astonished-looking while I peered into her 
ear. Only one wee bit of a black spider leg was visible! All the 
rest of Mr. Spider was already well out of sight within the ear. 

"Now," I thought, "What shall I do; what can I do?— Why, 
my flashlight ! " I am sure the inspiration came filtering through 
a few years of time from those first-aid classes back in U.B.C. How 
was it? Oh, yes. " If an insect is known to be in the auditory 
passage, flashing a light at the external ear will cause him to back 
out." 

30 



Quickly I ran out to the car, thanking my lucky stars for the 
brand-new flashlight with which it was equipped. I explained to the 
little teacher, who still seemed rather amazed at the proceedings, but 
who was a real brick, what it was all about and we settled ourselves 
as comfortably as possible for a session of flashing. Mr. Spider 
paid no attention whatever. The little teacher said she could not 
feel him there at all, and I began to wonder if his entrance into her 
ear had been an optical illusion of mine. All I could see was a tiny 
fraction of what resembled a spider's leg. Flash on, flash off; flash 
on, flash off. What else could one do? Should I fill the ear with 
olive-oil and chance it floating out? No; I was sure this light- 
flashing would work eventually. 

We tried to carry on a conversation and found it hard to keep off 
the subject of spiders in ears! I wonder if she realized what might 
happen if the insect wouldn't come out. Suddenly I saw the leg 
wriggle, and Miss C. said : " Oh, I can feel him wriggle. Gee, he 
feels funny." I was glad to find her such a composed young lady. 
We had been carrying on proceedings already for fully forty minutes 
and it must have been a nervous strain for her. 

Flashing continued for about twenty minutes more, with the leg 
continuing to wriggle provokingly. We were sure he was trying 
to wriggle back through the waxy entrance. Two legs appeared, and 
finally Mr. Spider himself, with a great rush, very subdued and waxy 
looking, and in an immense hurry to find other cover. I picked him 
off her outer ear in great glee. Nothing has ever given me greater 
satisfaction, and as a result of this little experience I am more than 
ever interested in first-aid measures. 

I find many people have pet tricks all their own. Often valuable 
hints can be picked up. Even our Medical Director of the Unit has 
some seemingly rather odd theories re first aid. Just the other day 
he told me of a way to control severe nose-bleed when all other 
measures fail, with the use of a small piece of salt pork in the bleeding 
nostril. Now, who is going to try that one out? 

Rita Mahon, R.N., 
Peace River Health Unit, Datvson Creek, B.C. 



DENTAL WORK IN VERNON SCHOOLS. 

One of the greatest achievements in public-health work in this 
district has been the improved mouth conditions of our school-children. 
We have here as fine a condition of good mouth hygiene and corrected 
dental defects, I am sure, as you will find in any school in the Province. 

It has taken several years to achieve this ; but if this standard 
can be maintained in the years to follow, I shall be satisfied with this 
phase of our public-health work here. 

31 



Our dental programme is a simple and, I think, a sound one, 
and if administered properly, one that can be carried on for an 
indefinite number of years. This is how we started it. 

The School Nurse in her reinspection of school-children found 
an appalling lack of interest among some of those parents who could 
afford to pay for their children's dental work, and also revealed that 
there were many dental defects among the children of indigents who 
would never be able to have this work done, or probably not until it 
was too late to do much good. This condition was persistently 
brought to the attention of the parents of those children who, we 
felt, could pay for this work, but something had to be done for the 
teeth of the indigent child. This was before the days of Government 
relief. 

I have always objected to raising money for this sort of work 
from proceeds of Tag Days, concerts, etc., as the publicity given to 
it in such cases would probably have swamped us with requests for 
assistance from many undeserving cases. 

We wanted to start a dental fund, not anything spectacular, but 
rather in a small way, and gradually build it into something per- 
manent, so we appealed to our faithful friend, the Vernon Women's 
Institute. Just at this time some Red Cross nursing classes were 
being held in the Province under the auspices of the Women's Institute. 
Part of the proceeds from these classes were to go to the Canadian 
Red Cross Society and the remainder to the Women's Institute. When 
the classes were finished and the proceeds distributed to the two 
societies, the Women's Institute here added to their share of the 
proceeds to make up the sum of $25 and sent it to me for our dental 
work. It was not a large sum, but it formed the nucleus of our dental 
fund. Some of our benefit societies and service clubs were interested 
and they too sent donations when appealed to for funds. This system 
continued for a couple of years. Then our School Board, recognizing 
the value of the work that was being done, included a sum of money 
for dental work in their estimates each year. It was not necessary 
to appeal for any more funds as the School Board still carry on this 
work as part of their yearly expenses. For the past few years this 
money from the School Board, together with the Provincial grant 
for dental work, constitutes our permanent dental fund. 

So much for the financial side; now for the children. This 
service takes care of needy cases and assists with others when we 
think it necessary, and applies only to pupils in the elementary grades. 
We started with the receiving classes and the entrance classes, the 
beginning and end of our elementary grades here, and gradually 
continued our work toward the intermediate grades, until now we 
are able to include all the elementary grades during the year. 

We pay particular attention to permanent teeth and mouth 
hygiene, and we try to do as much as we can each year with a certain 
sum of money, always keeping some in reserve for emergencies. 

32 



That is, we bulk the money and estimate the amount of work to be 
done each year, usually about seventy-five or eighty children. 

This work is divided among our four dentists, and it is done 
impartially, regardless of age, nationality, or length of residence in 
the district. The only stipulation is that we must be sure that they 
are really needy cases and would not be able to have the work done 
in any other way. 

This part of the work I take care of, and I find it difficult many 
times to decide just where to draw the line. I also make the first 
appointments. 

The work is done as quietly and tactfully as possible. There is 
no public clinic; in fact, we do not call it a clinic at all. Too much 
publicity would ruin the spirit of our work, and might also lead to 
some unpleasant controversies as to whether cases are needy or other- 
wise. 

But I wish to mention our local dentists, without whose hearty 
co-operation this work would have been impossible. They are doing 
a wonderful work — underpaid it is true; but nevertheless doing it 
well, and in this way making a wonderful contribution to the future 
health of a great number of our young Canadians. I am deeply 
grateful for their loyalty and support and thank them most sincerely 
for the many hours of free dental work that they have given to our 
school children. 

Elizabeth E. Martin, R.N. 



"TUBERCULIN TESTS IN A CITY SCHOOL." 

We have just completed tuberculin tests of 1,700 children and 
young adults in the City of Kelowna and the rural district. This 
was carried on by Dr. A. S. Lamb and Dr. G. F. Kincade, Travelling 
Medical Health Officers, assisted by Miss J. Peters, R.N., and Miss 
E. Pease, R.N. Since this is the first district in the Interior to be 
surveyed in this way, I felt that it might be of interest to other 
Public Health Nurses, who might be called on to organize a clinic, 
to have a brief outline of our trials and triumphs here. 

In the first place, publicity is of prime importance. We sent 
detailed notices home to the parents about six weeks before the tests 
were scheduled. We had an explanation of the test in local papers 
and mimeographed notices of the same were sent to each home with 
separate consent-slips. If at all possible, I would suggest that you 
have a letter written by the doctor carrying on the test, pointing- 
out again the difference between tuberculosis infection and tubercu- 
losis disease, these to be given to all children whose reactions were 
positive. 

33 



Dr. Ootmar and Mrs. Grindon arranged the schedule for the 
tests in the city schools as well as those in the district. I have no 
doubt that this was probably the hardest work in connection with 
our preparation for the clinic. To have the schedule so arranged 
that the doctors were not at three places at once or completely out 
of work was quite an accomplishment. Each child must be inspected 
forty-eight hours after the first dose; all the children who were 
negative at this inspection receive a second dose of tuberculin, and 
they are again inspected forty-eight hours after the second dose. 
That means that the doctors must visit the school three times at 
two-day intervals, and if you have ten or twelve schools to be included 




Tuberculin-testing at East Kelowna School. 

you will realize the complexity of the schedule. Seventeen hundred 
children and young adults were tested and positive reactors were 
X-rayed and had chest examinations in three weeks' time. 

If your district is to be the next " victim," try to allow yourself 
six weeks for preparation and publicity. Sorting and listing the 
names from consent-slips took three times as much time as the actual 
testing. As to the test itself, the two doctors and two nurses were 
such adepts that it took all my time to keep enough children in line 
to keep the doctors busy. Fortunately, this and keeping the records 
is all that is expected of you. To give you an idea of the speed with 
which the doctors and nurses worked, they gave the first test to 
394 children in two and one-half hours. It might save you a good 
deal of time and energy if you have one list according to age groups 
as well as one according to grades, as I did. A duplicate copy would 
not be amiss, one for yourself and one for the doctor to keep ; other- 
wise the doctor will borrow yours. 

The following statistical report is complete for the actual testing, 
but to date I have not the reports on chest examination or X-ray. 

34 



Eighty per cent, of school-children in rural and city schools were 
tested. 



Over 25. 




Age. 


0-6. 


6. 


7. 


8. 


9. 


10. 


11. 

1 


12. 


13. 


10 
5 


Total 

POS. 1 : - 


24 
1 

1 
4.1 


24 

2 
2 
8.2 


65 
1 
2 
3 

4.6 


51 
2 
4 
6 

11.7 


77 

1 

3 

4 
5.1 


57 

4 

3 

7 
12.2 


66 
3 
1 

4 
6 


57 

3 

7 
10 
17.7 


72 
8 


2 
7 


Pos. 2 

Tot. Pos - 


5 
13 


70% 


% Pos 


18 






Over 25. 




Age. 




14. 


15. 


16. 


17. 


18. 


19. 


20. 


Total. 


10 


Total 


79 
6 

3 
9 

11.2 j 
1 


51 

8 

4 
12 
23.5 


34 
2 
3 
5 

11.7 


28 

2 

3 

5 
17.9 


13 

2 

4 

6 
46.1 


14 
4 
2 
6 

43 


2 


724 


5 


Pos. 1 


52 


2 


Pos. 2 


48 


7 


Tot. Pos..... _ _. 


100 


70% 


% Pos 


13.8 



(1.) Total children tested of that age. 
(2.) Positive 1: Positive after one dose. 
(3.) Positive 2: Positive after two doses. 



Marion Miles. 



THE CHILD-GUIDANCE CLINIC. 

The first " child-guidance clinic " in Nanaimo was held in 
November, 1935. Suitable clinic-rooms were obtained from the 
United Church and consist of three separate medium-sized rooms 
which are upstairs in the Sunday-school hall. These rooms are quiet, 
well heated and lighted, and are ideal for such a clinic. It is neces- 
sary to have the three separate rooms because one room is used for 
the physical examinations, one for the psychometric tests, and the 
other room for Dr. Crease's consultations with the patient, parents, 
or relatives, as the case may be. 

The first task in connection with the clinic is to decide upon the 
patients, who may be referred to the clinic by the supervisor of the 
schools, Mr. Towell, or by the teachers, doctors, Public Health Nurses, 
or by the welfare-worker, Miss McCrae. The patient may be a young 
boy who does not mix well with the other children and who probably 
has some nervous habits, such as biting his nails, sucking his fingers, 
or stuttering; or perhaps another child has been stealing for no 
visible reason at all ; or the child may be a sexual pervert. These 
are a few examples of the cases which are referred to the clinic. 

After the patients have been decided upon for the clinic, either 
Miss McCrae or the Public Health Nurse takes a social history of 
the case. The social history is made up of the family's understand- 
ing of the clinic; the personal history, including the development, 
health, habits, school-work, and personality of the patient ; the family 
history, and an account of the home and home conditions. An 
explanation of the clinic is given to the patient and the parents are 

35 



asked to accompany the patient to the clinic. Besides this history, 
Mr. Towell has prepared a " personality rating test " to be used for 
these children. It is filled in by the child's teachers and attached to 
his social history. The personality rating test is made up in three 
main headings : First, attitude towards school-work ; second, dis- 
positional traits ; third, social traits. 

The clinic is held the first Wednesday of every month. Shortly 
before 9 o'clock on the specified day Dr. Crease, Psychiatrist; Miss 
Kilburn, Social Worker; and the nurse arrive and the clinic starts. 
The appointments have been made as follows; Two patients for 
9 o'clock, one for 10.30, and the remainder for 2 o'clock. Six patients 
make a very full day. Dr. Crease and Miss Kilburn read the social 
histories and meanwhile the nurse arranges the necessary equipment 
for the rooms and sets up physical-examination room. 

In the physical-examination room there is a large oak table, of 
which Dr. Crease is very proud. This table is most compact and 
was made in the Occupational Therapy Department of the Mental 
Hospital. It is used as an examining-table and in it there is sufficient 
room to store the writing material, pillows, sheets, instruments, etc. 
The nurse assists Dr. Crease when he examines the patient's eyes, 
ears, nose, throat, heart, lungs, takes the blood-pressure, performs 
the Babinski test; any laboratory tests or X-rays are done at the 
hospital later. The weights and measurements are recorded. During 
the physical examination Dr. Crease keenly observes the case for any 
abnormalities (such as speech difficulties) and nervous habits. He 
talks with the patient and makes him feel at ease, thus gaining his 
confidence. This examination takes approximately one-half hour. 
In a fairly large percentage of cases Dr. Crease finds abnormal 
physical conditions which may account for the patient's behaviour 
and problems. A case of hsemoplegia was found at one clinic which 
had existed for many years and explained the child's behaviour and 
the great difficulty under which he had been labouring. 

While the physical examination is being done Miss Kilburn is 
studying the history and is now ready for the patient, who is taken 
into the room where the psychometric or intelligence tests are given. 
During the administration of these tests Miss Kilburn observes the 
patient's behaviour and how he attacks problems. 

While Miss Kilburn is giving the psychometric tests Dr. Crease 
interviews the patient's parents separately and together. At the 
completion of the psychometric tests, which take approximately one- 
half hour, Dr. Crease then interviews the patient. 

Later Dr. Crease and Miss Kilburn review the history, the results 
of the medical examination and the psychometric tests. The problems 
which are found are discussed and a plan is formulated for the 
patient's future regarding medical treatment, school, social life, and 
living conditions. The parents are again consulted and the patient's 
condition is explained to them, also the type of treatment he should 
receive. The parents and patients are most co-operative and these 

36 



heart-to-heart talks with Dr. Crease do a great deal. They co-operate 
with him to the best of their ability, and in many cases where the 
child is being over-protected these talks with the parents have done 
much for the child. 

The clinic day comes to an end at 4.30 or 5 o'clock. Dr. Crease 
and his associates and the Public Health Nurses gather around the 
table and the findings are explained, the case discussed, and the 
treatment to be followed is outlined. The Public Health Nurses 
report on the progress of the former patients. 

Last but not least, the valuable co-operation of Miss McCrae, 
Mr. Towell, the teachers, parents, and doctors make it possible to 
have a clinic such as this, and we are hoping that by starting with 
the children in the preventive work in mental hygiene we will have 
a stronger race, both mentally and physically. 

Maxine Morris, 

Nanaimo, B.C. 



" EMANCIPATION OF CHILDREN'S PLAY-CLOTHES." 

Sweet-pea Festival, July 1st, 1936. To all residents of Duncan 
and the Cowichan District this means a showing of the finest sweet- 
pea blooms one can grow. In connection with this display a parade 
is held and what adult or child does not thrill to a parade. 

The Health Centre received an invitation to enter a float again 
this year. This request brought forth the question of : What can we 
put on that will emphasize a health project as well as being colourful? 
Finally it was decided to call the float, " Emancipation of children's 
play-clothes in the past 100 years." 

Having decided on the name of the float, it remained to collect 
the necessary material with which to work. 

First of all, we needed to have a truck promised, so the owner 
of a local garage was approached and he was only too pleased to 
offer the use of a suitable car. 

The next problem was : Could accurate information be obtained 
regarding children's dress of a hundred years ago? A letter was 
written to the Provincial Library telling of our project. In a few 
days we received a volume illustrating children's costumes since 1775. 

The necessary information being obtained, it remained to find 
children who would be suitable. The teacher of the junior school 
came to our assistance by selecting seven of her pupils, the children 
being overjoyed to participate. In fact, it required great tact and 
diplomacy on the part of the teacher to decide who should enter. 

A follow-up visit was then paid to the home to see if the parents 
were willing for the children to appear on the float, and it was a 
pleasure to discover that they were as keen as the little ones and all 
offered to make the costumes ; even the fathers offered to assist with 
decorating the truck. 

37 



The children will be dressed in the following costumes : Bathing- 
suit of 1835 made of heavy striped cotton, high at the neck and well 
below the knees, will be worn by one of the children who will be stand- 
ing beside Master 1936. This young man will feature a pair of 
swim-trunks and a good coat of tan. A second couple will be boys in 
play-suits. The boy of 100 years ago will wear long tight trousers, 
a frilly shirtwaist, bright jacket, and a bowler hat, showing a marked 
contrast to the play-suits of to-day. 1936 will be wearing shorts, a 
polo shirt, and sandals. A third group of three girls will feature, 
individually, one 1936 in a gingham sun-suit standing between the 
other two, who will be attired in the mode of 1835. This will consist 
of a high frilly-necked long-sleeved dress and long pantalettes topped 
by a large hat tied with ribbons. 

With this little band of children we hope to convey to the public 
how healthy and unrestricted the children's dress of to-day is as 
compared with that of 1835. 

Isabel McMillan, R.N. 



FERNIE'S PROGRESS. 

If change makes for progress, then in the last year we have 
surely progressed. We now work under a Commissionership, which 
eliminates School Boards, City Council, and all the rest of the usual 
city machinery. We also have a new School Inspector, a new princi- 
pal, several new staff members, and a new Medical Health Officer ; so 
there has been considerable readjusting to do. 

Fernie, as the world knows, is no longer a thriving mining centre, 
but we are still a centre of population, with all the usual problems to 
face. On the whole, we did fairly well in regard to health until 
influenza hit us this spring at the end of a month of sub-zero weather, 
which had sapped our vitality. The month of March ended with 10° 
below zero, but, in spite of depression, weather, and " King Flu," our 
children are in good form, with fewer underweights than in the years 
of plenty. Skin-diseases are very rare and, beyond a few cases of 
mumps and measles, we have enjoyed splendid health. 

I still have a vision of giving health service to all the small schools 
in the East Kootenay District, and it has been a joy to realize that 
Mr. Brown, our Public Schools Inspector, shares that vision. 

When the September term commences we shall have installed 
Junior Red Cross in our class-rooms, and I am looking forward to 
helping the teachers get things in running-order. We shall also have 
re-established our Home Economics and Manual Training Depart- 
ments by that time, so I really think we may proudly say that we have 
progressed in spite of obstacles, even, perhaps, because of them. 

Winifred E. Seymour, R.N., 
Provincial Public Health Nurse, Fernie, B.C. 

Ob 



"WHY NURSES GO GREY." 



Well, you certainly have a queer method of quarantining people. 
I don't see how you expect to keep it from spreading. . . . 

What! Peggy can go to school while Elenor has it? Well, that 
wasn't the way we used to treat it when I was in training (about 
twenty years ago) . We considered it just as contagious as anything 
else. You don't think a basin of lysol is necessary? Well, when I 
was nursing we used it — and we never had any cross-infection. . . . 

Well, I can tell you right how I don't see what earthly use the 
Health Department is — the way children are allowed to run around 
the streets spreading infection. What children? Well, I'm not say- 
ing. / don't want to make trouble. Why didn't I phone you when 
I saw them? Well, I'm not mean enough to tattle on my neighbours. 
You can't do anything about it now? Well, something ought to be 
done. I keep my children in — you know that. 

Yes, certainly. Anything you say, Nurse. Now Billy, mind 
what the nurse has said. You're to stay in for a week — even if you 
don't feel sick. No playing with the other boys. You see how care- 
fully she washes her hands before leaving? That's why she never 
gets these things. . . . 

And I said — well, there is something wrong somewhere when 
these people are allowed out so soon after. There they were — peeling 
all over — shedding large patches of skin every time they walked across 
the room. Did they have a doctor? Why, no; they weren't sick 
enough. How did they know i L was rubella? Well, my friend was a 
nurse once. Who were they? Well, now, I don't know that my friend 
would want the name given. The Health Officer wpuld be interested 
to see them? Well, no doubt; but I don't care to cause my friend 
any trouble. . . . 

I just called up to ask if I can let her out of the darkened room 
now. lean? But are you sure it's safe? Well, I want to be careful. 
And you said her sister could go to school. Well, I'm keeping her 
right in except when she's there — just to be on the safe side. We 
didn't let them out at all back on the Prairies. . . . 

Why should my son stay home? He's perfectly healthy even if 
he was playing with Frank yesterday. I'm sure he won't get it. 
Well, it's a pity that we can't even send our children to school 
when they're perfectly healthy. What do we pay our taxes for, 
anyway? . . . 

She said I had no business letting them out to play. And I said 
the nurse told me I could. They don't have to stay in for twelve 
days. That shut her up pretty quickly. . . . 

And she said she had never heard of anything so ridiculous. 
Keeping that child home. Why don't they keep the whole class home? 
She lives right next door and was playing with her that afternoon? 
Well, I'd hate to have my neighbours come down with anything. 
I suppose you'd quarantine us, then! . . . 

39 



Hello, is that the Health Department? Well, I just wanted to 
let you know that my neighbour's child is down at the beach — and her 
sister has rubella. What! She is allowed out until next week? Well, 
/ never heard of such a thing. . . . 

Well, I didn't phone you because we've had enough of the Health 
Department. They wouldn't let us sell any milk when the doctor 
thought Jackie had scarlet fever. Our milk is our bread and butter 
and it's too bad we can't be let alone. No, Vincent has never had it. 
What! He'll have to stay home? But he isn't getting along very 
well at school. It will just put him back some more if he has to miss 
a week. He never takes things, anyway. Well, it certainly seems 
a shame. I don't believe Jackie had it, anyway. . . . 

Well, you were right, Nurse. She came down with it on the 
exact day you said she might. It certainly is wonderful the way they 
do things nowadays. . . . 

And he said that if he wanted to make an issue of it they couldn't 
keep his child away from school. The Health Officer was crazy, 
anyway. He told him so to his face. . . . 

What! No placard? And the rest of us can go out until next 
week? Isn't that fine now! . . . 

And he has had to miss nearly two weeks of school — all for 
nothing. I told you he wouldn't get it. I build him up and keep 
him strong and healthy. He never gets these diseases the other chil- 
dren get. . . . 

Well, thank you very much, Nurse, I'm sure. It's nice to know 
that you are always there to look after the children. . . . 

Dear Teacher, — I am sorry Alfred had to stay home yesterday; 
he had a bad headache and felt dizzy. I am sending him this morning 
as he seems all right and he eats well, but I suppose if there are any 
germs floating around he would be in a condition to catch them. 
I think a great mistake is made in letting the children go back to 
school so soon after they have had these infectious diseases, and also 
letting other children in the family go to school while it is in the 
house. . . . 

M. R. Smith, 

Saanich. 



THE CHILLIWACK ROTARY DENTAL CLINIC. 

During the school-year of 1935-36 three new and important links 
were forged in the chain of Chilliwack's health and welfare pro- 
gramme. 

First, in November the Provincial Child-guidance Clinic was 
organized; later a permanent social-service worker was engaged, 
with headquarters in the City of Chilliwack, but who works in the 
surrounding area as well. Last, but not least, the formation and 
development of the Chilliwack Rotary Dental Clinic, with a constrtic- 

40 



tive educational and remedial programme which we hope will in time 
be purely preventive and educational. 

In the fall of 1935 the Chilliwack Rotarians, having decided upon 
a dental clinic as their service-work, organized this clinic. And a 
service it is in the true sense of the word, involving much effort and 
work, a great deal of planning, and needing a fine spirit of co-opera- 
tion in spite of handicaps. 

Previously the number of dental defects were appalling and 
remedial measures inadequate. True, some of the parents took care 
of these problems regularly, but the majority could not and did not 
take any action. It was very discouraging, month after month, to 
inspect these children and find, instead of improvements, a few more 
defects each time. 

A dental survey was made in both the city and municipality. Out 
of 1,536 children examined, 1,368 or 89 per cent, were found to have 
dental defects. The whole cost of the work needed was estimated 
at $7,480.25 on a reduced basis of from one-quarter to one-half of the 
normal cost. 

Due to the extent of the work required and with the object of 
giving dental care to as many pupils as possible, it was decided that 
the clinic would function for all public school-children at a reduced 
cost, and that those who could pay should do so, while an instalment 
scale should be worked out for those who could not pay in full ; those 
who could not pay after due investigation to be taken care of by the 
clinic. These are of course numerous. 

The Women's Institutes were asked to co-operate with the dental 
clinic and form committees for the purposes of investigating case? 
where there was any doubt about financial conditions and abili J 
to pay. 

The people who can pay in full or in part have the right to 
their own dentist, while for free cases the committee feels 
distribute the work equally amongst all the dentists. 

After the survey was made " consent-slips " were s<" 
the parents, stating the work needed and the estimated 
children took these slips home and were requested to brim 
signed by parent or guardian, with the necessary monr 
any explanations the parents wished to make. Thes, 
returned were handed to a certain member of the 
mittee, who with another member went over them a T 
findings at the next meeting of the Executive, where 
or arrangements made for investigating, etc. 

Tuesday and Thursday mornings are set a 
for clinic woi -c. 

Transportation for municipal s^ 1 
problem, which will require so r 
reopen in the fall. 

The clinic has been oper? 
its record is a, splendid o < 



«i 



cost of approximately $700. Largely due to the influence and activi- 
ties of the clinic, however, we know that about 100 other pupils have 
had their teeth attended to privately, which also fulfils our aim — care 
of dental defects in our school population. 

When the clinic was opened the sum of money which the Executive 
Committee had on hand was about $23. Splendid co-operation was 
received from Dr. Young, whose financial assistance of $350, as well 
as paying of the cost of the original survey done in November, formed 
the foundation upon which our Chilliwack Rotary Dental Clinic is 
built. 

The activities of the clinic will be carried on until about the middle 
of June, and what money remains after running expenses have been 
paid will be donated to other good work. 

The Executive Committee have several plans for an educational 
programme, beginning with the fall term. Posters, literature, and 
X-ray films of defective teeth and gums, etc., are to be shown in the 
Health and Baby Clinic rooms during the days of the annual fair. 
Later on, radio talks and lectures will be given by the various dentists 
to Women's Institutes and Parent-Teacher Associations. While, of 
course, continuous education will be carried on in the homes by the 
nurses. 

Our success depends on the educated individual and it is only 
through his or her co-operation and understanding of the work can 
the permanency of the Chilliwack Rotary Dental Clinic be assured. 

Claire Tait, P.H.N. 



" AN OPEN LETTER." 

RoiAL Oak P.O., 
Saanich, B.C . May, 1936. 

Vera, — You have often asked how I spend my days, so here 

The phone rings and I answer : " Hello. Yes, this is one 
speaking. You would like me to call at Mrs. Mortimer's, 
, give general care and report her condition to you later 
Doctor." 

rings frequently in the morning; often just as we are 

with a cod-liver-oil can in one hand and a bag in 

>ook tucked under one arm.) 

cum School in time to see several teachers before 

^s. Miss Rockwell, the Primary Grade teacher, 

,Q thing. A new pupil has arrived and 

: se well-ordered class-room. He 

'•awn to it the more pronounced 

very good; reading and oral 

decide that his mother might 



consent to an examination by a psychiatrist at the child-guidance 
clinic. This will mean a visit within a day or two to make 
arrangements. 

In Grade IV. the teacher reports the absence of a child who 
misses about a week every month with a cold or upset stomach. I have 
visited the mother time and again, making inquiries and offering sug- 
gestions. So far I cannot see that I've accomplished one thing. 

The principal hands me a note from a parent which reads : " Nora 
needs a new scribbler and art pencil. Would the school please provide 
them? " I know the circumstances of the family well enough to know 
that 15 cents in school supplies means a bottle of milk less at home. 
Nora will receive a book and pencil. 

For the next half -hour children come to my office to have cuts 
dressed; while others come for readmission certificates after being 
away from school. In the meantime a list is made of the absentees 
in each room, and fortunately it isn't such a formidable one to-day. 

I make a call on Mrs. Mortimer, who lives only a few blocks away 
from the school, and spend an hour carrying out the doctor's orders. 
The first visit is always the longest, because one never knows where 
to find towels, soap, basin, or clean linen! 

My next call is to a little girl named Patsy Jefferson, because a 
neighbour has reported that the child has brown, ring-like sores over 
her neck. Fortunately, Patsy is playing in the front of her home 
with Jimmy, whom I know. While I am talking to them, Mrs. Jeffer- 
son comes out and tells me all about her little girl while I try to 
sandwich in. I hope when I go back in two days that there will be 
an improvement. 

About 10.30 I telephone to the office to see if there are any calls. 
Sure enough; Mrs. Lehane would like to see a nurse. There is no 
address ; I am to get that from the postmaster ; and no reason given 
for the visit. The postmaster knows three families by that name; 
one wouldn't have anything to do with the Health Department, that 
eliminates them for the time being ; another is an elderly couple, half 
a mile north; the other is a family with four children. The latter 
is the right one. I cannot do anything when I arrive. A patient with 
a high temperature and abdominal pain needs a doctor. A message 
comes later saying Dr. Jones has sent Reynold to hospital. 

On the way home for dinner I drop in to see Mrs. Holiday. The 
dear old lady was held up two nights ago, gagged and bound to a chair. 
She has some bad bruises and cuts that we attend to. It cheers her 
up to have company. 

Referring to the absentee list again, I enjoy ticking the names 
off as I make the rounds. First this afternoon is a boy who had been 
away for three days with a cold. He is better, but is inspected and 
given a certificate to return to school. There are several other calls 
made for a similar reason. 

I am in difficulty, though, when one boy with chicken-pox sayp 
he has been playing with others the day before. These other bo; " ' 

43 



mothers cannot see why their children should be allowed to go to 
school for a while, then be kept at home for a given period. I am in 
disfavour up and down the street. 

Then there is Myrtle Ross, a stenographer, who has rubella. 
I nearly always ask these people where they think they might have 
been exposed to infection. It's very interesting to hear some of the 
tales. Myrtle thought she had contracted the infection from a girl 
with whom she works. I was a bit doubtful. During our conversa- 
tion she tells me about a party she had attended. Three of the boys 
had rubella the next day. One was her friend. She hadn't seen 
him for six months, so I don't expect she would stay ten feet away 
from him. It was eighteen days after this party that Myrtle had 
a rash. 

About 3.30 every Tuesday and Friday I give Mrs. Saunders a 
hypo. She always offers me a cup of tea. It's one of the things I look 
forward to these days. 

Mrs. Pearson is my last visit. She is a prenatal and expects to 
be confined at home. Just as likely as not she will have her baby 
to-night. Am I glad I'm not on duty? It won't be my night that 
is going to be disturbed. 

I am certainly tired so will end my letter right here. 

Yours, 

Dorothy Tate. 



HEALTH PURSUITS IN REVELSTOKE. 

Once again time to write an article for the Nurses' Bulletin. 
We say, " Time flies — alas ; ah, no, time stays, 'tis us who go." 

Last year, being a newcomer to the Public Health staff, my article 
was " First Impressions in Revelstoke " ; now, after fourteen months 
in the work, my thoughts turn to a review of the past year. 

A retrospective view, although somewhat disappointing, in that 
we have not seen the realization of all our dreams, is, nevertheless, 
necessary in our work and proves a stimulus to strive for greater 
results. 

Our thoughts turn back to our ambitious hopes, fresh enthusiasm, 
high ideals, our altruism, and we ask ourselves, " What have we accom- 
plished? Have I given my best? Has my work been worthy of the 
trust that has been placed in me by our beloved Chief, Dr. H. E. 
Young? " 

The following will be something of what we have tried to do in 
this little town on the threshold of our great Canadian Rockies : — 

Preschool Clinic. — This was started for the first time in Revel- 
stoke last June. We sent a written invitation to mothers with children 
. starting school in the fall. We explained the nature of the clinic, 
v, hich was to be held two afternoons in the week. The response was 

44 



marvellous, and we had a 100-per-cent. attendance. The clinic was 
held in a class-room in one of our public schools. The children were 
weighed and measured, examined for defects, and a friendly contact 
made with the child before he or she started to school. I gave a talk 
to the mothers, " Is your child ready for school," and later distributed 
a few hundred copies of health literature. The few defects we 
found were in each case corrected before the child came to school in 
September. 

School-ivork. — My work is mostly in the schools. We have a 
total enrolment of 650 in the public and high schools. During the 
past year there has been a very marked improvement in the health 
of our children and we are proud of our record. Last year our per- 
centage of underweights in the public schools was 39 per cent., as 
compared to 5 per cent, at the present, a decrease of 87 per cent. 
In the high school it was 18.5 per cent., as compared to 7 per cent, 
this year. I believe this is about the lowest percentage for under- 
weights in the schools of British Columbia. 

There may be several reasons for this marked decrease, but I 
believe the drinking of milk in the schools and cocoa at lunch-time 
(in the winter months) has to some considerable degree helped. 
Another reason may be that over 50 per cent, of our children take cod- 
liver oil during the winter months. There has also been a very fine 
co-operation from the parents in having physical defects corrected, 
because undoubtedly these defects were handicapping the health and 
progress of the child. 

Correction of Defects. — This has been my " pet hobby " for the 
past year and the results have been well worth while. In the three 
schools there has been a 67-per-cent. decrease in dental defects alone. 
At the present time the dental defects in the public schools is 17 per 
cent, and in the high school 13.5 per cent. The greatest gain, however, 
has been in the numbers of corrected eye-defects. Seventy children 
have received glasses or change of old lens in the past year. We have 
only two cases in our schools up to date with uncorrected eye-defects, 
and both these will be seen by the eye specialist this summer. Thirty- 
eight children had their tonsils removed, with several lined up for 
this summer. 

Perhaps we are more fortunate here than many communities, in 
that few of our families are on city or Provincial relief. We are a 
railroad town and medical care is provided for the C.P.R. families. 
However, we had about seventy-five children with physical defects 
whose parents were unable to pay for treatment. It was to assist 
these cases that we organized the Medical and Dental Fund. 

Medical and Dental Fund. — A committee was formed of five 
public-spirited and health-minded citizens. Meetings were held, 
articles published in the paper, and letters sent out to every organ- 
ization in town soliciting their interest and co-operation. I was 
asked to give talks explaining this project to some of the organiza- 
tions. Donations came in and very soon we had $125 in the treasury. 

45 



Thus our Medical and Dental Fund was launched. A month later we 
raffled a cedar chest made by a boy in the relief camp and this brought 
us in another $125. The children sold the tickets and we gave prizes 
to the two boys and two girls selling the most tickets. How they 
worked! The whole town and even the surrounding territory was 
canvassed and 625 tickets were sold. . With $250 in the treasury we 
were able to send sixty children for dental work and purchased glasses 
for three children suffering from defective vision. We plan to hold 
a Tag Day early in June to raise money for this fund. 

Vaccination Drive. — In checking over the number of pupils vac- 
cinated in our schools early in April, I was surprised to find only about 
10 per cent, vaccinated in the public schools and 41 per cent, in the 
high school. This seemed to me to be a serious state of affairs, so I 
decided to talk " vaccination." 

First a talk on vaccination and smallpox was given in each grade 
and the seriousness of smallpox was impressed upon the children. 
Then a letter was drawn up, mimeographed, and about 500 were sent 
into the homes. An article was also published in the weekly paper 
and some follow-up work done by home-visiting. The response was 
marvellous and in the Easter holidays 385 children were vaccinated, 
and this total does not include the pre-school children who were done. 
Now our percentage of vaccinated children is 92 per cent, in one school 
and 85 per cent, in the other, with several promising to be done in 
the summer holidays. This is, I think, a practical demonstration of 
what can be accomplished as a result of a little educational work. 

We hope now to start on a " toxoid-campaign " and it will be 
extremely gratifying if this goes over as well. 

And so we have taken stock and feel our balance-sheet does show 
some favourable gains. Ours is not a material gain and we know 
that the human asset exceeds in value by five times the amount of the 
value of material assets in our country. 

The most valuable for?n of wealth is not money but human life. 
Its conservation should be our greatest objective and our first concern. 
It has been said that the " wealth of the nation lies in the health of the 
children," and as Public Health Nurses it is our privilege to be " cru- 
saders " in this great public-health movement. 

Agnes Thom, R.N. 

Revelstoke, B.C. 



KEREMEOS AND DISTRICT. 

Having spent the greater part of my nursing-life in institutions 
and three years in army routine, I find that I cannot work to accom- 
plish anything without a definite plan. I therefore have a definite 
schedule which I follow all week, leaving margins each day for 
emergencies. In the course of my work I attend all minor cases 

46 



for those on relief, but send all others to a physician. Briefly, the 
schedule is this: — 

Monday. — Keremeos School and all things that come up in con- 
nection therewith. 

Tuesday. — Pre-school and prenatal work. 

Wednesday. — Cawston School in the morning and Hedley Indian 
School in the afternoon. 

Thursday. — Odd jobs and Chopaka Indian Reserve every other 
week. 

Friday. — Keremeos School and doctor's consultations at my 
house.. 

Saturday. — School-visits in the morning; off in the afternoon, 
except for emergencies. 

The district is scattered, but I carry on the usual educational 
programme as opportunity and time permits. 

(Mrs.) B. Thomson. 



" PROGRESS." 

Progress may suggest that we are travelling somewhere on a 
highway or advancing towards better conditions. Are we, in public- 
health work, just going on through space towards our objectives or 
are we keeping carefully to the highway leading to the goal ? Some- 
times I feel that I am in space or on a detour of difficulties, but have 
never felt that I have altogether stalled on the way. There have been 
upgrades too, but even then progress has been maintained, though 
extra effort has been needed to get over the top. 

Our ideal in public-health work, that of producing a health- 
conscious community of people all working towards the prevention 
of disease, may be said to be our goal, and what are we as nurses 
doing to bring about this happy condition? We are just one link in 
the chain, but are we doing our best to keep that link as strong as 
the rest? 

Progress in some cases is measured by advancement in miles 
covered in a given time. Schools have a progress record for each 
student as success in examinations is achieved, but attainments in 
public-health work can hardly be measured in either of these ways. 
If the incidence of infectious diseases may be used as a measurement, 
we in Penticton may have reason to consider we have advanced, for 
the attendance at school has been continuously good throughout the 
year. I think that the school attendance may be taken as a good 
index to the incidence of disease in the community. I find, too, that 
parents are becoming more and more co-operative in isolating infec- 
tious cases and feel that the success in controlling communicable dis- 
eases is largely due to this co-operation. People are becoming more 
health-conscious not only in the home, but towards the whole com- 

47 



munity. Thus our health-teaching in the school and home may be 
showing results. 

Through the co-operation of each of the doctors, several clinics 
were held for immunization against diphtheria. Some 325 children 
received the treatment and it is gratifying to know that many of the 
large families have received this protection. 

Neighbouring communities have been asking about having the 
services of a nurse and we are hoping to be able to extend the service 
to them in the not-too-distant future. I feel our demonstration 
here has been satisfactory and the effort is being appreciated when 
people wish the service extended. 

Yes, we have progressed. How much? 

M. A. Twiddy, R.N., 
Public Health Nurse, Penticton, B.C. 



" MIGHTY OAKS FROM LITTLE ACORNS GROW." 

Partly from a misunderstanding, the idea for a Civic Health 
Week was created ; and partly through a printer's error, Health Week 
became an " annual " event. 

Such is Fate; and surely a kindly Fate sat as chairman of the 
Nanaimo Civic Health Week Committee, for from the time that the 
idea was created in the first week of September until its success- 
ful culmination on the eighth of November, plans and programmes 
seemed to form themselves and to progress magically to fulfilment. 
It must have been Fate that made it possible to hold the first Child- 
guidance clinic in Nanaimo during Health Week; it must have been 
Fate that arranged for the Provincial Chest Clinic to be held that 
week; Fate again must have been responsible for the arrangements 
which brought Dr. Harry Cassidy to Nanaimo then. However, the 
fact that Fate had a very active and enthusiastic committee, and that 
the public are always keenly interested in anything pertaining to 
health, were in no small measure responsible for the success of 
Nanaimo's First Annual Health Week. 

One week before the Health Week the city was peppered with 
little yellow stickers, which demanded of the people in general, " Are 
you A 1 ? " and announcing that November 1st to November 8th was 
to be a Civic Health Week. (This idea was very good indeed, but 
unfortunately the glue was on the wrong side and by the following 
morning the rain had washed most of them off.) 

On the same day the Art Department of the High School Centre 
issued forty large yellow health posters, which were placed prom- 
inently in forty store windows on Commercial Street, along with a 
special health display and a " slogan." These slogans created a great 
deal of interest, as each slogan related the goods displayed in the 
window to health. For instance, a beauty " shoppe " featured sham- 

48 



poos, and had as its slogan, " Head First — to Health." A hardware 
store exhibiting enamel pots and pans which were filled with fresh 
vegetables had as a slogan, "Health in a Pot." A jeweller's store 
featuring alarm-clocks had the well-known adage, " Early to Bed and 
Early to Rise, etc." While one enterprising bank had selected the 
slogan, " It Takes Health to Earn Wealth." A battery and auto 
supply shop used the following : " To Check Your Battery See Us — To 
Check Your Health See Your Doctor." 

From November 1st to November 8th the days were filled with 
health events and Health Week became the " talk of the town." 

" Man Against Microbe," a movie made available through the 
Metropolitan Life Insurance Company, was shown, along with the 
regular feature at the Capitol Theatre on November 1st and Novem- 
ber 2nd. A Vaccination Clinic was held on Monday, November 4th, 




Demonstration for Health Week at Nanaimo. 



and Dr. Drysdale, M.H.O., vaccinated all children who wished to be 
done and who had the consent of their parents. The evening of the 
same day Dr. Harry Cassidy addressed a meeting of the Parent- 
Teacher Association on " Health Insurance." On Tuesday the regular 
weekly Baby and Pre-school Clinic was held in the clinic rooms at the 
Legion Hall. On Wednesday Dr. Crease held the first Child-guidance 
Clinic and on Thursday Dr. Kincaid conducted the Provincial Chest 
Clinic at the hospital. 

Throughout the week special articles on health topics appeared 
daily in the two local newspapers. The first article came out simul- 
taneously with the release of the little yellow stickers and was con- 
tributed by Mr. A. S. Towell, Supervisor of Nanaimo Schools, who 

49 



explained the great existing need for health education and the objec- 
tives of the forthcoming Health Week. The second, contributed by 
Mrs. T. A. Barnard, President of the Provincial Parent-Teachers' 
Association, gave the hearty support of that body to " the group of 
public-spirited citizens sponsoring Civic Health Week." Other press 
contributions were : " The Place of the St. John Ambulance Associa- 
tion in Health-work " ; " Public Health and Engineering," by the City 
Engineer, Mr. A. G. Graham ; " Mine-rescue Work," by Mr. Geo. 
O'Brien, Mine Inspector ; " Laboratory and Its- Contribution to the 
City," by Mr. G. Darling; " Books on Health," by Dr. Helen Stewart; 
" Immunization," by Dr. W. F. Drysdale; " Dealing in Futures," con- 
tributed by Dr. Amyot. 

Besides these, there were of course many news items regarding 
the activities in progress each day; also two or three editorials, and 
one full-page advertisement, from which blazed forth the announce- 
ment that this was to be Nanaimo's " First Annual Health Week." 

By the Friday of Health Week Nanaimo's citizens had become 
literally saturated with health information and had become thoroughly 
" health-minded," so that it was not surprising to find that on Friday 
afternoon the streets were filled with men, women, and children bound 
for the Pygmy Pavilion, where the final demonstration was to be held. 

It would require a large volume to describe minutely the various 
exhibits and programmes of the afternoon and evening, but the fol- 
lowing remarks overheard as the spectators viewed the exhibits are 
indeed enlightening: — 

" My teeth are awfully soft; the dentist says it isn't much use 
filling them any more; and do you mean to say that if all my life 
I had eaten those vegetables, and drunk that much milk — and taken 
cod-liver oil — and if my mother had done the same before I was born 
that I'd have had good teeth to-day? Well ! Well ! " 

" Oh, isn't it just the sweetest thing, the little bed, and the little 
bath ; and look at the little baby clothes all laid out to warm — baby 
clothes are so simple nowadays, aren't they? " 

" Bugs ! Bugs ! Are those little mites down in the microscope 
really the germs that cause a person to have T.B.? " 

" So that's how they give a patient a bath in bed — well, I guess 
it's all in knowing how to go about it. You know if I had only known 
how to do that when our Mary was down with the fever. . . ." 

" Yes, I have read of pulmotors ; they use them to resuscitate 
the drowned . . . and in cases of suffocation, you say. Well, it is 
good to know that there is one in town." 

" All these fancy fixings are good for nought ; give them a plateful 
of plain ordinary food and a sweet — but still, if I fussed and fixed 
a little for our Martie, maybe she'd take to her food better. . . . 
Why! that's just tapioca pudding, but it looks so tempting the way 
it's prepared." 

50 



At the far end of the hall the wall was brilliant with about 400 
health posters, made by the pupils of Grades IV., V., and VI. ; prizes 
for the best of these were donated by the Malaspina Chapter, I.O.D.E. 
These of course were a source of great interest to proud parents and 
eager children. 

The remaining side of the building, which measured about 60 feet, 
was devoted to the book exhibit, beautiful new volumes donated for 
exhibition purposes by Dr. Helen Stewart. It was a colourful dis- 
play — brightly coloured health posters in the background, with a 
central poster which stood 6 feet high. This depicted the " Tree 
of Knowledge," and from each branch, representing a different branch 
of medical science, an orange streamer led to a small table on which 
books related to that subject were listed and displayed. 




Demonstration for Health Week at Nanaimo. 



The programme itself was unusual, in that it took the form of a 
drama in black and white. Two very, very ideal children dramatized 
the health habits performed during a very, very ideal day. The hit 
of the evening occurred when the very, very ideal boy choked and 
sputtered when he cleaned his teeth, and then wiped his mouth on 
the sleeve of his shirt. This play was followed by an exhibition of 
folk-dancing by a class of high-school girls, and an exhibition of tum- 
bling, physical exercises, and pyramiding by the high-school boys. 

In addition to this, the audience was very much interested in a 
demonstration of mine-rescue work given by the Inspector of Mines 
and the man in charge of the Dominion mine-rescue station here. 

It is marvellous that such an extensive health educational demon- 
stration, the success of which depended on the splendid co-operation 

51 



of at least fifteen local organizations, forty or fifty local merchants, 
two newspapers, the University of British Columbia, and of course 
the Provincial Department of Health, should have evolved from the 
simple idea to have a small display of health literature and books. 

Muriel Upshall, 

Nanaimo, B.C. 



SAYWARD. 



Mrs. Walls reports very little change in Sayward, except for a 
few cases of chicken-pox and influenza. The district is a healthy 
one apparently, because the school attendance is good, even though 
financial conditions are as poor there as elsewhere. 

The dentist made a visit during the summer, when quite a lot 
of dental work was accomplished, which is gratifying. 



ESQUIMALT RURAL NURSING SERVICE. 

In a rural area, unlike that of a city district, the more pressing 
needs of the family as a unit must be met. Bedside-nursing has not 
been the primary consideration, nor too much emphasis is placed 
upon school when it has been desirable to get into the homes. 

The nurse has carefully considered her words for the sake of her 
organization, the public, and herself. In addition, attention has been 
paid to the keeping of case records, family folders, and a suitable 
filing system. With regard to the statistical monthly report, progress 
may be shown by comparing the previous month and the same month 
of the preceding year. With the statistical yearly report there may 
be appraisal and evaluation. A periodic report often provides stimu- 
lation and interest. Through such statistical material it may be 
possible to get community or legislative action to remedy condi- 
tions — as, for example, our most recent contribution to State Health 
Insurance. 

Group conferences have been undertaken with trained and com- 
petent speakers sponsored through the Parent-Teacher Associations 
and Women's Institutes for the public. We welcome all such confer- 
ences for nurses with doctors sponsored through the Provincial Board 
of Health. Already much interest has been shown by the staff of the 
Jubilee Hospital somewhat in the nature of " follow-in " as well as 
" follow-out " work. 

In the schools an attempt has been made to stress the avoidance 
of fatigue and overstrain in the adolescent, to induce healthy living 
in the school generally by co-ordinating health with economics in 
preparation of school lunches, and to increase the attendance by allow- 
ing a child to attend school during the incubation of a disease. 

52 






A pre-school programme has been attempted during the summer, 
mainly to detect and correct defects and to immunize the child against 
specific diseases before he enters school. The pre-school years of 
life being the most precarious, it would thus seem that a " summer 
round-up " is urgently needed. In our infant-welfare programme we 
stress the desirability of breast-feeding, and where artificial feeding 
must be resorted to we advise raising the standard of milk by pas- 
teurization and special care in handling same. We also urge the early 
registration of all prenatals. 




Sand-pile at Happy Valley School. 

The effect of the depression has been particularly noticeable in 
our district. The majority of our people are on relief and the effect 
of undernourishment on mentality and teeth entrenches the Public 
Health Nurse. 

Facilities for travelling cannot be met in this scattered district 
without the co-operation of the nurse ; transportation must therefore 
be considered. Victoria being 8 miles away, and there being no doctor 
closer than that, our educational programme must often be suspended. 

By meeting the people and attending their committee meetings, 
by assisting in their discussions, helping to advise them in some of 
their local problems, the nurse must surely benefit, and by concerted 
effort the aims of our service will be fulfilled. 

Dora W. Wilkie, R.N. 



" THE DISTRICT NURSE'S ' SOFT JOB.' » 

It has been said that the District Nurse has a " soft job " running 
around in her brand-new car. While the work is extremely inter- 
esting, I am going to try to show that it is no " soft job." 

53 



In this western district of the Peace River Health Unit the nearest 
hospital and doctor are 25 miles away from the nurse's headquarters. 
Roads are poorly built and travel by car is difficult at all times. 
In summer we have to contend with mud and in winter with snow 
and ice. Sometimes the distances which need to be travelled are 
very far and the hours of duty very long. 

Any one who has been in this country in the winter knows what 
it is to drive a car in snow which is 2 or 3 feet deep on the level. 
Chinook winds can alter the snow-covered roads into lakes of water 
and later into veritable glaciers. It is in such times that we seemingly 
get emergency calls. 

It was on such a morning that I planned on taking a day off. 
No sooner had I begun planning what I was going to do at home when 
there came a rap at the door and a messenger came with, " Nurse, 

there is a call from Valley ; a boy is very sick and they want 

you over there right away." 

You start up the faithful car and travel 11 miles over snow and 
ice. Guarded by a " lucky star," you arrive there safely. You find 
" Tommy " with a rapid pulse, a high temperature, and a very sore 
and tender right side. The mother is alone with her four children, 
the father being away to " town," some 40 miles distant. Between 
the mother and myself we decide that the sooner we can get " Tommy " 
to a doctor the better. We leave the other children, the eldest of 
which is 12 and the youngest 6, in charge of the place to make out 
as best they can and also to milk and feed the cow until the parents 
return. We phone the father and tell him we are coming. 

We start out about noon and manage to make fair headway for 
about 15 miles, when all at once the car refuses to go up a small hill. 
We leave " Tommy " in the car and get out to find we have a flat tire. 
" Tommy's " mother is rather adept with tools, and between us we 
take off the offending wheel and put on another. Everything is once 
more in order and we start off again. After zig-zagging through the 
snow for the next 20 miles, we arrived at the hospital at 4 p.m., where 
the anxious father is waiting. The doctor diagnoses appendicitis and 
decides to operate immediately. 

The parents remain in the hospital, and after lunch I start back 
on my lonely trip to headquarters. I arrive home some three hours 
later and plan on having a day off some other time. 

A month later, at 4 a.m., the whole house is disturbed with rapping 
and loud talking, and I leap out of bed and run downstairs to answer 
the call. By this time the head of the house has admitted three young 
men, the youngest of which is the " patient." 

" Sammy " has had an awful attack of appendicitis and should 
be taken to the hospital right away. " Sammy " does not appear to 
be ill and seems to be enjoying his " appendicitis." I ask him to 
undress and put him to bed. I take his temperature and pulse and 
find both normal. I press on his side and abdomen, and although he 
says it hurts, the expression on his face seems to belie his statement. 

54 



I decide not to take any chances, so prepare to take " Sammy " to 
a doctor as soon as dawn appears. We have our breakfast at 7 and 
" Sammy " is much displeased because I thought it best for him not 
to eat. We start off at 9, and after having some difficulty with the 
snow we arrive at a post-office and little store which is about half-way 
to " town " and hospital. Here the father is waiting with a girl who 
has been very sick; she, too, apparently has " appendicitis." I take 
her in my car, too, and the father rides behind in the rumble-seat. 
We arrive at the doctor's office about noon. 

The doctor examines the girl and finds acute appendicitis and 
sends her up to the hospital for immediate operation. 

He puts " Sammy " on the table and examines him. He finds 
there is " not a thing wrong with him." " Sammy " is rather dis- 
appointed and still declares that he was sick and says he is very 
hungry. 

We leave the doctor's office and go to a cafe for lunch before we 
start for home. The aroma of the eats in the cafe causes " Sammy " 
to forget his appendicitis and he eats a full meal of hamburger steak 
and " all trimmings." On the way home " Sammy " confesses that he 
was at a birthday party the day before and had " eaten too much 
birthday cake, got a bellyache, and vomited." 

In a district like this, where the doctor is so far away, the nurse 
comes in contact with many interesting and difficult cases. During 
threshing season there will be those who get their hands and fingers 
cut in the threshing-machine; during hunting season they still 
make mistakes and get shot ; children will get burned and scalded in 
the most unusual ways ; expectant mothers will doggedly stay at home 
and refuse to go to a hospital and the nurse is expected to race the 
" stork " to the home. 

This kind of work, besides the regular routine of school-work, 
prenatal and child-welfare work, makes the nurse's work very inter- 
esting, but far from a " soft job." 

Pauline Yaholnitsky, R.N., 

Progress, B.C. 



55 



We have the pleasure of publishing a full account of what can 
be done under a full-time Health Unit. The Peace River District was 
opened as a Health Unit with a full staff under Dr. J. S. Cull, D.P.H., 
and a staff of six nurses. During the summer two dentists examined 
and treated every child in the district. The account is a full review 
of an organized Health Unit, beginning as a complete Unit, and 
contains information for the public that will give them a resume of 
how organization, followed by administration through the agency of 
a trained staff, can produce results. 

Provincial Board of Health. 



HEALTH SERVICES UNDER THE LARGER UNIT 
OF ADMINISTRATION. 

By Dr. J. S. Cull, Director, Peace River Health Unit. 

To obtain the proper perspective of the health services of the 
Peace River Health Unit in this Larger Unit of Administration and 
to appreciate the benefits accruing therefrom, it is advisable, I think, 
to give a brief resume of conditions as they existed previous to 1934-35. 

At that time there were two part-time Medical Health Officers 
acting as School Health Inspectors, one north of the Peace River and 
the other south. These physicians visited the schools once a year 
and examined the pupils, sometimes rather hurriedly, and in the great 
majority of cases without the parents being invited to be present for 
the examinations of their children. Where defects were found notes 
were sent home to the parents, but little or no follow-up work was 
done to stress the importance of early remedial treatment. As a 
result, really very little actual medical service was brought to the 
child except where the conditions found were particularly pressing. 
Dental attention for the school-child was a thing almost unknown 
until the summer of 1934, when a service of this nature was rendered 
to certain sections of the district. The reports of the School Health 
Inspectors regarding the school buildings, equipment, environs, sani- 
tary arrangements, etc., were forwarded to the various School Boards, 
but owing to the lack of co-operation from these the improvements 
that were made, based on the Inspector's recommendations, were 
few and far between. 

The weakness of the system lay in two directions: First, in the 
traditional lack of co-operation from rural School Boards ; and, 
secondly, in the employment of part-time School Health Inspectors. 
The first has been most successfully remedied by the consolidation 
scheme under the Official Trusteeship of Dr. Wm. Plenderleith, while 
the second has been corrected by the installation of the Health Unit. 
It might be interesting to state briefly why the old system of health 
supervision has fallen down — because there has been no one continu- 
ously on the job to carry out those measures which are necessary 

56 



to prevent illness and death, those in charge have often not received 
the necessary training and they do not have the time to devote to 
public health with their other duties. It is constantly found that 
the Health Officer who is paid very little for his services is necessarily 
obliged to devote his time to the practice of his profession in order 
to make a living. He consequently pays little attention to public 
health. It does not pay him to do so. If he were a full-time Health 
Officer his entire time and energy would be devoted to the prevention 
of disease in his community. It is not the part-time Health Officer 
who is at fault, but the now-antiquated system. 

After the consolidation scheme had been in effect in this district 
for one school-year, a considerable sum of money had been saved in 
the operation of the schools and was set aside for health purposes. 
This, together with a grant from the Rockefeller Foundation and the 
Provincial Board of Health, was instrumental in bringing into being 
the present full-time Health Unit. If the above saving had not been 
made by the consolidation of school districts, it is doubtful if the 
school and pre-school children here would ever have enjoyed the 
health services which are at the present time being presented to them. 

The actual organization of the Health Unit took place during 
the summer of 1935 and the staff started work on September 1st, 1935. 
The personnel of the Unit consists of a full-time Director, who is 
Health Officer and School Medical Inspector for the Peace River 
District; four full-time Public Health Nurses who carry out a gen- 
eralized public-health nursing programme, including school-nursing. 
No routine bedside-nursing is carried on by the Health Unit staff. 
In addition to the above, there are three part-time co-operating nurses, 
located in the more isolated parts of the district, who take charge of 
the school-nursing in these areas. The full-time personnel co-operate 
with these other nurses in an attempt to give as full a nursing service 
as possible to the people and children of these more distant parts. 
The population served is estimated as 9,000, with 1,400 school-children 
and approximately 1,000 pre-school children. 

All full-time members of the staff have Unit cars for summer 
travel and arrangements are made for the use of teams and drivers 
for winter travel. 

These members have all received training in public health, as 
has also one of the co-operating nurses. 

To the best of my knowledge, this is the only Health Unit in 
Canada operating under the dual head of the Departments of Educa- 
tion and Health. This is, without doubt, the ideal system, for, after 
all, health and education are really inseparable — each being necessary 
to complete the other. 

The actual work of the Unit began under most auspicious cir- 
cumstances. Two full-time dentists were appointed for two months 
and almost the full time of the staff was taken up during September 
and October with the organization and operation of dental clinics. 
This service was free to school and pre-school children and did not 

57 



apply only to those school districts under consolidation, for arrange- 
ments were made with the other School Boards and eventually all the 
children of the Peace River District were given the opportunity of 
having complete and thorough dental treatment by a competent dentist. 
Nothing of this nature applying to the whole district had ever occurred 
before, and you may well imagine the benefits resulting therefrom. 
The continued neglect of dental attention in this part of the Province 
had caused the loss of many six-year permanent molars and a very 
serious condition of abscesses from badly decayed temporary teeth. 
The neglect and loss of the six-year molars we found in a large degree 
to be due to the ignorance of the parents to recognize these to be 
permanent teeth. Many deciduous teeth had been extracted from 
three to five years before they were replaced by permanent ones, 
causing lack of development in the jaw-bones, and resulting in irregu- 
larity of the permanent teeth and, in some cases, facial distortion. 

In former years absence from school because of .toothache was 
quite common, but this year many of the teachers have been remarking 
with enthusiasm on the improved attendance. 

Below is listed a general summary of the work that was done 
during the two months that the dental clinics were held. These 
clinics are to be an annual event and they alone will ensure a marked 
improvement in the general health of the children. 





Number 

of 
Patients 
treated. 


Fillings. 


Extrac- 
tions. 


Prophy- 
lactic 




Amalgam. 


Cement. 


Porcelain. 


Treat- 
ments. 


South of the Peace River 


659 
346 


749 
633 


136 
61 


in 

15 


834 
289 

1,123 


476 


North of the Peace River .. 


338 






Totals 


1,005 


1,382 


197 


128 


814 







Number transported by Unit personnel, 250 ; males treated, 522 ; 
females treated, 483. 

The District Nurse makes periodic visits to her schools and 
examines the children, weighs and measures them, and always is alert 
for the presence of communicable disease. If a child is found to need 
medical attention, the Health Inspector is acquainted with the fact 
either at once or at the time of the regular medical examinations. 
If the parents are on relief and they are not in a financial condition 
to pay for the treatment considered necessary, use can be made of 
a fund which has been set aside under the consolidation scheme to 
assist cases of this kind; the parents in these cases usually paying 
50 per cent, of the cost of the treatment. The 50 per cent, of the 
cost may be given in wood, ice, janitor-work, or other school services 
that may be required. 

It is expected that arrangements will be completed this summer 
whereby those children suffering from diseased tonsils and adenoids 
will be able to have surgical attention. 

58 



Where glasses are urgently needed for the preservation of the 
pupil's eyesight and the parents are unable to pay, the Consolidated 
Fund is again made use of. 

Preventive treatment, such as vaccination, inoculation against 
diphtheria and scarlet fever, iodine tablets or tincture, etc., are avail- 
able for all school-children desiring them. 

■ I would like to quote from the article on " Health " by Miss 
Dorothy Johnson (B.C. Teacher, April, 1936) : " Health-teaching 
should be directed at the parent; medical examinations are often 
hasty and recommendations are not followed up." I quite agree with 
her, but would like to say that these criticisms do not apply in this 
district and should not where any full-time Health Unit is established. 
We make a particular point of inviting the parents to be present at 
the time when their children are examined, as this makes an excellent 
occasion on which to discuss and talk over many health matters, and 
to advise the parent directly in regard to the care of his or her child. 

A considerable length of time is spent on the examination of 
each child and we feel that we get better results in this way than by 
just making a hasty examination. It is one of the duties of the 
District Nurse to follow up any recommendations that are made at 
this time and to strive continually to show the value of these. I quite 
agree that much of the value of the medical examination would be 
lost if this work were not done. 

Below are listed some of the figures taken from the Statistical 
Report ended December, 1935 : — 

Visits to schools 340 

Physical examinations 514 

Average per cent, of parents present 63 

Children inspected by nurses 2,722 

Notes to parents 66 

Home-school visits 203 

Quick inspections for contagion 763 

Exclusions 57 

Examined at office , 62 

Class-room talks 123 

Consultations with school officials 248 

This brings me to the school building itself. In this connection 
I may say that the buildings in this area are inspected from a health 
standpoint. Where poor or improper lighting is found, or different- 
sized desks are required, poor ventilation, or poor heating exists, 
a report is forwarded to the office of the Official Trustee stating the 
facts of the case. 

Under the old system one could have sent reports indefinitely 
to the School Boards and little or no action would have resulted. 
But now things are different, and in this Larger Unit of Administra- 
tion " action " is the word of the day. When a report is forwarded 
the defect or condition is remedied in very short order. 

59 



As a result of this the supply of drinking-water, toilet facilities, 
cloak-room facilities, lighting, heating, and ventilation have all been 
markedly improved. In the majority of schools in this district the 
desks are fixed to strips rather than to the floor. Thus they can 
all be moved over to one side of the room, and this tends to overcome 
the criticism of lack of space during a physical-education period. 

When one realizes that all these changes and improvements and 
increased health services have come about as a result of the adoption 
of the Larger Unit of Administration, one cannot be other than in 
favour of such a system. Little or nothing of this nature existed 
before, and I doubt if anything of a similar nature could be brought 
about in rural districts without the adoption of a similar consolida- 
tion scheme. It is a pleasure to work under such a system, and as 
the months go by and we see the improvement being wrought in the 
health of the children, I feel that the Department of Education is 
to be complimented for the introduction of such a plan, and I trust 
that the benefits of the larger-unit system will be extended to other 
rural districts. 

Some general statistics follow. These are from the Statistical 
Report ended December 31st, 1935, after four months of operation: — 

Hours on duty 3,474 

Average daily hours on duty 8 

Miles travelled — 

Car 11,000 

Team 675 

Horseback 202 

Boat 280 

Walked 158 

Visitors to office 236 

Phone calls received 99 

Phone calls sent 74 

Letters received 226 

Letters sent 229 

Investigations for contagion 41 

Home-visits re contagion _•_ 32 

Home-visits to T.B. suspects 9 

Prenatal visits 66 

Infant-welfare visits 146 

Infants examined 20 

Pre-school visits 120 

Pre-school examinations 35 

Number transported, other than for dental 

clinics 37 

Nuisance complaints investigated 10 

Water samples taken 3 

Inspections of water-supply 12 

Miscellaneous visits 354 

Investigations made 19 

60 



Social-welfare visits 59 

First aid given 22 

Meetings attended 32 

Meetings addressed 23 

Individual health talks 333 

Pieces of public-health literature distributed 261 



VICTORIA, B.C. : 
Printed by Charles F. Banfiei.d, Printer to the King's Most Excellent Majesty. 

1036. 









500-636-9125 



61 




tLASSN._ 

■UES,. rrr^t- No».< 

THE .LIBRARY 
JFfie University of Columbia 



ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 2 



MARCH, 1937. 



No. 4 




Parliament Buildings, Victoria, B.C. 



EDITORIAL. 



Looking through the accompanying pages, one is struck by the 
improvement in type and style of articles submitted in comparison 
with those sent in for previous bulletins ; perhaps the fact that we 
are all one year older, and consequently that much more familiar with 
local problems, is responsible. Whatever it is, here we are again 
showing definite progress all along the way. 

One could wish for more photographs to brighten up the tedium 
of the printed page, and we hereby make the humble suggestion that 
next year's articles be relieved by some interesting illustrations which 
could be provided for by keeping the Bulletin in mind when an 
unusual or unique circumstance arises during the year. Are we not 
all children still when it comes to looking through a magazine — first 
at the pictures and then at the articles? 

B. J. 







The world has no such flower in any land, 
And no such pearl in any gulf or sea, 
As any babe on any mother's knee. 

— Swinburne. 



TABLE OF CONTENTS. 

Page. 

Allen, Miss E. G. — The Neglected Age 5 

Arnould, Miss J. M. — Matsqui-Sumas-Abbotsford Demonstration Area 5 

B arbaree, Miss F. — Ski-ing 8 

Campbell, M. A. — Public Health 9 

Crafter, Miss L. W. V. — Victorian Order of Nurses 10 

Creelman, Miss L. — Revelstoke Reflections ^ 11 

Dunn, Miss N. E. — Consolidation of Schools 14 

Garrood, Miss 0. M. — Public Health Nurses and Education 17 

Gordon, Miss K. M. — An Impossibility becomes a Success 18 

Grierson, Miss M. E. — Maple Ridge and Mission Districts 20 

Grindon, Mrs. A. F. — The Value of an Annual School Health Cup Competition 21 

Jenkins, Miss B. — An Objective 24 

Kerr, Miss M. E. — Curious Superstitions and Beliefs 27 

Kilpatrick, Miss H. — What do you really do? ._. 29 

Law, Miss A. F. — Just One Call 31 

Mahon, Miss R. M. — Problems of Disease-prevention 32 

Malkin, Miss L. — Justification for the Appointment of a Social Worker to 
complete the Health and Education Programme in the Peace River 

District, B.C 34 

Martin, Mrs. E. — Vernon 36 

Miles, Miss M. C. — Time is Money — Absentees '. 37 

Moody, Miss E. — Chilliwack 41 

Morris, Miss M.-— Generalized Nursing System 42 

McMillan, Miss I. — Day before Christmas 43 

Putnam, Miss M. — Public Health Activities Nanaimo Indian Reservation 45 

Seymour, Miss W. E. — A City under a Commissionership 46 

Tait, Miss C.— The Kin Kiddy Camp 47 

Thomson, Mrs. B. — News Letter from Keremeos 49 

Twiddy, Miss M. A. — Preventive Nursing 50 

Walls, Mrs. E. M. — Sayward 51 

Wilkie, Miss D. — Notes of an Esquimalt Rural Nurse . 51 

Yaholnitsky, Mrs. P. — Toxoid and Vaccination Clinics 53 









THE NEGLECTED AGE. 

Arriving here on February 15th, 1932, I am nearing the close of 
my fifth year in this district. The work has proved particularly inter- 
esting and the public appreciative. 

School-work demands a major portion of the Public Health Nurse's 
time here, both in the buildings and home-visiting ; and now the Comox 
Logging Co. has started operations in the local town, it has greatly 
increased the school population, necessitating nine teachers to take 
care of the eight grades in the public school (we have not yet a junior- 
high system) . There are four teachers at the high school, a home- 
economics department, manual-training instruction, and Mr. Bouchard 
takes care of the physical education. Five years ago there were but 
seven teachers for the first eight grades, three at the high school, and 
a manual-training instructor. 

Not only has the population increased, but tuberculosis clinics 
have also gone apace, and instead of two or three visits annually, we 
are having the service every second Wednesday. 

There is still a branch of the work of physical welfare that is 
neglected — the pre-school age. I include these little ones at my wel- 
fare clinics for the infants, but they take more or less of a secondary 
place, and I feel that so much could and should be done for them in 
preparing for their future and for school. When given a little praise 
and persuasion I find them quite easy to reason with and very trusting. 
There are many here that are growing up around me so much so that 
they look upon me as a " safety-zone." There has been only one child 
so far to whom I could not give the second dose of tuberculin. He has 
a tremendously strong will for his four years and we resorted to the 
aid of his daddy ; when the child was asleep it seemed easier to handle 
the situation and was successful. 

In conclusion, I would like to submit a programme that I feel 
would be another step in advance and apropos in getting the little ones 
of the freedom age to take their place in life as healthy citizens — a 
monthly or bi-monthly clinic where they could be encouraged in the 
habits of using toothbrush and handkerchief in the form of drills, 
taught to gargle, to use the thermometer, encouraged in habits of 
tidiness, and in doing things for themselves. Weighing would help in 
regard to diet that is best for them, and teeth and tonsils would receive 
earlier attention. Furthermore, quite often contagious disease is inno- 
cently started and (or) spread by these small people because it is not 
discovered at the onset. 

E. G. Allen, P.H.N., 

Lady smith, B.C. 




MATSQUI-SUMAS-ABBOTSFORD DEMONSTRATION AREA. 

Our last year's report dealt with the initiation of the health-work 
in this district. This year we are able to show definitely the effects. 

Thanks to the Provincial Board of Health, the majority of the 
children have had their teeth attended to and there is already marked 



improvement in the health of many, most noticeable being the decrease 
in swollen submaxillary glands. 

It is now a pleasure to visit the schools and see the majority of 
the hands go up when the children are asked if they have cleaned their 
teeth. It does not seem possible that a short time ago many had never 
had a toothbrush, and, needless to say, it took weeks for some of them 
to acquire the regular habit of using them. Only the newcomers are 
the offenders now. For a while last fall it looked as though we were 
being swamped with Mennonites. Another school had to be opened 
in the Poplar area, where nature does not provide rich soil. Large 
families have been attracted to this district from Saskatchewan and 
other Prairie Provinces, seeking small homesteads or cheap land. 
Many are now in need, and in some cases emergency relief has 
been given. With lack of water and crowded quarters, there was 
an increase in skin-diseases, necessitating frequent exclusions from 
school and home visits. 

In August all the children from the most distant school were trans- 
ported to the dental clinic in the nurse's car. Two or three children 
or less, depending on the work to be done, were brought in to each 
dentist. None had to be persuaded to go, as they all looked forward 
to the trip to Abbotsford. One little Japanese counted his carious 
teeth and figured on a trip for each cavity. He was quite disappointed 
when he was finished in one morning ! 

The need for proper diet and careful cleansing of the teeth and 
regular visits to the dentist in the future has been constantly stressed. 
Many now take milk who never took it before. Alas, some have begun 
too late — one girl of 14 especially, regrets, after losing most of her 
teeth, that she never drank milk until last year. In a dairy country 
such as this it is a tragedy to see how many people do not realize that 
milk is such a necessary food. 

Not long^ago, I felt rewarded after having visited a home previ- 
ously about their milk-supply, also about Benny's tonsils, to find that 
they had purchased a cow first with their hop-picking earnings, and 
now the family has a supply of milk, where previously 1 quart of milk 
served ten, including two babies under 1 year of age. 

Quite a number of children have had their tonsils removed, and 
many more intend to in the near future. 

Thanks to the members and staff of the Crippled Children's Hos- 
pital, several of our school-children have had treatment, and the 
benefits they have received has made their lengthy stay well worth 
while. 

One of the present problems is that of obtaining glasses for 
children on relief, but we hope, before long, to see the way clear to 
procure them for the most urgent cases. 

In many cases of defective vision, the parents, after having a 
home visit, saw the necessity for glasses and promptly bought them. 
In others, it was only after showing the parents that their child's 

6 



vision had failed during the year following the doctor's examination 
that they realized the need for prompt attention. 

In September a talk was given in each school district about goitre- 
prevention, and over 800 children sent in their dimes, nickels, and 
pennies. What a task it was collecting the money, and, later, dis- 
tributing the iodine tablets ! 

For the first few weeks in September we were free from infectious 
diseases. It was too good to last. One morning a phone message 
came in saying that a child had died from poliomyelitis on Matsqui 
Prairie. So two weeks were spent checking thoroughly all absentees. 
There were many away due to the fear of a further outbreak, but, 
fortunately, no other cases appeared. The odd case of scarlet fever 
here and there meant that the ceaseless vigil had to be continued. 

In October the area suffered a sad loss in the passing of our 
beloved Director of Education, Mr. P. H. Sheffield. For several weeks 
new demands were made on the already crowded programme, but it 
was not long before a new Director was appointed, and we are most 
fortunate in having Dr. Wm. Plenderleith, who organized the Peace 
River Block. Under his direction a health unit is shortly to be estab- 
lished, and we can look forward to an extensive immunization pro- 
gramme, and many other necessary activities, as yet only visualized, 
but not realized. 

With all the schools now affiliated with the Junior Red Cross and 
the new curriculum stressing health, the children are rapidly becoming 
health-conscious, and, looking back, one can see a marked improvement 
in the personal hygiene. The parents show increased co-operation by 
the prompt reporting of infectious diseases and requests for visits 
when in doubt as to what is wrong with their children. 

With the new Philip Sheffield Memorial Auditorium recently 
opened and a gymnasium constantly in use, under the able direction 
of Mr. Paul Kozoolin, not only children but many adults are taking 
an active part in physical education. We are looking forward to the 
future, which holds much in store for those who wish to avail them- 
selves of all the Department of Education has to offer. 

Onward little soldiers, 
Marching on to wealth, 
All our young school-children 
Know the rules of health. 

Onward then ye people, 
This shall be your song, 
" Health " is now our motto, 
Join our happy throng. 



J. Maryon Arnould, P.H.N., 

Abbotsford, B.C. 



SKI-ING. 

The wonder of wonders that surprised all of Duncan was to see 
the staff of the Cowichan Health Centre venturing forth to enjoy the 
winter sport of ski-ing. When ever did any one expect to have suf- 
ficient snow on the island to allow for this exhilarating sport? With 
the old adage foremost in our minds, that " all work and no play makes 
Jack a dull boy," we attempt to keep abreast of the times by trying 
our hand at all fashionable sports, for at the present time ski-ing is 
commanding world-wide attention. Nor does one wonder at this, 
having experienced even a little of the thrills of skimming through 
the air. 

To experience the feeling of swooping down the hills, the wind 
against your face and the sound of crunching snow under your skis, 
is terribly exciting. After a small amount of practice one almost feels 






Many will be the falls. 



Ski-joring. 



like a ship breasting the waves or a bird flying against a breeze. Now, 
if any one had spoken of ski-ing in these terms the first day I tried, 
I am quite sure that I should have described it as more like feeling 
like an elephant on skates than a floating cloud. However, after the 
first clumsiness is past, practice makes perfect and soon a love of the 
thrill is developed. 

The approved advice to beginners is as follows : Learn to fall, 
as many will be the skids and the rough spots and the crossed skis 
that will upset your equilibrium, and many will be the bruises and 
scratches acquired through your first endeavour. The main point to 
remember is to remain elastic and to make your knees act as springs 
to your body to absorb the shocks which might otherwise upset you. 
The position taken is knees slightly bent, one foot in front of the 



other and skis together. Hold your body upright and watch the 
ground in front of you, adjusting your balance to suit the contour 
of the ground. As you gain confidence in yourself, refuse to fall. 
Remain determined to stay on your feet until you are actually thrown 
to the ground. To slacken your speed, point the tips of the skis 
together and push the backs of them outwards. 

According to C. Falcon, this is the correct way for a beginner 
to start along the happy way of successful ski-ing. We have tried it 
and found that, with this expert advice and a little practice, our runs 
became each time a little less clumsy and a little more perfect. The 
back yard, the hill behind the house, the country roads, or the rolling 
fields are splendid places to explore on skis. Try running, jumping, 
or ski-joring for thrills. Ski-joring is accomplished nowadays by 
being towed behind a car along smooth and well-packed roads at 
20 miles per hour. 

Nothing, I am sure, will afford you more good exercise or more 
howls of laughter than this pastime. We enjoy it and wish you the 
best of luck in your first ski-jump. 

Florence Barbaree, B.A.Sc, R.N., 

Cowichan Health Centre, Duncan, B.C. 



PUBLIC HEALTH. 

This winter I was one of the few privileged students who were 
permitted an insight into the more advanced fields of nursing service. 
For two weeks, in weather ranging from fitful and watery sunshine to 
near freezing temperatures, I accompanied one of the three Saanich 
nurses and visited homes representative of nearly every type of per- 
son — homes graduating from mere one-room, hot, overcrowded shacks 
to little smug stucco bungalows. 

Tired and fretful mothers, discouraged and beaten by economic 
circumstances beyond their ken, relaxed and brightened a little as the 
nurse stepped through the door. No trouble was too long for the nurse 
to listen to. Willingly she looked at the whimpering baby's rash, 
peered down the next toddler's throat, and discussed the disadvantages 
of rheumatism with the grandmother. 

Into the schools I went and watched shy little girls and tousled- 
headed boys extend their grubby hands and open their mouths to dis- 
play none too clean teeth for routine inspection. Suspicion of scarlet 
fever at that time intensified the examination of all school-children's 
throats; with the teachers' ready co-operation, records of absentees 
were made and subsequent home visits followed. 

" Back-stage " glimpses were obtained upon frequent visits to 
the central office at Royal Oak. Here could be observed the machinery 
that set this particular Public Health Unit in motion. All day numer- 
ous phone calls appealing for help were answered by a speeding busy 
nurse. 

9 



But as interesting and instructive this part may be, I frankly 
admit I was more intrigued by the social-service side of the depart- 
ment. To be able to go behind the scenes and see at hand their 
hopes, fears, successes, and losses was an experience that I shall not 
readily forget. 

M. A. Campbell, 

Provincial Royal Jubilee Hospital, Victoria, B.C. 

(Editor's Note. — Students from the Provincial Royal Jubilee 
Hospital spent periods of two weeks with the nurses at Saanich Health 
Centre.) 



VICTORIAN ORDER OF NURSES. 

The work of the Oliver, Osoyoos, and Okanagan Falls branch of 
the Victorian Order of Nurses is as comprehensive a branch of the 
public-health service as one nurse is able to make it, in that it includes 
school-work, pre-school and infant-welfare work, bedside-nursing, as 
well as the care of one Indian reserve. 

Perhaps a short account of the work among the Inkameep Indians 
would be of interest to some. One day a week is devoted to the 
reserve, and only strictly necessary bedside calls are made in the 
rest of the district that day. After travelling over the very rough 
road across the reserve, the first place of call is always the Indian 
day-school. There are usually from twelve to fourteen children 
present, ranging in age from 5 to 17 years old. These are all given 
a preventive treatment for trachoma, a disease which was previously 
very prevalent in this reserve, but is now well under control. They 
are also weighed once each month, and each day the teacher gives 
every child a dose of cod-liver oil, supplied by the Indian Department, 
and sees that they wash their hands and clean their teeth before school 
commences. 

Due to the co-operation of the teacher, there is an excellent health 
programme carried on in the school, and the children run a flourishing 
branch of the Junior Red Cross. Occasionally the nurse is invited 
to attend their meetings and speak to them. 

Before leaving the school the teacher reports any sickness among 
the adult population that has come to his notice, and then the Old 
Chief's home is always the next place of call. The Old Chief is well 
over 80, but still in complete possession of all his faculties. It is due 
to his efforts that this reserve has a school and a nurse, and he is 
still very much the chief of the tribe, though his son does most of the 
actual business for him nowadays. His English is, perhaps, a little 
difficult to understand, and his wife, a bent old lady of much his own 
age, speaks no English at all. 

After these two regular calls have been made various other houses 
on the reserve are visited. The nurse is always made welcome, and 
often consulted on a variety of subjects, and even a friendly talk on 
matters outside health is important. Each house must be visited in 
turn or the inmates feel neglected; and the friendliness between the 

10 



Indians and their nurse is the greatest help and power for good she 
has ; without it very little could be done in time of illness. Contrary 
to the general opinion, many Indian homes are quite clean and well 
kept, and the nurse is often aware that they have had an extra brush-up 
on the day she is expected. The Indians are usually eager to report 
any illness and will follow instructions as carefully as most white 
people. 

On the whole, the work on this reserve is most interesting and 
well worth the time given to it. The tribe is, for the most part, 
remarkably healthy, and tuberculosis, such a scourge on other reserves, 
is rare among the Inkameep Indians. 

L. W. V. Grafter, 

Oliver, B.C. 



REVELSTOKE REFLECTIONS. 

After five short months as the Public Health Nurse in Revelstoke, 
it is time to pause for a few moments to reflect on the work which has 
been accomplished and on the plans for the future. 

Before assigning my reflections to paper let me take this oppor- 
tunity to write a few words of appreciation of the splendid work of 
my predecessors, Miss Amy Lee, who so ably laid the foundations of a 
school-health service, and Miss Agnes Thorn, now Mrs. Ingley, who 
continued and expanded this programme. When I realize the great 
amount of work which was accomplished by these nurses I feel very 
humble as I review the past months. And yet I recall the excellent 
advice we were given as students — " Go slowly and be satisfied to reach 
a single objective at a time." 

The work in the schools occupies the greatest share of the nurse's 
time. There are two public schools and a high school, with a total 
enrolment of 640. In September the pupils were weighed, measured, 
and inspected for dental defects, poor vision, posture, and general 
cleanliness, and health reports were sent to the parents. A monthly 
inspection is made in each class-room to check on cleanliness and health 
and to encourage correction of defects. Rather than follow each 
inspection with a health lesson, after consultation with the teachers 
a time-table was arranged so that the nurse takes a lesson in each 
class-room every two weeks. At the teacher's request some definite 
subject is taken, otherwise health rules are stressed by means of stories 
and pictures in the lower grades, and in the upper grades some topic 
relating to public health is generally chosen. In November we had a 
cleanliness campaign in the lower grades in each school. The children 
were very interested in marking their charts, and at the end of the 
period a prize was awarded to the class-room which showed the 
greatest improvement. The teachers all agreed on the effectiveness 
of the campaign. 

First aid is taken with the boys of Grades VII. and VIII., and 
home-nursing with the girls. They are very enthusiastic about these 

11 



classes and the certificate awarded to the successful first-aiders is 
greatly prized. In referring to the home-nursing classes, the mothers 
often remark : " We had nothing like that when we went to school 
and I am certainly glad my girl has such an opportunity to learn." 
Thus one is amply rewarded for any extra time given to these classes. 
So far we have been very free from communicable diseases ; three 
cases of chicken-pox and six of mumps being our record since Septem- 
ber. Although there was a general epidemic of measles in Revelstoke 
just two years ago, there are many who have not had this disease, and 
our fear has been " measles " as we read of the number and oftimes 
seriousness of the cases in some parts of the Province. However, 
since we have had two cases of measles in our town, one a pre-school 
child who had been in Vancouver and another who was a visitor for 
the holidays, without any one contracting from them, we are now 
resting somewhat easier, but at the same time always watchful. At 
present we are in the midst of a mild 'flu epidemic and most are heed- 
ing the warning — to stay at home and keep warm if not feeling well. 
During the past week our average daily attendance has been less than 
75 per cent., but we are hopeful for a return to normal very soon. 

One hundred pupils have milk every morning recess. The majority 
pay for the milk, but those who are underweight and cannot afford to 
buy receive milk free. The Milk Fund is supported by the I.O.D.E. 
and the Women's Auxiliary to the Canadian Legion. Every child 
taking milk has made a monthly gain in weight, and there is 
many a happy smile when weighing-day comes and " Mary " and 
" Johnny " find that they need no longer be on the list of underweights. 

Four of the teachers have become quite enthusiastic over the 
organization of a Canadian Junior Red Cross Branch in their class- 
rooms. Until the present there have been no branch organizations in 
Revelstoke and we are looking forward to still further developments. 

One really worth-while accomplishment was the administration 
of toxoid to approximately 200 children — school, pre-school, and 
infants. Except for a few private cases, this was the first time 
toxoid has been given here and we were very pleased with the response. 
The very willing co-operation of the doctors was given and each held 
a clinic. An article was published in the local paper regarding the 
value of diphtheria-prevention, and notices were sent to all parents 
of children under 11 years of age. The great majority of these were 
returned with their consent to have the toxoid given. One notice 
was returned with the terse remark : " I don't see any reason in having 
this toxoid until there is a case of diphtheria in our town." Fortu- 
nately there are few parents who are so ignorant of modern public 
health. We hope to have other clinics in the fall and thus, before long, 
make diphtheria an impossibility in Revelstoke. 

In connection with the school programme the value of the 
follow-up work cannot be too greatly stressed. The home visit com- 
pletes the link between the parent, the child, the teacher, and the nurse. 
Most parents are eager to discuss the health of their children and are 

12 



very co-operative in attending to correction of defects. Many a mis- 
understanding is cleared by the home visit, with the result that the 
parent realizes that the best is being done for his child. 

To date the work with the pre-school children has been through 
the home visit. Sometimes the chance visit to the home of a school- 
child is the one of most value. For example, when making such a call 
one day it was noticed that a little 4-year-old had a very definite squint. 
The mother also had this defect. When it was mentioned that this 
could be corrected in the child, the mother replied that she understood 
it to be hereditary and she had been told by a neighbour that nothing 
could be done. Fortunately she was a very co-operative parent, and 
the next time I saw the little girl she had been fitted with glasses. 
She was indeed a grateful mother, who had merely followed the advice 
given on a chance visit. 

The infant-work is really my " chief delight." It is being carried 
out on a very small scale, but from small beginnings I have hopes of 
great developments. A list of all births is obtained from the hospital 
each month. For the out-of-town mothers a notice is sent for post- 
natal letters. Those who live in town are visited regularly, and they 
soon look forward to the Saturday-morning visit of the nurse with 
her scales, which tell how much baby has gained. Usually the mother 
has a question ready regarding the health and care of her baby, and 
then one feels indeed that some service has been given. 

So far a pre-natal clinic has not been organized. It has appeared 
to be more practical to carry on this work through the home visit alone. 
Perhaps in the future such a clinic may be feasible. • 

And now to future plans. First is a more complete immunization 
programme. A very successful vaccination campaign was held last 
spring, but still there are many in the public schools and 45 per cent, 
of the high-school pupils who have not been protected against smallpox. 
We are planning now for a clinic to be held after Easter and are 
hopeful that, many of the above-mentioned pupils, as well as many 
of the pre-school children, will come for vaccination. 

Next is the organization of a weighing-station for the infant and 
pre-school groups. All public-health workers realize the need for 
service to this group, for it is here that a good foundation is laid for 
future health. Just as soon as our blizzards have been forgotten for 
another season I hope to have the first of monthly " weighing-days." 
Even if these do not appear very popular at first I shall not be dis- 
couraged, because I believe that in time more and more mothers will 
avail themselves of the opportunity of visiting this station monthly 
to have their babies weighed and checked for defects, and to obtain 
literature and advice regarding diet, habit formation, and the countless 
every-day problems which worry and perplex the young mother who is 
seeking the best in health for her child. 

The third of my future objectives is perhaps only a dream, but 
none the less a very practical dream. It is the hope that some day 
the half-dozen or more rural schools which are in the outlying districts 

13 



of Revelstoke may have the services of the Public Health Nurse. There 
is a real need in these small places and an additional great opportunity 
for public-health teaching. 

When the time rolls around again and Dr. Young, without whose 
kindly advice and encouragement my way would have been less easy, 
asks for another contribution to the Bulletin, I hope that my plans 
will have materialized. Much has been learned by a very short experi- 
ence in the field ; but, oh ! how much more there is to learn and how 
much to do ! 

Lyle Creelman, B;A.Sc, R.N., 

Revelstoke, B.C. 



CONSOLIDATION OF SCHOOLS. 
From a Nurse's Point of View. 

Six years ago, in 1931, under the auspices of the Provincial Health 
Officer, Dr. Young, the Department of Education, and the Red Cross, 
a Public Health Nurse was stationed in the Sunset Prairie District of 
the Peace River Block. 

The vastness of this territory of scattered pioneer settlements, 
with weather and road conditions quite beyond description and the 
remoteness of the part-time Medical Health Officer from the large 
majority of settlers, constituted real problems to the nurse in this 
area. The greatest difficulty, however, which had to be met and 
overcome was that of the co-ordination of medical work in the schools. 
There was little or no co-operation with the nurse by parents, teachers, 
or local School Boards, and in an area of some 500 square miles, 
wherein no general agreement for systematic health-work could be 
reached, satisfactory results were obtained slowly and with the great- 
est difficulty. 

In some schools ventilation was of the worst kind ; in others no 
adequate washing facilities could be obtained. Drinking-water was 
frequently of the most unwholesome kind, such as could be procured 
from a near-by slough, and the common drinking-cup was in gen- 
eral use. 

On the appointment in 1934 of Dr. W. A. Plenderleith as Inspector 
of Schools for the Peace River Block, a plan for the consolidation of a 
majority of the school districts in this inspectorate was successfully 
launched with a view to increasing efficiency in school government and 
the bringing about of other much-needed reforms. 

Looked at from the purely educational point of view, the scheme 
was of the first importance. Local School Boards were often con- 
trolled by inexperienced and inefficient men. 

This problem was solved after much preliminary opposition by 
dissolving most of the local School Boards in the area where the 
Government had in any case been bearing, roughly, 90 per cent, of 
the financial burden of school administration. Inspector Plenderleith 

14 










became Official Trustee for the consolidated area, with full authority 
for all school expenditures and for appointment of teachers. An Offi- 
cial Correspondent was nominated in each school district so that the 
Inspector could remain in touch with the needs of each school, and 
could, through this means, receive suggestions from any one who had 
grievances to air or improvements to put forward. 

Before consolidation the school taxes were unevenly divided in 
the inspectorate — some school districts paying as much as 25 mills, 
while others paid as little as 1.3 mills. These inequalities could not 
at that time be avoided on account of the great differences between 
built-up developed areas and those still in a pioneering condition. 
The plan of consolidation effected a cure by making possible one mill 
rate for the whole inspectorate. Thus improvements in school condi- 
tions from all angles have been very happily brought about throughout 
the area. 

A marked decrease in taxation for those under the scheme of 
consolidation was a welcome feature in many districts, the actual 
cash saving during 1934-35-36 having been $4,315.70. 

Needless to say, the plan did not at first receive the support which 
later brought nearly every school district under the scheme. In the 
first place, a strong protest was made through the local press and 
by locally organized " protest meetings." Much was heard of the 
dictatorial methods of consolidation which centralized authority in 
one person and undermined democratic government in school matters, 
imperilled personal freedom, and thereby destroyed personal interest. 
With indefatigable effort, however, Dr. Plenderleith set out to meet 
all objections, attending innumerable meetings throughout the terri- 
tory for the purpose of explaining the chief points of the plan — namely, 
decrease in taxation and increase in efficiency and equipment of 
schools. With the promises given that no reasonable request made by 
any School Board would be turned down, and with the better under- 
standing of the scheme, the opposition lost its bitterness and prepared 
to give the plan a fair trial. The result has been remarkable, and 
to-day all but two of the school districts, whose financial status gave 
them the privilege of voting for or against consolidation, have entered 
into the scheme of their own free will. 

In addition to the advantages shown in the economic and admin- 
istrative departments, consolidation has made possible the organization 
of a complete school medical service in the Peace River Block. In 1935, 
a little over a year after Dr. Plenderleith's appointment, a Health 
Unit was formed under the control of a full-time doctor as Medical 
Health Officer with four full-time and three part-time nurses. An effi- 
cient plan was evolved for health-work in every district under 
consolidation. 

Every school under the scheme now has a uniform programme 
of school hygiene, the main features being as follows : — 

(1.) Toxoiding and vaccination for all children are now being 
carried on even in remote areas. 

15 



(2.) A programme incorporating baby and pre-school welfare has 
been organized; prenatal and postnatal work has been started. 

(3.) Two dental clinics have been held, each of which covered the 
entire inspectorate. 

(4.) Eye-glasses have been provided for many for whom this 
would have been impossible were it not for the assistance given under 
the scheme for consolidation. 

(5.) Addresses and lectures have been given by the staff to many 
public bodies. 

(6.) Adequate nutrition has been aided in special cases by cod- 
liver oil provided through the Department of Health. 

Two modern rural schools have been built with every considera- 
tion to proper lighting, ventilation, and sanitation. In passing, it may 
be of interest to my readers to know of a good scheme for the even 
heating of rural schools in the coldest of weather which any local 
carpenter can effect at a cost of about $25. A cold-air draught is 
brought in under a jacket heater and a ventilator controlled by pulleys 
is placed in the roof. The blue-print plans can be had on application 
to the Department of Health, Victoria, B.C. 

Other improvements included papering and kalsomining of walls 
and ceilings in ten schools; reflooring of six schools; repainting of 
schools ; purchase of additional grounds for two schools ; fencing and 
clearing grounds of seven schools ; purchase of sanitary paper towels, 
towel-containers, toilet-paper and toilet-paper holders for thirty-two 
schools; purchase of water-coolers and sanitary drinking-fountains 
for forty-six schools ; purchase of new stoves for eleven schools ; and 
installation of electric lights in two schools. 

Difficulties remaining are mainly geographical. The enormous 
area to be covered over the worst of roads in both summer and winter, 
and the very frequent inaccessibility of whole areas due to weather 
conditions, piling drifts of snow, gumbo mud or flooded muskeg, 
make work very severe and exacting. To keep strictly to one's pro- 
gramme is often impossible. In certain instances, therefore, our 
outposts are left untouched excepting for an annual visit of doctor 
and nurse. Other difficulties are not uncommonly met with in main- 
taining co-operation of parents in the observance of quarantine and 
in the encouragement of health principles in the home. One could 
wish that more home visits could be made by the nurses, but again 
the difficulties of accessibility and the scattered nature of the whole 
settlement make this far from easy. 

With the sympathetic help of the former Director, Dr. J. S. Cull, 
and of his successor, Dr. J. M. Hershey, and with the excellent co-opera- 
tion of the nurses themselves, our difficulties have been minimized, and 
what might otherwise prove to be an impossible burden physically 
and mentally has become a duty cheerfully carried out. 

N. E. Dunn, M.B.E., 

Supervisor of Nursing, Peace River Health Unit. 

16 



PUBLIC HEALTH NURSES AND EDUCATION. 

My dictionary tells me that the word " educate " means " to bring 
up (the child), to train, to bring out, and develop, mentally and 
morally." We note here that only the child is mentioned, what, then, 
of the adult? Do we as Public Health Nurses educate our adults 
and children as we should? Surely there is much to be done. Our 
time is so taken up by the common round of routine in our schools, 
controlling infectious diseases, etc., that often we lack time and 
opportunity to train our large family, the public. There are many 
ways. Let us consider some of them and the subjects we could 
present for discussion. 

First, the school-child, by the teaching of positive health in all 
grades. Our new school curriculum certainly has made a big stride 
forward in the teaching of health. We nurses should not be held 
responsible, but should supplement the teaching of this most im- 
portant of subjects from the public-health point of view. 

Secondly, more should be done for our junior and senior high- 
school students. Here we should teach home-nursing and child-care. 
The boys also should have the same opportunities, especially home- 
nursing. This could be done effectively through the Boy Scouts' 
Association. The boys can then earn their Missioner's Badge, the 
girls, Junior Red Cross certificates, and Girl Guides, their badges. 
I am glad to note that the new course of studies is making it com- 
pulsory for these subjects to be taught. I have been giving these 
courses for several years and always have very keenly interested 
students. Also the question of sex education should be taught in 
Grades VIII. and IX. Personally, I have never had any difficulty 
in teaching this subject as I have had splendid co-operation from 
my principal and the parents. I have used the following books with 
success : " Growing Up," by Karl de Schweinitz ; The " Three Gifts 
of Life," by Nellie M. Smith, A.M. Other groups can be formed, 
such as youth clubs for older girls and boys of high-school age, also 
for business girls. 

At these groups we discuss: Home-nursing; child-care; sex 
education; mental hygiene. 

Thirdly, we come to the much-neglected adult group. On the 
Continent and in England much has been done for adult education 
for several years. Alberta and other Provinces of Canada have 
been doing splendid work through extension courses from their uni- 
versities. Last year the extension department of U.B.C. started a 
course of lectures for adults, and are continuing them this year. In 
connection with them, study groups have been formed in Kamloops, 
thereby a greater interest is created by the adults themselves. 

The following are our study groups : (1) Economics; (2) current 
history; (3) modern literature; (4) science of public health; (5) 
Shakespeare. 

The last three groups hold for me the greatest interest. Our 
Shakespearian group has derived immense value from our studies 

17 



from the works of the greatest mind in English literature; but 
there — this particular subject may not interest many of my readers. 
As a Public Health Nurse, I feel we all should have definite interests 
and hobbies outside of our profession. Surely with added interests 
we should be enriched, thereby making us of greater value to our 
communities. Now to our science-study group. We have several 
women very interested in the various angles of this most important 
science of public health. I am fortunate in having articles dealing 
with the many phases of public health. These are generously pro- 
vided by our Department of Health. We read and discuss them at 
length. I find this group keenly alive to the value of these studies. 
They wish me to express their appreciation to Dr. H. E. Young for 
this literature. 

The groups have studied and discussed with interest " The New 
Health Curriculum in the Schools," by Dr. H. B. King. Other sub- 
jects we are discussing are: Mental hygiene; sex education for the 
adult and the child; the pre-school child; child psychology; and 
many others. There is such a wide field to cover. Then we have 
the young, keen mind of the student-nurse in our hospitals. There 
should be found the opportunity of giving public-health lectures. I 
find them willing to absorb new ideas. Another good method is to 
write and produce short plays illustrating one's teaching. These I 
have presented from time to time to our parents at the end of the 
school term. I am producing " An Ounce of Prevention " next June, 
using some of my students for the cast. 

I have tried to point out a few means of extending education in 
public health. Of course there are many more. We all have our 
own ways of developing and teaching, and yet we can all help each 
other by the exchange of ideas. Education should be the keystone 
of our work. 

v " Learning maketh the soul young, it decreases the bitterness 
of old age. Gather then wisdom, gather sweet fare for thine old 
age." — Leonardo da Vinci. 

Olive M. Garrood, R.N., 

Kamloops, B.C. 



AN IMPOSSIBILITY BECOMES A SUCCESS. 

A few years ago the establishment of a dental clinic in Nelson 
was considered an impossibility. Last year I recounted some of the 
difficulties we met with in laying the foundation for such a clinic. 
I should like now to report progress in our new undertaking. 

Early last June the School Board appointed three of its members 
to act as a Dental Committee. Arrangements for financing the 
scheme had already been completed as outlined in my last article. 
A preliminary survey had been made by Dr. Walley, and it was the 
task of this committee, working in collaboration with Dr. Walley and 

18 






myself, to work out details and submit its recommendations to the 
Board. The plan decided upon was as follows : — 

(1.) That we have a semi-mobile type of clinic, which could be 
transferred easily from school to school and could later be mounted 
on a trailer and used as a mobile clinic to serve outlying districts. 

(2.) That necessary changes be made in the three schools to 
accommodate such a clinic. 

(3.) That, as a beginning, we should carry on an educational 
programme for all school-children, and examine and report dental 
defects in all children attending our public schools. 

(4.) That we would provide free dental care to all children — 
(a.) Whose mothers were receiving mothers' pensions: 
(b.) Whose families were on relief: 

(c.) Who came from homes where the average income was 
less than $15 per month per person. 

These recommendations were accepted, and Dr. Walley was 
appointed by the School Board to act as half-time dentist. A second- 
hand dental chair was purchased, together with a second-hand cabinet, 
bracket table, hand-piece and motor,' sterilizer table, and rubber 
floor-mat. The sterilizer and all instruments were new. The neces- 
sary plumbing and electrical changes were made in the schools. 
Dental records from other centres were studied and a form designed 
that would best meet our needs. 

The last piece of equipment arrived on the day that school opened 
in September, and on the next day we started our examinations. 
Out of 460 children attending the Central School, we found 96 per 
cent, suffering from dental defects. Dr. Walley gave dental talks in 
all rooms of the school, and by the time the examinations were fin- 
ished many requests for free treatment had been received. These 
were referred to the Dental Committee for approval, and almost 
every one of the 137 submitted proved eligible. Monthly letters on 
" Dental Care " were mimeographed, and the first of the series were 
sent out at the end of September, in the hopes that the parents of 
children not eligible for free treatment might be stimulated into 
taking their children to their family dentist. 

Knowing that it would be impossible to complete all the work 
requested, we concentrated on Grades I. and II. of the Central School, 
and on the two upper grades, so that next year we would have a good 
start both in Central School and in Junior High. Thirty-five pupils 
had dental work completed at our clinic, the average treatment for 
each child being nine 20-minute appointments. One hundred and 
seventeen pupils returned cards signed by family dentists, which with 
the 4 per cent, already found free from defects brought the number of 
children with well-cared-for mouths up to 39 per cent. Cards signed 
by family dentists are still coming in, and we feel that the percentage 
will be much higher by the end of this term. 

On November 19th we moved our clinic to the Hume School. 
It required barely half an hour to dismantle our equipment and get 

19 



it ready for the transfer, and even less to set it up again in its new 
quarters. Two hundred and fifty children were examined, and there 
were ninety-eight requests for free work. Twenty-two cases were 
completed by the clinic and eighteen cards signed by family dentists 
were turned in. The work was somewhat hindered by the Christmas 
examinations, and many children who were examined at that time 
are having their teeth attended to by family dentist now. 

On January loth we moved to the Junior High School. Three 
hundred and fifty children were examined, and up to the present 
(February 1st) we have had fifty -five requests for free treatments 
and have had fourteen cards returned signed by family dentists. 
The majority of the children are still to be heard from. 

A certain amount of emergency work has been done in all schools, 
both for clinic cases and for children who are under the care of a 
family dentist. For the latter, a temporary dressing was put in 
and the child advised to visit his own dentist after school-hours. In 
this way we feel that we have saved the children a considerable loss 
of school-time. 

The dentists of the town have voiced their approval of our plan. 
The parents have proven both interested and co-operative. Dental 
health in the schools is improving steadily, and we hope in time to 
extend our service to both pre-school children and those living in 
outlying districts. In fact, we feel that, in spite of the gloomy fore- 
bodings of some of our well-wishers, we have made our " impossi- 
bility " not only a reality, but an unqualified success. 

Kathleen M. Gordon, R.N., 

Nelson, B.C. 






MAPLE RIDGE AND MISSION DISTRICTS. 

The homely old " saw," " You can lead a horse to water, but 
you can't make him drink," is somewhat illustrative of the persuasion 
necessary for the carrying-out of public-health principles by the in- 
dividuals in a district. 

It is most encouraging that the persuasion need not be as pro- 
longed or insistent as formerly and that results are more satisfactory. 
The majority still need leading, while some refuse to drink of 
the essentials of health hygiene and care, and some go to inferior 
"springs " of health knowledge. An increasing number are glad 
to be led, however, and are anxious to partake of the most scientific 
source available. 

The attitude of most of the parents toward the new curriculum 
in the schools is an example of this. Many are very pleased indeed 
that their children are being taught nature, science, and health so 
much more basically and comprehensively. Seldom does one hear 
now of the complete efficacy of the three R's from parents. 

20' 



The " powers that be " are endeavouring to supply at least some 
of the new equipment necessary to carry on the new programme. 
Some of them are deeply interested. 

The earnestness and the endeavour of most of the sixty-six 
teachers to carry out the new projects is a source of amazement to 
me. Many have spent their own money for books or articles that 
would aid them in teaching the subject more efficiently. Great praise 
is due to these men and women for their very large contribution to 
the world's progress. 

Knowledge of the injurious effects of dental caries, infected 
tonsils, defective vision, etc., is being gained by more people; also 
the definite need of a full and balanced diet and proper rest, as evi- 
denced by the decided drop in the number of underweights among 
the school-children. 

The T.B. Survey with the tuberculin-testing of 594 Japanese 
children by Dr. Lamb and Miss Peters last year has been a productive 
element in preventive education. Many are anxiously awaiting the 
early return of Dr. Lamb for the complete survey of all the children 
in the schools. 

Of the 594 receiving the tests, 16.3 per cent., or ninety-seven, 
had a positive reaction, eighty-eight with the first dose and nine with 
the second dose. All of them with their parents were X-rayed and 
examined. Twenty-two of them, including five adults, were to be 
kept under observation and rechecked. One of the adults and three 
of the children were put on the " cure." Those on the " cure " have 
been faithful to their regime and examination six months after 
showed that they had improved. 

The survey has also stimulated interest in the clinics among 
some of the older Japanese, a number attending the Tuberculosis 
Clinic in Vancouver, resulting in two more " new " cases being dis- 
covered and hospitalized and two others under observation. 

Dr. Lamb's six regular clinics held here last year had much 
larger attendance than previous ones. Four new cases were dis- 
closed and a number of old cases pronounced progressing favourably. 

The discussion of a Public Health Nurse for each district here 
has become official, and the hopes are higher for the time to organize 
for and hold more toxoid and vaccination clinics, also for well-baby 
and pre-school clinics and prenatal welfare — more time to go into 
the homes to give information that will assist them in building and 
safeguarding their health and usefulness. 

Mary E. Grierson, R.N. 



THE VALUE OF AN ANNUAL SCHOOL HEALTH CUP 

COMPETITION. 

It is always difficult to arouse interest in new and progressive 
ideas of health and sanitation in rural farming districts, where 

21 



things move slowly, and so often the old saying is quoted, " What 
was good enough for my father is good enough for me." 

There is even opposition to the teaching of new ideas shown by 
some parents, as, for example, when one of our teachers received 
this letter from an indignant Italian father : " You got no business 
tell Antonio brusha da teeth! I never brusha da teeth, got good 
teeth. My sister brusha da teeth, wear them out. They all come 
out. You teacha Antonio read, write, not what he should do at 
home." 

This true -incident also brings to mind that tale of the sturdy 
Scotch farmer, who literally " floored " the Health Nurse by doubling 
up a brawny forearm, saying scornfully : " All this clack aboot vita- 
mins ! Look at ma muscle, and I niver had a vitamin in ma life ! " 

I shall always remember the early days of rural health organiza- 
tion in my district, and tackling this very problem of health education 
with an old gentleman who had been a much-esteemed school trustee 
for many years. He did not believe in " This new-fangled idea of 
having a school nurse ; they never had them in his time, and look at 
him ! " We threshed the matter out in the middle of a ploughed field 
one lovely spring day. He sat on his horse-drawn disk harrows, 
smoking a pipe, and I stood over my shoe-tops in soft wet soil and 
thus discussed this important matter of Health education. After a 
long argument he was won over to the idea of " Giving the nursing 
a trial," and so the first step forward was made in that district, where 
now the Health Nurse and her teachings is accepted as a matter of 
course. 

With nine other Rural School Boards to be convinced in like 
manner of the value of new ideas in school-health work, it was neces- 
sary to think of some project which would arouse the personal interest 
of both School Boards and scholars; stimulate a healthy spirit of 
competition between school districts, and show how much progress 
had been made from year to year. A school health cup competition 
seemed the ideal plan, and when the cup was donated by the District 
School and Medical Health Officer interest soon began to grow among 
children, teachers, and school trustees. 

Much thought was given by the School Nurse as to the points 
upon which the competition should be based. It was necessary to 
evolve a plan which would bear directly on all aspects of school sani- 
tation and health education, as these phases of school hygiene affected 
school trustees, teachers, children, parents, and janitors. It was also 
necessary to plan a schedule which would be equally fair to every 
child and School Board working in the different types of schools. 
This was indeed a problem, but finally the following schedule with 
thirteen main sections was drawn up; each section divided into 
about ten subsections, for which a rating of 100 points was given. 
A copy was given to all School Boards, teachers, and janitors, as 
follows : — 

22 






Points. 

Section I. Cleanliness of children (general), 

7 subsections 100 

Cleanliness of children (teeth).— 100 
Section II. Hygiene of the school-room, 8 sub- 
sections 100 

Section III. Sanitary condition of the toilets, 

9 subsections 100 

Section IV. Facilities for drinking-water, 7 

subsections _ 100 

Section V. Hand-washing facilities, 7 sub- 
sections ! 100 

Section VI. Heating and ventilation of the 

school-room, 9 subsections 100 

Section VII. Lighting of the school-room, 7 

subsections 100 

Section VIII. Provision for school lunch, 6 

subsections 100 

Section IX. Equipment of the playground, 

10 subsections 100 

Section X. Sanitary condition of the play- 
ground, 6 subsections 100 

Section XI. Response to health education: — 

(a.) Consents to goitre treatment (per- 
centage of pupils) 100 

(b.) Consents to toxoid immunization 

(percentage of pupils) 100 

(c.) Consents to vaccination against 

smallpox (percentage of pupils) 100 

(d.) Consents to tuberculin test (per- 
centage of pupils) 100 

Section XII. Results of health education : — 

(<x.) Taking goitre treatment (percentage 

of those giving consent) 100 

(b.) Immunized against diphtheria (per- 
centage of all pupils) 100 

(c.) Vaccinated against smallpox (per- 
centage of all pupils) 100 

(d.) Tuberculin-tested (percentage of all 

pupils) 100 

Section XIII. Interest in health education, 8 

subsections 100 

The grading throughout the school-year is done by the School 
Nurse, and the itemized results published in the annual topical report, 
which is studied with much interest. 

Some very tangible results in the different schools have been 
noted from year to year as a result of the rural schools health cup 
competition. 



23 



For instance : School buildings have been painted and repaired 
inside and outside. Electric light has been installed. School sani- 
tary arrangements have been improved and necessary requisites 
provided. Hand-washing facilities and paper towels have been pro- 
vided. In three schools running water and sanitary bubblers have 
been introduced at some cost to local ratepayers ; in others each child 
has his own cup. Heating has been improved. Playgrounds have 
been improved and sports equipment, etc., supplied. 

Rural school trustees have most certainly taken an interest and 
pride in trying to make their own school on a par or even better 
equipped than other schools in the district; this attitude in years of 
rural depression and scarcity of funds is most commendable, and 
encouraging to the School Health Service. 

With regard to the children, there is a great improvement in 
personal cleanliness and good response is given in general to health 
education, an attitude which is fostered by splendid co-operation of 
the teaching staffs. 

This responsive attitude of children and parents is well shown 
in the final results published in the 1935-36 Annual Report. With 
808 children on the register during the year attending ten rural 
schools: 99.68 per cent, consented to goitre treatment; 96 per cent, 
consented to the tuberculin test ; 89 per cent, were immunized against 
diphtheria. 

Appreciation of the response to health-teaching in the schools has 
been voiced by the School Inspector and also by the organizer of the 
Junior Red Cross. 

The value of an annual school health cup competition has thus 
been well demonstrated, and although the grading throughout the 
year throws extra work and responsibility upon the School Nurse, 
yet the final results are worth all the trouble taken. 

Anne F. Grindon, R.N., 

Keloivna Rural Schools, B.C. 



AN OBJECTIVE. 

When I decided to weave a few words around the above topic 
I discovered that, according to the Oxford Concise Dictionary, an 
" objective " meant a great many things I hadn't thought about, 
especially in the realm of philosophy. However, I did find, tucked 
in almost as an afterthought, the idea I had in mind, to wit : " A point 
aimed at." Why that angle should be so incidental in the dictionary 
still puzzles me, because I thought that every one has on objective 
and that the Concise would have given quite a little space to its 

24 




ramifications. But isn't that typical of life? The things we revere 
and hold sacred are of no interest to the rest of the world. 

To return to the topic, who was it said that if you aim at a star 
you may reach the top of the tree, but if you aim at the top of the 
tree you land on a lower branch ? All of which is by way of an intro- 
duction to the suggestion that we nurses, of all people, should aim at 
an objective in life. True, the fact that we are nurses proves that we 
have attained one objective, but it is so easy to settle down comfortably 
and sigh — comfortably — deciding that we have got as far as we can 
get. We are so prone to " rust in routine " until we find uncertain 
relief in wedded bliss or forced retirement. How many of us vowed at 





mBSBKKKSSOSBSm 



t 



" 50-50 per cent." 

graduation : " Well, here's one person who won't spend all her life 
just doing ordinary nursing " ; and yet, ten years later, we are still 
at the.same thing — perhaps in the very same position? 

The purpose of these few paragraphs is to suggest that nurses 
should have an objective at which to work " The point aimed at " is 
purely a personal choice of course, but if it is in the field of nursing, 
medicine, farming, literature, business, art, or music, etc., it should 
most certainly be beyond the path of daily routine — however con- 
scientiously we are travelling that path at present Last year a hobby 
was suggested as a way of relaxation — this will also apply as an 
objective. I wonder how many tried it ! 



25 




" The final warning." 



In Miss Kerr's article on " Ghosts " we are asked for contributions 
to her collection of " superstitions." I wonder if the old truism, 
" Hope springs eternal in the human heart," could be called a super- 
stition ! If not, then it is not too much to fix an objective seemingly- 
above our reach — and high as it may be, if reaching it will be primarily 
for the good of society, a watchful and munificent Providence will 

26 



smooth out the path until the goal is reached. Did not Browning 
realize this when he wrote : " A man's reach must exceed his grasp — or 
what's a Heaven for? " 

Bertha Jenkins, R.N., 
Supervisor, Saanich Health Centre. 



CURIOUS SUPERSTITIONS AND BELIEFS. 

" Do you believe in ghosts? " In a deep, hollow voice, the ques- 
tioner stirs our hidden fears, and we feel our hearts beat faster as 
we listen to awesome tales of mystery and magical apparitions. Then, 
when the period of tension is passed, we shrug and laugh : " But 
nobody really believes in those sorts of things to-day ! " Perhaps 
not — perhaps they do. Many of us, supposedly intelligent, wide- 
awake, well-trained Public Health Nurses, have little secret rites we 
perform on occasion. Did you ever wish on a new moon? Why? Do 
you surreptitiously "touch wood" to offset a little mild boasting? 
Do you really believe it helps any? 

Since few of us can deny we have a weakness for these super- 
stitions, we may expect that many of the foreigners, who comprise a 
goodly number of our population, will present serious teaching prob- 
lems because of the fears that are part of their heritage. Public 
Health Nurses, whose programmes are developed chiefly along educa- 
tional lines, may not be confronted by so many baffling situations as 
their fellow-workers who include bedside-nursing in their services. 
However, it may be of value to try to discover what is behind the ideas 
and customs to which some individuals cling so tenaciously, for only 
by understanding them can the Public Health Nurse offset their effects 
upon her teaching. The nurse who is tolerant, who has taken the 
trouble to secure some information on these matters, and who has 
the happy faculty of being able to understand the other person's point 
of view will find that she can more readily win the confidence and 
co-operation of her client and that her suggestions will be received 
with less resentment. Success does not always follow even where the 
greatest effort has been used, but many times a mother can be per- 
suaded to try the strange new " Canadian " ways of doing things 
because of the confidence she places in the nurse and the desire she 
has to please. 

It is possible to mention only a few of the superstitions and 
customs and traditions that one may encounter. Every nurse who 
works among foreigners could add to the list. I should be glad to 
receive information relative to peculiar customs encountered in the 
various communities. 

One of the first beliefs that comes to mind is the reference to the 
communicable diseases as " children's diseases." To the uninformed 
mother, communicable disease is as much a part of childhood as cutting 

27 



teeth. The theory that these diseases are spread by foul air, by night 
air, by the odours from garbage-dumps, is still prevalent despite all 
the teachings to the contrary. At one time the idea of transferring the 
diseases to animals as a method of cure was propounded. A hair from 
the head of a child infected with whooping-cough was placed between 
two slices of bread and fed to a dog. If the dog coughed, it was 
taken as proof the disease had been transferred to him and the child 
would recover. 

The suggestion of the use of colour in the treatment of disease 
came later. It so happened that a royal prince contracted smallpox. 
During his illness he was clothed in red, the hangings of his room 
were red, and all who attended him wore red clothes. Should any one 
question the efficacy of red since the prince recovered? Does not 
grandfather still derive greatest benefit from red underwear in the 
winter-time ? 

Another fallacy we frequently encounter is that scarlet fever is 
spread through the agency of the desquamated skin. A sheet is fre- 
quently suspended in a pan of lysol solution to act as an effective 
barrier in a doorway. Can you visualize the micro-organisms mount- 
ing the particles of dead skin as an Arab his steed and galloping 
through the doorway? 

How many people still believe that lockjaw is caused by cutting 
the tissue between the thumb and the index finger? The whole germ 
theory of disease is disbelieved by some who demand something more 
positive by way of proof than microscopic organisms that are too 
small ever to cause much trouble. 

Perhaps the most interesting superstitions centre around the 
maternal cycle. Almost every foreign woman longs to become the 
mother of a male child. Deified personages have received the prayers 
and offerings of women all through the ages. The Romans had five 
or six goddesses who performed various offices in this connection. 
In even the more primitive races stress is laid upon the importance 
of satisfying every wish the pregnant woman may express regarding 
food. This woman must avoid all fright, or the child will die; she 
must not bathe, go to a funeral, catch her breath, or cross her hands 
over her heart lest her baby should develop heart-trouble. 

During the confinement many special precautions may be taken. 
A razor-sharp axe suspended beneath the bed will cut the pains. 
No dusting or sweeping should be permitted in the patient's room, is 
another belief. Dust in the air provides a medium through which 
the evil spirits can approach the mother. The Hebrew mothers 
dreaded in particular, Lilith, the legendary first wife of Adam who 
is always working mischief. If a baby smiles on a Sabbath night 
during the new moon, it is a sign that the enchantress is playing with 
it. In order to drive her away, one must tap the baby thrice on the 
nose and utter rude words to its tormentor. Even greater than this 
fear is the dread that Lilith will come during the labour and steal 

28 



the child. As a protection against this she hangs prayers of deliver- 
ance on her bed and the walls of her room. 

One should never admire a pretty foreign baby, because of the 
jealousy such expressions may excite among the evil spirits. Near- 
East people offset a stranger's unwelcome praise by spitting on their 
infants. Irish mothers mention the name of God in speaking of their 
children, as otherwise He may punish them for boasting. Brightly 
coloured beads and other charms may be fastened to the person, crib, 
or carriage of an infant to deflect the evil glances of the spirits. 

These are only a few of the beliefs that might be mentioned. 
What ones have you found? Let us make a collection of them and 
so help each other in the solution of the difficult problem such super- 
stitions present. 

Margaret E. Kerr, B.A.Sc, R.N., 

Instructor, Department of Nursing and Health, 

University of B.C. 



WHAT DO YOU REALLY DO? 

How many times have we heard : " I have often seen the Health 
Centre and the nurses driving about, but what do you really do?" 
This is quite a conundrum. 

Several years ago, in an annual report, our aim was stated to be 
" to improve health, prevent disease, and mitigate suffering throughout 
the district." Although this is still our object, such a trite reply is 
inadequate. Our monthly reports are full of statistics, quite uninter- 
esting to the average person, for how little they convey ! They show 
that we do some bedside-nursing; infant, pre-school, prenatal, and 
postnatal visits ; social service and school-nursing with its many prob- 
lems ; but in addition there is a great variety of unclassifiable things 
that never appear in reports. 

This is the story behind what fell into the category of a social- 
service visit. In the wee small hours one October morn we had an 
epochal visitation. Answering a loud peal of the door-bell, we were 
confronted by two policemen bearing four naked children. Imagine 
our consternation ! It appeared that the parents were suffering from 
some religious delusion and found it necessary to strip themselves and 
their family of five children, aged 7, 4, and 3 years, and twins of 18 
months, and to take to the woods. 

The police had answered the call of a passer-by and had managed 
to pick up the four youngest and to bring them into town to our care. 
We had just acquired an oil kitchen range and we were more than 
thankful for the plentiful supply of hot water. The order of the day, 
or rather night, was mustard baths and hot milk all round ; then a 
search in our " poor and needy " cupboard for something resembling 
nighties. The children, after this, were put to sleep on chairs, the 
chesterfield, and a cot in our living-room. 

29 



While all this was in progress, one of us climbed into uniform and 
started off with two car-loads of police officers to the scene of the 
birthday-suit ceremony in search of the others. Imagine if you can 
the feelings of the nurse when, as the cars stopped, the hope " that 
shooting should not be necessary " was voiced. Then, as the men 
were disappearing into the surrounding bush, one said : " You won't 
be afraid to stay alone will you, Nurse? " Imagine the darkness and 
solitude in the country at 3 a.m. 

After much searching, the father, mother, and eldest child were 
found and transported back to Duncan, where the latter two were left 
in our care at the Health Centre, where they were visited by the doctor. 
More baths followed, and after giving the mother a sedative we 
made sure all were asleep. Bed for us was out of the question by this 
time, so after partaking of coffee two of us set off for the home to 
gather any available clothes for the morrow. 

Realizing that the farm was deserted, we rummaged around a bit 
more until we found and armed ourselves with some chicken-feed and 
sallied forth into the barnyard, calling " Chuck, choock " in the 
approved fashion. After an unsuccessful effort to find the cows, we 
appealed to a kindly neighbour, who agreed to take charge. Then back 
home to spend the day caring for and keeping track of our large family 
until they could be transferred to other care. The day was ruined as 
far as routine work was concerned, and it was early to bed for all 
that evening. And so, back to normal. 

Clothes are always a problem. But have you ever tried to outfit 
a family of eight children on $50? Try it some time if you think it 
is easy. Even try to get clothing for three little ones on $10, or a 
layette on $5. These duties have fallen to our lot within the past 
few months. Then, to climax all, we were called upon to produce 
clothing for a body fifteen minutes before the funeral as the family 
had failed to appear with the desired articles. 

Our " poor and needy " cupboard would be a gold-mine to the 
owner of a " Used Clothes Emporium." The positively wild ideas enter- 
tained by some good-hearted souls about what would be useful to needy 
families affords us much amusement. The accumulation of hats, 
" holey " shoes, out-of-date clothes riddled with moth-holes, not to 
mention the conglomeration of corsets, is priceless. 

The Health Centre functions also as a clearing-house for 
produce — from thoughtful farmers to less fortunate families. Occa- 
sionally there is such an inundation that we cannot cope with it. 
At one time we had a pile of forty-two vegetable marrows waiting 
for homes. However, there is real satisfaction in knowing that we 
can always obtain fruit and vegetables when the need arises. 

Occasionally we request definite articles through the local press. 
Recently a call came for a baby-buggy. Within two days we had a 
really marvellous assortment — some with and some without wheels. 

Another phase is that of an unofficial employment bureau. Given 
a little time, we supply almost everything on demand — from practical 

30 



nurses, housemaids, housekeepers, companions, caretakers, to farm- 
hands. Then, too, we must find homes in town for expectant mothers 
waiting to enter hospital. 

Some even think we provide a free transportation service. One 
hopeful individual once was very vexed when we refused to convey her 
to a settlement 20 miles distant when the snow was so deep that even 
the bus service was disrupted. It seems hard to make all realize that, 
though we " just drive about," our time is more than fully occupied. 

Kindly neighbours add to our troubles. With the best intentions 
they ask us to call on some one in their district. They do not realize 
that we cannot always just walk into any home. Sometimes such calls 
are answered only to find that the report was quite unjustified and the 
time spent is practically wasted. However, remembering the cry of 
" wolf, wolf," all calls must be answered. 

All in all, we lead a very varied life here in Duncan. There is 
very little we do not do, but it all adds to the zest of the work and 
makes for a better feeling in the district, opening more doors to our 
work. The original question is still unanswered, but I wonder if 
any one could ever really classify everything in this large field of 
endeavour. 

H. Kilpatrick, B.A., B.A.Sc, R.N., . 
Supervisor, Coivichan Health Centre, Duncan, B.C. 



JUST ONE CALL. 

A message comes in to the nurse. She is wanted up at Yapp 
Alley. 

" Yapp Alley," to the uninitiated, is the name given to a little 
Finnish settlement situated about 11/2 miles up Cowichan Lake from 
Youbou. The frame houses are built identically, in a straight row 
along the west bank of Cottonwood Creek. There are two ways 
only to get to Yapp Alley — either by boat up the lake or, and more 
usually, by walking along the railway. Just now the tracks have 
been ploughed clear by the train and have a bank of snow from 2 to 4 
feet in height on both sides. 

The nurse sets out about 3 o'clock in the afternoon of a day 
early in February. The air is balmy despite the snow; the moun- 
tains arounds are shining in the light of the setting sun. 

As she goes past the mill she notices a water-tank — a mass of 
huge icicles. Peering under the tank, she can almost imagine herself 
at the entrance of a huge cavern in some far-off glacier. The ice has 
that clear blue colour that is only found where ice is translucent. 
Proceeding up the track, the nurse sees the steam from the engine 
of a train ahead of her and fervently hopes it will stay where it is 
until she crosses the trestle over the Cottonwood. However, it is 
not to be — down comes the train and she is forced to leave the track 

31 



and take refuge in the bank of snow. Fortunately it is not very 
deep — only up to her waist. She stands there with snow filling her 
gum boots and melting clammily down the backs of her legs while 
the train lumbers slowly by; then, floundering out of the snow, she 
sets off once more. 

Crossing the trestle in safety, she encounters a further obstacle 
in the shape of an engine, a snow-plough, and a number of flat cars 
that are drawn up across the only road to the houses that she wants 
to reach. She stands for a few minutes at loss and slightly confused 
by the chufling and hissing of the big engine. 

A kindly trainman notices her dilemma. " Want to cross, Miss? 
Just a minute, and we'll couple up and move the cars." He signals 
to the engineer; the cars are coupled and move past. She crosses 
quickly and goes down the trail to her destination. 

Two hours later, her work done, she comes back to find the same 
train drawn up, facing the opposite direction. There is nothing but 
a bank of snow, 4 feet high, all along her side of the train. The only 
path is across the track. 

" Come through this way, Miss. The men are eating and the 
train will be here half an hour yet." Looking toward the voice, she 
sees one of the engineers above her in the cab, leaning down with 
outstretched hand. Pushed from behind by a sectionman who had 
just come up, and pulled by the engineer, she reaches the floor and 
passes through the cab, to be assisted down to the trail on the other 
side. The sectionman is on his way home also, . and as they walk 
down the track together he regales her with a thrilling story of three 
cougars he had shot on the mountain above them just the evening 
before. 

About a mile farther down they come upon a string of ten flat 
cars. There is no way to go around, so, assisted once more, the 
nurse scrambles up and they walk along the top, leaping from car to 
car. They must hasten now to reach the siding before another train 
comes. As the train approaches, the last few steps are taken on the 
run ; the train passes, then it is a clear road home. 

The nurse thanks her companion and bids him good night, 
reflecting to herself how often she meets with such kindness and 
help as she goes about her work among the people of the district. 
Climbing the stairs to her room, she notices how the light is fading 
and stars are beginning to twinkle in the clear sky to the east. An- 
other day is ended' — another call has been answered. 

Annie S. Law, R.N., B.A., B.A.Sc, 

Youbou, B.C. 



PROBLEMS OF DISEASE-PREVENTION. 

Disease-prevention — one of our primary reasons for existence — 
remains a difficult problem under conditions present in the Peace 
River District. 

32 



Prior to 1935, when the Health Unit was organized here, many 
cases of communicable disease went unreported. Some still go un- 
reported. Due to distance, difficulty of transportation, and scattered 
population, communicable disease, even when reported and seen, has 
often almost passed the recognizable stage. The supreme confidence 
of the settlers in making their own diagnoses and prescribing treat- 
ment fills a poor Public Health Nurse with awe. Most of their mistakes 
are made in being too careless. The idea is very prevalent that " the 
children may as well have it and get it over with." The method of 
isolating a case at home is often impossible when one realizes that 
many of the homes are one-, two-, or three-roomed shacks. There are 
no isolation hospitals where one might send the stricken member of a 
family. Also it is frequently impossible to see the case more than 
once during the course of the disease. All directions re care, isolation, 
quarantine, etc., must be thoroughly given and thoroughly understood 
at this time. These and other reasons make disease-prevention a 
" bigger than ever " problem here. 

It is interesting to note some special conditions with which we 
have been confronted. During 1936 a few scattered cases of scarlet 
fever were found. The reaction of the general public was very marked. 
Many voluntarily brought their children for immunization. There was 
much talk re closing schools, methods of fumigation (?), periods of 
quarantine, etc. Many residents still firmly believe that only their 
having had an old tin of lysol or creosote solution continuously boiling 
on the stove saved the family from complete obliteration ! 

Undoubtedly every one was very much frightened of scarlet fever. 
It proved a good opportunity to teach and demonstrate methods of 
prevention and control. Talks were given in various schools and at 
Women's Institute meetings. The value of reporting and isolating 
suspicious cases early was stressed. One might cite several cases 
which occurred during the year wherein we were wholly successful 
in controlling spread of disease. This included cases of measles, 
mumps, and chicken-pox as well as scarlet fever. In each instance 
the case had been reported very early to one of our staff. Measures of 
control were enforced and the results proved satisfactory. One began 
to feel, with some assurance, that an epidemic would not be possible 
here. A great deal of toxoiding and vaccinating had been carried out. 
People were enthusiastic over this and a great deal of literature and 
information re spread of disease in general was disseminated. 

Suddenly we were surprised to find that cases of rubella had been 
at large, unreported, and had spread the disease very thoroughly 
throughout one country and one town school district before discovered ; 
no one seemed much disturbed. It was " only the German measles," 
yet school attendance was markedly affected for a month or more. 
In three known cases children were seriously ill with conditions evi- 
dently influenced by rubella, and still much comment and criticism 
was aroused when methods of control were insistently applied. 



Although, at the time of writing, the disease has reached epidemic 
proportions, we endeavour to remain calm and composed. We suppose 
rubella will gradually die out as such things do. Conditions have been 
controlled in so far as possible and we have learned another valuable 
lesson. It is impossible completely to control spread of communicable 
disease unless we have 100 per cent, co-operation from every one. 
Many are unaware that neglect to report cases is liable to fine or 
imprisonment. Education to recognize early symptoms is essential. 
Early reporting of any suspicious case would often save much trouble 
later. People must be made aware of their responsibility in the above 
respects. In teaching health in schools we should stress these matters. 
Our future citizens will benefit if they early develop this sense of 
responsibility. Parents and teachers are often almost totally unin- 
formed. Surely we, as Public Health Nurses, cannot too often discuss 
problems of disease prevention. 

Rita M. Mahon, P.H.N., 

Peace River Health Unit. 



JUSTIFICATION FOR THE APPOINTMENT OF A SOCIAL 

WORKER TO COMPLETE THE HEALTH AND 

EDUCATION PROGRAMME IN THE 

PEACE RIVER DISTRICT, B.C. 

Discussion of work in the Peace River District of British Columbia 
must be preceded by a brief description of the country because of its 
geographic and economic position. It is a valuable wheat-growing 
area situated about two-thirds of the distance northward on British 
Columbia's eastern boundary. The only outlet for its product is via 
rail to Edmonton. In fact, the only reasonable means of access to 
the rest of British Columbia is by rail or road through Alberta. This 
isolated area is roughly 2,000 feet above sea-level and comprises some 
6,150 square miles, deeply gouged by the Peace River, traversing it from 
west to east, and its many tributaries. The communities are widely 
scattered ; the main roads graded, but ungravelled on the whole, and 
transportation difficult and various due to rain, mud, snow, drifts, and 
ice. The few original settlers of 1911-12 were augmented in 1919-20 
and again in 1928-29. At this time there was a great influx of settlers 
from the dried-out areas of Southern Alberta and Saskatchewan. 
Some of the latter had known the amenities of life, and, far from 
young, are valiantly making a second start in a pioneer country. 
Many more, the invariable transient lured by glowing tales of easy 
wealth, and still others, the poor, we shall always have with us. 
To date, save in a few cases, all the homestead buildings are of logs 
and there are many sod roofs to be seen. The home is usually one 
room which may or may not have a partition. The chief social 
pleasures of the people are the local fair in summer and an annual 
round of dances at Christmas-tide, with the occasional dance between 




34 



seasons. Twenty miles is no deterrent to such pleasures, but of neces- 
sity in many instances the whole family must go and the return trip 
is delayed till dawn breaks. In the year 1935-36 the estimated popu- 
lation was 9,000, including 1,400 school-children and 1,000 pre-school, 
and there were sixty-five school districts. 

In 1934-35 a consolidation scheme, which is a Larger Unit of 
School Administration, with one Official School Trustee, who is also 
the School Inspector, came into being. As a direct result of money 
saved the Peace River Health Unit was launched September 1st, 1935, 
with grants from the Rockefeller Foundation, the Provincial Depart- 
ments of Education and Health. This Health Unit is a decentralized 
organization of the Provincial Board of Health, which acts in an 
advisory and supervisory capacity. There is a full-time Medical 
Health Officer, four full-time Public Health Nurses, and three part- 
time nurses, one of whom is a Public Health Nurse. Each nurse has 
a given number of school districts and makes her home as central to 
her area as possible. The health programme is a generalized one, save 
for bedside-nursing, which is only done in emergencies. An active 
immunization programme is well under way now and, owing to associa- 
tion with the consolidation of schools, free dental clinics for school and 
pre-school children have been organized each year, and some very 
necessary tonsillectomies and eye-glasses have been obtained, the 
parents co-operating to the extent of 50 per cent, of the cost. The home 
visit, I feel, is the most important factor in the work to-day for a 
number of reasons. First of all, it is a background to the health pic- 
ture presented by the school-child. Secondly, the actual type of living- 
quarters and the homestead environment are deciding factors in what 
the nurse may hope, at present, to achieve in her teaching, whether 
in the home or in the school. Thirdly, it serves as a valuable contact 
with the father, young adults of the family, or other grown-ups, some 
or all of whom appear from an apparently uninhabited landscape, fol- 
lowing the arrival of the nurse's conveyance, be it car, sleigh, or 
democrat, or be it simply herself on her own two feet. Once contacted 
thus, the future holds many opportunities for health talks, in meetings 
along the way or at the combined store and post-office on mail-days. 
Fourthly, with the number on relief almost decimated following the 
good crop this year, the home visit is the only way of ferreting out 
prenatal cases. 

Other Government facilities are handled through the Government 
Agent and the police. Among these are Relief, the Infants, Mothers' 
Pensions, and Children of Unmarried Parents Acts, etc. Not infre- 
quently the local Public Health Nurse is asked by Government depart- 
ments, neighbours, or the Church to report on some home. More 
often that Public Health. Nurse feels her hands tied in trying to put 
over her health-teaching, due to the social and economic problems 
already obtaining in the home. - An official investigation demands 
special training in social-welfare work and uninterrupted time for the 
case. The first the Public Health Nurse does not boast; the second 

35 



is often difficult because her time is limited by a definite programme 
of duties. On the other hand, this same nurse traverses her area 
each month, and through her contact with the school and its teacher 
she is fairly well posted as to any trends that may be developing in 
the homes. In at least one area, where there is a " red " element, a 
moral laxity has crept into the social life of the people and serves as a 
bad example for the school-children. The isolation and drudgery of 
homestead life seems to take its toll in the development of mental 
cases. Now the distance from the Peace River District to Vancouver 
or Victoria requires at the minimum ten days for a reply by mail in 
summer, fourteen days or more in winter. Neglected children and 
delinquents must be sent out to Vancouver with a matron, entailing 
great expense to the Government because of the distance, time, and 
rail transportation. Should an experienced Social Worker, with trans- 
portation allowed her, be posted in the Peace River District, at least 
some of the social and economic problems could be straightened out 
before the situation came to a head. A truer picture could be obtained 
in questions of relief, mothers' pensions, etc., than that gained at 
present through the eyes of the police or Public Health Nurse, and 
greater justice would be done. In cases of neglect it would be possible 
in certain instances to obtain suitable foster-homes in a distant part 
of the Peace River District itself. These could be supervised by the 
Public Health Nurse under the direction of the Social Worker, for the 
foster-child would be the nurse's school or pre-school child. After all, 
these children come from homesteads, and if retained on homesteads 
will probably develop into as good farmers and farmers' wives as their 
more fortunate neighbours' children. Why should they not remain 
in this district instead of being sent to a city? 

The Government has seen fit to develop in this isolated area of 
British Columbia two departments from the past — the Larger Unit 
of School Administration and the Decentralized Health Unit. . The 
former is in its third year, the latter in its second, and both are 
apparently justifying their existence. The work, however, might be 
advanced with the co-operation of an experienced Social Worker, and 
it is legitimate to believe that, under the circumstances, the service 
of such a person would pay for itself. 

L. Malkin, P.H.N., 

Fort St. John. 



VERNON. 

Looking back for a few years, I feel that public health here has 
expanded from year to year, and this last year, despite an epidemic 
of measles in the early part of the year, has been a good one from a 
public-health point of view. 

During this past year we have had voluntary hospital insurance 
in this district. Many of our poor people have taken advantage of 

36 



this. As this includes treatments, I find our skin-diseases among 
the children, especially impetigo, are clearing up more quickly with 
the use of our hospital quartz lamp. Also more diseased tonsils are 
being removed than formerly. 

Dental work is being carried on as usual, our Dental Fund taking 
care of the teeth of the majority of our needy children. We are 
finding fewer teeth to fill each year, and our work seems to be 
changing from a corrective to preventive dental work. 

Home-nursing classes are carried on too. We have two a week, 
when possible, throughout the school-year. 

This year we intend to procure glasses for those needy children 
who have defective vision. A drive has been started to raise funds 
for this purpose, and we are meeting with a great deal of sympathy 
and support. A committee representing our local benefit societies, 
clubs, etc., is being formed, and sufficient funds are in sight to take 
care of all these cases that do not come under or who are not helped 
by the Institute for the Blind ; our aim being to provide glasses when 
necessary as soon as defective vision is recognized. 

We also are in the midst of a toxoid campaign, and when we 
finish this we will vaccinate in the spring. We vaccinate our receiv- 
ing classes and what pre-schoolers we can each year, and henceforth 
we intend giving toxoid to our receiving classes each year as well. 
Of course, many of these may have been toxoided as infants, but we 
intend doing the " left-overs " each year as they come in to school. 

In my visits to the homes of our new Canadians, I notice in many 
cases an increased interest in British customs and a greater desire 
on their part to improve their standards of living through education. 
They are getting outside their own narrow circle, and I think the 
Public Health Nurse appreciates, probably more than any one else, 
in the rural districts, at least, that these people, poor though some 
of them are, are contributing a vast amount of wealth in colour, art, 
music, etc., to our Canadian life. 

E. Martin, R.N. 



TIME IS MONEY— ABSENTEES. 

During the last four years in which I have served in the capacity 
of School Nurse in the City of Kelowna, I have kept records of atten- 
dance of the school-children. I have come to the conclusion, which is 
shared by all teachers, that school-time has a commercial value to the 
pupil which is seldom appreciated by the child or his parents. 

With this point in mind, a great deal of our efforts have been 
directed at improving poor attendance. There are two reasons for this 
improvement — one from the school point of view, with which we shall 
deal at length in this article, and one from the public-health point of 
view, which is also most important and which has a great bearing on 
the situation. The public-health point of view is of course the fact 

37 



that in checking absentees one is certain to find communicable diseases 
in their infectious stages, and one has therefore more opportunity to 
check its spread. 

Every morning each teacher sends a list of absentees to my office ; 
wherever possible the reason for absence is noted. .These lists are 
checked every morning. At the moment, with an epidemic of mumps 
on the wane and intermittent cases of 'flu, we have had over 200 chil- 
dren out in Grades I. to VI. Each child's parent is telephoned or 
visited unless the child has a reliable brother or sister at school, when 
they are asked. Daily-attendance graphs have been kept for three and 
a half years. You will understand that with 200 children away 
there will be a good many of these in homes where there are no tele- 
phones, and also where there are no other brothers or sisters; these 
cases entail an immense amount of work and time, because all the visits 
have to be made on foot and the town covers a distance of at least 
9 square miles. Checking up attendance has loomed very large in my 
day's work for some time now. 

During this four-year period we have been unfortunate in that 
we have had numerous epidemics, the most outstanding of which was 
that of infantile paralysis in September and October of 1934. This 
was the only time that the schools were closed, and then for three 
weeks. There were sixteen cases of infantile paralysis and one death ; 
none of the children who recovered developed any serious after-effects. 
We have also had to contend with mumps, measles, whooping-cough, 
chicken-pox, and an occasional case of scarlet fever, two cases of 
typhoid, and those annoying skin-diseases, impetigo and scabies. 
I expect the majority of my fellow-workers have been called on to 
deal with one or all of the above mentioned at some time or other. 

Absence in the winter and spring is due usually to sickness, but 
in the fall we have a problem which to date has not been solved- — 
namely, that of school-children looking after younger brothers or 
sisters while their parents are working at the cannery or packing- 
house. Many children in this way miss as much as two months of 
school at the beginning of the term. The only solution for this problem 
is a suitable creche in which small children could be cared for all day. 
Local organizations have been approached with this idea, but they all 
feel it is too large an undertaking. 

Absentees can be divided into the following groups: (1) Those 
who are ill; (2) children whose help is required if there is sickness 
at home; (3) children of parents who do not realize the importance 
of education; (4) children who play " hookey." 

Of the above classification, the third is the most dangerous and 
very often they are responsible for creating such a poor mental atti- 
tude to school ; it is small wonder that they complain that their children 
gained very little from education in the elementary schools. Another 
source of trouble is parents who send children with a rash or other 
symptoms of infectious diseases. They are also responsible for a great 
loss of school-time.' 



I have tried with the data at my command to work out the cost 
per child per day. This, I realize, can only be an estimate, because 
the personal factor does enter into teaching" more than many other 
professions. An instance : A lesson has been taught to twenty children 
out of a class of thirty. That lesson must be repeated for those ten 
children who were away, and this usually has to be done in school-time. 
The saying, " Time is money," is as applicable to school-time as to 
any other time. With a total attendance of 1,153 pupils in Grade I. 
to Senior Matriculation, the cost per capita per day is 33 cents. All 
expenditure, including sinking fund and interest, came to $73,500. 

The per capita cost is of course based on the whole school popula- 
tion, but the graphs and average daily absentees of which mention is 
made are statistics from one school — namely, the elementary, with an 
enrolment of 663 pupils. The general trend of a graph of absentees 
in the elementary school is also applicable to the general attendance in 
all schools, especially if there are infectious diseases present. 

Enrolment fluctuates with the years and school costs have their 
" ups and downs " ; so for matters of comparison over the last four 
years we have used the per capita cost for 1935-36. The greatest 
number of absentees in one day was on March 11th, 1935, when there 
were 350 children absent. The cost for this day alone was $116.60. 
For that month of March the average daily number absent was 248 ; 
the cost was $82 a day, and for twenty-one days the cost amounted 
to $1,722. 

Looking at the problem from another angle: Consider a family 
of four children, one of which has developed mumps; he is out of 
school for ten days (school) , the cost of which is $3.30. The other 
three children may come to school for twelve days and then they must 
remain out of school for sixteen days, or twelve school-days, which 
amounts to $12. If these three children do develop it in orthodox 
time (eighteen days), the quarantine cost will be $4.95 and the cost 
for each child while they have mumps is $3.30 — $9.90. 

Total cost to city and Government : First case, $3.30 ; quarantine, 
eighteen days, $4.95; three mumps cases, $9.90; total, $18.15. 

This does not include the all too common occurrence of each child 
becoming ill with mumps at separate intervals, in which case the cost 
would be increased greatly. Neither does it include the fact that the 
breadwinner of the family is very often infected and is unable to work 
for two weeks. 

Another example of an infectious disease in which time is a most 
important factor — whooping-cough, with its quarantine of six weeks 
or thirty school-days. For contacts of whooping-cough the quaran- 
tine is two weeks, and if the child develops it after that time he is 
excluded from school for six weeks, so altogether he has to' be away 
for eight weeks of school-time. The cost for one child with whooping- 
cough to the school is $9.90 and the cost for eight weeks is $13.20. 

Endless examples of this kind could be given. Unfortunately the 
loss is not only that of school-time, but in many cases the child's 

39 



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40 



health is seriously impaired by these infectious diseases and in this 
way his work at school is seriously affected. The above examples 
apply only to one family or one child, but if there is an epidemic present 
figures can be multiplied a hundredfold. 

Consider the following: — 

Average daily cost — cost per Year. 

1933-34 $13.53 $2,191.86 

1934-35 31.35 5,548.95* 

1935-36 16.50 2,706.00 

Average for five months, Sep- 
tember to February, 1936-37 26.40 2,490.60 

The problem of absentees is a large one, and one with which it is 
very difficult to deal under the present system. It must be remem- 
bered that it is up to all parents of school-children to make themselves 
responsible for daily attendance for their children. This should not 
of course be carried to a point of fanaticism ; if a child is ill he should 
of course stay home, but that is really the only valid excuse for absence. 

The graph on page 40 represents average monthly costs beginning 
in October of each year. 

M. C. Miles, B.A.Sc, R.N., 

Keloivna, B.C. 



CHILLIWACK. 

The incidence of slight thyroid in the Fraser Valley has been an 
ever-existent problem. It has been a challenge to all interested in the 
welfare and health of the children. The number of cases found in the 
schools was so great that it was determined to have thyroid tablets 
given in the class-rooms as a preventive measure. 

In 1933 arrangements were made with a local druggist for the 
nurse to procure the preventive tablets at a cent apiece. These tablets 
were sold to the children for the same price, but with the stipulation 
that twenty-five tablets be bought and taken one a week in the class- 
room. 

During the first year of this work, naturally, the response on the 
part of the parents was not as great as desired. Only 152 pupils of 
approximately a thousand deemed it worth trying. Possibly many 
shied from " those new-fangled ideas." 

The next term saw a vast improvement, chiefly due to the nurse's 
forethought in mailing explanatory letters. These letters pointed out 
the fact that treatment was given goitrous cattle. Then why not wise 
in humans? Immediately the number of pupils taking the' preventive 
treatment rose to 490. 

The school-year 1935-36 showed a little more improvement, 
bringing the number to 504. In this term the means of obtaining the 
tablets changed slightly. It was found possible to procure " the choco- 



* Just school-time. 

41 



late-coated candies " from the Provincial Board of Health at the low 
cost of forty for 15 cents. 

With three years' work, the public's awareness of slight goitre 
and its possibilities has been gratifying. As a result of this attitude 
the improvement in the children's condition has been so great that it 
has not been thought necessary to continue with the tablets ; instead, 
iodized salt for use in the home is now advocated. 

One of the two Mennonite districts in the valley proves an example 
of the advance obtained. This area lies at the eastern end of the 
Sumas reclaimed area. 

In the school-year 1935-36, of the then existing school population 
of 121, sixty-two children showed signs of varying degrees of slight 
thyroid. Compared to this, fifty-eight consented to take the preventive 
treatment. 

The year 1936-37 has shown an even greater advance. Of the 
present 140 students, forty have slight goitre. This means that twelve 
have been cured and only six new ones found (the new ones are from 
the Prairies). The remainder have noticeably decreased in size. 

A very interesting situation has arisen during this term. At the 
present we can boast that 58 per cent, of the children are now in the 
habit of using iodized salt extensively in the home. The teachers 
have found that the work done in this line has been well repaid. 
Several of them have remarked that the general result in school-work 
and behaviour has been noticeable. 

If three years can do this, then we hope and believe that several 
years of continual attention will show itself and become obvious to 
the skeptical. 

Eva Moody, R.N. 



GENERALIZED NURSING SYSTEM. 

During the past year the generalized nursing system in Nanaimo 
has been undergoing a period of trial. Previous to this time the two 
nurses were doing specialized nursing-work. The School Nurse looked 
after the school-children, about 1,100 in all, and attended the baby 
clinics; while the Public Health Nurse looked after the remainder 
of the work, which included prenatal, bedside-work, maternity cases, 
infant and pre-school, tuberculosis, mental hygiene, and the clinics. 

A year ago it was decided to ask two adjacent districts — namely, 
Harewood and. Nanaimo Bay — to come into the nursing system. These 
districts were to have a demonstration of the nursing-work for six 
months, at the end of which time the ratepayers were to vote on 
whether they would accept the service ; and at the same time Nanaimo 
itself was to try the generalized nursing system for a year. 

The first step was to organize a Public Health Board. Under the 
specialized system in Nanaimo, a committee of interested women, or 
the Nursing Council as it was called, directed the nursing-work, and 

42 



now the committee had to be extended to take in these new districts. 
Consequently two members were chosen from each School Board, one 
from each Parent-Teachers' Association, two from the Nursing Coun- 
cil, and the Public Health Nurses. Although a new Board was formed, 
the Nursing Council remained intact to carry on clinic-work. 

The work under the generalized system is divided so that each nurse 
has her own work in her own district. One nurse looks after Nanaimo 
as included in the city limits ; the other has Nanaimo Bay and Hare- 
wood. In order to divide the work more equally, the nurse in the outside 
district has included in her work the city high school and the Indian 
reserve, with the result that each nurse has approximately 700 school- 
children under her supervision. Besides the schools, each nurse has the 
T.B. cases, prenatal, infant and pre-school, maternity cases, bedside- 
care, and mental hygiene in her own district. Included in this pro- 
gramme are clinics taking care of the different phases of the work ; e.g., 
dental clinic once a week, chest clinic under Dr. Kincaid once a month, 
child-guidance clinic under Dr. Crease once a month, and infant and 
pre-school clinic once a week. Besides this baby clinic there are held 
monthly a Chinese and Indian clinic. 

From December to July several public meetings were held in the 
outside districts, with either Dr. Young or Dr. Amyot in attendance. 
The purpose of these meetings was to explain the nursing service to 
the public, the cost, and to answer any questions they might ask. 
Education of the public was accomplished by dodgers, sent home with 
the school-children, press correspondence, and actual conversation with 
the people. In the meantime the nursing-work was being carried out 
in the schools and homes, and, through this, much education was done 
and a splendid contact was made. At the Parent-Teachers' meeting 
several talks were given. 

The six months of trial soon slipped by and the long-looked-f or day 
in July came when the districts were to vote upon the service. Those 
interested could not see how the districts could possiby turn down such 
a service, and they were not disappointed as the nursing service again 
won its case, and thus Nanaimo has added two districts to its nursing 
service and has for itself the advantages of a generalized nursing 
system. 

Maxine Morris, B.A.Sc, R.N., 

Nanaimo, B.C. 



DAY BEFORE CHRISTMAS. 

There goes the telephone. " Is that the Health Centre? Can one 
of the nurses come over right away ; Johnnie has a rash and I don't 
know what it is." 

" Has John been in contact with any infectious disease? " 

" Oh, no ; two weeks ago he slept with his cousin, who developed 
measles the next day, but he hasn't been near him since." Ugh! 

" Well, put John to bed away from other children and I will see 
him this morning." 

43 



The phone again: " Is that one of the nurses? This is Mr. A., 
of the Christmas Cheer Committee. About that family of Burns with 
eight children; it has been reported to us that they are always well 
dressed and really do not need a hamper." 

" We are acquainted with the family, Mr. A., and know that the 
mother makes all the children's clothes from cast-offs from friends. 
She is a very industrious little body and a hamper would be much 
appreciated, for they have nothing extra for Christmas." 

" Very well, then ; we will send them a hamper, for you know 
best." 

The bell again ; this time the door — a lady with a parcel of clothes 
for some needy child. While this one is being taken in, the telephone 
rings again, more door-bells, more phone calls — for this is the day 
before Christmas. 

Being visitors, we ask: " Is it always as busy as this? " 

We receive the laughing answer : " Not quite so bad, but it is a 
great life." 

There are only two nurses for the holiday and they started their 
day early, and will apparently have little leisure all day as there are 
nursing calls to answer and hampers to be delivered to several out- 
of-way places. 

The hall was not quite so full of parcels as the office, which had 
every nook and cranny full; however, it was necessary for one to 
step carefully. "This one is for Mrs. Brown when she calls; this 
for Mrs. White; and probably Mrs. Black will be in for a small bottle 
of Friar's Balsam for Johnnie's cold. These others we will deliver. 
Please write all messages in this book and one of us will be in from 
time to time." So ran the instructions, for we were to be left in 
charge. "What happens if an accident is brought in?" we wail. 
" Send for the doctor " is laughingly called back as the cars speed 
away. 

The kitchen table is piled high with white gifts brought in for 
the nurses to distribute to the needy of the district. These are 
unpacked between answering the many calls of door and telephone. 
Our voices must have sounded very professional, for some of our callers 
started explaining their ailments before we could make them under- 
stand that we were only visitors, and ask them : " Will you leave your 
number, please? " 

" It wasn't until 1.30 p.m. that the nurses returned and came 
flying in for a hurried meal, which, like all others, was interrupted 
by phone calls. They left again almost immediately, and when we 
had recovered our breath, so to speak, we washed up and tidied things 
away. There followed a lull of nearly half an hour. What can have 
happened ? But — there goes the door-bell again. A Chinese boy with 
a parcel for the school nurses. Ginger, I believe. 

And so it goes until the nurses return late in the afternoon. 
Their big hope is that no one has been forgotten and that all will enjoy 
a Merry Christmas. 

44 



N.B. — This portrayal of our Christmas rush was the impression 
gained by two visitors who took the calls for us the day before 
Christmas. 

I. McMillan, R.N., 

Cowichan Health Centre. 



PUBLIC HEALTH ACTIVITIES, NANAIMO INDIAN 

RESERVATION. 

Included in the public-health programme of Nanaimo is the very 
interesting work on the Indian Reservation. It was a long, hard 
grind to dispel the resentment of the Indians toward — what they 
thought — the intrusion of the Public Health Nurse. In fact, it is 
still very evident in some families. Nevertheless, the majority appear 
to welcome the nurse and to benefit from her teachings. 

The most important phase of work is, of course, the school. 
Children, about forty in all, from both the local and up-the-river 
reserves attend. The chief difficulty is the irregular attendance. 
The parents do not seem to realize the importance of uniform atten- 
dance — the most trivial reasons are adequate to warrant absence from 
school. Moreover, as soon as the fishing season opens, whole families, 
including the youngsters, pack and travel up-river. As a result 
duplication of work is necessary when it comes to weighing, measur- 
ing, physical inspections, etc. These difficulties, though, are only 
minor details compared with the difficulty of preventing and con- 
trolling the skin-infections — namely, impetigo and scabies, and, worst 
of all, pediculosis. The children suffering from these infections are 
not excluded from school. To do this would in no way lessen the 
close contact of the children. To have them at school facilitates 
the nurse in treating the cases. Three visits a week are made to carry 
on these and any other treatments, check up on absentees, when 
possible, and to carry on a further school programme. 

Another definite feature is the infant and pre-school programme. 
Once a month, in the school-house, is set up a clinic, to which the 
mothers come to have their babies weighed, and to receive advice from 
the nurse and doctor, the latter giving a thorough examination at 
each visit. Strange as it may seem, the mothers regard this as a 
wonderful piece of service. At our first clinic a few of the mothers, 
when they saw the doctor, went out to bring in one or two of the 
more uninterested mothers. Although the clinic is held once a month, 
any necessary visits are made to join together the stray ends. 

Needless to say, tuberculosis is fairly prevalent among the Indians. 
At each monthly chest clinic, Dr. Kincaid usually examines several 
suspects and contacts from the reservation. Difficulties arise now 
from all sides. With two or three families living under one roof, 
it is very difficult to trace the contacts and then to isolate the infected. 
And to complicate matters, even at the best of times, two or three 
visits are required before the Indian realizes that the nurse means 
business. 

45 



Now the prenatal programme. This is extremely slow, for the 
simple reason that the young mothers are under the thumb of their 
parents and grandparents, who, after giving birth to a dozen (more 
or less) of their own, believe that they know sufficient. To cite an 
example : Just recently a baby was born under the care of the grand- 
mother after detailed arrangements had been made for the doctor. 
Three days later the nurse, making what she thought was a prenatal 
visit, found the mother already up and the baby getting along 
splendidly. 

It is evident that there is plenty of room for advancement in the 
public-health programme on the reservation, but the nurse has to go 
very, very slowly. Nevertheless, with the splendid co-operation she 
is receiving from the Medical Health Officer, the future looks bright 
and rosy. 

Madeleine Putnam, B.A.Sc, R.N. 



A CITY UNDER A COMMISSIONERSHIP. 

The early years of the depression made a very deep impression 
upon the lives of the people of the City of Fernie. Fernie is a coal- 
mining town and has no other industry, so, when oil-burners came 
into being for factory and railway use, there was a great slump in 
coal and Fernie suffered more severely than most coal towns. 

At that time we had the usual form of municipal government, 
with its attendant expenses, regarding salaries, and also the usual 
political issues. In January, 1935, we reached a climax, and it was 
realized by the citizens of Fernie that drastic changes were imminent. 
At that time North Vancouver was under the administration of a 
Commissioner, and affairs there were progressing very satisfactorily. 
It was decided to place Fernie under the management of the same 
Commissioner, and the new dispensation came into being with the 
former City Clerk in the position of Acting-Commissioner under the 
direction of the Commissioner residing in Victoria. 

This system automatically did away with the former machinery 
of government — namely, the Mayor and Council, Police Commission, 
and School Board; vesting all power in the hands of the Com- 
missioner. Expenses were cut down in a marked degree, especially 
in regard to salaries. The School Board ceased to function as such, 
but with our very alert and able Inspectors, and an equally alert prin- 
cipal with an efficient staff, all educational matters are well and ably 
directed. 

The town is policed by the Provincial staff and relief conditions 
are probed by the Provincial investigators. A member of the Pro- 
vincial Social Service looks into the pension and neglected-children 
cases, and the health of the schools, communicable-disease control, etc., 
are under the management of a member of the Provincial Public 
Health staff. 

46 



Before the slump in coal-mining Fernie was as prosperous and 
progressive as any place in the Province, with a vast pride in itself 
as a city. Its machinery of government is unequalled by any other 
city in the Province — namely, administration buildings, post-office, 
city hall, schools, banks, coal company's offices ; and its hotels, stores, 
and homes compare satisfactorily with other towns. When we real- 
ized that the slump was here to stay, it looked for a time as if we 
were a doomed city, as there was practically no source of revenue, 
with the exception of the taxes, and even these could not be met by 
the people who were forced to go on relief. 

We do not say, of course, that a city runs better under a Com- 
missionership than in the old way, but we do know that affairs have 
run smoothly, the expenses of administration have been cut to the 
minimum, political issues have been eliminated, and duplication of 
services and records no longer exists. 

Business is carried on as usual and repairs are undertaken. One 
building taken over by the city for taxes has been utilized as a com- 
munity club, where badminton, basket-ball, and other games are 
carried on, and tournaments are held with teams from other towns. 
Other buildings were torn down and a school-house built, in which to 
house the newly reopened home-economics and manual-training de- 
partments. A gymnasium has also been added to the school, with 
a fully qualified physical instructor in charge. 

We have also organized junior high in our schools and it is 
working out very satisfactorily. All the grades from VII. up now 
have the advantage of the instruction of experts in their particular 
subjects, and we all feel that the more gradual progress of the student 
from elementary to high school, through the junior high, will be very 
beneficial, especially from a psychological view-point, as many mental 
adjustments made at an earlier age and in a more gradual manner 
will be much more readily assimilated. 

This paper sounds more like a discourse on municipal and edu- 
cational conditions than a health paper, but these conditions, along 
with mental hygiene, go to make up the health conditions of a com- 
munity. Our new organization has created a vastly co-operative 
reaction from all sections, and the physical health of both staff and 
students is as good and better than in previous years. Also, our 
name is more conspicuous by its absence in the communicable-diseases 
reports than most places. 

I hope that this account of a town under a Commissionership 
may be of interest to some of our readers. 

Winifred Seymour, R.N. 



THE KIN KIDDY CAMP. 

This, as the name implies, is a summer camp for children, under 
the sponsorship and supervision of the Kinsmen's Club of Chilliwack. 
Its young and ambitious members could surely find no other project 

47 



worthier of their energy and able efforts, and the interest they show in 
its advancement and promotion is to their credit as men and citizens. 

The camp was established about six years ago at Cultus Lake, 
which is a lovely spot and a summer resort, at a distance of about 
8 miles from Chilliwack. 

In the beginning the camp accommodated about twelve or fifteen 
children, and naturally all the conveniences and necessities could not 
be provided at first. 

As time went on the camp grew, and is now an imposing structure 
valued at $1,000, with accommodation for about thirty children and 
for the staff in charge. Last year a kitchen was built on at the back 
of the building proper, replacing the kitchen previously used, which 
was separate, small, and far from convenient. There is also a large 
dining-room, which also serves as a recreation-room, which has a 
fireplace and is supplied with a radio loaned by some interested citizen. 
There is also an electric washing-machine and an electric pump fur- 
nished, as well as a kitchen range and a good-sized sink. 

Daily delivery service from the town of Chilliwack is provided. 
Vegetables and fruit are donated by farmers during the period the 
camp is active. Contents from 500 boxes of cereals were consumed 
last year, as well as a daily consumption of 100 lb. of Edenbank milk, 
and the menu is varied and interesting as well as nourishing. 

The School Nurses select the pupils who go to camp. Tuberculosis 
contacts are the first consideration, and underprivileged children from 
homes on relief or from poor homes comes second. Sometimes there 
is a little difficulty in selecting these, and usually the same families are 
represented each year at camp. Last year there were about twenty- 
eight children, half of which number are city children and half being 
from the municipality. 

The staff consisted of a man in charge, and one year a woman 
in charge of the girls' activities, and a cook. 

The camp is open for a month, usually from the middle of July 
to the middle of August. 

The routine is like that followed in most rest sanatoriums. The 
children arise at half -past 7, breakfast is served at 8, and the rest 
period at noon for an hour and a half, with the hour of 8 p.m. set for 
retiring. 

Each child is required to take a few personal belongings. These 
include a blanket and a bathing-suit and a change of underwear, and 
the rest is supplied by the camp ; a uniform for all the youngsters ; 
towels are provided. Soap is supplied by one drug-store and tooth- 
brushes by another. 

A nurse keeps an eye on the camp and a doctor is supposed to 
drop in every day for general supervision. 

The children play and swim and hike. They are weighed and 
measured regularly and records of these are kept. But the big change 
lies not in their increased weight, which averages 5 lb., as it does in 

48 



their attitude in general ; their increased vitality after the first week 
or so ; their improved appearance of brighter eyes and better colour ; 
their greater ability of adjustment to new conditions and new play- 
fellows. 

Claire Tait, R.N., 

Chilliivack, B.C. 



NEWS LETTER FROM KEREMEOS. 

As I look back on the last six months, I feel that they have been 
very full indeed ; full of activity and interest. 

This year we branched out a little and added Hedley School to 
our district, so now I have four schools — Keremeos, Cawston, Olalla, 
and Hedley. Hedley is a booming mining town and fortunate in 
having very progressive and splendid community men in charge of 
mining operations. 

Also are we fortunate in having a local Health Officer very keen 
on public health; so I feel that my task is unusually easy, simply 
carrying on what every one thinks is the right thing — namely, teach- 
ing health in the community. 

At first I did not know just where to fit Hedley School in, but I 
found a day, the first Monday in each month. I weigh and measure 
all children (about 100) twice yearly and give out weight-cards. Then 
each month I weigh the primary-room and underweights and give a 
physical examination in the intermediate grades. I give a health talk 
to each room at the beginning of the term on the health rules, and 
after that as often as is necessary. I get a list of absentees on each 
visit and call at these homes, thus getting acquainted with the parents ; 
and the parents, through me, with the conditions at school. The atti- 
tude of the people is splendid. 

In October we did a tuberculin test on all our school-children. 
Almost 100 per cent, consented to this test. Reactors are being taken 
to Penticton or Princeton for a check-up. Some went in the fall; 
others will go this spring. 

A case of measles cropped up in Keremeos High School early in 
December. All non-immunes were infected, but through good co-opera- 
tion on the part of the infected homes the disease did not spread into the 
other rooms at school. As a precautionary measure for the rest of 
this season, with the consent of the Health Officer and the approval 
of the teachers, I made the rule that any one with a cold or a cough 
must stay home for four days. In that time symptoms have subsided 
or show a definite trend. 

In the spring I am planning a toxoid clinic, taking in Keremeos, 
Cawston, and Olalla. We do this every two years, our birth-rate not 
being very high. This seems to keep us protected. 

B. Thomson, R.N. 

49 



PREVENTIVE NURSING. 

In a recent number of the Canadian Nurse there appeared an 
interesting article entitled " Helping Marjory to get Well." The 
writer derived a great satisfaction, as result of the many weeks of 
labour, in the recovery of one who was so severely injured. Seeing 
such patients recover and return to their homes and normal life is 
the greatest reward that curative nursing produces, and that is great 
indeed; but how about ''Keeping Marjory well"? Is there not a 
thrill in that also? To the nurse who has had experience in both 
the curative and preventive fields, I think that seeing most of the 
Marjories and Johnnies taking their places without having had mis- 
haps produces a very great satisfaction. 

The writer of the article, referred to above, tells what she learned 
from the case, but does not refer to what Marjory learned from the 
experience. The patient had to learn through bitter pain, to say 
nothing of the expense, that it is very dangerous to use kerosene on 
a fire. Would that she had learned the lesson in an easier way! 

In caring for the sick and injured, do we think enough about 
how the misfortune might have been prevented? John is recovering 
from pneumonia; do we think how the whooping-cough which re- 
sulted that way might have been prevented? Mary is getting over 
scarlet, but do we know where she contacted the disease? It some- 
times becomes a satisfaction to the Health Nurse to have helped to 
get Mary isolated when the first signs of the trouble appear, and joy 
is hers if no other member of the family or class comes down with 
the disease. 

It gives even greater joy to the Health Nurse to see all the 
children free from infections, for she can devote her time to spread- 
ing the good news that Mary need not have diphtheria, T.B., and 
many of the other diseases that still cause a great deal of suffering 
and exnense. She can teach Marjory the dangers of using kerosene 
on a fire, and John's and Mary's mothers receive information on 
preventing scarlet and whooping-cough. 

When the School Nurse sees reports of " all present " at school, 
she then has time to turn her energies to plans for keeping up that 
record by the various means. She gets great joy from notes like this : 
" Dear Nurse, — John has a slight sore throat this morning, so have 
kept him in bed and away from the others till I see if anything further 
develops. If so, I shall call the doctor and report to you later. — 
Yours, Mrs. H." Although we are sorry John has not remained in 
perfect health, we are glad to have such co-operation from parents. 
Widespread health-consciousness of this kind in parents would soon- 
put Health Nurses out of their positions ; but, alas ! both preventive 
and curative nurses are still needed. When shall we all become un- 
employed because everybody is careful? 

50 



We must still keep on guard and help to mend the rents of mishaps 
and illness so long as we allow these enemies to remain, and get what 
satisfaction we can from service to others, hoping that " Each to- 
morrow finds us farther than to-day." 

M. A. Twiddy, R.N., 

Penticton, B.C. 



SAYWARD. 



We have had quite a strenuous winter — lots of snow and some 
very cold weather, making it impossible to get around. It is not the 
amount of work; it is the time it takes to get around this time of 
the year. We are very fortunate in one thing in this isolated district — 
we do not get a lot of " infectious diseases." 

In the spring and fall we usually have a certain amount of influ- 
enza. This last two weeks we had " measles " brought in by one of 
the young adults who had been visiting Vancouver. So far there have 
been no other cases outside of his own home; his two brothers and 
sister have contracted it. 

As regards " goitre," some of the school-children have had the 
iodine-tablet treatment for prevention of goitre. There have been 
no cases of goitre in the children since I have been in Sayward, which 
is seventeen years. 

As far as co-operation of the people is concerned I am sure the 
majority of them appreciate the services of the Public Health Nurse. 
There are always a few in these small out-of-the-way places who have 
very peculiar ideas as to what a nurse can do and should do. I do 
what I think is best and what I can. 

In Sayward the Public Health Nurse is somewhat different to 
other places. One has to go places, anywhere, anytime, and do 
anything. 

There is no doctor to call on, except the doctor on the " Columbia 
Coast Mission Boat," who visits once a month; not always that, as 
weather and S.O.S. calls always have to be taken into consideration. 
In cases of emergency I can usually get a gas-boat to Rock Bay Hos- 
pital, about 20 miles from here; even that sometimes is difficult as 
the gas-boats are not always in running-order, and then the only 
other recourse is to wait for the U.S.S. Co., which only comes twice 
a week. 

E. M. Walls, R.N. 



NOTES OF AN ESQUIMALT RURAL NURSE. 

The Esquimalt Rural Nursing Service is representative of what 
is being done south of Duncan towards that better-health scheme on 
lower South Vancouver Island. It is the nucleus of what we hope 
will follow later — a unit, not unlike that of Saanich, fortified with a 

51 



full-time Medical Health Officer, with its two or even more fully 
trained Public Health Nurses. It seems to me that progress made 
by a committee and the public can be termed concrete, but by 
a nurse more often abstract and totally eclipsed if she allows it to 
be " bulletinized." However, there are a few significant changes on 
the Island comparable with those of the Mainland, and, figuratively 
speaking, cutting our own cloth a little less material is wasted. Some 
of our biggest problems have been essentially local and are problems 
which we have made every attempt to solve ourselves. 

First and foremost, in addition to our executive and council, we 
have a nursing committee, meeting regularly once a month to discuss 
the particular problems which are daily confronting the nurse. Up 
to October, 1936, the nurse was a very much disjointed factor as far 
as the committee was concerned and her presence not required at a 
meeting. It was with a great deal of effort that new clinics were 
established, boundaries extended ; consequently her progress was slow. 

Following in the wake of the new committee, the nurse's equip- 
ment was brought up to date ; secondly, the new record system has 
been introduced in part, the binder to follow later on an instalment 
basis; thirdly, the school service has been extended to the children 
from this district attending Victoria High School. The follow-up 
service initiated by the city nurse is completed by the rural one. 
Epidemics which extend to us from the city in this way, as, for 
example, our late measles epidemic, are now being checked before 
many more children are endangered in the country. Fourthly, a loan 
cupboard was suggested, filled, and kept intact by the nursing com- 
mittee itself. At the same time an additional fund has been set aside 
for miscellaneous emergency needs. At all times the E.R.N.S. has 
been mindful of the indigent, stimulating and assisting when it has 
been advisable to do so. Sixthly, the committee has stressed the need 
for more home visits and fewer transportations. It seems advisable 
to encourage neighbours and friends to help ; in the long run more 
real good is done for the community. Seventhly, fees are payable for 
visits made to the acutely ill, providing they are in a position to pay. 
Responsibility of the patient recovering is placed on capable members 
of the family. The majority very readily accept this care, with a new 
interest, when instructed by the nurse, who is able to make a seemingly 
unpleasant task interesting. 

The Public Health Nurse in Langford is somewhat of an inter- 
mediary, procuring assistance for the undernourished, finances and 
doctors for the correction of defects. Eighthly, standing orders are 
to be revised by the new committee and the nurse. Up to the present 
orders have been verbally given by doctors over the telephone, which 
from the view-point of the nurse might some day prove very un- 
satisfactory. 

Our greatest difficulty is no doctor in the district. A patient taken 
to a doctor's office must often wait for a considerable time. Sometimes, 
to offset this difficulty and to ensure a nurse's speedy return to her 

52 



district, responsibility has been assumed by the housemen of Jubilee 
and St. Joseph's Hospitals. Immediate care has been taken of the 
patient until assumed by the family doctor. 

Lastly, Dr. Grant and the medical men of Victoria and districts 
adjoining have worked together and held regular meetings to advance 
methods of communicable-disease control. A very close watch has 
been kept on the district with regard to streptococcus throats and ear- 
infections. There has been 'careful observation of the relationship 
of school attendances and disease in the respective districts. 

Such a measure would prove somewhat satisfactory with regard 
to the Public Health Nurses. The suggestion has already come from 
Miss Young that we form a discussion group. A number of the nurses 
from Saanich, Esquimalt, Rural Esquimalt, and Victoria Centre have 
already expressed a willingness to co-operate. This should make more 
uniform our methods of approach and eliminate the unnecessary pit- 
falls of the nurse who is working alone. 

The institutes have, as follows, grown in the extent of their 
usefulness : Shirley has asked for another clinic and promised to follow 
up recommendations given by the doctor. Happy Valley and Langf ord 
have jointly supported in the past one infant and pre-school clinic; 
now they have two, one in each district, every other month. 

The first toxoid and vaccination clinic, supported by both districts, 
will be held in Langf ord on February 13th. A lively interest, too, has 
been exhibited by the Parent-Teacher Associations; cocoa at noon 
hour, toothbrushes for distribution, and added equipment for the 
schools. Through their efforts a first-aid course was sponsored this 
winter and also occupational courses given to the girls. Last year 
they canvassed the district to bring in the nursing service, when other- 
wise there would have been no district nurse; with this stimulation 
of interest, the following year the difficulty had been almost overcome. 

The Canadian Legion, too, has played a part, significant to its 
members, the returned men and their families. 

Educational material has been provided from various sources, 
which we are attempting to use to further elucidate for the teachers 
the health programme laid down in the schools. 

I think we, too, have made the turn. 

Dora Wilkie, R.N. 



TOXOID AND VACCINATION CLINICS IN WEST DISTRICT 

OF PEACE RIVER BLOCK. 

I have been in this district just a little over a year and can see 
many problems which apparently for the time being have no solution, 
but there are other problems which can be worked out. 

I think the most valuable piece of work done here was the 
toxoiding and the vaccinating of the pre-school and school children. 
When people live in remote places, 50 to 100 miles from a doctor 

53 



or hospital, it is satisfying to them to know that they need not worry 
about the dreaded diphtheria and smallpox. 

The doctor and I arranged a very systematic programme for the 
twelve schools in the district. The work was to be begun the first 
week in August and completed by the end of September. 

At the beginning of our work the weather was glorious and roads 
excellent. We completed the first inoculations very successfully. 
Three weeks later our second series was equally successful. One 
would be led to suppose that the tales told of transportation difficulties 
in the " Peace " were a myth. 

However, when the time came for the third series of inoculations, 
things looked vastly different. The morning of September 14th, 1936, 
found us trapped in our homes with about 3 feet of snow. This made 
travel impossible and operations were postponed for a week. When 
this time came, another picture of transportation problems came to 
the fore. While the snow had gone, the roads were now converted 
into veritable seas of mud. The doctor started out in his car in spite 
of it, but after 10 miles of travelling in low gear he was forced to 
give up. 

Our work was not completed until December 15th, and, in spite 
of all difficulties, the records of toxoid and vaccinations at the end 
of 1937 are something like this : 68.6 per cent, of all school-children 
toxoided ; 62.6 per cent, of all school-children vaccinated ; 62.6 per cent, 
of all pre-school children toxoided ; 50 per cent, of all pre-school chil- 
dren vaccinated. 

There was very little opposition to our work. The greatest 
difficulty is to get to the places to do the work. The majority of the 
people are very glad to have their children protected from every 
disease possible. 

Pauline Yaholnitsky, P.H.N. 



VICTORIA, B.C. : 
Printed by Ciiaui.es F. Banfield, Printer to t ho King's Most Excellenl Majesty. 

1037. 



350-337-4984 



54 



i 

ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 2 



MARCH, 1938. 



No. 5 




Head Office: Top floor— right. 



EDITORIAL. 

The request for articles for the Nurses' Bulletin comes around 
as regularly as Easter does ; but we seem to prepare for Easter with 
much more gusto than we prepare for the Bulletin — naturally! 
However, as one nurse to another: Do you not get tired of reading 
repeated yearly reports in the Bulletin? We are all engaged in the 
same type of work; we have all done tuberculin tests; we are all 
conducting clinics of various types, and are all carrying out a con- 
scientious preventive public-health programme — BUT we can all read 
the sum total of this work in the annual report issued by the Board 
of Health. Why, then, fill the one magazine of the year with so many 
rehearsals of our daily routine activities? So many of us have done 
just that. 

For the benefit of nurses all over the Province, each nurse should 
submit, for the Bulletin, a serious — or humorous — article of definite 
professional or secular value so that each of us may refer to it for 
information and relaxation. The Bulletin has been published for 
fourteen years, and it is a poor commentary on our progressive public- 
health work that we cannot produce something that could be read with 
enjoyment. We owe to the Board of Health a tangible return for 
privileges received, and in what better way could we express this than 
by making this a REAL Bulletin ? 

B.J. 




"Hello, Nurse! What's your name?" 



TABLE OF CONTENTS. 



Armstrong, Miss 
Arnould, Miss J. 
Blank, Miss L — 
Crafter, Miss L. 
Dunn, Miss N. E, 
Garrood, Miss 0. 
Gowan, Miss M.— 
Grierson, Miss M 
Grindon, Mrs. A. 
Jenkins, Miss B.- 
Little, Mrs. M. — 
Maguire, Miss E.- 
Malkin, Miss L.- 
Martin, Mrs. E- 
Miles, Miss M. C 
McFarlane, Mrs. 
Time Out 



Page. 

N. E. — North Vancouver Eye Clinic 5 

M. — Water Problems in a Rural Area 6 

A Rural Baby Clinic 7 

W. V. — Communicable-disease Control 8 

— Tuberculin Testing in Nelson Schools 9 

M.— Sir Truby King— A Tribute 10 

-Peachland-Westbank : 12 

. E. — Dewdney Health District 13 

P.— Dental Clinic 15 

—On Being a Patient 17 

What We, Are Doing 18 

-The Mennonite in British Columbia 22 

•Sex-education 25 

Vernon 26 

—School Dental Clinic 27 

R.— A Ditty from the North 28 

29 



Upper Island Symposium — -The Need for a Field Super- 
visor 30-35 



Putnam, Miss M. 
Goward, Miss K. 
Snowden, Miss E. 
McInnes, Miss A. 

KlLPATRICK, Miss H. 

McMillan, Miss I. 

Law, Miss A. S. 

Moody, Miss E. — Chilliwack Municipality at a Glance 36 

Ochs, Miss E. — Vaccination in a Rural Area 39 

Priestly, Miss E. D. — Our First Year 40 

Seymour, Miss W. E. — Fernie 41 

Sheppard, Miss K. — Tonsil Clinic in the Peace River Block 42 

Smith, Miss M. R. — Vaccination at Normal School 44 

Tait, Miss C— What of Eyes and Ears? 45 

Tate, Miss D. 1 

Freeman, Miss V. J [Transportation 46 

Thomson, Mrs. B. — Contrasts 49 

Twiddy, Miss M. A. — A Child-study Group 49 

Wilkie, Miss D. — Growing Up 50 

Wooding, Miss L. A. — Gibsons Landing 52 

Yaholnitsky, Mrs. P. — Dental Clinic 53 






NORTH VANCOUVER EYE CLINIC. 

The North Vancouver Health Unit, in common with other organi- 
zations of similar nature, has experienced a certain amount of diffi- 
culty in correction of physical defects. During the regular physical 
examination of school-children we found that a fair number had 
defective vision. Defective to such an extent that it was materially 
retarding their school progress. 

Since the Health Unit is concerned not only with the school- 
children, but with the health and welfare of the community as a whole, 
many adults and a few pre-schools came asking us to help them get 
a proper eye examination and glasses. 

For a few years after the inception of the Health Unit we were 
able to send these cases to the Out-patients' Department of the Van- 
couver General Hospital. But, due to the enormous pressure of work 
at that clinic, it sometimes took months to complete an examination. 
Then one sad day we were told we could send no more. 

In December, 1934, an eye clinic was organized under the aus- 
pices of the North Vancouver Health Unit. Through the generosity 
of the North Vancouver General Hospital, in which our offices are 
situated, we were allowed the use of the X-ray room in which to hold 
our clinic. Our own two offices, and at times the waiting-room in 
the hospital, serve as waiting, admitting, and treatment rooms. By 
treatment is meant the dilation of the pupil of the eye with homatro- 
pine and cocaine disks. All patients under 40 require this dilation. 
It is really surprising the number of women who do not mind 
admitting they are over 40 ! 

Having no eye, ear, nose, and throat specialist in North Vancou- 
ver, we were obliged to go farther afield, and one from Vancouver 
consented to come over to assist us. 

The financing of the clinic is, of course, a difficult matter. The 
city and district agreed to pay one-third of the usual fee for examina- 
tions of all people admitted to the clinic who are on relief. But in 
this, as in any other, community there are numerous people needing 
attention who are in circumstances little better, if any, than those 
who are receiving municipal relief. These people are examined at the 
clinic through the kindness and generosity of the attending physician. 

Payment for glasses presented another difficult problem. The 
North Vancouver Kiwanis Club was approached and agreed to pay 
for the glasses for school-children. The Canadian Red Cross Society 
also consented to pay for five pairs of glasses a month, provided that 
three of this number were for those for whom the Canadian Legion, 
War Veterans, or the Army and Navy League would ordinarily assume 
some measure of responsibility. 

We average ten examinations at each clinic. These cases are not 
all for refractions, because people with various conditions of the eye, 
ear, nose, and throat are referred to our clinic by the doctors in the 
community. 



Since the eye clinic has been established 112 children have been 
examined, each making at least two visits. The eyes of 103 children 
have been refracted. The remaining nine children had various con- 
ditions of the eyes, ears, and nose. One hundred and fifty-five adults 
have visited the clinic, 129 of which have been cases of refraction and 
26 have been cases suffering from other pathogenic conditions of the 
eye, ear, nose, or throat. 

N. E. Armstrong, R.N., 

North Vancouver Health Unit. 



WATER PROBLEMS IN A RURAL AREA. 

One of the many public-health problems centres around water, 
or the lack of water. While water may actually cover three-fifths of 
the entire earth's surface, it is not always accessible or drinkable. 

Water is not technically a food, but it is an essential part of the 
diet. In addition, it bears an important relationship to personal hy- 
giene, inasmuch as it is necessary for the maintenance of proper 
cleanliness of the person, the clothing, and other conditions of one's 
surroundings. 

In making a survey of the school area water-supply ten of the 
nineteen schools had tap-water, two had water carried from near-by 
streams, two from neighbours' wells ; the remaining five used pumps. 
When water samples were taken and sent to the Provincial Laboratory 
for tests, only one well was found to be free from faecal bacteria and 
five taps and fountains. 

One did expect the tap-water to be free of faecal bacteria, but 
when three taps from the same water-supply showed the presence of 
faecal bacteria it created an unpleasant situation, for the source of 
the supply had been considered to be pure. After a thorough investi- 
gation, much consternation, and further tests, it was decided that the 
water was only contaminated temporarily. Further investigation 
showed that the fountain, after having several positive reports, tested 
negative after it was pulled apart and thoroughly cleaned. 

Even though wells have been rebuilt and repaired and thoroughly 
pumped out and chlorinated, some later showed the presence of faecal 
bacteria. This makes us consider the conditions caused not only by 
sewage, but by birds, mice, etc. 

Even though a well seems a safe distance from a toilet, if the dry 
toilet has been in use twenty-five years, and the cribbing and lining 
of the once good well has given way, perhaps this, too, may cause 
recurrence of the faecal bacteria in the water sample. 

The rebuilding of wells is not as simple as it sounds. In the first 
place it is an expense, especially in gravel. Recently one well was dug 
in the gravel area, and the first few feet cost at the rate of $1.50 per 
foot. When 124 feet was reached below the surface they drove a pipe 
yet another 7 feet. This was not a cheap well; but owing to water 
being very scarce in the district the expense is inescapable. 

6 



It is rather embarrassing when letting people out of quarantine 
and telling them to shampoo the hair, take a bath, etc., to have them 
say: "How can we; we have no water? We have to carry it for 
half a mile." 

One often takes it for granted water is available. With many 
large families living on gravelly land, with very small homes and the 
barest necessities, the idea of a bath is more often a fad than a fact. 
With the installation, where necessary, of wash-basins, sinks, 
and paper towels in schools, many children are now proud of their 
clean hands. 

J. M. Arnould, R.N., 

Matsqui-Sumas-Abbotsford Area. 



A RURAL BABY CLINIC. 

Out where the sun is a little brighter and the air a little purer, 
one finds health. Country babies are, on the average, very healthy, 
but there are still many problems that confront the rural mother. 
We find, too, that much of the recent knowledge concerning preventive 
medicine and infant-feeding are quite unfamiliar to her. To bring 
this more recent data into the country home, and to stress the rela- 
tionship between proper diet and gain in weight, it was felt that a 
weighing-station for babies would be of advantage in the Municipality 
of Chilliwack. 

In organizing such a clinic in the winter months, one would 
necessarily encounter difficulties. Not alone because of the inclement 
weather and impassable roads, but also because of the fact that the 
farm-houses are scattered and walking to the nearest hall usually 
means a distance of one or two miles. Few families can afford the 
luxury of a car. 

In spite of these drawbacks, our first clinic was held in Atchelitz 
District. The various organizations in this community proved them- 
selves very helpful. First, the Farmers' Institute donated the use 
of their hall and arranged for the heating of it on Wednesday after- 
noons. Then through their leaders the Women's Clubs made known 
the date and place of our first infant and pre-school assembly. 

Announcements were also made to the school-children that they 
might carry the news home to their mothers. The older ones made 
posters and displayed them in the local store and hall. 

Surely such co-operation should produce results, and we are glad 
to say that it did. The attendance, though small, was larger than 
expected, and included several pre-school children. We will particu- 
larly welcome these at our future clinics because, after all, they are 
in close daily contact with their brothers and sisters of school age 
and become possible sources and victims of disease. Education of 
mothers at these clinics will, we hope, reduce the instance of pre- 
ventable infections in the home. For this reason, besides weighing 

7 



each infant and child and answering numerous questions, we dis- 
tributed health literature. 

Perhaps our present methods may not be helping those whom 
we most desire to help, but through the organization of this and other 
clinics throughout the valley we shall learn something more and profit 
by our mistakes. Then we shall be one step nearer our goal — namely, 
a well baby through a health-conscious mother. 

Lillian Blank, R.N., 

Chilliwack, B.C. 



COMMUNICABLE-DISEASE CONTROL. 

During 1937 the Oliver, Osoyoos, and Okanagan Falls District 
was fortunate in having no serious epidemic of communicable dis- 
ease. This was perhaps largely due to the fact that parents are 
beginning to realize the importance of early reporting of any suspi- 
cious symptoms ; and, though there were three separate outbreaks of 
whooping-cough and two of measles, these were all under control 
before more than the first case and its immediate contacts were 
affected. As much publicity as possible was given to these cases, in 
an effort to teach by example the preventive work of the Medical 
Health Officer and the Public Health Nurse, so that the future 
co-operation of the public might be obtained. 

Vaccination and diphtheria-toxoid clinics occupied considerable 
time this year; the arranging and visiting in connection with these 
taking far longer than the time actually spent in the clinics. How- 
ever, we were fortunate in obtaining a high attendance at all our 
clinics, so felt the time had been well spent. Two of the schools in 
the district are now 100 per cent, vaccinated, and the rest not far 
behind. In spite of the gloomy forebodings of the anti-vaccination- 
ists, from whom no district is entirely free, few of the children missed 
even one day of school, and those who were absent were all visited 
to make sure there was nothing serious the matter. Later the nurse 
was particularly glad she had made these visits, as it enabled her 
to deny the occasional story she heard of " the terrible arm Mrs. 
Somebody had heard little Gladys So-and-so had had." 

In 1937 the Government Travelling Chest Clinic visited Oliver 
for the first time. Previous to its arrival many of the school-children 
had received the tuberculin test, and all those with a positive reaction 
were examined. Many adults also took the opportunity to attend this 
clinic, and, at the request of the nurse, several Indians came down 
from the reserve. The only active cases found were a sister and 
brother from this reserve. 

Though no doubt much could still be done in this direction, it is 
felt that something at least has been attempted in disease prevention 
by these efforts. 

Lucy Crafter, R.N., 

Oliver, B.C. 

8 



THE TUBERCULIN TESTING IN NELSON SCHOOLS. 

Having been transferred last fall from the Peace River, I have 
not yet spent sufficient time on duty to carry out any detailed 
programme. 

What may be of interest to my fellow-colleagues is a detailed 
account of tuberculin testing in one school, written with the view- 
point of organization, and what may be of most help to the parents 
and the medical staff. Some may improve on it; to others it may 
be of help. 

The subject of T.B. testing was introduced last year to the public 
by Dr. F. M. Auld, who is in charge of the T.B. work in this district. 
This was done by lectures and demonstration. One hundred and 
twenty-seven first tests were given at the Central School. This year, 
with the help of Dr. F. P. Sparks, Medical Health Officer, Dr. Auld 
is tuberculin-besting all school-children. 

In the Central School of 450 pupils the T.B. testing has just been 
completed. The consent forms were mimeographed letters to parents. 
In the advance grades each pupil filled in his own, with the co-opera- 
tion of the teacher and nurse. This saved much valuable time and 
the children enjoyed it. They took them home for the parents' signa- 
ture. We had 80 per cent, consents from parents. On account of 
the fact that there were large numbers to be tested and two doctors 
were working, the class-rooms were used. We had splendid co-opera- 
tion from the teachers, who acted as secretaries and carefully checked 
the name of the child as he was done. We found two things of para- 
mount importance — fresh air and plenty of interesting seat-work. 
The seat-work took their minds off the needle and injection and kept 
them busily occupied. As a result only four cases out of 390 were 
referred to the medical room. The technique used was alcohol prepa- 
rations, an alcohol-lamp for flaming the needle on a metal tray. We 
worked rapidly at the rate of 100 patients per hour. 

All data were recorded on school cards and then filed. All doc- 
tors were notified by mimeographed letter of positive reactors. All 
parents of positive reactions were visited and history written up. 
They were asked to get in touch with their own private doctor to be 
referred to the Travelling Clinic. We found 13.33 per cent, positive 
reactors in the school. 

We found this quite an amount of work but it proved so worth 
while. 

Case A. — Six-year-old reactor. On visiting, found other pre- 
school children. The family would give no history, but the grand- 
mother, who lived a quarter of a mile away, had a bad cough. The 
children often used to visit her. In looking over our Provincial 
records, the grandmother was found to be a positive open case. With 
the co-operation of the family doctor, they were again warned of the 
danger the children were running. 

Case B. — No family history, but the child had raw milk as a baby 
from a herd that was destroyed by the Government. 



Case C. — Mother died at home last year of T.B. No check had 
been made of the three children who showed severe reactions to the 
first T.B. test. The mother never at any time had been admitted to 
the Sanatorium, and one wonders what the technique was carried 
out at home and also what the future holds for those three children. 

These are only a few of the interesting' cases that the files showed 
and the importance of this piece of public-health work. 

Many of the parents were worried about their children and asked 
us to have Dr. Kincaid lecture, which he has kindly consented to do, 
with lantern-slides. He also wished to speak to only small groups. 
Two days have been set aside for school-children at the hospital for 
the Chest Clinic. Dr. Kincaid has asked that the nurse attend the 
clinic. 

" It is not truth that makes men great, but men that make truth 
great." 

Nancy E. Dunn, R.N., M.B.E., 

Nelson, B.C. 



SIR TRUBY KING— A TRIBUTE. 

Women all over the world know the name of Sir Frederick Truby 
King, who worked all his life to improve the health of children and 
their mothers. He passed away on February 9th, 1938, at the age of 
79, after a long illness. 

Dr. Truby King was knighted in 1925 for his work for child 
and maternal welfare. He was known as " the baby's friend," and 
his reputation stood so high that the United Kingdom Government 
once borrowed his services from New Zealand to establish a babies' 
hospital and mothers' training centre in England. 

At the age of 22, Truby King left New Zealand to study at 
Edinburgh University. After a brilliant career at the medical school, 
during which time he won a much-coveted honour, the Ettles scholar- 
ship, he spent some years in Scotland and England. Then he studied 
public health and was one of the first few graduates in preventive 
medicine. He specialized in mental diseases. Returning to New 
Zealand, he held several important posts before being appointed, in 
1889, Medical Superintendent of Seacliffe Mental Hospital, some 20 
miles from Dunedin. 

Always a profound thinker, Dr. Truby King was stirred at the 
amount of suffering he noted. So much, he felt sure, was preventable, 
and he set about finding some solution. It was his conviction that 
the terrible increase in mental diseases could only be stemmed by 
beginning at bed-rock ; this is, teaching women how best to care for 
themselves and their children. He began by working quietly among 
the mothers and babies in and around the village of Seacliffe. For 
three years he and his wife battled without aid, fighting uphill against 
apathy, ridicule, and ignorant prejudice. 

10 



In 1907, at a public meeting in the town hall of Dunedin, the 
Plunket Society was formed. Progress at first was slow; only the 
few and far-seeing gave active support. But one by one the cities 
and towns recognized the benefits, and branches of the society became 
widespread in New Zealand. 

By 1912 statistics of reduction in infantile mortality showed the 
value of the society's work, and Dr. Truby King was asked by the 
Government to establish branches wherever he could find women 
willing to undertake the management. By 1917 the work had created 
interest abroad, and about the middle of that year the authorities in 
England, appalled at the terrible wastage of infant-life there, cabled 
Dr. Truby King, asking him to establish his system in the heart of 
the Empire. Miss Nance Pattrick was transferred to his assistance. 
(She passed on last year after many years as Director of Plunket 
Nursing, and was known in Kamloops.) Their work was a success 
and since then Plunket centres have been established in South Africa, 
Palestine, Australia, Canada, and Brazil. 

A great soul has passed on — Sir Truby King, C.M.G., the grand 
old man of New Zealand. A privileged few in Canada have known 
him for many years. A man, simple as only the great are, he gave 
his scientific knowledge freely to all. He was a man of dynamic 
personality filled with undaunted courage and enthusiasm. He was 
founder and general president of the Royal New Zealand Society for 
the Health of Women and Children for twenty-two years. The exis- 
tence of this society was due to Sir Truby King, who inaugurated it 
in Dunedin in 1907. The purpose of this society has been described 
by Sir Truby as follows : — 

" It seeks to bring simple common sense, enlightenment, and 
accurate scientific knowledge and conviction as to the fundamental 
needs of mother and child into the homes, lay and professional." 

The society was started as a league for mutual helpfulness and 
mutual education, with the full recognition of the fact that, so far 
as motherhood and babyhood were concerned, there was much need 
for practical reform and " going to school " on the part of the cul- 
tured and well-to-do as there was on the part of the so-called " poor 
and ignorant." 

Sir Truby King's gospel for the health of the mother and the 
baby has spread world wide. His system of child-care is used in 
many countries, including Canada. After the Great War he received 
a knighthood in recognition of his work for the Empire. He visited 
Canada in 1928 with his daughter and was prevailed upon to address 
the Canadian Club of Vancouver. I well remember the occasion ; the 
great driving force of his personality, simplicity, and charm. He 
said : — 

" Canada needs immigrants and the best immigrants she can 
have are healthy babies. Since coming to Canada I hear the cry, 
' Back to the land, my boy.' I say to the mothers, ' Back to the breast 
with your babies,' for it is their birthright." 

11 



On another occasion in an address, " Progress in Child Welfare," 
he said : — 

" The main questions are: What sort of parents and what sort 
of homes and environments have the rising generations had? What 
sort of mothers have they had ? What sort of nutrition, feeding, and 
care have been bestowed upon them? What sort of example, educa- 
tion, and discipline have they had? And what sort of habits have 
been formed at home, at school, and at the pictures ? The main thing 
to grasp is the fact that every child is more or less made or marred 
before reaching school age — say, six years from birth. These six 
years are of far greater and formative and constructive importance 
than the next sixty years of life. Not only from the standpoint of 
bodily form, physique, and freedom from disease, but also as concerns 
the mind, the moral nature, and the whole future habits and character 
of the individual." 

Mankind has benefited by the truly humanitarian way in which 
he used his scientific knowledge. His motto always was : " It is wiser 
to put up a fence at the top of a precipice than maintain an ambulance 
at the bottom." His work will live for ever through healthy children, 
who will be a monument to his greatness. 

strong soul, by what shore 
Tarriest thou now? For that force 
Surely has not been left in vain ! 
Somewhere surely afar, 
In the sounding labour house vast 
Of being, is practised that strength, 
Zealous, beneficient, firm. 

— Matthew Arnold. 

Olive M. Garrood, R.N., 

Kamloops, B.C. 



PEACHLAND-WESTBANK DISTRICT COMMITTEE. 

Throughout the year we have carried on a generalized pro- 
gramme. Of necessity, as this district of Peachland-Westbank is 
more or less isolated, considerable time is spent in emergency and 
bedside-nursing, but many more hours are devoted to preventive work. 
However, because of the distance to larger towns, the incidence of 
communicable disease here is somewhat lower. 

Pre-school and infant-welfare work consists of home visits and 
well-baby clinics, which are attended by Dr. Ootmar, of Kelowna. 
This year special clinics were held, when forty pre-school and fifty 
school-children were given diphtheria toxoid. 

In the schools all class-rooms, including Grades I. to VIII., are 
now enrolled as branches of the Junior Red Cross. The children have 
derived much pleasure and knowledge from their meetings and health 
programmes. Many physical defects have been corrected and the 
percentage of underweight pupils has greatly decreased. Tincture of 
iodine has reduced the simple goitre so prevalent here. 

12 



This year our tuberculin survey revealed three boys with positive 
local reactions. Each was later given another examination by Dr. 
Kincaid, of the Travelling Chest Clinic. All three reactors had 
recently come to Peachland from other parts of Canada. 

During September and October, when acute anterior poliomyelitis 
was the cause of great concern in this valley, under the direction of 
the local Health Officers we used the preventive nasal spray. Peach- 
land school was closed for a short time, but the four other schools 
remained in session and all absentees were visited. 

Our programme includes supervision of the health of the Indians 
on the near-by reserves. More and more the Indians are reporting 
cases of illness, seeking advise, and observing rules of quarantine in 
cases of communicable disease. When a case of measles developed 
this summer the infection spread no farther than two immediate 
contacts. 

At present vaccination is of great importance as cases of small- 
pox have been reported near the Border. A few weeks ago Dr. Willits 
vaccinated many of the Indians and now we are holding clinics for 
school and pre-school children. 

Another step forward in community welfare was the establish- 
ment of a Provincial Recreation Centre at Westbank. The good 
attendance is evidence of the appreciation of the young people, who 
greatly enjoy the evenings when Jack Lynnes comes from Kelowna to 
lead our group. 

So with great hope we look forward to this year of 1938 for 
further advancement and increased community health. 

M. Gowan, R.N., 

Peachland-Westbank. 



DEWDNEY HEALTH DISTRICT. 

One goal, long hoped and worked for, has at last been reached. 
The Maple Ridge and Mission Districts each has its own Public Health 
Nurse, and, albeit, Mission, the smaller half as to school enrolment, 
had five rural schools added to it. Another goal glimpsed in the 
distance is a full-time Health Unit. 

Maple Ridge District has had an excellent nurse all its own since 
January 1st of this year. The Mission District, together with the 
areas to the east of it, now has the title of Dewdney Health District. 
It is comprised of fifteen schools, in rather a scattered area, with an 
enrolment of 968. For the past few years I have only been able to 
visit each district every other month, but now I can make more fre- 
quent visits, which is much more satisfactory. 

In the past two months I have endeavoured to become better 
acquainted with the homes of pupils, infants, etc. The first month 
was chiefly taken up with the five " new " areas which have not had 
a Public Health Nursing Service before. Since there have been no 

13 



cases of communicable diseases of any kind, I have had more time for 
a generalized programme than was previously possible. 

Plans are being made for central office and clinic rooms, and by 
the next year we have high hopes that numerous clinics will be held 
in this area, and we hope that a medical room will soon be built in an 
eight-roomed school for us. 

Through municipal medical fees for indigents and the assistance 
of the Comet Club, twenty pupils have had their tonsils and adenoids 
removed in the past eight months. Ten pupils have received eye tests 
and glasses through the School Board and twelve others have been 
able to assume the cost themselves. This is most encouraging and I 
feel as though the field is just opening up. 

Mary E. Grierson, R.N., 

Mission, B.C. 







" Yeth, I had a thwell time." 



14 



THE ORGANIZATION OF A DENTAL CLINIC IN THE 
KELOWNA RURAL DISTRICTS. 

The Kelowna Rural School Districts cover an unorganized farm- 
ing" area of some 200 square miles on the eastern shore of the 
Okanagan Lake in the interior of British Columbia. 

Ten local School Boards have charge of the educational needs 
of an ever-increasing and changing school population of some 850 
children, comprising some sixteen nationalities. Each local Board 
has difficult problems of financing, due to non-payment of school taxes 
by many of the farmer taxpayers, and the fact that many parents of 
school-children are simply land-workers and do not pay any taxes. 
Owners and renters of small farms receive a poor price for their 
products, and many land-workers earn a small wage of from 10 to 15 
cents an hour during the summer months, necessitating Provincial 
Government relief during the winter months. 

Such is the local situation and such the problem which has always 
confronted the School Health Service when considering the great need 
of dental care for the children. 

The School Boards, already helping to finance the School Health 
Nursing Service, felt that they could not take upon themselves the 
heavy expense of attempting to finance a dental clinic. No other 
rural organization had means, or any prospect of obtaining the means, 
for such a project, although frequent reports had been presented and 
all recognized the need for such a clinic. 

The Provincial Department of Health has many calls upon its 
resources, but yet another strong plea for aid last July brought from 
Dr. Young a promise that if parents, local School Boards, and four 
local Women's Institutes would co-operate with the conditions laid 
down by the Department, that dental care would be provided as a 
demonstration during the next school-year. 

The conditions were that School Boards and institutes should 
provide suitable working-quarters, with light, heat, and water, and 
that a high percentage of parents should give consent for dental care 
for their school and pre-school children, and also be willing to pay a 
cash fee of $1 for each child treated. 

When schools reopened in September, 1937, the campaign began. 
School Boards were informed of the conditions, and asked to send 
a representative to form local committees with the School Principal, 
School Nurse, and a member of the local Women's Institute (if organ- 
ized) . Parents were circularized with a letter setting forth the great 
advantages of such a clinic for both school and pre-school children, 
and asked to give a signed consent for the treatment of their children 
and to the payment of a $1 fee for each child treated. 

By the end of October we were able to inform the Department 
that approximately 70 per cent, of the parents had sent in a written 
consent to the conditions; that School Boards were much interested 

15 



and willing to provide suitable accommodation; and that the largest 
Women's Institute was most enthusiastic and willing to sponsor the 
pre-school children's clinic. 

The twenty-seven rural teachers were also most enthusiastic, 
pointing out the need of dental care to the children in health lessons, 
assisting in distributing and collecting letters of consent, and express- 
ing willingness to be responsible for the acceptance and receipt of fees 
from the children in the individual classes. Even the collecting of 
the small fees is in itself a problem, and any success obtained has been 
due to the repeated efforts and constant reminders of individual teach- 
ers to the children under their care. Too much appreciation cannot 
be given to the teachers for their hearty co-operation, for without 
their willing aid it would have been impossible to have successfully 
organized the detailed work of such an intensive campaign. Each 
teacher was given a duplicate copy of the School Nurses' dental 
register, and very frequent checks and rechecks were made. This 
register is invaluable to the clinic assistant as a reference upon which 
the work of the clinic is based. 

In December, 1937, a letter came from the Department of Health, 
stating definitely that Dr. Ross Currie, D.D.S., would be ready to 
begin operations in our districts on February 1st. School Boards were 
again notified and a drive made for fees. By this time about 10 per 
cent, of our school-children were receiving Government relief, and 
permission was given by the Department for these children to receive 
free care, also certain children from the devastated Prairie areas, who 
were not eligible for relief from the Provincial Government of British 
Columbia. Also by arrangement with the local Provincial Relief Offi- 
cer certain fathers of large families on relief were given extra work- 
days to pay for the dental fees. 

The Department had expressed a wish that pre-school children 
should also have the opportunity for care, so, in addition to the first 
inclusive letter to parents, a special pamphlet was written by the 
School Nurse, stating in very simple language reasons for the care 
of the teeth of small children, and inviting each mother to bring her 
young children to a free clinic for examination by the dentist at a 
definite time and place, and a fee of $1 per child would be charged. 
These notices have been mailed and will be mailed to all mothers of 
pre-school children in ten school districts, so that all children will have 
an opportunity to receive dental care when the dentist is in their local 
school. By these means we hope to have a good response. 

Dr. Currie started operations in our largest school district on 
February 1st, every one helping to set up the clinic in the teachers' 
room of the school. The Department most kindly provided salary 
expenses, also for a permanent clinic assistant, which facilitates mat- 
ters greatly. We are really proud of the set-up of the clinic, also of 
the school-children, whose clean teeth and excellent behaviour have 

16 



been commended. The behaviour of the children is due in no small 
part to Dr. Currie himself, who combines kindness and firmness with 
a real understanding of the psychology of childhood. 

Anne F. Grindon, R.N., 

Keloivna, B.C. 



ON BEING A PATIENT. 

Have you ever been a patient? Have you ever been admitted to 
a hospital by a conscientious pupil nurse who insisted on strict ad- 
herence to hospital routine by making you get into bed — even though 
your operation was not slated until 10 o'clock next morning — and you 
had walked in? If not, you have missed a tremendous experience. 
It wasn't so much being put to bed; it was having to disrobe with 
strangers around and no privacy, and having to don that priceless 
open-backed gown which refused, on principle, to even cover your 
knees! It gave the feeling that one was all front, and, as they say 
in the Army, " a good soldier never looks behind " (we hope) . 

But that was only the beginning. There followed during the 
course of the evening the inevitable "local prep." and S.S.E. (the 
request for self-administration being steadfastly refused on grounds 
of routine) , which was the most embarrassing piece of ritual any one 
was ever subjected to. After that it didn't matter what happened, 
and absence of sleep and absence of breakfast the next morning you 
just took in your stride. 

The trip to the O.R. is taken with a good deal of speculation; 
you looked so cute before taking the trip ! All dressed up in volu- 
minous socks and tight skull-cap — you felt ready for anything ; in fact, 
you felt very much like a warrior with the nurse pushing you, willy 
nilly, along the corridors, and, because you were a nurse, the head 
nurse walking beside, keeping guard. The elevator-man, recognizing 
you, elevates his eyebrows, and, with a know-it-all laugh, wishes you 
luck! 

The speculation is at fever height when you are ushered into the 
O.R. theatre. The scrub nurse hears your name — and gasps; the 
anaesthetist, busying himself, passes some disquieting remark about 
" getting her under as soon as possible because the Doctor is almost 
ready," and forthwith proceeds to see how much a part of the bridge 
of your nose he can make the gas-mask. You say to yourself, feeling 
quite inebriated by this time with the Nembutal : " I'll fool him ; I 
won't go under." And the next thing you know every one is talking 
at the same time and they are yanking you off the O.R. table and 
literally dumping you back on to the stretcher. Vaguely you try to 
think things out. You don't really care what they're doing, and, like 
something detached, you hear your condition being discussed and are 
dimly conscious of the fact that you have an abdomen which feels 
strangely different. Suddenly you wake up again to the fact that the 
ceiling looks awfully small and people very close to you, and with 

17 



difficulty you arrive at the conclusion that you must be going down in 
the elevator ; but don't care about anything — it's a glorious feeling — 
and off you go again. 

The next inroad into your consciousness is the fact that you hear 
your Doctor's voice (sounds like that poem, the " Village Blacksmith " 
— he hears his daughter's voice, singing in paradise) . I don't mean 
that your Doctor's voice sounds like the village blacksmith! . . . 
" How are you feeling? " booms the voice, and you say, coyly: " I'm 
fine; how are you?" And much laughter is heard. I don't know 
why . . . and you're off again, only to be brought back by the 
jab of a needle from the intravenous set-up. 

The first days and nights roll slowly around, punctuated by hypos 
at regular intervals, and the forced fluids which you learn to abhor — 
even to your favourite ginger-ale — which, like lemonade, and orange- 
ade, and thin soup, all end up as a dark-brown taste. But every one 
is extremely kind through it all, and finally you arrive at the stage, 
via gas pains and sedatives, where you begin to take a little interest 
in your dinner-tray and to make life generally miserable for those in 
attendance. 

You have come through a unique experience, and one which has 
given you a greater sympathy for your patients, one which, too, has 
given you a firm conviction that the rest of your life should be spent 
in gratitude to Almighty God for the privilege of being, once again, 
a nurse. 

B. Jenkins, R.N., 
Supervisor, Saanich Health Centre. 



"WHAT WE ARE DOING" AT REVELSTOKE. 

I arrived at Revelstoke on Wednesday morning, September 8th, 
to take over the duties of School Nurse, and to one little girl at least 
my coming was an event of no little importance. " Mother ! " she 
cried, rushing home from school. " We are going to be taken care 
of. There is sl new nurse at school ! " And, strange to say, Evelyn 
provided my first home-contact. 

The post-term work — weighing, measuring, and inspecting — was 
the first item on the programme. It was well into October before 
I had finished the two public schools and the high school. But I know 
of no better way to become acquainted with the children and of learn- 
ing who is who. 

This done, I took stock — learned what my predecessor had accom- 
plished and what she had planned to do. I carried on from there. 

Dental Survey. — A dental survey was scheduled for the fall. To 
get this project under way as speedily as possible the dentists were 
approached and their co-operation assured. It would take a little 
time to arrange for two free mornings. In the meantime we at the 
schools were busy. The teachers filled in the dental cards with the 
names of their respective pupils ; the co-operation of the School Board 



18 






and of the principal was assured, and our dental survey became a 
reality. 

" It is rather startling, once the machinery is set in motion, how 
fast the wheels go round." On the mornings of October 28th and 
29th, respectively, Drs. Marr and Chambers arrived at the schools 
at 9 a.m. sharp and began their examination. The children came to 
the nurse's room one after the other, card in hand, and passed before 
the dentists. They enjoyed it — thought it a special treat; but it 
was rather a back-breaking job for the two men. A kitchen chair 
is not the most comfortable equipment to bend over for any length 
of time. However, it was time well spent, as results proved. 

It really is splendid the way the parents have co-operated. Some 
very encouraging comments were received. " This work will be 
attended to immediately." " Yes ; soon." Or, " Attending dentist." 
Others followed instructions explicitly and left the report with the 
dentists. Then came reports from the indigent group, stating why 
they could not have work done. And so our reports automatically 
fell into three groups — those having work done; those who had 
promised ; and the latter, indigent group. 

A representative group of cards of the indigent class was given 
to the dentist for an estimate as to the amount of money necessary 
to put the teeth of these children in order. 

Forty-three were represented. The total cost was set at $235. 
Low charge, $1 ; high charge, $13 ; average charge, $5 per mouth. 

This group represented one school only. The amount was doubled 
to meet the need in the two schools and a small margin allowed. 

Appraised of these facts and of the great need for aid, Dr. Young 
came to our rescue with a promised grant of $500 from the Provincial 
Board of Health. One-half of this amount arrived in January, 1938. 

Though the work among the indigents has not progressed as 
speedily as one might wish, work on the whole has moved forward 
steadily. Temporary-defects figures do not register much improve- 
ment; but this is partly due to the fact that the dentists prefer to 
leave them, unless they are bothersome, to preserve the dental arch. 
Of course when teeth constitute a menace to the child's health, that 
is a different matter. Take the case of Billy, for instance. At the 
survey my attention was drawn to him. " Several abscessed teeth 
that should be removed," said the dentist; " and I'm not surprised," 
he added when he learned that Billy's standing was at the " foot of 
the class." But the story has changed — there's a new chapter. Billy's 
dental card now reads : " O.K. Teeth removed. General anaesthetic 
at home." And he's doing well at school — a changed boy entirely — 
healthy and happy — his teeth no longer a menace to his health. 

To further encourage interest in dental health, the I.O.D.E. have 
placed in each class-room a beautiful hand-designed Dental Health 
Honour Roll. As each child's mouth reaches 100 per cent., or as near 
as possible, a star will be placed beside his name. This will give a 

19 



general idea of the standing of each room and should be a source of 
interest to all. 

" There is not one thing in preventive medicine that equals 
mouth hygiene and the preservation of teeth," said Dr. Wm. Osier. 
I should like to add : " There is not one thing that will contribute 
more to this end than a dental health survey. It creates a stir, 
introduces a note of authority, and cuts the pattern for the work that 
is to be done." 

Tonsils. — Here one faces an entirely different problem. Fear is 
the demon one has to contend with. I have learned to respect the 
view-point of the parents. Their faith in their belief is a tangible 
thing. It is not to be cast lightly aside. For instance, when I am 
told that one can be born with enlarged tonsils just as with enlarged 
stomach, I do not contradict such a statement. I take into considera- 
tion the fact that my informant is an intelligent person. " Once you 
have your tonsils out, the next thing is appendicitis," I'm told. A boy 
of 17 confessed to me : " I'm afraid of the anaesthetic." And I tell 
you, his is a real fear ! No amount of persuasion has so far had any 
effect. 

There is such a difference of opinion as to whether or not tonsils 
should be removed that the question is open to much controversy. 
However, I have fortified myself with all the reliable information I 
could gather on the subject — articles by leading medical men — and it 
is generally agreed that tonsils should be removed for the following 
reasons : — 

(1) Such enlargement that they cause obstruction of the throat; 
(2) recurring follicular tonsillitis; (3) swollen glands of the neck; 
(4) recurring attacks of running ears; and (5) the tonsils acting as 
a focus of infection. 

On the Credit Side. — It took but one visit to convince Evelyn's 
parents they ought to see the family doctor. She was pale, puny, and 
odd-looking, and her tonsils were very large. They were wise par- 
ents; they followed the doctor's advice for immediate removal of 
tonsils that were definitely a " focus of infection." Now, instead of 
standing still, Evelyn is gaining well each month; has improved in 
appearance and in her school-work remarkably. These parents went 
about it in a big way; besides Evelyn, two other children in the 
family (boys) had their tonsils out. All of which demonstrates, if 
one can but persuade the parents to seek the advice of their family 
physician and abide by his decision, something lasting has been 
achieved. 

Defective Vision. — Since the beginning of the fall term in Sep- 
tember, eleven children have been found to have defective vision 
requiring correction. Nine have been supplied with glasses — three 
of these were indigent cases ; the remaining two are slated to see a 
specialist. Several children have had glasses changed — a few are 
indefinite cases. 

20 



We are very fortunate in having a man like Mr. Bews, the local 
optometrist. He gives all school-children sent to him a careful exami- 
nation free of charge. I value his assistance highly. Money for the 
supplying of glasses to indigent children has come through several 
organizations — the Native Sons of Revelstoke, the Women's Auxiliary 
to the Legion, and the Rotary Club. This money will be placed in 
trust to be used for the sole purpose for which it was donated. I feel 
very happy about this. It means that every child now has an even 
chance to compete with his fellows. Before me as I write I have a 
letter received to-day from a grateful mother. She says in part: 
" I want to express my very sincere thanks to you for getting Sharry 
her glasses, etc. ; she needed them badly." Yes. She did need them 
badly. Her teacher told me he had to lead her right up to the board 
before she could see what was written there. I'm sure it must be 
a source of great satisfaction to the members of the various organiza- 
tions to realize that because of the aid they have given a little girl's 
vision is restored. 

Milk at School. — As in former years, the I.O.D.E. and the 
Women's Auxiliary to the Legion supply milk to the schools; also 
cocoa for the lunches. Eighty children are taking milk this year. 
Those who cannot afford to pay receive this service free. The paying 
group are charged 50 cents every four weeks for one-half pint of milk 
each school-day (including straws). This service has proven a boon 
to the poorer children. I like to think that the added sparkle in their 
eyes, and a slight bloom on the cheek, is due to the daily milk service 
at school. It is a treat to see the group of twelve little children in 
Grade I. gathered around the table sipping their milk. And were one 
to watch until the end, one would see the teacher, ever alert, line up 
her little charges after they had put down their bottles and straws on 
papers provided — a lesson in tidiness — then march them out of the 
room and on to the playground — a happy, healthy group. 

Communicable Diseases. — Fortunately, there has not been an 
epidemic to contend with during the past year. One case of mild 
typhoid, one of measles, and one of chicken-pox about covers our 
contagious diseases ; except for a slight irritation of the eyes which 
is at present causing a few absentees from school. This condition 
generally accompanies a cold. 

I was told the other day : " We haven't the epidemics now we 
used to have before the nurses came." Though I could not resist 
the warning, " Touch wood ! " — nevertheless, I experienced a thrill of 
admiration for the nurses whose teachings had left so profound an 
impression on the mind of this woman — and she a mother. 

"Who keeps the infectious disease going?" questions Dr. Hill; 
and answers : " Chiefly, the mother." And so it would seem our 
efforts are producing the desired effect. In the follow-up work in 
connection with the above contagious diseases, I have found in each 
instance the mother well informed and co-operative. Suffice to say, 

21 



not another case developed in the city from any one of the above 
" first cases." 

There is much more to tell ; but one could go on and on, and so 
I bring to a close this chronicle of events of the past five months by 
giving you a glimpse of another side: — 

" What is life, if full of care, we have no time to stand and 
stare? " 

Literally, on two occasions during the past week, I did just 
" stand and stare." It was the Annual Ski Tournament, an event 
of importance to the young people particularly. The school-children 
had two free afternoons. Some of them were active participants. 
It really was fun to watch them, puffing in after a 3-mile jaunt on 
skis, cheeks aflame with colour. Teachers were out in a body, 
enthusiastic spectators. To me, the men's ski-jumping was a special 
thrill. It certainly takes courage, perfect co-ordination of mind and 
body, and plenty of stamina to follow this exacting sport. The 
youngsters scurried down the hills like rabbits ; in the simple " down- 
hill " a number took the small jump and did remarkably well. Others, 
of course, came down in a most irregular way — a conglomeration of 
arms, legs, and skis. However, it kept the spectators interested, and 
without a doubt the youngsters enjoyed themselves immensely. 

" Keep your mind on the great and splendid thing you would like 
to do, and you will find yourself unconsciously seizing upon oppor- 
tunities that are required for the fulfilment of your desire. 

" Carry your chin in, and the crown of your head high. We are 
gods in the chrysalis." — Elbert Hubbard. 

Margaret Little, R.N., 

Revelstoke, B.C. 



THE MENNONITE IN BRITISH COLUMBIA. 

By reason of the large influx of Mennonites into British Columbia 
in recent years, some of the Public Health Nurses find that a great 
part of their time and effort is necessarily spent among these people. 
To those who have not been in contact with this religious sect the 
following account of their history and beliefs may prove of interest. 

The history of the Mennonites goes back 400 years. Their 
founder, Menno Simons, a native of Holland, was a priest of the 
Roman Catholic Church. In 1537 he left the Church and began 
preaching his own doctrines. He extolled against war, revenge, 
divorce, the taking of oaths, infant baptism, and the holding of civil 
offices. He exhorted his followers to lead a Puritan-like existence 
and strove to isolate them from the world so as to prevent contact 
with a secular civilization. Menno's radical programme excited the 
wrath of Catholics, Lutherans, and Calvinists alike, and here com- 
menced the long years of persecution for his adherents. 

In 1583 Menno and his followers were compelled to leave Holland 
and fled to Prussia. The Prussian noblemen promised protection 

22 



from persecution and exemption from military service in return for 
the Mennonites' agricultural experience. However, after 100 years 
of prosperity the Mennonites were again forced to find a new home 
to escape compulsory military service in Prussia. 

Catherine of Russia, knowing the ability of the Mennonites as 
farmers, invited them to settle in South Russia, promising exemption 
from military service, and educational and religious liberty. Her 
invitation was accepted, resulting in the migration of some 8,000 
Mennonites to Russia during the years 1787 to 1840. Here the sect 
grew and prospered for another hundred years, and as the Mennonites 
were forbidden to divide their lands it was soon necessary to buy more 
land to settle the younger people. " Daughter " colonies spread 
throughout Southern Russia. 

In 1870 the Russian Government demanded military service of 
the Mennonites, and it was only after much negotiation that they 
were allowed to perform forestry service instead of military training. 
Nevertheless, their old feeling of security was gone and a delegation 
was sent to America to look for a new place of abode. 

The Canadian Government in 1872 granted the Mennonites some 
720 square miles of land in Manitoba, along the International Bound- 
ary, and guaranteed exemption from military service along with other 
privileges. Soon the migration to Canada commenced and by 1879 
over 1,400 families had settled in Southern Manitoba. 

During and after the Great War a violent dislike grew among 
the Canadian peoples of all things German. The Government with- 
drew the privilege of separate schools for the Mennonites and 
insisted on attendance at public schools and the use of the English 
language. Rather than give up the language of their religion, some 
4,000 Mennonites left Manitoba for Mexico in the years 1922 to 1925, 
those remaining accepting the rulings of the Government. 

The Mennonites still living in Russia were having their troubles. 
In 1919 during the Revolution they were compelled for the first time 
to take up arms to protect themselves from marauding bandits, and 
later were driven from Russia by the Communists. They came to 
Canada, arriving here practically destitute, but " with a progressive 
spirit and a thirst for education." 

The first movement into British Columbia started in 1928, some 
of these people wishing to live in a milder climate, one more like that 
of their old home in Russia. Settlements sprang up at Yarrow and 
Sardis, a few miles south-west of Chilliwack. The Abbotsford com- 
munity came into existence in 1931 and consists of some 100 families. 

There are two churches in the Mennonite Colony near Abbots- 
ford and the life of the community revolves around these. The 
Mennonite Brethren " insist on conversion and adult baptism as the 
basis of church membership . . . they maintain a Puritan dis- 
cipline in matters of conduct, with strict injunction to keep the Sab- 
bath. They are forbidden to dance, play cards, smoke, or drink." 
Their chief " article of faith " makes it impossible for a Mennonite 

23 



to bear arms for any purpose. Children attend Sunday-school for 
one hour in the morning and church service follows. Each church 
prides itself on its choir. 

The Mennonites are careful to keep the German language alive, 
as it is the language of their religion and has been preserved through 
the centuries of their residence in Europe. The children attend Ger- 
man school from 9 until 2 each Saturday. 

Owing to the near impossibility of making a living from the 
land on which some of the families are located they have been com- 
pelled to accept relief. They live a quiet, sober life, their diversions 
including community singing, games, plays, reading, and in some 
families the enjoyment of the radio. Meals, to a large extent, 
resemble those of their English-speaking neighbours. 

In 20 per cent, of the families medical attention is arranged for 
in the following manner : A Mennonite doctor, with headquarters at 
Sardis, 20 miles distant, is paid $10 a year by each family. Bachelors 
and couples without children pay less. The doctor visits the minister 
of the community each week, who refers him to any family needing 
medical advice or attention. The majority of the remaining families 
seldom call a doctor until an illness is well advanced. A large pro- 
portion of the children suffer from infected tonsils, adenoids, defective 
vision, and in some cases malnutrition. Lack of funds prevents the 
correction of these conditions in most instances, yet the school atten- 
dance is usually good throughout the year. 

Formerly Mennonites objected to quarantine for infectious dis- 
eases; now it is only the occasional family who breaks quarantine. 

One observes when visiting and giving advice to parents that 
much store is set on the use of patent medicines and ointments. 

The Mennonites feel that it is " up to God " as to the number of 
children each couple shall have. Birth-control is unthought of. 

Generally speaking, the homes are small, simply furnished, but 
clean. Adults and children respond readily to kindness and con- 
sideration from the outsider. Once the nurse has gained the con- 
fidence and liking of the people, she experiences no trouble in having 
her wishes carried out. The husband is usually spokesman, the 
wife saying very little. Children are subdued and unresponsive to 
strangers. At school they are very appreciative of attention given 
them by the nurse and are keen to follow her advice. 

Much work in the medical and public-health fields has yet to be 
done among the Mennonites. Still, we feel that the result of our 
labours so far are encouraging. 

Evelyn Maguire, B.A.Sc, R.N., 

Matsqui-Sumas- Abbots ford Area. 



24 



SEX-EDUCATION. 



My public-health experience comprises a period of eighteen 
months " in the field " in a frontier country. Here I feel there is 
room for more " sex-education " to offset the " sex-malinformation," 
which is obviously present, and that in several ways this is an oppor- 
tunity for the Public Health Nurse. In discussing the following I 
do not wish to imply that my frontier country is worse than other 
districts, urban or rural. However, I do point out that the population 
is small and is seasoned with those who failed to adjust themselves 
in society " outside," and that, though the population is scattered, 
everybody knows everybody else and his affairs. 

As to the result of sex-malinformation, perhaps the most serious 
in its consequences is the abortion, and, from what is heard indirectly, 
these are all too frequent. Then there are the forced marriages, 
sometimes obviously an outcome of the unsuccessful attempt at 
abortion. And there are the unmarried mothers too often only in 
their early teens. Among school-children, though proof may be 
wanting, we cannot but believe that there is illicit sexual intercourse, 
for where there is smoke there is fire. Lastly, there is the unanswered 
question of how life really begins and where babies come from — 
a subject which has been discussed by Molly and Louise, her older 
playmate. 

Now, Molly is a dear little 8-year-old and probably looks up to 
10-year-old Louise, who is also a dear little girl and Molly's only 
companion in an ungraded school of twenty-five boys and five teen- 
age girls. Right here with Molly's mother is the Public Health 
Nurse's opportunity. Later she will visit Louise's mother. In the 
meantime Molly's mother can be shown how she can refer back to 
that question and answer it briefly and satisfactorily. Mother may 
be pleasantly surprised that such a subject can be broached so readily 
and in such simple terminology. She and her husband and Molly's 
big brothers have no hesitation about discussing reproduction of the 
various animals on the homestead, because in that line they have 
suitable terminology to apply. But in the case of human reproduction 
they are ignorant and afraid. Then leave with them that pamphlet, 
" When and How to Tell the Children," and a seed is planted. If 
mother and dad still feel they cannot handle the situation, at least, 
now that it has been broached, they are more likely to ask the Public 
Health Nurse (or another " educator " in the district who has the 
ability to handle this subject) to take it up with the child herself. 

It is wise to realize here that sex-education is in its infancy to- 
day, that there are those, whether professional or lay, who are unable 
to discuss it comfortably with the pupil, adult or child, and that, if it 
cannot be discussed comfortably, it is a subject best left alone. 

Another way of approaching the mothers is in the maternity 
ward of the local hospital. There mothers are enjoying the freedom 
from routine household worries and are glad to find and read that 
charming little book, " Growing Up." Incidentally, it can be men- 

25 



/ 






tioned here that with it are a complete set of " Mothers' Advisary 
Letters," which a mother can re-read at leisure. To follow up this 
beginning there are sex-education pamphlets for the various age- 
groups which may be used later in the home. " Big Problems On 
Little Shoulders " has some good chapters on this subject and the 
problems arising from it, and because of this and its other good 
material it is a book to be recommended as handbook for anybody 
interested in child-training. Financing such a programme is an item, 
but finances are usually overcome where there is a will. For instance, 
an alive women's group can be interested to buy such literature and 
loan it out to the members. 

True, the present public acceptance of irregular situations within 
the community is an unhealthy atmosphere in which to bring up a 
family and it will probably obtain for some time. Yet where the 
young people have knowledge and understanding there is less like- 
lihood of such an example being detrimental to them. ' And so, with 
sex-education permeating society from the parent to the child and on, 
there is reason to look forward to a time when such situations will 
not be acceptable and will therefore occur with less frequency. 

Bibliography : On request. 

L. Malkin, R.N., 

Fort St. John, B.C. 



VERNON. 

This year I am going to outline a few of the " high spots " in 
my general work for the year. 

We just got nicely started in our school-^work last September 
when a case of polio developed in our district. Our Medical Health 
Officer closed the schools for two weeks, and we visited homes and 
patrolled the streets, in order to keep a close watch on the children. 
We repeated the same thing again in October for a shorter period 
of time. 

In November our new school buildings were formally opened by 
Dr. Weir, Minister of Education. These buildings — one a large addi- 
tion to our elementary school, and the other a new junior and senior 
high school — are beautiful buildings, and in each of these buildings 
spacious quarters have been provided for the nurse. 

Just after Christmas we began preparing for our tuberculin 
testing in the schools. Literature and consent-slips were sent to 
every home where there were school-children. Early in February we 
were ready, and Dr. Kincaid and nurse arrived to do the testing, 
which, together with the X-raying, was completed in three weeks. 
This work was popular with the parents, satisfactory, and very worth 
while. 

Have two large classes in the junior high school, a Little Mothers' 
League, and also a house-nursing class. Before the Easter holidays 
we hope to have practical demonstrations by some of these girls, to 
which the principal and staff members will be invited. 

26 



During the months of February and March hot soup and cocoa 
are being served to approximately 300 of our school-children. Pro- 
vision is made for those who are unable to pay the small charge made. 

Through the kindness of the staff of the Crippled Children's 
Hospital, many of our children have been successfully treated there. 
At the present time this district has seven children there undergoing 
treatment. 

We hope to finish up our dental- and eye-clinic work for the year 
by the end of May. 

In June we hold our vaccination clinic in the elementary school 
for all the pre-schoolers. This is held on the same day that the 
parents bring their children in to register them for the beginners' 
class in September. 

We also toxoid once a year, doing our beginners some time during 
their first year in school, September if possible. 

We have a very large class of adults and high-school pupils 
attending the physical-education classes in the Scout Hall. These 
classes are held under the capable direction of Bill Ladner, one of the 
teachers on our staff. This class is probably the largest of its kind 
in the Okanagan Valley. 

Elizabeth E. Martin, R.N., 

Vernon, B.C. 



THE SCHOOL DENTAL CLINIC. 

The health of the school-child is and always will be of prime 
importance in preventive medicine. This principle is so fundamental 
in its application that very often a Public Health Nurse is employed 
for the express purpose of doing only school-work. It is one of the 
basic principles because, aside from health teaching and training of 
children at school, it also serves as the best means of approach to a 
home. A mother will usually welcome a visit from the nurse if it is 
about her child and his problems. 

Among our most difficult problems is the treatment of defects; 
thus the remedial treatment of defects presents what seem to be in- 
surmountable difficulties at the present time. Children have tonsils, 
adenoids, poor eye-sight, goitre, and other defects which the nurse 
feels merit attention. Upon visiting the parents of the child the 
nurse finds that the parents agree whole-heartedly with the nurse, 
but they simply cannot afford the expense of an operation or the 
necessary treatment. Unfortunately, too, it seems that it is those 
people who are struggling to keep off relief who bear the brunt of 
this suffering. 

Having worked in an area in which there was no dental clinic, 
I can appreciate a school dental clinic to the full. It is amazing the 
difference that it has made; at first it seemed too good to be true. 
To be able to give each child dental treatment free of charge has made 
a great difference to the health of the children in general. This treat- 

27 



ment has been carried on since February, 1936. Emergency tooth- 
aches are treated and each child receives the necessary treatment, 
filling, and extractions, etc., once during his school-life. After their 
initial treatment is completed they are expected to carry on them- 
selves. To date the older children have all been treated, except new 
pupils and Grades I. and II. These are the children which are being 
treated now. When the work was very heavy during the first year 
there were four school dentists, but since February, 1937, one dentist 
has been giving us each school morning for the clinic. 

The accompanying table will give some idea as to the scope of 
work carried on since February, 1936. The cost per child over this 
two-year period has been $3.21. This figure was arrived at by divid- 
ing the total cost (borne by the Provincial Board of Health) by the 
total number of children attending the clinic during that time. Un- 
fortunately, some of these children have stopped school and therefore 
were not completed cases; so that the $3.21 represents the cost per 
child attending the clinic rather than the completed cost. This cost 
does not take into consideration the office overhead of the dentists 
employed. The number of children treated and the number of 
patients does not tally because some children had to return to the 
clinic as many as four and five times. 

Marion C. Miles, B.A.Sc, R.N., 

Matsqui-Sumas-Abbotsford Area. 



A DITTY FROM THE NORTH. 

In B.C.'s Peace River Country, 'tis scarce three years ago, 
We started our Health Unit here amid the frost and snow. 

People said it wouldn't prosper, " Wait till 50 below," 

Or, " Mud of the Peace River Country just won't let car wheels go. 

Our first Director, Dr. Cull, a very wise young man, 

Said to his Public Health Nurses, " Let's get busy while we can. 

" We'll get to know these people. We'll immunize them all, 
And to round up mumps and measles we'll always be on call. 

" We'll examine all school children. I'm sure we're elected 
To find their defects and their ills and then get them corrected. 

" Our duties are many and our handicaps great. 
There's hard work ahead- — let's blame it on fate. 

" The weather and the mud is as bad as they told us, 
And now my good nurses, let nothing dare hold us! " 

We've immunized the people against what all we can, 

And now they're asking more of it. Such are the ways of man! 

Teeth and tonsils have had a share of really close attention, 
And other problems we've checked off — too numerous to mention. 

Three years we have been striving and our Unit still stands true, 
Schemes and plans for further service spur us on to work anew. 

28 



Of course our staff has changed a bit. Doc. Cull has gone away. 
Some of our nurses left us, Doc. Hershey's come to stay. 

These are our ways of travel: by boat, by sled, by car, 
On horseback, in a wagon. Sometimes on foot we are. 

The weather's really not so bad when you dress in proper togs. 
Mud roads can be conquered — why just chop down some logs! 

Most residents now greet us with smiles and pleasant words, 
In the local vernacular we're really " not bad birds." 

We carry on the same old job we first set out to do. 

There's something in it has allure. I'm sure you'd feel it too. 

So if you'd like some Public Health work to prevent your getting blue, 
Come up to the Peace River Country. She'll put her spell on you. 

Rita M. McFarlane, P.H.N., 

Peace River Health Unit. 



TIME OUT. 
1826. 

While rummaging through some old papers we found the follow- 
ing " recipe " for an ointment which interested us. It bears the date 
1826. 

" To cure bruises, sprains, stiff joints, etc. — To 1 teacupful good 
West India rum add V2 a cup of Neat's foot oil and % teacup of angle 
worms. Simmer them together over a slow fire until the rum appears 
to be evaporated or gone. Strain it and put into a phial for use. 
This will have a most powerful effect on bruises, stiff joints, etc. 
(Also, probably, on the olfactory organs. — Ed.) Of course, that was 
before the days of doing laws and scientific knowledge of doing 
therapy. Some one may say, " Why waste the rum? " — Patchwork, 
CM. & S. 

Hygiene Note. 

The modern girl, comments a health adviser, keeps out in the 
open air more than her mother did. 

Yes, and it's also true that the modern girl keeps more out in 
the open air than her mother did. — Lets Go, CM. & S. 

Ethical Publicity. 

Sandy joined a golf club and was told by the professional that if 
his name was on his golf-balls and they were lost, they would be 
returned to him. 

" Good," said the Scot, " put my name on this ball." 

The Pro did so. 

"Would you also put M.D. after it?" said the new member. 
" I'm a doctor." 

The Pro obliged. 

" There's just one more thing," went on the Scot. 

" Can ye squeeze ' Hours 10 to 3 ' on as well? " — Medical Times. 

29 



Quite Improbable. 

At a recent party a game called for each participant to represent 
the title of some famous book or novel. One elderly lady (who copped 
the prize) appeared with a large picture of the Dionne Quintuplets 
printed across her gown. She said she represented Sinclair Lewis' 
latest novel, " It Can't Happen Here." — The Doctor. 

Cure or Poison? 

Voice over phone : " I can't sleep, doctor, can you do anything 
for me? " 

Doctor : " Hold the phone and I'll sing you a lullaby." — Sheboy- 
gan (Wis.) Press. 

Dignity is one thing that cannot be preserved in alcohol. — Lets 
Go. 

How would you answer this? 

Betty (aged 7) to her teacher: "Well, Miss A., what I would 
like to know is ' Who borned God ' ? " 



THE NEED FOR A FIELD SUPERVISOR. 



UNIFORMITY OF PRACTICES. 

It is obvious that the efficiency of public-health nursing depends 
upon, among others, the following elements : — 

(1.) Uniformity of procedure. 

(2.) Up-to-date standards. 

(3.) Accurate, up-to-date, and valuable records. 

I am sure that each and every nurse in the field is quite confident 
that, in order to achieve such uniformity, a field supervisor is a neces- 
sity, especially in districts farthest removed from the big centres of 
public health. Take No. 1, " uniformity of procedure " — how often 
does a nurse carry on at procedure which has long since become 
obsolete? In the school, for instance, it has been decided in the larger 
districts, quite recently, that the weighing of underweights each month 
is no longer considered valuable. However, it is a certainty that 
many nurses, although they themselves feel that it is a waste of time, 
do not wish to take the initiative or responsibility of abolishing the 
practice. This is just one problem; many others are continually 
coming to light in other phases of the programme. 

" Up-to-date standards " is more or less an extension of number 
one, for only by having supervision of the different changes can the 
standards of public health be kept at the very highest level. In this 
way new ideas are introduced into every district at the same time. 

In regard to the development of new phases in the field of public 
health, a good example is the new record system which is being intro- 
duced into most districts. Much work, worry, and general depression 

30 



would be avoided if there were some one advising how to start the 
system properly and carry on in a practical way. 

A field supervisor would see that record-keeping was consistent 
in each centre throughout the Province, thereby assuring standardiza- 
tion and continuity of the Public Health Programme. 

M. Putnam, B.A.Sc, R.N., 

Nanaimo. 



CONSTRUCTIVE SUPERVISION. 

The scope of work for the Public Health Nurse is so wide that 
at times it may seem overwhelming. Especially may this be true for 
the new adventurer, of whom there will be increasing numbers yearly. 

A field supervisor in her periodic visits might help the nurse to 
maintain a right balance in her work by counsel and constructive 
criticism. May I quote Mary Gardner, when she says: — 

" Old educational methods will need constant revision. Perhaps 
even now we are on the threshold of certain radical changes. In our 
effort to adjust great numbers of nurses to their work, we have been 
very insistent on standardization and a pulling-up of the weaker to 
the level of the stronger. To accomplish this, emphasis has been 
placed on very definite standardization of method, even down to 
minute detail. Has the pendulum swung far enough, or perhaps too 
far, in this direction? Has the time possibly come when public- 
health nursing can better be served by encouraging a greater 
individualism? " 

Invaluable as are the knowledge and inspiration gained at uni- 
versity, it is after the student is at work and is reacting to the needs 
of her community — or not doing so — that the stimulus of an under- 
standing and experienced chief may help her to develop that greater 
individualism for which Miss Gardner appeals. 

In the 1932 report, as chairman of the Education Committee of 
the National Organization of Public Health Nursing, Elizabeth Fox 
said, in part: — 

" More and more we shall need artists, not mechanics ; and 
artists are developed by enrichment of inner experience, not by 
efficiency methods. How can we stretch our education or how can 
we modify it to provide that wider and deeper understanding? How 
can we produce thousands of artists ? " 

If we in the field are continuing our education, as I hope we are, 
may we look to the guidance of the field supervisor to help us become 
artists in our work. K. Goward, 

Nanaimo. 

AN INTERMEDIATOR. 

The need for a field supervisor is generally felt to be a vital 
necessity by most Public Health Nurses in British Columbia. In 
many of the more or less isolated districts the nurses feel the need 

31 



of some one with whom they could discuss the minor problems and 
difficulties which they come across in their daily work. Of course 
there is always the Provincial Board of Health willing to help, but 
so many problems could be solved much more easily by discussion 
than by correspondence. 

Also, we sometimes see a good nurse in a district to which she 
is totally unsuited. If we had a supervisor who understood the con- 
ditions under which this nurse worked and understood her tempera- 
ment, it would do away with " round pegs in square holes " and 
would result in a more smoothly running Public Health Service with 
less friction between local board and nurse. There are many ques- 
tions which come up between the district nurse and her local Board 
of Control that could be settled more favourably by a field supervisor 
than by the nurse herself. The Board may sometimes feel that their 
nurse is not doing her duty in the way they would desire, yet do not 
know how to approach her without causing considerable antagonism. 
If there was a field supervisor, she could act as a go-between and 
tactfully explain the situation. 

It is always difficult to make a community, as a whole, realize 
the benefit that may be gained from a Public Health Nursing Service, 
and though some may want the service most urgently, they may be 
overruled by the many who can not see the advantages to be gained. 
Yet, should that service be instituted, those previously in the negative 
would be the first to make use of the service and in that way learn 
its worth. Actual demonstration is necessary before some will 
believe in the value of public-health work. For this purpose a well- 
trained and experienced supervisor could be of great value. She 
could go into these districts and spend some time there talking and 
demonstrating the value of a nursing service to the people. The 
knowledge gained by the supervisor in her contacts would be invalu- 
able in the choosing of a nurse suitable for that district. 

E. Snowden, R.N., 
A. McInnes, R.N., 

Coombs and Qualicum Beach. 






ONE SUPERVISOR FOR ALL PUBLIC HEALTH 

SERVICES. 

During the past few months we on Vancouver Island have been 
visited by specialized workers of three different phases of our pro- 
gramme — namely, the supervision of students and tuberculosis and 
V.D. services. If and when we have the beneficial supervision we 
desire and need, could not at least two — if not all — of these branches 
be covered by one individual? Granted that T.B. and V.D. work 
have recently undergone great development in the Province, and 
admitted that such comparatively new specialized fields require 
specific instruction to the workers in the field, still the field super- 
visor would be quite capable of transmitting a full understanding 

32 



of the essentials. There is a natural tendency for specialized super- 
visors to lose sight of the Public Health Nursing Programme as a 
whole, and to expect rather too much concentration on their par- 
ticular phases. With her knowledge of conditions in the field, the 
supervisor would aid us in the absorption of each new development 
into our programme without any loss of balance in the work. 
Although the time spent with the several representatives could never 
be said to be wasted — and we all like visitors at times — still, it would 
seem that the concentration of the necessary supervision into one 
department would result in the saving of the nurses' time. This 
year, when we are all working at " top speed," this point cannot be 
overlooked. 

Our ideal now is a more uniform development of the Public 
Health Nursing Programme throughout the Province. To gain this 
end, one of the chief requirements is the early provision of the 
instructive and constructive supervision of our work by a trained 
supervisor. 

H. Kilpatrick, B.A., B.A.Sc, R.N., 

Duncan, B.C. 



HEALTH SUPERVISION OF THE NURSES IN THE FIELD. 

We who are " health-workers " know full well the importance 
of physical fitness. Under our present system the maintenance of 
the health of the nurses cannot be given the attention it merits. 
We are not blessed with equal vitality, and in the placing of nurses 
in the field, " health " should be given first consideration. Even 
supposing a nurse is pronounced " fit " after her annual physical 
examination, the question persists, is she capable of taking on and 
carrying the responsibility of a heavy district? A field supervisor, 
and such a person only, with her information concerning the district 
in question, together with her intimate knowledge of the nurses, 
would be able to place the staff most suitably. Thus, with the 
establishment of those nurses who are definitely physically able to 
carry on the work, the deplorable experience of " breakdowns " in 
the field will be a thing of the past. 

Not only the health of new nurses but also that of the estab- 
lished workers is the responsibility of the field supervisor. Naturally 
our work is heavier at some periods than at others. Our policy 
throughout is prevention. At present it is almost impossible to 
obtain relief to allow short periods of preventive sick-leave. With 
a supervisor in control and central registration of Public Health 
Nurses not actively employed — such as those who are married — 
temporary workers could be established. 

Furthermore, with a field supervisor at the helm, the many 
Public Health Nurses would be bound together more closely. One 

33 



of the many benefits of such an organization would be a system of 
pensions. Such a plan is in progress in New Zealand, embracing 
invalidity as well as superannuation. 

H. Kilpatrick, B.A., B.A.Sc, R.N., 

Duncan, B.C. 



TRAINED AND PROPERLY QUALIFIED SUPERVISORS. 

As the demand for nurses trained in public health is increasing 
all over British Columbia, so is the need for supervision in public- 
health nursing. Supervision to be effective can be carried out by a 
trained person only. A supervisor might be an excellent nurse, but 
her work useless if she lacked ability and training. Ability by itself 
would accomplish much, but how much more can be accomplished with 
training. 

How are we to get trained supervisors? 

Universities in America are now offering courses of supervision 
in public-health nursing. One college describes the course as " A 
fundamental course planned for supervisors of Public Health Nurses." 
The second half of this course is field-work in supervision, where the 
student receives opportunity for observation and participation in urban 
and rural supervisory programmes, the relation of staff members and 
supervisor, and programmes of staff education. 

As yet there is no course offered in supervisory work in public 
health in this Province. If there was a Supervisor of Public Health 
Nurses, there would be an opening for field-work in supervision. 
Students could be given practical experience and taught how to carry 
out effective supervision. They could have opportunities to put into 
practice those lessons taught in class. 

Nurses particularly interested in supervisory work could perhaps 
arrange to work and study under the supervisor. Much practical 
work could be done that is, as yet, impossible. How varied an ex- 
perience a student might get could she travel with the supervisor and 
learn the different ways of working with urban and rural nurses — an 
experience that would be of great value to her in later years when she 
herself will hold a supervisory position. 

Many are the requirements of the ideal supervisor. These may 
be dealt with from the standpoint of educational background and 
experience, and last, but not least, personality. 

Not only should she have an academic training with postgraduate 
work in teaching and supervision, but also a sound cultural back- 
ground. To reach a full understanding of all phases over which she 
must assume control she must have had several years' experience in 
the field, both in rural and urban districts. 

To fulfil our ideals of a field supervisor, we must have one who 
radiates personality and inspires confidence in all with whom she 
comes in contact. The essential traits are almost without number — 
tact, enthusiasm, cheerfulness, frankness, and kindliness. These and 

34 



many others will show in her ability to work with and for the nurses 
and spur them on to more and better work. As the day of her arrival 
on one of her periodic visits comes, all will welcome her again and 
will be loathe to see her depart. 

I. McMillan, R.N., 

A. S. Law, B.A., B.A.Sc, R.N., 

Duncan, B.C. 




" I'm getting my picture for the next Bulletin." 



35 



CHILLIWACK MUNICIPALITY AT A GLANCE. 

With opening of the fiscal year 1937, it was thought wise to start 
organizing a vaccination campaign; the importance of which was 
realized when we discovered that approximately only 10 per cent, of 
the 1,253 children were immunized against smallpox. 

Consent-cards with illustrative books were sent to each family. 
Talks were given in the schools and wherever possible articles were 
placed in the local paper. Although this district has many so-called 
" conscientious objectors," not an angry remark was made, no oppos- 
ing article was sent into the paper, nor was one note sent from an 
irate parent. 

Arrangements were made so that each of the local doctors should 
have approximately the same number of children to vaccinate and 
that the work should be done in the schools at a designated time. 
Each vaccination was to cost 50 cents. 

This price was naturally prohibitive in many cases. To over- 
come this the Provincial Department of Health agreed to pay half the 
indigent bill if the School Board would pay the other half; this was 
done. 

It took three months to cover the work in the sixteen schools of 
the municipality. The main reason for the delay was our unwilling- 
ness to run the risk of having a communicable disease named as the 
direct result of vaccination. The campaign came to a happy comple- 
tion when 710 children were added to the list of immunized. 

The Rotarians of this district have taken a keen interest in the 
welfare of local children. This was plainly shown when they com- 
menced to educate people to a need of dental consciousness. The idea 
of giving each child the benefit of a dental survey in school, the oppor- 
tunity of having work done at a reduced price, and the choice of family 
dentist started the ball rolling in the right direction, and the increase 
of work was so great that all were encouraged but the dentists. 

The dentists seemed to feel that they were losing a great deal of 
money. The net result was that for the past year it has been found 
necessary to attend to indigents only ; a lowering of the high standard, 
but unavoidable. 

Besides this work, Rotarians at Christmas-time make a point of 
inviting thirty underprivileged children to a big dinner and Christmas 
tree. In summer they hold a picnic at the lake with about fifty of the 
same class of children attending. 

Speaking of clubs, the Kinsmen are very active in tuberculosis- 
work, particularly prevention programmes. Every summer they in- 
vite thirty underweight and tubercular-contact children from Chilli- 
wack and district and Agassiz to a splendid permanent camp, named 
the Kin Kiddy Kamp, for a month. They are closely watched by a 
doctor and nurse, and have their play, sleep, and work supervised 
according to Tranquille regulations. This is a splendid work which 
has saved more than one child from hospitalization. This Club has 
also, during the winter months, been a great aid in building the health 

36 



of indigent children by their donations of cod-liver oil, which is 
distributed by the nurse. 

Whenever Dr. Lamb, of the Travelling Chest Clinic, is in town, 
the Club is ready to provide transportation to patients who need it. 
Last year Dr. Lamb was in this district twice and examined eighty-six 
adults and thirty-four children. 

The Kinsmen were a great help in building up the tuberculin 
survey which was conducted last October. They gave explanatory 
talks over the radio and sent articles to the local paper. 

In the meantime it was necessary to send consent forms and 
literature to all schools. The number of consents was very gratifying. 
Approximately 90 per cent, had the tuberculin test. Of the 1,187 
children tuberculin-tested, only 126 were found to react positively, and 
on further examination and X-ray twelve of these needed to be re- 
checked, but no positive cases were discovered. This was a time- 
consuming piece of work, but it was so interesting and the results 
were so encouraging that the time was considered well spent. 

A big question in this district is the handling of several problem 
cases and many subnormal children. A great deal of this difficulty 
. has been solved since we have had a guidance clinic conducted by Dr. 
Crease, assisted by Miss Kilburn. Last year one adult was recom- 
mended for institutionalization, advice given regarding three problem 
children, and two subnormal children were excluded from school. 

Several years ago the need of an eye, ear, nose, and throat 
specialist in Chilliwack was felt. Through the Department of Health 
arrangements were made so that a doctor could come to Chilliwack 
whenever the nurses had enough cases for half a day's work. This 
work has grown so that last year it was necessary to have this service 
almost every month, and twenty-five adults and twenty-two children 
were examined. Such services are rendered at the same prices as in 
New Westminster ; the convenience to the people is much appreciated. 
Obviously the general public is becoming more keenly conscious of the 
importance of the care of the eyes. 

Since commencement of health-work in 1928 a ladies' organiza- 
tion has been helping the nurses. This organization is called the 
Auxiliary to the School Nurses. This group of ladies is composed of 
a representative from each organization in the valley. The progress 
of work can be reported throughout the district and continual contact 
with various groups maintained. Each organization contributes some 
money annually to the Auxiliary to help indigents as the necessity 
arises. 

The " Auxiliary to the School Nurses " holds a meeting each 
month, at which time the nurses report any outstanding matters, 
opinions are asked for, and help is sought for obtaining glasses or for 
1 having tonsils removed. During 1937, seven pairs of glasses were 
provided and three children's tonsils were removed. The amount of 
help that this organization gives the nurses cannot, therefore, be 
measured because it forms the nucleus of our health-work. 

37 



This organization has also been keenly interested in the welfare 
of the infant and pre-school group. Since a child specialist cannot 
possibly establish himself in such a small area, it was thought wise to 
engage one to examine children at a stated time and to emphasize the 
necessity for regular examinations. It was also decided to hold an 
annual well-baby clinic at the local fair, with a Vancouver child 
specialist in attendance. 

Last year this work was very gratifying, if attendance is an 
indication, and in one day 105 infants, pre-school and school children 
took advantage of the free examination from the municipality; the 
best attendance for many years. 

Such work was made possible the past two years by the co- 
operation of the Department of Health in paying the fee of the 
attending specialist and of two doctors. 

As a result of such work a change is noticed in the parents' 
attitude towards the family physician. It is obvious that they are 
now more inclined to have their children frequently examined than to 
wait until the need arises. 

It is true in all districts that there are many destitute families 
who need attention, particularly during winter months. Such work 
has been facilitated here by the forming of a Community Chest. This 
organization, made up of people interested in the welfare of the 
unfortunate, collects money from the local business people, gathers 
clothing and vegetables, and dispenses hampers to the needy at 
Christmas. 

The Community Chest functions all year, but is most active during 
the winter season. At that time rooms are opened at certain hours 
to receive requests and grant them when thought advisable. Many 
families receive beds, bedding, layettes, medicines, new and used cloth- 
ing and shoes, provisions, vegetables. Sometimes relief is given at 
the recommendation of the Community Chest. 

We find that many children remain at school for lunch, and 
few, therefore, have anything hot to drink until they return home. 
Wherever possible this has been corrected by the Parent-Teachers' 
Associations or Women's Institutes, who form soup committees in 
order to serve hot soup to children at the noon hour. 

Some of these organizations canvass the area for money and 
vegetables, while others raise a great deal of money through social 
activities, and in addition the children are required to pay a small 
sum. Results are hard to measure, but the schools that have had this 
privilege have had fewer colds. 

The most far-reaching result of the year was the appointment of 
a second nurse in the municipality. A great deal of this work was 
done by the various local organizations and Dr. Young's timely finan- 
cial help made the appointment possible last October. A happy day. 

Last year was a very active year and we hope to accomplish a 
great deal more in the future, especially since the people are becoming 
obviously more health-minded. Eva Moody, R.N., 

3 8 Chillhvack, B.C. 



VACCINATION IN A RURAL AREA. 

In November, 1937, a vaccination consent form was given to 
each pupil in the Matsqui-Sumas-Abbotsford Educational Area. It 
read : — 

" If you wish your child (name) vaccinated against smallpox, 
please sign this form and return to the school as soon as possible." 

There were no high-pressure campaign methods employed, but 
the necessity for immunization was stressed during home-school 
visits. Short talks were given in the class-rooms on the nature and 
purpose of vaccination and literature was distributed with the forms. 
It was made plain to every one that there was no compulsion what- 
ever about this vaccination campaign. The usual objectors were met 
with ; these were mostly members of religious sects. 

The response was, in our opinion, satisfactory. At the time, 
there were in the fifteen public schools and Consolidated High School 
of this area some 1,670 pupils. Of these, 1,022 returned signed con- 
sent forms and were vaccinated. In addition, mothers brought 
thirty-nine pre-school children to be immunized and four school- 
teachers were vaccinated with their pupils. 

Vaccination was done in each of the schools by the Medical 
Health Officer, with the Supervisor of Health Nurses in attendance. 
Consent forms were carefully checked and rechecked to make sure 
that no child was vaccinated without the written permission of parent 
or guardian. 

The following was the method used in vaccinating : — 
The deltoid region of the left arm was washed with rubbing- 
alcohol. When this had evaporated, a drop of vaccine was put on 
the skin and a series of small punctures made through it with the 
needle. The vaccine was then wiped off with dry cotton. Children 
who had been dreading the ordeal wanted to know if that was all 
there was to vaccination? They were warned against scratching the 
scab and told not to use shields or bandages. 

There was very little trouble from sore arms. Some " takes " 
were more severe than others, and in some cases illness due to heavy 
colds prevalent at the time was attributed by parents to the vaccina- 
tion. One child developed an alarming rash a week after being vacci- 
nated. This was found, upon diagnosis, to be a mixture of scabies 
and impetigo. The scars with the method used here were small, and 
parents who were vaccinated years ago were favourably impressed 
by the dispatch of the modern method and the neatness of the 
resulting scar. 

A total of 1,065 individuals were vaccinated here. Of these, 210 
had been successfully vaccinated previously and showed immune 
reactions. All of the 855 primary vaccinations were " takes." All 
school-children were inspected on the seventh day by their School 

39 



Nurse, the reactions noted, and each child vaccinated was given a 
certificate with the signature of the Medical Health Officer. 

Elizabeth Ochs, R.N., 
Matsqui-Sumas-Abbotsford Area. 



OUR FIRST YEAR. 

As this district is one of the Provincial Health Department's new 
babies, I write very humbly of the work here. 

Prince Rupert, the city 500 miles north of Vancouver, at the 
terminus of the Canadian National Railway, and built by one of the 
best natural harbours the world has (so they tell us), really should 
be a rival city of Vancouver, if all the well-laid plans had worked 
out that way, and by this time in that case there would have been 
a well-organized Health Centre and a whole staff of Public Health 
Nurses. However, in reality, Prince Rupert is a very attractive little 
city, built on the shelves of rock beside this same harbour, with a 
very lovely view of the mountains around and the islands across the 
harbour, particularly as the sun sets behind them, and they did not 
have a Public Health Nurse till September, 1937. 

Much of these first six months, then, have been spent in organiz- 
ing the work and one cannot mark very much progress yet. 

A real epidemic of measles with over 600 cases, an epidemic of 
whooping-cough, and some scarlet fever made the work a little uphill, 
like the country around us, but did add a good deal of zest to it. 
We were very thankful that most of the children apparently made a 
good recovery. 

One project that has been completed is that of giving milk to 
the school-children. The children here had not been drinking the 
milk that they should, although there are three dairies supplying 
fresh milk. It is expensive and the canned-milk habit has become 
quite the custom. However, the three chapters of the I.O.D.E. took 
up the nurse's suggestion and have been assisted by other organiza- 
tions in the city most nobly, and at present a great many children 
are enjoying a drink of milk during the morning. 

As a beginning, the plan was to include only the first three 
grades, but the demand was soon so great from the older children 
that it was necessary to include the whole school. Some, I believe, 
hardly knew the taste of fresh milk, and the nurse has been told of 
several cases where the children have made it very plain at home 
that they would like the plan carried out at home over the week-end 
— when they would never touch milk before. We hope that these 
children will show much benefit from this extra nourishment and 
new habit, and that even at this stage some dental cases may be 
prevented. 

A T.B. survey of the schools was done last year by one of the 
local doctors under Dr. Lamb's instructions — that is to be completed 
with the new children in the school this month, I hope; and very 

40 



soon we plan a vaccination clinic and I hope a toxoid clinic, as there 
are very few children immunized against diphtheria and a large 
group not vaccinated. 

One of the chief industries of this community is fishing. It is 
very interesting to watch them " seining " for herring in the harbour. 
It is the custom to give the first catch away. This amounts to several 
thousand pounds. One afternoon I happened to be in the school 
when the message came to tell the children that there would be 
herring on such-and-such a wharf after school if they would come 
after it. I wish I had a snap-shot to send you of some of the pic- 
tures that greeted me cheerfully that afternoon coming back from the 
wharf with pails and saucepans overflowing with herring for supper. 

There is much work to do in this new district. Sometimes it 
overwhelms one; but with this beginning we hope that it will grow 
and that the community will feel the benefit of the Public Health 
Nursing Service and the Disease-prevention Programme. 

E. Dorothy Priestly, R.N., 

Prince Rupert, B.C. 



FERNIE. 



The reading of Dr. Young's report in the Medical Inspection of 
Schools is like the reviewing of one's life before the end of the old 
year ; with this exception : In the reviewing of one's life at the close 
of the year one very humbly looks upon all the good intentions 
scrapped and the long list of failures, but, in our superior officer's 
report, we are struck with the amount we have accomplished and 
the spirit in which it has been carried out by the nurses and received 
by the public. 

The control of epidemics seems one of the greatest steps in pre- 
ventive medicine and is the one which gains greatest whole-hearted 
co-operation from the teaching staff. 

The interest that children show in their weights is the best 
check-up on malnutrition, and even the youngest are quick to see the 
relationship between diseased tonsils and teeth and healthy growth 
when it is explained to them; these two defects are attended to in 
large numbers, especially during the holiday terms. 

All serious eye-defects receive attention, and fracture cases, 
which seemed almost epidemic this year, are out of school for a very 
short period, as they can get the attention they need from the nurse. 

All cases needing medical and surgical attention receive it much 
more promptly when referred by the nurse, as the mothers very often 
do not realize the urgency of the case — such as sore throat developing 
into severe tonsillitis, or a stomachache into an acute appendicitis 
within a few hours. 

The mothers more and more find the nursing service a help, espe- 
cially in the disorders and ailments of adolescent children ; and the 
student of past years now brings her young baby to be checked over 

41 



for weight and to receive advice on diet and any unusual growth 
or skin condition. The " advisory letters " are much appreciated, 
especially by these younger mothers; the fathers study them as well. 

The more sustained attendance in the schools and the brevity 
of any epidemic, along with the feeling of confidence both pupils 
and parents have in the nursing service, are clear indications that 
the public has become educated to what the public-health service is 
and in how many ways it can aid them in attaining to a better health 
standard than ever before. 

To copy from the report : " To put in a few words, the benefit 
obtained is one of value to the community in general and to the school 
in particular. Naturally, the betterment of health conditions in the 
school is reflected in the general well-being of the community." 

Winifred Seymour, R.N., 

Fernie, B.C. 



TONSIL CLINIC IN THE PEACE RIVER BLOCK. 

The tonsil clinic was in full operation upon my arrival in the 
Peace River Block. It has proved a very successful method for the 
removal of diseased tonsils among the children here. 

Following the regular examination of the school-children, it was 
apparent that some were affected with diseased tonsils which were 
detrimental to the health. Parents in many cases had been informed 
of these conditions, and except in a few cases had not taken any 
action. Reasons for this were due chiefly to the characteristic con- 
ditions of this part of British Columbia. 

The majority of people live on homesteads, some of which are 
a very long distance from a doctor or hospital. Often the only means 
of travel is by team, and at times travelling is practically impossible 
due to poor roads and climatic conditions. Also, on the other hand, 
during the good weather both men and teams are busy on the land. 

Many parents also feel they are unable to meet the added expense 
which would be entailed in such work. They are really trying to 
build a home from the beginning, which is typical of pioneering, and 
they really need their finances for the maintenance of themselves 
and children. 

Another reason, although it may not always be a major one, is 
lack of knowledge of hygiene and the way to maintain health. Time, 
money, and mind have been occupied with building a home and 
making a living. The people do not realize the value of practising 
all the health rules, nor know that tonsils can be detrimental to 
health in that they are sometimes the forerunners of serious dis- 
eases such as rheumatism and cardiac conditions. However, through 
the efforts of the staff of the Health Unit, many parents are learning 
the value of health rules put into practice and are more ready to 
co-operate. 

42 



Because of these difficulties it was decided that a different plan 
must be put into effect, in order that the work could be done success- 
fully on a large scale. The chief aims were to have the defects cor- 
rected and to make no distinction between the economic conditions 
of the people whatsoever. An arrangement was made with the hos- 
pital authorities, the doctors, the Official Trustee, and the Medical 
Health Officer, whereby a special flat rate was to be paid to cover the 
hospital and doctors' fees. For the few who were unable to pay the 
full rate, arrangements were made that they could work out the 
balance on various schools where there is a certain amount of work 
to be done such as painting and kalsomining, repairs, moving of 
privies, and also putting in the year's supply of wood and ice. The 
payment for the removal of tonsils and adenoids was to be made 
through the Official Trustee, who also arranged the work that was 
to be done by those parents who were paying part and working the 
balance. 

Following the completion of these arrangements, the members of 
the Health staff interviewed the parents, advising them of the need 
of the removal of the diseased tonsils and adenoids. From those 
parents who were in favour of the work they obtained a written 
permission from them, and also made arrangements for payment, 
to be either in full or part cash and part by working. 

The clinic was held during July and August of 1937. The chil- 
dren were transported to and from the hospitals by members of the 
Health staff. Following the return of the child home, the parents 
were instructed regarding the post-operative care, as the majority 
of the children remained in the hospital for a day following the 
operation. Usually, within the next week, and as far as it was 
possible, another home visit to note the progress of the child, and 
also to give further instruction, if necessary. The mothers seemed 
to appreciate these follow-up visits, as they felt the Health Unit 
was sharing the responsibility of caring for their children by giving 
the needed instruction. 

One of the greatest factors in the operation of this clinic was 
the distances that had to be covered in transporting the children. 
At times trips from 70 to 95 miles were made. In some instances 
the parents co-operated and brought their children to a central point 
where they were met by a member of the staff. On one of these 
trips, which was made partly by boat, members of the staff and two 
children spent the night on a sand-bar in the Peace River. They felt 
little the worse for their experience, however, except for lack of 
sleep, and looked upon the night's outing as one of the episodes that 
made life in the Peace River Block varied. 

Tonsillectomies were advised in 147 cases and 138 children had 
their tonsils and adenoids removed, showing how successful the first 
tonsil clinic in the Block proved to be. The results are manifesting 
themselves, as there is improved health among these children. In 

43 



one case, for example, one boy has gained about 12 lb. and is taking 
a keener interest in his own health. 

Thus through the clinics and by other means, the Health Unit 
here is trying to teach the people of the Block the " way to health," 
also that " an ounce of prevention is worth a pound of cure." 

Kathleen Sheppard, R.N., 

Rolla, B.C. 



VACCINATION AT NORMAL SCHOOL. 

As School Nurses we are accustomed to observing vaccinations 
in children and younger people. We know the usual course of events 
and can reassure those concerned as to the results. It is unusual 
for a school-child to be affected to any extent by a " take " or to miss 
even a day at school because of it. With proper supervision and care 
of the pustules, there is always invariably a quick healing and a 
neat scar. 

When, however, we consider the question of vaccinating adults, 
we are not prepared to be dogmatic. There is always the uncertainty 
as to the extent of the reaction. Some individuals will respond so 
heartily to the vaccine as to be incapacitated for a day or two, or 
have a painful arm or painful glands in the axilla for the same period. 
While this is a very small price to pay for protection against a dread 
disease, it is often a deterrent to the average busy adult. Those 
who are working, those who are engaged in important projects, 
those who are preparing for examinations in the near future, are 
reluctant to impose on themselves anything likely to interfere with 
their plans. To the wage-earner the loss of one or two days' work 
is a serious consideration, and to the student any indisposition is 
likely to disrupt courses of studies. With these points in mind, it 
might be interesting to consider some vaccinations done at the Pro- 
vincial Normal School in January, 1938. 

Following an address by the Medical Health Officer on the sub- 
ject, fifty-one students signed for vaccination. Of these, twenty-one 
had never been done before and had proper takes. Twenty-nine had 
been done in previous years. Of these, twenty-two had immune reac- 
tions, five had accelerated reactions, one had a normal take. One 
student had never been done before and did not have a take, or, in 
fact, any reaction even when revaccinated. There is a possibility, 
however, that she may have had a mild case of smallpox in infancy. 

The " takes " were dressed with very light gauze dressings — 
fastened with adhesive well away from the inflamed area. The 
students were given instructions on personal care as well as on care 
of the pustules, and were excused from physical education for the 
required period. Only those students were done who were in good 
health at the time, and aseptic methods were used. The use of the 
light gauze dressings protected against rubbing of sleeves and pos- 
sible introduction of infection. 

44 



The results from this clinic will be apparent later when these 
same student-teachers scatter to different parts of the Province 
and are placed in charge of school-children. The presence of an 
enlightened and co-operative teacher is often the chief factor in the 
control of communicable disease in the school-room, and the success 
or non-success of immunization clinics depends almost as much on 
the teacher as on School Nurse or Health Officer. 

M. R. Smith, B.A.Sc, R.N., 

Saanich, B.C. 



WHAT OF EYES AND EARS? 

The great moments when the highlights of achievement play upon 
the field of endeavour are comparatively few in life and in our chosen 
work as well. 

They do occur, of course, from time to time, as, for example, a 
big tuberculin-testing campaign such as we had in Chilliwack last fall, 
with a 90 per cent, satisfactory response from the parents and with 
results so splendid that not a case of active tuberculosis was found, 
not even among the older high-school students, among whom one 
might fear, perhaps, a case or two might be found. Or again the 
thrill of seeing a child-guidance clinic organized and seeing its excel- 
lent services placed in a community and its value increase with the 
years. Also the day when the Rotarian Service Club decided to make 
as its great objective a Rotarian dental clinic, which would function 
as a service taking care of dental defects, especially at first and com- 
pletely now of those school-children whose parents are unable to 
shoulder this responsibility themselves. The work and the improve- 
ments made in the two years since first it opened cannot be adequately 
appreciated. 

But these are the peaks ; in between lies the routine of every day 
in long stretches. We know it is the constant efforts of each day that 
really counts. The home visits with a purpose or two ; the unremit- 
ting attention to details; the interest in individual problems, all of 
which determine the success of our work. Doubtlessly it is the hard- 
to-define personality of the health-worker which really means the most 
and which the people remember the longest. 

But to make our routine more valuable and our work more ac- 
curate I wish we had a few improvements in the way of good equip- 
ment. We find — I know many feel the same way — the ear-testing 
method, be it whisper or watch test, most inadequate. Last fall, after 
reading Gates' " Improvements in Reading," especially, of course, the 
part dealing with vision and hearing tests, I became fired with the 
ambition to do things better and with greater precision. 

In " Improvements in Reading," by Gates, he refers one to write 
to the McKesson Appliance Company, Toledo, Ohio, regarding these 
instruments, called " acumeters," for testing the acuity of hearing. 
They cost $97.50 from the United States and would cost more by the 

45 



time we receive them here. Owing to the cost I felt, perhaps, I could 
not ask for these for the schools at present. 

So I made inquiries in connection with the " telebinoculars " for 
eye-testing. Particulars were received from the Keystone View Com- 
pany, Meadville, Pennsylvania. Price quoted was $75 — probably $85 
with excise tax, and so on, by the time received here, and unfortunately 
prices since then have advanced. 

I was very anxious to obtain these telebinoculars and brought up 
the matter at a School Board meeting. They were in favour, provided 
the instrument is of value, and naturally wished to see letters recom- 
mending it for same. I wrote here and there, but the telebinoculars 
are not in use in Western Canada, apparently, nor in Eastern Canada 
either, for no replies were received. Mr. Hudson sent recommenda- 
tions from various schools and offices in Oregon and Washington and 
these I expect to present at the next School Board meeting. 

If any of the other nurses know of the value of either of these 
instruments I would like to hear from them, or if they know where 
reliable information can be obtained as to their worth I would appre- 
ciate it, for, considering that our eyes and ears are the means by which 
we know the rest of the world, any of these aids in detecting defects 
early in life cannot, surely, be overestimated. 

Claire Tait, R.N., 

Chillhvack, B.C. 



TRANSPORTATION. 

I'm going to write you a fair little ditty, 
About one of our nurses in Sweet Garden City; 
About trials and worries of car transportation 
And how they upset her fine disposition. 

She starts in the morning 
As fresh as a daisy, 
Tho' around about ten 
She is feeling quite hazy. 




46 



In the course of her travels 
She gets stuck in the mire, 
Or, what is much worse, 
May have a flat tire. 

Her arms waving wildly 
To people who pass, 
She hopes they will help her 
And offer her gas. 




At night while on duty, 
If the telephone rings, 
She wonders who that is 
And grabs up her things. 

The phone is insistent; 
" Oh, nurse," a voice calls, 
" Come quickly, my husband 
Is fast going bald." 

The phone rings again, 
This time to suggest, 
" My Billie has fever 
And spots on his chest." 




47 



she jumps in her car — 
The night's black as pitch- 
She steps on the gas, 
And goes in the ditch ! 

On leaving the car 
She climbs in a boat, 
And then does her best 
To keep it afloat. 




D 









WUrfo 



By the time she arrives 
At her destination 
She feels very much 
Like saying D ! 

When at last with her patients 
All night she has tarried, 
She drags her car home 
And decides to get married. 




D. Tate, R.N., 
F. Freeman, R.N., 

Saanich Health Department. 



48 



CONTRASTS. 

As I write to-day, with the ground all covered with snow, I am 
reminded of a beautiful spring day just a year ago. It was a lovely 
day, one of those green and blue ones so typical of the early spring. 

We were holding a toxoid clinic and about thirty-one babies, 
ranging from six months to four years, had arrived and were waiting 
for the doctor. They looked awfully sweet all dressed up in pretty 
pinks, blues, yellows, and whites, with hair all combed and curled. 
While we waited the conversation centred around child-welfare, and 
one mother remarked: " I feel just a little bit as if we were leading 
our lambs to the slaughter. I hate the thought of sticking a needle 
into these poor little arms." It seemed a good time to draw the 
contrast between the poor babies who have in the past, for lack of 
diphtheria toxoid, died the agonizing death of a paralysed throat or a 
worn-out heart. " What," I asked her, " was a mere pin-prick in 
comparison to a tragedy like that? " I pointed out to them that they 
should be grateful for the privilege of immunization against such a 
disease — and I really think they were. How times have changed — 
and what contrasts there are between the old ways of doing things 
and the new! 

B. Thomson, R.N., 

Keremeos, B.C. 



A CHILD-STUDY GROUP. 

In the 1932 Bulletin there appeared an article by Miss Kerr on 
the above subject, but it was not until after her visit last December 
that we started to organize a group here. 

I thought only to start the ball rolling when I invited the first 
group together and explained the possibilities of such a study, but 
since a real child psychologist did not appear we have gone on with 
the study week by week for over a month. Our attendance is not 
large (average of ten), but we have had some very interesting dis- 
cussions on food, elimination, clothing, etc. We expect to go on with 
such subjects as health attitudes, sex-training, emotions of children, 
play habits, etc., and I am looking forward to these meetings with 
pleasure for an opportunity to learn about the behaviour of children 
from the mothers. 

We adhere to the discussion method — discussing questions sug- 
gested in the helps and those that are introduced by the group. 

We use the text, " Parents and the Pre-school Child," by Blatz 
and Blot, and any other texts which the members may have ; also the 
outline by Jennie I. Roundtree, Ph.D., which has been used in Van- 
couver study groups. 

A similar group of mothers are studying this subject at Nara- 
mata. A well-selected committee arranges the subjects for each 
meeting and appoints leaders. 

49 




It seems to me that there are great possibilities in such study 
groups — possibilities of improving the child's pre-school training, so 
that there will be fewer problems when school is reached. The atti- 
tudes of both parent and child towards health and social problems 
should also be improved, so that failures in later life will be prevented. 

M. A. Twiddy, R.N., 

Penticton, B.C. 



GROWING UP. 

The new record system suddenly thrust into our midst seems to 
have been the skeletal structure necessary upon which to fashion 
even more securely our fields of endeavour, resulting in its further 
natural growth and development. 

Some signs of advancement have been T.B. records sent from 
head office indicating known doctors' cases in our district. These 
cases are then able to receive the additional care Which has long 
awaited them and are no longer at a standstill for lack of closer 
supervision. 

The communicable-disease records compiled year by year are of 
particular statistical value to ourselves. Tonsillitis and sore throats, 
prevalent more so in the Happy Valley School area, do not seem to 
be the result of one causal factor, but rather the influx of poor people 
into an already impoverished district, where education is at a particu- 
larly low level and superstition in some quarters still prevails. It is 
a gradual process, but they are being removed one by one. This 
factor may also account for there being fewer toxoids done in the 
same area. There also lacks a certain amount of impetus from the 
teaching staff, judging from results obtained from other quarters 
where a whole school has been toxoided, the teacher giving his whole- 
hearted support. There remains much to be done in this locality to 
awaken the public's interest and to set into motion communicable- 
disease prevention. 

Prenatal supervision is even more adequate with our new system. 
We would like to receive a monthly letter from our Relief Officer 
stating the number of prenatals who invariably come to his attention. 
Transportations to doctors' offices have been provided. 

Infant and pre-school developments have been mostly in the 
nature of well-baby, dental, toxoid, and vaccination clinics. Trans- 
portation also provided. 

Our greatest strides have been made this year in the school-work, 
with the provision of a dental clinic in the Langford Women's Insti- 
tute Hall, also in the work of the School Medical Health Officer, 
through Dr. Young providing toxoid for five schools. Transporta- 
tions being provided to these local clinics have saved considerable 
time for the nurse and expenditure in gas, etc., for the committee. 
Tuberculin has also been given whenever necessary in our schools 
and followed up on the advice of the Medical Health Officer with 
X-ray at the Jubilee Hospital. Water is being piped into Shirley 

50 



School, and we hope this will also be accomplished in our other two 
small schools. 

The dental clinic itself deserves some mention, for it was not 
without real work that it has been set into action. Each Thursday 
morning the dentist, with his own nurse, visits the clinic, and works 
from 9 until 12. He is paid $3 per hour; the charges to patients 
are $1 for a permanent filling, 50 cents for a temporary filling, and 
50 cents for an extraction. Up to the end of February the parents 
have paid $48, other organizations $41, and the use of hall by 
Women's Institute estimated at $16 ; from Dr. Young, $100. Opera- 
tions to end of January, 136. Forty-five children have been treated 
and the cost to date has been $33. The nursing committee have 
generously decided to continue this good work for another year. 
Collections are slow and the problem of raising money in our district 
is not altogether easy ; however, with some bright new idea, we hope 
the project will continue. Dr. McCarter has consented to meet both 
Happy Valley and Langford Parent-Teacher Associations with the 
express purpose of making the parent better acquainted with 
dentistry as the dentist knows it. He also welcomes any parent who 
cares to interview him at the clinic. 

Our social service is mainly in conjunction with the Welfare 
Office in Victoria, where contacts are made and deserving people 
helped by pensions, blind pensions, etc., or are perhaps given relief. 
Clothing, food, and bedding are given out from local organizations 
or from individual givers, as the case may be. 

The bigger question of sanitation is primarily for the Medical 
Health Officer, but some information is required for our records, 
as, for example, toilet facilities, septic tanks, and sewers, which 
are mostly inadequate. Wooden houses prevail and water-supply is 
generally good, but milk-vendors are not at all uniform. I think 
there should be more tuberculin-tested cattle, so that undulant fever 
in our district would be a little less prevalent. 

Most of the people either rent their homes or have them mort- 
gaged; few own property on their own. The Albert Head project 
has served to keep many people off relief. 

The Public Health Nurse avails herself of contacts made in the 
City of Victoria, especially in the public-health nursing groups, where 
problems may be jointly solved. 

The case-histories are added to day by day and we hope soon to 
have them ready for inspection. New daily report forms have been 
introduced, which serve to record more work done and are an economy 
and saving to the committee. 

There is still a maximum of first-aid nursing done, and assistance 
is given to people so that they may avail themselves of doctors' 
services in acute illness ; while at the same time we are stressing 
the preventive side of nursing. 

D. Wilkie, B.A.Sc, R.N., 

Colwood, B.C. 

51 



GIBSONS LANDING. 

After much preliminary discussion by the various branches it 
was finally decided, in June, to call a Public Health Nurse to take 
charge of the districts, including Gibsons Landing, Sechelt, Wilson 
Creek, Roberts Creek, Granthams Landing, Hopkins Landing, and 
Gower Point, the area of which amounts to about 26 miles by 4. 
A car also was purchased, though not available till some weeks after 
the district was opened. 

To one coming directly from the Prairie the roads at first seemed 
all hills and turns, but now in retrospect the Prairies seem terribly 
flat. The beauty of the scenery still impresses one with its changing 
moods. 

With the close of the holiday season in September, six schools, 
with an enrolment of 199 students, were listed for visits, and despite 
the fact that several families have left the district the influx has 
dominated and we now have an attendance of well over 200. 

The pioneer work of discovering the infants and pre-school 
children has resulted in an encouraging list of children, and the 
contacts thus made will undoubtedly prove their worth still further 
as the work progresses. 

Our first child-welfare clinic was started in January, and while 
the attendance was not high — the weather being unfavourable — we 
feel encouraged by our efforts in that direction. 

Diphtheria immunization is the leading topic at the present time, 
and we hope before very long to be really active along these lines. 

Whilst there are many pensioners in this locality, their demands 
have been few, possibly due to the combination of a quiet life and a 
good climate. 

In the early fall a class in St. John Ambulance " first aid " for 
senior girls was organized and completed satisfactorily, and from the 
enthusiasm aroused through this group we were obliged to organize 
an adult group, which, according to regulations, is being taught by 
one of the local doctors. 

Some one from afar has, in writing, remarked that Gibsons 
Landing had a lonesome sound. I am sure if they were here they 
might be convinced otherwise, apart from the fact that the trip to 
Vancouver is only two hours on the boat practically any day. Even 
yet the trip to town each month savours of an adventure, for there 
is always so much to do and see in the big city. 

Lillian A. Wooding, R.N., 

Gibsons Landing, B.C. 



52 



ON REGULAR YEARLY DENTAL CLINICS IN THE 
PEACE RIVER HEALTH UNIT. 

For the past three years, 1935-36-37, since the Peace River 
Health Unit was organized, we have held dental clinics throughout 
the Block each year. These were made possible through the co-opera- 
tion of the Provincial Board of Health, which paid the cost of 
materials, travelling and incidental expenses, and the Official Trustee 
paid the salary of the dentists, who came in from Vancouver. 

A very interesting and important work is being done by these 
clinics from several angles. 

(1.) Absentees from schools because of toothache is a thing of 
the past. 

(2.) The dentists have helped a great deal in stimulating the 
interest of the parents and children in the care of teeth with relation 
to general health. 

(3.) Extractions have been reduced over 68 per cent, in 1937 
over 1936. 

(4.) Generally speaking, this work could not otherwise have been 
done because of financial circumstances. 

Years show that a child will develop, on the average, slightly 
over one cavity per year and also show how quickly teeth will de- 
teriorate with the lapse of one year's treatment (Fort St. John and 
Rolla received treatment in 1935 and 1937 but not 1936), as in the 
case of Fort St. John and Rolla, where treatment was not carried out 
in 1936. It can be understood that yearly treatments of teeth become 
more a preventive type of work, as a cavity in the course of a year is 
small and danger to general health is greatly reduced, as also the 
possibility of extraction of teeth is reduced. Here it may be added 
that costs are also reduced. In the Peace River Health Unit the cost 
per child for the year 1937 was reduced to 20 per cent, per child over 
1936, and the cost per operation to 10 per cent. 

The cost of yearly clinics is high, but we consider it very neces- 
sary and would like to see it continued. It would seem reasonable to 
suppose that a resident dentist would be the solution to cheaper opera- 
tion of dental clinics in the Block. This would of course eliminate 
the costs of travelling to and from Vancouver. This would also be 
advantageous from the point that some arrangement could be made to 
have children treated who may need immediate care. It is believed 
that a resident dentist could make a good living doing private work 
and in this way could do our special work considerably cheaper. 

Pauline Yaholnitsky, R.N., 

Progress, B.C. 



53 




" The end of the Day.' 



VICTORIA, B.C. : 
Printed by Charles F. Banfield, Printer to the King's Most Excellent Majesty. 

1938. 



850-338-3154 



54 






ISSUED BY THE 

PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA 



Public Health Nurses' Bulletin 



Vol. 2 



MARCH, 1939 



No. 6 








We salute Their Majesties. Long may they reign. 



EDITORIAL. 

To the nurses one and all we give a new type of Bulletin that has 
been carefully prepared along the lines of certain topics. We feel 
sure you will like this new Bulletin and know that you will derive 
much pleasure and profit in its perusal. 

B.J. 




Peace. 



TABLE OF CONTENTS. 

Page. 

Armstrong, Miss N. E. — Value of Affiliation with Metropolitan Health Unit—. 5 

Jones, Miss N. E. — Vancouver Island Unit of Tuberculosis Control 6 

Law, Miss A. S. — Cowichan-Peace River : A Comparison 9 

Leslie, Miss J. — Rebirth of Public Health Service in Port Alberni 14 

Little, Miss M. — A Vaccination Clinic — Revelstoke 17 

Malkin, Miss L. — Another Dental Clinic — Esquimalt Rural Nursing Service . 21 

Miles, Miss Marion — Organization of a Rural Health Unit 27 

Pease, Miss E. — Aspects of Tuberculosis Work in the Okanagan 30 

Priestley, Miss E. D. — Reaction of Opening a New Health Centre in Prince 
Rupert 33 

Whitehead, Miss U. — Development of a Programme in V.D. Control 36 

Young, Miss Fyvie — Practical Problems involved in Supervision 47 



THE VALUE TO AN OUTLYING UNIT OF ITS AFFILIATION 
WITH THE METROPOLITAN HEALTH COMMITTEE. 

The development of the health programme in Vancouver, as in 
most large cities, was based on the organization of specialized health 
services. Following the trend of public health thought, there was 
a feeling in some quarters that an amalgamation of the specialized 
services would be desirable. It was not, however, until a critical 
situation arose, necessitating immediate consultation between Pro- 
vincial and city health authorities, that the difficulties involved became 
apparent, and that machinery was set in motion to analyse the situa- 
tion. 

Under authority from the Provincial Board of Health, a plan 
was outlined whereby all health services would be centralized under 
one head. Quoting from the reported plan submitted in 1936, the 
Division of Public Health Nursing was to include school health, child- 
welfare, and tuberculosis programmes. The organization to be known 
as the Metropolitan Health Committee was planned to include the 
Greater Vancouver area and near-by municipalities willing to partici- 
pate, and started functioning in 1936. 

The City and District of North Vancouver has had, since 1930, 
a full-time Health Unit, in which a generalized programme has been 
developed to meet the needs of the community. The Unit office is 
situated in the North Vancouver General Hospital, which brings us 
into close contact with the medical profession and the hospital authori- 
ties. Child-welfare, school health, tuberculosis and communicable 
disease control comprise the programme of the Unit. 

The inclusion of the North Vancouver Health Unit in the organi- 
zation of the Metropolitan Health Committee did not necessitate any 
significant change in the programme already in operation. Certain 
theoretical advantages may be said to accrue as the result of this 
amalgamation of an outlying unit with the larger organization. 

After a period of over two years it may be of interest to the 
public health nursing groups to review the advantages that are 
apparent. 

Contact with a Larger Staff. 

A small group has a limited opportunity for active discussion 
and is apt to carry on from day to day without much change. Where 
contact with a larger group of public health nurses is possible, the 
experiences and ideas of others are introduced with advantage to 
the smaller staff. An experiment conducted in one unit will result 
in conclusions which another unit may use profitably. If a judicious 
selection is made of those conclusions shown to be good, much time 
and effort may be saved. 

Consultation with Specialized Supervisors. 

The Public Health Nurse working in a district meets problems, 
in dealing with which she may feel that she needs some guidance. 
As at present set up the Metropolitan Health Committee has special- 

5 



ized supervisors for the divisions of Child-welfare, School Health, 
and Tuberculosis Control, whose function it is to advise in their 
respective fields. One advantage gained by the North Vancouver 
Health Unit, in amalgamation, has been the addition of this consultant 
service to its staff. 

Inclusion in a Staff Education Programme. 

There are many difficulties to be encountered when a Public 
Health Nurse wants to keep herself up to date in her knowledge of 
medical, nursing, and public health practice. Individual effort is 
important, but for the members of a small staff there are few incen- 
tives and limited opportunities for gathering information other than 
by reading. Where plans can be made for a group of forty or so 
nurses, the available resources are much greater. The Metropolitan 
Health Committee, recognizing the value of continuous education, 
arranges regular meetings at which all members of the public health 
nursing staff are present, and to which various speakers are invited. 
These speakers, because of their work and experience, are able to 
tell us of new treatment and preventive measures, to interpret the 
work of other organizations in the community, and to bring stimulat- 
ing material of value to the Public Health Nurse. 

There has not been time since the date of amalgamation to justify 
any evaluation of advantages or disadvantages. Account should be 
taken of the fact that a small city situated so near a much larger one 
presents a type of community development that is in many ways 
unique. Undoubtedly when in future the amalgamation, not only of 
North Vancouver but also of other neighbouring municipalities, with 
the larger centre is of longer standing, other advantages to the com- 
munities such as ours will become apparent. 

Norah E. Armstrong, R.N., B.A.Sc. 



THE VANCOUVER ISLAND UNIT OF TUBERCULOSIS 

CONTROL. 

The Vancouver Island Unit of Tuberculosis Control is comprised 
of both stationary and travelling clinics, with headquarters in Vic- 
toria. The stationary clinic is under the supervision of Dr. Frederick 
Kincaid, and the travelling clinics, while operated by the staff of the 
Victoria Unit, are under the general supervision of Dr. Gordon Kin- 
cade in Vancouver. Working in conjunction with Dr. F. Kincaid 
are three part-time medical men, one nurse, one part-time social 
worker, and three part-time nurses up-island, mention of whom will 
be made later. There is bed accommodation in the Pavilion, Royal 
Jubilee Hospital, for 40 patients, receiving active treatment; 21 in 
the Infirmary Quarters at St. Joseph's Hospital ; 19 for convalescents 
in the Villa at St. Joseph's Hospital. In this connection it may be 

6 



stated that all beds in the Province are pooled from the Head Office 
in Vancouver, and the Victoria beds are not kept for island cases only. 
At the end of the year 1937 all cases in the Island register were 
reviewed and tabulated as follows : — 

(1.) In hospital under the Tuberculosis Divi- 
sion 57 

(2.) At home, but under treatment or close 

observation (cases not necessarily open) 140 
(3.) Cases at home (all definitely closed) 506 

(4.) Total number of cases on Island register 

Dec. 31st, 1938 703 

These figures show an improvement over previous years. Indian 
patients are not included in these figures as they come under the 
Department of Indian Affairs of the Dominion Government. A small 
but inadequate start has been made in caring for these people. 

The clinic nurse is on duty in the clinic every morning receiving 
cases, taking histories, giving tuberculin, and generally assisting the 
examining Medical Officer. During the past year the nurse spent 
two to three half -days per week visiting cases in their homes, having 
made 796 visits in 1938. These visits took the form of following 
up cases discharged from hospital, looking up contacts and patients 
who had failed to keep their clinic appointments, and giving instruc- 
tion wherever possible. Whenever a social problem arises, it is 
handed over to the Social Worker. All cases requiring bedside care 
are referred to the V.O.N. These cases are very few, as most of 
such are in hospital. 

Special efforts are being made to bring in all known contacts of 
active cases for examination. This has made a considerable increase 
in the work of the clinic nurse, who has found it necessary to curtail 
the visiting of old, inactive cases who attend at regular intervals for 
examination, so as to concentrate on finding contacts and the super- 
vision in their homes of the comparatively few active cases. The 
inactive cases are not overlooked and every one of them has a definite 
appointment for re-examination in the clinic and is followed up if 
the appointment is not kept. 

The foreign population of Victoria consists of British Indians, 
Japanese, and Chinese. The nurse has had no difficulty with the two 
former, but with the Chinese it has been different. Owing to the 
language problem and no clear understanding of the nurse's motives, 
little or no progress has been made. The Unit has been fortunate 
now in enlisting the co-operation of the head of the Chinese Benevo- 
lent Society, who is also the head of the Chinese Hospital, and of the 
Reverend Clarence Lee, Chinese Priest of the Good Hope Mission. 
This Mission works for the Chinese people under the direction of the 
Anglican Bishop. By this means we hope to make a better contact 
with these people. 

7 



The Occupational Therapy Department undertaken by the 
Kiwanis Club and financed by the local Christmas Seal Fund, has 
made great progress. There is a work-shop and a store. A trained 
occupational therapist is in charge. Thirty-three patients have 
learned handicraft in the wards, thirty-seven attended the work-shop. 
The majority of these were in the convalescent wards. Some were 
out-patients who attended daily. Thirty-four took educational courses 
in high school work and ten Indians in elementary work. Some of 
the thirty-four were patients in homes. 

Travelling clinics are held at the following up-island centres: 
Duncan, Chemainus, Ladysmith, Nanaimo, Cumberland, Campbell 
River, and Port Alberni. 

During the year 1938 the number of clinics held and the average 
number of patients seen were as follows : — 

Duncan 10 clinic days — 160 patients. 

Chemainus 4 clinic days — 61 patients. 

Ladysmith 5 clinic days — 71 patients. 

Nanaimo 16 clinic days — 310 patients. 

Cumberland 11 clinic days — 214 patients. 

Campbell River 3 clinic days — 42 patients. 

It was formerly the policy of the Victoria Unit to have the clinic 
nurse travel up-island with the doctor, assist at the clinics, take 
X-rays, give tuberculin, etc. ; but it was found that the periodic 
contact at the time of the clinic was not sufficient and that the nurse's 
work suffered in Victoria during her absence. Three part-time nurses 
have been added to the staff and the contact is now continuous over 
the whole territory. One was taken on in December, 1936, at Port 
Alberni; one in December, 1936, in Cumberland, covering Comox 
and Courtenay as well ; one in August, 1938, at Nanaimo, covering 
as well Chemainus, Duncan, and Ladysmith. These nurses arrange 
the appointments, see that the X-rays are taken (now being taken 
by the local hospitals), sputum tests made, and so on. They assist 
the travelling Medical Officer at the clinics and in every way try to 
co-operate with the Public Health Nurses. The Victoria clinic nurse 
made her last visit up-island in June, 1938. Pneumothorax treat- 
ments are given in Ladysmith every two weeks by one of the Victoria 
doctors. About eleven patients receive treatment each time. 

When a new case is diagnosed a special " P.H.N. No. 7 — green 
form " is made out in duplicate by the Unit. These forms are sent 
out to the nurses. In Port Alberni and Cumberland to our special 
workers and to the Public Health Nurses in Nanaimo, Duncan, and 
Ladysmith. In the outlying districts where there is no nurse, the 
P.H.N.'s are sent to the Welfare Worker. A short report on patient's 
home conditions and financial status is entered on the forms and one 
copy sent to Miss J. B. Peters, R.N., Provincial Supervisor of Tuber- 
culosis Nursing, at the Central Office in Vancouver. When a patient 
moves from one district to another this form is sent to Miss Peters, 
who forwards it on to the nurse or Welfare Worker in the district 



8 



to which the patient has gone. The person who receives the copy 
of the P.H.N, is responsible then for that case. 

A considerable amount of educational work was done during 1938 
by the Unit in the way of distribution of literature and lectures to 
the nurses by the Medical Director. At the Fall Fair, 1938, a booth 
was erected by the Occupational Therapy Department. This booth 
displayed samples of work done by the patients — X-ray films of chests 
in various stages of disease — and an illuminated map showing the 
different Units and treatment centres in the Province. Literature 
was distributed freely. This was conducted for a week by Miss J. 
Peters, assisted by the clinic nurse, the supervisor of the Tuberculosis 
Pavilion, and student-nurses. 

There may be some cases still unknown to the division, but as 
time goes on, with such an intensive programme, these will of a 
necessity be steadily decreased, which is the object of the Division 
of Tuberculosis Control. 

Nellie Moore Jones, R.N., P.H.N. 



PUBLIC HEALTH NURSING IN THE PEACE RIVER 
AND IN COWICHAN— A COMPARISON. 

Cowichan Health Centre and the Peace River Health Unit — two 
Public Health organizations with the same aims and objects, and yet 
what a contrast can be drawn between nursing as carried out in the 
two places. 

Cowichan Health Centre has its headquarters in Duncan, an old- 
fashioned town situated in the valley of the Cowichan River, on 
Vancouver Island. Duncan — a town in the centre of a district spoken 
of as " a little bit of Old England," a town with a certain quietness 
and reserve often found in older places. Small farms are dotted 
around this country of lakes and rivers, valleys and densely wooded 
hills ; where the roads wind and twist from one place to another and 
buses and cars go by all day, for the main Island Highway passes 
through the town. 

The Peace River Health Unit has its headquarters in Pouce 
Coupe, a village of two to three hundred inhabitants ; it is situated 
in that part of British Columbia known as the Peace River Block, 
a few miles from the Alberta Boundary. This village, in which are 
located all the Government offices for the Block, ceased to grow when 
the railroad passed 6 miles farther on to Dawson Creek. 

To a country like the Peace River, a railroad is the one link with 
" outside " ; to it is brought all that is produced in grain and stock. 
Farmers cannot prosper unless they can get a market, and so Dawson 
Creek has grown quickly, for as " end of steel " it is the shipping 
centre for the surrounding countryside. All around the town can 
be seen fields like squares in a huge patchwork quilt. No matter 
what hill or rise you reach, always in the distance you see an open 

9 



field. The roads here run perfectly straight for miles, following the 
edges of these fields. 

This brief description will serve to show the difference between 
the two types of country in which the nurse must carry on her work. 

Public Health Nursing in the Peace River and in Cowichan is 
affected, primarily, by the contrast in the two health organizations. 
For instance, the nurse who works in Cowichan is working in a Health 
Centre, and is actually employed by a committee of women repre- 
sentative of the community. The Health Centre is supported to a 
large degree by the people of that community, with the help of grants 
from the Provincial Board of Health and the Department of Educa- 
tion. We may consider Cowichan Health Centre, then, as essentially 
a community project, depending for its existence and support on the 
good-will of the people whom it serves. 

In the Peace River, the greatest advantage that a nurse has, is 
the fact that she is working directly under a full-time Medical Health 
Officer, and only those who have worked in two such places can realize 
what this means. The Medical Director is responsible to the Provin- 
cial Board of Health which, with the Department of Education, 
finances the Health Unit. Perhaps because of this there is not that 
feeling that the Unit belongs to the community. The more prevalent 
idea seems to be that the Public Health workers are Government 
employees, rather than employees of the community, as in Cowichan. 

Insensibly, this attitude on the part of the public makes work 
in the two districts differ, particularly in regard to the public's rela- 
tions with the Centre and the Unit, and all each stands for. In the 
first instance the people seem to feel that the nurses belong to them, 
that the people also have a responsibility to help in carrying on 
Public Health work. This feeling is helped, too, by the fact that the 
Centre has been established for so many years ; from nearly twenty 
years ago, when it was a Red Cross centre with one nurse, to the 
present day when there are four fully-qualified Public Health Nurses 
on the staff. Those for whom the Centre works have seen it grow 
and helped to make it what it is to-day. 

In contrast, the attitude toward the Unit is much more imper- 
sonal. People seem to realize and appreciate what is being done 
but, as yet, their appreciation is more or less limited by their under- 
standing of what Public Health means in a community. In the com- 
paratively short time since the Unit has been organized, an amazing 
amount of educational work has been done, and it would seem that 
as the general public's understanding of Public Health grows, so 
will grow their co-operation with the Public Health workers. 

The general programme carried out in the two districts is the 
same, but the contrast lies in the difference in organization and in 
climatic, geographic, and topographic conditions. Considering then 
the work done in the schools; in Cowichan, in an area of some 600 
square miles, about twenty schools are under the supervision of five 
different Medical Health Officers, and four nurses, who are all sta- 

10 



tioned at Duncan. Sixteen of the schools are visited weekly, the 
remaining four monthly, the most distant school is approximately 
38 miles from Duncan and the majority are within a radius of 25 
miles. Most of these lie on, or close by, one or other of the main 
highways, and can be reached all year round except in exceptional 
winters. At no time is the weather too severe for the nurses to 
venture out. Thus the schools can be visited regularly, on the same 
day every week, and the people of the various districts have learnt 
when to expect the nurses. 

The contrast between this programme and that in the Peace 
River is outstanding. The Health Unit serves the entire Peace River 
Block, an area of some 7,000 square miles, over which are scattered 
the fifty-six schools that are under the supervision of one Medical 
Health Officer and four nurses, with two part-time nurses in two of 
the most isolated districts. The distances travelled vary from 5 to 
150 miles, and the nurses have been stationed in four of the most 
thickly populated districts in the Block. In general, it is planned 
to visit each school monthly with the exception of those which, owing 
to distance and inaccessibility, are visited yearly. 

A description of a trip taken each year by the doctor and nurse 
will serve as an illustration of what is meant by " inaccessibility/' 
On a Monday morning they leave Dawson Creek to examine the school 
on an Indian Reserve at Moberley Lake. It is a rainy day, early in 
October, and the car slithers and slides all the 50 miles to the Peace 
River. The roads across the river are drier and the next 15 miles 
to Fort St. John are covered quickly, then from Fort St. John west 
along a road that follows the river, to a point known as the " Half- 
way." A perilous crossing is made with the car balanced on two 
planks placed crosswise on two small flat-bottomed boats. The 30 
miles of so-called road from Halfway to Hudson Hope are passable 
only if dry; otherwise the journey must be made up-river by boat. 
Hudson Hope is reached that evening and a stop is made overnight. 
Next morning the river is crossed and nurse and doctor stow them- 
selves in a large, springless wagon, drawn by two small horses. They 
prepare, as comfortably as possible, for a 28-mile journey over a 
rough pack-trail. Fortunately, it is a glorious day and they enjoy 
some magnificent views of the distant Rockies. Their destination 
at Moberley Lake is reached after sundown and they spend the night 
at the home of the only white settler there. Next morning the school 
is visited, all the children examined, weighed, measured, and eyes 
tested. Any necessary home visits are made, then all pack once more 
into the wagon. In a thick snowstorm, and pursued by a noisy pack 
of six or eight large dogs, they make their way along the edge of 
the lake, passing log cabins and Indian wigwams. Late that night 
they reach Hudson Hope and, fed and warm again, fall into bed. 
Next morning the school at the Hope is examined, various home 
visits made, the boat is loaded and off down the river that afternoon. 
Into the car at Halfway and Fort St. John is reached at 10 p.m. 

11 



Another night in the hotel, an early start next day and back at the 
starting-point that afternoon. Approximately 300 miles by car, boat, 
and wagon have been covered to examine two schools. 

This trip could have been, and a few years ago was, much more 
difficult. It is only lately that roads in the Peace River Block have 
become passable for cars. Formerly the Unit staff had to travel 
nearly all winter by team, and even now it is only the more travelled 
roads that are kept open. The nurse does not know from one day to 
the next whether she will be able to travel. The thermometer has 
been known to drop from 40 above to 40 below in twelve hours. An 
inch or so of snow does not sound harmful ; yet, if a stiff wind rose, 
in an hour or two that 2 inches would be swept from the huge open 
fields, to be piled on the roads in drifts 2 or 3 feet deep. In warmer 
weather, there is always the question of whether it will rain. A few 
hours of rain and the road may become a mass of sticky mud, into 
which the car will slowly sink and remain until pulled out by some 
team. Always work has to be done " weather permitting." 

Considering what is actually accomplished in the schools, the 
greatest difference between the Peace River and Cowichan is in the 
correction of defects among school children, with the balance heavily 
in favour of the former. 

This excellent progress has been achieved to a great extent by 
the fact that fifty-three of the schools are consolidated into one unit, 
the Peace River Educational Administrative Area, under the direc- 
tion of one administrator who is Inspector of Schools and Official 
Trustee. This enables the parents to make arrangements regarding 
payment for the removal of tonsils or procuring of glasses. The 
Official Trustee pays for the correction and the parents repay him 
by cash or, in the majority of cases, by doing work in the various 
schools. There is no reason, then, why any child should suffer 
because his parents cannot afford to have him treated. All the nurse 
has to do is to procure a signed agreement from the parent and see 
that the child is taken to hospital or to the oculist. 

Dental-work is done by a Dental Clinic which is financed by the 
Provincial Board of Health and the Official Trustee. All school and 
preschool children are examined and treated yearly free of charge. 
To one who has worked among children at the Coast, it is a continual 
source of amazement to see children with sets of perfect or almost 
perfect teeth; the result in part of regular dental supervision. 

Contrast this condition with that at Cowichan where twelve 
children a year may be treated at the hospital free of charge, where 
glasses are sometimes supplied at a reduced rate, and where dental- 
work is carried out only when sufficient money can be raised to carry 
on a clinic. As a result of this, only the very worst of the defects 
of those who cannot afford to pay can be corrected. In most cases 
where there is no money there is no work done. 

12 



Except for dental treatment infant and preschool welfare is 
more complete in Cowichan. Owing to distances and weather con- 
ditions in the Peace River it is almost impossible to pay regular 
monthly visits during the winter months. There is a difference, too, 
in the parents' attitude towards the Public Health Nurse. In Cow- 
ichan mothers will call or telephone the nurse to a far greater extent. 
Mothers in the Peace River are more independent, probably because 
it is only so recently that they have been able to get assistance. 

Perhaps, while independence is being mentioned, we should touch 
on bedside-nursing. In Cowichan a great deal of the nurses' time 
is taken up with this work, necessary no doubt, but not actual public 
health. Only in an emergency is bedside-nursing clone in the Peace 
River. The very ill are taken to hospital, those at home are taken 
care of by some member of the family or a capable neighbour. 

One last contrast may be found in the work done in sanitation. 
In a country like the Peace River, where the water-supply is so 
limited and uncertain, where sanitary arrangements are so primitive, 
good sanitation is of vital importance. Wells in this country are 
scarce and the water generally not drinkable. The majority of people 
use ice-water in summer and melted snow or ice in winter. In the 
country districts, surface water from dams and scoop-outs is used, 
often for the family as well as the stock. The possibility of con- 
tamination of such a supply can easily be imagined. 

An intensive educational programme is being carried on by the 
entire staff of the Health Unit. People are being taught the value 
of chlorination of all drinking-water and chlorine outfits are being 
distributed. The placing and care of out-houses and protection from 
flies are stressed. Clinics for typhoid immunization have been and 
are being held at various times. In Cowichan, where drainage is 
good, wells numerous, and the water-supply sure, sanitation presents 
few problems. 

To a nurse who has worked in two such districts, the greatest 
contrast would seem to be these. 

On the one hand she is working with five part-time Medical 
Health Officers, under all the disadvantages this entails. She is 
working in an old-established centre in a district quite densely popu- 
lated, where roads are open all year round, where weather conditions 
permit nurses to travel everywhere, and where the public have become 
more or less educated as to Public Health and what it means. 

On the other hand, she has the great advantage of having one 
full-time Medical Health Officer. She is working in a new unit, in 
a new country, among a scattered population, where distances are 
great, travel often impossible; where any work depends on the 
weather; where the people are just beginning to realize what is 
meant by Public Health, and where there seems to be such scope for 
further work, so many new things to do. 

Annie S. Law, R.N., B.A., B.A.Sc, 

Dawson Creek, B.C. 

3 13 



THE REBIRTH OF A PUBLIC HEALTH SERVICE. 

It was my good fortune, last September, to be sent to reopen 
a Public Health Nursing Service at Port Alberni. 

I am the first " School " Nurse to be appointed. There have 
been Red Cross Nurses here in the past, who served a large district 
and visited various schools; but the last one, Miss Grierson, left 
several years ago, and her place has never been refilled. 

My appointment is through the Port Alberni Public School 
Board, and I visit only the two elementary schools in the city and 
a high school with two hundred students which serves the entire 
surrounding district. Until the end of January I also went to the 
Alberni elementary school, but differences arose between the two 
School Boards and the service to that town was dropped. I have 
about 900 school children under my care, and hope before long to 
have a baby clinic and do some prenatal and preschool work. There 
is a nurse, Miss Wood, already in charge of the tuberculosis work in 
the district, so that I have little to do with that branch of the service. 

Port Alberni is a seaport town of some 4,000 inhabitants, situated 
on Vancouver Island, at the head of a long natural canal which runs 
inland for about 30 miles from the Pacific. It is hilly and straggling, 
and divided into sections by two deep ravines, which make travel 
difficult. It is an outgrowth of the older, more residential town of 
Alberni, and came into being in 1912 when it was discovered that 
deep-sea vessels could come up the canal without risk. There are 
two large lumbering companies in the town, and long, grey freighters 
from all parts of the world wind their way up the narrow channel, 
spend a few days tied up to the timber-laden wharves, and leave with 
their decks piled high with freshly-sawn hemlock and Douglas fir. 
Fishing is also an important industry, and the broad expanse of water 
in front of the town is alive with small craft, crawling slowly up- 
stream with their catch or chugging briskly off towards the ocean to 
set their nets or trawl for salmon along the coast. 

Our children come from the homes of loggers, business-men, mill- 
wrights, and fishermen. There are Japanese, Chinese, Hindus, and 
Europeans, and many spring from sturdy Scotch fishing-village stock. 
Earnings are small, but there is little real misery or unemployment; 
and the children, on the whole, are adequately clothed and fed. They 
are rather pale and peaked, perhaps on account of the heavy fogs 
that cling obstinately to the walls of the valley and blot out the rays 
of the sun. 

Port Alberni is growing rapidly. A few years ago a large new 
sawmill was opened, which meant new logging camps up the valley 
and new businesses opening up in the town. There was a shortage 
of houses. The school and sanitary arrangements fell suddenly 
behind the needs of the people. The harassed city fathers are doing 
all that they can to meet the demand, but as fast as houses fall vacant 
new families arrive, and children are being taught in several small 
wooden buildings which would in the ordinary course of events have 

14 



been abandoned when the new and modern main school was built. 
There is no space on the school-grounds for a nurse's office; but 
I have been provided with a room at the City Hall, which is proving 
very satisfactory as it is more convenient for parents wishing to 
consult me. 

The appointment of a School Nurse was made in response to 
strong public feeling that such a service was needed. The Parent- 
Teacher Association had played a large part in getting the appoint- 
ment made, and within a few days of my arrival invited me to speak 
at their meeting. The teachers were unfeignedly glad to see me. 
They had worked hard, during the years that the school had been 
without a health nurse, to check epidemics and get physical defects 
corrected; and they were glad to be relieved of their burden. The 
children themselves were tremendously impressed, and within a few 
hours of my first school visit were greeting me all over the town with 
loud " Hullos " and excited whispering that " Here comes the School 
Nurse ! " All this was very helpful, for it is nice to come into a 
perfectly strange district and be welcomed as an honoured guest. 

So far, I have been able to do little more than gather information 
and build up my records. The medical examinations were not com- 
pleted until December, and the task of visiting parents and talking 
over the possibility of getting defects corrected has only just begun. 
Miss Wood and I have just finished a tuberculin test of all children 
in their first year of school, and the two positive cases have been 
examined at the Travelling Clinic and their environment checked. 

The townspeople are almost hysterically nervous about epidemics, 
possibly because there has not for some time been an organized health 
service in the schools. During the autumn there was a slight out- 
break of a very mild type of scarlet fever. The schools reported 
about one case a month, and there were perhaps an equal number 
of cases among preschool children; but the general public was con- 
vinced that the whole town was alive with cases, and many and oft 
were the rumours that the schools were about to be closed down! 
Partly to reassure the parents and partly to cut down loss of school- 
time, an immunization clinic was held at the Alberni elementary 
school, and 113 children were treated with scarlet fever toxin. 
Several more were given the treatment by their own doctor, and 
the spread of the disease was effectively stopped. There have been 
no cases reported in the Port Alberni school since the opening of 
the spring term. 

About the middle of February a case of smallpox broke out on 
board a boat in the harbour. It was quickly under control, and it is 
very doubtful if the town was ever in any real danger; but the 
longshoremen who had been on the boat bore the news home, and 
within a few hours the whole place was in a panic. The teachers 
wondered whether or not the children of these longshoremen should 
be excluded from school. The townspeople searched themselves for 

15 



spots. One man burnt his clothes. And the pros and cons of vacci- 
nation were discussed in every home. 

This incident showed up two things. First, the extraordinary 
ignorance of the general public in matters of public health. Secondly, 
the appalling number of children and adults in the district who had 
never been vaccinated. 

Partly to spread information, and partly to get as many children 
as possible vaccinated while public interest was high, a school clinic 
was held. No attempt was made to press the treatment, but Govern- 
ment pamphlets were sent out with the permission slips, and every 
inquiry and objection was carefully answered. Many parents sought 
me out at my office, and I did my best to explain the disease and its 
control. As a result, many doubters signed their consent, and 339 
children have already been treated, with consents still drifting in. 
The clinic was for elementary students only; but a short talk was 
given in each high school class-room, explaining the prevalence of 
smallpox in some countries and the value of vaccination. 

The needs of the district as shown up by information gathered 
so far are as follows : — 

(1.) Some form of fund whereby dental and eye treatment can 
be obtained for underprivileged children. Over 20 per cent, of the 
children have uncorrected eye defects, and many more have defective 
teeth. Several have teeth that are soft and crumbling, mute evidence 
of the lack of prenatal and preschool care. A dental clinic has been 
suggested, but in the present overcrowded condition of the schools 
would be an impossibility; and it is hoped that we can work out 
some scheme whereby the children can be given a card and have the 
privilege of going to any dentist in town, with a nominal charge per 
tooth to be paid by the child himself, and the balance of the expense 
met from the fund. Eye treatment will be a slightly more complex 
problem, as we have a resident optometrist and a visiting eye, ear, 
nose, and throat specialist, but it is hoped that we will be able to work 
out some scheme that will not give offence. 

(2.) Some system by which the children can obtain cod-liver 
oil at cut or bulk prices. This is a sunless district, and the children, 
even from comfortable homes, are a little peaked. It is hoped that 
we may be able to buy the cod-liver oil in bulk, and distribute it at 
cost price to the children. 

(3.) Education of all concerned in the planning of food budgets 
and the importance of milk in the diet. The cost of living is high 
here, and, as usual, milk has been the first thing to be eliminated as 
a luxury. 

(4.) Preschool, infant, and prenatal work as soon as it can be 
managed, to ensure a healthy school population for the future. 

I am trying, during this current school-year, to see each child 
personally, weigh him, measure him, fill in the details of his health 
card, and get to know a little of him as an individual. During my 
school visits I go to each class-room and speak to each teacher, but 

16 



have not yet spent much time on class-room inspections and health 
talks. I am trying to reach the parents through the Parent-Teacher 
Association, by visits, by pamphlets, and by interviews at the office ; 
so that by next September I hope to be familiar enough with the 
district to be able to settle down into a more orthodox routine and 
have some, at least, of my schemes in operation. I can do little more 
about the defects until some sort of financial aid has been provided; 
but so far have only just begun to talk over plans with my committee. 
In fact, I have spent almost all my time so far in gathering up infor- 
mation, and in striving to win the confidence and co-operation of 
all those with whom I am to work. 

Joyce Leslie, R.N., P.H.N., 

Port Alberni. 



A VACCINATION CLINIC. 

It was Kipling who wrote : — 
Files— 
The Files- 
Office Files ! 

Oblige me by referring to the Files. 
Every phrase of every phase 
Of that question is on record in the Files — 
(Threshed out threadbare — fought and finished in the Files) . 

But I doubt if Kipling had in mind the Public Health Nurse when 
he wrote these lines, perhaps he might have chuckled at the thought ; 
but they do indeed apply to her work. For in her files is threshed 
out threadbare every phrase of every phase of that question — that 
question of mental and physical virtues — that need for correction, or 
the amount of protection that has been, or should be, accorded each 
and every child recorded there. 

So, when we set about plans for a vaccination clinic, we searched 
our files. The objective was not to discover whether or not a vacci- 
nation clinic was necessary; but to discover who had not been vac- 
cinated — these were the people we must contact. Here are the figures 
compiled October, 1938: — 

Number vaccinated 63 per cent. 

Number not vaccinated 37 per cent. 

Preliminary Work. — Clinics are a routine procedure — " Vaccina- 
tion in the fall, toxoid in the spring." When these seasons begin to 
roll around, we begin to make our plans. But it is the work leading 
up to the clinic proper that requires so much time and thought. Take 
for example a few jottings of things to do : — 

(a.) Interview doctors. 

(b.) Send out mimeographed letters to parents. 

(c.) Arrange for publicity. 
The Intervietu. — Approach the doctors with all the facts in hand, 
and much valuable time will be saved. For instance, one becomes 

17 



familiar with the fact that Saturday is the most convenient day. 
And so one goes prepared — all the dates are Saturdays. 

Mimeographed Letters. — This work is invaluable. It is gener- 
ally done by the high school commercial group. The letters are pre- 
pared in the form of a questionnaire, and reach the home through 
the school children. Folded within each letter is a pamphlet explain- 
ing the " What, Why, Who, When, and Where of Smallpox," and the 
absolute protection provided by the simple procedure of vaccination. 
Parents are asked if they would like this protection for their children, 
and if so, to please enter the names in the space provided for the 
purpose. They are to sign and return the slips to the School Nurse. 
From these consent slips our list is prepared, and the vaccine ordered 
accordingly. This phase of the work requires constant check-up to 
obtain full returns. Occasionally, a visit to the home is necessary. 
Thus, with the machinery set in motion, we begin to prepare material 
for publicity. 

We are Challenged. — " What about the disadvantages of all this 
business?" challenged a father who had occasion to visit our office. 
" You nurses and doctors stress all the advantages ; but what about 
the other side! . . . Isn't there a possibility of danger too?" 

I was tempted to inquire : " Wasn't there an element of danger 
in the very thought of life itself?" But I remembered the many 
stories told of " bad " arms, and such, following vaccination. The 
man was justified. One should know both sides. I countered with 
the statement that I had been vaccinated twice. First, when a baby, 
and later when a student of public health at the University of British 
Columbia. I explained that we students had practised upon each 
other the art of vaccination. We had no fear whatever of any ill 
effects, because we knew that the vaccine was absolutely pure. The 
question was not lightly disposed of. It was also explained that 
there are certain children who react to vaccine more severely than 
others. It was pointed out that authorities generally agreed that 
this was an indication that the child might possibly have developed 
a severe type of the disease itself, if exposed to it unprotected by 
vaccination. I hesitated to show them; but pictures were produced 
showing the effects of smallpox upon the unvaccinated. The man 
shuddered at the sight. Rather drastic, perhaps ; but as I remarked 
to him, " I can't think of anything more terrible than having the 
disease itself." 

It was one of the marvels of our recent vaccination clinic, the 
fact that this man's children were brought for vaccination. Now 
they are protected against both diphtheria and smallpox. 

We cover the Country, too. — In September of 1938, Dr. H. E. 
Young, our Provincial Health Officer, through the Department of 
Health, was able to provide funds for transportation into the country, 
one day per week. This is the amount of time allotted to the nurse 
by the School Board for her visits to the country schools. Unfortu- 
nately, we were unable to arrange for transportation until about 

18 



the middle of October. The car available for this purpose, at the 
only garage offering this service, had been in a smash-up. I finally 
had to admit that nothing could be accomplished in this " waiting 
game " before winter set in. Then the idea was born, that if we 
did nothing more than introduce the Health Service through the 
medium of vaccination, this in itself would be worth while. 

And so the first visit was made to the country schools in the 
middle of October. The poor teachers were fairly deluged with pam- 
phlets. However, when the situation was explained to them that 
we were extending the Health Service into the country schools in 
this way, they became just as eager as we. And here I must pay 
tribute to the country teachers. If it hadn't been for their whole- 
hearted enthusiasm, their assuming full responsibility for their end 
of the game, we should never have accomplished what we did in so 
short a time. Pamphlets were again sent home through the children, 
and the parents asked if they would consent to vaccination. Six 
schools were covered. 

On my second visit I could scarcely refrain from cheering as 
the teachers handed me the requests that had come in. Returns were 
almost unanimous. This glowing report was rushed in to our Dis- 
trict M.H.O., who there and then set the day of the country clinic. 
My third visit reported this fact to the teachers; the fourth visit 
was — Vaccination Day. 

Our District M.H.O. — Before beginning the actual clinic the 
doctor addressed the children. He told them the story of Jenner, 
and of how he had made the discovery that vaccination would prevent 
smallpox. He ended by asking them to remember the name of this 
great man who had done so much for humanity. 

Mothers came, bringing smaller members of the family to be 
done. It was a very happy occasion. We had no difficulty at all 
with the children. There was no sense of fear — something we do 
have to contend with, occasionally, in our city clinic. Teacher acted 
as clerk. The children were lined up with sleeves rolled up; an 
older pupil applied green-soap to the spot; nurse washed the part 
and applied alcohol, and the child moved forward to the doctor to be 
vaccinated. 

A thrill of excitement attended the whole district campaign. 
One mother voiced her interest in these words : " Nothing like this 
has ever before been done for us. No one has ever paid any attention 
to us out here — until now." It was explained to the people that what 
appeared to them to be neglect was really a problem of transportation. 
We had no means of reaching them before. The Provincial Health 
Department had provided this opportunity for transportation, and 
the City of Revelstoke had allowed their School Nurse the time for 
visits. 1 As often as possible, weather permitting, we would visit 
them, and extend the advantages of our Health Service from this 
time forward. ' 

19 



In the meantime, our city clinics had been held. As I have 
stated before, it is the preliminary work that requires the time and 
thought. The actual clinic day is a mechanized, swift-moving sort 
of business. " Line them up with sleeves rolled up, and we'll do 
them in no time." We had three doctors working steadily, and the 
children came on time. Nurse kept the doctors supplied with vaccine ; 
kept tab on the vaccinees, and regulated traffic, which in the outer 
room was pretty congested. 

A man tried to push his way forward. " What's going on here? " 
he wanted to know, and added, " I thought nobody believed in this 
business " ; ending with the humorous remark, " This is the busiest 
place in town." 

A total of one hundred and sixty-eight children were vaccinated. 

The following figures demonstrate the value of routine clinics 
as being a most effective method of building up in a community a 
general immunity against a specific disease. 

November, 1938. Percentage protected against smallpox: — 

Clt y— Per Cent. 

School No. 1 86.5 

School No. 2 80.0 

Rural — 

School No. 1 92.0 

School No. 2 93.0 

School No. 3 87.5 

School No. 4 87.5 

School No. 5 100.0 

School No. 6 62.5 

Of the latter school, five of the six attending that day were done ; 
two others, who had consent slips, were in hospital having their 
tonsils out. These we will contact again. 

And now we shall take, for comparison, our former figures of 
October, 1938:- PerCent 

Number vaccinated 63.0 

Number not vaccinated 37.0 

The same group — November, 1938 : — 

Number vaccinated 86.5 

Number not vaccinated 13.5 

Of the rural group : In one school alone not one of the children 
had ever been vaccinated. Results were 100 per cent. 

There was a question put to me the other day by a visiting, 
interested educationalist : — 

Question : " Don't you think or, rather, do you think, these 

clinics may be just a little overdone?" 

Answer : " No. I do not. If we didn't hold these clinics we 
would soon be back to the conditions of the ' dark ages.' As it is 
now, with our clinics coming along regularly — even though we protect 

20 



just a few at a time — we should never be in any danger of these 
diseases developing epidemic proportions — which as we all know, is 
a costly business. Then again, it seems to be human nature to ■ want 
to be ' reminded. And so our clinics remind the forgetful ones that 
it's time to vaccinate." 

Margaret Little, R.N., P.H.N., 

Revelstoke, B.C. 



ANOTHER DENTAL CLINIC. 

Children have attended the clinic dentist for years under the 
Esquimalt Rural Nursing Service, which at present covers five of 
the school districts in the unorganized territory 8 to 30 miles west 
of Victoria city. The cost, a minimal charge per operation, was 
borne by parent or service, supported by the Provincial Board of 
Health, or both, according to the existing arrangement. The clinics 
were held on a half-day each week in Victoria and last year, locally; 
the children being transported to and from by the staff nurse. 

But the payments were not being made by the parents, and 
parents were dissatisfied. A year ago the executive of the E.R.N.S. 
approached the Provincial Board of Health once more and the fol- 
lowing plan was evolved. The latter was to provide the dentist and 
materials, and the E.R.N.S. the place, assistant, and organization. 
The objective was complete dental care, or cleaning and all necessary 
fillings (other than gold work) and extractions for preschool, school, 
and high school children at a prepaid cost to the parent of $1.50 per 
child. In June, 1938, the parents were notified of the proposed plan 
by circular letter, and by August, 1938 — the time-limit set — nine 
families had signified approval by replying, and prepayment was 
made for six children — a discouraging response. The matter was 
then dropped until the council and their dental clinic plan was ratified 
by the council's re-election at the annual meeting of the E.R.N.S. 
in October. 

In the meantime the new staff nurse made a detailed examination 
of the school children's teeth, recording visible cavities on individual 
dental cards, and adding any other remarks as to cleanliness, stains, 
colour of gums, etc. Armed with these facts, she was ready for the 
intensive campaign of home visits begun at the end of October. When 
the school or preschool child was at home, the parent was invited to 
look into his child's mouth where, with the aid of teaspoon and flash, 
the parent saw for himself, and often for the first time, the obvious 
defects. Other facts were pointed out and discussed, as the impor- 
tance of annual prophylaxis to control the deposit of calculus, which 
causes gum-injury and predisposes to pyorrhoea in later years; the 
badly fissured permanent teeth which present such attractive nests 
for destructive food and germs that the most skilfully manipulated 
toothbrush cannot sweep them away. Then there is that discolora- 
tion of the enamel which may indicate a large cavity beneath it. 

4 21 



The relationship of abscessed teeth to infected tonsils or appendix is 
another argument, as well as the deformity of mouth following early 
extractions of temporary teeth, and the malnutrition due to defective 
chewing-surface. Where no visible defects were present, the impor- 
tance of the annual check-up was stressed, together with the fact 
that the tiny cavity filled now may save a questionable filling or even 
an extraction if neglected. For the preschool child there is the value 
of the visit made before fillings or extractions are required. As the 
results of our clinic showed that only two school and three preschool 
children of the 134 completed had teeth free from cavities, the visit 
to the dentist is important even though nurse and parent can see no 
cavities. Some visits were made in the evening or on the week-end 
as father could then be cornered and some of these new-fangled ideas 
presented to him, not necessarily with the desired effect, but always 
with the hope that next year he won't be quite so sure that " milk 
teeth are no use anyway " ; especially if, in the meantime, he has 
been kept awake by a child crying with toothache, and his request 
for transportation to the dentist is no longer considered an emergency 
by the Nursing Service. 

Criticisms of previous dental clinics had to be listened to. 
" A filling came out," is the most common complaint, and the solution 
is found in the piece of waste amalgam the child discovered in his 
mouth a day or so after the clinic. Such a statement made months 
later can be solved by examination of the child's mouth and his dental 
record-card, and usually indicates new cavities or a fresh cavity 
affecting or adjacent to a previous filling. One family thought 
these clinics were for indigents, yet in many cases where there was 
a family dentist it was found that the child had not visited him for 
several years, if at all. Regardless of financial standing, lay people 
to-day are still far behind modern dentistry; and one of its axioms, 
that every case where dental caries is indicated should receive dental 
care, was upheld lately at an informal gathering of prominent 
dentists. In the first place, all the older people and most of the 
younger generation are afraid of the dentist's chair, and many will 
not take their children to the dentist until forced to, with toothache. 
On the other hand many dentists are not particularly interested in 
children as patients, and have neither the time nor the inclination 
to understand them and win them — a highly specialized and difficult 
procedure in any case without being complicated by a toothache. 
Even if the child is a regular visitor to the dentist, all work cannot 
be finished at one sitting, as only a given amount of time can be 
allowed for each office appointment. Who has not been told that 
there is a small cavity but that it can go till the next periodic visit? 
And does finance enter into the picture? Parent dreading the ex- 
pense, and dentist hesitating to present a larger account, thereby 
scaring off the parent, when certain cavities can be left untouched for 
a limited period. The annual dental clinic can never take the place 
of the family dentist, for modern dentistry recommends a check-up 

22 



every four to six months, especially for children; and a clinic such 
as the one in question could only be an annual event at most. Besides 
we will have signally failed if children, who have attended the annual 
dental clinic, do not, as young adults, accept its teachings and return 
to the family dentist for the periodic check-up. The clinic dentist 
does what is necessary in the child's mouth at the time, and if there 
is a great deal of vital work treatment may be limited by what is 
best for the child at that time, and, in such an event, the family 
dentist must be consulted. 

And this brings us to the question of collections. Prepayment 
is important for two reasons. Firstly, collections are always more 
difficult after the dental-work is completed. In winter and spring 
there are more people on relief or out of work and because of the 
Christmas shopping. The one stipulation of Dr. H. E. Young, the 
Provincial Health Officer, in helping to finance this clinic was that no 
child should be refused because of inability to pay ; yet the dental-work 
was offered to the parent at a prepaid cost of $1.50 per child. Indi- 
gence, indifference, and (or) ignorance usually present a non-paying 
group ; but must their children be allowed to suffer ? At the present 
clinic the gap was bridged by a Service Fund to which the nurse had 
access. From this fund sufficient money to complete payment for 
his children was given to the parent with the understanding that 
all or part of it could be returned if his means permitted later. Then 
when he paid this money in for dental care he was given an E.R.N.S. 
receipt, and as far as the Community and Nursing Service are 
concerned every child has been paid for in full by the parent. Inci- 
dentally, some money has already been returned to the Service Fund. 
Solution of this problem for a future clinic presents a real challenge 
to all concerned — parents, children, and council. Have you any sug- 
gestions ? One mother says that she has heard of a collective school- 
children's bank account and feels that the children encouraged to 
save their pennies might finance their own dental-work. Secondly, 
prepayment is important, because the duplicate kept of the receipt 
for the $1.50 constitutes the parents' consent to or permission for 
complete dental care. Work upon which restrictions are placed by 
the parent should not be undertaken by such a clinic, as there is risk 
of a tooth being extracted where the parents did not believe in extrac- 
tions, for instance, and therefore the possibility of a Court case. Does 
the parent dictate to the school-teacher as to what shall or shall not 
be taught his child in the school-room? Then why should a parent 
dictate to the dentist as to how many cavities are to be filled? Yet 
such was our experience, and it is a point on which a firm stand must 
be taken from the first. Restrictions should only be accepted on 
written request from the family doctor. It is the nurse's responsi- 
bility to transfer from school or preschool card to dental card any 
disability which might be a guide to the dentist, such as " heart 
condition," " bleeder," etc., and to point such fact out to the dentist 
at the child's appointment. 

23 



And so, parents won over and collections made, time and place 
had to be arranged. The month being January and weather uncer- 
tain, the two outlying schools were the first scheduled on the list so 
that they might be completed before bad weather, or if necessary, 
switched to the end of the clinic after bad weather. Infections are 
to be reckoned with, especially those skin infections of staph, and 
strep, origin, for the dentist cannot be allowed to risk such an infec- 
tion himself. At a first clinic of mixed age-groups as this was, 
only a very rough estimate of days in each school district can be 
made, based on completing eight to ten children per day. The whole 
schedule must be very flexible, and preschool children planned for 
and notified only two or three days ahead. Preschools were allowed 
a half hour's appointment each in the mornings and any gaps were 
filled in by children from the lower grades. The higher grades were 
taken after lunch and high school students at four, when they returned 
by bus from the Victoria High School. So much work had to be 
done for some of these older children that they had to miss a half 
day's schooling. 

The place always presents a problem from several angles — 
distance from school, which is presumably the centre of the dis- 
trict, heating, lighting, and waiting-room — the last seldom attained. 
A good northerly window provides the best lighting and in winter 
must often be supplemented with artificial light. — And this is another 
reason why country school districts should not be undertaken in 
winter, for to work by gas-lamp light for a number of hours each 
day over a period of dark winter weather is too much to ask of a 
human being doing the fine work required by dentistry. If the heat- 
ing must be by air-tight heater, do provide a high screen, of tin if 
in cramped quarters, to prevent the direct heat from stove and from 
pipe. To outwit the many factors that make stoves smoke have it 
set up and try it out ahead of time for, in any case, wind or wet 
wood will probably give a day's battle with smoke or cold. As to 
place, a near-by hall and an isolated room with separate entrance 
and conveniences in a private home were utilized, and in one instance 
the back of the school-room, an old barn, was curtained off for the 
clinic, and for four days school and clinic carried on simultaneously. 
That such a feat was accomplished is probably the exception that 
proves the rule that no clinic shall be held in a class-room where 
school is in session. Public Health literature was on hand for parent 
or child, but an opportunity was neglected in not decorating our clinic 
walls with posters. No transportations were made and the Public 
Health Nurse assisted the dentist, charted the work, and kept the 
daily dental report sheet and saw that there was always a child 
waiting. In this the teachers co-operated by sending one or more 
children from the list supplied to them by the nurse, as she notified 
them through a child returning to the class-room. Dental appoint- 
ment cards, dental record cards, and the daily dental report sheets 
were obtained from the Provincial Board of Health. The dental 

24 



appointment cards, addressed and with a 2-cent stamp affixed, are 
accepted by the post-office. Linen, dry wood, enamelware, and janitor 
service were volunteered by friendly parents and gratefully accepted. 

And so just three and a half months after intensive organization 
was begun, the dental clinic was completed except for one district 
of twenty-five children wishing dental care, to which a visit will be 
made when a skin-infection in the district has cleared up. This year 
dental service was given to more than twice as many children as 
under the old arrangement last year, and took three and a half weeks 
for four schools instead of less than three weeks for five schools as 
we had hoped. 

A long time for organization and completion, you will say, and 
the reply is " yes," and the ultimate outcome can only be measured 
when a second clinic is undertaken in a year's time. For those who 
are interested in figures the statistical reports will be forwarded but 
are not discussed. 

The clinic itself was a strenuous affair for all concerned, physic- 
ally and mentally; each school-child showed fear and nervousness 
to varying degrees, accompanied by fussing or crying, asking when 
he could go or, saying nothing, clenched his hands and rammed his 
toes into the floor. Each of these manifesting even the last, make 
dentistry difficult, and each had to be handled individually by the 
dentist in the light of his knowledge and experience. It is to his 
credit that no child left the room crying, and that some of the most 
difficult smiled sheepishly as if to say, " I'm ashamed of myself, please 
don't tell on me." In the light of past experience in the Peace River 
Health Unit, where dental clinics were an annual event and atten- 
dance was a privilege every child expected, the difficulties encountered 
in contacting these children have been a puzzle. That the child has 
reflected his parent's attitude towards dentistry may be true. That 
the children of the Peace are a more hardy lot and can take it better 
than our children, local to Victoria, however, cannot be accepted so 
easily. But is it not possible that the child in the North has learned 
to accept dentistry as he accepts arithmetic at nine every school-day, 
and like arithmetic, if he happens to dislike it, well, the less fuss 
made about it the better ? In contrast our children here have always 
associated dentistry with toothache and consequent extraction, or with 
deep cavities and the discomfort of large difficult fillings. Dentistry 
for him is also charged with the special significance of an appoint- 
ment for the given clinic day and the misery of looking forward to 
that fatal day and of spending most of that time waiting round at 
the clinic till all are attended to and of being transported in the 
nurse's car, which is also something of an event. Add to this the 
fact that work was seldom completed at one visit, and the child had 
another session or more hanging over his head, and there is real 
reason that the child should accord this very outstanding and special 
occasion in his life the very special reaction it would seem to demand 
and so bask in the sympathy of schoolmates and parent. 

25 



The handling of the preschool child, on the other hand, though 
difficult, is truly fascinating and requires every wile. Many little 
children are confident in mother's decision and happy to go to the 
dentist. Their reaction, however, on arrival or even after they have 
been in the chair awhile cannot be foretold. The whole visit is preg- 
nant with new experiences, from being dressed up in his better 
clothes, from what he sees as the chair and equipment, what he hears 
as the drill and gasoline stove, to what he is told to do as " open 
wide," " rinse your mouth," " spit," etc., all the more reason for 
bringing him to the clinic when he is a tiny child and before these 
new experiences are associated with the disadvantages of having 
an extraction or a deep cavity filled. In the case of the deep cavity 
it is almost impossible for the dentist to do a satisfactory job for 
the young child whose little head rolls from side to side, tongue seems 
to fill his mouth, and saliva pours down his cheek. Enough that, on 
his first visit, he should have an examination and his teeth cleaned 
and as in some cases, a few tiny fillings manoeuvred — to his parents' 
surprise. 

And the parent is a very important factor in the outcome of his 
child's visit to the dental clinic. If the child is timid the parent can 
lend assurance by his silent presence, and the term " silent presence " 
is used advisedly, for nothing must interrupt or break the contact 
being established between dentist and child. Even if the child is 
a spoilt baby or a young rascal, the very fact that the parent co-oper- 
ates by accepting the authority of the dentist and going out of the 
room as requested, spontaneously establishes in the child an accep- 
tance of the authority of the dentist, once the first loud protest is 
over; for the child is an honest and reasonable human being. And, 
following a clinic such as ours, if the school-child has had a great 
deal of work done at one sitting, as was necessary for so many of 
our children, the parent can accept the child's fatigue and swollen 
lips in a matter of fact yet tender manner and make him comfort- 
able in bed. There, following a hot drink, the child will drop off to 
sleep and awake refreshed, for he reacts quickly to food and warmth 
and sleep. To the question " Why not give the child a break and 
just do a little work at a time? " The answer is " Why should the 
child have to look forward to another session when the one session 
will do?" Two or more such sessions imprint the experience more 
indelibly upon his memory, whereas the memory of the one experience 
will fade and we know that, complete dental care having been accom- 
plished this year, next year's session can only be an experience of 
minor importance in comparison. Perhaps the hardest fact some 
parents had to face was the large number of fillings and extractions 
necessary to complete dental care. It seemed to reflect their lack 
of parental care and therefore extraneous causes were sought and 
discussed, such as lack of minerals in the soil, and the possibility 
that the dentist, for his own ulterior purposes, was doing more work 
than was necessary. 

26 



For the Public Health Nurse, the clinic was strenuous indeed, 
not only because of the specific problems arising but because of the 
public health matters which had to be attended to after hours and 
on week-ends. 

To the dentist all credit and the hope that he may be given and 
accept an opportunity to follow-up this very difficult pioneering in 
preventive dentistry. 

In summary, experience at this and other dental clinics for 
children has provoked considerable thought and afterthought, but 
once more stresses the importance of the annual dental clinic for 
preschool and school children, offering complete dental care at a pre- 
paid nominal charge to the parent. The pleasant contact established 
with the preschool child is then carried through from year to year 
and the large time-consuming and therefore expensive cavity is prac- 
tically eliminated. And the importance of education has again been 
proved; for it may be seen in the light of this experience, that the 
home contact made by the nurse before the clinic could have fore- 
stalled more of the problems which arose at this clinic. 

L. Malkin, R.N., P.H.N., 

Lang ford, B.C. 



THE ORGANIZATION OF A RURAL HEALTH UNIT. 

A Health Unit is an organization of trained workers consisting 
of Public Health Nurses and a Medical Health Officer, whose duty 
it is to promote health and prevent disease. This is accomplished 
by teaching the rudiments of healthful living to adults and children. 
A rural Health Unit, of course, is one in which the population is 
living in the country. Such a Unit has been formed in the upper 
Fraser Valley, with headquarters at Abbotsford. 

Matsqui and Sumas Municipalities are included in this Unit, 
as well as the Village of Abbotsford. Geographically, this district 
lies between the Fraser River on the north and the American bound- 
ary on the south. The eastern border of Sumas coincides with that 
of Chilliwack Municipality, and the western border of Matsqui coin- 
cides with that of Langley Municipality. The area of the Matsqui- 
Sumas-Abbotsford district is 15 square miles, this also includes Town- 
ship 20 and Huntingdon, which are unorganized territory. Topo- 
graphically speaking, Sumas Municipality consists of a wide valley 
running north to south. It is excellent farm land, since a good deal 
of it is reclaimed from Sumas Lake. This land is dyked and a run- 
off assured by means of a pumping-station at the northern limit of 
the municipality. Sumas Mountain forms a geographical boundary 
between Sumas and Matsqui Municipalities, and is on the north-west 
boundary of Sumas. This mountain carries on in a series of ridges 
to the Fraser River in the north. Abbotsford Village is at the south- 
ern base of this same Sumas Mountain. It will be understood from 
this that Abbotsford lies very near to the centre of the two sur- 

27 



rounding municipalities. Matsqui consists, too, of flat prairie land 
and highland, its village lies 6 miles south of the Fraser River, in 
the midst of a large farming area. The highlands extend west and 
south of Matsqui Prairie. Unfortunately, the geographical and 
political divisions do not always agree, and in Matsqui Municipality 
is included a part of Glen Valley, which is very inaccessible from 
Matsqui Municipality. The population of this 15 square miles is 
approximately 8,000. 

While at first thought there seems very little connection between 
weather and a Health Unit, there is this point to be considered: 
For how many months of the year can the nurse expect to be in direct 
contact with the schools and school children ? If snow makes schools 
inaccessible, it also makes homes inaccessible. For this reason the 
nurse must plan her work accordingly. In the Matsqui-Sumas- 
Abbotsford area the past two winters have not been severe, although 
three years ago the roads were impassable for six weeks. There 
has been snow during the winter, but not enough to upset the schedule 
for more than two weeks at any one time. 

The Matsqui-Sumas-Abbotsford area was chosen as a suitable 
district in which to carry on an experiment in rural school con- 
solidation. This decision on the part of the Provincial Government 
was put into effect in September, 1935, under the leadership and 
guidance of a Director of Education, who also served as Official 
Trustee. At this same time a School Nurse was appointed. In 1937 
it was decided by the Provincial Board of Health to establish an 
experimental Health Unit to work in collaboration with the Educa- 
tion Office in so far as the nursing service dealt with health matters 
in the rural schools of the area. With this experiment in mind a 
Supervisor of Nurses and two more fully qualified Public Health 
Nurses were appointed to this area. The staff of the Unit was com- 
pleted with the appointment in August, 1938, of a full-time Medical 
Health Officer. 

The school population was used as a basis for division of the 
district among the nurses. The area was divided in such a way that 
there was no duplication in the country covered. This may be diffi- 
cult at times, especially in an area where there is any amount of 
consolidation, since children from all points are brought to a central 
school. However, this can be overcome by appointing one person to 
report absentees to the nurse from whose district the students come. 
The three nurses in the district are directly responsible for their 
own areas ; the supervisor is responsible for the two central schools 
in Abbotsford, as well as for administrative work. 

There is a central office located at Abbotsford. This office is 
open from 8.30 a.m. to 5.30 p.m. from Monday to Friday. There is 
one nurse on duty each week-end. Her hours include : Office hours, 
9 a.m. to 12 a.m. ; and " on call " duty all day Saturday and Sunday. 
However, since no bedside-work is done there is little call on the 
nurse's time, but it has been felt that there should always be some 

28 



representative in the area. The annual holiday is of a month's 
duration, either July or August, but there is always some one on 
duty. With four members on the staff this means that a nurse is 
on duty only one week-end in four. Each nurse in the area is sup- 
plied with a car. It can readily be understood that a nurse in a rural 
area is of little value without a car. This point, of course, is very 
difficult for the layman to grasp. To him, the nurse is just " running 
around the country in a Government car." It takes time and results 
to erase this notion from the minds of the laity. 

A central office has been found to be the most successful. At 
first, each nurse had an office in her own area ; one supplied by the 
municipality. But it has been found more convenient to have a 
central office to which each nurse reports in the morning and in the 
afternoon. Here also are kept all records. Each nurse has her own 
desk, as well as her own visible filing-book for the schools for which 
she is responsible. The Medical Health Officer and Supervisor of 
Nurses have an office separate from the other members of the staff. 
In the same building there is accommodation for the Abbotsf ord baby 
clinic held monthly, a large waiting-room and an examining-room. 
To date, the administrative work has been done by either the Medical 
Health Officer or Supervisor of Nurses. This work has included all 
family histories completed to the present time, as well as names and 
addresses on all school, infant, and preschool cards. This substan- 
tially increased the amount of office- work, but it was well worth while, 
since it has added greatly to the uniformity of records, especially 
since this typing was done by one person. If the Supervisor is 
responsible for this work, she becomes familiar with families in the 
area even though she has had very little contact with them. 

Since the inception of the Fraser Valley Health Unit in 1935, 
when there was one nurse in the district, school-work has received 
the greatest consideration. Previous to August, 1938, when the full- 
time Medical Health Officer was appointed, only beginners were 
examined by the part-time Medical Health Officer — all other children 
were examined by the nurse. Any cases about which the nurse is 
doubtful are referred to the doctor. Last term vaccination clinics 
were carried on in each of the schools in the district. These clinics 
were held by the part-time Medical Health Officer. This school-year, 
toxoid clinics have been held in all the schools as well as at the baby 
clinics. We. are fortunate in having a part-time dentist who gives 
the morning to school dental-work. To date, children have been sent 
to the dentist once and have had full treatment. After this initial 
work it was expected that the family would be responsible for later 
development in care of the teeth. Through efforts of local organiza- 
tions there has been collected enough money to purchase glasses for 
some of the needier children. Problem cases are examined at the 
child-guidance clinic and advice as to treatment is given to the 
parent who accompanies the child. These clinics are held once a 
month. 

29 




Baby clinics were first organized in May of 1938, when twenty- 
five babies registered. At this time we had a weighing station since 
there was not a full-time Medical Health Officer to examine the babies. 
Since May, however, four clinic centres have been established at 
which registration now totals 210. It is hoped that, in the near 
future, these will be supplemented, especially in the more distant 
parts of the area. The response to the toxoid campaign has been 
excellent at all four centres; indeed, many requests have been made 
for other preventive measures. 

The number of tuberculosis visits has increased greatly in the 
last six months. A pneumothorax machine has been installed in the 
Abbotsford hospital and those people living there have taken advan- 
tage of the opportunity to receive treatment rather than go in to 
Vancouver. The Travelling Chest Clinic visits the area every six 
months. 

It is impossible to come from a city to a rural area without 
noticing a decided change in tempo. Life in the country is not 
attuned to speed, and the nurse who is doing public health work in 
the country must of necessity adapt herself to the life of those 
amongst whom she is working. It is essential then, that the nurse 
in a rural area know the industries and their effects on the lives of 
the people. For instance, there is very often a definite health prob- 
lem in a mining town. In the Fraser Valley one finds, of course, 
extensive farming areas. Aside from this there is a plant at Kilgard 
where bricks and other clay products are made from local clay. Con- 
sideration in a rural area must also be given to nationality groups. 
To the Fraser Valley, during the last five years, have come settlers 
from the drought area of Saskatchewan. By far the greatest number 
of these are Mennonites, a religious sect, of Russian-German origin. 
A great deal of thought must be given to these racial groups. With 
some knowledge of their beliefs the nurse finds that they are more 
co-operative, especially if she recognizes these beliefs and taboos 
while working amongst them. More can be accomplished with the 
children of these families than with the parents themselves, because 
of the barrier of language. There is also a large Japanese settlement 
in Matsqui Municipality. These people are most co-operative in any 
preventive programme. Mariqn Miles> R N ^ B A gc _ 

Abbotsford. 

SOME ASPECTS OF TUBERCULOSIS WORK IN 

THE OKANAGAN. 

To show you how the tuberculosis clinic works, its connection 
with other departments, and its methods of case finding, I thought 
the best plan would be to follow a case of tuberculosis from the time 
she first visits the clinic till she is cured. Some means by which 
people are brought to the clinic and some of the results of the work. 

I will start with the case of Mrs. Jones. She feels tired more 
frequently than is usual, has a slight cough, some chest pain; so 

30 



she visits her family doctor. Her symptoms are not very definite, 
but are suggestive of tuberculosis. The doctor thinks a chest spe- 
cialist's examination and an X-ray advisable before making any 
diagnosis. Knowing the tuberculosis clinic will be coming through 
the Okanagan the next week, as he has received a notice from them 
to this effect, he makes an appointment for his patient. She has an 
X-ray and a thorough examination of her chest, also a sputum exami- 
nation and a detailed history taken. The results of the examination 
turn out to be a case of tuberculosis with a positive sputum. This 
means that the patient herself needs immediate attention in a sana- 
torium, where she can have proper rest, treatment, and education in 
how to care for herself and protect others. Also in the sanatorium 
she is isolated from her family and the rest of the community whom 
she would infect with her positive sputum. At this time the Public 
Health Nurse and the Welfare Visitor in the patient's community 
are notified as to her condition. They immediately visit the family, 
and the Public Health Nurse advises them all to be X-rayed and 
examined and arranges for them to attend the next clinic. The Wel- 
fare Visitor straightens out any financial problems or other upsets 
that may result from the fact that a member of the family has been 
removed from the home. In the short period that intervenes before 
the patient actually enters the sanatorium, the Public Health Nurse 
probably visits the family to explain to them how to care for the 
patient, how to protect the rest of the family, and to settle any 
worries, and so on, that may arrive when the family is to be broken 
up for a while. The Tuberculosis Department has some interesting 
literature for these occasions which the nurse will give out. Eventu- 
ally after some months the time comes when Mrs. Jones is well enough 
to leave the sanatorium. Her sputum is negative, but she must still 
carry on with treatment. Perhaps she has to have her lung collapsed 
by pneumothorax, and this is done by her own family doctor, whom 
she visits at stated intervals for the refills. He is advised by the 
sanatorium as to how this should be done and every time the clinic 
visits the community, Mrs. Jones comes in for an X-ray and examina- 
tion. Her doctor discusses her progress with the clinic doctor and 
any change in regime that may be necessary is arranged. Her family 
are X-rayed and examined every year, and all those with whom she 
has been in contact are examined from time to time. The Public 
Health Nurse in the community visits the family from time to time 
and maintains a contact with them and the clinic. 

This accounts for the case that is sent in to the clinic by her 
doctor; but, as you know, there are many cases of tuberculosis, in 
its early stages, who present very slight symptoms and so do not 
consult their doctor. Also there are those people who have at one 
time been active, are now arrested, who have never been diagnosed 
as tuberculous, but who might break down again under any adverse 
condition. These cases may be picked up by various other means, 
such as tuberculin testing in the schools. All the school children in 

31 



the Okanagan have been tuberculin-tested within the last two years. 
One case of active tuberculosis in these children was discovered. A 
percentage of these children had calcined nodes, calcined glands, and 
so on, and will be watched carefully for any disease, especially through 
adolescence. The point is: Why did some of these children have 
positive reactions from the tuberculin-testing when most of them had 
clear lungs? To answer this, we X-ray their parents and teachers, 
who are the most likely contacts of school children. Here we might 
find the case, either an active tuberculous case or cured at present, 
but at one time active; hence these persons should be watched. A 
positive tuberculin test may come from infected milk and such has 
been found to be the case in several instances. 

Another method by which cases of tuberculosis may be brought 
to light is through the examinations for silicosis that are now com- 
pulsory once a year for all underground workers in the hard-rock 
mines in British Columbia. This entails an X-ray and examination 
of the chest. Quite a number of cases of tuberculosis have been 
found in men who would probably otherwise not have complained to 
their doctor till the disease was far advanced, and presented far more 
serious symptoms from a tuberculosis point of view. 

The Indians are quite a problem in British Columbia, partly due 
to the living conditions and mode of life of most of them, and probably 
because they have only come in contact with tuberculosis since their 
connection with the white man. The Indian seems more susceptible 
to tuberculosis than we are. Recently the Indian Department has 
realized that their wards need more attention in this line and have 
allotted considerably more money than heretofore for their care. 
More beds in the sanatoriums and hospitals are being allotted for 
them and a number of surveys of the Reserves are being made. The 
children in most of the Indian Residential Schools are tuberculin- 
tested every year. The incidence of tuberculosis is much higher than 
in whites, but it has been observed that they make very good progress 
with proper care and treatment. As British Columbia has the largest 
Indian population of any Province in Canada, and as they are in 
constant contact with the whites in many places, one realizes how 
necessary it is to check this great source of infection, both for our- 
selves and the Indians. 

The work of tuberculosis control in the Okanagan has really been 
carried on quite extensively for some years now, and it is very seldom 
that a new far-advanced case of tuberculosis is discovered. This is 
due to the fact that most of the cases are known and watched; the 
positive cases are isolated immediately, the children are kept under 
observation, and the contacts of all known cases are checked. This 
is largely due to the work of the Public Health Nurses in the area, 
and the good results of their efforts are proved by the favourable 
statistical comparisons with areas where there are far greater facili- 
ties for tuberculosis control than in the Okanagan. 

E. Pease, R.N., P.H.N., 

32 Kamloops. 



THE REACTIONS ON THE OPENING OF A NEW 

HEALTH CENTRE. 

I have been assigned this subject for our 1939 Bulletin because 
in September, 1937, I came to Prince Rupert to be its first School 
Nurse. 

Since it is from this experience that the following reactions have 
been noted, it is felt necessary to recite some of the things accom- 
plished or otherwise in this particular district. The district is proba- 
bly comparable to many others in the Province, though they are all 
individual. To many who are in districts that have grown to maturity 
it will prove that pioneer days are not over for public health in British 
Columbia, and that problems are still arising in new districts similar 
to those of the past; others may be struggling with the same diffi- 
culties and exulting over the same joys and accomplishments. 

We talk about reactions from the very earliest days of our 
training, both in the lecture-room and on the ward, and in public 
health work it is due to reaction of a certain kind and in certain 
places that we seize opportunities to build and expand the work. 
The dictionary says that any revolution, reform, or progress has 
" counter-action," so we look for both good and bad. When we 
started public health up here it was progressive, of course, for Prince 
Rupert to want a School Nurse, even at this later date, and there 
were reactions from the time she stepped off the boat — her own first 
one being that she would like to get back on again. 

We are still far from being a Health Centre, but a Health Centre 
must have a beginning and one thing that has made the hard days 
easier was the thought that we could have a very fine Health Centre, 
all things being equal. 

Prince Rupert is a city of between 5,000 and 6,000 people ; includ- 
ing 1,100 school children. It is managed by a City Commissioner, 
placed here by the Provincial Government some four years ago. 
This, of course, means that there is no School Board, but that this 
one man is the sole authority in the municipality. 

First conversations with the Commissioner were encouraging. 
He was decidedly interested in public health and realized that its 
scope reached further than a School Nursing Service, but I was 
impressed with the idea that this new experiment was not to cause 
any expense to the municipality even while setting it up. A new 
loose-leaf binder was already purchased for my records and a small 
" Health Meter " scale for weighing the children, and I was assured 
that when school would open the following week the teachers would 
find a corner for me somewhere which I could use for an office. 
There was a Medical Health Officer, but he was not the school doctor 
and it seemed necessary to make it understood right at the first that 
a school doctor was very necessary. There are three elementary 
schools and a high school here. "The people seemed fairly prosperous ; 
mostly of British stock with a good percentage of Scandanavians, 
and a few Orientals. The main industry is the fishing. The largest 

33 



coldnstorage plant, for fish alone, in the world is here and emr 
fair number of people. There are also a Dominion Government 
Fisheries Experimental Station, a Government dry-dock, and G.N.R. 
shops and offices. There are a fair number of families on city relief 
for the size of the town, more of course when there is a poor fishing 
season. The people are healthy, and I was assured I would find the 
Children the same. The town seems to be little troubled with epi- 
demics of infectious diseases. There is a Provincial Welfare Worker 
in the district who also visits the Queen Charlotte Islands and a large 
part of the inferior. Any social service work is done by the Salvation 
Army and one chapter of the I.O.D.E., and there is no medical relief 
given to people receiving public maintenance. There is no other 
mode of transportation than that of walking. 

I soon found out that except for a small notice in the daily paper 
the previous June no one knew of my appointment beside the Com- 
missioner, and most of the people were hazy about what my duty 
might be and decidedly skeptical of its value. 

The first day of school I set out to find the schools to introduce 
myself to the teachers and to find "my corner." There were some 
people who gave me a real welcome, because they knew what a School 
Health Service would mean and were anxious to do their part to help. 

The next week I examined the children, who, of course, rose to 
the occasion as children always do with a new service and were soon 
advertising what was being done for them in school. I was anxious 
to know their parents and their environment and so, those first 
months before Christmas I made those contacts which I felt would 
be most useful in the long run. Wherever I went I was welcomed 
with true Northern hospitality. These people were an intelligent 
co-operative group who were interested in anything connected with 
the welfare of their children. 

Among the more comfortable homes I found a large number of 
families living on a comparatively small yearly income, earned in a 
short fishing season, and other small salaried families who were 
struggling to keep their heads above water. By the time these people 
had housed, clothed, and fed their children they had nothing left for 
doctors' and dentists' bills with which to correct the defects I had 
come to report. With no hospital clinics or medical relief provided 
by the municipality this seemed an insurmountable obstacle, for one 
hesitates to burden parents, already using all their ingenuity to make 
ends meet, with a story of diseased tonsils and decayed teeth and their 
effect on general health ; and yet, to me, the function of public health 
is the promotion of health by the prevention of disease which also is 
dependent upon treatment. 

The first reaction to the work was in January of that first year 
when, after a ravaging epidemic of whooping-cough and measles, I 
decided to start giving the small children milk at school in the 
mornings. A questionnaire was sent to each family, who responded 
whole-heartedly to the plan, not only wanting it for their small chil- 

M 





dren but the older ones too. Fresh milk is expensive here, and not 
used as freely as it should be for the children to drink ; however, this 
plan offered milk a little cheaper and assured the children of half a 
pint daily. The I.O.D.E. sponsored the project and gave fifty to sixty 
free bottles daily. Milk drinking has now become an institution in 
the elementary schools and is still receiving the support of the parents 
and the organization. 

The advent of the green slips from the T.B. Division helped to 
explain some other duties the nurse could absorb, and the title of 
" School Nurse " was changed to " Public Health Nurse," which is 
now better understood. 

The men of the community became interested in our work. They 
were not to be outdone by the ladies. This I felt was a very encourag- 
ing reaction. I was asked to speak to the Rotarians at one of their 
luncheon meetings and this resulted in the establishment of a very 
promising dental clinic by them, together with the help of the Pro- 
vincial Department of Health. Even in its short existence this clinic 
has helped a great many needy children. The committee are not only 
interested in the remedial work but in the prevention of dental caries 
and its relation to nutrition, so they insert a couple of articles along 
this line in the daily paper occasionally. 

From the very beginning it was felt that there was a great need 
for a well-baby and preschool clinic where contacts could be made 
with the parents before the child started to school. One or perhaps 
two of the doctors seemed to give definite postnatal care, but the other 
mothers seemed to carry on alone with only the help of a list of feeding 
changes provided by the doctor. It was felt that much more help 
could be given these mothers, so the doctors agreed to attend the clinic 
in turn each week and attendance has been very good. 

The reaction of the people to immunization was not very encour- 
aging. Previously very few school children were vaccinated and only 
a very few have been immunized against diphtheria. The people 
listened but seemed little impressed. Smallpox and diphtheria were 
things you read about happening in other places but not here. How- 
ever, this fall a scarlet fever scare invaded our city. The Medical 
Health Officer agreed to Dick test the school children. Permission 
was granted in over 800 cases; all positive reactions were advised 
to see their own doctor about immunization, and 200 went of their 
own accord to their own doctor and had immunization treatments. 
I feel many more could have been done if clinics could have been 
arranged. 

So much then for favourable reactions. So far nothing has 
availed to convince our Commissioner that we should have a school 
doctor to do school medical examinations, nor to convince our medical 
men that they should co-operate to bring this about, although they 
have co-operated in many other ways; perhaps it is because they 
were not consulted before the nurse came to the district and that they 
just still do not understand what her work is. The problem is to 

35 



make them feel that public health needs them in its work and does 
not wish to intrude into their sphere. Time will surely bring this 
about and produce a more favourable reaction from them. 

Many times, even from the beginning, I have wished I could 
consult an understanding supervisor who could have visited the dis- 
trict and have helped me in my difficulties. We go out to the district 
well armed with our Public Health training and a knowledge of the 
general public gained in our previous experiences, and while it is 
true that experience teaches if we ourselves are bigger and broader 
minded after having had our experiences, but it does seem that, if we 
could have the benefit of some one else's experience and if we could 
have advice and guidance so that the progress of the work will not 
be hampered, even for a short time, through a false inexperienced 
step we should feel so much more confident. It is an old adage " Two 
heads are better than one " and a second head taken into consultation 
would make difficulties seem easier and would temper enthusiasm 
with a little caution. 

The reaction then as I see it — or, should I say, feel it — to the 
little health service I have been able to offer in this community in 
seventeen months is : The people say " Give us MORE, we'll do our 
part to help." The medical profession hesitates to say anything, the 
municipality says, more or less, " Have as broad a programme as you 
wish, but don't ask us to spend any money to provide equipment, 
much less a car." The nurse sees the needs of the community from 
all public health angles, but feels the force of these conflicting reac- 
tions ; and in spite of an earnest desire she must take the middle of 
the road with a vision ever before her of the time when, by much 
patience, reactions will all blend and the goal will be reached. 

E. Dorothy Priestly, R.N., P.H.N., 

Prince Rupert, B.C. 



A SUGGESTED PROGRAMME FOR VENEREAL DISEASE 

CONTROL IN A COMMUNITY OF FIVE TO 

TEN THOUSAND. 

Introduction. 

Nurses engaged in public health work to-day are becoming 
increasingly aware of the great challenge presented to them in the 
control of the venereal diseases, namely, syphilis and gonorrhoea. In 
the face of many other health problems demanding constant attention, 
these two infections are steadily gaining recognition as the major 
issues in modern public health. It is now accepted that a persistent, 
vigorous campaign against these diseases should form part of every 
well-balanced health programme. The acceptance of this challenge 
by Public Health Nurses, calls for clear thinking as to the strategy 
to be employed in reducing to the minimum these infections which 
form so great an obstacle to human health and happiness. In plan- 

36 






ning such a campaign it is essential to understand that the social 
hazard accompanying these infections usually far outweighs the health 
problem they present to the individual. This social hazard, arising 
from mistaken public opinion as to infectiousness and method of 
transmission, forms the chief point of attack. It is this aspect of 
the problem which calls for special consideration on the part of the 
Public Health Nurse, and which justifies the differential treatment at 
present accorded to these infections as compared with other com- 
municable diseases. Sound knowledge is the strongest weapon which 
can be used to break down the mistaken public opinion causing this 
social hazard, and it is only by the reduction of this significant factor 
that the individual — and the community — will be persuaded to face 
the issue honestly as a major health problem. 

Since unsound public opinion in the form of ignorance is the 
greatest obstacle in the path of venereal disease control, it is essential 
that education, the most powerful force to overcome this lack of 
knowledge, be accepted as the basis on which to build the community 
health programme aiming to reduce syphilis and gonorrhoea. 

Plan. 

The plan for venereal disease control in a community of five to 
ten thousand people is basically the same as that used in larger 
centres, except in the arrangements for treatment, which will be 
discussed later. This plan, by reason of the difficult factors involved, 
must be a long-range one, and it can only be successfully established 
after years of persistent co-operative effort. It is to be regarded as 
a community project in which the Public Health Nurse co-operates 
with the Medical Health Officer, private physicians, educational 
authorities, and the public in the use of community resources to 
establish adequate protection against syphilis and gonorrhoea through 
knowledge and a healthy environment. Such a plan may be studied 
under the two main headings of Prevention and Medical Services. 

Prevention. 

This may be practised through the medium of community educa- 
tion, remembering always that the control of venereal disease is 
synonymous with the establishment of good social hygiene. Since 
the first step in public education is the self-education of those who 
are to teach the public, the Public Health Nurse must arm herself 
with knowledge of the following matters that she may successfully 
pass them on as protective measures to the community she serves. 
These are as follows: — 

Facts about Venereal Disease. 

Safety of infected Persons. 

Legal Provision for Prevention. 

Public Provision for Treatment. 

Contributing Factors in acquiring Venereal Disease. 

Value of Medical Examination. 

37 



It has been said that " success in any campaign demands, first, 
individual knowledge of the habits of the enemy; and second, a 
planned method of attack based on that knowledge." The first step 
then for the Public Health Nurse is the study of certain fundamental 
facts about syphilis and gonorrhoea — two major enemies of her com- 
munity's health. Each of these infections may be considered under 
the following headings : — 

Causative Organism. 

Methods of Transmission and Period of Communicability. 

Incubation Period and Common Symptoms. 

Methods of Diagnosis and Treatment. 

Prognosis of treated and untreated Cases. 

Syphilis. 

The worker in public health should herself realize and then teach 
the community that " there is no other single disease which causes 
a greater degree of human unhappiness, total disability, and loss of 
earning-power." Therefore, from a social and economic view-point 
as well as the health angle this infection demands effective application 
of the powerful weapons science has provided against it. The 
strength of these weapons may be summed up in the following 
statement : — 

" No other single disease exists for which there is (1) more 
accurate means of confirming clinical diagnosis, (2) for rendering 
the patient non-infectious, (3) arresting the destructive spread of 
the causative organism, (4) under favourable conditions effecting 
remarkable cures." These important facts about syphilis correctly 
interpreted to the public are the sure foundation on which the nurse 
may build a healthy and scientific attitude toward overcoming this 
greatest of communicable infections. The study of syphilis may be 
made under the headings formerly given, the first of which is 
Causative Organism. 

Causative Organism. 

Syphilis, the most deceiving and serious of all communicable 
infections, is caused by a corkscrew-shaped germ known as the 
Treponema pallidum or Spirochaeta pallida. This infection gives 
rise to certain local and constitutional symptoms, runs a chronic 
course and has two definite stages. First, the Early, during which 
primary and secondary symptoms appear or the infection may be 
latent — i.e., without symptoms — and, secondly, the Late, during which 
tertiary symptoms may present themselves or again be latent. It is 
usually classified as acquired and prenatal, depending upon whether 
it is developed before or after birth. 

Methods of Transmission and Period of Communicability. 

The germ of syphilis has the power to penetrate the mucous 
membrane without there being an abrasion present, and to penetrate 
the skin whenever the slightest abrasion has occurred. Transmission 

38 






is therefore by direct personal contact with infected persons through 
kissing, sexual intercourse, and from the infected mother to her 
unborn child. 

Poor practices, such as the use of common drinking utensils, 
common towels, and the exchange of pipes, cigarettes, and toilet 
articles, may all contribute toward the spread of this infection. 
Refraining from sexual contact during infection, and the faithful 
continuance of treatment of the infected pregnant woman, are the 
most certain ways of preventing the spread of syphilis. The nurse 
as educator should therefore stress the importance of good personal 
hygiene and adequate prenatal care as strong preventive factors 
against acquiring this infection. 

The period of communicability lasts as long as there are infec- 
tious lesions present, such as the primary sore, mucous patches, a 
crusted or oozing rash or ulcers. All of these, except the primary 
sore, may appear at intervals over a period of three to four years in 
untreated patients. These factors make the early stages of syphilis 
very important from the public-health angle, and it has been truly 
said that " the nurse who has a high index of suspicion plus a scientific 
background of knowledge may be instrumental in uncovering sus- 
pected sources of infection by getting such patients under medical 
care at the earliest possible moment." 

Incubation Period and Common Symptoms. 

The average length of time for the first symptoms to appear is 
three weeks from the date of exposure, although the period may vary 
from ten days to eight weeks. It then takes from one to three weeks 
for the blood to become positive, and four to eight weeks for the 
secondary symptoms to appear, during which stage the patient, if 
untreated, is highly infectious. A thorough understanding of the 
incubation period forms one of the most important defences the nurse 
can offer her community when charged with the observation of 
contacts to early cases of syphilis. 

Common Symptoms of acquired Syphilis. 

The primary stage of syphilis is characterized by a sore known 
as a chancre occurring at the germ's port of entry. It is usually on 
the genitalia but it may be on the lips or other parts of the body. 
It is often painless and so inconspicuous as to be ignored, and the 
patient is fortunate who consults a physician for this symptom and 
secures an early diagnosis. Shortly after this primary lesion appears 
there is enlargement of the nearest lymph glands. These symptoms 
may persist for several days or weeks, but finally heal, leaving little 
scarring. 

The secondary stage, which develops four to eight weeks after 
the appearance of the chancre, has as its most common symptom a 
skin-eruption which varies from an intense one covering the entire 
body to one so slight that it passes unnoticed. This may be accom- 

39 



panied by sore throat, swelling of the glands, headache, fever, and 
patchy falling out of the hair and eyebrows. 

Again, all these symptoms may be so slight as to pass unnoticed, 
and it is the fortunate patient who places himself under medical care 
and obtains a diagnosis at this time. These symptoms may disappear 
after many weeks, and either never return to warn the patient or may 
appear at variable intervals for three to four years. These two stages 
constitute what is known as early syphilis, and offer the greatest 
challenge to the Public Health Nurse from a point of infectiousness. 
The fact that patients started under treatment at this time and faith- 
fully continuing it have a higher percentage of recovery than other 
groups is also very important. Late syphilis — i.e., syphilis which is 
of four years or more duration — manifests itself in many different 
forms. These symptoms may arise from the cardiovascular and 
central nervous system and cannot be diagnosed without special 
examination. Since they are non-infectious they do not present such 
a public- health problem, but the nurse noticing them should endeavour 
to have the patient placed under medical care as soon as possible. 

Miscarriages, still-births, malformed infants, blindness, deafness, 
general paralysis, and insanity are some of the tragic results of 
untreated syphilis. It therefore behooves the nurse entrusted with 
the charge of the community's health to strive for the prevention of 
these disasters by urging prenatal and annual medical examination, 
and the keeping of infected patients under treatment till cured. 

The Symptoms of Prenatal Syphilis. 

The symptoms of prenatal syphilis are lesions of the skin and 
mucous membranes, usually occurring on the palms and soles and 
about the mouth, nose, anus, and genitals. They may be spread over 
the entire body. There may also be a condition of the nasal mucous 
membrane producing a discharge known as " snuffles." This dis- 
charge and that from any open lesion is, like that from the lesions 
of primary and secondary acquired syphilis, highly infectious, and 
requires careful isolation until treatment has rendered the patient 
non-infectious. These symptoms may be latent at birth and the first 
intimation of the infection may not occur till late childhood or the 
early teens. The symptoms then shown may be inflammation of the 
cornea of the eye, known as interstitial keratites, which if untreated 
may result in blindness, deafness of a very serious type, and peculiar 
wedge-shaped teeth with crescent-like notched edges. The bones may 
be affected, showing shins which are outwardly bowed and thickened, 
or the joints may be enlarged but cause no pain. Other symptoms 
showing involvement of the nervous system may occur. 

The nurse in studying these symptoms should always be careful 
to avoid creating unnecessary fear, but there appears no valid reason 
why the community should not receive instruction in the signs of 
this communicable infection as is given in others such as typhoid or 
tuberculosis. The important attitude to build up in health education 

40 






is an awareness of the signs of ill-health, plus a knowledge of the 
factors available for its treatment. If, in conjunction with the teach- 
ing of symptoms, there is stressed the soundness of the treatment for 
the infection, it does not appear that any harm can be done in this 

regai . Methods of Diagnosis and Treatment. 

Syphilis is diagnosed by means of laboratory tests, certain clinical 
symptoms, and the patient's history. These three factors are care- 
fully considered before diagnosis is established. Since the treatment 
of the infections varies with the stage it has reached, certain specific 
laboratory tests are used to determine the degree of infection. These 
include a dark-field microscopic examination of the serum from the 
primary sore to determine the presence of the germs of syphilis. A 
blood test which shows the chemical reaction of the blood to certain 
substances, thereby revealing the presence of syphilis. These tests 
are known as the Wasserman, Kahn, Hinton, and Kline. A spinal- 
fluid examination which shows the chemical reaction of the spinal 
fluid to certain tests, thereby indicating that the infection has pene- 
trated the nervous system. Certain abnormalities in the fluid also 
show the degree of severity of the infection and prove a valuable 
guide to treatment. 

Treatment is dependent on the stage of the infection, the struc- 
tures involved, and the individual tolerance of the drugs used. It is 
felt that the community should be taught that adequate treatment can 
only be given by a qualified doctor, and should be strongly warned 
against quacks. The public should know that adequate treatment for 
early cases consists of weekly injections of certain drugs, arsenic, 
given intravenously, which has the power to kill the germs of syphilis, 
and mercury and bismuth given intramuscularly for their tonic effect. 
This treatment should be taken at regularly weekly intervals for a 
period of eighteen months to two years, and treatment should never 
be stopped until the doctor advises it, as relapses may occur. It 
should be taught, too, that an annual medical examination, including 
specific tests for syphilis, is needed by all patients after their dis- 
charge, and that all patients having once had the infection should 
advise their attending physician of this fact. Treatment of late 
syphilis with neurological involvement is by the use of a drug known 
as tryparsamide, and by malarial therapy, both of which have the 
power to destroy the germ when it has penetrated the nervous system. 

Treatment of prenatal syphilis is basically preventable; i.e., the 
infected mother should receive weekly treatment early in pregnancy 
to prevent the birth of syphilitic children. Children are treated by 
special preparations as their condition warrants. 

Prognosis of treated and untreated Infections. 

The nurse should stress the value of early diagnosis and early 

treatment faithfully taken each week. She should teach that the 

highest chance of recovery lies in the patient starting treatment 

before his blood has become positive and continuing it faithfully. 

41 



She should teach that all early syphilis has a high percentage of 
recovery if treatment is regularly taken. Importance should be 
attached to the fact that late syphilis can be arrested, further damage 
prevented, and the patient's health markedly improved. The com- 
munity should know that the future of untreated syphilis is fraught 
with danger since it is unknown what serious complications may 

arise. 

Safety of infected Persons. 

This factor is one of the most important in the programme of 
education, since great injustices are often visited upon the unfortu- 
nate syphilis patient, and frequently cause his lapse from treatment. 
The discharging of patients from employment and the social ostra- 
cism they suffer is largely due to fear arising from ignorance. It 
should be made widely known that patients with infectious syphilis 
are rendered non-infectious in five days after three treatments at 
forty-eight-hour intervals. The nurse should teach also that the 
infected patient taking treatment regularly and practising good 
hygiene is no more of a menace to the community than any other 
person, except in sexual relationships, when the infection is in the 
early stages. Knowledge of the delicate nature of the causative 
organisms should be stressed, and the fact that they quickly die when 
exposed to air, soap, and water. 

Legal Provision for Treatment. 

The nurse should teach the community that legislation exists for 
prevention of prenatal syphilis by examination for this infection 
prior to marriage, as provided for in the amendment to the " Mar- 
riage Act," 1938, and by making treatment compulsory, as required 
by the " Venereal Diseases Suppression Act," 1936. It should be 
made known that the Medical Health Officer has the authority to 
arrange for examination of all persons exposed to, or reported to be 
suffering from, this infection. In this regard great stress should be 
laid on the protection afforded the patient with venereal disease by 
making it known that no information is ever given about patients 
without their knowledge and written consent. This should tend to 
reduce the fear of discovery which often prevents treatment. An 
important thing for the community to realize is that the transmission 
of venereal disease by a person knowing himself infected is a punish- 
able offence under the " Venereal Diseases Suppression Act." 

Public Provision for Treatment. 

Under this heading should be made known the fact that the con- 
trol of venereal disease is considered a serious enough matter for 
governmental responsibility. The nurse should make known that the 
public provision for treatment includes free clinic service in certain 
areas, free drugs for treatment, and free consultive service for all 
doctors, thereby lowering the cost to the patient. She should use her 
discretion in making known that help is available for transportation 
where the lack of funds proves an obstacle to treatment. 

42 






Contributing Factors in acquiring Venereal Disease. 

There are many factors which should be considered under this 
heading-, but six major ones have been selected for study as follows : — 

(1.) Lack of Control over the Basic Appetites. 

(2.) Lack of Sex-education. 

(3.) Lack of Healthy Physical and Mental Recreation. 

(4.) Lack of Congenial and Remunerative Employment. 

(5.) Alcoholism. 

(6.) Prostitution. 

It is admitted that any one of these factors would provide 
material for study over a period of years, but the plan for venereal 
disease control needs considerable time for maturing, since an 
analysis of a few of the contributing causes show how complex is the 
task in hand. 

Lack of Control over the Basic Appetites. — This is a matter of 
faulty childhood training. This training is the mutual responsibility 
of parents, teachers, and Public Health Nurses, and this group can 
do much in the way of securing information as to the best methods 
for this task. 

Sex-education. — This task will frequently fall to the lot of the 
nurse, and it is important that she prepare herself for the teaching of 
this most vital matter, by study and discussion with the parents and 
the teachers, as to the value of sublimation and other means of 
redirecting the sex urge. 

Lack of Healthy Physical and Mental Recreation. — Since this is 
one of the major contributing factors in the acquiring of venereal 
disease, the nurse should strive to foster public opinion to demand 
and obtain adequate community recreational facilities. This is par- 
ticularly needed for the unemployed groups. 

Alcoholism. — The public-health worker should be aware of the 
close connection between alcoholism and venereal disease. When- 
ever opportunity arises she should point this out and urge adequate 
supervision of mixed beer-parlours to avoid the use of them for 
soliciting by prostitutes and the repression of " bootlegging." 

Lack of Congenial and Remunerative Work. — Efforts should be 
made to rouse the social consciousness into awareness of the need to 
provide remunerative work. In order that economic pressure will 
not further increase prostitution public opinion should be fostered 
to demand enforcement of the " Minimum Wage Act." While this 
may appear more of a social work procedure than a public health one, 
yet in rural areas the Public Health Nurse usually assumes the dual 
function of a health and welfare worker. 

Prostitution. — This problem, the most baffling of all to contend 
with, is the source and root of venereal disease. Unless the health 
worker can make the community aware of this and build up a deter- 
mination to reduce it, syphilis and gonorrhoea will continue as the 
outstanding menaces they still are. The nurse will need to under- 

43 



stand that the best way of reducing prostitution is by prevention, and 
that concurrently with this the community must demand suppression. 
Since the Public Health Nurse is one of the chief moulders of public 
opinion she may do much to teach that segregation, which will doubt- 
less be offered as an alternative, does not pay. By constantly sup- 
porting the policy of repression much can be done to bring it about 
and thereby forge a strong link in the chain of venereal disease control. 

Value of Medical Examination. 

The most important factor in prevention lies very largely within 
the nurse's power. She should use to the utmost her influence in 
securing adequate prenatal examination and, if necessary, treatment 
for the infected mother. In this way the almost entirely preventable 
infection of prenatal syphilis is eliminated. The community should 
be educated to the fact that prenatal syphilis is one of the gravest 
reflections upon its health programme. The value of annual medical 
examination as another preventive factor should be constantly 
affirmed by the health worker. 

Methods of Community Education. 

The methods to be used in this educational programme of 
venereal disease control are those used for other health subjects. 
The facts must be presented in a frank, interesting manner by means 
of papers, talks, and films, by the study of pamphlets and books, by 
attractive posters and exhibits. Newspaper articles, radio talks, 
study groups, and carefully planned discussions are also of great 
value. Word of mouth publicity is also a good form of disseminating 
knowledge. Institutes, or short groups of lectures at weekly intervals, 
might be planned and symposiums in which the Medical Health Officer, 
parent, teacher, and Public Health Nurse take part might be arranged. 
Once the conventional restraint has been broken it will not be hard to 
keep the interest. The chief task will be in meeting the demand for 
knowledge. A canvassing of the local organizations should be made 
and, if possible, certain aspects of the problem studied in turn by 
each group. The educational programme contains much material 
and will provide interest for many years of study. This problem of 
the prevention of venereal disease by education, is one that needs the 
whole-hearted interest and support of the community. It will, how- 
ever, fall to the lot of the nurse as a health educator to lead the way. 
Teachers, clergy, parents, employers, employees, men, women, and 
youth should all be enlisted in the cause of knowledge, so that the 
menaces to the public health of syphilis and gonorrhoea may be 
overcome. 

Medical Care. 

The adequate provision of medical care for syphilis and gonor- 
rhoea has now been accepted as a governmental responsibility. In 
the larger centres this public care is afforded by clinic service, but in 
the smaller centres this service is not satisfactory. The reasons for 

44 



this are obvious. Such communities cannot offer general clinic care 
under whose protection the venereal disease patient may receive treat- 
ment, and treatment centres for this purpose alone do not work owing 
to the attendant publicity. Medical care for these patients should 
therefore be given in the privacy of a doctor's office. The mere 
difference in the place of treatment in no way lessens the Public 
Health Nurse's responsibility for the attendant services of case- 
finding and case-holding which are so important in the plan for 
venereal disease control. 

Case-finding. 

The success of the nurse in this field lies in the establishment of 
a good relationship between the physician, the patient, the nurse, and 
the Medical Health Officer. If adequate interpretation of the need 
for examination is given, the patient — an important guide in this 
search — usually co-operates. The nurse should emphasize that 
privacy, which is every infected person's right, will be maintained 
unless it proves incompatable with public safety. If, however, it is 
necessary to disclose the patient's name, a signed consent form should 
be obtained, but such procedure is only to be used as a last resource. 

If the infection is a fresh one, the investigation should be carried 
out as rapidly as possible to arrest the spread of the infection and 
give the optimum protection of early examination of contacts. The 
maximum incubation period and the duration of the infection must 
be considered, and every suspicious exposure during these periods 
should be examined. Although such investigation often calls for 
hard, tedious, and unproductive work the stimulus of finding fresh 
cases always lends its new impetus. 

In familiar groups, the nurse's part may be summarized as 
follows : " Stressing the importance of medical supervision early in 
pregnancy. Arranging examination of the new-born child. Arrang- 
ing examination of contacts, father and children." Literature studied 
by the patient often results in the voluntary examination of contacts, 
and since education is the basis of success in this field, the better the 
instruction, the better will be the response. 

Case-holding. 

The follow-up of patients for the private physician is a service 
greatly needed in small communities, and there is no other public 
health function which is of greater value. It has been said that " the 
control of venereal disease depends upon the extent to which the 
patient can be trusted. How well he can be trusted depends on how 
well he has been instructed." Here again the value of interpretation 
is evident. Case-holding is basically dependent on the patient's first 
visit to the physician, when efforts should be made to anticipate 
factors leading to neglect of treatment, and spread of infection. It 
may, however, fall to the lot of the nurse to become the " case-holder," 
and there are three well established techniques which will determine 
her success in this field. These have been described as follows : — 

45 



" (1.) The education of the patient, (2) the making of the needed 
readjustments by the patient in his personal attitude and economic 
life, (3) the establishment of the case-work approach, which results 
in enlarging the capacity of the patient to resume his responsibilities, 
increases his sense of personal respect, and develops his initiative." 
Case-holding should, like case-finding, be carried out on a selective 
basis; the more important cases, such as early syphilis, prenatal 
syphilis, syphilis in pregnancy, and acute gonorrhoea, taking prefer- 
ence. The mechanics to be used are the sending -of letters addressed 
in longhand, and so worded as to protect the patient should they fall 
into other hands. Visits to induce the patient to return for treat- 
ment, and furnishing aid with transportation are also valuable. If 
the persuasive approach fails, the regulations for enforcement of 
treatment may be used. Follow-up work should be analysed to 
determine the causes of lapse from treatment and definite attempts 
made to overcome these obstacles. The main contribution made by 
the Public Health Nurse to case-holding, therefore, should be educa- 
tional and supportive. 

Instruction in the Home. 

This function is primarily that of the Public Health Nurse, for 
here she teaches the application of good personal hygiene and strives 
to produce an environment in which it may be practised. 

Use of Community Resources. 

The Public Health Nurse in the smaller centres acts not only as a 
health teacher but often renders first aid for the social problems of 
her patients. It is desirable, when possible, to refer these to a Social 
Worker, but often the nurse has to carry such situations over a period 
of time. Use, therefore, should be made of all community resources 
to help in the psychological treatment often required by the venereal 
disease patient. CONCLUSION. 

It has been truly said that " the control of venereal disease is a 
problem not of diagnosis and treatment alone, but of (1) discovering 
how to persuade people to suspect infection, (2) to seek a diagnosis, 
(3) to take treatment till cured." The community programme here 
suggested is offered as a means of accomplishing these three objec- 
tives. The difficulty lies in how to develop the reality into the ideal. 
This reality involving human nature and its weaknesses of misunder- 
standing, ignorance, and difficulties is closely linked up with the 
breaking of an exacting moral code. The ideal towards which all 
Public Health Nurses strive is embraced in that concept of public 
health which has as its objectives the removal of all obstacles to 
human health and welfare. To accomplish this end, the programme 
for venereal disease control must be one of combined community 
effort in which the Public Health Nurse plays one of the leading roles 
as guardian of the public health. 

Ursula Whitehead, R.N., 

Vancouver. 
46 






SOME PRACTICAL PROBLEMS INHERENT IN SUPERVISION 

IN BRITISH COLUMBIA. 

By Fyvie Young, R.N., B.A.Sc, M.A. 

Instructor, Department of Nursing and Health, 
The University of British Columbia. 

" The central point in Dr. Stampar's philosophy and method is 
that the doctor should seek out the patient and not wait for the patient 
to come to him." These words are from the chapter, " Dr. Hercules," 
in Louis Adamic's book " The Native's Return," in which he describes 
the dramatic work of a man who established a public health pro- 
gramme in a Yugoslavia ravaged by disease in the post-war years. 
For us it is an accepted fact in public health nursing work in British 
Columbia to acknowledge the importance of prevention and of educa- 
tion at all ages and in all states of illness and health. We are taught 
that it is important to be on the alert for the early case, for predis- 
posing causes, and for the signs of developing problems; believing 
that it is the greater economy to avoid, when possible, the cost of 
lengthy cures, of incapacity, and of probable dependence. For the 
public health nursing group in general the result of this policy is to 
direct attention from themselves to the individual, the family, and 
the community group in an effort to develop an appreciation of health 
and some responsibility for maintaining it. 

In concentrating on the above policy are we tending to become 
one-sided in our thought? That this article bears the title it does, 
suggests that within our organization we have not yet considered 
some implications that are the outcome of growth. Is this likely to 
become serious? Should we be giving it observation and attention? 
Is this a time when the " doctor " should seek out the " patient " 
rather than wait for the " patient " to come to him? 

In comparison with other Provinces and States, British Columbia 
has established and maintained consistent standards of preparation 
for Public Health Nurses. A public health nursing course is required 
of all nurses employed by services responsible to the Provincial Board 
of Health, by the Victorian Order of Nurses, and by most urban health 
services. Geographically, the Province falls into sections denned by 
mountains. The population is not uniformly distributed and the 
problems of transportation are many. The establishment of health 
services in the average community has been the outcome of a local 
request and in most cases they have been limited to the part of the 
district willing to contribute financially. Thus in the public health 
nursing service, commonly designated as " provincial," Public Health 
Nurses have been appointed to positions as they opened up, each being 
given the responsibility for developing a public health programme, 
to the best of her ability, along accepted lines according to the needs 
of the community. In the early years, therefore, when the staff of 
Public Health Nurses was comparatively small, the responsibility 
delegated to each nurse was a stimulation in itself. The natural 

47 



expansion of public health programmes, and an increased understand- 
ing on the part of the public, however, have meant an increase in 
staff and in the complexity of the community picture which demands 
a different approach to the question as a whole. 

As a result of the development described above, it has been neces- 
sary, in those centres where staff increases have occurred, to appoint 
one person as supervisor. The designation, when first made, implied 
seniority and bestowed on its possessor the responsibility for adminis- 
tering and directing the service. As a rule, such an appointment 
was made because the recipient possessed organizing ability and was 
felt to have had sufficient experience in the field to direct others. 
Most time and effort continued to be focused, however, on the render- 
ing of service in the field, and a minimum was expended on adminis- 
trative planning by those concerned. In British Columbia the title 
Supervisor has been applied to Public Health Nurses occupying the 
following types of positions : — 

(a.) Senior nurse in a Rural Health Centre, e.g., Cowichan. 
(b.) Senior nurse in a Rural Health Unit, e.g., Saanich. 
(c.) Senior nurse in an Urban Health Unit, e.g., any of 
the units of the Metropolitan Health Committee, Van- 
couver. 
(d.) The consultant, or specialized supervisor, in an Urban 
Health Service, e.g., in child-welfare, tuberculosis, 
school health in the Metropolitan Health Committee. 
(e.) The nurse responsible for the supervision of Public 
Health Nurses in the carrying-out of the work of a 
Division of the Provincial Board of Health, e.g., the 
Division of Tuberculosis Control. 
There are, then, a number of people bearing the same title but 
filling positions of varying responsibility. If one talks with any of 
the above-mentioned Supervisors, as the writer has done from time 
to time, it is to be aware of an element of confusion and an encourag- 
ing dissatisfaction on their part as to their responsibilities. Asked if 
they feel they have problems, they say, " Yes," and in almost the same 
breath outline several, usually involving difficulties arising from the 
essential lack of concrete duties inherent in such work. For purposes 
of discussion, their difficulties could be classified roughly under the 
headings, " the need for time," " the need for preparation," " the need 
for consultation," " the need for definition," and " the need for further 
public education," 

The Need for Time. — The Public Health Nurse holding a senior 
position with administrative responsibility — in other words, the 
Supervisor, in a health centre, a rural or an urban health unit — is 
responsible equally with her staff, for carrying on the district service. 
In addition she may be responsible for compiling monthly and annual 
reports which involve time spent not only on her own records but also 
in studying those of the staff. She is responsible for the calibre of 
the work carried on, for the planning of programme, and for numerous 

48 






outside contacts. She is expected to have a thorough knowledge 
of the health district and of its needs and resources. She must deal 
with questions of relationship, dissatisfactions, ambitions, etc., per- 
taining to members of her staff. She should be a source of informa- 
tion on matters of policy and new theories in the teaching of health, 
both of which require time for reading and discussion. She must be 
free on occasion to attend committee meetings, to address community 
groups, to prepare special reports and papers, and she may be 
required to contribute to the planning of a programme for the educa- 
tion of the public health nursing student. In addition, some Super- 
visors must budget their time to allow for duty on the telephone, for 
correspondence, and for other routine clerical work. 

The Need for Training. — The innumerable demands made on a 
Supervisor's time require much technical ability for which she has 
had little or no training. As a rule she has had no business training, 
and where clerical assistance is not provided in an office much effort is 
expended not only in composing but in typing out correspondence, 
reports, etc. They require immediate attention as a rule, are definite 
in character, and tend to encroach on the time that might be given to 
less concrete but more truly supervisory responsibilities. 

Public health nursing work at its best must be carefully planned, 
if worth while ends are to be reached for the individual and the 
community. A nice judgment is required in deciding what responsi- 
bilities are to be assumed and in guiding staff to do their best work. 
The Supervisor responsible for part of the district service has, to 
that extent, the same status as her staff and one gathers there is at 
times a tendency among staff members to regard the Supervisor as 
one of themselves. This fact, combined with her own awareness 
that she has had no more training than they for the position she holds, 
is apt to lessen her confidence in herself. Her contact should be with 
the district as a whole, but under existing conditions her main atten- 
tion is necessarily directed toward part of rather than the whole area, 
which mitigates against smooth and satisfactory administration and 
supervision. Almost without exception, those who carry the execu- 
tive responsibility feel the need for special training in the art of 
supervision and, more specifically, are conscious of a lack of sufficient 
special training in the following fields : Psychology and its application 
to the many problems in which people are a main consideration; 
group leadership and its application to contacts in the community 
and on the staff; practical methods of supervision of the staff mem- 
ber in her district. 

The Need for Consultation. — Every Public Health Nurse has 
some feeling of the progress being made in public health work and 
senses that much can be gained from the exchange of ideas with those 
working in other districts. Unfortunately, the geography of British 
Columbia makes frequent contact between staffs impossible and at 
the present time the majority are able to meet together for discussion 
only once a year. This deficiency might be remedied to a great extent 



,10 



by the appointment of a Provincial Supervisor, with seniority and 
powers commensurate with her duties, who would act as liaison 
officer between centres. 

The Need for Definition. — Do all the responsibilities and all the 
problems that have been mentioned in the section " The Need for 
Time " rightfully rest on the shoulders of a Supervisor? Can she be 
expected to carry them all and, if not, which merit most attention and 
first consideration? 

One general definition of supervision states that : " Supervision 
may be thought of as the work of discovering the needs of Public 
Health Nurses in any given situation (urban or rural) and of organiz- 
ing ways and means to meet the needs that are found. Generally 
speaking, the aim of the individual Supervisor is to facilitate the 
growth (physical, intellectual, and emotional) of the staff worker to 
the end that she may become an effective community agent for the 
promotion of health." 

To concentric circles have been used by Dr. C. E. A. Winslow to 
describe the relationship of the public health nursing organization 
to the community ; the inner and smaller one representing the public 
health nursing service, the outer and larger one the community. At 
the centre is the Supervisor, maintaining contact on the one side with 
developments in public health science, with the physician, health 
authorities, school authorities, and social organizations, and on the 
other side transmitting what she has gained to the staff nurse who 
is the vital contact with the family through the individual. The staff 
nurse, working in the community, is ultimately the person on whom 
the real success of a public health nursing programme depends, and 
her ability to make effective contacts and to plan constructively should 
be kept at a maximum. 

If, then, we accept these facts, that the aim of supervision is to 
meet the needs of the public health or staff nurse, and that the staff 
nurse is in a position to make or break a public health nursing pro- 
gramme, we are justified in classifying the requirements of a Super- 
visor under three headings, as follows : First, she must be a teacher. 
Her knowledge of the district, her judgment in carrying out the 
policies of the organization, and her understanding of the factors 
that affect relationships with other authorities in the community are 
important in their effect on the confidence her staff has in her. Her 
ability to instruct will determine how much of this information is 
understood and used by the staff. Second, she should have an ability 
to see and develop individual ability in the members of her staff. 
Just as the Public Health Nurse in the home studies the forces that 
are important in the life of a family in order to help an individual 
to find the ways best for him of meeting his health problems, so a 
good Supervisor must study her staff member to determine how best 
to help her to strengthen her weak points and to make use of her 
abilities, as well as to develop good team-work among all members of 
the staff. The third requirement of a Supervisor is administrative, 

50 



involving the management of the multifarious demands arising in 
connection with the office, the writing of reports, etc. 

The Need for Further Public Education. — One of the greatest 
difficulties which a Supervisor has to meet in any local situation is a 
lack of understanding on the part of the public of her specific func- 
tions. The lay members of the board employing her, who may 
represent municipal or school authorities, etc., are concerned with 
the cost of the service and are sometimes limited by this point of 
view to an appreciation of purely concrete activities. If she is con- 
stantly on the move in the district and always obviously busy with 
some job, they feel she is earning her salary. Their failure to 
understand the real problems besetting a Supervisor might easily 
result in such conflict of opinion as to necessitate her resignation. 
Where the public has been thoroughly informed, however, and has 
some understanding of a Supervisor's three-fold function of imple- 
menting a satisfactory programme, of justifying in the minds of 
those locally responsible the outlay of tax money, and at the same 
time of satisfying the individual requirements of the community, it 
is conceivable that such a resignation would not materialize. 

To clarify local understanding and to help educate the taxpayer 
there is a two-fold division of responsibility. The Supervisor and her 
staff with their knowledge of conditions and attitudes in the com- 
munity should utilize every opportunity to impart correct information 
regarding the nature and purpose of their work. Equally, the Pro- 
vincial health authority has an obligation to do more than rely solely 
on the selection of individuals so well qualified that they can be 
expected to meet and handle all situations. Public health is regarded 
by many as one of the greatest factors in the national life of to-day, 
and it seems evident when one gives the matter thought that more 
responsibility should be assumed by the Provincial department in 
harmonizing the various opinions existing between the Provincial 
Board of Health, the local authorities, and the public health services 
in the field. 

Conclusion. 

In the development of this paper, the writer is well aware that 
there are many problems and contributory factors relating to super- 
vision, of which the reader may be conscious, upon which no enlarge- 
ment has been attempted. Emphasis has been placed intentionally 
on the problems of organization and administration in the belief that 
dealing constructively with them will prove to be the best preventive 
measure that could be applied to avoid the development of other and 
more complicated problems. 

Certain conclusions, for which this article is the background, are 
outlined below and are submitted to the reader: — 

(1.) That there is a very definite need for special training in 
the art of supervision, and that at the present time those who are 
supervising in public health nursing in British Columbia have not 
had special training for their work. It might be recommended that 

51 



consideration by the Provincial Board of Health and by the University 
should be given to planning - a course that would provide for the lacks 
mentioned under " The Need for Training." 

(2.) That natural conditions in British Columbia tend to limit 
opportunities for contact between centres which would be of benefit 
to all public health workers. It is recommended, here, that considera- 
tion should be given to the appointment of a Provincial Supervisor 
who would act as liaison officer between centres. ' 

(3.) That there are difficulties inherent in the education of any 
community and in the directing of public opinion which may have a 
definite effect on public health work. It would seem desirable for the 
Provincial Board of Health to appoint some one who would act as 
consultant to the local health staff and assume some responsibility 
for the directing of public opinion and the development of under- 
standing between local boards, health services, and the Provincial 
Board of Health. For practical purposes the same individual could 
carry out these as well as the functions suggested in (2). 

(4.) That there is a need for limiting any demands made on a 
Supervisor's time that encroach on her more important responsi- 
bilities. The recommendation is made that consideration should be 
given in all centres to the relative cost of providing clerical assistance 
in an office and expecting the Supervisor to undertake this type of 
work. 

An awareness of the problems inherent in public health nursing 
supervision is most evident in the public health nursing group itself. 
In other words, we are in the position of the " doctor " who must 
seek out his " patient," and if problems are to be met it is we who 
must take the initiative. 



52 





Finis. 



VICTORIA, B.C. : 
Printed by Charles F. Banfield, Printer to the King's Most Excellent Majesty. 

1939. 



350-339-8609 



53 



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