醫務衛生署年報 Medical and Health Department Annual Report 1948-1949

RBB 40h

SANITARY

LIBRARY

ROY

INST

HONG KONG

ANNUAL REPORT

OF THE

DIRECTOR OF MEDICAL SERVICES

FOR THE PERIOD

1ST JANUARY, 1948 TO 31ST MARCH, 1949.

RBB/40h

10731

22501292892

HONG KONG

ANNUAL REPORT

OF THE

DIRECTOR OF MEDICAL SERVICES

FOR THE PERIOD

1ST JANUARY, 1948 TO 31ST MARCH, 1949.

WELLCOME ASTITUTE

Col.

"nec

Ann Rep WAZ8 .THE

H77

1947

ADMINISTRATION

CONTENTS

Γ.

A. General

Boards

C. Staff

D. Legislation

II. PUBLIC HEALTH

III.

General Remarks

VITAL STATISTICS

A. Population

B. Births

Deaths

Infant Mortality

Maternal Mortality

- JL

IL J

г..

F. Principal Causes of Death

IV. HYGIENE & SANITATION

(1) General Measures (ii) Anti-Epidemic (iii) Health Propaganda (iv) Port Health Work

(v) School Hygiene

(vi) Nutrition

(vii) Social Hygiene

LJI

MATERNITY AND CHILD WELFARE

HOSPITALS AND DISPENSARIES

VI.

VII.

DENTAL CLINICS

VIII.

PHARMACEUTICS

LJI

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IX. Menico SOCIAL WELFARE ACTIVITIES

X. TRAINING OF PERSONNEL

ANNEXURES

(A)

(B)

(0)

(D)

(E)

(F)

Chart of Organisation of the Department Maps of Medical Institutions

זי

JLI

Establishment of the Department at 31-3-49 Table and graph showing deaths by ages for 1948 with the age distribution as found in the 1921 and 1931 censuses. Notifiable Diseases, Deaths and notifications

from 1946-1948

Tuberculosis Report

Report of Infant Mortality Committee

...

(H) School Health. Results of medical inspection

of pupils and defects found in schools

Summary of Hospital Work

Cases Treated in Government and Gover- ment assisted hospitals with total deaths in the Colony for 1947 and 1948

(K) Report of the Tsan Yuk Hospital

Mortuaries: Summary of Work

IJL

49-51 59

54-55

*3* **

134

187

ILI

138

145

152

(M) Report of the Malariologist (N) Report of the Government Chemist

Report of the Government Pathologist

(0)

Digitized by the Internet Archive in 2019 with funding from Wellcome Library

https://archive.org/details/b31405964

I.-ADMINISTRATION.

A. General.

　In this report the text will refer to the period January 1st, 1948 to March 31st, 1949, but all statistical tables will refer to the calendar year 1948. Any discrepancies between fext and tables are explained by this arrangement. It is proposed in future years that the text should refer to the financial year i.e. April Ist to the following March 31st, while statistical tables will refer to the calendar year as before. The period of fifteen months covered by the text this year being due to the fact that it is the transitional stage.

2. During the period under review the tendency was for the departmental activities to approach steadily the more normal peace time routine.

　3. In the latter part of the year the office of the Principal Almoner was moved from the Queen Mary Hospital, where it had been since the beginning of the Almoners sub-department in 1989, to the Medical Department headquarters. The work of the sub- department has developed to such an extent that the Principal Almoner's duties are no longer specially concerned with the Queen Mary Hospital.

　4. In January 1949 the Royal Naval Hospital evacuated the remaining words occupied by them at the Queen Mary Hospital and as many of these wards as could be equipped and staffed were put into operation.

　5. In a number of administrative matters concerning the medical profession as a whole, the advice of the Hong Kong & China Branch of the British Medical Association and the Hong Kong Chinese Medical Association was sought and their helpful co-operation was appreciated.

6. The chart in Annexure A shows the system of decentrali- zation in the department. Maps showing the position of medical institutions in the Colony are shown in Annexure 3.

B. Boards.

　　　The Mediral Advisory Board to His Excellency the Governor. This Board consists of representatives of the three Services and the British and Chinese Medical Association with the Deputy Director of Medical Services as Secretary. It met regularly during the early and latter part of the period under review but meetings were not held during the absence on leave of the Director of Medical Services. The community owes a debt

of gratitude to the members of this Board who give so much of their valuable time to this work.

8. Medical Board. The Medical Board consisting of the senior Naval and Military doctors for the time being in the Colony, two registered medical practitioners and three other persons appointed by the Governor, is responsible for the control of admissions to the Medical Register and for dealing with matters of professional ethics among medical practitioners in the Colony.

9. Dental Board, The Dental Board consisting of the Government dental surgeon, two medical practitioners and two dental surgeons appointed by the Governor, carries out the same responsibilities for dental practitioners as does the Medical Board for the doctors.

10. Nurses Board. The Nurses Board consisting of the Principal Matron, one member appointed by the University and four members appointed by the Governor, is responsible for controlling admissions to the nurses register and for the qualifying examinations for nurses throughout the Colony, Candidates for these examinations come from seven approved training schools, two of which are Government hospitals and the remaining five private institutions.

II. Midwives Board. The Midwives Board consists of eight persons two of whom must be certified enrolled midwives appointed by the Governor. This Board is responsible for the Midwives register and for qualifying examinations and discipline among Midwives as is the Nurses Board for nurses.

12. The Director of Medical Services is er officio Chairman of these Boards.

C. Staff.

13. In May the Director of Medical Services went on leave and Dr. Thomas 0.8.E., M.D. (Hong Kong) acted as Director of Medical Services until December 17th, when the Director of Medical Services returned. This was the first occasion on which a local officer has taken charge of a major Government department.

14. As in most other parts of the world great difficulty has been experienced in completing the establishment of the pro- fessional and technical staff, Among the doctors barely one third are expatriate officers and the department, therefore, depends greatly on a steady production of doctors by the University. Unfortunately considerable difficulties have been experienced by the University in getting into full swing after the Japanese occupation and, while a certain number of doctors have graduated each year, the full output cannot be expected until 1952. consequence, in order to maintain the medical services, it has been necessary to appoint, on a purely temporary basis, doctors who have qualified in China and other parts of the world, but who are not eligible for registration in Hong Kong. The policy is to replace these doctors by those eligible for registration when the opportunity arises.

As a

15. Annexure C shows the establishment as it was on March 31st, 1949.

D. Legislation.

　　16. The following legislation affecting public health was enacted during the year 1948:-

Dangerous Drugs (Amendment) Ordinance, No. 5 of 1948. Births & Deaths Registration Amendment Ordinance, No.

10 of 1948.

Public Health (Food) Amendment Ordinance, No. 19 of

1948.

Penicillin Ordinance, No. 21 of 1948.

Public Health (Sanitation) Amendment Ordinance, No. 45

of 1948.

The Hong Kong Anti-Tuberculosis Association Incorpora-

tion Ordinance, No. 55 of 1948.

Medical Registration Amendment Ordinance No. 12 of 1949. Orders, Rules, Regulations and By-lawe:-

Public Health (Sanitation) Ordinance, 1935 (By-laws for

Dangerous & Offensive Trades) G.N. A.17 of 1948. Public Health (Food) Ordinance, 1935 (By-laws for Roast

(or Cooked) Meat shops.) G.N. A.37 of 1948.

Births and Deaths Registration Ordinance, 1934 (Amend-

ment of First Schedule) G.N. A.65 of 1948.

Public Health (Food) Ordinance, 1935 (Amendurent of

By-laws re Markets) G.N. A.74 of 1948.

Public Health (Sanitation) Ordinance, 1935. (Amendment

of By-laws re Laundries) G.N. A.105 of 1948.

Public Health (Food) Ordinances, 1935 (Amendment of By-laws re Sale of Milk generally and Dairies & Milk Shops) G.N. A.125 of 1948.

Dangerous Drugs Ordinance, 1935 (Addition of Certain

Drugs to the Schedule) G.N. A.125 of 1948.

Births Deaths Registration, 1934 (Additions to lists of

Birth Register Offices) G.N. A.143 of 1948.

Public Health (Food) Ordinance, 1935 (By-laws for Shops for the Sale of Salted or Dried Fish or Sharks Fins) G.N. A.149 of 1948.

Quarantine & Prevention of Disease Ordinance, 1936 (Declaration of "poliomyelitis" as a notifiable disease) G.N. A.199 of 1948.

Public Health (Food) Ordinance, 1935 (Amendment of By- laws re Restaurants, Eating Houses and Food Stalls) G.N. A.204 of 1948.

Public Health (Food) Ordinance, 1935 (Amendment of By- laws re Sale of Milk generally and Dairies and Milk Shops). G.N. A.213 of 1948.

New Territories Regulation Ordinance (N.T. Offensive Trude

Rules) G.N. A.223 of 1948.

Births & Deaths Registration Ordinance, 1934 (Regulations re Births Registration-Special Registers) .Ñ. A.248 of 1948.

Adulterated Food and Drugs Ordinance, 1935 (Amendment

of Regulations) G.N. A.202 of 1948.

Hawkers Ordinance, 1935 (Amendments of By-laws) G.N.

A.267 of 1948.

Public Health (Food) Ordinance 1935 (Amendment of By-

laws re Markets) G.N. A.280 of 1948.

Pharmacy & Poisons Ordinance, 1937 (Amendment of

Regulations) (N. A.289 of 1948.

Births & Deaths Registration Ordinance, 1934 (Amendment of Medical Certifiente of the Cause of Death) G.N. A.318 of 1948.

The following legislation was enacted during the period January 1st, 1949 to March 31st, 1949.

Public Health (Animals & Birds) Ordinance, 1935 (Order re prohibition of importation of equines into the Colony) GN. A.4 of 1949.

Public Health (Food) Ordinance 1935 (Amendment of By-

laws re Markets) G.N. A.14 of 1949.

Public Health (Sanitation) Ordinance 1935 (Amendments of By-laws re Mosquito Prevention) G.N. A.19 of 1949. Pharmacy & Paisons Ordinance 1937 (Amendment of

Regulations) G.N. A.54 of 1949.

II.-PUBLIC HEALTH.

General Remarks.

17. The health of the Colony during the 15 months under review was good, whether judged by standards of nutrition or by the statistics of morbidity and mortality.

18. Living conditions remained very much the same as in 1947. It seems likely that there was a slight increase in the population, but this was not sufficient to affect appreciably the standards of living or the degree of overcrowding.

19. Once again there was no smallpox or cholera epidemic, no case of cholera being reported at all and only a few isolated cases of smallpox which did not give rise to secondary cases.

20. A combined medico-social survey was carried out during the summer months under the chairmanship of Professor Robert- son, Professor of Economics at the University. A block of 40 flats containing about 1,800 people was chosen for investigation. At the time of writing this report results are being analysed by the Government Statistician and it is hoped the report will be available during the coming months.

III.-VITAL STATISTICS.

A. Population.

　21. As was the case in 1947 there is a considerable discrepancy between the estimated population and that obtained by extra- polation methods. The table set out below gives the population figures from 1920 until 1948 (Excluding the period of occupation by the Japanese).

TABLE 1

Year

(1) Estimated Population (2) Estimated Population

648.150

1920

547.350

825.116

1921

595,880

1922

638.300

578.200

1923

667.900

597.300

895.500

1924

714.500

1925

725.100

786.920

1926

710,100

786.920

1927

740,300

894.400

1928

766,700

970.440

1920

802.900

1.047.260

1930

838.900

1.047.400

1931

840.473

878.947

1932

000.812

900.812

1933

922.643

1934

944.492

1935

966 341

966.341

1936

988,190

1937

1,281,982

1,006,982

1938

1,478,619

1,028,619

1939

1.750.256

1.050.256

1940

1,821,893

1.071.893

1941

1942 - 1044

1945 (Sept.)

1.639.357

Not available

(Japanese Occupation)

Under 600.000

1.039.357

Not available

1946

1947

1948

1.500,000-

1.600.000

1,750.000

1.800.000

1.168.815

1,214.762

1.126.318

(1) Official estimate published by the Department of Statistics in the Government Gazette, Supplement No. 4 of March 4th, 1949.

(2) Estimated by extrapolation methods from the previous census.

or by other methods.

B. Births.

22. Table 2 shows the number of births recorded with the birth rate per mille according to the population estimates from 1934. when the present Births and Deaths Registration Ordinance was introduced, until 1948.

TABLE 2

Year

No. of Births Registered

Birth rate using estimated population (1)

Birth rate using estimated population (2)

22.11

1934

20,886

22.11

1935

25.037

25.9

1930

27.383

27.8

1937

32.303

25.19

32.1

1938

35.893

24.3

34.9

1939

46.575

26.7

44.4

1940

45,064

24.73

41.9

1941

45.000

27.44

43.29

1942

10.343

Not available

(Japanese occupation)

1943

20.732

1944

13.687

1945

3.712

1946

31,098

20.1

26.6

1947

42.473

24.3

1948

47,475

26.4

42.2

23. In addition 1022 post registered births were recorded.

24. Legislation was introduced in December, 1947 to permit re-registration of births recorded in the registers which were destroyed or lost during the Japanese occupation. A total of 438 births were registered under this Ordinance.

C. Deaths.

25. The following table shows the deaths registered and the death rate per mille based on the estimated population.

TABLE 3

Year

No. of Deaths Registered

Death rate using estimated population (1)

Death rate using estimated population (2)

1926

12,516

17.62

15.0

1927

14.761

19.93

16.5

1928

14.735

19.21

15.06

1929

17.565

21.89

18.77

1030

10.268

19.4

15.14

1931

18.797

22.36

24.08

1032

19.829

24.74

1933

18,161

22.11

1934

19.766

20.93

1935

22,133

22.90

1936

26.356

26.60

1937

34.635

34.4

1938

38.818

1939

48.283

26.25 27.6

37.7

1940

$1,010

1941

$1.324

1942

83.435

33.48

37.4

Not available

(Japanese occupation)

Not available

(Japanese occupation)

56.9

1943

40.117

1944

24.936

1945

23.089

1946

16.653

1947

13,231

1940

13.434

10.7

7.6

7.5

14.2

10.9

11.9

26. The remarkable fall in the death rate in the post war years is in keeping with similar changes in many other parts of the world. Local explanations for this fall are probably the definite improvements in the nutritional standards in the "under privileged members of the community and the extensive inoculation and vaccination campaigns which have played some part in keeping the Colony free from cholera and smallpox during 1947-48.

27. In December 1947 legislation was introduced to permit re-registration of deaths recorded in the lost registers as was done in the case of births and 11 deaths were registered under this Ordinance.

28. The Post registered deaths for 1948 amounted to 80.

29. The graph in Annexure D shows a comparison between the deaths at different ages with the age distribution found in the censuses of 1921 and 1931.

D. Infant Mortality,

30. The table below shows the number of infant deaths per thousand live births for the years 1928 to 1948.

Year

TABLE 4

Infant Mortality Rate

1928

458

1920

662.9

1930

557.5

1931

617.42

1932

525.28

1933

454.89

1934

347.34

1935

316.36

1936

372.42

1937

376

1938

343

1939

345

1940

327

1941

1942 to 1945

Not available

Not available (Japanese occupation)

1946

1947

1948

89.1

102.3

91.1

31. As in the case of the general death rate, the infant mortality rate has been considerably lower in post war years than in any previous year for which records are available.

32. The figures now published for 1946 and 1947 differ from those published in previous reports. It was found that an error had been introduced in the method of computing these figures in post war years and this has now been adjusted.

33. Table 5 shows the infant and neo-natal deaths also the neo-natal deaths per thousand live births.

Age Period

TABLE 5

1946

1947

1948

0-1 day

1-7 days

1-4 weeks

L'IL

4 weeks - 3 months

3-6 months

8 9 months

9-12 months

Total under 1 year

174

273

221

264

376

467

563

$14

745

771

981

900

462

750

665

LI-II.

367

731

775

169

421

551

2.770

4.346

4.324

89.1

102.3

91.1

1.463

1,433

34.4

30.2

Infant Mortality rale

No. of deaths under 4 weeks

Neo-natal Mortality rate

---

1,001 32.2

　　34. The numbers for still births for the years 1947 and 1948 were 1848 and 1251 giving a still birth rate per thousand total births of 30.8 and 25.7.

E. Maternal Mortality.

35. Table 6 shows the causes of death ascribed to pregnancy and child birth excluding abortions for the years 1946 to 1948,

TABLE 6

Inter-

national

Causes of Death

1946 1947

1947 1948

No.

142

Eclopic gestation

143

Haemorrhage of pregnancy

144

Toxaemias of pregnancy:-

(a, b) Eclampsia, Albuminuria

(d) Others in 144

145

Other diseases and accidents of

pregnancy

146

147

148

149 150

Haemorrhage of childbirth and

puerperium

Infection during childbirth and

puerperium

Puerperal toxaemias:-

(a. b) Eclampsia, Albuminuria (e) Acute Yellow atrophy

(d) Others in 148

Other accidents of childbirth

Other conditions of childbirth and

puerperium:--

(a) Mastitis

(b) Puerperal psychosis

חיון

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142-150

TOTAL

36. Table 7 shows the maternal mortality for 1946-1948

with rates per thousand live and stillbirths.

TABLE 7

Pregnancy & Child- bearing (Nos. 142-150 of International List)

Abortion (Nos. 140-141 of International List)

Maternal

Mortality Rate

Total Live

Year

Live

Births

Still

Births

& Still

Births

Rate per

Nos. of

Deaths

1.000

Births

Nos, of

Deaths

Rate per

1,000

Births

Nos, of

Deaths

Rate per

1.000

Births

1946

31.098

685

31.783

1.01

0.22

1.23

1947

42.473

1.348

43.821

1.55

0.07

1.62

1948

47.475

1.251

48.726

1.33

0.14

1.47

F Principal Causes of Death.

37. Table 8 shows the principal causes of death during the years 1946, 1947 and 1948.

―

TABLE 8

Number of Deaths

Causes of death (classifed by 1938 Revision of International List)

1946

1947

1948

Smallpox

1.306

129

Cerebrospinal fever

Beri-Beri

137

1,318

312

140

ILIII

Diphtheria

Malaria

765

253

193

Influenza

....

Tuberculosis of respiratory

system

Other forms of tuberculosis Syphilitic diseases

Cancer, malignant disease

1.475

1.420

1.443

343

L... P

443

518

243

277

304

397

Intracranial lesions of vascular

origin

189

204

275

Other diseases of nervous system

and sense organs

132

180

Diseases of the heart

379

514

572

Other diseases of circulatory

system

Bronchitis

839

529

419

JJLI ILI-ILI

Pneumonia (all forms)

4.129

3.464

3.157

Other diseases of respiratory

system

197

139

125

Enteritis and diarrhoea

1.235

1.179

1.757

Other diseases of digestive system

337

361

318

Non-venereal diseases of genito-

urinary system

226

341

350

Premature births, congenital mal-

formations and diseases of

early infancy

982

1.289

1.214

Other defined diseases

786

445

517

Old age, senility

142

ייו....

101

113

Violence (accidents, suicide,

homicide, etc.)

631

686

781

Ill-defined causes

489

5.22

903

TOTAL

16.653

13.231

13.434

38. Annexure E shows the number of cases of notifiable diseases with the deaths at all ages for the years 1940, 1947 and 1948, also the age groups of diseases notified for 1948 and the notifications, deaths and deaths per 100 notifications for cerebro spinal meningitis, cholera, diphtheria, enteric fever and smallpox since 1928.

(a) Tuberculosis (all forms).

39. This disease gives rise to the second largest number of deaths for any single disease for all ages but is the chief cause of death among adults. A report on the Inberculosis service is

given in Annexure F.

(6) Enteric Fever.

40. There was an increase in the number of cases of enteric fever in 1948 as compared with 1946 and 1947, but the death rate per 100 notifications has steadily fallen. The cases were sporadic and widespread throughout the Colony and at no time was it possible to identify any single source of infection.

41. The number of cases of smallpox recorded for 1948 was the lowest since records were kept.

(d) Measles.

42. Table 9 shows the notifications and deaths according to age groups for measles during the years 1946, 1947 and 1948.

TABLE 9

1946

1947

1948

AGE GROUP

Notifica-

tions Deaths lions ¡Deaths

Notifica-

tions | Deaths

0 to 5 years to 15 years

135

148

15 to 25 years

25 to 35 years

35 to 45 years

45 to 55 years

55 to 65 years

|--6582

65 to 75 years 75 & over

Unknown

TOTAL

Deaths per 100

notifications

317

140

190

(e) Pneumonia (all forms).

43. As in previous post war years pneumonia claims the greatest number of deaths taking all ages into account. There has, however, been a steady fall in the deaths recorded with the result that the deaths in 1948 from this cause were only a little over three quarters of those in 1946.

44. The majority of these deaths were among infants and were due to lack of adequate medical attention. Investigations into the cause of infant mortality made by a committee under the chairmanship of Dr. Lee Hah Liong showed that in only two and a half per cent of infant deaths recorded had the child been seen by a doctor for longer than twenty four hours before death (See annexure G).

(/) Cancer.

　　45. Table 10 shows the deaths and death rate for cancer as a whole for the years 1946, 1947 and 1948 and table 11 shows the number of deaths and the death rate per total cancer deaths according to site and sex for the same period.

TABLE 10

Year

Estimated Population

Number of Deaths

Death rate per million | Death rate per million

using estimated

population (1)

using estimated population (2)

(1)

(2)

1946

1.500.000

1.169.815

114

163

277

73.5 105.2❘ 178.7

97.5 139.5 = 237

-1.600.000

1947

1,750,000

1.214.762

126

178

304

101.7 173.7

1948

1.800.000

1,126,316

169

228

397

93.9❘ 126.7

126.7 220.6

150

103.7 146.5 250.2

202.4 352.4

Inter-

national

No.

Sites

TABLE 11

No. of Deaths

Registered

Per 1,000 Total

Cancer Deaths

1946

1947

1948

1946

1947

1948

M. F.

Buccal cavity and Pharynx

Digestive organs and peritoneum 73

Respiratory system

Uterus

Other female genital organs

Breast

824 |||

23 1

175:

182:

79 i

101

640.

331

6271

286

213; 126

597: 315

441

37|

40;

531

331

354

372

129

118

100

Male genital organs

Urinary organs

Skin (Scrotum excepted)

ל =

DONN

261

18:

24.

12:

Brain and other parts of the

ᅥ

nervous system

1 !

Other and unspecified organs

200

-N

$1 12

881 49

241 11

47:

...

83! 30

ALL SITES

114

103

126 178 169

228

1,000 1,000 1,000 1,000 1.000 1.000

(g) Enteritis and Diarrhoea.

46. There has been a considerable increase in the number of cases recorded in 1948 as compared with 1946 and 1947. AA in the case of pneumonia, the majority of these deaths occurred in infants. The relatively high figure of 1214 deaths included in Table 8 under the beading premature births, congenital malformation and diseases of early infancy is due to the high number of deaths recorded in the first of these categories in some of the foundling homes. (See Annexure 0).

IV.-HYGIENE & SANITATION.

(a) Organisation,

(i) General Measures.

47. The urban health work is carried out under the following Ordinances:-

1. Public Health (Sanitation) Ordinance.

Public Health (Food) Ordinance.

3. Adulterated Food & Drugs Ordinance.

Quarantine & Prevention of Disease Ordinance. Public Health (Animals & Birds) Ordinance. Hawkers Ordinance.

48. To deal with this work Hong Kong, Kowloon and New Kowloon are divided into 5 Health Districts, three in Hong Kong and two in Kowloon, each with a Health Officer and a Senior Health Inspector. Each district is then sub-divided into sections under the care of a Health Inspector. There are 43 sections in all-25 in Hong Kong and 18 in Kowloon and New Kowloon.

49. In addition to district duties, other health inspectore are employed on conservancy, refuse collection and disposal, control of hawkers, markets and slaughter houses, meat and food inspection and sampling and cemeteries.

50. Rodent Control is under a specially appointed officer.

(b) Sanitation.

51. The sanitation of the urban area is under the control of the Urban Council with a Chief Health Inspector in charge.

52. There are two systems of night soil removal in opera- tion by water carriage sewerage and by bucket conservancy. Bucket conservancy is forced on the Colony by old types of houses, water scarcity and flush restricted areas. 10% of the 155 tons of human waste collected daily were transported to maturing tanks at Castle Peak. Experiments are being carried out to find out how far maturation helps in rendering this material safe for use as a fertiliser.

　　53. The shortage of houses continued with the resulting gross over-crowding. Newcomers of the poorer classes flocking to the Colony have found accommodation in huts and hovels on every available hillside and on the remaining sites of bombed and ruined buildings and have even established huge colonies on the roofs of tenement houses in the centre of the city. Surveys of this squatter population show that in June of 1948 the approximate number was 30,000. It is estimated that this number was doubled by the end of the year.

　　54. These squatter communities are herded closely together with a complete absence of any form of sanitation or water supply and thus form a continuous threat to public health.

The type

of hut or hovel, generally made of wood with bamboo matting or oiled paper, creates au ever present fire risk and in fact caused five fires during the year which resulted in the destruction of several hundreds of squatters homes and in one case the fire spread to adjacent domestic buildings.

　　55. In August a committee was formed and special legisla- tion was introduced to deal with this problem, since then progress has been made in effecting a clearance in the central area.

(d) Water supply.

　　56. The main water supply in the urban area is piped and of excellent quality. Many wells exist on the mainland and these are a source of auxiety, particularly during periods of epidemic intestinal disease. The supply of potable water was good during the dry season and few restrictions were imposed. During 1948 consumption was 11,098 million gallons, just under 20 gallons per head per day, 2,437 samples from the public supply were examined bacteriologically and 689 chemical (or physical) examinations were

made.

57. The title refers to Public Health in the New Territories including the remote islands, A Medical Officer of Health is resident there, with 6 Health Inspectors.

　　58. New legislation, revising the health rules, is slowly being introduced. The new drafts contain much on subjects not previously dealt with; such as slaughter houses, control of markets. and conservancy.

59. A set of rules on Offensive Trades became law in September.

60. The work of the Health Staff has been directed chiefy to improvement of hygiene in licensed premises such as restaurants, eating houses, food preparing establishments and food factories and to the control of markets and hawkers and to schemes for village planning and better housing. Marked improvements have taken place in Shek Wu Hui and Shatin. The condition of markets is improving rapidly.

וסי

61. There are nine Government Dispensaries giving free medical treatment to the villagers at Tai Po, Fanling, Sha Tau Kok. In Long, San Hui, Sai Kung, Cheung Chau, Sham Tseng and Tai O. These Dispensaries have also a few beds for maternity cases. Midwives attend maternity cases in the villages as well, The medical needs of smaller villages which can be reached by road are provided by two travelling dispensaries. A launch carrying medical supplies makes frequent trips to the more remote islands. In January 1949 the Sham Tseng Dispensary reverted to private control.

62. In May a successful Health Week was held. Steady education of the people is being maintained in health matters. The cinema van visited three times and helped particularly in the vaccination campaign. This van proved very popular.

63. There is every reason to believe that the preventive aspect of health work is developing and that the people welcome the teaching. The purely enrative aspect of Dispensaries is necessary and serves as a means of establishing friendly contact with the people and of getting in touch with the progressive elements in the population who appreciate the results. The combination works well and preventive measures are well received and supported by village elders.

(ii) Anti-epidemic.

64. This branch of the work is controlled from a central office and is carried out by all Health Officers, Dispensaries, Hospitals, School Medical Officers and the Port Health Office. In addition there is a mobile unit attached to the central office. The main work is devoted to the control of smallpox and cholera epidemics and attention was concentrated in the first place on the squatters, who were considered the most likely forus of disease,

Table 12 shows the number of vaccinations and inoculations done each month.

TABLE 12

Month

1948

Anti-

‣ Smallpox

Anti-

Cholera Diphtheria

Typhoid

Plague

Vaccina-

inocula-

tions

No. of persons treated with anti-rabies inoculations

Anti-

Typhus

Tetanus

inocula-

Inocula-

tions

January

95.276

5.692

4.204

737

285

644

199

February

89.363

3.542

3.596

463

135

108

710

219

March

134.423

9.652

6.408

1.139

208

1.437

305

April

46.773

$4.318

738

914

179

194

1.612

686

May

18.097

86,138

942

376

219

1.485

708

June

15.623

88,549

499

1.178

205

212

1.542

567

July

14,424

49.910

968

182

223

770

663

August

14.074

35.599

667

112

203

643

598

September

14.776

26.052

1.530

1,219

160

429

575

October

149.930

7.162

2.670

940

187

785

218

November

169.437

6,043

1.586

876

171

559

490

December

127.146

6.667

2.442

891

240

560

634

Total

889.342

379.324

23.703

10.834

1.701

2.074

11.196

5.861

24 |

05. Rodent control is under the administration of a Rodent Control officer and forms an integral part of the anti-epidemic work. The systematic destruction and control of rats was carried out on the general principles laid down in the "Control of Infestation of H.M.8.0. of 1946, and adapted to the circum- stances and conditions in the Colony. Block control was aimed at by using prebaiting followed by poison and post baiting to detect the presence of survivors, Minor infestations are dealt with by trapping. Rats caught by trapping are chloroformed and examined for fleas which are counted and classified for in- formation on the prevailing flea index. All rats collected are examined microscopically, and a microscopic examination is made for signs of plague.

GG. R. Norvegicus is the more common type of rat found in the tenement houses. R. Rattus is more common in ships but is also found in tenement houses. The final disposal of all rats is by burial,

67. In addition to these more specific measures, the Health Inspectorate conduct routine activities such as the prevention of sale of cut fruit, shell fish and ice cream products made by unlicensed factories. All food factories, restaurants, eating houses are inspected regularly and there is frequent sampling of milk and ice cream.

(iii) Health Propaganda.

68. This important branch of the Health Services is being developed steadily. In order to stimulate interest among the population and to obtain their co-operation a Health Week was again held in May. It was on similar lines to that of 1947. Six subjects were chosen as follows: Maternity and Infant Welfare, Flies, Mosquitoes and Malaria, Spitting and Tuberculosis, War against rats, and a review of the services provided for prevention of disease and the part every citizen can play, Posters were prepared and posted in prominent places, a school competition was organised and the public address systems and the cinema van was in constant action. Wireless talks were given to link up with the subjects treated on that particular day by the posters, newspaper articles and talks. The publicity was given in both Chinese and English. This week was a success but it was felt that in future years the tendency should be rather to concentrate on steady work all the year round and to retain the Health Week as an infrequent spurt. With this in mind, five films have been made by local talent and these have been shown steadily by the cinema fan. Other films are in course of pre- paration. Use has been made of the van in stimulating vaccina- lion by showing pictures and thus giving the publicity and providing the vaccination service on the spot.

69. The cinema van consists of an adaption of an army vehicle fitted with a generator and projector and so arranged as to throw the pictures on the reverse side of a screen fitted at the

back of the vehicle, and so shaded as to allow an audience to see the pictures during daylight. In addition an amplifier is fitted with a microphone for direct speech, or a wire recorder can be fitted so that any special propaganda may be repeated again and again from the same recording. This provides much needed relief for the broadcaster.

　　70. In a more routine manner vaccination and inoculation are stimulated by the notices in the local press showing where these immunisations may be done free. Vaccination and inocula- tion have now become a condition of licence in eating houses and factories.

71. Spitting in the streets was less noticeable except for a period when the many newcomers from China were unaware of Hong Kong laws. A short notice warning the public of the dangers is shown at every performance in the cinemas. This has had an excellent effect.

72. On one day in every week a special patrol is on the look-out for spitting offenders. These are arrested at once and

fines up to $25 have been imposed.

(iv) Port Health Work.

　　73. The activities of the Port Health Office rover work at the sea-port, the railway terminus and the air-port.

　　74. The staff of the Port Health Office consists of a Port Health Officer, a Second Port Health Officer, seven Assistant Port Health Officers, three registered midwives and eight public vaccinators. Additional stuff of twenty-two temporary public vaccinators was needed during periods of high pressure of work.

75. The Port Health Office was transferred from King' Building to the Marine Department building in May. This juxtaposition with the Marine Department has resulted in much closer and more efficient co-operation.

76. On the 1st July, the second quarantine anchorage at Kowloon Bay was opened for ships entering the harbour from the eastern entrance. The original anchorage at Stonecutters for ships coming in at the western entrance was continued as well.

77. Further progress was made in the scheme to establish a quarantine station at Junk Bay in the old Rennie's mills site, tentative plans have been drawn up and have been considered by the Port Executive Committee.

78. During the year 4,326 vessels with 195,038 passengers and 212,354 crew were examined at the quarantine anchorages. Three ships had infectious disease on board, the motor vessel Ruys and the S.S. General Meigs each with three cases of smallpox and the motor vessel Pures with one case of smallpox.

79. Owing to an outbreak of smallpox in Cantou inspection of passengers arriving by train was carried out from 5th January, 1948 to 10th March, 1948. 168,752 passengers were examined and 85,565 were vaccinated at the station, nine cases of leprosy were discovered in the course of inspection.

80. 56,926 emigrants and 16,512 crew from 133 emigrant ships were examined. There were 42 rejects.

81. 2,468 Bills of Health were issued, 2,486 to Merchant ships, 30 to 11.M. ships and 2 to U.S. warships. The anticipated reduction in the demand for bills of health did not take place, there being 221 more issued this year than last year.

82. 63 ships from plague infected ports were examined, cargoes being inspected and the degree of rat infestation being investigated and dealt with where necessary,

83. Three vaccination and inoculation centres at the Fire Brigade Building, Harbour Office, and the Tsim Sha Tsui Health Centre were maintained during the year.

84. 3,004 river vessels were inspected and 1,248 ferry launches. 337 water boats were examined and 356 samples of water taken. All wharves along the Hong Kong water front are inspected daily.

85. 2,577 aircraft from infected ports were inspected, with 37,562 passengers and 9,927 crew. Of these 2,149 aircraft were from plague infected ports and carried 37,531 passengers und 9,898 crew. The hand baggage of all passengers was treated with A.L.63. 35 radio pratiques were issued by the Port Health Officer. 124 ships were fumigated with a total tonnage of 204,051 and 1,720 rats were recovered. Sulphur fumigation was used in the early part of the year but after 10th July, 1948 cyanide fumigation was also used.

NO.

On 1st September, 1948 the International type of certi- ficate for vaccination and inoculation was adopted, previously a modification of this had been used.

87. After 1st June, 1948 arrangements were made for the Port Health Officer to authenticate signatures of private practi- tioners in Hong Kong. A total of 2,830 certificates were authenticated. On 17th February, 1948 Dr. P. M. Kaul, Director of the Singapore Office of the World Health Organisation and Dr. L. Nicholls, former acting Director of the same office visited Hong Kong and were shown the work of the Port Health Office.

(v) School Hygiene.

88. The staff of the School Hygiene Branch consists of one medical officer in charge; four assistant medical officers, one nursing sister, four nurses, two health inspertors and clerical staff. In addition to this full time staff there is a part time staff consisting of two Ophthalmic surgeons and an Ear Nose and Throat surgeon.

　　89. The main duties of this staff are to advise the Education Department in matters relating to the health of school children and the health requirements in schools and to undertake the medical inspection of individual pupils who come under the Schools Medical Service Scheme.

　　90. Of a total in December, 1948 of 797 schools in the Colony with 117,485 pupils the following categories of schools came under the Schools Medical Service.

(a) 5 Government schools with a total of 787 pupils,

mostly Europeans.

(b) 21 Grant in Aid schools numbering 6,096 pupils and

mostly Chinese.

(e) 52 Subsidized schools numbering 9,224 pupils mostly

Chinese.

(d) 2 Private vernacular schools with 218 pupils.

making a total of 80 schools and 16,325 pupils.

　　91. The number of medical inspections undertaken in these schools with the results are shown in Annexure H.

　　92. Owing to the shortage of accommodation a two session system is adopted in many school premises.

　　93. With a few exceptions, Government and Grant in Aid Schools are conducted in buildings specially planned for school purposes and the premises are generally satisfurtory. The vast majority of subsidized and private schools, however, are condurteil in tenement flats or in buildings that were never intended to be used as schools. While regulations to safe-guard hygiene have been laid down in the Education Ordinance and which must be complied with before registration is granted, this type of school suffers from lack of proper facilities for physical exercise and is generally situated in a thickly congested urban area,

94. All proposed school buildings and all existing school premises in the urban area were inspected regularly. During the year 2,092 school inspections were carried out as follows: -

New applications for day schools

night schools

Applications for extension

Proposed Government school Routine inspection

Unregistered schools

י -

129

1,826 2

95. Of the premises inspected five were refused permits as being unsuitable. Defects found in existing schools are shown in Annexure II.

　　96. Prophylactic immunisations against diphtheria and vac- cination against smallpox was carried on throughout the year in all schools in the Colony. 9925 pupils received the first and second doses of alumn-precipitated toxoid and a further 3012 received the first dose only. 90,932 staff and pupils were inoculated against cholera and 39,842 were vaccinated against smallpox.

97. The pupils and staff received their inoculation either in the schools themselves or in the health centres in the vicinity.

98. In the schools coming under the School Medical Service the following categories of pupils were examined:-

() all new entrants.

(6) Routine examination of all pupils falling under the

age groups 5, 10, 12, 15 and 18 years.

te) All children placed under observation as a result of routine examinations, and those referred to doctors for special examination.

(d) All children for an annual check up of vision and

teeth.

99. Pupils found to be suffering from defects requiring treatment are instructed to attend one of the school clinics and a report on the child's condition is forwarded to the principal of the school concerned with the request that it should be forwarded to the guardian of the pupil.

100. General school clinics are held in three centres:-the Harcourt Health Centre, the Ellis Kadoorie school building, and the Kowloon Hospital out-patient department. Special eye clinics, dental clinics and ear, nose and throat clinics were held in the Harcourt Health Centre and Kowloon Hospital out-patient department.

101. Pupils requiring surgical attention could go to the Kowloon and Queen Mary Hospitals and all cases of suspected pulmonary tuberculosis were referred to the Tuberculosis Clinic at the Harcourt Health Centre.

102. Attendances at these Clinics were as follows:

TABLE 13

New Revisits

General School Clinic

Eye Clinics

Dental

Clinics

E.N.T. Clinics

5.530

886

4.411

249

6,256

595

1.315

11.785

1.481

5.726

311

Total

103.

　The optical workshop supplied 804 pairs of spectacles. to pupils during the year.

104. 120 visits were made by school nurses to the homes of school children who were in serious need of medical attention, but whose attendance at the clinics had been unsatisfactory.

(vi) Nutrition.

105. Until the end of February, 1948 the rationed quantity of rice remained at 5.6 taels a day or 34 catties for a period of

10 days at a cost of 48 cents a catty.

　　　　　　　　　　　　　　　　　　　　The four ration was 1.6 taela a day or one catty for 10 days at the cost of 44 cents a catty. On March 1st the price of rice was increased to 54 cents a catty and flour at 56 cents, but the rationed quantities remained the same. Flour ration remained in this position until September 15th when it was de-rationed. On August 1st the rice ration was increased to 7.2 taels a day or 44 catties for 10 days, the price remaining at 54 cents a catty. This was the position at the end of the year.

106. As in 1947 the general standard of nutrition was good with little evidence of gross under-nourishment or malnutrition. The two factors which appear to have contributed most to this improved nutrition standard is the considerable post war increase in wages in the labour and artisan classes and the limited ration of rice available which has resulted in a greater variety in the diet,

107. Deaths from nutritional diseases recorded during the year were 1 death from Barlows disease (infantile senrvy) and 140 from Beri-Beri. This latter figure compares with 812 in 1947 and 7229 in 1940, the last year before hostilities when these figures were available.

108. Hopes for the appointment of a nutrition officer were doomed to disappointment and at the end of the period under review there was still no officer in the department whose duties were primarily concerned with nutrition.

(vii) Social Hygiene.

109. The Health Officer Social Hygiene has a staff of 5 doctors to assist him, 1 technical assistant, 8 dressers and 17 nurses. There are five Government clinics:-Queen's Road West, (male and female), Wanchai (female), and the Harcourt Health Centre (male) on the Island, and in Kowloon one at Ashley Road (male) and one at Tsim Sha Tsui Health Centre (female). In addition to these centres, there is a small hospital at the Wanchai Social Hygiene centre which has 16 beds for women and four cots. There are also six male beds and two female beds in the Queen Mary Hospital. Attendances at these clinics are shown in Table

14.

TABLE 14

Male

Female

Total

Clinic

New

Old

New

Old

New

Old

Queen's Rd. W.

1,979

25.950

1,187

23.317

3.188

49.267

Wanchai

2,824 |

26.411

Tsim Sha Tsui

3,139

25.388

2.211 | 23.911

2,877❘ 30,791

5,035 | 50.322

| 6.016 |

56.179

Total

7,942

77,749

6,275 | 78,019

14,217 155,769

TABLE 15

110.

　The number of new cases and the total attendances at the out-patient clinics is shown monthly below:

Monthly.

New Cases.

Total Attendances.

January

976

10,793

ויזוי

February

812

7,716

March

1,256

11,832

April

1,475

13,534

May

1,860

14,023

June

1,520

16,132

July

1,278

15,587

August

1,247

14,609

September

1,102

13,651

October

1,167

13,740

November

972

12,070

December

1,052

12,081

14,217

155,768

111. A total of 149 cases of congenital Syphilis were treated during the year.

112. Home visiting is carried out by the nurses at the various clinics where attendance for treatment is irregular and attempts are made to persuade the patients to attend more regularly.

113. Proclamation No. 28 of the 21st March, 1946 giving powers for compulsory treatment of certain classes of cases lapsed at the end of 1947, but notifications of sources of infection are still being made and health visitors who subsequently get in touch with such girls have proved successful in persuading them to attend for treatment without the aid of legal powers of compulsion.

114. Tables 16 to 18 show the average number of attendances at the different clinics for cases of syphilis for the years 1946, 1947 and 1948. The low average of attendances at the Ashley Road Clinic is due to the high proportion of transients, such as seamen,

who attend there.

TABLE 16

1946

Clinic

Cases of Syphilis

Attendances

Average Number

Male

Ashley Road

728

5.671

7.79

Queen's Road West Wanchai

897

7,002

7.8

821

8.584

10.45

Female Tsim Sha Tsui

1.205

10.899

9.04

Queen's Road West

731

5.874

Wanchai

791

8.203

10.37

Tota!

5.173

46.233

1 8.94

TABLE 17

1947

Clinic

Cases of Syphilis

Attendances

Average Number

Male

Ashley Road

1.129

8.164

7.23

Queen's Road West Wanchai

686

7.472

10.9

803

9.943

12.38

Female Tsim Sha Tsui

883

9,180

10.37

Queen's Road West

435

5,572

12.8

Hanchai

777

7,941

10.22

Total

4.713

48.252

10.24

TABLE 18

1948

Clinic

Cases of Syphilis

Average

Attendances

Number

Male

Ashley Road

1.025

7.314

7.135

Queen's Road West Wanchai

754

9.843

13.06

993

9.926

10.00

Female Tsim Sha Tsui

832

8.996

10.81

Queen's Road West

475

8.391

17.66

Wanchai

812

8.724

10.74

Total

4.891

53.194

10.87

V.-MATERNITY AND CHILD WELFARE.

(a) Centres.

115. There are three Maternity and Child Welfare Centres, one at Tsim Taa Taui in Kowloon and one each at the Harcourt and Western Centres on the Island. Besides ante-natal and neo-natal clinics there are clinics for the care of babies up to 2 years of age. Test feeding and supplementary feeding where necessary is carried out and an extra meal of cougee, meat and vegetables is given to mothers who need it. Home visits are paid by the Health Nurses. Considerable attention has been con- centrated on the instruction of mothers and classes of instruction and the showing of films, lantern slides and other methods of demonstration were employed on the principle of instructing cer tain selected more intelligent mothers with the idea that they would in turn talk to and instruct their friends. Table 19 shows the attendances at the Infant Welfare Centres:

TABLE 19

New

Revisits

Total

Harcourt Centre Kowloon Centre Western Centre

2.534

31.913

34.447

2.897

33.654

36.551

2.407

41.196

43.603

Total

7.838

108.783

114,601

5,781 mothers and children were given diet supplements of congee or milk at the feeding centres.

116. 3,476 domiciliary visits were paid by the nurses. a total of 114,601 babies attending the centres, 38,733 were classified as healthy. This tendency for large numbers of infants to be brought because of actual illness is being discouraged and in January 1949, sick children clinics were opened in the public dispensaries and out-patient clinics and sick children attending the Infant Welfare clinics have since then been referred to these special sick children clinics. This has resulted in considerable increase in the time available for the educational and preventative aspects of the work at the Infant Welfare Clinics. The number of unte-natal attendances at the 3 centres is shown in table 20 below:-

Harcourt Centre Kowloon Centre

Western Centre

Grand Total

TABLE 20

New

Revisits

Total

330

529

859

387

702

1.089

177

435

612

094

1.666

2,560

(b) Maternity Hospitals and Homes.

117. There are two maternity hospitals, Tsan Yuk Hospital with 62 beds and the Eastern Maternity Hospital with 28 beds. In addition maternity cases are admitted to the Queen Mary Hospital, Kowloon Hospital and Cheung Chau Hospital, making a total of 180 beds available for maternity cases.

118. Besides these hospitals there are 15 centres in the urbau and rural areas where maternity service is provided free. In 9 of these there are from three to six beds for in-patients and i all centres there is a domiciliary service.

119. A total of 3386 cases were treated by these centres.

120. There were 99 maternity homes registered during the year. Table 21 shows details and size and situation. These homes were regularly inspected by the Supervisor of Midwives.

TABLE 21

Number of beds in each Home i 2

5 6 7 | Total

Number of Homes in Hong Kong | 10 |

19 |

Kowloon

| 16 |

Grand Total

| 26

36 27 38

2 2

Number of beds

52 108 | 108 | 30 12 | 14 | 324

　　121. There were 740 midwives registered, but of these ouly 173 were in active practice. 78 new registrations were made during the year and this figure included 59 new graduates and 19 re-registrations.

122. Table 22 shows the births attended by Doctors and Midwives for the years 1946, 1947 and 1948.

TABLE 22

1940

1947

1948

Queen Mary Hospital

117

398

719

Kowloon Hospital

979

1.261

1.189

Tsan Yuk Hospital

2,645

3.826

4.458

Eastern Maternity Home

868

1.633

1.831

Private Hospitals

4.058

9.066

12.161

Govt. Dispensaries (Attended by

Midwives)

640

1.260

1.582

Private Maternity Homes

9.586

13.150

14.324

Total births delivered in hospitals

　and maternity homes Domiciliary cases delivered by

Midwives

18,893

30.694

36,264

5.628

9.237

10.120

Total No. of births attended

24,521

39.831

-ILI➖➖

48.384

Total No. of births

31.098

42,473

47.475

т- г -г | г

Percentage of births attended

78.9

93.8%

97.7.

VI.-HOSPITALS & DISPENSARIES.

123. Annexure I gives a summary of the cases treated in the Government and Government assisted hospitals, clinics and dis- pensaries,

124. Annexure I shows cases treated at Government and Government assisted hospitals and the total deaths in the Colony for 1947 and 1948 by diseases.

(a) Queen Mary Hospital.

125. This is the largest hospital in the Colony containing 550 beds. The Royal Navy which occupied part of the upper two floors moved to their own hospital on 14th January, thus releasing the whole hospital for civilians for the first time since the re-occupation of the Colony. The Hong Kong University reorganized its clinical units with the appointment of a Professor of Surgery in August and a Professor of Medicine in October. Apart from the University work the main mass of patients admitted at the Hospital were emergencies of all kinds, accidents, police cases and Government servants.

126. There is no general out-patient department at this hospital which is situated four miles out from the centre of the town but a large out-patient clinic held at Sai Ying Pun is directly linked with it and special clinics are held there by the staff of the Queen Mary Hospital.

127. All admissions to the hospital are screened by the Almoners Department as to their ability to pay fees and where necessary their home conditions are investigated and additional food or other assistance provided.

128. Private consultations with members of the staff for both Government servants and the general publie are arranged through the Almoners Department.

129. During the year 7,099 in-patients were treated of which 760 were maternity cases. There was a total of 446 deaths.

4,258 operations were performed.

1830. Physical examination of

　　　　　　　　　　　　　　　of Government servants for employment to the permanent establishment number 2,271 for new appointments and 154 for confirmation to the permanent establish-

ment.

(b) Kowloon Hospital.

1831. This hospital consists of 182 beds and is the emergency hospital for the mainland and, with the exception of the University cases, deals with similar cases to those at the Queen Mary Hospital. During the year a special block was built containing 15 beds for patients in police custody. The whole hospital was rehabilitated for the first time since the reoccupation and the last traces of the war years have been removed.

　　132. Owing to the rapid growth of the Colony, the hospital is now quite inadequate for the needs of the mainland and in the latter part of the period under review, plans were made for placing 80 beds at Lai Chi Kok Hospital at the disposal of the staff of the Kowloon Hospital. During 1948 5,025 in-patients were treated including 1,352 maternity cases with 208 deaths two of which were maternity cases. 1,761 operations were performed.

　　133. There is a large out-patient department attached to the hospital where a total of 68,522 cases attended.

134. This hospital has accommodation for 123 patients. The average number of in-patients was 95. Out of 482 patients treated, 201 were discharged, 140 were transferred to Canton and 23 died. By agreement with the Canton anthorities cases were transferred to the Canton Municipal Mental Hospital where those who have had more than 3 months residence in Hong Kong are supported by the Ilong Kong Government.

　　135. The building is old and in unsuitable surroundings but has been rehabilitated throughout and with the appointment of a psychiatrist in October, to take charge of it, considerable advance has been made in the treatment available for the patients.

(d) Sai Ying Pun Hospital,

　　136. This hospital continued to he used as the infectious diseases hospital on the Island with accommodation for 100 beds capable of being increased to 150. A total of 557 cases were treated during the year and of these 88 died.

137. In the same compound though not associated with the infections diseases hospital is the Sai Ying Pun Out-patient department. A total of 80,754 new cases were treated in the department with a total of 157,105 attendances,

(e) Lai Chi Kok Hospital.

This

　　138. This hospital consists of two sections, The lower section with 290 beds is used as an infections diseases hospital and for tuberculosis cases, the upper block containing 180 beds is used partly for convalescent cases from Kowloon and Queen Mary Hospitals and partly as an annex to the Kowlonu Hospital. arrangement of beds became possible in the latter part of the period under review as a result of extensive repairs to the building. During the year a total of 1,324 cases were treated in the hospital made up as follows:-

260 infertious disease cases.

339 Tuberculosis cases.

725 treneral cases.

(f) North Point Convalescent Home.

139. Consists of a number of wooden huts with accommoda- tion for about 200 beds for convalescent cases from Queen Mary Hospital and Kowloon Hospital.

140. Owing to the poor structural condition of these huts, was decided to close the hospital in May and patients were trans- ferred to Lai Chi Kok Iospital. A total of 272 enses were treated

during the period it remained open.

(a) Felir Villas. Tuberculosis Sanatorium.

141. This Sanatorium consisted of a block of 9 converted houses. It was well situated and had accommodation for 33 patients, but was not very suitable as a sanatorium. At the end of March 1948 the sanatorium was closed and the patients trans- ferred to Lai Chi Kok Ilospital. A total of 77 patients were treated during the period it was opeu.

(h) St. John Hospital-Cheung Chau.

142. Government continued to maintain this hospital which was built by, and before the war was run by, St. John Ambulance Association. It has accommodation for 76 patients including 31 beds for tuberculosis cases and 12 maternity cases. A total of 1049 patients were treated in this hospital of which 663 were general cases, 69 were cases of tuberculosis and 317 were maternity

cases.

143. Attendances at the out-patients were 5,129 new cases with a total attendance of 9,869.

144. The tuberculosis cases admitted to this hospital were convalescent cases needing a period of additional rest before completing their hospital treatment.

(i) Hong Kong Prison Hospital.

145. This hospital which is part of Stanley prison consists of three wards, each containing 16 beds and 6 isolation cells. There were 818 admissions to the hospital and the daily average prisoners in hospital was 46. 13,068 prisoners reported sick during the year.

The total number of prisoners admitted to the prison during the year was 13,446. There were 8 deaths of which 7 were due to pulmonary tuberculosis.

(j) Tsan Yuk Hospital.

146. This hospital containing 62 beds is the largest maternity hospital in the Colony. It has been constantly overcrowded during the year dealing with some 400 cases per month. Annexure K gives a summary of the cases dealt with during the year.

(k) Government Assisted Hospitals.

　　147. There are five of these hospitals which receive consider- able grants from Government. Three of them known as the Chinese Hospitals comprise the Tung Wah Hospital with 467 beds, the Kwong Wal Hospital with 340 beds and the Tung Wah Eastern Iospital with 230 beds. The other two assisted hospitals are Nethersole & Affiliated Hospital under the aegis of the London Mission Society with 131 beds and the Hong Kong Anti-tuberculosis Association's Ruttonjee Sanatorium with 115 beds which was opened on the 24th February, 1949.

The Chinese Hospitals,

148. These hospitals are under the control of a medical committee consisting of members representing the Tung Wah Board of Advisers, the Tung Wah Board of Directors with the three Medical superintendents under the Chairmanship of the Director of Medical Services.

　　149. They provide hospital treatment primarily for the sick and poor, but have a few private wards.

The Nethersole Hospital.

　　150. The Nethersole Hospital eaters in the main for patients who can pay a very small amount towards their treatment. The Ruttonjer Sanatorium

　　151. The Ruttonjce Sanatorium staffed by the St. Columbam Mission of Eire among whom are registered doctors, nurses and pharmacists, caters for tuberculosis cases only and all treatment is free. In general, early open cases are admitted and there is a close liaison between the Sanatorium doctors and the Government tuberculosis clinic at the Harcourt centre which makes selection of this type of case possible. As this hospital was not open during the calendar year 1948, it will be excluded from all statistical reports,

Violet Peel Polyclinic,

　　152. The building which houses this clinic was a health centre before the war, but was badly damaged and looted during hostilities. Reconstruction and rehabilitation was completed in October, 1948 but in the meantime the Harcourt Health Centre, situated in the sume neighbourhood, had made its reopening as a health centre superfluous. It was therefore decided to use it partly as a polyclinic and partly as an ophthalmic hospital. Polyclinic, the only large clinic of its kind in this area, was opened on the 1st November. Owing to stuff difficulties it was necessary to postpone opening of the ophthalmic hospital. Weekly attend- unces at this Clinic grew from 725 for the first week to double this number by the end of the year.

The

Chinese Public Dispensaries.

153. There are 9 public dispensaries distributed throughout the urban area of the Mainland and Island. They provide primarily au out-patient service and a maternity service, including in some cases a few maternity beds, but in all cases a domiciliary service. In addition during the peak periods of anti-epidemic work the dispensaries form centres for propaganda and for vaccina- tion and insulation campaigns.

154. In January 1949 special linies for sick children were opened each morning in these dispensaries, and the result has been a very rupid rise in children's attendances from approximately 3,000 in January to 13,000 in March. Table 23 set out below summarises the work done at these dispensaries.

Out-Patients

TABLE 23

Deliveries

Public Dispensaries

Vaccinations

Inoculations

New

Attendances

cases

In-

patients

Domiciliary

Central

24.209

43.433

8,837

1,069

Eastern

30.882

45.813

1.831

24.866

2.762

Western

15.982

24.099

8.310

687

Aberdeen

14.055

20.739

330

2,714

208

Hunghom

15.006

21.993

3.657

Shaukiwan

31.730

50.346

349

5.442

728

Yaumati

43.366

72.463

11.365

1,069

Shamshuipo

37.051

72.958

278

30.771

1.370

Stanley

6.403

12.236

840

449

Total

218.684

364.080

1.928

1.053

97.302

8.406

45:

ཧ

New Tervitories Medical Centres & Maternity Homes,

155. There are 10 fixed medical centres operating in the New Territories together with two mobile nuits. The work of these fixed and mobile dispensaries is co-ordinated by an officer combining the functions of a medical officer and medical officer of health. The following table gives a summary of the work done by these units.

TABLE 24

Out-Patients

Deliveries

Dispensaries

New Cases

Atten- dances

In- Patients

Domici- liary

Tai Po

12.179

24.740

424

Hu Tung

1.605

3.631

Shataukok

1,473

6.809

Un Long

12.746

27.039

407

Ruttonjee

1.539

2.741

San Hui

2,108

4.634

137

Sai Kung

3.352

5.744

Tai O

5.912

14.778

134

Mobile (East)

3.848

7.697

Mobile (West)

1.969

3.361

Silver Mine Bay

290

560

Ping Shan (South)

1.632

3.560

Total

48.653

105.882

1.187

482

156. In October 1948 it was decided to reorganize the Ho Tung Dispensary to enable a small number of general in-patients. to be admitted, primarily for members of the Police Force who would otherwise be sick in quarters,

157. The Ruttonjee Dispensary which was originally pre- sented to the Government by Mr. J. II. Ruttonjee, C.H.E. formally hunded back to him in January, 1949.

Ambulance Service.

158. The Medical Department provides an ambulance service for all parts of the Colony for eases other than accidents and street emergencies which are dealt with by the Fire Brigade. This service is provided free of charge for all patients. There are 17 ambulances in use, 10 in Hong Kong, 5 in Kowloon and 2 in the

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New Territories.

　　　　　　　　Between them these ambulances covered 103,252 miles and have carried a total of 26,639 patients, 16,606 in ITong Kong and 10,033 in Kowloon.

Blood Bank.

159. In May 1948 the local Tor II Group approached the Medical Department with an offer to help in organizing a blood donor service, Efforts had been made during the previous 20 years with only a very limited success to develop a service of this kind and this offer was therefore welcomed and steps were at once taken to put it into effect. It was decided that for the time being it should be limited to the two Government Hospitals dealing with emergencies, that is, the Queen Mary Hospital and Kowloom Hospital, with the collecting centre to be at the Queen Mary Hospital. Influencing this decision was the fact that as much as a dollar per cubic centimetre of blood was being offered in other hospitals in the Colony not under Government control, and it was felt that this service should be on a strictly voluntary basis.

　　160. In March 1949 a special Sister was assigned to this work and a start was made in building up a blood bank as opposed to a blood donor service. The panel of donors reached the figure of 200, 32 of whom were Chinese. 102 transfusions have been given.

X-ray Department.

161. This department was shared with the Royal Navy until January 1949 when they moved to their own hospital thus making it possible for the Physiotherapy department to move back to its pre-war quarters. The work in the Department shows a further increase over previous years and table 25 is a summary of the work done.

TABLE 25

Kowloon Hospital

Queen Mary Hospital

Chests Bones

2.655

7.386

2.814

3.050

Abdomen

437

561

Barium Meals

171

307

Intravenous

Pyelography

116

Cholecystography

Lipiodol

(includes broncho-

graphy)

Cystography

Salpingography

Myelography

Ventriculography

Teeth

...

133

293

6. 202

11.824

Miniature Chests

31.082

(R.N.H, cases large

films

2,370

Miniature Chests

5,798)

162. During the year visits to do X-ray work were paid to the Kwong Wali Hospital and the Tang Wah Eastern Hospital and for part of the time screening work was done at the Harcourt Tuberculosis Clinie. Deep X-ray therapy was not available during the year but a small quantity of radium recovered from Japan was in constant use.

163. A miniature X-ray outfit, the property of the long Kong Anti-tuberculosis Association, was used at the Queen Mary Hospital for surveys and routine chest work.

164. The Physiotherapy department is under the administra- tion of the Government Radiologist and a summary of the work done is set out below:-

TABLE 26

In- patients

Treatments

Out- patients

Treatments

Kowloon Hospital

284

2.157

Queen Mary Hospital

464

3.522

1.500

779

14.124

7.076

Royal Naval Hospital

Cases

205

2.458

JILL

VII. DENTAL CLINICS.

165. There are three Government Dental Clinics. One at Sai Ying Pun Health Centre, one at Harcourt Health Centre and one at the Kowloon Hospital. Owing to shortage of staff only one of these centres, that at Sai Ying Pun was working full time, but during the latter part of the period under review whole time. dentists became available and all three clinics were in full operation.

166. The dental facilities available were quite inadequate to deal with all the demands made on them. The work was con- centrated on certain groups. In the first group were Government

servants and their families who were entitled to conservative treat-

ment as well as extractions. In the serond group were the children included in the schools medical service who were entitled to extractions only, but with the appointment of a whole time. dentist at the Harcourt Health Centre some conservative work for these children became possible. The third group consists of a small number of members of the general public who were in urgent need of dental treatment. Table 27 shows the total number of visits paid by these different categories in all clinics.

TABLE 27

Harcourt Health Centre

Kowloon Hospital

Sai Ying Pun Hospital

Government

servants

531

406

1.985

Families

317

235

932

School children

4.153

1.570

541

General Public

289

2.820

6.058

5,290

5.031

9.516

167. Two Dental Inspectors were employed during the year to inspect premises of registered dentists and investigate cases of un-registered dental practice. A number of police prosecutions

resulted.

VIII.-PHARMACEUTICS.

168. Mr. T. P. Mahon arrived in the Colony in January 1948 as chief pharmacist replacing Mr. L. J. Morley who had retired.

169. During the year 89 institutions were supplied from two distributing dispensaries, one is Hong Kong and one in Kowloon.

170.

　　　　An excellent surgical instrument repair service has been built up by the Stores department and a large number of un- serviceable instruments have been repaired.

171. Supplies from the United Kingdom have been slow to arrive und in some cases without any apparent reason. Much surgical equipment ordered more than two years ago is still outstanding.

172.

　　　　In October 1947 a Streptomycin Committee was appointed with the Senior Medical Officer as Chairman, and 8 members representing the University and the Government.

　　173. This Committee controlled the treatment of all cases. receiving streptomycin in Government institutions, and was responsible for the selection of the cases and the standardising of records. In March 1949 cases requiring treatment with strepto- mycin in the Ruttonjee Sanatorium also came under the control of this Committee as the Streptomycin was obtained from Govern- mient 301ives. 164 cases in all have been treated by this Committee.

IX.-MEDICO SOCIAL WELFARE ACTIVITIES.

174. At the end of the financial year ending April 1948, the relief section of the Medical Department was handed over to the Social Welfare Officer and the welfare activities of the Medical Department were confined to medico social work under the direc tion of the Principal Almoner with a staff of 3 Almoners and 7 Probationer Assistant Almoners and 3 students in training.

175. The members of the Almoners Department are placed at the following institutions: -

Medical Headquarters-Government

Supervisor

Queen Mary Hospital Kowloon Hospital

---

Harcourt Tuberculosis Clinic

Sai Ying Pun Centre

Violet Peel Polyclinic

I (Principal Almoner)

Lai Chi Kok (Post vacant, Visiting Almoners only)

176. Advice and material assistance was given to patients in need in the following ways:-

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རྕོ,

Repatriation to the country,

Supply of artificial limbs and other surgical appli-

ances.

Recommendation for hawker licences.

Maintenance of children in homes, crèches etc. Temporary financial assistance and the supply of clothes and food.

Communication with relatives of patients in other territories.

Advice on employment etc.

177. Close co-operation with other social welfare work in other Government departments was maintained and reports on all industrial accidents admitted to the hospitals or treated in the out-patients were made to the Labour Office. Road accidents were similarly reported to the Police Department.

178. Close co-operation was also maintained with the non- Government welfare organisations such as the Families Welfare Society and Salvation Army. Reference to the special work associated with the Tuberculosis Clinic will be found in Annexure F.

179. An attempt has been made to institute an after-care system for patients discharged from the Mental Hospital and efforts have also been made to place mentally defective women in suitable institutions.

180. At the end of the period under review, Miss M. S. Watson, M.B.E., Principal Almoner, who built up the Almoners sub-department from its beginuing, resigned on marriage.

―

X.-TRAINING OF PERSONNEL.

181. It is the aim of the Medical Department to train its own technical officers as far as possible up to the standards set in the United Kingdom. In some cases reciprocity has been achieved and in others it is hoped that reciprocity will not be long delayed.

　　182. Table 28 sets out the various technical groups who have received training from the department with their relative strengths: -

TABLE 28

Probationer Masseuses

Assistants

Radiographic

Probationer Dispensers

Laboratory

Assistants

Appoint- ments

Resigna- Lions

Strength

at 31.3.49

Probationer Health Inspectors

Assistant Almoners

יו

(Students in training)

Probationer Nurses

Midwives

Dressers

לל

　　183. The training of dressers and nurses was continued but only one nurse and one dresser passed the final qualifying examination. This small number was due to the fact that those who were probationers in training before the war have now com- pleted their course and the post-war group have not yet reached the stage of sitting for their final examination.

　　184. 22 Midwives, 16 of whom were registered nurses passed the final examination.

　　185. A number of health inspectors sat for examinations held by the Board of Examiners of the Royal Sanitary Institute (Hong Kong Centre) and of them 14 qualified for the Sanitary Inspectors Certificate and 19 for the Certificate in Tropical Hygiene.

186. One dispenser and one pharmacist qualified during the period under review.

187. Arrangements were made during the year with the Society of Radiographers by which they recognised training given to Radiographic Assistants in the medical department and agreed that examinations for the membership of the Society of Radio- graphers might be held in Hong Kong.

188. Negotiations with the Society of Medical Laboratory Technicians for similar recognition to be accorded to locally trained laboratory assistants unfortunately broke down but it is hoped at a later date that it may be possible to take this matter up again.

July, 1949.

I. NEWTON, Director of Medical Services.

Seat Rear

DEPUTY DIRECTOR MEDICAL SERVICES =

Liv

Myben

22.

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ANNEXURE "A"

DIANCTOR OF MEDICAL SERVICES

GIT CÔNEE

The song SARA

ے ہاں ستار تریام

Elway

Date Price då Dystem

Jonents and fameur WhitARE

Many F

PANEVALA PIAKKAA AGRANZ ARPIG Down - mumbai

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GRAAN VARAJ

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Chart chung the Dagorzation

of th

the

Medical Department

1948

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Jean Milkczy drivers

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DEBOLA DIBEC LOW

237-VA12, JADIOAMĄ,

عود المراجع الدم

COLONY OF HONG KONG MEDICAL FACILITIES MAP REFERENCE 1948

X+><@ | 00000

7 m

GOVT. HOSPITALS

NAVAL HOSPITALS MILITARY HOSPITALS CHINESE HOSPITALS

PRIVATE HOSPITALS GOVT DISPENSARIES

POLYCLINIC

　　　　　　　　　　8 INFANT WELFARE CLINIC 9 A SOCIAL HYGIENE CLINIC

10+ STJOHN'S AMBULANCE BRIGADE CENTRE

DENTAL CLINIC

PORT HEALTH CLINIC

CASTLE

PLAK

SAN HUT

-48-

ANNEXURE "B"

TAKU LING

ŠTIA TAU KOK

LOR MACHNU

[SHEVNG SHUI

[TA: PO

KAM TIK

SEE "SEPARATE MAP

Now!

LAN

TAU

CHENG CHÁU

HONG

KONG

(SEE SEPARATE MAP "B")

(TAI YU SHAN)

15JUKUNG

COFOMA

поне кона

14:03M

9AM C31

KTIMIC

YAT

Str

ANNEXURE B

O GOVT HOSPITALS (c) NAVAL HOSPITALS

00*90 | |@ > < + × ◊

MILITARY HOSPITALS

CHINESE HOSPITALS

PRIVATE HOSPITALS GOVT DISPENSARIES

7 E POLYCLINIC

INFANT WELFARE CLINIC

SOCIAL HYGIENE CLINIC

+ ST JOHN'S AMBULANCE BRIGADE CENTRE

DENTAL CLINIC

12 → PORT HEALTH CLINIC.

PUSA

+ Th

POUR PALAS

SACH

TANG MATARAJ

TAIW

OVEEN-MARY

HONG

MANITARY

KONG

LANCHI KON

לר

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63 ..

ANNEXURE C.

STAFF OF MEDICAL DEPARTMENT

AS AT 31.3.49.

Director of Medical Services

Deputy Director of Medical Services

Deputy Director of Health Services

Senior Medical Officer

Senior Health Officer

Radiologist

Malariologist

יי

Government Pathologist

LIL

Pathologist

Government ('hemist

Chemist

Dental Surgeon

Medical Officers & Health Officers etc.

104

Nursing Staff

528

Executive Officers

Health Staff

129

Clerical Staff

Pharmaceutical Staff

Laboratory Staff

X-Ray Staff

Massage Stuff

Dental Staff

Stewards

Vaccinators

Almoners

148

1-1

Others

Total

1824

2831

ANNEXURE D.

AGE DISTRIBUTION AS FOUND IN 1921 AND 1931 CENSUSES.

1921

1931

Years

Males Females Total

Males Females

Total

27.296

26.451

53.747

43.539

43.695

87.234

←

23.413

24.736

48.149

32.436

31.734

64,170

30.151

25.736

55.887

40.676

34.270

74.946

50.216

23,242

73.458

64.663

35.648

100.313

49.785

22,608

72.393

63.289

37,410

100.699

45.303

23.596

68.899

52.162

36.413

88,575

37.950

20.080

58.030

42.870

29.268

72.138

36.050

19.580

55.630

36.935

26.579

63,514

24.231

12,754

36.985

28.890

20,374

49.264

19.297

11.301

30,598

23.976

17.797

41.733

12.310

7.145

19.455

16.492

12.266

28.758

5.6

8.268

6.310

14.578

11,110

10.059

21.169

4.450

3.773

8.223

6.538

6.247

12,785

3.792

2,594

6.386

3.455

4.032

7.487

1,126

1.600

2,726

1,584

2,228

3,812

яс 81 - 100 Unknown

463

847

1.310

598

1.226

1.824

235

485

720

266

677

943

1.936

2.025

ANNUAL MORTALITY RETURN FOR 1948.

Male

Female

Unknown

Total

Under 24 hours

121

221

24 hours 1 year

1.961

2.140

4,103

1- 5 years

1.267

1.147

2,414

5-15

229

201

430

15-25

537

359

896

25-35

745

549

1.294

35-45

785

488

1.273

45-55

625

406

1.031

55-65

430

423

862

65-75

266

271

537

75 and over

168

250

*Unknown age

Sex & Age

Total

13.434

The majority of these bodies were removed from the Wing On fire.

NO OF DEATHS.

11,000.

13000

9,000

8,000

7,000.

6,000.

$,000.

4,000

3,000

2,000

1,000

ANNEXURE D.

ANNUAL MORTALITY RETURN FOR THE YEAR 1948,

WITH AGE MISTRIBUTION AS FOUND IN

1921 AND 1937 CENSUSES

NUMBER OF DEATHS

MALE= = FEMALE TOTAL

POPULATION

-110,000

-104008

AGE DISTRIBUTION,

1921

(937

- JKKKKKKKKAKE METTEN

90,000

NOTE:

DEPARTMENT OF STATISTICS

REFERENCE NOQ 772444

UNTIL THE NEXT CENSUS HAS BEEN TAKEN IT WILL NOT BE POSSIBLE TO CALCULATE THE NUMBERS OF DEATHS ON A PERMILLE BASIS, AUT THE TWO CURVES RELATING TO AGE DIS- TRIBUTION OF THE POPULATION AS FOUND IN THE 1921 AND 1931 CENSOSES, AFFORD SOME INDICATION OF THE SIGNIFICANCE OF THE ACTUAL NUMBERS OF DEATHS. IT WOULDAPPEAR PROBABLE THAT THE AGE DISTRIBUTION IS

STILL SUBSTANTIALLY THE SAME: THE PEAK OCCORING IN THE FIRST YEAR OF LIFE IS DUE TO THE GREAT NUMBERS OF DEATHS FROM BRON CHO-PNEUMONIA AND ACUTE ENTERITIS. THE RIJF IN DEATHS AFTER THE AGE OF 15 WHEN THE POPULATION FOR THE AGE-GROUP FALLS IS LARGELY DUE TO THE GREAT RISK OF DEATH FROM TUBERCULOSIS BETWEEN THE AGES OF IS. AND F. SEE TABLE Y OF ANNEXURE E

·40,000

-70,000

60,000

$6,000

40,000

30,000

24,000

AGES

ป

10000

ANNEXURE E.

NOTIFIABLE DISEASES.

Notifications & Deaths-1946 to 1948.

Total No. of Notifications

Total No. of deaths at all ages

Diseases

1948 1947 1948

1946 1947 1948

C. S. M.

Chickenpox

Cholera

293

566 |

137.

123

116

146

514

246

Diphtheria

161 i

122

140

Dysentery

172

158 1

183

60 1

18 I

Enteric Fever

221

246

311

115:

61 |

Malaria

2.422

608

763

253

193

Infantile Paralysis

Measles

317

160

190

26/

Plague

Puerperal Fever

.....

Rabies Human

4 i

Animal

Relapsing Fever

| | | ➖➖

77 | 25

6 !

Scarlet Fever

Smallpox

יייייו

1.998: 214

1.306

129

Tuberculosis

Typhus Fever

Yellow Fever

2.801

4.855 6.279

1.818

1.803

1.961

42 i

Whooping Cough

NOTE:-Malaria not notified after May, 1948.

Whooping Cough and Infantile Paralysis notifiable diseases since 29.10.47 and 30.7.48 respectively.

ANNEXURE E.

AGE GROUP OF NOTIFIABLE DISEASES

1948.

0-one year

1 yr. to 3 yrs.

3 yrs, to 7 yrs, ! 7 yrs. to 14 yrs,

Over 14 yrs,

Total

Diseases

M. F. Total M. F. Total M.

Total

F. | Totalı M.

F. Total

Total

F. Total

Bacillary

Clinical

Enteric Fever

Measles

Puerperal Fever

Cerebro-spinal

Meningitis

7 4

Chickenpox

36 24

Diphtheria

Dysentery:

Amoebic

*** |*|*|

16 i

10 26

ཧཱུཾ །||

281

Rabies:

Human

Animal

Scarlet Fever

Smallpox

Tuberculosis

139

234 165 128

293

116

Typhus Fever

13--1

|8w|an SSN

63 21| 18 | 39 [ 12

=88 1-108|

11 |

26 | 17

སྱཱཧཱསྶུ།

110

40 T

161.

256

22 2868

ses 8མྦྷ

57 i

194│

228 ARTESA -|

32 | 69

146

140

118

117 |

311

190

12!

1 |

77 | 193

164 119

283

3.365 1.011

5,278

3.949 | 2,330 |

6.279

2 i

Whooping Cough!

的

9।

Infantile

Paralysis

TOTAL

1761 | 176 | 149

328 | 245 | 208:

453

[ 195 158

| 353 239 200 439

3.698 2,100 |

5.798 4.553 2.815 7.371

Nil return for Cholera, Plague. Relapsing Fever & Yellow Fever.

Year

Notifications

Deaths

Cerebro-spinal- Meningitis (Meningococcal)

Deaths per 100

Notifications

Deaths

Cholera

Deaths per 100 Notifications

Notifications

ANNEXURE E.

Diphtheria

Deaths

Deaths per 100 Notifications

Enteric Fever

1928

16!

1929

1930

13 |

1931

1932

207

122

1933

191.

118:

1934

246:

125 |

2882882

140

Figures prior

95 |

231

57 1

to 1937 not

205

122

81 |

available,

162 :

83 |

1935

110

226:

136.

1936

123

375

214

899398785

240 |

741

207 |

61 |

43❘

221 |

214

202

207

212❘

319

418 |

136

1937

157

1.690

1.082 i 64

1938

483

223

547

363!

1939

488

214

708

448❘ 63

1940

| N.A. ¦ N.A. · N.A.

945

626

1946

293

85 1

514

24S!

$8889

308

148

464

176:

319

147

539

187 J

N.A.!

142❘ N.A,

N.A.!

385 ❘

N.A.

130 N.A.

N.A.

324

N.A.

161

221

115

1947

566

137 |

122 1

52 | 43

246

61 |

1948

140

311

88887788888¶SARN

616

304

977

854

270

249

212

175

566

433

153

104

16:

129

! 35 2,327

1,833

198

153

335

270

1,998

214

1.306

129

N.A.= Figures not available.

NOTE: Figures for war years 1941 to 1945 are not available.

Notifications

Deaths

Deaths per 100 Notifications

Notifications

Deaths

Smallpox

Deaths per 100 Notifications

لانا

ANNEXURE F.

REPORT ON THE TUBERCULOSIS SERVICE.

Tuberculosis, accounting as it does for 14.6% of all deaths in the Colony, is probably the most important single health problem facing the Government today. The problem is extremely complex and offers no easy solution. The population, as a result of the present economic and political conditions in China, is grossly inflated resulting in appalling conditions of overcrowding affecting all classes, but more particularly the working classes for whom little, if any, additional housing has been built during the past decade.

　　　The type of house in almost general use, a single large room orrupying a whole floor and divided by 6 foot partitions into cubicles, sonte as small as 36 square feet, and housing a whole family, while ideal from the point of view of ventilation, lends itself to easy spread of infection. To add to the existing difficulties numbers of tuberculosis sufferers travel fairly rousider- able distances to the Colony from neighbouring areas being attracted by the prospect of free treatment. It is a tribute to the resistance of the population that the deaths from pulmonary tuberculosis are maintained at their present level.

Should any deterioration in the local economic conditions occur, without a compensatory fall in the population, the tuberculosis deaths are likely to return to the high level observed before the war.

For various reasons reliable statistics are not available, In the first place, no recent census figures are available. The last census was taken in 1931, since when the population has doubled, halved, and doubled again, according to estimates, Nor is information available on the age and sex distribution of the population, an important feature in the analysis of statistics. relating to tuberculosis. It is quite usual to encounter individuals who work in the Colony and maintain their wives and families in their native villages. Thus the preponderance of males in the community is likely to be exaggerated-a probability which was confirmed in the 1931 census returns.

On the other hand, information in relation to tuberculosis is not satisfactory on account of incomplete notification. Numerous individuals attend the public clinics giving a history of having received private treatment yet never having been notified. Out of a total of 6270 notifications recorded during the year 537 were made by private practitioners, an average of 1.5 notifications per practitioner per year. The patient himself is far from anxious to have the knowledge of his disease made public on account of the social repercussions that are liable to ensue. One can only guess how much deliberately concealed tuberculosis exists.

ILL

　　The figures recorded for deaths due to tuberculosis are sur- prisingly low and in keeping with the low figures recorded for deaths from all causes. It is known that a number of advanced cases do return to China to die but how much indnence this has on the general figure is not yet knowu. The ratio of deaths to notifications of tuberculosis is low compared to the fadings in other parts of the world and indicate a high natural resistance to the disease. This high resistance is apparent in the response to hospital treatment, and in the number of healed lesions often extensive which are found on routine examinations and which so far as can be ascertained gave rise to no symptoms. For example a survey of 4515 Government servants carried out during the year showed the following results.

Active tuberculosis Healed

Suspicious

497

121

3808

Not tuberculous

　　The following table shows the figures of known cases and rates based on the accepted figure for population on

(a) Estimated population (1)

(b) Estimated population (2)

TABLE I

TUBERCULOSIS (ALL FORMS) NOTIFICATIONS AND DEATHS,

Population

Year

Estimated

(1)

Estimated

(2)

Notifica-

tion

Deaths

D N

Ratio

Death

Rates per 100.000 pop.

Estimated

(1)

Estimated

(2)

1928

766.700

979.440

2.537

330.9

259

1929

802.900

1.047.260

2,158

268.7

200

1930

838.800

1.047.490

1.994

237.7

190.3

1931

840.473

878.947

1932

900.812

1933

922.643

1934

944.492

Not Notifiable

1.983

235.9

225.6

2.042

226.6

2,225

241.2

2.179

230.7

1935

966.341

986.341

2.237

231.3

231.5

1936

988.190

088.190

2.416

244.5

1937

1.281.082

1,006,982

4.028

314.2

400.0

1938

1.473.619

1,028.610

4.920

332.7

478.3

1939

1.750.256

1.050.253

7.591

4.443

1 to 1.7

253.8

423.0

1946

1.600.000

1.168.815

2.801

1.752

1 to 1.6

109.50

149.8

1947

1.750.000

1.214.762

4.855

1.861

1 to 2.6

106.3

153.2

1948

1.800.000

1.126.316

6.279

1.961

1 to 3.2

108.0

174.1

It will be seen from the above that the progressive reduction in the tuberculosis death rate evident from 1928 onwards showed a marked adverse tendency from 1937 onwards accompanied by a sudden rise in the population due to the influx of war refugees from China. The outstanding feature of the table, however, is the drop in the figures for 1946-48 which, though increasing slightly over the period, have remained relatively steady.

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　In consideration of the rate as a whole some comfort can be obtained from the fact that even considering the local conditions the figure is only double that shown in UK. where social conditions are immeasurably better, where relief is available for all and where a comprehensive scheme for the diagnosis and treatment of tuber- culosis has been in existence for many years. The second out- standing feature is the improvement of the deaths/notification figures again exhibiting the resistance of the population to the disease. This recovery power is apparent in the shortness of the period of hospitalisation required to stabilise patients. This tendency is apparent in the local population only and is not true. of Europeans in whom the disease runs an expected course; it must, however, be emphasised that this is merely an impression gained from limited observation and that it is not yet backed statistically.

One very disquieting feature of the tuberculosis picture is the very high and increasing number of deaths from tubercular meningitis. This rising figure is out of all proportion to the smaller increase in the deaths from tuberculosis (all forms) and shows a progressive reduction in the age at death. This is a measure of the deterioration in the sorial conditions and indicates an increase in the intensity of infection. The rise may be due to an increase in the number of younger children at risk but is more probably a frne increase, as it is not apparent in the other forms of tuberculosis.

TABLE II

TUBERCULAR MENINGITIS

Deaths 1946 48.

1948

1947

M. F. Total M. F. Total

1948

: Total

63 48 111 18 LO

110

16:

106 216 163: 132

13:

gEས་

5 -15 - 25

-45 -55

- 75

IIL

· 75 + Unknown

Total

-г

- -

2800*0

295

70 169

137 | 127

264

190 157: 347

It will be seen that while deaths from tuberculosis tall forms) have risen by 5% over 1947 the tuberculous meningitis deaths have risen by 31%. Furthermore 85% of these deaths occurred before the age of 5 years as against 81% and 66% in 1947 and 1946 respectively.

Deaths from tuberculosis (other forms) have remained fairly steady over the past 3 years and have not shared the rise shown in the meningitis deaths nor is there any significant alteration in the age of incidence. It is of interest to note that the deaths. from tuberculosis (other forms) constitute 8.7% of all tuberculosis deaths, about the same proportion as is shown in the figures for United Kingdom. The origin of these infections is highly w likely to be from milk in view of the small amount of milk consumed in the Colony. There is no specialised service for dealing with non pulmonary disease and little accurate information is available on the subject.

TABLE III

DEATHS FROM TUBERCULOSIS (OTHER FORMS)

1946-1948.

1946

1947

1948

M. F. Total

mir. | ¡ 1 M. F. Total

M. F. Total

71 41 120

116

15 28

- 48

- 75

75 + Unknown

||enana

23 14

17 10

41 6

13 3

Total

99 75

174

LIL

105 74 179

98 73 171

Deaths from pulmonary tuberculosis have remained fairly constant over the past 3 years when considered unmerically in spite of the deterioration in social condition. Based on the estimated population (1) the rate has fallen steadily 92, 81, 80 per 100,000 in 1946, 1947 and 1948 respectively. Based on the estimated population (2) the figures for the same years are 126, 117 and 128 per 100,000. In consideration of the fact that the two sets of figures show different tendencies it would be futile to draw conclusions, It is obvious, however, that these figures do not reflect the increases apparent in the meningitis deaths.

It would appear therefore that the increased intensity of infection has been, to some extent at least, offset by the improved economic conditions resulting in improved resistance in adults.

　　The very substantial increases in the number of cases of pulmonary tuberculosis notified ran be accounted for by several considerations. In the first place the settling of conditions generally has resulted in more stabilised and organised medical services. Secondly, efforts are being made to ensure that all diagnosed rases are notified. Thirdly, the government has established a diagnostic service available to all without charge with the result that a large number of individuals who would other- wise be denied treatment on economic grounds are now being seen and notified, The principal feature of interest is the preponderance of male cases in all except the 65-75 age groups. How much of this preponderance is due to an increased morbidity rate and how much is due to variation in the sex distribution is difficult to determine exactly though it is thought likely that adult males outnumber females in the same age groups on account of the attractions in the nature of employment offered by the Colony, In the 1981 census it was found that males constituted about 60% of the population between the ages of 11 and 55 years. Assuming that conditions are now relatively the same, as would appear likely we have the explanation of the apparent higher morbidity in males. On the other hand the case mortality which is lowest in the 35-45 age groups is higher in females until this age after which the rates are fairly similar.

Agc

Groups

1946

TABLE IV

PULMONARY TUBERCULOSIS

Deaths and Notifications.

Deaths (Pulmonary)

1947

1948

Notifications (Pulmonary)

1948

F. Total

Total

0- 5

5- 15

143

256

151

-45

247

101

146

-65

-75 +

Unknown

སྐས།

88875887 ||

129

281

128

205

149

231

133

220

128 | 84

210

651

299

950

407

266

172

438

242

155

397

1.342

689

2.031

348

236

116

352

222 116 |

338

856

508

1.364

215

154

219

144! 82 I

236

367

269

636

118

121

128

249

TOTAL

943

! 532

1.475

888

532

1.420

871

572❘

1.443

3.593

2,055

5.648

9. OF DEATHS TO NOTIFICATIONS

Graph showing ratio of deaths to notifications in males and females expressed as a percentage and set out in

age group29.

Facilities for diagnosis and treatment are fairly widely scattered. A number of the Chinese hospitals run special out- patient clinics for the purpose and much of the work is done privately. Very little information in these services of a statistical nature is available. The largest single service organised for this purpose is the Government Anti Tuberculosis Service, instituted as a special service in 1947. The amount contributed from the different sources may be assessed from the notification returns,

From

(0) Anti Tuberculosis service

(b) Private practitioners

2,786

537

(e) Hospitals, Clinics etc., including other

Government Institutious

3,006

6,279

Government Anti Tuberculosis Service.

The Government Anti-tuberculosis service provides free diagnostic service available to all, either for the use of private practitioners or for voluntary attendance by the patients them- selves. It is now in its second year of operation. The principal elinie is at Harcourt Health Centre where daily morning sessions for diagnosis and afternoon sessions for treatment are held. Subsidiary clinics are held weekly in various outlying districts for the convenience of residents in these areas and are visited by the medical staff of the central clinic.

Details of clinic attendances are as follows:

A. Harcourt Health Centre.

(a) Attendances.

First Visits-referred by (a) private practitioners

468

(b) hospitals

927

voluntary attendances

11,717

contacts

204

13,316

Re-visits

52,423

Total

66,739

(b) Condition on first attendance.

Not tuberculosis

3,344

Tuberculosis (1) Active

3,107

(2) Inactive or healed

2,484

Suspicious

1,161

Diagnosis not completed

(patients did not re-attend)

3,220

- r

13,316

Bilateral cases outnumbered unilateral cases by 2 to 1. As yet no established classification scheme has been introduced.

B. Subsidiary Clinics.

(a) Attendances,

1st Visit

Re-visit

Un Long

158

335

Taipo

129

235

Sai Kung

6 (In operation only

a few weeks)

Aberdeen

170

337

י י ו +יזי

477

913

(b) Diagnosis.

Free from tuberculosis

290

Tuberculosis

187

477

Hospital Accommodation.

A total of 281 beds is available in government institutions for the treatment of pulmonary cases. These are distributed as

follows:

Queen Mary Hospital

Lai Chi Kok Cheung Chan

46 204

These beds, upon whom government servants have prior claims, are otherwise being set aside for early cases. Queen Mary Hospital provides all necessary surgical treatment and patients are kept there for short periods only being transferred to the other institutions to complete convalescence. Lai Chi Kok Hospital, originally built as a temporary institution, provides the bulk of the available beds. The accommodation and facilities provided are far from ideal and the lack of space and the fact that parts of the hospital are used for other purposes makes the provision of sanatorium routine a very difficult matter. Useful work is,

however, being done and some improvement in the conditions can be reported. The policy adopted of admitting early cases only was gradually introduced in the latter part of the year and the general outlook of patients and staff has improved.

Cheung Chau Hospital is used for convalescent cases in the main although some treatment cases are admitted. The treatment is carried out by a medical officer from the central clinic, but the general care and day to day requirements are undertaken by the medical officer in charge.

The Tung Wah Group of hospitals have been most co-operative in disposal of patients, and particularly in taking care of the advanced and ill cases.

The total number of beds available in the Colony for treatment of tuberculosis, calculated either on the standard of one bed per thousand population or one bed per tuberculosis death per year, falls very far short of the requirement but, under the circumstances hospital beds for the tuberculous will always be in short supply as the greater the provision, the greater the demand through the arrival of tuberculous individuals from other areas.

The known number of beds reserved exclusively for cases of tuberculosis is 427 distributed as follows:

Government Anti Tuberculosis service 281-Government Servants

and early cases. 40 Advanced cases. 40-

Tung Wah Hospital

Kwong Wah Hospital

Ruttonjee Sanatorium

do.

66-Early cases in adults & children. In pro- ceas of expansion. Working in co-opera- tion with Government service.

Results of treatment,

In the absence of any system of classification of cases, the results of treatment are impossible to assess and present, but, generally speaking, the response to treatment is highly satisfactory.

Radiological examination.

All X-ray work in connection with the clinic is carried out at the Queen Mary Hospital. First examinations are done on miniature films and thereafter according to request.

The absence of an X-ray unit in the clinie occasions some delay in diagnosis and disposal of patients, but this deficiency is being kept in mind in future planning. The radiologist has been most helpful and co-operative in the formulation and furthering of measures in- troduced in efforts to decrease these delays and reduce inconvenience to patients to a minimum. In view of the distance at which the X-ray unit is situated from the clinic transport to and fro is provided.

ו;

Bacteriological.

　　All bacteriological work done in connection with the tuber- culosis service is carried out at the Government Pathological Institute. Details of examinations carried out on behalf of the clinic are as follows:-

Positive Negative

Total

Sputum

958

2,229

3,187

Gastric contents

812

89%

Pleural fluid

112

Kahn test

1.782

211

1,993

Tuberculosis Visitors.

　　During the year a course was instituted for the training of health visitors for the tuberculosis service. Ideally such visitors should have nursing training before undertaking such a course, but, due to the lack of trained nurses, it has been necessary to select individuals and train them specifically for the post of health visitors in the tuberculosis service and to instil some kuowledge of nursing, hygiene and social welfare work during this training. The services of these visitors are utilised as follows:-

(a) Feeding scheme.

(b) Education of patients on domiciliary treatment. (c) Bringing up for examination and treatment patients

who have failed to attend the clinic.

(d) Contact examination.

The contact examination scheme has only recently been introduced and promises to be a considerable success.

It is so organised that the necessity for patients to attend the clinic is as far as possible abolished, having in mind the fact that the clinic is already overcrowded and symptomless contacts are not anxious to spend a complete morning among known infectious cases. At present only children under 8 years of age need attend and this only for tuberculin testing at a session held specifically for this purpose.

　　　　　　　　　The proportion of early cases so discovered promises to be high.

Social Provisions.

　　(tradual extension of social provisions has taken place during the period. Assistance is now provided both in cash and in kind.

　　Cash provisions are limited to cases who, because of financial difficulties, would be unable to accept hospital treatment when offered, on account of family commitments, A maintenance grant is provided for dependents during the patient's stay in hospital. Financial assistance is occasionally provided where a case intends to return to his native village.

Assistance in kind is provided by the department in the form of dietetic supplements. These supplements are not intended purely as a feeding scheme, but the diet is carefully chosen to provide items which would be likely to be lacking in the patient's normal diet and can be provided in a palatable form. The food is listributed by means of a specially fitted van, hot and ready for consumption, and delivered near the patients' homes. This scheme was started experimentally in November on the island, and met with a limited though increasing success, and has since been extended to the mainland, where the food is supplied at feeding centres kindly loaned for the purpose by the Social Welfare Officer.

Further assistance in kind is available for patients in the form of dried milk powder, which is distributed at the clinic weekly.

Such medicines as are required are distributed free.

Difficulty is experienced in placing tuberculosis sufferers in employment" following discharge from hospital. Considerable prejudice is encountered against such individuals but some success has been achieved by the Almoner's Department in finding suitable employment for a few ex-patients.

Propaganda,

One of the local problems on the preventive side is the illiteracy of the population. It has been estimated that almost 90% of the patients attending the public linies are unable to read. It is, therefore, extremely difficult to get health propaganda across to these individuals, An anti-spitting campaign was intro- duced and very considerable improvements in the habits of the general population in this connection are apparent. Health education including information on tuberculosis is also disseminated by cinema vans using locally produced as well as imported filma. The long term effects of this rampaign ran only be guessed hut good results are hoped for. A number of posters are also widely distributed in public places.

Surveys.

The use of mass radiography is not immediately contemplated on account of the comparative youth of the tuberculosis service and the lack of trained personnel available to deal with the resulting situation.

Streptomycin.

This drug is readily available on the open market at reaso6- able price. Its use in Government hospitals is prohibited except on the authority of a committee formed for the control of the use of the drug. Each case is assessed on its merits and ample supplies are available for approved cases free of charge.

(Sgd.) A. S. MOODIE,

MA), in-charge T.B. Clinic.

ANNEXURE G.

REPORT OF INFANT MORTALITY INVESTIGATION

COMMITTEE.

Director of Medical Services.

In March 1948, you appointed a Committee consisting of Dr. Lee Hah Liong as Chairman, Dr. R. K. W. Yang, Dr. K. T. Loke and Dr. Uttley as Secretary, to investigate the ranses of Infant Mortality and to make recommendations for the reduction of the high mortality rate.

　　Right from the beginning of the investigation, it was evident. that there would be considerable difficulties in getting enough scientific data on which to base any conclusions.

To collect any valid group of data would take two to three years. Deductions based on statistical evidence alone may be misleading, unless the numbers are sufficiently large, properly collected, and carefully and logically used. Although information such as could be supplied by the two best hospitals in the Colony, the Queen Mary and Kowloon Hospitals, might be useful, it was realised that cases going there are not necessarily the type of cases that the Committee wanted to investigate, and it was also felt that such cases were not a true cross section of the population with which the Com- mittee was concerned. On the other hand, charity hospitals have plenty of good material, but no records. The above mentioned difficulties prevented any statistical survey being made and the Committee adopted a more practical method namely the inter- viewing of doctors and the investigation of post-mortem records and death certificates. Even with these limitations, it is the Committee's opinion that their recommendations are based on the actual prevailing conditions.

　　　The Committee met a number of times and interviewed doctors and other workers when the following facts were brought to light:

(a) A steady fall in infant mortality had taken place from 660 per 1,000 in 1929 to 120 per 1,000 in 1947.

We believe that the following influences have been at work over the years which will tend to modify conclusions: --

(1) Improvement in the standard of living and in the

wage earning power of the poorer classes.

(2) Better supervision in the public health services in

recent years.

(3) A steadily improving accuracy in the returns of

births and deaths especially in later years.

(4) Better appreciation of food values. Beri-beri, which used to take such a heavy toll of infant livea, is not commonly seen nowadays.

are:

(b) The main killing diseases in order of their importance

(1) Bronchopneumonia which is the cause of half of the

mortality at these ages.

(2) Gastro-enteritis.

(3) Prematurity.

The Committee feels, however, that these names are labels rather than accurate diagnosis. In an interview with one of the doctors, we discovered that most of the infants at an institution accepting moribund babies were given the diagnosis of prematurity without sufficient scientific evidence to confirm the diagnosis. We feel that this applies to many other cases as well.

(c) Other diseases which influence the high mortality are:- (1) Tuberculosis. This is another important factor in the high mortality rate. This is to be expected in a society where the tuberculous infection is so prevalent. In addition, we feel that many cases that die, and are certified as marasmus, mal- nutrition, unspecified meningitis and bronchopneumonia were due to tuberculosis,

　(2) Syphilis. It was agreed that syphilis is a major indirect cause of death in the case of prematurity, miscarriages and abortions. Doctors emphasized the fact that, for obvious reasons, congenital syphilis was not commonly given as a cause of death on certificates.

(d) The following are important general factors in the high infantile mortality rate:-

(1) Overcrowding, bad ventilation and sanitation, and poverty.

These factors, which were found to have a great bearing on the high mortality rate in all big overcrowded cities in England some fifty years ago, are very much worse in Hong Kong today. (2) Belief in aged and harmful customs, superstitions and Chinese

medicine:

The importance of these cannot be overestimated. The great majority of the poor, and to a lesser extent the rich, when a child is ill, either seeks the advice of a friendly neighbour, or rushes straight to a Chinese medicine shop to accept the advice of the man behind the counter, or consults a herbalist and many women- folk seek temple advice. It is only late in the course of the disease that a western trained doctor is consulted, There is still a wide belief that Chinese medicine is good for internal diseases, especially for measles, bronchitis and influenza.

(3) Ignorance of the importance of fresh air:

　　The majority of Chinese do not realise the value of fresh air, either in health or sickness. They do not ventilate their rooms enough. Whenever there is sickness in the family, especially with fever, all windows are immediately closed and the patient is covered with layers and layers of clothes and blankets. All practitioners are familiar with the picture that is associated with the physical examination of a baby. If there is any window or door that is open, it is immediately fully closed. There is no such thing as taking off the clothes so that the doctor may make a thorough examination. The great heaps of clothes are merely pulled outwards and a little upwards and the doctor has to slip his stethoscope way up in order to listen to the chest. Any part of the abdomen that is uncovered by such a procedure, is im- mediately covered by the anxious mother or amal. They fear the exposure and the ratebing of a cold. Further, in such diseases. as measles, whooping cough, and bronchopneumonia, where fresh air and oxygen form an essential part of western treatment it is contra-indicated in Chinese therapeutics. One can understand their objections to direct draught, but to prevent draught is one thing and to stop entirely fresh air from entering the sick room is another. This single factor is one of the most important causes of respiratory liseases, directly or indirectly.

(4) Improper feeding:

　　There is an increasing tendency among the upper classes to substitute artificial feeding for breast feeding. Mothers of the poorer class, however, are quite eager to suckle their offspring, but, through force of circumstances, have to give up entirely or give partial feeding only. As cows milk in any form is beyond their means, starch, congee or potatoes are given as early as two to three months of age, very often with mouth to mouth feeding or by premastication by the mother. Of those that have breast milk, over-feeding in the early months is common, and breast feeding is frequently carried on for unduly prolonged periods, sometimes for much longer than one year. Improper feeding undoubtedly is an important cause of gastroenteritis.

(5) Female Labour.

　　This causes the mother to discontinue breast feeding and to neglect the baby.

(6) Over-clothing.

　　With the exception of the very poor who are under-clothed in winter, most Chinese tend to over-clothe their babies in all

seasons.

(7) Excessive fondling and carrying of the baby.

　　This occurs both in health and in sickness. The popular conception among the Chinese is that too much crying may jrodurr a hoarse voice which may last throughout life.

　　　　　　　　　　　　　　　　　　　　　　　　　　1 may weaken the abdominal wall and produce umbilical hernia.

What is most

feared is that it may even produce a lax or enlarged scrotum which is considered injurious to the future health of the male.

In a place like Hong Kong where tuberculosis and other respiratory diseases are so prevalent this excessive carrying of babies in the arms is very conducive to the spread of these diseases.

18) Notification of Infectious Diseases.

cases of

It must be pointed out that there are many bronchopneumonia following measles, and these usually are brought to a western trained doctor late in the course of the disease, because of the fear of the health measures that may follow the notification of the disease. The same applies to complications of other infectious diseases.

(9) Anaemia of Pregnant Mothers.

It is estimated that 20% of the ante-natal cases at Tsan Yuk Hospital hare anaemia. This is due to the restriction of diet, especially during the last three months of pregnancy, and is caused by (a) ignorance, (b) custom, (c) poverty and (d) vomiting of pregnancy. The bad custom of completely eliminating vegetables at this period, for fear of developing diarrhoea with consequent onset of premature labour is most injurious.

(10) Malnutrition in infancy.

This is still considered by some to be common, but it is a general malnutrition rather than one connected with any particular vitamin.

RECOMMENDATIONS.

I. Propaganda and Education.

While improvements in housing, sanitation and the standard of living take time, propaganda and education emphasising the following can be undertaken forthwith.

(1) The value of fresh air and proper ventilation.

(2) Personal habits and hygiene.

(3) The importance of breast feeding.

(4) Proper methods of infant feeding.

(5) The erroneous belief in the efficacy of Chinese

medicine.

Unlike western medicine which has advanced by leaps and bounds during recent years, Chinese medicine, not only has made no progress but actually has retrogressed. Although it may not be advisable, at this juncture, to speak directly of the error of the belief in Chinese medicine and the dangers associated with herbalist practice, we could achieve our aim by making known to the Chinese public the recent advances of western medicine, em- phasizing the preventives and specific curatives which we

now have, especially for diseases such as broncho-

　　　　　　　　　　　　　　　Be"h pneumonia, miliary tuberculosis, diphtheria and measles. Bronchopneumonia and miliary tuberculosis at present, cause about half the mortality in infancy. We should also emphasize the importance of bringing the baby early to the doctor in cases of illness. The Death certificates of 1947 show that only 24% had been seen by the doctor for more than one day prior to death.

(6) To implement No. (5) above, we advise, (a) the registration of herbalists, as has been done in China, (b) the control of their advertisements in the Chinese press.

II. Education and Propaganda through the following channels:- (1) Through boys and girls of school leaving classes; and in the case of girls, special attention to be paid to the art of mothercraft.

III.

(2) Through regular home visits to the new-born by trained nurses or health officers for a certain period. (3) Through lectures and films on street cornera. (4) Through ante-natal clinics, infant welfare centres, children's clinics, children's hospitals, and other social, charitable or educational institutions.

(5) Through midwives and private nurses.

To Provide Facilities for the care of babies through the Establishment of

(1) Ante-natal clinics.

(2) Infant Welfare Centres,

(3) Creches.

(4) Children's Clinics.

(5) Children's Hospitals. The Committee feels that the number of children's beds available in the Colony is hopelessly inadequate, and that the building of a children's hospital should be given first priority-at least it should take precedence over the building of a mental hospital.

IV. Co-ordination of all aspects of child health work-educational, preventive and curative, and the Provision of facilities for the training of staff for this work.

V. Infectious diseases and their notification.

Except for the more important infectious diseases such as cholera, smallpox and one or two others, the Committee felt that it was unwise to insist on the routine health measures normally enforced by the health authorities consequent on the notification of the diseases. These measures defeat their own purpose by making the great majority of Chinese refuse to go to a western trained doctor until it is too late for him to cure the disease.

VI. Tuberculosis.

The Committee recommends that this disease should be notifiable, but that no action be taken by the Health Department even for open cases ' It may be left to the practitioner if he takes upon himself the duty, to use his personal influence with the patient to point out to him the dangers of infecting others, especially babies and small children, and to advise him to take precautionary measures.

Except with the poorest class, most of the babies of Chinese families are taken care of partly or entirely by amals. They have the closest contact with the babies and handle all their food. The importance of these amnahs being carriers of diseases, especially tuberculosis cannot be over-estimated. Some means may be devised to educate these amahs in personal habits and hygiene, infant feeding and the rare of babies, and to induce their employers to have them checked up before engaging them for babies.

LEE HAN LIONG, Chairman,

Infant Mortality Investigation

Committee.

171

Schools

ANNEXURE H.

SCHOOL HEALTH SERVICE

RESULTS OF MEDICAL INSPECTION OF PUPILS.

Number of Pupils with Defects Requiring Attention

Number of

medical

inspections undertaken

pupils

with no

apparent

Number of

Observa-

tion

Treatment at General

Clinics

Treatment

at Eye

Clinics

Treatment at Dental

Clinics

defect

Treatment

at Ear.

Nose and

Throat

Clinic

Treatment

Treatment at Surgical Clinics

at Anti-

tuber-

culosis

Admitted

Clinics

Hospital

'A' type

1.102

309

€13

124

"B' type

- 28.03°;

55.82

ני

6.89.

6.89

11.25%.

2.63

8.736

1.898

4,594

1.615

1.038

2.067

152

=21

= 21.72%

52.58%

18.48.

11.88

23.66%

1.73

0.11%

0.14

→

ப்

0.01

→

'C' type

13.744

2.890

6.346

4.001

700

4,531

298

=52

= 21.02*,

46.17%

29.11.

5.09

32.96

2.16..

0.1%;

0.09%

'D' type

283

195

27.56

68.9.

33.92".

10.6".

33.21°.

1.41

Total

23.865

5.175

11.748

5.788

1.844

6.816

483

= 80

- 21.68*;

49.22^:

24.25

7.72°.

28.56**

2.02,

0.1%

.004

ANNEXURE H.

DEFECTS FOUND IN SCHOOLS.

Details of Defects found

Number of

School.

school

Number

Black-

premises found with inspected

Ventila- tion

Seats

White

General

Lighting

Letrines

Doors &

boards

defects

Windows

not matt

Water Closels

Windows without

backrests

washing required

repair required

surfaced

Government

悲

Grant-Aid

Subsidized

Hong Kong

Subsidized

Kowloon

Private

Hah Kor

144

Private

Kowloon

126

TOTAL

342

DEUXIMMA

BUON STDBERG

Hospitals:-

Queen Mary Kowloon Sai Ying Pun

Tsan Yuk

Stanley Prison

Cheung Chau

Clinics & Dispensarles:-

Violet Peel

Harcourt Tuberculosis

Social Hygiene

9 Public Dispensaries

12 New Territories Disps.

Family Clinic

Police Medical Post

------

Victoria Remand Prison

Matauchung Camp

Health Centres:-

Institution

ייויוווו

ANNEXURE I. OUT-PATIENTS-1948

TOTAL ATTENDANCES AT GOVERNMENT AND GOVERNMENT ASSISTED HOSPITALS, CLINICS AND DISPENSARIES.

Casualties

Dressings

Out-Patients

General

Babies Clinics

Ante-Natal

Post-Natal

Gynaecological

Social Hygiene

Eye

Ear, Nose & Throat

Anti-

Tuberculosis

TOTAL

10,582

4,835

1.477 i

384

T 1.049 ·

597!

14.089

25,145

62.180

6,293 1

859

1.492

18.849

303 |

119,956

| 46.903. 81,398

1.487

967

24.606

1,746 |

157.105

| 10.776

10.776

718 22,180

2.898

18.178

6,394 |

2,002 7

43.168

526

9.869

1,248 ❘

7,675

503

9.426

88.843

| 155,768 |

155.768

1.931

2 | 70.758 | 238,274 48.315 | 54.292

45.304 |

461

9.235

507

384,080

883

105,882

5.602 !

5.602

3.685

8.157

11,842

806

6.500

7.396

336

1.152

1.488

1,332

3.514

3.137

Western

612

-----

----

Kowloon (Tsimshatsui)

Harcourt

■■

■ 1.089

859

720

2.425!

2,278 |

Total of Govt, institutions

Tung Wah Group

18.103

354

222,274 489.890 46.2011 22,609 23,733 | 61,152 | 23,401 |

859 17.501157,860

4,556

Nethersole Hospital

39,435

3.792

4.344 678 15,376

וט חיוו

Grand Total

18.457 246.007590.480 73.484 73.48

26.9531.53737.433 157,860 51,848 2,846 90,233 1,296,938

45,007 2.646 | 90,233 1,113,273 ❘ 6.841

120.037

63.628

Total of Govt. institutions

Tung Wah Group

Nethersole Hospital

--------

Grand Total

Institution

Casualties

Dressings

General

Out-Patients

ANNEXURE I. OUT-PATIENTS

1948

NEW CASES AT GOVERNMENT & GOVERNMENT ASSISTED HOSPITALS, CLINICS & DISPENSARIES.

Babies Clinics

Ante-Natal

Post-Natal

Hospitals:

Queen Mary

9,091

Kowloon

4.835

3.683.

50.292

262:

1.610

190

372

313!

10.228

606

617 1

6,717

162

68.522

Sai Ying Pun

17.915

57.008

Tsan Yuk

614

5,540

532 !

3.981

704│

80.754

5,540

Stanley Prison

718

9.214 |

7,240

17,200

Cheung Chau

1,234 3.572

282 |

5.129

Clinics & Dispensarles:-

Violet Peel

384

3.957

281:

Harcourt Tuberculosis

Social Hygiene

14.217

9 Public Dispensaries

62.122 124,061 28.302 |

4,029

12 New Territories Disps.

1.198

15.348

31,612

188 T

Family Clinic

958

Police Medical Post

3.685

2.502

Victoria Remand Prison

806.

1.941

Matauchung Camp

236

878

4.622

26,420

28,420

14.217

170

218.684

307

48.653

958

6.187

2.747

1.114

Health Centres:-

Western

Kowloon (Tsimshatsui) Harcourt

177

313

397

521

330

840

490

908

1.170

[

7,733

15,877 114,627 284.021 28.772 | 8.920 | 606 7,042 354 F 25,876: 11,320 2,209

10.033 1,739 | 678 5,059

14.245 11,351 1,179 26.897 | 1.891

513,543

49.383

1,218

18.727

[

| 122.360

16.231 | 122.360319,930 41,310 10,665 1,284 14,310

14.245 13,242 1,179 | 26,897 581.653

Gynaecological

Social Hygiene

Ear, Nose & Throat

Anti-

Tuberculosis

TOTAL

Name

ANNEXURE I.

IN-PATIENTS TREATED IN GOVERNMENT AND

GOVERNMENT ASSISTED HOSPITALS 1948.

General Cases

2 ! 3

Infectious Cases

Other Than Tuberculosis

Tuberculosis

Maternity

Cases

Queen Mary Hospital

5,789

144 | 353

760

53 7.099

Sai Ying Pun Hospital

281

----PI

274

557

Tsan Yuk Hospital

714

5.267

5.990

Eastern Maternity Hospital

Wanchai Surial Hygiene

1.901

1,901

Hospital

[

623

823

---

Mental Hospital

482

Kowloon Hospital

3.520

1,352

11 5.025

Lai Chi Kok Hospital

725

280

339

¡ 1,324

Cheung Chau Hospital

659

317

1.049

Felix Villas

North Point Camp

268!

272

Stanley Prison Hospital

557

216

818

Total Government Hospital 13.136

948 987 9.597

540 | 25.217

New Territories

Dispensaries

1 1,323

1.344

Tung Wah Group

15.210

343 1.906, 11,437

28.096

Nethersole

3.041

145 1.144

4.376

Grand Total

--------

31 407 1.337 3,039 23,501 549 59.833

Mental Cases

TOTAL I-V

Cholera

Diseases

ANNEXURE J.

CASES TREATED IN GOVERNMENT AND GOVERNMENT

ASSISTED HOSPITALS AND TOTAL DEATHS IN THE COLONY.

1.-Infective & Parasitic Diseases.

Typhoid fever

Paratyphoid fevers

Plague:

(a) Bubonic, septicaemic and secondary pul- monary plague (infection by fleas or other

biting insects)

(b) Primary pneumonic

plague (infection

through respiratory tract)

Carried forward

Government

Hospitals

Governmen Assisted

Hospitals

Cases Treated. 1948

Deaths, 1948

Deaths, 1947

Male

Female

Male

119

139

123

149

Female

―

Diseases

Cases Treated. 1948

Deaths, 1948

Government

Hospitals

Government Assisted Hospitals

Brought forward

I.-Infective & Parasitic Diseases.--f'ontd.

Undulant fever (Brucellosis);-

(a) Infection by Brucella melitensis

(Melitococcus)

(b) Infection by Brucella abortus Bang (c) Unspecified

Cerebro-spinal meningococcal meningitis Malignant pustule and anthrax (Bacillus anthracis):

(a) Malignant pustule

(b) Septicaemic and visceral anthrax (c) Unspecified anthrax

Scarlet fever

Whooping cough

Diphtheria

Erysipelas

Tetanus

123

149

||| "gབསྐྱུ

109

Carried forward

335

Male

Female

2 |||

Male

Deaths, 1947

Female

NINOM

[228] ||

185

129

8:6-8|| | ||

10 1-8-9

171

131

Diseases

Brought forward

L-Infective & Parasitic Diseases,-Contd.

Cases Treated, 1948

Government Hospitals

Government

Assisted Hospitals

Male

335

185

129

Deaths. 1948

Female

Deaths, 1947

Tuberculosis of the respiratory system (including mediastinal glands):-

(a) With mention of occupational disease of lung (b) Without mention of occupational disease of lung

82%B

989

1.178

864

571

887

540

↓

531

Male

Tuberculosis of the meninges and central nervous

system:-

(a) Meninges

(b) Other sites

Tuberculosis of the intestines and peritoneum

(including

glands):-

(a) Intestines

mesenteric and retroperitoneal

(b) Other sites

122

190

157

137

127

Carried forward

1.489

2.124

1.211

Tuberculosis of the vertebral column

929

801

1,211

Female

1ΤΙ

131

Diseases

Brought forward

1.-Infective & Parasitic Diseases-t'ontd.

Tuberculosis of the bones and joints (excluding; vertebral column):

Coses Treated, 1948

Deaths, 1948

Government

Hospitals

Government Assisted Hospitals

1.489

2,124

(a) Bones (except vertebral column)

(b) Joints

-ו---.

Tuberculosis of the skin and subcutaneous cellular tissue

曉

Tuberculosis of the lymphatic system (excluding mediastinal (13), mesenteric and retroperitoneal

(15) glands)

Tuberculosis of the genito urinary system

Tuberculosis of other organs:- (a) Addison's disease specified as tuberculous

(b) Others

Carried forward

Male

1.211

音

| ང

Female

Male

Deaths, 1947

Female

829

1.211

801

יד

E T

1.622

2.223

1,227

841

1.223

807

(a) Glanders

(b) Tularaemia

Diseases

Cases Treated, 1948

Government

Hospitals

Government Assisted Hospitals

Male

Deaths. 1948

Female

Malc

Deaths, 1947

Brought forward

1.-Infective & Parasitic Diseases, L'outd

Disseminated tuberculosis:-

(a) Acute generalized miliary tuberculosis (b) Chronic generalized tuberculosis (c) Unspecified

Leprosy

1.822

2.223

1.227

841

1.223

807

]

298 |

Purulent infection and septicaemia (not associated with pregnancy, childbirth or the puerperium):

(a) Septicaemia

(b) Pyaemia

(d) Generalized infection by Bacillus coli

PNIN

ם לי

Gonococcal infections (all sites)

Other bacterial diseases (dysentery excepted):-

465

Carried forward

2,132

2,293

1,301

298

1.310

870

Female

910

Diseases

Brought forward

I. Infective & Parasitic Diseases,-Contd.

2.132

2.293

Government

Hospitals

Cases Treated, 1948

Deaths, 1948

Government Assisted Hospitals

1.301

Male

Female

Deaths, 1947

Dysentery:-

(a) Bacillary dysentery

(b) Amoebic dysentery

(d) Other or unspecified forms of dysentery

12 | .

91 -

༞ [ །༄།

Malaria:-

(a) Benign tertian

127

(b) Quartan

ΙΟ

I to

(e) Tropical (malignant)

tertian (including

blackwater fever)

204

(d) Other or unspecified malaria

143

281

120

Other diseases due to parasitic protozoa (except spirochaetes)

Syphilis:

(a) Locomotor ataxia (tabes dorsalis)

IÐ

(b) General paralysis of the insane

ដ

Carried forward

2.621

2.975

1.476

975

1.496

989

Male

898

1.310

870

Female

Diseases

Brought forward

I.--Infective & Parasitic Diseases,-l'ontd,

(d) Other forms of syphilis:-

(a) Congenital syphilis

(b) Syphilis of nervous system

tabes and general paralysis

insane)

JALILIIL

(d) Other or unspecified forms of syphilis

Relapsing fever:-

(a) Epidemic louse-borne (Sp. obermeieri)

(b) Transmitted by other vectors (Sp. duttoni) (c) Unspecified

Other diseases due to spirochaetes:-

(a) Spirochaetosis icterohaemorrhagica (Weil's

disease)

(b) Others

Carried forward

Cases Treated. 1948

Government

Hospitals

Government Assisted Hospitals

Male

2.621

2.975

1,476

Deaths, 1948

Female

975

Male

Deaths. 1947

Female

1.496

989

(except

of the

390

104

...

! 17

1 | |

| | 0

3.083

3.178

1.510

993

1.535

1.015

| | |

Diseases

Brought forward

I. Infective & Parasitic Diseases,-Could.

Measles

-----

Cases Treated. 1948

Deaths. 1948

Government

Hospitals

3.083

Government

Assisted Hospitals

Male

Female

Influenza:-

(a) With respiratory complications specified (b) Without respiratory complications specified

201

Smallpox:

(a) Variola major

(b) Variola minor (alastrim)

(e) Unspecified

的

Acute poliomyelitis and policencephalitis

Acute infectious encephalitis (lethargic epidemic):

(a) Acute lethargic (or epidemic) encephalitis (b) Sequelae of encephalitis lethargica (Parkin- sonism. post-encephalitic Parkinsonian' syndrome)

Carried forward

124

N N

Male

Deaths. 1947

Female

3.178

1.510

995

1.535

1,015

3.310

3.390

1.530

ស

1.011

1,623

1.103

ناتا

Diseases

Cases Treated, 1948

Government

Hospitals

Government

Assisted

Hospitals

Male

Deaths, 1948

Female

[BTI

Deaths, 1947

Female

Brought forward

I.-Infective & Parasitic Diseases.-'ontd.

Other diseases due or attributed to viruses:-

(a) Yellow fever

b) Rabies

3.310

3.390

1.530

1.011

1.623

1.103

(d) German measles

(e) Varicella (Chicken pox)

(1) Others

100

Tell ~ İ

Typhus and typhus-like diseases (Rickettsioses): (a) Louse-borne exanthematic typhus

(b) Typhus-like diseases transmitted by other vectors

I 1

Ankylostomiasis

177

Hydatid diseases:

(a) Hydatid disease of liver

(b) Hydatid disease of other and unspecified

organs

Carried forward

| │

3.401

3.570

1.540

1.031

1.626

1,112

- 04.

Diseases

Brought forward

I-Infective & Parasitic Diseases.-Contd.

Cases Treated, 1948

Deaths, 1948

Government

Hospitals

Government Assisted Hospitals

3,481

3.570

Other diseases due to helminths

157

300

Mycoses

Other infective or parasitic diseases:

(a) Venereal diseases (other than syphilis and gonorrhoea)

(b) Pernicious lymphogranulomatosis

(Hodgkin's disease)

(d) Other infective or parasitic diseases

II. Cancer and other Tumours.

Cancer and other malignant tumours of the buccal] cavity and pharynx:

(a) Lips

(b) Tongue

Carried forward

Male

Female

Male

Deaths. 1947

Female

1.540

1.031

1,626

1.112

F1 1 1 E

3,720

3.910

1.580

1.061

1.652

1.127

1 |

Diseases

Brought forward

11-Cancer and other Tumours,Contď.

Cases Treated, 1948

Government Hospitals

Government Assisted Hospitals

Male

3.720

3,910

1.580

Deaths. 1948

Female

1.061

[34]

Deaths, 1947

Female

1.652

1.127

Cancer and other malignant tumours of the diges tive organs and peritoneum:-

(a) Oesophagus

(b) Stomach & duodenum

(d) Rectum

(e) Liver and biliary passages

26040

(f) Pancreas

(g) Peritoneum

(h) Other or unspecified digestive organs

→

]

-5978- ||

-RIPE | " |

respiratory system:-

(a) Larynx and trachea

Cancer and other malignant tumours of the

(b) Bronchi, lungs and pleura

(e) Unspecified respiratory organs

Cancer and other malignant tumours of the

uterus:-

(a) Cervix uteri

(b) Other or unspecified sites

| |

1 1

121

Carried forward

3.847

4.190

1,690

1.220

1.736

1.248

AG -

Diseases

Brought forward

II-Cancer and other Tumours,-l'ontd.

Cancer and other malignant tumours of other or

Government

| Hospitals

Cases Treated, 1948

Deaths, 1948

Government Assisted Hospitals

Male

3.920

4.303

1.699

1.253

Female

unspecified organs:-

(a) Adrenal glands

(b) Bones

LIJL.

(d) Other and unspecified organs

| | 4

| | 10

Non-malignant

cysts):-

(a) Ovaries

tumours (including

dermoid

(b) Uterus

(d) Brain and other parts of the nervous system

(e) Other and unspecified organs

LIJIJI LILI

*****

3-888

AAA

~ ! ! | |

Turnours of undetermined nature:-

(a) Ovaries

(b) Uterus

(d) Brain and other parts of the nervous system (e) Other and unspecified organis

| | |N

| | | |

Carried forward

4.153

4.480

1.713

1.272

1.760

1.296

Male

Deaths, 1947

Female

1.749

1,282

Diseases

Brought forward

I-Cancer and other Tumours,-fontd

Cancer and other malignant tumours of other female genital organs

Cancer and other malignant tumours of the breast

Cancer and other malignant tumours of the male genital organs:-

(a) Scrotum

(b) Prostate

Cases Treated. 1948

Government

Hospitals

Government Assisted

Hospitals

3.847

4.190

三笞

Male

Deaths, 1948

Female

Male

Deaths, 1947

! Female

1.090

1.220

1.736

1.248

}

| | │

]

Cancer and other malignant tumours of the skin (scrotum excepted-51a)

Cancer and other malignant tumours of the brain and other parts of the nervous system: (a) Glioma (not specified as benign)

(b) Sarcoma

ILI

Carried forward

3.920

4.303

1,699

1.253

| 1

↓

1.282

1.749

Diseases

Government Hospitals

Cases Treated, 1948

Deaths, 1948

Government Assisted Hospitals

Brought forward

IL-Rheumatism, Diseases of Nutrition and of the Endocrine Glands, Other General Diseases and Vitamin deficiency Diseases.

Rheumatic fever:-

(a) Acute rheumatic pericarditis

(b) Acute rheumatic endocarditis

(d) Other forms. including acute rheumatism and rheumatic pleurisy

articular

Chronic rheumatism and other rheumatic

diseases:-

(a) Rheumatoid arthritis

4,153

4.489

1.713

│ས། །

(a) Chronic rheumatic polyarthritis

(b) Arthritis deformans

(b) Other forms of chronic articular rheumatism (e) Other forms of chronic rheumatism

1817:

154

| ~~ | | |

Gout

Carried forward

4.228

4.887

1.718

Male

Female

Male

1,272

1.760

Deaths, 1947

Female

1.296

―

།*│

to Tol

N|O||]

|||-|-

| | | | |

1.280

1.769

1,316

Diseases

Brought forward

III.-Rheumatism, Diseases of Nutrition and of the

Endocrine Glands. Other General Diseases and Vitamin deficiency Diseases,

ontd.

Cases Treated. 1948

Government

Hospitals

Government

Assisted Hospitals

Malc

4.228

4.887

1.718

Diabetes mellitus

Diseases of the pituitary gland

Diseases of the thyroid and parthyroid glands:- (a) Simple goitre

(b) Exophthalmic goitre

(e) Myxoedema and cretinism

(d) Other diseases of the thyroid gland (e) Diseases of the parathyroid glands

-aler

| | [ ! ¦

Diseases of the thymus, including hypertrophy (status lymphaticus)

Diseases of the adrenal glands (not described as tu berculosis):-

culous

(b) Others

(a) Addison's disease, not specified as tuber-

Carried forward

Deaths, 1948

Female

1.280

1 |

4.317

4.923

1.729

1.295

1,781

Malc

Deaths, 1947

Female

1.769

1.316

| !

1.320

ལ།

100

Diseases

Government Hospitals

Cases Treated. 1948

Deaths, 1948

Deaths, 1947

Government Assisted Hospitals

Male

Brought forward

III. Rheumatism, Diseases of Nutrition and of the Endocrine Glands, Other General Diseases

and Vitamin deficiency Diseases.-Contd.

Other general diseases:

(a) Osteomalacia

(b) Other general diseases

Scurvy:

(a) Infantile scurvy (Barlow's disease) (b) Other forms

Beri-beri

Pellagra

Rickets

Other vitamin-deficiency diseases

----

IV.-Diseases of the Blood and Blood-Forming

4.317

ལ་

1.923

| |

112

|ཌ99།རྭ

1.729

|ig|

Organs.

Haemorrhagic conditions:-

(a) Primary purpura

(b) Haemophilia

tions

Carried forward

Female

1.295

Male

Female

1.781

1.320

一沖

184

126

4.365

5.061

1.827

1.387

2.008

1.478

101

Diseases

Cases Treated, 1948

JUJQUIBAOD

Hospitals

Government Assisted Hospitals

Male

Deaths. 1948

Deaths, 1947

HETI

[PILIRI

Female

Brought forward

IV Diseases of the Blood and Blood-Forming

Organs,-'onti,

Anaemias (excluding splenic anaemia-75a):-

(a) Pernicious anaemia

(b) Other hyperchromic anaemias

(e) Hypochromic anaemias

(d) Other and unspecified anaemias

Leukaemias and aleukaemias:-

(a) Leukaemia

(b) Aleukaemia

Diseases of the spleen:-

4.365

5.061

1.827

185

1,387

2,008

1.478

- |

(a) Splenic anaemia

(b) Banti's disease

| 15

Other diseases of the blood and blood-forming

organs:

(a) Agranulocytosis

(b) Erythrocytosis

(d) Other diseases

Carried forward

4.443

5,382

1.860

1.406

2.050

1.503

102

Diseases

Government

Hospitals

Cases Treated, 1948

Deaths, 1948

Government Assisted Hospitals

Brought forward

V.Chronic Poisoning & Intoxication.

4.443

5.382

1.860

Chronic or acute alcoholism (ethylism):-

(a) Acute alcoholism.

(b)Chronic alcoholism

N||

Lead poisoning:-

(a) Specified as occupational

(b) Not specified as occupational

Chronic poisoning by other mineral and organic

substances:-

(a) Occupational poisoning

ILI

(b) Poisoning by narcotic and soporific drugs:-

(a) Narcotics

(b) Soporifics

(a) Unspecified poisoning

- ||

Male

1 1

Female

Male

Deaths, 1947

Female

1.406

2.050

1.503

Carried forward

4.549

5.397

1.861

1.408

2.051

1.504

|| 2

FOT

Diseases

Brought forward

VI.-Diseases of the Nervous System and

Sense Organs,

Encephalitis (non-epidemic):-

(a) Intra-cranial abscess

(b) Other forms

Meningitis (non-meningococcal) :-

(a) Simple meningitis

(b) Acute cerebro-spinal meningitis (not due to

meningococcus)

Diseases of the medulla and spinal cord, other than locomotor ataxia (30a) and disseminated sclerosis (87d)

Intra-cranial lesions of vascular origin:-

(a) Cerebral haemorrhage (not due to injury at birth-160a)

(b) Cerebral embolism and thrombosis (c) Softening of the brain

Carried forward

Cases Treated, 1948

Government

Hospitals

Government Assisted Hospitals

4.549

5.397

Male

Deaths, 1948

Female

Male

Deaths, 1947

Female

1.861

1.406

2,051

1.504

است

།

]

113

141

144

སྐ

4.644

5.604

2,051

1.524

2.280

1.664

104

Diseases

Brought forward

V1.-Diseases of the Nervous System and

Sense Organs,-fontd,

Intra-cranial lesions of vascular origin,-Contd.;- (d) Hemiplegia and other paralyses of unstated

4.644

Cases Treated, 1948

Government Hospitals

Government Assisted Hospitals

5.604

Male

Deaths, 1948

Deaths, 1947

Female

2.051

1.524

Male

origin

132

(e) Other intra-cranial effusions

Mental disorders and

deficiency

(excluding

general paralysis of the insane-30b):-

(a) Mental deficiency

(b) Schizophrenia (dementia praecox) (c) Manic-depressive psychosis

186

(d) Other mental disorders

203

Epilepsy

יחויי

(a) Chorea

Convulsions in children under 5 years of age

Other diseases of the nervous system:-

(b) Neuritis (non-rheumatic)

~ |!? -

IN IN

-------

יוו...

(d) Disseminated sclerosis

(e) Others

Carried forward

| | | |

- T1

5.201

5.931

2.090

1.540

2.306

1.608

ILLI

Female

2,280

1.664

105

Diseases

Brought forward

VL-Diseases of the Nervous System and Sense Organs,-Conti

Cases Treated, 1948

Deaths, 1948

Government

Hospitals

Government Assisted Hospitals

Male

Female

Male

Deaths, 1947

5.201

6.931

2.090

1.540

2.306

Diseases of of the organs of of vision (including

trachoma)

107

181

Diseases of the ear and of the mastoid process:- (a) Otitis and other diseases of the ear, without mention of mastoid (antrum) disease

(b) Diseases of the mastoid process

VII. Diseases of the Circulatory System. Pericarditis (including chronic rheumatic pericar- ditis):-

(a) Chronic pericarditis specified as rheumatic (b) Others

Acute endocarditis (excluding rheumatic endocar- ditis-58b):-

(a) Acute bacterial endocarditis

(b) Sub-acute bacterial endocarditis

Carried forward

5,474

6,227

2.138

[

1.688

1.570

2.339

1,716

106

Diseases

ויוויום

Brought forward VIL-Diseases of the Circulatory System,-Contd. Chronic affections of the valves & endocardium- (a) Aortic valvular disease unassociated with

mitral disease

(b) Other specified valvular disease (including sequelae of rheumatic fever)

(a) Acute myocarditis

(b) Chronic myocarditis specified as rheumatic (c) Myocardial degeneration. infarction and

sclerosis, and other chronic myocarditis, not specified as rheumatic

(d) Myocarditis not specified as acute or chronic Diseases of the coronary arteries and angina pectoris:-

(a) Diseases of the coronary arteries

(b) Angina pectoris without mention

coronary disease

Carried forward

Cases Treated, 1948

Government

Hospitals

Government Assisted Hospitals

5,474

6,227

227

199

PETH

Deaths. 1948

Deaths, 1947

Female

Male

Female

2,138

1,570

2,339

1.716

N BA

दया क

5.555

6.798

2.388

1.805

2.557

1.937

107

Diseases

Brought forward

VII. Diseases of the Circulatory System,-/watd.

Other diseases of the heart:-

(a) Functional heart disease without mention of

organic lesion

(b) Heart diseases specifled as rheumatic but otherwise undefined

(c) Other and unspecified diseases of the heart Aneurysm, except of heart (93) and aorta (30) Arteriosclerosis, excluding diseases of the coronary arteries (94), renal sclerosis (13 1b) and cerebral

Cases Treated, 1948

Government Hospitals

Government Assisted Hospitals

BIN

Deaths, 1948

Female

Male

Deaths, 1947

Female

5.555

6.798

2.388

1,805

2.557

1.937

es co

1-1

-* |

haemorrhage (83)

Gangrene

Other diseases of the arteries

Diseases of the veins (varices. haemorrhoids. phlebitis, etc.):-

(a) Varices

(b) Other diseases of the veins

185

Diseases of the lymphatic system (lymphangitis.

etc.)

Carried forward

5.787

7.058

2,422

1.824

1 !

2,575

1.956

108

Diseases

Diseases of the nasal fossae and annexa:- (a) Diseases of the nasal fossae

(b) Others, including sinusitis (state site)

Diseases of the larynx

Bronchitis -

(a) Acute

(b) Chronic

(c) Not distinguished as acute or chronic Broncho-pneumonia, including capillary bronchitis Lobar (pneumococcal) pneumonia Pneumonia (unspecified), including acute conges- tion of the lung

------

Cases Treated, 1948

Government Hospitals

Government Assisted Hospitals

· ·

Brought forward

5.787

7.058

2,422

1.824

2.575

1.956

VII-Diseases of the Circulatory System, Contd.

High blood pressure (idiopathic)

Other diseases of the circulatory system (including hypotension)

VIII.-Diseases of the Respiratory System (Not Specified as Tuberculous),

Carried forward

· Male

Deaths, 1948

Deaths, 1947

Female

107

178

APA FE 22

! ! │

123

100

142

132

411

472

100

1,752

1.228

1.243

1.390

1.203

507

331

228

395

228

146

134

114

6,512

10,561

4.255

3.501

4.786

3,781

Male

601

Female

Diseases

Government

Hospitals

Government Assisted

Hospitals

Cases Treated. 1948

Deaths, 1948

Deaths, 1947

Male

[ELP.

Brought forward

VIII.-Diseases of the Respiratory System (Not Specified as Taberculous),oned.

Pleurisy (not specified as tuberculous):

(a) Empyema

6.512

10.561

4.255

3.601

LIIL-

(b) Other or unspecified forms of pleurisy Congestion (chronic or unspecified). oedema, embolism, haemorrhagic infarction and throm- bosis of the lungs:-

(a) Haemorrhagic infarction of the lung (including pulmonary embolism)

(b) Acute oedema of the lung

י.

Asthma

-----JOIJLJ -ILI-LJ

Pulmonary emphysema

Other diseases of the respiratory system (except tuberculosis-13):-

(a) Silicosis

(b) Other occupational respiratory diseases

(d) Abscess of the lung

specified as occupational

(e) Other diseases of the respiratory system not

Carried forward

---

N = 10 a

6.675

4,786

3.781

237

། ། མ

[ཆསྐྲ།

129-

18.

| || |

4.330

3.647

4.870

3.814

10.922

Male

Female

110

Diseases

Brought forward

IX.----Diseases of the Digestive System.

Diseases of the buccal cavity and annexa, and of the pharynx and tonsils (including adenoid vegetations):-

(a) Diseases of the teeth and gums

(b) Septic sore throat

Cases Treated. 1948

Deaths, 1948

Government

Hospitals

6.675

Government

Assisted

Hospitals

Male

10,922

4.330

193

263

133

- LILJ

NNG

Female

Male

Deaths. 1947

Female

3.847

4.870

3.814

Diseases of the oesophagus

Ulcer of the stomach or duodenum:-

(a) Stomach

114

215

(b) Duodenum

Other diseases of the stomach (except cancer, other malignant tumours)

422

Diarrhoea and enteritis (under 2 years of age)

1.562

747

719

341

369

Carried forward

7.492

13,327

5.160

4.391

5,279

4.223

WE DO ON

[1]

Diseases

Brought forward

IX.--Diseases of the Digestive System.out.

Cases Treated. 1948

Deaths, 1948

Deaths, 1947

. Government

Hospitals

Government Assisted Hospitals

Male

7.492

13.327

5.160

Female

Male

Female

4.391

5.279

4,223

Diarrhoea, enteritis and ulceration of the intestines (2 years of age and over):-

(a) Diarrhoea and enteritis

382

548

159

132

279

190

(b) Ulceration of the intestines (except duodenum)

Appendicitis

Hernia, intestinal obstruction:-

(a) Hernia

(b) Intestinal obstruction

237

151

JIA

IA LA

O+

2.5

Other diseases of the intestines (including intestinal infection by B. coli):

(a) Diverticulitis

(b) Other diseases of the intestines

Cirrhosis of the liver:-

(a) With mention of alcoholism

108

ོ

(b) Without mention of alcoholism

Carried forward

8.398

158

14.425

↓

5.421

4.574

5.675

4,459

112

Diseases

Brought forward

IX.-Diseases of the Digestive System.Contd.

Other diseases of the liver:-

(a) Acute yellow arophy (not associated with pregnancy (144c) or the puerperium (148c)

Cases Treated. 1948

Deaths, 1948

Government Hospitals

Government

Assisted

Hospitals

Male

8.398

14.425

5,421

Female

4.574

Male

Deaths, 1947

Female

5.675

4.459

(b) Other diseases of the liver

Billary calculi

Other diseases of the gall-bladder and bile ducts:-

(a) Cholecystitis

without record record of

biliary

calculi

(b) Others

Diseases of the pancreas (other than diabetes-61) Peritonitis without stated cause

X.-Diseases of the Urinary and Genital Systems (not Venereal, or connected with Pregnancy or the Puerperium).

Acute nephritis

Carried forward

3,562

፡

103

14.664

5.484

4.629

42 20

5.750

4.501

3- 1 N

113

Diseases

Brought forward

X.-Diseases of the Urinary and Genital Systems (not Venereal, or connected with Pregnancy or the Puerperium) -fcentul.

Chronic nephritis:-

(a) Secondary to acute nephritis

Cases Treated, 1948

Government Hospitals

Government Assisted Hospitals

8.562

14.664

5.484

Male

Deaths, 1948

Female

(b) Arteriosclerotic kidney

&-X

327

102

Nephritis not stated to be acute or chronic

224

183

Other diseases of the kidneys and ureters (not connected with pregnancy):-

(a) Pyelitis, pyelonephritis and pyelocystitis

(b) Others

Calculi of the urinary passages:-

(a) Calculi of the kidneys and ureters

(b) Calculi of the bladder

***

28*

1417

Diseases of the bladder (except tumours):-

(a) Cystitis

(b) Other diseases of the bladder

Carried forward

8.847

15.425

5,632

4.756

5.808

4.647

Male

4.629

5.750

4.501

FIL

Deaths, 1947

Female

Diseases

Brought forward

X.-Diseases of the Urinary and Genital Systems (not Venereal, or connected with Pregnancy or the Puerperium)-Contd.

Diseases of the urethra, urinary abscess, etc.:- (a) Stricture of the urethra

8.847

Government Hospitals

Cases Treated. 1948

Deaths, 1948

Government Assisted Hospitals

Male

15.425

5.832

4.756

Female

Male

(b) Others

Diseases of the prostate:-

¦ 1

| │

(a) Hypertrophy of the prostate

(b) Others

Diseases of other male genital organs (not specified, as venereal)

162

161

1 │

Diseases of the female genital organs (not specified as venereal, or connected with pregnancy or the puerperal state):-

(a) Diseases of the ovaries, Fallopian tubes and parametria

120

(b) Diseases of the uterus

246

734

932

(d) Other diseases of the female genital organs

Carried forward

9,511

16.530

5.636

4.766

5,904

4.661

Deaths, 1947

Female

5.898

4.617

115

Diseases

Cases Treated, 1948

Government

Hospitals

Brought forward

XI.-Diseases of Pregnancy, Childbirth and the

Puerperal State.

Post-abortive infection:-

(a) Spontaneous, therapeutic or of unspecified origin:-

(b) Without mention of pyelitis

9,511

(a) With mention of pyelitis

]

(b) Abortion induced for reasons other than therapeutic:-

(a) By the woman herself

(b) By other persons

Abortion without mention of septic conditions:- (a) Spontaneous, therapeutic or of unspecified origin:-

(a) With record of haemorrhage, trauma or shock

(b) Without record of haemorrhage, trauma

or shock

Carried forward

Government Assisted Hospitals

Male

Deaths. 1948

Female

Male

Deaths, 1947

Female

16.530

5.636

4.766

5.904

4.661

-N

-- |

[

9.646

16.572

5.636

4.773

5.904

4.664

116

Diseases

Cases Treated, 1948

Government

Hospitals

Brought forward

XL-Diseases of Pregnancy, Childbirth and the Puerperal State, Contd.

(b) Abortion induced for reasons other than therapeutic

9.646

16.572

106

(a) By the woman herself

(b) By other persons

(e) By persons unknown or unstated

Ectopic gestation:-

(a) With mention of infection

(b) With mention of haemorrhage but not of

infection

Haemorrhage of pregnancy:-

(a) Haemorrhage from placenta previa (b) Haemorrhage from premature separation of placenta and other accidental haemorrhage; during pregnancy (except with abortion- 141)

(e) Other and unspecifled haemorrhages of pregnancy

Carried forward

. !

Government Assisted Hospitals

Male

Deaths, 1948

Deaths, 1947

Female

Male

5.636

4.773

5,904

4.664

9.758 | 17.062

5.636

4.798

5.904

4,678

Female

117

Diseases

Government Hospitals

Cases Treated. 1948

Deaths, 1948

Government Assisted Hospitals

Male

Female

>10

Deaths, 1947

Brought forward

XL-Diseases of Pregnancy, Childbirth and the Puerperal State,-Contd.

Toxaemias of pregnancy:--

(a) Eclampsia of pregnancy

(b) Albuminuria and nephritis of pregnancy (c) Acute yellow atrophy of liver associated

(d) Other toxaemias of pregnancy

9.758

17.062

154

8.220

12,472

533

129

5.636

with pregnancy

Other diseases and accidents of pregnancy:- (a) Normal labour

(b) Other than normal labour

Haemorrhage of childbirth and the puerperium:-

(a) Haemorrhage from placenta praevia during childbirth

➖➖➖➖➖➖➖➖ - - ILI - .|---

(b) Haemorrhage from premature separation of placenta during childbirth

LII

(e) Other haemorrhages during childbirth d) Other haemorrhages after childbirth

Carried forward

18.767

29.825

5.636

LIT

4.798

10 00

5.904

4.678

། །ཆ

4.826

5,904

4,712

Female

118

Diseases

Cases Treated, 1948

Deaths, 1948

Government

Hospitals

Government Assisted Hospitals

Male

Brought forward

XI.-Diseases of Pregnancy, Childbirth and the Puerperal Stale,-'ould.

Infection during childbirth and the puerperium:- (a) General OT local puerperal infections (including puerperal tetanus) with mention of pyelitis

(b) General ΟΓ local puerperal infections (including puerperal tetanus) without men- tion of pyelitis

(d) Puerperal embolism and sudden death

18.767

29.825

-| -

5.636

ETT

Puerperal toxaemias:-

(a) Puerperal eclampsia

(b) Puerperal albuminuria and nephritis

(d) Other puerperal toxaemias

Carried forward

יוויוו

*N-

3500 | 1

| - | |

Female

Male

Deaths, 1947

Female

4.826

5.904

4.712

TEAT

TTL

18.828

29.846

5.636

4.833

5.904

4.717

| | 1 -

119

* ! ]

Diseases

Brought forward

XI.-Diseases of Pregnancy, Childbirth and the

Puerperal State,--Contd.

Other accidents of childbirth:-

Cases Treated. 1948

Government Hospitals

Government Assisted Hospitals

Male

18,828

29.846

5.636

Deaths, 1949

Female

4.833

Male

Deaths, 1947

Female

5.904

4,717

(a) Laceration, rupture during parturition or other trauma of pelvic organs (without mention of haemorrhage)

267

(b) Other accidents of childbirth

Other or unspecified diseases of childbirth and the

puerperium:-

(a) Mastitis during the puerperium & lactation (b) Puerperal psychoses

- I

111

|| !

| |

[E]

XH.-Diseases of the Skin and Cellular Tissue.

Carbuncle, boils

142

Cellulitis, acute abscess

283

1.339

Other diseases of the skin and annexa, and of the

cellular tissues

241

717

Carried forward

19.899

32.022

5,658

4.857

5,921

4.745

120

Diseases

Brought forward

XIII.--Diseases of the Bones and Organs of

Movement.

Cases Treated, 1948

Deaths, 1948

Government Hospitals

Government Assisted Hospitals

19.899

32,022

Osteomyelitis and periostitis:-

(a) Acute

(b) Chronic

R22

SAR

Other diseases of the bones, except tuberculosis

(16, 17)

Diseases of the joints and other organs of move- ment:-

(a) Diseases of the joints (except tuberculosis -17b. and rheumatism-58, 59)

(b) Diseases of other organs of movement

Carried forward

Male

Female

Male

5.658

4.857

5.921

- |

Deaths, 1947

128

20.066

32.256

5.662

4,861

5.929

4.749

Female

4.745

}

121

Diseases

XIV. Congenital Malformations,

Cases Treated, 1948

Government

Hospitals

Government

Assisted Hospitals

Brought forward

20.066

32,256

5.662

Congenital malformations:-

(a) Congenital hydrocephalus

(b) Spina bifida and meningocele

(d) Monstrosities

(e) Congenital pyloric stenosis

(f) Cleft palate, harelip

(g) Imperforate anus

(h) Cystic disease of kidney

(i) Other stated congenital malformation:-

(a) Central nervous system

(b) Circulatory system

(d) Genito-urinary system

(e) Other sites

וייו

---

(1) Unspecified congenital malformations

Carried forward

20.195

32.308

→

Male

Deaths, 1948

||-|

||-~ |

~|~ | |

5.691

Female

Male

Deaths. 1947

Female

4.861

5.929

4.749

RONN

4.883

5.956

4.765

122

ཝ།ཋ།

Diseases

Cases Treated, 1948

Government Hospitals

Brought forward

XV.-Diseases Peculiar to the First Year of Life.

20.195

Congenital debility

Premature birth (still-births excluded)

Injury at birth (still-births excluded) -

(a) Intra-cranial or spinal haemorrhage due to injury at birth-

(a) With mention of operation

(b) Without mention of operation

(b) Other intra-cranial or spinal injuries a birth:-

(a) With mention of operation (b) Without mention of operation

Carried forward

· Government Assisted Hospitals

Male

Deaths, 1948

Deaths, 1947

Female

Malc

32.308

5.691

4.883

5.956

4.765

120

217

149

198

315

181

361

353

350

393

- H

20.525 T 32.555

6.177

5.454

6.428

5.363

Female

123

Diseases

Cases Treated. 1948

Deaths, 1948

Deaths, 1947

Government

Hospitals

Government Assisted Hospitals

Male

20.525

32.555

6.177

Brought forward

XV.-Diseases Peculiar to the First Year

of Life, Contd.

Other diseases peculiar to the first year of life: (a) Asphyxia during or after birth, atelectasis (b) Intoxication due to maternal toxaemia (c) Infections of the new-born, including non- syphilitic pemphigus

LILLI

(d) Melaena neonatorum (e) Other specified diseases (including gangrene or haemorrhage of umbilicus, icterus neona- torum, acute catarrhal hepatitis)

XVI. Senility, Old Age,

241

Senility, old age:-

(a) Old age

---|-| ■

b) Senility with mention of senile dementia Senility without mention of senile dementia

Carried forward

Female

5.454

ch 17

ཝཱ།

MAN

Male

Female

6.468

5.363

121

20.784

32.761

6.279

5.571

6,554

5.469

SIS

124

Diseases

Brought forward

XVII. Violent or Accidental Deaths.

Suicide or attempted suicide by poisoning:-

(a) By solid Or liquid toxic or corrosive substances:-

Cases Treated, 1948

Government Hospitals

Government Assisted

Hospitals

20.784

32,761

Male

6.279

(a) By corrosive substances

126

(b) By analgesic and narcotic drugs

tics)

(d) By other or unspecified solid or liquid

poisons

(b) By poisonous gas:-

(a) By coal-gas, including other gases in

domestic use

JLIIIIL.-|

(b) By motor exhaust gases

Carried forward

21.007

32.785

6,299

Deaths. 1948

Deaths, 1947

Female

Male

Female

5.571

6.554

5.469

5,596

6.573

5.487

| Gw

125

Diseases

Brought forward

XVII-Violent or Accidental Deaths, Contd.

Other forms of suicide or attempted suicide:-

(a) By hanging or strangulation

(b) By drowning

(e) By fire-arms and explosives

(d) By cutting or piercing instruments

(e) By jumping from high places

(f) By crushing:-

(a) Suicide or attempted suicide on railways (b) Other suicide or attempted suicide by crushing

(g) Suicide or attempted suicide by other or unspecified means

Infanticide or attempted infanticide (infants under

1 year)

Carried forward

Cases Treated, 1948

Government

Hospitals

Government Assisted Hospitals

21.007

32.765

21.091

32,765

Male

Deaths. 1948

Female

Male

Deaths, 1947

Female

6.299

5.596

6.573

5.487

" || " |

1 1

6.310

5.505

||ין

6.590

5.486

| - | | a

120

Diseases

Brought forward

XVII. Violent or Accidental Deaths,-Contd.

Homicide or attempted homicide by fire-arms (ages 1 year and over)

Homicide or attempted homicide by cutting or piercing instruments (ages 1 year and over) Homicide or attempted homicide by other or unspecified means (ages 1 year and over) Accidents on railways (and on tramways circulat- ing on special tracks not on roads or streets), including pedestrians killed by trains victims of collisions between trains and road vehicles (motor vehicles excepted-170a)

and

Cases Treated, 1948

Deaths, 1948

Government. Hospitals

Government Assisted Hospitals

21.091

32,765

Male

6.310

Female

Male

5.605

0.590

111

FLI

Automobile accidents:-

(a) Collisions with trains

(b) Collisions with trams

1.076

Carried forward

22.510

32.765

6.310

5.605

6.593

5.498

Deaths, 1947

Female

5.496

127

Diseases

Brought forward

XVII.-Violent or Accidental Deaths,-Conti

Other road transport accidents, excluding automo- bile accidents (170):-

(a) Tramway accidents (on roads) (b) Other road transport accidents

Water transport accidents, including all accidents on or from vessels or boats of any description (except seaplanes). whether at sea, on inland waterways. in harbours or along the coast

Air transport accidents, including all accidents due to aviation

Accidents in mines and quarries

Agricultural and forestry accidents:

(a) Accidents from farm machinery and vehicles (excluding road accidents)

Carried forward

Cases Treated. 1948

Government

Hospitals

Government Assisted Hospitals

22.510

32.765

155

Deaths, 1948

Deaths, 1947

Male

6.310

BB1134

5.605

1 1

Male

Female

0.593

5.498

| |

22.775

32.765

6.310

5.605

6.593

5.498

128

Diseases

Brought forward

XVIL-Violent or Accidental Deaths. -confid

Agricultural and forestry accidents,-Contd.

(b) Injuries by animals in farming, etc.:- (a) By venomous animals (b) By other animals

Accidents caused

machinery. excluding

Cases Treated, 1948

Deaths, 1948

Deaths, 1947

Government Hospitals

22.775

Government Assisted Hospitals

Male

Female

Male

32,765

6.310

5.605

6.593

5.498

铝!

accidents due to transport (169 to 173), agricul- tural or forestry machinery (175), or in mines| or quarries (174)

Food poisoning

Accidental absorption of poisonous gases Other acute accidental poisoning (not by gas)

Conflagration

---

-----

Carried forward

--.---

22.974

32.708

6.315

5.609

| | |

6.672

11 F

5.553

! 1 !!

129

Diseases

Brought forward

XVII.-Violent or Accidental Deaths, Contd.

Government Hospitals

22.974

Government

Assisted Hospitals

Cases Treated, 1948

Deaths, 1948

Deaths. 1947

Male

32.798

6,315 5.609

Female

Unknown Sex

Accidental burns (conflagration excepted)

Accidental mechanical suffocation

Accidental drowning

Accidental injury by firearms

255

105

Accidental injury by cutting or piercing instru-. ments

133

3 i

]

Accidental injury by fall, crushing landslide, etc.

868

ït

173

210

Cataclysm

Injury by animals

Hunger or thirst

Excessive cold

Carried forward

24.384

33.072

6.684 5.841

7.005

5,663

! Male

Female

6.672 5.553

130

Unknown

Sex

Diseases

Government Hospitals

Cases Treated. 1948

Deaths, 1948

Deaths, 1947

Government Assisted Hospitals

Brought forward

XVIL-Violent or Accidental Deaths, Contd.

Excessive heat

24,384

33,072

6.684 5.841

Lightning

-----

Other accidents due to electric currents

Attack by venomous animals

Other accidents:-

(a) Vaccina and other sequelae of vaccination against smallpox

(b) Other accidents due to medical or surgical intervention:-

(a) Anaesthetic accidents

(b) Other accidents

~ | | |

| Male

Female

| 1

| Unknown : Sex

(d) Other and unspecified accidents

286

Carried forward

24,698

33.075

0.714 5.847

7.021 3,673

Male

Female

7.003 5.663

'Unknown

Sex

Diseases

Brought forward

XVII-Violent or Accidental Deaths.-Contd.

Injuries of persons in military service during operations of war:-

(a) From poison gas

(b) From wounds

יווו--1----ויוי

Injuries of civilians due to operations of war:--

(a) From poison gas

(b) From wounds

Legal executions

XVIII.-I]]-defined Causes.

Sudden death

| | | │

| Son

Government

Hospitals

Cases Treated, 1948

Deaths, 1948

Deaths, 1947

Government

Assisted Hospitals

Male

Female

24.698

33.075

6,714

5.847.

Unknown Sex

Male

Female

7,021 5.673

5.673

| | │

11-

།།། ༄

Carried forward

24.736

33.075

6.733

5.847 51

7.035

5.677

Unknown

132

Diseases

Brought forward

XVIII.-Ill-defined Causes,-Contd.

Persons accompanying patients

Total

Cases Treated, 1948

Government

Hospitals

Government Assisted Hospitals

: Male

IT'

Deaths, 1948

Deaths. 1947

Female

Unknown

Sex

24.736

33.075

6.733 5.847

7.035

5.677

Causes unstated or ill-defined:-

(a) Ill-defined causes

144

343

400

(b) Found dead, cause unknown

178

181

causes

XIX.-Miscellaneous.

Under observation

Malingering

336

157

25.217

33.272

7,104

6,269

7,294 5,911

Male

Female

Unknown

Sex

133

131

ANNEXURE K.

OBSTETRIC REPORT ON THE TSAN YUK HOSPITAL

FOR THE YEAR 1948.

The following statistical summary shows the amount of work done in the Tsan Yuk Hospital for the year 1948:

Booked

Unbooked Total

Adult Patients admitted

3,699

1,131 4,830

Patients delivered in hospital:

JL J

3,491

1,058

4,549

Primi parae

Multiparae

Patients admitted after delivery

1,124

281

1,405

2,367

3,144

(B.B.A.)

Primiparae

]

Maternal deaths

Multiparae

Total patients delivered

Abortions

Patients transferred

Patients discharged undelivered

Maternal death rate (per 1,000 live

and stillbirths)

Infants born in hospital

Infants born before admission

3.497

1,060

4,557

202

272

1.9

0.4

LILL

3,524

1,069

4,593

(B.B.A.)

Total infants born

JL J

3,530

1,071

4,601

Infants transferred

Stillbirths (including macerated

foetus)

135

Stillbirth rate (per 1,000 live and

stillbirths)

21.00

57.06

29.39

Neonatal deutlis

Neonatal death rate (per 1,000 live

births)

9.86

26.79

13.68

Other infant deaths

The following points of interest are noted:

Pre-eclampsia.

There were 110 cases with no maternal death

and 6 stillbirths and 3 neo-natal deaths.

Eclampsia. There were 8 cases with no maternal death, I stillbirth and 1 neo-natal death.

Placenta Praeria. There were 25 cases with no maternal death, 5 stillbirths and 4 neo-natal denths,

135

Accidental Haemorrhage. There were 15 cases with one maternal death and 7 stillbirths.

Abnormal Presentations were as follows:

Tainl

Maternal

Sul.

Meninatal

Presentations

Number

Deatha

birth.

Deathe

Persistent Occipito Posterior

TI 1

Uncomplicated Breech

108

Complicated Breech

Face

Brow

Transverse

Twin Pregnancy.

There were 44 cases with no maternal

death, 3 stillbirths and 9 neo-natal deaths.

　　Contracted Peleis. There were only 6 cases, with no maternal death and oue neo-natal death.

　　Prolapse of Cord. There were 11 cases with no maternal death and 8 stillbirths.

Post-partum Haemorrhage. There were 58 cases with no maternal death.

Operative deliveries were as follows:-

Operation

Forceps

Internal Version

Embryotomy

Caesarean Section

Matemat

Carca

Dulhe

SCAL- birthe

Neo-natal Devika

　　Maternal Deaths. There were only two deaths during the course of the year. One was due to severe concealed accidental bleeding with shock and heart failure, the other was due to shock and heart failure following obstructed labour in a hydrocephalus which was sent in by a midwife with the body hanging outside.

case of

Maternal Morbidity. There were 12 cases of genital infection and 91 cases of extra-genital infection, with no death. The computation of the maternal morbidity figure on the total number of 103 cases works out at 2.25%.

　　Stillbirths and Neo-natal Deaths. There were 135 stillbirths (i.e. children born at or after the 28th week of pregnancy who failed to breathe after birth),

136

In addition there were 61 neo-natal deaths (i.e. deaths within 28 days of delivery, either in hospital or after transfer to another hospital, but excluding those discharged healthy). It is of interest to note that 51 of these 61 deaths were in cases of premature live-born infants, with a birth weight under 5 lbs. or 2,300 grams.

　　　　The year's figures showed 2.94% stillbirths and 1.37% neo-natal deaths, making a total wastage of infant life of 4.31%, which compares very favourably with that of previous years.

Sgd. GORDON KING, Consultant to the Government. Prof. of Obstetrics and Gynaecology.

University of Hong Kong.

137

ANNEXURE L.

A SUMMARY OF THE WORK DONE AT THE KOWLOON AND HONG KONG PUBLIC MORTUARIES.

1948.

Total number of Post-mortem Examinations performed

during the year

No. of male bodies examined

No. of female bodies examined

Sex unknown owing to decomposition

No. of claimed bodies sent from hospital, etc.

No. of unclaimed bodies mostly abandoned

Body of infants sent from Convent

No. of bodies cremated

No. of Chinese bodies examined

No. of Non-Chinese bodies examined No. of bodies Nationality unknown. No. of Medico-Legal Cases

2,973

1,522

1,394

563

2.410

500

412

2,937

461

Male

Female

Total

870

1,011

1,881

652

383

...

1,035

LII

No. of bodies under 2 years of age No. of bodies over 2 years of age No. of bodies received from the following sources :-

(Hong Kong)

Victoria District

Shaukiwan District

Other Villages

763

111

Total

906

(Kowloon)

Water Police Station

Tsim Sha Tsui Police Station

Yaumati

Mongkok

Shumshuipu

Kowloon City

Hunghom

Taua Wan Sheung Shui

Sha Tau Kok

Tai Po

Shatin

Ta Ku Ling

Castle Peak

Ping Shan

Lok Ma Chan

Kam Tin

Tai O

Cheung Chau

Sai Kung

Hospitals, etc.

ᅡ

יי

་་

יי

184

151

140

268

LJ ----

133

3 13

3 979

Total

2,067

138

No. of rats caught and brought to the mortuaries

191,096

No. of rats examined

191,096

No. of rats spleen smears taken for examination No. of rats infected with plague

12,679

Nil.

ANNEXURE M.

ANNUAL REPORT OF MALARIA BUREAU.

Notification of Malaria.

The arrangement by which Malaria was notified voluntarily by doctors ceased in May 1948 and as a result accurate figures. are no longer available.

Staff.

The staff of the Malaria Bureau was made up of 1 Malariologist, 5 grade I Inspectors, 2 grade II Inspectors, 3 Probationer In- spectors and 2 Health Inspectors who were seconded to the Bureau in March, 1948. Dr. J. B. Mackie departed to attend the 4th International Congresses on Tropical Medicine and Malaria at Washington us a Government Observer in April 1948. He returned to the Colony on December 11th, 1948. During his absence Dr. G. B. Smart was in charge of the Malaria Burenu.

Field Work.

Rough training of streams, stone drainage, clearing, subsoil drainage, and oiling were the methods used. In addition a cheap experimental form of rough concrete training was carried out in the Deep Water Bay Valley, and if this proves successful, it may be possible to extend it to other areas.

The R.A.F. have withdrawn their field work at the Airport on instruction from British Government, and the complete control of this district has been taken over by the Malaria Bureau.

Owing to the extensive excavation of land and large increase in building in all areas, control work was made more difficult. but no breakdown ovenrred. In addition to these larval control measures the Chinese villages of Sai Wan, Pokfulam, Telegraph Bay and Ngan Chi Wan, on the outskirts of our control area, were residually sprayed with D.D.T,

Malarial Surveys.

No malarial surveys were undertaken during the year, but checking larval surveys were periodically carried out in all areas. In addition periodic checks of incoming trains, lorries and aircraft

were carried out.

139

Laboratory.

　　In the present office of Malarin Bureau it has not been possible to put up a good insectary on account of the heat, but with the removal to a cooler level this will be done. Blood films as well as mosquito larvae and adults were examined, and the results of the examination are appended. The Identification of beetles, moths and flies was undertaken for other Departments, The results of identification of mosquitoes and larvae can be seen in Annexures M2 and M3.

New Territories.

Un-

　　Work continued to increase in the New Territories. Government Quarters and offices were sprayed with DIT. fortunately for the occupant in some cases, full advantage could not be taken of this measure on account of the poor state of the screening, or in some places, its complete absence.

Suppressive Paludrine (100 Mgm, twice weekly) for the second year again proved its efficiency in the protection of the European and Chinese Police, who are, of necessity in their work, exposed to considerable risk. So much so, that the Chinese Police on Government Mepacrine, in some places, changed over to Paludrine at their own expense. Both as a suppressive and from an administrative point of view Palndrine is superior to Mepacrine.

　　With the southward advance of the Communista there was an influx of non-immunes, both European and Chinese, into the New Territories. Notably the

the Auierican Seventh Adventist Mission who moved down two whole schools and their entire European and Chinese Staff, A complete blood parasite survey of these schools (some 500 people) was undertaken, and as expected coming from the north, were negative for Malaria.

　　Advice, which they have been quick to take, has been given them on the best methods of screening their buildings which ul necessity were makesnitt, and on the use of residual Gammexane and suppressive Paludrine.

A further influx has come in the Tsun Wan area where a large number of factories have been built. Alaiaria in these work people has been controlled with suppressive raiudrine, and an endeavour has been made to obtain tae co-operation of the owners in a combined housing scheme for the labour force which would be reasonably cheap to protect by anti-iarval measures,

　　Residual DDP and Gummexane have been proved most effective in reducing the mosquito catches in houses in the rural districts, but their future as a preventive measure in rurai malaria depends on their ultimate enect on the blood parasite rate and the incidence of malaria, and in this respect much more work has to be undertaken in each maisrious area of the world to determine the night-resting and feeding habits of the cairying species. this connection experiments in mosquito trapping in selected majarious districts in the New Territories to determine the habits of our local carrying species are now being undertaken-this work will take some time.

140

Experiments were also carried out in order to determine whether malaria could be controlled in villages in the New Terri- tories by monthly fumigation of dwellings with Gammexane, using Gammexane Smoke Generators.

The insecticidal action of Gammexane smoke is by direct kill and by the effect of the residue deposited on walls and ceilings of rooms after fumigation.

The three villages of Shum Tseng, Pok Wai, and Chuk Yuen were selected for the experiments with Chuk Yuen acting as a control. The parasite rate was taken as an index of the degree of malaria infection in each of the three villages and was deter- mined at the onset and termination of the experiments i.e. in May and December. Mosquito catches were carried out each month in order to determine the vector species in the respective villages and the effect of Gammexane on the mosquito population.

The dosage of Gammexane employed was a 2 oz. Generator per 4,000 cu. ft. of room space, but this dose was often exceeded; on the other hand, the proper sealing of rooms for 2 hours after fumigation could not always be ensured.

In view of the short period over which the experiments were conducted viz. one malarial season, it was decided to accept as significant only marked reductions in the parasite rates. Mosquito Catches.

A. hyrcanus var. sinensis was the predominant anopheline species in all these villages and was found mainly in pigsties. Á. minimus and A. jeyporiensis var, candidiensis, the two important vector species in the Colony, were found in small numbers in Shum Tseng and Pok Wai but not in Chuk Yuen. A few A. tessellatus were caught only in Pok Wai Village.

י י - -

Pok Wai Shum Tseng Chuk Yuen

Parasite rate (May, 1948)

Parasite rate (Dec., 1948)

NIL.

1.16%

16.6 % 18.9%

21.2 %

Malaria Parasites.

9.12%

Plasmodium vivax was the only species of malarial parasite encountered in blood films when determining parasite rates. Conclusion.

The conclusion drawn from the experiments is that the Gammexane Smoke Generator is unlikely to prove successful in controlling Malaria in Malaria endemic areas unless supported by other control measures.

On the other hand, the experiments proved that Gammexane Smoke is a powerful insecticide, although the residual effect after fumigation is not as lasting as that obtained by spraying with solutions of Gammexane or DDT. Bug infestations were eradicated and fly and mosquito nuisances were controlled for short periods in the two villages subjected to Gammiexane fumigation.

141

A larval survey carried out in November in hill-streams near the villages of Tau Yuen Wai and Foo Tau in the Ping Shan area gave the following result:-

A hyrcanus var. sinensis 147. A. minigus 24, A.

maculatus 3.

The two villages combined showed spleen and parasite

rates of 31% and 25% respectively.

A larval survey carried out in December in the hill-streams near Chung Uk Village, gave the following result:-

A. maculatus 98, A. karwari 55, A. hyreanus var, sinensis 121, A. jeyporiensis var. candidiensis 4, and A. minimus 52

　　The village showed a spleen and parasite rate of 48.7%, and 0% respectively.

Teaching of Mosquitology.

　　A course of twenty Lectures on this subject was given fo Public Health Tuspectors together with Field and Laboratory Demonstrations, Personuel of the Army and Navy were also given a course of instruction in Anti-Malaria Work, and arrange- ments have been made with the 'niversity to recommence the course in Malariology for the M.B. Ch.B.

Legal Action.

Sixty legal notices were served in the course of the year for Dosquito breeding, and two people were summoned.

Mosquito Nuisances.

Mosquito nuisances were investigated on behalf of the Urban Council at Eastern District, Central District, Upper Level. Pokfulam, Aberdeen, Stanley, Shek 0. Tytam Tuk, Shaukiwan, Kowloon City, Kowloon Tong, Kai Tak, Lai Chi Kok. Hung Hom, Yaumati and Tsim Sha Tsui,

Syd. J. B. MACKIE, Government Mulariologist.

142

ANNEXURE MI.

Malaria Cases notified by tovernment Hospitals and

Dispensaries and

Deaths from Malaria recorded by the Registrar

of Births and Deaths, during 1948.

Month.

Cases.

Deaths.

January

February

March

April

May

June

July

. т.г. ..... 1

August

LILL JL

238

September

103

October

147

November

---

December

1.115

190

January

February

March

April

May

June

July

Augus!

September

October

November

December

Month

A. maculatus

A. minimus

A. jeyporiensis

var, candidiensis

ANNEXURE M2.

RESULT OF IDENTIFICATION OF MOSQUITOES, 1948.

A. hyrcanus

var. sinensis

A. karwari

C. fatigans

Ae. albopictus

many

Ae. togoi

C. bitaenio-

rhynchus

→

143

Ar. obturbans

Month

A. maculatus

4 11

! A. minimus

A. jeyporiensis

var. candidiensis

ANNEXURE M3.

RESULT OF IDENTIFICATION OF LARVAE. 1948.

A. hyrcanus

· var, sinensis

A. karwari

C. fatigans

January

134

February

March

211

כי

many

LLLLL

many

1. JU

many

April

many

May

many

June

many

July

[

many

August i

many

September

many

October

many

November

147

many

December

101

many

C. bitaenio- rhynchus

Ae. albopictus

- 144

Ae. togoi

145

ANNEXURE N.

ANNUAL REPORT OF THE GOVERNMENT LABORATORY

FOR THE YEAR 1948.

　The work of the Laboratory continues to show a steady increase. A comparative table of samples examined is given (Table 1).

TABLE 1

1947.

1948.

(i) Waters & Waterworks Chemicals

897

680

JLIJLI

(ii) Foods & Drugs

(iii) Chemico-legal

(iv) Commercial

(v)

Biochemical

JILLJI

آتا

400

607

2,014

1,886

360

8,056

(vi) Coal from Department of Supplies,

Trade & Industry

101

г. гг -

(vii) Miscellaneous from other Government

Departments

173

3,874

6,609

　(i) Under this heading are included the routine examinations of the reservoirs and filter beds of the Colony water supply, daily samples from supply taps in various parts of the Colony, and samples from waterboats supplying shipping in the harbour.

　(ii) Food samples consisted principally of milk, for control of pasteurisation, but cases were found of butter substitutes being sold as butter, and arachis oil being sold as olive oil.

Table 2 shows the considerable range of material examined under this heading. There were no cases of homicidal poisoning.

A disastrous outbreak of fire occurred at the Wing On Com- pany Godown, as a result of which nearly 200 persons lost their lives. Mr. R. C. Terry, Assistant Government Chemist, carried out a detailed investigation into the cause of this fire, which was traced to the spontaneous combustion of washed nitrocellulose film. At the Commission of Enquiry which was set up both the Government Chemist and Mr. Ferry gave evidence.

The same material is believed to have caused another fire in a godown in the Colony.

　A dangerous commodity which was discovered during these investigations was crude caustic soda containing a large quantity of metallic sodium, sufficient to cause ignition when the material was placed in water.

1-16

TABLE 2

Chemico-Legal Analyses.

Toxicological Examinations (including postmortem

materials from 46 persons)

Urine and Blood for Alcohol determination

Articles connected with:

Acid-throwing

Bombs & Explosives

Collapse of Building

Firearms

Fraud

Illegal practising of Western medicine

Larceny

Licensing Laws

Medicines, Druga & PoisoTES.

Uutbreaks of Fire

Smuggling

Stains on clothing etc.

י...

255

119

GOT

147

TABLE 3

Toxicological Examinations.

No Poison present

Opium

Phenolic or Cresolic Compounds

Alcohol

Aspirin

Barbiturate

Calcium chloride

Calcium oxalate

Camphorated oil

Caustic Alkali

Crayon

Dyestuff

Fungi

Gasoline

Hydrochloric acid Hydrocarbon oil Hyoscyamine

Kai Po Yue Fish Magnesium sulphate Mercury

Methylene blue

L-L

LJ L

Morphine

Oxalic neid

Soap

Strychnine

Sulphuric acid

Thiamin

Yohimbine

Miscellaneous

וי,

255

(iv) Commercial samples form the largest single item of the work of the Laboratory. Fees collected have increased from $106,601 to $118,811, making a total of $262,844 since the war. It is unusual for a Government Laboratory to concern itself to this extent with consulting work, but this is necessitated by the absence of adequate private laboratories, and by the abnormal trading conditions. Table 4 gives details of the samples submitted.

148

TABLE 4

Commercial Samples.

Minerals & Metals:-

Aluminium

Aluminium silicate

Antimony

Antimony oxide

Asbestos

Beryl

Bismuth concentrate & ores

Brass, Bronze & Gunmetal

('bromite

Clay & Kaolin

Coal

Cobalt

Copper

Copper concentrate

Felspar

Fluorspar

Ferro-Manganese

Ferro-Molybdenum Ferro-Tungsten

Gold Graphite

Iron ore Iron oxide

Lead & Lead ores Manganese ore Magnesium Molybdenum

Molybdenum concentrate

Nickel

Pewter

LIL

Plated metal sheets

Quartz

Scheelite

Silver

Solder

IL JI

Talc

Tin

...

Titanium ore

244

PIL

Titanium dioxide

Tungsten

Tungsten concentrate

Wolfram ore

Zinc concentrate & ores

Zirconium

(Minerals & Metals, Total) C//

662

Oils & Fats:

149

TABLE 4

Commercial Samples,-Contd.

(Minerals & Metals, Total) B-J.

Aniseed oil

Camphor oil Cassia oil

Citronella oil

Clove oil

Coconut oil

Fuel oil

Groundnut oil

Isuborneol

Lard

Linseed oil

Lubricating oil Olive oil

Palm oil

L-LI

Paraffin Wax Peanut oil Peppermint oil Petrol

Rapeseed oil

Rosin

Stearine

Stillingia oil

Safrol

Soyabean oil Tallow

Teaseed oil

Terpineol Wood oil

Miscellaneous : -

Battery acid

Camphor

C'ement

Chemicals & Fertilisers

Chinese Luequer

Copra & Oil Cake

Firecrackers

Food-stuffs

Formaldehyde

Gallnuts Medicine

י.

Paints, Varnishes. Dyestuffs etc. Soap

Steamer Tanks

Water

Total

662

164

279

1,886

יוויווי

150

TABLE 4,-Contd.

Fees collected for commercial analyses

Fees collected for biochemical analyses

$116,421

2,390

$118,811

(v) The apparently sudden development of biochemical work is accounted for by the fact that the figure shown for 1947 was for November 1947 and December 1947 only. Private practitioners have made considerable use of the facilities provided.

TABLE 5

Biochemical Examinations.

Specimens received:

Bile

Blood

PILI.

Cerebro-spinal-fluid

Gastric eontents

Stool

Urine

Miscellaneous

Received from:

Anti T.B. Clinic Families' Clinic

Kowloon Hospital

Lai Chi Kok Hospital

Medical Post (Central Police Station)

Private Practitioners

Queen Mary Hospital

Sai Ying Pun Hospital

Tsan Yuk Hospital

Tung Wah Eastern Hospital

1.028

300

1,657

3,056

720

200

2,032

3,056

(vi) There has been a slight increase in the use made of the Laboratory by other Government Departments, although much of this resulted from the number of samples examined for the Fire Brigade following on the Godown fires referred to in para. (iii).

151

TABLE 6

Miscellaneous samples from Government Departments.

Samples from: --

Agricultural & Gardens Department

Controller of Stores

Fire Brigade Department

General Post Office:

Telecommunications Branch

Imports & Exports Department

Kowloon Canton Railway

Marine Department

Medical Department:-

Central Medical Stores

Health Officers & Inspectors

Medical Department Headquarters

Queen Mary Hospital

Slaughter House

Urban Council

Prison Hospital

100

= -1

り

NN - S

Public Works Department:

Building Ordinance Office

Electrical & Mechanical Office

Supplies, Trade & Industry Department

Staff.

　Mr. J. Redman, Government Chemist, proceeded ou leave ou 3rd March, 1948 and returned to duty on 8th March, 1949. Mr. D. E. Davis acted as Government Chemist during this period.

　Mr. E. Collins, Assistant Government Chemist, was seconded to the Imports & Exports Department during the same period.

　Mr. R. C. Terry, Assistant Government Chemist, joined the staff on 24th January, 1948.

　Mr. R. G. Barradas, Laboratory Assistant, was awarded a Colonial Welfare & Development Scholarship, tenuble for four years at Liverpool University, and left for the United Kingdom on 2nd August, 1948,

Government Laboratory, Hong Kong.

8th April, 1949.

Sgd. J. REDMAN.

J. REDMAN, B.Sc.Tech., A.M.C.T., F.R.L.C. Government Chemist.

152

ANNEXURE O.

ANNUAL REPORT OF THE GOVERNMENT PATHOLOGIST 1948. (1) Introductory.

This report deals with the activities of the Institute in Hong Kong, the branch in Kowloon, and the Queen Mary Laboratory. Throughout the year equipment, supplies, and technical books continued to arrive, making routine work casier to perform and enabling progress to be made in many directions.

Rewiring of the Institute and overhaul of all electrical installations were commenced in May and completed by the end of the year, when all the necessary fittings became available; in June the Gardens Department instituted regular attention to grass plots, shrubs, and surroundings; and by the end of March 1949 the buildings were renovated and painted throughout, with remarkable effect.

At the Queen Mary Hospital, the laboratory was moved into new quarters towards the end of the year and although somewhat cramped for space is serving the needs of the hospital well under the part-time direction of Dr. K. T. Luke.

The Kowloon branch continued to function with Dr. R. E. Alvares in charge, and has proved a most useful focus for Kowloon, both as regards routine laboratory examinations and as a centre for the distribution of vaccines. Repainting was carried out in the spring of 1949.

By arrangement with the Agriculture Department part of the animals housed in unsatisfactory quarters in the Institute, comprising rabbits, sheep, guinea pigs and mice, were removed to a far more suitable location in the New Territories for breeding and stock purposes.

Analysis of the nightsoil held in the so-called maturation tanks at Castle Peak revealed that the extremely high concentration of ova constantly present in this material showed little change after a month in the tanks, Clonorchis and Ascaris being especially prevalent and Ankylostoma proving to be demonstrably viable. Bacteriological findings for pathogenic organisms were negative, but are still under investigation.

Revenue for the period under review exceeded estimated revenue by $33,000.

The following were the more important additions to the library:

Gynaecological & Obstetrical Pathology-Novak.

Disorders of the blood-Whitley & Britten.

Handbook of Practical Bacteriology-Mackie & McCartney. Forensic Medicine Keith Simpson.

Medical Jurisprudence & Toxicology-Glaister.

Pathology of Tumours-Willis,

Textbook of Clinical Pathology-Parker.

153

　Staff Changes-Dr. K. T. Loke was confirmed in the post of Pathologist during the year. New appointments included Messrs. Shum Hay, laboratory assistant, Ko Jak Wai, attendant, Foug Kam, watchman, and Chan Ho, coolie. There were two resigna- tions-Poon Ting Kam, attendant, and Lee Sik, coolie.

N.B. The figures in the following tables include those of the Kowloon and the Queen Mary Hospital branches. Allocation of the work performed is shown separately in the Summary at the end of this report.

(2) Protozoology and Helminthology.

2. Blood films for malaria-Five thousand and fifty-five films were examined for the parasites of malaria. Classification of types found and negative findings are shown in the table.

TABLE I

Blood Examined for Malaria.

Chinese

Non- Chinese

Total

Sub-tertian

266

269

Benign-tertian

324

344

Quartan

152

Unclassified (Type undetermined)

Multiple infection

Negative

4.027

218

4.245

Grand Total

4.814

241

5.055

3. Filaria-Microfilarial parasites were found in five cases.

　4. Anthrax-Infection with B. anthracis was established in 19 instances of blood films taken from sick animals.

5. Faeces-Ten thousand six hundred and eleven stool specimens were examined for parasites, ova, or cytological picture. Using concentration methods on bulk specimens from night soil tanks, it would appear that infection with Clonorchis is almost as common 68 Ascariasis in this area.

- 154

TABLE II

Examination of Stools for Intestinal Parasites.

Chinese

Non- Chinese

Total

Ascaris

1.851

121

1.972

Clonorchis

306

312

Trichuris

Ankylostoma

Enterobius

563

597

323

332

ILI

Taenia

Fasciotopsis

Schistosoma

E. histolytica

Multiple infestation

1.303

1.321

Negative

5.082

892

5.974

Grand Total

9.518

1.093

J0.611

(3) Haematology.

Most of this work is carried out at the Queen Mary Laboratory and the Kowloon Branch, as shown in the Summary.

TABLE III

Hb. percentage

2.542

Total Red Cell Count

2.589

Total White Cell Count

3.100

Differential Count

3,906

Blood Sedimentation Rate

1,125

Blood Bleeding Time

Blood Coagulation Time

Platelet Count

Reticulocyte Count

Blood Grouping

Cross-Matching

681

177

Grand Total

14.277

155

(4) Serology.

　6. The Kahn reaction-Thirty-eight thousand, seven hundred and twenty-five sera were tested. This figure is again an annual record and can rightly be interpreted to mean unremitting hard work and responsibility on the part of the staff concerned.

TABLE IV

Examination of Blood Sera for Syphilis.

Chinese

Non-Chinese

Total

Strong Positive

3,052 2,497

Positive

1.698

920

Weak Positive

1,154

1.089

TNA

5,572 2.629

2.249

Doubtful

1.006!

938

1.947

II JL

Negative

13.114

12.591

518

105

26.328

Grand Total

20.024 18.035

554

112

38.725

7. Agglutination tests-One thousand six hundred and forty sera were examined for the presence of agglutinins against various organisms.

8. Blood Clot Culture Culture of the clot from agglutina- tion specimens was carried out as a routine from January 15th, and the positive findings at the Institute, which included 47 Bart. typhosum, 3 Baet. paratyphosum A, 1 paratyphosum B, and 1 paratyphosum C, often threw an interesting light on the agglutina- tion results. The para. culture, kindly confirmed by the Salmonella Reference Laboratory in London, represents the first known case of para. C infection in Hong Kong since the war.

рага.

TABLE V

Agglutination Tests.

Chinese

Non-Chinese

Total

Organisms

Doubt-

Pos. Neg. ful Pos. Neg.

Doubt- ful

Bact. Typhosum

223 899 19

to ta

1.275

Bact. paratyphosum A. 13

Enteric fever,

type undetermined

Br. melitensis

Br. abortus

LITI

Weil Felix reaction

B. 5

11 310

Grand Total

351

1,555

1.640

156

(5) Bacteriological Examinations.

9. Freces-Eight hundred and fifty-six stools were cultured for pathogenic organisma. No case of cholera was discovered.

TABLE VI

Examination of Stool for Organisms.

Bact, typhosum

dysenteriae (Group)

Cytology typical of

bacillary dysentery

B. dysentery (Flexner)

V. cholerae

(Shiga)

Chinese

Non-Chinese

Total

Pos. Neg.

Pos.

Neg.

402

3 1 275

NIN

457

305

Grand Total

731

4 1

856

10. Sputum-Eleven thousand and thirteen sputa were examined for the presence of the tubercle bacillus. In addition, culture and animal inoculation were called for in a few instances, as shown below, while gastric lavages for tubercle bacilli reached the high figures of seven hundred and thirty-six with eighty-three positive results.

TABLE VI|

Examination of Sputa for Tuberculosis.

Direct examination Culture

Animal inoculation

Chinese

Non-Chinese

Total

Pos. Neg.

Pos.

Neg.

4.396 2

6.158

165

267

10.986 20 7

Grand Total

4.399

6.179

165

270

11,013

―

157

　11. Urine-One thousand two hundred and sixty-two speci- mens were cultured for pathogenic organisms,

12. Urethral and cervical smears-One thousand two hundred and thirty-three specimens were examined for the presence of the gonococcus, with 95 positive results.

　13. Nasal smears, etc. for M. leprae-One hundred and forty-nine examinatious were made for the detection of this organism. 36 positive results were recorded.

　14. Throat swabs-One thousand eight hundred and eighty- seven swabs were cultured for C. diphtheriae.

TABLE VIII

Examination of Throat Swabs for Diphtheria.

Positive

Negative

Chinese

Non- Chinese

Total

165

LIL-

171

1.610

106

1.716

Grand Total .........

1.775

112

1.887

　15. Cerebrospinal fluid-Four hundred and seventy speci- inens were examined for the presence of pathogenic organisms.

TABLE IX

Examination of Cerebrospinal Fluids for

Pathogenic Organisms.

Meningococcus

Pneumococcus

M. tuberculosis

Negative

Chinese

Non- Chinese

Total

403

407

Grand Total

465

470

158

16. Rat spleen smears-Twelve thousand six hundred and seventy-nine examinations were made of smears for 1. pestis. No positive findings were recorded.

(6) Clinical Pathological Procedures.

17.

Irine examination-Eleven thousand four hundred and ninety-two routine, chemical and microscopic examinations of urine were carried out.

18. Friedman test for pregnancy-Seventy-seven such tests were performed. Owing to the abnormal demand and limited number of suitable rabbits, operation was resorted to in all cases, and whilst the average number of operations per animal was four, some rabbits were able to withstand successfully six laparotomies.

19. Miscellaneous tests--Two thousand one hundred and forty-nine tests of an unclassified nature were carried out.

(7) Preparation of Vaccine lymph.

20. Buffalo calves were used exclusively. A smaller quantity of lymph was prepared this year, sufficient to maintain stocks at satisfactory level, and there was no particular difficulty in obtaining the number of calves required.

(8) Preparation of Vaccines.

21. Cholera vaccine-Stocks were in process of preparation at the end of the year. The main difficulty in this branch has been lack of adequate refrigeration space in which to store the vaccines ready for use.

22. Antirabic vaccine-The 56 litres of antirabic vaccine prepared is once again a record figure. In the absence of sheep, goats were used, and the vaccine issued continued to be of the Semple type in 4% & 2% dilutions.

TABLE X

Cases Treated with Antirabic Vaccine.

Chinese

LI-

Non-Chinese

------

Treatment not completed

Treatment completed

Total

856

703

1.559

114

Grand Total

900

764

1.673

Anti-smallpox vaccine

cholera

T. A. B.

Plague

Rabic

- L

}

---

150

TABLE XI

Vaccine Production.

Vaccine issued

23.768 c.c.

Vaccine prepared

22,450 c.c. (In process of manufac- ture)

347.233 c.c.

22.680 c.c.

---

3,773 c.c.

-1

32.042 c.c. (2%)

38,110 c.c. (2.)

...

18,570 c.c. (4%)

18,570 c.c. (40)

Grand Total

---

448.066 c.c.

79,130 c.c.

(9) Examination of Water and Milk.

23. Water-Two thousand four hundred and thirty-seven samples of water from various sources were examined.

Unfiltered raw water

Filtered

TABLE XIE

248

244

Filtered and chlorinated water from service tap... 1,899

Well water

Water other than public supplies

Total

2,437

24. Bacteriological Analysis of Milk and Foods-One thou- sand one hundred and four examinations of milk were performed, chiefly at the instance of the Health Division. Nine hundred and twenty one examinations of a miscellaneous nature were also carried out as shown.

Milk

Ice-cream

Popsicle

Acrated water

Tinned food

160

TABLE XIII

Total

1,104

645

163

103

ILJ IL·L➖➖➖

2,025

(10) Morbid Histology.

25. There were seven hundred and three examinations of tissue made during the year. Tumours, both benign and malignaut, total two hundred and sixty-five. Carcinoma of the cervix, secondary carcinoma in lymph glands of the neck, (most cases due to nasopharyngeal growths) and carcinoma of the breast, continue to head the list of maliguant tumours in that order. The rest of the examinations were made for general pathological diagnosis and they include among others the following interesting

cases:

Hashimoto's disease, Schistosoma ova in the spleen, Filaria in a lymph gland, tuberculosis of the cervix, gumma of the brain and Spirochaeta pallida in the liver of a three months' old child.

26. Negri bodies-Thirty-five brains were examined for the presence of Negri bodies. There were two positive human cases, one resident in Shaukiwan, and one who was bitten in Canton and is therefore an imported case.

TABLE XIV

Brains Examined for Negri bodies.

Human brains

Dogs'

Positive Negative

Total

Fibroma

Lipoma

161

TABLE XV

Tumours Examined.

Endothelioma

Angioma

Lymphangioma

Nasal polyp

Rectal polyp

Uterine polyp

Cervical polyp

Fibroadenoma of the breast Fibromyoma of the uterus

cervix

Adenomyoma of the uterus Mixed salivary tumour Squamous papilloma

...

LILL

Cases

Sarcoma

Lymphosarcoma

Osteogenic sarcoma

(riant cell tumour (osteoclastoma)

Secondary carcinoma of cervical lymph gland

Carcinoma of nasal cavity

וי

nasopharynx lung mouth

oesophagus

liver (hepatoma)

Carcinoid tumour of the appendix

Carcinoma of rectum

lymph gland (other regions)

anus

breast

uterus

ILLJLI

cervix

...

Ovary penis

г.

testis (seminoma)

skin

Embryoma (Wilms' tumour)

Melauoma

Adamantinoma

Chorionepithelioma

Hydatidiform mole

Cysts of the ovary

(malignaut) broad ligament

Nature of Examination

TABLE XVI

Summary of Examinations.

Pathological Institute

Queen Mary!

Hospital Laboratory

Kowloon Pathological Institute

Total

Blood smears

Bact. typhosum

paratyphosum A

1 mine

Agglutination

reaction

Enteric fever, type undetermined

Br. melitensis

Br. abortus

| Weil Felix reaction

Serological reaction for syphilis

Malaria

Filaria

Kala-azar

845

430

1.275

224

127

351

38.725

38,725

2,285

1,021

1.749

5.055

B. anthracis

Hb, percentage

2.049

493

2.542

Total Red Cell Count

2.061

506

2.569

Total White Cell Count

2,280

906

3.188

Differential Count

1.204

1,861

811

3.906

Haematology Blood Bleeding Time

Blood Sedimentation Rate

1,005

119

1.125

❘ Blood Coagulation Time

Platelet Count

Blood Grouping

Reticulocyte Count

173

451

681

Cross-Matching

158

177

Naso-pharyngeal swabs (C. diphtheriae)

1,021

206

660

1,887

Cerebro-spinal fluid for pathogenic

Cultural

organisms

259

examination

Faeces for pathogenic organisms

470

Blood

£10

| Urine

173

626

2382

202

470

293

856

257

749

463

1.262

Faeces

Tissue sections

Intestinal parasites

Occult blood

M. tuberculosis

Brains for Negri bodies

Sputa

Gastric lavages for M. tuberculosis

Smears for gonococcus

2.354

5,229

3.028

10.611

169

173 21

409

703

703 35

4,037

2.820

4.147

11.013

708

736

213

114

906

1.233

Smears for M. leprae

Rat spleen smears for P. pestis

Urine (Routine, chemical & microscopic)

Friedman test

149

3.893

8.786

12.679

741

7,846

2.005

11.492

Bacteriological examination of milk and foods

analysis of water

1.214

811

2.025

2.437

Miscellaneous

837

1.108

204

2.149

Grand Total

63,300

29.364

28.111

120.775

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