醫務衛生署年報 Medical and Health Department Annual Report 1950-1951

RBB 140 j

ROYAL

RBB 40j

AITARY

LIBRARY

aus

HONG KONG

ANNUAL REPORTS 1950-51

MEDICAL AND HEALTH

SERVICES

12055

22501292972

ANNUAL

DEPARTMENTAL

BY THE

DIRECTOR

REPORT

MEDICAL AND HEALTH SERVICES

FOR THE

FINANCIAL YEAR 1950-1.

PRINTED & PUBLISHED BY NORONHA & COMPANY, LIMITED

PUBLISHERS

GOVERNMENT PRINTERS

OLD BAILEY ETREET, KONO KONG

WELL.

COH

Cas

No.

Ann Ry WA28

THE

177

1451

CONTENTS.

Paragraph

1. ADMINISTRATION

A. General

B. Boards

C. Stati

D. Legislation

II. PUBLIC HEALTH

General Remarks

III. VITAL STATISTICS

A. Population

B. Births

C. Deaths

D. Infant Mortality

E. Maternal Mortality

F. Principal Causes of Death

IV. HYGIENE AND SANITATION

(i) General Measures

(ii) Rural Health

(iii) Anti-Epidemic

L J

тогг

JILLI

(iv) X-Ray of Government Staff

(v) Health Education

(vi) Port Health Work (vii) School Hygiene

(viii) Nutrition

MATERNITY AND CHILD WELFARE

HOSPITALS AND DISPENSARIES

(ix) Social Hygiene

VI.

VII.

VIII

IX.

DENTAL CLINICS

PHARMACEUTICS

MEDICO-SOCIAL ACTIVITIES

X. TRAINING OF PERSONNEL

XI.

PATHOLOGICAL INSTITUTE

XII. CHEMICAL LABORATORY

XIII.

MEDICO-LEGAL

XIV. BIRTHS AND DEATHS REGISTER

XV. ACKNOWLEDGMENT

23 25

100

24 27

29 40

46 49

57 60

22%

88 103

104 - 110

111 120

121

128

129

133

134

139

140

150

тгг

151 152

153 - 164

165 193

194 - 264

265 268

269 - 274

275

276 - 281

282

283

284

285 - 290

291

ANNEXURES

(A) Chart of the Organization of the Medical Department.

(B) Maps of Medical Institutions

Page

(D) Chloromycetin in Typhoid Fever

(E) Births and Deaths-1947 to 1950

(F) Notifiable Diseases, Notifications and Deaths-1946

to 1950

(G) Tuberculosis Report

(H) School Health. Results of medical inspection of

pupils and defects found in schools

(I) Report of the Tsan Yuk Hospital

(J) Total attendances at Government and Government

Assisted Hospitals, Clinics and Dispensaries

(K) Cases treated in Government and Government Assisted Hospitals with the total deaths in the Colony for 1950

(L) Patients treated in Private Hospitals

117

(M) Annual Report of the Almoners' Department

118

(N) Report of Malaria Bureau

122

(0) Report of the Government Pathologist

128

(P) Report of the Government Chemist

141

(Q) Summary of the work done at the Hong Kong and

Kowloon Public Mortuaries

150

I. ADMINISTRATION.

A. GENERAL.

Throughout this report all statistics will refer to the calendar year 1950 but the text will refer to the financial year 1st April, 1950, to 31st March, 1951.

Once again early hopes for relatively peaceful developments in the department were shattered by pressure of events from outside the Colony, and many contemplated schemes for development had to be abandoned on financial grounds.

Unfortunately the same circumstances which called for caution in departmental expenditure also produced increased demands on the facilities available, and during the spring and summer months, when the population seemed to reach a peak, pressure on the medical facilities became so great that drastic changes had to be introduced in order to meet them.

　　　　4. The out-patient departments, primarily those in Kowloon, felt the greatest force of this pressure and the attendances at Kowloon Hospital became so numerous that the staff and accommodation available was quite inadequate.

　　　　5. To meet this urgent state of affairs a charge of one dollar was made for every visit to a doctor, except in such special clinics as Venereal Diseases, Tuberculosis, Ante-natal and Infant Welfare. This had the effect of reducing the number of attendances, primarily those with rather trivial conditions; but in the hardly pressed clinics, such as the Kowloon out-patients department, where conditions for attendance were already so trying that trivial cases were discouraged, the actual number of attend- ances after the introduction of a charge of one dollar rose by over 1,000 cases in a week.

　　　　6. This increase was in part accounted for by the fact that evening clinica from 6 p.m. to midnight were opened at the same time that the introduction of a charge of one dollar was made. These evening clinics filled a great public need by providing cheap medical treatment for those workers who could not spare the time to stand for several hours in a queue during working hours,

7. The pressure on the hospital accommodation was overcome to some extent by putting up additional beds in the wards. This, while going some way towards meeting the needs of the community, had the

- 1 -

disadvantage that the overcrowding in the hospitals inevitably lowered the standards of treatment, a serious drawback where the hospitals are train- ing schools for medical students and nurses.

　8. As in previous years the Director of Medical and Health Services received considerable help and co-operation from the Hong Kong and China Branch of the British Medical Association and the Hong Kong Chinese Medical Association. The great interest that these Associations take in the medical affairs of the Colony is one of the pleasantest facts to be recorded in this report.

　9. The truth of the saying that it is an ill wind that blows nobody any good has been demonstrated once again for, were it not for the many doctors now living in Hong Kong as refugees, many of them leaders in their profession, it would have been impossible to maintain the medical services in the Colony at their present standards.

　10. In my last report I stated that at the end of the financial year there were 36 doctors out of a total medical staff of 127 who belonged to this group of refugee doctors ineligible for registration in Hong Kong. The figure at the end of this financial year is 62 out of a total medical staff of 140.

　11. The evening clinic at Sai Ying Pun, run with the aid of voluntary help from a number of private doctors in the Colony, proved such a success that in September it grew too large for the staff available and was finally closed and replaced by the evening clinics opened under the scheme for charging a dollar for each attendance.

　12. The tuberculosis clinic for Kowloon, which it was hoped would be opened in September, 1949, was further delayed and was finally opened officially on 16th February, 1951.

　13. An additional block for Kowloon Hospital designed to take 72 beds is under construction at the present time. This, when completed, will give some much needed temporary relief to the pressure on the beds but the real solution is a new general hospital.

　14. In June, 1950, a committee was appointed by His Excellency the Governor to make recommendations for a five year building plan for the Colony.

15. Various proposals were put up for consideration by the Medical Department and it was agreed that a second tuberculosis clinic, to be built in Hong Kong, should be undertaken in the financial year 1951/52. It was agreed that a start should be made in the financial year 1952/1953 on two new hospitals, one a general hospital of 400 beds on the Kowloon

Hospital site together with an addition to the present maternity hospital bringing its beds from 48 to 150 and the conversion of the existing hos- pital, including the new block now under construction, into a children's hospital of approximately 150 beds and cots. The second hospital approved is to be a new mental hospital with a maximum accommodation of 250 beds. The site for this hospital is not definitely fixed but it will probably be at Aberdeen. It is proposed to start building this hospital also in the financial year 1952/1953. With the completion of this build- ing programme the medical facilities in the Colony will be greatly improved and Kowloon, for the first time in many years, should have a reasonable number of hospital beds for the needs of the inhabitants.

　　　　16. Considerable assistance from UNICEF was received during the year. This took three forms, the provision of equipment, the provision of fellowships and a feeding programme. Among the more important items of equipment received were special cots for the children's wards, incubators for maternity wards, various pieces of apparatus for use in the physiotherapy department (for paralysis associated with poliomyelitis) and a considerable amount of laboratory equipment.

Two

17. Six Fellowships were awarded, two of them to doctors, one for the study of child health and one for the study of tuberculosis. nurses also had fellowships for the study of tuberculosis and two nurses for the study of child health; one of these unfortunately became ill soon after arriving in England and had to return without completing the fellowship.

　　　　18. The feeding programme consisted in the distribution of dried milk through Government and charitable organizations. In all there were 31 distributing centres and a total of 68,087 pounds of milk have been distributed during the year.

　　　　19. Dr. P. H. Teng, the Senior Port Health Officer, visited Port Health Authorities in England and America, the American part of this tour being with the aid of of a W.H.O. fellowship. This exchange of in- formation has proved exceedingly helpful in the port administration.

　　　　20. On 1st September, 1950, the temporary headquarters of the Western Pacific Regional Office of W.H.O. was opened in Kowloon. Since that date there has been close liaison with the Medical Department which is of great benefit to the local community. Attached to the headquarters staff are experts in many branches of medicine and public health, and they have all been very ready and willing to give advice of the many problems in Hong Kong. This advice has ranged from an extensive investigation into the tuberculosis problem in Hong Kong covering a period of nearly 3 weeks, to brief interviews and consultations on such

specialized subjects as the production of dry B.C.G. vaccine. Among the subjects discussed were child health and maternity services, and it is hoped that a request for the visit of an expert on social hygiene problems will be met in the near future. The possibilities are also being investi- gated of a further important development in connexion with health education to be carried out locally with assistance from W.H.O.

　21. Under Notification No. AGNA 284 of 13th December, 1950, legislation was approved authorizing the formation of an auxiliary niedical service as part of the Essential Service Corps, but under the control of the Director of Medical and Health Services as unit controller. By the end of the financial year considerable progress had been made in recruitment.

22. A chart in Annexure A shows the system of decentralization in the department. Maps showing the medical institutions in the Colony are to be found in Annexure B.

23. Pharmacy Board.

B. BOARDS.

On 31.11.50. the Pharmacy and Poisons Ordinance was amended to establish a Pharmacy Board which will be responsible for the admission to and removals from the register, and for examinations for admission to the register. The Board consists of the Director of Medical and Health Services as Chairman, the Professor of Chemistry of the Hong Kong University, the Government Chemist and the Government Chief Pharmacist as ex officio members, and a Government Medical Officer, a Legal Adviser and three registered pharmacists appointed by the Governor as members.

　24. The Pharmacy Board held its first meeting on 12th February, 1951.

STAFF.

　25. On 24th May, 1950, the title of the Director of Medical Services was changed to that of Director of Medical and Health Services and a new post of Deputy Director of Medical and Health Services was created,

　26. This post was filled by the promotion of Dr. K. C. Yeo, M.D., B.S. (H.K.), D.T.M. & H. (Eng.), D.F.R. (Camb.) and two vacant posts of Deputy Director of Medical Services and Deputy Director of Health Services were filled by the promotion of Dr. K. H. Uttley, M.A., M.D., Bch. (Camb.), M.R.C.S. (Eng.), L.R.C.P., D.T.M. & H. (London), and Dr. G. I. Shaw, M.M., M.B., Ch. B. (Glas.), D.T.M. & H. (Eng.), D.P.H. (Edin.) respec- tively.

27. Annexure C shows the establishment of the department on 31st March, 1951.

D. LEGISLATION.

28. The following legislation affecting public health was enacted during the year 1950-51.

(I) Ordinances:

(a) The Law Revision (Miscellaneous Amendments) Ordinance

No. 9 of 1950.

Item 16-Amendment to the Midwives Ordinance No. 22 of 1910. Item 36-Amendment to the Asylums Ordinance No. 22 of 1936. Item 37-Amendment to the Nursing and Maternity Homes

Registration Ordinance No. 48 of 1936,

Item 38-Amendment to the Pharmacy and Poisons Ordinance

No 8 of 1937.

(b) The Law Revision (Miscellaneous Amendments) (No. 2) Ordin-

ance (Schedule Part I)

Item 13-Amendment to the Quarantine and Prevention of

Disease Ordinance No. 7 of 1936.

Ordinance No. 33 of 1950.

(d) The Pharmacy and Poisons (Amendment) Ordinance No. 36

of 1950.

(e) The Law Revision (Miscellaneous Amendments) (No. 3) Ordin-

ance No. 37 of 1950,

(Schedule Part I)

Item 8-Amendment to the Dangerous Drugs Ordinance No. 35

of 1935.

Item 10-Amendment to the Medical Registration Ordinance

No. 41 of 1935.

Item 11A-Amendment to the Pharmacy & Poisons Ordinance

No. 8 of 1937.

(II) Orders, Rules, Regulations and By-laws:

(a) The Nursing and Maternity Homes Registration Ordinance

1936 Amendment to the Schedule (G.N. No, A. 66 of 1950),

(b) Coroner's Abolition Ordinance 1888 The Places for Post

Mortem (Amendment) (No. 2) Order (G.N. No. 81 of 1950),

- 5

Poisons Regulations (G.N. No. A. 94 of 1950).

(d) The Midwives Ordinance 1910-Amendment to the regulations

(G.N. No. A. 96 of 1950).

(e) The Samaritan Fund (G.N. No. A. 113 of 1960).

(f) The Occupational Therapy Fund (G.N. No. A. 114 of 1950).

(g) The Nurses Rewards & Fines Fund (G.N. No. A. 115 of 1950).

(h) The Public Officers (Changes of Style) Ordinance 1937, (G.N.

No. A. 116 of 1950).

(0) The Quarantine & Prevention of Disease Ordinance 1936-

declaring "Malaria" as an infectious disease (G.N. A. 132 of 1950).

(/) The Public Health (Food) Ordinance 1935-Amendment to the

Market By-laws (G.N. No. A. 134 of 1950).

(k) The Public Health (Animals and Birds) Ordinance 1935 (G.N.

No. A. 143 of 1950).

(1) The Public Health (Food) Ordinance 1935-Amendment to the

Market By-laws (G.N. No. A. 154 of 1950).

(m) The Quarantine & Prevention of Disease (Plague) Regulations

(G.N. No. A. 159 of 1950).

(n) The Nurses Registration (Amendment) Regulations 1950 (G.N.

No. A. 179 of 1950).

(0) The Public Health (Food) Ordinance 1935-Amendment to the

Market By-laws (G.N. No. A. 181 of 1950).

(p) The Civil Aviation (Births, Deaths and Missing Persons)

Regulations (G.N. No. A. 247 of 1950).

(q) The Essential Services Auxiliary Medical Corps Regulations

(G.N. No. A. 284 of 1950).

(r) The Emergency (Penicillin Ordinance, 1948) (Amendment)

Regulations (G.N. No. A. 15 of 1951).

(s) The Public Health (Sanitation) Ordinance 1935-Amendment

of By-laws (G.N. No. A. 19 of 1951).

(t) The Emergency (Penicillin Ordinance, 1948) (Amendment)

(No. 2) Regulations (G.N. No. A. 25 of 1951).

(z) The Public Bath-House By-laws (G.N. No. A. 35 of 1951).

(v) The Registration of Pharmacists Holding Diplomas Regulations

(G.N. No. A. 50 of 1951).

(w) The Public Health (Food) Ordinance 1935-Amendment to the

Market By-laws (G.N. No. A. 57 of 1951).

II. PUBLIC HEALTH,

GENERAL REMARKS.

　　　　29. Again, the general health of the Colony has been good. There were no major epidemics, although the number of cases of typhoid during the summer months reached higher proportions than could be accounted for by the increase in the population.

30. In view of the overcrowded state of the hospitals and the neces- sity for keeping the length of stay in hospital as short as possible it was decided to treat all proved cases of typhoid in Government Hospitals with Chloromycetin. In all, rather more than 200 cases have been treated and a full technical report on this is being prepared for publication. A pre- liminary report will be found in Annexure D.

31. As was the case in 1949, there was little evidence of gross nutri- tional disease in the Colony and the general standard of nutrition remained good. Deaths from beri-beri totalled 39, which is the lowest figure yet recorded.

32. Unfortunately the population continued to increase in the early part of the year and is estimated to have reached a peak in April of 2,360,000. This further increase in the overcrowding had the effect, as regards tuberculosis, of offsetting to a large extent the benefits resulting from the improved economic and nutritional standards.

　　　　　33. Two unusual outbreaks of disease occurred, both associated with troops in the New Territories, and I am indebted to Colonel G. Anderton, A.D.M.S. Land Forces, for the following information:

34. There had been a considerable number of cases of infective hepatitis scattered generally throughout the Colony when, in the latter half of April and the early part of May, there was an outbreak of 34 cases at Sun Wai camp. On investigation it appeared that the water supply to the NAAFI came from two sources; that for the latrines from a stream, and that for drinking purposes from a Public Works Department piped supply to covered tanks, where the water was chlorinated by hand.

-7-

35. There was a communication between these two water supplies and without permission both the stop cocks were opened and it seems probable that the untreated water, being of greater pressure, entered the treated supply system and that troops drinking the water in the NAAFI did, on one or more occasions, drink untreated water.

36. All the cases occurred among the troops using this NAAFI. Officers and sergeants using another mess were not affected. It seems possible that there was some link between this untreated water and the outbreak of infective jaundice.

87. Eventually there was a total of 82 cases arising in this camp.

38. The second outbreak was one of sprue. Some 58 cases in all were discovered during 1950 and 6 more were suspected and under investi- gation at the end of the year. Of these 58 cases, 26 came from Sun Wai camp, where there had been this outbreak of infective jaundice.

　39. Out of 46 cases discovered in the last quarter of the year 34 of them gave a history of onset in the four months, May, June, July and August, the peak of the outbreak being in May with 12 cases followed by 8 in June and July and 6 in August. All cases occurred in Europeans who had been less than one year in the Colony and, in general, the majority of the cases came from the more primitive camps with a bucket sanitation, the exception being the Sun Wai camp, which has water borne sewage.

40. The high proportion of cases occurring in Sun Wai camp sug- gests that there may have been some connexion between this outbreak of sprue and the outbreak of infective jaundice.

III. VITAL STATISTICS.

A. POPULATION.

41. The estimated population published by the Department of Statistics gave a mid-year figure of 2,265,000, which represents a half million increase over the year 1949. Medical statistics, such as the number of births and the number of deaths from such diseases as cancer, intra-cranial vascular lesions and cardiac lesions, tend to support this great increase in the population. It seems likely that during the latter part of the year there was a drop in the population which was estimated by the Department of Statistics to be at that time slightly over two million.

　　　　42. As stated in my report last year this population figure must be accepted with some reserve in view of the fact that it gives a death rate in the Colony of 8.2 per mille. As the registration of births and deaths. in Hong Kong is very complete, the population figure presents the only doubtful factor.

　　　　43. Table I gives the population figures from 1920 to 1950 excepting the period of occupation by the Japanese.

TABLE 1.

Year

Estimated Population

1920

648,150

1921

625,116

1922

638,300

1923

667,900

1924

695,500

1925

725,100

1926

710,100

1927

740,300

1928

766,700

1929

802,900

1930

838,800

1931

840,473

1932

900,812

1933

922,643

1934

944,492

1935

966,341

1936

988,190

1937

1,281,982

1938

1,478,619

1939

1,750,256

1940

1,821,893

1941

1,639,357

1942 -

1944

1945 (Sept.)

1946

(Not available

Japanese Occupation)

Under 600,000

1,500,000

1947

1948

1949

1950 (End of

1,600,000

1,750,000

1,800,000

1,857,000

2,265,000

June)

　　　　44. Table 2 shows the sex and age distribution of the population as given in the 1921 and 1931 censuses and in a sample survey in 1950 of 82,499 persons of the age of 12 and over.

TABLE 2.

Sex and age distribution of the population in the 1921 and 1931 censuses and in the 1950 sample survey.

1921 Cens DA

1960 Sample Survey Bawed on an analysis of 82,499 formLK,

1931 Convo

Yeats.

Males

Females

Malea

Femalex

Mala

Females

Mules &

Fermalea

Males

Female

Mules & Females

(1)

Total Per+

{1} Total Per- Total Per- |sentage;

Total Per- Total Per centag

(1)

Total Per

centage

(1)

Total Per+ Total Per- Total Per-

centagel

cantage

senta

27,296

26,4611

48.539

243.695

87,234

28.411

24,736:

11-11

80.151

48.149

65,987

82.496

31.734.

64,170

16-20

50,216

17.12) 24,242|

21-25

49.785

14.96| 22,608

26--30

45,203

16.44 22,696

31-35

37.960

12,93❘ 20,080)

36-40

26,050

12.29 19.580

24,271

8.22) 12.7564

46 - 50

19,297

6.68| 11,301

14.91| 73.458)

14.60| 72.308

15.13| 48.899|

12.88 50.030)

12.66) 56.620

8.18 36,985

7.25| 80,69B:

40.676

16.37| 64.665

16.10 69.299)

15.43 62,162)

12.92) 42,870|

12.38| 36,936

8.23) 28.89

6.80 23,976:

34.27다:

74,946:

(2)

5,108 |

(2)

3,069

(2) T

9,072,

18.22 35.648|

14.83 100.319) 16.96- 6.777

16.99

5.061:

15.09 11,888! 16.12

17.84) 37.410;

15.57 100.699) 16.92

4.438

16.16

4,862:

14.70 36.413|

12.09 29.268)

10.41 26.679

8.14 20,374)

15.15| 88,576| 14.88

6,130

12.18 72,138) 12.12. 5,056 11,06| 80.614) 10.87

18.37.

4.752

14.49' 11,300)

14.16 10,882|

15.89

9.987! 11.8

14.82

9.0431 19.32

6.176

12.96 4,260 12.70

12.85

8.489 49,264

6.76 17.787

7.41| 41,773

8.28

7.02.

3.375|

8.44 2.964 5.83

61 -55 ---

19,455

56 -00

$26

4,450

66 TO

0.39

76-80

-------

81-10

Unknown

Total from 15 years

-----

12.310 (.20 7.146) 6,310 4.06| 14.578, 1.24 11.110 1.52 3,773 2.49 8.223 1.88 4.638 8.792. 1,29 2.584 1.00 6.126/ 1.42 3.456 1,126 1.600 1.08 2,726 0.60 1,584 2.229 0.91 3.812

163 0.16 $47 0.54 1,410 0.291 598 0.17 1,226 0.51 1,824 226 0.02) 435 0,21 720 0.16 266 0.08 $77 0.28 1,936. 0.66

4.33 16,492

4.65) 12.266

6.10 28,768

2,724

1,644

6.83 2,667

7.96 6.391

7.34

4.18 1.824

5.44 3.468

4.73

[

3.13: 10.069

1.84 6,247

0.97 4,082

4,18| 21,169

3.66) 1,126

2.82

1,336

9.98

2.461) 8.36

2.60 18,765,

2.15

738

1.95 1,011

3,01

1,749

2.38

1.68 7.487)

1.26

426

1.07

549

1.62

969.

1.32

0.64

196

0.49

192 0.67

2.88

0.62

4.31

0.14:

0.21| 127

0.17

0.01

943

1,026

416

0.04

0.07. 3B

0.06

0.34

208,476) 100 165,916❘ 100 449,391 || 100 ,254.766 100 240.313 100

596,079) 100 39.876) 100

38,562 LOG 73,427|| 100

Note:-(1) Percentages are based on total figures from 16 years old. (2) From 12 to 15 years only.

45. The figures in the sample survey were obtained by an examina- tion of 82,499 registration forms out of a total of approximately one million. Samples were taken from the New Territories, the floating population, and from the urban area. The registration covered all employed people and their dependents, including servants, over the age of twelve years.

B. BIRTHS.

　　　　　46. Table 3 shows the number of births recorded and the birth rate per mille according to the population estimates from 1934 when the present births and deaths registration ordinance was introduced.

Year

TABLE 3.

Births Registered 1934-1950.

No. of Births

Birth rate using estimated population

Registered

1934

20,886

22.11

1935

25.037

25.9

1936

27,383

27.8

1937

LIJLLJI

32,303

25.19

1938

35,893

24.5

1939

46,675

26.7

1940

45,064

24.73

1941

45,000

27.44

J- - - - - -

1942

---------ruri THI

10,343

Not available (Japanese Occupation)

1943

20,732

իզ

1944

13,687

1945

3.712

1946

31,098

20.1

1947

42.473

24.3

1948

47.475

26.4

1949

54.774

29.5

1950

60,600

26.8

　　　　47. In addition to these births 564 post-registered births were recorded.

　48. 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 513 births were registered under this Ordinance.

　49. These post-registered and re-registered births are not included in the figure of 60,600 above.

C. DEATHS.

　50. Except in outlying places in the New Territories, where deaths are recorded at the nearest Police Station as being from natural causes or otherwise, as an investigation by the Police suggests, all deaths have to be certified by a registered medical practitioner and the nomenclature adopted is that of the International Statistical Classifications of Diseases and Injuries and Causes of Death. 5.2% of the total deaths were recorded at the Police Stations as being from natural causes.

　51. Table 4 shows the deaths registered and the death rate per mille based on the estimated population,

TABLE 4.

Deaths Registered 1926-1950.

No. of Deaths

Year

Registered

Death rate using estimated population

1926

12.516

17.62

1927

14.761

19.93

1928

14,735

19.21

1929

17,565

HTH

21.89

1930

16.268

19.4

1931

18,797

22.35

1932

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

1938

38.818

26.25

1939

48,283

27.6

1940

61,010

33.48

Year

TABLE 4.-Cont.

Deaths Registered 1926-1950,-Cont.

No. of Deaths Registered

Death rate using estimated population

1941

61,324

87.4

1942

83,435

Not available (Japanese Occupation)

1943

40,117

1944

24,936

1945

------------------IL|

23.089

1946

16,653

1947

13,231

1948

++++

13.234

1949

16,287

18,485

10.7

7.6

8.8

8.2

1950

52. As in the other years since 1946, some comment is needed on the very low death rate recorded. Although this rate depends on an estimated population figure, the best evidence available in the Colony, including the medical statistics, suggest that this figure is probably fairly correct.

　　　　53. This being the case, the explanation for the low death rate lies most likely in the absence of major epidemics or severe nutritional dis- orders, and possibly in the age distribution of the population. Here again, unfortunately, no information is available about the younger age group, but in the age groups over 16 years the distribution would appear to be very similar to that in 1921 and 1931.

　　　　54. 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 7 deaths were registered under this Ordinance,

　　　　55. The post-registered deaths for 1950 amounted to 26. These post-registered and re-registered deaths are not included in the figure 18,465 above.

　　　　56. Table 5 shows the deaths at different ages for 1950, and the percentage of deaths in different age groups of 15 years and over com- pared with the percentage distribution of the population in the same age groups as estimated by the sample survey.

TABLE 5.

Deaths in age groups as compared with distribution of population according to the sample survey of 19′

1950 Sample Survey

1950 Deaths

Years

Males

Females

Males & Females

Males

Females

Males & Females

Total

Per-

centage

Total Per- centage

Total

Per-

Total

centage

Per-

centage

Total Per-

Total

Per-

centage

Under 1 year 1- 4

5-9

10-14

15-19

20--24

25-29

2,928

3.108

1,861

1.907

$6.037

3,768

281

222

503

* 3,819

* 2,916

* 6,735

100

#168

6,495

15.78 5.007

14.47

11.502

15.18

203

4.37

111

3.32

314

3.93

6,639

16.13 4,929

14.24 11.568

15.27

387

8.34

212

6.35

599

7.50

6.190

15.04 4.631

13.38 10,821

14.28

415

8.96

303

9.07

719

9.00

30-34

5,259

12.78 4,299

12.42 9.558

12.62

501

10.80

354

10.60

855

10.70

35-39

5.163

12.54 4.005

11.57 9,168

12.10

539

11.61

293

8.77

832

10.41

40-

3,738

9.08 3,450

9.97 7,188

9.49

488

10.51

229

6.86

717

8.97

2,823

6.86 2.562

7.41 5.385

7.11

402

8.66

244

7.30

646

8.09

50-54

2.016

4.89 2.202

6.36 4.218

5.57

419

9.02

264

7.90

683

8.55

55-59

JL LILJ

1.107

2.69

1.380

3.99' 2.487

3.28

338

7.28

258

7.721

596

7.46

60-64

918

2.23 1,138

3.29❘ 2,056

2,71

334

7.20'

272

8.14

606

7.59

65-69

453

1.12

606

1.75 1.059

1.39

277

5.97

264

7.90

541

6.77

70-74

250

0.61

261

0.76

511

0.67

169

3.64

233

6.97

402

5.03

75-79

0.20

102

0.29:

186

0.25

101

2.18/

165

4.94

266

3.32

80 years &

over

0.05

0.10

0.08

1.44

138

4.13

205

2.57

Unknown age.

0.02

0.03

0.10

Total from

15-19 years 41,159

100 i 34,605

100

! 75,764 100

4,642

100

3,341

100

$ 7.999

100

Note:- Age from 12-14 years only.

Percentage based on the total figures from 15 years old.

Including 1 unknown sex.

Including 6 unknown sex,

D. INFANT MORTALITY,

　　　　57. Table 6 shows the number of infant deaths per thousand live births for the years 1928-1950. The infant mortality rate for 1950 is almost the same as that for 1949.

TABLE 6.

Infant Mortality.

Year

Infant Mortality Rate

1928

458

1929

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

1949

1950

89.1

102.3

91.1

99.4

99.6

　　　　58. As in previous years, the deaths in infants under one year pro- vided almost exactly one third of the total deaths occurring during the year. The death rate among female infants was 107.7 per thousand live births, and among male infants 92.2.

59. In Annexure E is a table showing the number of births and deaths reported each month for the years 1947 to 1950. From this it will be seen that there is a definite seasonal incidence in the number of births, these falling each year in the spring and rising to a peak in the autumn,

60. Table 7 shows the infant and neo-natal deaths and also the neo-natal death rate per 1,000 live births for the years 1946-1950,

TABLE 7.

Neo-natal Mortality Rate.

Age Period

1946

1947

1948

1949

1950

0-1 day

174

273

221

219

308

1-7 days

264

376

467

454

539

1--4 weeks

563

814

T45

936

972

4 weeks-3 months

771

981

900

1.136

1,254

3-6 months

462

750

665

925

1,025

6-9 months

-12 months

Total under 1 year

---IT-

367

731

775

986

1.040

169

421

551

788

899

2,770

4,346

4,824

5,444

6.037

Infant Mortality rate

89.1

102.3

91.1

99.4

99.6

No. of deaths under 4

weeks

1,001

1.463

1,433

1,609

1,819

Neo-natal Mortality rate.

32.2

34.4

30.2

29.4

30.0

MATERNAL MORTALITY,

　61. Table 8 shows the maternal mortality rate for the year 1946- 1950 with the death rate per 1,000 live and still births. There was a welcome drop in the maternal mortality rate in 1950, the figure of 1.70 comparing with 2.12 in 1949.

TABLE 8.

Maternal Mortality 1946 to 1950.

Deaths, and rates per 1,000 Live and Still Births ascribed to:

(a) Pregnancy and Childbearing, excluding Abortion.

(b)

Abortion (including criminal).

E * Pregnancy

Year

Live Still Births Births

Total Live and

and Childbearing

+ Abortion

Maternal Mortality

Rate

Stilt

Births

of 1,000

No. Rate per No. of

Rate per

1,000

No. of

deaths Births

Deaths

Births

Deaths

Rate per 1.000

Births

1946 1947

31,098

625

LIIr

31.785

1.01

0.22

1.28

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

1949

54,774 1,321 56.095

115

2.01

0.11

119

2.12

1950

60,600 1.343 61.943

1.49

0.21

105

1.70

For 1946-1948, Nos. 142-150 of International List of Causes of Death. For 1949-1950 Nos. 640-649 and Nos. 680-689 of International Statistical

Classification of Diseases, Injuries and Causes of Death.

† For 1946-1948 Nos. 140-141 of International List of Causes of Death.

For 1949-1950 Nos. 650-652 of International Statistical Classification of

Diseases, Injuries and Causes of Death.

　62. Table 9 sets out the figures of deaths from toxaemias of pregnancy for the years 1946 to 1950,

1946

1947

1948

1949

1950

Year

TABLE 9.

Deaths from Toxaemias of Pregnancy.

Deaths from

Toxaemias of

Total Births

pregnancy

50 81

(including still

Death rate

births)

per 1,000

31,783

0.3

43.821

0.3

48,786

0.8

56,095

0.0

61,943

0.5

　　　　63. It will be seen from these figures that if the deaths from Toxaemias of pregnancy are subtracted from the total maternal deaths there is a remarkably constant maternal mortality rate and, in view of the very rapid increase in the demands on the maternity services (nearly 50%) since 1947, this reflects great credit on those concerned.

　　　　64. Table 10 sets out the figures for the causes of death ascribed to pregnancy and childbirth, excluding abortions, for the years 1946 to 1950.

Interna- tional No.

TABLE 10.

Causes of death ascribed to pregnancy and childbirth

675

640

642

643

644

645

646

648

649

670

671

672

673

Other haemorrhage of pregnancy

Cause of Death

1946 1947 1948 1949 1950

Pyelitis and pyelonephritis of pregnancy

Toxaemia of pregnancy

15 15

Placenta praevia

++++

+-+-+-+-----------

Ectopic pregnancy

|MOND | TH

Anaemia of pregnancy,

Other complications arising from pregnancy Pregnancy associated with other conditions. Delivery complicated by placenta praevia

or antepartum haemorrhage

Delivery complicated by retained placentai Delivery complicated by other post-partum

haemorrhage

Delivery complicated by abnormality of

bony pelvis

674 Delivery complicated by disproportion or

malposition of foetus

---------------++ |

Delivery complicated by prolonged labour

of other origin

678

Delivery with other complications

681

Sepsis of childbirth and the puerperium

682

Puerperal phlebitis and thrombosis

|கஎ

NHAN

683

Pyrexia of unknown origin during the

puerperium

684

Puerperal pulmonary embolism

685

Puerperal eclampsia

686

Other forms of puerperal toxaemia

687

688

Cerebral haemorrhage in pueperium

Other and unspecified complication of the

puerperium

Total

65 | 113

| ~ 0 | |

HON

F. PRINCIPAL CAUSES OF DEATH,

65. Table 11 shows the principal causes of death for the years 1946 to 1950.

TABLE 11.

Number of Deaths

Causes of death (classified by 1938

Revision of International List)

1946

1947

1948

1949

1950

Smallpox

1,306

129

Beri-beri

Cerebrospinal fever

Diphtheria

Malaria

Tuberculosis of respiratory system

Other forms of tuberculosis

Syphilitic diseases

Iniluenza

137

1,318

312

140

100

135

765

253

193

116

1,475

1.420

1,443

1,712

2,165

343

443

518

899

1,098

100

120

243

Cancer, malignant disease

277

304

397

513

659

intracranial lesions of vascular origin..

189

264

275

294

344

Other diseases of nervous system and

sense organs

132

180

Diseases of the heart

379.

514

572

620

.325

Other diseases of circulatory system

122

194

Bronchitis

839

529

419

611

743

Pneumonia (all forms)

4,129

3,464

3,157

4,391

4,485

Other diseases of respiratory system

197

139

125

105

248

Enteritis and diarrhoea

1,235

1,179

1,767

2.268

2,514

Other diseases of digestive system

337

361

318

454

492

Non-venereal diseases of genito-urinary

system

II LILJ

Premature births, congenital malforma- tions and diseases of early infancy Other defined diseases

Old age, senility

Violence, (accidents, suicide,

homicide, etc.)

Ill-defined causes

-----

-| -

226

341

350

343

287

982

1,289

1,214

1,204

1,262

786!

445

517

690

722

142

101

113

114

631

686

781

620

718

489

522

803

839

1,053

TOTAL

LILIL

16,653 13,231 13,434 16,287 18,465

　66. Annexure F shows the number of cases of notifiable diseases and the deaths at all ages for the years 1946-1950, also the age groups of diseases notified for 1950 and the notifications, deaths and deaths per hundred notifications for cerebro-spinal meningitis, measles, diphtheria, enteric fever and smallpox since 1928.

PNEUMONIA.

The

　67. The principal cause of death was pneumonia, all forms. figure of 4,485 represents a slight increase over the figure for 1949; of these deaths 2,117 occurred in children under one year old. DIPHTHERIA.

　68. There was a considerable increase in the number of deaths from diphtheria towards the latter part of the year, and the number of cases notified gave rise to some anxiety but prospects of an increase in the incidence in the new year fortunately did not materialize.

RABIES.

69. The outbreak of rabies which caused so much concern in 1949 died down to a considerable extent in 1950 and deaths from this disease totalled 11 human cases, 9 proved cases among dogs and one among cats, One human death occurred in November but with this exception there was no case of rabies in the last 5 months of the year.

　　　　70. The regulations introduced in 1949 for the control of dogs was still in operation at the end of 1950.

BERI-BERI.

　　　　71. Again there has been a fall in the number of deaths from beri- beri; and in view of the difficulty in finding clinical cases in the hospitals, there may well be some doubt about the diagnoses, mostly made post- mortem, of these recorded deaths.

ENTERITIS.

　　　　　72. There was an increase in the deaths from enteritis and diarrhoea. 1,640 of these occurred among children under one year of age.

73. An investigation recently carried out by the infant welfare nurses and reported in greater detail under the heading of Maternity and Child Welfare, suggests that the large number of deaths occurring among children under one year may be due to the great frequency of artificial feeding.

MALIGNANT DISEASES.

74. Table 12 shows the number of deaths and the death rate per million for malignant diseases as a whole for the years 1946 to 1950.

TABLE 12.

Malignant Diseases for the year

1946-1950.

Number of Deaths

Estimated

Death rate per million

Year

Population

1946

ILJL

1,500,000--

114

163

277

73.5

105.2

178.7

1,600,000

1947

➖ ➖ ➖ ➖ I

1,750,000

126

178

304

101.7

173.7

1948

1,800,000

169

228

397

93.9

126.7

220.6

1949

1,857,000

269

244

513

144.9

131.4

276.3

1950

JILI -

2,265,000

315

344

669

139.1

151.8

290.9

75. Table 13 shows the number of deaths and the death rate per 1,000 total deaths from malignant diseases according to site and sex for the years 1949 and 1950.

TABLE 13.

Death rate from Malignant Disease according to site and

sex for the year 1949-1950.

140 Malignant neoplasm of lip

141

Malignant neoplasm of tongue

Death rate

No. of Deaths Registered

Per 1,000 Total Cancer Deaths

1949

1960

Male

Female

Male Female

1949

Male Female Male Female

1950

Lewd 5 26 ~ 95-02||

00:00

181**E | 27 8 -|

127

159

LONG 2 22 | 5.

219

152

214

TL]

111

130

ר -

ཌ། ཅུ་

1121ong | 2å = *** | 5*

|3| | ༄a བྲཱཧྨ། གླ

133

142 Malignant neoplasm of salivary gland

143 Malignant neoplasm of floor of mouth 144 Malignant neoplasm of other parts of mouth and mouth unspecified

------

H+

145 Malignant neoplasm or oral mesopharynx 146 Malignant neoplasm of nasopharynx 147 Malignant neoplasm of hypopharynx 148 Malignant neoplasm of pharynx unspecified 150 Malignant neoplasm of oesophagus.... 151 Malignant neoplasm of stomach

152 Malignant neoplasm of small intestine, including duodenum

153 Malignant neoplasm of large intestine, except

rectum

154 Malignant neoplasm of rectum

155 Malignant neoplasm of biliary passages and of liver (stated to be primary site)

--------

156 Malignant neoplasm of liver (secondary and unspecified)

157 Malignant neoplasm of pancreas

158 Malignant neoplasm of peritoneum

159 Malignant neoplasm of unspecified organs 160 Malignant neoplasm of nose, nasal cavities, middle ear, and accessory sinuses

181 Malignant neoplasm of larynx

------

---

162 Malignant neoplasm of of trachea, and of bronchus and lung specified as primary 163 Malignant neoplasm of lung and bronchus, unspecified 39 to whether primary or secondary

164 Malignant neoplasm of mediastinum 165 Malignant neoplasm of thoracic organs

(secondary)

170 Malignant neoplasm of breast

171 Malignant neoplasm of cervix uteri Malignant neoplasm of corpus uteri

HP+

173 Malignant neoplasm of other parts of uterus, including chorionepithelioma

174 Malignant neoplasm of uterus, unspecified 175 Malignant neoplasm of ovary, Fallopian tube,

and broad ligament

176 Malignant neoplasm of other and unspecified

female genital organs

177 Malignant neoplasm of prostate

178 Malignant neoplasm of testis

179 Malignant neoplasm of other and unspecified

male genital organs

180 Malignant neoplasm of kidney

181 Malignant neoplasm of bladder and other

urinary organs

190 Malignant melanoma of skin

192 Malignant neoplasm of eye

199 Malignant neoplasm of brain and other parts of nervous system

194 Malignant neoplasm of thyroid gland

195 Malignant neoplasm of other endocrine glands 196 Malignant neoplasm of bone (including jaw

bone)

197 Malignant neoplasm of connective tissue 198 Secondary unspecified malignant neoplasm of lymph nodes

199 Malignant neoplasm of other and unspecified sites

---

111

185

192

숴고

LOHN

| | |*- en

885 58 3

↑

ON |

NM |

312

OD IN

?一

ON |

1* * *

TOTAL

---

209

244

315

344

1000

MEASLES.

　76. Table 14 shows notifications and deaths from measles for 1946 to 1950. The total figures for the last two years are similar but in 1950, there was an increase in the number of cases and deaths occurring under five years of age. There was, unfortunately, a further increase in the deaths per 100 notifications due to the greater number of cases occurring in the early years of life.

TABLE 14.

Notifications and Deaths from Measles.

1946

1947

1948

1949

AGE GROUP

Not Deatha Noti- Deatha fications

Reationa

Noti- Denthe Acationa

Hestions

1950

Noti- Deaths Not. Dentha

fications

0 to 5 years 5 to 15 years 15 to 25 years 25 to 35 years 35 to 45 years 45 to 55 years 55 to 66 years

65 to 75 years 76 and over

Unknown

Total

Deaths per 100 notifications

----■

-----

- P

135

------

148

12 1

8c9

136

NNO |

291 42 353 60

317

160

8 190

458

453

--------

1-1

ENTERIC FEVER.

　77. There was an outbreak of enteric fever during the summer months which in view of the already overcrowded state of the hospitals presented a serious problem as regards accommodation.

　78. Of a total of 907 cases notified there were 160 deaths giving a death rate per hundred notifications of 17.6, which is the lowest recorded since 1928. Previous lowest rates being 22 in 1948 and 21.8 in 1949.

　79. The cases were sporadic and spread out over the Colony, more or less in proportion to the density of the population. Comparatively there were more cases in Kowloon and the New Territories than on the island.

　80. Below is set out the monthly case incidence and deaths, from which it will be seen that the peak was reached in July.

TABLE 15.

Monthly incidence of Enteric Fever.

MONTH

CASES

DEATHS

January

February

March

April

May

June

-+-----T---------------------d

------------------+------+

106

July

129

August

September

October

November

December

ITI

110

TOTAL

907

160

　　　　81. In an attempt to reduce the length of stay in hospital, after June, all proved cases admitted to Government hospitals were treated with chloromycetin and approximately 200 cases were so treated. This pro- gramme was under the direction of Dr. Wilkinson, the Medical Specialist, and a detailed report by him is now being prepared. A preliminary report will be found in Annexure D.

SMALLPOX.

　　　　82. One case only of smallpox, and that of doubtful diagnosis, was notified during the year. There were no deaths. This is the lowest figure yet recorded in the Colony and only a total of 20 cases have been notified during the last three years.

83. As long as the vigorous vaccination campaign is carried out each winter it seems likely that smallpox will cease to be a menace to the community. In post war years between one and one and a half million vaccinations have been done each winter and there can now be very few susceptible people in the community.

DYSENTERY.

　84. The tendency shown in previous years for amoebic dysentery to supercede bacillary dysentery as the most frequent type of infection was not continued. Figures for 1950 being 177 cases and 10 deaths from amoebic dysentery and 258 cases with 15 deaths from bacillary dysentery.

TUBERCULOSIS.

　85. The second most important cause of death was tuberculosis in all forms. 9,067 cases (85% pulmonary) with 3,263 deaths reported in 1950 as against 7,510 cases, and 2,611 deaths, in 1949. The death notification rate was approximately the same in each year, 35.9 in 1950 and 34.8 in 1949.

　86. The deaths in acute forms in children under 5 amount to just over one quarter of the total.

87. A full report on the tuberculosis service will be found in Annexure G.

IV. HYGIENE AND SANITATION,

(0) Organization.

(1) GENERAL MEASURES.

　88. Under the administration of the Urban Council, Hong Kong Island and Kowloon, including New Kowloon, are divided into five main Health districts three in Hong Kong and two in Kowloon each under the charge of a Health Officer and a Senior Health Inspector. Each dis- trict is sub-divided into easily worked units of about 1,500 floors under the charge of a Health Inspector. Liaison between these districts and sections is made through a Chief Health Inspector and Superintendent of Sanitary Services. Technical advice is given by the Deputy Director of Health Services. There are now 62 health districts, 37 in Hong Kong and 25 in Kowloon.

　89. Each inspector is responsible for the general hygiene in his dis- trict and includes inspection of premises and investigation of nuisances, He is responsible for the investigation of infectious diseases and dis- infection.

　90. In addition to district duties other inspectors are employed on the hygiene of dairies, sampling, the control of wet cultivation, hawker control, markets and slaughter-houses, meat and food inspection, and con- trol of cemeteries.

　　　　91. Medical and health problems arising from work in the urban area are referred to the Director of Medical and Health Services.

(b) Sanitation.

　　　　92. A Chief Health Inspector, under the Superintendent of Sanitary Services, controls sanitation, including conservancy and refuse disposal. He also controls markets, slaughter-houses, cemeteries and squatters.

　　　　93. The Colony has two systems of nightsoil disposal: (a) a water- carriage system, the sewers of which flow directly into the harbour of Victoria, (b) bucket conservancy which is forced on the Colony through several factors, such as old type houses, water scarcity, and certain areas which are restricted from water-carriage on account of such local reasons as typhoon shelters which prevent the cleansing action of the sea.

　　　　94. In Kowloon a two pail conservancy system, serving about 320 houses, has been started as a pilot scheme to improve conditions. It is hoped this will permit removal by day instead of night, without nuisance. After a little over a year's trial, it promises well. The cost of materials may hold up the introduction of the scheme on a large scale.

　　　　95. Normally disposal of nightsoil is twofold. Part is dumped at sea and part goes to maturing tanks in the New Territories. During the year the need for fresh vegetables led to a demand by the farmers for raw nightsoil as fertiliser. In view of the urgency of an adequate supply of vegetables it was decided to accept the risk of intestinal bacterial infection and the request was allowed. The raw nightsoil was delivered at Tsun Wan and from thence distributed by lorry, in buckets, specially made, and in closed tanks, to depots all over the Territories. Vegetable production increased rapidly. There were, however, many disadvantages from fly nuisance and smell. In August of 1950 this distribution of raw nightsoil was stopped on account of the outbreak of typhoid. The old system of maturing nightsoil for 28 days was started again, and whilst this has little effect on helminthic disease, bacterial infection is less likely.

　　　　96. Meanwhile, a small pilot scheme in the making of compost with nightsoil and refuse is in being. A large and ambitious scheme for this purpose is being planned. and an expert is expected from the United Kingdom in the very near future.

(e) Housing.

　　　　97. Building goes on apace, but is mostly of the more expensive type. Only a few areas now remain as evidence of bombing during the Pacific War. Many new districts have been developed such as Shousan Hill, King's Road, and other outlying districts. Great numbers of semi-

permanent buildings have been erected without permits and are lacking in water supply and sewerage. This has created health problems,

difficult to solve.

(d) Squatters.

　98. Squatters continued to pour into the Colony during the year and have now reached the approximate figure of 330,000. Compared with the chaos early in 1950 there is now comparative order. In the central urban area, which was over-run early in the year, there are only a few odd squatters to be found. Following a methodically planned campaign urban areas were gazetted for clearance, the squatters given warning to clear out and, on an appointed day, any who remained were removed. It says much for those engaged that there were no incidents. The squatters now are congregated for the most part on the outskirts of the city and Kowloon. The necessity for lanes between the great masses of huts to lessen the dangers of fire is realized, but rendered difficult by the need to replace the huts moved in doing this. Several fires, responsible for the destruction of several hundreds of huts, but without loss of life, caused much concern, but shows the need for these fire lanes. Another develop- ment has been the establishment of squatter colonies in tolerated areas. In these areas huts have been allowed but only on certain conditions making for some safety from fire and disease.

　99. The large numbers of refugees connected with the military change-over in China and who, in the early part of the year, occupied the neighbourhood of Tung Wah Hospital, were shifted to an area at Jubilee Fort where sanitary conditions soon became very bad. Inoculation against cholera, vaccination, treatment of personnel with D.D.T. power applied by spray guns to kill lice, the liberal use of Gammexane on soiled areas, and education in the use of latrines provided by the Urban Council and some education in rubbish disposal helped to prevent epidemic dis- ease, except for a small outbreak of bacillary dysentery.

100. On 26th and 27th June nearly 6,000 nationalist soldier refugees with their families were removed to Rennie's Mill in an outlying district of the New Territories. This was arranged by the Social Welfare Officer, All personnel were again deloused before embarkation.

101. The squatter problem remains serious, but in the meantime ali major clearances have been held in abeyance, whilst the situation is re- viewed. Areas already cleared are kept cleared by a patrol and as an example of the persistence of the squatter, 692 newly erected huts were removed in March, 1951 alone.

(e) Water Supply.

　　　102. The main water supply in the urban area is piped and of excellent quality. Many wells exist on the mainland and these are a con- tinual source of anxiety, but are mapped out so that chlorination may be done at once in case of epidemic bowel disease becoming a threat.

During

the year this chlorination of wells was tried out in a pilot scheme, because of the rise in the incidence of typhoid. No real conclusion was reached as to its effect.

　　　103. Water restrictions had to he imposed throughout the whole year due to increased consumption making the supply inadequate.

(a) Geography.

(ii) RURAL HEALTH.

104. The New Territories including the islands of Lantau and Cheung Chau make up the rural area. There are many villages and several small townships such as Un Long and Taipo.

(b) Staff.

　　　105. A Health Officer, a Senior Health Inspector and 5 Health Inspectors are responsible for the health problems. Malarial work is controlled by a Malariologist with his own staff. The district is wide for the staff available and great development is taking place. One inspector resides on the island of Cheung Chau.

106. A District Commissioner is in charge generally and the Health Officer is his health adviser. Liaison is maintained through the Health Officer with the Director of Medical and Health Services on health matters.

(d) Clinics.

107. There are 9 Government dispensaries providing medical treat ment to the villagers at Tai Po, Fan Ling, Sba Tau Kok, Un Long, San Hui, Sai Kung, Ping Chau and Tai O. There are midwives based on these dispensaries who do domiciliary work, and in some of the dispen- saries there are maternity beds.

　　　108. There are two travelling dispensaries which visit such villages as can be reached by road, and a launch conveys medical supplies and a visiting medical officer to the islands.

109. The police penetration patrols referred to in my last report have continued to provide an excellent example of the co-operation of St. John

Ambulance Brigade with the police and the Medical Department; St. John Ambulance Brigade providing the technical staff and the Medical Depart- ment the equipment and drugs. These patrols have been much appreciated by the villagers and their value has been further enhanced by a voluntary dental service organized by the Hong Kong Dental Society.

110. Anti-malarial work is controlled by the Malariologist who has a team of Malarial Inspectors and daily paid workers under him. A report on this work will be found in Annexure N.

(iii) Anti-Epidemic.

　111. This work was under the control of the Senior Health Officer until August, when an epidemiologist was appointed.

112. Malaria was made a notifiable disease in June.

113. Infective hepatitis became very prevalent in the Colony during the year, particularly among the armed forces, and by the voluntary co- operation of the doctors in the Colony this disease was notified and some information as to its extent became available.

114. In order to reduce the time taken by medical practitioners in notifying diseases, a modified notification form was introduced consisting of a pre-addressed and postage free folder, and requiring the minimum of writing from the notifying doctor. The new form was also designed so that it could be used for quick reference for statistical purposes.

115. The principal work of the Anti-Epidemic Office is directed against smallpox and cholera, 1,431,676 vaccinations being done during the year and 615,968 cholera inoculations. There was no case of cholera reported during the year, and only one suspected case of smallpox. Immunization compaigns were put into operation against smallpox during the winter months and cholera during the spring and summer months. Efforts were concentrated in the first place on the squatter camps; other sections of the community being dealt with later. Notice of these cam- paigns was published in the press, and in the case of firms and factories with a staff of 50 and over, arrangements were made for a team to visit the office or factory concerned. This proved a most effective method.

　116. Rodent control was, for the greater part of the year, directed by an officially appointed officer. It consists of the systematic destruc- tion of rats and the examination of all trapped live rats for fleas, which are counted and classified, and the prevailing flea index established. The public is encouraged to put dead rats into public rat-bins. These are collected daily and sent to the public mortuaries, where they are all examined microscopically and a proportion, including those showing any abnormality, have spleen smears taken and a microscopic examination made.

117. Both Rattus norwegious and Rattus rattus are found in tenement houses, but the former is the more common. Rattus rattus is more common in ships.

118. Other anti-epidemic measures are directed against contamination of food such as cut fruits, shellfish and milk and icecream products during their manufacture and sale.

119. Immunization against diphtheria is carried out in schools and infant welfare centres. Effort has been made to extend this service.

　　　　120. Table 16 shows the number of vaccinations and inoculations done each month.

TABLE 16.

The number of Inoculations and Vaccinations done

during 1950.

　　　　　　　　Anti- Anti- Anti- Anti- Anti- Month Smallpox Cholera Diphthe-Typhoid Plague

Vaccina inocula- ria ino- inocula- inocula- tions tions culations tions tions

1950

No. of persona

treated Anti- Anti-

with Typhus Tetanus Anti-inocula- inocula- rabies tions

tions

inocula

tions

January February

ILI

221,722

6,802 1.158 2,200

679

449

1,229

154.023

4,872

377 2.970

613

455

936

March

238,469

7,223

565

4,369

648

1.751

1.060

April May June July

159,779

24,897

655

2.208

562

1.410

1.110

75,187 118,663

715

2,832

661:

1.195

1,319

26,630 139,371

283

6,054

663

1,067

1.277

27,915 107,586

177

21.148

620

946

1,295

August .....

18.330

90,791

137

9.670

556

894

1,146

September.

15.286

92.773

195

7,509

439

818

1.197

October

189,027

10.484

197 3,820

296

735

1.216

November

December

188,822 6,408 3,702 166,486 6,098 8.262

2,685

284

863

1.241

2,436

270

1.087

1,090

TOTAL... 1.431.676 615,968

16.423

67.410

120

6.091

11.850

14,115

(iv) X-Ray of Government Staff.

121. An X-ray survey of Government staff was carried out in 1949-50 involving a total of 22,688 persons of both sexes between the ages of 18 and 60 years. This figure constitutes about 98% of all Government staff, and includes also a number of teachers employed in private schools.

122. It is proposed, in future, to carry out this survey each year.

123. The overall incidence of active pulmonary tuberculosis was 1.1% or three times the incidence of active pulmonary tuberculosis found on

mass radiography in United Kingdom. An additional 5% were found to have significant lesions of which 80% were considered to be healed. Some indication of the general incidence of tuberculosis among the adult popula- tion may be inferred from these figures as this group is made up of persons of all economic strata within the community, but the figures must be regarded as favourably weighted in view of the fact that all are employed persons and an unknown proportion of the total have been screened by medical examination prior to employment in the service. *

124. In considering the incidence of

of disease by department cognisance is taken only of departments who sent 500 or more employees for examination. The figure obtained are as follows, expressed as percentages:

Departments

Government Stores

Public Works Department

General Post Office

Medical Department

Marine Department

Urban Council

Kowloon-Canton Railway

Police

Education Department

TIL

Active Quiescent

2.38

5.35

2.2

4.46

1.74

6.36

1.4

3.7

1.05

4.31

0.9

3.5

0.7

3.17

0.66

3.13

0.18

0.77

125. It will be noted that, with the exception of the Medical Depart- ment where the occupational risk of infection is greatest, the incidence is highest in the departments where manual labour is chiefly employed. The relatively favourable position enjoyed by the Sanitary Department, which is chiefly made up of unskilled labour, and by the Police Department, where one would expect a high incidence in view of their irregular hours, is to some extent explained by the fact that these departments were sur- veyed in 1948 and cases, where possible, were dealt with.

126. The General Post Office has been the subject of special action on account of the high known incidence of tuberculosis among the staff. In the nine months preceding the survey, eleven post office workers were admitted to hospital on account of pulmonary tuberculosis.

It was found at the survey that over 10% of total workers had significant lesions, almost double the figure for all Government staff. The matter was referred to the health section, who investigated conditions fully and found that incidence was greatest among workers in the basement, where

25% had significant lesions as against 2% among other post office workers. It has been recommended that work in this part of the building, which is very poorly ventilated, should be discontinued.

127. The figures obtained in this survey are not quite comparable to those obtained in the 1948 survey, where just under 2% of 4,515 Govern- ment employees were found to have active pulmonary tuberculosis, as the latter was incomplete and was principally among manual workers and police. At the same time a number of the tuberculous individuals found on the 1948 survey were dealt with in the intervening period and the 1949- 50 survey was already a select sample of Government employees.

128. A survey of 2,461 prisoners at Stanley Gaol showed an incidence of active pulmonary tuberculosis of 3.86%.

(v) Health Education.

　　　129. A good deal of health education has been done during the year at the Infant Welfare Centres by daily systematic mothercraft instructions and through the use of flannelgraph methods, film strips, posters and films. As is usual in these centres, an incalculable amount of good has been done by personal instruction of each mother. More than a third of the Health Nurses' time is spent doing this work in the home.

　　　130. Other activities of the Infant Welfare Centres included "parent- craft classes" for senior pupils from some local schools (through the co- operation of the Education Department), health education at centres operated by the Society for the Protection of Children, weekly visits to four "teaching centres" in outlying districts, and the training of anti- tuberculosis workers in health teaching in the home.

131. During the seven months of the year when it was in operation, the cinema van gave 229 shows to an estimated audience of 45,990 or an average of 201 persons per show. In addition the projectionist gave 76 shows in the infant Welfare Centres and 14 in the Conference Room at Medical Headquarters. The Medical Department artist assisted in making 2,199 flannelgraph cut-outs and posters for the mothercraft classes at the Infant Welfare Centres.

　　　132. Three copies of the coloured film "Family Health", produced by the Medical Department, were obtained during the year and a recorded commentary was made to go with it. Towards the end of the year work was begun on the first of a series of anti-venereal disease films.

133. A certain amount of health education was done over Radio Hong Kong, Rediffusion, and through the press. Greater use was not made of these because of the absence of full-time senior health education personnel and the pressure of other work,

(vi) Port Health Work.

134. The Senior Port Health Officer has a staff of eight doctors to assist him to control the port of Victoria, the airport at Kai Tak and the railway terminus in Kowloon.

135. During the early period of the year the Senior Port Health Officer, Dr. P. H. Teng, was away on study leave visiting sea and air ports in the United Kingdom, the United States of America and Canada, and during his journey took the opportunity to visit the port authorities in Singapore, Penang, Colombo and Manila.

136. Two quarantine anchorages were kept open throughout the year. Both sulphur and hydrocyanic acid were used for fumigations, which were carried out by the port health staff.

137. During the year, 13,781 ships and junks with 731,148 passengers and 537,991 crew were examined at the quarantine anchorages. No case of quarantinable disease was found on board any ship during the year. 159 ships were fumigated, nine of them with hydrocyanic acid.

TABLE 17.

Ships Fumigated.

Cubic Capacity

No. of Ships Fumigated

Total Net Tonnage

Rats Recovered

! Sulphur

H.C.N.

used

(lbs.)

(oza.)

יו

150

228,483

27,620,523

1,472 (359 mice included)

82,832

5,142

17,524

2,435,688

212

(40 mice included)

Total 159

246,007

30.050,211

1,684 (399 mice included)

82,832

5,142

138. Owing to the interruptions of through traffic to Canton, train inspection was carried out partly at the terminus station, Kowloon, and partly at Lo Woo station on the border. A total of 1,452,698 passengers was examined. 472,569 vaccinations were done and 126,846 cholera in- oculations were given.

139. 610 aircraft from infected ports, carrying 4,278 passengers were inspected. 954 passengers and 3,569 crew inoculations were performed. From 1st December, 1950, the charge for these inoculations were reduced from $20 to $15.

(vii) School Hygiene,

　　　140. All registered schools in the Colony are subject to inspection by the Schools Health Inspectors and have to conform to certain regulations designed to maintain hygienic standards in the school buildings; but only some 22,000 pupils were included in the Schools Health Service during the year 1950.

141. These pupils attended a total of 95 schools classified in three groups: -

(a) Government Schools with a total of 841 pupils, most of whom

were European.

(b) 28 Government Schools with a total number of 8,963 pupils,

most of whom were Chinese.

　　　142. During the year 25,994 medical enaminations of pupils were carried out. There were 17,549 attendances at the schools general clinics and 1,908 attendances at the eye clinics. The optical workshop supplied 1,001 pairs of spectacles. There were 8,761 attendances at the dental clinics and 386 at the ear, nose and throat clinics.

　　　143. A sample nutritional survey was carried out with the results as set out below in tables 18 to 21.

TABLE 18.

Types A, B and C Schools.

Standard of Nutrition

Age Group

No. Inspected

Normal

Slightly below normal

Poac

283

245

591

478

112

508

478

116

842

721

116

239

224

Total

2,582

2,171

400

TABLE 19.

Type A Schools.

Standard of Nutrition

Slightly below normal

Age Group

No. Inspected

Normal

Total

Poor

TABLE 20.

Type B Schools.

Standard of Nutrition

Age Group

No. Inspected

Normal

Slightly

Poor

below normal

OFONAX

215

173

248

207

404

849

112

106

Total

1,061

904

155

TABLE 21.

Type C Schools.

Standard of Nutrition

Age Group

No. Inspected

Normal

Slightly below normal

Poor

191

163

364

293

344

265

438

372

127

118

Total

1,477

1,223

245

　144. As might be expected, the nutritional standard in the Group C schools which provide for the poorest class of pupils is not so good as in the other two groups.

145. The general health of those children examined was good, and the defects found were mostly minor. Dental caries still remains the biggest single defect.

146. Annexure H, Tables 1 and 2 show the results of medical inspec- tion of pupils and the inspection of school premises.

　　　　147. There was a slight drop in the percentage of children found with no apparent defect from 37.14% in 1949 to 36.47% in 1950.

148. Negotiations for an extension of the Schools Health Service, re- ferred to in my last report were continued during the year with rather poor success to start with but better results later. Finally 130 schools with a varying proportion of the pupils agreed to take part in the scheme, and by the end of the year 25,423 children were enrolled. In addition to this, a small number of teachers were also included. In anticipation of approval by the Legislative Council for this extension, steps were taken to recruit staff and the extended scheme was put into operation on 1st April, 1951.

　　　　149. This extension brings the number of children now included in the Schools Health Service to 47,433 out of a total of approximately 160,000 children attending school. Unfortunately, owing to difficulty in obtaining ophthalmic and ear, nose and throat specialists, there is no like- lihood of the scheme being further extended in the near future.

150. All pupils taking part in the scheme pay $15 per year and for this receive the usual routine examinations as new entrants and at the ages of 5, 10, 12, 15 and 18. They will all receive out-patient and in- patient medical attention, but not domiciliary attention, an annual dental examination with extractions for milk teeth and conservative work for the second dentition, and an annual eye examination with the provision of spectacles where necessary. A small additional charge will be made for maintenance in hospital, but otherwise the $15 will be inclusive.

(viii) Nutrition.

151. The standard of nutrition in the Colony remained good, and there was little evidence of gross malnutrition or undernourishment.

152. Apart from the small sample survey carried out by the Schools Health staff, no nutrition survey was done during the year.

(ix)

Social Hygiene.

153. Social Hygiene is under the direction of the Senior Social Hygiene Officer, who has a staff of five doctors, one technical assistant, eight dressers and eighteen nurses to help him. Treatment is carried out in six Government clinics, three male clinics (two in Hong Kong and one in Kowloon), and three female clinics (also two in Hong Kong and one in Kowloon). In addition to these clinics, there is a small hospital, the Wanchai Social Hygiene Hospital. It has sixteen beds for women, and four cots.

154. During the year, 701 women were treated in this hospital. The attendances in Social Hygiene clinics are shown in Table 22.

TABLE 22,

Attendances at Social Hygiene Clinics.

Clinic

Queen's Road West Hanchai Tsim Sha Tsui

Total

-------

Male

Female

Total

New

Old

New

Old

New

Old

1,860

22,719

2,406

20,725

2,217

➖ ➖ ➖ ➖ ➖

3,605

23,285

7.871 66,729

812 21,576 24,111 2,624 30.096

5,663 75,783

2,672 44,295 4,623 44.836 6,229

13,524 142,512

53,381

155. In addition to these main clinics, small clinics were held in dispensaries in the New Territories, and treatment was given at the male prison at Stanley and the female prison at Lai Chi Kok, Whereas, the cases attending the urban clinics during 1950 included approximately equal numbers of gonorrhoea and syphilis, no cases of gonorrhoea reported for treatment in the New Territories. It is possible that this apparent absence of gonorrhoea can be, in part, accounted for by the fact that the ignorant Chinese country woman does not look upon gonorrhoea as a dis- ease, and would not, therefore, attend a clinic for treatment. 221 cases of congenital syphilis were treated during the year and 29 cases of opthalmia neonatorum.

　156. Starting in November, 1950, free Kahn tests were provided for all pregnant women attending either ante-natal clinics or midwives in private practice.

157. In the case of midwives in private practice, the patient, on first booking with the midwife, is referred to the nearest Government dispen- sary for a sample of blood to be taken, the report being returned by the Pathological Institute to the Supervisor of Midwives. In the case of a positive report, the midwife concerned is immediately informed of the position and gives instructions to the patient to attend the nearest social hygiene clinic. At the same time a copy of the report is sent to the social hygiene clinic concerned for their information and to enable them to send a health visitor to persuade the patient to attend the clinic for treatment if she does not do so of her own accord.

158. Should the patient not attend the nearest dispensary to have a sample of blood taken, the midwife is instructed to take a sample of cord blood at the delivery, and to send this to the Pathological Institute for testing, when the Supervisor of Midwives would again be informed of the result of the test.

- 36

159. From November, 1950 to March, 1951, ie, during a period of five months, a total of 8,483 Kahn tests were done on samples provided by private midwives, and of these 369 were found to be either doubtful or positive, and were referred to the social hygiene clinics for treatment. Figures provided from ante-natal clinics, infant welfare and the maternity services showed that approximately 7% of the ante-natal venous blood tests were positive and 1.5% of the cord blood tests. Of those referred to the social hygiene clinics for treatment only some 40% attended, in spite of home visits and efforts at persuasion, and of the 40% who attend- ed only 56% completed the treatment adequately.

　　　160. It is hoped that ultimately all pregnant women will be given the opportunity, and will take it, of having Kahn tests done on them and that all those who are positive will submit to a full course of treatment, but the scheme is a new one and the rather poor results achieved so far must be expected in view of the amount of education needed on this subject before the value of this service is appreciated by the women concerned.

161. A further move in the plan to obtain information on the extent of venereal disease in the Colony was an examination of all admissions to the male and female prisons in the latter part of the year.

162. The results from 1,471 prisoners examined at the male prison at Stanley were as follows:

Syphilis Gonorrhoea

-------

Syphilis and Gonorrhoea

Observation

Others

17.21%

...

1.18%

1.15%

5.74%

74.72%

163. At Lai Chi Kok female prison out of 424 admissions who had Kahn tests taken, 78 proved positive, .e. 18.5%.

　　　164. It is to be hoped that these figures do not represent a true cross- sections of the infection rate throughout the Colony as a whole!

V. MATERNITY AND CHILD WELFARE.

(a) Centres.

165. There are three main maternity and child welfare centres; one at Tsim Sha Tsui, in Kowloon, and two on the island, one at the Harcourt Health Centre and the other at the Western Health Centre. In addition, there are four subsidiary infant welfare centres: three on the island, situated at Stanley, Shaukiwan and Aberdeen, and one at Shamshuipo on the mainland. At both the main and subsidiary centres the principal emphasis of the work is on educating the mothers. Tables 23 and 24 show the attendances at the main and subsidiary centres.

- 37

Harcourt Centre

Kowloon Centre

Western Centre

Total

TABLE 23.

Attendances at Main Infant Welfare Clinics.

New

Revisits

Total

2,699

30,958

33,657

2,987

32,064

35,051

2,348

30,868

33,216

8,034

93,890

101,924

TABLE 24.

Attendances at Infant Welfare Teaching Centres.

ATTENDANCE

Under

NEW

Over

REVISITS

Grand

No. of Clinics

No. of Homes

Shaukiwan.

1 year 1 year

Total

Under

Over

Total

Held

Visited

Total

1 year 1 year

471

Stanley

210

Aberdeen Shamshuipo

227

461

****

533

3,626

1.788

5,409

6,942

101

506

282

1.692

683

2.375 2,607

532

263

1.327 i

632

1,959

2,222

527

489

1,922

334

2,256 2,745

396

Total

1,369

148 1,517

1,517 8,567 3,432 11,999 | 13,516

292

1,960

　166. There is no doubt that this work is very much appreciated by those mothers who attend the centre and, to judge from the regularity of the attendances, in all probability if the number of clinics could be in- creased to cover the whole populated area adequately, the great majority of mothers would, within a few years, be attending the infant welfare clinics. Unfortunately, each clinic, as at present constituted, cannot deal adequately with more than two or three thousand cases a year. This would mean that, on the basis of attendance during the first year of life only, to cover the whole infant field some twenty to thirty clinics would need to be established.

　167. During the year 9,901 home visits were made by the health nurses in connexion with infant welfare.

　168. The number of ante-natal attendances at each of the three main centres was as follows:-

Western

Tsim Sha Tsui Harcourt

1,146

1,914

959

　169. Table 25 shows the state of health of the babies attending the main infant welfare centres.

TABLE 25.

State of Health of Attendances at Infant Welfare Clinics,

NEW

REVISITS

Under one year

Over one year

Under one year

Over one year

Grand

Total

Total Total

Healthy

Un-

healthy

Healthy

Un-

healthy

Healthy

Un-

healthy

Healthy

Un-

healthy

Harcourt Infant

Welfare Centre

1,493 1.023

96 2,699 17,919 7.042 4,320 1,677 30,958 33,657

Kowloon Infant

Welfare Centre

1.412

1,459

2,987 16.802

7.448 5,813

2,001

32,064 35.051

Western Infant

Welfare Centre

1,570:

736

2.348

16,621 8,297 3,764

2.186

30,868 33.216

Total

4,475

3,218

139

202

8,034

51,342 22,787 13.897 5,864

93,890 101.924

170. An investigation into the incidence of artificial feeding of infants in the first few months of life was carried out during the year, with some very interesting results.

　171. The investigation was divided into two sections; the incidence found at the first home visit of the nurses and the incidence found on the first visit of the child to an infant welfare centre.

　172. Investigations in the first section were continued until 1,000 infants had been found having artificial feeding. This 1,000 proved to be 13.64% of all infants who had been visited. In general, they represent an earlier age group than do those included in the second investigation.

　173. Of 1,000 babies on artificial feeding, 500 were discovered by the nurses based on the Tsim Sha Tsui Centre in Kowloon, 279 by the nurses based on Harcourt Health Centre and 221 by the nurses at the Western Infant Welfare Centre.

　174. The great majority of mothers concerned had delivered either in a private maternity home or by a private midwife and this suggests a promising mode of approach for improving the situation, by education among midwives and private maternity homes.

　175. Enquiries as to the age at which artificial feeding was started showed that of 1,000, 397 had been artificially fed from birth, 263 started when only a fews days old, and 202 at about a week old. In other words, some 862 out of the 1,000 had been artificially fed during the first week of life, and of the remainder nearly all had been put on artificial feeding in the first few weeks of life. Most of the mothers had started artificial feeding on their own initiative, and only 27 stated they had been advised to do so either by a doctor or a midwife. The majority appeared to have been given no instruction on how to carry out the feeding.

　176. Of the various reasons given for not breast feeding, 757 mothers said they thought they had insufficient or no milk; 63 said that they were working; 45 said that they did not wish to give breast feeding, and 108 were unable to give any definite reason.

　177. It is significant that only 44 out of 1,000 were aware of the infant welfare centres. On investigating further it was estimated that probably some 700 out of 1,000 need never have been given artificial feed- ing at all.

　178. The second investigation concerned mothers and infants on their first visit to a centre. The results of the second investigation are set out in Table 26 and Table 27.

TABLE 26.

Age of infants on artificial feeding at

first visit to Centre.

Few days

1-4

weeks

1 month- 2 months

2-3

3-4

4-5

5-6

Total

Harcourt

238

577

242

143

1,410

Western

270

479

198

1.207

Kowloon

118

276

967

390

170

112

2,131

235

126

Shaukiwan

+JIOLEI

Stanley

------------

Aberdeen

THHHH

Shumshuipo

+HHHH

Total

236

820

2.190

967

480

306

264

6,252

TABLE 27.

Age of infant when first given artificial feeding.

From

Few

1-41 month- Birth Days weeks 2 months

2-3

3-4 4-5

5-6

Difficult

to check

Total

Total No.

of cards

inspected

Harcourt

TII

%% of

artificial

feeding

1,399 1.410

3,070

45.92

Western

137

104

Kowloon

Shaukiwani

Stanley

Aberdeen

Shumshuipo

906

1.207

4,174

28,92

2.131

2,131

4,995

42.64

230

235

589

39.90

303

17.16

338

26.92

126

506

24.90

TOTAL

144

107

4.934

5.252

13.976

37.58

179. From these tables it will be seen that 37.58 were being fed artificially at the time of the first visit to an infant welfare clinic. This figure was obtained by examining 13,975 clinic cards.

　　　180. This tendency to breast feeding is, in part, due to superstitions and old customs.

　　　181. When it is understood that most of these mothers are living in poor and overcrowded conditions were a whole family of five or six may have only a curtained-off cubicle enclosing an area of perhaps no more. than 64 square feet, with no window, and there may be as many as five or six of these cubicles on one tenement floor opening onto the outside air at one end only, and covering an area of 32 ft. X 13 ft. and when it is realised that cooking facilities are limited and communal to the whole floor and that the water supply is cut off for long periods during the day and most of the night, it will be appreciated that it is well nigh impossible to carry out artificial feeding with anything remotely resem- bling a safe technique.

　　　182. It seems more than likely that this very important investigation points the finger to the root cause of the very high incidence of enteritis in infants, and possibly of broncho-pneumonia, and that, if any significant change is to be made in the infant mortality, an attack on this tendency to artificial feeding will be essential, but such an attack can only be suc cessful if the money becomes available for sufficient infant welfare staff and clinics to be provided to deal with the whole infant population in the Colony.

(b) Government Maternity Hospitals and Homes.

　　　183. There are two Government Maternity Hospitals; the Tsan Yuk Hospital with 75 beds and the Eastern Maternity Hospital with 24 beds. In addition, maternity cases are admitted to special wards in Queen Mary Hospital and St. John Hospital, Cheung Chau, and a separate block at the Kowloon Hospital, making a total of 189 beds available for maternity

cases.

　　　184. There are nineteen midwives employed in 15 districts during 1950. Nine of these district centres have small maternity homes attached, and a total of 5,207 deliveries was carried out during the year by these mid- wives, 2,574 being domiciliary cases and 2,633 being delivered in maternity homes.

185. A new district centre at Silver Mine Bay was opened in July.

　　　186. In Annexure I will be found a summary of the work done at the Tsan Yuk Hospital. This work is under the direction of Professor Gordon King, Consultant to the Government, and Professor of Obstetrics and Gynaecology in the University of Hong Kong.

- 43

―

　187. 114 private maternity homes were registered during the year; 52 of these being in Hong Kong, 62 in Kowloon, (one in Tsun Wan). Fifteen of these were new homes.

188. Visits of inspection are paid to all private maternity homes by the Supervisor of Midwives, and 898 visits were made during the year, 463 of these being in Hong Kong and 462 in Kowloon and the New Territories.

　189. Table 28 shows the size and site of these private maternity homes.

TABLE 28.

Size and Site of Private Maternity Homes.

Size of Home

----------

Number of Homes in Hong Kong..

Number of Homes in Kowloon

1 bed 2 bed 3 bed 4 bed 5 bed 6 bed 7 bed Total

דם

16 26

Total number of Homes

27 42

114

H++

Total number of beds available

54 126 112 40

24 21 379

190. 816 midwives were registered in 1950, 69 of these being new graduates.

191. Of the midwives on the register, 210 were in active private practice. Regular inspection of their records and equipment were made by the Supervisor of Midwives.

192. Table 29 shows the number of patients attended by a doctor or midwife in the various institutions in the Colony from 1946 to 1950. In view of the large numbers of newcomers to the Colony it is surprising that they should have learned so quickly to appreciate the value of the maternity service provided. This administrative link with the newly born, also referred to in my report last year, has been used in the campaign to erradicate congenital syphilis, referred to in paragraph 156 under the heading of Social Hygiene.

- 44

TABLE 29.

Births attended by a doctor or midwife.

1946

1947

1948

1949

1950

Queen Mary Hospital

117

398

719

1,164

1,580

Kowloon Hospital

979

1,201

1.189

1.287

1,576

Tsan Yuk Hospital

2,645

3,826

4.458

4,228

5.012

Eastern Maternity Home

868

1,633

1.831

1,783

1,995

Private Hospitals

4,058

9.086

12.161

15,387

16,333

Government Dispensaries (Attended by

Midwives)

640

1.260

1.582

2.013

2.633

Private Maternity Home

9,586

13,150

14,324

18,730

21,226

Total births delivered in hospitals &

maternity homes

18,893

30,594

36,264

44,587

50,355

Domiciliary Cases delivered by Midwives

5.628

9,237 10.120 8,991

9,125

Total Number of births attended

24.521

39.831

46.384

53,578

59.480

Number of births unattended

6,577

2,642 1,091

1.196

1.120

Total Number of births

31.098

42,473

47,475

54.774

60,600

Percentage of births attended

78.9% 93.8% 97.7% 97.8% 98.2%

198. The Supervisor of Midwives, who is a senior doctor in the department, combines her supervisory duties with the secretaryship of the Midwives Board, and this close liaison between the supervisory staff and administrative board is an important factor in the efficiency of the maternity service.

VI. HOSPITALS AND DISPENSARIES.

194. Annexure J gives a summary of the cases treated in Government and Government assisted hospitals, clinics and dispensaries.

　　　　195. Annexure K shows the cases treated in Government and Govern- ment assisted hospitals, and the total deaths in the Colony for 1950.

196. A further influx of people into the Colony took place in the early part of the year and reached a peak in April. At this point the normal seasonal increase in attendances at hospitals and out-patient departments came into effect, with the result that, although the population probably did not increase after the end of April, attendances at the hos- pitals and out-patient departments did, and the increase continued until July, when it began to fall gradually.

(a) Queen Mary Hospital.

197. This is the largest hospital in the Colony, with 576 beds. It is the training school for both medical students and nurses and, until October approximately 200 beds in this hospital were allotted to the University clinical units for teaching purposes. In October an agreement was made with the University by which the whole of the third class. accommodation became available for teaching purposes.

198. The third class beds were allotted in approximately equal portions to the Government and University, the ultimate aim being to have two teaching units in both medicine and surgery on both the Univer- sity and Government sides. Owing to various administrative difficulties, this arrangement could not be brought into complete operation at once.

199. During the year, 9,819 in-patients were treated as compared with 8,794 in 1949. There were 615 deaths, of which 208 occurred within 24 hours of admission. 4,663 operations were performed.

200. In the Maternity Wing 1,608 cases were treated, with 1,604 deliveries and 4 deaths, giving a maternity mortality rate of 2.49.

201. There were 38 stillbirths and 41 neo-natal deaths giving a still- birth rate of 23.5 per thousand and a neo-natal death rate of 35.9 per thousand.

(b) Kowloon Hospital.

202. Kowloon Hospital is the only emergency hospital for the main- land, and its 190 beds are quite inadequate for dealing with the amount of work it is called upon to meet. In the latter part of the period under review, a further 72 emergency beds were being added which will provide some relief, but Kowloon will have to await the new hospital before it can be considered to be supplied with an adequate number of beds.

203. During the year, 6,285 in-patients were treated, and there were 397 deaths, 243 of these occurring within 24 hours of admission. 7,729 cases were admitted to the Maternity Block and 1,604 were delivered. There was one maternity death due to ruptured uterus.

204. There were 28 stillbirths and 23 neo-natal deaths giving a still birth rate of 17.5 per thousand and a neo-natal death rate of 20.9 per thousand.

205. In the general hospital, 2,277 operations were performed as com- pared with 1,963 in 1949.

206. Although Kowloon Hospital is a small hospital, there is a very large out-patient department attached to it, where general and special clinics are held, and where, since September 18th, 1950, there have been evening clinics from 6 p.m. to midnight. There has been an enormous increase in the number of cases seen in the out-patient department com. pared with previous years, and 284,280 new cases were dealt with as compared with 94,009 in 1949. The total number of attendances during the year was 364,966 as compared with 150,830 last year.

- 46-

　　　207. This great increase in the out-patient attendances presented grave problems and these were eventually solved by appointing a further four doctors to work during the daytime, which brought the total number of doctors on day duty to ten. In addition, four doctors were appointed to work from 6 p.m. to midnight at the evening clinics. This increase in the number of hours of attendance and in doctors available was sufficient to meet the medical demands, but with other facilities, such as latrine accommodation, waiting-room space and the marshalling facilities for such large numbers, the problem was less easily solved.

　　　208. It says much for administration of the hospital that the organiza- tion and direction of these vast crowds was carried out day after day quite smoothly, and much of the credit for this must go to the Almoners Department.

209. No less credit is due to those doctors who made no serious mis- takes while working at high speed for long hours in the out-patient depart- ment, with the ever present fear that they might miss some serious con- dition.

　　　210. The Mental Hospital is an old building, and is now not only in- adequate in size, but ill-adapted to modern methods of treating mental patients, and plans have been approved for replacing it during the next five years building programme. This hospital has official accommodation for 134 patients, but the daily average number of patients in recent years has been as follows:---

1948

119

1949

1950

156

　　　211. Owing to the difficulties in ingress and egress existing in Hong Kong, there is a greater tendency than was the case in previous years for families to send their relatives to the Mental Hospital rather than back to the native village. This change is shown, in part, by the increase in cases of senile dementia now being admitted to the hospital.

　　　212. The daily average number of patients during the first 3 months in 1951 showed a further increase over the 1950 figure, being 170 for January, 177 for February and 183 for March. During the year 915 cases were treated in the hospital, of which 719 were discharged cured or had sufficiently recovered to be taken care of at home, 3 were trans- ferred to other hospitals, 30 died and 163 remained at the end of the year.

213. There were 232 re-admissions.

214. The usual physical methods of treatment were employed, and curare modified electric-convulsive therapy was introduced during the year. The Asylums Ordinance, 1936, was amended in May, 1950, to permit the admission of voluntary patients, and a total of 8 patients in this category were treated up to the end of the year.

215. Rattan work, needlework, a library, carol-singing and short dramatic sketches produced by some of the local schools, provide the patients with some diversional therapy.

(d) Sai Ying Pun Hospital.

216. This hospital is the infectious diseases hospital for the island, and has a normal capacity of 88 beds, which can be increased to 150. During the year a total of 1,207 cases were treated, with 196 deaths which compares with 870 cases and 162 deaths in 1949.

　217. Under the same administration, but in a separate building not associated with the infectious diseases hospital, there is an out-patient department. During the year 79,123 new cases were seen in the day clinic, where the total attendances amounted to 177,256. On September 18th an evening clinic was opened from 6 p.m. to midnight and between that date and the end of the year, 10,123 new cases were seen and there was a total of 15,278 attendances. Total attendances, therefore, at this out- patient department, amounted to 192,534 as compared with 164,676 in 1949.

(e) Lai Chi Kok Hospital.

　218. This hospital, consists of two sections, the lower section, con- taining 290 beds, is an infectious diseases hospital, and the upper section, a convalescent hospital, with 180 beds.

　219. In the infectious diseases section 202 beds are set aside for tuber- culosis cases. In these beds a total of 454 patients were treated, with 29 deaths. The patients were admitted in an earlier stage of disease this year than was the case last year which resulted in a bigger turnover.

　220. The remaining 88 beds in the infectious diseases section dealt with a total of 868 patients, which represented an increase of 100% on the previous year.

221. At the end of the financial year, diversional therapy for the tuberculous patients was started by the Hong Kong Branch of the British Red Cross Society.

222. The upper section of the hospital is used as an overflow for Kowloon Hospital, where convalescent cases can be housed until fit for discharge.

(f) St. John Hospital--Cheung Chau.

223. This hospital, which is the property of the St. John Ambulance Association is being administered by Government under a five year agree- ment. It has 76 beds, of which 31 are for tuberculosis cases and 12 for maternity cases. 1,193 cases were treated compared with 1,089 last year, The figures were made up as follows:

General cases Infactious diseases

Tuberculosis cases

764

LI H

319

224. The tuberculosis cases were in a convalescent stage, and no special treatment was given to them.

(g) Tsan Yuk Hospital.

225. This is the principal maternity hospital in the Colony, and con- tains 75 beds. While the hospital under the administration of a Govern- ment medical officer, the University Obstetrical Unit is responsible for the clinical work, and Annexure I gives a summary of the work done during the year.

226. There were 5,385 cases admitted and 5,106 deliveries and only 2 deaths, giving a maternal mortality rate of 0.39 per thousand. The stillbirth rate was 17.05 per thousand and the neo-natal death rate 16.95 per thousand. During the year a 10 bedded ante-natal ward was added to the hospital.

227. On 24th March, 1950, the fifty-thousandth baby was born in the Tsan Yuk Hospital since the University Obstetrical Unit took charge of the work.

(A) Eastern Maternity Hospital.

228. This hospital consists of 24 beds. During the year 2,040 cases were admitted with 2,019 deliveries and no deaths.

229. During the year the system of keeping records at this hospital was altered to conform with that of the Tsan Yuk Hospital so that the statistics would be comparable.

　　　230. There were 24 stillbirths and 21 neo-natal deaths giving a still- birth rate of 11.9 per thousand and a neo-natal rate of 10.5 per thousand.

.49

(i) Government Assisted Hospitals.

231. There are five hospitals in the Colony run by charitable institu- tions which receive a considerable grant from Government. Three of them, known generally as the Chinese hospitals, and comprising the Tung Wah Hospital with 467 beds, the Kwong Wah Hospital with 340 beds, and the Tung Wah Eastern Hospital with 230 beds, are part of the charitable work carried out by the Tung Wah Board of Directors. The actual ad- ministration of the hospitals is under the control of the Tung Wah Hospital Committee comprising the three Principal Directors for the year with the three Medical Superintendents and two advisers, and is under the chair- manship of the Director of Medical and Health Services.

232. The two other assisted hospitals are the Nethersole and Affiliated Hospitals, associated with the London Mission Society, with 140 beds, and the Hong Kong Anti-Tuberculosis Association's Ruttonjee Sanatorium with 130 beds.

(7) The Chinese Hospitals.

233. Treatment in these hospitals is for the benefit of the poor, but there are a small number of private wards. During the year the total number of cases treated in these three hospitals was 40,909 as compared with 33,793 in the previous year.

234. The official bed accommodation is somewhat misleading in these hospitals, as they endeavour to meet with any demands made upon them, and the number of patients in both the Tung Wah and Kwong Wah Hos- pitals often exceeded by two hundred or more the official number of beds. Each of these hospitals runs an out-patient department, and the total com- bined attendances amounted to 139,616, which compares with 128,815 in 1949.

(k) Nethersole Hospital.

235. This hospital also caters for the poor in Hong Kong but, in general, a small charge is made for both out-patient attendances and in- patient treatment. 4,725 in-patients were treated as compared with 4,634 in 1949, and the respective figures for maternity cases were 1,647 and 1,414.

236. In the out-patient department there were 55,263 attendances compared with 80,341 in previous years.

287. Number of beds as at November, 1950:

Main Block

Maternity Block

123

- 50-

(1) Ruttonjee Sanatorium,

　　　238. This sanatorium is under the administration of the Sanatorium Management Committee on behalf of the Hong Kong Anti-Tuberculosis Association.

239. During the year the number of beds was increased from 120 to 130, and a total number of 319 cases were treated, with 12 deaths.

240. The close liaison between the sanatorium doctors and the govern- ment tuberculosis clinic (Harcourt Centre) referred to in my last report continued during the year, and the combined work of these two units provides a very valuable service to the Community.

(m)

Private Hospitals.

　　　241. In Annexure L is shown the cases treated as in-patients and out- patients at the main private hospitals in the Colony.

(2) Violet Peel Polyclinic.

　　　242. This Clinic is the third largest out-patient department in the Colony, and is situated on the island. There was a re-arrangement of the work during the year, and certain specialist clinics were held there in the afternoons.

　　　243. 75,742 new cases were treated with a total number of attendances of 126,804, the corresponding figures for 1949 being 59,839 and 99,482. During the summer, attendances at this clinic became so great that large queues began to form and a "black market" in attendance tickets came into being. However, with the introduction of the charge of $1, the trivial cases ceased to attend and the number of patients decreased some- what, but it seems probable that this decrease was largely a seasonal change, as towards the latter part of the financial year the number of attendances was again increasing, and the staff was having difficulties in competing with the numbers.

　　　244. The establishment of a night clinic as a means of dealing with this increase in attendances is under consideration.

(0) Stanley Prison Hospital.

　　　245. This hospital, which is incorporated in the prison itself, has three wards of 16 beds each and six isolation cells. A total of 1.156 patients were treated during the year, with a daily average of 36.

　　　246. 44,619 prisoners reported sick, and there were 12 deaths from natural causes. There were 7 deaths from judicial hanging.

(p) Public Dispensaries.

　247. There are 8 public dispensaries where treatment was provided free until 18th September, when a charge of $1 was made for visits to the doctors, as in the polyclinics. This resulted in a considerable drop in attendances, but it was the opinion of the doctors in these dispensaries, as in the polyclinics, that the drop consisted principally of trivial cases.

　248. Authority was given to all out-patient doctors to treat a case free if they were satisfied that attention was urgently required and the patient could not afford to pay $1. Other cases, unable to pay and not in need of urgent attention, were referred to one or other of the various free out-patient clinics run by the Tung Wah Hospitals, Kai Fong Associations and other benevolent societies.

249. The fact that there was no appreciable increase in the attend. ances at these free clinics following the introduction of the charge of $1 in the Government clinics suggests that no real hardship was produced by this charge. A total of 33 free cases were treated in these 8 dispen- saries between 18th September and the end of the year.

　250. At all public dispensaries the morning session was devoted to children and the afternoon session to adults, and these clinics formed a base for anti-epidemic work in the area.

　251. Midwives are attached to all of these dispensaries, and in one case there are a few beds, so that in-patient maternity work, as well as domiciliary work, can be carried out.

262. Table 30 summarizes the work done at these public dispensaries.

TABLE 30.

Attendances at Chinese Public Dispensaries.

Public Dispensaries

Out Patients

Children

Adults

New Attend- New Attend- Cases ances Cases ances

Deliveries

In pati- ents

Vacci- Inocu-

Domici- nations lations

liary

Central Eastern Aberdeen

➖ ➖ ➖ ➖➖➖ ➖ J

16,074 26,737 10,313

22.385

7.289

582

KAH

12.447

16,435

9,887

21.688

13.683

1,259

5.050

Hung Hom

---

13.082

7,978 14.938 11,114

5,749 12,259

284

3.387

17.051

6,146

2.043

Shaukiwan

Yaumati

Shamshuipo

Stanley

21.053

35,069

13,652

26,661

607

6,072

873

30.785

32.034

20,082 $2.860

248

9.552

1,706

22.761

41.447

18.414

38.687

509

16.847

2.110

745

1,388

789

5.096

185

1,351

1.115

Total

----

121.997 176,026

90,000

176,667

76.66 185

1,658

64,327

9.764

(9) New Territories Medical Centres and Maternity Homes.

　　　253. There are 9 public dispensaries and maternity centres in the New Territories with 2 mobile units, one working on the west and one on the east side of the mainland. The work of these dispensaries, three of which have a resident medical officer, is co-ordinated under a medical

officer of health of the New Territories, who works in close liaison with

the District Commissioner of the New Territories.

254. Both in-patient and domiciliary midwifery is carried on at seven

of these centres.

255. Table 31 gives a summary of the work done by these medical

centres.

TABLE 31.

Medical Centres-New Territories,

Out-patients

Deliveries

Dispensaries

New

Attend-

cases

ances

In- patients

Domici- liary

Tai Po

Họ Tung

Shataukok

Un Long

Sun Hui

Sai Kung

18.795

34,497

644

2,358

5,908

175

1,894

4,698

110

16,171

38,830

745

1.188

3.198

---------

122

2,892

5,159

Tai O

11,568

20.171

329

Silver Mine Bay

1,403

2,664

++++-----

Ping Chau

1.666

8,389

Travelling (East)

---

3.828

5,625

Travelling (West)

Tutur

3.083

4,800

Total

64,646

128,939

2,150

420

　256. At the Ho Tung Clinic there are a few beds available for general in-patients, primarily for members of the Police Force, and 189 patients were admitted during the year.

(2) Ambulance Service.

257. The Medical Department provides the ambulance service for the Colony with the exception of accidents and street emergencies which are dealt with by the Fire Brigade. Other ambulance services are also provided by the St. John Ambulance Brigade and the Tung Wah Hospitals group.

　258. Table 32 shows the work done by the Medical Department ambulances during the year.

TABLE 32.

Annual record consumption of Petrol, Oil, Mileage and calls for all Medical Department Ambulances.

Place

Annual mileage

Annual petrol in

Annual

Oil in

Annual calls

Remarks

gallon

Hongkong

53.080

5,275

5,719

6,985

ра- tient

Kowloon

91,696

10,788

461

8,494

14,796

Total:

144,776

16,063

1774

14,213

21,781

(8) X-Ray Department.

　259. The work in the X-ray Department continued to increase, as was only to be expected, in view of the great increase in in-patient and out-patient demands on the medical service.

　260. 67,833 cases were seen at the Queen Mary Hospital as compared with 58,629 in 1949. Similar figures for Kowloon Hospital were 25,737 and 15,831. Most of the increase in examinations made was in chest films.

261. Table 33 gives a summary of the work done during 1950.

―

TABLE 33.

Work done in the X-ray Department.

Examinations made

Chest

Bones

Abdomen

Intravenous Pyelography

Barium Meal

Hysterosalpingogram Cholecystogram Cystogram

--------

Retrograde Pyelogram

Bronchogram

Arteriogram

Dental

Ventriculogram

Cholangiogram

Encephalogram Peripheral Angiogram

Cerebral Angiogram Myelogram

י -

Flouroscopic Examination

Urethrogram

Sinogram

Pelvimetry

Cardioscopic Examination

Total:

Films expended

Mass Miniature

15′′ x 12′′

12" x 10"

10" x

6" x 8"

　　7" x Dental

Queen Mary

Kowloon

Hospital

59,153

19,204

5,104

5,114

1,522

614

214

679

294

110

404

610

140

104

67,833

25,737

38,111

3,871

13,788

5,836

ד.

14,077

4,878

1,855

3,249

7,225

4,130

1,406

578

1,324

840

　262. Radiation therapy was continued during the year, and further work was done on the radioactive cobalt "bomb" unit.

263. Table 34 sets out the therapy work done during the year.

TABLE 34.

Radiation Therapy cases treated in 1950.

Month

January February March April

May

June

July

August

September

October

November

+---

December

Deep Therapy Cases

Superficial Therapy Cases

Radioactive Cobalt Application Cases

Radium Application Cases

areceres="+

Total

101

--- --- - ----T---

ANAHERO LO DO OS TO DO IN V

121

　264. The Physiotherapy Department is under the administration of the Senior Radiologist, and a summary of the cases treated is given in

Table 35.

TABLE 35.

Physiotherapy Department.

In-patients

Treatment Out-patients Treatments

Queen Mary Hospital..

539

4,103

1,390

13,148

Kowloon Hospital

472

4,073

2,382

19,605

Lai Chi Kok Hospital

252

3,272

VII. DENTAL CLINICS.

　　　265. The Government dental clinics situated at Sai Ying Pun, Kowloon Hospital and the Harcourt Health Centre continued operations throughout the year, and Table 36 gives a summary of the work done.

TABLE 36,

Attendances al Government Dental Clinics.

Government Servants

Families

---------

School Children

General Public

Total

Harcourt Health Centre

Kowloon Hospital

Sai Ying Pun Hospital

257

1,598

4,800

351

1.333

2,400

6,032

2,440

387

202

4,381

8,912

6,842

9,752

16,499

　　　266. In the latter part of the financial year the dental surgeon visited Stanley Prison and Victoria Remand Prison, where emergency dental treatment was carried out.

　　　267. A dental surgery was also maintained at Queen Mary Hospital, which operated, part-time, for the benefit of in-patients and the staff of the hospital.

　　　268. There are two dental inspectors whose duties are to inspect the premises and equipment of registered dentists and to investigate cases of dental practice by unregistered persons.

VIII. PHARMACEUTICS.

　　　269. 113 institutions were serviced during the year as compared with 92 in 1949. The building of a new central medical store and distributing dispensary at the North Point store was proceeding, and it is anticipated that it will be ready for occupation early in the new financial year.

　　　270. Bulk solutions of sterile materials for injection reached a volume of 5,568 litres, and 12,428 vials of 20 cc. capacity were prepared and issued.

　271. The Streptomycin Committee continued to function during the year and controlled the use of all antibiotics, with the exception of penicillin, in Government institutions.

　272. 287 wholesale dealers licences were issued and 197 listed sellers licences. These figures compare with 258 and 183 in 1949. 44 pharma- cists were registered as compared with 38 in the previous year. A total of 366 premises were inspected.

　278. In November the administration of the Dangerous Drugs Ordinance was transferred from the Director of Commerce and Industry to the Director of Medical and Health Services.

274. In January 1951 speculation in antibiotics became very prevalent with the result that it became well nigh impossible for doctors and hos- pitals to obtain their requirements at reasonable prices. Emergency regulations were promptly introduced, and price control was established where necessary.

These measures proved effective.

IX.

MEDICO-SOCIAL ACTIVITIES.

　275. In July Miss A. M. Ballantyne, Principal Almoner, became ill, and Miss Cheng Sui Chun once again acted as Principal Almoner, and was still in charge of the sub-department at the end of the financial year. A full report on the work of this sub-department will be found in Annexure M,

TRAINING OF PERSONNEL.

　276. Training of personnel continued during 1950. The standard aimed at being that set in the United Kingdom.

　277. Nurses registered in Hong Kong are accepted for registration in the United Kingdom on the recommendation of the Nurses Board and, by agreement with the Society of Radiographers, the training in radio- graphy is recognized and an examination for membership of the Society of Radiographers can be held in Hong Kong.

　278. Negotiations with the Society of Laboratory Technologists for similar recognition of the training of laboratory assistant unfortunately failed.

　279. Table 37 shows the technical groups who have received training during the year.

TABLE 37.

Appoint- Resigna-

ment

tion

Strength at 31.3.51

Passed

Probationer Masseuse

Probationer Radiographic

---------

Assistant

Probationer Dispenser

Probationer Laboratory Assistant

Probationer Assistant Almoner

Probationer Nurses

Probationer Midwives

Probationer Dressers

₩

　　　280. During the latter part of the period under review, investigations were made into the possibility of establishing a training school for health nurses. Considerable progress has been made in working out a syllabus and the means of providing the theoretical and practical training, and it is hoped that in the early part of the next financial year details will be sufficiently advanced for a start to be made with the first batch of nurses. The standard to be aimed at is the Certificate in Public Health Nursing given by the Royal Sanitary Institute. There is an examining body of the Royal Sanitary Institute in Hong Kong.

　　　281. It is proposed to select the most promising nurses for this course, so that in years to come those members of the nursing staff holding the more responsible positions in the department will have a wider outlook than is possible with the present system of training.

XI. PATHOLOGICAL INSTITUTE.

282. The Pathological Institute, under the direction of the Govern- ment Pathologist, consists of a main building where a large amount of diagnostic work and the vaccine production is carried out. In addition to this there are two branches, one at the Kowloon Hospital which is responsible for most of the diagnostic work in Kowloon and one at Queen Mary Hospital which is mainly concerned with clinical pathology. In Annexure O will be found a detailed report of the work done during the

year.

XII. CHEMICAL LABORATORY.

　283. The Government Chemist, with a staff of two chemists and one assistant chemist to help him, is in charge of the chemical laboratory where commercial, medico-legal and biochemical work is carried out. Annexure P will be found details of the year's work.

XIII.

MEDICO-LEGAL.

　284. The Medico-legal work continued under the direction of Dr. T. C. Pang, police surgeon and consisted in forensic work, laboratory work and lectures and demonstrations to police officers and medical students.

XIV. BIRTHS AND DEATHS REGISTER.

　285. The registration of births and deaths and the administration of the Births and Deaths Registration Ordinance is under the control of the Director of Medical and Health Services. There is a central registry and a number of branch registries in different parts of the Colony and New Territories.

286. During the year considerable progress has been made in micro- filming those birth registers which are not already duplicated, 158 having been completed and 124 remaining to be done. There are, in all 757 birth registers, but 475 of these exist in duplicate.

287. There are 684 death registers, 298 of which exist in duplicate. No start has yet been made on micro-filming the death registers.

288. During the latter part of the period under review discussions were held with the District Commissioner of the New Territories with a view to introducing a procedure to make it easier to register births and to obtain copies of birth certificates in the New Territories.

289. Early in 1951, the Hollerith system for collecting and compiling statistics of mortality was introduced, and information was recorded by means of punched. Hollerith cards covering age, sex, marital status, nationality, occupation, place of residence, place of death and cause of death, and also whether or not the deceased was a squatter, whether the dead body was sent to a mortuary, and the registration number of the attending doctor.

290. It is hoped, by the introduction of this system, to make available statistics of mortality for scientific purposes.

XV.

ACKNOWLEDGMENT.

291. This will be the last annual report I shall write as Director of the Medical and Health Services of the Colony. I should like to take this opportunity of placing on record my appreciation of the co-operation that I have received from everybody in the department. During the four years I have been responsible for the direction of the department there has been steadily and, at times, rapidly increasing pressure on the facilities avail- able. This has meant many people working at high pressure and for longer periods than might normally be expected of them, but not only have these increased calls on their services been met by everybody cheer- fully, their enthusiasm has enabled me to introduce new services and to extend and improve those already in existence. Furthermore, when calls were made for economies there was all immediate appreciation of the position, and the heartbreaking business of abandoning favourite schemes was accepted cheerfully, and I was placed in the happy position of being able to select from among a number of suggested economies rather than having to force economies on unwilling heads of sub-departments.

I. NEWTON,

Director of Medical & Health Services.

EUDIGAN

UTTODESTO: HEALTH SERVICES

Malarialogset alaria. Inapes Lore

(Serior Port Health Officer

| Fort Health Officers, (Port Health Inspectors, (4 Inoculation CentraÐ.

Señor Social Hygiene Deficar and > Clinton

Čajová orrionz (Sho+]4]

and Schools Health Servios,

3° Infant Malfuro Clinics

4 lafant Welfare Toaching Centree,

(Senior Health offiour,

| Epidemiologist,

(Health OffiOUTE,

Chaujatent Health Officers,

(Health Inspectora.

(OFFLONE,

[Nomen] Officers

[und Appartant

EROGLORI Officers

|Senzor Fadin):

Department Physiotherapi

MEDICAL SY

(Senior Dental ||Surgeon' " Depart

(Cynaecological and [Datatrion) Speciali Surgical Specialsať|

Medical Spes in 1 Lat

Ophthalmic Surgeon"

Government Comm

Tuberculoede Specialist 2 Tuberculosis Clinica

Deputy Ingistrar and Births and Deatha

Ingletry

Chief Pharmacist'a Department

Chief Steward" Department

1.0.1% Polies Rodinal Port

N.0.1/ Stanley Prisco Hospital

Ten Hospitala

Theán Pölyolandes

unillos Visiting Medical Gr#Loera Hong Kong and Kowloon

Čiindow and Dispensaries

Nine in Urban Arda

Bighi in fural Arom

Polion "Burgoña

Chewdos) Laboratory

Pathological

(Prinsipel astron

(and all Nursing Stuff, | Dietitian,

{Superintendent and

( Training Officer for ( Harith Nurses,

Dental

Tung Wan Heapssa. Mediów). Čomitter

Pharmacy

Supervisor of Midwives

Principal Aladeer", Department

Medical Officer of Health

{Government Eidriven,

CHART SHOWING THE ORGANIZATION

How Territories

* THE

MEDICAL DEPARTMENT

1950

COLONY OF HONG KONG

MEDICAL FACILITIES MAP 1930,

Castle

Lok

Ling

Bispensary

阳

saterakty Tou

Dispensary

tor nhiệ

(See separate

ANNEX VEE

"A"

Pesala Prison Hoipital

أما لجok o رو اما

Miguel La 1

os.

* Bospital

Ösaloon Hoept fullà Out-patient Department (c) Korloon Tubefrukkie Ciała

Sham Shui

Publia Diop MALTY

Ở Trong Lịch Hapital

Paul Baulih Cantra

Hospital

one Clinic.

Public Dispossa ry

Hospital.

"B"

Fare brigade

ME. C tral Hospital

HONG

St. Jabł

Brigade Centre,

BL PAIN Hospital.

* Deklanjer Stokvarium

sa 6.1. Hompilating van Hantera dospital

A Hospital

Bestden Diapery alisematy

KONG

Gallery Hospital

ANNEXURE C.

Establishment of Medical Department as at 31. 3. 51.

Director of Medical and Health Services

Deputy Director of Medical and Health Services

Deputy Director of Medical Services

Deputy Director of Health Services

Secretary

Senior Medical Officer

Senior Health Officer

Medical Specialist

Gynecological and Obstetrical Specialist

Tuberculosis Specialist

Surgical Specialist

Senior Port Health Officer

Senior Social Hygiene Officer

Ophthalmic Surgeon

Government Pathologist

LILL

. г

- - - - - - -

Pathologist and Assistant Pathologists

Senior Dental Surgeon

Dental Surgeon and Assistant Dental Surgeons

Senior Radiologist

Radiologist

Superintendent Radiographer, Radiographers, and Radiographic

Assistants

Malariologist

Government Chemist

Chemists and Assistant Chemist

го ог

- +

Medical Officers, Assistant Medical Officers, Woman Medical Officers, Assistant Woman Medical Officers, and House Officers.

125

Principal Matron

Nursing Staff

Principal Almoner

Almoners

Executive Officers

Clerical Staff

LLII+

LJ ----

584

150

Chief Pharmacist, Pharmacists, Dispensers, and Dispensary

Supervisors

Physiotherapists and Assistant Physiotherapists

Senior Laboratory Technician, and Laboratory Assistants

Stewards

Health and Malaria Inspectors

Dietitian

Public Vaccinators

Other staff

יי

1,667

Total

- 67

2,743

ANNEXURE D.

Chloromycetin in Typhoid Fever.

As typhoid fever had assumed epidemic proportions in the Colony by the middle of 1950, and as many of the cases reaching the hospitals were seriously ill, a large scale experiment with chloromycetin was decided on, and begun in June 1950.

Cases of the disease have been treated as far as possible in two hospitals in the Colony; one at Lai Chi Kok on the Kowloon side, the other at Sai Ying Pun on the island of Hong Kong. A small group of cases has also been treated at the Queen Mary Hospital. This segregation of cases made the application of systematic treatment very much easier,

A proforma was drawn up to facilitate the collection of clinical and bacteriological data in all cases and to show the dosage of chloro- mycetin employed. A tentative dosage scheme consisting of 3 grammes of C. as a loading dose, followed by 2.75 gm. of C. on subsequent days up to a total of 25 gm. was used for all adult cases. Previous experience with chloromycetin had shown that the results obtained with a schedule of this sort were quite as good as those obtained by giving the drug in smaller doses at more frequent intervals. This scheme had to be modified in the light of later experience.

On admission to one of the receiving hospitals blood and marrow were taken from each patient for culture wherever possible. Few if any patient were admitted to the typhoid centres without a positive Widal reaction having already been obtained, but a positive Widal in an urban population such as Hong Kong's cannot be interpreted as proof positive of the existence of typhoid fever. Many of the victims of the disease, however, were refugees or country people who had recently arrived in Hong Kong and in such cases a Widal reaction showing a litre of 1/200 to H and O could safely be accepted as proof of typhoid fever. Wherever possible an attempt was also made to have at least a total white cell count done. Stool and urine culture were also made in cases where other investigations had proved negative. The ideal patient, of course, was one admitted with a +ve Widal reaction which was subsequently con- firmed by +ve blood and marrow cultures. As the series is not yet complete the % of such cases cannot yet be given accurately.

When these investigations had been completed treatment was begun on the lines already described, with dosage modifications where necessary for age. Although the data obtained have not yet been fully analysed certain points emerge clearly from an experience of the drug in approximately 200 cases of the disease. First, the dosage originally

suggested was probably too small in amount and too concentrated in time. Relapses, usually in the sixth week of the disease, became so common in September and October that the total dosage was raised to 30 gm. for the full course and this was spread over 14 days. This increase appears to have been effective in helping to reduce the relapse rate. Second, it has been made abundantly clear that the seriously ill patient admitted profoundly toxæmic in the third or fourth week of the disease does not stand a loading dose of 3 gm. In two of our early cases of this type an initial loading dose of that order was followed by a rapid Herxheimer-like reaction and death. The schedule was accordingly modified and all patients severely ill on admission were given either 0.25 gm. at hourly intervals up to a total of 3 gm. after which a total daily dose of 2.75 gm. in three divided doses could safely be given, or they were given 1 gm. at 4 hourly intervals to a total of 3 gm. on the day of admission and then 2.75 daily in three divided doses. No further Herxheimer reactions have been noted since these modifications were adopted. It has been noted that seriously ill patients of this type respond more rapidly to chloromycetin if intravenous fluid is given by drip (glucose saline 5%) during the first 24 hours of treatment. Third, chloromycetin resistance appears to exist and has been noted in at least two bacteriologically proved cases in this series. Fourth, the majority of cases respond rapidly and uneventfully to the drug. Within four days of beginning treatment the temperature becomes normal in most cases, but more striking and earlier than the decline in temperature is the disappearance of delirium and mental confusion. Not infrequently a patient who on admission was restless, semi-conscious and in need of tube feeding, has become quiet and rational within 48 hours of beginning treatment although his fever may still be high.

　　　　　　General treatment followed the normally accepted lines; parti- cular stress is laid on small frequent feeds of a high caloric, high vitamine low residue diet, and the maintenance of adequate hydration. In a few cases in this series it has been necessary to employ penicillin for respira- tion or other complications. A certain number of our patients on admission were incapable of swallowing. Such cases have been success- fully treated by passing a nasal tube and administering chloromycetin through it in a watery suspension. One such case, a young woman who developed a toxi-infective psychosis early in her attack of typhoid, was given both chloromycetin and fluids in this way throughout the whole. course of her disease and was finally transferred to the Mental Hospital, where she slowly made a complete recovery, All cases have been kept in bed for at least 14 days from the beginning of treatment and the majority of patients were clamouring to be up and about before this period had expired. Great difficulty has also been experienced in keeping the ravenous appetite of the average convalescent within reasonable bounds.

It is impossible to give exact figures for the series at this moment but up to midnight on 31.12.50 192 cases of typhoid fever had been treated with chloromycetin and there had been 24 deaths in this group. This gives a mortality rate of 12.5% for the treated cases. I attach little importance to this figure. Chloromycetin is an effective and a specific treatment for the enteric fevers which nevertheless remain a most severe and dangerous group of diseases. Many of the treated patients were admitted as late as the 30th or even 40th day of the disease and had already suffered so much damage that the only cause for surprise is that the total mortality figure is not much higher.

As this is only a preliminary and necessarily brief account of the use of chloromycetin in Hong Kong, it would be out of place to embark on a detailed discussion of bacteriological findings, rates of sterilization of blood and marrow by chloromycetin and so on. One final point, however, is worthy of emphasis and that is that in no single instance have toxic effects, due to chloromycetin, been noted. The drug has done much here to lessen the burden which typhoid fever imposes on the physicians and nurses who tend the disease.

MONTH

January

February

March

April

(Sgd.) P. B. WILKINSON,

Medical Specialist.

3. 1. 51.

ANNEXURE E.

BIRTHS AND DEATHS.

1947 to 1950.

Births

Deaths

1947

1948

1949 1950

1947

1948

1949

1950

------

3,413

3,884

4,269 5.112

1.158

1,086

1.249

1.363

3,271 3,346

3.823

4.129

5.038

2.840 3.655 2,751 3.674 4,063 2,819 3.027 3.041 3.451 3,010 8.257 3.723 4,750 1.131 4.004 3,909 4.235 4,870 1.215 5.364 1.096

4,126

4,422

1,244

1.096

1,200

1.391

4.761

1,278

979

1.230

1,386

4,097

1.104

887

1.225

1.342

3,938

1.022

1,112

1.194

1,567

1,109 1.388

1.558

1,266 1.597

1.970

1.283

1,504

1.570

4,199

4.617

5.548

5.765

1.089

1.332 1.406

1.593

4.507

4.433

5.738

5.763

1,035-

1.164 1,414

1.706

---

3.725

4.875 5,655

6.054

871

1.051

1,415

1,427

4,355 4,730 5,582

5.704

988

1,069

1.465

1.592

42.473 47.475 54.774 60.600

13.231

13.434

16,287

18,465

May June

July

August

September

October

November

December

Total

ANNEXURE F.

NOTIFIABLE DISEASES.

Notifications and Deaths-1946 to 1950.

Total No. of Notifications

Total No. of deaths at all ages

Diseases

1946

1947

1948

1949

1950

1946

1947 1948

1949

1950

Amoebiasis

118

153

177

C. S. M.

293

566

Chickenpox

123

116

146

195

233

Cholera

514

246

...

Diphtheria

161

122

140

261

524

Dysentery (Bacillary and

123

258

clinical)

104

907

Enteric Fever

221

246

311

----+-

408

Infantile Paralysis

Malaria

2.122

GOS

502

Measles

317

160

190

458

453

Plague

Puerperal Fever

+-+

Rabies Hum

28-9882 -*****

137

253

193

。

boku 856out2

135

160

116

Animal

Relapsing Fever

Scarlet Fever

Smallpox

1,998

214

1,306

129

Tuberculosis

Typhos Fever

2,801

4,855

6,279

7,510

9,067

1,818

1.863

1,961

2,811

3,263

。

Whooping Cough

306

Yellow Fever

NOTE: -Malaria not notified after May, 1948 and again notified since 20.6.50.

Whooping Cough and Infantile Paralysis notifiable diseases since 23.10.47 and 30.7.48, respectively.

ANNEXURE F.

Age Group of Notifiable Diseases

1950.

One year 1 yr. to 3 years 4 yrs. to 9 years 10 yrs, to 14 yrs.,

Over 14 years

Total

Diseases

-M. F. Total M.

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

F. Total M.

| F.

Total M.

F. Tota!

Cerebro-spinal

Meningitis

Chickenpox

33 45

Diphtheria

34)

க?

14!

5 D

35!

194

101

110 211

A38

49.

120

113

233

252

272

524

Dysentery

amoebic

108

151

123

177

Bacillary and

clinical

Enteric Fever

Measles

Puerperal Fever..

Rabies Human.

Rabies Animal...

Scarlet Fever

Smallpox

Tuberculosis

178

BUTT

Typhus Fever

Whooping Cough 21

angooooogoa

181

359, 555

Infantile

Paralysis

гто

Malaria

Relapsing Fever..

Total

-wo 8.8-0-0-*NA

ONN

75 | 128

***********

ཧྨ༤༠༠༠བྷཱུng w

241

39 108

NGUONOOD

ONOOK

194

222

216

258

455

287

742

562

345

907

251

202

453

525 1080

307

261

568

131

4602

2327

6929

5727,

3340

9067

124

121

136

170

306

13 12

352

445

387

115

502

122

308 5790

2859

8649 7833 4699 12542

+ |

281 287 568 925

876 1801 651 555 12061 186

Nil return for Cholera, Plague, and Yellow Fever.

Year

Notifications

Cerebro-spinal Meningitis (Meningococcal)

Deaths

Deaths per 100

Notifications

Measles

Deaths

Deaths per 100 Notificationa

Notifications

ANNEXURE F.

Diphtheria

per

100

Notifications

Deaths

Notifications

Enteric Fever

Smallpox

1928

1929

1930

ឥនឌ

240

616

304

140

207

977

854

221

270

249

------+

1931

--- --- --

Figures prior

231

214

४

1982

207

122

205

202

212

176

1933

191

113

to 1946 not

122

207

566

433

1934

246

C++------

125

162

212

153

104

1935

110

1986

123

1937

157

1938

488

223

1939

488

214

1940

N.A.

1946

293

1947

566

137

1948

1949

1950

-------------

198593482833

available.

226

136

319

375

214

418

136

308 148

464

176

319

147

539

187

N.A.

142 N.A.

N.A. 385

N.A.

130

N.A. N.A.

324

N.A.

317

161

160

122

190

140

458

261

453

524

135

22926

221

115

246

311

408

907

160

18888442KNN?

123838

129

6-4

2.327

1,833

198

153

325

270

1,998

1,306

214 129

OAN

N.A. Figures not available.

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

Deaths

Deaths per 100 Notifications

Notifications

Deaths

Deaths per 100 Notifications

ANNEXURE G.

(1)

TUBERCULOSIS

1950.

During the year the estimated population has increased by almost 25 per cent. The majority of this additional population has found its way into the restricted built up area of the Colony, and have somehow found accommodation in the already grossly overcrowded tene- ments. Although commercial conditions were good, especially in the earlier part of the year, at no time during the year was industry capable of absorbing the additional labour available through this population increase, and there must have been, although there is no statistical in- formation available in support of this statement, an increase in the numbers of persons not in employment with a consequent lowering of the general standard of living, and, while diseases due to dietetic deficiency have been rare, increases in morbidity and mortality from tuberculosis have been noted. This disease now accounts for 17.7% of the deaths from all causes as against 16% and 14.6% for the year 1949 and 1948 respectively, and is now the most important single disease in the list of causes of death. The death-rate per 100,000 has increased from 140.6 in 1949 to 144. Full details of the age and sex distribution of the popu- lation are not available and detailed statistical analysis is not therefore possible, but an analysis of a group of persons above the age of 12 years, totalling 82,499 showed a definite preponderance of males up to the age of 50 years after which females were in the majority. Examination of the deaths from tuberculosis, all forms, shows that, compared with 1949, the deaths at 5 years and over have increased by 16.6% while deaths below 5 years have increased by 41%. This progressive increase in deaths from tuberculosis under 5 years is one of the outstanding features of post-war statistics and is a reasonable yardstick of overcrowded home condition in the Colony. Evidence is accumulating to the effect that of every 50 persons living here one is suffering from active pulmonary tuber- culosis while 3 or 4 others have the disease in a quiescent form. With the density of the population such as it is, there must be few domestic floors in the working class districts of the Colony which do not house an infectious, or potentially infectious case of tuberculosis. The relatively high racial immunity of the local Chinese is becoming overwhelmed by massive infection, and in children, progressive primary and post primary tuberculosis with fatal result is becoming increasingly common. In the face of these conditions, any normal preventive or therapeutic measures can have but limited effect on the overall picture. A B.C.G. vaccination

campaign might to some extent improve the position but the most obvious and urgent measure is to reduce the density of the population either by a reduction in the overall population, or by a very substantial increase in the housing accommodation.

It is probable that the figures of death returns are fairly accurate as over 94% of all deaths were certified by registered medical practi- tioners. Notifications on the other hand are almost certainly an under estimate of the true position, as a large section of the community is unable to afford to attend private medical practitioners, although public clinics are meeting the need to an increasing extent. The available figures are as follows:

TUBERCULOSIS (ALL FORMS)

NOTIFICATION & DEATHS.

Year

Estimated population

Notifica- tions

Deaths D/N Ratio

Rates per 100,000 estimated population

1920

648,150

2,082

321.2

1921

626,116

1,894

303.1

1922

638,800

2.096

328.3

1923

667,900

2,108

315.6

1924

695,500

2,358

339.0

1925

725.100

2,291

315.9

1926

710,100

1.912

269.2

1927

740,300

2.123

286.7

1928

766,700

1929

802,900

1930

838,800

1931

840,473

1932

900,812

Not Notifiable

2,637

330.9

2,158

268.7

1,994

237.7

1,983

235.9

2,042

226.6

1933

922,643

2,225

241.2

1934

944,492

2.179

230.7

1935

966,341

2,237

231.5

1936

988,190

2,416

244.5

1937

1,281,982

4,028

314.2

1938

1,478,619

4,920

392.7

1939

1,750,256

7591

4.443

1 to 1.7

253.8

1940

1945

1946

1,600,000

2801

1,752

1 to 1.6

109.5

1947

1,750,000

4855

1,861

1 to 2.6

106.3

1948

1,800,000

6279

1.961

1 to 3.2

108.9

1949

1,857,000

7610

2.611

1 to 2.8

140.6

1950

2,265,000

9067

3,263

1 to 2.8

144.0

　　　　It will be seen from the above that total population and notifica- tions of tuberculosis have each reached their highest level and that the recent unfavourable trend of the tuberculosis death-rate has continued. Tuberculosis of the meninges accounts for 20% of all tuberculosis deaths as compared to 22% last year while the age distribution of the disease remains substantially as before.

Year

TOTAL DEATHS OF TUBERCULAR (MENINGITIS).

Total Deaths from Tubercular Meningitis

Percentage below

5 years of age

1946

169

1947

264

1948

347

1949

580

1950

G56

86.5

The percentage of deaths due to tuberculosis (other forms) and the age distribution are not significantly different from the 1949 figures.

TOTAL DEATHS OF TUBERCULOSIS (OTHER FORMS).

Year

Total Deaths from Tuberculosis (other forms}

Percentage below 5 years of age

1946

1947

1948

1949

1950

H H H.

174

179

171

326

442

　　　　Tuberculosis of the respiratory system accounted for 11.7% of deaths from all causes as against 10.5% and 10.6% in 1949 and 1948 respectively. This increase must be regarded as a true increase, and while apparent at all ages, it is most outstanding in the under 5 years age groups. Excluding the under 5 age group the proportion of deaths from respiratory tuberculosis to deaths from all causes is practically unchanged.

DEATHS FROM TUBERCULOSIS OF RESPIRATORY SYSTEM BY Age and SEX-1950.

Age Group

Male

Female

Total

Under 1 1 2

ITI

10--14

15-19

20-24

152

25 29 50-34 36-39

40 44

45-49

128

205

186

100

266

158

240

162

-----------

220

122

177

50-54

101

156

55-59

112

60-64

65---69

70-74

75-79

80-84

85 over

Unknown

Total:

1,333

832

2,165

　　　　　　Notification of tuberculosis has been compulsory since 1939. Below are set out the notifications classified according to origin. It is of interest to note that only 567 cases of tuberculosis were notified by the 345 registered medical practitioners not in Government Service, an average of about 1.6 notification per practitioner per year.

NOTIFICATIONS OF TUBERCULOSIS (ALL FORMS)

CLASSIFIED ACCORDING TO ORIGIN,

Harcourt T.B. Clinic

Government Institutions

Non-Government Institutions

Private Practitioners

Total:

-77

竹

· ·

2,959

2,339

3,202

567

9,067

　　　The age and sex distribution of notifications of respiratory tuber- culosis are as follows:

NOTIFICATIONS OF PULMONARY TUBERCULOSIS

1948

1950.

1950

1949

1948

Age Group

Males Females Persons M.

Under 1 1

...

ANN

LIK

10-14 15-19 20-24

34 28936

118

156

128

205

124

126

172

125

95 54

149

100

199

115

314

167

111

278

651 299

960

706

246

----

9.52

630

220

850

25-29

----

888

377

1,265

787 310

1,097

1.342

689

2.031

30-34

803

403

1,206

707

343

1,050

35-39 40-44

----

665

313

978

607 319

926

856 508

1,364

480

225

705

382

237

599

45-49 50 51 55-59 60-64 65-69 70-74

+++

321

177

498

254

136

390

367 269

636

217

----

163

380

191

116

307

----

114

205

117

2141

JPII

121 128

249

140

112

----

75-79

80-84

85 & over.. Unknown

សស

O NOO O

O ONA

As there is no information available as to the age and sex dis- tribution of the total population, it is not possible to produce standardized morbidity and mortality rates. Recently, however, a representative sample of the population above the age of 12 years was analysed which gives some indication of the relative age and sex distribution of the adult population only. Against these figures have been set the actual deaths and notifications recorded in the Colony, adjustment being made in each are group according to sex preponderance, and the figures thus obtained standardized to a fixed and equal proportion of the population for each age group. The final figures obtained give an indication of the relative morbidity and mortality for males and females for equal number of individuals of each sex in each and all age groups. The results obtained are shown graphically:

400

Number per unit of populat

(See Context'

Morbidity & Kortality ||||||

Respiratory Tuberculosia

-35-

GROOPS

　　　　　　　It will be seen that morbidity and mortality are greater in males at all ages, that maximum incidence in both sexes is in the 30-34 age group and that deaths increase steadily as age advances,

HOSPITAL TREATMENT.

　　　　　　　　The total number of beds set aside for the treatment of tuber- culosis is only a small fraction of the requirement. There is no organized treatment for tuberculosis other than respiratory tuberculosis. The greater part of the treatment of respiratory cases is done in Government and Government aided hospitals and in Ruttonjee Sanatorium operated by the Hong Kong Anti-Tuberculosis Association working in collaboration with the Government Scheme. The distribution of beds is as follows:

(a) Govt. Hospitals

Queen Mary Hosp. Lai Chi Kok Hosp. St. John Hosp., Cheung Chau

(b) Govt. Subsidized Hospitals

H+

202

291

110

130

...

531

　　　The patients in institutions at (a) and (c) are admitted through the Government Anti-tuberculosis Scheme, and those at (b) are admitted principally by direct admission, or by transfer from other institutions- mainly advanced cases,

OUT PATIENT DIAGNOSIS AND TREATMENT,

　　　During 1950, the Harcourt Tuberculosis Clinic, opened in 1947 by the Government for the diagnosis and treatment of pulmonary tuber- culosis, was the only institution offering such service to the general public. The building was adapted for the purpose and despite its unsuitability and small floor space, has continued to operate fairly smoothly. The total number of attendances in 1950 increased by 20% over last years figures, the main increase being in return visits. There are subsidiary clinics operated by the staff of Harcourt Clinic in outlying districts for the convenience of the patients in these areas. A composite report of the activities of all these clinics is shown below.

　　　A second tuberculosis clinic was opened in February, 1951 in Kowloon for the convenience of patients living on the mainland. This clinic was designed and built for the purpose, with the object in mind of dealing with large numbers as smoothly as possible and to ensure maximum protection of staff. It was hoped that this venture would relieve the pressure on Harcourt Clinic but, at least in the beginning, the attendances have been greater than those at Harcourt, while the latter has shown no drop in the anticipated attendances.

The clinics of the Tuberculosis Service give attention free of charge to all comers, irrespective of status or origin. Hospital treatment is available for only a small proportion of cases, selected purely on clinical grounds. Only ambulatory or domiciliary treatment is possible for the majority. A successful trial of P.A.S. for selected out-patients has encouraged the belief that much useful work can be done in this way. At the same time it has been found that some success can be achieved by a modified way of living. Employers too are becoming more cooperative in allowing their employees sickleave with pay although as yet the numbers are relatively small.

　　　A certain amount of collapse treatment is done for patients after discharge from hospital and for individuals who have been previously treated elsewhere.

　　　All patients in the Ruttonjee Sanatorium are followed up subse- quent to discharge by the medical staff there.

HARCOURT AND SUBSIDIARY CLINICS.

1950

1949

(a) First Visits

19,282 18,606

Attendances

(b) Return Visits

40,324 30,666

Total:

59,606

49,272

Voluntary attenders

16,358

13,322

Origin of

Referred by private practitioners

321

182

new

Referred by Hospitals.

1,041

873

patients

Contacts

632

386

Surveys

930

3,372

Total:

19,282

18,135

　　　　　　　It will be noted that the number of new patients and old patients alike has increased substantially. Particularly gratifying is the number of revisits recorded, a fair indication of the growing confidence of the public in the service given by the clinics.

The drop in the number attending as a result of Surveys is due

to a change in the policy in regard to Surveys.

STATE OF DISEASE, IF ANY, ON FIRST ATTENDANCE,

Not Tubercular

Active tuberculosis

Quiescent tuberculosis

Arrested tuberculosis

Diagnosis incomplete

Total:

9,551

4,584

1,906

454

2,787

19,282

　　Of the 4,584 patients suffering from active disease the classification according to the British System was as follows:-

A (Sputum negative)

Class I Class II

1,904

929

Class III

595

Class I

189

B (Sputum positive)

Class II Class III

440

527

The figure of 2,787 shown as 'Diagnosis Incomplete' shows a considerable drop as compared to the figure for 1949 of 4,173. This figure is made up as follows:

(a) Investigation incomplete as at 31st December

702

(b) Diagnosis incomplete through failure of patient to reattend. (c) Registered and did not wait to be seen

824

LLI

1,259

Total:

2,785

　　　That this figure has decreased as compared to that recorded last year is in a large measure due to the efforts made by the T.R. Visitors who visit and encourage patients to return for disposal. A very large number of patients are, however, untraceable due to the fact that either they give the wrong address or that they live in unnumbered squatter huts.

BACTERIOLOGICAL EXAMINATIONS,

Examinations carried out on behalf of the Tuberculosis Clinic by the Government Pathological Institute are detailed below:-

BACTERIOLOGICAL EXAMINATIONS......1950,

--------

Sputum Gastric Lavage

Pleural Liquid

Kahn Test

+ H

Positive

Negative

Total

1,526

3,689

5,215

RADIOLOGICAL EXAMINATIONS.

　　　Radiological examinations of patients attending Harcourt Clinic are carried out by the X-ray Department of Queen Mary Hospital-rather more than 5 miles distant-as no space is available for installation of the necessary plant in the clinic building. This causes considerable incon- venience to staff and patients alike. Free transport is provided between the clinic and the hospital for the use of patients.

　　　The new Tuberculosis Clinic in Kowloon is provided with X-ray facilities within the precincts of the building.

- 82

TREATMENT.

(1) Out-patient.

Specific out-patient treatment was given at the clinic as follows:

Initial

Refills

A. P. T.

726

Unsatisfactory

Abandoned

Completed treatment

Initial

Refills

P. P. T.

Abandoned

Unsatisfactory

Completed treatment

Streptomycin treatment

Specific drug

treatment

P. A. S.

Pleural Aspiration

(2) In-patient,

170

Hospital admission for the treatment of pulmonary tuberculosis were as follows:-

Queen Mary Hosp.

1- - - - -T1

Govt. Hospitals

Lai Chi Kok Hosp.

185

203

IT I

St. John Hosp., Cheung Chau

Total:

400

Non-Government Hosp. (Ruttonjee Sanatorium)

186

Grand total of admission:

586

The result of treatment in Government Hospitals were as follows:-

1950

1949

(a) No. of patients remaining in hospital at last day of

previous year

291

221

(b) Admissions:

Admitted direct through Aimoner's Department.

400

466

(i) Improved

296

ི

119

(1) Completed treatment

(ii) In same condition. (iii) Worse

Total:

317

181

(3) Died

----

(2) Discharged against medical advice

гт

(4) Transferred to other hospitals

143

Total number of patients discharge during year

398

396

(d) Number of patients remaining in hospital as at last

day of year

----+

293

291

　　　The substantial increase in the number of patient discharged "improved" is to some extent due to the more careful selection of cases for admission.

　　　A particularly satisfactory feature is the drop in the number of those discharged against medical advice which may be accounted for by improved hospital conditions and management, and improved service by the Almoner's Department.

The average duration of inpatient treatment was 267 days.

　　　The results of treatment in Ruttonjee Sanatorium are contained in the Annual report of the Hong Kong Anti-Tuberculosis Association.

　　　In addition, admissions of a number of cases with advanced disease were arranged to the Tung Wah Group Hospitals through the clinic but full details are not available.

SOCIAL WORK.

　　　It is obvious that with the development of a tuberculosis service under existing conditions emphasis must be laid on the social side as the

disease has become as much a social as a clinical problem, and with the gradual expansion of the service the scope of social assistance has been considerably extended and now reaches the patient in his home. All social services are concentrated under the control of the Almoner who also directs the activities of the tuberculosis Workers. As there is no general social security scheme in the Colony prolonged sickness constitutes economic disaster and while it is not possible with the available resources to assist all tuberculosis sufferers careful selection of cases is done on purely clinical grounds necessitating very close cooperation between the social and medical side. All patients on first diagnosis are interviewed by the almoner or her assistants and subsequently as indicated. All hospital admissions to the 521 available beds and transfers between the various hospitals in the scheme, assessment of hospital charges where necessary, examination of contacts, re-employment of patients, assistance in cash and in kind, repatriation, care of children etc. are the respon- sibility of the almoner. Below is set out an abbreviated list of the main activities of the Almoner's Department.

Total number of interviews

7,562

Number of patients recommended for admission to hosp.

1,193

(1) Govt. Hospitals

400

Hospital admission

(2) Ruttonjee Sanatorium

186

Transfers between hospitals

149

Cases still on the waiting list

850

Number of families assisted with weekly grants

107

Average weekly grants

•

$29.38

Number of patients repatriated

Number of hawkers licences obtained for patients or

relatives

Milk powder issued (one pound per patient per week)

Number of home visits

In addition the Almoner's Department attempts to secure employ- ment for patients or relatives, arranges isolation of children in the contact home, provides domestic assistance, arranges schooling of children, refers cases to other social organizations and generally looks after the patient and his family before, during and after treatment.

　　　　　　　Continued contact with the patients in their homes is maintained by the Almoner through the Tuberculosis Workers.

85 -

9,425 lbs.

602

TUBERCULOSIS WORKERS.

These Tuberculosis Workers are the principal link between the clinic and the patient in his home. The Colony is divided into ten areas, one Tuberculosis Worker being responsible for all the cases of tuber- culosis in each such area. Their function is to educate the patient as to how best to control his own disease and how to prevent its spread to other members of his household, to encourage regular attendance at the clinic, and to arrange contact examinations. With very few exceptions their visits are welcomed by the patients and the former air of suspicion with which official visitors had been regarded, is gradually being dispelled. Details of work done are as follows:

Total number of visits

Number of addresses not found

Number of patients returned to village

· LL

-------

8,959

975

355

9,249

6,566

Number of contact cards issued

Number of contacts examined as a result

Contact examination is arranged so that children under 8 years

of age are tuberculin tested and only if positive are they examined radio- logically. All contacts over 8 years are first examined by X-ray. The results are as follows:-

Under 8 years of age and tuberculin negative

Under 8 years of age and tuberculin positive

833

532

5,518

Total number all ages X-rayed

The results of X-ray and subsequent clinical examination where

necessary are as follows:

Under 8 Over 8

Years

No active tuberculosis

Active tuberculosis

Inactive or healed

Suspicious

+++

נו

Years

263

4,068

104

287

258

121

373

FUTURE DEVELOPMENTS.

　　　　　　　There is still no prospect of further additions to the facilities for treatment of patients in hospital. With the magnitude of the problem to be faced, substantial increases are necessary but it seems unlikely that bed provision will ever be adequate to meet the demand. Attention is therefore being concentrated on the improvement of facilities for outpatient treatment. A new clinic is proposed to replace the existing clinic at Harcourt Health Centre which is unsatisfactory in that it is too small, has no X-ray facilities in the building and exposes the staff by its unsatisfactory layout, to unnecessary risk of infection.

　　　　　　　The ways and means of starting off a B.C.G. vaccination cam- paign are under examination and it is hoped that a start will be made within the next six months. Delay is inevitable due to the necessity of finding ways and means of effecting this measure without substantial increases in staff, but it is obvious that this measure cannot be long delayed in view of the statistical returns and the increasing interest in the project apparent in the general public.

A. S. MOODIE,

Ag. Tuberculosis Specialist. 26th April, 1951.

Schools

ANNEXURE H.

Results of Medical Inspection of Pupils.

Number of Number of

medical

pupils with

defect

inspections no apparent

undertaken

Number of Pupils with Defects Requiring Attention.

Observa-

tion

Treatment Treatment Treatment Treatment

Treatment Treatment

at General

Clinics.

at Eye

Clinics.

at Dental

Clinics.

at E.N.T.

Clinics.

Surgical

Clinics.

at Anti-T.B.

Clinics.

'A' type

763

404

268

124

52.94%

85.12%

0.91%

5.89%

16.25%

0.78%

'B' type

10,670

3,264

5,329

1,208

1,286

2,177

30.59%

49.94%%

11.32%

12.05%

20.4%

0.8%

0.009%

0.11%

'C' type

14,561

5,811

5,210

2,679

913

4,273

144

39.9%

35,78%

18.39%

6.27%

29.34%

0.98%

0.006%

0.06%

Total

25,994

9,479

10,807

38,940

2,244

6,574

236

86.47%

41.57%

14.98%

8.63%

25.29%

0.91%

0.007%

0.07%

Schools

Number

of school

premises

inspected.

ANNEXURE H.

DEFECTS FOUND IN SCHOOLS.

Details of Defects found.

Number

Black-

Doors

found

boards

with

defects.

Lighting | Latrines

and

windows

not matt surfaced

Water

Closets

Seats White without washing

General

repair

backrests required required

Government

Grant-Aid

Subsidized

Hong Kong

Subsidized

Kowloon

Private

Hong Kong

171

Private

Kowloon

152

TOTAL

414

ANNEXURE 1.

Tsan Yuk Hospital-Report

for the year 1950.

　　　The attached numerical summary indicates, in concise form, the amount and the nature of the work carried out in the Tsan Yuk Hospital during the year under review.

The following features are of interest:

Record number of admissions. The total number of admissions to the Hospital during the year 1950 constitutes a record for any single year since the Hospital was first opened. No fewer than 5,385 patients gained entrance into the Hospital, of whom 5,106 were delivered of babies. The words "gained entrance" are used advisedly, for so great and so constant is the strain upon the number of beds available that many hundreds of patients had to be turned away and advised to seek admission elsewhere.

　2. High percentage of patients receiving antenatal care. Close upon 90% of the patients received antenatal care. This has been a very encouraging factor in the work as it affords concrete evidence of the increasing realization of the patients that antenatal care has something of value to offer, even if it is no more than a guarantee of admission to the Hospital in due course. The actual percentages of patients receiving antenatal care during recent years are as follows:

1939

1940

1941

1947

1948

1949

8.0% 27.3%

30.7%

69.5%

76.9%

85.4% 89.2%

1950

　3. Low Maternal Mortality Rate. Only two deaths occurred during the year.

One was a case of broncho-pneumonia and the other was a patient who died from cerebral hemorrhage complicating eclampsia. This gives the very low mortality rate of 0.39 per thousand.

　4. Low Stillbirth and Neonatal Death Rate. It will be noted that the Stillbirth Rate was 17.05 per thousand, and that the Neo-natal Death Rate was 16.95 per thousand live and still-births. This makes the total figure of fœtal and infantile deaths 34.0 per thousand live and still-births, which is a considerable improvement on last year's figure of 43.4 per

thousand. This is due in part to the treatment of many of the premature infants by means of four efficient incubators with thermostatic control of temperature and humidity. These incubators were provided from special funds available to the University.

5. New Antenatal Ward. A special 10-bed Antenatal Ward was added to the Hospital during the year. This was made possible by the vacation of premises formerly occupied by the Western District Chinese Public Dispensary.

6. The 50,000th Baby. On March 24th, 1950 the 50,000th baby to be born in the Tsan Yuk Hospital (since the University Obstetrical Unit was organized in 1925) was delivered. At an informal ceremony held at the Hospital early in July, at which the Director of Medical & Health Services, the Vice-Chancellor of the University and various members of the past and present staff of the Tsan Yuk Hospital were present, a silver cup and spoon were presented to the mother on behalf of her baby. The mother might be described as a typical Tsan Yuk Hospital patient. Her first baby was born in the Tsan Yuk Hospital two years previously. Her second baby happened to be the 50,000th delivery in the Hospital. She attended the Hospital on four occasions for antenatal care. She had a perfectly normal course in hospital and went home with a very fine baby girl weighing slightly more than the average birth weight of Chinese babies.

　　　　7. Need for a New Hospital. From the figures presented in this report it is manifest that there is a crying need for a new hospital. With the limited facilities and bed space of the Tsan Yuk Hospital we are trying to cope with an annual turnover of work which exceeds in magni- tude that done by the famous Rotunda Hospital in Dublin. There is an urgent need for a new hospital with 200 beds. Now that the adjacent site of the old Chinese Public Dispensary is vacant there is a genuine and vital demand for the erection of a modern and superlatively equipped maternity hospital to serve the populous and needy area in which the Tsan Yuk Hospital is situated. No better use of public funds could be made than for this object, which would combine an invaluable service to the local community with the provision of ideal training facilities for the large numbers of pupil midwives and the successive generations of medical students who receive their training in obstetrics in this hospital.

GORDON KING,

Professor of Obstetrics & Gynecology, Consultant to Government.

- 91

TSAN YUK HOSPITAL.

Report for the year, 1950,

Numerical Summary,

Delivered in Hospital:

Booked Non-booked Total

a. discharged well b. transferred

Admitted after delivery

Discharged undelivered

Died:

a. after delivery

b. undelivered

Abortion

Total

4,534

546

5,080

226

276

4,778

607

5,385

Of the 4,778 Booked Cases, 1,272 were primigravide and

3,506 were multigravida.

Of the 607 Non-booked Cases, 163 were primigravidæ and

444 were multigravida.

Total number of deliveries:

Booked

Non-booked

Total

3,671

630

4,301

Numerical Summary of Cases Delivered in the Tsan Yuk Hospital Admitted for Treatment or Admitted after Delivery.

Booked Non-booked Total

PRESENTATIONS (EXCLUDING TWINS):-

Anterior Position of Occiput

4,198

482

4,670

Posterior Position of Occiput

Breech

Face

Transverse

Compound

179

205

107

132

NOT N

Booked Non-booked Total

TWIN PRESENTATIONS:

Occiput Anterior

Occiput Posterior

Breech

Transverse

4,536

549

5,085

Patients delivered in Hospital

PREGNANCY TOXÆMIA:

a. Pre-eclampsia

b. Eclampsia

c. Nephritic Toxæmia

d. Essential Hypertension

151

182

➖ ➖ ➖ ➖ITI

NIN

LIL

PRESENTATION & PROLAPSE

OF CORD

HYDRAMNIOS

PRIMARY UTERINE INERTIA ..

OPERATIVE DELIVERY:

a. Forceps

b. Version

■TI

c. Willetts Forceps application.

d. Craniotomy

e. Hysterostomatomy

f. Cæsarean Section

OPERATION FOR POST-PARTUM

STERILIZATION

2ND & 3RD DEGREE PERINEAL

LACERATION & EPISIOTOMY

ANTE-PARTUM HÆMORRHAGE:

a. Accidental Hæmorrhage

b. Placenta Prævia

214

241

的

POST-PARTUM HÆMORRHAGE..

Booked Non-booked

Total

MANUAL REMOVAL OF

PLACENTA

MATERNAL MORBIDITY:

a. Cases (i) Puerperal Infection

(i) Other Causes

b. Percentage

1.52%

2.19%

1.59%

MATERNAL MORTALITY:

a. Cases

b. Percentage

INTERCURRENT DISEASES:

Cardiac Disease

Oedema

Syphilis

Gonorrhoea

Avitaminiosis B1

0.02%

0.18%

0.04%

163

184

144

155

Anemia

Malaria

---

ITI

Pulmonary Tuberculosis

Old Th. Hip

Old Tb. Sacrum

Bronchitis

Pyelitis

Diarrhoea

Trichuris ova present

+ H

Retention of urine

Trachoma

Gingivitis

J +

Impetigo

Parametritis

Endometritis

Pelvic cellulitis

Complete vaginal septum

Incomplete vaginal stricture

Bicornuate uterus

Ruptured symphysis pubis

Acute mastitis

Breast congestion

Cervical fibroid

Ovarian cyst

----

Booked Non-booked Total

■

INFANTS' REPORT.

Booked Non-booked Total

MATURE INFANTS:

Born alive and survived

Stillbirths (Including macerated

fœtus)

++++

Neo-natal deaths

4,097

443

4,540

Total

4,138

459

4,597

Booked Non-booked

Total

PREMATURE INFANTS:

(Birth weight 2,500 grams or

5 lb. and under)

Born alive and survived

371

427

Stillbirth (Including macerated

fœtus)

HOOLILJ-

Neo-natal deaths

Total

447

544

TOTAL NUMBER OF INFANTS

DELIVERED

4,585

556

5,141

Stillbirth rate (including macerated

fœtus)

1.16%

6.29%

1.71%

Neo-natal death rate

1.39%

3.96%

1.67%

Combined stillbirth and Neo-natal

Mortality rate

2.55%

-----duru

10.25%

3.88%

General Openingi Out- patients

Children'

Ante-n

Clinics

ANNEXURE J. OUTPATIENTS-1950.

Total attendances at Government and Government assisted hospitals, clinics and dispensaries.

INSTITUTION

Gynae- Social cological Hygiene

Eye

Nose Tuboz- Throat coloets

Total

Hospitals

Queen Mary

I LI

4,616

10,099

1,794

154 1,438

Kowloon

169,913 | 140,265

19,098

8,45€

986

1,818

143

22,716

204

131

18,579

1,717

364,966

Tsan Yuk

Sai Ying Pun

Stanley Prison

St. John

38,020

81,194 41,094

3,821

252

3,553

23,017 +1,583

192,534

ILJI LIIT-IT-

13,879

534

14,413

35,293

21,684

2,388

964

60,329

4,564

7,255 6.107

119

18,133

Clinics &

Dispensaries

Violet Peel

28,619

61,407

39,210

765 1,803

חד

126,804

Harcourt

Tuberculosis

Social Hygiene

156,036

57,785

156,036

& Public Dis-

pensaries

68,651

92,604 176,020

4,948

10,375

35-2,693

11 New Territories

Dispensaries

55,955

Family Clinic

65,625 3,234 6,734

2,183

143

674

Police Medical Post!

3,658

8,520 6,929

108

Victoria Remand

Prison

1,794

11,037

North Point Relief

Camp

156

469

Port Health

672

|| | ||

1,125

128,939

6,734

532

472

20,436

251

245

233

67!

13,617

664

| |

672

Health Centres

Western

1,146

Kowloon

1,914

Harcourt

959

916

1,870

Total of Government

Institutions

406,239 | 507,665 | 291,723

39,293

1,926

Tung Wah Group

21,186 54,768 38,355

5,841

17,389 158,905

2,972

49,070 6,048 60,110 16,491

1,538,268

139,616

Nethersole

Hospital

4,523 24,360

5,867

6,892

1,137

12,494

55,263

Grand Total

431,948 586,693 | 335,935 52,029

3,063

32,855 168,905

65,561 6,048 60,110

1,783,147

ANNEXURE J.

OUTPATIENTS--1950.

New cases at Government and Government assisted hospitals, clinics and dispensaries.

INSTITUTION

Hospitals

Queen Mary

General Dressings Out- patianta

|Children

Clinier

Ante-natal Port-natal Gynne- Social cologice! Hygiene

Ear, Nose

Eye

Tuber-

Throat eulonla

Total

4,616

7,393

326

541

143

Kowloon

Sai Ying Pun

Tsan Yuk

----

139,653

115,759

15,261

1,96,1

805

840

8,985

204

1,007

130

13,353

284,280

6,721

53,231 20,849

1,690

223

1,413

5,078

541

89,246

6,081

276

6,307

Stanley Prison

St. John

Clinics & Dispensaries

Violet Peel

Harcourt Tuberculosis.

26,639

16,585

1,176

219

44,619

1,624

3,934 3,667

9,352

11,462

38,241 24,457

! |

392

1,190

75,742

18,833

Social Hygiene

8 Public Dispensaries...

--------|

13,524

19,850

63,246 121,997

2,840

4,004

211,997

11 New Territories

Dispensaries

19,625

41,499 1,615

1,120

424

852

64,648

Family Clinic

912

Police Medical post

1,507

5,613

3,546

291

279

།3

22 11,444

Victoria Remand

Prison

793

4,705

וידי

5,778

North Point

Relief Camp

112:

224

370

Port Health

570

Health Centras

Western

199

turt

Kowloon

403

Harcourt

280

473

753

Total of Government Institutions

Tung Wah Group Nethersole Hospital

232,602 351,918 190,913 9,643 31,482 19,863

14,993

1,304

6,921

14,854

15,926

8,327

19,570 852,328

3,640

1,589

6,819

73,036

6,278 1,661

2,022

1,137

5,627

16,725

Grand Total

HH-

242,245 389,678 212,437

20,655

2,441 14,137 14,854 22,745

3,327

19,570

942,089

ANNEXURE J.

Inpatients treated in Government and Government

assisted hospitals 1950.

Name

General Cases

Infec- tious ❘ Cases

Tuber- Matern- culosis ity

Cases Cases

Mental

Total

Cases

Queen Mary Hospital

Kowloon Hospital

Sai Ying Pun Hospital

7.499 |

125

582

1,608

9,819

LIII

4,324

138

117

1,686

6,285

-------|

425

746

1,207

6,443

915

758

301

1,166

2,060

Tsan Yuk Hospital

Mental Hospital

Stanley Prison Hospital

Eastern Maternity Hospital

....

Wanchai Social Hygiene

Hospital

Lai Chi Kok Hospital

St. John Hospital

701

1,605

807 |

582

2,994

764

319

1,193

Total Government Hospitals

16,076

2,153

1,475

12,116

953

32,773

New Territories Dispensaries

139

2,272

2,412

Tung Wah Group Hospitals

---

22,861

449

3,772

13,827

40,909

Nethersole Hospital

2,965

1647

4,725

Ruttonjee Sanatorium

319

Grand Total

42,041

2,642

5,640 29,862

953 81,138

ANNEXURE K.

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Detailed List Number

Cause Groups

Number

Cases treated 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government

Hospitals

Government Assisted Hospitals

Whole Colony

Male Female Total

001-008

010

Tuberculosis of respiratory system

1,036

2,993

1,405

1,333

832

2,165

Tuberculosis of of meninges

and

central nervous system

147

646

102

454

324

332

656

011

Tuberculosis of intestines, peri-

toneum and mesenteric glands..

012-013

Tuberculosis of bones and joints..

163

108

014-019

Tuberculosis, all other forms......

108

345

020

Congenital syphilis

021

Early Syphilis

024

Tabes dorsalis

025

General paralysis of insape

A 10

022, 023

All other syphilis

266

026-029

030-035

Gonococcal infections

516

A 12

0.40

Typhoid fever

446

385

041-042

Paratyphoid fever and other Sal-

monella infections

A 14

043

Cholera

044

Brucellosis (undulant fever)

16(e)

045

Bacillary dysentery

(b)

046

Amoebiasis....

OLLI ILI LJULJILIJOI

(c)

047, 048

Other unspecified

forme

dysentery

168

18%

*991195 15 1112

235

ARIA 18

160

101

*88-AS DE 11100

170

330

5588-28 18

Carried forward

3,140

4,756

310

2,277

2,089

1,479

3.568

100

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases

treated 1950

Deaths 1950

Whole Colony

Male

Female Total

Brought forward

3.140 4,756

310

2,277

2,089

1,479

3,568

050

Scarlet fever

------++H

051

Streptococcal sore throat

051

Erysipelas

------------

053

Septicaemia and pyaemia

065

Diphtheria

456

056

Whooping Cough

152

057

Meningococcal infections

------tur

218

058

Plague

060

Leprosy

204

061

Tetanus

110

14998178

--------

062

Anthrax

LILI ➖ ➖➖➖

080

Acute poliomyelitis

-IT-ITĀTEIT-b+++

082

081, 083

084

Smallpox

085

Measles

091

Yellow fever

092

094

Rabies

36(α)

100

Acute infectious encephalitis

Late effects of acute poliomyelitis

and acute infectious encephalitis

Infectious hepatitis

Louse-borne epidemic typhus

------

266

|| 8 | | 198 || 15

105

| 532979

E_121

Carried forward

4.252

5,154

549 2,384

2,313

1,655

3,968

101

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Detailed List Number

Cause Groups

Number

Cases

treated 1950 Deaths 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government Assisted Hospitals

Whole Colony

Male Female Total

€ 330

(b)

101

Brought forward

Flea-borne epidemic typhus (murine)

4,252

5,154

549

2,384

2,813 1,655 3,968

(c)

104

Tick-borne epidemic typhus

(2)

105

Mite-borne typhus

102, 103

Other and unspecified typhus

106-108

A 37(a)

110

Vivax malaria (benign tertian)

124

(5)

111

(c)

112

tertian)

(d)

115

(6)

113, 114

Malariae malaria (quartan)

Falciparum malaria (Malignant

Blackwater fever

Other and unspecified forms of

169

116, 117

malaria

121

443

A 38(a)

128.0

Schistosomiasis vesical

(S. haematobium)

(b)

123.1

Schistosomiasis intestinal

(S. Mansoni}

འ

(c)

123.2

Schistosomiasis pulmonary

(S. japonicum)

(2)

123.3

Other and unspecified schistoso-

miasis

Carried forward

4,540 5,812

558

2,437 2,376

1,682 4,058

102

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

inter-

mediate

List

Detailed List Number

Cause Groups

Number

Brought forward

Cases

treated 1950

Deaths 1950

Whole Colony

Male

Female Total

4.540 5,812

558 2,437

2,376 1,682 4.058

125

Hydatid disease

40(a)

(d)

3539

127

Onchocerciasis

➖ ➖ ➖ ➖➖ ➖ ➖➖ ➖➖

(5)

127

Loiasis

(c)

127

Filariasis (bancrofti)

127

Other filariasis

A 41

129

A 42(a)

126

(5)

130.0

(c)

130.3

(2)

124, 128

130.1, 130.2

A 43(α)

037

(b)

038

(c)

039

(d)

019

(e)

흐드

071

072

Ankylostomiasis

Tapeworm (infestation) and other

cestode infestations

Ascariasis

Guinea Worm (dracunculosis)

Other diseases due to helminths

T-----

---

Lymphogranuloma venereum Granuloma inguinale, venereal Other and unspecified venereal diseases

Food poisoning infection and in- toxication

Relapsing fever

Leptospirosis icterohaemorrhagica

(Weil's disease)

------------

178

Carried forward

4.726 6,254

558

2,440 2.380

1,683

4,063

103

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases

treated 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government

Assisted

Hospitals

Whole Colony

Male Female Total

2,380 1,683 4,063

Brought forward

4,726

6,254

538

2,440

43(g)

073

Yaws

(k)

087

Chickenpox

133

(0)

090

Dengue

(1)

095

Trachoma

(2)

096.7

Sandfly fever

(2)

120

Leishmaniasis

(m)

121(2)

(b)

(c)

FEE

131

(0)

(p)

135

MIASIS

Scabies

086, 054, 069,

Trypanosomiasis gambiensis

Trypanosomiasis rhodesiensis

Other and unspecified trypanoso-

Dermatophytosis

All other diseases classified as in- fective and parasitic

||||盤|

---IJ

חחחחח"ד

1-2 8

A 44

063, 064, 070, 074, 026, 028, 089, DIET, 196,1 098.6, 096.8. 096.9, 122, 132- 134, 136, 138.

140-148

Malignant neoplasm of buccal cavity and pharynx

112

101

Carried forward

5,036

6,405

568

2,492

2,437

1,718

4,155

104

ANNEXURE K-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases

treated 1950

Deaths 1950

Whole Colony

Male

Female Total

Brought forward

5,036

6.405

568

2,492

2.437

1,718

4,155

A 49

A 50

*** 586

A 45

A 46

150

151

152, 153

Malignant neoplasm of aesophagus Malignant neoplasm of stomach... Malignant neoplasm of intestine, except rectum

138

123

154

161

162, 163

A 51

170

A 52

171

Malignant neoplasm of rectum Malignant neoplasm of larynx Malignant neoplasm of trachea, and of bronchus and lung not specified as secondary Malignant neoplasm of breast Malignant neoplasm of cervix uteri

NRN

----

ch A

157

118

-1

A 53

172-174

A 54

177

Malignant neoplasm of other and unspecified parts of uterus Malignant neoplasm of prostate...

** 9 8 |

༣།

A 55

190, 191

Malignant neoplasm of skin

A 56

196, 197

Malignant neoplasm of bone and connective tissue......

Carried forward

5,398

6,935

617 2,678

2,596 1.954 4,550

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Nuniber

Detailed List Number

Cause Groups

105

Cases treated 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government Assisted Hospitals

Whole Colony

Male

Female Total

Brought forward

5,398

6.935

617

2,678

2,596

1,954 4.550

A 67

155-160,

164, 165,

Malignant neoplasm of all other and unspecified sites

160

136

100

175

175, 176,

178-181,

192-195,

198, 199,

咄咄

A 58

204

200-203

Leukaemia and aleukaemia

Lymphosarcoma and other

neoplasms of lymphatic and

haematopoietic system

210-239

Benign neoplasms and neoplasms

of unspecified nature

699

178

A 61

250, 251

Nontoxic goiter

252

Thyrotoxicosis with or without

goiter

TIIT-----|

A 63

260

Diabetes mellitus

64(a)

280

Beriberi

+ +++++++

កដទ

(b)

281

Pellagra

-----

(c)

282

Seurvy

(d)

283-286

Other deficiency states

161

------ --LILIL

Carried forward

妈妈的

6,398

7,512

701 2,759

2,761

2,061

4,822

106

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Brought forward

Cases

treated 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government

Assisted

Whole Colony

Hospitals

Male

Female Total

---------

6,398

7,512

701 2.759 2,761 2,061 4,822

A 65(a)

290

Pernicious and other

hyperchromic anaemias

(b)

291

Iron deficiency anaemias

(hypochromic)

-----

(e)

292, 293

Other specified and unspecified

anaemias

315

A 66(a)

241

Asthma

393

(b)

240,

242-245,

All other allergic disorders, en- docrine, metabolic and blood

253, 254,

dispases

130

คง

270-277,

287-289.

294-299.

300-309

Psychoses

---

665

* 14

310-324,

Psychoneuroses and disorders of

326.

personality

221

A 69

325

Mental deficiency

----------

† 2

Carried forward

7,612

8,396 |

736

2,779

2,796

2,101

4,896

• Among these, 2 died of 002 Pulmonary Tuberculosis. I died of 002 Tuberculosis Pneumonia.

2 died of 491 Bronchopneumonia.

2 died of 019 Disseminated Tuberculosis.

1 died of 434 mediastinopericarditis sub-acute.

1 died of 521 Lung Abscess.

† Among these, I died of 945 Bacillary Dysentery. 1 died of 491 Bronchopneumonia.

107

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases

treated 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government Assisted

Hospitals

Whole Colony

Male Female Total

Brought forward

7,612

9,396

736

2,779

2,795 2,101

4,896

A 70

A 75

e prespec

330-334

Vascular lesions affecting central

nervous system

258

159

195

149

344

340

Nonmeningococcal meningitis

➖ ➖➖ ➖ ➖➖

345

Multiple sclerosis

-++

353

Epilepsy .....

----|

870-379

Inflammatory diseases of eye

385

Cataract

387

Glaucoma

144

77(a)

390

Otitis externa

-----TI

(b)

391-393

(c)

394

A 78(a)

380-384,

Otitis media and mastoiditis Other inflammatory diseases of ear All other disease and Conditions

Hu+T

386, 388, 389.

of eye

140

ཡ|=་།སྦྲུལ བྷཱ

----TIT

(b)

341-344,

All other diseases of the nervous

360-352,

system and sense organs

115

147

354-357,

860-369

395-998.

A 79

400-402

Rheumatic fever

A 80

410-416

Chronic rheumatic heart disease...

107

433

107

117

202

Carried forward

8,196

9,701

816

3,071

3,144

2,406

5.550

108

ANNEXURE K-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Detailed List Number

Cause Groups

Nuniver

Cases

treated 1950

Deaths 1950

Government

Hospitals

Government Assisted Hospitals

Government

Hospitals

Government

Assisted

Hospitals

Whole Colony

Male Female Total

Brought forward

8.196

9,701

816

3,071 3.144 2,406 5,550

420-422

Arteriosclerotic and degenerative heart disease

737

242

254

249

508

430-434

Other diseases of heart

232

120

440-443

Hypertension with heart diseases..

A 84

444-447

Hypertension without mention of

heart

A 85

450-456

Diseases of arteries

KOLO

----- ➖➖ ➖ ➖➖ ➖➖➖➖

A 86

460-468

Other diseases of

circulatory

system

236

306

----------------------------------

A 87

470-475

Acute upper respiratory infec

tions

460

276

480-483

Influenza

563

A 89

490

Lobar Pneumonia

142

736

257

327

187

514

401

Bronchopneumonia

399

3,127

108

1,831

1,870

1,969

3,839

A 91

492, 493

Primary atypical, other and un-

specified pneumonia

119

132

TINTE-----------

A 92

A 93

500

Acute bronchitis

128

156

291

304

595

501, 502

Bronchitis, chronic and unqualified

795

148

510

Hypertrophy of tonsils and

adenoids

184

A 95

518, 521

Empyema and abscess of lung...

ස

Carried forward

10.154 16,991

996 5,526 6.254

5,444

11,698

109

Inter-

mediate

List

Number

ANNEXURE K-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Detailed List. Number

Cause Groups

Cases

treated 1950

Deaths 1960

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government Assisted Hospitals

Whole Colony

Male

Female Total

Brought forward

10,154

16,991

996

5,526

6,254 5,444 11,698

- - - - - - - - -

519

Pleurisy

110

119

97(e)

523

Pneumoconiosis

(5)

511-517,

All other respiratory diseases

150

520-522,

524-527.

A 98(a)

530

Dental Caries

(b)

531-535

All other diseases of teeth and

supporting structures

100

A 99

540

Ulcer of stomach

137

336

A 100

541

Ulcer of duodenum

101

A 101

543

Gastritis and duodenitis

146

A 102

550-553

Appendicitis

466

200

A 103

560, 561,

570.

A 104(a)

571.0

(b)

571.1

(c)

572

Intestinal obstruction and hernia...

Gastro-enteritis and colitis,

between 4 weeks and 2 years

Gastro-enteritis and colitis, ages 2 years and over

Chronic enteritis and ulcerative

290

211

1 783282

100

colitis

➖ ➖➖ ➖ ➖ ➖ - - - - - -

མ

A 105

581

Cirrhosis of liver

605

2,769

1,415

1,182

1,268

2,450

150

136

190

124

Carried forward

12,235 21,248 1.154 7.130 7,775

6,927

14,702

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases

treated 1960

Deaths 1950

Government Hospitals

Government Assisted Hospitals

JODUURÐADD

Hospitals

Government

Assisted

Whole Colony

Hospitals

Male Female Total

Brought forward

12,235

21,248

1.154

7.130

7.775

6,927

14.702

A 106

A 107

584, 585

636-539,

Cholelithiasis and cholecystitis

Other diseases of digestive system

469

800

107

159

110

542, 544,

545.

573-580,

582, 583,

586, 587.

A 108

590

Acute nephritis

---------------

A 109

591-594

Chronic, other and unspecified

nephritis

LILLI

A 110

600

Infections of kidney

111

602, 604

Calculi of urinary system

A 112

610

Hyperplasia of prostate

A 113

620-621

A 114(a)

613

Hydrocele

(b)

634

(c)

601, 603,

605-609,

Diseases of breast

Disorders of menstruation

All other diseases of the genito- urinary system

-----PIITIILI-ILI

---------d

*SN=6CB

183

649

108

715 1,046

ཁྐྲསས-|

112

117

229

៦.

611,612,

614-617,

622-633,

635,-637,

Carried forward

13,908

24,057

1,201

7,330

8.028

7.133

15,161

111

Inter-

mediate

List

Number

ANNEXURE K-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Detailed List Number

Cause Groups

Cases

treated 1950

Deaths 1950

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government Assisted Hospitals

Whole Colony

Male Female Total

Brought forward

13,908

24,067

1,201

7,330

8,028 7,133 15,161

A 115

640-641,

681,682,

684.

Sepsis of pregnancy, childbirth and the puerperium

A 116

642, 652,

685, 686

Toxaemias of pregnancy and the puerperium

368

A 117

643, 644,

Haemorrhage of pregnancy and

670-672

childbirth

192

180

A 118

650

Abortion

without mention of

sepsis or toxaemia

279

691

A 119

661

Abortion with sepsis

A 120(c)

645-649,

Other complications of pregnancy,

673-680,

childbirth and the puerperium

2,597 1,378

2+2

683,

687-689

(5)

600

Delivery without complication

-----

8,375 14,174

A 121

690-698

Infections of skin

and kub-

cutaneous tissue

446 1,242

Carried forward

26,244

41,810

1.218.

7,413

8,042

7.256

15.298

112

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases treated 1950

Death 1950

Deaths 1950

Government

Hospitals

Government

Assisted Hospitals

Government Hospitals

Government

Assisted

Hospitals

Whole Colony

Male Female Total

Brought forward

26,244

41.810

1.218

7,418 8,042 7,256 15,298

A 122

A 123

720-725

726, 727

Arthritis and spondylitis

320

Muscular rheumatism and rheu-

matism, unspecified

131

A 124

730

Osteomyelitis and periostitis

150

A 125

737

Ankylosis and acquired musculos-

745-749

keletal deformities

است |

A 126(a)

716

Chronic ulcer of skin (Including

tropical ulcer)

409

(b)

700-714,

All other diseases of skin

135

429

716

(c)

731-736,

738-744

All other diseases of musculos- keletal system

A 127

A 128

751

754

Spina bifida and meningocele Congenital malformations of cir- culatory system

A 129

750, 752,

All other congenital malformations

153

1- 28

753.

755-759

760, 761

A 130

760, 781

Birth injuries

יד

Carried forward

26,943 43.220 1,258 ! 7.449

8,110

7.325

15.435

113

Inter-

mediate

List

Number

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Detailed List Nuniber

Cause Groups

Cases

treated 1950

Death 1950

Whole Colony

Government Hospitals

Government Assisted Hospitals

Government Hospitals

Government Assisted Hospitals

Male

Female

known

Un-

Sex

Total

A 191

A 132(a)

762

764

4 weeks)

(b)

765

Ophthamia neonatorum

(c)

763,

766-768

A 133

A 134

770

Brought forward

Postnatal asphyxia and atelectasis Diarrhoea of newborn {un der

Other infections of new-born

Haemolytic disease of new-born

26,943

---------

43,220 | 1.258

7,449 | 8,110

7,325

16.435

212

1 27

181

106

200

769, 771,

772

All other defined diseases of early infancy

249

Ёл

2 42

LILL

A 135

773-776

Ill-defined diseases peculiar to early infancy

506

1,825

120

275 400

309

710

A 136

794

Senility without mention of psy-

chosis

1 45

114

A 137(e)

788.8

Pyrexia of unknown origin

(b)

703

Observation, without need for fur-

ther medical care

410

146

(*)

780-787.

All other ill-defined causes of

788.1-788.7,

morbidity

125

58 556 502

1,065

788.9

Y 00

Medical or special examination

Total

28,687

45,555 | 1,440

7,893 9,325❘ 8,414

17,747

114

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

"N" Code. Alternative classification of Accidents, Poisonings, and Violence (Nature of Injury).

Cases

treated 1950

Death 1950

Whole Colony

Government Hospitals

Government

Assisted Hospitals Government

Government

Hospitals

Assisted

Hospitals

Male

F'emale

known Un-

Brought forward

28.687

45.555 |1,440 7,893 9.825

8.414

AN 138

N800-N804

Fracture of skull

264

AN 139

AN 140

AN 141

N805-N809

Fracture of spine and trunk

232

N810-N829

Fracture of limba

996

----T➖rTutu+HIL

N830-N839

Dislocation without fracture

NAAN

2 131

897

17.747

170

יי....

AN 142

N840-N848

Sprains and strains of joints and adjacent muscle

AN 143

N850-N856

AN 144

N860-N869

AN 145

AN 146

N870-N908

N910-N929

AN 147

N930-N936

Head injury (excluding fracture).. Internal injury of chest, abdomen and pelvis

Laceration and open wounds Superficial injury, contusion and crushing with intact skin surface Effects of foreign body entering through orifice

777

538

271

---LI

203

1 58 21

8 72

101

| |

AN 148

N940-N949

Burns

246

AN 149

N960-N979

Effects of poisons

467

185

AN 150

N950-N059

N980-N999

All other and unspecified effects of external causes

110

132

214

Grand Total

- - -

32,773

45,9531,700 7,903 19,812 | 8,645

18,465

Sex

Total

115

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases

treated 1950

Deaths 1950

Goverment Hospitals

Government

Assisted Hospitals

Government

Hospitals

Government Assisted Hospitals

"E" Code Alternative Classificaton of Accidents, Poisonings and Violence (External Cause)

AE 138

AE 139

E810-E835

E800-E802

Motor Vehicle accidents Other transport accidents

1,187

227

-------- 10

E840-E866

AE 140

E870-E805

141

E900-E904

Accidental poisoning Accidental falls

186

876

129

AE 142

AE 143

E912

E916

AE 144

E917, E918

Accident caused by machinery Accident caused by fire and ex- plosion of combustible material Accident caused by hot substance, corrosive liquid, steam

100

and

radiation

152

ITITIT

AE 145

£919

Accident caused by firearm

AE 146

E929

Accidental drowning and sub-

mersion

AE 147

E920

Foreign body entering eye and adnexa

E923

Foreign body entering other orifice

Whole Colony

Male Female Total

2* 197 &

104

001

18%

# 8. BE

142

ཁུལ

106

Carried forward

2,952

274

164

303

129

432

116

www

ANNEXURE K.-(Continued).

Cases treated in Government and Government assisted hospitals with the total deaths in the Colony for 1950.

Inter-

mediate

List

Number

Detailed List Number

Cause Groups

Cases treated 1950

Deaths 1950

Government

Hospitals

Government

Assisted Hospitals

Goverment Hospitals

Government

Assisted Hospitals

"E" Code Alternative Classification of Accidents, Poisonings and Violence (External Cause).

AE 147

E927

AE 148

E928

E910, E911,

Brought forward

Whole Colony

Male

Female Total

2.952

274

164

303

129

432

Accidents caused by bites and stings of venomous animals and insects

Other accidents caused by animals; All other accidental causes

HỘI LÀ

791

E913-E915

E921-E922

E924-E926

E930-E965

5970-E979

AE 149

E980-E986

AE 150

E990-E999

Injury resulting from operations of war

Homicide and injury purposely inflicted by other persons (not in war)

Total

322

110

! 1

142

1-8

234

4,086

398

260

487

231

718

ANNEXURE L.

In-Patients Treated in Private Hospitals

1950.

In-

Name

General fectious disease Cases

Cases

Tubercu- Mater-

losis

Mental

Cases

nity Cases

Cases

Total

Tai Wo Hospital

St. Paul's Hospital

Ling Yuet Sin Infant's

Hospital

Precious Blood Hospital Hong Kong Sanatorium

& Hospital

St. Francis Hospital

St. Teresa's Hospital

872

1.121

948

643

476

1.714

3,560

134

890

1,258

Hong Kong Central

Hospital

1.957

& 2.2 3.

144

32 52

1,020

2.275

518

224

2,144

445

720

4.927

906

158

490

1,980

2,094

TIIT

Total

г г- - - 1 - -т

11.848

389

1.816

2,242

16,363

Name

New Cases of Out-Patients at Private Hospitals.

1950.

St. Paul's Hospital

---

Hong Kong Central

Hospital

Ling Yuet Sin Infants'

Hospital

St. Francis Hospita!

Hong Kong Sanatorium

and Hospital

St. Teresa's Hospital Precions Blood

Hospital

Total

Dressings

General

Outpatients

Children's

Clinic

Ante-Natal

Clinic

Post-Natal

Clinic

Gynaecological Clinic

Eye Clinic

Ear, Nose, and Throat

Tuberculosis

Total

Figures

not available

Figures not available

213

549 46 37

891

780

3.444

402

3.846

-----~

618' 260

200 40 180

30 245 1,611

634

250

784

96 5,589 809 897. 77; 130

30 245 7,912

117

Name

Total Attendances of Out-Patients at Private Hospitals,

1950.

Dressings

General

Outpatients

Children's

Clinic

Ante-Natal

Clinic

Post-Natal

Clinic

Gynaecological Clinic

Eye Clinic

Ear, Nose, and

Throat

Tuberculosis

пгт

St. Paul's Hospital Hong Kong Central !

Hospital

91 19,185 1,041

897 21,214

2,071

2,093

Ling Yuet Sin Infants'

Hospital

St. Francis Hospital

611 2,122 45: 37 780

2.862

780

Hong Kong Sanatorium

and Hospital

8.624

872

9.494

St. Teresa's Hospital

145

1,850 1,200 1,400

130

545

40 80 885

6.275

Precious Blood

Hospital

9:07:

750

1,657

Total

282 34,028 4,385 3,067 167

548

80 1,782 44,376

ANNEXURE M.

ANNUAL REPORT OF THE ALMONERS' DEPARTMENT.

1. Staff.

　　　During this last year three new almoners have completed their first year's training and in January they were drafted to various hospitals where they are now gaining practical experience under more senior almoners. One almoner is still in England. Sickness of staff this year has made things more difficult, as for most of the time, the department has been understaffed, and with extra clinics and more beds available in hospitals the work itself has tended to increase.

2. Training.

　　　Training has only been given this year to the three student almoners and the volunteer trainees have been drafted to courses at the Hong Kong University and colleges in America and England. We feel that their course of training has been successful in so far as they gained some knowledge of the social welfare services in Hong Kong and their enthusiasm was fostered to such an extent that most of them are now taking university training in social science.

118

Total

At the beginning of the year, in co-operation with the Supervisor and Training Officer of Health Nurses, six Tuberculosis Workers were trained preparatory to the opening of the Kowloon Tuberculosis Clinic. There are now sixteen such workers under the direction of the almoners at the Harcourt Clinic and the Kowloon Tuberculosis Clinic.

3. General Work.

Owing to staff shortages due to sickness our plans for this year were not fully carried out, but we feel that some progress has been made in certain directions and assistance has been given to patients in the following ways:

(a) Artificial limbs and other surgical appliances.

　　　　　　　These have been supplied to those patients who need them. Funds being provided where necessary either by the Government or from the Almoners Samaritan Fund or from friends and relations. In all, Government has helped fourteen patients and grants to the value of $1,865 have been given to patients from the Samaritan Fund.

(b) Repatriation.

In previous years we helped patients to return to their home villages in China wherever possible. This year it has been more difficult as even if patients wish to return they find it difficult with the new regulations.

The Medical Department has made arrangements during the year for the maintenance of children of patients or of children who have been patients, in Homes in the neighbourhood.

(d) Financial assistance.

Temporary financial assistance and the supply of clothes and food has been given to the needy patients.

(e) Re-employment,

Many patients on their discharge from hospital have been advised about future employment and how best to obtain work. Visits have been made by the almoners to employers and if re-employment in the same industry is not possible other employers have been contacted and, with the co-operation of the Labour Office, whenever possible alter- native work has been found for the patient.

119

(f) Attempted suicides.

This year those patients who attempted suicide due to some real or imaginary illness have been advised by the almoner and helped when- ever possible to overcome their difficulties.

(g) Injured patients.

Patients injured as a result of an accident at work or on the road have been given advice and help and compensation obtained wherever possible. A close liaison is maintained with the Traffic Office and the Labour Office.

(h) Extra Food.

　　　Where the doctors recommend extra nourishment for patients, they are given powdered milk weekly or extra money with which to buy food.

Help has also been given in a variety of other ways applicable to the cases concerned. With the co-operation of Government depart- ments and voluntary welfare agencies much has been done to help patients on their discharge from hospital.

Tuberculosis Work.

A detailed report of this work will be found in the Tuberculosis Officer's report as the almoners' work is very closely linked with his. I would however, like to point out that this year the plans for the children's home which were being discussed last year have come to fruition. With the help of the Minnonite Mission we now have a home for children in contact with tuberculosis; at present the home can take 20 children. We hope that we may be able to expand this scheme as one Home is not sufficient for future needs.

(a) Rehousing.

In last year's report I mentioned that the Crown Lands & Survey Office had granted this department land on a yearly lease for patients who can build their own huts. We have been granted a sum of money from Government funds in order to help patients with the cost of these huts. The land is now being terraced with the help of the Prison Department and next year should see patients living on this land.

5. Mental Hospital.

This year we have been able to send a full time almoner student, who has had previous training in psychiatric work as well as a year's train- ing in this department to the Mental Hospital. Since she has been there many more patients have been followed-up and helped. The diversional therapy given by the Red Cross has been of great benefit to the patients.

120

6. Recreation.

(a) Occupational Therapy.

　　　　　　　A small committee was formed last year to deal with occupa tional therapy fund made up of voluntary grants. This year we have been able to obtain the co-operation of the Hong Kong Branch of the British Red Cross Society who have supplied us with voluntary instructors in diversional therapy. Many more patients are now undertaking this recreational activity especially at the Mental Hospital and Lai Chi Kok Hospital.

(b) Teaching trades as a form of rehabilitation.

There is now not only a rattan instructor at the Mental Hospital but we have been able to employ one at the Lai Chi Kok Hospital where patients who stay for a long term are able to learn a new trade.

A library is being continued at Lai Chi Kok Hospital and at the Mental Hospital but we are still very short of Chinese books.

Samarilan Fund.

　　　　　　　This year grants and loans have been given from this fund. Patients have been helped in the following ways:

(a) Temporary financial help has been given to families where the bread winner of the family was unable to work on account of sickness.

(b) Extra nourishment has been provided for patients who cannot

afford adequate diet themselves.

their families.

(d) Travelling expenses have been paid for patients going back to

their village or home, after discharge from hospital.

(e) Maintenance fees have been paid for children in creches while their mothers were in hospital and when there was nobody at home who to look after them.

(f) Hawkers' licences have been paid for and some small capital

provided if necessary.

(g) Telegram, buying stamps and stationery for patients.

(h) Magazines and books for long term patients supplied.

121

Although the work of the almoners department has not expanded during this year we feel we have consolidated and carried out most of the schemes which were in view in 1949. The shortage of staff has made it impossible to expand at all but our schemes for the future are very hopeful. We would like to thank all those associations and individuals who have helped our patients during the year.

A. M. BALLANTYNE,

Principal Almoner. 25th April, 1951.

ANNEXURE N.

ANNUAL REPORT OF MALARIA BUREAU.

In addition to the routine work of the Bureau, much consultative work was done with the Royal Navy, Army and Air Force, and further, experimental work into the properties of Water Miscible Gammexane as a mosquito and fly larvicide,

CONTROL.

Imagocides.

Residual spraying by DDT was carried out in three areas:-

Firstly: As a supplementary Barrier check in Chinese villages on the perimeter of the larval controlled areas-namely Pokfulam, Shek O, Chai Wan, Stanley, Telegraph Bay, Lai Chi Kok, and Ngau Chi Wan. This was done at three-monthly intervals.

Secondly: The perimeter villages surrounding the Army Camps at 22, 24 mile, Sekong, Sun Wai and Lam Chuen in an attempt to minimize the number of latent B.T, infections among the troops who are on prophylactic Paludrine.

Thirdly: The whole of the Government quarters in the New

Territories.

Control of Breeding.

　　　The larval control programme of the previous year was main- tained in its entirety, i.e. the whole of the inhabited area of Hong Kong Island, and in Kowloon, an area extending from Laichikok in the west to a mile beyond the Airport in the east, and as far north as the Kowloon

122

　　　Reservoir. In addition to this work it was found possible to extend the control area northwards from Lyemun to Rennie's Mill to protect the 20,800 immigrants in the area, and also to include Cheung Chau Island. Further to control the area of Paddy in the New Territories northwest of the Laichikok Hospital. Much work was also done for the Army, Navy and Air Force on the perimeter of their various establishments in the New Territories and adjacent islands.

Permanent Work.

In regard to permanent work, the concrete filling of pools along the sea coast was continued by the staff of the Malaria Bureau and some 30,000 pools were thus dealt with. The whole of the sea coast between Kennedy Town and Tytam has now been done and permanently cleared of Aedes togoi.

Experimental Control of Larval Breeding by Water Miscible Gammexane,

　　　　　　　In the early part of the year water miscible Gammexane became available locally, and experiments were undertaken to determine its suitability as a larvicide under local conditions.

These proved eminently successful, and it was found that com- plete control of breeding would be obtained both in uncleared streams and in paddy by a dosage which was non injurious to vegetation. This represented a great advance over control by malariol in that paddy and vegetable crops using pools and stream water could be controlled without damage to the crop, relations and co-operation with the farming population were considerably improved, and finally less labour was required to do expensive clearing of vegetation.

　　　　　　　Further experiments by the Malaria Bureau to produce a "Gammexane brick" to reduce the weekly application of Gammexane by spraying, were also successful.

It was found that 25% Gammexane and 75% Plaster of Paris formed a brick which completely inhibited larval breeding in tanks and still pools for two months, and in small streams for one month.

As a result of these experiments, it was decided to change over from control by malariol, to control by water miscible Gammexane, and so reduce the labour force by 90 men in June. The saving in wages from this source enabled the many extensions of the control programme already described to be undertaken within the limit of the Anti Malaria Field Work Vote.

123

RESULT OF CONTROL

Anopheline Prevalence,

Numerous checking catches and surveys were made by the Malaria Bureau in the controlled area of Kowloon and Hong Kong, but no anophelines, either larvæ or adults could be found. Incoming air craft were similarly searched with negative results.

This does not mean that the larval control programme could be relaxed in any way, as Malaria Bureau checks have proved heavy vehicular traffic from the New Territories, and some 400 junks, are daily pouring their quota of mosquitoes into the controlled area. Complete permanent mosquito sterilization as reported from Cyprus would therefore be impossible.

Culicine Prevalence.

In the areas controlled by the Malaria Bureau, control of culicine mosquitoes was also undertaken.

　　　The introduction of the Gammexane Brick much facilitated the control of rock pool, Aedes togoi breeding in nearby islands. These had formerly contributed to the mosquito nuisances on the south side of Hong Kong Island.

　　　In the urban area where this work is done by the Urban Council, mosquito nuisances were investigated on their behalf at Shaukiwan, North Point, Happy Valley, Bowen Road, Wong Nei Chong, Mt. Parish, Queen's Road East, Caine Road, Queen Mary, Mt. Cameron, Aberdeen, Yaumati, Lai Chi Kok and Hung Hom.

MALARIA INCIDENCE.

　　　Although some 412 cases of malaria were notified in the Colony from the civilian population, only 7 of these were European, and on investigation all seven of these proved to have been contracted in the New Territories outside the controlled areas. The European malaria rate is the only criterion of the effect of the control work on the Malaria incidence, and as this is nil, the present control programme would appear to be completely effective.

　　　For the first time for twenty years no cases of malaria were reported from the Laichikok Hospital and Prison. This is due to the larval control of the paddy in that area made possible by the introduction of Water Miscible Gammexane.

　　　The Chinese cases notified were relapses among the local inhabitants and the enormous transient population, who come from a territory where the principle carrier (A. mininus) has an infection rate of 12%.

124

　　　　　　　Notification of malaria was made compulsory in June of this year, since which time some 46 cases have been notified by private practitioners.

　　　　　　　　In the New Territories 106 cases of malaria were notified from a population of 200,000. This low rate taken in conjunction with the high village infection rate (12%) of A. mininus confirms previous observations that the native population have a high degree of immunity.

COSTS.

Total expenditure:

Gammexane Malariol

Insecticides

Supervising staff

Labour

Transportation

LILI➖➖

$ 35,051.00 36,180.00 156,933.00 342,173.00

9,000.00

$579,337.00

From an estimated population of 2,265,000, the expenditure per capita of approximately H.K. 20 cents is the cheapest rate so far reported in the world in Malaria control work.

OTHER WORK.

Fly Control Work.

Experiments were carried out at the Government Compositing Station Tsun Wan, and the maturing tanks at San Hui to determine whether Gammexane could be used prophylactly to prevent fly breeding in nightscil.

　　　　　　　Experimental tanks and control pits were built by the Bureau at these centres and it was found that up to the time of writing, a dilution of 1-3,000 of water miscible Gammaxane was sufficient to inhibit com- pletely any fly breeding in nightsoil. A field trial was also undertaken at Fanling, New Territories from October to December to determine whether spraying of manure sumps by Gammexane could control the fly nuisance in that horticultural centre. This was also successful-a bi-weekly spray- ing of the sumps giving complete control of breeding. Detailed results of the experiments are given in Appendix A.

13th April, 1951.

125

J. B. MACKIE,

Malariologist.

ANNEXURE N.

ANNUAL REPORT OF MALARIA BUREAU.

APPENDIX A. (FLY CONTROL).

Field Trial of Gammexane Dispersible Powder P520 as a Fly

Larvicide in Control of Sumps,

The efficacy of "Gammexane" Dispersible P520 was further tested for a period of about three months in large scale field trials for the eradication of fly larvæ bred in manure sumps. The tests were carried out in a half mile area of which Fanling Military Camp and Police Training School were the centre in the months of October, November and December, 1950. The incidence of fly breeding is the heaviest of the year during these months.

About 150 fly-larvæ infected sumps were chosen for the tests. The sumps were of varying size. The largest was 9 ft. by 10 ft. The smallest was 5 ft. by 4 ft. The manure in the selected sumps was of different consistency. The nature of the manure varied from sump to sump.

The size of the sumps selected for this experiment was observed, to determine the quantity of "Gammexane" Powder required for the treat- ment of each (2 oz. per 10 sq. ft.).

ment.

The same spraying technique was used throughout the experi-

　　　All the selected sumps were treated with "Gammexane" suspen- sion on the 10th October, and again on the 17th October, 1950, at a dosage of 2 oz. per 10 sq. ft. As the sumps had never been treated previously with insecticide or larvicide of any kind, fly breeding recommenced on the 4th or 5th day after treatment. It appeared that these sumps had not received an adequate dose, and a twice-weekly spraying was therefore adopted on the 24th October, 1950. After the introduction of this method of treatment, the fly breeding of the sumps was brought under complete control.

As the results of the dosage of P520 used in these twice-weekly treatment was so successful, trials were carried out using a comparatively lower rate. On the 7th November, 1950 a lower dosage (1 oz. per 10 sq. ft.) was used. The same good results were achieved in these tests as in the first tests in which a higher dosage was used.

Weekly observation of the fly population was made in three places, the Police Headquarters, the Military Camps and the bazaar at

126

the Fanling cross roads, prior to the beginning of, and throughout the trial. Literally thousands of Musca vicina were to be found in the kitchens, and on the food in these three centres. This high level was maintained in these three places for two weeks after the first treatment, but was then progressively reduced, and after the first month remained at a level of 5 to 18 flies per centre per inspection up to the end of December, 1950.

The results of the tests indicated.

that treatment carried out twice a week achieves an adequate control.

that the quantity of P520 can be reduced in subsequent treatments when control has been attained.

that a small dosage (1 oz. per 10 sq. ft.) proves to be effective as a continuous treatment.

that it requires a big labour force to carry out a mass control.

　　　　　　　In conclusion no cases of dysentery during the control period were reported either from the Military Camp or Police Training School, although there were a number from the neighbouring Camps,

　　　　　　　The cost of the Gammexane (350 lbs.) used for the three months period was $550.- on the basis of 150 sumps, this works out at $1.10 per sump per month. The treatment of these 150 sumps was a day's work for 4 coolies. Thus the cost of labour is approximate $4.- per month per sump-making a total cost (unless Army personnel are used) of $5.- per sump per month.

2. Experiments in the Prevention of Fly Breeding in Raw Nightsoil by Gammexane Dispersible Powder P 520.

　　　　　　　Two sites were chosen for the experiment, one at the com- positing station at Tsun Wan where there is heavy Musca vicina breeding, and one at the San Hui maturing plant where the species Chrysomyia and Lucilia predominate.

Six concrete cells holding approximately 40 catties of nightsoil each were constructed. One was used as a control, and to the nightsoil in each of the others was admixed Gammexane in the following pro- portions: 1/800, 1/400, 1/200, 1/100 and 1/50. As no previous work had been done on this subject, the dilutions of necessity had to be on the high side.

127

The experiment was started on 28th December, 1950 and con- tinued to the time of writing. The humidity was rather high (70-90%) and the temperature averaged about 65".

　　　The cells were examined daily, but although large numbers of Musca vicina were seen on the surface of nightsoil in the control cell, and of dead ones on the treated cells, no signs of larval breeding were found until the 10th January (ie. the 14th day). This breeding was entirely confined to the control pits in each station, but no larvæ were found in the treated pits at either station.

A subsequent series of experiments using Gammexane in dilutions. of 1/800, 1/1,600 and 1/3,200 have also been completely inhibitory to all forms fly larval breeding in nightsoil up to the time of writing. These experiments will be continued under summer conditions of temperature, humidity, and rain fall.

The present cost of nightsoil is 50 cents per bucket of 50 lbs. Thus, based on the minimum effective dilution of 1/3,200 ie. oz. of Gammexane to 50 lbs. of nightsoil, the cost of prevention is only Cents H.K. 3 per hucket.

J. B. MACKIE,

Malariologist.

ANNEXURE O.

ANNUAL REPORT OF THE PALHOLOGICAL INSTITUTE

INTRODUCTORY.

Further expansion of routine work, shown graphically here- under, was the most significant feature of the year's activities, apparently not caused by any further increase in the population, but due partly to the institution of antenatal Kahn tests for all maternity cases, which in effect practically doubled the numbers of such tests performed and partly to a general expansion of work of the Kowloon branch, which dealt with 10,000 more specimens than in the previous year.

Vaccine production, more directly related to the size of the popu- lation, has become a continuous struggle to produce what is required in premises which were designed for a mere fraction of the present output.

128

　　　On one unfortunate occasion, when two refrigerators happened to break down simultaneously, our lapinised strain of rinderpest virus died, but the importation of a new strain from Bangkok soon put matters right.

　　　　　　　Store room facilities at the Institute were amplified by the con- version of a room adjoining the yard, and the installation of shelves and bars to the windows.

　　　　　　　Experiments carried out last year on nightsoil for use as a fertilizer having shown that a satisfactory and economical method of rendering the material safe within a short period, as regards ova of helminths, has yet to be discovered, this year an investigation was com- menced to see whether vegetables grown under treatment with human nightsoil-a system common throughout China-were in fact infective by the time they appeared for sale in wholesale markets. So far only a few leaf and root specimens have been examined, but the fact that fæcal B. coli was isolated from the fourth sample of carrot, whilst the second specimen of cabbage contained, in addition to fæcal B. coli, ova of ascaris, ankylostoma, clonorchis, and trichuris, is perhaps sufficiently significant.

Other items of interest included the discovery of a typhoid carrier at the Sai Ying Pun Hospital and a bacillary dysentery carrier at the Mental Hospital; two instances of Bact. paratyphosum C infection; the establishment of Pasteurella aviseptica as the cause of an outbreak of fowl cholera in a local dairy; and the isolation of B. pyogenes from the liver of a cow which died of pyæmia.

The following additions were made to the library:-

Rhodes and Van Rooyen,

Textbook of Virology

La Rage

Remlinger & Bailly,

Practical Section Cutting & Staining

----

Clayden,

Malaria Diagnosis

Field.

Staff changes-In May Mr. C. Y. Chan was engaged as Labora-

tory Assistant on probation; Dr. R. E. Dr. W. T. Liu left the service for health

Alvares returned to duty and reasons in June; Mr. A. E. P.

Grimmo, Senior Laboratory Technician, returned from home leave in October; and Dresser Lau Lai Sang was transferred temporarily to the Institute staff in December to help in the Kahn test.

129

TABLE I.

Annual Number of Specimens Examined.

Year

1930

8,721

1931

11,632

1992

17,208

1933

16,918

1934

22,271

1935

27,463

1936

38,797

1997

42,096

1938

44,710

1939

60,790

1946

51,957

1947

107,335

1948

120,775

1949

128,542

1950

149,259

(2)

Protozoology and Helminthology.

2. Blood films for malaria--Four thousand two hundred and twenty-four films were examined for the parasites of malaria. Classifica- tion of types found and negative findings are shown in the table. More B. T. and less M. T. than last year was seen.

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

TABLE 1.

Blood Examination for Malaria.

Sub tertian Benign-tertian Quartan

Unclassified (type undetermined) Multiple infection

Negative

Grand Total

- JILLI

Chinese

Non-Chinese

Total

121

--------

287

HON

122

292

-L

3.583

172

3,765

4,044

180

4,224

130

Filaria-Microfilarial parasites were found in three cases.

Anthrax--Infection with B. anthracis was established in 19

instances in blood films taken from sick animals.

5. Kala-azar Leishnan-donovan bodies were

5 instances in Chinese patients.

were demonstrated in

　　　　　6. Fæces Fourteen thousand and fifty-three stool specimens were examined for parasites, ova, or cytological picture. Figures for E. histo- lytica are 27% higher than last year.

Ascaris

TABLE III.

Examination of Stools for Intestine Parasites.

Clonorchis

Trichuris

Ankylostoma

Taenia

Schistosoma

Fasciolopsis

E. histolytica

Multiple infection

Negative

Grand Total

Chinese

Non-Chinese

Total

1,402

112

517

820

423

སྐྲཝཎྞས|||

1,514

529

911

435

115

176

1.287

1,307

7.706

1.375

9.081

12,370

1,683

14.058

(3)

Hæmatology.

　　　　　　　　Most of this work is carried out at the Kowloon branch and at the Queen Mary Laboratory, as the Summary shows. Activities at the latter had to be restricted this year owing to shortage of trained staff.

TABLE IV.

Hb. percentage

1,543

Total Red Cell Count

Total White Cell Count

Differential Count

Blood Sedimentation Rate

Blood Coagulation Time Blood Bleeding Time

Platelet Count

Reticulocyte Count

Blood Grouping

Cross Matching

-----

1,455

2,480

2,301

714

355

222

Grand total

9,117

131

(4) Serology,

7. The Kahn reaction-Fifty-five thousand three hundred and one sera were tested. This represents an increase of 36% on last year's figures and was due chiefly to the test being carried out on all maternity cases and on all newly sentenced prisoners, a measure which was intro- duced towards the end of the year. For the antenatal cases and for cord blood, the Berger-Kahn modification was performed.

TABLE V.

Examination of Blood Sera for Syphilis.

Chinese

Non-Chinese

Total

Male

Female

Male

Female

Strong Positive

1,311

1,399

2,712

Positive

1,880

2,161

4,042

Weak Positive

1,706

1,751

3,461

Doubtful

1.476

1,770

3,253

Negative

11,151

30,504

41,833

Grand Total

17,524

37,685

105

55,301

8. Agglutination tests-Two thousand four hundred and fifty-eight sera were examined for the presence of agglutinins against various organisms. It appears that paratyphoid A infection is much commoner than paratyphoid B, and that paratyphoid C is found in the Colony occasionally. Only one case gave a positive Weil-Felix reaction.

TABLE VI.

Agglutination Tests.

Chinese

Non-Chinese

Organisms

Total

Pos. Negative | Doubtful

Bact. Typhosum

Bact. paratyphosum A

Enteric fever

782

1.040

136

(00

4 11

39 2,028

Type undetermined

Br. melitensis

Br. abortus

Tut+++----

Weil-Felix reaction .....

237

297

Grand Total

900

1.280

144

39 2,458

132

(5)

Bacteriological Examinations.

　　　　　　　Blood clot culture-Bact. typhosum was isolated from the Widal clat in one thousand and seventy-eight instances, paratyphoid A sixteen times, and paratyphoid C once. This remains a useful supplementary procedure to blood and bone marrow culture for the enteric group of organisms.

10. Fæces Three thousand three hundred and ninety-four stools were cultured for pathogenic organisms. No case of cholera has been discovered since 1947.

TABLE VII.

Examination of Stool for Organisms.

Chinese

Positive Negative

Non-Chinese

Total

Positive Negative

Bact. typhosum

2,217

2,385

---

B. dysenteriae

(Group)

628

636

Cytology typical of

bacillary dysentery.

B. dysentery

(Flexner)

B. dysentery (Shiga).

Salmonella group

V. cholera

107

128

139

+++

139

Grand Total

374

➖ ➖➖ ➖ IT

2,900

3,394

　　　　　11. Sputum-Thirteen thousand eight hundred and forty-eight sputa were examined for the presence of the tubercle bacillus. In addition gastric lavage from 144 patients gave 11 positive results.

TABLE VHI.

Examination of Sputa for Tuberculosis.

Chinese

Non-Chinese

Total

Positive Negative

Positive

Negative

Direct examination

Culture

3,836

9,640

169

13,677

140

170

Animal inoculation

117

Grand Total

3,844

9,781

191

13,848

133

12. Urine-Two thousand one hundred and eighty-seven specimens were cultured for pathogenic organisms.

13. Urethral and cervical smears three hundred and forty-one smears were examined for the presence of the gonococcus, with forty-one positive findings.

14. Nasal smears, etc. for M. lepræ-Three hundred and fifty-eight examinations gave seventy-five positive results.

15. Throat swabs-Four thousand two hundred and ten throat swabs were cultured for C. diphtheria; and two hundred and twenty-two were examined for the presence of hæmolytic strepticocci, with six positives recorded.

TABLE IX.

• Examination of Throat Swabs for Diphtheria.

Chinese i Non-Chinese

Positive

Negative

----

Grand Total

685

3,314

3,899

Total

593

303

3,617

311

4,210

16. Cerebrospinal fluid-Nine hundred and fifty specimens were examined for the presence of pathogenic organisms.

TABLE X.

Examination of Cerebrospinal Fluid for Pathogenic Organisms.

Meningococcus

Pneumococcus

M. tuberculosis

Negative

Grand Total

+++

Chinese

Non-Chinese

Total

904

920

934

950

17. Rat spleen smears-Fifteen thousand six hundred and four examinations were made of smears for P. pestis, with no positive findings.

184

(6) Clinical Pathological Procedures.

　　　　　18. Urine examinations-Thirteen thousand one hundred and thirty- seven routine and miscropic examinations of urine were carried out.

　　　　　19. Pregnancy tests-Friedman tests on rabbits dropped to forty-six, whilst frog tests, using the male Rana rugulosa, which is readily available locally, numbered four hundred and twenty-seven.

　　　　　20. Miscellaneous tests-Five hundred and seventy-seven examina- tions of an unclassified nature were carried out.

(7) Preparation of Vaccine Lymph.

21. Both supply and quality of the buffalo calves used for lymph production were satisfactory, but conditions under which this work is earried out continued to be primitive by modern standards, necessitating the use of umbrellas during inclement weather.

(8) Preparation of Vaccines.

　　　　　22. Rather less cholera vaccine was prepared this year, but it was thought advisable to make thirty-four litres of plague vaccine. The 100 cu. ft. refrigerator, acquired last year, has been out of commission for the past several months.

　　　　23. Rinderpest vaccine, prepared from a lapinised strain, was produced throughout the year for the benefit of the Agricultural Depart- ment.

　　　　　24. Antirabic vaccine-a new strain of fixed vírus was obtained and used. Fortunately the 1949 outbreak of rabies appeared to be dying out during the second half of the year.

Chinese

Non-Chinese

TABLE XI.

Cases Treated with Antirabic Vaccine.

Treatment completed

Treatment not completed

Total

1.576

2,142

3,718

132

182

314

Grand total

1,708

2,324

1,032

135

TABLE XII.

Vaccine Production.

Vaccine prepared

Vaccine issue

Anti smallpox vaccine

54,200 c.c.

37,239 c.c.

cholera

T. A. B.

- ILI‒‒IJLI

Plague

Rabic

529,700

531,690

14,300

34,260

94,680

300

(2%)

101,980

Rinderpest

Grand total

(4%)

...

81,020

120,150

68,470 th

58,300

873,760

910,829

(9) Examination of Water and Milk.

25. Water-Two thousand six hundred and thirty-three samples of water from various sources were examined. The Colony's water supply continues to be most satisfactory bacteriologically.

Unfiltered raw water

Filtered

TABLE XIII.

Filtered and Chlorinated water from service tap

Well water

Water other than public supplies

Grand total

244

247

ITI

2,011

122

LJIL

2,633

26. Milk and other foods One thousand and forty-nine examinations of milk were carried out, with very few unsatisfactory results. In additions, seven hundred and sixty-four samples of ice-cream, popsicles and aerated water were tested. Ice-cream samples were found below standard occasionally.

136

Milks

+-+

Ice-creams Popsicles

Aerated waters

TABLE XIV.

- + ·

1,049

438

126

200

H .гг 1

Grand total

(10) Morbid Histology,

1,813

　　　　　27. Negri bodies--Sixty-nine brains were examined for the presence of Negri bodies. There were eleven human cases, nine dogs and 1 cat, whereas last year the figures were twenty humans and forty-one dogs.

TABLE XV.

Brains Examined for Negri bodies.

Human brains

Dogs'

Cats'

Kats'

Total

Positive

Negative

Total

*****

28. Four hundred and sixty-seven tissue sections were examined for histological diagnosis. Of these, two hundred and twenty-two were benigh or malignant tumours.

TABLE XVI.

Tumours Examined.

Fibroma

Neurofibroma Angiofibroma Angioma

-----

　　　Fibrous epulis Lipoma Chondroma

Nasal polyp

　　　Rectal polyp Umbilical polyp Uterine polyp Vaginal polyp Cervical polyp

. -

137

Fibroadenoma of breast

Fibromyoma of uterus

cervix

Mixed salivary gland tumour

Thymoma

Squamous papilloma

Pigmented nævus

Melanoma

Sarcoma

Lymphosarcoma

Osteogenic sarcoma

LIJJILJI

Secondary carcinoma of cervical lymph gland

Lymphæpithelioma

Carcinoma of Nasopharynx

mouth lung

liver (hepatoma)

stomach

colon

rectum

כל

breast

uterus

[

cervix

vagina

penis

urethra

tests (seminoma)

г.

}

כל

(teratoma)

+ -

skin

카

thyroid

in dermoid cyst

Cysts of the ovary (benign)

Hydatidiform mole

Chorion epithelioma

(malignant)

(broad ligament)

L+

Adenoid cystic epithelioma (Brooke's tumour)

138

NDO

NIN

139

Agglutination

TABLE XVII.

SUMMARY OF EXAMINATIONS.

Nature of Examination

Bact. typhosum

paratyphosum A

Enteric fever, type undetermined

Br. melitensis

Br. abortus .....

Weil Felix reaction

Serological reaction for syphilis

Malaria

Filaria

Blood smears

B. anthracis

Hb. percentage

----------

Haematology

----

Total Red Cell count

Total White Cell Countma Differential Count

Blood Sedimentation Rate Blood Coagulation Time) Blood Bleeding Time... Platelet Count

Reticulocyte Count Blood Grouping

Cross Matching

+--------

ייי

Patho-

Queen

Kowloon

logical

Institute

Mary

Hospital

Laboratory

Patho-

Total

logical

Institute

991

216

943

2,150

140

297

55,301

1.512

479

2,283

1,224

441

1.102

1,543

323

1.123

1.455

396

2,066

..................JLIŢI

2.480

199

226

1.876

2,301

489

221

714

++++++

| N |

326

355

114

103

222

140

TABLE XVIL-(Continued).

SUMMARY OF EXAMINATIONS.

Nature of Examination

Cultural

examination

Naso-pharyngeal swabs (C. diphtheriae)

lisem. Streptococci

VILLJIL

Cerebrospinal fluid for pathogenic organisms Faeces for pathogenic organisms.

Blood clot culture (enteric organisms only)

Blood

Urine

Intestinal parasites

Occult blood

Facces

Tissue section

M. tuberculosis

Brains for Negri bodies....

Sputa

Gastric lavages for M. tuberculosis

Smears for gonococcus

Smears for M. leprac

Rat spleen smears for P. pestis

Pus & body fluid

Urine (Routine, chemical & microscopic)

Pregnancy tests (Friedman)

(Frog)

Bacteriological examination of milk and foods

Bacteriological analysis of water

Miscellaneous

Grand total

Patho-

Queen

Kowloon

logical

Institute

Mary

Hospital

Patho-

logical

Total

Laboratory Institute

2,391

143

1,676

4,210

222

165

238

547

960

1,639

466

1.347

3.452

1.065

310

184

1,559

175

300

430

905

463

903

821

2.187

HOT

1,986

4.949

7,118

14,053

203

105

314

198

237

467

+IITIIJ

5,646

2,223

5,979

13,848

144

210

341

149

189

358

6,844

8.760

15.604

316

133

510

565

6,764

5,808

13.137

296

131

427

1,050

763

1.813

2,633

-----T------------

363

138

677

84.411

20.111

44.737

149,259

Sd. E. F. DUCK,

M.B., B.B. (Lond.), M.R.C.S., L.R.C.P.,

D.P.H., D.T.M. & H. (Eng.) Government Pathologist.

ANNEXURE P.

ANNUAL REPORT OF THE GOVERNMENT LABORATORY FOR THE YEAR 1950.

A comparative table of samples examined (Table 1) shows an increase over the work for the previous year. This is accounted for by the larger number of specimens submitted for biochemical examination, and by the absorption into this Laboratory of the Department of Com- merce & Industry Laboratory.

TABLE 1.

1949

1950

(1) Waters & Waterworks Chemicals

722

619

(ii) Foods & Drugs

(iii) Chemico-legal

728

628

(iv) Commercial

2,063

1,309

(v) Biochemical

4,547

5,658

(vi) Coal from Department of Commerce &

Industry, Supplies Branch

132

(vii) Miscellaneous from Government Depart-

ment

158

165

(viii) Work under Dangerous Drugs Ordin- ance and Dutiable Commodities Ordinance from 24.11.50 to 31.12.50

670

8,404

9.147

(i) The usual routine chemical control of the public water supply has been maintained, and under this heading are also included samples from various other streams and wells, submitted mainly by the Public Works Department. Certain septic tank installations have also been investigated. The waterboat supply in the harbour is periodically examined for salt water contamination, and control has also been made of the chlorination of certain local swimming pools.

(ii) The food samples examined consisted mainly of milk. Samples of milk bread, which may be retailed at a higher price than the plain variety, were submitted by the Price Control authorities.

L-

141

(iii) Tables 2 and 3 show the variety of work under this heading. There were no cases of homicidal poisoning, but certain exhibits were examined in a case of bomb-throwing in the street, which resulted in the death of a pedestrian.

　　One case of forgery of high denomination United States notes accounted for the exhibits listed in Table 2. These were remarkably accurate reproductions of U.S.$100 and U.S.$50 bills.

　　Two cases of alleged sabotage were investigated, one of an aircraft at Kai Tak Airport, and one of a Royal Naval vessel,

TABLE 2.

Chemico-legal Analyses.

Toxicological examinations (including post-mortem materials from

90 persons)

Urine and Blood for Alcohol determination

Articles connected with:-

Acid throwing

Accidental drowning

Arson

Assault

Dangerous goods

Explosions

Export Control

Firearms

Forgery

Fraud

Illegal firecrackers

Illegal practising of Western medicine

Larceny

Licensing laws

Medicines & Drugs

Murder

Rape

281

Sabotage

Suicide

Traffic accidents

Miscellaneous

628

142

No poison present

Opium

TABLE 3.

Toxicological Examinations.

Phenolic or Cresolic Compounds

Alcohol

Alkalies

Arsenic

Aspirin

Barbituric acid derivatives

Camphor

Chloral hydrate

Cyanides

D.D.T.

Gelsemium Elegane Benth

Hydrochloric acid

Iodine

Kerosene

-----

Lead

Mathyl salicylate

Oil of cinnamon

LJI

Potassium permanganate

Quinine

Strychnine

Miscellaneous

IN KO LA

281

(iv) Commercial work, though not quite on the scale of previous years, again formed a very considerable part of the work of the Laboratory. Fees collected amounted to $101,293.50, compared with $141,169.00 for the year 1949. The various samples dealt with are listed in Table 4.

143

TABLE 4.

Commercial Samples.

Minerals & Metals:-

Alum

Aluminium

Antimony

Arseno-pyrite Asbestos

Babbitt metal

Bauxite

Bismuth

Brass

Cassiterite

Chromite

Clay & Kaolin

Clinker

Coal

Copper

Felspar

H +

Fluorite

Ferro-manganese

Ferro-tungsten

Ferro-silicon

Gold

Granite

Graphite

Ilmenite

Iron ores

Lead

Lead sheets

Lime

Limestone

Magnesium silicate

Manganese ores

Mica

Molybdenum

Nickel plate

Pewter

Quartz

Realgar

Rock phosphate

Scheelite

Silice gand

Silver

144

+ J

LLL

112

LLI

TABLE 4.-(Continued).

Commercial Samples.

Minerals & Metals,-cont.

Soil

Talc

Tin

Tin middlings

Tin concentrates

Wolfram ore

Zinc

Zinc oxide

Misscellaneous ores

Oils and Fats:-

Aniseed oil Camphor oil Cassia oil

Citronella oil Peppermint oil Coconut oil Groundnut oil

Mustard seed oil

Palm oil

Rapeseed oil

Soyabean oil

+++

Stillingia oil

Teaseed oil

Wood oil

Diesel oil

Lubricating oils

Lard

Miscellaneous:

•

197

Acetic acid

Apricot kernels

Asphalt

Building materials (concrete etc.)

Butyl alcohol

Camphor

Cassia lignea

Chinese lacquer

Coal-tar

Derris root

T-

- T 1

145

Dinitro-chlorobenzene

TABLE 4.~~(Continued).

Commercial Samples,

Miscellaneous,-cont.

Disinfectants

Enamel ware

Fertilizers and Feeding stuffs

Film

Foodstuffs:

Agar Agar

Albumen chips

Arrowroot

Bengers Food

L J H

to 60

Bread

Butter

Cocoa powder

-----

Egg yolk powder

Groundnuts

Herrings

Honey

Icecream powder

Milk and Milk powder

Pear juice

Salmon

...

Sesame seeds

Sodium glutamate

Soyabeans

Starch

Sugars

Wheat flour

Yeast

Galangal root

Gelatine

Green ramie

Hexylresorcinal

Industrial caustic soda

Kerosene

Menthol crystals

Mimosa extract

Mustard seeds Liquor extract Ortho-toluidine P.A.S. sodium Paints

+ +

тгт

LI H

146

TABLE 4.-(Continued).

Commercial Samples.

Miscellaneous, cont.

Poster paper Potassium bichromate

Potassium nitrate

Printing ink

Red phosphorus

Rhubarb

Rongalite C

Santonin

Sea grass

Sludge

Soap

Soda ash

г. . г.

Sodium fluoride

Sodium hydrosulphite

Sulphuric acid

Textiles

Tobacco extract

Water

NIN

Water sterilizing outfits

Waxes

Wood preservative

Wines & spirits

Chemicals, dyestuffs, drugs, cali-

brations etc.

1,309

　　　　　(v) The number of biochemical examinations again increased and details are given in Table 5.

TABLE 5.

Biochemical Examinations.

Specimens received:-

Blood

Cerebro-spinal fluid

Gastric contents

Stools

Urine

Miscellaneous

3,031

612 1,847

147

105

TABLE 5.-(Continued).

Biochemical Examinations.

Received from: -

Harcourt Infant Welfare Clinic

Kowloon Hospital

Lai Chi Kok Hospital

Mental Hospital Nethersole Hospital Port Health Office Private Practitioners Queen Mary Hospital Ruttonjee Sanatorium Sai Ying Pun Hospital Tsan Yuk Hospital

Tung Wah Eastern Hospital

1,007

194

284

LJ C

3,853

142

5,658

(vi) & (vii) Coal samples were again regularly examined for the Department of Commerce and Industry, and with the arrival and instal- lation of a new bomb calorimeter these can be more adequately dealt with. Most Departments of the Government make use of the facilities provided by the Laboratory, as shown in Table 6.

TABLE 6.

Miscellaneous Samples from Government Departments.

Samples from:-

Agricultural Office

...

Controller of Stores

Department of Commerce & Industry.

Fire Brigade

Kowloon Canton Railway

Marine Department

Medical Department:

Headquarters

Health Officers & Inspectors

Malariologist

Queen Mary Hospital

Urban Council

- 148

TABLE 6.-(Continued).

Miscellaneous Samples from Government Department.

Public Works Department:-

Building Ordinance Office Drainage Office

Electrical & Mechanical Office Port Work Office

-2*

Waterworks Office

165

　　　　　(viii) As previously mentioned, an administrative change of some importance took place on the 24th November 1950, when the Laboratory of the Department of Commerce & Industry was closed, and all the analytical work under the Dangerous Drugs Ordinance and Dutiable Commodities Ordinance was transferred to this Laboratory. Table 7 gives details of this work, the volume of which is very considerable.

TABLE. 7.

　　　　　　　Analytical Work under Dangerous Drugs Ordinance and Dutiable Commodities Ordinance from 24.11.50 to 31.12.50.

(i) Dangerous Drugs Ordinance.

Certificates of Contents issued

(ii) Dutiable Commodities Ordinance.

Certificates of Contents issued

Cigarettes

Paints

119

(iii) Examination of Samples for duty assessment.

Beer

г.

Brandy, Port, Whisky & Gin

Chinese Liquors

Perfumes

Table Waters

(iv) Denaturation of Alcohol.

Certificates issued

४

- ++

· +

י .

149

670

149

STAFF.

1951.

Mr. Edward Collins, Chemist, proceeded on leave on 15th March,

　　Mr. Tong Kwok Hung, joined the staff on 24th November, 1950, when the Department of Commerce & Industry Laboratory was trans- ferred.

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

ANNEXURE Q.

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

1950.

Total number of Post-mortem Examination 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 No. of bodies cremated

3,913

2,137

1,767

713

3,200

1,168

No. of Chinese bodies examined

JILJIL

No. of Non-Chinese bodies examined

No. of bodies Nationality unknown

No. of Medico-Legal Cases

3,887

441

Male

Female

Total

No. of bodies under 2 years of age................

1,243

1,292

2,535

No. of bodies over 2 years of age

894

475

1,369

No. of bodies received from the following sources:

(Hong Kong)

Victoria District

Shaukiwan

From hospitals

Infant convent

150

503

149

136

Total

884

(Kowloon)

District, Police Station & Hospitals.

Marine Police Station

"T" Land

Yaumati

Mongkok

Shumshuipo

Tsun Wan

Castle Peak

Ping Shan

Hung Hom

Kowloon City

Sai Kung Cheung Chau

Lok Ma Chau

Kam Tin

Sheung Shui

Ta Ku Ling

Tai Po

Shatin

Tai O Shataukok Hospitals

...:

J HF+

101

114

499

י .

123

387

1,521

Total

3,029

No. of rats caught and brought to mortuaries

No. of rats examined

No. of rats spleen smears taken for examination

No. of rats infected with plague

- 151

JL L

208,263

LFIL

208,263

15,604

Nil.

וריין.

י -

INGAT

BUZAL

dove,