24249
RBB
405
HONG
KON
ANNUAL
DEPARTMENTAL
REPORTS
NG
1959-60
RBB 40S
PRICE: $9.00
THE ROYAL SOCIETY
for the Promotion
OF HEALTH LIBRARY
DIRECTOR OF MEDICAL
AND HEALTH SERVICES
22501293169
:
HỒNG KONG
ANNUAL DEPARTMENTAL REPORT
BY THE
DIRECTOR OF MEDICAL
AND HEALTH SERVICES
FOR THE
FINANCIAL YEAR 1959 - 60
PRINTED AND PUBLISHED BY W. F. C. JENNER, GOVERNMENT PRINTER AT THE GOVERNMENT PRESss. Java Road, Hong KoNG
EXCHANGE RATES
When dollars are quoted in this Report, they are, unless otherwise stated, Hong Kong dollars. The official rate for conversion to pound sterling is HK$16=£1 (HK$1=1s. 3d.). The official rate for conversion to U.S. dollars is HK$5.714=US$1 (based on £1=US$2.80).
WELLCOM
1.:UTE
Coll.
Cail
No.
I.
CONTENTS
THE COLONY'S HEALTH Service
Introduction
Events of Importance during the year 1959-60 . Administration of the Medical and Health Services
Staff
Finance
Legislation
Professional Registers.
Work of the Statutory Councils and Boards
+
Paragraphs
7
-
6
17
18
19
-
27
28 32
33
-
34 35
-
36 - 54
JI.
PUBLIC HEALTH
General Comments
Vital Statistics
HI.
WORK OF THE HEALTH DIVISION
Hygiene and Sanitation
Urban Areas
Rural Areas
Epidemiology
Port Health
Tuberculosis
+
Malaria Bureau
Social Hygiene
District Midwifery Services.
Maternal and Child Health.
School Health
Industrial Health.
Health Education
i
55
56 - 61
+
+
62 - 67
68 - 69
70 - 100
101 112
113 - 181
182 - 200
201 - 217
218 - 226
227 - 235
236 - 242
243 - 247
·
■
248 - 250
+
IV. THE WORK OF THE MEDICAL DIVISION
Hospitals
Government Assisted Hospitals
Out-patient Services
Specialist Services
Radiology
Radio-diagnosis
Radiotherapy
Medical Physics
Ophthalmology
Dental Service
Government Institute of Pathology
Forensic Pathology
Government Chemist's Laboratory
The Pharmaceutical Service
The Almoner Service.
Physiotherapy
Occupational Therapy
Medical Examination Board
Blood Banks
Hospital Administration and Supply
Staff Welfare
U.N.I.C.E.F. Projects.
Auxiliary Medical Service.
V. TRAINING PROGRAMME
Doctors
Dentistry
Nurses
Midwives
H
+
ii
Paragraphs
251 - 308
309 - 331
+
332 - 338
L
339
340
341 342
-
343 - 345
+
346 - 349
L
4
350 - 352
353 - 361
362 - 373
374 375
+
·
376 - 381
382 - 384
385 - 394
395 - 401
402 - 411
L
412
-
416
417 419
-
+
420
+
422
423
+
424
r
I
425 - 431
432 434
-
435 - 437
438 441
-
442 - 443
Paragraphs
V. TRAINING PROGRAMME Contd.
Health Visitors.
Radiographers
+
Laboratory Technicians
Other Forms of Department Training
P
Attendance at Conferences and Meetings includ- ing those sponsored by the World Health Organization
Courses of Study including World Health Organ-
ization Fellowship
·
444 - 445
446
447
-
448
449 - 450
451
Visitors
VI. BUILDING PROGRAMME
VII. PUBLICATION
+
ACKNOWLEDGMENT
VIII.
ACCOUNTS
Samaritan Fund
Nurses Rewards and Fines Fund
IX.
MAPS
X.
APPENDICES
452
453
454
455
+
Statistical information in this report
refers to the calendar year 1959
1. THE COLONY'S HEALTH SERVICE
INTRODUCTION
THE Colony of Hong Kong occupies a land area of 3981 square miles. The estimated mid-year population in 1959 was 2,857,000 of which approximately 86% is concentrated in the urban areas of Kowloon and Hong Kong Island. This distribution of a population of 2,457,000 within 21 square miles of the urban areas gives rise to an average density of 117,000 persons to the square mile. It is a young population and although the age structure will not be known accurately until after the 1961 census, there is good reason to believe that one third is aged 15 years or under, that there are some 460,000 children of pre-school age and that there is a predominance of males amongst the young adults.
2. At the end of a decade and during World Refugee Year it is appropriate to review the demands on the medical and health services and the progress made towards meeting these demands. Despite shortage of land, housing and domestic water supplies an increase of population of some 1,000,000 due to the influx of refugees has been accepted. These refugees have not been segregated as such but have become part of the community and the medical and health services of Government and other agencies have been operated on a basis of serving the medical need of the individual without query as to origin.
3. The impact on all services has been of staggering proportions and heavy public expenditure on water supplies, housing, communications and social services has been met from the Colony's own resources. Shortage of trained medical, nursing and health staff has so far been the most important factor limiting the expansion of the medical services. As a result, the building and staffing of clinics and hospitals has not been able to keep pace with the rapidly increasing demands for western medicine. Thus more and more work has fallen on already over- burdened institutions. Nevertheless by applying modern methods of prevention and cure the results as measured by the vital statistics of the past ten years, have been encouraging. However there can be no complacency in the face of the enormity of the task ahead and the necessity for an increasing tempo of development if the needs of a population increasing by approximately 3% per annum are to be met.
even according to standards imposed by local resources rather than those considered desirable in the modern industrial state.
4. During the past five years emphasis has been on the development of training facilities for the greatly increased numbers of doctors and nurses needed to staff the very large programme of clinic and hospita! development in hand. The building of such new clinics or hospital accommodation that has been undertaken during this period has had to be geared to the annual output of trained staff available each year and has thus necessarily been limited.
5. The pressure on existing institutions has to a certain extent been met by holding evening clinic sessions, by accelerating, as far as possible within the limits of safety, the turnover of patients in hospital and by developing measures for the prevention of disease that can be applied under local conditions.
6. Such results as have been achieved during the past ten years are outlined in more detail in the relevant sections of this report. The salient features have been a considerable reduction in infantile mortality rates, the absence of the formidable epidemic diseases during the past seven years, the cessation of malaria transmission in the urban areas, the elimination of rabies and the progressive reduction of the tuber- culosis mortality rate from 208 per 100,000 in 1951 to 76.2 per 100,000 in 1959.
EVENTS OF IMPORTANCE DURING THE YEAR 1959/60
7. The Society of Apothecaries in London again held examinations for the L.M.S.S.A. in Hong Kong. Of the 118 candidates who entered for the examinations, 106 sat the examinations. Of these 39 passed in all subjects and 45 passed in one or more subjects. Prior to the written examinations a 3 months refresher course was conducted by University and Government clinicians at the Queen Mary Hospital.
8. There are now 82 refugee doctors who have obtained the L.M.S.S.A. as a result of the facilities which, with the approval of the General Medical Council of the United Kingdom, have been so generously accorded by the Society. A third and last L.M.S.S.A. examination will be held in Hong Kong towards the end of 1960.
9. Work continued on the drafting of legislation for the registration and licensing of medical clinics operating in the Colony.
2
Salaries Commission
10. The Commission completed its work during the year and those recommendations which were accepted by Government became effective in January 1960. The consolidation of the former high cost of living and expatriation allowances into the basic salary, 90% of which is now pensionable, has considerably improved career prospects. More promotion posts have enhanced the opportunities for the accelerated promotion of well qualified and able officers in the junior ranks of the service. Women Medical Officers who have completed their probationary service and who are members of the permanent and pensionable establishment are now receiving pay equal to that of their male counter- parts.
Drug Addiction
II. The publication in November 1959 of a White Paper on the Problem of Narcotic Drugs in Hong Kong focussed attention on the widespread use of addicting narcotic drugs, particularly heroin. The treatment and rehabilitation of drug addicts amongst convicted prisoners. has been placed on a sound basis at H.M. Prison Tai Lam where 700 prisoners can be accommodated. There is however a demand for accommodation for the treatment of addicts on a voluntary basis and the details of a pilot scheme, within the new Castle Peak Hospital of 1,000 beds for mental patients, have been worked out. A ward block of 120 beds will be set aside for this purpose and addicts coming forward as voluntary patients will be expected to surrender their liberty for a period of six months. During this time treatment and training will be given which is designed to build up the individuals physically and psychologically for rehabilitation and re-absorption into the community. Full social and medical records will be obtained with a view to assessing the local circumstances giving rise to addiction and the measures best fitted to prevent it. A vital necessity in any such rehabilitation pro- gramme is the cutting off of sources of supply and thus of temptation. To this end a vigorous drive against traffickers is being maintained by the police and preventive services, with considerable success.
12. The secondment of a trained Psychiatrist to the Prison Medical Service has enabled some preliminary investigation into the causes of drug addiction amongst prisoners to be started.
Dental Council
13. The statutory regulation of the practice of dentistry in Hong Kong dates from the promulgation of the Dentistry Ordinance No. 16
1
of 1914. Since that time successive Dental Boards have maintained a Register and acted as the examining and disciplinary bodies. During 1957 work started on the drafting of a new Dentists Registration Ordinance which was designed to bring the legislation up to date and more in line with the Medical Registration Ordinance. The Dentists Registration Ordinance 1959 replaces the Dental Board by a Dental Council and the new Council met for the first time on the 7th October, 1959. The new Council will continue to function as an examining body.
14. A tribute is paid to the work of successive Boards over the past 45 years which has culminated in a project approved in principle by the University of Hong Kong and the Government to establish a University Dental School. Arrangements for the pre-clinical training of dental students have been made in conjunction with the development of pre-clinical facilities in the Faculty of Medicine, due to become effective during 1962. Meantime the planning of a Dental Hospital has started with site investigations and the drafting of schedules of accommodation,
Mental Deficiency
15. A report on the problem of Mental Deficiency in Hong Kong was compiled in 1955 by a Sub-Committee of the Hong Kong Council of Social Services. This report recommended the building of an institu- tion to care for a number of known defectives who were being accom- modated in a variety of institutions unsuited to this purpose. Tentative plans were made thereafter to develop an institution of some 200 beds but the problem of recruiting an adequacy of suitable trained staff had proved to be almost insuperable.
16. In view of modern trends in the policy governing institutional care for mental defectives, Government decided to invite Dr. L. T. T, HILLIARD of the Fountain Hospital, London, who is a member of the W.H.O. Expert Committee in Mental Deficiency, to visit Hong Kong and to report on the local situation and to make recommendations. Dr. HILLIARD accepted the invitation and spent six weeks in Hong Kong during February and March 1960. His report was submitted to Govern- ment at the end of March and is now being studied.
Planning
17. An important innovation during the year was the establishment of a Planning Section within the Medical Headquarters organization. In charge of a Principal Medical Officer assisted by an Hospital
4
Secretary all development projects are processed by this unit which is responsible for the co-ordination of all requests for accommodation and equipment for new Medical & Health Department institutions. The first task was to work out in some detail the development proposed for the five years 1960-65 and to make provisional estimates of the cost entailed. This task was completed and the proposals submitted to Government in December, 1959. In addition to work on departmental projects, assistance was also given to the Tung Wah Hospitals Medical Committee in connexion with the re-building of the Kwong Wah Hospital.
ADMINISTRATION OF THE MEDICAL AND HEALTH SERVICES
18. Statutory responsibility for the administration of the services safeguarding the public health in Hong Kong lies jointly with the Director of Medical and Health Services, the Urban Council, the District Commissioner New Territories and the Commissioner of Labour. Executive functions in connexion with curative medical services and a number of aspects of preventive medicine throughout the Colony are the responsibility of the Medical and Health Department. The Urban Council is concerned with environmental sanitation in the urban areas of Hong Kong and Kowloon through the Urban Services Depart- ment. The District Commissioner has executive functions as the Health Authority for the New Territories and administers its environmental sanitary services. Health Officers are seconded in an advisory capacity to the Urban Services Department and the District Administration, New Territories. The Labour Department has an Industrial Health section which also has officers of the Medical and Health Department on its staff.
STAFF
19. The Director of Medical and Health Services is the Head of the Department, the chief adviser to Government on medical and health policy, and an official member of the Legislative Council. He is a member of a number of the Boards and Committees of voluntary organizations engaged in medical and health work whose activities receive substantial support by way of Government subventions. He is also the Chairman of the Radiation Board and of the Statutory Boards dealing with the registration and disciplinary control of Medical Practitioners, Dentists, Pharmacists. Nurses and Midwives.
20. The Deputy Director of Medical and Health Services is the chief executive medical and health officer who co-ordinates the work of the
5
Medical and Health Divisions. Each of these divisions is in charge of an Assistant Director. The Principal Matron is the Chief Nursing Officer and administers the Nursing Division which provides nursing, mid- wifery, health visitor and health sister services.
21. The Health Division, which is the administrative responsibility of the Assistant Director of Health Services, is composed of units deal- ing with tuberculosis, malaria, port health and epidemiology, maternal and child health, school health and social hygiene, the latter including venereal diseases, leprosy and dermatology. Each of the component units of the Health Division is in the charge of a Specialist or of a Medical Officer with special experience and training. In addition, advisory services are given to the Urban Services Department, the District Administration New Territories and the Labour Department. The Assistant Director of Health Services is Vice-Chairman of the Urban Council. He is assisted in the work of the Division by a Principal Health Officer at Headquarters.
22. The Assistant Director of Medical Services, responsible for the administrative routine of the Medical Division, is assisted by a Principal Medical Officer at Headquarters and by two Principal Medical Officers who are respectively Medical Superintendents of the two Government general hospitals, one on Hong Kong Island and one in Kowloon. There are clinical units of general medicine, general surgery, anaesthesia, ear, nose and throat, neurosurgery, obstetrics and gynaecology, ophthalmo- logy, orthopaedics, pathology, psychiatry and radiology, each of which works under the clinical direction of a Specialist. There are two infectious diseases hospitals, one on either side of the harbour. The Government Dental Service is under the direction of a Senior Dental Specialist and the Government Chemist is responsible for the work of the Government Laboratory. The work of the Government outpatient clinics throughout the Colony is co-ordinated by the Medical Division although certain of the services rendered from these clinics are provided by the Health Division. The Medical-Social, Occupational Therapy and Physiotherapy Services are also part of the Medical Division.
23. The Auxiliary Medical Service, which is a branch of the Civil Defence Services, is administered by the Medical Defence Staff Officer who is a member of the Medical and Health Department Headquarters staff. The Director of Medical and Health Services is the Unit Controller.
24. The routine administrative, secretarial, establishments and clerical work of the Department is under the general direction of the
G
Secretary, while the Principal Accountant and his staff deal with the financial and accounting duties. The Boards section is supervised by the Boards Secretary.
25. The pharmaceutical and dispensing activities are the respon- sibility of the Chief Pharmacist who also has inspectorial duties in connexion with the Dangerous Drugs and Pharmacy and Poisons Ordinances.
26. The Chief Hospital Secretary is responsible for the supply of equipment and the day-to-day lay administration of the hospital and clinic services. The hospitals and clinics are at present grouped into two large units to each of which is posted an Hospital Secretary. Assistant Hospital Secretaries are posted to the larger and more important institutions within the groups.
27. Appendix 1 shows the establishment at 31st March, 1960,
FINANCE
28. The actual expenditure of the Medical and Health Department for the financial year ended 31st March, 1960 was $45,925,081 to which should be added a further $18,988,424 disbursed in the form of sub- ventions. Capital expenditure on medical projects under the Public Works Non-Recurrent head totalled $15,442,311. These amounts represent 11.32% of the Colony's total expenditure during the year. This does not include expenditure on environmental sanitation by the Urban Services Department and the District Administration of the New Territories.
29. A Statement of Expenditure for the ten years from 1950-51 to 1959-60 is shown at Appendix 2.
30. The total revenue collected by the Department during the year from all sources totalled $3,097,438.
31. The largest subvention was made to the Tung Wah Group of Hospitals which received $8,500,000; in addition, a further capital grant of $4,381,719 was made towards the cost of Phase 1 of the re-develop- ment of the Kwong Wah Hospital.
32. Other major subventions were $2,926,482 to the Grantham Hospital, $1.346,979 to the Hong Kong Anti-Tuberculosis Association and $550,000 to the Mission to Lepers, Hong Kong Auxiliary,
+
LEGISLATION
33. The following legislation dealing with medical and health matters was enacted during the year 1959/60:
Ordinances:
(1) Dentists Registration Ordinance, 1959.
Rules and Regulations:
(a) Poisons (Amendment) Regulations, 1959. (G.N.A. 22/59). (b) Poisons List (Amendment) Regulations, 1959 (G.N.A. 23/59). (c) Poisons List (Amendment) (No. 2) Regulations. 1959. (G.N.A.
35/59).
(d) Poisons (Amendment) (No. 2) Regulations, 1959 (G.N.A.
36/59).
(e) Nurses Registration (Amendment) Regulations, 1959. (G.N.A.
51/59).
(f) Dentists (Registration and Disciplinary Procedure) Regulations.
1959. (G.N.A. 54/59).
(g) Poisons (Amendment) (No. 3) Regulations, 1959. (G.N.A.
58/59).
(h) Poisons List (Amendment) (No. 3) Regulations, 1959. (G.N.A.
59/59).
(1) Importation (Prohibition) (Radiation) Regulations. 1959.
(G.N.A. 73/59).
() Dangerous Drugs (Amendment of Schedule) (No. 2) Order.
1959. (G.N.A. 104/59).
(k) Poisons (Amendment) Regulations, 1960 (G.N.A. 5/60). (1) Poisons List (Amendment) Regulations, 1960. (G.N.A. 6/60).
PROFESSIONAL REGISTERS
34. There are five statutory bodies dealing with the registration of medical practitioners, dentists, pharmacists, nurses and midwives. The Hong Kong Medical Council is responsible for the registration of medical practitioners and has responsibilities in connexion with dis- ciplinary proceedings and offences; it is not an examining body. The Dental Council. Pharmacy Board, Nursing Board and Midwives Board all maintain registers, regulate training, hold examinations leading to registration or enrolment and have disciplinary powers.
8
35. At the 31st March, 1960 the numbers of persons on the statutory registers were as follows:
31st March, 1951
401
357
47
837
52
831
Register of Medical Practitioners
Register of Dentists
Register of Pharmacists
} Register of Nurses {
Roll of Midwives
31st March, 1960
913
389
88
Female
1.646
Male
88
1.618
WORK OF THE STATUTORY COUNCILS AND BOARDS
Medical Council
36. The Council met ten times during the year for the transaction of routine business; 9 notices to medical practitioners were issued for guidance on points of ethics. There were no disciplinary inquiries but the Preliminary Investigation Committee met once to consider a com- plaint which was not referred to the Council for an inquiry.
Dental Council
37. The Dental Board met three times before the enactment of the new Ordinance and thereafter the Dental Council met four times. There were nineteen applications considered for registration as dentists, of which fourteen were accepted without examination. Of the remaining five applicants, two were required to pass the Council's examinations before being accepted for registration and the three other applicants were rejected as their curriculum of training was not up to the standard required by the Council for entry to its examinations.
Pharmacy Board
38. The Board met five times for the transaction of routine business, mainly in connexion with the control of habit-forming drugs, of certain phosphorus compounds in use as insecticides and of antibiotics.
39. Proposals for the amendment and re-enactment of the Pharmacy and Poisons Ordinance were completed and were submitted to Govern- ment for approval to prepare a draft Bill.
40. These proposals included the Board's suggestions for the restriction of the employment of part-time pharmacists and for simplifi- cation of the control of antibiotics together with a number of other suggestions designed to make the Ordinance more easily understood by the lay public.
9
41. Proposals for a scheme to provide scholarships overseas for pharmacy students were also prepared and submitted to Government for consideration. It is hoped that provision of a scheme on the lines of the one proposed will ensure an adequate supply of well trained pharmacists for the future, since the absence of any training facilities in the Colony is making recruitment to the profession difficult.
42. There were 18 applications for registration, of which 5 were accepted without examination and one accepted after passing the Board's examinations. Two applications were rejected and 10 applicants were required to undertake further practical training, under the supervision of a registered pharmacist for periods of one to two years, before becom- ing eligible for examination.
Nursing Board
43. The qualification of Registered Nurse granted by the Board has been recognized by the Nursing Councils in the United Kingdom since 1939. Statutory preliminary and final examinations are held twice each year in the English and Chinese languages, under the general supervision of the Board, which appoints examiners, conducts the examinations and approves the results.
44. The Nursing Board met four times during the year. In addition to business in connexion with examinations, amendments to the Regula- tions governing eligibility of candidates for examination were proposed and subsequently approved by Government. Work continued on the drafting of a revised Nurses Registration Ordinance.
45. Following the decision to open a supplementary part of the Register for Mental Nurses, an agreement for reciprocal registration was under negotiation with General Nursing Council of England and Wales and approval was obtained during March 1960 for the use of the General Nursing Council Syllabus of training. Six students are at present in training and the first full intake of new student is expected to take place in July 1960. The Board is now making examination arrangements for a Certificate of Mental Nursing, in preparation for the first Final Examination to be held in July, 1961.
46. During the year, 315 candidates were entered by the approved training schools for the preliminary examination in General Nursing held by the Board and 156 passed in all subjects; there were 226 candidates accepted for the final examinations and 156 passed in all subjects.
10
47. There were 167 applicants for registration as general nurses and 163 were accepted. Of these 147 were nurses who had qualified at the Hong Kong Training Schools recognized by the Board and their names were entered in the Register after passing the Board's final examination; 14 trained outside the Colony were accepted without examination and 2 trained outside the Colony were accepted after passing the Board's final examination.
Midwives Board
48. This Board meets four times each year and conducts examina- tions in April, July, October and January. The course of training in midwifery lasts two years for pupil midwives entering the course direct but registered nurses are accepted for entry to the examination after one year's full time training in midwifery.
49. Owing to the social conditions existing in the Colony there is very little scope for domiciliary midwifery and the majority of confine- ments take place in hospitals and maternity homes. Therefore the qualification given by the Board is not fully recognized by the Central Midwives Board of the United Kingdom for registration there. There is, however, a remission of three-quarters of the period of training in the United Kingdom granted to midwives registered in Hong Kong who may wish to sit the State Certified Midwives examinations.
50. There were 145 candidates from approved training schools in the Colony accepted for the Board's examinations; of these 132 passed the examinations. There were a further 6 applications for enrolment, of these 2 trained in the United Kingdom were accepted; in addition, 4 names were restored to the Roll.
51. A first draft of the revised Midwives Ordinance Bill and Regula- tions were considered at the March meeting and a revised draft is now in preparation.
Radiation Board
52. This Board which was constituted by the Radiation Ordinance No. 35 of 1957, met once during the year to consider draft regulations for the control of irradiating apparatus. A drafting sub-committee is at work on the preparation of these and other regulations, but due to the complexity of the subject and the necessity to conform as far as possible with international standards still the subject of discussion. progress in drafting has been necessarily slow.
|1
Storage of radioactive materials and fire precautions
53. The Board was consulted by the Chief Officer, Fire Brigade, on the precautions to be taken in fire-fighting operations where radio-active materials were involved and on the Board's advice a Fire Brigade Order was compiled and issued.
54. The Board also gave attention to the storage of radio-active materials and advised on the proper precautionary measures both for the storage of goods and the protection of personnel.
II. PUBLIC HEALTH
GENERAL COMMENTS
55. Despite the very large movements of people in and out of Hong Kong each year there has continued to be a remarkable freedom from major epidemics. Again there was no case of smallpox, cholera, typhus, plague or relapsing fever. Influenza remained at a low level of incidence but diphtheria and typhoid continued to levy an unnecessarily high toll of morbidity and mortality. The incidence of diphtheria rose by 34% over the previous year but the number of deaths was smaller than in 1958. There was no case of human or animal rabies for the fourth year in succession.
VITAL STATISTICS
56. Registration of all deaths and live births occurring in the Colony is compulsory under the Births and Deaths Registration Ordinance. Still births are not registrable but the numbers received by cemeteries for burial are recorded. Table 1 shows the annual returns for births and deaths during the period 1950-59.
TABLE I
BIRTHS AND DEATHS 1950/59
Crude Live
Estimated
Total Live
Year
Mid-Year
Births
Birth Rose (per 1,000
Still Births recorded
Total deaths
Crude Death Rate
Population
population)
(per 1,000 population)
1950 ...
2,265.000
60.600
26.8
1.343
18,465
8.2
1951
2,013,000
68.500 34.0
1.180
20,580
10.2
1952
2.250.000
71.976 32.0
1,157
19,459
8.6
1953
2,250.000
75,544 33.6
1,158
18,300
8.1
1954
2,277,000
83.317 36.6
1.341
19,283
8.5
1955
2,340,000
90,511 38.7
1,250
19,080
8.2
1956
2.440.000
96.746 39.7
988
19.295
7.9
1957
2,583.000
97.834 37.9
1,245
19,365
7.5
1958
2,748,000
106,624
38.8
1,297
20,554
7.5
1959
2,857,000
104,597
36,6
1.393
20,250
7.1
12
57. For the first time since the war, there was a fall in both the birth rate and in the total number of live births registered. The net natural increase in the population during the year was 84,347 which is 1,723 less than for 1958. Without accurate census data, the low crude death rate has little significance but could be said to reflect the youth of the population, one third of which is estimated to be under fifteen years of age; from such survey data as are available it seems evident that there is a preponderance of males in the young adult age groups.
58. Table 2 shows the recent trends in infantile and maternal mortality. The reduction of both the infantile and the maternal mortality rates by over 50% in a period of 10 years has been achieved in spite of the rapidly increasing number of births.
TABLE 2
MATERNAL AND INFANT MORTALITY
Neo-natal mortality rate (per 1,000 live
Maternal Mortality Rate (per 1,000 total births)
Infantile Mortality
Year
rate (per 1,000
live births)
births)
1950
99.6
30.0
1.70
1951
91.8
31.3
1.59
1952
:
77.1
26.3
1.14
1953
73.6
25.8
0.97
IP
1954
72.4
24,6
1.24
1955
66.4
23.1
1.16
1956
60.9
24.2
0.90
1957
55.6
23.8
1.06
■
1958
54.3
23.4
0.85
1959
48.3
21.3
0.73
59. Table 3 shows a comparison of the main causes of infantile mortality for 1950 and 1959, It will be seen that there have been marked reductions in the mortality from infectious and other febrile conditions, although much still remains to be done in the control of broncho- pneumonia and gastroenteritis. The neonatal mortality rate has declined but by no means to the same extent, an experience shared by many other countries; the epidemiological implications of this in Hong Kong have yet to be studied.
13
Disease Group
Respiratory Tuberculosis
Tuberculosis Meningitis
TABLE 3
INFANTILE MORTALITY 1950/59
Other Forms Tuberculosis
Tetanus
Bronchopneumonia
Pneumonia other forms
Bronchitis
LL
Gastroenteritis over age
of 4 weeks
Congenital Malformations
Birth Injuries
Post-natal Asphyxia
Pacumonia of Newbor
Diarrhoea of Newborn
. .
י
י
J
Blood Diseases of Newborn Nutritional Maladjustment
Immaturity
יי
7950
7959
International
Torel
List
Dearls
Deaths under 1
Numbers
Ander
per 1.000
Total Dratha under
Deaths
under 1
Iyear
five births
1 year
per 1,000 live birthr
001-008
91
1.5
25
0.2
010
146
2.4
91
0.9
J
011-019
83
1.4
S
0.05
061
84
1.4
62
0.6
491
2001
33.0
1667
15.9
490.492-3
116
1.9
16
0.15
500-502
402
7.0
21
0.2
571
1534
25,3
926
8.8
750-759
70
1.1
172
1.6
1
760 & 761
49
0.8
37
0.3
762
36
0.6
292
2.8
762
190
3.1
322
3.1
יי
764
89
1.5
60
0.6
770 & 771
70
1.1
83
0.8
772
27
0.4
81
0.8
776
706
11.6
766
7.3
795
75
1.2
123
1.2
Ill-defined Causes
60. The fall in the maternal mortality rate has been mainly brought about by reductions in the incidence of death from toxaemias and haemorrhages of pregnancy. Deaths from septic complications of preg- nancy, childbirth, and the puerperium have remained satisfactorily low.
61. Table 4 shows the changes in the mortality pattern which have occurred over the last ten years. Deaths from infectious diseases have. declined considerably due to therapeutic advances and possibly to a rise in the general standard of health, Respiratory diseases are declining only slowly, mainly because of the rapidly increasing child population which is particularly vulnerable to bronchopneumonia. Diseases of the later years of life can be seen to be of increasing importance with the gradual rise in the relative incidences of cardiovascular, central nervous (mainly cerebrovascular), and neoplastic lesions; this is to be expected from the "freezing" of a swollen and relatively young population in the Colony 10 years ago. The effect of a rapid natural expansion of such a population in a confined area such as Hong Kong is reflected in the figures for accidents and violence.
14
TABLE 4
ANALYSIS OF MORTALITY FOR THE YEAR 1950, 1953, 1956 AND 1959 (Given as Percentage Total Deaths)
Disease Group
Detailed List Numbers
1950
1953
1956
1959
I. Infectious & Parasitic
001-138
22.0
19.3
16.2
14.2
יי
2. Neoplastic
LL
140-239
3.7
5.6
7.0
9.3
3. Allergic, Endocrine,
Metabolic & Blood
4. Nervous System &
Sense Organs
5. Circulatory System
6. Respiratory
240-299
0.7
1.3
1.2
1.I
300-398
2.4
400-468
5.5
470-527
29.9
P
7. Intestinal
530-587
16.3
I
8. Genito-Urinary
& Puerperium
590-637
1.6
9. Pregnancy, Child-birth
640-689
0.6
10. Skin & Musculo-Skeletal
690-749
0.2
30882 38
4.9
6.2
7.6
8.9
21.3
22.3
15.1
11.3
2.1
2.1
0.5
0.4
0.4
0.4
11. Congenital Malformations &
Diseases of Early Infancy
750-776
6.8
9.7
[1.2
12. Ill-defined Causes
780-794
6.4
7.4
22
9.3
7.5
8.7
13. Accidents, Poisoning &
Violence
E800-E999
3.9
4.0
5.0
5.8
Urban Areas
III WORK OF THE HEALTH DIVISION
HYGIENE AND SANITATION
62. Responsibility for environmental sanitation in the urban areas rests with the Urban Council and Health Officers are seconded to the Urban Services Department from the Medical and Health Department. The Assistant Director of Health Services as Vice-Chairman of the Urban Council is the co-ordinating link between the two Departments in so far as communicable disease control, through better environmental sanitation, food hygiene and vector control, is concerned. The Health Officers are concerned with the guidance of and advice to the Health Inspectorate in the day to day management of these health problems.
63. Through the medium of routine house inspections carried out quarterly by the Health Inspectorate there is a close link with health. education activities in connexion with immunization against diphtheria and typhoid and with the control of intestinal infections.
64. During a greatly intensified diphtheria immunization campaign, mobile inoculation teams worked closely with the health inspectorate in
15
a systematic drive to ensure that the children at most risk in the densely populated tenement and resettlement areas on both sides of the Harbour were adequately protected against diphtheria. As a result the number of second and booster doses of APT rose to a much more satisfactory level and in the Kowloon urban area alone it was estimated that some 50,000 children received the requisite first and second doses. This was achieved by establishing inoculation posts at strategic points working at times convenient to parents while Health Inspectors conducting house inspections made known the facilities offered. Inoculation teams also visited roof-top squatter families at least once during the campaign and a second round of visits was under way at the end of the year. Although the drive was primarily against diphtheria, typhoid vaccine and smallpox vaccination were also available when required and accepted.
65. The Health Officers also maintained investigations into the source of known cases of diphtheria, typhoid, dysentery, amoebiasis, poliomyelitis and tetanus. Where applicable contact examinations were arranged and carriers treated.
66. Special attention continued to be given to food hygiene, the education of food handlers and of the proprietors of establishments selling raw or cooked foods being a major activity. The incidence of unsatisfactory samples of milk and ice cream continued to be unduly high and an average of 30% of samples taken were below standard.
67. This problem must be considered against the background of the density of population, the number of individuals who depend on low priced food establishments close to the place of work, and the wide- spread indifference to and lack of knowledge about elementary food hygiene. Therefore improvement in standards will only become significant as the many squatters are adequately rehoused, as more adequate piped water supplies are available and as modern sewerage replaces the many insanitary closets still existing in the old tenement and squatter areas.
Rural Areas
68. The District Commissioner New Territories is the statutory Health Authority in the Rural Areas. The appointment of a Principal Medical Officer of Health for the New Territories, whose function it is to co-ordinate the curative and preventive work, became effective in October. Assisted by two Health Officers and 10 Health Inspectors, attention to practical health education stemming from the centres of curative medicine, the clinics, is now receiving priority in environmental sanitation. Routine work on the control of licensed food premises and
16
food handling has been intensified with some encouraging results. Nearly all licensed food premises not provided with water-borne sanita- tion now have aqua privies in place of dry latrines. Ways and means of improving sanitation in the villages are under consideration by the Rural Development Committee and pilot co-operative village cleansing schemes are being set up in two villages in co-operation with the Depart- ments of Agriculture, Fishery and Forestry and Co-operative Develop- ment. Other such schemes are under consideration.
69. The pilot scheme of malaria prophylaxis started in two villages in the Sai Kung area during 1959 led to a considerable reduction in the number of cases of malaria. However after the initial interest of the villagers in the scheme had waned, it had to be discontinued owing to lack of co-operation. Further epidemiological investigations are con- tinuing which include a survey of malaria parasites in the blood of children under ten years of age, with febrile conditions, attending clinics and dispensaries throughout the New Territories.
EPIDEMIOLOGY
70. During the year 1959 there was an increase in the number of cases of the more common notifiable diseases, the main exceptions being acute anterior poliomyelitis, measles and amoebiasis. The major factors in this increase are the rapidly-increasing population, mainly in the young and most susceptible age-groups, and the greater use of the medical facilities provided by Government and other agencies. The most disturbing feature of the year was a 34% rise in the incidence of diphtheria, an event which is discussed more fully later.
71. The total mortality from the notifiable diseases, however, con- tinued to decline; even in the case of diphtheria, the number of deaths was less than recorded in the previous year.
72. Appendix 3 gives the numbers of cases and deaths from notifi- able infectious diseases recorded during 1959.
Amoebiasis
73. Compared to 1958, there was a slight fali in the incidence of cases recorded. The mildness of the initial symptoms commonly met with militates against an accurate assessment of the problem but it is interesting to note that, of the cases recorded, 57% of cases occurred in the Kowloon Peninsula, 33% on Hong Kong Island and 10% in the New Territories; this accords fairly closely with the estimated distribu- tion of population in these three areas of the Colony.
17
Bacillary Dysentery
74. A 50% increase was recorded in the notifications of this disease but mortality remained low. Just over half the cases reported were in children under 10 years of age. The preponderant organism found is Sh. flexneri, while both Sh. boydii and Sh. sonnei are reported from time to time.
Enteric Fever
75. The increase in the notifications of this disease was due to the recurrence, during 1959, of a summer peak after a lapse of four years. The incidence rate in the 5-9 and 10-14 age groups remained high, children in these groups accounting for 44% of the cases reported. This disease is particularly prevalent in the parts of the Kowloon Peninsula where squatters are concentrated with consequent lowered standards of sanitation and increased dependence on water sources other than the Government mains supply.
Chickenpox
76. There was no change in the number of notifications as compared with 1958 and mortality remained low. It is primarily a disease of the colder months, the great majority of the cases occurring during the first four months of the year.
Cerebro-Spinal Meningitis
77. The incidence remained at a low level and this disease is not a public health problem in the Colony at present.
Diphtheria
78. As previously mentioned, there was a disturbing rise in the incidence and the number of cases was the highest ever recorded; 80% of the cases occurred in children under the age of 10 years. However, the case fatality rate was the lowest ever recorded.
79. As usual, the rise occurred during the cooler months, reaching a peak during December, 1959. The main concentration of the disease was in the densely-populated tenement areas of Kowloon and in the Mainland portion of the New Territories. The incidence on Hong Kong Island remained comparatively low but there also the majority of cases were reported from the densely-populated areas.
80. The clinical picture was predominantly that of laryngeal diph- theria due to C. diphtheriae mitis; only in rare instances was a gravis strain isolated. The occurrence of "bull-neck" in many patients who had
18
previously had herbal throat powders insufflated onto the fauces, a traditional practice referred to in last year's Report, was further investigated. In the samples of powder analysed there were varying concentrations of realgar (arsenic disulphide) and investigations are continuing with a view to determining whether or not the condition is due to a non specific irritant effect of the powder itself rather than due to the arsenic content.
Measles
81. There was a slight drop in the number of notifications of this disease but the high case fatality rate, 23.7% during 1959. is a strong indication that reporting of this disease is by no means complete. As in other diseases spread by droplet infection, most of the cases occur during the first quarter of the year.
Poliomyelities
82. There was a marked drop in the incidence of this virus infection, and cases occurred uniformly throughout the year, there being no peak during the summer months as in 1958/59. There was, however, an increase in the case fatality rate. Most of the cases and deaths amongst Chinese were in the 0-1 year age group; seven non-Chinese cases were reported, mainly in Europeans recently arrived in the Colony. Two- thirds of the cases occurred on the Kowloon Peninsula,
Whooping Cough
83. There was a considerable drop in the number of notifications, and only two deaths were recorded. As in the cases of chicken-pox and measles, the number of unreported cases is estimated to be considerable. Puerperal Fever
84. Only one instance of this disease was recorded in a patient who. having been attended by a qualified midwife, left the Maternity home against advice.
Ophthalmia Neonatorum
85. This disease, made notifiable in June 1958, showed a marked increase in the number of notifications. 98%, of which came from Government Ophthalmic Clinics; these cases were investigated by Health Visitors working in the Government Ophthalmic Service.
Malaria
86. There was a drop of 33% in the number of notifications of this disease during 1959 as compared to 1958. Of these, 89% were amongst
19
residents of the New Territories, mainly in the district around Sai Kung on the south-eastern part of the mainland. There was one death.
Tuberculosis
87. Cases notified during the year were 817 more than during 1958, but there was a further fall in the mortality rate to 76.2 deaths per 100,000 estimated population. This disease is the greatest public health problem in the Colony and is considered in detail later in this report.
Influenza
88. Influenza was made voluntarily notifiable following the wide- spread outbreak of 1957. During 1959, a total of 11,659 notifications were recorded; of these, 73% occurred in the first half of the year. There were only 26 deaths attributed to influenza.
Other communicable diseases which are not notifiable
Tetanus
89. Of 131 cases of tetanus reported, 76 cases were of tetanus neonatorum. The case fatality rate was high, particularly in the new born. The infection amongst the latter is attributed to the application of ground ginger root as a styptic to the umbilical cord.
90. The risk of tetanus neonatorum due to the improper preparation of ginger root was brought to the notice of the representatives of the Chinese Herbalists and their co-operation sought to try and insure proper cleansing of the raw ginger root before it is prepared as an herbal remedy,
Food Poisoning
91. There were 527 cases of food poisoning recorded of which 81 were due to coagulase positive staphylococci.
Vaccination and Inoculation Campaigns
92. Free prophylactic vaccinations against enteric fever, diphtheria, cholera and smallpox continued to be available to members of the public at all Government Hospitals and Clinics, Port Health Inoculation Centres, and District Health Offices.
93. During April and May, the occurrence of smallpox in Singapore, a port with which Hong Kong has close links by sea and air, called for special precautions to prevent the establishment of the disease in the Colony; one of these precautions was the intensification of the annual
20
vaccination campaign, resulting in a total of just over one million persons being vaccinated during 1959.
94. The anti-typhoid campaign held during the summer months produced a fairly satisfactory response. While the numbers presenting themselves for the first dose of vaccine were not as high as in some recent years, there was a marked improvement, mainly amongst school children, in those presenting themselves to receive the second inocula- tion: 29% of those initially inoculated failed to return for a second dose.
95. At the beginning of the year, an Interdepartmental Committee on Health Education was formed consisting of representatives of the Secretariat for Chinese Affairs, the District Administration New Territories, the Government Information Services, the Labour, Educa- tion, Urban Services, Resettlement and Medical & Health Departments under the Chairmanship of the Assistant Director of Health Services. Its initial task was, and still is, to obtain maximum co-operation by the public in all attempts to raise the level of immunity against preventable diseases posing serious public health problems. The first activity of this committee was the intensification of the annual anti-diphtheria campaign which commenced in September. An Inoculation Record Card was introduced for general distribution and it is encouraging to note that in many instances this is now regarded as an important personal document for the child; as an incentive, a plastic figurine symbolizing 'Health' was given to each child receiving the complete course of two doses of P.T.A.P. Further, there was an intensification of the general propaganda programme in support of the campaign, which received considerable support from the local Kaifong Associations, including the Women's sections.
96. At first, the inoculations were carried out by mobile teams of inoculators visiting certain strategic points on both sides of the harbour in rotation. The initial response was good but after two months, numbers began to decline and it became apparent that to achieve a high level of immunity amongst the child population it would be necessary to offer protection against the disease as near as possible to the indivi- duals home. To affect this, inoculators were attached to teams of Health Inspectors of the Urban Services Department making their daily house inspection visits, teams were sent to squatter areas both on hillsides and rooftops and there was block-by-block coverage of Resettlement Estates. By December, it was obvious that the main sources of the disease were in Kowloon; accordingly, after the commitments on Hong Kong Island
21
had been met, all available inoculators were concentrated in the Peninsula. At the end of March, 1960, it was estimated that at least 50% of children in the 0-9 age group had received full protection against diphtheria either in this campaign or in those held in previous
years.
97. The numbers of prophylactic immunizations carried out during 1959 are detailed in Appendix 4.
Recent Trends in Infectious Diseases
98. Table 5 shows annual morbidity and mortality rates during the period 1950-1959 for the main infectious diseases occurring in Hong Kong.
TABLE 5
MORBIDITY AND MORTALITY RATES OF CERTAIN
NOTIFIABLE DISEASES
1950/59
(per 100,000 estimated population)
Discase
L.R.
Tuberculosis
M.R.
130.6
1950 1957 1952 1953 1954 1955 1956 1937 1958 1959
400.3 689.8 658.7 528.9 $49.3 604.7 498.2 529.0 144.] 208.1 158.8
490.7
500.6
126.3 120.1 107,7 103.6
83.8 76.2
I.R.
23.1 28.5 43.9
49.6
48.5
35.9 29.3 48.0
56.6
73.0
Diphtheria
M.R.
6.0
6.0
7.0
5.9
5.1
3.0
3.1
5.0
4.9
4.1
Enteric fever
1.R.
40.0
50.9
54.7
63.7
48.3
31.4
32.3
28.2
29.7
34.9
г.
M.R.
7.1
6.7
7.0
5.7
3.6
2.5
2.0
1.3
1.2
1.1
. .
I.R.
7.8
7.7
8.9
12.7 10.4
9.0
7.5 8.4
9.5
8.4
Amoebiasis
··
M.R.
0.4
0.4
0.3
0.3
0.3
0.3
0.2
0.3
0.4
0.6
1.R.
11.4
18.6
14.9
Bacillary dysentery
M.R.
0.7
1.4
1.0
1.2
29.4 23.5 1.6
22.4 23.0
21.3
15.4
23.2
1.6
0.2 0.3
0.9
0.9
Malaria
1.R. M.R.
24.4
37.6
58.0
40.0 37.7
18.4 20.3 17.3
24.0
15.5
3.9
1.7
2.0
2.0
0.7
0.4
0.2
0.04
0.04
..
1.R.
Acute poliomyelitis M.R.
0.7
1.4
0.8
1.0
2.1
2.2
1.3
1.7
9.5
3.0
0.1
0.1
0.2 0.1
0.4
0.1
O.L 0.3
1.5
0.7
I.R.
20.0
26.2
30.0 29.4 26.2
Measles
M.R.
2.8
1.9
3.4 2.2 5.5
23.2 29.1 33.9 3.8 3.5 3.6
28.6
26.0
7.0
6.2
L.R.
Incidence Rate--calculated from notifications received. M.R. Mortality Rate.
99. In general, there is a sharp increase in incidence of these diseases during the years 1951/53, followed by a decline during the next two or three years; in the last three years of the decade, there has been a levelling-off or rise in the general morbidity. The general mortality trend is downwards, after a sharp rise during 1951/52, although there are exceptions, namely amoebiasis, poliomyelitis, and measles. The pattern thus presented must be considered against the background of a great influx of people, followed by expansion of all public services and a high birth rate giving a rapid increase in the number of susceptibles.
22
100. Consideration of the individual diseases reveals the following points:
(a) Tuberculosis
The incidence of this disease would appear to be gradually subsiding after the peak of 1951. The mortality rate, however, has declined markedly, and in 1959 was only 37% of that recorded in 1951.
(b) Diphtheria
This showed a rapid increase during the early years of the decade reaching a peak in 1953. The first organized anti-diphtheria campaign started in 1952, using alum-precipitated toxoid supplied by UNICEF. The ensueing campaigns of 1953 and 1954 resulted in a raising of the level of immunity to produce a marked decline in the incidence of the disease during the next two years. Since 1955 a combination of rapidly- rising population under 5 years of age plus increasing public apathy have resulted in a great increase in morbidity, although mortality has by no means been so greatly affected. In fact, the case fatality rate for diphtheria during 1959 was the lowest on record.
(c) Enteric Fever
Gradual improvements in sanitation and environmental hygiene have resulted in a markedly lower incidence of this disease. However, the elimination of annual fluctuations and the production of a further marked decrease in the morbidity rate is to a great extent dependent on the provision of an adequate water supply. The introduction of the use of Chloramphenicol is reflected in the rapidly-decreasing mortality from this disease.
(d) The Dysenteries
Both amoebiasis and bacillary dysentery have remained comparatively steady and reflect the need for a rise in the standards of individual personal hygiene.
(e) Malaria
This disease has declined markedly and only two deaths from it have been reported during the last three years.
(f) Poliomyelitis
Poliomyelitis has in general remained sporadic except in 1958 when there was a marked rise in incidence during the summer months. The mortality rate is, however, rising and, in view of the increasing popula. tion of young children and the gradual spread of water-borne sewerage.
23
will no doubt continue to do so until widespread immunization of the most vulnerable age groups has been attained. A polio virus laboratory unit has now been established and an investigation into the types and prevalence of enteric viruses is under way.
(g) Measles
The incidence rate of this disease, as measured by the number of notifications, has remained comparatively steady over the decade, but the mortality rate has shown a consistent rise, so that at present measles ranks second only to tuberculosis as a cause of death from infectious disease; this rise, at least in part, is due to improvements in death certification and must be considered in conjunction with the con- siderable fall in mortality from bronchopneumonia which has occurred since 1950.
PORT HEALTH
101. The Port Health Administration is responsible for all measures designed to prevent the introduction of infectious diseases into the Colony by land, sea, or air; for the sanitary control of the port areas and of the airport; for the carrying out of the provisions of the Interna- tional Sanitary Regulations as embodied in the Quarantine and Preven tion of Diseases Ordinance; for the compilation of epidemiological statistics and reports and for the organization of prophylactic vaccina- tion campaigns. There are also statutory responsibilities under the Hong Kong Merchant Shipping Ordinance and the Asiatic Emigration Ordin-
ance.
-
102. A weekly exchange of epidemiological information is maintain- ed with the W.H.O. Epidemiological Station, Singapore, and copies of reports are forwarded for the information of the Secretary of State for the Colonies.
103. All persons entering the Colony are subject to a quarantine inspection, arrivals by sea at the two quarantine anchorages in Kowloon Bay and off Stonecutters Island, arrivals by air at Kai Tak Airport and persons crossing the land frontier, at the Lo Wu Quarantine Post. All immigrants without valid certificates are vaccinated against smallpox.
104. Other routine work carried out includes the deratting and disinsecting (including fumigation) of ships; sanitary duties in the port area and airport, including supervision of water supplies and control of mosquito breeding on small craft in the harbour: control measures to keep the port and airport free from Aedes aegypti; inspection of all vessels carrying over twenty unberthed emigrants: and issue of Bills of
24
Health which, although no longer required for international voyages, continued to be applied for by the masters of many vessels.
105. An important service rendered to shipping is to give medical advice by wireless to ships at sea; during 1959, twenty ships cabled "Porthealth" Hong Kong for advice on the treatment of sick persons on board.
106. Four launches and one fumigation barge were allocated by the Marine Department for Port Health work. The four launches, equipped with stretchers, first aid equipment and radio telephones, provide an ambulance service in addition to the routine work in the port area. They were also used frequently by the Department for miscellaneous duties, mostly in the outlying islands.
107. The increase of shipping entering the port had called, in March 1958, for an extension of the quarantine inspection hours to the official time of sunset, instead of 6 p.m. In May 1959, there was a further extension until midnight. Figure 1 shows the variation in this aspect of Port Health work over the past decade.
FIGURE 1
Number of Ships Inspected (excluding River Boats & Junks)
6.000-
4,000-
2,000-
L
1950 1955 1959
Number of Persons Inspected on Ships
(excluding River Boats & Junks)
Passengers
600,000-
Crew
400,000-
200,000-
25
1950
1955
1959
108. The night landing service at Kai Tak Airport was officially inaugurated during July. The medical inspection hours were extended accordingly to midnight, or later as required, and the additional staff necessary for this service was provided. Figure 2 shows the expansion of work at the Airport during the last 10 years.
Number of Aircraft
Inspected
FIGURE 2
Number of Persons
Inspected
50,000-
Passengers
40,000-
Crew
1,500-
30,000-
1,000-
500-
1950 1955 1959
20,000-
10,000-
1950
1955
1959
Prophylactic Vaccinations and other measures
109. During the year, the recruitment of five additional inoculators brought the establishment in this grade to a total of seventy. Inoculators are posted to twenty five different stations and centres throughout the Colony and are responsible for the field-work of the inoculation and vaccination campaigns.
110. The continued occurrence of cholera in Thailand during the first six months of the year called for the maintenance of a careful check on arrivals by sea and air from Bangkok. In addition, over 1,000 lbs. of fruit, vegetables, or other foodstuffs, considered to be potentially dangerous to health on account of cholera, were impounded and destroyed.
II. A small outbreak of smallpox occurred in Singapore during April and May: a careful survey was made of all passengers and crews
26
arriving from that port by sea or air, but no case of the disease was detected or occurred.
112. The number of persons arriving at Lo Wu showed an increase of 33% over the previous year. The modifications to the Frontier Port. which were completed at the end of 1958 enabled a smoother traffic flow and hence there was no difficulty in coping with the increased numbers. Of the 416,133 persons entering through Lo Wu during the year 50,543 were vaccinated against Smallpox.
Number of Persons Inspected
Year
1950
1955
1959
1.452.698
113,871
416,133
TUBERCULOSIS
113. While progress in the prevention of tuberculosis in the youngest age groups has been substantial during the past ten years, morbidity in the adult groups has remained very much the same. There has been nevertheless an encouraging fall in the mortality rate and those with tuberculosis are living longer, the average age at death from tuberculosis now being 37 years whereas in 1952 it was 25 years.
TABLE 6
TUBERCULOSIS
Percentage of
Death rate
Year
Population
per 100.000
Percentage of total deaths
tuberculosis deaths below 5 years
1950
2,265,000
144.0
17.7
38.3
1951..
2.013.000
208.0
20.0
34.0
1952 ..
2,250.000
158.8
18.4
34.3
1953 ..
2.250,000
130,6
16.0
36.2
1954 ..
2,277.000
126.3
14.9
31.2
1955..
2,340,000
120.0
14.7
28.0
1956 ..
2,440.000
107.0
13,6
25.0
1957 ..
2,583,000
103.6
13.9
21.2
- -
1958 ..
1959.
2.748.000
83.8
11.2
19.6
2,857.000
76.2
10.7
19.2
114. As a result of the policy of B.C.G. vaccination of the new born. chemo-prophylaxis of tuberculin positivity naturally acquired under 3 years of age and contact examination and treatment, the death rates at 5 years of age and under have declined very sharply since 1954.
17
FIGURE 3A
Graphs Showing the Rate of Decline of Death Rates from various Forms of Tuberculosis in Selected Age Groups based on 1954
100
08
40
20
ww
www
100
80
AU 4a
60
1 year
40
5 Jan
20
ལ་
All ages
1 your
$ year
55
56
ST
58
59
54
55
56
St
5.8
59
Pulmonary Tuberculosis Deaths
FIGURE 3B
Tuberculosis Deaths All Forms
100
Graphs Showing the Rate of Decline of Death Rates from various Forms of Tuberculosis in Selected Age Groups based on 1954
40
40
20
THE LEE HERE BET
100
1 year
60
5 years
40
20
All upc
1 year
5 years
5.4
55
56
58
59
54
5.5
56
57
54
59
Tuberculosis Meningitis Deaths
28
Tuberculosis (Other Forms) Deaths
115. During this five year period there has been a fall of 78% in the deaths from pulmonary disease under five years of age, a fall of 94% in the deaths from other forms of tuberculosis but a comparatively small reduction in the death rate from tubercular meningitis. This latter suggests little reduction in the morbidity in the total population and that only B.C.G. vaccination is affecting meningeal tuberculosis which, unlike the other more chronic forms of tuberculosis. is practically un- affected by treatment.
116. With regard to morbidity, tuberculosis notifications bear little relation to the total problem and the stage has not yet been reached when a population X-ray survey can be conducted with the certainty of offering treatment to all active cases detected. Nevertheless, evidence accumulated as a result of surveys over the last decade gives good reason to believe that an average of 2% of the total population have active. tuberculosis; a further 10% have radiological evidence of quiescent or arrested disease which may require little more than supervision. It is therefore assumed that facilities for the treatment of up to 60,000 cases of active disease will be necessary before any significant impact can be made on tuberculosis morbidity. About half this number of cases are already recorded at the Government Chest Clinics and an unknown number may be under treatment by other sources.
Agencies engaged in tuberculosis control
117. Government policy is to encourage and assist all voluntary agencies to participate in medical, social and welfare schemes which can be integrated into the programme of tuberculosis control. Because of the magnitude of the morbidity problem the greatest number of cases are being treated by ambulatory chemotherapy and most of this group are under treatment at the Government Chest Clinics. Hospital treatment on the other hand is provided largely by the Hong Kong Anti- tuberculosis Association, the Tung Wah Group of Hospitals, the Junk Bay Medical Relief Council and the Society for the Relief of Disabled Children. All these organizations receive recurrent grants-in-aid from Government; certain other hospitals also maintain a limited number of beds for tuberculosis patients. There is a close liaison between the voluntary agencies and the Government Tuberculosis Service.
118. The control programme is based on the following measures:
(i) Ambulatory chemotherapy of known cases.
(ii) Prophylactic chemotherapy of young contacts.
29
(iii) B.C.G. vaccination of new-born children and older tuberculin
negative reactors.
(iv) Hospital treatment of selected cases that will respond to
medical or surgical in-patient treatment.
(v) Limited case finding through X-ray surveys subject to sick
leave and re-employment guarantees.
(vi) An annual X-ray survey of all Government employees.
Government Tuberculosis Service Facilities
Ambulatory Chemotherapy
119. First introduced in 1950, using P.A.S. for a group of 45 cases, ambulatory chemotherapy now plays the major part in the control programme. Experience of the combined use of P.A.S. and I.N.A.H. was not so successful as had been expected from the good reports of its use elsewhere. Therefore two years ago streptomycin by daily injection on six days of each week was added to the course of treatment with combined P.A.S. & IN.A.H. The three drugs are now given as a standard until no further improvement is seen, which may be for a period of up to fifteen months. Thereafter the combined P.A.S. & I.N.A.H. tablets are continued, the minimum duration of treatment being for two years. Complications arising from this course of treatment are relatively rare and the few cases of hyper-sensitivity seen at the Chest Clinic are admitted to hospital; however, the total incidence of skin sensitivity reactions is not yet known and a number of cases attend dermatology clinics without informing the chest clinics. This aspect of the problem is now under investigation.
120. The principal problems of ambulatory chemotherapy are the failure to continue with treatment once symptoms are relieved, irregular attendance and the failure to take the PAS/INAH tablets in addition to the streptomycin injections. During 1959, 21% of the cases under treatment failed to continue treatment despite home visits and follow-up; of those patients attending the clinics, a sample of 6000 examined showed that between 87% and 90% had PAS in the urine. This indicates that the combined PAS/INAH tablets are on the whole taken regularly.
121. There are three fulltime chest clinics operating, one on Hong Kong Island and two in Kowloon. In addition there are eleven part- time out-patient clinics and nine injection centres. Evening sessions have been continued at three clinics and are beginning to prove more popular.
30
The establishment of the injection centres conveniently sited for those at work has greatly improved attendances for treatment. In addition, in the New Territories the staff of the clinics at Tsuen Wan, Yuen Long, Ho Tung, Tai Po, Sai Kung. Lamma, Peng Chau & Cheung Chau maintain an injection service. This also applies to the clinics at Stanley and Aberdeen on Hong Kong Island.
122. All treatment is given free of charge at the Government Chest Clinic.
123. The volume of work now undertaken at the Government Chest Clinics has strained the facilities to the utmost and has imposed a limit on the number of new cases that can be accepted at the major chest clinics each day. This limit applies only to cases presenting voluntarily for investigation and does not apply to referred cases. The expansion of the work at the Chest Clinics during the ten year period is shown in Table 7.
TABLE 7
GOVERNMENT CHEST CLINICS 1950/59
1950
1955
1936
1957
1958
1959
First attendances
J
19,282
40.061
34.607
35,126
39,454 39,008
Cases of tuberculosis
discovered
6.944
10,449
10,733
11,428
12,270 14,406
Total attendances for
treatment
40,324
320,426
401,568
539,282
803.326 1,655,100*
Under treatment from
previous year
Started treatment during
the year
Completed treatment
Failed to attend
Admitted to Hospital
1.703
5.887
9.132 13.733
7,861
7,964
[1.546 11,357
3.386
1.037
P
1,213
1,048 2,064
852
LL
2,022
2,868
3.048
5,391+
from Chest Clinics
586
965
1.029
1,078
1,511
1.587
Still on treatment at
end of year
2.824
5,887
9.132 13.733
16,062
* Due to expansion of injection facilities.
† A large proportion are recorded as 'returned to village outside Hong Kong'.
124. During 1959 there has been noted for the first time a sub- stantial reduction in the severity of the disease in new cases and there is no doubt that the proportion of early cases diagnosed is increasing. The percentage of infectious cases dropped from 29% in 1958 to 20% in 1959. This reduction gave cause for a bacteriological cross check of patients entering and leaving hospital and the hospital results, after multiple smears and culture, compared more closely than was expected with the clinic results, which are based on a single sputum examination.
31
Chemoprophylaxis
125. Starting in 1958, INAH has been given for a period of one year to children under the age of three years with a positive tuberculin test not due to B.C.G. and who shew no radiological or other sign of tuberculosis. This is part of the contact examination scheme but is also applied to other children attending the Maternal & Child Health Clinics. The number treated totalled 328 of which 200 were attending the Maternal & Child Health Clinics. In this way, acute post primary tuberculosis which constitutes a considerable proportion of infant deaths, mainly from tubercular meningitis, has also been attacked.
126. With the widening cover by B.C.G. vaccination the proportion of contacts in this group who would be suitable for INAH therapy is diminishing and is expected to continue to do so.
B.C.G. vaccination
127. A B.C.G. vaccination campaign was started in 1952 under the sponsorship of and with assistance from U.N.I.C.E.F., and continued in this way until 1955. The campaign as such was then discontinued and the activities incorporated into the general organization of the Tuber- culosis Service. The personnel employed in this work were dispersed into other sections of the Tuberculosis Service where it was considered they could operate more conveniently. The central B.C.G. office has now become a supply organization with a total staff of five, under the administrative control of the Tuberculosis Service and is responsible for the examination and vaccination of contacts, surveys of children in certain groups and for the operation and control of the B.C.G. campaign in new born children,
128. The B.C.G. Vaccination figures since the beginning of the campaign in 1952 are as follows:
TABLE &
BCG Vaccination
New Born
Tuberculin Test
Year
Completed Negative
Test
Vaccinated
Babies Vaccinated
Grand total Vaccinated
1952
176,728
38,173
3,120
41,293
1953
77,422
27,024
4,883
31,907
1954
52.620
15.234
3,050
18.284
1955
58,606
15.775
9,587
25,362
1956
38.523
5,629
23,418
29,047
1957
34,737
10.074
35,149
45,223
1958
29,107
10,390
49,865
60,255
1959
16.568
8,518
62,261
70,779
ILL
Total
484,311
130,817
191,333
322,150
32
B.C.G. vaccination of New-born Babies
129. B.C.G. vaccination of new-born babies is carried out by the multipuncture method using 20 mgm/c.c. vaccine. This vaccine is freely available to all private medical practitioners, midwives and clinics.
130. The vaccinators attached to the central B.C.G. office visit the principal hospitals as often as appears necessary to achieve maximum results; in certain hospitals this entails a daily visit. The calls upon their time are increasing and to maintain the tempo further increases of staff will be required. Of the 104,579 babies born during the year, 62,261, or 59.53%, were vaccinated with B.C.G. The success of this aspect of the work can be gauged from the returns over the past eight years:
Year
1952
1953
1954
1955
1956
1957
1958
Percentage vaccinated
4.33
6.49
3.66
10.59
24.21
35.93
46.86
59.53
1959
131. The returns each month show a steadily mounting total and it is anticipated that the current year will show further substantial increases. This aspect of the control programme probably gives the best return for the work done in the group to which it is applied and should, if reports from elsewhere are to be believed, show excellent long term results in reducing morbidity as well as mortality.
B.C.G. Vaccination of Other Groups
132. Vaccination of other age groups is carried out by the classical method using vaccine of 1 mgm./c.c. strength. Vaccination is given to tuberculin negative contacts of known cases of tuberculosis, through the tuberculosis clinics; it is also carried out in the Maternal and Child Health Clinics and at the B.C.G. clinic operated by the Hong Kong Anti-Tuberculosis Association. A certain amount of vaccination is also carried out by the School Health Service. The total number of children vaccinated during 1959 was 8,518 out of a total of 16,568 children tested, This side of the work is steadily decreasing and, with the rapid increases in the number of B.C.G. vaccinated new-born children, should eventual- ly be reduced, it is hoped, to a minimum.
33
Chest Surgical Clinics
133. A Clinic is held weekly at the Government Chest Clinic in Wan Chai by the Government Chest Surgeon where he sees cases referred for an opinion and the follow-up cases already operated upon. The attendances during the year were as follows:
First visits Revisits
Total
123
612
735
134. A further session is held once in two weeks by the Chest Surgeon attached to the Grantham Hospital who is assisting with the treatment of chest clinic surgical cases.
First visits Revisits
Total ...
...
226
144
370
135. As more patients come under ambulatory treatment the number of cases suitable for chest surgery is increasing. Thus there has been a slight rise recently in the numbers on the waiting list, despite the combined efforts of the two thoracic surgeons.
136. The thoracic surgery done in connexion with clinic patients was as follows:
Thoracoplasty
Corrective Thoracoplasty
Wedge resection
Segmental resection
Lobectomy
Pneumonectomy
Other operations
(a) Minor
(b) Major
TABLE 9
Govt. Thoracic Surgeon
Grantham Hospital Surgeon
18
16
71
6
55
48
8
21
12
16
29
No 28 Kai
6
26
60
18
2
With the recent participation of the Ruttonjee Sanatorium Surgeons it is anticipated that the waiting time for chest surgery, now less than three months, can be reduced to a minimum or even abolished, despite the increasing number of cases for which surgery is indicated.
The Orthopaedic Clinic
137. Started in 1957, this clinic is held at the Wan Chai Chest Clinic, under the joint direction of the University Consulting Orthopaedic
34
Surgeon to the Government and the Government Orthopaedic Specialist. Medical, clerical, nursing and social assistance is provided by the Government Tuberculosis Service and chemotherapy and supervision are carried out in the Government Chest Clinics. The X-ray service is provided by the Hong Kong Anti-Tuberculosis Association at Ruttonjec Sanatorium, on a repayment basis. A plaster clinic operates in associa- tion with this Clinic and physiotherapy is also available at Wan Chai.
138. Treatment is initially mainly by chemotherapy and, at the appropriate time, hospital treatment is available in the surgical wards of Queen Mary Hospital, at the Grantham Hospital, at the Sandy Bay Convalescent Home and at the Ruttonjee Sanatorium.
139. Attendance at the Orthopaedic clinics for consultation were as follows:
First visits Return visits.
Total ..
1957
1958
1959
543
629
617
768
2,083
3,503
1,311
2,712
4,120
140. An analysis of the 1959 cases in relation to the site of disease showed the following:
Spine
Hip Joint Other
Total
303
125
189
617
141. The Orthopaedic Surgeons are now of the opinion that most of the old chronic cases have been treated and that the new cases being seen are of comparatively recent origin. It is also possible that as a result of B.C.G. vaccination there has been a true drop in the incidence of tubercular bone disease in the youngest age groups.
Radiology
142. All X-ray work in connexion with the Tuberculosis Service is carried out by the staff of the Radiological section who are adminis- tratively responsible to the Senior Radiological Specialist. Static units are installed in the main clinics and branch clinics are served as far as possible by two mobile units.
143. First examinations are now all done on large papers which satisfactorily serve the purpose and are considerably cheaper than films. In addition they are less subject to the effects of the humid climate.
35
144. The total number of exposures rose again by almost 10% to 194,181, of which 128,894 were on large papers or films.
Bacteriological Examinations
145. The bacteriological work done for the Tuberculosis Service is carried out under the direction of the Government Pathologist. The total number of sputum smears examined was 44,785, a rise of 1,714 as compared with last year. Gastric cultures totalled 186 while laryngeal cultures, which have largely replaced gastric cultures, reached a total of 1,131.
146. Wide publicity is being given to the occurrence of atypical acid fast organisms in various parts of the world and the culture procedure in the laboratories has been adjusted to find examples in Hong Kong. Already a few have been isolated but the present indications are that this is likely to be a curiosity rather than a local problem.
Hospital Treatment
147. The detailed distribution of beds for tuberculosis in the civil hospitals throughout the Colony is shown in Appendix 5 and the total figure can be accepted as the average number of beds set aside through. out the year for the in-patient treatment of tuberculosis. Of this number 252 beds are maintained in Government Hospitals, 876 in hospitals managed by the Hong Kong Anti-Tuberculosis Association, 200 are in the Tung Wah Group of Hospitals and 180 in the Haven of Hope Sanatorium. This number may fluctuate from time to time particularly in the Government Hospital at Lai Chi Kok where this year the greatly increased diphtheria incidence called for a temporary re- distribution of convalescent and tuberculosis beds, over a period of two months, for the nursing of cases of severe diphtheria.
148. In addition to the beds available to the Tuberculosis Service in Government Hospitals, there are 444 beds in the Grantham Hospital and 336 beds in the Ruttonjee Sanatorium, which includes the Freni Memorial Convalescent Home. Admission is governed by the policy of utilizing the beds to the best possible advantage of patients whose recovery can be hastened by medical, pulmonary surgical or orthopaedic treatment or who require emergency admission for complications arising during ambulatory chemotherapy. It is not yet possible to use hospital beds entirely for the segregation of open cases whose home conditions are such that isolation is desirable. This aspect of the control pro- gramme is being investigated with a view to providing an institution for
36
the open chronic cases who do not respond to chemotherapy. Unfortun ately staff and financial considerations have so far prevented the formulation of any positive steps in this direction.
The Hong Kong Anti-Tuberculosis Association
149. Incorporated by statute, the Association administers two Hospitals, a Convalescent Home, a B.C.G. Clinic, a Tuberculosis Insurance Scheme and a Health Education Service. The two hospitals are the Grantham Hospital and the Ruttonjee Sanatorium; the Freni Memorial Convalescent Home is adjacent to the Ruttonjee Sanatorium and the two institutions are managed as one. The Hong Kong Anti- Tuberculosis Association Board is the governing body of the Associa- tion; the Grantham Hospital is the responsibility of the Grantham Hospital Management Board and the Ruttonjee Sanatorium and Freni Memorial Home are managed by the Ruttonjee Sanatorium Management Board. The Hospitals Management Boards are appointed annually by the Board of the Association and consist of nominated members of the Association Board: members of the staff of each institution attend the respective Management Board meetings.
150. The Association's work receives considerable voluntary sup- port and the hospitals are generously subsidized by Government. Treatment at the Ruttonjee Sanatorium and the Freni Memorial Home is entirely free; at the Grantham Hospital maintenance fees are charged on a non-profit making basis and Government now subsidizes 444 of the beds at the rate of $18 per day for each bed occupied by a Government-sponsored non-fee-paying patient.
Ruttonjee Sanatorium & Freni Memorial Convalescent Home
151. Operated as a single unit by a Board of Management these two institutions accommodate 336 beds of which 120 are in the Convalescent Home. Treatment is free and 42 beds are maintained by sponsoring bodies at an annual endowment cost of $3,500 per bed per annum. A Government subvention of $1,346,979 towards capital and main- tenance costs was made during the year.
152. Medical and senior nursing staff are provided by the Sisters of the St. Columban Roman Catholic Mission and staff of the Medical Faculty of the Hong Kong University act in a consultant capacity. Full medical and surgical treatment are given free of charge and there is a close liaison with the neighbouring Wan Chai Government Chest Clinic. Admission is through the sponsoring agencies, the University Clinical Units and the Government Chest Clinic.
37
153. The Sanatorium staff conduct a follow-up clinic for all patients discharged from Ruttonjee Sanatorium and the Freni Memorial Con- valescent Home. All the necessary social work in these institutions is the responsibility of the Almoners working in the Tuberculosis Service.
154. During the last few months of the year more pulmonary cases in need of thoracic surgery have been under treatment and more beds have been set aside for the surgical treatment of orthopaedic tuberculosis cases referred from the Wan Chai Orthopaedic Clinic referred to in paragraph 137 above.
TABLE 10
The number of patients admitted for treatment during the year wast
Adults through Government clinics Children (pulmonary) through Govt. clinics Children (orthopaedic) through Govt. clinics Other admissions and re-admissions
IL
279
55
51
...
277
662
Total admissions
Grantham Hospital
155. Designed and built as a modern hospital of 540 beds for the treatment of tuberculosis, this institution was opened in June 1957, Until August 1958 it was possible to staff only 360 beds of which 96 beds were set aside for paying patients. During the last quarter of 1958 the hospital became fully operational and now 444 beds are maintained by a Government subvention of $2,926,482.
156. The hospital is maintained by the Association through a Board of Management and free treatment is given in the 444 subsidized beds. Of these beds, 180 are under the clinical supervision of the Government Tuberculosis Service, the remainder of the hospital beds being the clinical responsibility of the Board's medical and surgical staff, consist- ing of a Medical Superintendent, a Chest Surgeon, an Anaesthetist and 4 Medical Officers. Government clinical staff consists of the Senior Tuberculosis Specialist, the Orthopaedic Specialist and the Thoracic Surgical Specialist, all of whom give part time services, and 3 full time seconded Medical Officers.
157. Subsidized patients on discharge attend the Government Chest Clinics for further treatment but the Grantham medical staff have full follow-up facilities. as desired, through the Government clinics. Medical social work for all subsidized patients is carried out by the Almoners in the Government Tuberculosis Service.
38
158. The number of subsidized patients admitted for treatment during the year was:
Grantham Hospital:
TABLE 11
Direct admissions
Transfers from paying beds Government Unit (pulmonary) Government Unit (orthopaedic):
Matc
30
IIL
Female 28
Children 57
IIL
225
40
173
115
553
The Tung Wah Group of Hospitals
Total admissions
159. This Group of Chinese Charitable Hospitals maintain some 200 beds for the medical treatment of tuberculosis, mainly cases of a more chronic nature. In addition, outpatient clinics are held for cases under ambulant chemotherapy. In these hospitals approximately one third of the total births in the Colony take place each year and accord- ingly great emphasis is placed on B.C.G. vaccination of the new-born. Throughout the year 73.06% of these new born babies were given B.C.G. in the hospital wards.
The Haven of Hope Sanatorium
160. Situated in the New Territories and managed by the Junk Bay Medical Relief Council, this Sanatorium has maintained 180 beds throughout the year for the medical treatment of tuberculosis. The Sanatorium is supported by a group of Protestant Missions of various denominations which sponsor the majority of the beds. Government gives an annual subvention of $108,000 for the maintenance of 45 beds for the free treatment of villagers suffering from tuberculosis, and for the provision of certain X-ray services to local residents. The Council also maintains an outpatient clinic for tuberculosis patients in Rennie's Mill,
161. Surgical facilities for pulmonary and orthopaedic cases in the Sanatorium are provided by the Alice Ho Miu Ling Nethersole Hospital on Hong Kong Island where patients are temporarily transferred for surgical treatment.
The Sandy Bay Convalescent Home
162. This Home of 54 beds is maintained by the Society for the Relief of Disabled Children and staffed in part by the Hong Kong
39
Branch of the British Red Cross Society. It is designed for the con- valescent care of children suffering from orthopaedic conditions many of which are due to tuberculosis. The Society receives a Government subvention of $15,000 towards maintenance costs.
X-Ray Surveys
163. Up to the present time, X-ray surveys of the general population have not been practicable in that the facilities for subsequent investiga- tion and treatment have been fully occupied in dealing with the existing case load. Certain selected groups are X-rayed annually however and X-ray surveys are carried out on request, for commercial and industrial organizations prepared to guarantee certain sick leave and re-employ- ment facilities for active cases of tuberculosis detected. There has been a considerable expansion of this latter activity during the year.
164. For the past ten years, Government employees have been required to undergo an annual X-ray examination of the chest. This follows a strict pre-employment examination during which all cases showing radiological changes are fully investigated. Therefore incidence of active disease in Government employees gives an indication of the effects of the impact of a high tuberculosis morbidity on a selected group in full employment. During 1959 an incidence of 1.29% of active tubercular disease was uncovered amongst Government employees; however there were only two deaths from tuberculosis in the group. which gives a mortality rate of 6 per 100,000.
165. All convicted prisoners are also X-rayed annually and here the percentage of active disease rises to 5.15%. As a considerable propor tion of prisoners are also drug addicts and are drawn from an unstable element of the community, this high morbidity is not unexpected.
166. A total of 76 firms participated in the X-ray survey scheme and 1.78% of active cases were diagnosed. Many of these firms also have annual surveys carried out so that this group of individuals is also selected. It is of interest that the number of firms and individuals participating rose from 51 to 76 and 8.768 to 12.995 respectively when compared to 1958.
School Teachers
167. Teachers in Government schools are X-rayed annually in the course of the Government survey. In private schools, teachers are required to register with the Education Department and before being passed fit to teach they have to undergo a chest X-ray, not necessarily
40
by the Government X-ray units. Accordingly records are available only for these teachers in private schools referred to the Government Chest Clinics because of an unsatisfactory X-ray. The figures for the past five years are:-
TABLE 12
1955
1956
1957
1958
1959
Referred to Chest Clinics
348
455
318
249
179
Unfit to teach on account of
pulmonary tuberculosis
36
49
53
23
32
Percent
9.2%
17.9
10.6% 10.7% 16.6%
This high incidence is undoubtedly due mainly to the referral of cases showing suspicious radiological findings for further investigation.
168. Those teachers found to be unfit are offered priority of admis sion to hospital but there is no compulsion and it is suspected that a number of teachers with active disease may be teaching in unregistered schools.
169. With the opening of another major full-time chest clinic in 1960 and plans in hand for two static X-ray survey centres in addition to the mobile units at present in use, it is hoped to start certain general population surveys in the near future, beginning in Resettlement Estates.
Medical Social Work.
170. This is carried out by a staff of Almoners assisted by 35 Tuberculosis Workers. The importance of this aspect of the work within a system of ambulatory chemotherapy needs no emphasis. Dense over- crowding, no comprehensive social insurance, low economic standards and the wide extent of out-patient therapy make imperative the earliest possible development of the home contact if the fullest use is to be made of the limited social assistance available.
171. The roles of the Tuberculosis Almoner and the staff of Tuber- culosis workers are complementary. As soon as a diagnosis has been made, the Almoner concerned interviews the patients and the social and economic circumstances are recorded. Thereafter, within one month if possible, a Tuberculosis Worker pays a home visit.
172. Once admission to hospital, other than as an emergency, has been recommended, names are placed on the waiting lists maintained by the Almoners according to the category of treatment required. The categories are chest medical (three units), chest surgical (three units), orthopaedic (four units), and special investigation (one unit). As far as
41
possible all forseeable social problems are thus settled before admission. saving much work at a later date.
173. Visits are paid by the Almoner to patients in hospital, a weekly visit being the usual practice. When possible the visit is paid in conjunction with the medical officer concerned. On discharge from hospital all patients are given a small supply of drugs to ensure con- tinuity of treatment until arrangements have been made for further care at the clinic most convenient to the place of residence.
174. For patients under ambulatory treatment at a clinic, attendance registers are kept by the Almoners so that failure to attend or irre- gularity in attendance can be noted. Defaulters are visited by Tuber. culosis Workers without delay and are encouraged to resume attendance, the dangers of failure being outlined and explained.
175. Drugs for oral administration are distributed through the Almoners section, usually by the Tuberculosis Workers. As the total of patients on ambulatory chemotherapy at any one time is in the neighbourhood of 16,000 the magnitude of this aspect of the work is considerable. The distribution of oral drugs as made up by the manu- facturers in packs containing one week's supply has been a great advantage.
Assistance to Patients
176. A sum of $250,000 was available during 1959 for assistance to patients. This aid was disbursed in the form of cash grants or additional food. During the year, 282 families received average cash grants of $23.25 each week compared to 238 families receiving average grants of $21.45 during 1958. Other cash grants, for travelling expenses, domestic help, rehabilitation grants and surgical appliances for ortho- paedic cases, were also made.
177. Additional food, in the form of one pound of milk powder per patient each week, cost $99.488. This form of aid was supplemented by assistance in kind consisting of 10,982 C.A.R.E. food parcels and 6,000 lbs. of fortified noodles.
The Tuberculosis Workers
178. The greatest part of the home visiting is carried out by the Tuberculosis Workers. Trained specifically for duties most suited to local conditions, they have no nursing training as their work is mainly on the social side. They are responsible through the Senior Tuber- culosis Workers to the Almoner and each has duties in a clinic which
42
cover reception, the maintenance of records and registers and assistance in the special clinics. Outside the clinic, each T.B. Worker is responsible for a district and afternoons are devoted to home visiting, health education and the organization of contact examinations.
179. The training is an 'In service' one and lasts for six to twelve months, the emphasis being on the practical side with a minimum of lectures on the elements of medical social work, record keeping and health education.
Tuberculosis Contacts
180. Efforts are made in the course of home visiting to have every close family contact of known cases of tuberculosis examined to exclude tuberculosis. Contacts under the age of 8 years are tuberculin tested, negative reactors being offered B.C.G. vaccination, positives being X-rayed. Other contacts are X-rayed at their convenience and without the need to first register at the chest clinics.
The findings during the year were as follows:
Under 8 years of age
Tuberculin Tests { Clinical Findings
of T.T. Positive
cases
Percentage of active
Over 8 years of age
Results of
Examination
following
contact X-ray
TABLE 13
ILJ
Negatives Positives Active Tuberculosis Inactive Tuberculosis Suspicious
Free of Tuberculosis tuberculosis
Active Tuberculosis
Inactive Tuberculosis
Suspicious Tuberculosis
Free of Tuberculosis
1958
1959
1,163
996
2,254
1.928
148
1 - -
110
37
65
384 1.685
324
1.429
ILL
4.33%
3.72%
385
336
183
159
746
658
7,070
6,856
4.59%
4.19%
11,801
10,933
Percentage of contacts over 8 years with active
tuberculosis
ггт
Grand total of contacts examined
181. There has been a drop in the total number of contacts examined as compared with previous years, but there appears to be no significant change in the findings.
MALARIA BUREAU
182. The Malaria Bureau, under the direction of the Government Malariologist, is responsible for all malaria control undertaken in the Colony and, in certain instances, deals with the breeding of culicine mosquitoes. It also offers expert advice to the Armed Services, the Pest
43
Control Unit of the Urban Services Department and to Hei Ling Chau Leprosarium. Lectures are given on malaria and allied subjects to various groups of health personnel under training.
Control operations
183. The important malaria vectors are A. minimus and A. jey- poriensis var. candidiensis, while A. maculatus and A. hyrcanus have also been proved to be potential carriers. For control purposes the Colony is divided into 'protected' and non-protected areas.
184. The whole of the urban area comprising Hong Kong Island, Kowloon, and New Kowloon is a protected area. In addition there are relatively small zones in the New Territories, at Rennie's Mill Camp, Kau Wa Keng, Chi Ma Wan Prison and the township on Cheung Chau Island, where control measures are maintained. Since the 1st April, 1959, similar measures have also been instituted at the new Shek Pik Reservoir site for the protection of workers engaged in the construction of the dam.
185. The extension of the control programme to Rennie's Mill and Kau Wa Keng only commenced in 1950, to Cheung Chau Island in 1951 and to Chi Ma Wan in 1955. From 1952 onwards, in the face of progressive urban development, protection has been gradually extended to the Ngau Tau Kok, Kwun Tong, Cha Kwo Ling and Lei Yue Mun areas in New Kowloon.
186. The method of control of malaria is based predominantly on anti-larval measures consisting of the rough training of streams, ditching and larviciding. Anti-malaria oil was at first employed as the main larvicide but, starting in 1950, Gammexane dispersible powder was used instead of oil. This continued satisfactorily until 1957 but, on account of development of resistance on the part of malaria vectors elsewhere against chlorinated hydrocarbon insecticides after prolonged use and in order to delay the possibility of the development as long as possible, it was considered advisable to reintroduce the use of oil, except in agricul- tural lands where its application would be unsuitable. Under local conditions this use of oil has proved to be safe and economical.
187. In certain instances, the Bureau also undertakes the control of culicine mosquito breeding. Against Culex fatigans, which has shown definite resistance to Gammexane, Diazinon dispersible powder has been found very useful, particularly when breeding takes place in sumps. For Aedes togoi which breeds profusely in brackish water in numerous rock
44
pools along the shore. Gammezane 'bricks' have continued to prove their effectiveness without any sign of resistance developing.
188. Results of the malaria control work in the urban areas have so far been satisfactory and the incidence of natural malaria transmis- sion has virtually been reduced to zero. Routine adult mosquito catches and larval surveys were carried out in the protected areas of Kowloon and Hong Kong throughout the year. Except in one or two instances. when young larvae of A. maculatus and A, hyrcanus were detected, all the other findings were negative. However vector mosquitoes abound just outside the protected areas and, given a favourable opportunity. can regain a foothold at any time. Therefore constant vigilance is neces sary and there is no room for complacency or relaxation of the control
measures.
189. In the New Territories, except in the few selected areas as mentioned above, there is as yet no overall vector control programme. In the rural districts, where the population is scattered and wet cultiva- tion is traditional, to adopt anti-larval measures as currently practised in the urban areas would not yet be feasible owing to the agricultural practices in use. Further, comprehensive anti-adult mosquito measures, once instituted, would have to be continued as long as unprotected con- tiguous borders are present, with a grave risk of resistance developing.
190. Police personnel and troops stationed in the New Territories. continue to depend on paludrine prophylaxis as their main line of defence against malaria.
191. In the Sai Kung district, in the eastern part of the New Terri- tories where the majority of malaria notifications originate, chemopro- phylaxis by weekly distribution of paludrine tablets was started towards the end of March 1959 in the two comparatively small villages of Pak Kong and Pak Sha Wan. This was designed as a pilot experiment in control by chemoprophylaxis but, unfortunately, the experiment had to be discontinued in January 1960 as the necessary co-operation from the public began to dwindle. The initial results of the scheme were however encouraging, since not a single case of fresh infection had been reported in either of these two villages throughout the period of medication; indeed, up to time of writing this report, although cases continued to appear in neighbouring villages, no fresh infections have been reported from the two villages concerned,
45
Cost of operation of the Bureau
192. The entire Colony population is at risk of the infection but approximately 2,367.000 persons are now under protection by anti-larval methods. For the year, the cost of the control operations, including action against nuisance mosquitoes in certain areas, was 37 cents (about five pence half penny) per head. This takes into account the emoluments of all staff and the expenditure on anti-malaria oil, insecticides and equipment.
Malaria incidence
193. Notification of malaria was made compulsory for the first time in the Colony in September 1945. The enforcement was discontinued in May 1948, but since June 1950 has been reintroduced.
194. Since 1950 the reduction in malaria mortality has been striking as may be seen from the following figures:
Year
1950
1951
LLI
ILL
ILJ
1952 1953 1954
1955
P
1
LII
LLI
LII
1956
---
1957
1958
TABLE 14
Cases notified Deaths
552
89
-- J
756
35
1,305
46
899
:
46
11
858
16
431
9
---
496
4
447
0
659
442
1
1959
195. Just over 90% of all cases notified during 1959 were from out. side the urban protected areas, and of these 72.6% came from the Sai Kung district; 27.1% of the Sai Kung notifications were from the boat population, the remainder being scattered amongst 43 small villages in the district. Of the blood parasites identified, 89.1% were P. vivax, 10.2% P. falciparum, 0.5% P. malariae, and 0.2% mixed infection of P. vivax and falciparum. All cases notified from the protected urban areas were fully investigated and not one could be proved to have contracted the infection in the protected zones.
196. There was one death recorded as due to malaria and again, as in the previous year, the victim had been the subject of repeated blood transfusions, this time for a malignant condition of the blood.
46
Malaria surveys
197. Two malaria surveys were carried out, one in the urban pro- tected areas and the other in the border zone in the north of the New Territories between Lo Wu and Sha Tau Kok. The former survey was amongst children between 2 and 14 years of age and was carried out in co-operation with the School Health and Maternal & Child Health Services. Between April and October 1959, 1,744 children aged two to five years were examined; the spleen rate was zero. From April to June 1959, 6,676 school children aged five to fourteen years were also examined and the number with palpable spleens was 18 or 0.27%. In addition 4,033 blood smears were taken from infants under one year of age attending urban Maternal & Child Health centres. All smears were cross checked at the Government Institute of Pathology and all were reported negative for malaria.
198. In the border areas 907 children between the ages of two and ten years were investigated in eleven villages of whom 11 or 1.1% had palpable spleens. There were no smears positive for malaria in 1,005 blood smears taken from children under 10 years of age.
199. At present, another survey of the incidence of malarial in- fection in children under 10 years of age in the New Territories is in progress. Blood slides are being taken by the medical staff from all febrile children under 10 attending dispensaries in the New Territories and are being examined at the Government Institute of Pathology. An endeavour will then be made to trace and treat all positive cases thus revealed. The survey is expected to give valuable information as to the prevalence of malaria parasites in the blood of children of this age group and at the same time expose at least some of the cases in which the diagnosis which might have been missed without blood examination. At the same time, as more and more cases are being treated, the reservoir of infection, it is hoped, will diminish.
Laboratory
200. The Bureau laboratory continued to carry out the routine identification and dissection of mosquitoes and the staining and exami nation of blood smears collected during the surveys. Field tests were conducted of the efficacy of insecticides and the susceptibility of anophe- lines to insecticides. Information on tests of insecticide resistance in adult mosquitoes was forwarded to the World Health Organization.
47
SOCIAL HYGIENE
201. The Social Hygiene Service provides free facilities for the diagnosis and treatment of venereal disease and leprosy. It is under the direction of the Senior Social Hygiene Specialist who is also the Govern ment Specialist in Dermatology. The service operates from six centres in the urban districts and four part-time centres in the New Territories; it also maintains the Wan Chai Female Social Hygiene Hospital which contains 30 beds and a female out-patient clinic.
Venereal Diseases
202. During 1959, there was a rise in the number of cases of primary and secondary syphilis and of chancroid, the figure for gonorrhoea was virtually unchanged and that for lymphogranuloma venereum had de- creased. This rise in the incidence of syphilis after a period of continuous decline corresponds to experience in many other cities, where the lowest incidence of syphilis was recorded five to six years after the introduc- tion of general penicillin therapy; this introduction took place in Hong Kong 1952/53. The annual incidences and trends of these diseases are shown in Appendix 6.
203. No death was recorded from congenital syphilis during the year. In 1950 the number was 29, and it was in that year that free Kahn tests were made available to all pregnant women; in 1953 the Kahn test was replaced by the more sensitive V.D.R.L. and Table 15 shows both the increasing use made of this facility and the declining sero-positive rate amongst the population.
TABLE 15
ANTE-NATAL BLOOD TESTS ON PREGNANT WOMEN
1953 1954
1955
1956 1957
1958
1959
No. of tests Clinics &
Hospitals
N/A
% of Positive Rate
N/A
20,748 8.5
23.716 26,803 27,330
4.5
3.8
3.5
28,026 3.3
46,932
2.6
No. of tests Private
Midwives
5.255
5.697
5,439
5,464
4,623
5.583
6.269
% of Positive Rate
7.2
6.0
4,2
3.4
2.7
3.2
2.3
204. There has been little change in the incidence of the late cardio- vascular or neurological complications of syphilis.
205. Penicillin continues to be the first choice for the treatment of syphilis and gonorrhoea, but in the case of syphilis the slightest manifestation of a reaction to the drug is followed by a change to chloramphenicol. One death due to anaphylactic shock occurred in an
48
elderly female patient following a penicillin-in-oil injection, a prepara- tion which has also caused a few severe reactions and which is now being replaced by an aqueous suspension.
206. Since the introduction of penicillin as the standard treatment of gonorrhoea, there has been a gradual rise in the numbers of peni- cillin-resistant gonoccocci. An interesting feature is that the present high figure in males of 23.7% resistant strains, which is obtained from laboratory results, is not found in clinical practice, there being only at 9% failure rate on the standard dosage of 400,000 units.
207. An investigation into the incidence of venereal disease in pro- stitutes attending the Social Hygiene clinics was made during the year. The following results are of interest.
TABLE 16
No. of Prostitutes attending for the first time
No. V.D. found
Syphilis
Gonorrhoea Early
late
latent
latent
1,086 Percentage
692
235
63
96
63.8
21.6
5.8
8.8
ILI
208. An increase in the establishment of social hygiene visitors has resulted in a considerable expansion of follow-up activities. In each case defaulting from treatment, the patient is contacted by letter and one-quarter of those so contacted return to continue treatment. Visits are then made to the addresses of those who do not respond, when, more often than not, the address given has been a false one.
Leprosy
209. In 1954 the first clinic for treating leprosy on an out-patient basis was organized and by the end of the year 1959 ten sessions were being held weekly in eight out-patient centres, while four other sessions each week are being held at social hygiene centres in conjunction with other clinics; one session is held monthly at Tsuen Wan. Infectious cases numbering 138 were admitted to the Hei Ling Chau Leprosarium which is maintained by the Hong Kong Auxiliary of the Mission to Lepers, as were also some cases either in reaction or in need of surgical attention. A very close liaison with this institution, which is referred to in paragraph 330 of this report, is maintained by the Social Hygiene Service.
210. For routine treatment at the Leprosy Clinics, dapsone is still the drug of choice; the use of diaminodiphenyl sulphoxide which was introduced for selected cases in 1958 has been discontinued following
49
upon conclusions reached at the W.H.O. seminar held in Tokyo in November, 1958. A clinical trial of ditophal, was commenced in 1959; bi-weekly inunctions of the drug are administered, combined with dapsone either orally or intramuscularly. Preliminary results have been encouraging and ditophal will soon be made available for general use. Diphenyl thiourea is now produced in tablet form and is used in selected cases showing intolerance to dapsone.
211. The surgical rehabilitation of patients suffering from deformi- ties and disfigurements has been still further developed in the Maxwell Memorial Hospital at the Hei Ling Chau Leprosarium. Orthopaedic treatment and plastic surgery is also provided in the Government hospitals where a limited number of beds is available for this purpose.
212. A review of 500 clinic patients was carried out by the University Orthopaedic Surgeon with a view to determining the number of cases of leprosy in need of surgical rehabilitation. The results are now being analysed and will be a valuable aid to the planning of the further development of the rehabilitation facilities.
213. Contact investigations are increasing steadily in numbers and child contacts are vaccinated with B.C.G. It is routine procedure for the home of each new patient to be visited within a month of the diagnosis being made and the contacts requested to attend for examina- tion: they are thereafter examined once every six to twelve months. Defaulting patients and contacts who do not attend for examination are visited and 36% return for treatment and examination; unfor- tunately many contacts are unwilling to attend after a year as they neither see nor feel any indication of disease.
214. The work done by the leprosy Out-patient Service during the past five years is outlined in Table 17.
TABLE 17
LEPROSY OUT-PATIENT SERVICE
1955
1956
1957
1958
1959
Admission to Clinics
Lepromalous
Tuberculoid
Mixed Type
762
751
981
976
767
170
160
173
160
111
198
262
262
214
183
0
1
1
5
3
Total Attendances
Number of Cases Admitted to Hei
Ling Chau
22,012
25.789
31,204
36,338
31,986
98
165
132
111
138
50
Dermatology
215. Patients with skin diseases may attend any of the Social Hygiene Clinics and, in addition, there are six consulting sessions each week, three on Hong Kong Island and three in Kowloon, for cases referred for a specialist opinion. Female in-patients are treated in the Wan Chai Social Hygiene Hospital, while beds for male in-patients are available at the Lai Chi Kok Hospital. The rapid expansion of the Dermatological service can be seen from the fact that 777 new cases were seen during 1951, while in 1959 the figure was 11,046.
216. Contact dermatitis, boils, subcutaneous abscesses and eczema continue to be the main diseases encountered. Appendix 7 shows the classification and frequency of the dermatological cases seen. All cases of industrial dermatitis and certain cases of contact dermatitis were notified to the Industrial Health Officer.
217. The advent in May of greisofulvin, which has radically altered the treatment of all fungus infections, has been a notable therapeutic advance in this field. The present high cost however limits its general
use.
DISTRICT MIDWIFERY SERVICES
218. The value of skilled attention during childbirth is widely appre- ciated in Hong Kong and over the past decade an average of 97.94% of the registered live births have been attended by qualified persons. Under the conditions of overcrowding existing, domiciliary midwifery is neither practicable as a general rule nor desirable, and domiciliary deliveries by Government and private midwives have fallen from 15% of the total births attended in 1950 to 6% during 1959. On the other hand the number of maternity beds in institutions throughout the Colony is approaching an adequate level. At the end of 1959 there were 1.498 maternity beds in public and private hospitals, clinics and maternity homes which, at a ratio of 1 bed for every 70 births, indicates that one service at least is not gravely short of beds.
219. In the past the Government policy has been to provide institu- tional care in the urban areas mainly in the maternity hospitals at the new Tsan Yuk and Kowloon General Hospitals. These institutions are however becoming more and more used for difficult or abnormal cases seen at the ante-natal clinics, while normal midwifery is dealt with at maternity homes attached to clinics or in private hospitals and maternity homes. New clinics to be built in the urban areas will now include a maternity home for normal cases where this service is warranted for
51
the district served. In this way pressure on maternity hospital beds will be eased and services for the uncomplicated case will be sited more conveniently and nearer home.
220. There are now fourteen Government maternity homes in clinics in the New Territories, two in the urban areas at the Eastern Maternity and Hung Hom clinics respectively. At 23 centres there are 53 domiciliary midwives available to undertake midwifery in nearby housing schemes and resettlement estates.
221. Table 18 sets out the categories of maternity services provided during the period 1950 to 1959 and the proportion of live births where a qualified person-doctor or midwife was in attendance,
'TABLE 18
LIVE BIRTHS 1950/59
according to type of Maternity Service
Type of Service
HOSPITALS
Government
Government-Assisted
Tomi Live Births in Hospitals
1950
10.163 (16.77)
1955
16.333 (26.95) { 22.654 (2.93)
26.496 (43.72)
44.912 (49.62)
1959
13,986 (15.45) 28.272 (31.24)
15,244 (14.58)
Private
34,646 (33.13) 3.152 (3.01)
DOMICILIARY
..
11
MATERNITY HOMES
{
Government Private
{
53.042 (50.72)
L
2,576 ( 4.25) 21,226 (35.03)
6,144 ( 6.79) 30,972 (34.22)
9,572 (9.15)
34.253 (32.75)
Total Live Births in Maternity Homes
f Government
Private
Total Live Births by Domiciliary Services
23.802 (39.28)
37,116 (41.01)
43.825 (41.90)
гг
2,558 ( 4.22) 6,949 (LL.47)
9,507 (15.69)
3,614 (3.99) 1,807 (2.00) 5,421 ( 5.99)
3.081 (2.95)
3,073 ( 2.94)
6,154 € 5.89)
TOTAL LIVE BIRTHS ATTENDED BY QUALIFIEDS
PERSONS
TOTAL LIVE BIRTHS REGISTERED
$9.805 (98.69)
60,600
87.449 (96.62) 90,511
103,021 (98.51) 104,579
Figures in brackets show the various numbers as a percentage of total live births registered.
222. The total number of cases attended by the Government District Midwifery Service during 1959 was 13,427 including still births and cases referred to hospitals. There were 168 still births recorded giving a still birth rate of 12.77 per 1,000 live births. The average annual case load for midwives was 263 compared to 280 during 1958 and the range varied from 52 to 795.
223. There is a continuing improvement in the frequency of ante- natal attendances and approximately 80% of women attended by Government or private midwives had at least one ante-natal examina- tion; the average number of ante-natal attendance for each case has risen from 3.4 in 1958 to 3.5 in 1959; the percentage of cases delivered without any ante-natal care was 13.44% the relevant figure for the previous year being 16.94%.
52
224. The Supervisor of Midwives who is a Government Medical Officer is responsible for the regular inspection and supervision of registered maternity homes and of the work of domiciliary midwives. Since September 1959 she has been assisted in this aspect of her work by a Health Visitor. There were 891 visits of inspection to the 122 maternity homes in the register during 1959.
225. Important aspects of the work are the vaccination of new born babies with B.C.G. and primary vaccinations against Smallpox. Altogether 54.74% of babies delivered by Government and private mid- wives were given B.C.G.; 81.08% of this cover was given by the Government midwives and 44,025 primary vaccinations were performed. 226. Table 19 gives a comparative outline of the development of the service during the past 10 years.
Government Midwifery Service
TABLE 19
District Centres
Midwives employed
-
1950
1959
16
23
ΣΙ
51
45
151
J
5.207
13.427
2,633
10.321
2,574
3.106
210
193
114
122
379
524
2
5
28,512
37,605
ггт
21,489
34.496
7,023
3,109
861
1,565
69
128
1.70
0.73
J
No. of Beds in Government Maternity Homes
Total cases attended
Maternity Home cases attended Domiciliary cases attended
Private Practising Midwives
No. of midwives in Active Practice
No. of maternity homes registered No. of beds
No. of nursing homes registered Total deliveries
Maternity home deliveries Domiciliary deliveries.
General
No. of midwives on Register
L
...
L
L
ILL
LLI
LIJ
No. of midwives passed the Midwives Board Exam-
ination
---
Maternal Mortality Rate
MATERNAL AND CHILD HEALTH
227. In this most important branch of the service the emphasis is on the prevention of disease and on health education, Once disease. exclusive of minor ailments, is detected the individual concerned is referred to the appropriate curative centre. All facilities are provided free and are available at seven full-time and twenty one part-time centres. No new centres were opened during the year but two of the existing centres were moved into more adequate premises. Additional
53
work undertaken was a regular visit by a Health Visitor to the North Point Relief Camp and, starting in January, 1960, a monthly visit by a M.C.H. team to the British 'Save the Children Fund Nursery' at the Wong Tai Sin Resettlement Estate.
228. Ante-natal sessions are held regularly in 28 centres and post- natal sessions in 16 centres. Total attendances at ante-natal sessions numbered 61,891 of which 17,418 were first visits; abnormal conditions were detected in 9.27% of mothers, oedema and hypertension being the commonest defects encountered. The routine chest X-ray, started in 1958, uncovered 2.1% of active tuberculosis in need of treatment. Pregnant women in need of dental cure are referred to the Government Dental Clinic.
229. Post natal sessions were, on the whole,
on the whole, relatively poorly attended there being 3,530 first attendances out of a total of 4,870. Of those attending 22.15% were in need of some form of treatment, mainly for affections of the cervix, vagina and misplacement of the uterus, in that order. The records suggest that consciousness of some defect is the main cause for attendance and that those women who feel fit do not take advantage of a routine post-natal examination. This is undoubtedly related to economic and family pressures arising from employment or home commitments.
230. The infant health sessions for children in the 0-2 years age group and the toddler sessions are very popular. Here health education and immunization sessions are the main activities. There were 399,633 attendances at 13.497 health education sessions when simple talks, film and puppet shows, flannel graph illustrations and practical demonstra- tions of infant care and child hygiene are given. It is stimulating to see the interest and practical participation of the parents, not infrequent- ly including fathers, on these occasions.
231. Immunization against diphtheria, typhoid and tetanus are given as a routine using A.P.T. combined antigen and triple vaccine accord- ing to circumstances. All total 20,166 infants received a full course of immunization during the year. Smallpox vaccination is given where necessary and all children not known to have had B.C.G., are tuberculin tested, those who are negative receiving B.C.G. Those who are tuber- culin positive but without radiological signs of active disease are given prophylatic INAH for a period of one year.
232. Home visiting constitutes one of the major activities and this activity increased by 18% to a total of 46,248 visits.
54
233. The M.C.H. service participates in the undergraduate training of medical students, student health nurses and pupil midwives. In-service training courses are run by the Health Sisters for health visitors and health nurses; courses are maintained for midwives in private practice and classes held for social workers and high school girls. An elementary child care course run by the Social Welfare Department was given a series of lectures on child development and care during June and July, 1959 by M.C.H. staff.
234. Food supplements, mainly milk and baby foods, were distri- buted, according to need, to nursing mothers and infants. UNICEF skimmed milk powder was again generously provided free for all centres; half-cream and full-cream milk is supplied by Government: Heinz Baby Foods and Farley's Rusks were also donated for distribu- tion from the centres.
235. It is of interest to record developments during the period 1950 to 1959. During that period, the in-service training of doctors and nurses was started in 1952, UNICEF aid in the form of equipment and skimmed milk powder began in 1953, and WHO assistance with staff was given during 1953 to 1955. The course of training for Health Visitors was inaugurated in 1954.
Centres
Full-time Subsidiary
Staff
TABLE 20
M.C.H. DEVELOPMENTS 1950/59
M.O. ic M.C.H.
M.O. ic Centres
1950
1959
3
7
4
17
---
Health Sisters
Health Visitors
Health Nurse
Attendances
Ante-natal
Post-natal
Infant Health
New visits Revisits
Total
New Visits Revisits
Total
New Visits Revisits Total
Infant Mortality Rate
1
3
9
P
3
L
L
2
34
18
26
I
17,418
44,473
-
3,019
61,891
3,530
1.340
4.870
9,551 105,889 115,440
28,227
299,671
327,898
---
..
L
LLL
55
99.6
48.3
SCHOOL HEALTH
236. During the year the Report of the Working Party, set up by Government in 1955 to examine the problem of providing a comprehen- sive school health service, was submitted to Government. Pending the submission and study of this report, particularly the degree of imple mentation the Colony can afford, the scope of the curative aspect of the school health service has been 'frozen' at the 1955 level.
237. Broadly speaking there are two aspects to the Service. The first is the control of environmental sanitation and communicable disease as a general public health measure applied to the Government and Government subsidized schools. This aspect of the work continues and, in addition, aid is given when requested for the control of com- municable disease in any registered school. During the year, effort was concentrated on raising the level of immunity to diphtheria and typhoid and the results were more satisfactory than any previously recorded.
238. The problem of providing personal curative services however has been seriously aggravated by the very sharp increase in the size of the population of school age. These services were available on a voluntary fee paying basis to all pupils in Government schools from 1946 onwards: during 1951 and 1952 children in private schools and grant-in-aid schools respectively were included in the scheme. The facilities offered were routine medical examinations at fixed intervals, the treatment of ailments, the correction of physical defects and specialist attention, including dental and ophthalmic treatment with the provision of spectacles at a subsidized price. The tremendous demand for voluntary participation however suddenly swamped the facilities available and in 1955 the scheme therefore had to be frozen, if staff and funds were not to be diverted to the grave detriment of the essential general curative services provided by Government.
239. During 1959 the total participants in the scheme dropped to 26,342 and there has been little more than the maintenance of routine activities as far as the personal services are concerned.
240. One event of considerable importance was the pre-fluoridation dental survey carried out on 10,000 school children during February and March 1960. Dental examinations were carried out on these children in the age groups of 6 to 8 and 9 to 11 in 46 different schools. Further reference is made to the School Dental Service in paragraphs 355 to 359.
56
No. of Sch.
Child.
rendered fir
TABLE 21
STATISTICAL SUMMARY OF DENTAL TREATMENT CARRIED OUT DURING 1958 & 1959 IN THE SCHOOL DENTAL SERVICE
No. of
No. of Sch.
School
Child, found
Type of Schools
Chuld.
Visits
dentally
examined
To require
Extractions Perm. Decid.
Other
Surricel
Operations
Fillings Perm. Decid.
Conservative Dressings Perm. Decid.
Prophy
Tactic
rrearment
2,244 9.407
6.237
434
1,051 169
1958
5,819
6.254
23,737
59
351
783
Government &
Total = 11,651
Toul☐ 6.671
Total = 1.220
Subsidized
Schools
1,958
8.596
11.089
907
1.531 235
1959
4.886
3,594
24,100
10
1,068
1.788
Toul = 10.554
Total
=
11.996
Tout = 1,766
103 1.778
1.630
955
15: 237
1958
Hennessy
· L
3,175
2.082
3.588
Ni
523
592
Road &
Total = 1,886
Total = 2.565
Total
388
Morrison
Hill Primary
84
1.590
1.393
990
223
315
Schools
1959
3.343
2,533
3.260
662
$54
Total
=
1,674
Total = 2.383
Total
543
304 1.389
4.510
328
412
95
1958
6.442
4,870
7.014
13
462
727
Toul =
1.691
Total = 4.838
Total =
= 527
Private &
Grani
Schools
534
1.076
4,233
351
387
44
1959
4,851
3,318
7.810
901
1.425
Total =
1.610
Total:
4.584
Total
= 431
2,656 12.574
12,357
1.717
1,634
501
1958
16,436
13,206
34.339
72
1.336
2.102
Total = 15,230
Total = 14.074
Total = 2,135
Totals
1959
13,080
9.445
35.170
2,576 11.262
Total = 13,838
16,715
2,248
2,146 594
18
2.631
3,767
Total = 18,963
Total = 2,730
57
241. Sanitary inspections and health education activities were maintained at the same level as the previous year. Table 21 sets out a comparative statement of the work done in 1958 and 1959 by the Dental Service.
242. It is of interest to record the improvement in heights and weights amongst school children in 1955 compared to those at school in pre-war years. These figures which have only recently come to light are illustrated in graphic form in Figures 4 and 5.
FIGURE 4
Average Height of Hong Kong Schoolchildren 1940 & 1955
FIGURE 5
Average Weight of Hong Kong
Schoolchildren 1940 & 1955
BQ - lb.
60- inches
50-
品
1955 Normal
1955 Nomıl
TO-
Pre-War 'Good Schools'
Pre-War 'Poor Schools'
Pre-War "Good Schools'
Pre-War 'Poor School'
60-
50
10
A
10
11
13
'Good Schools"
'Poor Schools'
Age 8
10
11
12
13
refer to nutritional status amongst fee paying pupils from higher income groups.
refer to nutritional status amongst pupils from the lower income groups who paid either nominal or no fees.
INDUSTRIAL HEALTH
243. The rapid expansion of industry in Hong Kong during the last ten years has created a number of new health problems. The health of workers in factories and in other industrial undertakings is the statutory responsibility of the Commissioner of Labour. In October, 1954, a start was made towards the organization of an Industrial Health
58
Section by the secondment of a specially-trained Medical Officer to the Labour Department. Since then, the Industrial Health Section has expanded and its work now covers most aspects of the problem in the Colony. Investigations are made into the working environments of the trades known to be hazardous to health, first aid facilities in factories have been developed and the medical supervision of workers in certain dangerous trades such as those dealing with lead or radio-active powders has been instituted, while two Health Visitors carry out individual case work on injured persons claiming compensation under the Workmen's Compensation Ordinance.
244. During the year, one more occupational disease came to light, namely "brassfounder's ague"; the disease is caused by exposure to zinc fumes and its effect, though unpleasant, is only temporary.
245. With the co-operation of private practitioners and Government Medical Officers, cases of silicosis and industrial dermatitis are notified to the Industrial Health Section, while surveys of the environmental working conditions in quarries and stone grinding factories continue and further X-ray surveys have been carried out on quarry workers. A clinical survey has also been conducted on all bitumen workers in one of the Government quarries; no sign of skin reactions to bitumen was observed.
246. The serious effects of over-exposure to certain insecticides have caused world wide concern; consequently workers in the Pest Control Unit of the Urban Services Department and officers of the Department of Agriculture, Fisheries, and Forestry working in close contact with these insecticides were medically examined and blood cholinesterase estimations were carried out. No evidence of any toxic effect was recorded.
247. Lectures are given on Industrial Health to probationer Labour Inspectors, Health Visitors, and Medical Students of the Hong Kong University. The Industrial Health Officer also took part in a course of Industrial Relations organized by the Labour Department, giving lectures on certain physiological and psychological aspects of indus- trialization.
HEALTH EDUCATION
248. A better appreciation by the Colony's population of the basic principles of hygiene and preventive medicine continues to be the main
59
health objective. A very wide field is covered by many branches of the Medical & Health Department while certain other departments are also concerned with various aspects of the subject in their respective spheres, Pooling of experience and co-ordination of effort are obvious necessities and so an Inter-departmental Committee on Health Education has been created. This committee, to which reference has previously been made in connexion with the anti-diphtheria campaign, consists of representa. tives from the Departments of Education. Labour, Urban Services, Information Services, and Resettlement, and from the Secretariat for Chinese Affairs and the District Administration, New Territories, under the chairmanship of the Assistant Director of Health Services.
249. All available methods are used in the various health education programmes undertaken by the Department with varying success. Pro- grammes based on methods designed for individual or group education have in general proved satisfactory, being used with success by the Maternal and Child Health Service, the Tuberculosis Service, the School Health Service and the Social Hygiene Service. On the other hand, mass campaigns directed towards widespread utilization of the facilities offered for prophylactic immunization against certain diseases are given a somewhat apathetic reception and have to be supplemented, as has been described in paragraph 96 on diphtheria, by various measures designed to make such prophylaxis available as close to the home as possible.
250. The co-operation of all voluntary bodies interested in health topics is actively encouraged, and during the year talks on such matters were given by members of the Department to Kaifong Associations. Welfare Societies, and similar organizations.
IV. THE WORK OF THE MEDICAL DIVISION
HOSPITALS
251. During the next five years the programme of hospital con- struction by Government, by the Tung Wah Hospitals Board of Directors, and by missionary bodies will result in seven new hospitals accommodating 3,872 beds. In addition, extensions to existing hospitals will add a further 318 beds to this total. The details in Table 22 give an indication of the phasing of this building programme which is estimated to cost $135,637,000 of which $124,537,000 will be from public funds.
60
New construction
Queen Elizabeth Hospital Kwong Wah Hospital Canossan Hospital
*Castle Peak Hospital Maryknoll Hospital Lutheran Hospital ... South Lantao Hospital
Extensions
Kowloon Hospital Pok Oi Hospital
+Queen Mary Hospital
• Mental Hospital.
TABLE 22
1960 1961
1962
1963
1964
1.320
1.230
203
1,000
50
52
17
냉장
68
50
↑ Approved in principle but construction not started.
200
252. To staff this number of beds over a period of five years is an undertaking of considerable magnitude and a programme for the training of doctors and nurses has been under way for some time. Trained nursing staff is likely to be the limiting factor and therefore priority in the construction of teaching and residential accommodation has been essential. A School of Nursing for the Tung Wah Group of Hospitals was opened in January 1960 and work on the Queen Elizabeth Hospital School of Nursing is well advanced. This latter School with residential accommodation for 562 sisters, staff nurses and student nurses will be opened in September 1960. At the Castle Peak Mental Hospital a course of training in Mental Nursing will start towards the end of 1960 but meantime there has been an intake of student mental nurses to the existing Victoria Mental Hospital, using the Queen Mary Hospital Preliminary Training School facilities for this part of the
course.
253. At the Kowloon Hospital a new block containing two operating suites each with two theatres and two surgical wards of 34 beds each will be put into use in April, 1960. The pressure on the Kowloon Hospital surgical beds has been such that the theatre facilities were totally inadequate to deal with the emergency surgery let alone other essential operative work. Therefore this new surgical block, which can be used for thoracic surgery when Kowloon Hospital becomes a tuber- culosis hospital, has been built to give some relief, pending the com- pletion of the Queen Elizabeth Hospital.
254. The pressure on the Maternity Wards has also been acute and a temporary ward of 36 beds was completed and opened in September, 1959.
61
255. Phase II of the re-development of the Kwong Wah Hospital was almost completed by the end of the year. This includes the School of Nursing and the East wing which will accommodate 437 beds. The Canossa Hospital of 203 beds, which will replace the original hospital of this name destroyed during the Occupation, will be opened in April 1960. Work on the site of the Maryknoll Hospital at Wong Tai Sin is now under way.
256. In the New Territories the Lutheran Hospital of 52 beds at Fanling, built from funds donated by the Jockey Club, was opened by H.E. the Governor in March 1960. A cottage hospital of 17 beds at Cheung Sha, South Lantau is nearing completion and will serve the Shek Pik Water Development Scheme staff as well as the local villagers. At Pok Oi Hospital work on an extension of 50 beds is now well under way.
257. At the end of March 1960 there were 31 civil hospitals in the Colony of which 12 are wholly maintained by Government; 10 are managed by voluntary or missionary bodies which receive recurrent subventions from public funds. There are 9 private hospitals and 5 nursing homes. Details of the accommodation provided are at Appendix 5. An analysis of the work done at the Government and Government assisted hospitals is at Appendices 8 & 9.
Queen Mary Hospital
258. This, the largest of the Government Hospitals, is an acute hospital and also the main specialist centre for the Colony. It is the teaching hospital for the Medical Faculty of the University of Hong Kong and the main Government centre for the training of nurses.
259. Of the hospital's 601 beds, 234 are allocated to the University Departments of Medicine, Surgery, Obstetrics and Gynaecology. The Professor and the staff of the respective Departments provide the clinical care of the patients admitted to these wards. Within the Department of Surgery is an Orthopaedic and Traumatic Surgical Unit, headed by the Senior Lecturer in Orthopaedic Surgery. As from April 1st 1959 the University Department of Pathology assumed complete responsibility for all clinical pathology in the hospital, except for chemical analyses which are still performed by the Government Chemist and for forensic pathology. There is also a combined University and Government Paedia- tric Unit of 29 beds headed by the Senior Lecturer in Pediatrics of the University Department of Medicine. The remaining 336 beds are allocated to the Government clinical units in general surgery, medicine,
62
radiology, thoracic surgery, neurosurgery, tuberculosis and otorhino- laryngology, each unit being headed by a Government Specialist; in addition a limited number of beds are available for ophthalmology, dermatology and midwifery.
260. The administration of the hospital is the responsibility of the Medical Superintendent, who is a Principal Medical Officer of the Department, and who is assisted by a lay Hospital Secretary. Radio- logical services, including radio-therapy, anaesthetic services, all nursing care. medical social work, physiotherapy, occupational therapy. pharmacy and hospital supplies are maintained by Government.
261. The Government Medical Unit conducts three specialist out- patient sessions each week at the Violet Peel Polyclinic and weekly specialist clinics at both Shau Kei Wan Dispensary and St. John Hos- pital on the island of Cheung Chau. Research into hypertension and renal disease, clinical trials of hypotensive drugs and studies of new investigatory techniques have been continued throughout the year. The treatment of the withdrawal symptoms in heroin addiction by using meprobamate only and electromyography in muscular and neuromus- cular diseases have been other clinical research activities.
262. In the field of thoracic surgery, the number of cases of broncho- genic carcinoma seen in the Government Thoracic Surgical Unit is increasing; in most of the patients the disease is far advanced and in only 18% was a successful resection possible. Cardiac surgery is at present limited to closed heart operations.
263. The resignation of the Neurosurgical Specialist in September. 1959, has restricted the scope of the Government Neurosurgical Unit temporarily to the treatment of traumatic neurosurgical cases only.
264. The staff of the Pediatric Unit conduct regular outpatient clinics at the Sai Ying Pun Outpatients Department and, in addition, hold three clinic sessions a week at Queen Mary Hospital, one for nephritic cases, one for haematological and cardiac cases and the third for the follow-up of cases presenting unusual clinical features.
265. The scope of the Government General Surgical Unit remains limited by the great pressure on beds and emergency surgery has per- force to take priority. Surgical clinics are held regularly each week at the Violet Peel Polyclinic by the Specialist and his staff but, owing to pressure of emergency work, waiting lists for elective surgery are increasing.
63
266. There is no outpatient department at the Queen Mary Hospital but the Casualty Department, which was opened late in 1956, is the only public casualty centre on Hong Kong Island with the requisite emer- gency specialist cover. The Casualty Department thus receives most of the traumatic, emergency and forensic cases arising in a densely populated area of over one million inhabitants.
267. Table 23 gives some indication of the increasing pressure on the facilities at the Queen Mary Hospital over the past ten years, the bed state during that time increasing from 576 beds in 1950 to 601 beds in 1959,
TABLE 23
Inpatients treated
Operations performed
First attendances at Casualty
1950 1955
9,819 12,516 14,439 14,620 4,663 6.895 7,230 7,212 (No record) 26,828 29,838
1958
1959
Kowloon Hospital
268. This is the main acute hospital for Kowloon and the New Territories and the Casualty Centre for that area. At the end of March 1960 there were 407 beds providing the general casualty and emergency cover for a population of approximately 1,700,000 persons. The hospital is staffed and maintained by Government and there are general medical, including paediatrics, general surgical, orthopaedic and traumatic, mid- wifery and gynaecology and anaesthetic units all headed by Specialists. The Hospital is also a training school for nurses and midwives.
269. The appointment of an Orthopaedic Specialist early in 1959 made it possible to establish a much needed Orthopaedic Traumatic Unit to deal with the greatly increased number of accidents brought to the Casualty Department. All fractures and injuries needing orthopaedic care, either on an in-patient or out-patient basis, are cared for by this Unit. The general surgical wards have at the same time been able to concentrate on the treatment of acute head injuries and of serious injuries to the soft tissues such as burns and ruptured viscera.
270. During the year a special investigation into the cases of trauma admitted to the wards revealed that the majority of accidents are caused by objects falling from a height-an interesting and not unexpected finding in a densely populated urban area becoming highly industrialized and with many multi-storey buildings. During 1958 and 1959 respectively 1,025 and 1,538 persons were injured in this way. Traffic accidents were next in frequency accounting for 964 casualties and 62 deaths during
64
1959. Then burns and scalds accounted for 392 admissions, the majority of whom were children residing in squatter settlements.
271. During the year the Orthopaedic traumatic unit admitted 1,483 patients and carried out 1,182 operations of which 1.035 were major operations.
272. An indication of the pressure on the Kowloon Hospital is given in an analysis below of the work carried out during the past 10 years. In 1950 there were 179 beds in the hospital; to-day there are 407. There were 4,559 general in-patients treated during 1950 and 13,242 during 1959. During that time the overall mortality rate has fallen from 8.7% in 1950 to 6.4% in 1959. This should be viewed in the light of the acute nature of the work undertaken and the very many seriously ill patients admitted. Table 24 indicates on a percentage basis the increase in the work carried out during the 10 year period.
TABLE 24
KOWLOON HOSPITAL 1950/59
1950 1951 1952 1953 1954 1955 1956 1957 1958 1959
Maternity Cases General In-patients
(excluding maternity)
Out-patients Attendances
(including casualty)
Operations
(excluding minor)
141
100
147 172 154 167 172 169 171
100
112 125
124
207 218
145 154 170 232 288
100
241 284
265 222 224 213 261 263 256
100
133 149 159 169 184 204 216 252 291
The returns for 1950 are taken as 100%.
273. A number of specialist sessions are held by the staff of Kowloon Hospital at the Out-patient department and at certain outlying clinics. Owing to the limitation of beds the medical and paediatric unit particularly has had to expand its activities mainly in the realm of out- patient care. During the year specialist clinic sessions were started at Shek Kip Mei, Tsuen Wan, Tai Po and Tai O.
274. The large general out-patient department adjacent to the Kowloon Hospital which includes the hospital casualty department dealt with 532,492 out-patient attendances during the year. The Casualty Department attended to an average of 196 emergency and accident cases every 24 hours throughout the year,
Lai Chi Kok Hospital
275. This hospital, built on two levels, is accommodated in buildings which were formerly a prison camp and it performs three functions; it accommodates all cases of infectious disease requiring admission to
65
hospital which occur on the mainland part of the Colony; it serves as a convalescent unit for Queen Mary and Kowloon Hospitals; and it accommodates a number of tuberculosis patients. The expansion of Kowloon, the increasing pressure on the two main acute hospitals, and the re-arrangement of the facilities for the hospital treatment of tuber- culosis can be seen from the changing number of beds allocated to each of these units shown in Table 25.
TABLE 25
BED ALLOCATIONS IN LAI CHI KOK HOSPITAL
Infectious Diseases Convalescent Cases Tuberculosis
10
Total
1950/59
1950
1955
1959
88
94
120
180
180
267
202
208
88
470
482
475
276. The unusually heavy incidence of diphtheria in the latter part of the year threw a great strain on the infectious diseases unit, and in December 144 beds were re-allocated to deal with the number of cases of diphtheria requiring admission; by the end of March, 1960, 57 of these beds had been returned to the tuberculosis unit.
277. The case mortality rate of 6.6% for diphtheria was the lowest ever recorded, the cause of death being either overwhelming toxaemia or 'late' bronchopneumonia not responding to the 'various antibiotics administered. A few reactions to antitoxin occurred and these responded well to adrenaline and antihistamine drugs. Over 90% of the children admitted with diphtheria had received no immunization, and of the remainder most had only received one injection of toxoid.
278. During the summer months there was, as is usual, a marked increase in the number of typhoid cases admitted. Only one death occurred, underlining the dramatic change which has taken place during the last ten years in the prognosis of this disease resulting from the introduction of chloramphenicol for routine treatment.
279. Bronchopneumonia accounted for a case mortality rate of 34.3% amongst children admitted with measles; many such patients are in extremis when they arrive and, while some respond well to antibiotics, others are too ill for treatment to have any effect. Tetanus showed a 48.8% case mortality; this high figure was due to the high proportion of tetanus neonatorum. Other infectious diseases seen were
66
tuberculosis meningitis, amoebic and bacillary dysenteries, encephalitis, and poliomyelitis.
280. For the convalescent and tuberculosis patients both physio- therapy and occupational therapy are provided on a full-time basis, while the Hong Kong Branch of the British Red Cross maintains a school for long-term child patients.
281. Owing to the increasing pressure on beds in Kowloon Hospital. the convalescent unit is having to admit more and more acute con- ditions, such as threatened abortions and appendicular abscesses not in need of immediate surgical treatment and the term 'convalescent unit' is now to a great extent a misnomer.
Tsan Yuk Maternity Hospital
282. This is the main obstetric hospital in the Colony. Built and equipped from funds donated by the Hong Kong Jockey Club, this modern institution of 200 beds was opened in 1955, replacing the Old Tsan Yuk Hospital of 85 beds. It is maintained by Government, which also provides the Medical Superintendent, resident house officers and nursing and administrative staff. Clinical work in the wards is the responsibility of the Professor of Obstetrics and Gynaecology in the University of Hong Kong assisted by members of the University Unit and some Government Medical Officers. All tuition of medical students in obstetrics is conducted here, and Tsan Yuk is also the Colony's main training centre for midwives undertaking the two year course conducted in Cantonese; refresher courses are also held from time to time for the benefit of practising midwives.
283. Ante-natal, post-natal and infant welfare clinics are held re- gularly. In addition, there is a special clinic for medical conditions complicating pregnancy, a social hygiene clinic for venereal diseases, and a Family Planning Clinic staffed and run by the Family Planning Association of Hong Kong. All three of these clinics are held once or twice each week.
284. Owing to the demand for institutional midwifery, it has become necessary to limit routine admissions to cases registered in the ante- natal clinics and these formed 95.5% of the 8,196 admissions during 1959. These in turn were restricted as far as possible to primipara, to women with a previous history of abnormal pregnancy or labour, to
67
'grand' multigravidae or to referred cases requiring specialist care. Cases not falling into these categories were referred to maternity homes or hospitals dealing with normal cases. The 'non-booked' cases admitted were suffering from complications of pregnancy or of labour and were referred by practising midwives, private practitioners, the Tung Wah group of hospitals and the Government midwifery service.
285. With the great rise in the number of births in the Colony during the last ten years and the greatly improved facilities in this specialized hospital, the proportion of operative deliveries has shown a marked increase. As can be seen from Table 26 this has resulted in a lowering of the still-birth and neo-natal mortality rates; the rise in the maternal mortality rate during 1959 does not reflect increased post- operative risks as five of the six deaths recorded were due to medical conditions complicating pregnancy.
TABLE 26
WORK OF THE TSAN YUK HOSPITAL 1950/59
Hospital beds
1950
1959
85
200
Total number of admissions
5,380
8.196
Total number of deliveries
5,085
7,440
Still-birth rate (per 1.000 total births)
23.20
13.97
G
Neo-natal mortality rate (per 1,000 live births) Maternal mortality rate (per 1,000 total births) Percentage operative deliveries
17.31
14.31
0.39
0.80
2.73
14.12
286. In addition to a hospital laboratory for routine clinical patho- logy investigations, there is a research laboratory which is staffed by members of the University of Hong Kong. Projects undertaken by the latter during the year were studies of blood groups in multiple preg- nancies, serological factors in cases of still-birth and hydrops foetalis. haematological values in primipara and multipara, and serum protein changes in pregnancy.
Mental Hospital
287. During February 1960 a further block containing 120 beds was completed at the new Castle Peak Hospital with the result that, at the end of March 1960, 230 patients were accommodated at Castle Peak. This new hospital of 1,000 beds is expected to be ready by the end of 1960.
288. In the meantime the Victoria Mental Hospital continued to be housed in two old and unsuitable buildings situated in a congested
68
part of the City. Originally designed to accommodate 140 patients, this institution housed during 1959 a daily average of 428.7 patients, as opposed to 156.4 in 1950. There was also an average of 266.3 patients a day on parole. Due to this great pressure on space, arrangements had to be made during the year to increase the accommodation. These arrangements consisted of temporary extensions to the Male Block, the erection of temporary buildings in the grounds, the enclosure of verandahs and an enlargement of the hospital kitchen.
289. Despite such unfavourable conditions the most modern methods of diagnosis and treatment are available to both in-patients and out-patients. During 1959, a standard electroencephalograph machine was installed, regular anaesthetic assistance became available. for the introduction of scoline-pentothal E.C.T., and weekly group psychotherapy sessions were commenced. All
commenced. All orthodox physical methods of treatment were employed including leucotomy. Later in the year difficulty was encountered due to the loss of the services of a neuro-surgeon, a loss which also affected the diagnosis of obscure. organic cases.
290. Chlorpromazine is still used to a great extent but several other tranquillizers have been used on a trial basis. Towards the end of the year a supply of the monoamine-oxidase inhibitors became available and were employed in the treatment of depressive states. Owing to pressure on facilities for treatment, no controlled therapeutic trials of the various drugs in use were possible.
291. Important expansion in the work of the Mental Health Service took place during the year. This was reflected not only in the recruit- ment of younger doctors interested in psychiatry. but also in the intensification of both undergraduate and post-graduate training, including monthly clinical meetings which attracted interest from members of the profession outside the Department. From the legal aspect, important innovations were the posting of a psychiatrist to the Prisons Department, assistance in the detailed planning of a 'Prisons Department Mental Hospital' and advice on the preparation of a draft Mental Health Ordinance.
292. The impending transfer to Castle Peak Hospital will end an era. It seems appropriate, therefore, to review the advances made over the past decade. The increase in in-patient treatment has already received comment, but the added burden imposed by rapid expansion
69
of outpatient treatment can be visualized from the following figures of out-patient attendances:
1950
1955
1959
New cases
583
752
Old cases
306
1,081
5,205
Attendances of discharged in-patients
723
449
Total
306
2.387
6.406
293. It is, however, in the administrative aspects of psychiatric treatment that the main advances have been made. Voluntary treatment became legal during 1950, and the number of patients taking advantage of this has risen from 8 in that year to 1,343 during 1959. Treatment on an informal day basis was introduced in 1953, but the number of patients so treated has remained small due to limited accommodation and to the inability of many cases to make the daily journey to and from the hospital. Since 1956 a liberal policy with regard to patients' visitors has been in force; visiting times have been more flexible; children have been allowed to enter wards; and, on occasions, relatives or friends have been able to stay overnight with patients. Finally, during 1959. certain of the temporary wards have been run as 'open wards'. while the chronic wards in Castle Peak Hospital were also conducted in a liberal fashion with patients taking part in field trips and visits of interest. Unfortunately, a true trial of the 'open ward' system cannot be attempted due to the presence of a certain number of criminal lunatics who cannot be accommodated elsewhere until a Prison Mental Hospital is available.
Sai Ying Pun Hospital
294. This hospital on Hong Kong Island, with a nominal capacity of 88 beds, is used entirely for the treatment of cases of infectious diseases. There is a wide seasonal fluctuation in the demands on the accommodation and as many as 163 in-patients may be in hospital at peak periods.
295. During the year there were 563 admissions for diphtheria with 28 deaths, 179 cases of typhoid with 1 death and 167 cases of bacillary dysentry. Cases of infective hepatitis, scarlet fever and streptococcal infections of the throat are becoming more and more common, as is rheumatic fever. Altogether there were 1,548 admissions during 1959 compared to 1,617 the previous year.
70
296. The level of morbidity of infectious diseases treated in Sai Ying Pun has not altered materially during the past decade. Mortality rates, however, have declined markedly.
TABLE 27
CASE MORTALITY RATES 1950/59
1950
1959
25.1%
4.9%
10.0%
0.5%
100.0%
52.9%
12.1%
Nil
92.0%
44.0%
...
Diphtheria Typhoid Fever
Tetanus neonatorum
Whooping cough
Tuberculosis meningitis.
(Mortality expressed in percentage of cases admitted).
These improvements are attributed to the use of modern chemothera- peutic and antibiotic agents in addition to the more widespread use of immunizing agents, even though the latter have not been given according to the recommended schedules, due to lack of parental co- operation. On the other hand there has been a considerable emergence of strains of pathogens resistant to the suphonamides and the commoner antibiotics. For example there is an increasing number of cases of staphylococcal gastro-enteritis. In addition to numerous cases of sulphonamide resistant bacillary dysentry, there were thirty cases of chloramphenicol resistance and three cases of terramycin resistance. Nevertheless the reduction in mortality rates in the major infectious diseases has been encouraging,
297. The Medical Officer in charge of the Infectious Diseases Hospital assists with the training of medical students and is part-time lecturer in infectious diseases at the University. He is also responsible for the general supervision of the out-patient work at the associated Sai Ying Pun Out-Patients Department, now temporarily accommodated at the old Tsan Yuk Hospital. This is one of the busiest institutions in the Colony and there were 241,091 out-patient attendances in 1959 compared to 232,760 in 1958. This is the out-patient teaching centre for medical students and the University clinical units in the Queen Mary Hospital hold regular out-patient sessions here.
298. The new Sai Ying Pun Polyclinic built with funds donated by the Jockey Club is now nearing completion and will be opened in July 1960. This nine-storey building will give enhanced and up-to-date facilities serving the very densely populated western district of the Island and will include a major full-time chest clinic.
71
St. John Hospital
299. This hospital, situated on the island of Cheung Chau, is the property of the St. John Ambulance Association and Brigade, but since the war, by agreement, it has been staffed and maintained by Govern- ment. It not only offers in-patient and out-patient facilities to Cheung Chau's population but also serves as a base hospital for the floating clinic covering the Colony's south western waters and a convenient centre for various specialist clinics-medical, tuberculosis, ophthalmic, social hygiene, maternal and child health and dental. Patients requiring major surgical procedures or other specialist in-patient treatment are transferred to the appropriate hospitals on Hong Kong Island. In addition to the general facilities, there is a 42-bed unit for the accom- modation of patients convalescing from pulmonary tuberculosis.
300. There were 2,085 in-patients treated during the year of whom 87 were transferred to hospitals in Hong Kong. There were 59,628 out- patient first attendances. The comparative figures for 1958 inpatients and outpatients were 2,212 and 56,870 respectively.
Prison Hospitals
301. Hospitals are maintained at the Stanley Male Prison, the Victoria Remand Prison, the Lai Chi Kok Female Prison, and the Tai Lam Centre for the treatment and rehabilitation of drug addicts.
302. At Stanley Prison there is a hospital of 82 beds for the accom- modation of prisoners who require treatment for conditions that do not warrant transfer to another hospital. The bulk of the cases treated are suffering from the effects of drug addiction, from various minor psychiatric disturbances and from tuberculosis.
303. An important step in the development of psychiatric services was the secondment to the Prisons Department of a Psychiatrist, in November, 1959. This Psychiatrist attends to remand prisoners awaiting trial in the Victoria Remand Prison and pays regular visits to the Stanley Prison and the various Training Centres to advise on the numerous psychiatric and personality problems encountered amongst prisoners, particularly in relation to drug addiction.
304. At the Remand Prison in Victoria there is a small ward of eight beds for the treatment of acute illness. The duration of stay in the Remand Prison is necessarily short but there are a number of cases of acute illness, particularly amongst drug addicts suffering from withdrawal symptoms, which have to be treated in this ward.
72
305. The effects of drug addiction amongst convicted prisoners is a major problem in H.M. Prisons and medical treatment during the period of withdrawal is followed by rehabilitation through routine occupation in prison workshops. The specialized prison for the treat- ment and rehabilitation of convicted male drug addicts maintained at Tai Lam Chung has given encouraging immediate results and it is striking to see the physical and psychological improvement which takes place within a relatively short period of weeks. However it is too early yet to gain any assessment of the relapse rate after discharge.
306. The female prison at Lai Chi Kok maintains a small hospital of ten beds under the supervision of the Medical Officer in charge of the Lai Chi Kok Hospital. Any cases of major illness are transferred to the custodial ward in the Kowloon Hospital.
Wan Chai Social Hygiene Hospital
307. This small 30-bed hospital was originally intended for the in- patient treatment of venereal disease amongst women and children. However, modern methods of treatment have reduced the importance of this aspect of the work and the tendency is for this institution to become a centre for the treatment of patients with acute skin disease who are now being admitted more and more frequently.
308. There is a busy out-patient department for the treatment of women suffering from venereal disease and a large number of exam- inations of known contacts are carried out every year.
GOVERNMENT ASSISTED HOSPITALS
The Alice Ho Miu Ling Nethersole Hospital
309. This hospital, operated by the London Missionary Society, offers general medical, surgical and maternity care. There are 287 beds including a modern maternity section of 80 beds. There is also a large out-patient department. The hospital caters for all classes of patients but the major part of the work is amongst the poor. This valuable contribution towards the Colony's medical services is supported by a substantial annual subvention from Government funds. In spite of staffing difficulties encountered during the year, 6,941 in-patients were treated and there were 63,785 out-patient attendances.
Tung Wah Group of Hospitals
310. Established 90 years ago, the Tung Wah is a charitable organization providing medical care, primary school education and
73
various welfare services for the poor. It is managed by a Board of Directors who are elected annually and who raise large sums of money for charitable purposes. A considerable proportion of the money raised is devoted to the maintenance of the three hospitals controlled by the group, namely the Tung Wah and the Tung Wah Eastern Hospitals situated on Hong Kong Island, and the Kwong Wah Hospital in Kowloon. The remainder of the expenses incurred by these hospitals are met by a large annual subvention from Government.
311. The work of the hospitals is subject to the general direction of the Tung Wah Hospitals' Medical Committee, which under the Chair- manship of the Director of Medical and Health Services, consists of the Chairman and Principal Directors of the Tung Wah, two members of the Tung Wah Hospital Advisory Board, the Medical Superintendents of the three Hospitals and the Deputy Financial Secretary (Finance). The Medical Superintendents are Government Medical Officers on secondment.
312. All three hospitals maintain large and very busy out-patient departments, but do not normally accept casualties. The general medical and surgical wards provide, in addition to care and treatment of many acute cases, much needed accommodation for those suffering from chronic illnesses requiring prolonged hospitalization. Two infirmaries are maintained for the care of persons suffering from incurable diseases.
313. Consultant services are provided, mainly by specialists in private practice whose services are given voluntarily; certain Govern- ment Specialists also act as consultants to hospitals within the Tung Wah Group.
314. The important part that the Tung Wah Hospitals play in the medical services of the Colony can be seen from the following table:
TABLE 28
WORK OF THE TUNG WAH GROUP OF HOSPITALS, 1959
Beds
Total in-patients
Total out-patient
admitted
attendances
Kwong Wah
659
42,380
285,773
Tung Wah
652
13,139
113,535
Tung Wah Eastern
336
8,245
170,527
Total
1,647
63,764
569,835
74
315. The maternity wards of these three hospitals which give a free service are the busiest in the Colony. Approximately one third of all births registered take place in these wards. At the Kwong Wah Hospital 22,698 births took place during 1959, an average of 58 births each day.
316. At the end of the year. Phase II of the Kwong Wah Hospital Re-development Scheme was nearing completion. The Nurses' Training School was opened by the Director of Medical and Health Services in January, 1960, while the opening ceremony for the Nurses' Quarters was performed at the end of March, 1960, by the Secretary for Chinese Affairs.
Pok Oi Hospital
317. This hospital, situated near Yuen Long in the New Territories, is a charitable institution of 50 beds. It is maintained by a Board of Directors and is largely supported by charitable donations augmented by an annual Government subvention. Originally, hospital treatment was mainly by traditional Chinese herbal medicines, but these have now been largely replaced by Western medicines.
318. An extension to the hospital, expected to be completed by July, 1960, will increase the number of beds to 100. The cost of this extension has been met partly by subscriptions from the public and the Directors and partly by a capital grant from Government.
319. During 1959, a number of administrative changes were made. The general administration of the hospital is now under an Executive Committee comprising 6 representatives of the Board of Directors and 6 representatives of Government. At the same time, a Government Medical Officer has been seconded to the hospital to act as Medical Superintendent; this officer is responsible for the day-to-day running of the hospital and also acts as a liaison between unofficial and official members of the Executive Committee.
Hei Ling Chau Leprosarium.
320. Maintained by the Mission to Lepers Hong Kong Auxiliary with the aid of a substantial recurrent subvention from Government, the Leprosarium is situated on the island of Hei Ling Chau which lies off the east coast of Lantau Island. It provides hostel accommodation for up to 540 leprosy patients and there are 50 beds for medical and surgical care in the Maxwell Memorial Hospitals; there are also 15 beds for leprosy patients with tuberculosis.
75
321. The average number of patients in residence throughout the year was 531. There were 138 admissions, and 119 patients discharged of whom 87 were in possession of 'negative' certificates; there were 2 deaths.
322. All patients receive regular and controlled treatment, the majority receiving D.D.S. in its various forms. An increasing number are being given thiambutosine by mouth and a small group was put on ditophal by inunction.
323. Much work has been done on the prevention of damage to anaesthetic hands and feet and the importance of this aspect is con- tinually emphasized to the patients so afflicted. In the surgical wards reconstructive surgery was carried out on a number of patients and 189 operations were performed for this purpose.
324. The detailed radiological study of the hands and feet of all patients was continued and a flouroscopy survey was done of all patients and staff. The laboratory undertakes regular skin smears and other routine investigations while a start was made on the taking, preparation and examination of skin biopsies from all patients.
325. All patients on the Island are expected to work in accordance with physical ability and previous occupation. Even the severely disabled and bedridden are encouraged to do basket work and embroidery. Patient-farmers supplied most of the vegetables consumed and pigs, rabbits and poultry are raised. Cattle breeding was discontinued on the advice of the Government Veterinary Department. Patients also carried out routine maintenance work and hospital and domestic duties.
326. A new activity was the planting, by the Forestry Department, of 10 acres of pine seedlings as a prelude to future afforestation to be carried out by patients. A start was made on the raising of seedlings on the island and a small area was planted by the patients.
327. There is a primary school for child patients, the staff of which hold evening classes for adults. An average of 27 children attended the school and 137 adults attended evening classes,
328. Trade training is carried out in workshops and the scope of training will be extended to tailoring and embroidery when a new work- shop, now under construction, is ready. The new building is being built from funds donated by the Marianne Reichl Aid to Lepers Group and it will also contain a clothing store and laundry.
329. Church activities and religious services for both Protestants and Catholics were continued and a new Church is being planned. Social
76
activities continued as in a normal community with games, a Drama group, a fortnightly film show and Boy Scouts and Girl Guides troops.
330. There is a close liaison with the Government Social Hygiene Service which undertakes the out-patient treatment of leprosy in Hong Kong, Kowloon and the New Territories. The majority of admissions to Hei Ling Chau are arranged in co-operation with this Service which also carried out the medical follow-up of discharged patients. There is also a close liaison between the Island Welfare Officer and the Government Social Welfare and Resettlement Departments.
Tuberculosis Hospitals
331. Reference has already been made in paragraphs 151 to 158 and 160 to 162 of the work carried out by the Grantham Hospital, the Ruttonjee Sanatorium, the Haven of Hope Sanatorium and the Sandy Bay Convalescent Home.
OUT-PATIENT SERVICES
332. In addition to the large increase in the size of the population during the past ten years there has been a considerable expansion in the demand for treatment by Western medicines. This has necessitated a rapid expansion of out-patient facilities at hospitals, clinics, health centres and public dispensaries throughout the Colony. The impact on the Government services alone is shown in Table 29 below and this does not take into account the work done by Government-assisted institutions or the service provided from numerous charity or low cost clinics maintained by a variety of welfare and other organizations.
TABLE 29
GOVERNMENT OUT-PATIENT SERVICES 1950/59
1950
1955
1959
Number of out-patient centres (including
Hospital O.P. Departments)
36
New out-patient attendances
852,328
Total out-patient attendances
1,538,268
46
70 1,604,856 1,732,832 2,869.045 5,107,644
333. During the year regular specialist out-patient sessions were maintained at a number of centres by the tuberculosis, social hygiene, surgical, ophthalmic, maternal and child health, and ear, nose and throat services. In addition, consultant sessions in general medicine have been started at seven centres in the urban and rural areas.
77
334. Evening sessions are held at seven of the larger clinics in the more densely populated areas. Lasting from 6 p.m. until midnight, they have proved to be very popular, providing as they do a service to the public outside the normal working hours.
335. During June 1959 it was possible to start clinic sessions on Sundays and public holidays at four centres in the urban area, two on each side of the harbour. These are designed to cater for patients. requiring emergency or urgent attention and have been made possible. by a re-arrangement of working hours during the week which will release staff for these emergency sessions. There has been an average attendance of 243 persons during each of these holiday sessions since this additional service was inaugurated.
336. In the rural mainland and island areas of the New Territories there are fourteen centres at which out-patient treatment is given; at seven of these one or more doctors are stationed permanently. There are two travelling dispensaries operating from Tai Po and Yuen Long respectively which visit a number of subsidiary centres on the mainland. The remoter villages on the Islands and certain points on the mainland are now served by two launches the M.Vs. 'Chee Hong' and 'Chee Wan'. These are fitted out as "floating clinics' and have a doctor, nurse and inoculator on the staff of each vessel. The M.V, 'Chee Wan', which is a twin screw launch, was donated by The Jockey Club and put into commission in October, 1959. Thus both the eastern and western sea- boards of the New Territories now have a 'floating clinic' service.
337. During June 1959 a medical officer was posted to the Shek Pik Reservoir Scheme on Lantau Island where a First Aid post is maintained and a general out-patient service will be available shortly at the South Lantau Hospital. Regular daily visits are paid to the maternity home at Mui Wo in Silvermine Bay when there are also out- patient facilities.
338. At appendices 10, 11, 12 and 13 are details of the work done during 1959 at the out-patient departments of Government and Govern- ment-assisted institutions throughout Hong Kong.
SPECIALIST SERVICES
339. There are Government Specialist Clinical Units of medicine, surgery, obstetrics & gynaecology, anaesthesiology, dentistry, neuro- surgery, ophthalmology, orthopaedic surgery, otorhino laryngology. pathology, psychiatry, radiotherapy, radiodiagnosis, social hygiene,
78
thoracic surgery and tuberculosis. In addition the Professors and certain Senior Lecturers of the University Faculty of Medicine act as con- sultants in medicine, surgery, obstetrics and gynaecology, orthopaedics, pathology and pediatrics. Certain of the Government Specialists act as Honorary Consultants to the Tung Wah Group of Hospitals in surgery, radiology, obstetrics and otorhinolaryngology, Part-time specialist services are also given to the Grantham Hospital by the Senior Tuberculosis Specialist, the Thoracic Surgeon and the Orthopaedic Surgeon.
RADIOLOGY
340. The Radiological Service, under the direction of the Senior Radiological Specialist, serves all Government medical and health institutions, reports on X-ray films taken at the hospitals of the Tung Wah Group and offers consultation facilities in all aspects of radiology for other institutions and, when requested, for private medical practi- tioners; it is also responsible for the teaching of medical radiology at the Hong Kong University. The service consists of 3 main branches, namely Radiodiagnosis, Radiotherapy and Medical Physics; the first two are headed by specialists and the third by an experienced Senior Physicist. Other activities include training for the Diploma of Medicinal Radiology (Diagnostic) & (Therapy) and the Membership of the Society of Radiographers. There is also a Clinical Photography unit.
Radio-diagnosis
341. This branch, which has its headquarters at the Queen Mary Hospital, provides a diagnostic service in nine institutions and clinics in Hong Kong and Kowloon; in addition it now operates two Mobile Mass Radiography Units, the second of which was put into service in August, 1959. All aspects of radiodiagnostic work required by the Department are covered, including the radiological work for the tuber- culosis service. In addition it undertakes the routine X-ray work for the Medical Examination Board and the annual X-ray survey of all Government employees.
342. During the year 339.269 X-ray examinations were made on 190,719 patients. The total of examinations increased by 49,944 over the 1958 figure. The three image intensifiers installed during the previous year have been of great benefit in cutting down exposure to radiation without any loss in diagnostic detail.
79
Radiotherapy
343. This section is at present entirely based in the Queen Mary Hospital but serves patients from throughout the Colony. Whereas 10 years ago it had only one deep X-ray machine, five obsolete radium needles, and a small amount of radiocobalt, there are now two deep X-ray machines, a 60-curie telecobalt service, a contact X-ray therapy machine, a large stock of radium needles and tubes, radio cobalt tubes, two implantation guns for radiogold grain implantation and other facilities for the use of radio-isotopes in the diagnosis and treatment of disease.
344. During 1950, only 31 malignant and 48 benign conditions were treated. In 1959 treatment was given to 1,113 patients of whom 901 were new cases; 893 cases of cancer were treated of whom 684 were new cases. There were 348 cases of nasopharyngeal carcinoma, 152 cases of cancer of the cervix and 134 cases of cancer of the breast. There were 220 benign conditions treated of which 180 were skin conditions. Radio-iodine tracer studies were carried out on 23 patients.
345. Because of the shortage of beds the majority of these cancer patients were treated as outpatients. There was a total of 11,865 attendances of which 852 attended the clinic for gynaecological condi- tions conducted by a team of Government radiotherapists and University gynaecologists.
Medical Physics
346. Established in 1956, this is now an essential branch of the Radiological Service. It assists in the physical aspect of planning radiation treatment, operates a radio protection service, assists in the development of new or improved radiological techniques, undertakes the teaching of radiological physics, calibrates the various irradiating machines at regular intervals, prepares radium or radiocobalt sources for application and maintains a workshop.
347. During the year the physicists took part in 975 X-ray or telecobalt plannings, made 198 plaster casts with wax seatings for the positioning of beam applicators and 88 plaster strip casts. In addition to maintaining full records of monitoring carried out in conjunction with the radio protection service, the branch gave advice to both Government and non-Government organizations on problems related to radiation hazards and protection.
348. Two important researches were conducted into the determina- tion by actual measurement of the radiation doses received by the lenses
80
of the eyes and the nasopharynx during a radical course of deep therapy.
349. Much work was done by the workshop in the maintenance and repair of radiological equipment, the assembly and installation of new equipment, the production of spare parts and of gadgets required for the development of new techniques. This has resulted not only in more efficient work but has effected considerable economies in operating
costs.
OPHTHALMOLOGY
350. There are two full-time major ophthalmic centres one at Arran Street in Kowloon and the other at the Violet Peel Polyclinic on Hong Kong Island. From these centres, ophthalmic teams hold 75 out-patient sessions each month at 14 part-time centres situated throughout Hong Kong, Kowloon and the New Territories. There are three 'sight saving' refraction centres and an optical workshop for participants in the School Health Service. Eleven Ophthalmic beds are available in Government Hospitals for the treatment of out-patients. An extension to the Service during the year is the British Red Cross Society Mobile Ophthalmic Unit, based at Arran Street, which pays a regular schedule of visits to centres in the New Territories. Donated to the Hong Kong Branch of the Red Cross Society by Mr. TANG Shiu-kin, C.B.E., it is maintained by the Branch, the professional staff of the Unit being provided by the Ophthalmic Service. It has been in operation since June 1959.
351. There were altogether 161,302 out-patient attendances of which 73,846 were new cases. This constitutes an increase of 26% above the 1958 figures. The optical workshop issued 2.702 new pairs of spectacles and replaced lenses in a further 425 instances. Treatment was given to 440 in-patients and 4,787 operations performed of which 1.424 were classified as major operations. The major part of the operative work is carried out in the theatres of the ophthalmic clinics and, with the services of two Health Visitors and two Almoners available, the risk of post-operative complications is little different between in-patient and out-patient surgery.
352. The Health Visitors paid 2.562 home visits and gave 4,389 health talks to new patients. The Almoners interviewed 20,868 persons and compiled 2,770 detailed case records; 480 patients who sustained industrial eye injuries were referred to the Labour Department and 435 new cases of blindness were referred to the Social Welfare Department for registration and rehabilitation.
81
DENTAL SERVICE
353. The Senior Dental Specialist, assisted by one Dental Specialist and 27 Dental Officers, maintains a general dental service for the Civil Service and a School Dental Service. In addition emergency treatment is given in Government hospitals, in Her Majesty's Prisons and at certain Government Outpatient clinics.
354. The general dental service offers treatment to all monthly paid Government officers and their families, with whom Government has a contractual obligation to provide such facilities. Emergency services for the general public, mainly extractions for the relief of pain, are held twice weekly at the Sai Ying Pun Hospital on Hong Kong Island and the Li Kee Memorial Dispensary in Kowloon, fortnightly at Tai Po and Yuen Long, and monthly at Cheung Chau and Tai Q.
355. The six School Dental Clinics are maintained for participants in the School Health Service and, although a larger number of fillings was possible during the year, extractions continued to be necessary in many cases-an indication of the extent of the problem of dental caries in Hong Kong. In this connexion a Colony-wide dental survey was carried out during March 1960, prior to the start of fluoridation of the domestic water supplies in Hong Kong. A preliminary assessment of the results of the survey, in which more than 8,000 school children aged between 6 and 11 were examined, indicates that less than one per cent within this age group are free from some degree of dental caries.
356. During the year two small additional Dental Clinics were opened, one static clinic for the general service at Farm Road, Kowloon and one Mobile Dental Unit. The latter was designed and built locally to provide full dental services for Government personnel in the New Territories, who are living considerable distances away from static clinic facilities; it also visits schools in the New Territories to under- take dental examinations and treatment for participants in the School Health Service. The Mobile Unit also provides a limited service for prisoners and certain other patients in the rural areas.
357. The work done during the year is detailed in the following table:
TABLE 30
Government Servants
Inspections prior to treatment Attended for the first time
Total visits by Government servants Total visits by dependants
Completed treatment and dentally fit
82
1958
1959
7,164
7,544
2.390
2,850
23,256
27,026
...
24,162
27,615
5,653
6,945
358. The delays in starting routine inspections and treatment for those on waiting lists who are not suffering from emergency conditions was reduced from an average of 11 weeks in 1958 to 84 weeks in 1959. There is still a considerable delay of six months or more in supplying prosthetic appliances, again excluding emergencies. However the ap pointment for the first time of an experienced and fully qualified Dental Technologist has enabled a re-organization of this aspect of the service to be started and systematic training of technicians has begun. Plans for a course of training of Dental Technicians at the Technical College have advanced to the stage where it is probable that the first intake of students will occur in September 1960.
359. In the School Dental Service the number of participating children again fell from 28,094 in 1958 to 26.123 in 1959; the ratio of fillings to extractions rose from 92:100 to 137:100. However the number of teeth which had to be extracted because they could not be saved is still very high, 2,576 permanent and 11.262 deciduous teeth being extracted.
Dental Services provided by Welfare & Missionary organizations
360. Welfare organizations maintain a number of dental clinics either for their own members or for the poor in their respective districts. The Hong Kong Dental Society continues to staff four free evening clinics each week, three in Kowloon and one in Hong Kong together with a fortnightly clinic at the Ruttonjee Sanatorium. The St. John Ambulance Brigade sends a Penetration Squad, which includes a dentist, each Sunday to the more remote areas of the New Territories where free treatment is given to those in need. A mobile dental unit built and operated by the Church World Service began operations in the New Territories during June 1959, where it provides emergency and routine dental treatment for poor people at low cost.
Control of Dental Practice
361. Two Dental Inspectors were employed throughout the year in connexion with the supervision and control of private dental practice. Premises used or proposed to be used by private dental practitioners were inspected regularly. There were four prosecutions for alleged dental practice by unregistered persons and three individuals were convicted of this offence.
83
GOVERNMENT INSTITUTE OF PATHOLOGY
362. The Institute has occupied premises in Caine Lane on Hong Kong Island since its foundation in 1905. It is the headquarters of the Government clinical pathology and public health laboratory service with branches in the Kowloon, Tsan Yuk, Lai Chi Kok and Sai Ying Pun Hospitals. In addition, vaccine production, supervision of the Blood Banks, and the management of the two public mortuaries are undertaken. by the staff of the Institute.
L
363. As from the first of April 1959, the University Department of Pathology at the Queen Mary Hospital has carried out all the routine clinical pathology, excluding medico-legal work and blood chemistry analyses, for this Hospital. In co-operation with the University a small polio-virus unit has also been established in the University Pathology Department, which is designed for investigation of the enteric viruses in Hong Kong and the laboratory control of the use of oral poliomyelitis vaccine should the need arise. The medical and technician staff are provided by Government and other staff by the University.
364. The new premises for the Institute in the Sai Ying Pun Poly- clinic are now almost ready and will be occupied in July 1960. Vaccine production will however have to be continued at Caine Lane until the Vaccine Institute, to be built in the New Territories, is ready.
365. During the year 471,573 specimens were dealt with as compared to 439,042 during 1958. This increase is again considerable, particularly since the major part of the Queen Mary Hospital clinical pathology has been undertaken by the University. There was a marked rise in the number of samples of water, milk, ice cream and food products, and in the sensitivity tests on M. tuberculosis. The results of the latter are set out in table 31 below.
TABLE 31
SENSITIVITY TESTS FOR MYCO. TUBERCULOSIS
Strongly resistant
Resistant
L
r..
Doubtfully resistant
Sensitive
Streptomycin 502 24.4. 557 27.7% 340 16.9", 6L0 31%
P.A.S.
I.N.H.
51 20% 302 15%
193 9.6%
433 21.5%
426 21.2%
513 25.5%
1,230 61.8% 870 43.3%
366. The isolation of atypical strains of acid-fast organisms was further studied and, in addition, 51 sputa were examined for the presence of paragonimus ova; & were found to be positive.
84
367. A1 appendix 14 is a summary of the examinations carried out at the Institute and its branches during 1959.
368. Courses of lectures and practical work for student technicians. were continued throughout the year and separate short courses of instruction in laboratory techniques were run for Health Visitors, Health Inspectors and Student Nurses.
369. One additional qualified technologist was recruited during the year and four others returned from study leave in the U.K. with the A.M.I.L.T. Three other technicians were sent on study leave to the United Kingdom to undertake advanced training in various branches of technology prior to sitting the examinations for the Associateship.
Vaccine Production
370. Vaccines to the value of $282,891 were manufactured during the year, which for the most part are issued free as a public health measure. The quantities of vaccines manufactured were:
TABLE 32
VACCINE PRODUCTION.
Vaccine prepared Vaccine issued
Anti-smallpox vaccine
Anti-cholera vaccine
Anti-typhoid-paratyphoid vaccine (Adult) Anti-typhoid-paratyphoid vaccine (Children) Anti-plague vaccine
Anti-rabies vaccine 2
Anti-rabies vaccine 4%
J
48,279 ml.
40,197 ml.
L
50,500 ml.
62,950 ml.
69,250 ml.
48,900 ml.
92,070 ml.
160 ml.
41,900 ml.
46,240 ml.
25,800 ml.
30,930 ml.
Grand total
227,829 ml.
329,347 ml.
P.P.D. Tuberculin diluted and issued
5,650 ml,
The Public Mortuaries
371. The two public mortuaries are situated one on either side of the harbour and to these are brought cases of sudden or unnatural death. In addition all rodent specimens sent in for examination for plague are dealt with at the two mortuaries, which each have a special section designed for this work. Table 33 sets out the work performed during the year.
85
TABLE 33
Kowloon
Victoria
Total Autopsies performed
3.084
1.256
Number of identified bodies
898
658
Number of unidentified bodies
2,186
598
Deaths due to natural causes Deaths due to unnatural causes
2,621
948
463
308
Males
1.107
802
Sex
Females
1,973
450
Unknown
4
4
F
Chinese
3,079
1,239
Race
Non-Chinese
5
17
Age Groups Over 60 years
135
181
45-60 years
380
290
30-45 years
662
222
15-30 years
134
108
I - 15 years
511
227
I month - 1 year
563
81
under 1 month
585
122
Stillbirths
110
18
Age unknown
7
Examination of rodents for plague
TABLE 34
Kowloon
Hong Kong
Total number examined
133,469
162,295
L
Dissection and mascroscopic examination.
36,920
65,895
Complete bacteriological examination
61
92
Positive for plague
Nil
Nil
372. The prevalence of suicide as a cause of death has given rise to a detailed investigation by the Government Senior Psychiatric Specialist. A monograph on this subject was published by the Hong Kong Univer- sity Press in November 1958.
373. It is of interest to record the frequency and pattern of causes of deaths occurring in this way during 1959. Table 35 is an analysis of suicide cases brought to the two public mortuaries.
86
TABLE 35
SUICIDES IN HONG KONG, 1959
Victoria
Kowloon
Drowning
37.9%
6.4%
Hanging
17.8%
26.4%
Jumping from heights
26.4%
25.4
I
гг.
Poisoning by Insecticides.
6.4%
20.0%
Other Poisonings
8.6%
19.5%
Others
2.9
ኑ
2.3%
100
100%
Total Suicides
140
220
FORENSIC PATHOLOGY
374. All medico-legal work in connexion with the investigation of crime is carried out from laboratories situated in the Police Head- quarters building. The laboratories are staffed jointly by the Medical and Health and Police Departments, the staff consisting of the Senior Forensic Pathologist in charge, two M.O.s and one Assistant Chemist, and five members of the Police Force, one of whom is a woman constable. Table 36 details the work done during the year.
TABLE 36
STATISTICS FROM 1ST APRIL, 1959 TO 31ST MARCH, 1960.
Examination of victims and suspects
416
Attendance at scenes of crime
99
Attendance at courts
61
Medico-Legal post mortems
184
Medico-Legal examination of weapons
84
Examination of hairs, fibres and other slides
364
Examination of clothing
642
Miscellaneous examinations (Articles)
275
Blood Grouping (Medico-legal)
1,582
Blood Grouping (Police Officers)
653
Lectures to Police Officers including advanced course Assistance in Raids
38
Illegal dental practice
Breach of Pharmacy & Poisons Ord. and Penicillin Ord. Unregistered Medical Practitioners
Abortions
375. The Senior Forensic Pathologist is Lecturer in Forensic Medicine at the Hong Kong University and also lectures on the medico- legal aspects of crime to the Advanced Detective Training Course.
87
47
12
Nil
4
Lectures are also given by the Assistant Chemist at the Police Training School on the handling of exhibits and on narcotics.
GOVERNMENT CHEMIST'S LABORATORY
376. This Laboratory carries out a wide range of analytical and consultant work for Government, for the Armed Services and for commercial and industrial concerns. The Government Chemist, four Chemists, one Scientific Officer, four Assistant Chemists and Bio- Chemists and nineteen other staff maintain the work of the Laboratory. 377. The total number of analyses carried out during the year was 42,086 which is an increase of 13% over the 1958 total. Of the samples analysed. 18,708 were bio-chemical analyses of blood carried out for hospitals and private practitioners. The next largest group of analyses was in connexion with 12,453 seizures of narcotics, mostly heroin, sent in for examination and certification,
378. The chemical examination of public water supplies is carried out as a routine, as is the analysis of samples of food and drugs for adulteration. Work for the Police, in addition to that done on narcotics, includes the investigation of poisoning and examinations in connexion with acid-throwing, arson, counterfeiting, drunken driving, robbing, and the unlawful possession of poisons and dangerous goods. Homicide by poisoning is rare in Hong Kong but suicide by poisoning is common. Organophosphorous insecticides, now placed under much stricter control, were most commonly used, followed in frequency by barbitu- rates, cyanide and lysol.
379. Work in connexion with dutiable commodities was carried out for the Department of Commerce and Industry and 6,409 samples of liquor, tobacco, fine gold and hydrocarbon oils were analysed. For the Government Stores and for certain commercial firms the checking of standards of a wide variety of commodities was undertaken. In the industrial health field, investigations were carried out in connexion with air pollution in work places due to sulphur dioxide, silica dust, lead and zinc fumes and industrial solvents.
380. An interesting aspect of the year's work was the checking of standards of locally made-up pharmaceuticals exported to neighbouring countries as part of the U.S. foreign aid programme. All such exports must be supported by a certificate to show that the standards of the U.S. Pharmacopoeia have been met.
88
381. The categories of analysis undertaken during the year were:
Water & waterworks chemicals
Food and Drugs
Forensic
Toxicology
Commercial
782
431
890
598
IL
623
1,183
Miscellaneous
J
LJ J
Dangerous Drugs and Dutiable Commodities Ordinances 18,862 Importation/Exportation (Prohibition) (Specified Articles)
Order Bio-Chemical
ILI
9
18.708
THE PHARMACEUTICAL SERVICE
382. This branch, in charge of the Chief Pharmacist, has its head- quarters at the Central Medical Store at North Point on Hong Kong Island. Next to the Government Unallocated Stores, it is the main supply depot for pharmaceuticals, medical and surgical equipment and supplies and medical gases. There is a branch Medical Store in Kowloon which is the distribution centre for that side of the harbour, including the New Territories.
383. Manufacturing units for the supply of pharmaceuticals in bulk, usually in concentrated form. are maintained at both North Point and Kowloon. Parenteral fluids are also manufactured in bulk at North Point and the Queen Mary Hospital. During the year 104,325 litres of parenteral fluids were manufactured and distributed to Government institutions. In addition, 106,362 sterile preparations were prepared which included a wide range of injections, burn dressings, bone wax, eye preparations and other items in general use at hospitals, clinics and dispensaries.
384. The Chief Pharmacist, who is a member of the Pharmacy Board, has important responsibilities in connexion with the enforcement of the Ordinances dealing with Dangerous Drugs, Pharmacy and Poisons and Penicillin. He has a staff of qualified pharmacists of whom two are occupied full time on inspectorial duties. The inspection of premises both manufacturing and retail and of records is carried out regularly. Table 37 sets out the work done in this field,
TABLE 37
Wholesale Poisons Licences issued Authorized Sellers Licences issued
1958 1959
344
350
29
32
Listed Sellers Licences (Part II Poisons only) Antibiotic Permits issued
251
282
209
203
Licences for movements of Dangerous Drugs
233
309
Premises inspected
988
1.104
Prosecutions initiated
4
3
...
89
THE ALMONER SERVICE
385. Under the social conditions existing in Hong Kong there is a vast amount of medical social work necessary to support the curative services. The Principal Almoner has her headquarters at the Harcourt Health Centre and she has a staff of 10 Almoners Class I and 30 Almoners Class II distributed between the Hospitals, the larger clinics and certain specialist services. Responsibilities additional to the actual medical social work include the administration of the Samaritan Fund, the Special Treatment vote, the distribution of free foods donated by C.A.R.E. and other welfare organizations, and the in-service training of newly recruited Almoners. There is also participation by the Almoners in the training of medical students, student nurses, social studies students and in the in-service training courses run by the Social Welfare Department.
386. The staffing situation has improved over the past two years and during 1959 six Almoners completed their first year of in-service training and seven more were recruited. The ratio of experienced to inexperienced Almoners is still too low and only 24% of the staff had had six years experience or more.
387. At the Queen Mary Hospital more work was possible amongst cancer patients undergoing radiotherapy and more time could be devoted to orthopaedic patients, particularly those attending the fracture clinic. At Kowloon Hospital the increase of over 2,600 hospital admissions proportionately increased the calls on the Almoners' time, particularly in connexion with the orthopaedic accident service aimed at early rehabilitation. There is necessarily a close contact with the Lai Chi Kok convalescent wards and one Almoner's time was devoted to this aspect of the orthopaedic work in both hospitals. At Lai Chi Kok the most difficult problems continued to arise in the finding of suitable employment for the disabled and in the rehabilitation of the paraplegics.
388. At the Mental Hospital, where full social records of all patients are most important, there are now four Almoners. The large number of patients who are out on parole requires a continuing close family contact if out-patient attendance are to be maintained and relapse avoided. Full case work was carried out for 951 cases compared to 724 in 1958.
389. The Tsan Yuk Maternity Hospital posed many problems deal- ing as it does with the complications of pregnancy. Arrangement for the care of the children of expectant mothers who required prolonged
90
ante-natal in-patient treatment, referrals of babies to the M.C.H. centres, the care of orphaned children and advice, where sought, on family planning are all making greatly increased demands on the service.
390. At the larger out-patient clinics the medical-social needs of various aspects of the general curative service are met as far as possible. These include, particularly, child care problems arising from unsatisfac- tory home conditions and the difficulty of regular attendance at physiotherapy, maternal and child health and other clinics due to the household or employment ties of the mother.
391. Almoners work full-time with the Tuberculosis. Social Hygiene and Ophthalmic Services. There have been encouraging developments in the attitude of patients and parents to these services as a result. particularly in leprosy work.
Samaritan Fund
392. During the year, expenditure totalled $14,487.75 disbursed in 3,305 grants which is an increase of more than 40% over that of last year. The majority of the grants were, as previously, in the form of travelling expenses and the re-imbursement of loss of earnings to the escorts of disabled patients.
Special Treatment Vote
393. Expenditure rose from $10,790 in 1958 to $20,518 in 1959 for the provision of surgical appliances to those who cannot afford the cost either in part or in toto. The Almoner concerned submits a social report on each patient together with the surgeon's recommendation and an estimate of the cost of the appliance. The Principal Almoner, after the appliance has been fitted, is then responsible for the submission of the account for payment from this vote. The arrival during February, 1960, in the Colony of a Surgical Appliance Technician on first appointment will greatly facilitate this aspect of the work of the Almoners.
394. The assistance and co-operation of the Family Welfare Society, the Silvermine Bay Holiday Camp, the Family Planning Association, CARE, the B.G.C.A. the Po Leung Kuk, the Bishop Ford Centre, and UNICEF in the medical social work are gratefully acknowledged. The close co-operation given by the Social Welfare Department of Govern- ment in the solution of problems of mutual concern in this field has been particularly valuable.
91
PHYSIOTHERAPY
395. The Headquarters of this service is at the Wan Chai Polyclinic on Hong Kong Island and there are physiotherapy units at the Queen Mary, Kowloon and Lai Chi Kok Hospitals. The Superintendent Physio- therapist, who is also a trained Tutor, has a staff of 18 physiotherapists and assistant physiotherapists. One of the physiotherapists is also a Tutor and it is planned to start a course of training, locally, in temporary premises and towards the end of 1960, based on the curriculum of the U.K. Chartered Society of Physiotherapists. There are at present two local girls on study leave in the United Kingdom working for the M.C.S.P.
396. Apart from the Wan Chai Centre, which was designed for physiotherapy, none of the units is accommodated in adequate premises. Much work has therefore to be done individually in the wards of the hospitals. Nevertheless considerable progress has been made and group therapy in classes has greatly expanded the scope of the work.
Poliomyelitis
397. At the Wan Chai Centre, the Orthopaedic Specialist holds a weekly clinic for poliomyelitis cases advising on treatment and the fitting of appliances. Classes are held for babies under two and their mothers so that exercises can be continued at home. There are also two classes for older children, one for those who can walk unaided and the other for those who need appliances; the aim of the latter is to get them fitted with an appliance and on their feet as soon as possible. A large post poliomyelitis clinic is also held at the Kowloon Hospital where a similar system is being developed. There are hydrotherapy tanks at both
centres.
General
398. There are now classes for hemiplegics, for arm disabilities including 'frozen' shoulders, elbow classes for small boys with fractures and dislocations and classes for industrial hand injuries in young men and women. Cases of the latter referred by the Labour Department are seen once weekly by a Health Visitor from the Industrial Health Section. Individual treatments in cubicles are also carried out as required and the installation of overhead suspension at the various centres has greatly aided the rehabilitation of those suffering from injuries affecting individual muscle groups.
92
399. Physiotherapy sessions for patients suffering from leucoderma are now held weekly instead of fortnightly.
400. The appointment of another physiotherapist specially trained in chest work has enabled more time to be devoted to the Thoracic Surgical Unit in the Queen Mary Hospital.
401. There is close co-operation with the occupational therapists in rehabilitation, particularly at Lai Chi Kok, where exercises are followed up by employment on machine work best suited to the re-education of the muscle groups affected.
OCCUPATIONAL THERAPY
402. The Senior Occupational Therapist, assisted by a staff of three Occupational Therapists and nine Handicraft Instructors, has her head- quarters in the Queen Mary Hospital with units working in the Mental Hospital and Lai Chi Kok Hospital where the majority of 'long stay' in-patients are accommodated.
403. A sum of $50,000 was allocated for the purchase of raw materials and miscellaneous stores, and articles produced were sold by the Welfare Shop in Kowloon and at the Annual Exhibition of Crafts at the Mental Hospital. In addition, the Controller of Stores purchased bamboo crutches, brooms, waste-paper baskets and other such items made by the patients. The total revenue received from the sale of articles was $17,100.80, of which $1,974 came from sales at the Annual Exhibition.
404. Incentive payments are made to the patients turning out articles which are sold, and this money is used to pay for entertainments such as film shows, Chinese operas, concerts and Chinese dinners.
405. The service is concerned mainly with in-patients but a few out- patient sessions have now been started. An innovation has been the start of relaxation exercises' classes conducted by a voluntary helper one evening a week for mental hospital out-patients. In-patient relaxation exercises have been held daily in the Victoria Mental Hospital and have proved to be very popular with those patients who are able to join in.
406. Occupational Therapy for mental hospital patients is carried out both at the Victoria and Castle Peak Hospitals. At the former there has been a high standard and wide variety of work maintained. The female patients have made toys, puppets, quilts, tapestries, plastic and paper flowers, scrap books, rattan wastepaper baskets, and plastic and rattan shopping baskets. They have also done needlework, embroidery,
93
crochet work and knitting. The male patients have done bamboo and rattan work, carpentry and furniture making in addition to broom making, splint making and basket work.
407. Some interesting work has been done by the Senior Occupa- tional Therapist in connexion with diagnostic painting and drawing by mental patients. Several paintings of good quality have been completed by patients, framed and used as ward decorations.
408. Outings to places of interest and to shop for materials used in the occupational crafts have been organized for selected groups of mental patients and have proved popular and beneficial.
409. At the Castle Peak Mental Hospital where the patients are mainly retarded and suffering from chronic conditions, occupation has been limited to relatively simple tasks in rattan work, machine sewing. needle work and gardening.
410. At the Queen Mary Hospital an overhead suspension was installed during the year and the standard of specific medical treatments has improved. It is now possible to treat disabilities of the hands, elbows, shoulders, legs and ankles in both early and late stages. Much more use is now being made of occupational therapy, particularly for orthopaedic conditions.
411. There is a wide field for specific occupational therapy at Lai Chi Kok, and the addition of a foot power loom and an electric lathe to the equipment has expanded the scope of the work. Plastic flowers, animals and baskets, rattan work, hooked rugs, dolls furniture, toys, jigsaw puzzles and pattern weaving have all produced articles of high standard. As many of the patients so occupied are permanently disabled much effort has been concentrated on instruction in the use of aids for essential activities such as eating, washing, dressing and walking.
MEDICAL EXAMINATION BOARD
412. The functions of this Board are to examine medically all candidates for appointment to the Government Service, all recruits to the Auxiliary Defence Service and all members of the Service prior to entry to the permanent establishment, to promotion or to transfer out- side Hong Kong. Work is also undertaken in connexion with the medical certification of prospective emigrants to a number of countries where an official certificate is demanded by the respective Immigration Authorities. All medical examinations include a full physical examina-
94
tion, an X-ray of the Chest, and such laboratory investigations as may be required.
413. The Board consists of a Chairman and four other Medical Officers, one of whom is a woman. Specialist advice is available on request from the Government specialist clinical units. Work done during the year is summarized in Table 38.
Gov't Appointments
TABLE 38
New examinations Re-examinations
Annual Total
י.
Aux. Defence Units 1958 1959 1958 1959
6,232 7,125 2.539 2,192 3,640
3,764 1.962 2,436
Miscellaneous
Total
1958 1959 1958 1959
149
137
8.920 9,454
65
81
5,667 6,281
9,872 10,889 4,501 4,628
214
218 14,587 15.735
2.513 2.411
Referred for a specialist opinion
414. Pulmonary tuberculosis still remains the commonest cause for rejection, and 1,712 cases were referred to the Senior Tuberculosis Specialist for an opinion on abnormal chest findings; of these 10.5% were rejected on account of active tuberculosis, 13.9% because of quiescent tuberculosis, and 13.0% because of arrested tuberculosis, a total of 37.4% of persons thus referred. The percentage of the total candidates examined who had healed pulmonary tuberculosis and who were eventually accepted for appointment was 4.7%.
415. Out of a total of 15,735 candidates examined by the Board. 1,128 were found medically unfit. Table 39 gives an analysis of the causes of rejection.
TABLE 39
Per 1,000 examinations
60.12
2.41
2.66
1.01
0.50
0.50
0.57
0.38
1.90
0.69
1.14
Diseases of the Respiratory System (excluding tuberculosis)
Pulmonary tuberculosis
Diseases of the Circulatory System
Diseases of the Alimentary System
Diseases of the Skeletal System
Diseases of the Genito-Urinary System
Diseases of the Nervous System
Diseases of the Endocrine System
Diseases of the Eye
Diseases of the Skin
Miscellaneous
95
-
:
:
416. The Board also undertakes the immunization of candidates appointed to posts which carry special risks. Tuberculin testing followed by B.C.G. vaccination when necessary, T.A.B. inoculations and Schick testing are employed routinely for this purpose.
BLOOD BANKS
417. The blood donation centre, maintained by the Hong Kong Branch of the British Red Cross Society on the Hong Kong water front, continued to collect and distribute blood to the Blood Banks at the Queen Mary and Kowloon Hospitals. The Society collected 4,311 pints of blood during the year, which is 1,002 pints more than in 1958. The total of blood received into the two Blood Banks was 5,871 pints, of which 73.4% came from the Red Cross, 22.5% from patients' relatives and friends, and 4.1% from other sources. The distribution of blood from the Banks, amounting to 5,805 pints, was:
Government Hospitals Grant-in-aid Hospitals Private Hospitals Military Hospitals
76.1%
19.4%
4.1%
0.4%
418. The laboratory work in connexion with blood donations is undertaken by the Government Institute of Pathology. Of the 66 pints of blood not used, some was made into plasma, the rest proving to be unusable for various reasons.
419. The greater part of the blood donated again came from the Armed Services in the Colony or from visiting Royal Navy and United States warships. There is an increasing band of regular donors amongst the Chinese residents and the Donors Club was again active under the guidance of the Chairman of the H.K. Branch of the British Red Cross Society, Mr. Wilfred WONG. There are now 145 Club members of whom 15 have given blood more than five times.
HOSPITAL ADMINISTRATION AND SUPPLY
420. This branch of the Service is the responsibility of the Chief Hospital Secretary assisted by four Hospital Secretaries and six Assistant Hospital Secretaries. There are two Group Hospital Secretaries, one in Hong Kong at the Queen Mary Hospital and one in Kowloon Hospital, who are responsible for the routine administration and supply of the medical institutions on the two sides of the harbour respectively. One Hospital Secretary is now working full time with the Headquarters Planning Unit and another, who will eventually take over at the Castle
96
Peak Mental Hospital, has the overall responsibility meantime for the Tsan Yuk Maternity Hospital, the Sai Ying Pun Hospital and Out Patient Department, and the Mental Hospital. Assistant Hospital Secretaries are posted to Lai Chi Kok, the Mental Hospital and Sai Ying Pun Hospital and Polyclinic.
421. The recommendations of the Salaries Commission regarding the creation of a definite cadre of Hospital Secretaries and their qualifica- tions, recruitment and training have been accepted in principle. This has enabled the necessary re-organization to be put in hand and further recruitment of Assistant Hospital Secretaries started. During the year a fourth qualified and experienced Hospital Secretary was recruited.
422. The function of this branch is the routine administrative work in the hospitals and clinics, which includes the supply of fuel, rations and medical and surgical equipment, the maintenance of equipment and furniture, the recruitment and discipline of all male menial staff, the maintenance of transport, the accounting for hospital stores and the initiation of maintenance and repair work on the fabric of buildings. The Chief Hospital Secretary is also the Departmental Welfare Officer and the UNICEF Liaison Officer.
Staff Welfare
423. The new Staff Recreation Centre at Kowloon Hospital has been completed so that there is now a focus for welfare activities at each of the two main hospitals. The Welfare Club continued to support schemes for the schooling of members' children, aid to pensioners and relief of families in distress. Chinese chess, football, table tennis com- petitions, and social gatherings and outings were organized and proved very popular. Staff relations continued to be very good and there were few cases requiring disciplinary action in relation to the size of the staff concerned.
UNICEF Projects
424. The skimmed milk distribution programme continued at the same level and 203,115 lbs. of milk powder were distributed to welfare organizations throughout the Colony. The total number of supple- mentary meals given at Feeding Centres was 1.275,670.
AUXILIARY MEDICAL SERVICE
425. Established ten years ago under the provisions of the Essential Services Corps Ordinance, the total strength at the end of March 1960
97
was 4,485 members of whom 1,002 were women. The Service is designed to duplicate the Medical Department staff in the event of a Colony-wide emergency, so that treatment can be given to all casualties while the day to day clinic and hospitals services to the general population are main- tained as far as is possible. In addition an expanded ambulance and first aid service, which comes under the operational control of the Civil Aid Services in an emergency, is staffed by A.M.S. personnel. The Medical Defence Staff Officer is responsible for the routine administra- tion of the service and the Director of Medical & Health Services is the Unit Controller.
426. One new unit was formed in Cheung Chau which has an island population of over 20,000 residents. This unit includes a large and keen women's section. The overall increase in membership of the Service was 134 members.
427. Emphasis is on training, and the First Aid Demonstration teams, one on each side of the harbour, have continued to do very good work, with a noticeable increase in efficiency and enthusiasm resulting from the efforts of these two teams.
428. There is a close liaison with the Civil Aid Services and 8 com- bined Civil Defence Zone exercises were held during the year. 'Live' casualties, using wound-faking and acting techniques, have made for realism and the more careful handling of casualties by rescue and first aid groups. Ambulance team members have also attended regularly at week-ends at the Casualty Departments of the Queen Mary and Kowloon Hospitals, where they have gained valuable experience by watching the handling and treatment of casualties by trained personnel. A new venture has been the secondment of members, trained in first aid, for voluntary part time work with the Ambulance Service main- tained by the Fire Brigade.
429. The auxiliary Ambulance Depots now have 1,200 members who carry out up to 14 hours of training each month; during the year 1,006 members were awarded proficiency certificates, 42 with distinction.
430. The training of pharmacists and dispensers in the preparation of intravenous fluids, and the storage of drugs and equipment for emer gency use, continued under the supervision of the Chief Pharmacist. This training takes place on two Sundays each month.
98
431. Table 40 sets out some details of the work done during the
year:
TABLE 40
COURSES OF INSTRUCTION
Officers
Basic First
Ald
Driving
Members attending
72
47
134
Telephonists & message writing
78
Store-
Aux. Dressers Aux. Nurses
Ward course
Basic Aux.
Members attending
keeping
57
(4 days)
55
(Hospital) (2 weeks)
Dressers
98
63
Members attending
+
WARD REFRESHER COURSE
Number of Qualified Auxiliary Dressers Number of Qualified Auxiliary Nurses Number of Qualified Drivers
432.
(5 days)
LI
V. TRAINING PROGRAMME
DOCTORS
I
:
J
JJ
533
961
223
Undergraduate training is carried out at the University of Hong Kong which confers the degrees of M.B., B.S., recognized, since 1911. by the General Medical Council of the United Kingdom.
433. Post-graduate training for higher qualifications is under the supervision of the Panel on Post-Graduate Medical Education, con- sisting of University and Government staff members, who advise on both general and individual aspects of the programme. Post-graduate clinical training at the Queen Mary Hospital is now recognized by the majority of the Examining bodies in Great Britain, while the Tsan Yuk Maternity Hospital is also recognized by the Royal College of Obste- tricians and Gynaecologists as a training hospital. It is mainly due to this programme that 65% of the specialist appointments in the Depart- ment are now held by locally-recruited personnel, and that a number of medical officers have also been able to obtain higher qualifications.
434. During 1959 a further Part I examination for the Diplomas in Medical Radiology in Diagnosis and Therapy was held in the Colony. This was the second such examination and this facility accorded by the Examining Board in England is gratefully acknowledged.
99
DENTISTRY
435. As yet, Hong Kong has no School of Dentistry although the proposal to establish a Faculty of Dental Science at Hong Kong University has been approved in principle. To meet the Colony's needs meantime, a Government Dental Scholarship scheme was started in 1954 to ensure a supply of qualified dentists until such time as the University Dental School comes into being. Seven of these Scholarships are granted annually by a Committee consisting of senior officers of Government and the University. Those who qualify as dental surgeons under the scheme may be required to work in the Government Dental Service for one or two years upon their return and in any case are required to practise in Hong Kong for not less than four years.
436. Three more scholarship students were sent to the Dental School of the University of Adelaide in January and four in February 1960 to the University of Melbourne. Five students graduated as Bachelors of Dental Surgery of the University of Malaya and returned to Hong Kong in 1959, leaving a total of 34 dental scholars still studying over- seas at the end of the financial year.
437. Two additional Dental Surgery Assistants were awarded W.H.O. Fellowships for training as Dental Nurses in Penang, Malaya, bringing the number of students to a total of five, three of whom are in Penang and two in Wellington, New Zealand. The role of the Dental Nurse is to carry out minor operative work under the supervision of a Dental Officer and to educate children, parents and teachers in the principles of dental health.
NURSES
438. There is full reciprocity of registration between the Nursing Board in Hong Kong and the General Nursing Council of England and Wales. Each year a number of qualified nursing staff, including both local and expatriate officers, go overseas to gain further experience in different aspects of nursing.
439. The Department maintains a Nurses Preliminary Training School at the Queen Mary Hospital, and this hospital and the Kowloon Hospital are training schools approved by the Nursing Board, in which the medium of instruction is English. Other approved nurses training schools are at the Tung Wah Hospitals, the Alice Ho Miu Ling Nethersole Hospital, and the Hong Kong Sanatorium and Hospital, in all of which the teaching is carried out in Chinese.
100
440. The continuing expansion of the work of the Department and the necessity to train nursing staff for the large new hospitals under construction has thrown a very considerable strain on the resources of teaching staff and accommodation. Up till now, the immediate demands have been met, but the strain will continue until such time as the Nurses Training School at the Queen Elizabeth Hospital in Kowloon has been fully established; the school is expected to open during September, 1960.
441. In December, 1959 the first course of training in mental nursing started at the Victoria Mental Hospital. It is being conducted by a male Tutor who has recently returned from the United Kingdom where he had obtained the Tutor's qualifications in mental nursing. In addition, a number of student nurses are under training in England for the Registered Mental Nurse Certificate so that a nucleus of trained mental nurses will be available when the Castle Peak Hospital has been opened.
MIDWIVES
442. Registered nurses who have trained in the Government School of Nursing can then proceed to take a one-year course in midwifery, using English as the teaching medium, in the maternity wards of the Queen Mary and Kowloon Hospitals. Nurses who have trained at the Tung Wah group of Hospitals. Alice Ho Miu Ling Nethersole Hospital and Hong Kong Sanatorium and Hospital can also take a similar course, conducted in Chinese, in the maternity wards of their respective hospitals.
443. For student midwives who are not registered nurses there is a two-year course of training carried out by Government staff, in Chinese, at the Tsan Yuk Hospital.
HEALTH VISITORS
444. Since 1954, a course of training has been held annually for Health Visitors at Harcourt Health Centre; all entrants to this course have previously obtained qualifications both in general nursing and in midwifery. The training, both theoretical and practical, covers a wide range of lectures, demonstrations and visits covering all aspects of public health work. At the end of the course, the students take the examination for the Health Visitor's Certificate which is conducted by the Hong
101
Kong Examination Board of the Royal Society for the Promotion of Health.
445. Only ten students are selected for each course so that tuition and constant assessment of the individual is possible.
RADIOGRAPHERS
446. The training for radiographers at the Queen Mary Hospital in both radiodiagnosis and radiotherapy is recognized by the Society of Radiographers in the United Kingdom. Examinations for both Parts I and II of the Membership of the Society have been held annually in the Colony for a number of years.
LABORATORY TECHNICIANS
447. The Government Institute of Pathology is recognized by the Institute of Medical Laboratory Technology in the United Kingdom as a teaching laboratory from which entrance can be gained directly to the Intermediate examination of the Institute. At present, students have to go to the United Kingdom to sit this examination and they sub- sequently undergo a further period of instruction there to qualify for entrance to the Associateship examinations.
448. In addition there is an in-service course of training for Medical Laboratory Technicians which follows closely the curriculum of the Institute of Medical Laboratory Technology and which leads to a departmental examination.
OTHER FORMS OF DEPARTMENT TRAINING
449. Courses of training are held for Assistant Physiotherapists, Dispensers and Tuberculosis Visitors, which do not lead to a recognized qualification, but which prepare those concerned for admission to permanent posts on the establishment after they have passed a depart- ment examination. In addition probationer almoners, who already hold a university degree and a recognized qualification in social science. receive a series of lectures on the local aspects of medico-social work.
450. The following table sets out the various categories of training undertaken departmentally during the year:
102
TABLE 41
Appointment
Resignation
Strength at 31.3.60
Passed
Assistant
Probationer Assistant
Physiotherapist
Probationer Radiographic
Student Dispenser
1
I
4(a) 14(8)
11
36
Student Laboratory Assistant
༨
6
+
Technician
(Psychiatric)
Nurses)
Student Medical Laboratory
Probationer Assistant Almoner
Student Nurse
Student Male Nurse
Student Nurse (Psychiatric)
Student Male Nurse
Student Midwives
Student Midwives (Registered
Student Health Visitor
Tuberculosis Visitor
14
38
21
8
8
7
121
IL
35
301
42
14
L
6
46
5
3
7
6
..
1760
27
1
44
49
48
18
2 = 1
|
1
10
10
9
1 1
11
6
(a) Part 1.
(b) Final Part.
(c) All training in United Kingdom (This number includes 1 Auxiliary Trained Nurse). (d) 12 training in United Kingdom-including 2 Registered Male Nurses Hong Kong.
ATTENDANCE AT CONFERENCES AND MEETINGS INCLUDING THOSE
SPONSORED BY THE WORLD HEALTH ORGANIZATION
451. The following table sets out the attendances by officers at Meetings and Conferences during 1959/60.
TABLE 43
Appointment
Chief Port Health Officer
Senior Medical Officer Health Sister
Senior Medical Officer
Senior Medical Officer Senior Sister Tutor
Medical Officer
LL
LL
rr
LL
Conferences etc. attended *W.H.O. Seminar on Veterinary
Public Health
*Annual Congress of the Royal Society for the Promotion of Health
Second International Hospital
Equipment and Medical Services Exhibition
International Hospital Congress
The Course of Instruction in use of Audio & Visual Aids at the Over- scas Visual Aids Centre
9th International Congress of
Paediatrics
103
Place Tokyo
Harrogate. York.
shire
London
Edinburgh London
Montreal.
Canada
TABLE 43-Contd.
Appointment
Conferences etc. attended
Place
Director of Medical & Health
Services
LL
•W.H.O. World Conference on
Medical Education
Chicago
LI
Taipei,
Taiwan
Istanbul,
Turkey
Assistant Director of Medical
Services
Senior Tuberculosis Specialist
Senior Dental Specialist
Acting Deputy Director of
Medical & Health Services
Acting Senior Health Officer
Senior Dental Specialist Dental Specialist
Government Chemist
Senior Dental Specialist
·
г
P
10th Session of the W.H.O. Regional Committee for the Western Pacific 15th International Tuberculosis
Conference
International Conference on Dental
Public Health Centennial Session
*7th Session of the Committee on
International Quarantine
*W.H.O. Seminar on Education &
Training of Sanitation Personnel W.H.O. Dental Health Seminar and 15th Australian Dental Congress International Seminar on Illicit Drug
Traffic
Seminar of the American Academy
of Implant Denture
Funds provided by the sponsoring organization.
COURSES OF STUDY INCLUDING WORLD HEALTH
ORGANIZATION FELLOWSHIP
New York
Geneva
Tokyo
Adelaide
Paris
New York
452. The following table sets out the courses of study attended by officers during 1959/60:
Appointment
2 Medical Officers.
| Medical Officer
| Medical Officer | Medical Officer
י
J
·
1
Course of Study
Place of Study
Fellowship, Royal College of U.K.
Surgeons
1 Woman Medical Officer Diploma in Public Health
Source of Funds Government
Government
Plastic Surgery
U.K.
·
Diploma in Public Health
U.K.
Government
Diploma in Public Health
Singapore
Jaycee
Scholarship
Singapore
Jaycee
Scholarship
I Medical Officer
L
L
Diploma in Medical
U.K.
Government
Radiotherapy
1 Medical Officer
I Principal Medical and
Health Officer
| Specialist ..
Diploma in Medical
U.K.
Government
Radiodiagnosis
-
Course in Basic Isotope
U.K.
Government
New technique in diagnosis
and treatment
U.K.
Government
? Medical Laboratory
Technicians, Grade II ..
II.
Associateship, Institute of
U.K.
Government
Medical Laboratory
Technology
104
Place of
Source of
Appointment
Course of Study
Study
Funds
I Senior Malaria Inspector Malaria Eradication
Philippines
I Health Sister
Tutor Diploma in Public
Health
U.K.
W.H.O.
Fellowship
Government
1 Senior Nursing Sister ..
Nursing Administration
U.K.
Colonial
(Hospital)
Develop-
ment and Welfare Fund
| Physicist
2 Radiographers
1 Almoner Class 1
1 Senior Male Charge
Nurse
г г
Hospital Physics
U.K.
Government
Membership. Society of
U.K.
Government
Radiographers (Therapy)
Certificate course in Mental
Health
U.K.
Government
י.
Venereal Disease. Fellowship U.K.
of the Institute of Tech- nician in Venerology Training in Pharmacy Inplant Therapy and
Relative Problems
Government
Australia Government
U.K.
Government
I Dispenser
| Senior Specialist
3 Student Nurses
(Psychiatric)
| Student Male Nurse
(Psychiatric)
2 Male Nurses
יי
Mental Nursing
U.K.
Government
Mental Nursing
U.K.
Government
Mental Nursing
U.K.
Government
Denmark
W.H.O.
Midwife Teacher's Diploma
U.K.
Colonial
1 Assistant Medical Officer Anaesthesiology 1 Nursing Sister
J
I Medical Officer
Membership, Royal College U.K.
Develop- ment and Welfare funds Government
of Obstetricians and
Gynaecologists
| Specialist..
Hypertension Thyroid Diseases U.K.
Government
and Clinical Neurology
I Medical Officer
2 Dental Surgery
Assistants
Certificate in Dermatology
Dental Nursing
1 Woman Medical Officer Post-graduate training in
U.K.
Government
Singapore
W.H.O.
U.K.
Own expenses
Anaesthesiology
1 Woman Medical Officer Licentiate. Medical Council
Canada
Own expenses
of Canada
1 Assistant Medical Officer Licentiate, Medical Council
Canada
Own expenses
of Canada
I Woman Assistant
Medical Officer
Diploma in Anaesthetics
P
U.K.
Own expenses
105
Appointment
| Nursing Sister
Place of
Source of
Course of Study
Study
Funds
w
·
Chest Surgery
U.K.
Own expenses
Tuberculosis Nursing
Australia
Own expenses
■
Midwifery & Paediatrics
U.K.
Own expenses
Post Graduate-course
U.K.
Own expenses
·
Orthopaedic Nursing
U.K.
Own expenses
Diploma in Dietitian
U.K.
Own expenses
· ·
1 Nurse
1 Nurse
1 Nurse
J J
| Nurse
J J
I Dietitian
VISITORS
453. The following distinguished medical men and women visited the department during 1959/60:
General
(i) Dr. Alice CARLETON of the Department of Anatomy at Oxford
University.
(ii) Dr. Sidney HOBBS, M.D. Obstetrician & Gynaecologist, Van-
couver.
(iii) Professor Ira Hiscock, Chairman, Yale University, Department of Public Health, arrived in Hong Kong on 13.6.59 on a short visit to discuss health problems and tuberculosis control. (iv) Mrs. Kamala V. NIMBAR, founder of Occupational Therapy in
India.
(v) A party of 10 Portuguese nurses, 2 religious sisters and 2 doctors
from Macao.
(vi) Professor Gordan M. FAIR of Harvard University, Consultant for the Regional Seminar on the Education and Training of Sanitation Personnel which was held in Tokyo, Japan arrived in Hong Kong on 4.9.59 for a 4-day visit.
(vii) Dr. MALLEN of Adelaide.
(viii) Dr. J. H. MARTIN, Senior Hospital Physicist of the Cancer Institute Board of Melbourne arrived on 10.10.59 for a 5-day visit to discuss radio-therapeutic equipment for the Queen Eliza- beth Hospital.
(ix) Dr. A. M. THOMSON, Deputy Director of the Obstetric Medical Research Unit, Aberdeen, arrived in Hong Kong on 19.10.59 for a two-month stay to investigate the prevalence and causes of stillbirths in Hong Kong.
(x) Sir Robert MACINTOSH, Nuffield Professor of Anaesthesia at Oxford University arrived in Hong Kong on 11.11.59 on a tour of Far Eastern countries on behalf of the British Council.
(xi) Dr. RAO, Director of Medical Services, Punjab.
106
(xii) Dr. Leroy E. BURNEY, Surgeon General of the Public Health Services of U.S.A., & Mrs. BURNEY paid a short private visit to the Colony on 25.11.59.
(xiii) Dr. Morton KRAMMER, Chief Biometrics Branch, National
Institute of Mental Health, Maryland, U.S.A.
(xiv) Dr. Kim Kyung-sik, Chief of the Department of Public Health.
Korea.
(xv) Mrs. B. M. STEPHEN, Lady Superintendent of Nursing General
Hospital, Tasmania.
(xvi) Dr. Stuart MADDIN of Vancouver. specialist in Syphilology and
Dermatology.
World Health Organization staff and fellows:
(i) Dr. Chen Te-san and Miss CHEN Hsiu-chuan, W.H.O. Nutrition Fellows for Taiwan visited Hong Kong and stayed from 25.5.59- 30.5.59.
(ii) Mr. John BAXTER, W.H.O. Fellowship, Architect in charge of the design, construction and maintenance of all Government medical building in Kenya arrived in Hong Kong on 1.6.59 for a week's stay.
(iii) Mr. S. POLAK, UNICEF representative, arrived in Hong Kong
on 22.7.59 for a five days visit.
(iv) Dr. Kim Tack-lim, W.H.O. fellow from Korea arrived in the
Colony on 18.8.59 for a 5-day visit.
(v) Dr. Seigi YOSHIZAKI, W.H.O. fellow from Japan arrived in the
Colony on 24,8.59 for a 2-week stay.
(vi) Mrs. Patricia HARTWELL. Director of Public Information Division at UNICEF Headquarters on her world tour of coun- tries aided by UNICEF arrived in Hong Kong on 15.11.59. (vii) Dr. Donald R. THOMSON, Area Representative. W.H.O. arrived in Hong Kong on 7.12.59 and proceeded to Macao. Returned on 10.12.59 and stayed for 3 days.
(viii) Dr. T. TEIXEIRA, World Health Organization Fellow from Brazil passed through Hong Kong on a private visit on 17.2.60. (ix) Dr. Don Won-choi, Health Officer, Republic of Korea and W.H.O. Tuberculosis Fellow, arrived in Hong Kong on 22.2.60. for a week's visit. Arrangements were made for him to observe the tuberculosis control activities, the social hygiene clinics and the leprosy service.
107
VI. BUILDING PROGRAMME
454. Reference has been made throughout this report to the increas- ing pressure on all institutions. However, during the year the results of the planning programme began to be evident and an indication of the progress made is outlined below:
(a) Completed new projects or major extensions:
(i) The New Tai O Dispensary, a three-storey building donated by the Hong Kong Jockey Club was opened on 23.4.59. (ii) The new Hung Hom Dispensary and Maternity Hospital
was opened on 30.6.59.
(iii) The new Maternity Block at Kowloon Hospital was com-
pleted and handed over to the Department on 7.9.59.
(iv) The Dental Clinic in the Farm Road Government Offices
was opened in March, 1960.
(b) Projects under construction or being planned :
(i) Work on the Sai Ying Pun Polyclinic is progressing and the building is expected to be completed in July, 1960. (ii) Queen Elizabeth Hospital-the excavation of the basement is completed, the piling was completed by February, 1960 and the contract for construction of the basement was let in February, 1960.
(iii) Queen Elizabeth Hospital Sisters' & Nurses' Quarters and
Training School should be completed by June 1960. (iv) Kowloon Hospital 'F' Block which contains two 34-bed wards and 4 operating theatres is nearing completion and will be ready for occupation in April, 1960.
(v) Work is progressing on the Castle Peak Hospital and a further 120 beds were occupied in February, 1960. The remainder of the 1,000 beds should be ready by September, 1960.
(vi) The building of the Jockey Club Clinic Kennedy Town is progressing and the building will be ready for occupation in June, 1960.
(vii) The Virus Laboratory at Queen Mary Hospital will be
ready for occupation in May, 1960.
(viii) Planning is continuing on-
(a) Sha Tau Kok Clinic and Maternity Home
(b) Jockey Club Clinic, Shek Wu Hui
108
(c) Jockey Club Clinic, Aberdeen
(d) South Lantau Hospital (Shek Pik) (e) Pok Fu Lam Godown (f) Yuen Long Clinic (g) Yau Ma Tei Clinic (h) Kwun Tong Clinic
(1) Tsuen Wan Clinic
(D) Cheung Sha Wan Police Clinic (k) Queen Mary Hospital Extension (Kowloon Hospital Kitchen
VIL PUBLICATIONS
455. The following articles were published by members of the Department:
I.
Title of Article Psychiatry and Social
Work.
2.
3.
The Use of Meprobamate
in the treatment of heroin withdrawal
symptoms.
Dental Health Education
of the Public.
4.
Treatment of Male Gonor- rhoea with a Chlorate
tracycline Sulphonamide
Combination.
Publication
Bulletin of the Hong
Kong Medical Associa tion.
Bulletin on Narcotics-
United Nations. April -June 1959.
Bulletin of the American
Association of Public Health Dentists. September 1959 & December, 1959. British Journal of
Venereal Disease. March, 1960.
ACKNOWLEDGMENT
Name and Title of Author Dr. P. M. YAP,
Psychiatric Specialist.
Dr. C. O. LEE,
Medical Superintendent. Queen Mary Hospital.
Mr. Walter C. ALLWRIGHT,
Senior Dental Specialist.
Dr. G. M. THOMSON.
Senior Social Hygiene Specialist.
No progress can be made without the active support and co-operation of all concerned in the task of providing a medical and health service in Hong Kong. The co-operation of other Departments of Government, of the voluntary and charitable associations and of the medical missions. is acknowledged with gratitude as is the practical generosity of the Hong Kong Jockey Club. A special tribute is paid to all grades of staff of the Department who have worked with loyalty and devotion towards the solution of the many medical and health problems with which Hong Kong is faced.
D. J. M. MacKenzie,
Director of Medical & Health Services.
109
110
SAMARITAN FUND
STATEMENT OF RECEIPTS AND PAYMENTS FOR THE YEAR ENDED 31ST MARCH, 1960
Description
Amouut
RECEIPTS
$
To Balance brought forward (on deposit with Accountant General)
Fund
$I8,478.45
Pensions and other monies
held on behalf of in-
dividual patients
Donations
..
Pensions and other monies received
on behalf of individual patients
2,256.13
20,734.58
LJ L
ILI
13.410.20
1,204.04
$35,348.82
Description
Amonat
$
...
16,075.45
1,052.80
PAYMENTS
By Providing maintenance, capital grants, clothing, food, travelling expenses, etc. to patients
Incidental expenses for individual patients paid out of pensions and other monies received on their behalf
Balance carried forward, (on deposit with Accountant General)
Fund
M
110
Pensions and other monies held on behalf of in-
dividual patients
LLL
$15,813.20
2,407.37
18,220.57
$35,348.82
Certified correct.
(Sgd.) G. ACABEG,
for Director of Medical & Health Services.
23. 5. 60.
(Sgd.) MAURA BENHAM,
Principal Almoner, Medical & Health Department. 23. 5. 60.
The above statement has been examined in accordance with Condition 6 of the Schedule to Legislative Council Resolution dated 24th May, 1950 (G.N. No. A. 113 of 26th May, 1950). I have obtained all the information and explanations that I have required, and I certify, as a result of this audit, that in my opinion the statement is correct.
AUDIT DEPARTMENT,
Hong Kong, 10th June, 1960.
(Sgd.) W. J. D. COOPER, Director of Audit.
1=
NURSES REWARDS AND FINES FUND
STATEMENT OF RECEIPTS AND PAYMENTS FOR THE YEAR ENDED 31ST MARCH, 1960
Description
Amount
*
RECEIPTS
To Balance brought forward (on deposit with Accountant General)
+1-
1,000.67
$1,000,67
Description
PAYMENTS
Amount
$
By Purchase of prizes, certificates, etc. for the year 1960
JL+
Nit
Balance carried forward (on deposit with Accountant General)
---
1,000.67
$2,000.67
Certified correct.
(Sgd.) G. AGABEC,
for Director of Medical & Health Services.
23. 5, 60.
(Sgd.) M. A. GRANT,
Principal Matron, Medical & Health Department.
23. 5. 60.
* Note: Expenditure on the Prize Giving Ceremony held on 18th February, 1960 at the Queen Mary Hospital was met from funds provided under Head 17 Subhead 20(6). The amount on deposit will be used in 1960/61.
The above statement has been examined in accordance with Condition 5 of the Schedule to Legislative Council Resolution dated 24th May, 1950 (G.N. No. A. 115 of 26th May, 1950). I have obtained all the information and explanations that I have required, and I certify, as a result of this audit, that in my opinion the statement is correct.
AUDIT DEPARTMENT,
Hong Kong, 10th June, 1960.
(Sgd.) W. J. D. COOPER, Director of Audit.
ISLAND MEDICAL FACILITIES
27
+36
HONGKONG
1. Ling Yuet Sin Infants' Hospital.
2.
Li Sing Primary School Clinic.
3.
Tean Yuk Hospital (a maternity hospital).
4. Mental Hospital.
5.
A
HONG KONG ISLAND
Sai Ying Pun Hospital (infectious diseases) and Out- patient Department (general outpatient with special clinics).
6. Tung Wah Hospital (a general hospital, with outpatient department and special clinice).
20. Violet Peel Polyclinic (general outpatient facilities with special clinics and an ophthalmic centre).
21. Ruttonjee Sanatorium (a tuberculosis bospital). Wan Chai Social Hygiene Hospital (a hospital for venereal and dermatological treatment).
22.
23. Harcourt Health Centre (a school health, maternal and child health centre and a male social bygiene clinic).
St. Paul's Hospital (a general hospital}.
24.
7. Alice Ho Miu Ling Nethersole Hospital (a general hospital).
25.
Tung Wah Eastern Hospital (a general hospital and outpatient department),
B. Port Health Inoculation Centre.
26.
St. John Ambulance Brigade Centre.
9.
Central District Health Centre (general outpatient facilities, Maternal and Child Health Centre and special clinics).
27.
Mount Butler Quarry Clinic.
28.
10. Police Medical Post (general outpatient and dental facilities for police officers and their families).
29.
30.
North Point School Clinic and Maternal & Child Health Centre.
North Point Health Centre (an outpatient department). Shau Kei Wan Public Dispensary (general outpatient facilities with special clinics).
Chai Wan Clinic and Maternal & Child Health Centre. Stanley Prison Hospital.
11. Port Health Inoculation Centre, Fung House.
12. Hong Kong Central Hospital (a general hospital).
31.
13. Hong Kong Families Clinic (general outpatient facilities for English-speaking Government servants and their families).
32.
33.
Stanley Dispensary & Maternity Home (general out- patient facilities and maternity home).
14. Military Hospital (a general hospital).
34.
Grantham Hospital (a tuberculosis hospital).
15.
St. Francis Hospital (a general hospital).
35.
16. Eastern Dispensary and Maternity Hospital (a mater- nity home with general outpatient facilities).
Aberdeen Public Dispensary (general outpatient facil- ities, with special clinics).
36.
Matilda Hospital (a general hospital).
17.
Wan Chai Clinic (a dental centre, tuberculosis clinic, and physiotherapy department),
37.
Naval Hospital (a general hospital).
38.
18. Hong Kong Sanatorium & Hospital (a general hospital).
19.
Medical Examination Board.
39. Sandy Bay Convalescent Home (an orthopaedic
bospital for children).
Queen Mary Hospital (an acute general hospital with casualty department).
Lai Chi Kok
Shom Shui Pol
Mong, Kok
Yau Ma T
Trim Sha Taul
KOWLOON PENINSULA MEDICAL FACILITIES
"Kowloon City.
Hung Hom
victori#
Kowloon
Boy
North Point
| 2
B
KOWLOON
40. Lai Chi Kok Hospital (an infectious diseases and
convalescent hospital).
41. Female Prison Hospital.
42. Li Cheng Uk Clinic (general outpatient facilities).
43.
Shek Kip Mei Health Centre (general outpatient facilities with special clinics, a chest clinic and maternal & child health centre).
14. Tai Hang Tung Clinic (general outpatient facilities), 45. Precious Blood Hospital (a general hospital).
53. Ashley Road Social Hygiene Clinic (a male treatment centre for venereal disease).
54. Kowloon-Canton Railway Staff Clinic (general out- patient facilities for Railway staff and their families and a dental clinic).
55. Tsim Sha Tsui Health Centre (a school health, maternal & child health centre, including a female social hygiene clinic and port health inoculation centre).
56. Hung Hom Clinic & Maternity Home (general out- patient facilities with special clinics and maternity home).
57. Ho Man Tin Maternal & Child Health Centre.
16. Sham Shui Po Public Dispensary (general outpatient facilities with special clinics).
58.
59.
47. Mong Kok Clinic (general outpatient facilities).
48. Government Ophthahnic Clinic-Arran Street (an ophthalmic centre).
49. Queen Elizabeth School Clinic.
60.
50. Kwong Wah Iospital (a general hospital and infirmary with outpatient department).
61.
51.
Yau Ma Tei Public Dispensary (general outpatient facilities).
52. Kowloon Police Medical Post (general outpatient and dental facilities for police officers and their families).
Kowloon Chest Clinic (a tuberculosis clinic). Kowloon Hospital and Outpatient Department (an acute general hospital with casualty department and outpatient department with special and dental clinics}.
St. Teresa's Hospital (a general hospital).
Kowloon Families Clinic (general outpatient facilities for English-speaking Government officers and their families).
62. Li Kee Memorial Dispensary (general outpatient facilities with special clinics and a dental clinic).
63. Ngau Tau Kok Maternal & Child Health Centre.
T
...
T
COLONY OF HONG KONG
MEDICAL FACIUMES
WHITE JIL
P
HONG KONG AND THE NEW TERRITORIES
M
DEEP BA
QUE HA CANI
UN TIM
CASTLE HEAL
EX
LANTAU
LA
+
LOGO TELANDI
The Ke
TUEN LOW
ML HTT
HEALING CHA
Γ
NE CHAN
1
Bị En H
FRA K
TAI PO
Harbau
11CWLCUT FLO
Victoria
1
C
NEW TERRITORIES
64. Sha Tau Kok Dispensary (general outpatient facilities with maternity beds).
65. Ho Tung Dispensary (a maternity home with convalescent beds).
66. Pok Oi Hospital (a general hospital).
67. Yuen Long Dispensary (general outpatient facilities with special clinics).
68. Castle Peak Hospital (a mental hospital).
69.
San Hui Dispensary (a maternity home, with special clinics).
70. Maurine Grantham Health Centre (general outpatient facilities with special clinics and a Maternal & Child Health Centre).
71. Sha Tin Maternity Home,
72.
H.K. Jockey Club Clinic, Tai Po (general outpatient facilities, special clinics including a dental clinic and maternity beds).
73. Sai Kung Dispensary (general outpatient facilities, special clinics and maternity heds).
74.
Haven of Hope Tuberculosis Sanatorium.
75. Canaan Convalescent Home.
76. Peng Chau Clinic (general outpatient facilities and special clinics with maternity beds). 77. Ilei Ling Chau Leprosarium,
78. North Larnma Clinic (general outpatient facilities with maternity beds).
79. St. John Hospital (a general hospital and outpatient department with special clinics).
80. Silver Mine Buy Dispensary (general outpatient facilities with maternity beds).
81. Tai O Dispensary (general outpatient facilities, with special clinics and maternity beds). 82. Shek Pik First Aid Post.
די
awilonarjit
APPENDIX I
ESTABLISHMENT OF THE MEDICAL & HEALTH DEPARTMENT AS AT 31.3.60
Director of Medical & Health Services
---
---
---
117
---
---
יו.
---
---
---
---
---
---
J
:
:
..
---
--
---
- PI
---
FI
---
LII
J
L
Deputy Director of Medical & Health Services Assistant Director of Medical Services Assistant Director of Health Services Assistant Director of Health Services (U.S.D.) Principal Medical Officer Principal Health Officer
LL.
PIL
Senior Radiological Specialist Senior Tuberculosis Specialist Senior Dental Specialist
LLL
Senior Social Hygiene Specialist
Senior Peychiatric Specialist Ophthalmic Specialist
Dental Specialist
LLL
Anaesthetic Specialist
Medical Specialist
---
JL-
---
LLI
LII
PII
---
--
J
LII
Fr
-
PPI
Radiological Specialist
Surgical Specialist
---
LLI
Tuberculosis Specialist
Orthopaedic Specialist
---
11-
Obstetrical & Gynaecological Specialist
Ear, Nose & Throat Specialist
Government Pathologist
Chief Port Health Ofeer ..
---
---
LII
---
ייו
JOL
י..
:
100
rr.
:
:
717
LL.
---
!
JIL
---
rrr
5
2
1
---
I
-
---
LLL
IIL
J--
LII
107
1
---
[11
---
LLL
-יו
IL
--L
Pri
11-
.-.
LII
---
1
L
↓
1
J
1
LII
...
LLI
JJJ
L..
L-I
Maluriologist
Senior Forensic Pathologist
11-
---
---
1
17-
ггг
1
Medical Officer, Assistant Medical Officer, Woman Medical Officer, Assistant Woman Medical
Officer and House Officer
Dental Surgeon and Assistant Dental Surgeon
LII
382
LII
31
Pathologist
Radiologist
Government Chemist
LL-
---
---
Chemist, Assistant Chemist, Biochemist and Assistant Biochemist Principal Matron Scientific Officer
110
...
Nursing Staff
LII
ILL
Dietitian
11-
-
---
Principal Almoner
JJL
+
---
--
:
*
1
LIL
JJ J
LLI
E
10
17-
LLI
LLI
1
rui
E
:
E
1
E
1,623
LIL
IPL
19
:
:
Almoner Class I and Almoner Cluer Il
Executive Grade Oficer
Clerical St.
---
.
---
---
Irr
LLI
PPI
---
J
ייי
1
48
14
rri
271
117
JJJ
89
26
Chief Pharmacist, Pharmacist. Dispenser and Dispensary Supervisor Superintendent Radiographer, Senior Radiographer, Radiographer and Assistant Radiographer Superintendent Physiotherapist, Physiotherapist and Assistant Physiotherapist Physicist Occupational Therapist
J
---
-
---
...
-
---
Chief/Senior Medical Technologist and Medical Laboratory Technician Senior Laboratory Assistant and Laboratory Assistant
Chief Hospital Secretary and Hospital Secretary
Health Inspector and Malaria Inspector
Senior Inoculator and Inoculator
Surgical Appliance Technician
Other Staff
LLI
---
ILL
│
Pri
JIL
-I.
---
ILI
Pri
68
10
ILL
LLI
---
PIL
---
PII
33
70
!
ILL
---
LII
:
E
Total:
107
E
1 2,788
5,656
119
120
APPENDIX 2
STATEMENT OF EXPENDITURE FROM 1950/51 TO 1959/60
І
1
Particulara
1950/51
1951/52 1952/53 1953/54 1954/55
1955/56 1956/57 1957/58 1958/59 1959/60
mcat
(a) Medical and
Health Depart
---
|
|
11,974,333
15,761,891 21,338,770 23,704,484 25,105,401 27,002,383 30,018,868 34,864,883
34,864,883, 39,792,298; 45,925,081
(b) Medical Subven- tions
་་་
(c) Capitul expendi- ture on medical
projects under Public Works Non-Recur-
Tent
Totul
3,427,329 4,238,183 4,543,185
5,550,973 6,281,573 6,185,682 7,411,263 9,706,931 14,178,093 18,988,124
|
264,865
312,715
210,672 1,297,135 3,639,250 1,779,424 1,706,233 1,408,976 5,755,291 15,442,311
!
15,666,527 | 20,312,789 | 26.092,627 30,552,592 | 35,026,224 34,967,489 | 39,166,364 | | 45,980,790 59,725,612 80,355,816
APPENDIX 3
NOTIFIABLE DISEASES
REPORTED CASES AND DEATHS 1958 AND 1959
No. of Notifications
Diseases
Cholera
ILJ
Plague
Smallpox
---
---
717
---
1958
No. of Deaths
1959
1958
1959
Yellow fever
Relapsing fever
++
+4+
Typhus (epidemic louse-borne)
Typhus {
Urban
{ Scrub
Amoebiasis
Dysentery
171
זיי
Bacillary Unspecified
Enteric fever { Typhoid
Poliomyelitis
Chickenpox
Paratyphoid
---
--
Cerebrospinal meningitis
ILL
---
171
1
1
I
262
239
12
18
LJL
L
423
662
24
25
1
1
1
1
783
970
31
31
---
33
27
3
1
262
86
41
20
278
278
3
3
...
28
25
17
17
Diphtheria
---
100
1,555
2,087
134
116
Mendles
Scarlet fever
1
Whooping cough
Puerperal fever
*Ophthalmia neonatorum
786
743
191
176
--
---
---
10
24
177
197
110
2
2
---
4
1
JL.
105
244
-
Human
--
Rabies
Animal
---
Malaria
Tuberculosis
---
Total
■
11
0
0
659
442
1
1
13,485
14,302
2,302
2,170
18,872
20,241
2,762
2,589
Ophthalmia neonatorum was declared notifiable in June 1958.
121
APPENDIX 4
ANTI-EPIDEMIC PROPHYLACTIC IMMUNIZATIONS 1958 AND 1959
Immunological Procedure
1958
1959
...
---
564,244
1,034,138
---
93,155
36,245
109,336
223,209
...
--
90,396
144,118
42,330
63,582
Anti-Smallpox Vaccination
Anti-Cholera Inoculation
Anti-Diphtheria Inoculations:
lat Dose
2nd Dose
Booster Dose
Anti-Typhoid Inoculations;
Ist Dose
2nd Dose
Booster Dose
Anti-Plague Inoculation
Anti-Typhus Inoculation
Anti-Rabies :
1st Dose
Other Doses
Lar
P
|
103,381
141,342
70,833
101,174
... |
95,044
92,712
236
205
1.082
1,597
...
3,046
3,517
12,266
13,872
Anti-Tuberculosis (B.C.G.) Vaccinations:
Tafants
Others
- 17
J
...
122
49,865
62,261
10,390
8,518
APPENDIX 5
NUMBER OF HOSPITAL BEDS IN HONG KONG 1959
-
GOVERNMENT HOSPITALS :
Eastern Maternity
Wan Chai Social Hygiene
St. Joha
---
36
· Pr
Medical Surgical
Gynaecol- Tuber- ogical culosis
Mental
Maternity
Infectious
Observa-
Total
tion
Queen Mary
---
---
Kowloon
---
---
---
Mental
Castle Peak
--L
Sai Ying Pun
Tran Yuk...
Lai Chi Kok
329
46
40
123
20
140
120
TH
ILI
11
TRI
TGI
47
206
14
11189
88
200
120
T
24
22
cota
4 cradles
15
&
37
14
601
82
7
12
339
140
120
88
200
475
24
30
100
Stanley Prizon
огг
Lai Chi Kok Female Prison
יו.
GOVERNMENT-Assisted HOSPITALS:
+
Tung Wab
Tung Wah Eastern
† Kwong Wab
---
PII
Alice Ho Miu Ling Nethersole
The Hong Kong Anti-T.B.
Ruttoajan Sanatorium
111
22
22
20
г гт
82
11
1
13
440
581
80
198
260
359
268
26
2.212
217
151
217
49
163
42
16
49
280
139
---
20
60
48
160
62
---
+ 82
49
14
elation,
336
Grantham
Pok Di
---
540
PIL
---
40
יי
111
Hei Ling Chau Leprosarium
---
Haven of Hope T.B. Sanatoriumi Sandy Bay Convalescent Home
PRIVATE HOSPITAL
Hong Kong Sanatorium & Hospital
Precious Blood
210
**38 ||9||
10
22
652
336
659
187
336
540
50
540
540
210
54
54
762
468
93
1,426
347
568
3,664
Frr
701
98
20
31
43
14
316
34
10
ST
St. Teresa's
St. Francia
LLL
St. Paul'..
-LL
Hong Kong Central Ling Yuet Sio Infants'
---
I
---
10
Matilda & War Memorial Canaan Convalescent Home
---
20
10
10
17
ггг
10
+++
34
30
30
10
98
5
20
15
70
| BGEX | 54
108
95
70
172
90
15
12
120
182
32
439
224
50
222
130
28
1,093
123
124
APPENDIX 5-Contd.
Medical
Surgical
Gymancol. Tuber- ogical culosia
Mental Maternity
Infectious
Observa-
tion
Total
PRIVATE MATERNITY HOMES!
Private NuRDING HOMES:
58
GOVERNMENt DispensARIES AND MATERNITY HOMES:
527
527
58
ILL
Sha Tau Kok
...
Ho Tung
Sai Kung
Tai 0
Soo Hui
LLI
Stanley
J-L
Hong Kong Jockey Club Clinic, Tai Po..
Yuen Long
---
6
6
25
27
宁
3
Ģ
13
יי!
7
---
15
---
...
+
3
Sha Tin Maternity Home
Silver Mine Bay Maternity Home
Maurine Grantham Health Centre
North Lamm. Clinic
4
---
9
6
26
26
6
Peng Chan
7
---
J
Hung Hom
---
LLI
14
14
13
135
148
GOVERNMENT HOSPITALS
GOVERNMENT-ASSISTED Hospitals
440
581
111
80
198
260
359
268
26
2,212
762
468
93
1,426
347
568
3,664
PRIVATE HOSPITALS
439
224
---
50
222
130
28
1,093
PRIVATE MATERNITY HOMES
527
527
...
...
PRIVATE Nuasive Homes
58
58
---
GOVERNHENt DispensANIES AND
MATERNITY HOMES
13
---
-
---
135
148
GRAND TOTAL
---
1,712
1,273
223
1,846
260
1.498
864
26
7,702
• Including 86 T.B. beds in Infirmary, Sandy Bay,
† Including 125 beds (i.e. 40 Med. & 85 Surg.) in Infirmary at Kwong Wah Hospital.
Jncluding 43 beds used for either medical or surgical cases.
Syphilis:
Primary
125
APPENDIX 6
ANNUAL INCIDENCE AND TREND OF VENEREAL DISEASE
1951
1952
1953
1954
1955
1956
1957
1958
1959
562
672
634
393
153
93
17
Y
19
Secondary
301
180
132
54
34
20
3
9
Early Latent
1,101
882
2,298
2,209
1.044
733
450
417
426
Late Latent
1,038
1,275
2,727
3,983
2,853
2,616
2,532
2.766
2.038
All Others
213
207
178
186
148
166
184
177
188
Gonorrhoea
6,903
8,546
11,625
10,785
11,309
10,609
8,281
8,360
8,362
Non-gonococcal Urethritis
870
770
869
776
800
644
481
Chaneroid
2,347
2,400
---
2,507
2,365
2,468
1,614
685
294 |
324
Lymphogranuloma Venereum.
197
111
208
286
249
140
178
91 i
53
Non Venereal Disease
...
1,643
4.508
7,708
7,150
6,623
6,245
5,855
5,458
4,997
APPENDIX 7
CLASSIFICATION OF DERMATOLOGICAL CASES 1958 AND 1959
Diagnovis
Total No. of Cases 1958
Percentage
Total No. of Cases 1959
Percentage
Lichen Plaous
21. Lupus Erythematous
Neurodermatitis
22.
Moniliasis
23.
24.
Porphyria
25.
26.
Pediculosis
27.
Perionychia, Whitlow
Pemphlolyx
28. Prickly Heat
Eczema-Miscellaneous
13. Exfoliative Dermatitis 14. Erythema Multiforme
15.
Erythema Nodosum
16. Herpes Zoster
17. Ichthyosis, Xorosis
18. Impetigo
19. Leprosy
20.
+
L.
Abrasions
2.
Acne
3.
+--
Alopecia Areata
+
---
4.
Boils, Folliculitis...
5.
Carcinoma
6.
Contact Dermatitis
7.
Dermatitis due to Clogs.
8.
Eczema Atopic...
9.
Eczema Infantile
10.
Eczema-Infective
11.
Eczema Scrotum
12.
22
0.64
110
1.09
---
T10
21
0.62
66
0.65
19
0.54
41
0.41
ггт
516
L
---
14,69
1,566
15.65
7
0.20
22
0.22
---
--
604
17.19
1,667
16.66
17
0.48
59
0.59
9
0.25
47
0.47
H
---
172
LIE
4.90
453
4.53
137
3.90
215
2.15
10
0.30
64
0.64
1
חוז
285
8.11
:
695
6.95
ILJ
717
8
0.08
TII
20
0.57
26
0.26
J-P
10
0.30
10
0.10
5
0.14
33
0.33
3
0.09
9
0.09
LTI
17
-
--
365
10.39
671
6.71
75
2.13
135
1.35
--
4
0.11
12
0.12
---
སྐ
17
0.48
39
0.39
7
0.20
0.09
+-
ILI
105
2.99
463
4.63
---
1
0.03
0.01
--
4
0.11
15
0.15
---
F
|
68
0.68
5
0.14
34
0.34
36
1.03
128
1.28
гто
29.
Pruritis
J
91
2.59
250
2.50
-г г
JJL
Scleroderma, Sclerodactyly Tuberculosis of Skin
35.
36.
37. Scabies
38.
39.
40.
་
41.
42.
43.
Warts
44.
45.
Leucoderma
Undetermined (Not Classed)
Urticaria ...
Varicose Dermatitis/Ulcer
---
Seborrhoeic Dermatitis
30. Peoriasis
31.
32.
Purpura
---
JIL
Ringworm of Scalp
33. Ringworm of Body
34. Ringworm of Groins
Ringworm of Feet and Hands
Rosacea
---
39
1.11
73
0.73
7
0.20
11
0.11
13
0.37
37
0.37
27
0.77
137
1.37
ILI
12
0.34
50
0.50
94
2.67
247
2.47
4
0.11
14
0.14
+
J
38
1.08
225
2.25
---
7
0.07
27
0.77
36
0.36
---
497
14.15
1,554
15.54
34
0.96
118
1.18
---
JLJ
49
1.42
118
1.18
27
0.77
196
1.96
TII
---
43
1.22
107
1.07
J
32
0.94
158
1.58
-TI
TII
---
126
APPENDIX 8
IN-PATIENTS TREATED IN GOVERNMENT AND GOVERNMENT ASSISTED HOSPITALS, 1959 CLASSIFIED ACCORDING TO INTERNATIONAL STANDARD CLASSIFICATION
INTERMEDIATE LIST OF 150 CAUSES
Cases Treated
Deaths
Deaths
Inter-
mediate
List
Detailed
List
Number
Number
Cause Groups
Govern-
Govern
Govern-
Govern
Whole Colony
meat
meat
Assisted
weat
ment
Hospitals
Hospitals Hospitals
Assisted
Hospitals
Male
Female
¡Sex Une
known
Total
A
A 2
-~
001 - 003
Tuberculosis of respiratory system...]
876
3,834
61
814
1,246: 4451
1,691
010
Tuberculosis of meninges and
A
***
3
011
A
012-013
A
5
: 014 - 019
...
central nervous system Tuberculosis of intestines, peri- toneum and mesenteric glanda Tuberculosis of bones and joints Tuberculosis, all other forms
108
554
30
346
224
199
423
19
31
1
5
6
12
102
503
1
11
6
16
98
131
10
21
24:
36
A
◊
020
Congenital syphilis
JLL
--
10
...
A
7
021
Early Syphilis...
5
--
TII
A 8
024
Tabes dorsalis...
---
14
y
2
3
A 9
025
General paralysis of insane
129
7
17
1
17
---
18
A 10
· 022 - 023
All other syphilis
r
62
34
7
6
I
I+I
56
026 - 029
A 11
030 - 035
A 12
040
Typhoid fever...
A 13
041-042
A 14
043
Cholera
A 15
044
Gonococcal infections
Paratyphoid fever and other
Salmonella infections
Brucellosis (undulant fever).....
267
---
487
I-I
304
6
21
13
།༤
1
31
i
22
1
2
N
.T.
ז.!
LJ J
A 16 (a)
045
Bacillary dysentery
324
32
3
-- L
20
25
---
(8)
046
Amoebiasis
---
107
28
-- J
8
12
18
(3)
047 - 048
Other unspecified forms of dysentery
10
1
1
A 17
050
Scarlet fever
18
...
Carried forward.....
• Including I death from A114(c)
2,658
$,471
145
1,238 1,629
703
2,332
127
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
Detailed
List
List
Number
Cause Groups
Covero-
Deaths
Govern.
Deaths
Number
Govern-
ment
Govern-
Whole Colony
10000
*02:00
Hospitals
Assisted
Hospitals
Hospitals
ment
Assisted
Hospitals
Male · Female
Sex UA-
koown
Total
Brought forward...
2,658 5,471
145 1,238
1,629
703
2,332
A 18
051
Streptococcal sore throat
4
A 19
052
Erysipelas
---
LII
A 20
053
A 21
055
Diphtheria
A 22
056
A 23
057
Septicaemia and pyaemia
---
Whooping cough
Meningococcal infections
60
79
46
41
$5
37
92
---
1,930
16
116
55
61
116
7
1
2
LIJ
10
+
LO
17
A 24
058
Plague
---
JL+
100
-
A 25
060
Leprosy
71
...
--
661
A 26
061
Tetanus
143
35
110
---
A 27
062
Anthrax
།ཤྩ།
|
2
87
---
A 28
080
A 29
082
A 30
081, 083
Acute poliomyelitis
Acute infectious encephalitis
Late effects of acute poliomyelitis
and acute infectious encephalitis..
83
1
16
тиг
20
5
1
3
A 31
084
Smallpox
ILJ
יי
+r
A 32
085
Measles
---
IL
252
A 33
091
Yellow fever
LLL
---
A 34
092
Infectious hepatitis
JIL
- 11
A 35
094
Rabies...
ཡ།།༄།
12
30
68
59
13
75
101
176
46
18
3
7
12
+
110
A 36
36 (a)
(6)
(c)
(
A 37 (0)
$3000
100
101
104
105
Mite-borne typhus
102 - 103
106 108
110
Louse-borne epidemic typhus
Flea-borne epidemic typhus (murine) Tick-borne epidemic typhus...
Other and unspecified typhus
Vivax malaria (benign tertian) Carried forward...
15
28
---
5,296
6,415
454
1,335
1,898
96 LI
2,859
128
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
Detailed
List
Number
List
Number
Cause Groups
Govern-
ment
Hospitals
Govern
ment
Assisted Hospitals
Deaths
Govern-
|
Govern-
Deaths
Whole Colony
ment
Elospitals
meat
Ansisted
Hospitals
Mate
Female Sex UD-
Totol
5,296
6,415
454 ! 1,335
1,898
961
known
| 2,859
---
1
1
A 37 (6)
(c)
(e)
A 38 (4)
99 00 0
111
112
Malariae malaria (quartan)
(d)
115
116, 117
123.0
(b)
123.1
129
224
(<)
123.2
(d)
123.3
113, 114
Brought forward...
Falciparum malaria (Malignant
tertian)
Blackwater fever
4++
Other and unspecified forms of
malaria
Schistosomiasis vesical (S. Haema- tobium)
---
Schistosomiasis intestinal (S. Man- soni)...
Schistosomiasis pulmonary
(S. Japonicum)
Other and unspecified schis-
tosomiasis
...
---
---
+
7
19
A 39
125
Hydatid disease
JIL
LJI
A 40 (0)
3000
127
Onchocerciasis
L4
127
Loiasis...
127
Filariasis (bancrofti)
PIP
127
Other filariasis
A 41
129
Ankylostomiasis
A 42 (0)
(c)
0 €00
126
cestode infestations
130.0
Ascariasis
1. P
130.3
(d)
124, 128
Tapeworm (infestation) and other
Guinea Worm (dracunculosis)
Other diseases due to helmintha
---
A 43 (0)
130.1, 130.2
037
Lymphogranuloma venereumn
+
Carried forward.......
2
-
1
|
1
HI
I
6
18
28
1
26 |
46
6
1918
30
5,382 6,528
454 1,336 1,900 963
2,863
1
130
Inter-
mediate
List
Number
Detailed
List
Number
Cause Groups
APPENDIX 8-Contd.
Cases Treated
Govern-
Deaths
Covero-
Govern-
Govern-
Deaths
Whole Colony
西
mtot
Hospitals
Hospitals
went Assisted Hospital
meat
Assisted
Hospitals
Male
Female
Total
known
(m)
possess
SO BOC
A 43 (6)
038
039
049
071
072
073
Yawe
087
Chickenpox
---
090
Dengue
095
Trachoma
---
096.7
Sandfly fever
---
120
---
Brought forward...
Granuloma inguinale, venereal
Other and unspecified venereal diseases, Food poisoning infection and intoxication Relapsing fever
Leptospirosis icterohaemorrhagica (Weil's disease)
---
---
LI
5,382
6,528 454 1,336 1,900 963
2,863
+r
1
13
4
I
4
| |
E
T
+1.
45
15
FF
---
IIT
L
Leishmaniasis
121 (a) Trypanosomiasis gambiensis. (b) Trypanosomiasis rhodesiensis
(n)
131
135
(e) Other and unspecified
trypanosomiasis
Dermatophytosis
Scabies
(p),036,054,059, All other diseases classified as
|063,064,070. infective and parasitic
[074,086,088,
:
55
41
2
6
..
•_ | | |_
5
3.
089,093,
096.1,096.6.
096.8,096.9,
[122,132-134,
136-138
Carried forward...
5,506
6,588
458
1,342 1,909
969,
| 2,878
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate Detailed
Deaths
List
Number
List
Number
Cause Groups
Govern-
Govern-
ment
Govern-
Hospitals
ment
Assisted
Hospitale
ment
Hospitals
Gover
ment
Assisted
Hospital
Deaths
Whole Colony
Male
Female
Sex Un-
known
Total
Brought forward...
5,506 6,588
458
1,342 || 1,909! 969
E
2,878
A 44
140-148 Malignant neoplasm of buccal
cavity and pharynx
125
216
---
A 45
150
A 46
151
Malignant neoplasm of oesophagus... Malignant neoplasm of stomach
73
47
90
192
INN H
21
129 | 141
73
214
21
19
52
19
71
19
104
113
117
230
A 47
152 - 153
Malignant atoplasm of intestine, except rectum
---
57
112
4
62
64
56
120
A 48
A 49
154
161
A 50
162 - 163
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... Malignant neoplasm of other and
---
unspecified parts of uterus
66
53
4
LI-
22
23
22
45
12
17
3
---
4
12
2
14
97
116
21
TH
A 51
170
100
72
3
- &
75
126
76
37
08
A 52
171
270
136
7
81
133
| | !
202
88
133
A 53
172 - 174
46
113
23
|
53
53
A 54
A 55
177
190 191
A 56
| 196 - 197
Malignant neoplasm of prostatę Malignant neoplasm of skin Malignant neoplasm of bone and
5
3
- L
L
S
5
L. J
8
7
3
1
6
A 57
· 155 - 160
164 - 165
connective tissue
---
Malignant neoplasm of all other
and unspecified sites
32
17
4
9
9
15
24
300
462
100
274
368,
1831
551
175 - 176
178 - 181
192 - 195
-
198 199
A 58
204
Leukaemia and aleukaemis.......
-+-
75
36
25
24
40 27
67
Carried forward.......
+
... 6,870
8,187
694!
2,209
2,863 1,838
4,701
131
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
List
Number
Detailed
List
Number
Cause Groups
Govero-
ment
Hospitals
Govern-
ment
Assisted
Hospitals
Deaths
Govern-
Gover
Deaths
Whole Colony
ment
Hospitals
ment
Assisted
Hospital
Malc Female
Sex Un-
known
Total
6,870 8,187
694
2,209
2,863 1,838
4,701
A 59
200 - 203
205
A 60
210 - 239
A 61
250 - 251
Brought forward...
Lyinphosarcoma and other neoplasms of lymphatic and
haematopoietic system Benign neoplasms and neoplasms
of unspecified nature
Nontoxic goiter
LJ J
62
18
14
7
18
14
32
LJI
L
J.L
921
379
13
7
12
16
28
63
12
---
---
L
A 62
252
Tyrotoxicosis with or without goiter;
151
53
I
12
12
A 63
260
Diabetes mellitus
157
74
4
19
21.
40
JIL
A 64 (2)
280
Beriberi
17
7
1
4'
LT).
7
...
..
132
32
281
Pellagra
LI
---
(c)
282
Scurvy...
1
...
(d)
283 286
A 65 (a)
7
290
LLJ
(b)
291
(c)
292 - 293
Other deficiency states
Pernicious and other hyperchromic
anneming
Iron deficiency anaemias (hypochromic)
Other specified and unspecified
45
197
28
24
30
+
ILJ
0
5
1
I
LI
17
26
2
2
A 66 (0)
241
anaemias
Asthma
206
150
16
16
18
14
32
10+
LLJ
136
489:
2
7
43-
27
70
280
---
---
(b)
240.
242 - 245
253, 254,
270-277
All other allergic disorders,
endocrine, metabolic and blood diseases
...
I
377
121
21
5
14 14
28
287 - 289.
294- 299
Carried forward...
9,029
9,718
767 2,292 3,015: 1,968
4,983
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
List
Number
Detailed
List
Number
Cause Groups
Govern.
Goveza-
ment
ment
Deaths
Govern-
Govern-
Deaths
Whole Colony
ment
Hospitals
Assisted
Hospitals
Hospitals
mest
Assisted
Hospitals
Male
Female
1Sex Un
kaowa
Total
Brought forward...
9,029
9,718
767
2,292 3,015 1,968
A 67
300 - 309
Psychoses
IIT
ITI
· · ·
1.602
1
⚫ 30
1
2
4,983
2
A 68
310 - 324
Psychoneuroses and disorders of
326
personality
508
80
† 1
A 69
325
Mental deficiency
41
22
P.I
# 1
4
A 70
330 - 334
Vascular lesions affecting central
nervous system
391
1,069
215
580
607
535
1,142
A 71
340
Nonmeningococcal meningitis
67
43
25
23
32
16
48
A 72
345
Multiple sclerosis
---
|
I'
1
A 73
353
Epilepsy
143
35
1
3
A 74
370 - 379
-
Inflammatory diseases of
eye
17
24
1
1
T
I
A 75
385
Cataract
154
145
A 76
387
Glaucoma
...
..
-- L
L+
23
48
A 77 (0)
390
Otitis externa.......
L+
4
3
(6)
391 - 393
Otitis media and mastoiditis
80
111
1
(c)
394
A 78 (0)
alex
380 - 384,
| 386, 388,
Other inflammatory diseases of ear. All other disease and conditions
6
34
310
47
| 389
!
Carried forward...
Among there-2 died of Al 3 died of AP
12,375
11,380
1,041
2,900
3,660 2,526
6,186
2 died of ABI
1 died of A82
1 died of A12
1 died of A55
2 died of AST 1 died of A60
1 died of A85 1 died of A89 6 died of A90
† died of A44
† died of Aló(a)
died of A70
Y
1 died of A95
3 died of ATO
2 died of A97(5)
133
1 died of A78(6)
2 died of A109
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
List
Number
Deaths
Detailed
List
Number
Cause Groups
Govern-
Govern.
Govero-
10000
ment
ment
Hospitals
Assisted
Hospitals
Hospitals
Goveru-
ment
Assisted
Hospitals
Deatha
Whole Colony
Male
Famelo
Sex Un-
known
Total
Brought forward...
12,375
11,380 1,041
2,900 3,660 2,526
| 1,660
6,186
A 78 (5) 341 - 344. |
350 - 352,
All other diseases of the nervous system and sense organs
327
156
24
8
23
24'
47
---
354 - 357,
360 - 369,
395 - 398
A 79
400 - 402
A 80
410-416
A 81
420 - 422
A 82
430 - 434
A 83
440 - 443
Rheumatic fever
Chronic rheumatic heart disease
Arteriosclerotic and egenerative heart disease
Other diseases of heart Hypertensive heart diseases
98
88
5
1
6.
6
12
---
422
321
44
85
95
144
239
---
112
349
28
139
417
316
733
...
227
896
35
178
179
162'
341
143
317
14:
95
149
102,
251
A 84
444 - 447
A 85
450 - 456
! Other hypertensive disease Diseases of arteries
тог
107 |
325
12
43
68
62!
130
89
--T
P10
193
11
12
72.
40:
112
A 86
460 - 468
A 87
470 - 475
A 88
480 - 483
Other diseases of circulatory system' Acute upper respiratory infections... Influenza
202
637
3
3
2
4
6
770
1,185
6
4
5'
5
10
98
267
1
11
14'
25
L+
+
IIT
A 89
490
Lobar Pneumonia
63
322
11
26
93
41
1
135
A 90
491
Bronchopneumonia
718
3,683
261
1,956
1,988
1,743
1
3,732
A 91
492 - 493
Primary atypical, other and
A 92
500
Acute bronchitis
A 93
501 - 502
A 94
510
|
a denoids
A 95
518, 521
unspecified pneumonia
---
Bronchitis, chronic and unqualified. Hypertrophy of tonsils and
---
...
Empyema and abscess of lung
97
309
23
13
52
36'
88
114
205
4
11
15:
15:
30
...
101
519
5
77
102'
921
194
378
53
гг.
96
43
17
5
Ел
501
TII
Carried forward...
16,537 | 21,248 | 1,545 | 5,556 | 6,987 5,366
84
2 12,355
134
APPENDIX 8-Contd.
Cases Treated
Deaths
Inter-
mediate
Detailed
List
Number
List
Number
Cause Groups
Govern
107:00
Hospitals
Govern-
ment
Assisted
Hospitals
Govern-
Govern
Deaths
Whole Colony
ment
Hospitals
meat
Assisted
Hospitals
Male Female
Sex Un-
known
Total
Brought forward...
16,537
21,248
1,545 5,556
6,987 5,366]
2 12,355
A 96
519
Pleurisy
25
90
4
65
20
85
+L
A 97 (a)
523
Pneumoconiosis
---
(b)
-
511 517,
All other respiratory diseases
472
141
32
12
77
51!
128
520, 522,
524 - 527
A 98 (a)
530
Dental Caries
36
F
1
i
(5)
$31 - 535
All other diseases of teeth and
supporting structures
189
37
H
A 99
A 100
A 101
A 102
A 103
540
Ulcer of Stomach
586
688
11
29
56
15:
71
- - -
541
Ulcer of duodenum
481
13
12
9
31
38
--1
---
543
Gastritis and duodenitis
102
200
2
---
550 - 553
Appendicitis
1,156
462
3
1
6
Π
+
560 - 561
Intestinal obstruction and hernia
628
436
18
11
54
16
70
TEXTER
4
570
A 104(0)
571.0
(b)
$71.1
Gastro-enteritis and colitis,
between 4 weeks and 2 years
Gastro-enteritis and colitis, ages
316
2,363
61
979
621!
557
2 years and over
412
662
17
235
170:
191
...
(c)
572
Chronic enteritis and ulcerative colitis:
18
86
3
28
40
A 105
581
Cirrhosis of liver
312
223
70
99
191
---
7
A 106
584 - 585
A 107
536 - 539,
Cholelithiasis and cholecystitis Other diseases of digestive system.
196
125
1
D
---
9
1,061
1,134
126
63
139!
ུང་འཚ
1,178
361
19
59
56
247
18
27
230
542. 544,
545,
573. 580,
135
586, 587
Carried forward.....
22,527 28,268 1,900
7,034
8,448 6,414, 2 14,864
582 - 583,
APPENDIX 8-Contd.
Inter-
Cases Treated
!
nediate
Detailed
List
List
Cause Groups
Number
Number
Govern-
ment
Govern-
Deaths
Govern-
Govern-
Deaths
Whole Colony
Hospitale
meat
Assisted
Hospitala
meut
Hospital.
ment
Assisted
Hospitals
Mole Female
1
Sex Un-
known
Total
!
ד
Brought forward...
22,527 28,268 1,900 7,034 8,448 6,414
2 |14,864
A 108
590
Acute nephritis
119
155
$
13
15
19
34
A 109
591 - 594
Chronic, other and unspecified nephritis
---
JOL
110
671
20
116
187
151
338
A 110
600
A 111
A 112
610
Infections of kidney
602, 604 · Calculi of urinary system
Hyperplasia of prostate
18
++
15
11
6
17
274
171
2
6
y
18
4
1
11
11
A 113
620, 621
Diseases of breast
-- J
53
64
A 114(0)
613
Hydrocele
+++
.--
91
108
(5)!
634
(c)
601. 603
605 - 609
Disorders of menstruation All other diseases of the
genito-urinary system
216
209
J
-11
1,533
2,124
7
3
14
611-612
136
614 - 617
622 - 633
635-637
A 115
640 - 641
681 - 682
684
A 116
642, 652,
685, 686
Sepsis of pregnancy, child-birth
and the puerperium
Toxaemias of pregnancy and the puerperium ...
210
987
275
21
36
36
A 117
643 - 644
670 - 672
Haemorrhage of pregnancy and childbirth
F
...
487
668
2
11
24
24
A 118
650
Abortion without mention of
A 119
651
sepsis or toxaemia. Abortion with sepsis..
...
588
3,263
1
1
LLI
3
48
1
2
2
3
Carried forward...
...i 27,234
36,043
1,950 7,205 8,683 6,665
2 15,350
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
List
Number
Deaths
Deaths
Detailed
List
Number
Cause Groups
| Govers-
Govern-
mcnt
Govern-
Govern-
Whole Colony
ment
meot
ment
Hospitals
Assisted
Hospitals
Hospitals
Assisted
Hospitals
Male Female
Sex Un-
koowo
Total
Brought forward...
27,234 36,043
1,950
7,205 8,693 6,665
2 15,350
A 120(a) 645 - 649
(b)
673 - 680
683,
687 - 689
660
Other complications of pregnancy, childbirth and the puerperium
6,576 1,367
3
13
13
Delivery without complication
9.833 35,943
1
1
A 121
690 - 698
1
A 122
A 123
| 720 - 725
137
317
A 124
A 125
726 - 727
Infections of skin and
Arthritis and spondylitis Muscular rheumatism and
rheumatism, unspecified Osteomyelitis and periostitis Aukylosis and acquired
musculoskeletal deformities
Chronic ulcer of skin (including
tropical ulcer)
All other diseases of skin
subcutaneous tissue
939
821
23
21
28
49
90
251
1
2
5
7
י.
16
47
1
1
1
2
...
..
730
737,
745 - 749
F
A 126 (a)
715
(b)
700 - 714
716
|
(c) 731-736
All other diseases of
: 738 - 744
musculoskeletal system
324
42
2
I
1
2
A 127
A 128
751
754
Spina bifida and meningocele
5
+
1
اد
2
1
3
Congenital malformations of
:
circulatory system...
83
13
भ
27
&
32
31
63
A 129
750, 752,
753
All other congenital malformations.
228
219
47
52
80
50
130
!
760 - 761
762
A 130
A 131
| 755 - 759
Postnatal asphyxia and atelectasis.
Carried forward.......
Birth injuries...
26
3
19
8
25
13
38
518
125
16 |
95
190
103
293
46,516
75,288
2,081
7,401
9,044 6,924
2 15,970
154
52 !
1
4
8
33
इ ।
45
138
412 i
208
5
11
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
List
Number
Deaths
Deaths
Detailed
List
Number
Cause Groupe
Govern-
| ment
Hospitals
Govern-
ment
Amisted
Hospitals
Govern-
Govern-
ment
Whole Colony
Hospitals
Assisted
Hospitals
| Hale Female
Sex Un-
known
Total
Brought forward...
46,516 | 75,288
2,081 7,401 9,044 6,924
215,970
A 132(a)
764
Diarrhoea of newborn (under 4 weeks)
72
136
5
52
36
24
60
(b)
765
Ophthalmia neonatorum
H
24
2
(e) 763, 766-768 Other infections of new-born
156
110
17
76
204
136
340
A 133
770
Haemolytic disease of new-born
4
44
2
36
51
18
69
:
A 134
[769, 771,772| All other defined diseases of early
1
infancy
ILJ
305
138
47
+4
55
51
106
A 135
773 - 776
Ill-defined diseases peculiar to early infancy
491
718
127
464
427:
347
774
---
A 136
A 137 (0)
794
788.8
(5) 793
Senility without mention of psychosis
6
453
1
186
130
308
438
Pyrexia of unknown origin...
54
137
Observation, without need for
further medical care
380
860
(c) 780 - 787,
All other ill-defined causes of
788.1-788.7.
780.9,
789-792,
morbidity
349
164
B
30
ITI
714
603]
6 1,323
4
795
138
Carried forward...
48,357 78,050
2,288
8,289 10,661 8,411| 8 19,080
139
APPENDIX 8-Contd.
Cases Treated
Inter-
mediate
List
Number
Detailed
List
Number
Cause Groups
Deaths
Covero-
Covero-
Govern-
Govern-
Deaths
Whole Colony
Fent
ment
ment
Assisted
Hospitals
Bospitals
Hospitals
ment
Assisted
Hospitals
Male Female
Sex Un-
known
Total
Brought for card...
48,357
78,050
2,288
8,289 10,661 8,411
819,080
AE 138 E810 E835 Motor Vehicle Accidents
AE 139 E800 - E802 Other transport accidents .E840 - E866)
AE 140 E870 - E895| Accidental poisoning....
677
810
74
96
51
147
24
361
25:
61
320
2
13
16
5
22
..
AE 141 E900 - E904. Accidental falls
...
...
1,452
14
68
1
86)
35
121
AE 142 E912
Accident caused by Machinery
215
1
1
AE 143 E916
Accident caused by fire and explosion of combustible material
217
3
19
30
14
41
AE 144 E917, E918 Accident caused by hot substance,
corrosive liquid, steam and radiation
Accident caused by fire-arm
528
12
39
21
21
42
1
I
3
AE 145 E919
AE 146 E929
! Accidental drowning and
submersion
44
1
106
44:
150
LII
L
Carried forward...
52,621 78,083
T
78,083 | 2,528 8,290 11,055 8,608;
819,671
APPENDIX 8-Contd.
Cases Treated
Inter-
Deaths
mediate
List
Number
Detailed
List
Number
Cause Groups
Govern- |
Govern-
ment
Govern
Govern-
Deaths
Whole Colony
ment
Hospitals
mtot
| Assisted Hospitals Hospitals
meat
Assisted
Hospitals
Male
Female
¡Sex Un * Total known
Brought forward...
52,621
78,083
2,528 8.290 11,055 8,608 8 19,671
AE 147
(a) |E920
Foreign body entering eye and adnexa
L..
-- J
2
(b) ¡E923
Foreign body entering other orifice...
181
2
(c) ¡E927
Accidents caused by bites and stings of venomous animals and insects...
54
1
1
1
J
(d) E928
Other accidents caused by animals...
1
L
(6) E910, E911. All other accidental causes
1,759
13
35
96
431
139
E913-E915,
E921-E922,
E924-E926,
E930-E965
AE 148 E970-E979 Suicide and self-inflicted injury
529
76
2131
190
403
AE 149 E980 - E985
140
LJ J
147
15
23
Homicide and injury purposely inflicted by other persons (not in war)
IL L
AE 150 E990 - E999] Injury resulting from operations
32
of war
---
GRAND TOTAL...
55,297 | 78,100 2,657
8,290 11,389 8,853
8
20,250
APPENDIX 8-Contd.
Cases Treated
Deaths
Inter-
mediate
Detailed
List
Number
List
Number
Cause Groupe
Govero-
Govern-
Govern-
Gavern-
Deaths
Whole Colony
meat
ment
Hospitals Hospitals
Assisted
Hospitals
ment
Assisted
Hospitals
Mate
Female
|Sex Un-|
known
Total
141
AN 138 N800- N804 Fracture of skull
307
27
15
12
27
י.
717
---
AN 139
N805 - N809 Fracture of spine and trunk
277
2
26
20
6
26
AN 140
AN 141
AN 142
N810- N829
Fracture of limbs
+
1,286
8
10
16
N830. N839
Dislocation without fracture
86
2
1
1
N840 - N848
Sprains and strains of joints and adjacent muscle
25
1
---
AN 143
AN 144 N860- N869
N850 N856
Head injury (excluding fracture)
1,850
5
148
1
202
96
298
IIL
AN 146
AN 145 'N870 - N908 N910- N929|
Internal injury of chest. abdomen and pelvis Laceration and open wounds
155
LII
-- L
I
29
103
45
148
995
2
4
7
7
14
Superficial injury, contusion and crushing with intact skin surface.
108
1
2
1
1
2
AN 147 N930-N936 Effects of foreign body entering
through orifice
184
3
5
6
11
AN 148
N940
N940- N949
Burns
-
-
711
17
53
44
34
78
AN 169
N960- N979
Effects of poisons
887
3
58
85
88
ILJ
173
AN 150
N950- N959; All other and unspecified effects IN980 - N999-
of external causes
...
- PI
69
4
7
236
140
376
TOTAL...
6,940
50
369
1
728
442
1,170
APPENDIX 9
IN-PATIENTS ADMITTED INTO GOVERNMENT, GOVERNMENT-ASSISTED AND PRIVATE HOSPITALS IN 1959, INCLUDING CASES REMAINING IN HOSPITALS FROM THE PREVIOUS YEAR
NAME
Government Hospitals:
Queen Mary Hospital
Kowloon
Sai Ying Pun
Taan Yuk
Hental
-- J
*Castle Peak
Stanley Prison
---
---
Eastern Maternity
Wan Chai Social Hygiene
Lai Chi Kok
St. John
rri
---
IIL
Lai Chi Kok Female Prison
TOTAL
Cencral
Będo
In- fectious
LECE
Tuber. Mater. culosio inity
Mental
Tolai
cane:
casps
CALEN
110
601 339
12,906
105
213 1.962
[5,186
12,977
88
146
3,646
31
16,888
335
1,328
34
1,697
200
1.353
8,794
10,147
140
2,1531
---
2,153
120
82
1,138
104
160
1,424
IIL
24
73
2,324
2,397
30
291
318
609
475
320
1.983
257
2,560
100
1,282
70
133
678
13
43
17
10
2,163
73
---
Government-Assisted Hospitals:
Tung Wab Group
Alice Ho Miu Ling Nethersole Ruttonjer Sapatorium
Grantham
Pok (i...
---
I
2,212
30,718
3,999
960
17,414 2,206
55,297
ILL
---|
1,647
29,267
287 4.378
!
400
2,396
33,524
65,587
336
17
540
| le
63
100 2,400
6.941
842
859
1,334
1,334
5.0
1,403
0B5
2,208
540
661
661
!
210
5+
256 174
256
174
- rr
Hei Ling Chau Leprosarium
Haven of Hope Tuberculosis
Sanatorium
Sandy Bay Convalescent Home
TOTAL
Private Hospitals:
St. Paul'e
3,664
35,065 1,124 5,102
36,809
78,100
:
172 120
1,840
258
333
650
3,0BL
--I
152
1
160
312
108
IL-
2.585
69
123
197
2,974
316
-Pr
6,346
169
256
1,500
125
6.404
70
1,285
10
1,303
9.5
100
2,700
96
75
465
3,336
90
--
3,102
$7
253
3,446
947
1
1,074
225
Ling Yuet Sin Infants'
Precious Blood
Hong Kong Sapatorium St. Francis
St. Terena"L
Hong Kong Central
Matilda and War Memorial...
Canaan Convalescent Home...
TOTAL
rr
---
1,093 18,959
634
1,078 3,352
132
24,155
GRAND TOTAL
6,969 84.742
5,757
7,140 | 57,575 | 2,338
157.552
Figures included in Mental Hospital's return.
142
APPENDIX 10
OUT-PATIENTS - 1959
TOTAL ATTENDANCES AT GOVERNMENT AND GOVERNMENT ASSISTED HOSPITALS, CLINICS AND DISPENSARIES
INSTITUTIONS
Dress- ingi
General Chil-
Out- dren's Patients Clinics
Ante- Post. Gynaeco- Social natal
logical Hygiene natal
Ear. Nose & Eye
Tbrook
Tuber. culosis
Comunity
Ortho. paedic
L.rproty Mentul
Total
Hospitals:
Queen Mary
Kowloon
Toon Yuk
St. John
Stanley Prison
Lai Chi Kak Female Prison
Mental
---
10.003
10.115
258
2.939:
720 3.671
23
257,014;
163, 196
3,104
15,613)
1,077
4.543
441 10.039
37
22.307 71,627
2,480 6.249
4,604
37.664:
3,685
5,211
30,269 37,094
2,077;
5
1,893
220
19,116
99,430
5,500
14.390
דין
2,377 1,707
53,306
532.492
45.953
76,778
182
11
128,103
14,390
E
6,406
6,406
954
238,897
1,569
349,851
! |
37,96%
2.245
131
$18,876
1,875
234
508,017
218
447,068
213.026
5,810
912,970
1,371
963,177
10,499
7,263
Clinice and Dispensaries :
Sai Ying Pun
Violet Peel
Violet Peel Ophthalmic Clinic
Wan Chai Chest Clinic
Kowloon Chest Clinie...
39,018 143,943
99.613
78,041| 3,645 109,806 90,177
[0] 4,616 1,345
352
Shek Kip Mei Chest Clinic
T
Social Hygiene Clinics...
| | | | |
4,663 2,271
37.961
4,002
576,497
505,908
446,850
TTT
213,026
Hong Kong & Kowloon Public
Diep.
-LI
206,919
474,626, 190,772, 11,966
1,008
New Territories Dispenseries .......
83,265
Families Clinic Hong Kong Familier Clinic Kowloon
99,311 103,963) 30,667, 10,499
1,016'
1,296 7.440 3,218
1,743
5,771
8,927
339 20,117
1,135 10,963
7,263
| │
Hong Kong Police Medical Port
16,688
12,096: 13,421
251:
363
75.
540
10
205
Kowloon Police Medical Post...
2,15]
12,596 17,029
324
614
188
1,395
168
Victoria Remand Prison
1,900
49.124
L
Ta'
Victoria Remand Prixon
Families Clinic
Port Health
25
76
196
23
1,845
Kowloon-Canton Railway Clinie, Chi Ma Wan Prison Clinic
198
1,580 1,463
¦ ¦
4,185
5,027
7,461 59,463
IE
332
4,083
***
Tai Lain Chung Prison Clime....... Government Ophthalmie Glinic
--Art Street
J
Government Ophthalmic Clinic
-Shau Kei Wan
Goveniment Ophthalmic Clinic
ww
-Yu Kwai Sibe
Mobile Unit British Red Cross
Society
Aberdeen
Rennie's Mit Clinic
Health Centres 2
Harcourt
Western...
Kowloon
Chai Wan
Ho Man Tia
Shak Kip Moi
---
---
Central
PII
!
40,503
2.708
506
44,484
773
211
50,378 5,298
736
13,663 2,041
6:44
26.977
1,540
226
36.693
3,951
430
I
36,63 L
664
214
T
!!
88,491
3,426
115
4.474 161
218
!
!
|
1
11
44.069 34,475 51,098
336
1,845
3,241
11,978
69,417
86,491
3,426
1:5
4.474
164
218
43,717
45,468
56,412
16,348
28,743
41,074
37,509
Total of Government
Institutiona
Tung Wah Group of Hospitals,
Alice Ho Miu Ling Netherøsle
Hospital
799,827 1,262,765 784,870 124,155
30,667 305,744 154,395, 24,446
196' 23,641 6,552 14,171
10,577 18,495 228,975 157,801
453 5,981
21,278
1,349 17,876
20,775, 1,558,579 130,451
5,400 19,731
16,008 7.949
6,417 5,107,644
60. 1,610
569,835
T
Rationjee Sanatorium
16,103 38,519 1,154
29,924
Pok Of Hospital
Grantham Hospital
Rennie's Mill Church Clinic
GRAND TOTAL...
830,690 1,638,177| 984,336 163,928 12,379 42.352 228,975' 179,079 26,215 1,605,568 110,511 17,6-18
• Palicats seen in Hong Kong University Eye Clinic.
T
15.283
248 11,727
63,785
15,283 55,778
248 41,651
7,949
6,117 5,854,204
143
APPENDIX 11
OUT-PATIENTS 1959
NEW CASES AT GOVERNMENT AND GOVERNMENT ASSISTED HOSPITALS, CLINICS AND DISPENSARIES
INSTITUTIONS
| Dress-
inge
Genrent Chil-
Out- dren's patients Clinics
Ante. Jata]
natal
Post. Gynaeco. Social
logical Hygiene
Eyc
Eas, Noat & Throat
Tuber. eulonin
Casualty
Ortho- paedic
Leprosy
Mental
Total
Hospitals:
Queen Mary
10,003
1.649
110
Kowloon
69,090
131.460
580
449 3,108
3701
535
23
Tano Yuk
1,423
6,827
983 2,108 3,135
308: 3,174
37: 15.941
297:
29.831
71,627 1,462
273,597
11,385
St. John
4,052
24,256 20,635
684
767
229
Stanley Prison
59,629
JIL
4,643:
41,164
1,264
1,634
552!
39
11
Lai Chi Kok Female Prison
49,397
14,390
Mentul
---
! |
14,390
752
752
725
1,569
617
19
13
5
Clinics and Dispensaries 2
Sai Ying Pan
Violet Peel
Violet Peel Ophthalmic Clinic.. Wan Chai Chest Clinic...
Kowloon Chest Clinic
---
Shek Kip Mei Chest Clinic
7,306,
59,709 34,758 1,506
42.265 57,155 50.959
2,001
575
*1,394,
162
567 1,166
12,082
L
16,758
10.072
7,302
Social Hygiene Clinic
28,980,
Hong Kong & Kowloon Public
Dispensarire ....
61,282
316,640 159,563
4,355
#32 2,010
220
3,940
1,136
New Territories Dispensaries..
21,279
70,449
81,057
8,383
423
813
4,530
180
106 1,797
1,135 10,944
Families Clinic, Hong Kong
666
Families Clinic Kowloou
7.263
| |
1
Hong Kong Police Medical Pol
10.805
7,106
Kowloon Police Medical Post..
882
9,762
7,490 13,044
153
317
227
54
295
3
411
338
91
9451
132'
Victoria Renand Prison
502
25,518
I
171
Victoria Remond Prison
Femily Clinic
61
150
23
Purt Health
1,681
Kowloon-Canton Railway
Clinic
153)
1.387
1.387
Chi Ma Wao Prison
1,719
3.653
332
670!
3,019
Tai Lam Chung Prison Clinic...
Government Ophthalmic Clinicj
Arran Street...
Government Ophthalmic Clinic
Shau Kei Wan
Government Ophthalmic Clinic
Wu Kwai Sla
---
Mobile Unit British Red Cross
Society
Aberdeen Clinic
Beanie'. Mill Clinic
Health Centres :
Bercourt
Western...
Kowloon
Chai Wan
Ho Man Tin
Shek Kip Mei
Central
3,186
456
284
3,330
186
185
4.024
964.
292
1,081:
673)
$14
1,820!
433
3561
4.165' 2,773
1,027
297.
157
132
2,040
43,333
1,813
63
2,825
146 158
142
25
95
166
¦ ¦
17
| | | | | ¦ │
128,541
153,276 12,082 17,394 10,985
1,307 28,980
551,361 206,753
666
7,263
25,710
25,514
26.211
247
* 1,68)
2,827
5,704
6,368
43,123
1.813
63
2,825
146
152
3,926
3,701
5,280
2,268
2,409
$,487
3,062
Total of Government
Institutions
Tung Wah Group of Hospitals.
Alice Ho Miu Ling
Netherrule Hospital...
Buttonjer Sanatorium...
Pok Of Honpitul
Rennie's Mill Church Clinic
I
236,081 772,988' 419,012 29.701 8,106| 7,225 34,313 71,260 7,7751 39,371 102,740|
13,222 125,939 56.544 10,660!
453
2,918 1.349 5,2201
499)
7,291 1,334
7,891 17,300 1,099; 1,377
6,810
2,061
2,006
3.267
330
763
1,132,832
!
60
296
230,561
18,112
45.
45 26,290
80,
1,457
GRAND TOTAL...
+++
249,3031
915,486 494,190. 54.397|
9,900 | 14,944
34,313
77,970
9,836
41,502 102,800| 3,565
330
763
2,009,297
* Patients seen in the Hong Kong University Eye Clinic.
144
APPENDIX 12
ATTENDANCES AT PUBLIC DISPENSARIES (HONG KONG AND KOWLOON) - 1959
-
Out-patients
Deliveries
Children
Adults
Vaccina-
Public Dispensaries
Total
|
New Cases
attend- New Cases
Total attend- patients
In-
Domi-
tions
Inocula-
tions
ciliary
ances
auces
Central
41,430 |
68,247
6,418
1,703
Eastern
---
Shau Kei Wan
---
...
11,462
13,742
8,345
15,496
7,296
127
...
56,467
110,155
262
14.074
6,112
Aberdeen
Stanley
...
IIT
+1+
TH
14,649
16,071
10,341
26.011
592
7,406
1.064
- +1
+-+
...
1,101
1,688
2,417
7,331
206
19
925
Sham Shui Po
Yau Ma Tei
Hung Hom
Li Kee Memorial
Mong Kok Clinic
Tai Hang Tung Clinic ...
Lei Cheng Uk Clinic
---
Shek Kip Mei Health Centre North Point Health Centre Chai Wan Clinic
...
игт
46,179 !
91,540
255
17,929
14,535
20,521
-
LI
5,484 |
11,865
87
7,065
1,545
13,442
16,450
9,272 19,768
411
1
8,139
2,688
W++
:
46,849 51,192
26,556
42,658
337
58,401
28.169
---
25,261
36,370
36,786
54,140
ITI
---
54,234 68,219
17,803
49.046
|
- -
28,320 69,059
10,506
2.891
31,767
33,504
27,053 57,289
521
7,186
2.171
E
20,258
55,647
9,663
3,952
---
9,208 21,627
525
1,799
264
Mt. Butler Quarry Clinic
497
...
1,234
1,448
3,146
TOTAL
|
159,563 190,772 391,798 722.198
617
2,599
173,685
103,657
145
APPENDIX 13
ATTENDANCES AT MEDICAL CENTRES NEW TERRITORIES, 1959
Dispensaries
I
Deliveries
Domiciliary
Out-patients
Total
New Gases
In-patienta
Attendancer !
Hong Kong Jockey Club
Clinic, Tai Po
Ho Tung
Sha Tau Kok
Yuen Long
San Hui
Sai Kung
Tai O
-J
37,247
61,346
1,571
1
ITE
2,199
4,890
691
I
9.272
19,961
338
I
16
23,167
55,407
2,017
21
---
т.г
3,305
6,906
791
-
ILJ
20,138
31,379
415
3
29,294
41,130
333
4
Silver Mine Bay
LJ J
8,630
10,059
98
2
Peng Chau
6,722
9,074
146
1
Sha Tin...
7,312
13,325
587
25
L
8.875
10,188
$87
1,352
Travelling (East)
Travelling (West)
Maurine Grantham Health
Centre
North Lamma Clinic
Chee Hong Floating Clinic
Chee Wan Floating Clinic
33.792
71,479
2,047
1
---
...
4,124
6,468
50
2
826
826
6,958
12,527
Shek Pik First Aid Post
---
4,502
6,860
TOTAL
206,750
363,177
9,074
81
146
APPENDIX 14
SUMMARY OF EXAMINATIONS
Widal
Agglutination
Testa
Weil-Felix Brucellosis
177
ייי
11
Serological tests for syphilis
Blood smears
(Malarial parasites
Microfilaria
1B.
Authracis
Haemoglobin perceuloge
Total red cell count Total white cell count Differential count
Retiraloryte count
Thrombocyte count
:
Huematocrit estimation
Mean cell volume
Haematology
---
Mean cell haemoglobin
Mean cell haemoglobin concentration
Colour index
L. E. cells
Coagulation Uime
L-I
ILL
Bleeding time..
Marrow cytology
--L
100
Blood grouping
Cross matching
Fragility test
Prothrombin time
Fibrinogen level Sedimentation rate Rb D typing
Coombi test
FIL
Paul & Bunnell Test
Formo-gel test
---
[10
JJL
---
Nasal-pharyngeal sweba (C. diphṛberier|
Strep. pyogenes
Staphylococcus pyogenes
JLL
---
LI
Cerebrospinal fluid for pathogenic organisms
Facces for pathogenic organisms
Blood clot culture
---
-LL
ILI
H.K.P.I.
Q.M.H. | K.P.I.
Lab.
L.C.K.H. T.Y.H. S.Y.P.H.
Lab.
Lab.
Totul
L.b.
!
1,257 7
20
1.818
17
3,093
13
24
-rr
128,842
rrr
3.394
15
5,147
80
13
LIJ
LLI
114
10
41
10
138 |
128,842
66
8.715
11
171
51
899
2,909
13,195
4,066
11,834
1,234
31,137
392
1,952
1,326
442
21
251
4,384
1,407
3.096
8,746
1,801
1,203
1,332
17,586
282
2,742
9,765
1,797
780
1.126
17,092
315
1,338
16
33
1,704
622
1,532
19
24
2,197
B71
872
735
735
---
662
662
732
732
366
368
56
56
1
80
1,369
上白
12
1,389
LIJ
-
LIJ
---
318
1.953
17
12
1.283
136
136
3,189
6.803
10,310
---
...
8
111
457
1.128
461 1,130
LL.
309
309
101
559
1,077
394
36
130
2.297
610
#50
860
150
150
23
116
11,914
288
12,386
6,582
50
31.220
4,272
288
3,580
2,460
497
11,105
4,272
288
3,588
2,460
442
11,050
478
51
176
8.5
I
791
6,983
166
7.587
4
431
15,172
ILI
---
1,257
20
1,818
3,099
Blood
Bane marrа
Vrine
Sputum
425
20
L.180
1,628
*
Cultura | examination
Direct examination
Gastric lavager
Pus for N. gonorrhoeat
Pur and body fluids
Sensitivity tests
Examination of rats for P. pestis
{
Intestinal parasites
Occult blood
Myco. tuberculonia
Cerebro-spinal Quid for cell count and protein
Brains for Negri bodies
Spota
Gastric lavages for Myco. tuberculosis
Smears for N. gonorrhoeae
Smears for Myco. leprae
Pur and body fluids
Urine (routine, chemical & microscopic)
Pregnancy tests (Frog)
017
PI-
Bacteriological examination of milk, ice cream, ete.
F
analysis of water examination of food
Tissue section (a) Surgical
(6) Post-mortem
111
1.498
65
-PI
1,480
431
3.474
8.369
30
845
9,309
ILL
---
L
1,297
185
1,486
LLI
1,556
32
725
2,843
---
---
645
3,760
4.418
100
3,207
4,037
75
7.319
178
80
258
15,636
883
12,380
1,029
635
481
31,044
105
63
494
40
24
732
LII
5
115
120
ILI
4,636
189
629
705
179
6,339
30
---
LI
3.0
Pri
Irr
110
19.197
578
27,025
2,695
149
49,648
Pri
]
167
168
LII
48
28
409
490
PPI
LII
LLI
---
1,771 119 4,328
1.974
3,745
14
1.389
176
1,698
1,663
11,810
1,179
1,865
352
21,197
783
829
1.612
2,219
2.237
4,456
rri
1,830
1,200
3,030
400
400
--
1,620 242
1.620
Miscellaneous
E
יוו
1,318
14
454
30
106
12
242
1,934
GRAND TOTAL
111
*
וזו
238,614 | 17,075 158,074
26,035
26,513
5,262
471,573
147
1
|
-744
FLONG KONG
Code No.: 3039-60