醫務衛生署年報 Medical and Health Department Annual Report 1961-1962

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2124.

ANNUAL

DEPARTMENTAL

REPORTS

1961-62

C-21

• T

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DIRECTOR OF MEDICAL

AND HEALTH SERVICES

22501293392

HONG KONG

ANNUAL DEPARTMENTAL REPORT

BY THE

DIRECTOR OF MEDICAL

AND HEALTH SERVICES

FOR THE

FINANCIAL YEAR 1961 - 62

PRINTED AND PUBLISHED BY S. YOUNG, GOVERNMENT PRINTER

AT THE GOVERNMENT PRESS, 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).

WELLCOME INSTITUTE

LIBRARY

Coll. weit...mec

Call/

No.

MALE

FEMALE

1961 CENSUS POPULATION BREAKDOWN BY AGE GROUPS

AGE GROUPS

85-89

80-84

75-79

70-74

65-69

60-64

55.59

50-54

45-49

40-44

AGE GROUPS

85-89

80-84

75-79

70-74

65-69

60-64

55-59

50-54

45-49

40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

250,000

200,000 150,000 100,000 50,000

50,000 100,000 150,000 200,000

250,000

The challenge Hong Kong has to face in providing public services.

卜

CONTENTS

I. GENERAL REVIEW

Administration of the Medical & Health Services.

Staff

Finance

Legislation

Professional Registers

Work of the Statutory Councils and Boards.

II.

PUBLIC Health

General Comments

Vital Statistics

Paragraphs

1 - 23

25 - 34

35 - 38

40 - 41

59 - 62

63 - 67

III. WORK OF THE HEALTH DIVISION

Hygiene and Sanitation

Urban Areas

68 - 70

71 73

Rural Areas

Epidemiology

Quarantinable Diseases

Cholera

Historical

The 1961 Outbreak

The Hong Kong Outbreak

Treatment

Control Measures

Inoculation Campaign

75 - 81

82 - 84

85 - 94

་

95 - 96

97 - 102

103

•

104

105 110

111

138

139

Environmental Measures

Assessment

Notifiable Diseases

Other Communicable diseases which are not

notifiable

III. WORK OF THE HEALth Division-Contd.

Tuberculosis

Malaria Bureau

Social Hygiene Services

Port Health .

District Midwifery Services

Maternal & Child Health Services

School Health

Industrial Health

Health Education

IV. THE WORK OF THE MEDICAL DIVISION

Hospitals

Government Hospitals.

Government-Assisted Hospitals

Outpatient Services

Specialist Services

Radiology

Dental Service

Ophthalmology

Forensic Pathology

Government Chemist's Laboratory

Government Institute of Pathology

The Pharmaceutical Service.

The Almoner Service

Physiotherapy

Orthopaedic and Prosthetic Appliances

Occupational Therapy.

Medical Examination Board.

Blood Banks

Hospital Maintenance and Supply Auxiliary Medical Services.

Paragraphs

140 - 197

198 - 207

208 - 224

225 - 229

230 234

235 - 239

240 - 247

248 - 254

255 - 259

260 - 261

262 - 264

265

324

325 - 344

345 - 352

353

354 - 363

364 - 370

371 374

375 376

377 - 384

385 - 393

394 - 396

397 - 409

410 - 413

414 422

423 - 426

427 - 429

430 - 432

433

440

439

446

V. DEVELOPMENT PROGRAMME

Planning Unit

Building Programme

VI. HOSPITAL COSTING

VII. TRAINING PROGRAMME

Doctors

Dentists and Dental Nurses.

Nurses.

Midwives

Paragraphs

447 - 451

452

453 - 456

457. 460

461 - 462

463 - 466

467 - 468

Health Visitors

469

Radiographers

470

Laboratory Technicians

471

472

Physiotherapy

473

Other Forms of Departmental Training

474 476

Courses of Study Overseas

477

VIII. MISCELLANEOUS

Attendances at Conferences and Meetings

478

Visitors

479

Publications.

480

ACKNOWLEDGMENT

481

IX. MAPS

X. APPENDICES

vii

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

https://archive.org/details/b31406099

1. GENERAL REVIEW

To the discerning visitor the inevitable impression taken away from Hong Kong is that of a vital and industrious community of great versatility living in the face of largely unpredictable economic trends. It is a young population of which 40.8% are under 15 years of age and 16% below the age of five. The low crude death rate of 5.9 per 1,000 and the relatively high birth rate of 34.2 per 1,000 with a low infant mortality rate of 37.7 per 1,000 all indicate that it is a healthy popula- tion. The general state of nutrition is good.

2. There are 14 census divisions with population densities of over 2,000 persons to the acre. Despite this density, the restricted water supply and the problems of environmental hygiene posed by pre-war tenement buildings and the aggregations of squatter and roof top dwellings, the standards of personal hygiene maintained are creditably high. With a restricted land area of 3984 square miles and a natural increase of over 3% per annum, population densities must remain high. However, the resettlement and low cost housing estates that have been developed to meet rehousing needs, while planned for average densities of 1,800 to the acre, have protected water supplies, modern sewerage and highly organized public cleansing facilities. Apart from the Govern- ment Resettlement programme which has re-housed 439,000 squatters, private enterprise has provided accommodation with modern services for 500,000 people during the past six years. This is a significant advance towards higher standards of community health.

　　　3. As an international seaport and airport and the terminus of the Kowloon-Canton Railway, Hong Kong is necessarily vulnerable to the introduction of disease from outside. The total recorded movement in and out of the Colony during 1961 was 2,449,953 persons of which air traffic movement accounted for 458,428; passengers to and from the frontier station at Lo Wu numbered 868,298. The number of people coming in and going out of the Colony by small boats and junks is difficult to assess and it is here that quarantine safeguards can be most readily breached.

4. Besides being a centre for refugees who come in to make their home in Hong Kong. it is also a medical centre to which many come

from Mainland China for the treatment of tuberculosis and other chronic diseases as the opportunity offers and relatives or friends can be found who will provide temporary accommodation. Once in Hong Kong any individual can attend at Government or Government subsidized clinics or hospitals, which provide treatment free or at low cost, without inves- tigation as to origin. It is significant that during March 1962, of persons attending the Government Chest Clinics for free treatment of active tuberculosis, 124% had arrived in the Colony within six months. During the year 1961, 4,987 persons being treated for tuberculosis defaulted from treatment; many could not be traced and 2% of these were describ- ed as having 'returned to village'. This influx for treatment is not a new phenomenon, but it is one that is now being more clearly defined and it illustrates a part of a very considerable additional burden on the already heavily committed curative services provided for the 3,177,700 residents of Hong Kong.

5. The services developed to control tuberculosis, which is the major endemic disease problem in Hong Kong, are now being subjected to a fresh and impartial assessment of the results of the work of the past ten years. This review is being carried out, at the request of Government, by the Consultant in Tuberculosis to the Secretary of State for the Colonies, Professor F. R. G. HEAF, C.M.G., and by Dr. Wallace Fox of the Medical Research Council, who was formerly in charge of the Tuber- culosis Research Project in Madras. Professor HEAF visited Hong Kong first in 1952 when he reported on the situation existing at that time and made recommendations on the developments then required.

6. Professor HEAF and Dr. Fox have been asked to submit a report covering all aspects of the tuberculosis problem, with particular emphasis on the methods of investigation and research of a practical nature which will facilitate and guide the long term planning of the further measures of control necessary for the elimination of tuberculosis as a community health problem. Dr. Wallace Fox spent five weeks in the Colony in February and March 1962 and Professor HEAF's visit took place during April 1962.

7. The pressure on hospital beds has not eased, particularly in Kowloon. Some indication of the demand is given by the work of the Casualty Department of the Kowloon Hospital which attended to an average of 9.8 casualties every hour throughout the year. Traffic accidents, industrial accidents and accidents in the home constitute the heaviest load. Some additions have been made to the Kowloon Hospital

where 52 more beds were put into use for children. At the same time. a redistribution of tuberculosis cases to the Grantham Hospital from the Queen Mary and Lai Chi Kok Hospitals has freed more acute and convalescent beds for paediatric cases. Meanwhile, work on the two major Hospital projects of the Queen Elizabeth and New Kwong Wah Hospitals is going ahead rapidly. It is expected that the Queen Elizabeth Hospital will be opened in the middle of 1963 and that the New Kwong Wah Hospital will also be completed before the end of that year.

　　8. Inevitably, there is an increasing number of physically handi- capped in the younger age groups as a result of severe trauma on the roads or at work. More and more emphasis is accordingly being placed on rehabilitation services which will fit the disabled to return to full employment either in the accustomed field or in a new one more suited to the altered potential. The development of a Government Surgical Appliance Centre where artificial limbs and other prostheses are made locally and fitted in conjunction with physiotherapy is now beginning to make a significant contribution in this field. Voluntary agencies are also active in rehabilitation and the Tuberculosis Rehabilitation Service of the Lutheran World Service has made a modest but very promising start. The Kwun Tong Rehabilitation Centre sponsored by the Hong Kong Society for Rehabilitation will be completed in 1962 where special emphasis will be laid on the recovery and return to work of the victims of severe industrial injuries.

　　9. Progress has also been made in the registration, assessment and training of the blind and the deaf, again by voluntary agencies. The prevention of blindness and the early detection of visual defects has made considerable progress, while the addition of an Audiology Tech- nician to the staff has marked a significant advance in the assessment of hearing defects.

　　10. The Centre for the Voluntary treatment of Drug Addicts at the Castle Peak Hospital is now well established. Designed as a pilot scheme to gain experience of the pattern of addiction in Hong Kong and the most fruitful regimen of rehabilitation, much useful information has been obtained during this first year of its work. In the meantime, the Hong Kong Society for the Aid and Rehabilitation of Drug Addicts is going ahead, in close co-operation with the Government, with its plans for a Centre at Shek Kwu Chau, an uninhabited island adjacent to Cheung Chau, where accommodation for 240 addicts requesting treatment on a voluntary basis will be ready during 1962. The intention is to send

voluntary patients from the Government Drug Addiction Clinic to the Castle Peak Hospital for treatment during the period of withdrawal from the drug, and thereafter to transfer them to Shek Kwu Chau for a course of rehabilitation and training which will fit them to return to work. Re-employment and follow-up activities will be a combined effort shared between the Government Departments and Voluntary Agencies concerned.

11. The inauguration of a 'flying doctor' service to remote villages in the New Territories in March 1961 has proved to be very popular and worthwhile. Using helicopters of the Hong Kong Auxiliary Air Force, visits are paid weekly to 7 centres where minor ailments are treated, cases of emergency illness evacuated to hospital and much health education given. In remote rural areas a curative service is always the spear head of health education in the prevention of disease either through immunization or the practice of simple hygiene based on some elementary knowledge of disease processes and how they can be avoided.

12. The most significant event of the year was the re-appearance of cholera during August 1961 after an absence of 15 years, presumably introduced by the migrant small boat population. This followed an outbreak of paracholera El Tor in the Kwangtung Province of China and the subsequent occurrence of cases in Macau. The infection in Hong Kong was proved to be due to the El Tor type of vibrio cholerae of the Ogawa group and resulted in a total of 77 confirmed clinical cases. In addition, investigation of 731 contacts of clinical cases isolated at the emergency Quarantine Centre resulted in another 53 confirmed infections in contact carriers without symptoms. There was a total of 15 deaths, of which seven occurred before admission to hospital.

13. The first two cases were reported on the 16th August and the last one on the 8th of November. However, the majority of cases occur- red during the first 12 days when 52 patients suffering from clinical cholera were admitted to hospital; subsequently 24 cases occurred during the next 26 days and the emergency phase was over by the 23rd September. Thereafter one isolated case occurred on the 8th of November, coming to light only because all cases of gastro-enteritis were being investigated for vibrio cholerae infections as a routine,

14. The public reaction to the situation was most heartening. There was no hint of panic and full co-operation in the emergency measures applied to control the outbreak was evident from the start. There was an unprecedented demand for inoculation and, between the 14th August

when precautionary measures were first applied and the 25th August, 1,855,830 persons were given vaccine. By the end of the inoculation campaign sample surveys indicated that over 75% of the total popula- tion had been immunized.

　　　15. Strict and comprehensive measures of quarantine and environ- mental hygiene were applied throughout the Colony and were accepted readily. The cardinal feature was the isolation, in the emergency Quarantine Centre at the Chatham Road Camp, of all immediate con- tacts of the confirmed clinical cases. All confirmed contact carriers were further isolated in another section of the Centre and given prophylactic treatment with antibiotics, to which the vibrio cholerae isolated were known to be susceptible, until three negative rectal swabs in succession had been obtained. These particular quarantine measures are believed to have had a significant influence in preventing an outbreak of epidemic proportions with many deaths. In conjunction with the early treatment in hospital of clinical cases, protection of the water supplies and strict control of markets and food hawkers there seems to be no doubt that the initial widespread dissemination of vibrio cholerae, indicated by the sporadic appearance of clinical cases, was contained most effectively by this isolation of all immediate contacts of those suffering from overt cholera.

　　　16. The high degree of public co-operation is underlined by the fact that there was no concealment of cholera cases or deaths. Memories of cholera in the past and knowledge of what had happened or what was happening to relatives in neighbouring China must have had no small influence on this favourable reaction of those most vulnerable to cholera-the boat people, the waterside communities and the grossly overcrowded tenement dwellers.

17. During February and March 1962 a further cholera immuniza- tion campaign was launched in anticipation of a possible recurrence of cholera in the summer of 1962. The results were encouraging amongst the groups most at risk, where an average of over 80% of cover was achieved. The response in the urban areas was not so good but the indications are that, over-all, some 53% of the total population had received cholera vaccine by the end of April.

　　　18. Routine laboratory investigations of all cases of gastroenteritis, of water supplies, of night-soil and of fruit and other potential vehicles of infection have been continued throughout the year with entirely. negative results since November 1961.

19. Further comment is made on cholera in paragraphs 75 to 110 of this report and the outbreak has been fully recorded in the Govern- ment White Paper on the Outbreak of Cholera in Hong Kong tabled in the Legislative Council on 13th December, 1961.

20. The Medical Advisory Board which was established in 1946 to advise on health problems arising after the re-occupation, was recon. stituted during the year with wider terms of reference. Now representa. tive of all major organizations concerned with medical and health work in the Colony, its function is to advise His Excellency the Governor on all problems referred to the Board which concern the health of the people of Hong Kong.

21. The proposal to establish a School Medical Service, utilizing the services of private medical practitioners, has been welcomed by the Chinese Medical Association and over 200 of its members have agreed provisionally to participate in the Service. A Working Party consisting of unofficial members of Councils, of representatives of Government Departments, the Chinese Medical Association and private Schools is being constituted to make recommendations to Government on the organization and working of this Service.

22. Reference was made in the last Annual Report to the outline development plan for the Medical and Health Services, covering a period of fifteen years. Following receipt of the corrected census returns, the 1960 to 1965 segment of the plan, already approved in principle, was reviewed and the provisional programme for 1966 to 1972 considered in detail in relation to population densities and their projected distribution, A comprehensive plan has now been compiled and is being examined by the Government.

23. A happy and memorable event was the visit by Her Royal High- ness The Princess Alexandra of Kent to the Queen Elizabeth Hospital School of Nursing in November. A guard of honour was formed by nurses and student nurses from the Government Hospitals and the members of the Nursing Board and the Midwives Board were presented to Her Royal Highness. At the reception that followed, Her Royal Highness talked to leading members of the nursing profession and to a number of student nurses and student midwives from the general nurses and midwives training schools in the Colony.

ADMINISTRATION OF THE MEDICAL AND HEALTH SERVICES

24. 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 Direc- tor of Urban Services, the Commissioner of Labour and the District Commissioner, New Territories. Executive functions in connexion with curative medical services and a number of aspects of preventive medicine throughout Hong Kong are the responsibility of the Medical and Health Department. The Urban Council is concerned with environmental sanitation in the urban areas of Hong Kong Island and Kowloon, through the Urban Services Department. The Director of Urban Services has executive functions as the Health Authority for certain of the townships in the New Territories and administers their environmental sanitary services. Medical Officers of Health are seconded in an advisory capacity to the Urban Services Department and the Labour Department has an Industrial Health section staffed by personnel of the Medical and Health Department.

STAFF

25. 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 Practi- tioners, Dentists, Pharmacists, Nurses and Midwives.

　　　26. The Deputy Director of Medical and Health Services is the chief executive medical and health officer, who co-ordinates the work of the Medical and Health Divisions, each of these divisions being in charge of an Assistant Director. The Deputy Director is also Vice-Chairman of the Urban Council and is the principal adviser to that body on health matters. The Principal Matron is the Chief Nursing Officer and administers the Nursing Division which provides nursing, midwifery. health visitor and health sister services.

　　　27. The Health Division, which is the administrative responsibility of the Assistant Director, Health, is concerned with infectious disease control, personal health services, rural hygiene and certain ancillary services. The Medical Division is the responsibility of the Assistant

Director, Medical, and is concerned with the provision of curative and specialist clinical services. Each Assistant Director is assisted by a Principal Medical and Health Officer at Headquarters, and each division is divided into units which are individually under the charge of a Specialist or of a Medical and Health Officer with special experience and training. The respective spheres of responsibility of the two Divisions are outlined in Appendix 2.

28. The Principal Medical and Health Officer (Planning) assisted by a Senior Hospital Secretary, is responsible for the co-ordination of all requests for accommodation and equipment for new Medical and Health Department institutions, for the processing of building plans and for the detail of the forward planning of the Department's activities. In addition, advice and assistance are given on request to voluntary and private organizations engaged in the planning and erection of medical institutions.

29. The Auxiliary Medical Service, which is a branch of the Civil Defence Service, 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.

30. The routine administrative, secretarial, establishment and clerical work of the Department is under the general direction of the Secretary. while the Principal Accountant and his staff deal with the financial and accounting duties. The work of the Boards section is co-ordinated by the Boards Secretary.

31. The pharmaceutical and dispensing activities are the responsi- bility of the Chief Pharmacist, who also has inspectorate duties in connexion with the Dangerous Drugs and Pharmacy and Poisons Ordinances.

32. The Government Chemist is responsible for the work of the Government Chemical Laboratory which undertakes the analytical, forensic chemistry and standards work in the Colony.

33. The Chief Hospital Secretary and his staff undertake 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 each of which is the responsibility of a Hospital Secretary. Assistant Hospital Secretaries are posted to the larger and more important institutions within these groups.

34. Appendix I shows the establishment at 31st March. 1962.

FINANCE

35. The actual expenditure of the Medical and Health Department for the financial year ended 31st March, 1962, was $64,064,336 to which should be added a further $25,009,269 disbursed in the form of sub- ventions. Capital expenditure on medical projects under the Public Works Non-Recurrent head totalled $9,836,801. These amounts represent 10.38% of the Colony's total expenditure during the year. This does not include expenditure on environmental sanitation by the Urban Services. Department and the New Territories Administration.

　　　36. A Statement of Expenditure for the five years from 1957-58 to 1961-62 is shown at Appendix 3.

37. The total revenue collected from all sources by the Department amounted to $4,859,444.

38. The largest subvention was made to the Tung Wah Group of Hospitals which received $12,495,539. In addition, a further capital grant of $4,922,184 was made towards the cost of Phase IV of the rebuilding of the Kwong Wah Hospital. Other large subventions were $1,060,000 to the Alice Ho Miu Ling Nethersole Hospital, $2,930,736 to the Grantham Hospital, $1,000,000 to the Hong Kong Anti-Tuberculosis Association, $740,000 to the Mission to Lepers, Hong Kong Auxiliary and $450,000 to the Pok Oi Hospital.

LEGISLATION

39. The following legislation dealing with medical and health matters was enacted during the year 1961-62. Mention is made of the purpose of the more important ordinances in the body of this report.

Ordinances:

(i) Nurses Registration Ordinance, 1961.

(ii) Dangerous Drugs (Amendment and Validation of Regulations)

Ordinance, 1961.

(iii) Pharmacy and Poisons (Amendment) Ordinance, 1961.

(iv) Mental Health (Amendment) Ordinance, 1961.

(v) Dangerous Drugs (Amendment) Ordinance, 1962.

(vi) Quarantine and Prevention of Disease (Amendment) Ordinance,

1962.

Rules and Regulations:

(a) Dangerous Drugs (Amendment of Schedule) Order, 1961,

(G.N.A. 61/61).

(b) Penicillin (and other Substances) (Amendment) Regulations,

1961, (G.N.A. 69/61).

1961, (G.N.A. 75/61).

(d) Nurses Rewards and Fines Fund-Legislative Council Resolu-

tion, 1961, (G.N.A. 77/61).

(e) Poisons (Amendment) (No. 5) Regulations, 1960, (G.N.A.

78/61).

(f) Poisons List (Amendment) (No. 5) Regulations, 1960, (G.N.A.

79/61).

(g) Poisons (Amendment) Regulations, 1961, (G.N.A. 80/61), (h) Poisons List (Amendment) Regulations, 1961, (G.N.A. 81/61). (i) Poisons (Amendment) (No. 2) Regulations, 1961, (G.N.A.

82/61).

Quarantine and Prevention of Disease (Scale of Charges) (Amendment) Regulations, 1961, (G.N.A. 101/61).

(k) Midwives (Registration and Disciplinary Procedure) (Amend-

ment) Regulations, 1961, (G.N.A. 113/61).

(1) Prevention of the Spread of Infectious Disease (Amendment)

Regulations, 1961, (G.N.A. 133/61).

(m) Dangerous Drugs (Amendment of First Schedule) (No. 2) Order,

1961, (G.N.A. 141/61).

(n) Poisons (Amendment) (No. 3) Regulations, 1961, (G.N.A.

147/61).

(0) Poisons (Amendment) (No. 4) Regulations, 1961, (G.N.A.

148/61).

(p) Poisons List (Amendment) (No. 2) Regulations, 1961, (G.N.A.

149/61).

(9) Poisons List (Amendment) (No. 3) Regulations, 1961, (G.N.A.

150/61).

(r) Mental Health Regulations, 1962, (G.N.A. 3/62).

(s) Medical Practitioners (Registration and Disciplinary Procedure)

(Amendment) Regulations, 1962, (G.N.A. 20/62).

PROFESSIONAL REGISTERS

40. There are five statutory bodies dealing respectively with the registration of medical practitioners, dentists, pharmacists, nurses and midwives. The Hong Kong Medical Council has statutory powers governing the registration of medical practitioners and has duties in

connexion with disciplinary 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.

41. At the 31st March, 1962, the numbers of persons on the statutory registers were as follows:

ILL

J-J

WORK OF THE STATUTORY COUNCILS AND BOARDS

Medical Council

1,062

402

102

1,943

114

1,896

42. There were seven ordinary meetings of the Council and three meetings to inquire into disciplinary charges. The Council's Warning Notice to Medical Practitioners was revised during the year and a number of supplementary notices issued during the past 5 years were incorporated into the revised Notice which at the end of the year was in the hands of the printers.

43. The Preliminary Investigation Committee met five times to con- sider charges of advertising and two cases were referred to the Medical Council for inquiry. The first inquiry involved two meetings and result- ed in the defendant being found guilty and reprimanded. The second inquiry is down for hearing in April, 1962,

44. During the year there were 130 applications accepted for full registration and 32 applications for provisional registration. There were 20 names erased from the Register as a result of death, departure from Hong Kong or failure to notify changes of address.

Dental Council

　　　　45. The Council met seven times during the year and the Preliminary Investigation Committee met twice to consider disciplinary charges, neither of which was referred to the Council for an inquiry.

　　　　46. There were seventeen applications for registration, of which eleven were accepted without examination. One applicant was required to sit the Council's examinations which he passed, being then registered. Five applications were rejected.

Pharmacy Board

47. The Board met four times for the transaction of routine business. There were fifteen applications for registration of which two were accepted without examination; four applicants were accepted after pass- ing the Board's examinations and nine were required to undergo further practical training in the Colony before being allowed to enter for the examinations.

48. Following representations made by the Board, Government agreed to the provision of a limited number of scholarships for the study of pharmacy in Australia. One such scholarship was awarded during the year.

Nursing Board

49. The Nurses Registration Ordinance, 1961, and the Nurses (Registration and Disciplinary Procedure) Regulations, 1961, were en- acted in July. This has brought up to date the law governing the training, examination and registration of nurses and has made comprehensive provision for disciplinary procedures in line with that for doctors, dentists and midwives.

50. There were four meetings of the Nursing Board, the main business conducted being in connexion with examinations in general nursing and psychiatric nursing. Examinations were held in June and December with the following results:

General Nursing

Preliminary Examinations

Final Examination

-- J

PIL

---

Entered Passed

433

282

233

IIL

158

Psychiatric Nursing

Preliminary Examinations

51. There were 200 applicants for registration as General Nurses of whom 177 were accepted; 162 of these nurses were from the approved Training Schools in Hong Kong and a further 15 nurses trained outside the Colony were accepted without examination. Of the remaining appli- cants 9 were required to sit the Final Examinations, 8 were advised to take a full year's course of training at an approved Training School and 6 were required to undergo further practical training before entering for the final examinations. Six applications for re-registration were approved.

52. The Preliminary Investigation Committee met once to consider a disciplinary charge but found no grounds for an inquiry by the Board.

Midwives Board

　　　53. This Board also meets quarterly and examinations are held in April, July, October and January. A total of 163 candidates entered for the Boards examination of whom 155 passed.

54. There were 157 applications for registration and 155 were accepted; 152 of the applicants had completed their training in Hong Kong. Two applications for restoration to the Register were approved. 55. The Preliminary Investigation Committee met on one occasion but found no cause for a disciplinary inquiry.

Radiation Board

　　　56. There were three meetings during the year, the main business being consideration of the draft Radiation (Control of Radioactive Sub- stances) Regulations. These Regulations, which are complementary to the draft Radiation (Control of Irradiating Apparatus) Regulations, are designed to replace existing regulations (which deal only with industrial undertakings) and to extend control to all undertakings which manu- facture, store or handle radioactive substances.

57. These two sets of Regulations, taken together, will cover the field of control considered necessary at the present time in relation to radiation hazards.

Medical Advisory Board

　　　58. This is a non-Statutory Board appointed by His Excellency the Governor. Reconstituted on the 1st July, 1961, its terms of reference are 'To advise the Governor on any matters of medical and health policy referred to the Board by the Director of Medical and Health Services'. There were three meetings during the year at which the Medical and Health Services Development Plan covering the period 1961 to 1972 was considered in detail.

II. PUBLIC HEALTH

GENERAL COMMENTS

59. For the first time in 15 years Hong Kong was declared a cholera infected area on the 16th August, 1961. Despite the overcrowding, limited water supplies, inadequate housing and lack of modern sanitation. in large parts of the urban area, the attack rate was very low and the outbreak was quickly contained.

60. Otherwise the general level of health has been well maintained and although there was an overall rise in the number of notifications of infectious diseases, this was largely due to an epidemic of measles during the first quarter of the year. There was a small increase in notifi cations of chickenpox, poliomyelitis, bacillary dysentery and tubercu- losis. The morbidity from diphtheria continued to decline.

61. Measles was responsible for a small increase in the total of deaths from infectious diseases while the number of deaths from the diseases of later life continued to rise. The increase in morbidity and mortality from accidents of all kinds continues unabated.

62. The notification of infectious diseases is compulsory and a small fee is paid by Government for each notification. Nevertheless only a fraction of the infectious diseases seen outside the Government Hospitals and Clinics is notified, resulting in a gross distortion of the epidemio logical data and making contact tracing and control measures difficult. This is particularly so for tuberculosis and further comment is made later on this aspect.

VITAL STATISTICS

63. The registration of all deaths and live births occurring in the Colony is compulsory under the Births and Deaths Registration Ordin- ance. Still births are not registrable but the number received by ceme- teries and crematoria are recorded. Table 1 shows the annual returns for births and deaths during the past five years period.

TABLE 1

BIRTHS AND DEATHS 1957-61

Estimated

Total Live

Crude Live Birth Rate

Year

Mid-Year

Birks

(per 1.000

Still Brrrk Recorded

Total

Deaths

Population

Population)

Crude Deard Rare (per 1.000 Population)

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

104,579

36.6

1.393

20,250

7.1

1960

2,981,000

110,667

37.1

1.680

19,146

6.4

1961

3,177,700

108,726

34.2

1,683

18,738

5.9

64. After reaching a peak in 1960 the total of live births and the crude birth rate showed a slight decline in 1961; there was a natural increase of 89,988 persons during the year. The age structure of the population is reflected by the low crude death rate, the continuing decline of which can be attributed largely at this time to the con- comitant fall in infant mortality.

65. The mortality pattern continues to show the same trends observed during previous years, namely, decreasing mortality from the communicable diseases and increases in deaths from diseases of later life, particularly neoplasms and cerebro-vascular disorders. An analysis of mortality for the years 1957-61 can be found in Appendix 4.

　　　　66. Table 2 shows the recent trends in infantile and maternal mor- tality. Infant and maternal mortality rates continued to fall but the neonatal mortality rate remained more or less stationary.

67. An analysis of maternal mortality over the past 5 years is shown in Table 3. A marked reduction in deaths from ectopic gestations and toxaemias complicating pregnancy was noted.

TABLE 2

Infantile Mortality

INFANTILE AND MATERNAL MORTALITY 1957-61

Neo-natal Mortality

Maternal Mortality

Year

Rate (per 1,000

live births)

total births)

1957

55.6

23.8

1.06

1958

54.3

23.4

0.85

1959

48.3

21.3

0.73

1960

41.5

20.9

0.49

ויי

1961

37.7

21.0

0.45

TABLE 3

ANALYSIS OF MATERNAL MORTALITY 1957-61

(per 1,000 total births)

Year

Sepsis (excluding

Toxaemias Haemorrhages Abortions

Septic Abortions)

Ectopic Pregnancies

Others

1957

.020

.373

.334

.040

.060

.132

1958

.028

.269

.250

.037

.111

.158

1959

N/A

.340

.226

.028

.066

.056

1960

.010

.179

.143

.045

.072

.045

1961

.009

.09

.027

.036

.027

.072

Urban Areas

III. WORK OF THE HEALTH DIVISION

HYGIENE AND SANITATION

68. The Urban Council is responsible through the Urban Services Department for environmental sanitation in Hong Kong, Kowloon and New Kowloon. The Deputy Director of Medical and Health Services serves as Vice-Chairman of the Urban Council and is the co-ordinating

link between the two Departments for the control of communicable disease through improved environmental sanitation, food hygiene and pest control. Medical and Health Officers are seconded to the Urban Services Department from the Medical and Health Department and work under the direction of an Assistant Director of Medical and Health Services who is posted to the Urban Services Department as Assistant Director, Hygiene. He is responsible for the guidance of the Health Inspectorate in particular and for advice to the Urban Services Depart- ment as a whole on the day to day management of environmental health problems.

69. Medical and Health Officers in the urban areas, in addition to their duties connected with the maintenance of satisfactory standards. of environmental sanitation and food hygiene, are responsible for local co-ordination of all epidemiological measures to control the transmission of infectious diseases. Exceptions are tuberculosis, venereal disease, leprosy and malaria which are the concern of specialized branches of the Medical and Health Department. Through the media of the routine house inspections and the regular visits to licensed food premises carried out by the Health Inspectorate, much health education is possible in connexion with immunization campaigns and with the control of in- testinal infections. With the assistance of fully trained Health Visitors, the Health Officers maintain investigations into the sources of known cases of diphtheria, tetanus neonatorum, poliomyelitis, typhoid and certain other intestinal diseases.

70. These activities are closely co-ordinated with the activities of teams of inoculators of the Epidemiological Section of the Medical and Health Department which work under the immediate direction of area Health Officers and offer prophylactic immunization against smallpox. diphtheria and enteric fever.

Rural Areas

71. The Director of Urban Services has statutory powers controlling sanitation, food hygiene, cleansing, amenity and allied services in the townships and the more developed villages in the New Territories while the District Commissioner is the licensing authority for all hawkers and premises where food is handled. The Medical and Health Department provides the curative medical services and the Principal Medical Officer of Health, New Territories, advises the respective authorities on all health matters affecting the area.

　　　72. The Medical and Health Department is responsible for environ- mental health in rural areas. The main emphasis is on health education stemming from the curative centres and designed to stimulate self-help through village schemes of environmental sanitation.

　　　73. Active measures continue to control the illegal slaughtering of animals for food and the sale of unwholesome meat, but considerable difficulties are encountered in detecting offenders. Insanitary conditions. in workmen's settlements around new development projects continue to be a health problem.

Quarantinable Diseases

EPIDEMIOLOGY

　　　　74. Prior to the outbreak of cholera in 1961, there had been no case of quarantinable disease notified in the Colony since 1952. On that occasion there were three cases of smallpox, two of which were imported.

Historical

CHOLERA

75. Cholera was first recorded in Hong Kong in 1858. Records are incomplete but it was reported that as many as fourteen hundred were destroyed by the disease' in the fishing village of Aberdeen. Thereafter, cases were reported annually between 1862 and 1866 followed by a break of 19 years. Cases then appeared in 1885, 1888 and 1891 after which cases again occurred annually during the years 1894 to 1897. Four years later, in 1901 there was another five years of annual occurrence followed by a 3 years' interval. However, from 1908 to 1916 cholera again occurred each year; during 1913, in August, fifty cases occurred *almost all of which were on board fishing and cargo boats belonging to the village of Shaukiwan'. Between 1919 and 1927, again a small number of cases was recorded each year with the exception of 1924.

76. Towards the end of April 1932, an epidemic of cholera started in Shanghai and spread throughout Southern China when it was estimated that 100.000 cases occurred with a fatality rate of some 50%. A total of 241 cases with 156 deaths was recorded in Hong Kong where two infectious disease hospitals were staffed and equipped to deal with the emergency.

77. The next episode was in August 1937 when the disease became epidemic with almost startling suddenness and nearly 1,000 cases were found, many refugees probably having brought the infection with them'. The measures taken included inspection and examination of all arrivals,

isolation and treatment of the sick, legislation to minimize infection of food, intensive house to house inspections, disinfection of infected dwellings and mass inoculation.

78. The outbreak continued on into 1938 and 'was aggravated by the steady stream of refugees into the Colony. Many more males than females were affected by the disease". According to the official reports, there was a total of 2,227 cases resulting in 1,445 deaths. However, Wilkinson (1943) has recorded this outbreak in some detail and accord- ing to his paper, the outbreak lasted until 1940. There are reports that the disease thereafter appeared sporadically during the first twelve months of the Japanese occupation.

Cases Deaths

TABLE 4

CHOLERA IN HONG KONG (WILKINSON 1943)

гго

1937

1938

1939

1940

1,690

547

708

647

1,082

363

448

331

79. In 1940, a carrier rate of 20% was found amongst certain sec- tions of the community just before the annual outbreak which started in June of that year and which reached epidemic proportions in July and August, waning during September.

80. During 1946, the first case of cholera was reported on the 8th January and was definitely established as an imported case from Canton, A further 6 cases were notified during March, of which four were im- ported; a further 29 were notified in April of which 25 were imported. Special anti-epidemic measures were established on the 1st April in the face of a steady monthly influx of an estimated 100,000 returning residents and refugees. Despite rigorous measures of environmental sanitation and mass inoculation with cholera vaccine, epidemic propor- tions were reached in June when, during the week ending the 15th June, 112 cases occurred. Altogether there were 281 cases during June with 137 deaths. The last case of cholera was reported on 26th September, 1946, and thereafter no further case of cholera was confirmed in Hong Kong until the 16th August, 1961.

TABLE 5

CHOLERA IN HONG KONG 1946

Cases Local Imported

Total

514

374

Bodies Dumped

Deaths

239

Inoculations Estimated Performed Population

371,608

1,550,000

　　　8. There are no records of the detailed bacteriological findings prior to 1961 now available but it was assumed that all these infections. were due to cholera Asiatica, predominantly of the Ogawa group. Haemolysis tests were not applied in the past and all the epidemics recorded presented the clinical picture of classical cholera.

The 1961 Outbreak

82. The infections confirmed during the Hong Kong outbreak in 1961 were proved, with one exception, to be due to the El Tor type of the Ogawa group of vibrio cholerae; there was only one infection of the Inaba group. Therefore, the recent history of paracholera or *enteritis choleriformis El Tor' in this region of Southeast Asia is of some interest.

83. Paracholera has occurred periodically in epidemic form in Indonesia over the past 25 years. Neighbouring countries had remained free of the infection until the middle of 1960 when El Tor cholera vibrios were isolated in Bangkok towards the end of an outbreak of cholera Asiatica. At this time the El Tor isolates were cultured from a few patients suffering from mild diarrhoeal conditions and from samples of food and water. In September, 1960, an epidemic of para- cholera El Tor occurred in Northeast Thailand.

　　　84. Meantime, an epidemic which started on the 5th January, 1960 in Macassar spread throughout the whole of Indonesia, affecting Java in 1961. The infection appeared in Sarawak in July, 1961, and con- currently paracholera was occurring in the Kwangtung Province of the Chinese Peoples Republic. Macau reported its first confirmed case on the 14th August, 1961, and the first two cases were confirmed in Hong Kong on the 16th August. On the 22nd September, 1961, the first case in the Republic of the Philippines occurred in Manila; in January, 1962, North Borneo was, in turn, infected.

The Hong Kong Outbreak

85. During the first week in August, international press agencies. carried reports of an epidemic of cholera occurring in the Kwangtung Province of China. At the same time, travellers entering Hong Kong by railway at Lo Wu presented anti-epidemic certificates of inoculation, against the 'four diseases', with T.A.B.-cholera vaccine. There were stories of a cholera-like disease affecting many villages in the rural areas of the province and causing many deaths. On the 10th of August, Reuter reported cholera in Macau, but this was not confirmed by the Macau Health Authorities. However, in view of the strength of the

rumours it was decided to take precautionary measures in Hong Kong and over the ensuing week-end the production of additional supplies of cholera vaccine was started, working on a shift basis. Cholera inocula- tion centres were designated, to open on Monday the 14th August, hospital and other staff most at risk were inoculated, and plans made to open cholera treatment centres and to intensify all necessary measures of environmental sanitation.

86. On Monday, the 14th August, a case of cholera was confirmed in Macau and Hong Kong imposed quarantine restrictions on Macau and the Kwangtung Province of China. Inoculation Centres were opened up on that day, the chlorination of unprotected well water supplies started in the urban areas, food inspections intensified, treatment centres prepared and a quarantine centre designated. Through the radio and the press the public was informed of the preparations made, the measures being taken and co-operation sought regarding the inoculation cam- paign and the practice of hygiene in the home.

87. Two suspected cases of cholera were reported on the 16th of August, one a gravely ill child with typical symptoms of cholera who was brought into a hospital in the New Territories from an isolated village on the shores of Deep Bay. The other was an elderly woman brought in dead to the Kowloon Public Mortuary from a junk anchored off Cheung Sha Wan, Bacteriological confirmation of the presence of vibrio cholerae of the Ogawa group was available by mid-day on August 17th and Hong Kong declared itself infected with cholera and put into full operation the plans to deal with an epidemic.

88. A detailed report is given in the White Paper on the Outbreak of Cholera in Hong Kong which was laid before Legislative Council on the 13th December, 1961. (White Paper, December 1961). Therefore this report will deal mainly with the epidemiological features considered to be of interest.

89. Epidemiological action was based on the fact that cholera vibrios of the Ogawa group had again appeared in Hong Kong after an absence of 15 years. Early on, it was suspected that these virbrios were of the El Tor type and the haemolysis tests in the laboratory, although in conclusive and not clear cut, supported this. However, this differentia- tion is of no importance as far as the treatment of patients and the control of the outbreak is concerned'. (Pollizter 1959). The densely overcrowded foreshores, the aggregations of squatter and roof top dwellings and the inadequately sanitated old tenement areas in the

urban areas all presented a very grave risk of an explosive epidemic. Accordingly, the disease was notified to World Health Organization as cholera and appropriate action taken.

90. The outbreak lasted until the 23rd of September when the last but one confirmed case was admitted to hospital. There was then an interval of just over six weeks when one further confirmed infection came to light on routine investigation of a case of moderately severe gastro-enteritis admitted to hospital on the 8th of November. Since that time, routine sub-culture of all specimens sent to the laboratory from cases of gastro-enteritis has been continued, so far with entirely negative findings.

91. The total of proved vibrio cholerae infections was 130 of which 70 were admitted to hospital with clinical symptoms and a further 7 were brought in dead to the Public Mortuaries. The other 53 proved infections, all in persons without symptoms. were found amongst the 731 contacts of clinical cases who were isolated at the Chatham Road Quarantine Centre. Of the 70 patients treated in hospital 8 died, making a total of 15 deaths during the outbreak.

　　　　92. All of the clinical cases encountered were sporadic, were in persons of the Chinese race, and none of these clinical cases could be traced to either a previous clinical case, a known carrier or a clearly defined common source of infection. The contact carriers were all directly related to the respective clinical cases, being either members of the family or common habitation dwellers. The highest attack rate was in the boat people which accounted for 30% of the proved infec- tions in a group which constitutes only 4.42% of the total population. The contact carrier rate was 25. amongst the boat people but only 3% amongst those living on land. This is not surprising as the families living in sampans and junks use the boats as permanent dwellings, are of a low socio-economic group and live under very simple and primitive conditions.

93. The greatest number of clinical cases admitted on any one day between the 16th August and the 23rd September was eight, with fifty- two cases occurring during the first twelve days. From the 28th August onwards, there was a gradual decrease, 19 cases occurring over the next twelve days and only five between the 10th and the 23rd of September. Thirty-two cases were notified in Kowloon, 24 in the New Territories and 20 on Hong Kong Island.

94. Of the clinical cases 35% of those treated on Hong Kong Island presented symptoms and signs indistinguishable from classical cholera:

in Kowloon only 10% presented this picture. Of the 8 cases that died in hospital, two were drug addicts in very poor physical condition, a third was an old lady of 79 years of age and a fourth a man of 27 years suffering from a ruptured pyelo-nephritis and peritonitis. The other four deaths were in adults, all of whom were over 60 years of age. The seven persons brought in dead to the Mortuaries had all been ill for less than 36 hours, the majority dying within 6 to 12 hours of the onset of symptoms. Three of these deaths occurred in children aged five, seven and twelve respectively.

Treatment

95. The treatment of cases admitted to hospital was by the rapid replacement of fluid and electrolyte loss. Patients with clinical cholera coming to clinics in the New Territories were started at once on re- hydration with normal saline which was maintained during the journey by launch or ambulance to the relevant treatment centres maintained at the Lai Chi Kok Hospital, the old Victoria Mental Hospital and the Cheung Chau Hospital. Once admitted, patients were given rapid intravenous normal saline infusions-up to 2,000 ml. were given in one case between the time seen at a clinic and hour after admission to hospital. When more than 2 litres of saline had been given, 0.5 gm. of potassium chloride was given in 500 ml. of normal saline and after each 4 litres of saline, 500 ml. of 2% sodium carbonate was adminis- tered. After re-hydration had been achieved intravenous normal saline was given ml. for ml, of fluid lost through vomitus, stool and urine until convalescence had been established. The invisible loss from sweat- ing and respiration, amounting to one litre each day, was also replaced,

96. To begin with, noradrenaline was added to the intravenous fluids when the blood pressure was below 70 mm Hg and until such time as the blood pressure was restored. However, after the first week the method of estimation of the specific gravity of plasma advocated by Philips et al (1950) was adopted and normal saline, given at the rate of 75 ml. per minute, obviated the need for noradrenaline which is not without its risks under such circumstances. Chloramphenicol was also given intramuscularly in doses of one gramme 8 hourly until the patient was able to take the drug by mouth when it was continued in appro- priate doses for five days. This is of doubtful value as the modern treatment of cholera is a process of tiding over a period of altered physiology during an apparently self limiting disease. Using precision methods to estimate the fluid and electrolyte losses and giving the

　　essential replacements rapidly according to physiological requirements is all that is required in the form of therapy. In this way the fatality rate from cholera can be reduced to negligible levels provided that treatment is given early in the disease and that there is no severe under- lying chronic pathology which will tip the scales between life and death as it will do during any acute and severe clinical condition.

Control Measures

　　　97. The most significant single measure which limited the outbreak is believed to have been the isolation of 96% of the immediate family or habitation contacts. In Hong Kong where whole families live in cubicle spaces with numbers of families in the same room, the segrega- tion of contacts is no mean problem. Fortunately. the Chatham Road Camp with accommodation for 3.000 persons was available as a quarantine centre. Once a clinical case of cholera appeared, the con- tacts were identified by a team consisting of a Health Visitor and a Health Inspector and all were removed to the quarantine centre. A police guard was placed on the premises, disinfection carried out and the living quarters sealed until the contacts returned. It is a high tribute to all concerned that there was virtually no opposition to the quarantine measures and no losses of personal property occurred.

98. In the Quarantine Centre, rectal swabs were obtained from all contacts and the 53 contact carriers detected were isolated within the Centre. Of this latter group. 41 were given treatment with an antibiotic to which the strains of vibrios cholerae were proved to be sensitive. Contacts who were not proved carriers were isolated for six days and then returned to their homes. The contact carriers were isolated until at least three successive negative rectal swabs had been obtained. It is of interest, if not significant, that no secondary case of cholera occurred that could in any way be related to the contacts.

99. The first group of contact carriers which numbered 20 was treated with chloramphenicol. Later, two cases which did not respond to streptomycin were given chloramphenicol. The dosage for the adult was I gm. of chloramphenicol in 4 divided doses daily for a period of five days. In eleven cases, it took 96 hours before the first negative swab was obtained and the other 9 took 48 hours.

　　　100. Oral streptomycin was given to a second group of 21 of the contact carriers in 1 gm. doses hourly for 8 hours, on an empty stomach. The dose was reduced appropriately for children. Rectal swabs taken daily indicated that this cleared the bowel of cholera vibrios within

24 hours, except in two cases where the strains of vibrio proved to be resistant to streptomycin. In these two cases oral chloramphenicol in full therapeutic doses given over five days rendered the bowel free of vibrio cholerae.

101. Unfortunately, owing to pressure of work in the laboratory during the early stages, rectal swabs were taken from the chloram- phenicol group at only 48 hours interval. Therefore, the time factor for clearing the bowel was not comparable in the two groups and the only provisional conclusion is that streptomycin in the way given may be more rapidly effective provided that there is no true resistance factor arising.

102. Although antibiotics do not seem to have a place in the treat- ment of the clinical condition they do appear to have, under appro- priate control, a very definite place in the management of the contact. carrier state. This aspect requires intensive investigation as it offers a method of control of the contacts of clinical cases under conditions where isolation is not possible or practicable and short term therapy with an oral antibiotic could be used on a community basis.

Inoculation Campaign

103. The response to the call for inoculation with cholera vaccine was unexpected and almost overwhelming. There was a stock of 840,000 c.c.'s of cholera vaccine, prepared locally in the Government Institute of Pathology, in hand during the first week of August. This was suffi cient to inoculate some 1,200,000 persons giving one dose of I c.c. of 8,000 million organisms to adults with appropriate reductions for children between the ages of one and twelve years. This was expected to meet all demands until such time as fresh supplies were coming forward from the Institute at an expected rate of over 100,000 c.c.'s each day from the 18th August onwards. In the event, over one million inoculations were given between the 14th and the 19th of August and there had to be a temporary conservation of the remaining supplies over the week-end of 19th and 20th August. Due to the generous and quick response from many countries to an appeal for additional cholera vaccine, full scale inoculation was resumed on the 21st; by the 28th of August some 75% of the total population of the Colony had been inoculated. This was achieved by closing down many of the routine clinic and health activities and turning over the staff and premises to inoculation duties. The hospital services were not curtailed in any way during the outbreak.

Environmental Measures

104. On the environmental side, the whole of the Health Inspectorate and other supporting staff of the Urban Services Department was con- centrated on food inspections, markets and food hawkers control, the chlorination of wells, the control of fly breeding and the disinfection of premises.

Assessment

　　　105. In retrospect, the sporadic occurrence of cases and their dis- tribution throughout the Colony indicated a very wide spread of cholera vibrios throughout the community. There is accordingly a number of factors to be taken into account in assessing the epidemiology of this outbreak. The first is that the people of Hong Kong have many close family links with Kwangtung Province and they were disturbed by the accounts reaching them of an epidemic of cholera in Kwangtung Province. Next, the older people had seen cholera in the past and knew what could happen. The development, since the War, of health educa- tion in general and immunization techniques in particular has engen- dered a community sense of the benefits of inoculation, of early treat- ment of disease and of the environmental measures necessary during an epidemic emergency. Accordingly, when Hong Kong became infected, there was no concealment of cases and patients with symptoms of cholera were brought immediately for treatment to the nearest clinic or hospital. There was no opposition to the isolation of contacts or to the other environmental measures applied. Possibly the most sur- prising feature, judging by the past, was the demand for inoculation and a special tribute is due to the patience and good humour of the people in the long queues at the inoculation centres as they waited in the rain and the humid heat for their turn to come.

106. It was accordingly possible to apply fully the basic principles of the early isolation and treatment of clinical cases, the strict quarantine of contacts, the treatment of carriers, the immunization of the com- munity at risk and the necessary environmental measures to deal with potential sources and vehicles of infection.

　　　　107. The behaviour of the El Tor cholera vibrios in other countries affected during the past two years has demonstrated all the hall marks of cholera as a formidable epidemic disease. Undoubtedly, the problem in a predominantly urban area with all facilities available is an entirely different one to that presented by cholera in scattered rural communities. Nevertheless, the infecting agent was community wide in Hong Kong

in August 1961 and, yet, despite the continuing search for vibrios, agglutinable or non-agglutinable, none have been recovered since November of last year. This is not in accordance with past experience of a post-epidemic phase when cases of cholera have continued to appear sporadically for many months thereafter. Whether or not this is related to certain characteristics of the El Tor vibrio is not clear, but experience elsewhere of El Tor as it has occurred during the past months suggests that this is not entirely the answer.

108. The source of the Hong Kong infection was undoubtedly the Kwangtung Province and the introduction was presumably via the boat people who move between Kwangtung Province and Hong Kong in junks and sampans. All of the first cases appeared on the water fronts and it was only later that cases appeared inland. No case was traced to traffic by rail through Lo Wu where all entering the Colony had been given cholera vaccine or were inoculated on entry.

109.

The danger period during 1962 is expected to be during the months of hot humid weather in July and August. Accordingly, a cholera immunization campaign was started in February 1962 and continued throughout March and April. This time, in the absence of an emergency the public response was not so good. However, although only an overall 53% of cover of the whole population resulted, the boat people and waterside dwellers most at risk came forward readily and between 80% and 100% of these groups received a 'booster' dose of cholera vaccine.

110. An account of the outbreak is not complete without a sincere. tribute to the people of Hong Kong. All sections of the community gave unqualified and practical support to all measures taken while the outside world responded immediately and generously to the call for assistance with vaccine when additional supplies were most needed.

References

Wilkinson (1943) Cholera in Hong Kong. Lancet. 1943, Volume II,

P. 169-170.

White Paper (1961)-A Report on the Outbreak of Cholera in Hong

Kong. Government Printer, Hong Kong.

Pollizter (1959) Cholera-World Health Organization Monograph

Series No. 43.

Phillips et al (1950)-Measurement of Specific Gravities of Whole Blood and Plasma by Standard Copper Sulphate Solutions- Journ. Biolog. Chem. Vol. 183, No. 1.

Notifiable Diseases

11. During the year 1961, there was an increase in the number of cases of the more common notifiable diseases, the increase being most marked for measles and chickenpox while there was a decrease in notifications of diphtheria, enteric fever and amoebiasis.

112. Free immunization against smallpox, enteric fevers, diphtheria and cholera continued to be available throughout the year to all members of the public at all Government Hospitals, Clinics, Port Health Inocula- tion Centres and District Health Offices. In addition, inoculation teams visited schools, resettlement estates and other densely populated areas in conjunction with mass immunization campaigns. The outbreak of cholera interrupted for a period of six weeks the special campaigns against diphtheria and for vaccination against smallpox.

13. Towards the end of 1961 and continuing in early 1962, special attention was given to smallpox vaccination and a total of 801,876 vac- cinations were performed between November 1961 and January 1962. 114. A summary of the prophylactic immunizations given is at Appendix 6.

Amoebiasis

115. Amoebiasis occurs sporadically throughout the Colony and the number of cases notified varies from year to year. The incidence rate for this infection in 1961 was 6.78 per 100,000 of population being the lowest notified for many years: there were 12 deaths recorded from this

cause.

Bacillary Dysentery

116. There was a marked rise in the number of cases notified with 51.9% of the cases occurring in children under the age of 10 years. Eight deaths were attributed to bacillary dysentery, two less than the number recorded in the previous year.

117. Much intensive health education in the prevention of this infec- tion is carried out by Health Officers amongst those connected with the handling, preparation and sale of food. There were 122 carriers detected amongst case contacts and all were given treatment and not allowed to return to work until three consecutive negative stool specimens had been obtained.

די

Cerebro-spinal Meningitis

118. There were 36 cases notified with a fatality rate of 72.2%. The majority of the cases occurred in Kowloon, only seven occurring on Hong Kong Island and five in the New Territories. All were sporadic and were brought into hospital late in the disease.

Chickenpox

119. The number of cases notified showed a considerable increase over that of the previous year. The infection was most prevalent in the first 4 months of 1961 when a total of 402 cases was recorded as against 96 for the remaining 8 months of the year.

120. There were 7 fatal cases, the deaths being attributed to inter- current broncho-pneumonia.

Diphtheria

121. The intensive immunization campaign which commenced in the autumn of 1959 was continued throughout the year and although there was a further drop in the number of cases notified the decline was less marked than that of the previous year. This could be, in part, attributed to a break in the campaign for a period of 6 weeks during the cholera outbreak when all available staff was diverted for emergency duties.

122. Over 50% of the cases occurred in the densely populated tene- ments and squatter areas of Kowloon, C. Diphtheriae mitis was the pre- dominant causative organism and only in rare instances was an 'inter- medius' or a 'gravis' strain isolated,

123. Most of the 1,334 cases were in children under the age of 10 years with the highest incidence in the 0-4 age group. The number of deaths from diphtheria has not shown a fall in parallel with the drop in incidence but the case fatality rate remained low. During 1961 there were 109 deaths attributed to diphtheria, a case fatality rate of 8.2%.

124. Despite the poor response of the population to the facilities for immunization, approximately 60% of the children under the age of 10 years have now been protected and the continuing decline in incidence of the infection gives some encouragement, Another hopeful feature was that 95 carriers were detected amongst case contacts and thereafter ad- mitted to the Infectious Diseases Hospitals for treatment. During the previous year only 35 carriers had been detected.

Enteric Fever

　　　125. There was a slight drop in the number of cases and deaths notified during the year, there being 742 cases, as compared with 773 during 1960. The incidence rate in the 5-9 and 10-14 age groups remain- ed high accounting for 46.2% of the cases recorded. The case fatality rate was 3.2%. Twenty-six carriers were detected and treated. Of interest was a decline in the incidence of the infection in areas where the domestic water supply was derived from wells chlorinated during and after the cholera outbreak.

126. Owing to the priority given to diphtheria immunization through- out the year, no intensive prophylactic drive was possible. However, facilities for inoculation remained freely available to the public and the annual campaign was maintained in schools. Food handlers and the staff of licensed restaurants and eating houses are required to submit to inoculation with T.A.B. vaccine annually.

Malaria

　　　127. There were 812 cases notified with one death recorded during the year. The incidence was highest in the Sai Kung District of the New Territories. Detailed comment is made in paragraphs 198 to 207.

Measles

　　　128. There was a marked increase in incidence and in deaths, the total of 1,727 cases notified being the highest recorded in recent years. The disease reached its peak in February and then gradually declined. No cases were reported in November and only 4 in December. The case fatality rate was 25.2%, which high figure is an index of incomplete notification and the delay in bringing severe infections for the treatment of complications.

Poliomyelitis

　　　129. An increase in the number of cases of poliomyelitis was record- ed during the year, most of the cases occurring during the summer with The incidence peak in June. There were 184 cases notified with 39 deaths. The morbidity rate was 5.79 per 100,000 of population and the case fatality rate 21.2 per cent. Children under five years of age accounted for 83.2% of the total morbidity.

130. Faeca! surveys were carried out at intervals from June 1961 onwards in healthy children under the age of 5 years to obtain informa. tion on the seasonal variations in the excretor rates of poliovirus and other enteric viruses. The results obtained are shown in Table 6.

TABLE 6

POLIOVIRUS AND OTHER ENTERIC VIRUSES IN THE 0-5 AGE GROUP 1961-62

Positive other enterie viruses

Date

Number examined

Positive Poliovirus

Negative

Type 1 Type 2 Type 3

Total

June 1961

258

143

24 (9.3%)

91 (35.3%)

August 1961

247

116

11 (4.4%)

120 (48.6%)

November 1961

238

198

2 (0.8%)

38 (15.9%)

January 1962

211

190

5 (2.3%)

16 (7.5%)

April 1962

207

168

5 (2.4%) 34 (16.4%)

　131. Although Type 2 virus was not isolated in the course of the faecal surveys, a serological survey carried out in 1960 indicated that there is a wide circulation of all three types of poliomyelitis virus amongst the child population.

132. During February and March 1962 in conjunction with the Inter- national Social Service and the Lederle Corporation, children in orphan- ages destined for adoption into families outside Hong Kong were given trivalent oral poliomyelitis vaccine. Certain of the staff of the Department assisted with the work thus gaining practical experience prior to a mass immunization campaign, using oral vaccine, planned for late 1962. The marked drop in the excretor rate for polio and other enteric viruses sug- gests that the optimum time for mass immunization is during the winter months of the year.

Tuberculosis

133. Tuberculosis remains the major public health problem in Hong Kong and although the results achieved in recent years are promising, much remains to be done. The problem is considered in detail in para- graphs 140 to 197.

Other Notifiable Infectious Diseases

Influenza

134. Notification of this infection is entirely voluntary. Cases report- ed during the year numbered 6,223 with 39 deaths compared with 5,727 and 26 deaths in 1960.

Ophthalmia Neonatorum

135. 250 cases were reported as compared with 254 in 1960.

Puerperal Fever

136. Only 2 cases, both fatal, were registered during the year. Deliveries in both the cases took place in the home without the help of a doctor or a qualified midwife.

Scarlet Fever

137. Sporadic cases of this infection occurred throughout the year. 29 cases were reported as against 17 in 1960.

Whooping Cough

138. 47 cases were notified during the year, the lowest on record since 1949. One death was reported.

Other Communicable diseases which are not notifiable

Tetanus

139. Of 142 cases of tetanus admitted to hospital, 92 occurred in new born children, Most of the cases of tetanus neonatorum occur in infants delivered at home in villages situated almost exclusively in the New Territories. In such cases, assistance by an untrained person, the use of unsterile material and instruments and the common practice of applying ground ginger root to the umbilicus as a styptic, all combine to give a grave risk of tetanus neonatorum. Children attending Maternal and Child Health Centres are given routine immunization against tetanus using the toxoid preparations. Health education of parents and others in the areas most affected is a slow process despite the very considerable efforts of the health staff of the New Territories.

TUBERCULOSIS

140. The steady decline in the death rate from tuberculosis, which reached a peak in 1951, has continued. However, the morbidity, although changing in pattern, remains high and the figure of an average of 2% of persons with active tuberculosis in the community has not changed significantly. Of this 2% one fifth are open cases, infective to others.

Year

1951 .. 1952.

1953 .. 1954 1955

1956 ..

1957 .. 1958.. 1959 ..

1960 ..

1961 ..

TABLE 7

DEATH RATES FROM TUBERCULOSIS

Estimated

Death rate

population per 100,000

Percentage of total deaths

Percentage of tuberculosis

(mid-year)

from all cases

from tuberculosis

deaths below 5 years

2.013,000

208.0

20.0

34.0

2,250,000

158.8

18.4

34.3

2,250,000

130.6

16.0

36.2

2,277,000

126.3

14.9

31.2

2.340,000

120.0

14.7

28.0

2.440,000

107.0

13.6

25.0

2,583,000

103.6

13.9

21.2

2.748,000

83.8

11,2

19.6

2,857.000

76.2

10.7

19.2

2.981.000

69.9

10.8

10.5

3,177,700

60.0

10.2

11.5

141. The vaccination of new born babies with B.C.G., started in 1952, is now widely accepted and all agencies engaged in midwifery are participating. As 96% of the registered births take place in institutions, vaccination is greatly simplified and during 1961 the percentage vaccinat- ed was 79.31%. The percentage in 1952 was 4.33%. The effect of this measure is reflected to some extent in the notifications of tuberculosis amongst children aged 5 years and under. What percentage of the cases so notified have not received B.C.G. is not yet known, but this aspect of the situation is now under investigation.

TABLE &

TUBERCULOSIS NOTIFICATIONS UNDER FIVE YEARS

Under one Year

Under Five Years

% New Borns

All

T.B.

All

Vaccinated

Forms

Meningitis

Forms

T.B. Meningitis

1952 ..

4.33

2,388

583

321

108

1957 ..

35.93

1.441

448

270

114

1958 .

46.86

1.137

309

224

105

1959 .

59.53

975

276

190

1960

71.54

660

181

1961.

79.31

649

185

TABLE 9

NOTIFICATIONS OF TUBERCULOSIS (ALL AGES) 1961

Government Chest Clinics

Other Goverment Institutions

Tung Wah Group of Hospitals

Non-Government Institutions

Private Practitioners

Irr

8.957 2.056

947

112

512

12,584

142. The notifications of tuberculosis are far from complete and it will be seen that the great majority are made from Government Institu- tions which account for 87.5% of the total. On the other hand the registration of deaths is virtually complete and there were 1,907 deaths recorded as due to tuberculosis. An analysis of these deaths showed that full details of the previous history were available for only 651. Of this group 1.7% had no signs of tuberculosis; 27.6% had not received treat- ment prior to death. Of the 460 receiving treatment before death 219 had attended Government Chest Clinics and 241 had been under treat- ment by private practitioners. Assuming that death rates are roughly comparable in the two groups under treatment, it appears that some 9,000 notifications have not been made. This situation is also under investigation with a view to ensuring that the statutory obligation to notify tuberculosis is more fully appreciated and met.

143. An analysis of morbidity rates calculated from notifications and related to census data shows that tuberculosis morbidity is low under the age of 14 years after which it rises sharply to the age of 24 years, increasing thereafter gradually in the older age groups. In the age group 60-64 years, the death rate from tuberculosis is five times the average for all ages; in young persons the death rate is highest in the 0-4 years group being just over two-thirds of the rate for all ages. The most favour- ed group is between 10 and 19 years where the death rate is less than 6 per 100,000.

144. The major unknown factor is of course the number of persons coming into Hong Kong to get treatment for tuberculosis. An inquiry conducted in March 1962 showed that 124% of cases under active treatment had been in the Colony for six months or less. A review carried out in hospital patients showed that 14% had come to Hong Kong specifically for treatment. Of the 4,987 cases who defaulted from treatment during the year, about 2% was recorded as 'returned to village' which is taken to indicate that they had left the Colony to return home. [45. All cases attending the Government Chest Clinics are given treatment free without question as to origin. The increasing volume of work undertaken at the Government Chest Clinics is set out below.

TABLE 10

1957

1958

1959

1960

1961

First attendances

35,126

39,454

39,008 35,991 40,146

　　Cases of tuberculosis discovered Total attendances for treatment

11,428

539.282

12,270 14,406 12,937 15,270 *803.326 1,655,100 2,001,960 2,204,058

TABLE 10 Contd.

1957

1958

1959

1960

1961

Under treatment from previous year

5,887

9,132

13,733

16,062

16.433

Started treatment during the year

7,964

11.546

11,357

12.617

12,381

Completed treatment

1,213

1,048

2.064

3.724

3,776

Failed to attend

2,868

3,048

5,391

4,975

4.987

Admitted to hospital from Chest

Clinics

1,078

1,511

1.587

1.592

889

16.433

17.714

Still on treatment at end of year

9.132 13,733 16.062

Streptomycin course extended by daily injections.

146. Treatment at the Chest Clinics is by ambulatory chemotherapy which includes daily injections of streptomycin 6 days each week for periods up to nine months or more and concurrently combined PAS/ INAH in tablet form issued weekly to be taken daily. The oral therapy is continued for a period of up to two years from the start of treatment. Some chronic cases with positive sputum are maintained for long periods on INAH in the hope that they will become 'catalase negative". Hospital admission is arranged for those patients whose treatment can be ex- pedited by surgical or other means or who, for purely medical reasons, require in-patient treatment.

147. An analysis during the year of 1.500 patients who had com- pleted treatment showed that 65% showed satisfactory radiological im- provement and just over 94% of cases with positive sputum had been rendered sputum negative. Of those who fail to complete treatment, just under one third default during the first three months, the next largest group being those who have completed 12 months treatment. Amongst patients who can be traced, the majority give the reason that they are too busy to attend.

148. There are four full time Government Chest Clinics, each with its own X-ray department, which are open all day on week days and offer one evening diagnostic session each week, Part time clinics are maintained at twelve centres, visited once weekly by the tuberculosis staff, where daily treatment is continued by the permanent staff of the centres visited. A sessional advisory service is also maintained at four other centres maintained by voluntary agencies.

149. In addition there are injection sessions for patients receiving daily streptomycin at seven other centres; these are for the convenience of patients who cannot travel regularly to the main or branch clinics. They are supplemented by injection sessions on five nights each week at the four full time chest clinics for patients who cannot attend during

the day. These injection centres, particularly the evening ones, are very popular.

　　　150. Not surprisingly there is a large number of patients who do not attend with complete regularity. It is for this purpose that the very comprehensive regimen of treatment was instituted in 1958. If occasional injection sessions are missed the combined PAS/INAH tablets, provided they are taken regularly, will ensure that the long term result is not affected materially. Irregular drug taking is, however, a world wide phenomenon under such circumstances and it is of interest that surprise urine checks show that irregularity of drug taking varies from only 3% to 16% in the various clinics in the Colony.

151. The general picture is that new cases of tuberculosis coming forward for treatment are doing so at a much earlier stage of the disease. There is, however, still a not inconsiderable number attending the Gov- ernment Clinics for the first time with extensive disease and who have had treatment previously either in Hong Kong or in China. Of these many have organisms resistant to one or more of the standard drugs in use. The size of this resistance problem is unknown and is the subject. of urgent study and investigation. However, once a chronic case with resistant organisms is detected, contact investigations follow and treat- ment is fully supervised. It is the undetected resistant case moving freely in the community that is the main problem and, until prevalence surveys can be mounted, the total problem posed remains obscure.

Contact Tracing

152. Once a case of tuberculosis is diagnosed, Tuberculosis Workers. visit the home and arrange for the examination of family or close house- hold contacts. Those under 8 years of age are tuberculin tested and those over that age are X-rayed. During the year a total of 18,411 contacts underwent a full investigation, the findings being:

TABLE 11

CONTACT EXAMINATIONS 1960-61

Under 8 years of age

1960

1961

Tuberculin Tests

{

Negative Positive

907

831

LIJ

2,392

3,102

Clinical findings of

Active T.B.

Inactive T.B.

101

125

- - J

contacts showing

Positive Mantoux

Percentage of Contacts found to have active

Suspicious T.B. Free of T.B.

473

510

1.749

2,375

tuberculosis

2.09

2.34

Over 8 years of age

Result of Clinical

examination

following

'Contact X-rays

Active T.B. Inactive T.B.

Suspicious T.B.

Free of T.B.

Percentage of contacts found to have active

Tuberculosis

X-ray Surveys

1960

1967

318

421

387

665

1,043

1.002

8,766

12.390

3.02%

2,91

153. Government conducts annually an X-ray survey of all civil servants. In addition all prisoners are X-rayed each year and other X-ray surveys are undertaken, on request, of groups of employees in commercial or industrial concerns where certain conditions are met regarding sick leave for and re-employment of, persons found to be suffering from active disease. There are only two mobile X-ray units at present available for this purpose and they are very fully committed in dealing with radiological services to part-time clinics and to the annual and "conditional' surveys. A static X-ray Survey Centre is now being built on Hong Kong Island and another is planned for Kowloon.

154. During the year the following survey work was undertaken:

TABLE 12

X-RAY SURVEYS

Government Employees

Conditional

Prisoners

Surveys

Total examined

45.617

9.735

26.809

Further clinical and large film

examination

5.677

3.390

1.761

Active tuberculosis

399

485

313

Percentage of active tuberculosis

0.875

4.98

1.17%

155. Government servants undergo a pre-employment examination which excludes tuberculosis and are thereafter examined yearly. During 1961 there were 123 new cases diagnosed in Government servants who showed no signs in the 1960 survey. This represents an annual attack rate of 0.28 in what is a fairly representative cross section of the community. At the other extreme, the prison population is representative of the lowest socio-economic group 48.25% of which have an history of drug addiction when they are first committed to prison. The conditional surveys are carried out on employees working for enlightened firms which have an eye to the welfare of their employees. Thus none of these findings gives a precise indication of the incidence of active disease

in the general population which, on present data available, is estimated to average just over 2% in the adult population.

Tuberculin Testing and B.C.G. vaccination

　　　156. Through the Maternal and Child Health and School Health Services, tuberculin testing is carried out on children not known to have been vaccinated at birth with B.C.G. There are still some 20,000 to 30,000 unvaccinated children added to the community each year and it it estimated that there are about 100,000 of these all told in the 0-5 age group. During the year 17,474 children were tuberculin tested in Maternal and Child Health Centres and schools of whom 7,756 were negative and were vaccinated with B.C.G. This is a disappointing figure and merely represents those who have attended the various clinics where testing is done as a routine.

157. Children under three years of age who have not had B.C.G. but who show a positive tuberculin test are given I.N.A.H. for 12 months as a prophylactic measure in an effort to minimize the risks of a progressive primary tuberculosis. During the year 57 such children were discovered at the chest clinics and a further 90 through the Maternal and Child Health Service. There were thus 147 under treatment during 1961 compared to 180 during 1960.

158. The desirability of maintaining this measure, relatively small though it be, is underlined by the fact that for the first time in 8 years there was an increase in the infant death rate from tuberculosis. While the increase was not a significant one, there can be no relaxation in any measure, however small, that will help to consolidate the gains of the past ten years.

Surgical Tuberculosis

Thoracic Surgery

　　　159. Outpatient sessions for patients who need or have had chest surgery are held at the Wan Chai Chest Clinic by the Government Specialist in Thoracic Surgery and the Thoracic Surgeon from the Grantham Hospital. These sessions are held weekly and fortnightly respectively. In consultation with the staff of the Clinic, cases undergoing ambulatory chemotherapy who require surgical investigation or treat- ment are seen by the Thoracic Surgeons and the lines of investigation and treatment are planned. Thereafter, the patients are admitted to the Grantham Hospital; on discharge the subsequent follow-up takes place at the Wan Chai Clinic.

160. The numbers of cases seen during the past 3 years and since the inception of these sessions were:

First attendances Subsequent attendances.

Government Thoracic Surgeon 1959 1960 1961

123 103 112 612 803 891

Grantham Thoracic Surgeon

1960 1961

1959

226 147 125 144 262 321

Total ..

735

906 1,003

370 409 446

Orthopaedic Surgery

161. Outpatient sessions are conducted at the Sai Ying Pun and Kowloon Chest Clinics for patients with bone and joint tuberculosis and are maintained jointly by the University Consulting Orthopaedic Surgeon, who is the Professor of Orthopaedic Surgery, and the Govern ment Orthopaedic Specialist. Additional sessions are also held by the permanent staff at these two centres for patients requiring routine treat- ment and supervision. The surgery is carried out at the Grantham Hospital. Thereafter routine medical treatment and ancillary services such as physiotherapy, the fitting of appliances and medical social work are carried out by the personnel attached to the relevant clinic.

162. Attendances at these sessions over the past five years have been:

1959 1960 1961

1957 543

1958

768

629 2,083

617 3,503

441 4,001

415 4,618

1.311 2.712

4.120 4,442 5,033

Subsequent attendances

First attendances

Total

163. The analysis of the location of bone and joint disease in the new cases presenting has been:

Spine

Hip

Other bones and joints

1959 1960 1961

303

202

197

125

115

189

145

103

617

441

415

164. There has been a steady fall in the number of new cases attend- ing over the past three years and most of the long standing cases in the Colony have now been dealt with. First attendances are now almost exclusively early cases and as orthopaedic tuberculosis in Hong Kong is principally a disease of children, the downward trend associated with the decline of all forms of tuberculosis in the youngest age groups is considered to be largely due to the greatly increased scale of B.C.G. vaccination.

Radiology

165. The total number of examinations carried out on behalf of the Tuberculosis Service by the Radiology Branch of the Department was 305,088, an increase of more than 10% over the 1960 total. The largest proportional increase was in the use of 35 mm. and 70 mm. films. The static and mobile X-ray units attached to the Tuberculosis Service are maintained and operated by the Government Senior Radiological Specialist and his staff. There is a very close co-operation and consulta- tion between the Tuberculosis and the Radiological Services in all aspects of the diagnostic and routine supervisory radiology.

Bacteriology

　　　166. The Government Institute of Pathology undertakes all bacterio- logy for the Tuberculosis Service. There is a substantial increase in this work each year and the range of investigations is increasing all the time, During 1961, 47,984 direct smear examinations were carried out, an increase of 4,000 over the previous year. Culture and resistance examina- tions accounted for a further 12,000 procedures. A re-organization and expansion of the bacteriological tuberculosis work is at present under way to ensure the most comprehensive laboratory support possible within the space and facilities available.

Medical Social Work

167. One Senior Almoner, eleven Almoners and 55 Tuberculosis Workers are attached to the Tuberculosis Service. Their responsibilities include the interviewing of patients and their families, arranging hospital admission, hospital visiting, the home visiting and supervision of patients on ambulatory chemotherapy, assistance in money and in kind and rehabilitation.

　　　168. As soon as the diagnosis of tuberculosis is confirmed all patients requiring treatment or supervision are interviewed. The original inter- view is a comprehensive one and is based as far as possible on all future requirements while under treatment. During the year 11,443 new patients were interviewed while the total of interviews rose by almost one thousand to 36,517. Much additional interviewing is done subsequently by the Almoners' clerks, who also maintain treatment record cards and distribute drugs to be taken routinely by mouth.

　　　169. Admissions and re-admissions to hospital from the chest clinics are arranged by the Aimoners and this involves documentation, the financial aspects, advice to employers of admissions and the maintenance

of waiting lists. Waiting time for admissions is less than six weeks and, at the end of 1961, there were only 273 patients waiting of whom 120 were orthopaedic cases. The total number of admissions and re-admis- sions arranged by the Almoners was 1,529, a decrease of 63 compared with 1960. This was mainly due to re-allocations of beds in the Lai Chi Kok Hospital during the cholera outbreak and, before that, on account of the seasonal pressure due to diphtheria.

170. Ward rounds by Almoners, in company with the medical staff, are carried out as a routine and each patient is normally seen individual- ly at least once each month as well as by appointment if required,

171. The Almoners' Section is responsible for the preparation and maintenance of attendance registers of patients on outpatient therapy. After the initial interview by an Almoner, a Tuberculosis Worker pays a visit to the home, gives advice on hygiene and makes arrangements for contact examinations. In addition, irregularity of treatment or non- attendance is followed by home-visits. However, because of limited staff. much of the routine regular visiting has to give place to visits connected with irregular attendances or default from treatment. At present each Tuberculosis Worker is responsible for an average of 1,350 patients while the desirable maximum case load is 900. Patients are allocated on a district basis and the Tuberculosis Worker is attached more or less. permanently to her district and works from the relevant full time chest clinic. At the chest clinics these workers also assist with reception and documentation duties so that there is a continuing personal contact with the patients both at home and in the clinic, which promotes confidence.

172. The Tuberculosis Workers are recruited from girls of good education and intelligence and are given in-service training for a period of 6 to 12 months before being allocated to their districts. They are not fully trained nurses nor are they trained social workers.

Assistance to Patients

173. There is a Tuberculosis Assistance Fund available to the Senior Tuberculosis Almoner which amounted to $300,000 in 1961. Assistance to the dependants of patients under treatment in hospital is the principal object and disbursements are made on a formula based on previous family income and continuing commitments. During the year 274 families received an average weekly grant of $24.61. In addition, milk powder issued on the basis of one pound each week to each patient was a charge on the fund. Miscellaneous disbursements such as travelling expenses of patients coming from outlying districts for X-ray were also made from

the Fund. Surgical appliances for cases of orthopaedic tuberculosis were given to 131 patients at a cost of $3,148.

　　　　174. Another source of assistance is the Samaritan Fund at the disposal of the Principal Almoner. A total of $4,232.55 was given for travelling expenses such as are incurred by orthopaedic cases attending clinics.

　　　175. Donations in kind of rice, noodles, cooking fat, beans, clothing and blankets were also made possible through the generosity of C.A.R.E.

176. When it is not possible or expedient to assist patients from the resources available to the Tuberculosis Service they may be referred to other agencies such as the Social Welfare Department, the Family Welfare Society, Foster Parents Inc., and many other similar organiza- tions. Over 300 patients were thus referred, for assistance, to other welfare agencies.

Rehabilitation

177. Ambulatory treatment for the majority of patients who attend the Government Clinics means that the greatest number can continue at work, or spend relatively short periods in hospital before returning to their jobs. However, there is a considerable proportion of patients, in the 40-45 age group, of unskilled workers with chronic disease who have undergone thoracic surgery and who present a difficult re- employment problem. The Lutheran World Federation has launched a pilot rehabilitation scheme whereby patients recommended by organizations dealing with the treatment of tuberculosis are resettled either in agriculture, in small home industries or in other suitable employment. The total number of patients referred to the Lutheran Tuberculosis Rehabilitation Project from the Government Tuberculosis Service was 58 and initial results have been most encouraging. There is very close consultation and co-ordination with the Government staff by the personnel of this project which offers every promise of success and a much wider field of constructive rehabilitation.

Hospital Services

　　　178. The magnitude of the Tuberculosis problem in Hong Kong is such that it is not physically possible to segregate and treat in hospital all cases of active open tuberculosis. The place of ambulatory chemo- therapy, recently assessed on a scientific basis in Madras, has proved itself in practice over the past ten years in Hong Kong. However, hospital beds are necessary to any system of control and treatment and

they play an essential role in Hong Kong. While Government has established and developed outpatient facilities on a major scale, the provision of hospital services has been predominantly the role of the voluntary agencies largely subsidized by Government. Thanks to the practical co-operation of the voluntary agencies a co-ordinated system of hospitalization has been developed over the years.

179. During 1961 there were 1.825 beds set aside full time for the inpatient treatment of tuberculosis, 49% of which are in the two tuberculosis hospitals and the convalescent home maintained by the Hong Kong Anti-Tuberculosis Association. The other institution dealing exclusively with tuberculosis is the Haven of Hope Sanatorium at Junk Bay in the New Territories.

180. Beds for tuberculosis in Government Hospitals are in the Queen Mary. Lai Chi Kok and Cheung Chau Hospitals. At Queen Mary Hospital there were 52 beds during 1961 and there were 88 beds at Lai Chi Kok Hospital and 42 beds at Cheung Chau Hospital. The latter are used largely for young adolescents with positive sputum who have to be debarred from school until they are sputum negative.

181. The Tung Wah Group of Hospitals maintain tuberculosis beds mainly for patients with disease of long standing.

182. Beds were distributed as follows during 1961:

Government Hospitals

Hong Kong Anti-Tuberculosis Association:

Grantham Hospital

-- J

Ruttonjee Sanatorium (Including Freni Memorial Con-

valescent Home)

Haven of Hope Sanatorium

Tung Wah Hospitals

Other public and private hospitals

Total

ויי

212

540

336

---

392

210

146

1.836

183. Early in 1962 there was a re-distribution of beds, made possible through the co-operation of the Hong Kong Anti-Tuberculosis Associa- tion which is building an extension to the Grantham Hospital of 84 beds. This enabled 48 patients in the Queen Mary Hospital to be transferred to the Grantham Hospital and so make additional paediatric beds available at the Queen Mary Hospital.

184. Another pressing problem has been the admission of acute emergencies such as haemoptysis and pneumothorax which are brought to the two Casualty Departments of the Queen Mary and Kowloon

Hospitals and which require immediate admission. Such cases have had to be accommodated in general wards until they are fit for discharge or transfer to other hospitals. To meet this situation, emergency tuber- culosis beds have been provided at the Lai Chi Kok and Tung Wah Eastern Hospitals to which such cases will be admitted either direct or as soon as resuscitation has been effected and the patients fit to move. These are temporary arrangements until such time as a new wing with emergency facilities is available at the Ruttonjee Sanatorium and the present Kowloon Hospital is available for conversion. which will include a tuberculosis unit, when the Queen Elizabeth Hospital is opened during 1963.

The Work of the Voluntary Agencies

The Hong Kong Anti-Tuberculosis Association

185. This is the largest and longest established voluntary agency working exclusively in the field of tuberculosis. It maintains two hospitals and one convalescent home, containing a total of 876 beds, a B.C.G. Clinic, an outpatient clinic for the follow-up of discharged patients and a Tuberculosis Insurance Scheme. Supported by voluntary donations and some endowments, the Association receives substantial annually recurrent subventions from Government.

The Grantham Hospital

186. Opened in 1957, this hospital has 540 beds and is equipped as a modern chest hospital. An extension is now under construction which will contain 84 beds, a physiotherapy department and a school for the training of assistant nurses. Run on a fee-paying non-profit making basis, the hospital provides private, semi-private and general ward accommodation for fees of $35, $24 and $18 a day respectively. During 1961, Government maintained 444 of the beds in the general wards. and early in 1962 assumed responsibility for a further 48 beds eventual- ly to be accommodated in the new extension. Government also provides the clinical staff for 204 beds and undertakes the medical social work for patients in the 444 beds it maintains. The follow-up of patients discharged from these beds is undertaken at the Government Chest Clinics.

187. For purposes of clinical supervision within the hospital, there are the Grantham Pulmonary Unit of 240 medical and surgical beds, the Government Pulmonary Unit of 92 medical and 32 surgical beds and the Government Orthopaedic Unit of 80 beds. The Medical Superin-

tendent, responsible to the Grantham Hospital Management Board, is in administrative charge of the whole hospital and has clinical charge of the Grantham Pulmonary Unit medical beds. The Grantham Thoracic Surgeon has clinical charge of the surgical beds in that Unit, The medical and surgical beds in the Government Pulmonary Unit are under the clinical supervision of the Government Senior Tuberculosis Specialist and the Government Specialist Thoracic Surgeon respectively. The orthopaedic beds are in the clinical charge of the Government Orthopaedic Specialist. All staff throughout the hospital is provided by the Association with the exception of Government Medical Officers posted to the Government clinical units whose salaries are recovered from the Association. The Government Specialists act as consultants and no charge is made for their services. For part of the year the Government Orthopaedic Specialist post was vacant and the work of the Unit was undertaken by an Honorary Consultant Orthopaedic Surgeon in private practice.

188. The number of admissions continues to rise since the hospital became fully operational towards the end of 1958 and the work carried out during the year ending March 31st, 1962 is shown in the following table.

TABLE 13

New Admissions

1.006

Re-admissions

Discharged

978

Total Bed Days 193.897

Deaths

Spine

Orthopaedic Operations

Hip

Thoracic Operations

Others

Resections

Miscellaneous

Wedge Segmental Lobectomy

Pneumonectomy including

Thoracoplasty

Grantham

Thoracic Unit

Government

Thoracic Unit .. 6

189. An analysis of 254 cases which have undergone thoracic surgery in the Grantham Hospital unit has shown that 253 have remained sputum negative: 186 have returned to full time work, while 68 are working part-time.

Bathing a baby,

Health Teaching 'Prevention is better than cure".

Flying Doctor calling at a village,

Hailing Boat People to come for prophylactic immunizations.

The Ruttonjee Sanatorium and Freni Memorial Convalescent Home

　　　190. These two units are the responsibility of the Ruttonjee Sana- torium Management Board and are run as one. In the Sanatorium of 226 beds, medical, surgical and orthopaedic work is carried out while the Convalescent Home of 110 beds is for patients who are under drug treatment but sufficiently well not to be in need of special nursing care. Consultant services are supplied by the University Professorial Units of Medicine, Surgery and Orthopaedics. Medical and Senior Nursing staff are provided by the Sisters of the St. Columban Missionary Order.

　　　191. In addition, the medical staff of the Sanatorium maintain the B.C.G. and follow up clinic in the Association's Headquarters situated next door to the hospital, and undertake the X-ray and medical work in connexion with the Tuberculosis Insurance Scheme.

　　　192. The work done at the Ruttonjee Sanatorium and the Freni Memorial Convalescent Home during the year ending 31st March, 1962 was as follows:

TABLE 14

New Admissions

Re-admissions

Discharged

Total Bed Days

Deaths

Ruttonjec

Sanatorium

588

151

504*

77.417

Freni Memorial

Convalescent

Home

298+

295

39,121

NIL

• Includes 82 discharged to Children's Convalescent Home al Sandy Bay and 40 to other hospitals; 382 were discharged direct to home. An additional 295 were transferred to the Freni Home.

↑ This figure of 298 includes the 295 referred to above.

Spine

RUTTONIES SANATORIUM

Orthopaedic Operations

Hip

Thoracic Operation

Others

Resections

Miscellaneous including

Wedge

Segmental

Lobectomy Pneumonectomy

Thoracoplasty

ASSOCIATION FOLLOW UP CLINIC

Under treatment as outpatients

Annual check of patients under supervision only Total attendances

- L

1,711 1,906

12.904

ASSOCIATION B.C.G. CLINIC

Number of tuberculin tesled Number of B.C.G. vaccinated

832

247

193. The Association works very closely with the Government Tuberculosis Service and now provides in its two hospitals almost exclusively the facilities for thoracic and orthopaedic surgery required for the treatment of tuberculosis. Admissions to both the medical and surgical beds of the Grantham Hospital and, to a lesser extent, the Ruttonjee Sanatorium are now largely in respect of patients referred by the Government Chest Clinics although both hospitals also arrange admissions direct for their own referred cases.

The Tung Wah Hospitals

194. This group of three hospitals has a varying total of between 250 and 350 beds occupied by patients with tuberculosis. These beds are almost entirely occupied by cases of a chronic type and the turnover is accordingly relatively slow. No special subvention is made to support these beds as the total recurrent expenditure of the group is met by a Government subvention. In the maternity wards of these hospitals the B.C.G. vaccination of new born babies is carried out by the Govern- ment Tuberculosis Service staff.

The Haven of Hope Sanatorium

195. Maintained by the Junk Bay Medical Relief Society this interdenominational Protestant Mission Sanatorium accommodates 210 beds for the medical treatment of tuberculosis. No major surgical or orthopaedic work is undertaken. The Sanatorium staff also maintain a tuberculosis outpatient and follow up clinic at nearby Rennies Mill and carry out some tuberculosis survey work amongst the villagers in the Junk Bay area. Government maintains 60 beds in the Sanatorium for the free treatment of New Territories villagers and also gives a small annual grant towards the cost of the X-ray survey work.

Other Voluntary Agencies

196. Mention is made in paragraph 403 of the rehabilitation work carried out by the Lutheran World Federation and in paragraphs 339 to 341 of the work of the Sandy Bay Convalescent Home maintained by the Society for the Relief of Crippled Children. Tuberculosis beds. are also provided in the Nethersole Hospital and the Hei Ling Chau Leprosy Settlement, both of which organizations receive subsidies for general medical work.

Private Hospitals and Other Agencies

197. There are 132 beds provided in private hospitals and nursing homes, some of which are classed as charity beds in which treatment is given at low cost or free. There is also a considerable amount of ambulatory chemotherapy given by private practitioners but there is no information at present available either on the numbers of patients under treatment or the results of treatment. Mention has already been made regarding the paucity of notification of tuberculosis by private agencies dealing with the disease.

MALARIA BUREAU

　　　198. The Malaria Bureau, under the direction of the Government Specialist Malariologist, is responsible for all malaria control operations throughout the Colony and, in certain instances, it also undertakes the control of breeding of culicine mosquitoes. Lectures are given on malaria and allied subjects to various groups of health personnel under training and expert advice is offered to the Armed Services, to the Pest Control Unit of the Urban Services Department, to Hei Ling Chau Leprosarium and to Prisons in the New Territories.

Control Operations

　　　199. The important malaria vectors are A. minimuus found breeding in certain hill streams, seepages and irrigation ditches leading to rice cultivation and A. jeyporiensis var. candidiensis which breeds in rice. cultivation, fallow-rice fields, pools in rice stubble and water flowing through grass. Other anopheline species found in the Colony play little or no part in malaria transmission, Malaria control in the urban areas is based chiefly on anti-larval measures consisting of training and clean- weeding of streams, ditching and oiling. Anti-malaria oil continues to be employed as the main larvicide, although Gammexane Dispersible Powder is also used on a limited scale in areas where the application of oil is unsuitable. These anti-larval operations against anopheline breeding afford protection to over 24 million people living within the urban areas of Hong Kong. Kowloon and New Kowloon and in certain circumscribed areas in the New Territories.

200. Results of the Malaria control work in the urban areas continue to be satisfactory and the incidence of natural malaria trans- mission has been reduced virtually to zero.

　　　201. In most of the New Territories control by anti-larval or anti- adult measures is at present impracticable because of the scattered

population, the widespread traditional wet cultivation and the un- protected contiguous borders and islands. Therefore, the main line of defence against malaria for disciplined groups stationed in the New Territories consists of such anti-larval measures as may be practicable in the vicinity, screening where possible and chemo-prophylaxis. There were 19 cases of malaria notified from police and services personnel during the year.

202. The cost of the control measures during the year under review was 36 cents per head of population living in the protected areas.

Incidence of Malaria

203. Malaria is a notifiable disease, and the returns of the past five years are set out in Table 15.

Year

1957

1958

1959

1960

1961

TABLE 15

MALARIA 1957-61

Cases Notified

Deaths

447

659

442

833

812

204. The endemicity of malaria varies, as was proved by Malario- metric indices obtained from a survey carried out during the year in children between 2-9 years of age in 14 villages in the New Territories. Spleen and parasite rates ranged from 0% to 40.2% and from 0% to 20% respectively.

205. The total number of cases of malaria notified during 1961 was 812 as compared with 833 in 1960. Notifications of 91.3% of all cases were from outside the protected areas; 43.8% of the cases came from the area surrounding the small town of Sai Kung and 26.2% of the total from Lantau Island. Of the parasites identified 96.4% were P. vivax, 2.4% P. falciparum 10% P. malariae and 0.1% were undetermined.

206. A scheme to control malaria in the Sai Kung District is under consideration and an entomological survey was conducted in the area between July and October 1961 to study the anopheline larval habitat and relative species abundance. A. minimus and A. jeyporiensis var. candidiensis, the chief malaria vectors in the Colony, comprised 11.4% and 2.1% of the six anopheline species encountered during the survey.

Laboratory

207. The Bureau laboratory continued to carry out routine identi fication and dissection of mosquitoes and the examination of blood smears collected at surveys. Susceptibility tests of anophelines to various insecticides were conducted from time to time and the results forwarded to the World Health Organization.

SOCIAL HYGIENE SERVICES

208. This service which is the responsibility of the Social Hygiene Specialist consists of three branches dealing with dermatology, venereal diseases and leprosy. Facilities for the diagnosis of skin conditions are of considerable importance in bringing to light cases of latent syphilis and of early leprosy. Accordingly, the service is organized to provide 9 Centres for purely dermatology clinics; in addition there are thirteen social hygiene clinics, where venereal infections and leprosy undergo investigation and treatment and a number of cases of skin disease also attend. The Wanchai Hospital provides in-patient accommodation for the treatment of skin disease in women and beds for male patients are available at the Lai Chi Kok Hospital.

209. During the year the post of Social Hygiene Specialist remained vacant and the Principal Medical and Health Officer (Health) at Medical Headquarters was responsible for the administrative aspects of the service. It is believed that the Specialist post will be filled by the middle of 1962.

Dermatology

210. The dermatology clinics held at the nine centres recorded a total attendance of 6,094 cases referred for an opinion. At the Social Hygiene Clinics there were a further 12.173 first attendances for skin complaints which is 47.2% of the total of new cases seen at these clinics.

211. Biopsies, microscopic and culture examinations for fungi and tests for uroporphyrin are carried out at the clinics. Patients requiring radio-therapy for skin conditions are referred to the Sai Ying Pun Polyclinic.

212. Griseofulvin is now the treatment of choice for ringworm of the body, hair and nails. Neurodermatitis is treated at the Wan Chai Hospital with hydrocortisone lotion, using the vibro puncture technique. Discoid lupus erythematosis responds well to Plaquinol which has proved to be one of the less toxic chloroquin derivatives.

　213. Appendix 8 details the classification and relative frequency of the skin conditions seen. There is a close liaison maintained with the Industrial Health Officer and dermatological conditions known or suspected to be due to industrial hazards are notified to him.

Venereal Diseases

　214. Sixty one clinic sessions are conducted each week, including two new sessions for females started during the year. There was a total of 182,049 attendances of which 25,819 were new cases. Of the latter 36.2% attended on account of venereal disease, 16% were proved not to have venereal disease, and 47.2% were first attendances with skin complaints not related to venereal disease or leprosy.

　215. At Appendix 7 is the annual incidence and trend of disease for which patients attended the Social Hygiene Clinics over the past 11 years. During 1961 there were 35 cases of primary and 26 cases of secondary syphilis; the total of cases of syphilis, numbering 1,606, showed a 26% reduction of the total for the previous year. The incidence of gonorrhoea was the lowest on record in the eleven year period and there was a marked drop in the incidence of chancroid and lymphogranuloma venereum.

　216. Ante-natal blood tests are carried out as a routine on pregnant women attending Maternal and Child Health Centres. The following table shows the results over the past seven years. The value of this routine investigation is reflected in the low figures for congenital syphilis in babies under one year.

TABLE 16

THE TABLE SHOWS RESULTS OF THOSE TESTS OVER A 7-YEAR PERIOD

1955

1956

1957

1958

1959 1960 1961

No. of tests Clinics &

Hospitals

23.716

% of Positive Rate

4.5

26,083 3.8

27.330 3.5

28,026 3.3

46,932 2.6

52,068 2.3

51,449 1.6

No. of tests Private Mid-

wives

% of Positive Rate

5.439

4.2

5.464 3.4

4,623

2.7

5.583 3.2

6,269 2.3

6,805

6.940

1.9

1.4

　217. The incidence of venereal disease in prostitutes who attend voluntarily at the Social Hygiene Clinics either through contact tracing or for periodic investigation has been the subject of investigation since 1959. During 1957, owing to the increasing numbers of cases of peni cillin anaphylaxis, the prophylactic treatment of prostitutes was discon- tinued. Since that time there has been a relative increase in the incidence of gonorrhoea. Table 17 sets out the results to-date.

Year

1959

1960 1961

TABLE 17

VENEREAL DISEASE IN PROSTITUTES

No. of first

V.D. not found Gonorrhoea

attendances

Early Lafent

Syphilis

Late Latent

1.086

692 (63.8)

235 (21.6)

63 (5.8)

96 (8.8)

952

613 (64.4)

124 (13.0)

69 (7.2)

146 (15.4)

806

585 (72.6)

124 (15.4)

31 (3.8) 66 (8.2)

(Figures in brackets represent the percentage of first attendances.)

218. Default from treatment of venereal diseases still continues to be a problem and follow-up is made first by letter and then by visit. By letter, there was 27.8% of success, the highest figure since 1956. By visit there was 21.5% of success amongst females and 24% of success amongst males. Female social hygiene visitors paid a total of 14,000 visits to contacts and defaulters, while their male counterparts paid 2,939 visits. An almoning service has also been available to male out- patients and female inpatients throughout the year.

　　219. Penicillin remains the treatment of choice for both syphilis and gonorrhoea, but the slightest sign of intolerance is followed by an im- mediate change of therapy. No deaths from anaphylactic shock were recorded during the year.

　　220. In common with other notifiable diseases, the notifications of venereal disease received do not give a precise indication of incidence. Many patients receive treatment from sources other than the Govern- ment clinics and the figures recorded above apply only to the work of the Social Hygiene Clinics.

Leprosy

　　221. Sixteen clinic sessions are held weekly in nine centres solely for leprosy patients, while two other sessions each week are held in conjunction with other social hygiene clinics; in addition, one session is devoted to the care of leprosy patients suffering from trophic ulcers. During the year, 124 infectious cases, the same number as in the previous year, were admitted to the Hei Ling Chau Leprosarium which is main- tained by the Hong Kong Auxiliary of the Mission to Lepers; a very close liaison with this institution, which is referred to in paragraphs 334 to 336 of this report, is maintained by the Social Hygiene Services.

222. For routine outpatient treatment at the Leprosy Clinics, dapsone remains the drug of choice and is administered orally or intramuscularly; if there is intolerance to dapsone, diphenyl thiourea is exhibited instead.

ร

In selected cases, bi-weekly inunctions of ditophai are used, combined with routine systemic therapy, but there have been instances where a contact dermatitis has resulted and the inunctions had to be discontinued.

223. Surgical rehabilitation of leprosy patients suffering from deformities and disfigurements is carried out at the Maxwell Memorial Hospital at the Hei Ling Chau Leprosarium; it is also provided in certain Government hospitals where a limited number of beds is avail- able for the purpose.

224. In the epidemiological field, it is a routine for the home of each new leprosy patient to be visited by a Social Hygiene Visitor within a month of the diagnosis being made; personal advice is given, contacts are requested to attend for examination and it is urged that child contacts receive B.C.G. vaccination. After the initial examination, contacts are advised to return for re-examination at least once a year; those who do not return are re-visited as are patients defaulting from

treatment.

PORT HEALTH

225. The Port Health Administration is responsible for all measures designed to prevent the introduction of quarantinable infectious diseases into the Colony; for the sanitary control of the ports of entry by sea, air and rail; for the carrying out of the provisions of the International Sanitary Regulations as embodied in the Quarantine and Prevention of Diseases Ordinance and the Asiatic Emigration Ordinance; for the compilation of epidemiological statistics and reports and for the general organization of prophylactic vaccination campaigns. There are also statutory responsibilities under the Hong Kong Merchant Shipping Ordinance. A weekly exchange of epidemiological information is main- tained with the World Health Organization Epidemiological Station in Geneva.

226. All persons entering the Colony are subject to a quarantine inspection. Arrivals by sea are inspected at the two quarantine anchorages in Kowloon Bay and off Stonecutters Island respectively; arrivals by air are inspected 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,

227. Other routine work carried out includes the deratting, dis- insecting and fumigation of ships, sanitary duties in the port and airport, including supervision of water supplies, control measures to keep the

Anti-Cholera Campaign people waiting for anti-cholera inoculations.

HANCHAI

POST

OFFICE

Helicopter landing at a small village in the New Territorics.

port and airport free from Aedes aegypti and inspection of all vessels carrying more than twenty unberthed immigrants. A service rendering medical advice by wireless on request to ships at sea is also maintained. In addition to routine work, the Port Health launches, equipped with stretchers, first aid equipment and radio-telephones, provide an am- bulance service in the port area.

228. Four Port Health inoculation centres are maintained, 2 on the Island and 2 in Kowloon (including I at the airport), for the convenience of persons requiring International Certificates for travel. Free pro- phylactic vaccinations are also offered at these centres to members of the public. Inoculators are also posted to various centres throughout the Colony and are responsible for the field work in connexion with immunization campaigns which are carried out under the immediate supervision of Medical and Health Officers.

229. On the 14th August quarantine restrictions were imposed against persons arriving from Macau and the Kwangtung Province of China on the receipt of information that these areas were infected with cholera. A few days later the infection spread to Hong Kong and the Colony was declared to be infected with cholera on the 17th August. 1961. Details of the outbreak are given elsewhere in this report.

DISTRICT MIDWIFERY SERVICES

230. The difficulties attending home deliveries under existing housing conditions and the growing appreciation of the advantages of the skilled attention available in institutions have resulted in a continuing decline in domiciliary midwifery. During the year less than 3.5% of all registered births took place in the home as against 6% in the previous year. This is reflected in the further decline in maternal mortality which has shown a dramatic fall in recent years.

231. It is now Government policy gradually to withdraw facilities for domiciliary midwifery and to provide instead beds for normal mid- wifery in all new clinics constructed in urban areas where the needs of the district warrant this provision. In the New Territories the policy has been and still continues to be to include maternity beds in all new clinics. During the year 25 maternity beds were provided in the Jockey Club Clinic which was opened at Shek Wu Hui in June 1961.

232. The work of the Government Midwifery Service during 1961 is summarized in Table 18.

TABLE 18

GOVERNMENT MIDWIFERY SERVICE 1961

Maternity beds in hospitals

Maternity beds in maternity homes (urban) Maternity beds in maternity homes (rural) Midwives (excluding hospitals)

Cases attended (excluding hospitals)

346

149

16.430

rrr

Average case-load for each midwife (excluding hospitals)

238

233. Midwives in private practice attended 37.6% of all births, the great majority taking place in small maternity homes of from two to six beds. The Supervisor of Midwives, a Government Senior Medical and Health Officer, is responsible for the regular inspection of such homes and for general supervision of the work of the midwives; in this task, she is assisted by a qualified Health Visitor. The work undertaken in 1961 by the private midwives is outlined in Table 19.

TABLE 19

PRIVATE MIDWIFERY SERVICE 1961

Number of midwives in active practice Number of registered maternity homes

Number of beds

Maternity home deliveries

Domiciliary deliveries

Total deliveries

183

116

480

38.734

2,481

41,115

234. All midwives are trained to perform vaccinations against small- pox and to administer B.C.G. to new born infants. It is due to the efforts of these midwives, both Government and private, that 79.31 per cent of all children born in 1961 received B.C.G. protection, a measure which has resulted in a dramatic fall in child mortality from tuberculosis.

MATERNAL AND CHILD HEALTH SERVICES

235. In this most important and popular aspect of the work of the Department, the emphasis is on health education and the prevention of disease. All facilities are provided without charge, and once disease is detected, exclusive of minor ailments, the child concerned is referred to the appropriate branch of the curative service for investigation and any necessary treatment. When cured the patient is encouraged to return to the relevant Maternal and Child Health Clinic. The Health Education of groups of mothers in the clinics and of individuals while home. visiting is a permanent and continuing activity of the Health Visitors.

In the clinics all forms of group education are available, such as simple talks, film and puppet shows and flannel-graph illustrations; practical demonstrations and group discussions are widely used, the choice of medium depending on the subject and on the audience.

236. Clinics are held in both full-time and part-time centres and there are sessions for ante-natal and post-natal cases, for infants aged 0-2 years and for toddlers aged 2-5 years. Close liaison was maintained between Maternity Hospitals and the Maternal and Child Health Service to ensure the after care of infants requiring special attention. The work performed during 1961, as compared to that of 1960, is detailed in Table 20.

TABLE 20

MATERNAL AND CHILD HEALTH SERVICES 1960-61

1960

1961

Number of full-time centres

Number of subsidiary centres

Number of ante-natal sessions each year

2.023

2,131

New ante-natal attendances

20,296

22,995

Total ante-natal attendances

77.741

92,553

Number of post-natal sessions each year

816

857

New post-natal attendances

4,686

5,031

Total post-natal attendances

6,399

6,546

гг 1

...

Number of infant welfare and toddler sessions

each year

4,358

4,815

-- J

---

New infant welfare attendances

29.634

37,735

Total infant welfare attendances

307,956

363,206

New toddler attendances

5,052

8.990

Total toddler attendances Total home visits

40.187

57,903

59,071

64.167

237. A part-time centre was opened during the year in the new Jockey Club Clinic at Shek Wu Hui where infant health sessions were held once a week and ante-natal sessions twice weekly. Ante-natal and infant welfare clinics continued to be held once a month in Tai O on Lantau Island and infant welfare clinics were held twice weekly in the Wong Tai Sin Resettlement Estate. The total attendances at the Govern- ment infant and toddler clinics increased by 21% and new attendances by 11%; only 0.23% of those attending for the first time showed any abnormality. Immunization against diphtheria, whooping cough and tetanus is given as a routine using a triple vaccine. Smallpox vaccination is given where necessary and children not known to have B.C.G. are tuberculin tested, those with a negative reaction receiving B.C.G. Those aged 3 years and under who are tuberculin positive but without signs of active disease are given prophylactic I.N.A.H. for a period of one year.

238. The average attendances at ante-natal sessions were 43 as against 38 in 1960, but the average rate of attendances by each expectant mother dropped from 3.8 to 3. Post-natal clinic sessions are still the least popular and it seems that attendance is almost exclusively only by those who either suspect or are acutely conscious of an abnormality. During the year 24.09% of all women attending post-natal clinics needed some form of treatment.

239. All Maternity and Child Health Centres stopped their routine work during the cholera outbreak for a period of 2 weeks during which the staff worked full-time in the anti-cholera inoculation campaign.

SCHOOL HEALTH

240. The Medical and Health Department undertakes in all registered schools, through its School Health Service, responsibility for environ- mental sanitation, the control of communicable disease, immunization against diphtheria, smallpox and typhoid and health education. There is also a medical inspection and curative service provided for a limited number of participants in the existing contributory School Health Scheme. This latter scheme is under review and is expected to be replaced soon by a School Medical Service operated by private practi- tioners. To this end negotiations have been conducted with the Chinese Medical Association which has agreed in principle to assist with the launching of a comprehensive inspection and curative service; over 200 of its members have indicated their willingness to participate in a per capita contributory scheme.

241. During 1961 there were 24,330 pupils from 278 schools who were participating in the existing scheme. Medical inspections, clinic services, dental care and specialist eye and ear, nose and throat investiga- tions and treatment were provided. The following table sets out the work done.

TABLE 21

ATTENDANCES

Medical Inspections 39,327

General Clinics

Dental

Clinics

E.N.T. Clinics

47,405

34,086

1,715

Eye Clinics 3,806*

Hospital Admissions 63

* 2,181 pairs of spectacles and 281 pairs of lens replacements were issued.

242. There were no epidemics of infectious disease but there was an increased incidence of diphtheria, 312 cases being notified. Except during the cholera outbreak, the main emphasis was on diphtheria

immunization and 80,186 school children came forward for the full course of inoculations. This was part of an intensive campaign against diphtheria which included visits by Health Visitors to schools that had not applied for the services of immunization teams. The Health Visitors also held a series of meetings with headmasters of primary schools which had been arranged by the Health Education Officer.

243. During the autumn, special emphasis was also laid on vaccina- tion against smallpox and 67,484 vaccinations were performed in schools. 244. Special attention is also being given to tuberculin testing and the B.C.G. vaccination of negative reactors. This is part of a general investigation to check on the sensitivity state of pupils in registered schools throughout the Colony with a view to extending the B.C.G. service, as a routine, to all school children. Over a period of 4 months, 6,043 tuberculin tests were done and 1,527 negative reactors were given B.C.G. The positive reactors were investigated and known family contacts of tuberculosis, those with suggestive signs and symptoms and those with a 15 mm. or greater reaction were requested to attend for an X-ray examination. In these three groups a total of 484 were advised to attend for an X-ray; 384 of them showed no radiological evidence of disease and 65 were referred for full investigation at a chest clinic. The remainder did not co-operate by attending for X-ray examination.

245. Before being permitted to teach in registered schools, school teachers are required to undergo an X-ray examination. During the year 3,994 chest X-ray were taken and 29 teachers found to be suffering from active tuberculosis; in such cases permission to teach is refused and priority admission to hospital arranged. A further 270 teachers, after full investigation, were permitted to teach under supervision.

　　246. School premises are inspected routinely by Health Inspectors and all new premises or applications for extensions or alterations to schools are investigated to ensure adequate environmental sanitation. For this purpose 1,646 inspections were carried out and reports made on 67 plans for new schools or for extensions.

247. Health education activities included lectures by doctors and health visitors to teachers-in-training for whom visits were arranged to school clinics for practical demonstrations on the common health problems amongst school children. School visits by Health Visitors, home visits and talks to pupils and parents at school clinics are also routine activities that are an integral part of the work of the School Health Service.

INDUSTRIAL HEALTH

248. The health of workers in factories and in other industrial under- takings is the statutory responsibility of the Commissioner of Labour. The Industrial Health Section of the Labour Department which is staffed by personnel seconded from the Medical and Health Department, is chiefly concerned with the prevention of occupational disease and the protection of workers against health hazards arising from the working environment. Advice is offered to industry on problems connected with the hygiene of work places, the use of protective clothing and equipment and the provision of clinic or first-aid facilities.

249. Investigations continue into the working conditions in trades known to be hazardous to health and medical supervision is maintained of workers in certain dangerous trades such as those in which lead and radio-active substances are handled. Health Visitors carry out individual case work on injured persons claiming compensation under the Work- men's Compensation Ordinance.

250. An inter-departmental committee on Silicosis submitted its final report to Government in March 1962, in which it recommended certain measures for controlling the disease. The Committee found particular difficulty in attempting to formulate an acceptable compensation scheme for affected workers and recommended seeking expert advice, from out- side the Colony, on this issue.

251. The contamination of various working environments by toxic gases, fumes or dust, was the subject of continuing field surveys; temperature and ventilation studies have also been made in a number of factories.

252. Lectures on Industrial Health are given to probationer Labour Inspectors, Health Inspectors, Health Visitors and medical students of the University of Hong Kong. First Aid training classes for industry are organized by the Industrial Health Section and are conducted by the St. John Ambulance Association.

253. The staff of the Industrial Health Section during 1961 consisted of a Senior Medical and Health Officer, one Medical and Health Officer and three Health Visitors, ali of whom are seconded from the Medical and Health Department.

254. An additional commitment arose in connexion with the cleans- ing of aircraft contaminated by radio-active dust following on the Russian nuclear explosions. This involved extensive monitoring of rags

and mops used for cleaning and advice to employers regarding measures to protect personnel engaged in this work.

HEALTH EDUCATION

255. A better appreciation by the Colony's population of the basic principles of environmental hygiene and the prevention of disease con tinues to be the main health objective. A very wide field is covered by many branches of the Medical and Health Department and all available methods of Health Education are used in the various programmes under- taken. A novel method which was given a trial during an immunization campaign in rural areas in the New Territories is 'sky shouting". A helicopter flew over villages the day before immunization teams would be operating in the area and broadcast propaganda relating to the campaign. The response to this measure was most encouraging.

256. In general, health education methods designed for individual or group education have proved the most effective, being used with success in the Maternal and Child Health Service, the Tuberculosis Service and the Social Hygiene Service. On the other hand, methods suitable for widespread dissemination of health education, as in the immunization campaigns amongst the general public, are accorded a somewhat apathetic reception. However, a general response to mass pro- paganda can now be expected in the threat of an epidemic of major importance as was the experience during the cholera outbreak.

257. A number of other departments are concerned with various aspects of Health Education in their respective spheres. The Inter- departmental Committee on Health Education formed in 1959 continued to concentrate its efforts on the furtherance of the anti-diphtheria campaign. Health exhibits were included in the Agricultural Show in the Sai Kung district of the New Territories in September 1961 and in the Fisheries Exhibition in Aberdeen during the Chinese New Year in February 1962.

　　258. The co-operation of all voluntary bodies interested in health topics is actively sought and Kaifong Associations and Welfare Societies. are particularly active in this field. Many of the Kaifongs take a lively and practical interest in the health problems of their respective districts and co-operate in immunization campaigns and in education on environ- mental hygiene.

259. A small health education team, formed during the year in the New Territories, was active in promoting better standards of hygiene and living conditions in rural areas and in preparing the way for

immunization campaigns. The two floating clinics' donated by the Royal Hong Kong Jockey Club and the Flying Doctor service combined. curative treatment with advice on environmental hygiene and the preven tion of disease during visits to isolated coastal and inland villages.

IV. THE WORK OF THE MEDICAL DIVISION

260. The demands on the clinic and hospital services provided by Government continued to increase during the year. The point has been reached where these demands are barely contained by exploiting succes- sive ad hoc arrangements and any delay in the implementation of hospital and clinic development plans will inevitably reproduce soon the grave situation experienced five years ago. The steady influx of immigrants with few or no resources who have yet to establish them- selves in the community throw a heavy demand on the low cost general ward and clinic services. Assuming an annual influx of only 50,000 new residents and a natural increase of 90,000, the net annual gain in beds, doctors and clinics required to maintain existing ratios of provision is 438 beds, forty six doctors and one major urban clinic respectively. This does not take into account the service to temporary residents who come in specifically for medical treatment.

261. Figures I and II below indicate the outpatient attendances, the provision of beds and the admissions to Government institutions during the five year period 1957 to 1961:

2,000,000

1957

FIGURE 1

OUT-PATIENT ATTENDANCES AT GOVERNMENT CLINICA

Q] Repoel allradances

1954

GHI

INI

FIGURE 11

HOSPITAL BEDS

(Excluding Maternity Homes)

TOTAL HOSPITAL BEDS

GENERAL BEDS

5,000

➖➖ ➖ ➖➖ ➖-----

4,000

3,000

2,000

1,000

80,000

70,000

60,000

50,000

40,000

30,000

20,000

10,000

Governmeal

Gavomment-Assisted

Private

TOTAL CASES ADMITTED

GENERAL CASES ADMITTED

HOSPITALS

262. By the end of 1961 there were 40 civil hospitals and nursing homes in Hong Kong with accommodation for 9,464 beds. In addition there were private maternity homes which contained a total of 480 beds for normal midwifery. Details of the accommodation available are set out in Appendix 10. Of the civil hospitals 14 are maintained by Govern- ment and 11 are managed by voluntary agencies receiving recurrent subventions from Government, There are 10 private hospitals and 5 nursing homes. An analysis of the work done is at Appendices 9 and 11.

263. One new hospital was opened in the Wong Tai Sin district, the Maryknoll Hospital of 61 beds which is run by the Maryknoll Sisters. This is the first phase of development and will be followed by a second phase giving accommodation for an additional 50 paediatric beds. It also has a large general outpatient department.

264. Extensions to existing hospitals were opened or put into use during the year as follows:

Kwong Wah Hospital

Kowloon

Hospital

Beds available at 31.3.61

413 beds

$34 beds

Additional beds during year ended

31.3.62

161 beds

519 beds

Beds available at 31.3.62

574 beds

1.153 beds

...

GOVERNMENT HOSPITALS

Kowloon Hospital

265. This is the main casualty and emergency receiving centre for Kowloon and the New Territories, serving a population of just over two million. The Casualty Department maintains a 24 hour service and an average of 9.8 casualties were seen every hour throughout the year. A total of 86,218 attendances at Casualty was recorded of which some 52% were due to trauma; 1.1% of the total attendances were due to industrial injuries, the majority of which were hand injuries.

266. There were 19,459 admissions to the 526 beds and the average daily bed occupancy state was 547. This was possible only through the use of camp beds in wards and on verandahs; the number of camp beds in use varied from 126 to 27. The average duration of stay was 7 days. Table 22 below sets out the work done during the past five years.

Maternity Cases

TABLE 22

KOWLOON HOSPITAL 1957-61

Including Casualty and Outpatient Departments

1957

1958

1959

1960

1961

2,861

3,472

3,646

4,372

4,749

General Inpatients (excluding

Maternity)

7.819

10,695

13,242

16,052

19,459

Total Outpatient attendances

· L

547,026

558,010

532,492

547,592

605,654

Casualties attended (included in

above figures)

51,986

70,191

71,627

80,333

86.218

Operations (excluding minor

ones)

4.884

5,704

6,571

7,584

9,257

Mortality (expressed as per-

centage of admissions)

5.6

6.2

5.5

6.4

6.5

267. The major outpatient clinic in the hospital grounds, adjacent to the Casualty Department, maintains general and specialist clinic services.

268. There are medical, general surgical, orthopaedic, paediatric, obstetric and gynaecological and ear, nose and throat units. Each unit is under the clinical direction of a Specialist or of a Senior Medical Officer with a higher qualification. Other services include diagnostic radiology, pharmaceutical and surgical supply, clinical pathology, phy- siotherapy, almoning and a blood bank. A Principal Medical and Health Officer is Medical Superintendent, assisted by a Hospital Secretary, and all professional and other staff are provided by Government.

269. The medical unit continued to admit largely medical emer- gencies particularly patients with peptic ulcers and cirrhosis of the liver who presented with gastric haemorrhages. The numbers of acute cerebro- vascular accidents is rising sharply and there was again a marked in- crease in admissions from this cause which totalled 136 in 1961 com- pared to 107 in 1960 and 66 in 1959. The imperative need for a quick turnover of beds so that emergencies can be admitted poses a serious problem of the rehabilitation and disposal of recovered cases for whom adequate home accommodation is rarely available. The relatively few convalescent beds in the Lai Chi Kok Hospital are now used largely for cases fit for discharge from Kowloon Hospital but requiring more comprehensive nursing care than is normally given in a convalescent hospital.

　　　270. There are now two general surgical units in the hospital each headed by a Specialist. To meet the emergency and trauma needs the two operating theatre suites are working on a 24 hour basis and an

average of 25 major operations were performed each day throughout the year. Head injuries and severe burns continued to increase in num- bers and the main non-traumatic emergency is acute cholangitis. In the non-acute field, the range of surgery was wide, including closed heart and pulmonary surgery. In one surgical unit some 50 radical excisions of the oesophagus were performed. The second surgical unit formed has enabled a wider scope of plastic surgery to be undertaken, the specialist in charge having recently returned from a course of study of modern techniques in this field.

271. As would be expected under existing conditions, the orthopaedic unit dealt mainly with admissions due to trauma which accounted for 90% of the total. There has been a significant rise in the number of fractures of the neck of the femur in elderly people.

272. With a population containing 40% of children under 15 years of age, increased bed accommodation for paediatric cases has been essential. The opening of one new paediatric ward resulted in an in- crease of admissions to the Paediatric Unit by 51.5% during the first 3 months of 1962. In addition a convalescent ward for children was allocated in the Lai Chi Kok Hospital which has greatly helped the turnover in the acute beds. Bronchopneumonia, gastroenteritis and burns have accounted for the majority of admissions.

273. A helicopter landing strip was completed at the hospital in March 1962, which enables emergencies from outlying districts to be brought direct to the grounds. One case from Tai O, the most distant township in the Colony, was actually in bed in a surgical ward twenty- five minutes after being put on board the helicopter. This journey nor- mally takes five to six hours by launch and ambulance.

Queen Mary Hospital

274. This hospital of 601 beds on Hong Kong Island is the largest Government acute hospital in the Colony. It is the University Teaching Hospital and the Specialist Centre for Hong Kong Island. There is a Casualty Department which receives all emergency cases from the Island and serves a population of one million. There is no general outpatient department at the hospital.

275. The University Departments of Medicine, Surgery, Orthopaedics and Obstetrics and Gynaecology are all under the direction of a Pro- fessor and carry the clinical responsibility for a total of 296 beds. There are Government Medical, Surgical, Paediatric, Radiology, Radiotherapy. Neurosurgery, Thoracic Surgery, Anaesthetic and Ear, Nose and Throat

Units, each in charge of a Specialist. All nursing and other staff are provided by Government. There are Pharmacy and Surgical Supply, Physiotherapy, Occupational Therapy, Blood Bank and Almoning Services. The Clinical Pathology is carried out by the University Depart- ment of Pathology. The Medical Superintendent is a Government Prin- cipal Medical and Health Officer and is assisted by a Hospital Secretary. 276. Specialist outpatient clinics are held at the Sai Ying Pun Polyclinic by the University and some Government clinical units. Government specialist clinics are also held at the Violet Peel Polyclinic.

　　277. Throughout the year, there was a daily bed-occupancy averag. ing 720 with an average duration of stay of 14 days. The pattern of emergency admissions is broadly the same as in Kowloon and required the use of camp beds varying between 110 and 90 with a daily average of 100.

　　278. The Casualty Department, which provides a 24 hour service, dealt with 58,559 attendances during the year. There is a helicopter landing strip close to the hospital.

　　279. There were 18,247 admissions during the year and the table below sets out the work done over the past five years.

TABLE 23

QUEEN MARY HOSPITAL 1957-61

Including Casualty and Outpatient Department

1957

1958

1959

1960

1961

Maternity Cases..

1,950

1,975

1,962

2.144

2.324

General Inpatients (excluding

Maternity)

11,775

12,994

13,224

15,133

15,923

Total Outpatient attendances

42,513

44,845

53,306

47,437

58,559

Casualties attended (included in

above figures)

13,896

18,101

22,307

23,402

41.936

Operations (excluding minor

ones)

6,977

7,230

7,212

8,160

8,420

Mortality (expressed as per-

centage of admissions)

6.4

7.3

7.5

7.0

7.3

Tsan Yuk Hospital

280. This is the main specialist obstetric hospital in the Colony and the clinical supervision of the 200 beds is undertaken by the University Professor of Obstetrics and Gynaecology. She is assisted by her Univer- sity Lecturer Staff and by Government Medical and Health Officers; all nursing and other staff are provided by Government.

　　281. It is the teaching centre in Obstetrics for medical under- graduates and the training school for midwives who are undergoing the

two year course conducted in Cantonese and who have not trained as general nurses.

282. Admissions to the hospital are now mainly from amongst those women registered at the hospital ante-natal clinic, and 94.8% of the admissions were primiparae, 'grand' multigravidae, women with a pre- vious history of abnormal labour or referred patients who are in need of specialist care. The rest of the admissions were emergency cases referred by private midwives, general practitioners or the Government Midwifery Service.

283. The work carried out during the year is set out in Table 24.

TABLE 24

WORK OF THE TSAN YUK HOSPITAL 1960-61

1960

1961

Total admissions

Total deliveries

7,251

7,774

6,416

6,664

Still-birth rate (per 1,000 total births)

9.70

12.34

Neo-natal mortality rate (per 1,000 live births) Maternal mortality rate (per 1,000 total births) Percentage operative deliveries

12.17

13.71

111

0.16

0.77

20.12

21.13

284. Ante-natal and post-natal clinics are held weekly and consist of 6 ante-natal and 2 post-natal sessions. Since July 1961 an appoint- ments system has been in use and has been found to be satisfactory. Patients who are not within the categories which are registered at these clinics for admission to Tsan Yuk are referred to Government Maternity Homes or to private midwives for their confinements. There were 37,158 attendances at ante-natal sessions and 3,925 attendances at post-natal clinics. A Health Visitor from the Maternal and Child Health Service attends to give health talks, lasting 20 minutes, twice each week. During the ante-natal sessions milk drinks are given to the pregnant women, the supplies of milk coming through the good offices of social welfare agencies.

285. There are special consultant clinics during each week for medical conditions complicating pregnancy and for venereal diseases. The Family Planning Association also holds a clinic in the hospital out-patient department twice each week.

Castle Peak Hospital

286. This modern psychiatric hospital of a nominal 1,000 beds was opened by His Excellency the Governor on the 27th March, 1961. Sited in spacious grounds where the patients can have exercise, recreation and some outside work, every attempt has been made to preserve an

open appearance and give as much freedom as is possible. Of two storey pavilion structure, the wards are light and airy and the ancillary services include a large occupational therapy department, facilities for physiotherapy, electro-encephalography and an operating theatre which can be used for neuro-surgery. Within the hospital, one block of 120 beds has been set aside for the treatment and rehabilitation of drug addicts who come forward voluntarily for treatment. There is also a School of Psychiatric Nursing to which reference is made in para- graph 465.

287. The hospital is in the New Territories, some 22 miles from Kowloon and there is direct public transport between town and hospital. The majority of admissions are voluntary and come through the Hong Kong Psychiatric Centre situated in the former Victoria Mental Hospital on Hong Kong Island. This is also the main outpatient and Day Hospital from which patients discharged on trial from Castle Peak are super- vised and where therapy is continued.

　　288. The new hospital settled down remarkably quickly considering its size and it is not without significance that additional beds have already been fitted in to the new wards giving a total 1,119 beds available,

289. An additional psychiatric outpatient clinic was opened during the year in Tsuen Wan where a session is held once a week, conducted by staff from Castle Peak. Plans are in hand to establish a Psychiatric Centre with day hospital facilities in Kowloon and proposals have also been made for the re-housing of the Hong Kong Island Centre. The Almoning Service which has trained psychiatric social workers on the staff has broadened and expanded this section of its activities to keep pace with the developments of the Mental Health Service.

290. The work done at the hospital and the associated Psychiatric Centre and Day Hospital is recorded in Table 25.

TABLE 25

CASTLE PEAK HOSPITAL 1961

Total admitted 1st admissions

Total admissions

Re-admissions

Male

Female

Total

834

477

1,311

417

347

764

1.251

824

2,075

984

821

1,805

---

1,805 957

1.280

3,085

749

1.706

Discharged, including transfers and deaths Total patients treated in hospital

Voluntary patients

ILL

* There were 29 male and 14 female patients who died in hospital.

For convenience, the work of the outpatient centres and the Day Hospital is recorded here.

TABLE 26

HONG KONG PSYCHIATRIC CENTRE

Day Hospital

Admitted 1961

Discharged 1961

Total treated

Outpatient Clinics

Hong Kong

Tsuen Wan

Totals

...

1г.

Male

Female

Total

142

106

148

First

Subsequent Total

Attendances

1.116

9.636

10,752

106

319

425

1,222

9,955

11.177

291. A variety of therapeutic approaches to the treatment of psychia- tric disorders have been employed. No new drug therapy was introduced during the year but increasing emphasis is placed on drug combinations adjusted according to the stage of the illness. Psychotropic preparations, physical treatments and psychotherapy were all employed although there was considerably less use made of insulin shock therapy. While leucotomy was little used, the services of the Neurosurgical Specialist at the Queen Mary Hospital were well utilized, primarily for diagnostic investigations; once the operating theatre at the Castle Peak Hospital can be more fully used, it is probable that this work will be undertaken there. In the Day Hospital several patients were given courses of auto- genic training and this form of 'fractional hypnosis' gave satisfactory results.

292. It is appropriate here to pay a special tribute to the staff of the Mental Health Service for the practical and cheerful way they have faced the problems arising during this first year's work in the new hospital. In this, they have been greatly assisted by the Architects and maintenance staff of the Public Works Department as well as the staff of the Department of Agriculture and Forestry who have done good work in developing the grounds.

Drug Addiction Treatment and Rehabilitation Centre

293. This Centre was opened at the Castle Peak Hospital in March 1961, as a pilot venture to assess the effectiveness of a system of volun- tary treatment for drug addiction, the root causes of addiction in the voluntary group affected and the pattern of rehabilitation most suited to the social circumstances in Hong Kong. The Drug Addicts Treatment

　　and Rehabilitation Ordinance, 1960 gives the necessary statutory back- ing and addicts who volunteer for treatment are required to surrender their liberty for a period of not less than 6 months.

　　　294. There is an Addiction Clinic in the Hong Kong Psychiatric Centre where addicts desirous of treatment can register. Initially large numbers came forward to register and as the accommodation in the two- wards available at the hospital was limited, it was obvious that some criteria of selection had to be imposed. Registration was started on the 1st February and by the end of the first 4 weeks, 201 persons were on the register. At the end of the year, 583 addicts were registered of whom 162 had been admitted to the Treatment Centre and 112 of these had been discharged.

　　　295. In consultation with the Narcotics Advisory Committee certain criteria for selection for treatment were laid down. The cardinal points are a genuine desire to be rid of the habit, good prospects of re-employ- ment on discharge, an absence of any record of serious crime and free- dom from severe mental or physical disease. On registration all who come forward are documented. Their employment situation is investigated by a representative of the Secretariat for Chinese Affairs, a thorough physical examination including an X-ray is carried out and they are then interviewed by a psychiatrist. Thereafter, the Almoner investigates the social history and, as a rule, interviews wives or relatives. Once the case notes are completed they are assessed by the psychiatrist in charge of the Treatment Centre and a decision taken on immediate admis- sion or otherwise. If selected for admission, notification is sent through the Secretariat for Chinese Affairs. On admission the patient is given an explanation by the Almoner of the implications of signing the admis- sion form which, once signed, gives statutory authority to detain the addict for up to six months. Thereafter discharge is at the discretion of the Medical Superintendent of the Hospital, subject to any appeal to a statutory Board of Appeal. All documents concerning an addict who comes forward voluntarily are privileged and cannot be admitted as evidence in Court on a charge made under the Dangerous Drugs Ordinance.

　　　296. On admission, treatment is commenced by the substitution of methadone according to the intensity of withdrawal symptoms and the methadone itself is withdrawn over a period of one to two weeks. Adjunctive symptomatic treatment is also given, where necessary, to relieve distress. Many cases are physically ill and most are malnourished.

Therefore skilled medical and nursing care are essential at this time, the patients being treated in bed in the wards.

297. After some three weeks during which the physical and mental condition improves markedly and considerable weight is gained, the programme of occupational and recreational therapy is started. Domestic work, tailoring, wood-work, shoe repairing and gardening are allocated according to circumstances and there is an incentive scheme of payments which are credited to individual accounts. Some of the money can be used for purchases of sweets and additional foods and to support group incentives in the way of traditional dinners, operas and cinema shows. However, the major part of the payments is held as a credit, to help re-establishment expenses on discharge. Recreation in- cludes table tennis, cards, mahjong, dominoes, music parties, football, net ball, walks, outings and swimming.

298. During this period of rehabilitation the Almoner interviews patients in the ward, and builds up a basis of understanding with a view to follow up work on discharge. Contact is also made with relatives and with employers to try and ensure that the patient is given every assistance to re-instate himself when he leaves hospital.

299. After leaving hospital, patients are encouraged to come and see the Almoner once weekly for the first 3 months. If contact with the patient is not regular, a relative is asked to attend. Complaints of physical ailments, which are frequent, are referred to a general out- patient clinic and, where appropriate, the advice of the psychiatrist is sought. A club of ex-addicts has been formed which meets once a week, the Almoner attending as an observer who is there to guide the club activities and discuss points of general importance raised by the group.

300. While in the Centre a patient may be given leave to attend to family affairs or to make arrangements about a job. If suspected of a relapse while on leave the nalline test is applied. It has been found that the judicious granting of short periods of leave has been well worth while and, on the whole, the privilege has been respected.

301. Research is proceeding into the socio-economic background and clinical characteristics of addicts in Hong Kong, into the basic nature of addiction and into the place of aversion therapy in preventing relapse. Personality studies are also being conducted in which the Chinese version of the Maudsley Medical Questionnaire was given to an un- selected group of addicts, the Questionnaire having been previously validated against psychoneurotic outpatients. While there is evidence

that addicts are more neurotic than the average person, clinical experi- ence shows that any specific type of addictive personality cannot as yet be clinically delineated. It is possible to say, however, that as a group they have, for varying reasons, an inability to postpone pleasure and a low tolerance for tension arising from unsatisfied desires.

302, Much useful information has been accumulated as a result of the first year of work. It is too early to reach any categorical con- clusions, but valuable experience in management has been gained. A scheme of voluntary treatment appears to fulfil a real need but it is most important to exercise a high degree of selection for admission if the limited staff and facilities available are to be put to the best use. This has been emphasized by experience of the first group of 62 addicts admitted who were entirely unselected other than the selection inherent in the fact that registration was voluntary. This group contained a number of persons, about one-third, with a bad criminal record which had not been disclosed. They were aggressive, lacking in self-discipline and at times, violent. Once the bad elements had been assessed and weeded out, much more progress was made and the patients in the centre settled down.

　　　303. The crucial stage in treatment is after the withdrawal period is over and the patients are gaining weight and energy. They then become restless, start to worry about the future and are anxious to get back to their families. This is when a well disciplined programme of rehabilita- tion and recreation must be rigorously imposed. Material incentives and short periods of leave thereafter are valuable adjuncts to the programme. Once discharged, success depends on active follow-up and support which involves patient, employer and any relevant social agency that can contribute.

　　　304. Treatment and rehabilitation in the Centre is a first but essential phase in a long process. The assessment of cures will have to be made very cautiously over a long period. It is much too early to say other than that a scheme of voluntary treatment is well worth while. The crux of full success is to cut off supplies of addicting narcotics at the source. Thereafter, there will be many addicts of long standing who will continue to be a social problem but there will also be a substantial number who can be rehabilitated for a return to a worth while and productive life.

　　305. The following table indicates the turnover of patients during 1961. The relatively short average duration of stay is largely due to the

necessity to discharge in the early stages a number of individuals who proved quite uncooperative in treatment. These data apply to male addicts only and the relatively few female addicts who volunteer for treatment are treated as voluntary patients in the women's section of the hospital, under the provisions of the Mental Health Ordinance, 1960.

TABLE 27

ADDICTION TREATMENT CENTRE CASTLE PEAK HOSPITAL

Total patients admitted

Average length of stay of patients discharged

Total patients discharged

Maximum length of stay

Minimum length of stay

Reasons for premature discharge

Disciplinary infringements

Did not retum from leave

---

Employment available at once and prognosis good

ILL

Others-including severe physical illness uncovered during

withdrawal

1-7

ггг

- rr

Total

162 112

109 days 165 days

1 day

306. The Hong Kong Society for the Aid and Rehabilitation of Drug Addicts is building a rehabilitation centre on Shek Kwu Chau Island some 14 miles from Hong Kong. This centre will initially have accommodation for 240 addicts with workshop and other facilities. It is proposed to channel admissions through the Treatment Centre at Castle Peak Hospital where medical and nursing care will be given during the withdrawal period and the medical and psychological assess- ments made. The Society, a voluntary body, will be responsible for the capital and recurrent costs of the Island Centre to which Government is making capital and recurrent subventions.

Lai Chi Kok Hospital

307. This hospital of 479 beds situated on the outskirts of Kowloon consists of 12 two storey buildings, originally converted for use as an infectious diseases hospital for Kowloon and the New Territories. However, its function has changed under the pressure on acute hospital beds and it now has 241 convalescent beds, 150 infectious diseases beds and 88 tuberculosis beds. It is entirely staffed by Government.

308. The convalescent beds are used mainly for patients transferred from Kowloon and Queen Mary Hospitals. Numbers of these patients are, in fact, 'semi-acute' and in the immediate post-emergency phase.

　Accordingly, much more nursing care is provided than is generally required for convalescent beds. However, there is also a number of long stay cases such as paraplegics who cannot be discharged on account of quite unsuitable home conditions.

309. The infectious diseases section admitted mainly cases of diphtheria, typhoid, tetanus and measles with broncho-pneumonia. Other conditions treated during the year were tuberculous meningitis, polio- myelitis and bacillary and amoebic dysentery. During the cholera outbreak, one block was set aside as a treatment unit for a period of seven weeks from the 17th August.

310. Out of 1,885 admissions to the Infectious Diseases Section 925 were on account of diphtheria with a fatality rate of 7.4%; tracheotomy was necessary for 190 of these patients. The predominant strain of Cl. Diphtheria was of the mitis type.

311. The pulmonary tuberculosis unit admits patients who are being prepared for Thoracic surgery or who require a period of medical treat- ment in hospital. Ten beds are now set aside, since November, 1961, for the acute emergencies arising in pulmonary tuberculosis and which are usually referred direct from the Kowloon Hospital Casualty Department.

312. Physiotherapy and occupational therapy units are maintained full time as well as an Almoning Service. There is also a school for long-stay children which is run by the Hong Kong Branch of the British Red Cross Society.

Sai Ying Pun Infectious Diseases Hospital

313. This hospital of a nominal 88 beds is on Hong Kong Island and is used entirely for the treatment of infectious diseases; the daily average in-patient state is usually over 100. Table 28 below details. the causes of admission during 1961.

TABLE 28

INFECTIOUS DISEASE HOSPITALS 1961

Diphtheria

FLI

Typhoid

---

Tetanus

Amoebic dysentery Bacillary dysentery

Poliomyelitis

Tuberculous meningitis

Measles

TPI

Cases Admitted

Deaths

Case Fatality Rate (per cent)

1,176

100

8.50

369

.27

154

Irr

108

---

111

407

...

147

279

K-REA

48.70

.93

.98

20.41

42.42

12.90

314. Specialist clinics are held at the hospital twice weekly for surgical, gastric, genito-urinary and ear, nose and throat conditions. arising as the result of infectious diseases. Audiometry tests are carried out on two days each week as part of the E.N.T. Service.

315. In the course of the cholera outbreak, the staff of this hospital also took over the work of the Island cholera treatment unit established in the nearby male block of the old Mental Hospital.

St. John Hospital

316. Consisting of 100 beds and a general outpatient department this Hospital serves the Island of Cheung Chau and the neighbouring islands on the western sea-board. The floating clinic which serves the islands in this area uses Cheung Chau as a base. Specialist clinics for tuberculosis, paediatrics, medicine, dental, eye, social hygiene and skin diseases are also held at the hospital which provides accommodation for patients from Cheung Chau and the neighbouring islands who require general medical and minor surgical treatment which cannot be given on an outpatient basis. Those requiring medical or surgical specialist treatment are transferred to Hong Kong Island.

317. There are 42 beds set aside for patients with pulmonary tuberculosis who need inpatient supervision. These are largely occupied by adolescents with open lesions who cannot be allowed to attend school until they are rendered sputum negative.

Wan Chai Hospital

318. This small 30-bed hospital, originally intended for the inpatient treatment of venereal disease amongst women and children is now primarily an institution for the care of female patients with skin diseases and a busy dermatological out-patient department is also maintained there.

319. Out-patient facilities are also provided for the treatment of women suffering from venereal disease and for the examination of known female contacts.

South Lantau Hospital

320. This small hospital of 17 beds serves the workers on the Shek Pik Reservoir project and the villagers on the south-west coast of Lantau Island. The Medical Officer-in-Charge is also responsible for the dispensary at Mui Wo, serves as Health Officer for the area and visits the sick bay at Her Majesty's Prison at Chi Ma Wan.

Prison Hospitals

321. Hospitals under the care of Medical Officers are maintained at the Stanley Male Prison, the Victoria Remand Prison, the Lai Chi Kok Female Prison and the Tai Lam Prison, the latter being used exclusively for the rehabilitation of prisoners who are also drug addicts. A small sick-bay at Chi Ma Wan Prison is visited regularly by a Government Medical Officer.

322. At Stanley Prison there is a hospital of 90 beds for the accommodation of prisoners who require treatment for conditions which do not warrant transfer to another hospital. Regular visits are paid by specialist staff from the units in general medicine, tuberculosis and social hygiene. In July 1960, an in-service course of training in elementary nursing for Prison Hospital staff was started.

323. At Victoria Remand Prison, the hospital has been expanded to a total of 59 beds to provide isolation facilities and to accommodate the numbers of drug addicts under remand who are suffering from withdrawal symptoms. One of the prison blocks was converted into a Psychiatric Observation Unit in June 1961 for the observation and treatment of mental cases. It is staffed by 2 Prison Officers qualified in psychiatric nursing and 14 Hospital Warders under in-service training. The unit is under the clinical control of the Senior Specialist in Psychiatry and members of his staff pay regular visits to all main prisons and training centres to advise on the numerous psychiatric and personality problems encountered amongst prisoners.

324. The specialist prison at Tai Lam Chung for the treatment and rehabilitation of convicted male drug addicts continues to give en- couraging immediate results, but no assessment of the relapse rate after discharge has yet been possible.

GOVERNMENT-ASSISTED HOSPITALS

325. There are 26 voluntary bodies receiving direct subventions from Government for work in various medical fields including the maintenance of 16 hospitals and related institutions. Mention has already been made in paragraphs 186 to 192 and 195 of these dealing entirely with tuberculosis namely, the Grantham Hospital, the Ruttonjee Sanatorium and Freni Memorial Convalescent Home and the Haven of Hope Sanatorium.

The Tung Wah Group of Hospitals

326. In this group there are three hospitals and two infirmaries which accommodate 2,326 beds. Incorporated in 1870 by statute which is

based on the charitable aims and objects of Chinese tradition, a Board of Directors is elected annually. Management of the hospitals and infirmaries is delegated by the Board to the Tung Wah Hospital Medical Committee which is under the chairmanship of the Director of Medical and Health Services and is composed of the Chairman of the Board of Directors, the three Principal Directors of the Board, a prominent Chinese citizen appointed by His Excellency the Governor, a member from the Permanent Advisers to the Tung Wah Board, representatives from the Government Finance, Public Works and Medical Departments and the Medical Superintendents of the Hospitals. The Board of Directors raises large sums annually from donations, charity functions, public appeals and a flag-day. This money is devoted mainly to capital expenditure on hospitals, primary schools and welfare services for the poor. Government gave a subvention of $12,495,539 in 1961-62 to meet the recurrent expenditure of the hospitals and infirmaries.

327. Each hospital provides general medical, surgical and obstetric facilities. In addition wards containing an average of 250 to 350 beds are set-aside in the hospitals and infirmaries for the accommodation of patients with tuberculosis. A Group Medical Superintendent and three Medical Superintendents are appointed by Government to the hospitals and Government Nursing Sisters are seconded to the Nurses Training school as Tutors. All training and other activities are conducted in Chinese. Consultant Services are given voluntarily by private medical practitioners and, in some instances, by Government Specialists.

328. Patients are admitted through large outpatient departments maintained at each of the three hospitals. A number of acute medical and surgical conditions are treated and there is also accommodation for patients with chronic disease requiring long periods of inpatient care. The infirmaries cater for many suffering from incurable or disabling diseases who cannot be cared for a home. The obstetric service is an extremely busy and important one and one third of the babies born in the Colony each year are delivered in the three Tung Wah Hospitals. The work done is detailed at Appendix II.

329. The major pre-occupation of the Directors at present is the redevelopment of the Kwong Wah Hospital in Kowloon. The re-building is being done in five phases, the fourth phase starting early in 1962.

As new wings are being added so the bed accommodation is increasing and with the opening of the North Wing the Kwong Wah Hospital has now 1,153 beds which is an addition of 519 since December, 1960. The ultimate nominal bed strength is to be 1.270 beds and it is anticipated that this redevelopment will be completed by the end of 1963. Plans are also in hand for an extension of the Sandy Bay Infirmary from 86 to 248 beds and for a new Infirmary at Wong Tai Sin which will give accommodation for 200 patients in its first phase. The Tung Wah and Tung Wah Eastern hospitals on Hong Kong Island have 630 and 336 beds respectively.

The Alice Ho Miu Ling Nethersole Hospital

330. This hospital of 281 beds on Hong Kong Island offers general medical, surgical and obstetric care and maintains a busy outpatient department. The senior members of the medical staff are appointed by the London Missionary Society which also contributes annually towards recurrent costs. There are specialists in clinical charge of the surgical, medical and obstetric departments of the hospital.

331. During the year, two Government representatives were appointed to the Hospital Executive Committee and arrangements have now been made to grant the annual subvention from public funds on a deficiency grant basis. At the same time, approval in principle has been given for the construction of a new East Wing containing mainly paediatric beds, additional accommodation for the Nurses Training School, for female staff quarters and for new Medical Staff Quarters. 332. Generous donations have been made by private individuals towards these developments. In addition, there is considerable voluntary support given annually towards recurrent costs which are augmented by hospital fees and a block grant-in-aid from Government funds. The hospital provides low cost in-patient care for the lower and middle in- come groups in the Chinese population and in this field it meets a particularly clamant need,

Pok Oi Hospital

333. Situated on the outskirts of Yuen Long in the New Territories the Pok Oi Hospital provides 118 beds for the treatment of medical and minor surgical illnesses that do not require specialist medical or surgical care. There are operating theatre, radio-diagnostic and labora- tory facilities. It is managed by an Executive Committee consisting of six representatives of the statutory Board of Directors and six representatives of Government. The Board of Directors provides

charitable services in the Chinese tradition and raises funds from voluntary sources for the capital and recurrent costs. These are augmented by Government subventions on a deficiency grant basis. A Government Medical and Health Officer is seconded to the Hospital as Medical Superintendent.

Hei Ling Chau Leprosarium

334. Maintained by the Mission to Lepers, Hong Kong Auxiliary, on an Island 6 miles from Hong Kong and with the aid of a substantial recurrent subvention from Government, the Leprosarium contains accommodation for up to 540 leprosy patients. The Maxwell Memorial Medical Centre provides fifty beds for the care of patients undergoing reconstructive surgery or suffering from intercurrent disease and a further 15 beds for male patients with tuberculosis. The Foundation Stone of the Physiotherapy Unit and a ward for female patients with tuberculosis was laid by Lady Black on the 22nd March, 1962, the funds for this development being raised by the Marianne Reich! Aid to Lepers Group. An important addition to the staff was the appoint- ment of a full time Physiotherapist; the physiotherapy needs had been met previously through the good offices of a part-time honorary Physiotherapist.

335. There is close liaison with Government Leprosy Clinics and all patients, the majority of whom are infectious, are admitted through these clinics. Treatment is mainly by the sulphone group of drugs but all available drugs are used and detailed records kept of the progress of the patients receiving treatment. A number of new surgical procedures have been introduced over the past three years, which ensure much less residual deformity. During the year 236 operations were performed, 190 being of the reconstructive type. This has been a most encouraging development, particularly as the backlog of patients in need of surgical treatment has now been substantially reduced.

336. All patients on the Island are expected to work in accordance with their physical capacity and previous occupation; training is available in agriculture, cottage industries and in certain light industrial occupations. There is a primary school for child patients, the staff of which hold evening classes for adults; social activities continue as in a normal community. Three children's cottages and an extension of the school building were completed and occupied during the year after which the old children's block was converted into badly needed class

rooms.

Our Lady of Maryknoll Hospital

337. The first stage in the Construction of this hospital was completed during the year and the institution was officially opened by the Director of Medical and Health Services on the 11th December, 1961. The new buildings contain 61 beds for adults, 12 cots for children and a large out-patient department. It is proposed to extend the existing hospital within two years by the erection of an additional wing which will increase the accommodation to a total of just over 100 beds.

338. The Hospital is managed and staffed by the Maryknoll Sisters and will serve the poor and needy in Wong Tai Sin. It is supported by donations of money and in kind from the United States of America and from well wishers in Hong Kong. Government has guaranteed a recurrent subvention of up to $250,000 per annum towards the operating costs.

Sandy Bay Convalescent Home

339. The Sandy Bay Home contains 54 beds for children suffering from bone and joint tuberculosis, poliomyelitis and other conditions. requiring long term orthopaedic care. Maintained by the Hong Kong Society for the Relief of Disabled Children, the day to day management is by an Executive Committee appointed by the Hong Kong Branch of the British Red Cross Society which also provides a school teacher for the children in the Home. Some 50% of the beds are occupied by children with bone and joint tuberculosis.

340. Supported largely by voluntary effort, a number of the beds are endowed on a yearly basis. An annual subvention is made by Government towards recurrent costs.

　　　341. An extension which will contain an additional 54 beds and a physiotherapy department with hydro-therapy facilities is now being built. The cost of the construction is being met by a generous donor.

London Missionary Society Maternity Clinic, Sheung Shui

342. This Maternity Clinic of 10 beds is run by a missionary Nursing Sister of the Society, assisted by locally appointed staff. Ante- natal and maternal and child health clinics are also maintained at the clinic. There is a Sheung Shui Maternity Clinic Advisory Board which supports the work and the London Missionary Society also makes an annual contribution towards running costs. There is also a recurrent subvention given by Government.

New Projects

343. At Tsuen Wan in the New Territories, local residents are engaged in fund-raising to build a 100 bed hospital to be known as the Yan Chai Hospital. It is proposed to incorporate by statute a Board of Directors with provision for an Executive Committee after the pattern for the Pok Oi Hospital. There is provision in the plans for extensions up to 300 beds in the future.

344. The Hong Kong Society for Rehabilitation is building a Re- habilitation Centre in Kwun Tong designed as a pilot scheme for the quick return to full employment of those who have been injured in industrial occupations. There will be three stages of development, the first to accommodate 80 patients and with facilities for physiotherapy and occupational workshops. This stage will be completed in September, 1962. During the second and third stages accommodation will be doubled and further workshops added, the aim being to establish eventually a sheltered workshop in the third and final stage.

OUTPATIENT SERVICES

345. The demands made on the outpatient clinics maintained by Government continue to be very heavy and this pressure has been no less severe on clinics maintained by Government-assisted institutions or by the various missionary and charitable organizations.

346. In contrast with the previous year there was only a moderate expansion of the Government clinic facilities in 1961-62. One clinic was opened at the Wong Tai Sin Resettlement Estate and contains 2 con- sulting rooms, a dispensary and treatment rooms. The Royal Hong Kong Jockey Club Clinic donated to the people of Shek Wu Hui and opened in 1961 provides 25 maternity beds, 4 casualty beds, a general clinic and a health office. There were also extensions to the Violet Peel Polyclinic and Farm Road Dental Clinic.

347. By the 31st March, 1962, work had started on the Anne Black Clinic in North Point and the Airport Health Station; the working drawings for the Jockey Club Clinic in Shau Kei Wan and the Jockey Club Surgical Appliance Centre in Kowloon are well on the way.

348. In addition to general outpatient clinics, regular specialist outpatient sessions were maintained at a number of clinics by staff from the tuberculosis, social hygiene, medical, surgical, ophthalmic, maternal and child health and ear, nose and throat services.

p.m.

349. Evening outpatient sessions continue to be held at seven of the larger clinics in the more densely populated areas and last from 6 until midnight. On Sundays and public holidays, clinic sessions are held at four centres in the urban area, two on each side of the harbour: these sessions cater for patients in need of emergency attention during week-ends and public holidays.

350. In the New Territories there are 16 outpatient centres, in eight of which one or more doctors are stationed permanently. The more remote areas of the New Territories are served by two mobile dispen- saries and two 'floating clinics'; the latter are launches, donated by the Royal Hong Kong Jockey Club, which provide curative and immuniza- tions facilities to isolated centres on the eastern and western coasts and on adjacent islands. Since March 1961 these facilities have been extended by means of a helicopter service to remote villages which are inaccessible by road. A helicopter ambulance service is also available for the con- veyance of cases, in need of emergency treatment, from remote areas in the New Territories and adjacent islands, to Kowloon Hospital.

351. The helicopter 'flying doctor' service operates once weekly and visits 7 Centres in rotation. The doctor is accompanied by a nurse and an inoculator. Minor ailments are treated, immunizations against diphtheria, cholera and smallpox carried out and talks are given on simple personal and village hygiene. This service has proved to be most acceptable to the villagers and very valuable from the general epidemio- logical point of view.

352. At Appendices 12 and 13 are details of the work done during 1961 at the outpatient departments of Government and Government- assisted institutions throughout Hong Kong.

SPECIALIST SERVICES

353. There are Government Specialist Clinical Units of medicine, surgery, obstetrics and gynaecology, anaesthesiology, dentistry, neuro- surgery, ophthalmology, orthopaedic surgery, otorhinolaryngology, pathology, paediatrics, psychiatry, radiodiagnosis. radiotherapy, social hygiene, thoracic surgery and tuberculosis. In addition, the Professors and certain Senior Lecturers of the University Faculty of Medicine act as consultants in medicine, surgery, obstetrics and gynaecology. orthopaedics, pathology and paediatrics. Certain of the Government Specialists act as Honorary Consultants to the Tung Wah Group of

Hospitals and others give part-time services as lecturers in the Faculty of Medicine.

RADIOLOGY

354. The Radiological Service, under the direction of the Senior Radiological Specialist, maintains radiodiagnostic, radiotherapeutic and medical physics facilities. Such facilities are provided mainly for Government hospitals and clinics, but consultant services are readily available to certain Government-assisted hospitals and, on request, to private medical practitioners. In addition, the Service undertakes the instruction of medical students at Hong Kong University in the basic principles of radiology and it conducts in-service training courses for both radiologists and radiographers, which are fully recognized by the various examining bodies in the United Kingdom.

355. There is also a Clinical Photography Section in charge of a Medical Photographer who, in addition to the clinical photography, makes slides for teaching purposes and gives demonstrations of techniques to student radiographers. This section develops the radiation monitoring films for the radiation protection service of the Department; X-ray reproductions for the radiology museum and for scientific publications are also made.

Radiodiagnosis

356. This branch provides a diagnostic service in 12 Government hospitals and clinics in the Colony, operates 2 mobile mass radiography units and provides assistance to the Tung Wah Group of Hospitals and the Pok Oi Hospital. It has also assisted the Alice Ho Miu Ling Nethersole Hospital in providing a radiological service until the 30th June, 1961. During the year, an X-ray Department which included both fluoroscopic and radiographic facilities and a special apparatus for skull radiography was opened in the Castle Peak Hospital.

357. The work performed by the radiodiagnostic branch during the year was as follows:

Hong Kong Island (Six full-time centres plus one mass miniature radiography unit)

LLL

Kowloon and New Territories (Six full- time units plus one mass miniature radiography unit)

Total

...

Patients

Examinations

219.390

124,029

220,226

104,424

439,616

228,453

358. This represents an increase of 16% in the total number of X-ray examinations and of 14% in the total of patients seen, compared to the previous year.

Radiotherapy

359. This section is based entirely at the Queen Mary Hospital except for a recently opened superficial radiotherapy unit in the Jockey Club Clinic, Sai Ying Pun. Deep X-ray and radiocobalt machines are used, a large stock of radium and radiocobalt needles is held and facilities are available for the use of radioisotopes in the diagnosis and treatment of disease.

360. The major part of the work is amongst patients suffering from malignant disease, most of whom were treated as outpatients owing to the shortage of hospital beds. Some of them are now accommodated at the Oxfam Hostel near the Queen Mary Hospital. This Hostel, run by Caritas, was opened in October 1961 and has 16 beds. Patients under treatment at the Queen Mary Hospital are given free transport by Government between the hostel and the hospital and in this way courses of therapy lasting several weeks can be given conveniently without tiresome travel over considerable distances. The Almoners attached to the Radiotherapy Branch arrange admissions.

361. In face of the increasing demand for radiotherapy, working hours have been staggered and two shifts are worked each day. This has avoided the necessity of a long waiting list for treatment. Details of the work performed at the Queen Mary Hospital during the year are given in Table 29.

TABLE 29

WORK OF THE RADIOTHERAPEUTIC SECTION 1960-61

Number of new patients seen

Number of new diseases diagnosed

Number of new cases of malignancy seen

Number of patients treated

LLL

LL-

Number of new cases treated

1960

1961

1.339

1,504

1.339

1,509

962

1,079

י - -

1,266

1,501

1.021

1,105

1,001

1,193

786

888

35,596

42,475

243

290

IIL

126

179

158

182

15,571

17,228

829

796

JLL

--1

Number of cases of malignant disease treated Number of cases of new malignant disease treated Attendances for X- and gamma ray treatment Radioisotope tracer studies

Courses of radioisotope therapy given. Radium or radiocobalt applications

Patient attendances at Radiotherapy Clinics Biopsies performed

110

Medical Physics and Workshop Section

362. As in previous years this section, under the immediate direction of the Senior Physicist, has played an important part in the routine work of the Radiotherapy Branch, and has assisted in the training of radiologists and radiographers. Other functions consist of a radiation protection service and the giving of advice and assistance to other Government departments, e.g. the Radiation Board, the Labour Depart- ment and the Fire Services Department in matters concerning radiation hazards and protection. The workshop undertakes the maintenance, repair and calibration of all the radiological and physics equipment. During the year it has also produced many spare parts, electronic machines and other devices to improve certain radiological techniques and the working efficiency of the Radioisotope Laboratory.

363. In April 1961 a new and bigger radioisotope laboratory was opened to replace the old one, which was too small to cope with the work demanded of it; in February 1962, a Siemen's Nucleograph was added to the counting equipment.

DENTAL SERVICE

364. The Government Dental Service, under the direction of the Senior Dental Specialist, provides general dental care for the Civil Service and a School Dental Service. In addition, emergency dental care is given to patients in Government hospitals, in Her Majesty's Prisons and at certain of the Government outpatient clinics.

365. One new clinic was opened in 1961 in the Castle Peak Hospital and one additional surgery was added to the Farm Road Government Offices Dental Clinic. The total number of dental surgeries operated by the General Dental Service is 32, of which one, at Tai O, is operated twice yearly for a month at a time and is visited for one day a month during the rest of the year. The work of the dental service is shown in Table 30.

TABLE 30

WORK OF THE GENERAL DENTAL SERVICE

7960

1961

Dental Surgeries in operation

32*

Attendances by Government Officers

39,018

52,039

Attendances by Dependants of Government

Officers

42,216

52,487

Attendances by General Public

24,789

25,797

Total Attendances

106,023

130,323

* Includes Tai O Dental Clinic used part-time only.

　　　366. Delays in starting routine inspections and treatment for persons not suffering from emergency dental conditions were still not eliminated in the majority of clinics, while the situation with regard to the provision of dental prosthetic appliances deteriorated owing to the continuing shortage of trained dental technicians. The training of student technicians is developing, however, and a second class of 4 students began work in January 1962.

　　　367. Six dental clinics are maintained for participants in the School Health Service. Over 8,000 extractions were necessary during the year, an indication of the large amount of dental caries in children in Hong Kong. Although it is confidently expected that the scheme of fluoridation of water supplies, which began in 1960 in the urban areas, will eventual- ly bring about a substantial reduction in caries rates in children, unless the consumption of refined sugars is restricted to meal times and unless a strict regime of careful tooth brushing immediately after meals is adopted, dental caries amongst children will continue to be a problem in Hong Kong.

Control of Dental Practice

　　　368. Two Dental Inspectors were employed throughout the year in connexion with the supervision and control of private dental practice, including the regular inspections of premises. There were 4 prosecutions for alleged dental practice by unregistered persons and 3 individuals were convicted of this offence.

Dental Health Education

　　　369. In September 1961, the first Dental Health Week to be held in Hong Kong was launched by the Hong Kong Dental Society. This received the full support of a number of Government departments, voluntary organizations and other interested agencies. The emphasis was on the prevention of dental disease, particularly in children. During this Week, demonstrations, lectures, film shows and puppet shows were given throughout the Colony. These were followed up by a continuous pro- gramme of dental health education which lasted until December. By that time it was estimated that more than 250,000 school children and teachers had received special instruction in dental hygiene.

　　　370. Dental health exhibits were prepared for the Sai Kung Agricul- tural Show in January 1962 and for the Fisheries Exhibition held at

Aberdeen during Chinese New Year. At the latter, Dental Officers and Dental Hygienists gave instruction in dental health and oral hygiene to some 23,307 persons, mostly fisher-folk, who visited the exhibit.

OPHTHALMOLOGY

371. This Service, under the direction of the Ophthalmic Specialist, operates two full-time centres, one on Hong Kong Island and one in Kowloon. It also holds regular sessions in a number of urban and rural clinics. In addition, the Mobile Ophthalmic Unit, maintained by the Hong Kong Branch of the British Red Cross Society for work in the New Territories, was staffed during the year by members of the Service. Operative procedures have been limited to a certain extent by a shortage of beds, but much outpatient surgery is now carried out in the operating theatres of the two main clinics, the patients being followed-up by Health Visitors. During 1961, out of 4,011 operations performed, the majority on an outpatient basis, some 1,529 can be described as sight- restoring.

TABLE 31

WORK OF THE OPHTHALMIC SERVICE 1960-61

New outpatient attendances Total outpatient attendances

Operations performed

---

JJ J

-11

111

Home visits by Health Visitors Spectacles provided for children

1960

1961

79,075

76,214

192,397

204,811

5,001

4,011

3,370

3,218

2,392

2,184

372. A survey of blind persons registered during the year was con- ducted on similar lines to those undertaken in 1953 and 1960. An analysis of the causes of blindness re-affirmed the findings of the previous year. There has been a marked decrease since 1953 in the incidence of keratomalacia; very few children were seen who had been blinded by this deficiency disease. Blindness due to trachoma has varied but little and all such patients are now over the age of 40, while no new cases are presenting in children. The trend in the incidence of blindness is a shift from the young child to the middle aged, a welcome change from the situation in 1953 when over 90% of blind adults claimed that they had been blinded when very young. Details of this survey are shown in Table 32.

TABLE 32

Cause

Ophthalmic-Subnutrition (Keratomalacia).

1953

Percentage of Total Blind Persons

1960

1961

()

Cataract

Trachoma

...

Glaucoma

3.5

---

Injuries (all types)

Syphilis

Congenital Defects

N.S. Uveitis/Optic Atrophy

Degenerative Diseases

7.5

3.5

...

6.5

...

2.5

3.0

1.5

...

100%

100% 100%

373. During the year 634 persons were certificated as blind and registered as such with the Social Welfare Department. Thereafter they were referred to the Hong Kong Society for the Blind which undertakes rehabilitation. A special survey conducted by the mobile unit in the New Territories and lasting two months detected 80 of the above total. It is of interest that at the census in March 1961 only 1,000 persons were recorded as totally blind. On the other hand, 4,000 persons have regis- tered since 1957 as being blind.

　　　374. This is due to differing criteria of blindness, as the census data, based on the ability to distinguish between light and dark, had to be related as simply as possible to the task performed by the enumera- tors. The incidence of blindness in Hong Kong, using generally accepted standards, is 1.33 per 1,000, compared to 2 per 1,000 in the West and exceeding 10 per 1,000 in Africa and other parts of Asia.

FORENSIC PATHOLOGY

　　　375. All medico-legal work in connexion with the investigation of crime is carried on in laboratories situated in the Police Headquarters building. The laboratories, under the direction of the Specialist Forensic Pathologist, are staffed jointly by the Medical and Health and Police. Departments. Lectures are given in various aspects of medico-legal work to Police personnel and the Specialist Forensic Pathologist is lec- turer in Forensic Medicine in the University of Hong Kong. Work undertaken during 1961 is detailed in Table 33.

TABLE 33

WORK OF THE FORENSIC PATHOLOGY LABORATORIES, 1961

Examination of victims and suspects

489

IIL

111

Attendance at scenes of crime

...

Attendance at courts

138

...

Medico-legal post-mortems

723

ILL

406

rrr

626

Medico-legal examination of weapons (knives, choppers,

hammers, etc., used in wounding, killing, etc.) Examination of hairs, fibres and other slides Examination of clothing (suspects, victims, witnesses) Miscellaneous examinations (instruments for abortions and other articles, e.g. shoes, stools, chairs, bedding, coins, watches, pens at scene)

Blood Grouping (Medico-legal) Blood Grouping (Police Officers)

111

ILL

LII

Lectures to Police Officers including advanced course

Assistance in Raids:

376

---

1,613

384

1г.

Breach of Pharmacy and Poisons Ordinance and Penicillin

Ordinance

110

Unregistered Medical Practitioners

Abortionists

-- J

Unregistered Dentist

- 11

111

IIL

---

ГГ.

Irr

---

Public Mortuaries

376. The two public mortuaries, one on Hong Kong Island and the other in Kowloon are under the control of the Specialist in Forensic Pathology. It is to these institutions that all cases of sudden, unnatural or uncertified deaths are sent, including deaths in Police or Prison custody, exhumed bodies and human remains. An account of the work done in the mortuaries is in Table 34.

TABLE 34

PUBLIC MORTUARIES 1961

Total number of bodies received

Total number of autopsies performed

Number of bodies claimed

Number of bodies unclaimed

Deaths due to natural causes Deaths due to unnatural causes

LLL

---

Victoria

1,095

Kowloon

2,827

640

LLL

1,518

683

ILL

1,417

412

1,410

899

2,323

...

196

504

GOVERNMENT Chemist's LABORATORY

　　　377. A wide range of analytical and consultant work for Govern- ment departments, for the Armed Services and for commercial and industrial concerns is undertaken in the Laboratory.

378. During the year the pressure on the biochemical section of the laboratory was appreciably relieved by the recently formed chemical pathology unit in the Government Institute of Pathology and although there was an increase in the other fields of work the total number of analyses and examinations carried out in 1961 decreased by 7% as compared to 1960. More time consuming and detailed analyses could accordingly be undertaken.

TABLE 35

WORK OF THE GOVERNMENT CHEMIST'S LABORATORY 1961

Samples Analysed

Biochemical

Dangerous Drugs Ordinance

Dutiable Commodities

Water and Waterworks Chemicals

Food and Drugs

Forensic

Toxicology

...

Dangerous Goods Regulations

Commercial

-11

ггг

...

ייי

- 11

Import/Export (Prohibition) (Specified Articles)

Orders Miscellaneous

111

Irr

гг.

---

101

1960

1961

20,230

15,720

IIL

---

13,724

9,871

ILL

LLL

7,148

8,029

731

2,513

--L

353

гг.

1,128

---

1,029

1,177

723

852

---

230

ггг

1,498

492

488

Irr

---

553

гг.

787

45,224

42,074

379. As shown in the Table above, the major part of the work is concerned with biochemical analyses, narcotics control and the assess- ment of dutiable commodities. The biochemistry section was largely engaged in essentially routine chemical analyses but it also dealt with a number of choline-esterase determinations in the blood of suspected cases of poisoning by organo-phosphorous insecticides. In the field of narcotics control the very energetic drive to stop illega! imports of addicting drugs resulted in a gratifying drop in the number of samples sent in for examination. The predominant drugs were again opium, heroin and barbitone in that order. Ten illicit heroin 'factories' dis- covered by the police were visited by Laboratory staff and a consider- able amount of apparatus and chemicals were examined in connexion. with the police investigations.

380. The determinations of dutiable commodities for the assessment of duty covered much the same range as in previous years. A change in the duty on light oils resulted in a drop in this type of work.

381. The examinations of water and water-works chemicals were almost trebled largely due to the routine checks of fluoridation of the public water supplies. Regular monthly analyses from the water treat- ment plants continued and in addition samples from 209 wells were examined, of which 67 were found to be potable supplies. The presence of sulphate producing bacteria in sea water samples, taken in the vicinity of the runway at Kai Tak, may explain the corrosion of the cooling systems of diesel engines used in that area.

382. Food and drugs examinations greatly increased, mainly due to a three-fold increase in food specimens sent in by the Health Inspec- torate following on the promulgation of the new Public Health and Urban Services Ordinance. The main emphasis was on the detection of adulterated milk and a number of successful prosecutions resulted. Although water was the main adulterant, the addition of reconstituted milk to fresh milk is becoming more common, particularly during the months when fresh milk is in short supply. The adulteration of sesame oil is common and some samples analysed contained up to 95% of mineral oil; soybean and coconut oil are other adulterants used. The addition of preservatives to foodstuffs is on the increase and most haphazard variations were encountered. This suggests that certain manu- facturers are not aware of either the correct amount of preservative required by law or of the proper techniques and this aspect is receiving close attention. There was an increase in the number of proprietary medicines analysed, particularly those containing vitamins; in general these proprietary preparations were found to be of high standard.

383. The toxicology and forensic chemistry work increased by some 15% and laboratory staff gave expert evidence in Court on over 120 occasions. In this field, officers of the laboratory also gave a series of lectures to the Criminal Investigation Department inspectorate on the work of the laboratory and the assistance that can be given in the course of police investigations. Toxicology investigations included regular checks on vegetables coming into the markets for traces of dangerous insecticides. During the cholera outbreak the laboratory staff gave valu- able advice on the use of disinfectants for washing vegetables coming in from cholera infected areas.

384. Work carried out for Government departments included the assessment of standards in connexion with tendering and subsequent

deliveries, the examination of inflammable and other dangerous goods. seized by the Fire Services Department and an extensive survey of explosive gases in the subsoil of the Kwun Tong Reclamation. Recom- mendations were made as to how the danger of gases in well shafts and other excavations could be dealt with safely. Analytical work was also carried out for a number of commercial and industrial concerns in the Colony.

GOVERNMENT INSTITUTE OF PATHOLOGY

385. The Institute, situated in the upper floors of the Sai Ying Pun Polyclinic, undertakes the major part of the clinical pathology and all the public health laboratory work for Government in the Colony and for some of the grant-aided hospitals. There is a major branch of the Institute in the Kowloon Hospital and small clinical laboratories are maintained at the Lai Chi Kok and Castle Peak Hospitals. The University Department of Pathology now carries out the routine clinical pathology at the Queen Mary Hospital and a Virus Unit in that Depart- ment is staffed from the Institute but works under the general super- vision of the Professor of Pathology. There is a branch vaccine manu- facturing laboratory in Caine Lane. During 1961 the volume of work again increased by over 12% and the detail is set out in Appendix 15.

386. During the cholera outbreak in August and September, a very heavy additional load was thrown on the Institute. A twenty-four hour cholera diagnostic service was established both at Sai Ying Pun and at the Kowloon Hospital branch, all cases of gastro-enteritis or suspected cholera being fully investigated for vibrios. In addition, as a routine, water samples from wells, small boats and other unprotected public supplies were examined. Possible vehicles of infection such as fruit, vegetables, fish and shellfish were also investigated. The very large number of rectal swabs from cases of cholera, their contacts and contact carriers was in itself a very heavy commitment. In addition the vaccine laboratory went over to the production of cholera vaccine on a 24-hour basis and 1,762,180 mls. of vaccine were manufactured between the 12th August and the 13th of September. As all staff had to be mobilized for primarily cholera duties the result was that much of the routine. work had to be curtailed or suspended during a period of two months.

Virus Laboratory

387. The Virus Laboratory is equipped mainly for diagnostic and survey work in connexion with entero-viruses. Three faecal surveys were carried out during the year at different periods to demonstrate

the seasonal variations of polio-virus excretor rates in Chinese children under five years of age. These surveys showed that polio-virus and other entero-viruses are distributed widely in the normal child population. the excretor rate being highest in the summer and declining gradually towards the end of the year. Types 1 and 3 polio-virus are the prevalent types and there is only a rough correlation between the excretor rate and the notification rate with a mean rate of 1,200 to 1. From clinical cases and their contacts a total of 1,060 specimens were examined amongst which 181 were positive for type 1 and 22 for type 3; no type 2 viruses were isolated.

388. Amongst other entero-viruses, Coxsackie viruses A9 and B3 were isolated as were ECHO types 2, 5, 6 and 8.

389. From time to time throat washings from suspected cases of influenza are investigated to ascertain the prevalent strain. There were two positive isolates obtained during the year which were antigenically identical with the A2/57 (A/Asian/57) strain supplied by World Health Organization.

Vaccine Production

390. The Vaccine Laboratory prepared and issued the following quantities of vaccines during the year.

Vaccine

Smallpox Rabies 2%

Rabies 4%

T.A.B. Adult

177

111

...

---

T.A.B. Children

Cholera

---

Prepared

54,404 mls.

Issued 39,766 mls.

45,076

44,200

28,362

29,930

22.850

49,250

32,450

67,100

3,590,100

-- J

JJ L

1,762,180

391. Pathologists at the Institute also carried out the autopsies at the Queen Mary Hospital and Kowloon Hospital, including medico- legal cases dying in these hospitals. During the year 421 such autopsies were performed.

392. Technicians from the Institute undertake the routine post- mortem examinations for plague in rodents sent to the Public Mortuaries by the pest Control Unit of the Urban Services Department. Amongst 69,161 rodents examined there was none found to be infected with plague.

393. During April and May 1961, the Intermediate Examinations of the Institute of Medical Laboratory Technology were held for the first time in Hong Kong, External examiners appointed by the Institute came out from London and 24 of the 25 student technicians, who had

been trained locally at the Government Institute of Pathology, were successful in the examinations.

THE PHARMACEUTICAL SERVICE

394. The purchase of drugs, dressings and instruments and their dis- tribution to Government and, to a lesser degree, to certain Government- assisted institutions, is the responsibility of the Pharmaceutical Service under the direction of the Chief Pharmacist.

395. The Central Medical Store is the headquarters of the Service and is located at North Point on Hong Kong Island. There is a branch store in Kowloon which acts as the distribution centre for Kowloon and the mainland part of the New Territories. During the year the Kowloon branch store moved into new premises which has provided considerably enhanced and more suitable accommodation. Manufacture in bulk of certain pharmaceuticals is undertaken at both these centres and fluids for parenteral administration are prepared at the North Point Head- quarters and at the Queen Mary Hospital.

396. 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 the control of antibiotics. He has a staff of qualified pharmacists of whom two are occupied full-time on inspection duties. The inspection of premises, both manufacturing and retail, and of their records, is carried out regularly.

TABLE 36

WORK OF THE PHARMACEUTICAL SERVICE 1960-61

Parenteral fluids prepared

1 гг

Other sterile preparations

Wholesale Poisons Licences issued Authorized Sellers Licences issued Listed Sellers Licences issued

Antibiotic Permits issued

Licences for movement of Dangerous Drugs Premises inspected

Prosecutions initiated

1960

116,000

1961 142,992 litres

120,475

142,612 items

414

417

536

621

223

260

294

395

1,625

2,778

LLI

THE ALMONER SERVICE

397. The increasing amount of medical-social work necessary to the efficient functioning of the curative services is the responsibility of the Principal Almoner and a staff of 3 Senior Almoners and 53 Almoners.

All the Almoners hold recognized professional basic qualifications in medical social work, while a number have additional post graduate qualifications obtained after study leave overseas. Almoners are attached to the larger hospitals, to certain of the main urban clinics and to the Tuberculosis, Ophthalmic and Social Hygiene Services. Additional re- sponsibilities are participation in the teaching of medical students, nurses, social studies students and in the in-service training of groups of social workers who are recent entrants to the Government Service. The Samaritan Fund, the Tuberculosis Assistance Fund and the Special Treatment vote are administered by the Principal Almoner and her staff while the distribution of free foods donated by welfare agencies is also undertaken by the Almoners,

398. In Kowloon, where the Almoners are in closer contact than most with patients from the very under-privileged groups, a general improvement in living conditions has been noticed during 1961. The Almoners have come across fewer people living in wooden huts with very poor sanitation and there has been less unemployment except amongst the aged and a small proportion of the physically unfit. Wages generally speaking are higher and there has been less dire poverty amongst the sick. On the other hand the social implications of many more emergency cases including traffic, industrial and household accid- ents, assaults and attempted suicides have demanded increasing attention. This change has had a definite effect on the lines of development of community services during the year, some of which have been initiated by the Almoners; in other instances help has been given with general planning and development. To all such community projects either in being or planned continuing help and co-operation has been given by the Almoners.

399. Hostel accommodation for cancer patients and accommodation for those needing residential care in the terminal stages of the disease. are urgent problems. The part played by the Oxfam Hostel has already been mentioned while the inclusion of a cancer wing in the proposed So Uk Hospital on which work has started in Kowloon, is another step towards meeting these needs.

400. The Caritas residential training centres for paraplegics at Aberdeen and Honeyville for male and female patients respectively are helping to meet another long felt need. In October 1961 a Cheshire Home was opened, in temporary premises on Hong Kong Island, which can accommodate 16 patients. These patients, who would otherwise occupy a hospital bed for very long periods, have shown a remarkable

re-appearance of interest in walking and in generally coming back to life' in the environmental conditions afforded by the Home.

401. The Special Schools Section of the Education Department now established has enabled the Almoners to arrange schooling for a number of handicapped children, the placing being made on the basis of a com- bined report from a doctor, an almoner and, where applicable, a physio- therapist. Assistance has also been given in the selection of pupils for the British Red Cross Society School for the Physically Handicapped at Kwun Tong which is to be opened in July 1962.

402. The Salvation Army Children's Convalescent Home in Cheung Chau was opened in October 1961. The Almoners and Paediatricians at the Queen Mary Hospital work very closely with the Salvation Army in the selection of child patients who require additional care in cheerful surroundings to ensure maximum benefit from hospital care.

403. The Lutheran World Service Rehabilitation Project has also already been mentioned in connexion with tuberculosis. Other rehabilita- tion activities maintained by the Lutheran World Service which are of great importance to the Almoners are schemes of assistance to the ex- patients club for those discharged from the Drug Addiction Treatment Centre, a plan to assist discharged mental hospital patients and their families and a project to provide wheel chairs for seriously disabled patients. Since this latter scheme was launched in November 1961, ten wheel chairs have been supplied.

404. The medical social work at the larger hospitals and clinics followed the pattern of previous years, covering a very wide and com- plex range of services. With the continuing heavy pressure on acute beds in the general hospitals the problems of convalescence under un- favourable home circumstances, and early rehabilitation and re-employ- ment are all of considerable urgency. To these are added the necessity for accommodation of cases of chronic illness and of the permanently crippled who require a radical adjustment in the way of living. All of these present a never ceasing challenge in the face of inadequate facili- ties. The many improvisation made and the degree of success achieved are a tribute to those who carry these responsibilities.

　　　405. Expenditure from the Samaritan Fund during the year rose by almost one third to a total of $21,059 details of which together with the Principal Almoners report are at Appendix 16. This increase is due largely to the opening of the Castle Peak Hospital, some 22 miles from the centre of Kowloon which entails considerably more assistance to-

wards the travelling costs of relatives visiting patients in hospital. Alto- gether 5,769 grants were made from the fund to enable patients and their relatives to attend hospitals and clinics throughout Hong Kong.

406. Expenditure from the Leprosy Fund rose to $5,511.60 and was largely disbursed in the form of assistance towards the rents paid by families of leprosy patients who are the Hei Ling Chau Leprosarium for long periods of treatment. The poorest families may receive grants of up to 60% of the monthly rent in Resettlement Estates.

407. The Special Treatment vote is used for the provision of sur- gical appliances to those who are unable to pay for them and who cannot receive aid from other agencies. Disbursements are made by the Principal Almoner on the basis of a full social report. The almoners also assist the staff of the Surgical Appliance Centre, the physiotherapists and the occupational therapists, in the problem of ensuring that appli- ances, once fitted, are fully used and maintained.

408. Generous donations of free foods, made by the C.A.R.E., the Catholic Relief Services, the Church World Service, the Lutheran World Service and U.N.I.C.E.F., were available for distribution by the Almoners and are gratefully acknowledged.

409. The medical social work of the Almoner Service was greatly assisted by the co-operation afforded by the Family Welfare Society, the Church World Service, Caritas, the Family Planning Association, the Hong Kong Branch of the British Red Cross Society, the Lutheran World Service, and the Po Leung Kuk. The Social Welfare Department and the Resettlement Department continued to give valuable co-opera- tion in their respective spheres.

PHYSIOTHERAPY

410. The Headquarters of this service is at the Physiotherapy Train- ing School which is housed in part of the old Pathology Institute in Caine Lane on Hong Kong Island. Physiotherapy units are maintained in the Queen Mary, Kowloon and Lai Chi Kok Hospitals and in the Wan Chai Polyclinic. A small unit operated in Castle Peak Hospital for a period of 4 months, but the increasing demand for physiotherapy in Kowloon Hospital, which has the busiest physiotherapy unit in the Colony, has made it necessary to transfer the staff from Castle Peak.

411. Clinics for post-poliomyelitis cases are held at the Wan Chai Polyclinic and in the Kowloon Hospital where treatment and the fitting of appliances is carried out on the advice of the orthopaedic surgeons.

Hydrotherapy tanks are available at both centres. Children are taught medical exercises in classes, this being the best method whereby large numbers of patients can receive prolonged spells of exercise which do not require the use of a treatment couch. The size of the children's classes increased steadily, and mothers were also taught how exercises can be continued in the home. Health Visitors of the Maternal and Child Health Service pay home visits in cases of irregular attendances in order to stress the importance of continued physiotherapy. A special class was opened in the Wan Chai Polyclinic to serve the increasing number of lower limb amputees.

412. At Queen Mary Hospital the number of pre- and post-operative chest surgery cases referred for physiotherapy during the year has been considerably reduced with the transfer of the Tuberculosis Thoracic Unit to the Grantham Hospital; on the other hand, physiotherapy work in connexion with neuro-surgery expanded very considerably.

413. There is a steady demand for physiotherapy amongst the con- valescent cases in Lai Chi Kok Hospital. With the co-operation of the Occupational Therapists, out-door activities such as table-tennis, ball games, darts and archery are provided for the wheel-chair patients.

ORTHOPAEDIC AND PROSTHETIC APPLIANCES

414. This Surgical Appliance Centre is temporarily accommodated at the Harcourt Health Centre. The technical staff was increased during the year and now includes a technician-in-charge, 4 student assistant technicians under training and 6 artisans.

415. The role of the centre is to provide a variety of prostheses, the majority for lower limb amputees, and to develop production procedures which are suitable to the climatic and social conditions existing in Hong Kong. A number of suitable procedures have been evolved and the standardization of some appliance parts has permitted the use of mass produced components with a consequent reduction in production time. With the increase in staff and the developing experience of the techni- cians the output of the unit has increased considerably. 231 appliances or prostheses were produced as compared with 24 in the previous year. Actual revenue for the year was $28,049 compared to $2,005 in 1960.

416. Development work on above-knee sockets and alignment jigs is now almost complete and long term results are being assessed. An adjustable socket and stand has been developed and successfully used, enabling the technicians to take a preshaped and aligned cast for above-

knee sockets; a composite socket for the above knee prosthesis is now being produced. This is made of nylon, epoxide resin and cork and the whole socket is formed under vacuum. More than twenty of these prosthesis have been supplied. Only two of them were considered un- satisfactory after a period of use and this appeared, in both cases, to be due to stump shrinkage after fitting. An interesting circumstance arose during the course of these experiments. Various authorities else- where stipulate that given and ideal socket shapes should be used. Hong Kong experience has been that no specific shape is suitable for all cases, the shape being dependent upon the individual. This is note- worthy and an endeavour is being made to establish this independent theory.

417. Below-knee prosthetic work has progressed and suitable pro- cedures have been evolved and improvements will be made as time permits. The development of a foot for above and below knee prosthesis has also been carried out. This foot dispenses with a mechanical ankle joint and it has been found to be economical and suitable for local use and is now made in the department.

418. The techniques of fabrication for lower extremity prosthesis have been applied to the upper extremity and well fitting and durable sockets are now made. A device has been constructed, which enables the technicians to align the wrist or elbow unit in predetermined posi- tions, thus providing the amputee with a more efficient range of motion.

419. Standardization of some appliance parts has permitted the use of mass produced components with a consequent shortening of produc- tion time. This is being developed and eventually will extend to most items. An improvement to the ring top calipers has also been made. This is the replacement of the oval ring with a polythene weight-bearing seat designed on the principle of the above-knee prosthesis. This has proved to be most efficient and economical.

420. Work on appliances for patients suffering from leprosy has pro- gressed and a technique for taking casts which provide for a diffusion of weight-bearing has been evolved. Of the seventeen patients dealt with only one suffered re-ulceration and it is suspected that this was due to trauma while not wearing his prosthesis.

421. Appliances for mutilated hands have also been evolved. Much of this work has been done with the co-operation of the Medical Officer in charge of Hei Ling Chau. When results are fully satisfactory it is

hoped to extend these facilities to the outpatients at Government Leprosy Clinics.

422. The facilities of the Centre now serve the Queen Mary Hospital, the Wanchai Physiotherapy Department fully and part of the work at Lai Chi Kok Hospital, Kowloon Hospital and the Sandy Bay Con- valescent Home. Much of the appliance work at the Kowloon and Lai Chi Kok Hospitals is done by an outside contractor as is the case for the Sandy Bay and Grantham Hospitals. It was hoped to assess all appliances made by outside contractors prior to their referral to the surgeon, but this proved impractical for various reasons. However, the contractors were invited to the department and shown improved methods of work which have subsequently been applied. Although facilities for all Government Hospitals are not yet available, due in the main to the quantity of work and lack of facilities, it is hoped that with the addition of staff, their increasing experience and the opening of the new centre at Kowloon Hospital in 1962, this will be overcome to some extent in the ensuing year.

OCCUPATIONAL THERAPY

423. The Superintendent Occupational Therapist, assisted by a staff of Occupational Therapists and Handicraft Instructors, is responsible for providing an extensive programme of specific occupational, re- educative, diversional and recreational therapy throughout the Depart- ment. These activities are concentrated in the institutions where there are long-stay patients, namely, the Queen Mary, Castle Peak and Lai Chi Kok Hospitals, while the Psychiatric Centre in Hong Kong provides a programme of specific occupational therapy for early psychotic and neurotic cases. A sum of $90,700 was available for the purchase of materials and miscellaneous stores and for the provision of incentive payments. Articles produced were sold by the Welfare Handicraft Shop in Kowloon and at the Annual Sale of Work and Exhibition of Occupa- tional Therapy. In addition, a number of items such as brooms and waste-paper baskets are made in quantity for the Government Stores Department. Incentive payments are made to patients in the Castle Peak Hospital and the Hong Kong Psychiatric Centre, who produce articles made for sale. This money is used to pay for entertainments such as film shows, Chinese operas, concerts and dinners. A wide range of articles is produced including paintings, rattan and wooden furniture, baskets of many types, toys, needle work, tapestry and woven articles.

Drug Addiction Centre

424. An extensive programme of both occupational and recreational therapy is provided for the patients in the Drug Addiction Centre of the Castle Peak Hospital. The patients are divided for convenience into 4 working groups; namely, tailors, wood-workers, gardeners, and ward and kitchen workers. An arrangement was made with a local industry whereby wood provided by the firm is converted into bottle-crates by patients on a repayment basis, the money being credited to Government. The incentive payment scheme for the Drug Addiction Centre has been under review and a differential scale of payment was started in February 1962. For this purpose the work of all patients in the centre is assessed twice daily and graded according to their output in relation to their mental and physical condition and general behaviour.

425. With the transfer of the tuberculosis thoracic unit from Queen Mary Hospital to the Grantham Hospital there has been a decline in the number of ward patients on occupational therapy. There has, how- ever, been a more than equivalent increase in the number of neuro- surgical and orthopaedic cases attending the occupational therapy department daily for specialized treatment.

426. At the Lai Chi Kok Hospital close co-operation is maintained with the Physiotherapists in the training of patients in the activities of daily living and in the programme of recreational therapy, particularly for the wheel-chair patients. One of the occupational therapists who is specially trained and has had considerable experience in the treatment of upper limb amputees has been working part-time with the Ortho- paedic Appliance Technician and assisting in the training of patients in the use of their newly fitted prostheses.

MEDICAL EXAMINATION BOARD

427. This Board performs the medical examination of all new en- trants to the Government and the Auxiliary Defence Services. Members of the Civil Service prior to transfer outside Hong Kong are also medi- cally examined by the Board. In addition, work is carried out on repay- ment for countries which require prospective emigrants to submit a certificate of physical fitness. Each examination involves a comprehen- sive physical examination, certain routine laboratory investigations, an X-ray of the chest and any other special investigations which may be considered necessary. Specialist advice is available from the Government clinical units. The work of the year is summarized at Table 37.

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TABLE 37

WORK OF THE MEDICAL EXAMINATION BOARD 1960-61

Government

Appointments

1960 1961

Auxiliary Defence Units 1960 1961

Miscellaneous

Total

1960 1961

New examinations .. Re-examinations

6,284 5,776

2,187 2,116

115

8,570 8,007

5,433

3,571

3,902 3,547

9,411 7,150

Annual total

11.717 9,347 6,089 5,663

175

147

17,981 15,157

　　　428. Of the persons referred for a specialist opinion the great majority are suffering from abnormalities of the respiratory system. Pulmonary tuberculosis accounted for the rejection of 88.7% of all persons rejected as unfit for service as against 88.5% in 1960. The analysis of the causes of rejection is given in Table 38.

TABLE 38

UNFITNESS DY CAUSES 1960-61

(per 1,000 total examination)

1960

1961

Pulmonary Tuberculosis

41.27

50.60

Diseases of the Respiratory System (excluding

tuberculosis)

1.84

2.84

Diseases of the Circulatory System

1.06

1.32

Diseases of the Alimentary System Discases of the Skeletal System Diseases of the Genito-urinary System Diseases of the Nervous System Diseases of the Endocrine System

Diseases of the Eye System Diseases of the Skin System Miscellaneous Diseases

0.31

.33

0.06

.13

J-J

0.33

.53

...

0.44

.59

---

0.39

.20

0.22

.53

0.06

ггг

0.83

.13

Total

LIL

46.61

57.47

　　　　429. The Board also undertakes the immunization of candidates appointed to posts which carry special risks. Immunization procedures consist of tuberculin testing and Schick testing followed by B.C.G. or diphtheria toxoid vaccination as required and T.A.B. inoculations.

BLOOD BANKS

430. The Blood Donations Centre, maintained by the Hong Kong Branch of the British Red Cross Society on the Hong Kong waterfront continued to collect and distribute blood to the Blood Banks at the

101

Queen Mary and Kowloon Hospitals; the laboratory work in connexion with blood donations was undertaken by the Government Institute of Pathology.

431. The year was a record one for the British Red Cross Society's Blood Bank where donations of blood received exceeded by some 700 pints the total for 1960. Although the greater part of the blood again came from members of the Armed Services or from visiting Royal Navy and United States warships, there was a marked increase in blood donations from the Chinese residents and the Donors Club under the guidance of the Chairman of the Hong Kong Branch of the British Red Cross Society continued to expand its activities. In addition a con- siderable amount of blood is donated direct to the Blood Banks by relatives of patients in the various hospitals. The sources and distribu- tion of blood received by the Blood Banks are detailed in Tables 39 and 40.

TABLE 39

SOURCES OF BLOOD DONATED 1961

British Red Cross Society

8,345 pints

Patients' Relatives and Friends

570 pints

Other sources

138 pints

LLL

TABLE 40

DISTRIBUTION OF BLOOD 1961

Government Hospitals

Government-Assisted Hospitals

---

6,448 pints 1,934 pints

PIP

ILI

267 pints

Private Hospitals

Military Hospitals

...

Manufacture of Plasma

ייי

Unusable due to various causes

4 pints 168 pints

393 pints

432. Despite this encouraging increase, there is still a serious shortage of blood if all demands are to be met. The supply was barely adequate to meet the emergency needs of the acute hospitals and much elective surgery had to be postponed for varying periods for lack of blood. Unless the situation improves greatly in 1963 when many more. acute beds will come into use there will be a very grave shortage of this essential to modern therapy. Much propaganda is being directed by the British Red Cross Society towards a significant increase in the number of Chinese donors as the Armed Services and visitor sources cannot be regarded as other than an evanescent source of supply. The people of Hong Kong owe a great debt of gratitude to those donors

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who are only temporarily resident in the Colony and who give blood which goes to the Chinese residents of the Colony.

HOSPITAL MAINTENANCE AND SUPPLY

　　　433. This activity of the Department is the responsibility of the Chief Hospital Secretary, assisted by a staff of Senior Hospital Secre- taries, Hospital Secretaries and Assistant Hospital Secretaries. There are two group Hospital Secretaries, one at the Queen Mary Hospital and the other at Kowloon Hospital, who are responsible for the routine supply and lay administration of the medical institutions on their respective sides of the harbour. In addition, one Senior Hospital Secretary is working in the Planning Unit at Headquarters and another is stationed at the Castle Peak Hospital. Assistant Hospital Secretaries are posted to major institutions within the two main groups.

　　　　434. The function of this branch is the maintenance of the routine administrative work in the hospitals and clinics. This includes the supply of fuel, rations and medical and surgical equipment, the main- tenance of equipment and furniture, the recruitment and discipline of all male meniai staff, the maintenance of transport and the initiation of repair work to the fabric of buildings. The Chief Hospital Secretary is also the Departmental Welfare Officer and the U.N.I.C.E.F. Liaison Officer.

　　　435. The Hospital Services Section was formed during the year. It is responsible for the day to day running and maintenance of the steam and engineering services in the major institutions and is under the con- trol of the Electrical and Mechanical Engineering Branch of the Public Works Department.

Staff Welfare

436. The Medical and Health Department Staff Welfare Association and its branches in Kowloon and Castle Peak, provide staff recreation centres in the Queen Mary, Kowloon and Castle Peak Hospitals and the Association continues to support a number of welfare schemes to aid the families of members or of pensioners.

　　　437. In the Jockey Club Clinic, Sai Ying Pun, the staff canteen and light refreshment kiosk for outpatients continued to be administered by the Association.

438. Staff relations continued to be good and there were very few cases requiring disciplinary action in relation to the size of the staff concerned.

103

439. Altogether, 112,501 lbs. of U.N.I.C.E.F. milk were distributed to welfare organizations throughout the Colony and the total number of supplementary meals given at feeding centres was 1,200,019, an increase of 103,420 over the previous year. An examination of the milk distribution system was carried out during the year by an auditor from the United States who reported favourably on the working of the system.

AUXILIARY MEDICAL SERVICE

440. Recruitment to the Auxiliary Medical Service was started in October 1950 under the provisions of the Essential Services Corps Ordinance 1950. The aim of the service is to train and maintain a corps of men and women who are available to greatly augment the hospital and ambulance services during an emergency.

441. Up to June 1961 those joining the Auxiliary Medical Service were both volunteers and conscripted members. On the abolition of conscription in that month, only 780 out of 2,075 conscripted members requested to be released from further service. However, as a result of subsequent successful recruiting campaigns the loss of members through the release of those conscripted has been more than balanced by the volunteers recruited and the strength of the Service at 31st March, 1962, stood at over 4,600 men and women.

442. The Medical Defence Staff Officer is responsible for all routine administration and training activities and the Director of Medical and Health Services is the Unit Controller. During an emergency the ambulance and first-aid sections of the service come under the opera- tional control of the Civil Aid Services.

443. Three sub-units were active in the New Territories at Tai Po, Tsuen Wan, and Cheung Chau and a fourth sub-unit was formed during the year at Sha Tin. Demonstrations were given, during the Kai Fong Welfare Association's 'Traffic Safety Week", in first-aid and in improvi- sation when medical equipment is not immediately available. Joint demonstrations were also given by the Civil Aid Services and the Auxiliary Medical Service to medical officers and Kai Fong officials in the rescue, first-aid and evacuation of casualties.

444. Co-operation with the Civil Aid Service continued to be of a high standard and during the year five combined Civil Defence Exercises were staged in Hong Kong, Kowloon and Tai Po. The use of wound-faking and acting techniques have contributed considerably to a marked degree of realism during these exercises.

104

　　　445. A further 644 members of the Auxiliary Medical Service bad their blood groups determined during the year, making a total of over 4,400 members who have been blood grouped since 1960,

　　　446. During the cholera outbreak in 1961 members of the Auxiliary Medical Service were employed on duties in the quarantine station and inoculation centres.

V. PLANNING PROGRAMME

PLANNING UNIT

447. This unit, which was established towards the end of 1959, is situated in Medical Headquarters and is staffed by a Principal Medical and Health Officer and a Senior Hospital Secretary. Its functions are:

(a) to prepare outline plans for the provision of medical and health facilities in Hong Kong in consultation with other branches of the medical services concerned;

(b) to undertake in close liaison with the Public Works Department the detailed planning of units approved by the Finance Commit- tee of the Legislative Council;

(c) to give advice and assistance to voluntary organizations and other philanthropic bodies which are co-operating with the Government in the provision of medical facilities.

　　　448. Following upon the census taken in March 1961, the Unit prepared a programme detailing the additional hospital and clinic services which would be required during the period 1966-1972 if the provision expected to be available to the public by the middle of 1963 is to be maintained at that level in the future. These proposals are now under consideration by Government.

　　　449. The Unit has also concerned itself with the implementation of the detailed plan covering the period 1960-1965 which was approved in principle by the Executive Council in June 1960. Draft schedules of accommodation, staff, and equipment for approved projects have been prepared and examined in consultation with the Colonial Secretariat, after which they were submitted at the appropriate time to the Public Works and Staff Increases Sub-Committees and to the Select Committee on Estimates.

　　　450. Once approval of a new project has been given, sketch plans are checked and, providing that no amendments are considered necess- ary, authority for working drawings to commence is sought, after which

105

the project is allocated its priority. The Planning Unit also arranges for the initial equipment of projects prior to their being handed over on an operational basis to the relevant branch of the Service.

451. The Unit has devoted much of its time to the details of the equipment of the Queen Elizabeth Hospital which is expected to be completed in March 1963, and to be commissioned and opened in July 1963. This project has now reached an advanced stage of planning and much of the equipment has already been ordered.

452. During the financial year 1961-62 eight projects which had been completed were handed over. On the 31st March, 1962, seven projects were under construction and a further eight had reached a stage where working drawings were being prepared; sketch plans of a further seven projects had been completed by the architects of the Public Works Department or by private architects appointed for the work. There are a further 15 projects listed in the Estimates for the financial year, 1962-63, on which detailed planning will start according to the priority allotted. Details of the progress of approved works are as follows:

BUILDING PROGRAMME

April 1, 1961 to March 31, 1962

(a) Eight buildings or extensions to existing institutions were completed

during the year.

April 10, 1961

June 1, 1961

June 12, 1961

June 14, 1961

Queen Mary Hospital Radiophysics Laboratory contain- ing the equipment necessary for the proper control of radiotherapy and isotope therapy.

Medical Department Store, Kowloon A A temporary building which will enable the requisitioned godown to be returned to its owners pending the completion of a permanent store,

Wong Tai Sin Resettlement Clinic containing two con-

sulting rooms, a dispensary, and treatment rooms. Farm Road Dental Clinic Extension containing an

additional dental surgery.

June 23, 1961 Jockey Club Clinic, Shek Wu Hui containing 25 mat- ernity beds, 4 casualty beds, a general clinic and a health office.

Aug. 20, 1961

Feb. 19, 1962

Feb. 26, 1962

Tai Hang Malaria Store.

Violet Peel Clinic Extension containing a waiting room

and an enlarged dispensary.

Conversion of Kowloon Hospital Nurses' Quarters to

wards accommodating 40 beds.

(b) Seven buildings were under construction on March 31, 1962.

1. Air Port Health Station.

2. Anne Black Clinic, North Point.

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3. Jockey Club Clinic, Shau Kei Wan.

4. Medical Department Store, Hong Kong. 5. Queen Elizabeth Hospital.

6. Queen Elizabeth Hospital Specialist Clinic.

7. Jockey Club Surgical Appliance Centre.

prepared on March 31, 1962.

1. Jockey Club Clinic, Wang Tau Hom.

2. Kam Tin Clinic.

3. Kwun Tong Clinic.

4. Li Po Chun Clinic, Tai Kok Tsui.

5. Queen Mary Hospital, Operating Theatre Block.

6. Queen Mary Hospital, Professional Suites.

7. Robert Black Clinic, San Po Kong.

8. Yuen Long Clinic.

(d) Sketch plans for seven buildings or extension were prepared during

the year.

1. Combined Vaccine Institute.

2. Jockey Club Clinic, Yau Ma Tei,

3. Kowloon City Maternal & Child Health Centre.

4. Mui Wo Clinic Extension.

5. Queen Mary Hospital, Quarters for Nursing Staff.

6. Sha Tin Clinic.

7. Tsuen Wan Clinic.

(e) The preparation of sketch plans has not yet commenced on the 15

other buildings which are listed in the 1962-63 estimates.

1. Ap Lei Chau Clinic.

2. Castle Peak Clinic.

3. Chai Wan Clinic.

4. Cheung Chau Hospita! Extension.

5. Cheung Sha Wan Clinic.

6. Dental Clinic, Kowloon.

7. Government Stores, Kowloon (includes Medical and Health

Department Stores).

8. Lai Chi Kok Hospital.

9. Mental Defectives Home.

10. Mental Health Centre, Hong Kong.

11. Morrison Hill Clinic,

12. Sai Ying Pun Hospital (Redevelopment of site)

13. Shau Kei Wan Hospital.

14. Tsz Wan Shan Clinic.

15. Wong Tai Sin Clinic.

107

VI. HOSPITAL COSTING

453. During the 1962-63 Budget Debate a request was made that the Annual Report should contain costing figures of the various hospitals and clinics as is being done by the Ministry of Health in Britain. There is as yet no cost accounting organization available to do this, but the administrative staff of the Medical Division have maintained records of expenditure on certain representative hospitals and clinics over the past two financial years. These costings, however, do not include annually recurrent charges on capital outlay, i.e. land, interest, depreciation etc. Moreover they also omit expenditure on passages, pensions, maintenance of buildings and grounds, water, stationery and telephones, which is met from non-departmental votes. They must therefore be regarded as being of comparative, rather than absolute, validity.

454. Subject to these reservations, the costings of representative hospital units during 1961-62 were as follows:

Cost per

Unit

Total Cost

bed per

patient

day

year

treated

beds) ..

יי

Queen Mary Hospital (Acute general

beds: Teaching Hospital) Kowloon Hospital (Acute general

Lai Chi Kok Hospital (Infectious

and Convalescent)

· L

$13,039,173

$52

$19,119

S 713

$ 9,972,110

$46

$16,931

$ 404

יי

$ 2,389,515

$14

$ 4,968

$ 351

Tsan Yuk Hospital (Maternity &

Teaching)

$ 2,124,747

$29

$10,624

$ 240

Castle Peak Hospital (Mental)

$ 5,360,478

$13

$ 4,790

$2,519

(All figures are rounded off to the nearest dollar).

Included in the above are the cost of treating outpatients at these institutions as it is impossible at present to cost these separately. The numbers of such outpatients are shown in appendices 12 and 13.

455. The marked difference between the average cost of treating each patient at the Queen Mary and the Kowloon Hospitals is due to the shorter average stay of patients in the latter hospital as this hospital has far more convalescent beds allocated in the Lai Chi Kok Hospital, The cost per patient treated at Castle Peak Hospital reflects the long average stay of psychiatric patients.

456. Records are also maintained of the expenditure on certain typical clinics. These show that operating the Sha Tau Kok Clinic (a small rural clinic) cost $46,119 during the year and that 20,473 out-

108

　　patients and 457 maternity admissions were treated at this institution. Similarly, operating the Hong Kong Jockey Club Clinic, Aberdeen (a large rural clinic) cost $253,786.00 and 49,100 outpatients and 1,579 maternity admissions were treated. The Kowloon Chest Clinic for tuberculosis cost $1,125,337 and there were 712,353 attendances for treatment, which gives an unit cost of $1.60 for each attendance.

VIL TRAINING PROGRAMME

DOCTORS

　　　457. The University of Hong Kong confers the degree of M.B.,B.S. which has been registrable with the General Medical Council since 1911. At present the Faculty of Medicine admits between 70 and 80 students each year, of whom, between 35 and 50 eventually graduate. After provisional registration with the Medical Council of Hong Kong the graduates are required to undergo a 12 months' period of compulsory internship in posts approved by the University. There are plans to gradually increase the intake of medical students to about 120 each year between now and 1966 with the aim of graduating some 80 doctors each year.

　　　458. The post-graduate training of doctors in the Government Service for higher diplomas necessary for appointment to Specialist clinical posts in general medicine, surgery, orthopaedics, paediatrics and obstetrics and gynaecology, is under the supervision of a Panel on Post-Graduate Medical Education which consists of the University Clinical Professors, the Government Clinical Specialists and members of the Medical Headquarters staff. The Panel meets twice yearly to review the progress of the doctors under training and to make recom- mendations regarding the award of study leave overseas leading to higher qualifications.

459. A number of clinical posts in the major hospitals are recognized for post-graduate training by the majority of the examining bodies in Britain. The Examining Board in England of the Royal College of Surgeons has held examinations annually in Hong Kong for Part I of the Diploma in Medical Radiology both in Diagnosis and Therapy during the past three years.

460. The programme of training of doctors for the post-graduate qualifications necessary to staff the clinical units in the new Queen Elizabeth Hospital is now well advanced and the supply of well qualified

109

and experienced clinicians is assured in practically all the specialist fields.

DENTISTS AND DENTAL NURSES

461. No undergraduate training in Dentistry has yet been established in Hong Kong, but Government awards seven scholarships annually, at present tenable in Australia. At the end of March 1962, there were 36 Government Dental scholars studying at Australian Universities. 5 graduates in Dentistry returned from Australia during the year, these doctors being the first to qualify in Australia under the existing Scholar- ship Scheme.

462. Dental nurses trained to carry out preventive and minor opera- tive work in the Government Service under the supervision of Dental officers are being trained in New Zealand and Penang. A further two student dental nurses were sent to Penang under World Health Organiza- tion scholarships during 1961.

NURSES

463. The event of the year was a visit paid by Her Royal Highness The Princess Alexandra of Kent to the Queen Elizabeth Hospital School of Nursing on the 8th November, 1961.

464, The School, which was opened in September 1960, has doubled the facilities for the training of nurses and there are now 431 student nurses undergoing general nurse training. The opening of the Queen Elizabeth Hospital in mid 1963 and other developments will absorb the whole output of this school and the complementary Nurses Pre- liminary Training School at the Queen Mary Hospital.

465. The School of Psychiatric Nursing at the Castle Peak Hospital, now in its second year, has 43 students in training of whom 9 are women. The increased numbers now coming forward for this training is encouraging and it is believed that the prejudice against nursing in a Mental Hospital is gradually being overcome. A welcome addition to the psychiatric nursing strength was the return of 11 qualified psychiatric nurses who have trained in British Mental Hospitals under a Govern- ment Scholarship Scheme.

466. Nurses Training Schools approved by the Hong Kong Nursing Board are also maintained by the Tung Wah Group of Hospitals. Nethersole Hospital and the Hong Kong Sanatorium and Hospital. At the end of March 1962 there were under training as general nurses:

110

Government Schools of Nursing

Tung Wah Hospitals

---

Nethersole Hospital

Hong Kong Sanatorium and Hospital

Total

Women Men

Tota!

372

431

360

122

123

950

1.010

J-J

MIDWIVES

　　　467. Registered general nurses who have trained in the Government Schools of Nursing are expected to proceed to a one-year course in midwifery, conducted in English as the teaching medium, in the mater- nity wards of the Queen Mary and Kowloon Hospitals. Nurses who have trained in the other approved training schools can also take a similar course, conducted in Chinese, in the maternity wards of their respective hospitals.

　　　468. For student midwives who are not registered nurses there is a two-year training course conducted in Chinese by Government staff at the Tsan Yuk Hospital.

HEALTH VISITORS

　　　469. As in previous years, a course of training was held at the Harcourt Health Centre for ten student Health Visitors. Each entrant to this course has previously obtained qualifications both in general nursing and in midwifery. After one year's tuition and study, the students take the examination for the Health Visitor's Certificate which is conducted by the Hong Kong Examination Board of the Royal Society for the Promotion of Health.

RADIOGRAPHERS

　　　470. The training of radiographers at the Queen Mary Hospital in radiodiagnosis is recognized by the Society of Radiographers in the United Kingdom. Examinations for both Parts I and II of the Member- ship of the Society of Radiographers (Diagnostic) are held annually in the Colony.

LABORATORY TECHNICIANS

471. 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. This examination was held in the Colony for the first time in May 1961 when out of the

111

twenty-five candidates who entered for the examination only one failed to qualify. Two examiners came out from London for the examinations and the accordance of this facility by the Institute of Medical Laboratory Technology is gratefully acknowledged.

472. The Institute maintains 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 necessary for advancement in the Service. The content of the course enables those suitably qualified to enter later for the examinations leading to the Associateship of the Institute of Medical Laboratory Technology.

PHYSIOTHERAPY

473. A Physiotherapy Training School which was established in September 1960, provides a full-time course of training in Physiotherapy. The course follows completely the syllabus laid down by the Chartered Society of Physiotherapy in the United Kingdom, and is conducted by qualified Physiotherapy tutors. Recognition of this course of training by the Chartered Society is now being sought. Meantime, the School is accommodated in converted premises in the old Pathology Institute on Hong Kong Island and it will remain there until the completion of the Queen Elizabeth Hospital in Kowloon where there will be a properly designed and fully equipped School of Physiotherapy.

OTHER FORMS OF DEPARTMENTAL TRAINING

474. In-service courses of training are held for Dispensers, Tuber- culosis Workers, Social Hygiene Visitors, Dental Technicians and Orthopaedic Appliance Technicians. These do not lead to recognized qualifications but prepare those concerned for appointment to permanent posts on the Establishment after they have passed departmental examina- tions.

475. A preliminary training period of three months including lec- tures, discussions, visits of observation and practical work followed by individual weekly tutorials throughout the ensuing 9 months is arranged for Almoners who enter the Department with the basic qualification of a University Degree in Social Studies.

476. Table 41 sets out the various categories of training undertaken departmentally during the year:

112

Probationer Assistant

Physiotherapist

Probationer Assistant

Radiographer

Student Dispenser

TABLE 41

DEPARTMENTAL TRAINING [96]

Appointment

Strength at 31.3.62

Resignation

Pussed

7 1st year

6 2nd year

109

372

34 12 9 9 4 50

Student Laboratory Assistant

Student Medical Laboratory

Technician

Student Nurse

Student Male Nurse

*Student Nurse (Psychiatry)

†Student Male Nurse

(Psychiatry)

Student Midwife

Student Midwife (Registered

Student Health Visitor

Nurse)

Anti-Tuberculosis Worker

Almoner Class II

"In addition, there are 3 Student Nurses (Psychiatry) training in United Kingdom. ↑ In addition, there is 1 Student Male Nurse (Psychiatry) training in United Kingdom.

COURSES OF STUDY OVERSEAS

477. The following table sets out the courses of study outside Hong Kong attended by officers of the Medical and Health Department during 1961-62:

Appointment

Course of Study

Place of Source of

Study

Funds

| Principal Medical &

Health Officer

Medical Services Administration

U.K.

Government

3 Medical & Health

Officers

Diploma in Medical

U.K.

Government

Radiodiagnosis

3 Medical & Health

Officers

Diploma in Medical

U.K.

Government

Radiotherapy

3 Medical & Health

Officers

1 Medical & Health

Officer

Membership, Royal College

of Physicians

U.K.

Government

Diploma in Public Health

Singapore

Government

113

Place of

Source of

Appointment

1 Medical & Health

Officer ..

4 Medical & Health

Officers

1 Medical & Health

Course of Study

Study

Funds

Medico-legal Training

U.K.

Government

Fellowship, Royal College

U.K.

Government

of Surgeons

Officer

Licentiate of Apothecarics

Ireland

Own expense

- r

יז

Hall

1 Assistant Medical &

Health Officer

1 Medical & Health

Officer

Licentiate of Apothecaries Hall Ireland

Own expense

Dermatology

U.K.

Govt. & Sino-

British

1 Medical & Health

Officer

Fellowship, Royal College of

Surgeons

U.K.

Govt. &

Common- wealth

1 Assistant Medical &

Health Officer

г.

Licentiate, Royal College of

U.K.

Own expense

Physicians, Licentiate, Royal College of Surgeons and Licentiate Royal faculty of Physicians & Surgeons

I Medical & Health

Officer ..

Licentiate, Medical Council

of Canada

U.K.

Own expense

| Medical & Health

Officer

Membership, Royal College

U.K.

Government

of Obstetricians and Gynaecologists

I Medical & Health

Officer

| Physicist

| Nursing Sister

Nursing Sister

| Dietitian

| Nurse

1 Midwife

1 Nursing Sister

1 Senior Almoner

гт

1 Almoner, Class 1 3 Medical Laboratory

Technicians, Grade II

Diploma of Bacteriology

U.K.

Government

+ ·

Radiation Physics

U.K,

Government

Thoracic Surgery-Nursing

U.K.

Own expense

Sister Tutor Diploma

U.K.

C.D. & W.

funds

Dietitic Course

U.K.

Government

Dietitics Diploma

U.K.

Government

Midwifery Training

U.K.

Government

Theatre Technique &

U.K.

Own expense

Management

Orthopaedic and Medical

U.K.

W.H.O.

Social Work

Medical Social

U.K.

Government

Associateship, Institute of

U.K.

Government

Medical Laboratory

Technology (Bacteriological

Technique)

114

Appointment

| Medical Laboratory

Technician, Grade II

Course of Study

Associateship, Institute of

Medical Laboratory Technology (Haemotology and blood transfusion Technique)

Place of

Study

Source of Funds

U.K.

Government

1 Medical Laboratory

Technician, Grade 1

Associateship, Institute of

U.K.

Government

Medical Laboratory

Technology (Virological Technique)

| Medical Laboratory

Technician, Grade II

Associateship, Institute of

Medical Laboratory

U.K.

Government

Technology (Chemical

Pathology Technique)

1 Medical Laboratory

Technician, Grade 11 Bacteriological Technique

1 Medical Laboratory

Technician, Grade II Chemical Pathology Technique U.K.

2 Dental Surgery

Assistants

U.K.

Own expense

Dental Nursing

Malaya

W.H.O.

VIII.

MISCELLANEOUS

ATTENDANCES AT CONFERENCES AND MEETINGS

　　　478. The following table sets out the attendances by officers of the Medical and Health Department at Meetings and Conferences during 1961-62.

Conferences etc. attended

Appointment

Senior Specialist (Psychiatry)

3rd International

Congress of

Place

McGill

Psychiatry

University,

Montreal

Senior Dental Officer

Congress of the Australian Society

of Orthodenlists

Sydney,

Australia

Annual Conference of the Australian

Sydney,

Dental Association

Australia

12th Session of the World Health

Wellington,

Organization

Regional Com-

New

mittee for the Western Pacific

Zealand

Senior Tuberculosis Specialist

16th International Tuberculosis

Conference

Principal Matron and Sister Tutor W.H.O. Seminar On Nursing

Administration

Funds provided by the sponsoring organization.

115

Toronto

Tokyo

Appointment

Health Sister

Conferences etc. attended

*W.H.O./United Nations Education,

Scientific and Cultural Organiza- tion's Seminar on Child Health And the School

Place

Manila

Senior Medical & Health Officer *W.H.O. Seminar on Maternal & Manila

Director of Medical & Health

Services

Assistant Director of Medical &

Health Services (Health)

Child Nutrition

Meeting of the Directing Council Dacca

of the Pakistan SEATO Cholera Research Laboratories

*W.H.O. Seminar on Smallpox

• Funds provided by the sponsoring organization.

Ceylon

VISITORS

479. The following distinguished medical men and women visited Hong Kong during 1961-62:

General

(1) Drs. P. KapOOR, Special Leprosy Officer, Bombay, S. S. MATHUR, State Leprosy Officer, Uttar Pradesh, and T. N. N. BHATTATHIRIPAD, Special Leprosy Officer, Kerala, from India arrived on 1.4.61 for a week's stay.

(ii) Miss Docia An KISSEITH, Chief Nursing Officer, Ghana, arrived

on 26.4.61 for a short visit.

(iii) Miss Frances UDELL, C.B.E. Chief Nursing Officer, Colonial

Office, London, from 12.5.61 to 17.5.61.

(iv) Professor R. McWHIRTER, Professor of Radiology, University of

Edinburgh, from 8.8.61 to 13.8.61.

(v) Dr. J. S. SODHY, Senior Tuberculosis Specialist, Federation of

Malaya, arrived on 28.8.61 for a six day's visit.

(vi) Miss M. F. CARPENTER. Director in the Education Division, Royal College of Nursing, London, arrived on 16.9.61 and stayed for a week.

(vii) Dr. F. J. Wright, M.D., F.R.C.P., Consulting Physician to the

Colonial Office in Edinburgh, from 18.9.61 to 26.9.61.

(viii) Lady ERROLL, wife of the Rt. Hon. F. J. ERROLL, Minister of State, Board of Trade, paid a visit to various institutions in the department on 9.10.61.

(ix) Dr. Mary KEISTER, F.A.O. House Economics Officer arrived on

1.10.61 for a ten day's visit.

116

(x) Dr. Hernan ROMERO, Professor of Preventive Medicine, Univer-

sity of Chile, arrived on 5.10.61 for a short visit.

(xi) Dr. J. C. AZURIN, Director of Quarantine, Manila, arrived on

26.10.61 for a two day's visit.

(xii) Dr. G. WEBER of the University of Mainz, Germany, paid a visit to the various Social Hygiene and Leprosy Clinics of the Depart- ment on 8.11.61.

(xiii) Dr. D. CHAKRABARTI, Medical Officer in-charge, Leprosy Training Centre, Medical College, Nagpur, India, arrived on 11.12.61 for a five day's visit.

(xiv) Dr. Joan REFSHAUGE, Assistant Director of Medical Services (Maternal & Child Health) in New Guinea, arrived on 14.12.61, and was shown round the Maternal & Child Health Centres by the Medical Officer in-charge, Maternal & Child Health.

(xv) Dr. S. SHARMA, Junior Specialist and Lecturer in Dentistry, S.M.S. Medical College and Hospital, Jaipur, India, from 15.12.61 to 20.12.61.

(xvi) Dr. Wallace Fox of the Tuberculosis Research Unit of the Medical Research Council arrived on 26.1.62 for a three week's visit.

(xvii) Dr. P. SRISWASDI of Thailand arrived on 10.1.62 for a two week's

visit.

(xviii) Professor Kenneth GoODNER of Jefferson Medical College of Philadelphia accompanied by Dr. T. E. WOODWARD and Dr. J. E. SMADEL, from 17.1.62 to 18.1.62.

(xix) Dr. Harold JOHNSTON, Deputy Director of the British Medical Research Council's Population Genetics Research Unit, Oxford, arrived on 3.2.62 for a week's stay.

(xx) Dr. A. J. HIBELL, Tuberculosis Control Officer in Fiji, arrived on

12.2.62 for a two day's visit.

(xxi) Dr. Suk Sung-tak of Korea arrived on 22.3.62 for a two week's

visit.

(xxii) Dr. H. S. GHOSH of India arrived on 27.3.62 for a short visit. (xxiii) Professor F. R. G. HEAF, C.M.G., M.D., F.R.C.P., Consultant in Tuberculosis to the Secretary of State for the Colonies. From 3.4.62 to 18.4.62.

[17

World Health Organization & U.N.I.C.E.F. Visitors

(i) Mr. Alfred H. TAYLOR, Chief Health Inspector, Ministry of Health, Kenya, revisited Hong Kong from 3.5.61 to 12.5.61 on a W.H.O. Fellowship.

(ii) Drs. Somborn VACHROTAI and Amnuay TRAISUPA, W.H.O. Fellows from Thailand arrived on 20.5.61 for a five day's visit. (iii) Dr. Alan H. PENINGTON, Area Representative for the World Health Organization in the North West Pacific Area, arrived on 4.7.61 for a short visit and revisited Hong Kong from 11.2.62 to 18.2.62.

(iv) Mr. Benijamini R. LOMALOMA, an Assistant Medical Officer in the service of the Fiji Medical Department arrived on 22.7.61 for a week's visit on a W.H.O. Fellowship.

(v) Dr. (Mrs.) KYUNG Ja-kim, a W.H.O. Fellow from Republic of

Korea arrived on 9.7.61 for a week's visit.

(vi) Dr. M. POSTIGLIONE, W.H.O. Senior Regional Malaria Adviser,

arrived on 26.10.61 for a short visit.

(vii) Dr. F. MORTARA of the Maternal & Child Health Unit, W.H.O.

Headquarters arrived on 13.12.61 for a four day's visit.

(viii) Dr. E. H. HERMANS, Professor of Dermato-Venereology at the University of Leyden, Rotterdam, and a member of the W.H.O. Expert Advisory Panel on Venereal Infectious and Trepone matoses with Mrs. HERMANS, from 16.12.61 to 18.12.61.

(ix) Dr. TAE Kyung-choi of the World Vision Leprosy Centre, College of Medicine, Yong-Sei University, and Dr. Youn Keun-cha of the National Institute for Public Health Training, Seoul, Republic of Korea, who had been awarded W.H.O. Fellowships to study leprosy control, arrived on 2.1.62 for a ten day's visit.

(x) Dr. (Miss) HYUNG Duk-kim of Korea, a W.H.O. Fellow, from

22.1.62 to 28.1.62.

(xi) Dr. Jacobus KEJA of the Department of Public Health of the Netherlands, New Guinea, from 8.2.62 to 11.2.62, on a W.H.O. Fellowship.

(xii) Dr. Oscar FELSENFELD, W.H.O. Consultant on Cholera, arrived

on 4.3.62 for a four day's visit.

(xiii) Mr. S. POLAK, Resident Representative, U.N.I.C.E.F, from 9.3.62

to 17.3.62.

118

PUBLICATIONS

480. The following articles were published by members of the

department.

Title of Article

The Possession Syndrome:

A Comparison of Hong Kong and French

Findings.

Some Aspects of

Schizophrenic Thought Disorder.

Acute Haemorrhagic

Pancreatitis as A Cause of Sudden Death,

Poliomyelitis Faecal and

Serological Surveys in the Chinese Population in Hong Kong. 1960. 5. Huntington's Chorea in

the Chinese.

Dental Health Education

of the Public.

Dentistry in Hong Kong.

The Interchange of

Photocell Circuit in the Estimation of Blood Glucose using the Autoanalyzer.

Publication Journal of Mental Science, London.

Bulletin of the Chinese Medical Association. Hong Kong. Bulletin of the Chinese

Medical Association. Hong Kong.

American Journal of

Tropical Medicine and Hygiene, January. 1962.

British Medical

Journal, 1962. Texas Dental Journal,

April, 1961.

Journal of the Malayan Dental Association, 1961.

Journal of the Medical

Laboratory Technology.

Name and Title of Author Dr. P. M. YAP, Senior

Specialist (Psychiatry).

Dr. P. M. YAP, Senior

Specialist (Psychiatry).

Drs. T. F. Tong, Y. K.

ONG. S. H. CHEAH and T. C. PANG, Department of Forensic Pathology. Dr. CHANG Wai-kwan and Mr. SHUM Hay, Govern- ment Virus Unit, Queen Mary Hospital. Dr. K. SINGER, Åg.

Specialist (Psychiatry) Mr. W. C. ALLWRIGHT,

Senior Dental Specialist Mr. W. C. ALLWRIGHT,

Senior Dental Specialist.

Mr. Na Chiu-lun, Medical

Technologist.

ACKNOWLEDGEMENT

　　　481. This account of the work of the year is incomplete without a sincere tribute to those who have accomplished it. With the ready support and co-operation of other Departments of Government and the voluntary and welfare agencies who make such a significant con- tribution in the medical field, all grades of staff in the Department have worked loyally and steadily. In the face of increasing pressure, they have responded willingly and effectively to the additional challenges that have been made. This was particularly so during the cholera emergency when all gave of their best, cheerfully and without respite, as the situation required. In this they were supported magnificently by the people of Hong Kong.

D. J. M. MACKENZIE,

Director of Medical and Health Services.

119

FAC

HONG KONG

DNOM

HONG KONG ISLAND

1. Kennedy Town Jockey Club Clinic (a maternity home

with general outpatient facilities and a maternal and child health centre).

Li Sing Primary School Clinic.

3. Ling Yuet Sin Infants' Home.

Tsan Yuk Hospital (a maternity hospital).

Mental Day Hospital.

Sai Ying Pun Hospital (infectious diseases) and Sai Ying Pun Jockey Club Clinic (general outpatient with special clinics).

Tung Wah Hospital (a general hospital, with outpatient department and special clinics).

bospital).

8. Alice Ho Miu Ling Nethersole Hospital (a general

9. Port Health Inoculation Centre, Marine Building. 10. Central District Health Centre (general outpatient facilities, maternal and child bealth centre and special clinics).

11, Police Medical Post (general outpatient and dental facilities for police officers and their families).

13.

12. Victoria Remand Prison Clinic (general outpatient facilities for prison officers and their families, and general outpatient facilities for detainees). Port Health Inoculation Centre, Fung House. 14. Hong Kong Central Hospital (s general hospital). 15. Hong Kong Families Clinic (general outpatient facilities for English-speaking Government servants and their families).

16. Canossa Hospital (a general hospital).

17. Military Hospital, Bowen Road (a general hospital}, 18. Medical Examination Board.

19. Violet Peel Polyclinic (general outpatient facilities with special clinics and an ophthalmic centre). Eastern Dispensary and Maternity Hospital (a mater- nity home with general outpatient facilities).

20.

21.

Wan Chai Clinic (a dental centre, tuberculosis clínic, and physiotherapy department),

22. Ruttonjee Sanatorium (a tuberculosis hospital).

23.

Wan Chai Hospital (a hospital for venereal and der- matological treatment).

24. Harcourt Health Centre (a school health, maternal and child health centre and a male social hygiene clinic).

25. Hong Kong Sanatorium & Hospital (a general

26.

27.

28.

29.

30.

31.

32.

33.

hospital).

St. Paul's Hospital (a general hospital).

Tung Wah Eastern Hospital (a general hospital and outpatient department).

St. John Ambulance Brigade Centre. Mount Butler Quarry Clinic,

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. 34. Stanley Prison Hospital.

35. Stanley Dispensary & Maternity Home (general out- patient facilities and maternity home).

36. Grantham Hospital (a tuberculosis hospital). Aberdeen Jockey Club Clinic (a maternity home with general outpatient facilities and special clinics).

37.

38. Matilda Hospital (a general hospital).

39.

40.

Military Hospital, Mount Kellet (a general hospital). Queen Mary Hospital (an acute general hospital with casualty department).

41. Sandy Bay Convalescent Home (an orthopaedic hospital for children).

121

Lai Chi Kahi

Sham Shul

KOWLOON PENINSULA MEDICAL FACILITIES

Meng, Kak Tau

Yau Ma T

Trim Sha Tael

Kowloon City

Hung Hom

victoria

Kowloon

North Point

Bay

KOWLOON

42. Lai Chi Kok Hospital (an infectious diseases and

43.

44.

convalescent hospital, with an Isolation Unit for the segregation of suspected cases of the quaran- tinable diseases).

Lai Chi Kok Female Prison Hospital.

Cheung Sha Wan Police Quarters Clinic (general out- patient and dental facilities for police officers and their families).

45. Li Cheng Uk Clinic (general outpatient facilities). 46. Shek Kip Mei Health Centre (general outpatient facilities with special clinics, a chest clinic and maternal & child health centre),

47. Tai Hang Tung Clinic (general outpatient facilities), 48. Precious Blood Hospital (a general hospital).

49.

Sham Shui Po Public Dispensary (general outpatient facilities with special clinics).

50. Mong Kok Clinic (general outpatient facilities). 51. Government Ophthalmic Clinic-Arran Street (an ophthalmic centre).

52. Queen Elizabeth School Clinic.

53. Kwong Wah Hospital (a general hospital and infirmary with outpatient department).

54. Yau Ma Tei Public Dispensary (general outpatient facilities).

55. Kowloon Police Medical Post (general outpatient and dental facilities for police officers and their families).

56. Ashley Road Social Hygiene Clinic (a male treatment centre for venereal disease).

57, Kowloon-Canton Railway Staff Clinic (general out- patient and dental facilities for Railway staff and their families).

58. Teim Sha Tsui Health Centre (a school health, maternal & child health centre, including a female social hygiene clinic and port health inoculation centre).

59. Hung Hom Clinic & Maternity Home (general out- patient facilities with special clinics and maternity home).

60. Ho Man Tin Maternal & Child Health Centre.

61.

Kowloon Chest Clinic (a tuberculosis clinic).

62. Kowloon Hospital and Outpatient Department (an acute general hospital with casualty department and outpatient department with special and dental clinica),

63.

64,

St. Teresa's Hospital (a general hospital).

Kowloon Families Clinic (general outpatient facilities for English-speaking Government officers and their families).

65. Li Kee Memorial Dispensary (general outpatient facilities with special clinics and a dental clinic). 66. Maryknoll Mission Hospital (a general hospital).

67.

60.

Wong Tai Sin Clinic (general outpatient facilities). Ngau Tau Kok Maternal & Child Health Centre.

123

T-

NEW TERRITORIES

MEDICAL FACIENT

114

HONG KONG AND THE NEW TERRITORIES

PAT

LA HTAV

נ-

דו

125

NEW TERRITORIES

69. Sha Tau Kok Clinic (general outpatient facilities with maternity beds).

70. Fanling Hospital (a general hospital).

71. Shek Wu Hui Jockey Club Clinic (general outpatient facilities with maternity beds).

72. Ho Tung Dispensary (a maternity home with convalescent beds).

13. Yuen Long Dispensary (general outpatient facilities with special clinics).

74.

Pok Oi Hospital (a general hospital).

75. Castle Peak Hospital (a mental hospital. 120 beds are being used temporarily for drug addicts).

76.

San Hui Dispensary (a maternity home, with special clinics).

77. Maurine Grantham Health Centre (general outpatient facilities with special clinics and a maternal & child health centre).

78. Tai Po Jockey Club Clinic (general outpatient facilities, special clinics including a dental clinic and maternity beds).

79, Sha Tin Maternity Home.

80. Sai Kung Dispensary (general outpatient facilities, special clinics and maternity beds).

81. Haven of Hope Tuberculosis Sanatorium,

82. Nansen Tuberculosis Rehabilitation Centre.

83. North Lamma Clinic (general outpatient facilities with maternity beds).

84. Peng Chau Clinic (general outpatient facilities, special clinics and maternity beds). 85. Hei Ling Chau Leprosarium.

86. Children's Convalescent Home, Cheung Chau.

87. St. John Hospital (a general hospital and outpatient department with special clinics). 88. Silver Mine Bay Dispensary (general outpatient facilities with maternity beds).

89, South Lantau Hospital (a general hospital with general outpatient facilities).

90. Shek Pik First Aid Post.

91.

Tai O Dispensary (general outpatient facilities, with special clinics and maternity beds).

APPENDIX 1

ESTABLISHMENT OF THE MEDICAL & HEALTH DEPARTMENT AS AT 31.3.62

　　　Director of Medical & Health Services... Deputy Director of Medical & Health Services Assistant Director of Medical & Health Services

---

Principal Medical & Health Officer

171

---

Senior Specialist

Specialist

Secretary

P+1

ITI

ILJ

++-

J-J

г.г

LJ L

---

...

---

TII

---

ITI

-- J

---

LJI

Treasury Accountant

-- J

Senior Medical & Health Officer

LJI

LJ I

---

TIP

Medical & Health Officer and Assistant Medical & Health Officer

Dental Officer and Assistant Dental Officer

Principal Matron

Nursing Staff

Dietitian

---

ITE

-H

330

1,874

Principal Almoper

---

..-

---

100

Senjor Almoner, Almoner Closs I and Almoner Class II

Chief Pharmacist

ITI

...

Pharmacist, Dispenser and Dispensary Supervisor... Government Chemist ...

Chemist, Assistant Chemist, Biochemist and Assistant Biochemist Chief Hospital Secretary, Hospital Secretary and Assistant Hospital Secretary. Executive Grade Officer

Clerical Staff

Ir.

---

Superintendent Radiographer, Senior Radiographer, Radiographer and Assistant

Radiographer

---

ITI

---

JL+

LIL

FIL

LJL

139

---

-- J

373

---

. г.

105

+-+

---

LJ L

TIP

111

TOP

TIP

Superintendent Physiotherapist, Tutor Physiotherapist, Physiotherapist and

Assistant Physiotherapist

LJ-

LJ L

JIL

LIT

Superintendent Occupational Therapist and Occupational Therapist

Scientific Officer (Medical)

LLL

LII

Senior Physicist and Physicist

---

IIT

Chief Medical Technologist, Senior Medical Technologist, Medical Technologist

　　　　and Medical Laboratory Technician Senior Laboratory Assistant and Laboratory Assistant

---

LII

Health Inspector and Malaria Inspector

Senior Inoculator and Inoculator

---

H-

Orthopaedic Appliance Technician and Assistant Orthopaedic Appliance

Technican

JLL

Other Staff

...

---

16+

4,009

127

Total

7,365

128

APPENDIX 2

THE DIVISIONS OF THE MEDICAL AND HEALTH DEPARTMENT

Medical Services

Hospitals, general clinics and outpatient departments

-excluding New Territories.

Clinical Specialist Services.

Health Services

New Territories-Curative and preventive.

Government Institute of Pathology,

Pharmaceutical Service.

Radiological Service.

Almoner Service,

Physiotherapy Service.

Occupational Therapy Service.

Medical Examination Board.

Maternal and Child Health Service.

District Midwifery Service.

School Health Service.

Dental Service.

Tuberculosis Service.

Social Hygiene Service.

Port Health Service--including epidemiology.

Malaria Control Service.

Government Chemist's Laboratory.

Forensic Pathology.

Industrial Health.

Health Education.

International Health Liaison,

APPENDIX 3

STATEMENT OF EXPENDITURE FROM 1957-58 TO 1961-62

Particulare

(a) Medical and Health Department

129

(b) Medical Subventions

Total

1957-58

1958-59

1959-60

1960-61

1961-62

34,864,883 39,792,228 45,925,081

56, 573,091|

64,064,336

9,706,931 14,178,093 18,988,424 21,910,889 25,009,269

LIL

1,408,976

5,755,291 15,442,311 12,369,272 9,836,801

---1

45,980,790 59,725,612 80,355,816 90,853,252 98,910,406

Total expenditure of the Colony

532,679,217 | 589,958,367 709,953,996

709,953,996 845,297,629 953,205,237

■+1

Percentage of Medical and Health Department

Expenditure to the Total Expenditure of the Colony

8.63%

10.12%

11.31%

10.75% 10.38%

130

APPENDIX 4

ANALYSIS OF MORTALITY FOR THE YEARS 1957-61

(Given as Percentage Total Deaths)

Disease Group

Detailed List Numbers

1957

1958

1959

1960

1961

1. Infectious and Parasitic

001-138

16.6

14.6

14.2

14.4

15.3

· P.

2. Neoplastic

ITI

...

140-239

7.5

8.9

9.3

10.5

12.3

3. Allergic, Endocrine, Metabolic and Blood...

4. Nervous System and Sense Organs

5. Circulatory System

240-299

1.6

1.1

L.1

300-398

4.6

5.3

6.2

7.2

8.3

400-468

8.0 :

8.3

8.9

9.7

10.7

6. Respiratory

---

ITI

+++

470-527

22.8

24.2

22.3

19.3

14.8

7. Intestinal

530-587

12.1

11.1

11.3

9.3

7.7

8. Genito-Urinary

LJI

590-637

2.2

1.9

2.1

2.0

1-г

9. Pregnancy, Child-birth and Puerperium

10. Skin and Musculo-Skeletal...

11. Congenital Malformations and Diseases of Early Infancy

ILI

640-689

0.5

0.4

0.3

690-749

0.4

0.5

0.4

0.3

0.2

750-776

10.5

10.8

9.3

10.7

11.1

12. Il-defined Causes

FIL

780-795

8.2

8.0

8.7

9.5

10.4

...

13. Accidents, Poisoning and Violence.

+++

E800-E999

5.0

4.8

5.8

5.7

5.9

APPENDIX 5

INFECTIOUS DISEASES NOTIFIED CASES AND DEATHS 1957-61

1957

1958

1959

1960

1961

Diseases

Cases

Deaths

Cases Deaths Cases Deaths

Cases Deaths

Cholera

130

...

ALL

Chickenpox

Diphtheria

typhoid)

Malaria

-+-

LIL

Measles

Amoebic dysentery

Bacillary dysentery (Including

unspecified dysentery)..

Cerebro-spinal meningitis

Enteric fever (Typhoid & Para-

217

262

239

334

215

---

550

424

663

678

742

...

TIT

---

280

278

304

498

1,239

129

1,555

13-4

2,087

116

1.450

1,334

109

728

816

997

773

742

ཚསྶ སྶ།

447

659

442

833

812

...

- 1

ILI

875

786

191

743

176

710

192

1,727

435

*Ophthalmia neonatorum Poliomyelitis

Poerperal fever

105

244

254

250

---

262

86 ·

148

184

Scarlet fever

· · ·

-IT

Tuberculosis

Typhus (mite-borne)

Whooping cough

LIL

13,665

2,675

13,485 2,302

14.302

2,178 12,425

2,085

12,584

1,907

-10

1гг

HOT

197

110

47!

Total

18,170 2,965

18.872

2,762

20,241 2,589 18,005

2,467 19,333 2,586

+Influenza

No No record

33,700

11,659 | 25

5,727

26 | 6,223

131

Remarks: * Notifiable since June 1958.

† Voluntary notifications.

The above table omits rabies, smallpox, plague, epidemic louse-borne typhus, yellow fever and relapsing fever-no case of any of which was reported during the years.

132

APPENDIX 6

ANTI-EPIDEMIC PROPHYLACTIC IMMUNIZATIONS 1957-1961

Immunological Procedure

Anti-Smallpox Vaccination

Anti-Cholera Inoculation

Anti-Diphtheria Inoculations:

lat Dose

ז..

1957

1958

1959

1960

1961

---

1,082,809

564,244

1,034,138

573,848

969.577

29,070

93,155

36,245

30,634 1,968,214

H-

2nd Dose

Fat

Booster Dose

+++

Anti-Typhoid Inoculations :

1st Dose

LJI

2nd Dose

LIL

Booster Dose

Anti-Plague Inoculation

Anti-Typhus Inoculation

Anti-Rabies :

LLI

143,897

109,336

223,209.

202,883

296,071

++-

+++

100.941

90,396

144,118

174.406

207,143

...

66,231

42,330

63,582

71,219

115,$66

LJI

LIL

ILJ

118,879

103,381

141,342

97,902

43,080

ILI

---

FIL

88,605

70,833

101,174

78,103

30,013

+1+

120,891

95,044

92,712

38.374

38.624

++1

+r+

299

236

205

220

224

1+1

+17

· +

1,421

1,082

I,597

1,409

981

3,080

3,046

3,577

3,717

3,786

LIL

11.474

12,266

13,872

12,846

14.342

1st Dose

+-+

IIL

---

Other Doses

FIL

+++

Anti-Tuberculosis (B.C.G.) Vaccinations:

---

35,149

49,865

62,261

79,169

86.234

---

...

10,074

10,390

8,518

11,054

7,756

Infants

---

Others...

APPENDIX 7

ANNUAL INCIDENCE AND TREND OF VENEREAL DISEASE

Year

Total New Patients

Total Attendances..

SYPHILIS

Total (Except Congenital)

Primary

| Secondary

Early Latent

Late Latent

All Others

Congenital

Gonorrhoea...

---

· P.

TII

Under I year

(Over 1 year

TII

1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961

17,934 23,565 37,392 36,652 34,853 32,490 31,391 27,841 28,980 26,281 25,819 152,294 149,237 213,091 223,031 203,701 180,148 193,674 203,954 213,026 213,733 182,049 3,215 3,216 6,969 6,825 4,232 3,628 3,190 3,372 2,680 2,091 1,555

562

672

634

393

153

୨ 19; 46

301

180

132

---

1,101 882

2,298

2,209

1,044

733

450

417

426!

296

202

1,038 1,275 3,727

3,983

2,853

2,616

2,532 2.766

2,038

1,590

1,173

213

207

178

186

148

166

184

---

177

188

139

119

164

111

116

131

6,903

8,546 11,625 10,785 11,309 10,609

9,881

8.360

8,362

6,506

5,997

---

тиг

777 2,088

870 770 2,347 2,400 2,507 2,365 2,468 197 111 208 286 1,643 4,508 7.708 7,150 6,623 5,908 7,376 8,165

869

776

800

644

481

591

509

1,614

685

294

324

873

635

249

140

178

6,245

5,855

5,458 4,997

4,717 4,293

8,437 9,814

8,701 11,046 10,611, 12,173

Non Gonococcal Urethritis

Chaneroid

Lymphogranuloma Venereun

Non Venereal Disease

Skin Disease

133

APPENDIX 8

CLASSIFICATION OF DERMATOLOGICAL CASES, 1959, 1960 & 1961.

Diagnosis

No. of cases 1959

No.of caper

No. of cases

1960

1961

Abrasions

110

1.09

0.71

0.94

Aene

0.65

0,66

0.83

Alopecia Areata

0.41

0.48

0.55

---

Boils, Folliculitis..

1,566

15.65

1,849

15.04

575

9.96

Carcinoma

0.22

0.07

0.05

Contact Dermatitis

---

1,667

16.66

2,244

18.26

1,351

23.41

Clog Dermatitis

0.59

0.20

0.42

Eczema-Atopic...

0.47

0.59

0.57

Eczema-Infantile

453

4.53

548

4.46

281

4.87

10.

Eczema-Infective

215

2.15

122

0.99

238

4.12

11.

Eczema

Scrotum

0.64

0.75

0.10

L+I

16.

12. Eczema Miscellaneous...

13.

Exfoliative Dermatitis

14. Erythema Multiforme 15. Erythema Nodosum Herpes Zoster

17. Ichthyosis, Xorosis

18. Impetigo

19. Leprosy

20. Lichen Planus

695

6.95

---

1,691

13.76

1,242

21.52

0.08

0.09

0.13

0.26

0.14

0.19

LIT

0.10

0.13

0.19

...

0.33

0.15

0.24

+ T

0.09

0.10

0.22

671

6.71

---

+++

554

4.51

256

4.43

135

1.35

124

1.01

1.59

0.12

---

0.03

0.08

Neurodermatitis

Porphyria

25. Paronychia, Whitlow

21.

Lupus Erythematous

22.

Moniliasis

23.

24.

0.39

0.31

0.45

0.09

---

་

463

4.63

541

---

4.40

226

3.92

0.01

---

0.15

0.21

0.35

+4+

26. Pediculosis

27. Pompholyx

---

28. Prickly Heat

+++

0.68

0.28

---

ITI

TIP

0.34

0.54

1.07

128

1.28

141

1.15

0.90

---

29. Pruritis

250

2.50

265

2.16

0.99

+1+

30. Psoriasis

0.73

---

0.79

0.83

тог

31. Purpura

---

TIT

32. Ringworm of Scalp 33. Ringworm of Body 34. Ringworm of Groins

JLJ

0.11

0.02

0.37

0.18

0.10

137

1.37

184

1.50

124

2.15

0.50

0.69

0.36

1-1

35. Ringworm of Feet and Hands

247

2.47

242

1.97

112

1.94

36. Rosacea

0.14

+--

0.08

0.07

37. Scabies

225

2.25

ILJ

0.54

0.05

40.

41.

38. Scleroderma, Sclerodactyly

39. Tuberculosis of Skin

Undetermined Urticaria ...

42. Varicose Derm./Ulcer

0.07

0.03

0.36

0.28

0.24

---

1,554

15.54

1,949

15.86

303

5.25

118

1.18

202

1.64

1.61

118

1.18

129

1.05

0.64

43.

Warte

44.

45.

196

---

1.96

263

2.14

1.71

---

Seborrhoeic Dermatitis

Leucoderma

107

1.07

0.63

0.73

158

1.58

169

1.38

127

2.20

134

APPENDIX 9

IN-PATIENTS TREATED IN GOVERNMENT AND GOVERNMENT-ASSISTED HOSPITALS, 1961 CLASSIFIED ACCORDING TO INTERNATIONAL STANDARD CLASSIFICATION

INTERMEDIATE LIST OF 150 CAUSES

Cases Treated

Inter-

mediate

Detailed

List

Number

Tuberculosis of respiratory system... Tuberculosis of meninges and

central nervous system Tuberculosis of intestines, peri- toneum and mesenteric glands Tuberculosis of bones and joints Tuberculosis, all other forms Congenital syphilis

Deaths

Cause Groups

Govern-

Govero-

Govern-

Whole Colony

mient

ment

Assisted

Elospitals

■

Hospitala

Hospitale

Assisted

Sex Un-

Mala

Female

Total

Hospitals

known

1,220

3,684

693 1,087

505!

1,592

157

445

173

136

117

253

---

LIL

184

497

155

+--

BẺ LÀ H

-IL

---

TIP

---

147

[སཝཱ

TIG

+11

...

---

ILI

485

204

en |

│;

---

*73

---

171

---

541

---

3,014 5,178

204

પ

#15

900 1,341

681

2,022

| │

A 1

A 2

001 - 008

010

A 3

011

A 4

012 - 013

A 5

014 - 019

020

A 7

021

Early Syphilis...

024

Tabes dorsalis...

A 9

025

A 10

022 - 023

All other syphilis

026 - 029

A 11

030 - 035

A 12

040

Typhoid fever...

A 13

041 - 042

A 14

043

A 15

044

A 16 (0)

045

Bacillary dysentery

General paralysis of insane...

Gonococcal infections

1717

-- J

Paratyphoid fever and other

Salmonella infections

Cholera

Brucellosis (undulant fever).....

1гт

Carried forward...

* Excluding 53 Carriers who were treated in Chathain Road Quarantine Station. † 1 died of A70.

Including 7 who died on arrival to hospital.

135

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

List

Number

Deaths

Detailed

List

Cause Groups

Govern-

Number

mtot

Hospitals

Govern-

ment-

Assisted

Hospitals

Govern-

Whole Colony

ment

Hospitals

ment-

Assisted

Hospitals

Mele

Female

Sex Un-

knowo

Total

Brought forward...

3,014

5,178

204

900

1,341

681

A 16 (6)

046

Amoebiasis

155

2,022

(c)

047 048

Other unspecified forms of dysentery

A 17

050

Scarlet fever

A 18

051

Streptococcal sore throat

---

A 19

052

Erysipelas

...

A 20

053

Septicaemia and pyaemia

121

A 21

055

Diphtheria

JLJ

1,413

101

54'

109

A 22

056

Whooping cough

A 23

057

Meningococcal infections

A 24

058

Plague ...

A 25

060

Leprosy

667

A 26

061

Tetanus

173

A 27

062

Anthrax

དྷཎྜབྷཱཏི །དྡྷསྶ |

---

A 28

080

A 29

082

A 30

081, 083

Acute poliomyelitis

Acute infectious encephalitis

Late effects of acute poliomyelitis

and acute infectious encephalitis.

---

187

15!

A 31

084

Smallpox

LIL

---

LII

A 32

085

Measles

353

---

102

218

217!

435

A 33

091

Yellow fever

IIT

ITI

+--

---

A 34

092

A 35

094

Rabies...

A 36 (0)

100

Infectious hepatitis

Louse-borne epidemic typhus

121

---

PIT

136

Carried forward...

5,597

6,233

531

980

1,772 1,071

2,843

• 3 died of Al

1 died of A70

3 died of A56

1 died of AE 148/AN 150

137

Inter-

mediate

List

Number

APPENDIX 9-Contd.

Cases Treated

Deaths

Deatha

Detailed

List

Number

Cause Groups

Govern.

ment

Hospitals

Govern.

mtnt-

Assisted

Hospitals

Govern-

ment

Whole Colony

Hospitals

meat-

Assisted

Hospitala

Male Female

|Sex U

knowa

Total

5,597 6,233

531

980 1,772 1,071

2,843

A 36 (b)

101

(c)

104

(d)

105

(e)

102 - 103

106 - 108

A 37 (a)

110

(6)

111

(c)

112

(d)

115

(4)

113 114

116 117

A 38 (0)

123.0

(b)

123.1

goni)...

(c)

123.2

(d)

123.3

Brought forward...

Flea-borne epidemic typhus (nurine)

Tick-borne epidemic typhus...

Mite-borne typhus

...

Other and unspecified typhus

Vivax malaria (beníga tertion) Malariae malaria (quartan) Falciparum malaria (Malignant

tertian)

Blackwater fever

---

· Pr

LII

།

LII

| מL

- - -

Other and unspecified forms of

malaria

Schistosomiasis vesical (S. Haema- tobium)

---

Schistosomiasis intestinal (S. Man+

Schistosomiasis pulmonary

(5. Japonicum)

ITI

Other and unspecified schis-

tosomiasis

---

A 39

125

Hydatid disease

+-+

LIL

A 40 (G)

0000

127

Onchocerciasis

(b)

127

Loiasis...

---

тот

127

Filariasis (bancrofti)

FIL

127

Other filariasis

TH+

A 41

129

Ankylostomiasis

-IT

Carried forward...

---

+++

+-+

5,649: 6,282

$32

980

1,773 1,071

2,844

138

Inter-

mediate

List

Number

APPENDIX 9-Contd.

Cases Treated

Detailed

List

Number

Cause Groups

Govern-

ment-

Deaths

Govern-

Deaths

Whole Colony

ment

Aminted

ment.

A minted

Hospitals

Hospital

Hospitale

Male Femalo

Hospitals

'Sex Unr

know

Total

LIL

5,649 6,282

532

980 1,773 1,071

2,844

A 42 (0)

126

(b) |

130.0

(0)

130.3

(d)

A 43 (4)

JFFSETS ST LOSS

(m)

038

039

049

124, 128

130.1-130.2

037

Brought forcard...

Tapeworm (infestation) and other

cestode infestations

Ascariasis

---

Guinea Worm (dracunculosis) Other diseases due to helminths

---

Lymphogranuloma venereum Granuloma inguinale, venereal Other and unspeciɓed venereal diseases Food poisoning infection and intoxication

TII

071

Relapsing fever

- IT

---

072

073

Yaws

Leptospirosis icterohaemorrhagica

(Weil's disease)

---

087

Chickenpox

---

090

Dengue

---

...

095

Trachoma

---

096.7

Sandfly fever

...

+-+

120

Leishmaniasis

121 (a) Trypanosomiasis gambiensis... (b) Trypanosomiasis rhodesiensis (c) Other and unspecified

trypanosomiasis

Dermatophytosis

(a) |

(0) 1 135

131

Scabies

---

ITI

TIT

--1

---

ILI

+do

10+

咁

| |

TIP

- - -

...!

↓

LLI

Carried forward.....

5,761

6,380

536

981 1,776 1,077

2,853

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

Detailed

List

Number

List

Cause Groups

Govar

Number

Govern- !

Deaths

Govern

Covers-

Deaths

Whole Colony

ment-

meal Assisted Hospitals Hospitale

ment

Hospitals

meat-

Assisted

Hospitals

Male

Female

Six Un

known

Total

Brought forward...

5,761

6,380

536

981

1,7761 1,077

2,853

A 43 (p) 036,054,059,

139

063,064,070,

074,086,088,

089,093,

096.1,096.6.

All other diseases classified as infective and parasitic

---

096.8,096.9.

122,132-134,

136-138

A 44

140 - 148

Malignant neoplasm of buccal

cavity and pharynx

166

270

125

165.

255

A 45

150

Malignant neoplasm of oesophagus...

127

85.

126

A 46

151

Malignant neoplasm of stomach

123

208

135

165!

119,

284

A 47

152 - 153

Malignant neoplasm of intestine,

except rectum

100

---

A 48

154

Malignant neoplasm of rectum

A 49

161

Malignant neoplasm of larynx

A 50

162 163

Malignant neoplasm of trachea,

and of bronchus and lung not

specified as secondary

141

198

121

A 51

170

Malignant neoplasm of breast

149

184

A 52

171

Malignant neoplasm of cervix uteri...

373

126

598

173.

121

294

111

137

A 53

172 - 174

Malignant neoplasm of other and

unspecified parts of uterus

105

A 54

177

Malignant neoplasm of prostate

ཋ

A 35

A $6

190 191

396 - 197

Malignant neoplasm of bone and

connective tissue

JIL

Carried forcard...

Malignant neoplasm of skin

15'

.. 7,238

7,766

759

1,630

2,478

1,864

4,342

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

List

Number

Deaths

Detailed

List

Number

Cause Groupe

Covero.

ment

Govern.

ment-

Gove

Govern-

catat

Deaths

Whole Colony

Hospitale

Assisted

Hospitale

Hospitals

Assisted

Hospitals

Melc Female

[Sex Un-

known

Total

Brought forward...

7,238

7,766

759

1,630

2,478 2,478 1,864

4,342

A 57

155 - 160

Malignant neoplasm of all other

164 - 165

and unspecified sites

478

498

171

239

404

253

657

-T-

175 - 176

178 - 181

192 - 195

140

113

100

45;

TIL

---

1,207

246

250

288

---

140

!།།།

29!

A 58

A 59

198 - 199

204

Leukaemia and aleukaemia...

200 - 203

205

Lymphosarcoma and other

A 60

210 - 239

A 61

250 - 251

A 62

252

neoplasms of lymphatic and haematopoietic system

Beniga neoplasms and neoplasms

of unspecified nature

Nontoxic goitre

Thyrotoxicosis with or without goitre

A 63

260

Diabetes mellitus

TIT

A 64 (0)

280

Beriberi

171

(b)

281

Pellagra

---

...

(2)

282

---

283 - 286

A 65 (0

290

(6) !

291

(c). 292 - 293

A 66 (0)

241

Scurvy...

Other deficiency states

Pernicious and other hyperchromic

anaemias

Iron deficiency anaemias

(hypochromic)

Other specified and unspecified

anaemias

Asthma

TIT

---

362

IIT

]

325

242

17:

247

465

24!

L+

29!

Carried forward...

10,353 | 9,909

1,060

1,957

3,063 2,275

5,338

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Covero-

Ficat

Hospitala

Govern-

moot-

Assisted

Hospitals

Govern-

Deaths

Govern-

Deaths

Whole Colony

Teat

Hospitals

ment

Assisted

Hospitals

Mole

Female

!Sex U

known

Total

Brought forward...

---

10,353 9,909

1,060 1,957

3,063 2,275

5,338

A 66 ()

240,

All other allergic disorders,

242 - 245,

253, 254,

endocrine, metabolic and blood diseases

IL J

447

196

270 - 277,

287 - 289,

294 - 299

A 67

A 68

300 - 309

Psychoses

2,223

*22

310 324

Psychoneuroses and disorders of

326

personality

---

1,589

י1

A 69

325

Mental deficiency

ILJ

DIL

A 10

330 - 334

A 71

340

A 72

345

A 73

353

Epilepsy

A 74

370 - 379

A 75

385

Cotaract

A 76

387

Glaucoma

Vascular lesions affecting central

mervous system

---

Nonmeningococcal meningitis Multiple sclerosis

Inflammatory diseases of eye

Carried forward...

572

1,613

353

647

713

6881

1,401

---

194

ITI

233

173

15,795 | 12,120

1,490 2,629

3,834 3.004;

6,838

E.J

Among these - 5 died of Al

2 died of A82

2 died of A2

1 died of A83

1 died of A50

3 died of A90

3 died of 470

1 died of A109

1 died of 480

1 died of A81

† 1 died of A90

141

APPENDIX 9-Contd.

Cases Treated

6,838

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

Whole Colony

ment

mtot

ment

Assisted

Hospitals

Assisted

Hospitals

Male Female

Sex Up-

known

TOLAI

142

Brought forward...

15,795 12,120 1,490 2,629 3,834 3,004

A 77 (c)

(5)

390

391 - 393

Otitis externa....

(0)

394

A 78 (0)

380 384,

Otitis media and mastoiditis Other inflammatory diseases of ear... All other diseases and conditions

386.

388 - 389

(6) 341 - 344,

350 - 352,

354 - 357,

of eve

All other diseases of the nervous system and sense organs

TIT

---

281

447

307

360 - 369,

395 - 398

A 79

400 - 402

A 80

410 - 416

A 81

420 - 422

A 82

430 - 434

Other diseases of beart

A 83

440 - 443

A 84

444 - 447

A 85

450 - 456

Rheumatic fever

Chronic rheumatic heart disease

Arteriosclerotic and degenerative heart disease

Hypertensive heart disease Other hypertensive disease Discases of arteries

---

495

263

125

186

177

390

128

+-+

414

336

750

313

гтг

---

893

298

255

239

494

163

337

178

136

314

tur

159

518

101

ד..

---

255

761

129

A 86

460 - 468

A 87

470 - 475

A 88

480 - 483

Other diseases of circulatory system Acute upper respiratory infections... Influenza

178

658

803

763

---

504

A 89

490

Lobar Pneumonia

121

A 90

491

Bronchopneumonia

... 1,079

3,389

421

1,307

1,181

1,133.

2,314

A 91

492 - 493

Primary atypical, other and

unspecified pneumonia

Carried forward...

123

154

20,449 | 20,938

2,159

4,594

6,204 5,218

11,422

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

Deathe

Detailed

List

Number

Cause Groups

Govern.

Gover

Govern-

Number

mcat

mtal

weat

Hospitals

Assisted

Hospitala

Hospitals

Assisted

Hospitals

Deaths

Whole Colony

Male

Female

Six Un-

known

Total

Brought forward...

20,449 20,938 2,159 4,584

6,204 5,218

11,422

A 92

500

Acute bronchitis

-- L

138

A 93

501 - 502

A 94

510

Bronchitis, chronic and unqualified. Hypertrophy of tonsils and

149

427

131

adenoids

---

627

A 95

518, 521

A 96

519

- - -

A 97 (0)

523

(6)

511 - 517,

Empyema and abscess of lung Pleurisy

Pneumoconiosis

All other respiratory diseases

108

101

...

---

· · ·

729

477

༄| }=|

42.

520, 522,

524 - 527

A 98 (a)

530

Dental Caries...

---

(b)

531-535

All other diseases of teeth and

supporting structures

296

A 99

540

Ulcer of stomach

847

600

A 100

541

Ulcer of duodenum

415

тгг

36;

11.

A 101

543

Gastritis and duodenitis

139

- F

A 102

550 - 553

Appendicitis

---

1,244

332

A 103

560 - 561

Intestinal obstruction and hernia

739

311

511

570

A 104 (a)

571.0

(5)

571.1

2 years and over

(c)

572

Gastro-enteritis and colitis,

between 4 weeks and 2 years Gastro-enteritis and colitis, ages

Chronic enteritis and ulcerative colitis!

714

2,051

499

372

280

652

---

991

654

121

76,

136

---

A 105

581

Cirrhosis of liver

370

285

166

217

+-+

+++

ITI

À 106

584, 585

Cholelithiasis and cholecystitis

181

124

Carried forward...

P+1

28,053 26,878

2,465

5,446

7,115

5,824

12,939

143

APPENDIX 9-Contd.

Cases Treated

Deaths

Inter-

mediate

Liat

Number

Detailed

List

Number

Cause Groups

Govern

ment

Hospitals

Govern.

meat-

Assisted

Hospitals

Govern.

macot

Deaths

Whole Colony

Hospitals

ment-

Assisted

Hospitals

Male Female

Sex Un-

koowa

Total

Brought forward...

28,053 26,878

2,465 5,446

7,115 5,824

12,939

A 107

536 - 539,

542. 544.

545,

573 - 580,

Other diseases of digestive system...

1,339

1,037

158

128

85.

216

582 - 583,

586, 587

A 108

A 109

590

Acute nephritis

591 - 594

A 110

600

A 111

602, 604

A 112

610

Chronic, other and unspecified

nephritis

Infections of kidney -

Calculi of urinary system

Hyperplasia of prostate

A 113

620, 621

Diseases of breast

A 114(a)

613

Hydrocele

LJ L

ILJ

(6)

634

601, 603.

605 - 609,

611-612,

614-617,

Disorders of menstruation

611 612, ||All other diseases of the

genito-urinary system

128

236

185

339

149

130

279

155

10+

IT I

359

167

108

HEL

172

418

---

1,367

1,505

622 - 633,

635. 637

A 115

640 641, 681 - 682,

684

Sepsis of pregnancy, child-birth and the puerperium

155

↓

---

A 116

642, 652,

685 - 686

Toxaemias of pregnancy and the

puerperium

760

218

---

Carried forward.......

32,852

30,992

2,742

5.590

7,447| 6,097|

13,544

144

145

APPENDIX 9-Contd.

Cases Treated

Deaths

Inter-

mediate

Detailed

List

Number

List

Number

Cause Groups

¦ Govern-

Govern-

Dient

Govern.

Whole Colony

Hospitala

wcot-

Assisted

Hospitals

weat

Hospitals

Assisted

Hospitals

Male Female

¡Sex Un

known

Total

Brought forward...

32,852

30,992 2,742 5,590 7,447 6,097

13,544

A 117

643 - 644

670 - 672

A 118

650

Abortion without mention of

---

A 119

A 120(a)

651

645 - 649

673 - 680

683,

(b)

687 - 689

660

A 121

690 - 698

Delivery without complication Infections of skin and

Haemorrhage of pregnancy and

childbirth

sepsis or toxaemia.

Abortion with sepsis...

Other complications of pregnancy, childbirth and the puerperium

7,588 ! 1,284

7,250 | 34,449

LIL

392

481

---

1,236

2,360

---

subcutaneous tissue

---

ז..

A 122

720 - 725

A 123

726 - 727

Arthritis and spondylitis Muscular rheumatism and

A 124

730

A 125

737

745 - 749

A 126 (0)

715

(b)

700 - 714

rheumatism, unspecified Osteomyelitis and periostitis Ankylosis and acquired musculoskeletal deformities Chronic ulcer of skin (including

tropical ulcer)

All other diseases of skin

1.197

607

116:

336

---

230

+-r

LIL

210

...

- JL

382

405

716

(c)

731 - 736

738 - 744

All other diseases of musculoskeletal system

A 127

751

Spina bifida and meningocele

294

Carried forward...

51,676

71,356

| 2,767 5,620 7,4671 6,156

13,623

APPENDIX 9-Contd.

Cases Treated

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

Govern.

| Govern-

botot

Govern-

Whole Colony

ment-

Hospitals

ment Assisted Hospitals Hospitals

ment-

Assisted

Hospitals

Male Female

Sex Un-

known

Total

51,676 71,356 2,767

5,620 7,467 6,156

13,623

A 128

754

A 129

750, 752,

753

755 - 759

A 130

760-761

A 131

762

A 132(a)

764

765

(c)

763.

766 - 768

A 133

A 134

770

769,

771, 772

Brought forward...

Congenital malformations of

circulatory system.......

All other congenital malformations...

Birth injuries...

Postnatal asphyxia and atelectasis... Diarrhoea of newborn (under 4 weeks)| Ophthalmia neonatorum

Other infections of newborn

Haemolytic disease of newborn

All other defined diseases of early infancy

-- L

---

224

263

131

428

刺的

103

459

- LJ

191

264

ITI

131

* 2 21885

142

132

172

105

277

A 135

773-776

Ill-defined diseases peculiar to

early infancy

---

608

1,212

160

695

640

515

A 136

794

Senility without mention of Psychosis

457

121

143 286

1,155

429

A 137(a)

788.8

Pyrexia of unknown origin.

371

(b)

793

Observation, without need for

(e) 780 - 787

788.1-788.7

788.9

further medical care All other ill-defined causes of morbidity

445

858

TIT

LIL

622

406

100

623' 693

1 1,517

789 - 792 ¦

795

146

Carried forward...

54,721 75,941 · 3,157. 6,772 9,614 8,023

1. 17,638

147

APPENDIX 9-Contd.

Cases Treated

Deaths

Inter-

mediate

Detailed

List

Cause Groups

Govern-

ment-

Govern

Govern-

Deaths

Whole Colony

Number Number

Hospitale

ment Assisted

Hospitals

medi-

Assisted

Hospitals

Mate Female

Sex Un

kodwo

Total

Brought forward...

---

54,721 75,941 3,157 6,772

9,614 8,023

117,638

AE 138 E810 - E835 Motor vehicle accidents

1,198

AE 139 E800- E802 Other transport accidents E840 - E866

10+

1,039

115

179

AE 140 E870-E895 Accidental poisoning..

JIL

E912

AE 141 E900 - E904 Accidental fulls AE 142

---

Accident caused by machinery

---

347

1,173

44.

137

236

AE 143

E916

Accident caused by fire and explosion of combustible material...

248

AE 144 E917, E918 Accident caused by hot substance,

corrosive liquid, steam and radiation

AE 145

E919

Accident caused by firearm

AE 146

E929

Accidental drowning and

submersion

r - r

867

10:

126

172

Carried forward...

---

59.918 75,993

3.399! 6,773 · 10,018, 8,260.

1 18,279

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

List

Number

Deaths

Detailed

List

Number

Cause Groups

Govern-

Cover-

Govern-

Gover-

Deaths

Whole Colony

ment-

Hospital.

ment Assisted Hospitals Hospitals

meat-

Assisted

Hospitals

Male

Female

Sex Un-

known

Total

Brought forward...

59,918

75,993 3,399

6,773 | 10,018' 8,260

1 18,279

AE 147

(a)

E920

---

(b)

E923

Foreign body entering eye and adnexa

Foreign body entering other orifice...

---

350

(<)

E927

Accidents caused by bites and stings of venomous animals and insects...

(d)

1928

Other accidents caused by animals....

(e) E910-E911; All other accidental causes...

·E913 - E915

3,613

E921 - E922

:E924 - E926]

148

E930 - E9651

AE 148

E970 E979 Suicide and self-inflicted injury

519 1

188

148

336

AE 149 E980 E985

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

---

125

AE 150 E990 E999, Injury resulting from operations

of war

ITI

---

GRAND TOTAL...

64,630 76,004 3.476

0,294 6.77410,294 8,443 1 18,738

APPENDIX 9-Contd.

Cases Treated

Inter-

mediate

Detailed

List

Number

Cause Groups

Number |

Govern

ment

Gover-

ment-

Deaths

Govern-

Deaths

Govern

Whole Colony

Hospitals

meat Assisted

Hospitals

ment-

Assisted

Hospital

Male Female

Sex Un.

koown

Total

149

AN 138

N800 N804 Fracture of skull

---

AN 139

AN 140

N805-N809 Fracture of spine and trunk N810-N829 Fracture of limbs

---

N839

467

107

161

---

371

1,632

110

1 1

AN 141 'N830- N839 Dislocation without fracture

AN 142

AN 143

N840 - N848' Sprains and strains of joints and adjacent muscle

N850-N856 Head injury (excluding fracture)

3,169

105

142

217

AN 144

N860 N869 Internal injury of chest. abdomen

and pelvis

230

AN 145 IN870 - N908 AN 146 N910- N929

Laceration and open wounds

1,238

Superficial injury, contusion and crushing with intact skin surface...

199

Burns

AN 150

AN 147 'N930-N936 Effects of foreign body entering

through orifice

AN 148 N940-N949 AN 149 N960-N979. Effects of poisons

N950-N959 All other and unspecified effects

·N980 - N999- of external causes

400

↓

г- -

огт

...

1 F

1,103

---

796

100

---

■+1

174

242

132

374

TOTAL...

9,909

319

680

420

1,100

150

Institutions

GOVERNMENT HOSPITALS;

APPENDIX 10

NUMBER OF HOSPITAL BEDS IN HONG KONG 1961

Medical

Surgical

Gynaeco

logical

Tuber-

culosis

Paychiatric Maternity

lofectious

Observa-

tion

Total

Queen Mary

---

IL.

+++

Kowloon

158

---

Castle Peak

PII

H.K. Psychiatric Clinic

יוי

Sai Ying Pun

Tean Yuk.....

---

ILI

Lai Chi Kok

ייי

---

гг.

Woo Chai

---

110

St. John

---

South Lantau

·PI

601

526

(*)1,119

1,119

200

180

150

479

(6) 30

---

100

ILI

r+d

4 Prison Hospitals

COVERNMEnt DispensABIES AND

MATERNITY HOMES;

(d) 97

(a) 39

186

584

641

212

1,170

346

303

3,358

Aberdeen

---

Earlern

711

+44

Kennedy Town

ILL

- г

...

Stanley

LIJ

LLI

---

Hung Hom

---

Tai Po

---

Yuen Long

---

ILI

+74

Sha Tau Kok

---

· PI

Shek Wu Hui

---

ггг

Họ Tung

---

TOL

Sai Kung

---

LLI

Ti0

Sao Hui

---

LII

+44

---

-LI

Sha Tin

---

Silver Mine Bay

100

---

Maurine Grantham

North Lam.m.a

11-

---

Peor Chau

--L

---

Shek Pik First Aid Post

---

2:25

• 19

344

APPENDIX 10-Contd.

Institutions

GOVERNMENT-Assisted HOSPITALS!

Hei Ling Chau Leprosarium Haven of Hope T.B. Sanatorium Sandy Bay Convalescent Home Maryknoll Mission

ILI

(0) 40

1,185

440

206

PRIVATE HOSPITALA:

Hong Kong Sanatorium

Precious Blood

---

St. Teresa'

CLOOMAL

LLL

St. Paul's...

IIL

100

(/) 94

---

(k) 288

---

Hong Kong Central

Matilda & War Memorial

Children's Convalescent Home.

---

огг

...

ILL

+++

Fanling

JLL

---

Nansen T.B. Rehabilitation Centre

---

Cheung Chau ...

PRIVATE MATERNITY Homes

Medical

Surgical

Gynaeco-

logical

Tuber-

sychis Psychiatris| Maternity culosis

Observa-

Infectious

Total

tion

Tung Web

151

Tung Wah Eastern

---

147

Kwong Wah

LIJ

---

Alice Ho Miu Ling Netherole Ruttoujee Sanatorium

---

(g) 563

(b) 107

138

---

LLL

Grantham

110

---

Pok Di

---

PIL

2285

(f) 217

126

336

529

210

3397|18|||2|§. GA | KARA" |

716

336

1,274

281

336

540

114

540

210

1,481

580

574

4,4-66

3.00

106

288

190

172

PRIVATE NURSING HOMEL:

---

GOVERNMENT HOSPITALS, Dispensabin AND MATERNITY HOMES:

GOVERNMENT-ASSISTED HOSPITALS: PRIVATE Hospitals, MaTERNITY HOMES AND NURSING Hours:

GRAND TOTAL

ILL

733

234

132

134

480

603

641

213

1,170

571

303

14-

1.185

440

206

1.481

$80

$74

775

234

132

652

110

2,563

1,315

337

1,825

1,170

1,803

905

1,316

480

3,602

4,466

1,876

9,944

151

Remarks: (a) Including 120 beds in Drug Addiction Centre. Including 4 cots and 4 cradles.

Including 69 beds used for either medical or surgical canes. (e) Including 29 beds in Psychiatrie Observation Unit, Victoria Remand Prison.

(ƒ) Including 86 beds in Infirmary, Sandy Bay.

(g) Including 121 bada used for either medical or surgical cases in Infirmary at Kwong Wah Hospital.

(A) Including 45 bede used for either medical or surgical cases. Used for either medical or surgical cases.

General beds.

Casualty holding beds.

APPENDIX 11

IN-PATIENTS ADMITTED INTO GOVERNMENT, GOVERNMENT-ASSISTED AND PRIVATE HOSPITALS IN 1961, INCLUDING CASES REMAINING IN HOSPITALS FROM THE PREVIOUS YEAR

NAME

Government Hospitals:

General

Bed.

ID- Tuber. Mater. Pay- fections culosis nity chiatric

Tota

CALLI

cases

сант

Castle Peak

• 1,119

§ 3,085

3,085

107

---

Queen Mary Kowloon

Lai Chi Kok

THo Yuk

St. Jabo

Sai Ying Pun

Wan Chai

South Lantau

H.K. Psychiatric Clinic

4 Prison Hospitals

Dispensaries and Maternity Homes...

601

15,685

176

2,324

18,247

LLL

-- L

---

526

18,918

255

256

4.749

24,208

479

407

1,005

366

2,658

---

200

1,131

7,965

9,096

---

100

1.196

127

588

1.966

680

1,455

2,163

---

274

308

---

104

---

148

186

2,055

291

206

2,647

244

15,289

TOTAL

-~-

3,602

40,439

3,835

1.244

30,931

3,470

79,919

Government Assisted Hospitals :

Tong Wah Group Grantham

---

Hei Ling Chau Leprosarium Ruttonjee Sanatorium

Alice Ho Mi Ling Nethertola

Haven of Hope Tuberculosis.

Sanatorium

Pok Oi ...

---

Maryknoll Mission

Sandy Bay Convalescent Home

TOTAL

2,326

26,879

341

1,591 32,710

61,521

540

1,267

1,272

540

667

---

336

967

1,014

201

4,286

2,480

6,851

+ 250

426

429

---

LII

118

2,572

1,512

4,084

LII

---

107

166

ггг

4,506

33,820

1,061

4,421

36,702

76,004

Private Hospitals:

Hong Kong Santorium

St. Teresa's

CEROHA

St. Paul's

PPI

Precions Blood

LII

Hong Kong Control

Matilda and War Memorial...

Fanling ..

ILI

Children's Convalescent Home,

Cheung Chau

11-

Nursing Homes and Maternity Homes

300

7,120

200

1,837

193

9,550

---

LL.

288

4,593

230

176

959

5,983

100

---|

190

1,799

139

1.959

174

1,866

102

227

740

2,935

---

106

2,056

119

192

2,397

2,702

314

2.998

779

128

916

775

910

ILI

560

1.523

51 38,734

40,364

1,836

23,230

660

917 42,971

251

68,029

9,944 97,489 5,556

6.58110,604 3,721

223,952

TOTAL

GRAND TOTAL

•

Including 130 beds in Drug Addiction Treatment Centre.

§ In addition, there were 163 Drug Addicts treated in Drug Addiction Treatment Centre.

† Including Nansen T.B. Rehabilitation Centre.

Opened in September 1961, not started to take in-patients.

152

APPENDIX 12

OUT-PATIENTS. 1961

NEW CASES AT GOVERNMENT AND GOVERNMENT-ASSISTED HOSPITALS, CLINICS AND DISPENSARIES

Dress inga

General C#.

Onl. dren's patients Clinics

nuta!

Ante- Post- Gynaeco Social

Datal fogical Hygiene

Eyt

Exc. Nose & Throat

Tuber. culovir

Casualty

Ortho- pardic

Leprosy

Paychin Derma

triç tological

INSTITUTIONS

261 2,386

35,373 86,218 3,177

454

124

181

760

1,674!

606

Government Hospitals:

Queen Mary

9,221

504

Kowloon

51,763

145,230)

157 840

618 3,958)

385. 1,696

519 1,876

237

Tux Yuk

€35

6,733)

3,333

St. Joba

1,444

10.966

16,698

South Lantau

955

Stanley Prison

3,333

$7,823

Victoria Remand Prison

12,607

...:

Lai Chi Kak Female Prisno

14,988

Tri Lam Chung Prison

1,413

1,791

Clinics and Dispensaries:

26 181,

Total

47,435

295,146

10,699

30,334

1,301

44,319

13,267

14,988 4,039

　　　　　　　　　H.K. Psychiatric Clinic Sai Ying Poo

Violet Peel

40,101

09,445 73.745 1,500 79,056

70,741

Ophthalmic Cale

Wan Chei Chest Clinic..

Sai Ying Pun Chest Clinic

12010

2,130

2,390

1.486 047

969

2,080

65,630

TEET

1.116

I.L16

$75

179,144

250

193,075

65,638

11,210

11,326

5.774

Kowloon Cheat Clinic

L1,010

Shek Kip Mc Chest Clinic

11,033

7,850

Secial Hygiene Clinic

Families Clinic, Hong Kong

2,035

Families Clinic, Kowloon

936- 10,247

Police Medical Post. Hong Kong

5,601)

6,927)

6,407,

141

209

Police Medical Port, Kowloos...

4,600

0,938) 13.168

25,519

7,039

594

5.772

32,185

2.971

10,634

Police Quarter Clinic, Cheung

She Wan

249

418 41

20.033

26.823

1,500

6,087 L5,100

Victoria Remand Prison

22.081

Families Clinic

13'

975:

Stanley Prison Families Clinic

1,079

8,564

Chi Mi Wan Prison Clinic

2,257

4,116)

Kowloon-Canton Railway Clinic

1.192.

1.380

896;

Mt. Butler Quarry Clinic

794

905

Part Health Medical Poals

1,577

! ! | | | │

Public Dispensaries Hong

| | | | | |

988

9,643

6,373

3,468

2,504

1,577

Kong & Kowlood

123,356

413,808 154,495|

3,035

720.

1,800|

394

4.497

972

New Territories Dispensaries...

23,316

96,548) 95,000 12,038

942

912

5,620

1,008,

351 2,596

1,743. 15,447

552

706,126

મા

253,635

Maternal and Child Health

Central:

Harcourt

Western... Chai Wan

Central

Aberdeen

Kennedy Town

Kowloon

3,714.

352

3,749

243

1,3231

507

2,4041

150

2,180

1,670

2,647,

367

4,592

| | | | 11 |

Ho Man Tin

1,551

17B

Shek Kip Mei

8,801 1,660

205: 95

4,373

4.394

3,336

2,672

4,168

3,219

5,876

1,934

[1,449

Total of Government

Costitutions

280,433

953,964 479,196 34,952| 10,398

6,695 29.935

78,523

7,327

40,097 142,388) 2,715. 1,023

-| -

1,416 7,219!

2,076,261

Tung Wab Group of Hospital." 12,112

Allee Ho Mia Ling

Netherale Hospital...

166,420 39,295 33,153'

2,772

7,153 1,180 2,084 1,250[ 5,661

428

5,221

2,973

1,177

607

287

264,385

16,428

Ruttonjes Sumatorium.....

Grantham Hospital

Pak Oi Hospital

$12

13.642 21,371 1,556

$7,041

Rennie's Will Church Ginic Maryknoll Mission Hospital

Total of Government-Assisted

Justitutions

GRAND TOTAL...

1,224

154

142

2,480

1,057

1,857

12,606 191,296 61,976| 37,593 1,678 8.433

―

5,375

8.973

1,294

607

287

324.200

293,177) 1,145,260|| 541,172 72,545 12,076 15,120 29,935 23,898 10,200

41,393||| 142,995

3,002

1,023 1,416 1,249

2,400,469

• Patients seen at University Eye Clinics.

153

APPENDIX 13

OUT-PATIENTS 1961

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

INSTITUTIONS

Drti

ings

General Chit

Onl- Patients

drea's Clinic

Ante. .Datal

لفادي

Past Gynaeco Social

logoal Hygiene

Eye

ELT, Nove & Throat

Taber. culosis

Casualty

Ortho- predic

Leprosy

trio

Payobla". Dezza:

tological

Total

Covernment Hospitals'

Queen Mary

9.281'

746)

272

3.835

Kowloos

#57,531

203,928 9,011

20,892

5'8 1,0*9

249

5,200

435 B.35.5.

41.934 06.218

421 12,632

Tean Yuk

1,975!

37,158

3,925

$t. Jubo

1.192

13,187 19.865

1,916

1,469

124

South Lantza

1014

2,155

19+

Stanley Prison ...

17,348

79,151

Victoria Remand Prison

1,321

41,298

Lai Chi Kok Female Prison

14,900.

Tai Lan Chung Prion

3,860

74,0711

| | ¦ ¦ !

2,251

92.444

2,661

2,939

856:

Clinics and Dispensaries :

　　　　　　　H.K. Psychiatric Clinic Sui Ying Pun

141516

138,322, 106.415 112,1021 45.290

6.092

! | |

$8,559 505.654

43,058

38,353

3,393

245 404

184,256

43,023

14,988

81,734

10,752

2,254,

327,143

344,261

181,121

395,919

363,430

706,503

330,118

219,325

13,911

10,414

34,564

36,446

33,767

1,017

15,454

12.222

4,396

$,058

1,782

5,328 1,130)

1,214 1,128,501

432,253

Violet Prel

Ophthalmic Clinica

Wan Chai Cheat Clule Sai Ying Pun Chest Clinic Kowloon Chest Cliais....

　　　　　　　Shek Kip Mei Chest Clinic Social Hygiene Clinics.....

Families Clinic, Hong Kong Families Clinic, Kowloon

102,049

2,035 347

11,876)

10,247

Police Medical Posi, Hong Kong, Police Medical Pon, Kowloonj Police Quarters Clinic, Cheung,

She Wan

10,549

1,091

11,691 11,099 13,061) 17,175,

142

! ! | ¦ ¦

13,539

• 4,662

5.100

7,800

181,121

$95,040

769

1101

360,793

2,606

706,600

1,650

245

329,950

168

: : | |

22,015

14,241

Victorin Remand Prison

Families Clinic

Staaley Prison Families Clinic Khi hồ Tan Prican Clini

　　　　　　　Kowloon-Canton Railway Clinic ML. Butler Qarry Cinie Part Health Medical Pants

Public Dispensaries Hong

　　　　　　　　Kong & Kowloon New Textories Dispensacim

.. 293,322

39.

978

12.629

1,76

1,12

2.021

2.469

1.702

|| | . |

80.740

606,660

　　　925 117,353 112,979 47,930, 1---

103,069 12,133

2,314

1,247 9.234 3,306 12,907

4,173 2,792 47,390 15,417

1,743

Maternal and Child Healch

LIL

Centre:

Harcourt Western... Chai Wan Central Aberdeen

Keanedy Town Kowloon

Ho Man Tin

39,555 2,212

40.735

16,961 1,326

30.695 16,959 4,798

682

23,795 1,391 $1,843 $,001

205

19,370

207

47,252

41,965

18,770

JJ,519

$1,147

25.391

57,784

20.389

71,770

Shek Kip Mei

63,305 1,121 1,26

Total of Goverment

Institutions

499,248 1,484,710

672,226 154,260| 12,992

22,766 192,380| 209,473| 22,263] 1,931,847 150,959 25,984 29.978|

11,826

L8,780 6,038,592

Tung Wah Group of Hospitalı

Alier Ho Miu Ling Nethersole

Hospital

37,156

540

439,616| 121,794| 41,504 605 6,967

21,258 5,554 14.637 1,250) 10,855

16,757

11,490 17,918

607 1,376

595,948

62,102

Bullonjer Sawatariama

12,49)

12.491

Grantham Hospital

301

Pok Oi Hospital

L. TIG

Rennie's Mili Church Clinic

Marykno(c) Mission Hospital ..

Total of Government-Assisted

Institutions

28,884 4.495 2,079

39,550

74,402

293

283

5.07L

2,079

וח-

39,420 496,332 166,498 60,473 1,935 25,022

17,050

11,408 30,993

607 1,376

$52,394

GRAND TOTAL...

IRI

938,668| 1,981,042, 1,039,124 214,739, 14,927 48,588) 192,200| 226,523]

32,751 1,962,840 151,566 27,360, 29,978 11,626| 18,780| 6,890,986

* Patients seen at University Eye Clinic..

154

APPENDIX 14

NEW TERRITORIES CLINICS, 1961

Out-patient Attendances

Deliveries

Dispensaries

New Cases

Total Attendances

In-patients Domiciliary

Tai Po...

Ha Tung

Sha Tau Kok

Sha Tin ...

Yuen Long

San Hui

Sai Kung

Shek Wu Hui

Tai O

---

Silver Mine Bay

TII

FIL

37,831

64,719

1,752

1 I

2,908

5,711

545

- L

9,916

21,761

465

7,925

13,123

596

42,347

84,010

2,170

LJL

---

3,685

8,766

985

9,615

17,954

428

21,500

35,341

773

22,433

27,530

384

...

9,179

12,512

202

Peng Chau

ILI

---

6,629

9,067

158

Maurine Grantham

North Lamma...

Shek Pik First Aid Past

Sai Kung Travelling

Tai Po Travelling (East)

Yuen Long Travelling (West)...

---

53,961

112,227

2,329

6,287

9,083

4,602

6,927

|***

355

603

5,210

5,829

946

985

Chee Hong Floating Clinic

L-L

3,587

Chee Wan Floating Clinic

---

4,711

12,518

Total

253,635

452,253

10,850

155

APPENDIX 15

GOVERNMENT INSTITUTE OF PATHOLOGY 1961

(a) SPECIMENS EXAMINED

(1) Protozoology and Helminthology

I LI

32,346

(2) Haematology

(3) Serology

(4) Bacteriology (5) Mycology

(6) Public Health

(7) Histopathology

---

128,176

-TI

TII

1-1

145,500

---

TIT

...

tur

203,788

---

1,273

L+I

LJ L

J-I

---

TIP

8,073

---

4,334

(8) Biochemistry

(9) Clinical Pathology Examination

+++

++L

ILI

65,598

27,491

(10) Special Investigation...

115

Grand Total

---

616,694

(6) NOTIFICATIONS OF ANIMAL BITES

The following animal bite notifications were received during 1961:

Hong Kong

Kowloon

ILI

Total...

Dog Cal Monkey

Pig

Other Animals

Total

1,670

121

1,803

2,928

3,027

... 4,598

200

4,830

Advice was given as to anti-rabies vaccine treatinent and the following returas were received during 1961:

Chinese ...

Non-Chinese

Total ...

Treatment completed

Treatment not Treatment not completed required

Tota!

702

1,577

2,448

4,727

103

733

1.612

2.485

4,830

156

157

APPENDIX 16

SAMARITAN FUND

INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED 31ST MARCH, 1962

EXPENDITURE

Maintenance, capital grants, clothing, food and

travelling expenses, etc. Balance carried to Accumulated Fund

$21,059.70

Donations

---

587.30

$21,647.00!

BALANCE SHEET AS AT 31ST MARCH, 1962

LIABILITIES

Accumulated Fund as at 1.4.61 Surplus from Income and Expenditure Afc.

Certified correct.

G. AGABEG,

INCOME

$21,647,00

$21,647.00

ASSETS

$19,875.15

Cash with Accountant General

$20,462.45

587.30

$20,462.45

Certified correct.

MAURA BENHAM,

for Director of Medical & Health Services.

1. 6. 1962.

Principal Almoner, Medical & Health Department. 1. 6. 1962.

CERTIFICATE OF THE DIRECTOR OF AUDIT

The above Balance Sheet and the accompanying Income and Expenditure Account have been examined in accordance with Condition 5 of the Schedule to Legislative Council Resolution dated 24th May, 1950 (G.N.A. 113 of 26th May, 1950 amended by G.N.A. 33 of 22nd April, 1960). 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 Balance Sheet and Income and Expenditure Account are correct.

AUDIT DEPARTMENT,

Hong Kong, 7th July, 1962.

REPORT ON THE SAMARITAN FUND, 1,4.61 - 31.3.62

W. J. D. COOPER, Director of Audit,

Expenditure from this Fund has risen considerably, due partly to the opening of the new mental hospital 22 miles from the muin urban areas. The total amount spent during this financial your was $21,059.70. The main item of disbursement was on grants to patients and relatives for travelling expenses.

Donations for the same period totalled $21,647. The donors were: Royal Hong Kong Jockey Club $12,000, the Hong Kong Jockey Club (Charities) Ltd. $3,000, the Hong Kong and Shanghai Banking Corporation $1,000, Chinese Temples Committee $5,000. Miscellaneous donations accounted for the balance of $647.

Maura BenHAM, Principal Almoner.

epe

SONG KONG

Code No.: 0344862