RBB 40w
ANNUAL
DEPARTMENTAL
REPORTS
ONG
KONG
1962-63
THE ROYAL SOCIET for the Promotion OF HEALTH LIBRARY
RBB/40w
DIRECTOR OF MEDICAL
AND HEALTH SERVICES
27537.
22501293356
HONG KONG
ANNUAL DEPARTMENTAL REPORT
BY THE
DIRECTOR OF MEDICAL AND HEALTH SERVICES
D. J. M. MACKENZIE
FOR THE
FINANCIAL YEAR 1962 - 63
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).
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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
26
27
28 - 37
38 - 41
42
43
45 - 63
64 - 67
68 - 72
III. WORK OF THE HEALTH DIVISION
Hygiene and Sanitation
Urban Areas
Rural Areas
Epidemiology
Quarantinable Diseases
Cholera
Notifiable Diseases
J
73 - 75
Ꮀ
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76
Other Communicable diseases which are not
notifiable
Tuberculosis
Malaria Bureau
Social Hygiene Services
Port Health
77
78 - 94
95 121
-
122 123
--
124 - 180
181 189
190 - 202
203 - 209
+
jii
III WORK OF THE HEALTH DIVISION Contd.
District Midwifery Services
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Maternal and Child Health Services
School Health Services.
Paragraphs
210 - 214
215 - 221
+
·
222 - 228
Dental Service
229 - 237
Forensic Pathology
238 - 240
Government Chemist's Laboratory
241 - 251
Government Institute of Pathology
252 - 268
Industrial Health.
269 - 273
Health Education.
274 - 277
IV. THE WORK OF THE Medical DIVISION
278 - 279
Hospitals
280
H
282
Government Hospital
Government-Assisted Hospitals
Outpatient Services
Specialist Services
283 - 341
342 - 360
361-367
368
369 - 380
Radiology
Ophthalmology
The Pharmaceutical Service
+
+
381 385
-
386 - 389
390 - 402
The Almoner Service
Physiotherapy
403 - 408
Occupational Therapy
409 - 416
Orthopaedic and Prosthetic Appliances
417 421
-
Medical Examination Board
422 - 424
Hospital Maintenance and Supply
425 - 430
Auxiliary Medical Services
431 440
-
iv
V. DEVELOPMENT PROGRAMME
Planning Unit
Building Programme
VI. HOSPITAL COSTING
VII. TRAINING PROGRAMME
Doctors
Dental Staff
Nurses.
Midwives
Health Visitors
Radiographers
Laboratory Technicians
+
+
+
C
Physiotherapy
Other Forms of Departmental Training
Courses of Study Overseas
VIII. MISCELLANEOUS
Attendances at Conferences and Meetings
Visitors
Publications
+
Obituary
ACKNOWLEDGMENT
IX. MAPS
X. APPENDICES
T
V
Paragraphs
441
444
445
446
447 - 450
451 - 453
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454 - 456
457 458
459
460
-
461 462
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463
464 - 466
467
468
469
I
470
471
472 - 473
Digitized by the Internet Archive in 2019 with funding from Wellcome Library
https://archive.org/details/b31406105
1. GENERAL REVIEW
THE estimated mid-year population of Hong Kong in 1962 was 3,400,300 of whom some 40% are aged 15 years or younger. Living under condi- tions of average densities of 1,800 -2,000 to the acre in the urban areas with intermittent water supplies and some 25% of the urban population depending on a night soil conservancy service for sanitation, environ- mental conditions inevitably predispose to the transmission of the communicable diseases. The standard of nutrition is generally good, there is relatively full employment and standards of living are rising steadily as the rehousing programme develops.
2. Despite the conditions of over-crowding, the necessity to store water in tenement houses and the environmental conditions in the older tenement houses along the waterfronts and in the central districts of Hong Kong Island and the Kowloon Peninsula, the community health record during the year was remarkably good. The crude death rate remained low at 5.9 per 1,000 and the infant mortality rate declined further to 36.9 per 1,000 live births. The neo-natal mortality rate has remained relatively constant over the past four years ranging between 20.9 and 21.3 per 1,000 live births. The birth rate fell from 34.2 per 1,000 in 1961 to 32.8 per 1,000 in 1962 and the maternal mortality rate continued low at 0.48 per 1,000.
3. There were three important events which posed a definite threat to the public health. The first was the sudden and unexpected influx of illegal immigrants numbering some 140,000 in May and June. Later, in August, cholera El Tor again re-appeared and on the 1st of September, typhoon Wandu, which was the worst typhoon the Colony had experi enced since 1937, rendered many thousands homeless and made neces- sary many emergency centres for their reception and feeding. Despite these events, there were no related outbreaks of epidemic disease.
4. The large influx of illegal immigrants at a time when cholera might be expected to recur had apparently no influence on the outbreak which began at the end of August. A number of immigrants were examined during the influx and the night soil from latrines at the recep tion centre where illegal immigrants were detained was investigated bacteriologically with entirely negative results.
1
5. The most important medical finding amongst these immigrants was the high incidence of active tuberculosis in the older age groups; some 68,000, who were permitted to stay in the Colony, were required to undergo a chest X-ray during the process of registration and the issue of identity cards. The findings are described in some detail later in this report, under the section dealing with tuberculosis.
6. There is reason to believe that among the motives prompting in- dividuals to come to Hong Kong from China is a need for medical treatment. Certainly many of those who do come legally or illegally are very soon to be found at Government clinics. The impact falls most heavily on the Government tuberculosis, leprosy and mental health services.
7. A very significant and important event during the year was the visit by Professor F. HEAF, C.M.G. and Dr. Wallace Fox who came at the invitation of Government to make an assessment of the current status of tuberculosis as a community health problem. Their report and recom- mendations concerned the provision of enhanced facilities and staff for the Government Tuberculosis Service, the development of additional case finding, bacteriological and B.C.G. vaccination services, the ratio to population of hospital beds for the inpatient treatment of tuberculosis and the urgent need for research to guide policy planning for the future.
8. The Report was accepted in principle during October by Execu- tive Council, subject to detailed examination of the implementation of the recommendations. The Report was then referred to the Medical Advisory Board which consulted the various voluntary agencies engaged in tuberculosis control and it was still under consideration by the Board at the end of the year.
9. On the 22nd August, cholera re-appeared in the Colony and over the next six weeks, a total of eleven clinical cases occurred. The only fatality was in a man who had been ill for three days before being sent to hospital and who died on admission, before treatment could be start- ed. The whole Colony was declared an infected local area on the 23rd of August and the last case in the urban districts occurred on 20th September. One further case, the last in 1962, appeared in a village community in the New Territories on the 12th October.
10. Again there was a very widespread distribution of cholera vibrios throughout the community with remarkably few clinical cases presenting as a result. Strict quarantine measures were applied to all contacts of clinical cases and the appropriate environmental preventive precautions
2
strictly enforced. Nevertheless, using the communal night soil as an indicator, the only conclusion to be reached was that there were large numbers of undetected carriers, excreting cholera vibrios, at large in the Colony.
II. A mass immunization campaign using cholera vaccine prepared in the Government Institute of Pathology had been conducted in February, March and April 1962, when 53% of the total population received vaccine. During the outbreak itself a further million people were inoculated. In assessing the epidemiology, it appears probable that the immunity induced by wide scale vaccination greatly reduced the attack rate of the disease in the face of the widespread distribution of the cholera vibrios.
12. During the outbreak, the routine sampling of night soil was in- tensified and from the 29th October, 1962 to the end of March 1963, no further cholera vibrios were isolated.
13. Of the other communicable diseases of importance, poliomyelitis and measles showed unusually high incidence. The notifications of paralytic poliomyelitis during the year were the highest on record and the vaccination campaign using a Sabin type oral vaccine, which was conducted in two phases in January and March 1963, is believed to have cut short an epidemic of some proportions in which Type 11 and Type III polioviruses were playing a predominant part. In previous years, Type I virus had been almost exclusively the agent responsible for paralytic disease.
14. An epidemic of measles of considerable size and virulence occur- red in the winter months of the year under review following a period of 18 months during which the incidence was unusually low. The common fatal complication was broncho-pneumonia and an investigation carried out by the Paediatric Unit in Kowloon Hospital showed that the age group most vulnerable to this complication was that of 6 months to 2 years of age.
15. The Working Party set up to advise Government on the organi- zation and scope of a comprehensive School Medical Service began work in May 1962 under the Chairmanship of Dr. the Hon. A. M. Rodrigues, O.B.E., E.D. The intention is to establish a voluntary contributory scheme whereby the school children participating will receive physical examinations at prescribed intervals by private medical practitioners who will also supply curative treatment for ailments normally dealt with in a practitioner's consulting room. The Report of the Working Party was
3
submitted to Government in March, 1963. Government will continue to provide for all schools the existing services for the prevention and con- trol of communicable disease, including immunization programmes and environmental health services.
16. The pressure on general hospital beds continued unabated, and, in fact, increased. This was barely contained by the use of camp beds in wards, on verandahs and wherever else they could be fitted in. The rapid rate of turnover of patients in the acute wards was also maintained by utilizing subsidiary convalescent beds wherever they could be found. In meeting this pressure, the Tung Wah Group of Hospitals played a significant complementary role, particularly in Kowloon where, from February 1963 onwards, the Kwong Wah Hospital accepted direct, from the Kowloon Hospital Casualty Department, up to 25 emergencies each day.
17. The Castle Peak Mental Hospital of 1.000 beds, opened in March 1961, was also under heavy pressure. By the end of 1962, it had been necessary by rearrangement of ward accommodation to increase the nominal bed strength to 1,119 beds. Despite this increase, the parole system continued to be extensively used as well as the day out-patient centres on Hong Kong Island and, later, at the Queen Elizabeth Hospital Specialist Clinic in Kowloon.
18. The general hospital building programme is going ahead rapidly and some temporary easing of the pressure on acute beds in Kowloon is hoped for in 1964 when the new Kwong Wah Hospital re-development plan for 1,270 beds and the new Queen Elizabeth Hospital have been completed.
19. The Queen Elizabeth Hospital of 1,338 beds is to be formally opened early in September 1963, and with this in view a Commissioning Unit consisting of the designate Medical Superintendent, Senior Matron and Senior Hospital Secretary was formed in January 1963. The greater part of the equipment for the hospital which had been ordered from outside the Colony had arrived by the beginning of 1963 and it is anti- cipated that all patients will have been moved from the existing Kowloon Hospital to the Queen Elizabeth Hospital by the end of December 1963. Kowloon Hospital will then be renovated and modified, to function as a general rehabilitation centre of 304 beds complementary to the Queen Elizabeth Hospital and as a medical and surgical tuberculosis centre of 184 beds.
20. During March 1963 site works started at the Queen Mary Hos- pital preparatory to the extensions necessary to modernize this Govern-
4
ment Hospital which was first opened in 1938 and which is also the Teaching Hospital for the University Medical School. The extensions will include new operating theatre suites, a new radiology department, ward units for an additional 180 beds and enhanced teaching facilities designed to accommodate an increased intake of medical students.
21. Voluntary agencies are also engaged in general hospital develop. ment projects. The Tung Wah Hospitals Board opened an extension of 180 beds at the Sandy Bay Infirmary on Hong Kong Island in December, 1962, and plans were in hand to build an Infirmary of 210 beds at Wong Tai Sin in Kowloon. In Tsuen Wan, work had started on the 72 bed Seventh Day Adventist Hospital and the Yan Chai Hospital Board was incorporated by statute, preparatory to raising funds to build, initially. an hospital of 100 general beds, also in Tsuen Wan. Proposals submitted by the Protestant Churches to build a general hospital of 600 beds in Kowloon, to be known as the United Protestant Hospital, were also under consideration by Government.
22. The Government outpatient clinic building programme is also going ahead. In North Point on Hong Kong Island, the Anne Black Health Centre was opened in September 1962 by Lady Black, the wife of His Excellency the Governor. Named after Lady Black as a tribute to her practical concern for the welfare of the people of Hong Kong. half the cost of construction was donated by Dr. TANG Shiu-kin, C.B.E.. LL.D., and a group of his friends. Government met the other half of the building costs and equipped the clinic which is also being staffed and maintained by Government.
23. The Royal Hong Kong Jockey Club also donated two further clinics, the Queen Elizabeth Hospital Specialist Clinic and the Wang Tau Hom Clinic. The former is in the grounds of the Hospital and is designed to provide outpatient consultant and follow-up services main- tained by the clinical Specialist Units in the Queen Elizabeth Hospital. The latter is a standard urban type clinic which serves a new and rapidly growing resettlement estate. Both have been equipped by Government and are maintained from public funds.
24. At San Po Kong on the outskirts of the Wong Tai Sin Resettle- ment Estate, the foundation stone of another standard urban clinic was laid by His Excellency the Governor Sir Robert Brown BLACK, G.C.M.G., O.B.E., in February 1963. To be named the Robert Black Health Centre, this clinic has been built as the result of a generous personal donation of half the construction cost by Dr. TANG Shiu-kin,
5
and the architect, Mr. W. SZETO, has given his professional services free as his contribution. The remainder of the cost of the construction, the equipment and the maintenance is being provided by Government.
25. A feature of Hong Kong has always been the philanthropy of her citizens. Another notable event was the inauguration of the Li Shu Fan Foundation for Medical Education and Research. This inauguration took place in March 1963 during a meeting of the Hong Kong Chapter of the American College of Chest Physicians. His Excellency the Governor performed the Inauguration Ceremony which was attended by the President of the American College of Chest Physicians and a group of eminent physicians and surgeons from that College. Modelled on the Mayo Foundation. Dr. Li Shu-fan, M.B., F.R.C.S., LL.D., has made over to the Li Shu-fanı Foundation assets to the value of HK$18,000,000, the interest from which will be used to make grants for scholarships for medical and nursing undergraduate and postgraduate education, for medical research and for hospital treatment of the sick poor.
26. No report on the Medical and Health Services would be complete without an acknowledgment of the many and varied complementary activities carried out by a number of voluntary agencies. These activities range from the maintenance of large hospitals to assistance to individual patients who are handicapped by disease or disability. The major volun- tary agencies which assist the Medical and Health Department in the care, rehabilitation and social aid of the sick and handicapped are listed in Appendix 5 and their services are gratefully acknowledged.
ADMINISTRATION OF THE MEDICAL AND HEALTH SERVICES
27. Statutory responsibility for the administration of the services safeguarding the public health in Hong Kong lies jointly with the Direc- tor of Medical and Health Services, the Urban Council, the Director of Urban Services, the Commissioner of Labour and the District Commis- sioner, 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 sanita- tion in the urban areas of Hong Kong Island and Kowloon, through the Urban Services Department. The Director of Urban Services has execu- tive 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
6
to the Urban Services Department and the Labour Department has an Industrial Health section staffed by personnel of the Medical and Health Department.
STAFF
28. 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 appointed Official Member of the Legislative Council. He is a member of a number of the Boards and Committees of volun- tary 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 Councils or Boards dealing with the registration and disciplinary control of Medical Practitioners, Dentists, Pharmacists, Nurses and Midwives.
29. 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 environ- mental health matters. The Principal Matron is the Chief Nursing Officer and administers the Nursing Division which provides general and psy- chiatric nursing, midwifery and health visitor services. She is also a member of the Nursing Board and the Midwives Board.