醫務衛生署年報 Medical and Health Department Annual Report 1963-1964

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Queen Elizabeth Hospital opened on 10.9,63,

HONG KONG

ANNUAL DEPARTMENTAL REPORT

BY THE

DIRECTOR OF MEDICAL AND HEALTH SERVICES

P. H. TENG

FOR THE

FINANCIAL YEAR 1963 - 64

PRINTED AND PUBLISHED BY S. Young, GOVERNMENT PRINTER

AT THE GOVERNMENT PRESS, Java ROM, 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 INC. JTE

Coll.

Call

No.

WAZE

•JHE

CONTENTS

I. GENERAL REVIEW

Administration of the Medical & Health Services

Staff

Finance

Legislation

Paragraphs

1 - 22

24 - 32

33 - 36

39 - 57

58 - 60

Professional Registers

Work of the Statutory Councils and Boards

II. PUBLIC HEALTH

General Comments

Vital Statistics

III. WORK OF THE HEALTH DIVISION

Hygiene and Sanitation

Urban Areas

Rural Areas

Epidemiology

Quarantinable Diseases

Cholera

Notifiable Diseases

Other Communicable diseases which are not

notifiable.

Tuberculosis

Malaria Bureau

Social Hygiene Services.

Port Health

iii

61 - 65

66 - 68 69 - 70

71 72

73 - 90

91 - 114

115 - 116

117 - 167

168 - 177

178 - 190

191 195

III. WORK OF THE HEALTH DIVISION-Contd.

District Midwifery Services

Maternal and Child Health Services

School Health Services

Dental Service

Forensic Pathology

Paragraphs

196 - 201

202 - 207

208 214

215 220

221 - 222

223 229

230 - 254

255 - 258

259 - 262

Government Chemical Laboratory.

Government Institute of Pathology

Industrial Health

Health Education

IV. THE WORK OF THE MEDICAL Division

General Remarks

Hospitals

Government Hospitals

Government-Assisted Hospitals

Outpatient Services

263 264

265 266

267 - 320

321 - 343

344 - 349

Specialist Services

350

Radiology

351 - 363

Ophthalmology

364 - 368

The Pharmaceutical Service

369 - 372

The Almoner Service

373 - 384

Physiotherapy

385 - 389

Occupational Therapy

Orthopaedic and Prosthetic Appliances.

Medical Examination Board.

Hospital Maintenance and Supply

Auxiliary Medical Services

412 419

390 - 397

398 402

403 - 405

406 - 411

V. DEVELOPMENT PROGRAMME

Planning Unit

Building Programme

VI. HOSPITAL COSTING

VII. TRAINING PROGRAMME

Doctors.

Dental Staff

Nurses

Health Visitors

Radiographers

Laboratory Technicians

Physiotherapy

Paragraphs

420 - 424

424

425

426 - 429

430 - 433

434 - 438

439

440

441 - 442

443

Other Forms of Departmental Training.

444 - 446

Courses of Study Overseas

447

VIII. MISCELLANEOUS

Attendances at Conferences and Meetings

448

Visitors.

449

Publications

450

451

ACKNOWLEDGEMENT

IX. MAPS

X. APPENDICES

I. GENERAL REVIEW

THE Colony of Hong Kong occupies a land area of 3984 sq. miles, and the estimated mid-year population in 1963 was 3,592,100, of which 85% was concentrated in the urban areas of Hong Kong Island and Kowloon. It is a young population, approximately 40% being below the age of 15 years and only 5% over age of 60.

2. During the year, the major problems of overcrowding and of environmental hygiene, posed by pre-war tenement buildings and aggrega- tions of squatter and roof-top dwellings, were aggravated considerably by a serious shortage of water, the worst in the Colony's history; the total rainfall for 1963 amounted to only 35.48 inches, representing less than 42% of the normal annual rainfall. Accordingly, severe water restrictions had to be enforced and the great majority of the population were restricted to a four-hour mains supply every fourth day. As could be expected, many turned to other sources for augmentation of their water supply, and intensive chlorination was undertaken wherever possible of wells and of water obtained from other sources such as hill streams.

3. Despite the twin hazards of severe restriction of mains supply and use of water from suspect sources, there were only slight increases in the incidence of gastro-intestinal diseases. Even the re-appearance of cholera El Tor in June did not result in a widespread outbreak. In all, 115 cases of this disease were reported during 1963, occurring sporadi- cally between 29th June and 21st December; one further case was notified in February, 1964. The outbreak is reported in detail elsewhere in this report.

4. In spite of at the environmental hazards, the community health record during the year remained remarkably good. Both the crude death rate and the infant mortality rate declined further, the former to 5.5 deaths per 1,000 population and the latter to 32.9 per 1,000 live births. For the first time in five years the neo-natal mortality also showed a fall, from 21.2 per 1,000 live births in 1962 to 18.9 per 1,000 in 1963.

　　　5. A gratifying feature of the year was the great reduction in the incidence of paralytic poliomyelitis as a result of the mass vaccination campaign, using a Sabin type oral vaccine, which was conducted during the first quarter of 1963. Following this campaign, there was a sharp

decline in the number of cases reported and not one notification was received during the months of June, July and August, a period which had shown the peak incidence in previous years.

6. Past reports of the Medical and Health Department have made repeated mention of the increasingly heavy demands on the hospital and clinic services available in the Colony, which have resulted from the rapidly expanding population and from the increasing demand for Western medical attention. However, during the year under review there were two major developments designed to alleviate this pressure. One of these was the opening of the Queen Elizabeth Hospital by Hist Excellency the Governor on 10th September, 1963. The other was the acceptance by Government of a basic long-term development programme for medical services in Hong Kong,

7. The Queen Elizabeth Hospital is the largest acute general hospital in the British Commonwealth, and provides a welcome addition to the Colony's strained hospital services, particularly to those on the Kowloon Peninsula where the greatest expansion of population has occurred in recent years. Built as a single block, it is in reality two separate 'ward stacks' joined on the lower floors by administrative and central service areas. It accommodates 1,338 beds with all necessary ancillaries. The Sisters' and Nurses' quarters and the Nurses Training School are adjacent to the hospital and were opened in 1960. This hospital has replaced the Kowloon Hospital as the acute emergency hospital for Kowloon and the New Territories and, in addition, will provide facilities for highly specialized investigation and treatment in that area; these facilities include a large radiotherapeutic institute, donated by the Royal Hong Kong Jockey Club, for which equipment had not been completely installed by the end of the year under review. A phased programme to attain full functioning of the hospital and to transfer facilities from the Kowloon Hospital was commenced on 3rd December, 1963 and was completed by mid-January, 1964.

8. In 1959, a detailed plan of development for the five-year period 1960-65 was prepared; this was approved by Executive Council in 1960, subject to the examination of the details of each project by the Finance Committee of Legislative Council. This plan was an interim exercise only, as the absence of detailed population statistics made impos- sible any accurate long-term assessment of the problem.

9. Following the 1961 census, a revised programme for further development of curative services was prepared, designed to provide adequate facilities by 1972. After consideration by the Medical Advisory

Board, this plan was submitted to Government in 1962; the Board recom- mended its adoption, subject to the proviso that the estimates of cost, both capital and recurrent, might prove beyond the resources of the Colony. In view of this proviso, the plan was reviewed critically by an informal Working Party comprising members of the Colonial Secretariat and of the Medical and Health Department under the chairmanship of the Director of Medical and Health Services. The report of this Working Party was accepted by Executive Council in January, 1964, subject to the provision of necessary funds by the Finance Committee and to further detailed consideration of the plan at all stages; it was tabled subsequently as a White Paper in the Legislative Council.

10. The report was based on the stated policy of Government 'to provide, directly or indirectly, low cost or free medical and personal health services to that large section of the community which is unable to seek medical attention from other sources'. It briefly reviewed the history of medical and health services in Hong Kong, in particular during the years following the Second World War and then examined in detail the immediate requirements for out-patient curative services and for hospital beds of various categories.

11. With regard to the requirements for out-patient services, the report recommended a standard urban clinic for each 100,000 of the urban population and a standard rural clinic for each 50,000 of the population in rural areas. Other recommendations were made for the provision of clinics offering certain specialized services, for example in ophthalmic diseases, tuberculosis and social hygiene.

12. Referring to the provision of hospital beds, the report estimated that by the end of 1963 there would be 2.91 hospital beds of all categories per 1,000 population; this estimation assumed that the Queen Elizabeth Hospital and the new Kwong Wah Hospital would be fully operational at the time. The distribution of beds amongst the various categories would be as detailed in Table 1.

TABLE 1

PROVISION OF HOSPITAL BEDS (DECEMBER 1963)

Total Beds

Ratio per 1,000 population

General Maternity

---

ILL

LLJ

---

5,140 1.893

1.44

0.53

Infectious

+++

FLL

307

0.09

Tuberculosis

LII

---

1,820

0.51

Mental

---

1,176

0.33

Total

10,336

2.41

13. The report considered the available statistics on bed requirements as applied to Hong Kong, and estimated that by 1972 the minimal require- ments for the various categories would be as shown in Table 2.

TABLE 2

REQUIRED PROVISION OF HOSPITAL BEDS

General Maternity

Infectious

Tuberculosis

Mental

Total

+++

LLL

LIE

---

1972

+++

Bed ratio per 1,000 population

2.5

+++

0.5

0.2

...

0.5

0.55

---

4.25

14. It was estimated that by 1972 the population will have risen to five millions and, taking into account a number of new projects and extensions to existing hospitals now under planning-a total of 5,388 beds, the future requirements would accordingly be a further 5,600 beds, of which 4,760 would need to be provided by Government or by Govern- ment-assisted agencies. These requirements are detailed in Table 3.

Type

General Maternity

TABLE 3

BED PROVISION-1972

Beds existing at

Corrected Bed Ratio

per 1,000 population

Increase required Commitment

to attain recommended

ratios

3.12.63 or proposed

for Govern- ment and Government-

Total

per 1,000 population

per 7,000

assisted

Total

population

Agencies

+++

8,994

1.80

2,329

0.46

769

0.15

2,256 0.45

0.5

383

2.5

0,70

3,500

2,800

0.5

0.04

200

160

0.2

0.05

250

200

0.05

250

200

1,376 0.27

0.55

0.28

1,400

15,724

3.13

4.25

1.12

5,600

4,760

Infectious

Tuberculosis

Mental

Total

огт

15. The report also examined the provision of staff, the various standards of construction, accommodation and patient care, and the use of auxiliary staff.

　　　16. In conclusion, the financial implications were noted, although, as the report states, the preparation of detailed costs for a programme of such magnitude and complexity is not possible without a complete analysis of each individual project'. However, rough estimates envisaged a total capital expenditure of some $380 millions between the years 1962-63 and 1971-72, while the annual recurrent expenditure of the Medical and Health Department as detailed in the Colony's Estimates would rise to $250 millions by the end of this period. The latter estimate, however, does not show the full implications as there would be substan- tial fringe costs, and a more realistic figure was estimated to be of the order of $320 millions per annum. This would represent an expenditure of $64 per capita for a population of five millions.

　　　17. Another step towards the provision of satisfactory medical services for the greater part of the population was the enactment of the Medical Clinics Ordinance in September, 1963. This Ordinance, which came into force on 1st January, 1964, has as its principle object the control of medical clinics in order to protect the public from exploitation in so-called charity clinics where the service provided is below an accept- able standard. Special provision is made in Section 8 of the Ordinance to allow unregistered doctors, who have satisfied the Registrar of Clinics as to their medical capabilities, to continue to work in certain clinics registered with exemption. It is intended to review the application of this Ordinance after it has been in operation for eighteen months, but the Registrar is only enabled to exercise his powers for exemption of clinics for a period of three years.

18. Apart from the Queen Elizabeth Hospital, a number of other medical institutions, both Government and non-Government, were opened during the year. Notable amongst these was the Jockey Club Kowloon Rehabilitation Centre situated in the grounds of Kowloon Hospital. This building, erected with the aid of a generous donation from the Royal Hong Kong Jockey Club, consists of two two-storey blocks containing facilities for an orthopaedic appliance unit, physio- therapy and occupational therapy. The centre is designed to run in conjunction with the accident and rehabilitation services provided by the Queen Elizabeth Hospital, and will provide rehabilitation for those patients who have suffered an injury or illness which has left a physical disability requiring special treatment for the early restoration of function. The centre was opened by the Director of Medical and Health Services on 15th August, 1963.

19. It is once again a privilege to acknowledge the generosity of Sir Shiu-kin TANG, Kt., C.B.E., LL.D., which resulted in the opening of two important buildings during the year. The first of these was the Tang Shiu Kin X-ray Survey Centre and Dental Clinic attached to the Anne Black Health Centre at North Point on Hong Kong Island. The second was the Robert Black Health Centre at San Po Kong on the outskirts of the Wong Tai Sin Resettlement Estate in north Kowloon near Kai Tak Airport; this centre, built by equal donations from Sir Shiu-kin Tang and Government, was opened on the 27th August, 1963 by His Excellency the Governor; it is a standard urban clinic comprising an out-patient department, a maternal and child health centre, a 24-bed maternity ward and quarters for resident staff.

20. Another standard urban clinic opened during the year was the Li Po Chun Health Centre in Tai Kok Tsui. This building was made possible by the generosity of Mr. Li Po-chun who donated half the cost. It is recorded with regret that Mr. Li died on 20th November, 1963, and the opening ceremony was performed on 21st March, 1964, by his widow.

21. On 16th December, 1963 the Kam Tin Clinic and Maternity Home was opened by the Director of Medical and Health Services. This clinic containing out-patient facilities and a maternity ward of seven beds, was originally proposed by representatives of the Kam Tin and Pat Heung communities, who raised over $30,000 towards the project. The remaining cost of the building and its equipment was borne by Government.

22. Other expansion of medical activities is detailed elsewhere in this report, notably in the section recording the activities of the Tung Wah Group of Hospitals.

ADMINISTRATION OF THE MEDICAL AND HEALTH SERVICES

23. 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 Director of Urban Services, the Commissioner of Labour and the District Commis- sioner, New Territories. Executive functions in connexion with curative medical services, personal health 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 through the Urban Services Department with environmental sanitation in the

　　urban areas of Hong Kong Island and Kowloon. The Director of Urban Services has executive functions as the Health Authority for certain of the townships in the New Territories and administers their environ- mental 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

24. The Director of Medical and Health Services is the Head of the Department, the chief adviser to Government on medical and health policy, and an Official Member of the Legislative Council. He is a member of a number of the Boards and Committees of voluntary organizations. engaged in medical and health work whose activities receive substantial support by way of Government subventions. He is also the Chairman of the Radiation Board and of the Statutory Boards dealing with the registration and disciplinary control of Medical Practitioners, Dentists, Pharmacists, Nurses and Midwives.

25. 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 advisor to that body on health matters. The Principal Matron is the Chief Nursing Officer and administers the Nursing Division which provides nursing, midwifery and health visitor services.

　　　26. 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 Medicat and Health Officer with specialized experience and training. The respective spheres of responsibility of the two Divisions are outlined in Appendix 1.

　　　27. 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 institutions of the Medical and Health Department, for the processing of building plans and for the detailed 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 commissioning of medical institutions, especially those in receipt of Government sub- ventions.

28. The Auxiliary Medical Service, a branch of the civil defence services, is administered by the Medical Defence Staff Officer who is a member of the Medical and Health Department Headquarters staff. The Director of Medical and Health Services is the Unit Controller.

29. 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,

30. The pharmaceutical and dispensing activities are the responsibility of the Chief Pharmacist, who also has inspectorate duties in connexion with the Dangerous Drugs and Pharmacy and Poisons Ordinance. 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.

31. 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. Apart from the Queen Elizabeth and Castle Peak Hospitals which are separately administered, the hospitals and clinics are grouped into two large units, each of which is the responsibility of a Hospital Secretary. Assistant Hospital Secretaries are posted to the more important institutions within these groups.

32. Appendix 2 shows the establishment of the Department at 31st March, 1964,

FINANCE

33. The actual expenditure of the Medical and Health Department for the financial year ended 31st March, 1964, was $76,893,619, to which should be added a further $27,764,694 disbursed in the form of subventions to institutions carrying out medical work in the Colony. Capital expend- iture on medical projects under the Public Works Non-Recurrent head totalled $29,675,789. These amounts represent 10.3% of the Colony's

total expenditure during the year. This does not include expenditure on environmental sanitation by the Urban Services Department and by the District Administration of the New Territories.

　　　34. A Statement of Expenditure for the five years from 1959-60 to 1963-64 is shown at Appendix 3.

35. The total revenue collected by the Department from all sources totalled $5,894,949,

36. The largest subvention was made to the Tung Wah Group of Hospitals which received $15,272,374; in addition, a further capital grant of $2,516,245 was made towards the continuing work on the rede- velopment of the Kwong Wah Hospital; the total estimated cost of this redevelopment is $34.1 millions, of which Government is contributing eighty per cent. Other large subventions were $1,503,000 to the Alice Ho Miu Ling Nethersole Hospital, $3,459,401 to the Grantham Hospital, $1,200,000 to the Hong Kong Anti-Tuberculosis Association, $613,976 to the Mission to Lepers, Hong Kong Auxiliary and $550,000 to the Pok Oi Hospital.

LEGISLATION

37. The following legislation dealing with medical and health matters was enacted during the year 1963-64. Mention is made of the purpose of the more important ordinances in the body of this report.

Ordinances:

(i) Animals (Control of Experiments) Ordinance, 1963.

(ii) Medical Clinics Ordinance, 1963.

Rules and Regulations:

(a) Animals (Control of Experiments) Regulations, 1963. (L.N.

57/63).

(b) Poisons (Amendment) Regulations, 1963. (L.N. 137/63). (c) Poisons (Amendment) (No. 2) Regulations, 1963. (L.N. 139/63). (d) Poisons List (Amendment) Regulations, 1963. (L.N. 138/63). (e) Poisons List (Amendment) (No. 2) Regulations, 1963 (L.N.

140/63).

(/) Medical Clinics (Forms) Regulations, 1963. (L.N. 150/63).

PROFESSIONAL REGISTERS

38. 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 govern- ing 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 of enrolment and have disciplinary powers.

At 31st March, 1964, the number of persons on the statutory registers were as follows:

IIT

---

1,203

---

430

117

---

2,464

+11

ггг

144

(Male) -Mental (Male)

+++

огт

- rr

T11

WORK OF THE STATUTORY COUNCILS AND BOARDS

Medical Council

2,304

39. There were five ordinary meetings of the Council and five inquiries requiring eight special meetings during the year. The inquiries were in respect of disciplinary charges, two of which had been referred by the Preliminary Investigation Committee during the previous year. Three of the charges concerned the wrongful issue of international certificates. of inoculation against cholera and resulted in sentences of three months erasure, twelve months erasure and a reprimand respectively. One charge concerned the issue of two different death certificates in respect of one death and resulted in a sentence of twelve months erasure. One medical practitioner was found not guilty of a charge of advertising.

40. The Preliminary Investigation Committee met on three occasions to consider four disciplinary charges and three were referred to the Medical Council for inquiry. The fourth case was a charge of advertising and the Committee determined that no inquiry be held.

41. Notice to Medical Practitioners No. I was issued in November 1963, advising medical practitioners in regard to publicity and fee-splitting and gave a warning in regard the use of the words "clinic' or 'polyclinic' upon the Medical Clinics Ordinance coming into force on Ist January, 1964.

42. During the year there were 76 applications accepted for full registration and one application for reinstatement was granted; 57 applica- tions for provisional registration were also accepted. A total of 9 names were removed from the register during the year as a result of death, departure from the Colony or failure to notify changes of address.

Dental Council

　　　　43. The Council met five times during the year to attend to routine business.

44. Notice to Registered Dentists No. 2 was issued in December 1963 concerning approved forms of notices for insertion in the Press.

45. There were 34 applications for registration, of which 16 applicants had qualifications acceptable without examination and were registered. Of the remaining 18 applicants, 3 sat the Council's examination, passed and their names were entered in the Register. 13 others were accepted for examination and two applications were rejected.

Pharmacy Board

46. The Board met four times for the transaction of routine business. There were 18 applications for registration of which two were accepted without examination. 10 applicants were required to undergo further practical training before attempting the Board's examination and a further 4 applicants were granted direct access to the Board's examina- tion. Two applications were rejected.

47. Three examinations were held and I candidates passed, of which 10 were registered and one was required to undergo further practical training before registration was granted.

48. Under the Government scholarship scheme, a further scholarship was awarded for the study of pharmacy in the United Kingdom. Nursing Board

49. The Board met four times during the year. The General Nursing Council has been approached to recognize the Queen Elizabeth Hospital as a Nurses Training School in place of Kowloon Hospital. Examinations in general and psychiatric nursing were held in June and December, the results of which were as follows:

General Nursing

Preliminary Examination Final Examination

Psychiatric Nursing

Preliminary Examination

Final Examination

Entered

Passed

372

288

393

325

---

50. Of 345 nurses applying for registration in the general nursing part of the Register, 344 were accepted of whom 316 were from the approved Training Schools in the Colony and 28 were nurses who had trained outside Hong Kong, Some of the latter were required to sit and pass the Board's examination before registration and others were referred for further training. The remaining one application was rejected. One nurse, whose registration had lapsed due to absence from the Colony, was re-admitted to the Register. One name was deleted from the Register on account of death.

51. Thirteen candidates who passed the Final Examination in Psy- chiatric Nursing were registered.

52. No disciplinary investigations or inquiries took place during the

year.

Midwives Board

53. The Board met quarterly and examinations were held during the months of April, July, October and January. A total of 252 candidates entered for the Board's examinations, of whom 235 were successful.

54. There were 243 applications for registration and 234 were accepted; 227 of the applicants had completed their training in Hong Kong and 7, who qualified outside Hong Kong, were accepted without further examina- tion. Of the remaining 9, one was rejected and the others, who had com- pleted Part I of the Central Midwives Board examination held in the United Kingdom, were required to undergo six months further training before sitting the Board's examination. Three names were deleted from the Register on account of death.

55. No disciplinary investigations or inquiries took place during the year.

Radiation Board

56. Two meetings were held to consider draft Radiation (Control of Radioactive Substances) Regulations and Radiation (Control of Irradiating Apparatus) Regulations. Drafting of the Regulations was still progress at the end of the year.

Medical Advisory Board

57. The Board met three times during the year. Consideration was given to the Heaf-Fox Report, the Report on Tuberculosis Research prepared by experts from the Medical Research Council of the United

Kingdom, the Report on Development of Medical Services in Hong Kong and the Report by the Working Party on the School Medical Service in addition to other minor business.

[1. PUBLIC HEALTH

GENERAL COMMENTS

58. The general level of the public health was well maintained through- out the year despite increasing densities of population in the urban areas, inadequate housing in the most congested areas, strictly limited and restricted water supplies and some 20% of the population dependent on a nightsoil collection service for sanitation.

59. There was a slight decrease in the notifications of infectious diseases mainly due to a fall in the numbers of reported cases of tuber- culosis and of certain other respiratory diseases. There was a rise in the notifications of enteric diseases and also of chickenpox. Mention has already been made in this report of the markedly reduced incidence of poliomyelitis following the vaccination campaign held in the first quarter of 1963. The severe epidemic of measles, which commenced during the winter months of 1962, reached a peak in January. 1963, and thereafter gradually subsided.

60. In spite of widespread investigations, no cholera vibrios were found during the winter months from October, 1962 until the first case of cholera El Tor appeared in June, 1963.

VITAL STATISTICS

61. The registration of all deaths and live births occurring in the Colony is compulsory under the Births and Deaths Registration Ordinance. Still-births are not registrable but the numbers of still-born children received by cemeteries and crematoria are recorded. Table 4 shows the annual returns for births and deaths during the past five-year period.

TABLE 4

BIRTHS AND DEATHS 1959-63

Crude Live

Estimated

Total

Birth Rate

Year

Mid-Yeur

live births

(per 1,000

Still Births Recorded

Total Deaths

Crude Death Rate

(per 1,000

Population

Population')

Population)

1959

2,857,000

104,579

36.6

1,393

20,250

7.1

1960

TTT

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

1962

---

3,400,300

111,905

32.6

1,560

20,324

5.9

1963

---

3,592,100 115,263

32.1

1.633

19.748

5.5

62. The total number of live births registered again showed an increase, but the crude live-birth rate fell slightly as did the crude death rate. There was a natural increase of 95,515 persons, the highest ever recorded.

63. The mortality pattern continued to show the same trends observed during previous years, namely, decreasing mortality from the com- municable diseases and increase in deaths from diseases of later life, particularly neoplasms and cerebro-vascular disorders. An analysis of mortality for the years 1959-63 can be found in Appendix 4.

TABLE 5

INFANTILE AND MATERNAL MORTALITY 1959-63

Infantile Mortality Neo-natal Mortality

Maternal Mortality

Year

rate (per 1,000

live births)

total births)

1959

48.3

21.3

0.73

1960

41.5

20.9

0.40

---

1961

37.7

21.0

0.45

...

1962

1963

36.9

21.2

0.48

32.9

18.9

0.29

64. Table 5 shows the continuation of recent downward trends in infantile and maternity mortality. A notable point is the fall in neo-natal mortality, which had remained comparatively stationary for the previous four years.

65. An analysis of maternal mortality over the past 5 years is shown in Table 6. Toxaemias and haemorrhages of pregnancy were the principle fatal complications, although there have been marked reductions in death from these causes during recent years.

TABLE 6

ANALYSIS OF MATERNAL MORTALITY 1959-63

(per 1,000 total births)

Sepsis

Year

(excluding

septic

Toxaemias Haemorrhages

Abortions

Ectopic Pregnancies

Others

abortions)

1959

N/A

.340

.226

.028

,066

.056

---

1960

.010

.179

.145

.045

.072

.045

TII

1961

.009

.09

.027

ILL

.036

.027

.072

1962

018

.141

.185

.026

.044

.062

1963

.017

+++

.077

.L11

.009

.034

.051

III. WORK OF THE HEALTH DIVISION

HYGIENE AND SANITATION

Urban Areas

66. 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, in his capacity of Vice-Chairman of the Urban Council, is the co-ordinat- ing link between the two Departments for the control of communicable diseases by means of environmental sanitation, food hygiene and pest control. Medical and Health Officers are seconded as Health Officers to the Urban Services Department from the Medical and Health Depart- ment 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 Department as a whole on the day-to-day management of environmental health problems.

　　　　67. Health Officers in the urban areas, in addition to their duties connected with the maintenance of satisfactory standards of environ- mental sanitation and food hygiene, are responsible for the 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 routine house inspections and regular visits to licensed food premises carried out by the Health Inspectorate, much health education is possible in connexion with im- munization campaigns and with the control of intestinal infections. With the assistance of qualified Health Visitors, the Health Officers maintain investigations into the known cases of diphtheria, tetanus neonatorum, poliomyelitis, typhoid and certain other diseases.

68. These activities are closely co-ordinated with the activities of teams of inoculators from the Epidemiological Section of the Medical and Health Department, working under the direction of the Assistant Director of Medical and Health Services (Health) through area Health Officers and offering prophylactic immunization against smallpox, diphtheria, cholera, enteric fever and poliomyelitis.

Rural Areas

69. The Director of Urban Services has statutory powers controlling sanitation, food hygiene, cleansing, amenities and the allied services of licensing of hawkers and premises where food is handled, with the exception of slaughter houses and offensive trades, which remain the responsibility of the District Commissioner, New Territories. The Medical and Health Department provides the curative and personal health services and the Principal Medical Officer of Health, New Territories, advises the respective authorities on all health matters affecting the area.

70. The Medical and Health Department is also responsible for environmental health in rural areas. The main emphasis is on health education stemming from the curative services and designed to stimulate self-help in the villages through the development of simple measures which will improve environmental sanitation.

EPIDEMIOLOGY

Quarantinable Diseases

71. The whole Colony was declared a cholera-infected local area in terms of the International Sanitary Regulations on the 28th of June following the laboratory confirmation of a case of cholera El Tor; it was declared free of infection on the 20th of December, 1963, 15 days after notification of the 114th case. A further case was notified on the 22nd of December and the Colony was declared re-infected on that date. Seventeen days thereafter, on the 17th of January, 1964, the Colony was once more declared free of infection. The total number of cases in 1963 was 115 with four deaths attributable to the disease. Subsequently, a further case was notified on the 19th February, 1964, the Colony was declared infected on that date and declared free from infection eleven days after the notification.

72. No other quarantinable diseases occurred during the year.

Cholera

73. Following the outbreak in 1962 and in view of the continued incidence of cholera in the nearby countries, intensive preventive measures were taken throughout the year. These consisted of the bacteriological investigation for cholera vibrios of all specimens sent to the laboratory from cases of gastro-enteritis and of the routine sampling of night-soil, sea-water, well-water, and foodstuffs liable to be sources of transmission of the vibrios. Quarantine restrictions were maintained throughout the

year in respect of all notified infected local areas in the Philippines and the whole of Kwang Tung Province. The restrictions were applied also to other areas as and when these were declared infected.

74. The usual environmental preventive measures were enforced: increased chlorine content in the public water supply, the chlorination of all wells in the urban areas, the vigorous inspections of public eating places, food premises, markets and the control of itinerant food hawkers. Particular attention was paid to the collection and disposal of nightsoil and the bacteriological sampling of nightsoil conservancy tankers. All inoculation centres remained open for cholera inoculation and over 3,100,000 doses of anti-cholera vaccine were administered during the year.

75. The first case of cholera, Ogawa strain, type El Tor, occurred on the 27th June, 1963 and was confirmed bacteriologically the next day. A further 114 cases were notified subsequently, the last one occurring on the 22nd of December, 1963. Of these, one was an imported case, 5 were from the New Territories, 50 from Hong Kong Island and 59 from Kowloon. Six deaths occurred, of which four were attributable to cholera; two of these were brought in dead and diagnosed at post- mortem, the third was a child aged 14 years and the fourth was a middle- aged man who, having recovered from cholera, succumbed to uraemia. The two non-attributable deaths were a female aged 74 who, having recovered fully from cholera, died a fortnight later from bronchopneumo- nia and a male of 70 who died of uraemia.

76. The incidence of the disease was 3.2 per 100,000 of population and the case fatality rate 3.48 per cent. Cases occurred sporadically and, apart from one episode, no common relationship or source of infection could be identified.

77. Most cases came from amongst the poorest classes, particularly from overcrowded tenements and congested resettlement estates. Incidence differed appreciably between the three major areas of the Colony, the approximate populations of which were respectively 500,000 in the New Territories, over 1,800,000 in Kowloon and over 1,200,000 on Hong Kong Island. The disease incidence was therefore 1.0 per 100,000 in the New Territories, 3.28 per 100,000 in Kowloon and 4.16 per 100,000 on Hong Kong Island.

　　　78. In view of the experience of the past two years, a full scale mass inoculation campaign commenced in mid-May and, by the end of that month, 16% of the population had been immunized. A further 32%

were immunized in June and 23% in July. Thereafter the response decreas- ed rapidly and only another 6.0% were immunized in the period August- December, giving a total immunity state of 77.0%.

79. With the early appearance of the disease and its unprecedented continuance into the winter months, a re-inoculation campaign was commenced in mid-November and continued to the end of December. This campaign resulted in 10.9% of the population being given booster doses. The relationship of immunization, incidence and severity are discussed later in this report.

80. A total of 1,890 persons, immediate contacts of the clinical cases, were isolated; most were detained until seven consecutive and negative rectal swabs had been obtained. However, amongst these were 106 symptomless carriers; these were treated by oral streptomycin and not discharged until after both three consecutive and negative rectal swabs had resulted and a period of isolation of not less than seven days had elapsed.

81. The home of each case was thoroughly disinfected after bacte- riological swabs had been taken from all sites which might possibly give epidemiological clues; positive results were obtained from a variety of places but no definitely significant pattern emerged. Investigation of food habits revealed little of assistance, and widespread sampling of foodstuffs, including fish, shell-fish and water, were consistently negative, except on one occasion when the body contents of a spotted crab, taken from heavily-polluted water, were found to contain cholera vibrios. Subsequent extensive sampling of various types of crustacea were consistently negative. However, the possibility of transmission of the disease by contaminated shellfish cannot be ruled out and further investigations are proceeding.

82. Apart from the fatalities, all cases responded rapidly to treatment. The age and sex distribution is shown in Table 7.

TABLE 7

CHOLERA: AGE AND SEX INCIDENCE, 1963

0-4 Years

5-9 Years

10-19 20-44 45-59

M F

Years

M F M F

Years

2 4 2 1

24 15

Years

M F M

16 12 16 LO 66 49

Total

%% of total

cases

5.21

2.61

11.3

33.9

24.3

22.6

99.92

% of age-group

in population 15.3

13.7

18.8

34.8

12.3

5.1

100

　　　From this it will be seen that almost half the cases occurred in persons aged 45 and over, a group which constitutes only 17.4% of the population. In the 20-44 age-group, the incidence approximates to representation in the population while the younger age-groups had a far smailer expe- rience than would be expected.

　　　　83. Table 8 shows the relationship of inoculation state to the severity of the disease. The figures emphasise the abnormal mildness of the out- break-many of the patients in the 'mild' category had few symptoms and were only diagnosed as cholera after routine bacteriological in- vestigations. There is also some indication that the vaccine had afforded some degree of protection.

TABLE &

CHOLERA CASES BY SEVERITY AND INOCULATION STATE

(Figures in brackets represent percentage of total cases)

Mild

Moderate

Severe

Total

No. inoculated...

19(16.5%)

6( 5.2%) 4(3.5%)

29(25.2%)

No, not inoculated

29(25.2%)

18(15.7%)

39(33.9%)

86(74.8%)

Total ...

48(41.7%) 24(20.9%)

43(37.4%)

115(100%)

TABLE 9

SEVERITY OF CHOLERA CASES BY AGE, SEX AND INOCULATION STATE (Figures in Brackets Show Percentage of Total Cases)

Mild

Moderate

Severe

0-44

45+

0-44

45+

0-44

45+

Males

Inoculated

9(7.8%)

201.7%

1(0.9%)

2(1.7%)

0(0%)

Not inoculated 10(8.7%) 7(6.1%)

2(1.7%)

6(5.2%)

10(8.7%)

16(13.9%)

Females

---

2(1.7%) 2(1.7%)

2(1.7%)

0(0%)

6(5.2%)

4(3.5%) 6(5.2%)

7(6.1%)

Inoculated 5(4.3%) 3(2.6%) Not inoculated 6(5.2%) 6(5.2%)

　　　　84. Table 9 shows the severity of cases related to age, sex and in-ocula- tion state. The numbers in each category are too small to enable significant conclusions to be drawn, but there is, as would be expected, a definite tendency for the disease to be of a more serious nature in the elderly. There is little of note in the sex incidence 43% of the cases occurred in females who represent 49% of the population. The table again em- phasises the apparent value of inoculation, particularly the fact that

not one of the eight cases occurring in inoculated persons aged 45 years and over was of a severe nature. It is possible, however, that other factors may be involved and this is worthy of further study.

85. In addition to the 106 carriers found amongst contacts of cases, a further 14 were traced through nightsoil sampling. Out of the total of 120 carriers, 68, or 56.7 per cent, had been inoculated. It is of interest that this level of inoculation is below that of the population and also that age pattern corresponds closely to the age structure of the popula- tion whereas the sex distribution is similar to that of the cases. The results are detailed in Table 10.

TABLE 10

CHOLERA CARRIERS BY AGE AND SEX

0-4

5-9

10-19

20-44

45-59

60+

Total

M F

12 8

10 3

15 6

32 15

% of carriers ...

16.7

10.8

17.5

39.1

6 8

11.7

2 3

77 43

4.2

100

% of age-group

in population

15.3

13.7

34.8

12.3

5.1

100

86. Twenty-five per cent of the urban population, i.e. 33% of Hong Kong and 19% of Kowloon is not yet served by a water sewerage system and, commencing September, 1962, all nightsoil collecting vehicles were tested nightly for the presence of the vibrios of cholera El Tor. Nightsoil pails are collected from houses each night on demarcated routes; each pail is emptied into a hopper which in turn is pumped into a tanker. Two samples were taken from each tanker at the final disposal points and sent immediately for culture. During the year, at one time or another, 31 out of 34 routes in Hong Kong and all 28 routes in Kowloon were found to be infected. The first positive sample was obtained on 1st July, four days after the first case presented. Thereafter, Hong Kong routes were positive on over 700 occasions and Kowloon routes on almost 400 occasions. Distribution appeared to have no direct relationship to cases and followed rather than preceded them. Positive results were sporadic during the months of July, August and September, but there- after the infection was heavy and sustained until late October in Kowloon and late November in Hong Kong. Subsequently, positive results rapidly became intermittent once more and finally ceased.

87. From the beginning of the outbreak until the end of September, a team of Health Inspectors attempted the tracing of excretors of the

vibrio through the nightsoil sampling. All hoppers supplying a tanker notified as positive were sampled and almost one hundred such samples yielded vibrios. Following the report of a positive hopper, all nightsoi! buckets emptied into the hopper were then swabbed and on more than twenty occasions positive pails were found; all members of the house- holds using these pails were swabbed rectally. By these means, fourteen symptomless excretors of vibrios were discovered and were isolated together with their immediate contacts, 227 in number.

　　　　88. These investigations did not produce any associations with clinical cases and, when pressure on the laboratories became excessive in September, the tracing of excretors of vibrios by this means had to be abandoned. However, routine sampling of nightsoil tankers was continued, and has proved a reliable means of estimating the incidence of infection in the community.

　　　　89. Several investigations were undertaken into the distribution of vibrios amongst the lower income groups. More than 3,400 individuals from amongst remand prisoners, illegal and other immigrants and night- soil workers were rectally swabbed. Only one positive result was discovered in a nightsoil worker; this was from a total of 950 such workers who are exposed to great risk of infection.

90. Summarizing the outbreak, it may be said that there was evidence of widespread dissemination of the vibrio throughout the population, i.e. symptomless carriers, particularly in the latter part of 1963. In spite of this, comparitively few cases were reported although very intensive case-finding measures were continuously in force.

Notifiable Diseases

91. During 1963 there was a decrease of 1.2% in the overall incidence of notifiable disease. This was mainly due to a marked fall in the notifica- tions of poliomyelitis, tuberculosis, diphtheria, malaria and influenza. This fall was counteracted by increases in notifications of measles, chicken- pox, cholera, enteric fever and dysentery, both bacillary and amoebic.

　　　　92. Free immunization against smallpox, enteric fever, diphtheria and cholera continued to be available to all members of the public at all Government hospitals, clinics, Port Health inoculation centres, District Health Offices and Maternal and Child Health Centres. Registered doctors in private practice were issued with supplies of smallpox and cholera vaccine, free of charge. In addition, inoculation teams visited

schools, Resettlement Estates and other densely-populated areas during mass immunization campaigns. Poliomyelitis vaccine of the oral tri- valent Sabin type was available for children at all Maternal and Child Health Centres.

93. At Appendix 5 is a summary of the incidence of notifiable diseases over the past five years, and Appendix 6 details the numbers of prophylac- tic immunizations administered during 1963. The specific mortality rates of the principle infectious diseases during the year are shown in Table 11.

TABLE 11

SPECIFIC MORTALITY RATES OF SOME NOTIFIABLE INFECTIOUS DISEASES

Cholera

Disease

Amoebiasis

---

Dysentery { Bacillary

Unspecified

Typhoid

---

Enteric Fever { Paratyphoid

Poliomyelitis

Cerebrospinal Meningitis

Diphtheria

Measles

LLL

Puerperal Fever

---

Tuberculosis

1963

Case

Coses

Deaths

Fatality

Rates

Proportional Mortality

Specific

Death

Rates-per

Rates

100 deaths

from all per 100,000

population

Causes

115

3.48

0.020

0.111

241

4.98

---

0.061

0.334

791

}}

0.39

0.015

0.084

ייז

***

989

27}

2.60

0.142

0.779

7.55

0.020

0.111

48.00

0.122

0.668

871

9.87

0.435

2.115

110

3,416

405

11.85

2.051

11.222

50.00

0.006

0.028

ILL

13,031

1,762

13.52

8.922

49.052

Notes: (1) Total deaths from 1.1.63 to 31.12.63 were 19,748.

(2) Estimated Population for mid-1963 was 3,592,100.

Amoebiasis

94. An appreciable increase in the incidence of this disease was recorded although the case fatality rate remained unchanged.

Bacillary Dysentery

95. The incidence of this disease remained almost stationary during 1963 but there was a slight increase in severity as measured by the case fatality rate.

96. Much intensive health education in the prevention of dysenteric infections is carried out by Health Officers amongst those connected with the handling, preparation and sale of food. A total of 126 carriers was detected amongst contacts of cases; all were treated and restrained from return to normal activities until three negative and consecutive stool specimens had been obtained. The common organisms isolated were S. flexneri and S. sonnei.

Chickenpox

　　　　97. Notifications of this disease were comparatively few following the large number of cases (1,003) reported during the first quarter of 1963. Mortality was minimal.

Diphtheria

　　　　98. Diphtheria incidence continued to show the marked decline which has been observed since the commencement of an intensive and almost continuous immunization campaign in the autumn of 1959. Although disrupted by the cholera immunization campaigns of the past three years, this programme has given very encouraging results, the annual incidence having been reduced from 2,087 cases in 1959 to 871 in 1963. The cases presenting continued to be predominantly in children under ten years of age. The case mortality rate remained stationary.

　　　　99. Amongst the contacts of cases, 127 carriers of diphtheria were found and all were isolated in hospital until they were proved free of infection.

　　　　100. C. diphtheriae mitis continued to be the predominant organism and only in rare instances was in intermedius or gravis strain isolated.

Enteric Fever

101. An increase of approximately twenty per cent was recorded during 1963 in the notifications of this group of diseases. The increase was probably attributable to the abnormal drought conditions with the consequent severe restrictions on mains water supplies and the use of water from suspect sources. The case mortality remained low.

　　　　102. All food handlers, including staff of water-boats, are required by law to be protected by T.A.B. inoculation and, in addition, facilities for such inoculation were available to school-children and members of the public.

Malaria

103. Cases notified numbered 377 and there was one death. This disease is reviewed in detail in paragraphs 168 to 177 of this report.

Measles

104. The epidemic which commenced in the last quarter of 1962 continued into 1963 and reached its peak in January of that year. The case fatality rate remained high, reflecting the incomplete notification of the disease.

Tuberculosis

105. Tuberculosis continued to be the major public health problem in Hong Kong and is considered in detail in paragraphs 117 to 167 of this report.

Poliomyelitis

106. Only 53 cases of acute poliomyelitis were notified during the year as compared with 363 during 1962. Of these 53 cases only one occurred during the last nine months of the year-a period which had registered previously the highest incidence.

107. It is highly probable that this marked decrease resulted from the successful poliomyelitis vaccination campaign using oral Sabin-type vaccine and conducted during the first three months of 1963. In this campaign, 500,387 children aged 3 months to 5 years (approximately 85% of children in that age-group), received 2 doses of vaccine.

108. This campaign was continued at all Maternal and Child Health Centres for one week in each month of the year, with particular emphasis on children aged three months to one year. In spite of intensive propaganda and general health education, the response was poor and two further mass campaigns were held in the months of January and March, 1964. As a result of these, 92,571 children, or 77.3% of those in the target age group, received one dose of the vaccine and by the end of March, 1964, 59,981 had received two doses.

109. Faecal surveys on children known to be unvaccinated but close contacts of vaccinated children were carried out during the year in the months of April, June, August and December. The first took place six weeks after the ending of the second mass feeding of oral vaccine and gave an excretion rate of 43.3 per thousand of vaccine strains, evidence of spread of vaccine virus; 'wild' virus was rarely encountered.

110. Three serological surveys for poliomyelitis anti-bodies were carried out; these showed a relatively low conversion rate to type I anti- bodies. There was some evidence of anti-body formation due to spread of vaccine virus from vaccinated to unvaccinated children.

Ophthalmia Neonatorum

111. There has been little change in the incidence of this disease during recent years.

Puerperal Fever

112. Two cases with one death were reported during the year, both being delivered at home without help of a doctor or a qualified midwife.

Scarlet Fever

113. The recorded incidence of this disease remained unchanged.

Whooping Cough

114. The numbers of notifications declined by 37.7% compared to 1962.

Influenza

Other Communicable Diseases

　　　　115. The notification of influenza is entirely voluntary. Cases reported during the year numbered 3,483 with 27 deaths as compared with 6,374 with 39 deaths in 1962. Only one throat washing specimen, amongst 40 taken in November, was positive for influenza virus, this specimen being antigenically identical with the A2/57 (A/Asian/57) strain.

Tetanus

116. A total of 120 cases was notified during the year of which 56 occurred in new-born infants, mostly among those delivered at home in villages of the New Territories. In such cases, assistance by an untrained person, the use of unsterile material and instruments and the common practice of applying a powder containing raw ground ginger root to the umbilicus as a styptic, combine to give a grave risk of tetanus neona- torum. Children attending Maternal and Child Health Centres are given routine immunization against tetanus using the toxoid prepara- tions. The 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

117. Mention was made in the Report for 1962-63 of the visit of Professor F. HEAF, C.M.G., the Adviser on Tuberculosis to the Secretary of State for the Colonies and of Dr. Wallace Fox of the Medical Research Council Tuberculosis Research Unit in London. The pattern for the existing Government Tuberculosis Service was determined in 1952 and a review of the organization which has developed over the past 10 years for the control of tuberculosis and the results of the main policy was timely. While the broad principles of the report have been accepted, the detailed recommendations, particularly those concerning research, are still under active consideration by Government.

118. In brief, the policy has been to protect, by vaccination with B.C.G., those most vulnerable to fatal post-primary manifestations of the disease, to provide out-patient facilities for the ambulatory treat- ment of as many tuberculosis patients as possible and to reserve the limited hospital accommodation for the care and treatment of those patients not responding to ambulatory treatment or in need of surgical operations to hasten recovery. With an estimated two per cent incidence of active disease in the adult population it has been physically and finan- cially impossible to provide institutional care of the order required for the isolation of all infectious cases.

119. Full assessment of the results of this policy has not yet been possible. There has been a great reduction in overall mortality from tuberculosis which has been most marked in children. The incidence of the disease in children has also been lessened considerably. In adults, however, there would appear to be only a very gradual decline in inci- dence with comparatively high morbidity rates in various age-groups over 45 years; it is in these age-groups that there is also a high degree of resist ance to 'first-line' drugs.

Mortality

120. The number of deaths from all forms of tuberculosis continued the decline shown in past years; the mortality pattern since 1951 is shown in Table 12.

TABLE 12

MORTALITY FROM TUBERCULOSIS 1951-63

Tuberculosis

Estimated

Tuberculosis

deaths as

Year

Population

Death Rate

(mid-year)

per 100,000

percentage of

total deaths

Percentage of tuberculosis deaths below

5 years

1951

2,013,000

208.0

20.0

34.0

1952

2,250,000

158,8

18.4

34.3

1953

2,250,000

130.6

16.0

36.2

1954

2,277,000

126.3

14.9

31.2

1955

2,340,000

120.0

14.7

28.0

1956

2,440,000

107,0

13.6

25.0

1957

2,583,000

103.6

13.9

21.2

1958

2,748,000

83.8

11.2

19.6

1959

2,857,000

76.2

10.7

19.2

1960

2,981,000

69.9

10.8

10.5

1961

3,177,700

60.0

10.2

11.5

1962

3,400,300

55.3

9.25

5.74

1963

3,592,100

49.05

8.9

5.50

　　　　121. The infant mortality rate from tuberculosis has continued to fall rapidly and in 1963 the rate was 0.16 deaths per 1,000 live births, which represents only 5.6% of the figure ten years ago. This is attributable to the wide acceptance of vaccination with B.C.G. for newly-born babies; in 1963, 83.44% of all new-borns received this vaccine compared with 4.32% in 1952.

　　　　122. The average age at death again rose slightly to a figure of 47 years.

Morbidity

123. Notifications of tuberculosis have fluctuated between 12,000 and 15,000 per year during the past ten years. The rate of notification has, however, continued a steady downward trend since 1955, except for the 1962 figure which was artificially inflated by the large number of illegal immigrants entering during that year. The rate for 1963 was 363 notifications per 100,000. Details of notifications according to origin are shown in Table 13.

TABLE 13

ORIGIN OF TUBERCULOSIS NOTIFICATIONS 1961-63

Government Chest Clinics...

...

Other Government Institutions

...

Tung Wah Group of Hospitals Non-Government Institutions and Private

Practitioners

Total

+++

1961

1962

1963

8,957

10,691

8,794

2,056

1,680

1,660

947

801

864

624

1.091

1,713

12.584

14,263

13,031

124. With regard to age and sex distribution, the greatest numbers are between the ages of 25 and 50 years, and there is a marked predom- inance of males.

125. The decline in the incidence of the disease in children under five is attributed to the increasing acceptance of B.C.G. vaccination. Despite the fact that a considerable proportion of these young children loss their tuberculin sensitivity within a period of two years after vaccina- tion, it does appear that some degree of protection nevertheless persists. Investigation showed that, in common with experience elsewhere, 33% of previously-known reactors lost their sensitivity over a period of 18 months. Revaccination with B.C.G. on entry to school is still being considered and preliminary investigations are proceeding.

Work of the Government Tuberculosis Service

126. All cases attending the Government Chest Clinics are given treatment free, irrespective of origin. The volume of work undertaken at the Government Chest Clinics during the past five years is detailed in Table 14.

TABLE 14

WORK OF GOVERNMENT CHEST CLINICS 1959-63

First attendances

...

Cases of tuberculosis discovered...

Total attendances for treatment...

1962

1963

1959 1960 1961 39,008 35,991 40,146 43,519 39,277 14,406 12,937 15,270 16,541 1,655,100 2,001,960 2,204,058 1,901,425 1,414,009

15,036

Under treatment from previous

year

---

Started treatment during the year Completed treatment

LLL

13,733 16,062 16,433 17,714 17,372

11.357

12,617

12,381 12,190 9,694

2,064

3,724

3.776

4,935

7,147

Failed to attend

---

5,391

4,975

4,987

5,371

5,208

Admitted to hospital from chest

clinics

1,587

1,592

889

921

811

Still on treatment at end of year...

16.062

£6,433

17,714

17,372

14,049

127. Treatment at the Chest Clinics is by ambulatory chemotherapy, which includes daily injection of streptomycin six days each week, com- bined with oral PAS and INAH, for a period of six months. At the end of this period, 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 with the aim of ultimately rendering them catalase negative'. Hospital admission is arranged for these patients whose treatment can be expedited by surgical or other means or who, for medical or very pressing social reasons, require in-patient treatment.

128. There are four full-time Government Chest Clinics which, in addition to normal day-time working, offer one evening diagnostic session each week. Part-time clinics are maintained at twelve other centres and a sessional advisory service is provided at four other centres maintained by voluntary agencies. In addition to these specialized sessions, routine sessions are provided for the daily injections of streptomycin at a number of centres, for the convenience of patients who cannot travel regularly to the full-time clinics.

　　　　129. Case finding is not practised on any scale as the available services are already heavily committed to the care of those patients who present with active disease. All Government employees undergo an annual X-ray examination and similar surveys are undertaken, on request, of employees in industrial concerns and private institutions, subject to certain conditions concerning sick-leave and re-employment for persons found suffering from active disease. Otherwise, little case finding is performed, but this aspect of the control programme is being reviewed in the light of the Heaf-Fox Report. The results of surveys undertaken during the year are shown in Table 15.

TABLE 15

X-RAY SURVEYS-1963

Government Conditional Prisoners Employees Surveys Surveys

Total examined

51,180

41,905

4,994

Clinically examined

6,228

2,979

970

Active tuberculosis

280

338

229

Percentage active tuberculosis

0.55%

0.86%

4.6%

Contact Tracing

　　　　130. Following the diagnosis of a case of tuberculosis, Tuberculosis Workers visit the patient's home and arrange for the examination of the

family and other close household contacts; those under eight years of age are tuberculin-tested and those over that age are X-rayed. During the year a total of 28,546 contacts were fully investigated, the findings being detailed in Table 16.

Under 8 years of age Tuberculin Test

TABLE 16

CONTACT EXAMINATIONS 1962-63

Clinical examination

(of contacts showing positive children) Positive Mantour

{Negative

Positive...

Active tuberculosis

Inactive T.B.

1962

1963

611

308

+++

3,492

5,632

205

200

404

453

395

114

2,803

4,628

3.45%

2.31%

(Undetermined)

Suspicious T.B.

Free of tuberculosis

Percentage of contacts found to have active T.B.

Over 8 years of age

Results of clinical

examination

Inactive T.B.

(Undetermined)

suspicious T.B.

Active tuberculosis

289

400

---

374

846

T+

753

984

11,775

20,376

2.11%

1.77%

following

'Contact' X-rays

Free of tuberculosis

Percentage found to have active T.B.

Tuberculin Testing and B.C.G. Vaccination

131. Mention has been made previously of the effects of B.C.G. vaccination of the newborn. However, some 20,000 unvaccinated infants are added to the community each year, but this number is appreciably reduced through the Maternal and Child Health and School Health Services where tuberculin testing is carried out on children not known to have received B.C.G. vaccination at birth. During the year, 37,465 children were tuberculin tested in Maternal and Child Health Centres and schools of whom 13,484 were negative and received B.C.G. vaccina- tion.

132. Children under three years of age who have not had B.C.G. but who show a positive tuberculin reaction are given INAH for one year in an effort to minimize the risks of a progressive primary tuber- culosis. During the year 48 such children were discovered at the chest clinics and a further 51 through the Maternal and Child Health Service. Thus there were 99 under treatment during 1963 as compared with 188 during 1962.

Thoracic Surgery

　　　　133. 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 under- going ambulatory chemotherapy who require surgical investigation or treatment 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.

Orthopaedic Tuberculosis

　　　　134. 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.

　　　　135. Attendances since the beginning of this service are shown in Table 17 and the classification of cases according to site of disease is presented in Table 18.

TABLE 17

ORTHOPAEDIC TUBERCULOSIS ATTENDANCES 1959-63

First Visits Revisits

Total

Spine Hip Joint Others

---

1959

1960

1961

1962

1963

617

441

415

397

288

3,503 4,001

4,618

3,685

5,747

4,120 4,442

5,033

4,082

6,035

TABLE 18

ORTHOPAEDIC TUBERCULOSIS BY SITE 1959-63

LLL

Total

---

1959

1960

1961 1962

1963

303

202

197

158

+++

125

115

109

---

189

145

103

617

441

415

397

288

136. The effects of the general campaign against tuberculosis by treatment and by the almost universal use of B.C.G. vaccination are now becoming apparent and it is likely that the decrease in orthopaedic tuberculosis will continue. For the first time since the service was started, not a single child was on the waiting list for admission for treatment despite a reduction during the year in the number of beds available for such cases. Amongst adults, this manifestation of the disease remains a problem and, as might be expected, numbers are declining only slowly.

Radiology

137. The total number of examinations carried out during 1963 on behalf of the Tuberculosis Service by the Radiological Branch of the Department was 231,122 as compared with 263,982 in 1962; almost one-third of these were performed by the use of 35 mm. or 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 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

138. All the bacteriological work done in connexion with the Tuber- culosis Service is carried out at the Government Institute of Pathology. The standard of the work is high and compares well with that elsewhere. This was demonstrated during drug trials carried out in Hong Kong which were performed under dual bacteriological control, both in Hong Kong and in Britain and West Germany.

139. The volume of work done was restricted during the greater part of the year owing to the demands of the cholera outbreak on bacte- riological facilities. Nevertheless, the total number of sputum smears examined by direct microscopy rose by 4,000 to a total of 90,806, but culturing was reduced from 13,710 specimens in 1962 to 7,364 in 1963.

[40. Reference was made in the last report to the collection of informa- tion on primary drug resistance for analysis by the British Medical Research Council. This investigation was completed during the year and preliminary results indicate that a large percentage of patients who deny previous treatment for tuberculosis are in fact excreting resistant bacilli.

Medical Social Work

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

142. Every case attending the clinics who is diagnosed as suffering from tuberculosis is directed to the Aimoner's Department for interview. At this interview details of social background are recorded, arrangement is made for the start of treatment if recommended and a suitable time and place is arranged. Further interviews in connexion with treatment and connected problems are arranged as necessary.

　　　　143. In parallel with the drop in attendance of new patients, first interviews dropped from 11,754 to 9,549 and total interviews dropped by 9,193 to 24,249. This substantial drop has occurred concurrently with the fall in pressure on the clinics which has been noticed since late 1962. In addition, there has been an increasing degree of decentralization and work has been delegated to clerical staff, although such work is not recorded in the numbers of interviews mentioned.

144. Admissions and readmissions to hospital from the chest clinics are arranged by the Almoners and this involves documentation, the financial aspects, advice to employers of admissions and the maintenance of waiting lists. While the majority of patients still express a preference for hospital treatment, there is a growing number who request out- patient treatment. Co-operation with the Kwong Wah Hospital, com- menced in 1962, has proved most valuable and has offered facilities in Kowloon for the admission of persons suffering from acute complica- tions of the disease.

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

146. 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 visits. the home, gives advice on hygiene and makes arrangements for contact examinations. In addition, irregularity of treatment or non-attendance is followed-up by home visits. Because of limited staff, much of the routine

regular visiting has to give place to visits connected with irregular attend- ances or default from treatment. 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 documenta- tion duties so that there is a continuing personal contact with the patients both at home and in the clinic, which promotes confidence.

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

Assistance to Patients

148. There is a Tuberculosis Assistance Fund available to the Almoner section of the Tuberculosis Service which amounted to $300,000 in 1963. Assistance to the dependents of patients under treatment in hospital is the principal object and disbursements are made on a formula based on previous family income and the continuing family commitments. During the year 260 families received an average weekly grant of $27.71, as compared to $26.38 in 1962. 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 100 patients at a cost of $7,814, of which $5,196 came from the Assistance Fund, the remainder being subscribed either by the patient or by voluntary agencies.

149. Another source of assistance is the Samaritan Fund at the disposal of the Principal Almoner. A total of $1,674 was given for travel- ling expenses such as are incurred by orthopaedic cases attending clinics.

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

151. 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. A total of 400 patients were referred to these welfare agencies for assistance.

Rehabilitation

　　　　152. 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 number of patients in the 40-45 age-group who are unskilled workers with chronic disease and who have undergone thoracic surgery; these present a difficult re-employment problem. The Lutheran World Federation operates a rehabilitation scheme whereby patients recommended by organizations dealing with the treatment of tuberculosis are resettled either in agricul- ture, in small home industries or in other suitable employment. The total number of patient referred during the year to the Lutheran Tuber- culosis Project was 107, as compared to 56 in 1962. There is very close consultation and co-ordination between Government staff and the per- sonnel of the project.

Hospital Services

　　　　153. 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 chemoth- erapy, 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 had been predominantly the role of the voluntary agencies. Thanks to the practical co-operation of these voluntary agencies, who receive substantial Government subventions, a co-ordinated system of hospitalization has been developed over the years.

154. During 1963, 1,727 beds were available for the in-patient treat- ment of tuberculosis. Of these, 55% were in the two tuberculosis hospitals and the convalescent home maintained by the Hong Kong Anti-Tuber- culosis Association. The other institution dealing exclusively with tuber- culosis is the Haven of Hope Sanatorium at Junk Bay in the New Territories.

155. Beds for tuberculosis in Government Hospitals are in the Lai Chi Kok and Cheung Chau Hospitals. During 1963 there were 72 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. The Tung Wah Group of Hospitals maintains tuberculosis beds mainly for the care of patients with long-standing disease. The distribution of all tuberculosis beds is shown in Table 19.

Government Hospitals

TABLE 19

TUBERCULOSIS BEDS 1963

Hong Kong Anti-Tuberculosis Association:

Grantham Hospital

...

- rr

гтт

111

Ruttonjee Sanatorium (Including Freni Memorial

Convalescent Home)

Tung Wah Hospitals...

Haven of Hope Sanatorium...

Private Hospitals

122

613

343

355

---

...

---

230

LJ J

ז..

---

Total

---

1,727

156. The Lai Chi Kok and Tung Wah Eastern Hospitals provide beds for the admission of acute tuberculosis emergencies, such as haemoptysis and spontaneous pneumothorax, which are brought to the casualty departments of the Queen Mary and Kowloon Hospitals. Such cases are admitted either direct or as soon as resuscitation has been effected at the receiving hospital and the patients are fit to move.

The Work of the Voluntary Agencies

The Hong Kong Anti-Tuberculosis Association

157. This is the largest and longest established of the voluntary agencies working exclusively in the field of tuberculosis. It maintains two hospitals and one convalescent home, containing a total of 956 beds, a B.C.G. clinic and outpatient clinic for the follow-up of discharged patients and a Tuberculosis Insurance Scheme. Supported by voluntary donations, the Royal Hong Kong Jockey Club and some endowments, the Association also receives substantial annually-recurrent subventions from Government.

158. The Association works very closely with the Government Tuber- culosis Service and now provides in its two hospitals almost all available facilities for the thoracic and orthopaedic surgery required for the treat- ment of tuberculosis. Admissions to both the medical and surgical beds of 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 Grantham Hospital

159. Opened in 1957, this hospital of 613 beds is equipped as a modern chest hospital. An extension was completed early in 1963; this contains wards totalling 84 beds, a physiotherapy department and a school for the training of nurses for the British Tuberculosis Association Nursing Certificate. 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 1963, Government maintained 492 of the beds in the general wards, including 48 beds in the new extension. Government also provides the clinical staff for 252 beds and undertakes the medical social work for patients in the 492 beds it maintains. The follow-up of patients discharged from these beds is undertaken at the Government Chest Clinics.

160. For the clinical supervision of Government-sponsored patients. within the hospital there are the Grantham Pulmonary Unit of 240 medical and surgical beds, the Government Pulmonary Unit of 138 medical and 34 surgical beds and the joint Grantham-Government Orthopaedic Unit of 80 beds. The Medical Superintendent, responsible to the Grantham Hospital Management Board, is in charge of the medical administration of the 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 a visiting consultant in Orthopaedics. 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.

The Ruttonjee Sanatorium and Freni Memorial Convalescent Home

161. These two units are the responsibility of the Ruttonjee Sanatorium Management Board and are run as one. In the Sanatorium of 233 beds, medical, surgical and orthopaedic work is carried out, while the Con- valescent Home of 110 beds is for patients who are under drug treatment

but are sufficiently well not to be in need of special nursing care. Con- sultant 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.

162. 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.

163. The numbers of patients admitted during recent years are shown in Table 20.

TABLE 20

WORK OF RUTTONJEE SANATORIUM AND FRENI MEMORIAL CONVALESCENT HOME

1960-63

Adults through Government Clinics

Children (Pulmonary) through

Government Clinic

Children (Orthopaedic)

1960

1961

1962

1963

350

289

439

370

---

252

302

427

504

ILL

693

678 985 967

+++

Other admissions and re-admissions

Total...

The Tung Wah Group of Hospitals

164. This group of three hospitals has a varying total of between 300 and 454 beds available for 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 busy maternity wards of these hospitals the B.C.G. vaccination of new-born babies is carried out by staff of the Government Tuberculosis Service.

The Haven of Hope Sanatorium

165. Maintained by the Junk Bay Medical Relief Society, this inter- denominational Protestant Mission Sanatorium provides 230 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 Rennie's Mill and carry out some tuberculosis survey work amongst the villagers in the Junk Bay

area. Government maintains 80 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

166. The Lutheran World Service developed in 1961 a pilot rehabilita- tion scheme for patients with arrested or cured tuberculosis. The scheme has now become well established and its activities are being expanded as additional facilities become available.

Private Hospitals

　　　167. There are 64 beds provided in private hospitals, 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 such treatment.

MALARIA BUREAU

　　　　168. The Malaria Bureau, under the direction of the Specialist (Malariology), is responsible for all malaria control operations through- out the Colony and, in certain instance, also undertakes the control of the breeding of culicine mosquitoes. In addition, lectures are given on malaria and allied subjects to various groups of health personnel under training, and expert advice is given as required to the Armed Services, to the Pest Control Unit of the Urban Services Department, to Hei Ling Chau Leprosarium and to Her Majesty's Prisons in the New Territories.

Control Operations

169. The important malaria vectors are A, minimus and A. jeyporiensis var, candidiensis. Malaria control in the urban areas is based chiefly on anti-larval measures consisting of training and clean weeding of hill streams, ditching and oiling. Anti-malaria oil continues to be employed as the main larvicide, although Gammexane Dispersible Powder and Diazinon are also used on a limited scale in areas where the application of oil is unsuitable, such as in rice fields and irrigation ditches leading from seepages to rice cultivation. The urban control programme includes Hong Kong Island and, in Kowloon, an area extending from just beyond Lai Chi Kok in the West to Lei Yue Mun in the east, end as far north as the Kowloon Reservoir. Also included in the programme are certain

circumscribed rural areas in the New Territories such as Rennie's Mill, the township on Cheung Chau Island, and the Chi Ma Wan Open Prison and the Shek Pik reservoir project in the south of Lantau Island.

170. The results of anti-larval operations, as checked by routine adult mosquito catches and larval collections, are satisfactory and the incidence of natural malaria transmission in the controlled areas con- tinues to be virtually nil.

171.

In most of the New Territories, control by anti-larval or anti- adult measures is at present impracticable because of the scattered popula- tion, the widespread traditional wet cultivation, and the unprotected continguous borders and islands. The main protection against malaria for disciplined groups stationed in the New Territories consists therefore of such anti-larval measures as may be practicable in their immediate vicinity, screening where possible and chemoprophylaxis.

172. The cost of control measures during the year was 34 cents per head of population protected.

Incidence of Malaria

173. Malaria is a notifiable disease, and the returns of the past five years are set out in Table 21.

Year

1959

1960

*1961

1962

1963

---

TABLE 21

MALARIA 1959-63

Cases Notified

Deaths

442

833

---

812

754

377

+++

---

• The taking of routine blood smears of all febrile childern of 10 years and younger attending Government clinics in the rural areas was instituted in 1960.

174. The total of 377 cases reported during 1963 was the lowest figure recorded since notification commenced. This reduction was probably a result, at least in part, of the long drought causing a reduction in wet cultivation and hence lessening the extent of mosquito breeding.

175. Of all cases notified 89.1% were from outside the protected area. Of the cases, 47.5% came from the area surrounding the town of Sai Kung on the east coast, 18.3% were from Lantau Island and 13.5% from the Tai Po District. Of the parasites identified 93.3% were P. vivax, 4.2% were P. falciparum and 1.3% were P. malariae.

　　　　176. Malariometric surveys were continued; spleen and parasite rates amongst children between the ages of two and nine years were deter- mined for nine villages in the New Territories. Spleen rates ranged from 0% to 0.35% and parasite rates from 0% to 14.5%, results which were similar to surveys carried out during previous years.

Laboratory

　　　　177. The Bureau Laboratory continued to carry out the routine identification of mosquitoes and the examination of blood smears collected at surveys or submitted from outlying dispensaries. Of 825 A. minimus and A. jeyporiensis var. candidiensis and 91 other anopheline species dissected during the year, none were found to contain sporozoites. In addition precipitin tests were carried out to study feeding habits. Other activities of the Bureau included lectures and demonstrations on anti- malaria work to medical students, Health Inspectors and Health Visitors.

SOCIAL HYGIENE SERVICE

　　　　178. 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 the discovery of cases of latent syphilis and of early leprosy. Accordingly, the service is organized to provide nine centres for purely dermatology clinics. In addition there are thirteen social hygiene clinics, where venereal infections and leprosy undergo investigation and treatment, although a number of dermatological cases also attend these clinics. The Wan Chai Hospital provides in-patient accommodation for the treatment of skin disease in women and children and a few beds for male patients are available at the Queen Elizabeth and Lai Chi Kok Hospitals. A small number of patients with skin disease are admitted to the Queen Mary Hospital for teaching purposes.

Venereal Diseases

　　　　179. The venereal disease clinics serve members of the public, seamen of all nationalities, women referred from Maternal and Child Health Centres and gynaecological clinics, prison inmates, patients in the Castle Peak Hospital, persons referred from the Medical Examination Board and applicants for emigration to the United States and Canada. Any treatment required is given free of charge. In addition, a large number of dermatological conditions are seen and treated at these clinics. There was a continued rise, in general conformity with world statistics, in the

primary and secondary syphilis rate during the year, but the incidence in the teenage group of the population has not risen in the manner expe- rienced in the U.S.A., the United Kingdom, Australia and Europe. The trends over the past ten years are shown in Appendix 7.

180. The incidence of gonorrhoea remained fairly stable, but further control of the disease remains a problem because of difficulty in the diagnosis of chronic cases, especially in females. Penicillin is normally the first method of treatment but resistance and anaphylaxis continue to increase. Other antibiotics have strict limitations due to higher costs and difficulties in the supervision of administration.

181. The incidence of latent syphilis continued to fall. This is to be expected if the overall diagnosis and treatment of syphilis over the past ten years has been effective.

182. Ante-natal blood tests for syphilitic infection are carried out as a routine on pregnant women attending Maternal and Child Health Centres, and Table 22 shows the results over the past five years. The value of this routine investigation is reflected in the low figures for con- genital syphilis in babies under one year of age.

TABLE 22

V.D.R.L. EXAMINATIONS IN EXPECTANT MOTHERS 1959-63

No. of tests (Clinics & Hospitals).... 46,932

% of Positive rates

No. of tests (Private Midwives)

%% of Positive

ILL

Registered live births

1959

1960 52,068

1961

$1,449

1962 1963 55,159

31,544

2.6

2.3

6,269

6,805

1.6 6,940

2.2 7,645

1.6 3,690

2.3 104,579

1.9 110,667

1.4 108,726

1.5 111,905

1.1

115,263

183. 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 under review since 1959. Table 23 sets out the results to date.

TABLE 23

VENEREAL DISEASE IN PROSTITUTES 1959-63

No. of Prostitutes

Syphilis

Year

attending for the Gonorrhoea

Early

Late

first time

latent

Jatent

1959

1,086

235

1960

952

124

146

1961

806

124

1962

917

155

1963

938

140

.гг

Leprosy

　　　　184. During 1963 there were one full-time and one part-time clinics in Hong Kong, four part-time clinics in Kowloon and weekly clinics held in certain outlying centres in the New Territories. New cases of leprosy treated numbered 258, of which 100 presented with lepromatous, 144 with tuberculoid and 14 with diamorphous manifestations of the disease. Of the infectious cases, 134 were admitted to the Hei Ling Chau Leprosarium. This institution is maintained by the Hong Kong Auxiliary of the Mission to Lepers and a very close liaison is maintained between the staff of the Mission and the Social Hygiene Service.

　　　　185. Some severely ulcerated tuberculoid cases were admitted to Orthopaedic Units at Queen Mary and Queen Elizabeth Hospitals, while others were admitted to Hei Ling Chau. A weekly Ulcer Clinic is held in Hong Kong, during which plaster casts, footwear and special splints, devised by the Orthopaedic Appliance Section, are fitted. Hei Ling Chau provides training facilities for the deformed, and the Hong Kong Society for Rehabilitation has been able to take post-surgical cases for rehabilitation and trade training.

　　　　186. The Almoners attached to the Service assist patients in Hei Ling Chau and in outpatient clinics with various problems arising from domestic worries, resettlement and employment. In this task they receive help from the Social Welfare Department and from various religious and private welfare agencies.

　　　　187. The prejudice against employment of the cured leper is begin- ning to disappear through the efforts of welfare workers and educa- tional programmes for the general public and employers. Government and private employers in 1963 absorbed into full or partial employment approximately 100 cured cases. Comprehensive and effective recording of the work potential of patients attending clinics was put into action during the year.

Dermatology

188. Apart from dermatological clinics held at all Social Hygiene centres, consultant services are provided for in-patients at all Government Hospitals and also for the Tung Wah Group of Hospitals. Two out- patient clinics are held each week at both the Queen Mary and Queen Elizabeth Hospitals and sessions for medical students are also held twice weekly. Lectures in dermatology are given to student nurses at Queen Mary and Queen Elizabeth Hospitals, Health Nurses, Student Physio- therapists, Health Inspectors and Social Welfare Trainees. During the

year, postgraduate courses in Dermatology were given to members of the two Medical Associations and other doctors.

189. A complete survey into the incidence and cultural characteristics of mycological conditions seen in Hong Kong was undertaken and the Service runs a mycological diagnostic service in its laboratory. Surveys and research into the incidence and possible causes of acute and subacute lupus erythematosus are being undertaken,

190. A total of 10,740 new cases were registered at clinics during the year and 303 cases were admitted to hospital. A classification of dermatological cases for the past three years is given at Appendix 8.

PORT HEALTH

191. 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 and for the compilation of epidemiological statistics and reports. 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.

192. 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 fron- tier by rail at the Lo Wu Quarantine Post. All immigrants without valid international certificates against smallpox are vaccinated.

193. Other routine work carried out include the deratting, disin- secting and fumigation of ships, sanitary duties in the port and airport, including supervision of water supplies, control measures to keep the 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 a sea am- bulance service in the port area.

194. Four Port Health inoculation centres are maintained for the convenience of persons requiring International Certificates for travel, two on Hong Kong Island and two in Kowloon, including one at the airport. Free prophylactic vaccinations are also offered at these centres to members of the public.

　　　　195. Out-patient clinic facilities are provided in the Airport for Govern- ment servants working at the Airport and for their families. This clinic includes a vaccination centre for members of the public who require International Certificates of Vaccination and it also serves as a first- aid post.

DISTRICT MIDWIFERY SERVICES

　　　　196. The difficulties of 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 con- tinuing decline in domiciliary midwifery. During the year only 2.5% of all registered births took place in the home; the remainder of the deliveries were either in hospitals or in Government or private maternity homes. This is reflected in the further decline in the maternal mortality rate, which has shown a dramatic fall in recent years.

　　　　197. It is now Government policy gradually to reduce facilities for domiciliary midwifery and to provide instead beds for normal mid- wifery in all new Health Centres 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.

198. During the year 52 maternity beds were provided in Kowloon in the maternity wards of the Robert Black Health Centre at San Po Kong and the Li Po Chun Health Centre at Tai Kok Tsui; in addition a mater. nity home of seven beds was opened at Kam Tin in the New Territories. 199. The work of the Government Midwifery Service during 1963 is summarized in Table 24.

TABLE 24

GOVERNMENT MIDWIFERY SERVICE 1963

ILL

---

ILI

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

Cases attended (excluding hospitals)

LLL

---

ILL

Average case-load for each midwife (excluding hospitals)

412

136

154

...

100

21,162 225

200. Midwives in private practice attended 41.4% of all births, the great majority of these 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 inspections of such homes and for the general supervision of the work of the midwives; in this task, she is assisted by a qualified Health Visitor. The work under- taken in 1963 by the private midwives is outlined in Table 25.

TABLE 25

PRIVATE MIDWIFERY SERVICE 1963

Number of midwives in active practice Number of registered maternity home Number of beds

Maternity home deliveries

Domiciliary deliveries

Total deliveries

LLL

.יי

---

LLL

---

rrr

...

---

196

109

510

44,187

1,595 45,782

201. All midwives are trained to perform vaccinations against smallpox and to administer B.C.G. to new-born infants. It is due to the efforts of these midwives, both Government and private, that 83.44% of all children born in 1963 received B.C.G. protection, a measure which has resulted in a dramatic fall in child mortality from tuberculosis. In addition, refresher courses are held at the Tsan Yuk Hospital for midwives in private practice.

MATERNAL AND CHILD HEALTH SERVICE

202. In this most important and popular aspect of the work of Depart- ment, which is maintained on a 'well-baby' clinic basis, the emphasis is on health education and the prevention of disease. All facilities are provided without charge, and, once disease is detected and unless the ailment is minor, the child concerned is referred to the appropriate branch of the curative service for investigation and any necessary treat- ment. When cured, the patient is encouraged to return to the relevant Maternal and Child Health Clinic. Health Education programmes for groups of mothers in the clinics and of individuals during home visits are permanent and continuing activities of the Health Visitors. In the clinics, all forms of group health education are available such as simple talks, film and puppet shows and flannelgraph illustrations; practical demonstrations and group discussions are also widely used, the choice of medium depending on the subject and on the audience.

203. 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 is 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 1963, as compared with that of 1962, is detailed in Table 26.

TABLE 26

MATERNAL AND CHILD HEALTH SERVICE 1962-63

1962

1963

No. of full time centres

No. of subsidiary centres

No. of ante-natal sessions each year

New ante-natal attendances

Total ante-natal attendances

-гг

Number of post-natal sessions each year...

---

2,195

2,413

LLL

23,203

25,897

...

---

98,245

111,324

931

914

New post-natal attendances

5,023

5,233

Total post-natal attendances

6.560

ILL

Number of infant welfare and toddler sessions

each year

P11

6,987

...

---

5,103

5,268

---

44,348

73,520

417,760

632,328

J. L

+++

L++

9.989

13,194

---

69,774

92,358

---

82,231

89,616

New infant welfare attendances Total infant welfare attendances New toddler welfare attendances Total toddler attendances Total home visits

　　　　204. Two full-time centres were opened during the year-the Robert Black Health Centre in August, 1963, and the Li Po Chun Health Centre in March, 1964. Following the opening of the former centre, the twice- weekly infant clinics, previously held in the nearby Wong Tai Sin Resettle- ment Estate, were discontinued. Two subsidiary centres were opened, one at the Li Cheng Uk Resettlement Estate in September, 1963 and the other in the Kam Tin Health Centre in January, 1964. The total attend- ances at the clinics for infants and toddlers increased by 29.6% and new attendances by 16.6%. Only 0.13% of those attending for the first time showed any abnormality.

205. Immunization against diphtheria, whooping-cough and tetanus is given as a routine, using triple vaccine. Smallpox vaccination is given where necessary and children not known to have received B.C.G. who are tuberculin positive but without signs of active disease are given prophylactic I.N.A.H. for a period of one year.

　　　　206. The Colony-wide average attendance at each ante-natal session was 46, as against 44 in 1962, and the average number of attendances by each expectant mother was four. Post-natal sessions are the least

popular and it seems that attendance is exclusively confined to women who either suspect or are conscious of an abnormality; 20.06% of those who attended for post-natal care needed some form of treatment.

207. Maternal and Child Health Centres played an active part in the oral poliomyelitis vaccination campaign held in January and March, 1964, and they provided all the specimens required for the virological and serological studies carried out by the Government Virus Laboratory in connexion with the campaign.

SCHOOL HEALTH SERVICE

208. 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, cholera 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 will be replaced in Septem- ber, 1964, by a School Medical Service operated on a per capita con- tributory basis by private practitioners. To this end, negotiations have been conducted with the Chinese Medical Association, members of which have agreed to participate in a medical inspection and curative service for school-children.

209. During 1963, 24,859 pupils from 228 schools were participating in the existing contributory School Health Service. Medical inspections, clinic services, dental care and specialist ophthalmic and ear, nose and throat investigations and treatment were provided. Table 27 sets out the work done.

Medical Inspections

TABLE 27

WORK OF SCHOOL HEALTH SERVICE 1962

General Clinic Attendances

32,673

Dental Attendances

E.N.T. Attendances

1,189

Ophthalmic Attendances

37,265

27,873

1,971 pairs of spectacles and 292 pairs of lens replacements were issued.

3,641*

210. Apart from major outbreaks of measles and chickenpox there were no epidemics of infectious disease amongst children of school age. A total of 121,458 school children were fully immunized against diphtheria and a further 39,648 were given booster doses; 9,032 children were vaccinated against smallpox and 485,723 were inoculated against cholera.

　　　　211. Tuberculin-testing was carried out during the year as part of a general investigation to check 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. Tuberculin tests numbering 34,793 were performed and 10,706 children were vaccinated with B.C.G. Positive reactors were investigated, as were 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 644 children were advised to attend for an X-ray; 616 of them showed no radiological evidence of disease and 15 were referred for full investigation at a chest clinic. The remaining 13 did not attend for X-ray examination.

　　　　212. Before being permitted to teach in registered schools, school teachers are required to undergo an X-ray examination. During the year, 4,243 chest X-rays were taken and 37 teachers were found to be suffering from active tuberculosis; in such cases permission to teach is refused and priority admission to hospital arranged. After full investigation a further 139 teachers were permitted to teach under regular medical supervision.

213. Registered school premises are inspected routinely by Health Inspectors; all new premises and all proposals for extensions or altera- tions to existing schools are investigated to ensure adequate environ- mental sanitation and hygiene. Such inspections numbered 2,330 during the year.

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

DENTAL SERVICE

215. The Government Dental Service, under the direction of the Senior Dental Specialist, provides general dental care for the Civil Service as well as a School Dental Service, related to the School Health Scheme. In addition, emergency dental care is given to patients in Government hospitals, to prisoners in Her Majesty's Prisons and to the public at certain of the Government out-patient clinics. The work of the General Dental Service during the years 1961-63 is shown in Table 28.

Year

1961

1962 1963

TABLE 28

WORK OF THE GENERAL DENTAL SERvice 1961-63

Attendances

---

130,323 138,377 145,128

Deciduous Teeth Permanent Teeth

Restored Extracted Restared Extracted

Persons rendered dentally fit

15,086

18,844

5,304 19,196 51,329 33,895 6,254 20,269 48,893 34,599 6,406 21,649 52,254 33,535 21,628

216. Two new dental clinics were built during the year. In May a clinic of advanced design especially for the treatment of children and named the Tang Shiu Kin Dental Clinic for its benefactor was opened in North Point. Accommodation is provided for two dental officers and four dental nurses. The accent in this clinic is on prevention of dental disease and the waiting hall is specially planned for dental health education with an attractive decor and audio-visual aids. In December the dental section of Queen Elizabeth Hospital began operations. This small two- surgery unit is of compact design and, in association with beds and a special operating theatre, is equipped to deal with all kinds of oral surgery including fractures of the face and jaws.

School Dental Service

217. The participants in the School Health Service received dental examinations and treatment from an operating staff comprising six dental officers and four dental nurses whose work is outlined in Table 29.

TABLE 29

WORK OF THE SCHOOL DENTAL SERVICE 1961-63

No. of

Attend-

Year

partici- ances for

Deciduous Teeth Restored

Extracted

Permanent Teeth

Restored Extracted

Participants rendered

paus treatment

dentally fit

1961

24,330 31,242

4,262

8,413

18,571

2,352

2,332

1962

1963

24,919 29,891 4,051 28,859 27,940 4,291

7,423

18,234

1,760

2,931

6,871

17,366

1,549

3,099

Dental Epidemiology

218. Fluoridation of water supplies throughout the Colony began in March, 1961. The fluoride ion concentration has since then been generally maintained at 0.9 parts per million during winter months and 0.7 parts per million during summer. Although it is too early for a noticeable effect upon the dental health of the population, it is anticipated that a

marked reduction in caries incidence amongst children will result, partic- ularly in those children born after 1960.

Dental Health Education

219. A continuous programme of dental health education is main tained in all Government Dental Clinics by professional and auxiliary staff with the aim of impressing on patients the need for good oral hygiene and regular dental care.

Control of Dental Practice

220. Two Dental Inspectors were employed throughout the year in the supervision and control of dental practice, and made regular inspection of premises. There was one successful prosecution for alleged illegal practice of dentistry by an unregistered person under the Registra- tion of Dentists Ordinance, 1959.

FORENSIC PATHOLOGY

221. All medico-legal work in connexion with the investigation of crime is carried out in laboratories situated in the Police Headquarters building. These laboratories, under the direction of the Specialist in Forensic Pathology, are staffed jointly by the Medical and Health and Police Departments. Lectures are given in various aspects of medico- legal work to Police personnel. The Specialist is part-time Lecturer in Forensic Medicine at the University of Hong Kong. Table 30 details work of the laboratories during the year.

TABLE 30

WORK OF THE FORENSIC PATHOLOGY LABORATORIES 1963

Examination of victims and suspects

rth

Attendance at scenes of crime

Attendance at courts...

ггг

ILL

111

Medico-legal examination of weapons Examination of hairs, fibres, etc.

Examination of clothing Miscellaneous examinations

ILL

LLL

---

Blood grouping (medico-legal) Blood grouping (Police Officers) Lectures to Police Officers

+11

ייז

362

119

LLL

---

ILL

---

...

ггг

T11

Identification of nature of meat-dog, cat, etc. Chemical examinations

Assistance in Raids

---

- rr

ILL

---

558

726

287 2,109 894

---

TEL

■

Breach of Pharmacy and Poisons Ordinance and Penicillin

Ordinance

Unregistered Medical Practitioners... Abortionists

Unregistered Dentists

FLL

---

...

---

ILL

+++

DE LA VO D

Public Mortuaries

222. The two public mortuaries, one on Hong Kong Island and the other in Kowloon, are under the supervision 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.

TABLE 31

WORK OF PUBLIC MORTUARIES 1963

---

...

Total number of bodies received Total number of autopsies performed Number of bodies claimed

Number of bodies unclaimed Deaths due to natural causes

---

LJI

Deaths due to unnatural causes

---

Victoria

Kowloon

1,163

2.997

598

1,126

803

1,662

360

1,335

872

2,458

291

539

GOVERNMENT CHEMICAL LABORATORY

223. The Laboratory carries out analytical and consulting work of a very varied character for Government Departments, the Armed Services, commercial firms and private individuals. The total number of all samples examined was 45,051, an increase of 11% over the number examined in 1962; this increase was due mainly to increases of samples of narcotics, water and dutiable commodities. Table 32 shows the work of the Lab- oratory during the year.

TABLE 32

WORK OF THE GOVERNMENT CHEMICAL LABORATORY 1962-63

Samples Analysed

1962

1963

Biochemical

14,326

13,185

Dangerous Drugs Ordinance

Dutiable Commodities

Water and Waterworks Chemicals

9,963

13,528

ILL

8,212

9,341

...

---

2,681

3,893

Food and Drugs

Forensic

Toxicology

ILL

JLL

ILL

LJ J

1,147

1,086

...

---

гг.

---

1,002

797

LLL

690

899

111

Dangerous Goods Regulations

Commercial

LLL

Import/Export (Prohibition) (Specified Articles)

Orders Miscellaneous

---

ILL

343

370

---

632

868

---

111

1,437

1,081

40,440

45,051

224. The major part of the work is concerned with biochemical analyses, narcotics control and the assessment of dutiable commodities.

A great variety of work was done for the Police Department during the year, which included cases of forged or altered documents, the examina- tion of counterfeit gold, tear gases, exhibits from the scene of 'hit-and- run' accidents and material from explosions, acid-throwing and arson. 797 specimens of drugs of various kinds were examined in connexion with infractions of the laws relating to the sale of poisons and to the possession of prohibited insecticides.

　　　　225. The value and range of dutiable commodities examined for assessment or remission of duty were similar to those in previous years. A continuous check was maintained on the level of fluoridation of the public water supplies, samples being taken daily from each station at which fluoride is added.

Water and Waterworks Chemicals

　　　　226. The water emergency brought a considerable amount of extra work to the laboratory. The tankers collecting water from the tidal estuary of the Pearl River were at first manned with testing officers drawn from various sections of the Medical and Health Department to ensure that water was not brought back with more than an acceptable degree of salinity. The testing was at first done chemically but, when conditions later became more exacting with a rise in the salinity of the river, a system of practically continuous salinity testing by electrical apparatus was established on each ship. This proved of value in enabling the ships to load the maximum possible amount of water in rapidly varying con- ditions of salinity. Eventually, outside staff were recruited and trained for this work. Considerable work was done by members of the laboratory staff in special surveys of the river as a guide to the tanker operation and in purification of the river water on arrival in Hong Kong.

　　　　227. In addition, the water emergency caused a large increase in the number of samples of well water submitted for analysis, either for potable or industrial purposes. An officer with special professional qualifications in water treatment was recruited during the year.

　　　　228. The number of samples of food and drugs submitted for examina- tion under the Public Health and Urban Services Ordinance remained steady. Particular attention was paid to milk and to products containing preservatives. A large number of samples were examined for the presence of preservatives, and both non-permitted preservatives and excessive concentrations of permitted preservatives continued to be found in a number of locally-manufactured products.

229. Work carried out for Government departments included the assessment of standards in connexion with supply of various commodities and the examination of inflammable and other dangerous good seized by the Department of Fire Services. The number of commercial samples dealt with showed a marked increase and covered a very wide field, including alloys, oils, chemicals, drugs, fire crackers, paints and textiles.

GOVERNMENT INSTITUTE OF PATHOLOGY

230. The Government Institute of Pathology, 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 Govern- ment in the Colony and for some of the grant-aided hospitals. The branch of the Institute in Kowloon Hospital closed in December, 1963, to enable extensive conversions and was transferred temporarily to the laboratories of the Queen Elizabeth Hospitals. Small clinical laboratories are main- tained at the Lai Chi Kok and Castle Peak Hospital. The University Department of Pathology carries out the routine clinical pathology for the Queen Mary Hospital, and a Virus Unit in that Department is staffed from the Institute but operates under the general supervision of the Professor of Pathology. There is a branch laboratory in Caine Lane on Hong Kong Island for the manufacture of vaccine. The work of the Institute during the year is detailed at Appendix 9.

231. A major event during the year was the opening in December of the modern and well-equipped laboratories of the new Queen Elizabeth Hospital. The number of examinations performed there showed a rapid rise as the wards were opened, and the increase is expected to continue. A Blood Bank with a 24-hour service was also established.

232. Courses of lectures and practical classes for Student Technicians were held throughout the year. Separate courses of lectures were also given to Health Inspectors and Health Visitors.

233. The Vaccine Section of the Institute continued to manufacture standard cholera vaccine of 8,000 million organisms per millilitre, and over 3,000,000 doses of vaccine were used in the course of mass anti- cholera inoculation campaigns held during the year. A reserve of some two million millilitres is always maintained.

234. Systematic examination for V. cholerae in night-soil from collect- ing vehicles was carried out throughout the year and stool specimens from cases of gastroenteritis were investigated routinely for vibrios.

In addition, the investigation of water from all sources and of other possible vehicles of infection such as fruits, vegetables, fish and shell- fish for cholera organisms was continued throughout the year. On the occurrence of the first clinical case of cholera, a twenty-four hour cholera diagnostic service was established at the Institute in Sai Ying Pun and in the Kowloon Hospital branch of the Institute.

　　　　235. During the year 77,085 specimens of faeces, nightsoil, food, water, etc. were examined for V. cholerae, with 1,627 positive results. This extra work necessarily resulted in a reduction of certain other routine services until the cessation of the outbreak at the end of the year.

236. Despite this, there was again an increase in the number of examinations carried out in this Institute during the year, though this was not so marked as previously. The total of 776,793 was 60,398 more than the corresponding figure for 1962. The grand total includes 2,122 examinations carried out in the Virus Unit and 1,931 blood groupings performed for personnel of the Auxiliary Medical Services and other bodies.

　　　　237. In the tuberculosis section, fluorescent microscopy was in- troduced for direct examination of smears for tubercle bacilli and this has greatly facilitated such work. Numerous sensitivity tests and other investigations were also carried out in connexion with tuberculosis drug trials.

Virus Laboratory

238. The Virus Laboratory is equipped mainly for diagnostic and survey work in connexion with entero-virus. The Unit carried out a number of faecal and serological surveys for the mass anti-poliomyelitis vaccination campaign. This campaign appeared to be very successful, in that a high conversion rate was obtained and 'wild' poliovirus almost completely disappeared from the community.

　　　　239. Four faecal surveys were carried out during the year in the months of April, June, August and December and involved children aged three to twelve months. The first of these surveys was performed approximately six weeks after the second mass feeding of Sabin vaccine, the children sampled being unvaccinated but known to be in reasonably close contact with vaccinated children. From this group, an excretion rate of 43.3 per thousand of 'vaccine' strain poliovirus was found,

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　in- dicating evidence of spread of the vaccine. The excretion rates of 'wild'

poliovirus during the three months in 1963 were very markedly less than in previous year. Other enterovirus excretion rates were also lower.

240. Three serological surveys for polio-antibodies were carried out. The first, in April, 1963 was on sera obtained in Maternal and Child Health Centres from children aged 6-12 months who had received two doses of oral Sabin trivalent vaccine. Presence of antibodies was assumed at a titre of 1:4. The conversion rates obtained from this group, known to be 'triple negative' before vaccination, are shown in Table 33. One of the factors in the relatively low conversion rate for Type I antibodies may have been interference from other enteroviruses in March.

TABLE 33

POLIOMYELITIS CONVERSION RATES

Antibody Type

No, showing presence

of anti-bodies

Type 1 Type II Type III

...

---

+++

Total

---

2206

Serological conversion rate

66%

98.5%

95%

---

241. Sera was also received from 50 unvaccinated children aged three months to five years who had been in reasonably close contact with vaccinated children. In the age-group 7-12 months ie, that most at risk, comparison of antibody levels found in April, 1963, with those found in unvaccinated children of the same age in December, 1962, showed a general increase of polio-antibody levels. This can be attributed to the spread of the vaccine virus in the community.

242. In December, sera were received from unvaccinated children aged three to twelve months to detect "triple-negative' children for further follow-up. Of these, 37 were from the age-group 7-12 months, and a comparison with the April survey showed a general percentage increase of "triple negative' children-65% in December and 25% in April. Most noteworthy was the complete absence of antibody to Type I poliovirus in all 37 children tested; it can be presumed that these children had not been exposed to either the 'wild' or the 'vaccine' virus.

243. During the mass campaign in the first quarter of 1963, a control group of 79 'triple-negative' children was surveyed by weekly rectal swabs for twelve weeks, poliovirus isolation and 'marker' tests being carried out in each case. After feeding of the virus, the results showed that the average duration of excretion was approximately five weeks and that Type II was the dominant type after the first feeding followed

by Type III. There was also a general marked correlation between the type of vaccine virus isolated from the faeces and the subsequent antibody response. Overall excretion rates of the vaccine types after feeding were 34% for Poliovirus Type I, 93% for Poliovirus Type II and 87% for Poliovirus Type III.

244. From the 53 cases reported in 1963 none of the isolates were Type I, which in the previous year had caused 90% of the cases. The results of routine diagnostic examinations carried out by the Virus Laboratory on specimens received for virus isolations and serological studies are summarized in Table 34.

TABLE 34

Clinical cases

ISOLATION OF POLIOVIRUS

Number examined

Positive poliovirus

Negative

Type 1 Type II Type III

Faeces

---

Throat swabs

---

C.S.F.

Faeces

T11

...

052

311

Contact cases

Convalescent cases

345 34

245. Commencing in December, samples of nightsoil from Kowloon and of Moore's swabs in sewage from Hong Kong were taken to obtain data on the prevalence of 'wild' and 'vaccine' strains of poliovirus. Two out of eight samples of nightsoil from Kowloon showed the presence of 'vaccine' poliovirus.

Respiratory Virus Identification

246. In March, 1963, the Virus Laboratory was designated a National Influenza Centre by the World Health Organization who supplied reagents for influenza virus studies.

　　　　247. Throat swabs were received from cases of respiratory infection in children and babies from the Paediatric Unit, Queen Mary Hospital, together with paired sera. Respiratory syncytial virus (R.S. virus) was isolated from four of these cases who were all under one year of age. All sera were tested for antibodies by complement-fixation technique and a more than four-fold antibody rise to the R.S. virus isolated was obtained in some of the cases. It is therefore evident that the virus does occur in Hong Kong and is likely to be an important cause of respiratory infection in children under the age of twelve months.

248. All sera received were also tested for complement-fixation antibodies to Influenza A, Influenza B, Adenovirus, Q-fever, and psit- tacosis. Results are shown in Table 35,

TABLE 35

RESPIRATORY VIRUSES 1963

Influenza

Influenza Adenovirus

Respiratory syncytial

Psittacosis

Fever

VITUS

No. Presence of antibodies Percentage showing

antibodies

33% 0

33%

55% 0

Vaccine Production

249. The Vaccine Laboratory prepared and issued during the year the quantities of vaccine shown in Table 36.

TABLE 36

VACCINE PREPARATION 1963

Anti-smallpox vaccine Anti-rabies vaccine 2) Anti-rabies vaccine 4

---

Anti-typhoid-paratyphoid vaccine

Anti-cholera vaccine

---

Anti-plague vaccine

Prepared during 1963

Issued during

1963

20,180 ml.

19,827 ml.

LLL

51,650 ml.

50,400 ml,

JLL

39,850 ml.

39,100 ml.

---

96,000 ml.

84,950 ml.

---

2,668,850 ml.

2,668,425 ml.

19,350 ml.

30,850 ml.

110

rrb

Post-mortem Examinations

250. Pathologists from the Institute carried out 485 post-mortems at the Queen Mary Hospital and Kowloon Hospital, including medico- legal cases, on patients dying in those hospitals.

251. Technicians from the Institute undertake the routine post- mortem examination for plague of rodents sent to the Public Mortuaries by the Pest Control Unit of the Urban Services Department. Of 129,808 rodents examined, none were found to be infected with Pasteurella Pestis.

Blood Banks

252. The Blood Donation 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 Kowloon, later the Queen Elizabeth, and Queen Mary Hospitals. The laboratory work in connexion with this was undertaken by the Govern- ment Institute of Pathology,

253. Donations of blood received during the year exceeded by some 230 pints the total for 1962. 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 further increase in blood

Jockey Club Rehabilitation Centre, Kowloon opened on 15.8.63.

Robert Black Health Centre, San Po Kong opened on 27.8.63.

ГТ

Kam Tin Clinic and Maternity Hospital, New Territories opened on 16.12.63.

Li Po Chun Health Centre, Arran Street, Kowloon

opened on 21.3.64.

　　　donations from the Chinese residents, and the Donor's 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 considerable amount of blood was donated direct to the Blood Banks by relatives of patients in the various hospitals. The sources and distribution of blood received by the Blood Banks are detailed in Tables 37 and 38.

TABLE 37

SOURCES OF BLOOD DONATED 1963

British Red Cross Society Patients' relatives and friends...

---

Other sources

Total

---

ILL

---

ггг

Government Hospitals

TABLE 38

DISTRIBUTION OF BLOOD 1963

FOL

Government Assisted Hospitals

Private Hospitals

Military Hospitals

Manufacture of Plasma

- г г

Preparation of Coombs Reagent Unusable due to various causes

rrr

TTI

8,384 pints

1,144 pints

0 pints

9,555 pints

6,919 pints

2,023 pints

---

448 pints

O pints O pints

PT-

---

ייי

---

O pints

---

258 pints

Total ...

ייי

г гт

9,958 pints

254. Despite this encouraging increase, there is still a serious shortage of blood to meet all demands. In fact, 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. Much prop- aganda is being directed by the British Red Cross Society to promote an increase in the number of Chinese donors, as the Armed Services, other temporary residents and visitors cannot be regarded as other than a transient source of supply. The people of Hong Kong owe a great debt of gratitude to these donors who, though only temporarily resident in the Colony, give blood for general use.

INDUSTRIAL HEALTH

255. 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 is chiefly con- cerned 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.

256. Investigations continued 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.

257. The Industrial Health Section conducted field surveys of working environments for detection of toxic gases, fumes and dust. Temperature and ventilation studies were made in a number of factories as well as investigations into ventilation of basement workrooms and into the health hazards of tunnelling.

258. Clinical field surveys carried out included chest X-ray examina- tions of workers in dusty trades for silicosis, and surveys of industrial dermatitis, of the health of the skin of workers handling tarry compounds and of Waterworks officers handling fluorides.

HEALTH EDUCATION

259. A better appreciation by the Colony's population of the basic principles of environmental hygiene and the prevention of disease con- tinue to be the main health objective. A very wide field is covered by many branches of the Medical and Health Department as an integral part of the service, and all available methods are used in the programmes undertaken. In general, those methods designed for individual or group education have proved to be the most effective, being used with partic- ular success is the Maternal and Child Health Service, the Tuberculosis Service and the Social Hygiene Service.

260. A number of other departments are concerned with various aspects of Health Education in their respective spheres, and the Inter- departmental Committee on Health Education formed in 1959 sits in an advisory capacity on any matters related to Health Education which may be referred to the Committee.

261. 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. During the year, a Health Exhibition was organized by the 28 Kaifong Health Education Sections Committee, in which the

　　　Medical and Health Department co-operated by producing displays of various aspects of preventive medicine.

　　　　262. The Health Education Team, formed during 1961 in the New Territories, was active in promoting better standards of hygiene and living conditions in rural areas and in preparing the way for immuniza tion campaigns. The two 'floating clinics' donated by the Royal Hong Kong Jockey Club and the 'flying doctor' helicopter service combined curative treatment with advice on environmental hygiene and the preven- tion of disease during visits to isolated coastal and inland villages.

IV. WORK OF THE MEDICAL DIVISION

　　　　263. The demands on the clinic and hospital services provided by Government continued to increase during the year. This increase has resulted from two main factors-the rapidly expanding population and the increasing tendency to turn from traditional Chinese medicine towards Western methods of treatment.

　　　　264. Figures I and II show the out-patient attendances, the provision of beds and the admissions to hospitals, both Government and non- Government, for the five year period 1959-1963.

FIGURE I

OUT-PATIENT ATTENDANCES AT GOVERNMENT CLINICS

1959-1963

6,000,000

5,000,000

1000,000

3,000,000

2.000.000

New casi

Repeat nitendumen

1959

1960

1961

1962

1963

6,000

5,000

4,000

3,000

2,000

FIGURE II

HOSPITAL BEDS

(Excluding Maternity Homes)

TOTAL HOSPITAL BEDS

GENERAL BEDS

Government

Government-Assisted

Private

1,000

1E71

90,000

80,000

70,000

60,000

50,000

40,000

30,000

20,000

10,000

TOTAL CASES ADMITTED

GENERAL CASES ADMITTED

HOSPITALS

　　　　265. At the end of 1963, there was a total of 11,086 beds available in all hospitals in Hong Kong, excluding those hospitals maintained by Her Majesty's Armed Forces; this total includes 574 beds in the Kowloon Hospital which closed for reprovisioning in January, 1964. An additional 630 beds in private maternity and nursing homes were also available. Details concerning this hospital accommodation arc given in Appendix 10 and an analysis of the work done is set out in Appendices 11 and 12.

266. The main event of the year was the opening of the Queen Elizabeth Hospital, mention of which has been made previously in paragraph 7. The re-development programme of the Kwong Wah Hospital in Kowloon continued to progress satisfactorily and is described later in this report in paragraph 325.

Queen Mary Hospital

GOVERNMENT HOSPITALS

267. The Queen Mary Hospital is an acute hospital serving as the main specialist centre for Hong Kong Island and as the University teaching hospital for the Medical Faculty of the University of Hong Kong. It is also one of the two Government centres for general nursing training.

　　　　268. Of the hospital's 623 beds, 313 are controlled by the University teaching units, which comprise the University Departments of Medicine, Surgery, Orthopaedics, Paediatrics and Obstetrics and Gynaecology, each under the direction of a Professor. The remainder of the beds are allocated between various Government clinical units, comprising medical, surgical, radiology, neurosurgery, thoracic surgery and ear, nose and throat units, each in the charge of a Specialist. All nursing and other services are provided by Government, except for the clinical pathology which is carried out by the University Department of Pathology. The administration of the hospital is the responsibility of a Government Principal Medical and Health Officer who is assisted by a Hospital Secretary,

　　　　269. The hospital, which was built in 1937, has during recent years proved inadequate both for its function as a teaching hospital and also for the increasingly specialized services it is called upon to provide. Accordingly, plans have been drawn up during recent years to extend the hospital. These extensions will take the form of a new professorial suite to provide improved facilities for teaching an increased number

of students, which will also house a radio-therapeutic department; a seven-storey block connected to the rear of the main hospital, accom modating 4 theatre suites, a central sterile supply department and an expanded pharmacy; and a large radio-diagnostic department at the front of the main building. In addition, there will be increased accom- modation for nurses and the Nurses Training School, now accommodated in the main hospital, will be reprovisioned in the nurses home. By April 1963, the plans for these extensions were well advanced, and during the year a start was made on site formation for the main buildings. A new emergency generator house and more parking spaces for vehicles were constructed, the work being completed at the end of November; the kitchen, which was proving inadequate to cope with the increasing numbers of patients, is being reprovisioned on the roof of the hospital, and this work was nearing completion by the end of March 1964.

270. Although the hospital has a nominal capacity of 623 beds, the increased demand for services, particularly from emergency admissions, required the use of camp beds averaging 120 each day throughout the year.

271. Apart from the casualty department, which provides a 24-hour service for emergencies from Hong Kong Island, no general out-patient clinics are held at the hospital. However, specialist out-patient 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.

272. A total of 21,518 patients were admitted during the year, and Table 39 sets out the work of the hospital over the past five years.

TABLE 39

QUEEN MARY HOSPITAL 1959-63

Maternity Cases admitted

---

1959 1960 1961 1,925 2,103 2,300

1962 1963

2,390

2,250

General in-patients

(excluding

maternity)

PII

---

Total out-patient attendances

12,695 14,612 15,376 63,676

18,336

19,268

58,191 71,046 83,458

81,209

Casualties attended (included in the

above figures)

Operations (excluding minor ones)...

Mortality (expressed as percentage

of admissions)

22,307 7,212

23,402

8,160 8,420 9,681

41,936 46,589

43,816

9,623

7.5

7.0

7.3

6.6

7.5

+11

Queen Elizabeth Hospital

273. Reference has already been made in paragraph 7 to the com- missioning and opening of this institution, which not only is the largest hospital in Hong Kong but also is the Colony's largest building with a built-over area of nearly one million square feet.

274. Apart from the emergency services of its casualty department, the Queen Elizabeth Hospital is designed to provide modern specialized facilities for the rapidly expanding population of Kowloon and the main- land portion of the New Territories. After nearly a year of preparatory work by a commissioning unit, the hospital of 1,338 beds began to admit patients on 3rd December, 1963, and was fully operational by 14th January, 1964. However, the Institute of Radiology, which will offer the most modern radiotherapeutic measures, was not functioning by the end of the year under review; it is expected that the Institute will be opened towards the end of June, 1964. Other parts of the hospital not com- pleted at 31st March, 1964, were the laundry and certain of the quarters.

　　　　275. The casualty department, opened on the 17th December, 1963, dealt with a total of 27,867 emergency cases between that date and 31st March, 1964. An analysis of these cases has been made, and the results are detailed in Table 40.

Traumatic

TABLE 40

CASUALTY DEPARTMENT, QUEEN ELIZABETH HOSPITAL

Non-Traumatic

Assault Traffic

Industrial Domestic

Sport... Other...

Infectious

LII

---

+++

Medical & Paediatric

Surgical

Obstetric

9.4%

6.0%

---

9.9%

16.9%

---

1.1%

4.0%

47.3%

0.9%

27.2%

...

12.9%

---

0.6%

...

3.7%

1.4%

---

-J

5.5%

52.2%

.5%

Total

100.0%

---

Unknown

Gynaecological

Psychiatric

Other...

276. Of the total casualty attendances, 21.4% were admitted to the hospital, 8.1% were referred to other hospitals for admission and 70.5% were treated and sent home. It was noteworthy that the commonest type of attendance was for an industrial hand injury.

Kowloon Hospital

277. For the greater part of the year until the opening of the Queen Elizabeth Hospital, the Kowloon Hospital continued to serve as the main casualty and emergency receiving centre for Kowloon and the New Territories, an area with a total population of approximately 24 million. The casualty department maintained a 24-hour service, un to the 17th December, 1963, when its facilities were transferred to the Queen Elizabeth Hospital and an average of 12.8 casualties were seen. every hour of that period.

278. As in previous years, the hospital was under continuous pressure, particularly from emergency admissions, and its 574 beds had to be considerably augmented by the widespread use of camp beds in wards and on verandahs; in addition, the high rate of patient turnover recorded during the last few years was perforce maintained. Table 41 sets out the work of the hospital over the past five years.

TABLE 41

KOWLOON HOSPITAL 1959-63

Maternity cases admitted

---

1959

3,646

1960 1961

1963

4,372 4,695 4.487 4,638*

1962

General inpatients (excluding

Maternity)

Total O.P.D. Attendance

---

547,628

13.242 16,052 19,102 569,682 671,912

24,895 24,754†

635,679 523,056

Casualty Attendance (including in

above figure}

71,627 80,333 86,218

6,571 7,584

97,246 107,489†

9,257

11,748 10,728

5.5

6.4

6.5

7.6 5.89

Operations (excluding minor cases)... Mortality (Expressed in % of

admissions)...

up to 11.12.63, † up to 17.12.63.

279. The large outpatient department adjacent to the hospital provides facilities for general cases; this department continued to function after the transfer of the other facilities to Queen Elizabeth Hospital. In addition, specialized clinics were held at the Specialist Clinic situated in the grounds of the Queen Elizabeth Hospital.

280. Medical, general surgical, orthopaedic, paediatric, obstetric and gynaecological and ear, nose and throat units were maintained, each under the clinical direction of a Specialist or of a Senior Medical Officer with a higher qualification. Other services included diagnostic radiology, pharmaceutical and surgical supply, clinical pathology, physiotherapy, almoning and a blood bank. A Principal Medical and Health Officer was Medical Superintendent, assisted by a Hospital Secretary, and all professional and other staff were provided by Government.

281. As in previous years, the medical unit continued to admit a large number of acute medical emergencies, particularly gastric haemor- rhage resulting from peptic ulcer or cirrhosis of the liver. The number of acute cerebro-vascular accidents continued to rise rapidly and, by the time that the hospital's facilities were transferred, rehabilitation and disposal of recovered cases had become a serious problem. This had been accentuated by the need for a quick turnover and by the domestic housing problems facing the greater proportion of the population.

282. The two general surgical units continued under increasing pressure, in particular due to emergencies admitted through the Casualty Department. During the year, the number of emergency cases admitted to surgical wards was eight times greater than the number of elective cases admitted through the specialized clinics.

283. As would be expected under the existing conditions of over- crowding and rapidly-increasing population, the orthopaedic unit con- tinued to deal mainly with traumatic cases which accounted for 85% of the total orthopaedic admissions; of the remainder, two-thirds were acute orthopaedic cases (e.g. acute sciatica, tuberculosis of joints and severe sprains), while the other third was composed of other types of orthopaedic conditions.

284. Following the opening of the Queen Elizabeth Hospital, Kowloon Hospital, apart from the general out-patient department, closed to enable renovations to be undertaken as certain of the buildings are over thirty years old. On the completion of these, the hospital will re- open in its new role of a subsidiary of the Queen Elizabeth Hospital for the care of patients who have passed the acute stage of their illness but who still require a period of convalescence or rehabilitation before returning to normal life. In addition, a certain number of beds will be allocated for persons suffering from tuberculosis; these will be for three categories of patients, namely, those suffering from emergency com- plications of the disease, those requiring surgery for either pulmonary

or orthopaedic manifestations and those in need of treatment with special combinations of drugs.

Tsan Yuk Hospital

285. This is the main specialist obstetric hospital in the Colony and the clinical supervision of its 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.

286. It is the teaching centre in Obstetrics for medical undergraduates and is the Colony's training school for midwives who have not trained as general nurses and who undergo a two year course conducted in Cantonese.

287, Routine admissions are now limited to cases registered at the hospital ante-natal clinic; these are in the main primiparae, grand mul- tigravidae, women with a previous abnormal obstetric history or referred cases requiring specialist care; such cases comprised 93.8% of the total admissions during 1963. The rest of the admissions were emergency cases referred by private midwives, general practitioners or the Govern- ment Midwifery Service. The work carried out by the hospital during the year is set out in Table 42.

TABLE 42

TSAN YUK HOSPITAL 1962-63

Total admissions

Total deliveries

...

LJI

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

Neo-natal mortality rate (per 1,000 live births)

Maternal mortality rate (per 1,000 total births) Percentage operative deliveries

Ante-natal attendances

Post-natal attendances...

---

1962

1963

---

7,340

7,624

5,993

6,591

10.68

15.00

---

11.70

10.03

Nil

0.15

20.63

21.59

---

34,786

36,908

3,739

4,115

288. Ante-natal and post-natal sessions are held regularly. In addition there is a special clinical for medical conditions complicating pregnancy, a social hygiene clinic for venereal disease and a family planning clinic staffed and conducted by the Family Planning Association of Hong Kong.

Castle Peak Hospital

289. This hospital for psychiatric patients is situated at Castle Peak in the New Territories. It was originally designed for 1,000 beds but pressure has been such in the three years of its existence that accom- modation has had to be provided for a far greater number of patients and during the year the average number of inpatients in the hospital was in excess of 1,200. Psychiatric cases from the whole Colony are admitted to this hospital, the great majority of whom continue to present as voluntary patients.

290. The Hong Kong Psychiatric Centre situated on Hong Kong Island is the main outpatient department and is combined with a day hospital which also provides observation, treatment and supervision for patients on parole from Castle Peak Hospital. In addition, psychiatric outpatient sessions were held regularly at the Queen Elizabeth Hospital Specialist Clinic in Kowloon and at the Maurine Grantham Health Centre in Tsuen Wan.

291. Training in psychiatric nursing was successfully continued and is referred to in paragraph 436. Fifth-year medical students also spent a week in residence at the hospital to receive practical training in psychiatry.

292. In therapy, new psychotropic drugs came into use, particularly Valerium, Amitriptylline and Haloperidol. Aversion therapy continued to be given for some out-patients, while there was a revival of insulin shock therapy for a few intractable cases of schizophrenia. In the depres- sive states the use of the mono-amine-oxidase inhibitors continued to be effective.

　　　293. Occupational therapy plays a very considerable part in the management of psychiatric patients and a comprehensive range of activi- ties in industrial, craft and gardening work was organized successfully throughout the year. In addition to the various forms of employment, a full programme of out-door and indoor recreations was maintained.

294, Psychiatric social work was undertaken by Almoners attached to the main hospital and to the out-patient day hospital. The New Life Mutual Aid Club, a registered society, consists of discharged patients and their relatives; the club aims to promote the mental and physical health of its members, to help with social problems and to induce a better understanding by the public of the problems that face mental patients.

295. Tables 43 and 44 show the work of the Castle Peak Hospital and that of the Day Hospital and psychiatric out-patients centres respec- tively.

TABLE 43

WORK OF CASTLE PEAK HOSPITAL 1963

Male

Female

Total

Patients in hospital on 1.1.63

939

517

1,256

Patients admitted: First admission

773

525

1,298

Re-admissions...

468

367

835

Total admissions...

1,241

892

2,133

Patients discharged (including transfers and

deaths*)

954

810

ILI

LJ J

1,764

Patients in hospital on 31.12.63

---

+++

1,026

599

1,625

There were 7 male and 2 female patients who died in hospital.

TABLE 44

WORK OF DAY HOSPITAL AND PSYCHIATRIC CENTRES 1963

Psychiatric Day Hospital

Mole

Female

Total

Patients attending on 1.1.63 Admissions during year Discharges during year Patients attending on 31.12.63

139

102

241

FIL

140

FEE

+++

100

241

---

Psychiatric Clinic Attendances

(excluding parole cases)

New

Repeat

Total

Hong Kong

---

L LJ

1,021

20,037

21,058

Queen Elizabeth Hospital

248

823

ILL

LLL

1,071

Tsuen Wan

116

+++

---

+++

838

954

Drug Addiction Treatment Centre

296. This centre is situated at Castle Peak Hospital and provides treatment on a voluntary basis for male drug addicts who are prepared to surrender their liberty for a period of six months. With the opening in April, 1963, of the Shek Kwu Chau Centre operated by the Society for the Aid and Rehabilitation of Drug Addicts, patients were retained in Castle Peak Hospital for only the first month of their treatment during the immediate withdrawal period. Thereafter they were transferred to Shek Kwu Chau for a further five months of rehabilitation.

297. No basic change was introduced into the therapeutic treatment, although attempts were made to substitute orai administration of meth- adone instead of by injection. Occupational therapy continued to be an important part of the treatment regime, as experience over the past few years has made it apparent that the essential problem is prevention of relapse.

　　　　298. The Pui Sun Fraternal Association continued to function under the aegis of the Lutheran World Service. By the end of the year there were 113 registered members and premises had been made available to them for use as a meeting place. The main problem has been the lack of sound leadership from amongst the group themselves, and they had to be strongly supported by the Almoners of the Department in co- operation with the Lutheran World Service.

299. Research studies were continued amongst the patients admitted to the centre. Preliminary data from the radiological study of lung changes in narcotics smokers revealed reticular changes to be present in 10% of the cases, and in over half of these there was evidence of other pulmonary tesions. Parallel with these findings it was observed that, despite selec- tion for admission on ground of good health, only 29% of cases had negative X-ray findings, there being a high incidence of pulmonary tuberculosis and emphysema, 33% and 25% of cases respectively. This data is now under critical examination.

300. Table 45 analyses the results of treatment for all patients registered since the opening of the centre in March, 1961, up to the end of March, 1964,

TABLE 45

DRUG ADDICTION TREATMENT CENTRE MARCH 1961-March 1964

Registered

1,567

Submitted to Selection Procedure 192

Yes 1,375

Yes

Approved for Admission

585

790

Yes

Admitted for Treatment

186

604

Yes

Followed-up by Almoners

290

314

Yes

Currently Abstinent

124

190

Lai Chi Kok Hospital

301. This hospital of 481 beds serves three categories of patients: 150 beds are allocated for infectious diseases, 72 for pulmonary tuber- culosis and the remaining 259 beds for convalescent patients from Kowloon (later Queen Elizabeth) and Queen Mary Hospitals.

302. Physiotherapy and occupational therapy units are maintained at the hospital, the former dealing mainly with the orthopaedic con- valescent patients and children with poliomyelitis while the latter deals with the long-stay convalescent and tuberculosis patients.

303. In the infectious disease section, the main change during the year was a marked reduction in the numbers of admissions due to diph- theria and poliomyelitis. In the former disease, the reduction was approx- imately 42%, from 874 in 1962 to 503 in 1963. However, the cases seen continued to be of a severe character and 160 of them required immediate tracheotomy when presenting at the hospital.

304. With regard to poliomyelitis, there was a marked reduction in the number of cases admitted, reflecting the success of the mass oral vaccination campaign conducted in the first quarter of 1963.

305. As in the previous two years part of the hospital had to be made available for the isolation of cases suffering from cholera. The 1963 outbreak of this disease is reviewed in paragraphs 73 to 90 of this report.

306. Other diseases seen were typhoid, tetanus (mainly tetanus neonatorum) and dysentery, both bacillary and amoebic.

307. Details of the infectious cases requiring admission to the Lai Chi Kok Hospital and the Sai Ying Pun Hospital are shown in Table 46.

Sai Ying Pun Infectious Diseases Hospital

308. This hospital of a nominal 88 beds is situated on Hong Kong Island and is used entirely for the treatment of infectious diseases. The main pattern of disease seen is similar to that detailed previously for Lai Chi Kok Hospital and here also the number of diphtheria and poliomy- elitis cases showed a marked decline during the year.

309. An increasing number of bacillary dysentery cases and carriers were encountered during 1963; many of the organisms were resistant to the more common antibiotics.

　　　　310. Forty-nine cases of cholera were admitted during the year to the cholera wing; no deaths occurred although some patients were suffer- ing from intercurrent disease such as carcinoma of the lung, aortic stenosis and diabetes.

311. Table 46 details the cases of infectious disease admitted during 1963 to both Sai Ying Pun Hospital and Lai Chi Kok Hospital.

TABLE 46

INFECTIOUS DISEASE HOSPITALS 1963

Cases

Deaths

Admitted

Case Fatality Rate (per cent)

Diphtheria Typhoid

816

9.31

485

1.44

---

Tetanus

Amoebic Dysentery

Bacillary Dysentery

148

559

---

LIJ

233

ANNER

48.65

2.23

0.36

33.33

8.58

Tubercular Meningitis Measles

St. John Hospital

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

　　　　313. There are 42 beds set aside for patients with pulmonary tuber- culosis who need in-patient supervision. These are largely occupied by adolescents with lesions of such nature that they cannot be allowed to attend school until they are rendered sputum negative.

Wan Chai Hospital

　　　　314. 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. A busy dermatological out-patient department is also maintained.

　　　　315. 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

316. This small hospital of 17 beds was originally designed to serve the workers on the Shek Pik Reservoir which was completed during the year. It now serves the villages and the south-west coast of Lantau Island and, as communication facilities on the island expand, is becom- ing available to an increasingly greater population. The Medical Officer- in-Charge is responsible for the Dispensary and Maternity Home at Mui Wo and for sick prisoners and staff at Her Majesty's Prisons and Detention Centres on the island; he also serves as the Health Officer for the area.

Prison Hospitals

317. Four hospitals with a total of 185 beds are maintained within prison compounds in the Colony at Stanley Prison, Victoria Prison, Tai Lam Prison and Lai Chi Kok Female Prison.

318. Stanley Prison Hospital containing 90 beds is concerned with the health of over 3,000 prisoners and over 400 staff. Apart from the general out-patient clinic, specialist sessions are held for tuberculosis, venereal disease, leprosy, eye diseases and dentistry. The major problem during the year under review was an outbreak of bacillary dysentery commencing in mid-January, 1964 and continuing for some 24 months. This was traced to food handlers in the kitchen and was brought under control by the imposition of more stringent hygiene and sanitation

measures.

319. H.M. Prison, Tai Lam, continues to give encouraging immediate results in the treatment and rehabilitation of convicted male drug addicts.

320. The Victoria Remand Prison has, in addition to a hospital for general diseases, a special psychiatric observation unit for suspected cases of mental disease in prisoners. This unit is under the clinical supervi- sion of the Senior Specialist in Psychiatry, members of whose staff also pay regular visits to all main prisons and training centres to advise on the numerous psychiatric and personality problems encountered amongst prisoners.

GOVERNMENT ASSISTED HOSPITALS

321. Financial assistance mainly by means of an annual subvention is given by Government to twelve hospitals maintained by voluntary organizations.

　　　　322. Paragraphs 157 to 165 mention those institutions which are concerned solely with the care of patients suffering from tuberculosis.

The Tung Wah Group of Hospitals

　　　　323. This group comprises three large hospitals and one infirmary. 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. This Committee 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 Advisors to the Tung Wah Board, representatives from the Government Finance, Public Works and Medical and Health Departments and the Medical Superin- tendents 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 $15,272,374 in 1963-64.

324. Each hospital provides general medical, surgical and obstetric facilities. In addition, certain wards are set aside in the hospitals and infirmary 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.

325. During the year the major occupation of the Directors continued to be the redevelopment of the Kwong Wah Hospital in Kowloon. The north wing, the fourth phase of the redevelopment programme, was completed in June, 1963, and commissioned in the following month. By the end of the year under review the south wing, the fifth and last major stage of the development, was nearing completion and was officially opened in March, 1964, by the Hon. R. C. LEE, C.B.E., J.P. On the completion of this, all that remains to be done is the reconstruction of the mortuary and of certain quarters and a new building for the herbal out-patient clinic.

326. In addition to this major institution, a number of other projects were undertaken during the year by the Directors. At the Tung Wah Eastern Hospital additional quarters were made available for the accom- modation of doctors and of nurses. The construction was started in June, 1963, and the premises were opened by the Hon. FUNG Ping-fan, O.B.E. on 5th March, 1964. Site formation work was completed and construction commenced on the first stage of the Wong Tai Sin Infirmary; this institution, designed to accommodate 210 chronic and disabled patients, was made possible by a generous donation from the Australian World Refugee Year Fund and the foundation stone of the building was laid on the 25th March, 1963, by Mr. C. R. MCKERIHAN, C.B.E., Treasurer of the Australian National Committee for World Refugee Year. The Directors also embarked on a further project at the Sandy Bay Infirmary designed to provide 270 beds; 70 of these will replace old hutted accom- modation for tuberculosis patients while the remaining 200 are to be used for the accommodation of convalescent patients from Queen Mary Hospital. The foundation stone for this building was laid on 23rd March, 1964, by Mr. LEE Iu-cheung, C.B.E.

The Alice Ho Miu Ling Nethersole Hospital

327. This hospital provides 300 beds for general medical, surgical and obstetric care and maintains a large out-patient department. The senior members of the medical staff are appointed by the London Mission- ary Society which also contributes annually towards the recurrent costs.

328. Although the demolition of the old east wing and the nurses quarters was completed during the year, the estimates for the redevelop- ment programme were of such magnitude that the Hospital's Executive Committee decided to abandon this plan and to enter into negotiations with the committee of the proposed United Protestant Hospital. With the demolition of these sections, the dispensary, radiological department and the surgical operating theatres had to be rehoused, and were accom- modated in the remaining buildings, albeit under rather cramped cir-

cumstances.

329. In spite of these difficulties, the hospital continued to provide low-cost in-patient care for the lower and middle income groups and in this field it meets a marked need.

Pok Oi Hospital

330. 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 care. There are operating theatre, radiodiagnostic and laboratory facilities of a simple nature. It is managed by an Executive Committee consisting of six representatives of the Statutory Board of Directors and six representa- tives of Government under the chairmanship of the Deputy Director of Medical and Health Services. The Board of Directors provides char- itable services in the Chinese tradition and raised funds from voluntary sources for capital and recurrent costs. These are augmented by Govern- ment subvention on a deficiency grant basis. A Government Medical and Health Officer is seconded to the hospital as Medical Superintendent. 331. New staff quarters and a hospital kitchen were completed in September, 1963, and opened in November, and work continues on the construction of the out-patient department. During the year, the Directors submitted a plan for the construction of a three-storey building to replace the present overcrowded and inadequate maternity and children's wards; however, the foundations of this building will be such that further exten- sions will be possible should need for expansion of the hospital's services arise in the future.

Hei Ling Chau Leprosarium

　　　　　332. Maintained with the aid of a substantial recurrent subvention from Government by the Mission to Lepers, Hong Kong Auxiliary, on an island six miles from Hong Kong, the leprosarium contains accom- modation for up to 540 leprosy patients. The Maxwell Memorial Medical Centre provides 50 beds for the care of patients undergoing reconstructive surgery of suffering from intercurrent disease and a further 15 beds for male patients with tuberculosis. Facilities are also provided for physio- therapy and occupational therapy.

　　　　333. The island suffered severely from the drought experienced during the year. The reservoir was exhausted prior to the light summer rains and water had to be transported by boat to the island from 30th May to 25th November, when reliance was once again placed on the reservoir alone. However, the shipments had to be recommenced on 10th March, 1964. By the end of the year under review proposals were well in hand to connect the island to the Shek Pik underwater main running from Lan Tau Island to Hong Kong Island.

334. During 1963 a submarine cable to carry electricity from Lan Tau Island was laid and all work was completed by 20th September. The provision of a 24-hour mains electricity supply has proved most valuable to the island's work.

335. There was little change in the therapeutic regimes administered on the island, but small quantities of sulphamethoxypyridazine were used with good results.

336. One effect of the drought was a reduction in the number of surgical operations performed, particularly in the period between April and August. The total number of operations in the year was 150 as compared with 284 in 1962.

337. 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 com- munity.

Our Lady of Maryknoll Hospital

338. This hospital is located adjacent to a larger resettlement estate in the Wong Tai Sin area of Kowloon. The hospital, which contains 59 beds, is staffed by the Maryknoll Sisters who are assisted by locally- trained nurses and midwives. Laboratory, pharmacy, radiological and almoning services are available.

339. A general out-patient department is also maintained and this was attended by 63,651 patients during 1963.

Sandy Bay Convalescent Home

340. This home is maintained by the Hong Kong Society for the Relief of Disabled Children and contains 108 beds. All beds are for children requiring long-term orthopaedic care, particularly those suffering from bone and joint tuberculosis. Most of the patients have previously undergone major surgical operations at the Queen Mary Hospital, but there are also admissions from the Ruttonjee Sanatorium and from the Government Tuberculosis Service. A school teacher is provided for the children by the Hong Kong Branch of the British Red Cross Society.

341. The drought seriously affected the work of this hospital, and hydrotherapy was perforce discontinued. In June and July a number of patients were sent home and were recalled only when the water situation had eased somewhat towards the end of the year.

Hong Kong Society for Rehabilitation Kwun Tong Rehabilitation Centre

342. This centre, opened in September, 1962, accommodates 80 patients. It has occupational workshops and facilities for physiotherapy,

　　　and is designed to assist in the quick return to full employment of those who have been injured in industrial occupations.

London Missionary Society Maternity Clinic, Sheung Shui

　　　　343. This maternity clinic of ten beds is conducted by a missionary Nursing Sister of the Society, assisted by locally appointed staff. Ante- natal and maternal and child health sessions are also maintained at the clinic. The Sheung Shui Maternity Clinic Advisory Board, consisting of local residents, supports the work and the London Missionary Society also makes an annual contribution towards running costs. This is aug- mented by an annual recurrent subvention from Government funds.

OUT-PATIENT SERVICES

　　　　344. Pressure continued to increase throughout the year on all general out-patient and certain specialized clinics. However, there was marked reduction in attendances at tuberculosis clinics and consequently total attendances at all out-patient clinics maintained by Government fell by some 320,000 to a figure of 5,771,288; of these some 2,271,000 were

new cases.

　　　　345. New facilities which became available during the year have already been detailed in paragraphs 18 to 21 of this report.

　　　　346. In addition to general out-patient services, regular specialist out-patient 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.

　　　　347. Evening out-patient sessions continued to be held at seven of the larger clinics in the more densely-populated areas, lasting from 6 p.m. 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.

　　　　348. In the New Territories, apart from the fixed out-patient centres, two mobile dispensaries are operated on land, while two launches act as 'floating clinics' and serve the more remote islands and the outlying coastal areas of the mainland. A helicopter 'flying doctor' service continued to operate once weekly to villages in the New Territories not easily accessible by other routes. The helicopter service was also used to transfer patients, in urgent need of emergency medical care, from outlying areas to hospital.

349. Appendices 13 and 14 detail the work done during 1963 at the out-patient departments of Government and Government-assisted in- stitutions.

SPECIALIST SERVICES

350. 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, ortho- paedics, 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

351. The Radiological Service, under the overall direction of the Senior Specialist in Radiology, consists of three branches-radiodiagnosis, radio- therapy and medical physics. It serves mainly Government institutions, but consultant services are also available to Government-assisted hospitals and to private medical practitioners on request. The headquarters of the service was situated for most of the year in the Queen Mary Hospital, but was being transferred gradually to the Queen Elizabeth Hospital by March, 1964.

352. The Senior Specialist and his staff undertake the instruction of medical undergraduates of the Hong Kong University in the basic principles of radiology. They also conduct in-service post-graduate training courses for radiologists leading to the Diplomas in Medical Radiodiagnosis and Medical Radiotherapy (D.M.R.D. and D.M.R.T. respectively) awarded jointly by the Royal College of Physicians, London, and the Royal College of Surgeons, England. Courses of instruction for student radiographers in preparation for the examinations for the Membership of the Society of Radiographers (London) are also main- tained.

Radiodiagnosis Branch

353. This branch provides a full X-ray diagnostic service in each of the following Government institutions:

Hong Kong Island

　Queen Mary Hospital Tsan Yuk Hospital Sai Ying Pun Polyclinic Sai Ying Pun Chest Clinic Wan Chai Chest Clinic Medical Examination Board Victoria Remand Prison Tang Shiu Kin Survey Centre

Mobile Mass Radiography Unit (1)

Kowloon and New Territories

Queen Elizabeth Hospital Kowloon Hospital Castle Peak Hospital Lai Chi Kok Hospital

Shek Kip Mei Chest Clinic Kowloon Chest Clinic

Mobile Mass Radiography Unit (2)

354. Details of the work done by the branch during the year are shown in Table 47.

TABLE 47

WORK OF THE RADIODIAGNOSTIC BRANCH 1963

No. of

Patients

No. of

Alms

Exams.

Hong Kong

Queen Mary Hospital

Sai Ying Pun Clinic (General Radiography

Section)

Sai Ying Pun Chest Clinic

Wan Chai Chest Clinic

Tsan Yuk Hospital

Medical Examination Board

Tang Shiu Kin X-ray Survey Centre Mobile MMR Unit No. 1

Kowloon and New Territories

Kowloon Hospital

Queen Elizabeth Hospital Kowloon Chest Clinic Shek Kip Mei Chest Clinic

Lai Chi Kok Hospital

Castle Peak Hospital...

Pok Oi Hospital

Mobile MMR Unit No. 2

X-rayed

taken

24,368

43,064

96,348

LLL

17,615

21,621

52,917

17,086

40,027

40,100-

13,852

47.152

47,152

---

7,299

8,466

9,987

---

13,803

20,475

21,656

16,987

45,606

45,276

62,677

107,592

2,161

2,615

12,116

40,417

82,881

72,974

18,383

42,036

45,930

---

1,876

1,935

3.568

2,943

3,070

3,902

981

956

---

1,228

53.783

---

56,723

57,014

Total

LLL

322,346

496,291

635,077

　　　　355. The total number of examinations performed showed a decrease of 1.8% from those performed during the previous year, while the total

number of individuals examined declined by 2.8%. These decreases are explained by the mass chest X-ray survey of illegal immigrants which had been carried out during the summer of 1962.

356. The opening of the Tang Shiu Kin Survey Centre in May, 1963, provided a headquarters for all mass chest radiographic survey units on Hong Kong Island, whether mobile or static.

357. The radiodiagnostic section of the Queen Elizabeth Hospital Institute of Radiology was brought into operation at the end of November, 1963. It is equipped with most modern radiological machinery, including automatic film processing and drying units.

Radiotherapy Branch

358. Facilities for deep X-ray, telecobalt, radium and radioisotope therapy, and also for diagnosis using radioisotopes, are provided at the Queen Mary Hospital, which was the headquarters of this branch. It also operates a service, mainly for superficial and contact X-ray therapy, at the Jockey Club Clinic, Sai Ying Pun

359. Due to the shortage of beds at the Queen Mary Hospital, hostel accommodation has been provided at the Oxfam Hostel, Victoria Road, for some of the poorer patients receiving radiotherapy at the Queen Mary Hospital who live at considerable distances from the hospital. This hostel is run by the Catholic social welfare organization-Caritas, but free transportation between the hostel and the Queen Mary Hospital is provided by Government.

360. By the end of the year under review the radiotherapeutic section of the Queen Elizabeth Hospital Institute of Radiology was nearing completion. This Institute contains two linear accelerators and a betatron and will provide the Colony with most modern facilities for radiotherapy. 361. A comparison of the work done during 1962 and 1963 is shown in Table 48.

TABLE 48

WORK OF THE RADIOTHERAPY BRANCH 1962-63

1962

1963

New patients seen

11-

1,564

1,566

New patients with malignant disease seen New patients with non-malignant disease seen

Patients treated...

1,089

1,121

475

445

---

ILI

---

ILL

1.792

1,830

New patients treated

ILL

---

LLI

1,236

1,245

1962

1963

TII

treatment)

-TI

---

Old patients treated

Patients with malignant disease treated

New patients with malignant disease treated Old patients with malignant disease treated Patients with non-malignant disease treated

Deep radiotherapy treatment (X-ray & Telecobalt)... Contact & superficial radiotherapy treatments. Radium, radiocobalt, radiostrontium & radiogold

applications

Radioiodine for thyrotoxicosis (courses of treatment) Radioiodine for carcinoma of thyroid (courses of

Radioiodine for thyroid function tests

556

585

---

-- r

1,366

1,452

935

974

431

478

426

378

41,090

47,211

1,385

606

196

186

...

163

228

272

563

Radioiodine for scanning of whole body for

metastases

---

ILL

583

Radioiodine for scanning of neck only

Physics Branch and Workshop Section

362. As in previous years this section, which is 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. Its other functions consist of operating a radiation protection service for the Radiological Service and of giving advice and assistance to other Government departments in matters connected with radiation hazards and protection. The workshop section undertakes the maintenance, repair and calibration of all the radiological and physics equipment in the Department. It produced many spare parts during the year, as well as electronic instruments and other devices designed to improve certain radiological techniques and the working efficiency of the Radioisotope Laboratory. This section has also been largely responsible for the installation and commissioning of radiological equip- ment in the Queen Elizabeth Hospital Institute of Radiology.

Clinical Photography Service

363. This service, established in 1958, is staffed with two medical photographers. In addition to routine photographic work, this section undertakes the teaching of basic principles of clinical photography to student assistant radiographers.

OPHTHALMOLOGY

364. This service, which is under the direction of the Ophthalmic Specialist, maintains two full-time centres with surgical facilities, one on Hong Kong Island and one in Kowloon. Ophthalmic teams also visit regularly, on a session basis, clinics in urban and rural areas.

365. During the year only 467 persons were registered as blind, a marked contrast with the number of 742 registered in the previous year; only thirty-five of these were children under fifteen years of age. The major causes of blindness recorded in these persons were: - cataract (43%), glaucoma (12%), trachoma (11%) and keratomalacia (10%).

366. There have been marked changes in the incidence of the various causes of blindness over the past decade, as can be seen from Table 49.

TABLE 49

CAUSES OF BLINDNESS 1953-63

(Expressed as percentage of total blind persons registered in year)

Cause

Keratomalacia

Senile Cataract

Trachoma

Glaucoma

Injuries (all types)

Syphilis

Congenital Defects...

N.S. Optic Atrophy/Uveitis Degenerative Diseases

---

...

1953

1963

---

TII

3.5

F +1

2.5

7.5

3.5

---

LII

367. Of the total of 2,915 operative procedures undertaken during the year, 2,548 were performed on an out-patient basis, the patients being followed-up by health visitors. Of all these operations, 1,307 can be described as sight-restoring.

368. The work of the Ophthalmic Service in 1962 and 1963 is detailed in Table 50.

TABLE 50

WORK OF THE OPHTHALMIC SERVICE 1962-63

New out-patient attendances Total out-patient attendances Operation performed

Home visits by Health Visitors Spectacles provided for children

TII

1962

1963

L-

83,852

93,343

ILI

236,416

251,374

LLL

4,056

2,915

3.260

3,682

1.757

2,233

THE PHARMACEUTICAL SERVICE

369. The headquarters of this service is at the Central Medical Store located in the Government Stores Compound, North Point. The Chief Pharmacist is in charge of a staff of two Senior Pharmacists, ten Phar- macists and 131 Dispensers, the majority of whom are posted in a total of fifty-four hospital pharmacies and out-patient dispensaries in various parts of the Colony, The Chief Pharmacist is a member of the Pharmacy Board and is largely responsible for the enforcement of the Ordinances dealing with dangerous drugs, pharmacy and poisons and antibiotics. Two Pharmacists carry out full-time regular inspections of manufactur- ing houses, retail pharmacies and the dispensaries of Government- assisted and private hospitals.

370. During the year considerable assistance was given by members of the inspectorial staff to the Police Department in raids on premises involved in the illegal possession of dangerous drugs, antibiotics and scheduled poisons. The work done in 1963 is shown in Table 51.

TABLE 51

PHARMACEUTICAL CONTROL 1962-63

Wholesale Poisons Licences issued Authorized Sellers Licences issued Listed Sellers Licences issued Antibiotics Permits issued

---

Licences for movement of Dangerous Drugs

Premises inspected

Prosecutions

---

- - г

1962

1963

453

439

FFF

640

662

315

310

408

384

---

2,563

3,393

JOI

　　　371. The Central Medical Store is the main depot supplying all Government medical institutions in Hong Kong and the surrounding islands with pharmaceuticals, medical and surgical equipment and supplies and medical cases. A branch, the Kowloon Medical Store, is the distribution centre for Kowloon and the New Territories. Manufactur- ing units for the supply in bulk of pharmaceuticals in concentrated form are maintained at both stores. Parenteral fluids and other sterile preparations are manufactured at the Central Medical Store and at the pharmacies of the Queen Elizabeth and Queen Mary Hospitals. During the year, over 160,000 litres of miscellaneous parenteral fluids were prepared. Other sterile preparations, which included a wide range of ampoules for injection, ophthalmic solutions and ointments, totalled about 350,000 items.

372. On the opening of the Queen Elizabeth Hospital, the Central Sterile Supply Department of that institution commenced operation. After certain teething troubles the service is now functioning satisfactorily, and its value and advantages are being weighed.

THE ALMONER SERVICE

373. Medico-social work, which is an essential adjunct to the curative medical services of Government, is the responsibility of the Principal Almoner and a staff of 4 Senior Almoners and 64 Almoners. Amongst the latter is included the first male almoner to be recruited in Hong Kong a significant and welcome development.

374. Almoners are attached to all the larger hospitals, to certain of the main clinics in urban areas and to the Tuberculosis, Ophthalmic, Mental Health and Social Hygiene Services. The work of the Tuber- culosis Almoner Service is detailed in paragraphs 141 to 151 of this report.

375. In the larger hospitals and clinics the range of almoner services. is wide and complex. The Orthopaedic and Neurosurgical Units required particular attention as the many accident cases need guidance and assist- ance when ready for discharge. Schooling for handicapped children frequently presents difficulty and, due to the considerable help given by voluntary organizations, much has been accomplished in this sphere. The Hong Kong Branch of the British Red Cross Society provides a teacher for the children's wards at Queen Mary Hospital and maintains the Princess Alexandra School in the Crippled Children's Home at Kwun Tong. The Salvation Army Convalescent Home at Cheung Chau received children from the wards of the Queen Mary, Kowloon and Lai Chi Kok Hospitals during the year. For adults, the Kwun Tong Rehabilitation Centre provided accommodation and physical therapy for discharged orthopaedic cases and the Oxfam Hostel housed and fed destitute patients undergoing radiotherapy. The need for convalescent and long-term beds for patients who are ready for discharge from the acute hospitals remains urgent if the present rate of turnover in such hospitals is to be maintained.

376. In the Mental Health Service, the almoner's work is rather more specialized and time-consuming, requiring skilled case work with the family of the patients, particularly home visits which are useful in this type of social work.

377. Drug addicts coming forward for voluntary treatment have also required much individual social work. Almoners assist in the selection of voluntary patients for admission to the Treatment Centre at Castle Peak Hospital and deal with the problems arising in the families who are left at home during the patient's six months absence, as well as with other difficulties which may become apparent when the patient is ready for discharge.

378. The almoners attached to the Social Hygiene Service are chiefly concerned with patients suffering from leprosy. The problem of employ- ment of these patients after clinical cure remains difficult as, apart from ostracism based on traditional fears, many of the patients are illiterate and unskilled.

379. In the Ophthalmic Service, the almoners attend on a full-time basis at the two ophthalmic centres-the Violet Peel Polyclinic and the Arran Street Eye Clinic. A visit is also made once weekly with the ophthal- mic team to the Yuen Long Clinic.

　　　380. The in-service training of newly appointed almoners is organized by the Principal Almoner at the Harcourt Health Centre. Instruction and talks on medical social work are also given to student nurses, to medical students and to social studies students from the University of Hong Kong, to secondary school pupils and to other groups of potential social workers.

381. The Samaritan Fund administered by the Principal Almoner disbursed $19,103.35 during the financial year 1963-64. The main expend- iture was on fares for travel to enable patients to attend for treatment and, in the case of Castle Peak Hospital, for relatives to see doctors. This fund relies entirely on private donations without assistance from Government and expenditure is therefore limited.

　　　382. The Leprosy Fund expended $9,027.70 in the year; the fund is used largely for assistance in paying rents for the accommodation of families of patients undergoing prolonged treatment in the Hei Ling Chau Leprosarium.

383. Generous donations of free foods, made by C.A.R.E., the Catholic Relief Services, the Church World Service, the Lutheran World Service, the Boys and Girls Clubs Association and U.N.I.C.E.F., were available for distribution by the Almoners and are gratefully acknowl- edged.

384. The medical social work of the Almoner Service was greatly assisted by the ready co-operation afforded by the Family Welfare Society, The Church World Service, Caritas, the Family Planning Association of Hong Kong, the Hong Kong Branch of the British Red Cross Society, the Lutheran World Service, the Salvation Army, the Hong Kong Cheshire Home, the Hong Kong Society for Rehabilitation and the Po Leung Kuk. In addition, the Social Welfare Department and the Resettlement Department continued to give valuable co-operation in their respective spheres.

PHYSIOTHERAPY

385. The Physiotherapy Service was greatly expanded and modernized during the year by the opening of two large, new and well-equipped departments, one at the Queen Elizabeth Hospital and the other at the Jockey Club Kowloon Rehabilitation Centre. Each of these centres has a large gymnasium, extensive treatment areas and a hydrotherapy unit. These centres have replaced the facilities of the grossly-overcrowded department previously maintained in Kowloon Hospital.

386. A marked decrease in the number of cases suffering from the after-effects of poliomyelitis was noted during the year. This was in part due to the water shortage causing the cessation of all hydro-therapy; however, very few new cases of the disease were seen during the year, most probably as a result of the immunization campaigns.

387. At the Queen Mary Hospital there was some slight decline in the work owing to decreased numbers of neurosurgical patients.

388. At the Lai Chi Kok Hospital there are large numbers of cases requiring physiotherapy amongst both the surgical and orthopaedic convalescent patients transferred from Kowloon Hospital. With the closure of Kowloon Hospital, more orthopaedic convalescent beds had to be made available and by March, 1964, there were 138 orthopaedic cases in the hospital. This placed a severe strain on the staff during the first quarter of 1964.

389. The training school, previously accommodated in temporary premises in the old Pathology Institute in Caine Lane, was transferred at the end of 1963 to the new and well-equipped school in the Queen Elizabeth Hospital. Until full functioning of the main department at the hospital has been attained, the practical work of the students is divided between the department and Kowloon Jockey Club Rehabilitation Centre.

OCCUPATIONAL THERAPY

　　　　390. The activities of this unit are the responsibility of the Superin- tendent Occupational Therapist and are mainly in those institutions. which have large numbers of long-stay patients. The work is particularly valuable for psychiatric and drug-addiction patients.

　　　　391. The year under review saw considerable expansion of the Occupational Therapy Department with the openings of the Jockey Club Kowloon Rehabilitation Centre and of the Queen Elizabeth Hospital.

　　　　392. At Castle Peak Hospital some 600 patients attended each day the various occupational therapy groups; activities for women patients included craft-work, toy-making, sewing, pottery-modelling, painting and music classes, while carpentry, rattan work, tailoring and gardening were the main occupations for men patients. Considerable work was carried out on Government orders for brooms, brushes and mops, and a selected group of patients was employed on making wooden crates for a local brewery. Recreational activities, both indoor and outdoor, were organized on an increased scale during the year and included field games, concerts, film shows and other social activities.

　　　　393. In the Drug Addiction Treatment Centre at Castle Peak Hospital there was a particular need for occupational therapy activities. The patients, who are all male, undergo voluntary treatment for their addiction for a period of six months and are in an entirely different category to those suffering from mental disorders who are housed in the main blocks. of the hospital. The payment incentive scheme was not successful and added to the remedial value of the work done; it was found that the response and behaviour of patients was enhanced by separation into small working groups of not more than six persons. Sewing and tailoring work was undertaken for the Central Linen Store of the Medical and Health Department. Other groups helped in ward cleaning and kitchen duties and a construction group was most useful both in concreting paths around the hospital and in the building of a pavilion in the grounds. A full range of recreational activities was maintained and relations between staff and patients were greatly improved in comparison with the early periods of this pilot voluntary treatment scheme. Numbers have been reduced, however, since the opening of the Shek Kwu Chau Centre.

394. At the Queen Mary Hospital, occupational therapy is less frequently prescribed as the great majority of inpatients are acute cases,

but essential after-care, particularly for post-operative orthopaedic patients, is increasingly prescribed. New equipment during the year included a bed loom for use in the orthopaedic wards and a new treadle fret-saw.

395. The work at Lai Chi Kok Hospital is of considerable variety, being amongst tuberculosis patients and the convalescent patients from Kowloon Hospital. Weekly outpatient treatment and job-training ses- sions for men with amputated limbs were continued with the object of giving these patients confidence and skill in the use of their newly- fitted prostheses. The majority were arm amputees eager to resume employment.

396. A new departure during the year was the commencement of an assessment project at the Wan Chai Polyclinic, in conjunction with the Physiotherapy Department, to train the physically-handicapped in normal day-to-day activities. This scheme has been of particular value in assisting disabled housewives to care for their families. In November, 1963, weekly visits were commenced to the tuberculosis patients in St. John Hospital, Cheung Chau.

397. The Seventh Annual Exhibition and Sale of Work was held in the City Hall in October, 1963, and was officially opened by Lady BLACK, the wife of His Excellency the Governor. The exhibition showed, for two full days, a wide range of handicrafts by patients of all sections of the Occupational Therapy Service, and the sale of finished articles realized $10,144.60. In addition, other sales of products during the year realized a further $16,025.

ORTHOPAEDIC AND PROSTHETIC APPLIANCES

398. This unit is staffed by an Orthopaedic Appliance Advisor, six student assistant technicians and seven artisans. The unit, previously housed temporarily at the Harcourt Health Centre, moved to new premises in the Jockey Club Kowloon Rehabilitation Centre in August, 1963. This well-equipped and well-designed centre contains all workshops necessary for the production of plastic, metal, leather and wooden parts for such appliances.

399. The training of the student technicians has proceeded satisfac- torily, and the Institute of British Surgical Technicians in London have now agreed to recognize this training for entry to its examinations.

　　　　400. The amount and variety of work undertaken have increased considerably; 1,100 surgical appliances, totalling $104,881 in value, were produced compared with 577 in the previous year. The output is, however, still insufficient to meet the demand and on 31st March, 1964, there were 369 prescriptions outstanding. Fees recovered against the cost of these appliances were $52,926 compared to $45,139 in 1962.

　　　　401. Apart from routine work at Government hospitals, out-patient departments and physiotherapy clinics, visits were made on request to the Sandy Bay Convalescent Home, the British Red Cross Crippled Children's Home at Kwun Tong and Hei Ling Chau Leprosarium, Co-operation with the Hong Kong Society for Rehabilitation, the Lutheran World Service and the Social Welfare Department was successfully con- tinued throughout the year.

402. Experimental procedures during the year covered a wide variety of disabilities. These included a device for the taking of weight-bearing casts for below-knee amputation stumps, a carbon-transfer process for the fitting of below-knee sockets, the production of spinal supports of a composite laminate producing a light and hygienic appliance and a procedure for producing grip impressions of deformed hands.

MEDICAL EXAMINATION BOARD

403. This Board performs the medical examination of all new en- trants to Government employment and to units of the Essential Service Corps. Members of the Civil Service prior to transfer outside Hong Kong are also medically examined by the Board. In addition, work is carried out, on request, for countries which require prospective immigrants to submit a certificate of physical fitness. Each examination involves a comprehensive physical check, 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 Govern- ment clinical units. The work of the year is summarized at Table 52.

TABLE 52

WORK OF THE MEDICAL EXAMINATION BOARD 1962-63

Government

Appointments

Auxiliary Defence Units

Miscellaneous

Total

1962 1963 1962 1963 1962

1963

1962 1963

New examinations...

6,725 9,002 1,984 3,079 106

8,815 12,174

Re-examinations

---

3,773 3,459

3,081 2,364

6,855 5,823

Annual total 10,498 12,461

5,065 5,443 107

15,670 17,997

404. Of the persons referred for specialist opinion the great majority are suffering from abnormalities of the respiratory system. Pulmonary tuberculosis accounted for the rejection of 79% of all persons found as unfit for service as against 84% in 1962. The analysis of all causes of rejection is given in Table 53.

TABLE 53

UNFITNESS BY CAUSES 1962-63

(per 1,000 total examinations)

1962

1963

Pulmonary Tuberculosis

44.29

39.45

Disease of the Respiratory System (excluding

Tuberculosis)

6.76

2.00

111

Disease of the Circulatory System

2.11

2.39

Diseases of the Alimentary System

Diseases of the Skeletal System

Diseases of the Genito-urinary System Diseases of the Nervous System Diseases of the Endocrine System

Diseases of the Eye

T11

0.38

3.50

...

0.06

0.11

0.19

0.28

0.45

1.55

0.19

0.17

---

0.51

0.17

Diseases of the Skin

---

Miscellaneous Diseases

---

+++

- JI

Total

2.68

---

0.19

0.22

57.81

49.84

405. 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.

HOSPITAL MAINTENANCE AND SUPPLY

406. This function is the responsibility of the Chief Hospital Secretary, assisted by a staff of Senior Hospital Secretaries, Hospital Secretaries and Assistant Hospital Secretaries. There are two group Hospital Secre taries, one at Queen Mary Hospital and the other Kowloon Hospital, who are responsible for the routine supply and lay administration of the medical institutions on their respective sides of the harbour. Assistant Hospital Secretaries are posted to major institutions within the two main groups. However, the Queen Elizabeth Hospital is administered as a separate unit by a Senior Hospital Secretary assisted by two Hospital Secretaries. In addition, a Senior Hospital Secretary works in the Planning

　　　Unit at Headquarters while a Hospital Secretary, stationed at the Castle Peak Hospital, is responsible for that institution.

407. The function of this branch is the maintenance of the routine non-professional 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 menial staff, the maintenance of transport and the initiation of repair work to the fabric of buildings. The Chief Hospital Secretary is also the Department Welfare Officer and the U.N.I.C.E.F. Liaison Officer.

　　　　408, A Hospital Services Section is responsible for the day-to-day running and maintenance of the steam and engineering services in the major institutions, and is under the control of the Electrical and Mechan- ical Engineering Branch of the Public Works Department. Electronic equipment has again been maintained most efficiently by the staff of the Telecommunications Division of the Postmaster General's Department and grateful acknowledgement is made of the valuable assistance given by these two Departments.

Staff Welfare

　　　　409. The Medical and Health Department Staff Welfare Association is located on Hong Kong Island and has branches in Kowloon (including Kowloon and Queen Elizabeth Hospitals) and Castle Peak Hospital. The Association provides three staff recreation centres and supports a number of welfare schemes to aid the families of members or of pen- sioners.

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

UNICEF Assistance

　　　　411. The milk feeding programme, which is sponsored by UNICEF, continued throughout the year. Altogether, 189,895 lbs. of UNICEF milk were distributed to welfare organizations throughout the Colony and the total number of supplementary meals given at feeding centres was 1,518,553, an increase of 141,900 over the previous year.

AUXILIARY MEDICAL SERVICE

412. Recruitment to the Auxiliary Medical Service was started in October, 1950, under the provisions of the Essential Services Corps Ordinance, 1950. The primary aim of the Service is to train and maintain a corps of men and women who are available to greatly augment the Colony's hospital and first-aid services during an emergency. During recent years, however, increasing use has been made to members of the Service to support Departmental staff during outbreaks of infectious diseases and during mass inoculation campaigns.

413. Up to June, 1961, those joining the Auxiliary Medical Service were both volunteer and conscripted members. On the abolition of conscription in that month, conscripted members had the opportunity either to become volunteers or to resign. The loss of conscripted mem- bers has been more than balanced by the volunteers recruited and the strength of the Service at 31st March, 1964, stood at over 5,000 men and women.

414. 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 a total Colony emergency, the ambulance and first-aid sections of the Service come under the operational control of the Civil Aid Services.

415. There are now 41 Ambulance Depot Teams spread over 24 districts of Hong Kong, Kowloon and the New Territories. Training has continued to progress satisfactorily throughout the year, and keen competitions for the 'MacKenzie' Shield, the 'Teng' Cup and the 'Small' Cup were of considerable value in improving the all-round efficiency of the teams.

416. Demonstrations were given on first-aid and artificial respiration during the Kai Fong Welfare Association's Health Education Exhibition. In the practical field, members of the service rendered first-aid to victims of traffic accidents, a house collapse and an explosion, and attended a number of fires both in Hong Kong and Kowloon. They were also em- ployed during the cholera outbreak on duties in the isolation centre and at inoculation stations.

417. Twenty-two Auxiliary Dressers from the Ambulance Teams are on duty every Sunday with the Fire Services, thereby gaining valuable practical experience in the use of equipment and in the routine work of the Fire Services ambulance section.

　　　　418. The blood-grouping of new members of the Auxiliary Medical Service was continued, and the Service continued to be responsible for making arrangements for the grouping of all members of the Auxiliary Defence Units.

　　　　419. On 17th March, 1964, a number of members of the Auxiliary Medical Service were presented with the ribbon of the Civil Defence Long Service Medal by His Excellency the Governor. Among those receiving the ribbon was the Unit Controller, Dr. P. H. TENG, O.B.E.

V. DEVELOPMENT PROGRAMME

PLANNING UNIT

　　　　420. The functions of this unit, staffed by a Principal Medical and Health Officer and a Senior Hospital Secretary, are:

(a) to prepare outline plans for the development 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 projects approved by the Finance Com- mittee of the Legislative Council; and

(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.

　　　　421. The Planning Unit has also been responsible for the implementa- tion of the plan for development of hospital and clinic services covering the period 1960-65 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 sub- mitted at the appropriate time to the Public Works and Staff Increases Sub-Committees and to the Establishment Committee. Standard schedules are available for various types of out-patient clinics, maternal and child health centres and maternity homes; these standards have been accepted by Government and simplify greatly the preparatory work required for the lesser projects undertaken by the Planning Unit.

　　　　422. Once approval of a new project has been given, sketch plans are checked, and, providing that no amendments are considered neces- sary, authority is sought for working drawings to commence; the project

is then allocated its priority and the Planning Unit supervises all stages of its development until it is handed over as an operational unit to the relevant branch of the Service.

423. Mention has already been made in paragraphs 8 to 16 of this report of the White Paper on the Development of Medical and Health Services in Hong Kong. This report, accepted by Government, will provide a firm basis for future long-term planning.

424. During the financial year 1963-64, ten projects which had been completed were handed over. On 31st March, 1964, seven projects were under construction and another seven had reached a stage where working drawings were being prepared. Initial planning has commenced on a further seven projects, which are being undertaken by architects of the Public Works Department or by private architects appointed for the work. An additional seven projects are listed in the Estimates for the year 1964-65 which await financial approval and the allocation of a priority so that detailed planning can start. Progress of approved works is detailed below.

BUILDING PROGRAMME

(April 1st 1963-March 31st 1964)

(a) Building of extensions to existing institutions completed during the

year:

May 2nd, 1963

August 15th, 1963

August 27th, 1963

September 10th, 1963

September 23rd, 1963

Tang Shiu Kin X-ray Survey Centre and Dental Clinic - donated by Sir Shiu-kin TANG, C.B.E., LL.D., K.St.J.(A), J.P.

Jockey Club Kowloon Rehabilitation Centre donated by the Royal Hong Kong Jockey Club and situated in the grounds of Kowloon Hospital, comprises Orthopaedic Appliance, Physiotherapy and Occupa- tional Therapy units.

Robert Black Health Centre, San Po Kong-erected from funds provided equally by Sir Shiu-kin Tang, C.B.E., LL.D., K.St.J.(A), J.P. and the Hong Kong Government, provides outpatient facilities. maternal and child health centre and a maternity ward of 24 beds.

Queen Elizabeth Hospital, Kowloon An

An acute general hospital of 1,338 beds, provides in-patient and out-patient specialist services, a casualty unit, laboratory, radio-therapeutic, radiodiagnostic and dental facilities and complete ancillary services. Li Cheng Uk Maternal and Child Health Centre.

November 30th, 1963

December 16th, 1963

January 1964

February 1964

March 21st, 1964

Queen Mary Hospital Extension. Stage -com- prising car park, air-conditioning plant, generating house and re-alignment of approach road. Kam Tin Clinic and Maternity Home-built with the aid of funds collected by the communities of Kam Tin and Pat Heung in the New Territories, comprises general out-patient facilities and 7-bed maternity ward.

Lai Chi Kok Hospital A linen exchange store has

been added to the facilities at this Hospital. Castle Peak Hospital-Linen exchange store, Hospital Secretary's Store, Media Room and Bus Terminal have been added.

Li Po Chum Health Centre, Tai Kok Tsui, Kowloon

built with the aid of a generous donation from the late Mr. Li Po-chun, comprises general out- patient facilities, a maternal and child health centre and a 22-bed maternity ward.

(b) Projects under construction on 31st March, 1964:

(i) Jockey Club Health Centre, Kwun Tong, is expected to be completed

in April, 1964.

(ii) The Lions Club Government Maternal & Child Health Centre, the capital costs of which are being shared by the Lions Club of Hong Kong and the Hong Kong Government, is expected to be completed in May, 1964.

(iii) Queen Elizabeth Hospital Institute of Radiology, donated by the Royal Hong Kong Jockey Club. The installation of equipment is expected to be completed in June, 1964.

(iv) Jockey Club Polyclinic, Shau Kei Wan, is expected to be completed in

July, 1964.

(v) Sha Tin Clinic and Maternity Home. Site formation has been completed. (vi) Queen Mary Hospital Extensions, New Kitchen.

(vii) Tai Wo Hau Maternal and Child Health Centre. Alterations to a block in the resettlement area to provide for this Centre will be completed in June, 1964.

1964:

(i) Yuen Long Health Centre. (ii) Tsuen Wan Outpatient Clinic. (iii) Cheung Sha Wan Health Centre.

(iv) Jockey Club Clinic, Yau Ma Tei.

(v) Queen Mary Hospital Extensions (Stages II and 111): operating theatre and radiodiagnostic unit, professorial building and quarters for nursing staff.

(vi) Wong Tai Sin Police Quarters Clinic.

(vii) Kowloon Hospital, Alterations, Additions and Improvements.

(d) Projects on which initial planning has continued or commenced:

( Combined Vaccine Institute.

(ii) New Lai Chi Kok Hospital.

(iii) Mental Defectives Home.

(iv) Castle Peak Clinic and Maternity Home.

(v) Chai Wan Maternity and Child Health Centre.

(vi) Morrison Hill Health Centre.

(vii) Lions Club Government Maternal and Child Health Centre, Extensions.

(e) Projects listed in the 1964-65 Estimates for which initial planning has

not yet commenced:

(i) Redevelopment of Sai Ying Pun Site.

(ii) Shau Kei Wan Hospital.

(iii) Hong Kong Mental Health Centre.

(iv) St. John's Hospital, Cheung Chau: Outpatient Clinic and Major Altera-

tions.

(v) Tsz Wan Shan Clinic and Maternity Home.

(vi) Wong Tai Sin Clinic.

(vii) Kowloon Dental Clinic.

VI. HOSPITAL COSTING

425. For the past few years figures have been maintained, using exactly the same basis of expenditure for comparison, of the costing of representative hospital units. Figures for the years 1962-63 and 1963-64 are shown in Table 54. The total costs for each unit and for each bed per annum have been slowly rising, but, owing to the rapidly-increasing numbers of patients treated and the consequent rapid turnover, the average cost of treating each patient has generally declined.

TABLE 54

HOSPITAL COSTING 1962-63 and 1963-64

1962-63

1963-64

Cost per

Cast per

Cost per

Unit

Total Cost

bed per year

patient treated

Total Cost

bed per year

patient

treated

Queen Mary Hospital

(Acute general and leaching) $13,753,733 $18,814.95

$ 645

$13,699,398 $21.989.40 $ 619

Kowloon Hospital

(Acute general)

LLL

$11,263,708 $17,066.22

$ 376

$11,203,960 $19,519.09 $ 373

Lai Chi Kok Hospital

(Infectious & convalescent) $ 2,303,730 $4,789.45

Tsan Yuk Hospital

(Maternity and teaching)

$ 2,171,967 $10,859.83

$ 283

$ 253

$ 2,306,965 $4,796.18

$ 2,327,260 $11,636.30

$ 320

$ 271

Castle Peak Hospital

(Mental)

$ 6,156,883 $ 5,502.13

52,635

$ 6,230,200 $ 5,567.65

$1,724

VIL TRAINING PROGRAMME

DOCTORS

　　　　426. The University of Hong Kong confers the degrees of M.B., B.S. which have been registrable with the General Medical Council of the United Kingdom since 1911. After provisional registration with the Medical Council of Hong Kong, the graduates are required to undergo a twelve months period of compulsory internship in posts approved by the University. The number of students admitted to the Faculty of Medicine was increased to one hundred during the year and it is expected that by 1967 the number of graduates will have risen from between 35 to 50 to some 80 each year.

427. A number of clinical posts in the major hospitals are recognized for post-graduate training by the majority of the examining bodies in Britain.

　　　　428. The post-graduate training of doctors in the Government Service for higher qualifications necessary for appointment to specialist clinical posts in general medicine, surgery, orthopaedics, paediatrics and obstetrics and gynaecology, is under the supervision of the 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 awards of study leave overseas.

　　　　429. The programme for training of doctors for post-graduate qual- ifications necessary to staff the clinical units in the new Queen Elizabeth Hospital proved its value on the opening of that institution. The supply of well-qualified and experienced clinicians was completely adequate in most fields and most of the new units required were formed without difficulty. However, there is a shortage in certain of the less general specialities, but it is expected that this will be remedied within the next two to three years.

DENTAL STAFF

　　　　430. No undergraduate training in dentistry has yet been established in Hong Kong, but Government during previous years had awarded annually scholarships for the study of dentistry overseas. This scholarship scheme was suspended temporarily in 1963, but during the year two scholarship

students qualified in Australia and returned to the Colony. Altogether, since the scheme commenced in 1954, 23 students have returned to Hong Kong as qualified dental surgeons.

431. The fourth class in dental technology, comprising four newly- appointed student dental technicians, began training in January, 1964; however, one of these students resigned almost immediately after joining. The initial training of the students is carried out in the dental laboratory of the Hong Kong Technical College, which was set up by the College in 1960; in the evenings the laboratory is used for the further training of dental technicians, most of whom are in the employment of dentists in private practice. 30 places are available on two concurrent thirty-week evening courses.

432. One dental technician and two student dental technicians passed the Intermediate Examination in Dental Technology of the City and Guilds of London Institute, the first local technicians ever to do so.

433. Dental nurses, who carry out preventive and minor operative work in the Government service under the supervision of dental officers, are being trained in New Zealand and Penang. Six of these dental auxil- iaries are now employed in the public service in Hong Kong. A further student dental nurse was sent to Penang, where there is now a total of five such students training under scholarships awarded by the World Health Organization.

NURSES

434. During the year, course of training continued satisfactorily in General Nursing, Psychiatric Nursing, Midwifery and for Health Visitors.

General Nursing

435. There is full reciprocity of registration between the general nursing qualifications of the Nursing Board in Hong Kong and of the General Nursing Council of England and Wales. In the Queen Elizabeth Hospital School of Nursing and in the Nurses Training School at the Queen Mary Hospital, the medium of instruction is English, while in the other approved Nurses Training Schools, which are maintained by the Tung Wah Group of Hospitals, the Alice Ho Miu Ling Nethersole Hospital and the Hong Kong Sanatorium and Hospital, teaching is carried out in Chinese. At the end of March, 1964, the numbers under training were as shown in Table 55.

100

TABLE 55

NURSES IN TRAINING MARCH, 1964

Government Schools of Nursing

Tung Wah Hospitals

111

Women

Men Total

483

566

Frr

ггт

361

ייי

135

140

1,119

1,202

Nethersole Hospital

+++

Hong Kong Sanatorium & Hospital...

Total

Psychiatric Nursing

436. The School of Psychiatric Nursing at the Castle Peak Hospital, now in its third year, had 66 students in training, of whom 23 were women. Although the number of entrants to the Psychiatric Nursing course in- creased from 34 to 66, the response, particularly from female students, is not yet sufficient to meet the demand for locally-trained psychiatric nurses. The qualification is fully recognized by the General Nursing Council of England and Wales.

Midwives

　　　437. 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 maternity wards of the Queen Mary and Queen Elizabeth Hospitals. The number of nurses taking this course increased from 72 to 97 owing to the greatly- increased number of maternity beds made available for such training by the opening of the Queen Elizabeth Hospital. Nurses who have trained in other approved training schools can also take a similar course, con- ducted in Chinese, in the maternity wards of their respective hospitals.

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

HEALTH VISITORS

　　　439. 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

LOI

examination for the Health Visitor's Certificate, which is conducted by the Hong Kong Examination Board of the Royal Society for the Promo- tion of Health.

RADIOGRAPHERS

440. 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

441. 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 Intermediate Examination is now held in Hong Kong at intervals of approximately three years.

442. 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 examination leading to the Associateship of the Institute of Medical Laboratory Technology.

PHYSIOTHERAPY

443. 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. The school, previously accommodated in converted premises in the old Pathology Institute, moved during the year into a new and well-equipped building in the Queen Elizabeth Hospital.

OTHER FORMS OF DEPARTMENTAL TRAINING

444. In-service courses of training are held for Dispensers, Tu- berculosis Workers, Social Hygiene Visitors, Dental Technicians and

102

Orthopaedic Appliance Technicians. These do not all lead to recognized qualifications but prepare those concerned for appointment to permanent posts on the Establishment after they have passed a departmental examina- tion.

　　　445. A preliminary training period of three months, including lectures, discussions, visits of observation and practical work, followed by in- dividual weekly tutorials throughout the ensuring nine months, is arranged for Almoners who enter the Department with the basic qualification of a University Degree in Social Studies.

446.

　　　　　　Table 56 sets out the various categories of training undertaken departmentally during the year.

TABLE 56

DEPARTMENTAL TRAINING-1963

Appointment

Resignation

Strength at 31.3.64

Passed

Student Assistant Physiotherapist

Student Assistant Radiographer

14(1st year)

9(2nd year)

103rd year)

Student Dispenser

Student Laboratory Assistant...

Student Medical Laboratory

Technician

FrL

Frt

Student Nurse

176

468(a)

Student Male Nurse

---

Student Nurse (Psychiatry)

Student Male Nurse (Psychiatry)

46(6)

Student Midwife

Nurse).

Lur

---

Student Midwife (Registered

Student Health Visitor ...

Tuberculosis Worker

LFF

106(c)

100

FLL

Almoner

---

(a) including 43 in Midwifery Training.

(6) including 3 Prison Officers seconded for 3 years.

(c) including 6 Registered Nurses possessing Part I certificate from England taking 6 months training only from 1.4.63-30.9.63. Also including 2 Non-English speaking Registered Nurses taking the 1 year Midwifery Training course in Tsan Yuk Hospital,

103

COURSES OF STUDY OVERSEAS

447. The following table sets out the courses of study, outside Hong Kong, attended by officers of the Medical and Health Department during 1963-64:

Place of

Source of

Appointment

Course of Study

Study

Funds

| Senior Medical &

Health Officer

Medical Services

U.K.

Government

Administration

| Senior Medical &

Health Officer

Engineering Control of

U.K.

Government

& Medical & Health

Officers

Occupational Hazards Fellow, Royal College

of Surgeons

U.K.

Government

I Medical & Health

Officer

Fellow, Royal College

of Surgeons

U.K.

Common-

wealth Scholarship

Government

5 Medical & Health

Officers

1 Medical & Health

Officer

1 Medical & Health

Officer

2 Medical & Health

Officers

2 Medical & Health

Officers

Membership, Royal

College of Physicians

Membership, Royal

College of Physicians

Membership, Royal

Australian College of Physicians

Diploma in Psychological

Medicine

U.K.

Own expense

Australia

Own expense

U.K.

Government

Diploma in Psychological

Medicine

U.K.

Own expense

5 Medical & Health

Officers

2 Medical & Health

Officers

Member, Royal College of

Obstetrics & Gynaecology Diploma in Public Health

U.K.

Government

U.K.

Government

1 Medical & Health

Officer

Diploma in Public Health

U.K.

Government

and Diploma in Industrial Health

| Medical & Health

Officer

Diploma in Clinical

Pathology

U.K.

Government

2 Medical & Health

Officers

2 Medical & Health

Officers

1 Medical & Health

Officer

Diploma in Medical

U.K.

Government

Radiology (Diagnosis)

Postgraduate Course in

U.K.

Government

Criminology & Medicolegal

Training

Course in Dermatology

U.K.

Government

104

Place of

Appointment

Course of Study

Study

Source of Funds

I Medical & Health

Officer

Tuberculosis Course

U.K.

Government

I Medical & Health

Officer

Diploma in Ophthalmology

U.K.

Government

1 Medical & Health

Officer

Diploma Course in

U.K.

Government

Bacteriology and Training

in Virology

I Medical & Health

Officer

Course in Drug Addiction

U.K. &

W.H.O.

U.S.A.

Fellowship

I Medical & Health

Officer

Abdominal Surgery

U.K.

Common-

wealth

Scholarship

1 Medical & Health

Officer

D.L.O.

U.K.

Own expense

3 Medical & Health

Officers

L.A.H.

Ireland

Own expense

1 Medical & Health

Officer

L.M.S.S.A.

U.K.

Own expense

1 Medical & Health

Officer

L.M.C.C.

Canada

Own expense

1 Medical & Health

Officer

Clinical Training in

Canada

Own expense

Physiotherapy &

Tuberculosis

1 Medical & Health

Officer

Dip. in Otorhinolaryngology

Austria

Own expense

1 Physicist

Training in Radiation

U.K.

Government

Work

| Radiographer

F.S.R.

U.K.

Government

1 Almoner

Social Work

Canada

Canadian

I Almoner

Medical Social Work

U.K.

1 Almoner

Master Degree in Social Work

Canada

Laidlaw

I Almoner

Training in anti-

U.K.

Tuberculosis Work

I Almoner

Degree of Bachelor

Canada

of Social Work

1 Almoner

Social Work

U.S.A.

Rotary

Scholarship

Common- wealth Scholarship

Government

Foundation

Scholarship

Government &

Chest & Heart

Association

Own expense

105

Place of

Source of

Appointment

1 Senior Dental

Officer

1 Dental Officer 1 Senior Medical Technologist

1 Senior Medical Technologist

| Medical Laboratory

Technician, Grade II

I Medical Laboratory Technician, Grade II

5 Medical Laboratory

Technicians, Grade II

7 Medical Laboratory

Technicians, Grade II

Diploma in Public

Dentistry

Course of Study

Study

Funds

U.K.

Government

Diploma in Orthodontics

U.K.

Government

Fellowship of the Institute

U.K.

Government

of Medical Laboratory Technology

(a) Fellowship of the

U.K.

Government

Institute of Medical

Laboratory Technology.

(6) Diploma in Bacteriology.

Bacteriological Methods

U.K.

Government

in Tuberculosis

Forensic Science

U.K.

Government

Associate of the Institute

U.K.

Government

of Medical Laboratory Technology

Associate of the Institute

U.K.

Own expense

of Medical Laboratory Technology

4 Dental Surgery

Assistants

Dental Nursing

Penang.

W.H.O.

Malaya

Fellowship

& Govern-

ment

1 Malaria Inspector.

Class II

Malaria Eradication

Manila

W.H.O.

Fellowship

& Govern-

1 Nursing Sister

Ward Sister Course

U.K.

ment

Sino-British

(Psy.)

Scholarship

1 Nursing Sister

Ward Sister Course

U.K.

Sino-British

I Nursing Sister

Sister Tutor Diploma

U.K.

British

1 Nursing Sister

Sister Tutor Diploma

Australia

1 Nursing Sister

Sister Tutor Diploma

U.K.

1 Nursing Sister

Nursing Administration

(Hospital)

U.K.

1 Nursing Sister

Neurosurgical Nursing

Canada

106

Scholarship

Government &

Technical

Assistance

Tung Wah

Group of Hospitals Government &

C.D. & W. Fund

Government &

C.D. & W. Fund

Government &

C.D. & W. Fund

Appointment

Course of Study

I Health Sister

Nursing Administration

(Public Health)

Place of Study

U.K.

Source of Funds

Gov't & Her

Majesty's Gov't in U.K. (Dept. of Tech- nical Co-

operation)

1 Health Sister

Nursing Administration

U.K.

C.D. & W.

(Public Health)

Fund

1 Health Visitor

Speech Therapy

U.K.

Government

Occupational Health Nursing

UK.

Government

1 Senior Male Charge

Nurse (Psy.)

Nursing Administration

U.K.

(Hospital)

H.K. Gov't & Her

Majesty's Gov't in U.K. (Dept. of Tech- nical Co-

operation)

1 Male Nurse

Theatre Technique

U.K.

B.C.N.M.

Fund

1 Male Charge Nurse

Venereal Disease

U.K.

Government

1 Nurse

Diploma in Dietitics

U.K.

Government

Ophthalmic Nursing

U.K.

Government &

B.C.N.M.

Fund

1 Nursing Sister

Part 11 of Midwifery

U.K.

Own expense

Training; and Premature

Infant Care

I Nursing Sister

E.N.T. Surgery

U.K.

Own expense

I Nursing Sister

Cardiac and Thoracic

Nursing

Australia

Own expense

1 Nursing Sister

General Surgery

U.S.A.

Own expense

1 Dietitian

Diploma in Dietitics

U.K.

Own expense

3 Nurses

1 Nurse

E.N.T. Nursing

Australia

Own expense

Canada

Own expense

1 Nurse

Operating Theatre

Technique and Manage-

ment, Paediatric Nursing,

Obstetric Nursing and Nursing Care of Com- municable Disease

Part 1 & 11 Midwifery

Training and Theatre Technique

E.N.T. Nursing, Theatre

Technique and

Gynaecological Nursing

107

U.K.

Own expense

Australia

Own expense

Place of

Source of

Appointment

Course of Study

Study

Funds

3 Nurses

Further training in Nursing

Australia

Own expense

of Infectious Diseases

I Nurse

1 Nurse

3 Nurses

Operating Theatre and

Canada

Own expense

Surgical Nursing

Gynaecological Nursing,

Australia

Own expense

Infectious Diseases

Thoracic Nursing

U.K.

Own expense

2 Nurses

E.N.T. Nursing

U.K.

Own expense

2 Nurses

Gynaecological Nursing

Australia

Own expense

I Nurse

Part II Midwifery Training

U.K.

Own expense

1 Nurse

Dermatology Nursing

U.K.

Own expense

I Nurse

Part II Midwifery Training,

Premature Infant Nursing and Paediatric Nursing

U.K.

Own expense

VIII. MISCELLANEOUS

ATTENDANCES AT CONFERENCES AND MEETINGS

448. The following sets out the attendances by officers of the Medical and Health Department at Meetings and Conferences during 1963-64.

Appointment

Director of Medical &

Health Services

Health Sister

Almoner, Class I, &

Orthopaedic Appliance Advisor Specialist (Dental)

Chemist

Conferences, etc. attended

W.H.O. Seminar on the Role

of the Hospital in the

Public Health Programme.

Annual Congress of the Royal

Society for the Promotion of Health,

9th World Congress of the

International Society for the Rehabilitation of the Disabled. 51st Annual Meeting of the

International Dental Federation. 22nd Conference of the

International Union of Pure and Applied Chemistry & 19th International Congress of Pure and Applied Chemistry.

Place

Manila

Eastbourne

Copenhagen

Stockholm

London

Orthopaedic Appliance

Advisor

Dental Officer

Senior Specialist

(Psychiatry)

6th International Prosthetics

Course.

Copenhagen

British Dental Association

Oxford

Annual Meeting.

W.H.O. Expert Advisory Panel

on Mental Health.

Geneva

108

Appointment

Specialist (E.N.T.)

Senior Medical and Health Officer

Conferences, etc. attended

9th Congress of the Pan-Pacific

Surgical Association.

W.H.O. Seminar on Immunization in the Control of Communicable Diseases.

Place

Honolulu

Manila

VISITORS

　　　　449. The following distinguished medical men and women visited Hong Kong during 1963-64.

General

(i) A group of American psychiatrists, headed by Prof. Jules Masserman, Chairman of the American Psychiatric Association, visited the Castle Peak Hospital on 21.5.63 in the course of a round-the-world professional tour.

(ii) Mr. J. F. WILSON, O.B.E., Director of the Royal Common- wealth Society for the Blind, visited the Colony from 31.5.63 to 9.6.63 and called on the Director on 6.6.63 for a general discussion on the problems of rehabilitation and research into the nutritional aspects of eye diseases.

(iii) Mr. Bruce W. EVERIST, M.D., Chairman of the Committee on Accident Prevention of the American Academy of Paediatrics, visited the Colony from 7.7.63 to 11.7.63 in the course of a world tour to study accident prevention activities.

(iv) Prof. LIM Kok Ann, Professor of Bacteriology, University of Singapore, visited the Department on 7.7.63 to discuss the progress of virus work in Hong Kong.

(v) Dr. J. M. LISTON, C.M.G., Chief Medical Officer, Department of Technical Co-operation, arrived in the Colony for a week's stay on 4.9.63.

(vi) Lord Lansdowne, Minister of State for Commonwealth and Colonial Affairs, visited the Queen Elizabeth Hospital on 12.9.63. (vii) Drs. J. V. GALOTTO and W. S. DAVIS of the Catholic Charities' Guidance Clinics, Diocese of Brooklyn, visited the Castle Peak Hospital on 2.9.63.

(viii) Dr. David LANDAU, an American psychiatrist, visited the Castle

Peak Drug Addiction Centre on 30.9.63.

109

(ix) Prof. Theodore WOODWARD and Prof. Kenneth GooDNER of the Jefferson Medical College of Philadelphia visited the Colony

on 18.10.63 and called on the Director to discuss various aspects of cholera control.

(x) Dr. Robert E. STOWELL, Scientific Director, Armed Forces Institute of Pathology, Washington, visited the Department on 28.10.63.

(xi) Prof. R. CRUICKSHANK, Professor of Bacteriology, University of Edinburgh, Scotland, visited the Colony on 1.11.63 and discussed problems in the field of communicable diseases. (xii) Mr. Stanley Mosk, Attorney General for the State of California,

visited the Castle Peak Hospital on 9.11.63.

(xiii) Dr. R. A. CHAPPEL, Assistant Executive Officer for Health, South Pacific Commission, Noumea, New Caledonia, visited the Colony on 12.11.63.

(xiv) Dr. Otto GLUCK, Municipal Councillor and Member for Health of the City of Vienna, visited the Queen Elizabeth Hospital on 2.3.64.

(xv) Miss Sheila QUINN, Director of the Social and Economic Welfare Division of the International Council of Nurses, visited the Colony from 26.3.64 to 6.4.64.

W.H.O. & U.N.I.C.E.F.

(6) Mr. S. POLAK, Resident Representative, Thai Area Mission, U.N.I.C.E.F., visited Hong Kong from 1.4.63 to 14.4.63, and called on the Director on 4.4.63 for a discussion and review of the milk distribution programme,

(ii) Mr. Henry C. CHENG of Taiwan arrived on 3.4.63 for a five days'

visit to study food and drug control.

(iii) Mr. WONG Mook-ow of Singapore visited Hong Kong from

21.4.63 to 3.5.63 to study leprosy control.

(iv) Prof. C. Y. CHOW, W.H.O. Regional Entomologist, visited

Hong Kong from 22.4.63 to 30.4.63.

(v) Mr. WEI Yan-sei and Mr. LEE Chi-nam of Taiwan arrived on 27.4.63 for a week's stay to study the drainage system of the Colony.

110

(vi) Dr. BONG Han Ahn, Director of the Inchon Sea-port Quarantine Station, Inchon City, Kyunggi Do Province, Korea, visited the Colony from 20.5.63 to 25.5.63 to study quarantine procedures in Hong Kong.

(vii) Dr. Gabino BALBIN, Regional Director, Regional Health Office No. 3 of the Philippine Department of Health, arrived on 20.5.63 for a five days' stay to observe urban and rural health administration.

(viii) Dr. CHEN Kuo-hsin of Taiwan arrived on 14.6.63 for a two weeks' stay to observe the venereal disease control programme. (ix) Dr. JAP Kon-soeng of North Borneo arrived on 1.7.63 for a week's stay to observe the operation and trends of rural health services.

(x) Miss CHU Pao-tien, Dean of the Junior College of Nursing, Taipei, visited the Colony from 8-12.7.63 to study public health training programmes in maternal and child health, health education and public health nursing.

(xi) Dr. J. FORT, W.H.O. Consultant on the Treatment and Rehabili- tation of Drug Addicts, visited the Colony from 13.7.63 to 19.7.63 to study facilities for the treatment and rehabilitation of drug addicts.

(xii) Dr. Colonel J. Ferris FULLER, W.H.O. Consultant in Dental Health, arrived on 24.7.63 for a five days' stay to study the training of dental officers in the techniques of dental epidemiolo- gical surveys.

(xiii) Dr. CHONG Chun-hian, Medical Officer in charge of the Kuching General Hospital, arrived on 5.8.63 for a two weeks' stay to study hospital administration.

(xiv) Dr. Jiro UTO of Japan visited the Colony from 7.9.63 to 15.9.63

to study port health and quarantine services in Hong Kong. (xv) Dr. John BOWERS, W.H.O. Consultant on Medical Education,

visited the Colony on 11th and 12th November, 1963.

(xvi) Dr. Edward GRZEGORZEWSKI, Director of the Division of Education and Training, W.H.O. arrived on 28.11.63 for a 3 days' study visit.

(xvii) Dr. Yu Un-soong, Director of the National Seoul Air-port Quarantine Station, and Mr. Ki Duk Kim, Section Chief,

Ell

visited the Colony on 2.12.63 to observe the quarantine station in Hong Kong.

(xviii) Dr. Guthe, Director, Venereal Disease and Treponematoses Control, W.H.O., visited the Colony on 5.12.63 to discuss local problems in venereal disease.

(xix) Dr. A. E. LINDQUIST, W.H.O. Consultant, arrived on 6.12.63 for a 4 days' stay to advise on mosquito control at international airports.

(xx) Dr. Kim Ung Sik of Korea arrived on 6.12.63 for six-days' stay

to observe leprosy control in Hong Kong.

(xxi) Dr. I. C. FANG, Regional Director, W.H.O. visited the Colony from 8.12.63 to 11.12.63 for discussions with the Director.

(xxii) Dr. P. LEPINE, Head of the Virus Research Division of the Pasteur Institute in Paris, and Dr. B. CVJETANOVIC, Chief Medical Officer, Bacterial Diseases, W.H.O. visited the Colony on 19.12.63 to observe laboratory facilities in Hong Kong.

(xxiii) Dr. O. FELSENFELD, W.H.O. Consultant on Cholera, arrived on 26.12.63 for discussions with officers of the Department on the cholera situation.

(xxiv) Dr. G. R. WADSWORTH, Reader in Human Nutrition from the Queen Elizabeth College, visited the Colony from 13.1.64 to 16.1.64 in his capacity of W.H.O. Consultant to the Seminar on Methods to Improve Nutritional Standards at the Village Level.

(xxv) Dr. CHUNG Tai Kim of Korea arrived on 13.1.64 for a study visit of 4 days to observe public health and maternal and child health services.

(xxvi) Dr. Alan H. PENINGTON, W.H.O. Area Representative in Taipei, visited Hong Kong from 20.1.64 to 25.1.64. He discussed developments in the School of Physiotherapy and also visited the Queen Elizabeth Hospital.

(xxvii) Dr. Lin Hong-te of Taiwan visited Hong Kong from 17.2.64 to 20.2.64 on a study visit to observe mental hospital administra- tion.

(xxviii) Dr. P. VISALVETHAYA and Dr. B. SUNAKORN of Thailand arrived on 26.3.64 for a two days' stay to observe tuberculosis control work.

112

PUBLICATIONS

450. The following articles were published by members of the depart-

ment.

Title of Article

1. Various chapters on Nas-

opharyngeal Carcinoma.

2. A report of the systemic

use of 5-fluorouracil in the treatment of Chinese cancer patients.

3. The Hong Kong Chinese

Female Bony Pelvis and Its Influence on Labour: A Radiographic and Clinical Study of 1005 Women.

4. Tuberculosis in

Hong Kong.

5. Planning the Modern

Dental Surgery.

6. Mirror Heads, an

Investigation into the Effects of Heat Sterilization.

7. Cardiac Resuscitation in the Dental Surgery.

8. Aging and Mental

Health in Hong Kong.

9. An Examination of the

Crosscultural Approach to Psychosomatic Pathology, with special reference to Hong Kong. 10. Unusual Presentation of

Portal-Systemic Encephalopathy.

11. Hepatic Encephalopathy as a Psychiatric Problem. 12. Gilles de la Tourette's

Disease.

Publication

Neoplastic Disease

at Various Sites- Tumours of the Larynx and Pharynx. British Journal of

Cancer.

Journal of Obstetrics & Gynaecology of the British Common- wealth.

Tubercle, London,

Vol. 44, No. 3, 1963. The Dental

Practitioner, 1963. Volume XIII No. 7.

The Dental

Practitioner, 1963, Volume XIII No. 12.

The British Dental

Journal, 1964 Volume 116.

Processes of Aging.

W.H.O.

British Journal Clin.

Practice.

American Journal of

Psychiatry. American Journal of

Psychiatry.

113

Name and Title of Author

Dr. H. C. Ho, Senior

Specialist (Radiology)

Dr. H. C. Họ, Senior

Specialist (Radiology) Dr. Daniel P. S. CHAN, Medical & Health Officer.

Dr. H. C. Ho, Senior

Specialist (Radiology) and Dr. C. P. WONG, Medical & Health Officer.

Dr. A. S. MoODIE, Senior

Specialist (Tuberculosis) Dr. W. C. ALLWRIGHT,

Senior Specialist (Dental) and

Dr. W. H. BURNDRED, Senior Dental Officer.

Dr. W. C. ALLWRIGHT,

Senior Specialist (Dental) and

Dr. K. K. WONG, Dental Officer.

Dr. W. C. ALLWRIGHT,

Senior Specialist (Dental) and E. CHEONG, Dental Officer. Dr. P. M. YAP, Senior

Specialist (Psychiatry). Dr. P. M. YAP, Senior

Specialist (Psychiatry).

Dr. K. SINGER,

Specialist (Psychiatry).

Dr. K. SINGER,

Specialist (Psychiatry), Dr. K. SINGER,

Specialist (Psychiatry).

Title of Article

13. Psychogenic Muscular

Spasm,

14. The Frequency of the

ABO Blood Groups Amongst the Chinese Population in Hong Kong.

15. A Programme For the

Establishment & Training of Orthopaedic & Prosthetic Appliance Technicians in Hong Kong. 16. Orthopaedic & Prosthetic

Appliances in Hansen's Disease.

17. Below-Knee Prostheses in

Hansen's Disease.

18. Establishment of

Orthopaedic & Prosthetic Services in Afro-Asian

Publication

Bulletin of the

Hong Kong Chinese Medical Association.

Bulletin of the

Hong Kong Chinese Medical Association, Volume 14, No. 1.

Orthopaedic &

Prosthetic Appliance Journal, and Prostheses, Braces & Technical Aids. Journal of

Rehabilitation in Asia.

Proceedings, 9th World

Congress on Rehabilitation.

Rehabilitating the

Disabled in Africa,

Name and Title of Author

Dr. W. H. Lo, Medical &

Health Officer and Dr. M. H. WONG, Medical & Health Officer.

Dr. T. C. PANG, Specialist (Forensic Pathology), Dr. G. T. F. TONG, Medical & Health Officer and

Dr. F. K. LEE, Medical & Health Officer. Mr. J. A. E. GLEAVE,

Orthopaedic Appliance Advisor.

Mr. J. A. E. GLEAVE,

Orthopaedic Appliance Advisor.

Mr. J. A., E. GLEAVE,

Orthopaedic Appliance Advisor.

Mr. J. A. E. GLEAVE,

Orthopaedic Appliance Advisor.

Countries Part I.

ACKNOWLEDGEMENT

451. It is a pleasure and a privilege to pay tribute to all concerned in the work which is recorded in this report. In these achievements the staff of the Medical and Health Department, who have worked so loyally in the face of mounting pressure, have received great support and co- operation from other Departments of Government and from the voluntary and welfare agencies who make such a significant contribution in the medical field. Special tributes are paid to the Architectural Branch of the Public Works Department for their continued and ready assistance in the construction of new hospitals and clinics, particularly the Queen Elizabeth Hospital, and to the Royal Hong Kong Jockey Club and other private donors whose generosity has made possible so many of these buildings. Finally, the public of Hong Kong whose energy, industry and understanding have been the main factors behind the achievements recounted in this report.

P. H. TENG,

Director of Medical and Health Services.

114

ポー

·.

וי

HONG LONG ISLAND MEDICAL

+37

LONG BONG

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,

21.

23.

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

22. Ruttonjee Sanatorium (a tuberculosis hospital). Wan Chai Hospital (a hospital for venereal and der- matological treatment).

24.

3. Ling Yuet Sin Infante' Home.

4. Tsan Yuk Hospital (a maternity hospital).

H.K. Psychiatric Clinic & Day Hospital.

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

25.

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

26.

27.

8. Alice Ho Miu Ling Nethersole Hospital (a general

hospital).

28.

29.

30.

9. Port Health Inoculation Centre, Marine Building. 10. Central District Health Centre (general outpatient facilities, maternal and child health 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 (a general hospital). 15. Hoog 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). Medical Examination Board.

18.

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.

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

Hong Kong Sanatorium & Hospital (a general hospital).

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

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

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

Anne Black Health Centre (a maternity home with general outpatient facilities, a maternal & child health centre, a dental clinic and a X-ray survey centre).

31. Shau Kei Wan Public Dispensary (general outpatient facilities with special clinics).

32. Chai Wan Clinic and Maternal & Child Health Centre. 33. Stanley Prison Hospital.

34.

35.

Stanley Dispensary & Maternity Home (general out- patient facilities and maternity home). Grantham Hospital (a tuberculosis hospital).

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

37. Matilda Hospital (a general hospital).

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

39.

40.

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

117

Lai Chi Kok

Sham Shui Pol

KOWLOON PENINSULA

DICA MEDICAL

FACILITIES

Mong, Kor Tani

Kowloon City

Tau Ha Tai

Trim Sha Taal

Hung Hom

Visterin

Kowloon

Boy

North Point

KOWLOON

41. Lai Chi Kok Hospital (an infectious diseases and convalescent hospital, with an Isolation Unit for the segregation of suspected cases of the quaran- tínable disease).

42.

Lai Chi Kok Female Prison Hospital.

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

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

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

58. Tsim Sha Tsui Health Centre (a school health, maternal & child bealth 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.

61.

62.

46.

47.

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

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

63.

49. Li Po Chun Health Centre (general outpatient facilities).

Government Ophthalmic Clinic-Arran Street (an ophthalmic centre).

50.

51.

Queen Elizabeth School Clinic.

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

64.

Ho Man Tin Maternal & Child Health Centre. Kowloon Chest Clinic (a tuberculosis clínic). Kowloon Hospital and Outpatient Department (an acute general hospital with casualty department and outpatient department with special and dental clinics).

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

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

65. Li Kee Memorial Dispensary (general outpatient facilities with special clinica and a dental clinic).

66. Wang Tau Hom Jockey Club Clinic (a maternity home with general outpatient facilities and a maternal & child health centre).

Maryknoll Mission Hospital (a general hospital). Wong Tai Sin Clinic (general outpatient facilities). Air Port Health Station.

53.

Yau Ma Tei Public Dispensary (general outpatient facilities).

67.

54. Queen Elizabeth Hospital (an acute General Hospital with casualty department and Specialist Clinic), 55. Kowloon Police Medical Post (general outpatient and dental facilities for police officers and their families). $6. Ashley Road Social Hygiene Clinic (a male treatment. centre for venereal disease).

68.

69.

70.

Kwun Tong Maternal & Child Health Centre,

71.

Kwun Tong Rehabilitation Centre.

72.

Robert Black Health Centre (A maternity home with general outpatient facilities).

119

MEN

TERRITORIES

MOOKA ZOLTA

HONG KONG AND THE NEW TERRITORIES

ISLAND

WIL

BAY

NEW TERRITORIES

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

74. Fanling Hospital (a general hospital).

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

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

77. Yuen Long Dispensary (general outpatient facilities with special clinica).

78.

Pok Oi Hospital (a general hospital),

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

80.

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

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

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

83. Sha Tin Maternity Home.

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

85. Haven of Hope Tuberculosis Sanatorium.

86. Nansen Tuberculosis Rehabilitation Centre.

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

88. Peng Chau Clinic (general outpatient facilities, special clinics and maternity bede). 89. Hei Ling Chau Leprosarium.

90. Children's Convalescent Home, Cheung Chau.

91. St. John Hospital (a general hospital and outpatient department with special clinics). 92. Silver Mine Bay Dispensary (general outpatient facilities with maternity beds).

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

94. Shek Pik First Aid Posl.

95. Tai O Dispensary (general outpatient facilities, with special clinics and maternity beds). 96. Kam Tin Clinic (general out-patient facilities with maternity beds).

121

APPENDIX I

THE DIVISIONS OF THE MEDICAL AND HEALTH DEPARTMENT

Health Services

Medical Services

Hospitals, general clinics and outpatient departments

-excluding New Territories.

Clinical Specialist Service.

Pharmaceutical Service.

Radiologica! Service.

Almoner Service.

Physiotherapy Service.

Occupational Therapy Service.

Medical Examination Board.

New Territories-Curative and preventive.

Government Institute of Pathology.

Maternal and Child Health Service.

District Midwifery Service.

School Health Service.

Dental Service.

Tuberculosia 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.

122

APPENDIX II

ESTABLISHMENT OF THE MEDICAL & HEALTH DEPARTMENT AS AT 31.3.64

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

Senior Specialist

Specialist

Secretary

Deputy Secretary

г. .

---

TII

LJ I

LJI

IPT

---

LJ L

---

Senior Treasury Accountant

Principal Medical & Health Officer

Senior Medical & Health Officer

זיי

Medical & Health Officer and Assistant Medical & Health Officer Senior Dental Officer, Dental Officer and Assistant Dental Officer Principal Matron

...

Nursing Staff

Dietitian

---

PIO

---

ITI

...

390

---

2.555

Principal Almoder

---

Senior Almoner and Almoner

Chief Pharmacist

---

ILJ

IJL

---

JIL

---

LJ J

Senior Pharmacist, Pharmacist, Dispenser and Dispensary Supervisor Government Chemist

L--

LJ-

-L,

Chemist, Assistant Chemist and Assistant Biochemist

---

152

г. г

---

Scientific Officer

Senior Physicist and Physicist

Assistant Hospital Secretary

Clerical Staff

..ז

---

...

---

...

Chief Hospital Secretary, Senior Hospital Secretary, Hospital Secretary and

Executive Grade Officer

---

חי -

זיי

---

450

Senior Laboratory Assistant and Laboratory Assistant Health Inspector and Malaria Inspector Senior Inoculator and Inoculator

Technician

Other Staff

---

ייז

LJ-

Superintendent Radiographer, Senior Radiographer, Radiographer and Assistant

Radiographer Superintendent Physiotherapist, Tutor Physiotherapist, Physiotherapist and

Assistant Physiotherapist

-LI

Superintendent Occupational Therapist and Occupational Therapist Chief Medical Technologist, Senior Medical Technologist, Medical Technologist

and Medical Laboratory Technician

ILJ

LJ J

ILJ

112

---

...

---

ILI

JIL

128

гуг

ILL

---

106

Orthopaedic Appliance Technician and Assistant Orthopaedic Appliance

LJI

...

1-1

751

---

4,589

Total

8,871

123

124

APPENDIX III

STATEMENT OF EXPENDITURE FROM 1959-60 TO 1963-64

Particulars

(a) Medical and Health Department

(b) Medical Subventions

- LJ

(e) Capital expenditure on medical projects under Public Works Non-Recurrent

...

Total

1959-60

1960-61

1961-62

1962-63

1963-64

45,925,081 56,573,091 64,064,336 68,541,015 76,893,619

18,988,424: 21,910,889 25,009,269 | 26,386,405 27,764,694

15,442,311 12,369,272 9,836,801 28,262,729 29,675,789

80,355,816 90,853,252 98,910,406 123,190,149| 134,334.102

Total expenditure of the Colony

---

709,953,996 845,297,629 953,205,237 1,113,276,099|1,295,372,840

Percentage of Medical and Health Department Expenditure to the Total Expenditure of the Colony

11.31%

10.75% 10.38%

11.07%

10.37%

125

APPENDIX IV

ANALYSIS OF MORTALITY FOR THE YEARS 1959-63 (Given as Percentage Total Deaths)

Disease Group

Detailed List

Numbers

1959

1960

1961

1962

1963

1. Infectious and Parasitic

001-138

14.2

14.4

15.3

13.5

12.8

2. Neoplastic

140-239

9.3

10.5

12.3

12.4

13.4

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

240-299

1.1

1.2

1.5

4. Nervous System and Sense Organs

300-398

6.2

7.2

8.3

8.4

9.1

5. Circulatory System

400-468

8.9

9.7

10.7

11.0

12.2

---

- - -

6. Respiratory

470-527

22.3

19.3

14.8

13.9

13.3

7. Intestinal

530-587

11.3

9.3

7.7

6.8

7.1

TII

· - ·

10.

Genito-Urinary

9. Pregnancy, Child-birth and Puerperium

Skin and Musculo-Skeletal...

11. Congenital Malformations and

Diseases of Early Infancy

12. Ill-defined Causes

---

13. Accidents, Poisoning and Violence...

590-637

2.1

2.0

2.1

2.2

гто

---

640-689

0.4

0.3

0.2

690-749

0.4

0.3

0.2

750-776

9.3

10.7

11.1

11.4

11.3

780-795

8.7

9.5

10.4

11.4

9.9

TII

E800-E999

5.8

5.7

5.9

7.6

6.3

APPENDIX V

INFECTIOUS DISEASES NOTIFIED CASES AND DEATHS 1959-63

1959

1960

1961

1962

1963

Diseases

Cases Deaths

Cases.

Deaths

Cases Deaths Cases Deaths

Cases

Deaths

Cholera

130

Amoebic dysentery

Bacillary dysentery (Including

unspecified dysentery)...

Cerebro-spinal meningitis

239

334

215

195

115

241

· · ·

663

678

742

795

802

Chickenpox

Diphtheria

typhoid)

Malaria

Measles

278

304

498

707

---

1,199

тгг

---

2,087

116

1,450

1,334

109

1,022

102

871

Enteric fever (Typhoid & Para-

997

773

TIL

742

826

1,038

442

83.3

812

794

377

---

743

176

710

192

1,727

435

2,317

326

3,416

405

*Ophthalmic neonatorum. Poliomyelitis

Puerperal fever

Scarlet fever

Tuberculosis

Typhus (mite-borne) Whooping cough

Total

...

244

254

250

-F

310

240

148

184

363

---

וי.

14,302

2,178

12,425

2,085

12,584

1,907

14,263 1,881

13,031 1,762

110

100

20,241 2.589 18,005

2,467 19,333 2,586 21,773 2,447

21,515

2,334

†influenza

11,659 |

25 5,727

26 6,223

6,374 ❘

39 | 4,433

Remarks:

* Notifiable since June 1958.

† Voluntary notifications.

126

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 year,

127

APPENDIX VI

ANTI-EPIDEMIC PROPHYLACTIC IMMUNIZATIONS 1959-1963

Immunological Procedure

Anti-Smallpox Vaccination

Anti-Cholera Inoculation...

Anti-Diphtheria Inoculations

1st Dose

2nd Dose

Booster Dose

JLI

...

Anti-Typhoid Inoculations:

1st Dose

2nd Dose

Booster Dose

тгг

Anti-Plague Inoculation

Anti-Typhus Inoculation

Anti-Rabies :

---

ILI

...

151

...

1st Dose

JUL

...

וי.

Other Doses

JIL

LJI

JIL

LJI

---

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

Infants

Others

JLL

LII

1959

1960

1961

1962

1963

1,034,138

573,848

969.577

744,599

321,942

36,245

30,634

1,968,211

2,976,274

3,101,766

223,209

202,883

296,071

323,521

371,059

...

144,118

174,406

207,143

312,374

281,369

63,582

71,219

115,566

129,279

146,374

141,342

97,902

43,080

21,440

17.779

101,174

78,103

30,013

11,734

10,696

92,712

38.374

38,624

30,141

28,864

205

220

224

249

618

1,597

1,409

981

275

255

3,577

3,717

3,786

3,784

3,829

13,872

12,846

14,342 |

15,010

17,019

62,261

79,169

86,234

91,304

98,342

P+1

8,518

11,054

7.756 1

26,939

14,175

Year

APPENDIX VII

ANNUAL INCIDENCE AND TREND OF VENEREAL DISEASE

1953 1954 1955 1956 1957 1958 1959 1960 1961

1962

1963

Total New Patients

Total Attendances...

SYPHILIS

(Total (Except Congenital)

Primary

Secondary

Early Latent

Late Latent

All Others

Congenital

Gonorrhoea...

(Under 1 year

lover 1 year

37,392 36,652 34,853 37,392 36,652 34,853 32,490 31,391 27,841 28,980 26,281 25,819 27,264 23,761

213,091 223,031 203,701 180,148 193,674 203,954 213,026 213,733 182,049 179,135 147,588

6,969 6,825 4,2321 3,628 3,190

3,372 2,680 2,091 1,555 1,858 1,487

634

393

153

154

164

132

2,298

2,209

1,044

733

450

417

426

296

202

359

307

3,727

3,983

2,853 2,616

2,532

2,766

2,038

1,590

1,173

1,216

864

178

186

148

166

194

ILJ

177

188

139

119

103

111

116

131

11,625 10,785 11,309

10,609

9,881

8,360

8,362

6,506

5,997

5,747

5,696

Non Gonococcal Urethritis

870

---

Chancroid

2,507

770

2,365 2,468

869

776

800

644

481

591

509

453

379

1,614 685

294

324

873

635

356

347

Lymphogranuloma Vencreum

208

286

249

140

178

Non Venereal Disease

Skin Disease

7.708

7,150

6,623 6,245

5,855

5,458 4,997 4,717

4,293 5,489 4,155

5,908

7,376

8,165 8,437

9,814

0,701 11,046 10,611 12,173] 12,917 10,740

128

APPENDIX VIII

CLASSIFICATION OF DERMATOLOGICAL CASES FOR 1961, 1962 & 1963

Diagnosis

No. of asses 1961

No. of caree 1962

No. of cases 1963

Abrasions

2. Acne

---

Alopecia Arența

Boils, Folliculitis...

Carcinoma

0.94

1.33

114

1.35

0.83

0.77

1E8

1.40

0,55

0.81

0.84

575

9.96

566

8.37

421

4.99

0.05

0.04

0.12

...

Contact Dermatitis

1. Clog Dermatitis

Eczema Atopic...

Eczema-Infantile

1,351

23.41

1,019

15.06

791

9.38

0.42

0.38

0.08

0.57

1.46

268

3.18

281

4.87

315

4.66

197

2.34

10.

Eczema Infective

238

4.12

36 L

5.34

588

6.98

11.

Eczema

Scrotum

0.10

0.22

0.19

1-1

12.

Eczema Miscellaneous...

1,242

21.52

1,931

28.55

2,720

32.26

13.

Exfoliative Dermatitis

　　　14. Erythema Multiforme 15. Erythema Nodosum

Herpes Zoster Ichthyosis, Xorosis

JLI

0.13

0.04

0.08

0.19

0.16

0.21

0.19

0.09

0.07

16,

17.

18. Impetigo

19.

Leprosy

---

0.24

0.36

0.33

0.22

0.28

0.13

LII

LJ J

256

JIL

LJI

4.43

292

4.32

228

2.70

1.59

1.44

127

1.50

21.

22.

23.

24. Porphyria

20. Lichen Planus

Lupus Erythematous Moniliasis Neurodermatitis

0.08

0.01

0.45

0.36

0.42

0.03

0.04

226

3.92

301

4.45

491

5.83

ITI

}

0.01

25. Peronychia

26. Pediculosis

27.

Pomphlolyx

28. Prickly Heat

29. Pruritis

30. Peoriasis

31. Purpura

32.

---

г. г

Ringworm of Scalp

33. Ringworm of Body

34. Ringworm of Groins

35. Ringworm of Feet and Hands

0.35

---

0.42

0.44

0.04

0.01

1.07

0.42

0.31

---

- LI

---

0.90

0.75

0.23

0.99

1.17

115

1.36

0.83

100

1.47

141

1.68

- -

0.08

0.10

0.15

0.17

124

2.15

202

2.99

279

3.31

0.36

0.61

0.95

112

1.94

143

2.12

184

2.19

36.

Rosacea

37.

Scabies

38.

0.07

0.23

170

0.05

0.03

0.04

40.

41.

42.

43.

Warts

44.

45.

Scleroderina

39. Tuberculosis of Skin

Undetermined

Urticaria ...

Varicose Dermatitis

JJL

0.03

0.01

0.03

0,24

0.16

303

5.25

207

3.06

304

3.61

1.61

130

1.93

227 2.69

0.64

0.75

62 0.74

JIL

ILJ

1.71

134

1.98

238

| 2.82

Seborrhoeic Dermatitis

0.73

1.26

218

2.59

---

Leucoderma

127

2.20

141

2.08

162

1.92

129

APPENDIX IX

GOVERNMENT INSTITUTE OF PATHOLOGY, 1963

(0) SPECIMENS EXAMINED

(1) Protozoology and Helminthology

(2) 0. Haematology

b. Blood Grouping

(3) Serology

...

(4) Bacteriology

JIL

г. г

ILL

26,736

144,459

1,931

106,049

JIL

---

268,386

-1

---

4,445

...

гіг

69,630

(5) Mycology

(6) Public Health...

(7) Histopathology

(8) Biochemistry

(9) Clinical Pathology Examination

(10) Special Investigation ...

(11) Virus Unit

...

JIL

...

г. -

---

TII

5,769

112,002

34,807

---

457

+++

2.122

Grand Total

---

(b) NOTIFICATIONS OF ANIMAL BITES

The following animal bite notifications were received during 1963:

776,793

Dog Cat Monkey

Pig

Other Animals

Total

Hong Kong

1,960

101

2,075

Kowloon

3,652

บ

3,690

Total...

5,612

129

5,765

130

131

APPENDIX X

NUMBER OF HOSPITAL BEDS IN HONG KONG - 1963

Iof

Obv.

Others

Total

---

PII

---

145

457

106

245

165

1.1 19

48)

623

1,338

574

1,119

200

154

---

140

398

200

4981

100

271

301

118

185

---

818 2,172 25 3B 162

520

61 131

122

1,161

173 279

108

4,765

GOVERNMENT HOSPITALS ;

Queen Mary

Queen Elizabeth

Kowloon

Castle Peak

LJ J

H.K. Psychiatric Clinic & Day Hospital

Sai Ying Pun

Tron Yok...

Lai Chi Kok

Wan Chai

St. Joho

ILI

South Lantau

4 Prison Hospitals

TOTAL

OPP

ггг

GOVERNMENT DispensARIES:

Aberdeen

Eastero

Anne Black

011

-1

---

rol

---

Kennedy Town

LII

ייי

Stanley

---

Hung Hora

IIL

Tai Po

ггг

Yuen Long

...

---

Sha Tau Kok

-4

•

Shek Wu Hui

---

LII

Ho Tung

LII

JJL

LII

Sai Kung

- L

Tai 0

---

LII

San Hui

---

Sha Tin

---

Silver Mine Bay

---

Maurine Grantham

- rr

ILL

North Lamnia

-гг

---

ITF

Peng Chan

---

Shek Pit First Aid Post

rrr

LIT

Robert Black

.י.

Wung Tau H

LLL

-1

г гт

Kami Tin

---

ILI

---

TOTAL

JJJ

LLL

...

• 201

Casualty holding beds.

זי

309

APPENDIX X-Contd.

Med.

Surg.

Ophth.

E.N.T.

Gyn.

Mat.

Babies

PLE.

Chro.& rehab.

Coov.

Cust. 4

CAM.

דבני

Obv. Others

Total

GOVERNMENT-Assisted HOSPITALS:

Tung Wab

Kwong Wah

Tung Wah Eastern

Alice Ho Miu Ling Nethersole

Kuttonjee Sanatorium

Granthami

Pok Oi

---

Hei Ling Chau Leprosariuni Haven of Hope T.B. Sanatoriura Sandy Bay Convalescent Home Maryknoll Mission Hospital

H.K. Society of Rehab. Medical Rebabilitation Ceotro

---

152

111

108

570

ווז

---

LLL

L-I

ឆន្ទះ | | | | |ន

124

184

91 226

57 67

$885 | 18 || 12

131

491

184

235

673

338

1,374

300

343

613

343

413

118

5401

540

196

203

102

108

ILI

---

TOTAL

LII

---

1,006

423

33 211 45: 19| 340) 1,418 | 540

136 10:

4,709

132

PRIVATE HOSPITALS:

H.K. Sanatorium & Hospital

Precious Blood

St. Teresa's

Canossa

.PI

St. Paul's

Hong Kong Central

PPI

Matilda & War Memorial

Faoliog

ILL

---

10-

---

274

---

16 21

---

Children's Convalescent Home, Cheung Chau...

TOTAL

---

644

247

PRIVATE MATERNITY HOMES

זיי

PRIVATE NURSING HOMES

GOVERNMENT HOSPITAL

GOVERNMENT DISPENSARIES

GOVERNMENT-ASSISTED HOSPITALS

PRIVATE HOSPITALS

PRIVATE MATERNITY HOMES

136 23 61

547

| || |

21822||

316

106

274

183

174

120

1,303

$47

816, 1,172

162

$20

6' 181 122

1,161

173 | 279

108' 4.765

289 |

---

1,006

644

423

33 212

452 19 340 1,418 540

136

309

4.709

136

61 58

1.303

יי!

5471

547

---

PPP

PRIVATE NURSING HOMES

101

г-г

GRAND TOTAL

игг

100

19 | 1.842

436, 1,996

48 582 1,598 540 1,167 142 142 173 283

108,11,716

APPENDIX XI

IN-PATIENTS ADMITTED INTO GOVERNMENT, GOVERNMENT-ASSISTED AND PRIVATE HOSPITALS IN 1963, INCLUDING CASES REMAINING IN HOSPITALS FROM THE PREVIOUS YEAR

NAME

Government Hospitals:

Cencral

Beda

Io- Tuber. Mater- Pay- fectious culosis nity chiatric

Total

CARCE

CRO+

CHACH

Castle Peak

---

1,119

*3,613

3,613

Queen Mary Kowloon

Lai Chi Kok

Tran Yuk

St. Jobo

Sai Ying Pun

Wan Chai

South Lantau

LII

---

H.K. Psychiatric Clinic

4 Prison Hospitals

rri

Dispensacies and Maternity Homes.

Queen Elizabeth

TOTAL

Government-Assisted Hospitals:

огг

L-L

623

19.615

140

2,290

22,139

$74

24.435

445

408

4,721

30,059

ILL

JIL

481

$,367

1,636

137

+7,201

---

200 |

773

7,815

8.588

---

100

1,073

162

611

1,899

--L

LII

732

1,594

2,340

298

374

LLL

---

198

253

LIN

291

185

2.967

215

220

3,527

309

1,338

1,276

20,583 308

20,583

1,647

5,074

56,734 3.982

1.173 36,447

*4,178 |*102,514

Tung Wah Group

2,385

34,890

511

1.350

29,901

Grantham

613

140

1,421

66,706 1,501

Hei Ling Chau Leprovarium

$40

658

Rattoojee Sanatorium

$43

1,245

658 1,301

Alice Ho Miu Ling Nethersole

300

4,940

104

2,338

7,440

Haven of Hope Tuberculosis

Sanatorium

203

414

Pok Of ...

---

118

3,630

2,551

6,181

Maryknoll Mission

H.K. Society of Rebab. Medical

Rehabilitation Centre

TOTAL

Private Hospitals:

Hong Kong Sanatorium

ггг

LLI

1,940

842

2,887

Sandy Bay Convalescent Honie

108

249

PIE

4.709

45,845 1,328

4.624 35,632

$7,483

---

316

8.201

193

157

2,211

221

30,986

St. Teresa's

CADDAIL

St. Paul's

Precious Blood

---

274

---

8,088

570

260

1,040

9,958

---

183

3,159

160.

3,377

---

174

2.660

180

506

636

4,062

---

106

1,489

143

1,657

---

Hong Kong Contral

Matilda and War Memorial...

Fanling...

Children's Convalescent Home,

Cheung Chau

Nursing Homes and Maternity Homes

---

120

3,470

226

3,783

886

162

1,051

1,110

1,270

129

630

818

44 45.782

46,649

TOTAL

---

1,933 29.950

1,044

1,205 50,446

277

62,922

GRAND TOTAL

---

11,716 132,529

6,354

7,002122,525

4.509 272,919

In addition, there were 224 Drug Addicts in Drug Addiction Treatment Centre.

+ Jacluding 5,701 convalescent patients transferred to Lai Chi Kok Hospital from Queen Mary 142, and

Kowloon 5,059.

133

APPENDIX XII

IN-PATIENTS TREATED IN GOVERNMENT AND GOVERNMENT-ASSISTED HOSPITALS, 1963 CLASSIFIED ACCORDING TO INTERNATIONAL STANDARD CLASSIFICATION

INTERMEDIATE LIST OF 150 CAUSES

Cases Treated

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

meat

Hospitals

Govern-

ratüt-

Assisted

Hospitals

Goverd-

Govero-

ment

Whole Colony

fotot-

Hospitals!

Assisted

Hospitals

Mule

Ferakc

Sex Un-

known

Total

A 1

A 2

001-008

010

Tuberculosis of respiratory system... Tuberculosis of meninges and

1,161

4,022 |

136: 649

1,107

452

1,559

134

A 3

011

012 - 013

'014 - 019

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

115

H-

169

70!

156

194

431

130

100

A 6

020

Congenital syphilis

A 7

021

Early Syphilis...

A a

024

Tabes dorsalis..

A 9

025

General paralysis of insane

167

A 10

022 - 023

All other syphilis

-N

026 - 029

A 11

030 - 035

Gonococcal infections

།

A 12

040

Typhoid fever...

622

298

...

A 13

041 - 042

Paratyphoid fever and other

Salmonella infections

A 14

043

Cholera

112

的奶

A 15

044

Brucellosis (undulant fever)...

A 16 (0)

045

Bacillary dysentery

691

61 !

---

Carried forward...

3,357

5,160

221

775 1,261

564

1,825

APPENDIX XII-Contd.

Cases Treated

Deaths

Inter-

mediate

Detailed

List

Number

List

Number

Cause Groups

Govern-

meat

Hospitals

Govern-

ment-

Assisted

Hospitals

Cover-

Govern-

Deaths

Whole Colony

ment-

ment

Hospitals

Assisted

Hospitals

|Sex Un-|

Male

Fem lo

known

Total

Brought forward...

3,357 5,160

221

775

1,261

564

1,825

A 16 (5)

046

ILI

(c)

047 048

A 17

050

Scarlet fever

A 18

051

Streptococcal sore throat

A 19

052

Erysipelas

ITI

A 20

053

Septicaemia and pyaemia

135

A 21

055

Diphtheria

TII

---

A 22

056

Whooping cough

A 23

057

A 24

058

Plague...

A 25

060

Leprasy

---

A 26

061

Tetanus

LJI

ILL

A 27

062

Anthrax

...

---

A 28

080

A 29

082

A 30

081, 083

A 31

084

Smallpox

A 32

085

Measles

ITI

---

A 33

091

Yellow fever

A 34

092

Infectious hepatitis

---

A 35

094

Rabies...

A 36 (0)

100

ILJ

Louse-borne epidemic typhus

Amoebiasis

Other unspecified forms of dysentery

143. 115

---

115

985

Meningococcal infections

---

JLL

---

Acute poliomyelitis

Acute infectious encephalitis Late effects of acute poliomyelitis

and acute infectious encephalitis.

106

198189 5

673

...

314

199

105

---

|:མདྷ དྷ། །༄།

211

194

405

Carried forward...

5,557 6,395

.463

835 1,625

906

2,531

136

Inter-

mediate

List

Number

APPENDIX XII-Contd.

Cases Treated

Deaths

Detailed

List

Cause Groups

Number

Govero-

ment

Hospitale

Govern-

ment.

Assisted

Hospitals

Govers-

Govern-

Whole Colony

ment

Hospitals

ment.

Aginted

Hospitals

Mate

Female

Sex Un

koowo

Total

5,557 6,395

463

835

1,625

906

2,531

A 36 (6)

101

(c)

104

(d)

105

(e)

102 - 103

106 - 108

A 37 (0)

110

(b)

111

(c)

112

(d)

115

113 114

116 117

A 38 (0)

123.0

(b)

123.1

(4)

123.2

(d)

宣

123.3

A 39

125

Brought forward...

Flea-borne epidemic typhus (murine) Tick-borne epidemic typhus.

Mite-borne typhus

Other and unspecified typhus

Vivax malaria (benign tertian) Malariae malaria (quartan) Falciparum malaria (Malignant tertian)

Blackwater fever

LJ J

JLI

LFI

Other and unspecified forms of

malaria

ILL

LJD

ILJ

Schistosomiasis vesical (5. Haema- tobium)

I LJ

Schistosomiasis intestinal (S. Man- soni)...

ILL

Schistosomiasis pulmonary

(5. Japonicum)

JIL

Other and unspecified schis-

tosomiasis

---

Hydatid disease

---

- ז

TOI

+- F

LL F

A 40 (4)

3009

127

Onchocerciasis

---

127

Loiasis...

JL+

127

Filariasis (banerosti)

LJI

-L

TOI

127

Other filariasis

A 41

129

Ankylostomiasis

J.L

Carried forward...

| |

[

---

-- F

124

5,600

6,533

463

835❘ 1,6261

906

2,532

APPENDIX XII-Contd.

Cases Treated

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Covero-

Deaths

Covers-

Deaths

Govero-

Coveco-

Whole Colony

ment-

mcot

Hospitals

Assisted

Hospitals

Hospitala

ment-

Aesisted

Hospitals

Male Female

Sex Vo-

known

Total

5,600 6,533

463

835 1,626

906

2,532

A 42 (0)

126

(b)

130.0

@ 800 3800 os vessast

(1)|

130.3

124, 128

130.1-130.2

Brought forward...

Tapeworm (infestation) and other

cestode infestations

Ascariasis

---

1гг

Guinea Worm (dracunculosis) Ocber diseases due to helninths

Lymphogranuloma venereum Granuloma inguinale, venereal

LJI

207

→

278

Other and unspecified venereal diseases Food poisoning infection and

(d)

A 43 (0)

037

(6) 038

(c)

039

049

intoxication

LJI

(+)

071

Relapsing fever

(/) 072

Leptospirosis icterohaemorrhagica

(Weil's disease)

073

Yaws

---

- - -

---

087

Chickenpox

090

Dengue

---

095

Trachoma

LLJ

---

096.7

Sandfly fever

---

120

Leishmaniasis

+++

---

...

137

121 (a) Trypanosomiasis gambicusis. (6) Trypanosomiasis rhodesiensis (c) Other and unspecified

trypanosomiasis Dermatophytosis

(n)

131

135

Scabies

JLL

---

Carried forward...

| | │

5,800 7,043

465

835 1,626 909

2,535

APPENDIX XII-Contd.

Cases Treated

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govcro-

mtat

Govern-

ment-

Govern-

Hospitals

Govern-

ment Assisted Hospitals Hospitals

Deaths

Whole Colony

tatat-

Assisted

Hospitals

Malc

Female

|Sex Un-

known

Total

Brought forward.....

5,800 7,043

465,

835

1,626

909

2,535

A 43 (p)|036,054,059,

(063,064,070,

,074,086,088,

089,093,

096.1,096.6.

All other diseases classified as infective and parasitic

102

1096.8,096.9,

122,132-134,

136-138

A 44

140 - 148

Malignant neoplasm of buccal

3686

cavity and pharynx

191

422

A 45

150

Malignant neoplasm of oesophagus..

158

A 46

151

Malignant neoplasm of stomach

172

286

A 47

152 - 153

Malignant neoplasm of intestine,

except rectum

P10

131

A 48

154

A 49

161

Malignant neoplasm of rectum Malignant neoplasm of larynx

KER BEN

200

213

115

328

87.

112

130

170:

128

298

521

A SO

162 - 163

Malignant neoplasm of trachea,

and of bronchus and lung not

specified as secondary

185

372

188

222

165]

387

A 51

170

Malignant neoplasm of breast

161

224

120]

120

A 52

171

Malignant neoplasm of cervix uteri..

442

228

146

A 53

172 - 174.

Malignant neoplasm of other and

A 54

177

A 55

190 191

A 56

196 - 197

unspecified parts of uterus

Malignant neoplasm of prostate Malignant neoplasm of skin Malignant neoplasm of bone and

connective tissue

---

Carried forcard.......

107

471

...

୫

7,561

9,122 |

668

1,636

2,436

1,761

4,197

APPENDIX XII-Contd.

Cases Treated

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

ment-

Govern-

Govern

Whole Colony

ment-

ocat

Hospital

ment Assisted

Hospitals

Assisted

Hospitals

Male Female

[Sex Un-

known

Total

Brought forward...

7,561 9,122

668

1,636 2,436 1,761

4,197

A 57

155 - 160

Malignant neoplasm of all other

164 165

and unspecified sites

698

702

219

319

563

307:

870

175 176

139

178 - 181

192 - 195

198 - 199

A 58

A 59

204

Leukaemia and aleukaemia..

158

200 - 203

205

Lymphosarcoma and other

neoplasms of lymphatic and

haematopoietic system

111

281

A 60

210 - 239

Benign neoplasms and neoplasms

A 61

250 - 251

A 62

252

of unspecified nature

Nontoxic goitre

-H

Thyrotoxicosis with or without goitre

1,444

438

351

A 63

260

Diabetes mellitus

LII

L+

A 64 (a)

280

Beriberi

---

(6)

201

Pellagra

JIL

ITI

(4)

282

Scurvy...

ཤྩ།།

436

➖➖ ➖

TII

អ្វីៗថ្មីៗ | |

ས།

(d)

283 286

Other deficiency states

JIL

342

ITI

A 65 (a)

290

++.

{r}

291

Pernicious and other hyperchromic

anaenua!

Iron deficiency anaemias (hypochromic)

Other specified and unspecified

ILL

FIL

ITI

}

227

3 ¦

103

- J

anaemias

317

270

20!

30:

ILL

LII

A 66 (0)

(a) |

241

Asthma

366

602

271

ILI

---

Carried forward...

11,422

12,521

1,034

2,083

3,247 2,279,

5,526

140

APPENDIX XII-Contd.

Cases Treated

Inter-

mediate

Deaths

Detailed

List

Number

List

Number

Cause Groups

Govern-

ment

Bospitals

Covero-

meat-

Assisted

Hospitals

Govern-

ment

Deaths

Whole Colony

Hospitals

ment-

Assisted

Hospitals

Malc

Female

1Sex Unst

known

Total

Brought forward...

...

11,422 12,521

1,034 2,083

3,247 2,279|

5,526

A 66 (b)

240,

242 - 245.

253 - 254,

270-277,

287 - 289,

All other allergic disorders, endocrine, matabolic and blood

diseases

++1

15 T

...

666

330

10.

21'

100

ITI

2,507

2,108

TII

---

806

2,628

469

778

836

792

1,628

127

35]

294 299

A 67

300 - 309

Psychoses

A 68

310 - 324

326

Psychoneuroses and disorders of personality

A 69

325

Mental deficiency

ד..

A 70

330 - 334

A 71

340

A 72

345

A 73

353

Epilepsy

LIJ

A 74

370 - 379

Vascular lesions affecting central

nervous system

---

Nonmeningococcal meningitis

Multiple sclerosis

ILI

Inflammatory diseases of eye

A 75

385

Cataract

A 76

387

Glaucoma

ני..

233

105

221

199

Carried forward.......

...] 18,212 16,103

1,562 2,915 4,158, 3,125

7,283

141

APPENDIX XII-Contd.

Cases Treated

Inter-

mediate

List

Number

Deaths

Detailed

List

Number

Cause Groups

Govern-

ment-

Govern-

Whole Colony

10500

Hospitals

meot Assisted Hospitais Hospitals

mcot

Assisted

Hospitals

Male

Female

Sex Un-

known

Total

Brought fortcard.....

18,212 16,103 1,562

2,915 4,158 3,125

7.283

A 77 (0)

390

Otitis externa....

(6)

391 - 393

Otitis media and mastoiditis

135

(c)

394

A 78 (a)

380 384,

386.

388 - 389

Other inflammatory diseases of ear... All other diseases and conditions of eye

---

257

(b)

341 - 344,

350 - 352,

All other diseases of the nervous system and sense organs...

514

345

354 - 357,

360 - 369,

395 - 398

A 79

400 - 402

Rheumatic fever

159

130

A 80

410 - 416

Chronic rheumatic heart disease

697

971

145

227

A 81

420 - 422

heart disease

A 82

430 - 434

A 83

440 - 443

Arteriosclerotic and degenerative

Other diseases of heart

Hypertensive heart disease

274

374

IIT

445

330

775

457

---

1,092

118

495

403

418

821

174

686

216

139

355

A 84

444 - 447

450 - 456

Other hypertensive disease Diseases of arteries ...

229

639

159

238

153

A 86

460 468

A 87

470 - 475

480 - 483

A 89

490

A 90

491

Bronchopneumonia

A 91

492 - 493

Other diseases of circulatory system Acute upper respiratory infections. Influenza

Lobar Pneumonia

Primary atypical, other and

unspecified pneumonia

Carried forward...

209

848

769

2,002

ITI

134

--+

...

---

1,303

4,080

445

1,248 · 1,095

1,024

2,119

152

178

23,807

28,179

2,356

5,081

6,671

5,398

12.069

APPENDIX XII-Contd.

Cases Treated

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

ment-

Deaths

Govern-

meat

Covero-

Deaths

Whole Colony

ment-

| Hospitals

Assisted

Hospital

Hospitale

Assisted

Hospitals

Male

Female

Sex Un-

known

Total

Brought forward...

25,807 | 28,179

2.356

5,001 6,671 5,398

12,069

A 92

500

Acute bronchitis

526

A 93

501 - 502

A 94

$10

Bronchitis, chronic and unqualified..... Hypertrophy of tonsils and

220

769

55 1

171

adenoids

470

136

LJI

A 95

518, 521

Empyema and abscess of lung

130

115

A 96

519

Pleurisy

A 97 (0)

523

Pneumoconiosis

བྱཱ-

TII

(b)

511 - 517, · All other respiratory diseases

789

968

ཐྭ།

103

520, 522,

524 - 527

A 98 (a)

530

Dental Caries

---

IIT

...

(b)

531 - 535

All other diseases of teeth and

supporting structures

285

A 99

540

Ulcer of stomach

JIL

1,217

949

A 100

541

Ulcer of duodenum

455

123

---

A 101

543

A 102

550 - 553

Gastritis and duodenitis

Appendicitis

190

454

---

· P ·

1,405

440

A 103

560 - 561

Intestinal obstruction and hernia

730

585

-- L

570

A 104 (a)

$71.0

(b)

571.1

(c)

572

A 105

581

Cirrhosis of liver

A 106

584, 585

Gastro-enteritis and colitis,

between 4 weeks and 2 years

Gastro-enteritis and colitis, ages

2 years and over

Chronic enteritis and ulcerative colitis

Cholelithiasis and cholecystitis

Carried forward...

822

1,614

126 |

311

251

239

490

1,288

946

11]

102

489

278

+-+

111

219

284

267

189

-·|--

32,677

36,490

2,738 5,799

7,529 5,998

13,527

142

Inter-

mediate

List

Number

APPENDIX XII-Contd.

Cases Treated

Detailed

List

Number

Cause Groups

Govero-

Feat

Hospitala

Govern-

meat-

Assisted

Hospitals

Deaths

Govern-

ment

Govern

Deaths

Whole Colony

Hospitals

meat-

Assisted

Hospitals

Mole Female

Sex Un.

known

Total

Brought forward...

32,677 | 36,490

2,738

5,799 7,529 5,998)

13,527

A 107

536 - 539,

542, 544.

545,

573 - 580.

Other diseases of digestive system...

1,742

1,186

182

161

125

286

582 - 583,

586, 587

A 108

A 109

590

Acute nephritis

591 - 594

nephritis

A 110

600

A 111

602, 604

A 112

610

A 133

620, 621

Diseases of breast

A 114(0)

613

Hydrocele

634

(c)

601, 603,

605 - 609,

611 612,

614-617,

622 633.

A 115

635 - 637

Chronic, other and unspecified

Infections of kidney

Calculi of urinary system Hyperplasia of prostate

Disorders of menstruation

All other diseases of the genito-urinary system

640 - 641, | Sepsis of pregnancy, child-birth

TII

...

JLL

TIF

145

362

-- P

290

$18

106

224

198

151

349

223

13!

499

374

+--

100

131

187

298

1,739

1,635

143

681 - 682,

and the puerperium

130

TII

684

A 116

642, 652,

685 - 686

Toxaemias of pregnancy and the

puerperium

599

324

Carried forward...

38,445 | 41,505

3,057

6.126

୨

14,257

7,932 6,325.

APPENDIX XII-Contd.

Cases Treated

Inter-

mediate

List

Number

Deaths

Detailed

List

Number

Cause Groups

Govern.

Govern-

ment

Govern-

Govern.

Deaths

Whole Colony

ment.

meat-

Hospitals

meat Assisted

Hospitals

Assisted

Hospitals

Male Female

Sex Un-1

known

Total

A 117

643 - 644

670 - 672

A 118

650

A 119

A 120(a)|

651

ILL

645 - 649

673 - 680

Brought forward...

Haemorrhage of pregnancy and childbirth

· · ·

Abortion without mention of

sepsis or toxaemia...

Abortion with sepsis...

---

Other complications of pregnancy, childbirth and the puerperium

38,445 41,505 3,057 6,126

7,932 6,325,

14,257

683,

(5)]

687 - 689

660

Delivery without complication

A 121

690 - 698

Infections of skin and

subcutaneous tissue

A 122

720 - 725

A 123

726 - 727

Arthritis and spondylitis Muscular rheumatism and

TII

A 124

730

A 125

737

A 126 (a)

745 - 749

715

A 127

(5); 700 - 714

716

730 - 744

751

rheumatism, unspecified Osteomyelitis and periostitis Ankylosis and acquired musculoskeletal deformities

Chronic ulcer of skin (including

tropical ulcer)

All other diseases of skin

All other diseases of musculoskeletal system Spina bifida and meningocele

TII

355

648

1,467

2,820

102

8,040

1,193

6,917 | 34,929

1,434

799

222

391

255

171

404

336

131

---

498

Carried forward.......

...

58,197 82,967! 3,075 6,149

7,952 6,365

1 1

14,315

144

145

APPENDIX XII-Contd.

Cases Treated

A 128

754

A 129

750, 752,

753

755 - 759

A 130

760 - 761

LI-

A 131

762

A 132(0)

764

(6)

765

763,

Inter-

mediate

Deaths

Detailed

List

Number

List

Number

Cause Groups

Govern-

ment-

Hospitals

Govern

mcat Amisted Hospitals Hospitalz

Covice

ment-

Assisted

Hospitals

Whole Colony

Male Female

Sex Un

known

Total

Brought forward...

Congenital malformations of

circulatory system...

All other congenital malformations...

Birth injuries..

...

ז..

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

Other infections of newborn

---

58,197

82,967 3,075

6,149 7,952, 6,365

14,315

125

32.

316

383

136

271

105

118

22:

55.

127

131

100;

231

168

226

201.

154

355

766 - 768

A 133

A 134

770

Haemolytic disease of newborn

113

66'

179

769,

All other defined diseases of early

771, 772

infancy

- - -

TII

14.

A 135

773-776

Ill-defined diseases peculiar to

early infancy

...

TII

544

1,023

158

599

576

467

1,043

A 136

794

A 137(0)

788.8

Senility without mention of Psychosis Pyrexia of unknown origin

395

206

263

423.

686

385

(b)|

793

Observation, without need for

788.1788.7:

further medical care

788.9

789 - 792

853

887

morbidity

...

1,067

575

651] 599

14 1,264

795

Carried forward...

... 61,777 87,201

3,457

7,315 10,134 8,349

14 18,497

146

APPENDIX XII-Contd.

Cases Treated

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

went

Govern-

ment-

Gover

Govern-

Death.

Whole Colony

meat-

Hospitals:

meat Assisted

Hospital

Hospitals

Assisted

Hospitals

Hole Female

|Sex Un-|

known

Total

Brought forward...

AE 138 E810 E835 Motor vehicle accidents

61,777

87.201

3,457 | 7,315 10,134 8,349| 14 | 18,497

---

2,461

123

144

224

AE 139 E800 E802 Other transport accidenta E840 - E866

399

AE 140 E870 - E895| Accidental poisoning

AE 141 E900 - E904| Accidental falls

AE 142

E912

Accident caused by machinery

393

144

ITI

5,548

113

150

666

AE 143

E916

Accident caused by fire and explosion of combustible material..

345

291

AE 144 E917 - E918| Accident caused by hot substance, corrosive liquid, steam and radiation

---

1,044

11!

AE 145

E919

Accident caused by firearm

AE 146

E929

Accidental drowning and submersion

101

133

175

Carried forward...

72,737

87,307

3,738

7,315 10,653 8,569

14 | 19,236

147

APPENDIX XII-Contd.

Cases Treated

Inter-

mediate

List

Number

Deatba

Deaths

Detailed

List

Number

Cause Groups

Govern-

ment

Hospitals

Govern-

meat-

Assisted

Hospitals

Gover

Govern-

ment

Whole Colony

Hospitala

Asolated

Hospitali

Male

Female

|Sex U

known

Total

72,737 87,307

3,738

7,315 10,653 8,569| 14 | 19,236

136

2,068

139

82:

107

AE 147

(0)

E920

(b)

E923

E927

(d) E928

Brought forward.....

Foreign body entering eye and adnexa

...

IIT

10+

503

Foreign body entering other orifice...

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

Other accidents caused by animals..

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

E913-E915

E921 - E922,

E924 - E926! E930 E965.

AE 148 E970 - E979

Suicide and self-inficted injury

---

490 |

216

154

370

AE 149 E980 E985

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

277

...

+76,217 87,453 3,835

7,321 |10,973' 8,761

AE 150 E990 E999 Injury resulting from operations

of war

...

GRAND TOTAL...

1419,748

+ Including 5,701 convalescent patients transferred to Lai Chi Kok Hospital from Queen Mary 142, & Kowloon 5,059.

APPENDIX XII-Contd.

Cases Treated

Deaths

Inter-

mediate

List

Number

Detailed

List

Number

Cause Groups

Govern-

ment

Hospitals Hospitals

Govern-

meat-

Assisted

Cover.

Hospitals Hospitals

Govern

mafot.

Assisted

Deaths

Whole Colony

Mole Female

Sex Un-

known

Total

AN 139

AN 138 N800 N804 Fracture of skull

595

117

206

303

LJI

ILI

N805 N809 Fracture of spine and trunk

482

AN 140

N810-N829

N810- N829 Fracture of limbe

2,330

AN 141

AN 142

N830 N839

Dislocation without fracture

155

N840- N848

Sprains and strains of joints and adjacent muscle

AN 143 N850-N856 AN 144 N860- N869]

ILJ

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

5,090

101

103

146

298

- - -

ILI

AN 145

AN 146

- N870 N908

Laceration and open wounds

2,220

N910 - N929| N910 - N929

Superficial injury, contusion and crushing with intact skin surface.

253

]

AN 147 N930-N936 Effects of foreign body entering

through orifice

AN 148

N940 - N949| Buros

657

L-L

J-

1,342

AN 149 N960 - N979)

N960 N979 Effects of poisons

FLI

749

121

AN 150

N950- N959 All other and unspecified effects N980 - N999!

of external causes

JL.

225

268

129

397

148

TOTAL...

14,440

252

378

839

412

1,251

APPENDIX XIII

OUT-PATIENTS - 1963

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

INSTITUTIONS

Dress- ings

General Out- patients

dren's Clinica

Ante- antal

Poal- DALA

¡Gyaneco- Social

fogical Hygiene

Exc

Exc. Nove & Throat

Tuber- enlogis

Casualty

Ortho. predic

Leprosy

Psychia Derma-

Lric tological!

Touri

Government Hospitals:

Queen Mary

13,294

565

Kowloon

42.440

133,787

Taan Yuk

St. John

South Lantau

3.059!

124

24,857

Stanley Prison

1433

$1.07

Victoria Remand Prison

431

10,894

Lai Chi Kok Famule Prison

940

Tai Lam Chung Prison

284

3,155

Queen Elizabeth Hospital

524

377

412

547

40.243

L46

107,489 1.819

6,319 665 46

3.679

6211

136

743

1611

420

1,083

736i

246

1,413

428

1141 3,895.

i. [

56,480

305,538 LEE

T│

| | │! │

Clinics and Dispenaarias : H.K. Paychiatric Clinic Sai Ying Puo Violet Peel

---

Ophthalmic Clinics

Wan Chai Cheri Clinic... Sai Ying Pun Chest Clinic Kowloon Chest Clinic Shek Kip Mei Chest Clinic Social Hygiene Clinics..... Families Clinic, Hong Kong Families Clinic, Kowloon

L-I

L0,336 41,703

104,5031 71.839! 1,336 127,014|

2169

.222

2,625

1.942

234

1,062,

B12

284

2,650

76,390

10,069

5,122

266|

10,705

6.736

1 1 1 1

1 1

31,161

963 34,897 L1,375

1,236

5,594

3,895

1.021

420

197,13$

865

173,328

76,390

10.071 5,412 10,713 6.7$1 32,912

23,761

720

5,512)

117

TOS 10,412.

Police Medical Post, Hong Kong

7,341

Police Medical Post, Kowloon...

5,612

6,187 7,829

3,515

$19

11,192

Police Quarter Clinic, Cheung

Sha Wan

4,537

1,958) 11,146|

Victoria Remand Prison

Families Clinic

Stanley Prison Families Clinic

174

Chi Mi Wan Prison Clinic

1,925

1,053 7,347) 3,677

| | |

Kowloon-Canton Railway Clinic

136

L.615

Mt. Butler Quarry Clinic

$40

3,028

Port Health Medical Porte

4,390

| | | | | | |

[

197

113

|||

Queen Elizabeth Specialist

Clinic ...

Public Dispensaries, Hong

Kang & Kowloon

New Territories Dispensaries

Maternal and Child Health

Genere:

2,3521 *6,260

1,134 1,789

103.622 513.733j 136.363|| 3,660

732 20,431 165,717) 94,890 14,358 1,367

8491

1,317

L.865

1,736

128

6,352

1,807

309

2,614

289

135

918

7,156

2,616] 3,470 23,107

6,357

10,529

20,156

24,833

19,754

1,097

8.021

5.602

1.951

3.868

4,390

254

949

10.969

1,766

779.131

11s

115

334,400

Harcourt

5,916 31.

392;

Aberdeen

Western...

Chai Wan

Central

Anne Black

Kennedy Town

Kowloon

5,076

122

206

2.319

524

3.439

192

128

3,310

1.174

307)

2,634

1,430.

415

3,185

324

112

4,227

6071

417

Wang Tan Hom

Shek Kip Mei

Robert Black

Total of Government

Jolitution

5,446. 1,084

372

11,237)

1.097

199

2,127

665

267,443| 1,193,769 343,397

87,886

11,915 6,021

27,5231 93,291) 9.908 34,577| 162,263|

6,626

5,484

3,241

3.759

4.791

4.479

3,621

7,25]

4.902

13.217

2,827

3,409

1,063

1,390 13,238

2,270,952

Tung Wah Group of Hospitals. 14,094 163.946 25,411 27,671 1,094 Alisé Ho Miu Ling

4,611 3,90T

1.091

406

345

Netherole Hospital...

6,692

2.687 1,141

5,384

Auttanjee Sanatorium.....

Grantham Hospital

---

Renoir', Mill Church Cliniş

905

1,382

114

171

260

47 135

Pak Oi Hospital

164

Maryknoll Mission Hospital

Total of Government-Assisted

Justitution

FIL

GRAND TOTAL...

1,524)

14,764 19,776 2,665 10,545 939 1,053

582

321!

101

---

17,301 198,310. 46,426

34,076

2.017 8,054

4,782

4,175

1,295

404

345

284,744|| 1,392,099 429,123| 71,962 14,732 14,075 27.523 98,013: 14,083 39,872 182,670| 3,754 1,063

Including 1.566 Medical ennen and 4.694 surgical ensen,

245,199

15,904

3,975

37.995

263

132

15,249

263

132

318,384

1,653 13,370'

2,589,336

149

APPENDIX XIV

OUT-PATIENTS - 1963

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

INSTITUTIONS

Drea ing

General Chil

Ou1- dren's Patients Clinico

Aote- Post. natal natul

Gynares- Social

logical Hygiene

Eye

Ear. Nose & Throat

Tuber- culosir

Casualty

Ortho- predic

Leprosy

Paychia Derma- the tological

Total

659

66,218 477,039

44.678

55,823

3,419

156,630

32,420

9.079

73,766

3,895

21,058

2,489

389,622

2,287

341,486

214,162

230,551

4,253

185,652

1,782

259

436,816

250,205

24,100

20,555

192,251

17,638

13,044

397|

120

36,911

37,234

113.

14,508

111 |

1,473

17,896

12,289

2,444

6,000

6,285

529

10,897

8901

1,085

3,434

88,452

3,325

1,248,780

954

254:

505,041

Government Hospitals!

Queen Mary

LIN

Kowloon

LII

13,294 165,428

05-0 183,912

136

3,868

775: 1,462

990

43,816

368

107,489 20,214

Tran Yuk

LII

3,455

36,908 4,115

WIL

St. Joba

4,751

35,469

6,020) 2,286

1,556 1.495

South Lantau

859

2,230

168

Stanley Prison

11,207

84.969

575

227

3,501!

56,623

749

162

2,944

Victoria Hemand Prison

1,404

31,016

Lai Chi Kok Female Prisou

935

7,898

246

! ¦

Tai Lam Chung Prison

2,663

60,419

1,826

744

Queen Elizabeth Hospital

114 9,895

| ! ¦

Clinica and Dispensaries :

　　　　　　H.K. Psychiatric Clinic Sai Ying Puo

Violet Pert

63,043 144,743

147,827 105,306 188,905

294 15,315

0,408

214,162

8,594

2,901

| |

3,280

2,650

9.827

| │

Ophthalmic Clinics

Wan Chai Chest Clinic Sai Ying Pun Cheat Clinic Kowloon Cheat Clinic... Shek Kip Mei Chest Clinic Social Hygiene Clinica..... Families Clinic, Hong Kong Familien Clinic, Kowloon

17.630

13.044

Palier Hediral Pol. Hant Kon

13,869

11.350

10,298)

Police Medical Post, Kowloon

8.560,

11.743 16,931

Police Quarters Clinir. Cheung

Sha Wan

6,490

2,264 5,739

Victoria Remand Prison

Families Clinic

103

Stanley Prison Families Clinic'

5.546

1,371 12,350

Chi al Pan Priku Clair

4,464

7,825

| | |

Kowloon-Canton Railway Clinic

Ms. Butler Quarry Clinic

190 1,645

1,403

851

Port Health Medical Porta

4.643 6.285!

Queen Elisabeth Specialist

Clinic

243

147,588

230,528

181,379

434,775

250,195

529

51,096) 53,911

1,504

28,804) 1,182

41.547

34,103 5,025

34,305 5,747

31,257 1,457

64.671 3,549) 911

24,442| 5,663

30,204) 4,211

7.922 1,133

LII

912,438) 1,818,982

BU5,969 137,149|

Public Dispensaries Hong Kong

& Kostaon

Nosa Territories Dispensaries

Maternal and Child Health

Centres:

Harcourt Westerb...

Chai Wo

Central

Ange Black

Aberdeen

Kennedy Town Kowloon

Wang Tau Hom

Shek Kip Mei

Robert Black

Total of Government

Institutions

43,579) 1,350 13,964 2,072 4,948

155,459) 14,349 1.076 2,014 115,324| 183,718! 112,72 63,974) 1,481

339,612 693,359,

406

6,665

3.9 13,989 4,530 6,268 2,614 136 3,487 16,350 6,245 57.199 23.1077

671

$9,351

363

206

54,570

416

30,402

879

141

42.374

481

39,696

586

40,658

197

32,911

69,139

30,531

964

93,341

10,317

10,853 24,930 155,691| 252,631| 30,454) 1,224,396 188,044

24,930

37,079) 36,372||

23,097) 33,205 5,771,208

Tung Wah Group of Hospital Alice Ho Miu Ling Netherole

Hospital

Buttonjee Sanatorium

Granthin Hospital

Rennie's Mill Church Clinic Pok Oi Hospital

Maryknoll Mission Hospital

Total of Government-Aeristed

Institutions ...

40,554) 460,500,

1071 29,335

422

75,739

80,703

15,174

1,833 6,642

1,141 21,259

15,097

14,554 13,570

408. 1,739

712,739

67,016

4,278, 15,479 2,365; 26,770 2.176 46,019

152

406

786

15,627

1.304

15,637

432

468]

22.903

36,179 1,919

1,505 3,7541

73,233

601

492

440

306

55,173

49,430 578,925 113,423 101,550|

3,575 28,545

15,583

15,340 30,503) #76 1,739

440

186 946,113

GRAND TOTAL...

---

961,868 2,397,907, 999,392 241,699) 14,428 53,475 155,691| 268,214

45,794

1,254,897 388,920 38,818

36,372

23,537

33,389 6,717,401

1,50

APPENDIX XV

NEW TERRITORIES CLINICS, 1963

Out-patient Attendances

Deliveries

Dispensaries

New Cases

Total Attendances

In-patients

Domiciliary

Tai Po...

He Tung

- L

38,234

65,466

1,846

...

2,412

5,164

471

Sba Tau Kok

ILI

---

9,692 1

19,560

437

Sha Tin.

---

11,951

24,597

645

Yuen Long

San Hui

Sai Kung

Shek Wu Hui

Tai O

JLI

Silver Mine Bay

Peng Chau

Maurine Grantham

North Lamma

JIL

---

57,536

112,300

2,359

8,144

15,879

1,215

JUL

---

TII

8,633

13,157

577

...

LJ J

49,299

89,065

1,999

---

21,936

26,511

371

---

9,293

12,285

163

LJJ

8,555

10,657

152

82,579

151,068

2,845

---

4.949

9.666

Kom Tin

--1

Shek Pik First Aid Post

Sai Kung Travelling

LJI

1,484

4,509

703

Shek Wu Hui Travelling

LJI

1,201

1,239

Tai Po Travelling (East)

1,164

1,204

Yuen Long Travelling (West).........

1,309

1,317

Chee Hong Floating Clinic

6,307

6,417

Chee Van Floating Clinic

8,824

14,525

Kat 0

191

538

Total

+++

TIP

334,400

585,841

13,183

151

152

APPENDIX XVI

SAMARITAN FUND

INCOME AND EXPENDITURE ACCOUNT FOR THE YEAR ENDED 31ST MARCH, 1964

EXPENDITURE

Maintenance, capital grants, travelling expenses, etc. Balance carried to Accumulated Food

---

INCOME

---

$19,076.05

2,353.15

Donations:

The Hong Kong Jockey Club (Charities) Ltd. $12,000.00 Secretary for Chinese Affairs

...

---

4,200.00

Hongkong & Shangbai Banking Corporation.

1,000.00

Mr. Yuan Chiu-chi & Others

PPI

4.229.20

$21,429.20

$21.429.20

LIABILITIES

Accumulated Fund as at 1st April, 1963 Surplus from Income and Expenditure A/C

Certified correct.

ייי

BALANCE SHEET AS AT 31ST MARCH, 1964

ASSETS

-10

יוי

LLL

---

$16,261.95

$ 2,353.15

Carl with Accountant General

---

$18.615.10

Certified correct.

...

TEX

$18,6 15.10

$19,615.10

S. C. CHENG,

Acting Príncipal Almoner, Medical & Health Department.

29th May, 1964.

CERTIFICATE OF THE DIRECTOR OF AUDIT

G. AGABEG,

for Director of Medical & Health Services. 29th May, 1964.

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.Ñ.A. 113 of 26.5.50, amended by G.N.A 33 of 22.4.60). 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,

5th June, 1964.

REPORT ON THE SAMARITAN FUND 1.4.63-31.3.64

D. G. BRITTEN, Acting Director of Audit.

Requests for assistance from the Fund have been steadily rising but in view of the increasing difficulty in obtaining sufficient income, which is raised exclusively from non-Government sources, endeavours have been made to halt the upward trend of expenditure. Thanks to this and the generosity of donors there is consequently a small surplus of income over expenditure for the year which is particularly welcome in wiew of last year's deficit.

S. C. CHENG, Acting Principal Almoner.

GPAK

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