upon conclusions reached at the W.HO, seminar held in Tokyo in November, 1958. A clinical trial of ditophal, was commenced in 1959; bi-weekly inunctions of the drug are administered, combined with dapsone either orally or intramuscularly. Preliminary results have been encouraging and ditophal will soon be made available for general use. Diphenyl thiourea is now produced in tablet form and is used in selected cases showing intolerance to dapsone.
211. The surgical rehabilitation of patients suffering from deformi- Lies and disfigurements has been still further developed in the Maxwel! Memorial Hospital at the Hei Ling Chau Leprosarium. Orthopaedic treatment and plastic surgery is also provided in the Government hospitals where a limited number of beds is available for this purpose.
212. A review of 500 clinic patients was carried out by the University Orthopaedic Surgeon with a view to determining the number of cases of leprosy in need of surgical rehabilitation. The results are now being analysed and will be a valuable aid to the planning of the further development of the rehabilitation facilities.
213. Contact investigations are increasing steadily in numbers and child contacts are vaccinated with B.C.G. It is routine procedure for the home of each new patient to be visited within a month of the diagnosis being made and the contacts requested to attend for cxamina- tion; they are thereafter examined once every six to twelve months. Defaulting patients and contacts who do not attend for examination are visited and 36% return for treatment and examination; unfor- tunately many contacts are unwilling to attend after a year as they neither see nor feel any indication of disease.
214. The work done by the leprosy Out-patient Service during the past five years is outlined in Table 17.
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TABLE 17
LEPROSY OUT-PATIENT SERVICE
1955
1956
1957
IV58
Admission to Clinics
762
731
981
976
Lepromatous
110
173
160
111
Tuberculoid
198
262
162
114
183
Mixed Type
0
1
S
Total Attendances
22.012
3.5.189
31.204
36,318
3
31.986
Number of Cases Admitted to He
Ling Chau
93
165
132
11
138
50
Dermatology
215. Patients with skin diseases may attend any of the Social Hygiene Clinics and, in addition, there are six consulting sessions each week. three on Hong Kong Island and three in Kowloon, for cases referred for a specialist opinion. Female in-patients are treated in the Wan Chai Social Hygiene Hospital, while beds for male in-patients are available at the Lai Chi Kok Hospital. The rapid expansion of the Dermatological service can be seen from the fact that 777 new cases were seen during 1951, while in 1959 the figure was 11,046,
216. Contact dermatitis, boils, subcutancous abscesses and eczema continue to be the main diseases encountered. Appendix 7 shows the classification and frequency of the dermatological cases seen. All cases of industrial dermatitis and certain cases of contact dermatitis were notified to the Industrial Health Officer.
217. The advent in May of greisofulvin, which hus radically altered the treatment of all fungus infections, has been a potable therapeutic advance in this field. The present high cost however limits its general
use.
DISTRICT MIDWIFERY SERVICES
218. The value of skilled attention during childbirth is widely appre- ciated in Hong Kong and over the past decade an average of 97.94% of the registered live births have been attended by qualified persons, Under the conditions of overcrowding existing, domiciliary midwifery is neither practicable as a general rulo nor desirable, and domiciliary deliveries by Government and private midwives have fallen from 15% of the total births attended in 1950 to 6% during 1959. On the other hand the number of maternity beds in institutions throughout the Colony is approaching an adequate level. At the end of 1959 there were 1,498 maternity beds in public and private hospitals, clinics and maternity homes which, at a ratio of 1 bed for every 70 births. indicates that one service at least is nol gravely short of beds.
219. In the past the Government policy has been to provide institu- tional care in the urban areas mainly in the maternity hospitals at the new Tsan Yuk and Kowloon General Hospitals. These institutions are however becoming more and more used for difficult or abnormal cases seen at the ante-natal clinics, while normal midwifery is dealt with at maternity homes attached to clinics or in private hospitals and maternity homes. New clinics to be built in the urban areas will now include a maternity home for normal cases where this service is warranted for
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