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.
140. 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
32
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 Almoner'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 lanc 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 ure 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 udvice 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
33