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ANNEXURE F.
REPORT ON THE TUBERCULOSIS SERVICE.
Tuberculosis, accounting as it does for 14.6% of all deaths in the Colony, is probably the most important single health problem facing the Government today. The problem is extremely couplex and offers no easy solution. The population, as a result of the present economic and political conditions in China, is grossly inflated resulting in appalling conditions of overcrowding affecting all classes, but more particularly the working classes for whom little, if any, additional housing has been built during the past decade. The type of house in almost general use, a single large room occupying a whole flour and divided by 6 font partitions into cubicles, some as small as 36 square feet, aud Lousing a winle family, while ideal from the point of view of ventilation, lends itself to easy spread of infection. To add to the existing difficulties numbers of tuberculosis sufferers travel fairly consider- able distances to the Colony from neighbouring areas being attracted by the prospect of free treatment, It is a tribute to the resistance of the population that the deaths from pulmonary tuberculosis are maintained at their present level.
Should any deterioration in the local economic conditions occur, without a compensatory fall in the population, the tuberculosis deaths are likely to return to the high level observed before the war.
For various reasons reliable statistics are not available. fu the first place, no recent census figures are available. The last census was taken in 1981, since when the population has doubled, halved, and doubled again, according to estimates. Nor is information available on the age and sex distribution of the population, an important feature in the analysis of statistica relating to tuberculosis. Il is quite usual to encounter individuals who work in the Colony and maintain their wives and families in their native villages. Thus the preponderance of males in the community is likely to be exaggerated-u probability which was confirmed in the 1931 census returna.
On the other hand, information in relation to tuberculosis is not satisfactory on account of incomplete notification. Numerous individuals attend the public clinics giving a history of having received private treatment yet never having heen notified. Out of a total of 6279 notifications recorded during the year 587 were made by private practitioners, an average of 1.5 notifications per practitioner per year. The patient himself is far from anxious to have the knowledge of his disease made public on account of the social repercussions that are liable to ensue, One can only guess how much deliberately concealed tuberculosis exista.
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The figures recorded for deaths due to tuberculosis are sur- prisingly low and in keeping with the low figures recorded for deaths from all causes. It is known that a number of advanced casea do return to Ching to die but how much influence this has on the general figure is not yet known. The ratio of deaths to potifications of tuberculosis is low compared to the findings in other parts of the world and indicate a high natural resistance to the disease. This high resistance is apparent in the response to hospital treatment, and in the number of healed losions-often extensive which are found on routine examinations and which so far as can be ascertained gave rise to no symptoms. For example a survey of 4615 Government sorvauts carried out during the year showed the following results.
Active tuberculosis Ilealed Suspicious
Not tuberculous
SA
497
121
3809
The following table shows the figures of known cases and rates based on the accepted figure for population on
(a) Estimated population (1) (6) Estimated population (2)