other hand, poliomyelitis continued to show a tendency to in. crease, there being 49 cases with 9 deaths as compared with 22 cases and 3 deaths in 1953. Out of that total, 20 were Chinese and 29 non-Chinese including 24 Service personnel and their families. A feature of poliomyelitis in Hong Kong is that it affects foreign new comers much more than the local popula- tion. The Chinese cases, with few exceptions, were infants, while the majority of the non-Chinese infected were young adults recently arrived in the Colony. Some of the cases in non-Chinese proved rapidly fatal while others were of a non-paralytic type. The cases showed a scattered dia- tribution with no apparent relation to each other, which would seem to indicate that poliomyelitis is widespread in the Colony in a sub-clinical or unrecognized form. For that reason the use of active vaccination of the general population, in view of recent events, requires most careful consideration. Puerperal fever also slightly increased, there being & cases as against 2 in the previous year. There has also been an unusual prevalence of scarlet fever, normally a rare disease in Hong Kong. Possibly a new or more virulent strain of the organism has been introduced by new comers to the Colony. Apart from tuberculosis, which is reported on separately and in more detail, diphtheria and typhoid proved again to be the major problems of the year. Almost the same number of diphtheria cases were reported as in the previous year, despite energetic measures taken to combat this disease, but in view of the fact that the child population was vastly in- creased and that, prior to the anti-diphtheria campaign, the diphtheria incidence tended roughly to double in each successive year, these campaigns may be credited with at least slowing and checking the spread of the disease though, as yet, they have failed to bring it completely under control.
32. Under the prevailing hygienic conditions and with the continued use of nightsoil as a surface manure, enteric diseases are inevitable. The reported cases show a slight decrease on the figures of the previous year, but there is little justification for complacency in this. Persons living under the existing conditions of fantastic overcrowding and further hampered by
the severe lack of water are incapable of maintaining the standard of cleanliness necessary to prevent this disease. In addition the majority of the population is far from being well versed in the precautions necessary to prevent this disease. Continuous efforts are being made to meet the problem both by instruction and by giving prophylactic vaccination. In this work a special mobile unit equipped with loud hailers and operat- ing as a travelling vaccination centre has proved by far the most effective weapon. This unit was donated by the Rotarians of Hong Kong. As in the case of diphtheria, the best that can be said is that these measures appear to have succeeded in somewhat reducing and slowing the spread of the disease.
33. Rabies has been rather more prevalent this year amongst animals, 8 dogs and 1 pig having been found to have been infected. All cases were in the New Territories. Details of the notifications of infectious diseases and the mortality due to them are attached at Appendix 2.
Tuberculosis,
34. The incidence of tuberculosis as shown by notifications shows an increase which may be due to the greater use now being made of the available diagnostic facilities. Analysis of the notifications and consideration of the mortality in the different age groups indicates either an extremely unusual epidemiological picture or a high degree of unreliability in the statistics, and presents a problem which merits further study
35. The mortality rate from Tuberculosis shows a drop to 126,3 per hundred thousand of the population and tuberculosis now accounts for 14.9% of the total deaths. The downward tread which has been apparent since 1925 is likely to continue provided there are no further major population or social changes such as occurred in 1937 and 1950. At the same time there has been an absolute increase in the total deaths from respiratory tuberculosis, the rise being in the number of male deaths recorded. Deaths above the age of 10 years show a marked excess in males which reaches a peak in the 40-44 age group
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