multi-puncture method gave least trouble and that vaccine of 20 mgm. strength produced the most satisfactory conversion rate. There is however a great reluctance amongst mothers to permit their children to be vaccinated and less than one sixth of the children born in the hospitals are vaccinated.
Social Work.
46. All proved cases of pulmonary tuberculosis requiring investigation or treatment are interviewed by an Almoner. Particulars of the social and economic background of these patients are recorded and filed with the address thus providing a useful cross reference for the medical case cards filed by registration number. An alphabetical index would prove of little use in view of the difficulty generally experienced in standardizing the romanization of Chinese names. The Almoner has at her disposal a sum of $100,000 allocated from public funds for disbursement in accordance with an agreed scheme. Treat- ment allowances are available on an approved scale to patients whose prognosis is good and who give up work on the advice of the medical staff for the purpose of undergoing treatment. This applies particularly to teachers, who on detection are forbidden to teach and are therefore deprived of their means of earning a livelihood. These allowances are mainly used for the main- tenance of families of patients hospitalized, but in certain cases they are applicable also to patients undergoing ambulatory treatment. Additional nourishment may be provided from this fund also in the form of milk powder issued on the basis of
lb. per week to patients on treatment in the clinic.
47. Much of the home supervision of tuberculosis patients falls upon the Tuberculosis Visitors, 23 in number. These Visitors are local girls, locally trained and without any nursing background, and are attached to the Almoner's section and not, as is customary elsewhere, to the nursing side. Their day is normally divided between work in the clinics, assisting medical officers with clerical work, and, in the afternoons, in home visiting. At the first visit the Visitor instructs the patient on the simple methods of limiting spread of infection by isolation
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as far as may be practicable, the proper disposal of sputum, and wise habits of rest and diet. At the same time the Visitor endeavours to ensure that all household contacts are examined and all younger children tuberculin tested and, if necessary, vaccinated by B.C.G. vaccination.
Leprosy.
48. The leprosarium on Hay Ling Chau Island (Isle of Happy Healing) is administered by the Mission to Lepers and is therefore a private Institution subsidized by the Hong Kong Government. It works in close collaboration with the Govern- ment leprosy clinics. The available accommodation in the leprosarium is still inadequate and admission is strictly limited. The majority of lepers are treated as out-patients at Govern- ment out-patient clinics. Fortunately it has been found possible with modern drugs to render the majority of cases of leprosy non-infectious by treating them on an ambulatory out-patient basis. This method has the added advantage of not removing the unfortunate sufferer from his normal environment and employment, a step which later is apt to raise problems of rehabilitation. During the year 3 clinics for treating lepers on an out-patient basis have been organized. The attendances are phenomenally high and during the year amounted to 11,526. The routine treatment is Dapsone (di-amino diphenyl sulphone) administered either by mouth or as a 20% suspension given by intramuscular injection weekly. There is a tendency in approximately 40% of cases for a therapeutic reaction, or exacerbation of signs which requires modification or cessation of treatment followed by gradual resumption. The clinical response shown by gain in weight and amelioration of skin manifestations is satisfactory, but bacteriological reversal is sometimes disappointingly slow.
Rehabilitation.
49. A special committee has been set up by the Mission to Lepers, Hong Kong Auxiliary, to deal with the vexed problem of the rehabilitation of cuced and non-infectious lepers. Two
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