facilities are available for the Grantham Hospital medical staff to follow up such cases as they may wish, using Government clinic facilities for this purpose. All social work in connexion with these patients is carried out by the Government Tuberculosis Almoner and her staff.
162. The combined total of 336 beds at the Ruttonjee Sanatorium and Freni Memorial Convalescent Home is operated as a single unit which is devoted mainly to the treatment of pulmonary cases, and is staffed by doctors and nurses of the St. Columban Roman Catholic Mission, while the Hong Kong University Clinical Units provide the consulting staff and full medical and surgical treatment is available, The Sanatorium staff run a follow-up clinic for patients discharged from the hospital and a B.C.G. clinic is also maintained. All social work in the institution is carried out by the Government Tuberculosis Almoner.
The Tung Wah Hospitals
163. Out-patient facilities for the treatment of tuberculosis are provided at the three hospitals and there are 210 beds set aside for in-patient treatment.
The Haven of Hope Sanatorium
164. This is maintained by the Junk Bay Medical Relief Council and situated in the New Territories. There are [22 beds entirely devoted to the treatment of tuberculosis. The Council also supports out-patient clinic facilities in neighbouring villages.
The Sandy Bay Convalescent Home
165. The Home contains 54 beds, a proportion of which are occupied by convalescent cases of bone and joint tuberculosis. It is maintained by the Society for the Relief of Disabled Children, assisted by the Hong Kong Brauch of the British Red Cross Society, which provides certain of the staff.
Private Agencies
166. The treatment of tuberculosis is also carried out in private hospitals and nursing homes although no specific number of beds is set aside for this purpose. Treatment is also given on an out-patient basis by general practitioners but the extent is unknown as the notifica- tions bear no relation to the number of cases so treated. The numbers are believed to be high.
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The Government Tuberculosis Service Ambulatory Chemotherapy
167. After a preliminary trial during 1950, the possibilities of ambulatory chemotherapy were quickly realized and have been developed to the utmost during the past eight years, within the limita- tions set by accommodation and staff. The widespread use of this form of therapy has been the subject of considerable criticism, much of which can only be based on conservatism rather than realism. With an estimated 60,000 persons in the community suffering from active luber- culosis, segregation and institutional treatment for all is not a practical possibility let alone & fuancial one. Therefore, to obtain the best results attainable within the community resources, policy has necessarily con- centrated on the sterilization of as many sources of infection as possible by chemotherapy, the protection by B.C.G. vaccination of the most vulnerable age group and the maximum utilization of hospital beds for cases with prospects of cure and of a return to useful life.
168. One of the main criticismus levelled against the use of ambula- tory chemotherapy is that it encourages the emergence of resistant strains.
169. The segregation of chronic cases of tuberculosis, particularly those excreting strains of the mycobacterium resistant to present therapy, undoubtedly poses a problem that requires careful study in relation to the total resources. This problem of the chronic resistant case is at present under investigation and preliminary results indicate that there is a significantly high proportion of chronic infectors' who should be segregated but for whom such facilities are not available. On the other hand, pessimism regarding the future and the impact of these chronic open cases on the total problem is only warranted if it is assumed that research will not bring to light more potent non-toxic agents which will be efficacious against the resistant strains. Meantime the policy of the greatest good for the greatest number must prevail and existing re- sources be utilized to this end.
170. The regimen of treatment for ambulant cases has been extended during the year so that the average patient now starts off treatment with a three-month course of combined streptomycin sulphate- dihydro- streptomycin given by injection on six days of each week together with specially prepared tablets combining PAS and INAH. The palatability
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