a systematic drive to ensure that the children at most risk in the densely populated tenement and resettlement areas on both sides of the Harbour were adequately protected against diphtheria. As a result the number of second and booster doses of APT rose to a much more satisfactory level and in the Kowloon urban area alone it was estimated that some 50,000 children received the requisite first and second doses. This was achieved by establishing inoculation posts at strategic points working at times convenient to parents while Health Inspectors conducting house inspections made known the facilities offered. Inoculation teams also visited roof-top squatter families at least once during the campaign and a second round of visits was under way at the end of the year. Although the drive was primarily against diphtheria, typhoid vaccine and smallpox vaccination were also available when required and accepted.
65. The Health Officers also maintained investigations into the source of known cases of diphtheria, typhoid, dysentery, amoebiasis, poliomyelitis and tetanus. Where applicable contact cxaminations were arranged and carriers treated.
66. Special attention continued to be given to food hygiene, the education of food handlers and of the proprietors of establishments selling raw or cooked foods being a major activity. The incidence of unsatisfactory samples of milk and ice cream continued to be unduly high and an average of 30% of samples taken were below standard.
67. This problem must be considered against the background of the density of population, the number of individuals who depend on low priced food establishments close to the place of work, and the wide- spread indifference to and lack of knowledge about elementary food hygiene. Therefore improvement in standards will only become significant as the many squatters are adequately rehoused, as more adequate piped water supplies are available and as modern sewerage replaces the many insanitary closets still existing in the old tenement and squatter areas.
Rural Areus
68. The District Commissioner New Territories is the statutory Health Authority in the Rural Areas. The appointment of a Principal Medical Officer of Health for the New Territories, whose function it is to co-ordinate the curative and preventive work. became effective in October. Assisted by two Health Officers and 10 Health Inspectors. attention to practical health education stemming from the centres of curative medicine, the clinics, is now receiving priority in environmental sanitation, Routine work on the control of licensed food premises and
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food handling has been intensified with some encouraging results. Nearly all licensed food premises not provided with water-borne sanita- tion now have aqua privies in place of dry latrines. Ways and means of improving sanitation in the villages are under consideration by the Rural Development Committee and pilot co-operative village cleansing schemes are being set up in two villages in co-operation with the Depart- ments of Agriculture, Fishery and Forestry and Co-operative Develop- ment. Other such schemes are under consideration.
69. The pilot scheme of malaria prophylaxis started in two villages in the Sai Kung area during 1959 led to a considerable reduction in the number of cases of malaria. However after the initial interest of the villagers in the scheme bad waned, it had to be discontinued owing to lack of co-operation. Further epidemiological investigations are con- tinuing which include a survey of malaria parasites in the blood of children under ten years of age, with febrile conditions, attending clinics and dispensaries throughout the New Territories.
EPIDEMIOLOGY
70. During the year 1959 there was an increase in the number of cases of the more common notifiable diseases, the main exceptions being acute anterior poliomyelitis, measles and amoebiasis. The major factors in this increase are the rapidly-increasing population, mainly in the young and most susceptible age-groups, and the greater use of the medical facilities provided by Government and other agencies. The most disturbing feature of the year was a 34% rise in the incidence of diphtheria, an event which is discussed more fully later.
71. The total mortality from the notifiable discases, however, con- tinued to decline: even in the case of diphtheria, the number of deaths was less than recorded in the previous year.
72. Appendix 3 gives the numbers of cases and deaths from notit- able infectious diseases recorded during 1959.
Amoebiasis
73. Compared to 1958, there was a slight fall in the incidence of cases recorded. The mildness of the initial symptoms commonly met with militates against an accurate assessment of the problem but it is interesting to note that, of the cases recorded, 57% of cases occurred in the Kowloon Peninsula, 33% on Hong Kong Island and 10% in the New Territories; this accords fairly closely with the estimated distribu- tion of population in these three areas of the Colony.
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