X1000306-1959-60_Part01 — Page 21

(iii) B.C.G. vaccination of new-born children and older tuberculin

negative reactors,

(iv) Hospital treatment of selected cases that will respond to

medical or surgical in-patient treatment.

(V) Limited case finding through X-ray surveys subject to sick

leave and re-employment guarantees.

(vi) An annual X-ray survey of all Government employees.

Government Tuberculosis Service Facilities

Ambulatory Chemotherapy

119. First introduced in 1950, using P.A.S. for a group of 45 cases, ambulatory chemotherapy now plays the major part in the control programme. Experience of the combined use of P.A.S. and I,N.A‚H, was not so successful as had been expected from the good reports of its use elsewhere. Therefore two years ago streptomycin by daily injection on six days of cach week was added to the course of treatment with combined P.AS, & IN.A.H. The three drugs are now given as a standard until no further improvement is seen, which may be for a period of up to fifteen months. Thereafter the combined P.A.S. & 1.N.A.H, tablets are continued, the minimum duration of treatment being for two years. Complications arising from this course of treatment are relatively rare and the few cases of hyper-sensitivity seen at the Chest Clinic are admitted to hospital; however, the total incidence of skin sensitivity reactions is not yet known and a number of cases attend dermatology clinics without informing the chest clinics. This aspect of the problem is now under investigation.

The principal problems of ambulatory chemotherapy are the failure to continue with treatment once symptoms are relieved, irregular attendance and the failure to take the PAS/INAH tablets in addition to the streptomycin injections. During 1959, 21% of the caves under treatment failed to continue treatment despite home visits and follow-up; of those patients attending the clinics, a sample of 6000 examined showed that between 87% and 90% had PAS in the urine. This indicates that the combined PAS/INAH tablets are on the whole taken regularly.

121. There are three fulltime chest clinics operating, one on Hong Kong Island and two in Kowloon. In addition there are eleven part- time out-patient clinics and nine injection centres. Evening sessions have been continued at three clinics and are beginning to prove more popular.

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The establishment of the injection centres conveniently sited for those at work has greatly improved attendances for treatment. In addition, in the New Territories the staff of the clinics at Tsuen Wan, Yuen Long. Ho Tung. Tai Po. Sai Kung. Lamma. Peng Chau & Cheung Chau maintain an injection service. This also applies to the clinics at Stanley and Aberdeen on Hong Kong Island.

122. All treatment is given free of charge at the Government Chest Clinic.

123. The volume of work now undertaken at the Government Chest Clinics has strained the facilities to the utmost and has imposed a limit on the number of new cases that can be accepted at the major chest clinics cach day. This limit applies only to cases presenting voluntarily for investigation and does not apply to referred cases. The expansion of the work at the Chest Clinics during the ten year period is shown in Table 7.

First attendances Cases of tuberculosis

discovered

Total attendances for

TABLE 7

(OVERNMENT QIEST CLINICS 1950/59

7930

1955 1947 19,283 40.061 34,5607 35.126

6.944 10,449 [0,TA3 11.438

40.324

1958 1959 39,454 39.008

12.270 14,406

320,426 401.568 $39,782

301.326 1.655,100*

1.703

5.887

9.03.2 13.733

7.861

7,964

11,546 11,357

3.386

1.037

1.213

1.045

2.064

852

2.022 2,868

3.048

5.391+

586

963

1029

1.076

1,537

Suff on treatment at

end of year

2.824

5,887 9,112 | 3,733

16,162

* Due to cxpumaban of injeçuen facilėties.

Treatment Under treatmeal from

previous year Started Trealment during

the year Completed treatment Failed to attend Admitted to Hospital

from Ches. Clinics

↑ A larso propomion are recorded as "returned to volans ouside Hong Kong“.

124. During 1959 there has been noted for the first time a sub- stantial reduction in the severity of the disease in new cases and there is no doubt that the proportion of early cases diagnosed is increasing. The percentage of infectious cases dropped from 29% in 1958 to 20% in 1959. This reduction gave cause for a bacteriological cross check of patients entering and leaving hospital and the hospital results, after multiple smears and culture, compared more closely than was expected with the clinic results, which are based on a single sputum examination.

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