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Branch of the British Red Cross Society. It is designed for the con- valescent care of children suffering from orthopaedic conditions many of which are due to tuberculosis. The Society receives a Government subvention of $15,000 towards maintenance costs,

X-Ray Surveys

163. Up to the present time, X-ray surveys of the general population have not been practicable in that the facilities for subsequent investiga- tion and treatment have been fully occupied in dealing with the existing case load. Certain selected groups are X-rayed annually however and X-ray surveys are carried out on request, for commercial and industrial organizations prepared to guarantee certain sick leave and re-employ- ment facilities for active cases of tuberculosis detected. There has been a considerable expansion of this latter activity during the year.

164. For the past ten years, Government employees have been required to undergo an annual X-ray examination of the chest. This follows a strict pre-employment examination during which all cases showing radiological changes are fully investigated. Therefore incidence of active disease in Government employees gives an indication of the effects of the impact of a high tuberculosis morbidity on a selected group in full employment. During 1959 an incidence of 1.29%, of active tubercular disease was uncovered amongst Government employees; however there were only two deaths from tuberculosis in the group. which gives a mortality rate of 6 per 100,000.

165. All convicted prisoners are also X-rayed annually and here the percentage of active disease rises to 5.15%. As a considerable propor- tion of prisoners are also drug addicts and are drawn from an unstable element of the community, this high morbidity is not unexpected,

166. A total of 76 firms participated in the X-ray survey scheme and 1.78% of active cases were diagnosed. Many of these firms also have annual surveys carried out so that this group of individuals is also selected. It is of interest that the number of firms and individuals participating rose from $1 to 76 and 8,768 to 12,995 respectively when compared to 1958,

School Teachers

167. Teachers in Government schools are X-rayed annually in the course of the Government survey. In private schools, teachers are required to register with the Education Department and before being passed fit to teach they have to undergo a chest X-ray, not necessarily

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by the Government X-ray units. Accordingly records are available only for these teachers in private schools referred to the Government Chest Clinics because of an unsatisfactory X-ray. The figures for the past five years are! --

TABLE 12

1955

1956

1957

1958

1959

Referred to Chest Clinics Unfil to teach on account of

pulmonary tuberculosis Percent

348

455

318

349

ETO

30

49

50

32

I

10.6% 10.7% 16.6%

9.2%.

17.9%

This high incidence is undoubtedly due mainly to the referral of cases showing suspicious radiological findings for further investigation.

168. Those teachers found to be unfit are offered priority of admis- sion to hospital but there is no compulsion and it is suspected that a number of leachers with active disease may be teaching in unregistered schools.

169. With the opening of another major full-time chest clinic in 1960 and plans in hand for two static X-ray survey centres in addition to the mobile units at present in use, it is hoped to start certain general population surveys in the near future, beginning in Resettlement Estates.

Medical Social Work.

170. This is carried out by a staff of Aimoners assisted by 35 Tuberculosis Workers. The importance of this aspect of the work within a system of ambulatory chemotherapy needs no emphasis. Dense over- crowding, no comprehensive social insurance, low economic standards and the wide extent of out-patient therapy make imperative the earliest possible development of the home contact if the fullest use is to be made of the limited social assistance available.

171. The roles of the Tuberculosis Almoner and the staff of Tuber- culosis workers are complementary. As soon as a diagnosis has been made, the Almoner concerned interviews the patients and the social and economic circumstances are recorded. Thereafter, within one month if possible, a Tuberculosis Worker pays a home visit.

172. Once admission to hospital, other than as an emergency, has been recommended, names are placed on the waiting lists maintained by the Almoners according to the category of treatment required. The calegories arc chest medical (three units), chest surgical (three units), orthopaedic (four units), and special investigation (one unit). As far as

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