150. The analysis of the location of bone and joint disease in the new cases presenting has been:
Spine Hip
Other bones and joints
Total
19,59 1960 J061 1962
303
202 197 197
125
94 115
109
189
145
103
91
517 441
415
397
151. The number of cases presenting with orthopaedic tuberculosis has again shown a reduction. This is mainly a post-primary disease with a predilection for children between the ages of 6 and 12 years. Although post-primary tuberculosis in Hong Kong is diminishing rapidly, its incidence in this particular age group has not yet been materially affected. It is expected that the total of cases of orthopaedic tuberculosis will decline markedly within the next four years when children vaccinated with B.C.G. during the period 1957 to 1959 move into this susceptible age range.
Radiology
152. The total number of examinations carried out during 1962 on behalf of the Tuberculosis service by the Radiology Branch of the Department was 263,982 as compared with 305,088 in 1961, and almost one-third of these were performed by the use of 35 mm. or 70 mm. films. The static and mobile X-ray units attached to the Tuber- culosis Service are maintained and operated by the Government Senior Radiological Specialist and his staff. There is a very close co-operation and consultation between the Tuberculosis and the Radiological Services in all aspects of the diagnostic and routine supervisory radiology.
Bacteriology
153. The Government Institute of Pathology undertakes all bacterio- logy for the Tuberculosis Service. The number of direct smear examina- tions rose from 47,984 in 1961 to 86,281 during 1962, while culture and resistance examinations accounted for a further 13,710 procedures as against 12,000 in the previous year. In addition an investigation was carried out during the year on the sensitivity of the organisms from new patients attending the tuberculosis clinics for the first time. This survey is as yet incomplete, but preliminary results indicate a very high level of primary drug resistance, L.e. a large percentage of patients who deny previous treatment for tuberculosis are found to be excreting resistant bacilli.
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Medical Social Work
154. One Senior Almoner, cleven Almoners and 55 Tuberculosis Workers are attached to the Tuberculosis Service. Their responsibilitics include the interviewing of patients and their families, arranging hospital admission, hospital visiting. the home visiting and supervision of patients on ambulatory chemotherapy, assistance in money and in kind and rehabilitation.
155. As soon as the diagnosis of tuberculosis is confirmed all patients requiring treatment or supervision are interviewed. The original interview is a comprehensive one and is based as far as possible on all future requirements while under treatment. During the year 11,754 new patients were interviewed, a slight increase on the previous year's figure although the total number of interviews was 33,412, being a fall of 10% as compared to 1961. Much additional interviewing is done subsequently by the Almoners' Clerks, who also maintain treat- ment record cards and distribute drugs to be taken routinely by mouth. 156. Admissions and re-admissions to hospital from the chest clinics are arranged by the Almoners and this involves documentation, the financial aspects, advice to employers of patients being admitted to hospital and the maintenance of waiting lists. While the majority of patients still express a preference for hospital treatment, there is a growing number who express preference for out-patient treatment. Due to increased pressure, the reasons for which have been outlined pre- viously, the beds available for hospital treatment were in greater demand during the year and the number of persons on the waiting list at the end of 1962 was 374 as compared to 273 in December, 1961.
157. Ward rounds by Almoners, in company with the medical staff, are carried out as a routine and each patient is normally seen individ- ually at least once each month as well as by appointment if required. 158. The Almoners Section is responsible for the preparation and maintenance of attendance registers of patients on outpatient therapy, After the initial interview by an Almoner, a Tuberculosis Worker pays a visit to the home, gives advice on hygiene and makes arrangements for contact examinations. In addition, irregularity of treatment or non- attendance is followed up by home visits. However, because of limited staff, much of the routine regular visiting has to give place to visits connected with irregular attendances or default from treatment. Patients are allocated on a district basis and the Tuberculosis Worker is attached more or less permanently to her district and works from the relevant
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