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was 0.086 deaths per 1,000 live births as compared with 0.17 deaths per 1,000 in 1965 and 1.2 deaths per 1,000 in 1951.

Viral Hepulitia

33. Notification of this disease is not compulsory. While the figures recorded for the period under review are therefore not strictly com. parable with those of previous years, there had been an impression of a rise in the incidence of the disease during the first three months of 1966. Attention was drawn to the large number of inoculations given during the mass immunization campaigns each year and therefore dis- posable syringes have been used in immunization campaigns since August 1966.

34. Developments in certain other communicable diseases are re. viewed later in this report, while the remainder showed little variation during 1966 and hence require no comment.

III. WORK OF THE HEALTH DIVISION

AREA HEALTH WORK

35. Much of the work of the area Health Officers, apart from their duties with the Urban Services Department in the maintenance of satis- factory standards in environmental sanitation and food hygiene, has been recounted in the preceding paragraphs on Epidemiology. Such work included not only the field investigations into the major com- municable diseases but also the co-ordination of the activities of teams of inoculators participating in prophylactic immunization drives. Four such campaigns were staged during the year and reference has already been made to three, namely cholera, poliomyelitis and diphtheria. The fourth, promoting smallpox vaccination, was held during the Chinese New Year period in February 1967, traditionally an auspicious time for receiving this immunization. The increasing importance of Hong Kong in international travel by sea and air and the prevalence of smallpox in nearby countries underline the need to maintain a bigh level of com. munity protection against the disease.

TUBERCULOSIS

(See tables 17-23)

36. As stated previously, tuberculosis is the major health problem of Hong Kong. The magnitude of the problem makes it impossible both physically and financially to provide institutional accommodation of the order required for the isolation of all infectious cases. The policy for

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control of the disease has been to protect, by vaccination with B.C.G., those most vulnerable to serious post-primary manifestations, to provide out-patient facilities for the ambulatory treatment of as many tuber- culosis patients as possible and to reserve the limited hospital accom- modation for patients not responding to ambulatory treatment or in need of surgical intervention. This policy is also important for economic reasons as persons suffering from the disease will be reluctant to seek treatment if prolonged periods of hospitalization with consequent loss of income are necessary. In the execution of this policy there has been a high degree of co-operation between Government and voluntary agencies concerned with the problem, particularly the Hong Kong Anti- tuberculosis and Thoracic Diseases Association. The Government Chest Service maintains the B.C.G. vaccination and out-patient treatment programmes while the voluntary agencies, aided by substantial Govern- ment subventions, maintain most of the hospitals.

37. To keep pace with the rapid changes which are occurring in the fields of treatment and prevention of tuberculosis, close liaison has also been maintained with agencies outside the Colony. During the year planning was well advanced for a chemotherapy trial which should yield extremely valuable results in the treatment of patients suffering from tuberculosis in Hong Kong. This study is being undertaken in conjunc- tion with the Tuberculosis and Chest Disease Research Unit of the Medical Research Council of United Kingdom and the Hong Kong Anti-tuberculosis & Thoracic Diseases Association. Briefly it will evaluate the most effective policy of treatment for tuberculosis patients in Hong Kong and also investigate the use of a rapid-slide-culture sensitivity test. Co-operation is maintained with the World Health Organization and this organization has assigned a bio-statistician to this department to advise on development of statistical procedures for the evaluation of the tuberculosis programme in Hong Kong.

Mortality

38. During the year there was a slight rise in the number of deaths from tuberculosis. The great majority of deaths occurred in elderly males who had been suffering from tuberculosis for many years and died from its sequelae rather than from active tuberculosis. The average age of death from tuberculosis rose from 49 in the previous year to 53 in the year under review; the comparable figure in 1956 was 32. Changes taking place in mortality from tuberculosis of various ages are presented in Figure 5. The level of B.C.G, coverage at birth remains high al 90.22% of new-borns. (Figure 6).

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