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over the past years. Attention was drawn to the large number of inocula- tions given during the mass immunization campaigns each year and since August 1966 disposable syringes have been used in such immuni- zation campaigns. In 1967 a small reduction in the number of patients treated for this disease in hospitals was recorded but the effect on the disease following the use of disposable syringes remains to be assessed. 33. Developments in certain other communicable diseases will be reviewed later in this report, while the remainder showed little variation during 1967 and hence requires no comment.

III. WORK OF THE HEALTH DIVISION

AREA HEALTH WORK

34. 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 communic- able 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 in March 1968. 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 high level of community protection against the disease.

TUBERCULOSIS

(See tables 17-23)

35. As stated previously, tuberculosis is the major health problem of Hong Kong. The policy for control of the disease has been to protect. by vaccination with B.C.G., the new borns, who are particularly vulner- able to the fulminating forms of the disease, and the primary school entrants who may develope active disease later in life. For actual cases of the disease, it has now been shown that in a large proportion of cases out-patient therapy is at least as good as institutional treatment. The not inconsiderable institutional resources are reserved for those not

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responding to out-patient therapy, for acutely ill cases, for those where the diagnosis is in doubt and for those in need of surgical intervention. 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-paljent treatment programmes while the voluntary agencies aided by substantial Government subventions, main- lain most of the bospitals.

36. To keep pace with the rapid changes which are occuring in the Gelds of treatment and prevention of tuberculosis, close liaison has been maintained with agencies outside the Colony. As a result of this liaison two events of major importance to the Chest Service resulted. The first was the assignment of a bio-statistician by the World Health Organiza- tion; this resulted in a complete re-appraisal of the statistical material produced by the Chest Service and as a direct consequence many changes of a fundamental nature were introduced. In conjunction with the Tuberculosis and Chest Diseases Research Unit of the Medical Research Council of the United Kingdom and the Hong Kong Anti-tuberculosis and Thoracic Diseases Association, a trial started in March 1967 to evaluate the most effective policy of treatment for tuberculous patients in Hong Kong and to investigate the use of a rapid-slide-culture sep- sitivity test. This chemotherapy trial should yield extremely valuable results in the treatment of patients suffering from tuberculosis in Hong Kong.

Mortality

37. During the year the number of deaths from tuberculosis fell slightly although the total did not reach the low figure of 1965. The great majority of deaths continued to occur 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 was 55. Changes taking place in mortality from tuberculosis of various ages are presented in Figure 5. Evidence of progress against the disease in the young is shown by a further appreciable fall in the Infant Mortality Rate for tuberculosis from 0.12 to 0.07 per 1,000 live births. The level of B.C.G. coverage at birth remains very high at 95.4% of new-borns. (Figure 6).

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