the problem, particularly the Hong Kong Anti-tuberculosis and Thoracic Discases Association. The Government Chest Service main- tains the B.C.G. vaccination and out-patient treatment programmes while the voluntary agencies, aided by substantial Government sub- ventions, maintain most of the hospitals.
36. To keep pace with the rapid changes which are occuring in the fields of treatment and prevention of tuberculosis, close liaison bas been maintained with agencies outside the Colony. The treatment policy study which was started in March, 1967, in conjunction with the Medical Research Council of the United Kingdom has progressed in a most satisfactory manner and by the end of the year under review, when the study closed, 619 patients had been admitted to it. Preliminary results are now becoming available and the study should be most valu- able in the planning of future treatment policies.
37. Consequent to the assignment of a bio-statistician by the World Health Organization to the Chest Service the production of statistical material has been re-organized and is now on a very sound footing. Following upon this re-organization there has been fluctuation in certain important statistics. This fluctuation is, however, of a temporary nature and should not recur in the future.
38. During the year a very considerable amount of laboratory work was carried out in preparation for a joint study with the World Health Organization of the most efficacious method of administering B.C.G. in the circumstances of Hong Kong.
Case finding
39. In the past the large number of patients attending the Chest Clinics made large-scale case-finding undesirable. With improved facilities and the decrease in the number of patients case-finding has come to play an increasingly important role. Emphasis being placed on symptom-motivated patients and health education techniques are being used to ensure a proper understanding of the disease.
Mortality and Morbidity
40. During the year the number of deaths fell slightly, this fall being most marked in those under 50 years of age. The great majority of deaths continued to occur in elderly males who had been suffering from tuberculosis for many years and who died of its sequelae rather than from active tuberculosis. The average age of death rose to 56.5 years. Tuberculosis mortality by age and sex is shown in Figure 6.
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1-OW
FIOULE &
TUBERCULOSIS MORTALITY BY AQB & SEX 1956 – 1955 d. 1966 - 1968
+
F
AFIK SPUN
الريال
JALLIK 1954 - PHU
FT MALE
T
41. Notifications fell sharply and the notification rate at 249.4 per 100,000 of the population is by far the lowest recorded in recent years. Part of this fall was due to a tightening up of the notification system, to the elimination of double notification and to there now being well- defined criteria for the notification of tuberculosis. Figure 7 shows the changes which have taken place in age and sex specific notification rates. There have been marked reductions in the incidence of the discase during childhood. There has been little change in the vulnerability of adoles- cents and there has been some reduction in the incidence of the discase amongst middle-aged adults. The bigh susceptibility of males, except in childhood, corresponds with the pattern recorded elsewhere in the world.
Work of the Government Chest Service
42. The Government Chest Clinics provide ambulatory chemothera- py services for the great majority of cases of tuberculosis, hospital admission being reserved for emergencies, cases requiring investigation, and those requiring second-line drugs or surgical intervention. Increas- ing attention is being paid to the public health aspects of tuberculosis. 75 Health Auxiliaries whose main duties consist of contact tracing and
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