X1000307-1956-57_Part01 — Page 20

Pathologist and is carried out in the Pathological Institute or one of its branches. The number of examinations is voluntarily restricted to a minimum by the clinic staff on account of staffing problems in the laboratory service. The examinations carried out on behalf of the Tuberculosis Service during the year were as follows: -

Positive

Sputum { Negative

10$5.

1956.

1,503

7,202

22.300

26,033

29,812

32,241

Castric Lavage {

Positive Negative

12

280

238

272

229

98. It will be seen that the total examinations have incrensed by 3,486 or over 11.

Ambrilatory Chemotherapy.

99. Ambulatory chemotherapy was started in the chest clinics in an experimental way in 1950, has steadily increased in scope and magnitude since that time, and has now become the spearhead in the therapeutic attack on the tuberculosis problem. The hospital beds, which at the inception of the service were the only available means of treatment, have now been relegated to a secondary but very important role in the treatment scheme, being now used for the further treatment of cases whose disease has not been controlled by ambulatory treatment, for the isolation of certain special cases, and for the investigation of cases where there is doubt in the diagnosis.

100. Treatment by ambulatory chemotherapy is now inter- nationally accepted as having a useful part to play in the treat- ment of tuberculosis, its application varying according to local circumstances. The advantages of this method in Hong Kong are as follows:-

(1) the available beds are totally inadequate to deal with the tuberculosis problem using orthodox hospital treatment; (ii) many patients prefer ambulatory treatment as it enables them to retain their job and to maintain their family during treatment:

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(iii) it is almost 90% as effective as hospital treatment although 10-15% of patients require subsequent admission to hospital;

(iv) using combined ambulatory and hospital treatment, nine times the number of patients can be treated at the same cost as by orthodox hospital treatment.

101. Treatment is arranged in "courses" each lasting 12 weeks and is based on accepted combinations of drugs, using streptomycin (biweekly injection) P.A.S., LN.A.H. and various proprietary preparations.

102. To operate the scheme efficiently it is necessary to have an adequate number of hospital beds with full surgical facilities to support the ambulatory phase of treatment. As two addition- al clinics have already passed the planning stage it will be necessary to increase the beds available to support the increased volume of ambulatory work when these clinics come into operation.

103. Cases treated during the year were as follows:-

Cases brought forward from 1955 Started treatment in 1956

Total

1,703

7.881

9,564

Completed treatment 1966

1,037

Failed to attend

2,022

Treatment incomplete

Admitted hospital

445

Transfer clawhere Known to have died

I

140

39

5,687

Sul on treatment at $1.12.56 104. These figures represent almost the maximum capacity of the clinics. The small number recorded as having completed treatment during the year results from the policy of extending treatment duration in all cases and in some for as long as 2 years. Of those who failed to complete treatment almost one- third had been under continuous treatment for a period of six months before their attendance lapsed. Included also in the

total of those who failed to complete treatment are a number who took advantage of easier travel arrangements to China to visit relatives but who have subsequently resumed treatment. The total numbers handled in Kowloon were higher than in Hong Kong by about 14% but the lapses in attendance were also higher.

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