prejudice to the health of their pupils. They have complete freedom of choice as to where they may have treatment, but they are accorded priority right of treatment at the chest clinics and admission to hospital if necessary.
Future Outlook.
151. The results achieved from the use of ambulatory chemotherapy have exceeded all expectations. As a result of these findings the whole tuberculosis treatment scheme has changed, emphasis now being made upon this form of treatment, with hospital treatment taking a secondary but essential part in the programme. Such a scheme is within the means of the community to implement, as the bed provision required is reduced to about one eighth of what would be required with orthodox treatment. A substantial increase in the facilities for ambulatory treatment will be made within the next eighteen months with the opening of two new chest clinics, so that the total resources of the chest clinics should be capable of dealing with about 10,000 patients on continuous treatment, the duration of treatment varying according to the case but not being in any case less than nine months, and in the majority being twice as long. This total represents only about 207 of the total of the estimate of active cases in the Colony. In order to keep the scheme properly balanced, the number of hospital beds should be increased also, and the facilities for thoracic surgery should be adequate to keep these beds in full and efficient use. At present the beds available are insufficient to deal with the needs of the existing clinics, and no immediate prospect of an increase is in sight. The situation will be improved some years hence: if the existing Kowloon Hospital is turned over for the treatment of tuberculosis, when the new hospital is completed, but that is still some years distant, and the needs are already urgent.
152. The results of the B.C.G. vaccination are not yet obvious but it is hoped that the present downward trend of infant tuberculosis will continue. Efforts must be redoubled in this direction as this probably offers the best prospect for the future.
Malaria.
153. Due to new commitments and extension of work under- taken during the year the Malaria Bureau staff has been
increased by one Malaria Inspector and 45 temporary or daily rated workers.
154. In August, 1956 the Bureau's Kowloon Office moved to the new District Branch Offices Building at Un Chau Street, thereby relieving the congested conditions which prevailed at the former premises and improving laboratory facilities.
155. Construction of temporary Coolie Quarlers and one oil store was completed in December 1956 at the new Castle Peak Hospital site. In addition, two other new oil stores-one at Kun Tong and the other at Cha Kwo Ling-were handed over to the Bureau in March 1957. These new structures provide the storage facilities necessary to cope with the extension of work in these areas.
166.
Control relies mainly on anti-larval measures. Areas at present under active control consist of the populated portion of Hong Kong Island, Kowloon and New Kowloon, which roughly corresponds to the urban areas of the Colony in which the main bulk of the population (about 90%) is concentrated. In addition, in the New Territories, the southern inhabited portion of Cheung Chau Island, the Tai Lam Chung Reservoir Site. Rennie's Mill Camp, the Castle Peak Hospital area and the new Chimar
awan Prison on Lantan Island are similarly protected.
157. At Huy Ling Chau Leprosarium the necessary insecti- cides have been supplied by the Bureau, and anti-malaria work is undertaken by the staff there.
168. As in previous years since 1950, "Gammexane" disper- sible powder. P520, has been in use as the larvicide for field work. Results have been satisfactory, and from field observa- tions, no resistance of the tocal species of anopheline mosquitoes to this insecticide has so far been noticed, although the Bureau has been very watchful for its possible development.
159. Numerous checking catches and surveys were made by the Bureau in the controlled areas of Kowloon and Hong Kong and, except in one or two instances, no anophelines, either larval or adults, were found. Vector mosquitoes, however, abound on the borders of the controlled areas, and given a favourable opportunity, can increase rapidly at any time. It needs no emphasia that constant vigilance is necessary.
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