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66. With new and better clinic premises and the extension of visiting specialist services, attendances at all clinic sessions have increased considerably-in the case of children's clinics the increase has been almost twenty five per cent,

67. The travelling dispensaries continue to extend their activities to the more remote villages and, in January 1958, a most useful addition to New Territories Medical Services was a health launch, 'Chee Hong" also donated by the Hong Kong Jockey Club; this 'floating clinic" will serve isolated communities of the eastern seaboard of the Colony and regular scheduled stopping places have been arranged for islands and remote mainland villages in the Tolo Harbour-Mirs Bay area. The staff consists of a Medical Officer, a Nurse-Midwife and a Public Vaccinator; general medical treatment, minor surgery, prophylactic immunizations and emergency obstetric work can be carried out either ashore or on board. The vessel has four stretcher beds and a radio telephone link with Kowloon.

68. A very intensive and successful anti-diphtheria immunization campaign achieved a total of 69,519 inoculations, which must represent a high proportion of the child population of the New Territories. Reference must be made here to the great help and co-operation given by the District Administration and the Assistant Commissioner of Police (New Territories and Marine) for the loan of transport and loudhailers for use in the more inaccessible districts by the vaccinating

teams.

Epidemiology

69. During the year a total of 18.170 cases of notifiable conmunica- ble diseases was registered, representing an increase of 2,099 or 13-1% over that of the preceding year. The rise was due mainly to increases of 1,510 for tuberculosis (from 12.155 to 13,665), 525 for diphtheria (from 714 to 1,339) and 166 for measles (from 709 to 875). Other diseases showed either a decline or a very slight variation. Of the total number of notifications, 14,052 or 77-3% were made by Government Hospitals and Clinics, 1,986 or 10-9% by the Tung Wah Group of Hospitals and the remaining 2,132 or 11-7% by private practitioners and other hospitals. The total number of deaths due to these diseases was 2,965 as against 2,870 in 1956, showing a rise of 95 or 3·3%.

70. The incidence and mortality rates of notifiable diseases in 1957 were 703-4 and 114-8 per 100,000 of population respectively as against 658-6 and 117-6 in 1956.

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71. The table at Appendix 2 gives the numbers of cases of and deaths from notifiable diseases reported in the Colony in 1957,

Influenza

72. A large scale outbreak of influenza was experienced in the late spring. The source of the attack was uncertain but the disease had been prevalent in Japan during the preceding winter months and had later spread to China. In Hong Kong the incidence showed a sudden rise in the second week in April and reached epidemic proportions by the end of the month; the total numbers affected were not accurately known since the disease was not notifiable but a conservative estimate indicates that about ten per cent of the population suffered from the condition, that is, approximately 300,000 persons. Some curtailment of public transport services and of industrial output occurred as a result of staff illness, but there was not any widespread or serious dislocation.

73. A number of extra outpatient clinics were opened and night sessions from 6 p.m. to midnight were held in existing clinics in order to deal with the large numbers seeking treatment; these clinics were maintained for two weeks and throughout the Easter Holiday week-end during which time the epidemic reached its height.

74. The clinical course of the disease was mild and very few complications were noted. A total of 40 deaths was ascribed to influenza during the three month period March to May and over half these deaths occurred in persons over 60 years of age. The total number of deaths From other diseases, apparently precipitated by the influenza outbreak, was increased during these months.

75. The outbreak declined rapidly at the beginning of May and no secondary wave of cases occurred during 1957. The virus responsible was identified in several Far East areas as type A/Asian/57, hitherto unknown, which later spread to most other parts of the world and caused appreciable epidemics.

76. Information of a recurrence of cases of influenza in Japan was received in October and caused some concem lest the Colony be again attacked, as a precautionary measure and to gain carly warning, medical practitioners were requested to notify influenza cases, seen in their practices, on a voluntary basis twice weekly. This arrangement, together with notifications from Government medical sources resulted in a total of 925 cases being reported by the end of 1957.

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