271. Family contacts of both tuberculoid and lepromatous cases were cxamined regularly when it was possible to trace them. The number examined in 1957 was 68% higher than the figure for 1956. Child contacts were referred for B.C.G. vaccination.
272. In treatment, oral dapsone or Avlosulfon Soluble by in- tramuscular injection is the standard therapy. Dapsone suspension ceased to be employed because of the occasional occurrence of oil abscesses as a complication.
273. Selected cases for surgical treatment by bilateral ulnar nerve transplant were admitted to Queen Mary Hospital.
274. A colour film illustrating the activities of the leprosy out- patient clinics was made in July 1957 and shown at the Regional Meet- ing of the World Health Organization held in Hong Kong in September.
DISTRICT MIDWIFERY SERVICES
275. Apart from the hospital midwifery services the Department operates a domiciliary and maternity home midwifery service throughout the Colony. Forty four midwives, an increase of seven over the previous year's figure, were employed at twenty one district centres; thirteen of these centres have maternity homes attached providing a total of 127 maternity beds. The great majority of these beds are in the New Territories since the policy in the more crowded urban districts has been to use the maternity facilities available in general or specialized hospitals. The remaining eight centres have resident midwives doing domiciliary deliveries.
276. Two new centres were opened during the year, one in June 1957 on Lamma Island, which has six maternity beds in charge of a nurse with midwifery qualifications. The other is at the Shek Kip Mei Clinic which was opened in December 1957, and has a staff of three midwives for domiciliary work.
277. The total number of cases attended in 1957 was 11,779, of which 8,216 were maternity home patients and 3,563 domiciliary cases, Live births totalled 11,538, approximately 11% of all registered births. 151 still births were recorded giving a still birth rate of 12-9 per 1,000 births.
278. The average annual 'case load' per midwife was 267, satisfactory reduction on the previous year's figure of 314. The range of this case load is wide and varied from twenty six for the midwife on Lamma Island to 538 at Yuen Long.
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279. The frequency of ante-natal attendances continues to improve slowly. The average number of attendances per case was 3-29, but 22-74% of the mothers delivered had had no ante-natal care, this latter figure was 29-17% in 1956.
280. There are 1,334 midwives registered in the Colony but only 202 are in active private practice. 174 of these maintain small maternity homes and twenty eight do domiciliary work only. Twice as many mid- wives practice in Kowloon as in Hong Kong.
281. Private midwives delivered 35,608 cases during the year. The number of live births was 35,331, which is over one third of all births registered in the Colony in 1957. The figures for unte-natal attendances are almost identical with those recorded by Government District Mid- wives, the average attendances per case being 3-31 and the percentage of cases delivered without any ante-natal care was 20-71.
282. Regular inspection and supervision of private maternity homes is carried out by the supervisor of Midwives: 797 such visits to the 132 homes on the register were made during the year. Particular attention is paid to the hygiene of the premises, to maternity equipment and to records.
283. A very encouraging increase was recorded in the number of B.C.G. vaccinations given to infants within a few days of birth. This anti-tuberculosis measure is being increasingly advocated and has been again successfully pursued in the recent year. 34% of babies delivered by midwives in 1957 received this vaccination; of the 15,927 vaccina- tions recorded 678% were carried out by Government midwives and the remainder by midwives in private practice. Vaccine is provided free of charge to all medical practitioners and midwives in the Colony.
284. The vaccination of infants against smallpox also continued to be offered as a routine protective procedure and 35.958 primary vaccina- Lions were performed by midwives during 1957.
MATERNAL AND CHILD HEALTH
285. This Service provides, for the general public, ante-natal and post-natal care, infant welfare, and 'toddler' care up to school age. The main emphasis is on preventive medicine and health education. The Service operates from six full-time and twenty part-time centres through- out the Colony. Existing services have been developed and expanded during the year. A new full time centre was opened in November 1957 at the Shek Kip Mei Clinic and another is to open in April 1958 at the
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