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Almoners during the year. Six new entrants were recruited for training in the Assistant Almoners grade. Resignations and leave granted for further studies abroad resulted in the reduction of the proportion of senior and experienced almoners to almoners in training; this meant that 57% of the staff had had less than three years experience in the Department and only 32% had served for six years or more. As so much of the medical social work depends on individual case work by experienced almoners this threw a considerable strain on the more senior staff.

428. There is an increasing awareness of the part the medical social worker plays in the treatment and the full recovery of patients. Discussions, ward rounds and consultations with the Almoners are being more frequently utilized by the medical staff as an integral part of the plan of treatment. However, the greatly increased numbers of out-patients and in-patients and the development of services dealing with long-term patients, such as orthopaedics, has inevitably resulted in some restriction of the scope of the case-work carried out by the Almoners. In some instances it has been possible to hand over certain responsibilities to other branches. For example, admissions to Kowloon Hospital are now the responsibility of an Admissions Officer; the appointment of an Health Visitor to the Ophthalmic Service has been of mutual advantage as the hygiene and feeding problems can be more readily dealt with by the Health Visitor; voluntary associations engaged in welfare work have also assisted greatly by assuming responsibilitics in connexion with the follow-up of patients.

429. The formation of neuro-surgical and orthopaedic units during the last two years at the Queen Mary and Kowloon Hospitals respectively has called for a considerable development of the almoning service. In addition the number of tuberculosis beds for which the Tuberculosis Almoners are responsible has increased from 873 to 1,016. The rehabilitation of long stay cases has always been the focus of the almoners' work at the Lai Chi Kok Hospital and to this has been added a great deal of work in connexion with a considerably increased turnover of short-term convalescent patients.

430. At the Mental Hospital there are now three full-time almoners and the detailed case work so necessary for the mentally ill has been more adequately covered. In 1958 a total of 1,777 patients was admitted and full social records were compiled for 724; the figures for 1957 were 1,358 and 442 respectively.

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431. The visiting, by relatives. of patients in the Castle Peak Hospital is difficult on account of the distance and transport problems. The Mental Health Association has made available a private cur once a month throughout the year and this has enabled a small number of relatives to maintain contact with both patients and almoners,

432. At the Tsan Yuk Maternity Hospital problems in connexion with the care of young children during the mothers' stay in hospital, Samaritan Fund grants to compensate for loss of carnings, and arrange- ments for the artificial feeding of young babies where breast feeding is contra-indicated have all been routine activities. Advice on family planning and reference to Family Planning Association clinics is given when it is sought and arrangements are made where necessary for the care or adoption of babies whose mothers have died after childbirth.

433. The almoners' work at the major polyclinics is continually expanding and the social angle of recovery in cases of poliomyelitis and meningitis has entailed much case work. An interesting feature is that the reference of mothers with young babies to Maternity and Child Health Centres has dropped as there is an increasing awareness amongst mothers of the value of the service provided and they now tend to seek it on their own initiative.

434. An analysis of 152 patients attending Out-patient Departments. for whom fuller case work was required showed that 36% were under 11 years of age, 21% were in the 11-30 age group, 34% in the 31 - 50 group and only 9% were over 50. Just under one-third of the cases were referred by doctors, one-seventh by nursing stuff, balf made their own application and the remainder came to light during routine inter- views or were referred by outside organizations.

435. The almoners attached to the Social Hygiene Service have duties in connexion with leprosy, skin disease and venereal discase patients. The rehabilitation of cured leprosy patients continues to be a most difficult task but more encouraging progress has been made in co-operation with the Resettlement and Social Welfare Departments.

436. The Ophthalmic Service was short of the services of one of the two almoners for the greater part of the year but the posting of a second almoner in November eased the situation. Of 60,791 new cye cases seen. some 8.000 were referred to the almoners and full case work was completed for 1,723. There were 1,113 patients requiring cyc operations and of these 333 were taken into hospital because the social background made this desirable: 504 cases of incipient blindness were

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