B r i t . J . O p h t h a l . ( 1 9 5 8 ) 4 2 , 3 9 4 .

O PHTHALMIC DISEASE IN HO NG KO NG*

B Y
G. C. DANSEY-B RO WNING
Hong Kong
HO NG KO NG, w h i c h l i e s on t h e s ou t h c oa s t of Ch i na j u s t w i t h i n t h e t r op i c s ,
c ons i s t s of s om e 1 9 3 i s l a nd s s u r r ou nd i ng a m ou nt a i nou s p e ni ns u l a t o t h e
e a s t of t h e Pe a r l Ri v e r . Th e c a p i t a l , V i c t or i a , s i t u a t e d u p on t h e i s l a nd of
Hong Kong ( Ha v e n of F r a gr a nt St r e a m s ) , f a c e s t h e Kow l oon ( Ni ne Dr a gons )
p e ni ns u l a a c r os s a p e r f e c t na t u r a l h a r b ou r . At t h e p r e s e nt , t h e Col ony ' s
p op u l a t i on r a nge s u p w a r d s f r om
2 1
m i l l i on, 9 8 p e r c e nt b e i ng Ch i ne s e .
Som e 2 m i l l i on p e r s ons l i v e c r a m m e d i nt o t h e 1 2 s q u a r e m i l e s of t h e u r b a n
a r e a s of Kow l oon or V i c t or i a , gi v i ng i n t h e s l u m a r e a s a d e ns i t y of 2 , 0 0 0
p e r a c r e ( Annu a l De p a r t m e nt a l Re p or t of t h e Di r e c t or of Me d i c a l a nd
He a l t h Se r v i c e s , 1 9 5 4 -5 6 ) . Th i s m u l t i t u d e d u e t o i m m i gr a t i on a nd a p r o-
d i gi ou s b i r t h -r a t e s h ow s a n a nnu a l i nc r e a s e of 8 0 , 0 0 0 ( Annu a l Re p or t , 1 9 5 6 ) .
O nl y 5 0 of t h e r e m a i ni ng 3 8 0 s q u a r e m i l e s of t h e Col ony ' s a r e a a r e s u i t a b l e
f or a gr i c u l t u r e , or i nd e e d f or a ny ot h e r p u r p os e . Ye t s om e f u r t h e r h a l f
m i l l i on p e r s ons m a k e t h e i r l i v i ng e i t h e r b y f a r m i ng or b y f i s h i ng t h e s e a s
s u r r ou nd i ng Hong Kong.
Ec oNoMY
Es t a b l i s h e d s om e 1 1 6 y e a r s a go, Hong Kong q u i c k l y b e c a m e one of t h e
p r i nc i p a l e nt r e p ot s of t h e Ch i na Tr a d e -a p os i t i on r e t a i ne d u nt i l 1 9 4 9 .
Re c e nt p ol i t i c a l c h a nge s on t h e m a i nl a nd of Ch i na h a v e r e s u l t e d i n a s h i f t
t o l i gh t i nd u s t r y w i t h e m p h a s i s on t e x t i l e a nd p l a s t i c m a nu f a c t u r e s . Al s o
t h e Col ony h a s h a d t o a b s or b ne a r l y one m i l l i on r e f u ge e s i n s e a r c h of
s e c u r i t y a nd e m p l oy m e nt . Th e m a j or i t y of t h e Ch i ne s e p op u l a t i on h a i l
f r om t h e ne i gh b ou r i ng p r ov i nc e s of Kw a ngt u ng a nd F u k i e n. Th e y a r e onl y
one ge ne r a t i on r e m ov e d f r om a n a gr i c u l t u r a l s oc i e t y b a s e d on f i x e d t r a d i -
t i ons , a nd op e r a t i ng u nd e r r u l e s t h a t s c a r c e l y h a v e c h a nge d i n 2 , 0 0 0 y e a r s .
In c ons e q u e nc e , t h e s e Ca nt one s e -a ge ne r i c t e r m w h i c h e m b r a c e s Hong
Kong' s Ch i ne s e -h a v e a c om p l e t e l y op e n m i nd a s t o t h e r e l a t i v e v a l u e s of
t h e O r i e nt a l a nd O c c i d e nt a l s y s t e m s of m e d i c i ne . O n t h e w h ol e t h e y t e nd
t o p r e f e r a t f i r s t i ns t a nc e t h e m i ni s t r a t i ons of t h e i r ow n h e r b a l i s t s . B u t onc e
d i s e a s e d , b e i ng a t r u e r a c e of s h op k e e p e r s , t h e y a r e p e r f e c t l y w i l l i ng t o v i s i t
a l l a v a i l a b l e p r a c t i t i one r s of e i t h e r s y s t e m , " s h op p i ng a r ou nd " , e v e nt u a l l y
t o c h oos e t h e one w h o w i l l p r om i s e a c e r t a i n c u r e a t t h e c h e a p e s t f e e . In
*
Re c e i v e d f or p u b l i c a t i on Au gu s t 6 , 1 9 5 7 .
3 9 4
O PHTHALMIC DISEASE IN HO NG KO NG
op h t h a l m ol ogy , a t a ny r a t e i n t h e p oor e s t q u a r t e r s , t h e b a l a nc e a t t h e
m om e nt i s ni c e l y a d j u s t e d b e t w e e n t h e ob v i ou s v a l u e of w e s t e r n a nt i b i ot i c s
a nd t h e e x c e l l e nt i f e r r a t i c k now l e d ge of h e r b s a nd s i m p l e s t h a t t h e i nd i ge nou s
p r a c t i t i one r s h a v e a c q u i r e d t h r ou gh ge ne r a t i ons of t r i a l a nd e r r or a t t h e i r
p a t i e nt s ' e x p e ns e .
INCIDENCE O F DISEASE
In 1 9 5 3 , e s t i m a t e s of t h e i nc i d e nc e of op h t h a l m i c d i s e a s e a m ongs t t h e
v e r y p oor i n t h e Col ony i nd i c a t e d a p ot e nt i a l a t t e nd a nc e of 1 5 0 , 0 0 0 p e r
a nnu m . Th e s m a l l w h i t e -c ol l a r c l a s s w e r e a d e q u a t e l y c a t e r e d f or b y s om e
f ou r t e e n p r i v a t e p r a c t i t i one r s of op h t h a l m ol ogy , b u t t h e i r f e e s w e r e s u c h
t h a t a c ool i e on a b a s i c w a ge of 3 t o 4 $ a d a y c ou l d ne v e r a f f or d t o a t t e nd
t h e i r c l i ni c s . Th e F r e e Hos p i t a l s of t h e Ch i ne s e ( Tu ng Wa h ) Gr ou p c ou l d
of f e r t h e p oor a c h oi c e of e i t h e r We s t e r n or Ea s t e r n m e d i c i ne , b u t t h e i r t h r e e
p a r t -t i m e op h t h a l m ol ogi s t s c ou l d onl y d e a l s k e t c h i l y w i t h 3 0 , 0 0 0 a t t e nd a nc e s
p e r a nnu m , a nd t h e r e w e r e d e f i ni t e l i m i t s t o t h e c os t of d r u gs a nd t r e a t m e nt
p r ov i d e d . It w a s t h e r e f or e i ne v i t a b l e t h a t t h e s m a l l gov e r nm e nt op h t h a l m i c
s e r v i c e s h ou l d ne e d c ons i d e r a b l e e x p a ns i on a s s oon a s a n e f f e c t i v e s y s t e m
of ou t -p a t i e nt r e c or d s h a d b e e n e s t a b l i s h e d a nd c e r t a i n s u r v e y s of op h t h a l m i c
d i s e a s e h a d b e e n c a r r i e d ou t .
Th e 1 9 5 3 s u r v e y s s h ow e d t h a t t h e p r i nc i p a l d i s e a s e s p r e s e nt i ng a t t h e
u r b a n c l i ni c s w e r e a s f ol l ow s :
( A) Ac u t e i nf e c t i on of t h e a nt e r i or s e gm e nt of t h e gl ob e ( op h t h a l m i a ) , a s s oc i a t e d
w i t h v a r y i ng d e gr e e s of s u b nu t r i t i on.
( B ) Ph l y c t e nu l a r d i s e a s e .
( C) Sy p h i l i s .
( D) Tr a c h om a .
( E) U nt r e a t e d c a t a r a c t .
( F ) Gl a u c om a .
F u r t h e r f a c t or s a f f e c t i ng t h e i nc i d e nc e of d i s e a s e w e r e a l s o d i s c l os e d b y t h e s e
s u r v e y s :
( 1 ) O v e r c r ow d i ng. -In t h e s l u m s of Wa nc h a i or Sh a m s h u i p o, t h e a r e a of b e d
s p a c e t h a t a n a d u l t c a n a c q u i r e i s onl y 1 5 s q . f t -a l l t oo of t e n t h i s i s not onl y a
p l a c e t o s l e e p , b u t a l s o t h e s p a c e w h e r e i n h e h a s t o e a r n h i s l i v e l i h ood . In c ons e -
q u e nc e not m e r e l y i s t h e e p i d e m i c s p r e a d of op h t h a l m i a a c c e l e r a t e d , b u t t h e h i gh
r a c i a l t u b e r c u l os i s m or b i d i t y i s a ggr a v a t e d ; a l t h ou gh on t h e w h ol e t h e Ch i ne s e
s h ow a l ow s u s c e p t i b i l i t y t o t h i s d i s e a s e . Hong Kong' s w e e k l y not i f i c a t i on of
d e a t h s f r om t u b e r c u l os i s a v e r a ge s w e l l ov e r 4 5 , w h i l e t h e f r e s h l y d i a gnos e d c a s e s of
t h e d i s e a s e a r e h i gh e r t h a n 2 0 0 p e r w e e k . Som e 7 8 p e r c e nt . of d e a t h s i n t h e m a l e
a ge gr ou p 4 0 -4 4 y e a r s , a nd 3 0 p e r c e nt . of d e a t h s i n i nf a nt s u nd e r 5 y e a r s of a ge a r e
d u e t o t u b e r c u l os i s ( t h r e e -q u a r t e r s of t h e l a t t e r b e i ng d u e t o t u b e r c u l ou s m e ni n-
gi t i s ) .
In 1 9 5 4 a s e r i e s of 4 4 0 c h i l d r e n w i t h p h l y c t e nu l a r d i s e a s e a ge d 8 y e a r s or u nd e r
w a s t u b e r c u l i n-t e s t e d . Som e 8 5 9 p e r c e nt . of t h e s e w e r e r e p or t e d a s " T-T
p os i t i v e " . Al l t h e c h i l d r e n i n t h e s e r i e s h a d t h e i r c h e s t s x -r a y e d , w i t h i m m e d i a t e
3 9 5
G. C. DANSEY-B RO WNING
r e p or t s i n 4 8 c a s e s of a c t i v e p u l m ona r y t u b e r c u l os i s . O f t h e w h ol e , 2 0 5 p e r c e nt .
w e r e r e p or t e d e i t h e r a s b e i ng a c t i v e l y t u b e r c u l ou s or e l s e a s s h ow i ng r a d i ol ogi c a l
s t i gm a t a s i gni f i c a nt of t h i s d i s e a s e .
( 2 ) Di e t . -Th e k e y t o t h e w h ol e p r ob l e m of e f f e c t i v e m a s s t r e a t m e nt of
op h t h a l m i c d i s e a s e , not m e r e l y i n Hong Kong b u t t h r ou gh ou t Sou t h Ea s t As i a ,
l i e s i n t h e d i e t a r y i d i os y nc r a s i e s of t h e i nh a b i t a nt s . Du r i ng t h e f i r s t y e a r of l i f e ,
t h e Ca nt one s e i nf a nt i s k e p t a t t h e b r e a s t , a nd a r e c e nt s u r v e y s h ow s t h a t d u r i ng
t h i s p e r i od t h e w e i gh t -gr ow t h r a t e s c l os e l y p a r a l l e l t h os e f or i nf a nt s of ot h e r r a c e s .
How e v e r , d i r e c t l y t h e Ch i ne s e i nf a nt i s w e a ne d t h e w e i gh t -gr ow t h r a t e s s l ow u p .
In Hong Kong, w h e n a r t i f i c i a l f e e d i ng h a s t o b e r e s or t e d t o, t h e e c onom i c s of
p ov e r t y b r i ng i t a b ou t t h a t i nf a nt s r e c e i v e onl y u nf or t i f i e d t i nne d m i l k or a r i c e -
m u s h k now n a s c onge e . Th e Ca nt one s e d i s l i k e b r e a d a nd a v oi d a l l f or m s of
d a i r y -p r od u c e i n t h e i r d i e t . Th r ou gh ou t t h e y e a r t h e p oor e x i s t u p on b ow l s of
p ol i s h e d r i c e ga r ni s h e d w i t h a f e w v e ge t a b l e s a nd a l i t t l e s a l t -f i s h , e x c e p t f or t h e
t r a d i t i ona l f e a s t of p or k or c h i c k e n a t t h e Lu na r Ne w Ye a r . Th e m a j or i t y of ou r
s e r i e s of p h l y c t e nu l a r d i s e a s e s h ow e d a h e a v y i nf e s t a t i on w i t h Cl onor c h i s s i ne ns i s ;
t h i s t r e m a t od e h a s a s a n i nt e r m e d i a r y h os t t h e f r e s h -w a t e r c a r p -a s t a p l e of t h e
Ca nt one s e d i e t -a nd i t i s h e l d b y s om e a u t h or i t i e s t o a f f e c t ov e r 6 5 p e r c e nt . of
t h e p op u l a t i on of Kw a ngt u ng.
Th e s c h ool h e a l t h s c h e m e op e r a t i ng i n t h e Col ony r e p or t s t h a t 3 1 -8 p e r c e nt .
of i t s e nt r a nt s a r e f ou nd t o b e of p oor or s u b nor m a l nu t r i t i on, a nd t h a t a f u r t h e r
2 0 -6 p e r c e nt . a r e not e d a t t h i s t i m e a s b or d e r -l i ne c a s e s m e r i t i ng f u r t h e r ob s e r v a -
t i on. 1 8 -2 p e r c e nt . of t h e s e e nt r a nt s r e q u i r e d i m m e d i a t e r e m e d y of p h y s i c a l
d e f e c t s -t h e op h t h a l m i c s e r v i c e p r ov i d i ng s p e c t a c l e s f or a p p r ox i m a t e l y 1 0 p e r
c e nt . of t h e w h ol e e nt r y .
Di e t a r y f a c t or s a r e r e s p ons i b l e f or t h e l a c k of r e s i s t a nc e t o oc u l a r i nf e c t i on
a m ongs t ou r p a t i e nt s , r e a c h i ng i n e x t r e m e c a s e s t o p u r e k e r a t om a l a c i a , a nd
a s s i s t i ng i n t h e p r od u c t i on of a h i gh i nc i d e nc e of p h l y c t e nu l a r d i s e a s e . In
1 9 5 5 , a n a na l y s i s of 3 0 0 c h i l d r e n on t h e i r f i r s t a t t e nd a nc e a t ou r u r b a n c l i ni c s
s h ow e d 4 4 -6 p e r c e nt . t o b e s u f f e r i ng f r om op h t h a l m i a / s u b nu t r i t i on a nd a f u r t h e r
1 7 -0 p e r c e nt . f r om p h l y c t e nu l a r d i s e a s e . Li k e t h e Engl i s h t h e Ch i ne s e b e l i e v e
t h a t t o b e " good " a l l m e d i c i ne m u s t b e " na s t y or s e a r c h i ng" . In c ons e q u e nc e ,
t h e s a l v e s a nd p ow d e r s t h a t t h e l oc a l ne c r om a nc e r s , h e r b a l i s t s , a c u p u nc t u r e r s , a nd
t h e l i k e i ns t i l i nt o t h e e y e a r e i n a l l e s s e nt i a l s a b r a s i v e , a nd t h e e x c or i a t i ons s o
p r od u c e d a r e a l l t oo of t e n d i f f i c u l t t o d i f f e r e nt i a t e f r om m a s s i v e c r op s of p h l y c -
t e nu l e s .
( 3 ) Sy p h i l i s . -Th e Ch i ne s e c l a i m t h a t t h i s d i s e a s e i s p u r e l y a " f or e i gn-d e v i l "
i m p or t a t i on of t h e l a s t 1 5 0 y e a r s . B e t h a t a s i t m a y -i n 1 9 5 4 s om e 6 p e r c e nt . of
a l l p r e gna nt w om e n i n Hong Kong w e r e f ou nd t o b e s u f f e r i ng f r om u ns u s p e c t e d
s y p h i l i s , a nd i n t h e s a m e y e a r a n a na l y s i s of b l i nd ne s s i n m a l e s s h ow e d s e r ol ogi c a l l y
t h a t 1 0 p e r c e nt . w e r e d u e t o s y p h i l i s . Th e op h t h a l m i c c l i ni c s t h a t y e a r r e f e r r e d
s om e e i gh t y c a s e s of p r ov e n s y p h i l i t i c op t i c a t r op h y t o t h e Soc i a l Hy gi e ne Cl i ni c s
-not one of w h i c h h a d p r e v i ou s l y r e c e i v e d a ny f or m of a nt i -l u e t i c t r e a t m e nt .
Cu r i ou s l y e nou gh , t h e Ca nt one s e a r e c onv i nc e d t h a t b l i nd ne s s i s t h e i ne v i t a b l e
r e s u l t of t h e s i ns of t h e s u f f e r e r , a nd t h e a b ov e f i nd i ngs m a y b e h e l d t o gi v e s u p p or t
t o t h i s b e l i e f ; t h i s h a s b e e n one of ou r p r i nc i p a l s t u m b l i ng b l oc k s i n t h e s t r u ggl e
t o e nl i s t p u b l i c s u p p or t f or b l i nd -w e l f a r e .
3 9 6
O PHTHALMIC DISEASE IN HO NG KO NG
( 4 ) Tr a c h om a . -Hong Kong h a s a l w a y s h a d a n i na d e q u a t e w a t e r s u p p l y f or i t s
l a r ge c om m u ni t y , a nd i n t h e t r op i c s t h i s p os e s m a ny p u b l i c h e a l t h p r ob l e m s , not
t h e l e a s t of w h i c h i s t h e f a c i l i t y w i t h w h i c h c om m u ni c a b l e e y e -d i s e a s e s p r e a d . To
a ggr a v a t e m a t t e r s , t h e Ch i ne s e , w h i l s t f a s t i d i ou s i n t h e i r p e r s ona l h y gi e ne , a r e
c om p l e t e l y ob l i v i ou s of t h e ne c e s s i t y f or c om m u na l m e a s u r e s . Cons e r v a nc y i s
r e ga r d e d a s a w e s t e r n-f a d ; e x p e c t or a t i on a t a l l t i m e s a nd i n a l l p l a c e s i s a ge ne r a l
h a b i t ; t h e c om m u na l f a c e t ow e l w r u ng ou t i n t e p i d w a t e r i s u s e d b y a l l t h e c om -
p a ny a t t e nd i ng e a t i ng h ou s e s a nd p l a c e s of e nt e r t a i nm e nt t o r e f r e s h t h e f a c e a nd
h a nd s . O u r u r b a n c l i ni c s i n c ons e q u e nc e s h ow a c ons t a nt 1 5 -1 7 p e r c e nt . a t t e n-
d a nc e f or t r a c h om a , b u t t h e i nc i d e nc e i s c ons i d e r a b l y h i gh e r i n t h e r u r a l c l i ni c s
h e l d f or f a r m e r s a nd f i s h e r f ol k f or w h om h y gi e ne d oe s not e x i s t . Th e c h i l d r e n
a t t e nd i ng t h e m i d d l e -c l a s s s c h ool s s h ow v e r y l i t t l e t r a c h om a , b u t i n t h e or p h a na ge s ,
r u r a l s c h ool s , a nd i ns t i t u t i ons , t h e i nc i d e nc e a m ongs t t h e i nm a t e s i s a b ou t 1 1 p e r
c e nt .
( 5 ) Le s s Com m on Di s e a s e s
( a ) Pe c u l i a r t o t h i s r e gi on a nd h e l d b y s om e a u t h or i t i e s t o b e b ou nd u p w i t h
t h e h ot h u m i d c l i m a t e i s t h e Ca nt one s e d i s e a s e . Ea c h y e a r t h e op h t h a l m i c
c l i ni c s e x p e c t s om e f i f t y or m or e p a t i e nt s i n e a r l y m i d d l e a ge t o r e p or t w i t h a
p a r a l y t i c s t r a b i s m u s or ot h e r op h t h a l m i c s i gns t h a t on i nv e s t i ga t i on p r ov e t o
b e a h i t h e r t o u ns u s p e c t e d b u t b y now i nt r a c t a b l e ne op l a s m : na s o-p h a r y nge a l
c a r c i nom a .
( b ) Le p r os y i n Hong Kong p r ov i d e s 1 1 , 0 0 0 a nnu a l a t t e nd a nc e s i n t h e gov e r n-
m e nt c l i ni c s , a p p r ox i m a t e l y 5 0 0 ne w c a s e s b e i ng d i a gnos e d e a c h y e a r . In t h e
m a i n, t h e op h t h a l m i c s i gns a r e e i t h e r p a r e s i s a f f e c t i ng t h e or b i c u l a r i s oc u l i or
u v e i t i s i n t h e t u b e r c u l oi d t y p e of Ha ns e n' s d i s e a s e . We h a v e onl y s e e n one c a s e
of t h e c l a s s i c a l l e p r om a t ou s p a nnu s i n t h e l a s t 4 y e a r s , b u t a r e t i no-c h or oi d i t i s
t h e i ni t i a l a p p e a r a nc e of w h i c h i s e x t r e m e l y d i f f i c u l t t o d i f f e r e nt i a t e f r om d i a b e t i c
r e t i nop a t h y i s f r e q u e nt l y s e e n.
( c ) Th e Ch i ne s e i n Hong Kong a r e f i r m b e l i e v e r s i n v a c c i na t i on ( r e d -b e a n-
s ow i ng) a nd i n c ons e q u e nc e t h e a m ou nt of b l i nd ne s s d u e t o s m a l l p ox ( t h e
h e a v e nl y r e d -b e a n f l ow e r d i s e a s e ) i s ne gl i gi b l e . How e v e r , a f t e r t h e a c u t e
i nf e c t i ou s f e v e r s a nd i n p a r t i c u l a r a f t e r m e a s l e s , t r a d i t i on h a s i t t h a t t h e c h i l d
s h ou l d not r e c e i v e a f u l l d i e t f or one m ont h , a nd s u c h p a t i e nt s a r e a l l t oo of t e n
r e s c u e d j u s t u p on t h e b r i nk of k e r a t om a l a c i a .
PU B LIC HEALTH MEASU RES
Pr e l i m i na r y s u r v e y s of t h e Col ony ' s b l i nd p op u l a t i on i nd i c a t e d t h a t ne a r l y
5 0 p e r c e nt . of t h e s e u nf or t u na t e s c l a i m e d t h a t t h e y h a d l os t t h e i r s i gh t
b e f or e t h e a ge of 1 0 y e a r s . U ni t e d Ki ngd om s u r v e y s s t a t e t h a t onl y 6 -2 p e r
c e nt . of b l i nd p e r s ons a r e s o d i s a b l e d b e f or e t h e a ge of 1 5 y e a r s , a nd 8 2 3 p e r
c e nt . a r e r e p or t e d t o h a v e l os t t h e i r s i gh t a f t e r t h e a ge of 5 0 ( Sor s b y , 1 9 5 3 ) .
In 1 9 5 4 , t h e gov e r nm e nt e y e c l i ni c s of Hong Kong f r e e d a l l c h i l d r e n of t h e
a ge of 1 0 a nd u nd e r f r om a ny c h a r ge s f or t r e a t m e nt , d r u gs , h os p i t a l i z a t i on,
e t c . O t h e r w i s e a f e e -f or -s e r v i c e i s c h a r ge d of $ 1 p e r p a t i e nt . Th e ov e r a l l
v a l u e of t h i s t o a f a m i l y of s e v e n or t e n c h i l d r e n e x i s t i ng on a c ool i e ' s p a y
c a nnot b e e x a gge r a t e d . Im m e d i a t e l y , i ns t e a d of s e e i ng c h i l d r e n i n t h e l a s t
3 9 7
3 9 8 G. C. DANSEY-B RO WNING
s t a ge s of k e r a t om a l a c i a , w e w e r e a b l e t o t r e a t a c u t e i nf e c t i ons of t h e e y e i n
t h e e a r l i e s t s t a ge s . B y t h e m i d d l e of 1 9 5 3 , a l l gov e r nm e nt c l i ni c s , c l os e l y
c op i e d b y ou t s i d e p r a c t i t i one r s , s t a r t e d t o t r e a t t r a c h om a w i t h
Au r e om y c i n/
Te r r a m y c i n/ s u l p h ona m i d e t h e r a p y u nd e r s t r i c t W. H. O . c l a s s i f i c a t i on a nd
d i s c i p l i ne . At t h e s a m e t i m e , i n a l l c a s e s of d i s e a s e i n c h i l d r e n, w e r e i n-
f or c e d t op i c a l t h e r a p y w i t h s y s t e m i c a nt i b i ot i c s a nd nu t r i t i ona l s u p p l e m e nt s
( m a j i nl y v i t a m i ns A a nd D) t o ge t r a p i d i ni t i a l r e s p ons e t o t r e a t m e nt . Th e
r e s u l t s h a v e b e e n m os t gr a t i f y i ng, a nd now w e b oa s t t h a t w e onl y ge t " b l i nd
b a b i e s " f r om Kw a ngt u ng, a nd w e k now t h a t ou r " y e l l ow t r a c h om a oi nt -
m e nt " h a s a w i d e r e p u t a t i on t h r ou gh ou t Sou t h Ch i na . U nf or t u na t e l y
Hong Kong' s p r ol onge d t h e r a p e u t i c h one y m oon w i t h t h e a nt i b i ot i c s s h ow s
s i gns of b e i ng on t h e w a ne , a nd t h e r e i s a l s o a not i c e a b l e i nc r e a s e i n t h e
p h ot o-s e ns i t i v e r e a c t i ons t o s u l p h ona m i d e t h e r a p y s i m i l a r t o t h a t now
oc c u r r i ng i n t h e Me d i t e r r a ne a n a r e a .
Al l t oo of t e n i n op h t h a l m ol ogy , t h e r ol e of w e l f a r e a s a m os t v i t a l w e a p on
i n ou r a r m a m e nt a r i u m i s f or got t e n. Th e op h t h a l m i c a l m one r s h e r e h a v e
t o d e a l w i t h a p p r ox i m a t e l y one i n 2 5 of a l l ou r f r e s h c a s e s ; t h e y a c h i e v e t h e
m os t e x c e l l e nt r e s u l t s , gi v i ng a d v i c e on e c onom i c p r ob l e m s . Gi f t s of f ood
p a r c e l s a nd h om e -v i s i t s t o d e a l w i t h p r ob l e m p a r e nt s h e l p t o r e d u c e t h e
nu m b e r s of ou r " c h r oni c s " a nd s p e e d t h e p a c e of c u r e .
B LINDNESS
Ma c k e nz i e a nd F l ow e r s ( 1 9 4 7 ) e s t i m a l e d t h a t t h e r e w e r e ne a r l y 2 m i l l i on
b l i nd p e r s ons i n Ch i na . Su c h f i gu r e s m a y s e e m q u i t e f a nt a s t i c , b u t t h e r e
c a n b e no d ou b t t h a t t h e nu m b e r s m u s t b e a s t r onom i c a l i n a p op u l a t i on
r e c e nt l y s t a t e d t o a p p r oa c h 6 0 0 m i l l i on p e r s ons .
We b a s e ou r e s t i m a t e s of Hong Kong' s b l i nd p op u l a t i on u p on U ni t e d
Ki ngd om s u r v e y s , w h i c h w ou l d i nd i c a t e t h a t t h e nu m b e r of p e r s ons w i t h
v i s u a l a c u i t y of h a nd m ov e m e nt s , p e r c e p t i on of l i gh t , or l e s s w ou l d b e a b ou t
3 , 0 0 0 . Som e 5 5 1 of t h e s e w e r e s u r v e y e d i n 1 9 5 3 ( Ta b l e I) .
TAB LE I
MAJ O R CAU SES O F O PHTHALMIC DISEASE
Ca u s e Pe r c e nt a ge of Ca s e s
O p h t h a l m i a / Su b nu t r i t i on . . . . . . . . . . . . . . 4 4
U nt r e a t e d Ca t a r a c t s . . . . !. . . . . . . . . 1 6
Tr a c h om a . . . . . . . . . . . . . . . . . . 1 1
Inj u r y . . . . . . . . . . . . . . . . . . . . 1 0
Sy p h i l i s 5 . . . . . . . . . .
Conge ni t a l or He r e d i t a r y Di s e a s e . . . . . . . . . . 5
Gl a u c om a 3 5
U v e i t i s or O p t i c At r op h y of U nk now n Ae t i ol ogy . . . . 2 -5
Sm a l l p ox . . . . . . . . . .
Le p r os y . . . . . . . . . . . . . . . . . . 1
De ge ne r a t i v e Di s e a s e . . . . . . . . . . . . 1
Tot a l . . . . . . . . . 1 0 0
O PHTHALMIC DISEASE IN HO NG KO NG
Th i s p r e l i m i na r y s u r v e y , w h i l s t l e a v i ng u na ns w e r e d m a ny q u e s t i ons ,
c l e a r l y e m p h a s i z e d t h e f a c t t h a t t h r e e -q u a r t e r s of t h e b l i nd ne s s i n Hong
Kong w a s p r e v e nt a b l e . Th e m a j or d i s c r e p a nc i e s w i t h t h e U ni t e d Ki ngd om
f i gu r e s l a y i n t h e d i f f e r e nt a ge s a t ons e t , a nd i n t h e f i gu r e s f or u nt r e a t e d
c a t a r a c t a nd gl a u c om a ( 3 0 . 4 a nd 1 4 p e r c e nt . r e s p e c t i v e l y i n t h e U ni t e d
Ki ngd om ; Sor s b y , 1 9 5 3 ) .
In t h e s u r v e y of 8 0 0 b l i nd a d u l t s , s u m m a r i z e d i n Ta b l e II, t h e i nc i d e nc e
of c a t a r a c t a nd gl a u c om a i n Ch i ne s e a nd Eu r op e a n a d u l t s c l e a r l y a p p r ox i -
m a t e d . Th e c h a r a c t e r i s t i c s of m a l e b l i nd ne s s i n Hong Kong a p p e a r t o b e
t h e h i gh i nc i d e nc e of s y p h i l i s ( a s a ga i ns t 1 p e r c e nt . i n t h e U ni t e d Ki ngd om ;
Sor s b y , 1 9 5 3 ) , a nd of i nj u r i e s c ons e q u e nt on ne a r l y 5 0 y e a r s of c i v i l w a r ,
f l ood , a nd f a m i ne . In Hong Kong, a s i nd e e d t h r ou gh ou t t h e O r i e nt , t h e r e
i s no i d e a t h a t h e a v y w or k i s u ns u i t a b l e f or w om e n, h e nc e t h e p a r i t y
b e t w e e n t h e s e x e s i n " p e a c e -t i m e " t r a u m a t i c c a u s e s of b l i nd ne s s . F u r t h e r -
m or e , t h e Col ony i s onl y l i gh t l y i nd u s t r i a l i z e d , s o t h a t t h e s u m m a t i on of a l l
t y p e s of t r a u m a d oe s not a p p r oa c h t h e 2 4 -7 p e r c e nt . of t r a u m a t i c b l i nd ne s s
e nc ou nt e r e d i n t h e f i gu r e s f or t h e h e a v i l y i nd u s t r i a l i z e d U ni t e d Ki ngd om .
In f a c t , t h e t e x t i l e a nd p l a s t i c f a c t or i e s of Hong Kong a r e ge ne r a l l y of r e c e nt
c ons t r u c t i on, r i v a l l i ng t h e b e s t i n ot h e r c ou nt r i e s i n l a y ou t , e q u i p m e nt , a nd
e m p l oy e e -w e l f a r e s e r v i c e s . Ye t s i d e b y s i d e w i t h t h e s e e x i s t c onc e r ns i n
w h i c h t h e e m p l oy e e s l i v e a nd w or k i n c ond i t i ons a nd u nd e r a n a p p r e nt i c e s h i p
s y s t e m a na l ogou s w i t h t h os e of Tu d or Lond on.
TAB LE II
ANALYSIS O F 8 0 0 B LIND ADU LTS IN 1 9 5 4
Pe r c e nt a ge of Ca s e s
O p h t h a l m i c Ca u s e
F e m a l e Ma l e
O p h t h a l m i a / Su b nu t r i t i on . . . . . . 2 9 2 4
Ca t a r a c t s Si m p l e . . . . . . 2 5 0
l 3 0 4
1 2 -0
1 0
Com p l i c a t e d ; . . . . . 5 -4 8 -0 1
Tr a c h om a . . . . . . . . . . 1 4 -5 9
Ma j or Gl a u c om a Si m p l e x or Na r r ow Angl e 8 -0 R
9 5
5 -0
5 l
( Mor e t h a n Se c ond a r y . . . . . 1 5 f 0 7
O ne
p e r Inj u r y Pe a c e -t i m e 4 5 4 0
j u r y
~ ~ ~ ~ ~ ~ ~ ~ 4 -6 1 : } 1 7
c e nt . ) Wa r -t i m e 0 -1 1 3 1
Sy p h i l i s Conge ni t a l 2 l 2 6
g
0 2 } 1 0 2
Non-s p e c i f i c U v e i t i s . . . . . . 2 3 -5
Non-s p e c i f i c O p t i c At r op h y . . . . 1 1
Al l O t h e r Mi nor Ca u s e s ( Le s s t h a n O ne p e r c e nt . ) . . 1 0 0 - 1 0 0
3 9 9
G. C. DANSE Y-B RO WNING
Ne a r l y 9 0 p e r c e nt . of a l l a d u l t s w h o h a d l os t t h e i r s i gh t b e c a u s e of
op h t h a l m i a / s u b nu t r i t i on c l a i m e d t h a t t h i s h a d oc c u r r e d b e f or e t h e a ge of
1 0 y e a r s .
Th e s u r v e y of 2 0 0 b l i nd c h i l d r e n s u m m a r i z e d i n Ta b l e III, r e f l e c t s t h e
p oi nt s not e d e l s e w h e r e r e ga r d i ng t h e a ge a t ons e t of b l i nd ne s s , a nd t h e h i gh
b i r t h -r a t e . Tu b e r c u l ou s m e ni ngi t i s a nd e p i d e m i c e nc e p h a l i t i s a r e i n t h e m a i n
r e s p ons i b l e f or t h e f i gu r e s f or op t i c a t r op h y .
Mos t of t h e c h i l d r e n s u r v e y e d c a m e f r om i ns t i t u t i ons i n t h e Col ony , t h e
s l i gh t b i a s t ow a r d s f e m a l e s b e i ng d u e t o t h e f a c t t h a t t h e f e m a l e c h i l d i s of
l i t t l e e c onom i c v a l u e t o a Ch i ne s e f a m i l y , a nd i n c ons e q u e nc e r e a d i l y d i s -
c a r d e d i n t i m e s of d i s e a s e a nd s t r e s s . O ne of t h e m or e i nt e r e s t i ng c a u s e s
of u ni oc u l a r b l i nd ne s s i n c h i l d r e n c a nnot f e a t u r e i n t h i s Ta b l e . At t h e
p e r i od of t h e Ch i ne s e Ne w Ye a r , Hong Kong i s a b l a z e f or 4 8 h r s w i t h t h e
e x p l os i on of f i r e w or k s , a nd w e nor m a l l y e x p e c t t o s e e f ou r t e e n t o t w e nt y
c a s e s of gr a v e oc u l a r d a m a ge a m ongs t c h i l d r e n. F or t u na t e l y not m a ny e y e s
p r ogr e s s t o e nu c l e a t i on, b u t i t i s of i nt e r e s t t h a t t h e c a s u a l t y f i gu r e s a t t h i s
s e a s on a p p r oa c h t h os e i n Lond on on t h e e v e ni ng of Gu y F a w k e s Da y .
TAB LE III
ANALYSIS O F 2 0 0 B LIND CHILDREN IN 1 9 5 4
Pe r c e nt a ge of Ca s e s
O p h t h a l m i c Ca u s e
F e m a l e Ma l e
Ma j or O p h t h a l m i a / Su b nu t r i t i on . . . . . . 7 1 6 0
( Mor e t h a n
Conge ni t a l De f e c t s Ca t a r a c t s 1 2
9 5 1
p e r O t h e r t h a n Ca t a r a c t s
1 0 8
1
c e nt . )
Non-s p e c i f i c
O p t i c At r op h y
5 . . .
. . 6
Al l O t h e r Mi nor Ca u s e s ( Le s s t h a n O ne p e r c e nt . ) . . 1 0 0 1 0 0
In 1 9 5 5 , t h e c a s e h i s t or i e s of s om e 1 , 0 7 1 b l i nd p e r s ons w e r e e x a m i ne d t o
f i nd ou t h ow m u c h b l i nd ne s s w a s d u e t o a c om b i na t i on of s e v e r a l d i s e a s e s ,
a nd 1 5 4 w e r e f ou nd t o c om e i nt o t h i s c a t e gor y .
Am ongs t e i gh t y f e m a l e s , gl a u c om a w i t h s e c ond a r y c a t a r a c t ( 1 0 ) , t r a c h om a
w i t h s e ni l e c a t a r a c t ( 9 ) , s e ni l e c a t a r a c t w i t h t h e ot h e r e y e b l i nd f r om p e a c e -
t i m e t r a u m a ( 9 ) , non-s p e c i f i c u v e i t i s w i t h s u b s e q u e nt c a t a r a c t s ( 9 ) , a nd s e ni l e
c a t a r a c t s w i t h s e c ond a r y gl a u c om a ( 8 ) , w e r e t h e m a i n c om b i na t i ons .
Th e 7 4 m a l e s on t h e ot h e r h a nd p r e s e nt e d non-s p e c i f i c u v e i t i s w i t h s u b s e -
q u e nt c a t a r a c t ( 1 1 ) , a c q u i r e d s y p h i l i s w i t h s u b s e q u e nt c a t a r a c t ( 7 ) , gl a u c om a
w i t h s u b s e q u e nt c a t a r a c t ( 7 ) , a nd s e ni l e c a t a r a c t w i t h t h e ot h e r e y e b l i nd e d
b y p e a c e -t i m e t r a u m a ( 7 ) a s t h e m a i n c om b i na t i ons .
O PHTHALMIC ARRANGEMENTS
Th e gov e r nm e nt e y e c l i ni c s h a v e now e x p a nd e d r a p i d l y t o d e a l w i t h ov e r
8 5 , 0 0 0 a t t e nd a nc e i n 1 9 5 6 , a nd t h e f i gu r e s r e a c h e d 1 0 0 , 0 0 0 d u r i ng 1 9 5 7 . Tw o
4 0 0
O PHTHALMIC DISEASE IN HO NG KO NG 4
l a r ge w e l l -e q u i p p e d op h t h a l m i c c e nt r e s c a t e r f or t h e u r b a n a r e a s , a nd f r om
t h e m a s t a f f of t w e nt y , i nc l u d i ng f i v e op h t h a l m ol ogi s t s , p r ov i d e s 2 8 c l i ni c -
s e s s i ons m ont h l y a t e i gh t ou t -s t a t i ons t o c ov e r t h e w h ol e of t h e Col ony . O u r
b e d s a r e onl y t e n i n nu m b e r , w i t h a t u r n-ov e r of 3 2 p a t i e nt s e a c h d u r i ng t h e
y e a r , b u t t h e m a j or i t y of ou r m a j or a nd i nt e r m e d i a t e op e r a t i ons ( 2 , 5 0 0 -2 , 9 0 0
c a s e s p e r a nnu m ) i s c a r r i e d ou t a s " of f i c e -s u r ge r y " a t t h e m a j or c e nt r e s . Th e
p a t i e nt i s s e c u r e l y s t i t c h e d a nd s e nt h om e a f t e r op e r a t i on, a nd w e f e e l t h a t t h e
c om p l i c a t i on r a t e a p p e a r s t o b e no gr e a t e r t h a n i n t h os e w h o w e r e f u l l y
h os p i t a l i z e d . O v e r 7 5 p e r c e nt . of ou r c a t a r a c t s u r ge r y i s p e r f or c e c a r r i e d
ou t a s " of f i c e -s u r ge r y " .
SU MMARY
Su r v e y s of op h t h a l m i c d i s e a s e a nd of b l i nd p e r s ons i n Hong Kong a r e
d e s c r i b e d . Th e e x p a ns i on of t h e gov e r nm e nt op h t h a l m i c s e r v i c e a s a r e s u l t
of t h e s e s u r v e y s s h ow s t h e d e v e l op m e nt of t h e r ol e of p r e v e nt i v e op h t h a l -
m ol ogy .
My t h a nk s a r e d u e t o t h e Hon. Di r e c t or of Me d i c a l a nd He a l t h Se r v i c e s , Hong Kong, f or
p e r m i s s i on t o p u b l i s h t h i s a r t i c l e , a nd t o m y c ol l e a gu e s i n t h e O p h t h a l m i c , He a l t h , Tu b e r c u l os i s ,
a nd Soc i a l Hy gi e ne Se r v i c e s f or t h e i r c ons t a f i t h e l p .
REF ERENCES
HO NG KO NG ( 1 9 5 4 -5 5 ; 1 9 5 5 -5 6 ) . " Annu a l De p a r t m e nt a l Re p or t b y t h e Di r e c t or of Me d i c a l
a nd He a l t h Se r v i c e s f or t h e F i na nc i a l Ye a r s 1 9 5 4 -5 5 , 1 9 5 5 -5 6 " .
HO NG KO NG ( 1 9 5 7 ) . " Annu a l Re p or t , 1 9 5 6 " , p . 1 3 5 . Gov e r nm e nt Pr i nt i ng O f f i c e , Hong Kong.
H. M. S. O . , Lond on.
MACKENZ IE, C. , a nd F LO WERS, W. S. ( 1 9 4 7 ) . " B l i nd ne s s i n Ch i na " . Re p or t t o t h e Gov e r n-
m e nt of Ch i na . St a nh op e Pr e s s , Roc h e s t e r , Ke nt .
SO RSB Y, A. ( 1 9 5 3 ) . " Th e Ca u s e s of B l i nd ne s s i n Engl a nd , 1 9 4 8 -1 9 5 0 " . H. M. S. O . , Lond on.
2 6 *
4 0 1