of acute primary pneumonia and influenzal pneumonia admitted to hospital was 345, being fully 70 per cent. of the total notifications; of these 236 were treated in the infectious diseases hospital and 91 in the Royal Alexandra Infirmary. Deaths numbered 117, giving a case-mortality for all notified cases of 23.8 per cent. The case-mortality in the infectious diseases hospital was 15.8 per cent. and in the Royal Alexandra Infirmary 16-4 per cent., while among the cases treated at home (146) the case-mortality was 384 per cent., more than double that for cases admitted to hospital. The medical officer of health, commenting on these figures, states emphatically that all cases of pneumonia should be treated in hospital unless the home conditions are such as to command skilled medical and, especially, skilled nursing attention. The very large extent to which cases of pneumonia are now removed to hospital is shewn by figures for 1926 furnished by the sixteen principal towns and the districts of Lanark, Fife and Aberdeen counties. The total number of cases reported during the year was 11,403, and of these 4,977 were removed to hospital. In Glasgow out of 6,704 cases reported there were removed to hospital 3,688 cases, or 55 per cent.; this proportion was exceeded in Paisley, where 365 cases out of 619 reported, or 59 per cent., were removed. Other areas in which a large number of cases was removed to hospital are Lanark county (265 out of 1,302 cases), Dundee (186 out of 415 cases), Aberdeen (164 out of 434 cases), Motherwell and Wishaw (99 out of 260 cases), Clydebank (54 out of 115 cases) and Fife county (30 out of 165 cases). In Edinburgh out of 129 cases of acute influenzal pneumonia 47 were removed to hospital. From these figures it will be seen that local authorities are already doing a great deal to see that pneumonia patients receive the medical and nursing attention that is of such importance in treating this disease, but, as was indicated in the last Report, this side of public health work is a growing one. The demands on the accommodation provided by local authorities are likely to be very heavy in the future, and there can be no doubt that the needs of pneumonia patients will be one of the principal factors requiring local authorities to make additional hospital provision. 11. Influenza: Action by the League of Nations.-The epidemic of influenza in Western Europe during the past winter was the occasion of special action by the Health Section of the League of Nations. The League decided to ask the various Health Administrations for all available 1eturns, in order that they might be in a position to furnish each with recent information on the conditions in other countries. The points on which the League desired to be kept informed were as follows: (1) the presence or absence and the spread of the disease, and the cities and districts infected; (2) if prevalent, the clinical character of the disease; all causes, and to cases of and deaths from respiratory disease, heart disease and influenza; (4) the general measures taken to cope with the outbreak, especially those of international interest... In co-operation with the Registrar-General, who had particulars regarding deaths, we readily agreed to furnish the League with all available information regarding the prevalence of influenza in Scotland. A communication on these lines was addressed to the medical. officers of health of the sixteen principal towns, and the county medical officers of Lanark and Fife. This communication,. which was sent later to a number of other county medical officers in parts of Scotland to which the outbreak appeared to be spreading, elicited a number of valuable periodical reports. The information so obtained, along with the particulars of deaths collected by the Registrar-General, was forwarded weekly to the League while the epidemic was at its height, and was used in the compilation of the Special Reports on the Prevalence of Influenza incorporated in the Health Section's Weekly Record. The next step taken by the Health Section of the League was to ask that, in view of the importance of obtaining as much and as detailed information as possible regarding general influenza outbreaks before the lapse of time prevented the collection of much of the material, every European Health Administration should prepare a general report as soon as the epidemic was over in its country. It was considered that a comparative study of these reports might reveal facts which would be of utility in dealing with the next outbreak when it came. The Medical Director of the Health Section suggested that factors presenting a general interest would be in the first instance :- (a) The geographical distribution of the epidemic and the chronological order in which it appeared in the various towns or districts of the country. (b) The reported incidence in the various parts of the country in so far as this could be ascertained. (c) The movement from week to week of the general mortality, and of deaths from influenza, affections of the respiratory system and of the heart. (It would be important, in this connection, to know the rules for statistical classification of deaths in which influenza is known to have played a part, but which have in the end been caused by other diseases.) (d) The age-distribution of deaths from influenza, and whether peculiarities in this respect have existed in any localities or at any given time of the epidemic. (e) Description of the clinical types of the disease prevailing at different periods, and frequency of the various complications. (f) Particulars regarding previous influenza outbreaks, however mild; within the preceding six months, and regarding co-existing epidemics. (g) Bacteriological findings. (h) Measures taken toward the control of the epidemic. With a view to the preparation of a report dealing with the outbreak in Scotland, a letter was addressed to the medical officers of health of the sixteen principal towns and to the county medical officers of all the counties, asking them to furnish, when the outbreak was over, a general report on its course in their district, which would deal as far as possible with the points mentioned above. As it had been found that much of the useful information furnished in the weekly reports mentioned above was based on school attendances, medical officers of health were asked to consult school medical officers with a view to obtaining through them precise information as to the distribution of the disease among the schools, the number of schools that had been closed, and the periods of closure. It is hoped that the study of these reports and of other information in regard to the outbreak available will result in the preparation of a report shewing the course and the main clinical features of the recent outbreak of influenza in Scotland. The action taken by the Health Section of the League of Nations in regard to the epidemic is a matter of great interest to all who are concerned in public health administration. It is hoped that the information collected by the League will help to throw light on the nature of such outbreaks, the manner in which the infection is spread, and the means best calculated to keep it within bounds. 12. The Recent Outbreak in Scotland.-At the time of writing this Report the latest influenza outbreak in Scotland is rapidly abating, wherever it is not already over. A full account cannot be given until the general reports from medical officers of health referred to above have been received, but from the weekly reports sent in from certain districts it appears that the epidemic began in most parts of the country at Christmas or New Year time, increased in severity through the next few weeks, and reached its maximum intensity some time in February or early in March. Since then the prevalence has steadily diminished nearly everywhere, though in one or two places in the west the decline has been delayed, probably by some cause peculiar to the locality. There is at present no evidence to shew that the spread of the epidemic was from one point of the compass to another; probably communications between the more populous parts of the country are so good that a highly infectious disease like influenza breaks out at much the same time all over the country. On the other hand, it is naturally the case that towns were first attacked, and that the infection should spread later to more remote and outlying districts. The type of the disease was very mild, and by many practitioners it was not considered to be true influenza. A fairly typical description of the commonest form is a mild catarrhal condition of the respiratory passages." Lung complications were exceptional, and in most districts gastric complications were rare. In many areas the onset was marked by one or more of such symptoms as severe headache, backache, pains in the joints, epistaxis, a slight febrile condition, sore throat, bronchial catarrh, nasal catarrh, otitis media and, less frequently, vomiting and diarrhoea. A persistent cough was common, and was often difficult to get rid of even after general recovery. Occasionally the attack, the average duration of which was only a few days, was followed by lethargy or anæmia. Infectivity was high; often several members of the same family and occasionally whole households whole households were affected almost simultaneously; children were very liable to attack, but in some districts adults were almost equally susceptible. A concurrent outbreak of whooping-cough occurred in a few places. School attendance was greatly interfered with, particularly in the north, and the percentage of pupils present at some schools fell as low as 30 per cent. Among the measures taken to deal with the outbreak were removal to hospital of cases of influenzal pneumonia, or arrangements for their visitation by nurses at their own homes; closing of schools in a few areas, not so much in the hope of arresting the epidemic as with a view to preventing the return of children to school before they were fully recovered, and so obviating the risk of pneumonia; the visitation of schools by medical officers, advice as to exclusion of affected children and the examination of scholars present; and in one or two districts the supply of influenza vaccine. 13. Encephalitis Lethargica, Polio-encephalitis. and Poliomyelitis.-These three diseases were made notifiable throughout Scotland at the end of 1925, and accordingly have been generally notifiable now for more than a year. In the sixteen towns and the counties of Lanark and Fife the number of notifications was only slightly greater than in 1925; cases of encephalitis lethargica increased from 235 to 260, cases of polio-encephalitis from 3 to 6, and cases of poliomyelitis from 17 to 34. There is no evidence that an outbreak of any of the three diseases took place anywhere in Scotland during the year. 14. Infectious Diseases Notifications in 1925.-Statistics as to the number of cases of infectious diseases notified to local authorities during the year ended 31st December, 1925, have been compiled, and a summary, shewing according to age periods the number of cases of each disease notified in counties (landward) and burghs will be found in Appendix V. The total number of cases notified in counties (landward) with a total population of 1,571,998 was 15,409; in the burghs, with a population of 3,321,034, the corresponding number was 56,628. Of the diseases compulsorily notifiable throughout Scotland, those which are specified in the Infectious Disease (Notification) Act, 1889, are shewn under head A, and those which were made compulsorily notifiable by Regulations under Section 78 of the Public Health Act are shewn under head B. Diseases to which the provisions of the Infectious Disease (Notification) Act have been extended by certain local authorities are shewn under head C. Appendix VI shews in respect of each disease the total number of cases notified in counties (landward) and in burghs respectively, and the number and percentage treated in hospital. VENEREAL DISEASES. 15. Venereal Diseases Schemes.-No notable additions were made during the year to the schemes already approved for the diagnosis, treatment and prevention of venereal diseases in Scotland. Such new schemes as were approved applied to relatively sparsely populated areas-Berwickshire and parts of Inverness-shire-and were significant mainly as marking a close approach to the completion of arrangements for the whole country. The total cost of venereal diseases schemes to local authorities in 1925-26 was close on £75,000. 16. Treatment Centres.Of the 45 treatment centres in operation during 1925, one (Glasgow Royal Infirmary) ceased to be approved at the end of that year; another (Lightburn Joint Hospital, Shettleston) was closed as a treatment centre in May, 1926; while Shotts Sanatorium ceased to be a general treatment centre and became an irrigation station for male patients suffering from gonorrhoea. Three new centres were opened in 1926, one in Leith, for the treatment of male out-patients; one at Belvidere Hospital, Glasgow, where a pavilion was converted to provide ward accommodation for 24 male in-patients; and one at Maryhill, Glasgow, for the treatment of women and children sent from the ante-natal clinic in the same premises. The Leith centre fills an outstanding gap in the treatment facilities available for seafaring men, and its ideal situation with respect to the docks and the thickly populated adjacent district justifies the hope that it may, in time, come to rival the Broomielaw centre, in Glasgow, which was originally intended as a seamen's centre, but which now attracts a large number of male patients from all parts of the City of Glasgow. The new venereal diseases pavilion at Belvidere Hospital, Glasgow, which was opened on 1st January, 1926, was intended to replace the male in-patient accommodation lost through the closing of the Glasgow Royal Infirmary centre on the previous day. Unfortunately it did not prove possible to arrange for an immediate transfer to new premises of the out-patient work of the closed centre. This work was distributed, as far as possible, over the existing male clinics in Glasgow, and as a result the staffs of these clinics, though augmented, have for many months |