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sections of public health administration that are receiving attention from local authorities and their officers at the present time. We direct your attention to the chapters on Encephalitis Lethargica, Recent Methods of dealing with Diphtheria and Scarlet Fever, Ultra-Violet Ray Therapy, the Hospitals, and that part of the chapter on tuberculosis which treats of Pneumothorax. (We record our thanks to the Glasgow Public Health Department for furnishing the excellent skiagrams reproduced at page 65.) The medical certification of incapacity for work under the National Health Insurance system provides this year also a study of several problems connected with insured persons.

The disease known as Encephalitis Lethargica, or sleepy (as distinct from sleeping) sickness, has given much concern to medical men and local authorities during the last few years. The cause of it is still undiscovered; but this makes no difference to the urgency of providing care, accommodation and treatment. It was felt that an exact statement of our present knowledge of the disease would be of genuine value to medical practitioners, nurses, health visitors and others concerned with administration. Members of the medical staff are frequently asked for a reliable summary of the clinical phenomena, and an indication of the administrative procedure suited to a given case. The chapter on this subject should go some way to satisfy this request.

The measures taken in regard to diphtheria and scarlet fever and in connection with ultra-violet ray therapy are particularly applicable to children, and we are glad to be able to record some progress in regard to other aspects of the health of the child. Following on the investigation detailed in the last Annual Report, a Committee has been appointed to investigate the factors that predispose children to rickets, and the effect of different remedial measures, with a view to determining a definite line of treatment. The main investigation is being made by sub-committees at Glasgow and Aberdeen, with another subcommittee at Edinburgh in co-operation. Their inquiries are being limited meantime to nutritional factors affecting rickets, but in addition some of our officers are supervising an investigation into the nutritive value of milk for school children. We hope in the next Report to devote more attention to various matters affecting the health of children, and possibly to record some useful results in connection with the investigation that is now being carried on.

It is worthy of record that Sir Walter Fletcher, K.B.E., M.D., Secretary of the Medical Research Council, conferred with us and with our medical staff on the respective spheres of research appropriate to the Council and to the Board. It is possible that

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his visit may prove fruitful in a field that does not bear harvest in one season, but bears it abundantly at the time when the harvest is gathered in.

We would also direct your attention to the chapter containing notes of the arrangements made with the Health Section of the League of Nations for furnishing information on the spread of influenza. Although the facts do not fall within the year 1926, it is important to record immediately the arrangement made with the League. It is part of a larger international policy. We have to thank the Health Section of the League for their continued courtesy in furnishing us with copies of their health publications.

The chapter relating to the hospitals discusses some of the salient points in the national hospital policy outlined by the Hospital Services (Scotland) Committee. Since the Report was published there has been some quickening of the movement towards co-operation between the statutory and voluntary agencies, and some promising experiments in co-operation are now in progress. There is a wide field here for constructive effort to secure by the co-ordination of the various branches of hospital work the most economical use of existing resources. During the year there have been some important developments in both the statutory and voluntary services, and a good deal of building is in progress, but there does not seem to be any material change in the position as described by the Committee. The shortage of beds, especially for general medical and surgical illnesses, has not become less serious.

The cases of illness referred by Approved Societies and by medical practitioners to the district medical officers provide material for three regional studies. Since the appointment of

the district medical officers there has been a continuous increase in the number of cases annually referred to them, and additional appointments have been required. The pressure of work entailed in the examination of these cases has left little time or opportunity to the district medical officers to assist medical practitioners in a consulting capacity, but it has been possible in one of the districts to devote some time to this aspect of the work, with results recorded in chapter XVII. Other studies deal with the relative incidence of disease in the cases referred, and with the comparison of the number of cases from urban and landward. areas; with mitral disease following rheumatic fever, and with bronchitis. Both heart disease and bronchitis are among the chief causes of incapacity for employment among insured persons, and there is room for research and for further investigation in connection with both.

The chapter on foods deals in a comprehensive way with the administrative supervision and control of the food supply, with the measures taken to provide a satisfactory milk supply, and with the Preservatives Regulations, which have set definite limits to the sophistication of foods with preserving and colouring substances. A supplementary chapter is devoted to a survey, based on the annual reports of sanitary inspectors, of certain current methods of handling and storing food for sale.

We have observed with satisfaction that during 1926 the administration of the Tuberculosis Order, 1925, which is closely allied to the Milk and Dairies (Scotland) Act, 1914, resulted in the removal of no less than 1,852 cattle, with the grosser manifestations of tuberculosis, from the herds of Scotland. As the majority of these were undoubtedly cows, the removal of so great a number of sources of direct infection of children cannot but have a great effect on the future health of the community.

Under the Contributory Pensions Scheme about 12,800 order books had been issued by 5th January, 1926, for the payment of widows' and orphans' pensions. At 31st December, 1926, the number of widows' and orphans' pensions awarded exceeded 22,000. The total amount expended during 1926 in payment of pensions to widows and orphans was £790,036.

It is expected that on 2nd January, 1928, when the system of contributory old age pensions at the age of 65 comes into operation, pensions will be payable to about 51,000 applicants. Meantime, from 2nd July, 1926, all disqualifications relating to means were, subject to certain conditions, removed in the case of insured persons and the wives of insured men, who were thereby enabled to obtain old age pensions at the age of 70 without regard to the amount of their earnings or income.

The number of houses completed, with State assistance, for the working-classes during 1926 was 13,592. This figure includes 1,118 steel houses, but the number erected by local authorities and private enterprise with State assistance, namely 12,474, was the largest number in any year since the Stateassisted housing campaign was begun. Further, it is known that at least 1,338 houses of five rooms or less were erected during the year without any State assistance, and accordingly the total number of houses for the working-classes erected during 1926 was not less than 14,930. The erection of these houses means that local authorities have now begun to overtake the shortage throughout the country, and there is an expectation that the number to be completed in 1927 will be even greater.

To these notes in regard to matters of outstanding interest

we add the following comments on the general health of Scotland during the year.

The population of Scotland in 1926, as estimated by the Registrar-General at the middle of the year, was 4,903,300, and the total death-rate was 13.0 per thousand persons living. This death-rate is the lowest recorded in Scotland, except in the year 1923, when it was 12.9. The death-rates from pulmonary tuberculosis and from non-pulmonary tuberculosis continue to fall, and are lower than ever they were. The deaths from cancer in 1926 were less by 34 than in 1925, and the death-rate, which has been increasing in recent years, shewed no increase

in 1926.

During 1926 the death-rate of children under one year of age was 83 per thousand births, a lower figure than that of any year except 1923, which, as recorded above, established a low record in the general death-rate also. The death-rate of children between one and five years of age was, however, lower in 1926 than in any recorded year.

In regard to the incidence of infectious diseases, the statistics for the whole country have not yet been completed, but the returns from the sixteen large towns and two populous counties shew that compared with 1925 there was an increase. There was a large increase in measles, and there were increases on a less scale in diphtheria, scarlet fever, puerperal fever, cerebro-spinal fever, ophthalmia neonatorum, and certain forms of pneumonia.

In spite of this increased incidence, however, it is clear from the reports of the Registrar-General that the death-rate from the principal infectious diseases has again diminished throughout Scotland, from 0.84 per thousand persons living in 1925 to 0.63 per thousand persons living in 1926, a considerable reduction.

A glance at the summary, published by the Registrar-General, shewing the causes of death is illuminating. During the year the principal causes of death were as follows: from heart disease 7,410; from malignant disease 6,641; from apoplexy 5,905; from all forms of pneumonia 5,262; from diseases of early infancy, &c. 3,951; from bronchitis 3,586; from pulmonary tuberculosis 3,382; from nephritis 1,834; from influenza 1,418; from measles 928, and from diarrhoea and enteritis (under two years of age) 798. Much of the mortality represented by these figures is preventable, and the steady annual diminution of the figures under several of these headings represents much devoted work and even more forethought.

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1. Water Supply and Drainage.-The health of cities, towns and populous centres depends on the efficiency and adequacy of their sewerage and water supply systems. The importance of theseessential services has long been recognised by the Legislature: By the Act 13 & 14 Vict., cap. 33, intituled An Act to make more effectual Provision for regulating the Police of Towns and populous Places in Scotland and for paving, draining, cleansing, lighting and improving the same (15 July, 1850), it was made obligatory on the Commissioners of burghs to carry out such works as might be necessary for the effectual draining of the burghs; and the same Act laid upon the Commissioners the duty of continuing (or providing) and of maintaining and supplying with water "Cisterns, Pumps, Wells, Conduits, and other Waterworks for the gratuitous Use of any Persons who choose to carry the same away, not for Sale, but for their own private Use." Power to carry out drainage and water supply works was also given to the local authorities of landward areas by the Public Health (Scotland) Act, 1867. These were the beginnings of the services that are now considered an essential part of the corporate life of towns and villages.

The recognition by the communities and the local authorities in most of the urban areas in Scotland of the necessity of having these services made efficient and adequately maintained is such as to afford satisfaction. Experience during post-war years, however, and in particular during the year under review, has shewn that all the problems associated with these services are by no means solved.

In cities and large burghs, and in the larger special districts, the local authorities are usually alive to these problems and deal with them adequately and efficiently. But some other burghs, and also many villages, present problems that give rise to anxious thought. Their water supply and drainage systems, which have been in existence for several years, have become in many cases inadequate to meet increasing demands, due in great measure to higher standards of sanitary requirements, involving the introduction of baths and the substitution of water-closets for earthclosets. Many local authorities are alive to the need for still further improvements, and are endeavouring to have them carried into effect as far as possible, but sometimes obstacles bar the way to desirable progress. The drains may be old, of defective construction, or of insufficient carrying capacity; the available water supply may be inadequate, either owing to shortage of supply at the source, or, more frequently, to the

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