a decrease of 50 as compared with the previous year. The majority of these are resident in the West of Scotland area, and the proposed additions to the institutional accommodation in that area will no doubt result in the early admission of many of these cases for training. The steps that are now being taken in regard to training make it reasonable to assume that in the course of a few years there will be no blind persons capable of technical training who will not be receiving it.

A model scheme of arrangements for technical training prepared by the Scottish Advisory Committee is at present under consideration by the Board and the Scottish Education Department.

The period of training recommended by the Advisory Committee in bootmaking and repairing was approved.

6. Work of Outdoor Societies.-Proposals submitted by the Scottish Advisory Committee with regard to the duties of home teachers on the staffs of outdoor societies, and the more efficient organisation of societies, have in general met with the approval of the Department. Briefly, these proposals define the duties that the Committee consider should be undertaken by home teachers, and suggest a method of procedure which, if adopted, will ensure that the management committees of societies, some of whom in the past appeared to take little concern in the work of their staffs, will be brought to take greater interest in and to assume more responsibility for that work.

Approval was given to the appointment of two additional teachers to the staff of the Mission to the Outdoor Blind for Glasgow and the West of Scotland.

Considerable difficulty appeared to have been experienced by voluntary agencies in keeping in touch with blind persons removing from the area of one society to another, and suggestions were made to them on this subject.

7. Grants. The following statement shews the amounts paid to voluntary agencies in respect of their services during the past two years.

A scheme of assistance to home workers framed by the Northern Counties Institute for the Blind was approved. This is the fourth scheme of this kind in Scotland. Proposals have been made by the Advisory Committee for the extension and development of such schemes by voluntary agencies.

8. Wireless Telegraphy (Blind Persons Facilities) Act, 1926. -This Act, which became law towards the end of the year, provides for the issue of free wireless licences to blind persons (not resident in a public or charitable institution or in a school) on the production of a certificate of registration as

person issued by or under the authority of the local authority in whose area he is ordinarily resident. A circular letter was addressed to local authorities and voluntary agencies suggesting the procedure that might be followed in carrying out the provisions of the Act.

9. Arthur Pearson Memorial Fund.-A grant was made from the proportion of the Arthur Pearson Memorial Fund, allocated to the Department for distribution to charities for the blind in Scotland, towards furnishing a home for blind persons that had been opened in the west of Scotland in the course of the previous year.

MISCELLANEOUS SERVICES.

10. War Charities Acts, 1916 and 1919.-During the year an Order was issued disposing of the property of a charity which had been removed from the Register of War Charities by a Registration Authority.

11. Gas Poisoning in connection with Lochaber Water Power Scheme.-Under the Lochaber Water Power Act, 1921, the local authority and the Board are to be satisfied with the provision made for the proper housing and sanitary requirements of the workers and for the treatment of cases of sickness (including infectious disease) and accident. The general measures taken in regard to these matters were detailed in last year's Report. Co-operation with the local authority in this matter has been maintained; weekly reports on conditions at the undertaking continue to be received, and officers of the Department have again visited the works during the year.

It may be recalled that the scheme involves the driving of a tunnel 16 feet in diameter and 15 miles long, longitudinal in relation to the range of mountains to be traversed. Over this stretch of 15 miles there are 12 shafts piercing the mountain side, continued as adits which are more or less horizontal and meet the line of the tunnel at right angles. Excavation is proceeding at each end of the section of the tunnel served by the adit. Narrow-gauge railways run from a point near the working face to the shaft base, and after the firing of shots the debris is loaded by "muckers" on miniature trucks. From the shaft

base the trucks are raised to the surface, and the material is deposited in a suitable tip.

Means have been provided for ensuring adequate ventilation in the underground workings. Briefly the method is this-a 4-inch air line delivering air at 80 lbs. pressure is carried right up to the face for working the drills. After the explosion has taken place this line is left blowing free air into the heading to clear it. A 16-inch ventilating air line carried up to 175 feet from the face sucks out the vitiated air produced by the blasting, and fresh air enters by the adit and shaft.

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Several cases of tunnel-sickness, or what, following the parlance of the war, has been termed gas poisoning," have, however, occurred during the year, and special reports on these cases were obtained from the medical officer.

On the morning of 12th January liquid oxygen cartridges were fired at one of the faces at adit No. 5, and there seems to have been some delay in firing one of the cartridges. It appears too that the compressed air mechanism for ventilation was not functioning properly. The ganger reported that the men had returned to the face twenty minutes after firing; immediately on the resumption of work some "muckers" stated that they felt "stuffy," and later eleven of the thirteen men on the shift complained of headache, giddiness and nausea. In addition four of these eleven had further symptoms of suffocation, breathlessness, vomiting and weakness. These four were admitted to the camp hospital, while the other seven were able to resume work on the day following the incident.

A similar accident occurred at the same adit (the longest on the contract) on 25th March. Seven minutes after firing the heading was entered and found clear, and the compressed air ventilator appeared to be working satisfactorily. After a further ten minutes' interval work was resumed. Twenty minutes later twelve muckers reported themselves unwell and were allowed to leave. All shewed the same symptoms, viz. :-severe frontal headache and giddiness, palpitation, a feeling of tightness across the chest, weakness of the arms and legs, and in a few cases vomiting. All stated that they felt worse on coming out into the fresh air, and it was then that vomiting occurred. Every case shewed an increase of the pulse-rate, which, in some cases, reached 120 per minute. The pulse was regular in time, rhythm and force, and the blood pressure as estimated by the finger was good. Seven of those affected were able to resume work on the following day. The other five were admitted to hospital, whence they were discharged four days later. The remaining two were detained in hospital and suffered from hæmoptysis (blood spitting), which is suggestive of poisoning by nitric oxide gas. Samples of blood taken three and five days after the accident and pathologically examined gave negative results quoad gas poisoning.

Gas poisoning again occurred at the same adit on 31st March. On entering five minutes after firing it was found that

one hole had misfired. The misfire hole was fired with gelignite, and after a ventilation interval of thirty minutes work was resumed. Within some minutes all the men returned to the surface exhibiting symptoms similar to those already described. Only one man, however, shewed any marked increase of the pulse-rate, and he made a good recovery in hospital.

Further cases occurred on 15th September and 22nd October (the latter at the same adit as in the three earlier cases referred to above), but though the symptoms were similar the toxic effects were less severe and more transitory. On 15th September the ventilating tube which normally withdraws the vitiated air from the tunnel within 175 feet from the face was damaged, and ventilation was possible only 250 feet back from the face.

A review of all the circumstances suggests beyond all question that a gaseous poison was the causal agent. The nature of the gas has not been definitely established, though the absence of smell and the main clinical symptoms suggest carbon monoxide. It is true that the examination of blood specimens shewed no carbon monoxide reaction, but these were drawn some time after the occurrences, and the results of research are still so indefinite as to make it unwise to rely on blood-testing in itself.

The preventive is the adoption of thorough means of ventilation after each blast. The medical officer, dealing with this point, says:

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Difficulties arise in maintaining the current under various circumstances, such as the compression of stretches of tubing by force of explosion, accidental locking of the compressor, &c. A further striking feature is that while the men who have resumed working at the face are supplied with pure air, the muckers,' viz. those engaged in collecting the rock at some distance behind the face, may be respiring stagnant air that has partially escaped the in and out-going current. In order to obviate this observed fact measures have been adopted for spraying the comparatively untouched zone with liquid, thus allaying dust particles, and for perforating the exhaust ventilating tube in the same

area.

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It is hoped that strict attention to regulations forbidding re-entry until authorised foremen have tested the atmosphere may result in immunity from noxious effects; but it has to be recognised that the supply of pure air in a tunnel of so great length will, all the time, require the most scrupulous watch.'

12. Insulin.-The Public Health (Scotland) Amendment Act, 1925, provides that the powers of local authorities under the Public Health (Scotland) Act, 1897, shall include, and be deemed as from 1st March, 1924, to have included, power to make such arrangements as they may think fit and as may be sanctioned by the Board for providing medicines and treatment to persons who are suffering from diabetes and who, in the opinion of the

local authority, require assistance in obtaining such medicines and treatment.

Up to the end of 1926, 57 local authorities had submitted and obtained sanction to their arrangements under the Act, and during the year 965,700 units of insulin were issued to authorities under arrangements made with three manufacturing firms, Messrs. Boots Pure Drug Co., Ltd., British Drug Houses, Ltd., and Burroughs Wellcome & Co., whereby insulin is supplied at a special rate at present 2s. per 100 units, plus postage.

During the year also, 86,400 units of insulin were issued to parish councils.

13. The Consultative Councils.-The first six years of Council I's existence ended in March, 1926, and accordingly those original members of the Council who were still serving at that date were no longer eligible for re-appointment. Among the retiring members was Sir Norman Walker, who rendered valuable services in the guidance of the Council's affairs as ViceChairman during its first year, and as Chairman since March, 1921, when the Council appointed him to succeed Sir Donald Macalister in that office. The Council appointed Professor J. R. Currie as their Chairman for 1926-27, in succession to Sir Norman Walker. Among the subjects considered by the Council, either on reference from the Board or under their powers to initiate discussion, were the control of health propaganda; a draft Bill to amend the Midwives (Scotland) Act, 1915, and to provide for the registration and inspection of maternity homes; and the co-ordination of local hospital services.

Council II dealt with the correction of insurance committees' registers of insured persons; the provisions of the Economy (Miscellaneous Provisions) Bill relating to national health insurance; new arrangements for the provision of dental benefit to insured persons; laxity in the issue of certificates of incapacity by medical practitioners as a cause of excessive claims for cash benefit; and the more important recommendations of the Royal Commission on National Health Insurance.

Council No. III (on Local Health Administration and General Health Questions) completed consideration of the reference on public cleansing, and submitted an exhaustive report on the subject. They also reported on the draft Town Planning Regulations and the Midwives and Maternity Homes (Scotland) Bill, which had been referred to them. References on the provision of hostels for the housing of certain classes of the population and on co-operation between local authorities in public health matters were under their consideration at the close of the year.

Council IV (Highlands and Islands) had under consideration a reference on the adequacy of the medical services in the Highlands and Islands, and their report on the subject was in draft at the end of the year.

14. Provisional Orders.-During the year the usual scrutiny