.

extended industrial districts, where questions of communication and development in the different administrative areas are more or less interdependent. In districts of this nature the adoption of an agreed regional plan in skeleton form will be necessary before the details of individual schemes can be usefully considered.

At the close of the Conference the President intimated that the Board would make available the services of members of its staff for the purpose of conferring with local authorities and their officials in the initiation and development of townplanning schemes. A commencement of this work was made at the end of the year, and it is hoped that some real progress with town-planning will be made in the course of 1927.

38. Proposed new Schemes.-During the year two resolutions were received from local authorities deciding to prepare townplanning schemes. One of these was from the burgh of Glasgow, resolving to prepare schemes for four different areas described as the Western, Northern, Eastern and Southern Areas respectively. The other was from the Eastern District Committee of East Lothian, resolving to prepare a scheme for an area at North Berwick and Dirleton.

In last year's Report reference was made to an application by Dalkeith for authority to prepare a scheme for an area, outwith the burgh, situated between Bonnyrigg Road and Lasswade Road. After consideration, we indicated to the local authority that the objects of this scheme, which covered a comparatively small area of ground, could be quite well attained by the preparation of an agreed feuing plan. The local authority accepted this suggestion, and the resolution to prepare a townplanning scheme was accordingly cancelled.

39. Development Orders.-Two Orders were issued during the year under Section 4 of the Town Planning (Scotland) Act, 1925, permitting building operations within areas for which resolutions to prepare town-planning schemes had been passed. The schemes affected were the Longniddry and Dirleton schemes, both of which are in the area of the Western District of East Lothian.

CHAPTER III.

TUBERCULOSIS.

1. Continued fall in the Death-rate.-The steady fall in the mortality from tuberculosis suffered no interruption in the past year. On the contrary the year 1926 established new low records as regards both the pulmonary and the non-pulmonary forms of the disease, and for the first time a year's deaths from all forms of the disease fell below one per 1000 of population. The figures of deaths and death-rates for 1926 and the preceding ten years are given in the following table :

In 1926 the number of deaths from tuberculosis in Scotland was 4,857, representing a death-rate of 99 per 100,000 of the population. In 1916 the deaths from tuberculosis numbered 7,672 and the death-rate was 160 per 100,000 of the population. In other words the death-rate from tuberculosis in Scotland has been reduced in a period of ten years by 38 per cent. The reduction has been appreciably greater in the non-pulmonary than in the pulmonary cases, the percentage reduction in the former case being 43 and in the latter 35. As against this it must be kept in mind that for the three decades 1880-1910 the nonpulmonary death-rate remained practically stationary, while the pulmonary death-rate continued on the downward course on which it entered in the seventies of last century. The relatively greater decline of the non-pulmonary death-rate in recent years. is thus in a sense no more than making up leeway, and the surmise is not unreasonable that it reflects to some extent the later direction of organised effort against the non-pulmonary forms of the disease.

The following table shews the 4,857 deaths from tuberculosis in 1926 classified according to age-groups, and also, for purposes of comparison, the deaths in Scotland from all causes in that year similarly classified :

35

}

15

57

57

35

169

450

146 116 212

122

110

830

823

584

488

806 119

15 3,382

94

184 507 181 226 1,042 945 678 563 354 154 23 4,857

2.16 11.99 15.83 27-62 38.86 31-45 18:13 9.54 3.96 1.27 0-18 7-61

The table brings out clearly the years of life at which this disease exacts its heaviest toll. Of the total 3,382 deaths from pulmonary tuberculosis, 1,653, or very nearly one-half, took place between the ages of 15 and 35. Of the total 1,475 deaths from non-pulmonary tuberculosis 619, or roughly two in every five, were of children under five years of age. Altogether deaths from tuberculosis formed 7.61 per cent. of the national death-roll, a formidable percentage, but one which becomes almost insignificant when placed alongside the figures for the early adult years, of life. In the 15 to 25 age-group the percentage is as high as 38.86; or, to put it otherwise, two out of every five deaths at the ages 15 to 25 are the result of this disease.

2. Notification.-The following table shews the numbers of cases of tuberculosis, pulmonary and non-pulmonary, notified to medical officers of health in Scotland in the year 1926 and in each of the five preceding years. The figures are classified according to certain age-periods.

Statistics of notifications of tuberculosis are less reliable as an indication of the prevalence of the disease than statistics for other notifiable infections. They are of value, however, as giving some idea of the extent of the problem which tuberculosis presents to the local authorities. Over the last six years the number of new cases of tuberculosis notified each year has been in the neighbourhood of 12,000. It may also be noted from a comparison of the notification and mortality statistics for the last six years that for every 1,000 notifications of pulmonary tuberculosis there has been an average of 528 deaths from this form of the disease, while the corresponding average for non-pulmonary tuberculosis has been 353.

Number of Cases of Tuberculosis notified in Scotland during each of the Years 1921-26.

3. Admissions to Sanatoria, &c.-From returns furnished by local authorities it appears that during 1926 a little over 8,500 patients were admitted to sanatoria and tuberculosis hospitals, while approximately 7,000 patients were discharged. The number of tuberculous patients who died in institutions was just over 1,300, this being about 27 per cent. of the total deaths from tuberculosis. As pointed out in the Report for 1924, the number of deaths in institutions is some measure of the efforts of local authorities and their medical officers to isolate the advanced and dying patient. There is evidence that both the authorities and the officials are alive to the fact that isolation of the highly infective type of case is an important factor in prevention, and that, especially where the home conditions are unsatisfactory,

every effort should be made to persuade such cases to remain in hospital so long as their disease in of an open nature.

4. Sanatoria, &c.: Approved Accommodation.-At the close of 1926 the number of sanatoria, hospitals and other residential institutions (exclusive of poor law institutions) approved for the treatment of tuberculosis was 114, comprising :

(a) 15 institutions with over 100 tuberculosis beds.

The total number of beds definitely reserved for the treatment of tuberculosis in approved institutions was 4,339, the corresponding figure for 1925 being 4,170. The additional 169 beds. were obtained mainly by minor extensions and re-arrangements of accommodation at existing institutions. The figure 4,339 does not include all beds at approved voluntary institutions which are available to local authorities, as a number of these institutions. do not make any specific allocation of beds for tuberculosis patients.

5. Sanatorium Building Schemes.-The larger sanatorium building schemes referred to in the Report for 1925 were still in hand at the close of the year. These include the City of Glasgow's new sanatorium at Mearnskirk (464 beds), the 60-bed addition to Bellefield Sanatorium belonging to the same authority, and the 70-bed addition to the Dumfries and Galloway Joint Sanatorium. The last-named scheme is practically completed. Other schemes in hand include the 24-bed extension to the Lewis Sanatorium, the new 20-bed sanatorium at Lerwick, and the 14-bed extension at Argyll County Sanatorium, now practically completed. The new infectious diseases hospital being erected by the burgh of Airdrie will make provision for 16 tuberculosis beds to replace the nine at present available.

Reference is made in chapter VIII to the proposal of the town council of Aberdeen to take over from the parish council the administration of the Oldmill Hospital. It is contemplated that about 100 beds will be available for tuberculosis cases under this arrangement.

6. Joint Sanatorium Schemes.-Considerable progress has been made with the adjustment of the details of the proposal referred to in the last Report that the county and burgh authorities of Lanarkshire, excluding the City of Glasgow, should pool their institutional resources for the treatment of tuberculosis under a co-ordinated scheme of administration for the whole area. It is understood that nothing now stands in the way of the constitution of the proposed new joint authority.

Consideration was given during the year to a proposal by the Renfrew Joint Sanatorium Board to proceed with the erection of a sanatorium of 116 beds. A site near Lochwinnoch acquired by the Committee of the Renfrewshire King Edward Memorial Fund before the war has been available all along, but the building