schemes previously considered have had to be dropped on account of conditions arising out of the war. In view not only of the existing institutional provision generally, and of the schemes of considerable magnitude now in hand which will come into operation in the course of next year or so, we concluded that any material expansion in the matter of sanatorium provision for pulmonary tuberculosis would not be justified until the new schemes had been completed and their effect on the general position ascertained. The position as regards accommodation for non-pulmonary tuberculosis is different; the Report of the Departmental Committee on Hospital Services in Scotland, over which Lord Mackenzie presided, emphasised the need for additional beds for non-pulmonary tuberculosis. Such developments as local authorities find it possible to undertake under present financial conditions should therefore be specifically directed towards relieving this special need. An institution of the size proposed by the Renfrew Joint Sanatorium Board forms a unit which can be economically and efficiently administered, but as it would more than suffice for the non-pulmonary requirements of Renfrewshire alone, it was suggested that consideration should be given to the possibility of joint action with the Dunbartonshire local authorities, who had formed a combination for sanatorium provision similar to that for Renfrewshire, and who have been faced with more or less the same problem. The possibility of such joint action is being carefully explored by the respective authorities.

7. Private Institutions.-An addition to the accommodation available for the treatment of tuberculous children was made during the year by the conversion of Kirkconnell Hall, Ecclefechan, into a 44-bed sanatorium for boys. The institution is known as St. Fechans, and the proprietrix and medical superintendent is resident.

The St. Andrew's Home, Millport (referred to in the last Report), which provides for the treatment on modern orthopædic lines of non-pulmonary tuberculosis in children, has now been extended so as to accommodate 60 cases of this type.

8. Schools at Sanatoria.-Children undergoing treatment in sanatoria, whether for pulmonary tuberculosis in an early form or non-pulmonary forms of the disease, are usually resident in the institution for considerable periods, extending in some cases to a year or more. The grave loss in education which these children suffer if special arrangements are not made to meet their needs has forced itself upon the attention of sanatorium authorities. If the object of institutional treatment is to return the child to a normal life with restored health, it is also important that the educational progress of the child should not meantime be neglected. Obviously, however, the tuberculous child undergoing institutional treatment cannot be submitted to the full rigour of the ordinary school curriculum without the risk of further impairment of health. In the sanatorium the medical

aspect must take precedence, and educational arrangements should be carefully adjusted to the requirements of treatment. As a rule school classes in sanatoria should meet for comparatively short periods, and the school day should be correspondingly curtailed. In suitable cases a certain amount of instruction can be provided by the teaching staff to patients who are confined to bed. A sanatorium school should as far as possible be built on open-air lines, and the classes should be small enough to permit of adequate control by the teacher and to make it unnecessary to impose a too strict disciplinary regime. As regards bedside instruction, the limited experience meantime available suggests that the instruction hour is welcomed as a break in the monotony of a long and somewhat wearisome day. From the medical point of view, so long as the periods of instruction are strictly limited with an eye to the patient's condition, and so long as teachers are forthcoming with the necessary interest in and aptitude for this very special branch of work, the instruction afforded can serve only as a useful mental stimulant to the child, and may indeed be an important factor assisting in the patient's general recovery. It is not found that the arrangement of suitable class hours presents any serious difficulties. The teachers who take classes in the school-room are usually in a position to spend part of their day in affording bedside instruction. The real difficulty arises when the number of children in an institution is so small as not to warrant the appointment of a whole-time teacher. In one case we have recommended that an arrangement should if possible be made with the local Education Authority for the part-time services of a teacher who would be free to spend the remainder of her time in an ordinary school under that Authority. With proper co-operation between the different authorities, it may be said that it is only in small institutions at some distance from populous centres that any insuperable difficulty should be experienced in providing such measure of teaching facilities as will at least prevent the children from losing ground educationally.

Approved schools have been established at the following tuberculosis institutions, viz. :-Robroyston Sanatorium, Glasgow; Hairmyres and Stonehouse Sanatoria, Lanarkshire; Royal Victoria Hospital, Edinburgh; the City Hospital, Aberdeen ; South Eastern Counties Sanatorium, East Fortune; and Glenafton Sanatorium, Ayrshire. The first-named institution has a staff of four whole-time teachers; Hairmyres Sanatorium has a staff of three; the rest have each one teacher.

The cost of schools at sanatoria, including teachers' salaries, is met by the Tuberculosis Authority and not by the Education Authority. Accordingly the approved expenditure earns Tuberculosis Grant and has no claim on the Education Grants.

9. Tuberculosis Dispensaries.-The number of approved tuberculosis dispensaries in Scotland is now 33. A tuberculosis dispensary has been instituted for the burgh of Stirling. It is housed in old school premises, in a central part of the town,

which have been adapted for this purpose, and also for use as a child welfare clinic. The Paisley burgh dispensary has been removed to the handsome new Russell Institute which was gifted. to the town. The local authority of Dundee is in course of erecting a public health institute. This is intended, inter alia, to provide improved accommodation for the municipal tuberculosis dispensary, which has been handicapped in its working by the somewhat unsuitable character of its present premises.

10. Dental Treatment. The reaction of defective dental conditions on the general health of the individual has been the subject of considerable attention in recent years. So far as tuberculosis patients are concerned, it is generally recognised that defective dental conditions cannot but serve to retard the patient's recovery, and that local authorities must take measures to secure the remedy of such conditions if their other efforts. in the interests of the patient are to receive a fair chance.

Approval for grant purposes of the arrangements made by local authorities in this connection was restricted at first to extractions and fillings, but it has since been extended to cover moderate expenditure on the supply of dentures, where these are certified by the tuberculosis officer to be essential to the proper treatment of the patient's tuberculous condition, and where the patient is unable himself to provide them or to obtain them from other sources. When there is doubt as to the fees which should be specified in arrangements made with dentists, the local authority should take as their guide the agreed scale. of dental charges for members of approved societies. A revised scale came into force on 1st October, 1926, and for the purposes of the Tuberculosis Grant the fees set forth in this scale are regarded as maxima.

11. Grants, &c.-Payments out of the maintenance grant in aid of expenditure by local authorities on the treatment of tuberculosis during the year to 31st December, 1926, amounted to £292,026, 19s. 6d.

Payments of grants in aid of the capital cost of sanatoria and other institutions for the treatment of tuberculosis were also made during the year to the amount of £15,739, 18s.

In addition to receiving these grants, local authorities are reimbursed, out of funds provided by the Ministry of Pensions, for their expenditure on the sanatorium and hospital treatment of ex-service cases of tuberculosis which have been accepted by the Ministry as attributable to or aggravated by war service. The sums paid to local authorities to account of this service, during the year to 31st December, 1926, amounted to £23,458, 158. 9d. Payments out of funds similarly provided were also made to local authorities for (a) services of health visitors in the visitation of tuberculous ex-service men, and (b) services rendered by tuberculosis officers for the Ministry of Pensions in the matter of medical certification, &c. The sums paid during the year to 31st December, 1926, for services under