II. MEDICAL AND ALLIED SERVICES.

Infectious Diseases.

TUBERCULOSIS.

NOTIFICATION AND MORTALITY STATISTICS.

Statistics as to the number of cases of tuberculosis notified during the year 1922, the latest year for which figures are available, are given on p. 37 of this Report and in Appendix II.

The following table, compiled from figures supplied by the Registrar-General for Scotland, shows the number of deaths from tuberculosis during each of the past ten years :—

Deaths and Death-Rates in Scotland during the Ten Years, 1914-1923.

We have commented in previous Reports on the marked decrease in tuberculosis mortality in recent years. For the year 1923, notwithstanding the prevalence of unemployment and distress, the position has at least been maintained. In pulmonary tuberculosis the ground lost in 1922 has been regained.

It is noteworthy that Scotland, which since 1915 has had a lower death-rate from pulmonary tuberculosis than either England or Ireland, with the solitary exception of the years 1919 and 1920, has had since 1899 a higher death-rate in other forms of tuberculosis than either of the other countries.

During recent years there is an increasing disposition among a number of local authorities to use a part of their sanatorium and hospital accommodation for the treatment of non-pulmonary forms of the disease, and we hope that the extension of the facilities for treatment and the possibilities of improved methods of treatment will accelerate the fall in the death-rate, which during the last four years.

has been more gradual than in the first six of the past decennial period.

APPROVED INSTITUTIONS.

At the end of the year 1923 there were 107 sanatoria, hospitals and other residential institutions (exclusive of poor law institutions) approved by us for the treatment of tuberculosis. Of that number 24 had accommodation for fifty or more tuberculosis patients. The total number of beds reserved for the treatment of tuberculosis in approved institutions was 3953.

The number of approved tuberculosis dispensaries at the end of the year was 31.

Progress in the Completion of Institutional Schemes.

Satisfactory progress has been made in the completion of sanctioned schemes of further institutional provision. The Dumfries and Galloway Joint Sanatorium at Lochmaben (50 beds) was completed during the year and is now available for the admission of patients. The tuberculosis pavilions at the Robertson - Stewart Hospital, Rothesay (7 beds), the Clackmannan County Hospital, Alloa (6 beds), and the Kincardine County Hospital, Stonehaven (6 beds), have also been completed. Work on the larger schemes is well in hand. They comprise the South-Eastern Counties Joint Sanatorium at East Fortune (199 beds), a portion of which was in use throughout 1923, and the schemes of the Corporation of Glasgow for the erection of a sanatorium at Mearnskirk (300 beds) and the extension of Bellefield Sanatorium, Lanark (60 additional beds).

The Joint Sanatorium Board for the County and Burgh of Perth have decided, on the ground of cost, to abandon their scheme for the erection of a sanatorium at Murie.

We sanctioned a scheme submitted by the County Council of Zetland for acquiring a mansion-house near Lerwick for the purposes of a sanatorium, but the scheme has not been proceeded with as the County Council were unable to come to terms with the owner. We understand that alternative proposals are being considered.

The County Council of Caithness having decided to proceed with their former proposal to erect a small pavilion for tuberculosis at Wick (Town and County) Hospital, we approved the plans, which provide for 10 beds, and the work is now in progress.

VOCATIONAL TRAINING FOR SANATORIUM PATIENTS.

We approved the scheme of vocational training submitted by the Local Authority of the Middle Ward of Lanarkshire in connection with the industrial workshops at Hairmyres Sanatorium and Colony which were opened in the course of the year. Patients are being trained by qualified instructors in motor repairing, carpentry and cabinetmaking, boot repairing, basketmaking and toymaking. The experiment is one which we are watching with great interest. Training is also provided at the Colony in forest nursery work, pig and poultry rearing and market gardening. These facilities, while primarily intended for cases from the county of Lanark, are also

available to suitable cases from all parts of the country, particularly to those who have had a period of treatment in another institution and are recommended by the medical officer of that institution as likely to derive material benefit from a period of concurrent treatment and training.

TUBERCULOSIS (MAINTENANCE) GRANT.

The payments out of this grant during the year to 31st December, 1923, amounted to £292,737, 12s. 7d.

In consequence of a considerable increase on the original estimates of local authorities' expenditure it was found impossible to meet their claims in full out of the limited grant voted for the year 192223. Sanction was obtained to meeting the excess out of savings on other sub-heads of our estimates, but in conveying their sanction the Treasury requested that steps should be taken to ensure that in the following financial year the claims on the grant would not exceed the sum voted. We accordingly, after careful consideration of the estimates submitted by the local authorities of their expenditure for the year 1923-24, fixed for every authority a limit of expenditure on which the authority would be entitled to claim grant, and we advised local authorities that we could not undertake to pay grant on their expenditure except within the limits so fixed.

SANATORIUM (CAPITAL) Grant.

Payments of capital grant were made during the year to 31st December, 1923, to the amount of £43,166, 4s. 10d.

INQUIRY INTO THE MAINTENANCE COSTS OF INSTITUTIONS.

The detailed survey of the administration and costs of grantearning institutions, the initiation of which was mentioned in our last Report, has been continued throughout the year as the exigencies of the other duties of the investigating officers have permitted. A thorough investigation has been made into the methods of administration and the costs of about thirty sanatoria, hospitals and other institutions. The material collected is now being analysed and collated, and it is our intention so soon as that is done to make the results of the inquiry available to local authorities.

TUBERCULOUS EX-SERVICE CASES.

The arrangement whereby we reimburse local authorities out of funds provided by the Ministry of Pensions 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 continues in operation. The sums paid to local authorities to account of this service during the year to 31st December, 1923, amounted to £46,050, 13s. 5d.

Payments out of funds similarly provided are 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, etc. The sums paid during the year to 31st December, 1923, for services under (a) amounted to £404, 14s., and for services. under (b) the sum of £637, 7s. 6d. has been allowed for the year.

TRANSFER OF SANATORIUM BENEFIT FUNDS TO LOCAL

AUTHORITIES.

It was provided by the National Health Insurance (Termination. of Sanatorium Benefit) Regulations (Scotland), 1920, that the surpluses remaining in the sanatorium benefit accounts of insurance committees after providing for any deficits should be paid over to the appropriate local authorities. The accounts of the several committees have now been finally wound up. The surpluses amounted to £20,649, 5s. 3d. and deficits to £827, 9s. 9d., leaving the sum of £19,821, 15s. 6d. to be transferred to local authorities.

PROVISIONAL ORDER UNDER THE PUBLIC HEALTH ACT.

A petition was presented to us in October, 1922, by the Dumfries and Galloway Joint Sanatorium Board craving the issue of a Provisional Order under Section 145 of the Public Health (Scotland) Act, 1897, in connection with the acquisition of land forming part of the Lochmaben Parish Glebe for the purposes of the sanatorium which the Joint Sanatorium Board have erected at Lochmaben. Mr. David Gerrand, our Assistant Solicitor, was appointed our Commissioner to hold the usual inquiry, and reported to us that in his opinion the prayer of the petition should be granted. On 19th May, 1923, we issued a Provisional Order granting the prayer of the petition. No memorial was lodged with the Secretary for Scotland against the Order, which accordingly may now be considered as final.

VENEREAL DISEASES.
PREPARATION OF SCHEMES.

During the year we approved one new scheme, for the area administered by the recently formed Dumbartonshire Venereal Diseases Joint Committee, which represents all the local authorities in the County with the exception of the Burghs of Clydebank and Kirkintilloch, the former having a separate scheme and the latter being a co-partner in the Lanarkshire joint scheme. In many other areas, especially in the Counties of Fife and Kinross and Stirling and the Burghs of Glasgow, Greenock and Paisley, substantial improvements in the existing services--particularly in facilities for the treatment of patients-were sanctioned.

COMBINATIONS OF LOCAL AUTHORITIES.

While no formal Combination Orders under Section 83 of the Public Health (Scotland) Act, 1897, were issued, arrangements were approved whereby the treatment facilities provided at the Greenock and Paisley centres were made available on a pre-arranged financial

basis to patients from the adjacent parts of Renfrewshire. Similar arrangements were sanctioned for the use of the Dumfries Centre by patients from the Stewartry of Kirkcudbright and the County of Wigtown.

TREATMENT CENTRES.

New Centres Approved.-During the year premises were approved for use as venereal disease treatment centres at the following places :Chalmers Hospital.

...

Banff
Dundee ...

...

Reception House. (Males only.)

New Centres Opened.-Four treatment centres have been opened during the year, viz. :

Projected Centres.- Proposals are under consideration for the establishment of additional centres at the following places:

The possibility of establishing a treatment centre at Peterhead was investigated, but it was not found practicable to make satisfactory arrangements.

No centres have yet been provided in Inverness, Leith, Clydebank, Dumbarton, Galashiels or Falkirk, but we hope that it may be found possible to overcome the local difficulties which have hitherto stood in the way of the provision of treatment for the inhabitants of these towns and surrounding districts.

In some other places, while no concrete proposals for the institution of centres are at present under consideration, it is recognised that it may be desirable to provide facilities for treatment as opportunity affords and financial conditions permit. Among these are the following:-Wigtown or Stranraer, Oban, Kirkwall, Rothesay.

It is not contemplated that in all these places a fully-equipped centre would be necessary or desirable. In some of them it might suffice if a local practitioner specially trained for the work undertook to provide treatment on approved lines under a suitable financial arrangement with the local authority.

VENEREAL DISEASE ACT, 1917.

During the year an Order was issued bringing Section 1 of the Act into operation in the County of Perth, including the burghs therein. The issue of a similar Order for Ayrshire is being considered.

VENEREAL DISEASES GRANT.

The total sum paid out of the Grant during the year was £57,716, 15s. 7d., of which £56,705, 5s. 9d. was paid to local authorities or combinations of local authorities, £211, 9s. 10d. to