the particulars summarised below. At 31st March, 1922, the unexpended balance in the Fund amounted to £143,459, 7s. 2d. As shown below, the corresponding balance at 31st March, 1923, was £130,702, 3s. 1d., so that in the last financial year expenditure exceeded income by £12,757, 4s. 1d. It is estimated that at the close of the current financial year the balance will have fallen to about £114,000. Considering that the recurrent charges against the Fund have not reached their maximum under any head except that for medical service and that the Fund will be called upon to bear a great part of the cost of providing houses for doctors where these are not already provided, houses for nurses, hospices and hospital extensions, we cannot regard the financial position as satisfactory. At the end of 1923 we were in communication with the Highlands and Islands Sub-Committee of the British Medical Association, representing the practitioners giving service under the Highland and Islands medical scheme, on the question of a revision of the practitioners' grants in view of the fall in the cost of living and in practice expenses, but any reduction that may be possible in the cost of the medical service will not be of such amount as to relieve us of anxiety about the future maintenance of the other services that require assistance from the Fund. APPLICATION OF THE FUND. The following is a summary of the total charges, partly estimated, against the Fund for the calendar year 1923 for medical service, and for financial years ending in 1923 for the other services. Medical Service-Scheme of modified fees and Do. Do. Nursing Service ... special arrangements ... £44,000 00 Supplementary Scheme (Mile The foregoing grants are payable to medical practitioners, nursing associations, hospital managers, and local authorities as summarised below: Medical Service Practitioners receiving grants for services under the ... ... ... Practitioners receiving grants in lieu of insurance ... 151 20 Medical Service-(continued). Practitioners for whom substitutes were provided ... ... Special arrangements for particular districts and islands Nursing Service Grant-aided nursing associations. Hospitals and Ambulances Hospitals receiving grants Ambulance committees... Houses for Doctors ... .. ... 137 Number of parish councils to whom the grants noted above were paid Telegraphs and Telephones— ... The payments under this head in 1923 were made in respect of 10 circuits. Special Emergency Scheme. The grants paid in 1923 represented assistance allowed by us (1) towards the cost of emergency medical arrangements in 7 districts due to the illness of doctors, etc.; and (2) towards conveyance of a patient to hospital. Special Tuberculosis Scheme. The sum of £1357 represents (1) a grant of £300 paid to the Scottish Branch of the British Red Cross Society in respect of the Stornoway Tuberculosis Hospital, and (2) a grant of £1057 to the County Council of Ross and Cromarty towards expenditure incurred in 1921-22 on the treatment of tuberculosis in the District of Lewis. FINANCIAL POSITION OF THE FUND. The annual grant-in-aid of £42,000 is paid to a separate Fund, and any balance unexpended is not surrendered at the close of the financial year. The following is a statement of the income and expenditure of the Fund for the financial year which ended on the 31st March, 1923 Repayment of an advance made in May, 1921, ... Hospitals and Ambulance Service (Maintenance) ... ... ... ... £189,929 14 4 The foregoing figures refer to amounts actually received and paid within the financial year ended 31st March, 1923. Inspection and Supervision of Food. Apart from certain specific provisions, which relate principally to fresh meat and milk, the purity of foodstuffs is protected chiefly by the provisions of the Sale of Food and Drugs Acts, the principal Act on the subject being dated 1875, nearly 50 years ago. Since that date the methods of preparation and distribution of foodstuffs have been greatly developed, and in many respects transformed, and there is now a large variety of articles of food-meat, cereal or vegetablewhich are sold in tins, packets or bottles. This development of the system of distribution of foodstuffs has created its own problems, and the question of preservatives in tins, packets and bottles of food has occupied a great deal of the attention of administrative bodies and of the Courts. Dr. Gerald Leighton, our Medical Officer (Foods), has been appointed a member of the Committee on Preservatives and Colouring Matter in Food, which was set up by the Minister of Health to consider the whole matter and to report. MILK. The Milk (Special Designations) Order (Scotland), 1923. On the 19th June we issued the above Order, which is practically a re-issue of the Order of 1922, with certain amendments in matters of detail which experience showed to be advisable. The principal amendments were: (1) The requirement of the tuberculin test at intervals of 12 months instead of 6 months where two successive tests of a herd at an interval of 6 months had revealed no reactor, and where only animals from a licensed herd were added to the herd that was to be tested. (2) The introduction of a system of marking cows which were subject to the tuberculin test. (3) A provision that no animal which has reacted to the tuberculin test shall form part of a grade A herd. On the 10th August we issued a short amending Order, dealing with the bacterial count of grade A milk (pasteurised) and pasteurised milk. The effect of this Order is that after 1st January, 1924, grade A milk (pasteurised) is to contain not more than 30,000 bacteria per cubic centimetre, and no coliform bacillus in one-tenth of a cubic centimetre, and pasteurised milk is to contain not more than 100,000 bacteria per cubic centimetre. We are advised that if pasteurised milk is handled with proper precautions the amended figures of the bacterial count should enable distributors to sell such milk unbottled. Both the above Orders may be purchased from H.M. Stationery Office, 120 George Street, Edinburgh (S.R. & O. 1923, No. 656/S.42 and No. 869/S.55). Interpretation of the Milk (Special Designations) Order. Various questions of interpretation of the Milk (Special Designations) Order were submitted to us by local authorities and their In one it appeared that it was possible for a producer of milk, who was applying for a licence, to obtain a satisfactory number of points on the score card, although on two specific matters of detail he was infringing the dairy regulations of the local authority. Accordingly the local authority had declined to issue a licence. We agreed that, in order to prevent confusion and to secure compliance with the law, a licence for the sale of graded milk should not be granted where the premises did not comply with the dairy regulations. We further stated that in our view the conditions governing licences for the sale of higher grade milk were intended to operate on the assumption that the ordinary requirements of the existing law had been satisfied. Pasteurisation of Milk. An interesting development in regard to the pasteurisation of milk, in accordance with a licence granted under the Milk (Special Designations) Order (Scotland), 1923, occurred in a burgh in central Scotland. A dairyman, who had no considerable demand for pasteurised milk, wanted to be in a position to meet any demands that might be made for it, and asked whether the following method of pasteurisation would be considered satisfactory to the licensing authority, and would comply with the requirements of the Order. The milk in quantities of about 5 gallons would be placed in cans suspended in a boiler, and the temperature would be kept between 145° and 150° F. for at least half an hour. The milk would then be immediately cooled by means of a cooler surrounded by muslin, and subsequently bottled in terms of the Order. After communicating with the local authority we replied to the dairyman concerned that it was the local authority who required to be satisfied, in terms of the Order, with the methods of pasteurisation and the apparatus employed, but from the point of view of the interpretation of the part of the Order dealing with pasteurisation there appeared to be no objection to the process detailed, provided it produced milk that conformed to the bacterial count. The Bacterial Count of Graded Milk. The proper method of conducting the bacterial count for graded milk has received our careful consideration during the year. As this count, if carried out by different methods, may give widely varying results, it is of the greatest importance that the method of ascertaining the count should be standardised. Accordingly we issued a memorandum to bacteriologists detailing the methods of sampling and of the laboratory process that should be followed. This memorandum was designed to achieve uniformity in the method of ascertaining the count. We had occasion to communicate with the bacteriologists engaged on this work, and received from them valuable detailed observations on the whole subject. From the information supplied to us, it appeared that the coliform reaction was frequently found in samples taken for examination. Accordingly we pointed out to local authorities and to their bacteriologists that the coliform reaction, which is generally attributed to the lactic acid bacillus, should not often be found in samples of graded milk if particular care is taken in production and distribution. As this reaction is usually a sign of dirt or manurial contamination, we urged local authorities to ensure that the methods of production of higher grade milk, and the cleanliness of utensils, clothing and premises, should receive the most careful attention by those officers who were engaged in inspection. We also suggested (1) that the final calculation of organisms should be made at blood heat, in accordance with the terms of our memorandum (and not at room temperature), and (2) that a sample might be passed if the coliform reaction occurred in only one of three tubes. Fees for the Tuberculin Test, etc. In terms of the Milk (Special Designations) Order the charges to be made for carrying out the tuberculin tests for the purposes of the Order are to be fixed by the local authority. In the three districts of Lanarkshire the fees for carrying out the test have been fixed at the following rates: For a herd not exceeding 10 cows, 11 to 20 cows, 21 to 30 cows, ... ... Over 30 cows, ... ... Further, the local authorities of these three districts have decided to charge for annual licences only half of the maximum fees prescribed in our Order. Combination. In the County of Dumfries the five districts and some burghs have formed a joint committee for the administration of the Milk (Special Designation) Order. In Edinburgh the Town Council have authorised their officers to undertake the work of tuberculin testing, examining samples for the bacterial count, etc., where higher grade milk from the surrounding area is sold in the city. The Public Health (Condensed Milk) Regulations (Scotland), 1923. In terms of Section 8 of the Milk and Dairies (Amendment) Act, 1922, we framed Regulations prescribing standards for condensed |