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688 PUBLIC HEALTH SERVICES. Holland. Dr. H. C. Jennings reports that the work done in the county laboratory has been of great benefit, but would be of much wider service if a trained assistant were appointed. There were 26 cases of small-pox with no deaths. In 12 of the cases in Spalding infec- tion was traced to a tramp. There were 12 notifica- tions of ophthalmia with one case of impaired vision removed from hospital against medical advice. There were 52 deaths from pneumonia, and Dr. Jennings would like to have hospital treatment for all pneumonia cases. Two cases of encephalitis were notified and both died. The tuberculosis mortality was the lowest ever recorded ; 355 new cases were reported and 184 contacts were examined. The 30 shelters available in the county were used by 46 patients during the year. More local nursing associations are needed to ensure adequate attention to mothers in childbirth. As it is, the problem of the " handywoman " is an ever-present one. The amount paid in fees to practitioners called in by midwives was £ 88 18s., of which 69 5s. was recovered from patients. The public analyst reports a sample of egg powder as " inferior." It consisted of starchy matter and a small amount of baking powder, and was coloured with an aniline dye. There is, however, no accepted definition or standard for egg powder. Under the Tuberculosis Order 86 animals were slaughtered, four of which were cows in milk with tuberculosis of the udder. Several of the districts in the south of the county have unsatisfactory water- supplies and are in negotiation with the Spalding U.D.C., which own bores at Bourne, from which an ample supply of pure water is obtained. In an appendix on the isolation hospital accommodation of Holland Dr. Jennings indicates that the ideal would be to erect one hospital in a central situation to serve the whole county. Unfortunately, the lack of a piped water-supply in the greater part of the area very much limits the choice of suitable sites. MENTAL HOSPITAL REPORTS. THE Devon Mental Hospital issues this year its eighty-third annual report, illustrated by two photographs, one of the ballroom and the other of the female private ward, made gay by a veritable herbaceous border of hand-made floral decorations. There were 1333 patients on the register on Dec. 31st, 1928, an increase of 110 during the year, so that on the female side the hospital is now overcrowded and in urgent need of extension. The increase in the admission-rate is largely due to the reception of patients on contract from Staffordshire, Birmingham, and Plymouth. These were chronic cases, yet the recovery-rate for the year reached 37-82 per cent. The death-rate was 7-6 per cent., and autopsies were held in all cases where permission could be obtained- 72-34 per cent. The number of cases of pulmonary tuberculosis has been reduced by improved diet, and by ultra-violet ray and sanatorium treatment. In the autumn there were three cases of dysentery, but there has been no typhoid since the routine inocula- tion of all patients with " TAB " was instituted. The laboratory carried out a large number of routine and special examinations ; the dentist visited fort- nightly and examined 636 patients, and the visiting ophthalmic surgeon made 76 examinations. The visiting surgeon paid 40 visits, saw 107 cases, and performed 29 major operations. The visiting radio- logist made 59 investigations, and 35 patients were treated in the light department. During the year 13 men and 2 women suffering from general paralysis were treated by malaria, 7 by mosquitoes, and 8 by direct inoculation of malarial blood. Three of the patients were sent home, 4 showed no appreciable change, and 4 died. In future, arsenical preparations are to be given as well as malaria, and the results will be compared with those following malarial treat- ment alone. Parole within the estate was granted to 80 patients ; 46 were allowed outside and 55 were taken out by friends. As far as possible the open- door system is adopted. Char-a-banc picnics were enjoyed by 518 patients, and daffodil, primrose, and blackberry-picking parties were organised. The sum of B170 was raised at the annual patients’ sports. The method, devised by the engineer, whereby the wireless can be transmitted through the telephone system, continues to work satisfactorily, and there is a portable set for wards not supplied with a tele-- phone. The library has been completely reorganised in a central room, and the weekly illustrated papers are now circulated in folios made in the bookbinding department of the printers’ shop. Bookbinding occupies two patients, weaving five, net-making three, and mat-making two. The brush- and basket-making department, served by eight patients, has turned out excellent work, and knitting, rug-making, and raffia. occupy some of the women. In all, 271 patients have useful employment. At the out-patient clinic there were 63 attendances, nearly twice as many as in 1927.- A new sterilising room was added to the operating- theatre, and two new cottages were built for the male nursing staff. One nurse passed the final examination of the General Nursing Council, and 12 nurses and two attendants obtained their R.M.P.A. certificate. The Roxburgh, Berwick, and Selkir7c District Asylum: had 368 patients, including four voluntary boarders, in residence on May 15th, 1929. The recovery-rate was 35-2 per cent. and the death-rate 7-9 per cent. Cause of death was verified by autopsy in 17 cases.. During the year the hospital was fortunate in admit- ting more recoverable and fewer senile cases than usual. Apart from a sharp epidemic of influenza the health was excellent. The dental surgeons visited every fortnight. An occupational therapy class has been started, and a kinematograph apparatus has been installed. Thirteen members of the staff sat for the R.M.P.A. examination, and all but one were successful. ____ INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED SEPT. 14TH, 1929. N otifications.-The following cases of infectious disease were notified during the week :-Small-pox, 96 (last week, 150) ; scarlet fever, 2015, diphtheria, 1160 ; enteric fever, 113 ; pneumonia, 569 ; puerperal fever, 50 ; puerperal pyrexia, 90 ; cerebro-spinal fever, 13 ; acute poliomyelitis, 12; acute polio- encephalitis, 3 ; encephalitis lethargica, 14 ; continued fever, 1 ; dysentery, 4 ; ophthalmia neonatorum, 119. No case of cholera, plague or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the Metropolitan Asylums Board on Sept. 17th-18th was as follows :-Small-pox, 121 under treatment, 15 under observation (last week 156 and 14 respectively) ; scarlet fever, 1417 ; diphtheria, 1524 ; enteric fever, 21 ; measles, 243 ; whooping-cough, 209 ; puerperal fever, 23 (plus 6 babies) ; encephalitis lethargica, 125; poliomyelitis, 3 ; " other diseases," 25. At St. Margaret’s Hospital there were 22 babies (plus 10 mothers)‘ with ophthalmia neona- torum. Deaths.-In the aggregate of great towns, including London, there was no death from small-pox, 3 (3). from enteric fever, 9 (2); from measles, 2 (0) from scarlet fever, 27 (4) from whooping-cough, 24 (2)- from diphtheria, 103 (17) from diarrhoea and enteritis under two years, and 22 (2) from influenza. The figures in parentheses are those for London itself. Of the deaths from diarrhoea, (which have increased by one-third), 8 were reported from Liverpool, 7 from Gates- head, 6 from South Shields, 5 each from Birmingham, Hull, and Middlesbrough, 4 from Leeds ; while Glasgow, Dublin, and Belfast, reported 7, 5, and 5 respectively. Two deaths from measles were reported from Stoke-on-Trent. The number of stillbirths notified during the week was 265 (corresponding to a rate. of 42 per thousand births), including 40 in London.
