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for which school doctors have special advantages.Records of all cases of defective vision are kept, andfrom these it was found that all the cases of thisdisease in Liverpool could be traced back to one blindancestor ; transmission followed Mendelian laws, andwas not sex-limited as is commonly thought. Theonset was earlier than described by Leber. Accom-modation for. exceptional children, includingstammerers, is more nearly adequate in Liverpoolthan in most other areas ; a fine senior M.D. schoolhas just been added. Squint is treated in pre-schoolchildren, a most valuable provision, but otherwisehardly any mention is made of this age-group.

IKent.

Dr. Alfred Greenwood reports a year of smoothworking, with an increase in the total number ofexaminations. There is little mention of extendedfacilities for treatment or accommodation for excep-tional children, and there is still no open-air schoolbelonging to the county authority. The only specialschool noted is one for 36 mentally defective childrenat Tonbridge. Dental work shows progress, especiallyin the cooperation by the parents ; in some schools thepercentage of acceptances was 100, and fitting tributeis paid to the teachers. The dental trophy awardedto the school at Goodnestone shows the keen interesttaken by remote villages. Mr. F. J. Saunders, L.D S.,says the increase of parents accepting dental treatmenthas so occupied the staff that inspections are onlyhalf what they were three years ago; the otherchildren only receive dental treatment when it is Iapplied for, usually as a result of toothache. Mr.L. F. Hayes, L.D.S., remarks that the centres areunable to deal with the whole school population, evenwhen working to capacity. He stresses the value ofthe dental habit; now that almost the whole lifeof the individual is covered by dental schemes under(1) child welfare centres, (2) school dental centres,(3) dental benefits under the Insurance Acts, therecan be little excuse for dental unfitness. Thecriterion of success in school work is the percentageof children leaving school dentally fit. Dr. Greenwoodadds that rather fewer children are having dentaltreatment for the first time, and more are re-treated,and that this is inevitable unless the dental staff isexpanded. The oculist, Dr. J. W. Fox, speaks ofthe value of covering the " good eye " when the otheris squinting or amblyopic. He cites several examplesof benefit, in some of which the vision in the weak eyewas raised from 6/60 or less up to 6/9 or more. Thedisadvantages are trivial, and failure is due to notpersisting for the necessary minimum of six months ;the process should then, he says, be continued duringalternate months for another year. - Included in thereport are the results of some special inquiries bymembers of the staff. Dr. Dorothy Gallie deals withfaults in clothing and footwear. Dr. H. J. Phillipstraces some connexion between rheumatism and noseand throat conditions ; incidentally he notes that theresults of operation were unsatisfactory in 24’ 4 per cent.of cases. Dr. J. Selfe attributes much debility toincorrect feeding. Dr. F. Wolverson finds evidencethat the midday meal brought from home isinadequate ; if a school canteen cannot be provided,something should be done to augment the fare bythe provision of cocoa or (far better) milk. Dr.W. Lessey describes some types of neuropathic child.Dr. S. A. Tucker’s notes on enuresis are of generalinterest.

Leicestershire.Dr. J. A. Fairer directs attention to three links in

the coordination of infant welfare and school work: ’’

(1) Community of staff. (2) Arrangements fortransfer of records, especially of the physicallydefective. (3) Extension of ophthalmic treatmentto all necessitous pre-school children. Elsewhere henotes a fourth-namely, infant welfare exhibitions, ofwhich two have been arranged by the superintendentschool nurse, and attended by many of the elderschool girls to whom she also gives oral instruction.There are in the county no nursery schools, it is true,

but the need for them is not such as it is in crowdedtowns. Dr. Fairer is impressed with the importanceof after-care, especially in the case of crippled childrenwhose surgical -appliances need constant revision;much is hoped from the formation of local committeesassociated with the rural community councils. Bysuch means cripples and other defective children ofpre-school age would be looked after better. Ofthe orthopaedic work in the county he speaks withappreciation ; it includes ascertainment, orthopaedichospitals, clinics and agencies like the LoughboroughCripples’ Guild. Massage, electrical treatment,exercises and re-education, ultra-violet radiation andsurgical appliances are all provided, the only missingfeature is the special P.D. school, the establishmentof which in rural areas undoubtedly presentsdifficulties. Mr. Percy Ashton, L.D.S., has made aninvestigation of the condition of the teeth in childrenleaving school; 85’6 per cent. of the children examinedhad sound permanent teeth, 39 per cent. beingnaturally sound, and the remainder rendered soundby dental care. The treatment of defective visionis carried out by Dr. Constance Walters, who has madea special inquiry into myopia. It was found that upto five dioptres the incidence of each grade rosesteadily with age ; above five dioptres this did nothold, probably because the higher degrees of myopiaare due to congenital defect. Myopia was notdiscovered in pre-school children, but diagnosis atthis age is difficult. Dr. Walters has also investigatedthe relation of visual troubles to defective lighting inschools ; the percentage of children wearing glassesor showing symptoms of eyestrain was markedlygreater in the worse lighted schools, 19’4 against12’3. Dr. Mary Weston has studied the causes offatigue in secondary school girls. The hours perweek devoted to specific school activities were notedand features of the home life also considered. It wasfound that there were very wide variations in bothgroups ; hours given to class work and preparationamounted to 31 at some schools for girls of 14, andonly 20t at others. Some girls got 1117 hours sleepat night, some only7t. Dr. Weston regards concertedaction by parents, head teachers, physical traininginstructors, and doctors as seriously needed.

MENTAL HOSPITAL REPORTS.

THE WEST SUSSEX COUNTY MENTAL HOSPITAL atCHICHESTER had 877 patients on the books on Dec. 31stlast, exactly the same number as the previous year.The recovery-rate was 31’8 per cent. and the death-rate 7’52 per cent. The hospital suffered from influ-enza, enteric, scarlet fever, and tonsillitis ; the medicalsuperintendent remarks that overcrowding must havecontributed to these epidemics to some extent. Thedietary has been improved. Leave has been grantedfreely, and on an average 50 patients have had parolewithin the grounds and 29 more outside. The medicalsuperintendent thinks that there has been a decreasein the public fear of mental hospitals and quotes threeinteresting cases to show the demand for treatment.The consulting surgeon performed three operationsand the consulting rhinologist one. An advanced caseof general paralysis was treated with malaria at theHants County Mental Hospital and showed somephysical improvement. The hospital already has anX ray plant, and ultra-violet light is to be providedwhen the new admission hospital -and treatmentcentre is completed. The visiting commissionersuggests the appointment of an occupations officer.Six nurses and three attendants obtained theirR.M.P.A. certificate during the year.The STAFFORDSHIRE MENTAL HOSPITALS’ BOARD

have three hospitals under their care. At STAFFORDthere were 1042 patients resident at the end of lastyear and the overcrowding has become accentuated.Plans for an admission hospital have been approved,but building has not yet been commenced. Therecovery-rate for the year was 33’6 per cent. and thedeath-rate 8"07 per cent. General paralytics have

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been treated by sulfarsenol and biscam ; tryparsa-mide has been abandoned in favour of these prepara-tions as they are much less toxic and give betterresults. In the laboratory a good deal of work hasbeen done on bacterial toxins, and the presence ofhaemoglobin reductases in exotoxins of certaincoliform organisms has been established. The meta-bolism of epilepsy and primary dementia has beeninvestigated biochemically. One ward on each sideand the isolation hospital, which is occupied by men,are administered on the " open door " principle.Three men have full parole and two women and 33men are free within the estate. The general healthhas been good, except for three cases of erysipelasand 17 of tuberculosis. Women nurses are notemployed on the male side. Five attendants passedthe final examination of the R.M.P.A. during the year.At BURNTWOOD there were 940 patients in residence

on Dec. 31st last, and consequently considerableovercrowding. It is hoped to build an admissionhospital very soon. The recovery-rate was 35 per cent.and the death-rate 9’88 per cent. No less than78 per cent. of the discharged patients had pre-liminary periods of trial, many of them with moneygrants. There was a small outbreak of Plexnerdysentery, and the tuberculosis rate is high, as thepatients come from a densely populated area. Severaloperations have been performed, and X ray examina-tions are carried out by arrangement with a localhospital. Raffia and rug-making have kept a numberof patients occupied. A trained laboratory assistanthas been appointed, and a number of pathologicalexaminations have been made. About 10 per cent.of the male patients have parole and two wards eachside are conducted on the open-door system. Thevisiting commissioner urges the provision of a clinicalroom for each ward. Two dental surgeons visit fort-nightly. Four attendants gained the R.M.P.A.certificate during the year.At CHEDDLETON there were 1128 patients at the

end of last year. The medical superintendent notesa definite increase in the number of depressed middle-aged male cases admitted-the men whose servicesare first dispensed with when trade falls off and ordersare few. In 95 per cent. of the fatal cases post-mortem examinations were made. The Wassermannreaction has been tested in all new admissions—i.e., 233.Of these, 24 men and 5 women gave a positive result;20 men and 3 women had general paralysis. Malarialtreatment is given to all who show a positive serum.It seems to be the first rigor which is the only effectiveone, and any spirochaetes that survive the first rigorcan stand any number of subsequent ones. Of thecases treated by malaria during the last seven years,roughly one-third recovered, one-third were arrested,and one-third were not improved or died. A searching ’I

investigation has been made into the possible reasonsfor the high percentage of tuberculosis in the hospital.The medical superintendent declares that tuberculosiscan be abolished from mental hospitals if the publicchoose ; it is all a question of money, for the casesmust be properly segregated. There were 31 cases ofdysentery in the hospital during the year, with twodeaths. The medical superintendent is anxious tohave an X ray installation. Parole outside the estateis given to 60 men and 21 women and within thegrounds to 30 men and 5 women ; three wards oneach side are " open door." There are a number ofchildren in the hospital, who are taught with greatcare ; an occupational organiser visits from time totime.The HERTFORDSHIRE COUNTY MENTAL HOSPITALat ST. ALBANS had 881 patients at the end of last year.The recovery-rate was 28’6 per cent. and the death-rate7’ 19 per cent. Post-mortem examinations were madein 48 out of the 71 fatal cases. A male annexe hasbeen opened for bedridden men and has slightlyrelieved the overcrowding. A nurses’ home wasopened in January, and there are plans for providinganother 350 beds. The general health was satisfactoryexcept for a few cases of dysentery. Eight patients

only are suffering from tuberculosis. General para-lysis has been treated with tryparsamide, and two caseshave been given malarial inoculation. Dentaltreatment was given to 58 men and 81 women and anorganised effort was begun during the year to tacklethe problem of eliminating septic foci. An ear, nose andthroat surgeon has been appointed, and visits monthly.Ten operations were performed during the year.There is a physical drill class for men and a handicraftclass for women, and the canteen is running success-fully. Many routine investigations were carried outin the laboratory, which also does some work for thecounty mental officer of health. Eight men andeight women have parole beyond the estate, and 26men within the grounds. The visiting commissionersuggests the desirability of installing X rays, ultra-violet rays, continuous baths, and cinema. No femalenurses work on the male side. Six nurses and twoattendants obtained their certificates during the year.The report of the DOWN COUNTY MENTAL HOSPITAL

is illustrated with a number of photographs, includingan aerial view. There were 774 patients on the booksat the end of last year. The recovery-rate was34’3 per cent. and the death-rate 9’5 per cent. Thelatter shows a considerable increase on account ofinfluenza. Schemes for supplying electromedical andhydrotherapeutic installation, verandas, and sheltershave been approved. Rooms have been adapted foroccupational therapy with great success. There wasa great deal of paratyphoid, coincident with a wide-spread epidemic in the neighbourhood, and there wasan outbreak of swine fever in the farm at the sametime. Four attendants and six nurses obtained theR.M.P.A. certificate during the year.

INFECTIOUS DISEASEIN ENGLAND AND WALES DURING THE WEEK ENDED

SEPT. 6TH, 1930.Notifications.-The following cases of infectious

disease were notified during the week :—Small-pox,106 (last week 99) ; scarlet fever, 1411 ; diphtheria,1074 ; enteric fever, 82 ; pneumonia, 440 ; puerperalfever, 36 ; puerperal pyrexia, 92 ; cerebro-spinalfever, 7 ; acute poliomyelitis, 9 24 ; acute polio-encephalitis, 2 ; encephalitis lethargica, 10 ; dysen-tery, 10 ; ophthalmia neonatorum, 108. No case ofcholera, plague, or typhus fever was notified duringthe week.

I The number of cases in the Infectious Hospitals of theLondon County Council on Sept. 9th-10th was as follows:Small-pox, 216 under treatment, 4 under observation (lastweek 209 and 6 respectively) ; scarlet fever, 1449 ; diph-theria, 1671 ; enteric fever, 31 ; measles, 135 ; whooping-cough, 104; puerperal fever, 27 (plus 14 babies);encephalitis lethargica, 119 ; " other diseases," 35. AtSt. Margaret’s Hospital there were 16 babies (plus 8 mothers)with ophthalmia neonatorum.Deaths.-In the aggregate of great towns, including

London, there was no death from small-pox, 2 (0)from enteric fever, 10 (1) from measles, 8 (2) fromscarlet fever, 9 (1) from whooping-cough, 14 (7) fromdiphtheria, 50 (11) from diarrhoea and enteritis undertwo years, and 10 (6) from influenza. The figures inparentheses are those for London itself.The deaths from enteric fever outside London occurred

at Northampton and Cardiff. Liverpool reported threedeaths from measles and 2 from diphtheria. Four deathsfrom diarrhoea were reported from Liverpool, 3 each fromBirkenhead and Newcastle-on-Tyne, 2 each from Leicester,Manchester, Middlesbrough, and Swansea.The number of stillbirths notified during the weekwas 264 (corresponding to a rate of 38 per 1000 births),including 44 in London.

ENLARGEMENT OF BURTON INFIRMARY.-Exten-sions to Burton-on-Trent General Infirmary are beingmade at a cost exceeding £17,000. The work includesan enlargement of the out-patients’ department, and theerection of a new X ray department with the necessaryaccessories, a casualty ward with a new dispensary, a throatand ear department, and improved accommodation fornurses.