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examination; (3) that four places were reserved forthe sons of distinguished medical men; and (4) thatonly five places were reserved for women students.

Broadcasting Epidemiological Information.It was decided at a conference attended by delegates

from 12 Far Eastern administrations that the firstappearance in any part of Asia or Australia of cholera,plague, small-pox, yellow fever, or the unusual pre-valence of any other infectious disease, should beimmediately reported to the Far Eastern Epidemio-logical Bureau, and that a weekly bulletin should bedespatched recording : (1) The mortality from thesediseases ; (2) the existence of plague infection amongrats; and (3) notes of unusual epidemics. Theinformation collected by telegraph from the variousGovernments is broadcasted by the Government ofFrench Indo-China from their wireless station atSaigon, and in India this information is received atSimla by the Public Health Commissioner with theGovernment, and then distributed to the healthofficers of the large Indian ports, who have thus, eachSaturday morning, detailed information regarding thehealth of the major ports of the Far East up to themidnight of the previous Saturday.

Extended Distribution of Anti-Rabic Vaccine.The Pasteur Institute at Kasauli is now issuing

vaccines on a large scale to various centres for anti-rabic treatment. Prior to Jan. lst of the presentyear, the only regular issue of vaccine was to a railwaycentre at Allahabad, but recently a centre was openedby the Punjab Government at Lahore, one atRawalpindi for soldiers, and another at Rajkote, inKathiawar, and these are likely to be followed by ,,others in various parts of India. The Behar andOrissa Governments have decided, moreover, to opena centre and make their own vaccine. These develop-ments enable patients to be treated in their owndistricts.

Child T,,Ve7.jare Work in Madras.The Government in reviewing the report on child

welfare work for the quarter ending March 31st, 1925,state that only three district boards, 23 taluk boards,and 34 municipalities have sent in reports of theirwork. There are only 45 centres in the Presidencyfor a population of over 43 millions. The districts ofCuddapah, Kurnool, Guntur, Nellore, and Malabardo not possess a single child welfare centre. On theother hand, there are eight centres working in theChittoor district, and among the remaining districts,three-the Nilgiris, Vizagapatam, and Chingleput-have four centres each, two others have three centreseach, six have two each, while the rest have onecentre each. The municipalities of Chingleput, Madura,Vellore, Tanjore, and Ootacamund have each of themtwo centres, the two at Chingleput having beenorganised and maintained by the Red Cross Society.Only seven new centres were opened in the Presidencyin the year under review, in spite of the Government’sspecial appeal in the last year’s review. Thirteenlocal bodies have organised committees for intensivechild welfare propaganda and the inauguration ofnew centres wherever feasible. To facilitate theopening of more child welfare centres and theirefficient working the Government have decided, as anexperimental measure, to train four women as healthvisitors with a view to their subsequent employmentby local bodies.A successful " Baby Week " was recently organised

in Poona.

Training and Employment of Qualified Midwives.Only 17 municipalities and eight taluk boards are

so far known to have employed qualified midwivesin their service. Of these, four were appointed duringthe year under review by the municipal councils ofVillupuram and Cuddalore, and the taluk boards ofPerambalur and Koilkuntla. The appeal made by theDirector of Public Health to the local bodies to takesteps for the training of midwives did not meet withsufficient response. The supervision of the work of

trained " dhais " and the improvement brought aboutby training do not seem to have been adequate.

Medical Inspection of School-children in Madras.The system of inspection of pupils in recognised

: secondary schools sanctioned in 1920 is now to be, put into force. The inspection will be confined forthe present to recognised secondary schools for boys,school departments of colleges and training schools,and will be carried out annually by local practitionersselected by the local boards of management or theDirector of Public Instruction in consultation with theSurgeon-General. The aim will be to ascertain thegeneral physical condition of the pupil, the treatmentof those suffering from disease being left to the parents.The management of the school undertakes to maintainthe records and submit the required returns.

Meagre Hospital Facilities in Bombay.The Government of Bombay has addressed the

municipality on the subject of the inadequate hospitalaccommodation provided in Bombay, in comparisonwith its population and importance. The numberof beds available for the treatment of general diseasesis only 526, or approximately 1 bed for every 2000of the population. On making a comparison with theother leading cities of India, it has been found thatthe number of beds per 1000 of the population is asfollows: Lahore, 7-2 ; Madras, 3-4; Calcutta, 2-6 ;Bombay, 0-5. The Government call for a conferenceto discuss the subject of medical relief in the greatcity which has been aptly called " The Gateway ofIndia."

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Public Health Services.REPORTS OF MEDICAL OFFICERS OF HEALTH.THE following are some of the health statistics of

six counties for 1924 :—

S1..1rrey.Dr. Joseph Cates reports that the infant mortality

and general death-rate are slightly higher than in1923, and that influenza and its respiratory complica-tions were among the causes of this increased death-rate. The county council now has a comprehensiveand compact scheme for all branches of home visita-tion which has been evolved so as to obviate over-lapping. The county is divided into 12 areas.

In each area there is an assistant medical officer,who carries out school medical inspection and treat-ment, maternity and child welfare and dispensaryduties. Three or four health visitors, who are fullytrained nurses and hold the certificate of the C.M.B.and the health visitors’ certificate of the RoyalSanitary Institute, are allocated to each area. Thesehealth visitors carry out antenatal and birth visita-

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tion, follow up defects discovered in the scholars ofthe elementary and secondary schools, inquire intotuberculosis, supervise the mentally and physicallydefective, and visit the blind.

Surrey now has an organised scheme for the dis-covery and treatment of crippling defects. Childrenare referred to the assistant medical officers by thehealth visitors, teachers, school attendance officers,and voluntary workers, and after examination aresent to the orthopaedic centres included in the scheme.Children of school age, who reach the centres on theadvice of medical practitioners and other agencies,are seen by the ’assistant medical officers beforethe committee accepts liability for treatment. Theapproved orthopaedic centres are the Guildford CountyHospital, the Croydon General Hospital, the NelsonHospital at Raynes Park, and the aid-posts of theRed Cross Society at Kingston and Woking. Ateach centre there is in attendance an orthopaedicspecialist and nurses trained in massage, electricaltreatment, and plaster work. Minor operationsare carried out at the centres ; major operations inone of the hospitals mentioned or a London hospital.For certain of the patients prolonged in-patienttreatment is necessary, and 50 beds at the homes ofthe Waifs and Strays Society at Pyrford have beensecured for the purpose. These homes are recognisedby the Board of Education and are well equippedfor the operative treatment and education of cripples.The county council pay 3s. per attendance at thecentres for cases referred by their assistant medicalofficers and £104 a year for each occupied bed atPyrford. , - - -. - - -

Dr. Cates refers to the complaints, which are madefrom time to time by the Surrey local sanitary autho-rities, as to the dumping of refuse by certain of themetropolitan borough councils, and is emphatic thatthe time has arrived when urban communities shoulddestroy their refuse in a properly constructeddestructor. During the present year a survey will bemade of the methods adopted throughout the countyfor the disposal of refuse. A report on isolation hospitalaccommodation in the county indicates the need forsome reorganisation. For example, the FrimleyUrban District Council’s hospital at Mytchett isquite unsuitable, and diphtheria cases from thisdistrict are already sent to the Farnham Hospital.Dr. Cates considers that the Frimley hospital shouldbe closed and all cases of infectious disease sent tothe Farnham or some other hospital. Again, atRedhill are the well-constructed hospital of Reigateborough and the antiquated, unsatisfactory hospitalof Reigate district, whereas the former buildingwould serve both areas. A third recommendationis that the Epsom Urban District Council shouldclose their hospital and arrange for their patientsto be admitted to the Joint Hospital at Cuddington.The report for 1922 contained a complete survey ofthe Hogsmill ; that for 1923 a survey of the Wandle -,and the present report contains a survey..of theBeverley Brook. The condition of the BeverleyBrook, says Dr. Cates, is not so serious as that of theRiver Wandle, but furnishes additional evidence thatthe county council needs supplementary powers toenable them to deal satisfactorily with the conditionof the rivers in the county.

Wiltshire.Dr. Claude E. Tangye reports an increase in the

prevalence of encephalitis lethargica, there being12 cases notified as against three in 1933. Four of thecases ended fatally and most of the survivors suffereddamage to the nervous system. Five children ofschool age survived the disease with impaired mentalityand a sixth with facial paralysis. Other cases of thisdisease have occurred which were not notified atthe acute stage, but only diagnosed by the after-effects. The orthopaedic clinics which have beenstarted at Devizes, Trowbridge, Corsham, andSwindon in connexion with the Children’s OrthopaedicHospital at Bath, have been of great value to thetuberculosis scheme. Dr. Tangye points out that the

notification of tuberculosis is still incomplete and thatabout one-lifth of the deaths from tuberculosis in1924 were unnotified cases. An arrangement hasbeen made with Swindon whereby midwives notifyall cases of dischargiug eyes, however slight, to theborough medical officer of health. Under thisscheme 13 notifications were received by Dr. D. Brewer,the Swindon M.O.H., and the cases were subse-quently treated at the borough child welfare clinicwith most satisfactory results. The health visitors ofthe county council supervise boarded-out childrenfor most, but not all, of the boards of guardians inthe county. In consequence of the relatively highrate of maternal mortality in the county, the districtmedical officers of health were asked to furnishdetails of all deaths from complications of child-birth in return for a small fee. A number of suchreports have been received, but it is too early tojudge of their value. There are now six maternityand child welfare centres in the county. The centreat Trowbridge is the only one administered directlyby the county council, the others being undervoluntary committees. Antenatal work has beenbegun at the Trowbridge centre, and the employmentof practitioners of special experience in this workis a question which is receiving careful consideration.The report on the sewage works of the county shows

that there is considerable pollution of the rivers bya large number of unsatisfactory effluents. Only onelicence has been issued by the county council underthe Milk Designations Order-namely, for Grade Amilk. The shortage of houses in ’vlriltshire is stillacute and very little is being done in the matter ofthe inspection and repair of insanitary houses.Dr. Tangye reports that the provision, by which thelocal sanitary authority can carry out repairingwork in the default of the owner and charge theowner with the cost, is practically never used. Itis surprising to learn that there are four ruraldistricts which have no building by-laws. Ofthese, says, Dr. Tangye, " the Bradford-on-AvonRural District is conspicuous for the activity ofbuilding operations quite uncontrolled by the localsanitary authority."

Northamptonshire.Dr. Charles E. Paget notes the passing of the Thames

Conservancy Act, 1924, as one of the important eventsof the year. By this Act the jurisdiction of theThames conservators has been extended to sixadditional counties-viz., Northamptonshire, War-wickshire, Worcestershire, East and West Sussex,and Bedfordshire. The effect of the Act is to bringall sources of sewage pollution of the River Cherwelland its tributaries within the rural districts ofBrackley, Daventry, and Middleton Cheney under thesurveillance of the conservators. When the Billcame before Parliament there were three seriouspollutions of the Cherwell. In respect of two of theseaction had already been taken, but the Brackley R.D.Council had refused to carry out a scheme for Kings-Sutton on the grounds of expense. Dr. Paget pointsout that the standard of purity required by theThames Conservancy is much higher than thatadopted by any authority enforcing the RiversPollution Act. Presumably the Brackley R.D.Council will have to come into line. Dr. Pagetreports an increase in the prevalence of encephalitislethargica. There were 19 notifications in 1924,as compared with 6 in 1923 ; 9 of the cases endedfatally ; 7 of the 9 deaths occurred at or over theage of 45.The inspection of dairy cows in the county during

the year was interfered with by outbreaks of foot-and-mouth disease. To Dr. Paget’s regret, veterinaryinspection is not in operation in all parts of thecounty. There are two joint committees in the countyfor veterinary inspection and the results judged bysuccess in finding cows with tuberculous udders area curious contrast. Thus the veterinary inspectorof the Kettering Joint Committee found six cases

of tuberculous udders among 3808 cows, while the

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veterinary inspector of the Wellingborough JointCommittee found 16 tuberculous udders among2076 cows. The county analyst, Mr. K. W. Voelker,reports that nearly 10 per cent. of the 371 milk sampleswere adulterated, 26 being deficient in fat and 10being watered. The proportion of butter samplescontaining boric acid preservatives was much lessthan in 1923. One reads with interest that twosamples sold as " ginger brandy " were non-alcoholicsyrups flavoured with ginger, while a beverage withthe innocent name of " cowslip wine " contained29 per cent. proof spirit.

F6M*MC/M7’<;.Dr. A. Hamilton Wood reports a considerable

.amount of progress in the matter of prevention ofriver pollution. The activities of the Upper TameBasin Joint Committee have stimulated the authoritieswhose effluents were polluting the Tame before itreached Warwickshire. The Birmingham Tame andRea District Drainage Board have introduced manyimprovements including bio-aeration plants, and agreat improvement is expected in the quality ot theeffluent of 30,000,000 gallons per day dischargedinto the Tame below Water Orton. The conditionof the River Cole is also improved. Important recon-structions have been carried out at the sewage worksof both Hinckley and Nuneaton, which will improvethe condition of the River Anker. The Avon is stillpolluted by sewage from the city of Coventry, butit is expected that an improvement will shortly resultfrom the installation of the bio-aeration plant whichis now in progress at the city sewage works. Theeffluents from the Warwick sewage farms and theLeamington sewage works are still unsatisfactory.The county analyst, Mr. Rigby, reports that the

average composition of the milk samples analysedduring the year showed 8-75 per cent. of non-fattysolids and 3.88 per cent. of fat. For the first and fourthquarters of the year the average was about 8.74 percent. of non-fatty solids and 4-02 of fat. For the twomiddle quarters of the year the non-fatty solidsaveraged about 8-76 and the fat 3-73. The fat wasthus 0-3 per cent. higher during the winter quarters.The record of the V.D. clinics shows an increase innew cases dealt with from 179 in 1923 to 264 in 1924.The patients who ceased to attend without completingtreatment numbered 116, while only 40 were dischargedafter the completion of treatment. Dr. Wood, referringto the statement of the Ministry that no Exchequergrants are available towards the cost of the trainingof midwives, points out that local expenditure eitherfrom voluntary or rate-aided sources must be increasedif the efficiency of the county midwifery service isto be maintained.

In view of the high maternal mortality from child-birth provision has been made for complicatedmidwifery cases at several hospitals and at the countymaternity homes at Warwick and Rugby. TheWarwick home admitted six antenatal cases and theRugby home 12 antenatal cases during the year.Only 144 new cases attended the antenatal clinics,while the number of births in the county was 6722.Both of the county homes have been recognised bythe Ministry as training institutions for midwives.There were 34 notifications of ophthalmia neonatorumwith no cases of impaired vision. This result isattributed to the routine use of a colloidal silverpreparation by the midwives introduced in 1919 andperfected in 1920. The following are the cases ofblindness in infants from ophthalmia neonatorumduring the last nine years :-

ecess/n’re.

Dr. T. Robinson reports an effort towards the produc-tion of cleaner milk in the county. The county labora-tory is to be extended and its staff increased in orderto deal with milk samples’sent by the district councils.]3oth the district councils and the vendors will beinformed of the result of the examination. A cleanmilk competition was held during the year, for which20 farmers entered. For the competition six sampleswere sent by the competitor and one surprise samplewas taken. A steady improvement was noticed inthe samples as the competition progressed. Of the20 competitors eight produced Grade A milk in eachof the seven specimens, while only one competitorfailed to produce Grade A milk in any of the sevensamples examined. The Ministry have issued fourlicences for Certified milk and one for Grade A (tuber-culin tested), while the county council have issuedGrade A licences to three producers. Small-poxwas introduced into the county in December, 1923.There were 98 cases reported during 1924. The diseasewas of a mild type and caused no deaths.

Fife.Dr. G. Pratt Yule, in referring to the fact that the

Board of Health has issued an Order making infectivejaundice compulsorily notifiable, states that thisdisease appears to be associated with a similar condi-tion in rats and that it has occurred among minersin the county in the past, but would appear to havebeen limited to pits in the Lochgelly-Cowdenbeatharea. During 1924 seven lupus patients were sentto Edinburgh to receive treatment at Sir NormanWalker’s arc-light clinic at the infirmary. Dr. Yuleand Dr. McGillivray (the tuberculosis officer) weremuch impressed with the results obtained at thisclinic. They saw one case, who had been attendingthe infirmary for 40 years trying all kinds of treatmentwithout benefit, and whose lupus was practicallyhealed after four months of the light treatment.They recommended that a similar clinic be establishedat the county sanatorium at Glen Lomond. Dr.W. P. S. Johnson, the medical officer of the Dunferm-line V.D. centre, reports that, as compared with1923, there is an increase in the percentage ofgonorrhoea cases and a decrease of syphilis cases.

The percentage of cases which cease to attendbefore the completion of treatment was 13-3, whichcompares very favourably with the experiences ofother centres. Dr. Johnson points out that theclinic in Market-street is unfortunately situated ;for one thing, it is at a distance from the hospitalwhere the in-patient treatment is carried out, butthe principal objection is that the position is so exposedthat prospective patients are deterred from attending.Housing conditions are still difficult, and the needis particularly urgent in the mining districts ofKirkcaldy and Dunfermline. No applications havebeen made for licences to sell graded milk.

INFECTIOUS DISEASE IN ENGLAND AND WALESDURING THE WEEK ENDED AUGUST 29TH, 1925.

Notifications.-The following cases of infectious diseasewere notified during the week : Small-pox, 37 ; scarlet

fever, 1362 ; diphtheria, 787 ; enteric fever, 84 ; pneumonia,449 ; puerperal fever, 41 ; cerebro-spinal fever, 6 ; acute

poliomyelitis, 12 ; acute polio-encephalitis, 2 ; encephalitislethargica, 34 ; continued fever, 1 ; dysentery, 8 ; ophthalmianeonatorum, 109. There were no cases of cholera, plague,or typhus notified during the week.Deaths.-In the aggregate of great towns, including

London, there was 1 death from enteric fever, 20 frommeasles, 5 from scarlet fever, 40 from whooping-cough,12 from influenza, and 27 from diphtheria. There were218 deaths of children under 2 years from diarrhoea andenteritis, as compared with 177, 136, 108, 101, and 64 inthe preceding weeks. In London itself there were 10 deathsfrom diphtheria, 5 from whooping-cough, and 1 frominfluenza.