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Public Health Services.THE MINISTRY’S INSTRUCTIONS TO M.O.H.’s.

CIRCULAR 1048 of the Ministry of Health, issuedon Dec. 5th of last year, indicates that the instructionsto medical officers of health on drawing up theirreports for 1929 are the same as for the previousyear, except that reference to action under thestatutory provisions repealed by the Nursing HomesRegistration Act, 1927, is to be disregarded. Thecircular gives notice that in future the Registrar-General will furnish to all medical officers of healthparticulars of stillbirths by sex and legitimacy,and the medical officer is asked to include theseparticulars in his report. In the 1928 reports nogeneral rule was observed. In some cases theregistered stillbirths were given, in some cases thenotified only, and in other cases there was no referenceto stillbirths at all. In the past it has been our usualpractice to discontinue comments on the annualreports after the close of the year of issue. The1928 reports were, however, issued somewhat laterin the year than usual owing, we understand, topressure in the Registrar-General’s office, whichdelayed the sending out of the usual statistical informa-tion to medical officers of health. We proposetherefore to continue our comments on the 1928reports for some issues in the new year.

REPORTS OF MEDICAL OFFICERS OF HEALTH.TEN METROPOLITAN BOROUGHS.

THE following are some 1928 statistics of tenmetropolitan boroughs :

Relation of stillbirths to live births : Chelsea, 1.9 per cent. ;Hackney, 3-7 per cent. ; Hampstead, 3-6 per cent. ; Islington,2-5 per cent.; Poplar, 3-1 per cent.; Wandsworth, 2.0 percent.; and Woolwich, 3-5 per cent.

Chelsea.Dr. W. H. L. McCarthy’s report shows that full

use is made of the many voluntary agencies in theborough. Thus the Chelsea Health Society and Schoolfor Mothers, which employs four " part-time

" medicalwomen and a staff of health visitors, conducts theclinics and treatment centres in return for a subsidy of750. Lady Melchett is the chairman of the committee,and she and Lord Melchett have purchased a large site

adjoining the society’s present premises with a viewto erecting thereon a new maternity and child welfarecentre. The tuberculosis dispensary is located at theBrompton Hospital, and the tuberculosis officer, Dr.W. J. Fenton, is one of the honorary physicians to thehospital. The borough council makes an annualgrant of 61000 to the hospital and an additionalpayment of JE160 for home visitation by the nurses.The borough council also subsidises the NursingAssociation, the Day Nursing, and the InvalidChildren’s Aid Association, and has representationon the committees of these voluntary societies.Payments are made to the Ormond Maternity Home(six beds), the only institution of this kind in theborough, for the admission of necessitous maternitycases, and also to private midwives for domiciliaryattendance, the net cost to the council for theseservices being 28 10s. 6d. for 1928.

Complaints of a serious nuisance from the emissionof smoke and grit by the generating station of theLondon electric railways in Lot’s-road gave rise to aconference and the promise of the installation ofnew boiler plant and suitable grit-arresters. Owingto the overflowing of the Thames on the night ofJan. 6th-7th, 33 basements and ground floors ofinhabited premises were flooded, resulting in muchhardship and distress, and the ruin of a large amountof furniture and household equipment. Energeticrelief measures were adopted and no outbreak ofdisease was traced to the flood. An interestingsurvey of housing is given. A great part of Chelseais comprised in the Cadogan and Sloane Stanleyestates, and with the expiry of the leases the old typeof small house has largely disappeared, and duringthe last 30 years some 18,000 Chelsea residents of theworking and small trader class have had to migrate.Up to the war various trusts had however providedaccommodation for 7000 persons of this type. Sincethe war the position has been more difficult fortenants of small means. The borough council hasprovided a block of 56 flats at a weekly rental,including hot water and electricity, of from 25s. to:61 14s. 3d. Two other schemes are in hand for theerection of working-class dwellings by the Guinnessand Peabody Trusts respectively. Overcrowdingexists mainly in the western district and has beenlittle improved during the year. An effort is made tomove overcrowded families to the housing estatesof the County Council, 39 such families having beenmoved during the year, but in many cases the tenant sobject to being removed so far from their work. Animprovement scheme known as " World’s EndPassage " in the western district has been approvedand will result in the erection of 62 flats for 379

persons on the cleared site. There are a large numberof houses let in lodgings with insufficient accommoda-tion and conveniences for the several occupyingfamilies. Other problems are the dirty and destructivetenant and houses occupied by old people unable tolook after themselves. It is hoped to deal with thelatter under the L.C.C. Act, 1928, by removal tosuitable institutions.

Hackney.Dr. G. H. Dart mentions that a diphtheria immuni-

sation clinic, conducted by Dr. F. J. Porter-Smith,has been opened. The work has proceeded smoothly.but it is thought that the education authority mightgive more assistance in making the clinic known.The certificates of immunity granted numbered 292and 133 children were under treatment at the endof the year. Good results are claimed for the lighttreatment clinic by Dr. Dorothy Gere. The 111 cases.treated included 39 of malnutrition, 11 of failure togain weight without apparent cause, 21 of rickets,9 of marasmus, and 8 of debility after acute illness.Dr. Dart considers that the restrictions put by theMinistry on the supply of nursing assistance and milkto mothers are unreasonable. He also describes thedifficulty experienced in getting adequate repairs todilapidated property carried out. The boroughcouncil have in hand the erection of 132 flats and92 maisonettes.

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Hampstead.In 1925 it was estimated that some 2000 Hampstead

families were living in an overcrowded condition.During 1928, as the result of the borough council’s.action, 110 families were "1oved to the L.C.C. estates.at Wormholt and Watluig, making with previousremovals a total of 142. The inclusive weekly rentsof the houses on the Wormholt estate varied from14s. for a three-roomed flat to 21s. 6d. for a five-jfoomed cottage. The Watling rentals are somewhat’higher. When a house has been vacated by such aremoval, there is no power to prevent its beingimmediately overcrowded again, but, only power todeal with the new overcrowding after it occurs. Theborough council has, however, been most successfulin preventing recurrence of overcrowding by gettinginto touch with the person responsible for thereletting of the vacated house. Nearly half of thetotal births (1001) occurred in hospitals or nursinghomes. An analvsis was made of the availablehousing accommodation in 340 of the 538 births’which occurred at, home. Of these 340 births-11-5 per cent. occurred in one-roomed tenements,:34.4 per cent. in two-roomed, and 40-9 per cent. inthree-roomed. In three of the one-roomed tenements- there were 5 occupants and in one 6 occupants before-the birth. In one of the two-roomed tenements Ithere were 8 occupants, in two 9 occupants, and in- one 10 occupants prior to the birth of the baby.For the purpose of this investigation kitchens werecounted as rooms, but not sculleries, bathrooms, &c.The borough council subscribes 1 for every Hamp-stead mother confined in Queen Charlotte’s Hospital.’The municipal prematernity clinic is conduct,ed by,a "part-time" lady doctor and was attended by320 new cases.

Dr. Frank E. Scrase reports that the by-law madeby the council as to the fouling of public footways-,by dogs on the lead came into force in September,and was well advertised, and that the council’decided to take action against offenders reported.during 1928. Convictions were obtained in four’cases.

7sHMfOM.Dr. G. Clark Trotter gives an instance where the

notification of births proved a check on the accuracyof registration. A birth was registered and on

investigation as to why it had not been notified, itwas found that a woman had adopted a child andTe-registered its birth as a child of her own and herhusband, an absent seaman. The Registrar-Generaltook proceedings and the woman was fined 10s. Thematernity and child welfare work is conducted atfour voluntary centres with a coordinating committee.The work includes antenatal, light, and dental clinics. ’,One centre has a postnatal clinic where the mothersare examined six weeks after confinement. Thebalcony of the " west " centre was fitted with vita- Ifglass during the year. An outbreak of small-pox inan Islington institution involved a large amount ofwork but did not affect the borough itself. In the ’,investigation of puerperal fever the MetropolitanAsylums Board have provided facilities for the’exa.mina.tion of swabs from persons attending theconfinement. In one fatal case of puerperal sepsisa swab from the eye of the hanòYB"oman in attendanceshowed Streptococcus viridans and in another a swabfrom the septic finger of a handywoman showednaemolytic streptococci and staphylococci. A summaryfrom the " Dawes " report is given showing thatIslington sends great quantities of refuse to dumpsin TTertfordshire, and that the management of thetipping is much better conducted than formerly.A circular was sent to all dairymen in the boroughasking them to prevent roundsmen from depositingbroken glass in the roadway. Owing to complaintsa to indifferent milk sold at the Dairy Show at theAgricultural Hall, the inspector went to a staB overwhich were two notices " Pure New Milk 2d. per- glass" and " Milk with cr"’q,1’VJ. added 0 per glass."

A 2d. glass of milk was purchased and found to bedeficient in fat 54 per cent.The 37 cases of overcrowding dealt with during

the year only represented a proportion of thoseencountered owing to the difficulty of finding otheraccommodation. Application was made to the L.C.C.for housing accommodation for 174

" special hard-ship " cases. During 1928 52 houses were demolishedunder a L.C.C. improvement scheme and 24 wereconverted into business premises. Successful prose-cutions under the Sale of Food and Drugs Act includeda considerable number for liniment of turpentine notin accordance with the R.P. standard and for prescrip-tions inaccurately dispensed.

Poplar. ’

Dr. W. Allan Young reports that the overflowingof the Thames affected 1141 houses and involveda large amount of work in the cleansing and dis-infection of premises. The flood waters left behind amore or less offensive sludge. Floor boards had tobe lifted, water pumped out from underneath. coalhad to be supplied for drying, and lime and dis-infectants were freely used. In July the flooding of18 houses in North Bow by the blocking of a mainsewer occurred and similar operations had to becarried out. In June a diphtheria immunisationclinic was opened at the new maternity and childwelfare centre in Wellington-road, under the chargeof Dr. F..J. Porter-Smith. At the close of the year29 children had been immunised and at the time ofwriting the report the numbers attending for treat-ment had considerably increased. In reply to aninquiry from the metropolitan boroughs’ standingjoint committee on schemes for dealing with acuterheumatism in children, the Poplar Council con-

sidered that if a rheumatism supervisory centrecould be established at one of the large generalhospitals, with sufficient beds for several neighbouringboroughs and a convalescent hospital with educationfacilities could be established by the L.C.C. or

M.A.B., cooperation between Poplar and adjoiningboroughs in a scheme might be possible.

Child welfare work is divided between the boroughcouncil and the Royal College of St. Katharine.Dr. H. St. H. Vertue, the consulting physician of themunicipal observation wards, shows that satisfactoryand permanent results were obtained in most of theill-thriving babies admitted. A children’s con-

sultation centre has been established at the LondonHospital and during the year 16 cases from Poplarcentres were referred to it. Antenatal work issteadily increasing and the popularity of the artificiallight clinics with the mothers is shown by an increasein the attendances of 3678 over the 1927 figure to10,128. For the first time on record there was nodeath from puerperal sepsis in Poplar. Dr. HaroldWaller, the senior medical officer of the Royal Collegeof St. Katharine, in his report deals with the campaignagainst the overclothing of children. He, of course,admits that artificial light treatment has its place andhas served a useful rôle educationally, but he goes onto show with illustrations how much good can beachieved by natural sunlight and fresh air in a gardensuch as they have at the back of the College.

Southwark.

Dr. H. Wilson reports, as outstanding features of thepast year, an outbreak of small-pox, which had notappeared in the borough for 20 years, and the holdingof a most successful health week and exhibition.There were 19 cases of small-pox, mot’v of the mildtype, with one death. The housing problem is stillacute and overcrowding can only be overcome bydeportation. Many residents, however, object tobeing removed from a central position to a distancefrom their work and, if they do move, not infre-quently return. During the year 133 families weremoved to the L.C.C. estates. One slum area ha beencleared and the preliminary steps with regard to asecond are in progress. Sutherland House has been

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purchased for the maternity and child welfare scheme,and the work of two centres has been transferredthere. Much antenatal work is done at Guy’s Hospitaland it is proposed to have special antenatal sessionsat some of the municipal centres. The tuberculosisofficer, Dr. J. T. Crowe, refers with satisfaction to thework done by the open-air schools for tnberculouschildren at Bermondsey and Clapham Common, andto the value of the L.C.C. scheme for the boarding outof the children of infectious tuberculous cases. Hethinks the results of light treatment at Guy’s Hospital,perhaps owing to poor food and indifferent homes,have not come up to expectations. This form oftreatment will probably be discontinued but Finsenlight treatment for lupus will go on. An importantpart of the health department work consists in theexamination of food arriving at the wharves, and thecertifying of food products exported to foreigncountries. Considerable damage and inconveniencewas inflicted by flooding at the north end of theborough and every assistance was given in thecleansing of premises and the drying of damagedbelongings.

St. Marylebone.Dr. Charles Porter mentions, as two noteworthy

occurrences a small outbreak of small-pox (30 cases withno deaths) which was limited to St. Marylebone Homeand Hospital, and the advancement of the Carlisle-street improvement scheme to a further stage. The

area to be dealt with is the largest ever representedin the metropolis, covers 7 acres, and affects 340premises and 2832 persons. The scheme now awaitsthe decision of the Ministry. Dr. Porter deplores thelarge number of registered food stalls in the marketstreets. The highways committee refuses registrationwhen storage accommodation is unsatisfactory, andthe necessary improvements cannot be carried out.Dr. Mabel Brodie has been appointed to conduct adiphtheria immunisation clinic and at the end of theyear 60 children under 5 and 29 over 5 had beencompletely immunised. The public analyst, Mr.J. F. F. Rowland, would like to see a standard fixedfor manufactured food products, such as lemon-cheese, which may now contain hardly any of theexpected ingredients.

St. Pancras.

Dr. G. Sowden mentions that the borough council’sSomers Town housing scheme reached a furtherstage, when the first block of 44 tenements wasopened by H.R.H. Princess Mary on July 25th,1928. Two further blocks of 44 flats are nearingcompletion. The weekly rents, inclusive of rates andwater. are 13s. 7d. for a two-roomed tenement,16s. 5d. for a three-roomed, and 18s. 8d. for a four-roomed. Each tenement includes a kitchen withgas cooker, copper, bath, sink, larder, and dresser.There is a shortage of housing accommodation forpoorer persons with irregular employment or largefamilies, and the housing provision made by theL.C.C. estates is beyond their reach. A cheaperhouse is urgently needed for such families, saysDr. Sowden, and should be centrally situated in orderto lessen the cost of travelling to and from work.Dr. Sowden objects to the method of calculatingmaternal mortality from childbirth. The rate isgiven per 1000 live births, but is swollen by theinclusion of deaths incidental to pregnancy in itsearly stages. For example, of 33 cases of puerperalfever recorded in St. Pancras during 1928, only 22,and of five maternal deaths only two, followed thebirth of a viable child. The remaining 11 casesand three deaths followed the occurrence of mis-carriages, the total number of which is an unknownquantity. Further, one of the four deaths classifiedas puerperal sepsis was found on investigation to bedue to procured abortion.

St. Pancras was visited by a severe epidemic ofmeasles, which began in December, 1927. Measles isnotifiable in St. Pancras, and for the first time duringan epidemic preference was given to measles over

scarlet fever, as regards admission to hospital. Dr..Sowden is disappointed with the results obtained butadmits that statistics on a larger scale are necessarybefore any definite opinions can be expressed-Baldly, the results were as follows : 426 cases wereadmitted to M.A.B. hospitals and 33, or 7-7 per cent.,died ; 242 cases were admitted to Highgate Hospital,of whom 58 died, or 23-9 per cent. ; while 2930 were-nursed at home, of whom 24, or 0-8 per cent., died.

1<XMSMO?’.

Dr. F. G. Caley says the residents of Wandsworth,are fortunate in having 1202 acres of parks and openspaces in their area of 9199 acres, and also in havingeasy access to Wimbledon Common and Richmond.Park. The council’s obstetric consultant, Dr.Leonard Phillips, investigates any maternal deaths,which present special difficulty. There were 88 casesof small-pox with no deaths, and in several instancespersons actually suffering from small-pox were foundfollowing their usual occupations. At two diphtheriaimmunisation clinics, by the end of the year, 713 caseshad been treated ; 621 were negative on retestingand 92 were still positive when last tested. In threeinstances children, who had been treated but werenot thoroughly immunised, had attacks of diphtheriaso mild as to be negligible. Special arrangementshad been made beforehand to deal with the usualbiennial epidemic of measles. Measles is not notifiablein Wandsworth, but a successful effort to search outthe cases at an early stage was made by close co&ouml;pera-tion between the health visitors and school nurses,.and eventually five temporary health visitors wereengaged to deal with the epidemic. Nursing or

admission to hospital when required were arrangedfor without delay. The cases found during the ninemonths of the epidemic numbered 4566, and thedeaths during the same period were 38. This is asmaller fatality than in previous epidemics of similarmagnitude. The number of cases removed to hospitalwas 236, but the case-fatality of the hospital-treatedcases is not given. About 300 premises were affectedby the Thames flooding. Energetic relief measureswere adopted and 40 children from the area involvedwere sent into the country for a fortnight by the-Children’s Country Holiday Fund.

14’oo,livich.Dr. J. Macmillan mentions as one of the important

events of the year the opening of the Woolwich WarMemorial Hospital. It is a general hospital with asmall maternity section and an X ray electro-therapeutic department. The Woolwich Council’have made capital contributions and reserve 12 bedsfor children under 5 years of age and accommodationfor 66 maternity cases per annum. They havealready provided for another 144 maternity cases atthe British Hospital for Mothers and Babies. Boththese hospitals have an antenatal clinic attended by-the mothers who are to be admitted and both provideantenatal in-patient treatment when needed. Theelectrotherapeutist of the War Memorial Hospital,.Dr. J. E. A. Lynham, conducts the municipal lightclinic which was opened in October, 1927. Hereports good results in debilitated children, marasmicbabies, and rickets. Of 471 cases who have beenunder treatment, 177 are classed as much improved orcured, 89 as improved, 39 as stationary, 93 as still’under treatment, and 73 as having ceased treatment.Dr. Lynham explains the large number who haveabandoned treatment by the fact that at the beginningthere was a boom and the mothers expected miracles,but on being disillusioned they found it inconvenientto attend, especially from a distance.The Eltham housing estate of the borough council’

will be completely developed by the erection ofanother 142 houses. The estate covers 334 acres andwill include 2176 houses, about half of brick and halfof " Easiform " concrete. There are 1438 " A

" houseswith three bedrooms, 696 " B " houses with three,

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bedrooms and a parlour, and 42 " C " houses with z’

four bedrooms and a parlour. The rent, inclusive ofrates, is " A " 14s. Id., " B " 16s. 4d., " C " 18s. 7d.There is no gas and the council supplies electricityfor lighting and also for cooking and heating whenrequired. Illustrations of the lay-out plans of thehouses and photographs are given. Complaints ofmosquitoes have gradually disappeared since theimprovement of the drainage of the marshes and thesubstitution of concrete inverts for the ditches.

A REVIEW OF SCHOOL MEDICINE IN 1928.

THE general impression left by the reports of schoolmedical officers for 1928 is that school medicineis making steady progress on several sides. Its

range is now extended to cover more ages, so thatthe ideal of continuous medical care from birth toadolescence appears to be almost in sight. The chainbegins with the maternity and infant welfare centres,which are more and more becoming linked-bycontinuity of staff and transfer of records-with thework in the schools themselves. Cooperation oftentakes the practical form of extending the schoolservice’s facilities for treatment to pre-school infants.The advantages of this are obvious, for example,in the early treatment of squint and of the effect ofpoliomyelitis.Then there are the gradually increasing nursery

schools, following the lines of pioneers like theMacmillan school at Deptford. As yet they are few,in number but their great value for many districtsis becoming recognised. At 5 years of age thechildren enter the infants’ elementary schools, wherethe commencing curriculum contains little beyondplay and health culture. They then pass through thesteadily improving ordinary schools, where theyreceive continued medical care, the more gifted goingon to central or even secondary schools. The otherchildren formerly passed out of view, but already insome places, such as Blackburn, efforts are beingmade to secure continuity by linking up with thework of the labour exchanges and the factory surgeons,.and when, as is promised, the lower age of insuredpersons meets the school-leaving age, real continuitywill be possible for all.

The continuity goes further than this, for it isnoted in several reports that the new entrants-thechildren of mothers who have themselves learnedhygiene, mothercraft, and self-respect in the schools-show in their cleanliness and well-cared-for appearancethe result of the influence of the school medicalservice-especially of the nurses and of the teachers.By these means a steady rise in the percentage ofdean and well-nourished children is being produced,so that the contrast between the children of to-dayand those of 25 years ago brought out in somemetrospective reviews-for example, the story atLeeds-is really remarkable.The activities of the school medical service have

- not only been extended (so to speak) lineally, but theyhave increased in quality and also in variety and scope.A notable example is the growth of schemes for dealingwith rheumatism. Already they have spread fromBristol over the neighbouring counties, and they are:also rapidly developing in London and other largecities, both observation clinics and special countryhospitals being provided. The rheumatism schemeis noteworthy as an example of how well medicalmen-in private practice, as hospital physicians,and as public health officials--can cooperate for thegeneral good.The inauguration of additional orthopaedic schemes

on the lines suggested by the Board of Educationhas been a great step forward. An increasing numberof authorities have made the necessary provision ofan orthopaedic consultant, with a properly furnishedclinic, hospital accommodation for in-patient treat-ment, and a special (physical defective) school. Insome rural areas, such as Gloucestershire, it is foundto be a useful expedient to have the services of specially

trained nurses to visit the homes of cripple children.Coordination and cooperation in the various branchesof the public health service itself are being increased,as, for example, at Hull where the work of the serviceis divided into four sections with arrangements bywhich each can come to the help of the other.

Physical Training and Open-air Schools.Cooperation is spreading to all the activities that

are concerned with the healthy development of thechild. School drill and exercises are being moreclosely supervised by experts, who themselves some-times go further and deal specially with cases ofpostural defects. It is a pleasing feature of recentreports that still more of them contain a section by thesuperintendents of physical training, and mentionmany agencies, sports, games, swimming camps,under their supervision, for as one of them says," good posture goes with good health and an alertmind." The need for open spaces is being forced uponpublic notice by the work of the Playing FieldsAssociation, and (less happily) by the increasingnumber of street accidents to children. Fortunatelythe need is being realised-e.g., at Scarborough,which is also one of the places remarkable for theimmense amount of help that is given by voluntaryworkers.

Open-air schools, moreover, are being establishedin town after town, and under the best possibleconditions; for instance, of that designed at Smethwick,the medical officer says " it will compare favourablywith the best in the country." The new ordinaryschools, designed in the light of the knowledge gainedby experiments at Torquay and elsewhere, will havein their buildings excellent conditions of hygiene andsanitation; such a school is mentioned in the reportof the M.O.H. of Dover.

Treatment and Special Accommodation.In treatment again there has been both extension

and improvement. It will before long be the exceptionfor children to be sent home after operation for tonsilsand adenoids without at least 24 hours as in-patients.It is true that under some authorities good resultsseem to be obtained without this precaution, butsuch happy circumstances can scarcely be universaland the further provision of beds will help to reducethe prejudice against these operations, and so preventthe unfortunate friction that has been occasionallyreported.

In the treatment of ear conditions, especiallyotorrhea, many aural surgeons obtained strikinglygood results with various forms of new technique,which are described in their reports. Considering thelarge amount of preventable deafness that existsand its gravity as an economic handicap, theserecent developments are worthy of close attention.The year saw only a slight growth in the number of

centres and classes for stammerers. A good deal isgoing on in London, and on a small scale in places likeEastbourne. and it is to be hoped that the exampleswill be followed, for this is pre-eminently a subjectfor a specially trained teacher, to work under theclose supervision of an expert medical man.Dental work is steadily making itself felt. It could

not be expected that the splendid results of the specialarrangements at Cambridge would be found elsewhere,but the majority of the reports indicate markedprogress ; no longer are the dentists obliged to spendall their time merely extracting septic and unsavableteeth, their objective is more and more preventiveand even educational. Skin diseases, which were sucha great source of trouble both to the school and thefamily doctor. are becoming much less of a bug-bear. Dirt diseases like impetigo are disappearingwith the better standards of hygiene in the homes : -,while ringworm is being dealt with successfully.Some medical officers have been getting good resultswith thallium acetate, but in the majority of casesX ray treatment is adopted, and, it is remarked,

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not infrequently sought for by parents on the adviceof their private doctor.

In spite of all the progress, there are two or threeconditions and defects for which accommodation is

.sadly needed and most difficult to obtain. The recent

.extension of the Epileptic Colony and School atLingfield is all to the good, but the vast majority of- epileptic children in the country have no provisionmade for them. The same thing is true for the victimsof encephalitis lethargica. This disease has beenstudied very seriously but therapeutic experimentshave yielded little but disappointment. One of the-chief results of experience has been to prove thatmost of those suffering from its after-effects are quiteunsuitable for institutions receiving the insane orthe mentally defective, and yet there is very littleof the special accommodation that they require.Still more hapless, if possible, is the fate of those whohave combined disability, such as paralysis and mentaldefect. They create difficulty in schools for cripples,for the mentally defective, and in residential schools ;while it is pitiable to think of them as entirely ignored.For all these groups it is to be earnestly hoped thatsomething may be done when the reorganisation ofthe poor-law is accomplished.

In the reports of the school medical officers areoften to be found researches on topics of generalmedical interest, such as rickets, dental caries, nutri-tion, the sequelae of encephalitis lethargica, mentaldeficiency, rheumatism, and even such special subjectsas the auditory ossicles. These are summarisedin the report of the Chief Medical Officer of the Board-of Education, and are noted from time to time inour own columns, but they deserve a wider audiencethan they generally receive.

INFECTIOUS DISEASE IN ENGLAND AND

WALES DURING THE WEEK ENDED

DEC. 21sT, 1929.

Notifications.-The following cases of infectiousdisease were notified during the week :-Small-pox,195 (last week 265) ; scarlet fever, 2916 ; diphtheria,1681 ; enteric fever, 31 ; pneumonia, 1077 ; puerperalfever, 35 ; puerperal pyrexia, 114 ; cerebro-spinalfever, 13 ; acute poliomyelitis, 3 ; acute polio-,encephalitis, 4 ; encephalitis lethargica, 15 ; dysentery,5; and ophthalmia neonatorum, 84. No case ofcholera, plague, or typhus fever was notified duringthe week.

The number of cases in the Infectious Hospitals of theMetropolitan Asylums Board on Dec. 24th-25th was as

follows : Small-pox, 367 under treatment, 5 under observa-tion (last week 379 and 8 respectively) ; scarlet fever, 2563 Idiphtheria, 2597 ; enteric fever, 39 ; measles, 614 ; whooping-- cough, 132 ; puerperal fever, 23 (plus 9 babies) ; encephalitis ’,lethargica, 119 ; poliomyelitis, 3 ; " other diseases," 8. AtSt. Margaret’s Hospital there were 12 babies (plus 6 mothers)with ophthalmia neonatorum.

Deaths.-In the aggregate of great towns, includingLondon, there were no deaths from small-pox, 6 (2)from enteric fever, 42 (10) from measles, 10 (1) fromscarlet fever, 18 (2) from whooping-cough, 53 (11)from diphtheria, 42 (9) from diarrhoea and enteritisunder two years, and 67 (10) from influenza. Thefigures in parentheses are those for London itself.

Two of the deaths outside London from enteric fever werein Liverpool and the others in Bootle and Cardiff. Wiganand Manchester both returned 6 deaths from measles, andMerthyr Tydfil, 4. In Liverpool there were 6 deaths fromdiphtheria, and in Bristol and Leeds 3 each. Liverpoolalso reported 6 deaths from diarrhoea and enteritis. Thelargest number of deaths attributed to influenza was inBrighton, where 8 were notified. In Birmingham there were5, in Manchester 4, and in Leeds 3, while Sheffield (last week’6) reported 2.

The number of stillbirths notified during the weekwas 251 (corresponding to a rate of 42 per 1000births), including 32 in London.

Parliamentary Intelligence.HOUSE OF COMMONS.

MONDAY, DEC. 23RD.Pensions and the Seven Years’ Limit.

Mr. BEAUMONT asked the Minister of Pensions the dif-ference between his policy and that of his predecessor withregard to the seven years’ limit for applications.-Mr.F. 0. ROBERTS replied : I would refer the hon. Member tothe statement which I made in the House on Nov. 18th.The primary points of difference in procedure in dealingwith this class of application are that no claim will berejected solely on the ground of the time limit ; that everyapplicant will be invited to state his case and to give evidencein support of it in response to specific inquiries tending toelucidate the claim ; that full consideration (includingmedical examination wherever necessary) will be given toall evidence submitted, and war pensions committees havebeen instructed to consider and investigate complaintsfrom applicants whose claims have been rejected, and toreport specifically on them to the Ministry ; and, finally,that in the determination of all cases of material doubt ordifficulty independent medical experts, nominated by thePresidents of the Royal College of Physicians and the RoyalCollege of Surgeons, will be regularly associated with theMinistry.

Factory Inspection in India.Mr. DAY asked the Secretary of State for India whether

according to the latest information he had, the factoryinspectorate in India had been increased during the previoustwo years ; and if he could give the total present number.-Mr. WEDGWOOD BENN replied : According to the latestinformation available the total of the inspectorate is 48,including nine part-time additional factory inspectors.This represents a reduction of one on the figure for a year

; previously. Tuberculous Milk.

Dr. HASTINGS asked the Minister of Health the averagepercentage of non-designated non-pasteurised milk on saleto the public which contained the living germs of tuber-culosis ; and whether this percentage was increasing ordecreasing.-Miss SusAN LAWRENCE, replied : The averageproportion of milk samples taken by the larger local authori-ties and found to be tuberculous has recently been in theneighbourhood of 8 per cent. The results obtained bydifferent authorities fluctuate considerably, and it wouldbe difficult to say that the percentage for the whole countryis either increasing or decreasing.

Dr. HASTINGS asked the Minister of Health if he couldsay, approximately, what percentage of the milch cows ofthis country were reactors to the tuberculin test ; andwhether this percentage was increasing or decreasing.-Miss SusAN LAWRENCE replied : The number of milch cowsin this country which have been submitted to a tuberculintest is relatively few, and it is not possible therefore to saywhat proportion would react to the test or whether theproportion is increasing or decreasing.

Doctors’ Telephones in Outlying Districts.Mr. RAMSAY asked the Postmaster-General if he was

aware of the conditions which prevailed in the WesternIsles ; and whether he would consider the advisability ofestablishing a telephone in each doctor’s house and school-house, or other convenient centre, in every parish of theseisles, in the interests of the medical, surgical, commercial,and social services.-Mr. H. B. LEES-SMITH replied : Thedistances between parishes in these islands are often greatand the cost of providing telephone services is usuallyprohibitive, but any case in which there is a reasonableprospect of the revenue not falling too far short of theexpenses is sympathetically considered.

Census and Occupational Mortality.Major HILLS asked the Minister of Health: (1) whether it

was proposed to utilise the forthcoming census to provideand publish statistics of occupational mortality in respectof both sexes ; and (2) whether he was aware that, whereas,consequent on the census of 1921, the Registrar-Generalpresented a report, with tabulated statistics, on infantmortality, with reference to the father’s occupation, nosuch report was presented with respect to maternal mor-tality ; and whether, in view of the unduly high rate ofmaternal mortality prevailing, he would consider thepresentation of such a report in connexion with the forth-coming census at an early date after the completion of thetaking of the census.-Miss SusAN LAWRENCE (Parlia-mentary Secretary to the Ministry of Health) replied :The question of compiling, consequent upon the 1931census, statistics of the mortality of married women by