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The arrangements for the registration and inspection of slaughterhouses and the inspection of meat were deemed to be so unsatisfactory in one County that special action was taken. This action took the form of a conference, convened by the County Medical Officer of Health at the suggestion of the Department, of the Sanitary Officers of the Sanitary Authorities in the County. The conference was also attended by representatives of the Agricultural Department of one of the Welsh University Colleges as well as by one of the Department's Medical Officers. The opinion of this conference was that the number of slaughterhouses in the County should be reduced and the slaughtering centralized if possible in public abattoirs controlled by the Local Sanitary Authorities. Arrangements are being made for a further general conference, to which representatives of the Local Authorities, local butchers and farmers will be invited, and it is hoped that eventually a satisfactory solution of existing difficulties will be reached.

TUBERCULOSIS.

Notification.

The following table shows the total number of new cases of tuberculosis included in the annual returns furnished to the Department by Local Authorities in Wales in connection with the Public Health (Tuberculosis) Regulations, 1912, during each of the past ten years:

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Note. For the years 1923-27 inclusive the figures include all new cases coming to the notice of the Medical Officers of Health of Administrative Counties and County Boroughs, whether as a result of notification under the Regulations or otherwise, and are not strictly comparable with the figures for previous years.

For the first time, the returns for 1927 have shown the sources of information from which new cases, not formally notified, were

obtained. In 1927 there were 382 such cases, and it is unsatisfactory to record that 159 of these were discovered as the result of the examination of death returns.

This new information has revealed that in some cases the recommendations outlined in Circular 549 (Wales) of the 31st December, 1924, are not being carried out. The attention of Local Authorities concerned has been drawn by correspondence to any irregu larities discovered. In the case of one Local Authority, special statistics furnished showed that approximately one-third of the new cases in recent years died in the same year in which they first came under notice. It was suggested that the matter should be specially investigated locally. Unfortunately there is still evidence that patients frequently defer seeking medical advice until they are in the last stages of the disease.

Cases on Registers of Notifications.

The following table shows the number of cases of tuberculosis remaining on the registers of the Medical Officers of Health in Wales on the 31st December, 1927:

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These statistics are based on returns furnished by Local Authorities under Article 2 of the Public Health (Tuberculosis) Regulations, 1924.

The total of 19,433 cases compares with 18,957 cases on the notification registers on the 31st December, 1926. The number should be accepted as an under-statement of the actual number of cases of tuberculosis in the Principality. The Department are satisfied, however, that more attention is now being paid than formerly to the periodical revision of the registers, as well as to the discovery of cases proper for entry in the registers.

Deaths from Tuberculosis.

The number of deaths from tuberculosis in Wales recorded for each of the last ten years is as follows:

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The figures for 1927 may be set out in more detail as follows:

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There has been a substantial decline in mortality from tuberculosis of the respiratory system in Wales and Monmouthshire since 1911. The decrease between 1911 and 1921-5 for the several classes of areas is shown in the following table. Since the 1921-5 period there has been for Wales (all areas) a further decline of

sex:

4.3 per cent. for the male sex and 4.9 per cent. for the female

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* For the years 1911-20 deaths from miliary tuberculosis were included under " Pulmonary" tuberculosis, but from 1921 onwards they have, by international agreement, been included under Other forms" of tuberculosis. Deaths from miliary tuberculosis in Wales during 1911-20 accounted for 1.7 per cent. of the total number of deaths from tuberculosis (all forms). It follows that the actual decline in mortality between 1911 and 1921-5 was rather less (probably some 2 per cent.) than is indicated in the last three columns of the above table.

It will be seen that the decline in mortality from tuberculosis of the respiratory system in Wales since 1911 has been greater for the female sex than for the male sex. For 1911 there was an excess of female over male mortality in Wales, but for the period 1921-5 there was a slight excess of male over female mortality. The figures for 1926 and 1927 show that this slight excess has continued.

Nevertheless the mortality of females in Wales is relatively high when compared with the mortality of females in England and Wales. The male standardized death-rate in Wales during 1921-5 was 3 per cent. less than the corresponding rate in England and Wales. The female death-rate in Wales, however, was 28 per cent. higher than the corresponding rate in England and Wales. An excess mortality was shown for females at all age periods, reaching 36 per cent. at ages 15-25 and 31 per cent. at ages 25-45.

Mortality from tuberculosis of the respiratory system in Wales, as in England and Wales, is at its highest in the County Boroughs; for 1921-5 the rate for County Boroughs was 15 per cent. higher in Wales than in England and Wales. The death-rates in the rural districts in Wales compare most unfavourably with those in England and Wales; for the rural districts the mortality in Wales during 1921-5 was for the male sex 27 per cent., and for the female sex 44 per cent., in excess of the respective mortalities recorded for the rural districts of England and Wales, and for both

sexes there was an excess mortality at all age periods. The high death-rates in the aggregate of the rural districts of Wales are accounted for largely by the exceptionally heavy mortality experienced in the six western counties of Wales. This aspect of mortality from pulmonary tuberculosis in the Principality was dealt with in last year's Report.

Public Health (Prevention of Tuberculosis) Regulations, 1925.

On the 30th June, 1927, an Order was made declaring the Council of the Administrative County of Merioneth to be an Authority for the purpose of executing and enforcing the Public Health (Prevention of Tuberculosis) Regulations, 1925. Six County Councils in Wales have now been declared to be Authorities for enforcing these Regulations.

The King Edward VII Welsh National Memorial Association.

The provision of treatment for tuberculosis in Wales is carried out by the King Edward VII Welsh National Memorial Association, on behalf of the several County and County Borough Councils, under agreements with the respective Councils.

From the financial year 1921-22 onwards the seventeen Councils have contributed towards the cost of the Association's scheme at a maximum rate of one penny and one-third in the pound on actual assessable value. Owing to a somewhat considerable reduction in the assessable value for 1927-28, the Councils agreed temporarily for this year to increase the rate to approximately 1.4d. in the pound.

The gross expenditure on the maintenance of the Association's scheme for 1927-28 was £180,500, towards which the Local Authorities contributed £74,460. The corresponding figures for the year ended on the 31st March, 1927, were £183,868 and £73,979, respectively.

During the year 1926-27 the average number of beds occupied in Wales under the Association's scheme was 1,349. Of this number 1,331 beds were occupied at the Association's own institutions. The average cost per patient per week was 37s. 5d.; this compares with 38s. 7d. for 1925-26 and 39s. 11d. for 1924-25.

Kensington Hospital, Pembrokeshire.-During the year capital grant amounting to £7,903 was paid on the expenditure of £23,709 incurred in respect of the acquisition and adaptation as a hospital of the St. Brides Castle, Pembrokeshire. The property was purchased in 1921 for the purpose of providing residential treatment

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