been entered in the records during 1927 as having ceased to attend. Whilst the figures quoted above indicate a considerable measure of success on the part of the Treatment Centres in attracting patients to come for treatment, but a smaller measure of success in retaining the patients under treatment until rigid tests as to cure have been carried out, it has to be remembered that many of the cases which fail to continue their treatment, or to remain under observation until a cure can be pronounced, are rendered non-infective before ceasing to attend at the Centres. It should also be pointed out that there are many factors in operation, in addition to wilful default, which cause patients to cease attending at the Centres before the proper time. Some of the patients may have died, some may have removed to other areas without giving notice to the Centres, and some may have decided to continue treatment under private practitioners. Moreover, there are a number of patients who are constantly moving from place to place, and in some areas, particularly in port towns where a considerable proportion of the patients consists of seamen, the character of the occupation of the patients inevitably swells the total of the numbers who cease to attend before completion of treatment. No actual figures are available in regard to the several categories of cases mentioned above, but the records for 1927 show that, as regards patients removing to other areas, 3,174 cases of venereal disease. had received previous treatment for the same infections at other Treatment Centres. It is also found that many patients, although recorded in a particular year as having ceased to attend at the Centres, do in fact resume attendance at the same Centres for treatment of the same infection in a subsequent year. The number of cases of venereal disease who thus resumed attendance in 1927 was no less than 3,116. Financial. During the year ended on the 31st March, 1928, the Department paid grants in aid of venereal diseases schemes amounting to £291,997. This sum included £12,086 paid to Boards of Guardians, and £6,990 paid to the British Social Hygiene Council in respect of propaganda work approved by the Department. The net expenditure incurred by Local Authorities in England in carrying out their approved schemes during the year ended on the 31st March, 1927, was £367,335, being approximately £6,500 in excess of the net expenditure during the preceding year. The real increase in expenditure, however, was only about £2,500, as, owing to a change during 1926-27 in the basis on which the accounts. of two large Local Authorities are kept, a net expenditure of about £4,000, which would normally have been included in the accounts for 1927-28, appeared in the accounts for 1926-27. It may be pointed out that, in the last six years for which figures are available, an increase of 45 per cent. in the number of attendances at the Treatment Centres has been accompanied by a decrease of more than 16 per cent. in the expenditure of Local Authorities. Local Authorities have been informed of the maximum grants which will be available in aid of their expenditure during 1928-29, apart from the grants payable in respect of any developments which may subsequently be approved by the Minister. London Lock Hospital. In March, 1927, the London County Council, after a review of the arrangements made and required for the diagnosis and treatment of venereal diseases in London, decided not to renew after the 31st March, 1928, its arrangements with the London Lock Hospital. At the request of the Board of Management of the Hospital, the Minister has recently appointed a Committee to inquire into the administration of the Hospital. Maternity and Child Welfare. Steady progress has been made during the year in the development of this service, and special attention has been given to the care of mothers before, during and after childbirth. This is largely due to the general realization of the fact that the success achieved in recent years in the reduction of infantile mortality has not been accompanied by a corresponding fall in maternal mortality. Maternity and Child Welfare work is now being carried out by 48 County Councils, 79 County Borough Councils, 28 Metropolitan Borough Councils, 115 non-County Borough Councils, 118 Urban District Councils, 9 Rural District Councils and 2 Joint Committees of Urban and Rural District Councils. During the year the work was transferred in the case of three small Urban Districts to the County Councils, and a similar transfer was effected in three other Districts as from the 1st April, 1928. In two other cases the amalgamation of local government areas has resulted in a further reduction in the number of Local Authorities who are responsible for this work. GRANTS. The total amount of the grants disbursed in 1927-28 was £983,031, as compared with £909,644 in 1926-27, £765.477 being paid to Local Authorities and £217,554 to voluntary societies. The following table, containing an analysis of the net expenditure of Local Authorities in 1926-27, shows the various services administered by those Authorities in connexion with their Maternity and Child Welfare schemes, and gives the actual and proportionate expenditure on each service during that year : The total net expenditure shows an increase of 17 per cent. on that for 1925-26, which was £1,347,850, as stated in last year's Report. It should, however, be observed that a considerable proportion of this increase was due to the heavy expenditure on the supply of milk and food, to which reference is made below. The following table shows the grants paid to voluntary societies in 1927-28. The grant in respect of the first four services in the table is calculated on the expenditure eligible for grant which was incurred during the previous year, after deducting contributions by Local Authorities and payments by or on behalf of patients or inmates, while the grant for training is calculated on the number of students Training of Health Visitors and Midwives (Grants to ... £ 28,224 58,053 23,161 92,229 15,887 £217,554 HEALTH VISITING. There have been important developments in recent years in the training of Health Visitors, and on the 28th March, 1928, a circular (Circular 879) was issued reminding Local Authorities that on and after the 1st April, 1928, the Minister would not be able to approve the appointment of a woman for the first time as a whole-time Officer of a Local Authority with Health Visiting duties, unless she had obtained the new Health Visitors' Certificate under the conditions specified in Memorandum 101/M.C.W., which was issued in February, 1925. It was, however, announced that, in order to facilitate the taking of this Certificate by existing Health Visitors, the Minister had decided that they could be admitted to the examination for the Certificate after giving three, instead of five, years' satisfactory service. It was again emphasized that the position of existing Health Visitors should be fully safeguarded, and that their appointment by Local Authorities would be approved by the Minister without requiring further qualifications. There are now 10 institutions in England which are recognized by the Department for the training of Health Visitors. 153 students. completed their training during the year, of whom 117, in addition to 50 existing Health Visitors, obtained the new Certificate after passing the examination held by the Royal Sanitary Institute under conditions approved by the Minister. The circular mentioned above drew the attention of Local Authorities to the wide variations in the salaries and other conditions of service of Health Visitors, and suggested that the Authorities should give careful consideration to this question with a view to ensuring that adequate salaries are paid, and that the other conditions of service are satisfactory. There is evidence that difficulty is being experienced in obtaining candidates to undergo the necessary training for the work of a Health Visitor in consequence of the inadequate remuneration offered in many areas, and it is feared that there may be a shortage of suitable candidates unless they can be assured that there is a prospect of securing employment at reasonable salaries and under satisfactory conditions of service. The circular urged that, when the question of the remuneration of Health Visitors was under consideration, full weight should be given to the fact that all new entrants to the profession have now to devote 3 or 4 years to their training. Reference was also made in the circular to the fact that, in the case of women who have already devoted 3 years to their training as nurses and midwives, the expense of taking a six months' whole-time course of training in public health work, while earning no salary, has deterred some candidates from entering this profession, and alternative methods by which this difficulty has been overcome were described. In some areas in which the ordinary full-time course of training lasting six months has been provided, the candidates undertake to serve as Health Visitors in those areas for at least six months after obtaining the Health Visitors' Certificate, and they receive from the Local Authority during their training an advance of salary which is repaid during their first six months' period of service as Health Visitors. In other cases a course of training has been provided covering a period of not less than three academic terms, and including, as part of the practical instruction, actual health visiting by the students. The health visiting work is carried out under supervision, and the students are appointed by the Local Authority as probationer Health Visitors and are paid salaries not exceeding threefourths of the ordinary commencing salary of a Health Visitor. The total number of Health Visitors employed by Local Authorities on the 31st March, 1928, was 2,280. Of these, 946 were engaged wholly on Maternity and Child Welfare work, whilst the remaining 1,334 combined these duties with other public appointments, such as those of School Nurse or Sanitary Inspector. In addition, 341 Health Visitors were employed by voluntary agencies in connection with Infant Welfare Centres, and the services of 1,420 District Nurses employed by Nursing Associations were utilised by County Councils for health visiting work in rural areas. Approximately the equivalent of the whole-time of 1,869 women was devoted to health visiting at the end of the year. MATERNAL MORTALITY. Reference has been made in previous reports to the various directions in which Local Authorities can assist in diminishing maternal mortality. In a circular (Circular 517) issued on the 30th June, 1924, it was urged that action should be taken in every area to provide an efficient maternity service with a view to reducing the risks involved in childbirth, and special attention was drawn to the need for (i) ante-natal supervision and a largely increased number of Maternity Centres; (ii) the reference of difficult cases to obstetric specialists; (iii) the provision of more hospitals and homes for complicated midwifery cases, and for women whose homes are unsuitable for a confinement; (iv) the necessity for a high standard of practice by midwives; and (v) the education of public opinion in regard to the question of maternal mortality. It was also suggested that there should be an investigation in every area, by a competent and experienced medical officer, of all maternal deaths and of all cases of puerperal fever, with a view to ascertaining and preventing the causes likely to lead to maternal mortality. In last year's Report, a description was given of the measures which had been taken to secure the notification of all cases of puerperal pyrexia, and to enable medical practitioners to obtain any special facilities which may be needed for assistance in diagnosis, or for the treatment of patients who are unable to provide adequate treatment for themselves. In particular, Local Authorities were reminded of their powers to make provision, with the Minister's sanction, for the special treatment of women suffering from puerperal pyrexia, for consultation with an obstetric specialist, for skilled nursing, or for institutional treatment. Considerable progress has been made during the past few years in providing the necessary services. The number of ante-natal clinics has increased from 639 in 1924-25 to 847 in 1927-28, and the number of beds in maternity homes and hospitals which are recognised by the Department from 2,001 to 2,468. For cases of |