Educational propaganda for the prevention of tuberculosis has been conducted under the supervision of one of the Tuberculosis Physicians, who also acts as Superintendent of Education, and he is assisted by two organizers and lecturers. The travelling exhibition went on tour for several months through eight Counties (visiting 81 centres) in North and West Wales, and lectures and demonstrations were given to school children and others. Altogether, children from 149 schools attended the exhibition.

The total number of lectures and talks given during the year (including those in connection with the travelling exhibition) was 109 public lectures, and 676 talks or lectures to school children.

Statistics.-A Memorandum (No. 37/T) has been drawn up under which, as regards Wales, the Association will be required to furnish annually to the Department certain statistical returns giving general information as to the progress of the Association's scheme and the volume and character of the work carried out in connection with the dispensaries and residential institutions. These returns will also provide data for estimating the immediate results of treatment as indicated by the condition of patients when discharged from residential institutions.

The Association will retain for its own purposes the system of tabulation hitherto adopted, which in some respects is framed in greater detail than the form of returns required by the Department.

The following information relates to the work of the Association during the year ended on the 31st December, 1925 (the figures under head I are those approved in the Association's estimates for 1925-26):—

I. Number of Tuberculosis Physicians and Assistant Tuberculosis Physicians

Number of Medical Superintendents and other Medical
Officers of Institutions

Number of Sanatorium beds provided (4 Sanatoria)
Number of Hospital beds provided (12 Hospitals)

612

784

Number of Dispensary Areas ..

Number of Visiting Stations attached to Dispensaries

II. Total number of attendances at Dispensaries and Visiting
Stations

53,158

Cases under observation by Tuberculosis Physicians on the
31st December, 1924

New cases examined during 1925

2,809 10,067

Total number of cases examined by Tuberculosis Physicians

12,876

Analysis of the 12,876 cases examined (including 1,745 contacts) :—

(e) Cases still under observation on the 31st December,
1925

2,390

12,876

Of the 12,876 cases examined, 6,704 were males and 6,172 females.

III. Statistics of Cases referred for Treatment, 1925 :

cember, 1925 1,718

9162,634 2,839 1,371 4,210 843 407 1,250

Note. In the above table a number of the new cases would, of course, be included under more than one of the categories.

In addition to the number of new cases referred for domiciliary and dis pensary treatment during 1925 shown above, 546 old cases (288 males and 258 females) resumed domiciliary treatment, and 958 old cases (544 males and 414 females) resumed dispensary treatment during the year.

Grants. The total of the Exchequer grants paid to the Association in the financial year 1925-26 amounted to £101,882. Of this total, £1,584 was in respect of capital expenditure and £74,868 in respect of maintenance (£70,284 being the grant on account for 1925-26 and £4,584 being the balance of grant in respect of the previous year), whilst a sum of £25,430 was paid to the Association as a grant equivalent to the amount of the sanatorium benefit income which was available to Insurance Committees in 1920.

Special payments amounting to £10,195 were made by the Ministry of Pensions, through the Department, in respect of the residential treatment and training provided for tuberculous ex-service men whose tuberculosis was held to be due to war service. The Ministry of Pensions also paid £266 for special services rendered by the Tuberculosis Physicians of the Association to that Department during the year ended on the 31st December, 1925.

VENEREAL DISEASES.

All the County and County Borough Councils in Wales (17 in number) have made arrangements for the treatment of venereal diseases. During the year, two auxiliary Centres for the treatment of mothers and infants referred from Maternity and Child Welfare Centres were opened. There are now nine approved Treatment Centres and three auxiliary Treatment Centres which work in conjunction with Maternity and Child Welfare Centres.

During the year, 12,917 specimens of pathological material from patients in Wales were reported upon.

The number of new cases dealt with at Treatment Centres in Wales (excluding cases treated at Poor Law Infirmaries) during the year ended on the 31st December, 1925, was 5,237, making, with the number of cases under observation at the beginning of the year (6,206), a total of 11,443. In addition to these cases, 110 patients who ceased to attend Treatment Centres in previous years were recorded as having returned for treatment suffering from the same infection. The number of attendances at the out-patient clinics during the year was 96,797, and the aggregate number of in-patient days was 7,689. These figures show a general increase in each category over those for the year 1924.

Details of the work carried out at the Treatment Centres situated in Wales are given in the following table :

(1) Patients dealt with for first time..

(2) Patients who ceased to attend:

(a) Before completion of first course of treatment

(b) After one or two courses but before completion of treatment

(c) After completion of treatment but before final test ..

248 310

8

566 229 503 14

2

748

316 568 116 433 1,433 254 632

113

592

1,591

|

(3) Patients discharged after completion of treatment (4) Number of patients at end of year under observation 3,485 2,301 100 320 6,2061,842 | 1,722 76 267 3,907 Note:-One Treatment Centre which had for several years carried forward a large number of cases as "under observation," has written off these cases during the year 1925 owing to longcontinued non-attendance. This accounts for the large reduction in the number of cases "under observation" at the end of 1925.

Statistics of cases from Wales dealt with at English Centres are as follows:-New cases 168, attendances at out-patient clinics 2,043, aggregate number of in-patient days 523.

The estimated expenditure of the 17 Welsh Local Authorities (excluding Poor Law Authorities) on this service during the year ended on the 31st March, 1926, was £25,721. During the year net grants amounting to £16,912 0s. 10d. were paid by the Department in aid of expenditure on the diagnosis and treatment of venereal diseases. The net expenditure approved for grant purposes incurred by Local Authorities in Wales and Monmouthshire in carrying out approved schemes during the year ended on the 31st March, 1925, was £20,980 18s. 7d.

OTHER INFECTIOUS DISEASES AND ISOLATION HOSPITALS.

Sanction to a loan of £25,000 on account was issued to the Swansea Town Council in respect of the Hill House Isolation Hospital.

One application has been received from a County Council for an Order under the Public Health Act, 1875, as extended by the Public Health (Prevention and Treatment of Disease) Act, 1913, and the Public Health Act, 1925, empowering them to provide or arrange for the provision of isolation hospital accommodation.

Schemes for the extension of certain existing isolation hospitals and for the erection of one County smallpox hospital were under consideration at the end of the year.

Approval was granted under section 133 of the Public Health Act, 1875, to the Council of one County Borough for the temporary supply by the Council of insulin to the poorer inhabitants in their area.

MATERNITY AND CHILD WELFARE.
General.

There has been a continued development of the Maternity and Child Welfare service during the year under review, mainly in the provision of greater facilities for the hospital treatment of maternity cases, and the provision of hospital and after-care treatment for crippled children. Further developments in similar directions are anticipated during the coming year.

In view of the increased activity in the Maternity and Child Welfare service generally, several Local Authorities have found it necessary to increase their whole-time medical staff.

There was a slight check during the year 1924 to the progressive decline in the infant death-rate. The rate for the year was 77 per thousand births, as compared with the rate of 74 per thousand births during the year 1923. The rate for the year 1924 was still considerably lower than the rates recorded for the years before 1923.

The maternal mortality rate for Wales for the year 1924 was 5.01 per thousand births. This rate is the lowest for some years, but it still remains much higher than that for England and Wales.

The number of still-births remains high, the number notified per 100 registered live-births showing a gradual increase from 4.1 in 1921. to 4.7 in 1924. The notification of still-births is probably incomplete, and these percentages may not represent the true position.

There was an improvement during the year 1924 in the notification of births under the Notification of Births Act, 1907. The percentage of births notified was 94.8, as compared with 91.6 per cent. in the year 1921.

Health Visiting.

The following statement shows the number of women acting as Health Visitors on the 31st March, 1926 :

Note. For the purpose of column (6) the amount of time given to health visiting by each of the District Nurses in column (4) has been taken as one-tenth. The figures in brackets in column (3) represent the approximate equivalent of whole-time officers.

The number of persons employed by Local Authoriti; wholly on Maternity and Child Welfare work is the same as on the 31st March, 1925. There is a slight decrease in the number of officers of Local Authorities holding combined posts, and a small increase in the number of District Nurses, employed by Nursing Associations, who act as part-time Health Visitors in rural areas. As in the two preceding years, approximately the equivalent of the whole-time of 153 Health Visitors was devoted to health visiting during the year.

In a circular issued to Local Authorities they were informed that the appointment of a woman for the first time as a whole-time officer of a Local Authority with health visiting duties would not be approved on and after the 1st April, 1928, unless she had obtained the Health Visitors' Certificate referred to in the circular. To remove misapprehensions as to the qualifications required in the meantime for the post of Health Visitor, a circular was issued on the 22nd March, 1926, setting out such qualifications.

The total number of visits paid by Health Visitors during the calendar year 1924 to children under five years of age was 482,884, an increase of more than 70,000 over the number paid during the year 1921. The increase is observed generally in the number of visits to children over one year of age.

During the same year visits were paid by the Health Visitors to approximately 11,000 expectant mothers.

An application for the approval of a proposed course of training in public health work under the conditions laid down in Memo. 101/M.C.W. (Training of Health Visitors) has recently been submitted and is now under consideration.

Midwifery.

As indicated in the statement below, the number of midwives practising in Wales in 1924 shows a slight decrease as compared with the number in practice in 1923. A large number of untrained midwives have ceased to practise, but it will be observed that there is an increase in the number of trained midwives in practice.

Of the 57,426 births registered in Wales in 1924, about 90 per cent. were notified by midwives. Medical aid was summoned by midwives under section 14 of the Midwives Act, 1918, in 9,041 cases during the year. This is an increase of 670 cases as compared with 1923, and an increase of over 1,600 cases as compared with the year 1922.