even if light treatment did nothing more it would serve a worthy function in this."

Relief from pain has also been afforded to many patients. suffering from painful laryngeal tuberculosis.

In conclusion, all that can be said at the moment is that in most Scottish centres the encouraging results that have been obtained, and the general favour with which the tuberculosis officers look upon artificial irradiation, appear fully to justify the provision of this new therapeutic agent for the treatment of tuberculous patients. There is obviously a great deal yet to be learned in the application of ultra-violet radiation to medical and surgical cases. The whole subject is only in its infancy, and in view of the good it has obviously done, we must be encouraged by its successes and not unduly depressed by its apparent failures.

17. Child Welfare.-Two years ago the Carnegie Child Welfare Centre, Motherwell, was the only centre in Scotland that treated child welfare cases by ultra-violet radiation. At the end of 1926 there were fourteen child welfare centres equipped with ultra-violet lamps, and several others had the installation of lamps under consideration.

The principal burghs all have a fairly generous supply of lamps for the treatment of children. It may be of interest to give some details of the method of running one of the principal Glasgow centres.

In Glasgow Public Health Department, 20 Cochrane Street, the centre is equipped with four 25 ampère carbon arcs connected in series and an atmospheric mercury vapour lamp. The accommodation provided consists of a waiting-room, consulting room, treatment-room and bathing room. Treatment consists in general irradiation. The mothers attend and sit with the children on their knees during treatment, so that the mothers also get a limited amount of radiation. Cases are sent to the clinic from the child welfare centres. On arrival at the clinic the children are bathed to ensure a clean skin before being exposed to the lamps. The bathing arrangements at this centre are worthy of special comment. In the bathing room there are four baths suitable for young children, a basin, a sink pattern bath, and two more modern and convenient in type. These two are in the form of slabs, one end forming a deep well through which water flows. In this the skin is cleansed, a shower bath follows, and the water is then run off and the child dried on the warm slab. The temperature of the water is controlled by a regulating tap to which a thermometer is attached. After the children have had their bath they are seen by the medical officer who prescribes the treatment required. Each case is seen by the medical officer at the first two or three attendances and afterwards at regular intervals according to the response to irradiation. The nurse in charge attends to the position of the children and instructs the mothers regarding the rotation of the children during treatment. Exposures are carefully timed and recorded. After irradiation the children are wrapped in dressing

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gowns and taken to the dressing-room, where the skin receives, a light application of oil or some simple dusting powder.

The cost of treatment at the carbon arc lamps works out at about 1s. 5d. per child for 24 exposures, which is the average number that each child receives. This figure is based on the running costs of the lamps, and does not include the cost of rent, medical officer's or nurse's salary.

The treatment of children by ultra-violet radiation was begun in this centre in May 1925. The clinics are held three times a week, and the average attendance at each session is about 70. The increase in numbers has necessitated the formation of a waiting list.

Very careful observations on dosage have been made in Glasgow. As the result of a series of special tests it was found that practically no erythema was produced in children during the initial stages of irradiation. Later, as the exposure time increased, slight erythema appeared. The Glasgow experience thus agrees with the view already expressed that the erythema test cannot be taken as an index of the dose in the case of children. Very definite clinical response followed exposures that fell far short of what was necessary to produce any visible erythema. This observation led to a very considerable reduction of the initial exposure times, and to careful clinical observations of the response of each individual after a very short initial exposure. In place of the erythema test therefore the exposures are regulated by the response, and the duration of treatment is also regulated on the same basis. The cases fall into three main groups, namely: (1) those giving an immediate or rapid response, (2) those shewing a gradual response, and (3) those shewing a slow response. Out of 100 consecutive cases, most of which were treated by the carbon arc to initial exposures varying from one to six minutes at distance of three feet, the response was immediate, i.e. followed the first exposure, in 53 cases. This response was quite definite but obviously difficult to measure. It was observed at the first examination after the exposure. The special points noted were a changed facial and general aspect, placidity and contented look, increased brightness and alertness, better colour and contour, and an absence of strain and sagging of the facial muscles. In addition to these objective signs the mothers commented on improvement in one or more of the following, namely-sleep, appetite, activity and contentment. These signs of improvement may occur singly or in combination. Out of the 53 cases improvement in sleep was the chief symptom noted in 31 cases, better appetite the chief symptom in 6 cases, increased activity and/or contentment in 11 cases. Two of the cases shewed restlessness and sleeplessness after the initial exposure. This was taken to indicate an overdose. An exaggerated response to what would appear to be a normal initial dose was also noted in catarrhal conditions such as diarrhoea, and bronchial catarrh in rachitic and debilitated children. Occasionally also an exaggerated response in activity was noted during

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the day following the exposure. Instead of a moderate increase of activity such as the appearance of "liveliness," cheerfulness,' wanting to his feet," " kicking and crowing," or even walking a few steps "for the first time in his life," the child appeared wild and excited and jumped and romped in an exaggerated manner. These signs often delight parents of a formerly listless child, but the clinician regards them as the result of an over stimulation of the metabolic processes. That they should follow minute doses of ultra-violet radiation is evidence of its powerful action on an actively growing organism. Yet other cases shewed an increase of sensitiveness or nervous irritability, or in other ways manifested transient intolerance. With a lessening of the dose, and a more gradual increase in exposure times, these signs may disappear. Sometimes also an exacerbation of quiescent conditions resulted from an overdose, whereas very gradual increase in dosage often led to the apparent arrest or cure of the same conditions, e.g. adenitis, otorrhoea, bronchial and gastro-intestinal catarrh.

These are some of the exceptions, but normally, nervous stability is increased and a greater sense of well-being is evidenced in a more friendly and sociable attitude of the child to its environment. Sleep, appetite, colour, activity and muscular tone all improve; the skin improves in texture, the height and weight increase, especially when markedly below normal. In rachitic cases, in addition to these signs of general improvement, X-ray examinations repeated during treatment shewed marked improvement in the bones, especially when the cases attended regularly. In some the improvement in bone structure was more gradual, necessitating repeat courses of irradiation. Rachitic deformity was decidedly lessened by radiation, epiphyses diminished in size, wide fontanelles closed, tibial and abnormal spinal curves tended to straighten, and waddling gait almost disappeared: Improvement in rachitic deformities was less marked in children over two and a half years of age.

Examination of blood changes was made in the bacteriological laboratory. A constant change was noted in the rise of the hæmoglobin content, and there was also an increase in the number of red cells and leucocytes. In one well-marked case of anæmia the hæmoglobin rose from 25 to 75 per cent. during treatment extending over a period of a year, each course lasting about two months with six-weekly or two-monthly intervals.

Height and Weight.-During a period of two months, 20 children undergoing a course of irradiation were compared with 20 children of the same age who had attended a child welfare centre. The irradiated cases each received 20 exposures. At the close of the period the average gain in weight of the irradiated cases was 2:10 lbs. and of the controls 1.15 lbs. In height, the irradiated cases shewed an average increase of 1.6 inches and the controls 0.7 inches. It was also noted that after the cessation of treatment by irradiation increase in height and weight was even more rapid than during the course of treatment.

Irradiation has been found helpful in certain skin conditions common among children. Impetigo, eczema capitas, intertrigo, furunculosis, septic lesions, burns and scalds all quickly cleared up and the general condition of the child improved concurrently. Both local and general treatment were employed, but applicators for local treatment were not found to be necessary.

The light clinic is kept supplied by cases sent from the child welfare centres by the medical officers. During the year the Cochrane Street Clinic treated 640 children; 498 were cases of rickets; 58 were cases of debility following infectious disease and polio-myelitis; 63 were cases of malnutrition; 9 were cases of skin disease, and the remaining 12 a variety of special conditions.

A system of following up cases is in operation; in no case has any injurious after-effect been observed as the result of irradiation, and the progress of the cases has been well maintained.

A beginning has also been made in the treatment of mothers; fourteen cases in all were treated, eleven of them being cases of pregnancy with insomnia, nervous instability, debility or chronic bronchitis, and three post-parturition cases with nervous instability. The results on the whole were satisfactory.

Edinburgh has now had considerable experience in the irradiation of young children. There are light centres at the head office, Johnstone Terrace, at the Pleasance Centre, at South Fort Street, Leith, and at Victoria Park Home.

At the Johnstone Terrace Centre there are a carbon arc and a mercury vapour lamp. During the year 49 cases completed a course under the mercury arc and 25 under the carbon arc. In comparing the returns of the cases that shewed improvement in muscle tone, skin texture, appetite, sleep, &c. in the two groups there is no appreciable difference; the mercury vapour lamp appears to give quite as good results as the carbon arc. Muscle tone was improved in 84 per cent. of the carbon arc cases and in 87 per cent. of the mercury vapour cases. Appetite was improved in 76 per cent. of the carbon arc cases and in 77 per cent. of the mercury vapour cases. Improvement in skin texture was 76 per cent. and 70 per cent., and sleep 52 per cent. and 48 per cent. respectively under the carbon arc and mercury vapour lamps. Only one case is reported as having lost ground; it was treated by the mercury arc.

The normal practice at this clinic is to begin with two minutes' exposure, front and back, four minutes in all, with the mercury vapour lamp cases, or five minutes to the front of the body only with the carbon arc cases. The dose with the mercury vapour lamp is increased by two minutes until a full dose of thirty minutes is given (fifteen minutes to the front and fifteen to the back). The dose at the carbon are is increased five minutes until a full dose of one hour's irradiation is reached.

Under the mercury arc treatment was given twice weekly for seven weeks, the last six exposures being full 30 minute doses. Under the carbon arc treatment was given three times weekly and the last six exposures were hourly doses. Judging by the

recorded results it would appear that the mercury arc can lay claim to preference in respect to treatment and cost. The total time taken to complete course of treatment with the mercury vapour lamp is approximately 268 minutes and with the carbon arc 750 minutes. If the results are as good in the one case as the other the economy in time and in running costs is markedly in favour of the mercury arc. The matter is, however, one that would appear to require confirmation by other observers. Of the 49 cases treated at the mercury arc, 25 were cases of rickets, 10 cases of debility, 5 cases with tuberculous lesions, and 9 cases not thriving." Of the 25 treated at the carbon arc, 5 were cases of rickets, 10 cases of debility, 7 cases with tuberculous lesions, 4" not thriving," &c. All the cases improved, some to a remarkable extent.

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In Aberdeen the treatment of children by ultra-violet radiation has been carried out at the City Hospital, where there is a generous supply of carbon arc and mercury vapour lamps. Lamps have recently been provided at Burnside Home for mothers and babies, and at Oldmill Hospital. The equipment at the Burnside Home consists of two mercury vapour lamps, and at Oldmill Hospital of four 30 ampère carbon arcs and ten mercury vapour lamps. The experience already gained at the City Hospital has been sufficiently encouraging to justify this generous extension of equipment for ultra-violet treatment, and further results will be followed with interest.

So far in Aberdeen the treatment of child welfare cases has been confined, in the main, to cases of rickets. As a preliminary to the treatment of rickets in children an extensive investigation into the treatment of rats was carried out. The investigation was conducted on the following lines. Forty newly-weaned rats, six weeks old, were fed on M'Collom's rachitogenic diet No. 3143 daily, the only addition to this diet being distilled water. When the rats developed rickets twenty of them were treated by irradiation for 20 minutes daily at a distance of about two feet from an atmospheric mercury vapour lamp with an output of 30 units as estimated by the photo-electric cell. At the end of three weeks these irradiated rats shewed no signs of rickets radiographically, and the phosphorus and calcium content of their pooled blood was 6-8 and 11.9 milligrams respectively per 100 c.c. Other twenty rats were irradiated for the same time, at the same distance with the same lamp, but a piece of ordinary window glass 2 millimetres in thickness was interposed between the lamp and the rats. At the end of three weeks those rats irradiated through ordinary glass were examined radiographically and shewed extreme rickets, while the phosphorus and calcium content of their pooled blood was 4.8 and 8.2 milligrams respectively per 100 c.c. The glass used was tested for its transmission of ultra-violet rays, and it was found. to cut out all rays shorter than 3300 A, but to allow all the rays of longer wave-length to pass.

This experiment shewed that the important therapeutic