properties of radiation were due to rays shorter than 3300 A, and that the longer ultra-violet rays and ordinary light had no healing power.

In view of the results of this investigation into the case of rickets in animals it was decided to investigate the practical application of ultra-violet irradiation in children suffering from acute rickets. One hundred rachitic children varying in age from six months to two years were examined clinically and radiographically to ascertain precisely the degree of rickets and whether the condition was healing or not. In 23 cases there was little doubt that the disease was active, and these were accordingly admitted to hospital. They were irradiated daily for about two months, the initial dose being three minutes, which was increased daily by two minutes until a daily exposure of fifteen minutes was given. In all cases the phosphorus, calcium and cholesterol content of the blood was estimated before treatment commenced, and again when clinical and radiographic examination shewed the case to be cured. X-ray photographs of the limbs and ribs were taken before treatment was commenced and monthly during the course of treatment.

The following is the record of a typical case :

A. J., a male, aged one year two months, was admitted in July 1926, suffering from acute rickets. He was unable to walk and even to stand. There was bossing of the parietal bones; dentition was delayed; there were marked beading of the ribs, pronounced thickening of the epiphysis at the wrist and knee joints, and slight lateral curvature of the tibia. On admission, the cholesterol, phosphorus and calcium contents of the blood were respectively 80, 4·3 and 8.2 milligrams per 100 c.c. The radiograms of the limbs revealed marked thickening of the epiphysis, of the femur and tibia and definite curvature of the tibia. Treatment in graduated doses from three minutes general exposure increasing by two minutes daily up to a maximum of fifteen minutes daily was commenced immediately, and at the end of a month the rachitic condition was proved radiographically to have improved very considerably, while at the end of seven weeks' treatment the cure was proved complete, there being little bending of the tibia and no thickening of the epiphysis. During the seven weeks' course of treatment the blood calcium, cholesterol and phosphorus had risen from 8-2, 80 and 4-3 milligrams per 100 c.c.ms. respectively to 12.9, 125 and 5.73.

Similar results were got in the other 22 cases of the active rickets, and it would therefore appear that two months' irradiation is sufficient for the cure.

In Dundee an atmospheric mercury vapour lamp was installed in the Central Child Welfare Clinic, Victoria Road, in February, 1926. A special nurse is in charge of the lamp, but all the health visitors have been instructed in the working of the lamp,

the arrangement of the patients, and the keeping of records of exposure. The accommodation for light treatment at the centre is limited, and not all the children requiring treatment receive it. Extensions are in course of erection, and very soon adequate provision will be made for the treatment of greater numbers by means of irradiation. As regards dosage, the usual practice at this centre with babies is to begin with an exposure of five minutes to the front and five minutes to the back, at a distance of six feet in the case of babies and three feet in the case of older children. The dose is gradually increased until exposures of fifteen to twenty minutes back and front, at three feet from the lamp, are given. Treatment is given twice weekly, and extends for three months with a month's intermission during the course.

Since the installation was provided 132 cases have been treated, 23 babies and 109 children between the ages of one and five years. Of the total number only 76 have completed a course of treatment, or have been under treatment for a sufficient time to enable an expression of opinion to be given as to the effects of the irradiation. Of this number 37 were cases of rickets, 10 were cases of malnutrition in babies, 5 were cases of marasmus, 20 were cases of children between one and five years that were not thriving, and the remaining 4 included 3 cases of very nervous " children and 1 case of spasmodic wry neck.

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The results on the whole have been good. The rickets cases all improved rapidly, and 11 of them between one and four years of age that were unable to walk when treatment was commenced were able to do so after exposures varying in number from 7 to 11. Several were still under treatment, but had already shewn steady improvement.

All the malnutrition cases shewed definite improvement with increase of weight, better digestion, better sleep and lessened fretfulness. Some of the cases appeared to respond more quickly than others. A similar report was given in the marasmus cases, and all the mothers were unanimous in their reports that the children were less fretful, brighter and slept better.

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Most of the cases "not thriving" got distinct benefit from the treatment, and the nervous cases made excellent progress. The nervous cases were difficult to manage at first, owing to fear of the light, but after a few exposures they improved and became quite amenable. The mothers at the same time reported great improvement in the home lives of the children, fits of temper were fewer, appetite was less capricious, sleep was quieter, and fear of strangers diminished. Clinically it was noted that weight increased, there was improvement in muscular tone and in the condition of the skin, and lessened tendency to catarrhal affections.

At Greenock Child Welfare Hospital an atmospheric mercury vapour lamp has been in use for about a year, and a considerable variety of cases numbering in all 128 has been treated.

The majority of those treated were cases of rickets, and

where the disease was uncomplicated the results were very good and in many cases excellent. Of three cases of rickets complicated with pulmonary tuberculosis only one improved, and of three cases complicated with abdominal tuberculosis only one had a full course of treatment and shewed general improvement. Other rachitic cases complicated with alimentary diseases, skin diseases, cardiac and respiratory affections and the like all appeared to derive benefit.

Cases of atrophy, debility and marasmus treated numbered 23. Of the total 8 died, 4 were not improved and 11 improved. At this centre the results of treating cases of malnutrition by ultraviolet radiation have been a little disappointing. Cases of debility following diphtheria, influenza and respiratory diseases all derived great benefit, and one case of tuberculosis of the spine and one of abdominal tuberculosis were markedly improved.

18. Infectious Diseases and Convalescence.-Reference has already been made to the practice in some light clinics of irradiating children convalescing from acute illnesses, and there is evidence of a steady growth in the use of irradiation as a means of toning up such cases.

At Aberdeen City Hospital for the last six months irradiation has been practised on cases of acute lobar and broncho-pneumonia, immediately after the crisis had occurred or immediately after the temperature had settled. In the case of children suffering from whooping-cough, without any pneumonic complication, ultraviolet irradiation has been practised from the day of admission. As regards diphtheria and scarlet fever, the investigation is in its preliminary stage, but at present every other diphtheria admission is receiving treatment from the day of admission.

Briefly, there is no doubt that cases of pneumonia are making a more rapid convalescence, and there is some indication that cases of whooping-cough derive much benefit from this treatment also. It would appear, in short, that ultra-violet irradiation is the best tonic we have for these conditions.

19. Conclusion.-From this survey of the results of treatment by ultra-violet irradiation it would appear that there is still a good deal to be learned about the technique of its application. A primary condition of accurate dosage is the regular determination of the output of the lamps in use, and it would also appear that close clinical observation of response is of the greatest value in determining the most appropriate dose for the individual. There are differences of opinion of the value of irradiation in the treatment of the deeper tuberculous lesions, but generally its value in the less severe forms of non-pulmonary tuberculosis is unquestioned. In pulmonary cases the results have not been discouraging, but much more work will require to be done before any definite opinion of its value in these cases can be expressed.

In child welfare work no attempt has been made to give complete records of all the centres. The report shews what has

been done in a number of selected centres, and gives a fairly accurate picture of the nature of the cases treated, the methods adopted and the results obtained. On the whole the results are most encouraging. They fully justify the expense and labour involved in providing this method of treatment, and it is gratifying that the encouragement given to local authorities to provide ultra-violet treatment at child welfare centres has resulted in the effective restoration to health of large numbers of children.

CHAPTER VIII.

THE HOSPITALS.

1. The Mackenzie Report.-The Report of the Hospital Services (Scotland) Committee, which was submitted in January, 1926, made a noteworthy contribution to clearing up the hospital position in Scotland. Its distinctive service was that it uncovered the facts, shewed the relation of the several branches of the hospital services to each other, so enabling the interested public to view the Scottish hospital services as a whole, and brought out sharply the significant development of the poor law and local health authority hospitals in recent years, and the implications of that development on the future of the general hospitals. The Committee, it will be remembered, was appointed in June, 1924, under the chairmanship of the Hon. Lord Mackenzie, LL.D., " to inquire into and report upon the extent and nature of the inadequacy of the present hospital and ancillary services in Scotland, and to make recommendations for the development and maintenance of those services to meet the needs. of the community."

The Report has been widely discussed and its findings need not be summarised here in any detail. The Committee found that there was a shortage of 3,600 beds for general hospital work (including maternity and sick children), and, in addition, a shortage of beds for some of the infectious diseases-nonpulmonary tuberculosis, pneumonia, measles and whoopingcough. One thousand of the 3,600 beds were for maternity and sick children, and of these the Committee recommended that 600 should be included in the programmes of the local authorities. To equip Scotland with a reasonably adequate hospital service, the Committee put forward two programmes on the local authority side, 600 beds for maternity and children and an unspecified number of beds for the above infectious diseases; and, on the voluntary side, 3,000 beds. The Committee inquired into the possibility of finding poor law beds for general or infectious disease treatment, but they reported that, except in Glasgow and Aberdeen, there was no effective surplus of beds in the poor law hospitals. They reported also that, with a few highly important exceptions, the hospital arrangements under the poor law were inferior.

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The Committee considered that the shortage of hospital facilities could be overcome without any fundamental change in the hospital system of Scotland. "Our recommendations," they stated, are an attempt to formulate a hospital policy for Scotland which will preserve and maintain the voluntary hospitals and secure, by co-operation all round, and not least between the voluntary hospitals and the local authorities, a continuously adequate hospital service." In broad outline the