what he can towards keeping the house. He recently scalded his foot when lifting the kettle. He has been in hospital. His illness shews periods of remission. He has been in prison for theft. Before his illness his conduct was uniformly good.

The typical traits of Parkinsonism, with mask-like face and tremors, began about a year ago. The tremor chiefly affects the right arm and hand. He is muscularly feeble. He is also sometimes irritable in temper. When visited recently he seemed to be mentally normal or at least not markedly abnormal. He moves across the room very slowly. The tremor of his right arm is marked. He has a right divergent strabismus, but says that that existed before the onset of illness.

CHAPTER V.

OTHER INFECTIOUS DISEASES.

1. General.-Although complete notification figures for the whole of Scotland during 1926 are not yet available, the weekly returns received from the medical officers of health of the sixteen principal towns and the counties of Lanark and Fife and summarised in Appendix VII afford a basis for estimating the prevalence of infectious diseases. In the sixteen principal towns, with a total population of 2,390,885, the total number of cases was 76,002; in the counties of Lanark and Fife, with a total population of 420,584, the total number of cases was 8,061. The comparable figures for 1925 are 72,335 and 7,831 respectively, and there is therefore an increase in the total number of cases included in the summaries, but the real increase is less than the apparent, as the figures for 1926 are for the period of 53 weeks from 27th December, 1925, to 1st January, 1927, while the 1925 figures relate to a period of only 52 weeks. A very large increase is shewn for measles; other diseases shewing a considerable increase are diphtheria, scarlet fever, puerperal fever, cerebrospinal fever, ophthalmia neonatorum, acute primary pneumonia and acute influenzal pneumonia. Only a slight increase appears in the number of cases of encephalitis lethargica, although 1926 was the first year in which this disease was notifiable throughout the country. The diseases of which fewer cases are reported are whooping-cough and, to a less marked degree, chickenpox, pneumonia other than acute primary and acute influenzal, and non-pulmonary tuberculosis. In spite of these increases in the number of cases of infectious disease in the areas which furnish weekly reports, the Registrar-General shews that the death-rate from the principal epidemic diseases (enteric fever, measles, scarlet fever, whooping-cough and diphtheria and diarrhoeas in children under two years old) for the whole of Scotland fell from 0.84 per 1,000 persons living in 1925 to 0.63 per 1,000 persons living in 1926, a reduction of 25 per cent.

2. Smallpox. The immunity of the country from smallpox continued throughout 1926, not a single case being reported. Since the end of the year, however, the mild form of smallpox recently prevalent in England has made its way into Scotland, after hovering on the south side of the Border for some months, and an outbreak has occurred in Dundee.

3. Measles.-There were reported in 1926 from the sixteen principal towns and the counties of Lanark and Fife 26,160 cases of measles, nearly two and a half times as many as in 1925. An increased incidence was noted in Glasgow, Edinburgh, Paisley, Greenock, Ayr and Lanark County, while Dundee and Aberdeen

had fewer cases than in 1925. The heaviest incidence was in the first quarter, when there were 17,819 cases. Of these cases,

14,435 were reported from Glasgow, from which only 1,845 cases were reported in the remaining three quarters. The number of deaths from measles in the sixteen principal towns rose from 347 in 1925 to 657 in 1926, and the death-rate from 0-14 in 1925 per 1,000 persons living to 0-27 in 1926.

4. Whooping-cough.-While measles was exceptionally prevalent in 1926, whooping-cough was less prevalent than in the previous year. There were only 5,526 cases as compared with 17,859 in 1925, a reduction of 12,333. Glasgow, Edinburgh, Dundee, Aberdeen, Greenock and Lanark County all contributed substantially to this result, and the only place reporting a considerable increase in the number of cases was Kirkcaldy. The number of deaths in the sixteen towns was 292, and the deathrate fell from 0-45 per 1,000 in 1925 to the remarkably low figure of 0.12 per 1,000 in 1926.

5. Diphtheria. There was an increase of 827 in the number of cases of diphtheria reported, the figures for 1925 and 1926 being 5,194 and 6,021 respectively. This increase, which was shared by the two counties (Lanark and Fife) and by almost all the towns except Edinburgh, Aberdeen, Clydebank, Kirkcaldy and Ayr, is more than can be accounted for by the fact that the figures for last year are for a period of 53 weeks. There were 306 deaths in the sixteen towns, and the death-rate fell from 0.14 per 1,000 in 1925 to 0-13 in 1926.

6. Scarlet Fever.-The number of cases of scarlet fever increased from 13,126 in 1925 to 13,667 in 1926, a difference of only 541. While increases were reported from Glasgow, Aberdeen, Paisley, Greenock, Dunfermline, Hamilton and the county of Fife, these were almost balanced by the decreases reported from Edinburgh, Dundee, Motherwell and Wishaw, Clydebank, Coatbridge, Perth and the county of Lanark. The number of deaths from scarlet fever in the sixteen towns was 198, and the death-rate shewed a further decline from 0-10 per 1,000 in 1925 to 0-08 per 1,000 in 1926.

The use of the Schick test for ascertaining susceptibility to diphtheria and of the Dick test for ascertaining susceptibility to scarlet fever is dealt with in another chapter of this Report, where the work being done in Scotland to protect the population against these diseases by immunisation is also described.

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7. Typhus Fever.-Cases of typhus fever continue to be reported. The twelve cases mentioned in Appendix VII were all notified in Glasgow, and in four of them the diagnosis was not confirmed. Attention was also drawn during the year to outbreaks in three other towns, involving altogether 27 cases. the eight recognised cases in the Glasgow outbreak, which occurred in July and August, seven were in one family, while the eighth was that of a neighbour often in their house. Investigation of the family history led to the discovery of two further

G

cases of illness, one of which had proved fatal. It is probable that these two members of the family both suffered from unrecognised attacks of typhus fever and infected the other members, but the original source of their infection has not been traced.

In November four cases occurred in the burgh of Dumbarton, where three of the patients (two of whom died) were members of one family, while the fourth had visited one of the three while she was lying ill. The source of infection appears to have been another member of the family who had suffered from an unrecognised illness, but it is not known how she became infected, nor was it found possible to connect the outbreak with other outbreaks in Scotland occurring at about the same time. In November and December five cases were found in Stranraer. The connection between these cases was clear; two families were involved, and the two housewives had shared the nursing of a member of one of the households who had evidently suffered from an attack of typhus fever though the disease was not so recognised. The manner in which this man had been infected is, however, unknown.

A series of outbreaks of typhus fever took place in PortGlasgow in December and extended into January of the present year. Altogether there were eighteen cases occurring in five different groups. It was not found possible to trace any direct connection between the groups, but several of the patients were connected with the same church, and children from some of the houses attended the same school, in which there were about 1,200 pupils.

The occurrence of outbreaks of typhus fever in four towns in the south-west of Scotland is a disquieting feature in the record of the past year, and the following quotations from reports on some of the outbreaks by one of the Medical Officers of the Department illustrate only too plainly the unsatisfactory conditions in which a section of the population are living :

"Vermin were not found in the first, unrecognised, case but were seen in other members of the family. Doubtless the spread of infection was due to vermin."

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All patients and contacts were verminous in varying

degrees."

"The houses were very dirty and the people very lousy."

The people affected were all verminous, some very markedly so; the houses occupied by them were satisfactory.

As long as such statements can be made of any part of the population, there is a real risk of the occurrence of typhus fever; accordingly it is essential that the problem of the cleansing of persons should be properly handled. The problem has been under consideration for some time, and it is clear that, while the existing provisions for the cleansing of children are adequate,

those for the cleansing of houses, bedding, &c. require some strengthening. Provisions for the cleansing of adults are practically non-existent, and the need for them, as shewn by the facts mentioned above, is urgent. This is one of the questions which it is hoped to deal with shortly in amending public health legislation.

8. Infective Jaundice.-Regulations issued in December, 1925, provided for the continued notification of acute infective jaundice (spirochaetosis ictero-hæmorrhagica) throughout 1926, and it has since been arranged that notification will remain in force until the end of the current year. Comparatively few cases of the disease were found during the year, but these included a miner from Fife who recovered, and a youth, employed as a steel window-frame maker in Glasgow, who developed appendicitis and peritonitis and died. This was the first undoubted case that occurred in Glasgow. Examination of rats caught on the premises in which the boy worked and on neighbouring premises was negative for the spirochate of infective jaundice.

During the summer, reports were received regarding a few cases of jaundice, apparently of an infectious nature, in Kirkwall, and about one hundred cases, mainly among children, which had occurred in Lerwick since the early months of the year. From the information obtained it appears that in neither town were the patients suffering from spirochaetal jaundice. The Lerwick outbreak was specially investigated by Dr. J. M. Alston, of the Bacteriology Department, Edinburgh University, under the supervision of Professor Mackie. As already mentioned, evidence was found of infection by the causative agent of spirochætal jaundice. One of the rats caught in Lerwick and sent to Edinburgh for examination was found to contain the virus. of spirochætal jaundice. This is a further indication that the spirochete is found in rats in various parts of the country, and is not confined to rats found in or near coal mines.

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9. Pneumonia.-The total number of cases of pneumonia reported is 11,716 (acute primary pneumonia 10,225, acute influenzal pneumonia 1,142, other forms 349), as compared with 10,869 in 1925. There were 670 more cases of acute primary pneumonia and 400 more cases of acute influenzal pneumonia, but 223 fewer cases of other forms of pneumonia. The number of deaths from pneumonia in the sixteen towns was 3,473, and the death-rate per 1,000 persons living was 1.45.

10. Removal of Cases of Pneumonia to Hospital. The policy of admitting cases of pneumonia to infectious diseases hospitals belonging to local authorities as well as to general hospitals was referred to in the last Report, and the practice of certain local authorities was described. To the particulars there given in regard to what was done by local authorities in 1925 may be added information on the way in which cases of pneumonia were dealt with in Paisley in that year. The number of cases