Milk. During the year 4,568 samples of Milk (including 208 informal samples) were submitted for analysis, of which 375 were reported by the Analyst as non-genuine. Proceedings were instituted in 171 cases and fines amounting to £477 8s. 6d. (and costs amounting to £97 19s. 11d.) were imposed. Two milk vendors were fined £5 each for selling milk in dirty milk carts; and in another case disclosing a deficiency of 18 per cent. in milk fat, the fine imposed amounted to £40.

One Public Analyst called attention to cases where he ascribed deficiency in fats to incomplete milking. Another Analyst ascribed a general deficiency in fat contents of milk during a particular period to the phenomenally dry weather experienced during that period. The Public Analyst for the County of Denbigh reported the milk samples analysed by him during the second quarter of the year as being exceptionally unsatisfactory, no fewer than 13 out of 35 being below the standards, many of them being considerably below.

Miscellaneous Commodities.-Information as to the number of samples examined in the various commodities mentioned below, and the action taken thereon, is given in the subjoined table :-

Egg and Custard Powders.-The Analyst for Carnarvonshire reports on an egg powder as follows:-"The egg substitute consisted of rice flour and arrowroot mixed with 6.5 per cent. of a mixture of acid potassium tartrate and bicarbonate of soda coloured with a yellow dye. It is certainly misleading to call such an article 'Egg substitute,' as it does not contain any of the constituents of an egg, and it is doubtful

whether such articles should not be considered adulterated." The Public Analyst for the County Monmouth writes in a similar strain: "I am somewhat troubled in my mind in regard to those so-called egg powders which, though perfectly pure and harmless, do not appear to me always to carry a label which is strictly truthful and conveying an impression to the buyer of their being something which they are not."

Rice. The Public Analyst for the County of Denbigh writes: "The Rice sample sold as Best Rice' was faced with steatite and contained 8 grains of this mineral per lb. The facing is very objectionable and is known to have been very injurious."

Seidlitz Powders.-Eight seidlitz powders taken in one area were found to be not in accord with the requirements of the British Pharmacopoeia. The stocks were withdrawn and the wholesalers informed.

HEALTH OFFICERS.

Salaries.

Local Authorities have been urged to apportion the remuneration of Sanitary Officers whose appointments and salaries are subject to the Department's sanction as between basic salaries and bonus, and to revise the bonus every six months in relation to the fluctuations in the official index figure for the cost of living.

Consolidated salaries have been approved in a few exceptional cases on the understanding that they would be reviewed by the Councils from time to time.

The tendency has been for Local Authorities to readjust the salaries of their Sanitary Officers during the year to meet the decreased cost of living, and a number of applications have been received, particularly during the latter half of the year, for sanction to the payment of reduced remuneration.

The Department have continued to remind Local Authorities of the claims of ex-service men in connection with vacancies.

Medical Officers of Health.

Of the thirteen County Medical Officers of Health (each of whom possesses the Diploma in Public Health), twelve are also School Medical Officers. Only one officer gives his whole time solely to the duties of County Medical Officer of Health. The remaining twelve are also full-time officers, but in addition to school medical work they act in other capacities, e.g., as Medical Officers for Maternity and Child Welfare, for Venereal Diseases work, or under the Mental Deficiency Act, 1913.

In the County Boroughs, Municipal Boroughs, Urban and Rural Districts, 141 officers (21 of whom devote the whole of their time to the office of Medical Officer of Health, or to that office and other duties of a similar nature) were in office at the 31st March, 1922, the remainder being also in private practice. Twenty-nine of these officers performed the duties of Medical Officer of Health for more than one sanitary district. Each of three rural districts has two part-time Medical

Officers of Health. Thirty-three of these 141 Medical Officers of Health possess a Diploma in Public Health in addition to the other statutory qualifications.

During the year there were two instances in which full-time service was substituted for part-time service.

Sanitary Inspectors.

The number of Sanitary Inspectors holding office in Wales on the 31st March, 1922 (apart from assistants), was 194, of whom four were appointed by County Boroughs, 26 by Town Councils, 71 by Urban District Councils, and 79 by Rural District Councils. Of the remaining fourteen, ten serve more than one area, while four serve Port Sanitary Authorities and neighbouring sanitary districts.

During the year fifteen appointments were sanctioned by the Department. In three of these cases sanction was given to the officer concerned to obtain the required certificate of qualification within a prescribed period. In four cases the approval of the Department was withheld.

WORK OF INSURANCE COMMITTEES.

Appointment of new Insurance Committees.

The Insurance Committees which were appointed in July, 1913, were appointed for a term of three years, but, owing to the War, their original term of office was extended from time to time. The period of the final extension expired on the 31st October, 1921, and new Committees were elected under the provisions of section 59 of the National Insurance Act, 1911, as amended by section 3 of the National Health Insurance Act, 1921, and the Regulations made thereunder. The new Committees will hold office for a period of three years from the 1st November, 1921. The membership of the old Committees ranged from 40 to 60; the new membership ranges from 20 to 35.

Administrative Expenditure.

The method of ascertaining the basis for the distribution of the pool of the general funds available for administrative purposes was effected on the same lines as for the year 1920. On this basis a flat rate of £27 per 1,000 units was fixed by the Department. Where the income produced by this method was insufficient, recourse was had, so far as was found necessary in each case, to any balances available in the Committee's administrative and general purposes funds; and in a few cases, where the Department were satisfied that the circumstances of the Committees justified it, supplemental Exchequer grants were applied to augment the incomes so provided.

The total administrative expenditure of Welsh Insurance Committees for 1921 amounted to between £27,000 and £28,000.

Three appeals to the Minister were made on behalf of members of Committees against the decision of the Auditor to surcharge them under the provisions of Part I of the Third Schedule to the National Health Insurance Act, 1918, with the amount of unlawful expenditure incurred by the Committee. In two cases the appeal was dismissed,

with the result that sums of £17 10s. and £3 7s. 6d. were remitted to the Department in accordance with the provisions of the Act. In the other case the appeal was allowed.

Pricing of Prescriptions.

The number of prescriptions priced on behalf of Welsh Insurance Committees by the central pricing establishment for Wales for the year 1921 was 1,641,220. The cost of the prescriptions was £66,327 13s. 8d. -a decrease of £7,369 7s. 8d., or approximately 10 per cent., as compared with 1920. The administrative expenses of the central pricing establishment amounted to £2,979 14s. 3d.-an increase of £735 17s. This increase is accounted for by the cost of living bonus for the staff and by the fact that the Panel Committees no longer make a payment to the pricing establishment in respect of the statistical data supplied. Formerly substantial sums were received from this source. The cost of pricing for 1921 works out at 36s. 5d. per 1,000 prescriptions, as compared with 26s. 11-9d. for 1920.

Drugs and Appliances.

Article 34 of the National Health Insurance (Medical Benefit) Regulations, 1920, provides that the Panel Committee shall from time to time investigate the character and amount of the drugs and appliances ordered or supplied for insured persons by insurance practitioners (other than those supplied by practitioners at a capitation rate), and that if it appears to them in the case of any practitioner that by reason of the character or quantity of the drugs or appliances so ordered or supplied, the cost is in excess of what may reasonably be necessary for the adequate treatment of those persons, they shall make a report thereon including their recommendations to the Insurance Committee.

The Regulations further provide that the Insurance Committee shall consider the report, and if they are of opinion that the cost of the drugs or appliances ordered or supplied by the practitioner is excessive owing to their being extravagant in character or quantity, they may, if they think fit, recover from the practitioner such sum as they think fit. The sums so recovered are required to be paid to the drug fund of the Committee.

The Regulations give a surcharged practitioner the right of appealing to the Minister against the surcharge. During the year nine appeals were dealt with. In six cases the amounts of the surcharges were slightly reduced, while in the remainder the Committee's decision was upheld and the appeals were dismissed.

Approved Institutions.

Thirteen systems and institutions providing medical attendance and treatment were approved under section 15 (4) of the National Insurance Act, 1911, for the year beginning on the 1st January, 1921.

During the year a deduction from the Exchequer grant was made in respect of the action of a medical officer attached to an approved institution in furnishing post-dated medical certificates of incapacity to an insured member.

GENERAL PRACTITIONER SERVICES.

General.

The numbers of doctors and persons supplying drugs and appliances for insured persons in Wales who were under agreement with Welsh Insurance Committees on the 1st April, 1921, and the 1st April, 1922, are as follows:

The above figures represent the aggregate of the numbers under agreement with the several Insurance Committees. Some doctors and chemists are under agreement with more than one Committee. The number of individual insurance doctors and chemists on the 1st April, 1922, was 833 and 522, respectively.

The medical service under the National Health Insurance Acts has on the whole worked very smoothly in Wales, and the comparatively few complaints lodged by insured persons against practitioners have not been of a serious character.

Regional Medical Service.

The work of the Regional Medical Officers consists mainly in the examination of patients with regard to whom there is some doubt as to their having been rendered "incapable of work." Cases may be referred by Approved Societies, by insurance practitioners, and in the case of deposit contributors, by Insurance Committees.

The number of cases referred by Approved Societies during the year ended on the 31st December, 1921, was 8,063, by insurance practitioners 98, and by Insurance Committees 5. Of the cases referred by Approved Societies, 22 per cent. were found to be "capable," 35 per cent. "incapable," 18 per cent. were not examined owing to their "declaring off," and the remaining 25 per cent. failed to attend for examination for other reasons.

Medical Records.

Insurance practitioners are required under their terms of service to keep records of the diseases of their insured patients and of their treatment of them in a prescribed form.

When these medical records were first introduced there were indications that the medical practitioners were unfavourable to their adoption, but they are now beginning to find the cards useful from the clinical point of view, and very many who originally were doubtful about the utility of these records have voluntarily expressed appreciation of them. There are indications that the value of the records will be more generally recognised as time goes on. Where little or no attempt has been made to comply with this requirement of the terms of service, the attention of the practitioner has been called to the fact.