one important signatory, namely the United States of America, was not prepared to assent to placing the Office International under the League's direction. The Second Assembly accordingly dropped this portion of the scheme for the time being, and limited its Provisional Health Organisation to a Health Committee nominated by the Council and to a Medical Director and small expert staff appointed by the Secretary General. The Committee thus nominated by the Council consists in greater part of members of the Permanent Committee of the Office International and includes its President. By this arrangement and by an understanding arrived at between the Health Committee of the League on the one hand and the Office International d'Hygiène Publique, which remains autonomous, on the other, the endeavour has been made to avoid undesirable overlapping of work which would otherwise occur between two organisations possessing similar functions and duties, and at the same time to secure the mutual support which the two organisations are in position to give to each other through the nature of their respective constitutions. The Office International, which is essentially a consultative body representing the official health services of a large number of countries, acts as a general consultative body on any question of public health referred to it by the League; while the Health Committee, as a smaller and more executive body, is in a position to take up actively any proposals for special investigations emerging from the work of the Office International which the latter body is unable to carry out in consequence of the restriction of its constitution or the lack of funds. Collaboration has already been secured on these lines with promising results. Other parts of the original scheme, such as the relation of the League's Health Organisation to the League of Red Cross Societies and the International Labour Office, were maintained practically unchanged.

The proceedings of the Health Committee of the League, and of Commissions and Sub-Committees appointed by it, since this work was begun in September of last year, have been fully reported in various documents issued from Geneva. They include reports of a special conference which was held at the offices of the Department in London last December, and opened by the Minister, on the Standardisation of Sera and Serological Tests; a series of reports on the epidemic conditions in Russia and Eastern Europe; the report of an inter-European technical conference on the same subject held at Warsaw in March last; the report of a Sub-Committee on the estimation of the quantities of dangerous drugs which may legitimately be required for medicinal purposes; and other matters. The Department have continued to take an active part in the important work of this section of the League, as well as any other international health movements. Sir George Buchanan, with the assent of the Department, was nominated by the Council of the League as the British member of the Health Committee and as its VicePresident; and he has continued to attend the sessions of the Office International d'Hygiène Publique as the representative of Great Britain. Some of the special conferences of the League have naturally required specialised representation-that on the Standardisation of Sera, for example, was furnished by the Medical Research Council, and that at Warsaw by Colonel S. P. James, who has special charge of epidemic intelligence work in the Department. It should be added that Dr. Norman White remains seconded from the work of the Department to act as Chief Epidemic Commissioner for the League in regard to the prevention of typhus and other epidemic diseases in Eastern

Europe. At the request of the Secretary-General the Department placed the services of Dr. E. J. Steegmann, one of their temporary Medical Officers, at the disposal of the League for preliminary work required during the period preceding the decision of the Second Assembly on the Health Organisation. A communication from the Secretary-General, received after Dr. Steegmann's retirement in October 1921, expressed the Council's great appreciation of his services.

Although the work of the League's Epidemic Commission for combating typhus on the border States of Russia has continued during the year, its utility has been seriously curtailed by the smallness of the funds available, and from this and from many other causes it unfortunately proved impossible towards the end of 1921 to prevent the importation of typhus on a considerable scale into Eastern Poland, where it spread locally. This circumstance, together with the renewed apprehensions of extension of epidemic disease, including cholera from Soviet Russia, has led to the further international expert consideration of the whole question at Warsaw, to which reference has been made above. The recommendations of the Warsaw Conference were subsequently referred to the International Conference at Genoa.

At the Office International d'Hygiène Publique progress has been made on the important subject of revision of the International Sanitary Convention, 1912; a draft international agreement on the treatment of venereal disease in sailors has been adopted; and much comparative public health work has been undertaken.

VOLUNTARY HOSPITALS.

The Final Report of the Voluntary Hospitals Committee presided over by Lord Cave (Cmd. 1335) was presented on the 6th June, 1921. As a result of the Committee's recommendations the Government decided to make a grant up to a total of £500,000 to such Voluntary Hospitals in England, Wales and Scotland as needed assistance towards meeting the deficits on ordinary maintenance expenditure at the 31st December, 1921. The recommendation of the Committee in regard to a grant in aid of new capital expenditure was not adopted, as the Government took the view that they ought not to contribute towards building schemes at a time when hospitals were not paying their way and the cost of building was steadily falling. Apart from emergency grants in exceptional cases, the distribution of the grant was to proceed pro rata against fresh money from voluntary sources raised or in sight. The administration of the grant was entrusted, as suggested by the Committee, to a Commission appointed by the Minister of Health. This Commission was appointed on the 27th July, 1921, and the terms

appointment were published in a Parliamentary Paper (Cmd. 1402). The Commission consists of The Earl of Onslow (Chairman); Dr. Buist, M.D., F.R.C.P.; Lord Clwyd; Capt. W. E. Elliot, M.C., M.P.; Sir Robert Hudson, G.B.E.; Mr. D. O. Malcolm; The Marquess of Linlithgow; Sir Napier Burnett, K.B.E., M.D., F.R.C.S.; Sir Cooper Perry, M.D., F.R.C.P.; Mr. Wade Deacon, C.B.E.; Sir John Rose Bradford, K.C.M.G., C.B., F.R.C.P.; Sir George Makins, G.C.M.G., G.C.B., F.R.C.S.; Dr. R. A. Bolam, O.B.E., F.R.C.P., M.D.; with Mr. L. G. Brock, C.B., Secretary; and Mr. P. Barter, Assistant Secretary.

The provision of a Government grant was intended solely as an emergency measure to give the voluntary hospitals an opportunity of re-establishing their position as the conditions resulting from the War

disappear. The governing consideration, therefore, in the administration of the grant has been that its distribution should be accompanied by the adoption of measures calculated to re-establish the position of the Voluntary Hospitals on a secure and independent basis.

Following the recommendations of Lord Cave's Committee, the Commission decided to establish Local Voluntary Hospital Committees through which all applications for grants should be submitted. In addition to assisting the Commission with their recommendations on all such applications, the functions of Local Committees include the following:

(a) to act as local advisers to the Commission;

(b) to collect information as to the needs of their area;

(c) to further co-operation between hospitals;

(d) to co-ordinate appeals;

(e) to consider the possibility of arranging the transfer of patients where this can advantageously be done;

(f) to prepare, where practicable, schemes of co-operative pur

chase;

(g) to advise as to the adoption of a uniform system of hospital accounts throughout the area;

(h) to organise systematic contributions both from employers and employees in areas where no such systems at present exist; (i) to undertake the distribution of any contributions made by an Approved Society in cases where the Society is purely local in character; and

generally to take every possible step to assist the hospitals in their area to maintain the present voluntary system.

As a general rule the administrative County, together with the County Boroughs geographically associated with it, has been taken as the unit for the formation of each Local Committee. Some of the largest County Boroughs, however, have been constituted units by themselves. On the other hand in certain instances two or more Counties have been grouped together, the desire of the Commission being to allow in all cases such variations as might be necessary to meet local conditions and preferences. The Committees consist of representatives of the Local Authorities, the hospitals, and the medical profession, and generally not more than five nominees appointed by the Commission from residents in the area.

Immediately on its appointment the Commission took steps to secure the establishment of these Local Committees, and by the 1st May all the necessary Committees in England and Wales had been established except in eight areas. In Scotland six Committees out

of thirteen were complete by that date.

One of the first questions with which the Commission had to deal was the critical position of certain of the London Hospitals which had been driven by financial stress to close beds. King Edward's Hospital Fund for London undertook to act as the Local Voluntary Hospital Committee for the Metropolitan area, and submitted a detailed report on the situation, as a result of which the Commission, in November 1921, made emergency grants to London Hospitals amounting to £77,900. Subsequently further grants amounting to £18,600 were made to hospitals in the London area.

Meanwhile, applications for grants had begun to reach the Commission through the provincial Local Committees, and grants amounting to £23,500 were made to provincial hospitals. The total sum distributed to the end of the financial year was £120,000. A list of the grants made is given in Appendix II (page 143 below).

So far as it is possible to judge from the information at present available, the general position is more favourable than Lord Cave's Committee anticipated. The aggregate deficits in London amounted in 1921 to approximately £320,000 as compared with £463,000 in 1920. Complete figures are not available in respect of provincial hospitals, but, speaking generally, income has been well maintained in spite of unprecedented unemployment, and expenditure is decreasing. The margin between income and expenditure is steadily narrowing, and in some areas (notably in Devonshire) sustained and successful efforts have been made to reduce deficits. In London the King Edward VII Fund have launched a combined appeal on behalf of all metropolitan hospitals, and a scheme of mass contribution has been inaugurated which should go far to stabilise the financial position of the hospitals. Similarly in Manchester a system of mass contributions has been started in conjunction with the Hospital Saturday Fund, and similar schemes have been established on a smaller scale in other areas. The Oxford scheme, established by the Radcliffe Infirmary, has proved most successful, and this plan is being widely copied. While it cannot be said that the voluntary system is out of danger, the support it receives is increasing, and the improvement in the last twelve months has been very marked.

DENTISTS ACT.

The Dentists Bill, to which reference was made in last year's Report, was passed by Parliament and received the Royal Assent on the 28th July, 1921. Under the provisions of the Act a Dental Board has now been established with the following membership:

The Right Hon. F. D. Acland, M.P. (Chairman); L. G. Brock, Esq., C.B.; F. Butterfield, Esq.; Sir A. G. Chance, F.R.C.S. Ire.; D. McCoig Cowan, Esq., M.P.; W. H. Dolamore, Esq., M.R.C.S., L.R.C.P., L.D.S.; Professor W. H. Gilmour, M.D.S., L.D.S.; W. Guy, Esq., F.R.C.S. Edin., L.R.C.P. Edin., L.D.S.; Sir J. Hodsdon, K.B.E., F.R.C.S. Edin.; H. R. Robertshaw, Esq.; E. L. Sheridan, Esq., F.R.C.S. Ire., L.R.C.P. Ire., L.D.S.; J. Sinclair, Esq.; H. J. Waring, Esq., F.R.C.S.; and N. C. King, Esq., Registrar.

The Board was appointed in November and at once proceeded to prepare the necessary regulations, which were approved by the Privy Council on the 16th January. Since that date rapid progress has been made with the examination of applications for admission to the Register.

GENERAL NURSING COUNCIL.

The rules made by the General Nursing Council for the admission to the Register of existing nurses as defined in the Nurses Registration. Act, 1919, were approved by the Minister in July, 1921, after somewhat prolonged negotiations with the Scottish and Irish Nursing Councils. The Register was opened at the beginning of August, and up to the end of April 5,936 applications had been received and 3,744 nurses had been admitted to the Register. Registration is voluntary, and the number of applications in the first few months after the Register was opened

proved to be less than was anticipated. But the Rules have now been amended in certain particulars with the object of simplifying registration, and the rate of admissions has shown a distinct improvement. It is hoped that before the term of office of the present Council comes to an end a sufficient number of nurses will have been registered to form an adequate electorate for the election of nurse members of the succeeding Council.

At the end of 1921, Mr. Priestley, K.C., the Chairman of the Council, found himself compelled to resign, and Sir Wilmot Herringham, K.C.M.G., C.B., was appointed to succeed him. Mr. Priestley devoted much time to this work, and his legal experience made his help specially valuable in the drafting of the Rules. His resignation was regretted by all the members of the Council.

LUNACY AND MENTAL DEFICIENCY.

Detailed statistics in regard to Lunacy and Mental Deficiency are given in the Annual Report of the Board of Control, which is presented to Parliament. In view of the continued urgent need for national economy, it has not been found possible to modify the restrictions imposed upon the schemes of Local Authorities for making better provision for the care of mental defectives.

Considerable public interest has been directed to the conditions prevailing in mental hospitals by the publication of a book entitled The Experiences of an Asylum Doctor," by Dr. Montagu Lomax. In view of the serious nature of many of the allegations made therein, the Minister, on the 8th December, 1921, appointed a Committee. consisting of Sir Cyril Cobb, K.B.E., M.V.O., M.P., Dr. Percy Smith, M.D., F.R.C.P., and Dr. Bedford Pierce, M.D., F.R.C.P., with Mr. P. Barter as Secretary, "to investigate and report on the charges made by Dr. Lomax in his book (The Experiences of an Asylum Doctor') and to make recommendations as to any medical or administrative improvements which may be necessary and practicable in respect of the matters referred to by Dr. Lomax without amendment of the existing Lunacy Laws." The meetings of the Committee have been held at the offices of the Department, and the hearing of evidence was completed early in April.

Medical Officers of Health and Sanitary Inspectors.

The Public Health (Officers) Act, 1921, came into operation on the 1st April, 1922. This Act gives increased security of tenure to certain whole-time Medical Officers of Health and Sanitary Inspectors. It provides that, in the case of certain County Boroughs and in the case of County Districts where a portion of the salaries of these officers is paid out of County funds, Medical Officers of Health who are restricted from engaging in private practice, and Senior Sanitary Inspectors who give their whole time to public duties, cannot be removed from office except by the Minister or by the appointing authority with the consent of the Minister. The Act also provides that Inspectors of Nuisances shall in future be designated Sanitary Inspectors, and authorises Urban Sanitary Authorities to appoint more than one Sanitary Inspector.