Public Health.

INFECTIOUS DISEASES: TUBERCULOSIS.

Compulsory Notification.

The following table shows the total number of primary notifications of tuberculosis (after eliminating all notifications which were found to be duplicates) during each of the past six years :

The following table shows the number of deaths recorded from tuberculosis during each of the past six years :—

The Department have reason to believe that in many instances general practitioners have not systematically and promptly notified cases of tuberculosis as required by the Public Health (Tuberculosis) Regulations, 1912. In many areas it was found that as many as 50 per cent. of the fatal cases had not previously been notified. There also appeared to the Department to be considerable room for improvement in the arrangements for co-operation between the various agencies concerned in preventive measures in regard to this disease.

On the 30th December, 1921, the Department accordingly issued a circular letter to the County Councils and all Local Sanitary Authorities in Wales drawing attention to the importance of co-operation as between the Medical Officers of Health and the Tuberculosis Physicians of the Welsh National Memorial Association. With this object it was suggested that Medical Officers of Health should complete a form of report upon environmental conditions and containing a record of home contacts, and forward a duplicate copy to the Tuberculosis Officer for the area. In order to secure the prompt notification of cases by medical practitioners, it was suggested that County and County

Borough Councils should circularise the medical practitioners practising in their areas, drawing attention to the importance of strict compliance with their obligations under Article V. of the Regulations.

Article 3 of the Public Health (Tuberculosis) Regulations, 1921, provides for the first time that the register of notifications kept by the Medical Officer of Health shall be open to inspection by the Medical Officer of a Tuberculosis Dispensary which serves any area within which the District is situate.

King Edward VII. Welsh National Memorial Association.

As from the 1st May, 1921, sanatorium benefit ceased to be administered by Insurance Committees, and the provision of treatment for all persons suffering from tuberculosis devolved upon the County and County Borough Councils. In Wales, all the Councils act for this purpose through the Welsh National Memorial Association. The contributions which the County and County Borough Councils of Wales agreed to pay to the Association amount in the aggregate to £68,442, approximately equal to a rate of 1.34d. This represents an increase of 34d. on the rate agreed for the previous year.

Under the Public Health (Tuberculosis) Act, 1921, the powers of a County or County Borough Council in relation to the treatment of tuberculosis may be exercised through a committee specially appointed for the purpose, on which persons who are not members of the Council may be appointed.

Residential Institutions.-The residential institutions of the Association at the 31st March, 1922, consisted of four sanatoria with 600 beds and ten hospitals with 501 beds. Arrangements are also made by the Association for the treatment of tuberculosis patients in fourteen institutions belonging to other authorities or bodies.

The conversion of Craig-y-Nos Castle, Breconshire, into a hospital with 100 beds is nearing completion. The same applies to a hospital at Sealyham, Pembrokeshire (30 beds), and to a hospital at Machynlleth, Montgomeryshire (30 beds), and it is anticipated that these three hospitals will be available for the reception of patients on the 1st July,

1922.

The proposal to erect a hospital at Pontypool Road (to serve Newport and Monmouthshire) was abandoned by reason of the excessive cost of construction. The Association having been offered a mansion at Cefn Mably (situate midway between Cardiff and Newport), suitable for conversion into a hospital with 100 beds to serve this area, have been authorized to proceed with the scheme, and the usual Exchequer capital grants will be payable. A condition of the approval of this hospital is that one-third of the total number of beds shall be available for ex-service patients for a period of five years.

Approval has also been given to the acquisition by the Association of a property situated at St. Brides, Pembrokeshire, for the purpose of providing accommodation for 100 children, suffering from nonpulmonary tuberculosis, but no part of the cost of this scheme will at present qualify for Exchequer capital grants.

When the hospitals at Cefn Mably and St. Brides are available for the reception of patients, the two hospitals at Newport (Beechwood and Cardigan House) will cease to be used.

Additional accommodation has been provided at Meadowslea Hospital (Flintshire). This hospital is now recognised for 50 beds.

The Association are proceeding to convert part of Plas Llangwyfan (North Wales) Sanatorium, to provide facilities and equipment for the treatment of cases of surgical tuberculosis.

Ex-service Men and Women.-The Association have continued to provide residential treatment for ex-service men suffering from tuberculosis. Where tuberculosis was the disability on account of which any man was discharged from the Forces, or where tuberculosis is held to be attributable to, or aggravated by his service, the cost of any treatment in residential institutions was met by the Department and recovered from the Ministry of Pensions. As from the 1st May, 1921, these arrangements ceased to apply in the case of ex-service

women.

The number of ex-service patients in Wales who received residential treatment during the past three years was as follows:

Training Colony.-This colony is established at the South Wales Sanatorium, Talgarth. Instruction is still limited to training in market gardening and carpentry and joinery. For training in vocations other than these, arrangements are made for accommodating Welsh patients in appropriate institutions outside Wales. Similarly patients resident in England are admitted to the Talgarth Training Colony. The number of trainees admitted to the colony during the year was 24. On the 31st March, 1922, the number under training was thirteen.

Dispensaries and Visiting Stations.-There are now established by the Association in the Principality fourteen Central Dispensaries, around which are grouped 89 Visiting Stations. The following statistics give some indication of the activities of the Association during the year in this sphere of their work :—

Cases under observation on the 31st March, 1921

New cases examined during the year

Total number of cases examined by Tuberculosis Officers during

3,637

9,799

the year

13,436

Cases under domiciliary treatment on the 31st March, 1921 ..
Cases referred for domiciliary treatment during the year
Cases under domiciliary treatment on the 31st March, 1922

2,338

2,192

2,776

Educational Campaign.-One of the Association's Tuberculosis Physicians acts also as superintendent of the educational campaign. The staff assigned to this department also includes two organisers and lecturers. These three officers visit schools and training colleges

throughout the Principality and lecture to the scholars and teachers. In addition they address public meetings, and generally aim at spreading a wider appreciation of the importance of general hygiene.

Medical Staff-The medical staff of the Association consists of the Principal Medical Officer, the Medical Superintendents and Resident Medical Officers of their fourteen sanatoria and hospitals, together with fifteen Tuberculosis Physicians and four Assistant Tuberculosis Physicians, who are stationed at suitable centres in various parts of Wales.

Grants. The total Exchequer grants paid to the Association in the financial year 1921-22 were £118,600. Of this total £31,450 was in respect of capital expenditure and £62,150 in respect of maintenance, and a lump sum of £25,000 was paid to the Association as a grant equivalent to the amount of the sanatorium benefit income which was available to Insurance Committees in respect of the year 1920 for defraying the cost of treatment in institutions (including dispensaries).

VENEREAL DISEASES.

Thirteen of the seventeen Welsh Local Authorities have made arrangements for the treatment of venereal diseases within their areas at Centres situated in Wales. Cases from the remaining four areas are treated at Centres just over the border.

The Glamorgan County Council employ two whole-time Medical Officers on venereal diseases work, and are the only Local Authority in Wales employing whole-time Medical Officers on this service.

Nine Treatment Centres, approved under the Public Health (Venereal Diseases) Regulations, 1916, are now open in Wales for the diagnosis and treatment of venereal diseases. Seven of the nine Centres form part of existing hospitals and institutions, while the remaining two are established as special clinics.

In addition, two Poor Law Infirmaries in Wales have been approved for the treatment of these diseases.

During the year proposals have been considered for the setting up of a number of supplementary Centres in rural areas, but these have had to be abandoned for the present on account of the financial situation. An extension of the out-patient department of the King Edward VII Hospital, Cardiff, is at present being carried out with the approval of the Department. Proposals have been considered for establishing an auxiliary Venereal Diseases Clinic at Swansea for the purpose of treating venereally infected mothers and children attending the Maternity and Child Welfare Centre in that County Borough.

9,868 specimens of pathological material from patients in Wales were reported upon during the year.

The number of new cases dealt with at Treatment Centres in Wales (excluding cases dealt with at the Poor Law Infirmaries) during the year ended the 31st December, 1921, was 5,173, making, with the number of cases under observation at the beginning of the year (4,139) a total of 9,312. The number of attendances at out-patient clinics during the period was 78,542, and the aggregate number of in-patient days was 9,055.

(6478)

F

Details of the work accomplished at the Treatment Centres are given in the following table :

From a consideration of this table the fact emerges that the number of new cases presenting themselves for treatment was considerably lower in 1921 than in the preceding year, and there is accordingly some ground for the belief that the number of infective cases is being diminished. This view is supported by the returns of venereal diseases cases admitted to the Poor Law Institutions in South Wales, for the number of such cases has greatly diminished within the last few years.

The number of patients who discharge themselves from treatment before cure is effected remains high, although improvement in this respect is recorded in 1921 as compared with the previous year. Every effort should be made by the Local Authorities to keep these patients under treatment.

With regard to the cases from Welsh areas dealt with over the border, the numbers are as follows:-New cases, 180; attendances at out-patient clinics, 1,959; aggregate number of in-patient days, 1,078.

Grants amounting in the total to £23,343 14s. 5d. were paid by the Department during the financial year ended the 31st March, 1922, in aid of expenditure incurred on the diagnosis and treatment of venereal diseases.

ISOLATION HOSPITALS.

The general financial stringency has continued to deter many Local Authorities from embarking upon schemes for fresh construction even where increased accommodation is much needed. Local Authorities have, however, been encouraged to put forward their proposals in regard to isolation hospital accommodation so that the necessary preliminaries may be settled with a view to their schemes being put into effect as soon as the financial situation is eased.

Loans amounting to £9,030 for hospital purposes have been sanctioned during the year, and a number of applications were under consideration at the end of the year. Sanction was also given to loans for the purpose of providing motor ambulances for the Bangor Town Council Isolation Hospital and for the Conway and Penmaenmawr Joint Hospital Board.

Total.