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1945, 43 % died before they were one year old. Sincethen the mortality- among this group has probably notrisen, but the death-rate among older children has risenconsiderably, especially during the first three ’months ofthis year.

Prof. Gino Frontali, director of the Paediatric Clinic,Rome, said that, largely through the help of UNRRA,the rise in infant mortality resulting from wartime

conditions, had been curtailed. The mortality in Rome,123 per 1000 during 1944, was reduced to 85-70 in 1945and to 69-28 in 1946. Without help from abroad-conditions might again become serious.

Dr. M. Skokowska-Rudolf said that in Poland the dailyration of food, taking all sources into account, wouldamount in 1947 and 1948 to no more than 2000 caloriesa day. Largely as the result of the war, there are morethan 100,000 orphans and more than a million part-orphans ; more than 50,000 orphans are being caredfor in government orphanages. A comprehensivematernity and child-welfare] organisation is to beestablished.

Dr. C. 0. S. Blyth Brooke suggested that in somecountries women might well be encouraged to take agreater part in the management of child-welfare schemes.Programmes should, he said, not be obstructed by internalpolitical differences. He favoured the formation of aninfluential body, including perhaps leaders of the Church,to foster child welfare among the nations.

KING EDWARD’S HOSPITAL FUND FORLONDON

AT the 50th annual meeting of the council of the Fundin London on June 27 a message was read from theKing, as patron, recalling that the Fund had beenfounded by King Edward VII in 1897, to provideadditional support for the voluntary hospitals at a timeof difficulty and uncertainty.The Duke of Gloucester, president of the Fund, said

that when the distinction between the voluntary hospitalsand those maintained by the local authorities was endedthe Fund would help both- kinds of hospital. " Thefact that in this great reorganisation the Fund remainsfree to do its work in its own way is, I think, a markof public confidence in its management." Grants, hesaid, had recently been made for travel; representativesof Charing Cross Hospital had been enabled to make ashort continental tour to study hospital construction, witha view to planning the new Charing Cross Hospital tobe built at Harrow.Sir Edward Peacock, the treasurer, reported thattotal general receipts for 1946 amounted to 491,409,compared with 2464,710 in the previous year.

Dr. H. Morley Fletcher, chairman of the nursingrecruitment committee, said that the nurses’ health-

record forms issued by the Fund were selling at the rateof 30,000 a year. During the year over 4000 candidatesfor training had been advised at the Nursing RecruitmentCentre. The Fund was, he said, continuing its annualgrants of up to 25000 to group preliminary-trainingschools for nurses.

Sir Harold Wernher, presenting the report of theemergency bed service, said that 10,500 calls for help infinding a hospital bed for a patient had been dealt withduring the year-an increase of 55 % over the precedingyear. The shortage of beds, even for urgent cases, wasmore acute than ever, even though the London voluntaryhospitals had reopened since the end of the war no lessthan 3000 beds and now had only 15 % of their pre-warcomplement closed. " The overall shortage of beds,"according to the committee’s report, " is so serious thata point can be reached when no hospital, voluntary ormunicipal, can take in a patient even when urgentsurgery is required."

Sir Hugh Lett, presenting the report of the committeeon hospital diet, spoke of the value of meetings whichhad been instituted for catering officers. The standardof feeding in hospitals in the King’s Fund area was, headded, definitely improving.

Sir Henry Tidy, chairman of the convalescent homes’committee, said that a directory of homes was beingprepared. The committee had assisted in the reopeningof homes closed during the war.

Public Health

SmallpoxTHE only known focus of infection is at Bilston, where

1 further case has occurred during the past week. Thispatient, the wife of a patient removed on June 17,was admitted to hospital on June 29. She was vacci-nated at the time of her husband’s removal. Thiscouple had very few contacts. Unfortunately the samedoes not apply to the other Bilston family involved,from which 5 children were admitted to hospital onJune 20 and 21. The diagnosis of smallpox is notconfirmed in 4 other patients under observation.

PoliomyelitisThere was a further increase in notifications of polio-

myelitis from 31 in the week ending June 14 to 44 inthe week ending June 21. Some of these notificationswere connected with the localised prevalences mentionedlast week, but in addition small numbers were notifiedfrom all over the country except from the West andfrom Wales. There appears to have been a successionof cases in some localities. For example, in Ulverston,near Barrow-in-Furness, there were 7 notifications, fallingroughly into five generations, between April 6 andJune 21. Although notifications of polioencephalitishad not increased in the week ending June 21 (2 noti-fications), cases have occurred where the diagnosisbetween poliomyelitis and polioencephalitis has beendoubtful.

. Suspected BotulismOn June 6, 5 persons who had eaten lunch at a small

tea-shop in the London area on the previous day noticedabdominal discomfort followed by obstinate constipation.Of these, 2 vomited, and all subsequently developeddifficulty with vision, and/or speech and swallowing.1 man died on the twelfth day, and some still havesigns of poisoning with a persistent neurotoxin involvingthe brain stem. 2 have remained ambulant throughout.Although the origin and nature of the poison are stillunder investigation, a tentative diagnosis of botulismhas been made and preventive action taken. It is notimprobable that several, perhaps half a dozen, otherpersons were involved, and this note may help practi-tioners to make a retrospective diagnosis : ptosis, fixedpupils, and diplopia may still be present. The attention ofmedical officers of health should be called to suspiciouscases.

Notification of Puerperal Fever in LondonWhereas puerperal pyrexia is notifiable both in

London and the provinces, puerperal fever is notifiablein London only. Here the regulations are confused ;the separate notification of puerperal fever has beenfound to serve no good purpose, and the resultingstatistics have proved valueless. The London CountyCouncil’s hospitals committee has therefore suggestedthat the Public Health (London) Act, 1936, should beamended by the removal of puerperal fever from the listof notifiable infectious diseases.

Infectious Disease in England and WalesWEEK ENDED JUNE 21

VocctoM.—Smallpox, 7 ; scarlet fever, 870 ;whooping-cough, 2107 ; diphtheria, 220 ; paratyphoid11 ; typhoid, 7 ; measles (excludng rubella), 10,632 ;pneumonia (primary or influenzal), 328 ; cerebrospinalfever, 39 ; poliomyelitis, 44 ; polioencephalitis, 2 ;encephalitis lethargica, 2 ; dysentery, 47 ; puerperalpyrexia, 121 ; ophthalmia neonatorum, 64. No case ofcholera, plague, or typhus was notified during the week.The 7 cases of smallpox were notified at Bilston, Staffs.

Deaths.-In 126 great towns there were no deathsfrom enteric fever, 1 (1) from scarlet fever, 2 (1) fromdiphtheria, 7 (1) from measles, 13 (3) from whooping-cough, 78 (1) from diarrhoea and enteritis under two years,and 1 (0) from influenza. The figures in parentheses arethose for London itself.The number of stillbirths notified during the week

was 258 (corresponding to a rate of 26 per thousandtotal births), including 25 in London.