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(6) The general plan of campaign is to give each patient three treatments a week, beginning
with 5 minutes exposure only, back and front, on the first occasion, and subsequently lengthening
the exposure by five minutes each attendance until the maximum of half-an-hour back and front is
attained, so that after a fortnight each patient has an hour's exposure at each attendance. In the
case of very young babies these exposures have been diminished, especially at the beginning of treatment.
In order that as many patients as possible may enjoy the treatment three sets of patients are
kept under treatment simultaneously, so that there are six sessions a week.
(7) It has been found that in most cases it is necessary to extend the period of treatment
beyond the three months which was originally intended to be the limit. Three months seems hardly
long enough a time in which to develop the full benefits of the treatment, and frequently the attendances
of the patients are interrupted by trifling ailments, such as colds or feverish attacks, qr by
the incidence of parents' holidays involving a temporary removal to the seaside. Such opportunities
for a change of air are never discouraged as they are likely to prove of benefit at least equal to the
artificial sunlight. In consequence of these considerations many of the patients attend over a period
of four months although the average number of attendances per patient works out at 33 which is
only equal to eleven weeks, supposing that three treatments are taken regularly each week. But
as was pointed out above the regular succession of treatments is often interrupted.
(8) The temperature and pulse of the patients have been taken occasionally only, no effect
due to the treatment has been noted. Only two febrile patients have been treated, and in one case
the temperature settled down during the period of treatment and the patient did very well. The
precise diagnosis of this case was never established ; tuberculosis was suspected but no evidence of it
other than the rise of temperature was discovered.
The blood pressure was taken before and after treatment in 31 cases, in 18 there was no change,
in 9 there was a slight fall and in 4 there was a slight rise. I do not think any definite conclusion
can be drawn from these figures.
(9) Treatment was begun on 16th November, 1925.
(10) The total number of patients treated during the year ended 31st December, 1926, was 151.
(11) A weekly record of weights is kept, and a monthly record of heights. The record of
heights is only kept for children who are old enough to stand up unaided.
(12) There are still no facilities for making either photographic or radiographic records of
patients. As was pointed out in the report for last year the type of case treated in this clinic is as
a rule not severe, and changes in structure and appearance definite enough to be recorded by such
methods are extremely rare. The centre must be regarded as preventive rather than curative in
type. One or two cases have been specially sent to hospital to be radiographed, notably one case
where a chronic recurring empyema was sent for treatment, and it was desired to ascertain whether
there was any indication for further surgical treatment. No such indication was found and the
child was treated, but I regret to say that although at first the boy seemed to benefit and put on
weight, a recurrence of the empyema took place while treatment was being carried on.
(13) In general the children improved in brightness and alertness. I have no first hand reports
from teachers, but in several instances the mothers volunteered the information that since their
children had attended for artificial sunlight treatment they had done better at school, and one
case, a mentally defective child of mongol type, was reported by her mother to have greatly improved
in brightness, in tractability and in walking while under treatment. This child was under treatment
for eight months, but has now left the district.
(14) On the whole I am unable to give any general rule as to whether either the texture of
the skin, the colour of the hair or the presence or absence of erythema or desquamation bear any
relation to the benefit derived from the treatment. In any case the pigmentation produced by the
long flame carbon arc lamp appears to be very moderate in degree. In a few cases there was produced
a mottled erythema rather suggestive of german measles; this never lasted more than two days and
was not followed by desquamation.
(15) All the cases were submitted to general irradiation, no attempt was made to reduce
lesions by local irradiation. A few cases were found to suffer from headache unless the heads were
protected by brown paper shades. Two cases of summer dermatitis, a brother and sister were treated
and both of these seemed to be benefitted as regards their general condition ; they put on several
pounds weight and said they felt very well, but as might have been expected the skin lesions were
unaffected. At any rate they did not get any worse.
(16) The largest class of case treated was that which can only be described by the vague term
" general debility." Any one accustomed to deal with children will know the sort of child meant
by this term. On the whole they did very well, but not all equally well. A few put on as much as
five pounds in four months treatment but this was exceptional. For the most part one had to rely
on maternal reports for the estimation of their progress and these were very encouraging and there
is no doubt of the popularity of the artificial sunlight centre, both among the parents and the local
medical officers. There is always a waiting list of patients ready to begin treatment as soon as there
is a vacancy. I think this must be regarded as good evidence that good work is being done.
Other types of cases which deserve special mention are :—
[a) Pretubercnlar cases and also cases which have been in sanatoria.—Under the term " pretubercular
" are included cases of delicate children with a bad family taint of tuberculosis, but in