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dust is dealt with, and the other the proximal end of the affected
wards, we find that the exact distances in the case of the F and H
wards are 69 and 86 yards respectively; while so far as E and G
are concerned the distances are 108 and 120 yards.
Even if the offensive smell were to reach the wards, we are of
opinion that it could only give rise to an immediate and temporary
attack of diarrhæa in a highly sensitive individual. Such attacks are
more apt to occur in adults than in children.
In St. Saviour's Infirmary there are a large number of young
children who are especially likely to develop a constitutional state in
which there is an undue susceptibility of the mucous membranes
leading to nasal and bronchial catarrah and enteritis. This state
is known as "hospitalism." It quickly develops in infants even
under the best conditions of nursing, and it shows an especial incidence
on those who are wasted. Eleven of the patients subsequently
affected with enteritis were admitted to St. Saviour's
Infirmary with wasting diseases.
Dr. Neal, late Superintendent of the Wandsworth Infirmary,
has given us a list of the cases of enteritis in that institution. Of
the children who died, 8 out of 21 in 1911, 3 out of 15 in 1912, and
10 out of 18 in 1913 had been inmates for a longer period than one
month before attack.
Constance Road Workhouse has had no cases of enteritis during
the three last years. At this institution, although 82 births took
place during 1913, the infants were usually removed before the end
of a month; but on the supposition that the siding is such a potent
form of infection it seems odd that these babies, together with about
300 other sick persons, who are almost as near as the St. Saviour's
Infirmary, should have so completely escaped.
Gordon Road Workhouse, where there are a number of infants,
either foundlings or deserted, is closely affiliated to the Camberwell
Infirmary, and any child showing premonitory symptoms of infantile
diarrhæa is drafted to the Infirmary. These Gordon Road
infants form a large proportion of the deaths in the Infirmary. Out
of 16 deaths, 7 were of Gordon Road children, and of these 7, 4
had been inmates over one month. Of the 33 non-fatal cases admitted
to the Infirmary, 14 were from Gordon Road, and of these
14, 6 had been inmates over one month.
The milk at St. Saviour's is Pasteurised, and due precautions
are enjoined for its conveyance to the wards. It is impossible to
exclude the milk as a source of infection, especially in hot weather,
seeing that the common organisms giving rise to infective enteritis
are not completely destroyed by Pasteurisation.
Careful examination has been made of the sanitary state of the
St. Saviour's Infirmary. The drains have, where possible, been
tested by water, and in the main the results have been satisfactory.
There are one or two instances, however, where rainwater pipes
have been found to be leaky—some to a slight degree and a few to
a considerable extent.
The sanitary condition of the wards is, generally speaking,
satisfactory, with the exception of the flooring. This is not of a