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St. Mary Abbots Hospital.
During the year, we treated fifty-two cases of gastro-enteritis, of which thirty-eight recovered
and fourteen died. In an analysis of the deaths, I find that three were admitted in a moribund condition
and died in a few hours. All the deaths were in children under one year of age except three.
Most of the cases which died were very ill on admission, suffering from toxaemia and dehydration
and collapse. On taking a careful history of some of these cases, it was often found that they had been
four of five days without food, that is to say, they had been living on albumin water. This long period
of starvation made it impossible for the child to hold its own. In some cases of dehydration saline was
injected subcutaneously and sometimes intraperitoneally. I saw one very acute " fulminating case "
which had only been ill two days. On the third day the temperature was 105°F and death occurred on
the fourth day.
When a child continued to have fever, however slight, for over a week, the stools were examined
bacteriologically. This practice was also adopted outside the hospital. Morgan No. 1, bacillus Coli,
proteus etc. were the usual organisms present; no paratyphoid was discovered. In one case of chronic
diarrhoea and wasting in a child nine months old with no fever, the Shiga (dysenteric) bacillus was
isolated. This is a very rare condition in a child of this age. The father had been stationed in the tropics
whilst in the Navy but the agglutination test with his blood proved negative. A daily wash out of the
bowel with saline removed the bacillus in ten days' time and the child made a good recovery.
Amongst those which recovered, there were many cases of vomiting which was so severe that
hourly injections of glucose and water per rectum and drops of brandy by the mouth had to be given
every four hours for some days. Food was then gradually added, but these cases were often two or
three months in hospital. In most of the severe cases that recovered, the problem resolved itself into
finding a food which was well tolerated and in testing the digestive capacity of the infant by changing
the quality of the food very gradually. Only the mild cases were given routine treatment as a rule ;
in the severe types much would depend on the general condition of the child, the length of time the
illness had lasted and the previous treatment it had received.
Post Mortem Examinations.
I have been present at most of the post mortems and have been struck by the fact that all cases
without exception showed fatty degeneration of the liver and only in two or three cases was there any
evidence of inflammation in the intestine or enlargement of Peyer's patches. The pathology of this
disease is clearly an absorption of toxin from the bowel which makes its way through the portal vein
directly into the liver cells. The shock to the liver is so great that it ceases to store glycogen, the child
therefore cannot obtain sufficient sugar to live.
It is obvious that the good results obtained by routine treatment in the home are due to removing
the toxin as soon as possible by washing out the bowel daily and giving the child plenty of water to
drink, thereby helping the excretion of toxin and the prevention of dehydration. The malted milk
given on the second day is an easily digested food, containing dessicated milk, wheat flour, barley
malt, bicarbonate of soda, hardly any fat, and the mixture contains no unaltered starch, and a large
amount of sugar. This food helps the liver at the earliest possible moment to recover its capacity of
storing glycogen, and so the child can obtain the sugar which is so necessary to life.
Several doctors during the Summer asked me to see their cases.
(Signed) RONALD CARTER.
Dysentery.—Two cases of dysentery were notified during the year in the Holland and Earl's
Court Wards respectively. One patient contracted the disease during a voyage in the Mediterranean
and the other whilst on a holiday in the Austrian Tyrol.
Acute Rheumatism.—Under the Kensington (Acute Rheumatism) Regulations, 1927, acute
rheumatism, as defined in these regulations, was made a notifiable disease for three years from
1st October, 1927. The regulations define acute rheumatism as denoting the following conditions,
occurring separately and together in a child under the age of sixteen years.
(a) Rheumatic pains and arthritis, if accompanied by a rise of temperature ;
(b) Rheumatic chorea;
(c) Rheumatic carditis.
Before sanctioning these regulations, the Ministry of Health required to be satisfied that :—
(1) Efficient machinery existed for investigating the cases notified.
(2) There was accommodation for institutional treatment.
(3) The local authority was well organised in regard to health administration and
had good housing records.
The first of these conditions was provided by setting up a Rheumatism Supervisory Centre and
by arranging that on the receipt of a notification a health visitor should visit the home of the
rheumatic child to make certain enquiries and observations. The second was complied with by
making special arrangements with the Poor Law Authorities of Kensington, whereby in-patient
accommodation was set aside at St. Mary Abbots Hospital, and by making a grant towards the
provision of convalescent treatment. The third condition was already satisfied.
During the year 1929, 81 cases of this disease were notified, 50 of which were removed to
hospital for treatment.