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In the mild cases there was usually no rise of temperature, and only a short degree of dehydration.
It was, however, quite impossible to say if these cases were going to remain mild or not. I have
repeatedly seen the mild case merge into a severe gastro-enteritis, particularly when treatment was
deferred to the third day of illness.
The severe cases usually began with high fever—temperatures of 102 degrees to 104 degrees being
frequently present, with dehydration and in some cases accompanied by toxaemia.
A considerable number of breast-fed infants suffered from diarrhoea and vomiting. I did not see
any cases of toxaemia amongst these infants, but some were very definitely dehydrated and collapsed.
It was necessary to discontinue breast-feeding for two or three days, the mother in the meantime expressing
her breast milk and taking care not to lose it. After the third or fourth day, all these infants were
put back on the breast and did reasonably well.
I attended a number of children with chronic diarrhoea and vomiting. They were pale, flabby, and
wasted, and their temperatures were subnormal. They were not suffering from dehydration or toxaemia.
Their condition was due to what is known as a deficiency disease, that is to say, they had been brought
up on a wrong balance of the principal foods such as protein, carbohydrates and fats, and they also
had had no vitamins in their food. For instance, I saw children between the ages of seven and nine
months who had been fed on condensed milk, two or three teaspoonsful in 5 ounces of water, with
the addition of white bread and margarine and tea to satisfy their hunger. This diet had gone on for
months. The diarrhoea in these cases was not due to enteritis, but to faulty metabolic changes. On
a properly balanced diet suitable to their age with three or five drops of cod liver oil given three times
a day, and also one teaspoonful of orange juice, these children did well, provided they had sufficient
power of recuperation. Several of these cases, however, died in hospital, and no signs of enteritis were
found, and no fatty degeneration of the liver. They died because the normal processes of the body
ceased to operate. It is a functional rather than a pathological condition.
I also saw cases of marasmus due to food disorders where the children had lost more than 20 % of
their expected body weight for their age. An attack of enteritis in these cases is particularly serious.
Amongst older children there were some ten cases of chronic diarrhoea with a good deal of mucus
in the stools. These children had no vomiting, had no appetite, were losing flesh, and in some instances
were said to be suffering from tuberculosis. Routine treatment was most successful in these cases.
After a week with daily washing out of the bowels, rest in bed, with malted milk diet, the diarrhoea soon
subsided, and ordinary food was taken with relish.
I saw four cases of very acute diarrhoea and vomiting, sometimes called “fulminations,” wherè
the routine treatment was not successful. These children all died in hospital within two days. These
cases are fortunately very rare at the present time.
From an examination of the notes at the commencement of the report, it will be noticed that Summer
diarrhoea does not appear to be often infective from person to person. The child dies from an infective
condition produced in its own body. Cows’ milk seems to be more responsible in the causation of this
disease than any other form of food; and over-feeding in Summer time or at any other time is a frequent
cause of digestive disturbance.
I have shown that notification has brought to light a great variety of cases which would formerly
have received no treatment. Of course, diarrhoea is sometimes a symptom of diseases outside the intestinal
tract, and is secondary to, for instance, measles, pneumonia, etc. These secondary symptoms
have not been included in my description, but I should like to mention one exception, namely, otitis
media, or middle ear disease. In five cases where this was the cause, directly the pus escaped from the
ear, the diarrhoea began to subside. If this “first aid” method or routine treatment is more generally
adopted, enteritis caused by digestive disturbances should considerably diminish.
It has been possible to trace all the 472 cases attended by the district nurses, and of these only
18 proved fatal; 3 died in their own homes and 15 in hospital.
SUMMER DIARRHOEA, 1930.
The weather during last summer was not very hot except for a heat wave in August. I attended
29 cases in their own homes and paid 94 visits, and am pleased to report that none of the cases treated
by me outside hospital proved fatal. No complaints have been received with reference to the working
of the Council's scheme, and the parents were in many instances grateful for the prompt assistance
they received.
Health Visitor's Notes.
The number of cases notified was 85; of these, 60 were under one year of age, and 25 one year and
over.
The number of families in which the patient was the only case was 73, and the number of families
where more than one case occurred was 5.
Food on which the children were fed.
Mixed diet 34 cases.
Cows' milk 17 ,,
Dried milk 17 ,,
Breast only 5 ,,
Condensed milk 5 „
Unknown 7 ,,
“Mixed diet” means gravy and bread, or gravy and potatoes, with custard or milk pudding at the
mid-day meal. The other meals usually consist of cows' milk.
Amongst the notified cases, 48 were severe, and 37 were mild. Amongst the severe cases which
recovered, 27 received routine treatment and 12 did not. It is satisfactory to be able to record that
in every cases where routine treatment was provided within two days after the onset of the disease,
the child recovered.