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53
I attended 29 cases in their own homes and paid 77 visits during the year. I saw two cases of
dysentery in which the Flexner bacillus was isolated. These cases did not have routine treatment,
as I sent them into hospital.
There was an outbreak of Sonne dysentery in the nursery of St. Mary Abbots Institution. Seven
suspected cases were reported, but the Sonne bacillus was isolated in only three instances. The
infection was traced to a child who was admitted to the nursery from a home in North Kensington.
All the children did very well. They were immediately isolated, and no further cases occurred.
Another attack of Sonne dysentery occurred in the Separation Block at St. Mary Abbots Hospital
in November. Nine cases were reported, and the Sonne bacillus was found in each case. The infection
was introduced into the wards by a child who was admitted for broncho-pneumonia and began to
have diarrhoea, with blood and mucus, six days after admission. The child's parents removed him
from hospital and he was treated at home.
The other eight cases were sent to the Western Fever Hospital and did very well. The ages of
the children varied from seven months to 2½ years. They had no fever or vomiting and did not appear
to be ill.
The majority of the diarrhoea cases in the homes were suffering from acute dyspepsia, in which
vomiting was the chief symptom. A considerable number, however, had symptoms of enteritis as
well. In the mild cases there was no rise of temperature, but the acute enteritis cases had fever which
varied between 100º and 104°, with dehydration.
Nearly all the acute cases I saw were due to dietetic causes, the balance of the various foods being
faulty. In some cases contamination of cow's milk appeared to be the cause.
There were cases of chronic diarrhoea in which wasting due to food disorders was the real cause,
the diarrhoea being a symptom produced by a slight infection of the intestine and soon subsiding with
treatment. These cases suffered from subnormal temperatures, and the susceptibility to infection can
only be overcome by gradually increasing the amount of food, thereby increasing the child's weight
so that resistance to infection can be strengthened. The wasted child requires more attention to its
diet after the diarrhoea has subsided than is necessary in the case of a child of normal weight for its age.
Intestinal septicaemia was another cause of chronic diarrhoea. This was greatly benefited by
foutine treatment. The appetite returns very rapidly when the motions become healthy in appearance.
Mucous disease in older children, from two to four years of age, was also responsible for chronic
diarrhoea. These children are pale and wasted, and have no appetite. They are sometimes suspected
to be suffering from tuberculosis. All the symptoms clear up with routine treatment, and the children
make a good recovery when put on a well balanced diet.
Early rickets with diarrhoea was another condition seen. Here again, after the diarrhoea had
subsided, fresh air, dieting and cod-liver oil produced good results. These cases do not go to doctors
until some definite bone changes are visible. Coeliac disease, in which fat cannot be absorbed and
growth is impaired, was also observed.
The notification of diarrhoea apart from zymotic enteritis has brought to light a number of cases
of malnutrition which would pass unnoticed in the ordinary way. It is useless in these cases merely
to cure the diarrhoea and to leave the original cause untreated.
With regard to vitamins, it is well to remember that a properly balanced diet has sufficient of
these in it to satisfy the demands of the body. Vitamins will not remedy a deficient food supply.
Health Visitors' Notes.
Forty-one cases were notified. Of these, 17 were under one year of age and 24 were one year
and over.
The number of families in which the patient was the only case was 33, and the number
of families in which more than one case occurred was four.
The following table shows the food on which the patients were fed.
Diet. Cases.
Cow's milk 3
Breast only 4
Dried milks 6
*Mixed diet 23
Breast and cow's milk 4
Condensed milks 1
* " Mixed diet " means vegetable soup or gravy, and bread, custard or milk-pudding at the midday
meal. The other meals consist of cow's milk.
Amongst the 41 notified cases, 19 were severe and 22 were mild. Fifteen of the notified cases
were not attended by the district nurses. Eight of these were severe and seven were mild.
Kensington District Nursing Association.
The district nurses under Miss Eales attended 52 cases of diarrhoea, 26 of which were notified.
Not one of these proved fatal.
Twenty-one cases of diarrhoea occurred between the 12th January and the 31st June, and
31 between the 1st July and the 31st December.
There have been no deaths in the homes whilst the nurses were attending. Seven cases were
sent into hospital, and one of these died. The fatal case was really one of broncho-pneumonia, and
diarrhoea occurred secondarily when the child's strength was failing. The nurse attended this case
for only two days before removal to hospital.
The nurses paid 465 visits. Three of the cases required a large number of visits ; in one the nurses
paid 36 visits, in another 23, and in the third 24.
Deaths from Diarrhoea and Enteritis in 1931.
There were 40 deaths from diarrhoea recorded during the year. Thirty-seven deaths occurred
amongst cases which were not notified, and three amongst those notified. The district nurses attended
one unnotified case which proved fatal. Reference has already been made to this in the nurses' report.
Amongst the 40 registered deaths from diarrhoea, broncho-pneumonia or bronchitis was
included as a cause of death in 12 cases, septicaemia in one case, and the remainder were attributed
to gastro-enteritis, infective enteritis, or diarrhoea.
(Signed) RONALD CARTER.