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The following is a report by Dr. Carter giving particulars of cases of enteritis dealt with during
the year under review.
The council's scheme for the treatment of enteritis in the patients' homes has worked quite
smoothly. Last summer, there was a severe heat wave, the high temperatures resembling the years
1911 and 1921, when epidemics occurred. I attended fifty-six cases and paid ninety visits.
No case proved fatal. Eight cases were sent into hospital. These were found to be due to Sonne
dysentery and were highly infective, but no deaths occurred amongst them.
The symptoms in some of the cases last year were severe with high temperatures. Dietetic errors
were the causes in the majority of the infants. Amongst the older children, mucous colitis was
the cause and this was successfully treated by intestinal lavage combined with temporary feeding
with malted milk. In many cases there was great difficulty in resuming the normal diet and the
changes in the food had to be made gradually.
The notification of diarrhoea, apart from zymotic enteritis, has brought to light a number of
cases of malnutrition and these are the difficult cases to treat, as the child's resisting powers have been
considerably lowered before it is attacked with vomiting and diarrhoea.
Dysentery.
An outbreak of Sonne dysentery occurred during the year. Twenty-five cases were notified,
one in January, five in March and the rest between June and October. Only one death occurred,
the child being rather emaciated. Twenty-two oases were seen in children of one year of age and
over. The Sonne organism was isolated in each case. The majority of the patients were sent to fever
hospitals because of the infectivity of the disease. The children generally began to recover in four
days from the date of onset and routine treatment was quite satisfactory.
The medical officer of health requested me to write an account of the disease, which was circulated
to the general practitioners in the neighbourhood. When cases of Sonne dysentery occur in a subacute
form, they are very apt to be overlooked, and it is probable that some of the infectivity of summer
diarrhoea is due to this cause.
The origin of the outbreak was not ascertained. A number of cases occurred in the Sutton
Dwellings, but other districts of North Kensington showed the presence of the disease. One case
of Flexner dysentery occurred.
Health Visitors' Notes.
Eighty-three cases were notified. From January to June 30th, there were 14, from July 1st lo
October 31st, 62, and from November 1st to December 31st there were seven. Of these 38 were one
year of age and over, and 45 were under one year. Fifteen cases were sent into hospital.
The following table shows the food on which the patients were fed :—
Dried Milk 14
*Mixed diet 31
Cows' milk 17
Breast milk 12
Condensed milk 9
* " Mixed diet" means vegetable soup or gravy, and bread, custard or milk pudding, at midday
meal. The other meals consist of cows' milk.
Amongst the 83 notified cases, 32 were severe and 51 were mild.
District Nursing Association.
The district nurses under Miss Eales attended 120 cases of infantile diarrhoea. From January 1st
to June 30th, there were 43 cases, and from July 1st to December 31st, 77 cases. The nurses paid
1,326 visits.
Two deaths occurred whilst the nurses were in attendance and five amongst infants removed to
hospital. These children were very ill when the nurses were called in and intestinal lavage only was
given. During the year, 20 individual doctors in the neighbourhood availed themselves of the help
of the nurses and the full routine treatment was carried out in 63 cases.
Deaths from Diarrhoea and Enteritis.
There were 57 deaths from diarrhoea or enteritis (in children under one year of age) during the
year. Seven deaths occurred amongst those which had been notified. Reference has already been
made to these in the nurses' report. Fifty deaths occurred amongst children who had not been
notified and had not received the nurses' treatment in the homes. Out of 57 deaths, 52 cases died in
hospitals.
(Signed) RONALD CARTER.
Dysentery.—Twenty-five cases of dysentery occurred during the year. One was of the
Flexner variety and 24 cases were infected with the Sonne organism.
Of the Sonne cases, three occurred in the Baby Hospital, two in the Princess Louise Kensington
Hospital for Children, ten in private houses ; the remaining nine cases were reported from a large
block of residential flats occupied by persons of the working class and are referred to by Dr. Carter
in his report on enteritis. All the cases occurred in North Kensington.
Acute Rheumatism.—During the year under review, 50 cases of this disease were notified, 14 of
which were removed to hospital for treatment.
The fifth annual report on the working of the rheumatism scheme during the period
1st October, 1931, to 30th September, 1932, prepared by the physician in charge of the centre and
the medical officer of health, appears as Appendix I to this report.
Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a
separate section, no notifiable infectious diseases, other than those to which reference has been
made, were notified during the year.