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Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia but the only
kinds notifiable are acute primary pneumonia and influenzal pneumonia. Two hundred and eight
notifications were received, 151 patients being certified as suffering from acute primary pneumonia
and 57 from influenzal pneumonia.
The number of deaths from pneumonia during the year was 191, and 92 deaths were certified
to be due to influenza.
Zymotic Enteritis or Summer Diarrhœa.—In 1921, the borough council adopted a scheme for
the control and treatment of zymotic enteritis or summer diarrhoea. The scheme has operated
since 1930 during the summer months—from the 1st July to the 31st October.
The council retain the part.time services of Dr. Ronald Carter, who has made a special study
of zymotic enteritis. Dr. Carter pays periodical visits to the various infant welfare centres, where
he is consulted in reference to difficult cases. He also sees cases in their homes which are not
attended by other doctors.
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 zymotic enteritis in the patients' homes during the
period 1st July to 31st October has worked quite smoothly. Last summer was a phenominally hot
one, the heat continuing for about four months. We have to go back to the summer of 1911 to find any
parallel. In 1911 there was a severe epidemic and also in 1921. During last summer, I saw a few
isolated cases only of infective enteritis with high temperatures ; the great majority of cases of
diarrhoea and vomiting being due to dietetic causes.
I saw ten cases in their own homes and paid twenty.five visits between 1st January and 30th June,
a period prior to the introduction of the council's scheme. From 1st July to 31st October, I attended
thirty cases and paid one hundred and thirty visits. In November and December, after the council's
scheme had ended, I saw five more cases and paid fifteen visits. I have paid two or three visits daily
in some urgent cases. There can be no doubt that most cases require daily visits for the first few days
until acute symptoms subside.
As these cases occur at any time in the year, I propose that my services should be available during
the whole year in future.
No case proved fatal in the home.
I sent three cases to hospital because they suffered from toxaemia and so required special treatment
and nursing which could not be carried out in the home. These three children ultimately died
in hospital. Two of the fatal cases were under.weight for their age ; they were looked after by foster.
mothers who took every possible care of them. They did not react to the routine treatment in the
way that a child living under more normal conditions would do. These children took the malted food
well for two or three days, and then showed signs of collapse, the diarrhoea meanwhile having subsided
so that there was no marked dehydration ; the vomiting, however, returned and signs of toxaemia
supervened. The third child was well nourished but was being given too much cows' milk for its age
and weight and, in addition, was having cod liver oil and malt. The child was only four months old.
The mother was very young and did not understand the importance of measuring the food.
With regard to foster.children, I have noticed during the last few years that some of them are a good
deal below normal weight and show signs of anaemia.
I have seen no case of Sonne dysentery this year nor any case of paratyphoid.
I think there is no doubt that all children suffering from dietetic disorders are best treated in their
own homes. In this way they are protected from other sources of infection such as occur in the wards of
a hospital.
Health Visitors' Notes.
One hundred and six cases were notified. Of these, forty.seven were one year of age and over, and
fifty.nine were under one year. Out of forty.seven cases of one year and over, twenty.two were noted
as severe and twenty.five as mild ; out of fifty.nine cases under one year, thirty were severe and
twenty.nine mild in type. In only five out of one hundred and six notifications was there more than
one case of diarrhoea in the family. In these five families, two of the children died.
The following table shows the food on which they were fed :—
†Mixed diet 46 cases.
Dried milk 16 ,,
Breast only 16 ,,
Cows' milk 28 „
† " Mixed diet " means vegetable soup or gravy and bread, custard or milk pudding at mid.day meal. The
other meals consist of cows' milk.
District Nursing Association.
The district nurses under Miss Eales attended one hundred and four cases of diarrhoea. The nurses
paid 923 visits. One child died while the nurse was attending. Eleven cases were sent to hospital and
five died. Only four of those who died had routine treatment. One case refused treatment.
Results of ten years' treatment by the nurses.
The total number of deaths is 34 out of 836 cases.
Deaths from vomiting and. diarrhoea, and enteritis.
There were 42 deaths from diarrhoea or enteritis (in children under one year) during the year ;
eight of them had been notified but did not have routine treatment. Thirty deaths occurred amongst
infants who had not been attended by the nurses and had not been notified.
(Signed) Ronald Carter.