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97
Bow Road Clinic has served the northern half, and Simpsons Road
Clinic, opened on January 14th, the southern, thus quite doubling our
usefulness, as is evident from the numbers quoted, of cases treated and
"baths" given.
Children under five years are eligible, except cases of tuberculosis,
this being the rule of the Ministry of Health.
The large majority sent to me, or chosen by myself, from our Welfare
Clinics suffered from rickets, not only the obvious deformities of bones,
but delayed dentition, the catarrhal state with repeated bronchitis,
muscular weakness, delay in walking, lethargy and occasional convulsions.
A few of the older ones had anaemia and debility—usually produced bv
overcrowding, lack of fresh air and poor feeding.
All except very small, frail babies are given four minutes (two facing
back, two facing front) at a distance of 28 inches from the lamp, as a
first exposure. This is repeated on alternate days for four to six sessions
and increased by one minute every four to six sessions, till a maximum
exposure of eight minutes is reached. Each child is considered individually
and his response to treatment enquired into before he is promoted
to a longer exposure, and no rigid rule can safely be observed. Any
unfavourable sign (like restlessness at home) that may occasionally be
reported is a signal for cutting down the period of exposure, or at least
delaying promotion to longer exposure; but with our present system,
cutting down is very rarely necessary. I do not find with these young
children that eight minutes need usually be exceeded with the K.B.B.
lamp in use, as this has a high ultra-violet activity. Pigmentation is so
slight as to be negligible, and seems to have no relation to the clinical
effects.
A few cases (of rickety legs) are now on a course of red-with-infra-red
rays for 10 minutes, followed immediately by the ultra-violet bath.
This is in accordance with some recent experience recorded in this and
other countries, and as it is eminently satisfactory in our own Clinics, I
propose to extend the use of the red lamps in picked cases. The advantage
I have noted is a more rapid improvement in the rickets than I have found
in similar cases with ultra-violet only.
Seven cases have been reported in detail as of special interest.
Many others, less dramatic, have been remarkably encouraging to the
Sister and myself, as well as to their parents—especially perhaps fretful,