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130
cases, whether In-patient or Out-patient, are in the first place referred
to the Special Clinic by the Medical Officers at the ordinary Clinics.
They are either of the opinion that the child is in need of such extra help
as the Ward can give, or else they consider that there is some special
obstacle to the child's progress, which only a more prolonged and elaborate
investigation can elucidate than that which can be given at the ordinary
weekly clinics. As soon as the case has been satisfactorily investigated
and the child is on the fair way to health and recovery, it is sent back to
the Clinic Medical Officer with a report.
In-patients in the Wards.—47 cases were admitted altogether, a
number slightly larger than that of last year. The table shows the
variety of cases and the number of each kind:
Difficulty in Artificial Feeding 19
Malnutrition 7
Rickets 10
Neurosis 3
Food-refusal 2
Debility after Illness 2
Coeliac D sease 2
Diaphragmatic Hernia 1
Marasmus 1
47
The number of cases of artificial feeding that required treatment
in the Wards well exemplifies the difficulty of bottle-feeding as compared
with breast-feeding. These cases require very careful attention. Often
a good many varieties of food have been tried before the child comes
in, but without success. Frequently we have to deal not only with a
very ill-nourished child, but also with a badly-damaged digestive
apparatus. Nevertheless, it is possible, by careful observation, and
perhaps by means of several trials, to find a form of diet suitable to the
child's needs. Often it is of a more elaborate kind than is suitable for
use at home. We have to wait a little then, until the child becomes
thoroughly well and strong, and its digestion is quite restored and then
carefully change it to a diet within the capacity of its mother to make
and administer. It is wonderful how well these children grow away
when once they are digesting a good diet. If the good work begun in the