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121
The results of treatment were as follows:—
Recovered 48
Improved 12
Removed by Parents 2
Transferred to Hospital 1
Died 2
65
A sufficient account has been given in the past of some of the commoner
conditions, such as Malnutrition and Difficulty in Artificial Feeding.
Marasmus, Pyloric Stenosis and the Neurosis were described last year,
and there is no need to refer to them again. But a case of Coeliac disease
has not been admitted for some years. The main feature of this disease is
a very impaired power of absorbing fats, and a lesser impairment of
absorption of other foods. Large quantities of fat are passed in the
motions; great weakness and wasting set in, and there is much distension
and discomfort in the abdomen. The most important point in treatment
is to secure a diet which shall contain hardly any fat, and not much of
another class of foodstuff, the carbo-hydrates which includes the starches
and sugars. The diet in the worst stages consists mainly of skimmed milk,
white of egg, and the dried casein of milk, with some saccharin to remedy
the extreme tastelessness of the diet. As improvement takes place the
diet is extended; but it is really like building a house of cards, since the
slightest infection such as a cold, to which the patient will be peculiarly
prone, will bring back all the symptoms in their former severity and
necessitate starting again from the beginning. Our little patient was
immensely plucky and endeared himself to everyone by his grit. He was
over the worst of it when the Wards were closed for the holidays. Guy's
Hospital then kindly took charge of him, and there he made further
good progress.
I should like this year to draw attention to the fact that many cases
of Rickets are still admitted. This disease is not now seen in all the
severity of gross bowing of the legs and other hideous and disabling
deformities as it once was, but moderate degrees of it with considerable
stunting, mis-shapenness of limbs, bossing of the forehead, pigeon breast,
bad teeth and general fiabbiness of the muscles are still far too common.
Since so much care is expended on the diet and hygiene of the children,
and cod-liver oil and sunlight (the acknowledged remedies) are freely