View report page

129
or below weight and the breast milk was insufficient, special milk
mixtures appropriate to their needs have been supplied.
The attempt was made in 27 instances to establish or restore breastfeeding
after it had failed or ceased to be employed. It was successful
in 15, partially so in 3, and failed in 10. In this work to improve lactation
the three most important factors are the age of the baby, the distance of
its home from the Clinic, and the health of the mother. Where the baby
is only a few weeks old attendance three times daily on a few consecutive
days, with an occasional re-attendance, is usually enough. Cases undertaken
at five or six weeks may require for success that the mothers come
daily for three weeks or longer. This makes great demands on their
time and strength and, in the absence of transport, is only possible if
they live close to our premises.
In 93 instances enough observations were made to return precise
information to the Clinic physicians for their guidance. In about a
quarter of these a considerable improvement in the yield of milk was
registered during the women's attendance. In 45 others attendance was
either not long enough or regular enough for any reliable conclusions to
be drawn.
The department serves a useful purpose in the opportunities it affords
to observe the babies. Thus of those referred for wasting or vomiting
there are usually several in the year found to have pyloric obstruction.
The information gathered at the Clinics may or may not be enough to
arouse suspicion of this disorder. With the baby under observation all
day its detection is made easy, and those requiring operation can be sent
to the surgeon without delay. This year two such cases were discovered
on the first day of attendance and transferred at once to hospital; both
made satisfactory recoveries.
Eleven women were seen during the year with acute mastitis already
at an advanced stage. In several the onset dated from a day or two of
their return home from hospital, but few were aware of the significance of
the early symptoms. Eight occurred in primiparae. It is possible some
could have been saved much suffering and subsequent operations had they
appreciated the importance of seeking advice early. In four of six cases
seen soon after the onset, the attack subsided without suppuration. In
the other two, as in all the late cases, the inflammation resulted in abscess
formation requiring their admission to hospital.
H. K. WALLER, M.B.