Paediatrics in Western Nigeria.

The aim of this article is to present to the reader a broad view of the work of a general hospital in West Africa in its relation to the health of children. Facts and impressions were accumulated by the author during a year's sojourn in Nigeria, too short a time no doubt for a penetrating survey of local problems, but, possessed of the clinical potential of a flourishing and well-esteemed young hospital, long enough for a responsible survey of the main topics confronting workers in Child Health in West Africa. Practice in Africa is bewildering and refreshing to an English doctor, and requires a fresh approach adapted to experiences in new realms of pathology. Several published descriptions have focused attention on the University College Hospital, Ibadan, during its growth (vide British Medical Journal, 1956). Now it is completed and possesses facilities that are unexcelled in tropical Africa. Built beside a teeming Nigerian city, a centre both of commerce and administration, and closely in contact with a university already of considerable renown, the new hospital is exceptionally favoured in its circumstances and associations. In the waiting period while the new hospital was being built, the medical staff, who were already assembled, were occupied in creating a corporate hospital unit and at the same time in providing the local population of Ibadan with the fuller medical services that such an unexampled mustering of doctors and nurses made possible. These new facilities were grasped with alacrity, and in no sphere more willingly than by parents for their children. It was during this interregnum that the subject matter of this paper was collected. The base hospital was then the Adeoyo Hospital in the middle of the old town, a group of single storied buildings closely encircled by primitive dwelling houses, recently vacated by the Ibadan District Council to furnish the nidus of the University Hospital organization. The little renovation that was possible was done, and soon this primitive and unkempt small hospital became imbued with a mood of energy and promise, so that its achievements far over-reached its material restrictions. The children's ward consisted of a congested room with a balcony, together able to contain some 35 infants and children under 12 years of age. In this ward fulminating gastro-enteritis was treated beside broncho-pneumonia, septic ulcers beside extensive exposed burns, typhoid beside malaria and tuberculosis amidst them all. The frequency of cross infection can only be roughly guessed, but was certainly not very great, as instanced by the fact that diarrhoea seldom developed in hospital even in long-stay patients. Perhaps we owed this to the sunlight and free circulation of air in a ward with constantly open doors and windows. An element of squalor is inseparable from work in these circumstances, but the first affronted reaction to bed linen grey from use and re-use, to the one ward lavatory of hole-in-floor type which served for patients, staff and visitors, to the 'sluice room', a square cell with a tap and a hole in the wall from which the effluent flowed outside in a rather illdefined way, and to the chicken which continued defiantly to inhabit the out-patient verandah, passed when one realized that these were unalterable but temporary conditions, and that ill results from them were so much less than might be imagined.