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Report of the County Medical Officer—General. 77

In seven cases of puerperal fever, birth took place before the arrival of the midwife.
It is the duty of a midwife to advise that medical help is required when inflammation of the eyes,
however slight, occurs in infants. When a notice is received from a midwife that medical assistance has
been sought on this account, the Council's medical inspector at once visits the infant to ascertain that
it is receiving the medical assistance which the midwife has advised, and the medical officer of health
of the borough in which the patient resides is immediately informed of the condition of the case and
whether the infant is being removed to a hospital for treatment. The midwife is also visited to
learn particulars as to the case, the antiseptic precautions taken and the disinfection adopted by the
midwife after each visit to the case.
Moreover, in order that skilled attention should so far as possible be available, the Queen Victoria
Jubilee Institute, the Ranyard Nurses Society, the Holloway Nursing Institute, and the Nursing Sisters
of St. John the Divine were asked if they would be willing to allow their nurses to undertake, under the
direction of the medical practitioner called in, the care of these infants in order to see that the necessary
irrigation or swabbing of the eyes was properly done, and at the proper intervals. All the above societies
readily consented and during the year their services were made use of in 27 cases.
During the year 488 notices were received from midwives, stating that medical assistance had
been advised on account of inflammation of the eyes of infants, and, during the year, the results of investigation
into 537 cases were reported to the Midwives Act Committee.
456 cases were reported to be completely cured. In 6 cases there was impairment of vision,
20 died while still suffering from the disease, 2 were still under treatment, and in 53 instances the result
could not be ascertained owing to the removal of the parents, who could not be traced.
The day of the puerperium on which signs of inflammation were first noticed was: day of confinement,
20 cases; second day, 38; third day, 65; fourth day, 60; fifth day, 63; sixth day, 45;
seventh day, 52; eighth day, 57; ninth day, 38; tenth day, 50; later than tenth day, 39; not
ascertained, 10 cases.
A history of vaginal discharge in the mother was obtained in 213 instances, i.e., in 39.7 per cent.
of the cases.
The antiseptics used for the child's eyes at birth or as soon afterwards as possible were boracic
lotion in 160 instances; perchloride of mercury (1 in 4,000 or weaker) in 229; silver nitrate (a 1 or 2
per cent. solution) in 63; protargol in 16; biniodide of mercury in 2; boracic lotion followed by perchloride
of mercury in 7; boracic lotion followed by silver nitrate in 12; boracic lotion followed by
protargol in 2; perchloride of mercury followed by boracic lotion, 13; perchloride of mercury followed
by silver nitrate in 2; protargol followed by perchloride of mercury in 1; cyllin in 1; sterile water
in 20; and in the remaining 9 instances no details could be obtained. An interval between the birth
and the use of an antiseptic occurred in 94 instances owing to the fact that the infant was born before
the arrival of the midwife.
The following facts relating to the six cases in which impairment of vision supervened were
learnt:
(1) No history of vaginal discharge in mother. Boracic lotion used for eyes at birth. On
the 5th day a speck of matter was noticed in the corner of one eye, but there was no inflammation.
Medical aid was obtained on the following day. Result—Sight of right eye impaired.
(2) Vaginal discharge in mother. A two-per-centum solution of silver nitrate used for
eyes at birth. Onset on fifth day, only the right eye being affected; medical aid obtained at
once. Result.—Small opacities to the outer side of each eye. No nystagmus at present, and
child appears to see fairly well.
(3) Vaginal discharge in mother. A solution of perchloride of mercury (1 in 4,000) used
for eyes at birth; onset on seventh day, only the left eye being affected; medical aid obtained
on that day. Result.—Eyesight permanently injured.
Ophthalmia
Neonatorum