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52
It will be seen that all the cases occurring in 1926 recovered without any injury to sight. In
fact, since the year 1921 there has occurred only one case where there has been any impairment of
vision. This case was reported upon in my Annual Report for the year 1925, and now there is a
marked opacity in the left eye, but the sight of the right eye is saved.
These very gratifying results are largely due to the efforts made by the Council's Health Officers
to secure hospital treatment, and to the excellent arrangements which the Borough Council have
entered into with the Kensington District Nursing Association for the home treatment.
It is the duty of midwives to report all forms of inflammation of the eye, even when the condition
is not ophthalmia neonatorum, and these cases, in addition to pure ophthalmia cases, are dealt
with by the Kensington District Nursing Association. In 1926, the ophthalmia neonatorum
and inflammation of the eye cases attended by the nurses numbered 35 and the number of home
visits paid in connection with these cases was 359. These visits average 10 to each of the 35 patients,
and indicate the great amount of trouble taken with this disease. The visits paid by the Council's
"Women Health Officers are not included in the 359.
Puerperal Fever.—The incidence of this disease has been light during the past year, nine cases
only being notified. Eight were admitted to hospital, and the remaining case was admitted to a
nursing home. There were 6 deaths from this disease during the year.
A number of women were sent into St. Mary Abbot's Hospital immediately following an increase
of temperature shortly after confinement and they received prompt surgical treatment with the
result that signs and symptoms abated and satisfactory recoveries were secured. It is possible
that some of these may have become definite cases of puerperal fever in the absence of this treatment.
Arrangements for the early admission to St. Mary Abbot's Hospital of suspicious cases of this
disease were discussed fully in my report for 1922.
Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926.—
During the year, the Minister of Health issued Regulations relating to the notification of
puerperal fever and puerperal pyrexia, which came into operation on October 1st.
These Regulations prescribe the form in which medical practitioners are required to notify
oases of puerperal fever and, in addition, they provide for the notification of all cases of puerperal
pyrexia.
Puerperal pyrexia is defined as any febrile condition (other than puerperal fever which is
required to be notified under the Infectious Disease (Notification) Acts) occurring in a woman
within twenty-one days after childbirth or miscarriage in which a temperature of 100.4° Fahrenheit
has been sustained during a period of twenty-four hours or has recurred during that period.
The Council are required to enforce and execute the Regulations, and must cause to be sent to
all medical practitioners resident or practising within the Borough notice of the duties imposed
upon them. The Council must provide each doctor with a supply of notification forms. The
Medical Officer of Health must forward a copy of every notification to the County Medical Officer
within twenty-four hours of receipt and to the Metropolitan Asylums Board within twelve hours.
A medical practitioner is entitled to a fee of 2s. 6d. in respect of the notification of a case
occurring in his private practice and to a fee of 1s. if the case occurs in his practice as medical
•officer of a public body or institution.
Puerperal fever has been notifiable throughout the country since the Infectious Disease
(Notification) Extension Act, 1899, came into force. Experience has shown, however, that for
a variety of reasons notification of this disease has been far from complete, with the result that
not only are the statistics relating to the disease inaccurate and misleading (particularly as regards
incidence and fatality rate), but measures for the prevention and effective treatment of the condition
have been seriously hampered. In this connection, it should be pointed out that since 1902
maternal mortality has not declined proportionately in the same degree as the death rates from
all causes of women at reproductive ages, as the general death rate for all persons at all ages, or as
the infant mortality rate for children under one year of age. In fact, the child-bearing mother is
not sharing equally with the rest of the population in the improved public health. Maternal
deaths are due principally to puerperal infection.
The main reason for the comparative failure to notify is to be found in the fact that puerperal
fever is ill-defined and is not a specific disease comparable with scarlet fever or diphtheria. There
is frequently, therefore, a genuine doubt as to the correct diagnosis. The term moreover bears a
connotation which may be thought to imply some slur upon the patient or medical attendant, and
this may possibly act as a deterrent to notification of a doubtful case. In any event, it is certain
that many cases are not notified at all and that severe cases are often notified only when it is too
late for effective action to be taken. It is in view of these circumstances that the Minister has
found it necessary to modify the existing arrangements for the notification of puerperal fever by
jequiring the prompt notification of this morbid process as soon as symptoms suggestive of septic