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Erysipelas.—Forty-four cases were notified during the year, 18 of which were removed to
hospital The cases notified in the three preceding years were 70, 68 and 82. There was only one
death from this cause, the deaths in the three previous years being 5, 3 and 1.
Puerperal Fever.—Ten cases of this disease were notified, against 11, 9 and 8 in the three
preceding years. There were 6 deaths, against 7, 5 and 3 in the three previous years.
As the patients contracting this disease are in the child-bearing period of life, a fatal case does
not mean only the death of a woman in her prime, but it frequently results in a family of small
children being deprived of that maternal care and affection which is so essential to their welfare.
Indeed, there is no other disease which is likely to be followed by more disastrous consequences to
the family, and when it is realised that puerperal fever is very largely both preventable and curable,
it must be admitted that no local authority should rest content until everything has been done in
the direction of prevention and treatment. It may be said that treatment is not part of the work
of a local authority, but the welfare of the infant population is a very important duty falling to
them, and, therefore, the cure of puerperal fever must necessarily call for their careful consideration.
It is true that the number of cases notified is small, but this a good reason why an attempt
should be made to eradicate the disease.
Dr. Hobbs the Medical Superintendent of the St. Mary Abbot s Hospital, has devoted considerable
attention to the treatment of this disease, and, judging from papers he has published, he has adopted
a method of treatment which is remarkably successful. In fact he is bold enough to say that if
puerperal fever patients are admitted to the Hospital in the early stages of their illness, there would
be few, if any, deaths from this disease in his Institution.
The Borough Council should do everything possible to secure this early admission in order
that the Medical Superintendent may have an opportunity of treating his cases with successful
results, and also so that this infectious disease may be removed from private homes where it is
dealt with by general practitioners and midwives, who are compelled to carry on their ordinary
duties at the same time, and may, possibly, convey the infection to other patients.
The disease develops insidiously a short time after confinement, and it is often present for
several days before the medical attendant or midwife can be quite certain that the septic condition
of the patient amounts to puerperal fever.
It is because the signs and symptoms in the earlier stages of the disease are uncertain that
hospital or surgical treatment is so frequently postponed and notification so often delayed, and it is
well known that this postponement offers opportunity for the spread of infection and lessens the
prospects of recovery.
The medical practitioner cannot always be held responsible, because it is obvious that he
cannot be expected to make a definite notification in regard to such a serious condition, unless he
is reasonably certain that the disease exists, and, further, he is not anxious to send a patient to
hospital with a diagnosis of puerperal fever when, in fact, the ominous signs may disappear and the
case turn out to be a simple one within twenty-four hours.
I have had several consultations with the Medical Superintendent on this important question
with a view to ascertaining whether anything can be done in order to secure earlier admission, and
we conclude that it is advisable to make it known—
(i) That cases will be accepted at the Hospital on suspicion before the diagnosis is
definite, and
(ii) That medical men should be informed that, if they do send patients in the earlier
stages before the diagnosis is clear, they will not be expected to notify me but can rely on
Dr. Hobbs performing this duty in the event of the disease proving to be puerperal fever.
In bringing this information to notice, it is important to emphasize that my attitude in regard
to notification in these suspicious cases admitted to the Hospital does not apply in cases where
the disease is fully developed and the diagnosis clearly established before the patient is sent away
for treatment.
Cerebro-spinal Fever.—Two cases of this disease occurred in the Norland Ward. Both of
them were removed to hospital and one died. The notifications in the three preceding years were
6, 5 and 1.
Encephalitis Lethargica.—Four cases of this disease were notified, particulars of which
are subjoined:—
1. Female. Aged 42 years. Died in St. Mary Abbot's Hospital on January 3rd.
2. Female. Aged 74 years. Notified April 12th and died at home on April 25th.
3. Male. Aged 43 years. Notified May 26th. Removed to M.A.B. Hospital and
recovered.
4. Female. Aged 55 years. Notified June 13th. Removed to a Nursing Home at Putney
and died June 14th.
Ophthalmia Neonatorum.—This disease, which is an inflammation of the eyes of newly-born
infants, is in most cases due to the entrance of gonorrhoeal infection into the eyes during the
process of birth. It, however, sometimes results from the entrance of other forms of disease
germs at the time of birth, and infection may also occur at any time afterwards if disease bacteria
are brought into contact with the child's eyes by the unclean fingers of the mother or nurse. In
neglected cases ulcers may form on the outer membrane of the eye, and partial or complete loss of