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110
ophthalmia neonatorum.
APPENDIX B.
OPHTHALMIA NEONATORUM.
Memorandum to Inspectors.
ACTION TO BE TAKEN.
(A.)—WHEN PATIENT IS UNDER MEDICAL CARE AT HOME.
1. Find out the doctor's orders—seeing him, if necessary, for that purpose.
2. Satisfy yourself that the orders are being regularly and intelligently carried out.
3. If skilled nursing is evidently wanted, report the case specially to the Medical Officer of Health
(B.)—WHEN PATIENT IS NOT UNDER MEDICAL CARE.
1. Insist—first by persuasion, and, if that fails, by threats—on medical advice being taken, and see that a
promise to do so is carried out.
(Note.—Neglect to seek advice can be dealt with by prosecution under the ''Children Act").
'2. If poverty be pleaded, press for removal to hospital.
Advice is to be given on the following lines:
Ophthalmia is always contagious, the degree of contagiousness depending on the organism causing the
disease. If proper care be taken, the risk of the eyes of other persons in the family being affected is
slight.
Kissing the patient's face is dangerous, as the kisser's eyes are brought too near the affected eyes.
Any person attending to the child's eyes should wash her hands carefully immediately afterwards.
The child's eyes should not be wiped with handkerchiefs or anything else, except small pieces of clean
linen or pledgets of cotton wool—a separate piece being used for each eye—wetted with antiseptic solution
(boric acid is the best). Whatever be used should be thrown into the fire at once.
Except in very virulent cases, the child's eyes can be saved with a good prospect of undamaged vision.
Everything will depend on prompt treatment and an intelligent carrying out of the orders given by the doctor.
No line of treatment is to be indicated. That must be left entirely to the doctor.
The question of legitimacy is of importance, and will best be settled by indirect method, rather than by
direct question, except as a last resource.
Enquiry as to mother's health during pregnancy is to be directed to elicit information as to presence of
vaginal discharges, especially those due to venereal disease. Ophthalmia caused by such discharges is the
gravest form observed and oftenest leads to loss of sight. A married woman is less likely to suffer from such
discharges, while in general terms the possibility of infection in an unmarried mother should always be kept
in mind.
The relationship of date of attack of eye to date of birth will often afford useful suggestion of the
presence of vaginal discharge before confinement. Eye trouble coming on very early after birth should be
regarded with suspicion, and the enquiry as to discharges pushed as much home as possible.
Eye precautions at birth refer to cleansing of the eyes. That should be done with clean pledgets of
cotton wool or lint, a separate piece to each eye. Many midwives drop in a weak solution of silver nitrate—
a proceeding which does not appear to be necessary and may itself give rise to inflammation of the eye.
The note as to state of the eye must be limited to what can be observed without touching or opening the
eyes. It is very undesirable to run any risk of getting any discharge on the fingers, as the enquirer may
thereby infect her own eyes.
End of case. At last visit of home-treated case note is to be taken as to the state of the eyes and record
made of what doctor has told parent. Cases treated at hospital will be dealt with by letter from the Office.
In making enquiries a sympathetic attitude should be adopted at the outset, but a severe officialism may
become necessary to secure the proper treatment of the case. It will be well to use the oblique method of
enquiry—not to let it be seen what it is that is wanted, or the importance attaching to replies.
Arrangements will be made for—
(a) Bacteriological examination of the eye secretions ;
(b) Providing nursing where necessary ; and
(c) Removal to institutions.
Instructions will be issued later on the first two points.
Removal to hospital will in the case of new-born children necessitate the mother going with the child.
The M.A.B. ambulances will be used.
In the early stages of the case a daily visit not at the same hour) will be necessary, and, maybe, more
than one visit a day.