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Puerperal fever is included amongst the notifiable infectious diseases. Upon the
receipt of a medical certificate notifying a case, (1) enquiry is made at the house as
to the circumstances and any possible source of infection; (2) sanitary inspection of
the premises is made and the drains tested; (3) the question of the degree of
isolation requisite is left to the medical attendant and nurse; and (4) upon recovery
or removal disinfection of the bedding and clothing by steam is enforced.
The disinfection and cleansing of the bedding and clothing is of extreme
importance after puerperal fever, on account of the persistence of the infection and
the facility with which it is communicable from bedding and clothing to those
lying in. So also is the sanitary inspection and drain testing for the abatement of
any nuisances, especially effluvia, as these are well known to be highly dangerous
to the puerperal condition.
Erysipelas.—Buchan and Mitchell many years ago pointed out the close
correspondence in London between the seasonal mortality curve of erysipelas and
that of puerperal fever. It is generally a more readily communicable disease even
than puerperal fever, and overcrowding, want of ventilation, effluvia, dirt, and
other insanitary conditions, are well known predisposing causes. The disease is
due to the entrance into the system of septic micro-organisms. Usually vesicles or
blebs, and bullœ or blisters are formed which dry up into crusts and fall. The skin
also may desquamate and be shed in flakes or brainy powder. Sometimes
suppuration and sloughing take place, and matter and tissues are discharged. The
septic organisms are also found in abscesses and unhealthy wounds. These crusts,
flakes, and discharges spread the disease directly, or else indirectly by infected
bedding and clothing.
The same preventive measures required in puerperal fever should therefore be
applied to erysipelas, for the protection of life and health. In a letter to the
Chelsea Vestry in 1892, the Local Government Board urged that it is an infectious
disease, communicable to others, and of especial danger to lying-in women,
vaccinated children, in surgical operations, and to wounds generally. Sporadic
cases are always a source of danger, and in large institutions the disease occasionally
assumes formidable epidemic proportions. Therefore very forcible reasons exist for
the notification of the disease, and for taking preventative measures.
Unfortunately the term erysipelas may be strained to embrace anything from
the least inflammatory blush of the surface to the most intense inflammation and
destruction of the deeper cellular tissue. If enquiry, sanitary inspection, and
disinfection are applied to this disease, the probability is that the more trivial cases,
giving rise to little or no risk of infection, will be reduced in number, and that
notification will be more confined to those cases requiring disinfection and
sanitary inspection of the premises, that is to say, those cases producing marked
constitutional effects.
With a view to ascertaining what course is taken by other authorities, a circular
letter was sent to the Medical Officers of Health of the Metropolis, and from the
replies the following has been compiled:—
London Sanitary Authorities.—ERYSIPELAS.
Course taken upon Notification.
Marylebone—No action.
Lambeth—Inquiry, isolation, disinfection, and sanitary inspection, like other
Notifiable Infectious Diseases.