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52
Puerperal fever is included amongst the notifiable infectious diseases. Upon
1 lie 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.
Erysiptlas. - 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 microorganisms.
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 bramy powder. Sometimes suppuration and sloughing take place,
and matter and tissue 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 eases 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 preventive
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.
From time to time the value of the notification of erysipelas has been called
into question, and the conclusion arrived at has invariably been that there is
much value in the notification of the major or serious cases of erysipelas, but
that there is little value in the notification in the minor or trivial cases.
The problem to my mind was how to exclude the notification of localised
surface redness, swelling or heat of a trivial nature, often dignified by the