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In six cases (two of them fatal) the birth had taken place before the midwife arrived. Six
wives had two cases of puerperal fever each during the year. There were intervals of 3 months or more
between the two cases in three instances, and the midwife in the meantime had attended and delivered
several other patients, none of whom developed symptoms of puerperal fever. Two midwives delivered
their second patient who suffered from puerperal fever before any symptoms of puerperal fever had been
noticed in the first patient, and it is possible that infection may have been carried by the midwife from
one case to the other. The usual antiseptic precautions were taken by one of the two midwives before
she attended the second case. The other midwife states that she took antiseptic precautions before
the delivery of the second patient, but this is open to doubt and her conduct of these cases and her
general practice showed gross neglect. She was subsequently represented to the Central Midwives
Board and her name was removed from the roll of midwives. The remaining midwife who had two
cases in her practice delivered the first patient on the 1st day of the month and on the 6th called in
medical assistance on account of rise of temperature ; the doctor remained in charge of the case, and on
the 7th the midwife ceased attending ; on the 9th she and her clothing and apparatus were disinfected
and she resumed her work as a midwife and delivered two or three patients, none of whom developed
symptoms of puerperal fever. On the 16th day of the month she delivered a patient who was notified
on the 25th to be suffering from puerperal fever.
Ophthalmia.—It is the duty of midwives to advise that medical assistance should be sought in
any case of inflammation of the eyes, however slight, occurring in new-born infants. Notice of calling
in medical assistance must be sent to the Local Supervising Authority. In this way cases of inflammation
of the eyes are brought to notice. In October, 1907, special attention was drawn to the question,
and from that time full enquiries have been made into each case by the Council's inspectors. During
the last three months of 1907 there was a marked increase in the number of these notices, consequent
upon the verbal directions given by the Council's inspectors, and in January, 1908, a circular letter
was addressed to all practising midwives pointing out the importance of seeking medical assistance on
the first appearance of any inflammation of the eyes.
Ninety-seven such notices were received from midwives during the year, and in seven of these cases
medical assistance, though advised by the midwife, was not obtained. These seven cases were all very
slight and recovered completely. All the cases were investigated by the Council's inspector, who
obtained from the midwife details of the antiseptic precautions taken by the midwife and visited
the infant to see that it was receiving medical treatment. In twelve cases it has not been possible
to learn the final result of the illness owing to the patient's removal and present address not being
ascertainable. In one case an infant died before a cure was effected and in four there was impairment
of vision. The remaining cases were completely cured.
The cases were divided by the inspectors into three classes according to the duration of the discharge
from the eyes.
(a) Discharge from eyes lasting 10 days or less, 32.
(b) Discharge from eyes lasting 10-30 days, 16.
(c) Discharge from eyes lasting from 1-4 months, 46,
Four cases occurred in which there was reason for thinking that infection from the newly-born
infant took place, viz.:—
(1) Mother developed swelling and redness of lids of one eye and a slight discharge from eyes.
(2) Mother developed slight discharge from eyes lasting a few days.
(3) Mother and another child (aged 3 years) developed conjunctivitis.
(4) Mother developed conjunctivitis and discharge in the right eye.
The midwives disinfected their hands after treating the children's eyes and adopted ordinary
precautions such as burning the rags used for wiping the eyes. They also warned the mother to be
careful. In several cases the midwife got the mother or some other person to attend to the child's
eyes under her supervision so that she, the midwife, came in contact with the infection as little as
possible. In no case did it appear that the midwife carried infection from one patient to another.
Complete blindness did not result in a single instance, but impairment of vision occurred in
the following four cases:—
(a) Opacity 1/8 in. in diameter centrally placed in right cornea—some vision in right eye,
left eye clear. In this case symptoms were observed on 6th day after birth, when a private
practitioner was summoned.
(b) Opacity nearly covering left cornea—right eye clear. In this case the symptoms
were first observed on 3rd day after birth. On the 5th day a private practitioner was summoned,
and on the 9th the infant was taken to an ophthalmic hospital.
(c) Several opacities in both corneæ, but as they are not central there is probably
impairment of vision in both eyes, but not complete blindness. In this case symptoms were
first observed on the 6th day after birth, when a private practitioner was summoned.
(d) Right cornea practically covered with a large opacity, small opacity not central in
left cornea. In this case symptoms were first observed on the 6th day after birth and a private
practitioner was called in same day. The infant was subsequently taken to a hospital.