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97
Report of the Medical Officer of Health
usually ceases her attendance. It was also found impossible for the midwife personally to attend to
the infant's eyes as often as was requisite, i.e., in some cases four or five times daily, and this duty
was then left to the friends of the patient, who were utterly ignorant of the need for using clean rags
and sterile water.
The Council felt therefore that risk was being incurred by allowing cases of inflammation of
the eyes to receive no more attention than was bestowed on them by the people living in the house.
The Queen Victoria Jubilee Institute, the Ranyard Nurses Society, the Holloway Nursing Institute,
and the Nursing Sisters of St. John the Divine were therefore approached and asked if they would be
willing to allow their nurses to undertake, under the direction of the medical practitioner called in,
the care of these infants in order to see that the necessary irrigation or swabbing of the eyes was
properly done, and at the proper intervals. All the above societies readily consented and have since
rendered valuable services in these cases.
The arrangement by which the Council secured the voluntary services of the nurses of these
societies was made in August, and from that time until the end of the year nurses attended some
22 cases ; 18 of these subsequently recovered. It is, of course, only the more severe cases that the
nurses are asked to attend.
During the year 160 notices were received from midwives, stating that medical assistance had
been advised on account of inflammation of the eyes of infants, and, in addition to these, five other cases
came to light in which the onset is stated to have occurred after the midwife had ceased to attend. In
two instances where medical help was advised it was not obtained ; neither of these cases was very
severe and the infants eventually recovered. There was delay in obtaining medical help in 17 cases,
in three instances due to the fact that there were no signs of inflammation during the time the
midwife attended, and when the symptoms did appear the friends did not seek medical assistance
for some time. In two instances the midwife advised medical assistance, but her advice had not been
acted upon when the Council's inspector visited the infant. One mother persisted in refusing to have
medical assistance for a period of five days. In one case, a midwife who noticed some inflammation
on the twelfth day of life, did not consider the case serious and delayed to advise medical assistance
for five days, and in 10 cases where there was practically no inflammation at first, there was a delay
of two days in obtaining medical assistance. In all other cases medical help was obtained either on
the day of onset or the following day.
The Council's inspectors investigated all the cases and endeavoured to watch the progress of
the patients and learn the final result. 141 cases were reported to be completely cured. In 11 cases
there was impairment of vision, two died while still suffering from the disease, and in 11 instances the
result could not be ascertained owing to the removal of the parents, who could not be traced.
The duration of the illness in the 141 cases which recovered was :— ,
Disease lasting less than 10 days 58 cases.
„ between 10 days and 1 month 45 „
„ more than 1 month 38 „
The day of the puerperium on which signs of inflammation were first noticed was: day of confinement,
20 cases ; second day, 21 ; third day, 12 ; fourth day, 18 ; fifth day, 17 ; sixth day, 12 ; seventh
day, 13 ; eighth day, 16 ; ninth day, 18 ; tenth day, 10; after tenth day, 8.
A history of vaginal discharge in the mother was obtained in 59 cases, i.e., in 36 per cent,
of the cases.
The antiseptics used for the child's eyes at birth, or as soon after as possible, in these cases were
boracic lotion in 61 instances, perchloride of mercury in 65, silver nitrate or protargol in 32, biniodide
of mercury in 1 case ; boiled water only was used in the remaining 6 instances. In 124 cases the
antiseptic was used at the moment of birth ; in 26 an interval of less than half-an-hour occurred,
and in 9 a longer interval elapsed, owing to the infant being born before the midwife arrived.
The following particulars were learnt with regard to the 11 cases in which impairment of vision
supervened, and the extent of impairment is given in the " result."
1.Leucorrha in mother (who developed puerperal fever). Boracic lotion used for eyes at
birth. Onset of symptoms on fourth day. Medical practitioner in attendance before onset.
Result.—Sight in one eye lost.
2. No history of discharge in mother. Child born one hour before midwife arrived. Boracic
lotion followed by silver nitrate used for eyes by midwife at earliest opportunity. Onset of symptoms
on tenth day (after midwife had ceased attending), medical help obtained on thirteenth day.
Result.-Opacity covering right pupil. Nebula over inner half of left pupil.
3. Leucorrhœa in mother. Infant born three-quarters of an hour before midwife arrived
Boracic lotion followed by silver nitrate used by midwife for eyes at earliest opportunity. Onset of
symptoms on fourth day. Parents would not have medical assistance, although advised, until tenth
day.
Result.—Nebula slightly encroaching on inner half of left pupil about one-eighth of an inch in
diameter.
4. Vaginal discharge in mother. Perchloride of mercury used for eyes at birth. Onset of
symptoms on second day and medical help obtained on third day.
Result.—Opacity covering inner three-quarters of right pupil.
5. No history of discharge in mother. Boracic lotion and protargol used for eyes at birth.
Onset of symptoms on second day and medical help obtained at once. ,
Result.—Opacities over lower three-quarters of both pupils.