London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1912

[Report of the Medical Officer of Health for London County Council]

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89
Report of the County Medical Officer—General.
In three cases of puerperal fever, birth took place before the arrival of the midwife.
Seventeen midwives each had two cases during the year: in five instances the interval between
the cases was three months or more.
It is the duty of a midwife to advise that medical help is required when inflammation of the
eyes, however slight, occurs in infants. Great stress has been laid by the Council on the importance
of strictly observing this rule. When a notice is received from a midwife that medical assistance has
been sought on this account, the Council's medical inspector at once visits the infant to ascertain that
it is receiving the medical assistance which the midwife has advised, and the medical officer of health
of the borough in which the patient resides is immediately informed of the condition of the case and
whether the infant is being removed to a hospital for treatment. The midwife is also visited to
learn particulars as to the case, the antiseptic precautions taken beforehand, and the disinfection adopted
by the midwife after each visit to the case. It was found in some cases that when medical assistance
was obtained, the medical practitioner, after examining the infant's eyes, gave directions to the parents
as to the course of treatment and left instructions for them to seek again medical help if the inflammation
did not yield to treatment, and if there was no improvement in the condition of the child's eyes.
So long as the midwife remained in attendance, the treatment was for the most part carried out, at all
events once a day; but many of these cases had not recovered by the tenth day, the time the midwife
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 during the
year their services were made use of in 46 cases.
During the year 383 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, 2 other
cases came to light in which medical help was not called by the midwife.
The Council's inspectors investigated all the cases and endeavoured to watch the progress of
the patients and learn the final result. 298 cases were reported to be completely cured. In 4 cases
there was impairment of vision, 20 died while still suffering from the disease, and in 63 instances
the result could not be ascertained owing to the removal of the parents, who could not be
traced.
The day of the puerperium on which signs of inflammation were first noticed was: day of confinement,
23 cases; second day, 43; third day, 41; fourth day, 42; fifth day, 40; sixth day, 33;
seventh day, 42; eighth day, 31; ninth day, 36; tenth day, 26; later than tenth day, 24; not
ascertained, 4 cases.
A history of vaginal discharge in the mother was obtained in 114 instances, i.e., in 29 per cent.
of the cases.
The antiseptics used for the child's eyes at birth or as soon afterwards as possible were boracic
lotion in 137 instances; perchloride of mercury (1 in 4,000 or weaker) in 146; silver nitrate (a 1 or 2
per cent. solution) in 58; protargol in 12, and biniodide of mercury in 3 instances; in the remaining
cases sterile water was used. An interval between the birth and the use of an antiseptic occurred in
82 instances owing to the fact that the infant was born before the arrival of the midwife.
The following facts relating to the 5 cases in which impairment of vision supervened were
learnt:
(1) History of vaginal discharge in the mother during pregnancy. Boric lotion used for eyes
at birth. Onset of symptoms and medical assistance on sixth day.
Result: Infant reported blind in one eye.
(2) No history of vaginal discharge in mother. Perchloride of mercury (1 in 8,000) used for
eyes at birth. Onset of symptoms and medical assistance on sixth day.
Result: Infant reported to be blind in one eye.
(3) No history of vaginal discharge in mother. Perchloride of mercury (1 in 8,000) followed
by a 2 per cent. solution of nitrate of silver within an hour. Onset of symptoms on fourth day. Medical
aid obtained from private practitioner, specialist and at hospital as in-patient.
Result: Blindness of both eyes.
(4) History of vaginal discharge in mother. Boric lotion used for eyes a few minutes after
birth (child born before the arrival of the midwife). Onset of symptoms on ninth day and medical
aid obtained the next day. Out-patient at hospital.
Result: Loss of sight in one eye.
(5) History of vaginal discharge in mother. Perchloride of mercury (1 in 8,000) used at birth.
Onset of symptoms and medical aid obtained on seventh day.
Result: Loss of sight in one eye.
These results summarised are as follows:—
Blind in both eyes 2 cases.
Blind in one eye, other uninjured 3 cases.
18820 M
Ophthalmia
Neonatorum