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84
Annual Report of the London County Council, 1913.
Ophthalmia
Neonatorum
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 infants' eyes, gave directions to the parents
as to the course of treatment and left instructions for them to seek medical help again 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 24 cases.
During the year 286 notices were received from midwives, stating that medical assistance had
been advised on account of inflammation of the eyes of infants.
The Council's inspectors investigated all the cases and endeavoured to watch the progress of
the patients and learn the final result. 208 cases were reported to be completely cured. In 5 cases
there was impairment of vision, 13 died while still suffering from the disease, and in 60 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,
10 cases; second day, 24; third day, 30; fourth day, 25; fifth day, 36; sixth day, 34;
seventh day, 24; eighth day, 37; ninth day, 27; tenth day, 16; later than tenth day, 20; not
ascertained, 3 cases.
A history of vaginal discharge in the mother was obtained in 107 instances, i.e., in 37 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 127 instances; perchloride of mercury (1 in 4,000 or weaker) in 101; silver nitrate (a 1 or 2
per cent. solution) in 29; protargol in 4, and biniodide of mercury in 1 instance; in the remaining
cases sterile water was used. An interval between the birth and the use of an antiseptic occurred in
47 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) Vaginal discharge in mother. Perchloride of mercury solution used for eyes fifteen
minutes after birth. Onset on fifth day and medical help obtained at once. Result—Sight of
one eye impaired.
(2) Vaginal discharge in mother and father under treatment for specific disease. Boracic
lotion used for eyes at birth. Onset on day of birth and medical help obtained at once. Result—
Sight of one eye lost and the other affected.
(3) Vaginal discharge in mother. Boracic lotion used for eyes at birth. Onset on second
day and medical help obtained at once. Result—Sight of both eyes impaired.
(4) No history of vaginal disease in mother. Boracic lotion used for eyes at birth.
Onset on seventh day and medical help obtained at once. Result—Corneæ undamaged, but
infant suffering from chronic ciliary blepharitis.
(5) No history of vaginal discharge in mother. Boracic lotion used for the eyes at birth
Onset on fourth day and medical help obtained at once. Both eyes affected. Result—Loss
of sight of one eye.
The 286 cases of inflammation of the eyes occurred in the practices of 136 midwives.
1 midwife had 16 cases during the year 16
2 midwives each had 11 cases during the year 22
1 midwife had 8 cases during the year 8
2 midwives each had 6 cases during the year 12
4 „ 5 „ „ 20
8 ,, 4 „ „ 32
18 ,, 3 „ „ 54
22 „ „ 2 „ „ 44
78 „ „ 1 case „ „ 78
136 286