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Report of the County Medical Officer—Education. 219
Remark may be made on the fact that the syphilitic mothers had about 17 per cent, more
pregnancies than the "average" mothers. This is partly accounted for by the frequency of miscarriages.
The short intervals in these cases will allow of several pregnancies within the
same time as that occupied by one healthy pregnancy. Further, the frequency of stillbirths, and of infant
deaths keeps the family of the syphilitics down, so that where there is the desire for children the
pregnancies are increased in number.
On two occasions Mr. Harman examined large groups of children attending the elementary schools
of the Council with a view to ascertaining to what extent there were signs of affections of the eyes caused
by venereal disease. The investigations were undertaken in the ordinary course of school medical,
inspection, so that besides the condition of the eyes the state of the body generally was available for
comparison. In 1903 to 1904 he examined 22,000 children in the East of London in the districts of '
Hackney, Hoxton and Bethnal Green. Amongst this large number of children he found only five with (
eyes damaged by ophthalmia neonatorum, and also five suffering from the after effects of interstitial
keratitis of syphilitic origin. In 1905 and 1906, Mr. Harman examined in the same manner 18,000
children in Marylebone, and amongst these found only two cases of eyes damaged by ophthalmia neonatorum,
and three of interstitial keratitis. The percentage of damaged eyes amongst these two groups
of children totalling 40,000, was 0.017 per cent. for ophthalmia neonatorum, and 0 02 per cent. for
interstitial keratitis of syphilitic origin. In 1907, in following out an investigation on the incidence of
ophthalmia neonatorum, Mr. Harman examined the vision testing returns of the whole of the medical
staff of the Council. The returns covered 412,527 children. Amongst these children there were 46
cases of damaged eyes of the sort which appeared to be due to the result of early purulent conjunctivitis.
In many cases the history was clear and the diagnosis certain, but in others the conditions of the eyes
formed the only evidence available The percentage incidence of defect produced by this one cause works
out to 0.0111. Since all those children whose eyes are badly damaged from disease are removed from
the ordinary schools to the blind schools, it is necessary to correct the foregoing return by including
the cases on the roll of the blind schools. The London school children number about 790,000 under
14 years of age. Supposing the incidence of ophthalmia neonatorum to be proportionately the same
for the whole number as for the part, there would be altogether 88 cases of defect produced by this
cause in the schools at that time. In the blind schools there are on an average 92 cases of ophthalmia
neonatorum. So the total for London school children would be 180 cases, that is, one child
in every 4,400 has had ophthalmia neonatorum of such severity that the eyes received permanent
damage, and more often than not the child was blinded. From examination of his hospital case papers
Mr. Harman finds that of cases of undoubted ophthalmia neonatorum treated at hospital, whether
brought early when the prospects are good, or late when they are bad, no less than 69 per cent. escaped
without injury to the cornea. So that the 180 school cases represent only 31 per cent. of a group of
children who suffered from the disease.
The figures given in the foregoing section must be taken in conjunction with figures showing the
incidence of ophthalmia neonatorum taken within the first few weeks following birth. In 1907, Mr.
Harman took an unofficial census of one part of London. Eight doctors in private practice were good
enough to send him particulars of their midwifery practice. The district is an average London suburb.
Half the population live in tenements, the other half in houses with rents from £30 to £80 per annum,
though there are few at the higher rental. At the lowest estimate three-fourths of the children in the
district attend the public elementary schools. As a measure of prophylaxis against eye disease, seven
of the eight doctors were in the habit of relying upon the simple precaution of cleansing the eyes of the
infant with boiled water or boracic lotion as soon as it was-born, a few used a weak perchloride of mercury
lotion in children born of suspicious parents ; but one doctor used silver nitrate of 2 per cent. strength
in almost all cases as a prophylactic. The statistics covered 12,680 children born alive; and of these
110, or 0'87 per cent, were affected by a purulent conjunctivitis ; six, or 0 047 per cent., of the infants
had one or both eyes damaged in consequence of the attack. These figures have been confirmed by
the returns obtained since the application to this disease of the provision for compulsory notification.
Comparison between Mr. Harman's figures and those relating to the incidence of the after effects
of the affection as seen in the schools, may be made as follows:—
Number of
children. Injured. Total of known cases.
Newly born infants 12,680 6=0.047% 110=0.87%
(1 in 2,100)
L.C.C. School children 790,000 180=0.0226%
(1 in 4,400)
From this statement it will be seen that the cases of the disease known to have
resulted in injured eyes shortly after birth are to the cases subsequently discovered in the schools as
2 to 1. This difference is probably to be accounted for by the excessive death-rate known to occur
amongst the children of mothers affected with the disease.
23610 FF 2
The
incidence
of children
affected by
venereal
disease
amongst the
ordinary
school
population.
The
incidence of
ophthalmia
neonatorum
in the
ordinary
London
population.