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London County Council 1913

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

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220 Annual Report of the London County Council, 1913.
The following figures are taken from two sources, one from a West London, the other from a South
London hospital. In each case all the children considered are children attending London County
Council schools.
West London—Children examined, 1,188—
Affected by congenital syphilis 2
Do., not certain 1
Affected by ophthalmia neonatorum 2
South London—Children examined, 1,670—
Affected by congenital syphilis 8
By ophthalmia neonatorum 4
Excluding the one case in which the diagnosis was uncertain, the incidence of disease for these
two groups of children, numbering 2,858, is as follows:—
Congenital syphilis, 10 cases, or 0.349 per cent.
Ophthalmia neonatorum, 6 cases, or 0.21 per cent.
In comparing these returns with the returns obtained from the direct examination of the
children in school it must be remembered that the children seen at the hospital are those known to
have defective vision, and they are sent for treatment on that account. They represent about onetenth
of the total children in the schools, so that the hospital figures need to be correspondingly reduced
in comparing them with the school figures. If this be done it will be found that the difference is not
great when the varying methods of obtaining the returns are considered..
Mr. Harman, on three occasions, has examined the returns relating to the children attending
the Council's blind schools. On the first occasion, the examination was completed at the end of 1904
and the number of children dealt with was 255. On the second occasion the total including the
previous 255 children, was 363, these were examined prior to and including 1906.

On the third occasion, the children numbered 1,100, and they represent all seen prior to and including 1913.

Year of investigation. (1)Total seen. (2)Ophthalmia neonatorum. (3)Congenital syphilis. (4)
190425594=36.86%48 18.82%
1906363132=36.36%64=17.60%
19131,110268=24.35%343=31.2%
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The figures show that there has been a definite diminution of the incidence of cases of blindness
caused by ophthalmia neonatorum, and it is reasonable to credit this diminution to the great efforts
that have been made to prevent the disease in the past few years. The diminution is really greater
than appears by this method of tabulation, for the cases seen and accounted for in the first two counts
are included within the last return. The increase of the incidence of the cases of congenital syphilis is
affected by the diminution of the cases of ophthalmia. Part of this increase is, without doubt, due to
finer methods of diagnosis, cases that formerly were tabled amongst those of "uncertain origin"
are now definitely accounted for. It is certain that the number of cases of blindness due to ophthalmia
is diminishing both actually and relatively to the other causes of blindness. But there is not sufficient
evidence to state certainly that the apparent increase of the syphilitic cases is due to any other cause
than the diminution of one large class of cases of blindness and to the better means of diagnosis,
Mr. Macleod Yearsley has made a special study of the evidences of the relationship of venereal
disease to deafness. During his tenure of office as otologist to the deaf schools, 845 children suffering
from acquired deafness sufficiently severe to render it necessary to educate them in special schools or
classes have passed through his hands. Of these the number undoubtedly deaf from the effects of
congenital syphilis was 61, or 7.21 per cent. Of the 845 children, 427 were boys, with 21 cases of
congenital syphilis, 4.9 per cent.; 418 were girls, with 40 cases of congenital syphilis, 9.6 per cent. ;
so as was first pointed out by the late Sir Jonathan Hutchinson, the females affected were greatly
in excess of the males.
The following table gives an analysis of the symptoms and stigmata in the 61 cases of deafness
associated with congenital syphilis; The results closely correspond with experience in other lines of
practice. It is usual to find the deafness following the eye symptoms. The most commonly observed
accompanying stigmata are interstitial keratitis and Hutchinsonian teeth ; deafness with vertigo is rare.
Ocular Manifestations. Of 21 boys. Of 40 girls. Totals.
Interstitial keratitis was present in 19 37 50
Iritis was present in 7 13 20
Choroiditis was present in 1 2 3
Optic atrophy was present in 0 1 1
Aural Manifestations.
Deafness occurred before eye symptoms in 2 5 7
Deafness occurred after eye symptoms in 19 35 54
Vertigo occurred in 3 0 3
Nasal Manifestations.
Nasal caries, adhesions, deformity (saddle nose), etc., in 1 6 7
Other Stigmata.
Hutchinson teeth occurred in 11 26 37
Cranial caries occurred in 1 0 1
Tibial nodes occurred in 1 1 2
Joint affections occurred in 1 1 2
Palatal ulceration occurred in 2 4 6
Scarring of oral angles occurred in 2 3 5
Returns
of venereal
disease
affecting
children
seen at
hospitals
Ophthalmia
neonatorum
and syphilis
as cause of
blindness
Relation of
venereal
disease to
deafness.


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