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59
the staphylococcus might surely be regarded as being a purely symbiotic association
which could reasonably be looked for in a condition affecting the skin. The foregoing
suggestion must, however, be taken as a very tentative one, and it may well be that
the cocci above-mentioned are themselves no more than concomitants of one ultravisible
organism which has not yet been identified, in association with which the
others produce the disease in its different manifestations. A few cases are
undoubtedly of specific origin, these exhibiting definite divergence from the others.
For instance, the rash occurs on the soles of the feet and the palms of the hands,
which are otherwise immune from the attacks of pemphigus neonatorum. Furthermore,
the rash appears on the first day of the disease, that is to say, the infant is
born with it and has probably developed it in utero, whilst a further distinction is
that a fatal issue is very much more frequent. When a fatal issue arises it is
conceivable that the infant suffers from a systemic as well as local infection, the
organism having gained a ready entrance through the umbilicus.
Lying-in
homes.
The by-laws made under section 18 of the L.C.C. (General Powers) Act, 1921,
are being carried out by the keepers of lying-in homes, and are of assistance to
the Council in dealing with any complaint that may be made with regard to the
home.
Children
Act, 1908.
The powers of the Council under the Children Act, 1908 (Part 1), with regard
to infant life protection are fully indicated in the Annual Report for 1921. The
work of inspection is carried out by 14 visitors and two male inspectors. Nurse
infants who are being kept under specified unsatisfactory conditions, may under
powers given by the Act be removed to a place of safety—i.e., in London to Poor Law
institutions. During 1924, 7 nurse infants were removed, as compared with 6 in
the previous year. The Act permits the Council to grant whole or partial exemption
from inspection in cases where the circumstances appear to warrant such a course,
and partial exemption limited to inspection once or twice a year was granted in
4 cases.
All the homes in which foster children are kept are visited with a view to ascertaining
whether the sanitary condition of the premises is satisfactory. During
1924, 992 reports as compared with 1,009 during 1923 were made. The premises
were found to be satisfactory in 617 cases as compared with 648 the previous year.
Sanitary defects were discovered in 157 homes as compared with 143 the previous
year, while overcrowding was reported in 128 homes as compared with 141 in 1923.
Overcrowding and sanitary defects were found in 37 homes as compared with 18
the previous year. In 53 cases no action could be taken owing to the removal of
the infant prior to the visit of the inspector. In any case of serious sanitary defect
the attention of the borough council was drawn to the defect. A rearrangement
of the accommodation has in some cases enabled an improvement to be effected,
but in others this has been impossible and the foster mothers have in such cases
been urged either to obtain more suitable accommodation or to return the infant
to its parent. As will be obvious, the lack of suitable housing accommodation has
added to the difficulty of dealing with such cases.
The help of the local infant welfare centre is sought in the case of the illness
of an infant, and where a foster mother has charge of a weak or ailing infant she is
urged to take the infant to the centre and follow the medical advice given there.
The visitors are instructed to watch such cases with a view to seeing that the
treatment is carried out. Whenever a visitor is doubtful as to the progress of an
infant the matter is reported with a view to an inspection being made by one of the
Council's medical officers. This practice has worked very satisfactorily and has
been of great assistance to the visitors.
A nurse infant ceases to be under this part of the Act at the age of seven years,
but as the child usually attends school from the age of 5 years it has from that age
the additional advantage of supervision by the School medical service.
The number of deaths of nurse infants during 1924 was 26, as compared with