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1,365 cases, 488 cases proved to be ophthalmia neonatorum, as compared with 413 in
1926. 326 other cases that did not occur in the practice of midwives were also
notified, making a total for the year of 814 notified cases of this disease. The
percentage occurring in the practice of midwives was nearly 60 per cent., as compared
with 59 per cent, in 1926. All the cases that occurred in the practice of midwives
were investigated, and it was found that 475 were completely cured and 5 died, 2
cases could not be traced owing to removal of parents. Impairment of the vision
of one eye occurred in 6 cases; in addition there was impairment of vision of one
eye in a case not notified as ophthalmia neonatorum. 61 cases received in-patient
hospital treatment at St. Margaret's Hospital, as compared with 57 cases during 1926.
Classes for the post-graduate instruction of midwives have been carried on by
the Council for some years past. This year a number of demonstrations at institutions
were arranged, as in 1926, and were well attended. Lectures were also given at
yarious institutions, and appeared to give great satisfaction. It may be noted that
a letter was received from one of the lecturers who had been giving demonstrations
during the past few years to the effect that he observed a distinct improvement in the
appreciation of the importance of ante-natal work. In order to assist in the training
of pupils a supply of ante-natal cards is furnished to any institutions at which there
are pupils, so as to improve them in midwifery work, particularly with regard to
ante-natal examinations.
Training of
midwives.
Outbreaks of pemphigus neonatorum occurred during the year, the total number
of cases being 251, as compared with 140 in 1926. In view of the fact that the cause of
infection in the cases has been so obscure, an arrangement was made for a special
enquiry to be carried out by Dr. Christabel Eyre, who formed the following conclusions.
(1) The diagnosis of pemphigus neonatorum (bullous impetigo contagiosa)
was confirmed in all but 3 cases. (2) The disease appears to be very highly contagious.
The eight Chelsea cases, three Deptford cases, two in Lambeth and three
in Stepney, can be tiaced to one source of infection in each group. In all these cases
the infection was probably carried by the midwife. The other cases appear to be
isolated ones. (3) In all but two cases examined there was no likelihood of there
having been infection from the mother, either through ante-natal vaginal discharge,
puerperal sepsis, or any evident impetigo or sores. The cleanliness of home
surroundings did not appear to influence the severity of the disease. Contacts were
found suffering from impetigo in 2 cases. (4) In 20 cases noted the average period
after birth at which the outbreak appeared averaged 6-7 days, and the average duration
of the whole of the cases appears to have been from 10 days up to 3 weeks.
(5) In only two cases did grave constitutional disturbance ensue, although in many
cases the extent of the lesions was great. In only one case did' death ensue, therefore
the present outbreak may be considered to be of a mild form. (6) In six cases where the
serum from unbroken blebs was bacteriologically examined the staphylococcus
aureus was found in pure culture. (7) The organism appears in many cases to escape
all ordinary destructive measures, and it is therefore recommended that special
attention be paid by the midwife in contact with a case, to extra details such as the
handle of her bag, the gloves she has worn to and from the case, her fountain pen,
etc., in addition to the thorough disinfection she normally undergoes. (8) The
regulations at present enforced by the Council, so far as the midwife is concerned,
appear to deal as adequately as our present knowledge permits with the probable
sources of infection. The notification is very prompt, and the midwives are alive
to the great importance, both of early diagnosis and very careful personal disinfection
once the diagnosis is established.
With a view to bringing the disease more prominently to the notice of midwives
the Board issued a free pamphlet for distribution by local supervising authorities to
midwives practising within their various districts. Copies were sent by the Council
to all London midwives.
Pemphigus
neonatorum.