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75
in the same locality and had been attended by different midwives
resident in a Home. Two other cases attended by the same midwives
occurred about the same time in the same locality but actually
under the jurisdiction of a neighbouring authority.
The first cases occurred in the practice of midwife A, who took
over the nursing of an infant. At this time this midwife suffered
from a septic infection of one finger. In the course of a few days,
two infants delivered by her developed pemphigus, so she ceased
attending midwifery cases. A few days later, midwife B, also
resident in the same house, who had not been in contact with
these patients, had two cases. She thereupon ceased taking any
more midwifery cases, but continued to treat the infected infants.
The following day, a third nurse, midwife C, had two cases in which
the eruption appeared the same day.
The house was fumigated, instruments, etc., boiled and each
nurse took a few days holiday away from the Home. There were
no subsequent cases.
The source of the infection was ascribed to the septic condition
of the finger of midwife A. With regard to the spread of infection,
the fact that each nurse had her own bag, etc., and apparently
carefully treated all her appliances, suggests that conveyance of
infection is personal, possibly by droplet infection, and not by
means of fomites. The organism is presumably short lived outside
the body, otherwise one would assume outbreaks would be of far
commoner occurrence.
These conclusions agree with these arrived at as a result of
an extensive infection in this district in 1929. The association of
two cases together was repetition of what was noticed in the 1929
outbreak when it was suggested that this meant that the second
child was infected before the recognition of the disease in the first.
As the eruption usually did not occur on the same day in both cases,
the suggestion is that the first child was infectious before the onset
o the eruption and that there is a period of incubation, thus
bringing the disease into line with the systemic infections. An
alternative explanation of the association of the two cases is, of
course, that the second infant was not indirectly infected from the
first but that both were, at different, times, infected by the infectious
attendant.
Whereas in 1929 the cases were widely distributed throughout
the district, occuring in the practice of unassociated midwives,
in this limited outbreak, during the time the cases were occurring
in this locality, there was only one other case notified in the