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The second case occurred in the practice of a private midwife in
February. The midwife notified that the child was suffering from " watery
blisters " when the child was six days old. The midwife was suspended
from duty pending disinfection, and swabs were taken of nose and throat
(with negative results). Arrangements were made for a nurse from the
Essex County Nursing Association to attend the case and twenty-five visits
Avere made. No other cases developed, although it was discovered subsequently
that a case which the midwife had attended outside the Borough
about a month previously had developed Pemphigus after the midwife
had ceased attendance.
The third case occurred in the practice of a midwife in April. The
first vesicles appeared when the child was four days old, and the lesions
became more numerous and more extensive until the child was twelve days
old. The child was twenty-four days old before the lesions had entirely
disappeared. The handywoman in attendance was considered to be
capable, so she was allowed to complete her fourteen days with the patient,
after which she was required to disinfect herself and her clothing. A nurse
from the Essex County Nursing Association subsequently attended until
the child had recovered. Nineteen visits were paid. The midwife—
employed temporarily by another midwife—had actually left the patient
to nurse a woman who had had a baby fourteen days previously before the
diagnosis of Pemphigus was made. Of six cases with which this midwife
had been in contact, two developed skin lesions, but both were very slight
and neither was considered to be Pemphigoid. It was considered advisable
to suspend the midwife from duty for one week and she received £2 2s. as
compensation for loss of work during that week. Swabs were taken of her
nose and throat with negative results.
The fourth case occurred in the practice of a private midwife in June.
It was discovered at the Infant Welfare Clinic when the child wras 15 days
old. According to the mother the first blister developed on the 7th day,
but the midwife stated that, although there was a small pustule on the
face, no blisters had developed by the tenth day when the midwife ceased
attendance on the patient. The midwife had already undergone disinfection
by the time she was interviewed. No further cases of Pemphigus
developed in her practice. Arrangements were made for a nurse from the
Essex County Nursing Association to attend twice daily for eight days,
and once daily for the subsequent four days. Twenty visits were paid.
The four cases of Pemphigus Neonatorum recorded above made good
recoveries. In none were there any toxic symptoms.
Infant and Fœtal Mortality.
There were 76 deaths of infants under one year registered in
1933, giving an infantile mortality rate of 50.73. Table 8 shows
that the annual decrease in the number of births was greater in
1933 than in any of the last five years. In spite of that fact, the
infant mortality is lower than in 1932 (53.42).