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Fifteen occurred in the practice of midwives. Of these seven cases were
very slight, and eight were either severe or fairly severe.
Provided that the baby's relatives will co-operate with the attendants, the
care given in these cases is very satisfactory. The midwife not only calls in a doctor,
but also notifies the London County Council Inspector of Midwives. The latter
visits the home to see that the baby is receiving proper care, and visits the midwife
to see that she is taking proper precautions to prevent the spread of infection
amongst her patients. These cases are, as a rule, taken daily for treatment to the
Royal Ophthalmic Hospital. In eight cases it has also been necessary to make
arrangements with district nurses to attend once or twice daily to give skilled
attention to the eyes. No advantage has been taken of the arrangements made
by the London County Council for the admittance to certain hospitals in severe
cases of both the mother and the infant to obviate the necessity of weaning.
With two exceptions these have all made satisfactory progress ;
(i.) This was a very severe case, and the midwife urged the mother to send the
baby to a hospital; but neither the father nor his relatives would bestir themselves
to do this, saying it was unnecessary; when, four days later, a fellow-lodger in the
house, kindly volunteered to do it, the sight of one eye was lost and that of the other
much impaired.
(ii.) The mother had no relatives who could afford to spend time in attendance
at a hospital, hut so sent the baby to a private doctor, when she had the money
The case was a fairly severe one, and, although not neglected, required special
lotions and skilled treatment, and got worse rather than better ; it improved when
nurses were called in, and the mother was able to take the baby to the hospital. No
permanent injury to the sight seems to have occurred.
My own visits, consequent on the certificates received under Section 55 of the
Public Health (London) Act, 1891, and the notifications sent by the London County
Council Inspectors, are directed towards the education of the mother on the nature
of the disease, and the supervision of the case after the midwife has ceased to attend.
Notification and the consequent visiting has had a wholesome effect on the
attitude which parents and untrained attendants take towards this disease. An
attack of ophthalmia neonatorum has hitherto been regarded as a very insignificant
matter, only " a bit of a cold " in the eyes. As the result of these official enquires,
they now realise its importance, and are much more inclined to carry out the
instructions of the doctor or midwife.
(v.) Puerperal Septicaemia.
Only five cases have been certified.
Three were attended by doctors and very little enquiry was made into these.
One patient died, another, who was confined in June at a lying-in
hospital, was subsequently removed from there to an infirmary, and
is still there as an in-patient ; the third recovered.