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14
Visitor usually visits on the same day. If she finds that the baby requires
local applications to the eyes oftener than the doctor is able to give, and
the patient is treated at home, the East London Nursing Society is immediately
communicated with by telephone, and requested to send a nurse. It is left
to the discretion of the nurse to visit and apply treatment as often as she
considers necessary, or as often as the doctor in attendance requests her to do
so. The Borough Council pays for this nursing attendance per visit, and not
per case, so that there is no reason why the baby's eyes should not receive
proper care and prompt attention. On the other hand, if the patient is
attended by a midwife, she reports it to the London County Council by post,
and the Inspector of Midwives visits. If the latter considers that the case
requires treatment by a nurse, she telephones to this office and arrangements
are made to send a nurse as soon as possible. At the best, a longer time
must elapse before the nurse appears on the scene, than if the midwife reported
direct to the Public Health Office.
All Authorities are agreed that speed is the most important point in the
treatment of Ophthalmia Neonatorum. Every hour lost means that the disease
is obtaining a deeper hold. In addition, there is the danger of the other
inhabitants of the house contracting gonorrhoeal disease from the infected
baby.
If all cases of even slight inflammation of the eyes were notified direct
to the Public Health Authority by the midwife, as in the case of the doctor,
then immediate treatment could be secured. Another advantage would be
that the child could be seen at the Infant Welfare Centre after the third
week and the treatment continued if necessary.
The midwife is generally engaged for a confinement some time in advance,
and knows probably whether there is any suspicion of the expectant mother
to be suffering from Gonorrhoea. The immediate necessity is of course that
treatment be given to the mother, and to the baby when it arrives. But in
order to prevent the disease of Ophthalmia Neonatorum occurring in the
woman's next child, treatment should be given after her confinement, either
by a private practitioner, or at a Venereal Disease Centre.
It would be advisable to have a swab taken from every case of discharging
eyes in the newly-born. If on bacteriological examination the
gonococcus (the active cause of Gonorrhoea) is proved to be present, the
midwife should procure suitable treatment for the mother as well as for the
baby The infection is either contracted during birth or by subsequent
infection from the mother, as Gonorrhoea is spread by contact.