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temperature Case B, it will be seen that they were all
attended by the same midwife. This midwife is stated to
have contracted a septic finger from the baby of Case 2.
It appears that formerly she suffered at times from an
ear discharge, though not lately.
Swabs were taken from her throat, and the laboratory
report states: "The cultivation of this throat swabbing
gives considerable growths of streptococci with small numbers
of a non-pathogenic staphylococcus albus, and of a
chromogenic micrococcus catarrhalis.
"The streptococci occur iawn three strains, two of which
are haemolytic and one non-hæmolytic.
"The hæmolytic strains belong to Brown's beta type,
and according to Holman's grouping, one of the strains is
a true streptococcus pyogenes longus, and the other a
streptococcus angiosus. The third strain is of Brown's
gama type (non-pathogenic streptococci)."
A later report on the virulence of these two hæmolytic
strains reads:—
"Each of these streptococcal strains has been injected
subcutaneously and intra-peritoneally into white mice. None
of the animals died within a week of infection. Post-mortem
examination showed circumscribed local lesions at the site
of injection only."
CONCLUSIONS.
In my opinion the midwife, who attended Cases 1, 2
and 4, the two babies, and temperature Case B, was the
infective agent. It is my view that infections of this nature
are conveyed by individuals, and that the source is not as a
rule traceable to the room or ward of an institution.
Though the midwife's septic finger is stated to have
been contracted from the baby of Case 2, I do not think the
possibility that it was previously infected can be ruled out
completely.
I do not propose to review the methods of administration
adopted by the staff of the Kingston Nursing Association,
as an inquiry has been made by a medical officer from the
Ministry of Health.
The Public Health (Notification of Puerperal Fever and
Puerperal Pyrexia) Regulations, 1926, came into operation
on October 1st, 1926.
Puerperal Fever was previously notifiable, and still