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143
being in another Hospital, while a doctor's wife developed the trouble.
Elsewhere outbreaks have occurred at Hospitals in London, Birmingham and
as far north as Lanarkshire.
The most complete account of such cases has been carried out on those which
occurred at the City of London Maternity Hospital, a long-established
voluntary hospital of high repute.
In April 1935 an account of those cases was given owing to an increased
incidence amounting almost to an epidemic. A hundred consecutive cases were
described. The maximum number of cases fell during the last two and the first
two months of the year, suggesting that an epidemic .factor was at work. The
authors of the report stated that they did not find any factor such as ward
distribution, nursing personnel, or variations in local treatment by different
surgeons, to be significant, in fact, no adequate cause of the cases could be
discovered. They stated that the frequency of infection of the breast is
probably under-estimated, and that one of the chief reasons for this is that
patients pass to surgical care other than that responsible for delivery of the
patient.
In Ilford the latter did not hold good, as many of the cases were admitted
to the Isolation Hospital, and thus enabled a much more complete investigation
to be made, although it will be seen that the problem was a most intricate one,
intensified by the fact that some of the abscesses did not develop until a month
or more after the confinement.
The cause of the infection in each case was found to be an organism known
as the Staphylococcus Aureus. It has been generally held that a breast abscess
is caused by the nipples being sore or cracked and coming in contact with some
infected article. It was therefore first necessary to bacteriologically examine
such articles at the Maternity Home to be satisfied that the sterilisation of such
things as breast binders (which precaution is not taken at all institutions) was
effective. All investigations of this kind yielded, however, no positive result.
This confirms the results of the City of London Maternity Hospital, where it
was considered that the importance of cracked nipples tended to be exaggerated.
A complete bacteriological examination, however, of the patients at the
Isolation Hospital yielded the important fact that they were carrying the
particular organism in their nose or throa^. This discovery caused me, as an
additional precaution, to give instructions that the nursing staff at the
Maternity Home must wear masks whenever they were in the wards, and not
simply when attending to patients. It will be remembered that the Ilford
Maternity Home was one of the first to take the precaution of the wearing
of masks, and the Ilford Council to supply such masks to independent District
Midwives.
The next question was to consider how the infection was conveyed from
the nose or throat to the breast, and I therefore had throat swabs taken of a
number of babies whose mothers showed no evidence of trouble in the breasts.
These showed that 40% of the babies who were thus examined were carrying
the infecting organism in their throat and an examination of the nose and
throat of their mothers showed that they also were carrying the organism.
The probable sequence of events is therefore that the mother, carrying the
organism in her nose and throat, infected her baby's throat, probably by
kissing, and that the baby in turn infected the mother's breast when suckling.