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As the organism is frequently to be found in the nose or throat, the next
question which arose was as to whether the women found carrying the
organism entered the Home with the organism already in their nose and throat.
In order to clear this point, swabs were taken of a number of women in the
later stages of pregnancy. It was found that one-third were carrying the
organism in their nose and throat, showing that the infection did not take
place primarily in the Maternity Home. It is possible that, as suggested by
the Ministry of Health, some cross-infection might occur by patients being
moved into other wards with other patients during the alterations at the Home.
The fact, however that cases occurred before the moving of the patients took
place, and after the additional precaution with masks, shows that this factor
was not an important one.
The problem remains as to how to prevent the occurrence of these cases.
One solution which might be suggested would be to refuse admission to the
Home of all cases that showed infection of the nose or throat with the particular
organism. This would not only mean a great hardship to many women, but
might be valueless, as one negative swab would be of no value and some
women might be infected after their admission to the Home from visitors.
I consider the better course would be to immunise the women before
admission to the Home. A new product has recently been prepared to which
I propose to give a trial, although unfortunately no test of immunity such as
the Dick and Schick tests for scarlet fever and diphtheria has been yet devised.
The question has been raised as to why an isolation block is not provided
at the Maternity Home. I should decline to take the responsibility for any
such course, as in my opinion it would be a focus of infection for the whole
institution. The surgical block is intended for emergency and observation cases
only.
The dermatitis which affected the babies is due to the same organism as
that which affected the mothers, and explicable by the above results.
In my opinion, therefore, mastitis must be considered in some cases to act
similarly to an infectious disease, the primary infection taking place in the
nose and throat, the disease, like other infectious diseases, taking on
epidemic proportions when (1) the carrier-rate in the population is high compared
with the number of susceptibles, (2) the local or general immunity of the
patients is lowered (in some cases the organism was found in the breast milk
although no mastitis followed), and (3) the virulence of the organism is
increased.
It is satisfactory to note that the Ministry of Health, after a very full
investigation and with information of all the complaints made, states that
careful enquiry has not traced responsibility for the outbreaks to any failure
of technique or lack of care. This confirms the high record which the Maternity
Home holds.
It was first opened in July 1918 and since that date, for the 17 complete
years of working, the average death rate of mothers in the Home is 1.03 per
1,000, compared with 3.72 per 1,000 in Ilford excluding the Maternity Home ;
and the infant mortality rate of babies born in the Home is 21.5 per 1,000,
compared with 52,66 per 1,000 of those in Ilford excluding the Maternity
Home.