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Mrs. "C".
Delivered by Dr. "X" 18.6.38.
Onset of pyrexia 21.6.38 with symptoms of mania.
Consultation with consulting obstetrician 24.6.38.
Removed to West Middlesex County Hospital 25.6.38.
Notification from Hospital dated 28.6.38.
Notification received at Public Health Department 29.6.38.
No notification was received from Dr. " X " so that here again the case was not
immediately connected up with the Nursing Home.
Owing to the failure of the practitioners to notify the cases promptly and supply the
required information on the notifications the Medical Officer of Health was not aware
till July 2nd of the occurrence of three cases of puerperal pyrexia in a Nursing Home.
Since in each case a different doctor delivered the patient it seemed probable that
the source of infection might be in the staff of the home. The home was prohibited from
taking further maternity cases and on July 2nd all the staff, nursing and domestic, was
swabbed by Dr. Murray, Pathologist to the Richmond Hospital, and the practitioners concerned
were invited to be swabbed.
All rooms in which the patients concerned had been were disinfected. A smoke test
showed the drains to be defective and the necessary repairs were carried out.
On July 5th the results of the swabbing showed that haemolytic streptococci were
present in the throats of three nurses. A profuse growth of staphylococcus aureus was
obtained from the throat swab of a probationer nurse and a few doubtful haemolytic
streptococci from the throat swab of the cook.
Nurse " D" with a heavy growth of haemolytic streptococci, showed no clinical
symptoms and had just returned from holiday. She had been in contact with Mrs. "A"
but not with the other cases. She was suspended from duty.
Nurse "E" had been employed as a temporary nurse from 15th June. On 24th
June she developed a sore throat and was sent home. She had been in contact with
Mrs. " B " and Mrs. " C Her throat swab showed many haemolytic streptococci. Instructions
were given that two negative swabs must be obtained before she returned to
work.
In the case of Nurse "F" the swab revealed a few haemolytic streptococci. She
went on holiday on 4th July and instructions were given that she should not resume duty
till two consecutive negative swabs were obtained.
The probationer nurse and the cook were not suspended from duty but were debarred
from contact with any maternity cases pending the examination of further swabs.
On July 5th the home was allowed to take in new maternity cases as the probable
sources of infection had been removed. The various members of the staff were allowed
to return to work in each case after obtaining negative results from two consecutive swabs.
The attention of the doctors concerned was drawn to the requirements of the Puerperal
Pyrexia Regulations.
There appeared to be no corelation between the bacteriological findings. The swab
in the case of Mrs. "A" showed haemolytic streptococci, group A. At my request the
Ministry of Health Pathological Laboratory endeavoured to type the strain but were unable
to do so. The haemolytic streptococci obtained from Mrs. " B " were considered to be
Group A but no typing was carried out. No swabs were taken from Mrs. " C" as her
pyrexia was considered to be due to mania and not to infection. The haemolytic streptococci
in the cases of Nurse "D" and Nurse " E " were not of the type usually associated
with puerperal infection. On one occasion a swab from the probationer nurse showed
haemolytic streptococci, group A, type 12. This does not correspond with the type found
in Mrs. "A" The probationer had not attended any of the patients though the possibility
of her having been in their rooms could not be excluded. Negative results were obtained
from the swabbing of Drs. "Z" and " Y Dr. "X" was not swabbed.
The source of the infection of Mrs. "A" and "B" was not traced. No proof of
infection was obtained in the case of Mrs. " C No further cases occurred in the home.
E. L. ROBERTS.
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