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The majority of these cases of Puerperal temperatures were
delivered in their own homes: many of the cases delivered by
doctors were abnormal (including the abortions), and in most
cases the doctor was not engaged for confinement, but sent for
by the midwives because of some abnormality.
Under the scheme of the Council, arrangements for home
nursing of these women can be made with the various District
Nurses' Associations, or if the Medical Attendant so desires, the
patient can be admitted to the Plaistow Fever Hospital. Further,
the opinion of a Consultant Obstetrician can be obtained by the
practitioner attending the patient at home, if he communicates
with the Medical Officer of Health. In most cases, conditions
are unsuitable for the home nursing of very grave puerperal
cases.
PEMPHIGUS NEONATORUM.
An outbreak of pemphigus occurred in the Borough during
1927, 12 cases being notified. In addition, there have been 13
cases of "watery blisters" for which Medical aid has been called
in by the practising midwives, but these were never notified by
the doctors as Pemphigus.
Special visits are paid by the Health Visitors to every case
of pemphigus or "watery blisters," immediately after receipt of
notification by the doctor or of medical aid slip. Weekly visits
are paid thereafter as long as is necessary.
Six of the notified cases occurred in the practice of one
private midwife, who also reported seven cases of "watery
blisters." Her first case was not diagnosed as pemphigus, and
consequently disinfection was not carried out. This case was
rapidly followed by a series of cases, and in spite of adequate,
thorough disinfection, with transference of the infected cases to
other Nurses as soon as possible, the outbreak continued.
The midwife herself underwent a thorough medical inspection,
and though given a satisfactory report, was advised to take a
four weeks' holiday, which she did. In spite of all these precautions,
she continued to have further cases at intervals from May
till September. Since then her practice has been normal. One
baby died in this practice: the other infants were in a satisfactory
general condition throughout.
Four notified cases were in the practice of another private
midwife, with one death: she also reported two cases of "watery
blisters" during the outbreak. A similar investigation was
made as in the case of the first midwife, and arrangements were
made for the District Nurses to undertake the nursing.
Although the midwives concerned practice in adjoining areas,
no definite connection could be traced between them, or between
the individual cases. Two other private midwives, both equally
competent and careful, who practised in the same districts, had
no cases of "watery blisters" during 1927.
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