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" OPHTHALMIA NEONATORUM " AND MINOR NEONATAL INFECTION
682 with advantage, be of the surgery. towards the end given appointments More complete figures for the weeks commencing Oct. 22 and Nov. 5 are given in table v. They relate to a period when, as will be mentioned, a fourth consultingroom was in use ; the figures of patients waiting must therefore be divided by four, and not by three. The main factor in this improvement has been the appointments system. The chief effect of the shift system has been to spread the load. Up to 30 patients are seen before the time when surgeries used to start (at about 9.30 A.M. and 5.30 P.M.), and this has diminished the bulge in the waiting-room. The most significant evidence of improvement has been that we have now been able to reduce the size of our waiting-room so that it now accommodates about 20, instead of 60, patients. Not only does this make it a more attractive place, and lessen the risk of crossinfection, but the space saved has been used to provide a new and more efficiently designed office. The former office has been converted into a double-purpose room which can be used either as a surgery or for dispensing
It lit,4 in fact been used as a and office procedures. fourth consulting-room with an adjustment of our shift
Public Health
directed to this condition or its notification in the past few years locally. I suspect that what is being notified is probably a mild staphylococcal infection. Nearly all the extensive literature on antibiotiu-resiatant staphylococci refers to hospital practice ; and half of these infants were delivered at home. But, in resuming work in an infant-welfare centre after some six years’ absence, I have been extent of minor sepsis in the impressed by the newborn-sticky eye." mastitis (infective, not secretory), paronychia, blisters in the flexures, and discharging navels ; and I get the impression that such sepsis is becoming as important as impetigo was in school-children before the w-ar. In New Zealand staphylococcal infection of the newborn and pemphigus neonatorum are now notifiable diseases,’ presumably because Xew Zealanders are worried as to its prevalence. May this have any relation to the system of paying practitioners according to the number of items of service they provide, which must encourage the use of antibiotics’? The national figures do not, so far, reflect any rise in the notifications of ophthalmia neonatorum. It will be interesting to see whether the Ilford figures are an indication of the shape of things to come.
time than
men
and
might therefore,
" OPHTHALMIA NEONATORUM " AND MINOR NEONATAL INFECTION M.D.
I. GORDON Edin., M.R.C.P., D.P.H.
MEDICAL OFFICER
OF
HEALTH,
ILFORD
IN Ilford, as the accompanying figure shows, notifications of ophthalmia neonatorum were steadilv falling, until there were none in the four years 1952-55. In 1956, however, there were 10 (see figure). The disease notified is not classical opthhalmia neonatorum. When the notification was received, each case was visited by a member of the public-health department, and by that time the condition had practically subsided. No doubt many would have diagnosed the cases as " sticky eye " ; but why did the Ilford practitioners notify these 10 cases in 1956, and none in the previous four years, when undoubtedly they must have seen many cases of sticky eye ? Presumably in 1956 they were stickier than
usual. The-10 cases were notified by six different doctors; 5 of the infants were born at none notified more than 2. home in different parts of the town, and 5 in hospitalfour different hospitals, scattered over Greater London. In 2 of the home confinements there was the same midwife ; in the 3 others different midwives. Hence there is no question of a local epidemic or individual reporting idiosyncrasies. No publicity of any nature had been
system. No claim is made that the above represents an ideal has been done has been done under the pressure of events and in the face of severe limitations. Further developments wait on better days and more spacious surroundings. Until they come, purely administrative changes have enabled this practice to increase its facilities, to deal with all extra 2800 patients, and so to improve its organisation as to serve adequately a population of over 13,000 from a centre occupying approximately 1100 sq. ft.
arrangementwhat
I wish to express my thanks to the staff of the centre for their help in collecting the figures set out in this paper, to Dr. Gerald Ramage, county medical officer of health, for providing the information in table 111, and to Mr. S. Clewes, clerk to the Staffordshire executive council, for figures on the
practice population. The members of the partnership are Dr. B. A. Abbott, Dr. P. M. James, Dr. Stanley Dillon, Dr. P. J. MacMonagle, and myself,
present
Immunisation
against Diphtheria
Observations in Heston and Isleworth have led Andersen 2 to conclude that in immunisation against diphtheria booster doses of antigen provide no significant advantage over primary immunisation only. In a review of children born in 1941, 1944, and 1947, he found that of all who had undergone primary immunisation and had later received a booster dose 91.4% were Schick-nega.tive ; whereas of all who had undergone primary immunisation only 89-9% were Schicknegative. This difference being very small, Anderson concludes that, so long as the incidence ofdiphtheria reinains low, reinforcing inoculations should not be undertaken. Population of England and Wales The Registrar- General3 reports that projections of the population of England and Wales show that, on certain stated assumptions, the total population will increase from 44,821,000 (as at mid-1956) to 45,569,000 in 1961. 47,423,000 in 1976, and 48,545,000 in 1996. In 1956live births registered exceeded deaths by 177,657. The corresponding increase for 1955 was 146,090, and the average increase for the five years 1950-54 was 167,349. 1. Med. Offr, 1957, 97, 16. 2. Anderson, A. Ibid., March 22, 1957, 3. Registrar-General’s quarterly return Office. Pp. 32. 1s. 6d.
p. 161. no. 432, H.M. Stationery
,
It lit,4 in fact been used as a and office procedures. fourth consulting-room with an adjustment of our shift
Public Health
directed to this condition or its notification in the past few years locally. I suspect that what is being notified is probably a mild staphylococcal infection. Nearly all the extensive literature on antibiotiu-resiatant staphylococci refers to hospital practice ; and half of these infants were delivered at home. But, in resuming work in an infant-welfare centre after some six years’ absence, I have been extent of minor sepsis in the impressed by the newborn-sticky eye." mastitis (infective, not secretory), paronychia, blisters in the flexures, and discharging navels ; and I get the impression that such sepsis is becoming as important as impetigo was in school-children before the w-ar. In New Zealand staphylococcal infection of the newborn and pemphigus neonatorum are now notifiable diseases,’ presumably because Xew Zealanders are worried as to its prevalence. May this have any relation to the system of paying practitioners according to the number of items of service they provide, which must encourage the use of antibiotics’? The national figures do not, so far, reflect any rise in the notifications of ophthalmia neonatorum. It will be interesting to see whether the Ilford figures are an indication of the shape of things to come.
time than
men
and
might therefore,
" OPHTHALMIA NEONATORUM " AND MINOR NEONATAL INFECTION M.D.
I. GORDON Edin., M.R.C.P., D.P.H.
MEDICAL OFFICER
OF
HEALTH,
ILFORD
IN Ilford, as the accompanying figure shows, notifications of ophthalmia neonatorum were steadilv falling, until there were none in the four years 1952-55. In 1956, however, there were 10 (see figure). The disease notified is not classical opthhalmia neonatorum. When the notification was received, each case was visited by a member of the public-health department, and by that time the condition had practically subsided. No doubt many would have diagnosed the cases as " sticky eye " ; but why did the Ilford practitioners notify these 10 cases in 1956, and none in the previous four years, when undoubtedly they must have seen many cases of sticky eye ? Presumably in 1956 they were stickier than
usual. The-10 cases were notified by six different doctors; 5 of the infants were born at none notified more than 2. home in different parts of the town, and 5 in hospitalfour different hospitals, scattered over Greater London. In 2 of the home confinements there was the same midwife ; in the 3 others different midwives. Hence there is no question of a local epidemic or individual reporting idiosyncrasies. No publicity of any nature had been
system. No claim is made that the above represents an ideal has been done has been done under the pressure of events and in the face of severe limitations. Further developments wait on better days and more spacious surroundings. Until they come, purely administrative changes have enabled this practice to increase its facilities, to deal with all extra 2800 patients, and so to improve its organisation as to serve adequately a population of over 13,000 from a centre occupying approximately 1100 sq. ft.
arrangementwhat
I wish to express my thanks to the staff of the centre for their help in collecting the figures set out in this paper, to Dr. Gerald Ramage, county medical officer of health, for providing the information in table 111, and to Mr. S. Clewes, clerk to the Staffordshire executive council, for figures on the
practice population. The members of the partnership are Dr. B. A. Abbott, Dr. P. M. James, Dr. Stanley Dillon, Dr. P. J. MacMonagle, and myself,
present
Immunisation
against Diphtheria
Observations in Heston and Isleworth have led Andersen 2 to conclude that in immunisation against diphtheria booster doses of antigen provide no significant advantage over primary immunisation only. In a review of children born in 1941, 1944, and 1947, he found that of all who had undergone primary immunisation and had later received a booster dose 91.4% were Schick-nega.tive ; whereas of all who had undergone primary immunisation only 89-9% were Schicknegative. This difference being very small, Anderson concludes that, so long as the incidence ofdiphtheria reinains low, reinforcing inoculations should not be undertaken. Population of England and Wales The Registrar- General3 reports that projections of the population of England and Wales show that, on certain stated assumptions, the total population will increase from 44,821,000 (as at mid-1956) to 45,569,000 in 1961. 47,423,000 in 1976, and 48,545,000 in 1996. In 1956live births registered exceeded deaths by 177,657. The corresponding increase for 1955 was 146,090, and the average increase for the five years 1950-54 was 167,349. 1. Med. Offr, 1957, 97, 16. 2. Anderson, A. Ibid., March 22, 1957, 3. Registrar-General’s quarterly return Office. Pp. 32. 1s. 6d.
p. 161. no. 432, H.M. Stationery
,