Ophthalmia neonatorum : especially in reference to its prevention / by W. G. Sym.

  • Sym, William George, 1864-1938.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: Ophthalmia neonatorum : especially in reference to its prevention / by W. G. Sym. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    blind, and that a very large percentage of the patients must get well either spontaneously or under very simple treatment. I have referred to the fact that ophthalmia neonatorum is, in my opinion, commoner in England than it is in Scotland. This is to some extent borne out by the distinct difference in the relative pro- portion in the two countries of those who have been blind from Ijirth,—for blind from birth in the census papers includes not merely the very rare cases of infants actually born without vision, but those much more frequent cases in wliich sight has been lost during infancy. In England there are 809 blind persons per mil- lion, and of these one in every six is blind from birth; in Scotland there are only 695 blind per million, and of these not more than one in 7'7 is blind from birth. I cannot help thinking—and this is the chief consideration which led me to present this paper to you—that tliese facts must be taken in connexion with the very much larger proportion in England of births attended by midwives ratlier than by properly educated practitioners as compared with Scotland. In England, I under- stand, the proportion of births attended by midwives is rather more than one-half. 1 am not in a position to give numbers for Scot- land, but I do not believe it is anything approaching to that (11). If this be so, then another evil yet has been traced to the action of ignorant midwives, and one which merits careful consideration. It is quite true that some midwives do recognise the importance of this condition, and advise their clients to consult a practitioner ; but more than these are careless about the matter, and some are actively hostile to any such proceeding, and oppose it vigorously. It is looked upon by them as a reflection on their success in managing their cases, and they sometimes terrify their patients with a highly- coloured account of what will be the line of treatment employed towards the children. I have taken trouble to verify this myself, and you will find it remarked upon by other surgeons (8). In Schleswig, notwitlistanding the fact that it is a punishable offence on the part of a midwife to fail to report a case of purulent con- junctivitis, the Committee of the Schleswig Association, who inquired into this matter, reported that the rule is not carried into operation at all satisfactorily (10). Can we do anything, then, to bring about here a more satisfactory state of affairs? In certain States there are, as we have just seen, penal enactments directed against midwives who fail to report to proper authorities any case of purulent conjunctivitis in the new- born child. Austria and Switzerland took the lead in this matter in 1865; the midwife is obliged to call the parents' attention to the necessity of seeing a physician, and if they refuse to do so, she is compelled to report the case herself Tiic result of this has been that Horner was able to state that not a single case of blindness produced by ophthalmia neonatorum had been admitted to the Blind Asylum of Zurich for twenty years thereafter (8). The States of