The prognosis depends upon the state of the cornea when the case comes under treatment. If this be uninvolved, the chances of recovery are favorable.
Study of forty cases of ophthalmia neonatorum; average duration of gonor rhmal cases, fifty-three days; average du ration of non-gonorrhceal, thirty-six days. Francisco (N. Y. Eye and Ear Infirmary Reports., Jan., '95).
Etiology.—The origin of the conta gion is the morbid -vaginal secretion, the infection, as a rule, occurring at the time of birth by some of the secretion of the vagina being transferred to the lids of the infant and being carried into the eye the first time that the child's eyes are opened.
Twenty per cent. of all cases of blind ness are found in youth, and, of these, 20 to 25 per cent. are caused by blen norrhcea neonatorum. In 85 per cent. of these cases the affection begins within five days after birth, and, if immediately treated, 70 per cent. are cured. Early corneal complications are the gravest. Pflueger (Corres. ffir Schweizer Aerzte, Sept. 15, '95).
Catarrh of the newborn due to nitrate of silver studied. Results of 300 cases treated by Crec16's method. In 4 out of o_ • 100 there was no reaction, in 73 the secre tion had disappeared entirely on the fifth day, in the others it lasted longer. Irri tation was not caused so much by in creasing the number of drops as by using it on ,nece,-,,ivc days. Small and ill developed children are more sensitive to argentic nitrate than healthy ones. Catarrh for the first twenty-four hours is usually aseptic, and after that septic. Only 1 out of 300 cases had gonorrhceal conjunctivitis. II. Cramer (Centralb. f. Gynak., Mar. 4, '99).
Prophylaxis.—The great aim should be the prevention of contagion during birth. If this be done there is no disease in which prophylactic measures are so efficacious and the results obtained so gratifying. Since the adoption by oph thalmologists of adequate measures, the proportion of cases of ophthalmia ne onatorum has been reduced from 7.5 per cent. to 0.5 per cent. Vaginal antisep tics should be employed before labor.
Immediately the child is born, the lids should be wiped with a piece of lint saturated in bichloride solution (1 to 8000).
After the child has been washed, dur ing which care should be taken that none of the water is permitted to gain access to the conjunctival sac, a drop of a 2-per &nt. solution of silver nitrate should be dropped into each eye. The solution of silver in this strength excites consid erable irritation, and while its applica tion should always be insisted upon in hospitals and the like, in private practice, where no gonorrhceal contagion is sus pected, the douche before labor and the cleansing of the lids by bichloride solu tion, followed by a careful douching of the conjunctival with boric acid will suffice.
In making the applications the child should be laid on its back and its head placed between the knees of the physi cian, while an assistant seated in front 19 should hold its body in his lap and se cure the hands. The lids should then be gently separated by pulling on the skin of the eyelids above the upper and below the lower tarsus, and complete eversion of both lids performed.
Propensity of newborn infants to rub their eyes with their fists; source of con tagion—face and hands, as well as eyes— to be cleansed at birth. Ayers (Amer. Jour. Med. Sci., June, '95).
Theory advanced in favor of the method of Crede, that of direct inoculation of the eyes of infants by the vaginal secre tions, opposed. It is contended that the lids are rolled inward to cover and pro tect the eyes until after birth, and that when they are opened the portions hav ing any secretion from the vagina upon than are remote from the edges of the lids. Merely rendering the lids antiseptic is enough; instillation of silver solution is not prophylactic. A piece of cotton dipped in 1 to 100 mercury cyanide should be applied over the lids to dis infect thoroughly before bathing, and should be repeated after the eyes have been washed. De Wecker (Jour. de Clin. et de Thfir. Inf., No. 42, '99).