In no ease did more than slight con gestion of the conjunctiva follow the in stillation of nitrate of silver, and this only when 2-per-cent. solution was used. When the method was first employed the stronger solution was used, but in the last 928 children a 1-per-cent. solu tion was instilled. The most important point in the technique is to instill the solution as soon after tbe child is born as possible. If an hour has passed, it may be too late to prevent the infection. It is probable that the neglect of this latter precaution has led to the reported failures in other clinics. Hirsch (Klin isches Jahrbuch, Bd. iii, H. 3, 1902).
Granular Conjunctivitis (Trachoma, Egyptian Ophthalmia, Miliary Oph thalmia).
Definition.—Granular conjunctivitis is an inflammation of the conjunctiva, characterized by the hypertrophy of the tissues and by the development of small pinkish prominences or granulations on the conjunctiva, the chief tendency of which is to undergo absorption and pro duce serious cicatricial changes in the lids.
Although it was generally supposed that the disease was introduced into Europe from Egypt by Napoleon's army in 1798, it was subsequently shown that the disease had actually been endemic in Europe several centuries before. Ex cellent descriptions of the disease were recorded by the ancients, and measures adopted by them for its relief have come to light again in our own day under the form of the operation of scarification. Nevertheless, to Napoleon is due, in large measure, the propagation of the disease, for it was doubtless owed to the fre quency with which his armies came in contact with those of other countries, as well as with the civil population, that the disease spread so rapidly during the first part of the present century.
The Jews, the Irish, the inhabitants of the East, and the North American In dians are especially liable to the affection, while negrocs are practically exempt.
Geographically, the disease occurs more often in Arabia and Egypt, while western Europe is more exempt than eastern Europe. In the -United States it affects those dwelling in tenement houses, and is associated with unhygienic surroundings in large cities. It prevails in the Western prairies, and is found scattered widely over the country. High altitudes seem to render a certain im munity to the disease.
Verification of the law established by Chibret concerning the immunity given by a high altitude. A certain elevation above the sea-level offers the best con ditions for cure, but there is no abso lute immunity. Sattler (Revue Gen. d'Ophtal., Aug., '90).
the City of Mexico trachoma is very rare. The hygienic conditions of the lower classes being of the very worst, it is the altitude of the city (6000 feet) that renders it free from this pernicious disease. Race has nothing to do with the question, as there are many foreigners living in the city who are alike free from any visitation of the inflammation. Chacon (Gaceta Medica de Mexico, June 1, '92).
is a great differ ence in the symptoms, not only on ac count of the intensity of the changes, but also from the rapidity of the course of the disease. The signs of irritation are greater, the quicker the course of the disease. -Usually, the irritation symp toms are only moderate, but slight pho tophobia, lacrymation, and pain being complained of.
Not seldom the disease is so insidious that the subject does not know of its existence, the disturbance in vision due to corneal complication giving the first indication. This is especially the case when the disease occurs in eleomoscenary acute trachoma. Here the disease begins with marked inflammatory symptoms; the lids are cedematous, the conjunctiva swollen, and there is a rich secretion of pus.
Granular conjunctivitis may occur in either an acute or chronic form, accord ing, as it is or is not attended by the signs of acute inflammation.
Acute Granular Conjunctivitis (Papil lary Trachoma; Chronic Blennorrhcea).— This is rare in this country and should be differentiated from the violent ex acerbations to which the chronic forms of the malady are liable. In this variety there are all the signs of purulent con junctivitis, with the development of the granulations. The lids swell and the conjunctiva, both bulbar and palpebral, becomes injected. The papillm are en larged, and the characteristic granula tions are about the size of the head of a pin, and are situated, for the most part, in the retrotarsal folds—chiefly- the up per. They are also found scattered throughout the conjunctival membrane.