There is a direct proportion between ease of transportation and a low rate of blindness, while a higher ratio is to be expected where travel is poor and incon venient. L. Howe (N. Med. Jour., June 26, '97).
Seguelm are the result of corneal in volvement, for the conjunctiva is usually restored to a healthy condition; but, in the event of the corneal ulceration, all eventualities are possible; from a slight degree of opacity, on the one hand, to adherent leucoma, panophthalmitis, or even atrophy of the globe, on the other.
Treatment.—The chief indication in the treatment consists in carefully and frequently freeing the eyes of the copious secretion; for this purpose bichloride-of mercury or boric-acid solutions should be employed very often. To do this prop erly will require the constant care of two intelligent attendants. The patient should be put to bed, and, if but one eye be affected, its fellow slionld be carefully protected. For this purpose the device of Buller answers admirably. This con sists in a watch-g,lass held in place before the eye by strips of adhesive plaster. It should be removed every forty-eight hours and the eye thoroughly cleansed with a solution of boric acid. The sur geon should warn the patient of the danger of carrying any of the urethral discharge to the eyes and should caution the nurses about exercising the most punctilious cleanliness as regards their hands, and care in the use of towels, handkerchiefs, etc.
it is the duty of every physician at - tending a case of purulent conjunctivitis to warn those living with the patient of the very contagious nature of the dis charge from the eyes, and, where pos sible, to isolate both the patient and the nurse in charge. Johnson (Times and Register, Sept. 16, '93).
In gonorrliceal conjunctivitis, if only one eye is affected, the other should be hermetically sealed. The diseased organ should be washed, at least every half hour, with a solution of mercury bichlo ride, 1 to 5000, or a saturated solution of boric acid, and, every four hours, the conjunctival cul-de-sacs should be thor oughly cleaned with pyrozone. In ad
dition, ice-compresses, to be changed every few minutes, should be applied con stantly, day and night, in the first stage. When there is severe pain and swelling, relief may be afforded by canthotomy, slitting the conjunctiva, or leeching the temples. In the second stage, when the conjunctiva. has become velvety, the care ful application of a, 3-per-cent. solution of silver nitrate is best treatment. After its use the conjunctiva should be thor oughly cleansed with a saturated solu tion of common salt. In the third stage, when acute inflammation has completely subsided, the silver is replaced by crys tals of zinc or copper. In all stages atropilte should be used when there is any appearance of haziness or ulceration of the cornea. A. T. IIaight (Chicago Clinic, xiii, p. 317, 1900).
Great care should always be exercised in washing the eyes of these cases, as the pus frequently spurts out like a jet when the lids are separated.
If the swelling of the lids prevents ready access to the canthop lasty should be performed, as this pro cedure not only gives access to the but lessens the pressure of the lids, and gives room for the infection to spread.
In the first stage, ice-compresses should be applied constantly night and day and changed every few moments. In robust subjects.or when there is intense initial pain or swelling, marked relief may often be obtained by leeching the temples.
ln the treatment of fifteen cases of pnrulent ophthalmia good results were obtained by the mild and antiseptic method (silver, 5 grains; corrosive sub limate, 1 to 5000). Campbell (Harper Hosp. Bull., Detroit, Dee., '93).
.In the second stage, when the con junctiva has become velvety and the dis charge purulent, the conjunctiva should be touched with silver nitrate (15 to 20 grains to the ounce of water), to reduce the swelling and the amount of secretion. The silver-nitrate solution should be ap plied by the surgeon to the conjunctiva of the everted lids and then neutralized with a saturated solution of common salt, as directed in catarrhal conjunctivitis.