Great importance of reaching all parts of the conjunctiva with 3-per-cent. ni trate-of-silver solution in gonorrhceaI ophthalmia. Abadie (Bull. Gin. de Then, Jan. 15, '95).
Mien cornea implicated, quinine sul phate, 4 grains to 1 ounce, with smallest Possible amount of sulphuric acid; to be used in intervals, but not as ft substitute for silver nitrate. Tweedy (Practitioner, Mar., '95).
Purulent ophthalmia and daeryocys titis successfully treated by potassium permanganate solutions, 1 per cent. to 10 per cent. Case of diphtheritic conjunc tivitis treated by crude petrolemn-oil. Irian (Recucil d'Oplital., Aug., '95).
Protargol in 10-per-cent. solution used for personal application in purulent con junctivitis and 5-per-cent. solution for use at home. Furst (Fortsch. d. Med., No. 4, '9S).
I'rotargol in 5-per-cent. solution is practically a specific a.gain.st purulent conjunctivitis. A. Darier (Ophth. Klinik., Nov. 7, '93).
A 10-per-cent. ointment of the milky juice of the cassaripe plant is valuable in purulent disease of the conjunctiva ac companied by corneal ulcers. S. D. Ris ley (Phila. -Med. Jour., Oct. 29, '98).
It is best to delay the application of silver so long as the conjunctiva is hard and infiltrated. and the discharge is watery. A croupous membrane also contra-indicates its use.
In the third stage, when the signs of chronic conjunctivitis appear, the silver should be substituted by crystals of zinc and copper, but these should only be em ployed when the cornea is quite free from all sig,ns of acute inflammation and ulcer ation. During the entire course of the disease, the cornea should be carefully inspected, and, at the first appearance of ulceration, atropine should be instilled. This drug frequently serves a double pur pose in combating any existing iritis, as well as the corneal involvement. If corneal ulceration be present, great care roust be exercised in making the applica tions of silver to the everted lids, as press :ire on the globe might cause rupture of the ulcer. Care should also be exercised to prevent the silver coming in contact with the infiltrated cornea.
Ophthalmia Neonatorum.
Definition.—This is a purulent inflam mation of the conjunctiva occUrring in the newborn, characterized by great swelling of the lids and conjunctiva, and the copious discharge of contagious pus.
This is one of the most frequent of eye diseases, and is responsible for more cases of blindness than any other affec tion, the statistics showing that from 30 to 60 per cent. of the inmates of the different blind-asylums throughout the country owe their infirmity to its rav ages. Of the three hundred thousand blind in Europe, thirty thousand were rendered so by ophthalmia neonatorum.
Symptoms.—The disease usually ap pears on the second or third, more rarely on the fourth or fifth, day after birth. In the latter case, however, it is probable that infection is carried to the eye's after birth, either from the mother or the nurse or some other. person suffering from gonorrlacea.
The active symptoms are the same as the gonorrhceal conjunctivitis, except that they are not so severe. The swelling of the lids is not so great and the secre tion is less copious. The bulbar chemosis does not attain such a high degree, and corneal complications are not so frequent nor so serious.
The disease may occur in a severe type, with a tendency to invade the cornea; or it may run a milder course, without corneal complication.
In the mild form of conjunctivitis in the newborn there is little pus, much lacrymation, and moderate palpebral injection, although the pneumococcus is present. I'arinaud (La MO. Mod., Jan. 19, '95).
Pnetimococcic conjunctivitis to be sus pected when scarcely reddened palpebral conjunctiva, marked arborescent vascu larization of ocular conjunctiva, with slight ecchymosis near corneal border; secretion more lacrymal than catarrhal and containing floating muco-fibrinous flakes. Gasparrini (Annan di Otta1111°1., Jan., '95).
Bacteriological examination of 100 cases of infantile ophthalmia, clinically ranging from a simple catarrh to a se vere blennorrhcea. The following organ isms were found: Gonococci, pneumo cocci, and streptococci; possibly in some cases staphylococcus aureus and bacillus coll. The etiological importance of other organisms was doubtful. The se vere cases of blennorrhcea were, for the most part, caused by gonococci; but there occurred cases in which, in spite of most careful examination, gonococci were not found. The gonorrhceal cases always showed clinically certain pecul iarities. The cases without gonococci were never complicated by corneal ulcer, and ran a much shorter and milder course. Also cases of slight and medium severity without gonococci showed after a few days' treatment marked lessening or disappearance of purulent discharge, whereas the pus of gonorrhceal inflam mation seldom disappeared under two weeks. Gonococci were the cause of the inflammation in 41 of the 100 cases; in 25 of these the affection was severe. In gonorrhceal cases for days and weeks after pus has disappeared gonococci may be found in the conjunctival sac; so that the use of silver preparations must be continued long after purulent discharge has ceased. Groenouw (Arch. f. Ophthal., B. lii, p. 1, 1901).