OPHTHALMIA NEONATORUM.—III this disease, purulent conjunctivitis, the dis charge is much more copious and puru lent. Pseudomembranous conjunctivitis is never found among the newborn.
Pathology.—The local inflammation must be regarded as a severe form of catarrh only, in which, owing to the in tensity of the inflammatory process, the secretion is richer in fibrin and more prone to coagulation. Various grades of this plastic quality appear. In light cases it may manifest itself as a simple condensation of the secretion, flakes of fibrin forming, which can be readily washed off of the conjunctiva. In some cases, however, the exudate has the tenacity of a true diphtheritic mem brane.
Case of chronic membranous conjunc tivitis. A boy, S years old, had been under observation for eighteen months, with a thick, firmly-attached, yellowish white membrane covering the conjunc tiva of the upper lid. Treatment bad exerted but little influence upon the membrane, although it was then becom ing thinner. The eyeball had not been seriously damaged. But at one time in its course there bad been a severe ex acerbation of the disease in the eye, with soreness of the throat and patches of similar membrane on the tonsils, and rise of temperature. Two children that he came in contact with in the same ward at this time developed diphtheria and died. A sister of this boy had presented a similar chronic membranous conjunc tivitis. After it had lasted nearly a year and a. half she developed scarlatina with diphtheritic patches in the throat. This was accompanied by aggravation of the eye-symptoms, and necrosis of the cornea, with loss of useful vision in both eyes.
Although both these eases were care fully studied bacteriologically, and many micro-organisms discovered, the Klebs Loeffler bacillus was present in each case only dming the exacerbation, and not at any other time. (See illustration.) Lucien Howe (Trans. Amer. Oplith. Soc., '97).
In making a positive diagnosis of diphtheritic conjunctivitis the microscope does not aid very much. The xerosis
bacillus gives exactly the same reaction to the stain that the Klebs-Loeffler bacillus does; it looks the same under the microscope, and W thout clin i cal symptoms is of no significance whatever. The one fact which settles the diagnosis is the inoculation of rabbits or guinea pigs, because there is no reaction to the xerosis bacillus and there is to the diphtheria bacillus. Pinckard (Ophthal mic Record, Aug., '99).
Ophthalmia from infection with the diphtheria bacillus is not rare in London. At the _Northeastern Hospital for Chil dren about 2 per cent. of all cases are of this nature. Stephenson (Lancet, Feb. 17, 1900).
Etiology.—Croupous conjunctivitis is a disease of childhood, and usually de velops at first dentition. Its causal fac tors are the same as those of catarrh, but certain pyrexias, particularly measles and pseudomembranous vulvitis, pre dispose to it. It may be associated with croup of the larynx, trachea, and bron chial tubes.
Tr eat ment.—Hot-water compresses should be applied night and day until the pseudomembrane is removed. The general health should be seen to, and purgatives administered to produce watery evacuations. All caustics and irritants should be avoided so long as the pseudomembrane is present, but the eye should frequently be washed with bichloride-of-mercury (1 to 5000), boric acid, chlorate-of-potash, or chloride-of sodium lotions. As soon as the stage of acute catarrh sets in, the treatment should be the same as in acute conjunc tivitis.
Instances of croupous conjunctivitis that was complicated by disease of the entire cornea, an abscess involving the lower half of this latter membrane. The usual treatment failing to arrest the progress of the disease, a dressing of aristol was applied. This was followed in a short time by the most favorable results. Eliasberg (Archives d'Oplital., Feb., '93).
Irritating remedies, especially silver ni trate, harmful in pseudomembranous con junctivitis. Valude (Archives d'Ophtal., Oct., '94).