C. OPHTHALMIA NEONATORUM As in older children, blennorrhcea of the newborn is an acute infec tious inflammation of the conjunctiva which is characterized by profuse purulent secretion and granular infiltration. The method of infection in the newborn, however, is unique and the disease must be classed amongst the infections due to parturition.
Symptoms.—In the great majority of cases the disease begins on the second or third day of life, with mdema and slight redness of the lids, usually of both eyes, however, in one fourth to one fifth of the cases only in one eye. The mdema gradually increases until the skin of the lids becomes extremely tense; the lids are no longer opened spon taneously and arc separated with difficulty, by the physician.
At this time a fairly profuse, thin secretion commences, resembling in color washings from meat, and containing a few flocculi. Inspection of the conjunctiva shows severe hyperaemia and swelling, not confined to the palpebral portion and the fornix but extending also to the globe; here the process is usually least marked, but it occasionally leads to extensive swelling, limited sharply at the corneal margin (chemosis). Small luemorrhages in the conjunctiva are not uncommon. Two or three days after the beginning of the disease the secretion becomes thicker, lemon- to greenish-yellow, creamy and very profuse. The cedema of the lids gradually diminishes, the redness subsides, and the surface of the conjunctiva., smooth up to this time, becomes granular; the fornix becomes thickened and plump and bulges forward on evert ing the lids. After two to four weeks the suppuration diminishes, the granulations on the conjunctiva subside and its surface becomes smooth again; the secretion, losing its strictly purulent character, becomes first muco-purulent and less profuse and finally catarrhal; the hyperalnia lessens and the conjunctiva returns to its normal state; scar formation does not usually occur, even after the severest processes.
In many cases the inflammation does not extend so far; the purulent secretion is scant and may even be entirely wanting; in other cases the manifestations are severer, the ()Aetna especially extensive, the inflamma tion leading to the formation of pseudomenibranes on the tarsal conjunc tiva and occasionally to the occurrence of membranous tissue necrosis.
The severest complication is the involvement of the cornea in the inflammatory process: this has now, with the timely inauguration of the proper therapy, happily become a rarity. Infiltrations are formed at times on the margin and at times in the centre of the cornea; the superficial epithelium of the cornea becomes dull and suppurative solu tion of the tissues takes place with the formation of an ulcer which usu ally perforates. The central ulcers do not usually spread after perfora tion, but in some eases the entire cornea is involved. Marginal ulcers are easily overlooked when they are covered by the swollen conjunc tiva; they are either single or when multiple can become confluent, causing the loss of the entire cornea. The consequences of perforation differ according to its location; total or partial staphyloma, panophthal mitis with destruction of the bulb, capsular cataract, anterior synechire. The cornea] involvement usually occurs between the 5th and 14th day of the disease. As a rule the earlier the cornea becomes involved the severer is the disease.
Ophthalmia neonatorum is often accompanied by disturbances of the nutrition of the child and by fever. Except for the extension to the cornea, complications are rare. One of the most important is arthritis, caused by the entrance of the gonococcus into the circulation. The specific arthritis has as its seat of predilection the knee-joint; it may, however, attack other joints, such as the wrist, hip, ankle and shoulder. Sometimes mono- and sometimes polyarticular, it leads to painful swell ing in the neighborhood of the joints which become hot and crdem atous. Active movements are either not carried out at all or else only within a limited range: passive movements arc resisted and cause great pain. There is usually a serous effusion into the joint cavity. In some cases suppuration occurs in or around the joint. The arthritis runs a febrile course in some cases; in the majority, however it is afebrile. Permanent. impairment to joint functions does not occur. Vignaudon reports muscular atrophies occurring as the result of this arthritis.