The causative agent of the ocular inflammation, the gonococcus, has been demonstrated in the joint fluid in a number of cases, first by Deutschmann; in two cases (Sobotka, Finger) streptococci were found with the gonococcus.
Gonococcus stonm-atitis is the rarest complication of ophthalmia neonatorum; it may occur from the infected tears running off through the lachrymal ducts, or possibly from contamination of the oral cavity directly. It is manifested by extensive exudation and purulent secre tion; gonococci have been found in the secretion (Rosinski).
the vast majority of cases conjunctival blennorrhasa of the newborn is produced by the gonococcus of Neisser. In 44 per cent. of observed cases Groenow demonstrated the gonococcus; Ammon in 56 per cent. and Haupt in 71 per cent. When we consider the fact that in cases of longer duration we are not able to find the gonococcus, the percentage of cases caused by the gonococcus must be even higher than the above. The remaining cases of purulent conjunctivitis in the newborn are caused by the bacteria of inflammation: pneumococcus, streptococcus, bacillus coli, bacillus pseudo-influenzfe and possibly staphylococcus pyogenes aureus and others. Saemisch advises cata loging the cases of purulent inflammations of the newborn not due to the gonococcus as acute blennorrhceic conjunctivitis, in contradistinction to acute gonoblennorrhcea.
Pathogenesis.—Infection of the conjunctiva of the newborn can take place in various ways. As a rule the infection takes place from a urethritis or vaginitis of the mother. Herewith the child may be already infected in utero or, through the agency of the examining physician or midwife whose fingers carry the infection from the vagina to the eyelids of the child, and possibly also through infected amniotic fluid. Usually, however, the child is infected during the passage of the head through the birth canal, when the lids become covered with the secretion which reaches the conjunctiva when the eyes are opened.
In many cases the child is infected post partum from the hands of the nurse or mother. In institutions children of healthy mothers are sometimes infected indirectly from other children infected with blen norrlicea.
Experience teaches that the cases of ophthalmia arising from infec tion during birth only rarely begin later than the fifth day.
Diagnosis.—The diagnosis of gonorrhoeal ophthalmia is easily estab lished. It can easily be differentiated from simple catarrh caused by irritation (nitrate of silver catarrh) of the conjunctiva and from puru lent conjunctivitis caused by other than gonorrhoeal infection, by means of bacteriological examinations. In some cases an acute dacryocystitis, such as occasionally occurs in the newborn as the result of a congenital closure of the lachrymal duct, may give rise to confusion with gono blennorrhoea. With this condition, however, the disease is always uni lateral and by pressure over the tear sac pus may be expressed.
neonatorum is very prevalent, but owing to the prophylactic measures employed in maternities it has become less frequent.. Notwithstanding this, however, according to the statistics of Cohn for the year 1906, there are still 31 per cent. of the inhabitants of asylums for the blind in Germany, who owe their loss of vision to gono blennorrha- a.
The prognosis is good, when timely, suitable treatment is instituted. The non-gonorrhccal purulent inflammations lead to involvement of the cornea less often than the gonorrhoeal.
Prophylaxis is most important. Excellent results have been at tained from the procedure introduced by Credo. According to his ad vice, the infant should be cleansed and bathed immediately after birth; the lids cleansed externally with sterile water applied with cotton pled gets; then one drop of a 2 per cont. silver nitrate solution should be applied to each eye by means of a glass rod; this application should not be repeated.
Credo's method has given admirable results and has unquestionably reduced the frequency of blennorrhaa neonatorum. Since, however, its employment is not absolutely preventive, it is recommended to use re peated disinfecting vaginal douches during delivery. Many clinicians lay especial value on the cleansing of the lids externally with disinfect ing fluids immediately after birth, and some even prefer it to Crecle's method. Objection to the latter method is often raised on the ground that it frequently leads to irritation of the mucosa (silver nitrate ca tarrh). On these grounds a 1 per cent. solution of silver nitrate is often used. Substitutes for the nitric acid salt of silver seem only to be less effective than the latter itself.