Crede's method has doubtless been of great value in maternity hos pitals. The question as to whether it should be generally employed in private practice and possibly made obligatory, is still under lively dis cussion. It should be used, however, in conjunction with vaginal douches, in every ease in which the physician or midwife detects a puru lent vaginal discharge in the mother before delivery.
Late infections can be absolutely avoided by scrupulous cleanliness on the part of nurse and attendants. Nurses and mothers should be admonished to cleanse their hands thoroughly every time before hand ling the child. It is self-evident that mother and child should not em ploy in common such things as washing utensils, syringes, cotton, etc.
treatment of gonoblennorrhcea should be directed toward lessening the inflammation and removing as quickly as possible the accumulating secretion. To prevent. corneal complications ice com presses are used in the first stages of the disease and kept up until the secretion becomes slight and its purulent character has disappeared. For this purpose small gauze or hnt compresses folded four to eight times are used. Many of these are prepared, put on ice and changed every three to five minutes. Since the gauze or lint absorbs the secre tion, the compresses must be frequently replaced by new ones. When changing the compresses the secretion should be wiped away with sterile cotton. The secretion collecting in the fornix should be removed by douching. The douches should be used very often when suppuration has begun, every one-half to one hour, clay and night. It is in this connection of great importance to avoid any, even the slightest, injury to the corneal epithelium, in order to avoid paving the way for infiltra tions of the cornea.
The following solutions are recommended for douching: potassium permanganate in a red (3 per cent.), or in very dilute solution; subli
mate 1:5000; boracic acid three per cent; oxycyanate of mercury 1: 2000; also physiological saline solution; boiled water and others.
With the beginning of the secretion, the conjunctiva should be swabbed daily with a 2 per cent. solution of silver nitrate. Touching the cornea with the silver solution and the use of saline to neutralize it, should be carefully avoided. In case the inflammatory signs and the secretion should not soon diminish, one can employ a 3 per cent. solu tion of silver nitrate for application to the conjunctiva. If only one eye is attacked the healthy eye can be protected against infection by drop ping into it daily one drop of a 1 per cent. silver nitrate solution. Ban daging the healthy eye is very efficient, but irritations of the skin and also of the conjunctiva occur quite readily under the bandage. :Notwithstanding this, bandaging the healthy eye is often advocated when only one eye is affected.
When the cornea is involved, 1 per cent. atropine solution (when the ulcer is marginal, 1 per cent. eserin) should be dropped into the eye. moreover the use of the ice compresses must be discontinued; but not the application of silver nitrate. One should consult the text books on ophthalmology for further information on this topic.
Arthritides are treated by application of liquor aluminii acetici (P. G.) diluted eight times. It is best first to anoint the skin, over the diseased joints, with vaseline.
Purulent effusions into the joints, manifested by extensive inflam matory signs and established by exploratory puncture, are to be incised under aseptic precautions. Salicylates may be tried but seem to accom plish very little.