By Richard H. Lewis, M. D. 
Reprint from the North Carolina Medical Journal, 
March, 1879. 
WILMINGTON : 
Jackson & Bell, Printers and Binders. COMPLIMENTS OF 
NORTH CAROLINA 
MEDICAL JOURNAL. 
M. J. DeROSSET, M. D., 
THOMAS F. WOOD, M. D., 
Editors. 
Number 3. 
Wilmington, March, 1879. 
Vol. 3. 
ORIGINAL COMMUNICATIONS. 
OPHTHALMIA NEONATORUM. 
By Richard H. Lewis, M. D., Raleigh, 1ST. C. 
Blindness under any circumstances, even when occurring in the 
very old, who having almost completed the journey of life have 
least to lose, is one of the saddest of all afflictions. When it falls 
upon those in the prime of life, or worse, upon those who have not 
yet passed the period of joyous youth, and nips in the hud all 
those bright and happy dreams and anticipations of the future with 
Which the mind of the young is always filled, it is sadder still. 
But saddest of all it is, it seems to me, when the “blackness of 
darkness” settles down over the eyes of the newly born, before they 
have consciously seen even the glorious light of day, there to 
remain as long as life shall last, dooming the poor unfortunate to a 
life of helpless dependence, and in many instances to want and pos- 
itive suffering. It is true, that those who have never seen do not 
fully realize their privation, and that their feeling of regret is less 
keen than that of those who have once enjoyed sight ; but that 134 
OIMITHA LMIA XE((NATO It U M. 
negative happiness is more than counter-balanced by the deficiencies 
resulting from their never having had the use of the most im- 
portant of the senses, as will, I think, be made apparent further on. 
Such as have lost their sight later in life, have, previous to that 
calamity, acquired an amount of knowledge by means of the “un- 
conscious education’’ received through that sense, which astonishes 
us when we reflect upon how much of our own knowledge, and of 
a kind too that could have been obtained in no other way, has been 
taken in through the eyes. They have secured definite ideas of 
color and form in the abstract, especially of the more delicate 
phases of the latter, and they possess, indelibly stamped upon their 
memories, innumerable examples of both in the concrete. In them 
the conditions necessary to a high development of the mind are 
fulfilled, they can appreciate what is told or read to them of the 
physical world, and their education can be made much more per- 
fect and complete, and their pleasures of course greatly increased. 
Besides, they have stored up an immense amount of raw material, 
as it were, upon which the imagination can draw, ad libitum, in 
making up scenes of beauty for the inspection of the mind’s eye. 
A few pieces of colored glass in the kaleidoscope can make, it is 
said, almost an infinite number of combinations : the number of 
combinations of bits of form and color possible to the kaleidoscope 
of the mind, passes comprehension. The imagination is always 
highly developed in the blind, and they have it thus in their power 
to weave the most pleasing fancies, to build the most gorgeous air- 
castles of endless variety; and while such employment is neither 
profitable nor useful, it is certainly a never-failing source of 
pleasure, for it is well known that the happiest among men, are 
those who dwell a large portion of their time in chateaux en Espagne. 
In this way they can project their thoughts into external objects 
—in a word, get out of themselves. 
On the other hand, those blind from infancy have absolutely no 
conception of color, and their ideas of form, derived solely through 
the sense of touch, must necessarily be crude and imperfect. They 
can tell that an object is round or square, but of form in its more 
beautiful and graceful manifestations they have no knowledge;—the 
shape of a box or biscuit they can realize, but to such modifications 
of form as are seen, for example, in the waving wheat-fields, ortho OfillTU'A LM I A S'kOkATdRt'M . 
135 
rippli'hg surface of a moonlit lake, their eyes, both physical and 
mental, are forever closed. Of the physical world their knowledge 
must be exceedingly meagre, and having failed to acquire the mass 
of facts in the possession of their more favored brethren in afflic- 
tion, the foundation upon which is to be based their mental struc- 
ture, must, in the nature of things, be more narrow and circum- 
scribed. They are then not capable of as high an intellectual de- 
velopment, and are compelled to occupy a lower plane in the scale 
of spiritual being. Besides, they are unable to direct their thoughts 
into channels external to themselves with such facility and with so 
niuch pleasure, and consequently they are more prone to brood over 
their misfortune, one would think. 
Iam not prepared, however, to assert positively that they are not 
as happy in this way as the others never having had sufficient oppor- 
tunities of practical observation to form a just opinion ; but, inas- 
much as they must be intellectually inferior, their happiness, must 
be, to say the least, of a lower order. To use a strong illustration : 
a half-witted man may, after his fashion and according to his 
capacity, be as happy, or more so, than a highly intellectual man: 
but one moment of the philosopher's happiness is worth a lifetime 
of that of the idiot. 
At any rate, it is clear, I think, that those blind from infancy are 
more deeply afflicted than other blind persons who have first en- 
joyed some years of sight: and I have been led to say thus much 
upon a subject that some may think superfluous, for the purpose of 
showing, that if there can be degrees in the responsibility attach- 
ing to such cases, it rests upon us with peculiar heaviness in those 
cases of threatened blindness, occurring in the earliest dawn of that 
short day we are allowed on earth. 
Its applicability to the subject in hand appears, when I assert that 
the inflammation of the eyes of the newly born stands at the very 
head of the list of, certainly incurable, blindness occurring at any 
and all periods of life; and, that of the blindness coming on in the 
firstfew weeks after birth, it is the almost invariable cause. 
Mr. Carter, in his recent admirable work on the eye, when speak- 
ing of this disease, says, that it is supposed to be the cause of nearly 
one-half the blindness at present existing in England. I hardly 
think that the proportion would hold good altogether in this country, 136 
OPHTHALMIA NEONATORUM. 
for two reasons; first, because in England, on account of the 
greater abundance of eye-surgeons, those cases that can be reme- 
died by a timely operation, seek and obtain relief, while with us very 
many cases, notably congenital cataract, are neglected, either 
because the family physician lias not the instruments necessary, or 
because of bis reluctance to surgically interfere with an organ so 
delicate as the eye. There are a number of such cases at present in 
our asylum for the blind, which no doubt could have been given 
their sight by an operation during their infancy; but now, from 
non-development of the retina, it is too late. The other reason 
for the relatively larger proportion of blindness from the ophthal- 
mia of the new-born in England, is the greater crowding of the 
inhabitants into filthy tenements, and the consequent violations of 
the laws of health Avhich do not occur on this side of the Atlantic 
to such an extent, except possibly in a few of our largest cities, 
Rural populations are much less liable to this disease, and we would, 
therefore, expect to find a minimum of it in our own State, and 
doubtless it is as rare here as anywhere ; yet, nevertheless, it is the 
most frequent cause of blindness among the pupils at the asylum, 
and Hearn, from a list kindly furnished me by the matron, that of 
those who lost their sight under the age of three years* about 70 
per cent, became blind during the first few weeks of life, and pre- 
sumably, from the disease under Consideration. 
From the above it appears that the inflammation of the eyes of 
the newly born is the most destructive to sight of all the diseases 
of the eye, and consequently, there can be none in that class of 
more interest to the physician, or more deserving of oUr careful 
consideration; particularly, when we note the fact* that if promptly 
taken in hand, and properly treated* it rarely ends otherwise than 
in recovery. And it is of interest, not so much to the specialist, as it 
is to the general practitioner, for it is the aCcoucheur who first sees 
the disease, and who in a large majority of cases, is called upon to 
treat it. 
Ophthalmia neonatorum, or to speak more accurately, the con- 
junctivitis to which the newly born are peculiarly subject, is not a 
specific disease, possessing as it does, the same general characteris- 
tics as inflammations of the conjunctiva in older persons ; but, on 
account of its greater gravity when attacking those of such tender 0 PHTH AI AHA X EO NATO tit' M. 
137 
age, and because of certain modifications resulting from the in- 
fantile organization, it deserves, and in the best text hooks it has 
been given, a special name and a section to itself. 
The causes of this affection are various, but in most instances it 
can be traced to a want of cleanliness in one shape or another ; and 
generally, it is the result of an inoculation of the eyes of the infant 
with some vaginal discharge, leucorrhceal or gonorrhoea], either 
directly, during the passage of the head thrdugh the vagina in 
delivery, or, indirectly, through the hands of the attendants, or 
clothes soiled with it. “ The impure air of a room filled with 
excrementitial exhalations, smoke, dust, or acrid vapors, as well as 
the musty damp air of an unventilated room,” is a frequent source 
of this disease; and the children of the poorer classes who inhabit 
such tenements are much more liable to it than the children of 
those in better circumstances. It not infrequently owes its origin 
to exposure of the eyes to bright lights soon after birth, or to 
draughts of cold air, or other irregularities of temperature which 
would be likely to excite catarrhal trouble in other parts of the 
body: for the potency of the catarrhal influence, 'whatever it may 
be, in producing conjunctivitis, all will admit, who have observed 
the epidemics of “sore eyes” that often prevail at the same time that 
“ colds” of various kinds are peculiarly rife. Still another cause, 
is the entrance into the eye of some of the soap used in washing the 
child, or of the whiskey, that is by some midwives “absurdly 
rubbed over its head.” 
It makes its appearance almost always within the month, and gen- 
erally during the first Aveek of life, and in a majority of cases 
attacks in the beginning only one eye, but it is sure to extend to the 
other in a very few days, unless we are successful in protecting it 
from the discharge—a very difficult thing to do, by the way. In 
intensity it varies from scarcely more than an irritability of the con- 
junctiva, to full blown gonorrhoeal ophthalmia, there being every 
degree between the two extremes. Some writers recognize two forms, 
the catarrhal and the purulent, and while such a division of the sub- 
ject is not demanded by the scientific requirements of the case, as 
it is one and the same disease throughout, and it is impossible to 
draw a sharp line of demarkation between the two forms, they melt 
so imperceptibly the one into the other, yet T think it advisable, 138 
OiffTf llALM I a Ki'bKATOlir M. 
as facilitating the description of the disease, ilnd as affording it more 
accurate guide to treatment. 
The term catarrhal is applied only to the milder forms, those in 
which the discharge is mucous,or at worst, muco-purulent in quality, 
and limited in quantity, while the term purulent, is, as its name 
implies, used to designate those cases of greater severity in which 
the discharge is purulent in character, and, in some of the worst 
cases we may almost say, unlimited in quantity. 
In examining a case of the catarrhal form, the first thing that 
attracts our attention, is an accumulation of dried mucous at the 
corners of the eye and upon the lashes, glueing them together, and 
a greater or less amount of puffiness and swelling of the lids. This 
puffiness of the lids is usually a very prominent symptom, and is 
attributable to the laxity of the infantile tissues. 
On opening the eye we observe, that the edges of the lids are red 
and not ns thin as they should be, and. everting them, we find the 
palpebral conjunctiva thickened, and diffusely and uniformly red, 
and that of the globe exhibiting a network of engorged vessels with 
meshes of varying size according to the severity of the attack, 
through which the white sclerotic shows. Lying on the inner sur- 
face of the lower lid, and particularly on the retro-tarsal fold where 
the conjunctiva leaps over from the lid to the ball, we perceive 
flakes or strings of coagulated mucous or muco-pus. 
In the purulent form we find all these symptoms exaggerated. 
The lashes are a mass of matter, and at the inner corner of the eye 
in most instances, is a littte pool of pus, while the redness, puffi- 
uess, and swelling of the lids is marked, the upper lid being fre- 
quently so much enlarged as to overlap the lower. Opening the 
eye we find it literally bathed in pus, and after removing the dis- 
charge, we see that the palpebral conjunctiva is very red, very 
much thickened and swollen, and more or less rough in appearance 
from the enlargement of the papillae ; and that the ocular mem- 
brane is likewise diffusely red and swollen, and very often cor- 
rugated into concentric folds around thecornea, presenting thecon- 
dition known as chemosis, which is due to a serous effusion into the 
sub-mucous tissue of the globe. In the severest cases the swelling 
of the lids is so great, that they “ appear as large tumors in front 
of the orbital opening,” though this swelling may. for the reason 139 
Ol’HTJl ALMIA NEONATORUM. 
previously given, be excessive even in the milder forms,—and. they 
glow with an erysipelatous blush. The conjunctiva is greatly thick- 
ened, looks hard and branny, and the chemosis is excessive. 
The discharge, which in the beginning may be thin and serous 
and somewhat scanty,speedily becomes purulent, and so profuse that 
on separating the lids it gushes in a stream down the cheek. Indeed, 
the pus is secreted with such rapidity in some of those cases, that 
it can actually be seen forming on the conjunctiva which had been 
cleansed a moment before It is often streaked with blood, and the 
turgid conjunctiva will bleed frequently at the slightest touch, but it 
is a matter of no significance as the hemorrhage will be promptly 
checked by a return of the lids to their proper position. There is 
apt to be fever, general as well as local, and the little patient suffers 
much from pain. 
In examining every case, mild or severe, a view should, if possi- 
ble, be obtained of the cornea, for upon its condition will depend 
the prognosis and, to some extent, the treatment ; but if it cannot 
be easily accomplished it is better to desist. Force should never be 
employed for three reasons; first, because it is not apt to accom- 
plish the purpose, owing to the redundancy of tissue and the con- 
traction of the orbicularis; secondly, because there is danger of 
emptying the globe if the cornea be already thinned by ulceration 
(such accidents have happened) : and thirdly, because the crying and 
struggling of the child will be likely to increase the congestion and 
aggravate the inflammation. 
It can, however, be safely done by gently lifting from the ball, 
and elevating the upper lid with a retractor, if the physician hap- 
pen to have such an instrument. Whenever the lids, and particu- 
larly the upper lid, is everted for the purpose of examination, or 
for receiving the application, it should be promptly returned with- 
out fail to its proper position, as there is a natural tendency to 
ectropium and it may remain permanently everted. I need not say 
that in all manipulations of the eye the utmost care and gentleness 
should be employed. 
The disease runs its course in from one to eight weeks according 
to the severity of the attack. In the milder forms it advances slowly, 
reaching >ts acme usually in a little less than a week ; but in the 
worst cases it may attain its height in two or three days and 
totally destroy the eye in that time. 140 
01'IITHAL.MIA NEONATORU M. 
The clanger to the eye consists in the liability to an extension of 
the inflammation to the cornea, and that liability usually bears a 
direct ratio to the amount of swelling of the ocular conjunctiva, 
or chemosis. The effusion into the sub-mucous cellular tissue com- 
presses the vessels which impinge upon the edge of the cornea and 
furnish it with nourishment, and upon the amount of this pressure, 
depends the character of the lesion in great part. If the calibre of 
the vessels be only partially diminished, it is probable that the 
corneal lesion will be a circumscribed infiltration, or a restricted 
ulceration ; while, if it be more or less completely obliterated there 
is apt to be sloughing of the cornea en masse. 
The prognosis under proper treatment, if the cornea be bright 
and clear and entirely unaffected at the time the case comes under 
care, is, I think I may safely say, almost invariably favorable. I 
say almost invariably, for I cannot altogether agree with Mr. Carter 
in his assertion that no case of ophthalmia neonatorum should ever 
end in loss of sight. 
The experience of other surgeons equally as distinguished, is that 
there are some rare cases, which are nearly always due to gon- 
orrhoeal infection ; that in spite of the most skillful treatment, rush 
on to destruction of the eye ; and while I have been very fortunate 
myself in never having met with one of these cases, nor having had 
one that has been under my care from the beginning which ended 
otherwise than in perfect recovery, I remember very well a case 
that I was once called to see in consultation with one of the ablest 
and best informed physicians of my acquaintance, in which, not- 
withstanding the employment by him from the commencement of 
the most approved treatment, there was ulceration of both corneae, 
quite extensive in one and resulting in the condition known as 
hydrophthalmos and complete loss of the eye. 
In this case the conjunctival inflammation was never excessive, 
and I attributed its untoward end chiefly to the weakly condition of 
the infant ; and that leads me to say that the prognosis will be mod- 
ified to some extent by the general health and strength of the 
patient. 
Now while the outlook is exceedingly bright and promising if the 
suitable treatment be used, it is very gloomy if the disease be neg- 
lected, as it so often is through the ignorance of parents or mid- OPHTH A L MIA N EON A TO HT M. 
141 
wives, in thinking it a trifling matter, and in relying upon “a 
little mother’s milk,” an alum curd,” or some such remedy until 
irreparable damage is done. 1 do not deny that a great many cases 
get well any way, but it is equally »s true that very many others 
eventuate in blii dness when the sight could have been saved ; and 
I feel it my duty to urge upon my readers the importance of im- 
pressing upon the mothers among their patien's, and the midwives 
of their acquaintance, the fact, that a running from the eyes of a 
new born child is not a trivial matter, be it ever so si ght, for there 
is no telling how s->on it may become severe, and also, that they 
should always promptly summ >n a physician. 
In the matter of treatment the first thing to be looked to, is the 
prevention of the disease. Upon referring to its causes we will at 
once realize that the most scrupulous attention to cleanliness in 
everything, and everybody about the child, will be most effective in 
this. If the parturient woman be known to have a vaginal dis- 
charge of any kind, and, more particularly, if she be the subject 
of gonorrhoea, the vagina should be well washed out by the injec- 
tion of warm alkaline water during the labor, and the child’s eyes 
should be washed first as soon after its debut upon the world’s stage 
as possible. The injections can do the mother no harm and 
they may be the very simple means of saving the eye-sight of her 
offspring. 
Great care should be observed on the part of both mother and 
nurse to see that their hands are always clean before they handle 
the baby, and that all sponges and cloths of every description used 
about it are pure, and untainted by foul matter of any sort. 
Care should be taken likewise to see that the room during the 
first week or two of the infant’s life, is kept moderately dark, and 
that its eyes are protected from such sudden changes from darkness 
to light, as may result, for example, from the opening and shutting 
of an outer door. This difficulty is chiefly encountered among the 
poorer classes, notably with us among the negroes who, for the most 
part live in cabins of a single room, and we should always see to 
it that a protecting screen of some sort is “rigged up,” or that the 
bed and cradle are placed behind the door. By this means too the 
mother and child are also shielded from dangerous draughts, but in 
shutting out the draughts and too much light, we must be on our 142 
OPHTHALMIA NEONATORUM. 
guard not to overdo it and exclude the proper amount of ventila- 
tion. When we call to mind the fact that the whole family, in 
many instances consisting of father,, mother, and a half-dozen or 
more children, occupy this one room, and that soap and water are- 
in great part strangers to their skins, we can appreciate the neces- 
sity for ventilation. 
Fortunately, however, for them, their dwellings are generally so 
full of cracks that the perfection of ventilation—“the admission 
of fresh air through numerous small openings,” is already arrived 
at. If the disease shall have attacked one eye we must endeavor to 
prevent its extension to the other ; though we very often fail in our 
efforts. The simplest plan is to place a little soft cotton over the 
eye, a piece of oil silk over that, and to secure the whole with a 
a bandage. This should be renewed once every day and the eye 
examined, and if there be no sign of inflammation it should be- 
replaced. 
As cleanliness is the most important thing in the prevention of 
the disease, so it is a sine qua non in the treatment after it is once 
established, as it seems to me any one on a moment’s reflection will 
admit, though it is by no means uncommon for physicians to pre- 
scribe a lotion, and probably a very good one, to be dropped into 
the eye, without saying a word about first removing the discharge. 
It is self-evident, that before any curative action can be expected 
from a remedial agent, the administration thereof must be made 
under such conditions as admit of the exercise of its peculiar heal- 
ing properties, and the condition essential to the advantageous em- 
ployment of local astringents, the class of remedies demanded by 
the disease under consideration, is, that they shall eomeinto imme- 
diate contact with the diseased tissue. Therefore in the proper 
treatment of ophthalmia neonatorum, when the discharge is at all 
profuse, it is absolutely necessary that it be removed before the 
topical application is made. This is usually done in one of these 
ways; either, with a soft camel's hair brush, or by allowing a 
stream of water to trickle into the eye from a sponge, or by wash- 
ing it out with a syringe. 
Some object to the syringe on the ground that there is danger in 
its careless use, of mechanically injuring the conjunctiva, and that 
the stream is apt to be jerky and at times is thrown with too much OPHTHALMIA NEONATORUM. 
143 
force. I think, myself, that it is not advisable to use any syringe 
that ca not be manipulated with one hand, nor one that does not 
work very easily, but there can be no objection to a rubber ball 
syringe, the simplest form of which is seen in the ordinary drop* 
tube that ought to be in every drug store, and which answers the 
purpose admirably. With that little instrument and the most ordi- 
nary care, the eye can be safely, quickly and efficiently cleansed, 
and I much prefer it to any other method, though I am in the habit 
of supplementing it with the camel’s hairbrush to remove any frag- 
ments that obstinately adhere. 
It is always best for the physician to cleanse the eyes and make 
the application himself whenever he makes his visits, so as to in- 
struct the nurse, and to be sure that it is, at least occasionally, 
properly done. 
The simplest way in detail of doing this is as follows : Having 
spread a towel over his knees, let him place the child across his lap 
on the side of the eye that is to be washed, with a sponge or soft 
bit of rag under the temple to catch the water and discharge. 
Then, having tenderly separated the lids with the fingers of his 
left hand, let him inject a slow, steady stream of water or some 
astringent lotion into the inner corner of the eye, so that it must 
pass over the whole diseased surface before it makes its escape on 
the rag at the outer canthus. 
lie should be very careful that none of it rebounds into his own 
eye, as the discharge is exceedingly contagious, and he might in 
that way contract the disease himself. The syringing should be 
kept up until the eye is clean or nearly so, when, as above inti- 
mated, it may be supplemented with the brush. 
This cleansing process ought to be repeated just as often as the 
eye becomes filled with the discharge, but as a nurse is more apt to 
carry out definite directions that demand no excerciseof judgment 
(a quality totally lacking in many) on her part, it is safest always 
for the physician to decide himself how often it is necessary, and to 
direct that it be done at regular intervals, long or short, as the case 
be mild or severe, from every four hours to every ten or fifteen 
minutes during the day, and not quite so often during the night. 
Almost any astringent will serve a good purpose in the treatment 
of this affection, but those most commonly employed, are the 144 
O PHTIt A LMIA X EO N ATO R V M. 
nitrate of silver, sulphate and acetate of zinc, alum, acetate of 
lead and tannic acid. 
Of these, the best in the estimation of oculists generally, and 
certainly in my own opinion, is the nitrate of silver. The acetate 
of lead is an excellent remedy if the cornea be intact, but owing to 
its liability to undergo chemical decomposition and to become 
deposited upon the abraded surface, if the cornea happen to be 
ulcerated, in the form of the insoluble carbonate, producing a 
permanent opacity, it is best, as a rule, to omit it. 
If I were called on to defineexactly the treatment I would specially 
recommend, 1 should say this : Cleanse the eyes in the manner above 
described with a lotion composed of sulphate of zinc one gram, 
alum three grains, water one ounce, which, by the way, is the 
favorite remedy of the Surgeons of the Royal Ophthalnrc Hospital 
•of London, just as often as the accumulation of discharge demands, 
and every 12, 8, 6, or 4 hours, according to the severity of the case, 
instil into the eye a drop or two of a solution of nitrate of silver of 
the strength of two grains to the ounce of water. 
Under this treatment, if promptly undertaken and faithfully 
carried out, I am confident that very few cases would fail to recover 
completely. 
In the very mildest form it is generally sufficient to drop into the 
eyes a little of a weak solution of sulphate of zinc, gr. i—lj. to the 
ounce, two or three times a day. In the worst case*, where the 
swelling and chemosis are excessive and more or less tense in char- 
acter with a scanty serous discharge and fever, it is well to use cold 
compresses to the closed lids, if their proper application can be as- 
sured; but if not, it is best to omit them, as improperly applied they 
do more harm than good. When obtainable, it is preferable to have a 
block of ice at hand, with several pieces of lint or soft folded linen 
lying on it, so that,as soon as the piece on the eye becomes in the least 
warm, it can be immediately replaced with a fresh one ; and when 
the inflammation runs very high this will have to be done every 
three or four minutes—hence the difficulty of having it well done. 
If ice cannot be had the coldest water available will answer. The 
compresses should be kept up for at least a half hour at a time, and 
repeated several times during the day and night. 
In the earliest stage when the swelling is very great and tense and OPHTHALMIA NEONATORUM. 
145 
the discharge is thin and scanty only the weakest astringents are 
admissible, but as soon as the swelling subsides somewhat, as will 
appear from a slight wrinkling of the skin of the upper lid, and the 
conjunctiva becomes a little relaxed, and the discharge purulent 
and profuse, it is well, in addition to the faithful use of the zinc 
and alum lotion and the weak solution of silver, if that fails to 
check the disease, to apply, once a day, with a camel’s hair pencil, 
to the inner surfaces of the everted lids, a little of a solution of 
nitrate of silver of the strength of ten grains to the ounce, pro- 
vided its effect is partially neutralized in a fewr seconds, and before 
the lids are returned to their natural position in contact with the 
globe, with a solution of common salt applied with another brush. 
It is sometimes advisable in these cases to scarify the swollen and 
chemotie conjunctiva—it relieves pressure, and the local depletion 
is often of benefit, but it should always be done after the applica- 
tion of the strong silver, for if done before, the caustic may go too 
deep in its action. 
If the cornea become involved, the only change in treatment indi- 
cated is the addition to the other remedies of atropia, or belladonna 
in some form. The liquefied extract may be painted over the lids 
and around the eye, or better, a drop of a two grain to the ounce 
solution of the neutral sulphate may be instilled twice or three 
times in the twenty-four hours; but remembering the highly pois- 
onous character of the drug, and the tender age of the patient, it 
is important to keep a sharp lookout for any constitutional symp 
tom (dryness of the throat, flushing of the face, feverishm ss, &c.,) 
and immediately upon their appearance discontinue it for a time. 
If the disease show a tendency to become chronic it is often of 
advantage to vary the astringent, as any remedy when long con- 
tinued is apt to lose some of its virtues, or best of all, if it be pos- 
sible, to order a change of climate. 
I recall a case I had when living in Savannah, which, having ob- 
stinately resisted the most conscientious treatment with almost 
every known astringent for several weeks, wras finally cured by a 
weak collyriuin of zinc and two or three days at sea. 
It is probable, as I have communicated nothing specially new or 
original in wdiat I have had to say, that I have proven tedious to 
some of my readers, but, inasmuch as the text-books on the diseases 146 
OPHTHALMIA NEONATORUM.. 
of the eye ;ire in the hands of comparatively few of the general 
profession, and as this most important disease is not considered at 
all in some of the standard works on general surgery, midwifery, 
and diseases of children, it is not unlikely, I trust, that I have 
succeeded in giving a useful hint to others, and if I shall have been 
the means, indirectly though it be, of saving the sight of one of my 
fellow creatures I shall feel more than repaid. ERRATA—(Dr. Lewis’ Paper. 
On page 135—14th line from the top, “this” instead of their. 
“ 139—3rd “ “ “ “branny” instead of brawny. 
“ 141—20th “ “ “ “first” instead of just. 
“ 142—14th “ “ “ “renewed” instead of removed. 
“ 142—7th “ “ bottom “these” instead of three.