THE CARE OF EYES IN INSTITUTIONS FOR CHILDREN-FOURTEEN 
YEARS’ EXPERIENCE IN HOSPITALS AND HOMES 
FOR CHILDREN. 
WITH DISCUSSION. 
BY WILLIAM S. LITTLE, A.M., M.D., 
Chief Clinical Assistant Eye Department, Jefferson Medical College Hospital; Ophthalmic and Aural 
Surgeon, Church Home for Children. 
Read before the Philadelphia County Medical Society, June 23d, 1886. 
The number of hospitals and homes estab- 
lished in large cities and dispersed through 
country regions exhibits the aid that State, 
denominational, general and individual charity 
dispenses to juvenile life that demands its sup- 
port. While the question may be raised, whether 
adult life in ill health and poverty is always 
worthy of the aid that is so largely granted by 
the various charities in existence ; deserted and 
unsupported child life always demands a gener- 
osity that can never be lightly considered or 
withheld. Along with the aggregation of so 
many dependent lives in asylums is associated 
the responsibility of protection until they are 
able to care for themselves. Preventive medi- 
cine has no better field in which to work, than 
affording a safe-conduct to these children, whose 
health depends on the sanitary condition of the 
buildings they inhabit, the kind of food they 
receive, the protection from and proper treat- 
ment of disease occurring among them, or 
possible to be introduced from those continu- 
ously admitted, generally from among unhealthy 
surroundings and in a poor state of health. 
While appreciating the necessity of the exclu- 
sion of all communicable diseases, and the 
effects of epidemics that impair or destroy life, 
attention at this time is directed to the possible 
dangers to vision from communicable eye dis- 
ease in institutions for children—a disease not 
required to be reported to Boards of Health, or 
restricted by any law. Despite all the protec- 
tion that is thrown around the inmates of these 
homes, abuses arise which the State authorities 
and medical effort endeavor to combat; as has 
been illustrated in our own State quite recently 
by the former, aqd as has been exhibited by the 
latter, not long since, by the report of a com- 
mittee appointed by the New York Academy 
of Medicine to investigate the presence of con- 
tagious ophthalmia in the asylums and residential 
homes in that State. The results obtained by this 
committee have led me to introduce this topic 
before the Society. 
In 1878, Dr. R. H. Derby, of New York 
City, began, in an individual way, to investi- 
gate the subject, and presented, in October, 
1884, a report for the Committee of Hygiene of 
the county society, based on an examination of 
three asylums. He read, in June, 1885, a paper 
before the New York Academy of Medicine, on 
“ Contagious Ophthalmia in Asylums and Resi- 
dential Homes,” based on the results obtained 
from an examination made in twenty-four asy- 
lums, finding contagious ophthalmia present to 
the extent of 19.19 per cent., one out of five. A 
committee from the Academy of Medicine was 
appointed * to inquire further as to the presence 
of contagious ophthalmia in asylums and resi- 
dential homes, and suggest remedies for it. 
The committee consisted of Dr. C. R. Agnew, 
Dr. C. S. Bull, Dr. David Webster, Dr. Richard 
H. Derby (chairman), Dr. A. Jacobi; associate 
members, Dr. E. L. Oatman, Nyack, N. Y.; 
Dr. C. S. Merrill, Albany, N. Y.; Dr. John J. 
Milhau, of State Board of Charities ; Arthur G. 
Sedgwick, Esq., of State Charities Aid Asso- 
ciation ; Elbridge T. Gerry, Esq., President of 
Society for the Prevention of Cruelty to Children; 
James Gallatin, Esq., President of New York 
Association for Improving the Condition of the 
Poor. Sanitary experts from the Board of 
Reprinted from The Polyclinic, July, 1886. 
* June 23d, 1885, 
1 2 
Health acted with them, and twenty-four oph- 
thalmic surgeons assisted in making the inves- 
tigation. Fifty-one institutions are included in 
the report * of the committee, made January 7th, 
1886, to the Academy of Medicine. The pro- 
posed Act for the better preservation of the 
health of children in institutions, together 
with a statement in regard to the prevalence 
of ophthalmia in such institutions, was intro- 
duced into the legislature of the State of New 
York, February 4th, 1886, and the Act now 
awaits the Governor’s signature. The fifty-one 
institutions contained 12,684 children; of these, 
3862—thirty per cent.—had contagious oph- 
thalmia. 
Mr. William B. Wait, Superintendent of the 
New York Institution for the Blind, under date 
of January 27th, 1886, informed the committee 
that, in the past few years, thirty-nine cases of 
blindness had been received from eleven of 
these institutions; principally from three of 
them. 
It is not now proposed to describe fully con- 
tagious ophthalmia, or give the treatment, but 
rather to show how to prevent its introduction 
among inmates of an asylum, or, if it arises, 
how to control it. To draw the line at which 
a case of conjunctivitis becomes contagious is 
not easy; so much depends on the state 
of the whole conjunctival sac, whether hyper- 
aemic or already irritable; the general state 
of health is an important factor; whether the 
child has any dyscrasia; also, whether the 
sanitary surroundings are good, and no 
vitiated air inhaled. This is so in a given 
case, or among those exposed to a conjunc- 
tivitis, whether contagious or not, or when 
exposed to material that will develop it in 
an unhealthy conjunctiva. All states of the 
tissue that afford a hot-bed for contagion 
should be recognized and treated; such pre- 
cautions will do much to prevent the spread of 
contagion. 
With very young children, who are depend- 
ent on others to perform the ablutions of the 
body, and who cannot express the sense of pain 
or locate trouble, except by cries, the danger is 
the greatest; they require the services of re- 
sponsible, careful nurses, and need inspection 
by the physician oftener than other children. 
Neglect to use clean water and separate towels 
for each child is a most essential factor in 
the propagation of an ophthalmia. Older 
children, who can care for themselves in this 
respect, do not run so great risk, for they soon 
learn cleanly habits, if taught, and protect 
themselves, and can call attention to their 
trouble; they also do better if a responsible 
person is present when they wash their faces 
and bodies, to see that no indiscriminate use 
of water and towels occurs. The freedom large 
boarding schools have from ophthalmia illus- 
trates the advantage of individual and separate 
ablutions of the body. The inside of the lower 
eyelid will be fjpund, with a great many people, 
to be in a constantly irritated state, without se- 
cretion, the other portion of the conjunctiva 
normal; very like the mucous membrane of 
the posterior nares, is found to be, and is con- 
sidered a normal state, or an American peculi- 
arity. These are the cases that take on a 
catarrhal, or other inflammation, most easily, 
and afford the best condition for a contagious 
ophthalmia to feed on ; they need to be relieved 
by treatment, and watched, so that no further 
advance takes place. These cases may not 
need isolation, and are not dangerous, but if a 
secretion is associated with this state of the tissue, 
isolation and treatment till relieved, is the better 
plan in a crowded asylum for children. Phlyc- 
tenular conjunctivitis or keratitis can hardly 
be considered contagious, but is rather due to 
bad health, poor sanitary surroundings and 
ocular strain. It readily takes on a serious 
character, and needs constitutional and local 
treatment; the neglected conjunctivitis may 
take on a contagious condition. Tinea tarsi 
is to be looked after, or else becomes very 
troublesome, causing excoriated lid surface and 
distortion of the lid ; and pediculi, if allowed 
to exist on the person, may attack the part; isola- 
tion in such cases is necessary. Are granular 
lids contagious ? Such is not my experience 
among institutions or among families where it 
exists ; the neglected form, in which in addition 
to granulations, a chronic conjunctivitis is added, 
with constant secretion, associated with poor 
health, bad food and poor sanitary surround- 
ings, such a case may produce a contagious 
ophthalmia among others, if allowed to mingle 
among them, and use the same wash basins 
and towels, and sleep with others, vitiating the 
atmosphere and spreading the disease among 
already irritable conjunctivae ; it is not the con- 
* See Mew York Medical Record, February 13th, x886. 3 
tagion from the self-developed granule which 
is the cause, but the neglected chronic con- 
junctivitis associated with it. Diphtheritic con- 
junctivitis is rare; the constitutional symp- 
toms are so severe that medical aid would 
be called for; danger from this element is 
evaded by isolation, and correcting unsanitary 
surroundings ; it requires special knowledge in 
the care of the eyes to prevent the violent in- 
flammation from destroying the sight, and also 
the careful treatment that diphtheria demands. 
It has never developed in any of the insti- 
tutions with which I have been connected, 
but I have seen it, rarely, in consultation and 
private practice, and in the eye clinic. The 
high moral tone that should surround an 
asylum for children, is a barrier to any specific 
ophthalmia. The selection of those that care 
for the children is very important, and they 
should have their own lavatories and sleeping 
apartments, separate from the children. A night 
nurse should be on duty. Dr. R. H. Derby, in 
his article on “ Contagious Ophthalmia,” * 
quotes the description of the disease from 
Graefe and Saemisch, Vol. x, pp. 76 to 79, 
adding much to it from his own experience, and 
I would refer you to that article for a full de- 
scription. He says, “ It passes for a catarrhal 
affection of the eyes, and as such is treated ; or 
it exists, and this is often the case, without re- 
ceiving any medical treatment whatever.” Also, 
“ among them were those where the true 
granulations, the so-called trachoma of Arlt, 
were present; others that might be more prop- 
erly described as chronic conjunctival blennor- 
rhoea. In some the affection had extended to 
the cornea, producing pannus, and in certain 
cases, corneal ulceration had been followed by 
prolapse of the iris and adhesion. The secre- 
tion is contagious. In striking illustration of the 
communicability of the disease, it was often 
noticed that when a pronounced case was 
found, a group of children presented themselves 
in succession with the same trouble, and these 
were children who habitually occupied adjacent 
seats.” 
In the statement prepared by the committee 
of the Academy of Medicine,f the following 
sentence occurs: “ One peculiarity of the 
disease is that it may exist for months, and 
even years, in eyes which to the lay attendant, 
and even by the patient afflicted with it, have 
been thought to be perfectly healthy.” Else- 
where Dr. Andrews says: ‘‘But the majority 
of the cases of contagious eye disease in this 
and kindred institutions show no sign of eye 
trouble to a casual observer, and the disease is 
evident only when the lids are everted.” Con- 
tagious ophthalmia is a chronic conjunctival 
blennorrhcea, its secretion contagious, and dis- 
seminated in various states and ways ; power- 
ful and persistent to set up an ophthalmia in the 
conjunctiva with which it may come in contact, 
after developing de novo in a case from unhealthy 
surroundings and conditions ; its virulence de- 
pends on its strength, but may be variable, 
as a person is susceptible, or different conditions 
of the conjunctiva are present, and the state of 
health and surroundings vitiated. The charac- 
teristics of the tissue and the secretion need to 
be studied under the microscope. It acts like 
the secretion from a case of gleet, or the low 
types of inflammation any mucous membrane 
may assume. As far as the welfare of those 
we are now considering is concerned, it should 
be excluded, early recognized and rapidly ex- 
terminated. 
This much for what contagious ophthalmia 
is, the difficulties of recognizing it, the import- 
ance of frequent inspections of the eyes of 
children in “ homes,” and the danger it affords 
to the organs of vision. The importance of the 
subject warrants my intruding my experience 
in caring for the eyes of children upon you 
at this time ; the length of service and the 
good results obtained by carrying out strictly 
laws of prevention, and abiding by a sanitary 
and hygienic system, enables me to show how 
an institution, without medical legislation, has 
been conducted, by a Board of Directors and 
Lady Managers, who have been most untiring in 
their efforts to provide a model home for child 
life. The services of the medical staff have been 
much lightened by the condition and conduct 
of affairs in and about the institution. I refer 
principally to the Church Home for Children, 
Philadelphia, where I have been on duty for 
ten years. My service in hospitals and homes 
for children dates from 1872 ; in addition to the 
general medical service, I have had the care 
of the eyes and ears placed in my hands ; the 
importance of looking after the ears of the very 
young should not be overlooked, and demand 
* New York Medical Record, June 13th, 1885 
f See New York Medical Record, February 13th, 1886. 4 
the same inspection and care as the eyes; 
the difficulty of the examination calls for 
some expertness. My first service was as 
assistant resident physician to the Infants’ Hos- 
pital, Randall’s Island, New York, in 1872; here 
three hundred infants under three years of age 
were cared for; the wards were open to the 
foundlings of the city, mother and child, from 
the maternity wards of Charity and Bellevue 
Hospitals, that were homeless, and to the 
neglected mother and child of the city and 
county of New York. The sources of danger 
from contagious ophthalmia were as numerous 
as could be looked for, as immediate aid had to 
be granted. A reception ward took the place 
of a quarantine building, so that promiscuous 
accession to the numerous wards was prevented. 
No epidemic occurred during my service of a 
year, nor was blindness the result of any oph- 
thalmia. The death rate for the year was 
eighteen per cent. In 1873 I became one of 
the resident physicians to the Institution for 
Idiotic, Paralytic and Epileptic Children, and to 
the Nursery Hospital and Nurseries on Ran- 
dall’s Island. Some twelve hundred children 
were here cared for. The class of children be- 
longed to the element that the State is given to 
aiding. A quarantine building was provided 
and strictly kept. An eye ward existed in the 
Hospital and contained a number of cases that 
showed what contagious ophthalmia could 
accomplish; they came from this and other 
institutions; from the homes where they could 
not be cared for. It is not only in institutions 
that the disease is propagated ; the homes in the 
slums of a large city, where child life is neglect- 
ed, are hot-beds of it, and every eye clinic has 
it to contend with; such cases are apt to be 
shifted from institution to institution, till they 
reach the place of last resort. Perhaps my 
observation of these cases has stimulated me 
in the precautions I have always exercised in 
guarding the institution I was then in, and 
have been connected with since, against pos- 
sible contagion from this source. During my 
service only one eye was lost, and that was due 
to a constitutional taint, and occurred despite 
all medical and surgical relief. No epidemic 
of contagious ophthalmia arose during my 
service of a year; inspections were frequent, 
and the bathing rooms carefully looked after. 
The Commissioners of Charities and Correction 
were very zealous in providing for the wants of 
the children, and granted all requisitions. For 
a long time an ophthalmic surgeon has been 
on the visiting staff, and this institution does 
not appear in the list from which the statistics 
of the Committee on Contagious Ophthalmia 
are derived. 
In 1875 my service commenced as one 
of the visiting physicians to the Educational 
Home in West Philadelphia, a branch of the 
Lincoln Institute. Boys were here received, and 
one hundred accommodated. The strict laws 
as to admission (no one entered without a clean 
bill of health), the good habitation, liberal diet, 
and fine sanitary surroundings, always remedied 
when found defective, gave the staff little to do. 
Special care was taken of the bathing room, 
the cleanliness of the towels and basins. The 
boys were under constant surveillance. No epi- 
demic of contagious ophthalmia occurred dur- 
ing my service of several years, nor did blind- 
ness occur to any. Indian boys now occupy 
the Home, and an examination as to how their 
eyes are, now would be very instructive, as their 
manner of life varies so from that they former- 
ly exercised. In 1876 I was appointed one of 
the visiting physicians to the Church Home for 
children, at Angora, Philadelphia, and for the 
past few years, have been the ophthalmic and 
aural surgeon. It has been established thirty 
years. Here girls are principally cared for. 
The Board of Directors have given most careful 
consideration to the construction of the build- 
ing, and to all sanitary matters; the Lady 
Managers are most faithful in caring for the 
management of the Home. A judicious selec- 
tion is made in obtaining officers and servants 
for the care of the children. Since 1876 three 
hundred and eleven children have been cared 
for; at present there are eighty-nine inmates. 
Six deaths have occurred in the ten years; 
none during the past four years. Many of 
the children have been under observation for 
nearly the whole time, and more for a long 
period. The children are given over to the 
Home till eighteen years of age; an opportunity 
has thus been afforded to study the danger 
children so long resident in an asylum are ex- 
posed to; as dismissals occur, new ones come 
in to keep up the number. My duties as oph- 
thalmic and aural surgeon have been light, and 
no claim is made for personal service by the 
medical staff in obtaining the results of a recent 
examination, beyond the strict adherence to 5 
the By-laws, which say, " Every child must 
have been recently vaccinated, and, also, must 
pass a medical examination by the physician 
on duty at the time of admission.” Any case 
falling short of the medical examination is 
treated outside, and not allowed admission till 
well. A hospital ward exists, where all cases 
of illness are treated, and an extra ward for 
cases needing isolation. The sanitation is per- 
fect ; so much so that I can safely say it is an 
institution without a smell. The location is 
suburban. The bath rooms and wash rooms 
are especially well adapted for children ; foot- 
baths are placed in the flooring, clean basins, 
clean towels, are daily supplied, and a towel 
assigned to each child that has any disorder of 
skin or eye. A nurse superintends the bath 
rooms, and assists the children in washing. 
The food is of the best. Air space in school 
rooms and dormitories above the standard (six 
hundred cubic feet of air to each child, the 
lowest limit allowed). Each child has a bed 
to itself. The playground is large; no well 
water on the grounds. The visiting staff of 
physicians divide the work of inspection and 
medical care of the children during the year. 
Children with optical defects are provided with 
spectacles. A school is established in the 
Home. Since the appearance of the report of the 
Committee on Contagious Ophthalmia in New 
York, a thorough examination has been made 
of the children’s eyes, everting the upper lid 
and examining the conjunctiva carefully. 
Eighty-nine cases were inspected, with the fol- 
lowing result:— 
The whole conjunctival tissue normal 
in 49 cases. 
Inside lower lid congested, with no 
secretion, in . . . .31 cases. 
(These cases may be considered 
normal, but would afford a condi- 
tion for an epidemic to feed on.) 
Inside of both lids hyperaemic, no 
secretion. Optical defect present in 6 cases. 
Granular lids, no chronic conjunctivi- 
tis, upper lid, one eye, no secretion, 
slight pannus, . . . . 1 case. 
Phlyctenular conjunctivitis in . 1 case. 
Catarrhal conjunctivitis, secretion one 
eye, in 1 case. 
89 
One case was found, with a corneal opacity 
from former inflammation ; none existing now. 
No c hronic conjunctival blennorrhcea was found. 
No tinea tarsi was present. Blepharitis mar- 
ginalis in one case. No eye has been damaged 
or lost during the past ten years. The thirty- 
one cases with congested lower lid were practi- 
cally normal, as they exhibited the tendency of 
that part of the tissue existing among so many 
people, and had no secretion associated with it.* 
The result of the ocular examination corres- 
ponds well, with the general health of the 
children, under the care of the visiting phy- 
sicians, no death having occurred in four years. 
I am perfectly well aware that this Home has 
fewer numbers than many, and is not subjected 
to the immediate admission of children by 
order of the courts, or the homeless waifs of the 
city, but the same care that is exercised could 
protect many more, as well. The proposed Act 
before the Legislature of New York contains 
all the features that have been carried out at 
the Church Home, with such good results, and 
it affords an opportunity to give an example 
that shows the wisdom of seeking medical 
legislation for juvenile life in Homes, when 
such efforts are not attempted without it. Phila- 
delphia has thirty-seven Homes for children.! 
Are they all in a good sanitary state ? Does 
our blind asylum receive many cases from 
them ? I have preferred to call the attention of 
this Society to the subject of contagious oph- 
thalmia, by showing the results in an institu- 
tion in which the management, while desiring to 
be charitable to unprotected children, throws 
around them, without medical legislation, all 
that sanitary science and preventive medicine 
can do, to carry them through to a period of life 
when, in good bodily health, they can support 
themselves. It has been attempted in this way, 
rather than, without authority, to have made 
an examination of Homes, of the laws of which 
I was ignorant, and possibly have presented a 
deplorable state of things. Will our children’s 
asylums make as bad a showing as those in 
New York have done ? I venture to say, they 
will not. Conjunctival disease is not so frequent 
here, in the eye hospital, or in private practice, 
as in New York. Would it be well for this 
Society to know just what state of things, in this 
♦Two cases of otitis externa are now under treatment, 
f Six hospitals are established. 6 
respect, exists among these Homes, and if found 
to be present, and danger of blindness facing 
the inmates of them, to correct it, either by 
medical legislation, or by a better attention to 
sanitary and hygienic laws ? The managers of 
all such institutions must certainly desire it, for 
the welfare of their wards. Should not these 
institutions have an ophthalmic and aural 
surgeon on their staff of physicians ? Would 
it be going too far for boards of health to 
include contagious ophthalmia in the list of 
those diseases that are required to be reported, 
for the safety of the public ? The danger is as 
great outside of these institutions, as in them. 
These suggestions I submit to your considera- 
tion, based on the results that have been pre- 
sented to you, from several years’ experience 
in hospitals and homes for children. 
number of cases of contagious chronic purulent oph- 
thalmia, with or without trachomatous granulations, 
which, so far as prophylaxis prognosis and treatment 
are concerned, may be considered practically as be- 
longing to the same class. 
There is another form of ophthalmia which belongs 
to the class of ordinary catairhal conjunctivitis, the 
contagiousness of which is often not sufficiently im- 
pressed upon those having charge of such cases. This 
is the form popularly known as “ pink eye.” I have 
known this to be communicated by contagion from 
want of proper precautions, particularly at boarding 
school. Epidemic influence is properly considered 
the chief factor in the spread of this disease, but so 
long as there is any doubt about its contagiousness, 
patients should have the full benefit of it. In practice, 
it is safest not to make fine distinctions, but to treat 
all inflammations of the eye with discharge as con- 
tagious. 
Dr. Samuel D. Risley.—I was much impressed 
by the importance of one of Dr. Little’s concluding 
statements—that relating to the frequency and equal 
importance of so-called contagious ophthalmia outside 
of public charities. I would ask Dr. Little if he had 
kept any record of the percentage of applicants for 
admission rejected for this cause. Such a record 
would be both interesting and important, as throwing 
some light upon the importance of contagion as a 
factor in the aetiology of this disease. It has been my 
conviction for a long time that, while contagion is an 
important factor in the spread of the disease, it is 
by no means the only or most important source. It 
seems to me that its relation to these institutions has 
been exaggerated in some degree. I have had no 
direct experience, based upon official relations with 
these public charities, but forming my opinion from 
observation at the University Hospital Eye Clinic, I 
should say that children in the same walks of life, and 
subjected to like conditions of health, are equally 
liable to the disease, and that without the massing in 
one building. I fear too little attention is often paid 
to the personal equation. An acute catarrh, from irri- 
tation or cold, taking in a vigorous individual gets well 
in a few hours without treatment, whereas in feeble 
individuals,especially those from among the neglected, 
friendless, and badly-fed class from which our child- 
ren’s asylums are filled, the inflammation persists, and 
often, in spite of well-devised treatment, we have pre- 
sented the chronic contagious form of the disease ; 
certainly contagious for others in like condition of 
health. Dr. Little’s reference to the Indian children 
calls to mind that quite a large group of these boys 
has been at the University Dispensary service suffer- 
ing from trachoma. They have, without exception, 
been in poor health, and probably feeling the climatic 
DISCUSSION ON DR. LITTLE’S PAPER. 
Dr. George C. Harlan.—To illustrate the im- 
portance of what has been said, I will state that some 
years ago I made a careful examination of the in- 
mates of the Pennsylvania Institution for the Blind, 
and found that, out of 167 inmates, in one-third the 
blindness was due to purulent ophthalmia. This sub- 
ject has received considerable attention since then, and 
I do not think that these figures would now apply. 
This is not, however, an entirely reliable indication of 
the frequency of the disease, for in a large proportion 
of cases the patients receive competent treatment, 
which prevents the affection from resulting in com- 
plete blindness. 
I would like to know if Dr. Little’s observations 
tend to show that this chronic form of purulent oph- 
thalmia may, under bad hygienic surroundings, arise 
de novo, or that contagion is the only cause ? There 
is no doubt that contagion is the chief and most im- 
portant cause, and that the necessity of careful isola- 
tion cannot be too strongly urged. 
The speaker has referred to the question of granular 
ophthalmia. Exactly what is meant by this term, 
even after many years of discussion, is not always 
entirely clear. Arlt, in his clinical studies, recently 
translated, does not consider granular conjunctivitis, or 
trachoma, as a special disease, but merely a complica- 
tion of what he terms conjunctival blennorrhoea. He 
describes the latter affection as an inflammation of the 
conjunctiva with a muco-purulent discharge and fibro- 
plastic infiltration of the tissues of the lid. In com- 
paring a case of acute purulent ophthalmia, gonor- 
rhoeal, for instance, with one of granular trachoma, it 
seems to me difficult to consider them one and the 
same disease. At the sajne time, there is a large 7 
change to which they were subjected. They were 
badly nourished, tissues flabby, and were evidently 
out of sorts. In several cases, indolent ulcers of the 
cornea were associated with the conjunctival disease. 
There was in these cases another factor which may 
have been of some importance. They were highly 
hypermetropic, and had been subjected to the eye- 
strain of the educational process in the institution. 
The fact that this form of disease is so rare in private 
practice would seem to point to the important relation 
existing between this inflammation of the conjunctiva 
and the depressing influences surrounding the abject 
poor, from which class the disease is so largely re- 
cruited. 
The depressing influence of the disease itself should 
not, however, be overlooked. I am sure we have all 
repeatedly seen the health go down under the dis- 
couraging circumstances of chronic granular lids with 
vascular cornea following acute purulent ophthalmia. 
Dr. C. S. Turnbull.—I agree with Dr. Little in 
every respect. The proper way to prevent this affec- 
tion is by thorough inspection of the children before 
admission. 
My experience has been chiefly in the Catholic 
homes for children in this city. There the manage- 
ment cannot select the children, and it has been 
almost a hopeless task to stamp out the disease, which 
is almost a scourge. I have preferred to call this 
form of conjunctivitis “asylum ” or contagious tracho- 
matous ophthalmia. I am satisfied that the origin of 
the acute form of the disease is invariably inoculation 
with virulent pus. In St. Joseph’s Orphan Asylum, 
where they have 400 children, a “ sore-eyed child ” 
was admitted against the remonstrances of the Mother 
Superior, and in ten days 49 children had the dis- 
ease. They were quarantined on the top floor, and 
the Mother Superior and one of the Sisters devoted 
themselves to their care. They also contracted the 
disease, but by prompt treatment and unceasing 
vigilance all recovered. Three days after the sore- 
eyed child was admitted, several of the children were 
sent to the branch asylum in Germantown, and about 
one-half of the children in that institution contracted 
the disease. 
I have had no experience with Indian children 
brought East, but I have seen the disease in adult 
Indians, when I was West, with Prof. Hayden, in 
1874. I found trachomatous conjunctivitis of the 
dry form quite prevalent. It was attributed to the 
fact of their spending so much of their time in the 
smoke of their “ teepes.” 
The duration of true chronic “ asylum ” or con- 
tagious trachomatous conjunctivitis is at least three 
years. That is, within this time I consider there is 
danger of communicating the disease. 
With regard to treatment, I have found in the acute 
stage a solution of corrosive sublimate, one to six or 
eight thousand, with vaseline at bedtime, to anoint 
the lids and keep them from sticking, the best plan, 
and one to be recommended. In the chronic stage, 
to remove the hypertrophy of the Meibomian follicles, 
I use daily applications of sulphate of copper, which 
treatment, however, will be comparatively useless 
unless the lids be kept inverted until the excess of 
copper has been thoroughly washed off with cold 
water. 
Dr. B. Alexander Randall.—I agree with the 
statement that this disease is as common outside of 
asylums as within them. The personal equation as to 
the health of the individual is a most important mat- 
ter, as stated. These disorders are more or less 
preventable, and it is for this reason that this is an 
especially important matter in connection with asylums, 
where prevention is possible, and therefore imperative. 
Almost all these cases begin as acute affections. 
There is one point which has been barely alluded to. 
It is well known that the most important cause of 
this affection in new-born infants is the irritation from 
a vaginal secretion of the mother. Even in older 
children, such as fill these asylums, it is possible to 
have inoculation in a similar way, as they are rather 
prone to a sort of leucorrhoea. 
Reference has been casually made to discharging 
ears in this report. That there may be a casual con- 
nection here, cannot, I think, be too strongly insisted 
upon. In illustration, I will briefly allude to a case 
in the Children’s Hospital, in which a weak and 
anaemic nurse, in syringing a mastoid abscess, received 
a drop of pus in the eye. This was followed in ten 
hours by the occurrence of inflammation, which as- 
sumed the form of severe acute purulent ophthalmia. 
The case passed on to one of granular lids, but ulti- 
mately recovered. Other causes for the inflammation 
could not be absolutely excluded; but the evidence, 
positive and negative, indicated that the aural dis- 
charge was the cause. 
Dr. George C. Harlan.— Dr. Randall’s case is 
extremely important, if the connection with the mas- 
toid abscess can be completely made out, by vigorous 
exclusion of all other possible causes. We frequently 
have the conjunctiva exposed to the action of pus 
without blennorrhoeal ophthalmia following. The 
general opinion is that there is something specific 
in the discharge of conjunctival blennorrhoea. 
Dr. W. M. Welch.—I may allude to my experi- 
ence in the Northern Home for Friendless Children, 
with which institute I became connected in 1865, as 
attending physician, and served as such for eighteen 
years. The institution was always crowded, and it 
was difficult to convince the lady managers of the 8 
great importance of care in regard to admissions. As 
a result, contagious skin diseases and eye affections 
frequently found their way into the Home. Of these 
affections none were more common than purulent 
ophthalmia. During the earlier years of my service, 
I frequently saw in the course of a three months’ term 
one hundred or more such cases. Granular lids were 
also quite common. 
I have no question as to the contagious nature of 
the affection. It seemed to attack in preference chil- 
dren of broken health, and especially those of a 
strumous diathesis. Some years later, additional 
ground was secured, which was used as a playground, 
this gave the children more out of-door exercise, and 
enabled the building to be better ventilated. As a 
result, the general health of the children improved, 
and this form of ophthalmia disappeared. 
Dr. James W. Walk.—I have had three years’ 
experience with this affection in the institution re- 
ferred to by Dr. Welch. During my service a num- 
ber of children were admitted with what is popularly 
termed “ sore eyes.” The majority of children dur- 
ing their stay in the House had more or less inflam- 
matory trouble with the conjunctiva. They seem to 
outgrow their susceptibility to it. Those who had it 
when young, escaped it at a later period of life. New 
children were attacked, while the older ones escaped. 
We were in the habit of treating the disease in a 
somewhat routine manner, with a solution which I 
have not heard mentioned elsewhere. It was pre- 
pared as follows:— 
by an increase in the quantity of meat, and the epi- 
demic was averted. 
I believe that at the present time there is very little 
of the disease present in the institution. I know of 
only two cases in which blindness resulted, and in 
one of those the blindness is only partial. 
Dr. William S. Little.—I endeavored to make 
the paper of a general character, and did not take up 
the consideration of contagious ophthalmia or its treat- 
ment. 
In regard to the contagiousness of trachoma, I think 
that there are cases which are not in themselves con- 
tagious. I only found it in one case in the institution 
to which I have referred, by everting the lower lid. 
There were no symptoms to direct attention to it. 
This case had been in the institution for some time, 
and had not spread the disease. Possibly, if she had 
been placed in an institution where the sanitary ar- 
rangements were less perfect, the disease might have 
been communicated. If the body is sound, and the 
mucous membrane of the eye healthy, the contagion 
may be thrown off. Dr. Randall’s case of an eye 
being affected from material introduced accidentally 
from an ear case, is very instructive, especially as a 
trachomatous condition developed. 
Dr. Risley has reported as to the condition of the 
health and state of the eyes of the Indian boys re- 
ferred to in my paper. A number of children have 
been refused admission to the Church Home on 
account of conjunctivitis, but no record exists. As 
a leucorrhcea or a balanitis may arise de novo from 
neglect, unclean-Iine#and poor health, there is no rea- 
son why a conjunctivitis, under similar circumstances, 
should not arise de novo; but the sources of contagion 
are so numerous, that it must be considered the prime 
factor in producing inflammation of the mucous mem- 
brane of the eye, and as Dr. Harlan says, the general 
opinion is in favor of the discharge from conjunctival 
blennorrhoea being specific. The remarks of Drs. 
Turnbull, Welch and Walk illustrate the danger chil- 
dren’s homes are exposed to from what is already 
prevalent outside of them. 
R. Chloralis, grs. c 
Argenti nitratis, grs. x 
Zinci sulphatis, grs. xx 
Glycerinae, 
Aquae, ix. Solve. 
This proved extremely soothing, and I think bene- 
ficial. 
The effect of improvement of the general health 
was well exemplified on one occasion when an epi- 
demic was threatened. The dietary was improved