THE TREATMENT 
OF THE 
VffiOUS FORMS OF CONJUNCTIVITIS 
AS PRACTISED AT 
THE GERMAN HOSPITAL, 
READ BEFORE THE PHILADELPHIA COUNTY MEDICAL 
SOCIETY, DECEMBER 27, 1893, 
By LOUIS J. LAUTENBACH, A.M., M.D., Ph.D. 
PHILADELPHIA. 
chief of the eye clinic of the german hospital ; surgeon TO 
THE PENNSYLVANIA EYE AND EAR INFIRMARY ; THROAT AND 
NOSE PHYSICIAN TO THE ODD FELLOWS' HOME, ETC. 
Reprinted from the Transactions of the Philadelphia 
Medical Society for 1893. 
To which is added a Report of the New Patients in 
the Eye, Ear and Throat Departments of the 
German Hospital from their Inception. 
PHILADELPHIA: 
J. B. Smith, Printer, 2160 N. 21st St. 
1804. Reprinted from the Transactions of the Philadelphia County 
Medical Society for 1893. 
THE TREATMENT OF THE VARIOUS FORMS 
OF CONJUNCTIVITIS AS PRACTISED 
AT THE GERMAN HOSPITAE. 
READ BEFORE THE PHILADELPHIA COUNTY MEDICAL SOCIETY, 
DECEMBER 27, 1893. 
By LOUIS J. LAUTENBACH, A.M., M. D., Ph. D., 
PHILADELPHIA, 
CHIEF OF THE EYE CLINIC OF THE GERMAN HOSPITAL ; SURGEON TO 
THE PENNSYLVANIA EYE AND EAR INFIRMARY ; THROAT AND 
NOSE PHYSICIAN TO THE ODD FELLOWS' HOME, ETC. 
My connection with the Eye Department of the 
German Hospital dates back to a period of some three 
and a half years, during which time somewhat over 
five hundred cases of conjunctivitis have been treated 
in the clinic. This does not include the cases of hyper- 
aemia of the conjunctive or of symptomatic conjunc- 
tivitis, so often observed as a consequence of eye strain 
from refractive disturbances, nor are these cases recorded 
in the hospital reports, except as to their refractive 
error. The Eye Department of the German Hospital 
is under the charge of Dr. Charles S. Turnbull, under 
whom I serve as Chief of Clinic, and to whom I am 
indebted for much valuable aid and advice as well as 
encouragement, 2 
TREATMENT OF CONJUNCTIVITIS. 
The table here presented gives the number of cases 
of all the forms of conjunctivitis presenting themselves 
at the clinic during the years of 1891, 1892 and 1893- 
a total of 432 cases, as compared with 317 in the 
years of 1888, 1889 and 1890, showing the clinic to be 
a growing one, although not rapidly so: 
1891 
1892 
1893 
Total 
Conjunctivitis, Acuta .... 
. 22 
32 
29 
83 
'1 Subacuta . . . 
. 20 
6 
6 
32 
" Chronica . . . 
• 29 
30 
36 
95 
'1 Blennorrhoea . 
• 7 
4 
7 
18 
" Epidemica . . 
• 17 
13 
19 
49 
'1 Erysipelatous . 
. - 
- 
1 
1 
" Follicularis . . 
. 8 
3 
15 
26 
" Fhlyctenulosa . 
. 8 
9 
23 
40 
" Trachoniatosa . 
• 3i 
22 
19 
72 
" Traumatica . . 
• 5 
6 
5 
16 
Totals, . . 
147 
125 
160 
432 
The classification of the various forms of conjunc- 
tivitis varies with the ideas of different authors-no 
two seeming to use the same nomenclature-their vary- 
ing views depending, in the main, on the different 
pathological opinions held by each. For instance, 
epidemic catarrh is by many classed as a simple acute 
catarrh. The classification here presented makes no 
pretence as to being strictly scientific, but will com- 
mend itself as being thoroughly practical. 
Now, it is not my desire to take up each of these 
forms individually and study it separately and com- 
pletely, but rather to indicate some general rules about 
the treatment; some few thoughts which have come 
to be very important truths, and to indicate, wherever 
necessary, any modifications or additions. TREATMENT OE CONJUNCTITITIS. 
3 
The first step in the treatment of all cases of con- 
junctivitis is necessarily the cleansing of the conjunc- 
tiva, not simply the ocular or the palpebral portion, 
but of the whole conjunctiva including the folds-the 
lower palpebral fold especially. This necessity exists 
with the most acute as well as the most chronic, the 
simplest as well as the most complicated case. It is 
the key-note of the treatment. If we endeavor to 
cleanse and do not succeed in thoroughly doing so, we 
may cure many of our cases, but will not get as prompt 
nor as good results, and many cases we will find it im- 
possible to cure. For instance, while we may be suc- 
cessful with the simple catarrhs, we will often fail in 
the epidemic form, and in gonorrhoeal conjunctivitis 
we will invariably fail. 
How is the conjunctiva to be thoroughly cleansed? 
How is it best accomplished ? My method is to invar- 
iably cleanse first by means of Peroxide of Hydrogen, 
which I use in full strength, 15 vol. solution (testing 
over 10 vols. invariably). Now the pure peroxide 
stings considerably when used on the conjunctiva, often 
inconveniencing the patient very much, and when the 
solution is markedly acid it is far more painful, and 
indeed, is then unfit for use in the eye. The reason 
that this remedy has, comparatively speaking, met with 
so little favor among eye surgeons has been mainly 
because of the marked acidity of many of the solutions. 
This acidity is not only a cause of much pain but, 
indeed, sometimes an element of danger, as the con- 
jestion of the conjunctiva occasioned, is sometimes 
sufficient to interfere with the proper nutrition of the 
cornea. 4 
TREATMENT OF CONJUNCTIVITIS. 
Having used peroxide of hydrogen steadily for a 
period of almost ten years, I feel it but right to indi- 
cate the basis of my faith. I have in these years used 
various brands of the solution*. For a long time I 
relied upon the Marchand peroxide and found it fairly 
stable, but its acidity was so great as to prove a great 
bar to its use; indeed, very rarely could it be used in 
the eye without previously neutralizing the free acid. 
Later on I tried Bene's, and found this to answer my 
purposes very well, the acidity being still noticeable 
however. Among others, which I tried some three 
years ago, was that manufactured by the Oakland 
Chemical Co., and I to-day rely mainly on that prepara- 
tion. It is fairly constant in the amount of Oxygen it 
contains; fairly stable; is not much deteriorated by 
moderate changes in temperature; and the amount of 
free acid present is very small. It tests beyond io vols. 
invariably, usually from 12 to 16 vols. At the hospital 
I employ the Rosengarten brand and find that it and 
the Oakland are much the same in their action. Be- 
tween the two I can detect no marked difference. I 
lately tried Peuchot's, but find it entirely too acid to 
be used in the eye. 
Of all the kinds I have employed, having experi- 
mented with upward of a dozen, I can recommend for 
use in the eye only the preparations of Bene, of the 
Oakland Co. and Rosengarten's. The characteristics 
which these preparations have in common and which 
should be possessed by any peroxide employed, are 
first, invariably testing beyond 10 vols., preferably be- 
tween 12 and 16 vols. of oxygen; second, in being 
fairly stable-not losing their oxygen upon slight TREATMENT OF CONJUNCTIVITSI. 
5 
changes of temperature; third, and most important: 
having little or no free acid present; the amount of acid 
should be as small as is consistent with the stability 
of the preparation. 
By the use of a pure preparation, the entire con- 
junctiva can be most thoroughly cleansed; not only 
will the discharge on the surface be washed off, but that 
lying in the crevices and chinks will be decomposed 
and washed out. 
A word as to the method of use. From io to 30 
drops of the solution should be instilled at the outer 
canthus and the eye then closed, and with the fingers a 
degree of massage applied over the entire surface of 
both eyelids. Then the eye should be looked at, and, 
if necessary, a second, a third, and evena fourth appli- 
cation should be made. Often in trachomatous cases, 
after its application, it is well to evert the trachomatous 
lid, and, with the rubber end of an eye dropper, rub its 
conjunctival surface. The thorough application of the 
peroxide should invariably be followed by the liberal 
use of a saturated solution of boracic acid. This will 
wash out all the debris and soothe the possibly irri- 
tated conjunctiva. 
This treatment I never intrust to the patient, but 
always do it myself, using it as often as necessary from 
twice a week to once or twice a day. Occasionally I 
allow a patient to use a weaker solution of the perox- 
ide, from a three to an eight volume solution, but never 
stronger, used once or twice a day. The cleansing 
method that I advise the patient to follow is the liberal 
use of a saturated solution of boracic acid as a wash or 
eye bath, used almost invariably as hot as the eye can 6 
TREATMENT OF CONJUNCTIVITIS. 
bear, from two to eighteen times a day, even every half 
hour in many gonorrhoeal cases. 
Having thus thoroughly cleansed the conjunctiva, 
we have a surface upon which we can apply our 
appropriate remedies pnd are sure they will have the 
maximum effect. Not that it will always be neces- 
sary to employ anything beyond the cleansing before 
indicated, as indeed we will find many mild cases of 
conjunctivitis yield through these simple means. 
In cases of acute conjunctivitis, when further treat- 
ment is indicated, we direct the patient to use a mild 
solution of acetate or sulphate of zinc, or a solution of 
borax in camphor water, advising the hot boracic acid 
solution as a wash. 
In sub-acute conjunctivitis we employ usually either 
the solution of sulphate of zinc or of copper. 
In chronic conjunctivitis especially if there be much 
thickening of the conjunctiva, I direct, in addition to 
the treatment employed in the sub-acute cases, the use 
of massage on the eyelids three times a day immedi- 
ately following the instillation of castor oil (the oil to 
be used after the eye has been thoroughly bathed with 
hot boracic solution and roughly dried). The persist- 
ence in this method has, in numerous cases, been fol- 
lowed by what might almost be termed marvelous 
results. 
In conjunctivitis blennorrhcea or gonorrhoeal con- 
junctivitis, the peroxide treatment is to be used regu- 
larly once a day, and in very virulent cases, twice a 
pay. It is to be followed by the boracic acid solution, TREATMENT OF CONJUNCTIVITIS. 
7 
and this in turn by a strong solution of nitrate of silver 
brushed upon the lids with a small pledget of cotton 
on a cotton holder. I never employ brushes as I con- 
sider them incapable of being kept clean. Upon the 
first visit, I usually use a solution of 60 grains to the 
ounce; on the second day, if necessary, I employ the 
same solution, or may even use a solution as weak as 
5 grains to the ounce, or any strength between the two. 
Of course, in using such strong solutions, care must be 
taken to limit its action to the conjunctiva-not to 
allow a drop of it to touch the cornea, and to neutral- 
ize any excess of solution immediately. If there be 
much conjunctival swelling, especially of the circum- 
corneal conjunctiva, and particularly if this threatens 
the nutrition of the cornea, I scarify this freely in sev- 
eral places in lines radiating from the cornea. After 
the use of the nitrate of silver, again wash with bor- 
acic acid solution and send the patient home, with 
directions to wash the eye with hot boracic acid solu- 
tion either every 30 or 60 minutes as circumstances 
demand, and to use 2 drops of a two grain solution of 
nitrate of silver twice a day, and report the next day. 
Since adopting this method I have not had a case to 
resist a cure for over seven days, and in one instance, 
had a perfect eye after three days. I invariably direct 
these patients to use smoked glasses, as they, in addi- 
tion to protecting the eye from the dust, light and 
wind, prevent him from wiping them as much as he 
otherwise would. 
Epidemic conjunctivitis is treated in much the same 
way, except that the peroxide and boracic acid solu- 
tions are followed by a solution of nitrate of silver of 8 
treatment of conjunctivitis. 
five grains to the ounce, and the patient is directed to 
bathe the eye with boracic acid solution every hour or 
two, and to use a one grain to the ounce solution of nitrate 
of silver twice a day, and to wear smoked glasses. 
In follicular conjunctivitis the cleansing is the 
same. This may often be followed by the application 
of the alum stick, or sometimes the follicles are opened, 
or castor oil may be used by the massage method; the 
patient is directed to use the hot boracic acid solution 
as a wash three or four times a day, and the castor 
oil after each cleansing; again, at times, I direct 
an ointment of acetate of lead, one grain to the ounce, 
to be used in the lower lid at night. Of course, this 
is never to be ordered without cautioning the patient 
never to use the ointment for any other treatment than 
the present one, as it is never to be employed unless the 
cornea be intadi. 
In conjunctivitis phlyctenulosa, the cleansing is 
employed as above and is followed by the use of 
atropia, and this again, perhaps, by calomel. The 
patient is directed to use the hot wash four times a day 
with, perhaps, a weak solution of atropia and the yel- 
low oxide or mercury salve at night, protecting the 
eyes by means of smoked glasses. 
In conjunctivitis trachomatosa, the cleansing is in- 
variably very thoroughly employed, any source of irri- 
tation, such as misplaced cilia is, if possible, removed; 
all trachoma present are opened and thoroughly scraped 
out, any contracting bands being superficially incised 
and redundant tissue, if present, removed. After this 
peroxide is to be employed; to be followed, if neces- TREATMENT OF CONJUNCTIVITIS. 
9 
sary, with alum, sulphate of copper, or nitrate of sil- 
ver in stick. The patient is directed to cleanse the eye 
thoroughly and frequently with hot boracic acid ; to, 
in some cases, use castor oil with massage, either alone 
or in connection with the yellow oxide of mercury 
ointment at night; treating sequelae as they arise. 
In connection with the above local treatment there 
should be employed whatever general treatment may be 
found necessary. This is indeed often of the utmost 
importance in this class of patients. We will not here 
enlarge upon this subject. Each patient is a law unto 
himself and must be treated accordingly, but the key- 
note should be to rectify any abnormal conditions need- 
ing correction, and to restore the body to as nearly a 
normal one as is possible. 
The above is necessarily but a brief outline. It has 
been presented thus with the objedt of calling atten- 
tion to what I deem the foundation stone of the suc- 
cessful treatment of inflammation of the external parts 
of the eye-cleanliness and thoroughness. It is a truth 
which holds good in the treatment of the cornea as well 
as the conjunctiva. I wish to call attention to the 
method of obtaining cleanliness-the most thorough 
with which I am acquainted; and secondly, to the use 
of massage as one of the efficient but little used 
methods of treating conjunctival affections, especially 
conjunctival thickenings. Medicines prepared as oint- 
ments or as solutions in some oily menstruum lend 
themselves readily to this mode of treatment; thirdly, 
I have desired to call attention to the wonderfully suc- 
cessful results of the above treatment of gonorrhoeal 
conjunctivitis; and fourthly, I have wished to call 10 
TREATMENT OF CONJUNCTIVITIS. 
attention to the method in phlyctenular cases, as upon 
numerous occasions we have had cases which having 
proven unusually intractable at other hospitals, have 
readily succumbed under our method. In cases of 
phlyctenular diseases involving the cornea, this has 
been more often and more thoroughly illustrated than 
in the simple conjunctival cases. I recall two such 
cases now under treatment. One of a boy of twelve, 
who in a month, has obtained a better result than had 
been accomplished at any time during the past ten 
years of almost continuous treatment at other institu- 
tions in this and other cities. Upon several occasions, 
he was house patient at various eye hospitals. The 
other, a parallel case, is the one referred to in my paper 
on phlyctenular conjunctivitis in the Rhode Island 
Medical Society Monthly, November, 1893, page 53°- 
The conclusions which I have reached as a result 
of my hospital work are: that in these cases, thorough- 
ness, especially in cleanliness, is essential; that the 
entire conjunctival cavity must be effectually cleansed 
and prepared for any such curative agent which we may 
desire to use; and in addition to this, the patient should 
be directed to keep the eye as clean as is possible, but 
necessarily he can not do this as thoroughly as we can. 
Every case should be seen as often as necessary; in 
cases of doubt, have the patient come rather too often 
than not often enough. If necessary for the welfare of 
the case, donate some of your time at your office ; do 
for him all you can and always as thoroughly as neces- 
sary, even more so. If you fail at all, fail in doing 
for him too much. The results thus obtained will 
sometimes be unexpected, but ever gratifying. TREATMENT OF CONJUNCTIVITIS. 
11 
The Eye, Ear and Throat Departments of the Ger- 
man Hospital have clinics two days per week (Tuesdays 
and Fridays). The time to be devoted to the clinic 
work is presumably one hour, but it is upon rare occa- 
sions only that from two to three or more hours are not 
consumed. Considering the number of clinic days 
(100 in the year 1893), it will appear from the accom- 
panying table that the number of new patients in the 
Eye Department is not a meagre one. It will indeed 
compare most favorably with that of any general hos- 
pital in Philadelphia, and compared, even with the 
special hospitals, its record is by no means a poor one. 
Of course, as contrasted with the New York Ophthal- 
mic and Aural Institute, under the charge of Dr. Her- 
man Knapp, with a record of 6,961 new eye patients 
in 1893, largest number of any institution in this 
country) our number of new cases (910 in 1893) may not 
seem very great, but one must not forget that this dis- 
pensary is situated in the heart of the metropolis of 
America; that it has a daily service; that it is over 24 
years old; that it is a special hospital with a large build- 
ing, fitted with all necessary and convenient appliances; 
and that it is under the charge of one whose reputa- 
tion is world wide and who has the aid of numerous 
assistants. 
The record of 910 new eye patients treated at the 
German Hospital during 1893 is, under the conditions 
there present, a vary gratifying one, and one which has 
never been equalled in the history of the hospital. 
The eye and ear departments were opened in 1883, 
while the throat clinic was inaugurated in 1888 by (Dr. 
A. A. Bliss, who still has charge of the same). 12 
TREATMENT OF CONJUNCTIVITIS. 
Since 1890, all eye patients under 12 years of age 
have been referred to the clinic opened at the Mary 
Drexel Home, which is now under the charge of Dr. 
George Friebis. 
Number of New Patients treated in the Eye, Ear 
and Throat Clinics of the German Hospital: 
Eye Patients, 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 
Ger. Hospital, 304 425 617 441 701 642 654 602 723 677 764 
Mary Drexel Home, * * * 166 146 
Total,843 910 
Ear Patients, 124 165 207 145 177 260 222 226 199 186 183 
Nose and Throat Patients, 128 210 198 * 288 232 
* Not recorded in Annual Reports. 
1723 Walnut Street, Phila.