Contagious Ophthalmia in Aswmji^ 
and Residential Schools. 
By RICHARD H. DERBY, M.D., 
SURGEON NEW YORK EYE AND EAR INFIRMARY. 
{Reprintedfrom The Medical Record, June, 13. 1885.) 
Before asking the attention of the Academy to a paper 
of some length on the subject of 11 Contagious Ophthalmia 
in our Asylums and Residential Schools," the writer de- 
sires to state that the interest attaching to this subject is 
not of a purely scientific nature, but appeals to the hearer 
on the threefold ground of philanthropy, medicine, and 
social science. The writer also holds that no one famil- 
iar with the subject will deny that contagious ophthalmia 
is a disease as dangerous to sight as scarlet fever and 
typhus and other contagious diseases are to life and 
health, and that the welfare of those who have been 
adopted by our public institutions, and for whom we are 
in great measure responsible, demands some system of 
quarantine or medical supervision which shall not only 
insure recovery to those already afflicted, but which shall 
afford ample protection to those who have thus far es- 
caped contagion. 
There is probably no gentleman here present who has 
given particular attention to diseases of the eye, who will 
not bear witness to the fact that any child who is an in- 
mate of our public institutions, is far more likely to lose 
his sight from the inroads of contagious ophthalmia than 
to lose his life from scarlet fever or any of the diseases 
which are subject to quarantine regulations by the Board 
of Health. 2 
The writer would further state that, whereas the dan- 
gers from neglect are comparatively great, the disease it- 
self is perfectly amenable to treatment, and the reward 
which is to be expected from an adequate appreciation of, 
and attention to, the exigencies of the case is such as to 
render further neglect of the subject entirely inexcusable. 
This is his apology, if apology is necessary, for asking 
his hearers to follow him in the exhibition of statistics 
which, on a more trivial subject, would be considered 
dry and uninteresting. 
In October, 1884, the writer of this paper prepared, for 
the Committee on Hygiene of the County Medical So- 
ciety, a report on "Contagious Ophthalmia" in three of 
the asylums of this city. Since that time many other in- 
stitutions have been visited and the inmates examined, 
and we are now able to present a summary of results ob- 
tained from the examination of seven thousand four hun- 
dred and forty children, the entire number contained in 
twenty-four orphan asylums and residential schools of this 
city. Before detailing the results of these investigations, 
a brief description of the disease we are considering may 
be permitted. Blenorrhoic conjunctivitis in its chronic 
orm is characterized by injection of the conjunctiva of 
the eyelids, hypertrophy of the papillary bodies, and se- 
cretion of a purulent or a muco-purulent nature. The 
conjunctiva tarsi of the fold of transmission, the semi- 
lunar fold, are in general the seat of the disease, while 
the conjunctiva of the eyeball may, and generally does, 
in the earlier stages of the disease, escape.1 
The secretion is contagious. At an early period of 
the affection the meibomean glands are no longer to be 
seen upon eversion of the lids ; later on, the swelling of 
the semilunar fold increases, as does that of the fold of 
transmission ; the inner canthus ceases to be sharply 
defined ; the tear-points are disturbed in their position, 
and the passage of the tears interfered with. If the dis- 
1 Graefe und Saemisch, Band IV., pp. 76 to 79. 3 
ease progresses, the conjunctiva of sclera participates 
in the affection ; it becomes injected and shows serous 
infiltration, and at a later period these symptoms are 
intensified ; the ocular conjunctiva becomes swollen ; 
the lids can with difficulty be everted ; there is chemosis; 
the cornea is now in danger. Pressure of the swollen 
lids and of the chemosis upon its nutritive supply, lead 
to ulceration upon its surface, and unless relief in some 
way is found, perforation of the cornea and consequent 
prolapse of the iris may ensue. 
Blenorrhoic conjunctivitis in a vast number of cases 
remains an affection of the conjunctiva of the lids, and 
does not advance to the later stage which we just briefly 
described. 
It passes for a catarrhal affection of the eyes, and as 
such is treated ; or it exists, and this is often the case, 
without receiving any medical attention whatever. We 
have spoken of the secretion from a blenorrhoic con- 
junctiva as contagious; it may be transferred from eye 
to eye by means of a towel; it may be conveyed in the 
water used for washing ; the atmosphere itself may be 
the bearer of the contagion. 
Among soldiers in their barracks, in the crowded holds 
of vessels, in the over-filled homes of the poor, among the 
inmates of large institutions, contagious ophthalmia has 
been found, and as our investigations will show, an es 
pecially fertile field for this disease, so full of danger to 
the eyes, exists in the orphan asylums of a great city. 
In an experience of fourteen years as officer of one of 
the largest ophthalmic hospitals of the county, the 
writer has over and over again had children brought to 
him from some of our city institutions with their sight ir- 
reparably damaged, and with the sad statement, doubtless 
true, that before they were taken from their homes their 
eyes were perfectly sound. It was with a view of seeing 
how far this malady might exist among the children caied 
for in the asylums of this city that the investigations now 
detailed were made. 4 
The first asylum visited stands on one of the broad 
avenues of the city, on high ground. The children were 
examined in their class-rooms, and subsequently their 
dormitories and lavatories were visited. Among the boys, 
of whom there were 326 present, were found 96 cases of 
contagious ophthalmia ; among the girls were 65 cases 
out of an attendance of 331, making a total percentage 
of 24.5. In almost all the cases here found the disease 
was in what we have described as the first stadium. In 
many cases the appearance of the eyes before eversion 
of the lids betrayed no sign of the malady which was 
present. In certain cases, the child or its attendant re- 
marked that it had from time to time a cold in its eyes, 
nothing more. Occasionally, where the blenorrhoic process 
was most strongly marked, neither child nor attendant 
seemed aware that anything was wrong. In the dormi- 
tories each child had its own bed; in the wash-room, 
separate towels hung upon numbered hooks, and no 
basin was used ; small jets of water at intervals of a foot 
along a horizontal pipe placed above the sink, furnished 
each child with its supply for washing. In the boys' asy- 
lum a large sunken tub, perhaps ten feet long, was pre- 
pared for the bath, and in this eight children or more at 
a time were bathed. (Eight years ago I visited this same 
institution with the late Mr. Theodore Roosevelt. The 
object of the visit was to ascertain to what extent conta- 
gious ophthalmia then existed among the inmates. The 
notes of that examination were not preserved, but a large 
number of children were found then to have sore eyes. 
In the lavatories were a few roller-towels hanging on the 
wall, and these were used by the children indiscrimi- 
nately, those that had eye trouble and those that were 
well. It was in consequence of representations we then 
made that the children were thereafter supplied each 
with its own towel.) 
The next asylum, which we may designate as No. 2, 
showed among 1,586 inmates, 488 cases, or 30.7 percent, 
of contagious ophthalmia. 5 
In No. 3 were 782 inmates; of these in had sore 
eyes, or 14.2 per cent. In the lavatories hung on the 
walls twenty-five roller-towels, and these the attendant 
said were changed two or three times per week. 
In No. 4 were 188 children, and of these 93 or 49.4 
per cent, had sore eyes. In reference to the condition 
of things at this asylum, I make the following extract 
from a letter received May 27, 1885, from the physician 
in attendance : " When you made an official visit to our 
institution, in 1884, you found 92 children suffering from 
a contagious type of ophthalmia. ... At your 
suggestion the sore-eyed children were separated from 
the others, and subjected to a daily course of treatment 
for a period of five months, the present time of writing. 
I give the result-42 of the 92 are cured. Fifty of the 
whole number in the institution are still under treatment. 
. . . Two children never occupy the same bed ; a 
towel and brush is supplied to each individual. The bath- 
ing facilities are of the best, the grounds are ample, 
and the children have an abundance of out-door life. The 
dietary is excellent, and in a family of 200 it is but sel- 
dom that a child is so ill as to require the aid of a physi- 
cian." 
In asylum No. 5 were 740 inmates, and among them 
71 cases, or 9.5 per cent. Here we found two large 
rooms, with two immense bath-tubs in each, about which 
260 boys stand twice or three times a day and wash at a 
spigot, and then go irregularly to one of the sixty roller- 
towels that hang on the walls of each room. 
In asylum No. 6, out of 96 inmates were 26 cases, or 
nearly thirty seven per cent. 
In No. 7 were 15 cases among 262, or 5.7 per cent. 
In No. 8 were 455 children, and of these 74 had sore 
eyes, or 16.2 per cent. 
In No. 9, out of 155 children, 5 were affected, or 3.2 
per cent. ; each child was supplied with its towel. 
In No. 10 were 240 children ; there were 15 cases of 
sore eyes, or 6 per cent. These children were for the 6 
most part committed by the courts ; each child had its 
own box containing towel and brush. 
In No. ii were 21 children, and no case of granular 
ophthalmia. 
In asylum No. 12 were several buildings. In the first 
one visited I found 80 boys, from four to eight years of 
age. There were 47 cases of contagious eye-trouble. 
The cases were mostly severe, with free secretion. Of 
164 girls there were 80 cases of similar type. Louisa 
M , aged four years, came to me the day before, at 
the New York Eye and Ear Infirmary, with left eye in 
condition of central corneal perforation and extensive 
prolapse and acute granular ophthalmia. The mother 
said the child had gone into the asylum with good eyes, 
and had been there one year. The sisters in charge of 
the asylum remembered the case, and said they had sent 
the child out to have her eye operated (sic). The eye was 
beyond hope. Of 178 boys there were 56 cases ; of 29 in- 
fants under three years of age there were 21 cases. With 
these last the practice of the attendants was to use two 
towels, one for the sick, the other for the well eyes. In 
the case of the older children, each had its numbered 
towel. To summarize: among 451 children were 204 
cases of contagious ophthalmia, or 45 per cent. There 
was every evidence of over-crowding in this asylum ; 
no plan had been, or apparently could be, adopted for 
isolating such children as suffered from this grave dis- 
ease. The sisters in charge stated that they must receive 
all the children that were' sent to them, whether they had 
sore eyes or not, as they were for the most part commit- 
ments. The general physique of the inmates was not 
good, and the evidence their evening meal gave of the 
dietary was not encouraging. 
In marked contrast to this was asylum No. 13. The 
fine physical condition of all the children was noticeable. 
Each child had its own brush, comb, tooth-brush, and 
towel. The towels were changed twice every week. Of 
104 inmates there were 6 cases, or 5.7 per cent. 7 
In No. 14 were 310 boys, and of these there were 73 
cases, or 23.5 per cent. The large building in which these 
boys were cared for furnished each child with a small wire- 
screened compartment, in which stood his bed and wash- 
stand. In the infirmary were 14 children, all with recog- 
nized sore eyes, but the 50 and more cases found among 
the larger boys had received no attention, so far as in- 
quiry among the boys and their attendants showed, from 
the medical officer of the asylum. 
In No. 15 the children were found distributed in cot- 
tages, each child with its own towel, brush, etc.; of 151 
children there was 1 case, or less than one per cent. 
In No. 16 the children were arranged as in No. 15. 
Here was 1 case among 122 children, or .08 per cent. 
In No. 17, the asylum a large and spacious new build- 
ing, the children were well cared for. Among 399 chil- 
dren were 7 cases, or 1.7 per cent. 
No. t8 contained 245 children, and among them were 
40 cases of contagious ophthalmia, or 16 per cent. In 
the nursery department were half a dozen towels used at 
the discretion of the attendants. In the wash-rooms for 
the older children hung numbered towels. 
In No. 19 were 98 children and young women, and 
among them were 2 cases of contagious ophthalmia, or 
about two per cent. The dormitories were spacious, 
well ventilated, and each inmate had its own towel. 
In No. 20 were 124 girls, and among them 6 cases, or 
4.8 per cent. Each child had its own numbered towel. 
In No. 21 were 132 girls, and among them 21 cases, 
or 15.9 per cent. The school-rooms and dormitories 
were dark and badly ventilated. Each child was pro- 
vided with its own towel. 
In No. 22 were 18 girls between the ages of six and thir- 
teen. In No. 23 were 22 young women. In neither asylum 
were any cases. Both of these asylums were in private 
hands, and the inmates cared for in commodious houses. 
In No. 24 were 82 children, and among them 8 cases, 
or 10 per cent. 8 
' The communicable eye-diseases observed in these in- 
vestigations have been designated under the general term 
of contagious ophthalmia. Among them were those 
where the true granulations, the so-called trachoma of 
Arlt, were present ; others that might be more properly 
described as chronic conjunctival blenorrhcea. In some 
the affection had extended to the cornea, producing pan- 
nus, and in certain cases corneal ulceration had been fol- 
lowed by prolapse of the iris and adhesion. 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 
in the class-room occupied adjacent seats. 
It is not the purpose of this paper to consider in detail 
the various causes which lead to the development of con- 
tagious eye-diseases in the asylums which have been vis- 
ited. The part played by imperfect quarantine, bad lava- 
tories, overcrowding, bad hygiene-all this has been 
discussed in other places.1 
My purpose in these investigations will have been at- 
tained if I have drawn attention to the fact that in the 
asylums of our city, where children in large numbers are 
housed, and where the inmates are taken from the over- 
crowded, illy ventilated, unhealthful homes of the poor, 
there exists to an alarming extent a disease fraught with 
danger to the eyes of all assembled there. We have seen 
that this affection may be present without attracting the 
attention of the lay attendants of the children, and without 
calling for or receiving the care of the visiting physician 
of the institution. In certain cases, it is true, if the sub- 
ject is well nourished, and the hygienic surroundings good, 
the eye-trouble disappears without treatment. In too 
many cases, however, the disease, which has once estab- 
lished itself, goes on insidiously undermining the health 
of the eyes, and there comes a period when the affection 
' State Board of Health of New York, No. 44. 9 
is acute, and we hear of an epidemic of contagious oph- 
thalmia. Fortunate, then, are the unhappy inmates of 
such an institution, if many eyes are not lost before the 
disease can be controlled. The statistics taken from 
these asylums are appalling enough. We have found 
among 7,440 children that 1,428,01' 19.19 per cent., 
nearly one out of every five, had communicable eye-dis- 
ease, which he was liable to transfer to his neighbor. 
Nor does the trouble cease here, as has been observed 
in several of the institutions we have visited. So soon 
as an unusual number of children are found to suffer 
from sore eyes, it is not an uncommon practice for those 
who have the children in charge to send back to their 
former homes the worst cases, with the statement that it 
is better that, until the child recovers, treatment should 
be procured outside of the institution ; only those who 
are familiar with the homes of the poor in a great city 
can appreciate what a hardship is now wrought upon the 
unhappy guardians of such children. It is impossible 
that a child afflicted with contagious eye-disease should 
receive in its tenement-house home adequate treatment. 
This class of cases is often refused shelter in our best 
equipped eye infirmaries. The child must be brought 
three times, at least, in the week to the clinic for out-door 
patients. The already overtaxed parent must see to it 
that this frequent attendance is not neglected. The 
child becomes a fresh centre of contagium in the crowded, 
illy-cared-for home, where the food-supply is scanty and 
the simplest rules of hygiene are neglected. The case 
must often be neglected, and neglect means advance ot 
the morbid process, permanent, irreparable damage to 
the eyes. 
Were there time in this report, it would be proper to 
show how, by reason of a per capita allowance from city 
or State, it is in many of the institutions a pecuniary 
advantage to the asylum itself to receive as many children 
as possible within its walls, and overcrowding is thus di- 
rectly encouraged. In many asylums children are com- 10 
mitted by the civil authorities, and in others by charitable 
societies, whose object is the protection of their charges 
from cruelty at the hands of their natural guardians. 
Can a more refined cruelty be imagined than one which 
subjects a child with healthy eyes to the dangers which 
every epidemic of contagious ophthalmia carries with 
it ? 
This present report covers but a portion of the asy- 
lums of this great city. There are many others that we 
have not visited which would doubtless contribute their 
considerable quota of cases of communicable ophthal- 
mia. 
To meet this evil, certain conclusions force themselves 
upon us. 
Under no circumstances should children be received 
in an asylum until a competent authority has pronounced 
the eyes of the new-comers free from any trouble of a 
contagious character. Every asylum and residential 
school of the city should be called on to furnish to the 
Board of Health a statement certified to by its attending 
physician, of the number of cases of contagious eye-dis- 
ease at present within its walls. These cases should be 
separated from the other inmates of the asylum, and this 
quarantine should be rigidly enforced so long as a single 
case of this disease is observed. Adequate treatment 
must be supplied-not merely local treatment for the 
eyes, but such allowance of food and air as are necessary 
for the proper treatment of such cases. 
No less precaution for the safety of other inmates of 
these institutions should be taken where contagious oph- 
thalmia is found to exist than is now observed when a 
case of scarlet fever is recognized. 
It is impossible to read the statistics which have been 
presented in this paper without acknowledging the fact 
that a great evil calls urgently for prompt and systematic 
action for its relief. What shall be done, and where shall 
the beginning be made ? Our present inquiries have 
brought to our knowledge enough cases of contagious 11 
eye-disease to more than fill a large hospital devoted to 
this particular class of diseases. If such a hospital ex- 
isted, it would undoubtedly soon reduce the percentage 
of such troubles to a minimum. Such a hospital would 
receive and care for all cases of communicable eye-dis- 
ease until they could be returned cured to the institutions 
from which they were gathered. While we may not our- 
selves establish and maintain such a hospital, it behooves 
us as members of the Academy to make emphatic protest 
against the continuance of the present dangerous and 
inhuman practices which we have found at many of our 
city's institutions. Hoping that the members of the 
Academy here present will deem this matter worthy of 
their serious attention, I take pleasure in submitting it to 
their consideration.