Exudative Conjunctivitis. 
BY 
ALVIN A. HUBBELL, M. D., 
BUFFALO, N. Y., 
Fellow New York State Medical Associa- 
tion; Professor of Diseases of the Eye, 
Ear, and Throat in the Medical Depart- 
ment of Niagara University; Surgeon to 
the Good Samaritan Eye and Bar In- 
firmary, etc. 
REPRINTED PROM TRANSACTIONS OF 
She !Ee(b goik Stall gsbical slssocraticn. 
1887. EXUDATIVE CONJUNCTIVITIS. 
Conjunctival exudations have been observed for many 
years in some parts of Germany, but in England and the 
United States their occurrence has been comparatively rare. 
J. Soelberg Wells1 stated that he had never met with a 
case in England of “ true diphtheritic ” conjunctivitis, but 
had seen many cases in Yon Graefe’s clinic in Berlin. Car- 
ter2 admits its prevalence in Germany, especially in Berlin, 
but says he believes it to be “ wholly unknown in England.” 
Others, however, have observed “ diphtheria ” of the eye in 
England and other parts of Great Britain, and have reported 
undoubted typical cases, even such as have been common in 
some parts of Germany, of which the earliest and most com- 
plete description was given by Yon Graefe.8 
Pritchard,4 in 1857, stated that he had seen nine or ten 
cases of acute conjunctivitis in which “fibrin had been ef- 
fused, of the same physical characters as that effused in a 
recent case of pleurisy, which had adhered to the lids, and 
when unchecked by treatment had spread over the surface 
of the globe and destroyed the sight.” He gives the history 
of one case occurring in connection with scarlet fever, other 
members of the family having diphtheria of the throat.5 John- 
athan Hutchinson,6 in October, 1859, recorded a very marked 
and severe case. 
1 “ Treatise on the Diseases of the Eye,” third Am. edition, 1880, p. 76. 
* “ Practical Treatise on Diseases of the Eye,” Am. ed. by Green, 1876, p. 231. 
8 “Yon Graefe’s Arch. I'iir Ophthal.,” 1854. 
* “ British Medical Journal,” 1867, p. 981. 
6 See Mason, “ Royal London Ophthalmic Hospital Reports,” vol. vii, p. 167. 
8 “ Royal London Ophthalmic Hospital Reports,” vol. ii, p. 130. 2 
NEW YORK STATE MEDICAL ASSOCIATION. 
Since then numerous cases have been observed in Great 
Britain by Fredrick Mason,1 Samuelson,2 Nettleship,3 Twee- 
dy,4 A. Critchett and H. Juler,5 J. E. Adams,6 Hogg, Streat- 
field, and others. 
To show the comparative frequency of this disease in dif- 
ferent countries, I will quote from the excellent work of 
Ernst Fuchs.7 
No. 
Per 
Country. 
_ ______ 
Town. 
Author. 
Patients. 
Thousand. 
f 
Ivbnigsberg. 
J acobson. 
10,000 
21,440 
6.2 
Berlin. 
Hirschberg. 
'2.0 
Berlin. 
Scholer. 
10,000 
0.6 
Germany . . . < 
Diisseldorf. 
Mooren. 
108,416 
1.1 
Leipzig. 
Coccius. 
7,898 
0.2 
Heidelberg. 
Becker. 
7,547 
1.2 
Stuttgart. 
Berlin. 
9,827 
1.2 
Holland 
Utrecht. 
Bonders. 
3,000 
12,000 
2.3 
Austria 
Vienna. 
Adler. 
6.2 
France 
Paris. 
Fieuzal. 
34,577 
0.4 
England 
London. 
j Moorfield’s ? 
j Hospital. $ 
22,130 
0.2 
American statistics of this disease have not jet been col- 
lected. It is, however, rarely seen, and practitioners here 
have written very little upon the subject. Landeshurg8 has 
contributed an article, and Knapps has reported two ’cases, 
with remarks upon the disease. Alt10 has recently recorded 
nine cases. * 
It would appear from Knapp and Alt that in New York 
city and vicinity it is much more frequent than elsewhere in 
1 “Royal London Ophthalmic Hospital Reports,” vol. vii (Nov., 1871), p. 164. 
2 “Transactions International Medical Congress,’’ 1873, p. 127. 
3 “ St. Thomas Hospital Reports,” vol. x, 1880. 
* “ Lancet,” 1880, vol. i, pp. 125, 282; and 1882, vol. i, Jan. 7. 
® “Transactions Ophthalmological Society of the United Kingdom,” vol. iii, 1883, p. 1. 
6 “Royal London Ophthalmic Hospital Reports,” vol. x, p. 211. 
2 “On the Causes and Prevention of Blindness.” London: Bailliere, Tindall & Cox. 
1885, p. 171. 
s “Medical Bulletin,” Philadelphia, vol. iv, no. 5. 
3 “Archives of Ophthalmology,” vol. xi,1882, p. 1. 
10 “American Journal of Ophthalmology,” vol. iv, 1887, p. 41. EXUDATIVE CONJUNCTIVITIS. 
3 
this country. Knapp says that Dr. Born, during his three 
years residence in the New York Ophthalmic and Aural In- 
stitute, collected notes of seventy well marked cases, and 
that mild cases of “ croup ” of the conjunctiva are not infre- 
quent in his practice. Dr. Alt says he has seen at the same 
institution sixteen cases. Green1 stated, in 1876, that he 
had never seen but one case, and that not very well marked. 
Thus it is generally conceded that exudative inflammation 
of the eye in any of its varieties is very uncommon in this 
country; and this, too, has been my own experience. Among 
several thousand eye patients seen by me during the past ten 
years, I have met with only seven cases. I will give the 
history of one of these cases in detail, and the others I will 
refer to only in brief. 
On April 7, 1886, I was called in consultation by Dr. S. G. Dorr, of 
Buffalo, to see Nellie R., aged one and one half years, who had been sick 
a few days with febrile symptoms, and had a rash resembling that of 
scarlatina. She had also had trouble with the right eye for three days, 
which was at first considered to be purulent conjunctivitis. The doctor 
had prescribed suitable remedies for the patient, but the eye continued 
to get worse. 
At this visit the child was feverish, very restless, and the eruption on 
the skin and the strawberry appearance of the tongue were like those of 
scarlet fever. The throat was normal in every respect, and there was no 
manifest disease of the upper air-tract at any part. The left eye was 
healthy, and the right presented the following appearances : The lids were 
much swollen, tense, shiny, and red; the swelling extended considerably 
over the right side of the face and across the nose; the upper lid seemed 
elongated vertically, and projected over the lower lid, to which it was 
apparently adherent. The parts were very sore and tender, and the 
child was given chloroform to facilitate further examination. Anaesthe- 
sia having been induced, the lids were found to be very stiff, and where 
the edge of the lower lid was in apposition to the inner surface of the 
upper they were more or less adherent. They were separated with some 
difficulty, and with a lid elevator the upper one was lifted and turned 
out a little, when it was found that the upper and the lower lids were 
firmly glued to the eye-ball by the exudation, which had taken place 
from both the palpebral and ocular portions of the conjunctiva in their 
whole extent, and consolidated the surfaces in contact into one mass. 
1 “Carter’s I’ractical Treatise on Diseases of the Eye,” Am. edition, 1876, p. 232. 4 
NEW YORK STATE MEDICAL ASSOCIATION. 
The cornea, which was exposed with great difficulty, was free from exuda- 
tion. It was clear except in its extreme lower part, wThere it was cloudy. 
The lower lid was forcibly detached from the ball for a little distance, 
and the exudation was found to be of considerable thickness, and firm, 
and evidently had thoroughly infiltrated not only the ocular and palpe- 
bral conjunctiva, but more or less of the tissues beneath. While the 
lower lid was apparently adherent to the ball throughout, the upper was 
free for some distance from the margin, where it projected over the cornea 
and lower lid, and was adherent to the ball above the cornea and toward 
the retro-tarsal fold. No effort was made to break up the adhesions 
above. The exudation, as seen on the free portion of the conjunctiva of 
the upper lid and the detached portions of the lower, was of a color and 
appearance resembling wet chamois leather. It was tough, could not 
be wiped away, and there was no haemorrhage when torn. The dis- 
charge from the eye was not great, and was watery and straw-colored. 
The treatment advised consisted in frequent cleansing of the eye 
(every half hour) with one part of corrosive sublimate to 5,000 of a sat- 
urated aqueous solution of boric acid, and the constant application of 
compresses to the eye, kept wet with the same. The left eye was pro- 
tected by being covered with a compress of absorbent cotton, covered and 
held in place by a bandage. The patient’s head was also kept inclined 
to the affected side, so that the secretions and wash would not gravitate 
toward the sound eye. Internally, Dr. Dorr prescribed remedies princi- 
pally to keep the child quiet. I was requested by the doctor to continue 
with him in the case, and I therefore watched its progress and aided in 
the treatment to the end. 
April 8, the condition of the parts was unchanged, except that there 
was more swelling of the lids and face. The treatment of the previous 
day was continued, and to this was added the introduction of powdered 
boric acid, as much as could be contained, into the palpebral fissure, on 
the cornea, and as much as possible beneath the lids. This was repeated 
as often as the powder became dissolved, the parts being previously 
cleansed each time with the bichloride and boric acid solution. 
April 9, the cornea was as clear as when I first saw it. The face and 
lids were still more swelled, and the tissues of the lower lid seemed more 
infiltrated with the exudation. The skin of this lid wras also vesicated, 
the vesication extending downward from one half to three quarters 
of an inch from its margin, and one and one half inches transversely 
and outwardly from near the nose. The parts were very tender, and 
evidently painful, as the child was exceedingly restless, except when 
under the influence of narcotics. The secretion from the eye continued 
watery and yellow. The fever and rash were yet well defined, and the 
fauces were normal. The left eye was still unaffected, excepting that 
the lids were puffy from the extension of the swelling from the opposite EXUDATIVE CONJUNCTIVITIS. 
5 
side. The protective covering was kept applied, and the treatment con- 
tinued as before. 
April 10, the lower eyelid showed a deposit of the exudation exter- 
nally at the site of the previous vesication; and at about one third of an 
inch from the margin of the lid and toward the nose there were indica- 
tions of breaking down of tissue and sloughing. The general swelling 
was about the same, and the corneal haziness had not increased. The 
treatment was not changed. 
April 11, the exudates of the conjunctiva seemed to be softening, the 
secretions were more purulent, and the lids were beginning to loosen 
from the eye-ball. Pus was also discharging from the outside of the 
lower lid from a slit-like opening three quarters of an inch long, extend- 
ing outwardly from the nose, parallel with and about one third of 
an inch from the margin of the lid. The lids and face were a little less 
swollen. The powdered boric acid was continued as before beneath the 
lids, on the cornea, and externally over the affected parts. The bichloride 
and boric acid solution was now used only for cleansing the parts, which 
was done every hour or two. 
April 12, there was less swelling, exudates were clearing away in 
places, adhesions were giving way, and the discharge, which was pur- 
ulent in character, was free both from the conjunctival surfaces and the 
sloughing part on the outside of the lower lid. The same treatment was 
continued. 
April 18, the patient and the eye were decidedly better. The lids were 
no longer adherent to the eyeball, were still less swelled, the conjunctiva 
was becoming clean, there were no ulcerative processes, and its epithe- 
lium was reappearing. Pus continued to discharge as before, the cornea 
was unchanged, the rash had disappeared, and the patient was in every 
way comfortable. ' 
From this time the eye improved rapidly, and by the 17th the 
exudation had nearly all disappeared, the conjunctiva was assuming a 
normal appearance, the haziness of the cornea was clearing up, and the 
lower lid was healing externally. By the 19th, the epithelium of the 
conjunctival surfaces had completely re-formed, and ulceration of the 
conjunctiva, contrary to my expectations, had not taken place4 With 
such an amount of exudation and undoubted destruction of epithelium 
as existed in this case, I am still unable to understand why ulceration 
did not follow, with, possibly, cicatricial contraction or ugly adhesions, 
and how the parts could so favorably return to normal conditions. 
The eye remained red for several weeks, and the place in the lower lid 
where the sloughing had occurred healed slowly. The right lachrymal 
passage seemed to be involved to some extent in the exudative and 
sloughing processes, so that it became obstructed, and constant stilli- 
cidium followed the full recovery from the disease. A small scar was 6 
NEW YORK STATE MEDICAL ASSOCIATION. 
left on the lower lid where there had been sloughing. With these two 
exceptions, the recovery of the eye was full and complete, and the child 
in a few weeks appeared strong and robust. The left eye did not 
become implicated at all, and was uncovered as soon as the discharge 
from the right eye had ceased to become purulent. 
I will add that no diphtheria or scarlet fever was known to exist in 
the neighborhood; and that another child, a boy three or four years old, 
who had never had either of these diseases, and who could not be sent 
away, was in the house, and much of the time was in the room with the 
patient, but did not contract either scarlet fever or diphtheria; neither did 
any of the attendants, several in number. 
It has been my fortune to see six other cases of conjunc- 
tivitis with exudation, but neither of them presented the 
characteristics of the above case. Two of these were young 
men, in whom the exudation appeared on the conjunctiva of 
the lower lid toward the inner canthus, and on the contig- 
uous ocular conjunctiva. The exudation had the chamois- 
leather appearance, the infiltration extended into the tissues 
beneath the conjunctiva, and there was considerable swelling 
of the lid with chemosis and much pain and soreness. Cor- 
neal ulceration also developed. In each case the exudation 
apparently supervened upon an attack of acute purulent con- 
junctivitis. Under the use of a saturated solution of boric 
acid, both recovered, but with some destruction and cicatri- 
sation of the affected conjunctiva, and slight corneal opacity 
at the site of the ulcer. One of these cases I have previously 
reported.1 
Two other cases which I have observed were in adult males, 
in which there were patches of exudation on the conjunc- 
tiva of the lower lid of each eye, resembling that of faucial 
diphtheria, and which required several weeks to cure. These 
cases corresponded with those of so-called u chronic croupous 
conjunctivitis,” described by A. Critchett and Juler,2 and by 
Nettleship,3 Knapp4 also reports two cases of a similar 
character under the term “ croup of the conjunctiva.” 
1 “ Buffalo Medical and Surgical Journal,” August, 1884. 
5 “Transactions Ophthalrnological Society of the United Kingdom,” vol. iii, p. 1, 
8 “St. Thomas Hospital Reports,” 1880. 
4 “Archives of Ophthalmology,” vol. xi, 1882, p. 1. EXUDATIVE CONJUNCTIVITIS. 
7 
Another case1 of such conjunctival exudation has been 
seen by me, in which a thin pellicular membrane formed on 
the conjunctiva of one upper lid in a young man, debilitated 
and ansemic. There was marked conjunctivitis of a low 
type, and the pellicular exudate was easily removed with 
forceps, leaving the surface beneath bleeding at points, but 
only to re-form again soon. The disease was cured in a few 
days by instillations of boric acid solution. 
Still another case which occurred in my practice several 
years ago was that of a little girl seven years old, in whom 
the diphtheritic exudation seemed to extend from the throat 
through the nose to both eyes. The eye-lids became very 
much swollen, stiff, and discolored, and there was consider- 
able yellowish, watery secretion. The child died soon after 
the disease made its appearance in the eyes. 
General Remarks.—As to the nature and classification 
of exudations of the conjunctiva there appears to be a differ- 
ence of opinion. Mackenzie,2 the late renowned oculist of 
Glasgow, some years ago objected to making “diphtheritic 
conjunctivitis ” a “ genus or species ” in the classification of 
eye diseases, and regarded it rather as a symptom of “ much 
more serious changes going on in the deep-seated textures of 
the eye,” viz., of “ ophthalmitis,” which might be “ idiopathic, 
traumatic, and phlebitic,” and might “ follow measles, small- 
pox, scarlatina, and typhus, being in these last instances, in 
all likelihood, pysemic, or dependent on purulent infection of 
the blood.” But few, if any, who have had experience with 
this disease can agree with Mackenzie in his pathological 
views. 
There are those who hold that this is primarily a local dis- 
ease, while others believe it to be secondary, and but a local 
manifestation of a systemic disease. Some regard all exuda- 
tive cases as really diphtheritic, but in different degrees of 
severity. Others make two distinct varieties. One form they 
term “ croupous ” or “ membranous,” in which the exudation 
1 Keported in the "Buffalo Medical and Surgical Journal,” August, 1884. 
1 “ Royal London Ophthalmic Hospital Reports,” vol. ii, 1860, p. 176. 8 
NEW YORK STATE MEDICAL ASSOCIATION. 
is upon the surface of the conjunctiva, and may be easily 
wiped away, but soon to reappear again, which is generally 
limited to the palpebral portion, may be more or-less chronic 
in character, and may proliferate into polypoid or cauli- 
flower-like excrescences. The other form they designate 
“ diphtheritic,” in which the exudation takes place upon and 
within the conjunctiva, both ocular and palpebral, and into 
the tissues beneath, and which cannot be wiped away or 
removed without doing more or less injury to the adjacent 
parts. Other observers distinguish such varieties as “ cir- 
cumscribed,” “confluent,” and “diffuse” diphtheria (Hirsch- 
berg), and still others as “ partial ” and “ total.” 
I hold that a distinction should be made between the exu- 
dative forms of conjunctival disease ; and the division into 
croupous and diphtheritic conjunctivitis seems to me to be 
rational. In the first form, the exudation is fibro-plastic, 
superficial, partial, or more or less circumscribed; it can 
usually be removed easily, but re-forms again, and may super- 
vene upon an attack of catarrhal or purulent conjunctivitis. 
The symptoms vary in character, sometimes being mild and 
at other times severe, with swelling of the lids, chemosis, 
ulceration of the cornea, and much pain. The discharge is 
generally muco-purulent, sometimes altogether purulent. 
The exudation is not reproduced in others by communication. 
On the other hand, in the truly diphtheritic form the exu- 
dation is less circumscribed, is thrown out upon the surfaces 
of the conjunctiva, where it congeals into a semi-solid mass, 
frequently gluing the lids and the ball firmly together, and 
is also infiltrated into the tissues beneath. The lids become 
very stiff and much swelled, the upper one is elongated and 
overlaps the lower, the inner surfaces look yellowish-gray and 
anaemic, and the outer surfaces are dark-red and shiny. 
Frequently the skin of the lids vesicates, the vesication being 
soon followed by an external deposit of the diphtheritic exu- 
dation. The deposit upon and within the tissues so com- 
presses and chokes the blood-vessels that the nutrition of the 
cornea is seriously compromised, and too often it succumbs EXUDATIVE CONJUNCTIVITIS. 
9 
and sloughs, with permanent loss of sight. The «dis charge at 
first is comparatively scant, watery, and yellow. After three 
to eight days the exudation begins to soften, and the dis- 
charge becomes purulent. The constitutional disturbance is 
generally very great; an eruption resembling scarlatina is 
sometimes noticed, and the patient often dies. If death does 
not take place the eye recovers, sometimes with good vision, 
but more frequently with blindness, or with changes which 
very much deform the eye or impair its functions, these 
changes being due to the ulcerative processes, which are so 
destructive to the cornea and conjunctiva. The course of 
the disease is marked by much suffering, and it develops a 
specific virus which makes it directly communicable from one 
person to another. 
Thus it will be seen that the two diseases, croupous and 
diphtheritic conjunctivitis, present very different pictures in 
symptoms, results, and aetiology, and that the one is easily 
distinguished from the other. 
These diseases also differ in the indications for treatment. 
While it is not well determined as to what remedies should 
always be used, it is well determined what at certain stages 
and in certain forms should not be used. Certain caustics 
and stimulating agencies, properly applied, are permissible in 
croupous conjunctivitis, but in the diphtheritic form they 
are emphatically injurious. 
The proper treatment of croup of the conjunctiva seems to 
me to consist in strict cleanliness of the parts, the use of 
antiseptic remedies, and the occasional removal of the pseudo- 
membrane. In acute cases mild astringents should be fre- 
quently applied, and for this purpose, and also as an antisep- 
tic, I prefer boric acid solution. Weak solutions of nitrate 
of silver are also efficacious. In chronic cases, the careful 
cauterisation of the diseased surface, after the removal of the 
exudation, seems to be beneficial. As to other local applica- 
tions, a great variety Jiave been tried, but without any 
definite opinion having been formed as to their value. 
In treating diphtheria of the conjunctiva, Von Graefe’s 10 
NEW YORK STATE MEDICAL ASSOCIATION. 
original methods are still followed by many. These con- 
sisted in strictly avoiding caustics, at least until the onset of 
the purulent stage, and in using ice applications, leeching 
and other local blood-letting, mercurials, and most rigid and 
antiphlogistic regimen. In some cases, instead of cold, he 
used hot applications to the affected eye. Knapp1 says he 
“ knows of no more important remedy than the energetic and 
persistent application of cold,” and he does not endorse 
Mooren and Berlin, who use warm applications in the exuda- 
tive stage. Arlt2 recommends local bleeding in vigorous 
persons, and the use of cold to the lids proportionate to the 
degree of temperature in them. If “ the lids no longer feel 
hot, and especially if the applications are unpleasant to the 
patient, they should be stopped, or warm applications substi- 
tuted,” providing these are not contra-indicated by corneal 
ulceration. He doubts the utility of mercurials in this dis- 
ease. He says that a one per cent, solution of nitrate of silver, 
solutions of permanganate of potash, borax, chlorine water, 
etc., may be used later for the purpose of diminishing the 
secretion; but even without them “ the conjunctiva returns, 
in a few weeks, to its natural condition, so far as it has not 
become phthisical,” 
De Wecker3 says, “ Cauterisation and scarification should 
be avoided. Even cold must be employed but sparingly in 
severe cases. Alone of all the others, antiseptic treatment can 
be resorted to without misgiving from the very outset.” The 
amount of purulent discharge will decide the extent of cold 
that should be applied. The more marked the diphtheritic 
state, and the less the discharge, the greater the indication 
for heat. If the cornea becomes dull, and sloughs, abandon 
cold and use “warm aromatic fomentations, or compresses 
moistened with carbolised water, or a half per cent, solution 
of salicylic acid.” The only caustic “that can be directly 
1 “Archives of Ophthalmology,” vol. xi, 1882, p. 10. 
1 “ Clinical Studies on Diseases of the Bye, including those of the Conjunctiva, Cornea, 
Sclerotic, Iris, and Ciliary Body.” Translated by L. Ware, M. D. Philadelphia, 1885, p. 70. 
3 “ Ocular Therapeutics.” Translated by Litton Forbes, M. A., M. D., F. R. C. S. Lon- 
don, 1879, p. 68. EXUDATIVE CONJUNCTIVITIS. 
11 
applied to the mucous membrane in these cases,” he says, “is 
a strong solution of salicylic acid,” 1 to 10 of water with suf- 
ficient biborate of soda to dissolve the acid. “A preliminary 
application should be carefully tried, followed immediately 
by ablution in order to mitigate the pain.” If the vascularity 
of the conjunctiva is increased, its use may be persisted in. 
In some cases he advises certain forms of blood-letting, 
and, if not contra-indicated by weakness, bringing the 
patient under the influence of mercury, preferring inunc- 
tions for this purpose. The diet requires careful attention. 
Tweedy1 recommends the use of a solution of quinine, to 
be applied constantly to the eye by compresses wet in it, and 
frequently instilling it into the conjunctival sacs. His formula 
is,— 
Ijk Qninise sulpli. gr. iij. 
Acid, sulph. dilut., q. s. 
Aquse, §j. 
Nettleship2 says, “ The agents to be relied upon are 
(1) either ice or hot fomentations,—ice, if it can be used con- 
tinuously and well; fomentations, to encourage liquid exuda- 
tion and determination to the skin, if the cold treatment 
cannot be carried out, or fails to make any impression on the 
case ; (2) leeches, if the patient’s state will bear them; (3) 
great cleanliness.” 
Hirschberg, who has written considerably on this disease, 
advises iced applications and bran poultices, with mercurials. 
Dr. Bergmeister, of Vienna, and others, have used insuffla- 
tions of flores sulphuris (flowers of sulphur) with improved 
results. 
A. Yossius,3 of Giessen, has used a four per cent, solution 
of salicylic acid in glycerine, when aqueous solutions of car- 
bolic, salicylic, and boric acids had failed to benefit. The 
glycerine solution was painted on the conjunctival surfaces 
every half hour, with an immediate reduction of the swelling 
1 “Lancet,” vol. i, 1880, pp. 125 and 282. 
3 “ Students’ Guide to Diseases of the Eye.” Third Am. edition, 1887, p. 112. 
3 “Klin. Monatsbl. f. Augen,” 1881, Nov., p. 418; “Ophthalmic Review,” vol. i, 1882, 
p. 155. 12 
NEW YORK STATE MEDICAL ASSOCIATION. 
of the lids and chemosis, and the healing of a .large corneal 
ulcer, which threatened the destruction of sight. 
Dr. Mayweg,1 of Hagen, at the Heidelberg Ophthalmological 
Congress, 1884, spoke highly of the use of iodoform. His 
method was to open the lids, and, after thorough cleansing, fill 
the conjunctival sac with powdered iodoform, and then apply 
a pressure bandage. He stated that he had never failed to 
save the eyes when this treatment was begun before the 
cornea became affected. 
Alt,2 of St. Louis, contrary to the practice of most others, 
“treated the lids which came under my [his] observation, 
when the diphtheritic membrane was not yet large, or dur- 
ing its development, at once with nitrate of silver, thinking 
that the coagulation of the albuminous masses would act 
virtually in an antiseptic sense. The results were in the 
main satisfactory.” He admits, however, obtaining the best 
results in his last case, in which a continued antisepsis was 
kept up by instillations of bichloride of mercury, 1 to 2,500, 
every hour, and a solution of cocaine and atropia in a four 
per cent, solution of boric acid instilled every three hours. 
No nitrate of silver or other caustic treatment was used in 
this case. 
Other measures of combating this terrible disease, whose 
results are so disastrous to sight, have been recommended 
from time to time, but there is still much to be desired. My 
own treatment served me well in a most severe case, as well 
as in the more mild ones, but the experience is too limited to 
make it more than suggestive. I certainly shall repeat its 
use, if opportunity again presents itself. To recapitulate, it 
consisted essentially in cleansing the eye every half hour or 
hour with bichloride of mercury in a saturated solution of 
boric acid, 1 to 5,000, keeping compresses constantly applied 
wet with the same, and filling the conjunctival sac and pal- 
pebral fissure, and covering the cornea, with powdered boric 
acid, renewing it as often as dissolved or otherwise removed. 
1 “ Ophthalmic Keview,” vol. ill, 1884, p. 322. 
1 “American Journal of Ophthalmology,” vol. iv, 1887, p. 48. EXUDATIVE CONJUNCTIVITIS. 
13 
When the purulent stage was established, mild astringents 
and antiseptics were used, and, as such, the saturated solution 
of boric acid was selected. 
Other remedies may be used, and especially such as are 
indicated, when the cornea is affected, should be applied. As 
to prophylaxis in the diphtheritic form, isolation is important, 
at least from other children, as it is peculiarly a disease of 
childhood. When one eye only becomes affected, the other 
should be carefully protected. 
In this paper I have not attempted to present a systematic 
study of the subject, but rather to place on record some inter- 
esting cases of these rare forms of disease, and to direct 
attention to some methods of treatment that have commended 
themselves to other practitioners and to myself.