A Case of Persisting Hemorrhage 
from the Conjunctiva of a 
New-Born Infant, 
FOLLOWING THE LNSTLLLATLON OF A SOLUTION 
OF NITRATE OF SILVER. 
By G. E. DE SCHWEINITZ, M.D., 
OPHTHALMIC SURGEON TO THE PHILADELPHIA HOSPITAL. 
Reprinted from the Medical Record, April 18, 1891. 
It is well known that Credo’s method of instilling a 
drop of a two per cent, solution of nitrate of silver 
into the conjunctival cul-de sac of the new-born infant to 
prevent purulent conjunctivitis, sometimes is followed 
by hyperaemia and secretion of the conjunctiva, which 
usually disappears in a day or two. Very few instances 
are on record in which the reaction has assumed a dan- 
gerous type, and the enormous value of this prophylaxis 
of ophthalmia neonatorum has shown that its author’s 
judgment of the strength of the silver solution was wise. 
A few cases are known in which hemorrhage from the 
conjunctiva has followed this treatment, and has been at- 
tributed to the action of nitrate of silver. A notable ex- 
ample of this kind was published by Dr. Pomeroy in the 
Medical Record for August 20, 1887. In his case the 
instillation of a single drop of a two per cent, solution of 
nitrate of silver, carefully done and without laceration of 2 
the conjunctiva, was followed by violent pain, some se- 
rous discharge which rapidly became tinged with blood, 
and gradually developed into “ a slow, but persisting, ooz- 
ing of blood, startling to observe.” After treatment, con- 
sisting mainly of iced compresses and firm bandages, the 
hemorrhage stopped, but not before the condition of the 
infant was most alarming, and the hemorrhage so decided 
as to prove well-nigh fatal. 
The following case occurred in the maternity wards of 
the Philadelphia Hospital: A healthy colored woman 
was delivered, at 7 a.m., of a female child. The birth 
was a rapid one, the delivery of the head and the rupture 
of the membranes being almost simultaneous. The liquor 
amnii was of a dirty-yellow color and thick consistency. 
A drop of a two per cent, solution of nitrate of silver was 
instilled after the manner of Crede. Three hours later 
there was redness of the eyes and some discharge. The 
resident physician then made a second instillation of two 
drops of a nitrate of silver solution, twenty grains to the 
ounce. This was carefully done, and there was no lacera- 
tion of the conjunctiva. The eyes immediately were irri- 
gated with a saturated solution of boric acid, a treatment 
which afterward was continued each hour. At eleven o’clock 
at night no purulent discharge was manifest, but a bloody 
serum began to exude between the lids. The next morn- 
ing iced compresses and a lotion of alum, four grains to 
the ounce, were used. In the afternoon I saw the case, 
and found a fairly well nourished infant with persistent 
bleeding from the tarsal conjunctiva of both eyelids, the 
blood leaking out between the palpebral fissures, some of 
it apparently having found its way through the lachrymal 
canals into the pharynx, as the child vomited some blood- 
stained material. The alum collyrium was continued, 
but no bandages were applied. The next day the hemor- 
rhage continued, and with considerable severity. The 
eyelids were puffed up and their under surfaces covered 
with a very tenacious clot. This was removed with for- 
ceps, and the hemorrhage seen to occur from numerous 3 
points in the form of a persistent oozing. The blood 
clotted readily. At the end of the third day the hemor- 
rhage stopped, and the bloody discharge was replaced by 
a slight purulent secretion. A small linear ulcer formed 
near the edge of the cornea, which rapidly healed under 
the use of eserine. The child was somewhat shocked by 
the loss of blood, and the bodily temperature was main- 
tained by the application of external heat. 
The mother of this child was perfectly healthy, and 
never had experienced excessive bleeding herself. She 
knew of no member of her family who had been so af- 
flicted. It was not possible to interview the husband, 
but the wife stated that he had not been a “ bleeder,” 
nor, so far as she was aware, had there been any haemo- 
philic tendency in his family.1 Examination of the blood- 
clot did not reveal any unusual composition. There was 
no scar in the conjunctiva, after it healed, to indicate that 
any injury had been done to its surface. 
While it is not possible to prove that this child bled so 
persistently from the conjunctiva because of two drops of 
the silver solution, first of two and then of four per cent, 
strength, it is none the less true that the hemorrhage 
followed such applications, and, moreover, occurred not 
in association with the development of an ophthalmia 
neonatorum, as the original discharge, which appeared 
only three hours after instillation, seems more likely to 
have been of that character which has been noted in sev- 
eral instances as the result of the reaction produced by 
the nitrate of silver. 
I am indebted to Dr. Frances C. Van Gasken for her 
intelligent care of this case, and to my colleague, Dr. 
Montgomery, for the privilege of having seen it. 
1 So far as the writer is aware no cases of haemophilia have been 
described in the colored race.