A COMPARISON 
BETWEEN THE RESULTS § TREATMENT 
IN 
ONE HUNDRED CASES 
OF 
OPHTHALMIA NEONATORUM IN PRIVATE, 
AND 
One Hundred (’uses in Hospital Practice. 
By S. 0. AYRES, M. D,, Cincinnati. 
Reprint of Lancet and Observer, January, 1876. A COMPARISON 
BETWEEN THE RESULTS I TREATMENT 
IN 
ONE HUNDRED CASES 
OP 
OPHTHALMIA NEONATORUM IN PRIVATE, 
AND 
One Hundred Cases in Hospital Practice. 
By S. C. AYRES, M. D., Cincinnati. 
Ophthalmia Neonatorum is a disease not unfrequently met 
with in private practice. It occurs more frequently among 
the poorer classes and those uncleanly in their habits, hut the 
higher classes are not exempt. It sometimes runs a mild 
course and terminates favorably, hut at other times it is very 
violent and leaves the eyes more or less damaged. 
No one will deny the importance of this disease, and no one 
who has treated a case will question its danger to vision. It 
is a form of eye disease, which more frequently falls into the 
hands of the family physician, than the specialist, at least in 
its earlier stages. Various causes are assigned for its origin. 
It has been claimed that it is usually excited by contact of 
specific or acrid vaginal discharges, with the conjunctiva du- 
ring the act of parturition. There are undoubtedly many 
cases where there is no abnormal vaginal discharge in the 
mother and yet where the blennorrhoea assumes a violent form. 
On the other hand the children of mothers suffering from go- 2 
Ophthalmia Neonatorum, Etc. 
norrhoea, often escape entirely. Want of cleanliness in wash- 
ing the child after birth, impure air, sudden changes in tem- 
perature, atmospheric poisons, defective nutrition, exposure of 
the infant to bright light, have all been assigned as causes for 
this disease. Under favoring circumstances any one of them 
might be sufficient to account for its development. 
While it is important to know the cause in all cases if pos- 
sible, yet it is not essential to the treatment, for that depends 
on the severity of the case. 
Whatever may be its origin, and it is often obscure, we have 
a dangerous inflammation to deal with, and one which should 
receive the prompt and faithful attention of the attending 
physician. Unfortunately for the poor children it is often 
considered a simple, harmless inflammation which will pass off 
in a few days. Some simple collyrium is ordered and the 
case is entrusted to the nurse. She follows instructions, and 
the case progresses until it becomes alarming, when the child 
is sent off to some specialist. In other cases the nurse takes 
it upon herself to treat the case, until her resources are ex- 
hausted, when she calls upon a physician, who may consider 
himself fortunate if he does not find the corneae ulcerated and 
sloughing. Many of these cases fall into the hands of mid- 
wives. They are generally as ignorant as they are conceited, and 
undertake to treat the eye, unwilling to acknowledge that any 
one knows more than they. The consequence is a large pro- 
portion of the bad cases, which fall in the hands of the spec- 
ialist, have been treated by these women until, either the par- 
ents become alarmed and desert them, or the child is found to 
be blind. The distressed parents generally tell the same story, 
the midwife said that there was no danger, that children often 
had such inflammations and recovered entirely, and that she 
used “breast milk” and “chamomile tea,” and some other 
simple remedies “ which would do no harm if they did no good.” 
Thus are the anxious fears of the parents quieted, by one 
who is too ignorant to know the danger, and to stupid to see 
it when it is pointed out. 
In the smaller towns and in the country these cases are sub- 
jected to most inefficient treatment, or shamefully neglected. 
The patient is often several miles from the doctor, and he is 
not able to give it that attention it deserves, and has to entrust 
the treatment to the nurse or the old women of the neighbor- 
hood. Many physicians seem to be afraid to treat the disease. 
They do not attack it as they do inflammations in other parts 
of the body; if they did, their results in its treatment would 
be much better than they usually are. We feel justified in Ophthalmia Neonatorum, Etc. 
3 
making the assertion that less judgement is used in its man- 
agement than in that of any other disease to which infants are 
liable. 
This seems like a bold assertion, but we think that the sta- 
tistics presented below of one hundred cases in private prac- 
tice, compared Avith one hundred cases treated in the Cincin- 
nati Hospital, carry us out in it. 
These cases are recorded with the condition of the childs 
eyes, at the time it Avas presented for treatment. They had 
all of them been under the care of their family physician, or 
midAvife, or nurse up to that time. 
The ultimate result in all these cases cannot be knoAvn, as 
the vision often continues to improve,even for years Avhile the 
child is growing and developing. Thus very unpromising 
cases in the beginning, turn out much better than could safely 
be predicted for them while under active treatment. But 
enough is knoAvn to show the disastrous results of the disease, 
and its effects on the vision of the little sufferers. 
These cases are recorded in the order in which they were 
admitted for treatment. 
No. 
Age. 
Complications. Result Right Eye. 
Result Left Eye. 
1 
3 days 
2 
3 weeks 
. Central ulceration of 
cornea 
both cornese Not recorded 
Not recorded. 
3 
3 weeks 
. None..... Favorable 
Favorable. 
4 
2 months... 
. Ulceration and perfora- 
tion of both cornese.. Cen’l opacity of cornea Central opacity of cor- 
leucoma adherens 
nea and leucoma ad- 
some chance for iri- 
herens, hopeless. 
deetomy 
5 
2 months... 
. Blind from ulceration & 
perforation of cornese. Hopeless 
Hopeless. 
6 
4 weeks 
. Ulceration and perfora- 
tion of left cornea Favorable 
Not stated. 
7 
. None Favorable 
Favorable. 
8 
3 weeks 
. Ulceration of left cornese Favorable 
Opacity of cornea. 
9 
2 weeks 
. None Favorable 
Favorable. 
10 
9 weeks 
. Ulceration of cornea;.... Leucoma adherens 
Leucoma adherens. 
11 
5 days 
. None Favorable 
Favorable. 
12 
4 weeks— 
,. None Favorable 
Favorable. 
13 
3 months... 
,. None Favorable 
Favorable. 
14 
15 
3 weeks 
,. None Favorable 
Favorable. 
16 
5 weeks 
.. Ulceration and perfora- 
tion oi cornese Macula cornea 
Macula cornea. 
17 
2 weeks 
.. None Favorable 
Favorable. 
18 
19 
3 weeks 
. None Favorable 
Favorable. 
20 
21 
8 weeks 
.. None Favorable 
Favorable. 
22 
.. None Favorable 
Favorable. 
23 
1 year 
. Ulceration of cornese.... Macula cornea 
Macula cornea. 
24 
.. None Favorable 
Favorable. 
25 
4 months.. 
,. Ectropion and ulcera- 
tion of cornese Macula cornea 
Macula cornea. 
26 
27 
3 weeks 
.. None Favorable 
Favorable. 
28 
2 weeks 
,. Ulceration of left cor- 
29 
30 
3 weeks 
.. Ulceration of cornese..,. Not recorded 
Not recorded. 4 
Ophthalmia Neonatorum, Etc. 
No. 
Age. 
Complications. Result Right Eye. 
Result Left Eye. 
31 
5 months... 
. Corneae clear hut lids 
granulated Favorable - 
. Favorable. 
32 
4 weeks 
. None Favorable 
. Favorable. 
33 
4 weeks 
34 
. None Favorable 
. Favorable 
35 
. Ulceration left cornea... Favorable 
, Macula cornea. 
36 
. None Favorable 
, Favorable. 
37 
6 weeks 
. Ulceration right corneae Not recorded 
, Favorable. 
38 
6 weeks 
. Ulceration right corneae Not recorded 
, Favorable 
39 
16 months.. 
. Ulceration of corneae ... Macula cornea 
, Macula cornea. 
40 
5 weeks 
41 
. None Favorable 
Favorable. 
42 
. None Favorable 
, Favorable. 
43 
3 weeks 
. Ulceration and perfora- 
tion of left corneae Favorable 
, Leucoma adherens. 
44 
2 years 
. Blind from ulceration & 
perforation of corneae Hopeless 
Hopeless. 
45 
2 months .. 
. Ulceration of corneae... Macula cornea 
Macula cornea. 
46 
4 weeks 
. Ulceration of corneae.... Not recorded 
Not recorded. 
47 
. Blind from ulceration & 
perforation of corneae. Hopeless 
Hopeless. 
48 
2 weeks 
. None Favorable 
Favorable. 
49 
11 weeks-.. 
. None Favorable 
Favorable. 
50 
4 weeks 
. Large ulceration & per- 
foration of corneae Not recorded 
, Not recorded. 
51 
52 
3 months.... 
. None Favorable 
Favorable. 
53 
2 weeks 
. None Favorable 
Favorable. 
54 
2 weeks 
. Perforating ulcer of left 
55 
10 days 
. None Favorable 
Favorable. 
56 
3 weeks 
57 
7 days 
. None Favorable 
Favorable. 
58 
. None Favorable 
Favorable. 
59 
4 days 
. None Favorable 
Favorable. 
60 
8 months.... 
. Ulceration of corneae... Macula cornea 
Macula cornea. 
61 
13 days 
. Ulceration right corneae Favorable 
Favorable. 
62 
6 weeks 
. Central sloughing of 
63 2 years 
. Ulceration and slough- 
ing of corneae Lencoma adherens 
Lencoma adherens. 
64 
5 weeks 
. Ulceration and perfora- 
tion left eye Favorable 
Hopeless. 
65 
7 months.... 
. Ulceration and slough- 
ing of corneae Moderate vision 
Hopeless. 
66 
12 days 
. Ulceration of corneae.... Favorable 
Favorable. 
67 
. Left cornea ulcerated.... Favorable 
Favorable. 
68 2% years 
. Blind from sloughing of Eye blind and staphy- 
corneae lomatous 
Eye atrophied. 
69 
4 weeks 
. Ulceration of corneae.... Macula cornea 
Favorable. 
70 
71 
2 weeks 
. None Favorable 
Favorable. 
72 
3 months.... 
, Blind from ulceration & 
sloughing of corneae... Eye atrophied 
Eye blind & staphyl’t’s. 
73 
. None Favorable 
Favorable. 
74 
75 
3 weeks 
. None Favorable 
Favorable. 
76 
. None Favorable 
Favorable. 
77 
. None Favorable 
Favorable. 
78 
. None Favorable 
Favorable. 
79 
9 days 
. None Favorable 
Favorable. 
80 
2 months.... 
. Ulceration and slough- Leuconia adherens, eye Leucoma adherens, iri- 
ing of corneae lost 
dectomy &mod. res’It. 
81 
4 weeks 
. None Favorable 
Favorable. 
82 
. None Favorable 
Favorable. 
83 
4 weeks .... 
. None Favorable 
Favorable. 
84 
3 months.... 
• Ulceration and slough-Leucoma adherens Ci ’ee Leucoma adherens— 
mg of corneae for iridectomy 
hopeless. 
85 
. None Favorable 
Favorable. 
86 
3 weeks 
. Ulceration right corneae Not recorded 
Favorable. 
87 
. Blind from ulceration & 
sloughing corneae Hopeless 
Hopeless. 
88 
.None Favorable 
Favorable. 
89 
4 months... 
. Perforating ulcers of 
cornea} Vision fair 
Vision fair 
90 
. None... Favorable 
Favorable. Ophthalmia Neonatorum, Etc. 
5 
No. Age. 
Complications. 
Result Right Eye. 
Result Left Eye. 
91 3 months... 
. None 
Favorable 
.. Favorable. 
92 14 days 
. Small ulceration of each 
cornese 
Not recorded 
.. Not recorded. 
94 7 days 
.. None 
Favorable 
.. Favorable. 
96 10 days 
.. None 
Favorable 
... Favorable. 
97 4 weeks 
.. Ulceration right cornese Not recorded 
... Favorable. 
98 2 weeks 
.. None 
Favorable 
. Favorable. 
99 
100 3 weeks.... 
.. None 
Favorable 
... Favorable. 
In looking over the condition of the patients previous to the 
commencement of the treatment we find the following as the 
result. 
Fifty-eight per cent, were free from corneal complication, 
while in forty-two per cent the integrity of the eye was more or 
less impaired. 
Six per cent, were hopelessly blind in both eyes and jive 
per cent, in one eye from ulceration and sloughing of the 
cornea. Of the latter five cases we find the other five eyes 
terminated as follows: one favorably, one with chance for 
iridectomy, one with moderate vision after iridectomy, two with 
leucoma adherens in which an iridectomy was followed by toler- 
able result in one, and the remaining eye was not operated on. 
So that of twenty-two eyes affected in these eleven cases only 
one recovered with good vision. Ten per cent, recovered with 
more or less extensive opacities of both cornese and three per 
cent, with opacity of one cornea. Leucoma adherens of both 
eyes occurred twice and of one eye five times. The results in 
eleven cases are not recorded, five of central ulceration of both 
cornese, one of ulceration and perforation of the left cornea, 
one of ulceration and perforation of both cornea, and four of 
ulceration of the right cornea. Good results are recorded as 
following once after central ulceration of both corneae, once 
after ulceration of the right and once after ulceration of the 
left cornea. 
Of the eleven cases, in which the results are not recorded, we 
may say that they were complicated by severe central ulceration 
of one or both corneae, and tlaat \t would be unreasonable to 
expect all of them to make good recoveries. 
All of the 58 cases which were seen before the cornea had 
become implicated, recovered with perfect vision. The treat- 
ment persued in these was practically that described below as 
having been carried out in the Hospital. In none of them did 
the cornea become involved at any time during the course of 
treatment. 
Now in contrast with this result I am able to present the 
statistics of one hundred cases of ophthalmia neonatorum 6 
Ophthalmia Neonatorum, Etc. 
treated in the Cincinnati Hospital which Avere kindly collected 
for me by Dr. Watson. The record extends from March 2, 
1871, to March 11, 1875, inclusive. 
During this period one hundred cases were treated and in 
not a single one did any corneal complication arise and all 
recovered with good vision. They commenced as such cases 
usually do, and often many threatened to run a violent and 
destructive course, but under a simple but judicious treatment, 
were brought through to a favorable termination. We might 
reasonably expect, in the class of patients Avhich we find in 
our hospitals, to have more trouble in the management of 
such a disease as purulent conjunctivitis than we would have 
in private practice. 
We here look in vain for an explanation of the origin of 
this disease. The mothers are nearly all reported healthy. 
Six had offensive lochia after confinement, one had cystitis 
soon after delivery, one had erysipelas four days after confine- 
ment, three Avere anaemic, one had phthisis, one bronchitis, 
and one vaginitis. It is impossible to state hoAv many may 
have had gonorrhoea at the time of confinement, hut probably 
the number is not large. The greatest care is always exercised 
by the nurse in washing the child. The face and eyes were 
always attended to first and washed in clean wmter before the 
rest of the body was touched. 
The infants were all placed in as nearly equally favorable 
hygienic circumstances as possible, and yet out of 726 born 
during the period above questioned 100 had purulent con- 
junctivitis in a more or less seArere form. 
The greatest number 47 occurred in 1872, against 20 in 
’73 and 14 in ’74. 
Season of the year, seems to have had but little influence, as 
the largest number occurred in June, (14,) January (13,) and 
July (12,) respectively, and the smallest number in February 
and November, 5 in each month. 
The treatment of these cases Avhich was carried out almost 
entirely by the internes under the supervision of the attending 
oculist on duty, was Avith little variation as folloAvs: 
The eyes Avere cleansed every hour or half hour or even 
oftener in cases where the discharge Avas very profuse by gently 
separating the eyelids Avith the fingers and removing the 
accumulated pus with a soft rag or camels hair brush. A 
solution of alum, gr. ij. ad. aqua §ss. or of argent nitr, gr. ij. 
ad. aqua 5i« was dropped into the eye every hour or two. 
My colleague, Dr. Aub, uses cold compresses, day and night, 
in the acute stages. While I am not partial to them in the Ophthalmia Neonatorum, Etc. 
7 
purulent conjunctivitis of infants, yet, I occasionally order 
them. 
Every morning the eyelids were everted and brushed with a 
solution of argent, nitrat. grs. v. ad. xx ad. aq. dest. 
according to the severity of the case, and the lids washed off 
with tepid water. Unless the swelling of the lids mechanically 
prevented it, the cornea was inspected daily in each case. 
As the case improved the interval between the instillations of 
alum and argent, nitrat. was increased, and finally discontinued 
entirely, but the argent, nitrat. was continued in a weaker or 
stronger solution, until every trace of the disease had dis- 
appeared. 
The greatest stress was laid upon the thorough cleansing of 
the eye in the acute stages of the disease, and this was 
attended to not only by day but by night. 
To this part of the treatment, do we owe the immunity of 
the cornea from ulceration. The pus is neutralized or coagu- 
lated by the action of the nitrat. and alum, and its corroding 
effects thus prevented. 
Another important point in hospital treatment is that the 
cases receive attention immediately the slightest swelling of 
the lids is noticed and the severity of the disease is probably 
thus diminished. 
When the lids are very much swollen their eversion is an easy 
matter. Slight pressure with the tip of the index finger, upon the 
lid near the edge of the orbit, will generally suffice, or a probe or 
the handle of a camels hair brush may be used instead of the 
finger. As the lids get thinner their eversion is much more 
difficult. Then it is better to seize the ciliae between the 
index finger and thumb, or, the loose skin near the margin of 
the lid, and draw it a little down and out from the ball, and at 
the same time make pressure upon the upper edge of the 
tarsus, which if properly directed easily everts it. 
The best plan is for the operator to lay the child across the 
nurses lap and take its head between his knees, after first 
protecting them with a towel. In this way he can control 
the motion of the child’s head most easily, and make the 
applications most effectually. 
When a treatment so simple is followed by such excellent 
results, why is it that forty-two per cent, of those cases in private 
practice, no more severe in the beginning, than those in the 
Hospital practice, are followed by such disastrous results? 
There is nothing in the treatment which any intelligent physi- 
cian could not carry out successfully, and yet they will neglect 
and slight them. An oculist can not be on hand to treat every 
case, and there is no need of one. 8 
Ophthalmia Neonatorum, Etc. 
If purulent conjunctivitis was treated as promptly and care- 
fully as other infantile diseases are, we would have fewer blind 
in our asylums, and much less suffering and distress to the 
world. 
How few who visit our institutions for the blind ever think 
of the cause and prevention of the diseases which fills them. 
Sympathizing friends gaze upon the poor blind children as they 
move about, guided by their delicate sense of touch, and won- 
der why Providence should so afflict children who seem, other- 
wise, healthy and well developed. Generous donations often 
show how deeply these unfortunates excite the sympathy of 
those who can afford to he liberal to the afflicted. It is well, 
perhaps, that but few besides medical men can look behind the 
curtain to see the cause of all this trouble. 
This is a question which belongs not alone to the medical 
profession, but to the public—to the tax-payer and to the Leg- 
islator. Many of these children are thrown upon the-chari- 
ties of tKe State for protection and education, at a heavy ex- 
pense to the people. Could this expense be avoided, and the 
life-long affliction of the children prevented, by judicious 
treatment, certainly the State and the people would both be 
better off.