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and still more foolishly attempting to persuade the people to reject the son, because the father was instrumental in exposing their own selfish betrayal of the trust reposed in them by the people themselves. But they succeeded in this case as badly as in the other. And in view of the failure of their, original attempt at fraudulent suppression of the truth (fraudulent because based on false pretences), and in view of the signal failure of their recent attempt to punish those who exposed their first, it is highly probable that these high and aristocratical medical officials are now employing themselves in seriously considering whether honesty is not the best policy!
Ojphthahnological Contributions. By Theodor Ltebold, M.D.
OPHTHALMIA NEONATORUM. This disease comes now and then under the treatment of every physician, and therefore every one ought to be well acquainted with it and its best modes of treatment—" Cured, only a small speck on the cornea remaining," is frequently the reported result; but this small speck is no small affair for the patient, especially if situated right over the pupil. Aside from the fact that it does not look well, it is always a serious inconvenience for the patient, as even the slightest haziness prevents distinct vision, and the rays of light being diffused, it dazzles the eye very much, and keeps up frequently a hyperesthesia of the retina. So much for those who consider it only a slight affair, easily cured by internal homoeopathic remedies.
My position is that it is a purely local disease, and must be treated locally. That it is inoculated is best proved by the fact that it produces its own species again, just as well and sure as gonorrhoea and chancroid, moreover, it produces itself only again on the spot where it was engrafted, and that in a relatively short time, from a few hours to at most two or three days. Herein it differs from those infectious diseases, as syphilis (indurated chancre), small-pox, diphtheria, &c., which infect and infest the whole constitution before they show their external marks, and their state of incubation is therefore much longer.
A purulent or blennorrhoeic infection may be caused at any time during life, on a mucous membrane, and, therefore, what holds good for one, will Bo for the other. It would have been better to make the heading read, "Purulent Ophthalmia," than to single out the one part, which affects new-born children, but as it is once there, we will let it stand, as its most frequent representatives in numbers, and the purest in type. Ophthalmia neonatorum, only that inflammation can strictly be so called, which mnnifests itself not later than three days after birth. Some have spoken and written of the same in children six and twelve months old, they are cousins, I think, of the Doctor, who diagnosticated cholera infantum in a patient fifty years old.
Causes.—Bad care, crowding (in lying-in-asylums), strong light, sudden change of temperature, &c., &c., hare been accused, in my opinion, with not more right than if the same were said now-a-days to cause syphilis. But as syphilis can be undoubtedly inoculated in any way besides that during coition, provided that only the tine qua non, the syphilitic matter is brought in contact with a surface denuded or insufficiently protected with epithelium, is fulfilled, so a purulent ophthalmia may be occasioned at any time, and in any way that brings purulent or blennorrhceic matter in contact with the mucous membrane of the eye. A towel, a sponge is frequently the medium. Those Dangerous Sponges, as von Graefc calls them, have certainly caused not only many a blind eye, but even death by purulent infection or pyaemia. They ought certainly, and the time will come when they will be banished from all well regulated hospitals, as cleaning instruments, because they cannot with any possible ordinary care be kept clean themselves from pus, which finds a secure resting-place in their porous substance. The higher temperature of the sick-room certainly deteriorates the pus, "bonum et laudabUe" into a poisonous matter, and, therefore, not only another person may suffer from it, but even self-iufection is possible. I tried, when in Point Lookout General Hospital, to disinfect the sponges, as they are undoubtedly a very convenient and handy mode of cleaning wounds seemingly: but Chlorine as well as Permanganate fluid destroys them very quickly if done carefully; this makes this disinfecting process too expensive in large establishments, and, on the other hand, patients or nurses will not do it carefully, and each time after using them. So I discarded them, too, after a while entirely, telling the patients "why and wherefore," using the syringe and litter balls of oakum or picked lint instead. I cannot say that I saved this or that one from gangrene or pyaemia, but I know that those dreadful scourges were most frequent in those wards where the cleanliness was only superficial, and due care in this respect not exercised.
Strong light is certainly not a canse of a purulent ophthalmia: if it affects any structure, it is that of the r d by reflex action the moment too
much light strikes the same, .e are closed involuntarily in the newborn as well as in the old. All ch_Jren I have seen come into the world, had their eyes closed with a will and a determination, that has certainly protected many a one from purulent ophthalmia, provided they had plenty of water at their disposal immediately after. .
I do not say that every mother whose child becomes affected with purulent ophthalmia has a gonorrhoea;—by no means, it may be an acrid leucorrhcea, but it is certainly purulent matter of some kind. Here it will be perhaps the best place to allude to that application of the homoeopathic law by allopathic oculists, known as the cure of pannus by inoculation.
Dr. Piringer, of Germany, made the first experiments, I think, some thirty years ago, to cure, by means of exciting a flesh inflammation, pannus of the cornea, the effect of granular conjunctivitis, some cases of which really appear incurable under any kind of treatment. He inoculated from a new-born child affected with purulent ophthalmia such a case. A violent inflammation was'the consequence, which after running its course, left the mucous membrane smooth and the cornea clear. Certainly one of the most wonderful applications of the homoeopathic law.
Dr. George Lawson, Assistant Surgeon to the Royal London Ophthalmic and Middlesex Hospitals, writes in "The Royal London Ophthalmic Hospital Report, Vol. IV., Part II., 1864:
"The number of cases of severe granulations of the lids, accompanied with vascular cornese, which have been treated by the inoculation of purulent matter at the Hospital proves indubitably the success of this line of treatment. It is, however, necessary that the disease should be sufficiently advanced before such a mode of dealing with it can with safety be resorted to. The greatest success has resulted in those cases, where the lids were not only severely granular, but where the whole cornea was completely vascular, semi-opaque, thickened, and the pupil scarcely visible; where, in fact, there was Httle if anything to lose, and all to gain. Such eyes will bear strong purulent matter, as the yellow pus from an infant with purulent ophthalmia, whose mother may have suffered from gonorrhoea, and after a long course of suppuration, will almost invariably recover, and good useful sight will be regained.
"In the treatment of granulations by inoculation, much discrimination is required in the selection of the cases, and in the quality of the pus which should be used.
"The strength pf the pus, with which you wish to inoculate, may be judged of: 1st. by the color, and 2d. by the severity and duration of the inflammation which it has excited in the eye from which it is taken. The yellow pus is always more active, than the whitish discharge so commonly seen. Again, the period of the disease at which the pus is taken influences materially the amount of inflammation and suppuration it is capable of setting up. Pus from the eye of an infant in the early and most acute stage of purulent ophthalmia, will produce much more serious effects than that taken from the same eye at a later period of the disease, after it has undergone some treatment, and is ii> tiie'rVcline.
"Another point of practical imp 1> settled by the experience of
the Hospital. • . I -dl .'
"Pus fiesh from the eye of an infanf'gives-rise to a more moderate suppuration, with less oedema of the lids than when taken from an eye which is suffering from inoculation. The strength or virulence of the pus seems to increase in its travel through one or twq eyes, so that if A. is inoculated with mild purulent matter, the pus from A:'s eye will produce more intense ophthalmia in the eye of B. than the original pus which inoculated it.
"The most certain and effectual cure of severe and otherwise intractable granular lids undoubtedly is inoculation.
"Many other remedies give great, but temporary relief, and many cases, in course of time, get, to a certain extent, well; but the only remedial agent which will for a certainty destroy the granulations, and leave the lining membrane of the lid smooth viithin a definite period of time, is inoculation."
The disease is too well known to need a minute description here, and it remains to discuss its treatment. First the allopathic.
The most approved method is the caustic, and this is undoubtedly homoeopathic again. He who uses the Nitrate of Silver against purulent ophthalmia, is using a homoeopathic remedy, because if applied to the healthy mucous membrane, it produces an inflammation and a consequent suppuration very similar to that caused by purulent matter or other causes. It is not my intention to enlarge here upon the use of caustics in ophthalmic practice, I will leave this for another article. Only to a few points I would call the attention of those who use the Arg.-nitr. in this disease.
1. In fresh and acute cases we dare not use it too strong, that is not over iij. to v. grs. to |j. of water; if used too strong, it takes too long before the eschar is thrown off and reaction established, and in the mean time, the presence of the eschar after 12 to 20 hours seems frequently to have given rise to affection of the cornea, which persists afterwards.
2. Repeat only after reaction hm set in completely again, and this must be studied in every case separately; in some cases it is not only allowable, but must be repeated in six hours to secure the full beneficial results of this treatment, and in others, thirty-six hours are too early for a repetition.
3. If ulceration of the cornea exists already when the case is taken in hand, the Arg.-nitr. and the lead washes should be discarded entirely, because they not only throw down a deposit, but frequently enter into an organic compound, forming tissue, impenetrable to light, and unimprovable to even nature herself, which often very much thins and disperses other common scars and spots on the cornea, in the young in the course of time.
Though there is happily little danger that homoeopathists will use the Nitr. of Silver too strong, I doubt very much if weak solutions (gr. J-j. to |j.) do much good in inveterate cases; then it is generally directed to put a few drops in the eye once in so and so many hours, and thereby a continual irritation is kept up without allowing improvement to set in, or making sufficient impression on the disease. Secondly, the homoeopathic treatment, Aeon., Apis., BelL, for the inflammatory, and Hepar, Mercur., Sulpb., for the suppurative stage, have been, and still are the principle remedies in the different varieties of purulent ophthalmia. They do very well in light cases, but I have never seen them of much benefit in severe cases. In true gonorrhcaal ophthalmia, the eye is often destroyed in a very short time, and we need energetic local means to destroy the virus • and keep down the intense inflammation which threatens to destroy the organ. Happily we possess such a remedy in the judicious application of cold water. When in Point Lookout, I learned from a surgeon of the army a way to cure gonorrhoea, which has succeeded with me better than.any other. The simple prescription is: Patient put to bed, low diet, and urethra syringed out by means of a catheter every hour or two with ice cold water. The catheter, either a very small one or a double, is introduced up to the portk) membranacea, already filled with water, so that no air is introduced, and the urethra thoroughly washed out; the patient very soon learns to do it himself. The rationale of the treatment is very simply this: to dilute and to wush away the thick and tenacious infecting matter itself, which certainly only acts as a constant source of irritation. The cold contracts the swollen and inflamed mucous membrane, and brings on a healthy reaction. The same treatment I use in all purulent ophthalmias. The syringes for the eye known to me, I found it impracticable to introduce under the lids, where in the conjunctival sac often incredible masses of pus collect, retained by the forcible and involuntary closure of the lids. I had, therefore, a subpalpebral eye syringe constructed, which Messrs. Tiemann & Co., of this City, make now very nicely. The accompanying cut explains itself.
It can be introduced under the lids without any assistance to czz^ keep the lids apart, and it is almost impossible to do any injury to the eye, even if one had such a purpose. The mouthpiece is of hard India rubber, and is rounded off everywhere. Any mother of ordinary powers of understanding learns to use it herself very soon, and if told the possible consequences of negligence, generally will use it carefully. The frequency of its use depends entirely on the severity of the disease. If the pus collects every ten minutes, have it syringed out every ten minutes, day and night, until the danger is passed. To save an eye, no trouble is too great. In the inflammatory stage, the external application of cold should be continued with the internal. The best way to do this is to put a piece of oiled muslin on the eye, the rags, which are kept on ice lying on sticks of wood in a basin, are put on the muslin, after the water has been squeezed out of them, as it is not exactly necessary that the patient is kept hi a pool of water. In FroC von Graefe's Hospital I have seen the rags changed every^J5-20 seconds by the watch, in cases of gonorrhoeal ophthalmia and diphtheritic conjunctivitis. This is continued until the temperature is sensibly diminished, then rest is given until the heat augments again, when the process is resumed.
How long is the cold to be continued? Patients who are old enough to talk, will soon tell you when the cold becomes disagreeable, and then it is the right time to discontinue the ice; in children, the touch and appearance will show when the inflammation abates.
The cold is not to be used under any circumstances when the cornea is affected with ulceration before the case comes under treatment: then the stage where it does do good has passed, and experience has shown that it always in ulceration of the cornea does harm. Then the eye has to be syringed with warm water, and warm moisture has to be employed externally to promote the formation of vessels on the cornea, which are absolutely necessary for the repair of the tissue. The redder a cornea looks, and the larger the vessels leading from the Conjunctiva to the ulcer the belter. Those pale, gray, central ulcers are most to be dreaded, they lead very frequently to total destruction of the eye.
I think I have reason to believe that the Hydrastis-canadensis is a very valuable remedy in the suppurative stage. I employ it in the following manner: An infusion of the Hydrastin gr. j. to |ij. of water or weaker is used to syringe the eye with as often as the case seemed to demand.
In all cases where an infection is to be supposed, and only one eye is yet affected, prudence requires to seal the other hermetically up so that no matter can come into it First, clean picked lint on the eye, then a piece of lint or muslin, and over this, narrow straps of adhesive plaster; over the crevices, Collodium. But the eye must be inspected every twelve hours at least, to be sure that no inflammation is commencing underwit, andjthe dressing removed if such should be the case.