A CRITICAL STUDY OF ORGANIC PREPARATIONS OF SILVER IN THE TREATMENT OF CONJUNCTIVITIS
Authors: J. M. Kelly
Journal: BMJ (1907)

tC ORAL 1475 the'past-two years, in spite of treatment; "Six years ago the eyes were similarly affeoted..The pregent, atack has lasted fQr a month.the.hJldkpindoors.all.day;_theaxmarkd conjunctivitis and pbptopbobla,.but no rhinorr4oea.There Is no famaily history of tubercle-, bqt of-Iten stillborn children.The eyes showed largelphlyctenulae.4She was treated in the usual way, and recovery was complete in a few days.A. C. came with all-the symptpma of a severe chronic catarrhal conjunctivitis, oomglicated by. the p esence, of a septic ulcer on the left cornea.Shelgave a history of sore eyes for the previous year, but they had probablybeen In this condi- -tion for a longer period, rs most of the cilia were missing, and some of those present were distorted.She was treated with boracic lotien, atropine and fomentations, with the result that in three weeks the uicer was healed and the conjunctivitis much lessened, but then some, phlyetenular ulcers were seen on the outer side of the limbus of the left eye, thus showing the nature of the previous ulcer.A week later these ulcers, three in number,, were markedly raised up from the surface of the conjunctiva and gave the appqarance of tubercles rather tban phlyetenulae, The treatment 'as indicated for this con- -dition was cQntinued.A week, later these ulcers and swelling had reEolved, but several miliary phlyctenular ulcers were now seen on the inner side of the.cornea of.the same eye.The treatment was persevered with, and the whole conldition of the ayes .va4tlyimproved, A month later the refraction was ,examined under atropine, when compound hypermetropic estigmatism,wA$ fouad, Glasses were ordered, and up to the present her eyes have kept very free from inflammation.L. J. came,to hospital fast year cqmplaining of sore eyes of some considerable duration ; she had intense photophobia and lacrymatlon; the blepharospasm was so marked that it was with great difficulty that I was,able ito inspect tho corne4 even with retractors, and a nurse to hold the child.There was pnked injecti of the peApob al aid ocular conjunctiva, and on ulcer on each cornea;-she was treated without effect by ordinary measures for three weaks as an out-pativnt, thqn for the next month she became an in-patient, where the treat- menk,ooq,bin'd with cleanliness, fresh al,asnd gqod foo4, had a most beneflcial effect in reducing,the conjunetivitis and the acoompanying,phetophobla andlacrymation ; thewcornealIlcer healed also.Then she was discha;ged, wearing ;dark gl,sses, owing -to there still being some photophobia.Three weeks $pr,ab,sheet,PnFe.with the symptoms almQst as markedas in the fltst inst ima,tndialso a large gianulating ulcer on the left cornea.Again out-patient treatment for nearlI three weeks made.very'sglht1improvement,so she was admittled, but, even then the ,oithnresisted obstinately all our remedies.both local and' general ; she was given cod-liver oil, syrup of phos- phate ofirqs1, eyrnp of iodide of iron, and virol, alteraately with no benefit ; locally, atropine, both in solution and in oint- ment, was applied, hot and cold bathing, dionine by itself and in combination with the previous drug, but all to no purpose; fiially, adrepa ctlutioutwa appliely..bj, itself.;this,trnod the scale, and in a fortnight-the eyes improved considerably, -so that after two months' sojourn, in the hospi.tal it was possible to send her to a convalescent home ; now she has very llttle photophobia, no lacrymation, in fact is almost well, but is still using dionine for-the corneal nebulae.Ophthalmia Neogonorum.This is a purulent type of conjunctivitis found in the mewborn, in which the coDjunctiva shows a marked papillary development, and in which thre-is... seldom4any 4signs of scarring on recovery.The cause of this com- plaint in the great majority of instances is that micro- coccus described by Nelsser in: .1879,and known as. the Diplococcus gonorrhoeae; it is easily stained with methylene blue, and is decolorized by Gram's method.This micro- .Coccus is unique in being able to penetrate intact epithe- lium, hence the importance of early and.careful treatment.'The.othermicro-organisms concerned are the pneumo- cocci, streptococci, Bacter'um.coli,and otbers.The usual mode of infection is that during the birth of, the child -some.vginalsecretiQn gets into the palpebral sacs, but definite cases.-oPsnte partumrm infectionhave heep-reMoted at times, an&d recently by.Sidney Stepnsqn andd R-sa Ford5 and by G. D. Robinson,6 in someofwhlch-appnrently the infection took place through 'intact membrntanes.The symptomss commence c the secondor.third-day, rarely on the fourth.; the lJds become swollen, and may be markedly oedema1eous, there is itflammation, of both 10 min.20 min. 10min.20 min.PROTARGOL.Result.No growth.No growth.No growth.No growth.No growth.No growth.No growth.No growl h.No growth.No growth.Few small colonies on 2nd day.No growth.No growth.No growth.A few colonies on 3rd day.No growth.No growth.A few colonies on 2nd day.No growth.Growth on Ist day.A'few colonies ou 2nd day.No growth.No growth.Growth on 1st day.Growth on lst day. --0 min.1.0 6 days 10 min.1.5 10 days I10 min.nies.No growth.No growth.Growth on 1st day.Growth on 2nd day.No growth.No growth.Few colonics on 3rd day.No growth.