of the mother's condition, as to whether she has or has not gonorrhea, is important, and in the absence of a microscopic examination is the most reliable evidence we have. To ascertain the condition of the mother, while usually easy, is at times a difficult or delicate matter. The easy, direct, and accurate way to settle this question is by a microscopic examination of the discharge from the child's eyes for the gonococcus of Neisser. Finding this establishes the gonorrheal nature of the disease, while its absence proves it to be non-gonorrheal.

The prognosis of this disease depends upon a variety of circumstances. When seen before the cornea becomes involved, and with an environment favorable for intelligent management, the prognosis is good. I formerly believed and taught that with correct treatment every case could be cured, and vision saved entire. But one case seen several years ago, and treated by me in the most conscientious manner, and which resulted in the loss of about half of each cornea, taught me that some cases, even under the most orthodox treatment, will, by virtue of their very virulent nature, result badly. Fortunately, these failures need only be very rare, and the above is the only one which I can recall in my practice. But any involvement of the cornea renders the prognosis grave, and the more so the earlier in the disease the corneal trouble occurs. Low vitality of the child is unfavorable, as under such circumstances the cornea may slough entire. Another condition which bodes evil is a degree of ignorance, apathy, or poverty on the part of the family, which renders effective treatment difficult or impossible.

The most important point about this disease is its prophylaxis. Since it is caused by the vaginal discharge getting into the child's eyes, its prophylaxis consists in either keeping the discharge from getting into the eyes, or, if it has entered, of washing it out, and disinfecting the conjunctival sac with a 2-per-cent solution of nitrate of silver. When a physician is called upon to take charge of a pregnant woman, he should not only ascertain the condition of her general health, kidneys, etc., but among other things should learn whether there is a pathologic vaginal discharge, and if it is present, he should adopt suitable means

of irrigation or medication for its arrest, so when the child is born there may be no discharge to infect its eyes. Especially should this irrigation be energetic during the first stage of labor, and combined, if need be, with the use of the speculum and cotton mops to remove all pus from the vaginal folds.

In all suspected cases, immediately upon the delivery of the child and tying the cord, Crede's prophylactic treatment should be carried out. This consists of washing the child's eyes, and irrigating the conjunctival sac to flush out the pus, and next dropping into each eye a 2-per-cent. solution of nitrate of silver, which by its germicidal property destroys any germ remaining. Crede's prophylaxis is successful with almost absolute certainty. When faithfully carried out, it will seldom fail, even when the mother has a gonorrheal vaginitis. But while Crede's method is generally understood, and its success generally admitted, yet there seems to be confusion in the minds of some as to when and in what cases it is to be used.

It is now generally used as a routine practice in all lying-in establishments. It should, of course, be used in every case where a morbid vaginal discharge, whether gonorrheal or leucorrheal, is known or even believed to be present. And it should be used in every case where there are grave suspicions or doubts. On the other hand, in private practice where the mother's condition is known to be healthy, it may be omitted. But even in these cases the eyes and surrounding skin should be washed, and the conjunctival sac irrigated before the general bath is given.

I would urge upon all those doing obstetrical work the importance of always having a bowl of sterile water and cotton sponges ready before the completion of labor, with the same regularity that they provide a ligature for the cord; that the eyes of every child be immediately cleansed and irrigated; and in addition, in all suspected cases, a few drops of the solution of nitrate of silver be instilled; that this be done by the physician himself; and that under no circumstances should the water in which the child is later given its general bath be allowed to come in contact with its eyes.

When the disease has once developed, its treatment involves

the use of three remedies, viz., cleanliness, cold, and nitrate of silver. By cleanliness I mean hourly irrigations of the conjunctival sac to remove all pus. The fluid used may be sterile water, salt solution, or boric acid solution. The composition of the fluid is of much less importance than the thoroughness with which it is used.

Cold is best applied by having small pieces of soft domestic one inch square. These are plastered over a block of ice contained in a bowl placed near the crib. These little squares of domestic are removed from the ice to the eye, where they remain only one or two minutes, and are then replaced by other squares, being themselves returned to the ice. This cold can be used interruptedly, as each alternate hour, or each alternate two hours. Cold is especially indicated in the earlier stages of the treatment, and its virtue consists in making the child more comfortable, and in lessening the severity and danger of the disease.

The solution of nitrate of silver should consist of six or eight grains to the ounce of water, and should be applied once a day, not by the nurse, but by the physician, who should evert the lids, and, after removing all pus, mop the silver solution upon the tarsal conjunctiva. Dropping solutions of silver into the eyes in the treatment of this disease I regard as pernicious, as it destroys and removes the protecting epithelial covering of the cornea, and so favors its infection and destruction. Nitrate of silver is the remedy, and I regard with much less favor the various so-called astringents, as sulphate of zinc, tannic acid, boracic acid, etc., which are in mild cases useless and in severe ones a disappointment. Leeches, blisters, and canthotomy have no place in the treatment of this disease. If corneal ulceration occurs, the pupil should be kept dilated with a weak solution of atropine.

To correctly treat a case of ophthalmia neonatorum, two nurses, one for day and one for night, are needed, and should always be provided. Intelligent and faithful nursing counts for much in this disease, and should be not only insisted upon, but demanded. Nurses and other attendants should be warned of

the contagious nature of the discharge, and instructed in the protection of their own eyes. They should, when cleansing the eyes, wear protecting glasses or goggles, and immediately afterward wash their hands. In lying-in establishments, where ophthalmia neonatorum was formerly so rife, it was not unusual for nurses to contract the infection from the infants. The physician may also contract the disease, and should be on his guard.

Ophthalmia neonatorum causes 33 per cent. of the blindness in the blind asylums of Germany and Austria. In those of Philadelphia, Dr. Harlan found it to be 32 per cent.; while in the Tennessee School for the Blind, among 226 pupils, I found ophthalmia neonatorum to be the cause in 40 cases, or 17.6 per cent. This would seem to speak well for Tennessee, but the predominance of our rural over our urban population is probably the real cause.

Of such importance is this disease that several States have special laws upon it. These laws make it obligatory upon any nurse or midwife to call in a legally qualified physician whenever any infant in her care develops an inflammation of its eyes.

Is it not a reproach to the profession that this disease, which is preventable in the first place and curable in the second, should persist in being the cause of more blindness than any other condition that affects human vision?

Abstracts.

THE USE OF GLYCOZONE IN A FEW GYNECOLOGICAL CASES.*

BY C. H. POWELL, A. M., M. D., ST. LOUIS, MO.

It is surprising how physicians fall into habits regarding the use of certain agents in their practice, and how loth they are to resort to something new. No doubt this fact exemplifies the maxim: "Be not the first by whom the new is tried, nor yet

* Abstracted from New England Medical Monthly.

the last to lay the old aside." This saying, were it put into active practice, would interdict the use of any new drug or remedy, as from the very nature of things a leader must be acknowledged, and that leader would himself violate the above maxim.

In the treatment of uterine and ovarian diseases the wellknown glycerole of tannin tampon, or the use of glycerine and Goulard's solution, or glycerine with other astringents, has been for years recognized and appreciated by gynecologists over the entire world.

In the clinics, solutions of these agents are ever at hand, and habitually are ensconced into the vaginal canal with very little regard as to the scientific results that will accrue. It has often occurred to the writer that many of the solutions used by gynecologists favored the development of bacilli, and no doubt contributed in no small degree to the lighting up of attacks of pelvic peritonitis so frequently encountered by gynecologists.

Glycerine no doubt is without a peer in successfully treating a long range of diseases that afflict women, as the well-known hygroscopic qualities of the remedy bring about a local bloodletting from the hyperemic structures which, when followed by hot douching, is usually relied upon to reduce many inflammatory complications of the uterus and its adnexa.

Not being satisfied, for the reasons above given, with the usual formulæ of glycerine in gynecology, a sample bottle of glycozone which came to my desk several months ago, although not referred to in the treatment of diseases of women, appealed to me. Accordingly, in view of the highly oxygenating properties of th remedy, which I believed would necessarily possess bactericidal properties, I was induced to try glycozone in my gynecological practice; the results were so pronounced, and the beneficial influence of the remedy so decided and permanent, that I have for several months past persistently resorted to glycozone in preference to anything else in my local work. I will outline the following clinical cases as indicating its usefulness in the conditions stated: