296 



SCIENCE. 



[Vol. XIV. No. 352 



applied for permission to examine the inmates of the Perkins Insti- 

 tution for the Blind in South Boston, and was enabled to take notes 

 of 183 cases, all but one of which he personally examined. The 

 single exception was absent at the time of the visit, but his re- 

 corded history left no doubt as to the cause of his loss of sight. 

 Following the classification of Magnus, Dr. Derby divided these 

 cases- into four classes: I. Congenital blindness; II. Blindness in 

 consequence of idiopathic diseases of the eye ; III. Blindness of 

 traumatic origin ; IV. Blindness attributable to general dis- 

 ease. 



It is with the figures in the second class that we are more im- 

 mediately concerned, and especially with those of blindness de- 

 pendent on the ophthalmia of new-born children. There were 34 

 such cases out of 183, being a percentage of about 18.6. This is, 

 however, a smaller proportion than has been obtained by other 

 observers, and can only be accounted for by the limited number of 

 individuals he was able to examine. At the Sheffield School for 

 the Blind, Mr. Snell found 38.3 per cent blind from this cause, and 

 observers in general estimate that some 30 per cent of all blindness 

 is due to this disease. Even the examination at South Boston 

 reveals the fact that at least one in every five of the inmates of the 

 institution need not necessarily have ever come there. For it is an 

 established fact that the ophthalmia of new-born children can, with 

 few exceptions, be successfully prevented when there is reason to 

 apprehend its occurrence. It is also not an exaggeration to claim 

 that hardly a disease of the eye yields with more certainty to ap- 

 propriate treatment. Modern observers are united in the belief 

 that efforts at disinfection should mainly be directed to the eyes of 

 the child, which are most apt to receive the poisonous matter after 

 birth. Such being the case, is strict cleanliness alone sufficient, or 

 should an active disinfectant in addition be employed ? 



Experiments carried on by different observers have demonstrated 

 that the purulent infection of the eyes of new-born children can be 

 reduced to a minimum by the use of a disinfectant, and that the 

 most efficacious disinfectant is the nitrate of silver. Simple cleans- 

 ing of the eyes with water was found by Bischoff to reduce the 

 number of cases only one-half. Crede, the original proposer of the 

 use of nitrate of silver, had, before the introduction of prophylaxis, 

 314 cases among 2,897 children, 10.8 per cent. After beginning to 

 use the 2-per-cent solution of nitrate of silver, he had but from one 

 to two cases in 1,160 children, being o.i to 0.2 of one per cent. 

 Other agents have been tried. 



In the present state of our knowledge, it is not presumptuous to 

 assert that a case of this disease, terminating in a manner fatal to 

 sight, and treated without topical applications of nitrate of silver, 

 would be regarded as having been culpably neglected. So much 

 for the principal factor that operates in causing preventable blind- 

 ness.' Of that from trachoma it is less necessary to speak, as that 

 disease appears to be greatly decreasing in this community. The 

 greater care used in the regulation of emigration, the gradual im- 

 provement in the housing and sanitary surroundings of the poor, 

 and the discovery of jequirity as a remedy, are all working such a 

 change for the better that one is almost justified in looking for- 

 ward to a time when " granular lids " will be a tradition of the 

 past. There is but one other cause of preventable blindness on 

 which Dr. Derby briefly dwelt, — traumatic sympathetic ophthal- 

 mia, — of which he found 12 cases at the Blind Asylum, something 

 over 6 per cent of all affections investigated. With young children 

 the occasion for the occurrence of this disease is most frequently 

 the wounding the other eye by forks, scissors, and knives carelessly 

 left in their way. It can be guarded against by the timely removal 

 of the injured eye. 



To sum up the results of his investigation. Dr. Derby found 34 

 cases of ophthalmia neonatorum, 4 of trachoma, and 12 of the re- 

 sults of sympathetic ophthalmia,— together, 50 instances of prevent- 

 able blindness ; in all, 27 per cent of the inmates of the South 

 Boston Asylum who need never have gone there had they received 

 suitable care or enlightened treatment at the proper time. To di- 

 minish such a percentage in the future, the more careful medical 

 education of the present day will not alone suffice. Those who 

 propose to follow the profession of nursing must also be properly 

 instructed, and some degree of knowledge on these subjects be 

 diffused in the community. 



Suggestive Therapeutics.— Binswanger, in the Thera- 

 peutische Moiiatsdirift, Heft iii., i, 2, 3, 4, 1889, warns against 

 the inconsiderate and incautious employment of hypnotism. He 

 says that hypnotism under all circumstances has a disturbing effect 

 upon the mental condition, and that subjects of experiment are 

 always transiently hysterical, that the results in different individuals 

 cannot be predicted, and that unfavorable results may follow. He 

 further says, according to the Americaii Journal of hisaniiy, that in- 

 severe hysteria is the chief ground for suggestive treatment, where- 

 the hypnotic suggestion is the most effective and the least danger- 

 ous. When other methods are available for cure, hypnotism is not 

 needed, and in hysteria minor it should be kept in mind that the 

 possibility of a transition into hysteria major cannot be excluded in 

 the use of hypnotism. 



Oxygen Inhalation. — The opinions held among medical 

 men concerning the therapeutic value of inhalations of pure oxygen 

 are so various that any careful observations upon the subject are 

 worthy of attention. In the Practzh'oner (August, 1889) Dr. 

 Thompson discusses the subject from a theoretical point of view,, 

 and gives also the result of experiments upon animals and of ob- 

 servations upon patients. From experiment, and from considera- 

 tion of the laws of physics as they bear upon the absorption of 

 oxygen by the blood, it is quite evident, that, if an animal in a state 

 of perfect health is made to breathe pure oxygen at the pressure 

 under which this gas exists in the atmospere, but very little more 

 oxygen will be taken into the blood than if it breathed common air. 

 In order to make any considerable amount enter the blood above 

 that which is usually absorbed by it, a degree of pressure is neces- 

 sary which causes mechanical interference with circulation and 

 respiration. The old idea that animals cannot live in an atmos- 

 phere of pure oxygen is erroneous. As might be expected from 

 the foregoing statements, it is now proven that animals can live 

 for many hours in pure oxygen, under ordinary atmospheric press- 

 ure, without any symptoms or appreciable change, provided the 

 CO2 exhaled and the nitrogenous waste products of the body be 

 removed. The vague and inconstant sensations, experienced by 

 healthy persons who inhale pure oxygen freely, may be due to im- 

 purities contained in it. Practically, Dr. Thompson, as we learn 

 from a summary in Medical News, has found the inhalation of 

 oxygen valuable in many cases. In anaemia and chlorosis he has 

 derived no decided benefit from it. In malignant diphtheria with 

 rapid respiration, subjective dyspnoea, and cyanosis, relief was af- 

 forded only to the subjective dyspnoea, the cyanosis remaining the 

 same, and the patient dying from pulmonary oedema and heart- 

 failure. In a case of illumjnation-gas poisoning, with persistent 

 unconsciousness and subsequent pneumonia, the continuous inhala- 

 tion of oxygen had no effect whatever, either upon the breathing or 

 upon the cyanosis which occurred during several attacks of pul- 

 monary oedema. In a case of malignant endocarditis, with ex- 

 tensive valvular disease and dilatation, oxygen failed to relieve the 

 dyspnoea, either before or after obstruction occurred in the lungs. 

 In pneumonia, with rapid breathing, dyspnoea, and cyanosis, he 

 has often found oxygen of very great value. The dyspnoea may 

 diminish, while the cyanosis quickly vanishes, and the respiration 

 becomes slower and more natural. So also in capillary bronchitis 

 and asthma, especially when it is accompanied by much bronchial 

 secretion. In uremic dyspnoea he has found it of great use. In 

 one such case, with normal lungs and very intense dyspnoea, last- 

 ing for three days, each inhalation of oxygen was followed in fifteen 

 minutes by slowing and quieting of the breathing, slight improve- 

 ment in the cyanosis, and great increase of comfort to the patient. 

 Upon stopping the inhalation, the dyspnoea always returned. A 

 bibliography of the subject is appended to the article. 



NOTES AND NEWS. 



Through the efforts of Professor J. E. Denton, Stevens Insti- 

 tute is to have a new foundry and machine-shop. The building 

 will be 40 feet long by 26 feet wide, and will adjoin the end of the 

 main shop. It will be two stories high. The lower floor will be 

 used as a foundry and blacksmith's shop, and the upper floor for 

 wood-turning and carpentry. 



