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On the other hand, hot fomentations are occasionally better than cold, especially when corneal complications exist, or the surface of the conjunctiva is covered with a gray film. These are applied with squares of antiseptic gauze wrung out in carbolized water of a temperature of 120 degrees F., and frequently changed.

(2.) Constant removal of the discharge must be practised.

The lids are to be gently separated, the tenacious secretion wiped away with bits of moistened lint or absorbent cotton, and the conjunctival sac freely irrigated with an antiseptic fluid. For this purpose a saturated solution of boracic acid (which is feebly antiseptic, but very cleansing and slightly astringent), or one of corrosive sublimate, a grain to a pint (it is stated that a solution of one to ten thousand will retard the vitality of the coccus), may be employed. (1) Special and ingenious forms of lid irrigators have been devised. The cleansing process must be repeated at least every hour, day and night, and, if necessary, much more frequently.

The remedies mentioned on page 219 have found favor with some surgeons. In addition to these may be mentioned carbolic acid (one-half to five per cent.), nitrate of silver (one to two per cent.), alcohol and bichloride of mercury solutions, iodoform ointment (four per cent.), and aqua chlorini. Peroxide of hydrogen acts efficiently in cleansing away the purulent secretion. The frequent insertion of vaseline beneath the lids is highly commended.

(3.) The local application of nitrate of silver to the conjunctiva must not be made in the earlier stages before free discharge is established, nor in those cases, no matter what the stage, when the lids are tense and board-like, and the surface of the conjunctiva covered with a gray film, or a false membrane.

When the secretion is free and creamy, when the lids are relaxed, when the conjunctiva is dark-red and puckered into papilla-like excrescences, the time for its application has come. Once a day the palpebral conjunctiva and retrotarsal folds should be brushed over with a solution, ten or twenty grains to the ounce, its surface first having been carefully freed from any adherent discharge, and afterwards all excess of the drug washed away with water. In severe cases the mitigated stick, and even the solid pencil of nitrate of silver may be employed, great care being taken to neutralize the excess with a solution of common salt. All strong applications must be made by the surgeon himself. Ulceration of the cornea does not alter the treatment described, except that pressure upon the globe while manipulating the eye is to be avoided. So long as the discharge is abundant the use of the caustic is indicated. (2)

At the first appearance of corneal haze, a four-grain solution of atropine is to be dropped into the eye two or three times daily. If, however, a marginal ulcer forms, and danger of perforation is imminent, or even if this has occurred, good results are obtained with eserine. The use of eserine requires considerable care, lest any co-existing hyperemia of the iris be aggravated by the drug, and iritis ensue. For this reason many surgeons prefer not to employ it, although its great efficacy in preventing sloughing of the cornea cannot be denied.

Persistent swelling of the conjunctiva is sometimes treated by scarification. Division of the outer commissure to relieve pressure, leeching, and, indeed, any form of treatment followed by decided loss of blood, are hardly suited to young infants, although they may be indicated in adults.

If one eye alone is affected, suitable protection for the sound eye should be provided. This may be accomplished by antiseptic bandaging of the uninflamed organ (Buller's shield is difficult of application in infants). The daily use in the unaffected eye of a drop of a two per cent, solution of lunar caustic has been suggested.

Reduction of the inflammation with cold applications, for which, under the conditions named, hot affusions are substituted; absolute cleanliness; frequent irrigation with antiseptic and slightly astringent solutions; and at the proper stage nitrate of silver, will meet with the best results.

The attendants must be impressed with the fact that upon their faithful carrying out of directions and upon their unremitting care much, if not all, of the hope of bringing the case to a successful termination depends. The attendants must further be impressed with the contagious nature of the pus; all bits of rag and pledgets of lint used in the treatment must be destroyed, and after each treatment the hands of those engaged must be thoroughly washed and then disinfected with a solution of bichloride of mercury.