About thirty years ago a curious discovery in connection with purulent ophthalmia was made by Dr Loffler, a Prussian army surgeon. Many of the soldiers of his regiment being disabled by this disease, he submitted the eyes of all the men to a rigorous daily inspection, and he discovered in the lining membrane of the eyelids of some of them certain small granular bodies resembling boiled sago grains. Furthermore he noticed that, although those soldiers whose eyelids presented this peculiarity showed then no indications of the disease, they were subsequently invariably attacked by it; whilst those from whose eyelids the sago grains were absent as invariably escaped.
Subsequent investigators, amongst whom may be mentioned Drs Welch and Marston, have confirmed the accuracy of Dr Loffler’s observations and the soundness of his conclusions—that the occurrence of the sago grains is always an antecedent condition to an attack of purulent ophthalmia.
As to the nature of the little granular bodies known to pathologists as ‘sago grains,’ it seems to be generally admitted that they are follicles situated directly beneath the epithelium, which, in a healthy condition of the lining membrane, are not apparent, but which become swollen and enlarged when the membrane itself is in an unhealthy and irritable condition. In this respect they resemble the enlarged glands met with in scrofulous and weakly children.
“In a regiment the proneness to the development of sago grains is found to decrease as life advances; that is, to be much greater in young soldiers than in old ones, and by a parity of reasoning it is assumed to be greater in a community of children than in a community of adults. In any individual, and therefore in any community, the sago grains may disappear without producing mischief; but, as a matter of fact, sources of irritation to the eyes abound in the world, and when these sources of irritation act upon eyelids in which
sago grains are already present, they often excite the contagious form of ophthalmia.”[70]
[70] Brudenell Carter.
The diffusion into the atmosphere of the purulent discharge accompanying this form of ophthalmia is undoubtedly the means by which the disease is spread.
Hence it is that if one eye be affected the other may be saved from an attack by being hermetically sealed up—a method of prevention sometimes adopted by the ophthalmic surgeon.
Mr Brudenell Carter says “that the secretion passes along the tear-passages into the nostrils, and is driven out with the expired air at every breath; besides the chances of direct contact that must exist when a child with ophthalmia is perpetually sending into the atmosphere what I may describe as a spray of contagious particles.”
Medical opinion is in some measure divided as to the origin of this disease; for whilst there are authorities who believe that its propagation is due to contagion assisted by insanitary environments, there are others who incline to the supposition that these latter conditions alone are sufficient to produce it. Whether this is so or not there can be no question that impure air, overcrowding, filth, and deficient water supply, which implies insufficient ablution, serve to intensify and perpetuate it.