5. Chronic or habit vomiting, sometimes occurring in early infancy, may be difficult to control because of being incited by such slight causes as laughing, crying or being moved.
In addition to being caused by the above mentioned conditions, vomiting in young babies may usher in an acute infectious disease, as a chill does in an adult, or it may accompany such diseases as peritonitis, meningitis, brain tumors and toxic conditions such as uremia.
INFECTIONS
The infectious diseases which the obstetrical nurse is most likely to see in her baby patient are ophthalmia neonatorum; syphilis; impetigo; pemphigus and vaginitis.
Ophthalmia Neonatorum, inflammation of the eyes of the new-born or “babies’ sore eyes,” is one of the common diseases of infancy and certainly one of the most dreaded because of the tragedy of lifelong blindness which may follow in its wake. In the early days of organized work for the prevention of blindness the term “ophthalmia neonatorum” implied a gonorrheal infection, but it is now known that inflamed eyes and subsequent blindness may result from infection of innocent origin. Accordingly, in those states where it is required that the disease be reported, ophthalmia neonatorum is defined as inflammation of the eyes of new-born babies, irrespective of the cause. The disease is frequently due to the gonococcus, the baby’s eyes being infected from the mother during passage through the birth canal or infected later by her hands or clothing. Or the inflammation may be caused by the streptococcus, pneumococcus or the colon, diphtheria, or influenza bacilli while very frequently the infection is mixed.
It is estimated that about 20 out of every 1000 new-born babies have sore eyes, and though many of the infections are mild, between 5 and 8 of these 20 cases are capable of becoming serious and causing blindness if not speedily and skillfully treated. The number of cases which are neglected is suggested by the fact that about 10 per cent. of all blindness, the world over, is due to infant ophthalmia and that about 20 per cent. of the inmates of schools for the blind in this country are sightless from this cause. This does not take into account the unnumbered army of those who are partially blind, or blind in one eye, and thus seriously handicapped, as a result of this disease.
Symptoms. The first symptoms are redness and swelling of the lids, usually accompanied by a discharge of pus from the beginning, and they ordinarily appear during the first few days of life, but sometimes develop as late as the second or third week. The disease may run a very rapid course and cause blindness in 48 hours from the time the first symptoms appear, or it may persist for weeks. Ulceration of the cornea is the dreaded consequence of the inflammation as ulcers are followed by scars. When the scar is small, or to one side of the pupil, there may be little or no impairment of vision, but if it is large and centrally located it forms an opaque screen and causes blindness by shutting out the light, although the interior of the eye behind the scar is sound and uninjured. Sometimes the ulcer causes a perforation of the cornea through which the lens and vitreous humor are discharged.
Attempts have been made to remove the scar following a centrally located ulcer and replace it with a clear cornea from some such animal as a guinea pig, but the operation apparently has not been perfected. When it is, many blind persons may have their sight restored to them.
Prevention. It may be stated almost without qualification that ophthalmia neonatorum is a preventable and curable disease, and accordingly that blindness from this cause is inexcusable. Prevention lies first, in wiping the baby’s eyes immediately after birth and instilling a drop or two of a silver salt, such as nitrate of silver, argyrol or protargol, or bathing them with boracic acid solution; and second, in close watching for early symptoms and giving speedy treatment when they appear. This is urgent because there is no way of determining in the beginning whether the infection is mild or virulent. Nitrate of silver solution, 1 per cent., is the prophylactic most commonly employed and its use is now routine in most hospitals and in the practices of many physicians in this country. The solution is sometimes dropped between the baby’s lids, immediately after the birth of the head, and before the birth of the entire body, and sometimes immediately after delivery is completed. Many doctors follow the silver drops with normal salt solution to prevent the slight silver catarrh which so frequently occurs otherwise, and which may be confused with early symptoms of ophthalmia. Still others prefer simply to bathe the eyes with boracic acid solution (unless they know that the mother has gonorrhea) and to watch them closely for the slightest redness, swelling or discharge and give prompt treatment if these appear.
The Credé method, made famous by the Viennese obstetrician who introduced it in 1881, was to drop from a glass rod, a single drop of nitrate of silver, 2 per cent., into each eye immediately after birth. The routine use of this prophylaxis reduced the occurrence of ophthalmia in Credé’s clinics from 10 per cent. to .1 per cent. among the new-born babies.