Since it is now believed that close vigilance and subsequent care are equally as important as the prophylactic drops, the Credé treatment has been variously modified and other and weaker silver solutions are frequently used, and with satisfactory results. The dropping of a germicide into the baby’s eyes kills the organisms which may be present at the time, but it does not protect against subsequent infection. For this reason the nurse cannot be charged too earnestly to watch the baby’s eyes closely for the first evidence of infection, and report it to the doctor immediately, day or night, for the late infections are as destructive of sight as those which occur before or during birth.
Fig. 187.—Irrigating the eye with a blunt nozzle, the irrigation bag hanging low in order that the stream may be gentle. (From a photograph taken at Johns Hopkins Hospital.)
Treatment and Nursing Care. The treatment and nursing care in ophthalmia frequently require the greatest skill. There may be merely an application of silver and sponging with boracic acid solution or a gentle irrigation with a blunt nozzle (Fig. [187]), or the preservation of the baby’s sight may necessitate dressings and treatment which will require elaborate preparation (Fig. [188]), and may also require some form of treatment every quarter- or half-hour, day and night and occupy the entire time of two or three special nurses. The nurse’s duties in caring for the eyes will be explicitly defined by the doctor, but in general she must remember that she is nursing a baby suffering from an acutely infectious disease, who should be strictly isolated, and that as a rule she should wear a gown, rubber gloves and protective goggles while caring for him. All of her attentions to the inflamed eyes must be given with the greatest gentleness in order to avoid abrasion of the conjunctiva or injury of the cornea. Moreover, the baby with suppurative conjunctivitis is a sick baby often fighting for his life as well as his sight, and every effort must be made to preserve his strength and increase his resistance. Fresh air and careful feeding are imperative. Breast-fed babies have a distinct advantage over bottle-fed babies and for this reason the mother should always accompany the nursing baby if he is taken from his home to a hospital to be treated for ophthalmia neonatorum, unless there is a wet nurse available at the hospital.
Fig. 188.—Method of holding baby for eye examination or treatment. (Photograph and appended notes by courtesy of Dr. W. Gordon M. Beyers, Royal Victoria Hospital, Montreal.)
“The child’s body is swathed in a sheet or blanket in such a way that the arms are lightly, but securely, fixed against the sides. The nurse can easily support the body with one hand, and with the other draw down the lower lid (as shown in the photograph), or otherwise assist the physician. The doctor sits opposite the nurse, with a rubber sheet across his knees, and upon this a sterile towel. He holds the baby’s head gently, but firmly, between his knees, thus freeing both his hands for necessary manipulations. In the picture the physician is represented as about to apply a solution of nitrate of silver with an applicator of sterile absorbent cotton.
“Close at hand is a table on which are a bowl of boracic acid solution and sterile absorbent cotton for irrigating the eyes; an undine (if one prefers) for the same purpose; a kidney dish for collecting the washings; sterile applicators, and small dishes for nitrate of silver solution and for saline solution (to neutralise): besides bottles containing solutions of cocaine, atropine, and fluorescein. Culture tubes, sterile swabs, cover slips, forceps, and a spirit lamp are ready for bacteriological examinations; and in a glass are displayed lid retractors, which are usually indispensable to a thorough examination of the cornea. On the floor is a paper bag, which, with the contaminated swabs, applicators, etc., is burned on the completion of the treatment. Other articles may be added as required; but the important point is, that everything should be at hand before the examination is begun.
“The physician and the nurse are clothed in surgical gowns; and wear rubber gloves, which heighten cleanliness, and safety and comfort. It is to be carefully noted that they both are provided with protective glasses; for under no circumstances should this precaution be omitted in treating the purulent ophthalmias.
“The conditions here depicted will not always be possible of fulfillment, but they represent the ideal for which one should strive.”
It is of interest to nurses that the effort to safeguard the eyes of babies through preventive treatment and early care was developed into a national movement by one who also was influential in starting the training of nurses in this country, Miss Louisa Lee Schuyler. The lay work for the prevention of blindness, which is now country-wide, was started by the New York State Committee for Prevention of Blindness, which was organized by Miss Schuyler in 1908. She was its first Chairman and skillfully directed the work of the Committee for ten years. During the Civil War Miss Schuyler was a member of the Sanitary Commission and afterwards was one of the group which was responsible for starting at Bellevue Hospital, in New York City (in May, 1873), the first training school for nurses in this country, planned in accordance with Miss Nightingale’s standards for the organization and conduct of a school for nurses. Later, in 1911, the Bellevue School for Midwives was established as a result of the combined efforts of the Hospital Trustees and Miss Schuyler’s Committee for Prevention of Blindness, the course of training being outlined by a sub-committee composed of Miss Lillian D. Wald, Dr. J. Clifton Edgar and myself. So far as it is possible to learn this school was the first in this country to be conducted along the lines of a school for nurses, or after the manner of the midwife schools in England.
Syphilis, which ranks high among the scourges of mankind, is seen with distressing frequency among young babies. It may be contracted during uterine life, when it is said to be “inherited,” or it may be “acquired” after birth by kissing a syphilitic person or coming in contact with contaminated articles, such as clothing, or nursing from a diseased breast.
The most conspicuous symptoms are the familiar “snuffles;” the scaling, fissures or eruption on the soles, palms, buttocks and about the mouth; shrill, hoarse crying; swollen painful joints; partial paralysis and a general feebleness and inanition. Some or all of these symptoms may be present when the baby is born or they may develop any time within the first two or three months of life.
Babies of syphilitic mothers are often given mercurial inunctions immediately after birth, even though they have no symptoms of the disease as it is very likely to be present in a latent form. This is one reason for the routine inspection of the placenta, since in it is sometimes found the only indication for treating the baby. An infant who is known to have syphilis is given mercurial inunctions or baths, the ointment being rubbed into the groin, axilla, back and abdomen in rotation on successive days, to prevent irritation of the skin. The nurse should protect herself with rubber gloves, wash the area with warm water and soap and thoroughly rub in the ointment. Sometimes the ointment is put on the inside of the back of the baby’s binder, by which means he rubs it in himself. The syphilitic baby should be isolated and should not be put to the breast of an uninfected woman, but he may nurse from a syphilitic woman without harm to either her or himself. Good general care, including fresh air and sunshine are important to the baby suffering from syphilis.