Ophthalmia neonatorum : the problem after thirty years of statutory notification and sixty years of Credé prophylaxis / Arnold Sorsby.

  • Sorsby, Arnold, 1900-1980.
Date:
1945
Catalogue details

Licence: In copyright

Credit: Ophthalmia neonatorum : the problem after thirty years of statutory notification and sixty years of Credé prophylaxis / Arnold Sorsby. Source: Wellcome Collection.

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    (bd) Degree of Severity. 'The last 75 cases contained 26 in which the condition was mild, 34 in which it was moderate, and 15 severe, the criteria used being the amount -and nature of discharge and the swelling of the lids. As can be seen from the sub- joined table, there was no striking difference in the percentage of’cases giving a rapid cure in each of these subdivisions. Clinical cure Mild Moderate Severe 1-3 days 13 : a >) 1-8 days ‘ 9 14 4 9-30 days: relapses, poor response and intolerance 4 9 4 26 cL ee 15 Whilst no fine conclusions cari be drawn, it would appear that severe cases _ respond as well as those showing milder degrees of the infection. The rapid response that some severe cases give to sulphonamide treatment is so striking that the clinical impression was formed that severe cases do better than those less heavily affected. This is not borne out by the actual analysis. It is, however, clear that severe affec- tions do not necessarily mean prolonged treatment. (c) Unilateral Cases. No tangible difference in the results of treatment of the unilateral cases as. contrasted with those in which both eyes were affected was_ observed. (d) Sulphonamide Resistant Cases. In the second series of 333 cases just as in the first experimental series of 273 cases, some babies showed a poor response to the different sulphonamides. As can be seen from Table XIII, the 156 treated with sulphapyridine and the 84 with sulphamezathine by standard dosage showed no less than 17°3% and 16-7% of cases resistant to treatment. In so far as treatment was required for more than 8 days, or relapses and poor response were seen, or (in the case of sulphapyridine) intolerance, it should be stressed that an unsatisfactory response to sulphonamide does not generally mean complete failure; it is only exceptionally that the condition is not improved to a considerable extent, and only in rare instances is the response so poor that anxiety for the state of the eye and the ultimate outcome is felt. Characteristic of the findings amongst the sulphonamide resistant cases are the following data on 15 failures observed in the last 75 cases. Of these 15 cases 7 showed poor response and. 8 relapses. Of the 7 in the first group 5 were treated with sulphamezathine and the causal organisms were gono- coccus in 2 cases, Staphylococcus aureus in 2 more, and diphtheroids in one. The 2 remaining cases were a case of staphylococcus with Koch-Weeks bacilli treated with sulphanilamide, and a case with non-haemolytic streptococcus treated with sulphathiazole. In these last two cases the general condition was not good; the one case suffered from severe bronchitis, and the other developed broncho-pneumonia whilst under treatment. Ultimately these cases cleared up either by the administra- tion of another sulphonamide or by the local application of penicillin. Seven of the eight relapses had been treated with sulphamezathine and the organisms present were: pneumococci and diphtheroids two cases each, gonococcus, no organisms, and inclusion bodies one case each. In one case, in which pneumo- cocci were present, sulphanilamide had been used. In all these eight cases there was nothing in the general condition to explain the relapse, and they all cleared up when a further course of the original sulphonamide was instituted. 4 : It must as yet be left an open question whether the sulphonamide resistant cases represent infections due to relatively resistant strains of organisms, or failures that would no longer be seen with a further increase in dosage.