In the pre-antibiotic era gonorrhea showed a high prevalence also in industrialized countries. In Germany, more than 10% of all newborns developed gonorrheal ophthalmia neonatorum. Clinical courses of gonorrheal ophthalmia neonatorum were quite different in their severity but often caused significant impairment of eyesight up to total blindness in more than 5%. This accounted for 25-40% of cases of blindness in Germany. It was Carl Siegmund Franz Crede (1819-1892), a German obstetrician, who introduced the eye prophylaxis of eye drops containing 2% silver nitrate solution to every newborn child in his clinic in Leipzig on June 1st 1880. The incidence of gonorrheal ophthalmia neonatorum immediately decreased from 10% to 0%. Crede actively communicated these results and immediately published them in four publications within a time period of 3 years. These publications, which are discussed here, are written in a very pragmatic and strictly clinical style, ignoring new basic scientific insights into the microbiology of gonorrhea and the discovery of the corresponding pathogen, the "Micrococcus" by Albert Neisser, which Crede considered unimportant for his purposes. Against a high degree of opposition by many physicians, Crede put all enthusiasm into the call for education of midwives in this technique. Crede knew that this was the central way to ensure that all newborns could obtain this prophylaxis, including outpatients and home deliveries. Crede's eloquence led to the rapid spreading of "his" eye prophylaxis over the rest of the world. The concentration of silver nitrate was often reduced from 2% to 1% thereafter and in most countries the performance of this prophylaxis was rapidly enforced by law. By introducing this method, Crede saved or improved the eyesight of millions of people - a significant contribution to obstetrics, neonatology and pediatrics, ophthalmology and mankind. Still today, in the antibiotic era, other topical regimens for antiseptic prophylaxis against ophthalmia neonatorum are often referred to as "Crede's prophylaxis".
"However, the broad use of silver as a powerful clinical tool against infections is still in the future, because its full range of activity remains to be elucidated."
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