52 BACTERIOLOGY OF THE EYE 



soon occurs. This results, however, from their passage through the 

 lymph channels of the nose and throat. This latter site was shown 

 by Ribbert to have been the entering point of a streptococcal infection. 

 If we are to judge by the action of carmine dropped into the sac, the 

 invasion of the Bacteria begins in the lower part of the nasal duct. 

 When the canaliculi are closed, no general infection occurs. 



We find a similar state of affairs in man. The smallest lesions 

 under certain circumstances are sufficient, so that clinically the 

 conjunctiva may appear very slightly affected, and may rapidly return 

 to the normal, even in cases where it has been the point of entrance 

 of a general infection. Nicolle and Dubois 1 obtained swelling of the 

 pre-auricular gland (which cannot be due to any nasal condition) 

 in glanders after the material infected with glanders had been 

 introduced into the conjunctiva, which itself showed no special 

 changes. . 



The conditions may vary in different Bacteria as regards the human 

 subject. It is quite impossible, however, for organisms to pass into 

 the interior of the healthy globe from the intact conjunctiva of the 

 human eye. 



Pathogenic Protozoa can also cause general infection from the 

 conjunctival sac. This has been recorded by Stargardt in the case of 

 the Trypanosoma evansii, the cause of surra (in horses), by Romer, 

 with TV. gambiensi, the cause of sleeping sickness (' Ophth. Congr. 

 Heidel.,' 1906, SS. 317 and 325). 



The same thing may be possible in human beings with the 

 organisms already mentioned. A severe general infection from the 

 conjunctiva has only been observed in the case of acute streptococcal 

 infection (see p. 205). In pneumococcal cases and pyogenic staphylo- 

 coccal cases we may thus explain the slight rise in temperature, 

 which also occurs in Koch-Weeks cases. The general symptoms in 

 true (Loffler's) diphtheria of the conjunctiva are mostly toxic. For 

 further information see chapter on ' Conjunctivitis.' 



1 Presse Medicale, 1902, p. 977. 



