WOUND INFECTION 81 



cleansing ; there is often a very variable individual disposition to such 

 a condition. 



Many patients develop it after every operative interference, even when physio- 

 logical saline alone is used ; the loosening of the epithelium by cocaine has perhaps 

 something to do with it. Post-operative catarrh usually commences after several 

 days. The bacterial contents of the secretion vary. In three almost consecutive 

 cataract cases Ahelsdorff and Neumann (A. f. A., 1900, xlii., S. 68) found Gram- 

 negative Diplococci. De Lieto-Vollaro (Archivio di Ottalmol., 1905, xii., 7, 8), 

 working in my clinic, obtained xerose bacilli and occasional yellow Staphylococci 

 of low virulence ; and since then I have often obtained cultures of B. xerosis and 

 white Staphylococci, 1 the latter of low or moderate virulence. Bardelli and 

 Bossalino, on the contrary, report that the virulence of these Bacteria is raised by 

 the same causes which promote their growth. 



The varying findings show that the Bacteria here are of quite of secondary im- 

 portance. This view is confirmed by Knapp's researches. He found the common 

 conjunctival organisms in the secretions in post-operative conjunctivitis. We 

 cannot, however, exclude the possibility that they influence the catarrh, or that 

 they can cause a wound infection later, although that only rarely occurs. This 

 post-operative conjunctivitis certainly is less common with the open treatment and 

 thorough asepsis. 



Entropion spasticuni and similar conditions can act in the same way and produce 

 a catarrh. I have seen a peculiar case with profuse secretion and numbers of 

 Pneumococci, where, as a result of the wound giving way, secondary infection 

 resulted, and the eye was lost from pneumococcal panophthalmitis. As there was 

 no previous catarrh, perhaps scattered Pneumococci on a normal conjunctiva multi- 

 plied and increased in virulence in this case. 



Let alone that patients find it objectionable, from a bacteriological 

 point of view suspicion has been aroused as to the formerly universal 

 bandage after cataract operation. This has led many ophthalmic 

 surgeons to dispense with it altogether. The bandage certainly pre- 

 vents lid-blinking, and thus removes a considerable factor in the 

 physiological self-cleansing. By its action, and also from the increase 

 in temperature, a renewal of bacterial growth in the conjunctiva 

 must occur in spite of previous cleansing. Eepeated experimental 

 and bacteriological researches prove that a bandage applied for 

 twenty-four hours considerably increases the number of organ- 

 isms in the conjunctiva [Bernheim (loc. cit.), Marthen (loc. tit.), 

 Morax, 2 Bach, 3 Dalen, 4 Knapp 5 ]. 



1 The drawing, Plate II., Fig. 6b, showing Gram-positive Diplococci, was made from such 

 a conjunctivitis. 



- ' Recherches Bacteriologiques sur 1'Etiologie des Conjonctivites Aigues et sur 1'Asepsie 

 Oculaire' (These de Paris, 1894). 



3 ' Uber den Keimgehalt des Bindehautsackes, dessen natiirliche und kiinstliche Beein- 

 flussung, sowie iiber den antiseptischen Wert der Augensalben ' (A. /. 0., 1894, xl. 3). 

 Again, 'Antisepsis und Asepsis in ihrer Bedeutung fur das Auge' ['Samml. zwangloser 

 Abhandh' (Vossius), 1897 (Marhold, Halle)]. 



4 ' Mitteilungen aus der Univ.-Augenkl. in Stockholm,' 1899 (Fischer, Jena). 



5 Berlin. Ophth. Ges., June, 1907 ; K. M. f. A., July, 1907, Bd. ii. 



6 



