82 BACTERIOLOGY OF THE EYE 



The authors mentioned prove this by the numbers of organisms found before 

 and after the bandage is applied : Morax and Marthen in cases of cataract, the 

 others on normal persons. The variety of the organism is not appreciably altered ; 

 after bandaging, B. xerosis and white Stapliylococci are more obvious, and any 

 pathogenic organisms previously present are naturally increased. Dalen also 

 showed that on removal of the bandage the numbers of the Bacteria gradually 

 fell again. 



The increase in Bacteria depends on (1) the loss of the cleansing lid movements 

 and the diminished lacrymation ; (2) the increased temperature under the bandage 

 and the congestion of the conjunctiva. The first factor is in action without any 

 andage when the eyes are closed during the night (see p. 26). 



The dread of this bacterial increase has led many to an open 

 method of treatment i.e., the leaving off of any dressing. Hjort 1 of 

 Christiania, who certainly had previously a disproportionate amount 

 of wound infection, preferred that the lids should move even after 

 cataract extraction. Better to renounce rest and protection than 

 have an increase in Bacteria ! 



A critical examination of this apparently exact scientific statement 

 showed it to be very fallacious. 2 Dalen tested the bacterial increase 

 in the conjunctiva after application of a bandage, not for twenty-four, 

 but for eight to twelve hours, and showed that till then the Bacteria 

 were fewer in number than before the preliminary cleansing. Even 

 after twelve to fourteen hours (forty cases) he found an increase on 

 both sides in only four cases, an increase on one side and decrease on 

 the other in six cases, and a decrease on both sides in seven cases. 

 From other sources we know that a well-placed corneal section, 

 especially if it be in the vascular limbus, will, with complete rest, be 

 quite closed by this time. 3 



A dressing for the eye which will completely restrain lid 

 movements during- the early stages is neither irrational, 

 unmodern, nor unscientific, and even a moderate increase in the 

 number of the organisms does not affect the incision, if well 

 made. Our knowledge of infective processes is not merely concerned 

 with the presence and number of Bacteria, but with the condition 

 of their habitat and the method of infection. Each individual surgeon 



1 Zent. f. Prakt. A., 1897, SS. 138, 329; 1898, S. 33. Also Schiotz, Intern. Med. 

 Congr., Paris, 1900. section for Ophth. ; further literature, see my ' Ergebriisse, ' Lubarsch- 

 Ostertag, 1896-99, S. 49. 



2 Cf. Axenfeld, Munch. Med. Woch., 1903. 



3 Clarke ('Report of the International Congress in Utrecht,' 1899) showed that when 

 rabbits were kept narcotized, corneal wounds healed more rapidly, and that the process was 

 delayed by movements of the animal. Similarly every condition which hinders rapid 

 healing favours infection e.g., excessive use of cocaine, which damages the epithelium 

 (Mellinger, see literature, Masugi, K. M.f. A., 1901, ii., S. 634). The action of antiseptics 

 may be of importance ( ' Epithel-schadigung durch Sublimat'; see Widinark and Dalen). 

 Rapidity and dexterity in operating and a clean delivery of the lens are important in 

 preventing infection, while the opposite favours it. 



