WOUND INFECTION 83 



must estimate for himself the value of the factors operating in his cases 

 if he would do the best for his patients ; and it is not correct to take a 

 narrow view and institute a radical and perhaps incorrect schema. 1 



The question as to whether this rest in the early stages should 

 be obtained by means of a bandage, and how it should be applied, 

 finds various answers. We can say that protective goggles lined with 

 wool produce a condition of rest, as eye movements cease in the dark. 

 I find this quite suitable for most cases, and more comfortable for 

 patients. A well-applied bandage for twenty-four hours, however, is 

 very serviceable, and cannot be considered irrational. The method of 

 bandaging has produced quite as good aseptic results as ' the open 

 method.' 



Without going into the whole literature of cataract statistics (cf. Hess, ' Pathologic 

 des Linsensy stems,' ' Saemisch Handbuch,' 2nd edition), we may note that 

 the large series, almost without infection, of von Michel (Hauenschild, Zeit.f. Aug., 

 1899, S. 227), along with many others, was obtained by treatment with a 

 bandage. 



With wire goggles, and the eyes kept shut under them, a noticeable bacterial 

 increase occurs in the first twenty-four hours, though it is less than that which 

 results from the bandage. De Lieto-Vollaro 2 proved this on cataract cases in my 

 clinic. Even in the case of patients who, for experimental reasons, were given open 

 protective goggles, and left free to move their lids (iridectomy or needling casse), 

 a bacterial increase occurred with primary healing, though not to the same extent. 

 It must be noted that the results obtained on bandaging the normal eye do not 

 exactly correspond with those after operation, as in the latter case the irritation of 

 the operation, added to that of the previous preparation, will account for a certain 

 increase even under ' open ' treatment of the eye. 



The presence of microbes, which may appear quite numerous 

 in cultures (ten to twenty or more colonies of Sfapkylococci), and 

 which may cause an inflammation in rabbits, does not always produce 

 suppuration in the affected eye. 3 This fact, which was proved by 

 H. Knapp in 1886, must not be forgotten. Hildebrand, Bernheim, 

 and Marthen have shown that primary healing can occur in spite of 

 the presence of pathogenic organisms in the conjunctival sac. 4 Anti- 

 septic compresses laid on the lids have very little influence on 

 the presence of these pathogenic organisms. Bach has confirmed 

 this experimentally on artificially infected animals, using bandages, 

 compresses, and ointments on the lids (A.f. A., 1895, xxxi., S. 181). 

 Bach has also seen cataract wounds heal in the presence of numerous 



1 Knapp's recent researches gave the same result (Berlin. Ophth. Ges., June, 1907 ; 

 K. M.f. A., July, 1907, Bd. ii.). 



a Arch, di Ottal., 1905, xii., Fasc. 1, 8. 



3 See also Ramsay, 'Ophthalmology,' 1905, p. 430 ; also Gifford. 



4 Septic bandages, too, do not necessarily lead to wound infection (cf. Gcntli, A.f. A., 

 190-3, xlvi., S. 135). 



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