WOUND INFECTION 85 



cataract. Otswald found that the mixture of lens substance favoured infection. 

 Korotkow found the same condition of affairs (Wratsch, 1903, No. 50 ; Ann. 

 d'Ocul., 1904, cxxxii., 152). He found that the course of an endogenous wound 

 infection was much more serious if the lens capsule were opened and the vitreous 

 damaged. A wound infection much more rarely occurs in the case of a pure anterior 

 chamber wound, as the Bacteria introduced are much more rapidly overcome. 



The varying virulence of one and the same organism has resulted in different 

 experimenters obtaining different results, so that it would be hazardous to definitely 

 establish any standard. Bearing this limitation in mind, the large comparative 

 series of Picot 1 definitely shows the action of the various pathogenic organisms in 

 the anterior chamber. Staph. anreus and Streptococcus pyogenes produce rapid 

 suppuration; Pneumococci, Pnenmobacilli, and B. coli act more slowly, producing 

 a more fibrinous exudation. Typhoid bacilli produce no local results, even though, 

 like the other organisms, they may cause a fatal general infection. 2 Anthrax bacilli 

 produce a fibrinous, gelatinous exudate, free from cells. Tetragenus causes an 

 inflammation, which resolves spontaneously, even though fatal septicaemia results. 

 Picot could trace in his preparations with what varying rapidity the different 

 organisms died out locally ; this occurred relatively soon in the case of B. coh, 

 Pneumococcus, and Tetragenus, though it varied very much according to the 

 virulence of the particular culture used. 



Although it is well established that the immediate vicinity 

 of the eye is comparatively safe, that the eye occasionally over- 

 comes an infection, and that primary healing 1 is not impossible 

 in spite of the contact of pyogenie organisms, we must still 

 consider that the removal of the Bacteria, both before and during 

 wound healing, is well worth our utmost endeavours. 



It is now generally agreed that the conjunctival sac, like all other 

 exposed mucous membranes, cannot always, perhaps even can never, 

 be made absolutely sterile without damaging it by the very means 

 employed. The results quoted in the collected literature of anti- 

 sepsis and asepsis, referring to 'sterility in so many cases per cent.,' 3 

 and arrived at by actual trial, must be interpreted in the sense that the. 

 number of organisms ic as so reduced that a test collection no longer showed 

 any Bacteria. De Lieto-Vollaro's researches with susceptible media 

 never showed a complete sterility after cleansing, but only a diminu- 

 tion ; these results agree with those of Morax, Eymowicz, and others. 



The variation in the bacterial contents of the normal conjunctiva 

 makes it difficult, as Haab and his pupils have shown, to establish 

 from purely clinical statistics, the value of any method of cleansing 



1 Arch. d'Ophth., 1898, xviii. 341. 



2 Romer's researches (A. f. A., 1906, Iv. and Ivi. ) in intra-ocular inoculation show how 

 regularly and rapidly the infective agent is taken up by the blood -stream, so that it can 

 circulate in other organs, especially in the other eye, and settle down in them. Such a 

 transference is very little noticeable during purulent infection of the human eye. Fatal 

 general infection is very rare. On the other hand, Romer refers sympathetic ophthalmia 

 to such a blood infection. 



3 Records such as those of Bardelli, showing a 90 to 98 per cent, sterility with dilute 

 formol, are certainly too high ; the control research by Bach has proved this. 



