WOUND INFECTION 91 



sckmidt, as a rule, bacilli cannot be found in the vitreous after four days; Stregulina 

 and Sidler agree with this. Kayser could find no bacilli after seven days. Stregulina 

 attributes this largely to phagocytosis. I think, however, that the bacilli also find 

 the natural limits of their growth in the enclosed capsule of the globe, and that their 

 death still further inhibits the growth of the rest. Kisskalt holds the same views. 

 There is generally no formation of spores in the vitreous. 



It is possible, when Subtilis spores are introduced into the eye, that they only act 

 pathogenically after a considerable period of incubation. Hess brought this forward 

 in connexion with a case of late infection after cataract extraction, and stated that 

 recurrences of inflammation could be explained on the supposition that spores had 

 been enclosed in the healing wound. 1 Till now a latent period has never been 

 recorded after inoculation of Subtilis spores ; infection has always developed 

 immediately (Ulbrich). Kayser has shown that the toxin lies in the bodies of the 

 bacilli, and filtered cultures do not cause any action when injected into the vitreous. 

 It is especially interesting to note that stems which are very pathogenic in the 

 vitreous produce no inflammation worth mentioning in the cornea. This, however, 

 is not quite true for all sterns of Subtilis, as is shown by the inoculation 

 experiments of Michalski and Gourfein, and especially the findings of Zur Nedden, 

 who cultivated pathogenic B. subtilis pure from the cornea in two cases of Ulcus 

 serpens. 



AYhen introduced into the anterior chamber B. siibtilis produces a severe iritis, 

 which, however, heals without suppuration. I also have noticed how low the patho- 

 genicity of B. subtilis is for the anterior chamber in man. From the exudation in 

 the anterior chamber in a case of a perforating splinter of iron, though the condition 

 was improving, I was able to cultivate a Subtilis which produced rapid panophthal- 

 mitis when introduced into the vitreous of a rabbit. 



These Subtilis results are of very great interest, as they show how this organism, 

 considered to be a mere saprophyte, can act as pathogenic in a wound, especially of 

 the eye. A. few similar observations had previously been made. 



Gifford - produced a moderate reaction by using large numbers of saprophytic 

 organisms. Sattler found that Prodigiosus was pathogenic for the vitreous. Perles 

 and Lobanow carried out a large number of inoculations with various saprophytes. 

 Perles 3 produced a moderate inflammatory reaction in the anterior chamber and 

 vitreous with Bac. dendriticus, with Sarcina aurantiaca no result, and with 

 S. lutea an iritis only when it was injected into the anterior chamber, no result 

 when into the vitreous i.e., in general he obtained a negative result. Lobanow, 4 

 on the contrary, injecting Sarcina lutea, Proteus, Subtilis, Prodigiosus, B. agilis, 

 Fluorescens putridus, and Mic. roseus, into the anterior chamber and into the 

 vitreous, produced an inflammation varying in degree. B. violaceus, B. ruber 

 indicus, and B. candicans alone were non-pathogenic according to Lobanow. 



Certain stems of hefa, according to the experiments of Stower 5 appear capable of 

 producing inflammatory infiltrates. Lundsgaard 6 produced a keratitis with hefa, 

 but Knapp " could get no action from the same organism. 



Deyl 8 found that many stems of the so-called B. xerosis produced chronic intra 

 ocular inflammation in rabbits ; Kastalska and Demaria 10 found the same, and the 

 latter stated that this action was not equally intense with all stems. 



1 In other parts of the body (bones, encapsuled abscesses) the common pyogenic organisms 

 can become quiescent, and after a long time can cause a recurrence. This has not yet been 

 observed in the eye. 



2 A.f. A., 1886, xvi., S. 197. 3 Virckows Arch., 1905, cxl., S. 209. 



4 Wjestnik Oftal., 1899, xv., SS. 3, 215, and Wratsch, xx., p. 265. 



5 A.f. 0., 1899, xlviii. 178. 6 K. M.f. A., 1900, xxxviii. 13. 



7 A.f. A., 1886, xvi. 167. 8 Bohmische Akad. d. Wissens., 1893. 



9 Gesammelte Arbciten. Deutsch., 1899 (Moskau). 10 K. M.f. A., 1905, Beilageheft. 



