WOUND INFECTION 98 



those organisms quoted in the review by Brandts only occur scantily 

 on the conjunctiva on rare occasions. The more common Sarcinte 

 cannot multiply in the eye. Individual examples of the Subtilis 

 group are found fairly frequently on the conjunctiva. The cases, 

 however, of infection with Subtilis so far recorded have mostly been 

 due to direct infection from a soil-contaminated foreign body. 



The Changes which result from an Infected Wound of the Eye. 



The examination of human eyes with infected wounds should show 

 to what extent saprophytic inflammations occur, especially how far 

 Ulbrich's view that they are responsible for the subacute and chronic 

 forms (Iridocyelitis) l can be confirmed. 



The material is rarely accessible to bacteriological research, and, 

 with the exception of the quoted case of Hess and Eomer (Subtilis), we 

 have only the following records : Hirschberg And Frosch 2 cultivated 

 Pneumococci ; Cue"nod 3 obtained the same. I have on one occasion 

 cultivated very small Gram-negative bacilli, which would only grow on 

 blood media, and were closely related to the influenza group ; 4 on 

 another occasion Staphylococcus pyogenes albus of moderate virulence. 

 There is evidence in favour of the other possibility brought forward by 

 Ulbrich, that pyogenie organisms can also cause insidious in- 

 flammations (Leber, Deutschmann). A wound infection of this 

 kind which, even after several weeks' duration, did not lead to 

 panophthalmitis, has been examined in my clinic, and in it Brons 

 found the Bacterium coli liqucfaciens (Bacterium punctatum), an 

 organism which till then had never been recorded as pathogenic, but 

 had only been found in water. 5 



This question appears of great interest to me : How far should we 

 fear an infection from the ordinary saprophytes of the conjunctiva? 

 and to what extent has such been observed ? 



If we consider the common white Staphylococci of the normal conjunctiva (see 

 chapter on 'Normal Conjunctiva') as belonging to this class, we note that Gifford 



1 Aqueous fluid from the living eye is only very occasionally available for examination ; 

 it is not permissible to open the vitreous chamber for the purposes of obtaining material 

 for inoculation. Living eyes under these circumstances are therefore rarely available, and 

 those which are enucleated are usually in such an advanced stage that a bacteriological 

 examination is unsuccessful (cf. p. 4). 



For these reasons the question as to whether any mode of treatment (e.g., Schirmer's 

 mercurial treatment) is of use against a definite organismal wound infection cannot be 

 decided by the findings in the human eye, but at best merely by experimental methods. 



2 Heidelberg Congress, 1892 : discussion on Greeff's communication. 



3 Compte Rendu de la Soc. Franc;. d'Ophth.,1895, p. 534. 



4 Dissertation of Oertzen, Rostock, 1898, ' Uber Pneumokokken ' (Schluss). 



5 Schirmer (Internal. Ophth. Congress, Utrecht, 1899) attributed a number of subacute 

 infections to impure boric lotion. 



