WOUND INFECTION 97 



infections, as they also do when we include in the total the panophthal- 

 mitis developing out of a corneal sepsis. (Panophthalmitis resulting 

 from reinfection of old adherent scars belongs in part to this group.) l 



Prophylaxis in Affections of the Laerymal Passages, Conjunctiva, 



or Lids. 



Special emphasis must be laid on the preventive treatment of the 

 source of the infection, particularly if it be pneumococcal such as 

 a conjunctivitis, and more particularly in the working classes, 

 a dacryocystitis. In all cases where conservative measures fail 

 to secure the removal or destruction of the infection, especially in 

 the case of the labouring classes, a radical extirpation of the sac is 

 usually the best procedure. What, then, will be the condition of the 

 conjunctiva with regard to its bacterial contents and its infectiousness 

 after excision of the sac ? 



We have already shown that the flow of the tears is an important factor in the 

 self-cleansing of the eye ; yet in such cases this is permanently interfered with. 

 Can we then consider the condition after excision as comparatively favourable 

 with regard to infection ? The condition improves after the operation, because 

 a stagnation and multiplication of the organisms previously occurred above the 

 stricture in the nasal duct, and from this source infected material could find its 

 way backwards into the conjunctival sac. Of course there is a stagnation in the 

 conjunctival sac after the operation, but there is obviously a radical difference if the 

 interruption is above or below the lacrymal sac. In the lacrymal sac the conditions 

 are most favourable for the growth and increase in virulence of organisms, especially 

 the Pneitmococcus the commonest and most dangerous one for the eye 

 not only because the temperature of the sac exceeds that of the open and 

 moist evaporating conjunctiva, but also because the constant washing with sterile 

 tears ceases as soon as a complete stenosis occurs. No further fluid can find its 

 way into the sac when it has already been filled and cannot empty itself. The fluid 

 in the sac, too, is a better nutritive medium, the more so when a catarrh of the sac 

 causes an increase in its organic contents. 



From clinical experience and the bacteriological researches which 

 Plant and Zelewski 2 carried out at my instigation, we know that, 

 a few weeks after an extirpation, provided such has been perfectly 

 accomplished, the conjunctiva has become relatively safe from infec- 

 tion, and can be satisfactorily cleansed. The interval between the 

 sac operation and any other must not be made too short ; and it is 

 wrong to lay down any hard-and-fast time for every case, for the 

 conjunctiva and the lid margins in patients with dacryocystitis are 



1 (?/. Wagenmann, A. f. 0., 1889, xxxv. 116 ; Terson, Ann. d'Ocul, 1898, cix. 116 ; 

 Dolganoff and Sokoloff, A. f. A., 1903, xlvii. 361. 



3 Shutting off the sac by cauterization of the canaliculi is a protective measure ; in my 

 experience this closure, however, is not quite reliable (K. M. f. A., 1901, xxxix. 1, p. 369. 



7 



