WOUND INFECTION 103 



Endogenous Wound Infection. 1 



A trauma, such as an operation, can act as the cause which de- 

 termines the settling down of circulating micro-organisms. In 

 practice it is difficult thus to explain infections, as we must exclude 

 their entrance through the wound. Ectogenous infection is most 

 likely in wounds which show septic inflammation during the first few 

 days. For those infections which only show after the wound has 

 closed, and after an initial non-inflammatory stage, the possibility of 

 an endogenous origin becomes more and more insistent the longer 

 the time which elapses after the closure of the wound. We must in 

 such cases note the following points : 



1. Paths of infection may remain in apparently closed wounds, 

 along shreds of capsule, iris inclusions, etc. 



2. A certain latent period is possible in ectogenous wound infec- 

 tions. 2 The organisms introduced must reach a certain number, and 

 their action a definite degree, before they become obvious. The 

 ectogenous suppuration developing in the space left by a cataract 

 operation for this reason first shows itself several days later. 



In the case of purulent inflammations this latent period in the 

 eye, especially after cataract operation, varies within very narrow 

 limits, not only in the case of Pneumococci, which are usually the 

 organisms under consideration, but also of the other pyogenic forms 

 more rarely found. In dealing with these organisms it is very soon 

 apparent whether the eye will overcome them, or whether they will 

 find a good nidus therein. Kesiatant Bacteria, whose spores take 

 several days to develop into the growing form and cause suppuration, 

 have never been observed after operations. Only once has a late in- 

 flammation been observed in a case by Hess (Patlwlogie der Linse, 

 Handb. Graefc-Sacmiscli, 2 Aufl., 1905), in which Snbtilis was found. 

 Suppuration due to Snbtilis in splinter wounds has generally 

 developed rapidly after the injury, and experimental infections by 

 means of its spores have shown no latent period (Ulbrich, 

 Stregulina). 



We find, when we examine them further, that the cases to which point 1 refers 

 include the most of those eyes with adherent scars which are affected by an 

 apparently spontaneous deep suppuration, generally leading to panophthalmitis. 

 Leber and Wagenmann 3 have proved microscopically that in eyes where the 

 adherent cicatrices seemed quite unaffected the infection none the less had passed 



1 Of. section on ' Endogenous Infection.' 



2 Terrien's experiments show that latent miliary abscesses may remain for days in the 

 regenerated epithelium, and cause late infection (Arch. d'Oph., 1905, xxv., p. 360). 



3 A.f. 0., 1891. 



