WOUND INFECTION 105 



irritant or foreign body was very obvious. Koratkow states that an 

 operation wound only acts as a localizing site for endogenous in- 

 fections during the first few hours ; later there is no difference 

 between the operated and the normal eye. Experimental endogenous 

 wound infection results in the uvea either from embolism or from the 

 cut vessels. Koratkow ascribes a favouring influence to post-operative 

 detachment of the choroid. (For human eyes this latter statement 

 is doubtful.) The possibility, therefore, of an irritant as a localizer 

 is experimentally demonstrated. 



There is also the possibility that endogenous tuberculosis, syphilis, 

 and other processes, can become localized in a wounded eye. This 

 question is now being freely discussed in regard to keratitis paren- 

 chymatosa, but there has not yet been any bacteriological research 

 on the subject. 



The experiments by which Tornatola 1 sought to prove that a toxic 

 wound suppuration could occur in the eye must be considered to have 

 failed. Shimamura 2 conducted many experiments in my laboratory, 

 and proved that, on subcutaneous or intravenous injection of the 

 toxins of Staph.aureus, Streptococcus, or B.coli, suppuration or inflam- 

 mation of an injured eye never results, provided that the most 

 scrupulous care be exercised regarding asepsis at the site of injury, 

 and the prevention of secondary infection. Valenti 3 has lately described 

 an endogenous toxic inflammation artificially occurring in the con- 

 junctiva after subcutaneous injections of the toxins of B. coli. There 

 was no change in the eyeball. His whole work, and especially the 

 question whether any wound inflammation can thus be caused experi- 

 mentally, requires further investigation. 



The cases described by Tornatola, Lagrange, 4 Gasparrini, 5 and 

 Rothenpieler 6 as toxic metastases will not stand criticism, and cannot 

 be taken as proof that purulent inflammation can occur in wounds from 

 endogenous toxic infection. Whenever suppuration occurs in a 

 wounded eye we must consider, with our present knowledge, 

 that organisms are there present. 



The more chronic forms of inflammation, especially those of a sero- 

 plastic nature, are possibly due to endogenous toxic causes, for in the 

 pathology of other organs we have analogous local inflammations due 

 to circulating poisons. Such an endogenous toxic inflammation of 

 a wound has never yet been demonstrated, and in any individual case 



1 ' Le Inflammazione Postoperatoria in Oculistica,' 1900 (Messina). 



2 K. M.f. A., 1902, xl. 1, pp. 229, 273. 3 Arch, di Ottal., 1900, viii. 20. 



4 Congrfes de la Soc. Franc. d'Ophth., 1896, p. 370. 



5 Ann. di Ottal., 1895, xxiv. 343. 6 Zent. f. A., 1897, p. 304. 



