128 BACTERIOLOGY OF THE EYE 



albus e2ndermidis, B. coli, B. diphtheria, B. xerosis, Streptococcus pyogenes) ; 

 injections into the conjunctiva or anterior chamber, however, will produce a reaction. 

 But if an epithelial defect occurs, then the reaction occurs with simple instillations. 

 He considered injection under the conjunctiva as a delicate test of toxic action. 



We should not, however, be justified in attributing the positive results of Morax 

 and Elmassian to unintentional injuries. More recent investigation by Tschirkowski 

 in my laboratory has confirmed Morax and Elmassian's results completely. 



Valenti J made the remarkable observations concerning coli toxin : that a conjuncti- 

 vitis followed its subcutaneous injection away from the eye ; eight to ten hours after 

 the injection the excretion of the poison from the blood began in the conjunctiva ; the 

 organisms previously present on the conjunctiva became more virulent under the 

 action of the toxin, and took part in producing a conjunctivitis. Tschirkowski was 

 only able to confirm Valenti's results in part (A. f. 0., 1908). 



The interesting work of Coppez shows to what extent toxins from 

 the conjunctival sac act upon the cornea. 



According to him, diphtheria toxin, even without the action of pyogenic cocci, 

 can produce an intense reaction, and destroy the corneal tissues wherever a defect 

 in the epithelium occurs. It is also able gradually to loosen the intact corneal 

 epithelium. 



Streptococcal toxin has very little action upon the cornea, even if there be an 

 epithelial defect. From his own results Coppez considered that the contradictory 

 findings of Bardelli were due to the fact that he did not use a filtrate, but a bouillon 

 culture, in which the cocci were killed by some added disinfectant. 



Pneumococcal toxin had very little effect, even when there was an epithelial 

 defect. 



Coppez did not use staphylococcal toxin. He considered that Solowiew and 

 Molodorowsky's results are in need of confirmation. 



From these accounts we can readily" appreciate to what extent 

 corneal complications, in the various forms of conjunctival infection, 

 are due to the action of the toxins alone. The actual entry of the 

 bacilli, present as the cause of the conjunctivitis, is the most im- 

 portant factor ; their development, however, is more or less assisted 

 by the toxins. In this respect all the others are far behind the 

 diphtheria toxin. 



The statistical data which we have given show that there is still a 

 considerable proportion of conjunctival inflammations which is bac- 

 te.rioloyically negative, in which we find nothing, or only those organisms 

 to which we cannot attribute any causal significance. 2 With such 

 negative or negligible findings, we may ask whether a traumatic 

 or chemico-physical factor may not be at work (such as mal- 

 position, inturned cilia, concrements, the action of dust, 3 steam, 



1 Arch, di Ottcd., 1900, viii. 20. 



2 To attribute a causal significance, as Randolph does, to the common Staph. albus and 

 Bacillus xerosis, which are often found, is not justifiable. 



3 The action of grit or caterpillar's hair can produce a kind of conjunctivitis. 



