SPECIAL FORMS OF CONJUNCTIVAL INFECTION 201 



into the vitreous, again produced inflammation. Ulbrich 1 tested a large number 

 of saprophytic Bacteria anew with reference to their power of inducing inflammation 

 in the eye, and as a result of his researches, was of the opinion that post-operative 

 infection due to such saprophytic organisms was much more frequent than had pre- 

 viously been thought ; such cases clinically take the form, not so much of purulent 

 panophthalmitis as of subacute or insidious inflammations. Further cases have 

 been communicated by Gourfein and Welt, and among them one with bacilli of the 

 xerosis variety. The course of such wound infections is somewhat different from 

 that of Ulbrich's experiments, as it is necessary for the organism in question to 

 multiply in the interior of the eye. In operation cases they will only do this to a 

 very slight extent, so that they cannot induce an inflammatory reaction, or if they 

 do, it can only be very slight. Seeing that the Bacillus xerosis in concentrated 

 suspension, as a rule, dies out in the vitreous, the assumed capacity for propagation 

 there is not always present, and I therefore think that these Bacteria rarely have 

 anything to do with wound-infection. An experiment of Deyl 2 and those which 

 Demaria 3 carried out in my clinic show that there are stems of B. xerosis which can 

 propagate in the vitreous, which have a pathogenic action, and can remain a relatively 

 long time there. 



Here again the question arises, especially for those who favour the view of 

 identity, whether anti- diphtheritic serum should not be used in these cases, on 

 the chance at least that that particular bacillus is present. In my opinion such 

 measures are quite aimless. 



Even should proof be furnished of their complete identity, and the 

 possibility thus approached that, without infection from outside, toxic 

 diphtheria bacilli can develop and produce their results on the con- 

 junctiva, our proceedings in bacteriological diagnosis would remain 

 the same as they now are. Whether the Bacillus xerosis is to be 

 identified with the Bacillus diphtheria (Eoux, Schanz, Peters, Pes, 

 Behring, Hala, and others), or to be considered merely as a kindred 

 organism of the same group, as we find stated by the great majority 

 of bacteriologists (cf. the text-books of Gunther, Heim, Neumann and 

 Lehmann, the literature by Beck in the Kolle-Wassermann Hand- 

 book, and others), what we have to ascertain is, Are toxin-forming 

 bacilli present ? and when we find them, are we to consider them as 

 wholly or only partially responsible lor the inflammatory changes, 

 and direct our therapeutic measures against them ? Even then the 

 fact would remain that the non-toxic bacilli of the normal or simple 

 catarrhal conjunctiva are harmless in the cornea, and in wounds or 

 injuries. 



Our clinical bacteriological diagnosis and serum treatment, 

 which we should certainly carry out in pseudo-membranous inflamma- 

 tions, briefly summed up, consists in the following 1 measures : 



Several slide or cover-glass preparations should be made of the 



1 A.f. 0., 1905, lix. 8. 2 'Uber die Atiologie des Chalazions,' Prag, 1893. 



3 ' Mischinfektion von Tuberkulose- und Pseudodiphtheriebazillen im Auge.' K, M.f. A., 

 1905, xliii., Beilageheft (cf. here the literature). 



