THE CORNEA 301 



infection is also of value in those cases where the use of serum has 

 not yet been considered as of value. When an atypical infiltrate is 

 present, it will determine whether the condition is dangerous and 

 requires immediate surgical treatment. 1 



When Diplobacilli are present, the case is quite different. Even if 

 a severe purulent process occurs, treatment by zinc properly applied, 2 

 and combined with other measures of a conservative nature, will 

 almost invariably lead to a successful result. I have never seen a 

 case of diplobacillary infection of the cornea which we have not been 

 able to control by this means ; 3 though amongst my cases there have 

 been some which appeared too far gone for even an energetic cauteri- 

 zation, and in which, on account of the size and central position 

 of the ulcer, a Saernisch section would have resulted in extensive 

 adhesion. 



These are examples of purulent cases, and in them a method of 

 treatment based on etiology is especially valuable and necessary, on 

 account of their dangerous nature. 



Even in the case of the non-purulent or ' simple ' infiltrates and 

 ulcers, a bacteriological examination is often of considerable value. 

 Between the ' simple ' and the purulent cases there is no sharp 

 dividing line. The severe purulent cases often begin as simple infil- 

 trates. It is very important to establish the cause in the early stages 

 of, for instance, a wound keratitis after a superficial injury ; we then 

 know what we have to deal with. On account of some peculiarity in 

 the cornea, or in the situation of the ulcer, the clinical appearances 

 may at first be mild, and in the end malignant. In these cases, which 

 at first are mild clinically, I have been able to convince myself 

 that the virulence of the organism e.g., the Pneumococcus was high, 

 and that on account of immunity, or some refractory condition of the 

 cornea, this high virulence did not show itself. 



A bacterial diagnosis is often of value in many of the cases which 

 are non-purulent during their whole course. In these 'catarrhal 

 ulcers,' or marginal infiltrations, the DiplobacilK play an important 

 part; and the corresponding cases are very amenable to treatment 



1 Gabrielides ('Oplith. Microbiologique, ' 1907, p. 254) recommended a peculiar treatment 

 for purulent iilcers of the cornea. Having observed that bile had a bacteriolytic action on 

 the Piteumococci, and that these organisms did not grow on media which contain this 

 substance, he freely applied to the cornea a sterile solution of sheep's and rabbit's bile (along 

 with hot compresses and iodoform), and obtained good results. Morax has lately made a 

 similar report concerning the action of rabbit's bile (Cougr. de la Soc. franc. d"'0phth., 

 1907). 



2 Our technique is given in the work of Agricola, K. M. f. A., 1906, Beilageheft, and in 

 the section on ' Diplobacillary Conjunctivitis ' in this book. 



3 See Agricola, K. M. f. A., 1905, xliv., Beilageheft. 



