THE CORNEA 337 



The participation of the cornea in a general bacterial immunity, 

 as has been demonstrated by Romer for Pneumococci, 1 and by Loffler 

 for the organism of mouse septicaemia, is the basis of all further 

 attempts to influence this corneal disease by means of a serum 

 treatment. In the case of other bacteria, however, this statement is 

 not so applicable. 



On the basis of his preliminary experiments Romer began the 

 treatment of ulcus serpens. He considers prophylactic action as most 

 important ; this can be obtained in cases of injury where the con- 

 junctiva is septic, a dacryocystitis present, or in the early stages of 

 a traumatic corneal infiltrate. He placed the curative action in fully 

 developed and widespread ulceration in a very secondary position to 

 this preventive action. 



There is nothing to be said against the surgeon injecting prophylactic serum in 

 cases of recent corneal wounds with septic surroundings. 



It is absolutely necessary that the cases are not considered as protected and 

 saved ; the patient should be seen daily, and on any advance of the inflammation 

 immediately admitted to hospital. 



It is quite different when the patient comes with an infective inflammation. In 

 such cases the exhibition of an active serum is to be recommended, but every such 

 patient should at once be sent to an oculist, for the following reasons : 



1. The present serum is shown by the clinical records given later to be unre- 

 liable in advanced cases. This applies in a marked degree to the passive method 

 of application ; perhaps not so much so to the simultaneous method, but even then 

 its action is uncertain. Valuable time may thus be lost. Whether better results 

 can be obtained by the ' aggressin method ' remains to be seen. 



2. Although the great majority of cases of hypopyon-keratitis are due to the 

 Pneumococcus, still there are some which are due to other infections, especially 

 Diplobacilli. 



Romer has also demonstrated mixed infections, which in my experience are rare. 

 For such cases the serum treatment is naturally inefficient. 2 



On the other side, it must be admitted that many surgeons, from a want of 

 experience, fail in obtaining results when they take material for the diagnosis of an 

 ulcer. The scraping of such infiltrated places, too, may be detrimental to the 

 patient. The lamellae are loosened, and the contaminated point of the instrument 

 may infect the cornea more deeply, as I have seen in some patients. I consider it 

 possible that the art and manner of obtaining the material has an influence in 

 deciding whether the ulcer will progress or not, 3 and desire to call attention to this 

 point. It has, therefore, been the rule in my clinic for many years that suitable 

 treatment must at once follow every scraping of the cornea. In diplobacillary 



1 A. f. 0., 1903, 1., S. 99; also A. f. A., 1905, Hi., S. 83, and Verhandl. der Ophth. 

 Gesellsch., 1905. 



2 Failure of the seruni, with exacerbation and further progress, may in some cases be due 

 to the fact that other organisms may have infected the cornea secondarily, and these aie 

 not influenced by the pneumococcal serum. 



3 The eye must be kept steady while the material is being taken. Fixation forceps 

 should be used in unruly patients. The point of a sterile needle is carefully passed along 

 the progressive margin. Romer uses a platinum needle Zur Nedden has needles of a 

 special pattern. 



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