838 BACTERIOLOGY OF THE EYE 



suppuration frequent instillations of zinc solution suffice ; in staphylococcal and 

 other cases the cautery should be at once applied. In cases with Pneumococci an 

 active serum can be used along with the older methods. When the affection has 

 fully developed, there may be some assistance obtainable from serum, but with the 

 sera recommended up to the present this is uncertain. 



At the Heidelberg Conference in 1903, Ronier gave his clinical 

 results with passive immunizing. With the method which he then 

 recommended, the injection of 10 c.cm. of serum and its simul- 

 taneous local application, he obtained healing in each of twenty ulcers 

 in the earliest stage (vide supra}. In forty-eight advanced cases 

 80 per cent, were brought to a standstill by means of the serum. 

 This very favourable result was not maintained, though the results 

 in Wurtzburg remained much better than those recorded in the 

 literature as having been obtained elsewhere. 1 Romer was there- 

 fore impelled to try for further improvement. By careful experi- 

 ment he demonstrated that, by the active method, the injection of 

 a dead bouillon culture (25 c.crn. of a bouillon culture concentrated 

 to 1 c.cm.), produced an efficient and durable immunity in the ex- 

 perimental animal. He utilized the agglutinating action of the 

 serum as an approximate indication of the formation of the anti- 

 bodies in the system. It was proved that after intramuscular injec- 

 tion of the cultures the agglutinin was formed earlier and remained 

 longer, on account of the more rapid absorption from the muscles. 

 As this formation of agglutinin is not a certain test, control tests 

 of the opsonic index of the blood should also be made (<?/'. chapter on 

 ' Tuberculosis')- 2 



Romer found that a combination of the active with the passive 

 method was more efficient, and he therefore gave up the purely active 

 method. 3 In this simultaneous method the injection of the culture 

 has to precede the serum by some time. 



I will not here go into a detailed analysis of the records of other 

 authors; 4 that will be found in my ' Serumtherapie infectioser Augener- 



1 The fact that strains found in the vicinity of Wurtzburg were used in the production of 

 the serum might be considered to explain the more beneficial action of the serum in that 

 locality. Regional peculiarities have not been shown to be present in the bacteria of this 

 group. 



2 Romer has done this (Heidelberg Congress, 1907), and considered that opsonic 

 examination was not applicable to pneumococcal serum. 



3 Sattler (Leipzig) was not satisfied as to the value of purely active immunization. Only 

 very early cases were arrested ; those of moderate severity appeared sometimes to stop, and 

 then break out again rapidly. 



4 Romer states that no accurate conclusion as to the value of serum treatment can be 

 formed from small series of cases. It is true that an extensive material alone allows us to 

 determine what are the best possible results. Even then, in comparing the experience of 

 years, great differences in the cases may render comparison difficult. The question which 

 the clinician has to deal with in ulcus serpens is, Can I expect the new method to give such 



