THE CORNEA 339 



krankung, Freiburg,' 1905, and in the reports of the International 

 Medical Conference in Lisbon. By searching the records, and from 

 personal observation, I have added to the literature 1 120 cases treated 

 with serum ; from the collected material of about 200 cases, the 

 following conclusions must be drawn : 



In the preventive treatment of corneal abrasions with septic 

 surroundings, Eomer's serum (which will keep) can be tried along 

 with injections of dead cultures. The cases, however, should also be 

 carefully treated on general principles. 



For an established pneumococcal affection of the cornea, serum 

 treatment alone is only justifiable in the very early stages ; we are not 

 justified in depending on its action. Severe cases should be cauterized 

 at the outset. 



If the serum treatment be undertaken, further successive doses are 

 indicated, and even should an advance take place, the condition may 

 still be checked. In such cases we cannot even rely on doses of 

 30 c.cm. Enormous doses, even if they do in the end produce an 

 arrest of the process, are no improvement on the use of the 

 cautery, as the final scar will be very extensive. And even by their 

 use there is no certainty that the process will be arrested. Delay 

 may be fatal, and destruction result. 



In cases of ulcus serpens of moderate or marked severity treatment 

 with any of the present sera alone must be abandoned ; even the 

 assistance of active immunization is insufficient, except in cases which 

 are relatively benign, though extensive, and in which an expectant 

 treatment would otherwise appear admissible. 



good results as to justify my laying aside, and replacing, the present efficient method which 

 I possess ? Even a small series may supply the answer to this question : The comparison of 

 two apparently similar cases, the one treated with serum and the other without (Sattler), is 

 not without value. 



1 Pniiger, Korresp.-Bl. f. Schweizer Arzte, 1903. Sanz Blanco. 2 Span. Ophth. Kongr. , 

 1904 (Kl. M. BL). Castresana, K. M. f. A., 1905, xliii., ii., S. 289. Alvarado, Archives 

 Hispano- Amcr. , 1904, iv., S. 662. Oliveres, La Clin. Ophth., 1905, S. 179. Darier, ibid., 

 S. 29. Calderaro, La Clin. OcuL, 1904. Schnege, Inaug. Dissert., Konigsberg, 1904. 

 Zur Nedden, K. M. f. A., 1904, xlii. Schleich, Zeller, Wanner, W'urtt. Korresp.-Bl., 1904, 

 1905. Paul, K. M.f. A., October, 1905, ii., and January, 1906, i. Diehl, Inaug. Dissert., 

 Giessen, 1905. Sattler, Heidelbergcr Kongr., 1905, Disc. Mayweg. ' Vers. rhein.-westfal. 

 Augenarzte,' K. M. f. A., 1906, ii. Heilbron, Berliner Klin. Woch., 1906, No. 21. 

 F. Cohen, ' Zwaug. Abhancl. von Vossius.' 1907, vii. 4. Vossius, Med. Woch., 1906, vii., 

 No. 6. 



Darier (Clin. Ophth., 1905) and Fromaget (Ann. d'Ocul., 1907, p. 59) claim to have 

 obtained good results in the treatment of pneumococcal infection of the cornea by the use 

 of diphtheria serum. No definite proof is furnished by their scanty material. 



Deutschmann lately reported having obtained healing, in cases of hypopyon-keratitis 

 where the cautery had failed, by the use of a hefa serum (Ruete-Euoch, Hamburg). 

 Further confirmatory reports must be awaited. 



My tables also contain cases by Sattler, Peters, Fuchs, von Michel, Bach, Cramer, 

 Seigrist, Mayweg, Schleich, Zur Nedden, Saemisch, Bjerrum, Stoewer, Dimmer, Axenfeld. 



222 



