368 BACTEBIOLOGY OF THE EYE 



Karpinski found the organism of distemper in one case (Ann. d'Ocul, 

 1896, T. 116, p. 363). In the non-purulent cases the same arguments 

 may be used as were applicable to the cases of benign metastatic 

 ophthalmia. On account of the similarity of this capsule to the 

 structure of a joint, these forms are often attributed to toxic causes. 

 It is undoubted that toxic inflammation of the optic nerve can occur 

 (<?/". Uhthoff, K. M ./. A., 1900 ; also Birsch-Hirschfeld, Antonelli, and 

 ethers). 



Our knowledge of the non-purulent, but still bacterial, embolic 

 inflammations of the eye was greatly increased by the experimental 

 investigations of Stock, 1 Selenkowski, and Woyzechowski. 2 



Following Moll's method, Stock injected Bacillus pyocyaneus into the veins of 

 rabbits, and produced metastatic uveal inflammations ; where in Moll's experiments 

 no clinical observations of the course could be obtained, on account of the speedy 

 death of the animal, in Stock's cases the embolic iritis and disseminated choroiditis 

 healed without leaving any marked changes. This occurred even though very 

 virulent strains were used, the smallest trace of which, injected into the vitreous or 

 anterior chamber, would cause immediate suppuration and panophthalmitis. Stock 

 explained the increased action of the organisms when directly injected over that 

 obtained when metastatically deposited, by the supposition that in the latter case 

 the bacteria, being in the blood, were surrounded by the protective substances 

 before they could develop. 



Woyzechowski, with Pyocyaneus, Staphylococci, and Streptococci, of varying 

 virulence, was able to produce metastatic inflammation of varying degree in cats and 

 rabbits, and even very mild affections were thus obtained. When very feeble cultures 

 are used, some localizing irritant is necessary for the determination of a metastatic 

 inflammation (cauterization of the eye, or the introduction into it of a foreign body). 

 (These authors consider that organisms of medium virulence can pass from the 

 vessels into the aqueous, and even into the vitreous, and thence disappear without 

 causing any clinical phenomena.) 



When, however, we consider purulent metastatic oplitlialmitis in man, 

 regarding which naturally there is a far greater amount of material 

 available, we see from the literature that the puerperal form, which 

 formerly was so frequent, is gradually becoming rarer. In this affec- 

 tion, which is almost always caused by the Streptococcus pyoycncs, the 

 almost invariable result is a panophthalmitis, provided that life is 

 continued long enough ; it is rare that a phthisis bulbi occurs without 

 a complete panophthalmitis, and mild benign cases are practically 

 unknown. 



A special tendency of the eye to metastatic affection in puerperal septic pyaemia 

 must be inferred, for the equally common surgical pyaemia of the pre- antiseptic 

 days was not nearly so often the cause of metastatic ophthalmia. Perhaps this was 

 due to the .freer breaking down of septic thrombi, or the greater prevalence of 



1 K. M.f. A., 1903, xli. , i., S. 81 (see here literature of earlier works). 

 . ' 2 A.f. A., 1903, xlvii,, S. 299. 



