ENDOGENOUS INFECTIONS 369 



endocarditis, and perhaps also to the circumstance that the Streptoccoci, which are 

 almost always the cause of the condition, developed special affinities for the eye in 

 the body altered by the puerperium. 



Surgical metastatic ophthalmia, in these days of antisepsis and 

 asepsis, is of far less importance than metastasis in eryptogenetic 

 and other infectious diseases. In this last group Pneumococci, which 

 are seldom the cause of sepsis in puerperal or surgical cases, are the 

 common cause of metastatic ophthalmia ; only rarely are other causes 

 at work (Bac. typhosus, 1 B. coli communis* Pneumobacilli). 3 The 

 Bac. typhosus can also cause specific metastases in the eye. Bertozzi 

 observed a case of Vincent's angina with the Bacillus fusiformis* after 

 measles (Ann. di OttaL, 1907, xxxvi., p. 138). A subacute endo- 

 genous panophthalmitis can exceptionally occur from tuberculosis 

 (De Lietro Vollaro, Munch, Demaria, K. M.f. A., 1905, Beilageheft; 

 cf. here the literature). In Demaria's case there was a mixed infec- 

 tion, with a peculiar pseudo-diphtheria bacillus. 



Doubts have been cast on Mitvalsky's alleged finding of the Bacillus 

 typhus exanthcmatosus of Krai, as to whether it was not a post-mortem 

 invasion, there being a considerable degree of putrefaction. 5 



The specific organism (influenza bacillus) has been found in cases of 

 intra-ocular inflammation in influenza by Tanja, Dinoux, and Casali 

 (Ann. di OttaL, 1907, xxxvi., p. 120). The case of orbital abscess 

 which I have recorded, and which was observed by Siegrist, might 

 perhaps have resulted from one of the accessory sinuses of the 

 nose. Eversbusch (Stapli. aureus), Lavagna (Staph. citr. tetrag.}, 

 Despagnet (Strep, and Sta/j/t.), Haushalter, Vilber, and Alfieri 

 (Pneumoc.), have demonstated the presence of other organisms in 

 influenza metastases. 



From what we know of such cases, a microbic metastasis is the most likely cause 

 of intra-ocular affections of the relatively benign form in gonorrhoea 6 and recurrent 

 fever. Should the opportunity to examine such cases occur, it should be noted 



1 Gasparrini, Ann. di OttaL, 1895, xxiv. 343; Gillet de Graudmout, Arch. d'Ophth., 

 1892. Panas saw an angioma of the orbit suppurate from infection with the Bacillus 

 typhosus (Festsch. f. Helmholtz, 1891). Stock's case (K. M. f. A., October, 1906, ii.), in 

 which Staphylococci were found, showed that every metastatic ophthalmia occurring during 

 or immediately after a typhoid need not be specifically typhoid. 



2 Desbrieres, These de Paris, 1893; Loeser, Z. f. A., 1902, viii. 24. In this case the 

 orbit was also affected. 



3 Wopfner, K. M.f. A., 1906, xliv., i., p. 386. The ophthalmia occurred in pneumonia 

 after cataract operation. 



4 The work of Lekowicz with reference to these polymorphic, Gram-negative bacilli, 

 which are so common in the mouth, and can be cultivated anaerobically on serum agar, 

 can be found in the Cent. f. akt., Orig., 1906, p. 153. 



5 Reviewed by Axenfeld, A. f. 0., 1894, xl. 4. 



a In a globe enucleated two months after the onset of a gonorrhceal metastasis, J. Roosa 

 was unable to find any Gonococci (Post-Graduate, 1906). 



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