370 BACTERIOLOGY OF THE EYE 



whether the organismal cause has only settled down in the vessels, and has not yet 

 passed out into the exudate. A recurrent fever will probably supply an opportunity 

 for the experimental decision of this question, for Ewetzky 1 has succeeded in 

 inoculating apes with this disease, and observed in them the usual iridochoroiditis 

 as an after-effect. 



It has not yet been possible to decide in which class endogenous rheumatic 

 inflammations should be put. Bucheron, 2 from the excellent results which he 

 obtained in fifty cases treated with Marmorek's serum, refers the cause to the 

 Streptococcus. The variability in their course makes such a conclusion uncertain. 

 It is possible that mild metastases do occur in which the organism mentioned is 

 causal. This view is supported by the experiments, previously mentioned, of Stock, 

 Selenkowski, and Woyzechowski. Poyton and Paine (Ophthalmoscope, October, 

 1903) obtained from the blood of a patient with rheumatic fever a Streptococcus, with 

 which they were able to produce a benign hsematogenous iridocyclitis in the rabbit. 



L. Miiller's case of miliary actinomycosis of the choroid 3 is an 

 isolated one. In the tuberculoid nodules the Ray-fungus was not to 

 be seen. 



We are not justified in classifying the rnetastatic affections of the 

 eye merely according to the causal organism, as these can cause 

 variable appearances. Certain points of differentiation can, however, 

 be recognized. 



The streptococcal cases. 4 concerning which there is a large amount of material 

 available, generally develop as an acute suppuration, with panophthalmitis and per- 

 foration of the globe. Naturally this is not invariable, for the virulence of the Strepto- 

 coccus varies. Those Streptococci which are the cause of septic pyaemia, as a rule, 

 are very pathogenic. A favourable termination is very rarely observed in the eye 

 (Grunert). It is the puerperal cases, mostly due to this organism, which have 

 had a noticeably violent suppurative course. The anatomical and bacteriological 

 examination of such cases shows that, when an embolism has occurred, the Strepto- 

 cocci grow at an extraordinary rapid rate in the eye, particularly in the vitreous, 

 but also in the other layers. Large portions of the capillary system of the retina 

 will be completely replaced by bacterial aneurysms ; the organisms can grow into 

 the larger vessels, causing rapid atrophy of the tissues of the retina. 



1 Westnik Oft., 1897, xiv., i., p. 51, and Zent. f. A., 1897, p. 111. 



2 Ann. d'Ocul., 1896. Of. Chevallereau, Chaillous, Inter. Confer.. Lucerne, 1904, B., 

 p. 310 ; also Fuchs, A.f. 0., 1904, Iviii. 39L 



3 K. M.f. A., 1903, xli., i., p. 236. 



4 Vossius, Wagenmann, Pousson, van der Bergh, Despagnet, Mitvalsky, Rancurel, 

 Herrnheiser (three cases) all puerperal cases ; Panas, Axenfeld (five cases). See the 

 further literature: Axenfeld, A. f. 0., 1894, xl., 3, p. 24. Wagenmann, Hcidel. Congr., 

 1896, p. 293. v. Michel, Z.f. A., 1902, p. 1 ; capillary embolisms, just as in the previous 

 case of Michel, were here present. Veillon and Morax, Ann. d'Ocul., 1894, cxi. 341. 

 Chaillous, K* M.f. A., 1905, xliii., i., p. 434. Grunert, ' Retinitis Septica u. Metast,,' 

 30 Vers., Heidel., 1902, p. 338. Lenhartz, 'Die Septische Erkrankuugen ' ( ' Kothnagels 

 Spec. Path. n. Therapie,' 1903, iii. 151). Berger, A. f. 0., 1896, p. 494. Liebrecht. 

 K. M.f. A.. 1903, xli., ii., p. 124. Onfray, Arch. d'Ophth., 1904, p. 43. Bull, Amer. 0. S., 

 1901, p. 316. Terson, La Clin. Ophth., 1905, p. 167. De Schweinitz, Ophth. Rec., 1904, 

 p. 201, and Sect, of Ophth., Philad., February, 1906. Stock, A". M.f. A., 1906, xliv., ii., 

 p. 431. Pagenstecher, jun., ibid., 1906, ii. 530: a case of Streptococcus mucosus. Bivona, 

 Progr. Oftal., April, 1906. Kipp. Amer. Jour, of Ophth., 1906, p. 324. Vogelsang. 

 Inaug. Dissert., Amsterdam, 1907, p. 59. De Schweinitz, Ann. of Ophth., 1907, p. 41 

 (bilateral puerperal case with recovery). 



