374 BACTEKIOLOGY OF THE EYE 



fore, justifiable to consider this etiology probable, though, of course, it must not be 

 taken as established. There are, however, pneumococcal metastatic suppurations 

 which are so virulent that they rapidly lead to panophthalrnitis. 



Bietti was therefore right when he attributed a spontaneously healing uveitis, 

 with replacement of an inflammatory detachment of the retina, in a child with 

 broncho-pneumonia, to a pneumococcal metastasis rather than to a purely toxic 

 condition. 



Metastatic inflammations in epidemic cerebro-spinal meningitis 

 are almost always comparatively mild in their course that is to say, 

 they rarely go on to complete suppuration. In this affection quite 

 mild abortive metastases are not uncommon. 



It can be taken as certain that such cases, in so far as they occur in large 

 epidemics, are due to the Meningococcus iniracellularis of "Weichselbaum (whose 

 occurrence on the conjunctiva has already been considered, p. 216). This has been 

 definitely proved in cases by Wintersteiner, 1 Axenfeld, 2 and Morax. 3 Uhthoff 4 was 

 able to demonstrate cocci in sections, though Heine's 5 investigation of their nature 

 was negative. Anatomical examinations of the earlier cases was also negative. 

 This might well be due to the fact that the Meningococci in the infected eye rapidly 

 die out, and when the eye is available for examination they cannot any longer 

 be demonstrated. The case recorded by Zimmerrnann and Brown- Pusey 6 was only 

 examined after an interval of years. 



The early stages of these meningococcal metastases have never yet been examined 

 anatomically and bacteriologically ; still, we can conclude that the ophthalmitis 

 develops from metastases, and not by a spread from the meninges through the optic 

 nerve sheath. In the cases examined by Kudnew, Oeller, and Uhthoff, the sheath 

 of the optic nerve was normal, and the retina or the choroid was destroyed by 

 suppuration. 



Axenfeld's" examinations of cases of metastatic ophthalmia in pneumococcal 

 meningitis, which sometimes occurs in small epidemics, also assist in deciding this 

 question. In one of his cases a bacterial embolism was demonstrated in the retina, 

 and in another large numbers of Pneumococci were found in the purulent retina, 

 while the optic nerve sheath was quite normal. He was also able to show and this 



xxvi. 306. Alfieri, Arch, di Ottal, 1897, iv. 328. Malfi, Arch, di Ottal., 1899, vii. 125. 

 Morax, Soc. Franc,. d'Ophth., 1898. Haushalter, Gaz. ffebdom., July 8, 1895. Ahlstroem, 

 Ann. d'Ocul., 1897. Schwarz, Deutschmann s Beitraye z. Aug., 1898, S. 34. Silcock, 

 T. 0. S., 1900, p. 112. Dhuyelle, These de Paris, 1900, S. 25. Bull, Amer. Ophth. Soc., 

 1901. S. 316. Gisselbrecht, These de Nancy, 1902. Bovier-Lapierre, These de Lyon, 1902. 

 Bietti, K. M.f. A., 1903 (Festschr.f. Manz, S. 51). Petit, Ann. d'Ocul., 1901, cxxvi. 186. 

 Purtscher, Zent. f. PraU. Aug., September, 1902. Romer, K. M. f. A., 1902, xl., 1, 320. 

 Casali, XVI. Kongr. Ital. Ottal., ibid., 1903, xli., i., S. 338, and Ann. di Ottal. Weeks, 

 Ophth. Record, 1903, S. 61. Wendt, ' Doppels. Metast. Ophth. bei eiiiem Kind,' Inaug. 

 Dissert, Jena, 1901. Zobel, Zeit. f. A., 1904, xi., S. 32. Morax, Ann. d'Ocul., 1904, 

 cxxxii., S. 409. Lenhartz, 'Die Septischen Erkrankungen ' ('Nothnagels Spec. Path, und 

 Therapie,' 1903, Bd. iii., p. 15). Vogelsang, Inaug. Dissert., Amsterdam, 1907, p. 71. 



1 Wien. Klin. Woch., 1904, p. 996. 



2 Remarks on Haglund's paper, K. M. f. A., 1900. Gram-negative Diptococci were 

 recently found in a very mild case of iris metastasis ; these may have been Meningococci 

 (there was no reason to consider that they were Gonococci). Cultures were unsuccessful. 



3 Soe. d'Ophth. de Paris, October, 1905 ; also Hanke, Wien. Ophth. Ges., April 17, 1907, 

 and Abt, Soc. d'Ophth. de Paris, 1902, p. 81. 



4 Ver. d'Ophth. Ges. ffeidel., 1905, p. 102. 



5 Bcrl. Klin. Woch., 1905, No. 25. 6 Annals of Ophth., 1903, xii. 446. 

 7 Monatsschr. f. Augenh. u. Psychiatric, 1897, i. 



