880 BACTERIOLOGY OF THE EYE 



variety of chronic inflammations. This is a distinct confirmation of 

 the teaching of von Michel, based on clinical observation as to the 

 cause of chronic uveitis in man. 



The great majority of the cases of chronic uveitis are therefore not 

 likely to be purely toxic. On the other hand, these experiments 

 tend to the idea of the metastatic causation of sympathetic 

 ophthalmia. This view was first brought forward by Berlin, later by 

 Panas, Moll, Picot, and in a modified way by Schmidt-Bimpler, and, 

 though freely controverted, has much in its favour. 



The Leber-Deutschmann hypothesis of transference in continuity, 

 particularly through the sheath of the optic nerve, can no longer 

 be considered as proven ; its alleged demonstration by cultures, 

 microscopy, and experiment will not stand criticism. 



On the other hand, the experiments of Picot 1 and Romer 2 show 

 that the transference from an eye experimentally infected either does 

 not occur, or does so with very great difficulty by way of the optic 

 nerve or its sheath, but that it can occur with ease and regularity 

 by way of the circulating blood. This was the case with various 

 bacteria. Romer demonstrated it for many saprophytes, and also for 

 bacteria which could be recognized by their spores for a relatively long 

 time. Trypanosomata (Protozoa) also produce a rapid general infec- 

 tion from the eye (Romer, A. Leber, Stargardt). Experiment is in 

 favour of the metastatic hypothesis. 



Picot insists that this passage of organisms from an experimentally infected eye 

 into the blood is an important factor in the pathogenesis of sympathetic ophthalmia, 

 the more so as he obtained a metastatic inflammation in the other eye in a tetra- 

 genus experiment. 



The experiments which Eomer has recently published show with what ease and 

 rapidity the organisms can pass from an infected rabbit's eye into the blood, even 

 in cases where the refracting media alone are infected without injury to a single 

 vessel. Eomer did not limit himself to the clinical demonstration of severe fatal 

 general infection, but examined the blood and also the other eye at varying times 

 after the infection of the first one. The inoculated organisms could be demonstrated 

 after a few hours in the second eye. Eomer states that they are freely found in the 

 blood of the uvea. 



The question then arises, To what extent can these facts be applied 

 to man ? The clinical fact, that a fatal general infection extremely 

 rarely results from a suppurating eye, even in the severest pan- 

 ophthalmitis 3 (due to the most virulent organisms), seems to show that 



1 Arch. d'Oph., 1898, xviii. 341. 



- Ophth. Gcs., Heidel., 1903, p. 40; A. f. A., 1906, Iv. 4, and 1906, hi. 1. 



3 Wnrdemann and Becker (Ojrhthalmofogy, 1906) describe such a case, giving cultures. 

 Fatal general infection occurred in a case of Basedow's disease from a streptococcal 

 panophthalmitis caused by the lagophthalmos. 



