ENDOGENOUS INFECTIONS 381 



the conditions are different in man. Severe general sepsis is very rare. 

 The difference may be due to the fact that, as in the experiments of 

 Picot and Eonier, large numbers of highly virulent organisms intro- 

 duced into the aqueous or the vitreous could pass into the blood or 

 lymph channels before any obstruction was interposed. On the other 

 hand, when a wound infection develops in an eye, the number of 

 organisms introduced is less, and an obliteration of the passages out 

 of the eye can be produced by cellular and fibrinous deposits, the 

 powers of resistance being greatly increased. 



Cases are very rare in which, after a bulbar infection, we find 

 a meningitis resulting by spread in continuity (cf. p. 348, and the 

 literature by Lapersonne, Enslin, and Kuwahara). 



We do not, however, claim, even in man, that organisms do not 

 pass into the blood during the course of an eye infection. Slight 

 general feverish symptoms are not uncommon. Special investigation 

 is necessary to show whether, and to what extent, a slight general 

 infection does occur in such cases in man. Micro-organisms have 

 never yet been demonstrated in the blood in panophthalmitis ; and 

 even if this were so with the pyogenic bacteria to a limited extent 

 merely, it need not necessarily be so with other organisms. 



While Schniidt-Rimpler, Panas, Moll, and Bach consider the infection of the second 

 eve to be brought about by organisms already present in the body, being localized 

 by the irritation or the trauma reflexly affecting the other eye, the older opinion 

 (Leber, Schirmer, etc.) has lately been championed by Romer that the presumptive 

 causal agent enters the injured eye from without and spreads from there. 



If the rare cases of sympathetic ophthalmia without any perforating wound are 

 to be brought into line, an endogenous infection of the first affected eye must be 

 presumed. 



Schmidt-Pdmpler attempted to explain the metastatic occurrence of sympathetic 

 ophthalmia, without noticeable general disturbance or metastatic inflammation in 

 other organs, by attributing to the other eye a preparatory disposition, due to a 

 sympathetic irritation from nervous influence. Mooren, Rumpf, and Bach reported 

 that they obtained an increase in the albuminous contents of the aqueous in one 

 eye of the rabbit by experimentally irritating the other. Wessely, Tornabene, 

 and Stock 1 could not confirm this. By more refined methods, the hsemolysin 

 reaction, Ronier - showed that there was really no change in the secretion to be pro- 

 duced thus, and he insisted that the exclusive affection of the other eye was due to 

 the fact that the organisms were exclusively pathogenic for the eye. In the section 

 on ' Wound Infection,' we have already discussed the question as to the occurrence 

 of organisms which under other circumstances act as saprophytes (see p. 191 ; cf. 

 the work of Ulbrich). 



The alleged experimental proof of the localizing action of a sympa- 

 thetic irritation must therefore be put aside. It should be noted that 



1 K. 31. f. A., 1903, xli., i., pp. 81, 228 (literature here). 



2 A.f. 0., 1903, Ivi. 3. 



