382 BACTERIOLOGY OF THE EYE 



in the experimental animals no condition can be produced analogous 

 to the sympathetic irritation of man (photophobia, contraction of the 

 pupil, and vasomotor irritation). The localizing action for circulating 

 bacteria of such a vasomotor irritation as occurs in man is by no 

 means disproved ; on the contrary, from analogies in general 

 pathology, it must be considered as quite possible. It could con- 

 ceivably occur even if anomalies of secretion did not take place in 

 sympathetic irritation. This is important with reference to the dis- 

 cussion on deep-seated bilateral endogenous inflammations of the 

 globe (especially keratitis parenclrymatosa) following a unilateral 

 trauma. It is claimed by many that Homer's experiments have finally 

 excluded any connexion between them. Such is certainly not the 

 case ; the question is one of great difficulty. 



I do not, however, consider that the modified theory of ciliary nerve 

 influence is proved. The objection to it is more that there are so 

 many cases of sympathetic ophthalmia which are not preceded by the 

 symptom-complex of sympathetic irritation than that the experiments 

 quoted have proved it invalid. They have only taken away from it 

 one of its presumed experimental supports. 



Golowin 1 and Santucci 2 state that the destruction of certain cell groups in the 

 wounded eye, more especially in the ciliary body, cause the formation of cytotoxins 

 in the blood, which can act upon analogous parts of the other eye. This is, of 

 course, no explanation of sympathetic ophthalmia as a whole, as a definite pro- 

 gressive inflammation, often going on after enucleation of the first eye to consider- 

 able destruction, and obviously a true infection of the second eye (Pusey, A. f. 0., 

 xxxii. 334). The view advanced by Bellarminow and Selenkowski, 3 and sup- 

 ported by experiments, that sympathetic inflammation is exclusively a transference 

 of toxins, seeing that the poison of the Siapliylococcus aureus, when injected into the 

 vitreous or the optic nerve, can produce inflammation on the other side, is not con- 

 clusive, as this poison certainly has nothing to do with sympathetic ophthalmia. 

 Their experiments also require confirmation. 



Stock 4 was absolutely unable to confirm the similar statement by Gasparrini ^ 

 that an inflammation on the other side could be produced by the injection of 

 diphtheria toxin. 



The whole clinical course of sympathetic inflammation is against such a purely 

 toxic origin ; at most the invariably benign papillo-retinitis sympathetica, which 

 heals promptly on the enucleation of the first eye, may suggest such an origin. It 

 would be better to reserve judgment even on this point till the etiology of the whole 

 condition is better understood. Stock's experiments have shown that haematogenous 

 tubercles in the choroid heal more rapidly and completely than similar ones in the 

 anterior part of the uvea, and it is not unlikely that a corresponding state of affairs 

 may obtain in sympathetic ophthalmia. 



1 Ami. d'Ocul., 1905, cxxxiii. 233. Wrcdsch, 1905, No. 22. 

 - La Clin. Oculista, 1906, vii. 2685. 



3 Cf. ref. K. M.f. A., 1900, Beilag., and A. f. A., 1901, p. 1, and 1902, p. 55. 



4 K. M.f. A., 1903, i, p. 81. 5 Ann. di OttaL, 1901, p. 285. 



