ENDOGENOUS INFECTIONS 383 



Similarly, we cannot accept the old hypothesis of nerve irritation, even in its new 

 form, as given by Theobald (Ophth. Eec., 1904, p. 329), making sympathetic 

 ophthalmia non-infectious, like herpes zoster. Quite frequently no such irritation 

 of any sensory nerve is present at the commencement of a sympathetic ophthalmia. 



Findings in Sympathetic Ophthalmia. 



On all sides it is admitted that sympathetic ophthalmia is an infectious disease 

 which arises by the inoculation of bacteria (Leber). It is also agreed that the 

 pyogenic organisms on which Deutschmann laid special stress have no relation to 

 sympathetic ophthalmia. In the great majority of cases they have not been 

 found when material has been taken with aseptic precautions from either the 

 exciting or the sympathizing eye ; and in those cases where cultures of these 

 organisms were obtained either a contamination . or a secondary infection occurred. 

 Deutschmann's finding of bacilli and cocci in certain exciting 1 eyes, which he 

 examined microscopically, and also once in a sympathizing eye, as well as in the 

 nerve sheaths, is not convincing. Such a purely microscopical proof can be con- 

 fused by the presence of mast-cell granules, nuclear fragments, etc. It must be 

 considered that with our present methods no certain demonstration of micro- 

 organisms which could have an etiological significance has succeeded in anatomical 

 preparations, in experiment on animals, or in cultures. I have often attempted 

 this, but always in vain. The relation which is sometimes claimed to exist between 

 tuberculosis and sympathetic ophthalmia is unlikely, and can be laid aside. 2 



Kaehlmann 3 records finding bacilli and very small moving particles with the 

 ultramicroscope ; this cannot be taken to have any general importance, as bacilli of 

 that size would have been seen with the ordinary immersion lenses, and in every 

 attempt made by others this has not been the case. It is much more likely that 

 these granular bodies were something quite secondary. 



Following up the idea that sympathetic ophthalmia was a metastatis, Zur Nedden 4 

 injected the blood of sympathetic patients into the vitreous of the rabbit to see 

 whether an inflammation would be caused, and reports that such did occur to a 

 greater degree than with the blood of normal persons. The re-inoculation of the 

 vitreous of other animals with the vitreous of the infected animal produced in- 

 flammation, and from the vitreous of the fourth inoculated generation a peculiar 

 variety of the pseudo-diphtheria bacillus was grown. It was very refractory to 

 staining; with an alcoholic fuchsin solution 1 in 10, after twenty minutes small 

 rods could be seen. These were more easily seen by the Gram stain when the 

 alcohol was carefully used ; their cultivation was difficult, and only succeeded when 

 a considerable amount of vitreous was added to rabbit's blood-serum-bouillon. The 

 organisms could be gradually accustomed to ascites media and Loffler's serum, and 

 their form became more and more like that of pseudo-diphtheria bacilli ; they grew 

 more slowly as grey, slightly granular colonies. They had a very great resisting 

 power against heat, standing 60 C. for three-quarters of an hour without being 

 killed. When injected subcutaneously or into the peritoneum, they caused localized 

 inflammatory nodules, which resolved spontaneously. Even when in small 

 quantity in the vitreous they caused an insidious inflammation, leading to shrinking, 

 very similar to the inflammation produced when the organisms were injected into 

 the blood. When large quantities were injected into the carotid, metastatic 



1 The word ' exciting ' is used as translation of Sympathizierend, the original eye, and 

 ' sympathetic ' is used as translation of Sympatisch, the secondarily affected eye (A. M.). 



2 Cf. K. M. f. A., 1900, Beilag., p. 107; 1900, Bd. xxxviii., p. 578; and Brous 

 Jfiinch. Mcd. Woch., 1906, p. 1938. 



3 Deutsche Med. Woch., 1904. 4 A. f. 0., 1905, Ixii. 2. 



