CHAPTER XI 

 THE ORBIT 



SEEING that the infectious diseases of the orbit are, with rare excep- 

 tions, due to a spread from neighbouring organs only very rarely 

 are they metastatic their bacteriology will agree with that of the 

 surrounding parts. 



The bacteriology of the orbit corresponds in a very marked degree 

 with that of the accessory sinuses of the nose. 1 



In this connexion we only need to indicate the careful investigations and the 

 collected literature in the work of Stanculeanu and Baupp on the bacteriology of 

 the empyemata of the sinuses (Intern. Med. Congr., Paris, 1903, sec. of Ophth., 

 p. 103), and the ' Handbuch der Erkrankungen der Nase,' by Zarniko (second 

 edition, 1905, Karger, Berlin). The first authors state that in the foetid, stinking 

 empyemata, which are especially due to carious teeth, along with pyogenic organ- 

 isms, anaerobic putrefactive organisms were found (according to Veillon and Zuber 

 B. perfmngens, B. ramoaus, B. serpens, B. fragilis, St. parvulus, to which 

 Zarniko adds B, fluor. putr,, and B. pyog. feet.). These putrid inflammations 

 mostly spread from the maxillary antrum, and originate from the teeth, whose im- 

 portance in orbital inflammations was first pointed out by Pagenstecher. In the 

 simple purulent or muco-purulent empyemata, which are most commonly found in 

 the other sinuses, the pyogenic organisms alone are found, and according to Stancu- 

 leanu and Baupp, in the following order of frequency : 



1. Pneumococci. 



2. ,, with Streptococci, 



3. ,, with Pneumobacilli (Friedlander). 



4. Streptococci alone. 



5. Stapliylococci alone. 



The actual frequency might vary in other lists ; the overwhelming importance of 

 the Pneumococci is established from large collections of material. To this list must 

 be added the rare cases of influenza bacilli, diphtheria bacilli, and Meningococci 

 being found in the empyema, of which they were the cause (cf. Zarniko's literature ; 

 also Eversbusch, second edition Graefe-Saemisch, 1903, and the collected literature 

 by Brons in the ' Ergebnisse ' Lubarsch-Ostertag, 1900-1905). Pseudo-diphtheria 

 bacilli have been often found, but are of uncertain significance. 



1 As Fuchs first showed, the lacrymal sac, being in close relation to the sinuses, is 

 occasionally the source of orbital complications (see the literature by Mouzels, These de 

 Bordeaux, 1903; by True, Ann. d'Ocul., 1900, p. 94; and Antonelli, Ophth. Klinik, 1900, 

 No. 7). It is doubtful whether or not in many of these cases the sphenoidal sinus was not 

 also affected. 



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