386 BACTERIOLOGY OF THE EYE 



Seeing that the empyemata of the sinuses often occur in the course, 

 or as sequelae, of infectious diseases, the orbital complications which 

 they cause were formerly considered as metastatic, the connexion 

 between them and the nasal condition not being known. We now 

 know that the case is different. 



It should be noted that the original sinusitis can heal by evacuation 

 into the nose, while the orbital condition to which it gives rise is pro- 

 gressive, as it cannot find any drainage. At the time that the orbital 

 condition is under treatment the original sinusitis may be healed. I 

 have been able to demonstrate such a condition by exploratory trephin- 

 ing in the case of an orbital suppuration connected with an influenzal 

 sinusitis. 1 We can only consider an orbital inflammation as metas- 

 tatic when the evidence is conclusive on that point. 



It is therefore not to be wondered at that the orbital inflammations, 

 so far as their bacteriology is given in the literature, agree in all 

 bacteriological essentials with the Sinus affections. It is hardly 

 necessary to go through these singly. 



Pneumococci have been found by Hirsch, 2 Kuhnt, 3 Guignot-Cabannes, 4 Faure 

 (These de Bordeaux, 1903), De Lapersonne, 5 Weiss, 6 Lefran^ois," Axenfeld, s Vossius," 

 Thomson. 10 



Streptococci, in part mixed with Stapliylococci, by Berger, Eeis, Panas, 11 

 Trousseau, Axenfeld, Brand, Hirsch, Thomson (loc. cit.), Villard (Arch. d'Ophtli., 

 1895, p. 477). 



Staphylococci alone by Pergens, Axenfeld, De Lapersonne, Brand, Thomson, 

 Orlandini, 12 Terson (Sec. d'Ophth., 1894). 



Influenza bacilli by Siegrist, 13 Axenfeld and Brand. 14 



B. fusiformis, Morax (Soc. Franq. d'Ophth., 1905, p. 385). 



The empyemata and the orbital inflammations which occur in pneumonia are not 

 always due to the Pneumococcus, nor those in influenza to the influenza bacillus. 

 On the contrary, the bacteriological findings vary in one and the same originating 

 disease. Organisms are previously present in the nose (perhaps, too, in the sinuses), 

 and these can act pathogenically when the lowered general condition gives them 

 opportunity. 



De Lapersonne considered that cases caused by the Staphylococcus are relatively 

 milder than those suppurations which are due to Pneumococci, Streptococci, or 

 Friedlander's Pneumobacillus. 



Page's opinion (Ann. d'Ocul., 1895, p. 341) that ozsena bacilli from the nose or 

 infected nasal sinuses can reach the eye and there set up an iritis is quite unproved. 

 It is certainly not impossible that a general infection has so occurred, and that the 



1 Deutsche Med. Wocli., 1902, S. 713. 2 Prayer Med. Wocli., 1894. 



3 ' Die Erkrankungen der Stirnhcihle, ' 1895 (F. Bergmann). 



4 ' Pneumococcies Oculaires, ' These de Bordeaux , 1905. 



5 'Les Complic. Orbit, des Sinusites,' Congres Fran^. d'Ophth., 1903. 



6 Z.f. A., 1904, x., S. 16 and 91. 7 Annales d'Ociil, 1899 S. 21. 

 8 Deutsche Med. Woch., 1902, S. 713. Z.f. A., 1900, iv., S. 16. 



10 B. M. J., September, 1906. " Arch. d'Ophth., 1895, xv., S. 129 



18 'Jahresber.,' Michel-Nagel, 1904, S. 698. 



13 A.f. 0., 1894, xl., 3 and 4, ' Anmerknng.' 14 Inaug. Dissert., Freiburg, 1902. 



