Text-book of ophthalmology / by Ernst Fuchs ; authorized translation from the eleventh revised and greatly enlarged German edition with numerous additions by Alexander Duane.

  • Ernst Fuchs
Date:
[1911]
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Credit: Text-book of ophthalmology / by Ernst Fuchs ; authorized translation from the eleventh revised and greatly enlarged German edition with numerous additions by Alexander Duane. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

    53/1032 page 37
    Of chronic infectious diseases must be mentioned in the first place tuberculosis (lepra resembles it) and syphilis. In addition there are gonorrhoea, when by entrance into the blood channels it has led to general infection, and also articular rheumatism, with regard to whose causal agent no decision has yet been reached. These diseases are complicated by eye inflammations which, in conformity with the pathogenic prop- erties of their exciting germ, are not acute and purulent but chronic and non-purulent. The different membranes of the eye are attacked by these inflammations with different degrees of violence, and this does not depend simply on the vascularity of the membrane, for the non-vascular cornea is often affected. It is assumed that the microbes in question or their toxins possess a differing affinity for the individual membranes of the eye. By far the oftenest to suffer is the uvea, and in this the iris and ciliary body suffer the most, the chorioid less. Tuberculous, syphilitic, gonorrhceal, and rheumatic irido-cyclitis are frequent diseases. The way in which the uvea participates in the general infection, whether by the presence of the bacteria themselves in the tissue or by the mere action of toxins, has been but little investigated as yet and is probably not always the same. In tuberculo- sis at times iritis occurs with evident tubercle nodules which without doubt are caused by the bacilli themselves; but still more often we find a chronic iritis which neither clinically nor microscopically shows tubercle nodules nor allows us to demonstrate bacilli by the microscope or by inoculation, so that we should be inclined to attribute the iritis to a simple toxin action. But the possibility is by no means excluded that in such cases the tubercle bacilli themselves, although in scanty pumber and in a weak- ened state, may be the cause of the inflammation. Stock, by injecting tubercle bacilli into the blood of test animals, has produced small nodules in the iris and white patches in the chorioid, which disappeared again after a short time, while severe tuberculosis always develops when the tubercle bacilli are introduced into the eye. Stock explains the benignity of the affection in the first case by the assumption that the tubercle bacilli may have undergone weakening, due to their stay in the blood. The like explanation may hold good for the cases of benign tuberculosis of the uvea in man. The cornea becomes diseased under the guise of keratitis parenchymatosa, kera- titis eczematosa (scrofulosa), and sclerosing keratitis. The first disease is in most cases to be attributed to hereditary syphilis, the two latter affections to tuberculosis. Here, again, it is not determined whether the disease of the cornea depends upon the direct action of the microbes which may get into the cornea from its marginal vessels or upon the action of toxins. In animals, at all events, there can be produced by the inoculation of syphilitic material an inflammation which resembles parenchymatous keratitis and in which spirochaete can be demonstrated in the cornea. A similar keratitis can be produced experimentally, by injecting the trypanosomes, which are akin to the spiro- chsetaa. The retina, in which the metastases that occur in the course of acute infectious diseases are most often localized, is rarely affected primarily, but very often secondarily in chronic infectious diseases. By endogenous infection of wounds we understand the settling of microbes, which are present in the circulating blood, in those parts of the body that have been injured by traumatism. This process can be set up experimentally by injecting pyogenic germs into the blood channel and then injuring the eye. What can be done in experiments on animals must be regarded as probably also possible in man, and some cases which have been carefully examined belong with great probability in this category [of endogenous wound infection]. But we must be very careful how, without surer proof, we accept this process as a convenient explanation of all possible diseases whose causes we do not know.
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