Some practical aspects of conjunctival bacteriology / by Freeland Fergus.

  • Fergus, A. Freeland (Andrew Freeland), 1858-1932.
Date:
[1905]
Catalogue details

Licence: In copyright

Credit: Some practical aspects of conjunctival bacteriology / by Freeland Fergus. Source: Wellcome Collection.

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

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    surgeon residing m another town. The night after t'he operation she was seized with violent pain in the eye ^Sh ultimately became an atrophic stum?, either from ^ute suppuration or from irido-cyclitis. She happened to admitted under my care at the Eye Infirmary to have thi other eye done, and, following my usual plan, thoroueh investigations were made, ' ^8 It was then discovered that there was plenty of strepto- coccus in the conjunctival fluid of the remaining eye. That afforded an ample explanation of the disaster to the first eve and gave warning as to the treatment of the second. Had an operation been at once performed there is every probability that the second eye would also have been lost. A period of a fortnight passed before the condition of the conjunctiva warranted an operation. This was done in the usual manner by combined extraction, a large conjunctival flap being cut. J? or the first ten days the patient was absolutely free of all pain, and the wound healed rapidly and well. At the end of that time, however, she complained one night of a good deal of pain, and on examining her next day I found the lids somewhat swollen and all the other evidences of an acute catarrhal conjunctivitis present. On making cover-glass preparations it was observed that streptococci were abundant in the discharge. It was a streptococcic conjunctivitis—a reinfection of the conjunctiva, probably from the nasal cavities. Fortunately the wound was firmly united, and the eye was beyond risk so far as vision was concerned. Take another example out of many which I could give: At present there are in the hospital 3 children who are all affected with very similar injuries. In each there has been a penetrating wound of the cornea followed by traumatic cataract. One of these eyes is as quiet and free from irritation as in the most healthy condition. In this case there are no micro-organisms in the conjunctival fluid, or only those which are perfectly innocuous. Both of the others are extremely irritable, and in each there is an acute catarrhal condition of the conjunctiva. In the discharge from one of these cases pneumococci are abundant. In that of the other there are numerous micro-organisms which at present are undergoing the process of being identified.* It will not do in instances such as these to say that the difference depends upon a different amount of swelling of the lens. A swollen lens will not per se determine any external irritation. Such a lens, if not properly treated, may and very likely will give rise to a traumatic glaucoma, but it will not give rise to a catarrhal condition of the conjunctiva or to an iritis. Again and again I have needled lenses both for con- genital cataract and for high myopia so as to nearly fill the anterior chamber with lens debris, but I have never seen apart from micro-organic life any acute condition. Oases such as have been described might be almost indefinitely multiplied, but these instances must suffice for the present. To sum up this part of the subject: No operation which involves the opening of the ball should be undertaken if bacteriological investigations reveal the presence of staphy- lococcus aureus, streptococcus, pneumococcus, or any other »The eye which had the pneumococci subsequently developed a hypopyon with irido-cyclitis, and had to be enucleated. The other made an excellent recovery, and in this respect it is interesting to not« that the micro-organism turned out to be the staphyloooccua albus.