INOCULATIONS IN 
TUBERCULOUS IRITIS. 
BY 
RUDOLF DENIG, M. D., 
Resident Assistant Surgeon at the 
New York Ophthalmic and Aural Institute (Dr. Knapp's). 
REPRINTED FROM THE 
Neto Ycrfe Neutral journal 
/or October 9, 1897. Reprinted from the New York Medical Journal 
for October 9, 1897. 
INOCULATIONS IN TUBERCULOUS IRITIS* 
By RUDOLF DENIG, M. D., 
RESIDENT ASSISTANT SURGEON 
AT THE NEW YORK OPHTHALMIC AND AURAL INSTITUTE (DR. KNAPP'S). 
The proper method of verifying the diagnosis of 
tuberculosis of the iris consists of inoculations into the 
anterior chamber of rabbits. 
The omission is explained by the fact that iridecto- 
mies are permissible only in cases with pupillary occlu- 
sion (" seclusio pupillse "). 
Though it seems best to prove the presence of the 
bacilli by the same method by which sputum is ex- 
amined-i. e., by the microscope-this is not always 
possible. Baumgarten, e. g., has reported some cases 
in which, despite the use of material without bacilli, 
true tuberculosis nevertheless developed after the in- 
oculation. He believes this to be caused by involution 
(spores) of the bacilli. Nevertheless, the inoculation 
into the rabbit may prove to be a failure too, although 
a true tuberculous iritis exists in the patient, as the 
following observation shows: 
A large portion of the iris of a man thirty-three 
years old, presenting parenchymatous keratitis with 
nodular iritis, was removed by iridectomy and cut into 
* Read before the German Medical Society, New York, June 7, 
1897. 
Copybight, 1897, by D. Appleton and Company. 2 
INOCULATIONS IN TUBERCULOUS IRITIS. 
two parts, a ciliary and pupillary one. Inoculations 
into the anterior chamber of two rabbits were made; 
the iris of the rabbit inoculated with the pupillary 
portion was not affected, while that inoculated with the 
ciliary portion showed the beginning of iritis about four 
weeks after the inoculation; hence, from the considera- 
tion of the above-mentioned results we might suppose 
that the bacilli irregularly distributed over the iris may 
have accidentally spared that particular portion of iris 
which was excised and utilized for inoculation. In view 
of this an observation of Leber's is interesting; it con- 
cerns a girl, thirteen years old, with the clinical picture 
of tuberculosis of the iris, complicated with a suspicious 
catarrh of the lungs and a previous tuberculosis of the 
elbow joint. Nevertheless, the inoculation was unsuc- 
cessful. 
I may here be permitted to make some remarks 
upon inoculation tuberculosis. Both in human and 
in inoculated tuberculosis of the iris we observe vari- 
ous forms, either the more benign nodules, or, at other 
times, the granulation tumors, which latter generally 
destroy the eye by cheesy degeneration. Samelsohn 
investigated the cause of this varied clinical manifesta- 
tion, introducing the tuberculous virus from one rabbit 
into the anterior chamber of another, and so on with a 
series of rabbits, in order to immunize them, but with- 
out any success. 
I have followed a different method, using extremely 
infectious cultures of tubercle bacilli and cultures ar- 
tificially attenuated in their virulence (at 40° C. for 
one hour in the incubator, or cultures which had been 
exposed to the daylight in the laboratory for about 
six months), using for my material rabbits, some very INOCULATIONS IN TUBERCULOUS IRITIS. 
3 
strong or very weak, others again which were old or 
young. I have always made control experiments. As 
to the technics of inoculation, I introduced the bacilli 
into the anterior chamber, suspended in a watery medi- 
um, using a hypodermic syringe. 
The result of the inoculation was that the physical 
condition of an animal, whether strong or weak, had 
no influence at all upon the benignity or malignancy 
of the course of the tuberculosis. I find, for instance, 
in my records an experiment concerning a very small 
and weak rabbit into which a very virulent culture 
was injected; small, multiple nodules gradually devel- 
oped in the iris, but disappeared again after about seven 
weeks; while a strong rabbit, infected with some of the 
same culture, showed a granulation tumor of about the 
size of a pigeon's egg. 
We find analogous conditions in human tubercu- 
losis. In a previous publication I demonstrated that 
patients afflicted with ocular tuberculosis do not in- 
variably exhibit a general scrofulous condition. Among 
eighty-six cases, e. g., of tuberculosis of the human 
iris, ascertained by microscopic examination or inocula- 
tion, there existed no simultaneous tuberculosis of the 
body in seventy-one, although among the latter twenty- 
seven were suspicious and four presented signs of previ- 
ous tuberculosis of other organs. But, excluding these 
thirty-one cases, forty are left-nearly fifty per cent.- 
absolutely sound and healthy persons, a fact by which 
we understand why in many cases, observed only from 
the clinical picture, the diagnosis of lues was more fre- 
quently made than that of tuberculosis. 
Furthermore, the attenuation of my cultures was 
absolutely indifferent as to the intensity of the tuber- 4 
INOCULATIONS IN TUBERCULOUS IRITIS. 
culosis. The same picture of tuberculosis could be pro- 
duced with attenuated as with very virulent cultures. 
Therefore the different intensity of reaction is not 
due to the bacilli, but to the susceptibility of the in- 
oculated organ-viz., to the individual aptitude or im- 
munity of the entire organism, or even, perhaps, of cer- 
tain parts. 
I have still to mention the result of inoculations 
into the ciliary body of some rabbits. There developed 
a small or large tumor of the ciliary body with iritis, 
but usually without any nodules in the iris itself. In 
some cases there were also nodules in the chorioid, 
associated with neuritis optica and subsequent atrophy 
of the optic nerve. In consideration of the results ob- 
tained in these latter experiments, we might well-nigh 
regard as of tuberculous nature some forms of serous 
inflammation of the iris which clinically may present 
as their aetiological base a tuberculous nodule of the 
ciliary body. 
It is a well-known fact that the tuberculosis of the 
iris in the human being, as well as in the inoculated 
animal, may heal, the small nodules especially often 
disappearing without any further damage to the eye. 
As to the metastasis and generalization of tuberculosis 
of the iris, I have to state that in no instance the 
tuberculosis of the inoculated rabbits became general. 
They remained under observation for about a year. 
This fact-though the percentage might be somewhat 
high-is especially interesting since it is contrary to the 
common views, according to which it was particularly 
noteworthy when the animal did not succumb.* 
* In connection with these observations, I may mention a publication 
of Martinotti (professor of pathology at Bologna, Italy, Centralblatt fur INOCULATIONS IN TUBERCULOUS IRITIS. 
5 
In accordance with my own views these results prove 
that similarly the tuberculous processes in the human 
iris (and chorioid) generally remain localized, and that 
we have to regard them in the same light as the local 
tuberculosis of the lungs, bones, glands, and articula- 
tions. If we consider in that light the above-mentioned 
eighty-six cases of tuberculosis of the iris we find that 
in only eleven cases there followed a tuberculosis of 
other parts of the body, while in eight cases, which 
had perished, a previous or coincident tuberculosis was 
demonstrated. The other sixty-seven cases remained 
healthy, nearly two thirds of them remaining under 
further observation for some time, in some instances 
covering a period of nearly eleven years. 
In connection with this I stated in a previous paper 
the rarity of metastasis in the eye from local tubercu- 
losis of the lungs, articulations, etc. In only five 
cases did I see lesions of the chorioid which might 
possibly have been tuberculous in nature, while two 
hundred and fifteen did not show any changes in the 
eye. 
Therefore, in cases of tuberculosis of the iris (and 
chorioid) I would hesitate to perform an enucleation of 
the eyeball. It might be advisable only in cases of rap- 
idly growing granulation tumors, which usually entail 
destruction of vision; but even in such cases the fact 
has to be considered that metastasis may originate not 
from the tuberculosis of the eye, but from other struc- 
Bakteriologie, 5, ii, 96) concerning a distinct antituberculous action of 
sodium sulphocyanate. Martinotti made inoculations into the anterior 
chamber of rabbits with tubercle bacilli, and found that after the injec- 
tion of sodium sulphocyanate the rabbits, " to his and his assistant's 
great astonishment," did not succumb to general tuberculosis. 6 
INOCULATIONS IN TUBERCULOUS IRITIS. 
tures as well; for instance, we know that tubercle ba- 
cilli are found in the glands of people otherwise perfect- 
ly healthy. From such a source bacilli may as well in- 
fect the iris as other organs of the body. I should like 
here to draw attention to a very interesting paper of Dr. 
Freudenthal's (Annals of Otology,Rhinology, and Laryn- 
gology, February, 1897) concerning the presence of tu- 
bercle bacilli in the nasopharynx, whence the bacilli 
may enter the lymph paths and produce tuberculosis in 
any part of the body. The New York Medical Journal. 
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