326 RHINOSCLEROMA 



they could be stained by Gram's method, but more recent obser- 

 vations show that, like Friedlander's organism, they lose the stain. 



From the affected tissues this bacillus can be easily cultivated 

 by the ordinary methods. In the characters of its growth in 

 the various culture media it presents a close similarity to that 

 of the pneumobacillus, as it also does in its fermentative action 

 in milk and sugar-containing fluids. The nail-like appearance 

 of the growth on gelatin is said to be less distinct, and the 

 growth on potatoes is more transparent and may show small 

 bubbles of gas ; but it is doubtful whether any distinct line of 

 difference can be drawn between the two organisms so far as 

 their microscopical and cultural characters are concerned. 



The serum of patients suffering from the disease gives fixation 

 of complement when tested with an emulsion of the bacillus, but 

 varying results have been obtained as regards the validity of the 

 test in the differentiation of the bacillus from the allied 

 organisms. 



The evidence that the organisms described are the cause of 

 this disease consists in their constant presence and their special 

 relation to the affected tissues, as already described. From 

 these facts alone it would appear probable that they are the 

 active agents in the production of the lesions. Experimental 

 inoculation has thrown little light on the subject, though one 

 observer has described the production of nodules on the con- 

 junctivas of guinea-pigs. The relation of the rhinoscleroma 

 organism to that of Friedlander is still a matter of doubt, and 

 the matter has been further complicated by the fact that a 

 bacillus possessing closely similar characters has been found to 

 be very frequently present in ozcena, and is often known as the 

 bacillus ozoence. The last-mentioned organism is said to have 

 more active fermentative powers. From what has been stated 

 it will be seen that a number of organisms, closely allied in their 

 morphological characters, have been found in the nasal cavity 

 in healthy or diseased conditions. There is no doubt that 

 rhinoscleroma is a specific disease with well-marked characters, 

 and it is quite possible that one member of this group of 

 organisms may be the causal agent, though indistinguishable 

 from others by culture tests. There is, however, a tendency on 

 the part of recent investigators, e.g., Perkins, to consider the 

 "bacillus of rhinoscleroma" to be identical with the pneumo- 

 bacillus, and its presence in the affected tissues to represent 

 merely a secondary invasion. The subject is one on which more 

 light is still required. 



