56 BACTEKIOLOGY OF THE EYE 



invariable presence of this organism in acute eczema has been demon- 

 strated, from the dermatologist's point of view, by Scholz. Herzog 1 

 takes the intermediate view, and regards the Staplnjlococci as causal 

 in many cases of eczema where there is a disposition, and only as 

 secondary in the other cases. 



The presence of pus-forming cocci in large numbers is a character- 

 istic of impetiginous eczema ; Streptococci also are very often present. 



Impetigo contagiosa 2 sometimes occurs on the lids, and in the fresh 

 eruptions we find large numbers of Streptococci, 3 less commonly pyo- 

 genic Stapliylococci,^ Terson considered that the Streptococci were 

 primary, and that the Staphylococci were a contamination which per- 

 sisted after scabbing occurs. 



Kolle and Hetsch 5 consider that there is not sufficient proof that 

 the pus-forming cocci are really the cause; some unknown specific 

 germ may be the cause of its transmission. 



Blepharitis Ulcerosa. 



When a suppurative ulceration develops at the lid margins, either 

 as a primary condition or as the result of a simple seborrhosa, then 

 the etiological bacteriological problem becomes of considerable import- 

 ance, although in the course of the affection the general health of the 

 patient and the condition of the nidus is even of greater interest. 



In searching for cases parallel in their dermatology, we meet with the difficulty 

 that these lid changes are not thoroughly understood. Horner and Von Michel 6 

 were at great pains to introduce a dermatological classification for diseases of the 

 lids, and considered that blepharitis ulcerosa was actually an eczema with excessive 

 secretion ; this in hairy regions affects the mouths of the follicles, settling in them 

 and causing the hairs to fall out. Infection, pustules, and chronic infiltration 

 followed. Michel's pupil Herzog" has recently given expression to the same views. 

 According to him, the ulceration and abscess formation imply partly an impetigo of 

 the hair follicles, partly a folliculitis suppurativa externa or int&rna, or else a 

 combination of these produced by the eczema of the skin. 8 



1 Zeit.f. A., 1904, xi., S. 163. 



2 Of. Moberg, Munch. Med. Woch., 1905, S. 2095. 



3 Kurth, Arbeiten des Kaiscrl. Gesutidheitsamles, vii., p. 389. 



4 Kaufniann, Arch. f. Dermat.u. Sypli., xlix., 2-3. 



Handb. Kol. u. Wass.,' Bd. iii., 1903, S. 903. 



6 'Handb. der Augen. von Graefe-Saemisch,' 1 Aufl., Liderkrankungen. 



7 Zeit.f. Aug., 1904, xii., S. 151 et seq. 



8 Since Mulder (Neederl. Tijds. v. Genccsk, 1899, ii., p. 803), Hunsche (Munch. Mod. 

 Woch., 1900, S. 1563), and Jorss (Deutsche Med. Woch., 1899, No. 1), bave proved it to be 

 quite as frequently present under normal conditions, the saprophytic Acarus folliculorum, 

 described by Rahlmann (K. M. f. A., 1899, xxxvii., S. 33) and Snellen, jun. (Neederl. 

 Gogh. Bijdr, 1899, viii., p. 85), as the cause of blepharitis, has lost this attributed etiology. 

 Oyenard came to the same result (' El Desmodex Folliculorum en los Parpados Tesis,' 1907, 

 Buenos Ayres). Herzog (K. M. f. A., 1904, i., S. 177) granted that it favoured the 

 entrance of cocci by preparing the way. Majocchi and Burckardt found Acari in chalazion. 



