THE LIDS 57 



On the other hand, the affection of the hair follicles, with the forma- 

 tion in them of small abscesses, strikes one so forcibly that the disease 

 reminds one strongly of an acne of some hairy region, of a sycosis 

 simplex 1 ('sycosis staphylogenes,' Herzog). Many cases of blepharitis 

 are of this nature, especially those where a typical sycosis of the beard 

 is present. Clinically, those forms of blepharitis which begin in the hair 

 follicles cannot with certainty be distinguished from the eczematous 

 forms, especially in their later stages. Herzog agrees with Unna in 

 wishing to reserve the name ' acne ' for those cases where the gland 

 ducts are blocked by a hyperkeratosis, and suppuration then occurs 

 through the growth of organisms. He reserves the expression ' super- 

 ficial or deep furuncle ' for those cases occurring independently of the 

 formation of comedones. The isolated hordeolum usually belongs to 

 the latter group, as do the cases referred to later. Widmark, 2 Leber 

 and Sattler, 3 and Gallenga, 4 were the earliest investigators of ulcerative 

 blepharitis, also Deyl, 5 Burchard, 6 Gifford, 7 Weeks, 8 Straub, 9 Morax, 10 

 Bach, 11 Terson and Cuenod, 1 ' 2 Bayersdorfer, Herzog, 13 and Duane, 14 

 have worked out this subject. 



Anreus was usually met with. In twelve cases from the bead of pus occurring 

 under the crust, Cuenod obtained aureus pure eight times, mixed with Staphylo- 

 coccus albus twice, and Staphyiococcus albus pure twice. The anreusw&s always 

 very pyogenic in the rabbit's cornea, the albus only slightly so. In ten other cases 

 direct inoculation from the crusts always produced yellow cocci ; their virulence 

 was not tested. 



Bayersdorfer always got aureus from blepharitis ulcerosa. Straub had the same 

 result in ulcerative eczema of scrofulous patients. Personally, I have regularly 

 obtained the aureus in marginal pustules of the lid. 



Herzog's findings agree ; the Staphylococci which he obtained very often showed 

 a double form and varied greatly in size. The Diplococcus albicans which he grew 

 from one or two cases is very closely related to the white non-liquefying Staplujlo- 

 coccus, but has a low pathogenicity. 



He obtained Staphyiococcus albus in a patient with sycosis staphylogenes of 

 the beard and eyelashes. (Herzog differentiates sycosis simplex from sycosis para- 

 sitlca (herpes tonsurans) by the fact that in ,the Blatter the hairs break foff and 

 in the former they completely disappear. 



1 Winselmann (K. M. f. A., 1902, xl., ii., p. 393) considers blepharitis ulcerosa as a 

 primary sycosis. 



2 Hijgiea, 1885. p. 581 ; Beitrcige z. A., 1891, Leipzig, bei Veit u. Co. 



3 'Die Bedeutung der Bakteriologie in der Augenheilkunde ' (Internatioualer Ophthal- 

 mologenkongress in Heidelberg, 1889). 



4 Ital. Ophth. Kongr. Genua, 1886 (Ann. di Ottal., 1887). 



5 ' tiber einige Entziindungeii der Augenlider ' (Bohmische Akademie d. Wissenschaften, 

 893-94). 



6 Zent.f. A., 1887, S. 40, and Der mat. Zeit., 1894, i. 4. 



7 A.f. A., 1886, xvi., S. 197. 8 Amer. Jour, of Dermat, 1905, S. 366. 

 9 A. f. A., 1892, xxv., S. 416. 10 These de Paris, 1894. 



' u A.f. 0., 1894,, xl., S. 3. 12 ' Bacteriologie des Paupieres,' 1894. 



13 Zeit.f. A., 1903, xi., and 1904, xii. 14 A.f. 0., 1906, xxxv., S. 484. 



