THE LIDS 61 



circumstances, lend to self-infection. The Staphylococci vary in 

 virulence, and when, through long cultivation, aurcus begins to lose its 

 virulence, it can regain it by passage through an animal. Bossalino 

 produced exaltation of virulence in a stem of aurcus obtained from 

 the conjunctiva in a case of cataract. At first it was only moderately 

 pathogenic for the rabbit's cornea, but after being twice inoculated, a 

 severe purulent infection occurred. 



As with the conjunctiva, 1 so here, there is no evidence to justify 

 a generalization that the common skin saprophytes can assume a 

 marked pyogenic character. The experiments of Eupprecht in our 

 laboratory, however, point that way. A. Terson 2 is very emphatic in 

 favour of a transformation of the skin organisms into pyogenic forms ; 

 so are Duane and Hastings, 3 the latter quoting Gifford. 4 



Wright's specific vaccine treatment should be carefully considered 

 in chronic staphylococcal affections of the .lids. This subject will be 

 fully considered later under the heading ' Opsonic Index.' 



The condition known in the literature as a ' lid abscess ' 5 is generally 

 only a severer form of what we have already described as an infected 

 gland, furuncle, or hordeolum. The majority of those cases of 

 Gallenga's 6 which occurred so frequently in the summer of 1904 fall 

 into this class. Staphylococcus aureus and allus were found in the 

 pus ; Streptococcus only twice. Pyogenic Staphylococci are generally 

 the cause of those circumscribed abscesses which have no special 

 tendency to diffusion. In the case of those more profuse and phleg- 

 monous suppurations which occur after wounds and erysipelas, 

 Staphylococci 7 can certainly be found; but the Streptococci are more 

 important, just as in the case of the phlegmonous dacryocystitis, 

 in which Widmark has shown the importance of the Streptococcus 

 pyoyenes. 



Lid abscesses have been noted after various general infections, but 

 without definite determination of the organisms present. 8 Frugiuelli 9 



1 Tersou, Arch. d'Ophth., 1893 ; Gallemaerts, La Polidinique (Brux.), September 15, 

 1897 ; Richter, Beitrdge z. Aug., 1905, S. 63 (' Streptococci '). 



2 Loc. tit., p. 455. 3 New York Med. Jour., May 26, 1906. 



4 A.f. A., 1887, xvi., p. 197. 



5 Fatal septic infection from a hordeolum or lid abscess is very rare (Guth, Pragcr Med. 

 Woch., 1898, No. 3 ; Gallemaerts, I.e.). I have myself seen a fatal case of thrombosis of 

 the orbit and sinus, due to Staphylococcus pyogenes aureus, which arose from a lid furuncle. 

 Lesniowsky described a similar result in a hordeolum. 



6 La Clinica Oculistica, October, 1904. 



7 Zia, ' Phleg. Entzund. der Lider u. Gangriiu der Bindehaut durch Staphylokokken, ' 

 ' Ophth. Kl.,' 1904, p. 306 ; Valude, Ann d'OcuL, 1890, C., p. 60. 



8 Bock (Zent. f. A., 1890, p. 508), Landolt (Semaine Med., 1890, No. 3), and others, after 

 influenza; Jackson (Brit. Med. Jour., March 23, 1895), after scarlet fever. Fuchs ('Text- 

 book,' 1905) reports a lid abscess in blennorrhnea. 



9 Gaz. Interned, di Medicina Pratica, 1900, iii. 286. 



