62 BACTERIOLOGY OF THE EYE 



described a pneumococcal abscess following on a pseudo-membranous 

 conjunctivitis. Gifford found sclerosis alone in some cases (Jour. 

 Amer. Med. Assoc., October, 1903). 



Erysipelas. 



Erysipelas of the lids, just as elsewhere, is caused by the Strepto- 

 coccus pyogenes. The Streptococcus erysipelatis first described by 

 Fehleisen, cannot be definitely distinguished from the Streptococcus 

 pyogenes, either microscopically or by cultures, especially as the power 

 of producing suppuration or erysipelas in animals can vary in one 

 and the same strain of the organism. 



I am not aware of any special investigations of erysipelas of the eyelids. In cases 

 where recurrent erysipelas arose from an infected lacrymal sac, I found Strepto- 

 coccus pyogenes in the pus from the sac, and Morax, Cuenod, and A. Terson 1 have 

 reported the same. Bacteriological examinations have been made of the less 

 common lid abscess and the still rarer gangrene after erysipelas. Mitvalsky, 

 Cuenod, and Gabrielides 2 found Streptococci ; Roger and Weil, on the other hand, 

 found Staphylococci (cf. p. 63, ' Gangrene '). This latter observation recalls the 

 fact that Staphylococci can produce an appearance similar to erysipelas, but without 

 the same infectiousness or peculiar method of spreading. 



Erysipelas of the face or eyelids can spread to the orbit and even 

 to the meninges, serum treatment will perhaps be very valuable in 

 such cases. 



It may be remembered that, according to Leber, in such cases an 

 erysipelas of the skin may rapidly disappear, and that then the orbital 

 cellulitis is the prominent feature (suppressed erysipelas). No bac- 

 teriological examinations of such cases are available, and it is still a 

 question whether or not a suppressed sinus affection was not the 

 original cause. Von Michel 4 found Streptococcus pyogenes in the 

 eruption of an impetiginous eczema resembling the bullous form, 

 which developed on an erysipelatous area of skin. Mosetti 3 described 

 a streptococcal suppuration of the lacrymal gland after erysipelas. 



Cases where the skin is swollen and there is a suspicion of ery- 

 sipelas are only differentiated from a commencing eczema with great 

 difficulty. To make a bacteriological examination the margin of the 

 affected area should be carefully cleaned, the skin scarified, and the 

 blood or serum examined for Streptococci. 



Cudnod holds the view that Streptococci remain present in the 



1 'Maladies des Paupieres, ' Eiicyd. Frani;. d'Ophth., 1906, p. 399. 



2 ' Ophthalmologie Microbiologique,' 1907. p. 320. 



3 Ann. di Ottal., 1905, xxxiv. 3. * A. f. A., 1901, xlii., p. 301. 

 6 Cuenod, Tliese de Paris, 1 894. p. 67. 



