THE LIDS 68 



thickened lids and face after erysipelas, just as Sabouraud 1 found to 

 be the case in similar skin thickenings of other parts of the body- 

 Definite proof of this in the lids has not yet been brought forward. 



Gangrene of the Lids. 



There is no sharp demarcation line between those infections which 

 cause abscesses of the lids and those inflammatory necroses called in 

 the literature ' gangrene of the lids.' It must be noted that in our 

 literature this name is not only used for that form of decomposition 

 which, as Eomer and Morax show, is due to the putrefactive Bacteria, 

 but also as a general term for any inflammatory necrosis of the lid 

 tissues. The bacteriological examinations which have been made in 

 such cases give various results, corresponding to the fact that the 

 necroses can result from various infective agents. The possibility of 

 a specific serum treatment (streptococcal, antnrax, or diphtheritic) 

 gives an importance to their bacteriological differentiation. 



Such cases can occur in the course of general fevers (influenza, measles, scarlet 

 fever, typhoid, small-pox, chicken-pox, erysipelas, whooping-cough). Joss described 

 an apparently metastatic case after erysipelas. Mitvalsky 2 found Streptococci, Roger 

 and Weil 3 found non-liquefying Staphylococci in a case of gangrene after erj'sipelas. 

 Ronaer found Streptococci and proteus in gangrene after chicken-pox. Axenfeld 

 described a case of commencing gangrene of all four lids in a streptococcal diph- 

 theria of the conjunctiva after measles, and similar cases have been described 

 clinically by Fieuzal and Knies. Valude and Morax found Streptococci in gan- 

 grene following on a slight injury to the lids. Pes found Streptococcus after the 

 sting of an insect, and Staphylococcus pyogenes aureus with Streptococcus after a 

 scratch. Possek also found Streptococcus. 



Other cases may be due to pycemic metastases. The case quoted 

 by Mitvalsky, in which gangrene from Streptococci followed endome- 

 tritis, is certainly of this nature. I have seen and examined micro- 

 scopically a metastatic lid gangrene from Stapliylococcus pyogenes aureus 

 in a girl suffering from pyaemia. 



Infection by diphtheria bacilli can also cause gangrene of the lids. 

 In a case from Tubingen (Schleich) Steffens and Schillinger found 

 diphtheria bacilli (along with Staphylococci and Streptococci) in the 

 necrotic tissues of the lid. They emphasized, the importance of serum 

 treatment. Mori and Yamanoto record another case of the same 

 kind. Hala, 4 Eandall, Kolle, Caspar (quoted by Brons), have described 

 similar suppuration of the lids from diphtheria infection. These 



1 Ann. de Dermat. et Syph., May, 1890. 2 K. M. f. A., December, 1892. 



3 Roger and Weil, 'Gangrene benigiie des Paupieres,' Prcsse Med., 1901, p. 157. 



4 Wien. Klin. Rund., 1904, No: 49. 



