THE LIDS 73 



regularly found in rhinoscleroma, from which fact, in spite of occa- 

 sionally expressed doubts, the majority of dermatologists accept them 

 as causal. 



Examples of typical Actinomycosis, with microscopical proof of 

 the presence of nodules (Drusen), are given in the cases recorded by 

 Pa,rtsch(Zentr.f.Aug., 1893, S. 161), Darierand Gautier (Ann.de Dermat. 

 et Syph., 1891, p. 449), Dor (Gaz. hebd. de Med. et Chir., 1895, No. 4), 

 and Eansom (Brit. Med. Jour., June 27, 1896). The lids participate 

 in the marked changes occurring in the cheek and orbit. The bac- 

 teriological diagnosis is of interest to the ophthalmic surgeon on 

 account of the ' fungus concretions ' l described in Chapter VII., whose 

 classification causes considerable difficulty because of the variability 

 of the organism, and the keen discussion which is now taking place 

 respecting the whole group of Actinomycetes. 



The 'branching fungi ' the Actinomycetes on solid media form thick, prominent, 

 tough, crinkled, or knobby colonies ; and in fluids rounded granules or nodules, which 

 sink to the bottom and cannot be shaken out. In the body yellow granules are 

 formed. When examined microscopically, we see long, thin, straight, or coiled 

 filaments, Gram-positive, having side branches, and often ending in club-shaped 

 thickenings. They may stain in sections, and thus present the appearance of chains. 

 In young cultures they sometimes greatly resemble the Bacillus diphtheria. By 

 multiple fission an appearance of spores or cocci is formed by their resolution. In 

 the centre of the culture, and well seen in embedded sections, a thick tangle is 

 formed, with radial bundles of fibres passing out from it. In the tissues of animals 

 radially arranged knobby swellings are formed, which do not stain with Gram. 

 Amongst the many members of this group we recognize, on account of its orange 

 agar cultures, and its slow liquefaction of gelatine, the Actinomyces bovis, the 

 cause of the disease in man and cattle. Descriptions, however, vary considerably. 

 For further particulars see Schlegel, Handb. von Kolle und Wass., Bd. iii., and 

 Petruschky, ibid. 



Israel's form of Actinomyces bovis, which is characterized by its anaerobic, 

 growth, and by the absence of branching in the cultures, according to Mertens, 

 (Zentr. f. BaTct., xxix., S. 641) can be transformed into the aerobic form of Bostroem 

 of which it is only a variety. 



Glanders (farcy, Eotz, morve) has several times been observed on 

 the lids. Knapp (Arch, of Oph., xxvii., p. 374) found the Bacillus 

 mallei in an ulcer of the lower lid. In Neisser's case (Berl. Klin. 

 Woch., 1892, S. 321) an inflammatory swelling developed from the 

 inner canthus, and later led to a dacryocystitis. Grourfein found the 

 Bacillus mallei in the pus from a lacrymal sac, identifying it by inocu- 

 lating guinea-pigs, from which he was able to grow the bacilli in 

 the typical manner. (Cultures are essential to differentiate allied 



1 It must be emphasized that the case of De Vincenti (Lavori della Glin. Ocul. di Napoli, 

 iii, p. 324) was later proved by Fuchs to be a 'concretion in the conjunctiva.' Similarly 

 the case of Demicheri (Arch. d'Oph., 1899, xix., p. 102) is not one of actinomycosis, but a 

 concretion, mistaken on account of its radial arrangement. 



