THE LIDS 75 



the lid is the favourite site of this essentially rare disease. In about 

 forty or fifty cases at least ten were primarily lid affections. 



The single similar record in the German literature is that of 

 Eosenstein (Zentr.f. Aug., 1904, S. 14), who found a pure 'hefa' in 

 an ulcer of the lower lid. The organism was ' mostly in a spore 

 condition; here and there mycelial forms could be seen.' Cultures 

 failed. The case differed clinically from that of Gilchrist, in that 

 within fourteen days a deep ulcer the size of a bean developed. At 

 the end of his paper Eosenstein describes the case as ' contaminated 

 by hefa cells.' The etiological significance therefore of this finding 

 is not determined. 



The disease described by Gilchrist begins as a papule, which then 

 slowly passes into a dark red moderately elevated swelling, in which 

 numerous small abscesses develop, without, however, any tendency to 

 widespread ulceration. While the disease progresses healing may 

 occur at the original site. 



(The clinical aspect resembles that of ' framboesia Brasiliana,' which 

 Breda 1 has found affecting the lids in a single case. The etiology of 

 this disease is still unknown.) 



The Blastornycetes appear in the contents of the small abscesses as 

 small round, refractile, vacuolated bodies, having a double contour, 

 often lying in pairs or in branching chains. In culture (small white 

 colonies, with thread-like processes and aerial hyphae) a mycelium is 

 formed. Busse (Kolle u. Wass., Handbuch 1903, Bd. i., S. 681) therefore 

 denies that this fungus is a Blastomycete ; it belongs more to the Oidia. 

 Microscopically the skin shows profuse hypertrophy of the epithelium, 

 with an inflammatory infiltration and abscess formation in the corium. 

 Inoculations of the culture in animals produced a similar clinical 

 picture. 



This infection might, with more careful examination, be found by 

 us (in Europe) more commonly. Our knowledge of pathogenic hefae 

 (Saccharomyces hominis or S. Busse) is mostly due to the work of 

 Busse. According to him, their demonstration in the tissues is most 

 readily achieved in fresh preparations, especially after the addition 

 of caustic soda. The bright concentrically marked hefae with their 

 double contour are then very clear. 



In aniline stained preparations it is very difficult to find them. 

 The best method is to counter-stain a haematoxylin or hsematein 

 preparation with very dilute carbol fuchsin (1 : 20 water) for 

 one-half to twenty hours, and slightly decolorize with alcohol. If 



1 Annali di Ottal., xxiv, supl. 189. 



