SPECIAL FORMS OF CONJQNCTIVAL INFECTION 253 



contagious or not (cf. Dimmer, Wien. Klin. Woch., 1905, p. 2). For 

 my own part, I have not been able to find these Blastomycetes. 



SECTION 8. THE SO-CALLED SCEOFULOUS (PHLYC 

 TENULAE, ECZEMATOUS) INFLAMMATIONS. 



The well-known appearance of phlyctenular, scrofulous, or eczema- 

 tous conjunctivitis naturally gave rise to the idea that the individual 

 phlyctens, the subepithelial nodules, owed their origin to circum- 

 scribed ectogenous infections, which, according to the known principles 

 of the pathology of inflammation, would determine a collection of leuco- 

 cytes. The vulnerability of the epithelium, which, since the time 

 of Virchow, has been considered to occur in these scrofulous indi- 

 viduals, prepares the way for an ordinary infection. At the com- 

 mencement of the bacteriological era this idea was supported by many 

 observers (Duclos and Bucheron, Leber, Sattler, Gifford, Straub, 

 Gallenga). These authors only alleged a limited etiological signifi- 

 cance to the Bacteria found, but Burchard and Bach, and D. Smith 

 distinctly state that the phylctens are caused by a circumscribed 

 inoculation with pyogenic cocci, especially the Stapliylococci. 



Burchard's results cannot be considered in this discussion, as this 

 author did not say either how old the phlyctens were or in what 

 proportion the Bacteria in question were found. For the same reason, 

 the later work of A. Michel (Bordeaux) does not assist us. Exact 

 details on this question are absolutely necessary, as in old-standing 

 cases of such superficial eruptions the demonstration of individual 

 organisms is of no value for the diagnosis of the original cause, just 

 as no causal significance can be attributed to the presence of Stapliy- 

 lococci in variola pustules or pemphigus vesicles. In old phlyctenules, 

 too, the original cause may have disappeared, just as in Bach's ex- 

 periments on animals the Stapliylococci introduced into the conjunc- 

 tiva could not be seen after a few days had elapsed. 



In considering this question, we must clearly bear in mind that in 

 a mucous membrane which normally contains Bacteria, and which in 

 these scrofulous persons is specially rich in the Stapliylococci, any 

 superficial affection will be very rapidly contaminated. Before we can 

 explain the phlyctenules as inoculation infiltrations due to the known 

 pus producers, especially the Stapliylococci, we must demonstrate in 

 the contents of very early phlyctenules the regular presence of a 

 definite number of these organisms. 



The results of Axenfeld, von Bach, Neumann, and L. Miiller have 



