254 BACTERIOLOGY OF THE EYE 



shown that this is by no means the case. On the contrary, their 

 researches show, especially in these very early cases, that the results 

 were negative in a comparatively large number of cases, and that in 

 some of the remaining ones the number of the organisms found was 

 so small, and they were so various in their nature, that no definite 

 conclusions with regard to the cause could be drawn from their 

 presence. 



Gifford and Straub would attribute the localization of the phlyc- 

 tenules at the scleral limbus to the stagnation of tears laden with the 

 Staphylococci and their toxins, in the cleft between the cornea and the 

 sclera. I cannot admit the existence of such a cleft. The surface of the 

 cornea passes quite evenly over into the conjunctiva bulbi, and when 

 in many scrofulous catarrhs the conjunctiva does rise up from the 

 corneal level, it is a result of the irritation. Straub attributes the 

 earliest commencement of the phlycten to toxic irritation, to which 

 the bacterial invasion is added later. In the many cases where few 

 or no Staphylococci are to be found in the conjunctival secretion this 

 presumption of a concentration of toxic action at one spot is not justi- 

 fiable. Does not Straub by this very hypothesis presuppose some 

 alteration in the limbus which is not due to an infection? In a 

 recent paper Bach has modified his view that an antecedent localiza- 

 tion of cocci cannot be held to occur in the small vesicular eruption of 

 the corneal epithelium. 



From his experiments Meijers comes to the conclusion that the 

 Staphylococci are not without some influence in this infection. Van 

 Haaften, a pupil of Straub, attributes to the Staphylococci an active part 

 in the production of scrofulous ophthalmia. He came to this con- 

 clusion because he found them relatively more common in the con- 

 junctival discharge of such cases than in that of normal persons. 

 These authors did not examine the contents of the phlyctens ; their 

 results, therefore, are not decisive with regard to the incidence of this 

 eruption. Van Haaften goes too far when he considers that the eye- 

 changes are simply ' Staphylococcal scrofula,' as the cultures of 

 more than a third of his cases were negative. Morax reports that 

 he often found Staphylococci in the conjunctival secretion of phlyc- 

 tenular cases, but that the results were also often negative ; he con- 

 siders that their causal influence is doubtful. Leber's description of 

 the condition as impetiginous appeared to him to be the best. With 

 what care the question of secondary infection must be considered is 

 also shown by the frequency with which the inevitable B. xerosis is met 

 with. We may, at least, consider the hypothesis that the phlyc- 



