SPECIAL FORMS OF CONJUNCTIVAL INFECTION 255 



tenules are due to localized inoculations with Staphylococci as not 

 sufficiently proved. The Staphylococci must not be considered to have 

 nothing to do with the question ; their presence added to an inflam- 

 matory process does influence its further course. This is so, not only 

 in the cornea, but also in the conjunctiva. 



The inoculations of the human conjunctiva made by Burchard and 

 Bach, who introduced large quantities of Stapliylococci into conjunc- 

 tival pockets, cannot settle this question either way. 



Such severe disturbances of the tissues do not precede the forma- 

 tion of phlyctenules, and further, we can obtain abscess formation in 

 this way with a variety of organisms. When, however, Bach scratched 

 the conjunctiva bulbi with a needle, and then introduced virulent 

 aureus into the conjunctival sac, he obtained no phlyctenules ; this 

 Leber had previously done, also without any result. In distinctly 

 scrofulous patients, even in those who had just had an attack of 

 kerato-conjunctivitis eczematosa, small aseptic wounds produced no 

 phlyctenules. 



The examination of the secretions of these cases, and even of cases of 

 acute catarrhal conjunctivitis, often gives a negative result that is to 

 say, only B. xerosis and a few organisms of uncertain significance can 

 be found. Bach holds the opinion that the number of the organisms 

 is lessened by means of the tears ; but, as a matter of fact, in other 

 forms of infection, with a similar amount of secretion, we find that the 

 number of the organisms is increased. The so-called scrofulous forms 

 of catarrh sharply contrast with the others, in that with a profuse 

 discharge we either find no organisms or only a few. 



The virulent yellow Stapliylococci or the Streptococci are found only 

 in a proportion of the cases in which we have associated an impeti- 

 ginous eczema. 



Here and there undoubted conjunctivitis organisms are to be met 

 with, and there is no doubt that in scrofulous persons these can pro- 

 duce the appearances of a phlyctenular affection. 



Morax and Axenfeld have observed this in cases of diplobacillary 

 infection, and Gasparrini and Axenfeld in pneumococcal conjunc- 

 tivitis. In many epidemics a free phlyctenular eruption appears, 

 without any general condition being present as a basis. Such 

 cases have been occasionally observed. The occurrence of eruptions 

 of phlyctenular character at the margin of the cornea has been 

 observed by L. Miiller only in scrofulous subjects ; they occurred 

 regularly in the epidemic of Koch- Weeks conjunctivitis recorded by 

 Markus. The condition present in these cases may correspond 



