SPECIAL FORMS OF CONJUNCTIVAL INFECTION 257 



(E. Cohn, Stock). This is no proof that a pure endogenous kerato- 

 conjunctivitis does occur. The possibility of its occurrence, however, 

 must be considered. 



In his work on this subject Bruns gives my opinion on this point 

 in the following words : ' Axenfeld considers that scrofula is the 

 decisive etiological factor, endogenously producing the phlyctenular 

 process, and that the associated ectogenous irritations only play a 

 secondary part.' This does not accurately represent my views. I 

 have never positively stated that scrofula will produce a phlyctenular 

 inflammation in a purely endogenous manner. I have opposed the 

 view that the endogenous factor can be left aside, and that the problem 

 is solved by the finding of Stapliylococci, stating that we are not 

 justified at the present time in excluding the possibility of its occur- 

 rence in an endogenous manner. The question as to whether such an 

 endogenous infection really does occur, and to what extent, and in 

 what manner it is produced, is quite open. There is a great difference 

 between the statement that ' the affection arises endogenously ' and 

 that ' the possibility of an endogenous origin cannot be excluded 

 i.e., is still open to discussion.' (Similarly Krause is not justified in 

 saying that I have pronounced myself as ' against the bacterial 

 etiology ' of this condition.) 



Microscopical examination, with the help of bacterial staining, has 

 shown no organisms to be present in the interior of fresh phlyctenules 

 (Axenfeld, Leber, Wagenmann, L. Miiller, Hertel, Mayou). 



Similarly, the inoculation of fresh phlyctenules into the anterior 

 chamber of rabbits has not produced infection (Augieras, Leber, 

 L. Miiller) ; only in one of Miiller's cases did a suppuration occur. 



The purulent secretion from such cases of catarrhal conjunctivitis 

 often causes no reaction in the eyes of animals susceptible to Stapky- 

 lococci. These facts, along with the histological structure of the 

 phlyctenules, and the whole clinical appearances, finally exclude the 

 unlikely hypothesis that this form of inflammation is a true tubercu- 

 losis. That it certainly is not. It is, on the contrary, simply in- 

 flammatory, 1 although there is an indirect connexion between these 

 local scrofular phenomena and general tuberculosis. L. Miiller has 



1 The occasional giant cells which occur (Leber) are not of the Langhan's type, and do 

 not prove any tubercular element to be present. On account of these findings, Leber asks 

 the question whether or not dead tubercle bacilli are concerned in their production. In 

 their interesting experiments with dead tubercle bacilli, Leber and Bruns produced changes 

 which were not quite similar to the phlyctenular changes in man. Limbal tuberculosis 

 does occur, though it is rare, and in the early stage resembles phlyctenules. Stock has 

 succeeded in experimentally producing similar conditions through the blood in rabbits ; 

 they were essentially different from phlyctenules, as are also the other forms of nodules at 

 the limbus (e.g., in acne rosaceae). 



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