258 



very carefully examined large numbers of excised phlyctenules for 

 tubercle bacilli, but has never found any. In twenty cases in which 

 the anterior chamber was inoculated in rabbits, only once a transient 

 nodule occurred. 



The source of these scrofular or phlyctenular (eczematous) external 

 affections of the eye must therefore be considered in many respects to 

 be an open question. It is certain that Bacteria from without can 

 induce the condition ; but whether it is always such a cause, which 

 produces these clinical appearances in the people who are liable to 

 local catarrhal and vasomotor disturbances, or whether mechanical, 

 chemical, or endogenous agencies can have the same effect, can only 

 be settled after further researches have been made. This question of 

 etiology is in many respects analogous to that of the etiology of eczema 

 of the skin, concerning which no uniform results have yet been found, 

 mostly on account of the difficulty of differentiating the secondary 

 organisms present. The sharply marked seborrhceic eczema alone 

 (Unna) can be considered as certainly parasitic. The latest work of 

 Scholz attributes to the Staphylococcus aureus some agency in the 

 causation of the acute forms of eczema. Scholz comes to the con- 

 clusion that this organism is the primary cause (Deutsche Klinik, 

 1903). 



Klingmiiller has reviewed the whole question of the pathology of 

 eczema still more recently, and from the experience of the Neisser 

 clinic he concludes that in every eczema of the skin, almost without 

 exception, large, but varying, numbers of Staphylococci are present, 

 the yellow being more common than the white. ' They only fail in 

 the vesicles, the primary lesion of the epithelium.' This fact of itself, 

 unless otherwise explained, is directly opposed to the cocci being the 

 direct cause of the vesicles. A true eczema has never been produced 

 either with them or their toxins ; at most they have only caused a 

 spontaneously healing dermatitis. They appear only to flourish on a skin 

 which has been rendered susceptible, or is predisposed, to their action. 

 Bender, Bockart, and Gerlach produced an eczema by the action of 

 staphylococcal filtrate free from organisms on the previously irritated 

 skin of the arm. This is explained by M. Neisser and Lipstein l as 

 not being due to the toxic activity of the Staphylococci, for a similar 

 alkaline bouillon and also the inactive filtrate (heated to 70 C.) pro- 

 duced the same result. In these cases they considered the eczema to 

 be due to a non-specific chemical irritation. 



The following points should be noticed : In eczema the aureus 



1 Kolle-Wassermann, 1903, Bd. iii., p. 130. 



