276 BACTERIOLOGY OF THE EYE 



group, then the Streptococci and the other pyogenic bacilli. Staj>]ti/l<>- 

 cocci are rather common in small numbers, as casuals along with other 

 organisms ; but it is rare to find them in pure culture, or so in excess 

 that they could be taken to be causal. None of these infections will 

 attack the lacrymal sac unless they are fixed there by some predispos- 

 ing factor. Any stoppage of the duct, especially one which is due 

 to nasal conditions, has an important influence. Voelkers and Rehr 

 lay stress upon injuries to the mucous membrane due to small foreign 

 bodies which pass down from the conjunctiva. Individual variations 

 in the nasal duct have also a predisposing influence. Cases of catarrhal 

 dacryocystitis primarily due merely to the introduction of the last- 

 named irritant are quite rare. Cases are quite common in which a 

 transient obstruction occurs due to the infected mucous membrane 

 swelling up, and in which complete healing can be obtained by simply 

 washing out the sac. Even in these cases I have mostly found 

 Pneumococci. 



A primary infection must be presumed in many of the cases of 

 tuberculosis of the sac in which no changes can be found, either in the 

 nose or in the surrounding parts. It is quite impossible to say 

 whether these infrequent cases may not be endogenous. (I consider 

 that endogenous tuberculosis of the conjunctiva is not such an extreme 

 rarity.) Considering the experiments of Valude (see ' Wound Infec- 

 tion,' p. 78), it seems hardly possible that a healthy sac with a normal 

 passage can be infected by tubercle from without. A ' primary tuber- 

 culosis of the lacrymal sac ' in many cases may develop ectogenously 

 on the basis of a previous stenosis or a simple dacryocystitis. 



Not uncommonly the tuberculosis arises from a lupus of the nasal mucous 

 membrane finding its way upwards. In many cases the dacryocystitis in a nasal 

 tuberculosis is really non-tubercular, and merely a simple inflammation due to the 

 retention of the secretions (Jaulin, Ginsberg, Shiba, K. M. f. A., 1905, Beilageheft, 

 'A^enfeld, Med. Klin., 1906, No. 7). Even a dacryocystitis complicating a tuber- 

 culosis of the conjunctiva (see here the literature) need not necessarily be tubercular 

 (A.' Levy). 



Seeing that tubercular dacryocystitis cannot always be diagnosed as such 

 clinically, Morax recommends that the secretion should be stained for the tubercle 

 bacilli. This, however, is not always a certain method, as a negative result will 

 often occur in tubercular cases. 



Trachoma seems to have more affinity for the lacrymal sac, although 

 primary trachoma of the lacrymal sac has rarely been demonstrated. 



In the chapter on ' Trachoma ' it has been shown how a complicating dacryocystitis 

 is often trachomatous. Kuhnt, Werncke, Eaehlmann, Ischreyt, and Basso found 

 microscopically so many follicles in the sac that trachoma could be certainly 

 diagnosed. 



The hypothesis that there is really a true trachoma of the sac is not contradicted 



