THE LACRYMAL APPARATUS 279 



occurred in large numbers and in a virulent form. (The enormous 

 numbers of Pneumococci which can fill the sac are shown in Fig. 52, 

 from a preparation by Stock. This specimen was obtained immedi- 

 ately after death from a patient suffering from trachoma with an 

 untreated dacryocystitis chronica, and was stained by the Gram- 

 Weigert method. The lumen of the canaliculus at the entrance into 

 the sac is filled with Pneumococci [blue]. At one point they have 

 begun to break through into the surrounding infiltrated trachomatous 

 tissues.) Rollet, Guignot, D. Smith, Poulard, and Roche have found 

 the same appearances. As these organisms in culture often grow in 

 the form of long chains, we may conclude that some of the appear- 

 ances which have been described as due to Streptococci have really 

 been of this class (Poncet and Redard, Soc. Franc. d'Oph., 1886). 



The relative frequency of the different organisms varies in the different series. 

 Gerstenberger (Wurzburg) in 12 cases found Streptococci 4 times, Staphylococci 

 5 times, Pneumococci 4 times. Gourfein in 40 cases found : 



18 times Pneumococci (8 pure, 4 with Staphylococci, 6 with 



Streptococci). 

 14 ,, Streptococci. 

 4 ,, Staphylococci. 



4 ,, Pneumobacilli. 



In 30 cases of catarrhal dacryocystitis, methodically examined in my clinic by 

 Brons during 1906, the following were the findings : 



16 cases contained Pneumococci in excess (8 pure, 7 mixed with a few 

 other organisms. Staphylococci 5 ; Bac. fluor. 

 liquef., Streptococci, and Bac. coli commiunis, 

 1 each). 

 7 ,, ,, Staphylococci in excess (1 with Diplobacilli). 



5 Gram negative bacilli, ; 1 influenza (with a few 



cocci), 1 the Pneumobacillus fwith a few cocci). 



Many of the cases contained stray xerose bacilli in the secretions. 



The Pneumococci from the lacrymal sac agree in their cultural and morpho- 

 logical features with those obtained from ulcera serpentia, or from the conjunctiva 

 (see p. 183). The variability of their form in cultures and their differential 

 diagnosis from the Streptococci is fully given on pp. 184 and 207. 



There is a marked difference between the action of the Pneumococci from the 

 conjunctiva and those from the lacrymal sac. The former may be quite harmless, 

 with feeble power of growth and virulence ; but when they do cause an inflammation, 

 it is typically an acute spontaneously healing conjunctivitis (see ' Pneumococcal 

 Conjunctivitis'). The Pneumococci rapidly disappear, and a chronic inflammation 

 from this cause is (rare. On the other hand, the organisms in the lacrymal sac 

 do not cause such a reaction ; the catarrh Jhere is eminently chronic. Under 

 some circumstances the Pneumococci may remain present for years, and that, 

 too, with a greater virulence than they have when obtained from the conjunctiva. 

 This is shown by the malignancy of the corneal lesions produced, and by the 

 results of experimental inoculations with the secretion (Schmidt-Rirnpler), and with 

 cultures. 



