286 BACTERIOLOGY OF THE EYE 



women, the upper canaliculus was only four times affected. At its 

 greatest the swelling reaches the size of a hazel-nut, and generally is 

 less. An elongated, firmly resistant mass is felt in the region of the 

 canaliculus, and the corresponding punctum is dilated. The greenish 

 or darkly-stained contents of the canal, when pressed upon, sometimes 

 pass to the opening, but they are not evacuated ; either nothing comes 

 out or else only a very little pus. The passage into the nose may not 

 be closed, and fluid can be washed through from the canaliculus. A 

 perforating ulceration of the skin has never been observed in these 

 cases ; the clinical appearances remain the same for months ; the 

 swelling may increase, but will not exceed the maximum stated. It 

 is not known whether such cases would heal spontaneously or not, as 

 every case which has been observed has been incised and evacuated, 

 with rapid and permanent healing. In a single case reported by 

 Krukow-Kastalsky, when the concretion was removed from the lower 

 canaliculus, a similar one developed in the upper. 



When the canaliculus is opened in the usual manner, a peculiar 

 mass either comes out at once or does so with a very slight pressure. 

 Sometimes there are several larger or smaller masses. The mucous 

 membrane of the inflamed canaliculus is very much stretched, but its 

 continuity is quite intact, and the mass is not adherent to it anywhere ; 

 it can be removed easily, and with any blunt instrument, and is only 

 retained when the incision has been too small, or the mucous mem- 

 brane has developed side pouches. There is only a single case 

 recorded in which a loose connexion with the walls could be demon- 

 strated (von Schroder). 



The material removed varies in amount from half the size of the 

 lens to that of a bean. Its surface shows fine elevations and clefts at 

 places, and has a waxy appearance. Its colour is mostly greyish-green 

 or greyish-yellow. Many concretions are brown or dark brown ; these 

 are older, harder, and less easily teased out than the more recent ones, 

 which are very readily broken up into smaller fragments, which can 

 easily be squeezed out like wax between two cover- glasses. In some 

 cases calcification of the concretions occurs (A. von Graefe, Gruning). 

 The mass of mould seems finally to die, when we have a calcareous 

 body surrounded with debris (Snegirew, Capellini). The micro- 

 scopical examination by Capellini of these later stages is of special 

 interest. The concretions contained calcium monophosphate and 

 carbonate. In the sections a dendritic netlike structure was very 

 evident, produced by radially arranged needle-shaped crystals ; the 

 most peripheral layers of the individual crystalline masses were 



