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BACTERIOLOGY OF THE EYE 



like hairs, and under a low magnification appeared homogeneous ; they were here 

 straight, there coiled quite irregularly, and they branched, though not freely. 

 They differ from Streptothrix bnccalis, which is thicker, straight, and stiff, is 

 definitely segmented, and does not branch ; the Streptothrix foersteri does not 

 give the iodine reaction. The growth is analogous to Leptothrix to the extent that 

 the main mass of the concretion is formed of the fungus alone. Von Reuss and 

 Goldzieher undertook a revision of the literature on the basis of Cohn's results. 

 They identified the older cases with those due to the Streptothrix foersteri. Since 

 then this name is mostly used in the statistics until in 1894, when Schroder and 

 von Huth applied the name ' Actinomycosis ' to the concretions on account of the 

 presence in them of refractile bodies with knotted or clubbed processes. Their 

 communication was anticipated by that of Tommasoli and Bajardi, but these latter 

 were not known in the ophthalmic literature. Goldzieher and von Eeuss con- 

 sidered that the earlier cases were Streptothricece, and von Schroder collects the 

 literature to date under the heading of ' Actinomycosis ' that is, he considers the 

 condition due to a particular form of Streptothrix. He identifies the mould with 

 the Actinomyces hominis seu bovis, and it must be admitted that in his own cases, 



FIG. 58. DALEN'S CONCRETIONS. AGAK CULTURE. 



and in those of the authors who found these typical globular refractile bodies, this 

 conclusion from histological grounds is just as valid as is the customary surgical 

 diagnosis of this organism. In the large number of cases in which no globules 

 were seen, but only fibrils, the variability of the Actinomyces is such that its 

 presence cannot be excluded. Bostrom and Israel claimed that the older cases 

 were Actinomycosis, and Ferdinand Cohn later agreed with them. Schroder con- 

 siders that the comparatively benign character of the affection, when compared with 

 Actinomycosis in general, is not evidence against such a cause ; for this can be 

 explained by the fact that the fungus here lies in an epithelial cavity, and also by 

 the low nutritive value of the tears. 1 



This communication (of Schroder) attracted general attention, with the result that 

 still further statistical records were forthcoming under the title of ' Actinomycosis of 

 the Canaliculi ' (Ewetsky, Elschnig, Lange, von Schroder, Mitvalsky, Robert, Terson, 

 Ginsberg, Mackay, Cartais, Awerbach). In one of his later cases von Schroder 

 was able to show that the mould filaments had penetrated the walls of the 

 canaliculus ; the clinical picture was, however, the same. 



J It is interesting to note that Majocchi found a similar concretion in Wharton's duct 

 (Arch, per le Scienze Med., 1892, xvi. 15). Miodowski (Arch. f. Laryng., xix.) found 

 granules like Actinomyces in the tonsil ; Saxer found a similar appearance in the tonsil. 



