THE LACRYMAL APPARATUS 



289 



Doubts as to the correctness of the new view are aroused by the anomalous 

 clinical appearances, and by the general agreement that Actinomyces bovis 

 belongs to the family of the Streptothricece, the members of which can resemble 

 each other very fully in their morphology, though in other respects they are 

 essentially different. Lachner and Sandoval, Axenfeld and Kastalsky, insist that 

 exhaustive examinations of cultures are necessary before these organisms can be 

 denned with certainty. At present it is better to speak of Streptothricece. If we 

 consider the Streptothricece as Actinomycetes, then the concretions can be Spoken 

 of as Actinomycosis. We should not conclude that these organisms have been 

 proved to be identical with the variety Act. hominis seu bovis. Van der Straeten 

 goes still further, and considers that this affection is only a pseudo-actinomycosis, 

 because the clinical picture is so different, and the typical refractile bodies are 

 wanting ; Bourgeois expresses the same opinion. 



FIG. 59. AXEXFELD, CASE I. ANAEROBIC AGAR CULTURE. 



Axenfeld and Cahn have shown that this exclusion of the Actinomycetes goes too 

 far in the other direction, for the reasons brought forward by Van der Straeten do 

 not definitely exclude the presence of this organism (see p. 293). The further 

 examination of this case by Awerbach has shown that it agrees with the Actino- 

 myces bovis in many particulars, so that the name is rightly applied to it. 



The work of Silberschmidt shows that the variety known as Actinomyces bovis 

 is not the only one which takes part in the formation of concrements. In 1900 he 

 obtained two series of cultures ; till then every attempt at cultivation had mis- 

 carried, or else, as in the two first cases of Kastalsky and Axenfeld, was not com- 

 plete enough for thorough identification. 



In fresh and unstained preparations Silberschmidt found fine Gram-positive 

 segmented filaments, and along with them elements resembling cocci. Very few 

 branches occurred, and here and there were slightly thickened ends to the filaments. 

 No radial arrangement of fibres with clubbed ends could be seen, nor were the 

 filaments coiled. 



19 



