THE LACRYMAL APPARATUS 293 



a case in which Kempner gave the diagnosis of Leptothrix ; the findings were like 

 those of the previous cases, but no branching could be seen in the fine, slightly- 

 coiled filaments. As such branchings can be very infrequent in the Strepto- 

 thricece, and may only be obvious in cultures (Axeiifelcl and Cahn), such an 

 observation is not diagnostic, as the determination of the organism by cultures was 

 not made, and the iodine reaction l was not obtained. 



Awerbach also considered that the diagnosis of Leptothrix in these cases was not 

 justified. The same can be said of Piorkowski's record of a case of Segelken's. 

 This author concludes that Leptothricece cannot be proved to take part in this 

 affection, especially as in the case referred to radially marked bodies were seen ; 

 nor can they be excluded on account cf the uncertainty about the exact definition 

 of the members of this family. Smear preparations made from Capellini's highly 

 calcified concretion showed unbranched filaments, which were considered to be 

 Leptothrix ; but against this view the uncertainty already mentioned must be 

 taken, especially as club-shaped bodies which were taken to be Actinomyces 

 occurred. No certain diagnosis was possible in this case. Cultures miscarried. The 

 diagnosis of Leptothrix, made from purely microscopical evidence in another case, 

 is marked by Capellini with a query. (Basevi found putrid pus in the lower 

 canaliculus ; this contained Leptothrix besides Pneumococci and Staphylococci ; 

 the diagnosis, however, was not based on any exact grounds. There was no con- 

 cretion in this case. The patient had washed his eye in sputum.) 



Cannas contributes an interesting communication regarding this question. In 

 the pus from the canaliculi he found, along with bacilli and cocci, spirillae and 

 filaments which appeared to him to be fragments of Leptothrix. The concretions 

 mostly consisted of very fine, long, thickly felted filaments, in which Cannas could 

 find neither branching nor segmentation. They stained by Gram's method, and 

 were violet on the addition of Lugol's fluid. 



The culture on gelatine after a few days showed, along with other organisms, 

 a large greyish- white colony with a notched translucent margin, which, when trans- 

 ferred to glycerine agar, rapidly covered the whole surface with a greyish-white 

 membrane. Slow liquefaction occurred in a gelatine stab culture ; in bouillon 

 a free deposit occurred after forty-eight hours. Cannas found under the microscope 

 typical clusters of Leptothrix buccalis, as they occur in teased preparations. No 

 result on injection into animals. Cannas gave the diagnosis of Leptothrix based 

 on Robins's researches (1855). 



These findings differ markedly from all the others, and the consensus of opinion is 

 that Leptothrix does not grow in this manner. The diagnosis of Leptothrix is not 

 consistent with a spirilla. Further, this is the first and only occasion of a positive 

 reaction with iodine. It is also remarkable that only a single colony of the variety 

 grew. 



Cannas quoted the researches of Majocchi with regard to the concretions in the 

 salivary ducts, and comes to the same conclusion that the parasitic elements may 

 vary, so that we can have (1) Leptothrix, (2) Streptothrix Foersteri, (3) Actino- 

 myces. Cannas' results do not seem to me to be at all convincing. 



Lately Awerbach has obtained very good results by culture. In the concrements 

 he found globular bodies (' Drusen'), with here and there slight thickenings of the 

 radiating lines. There were no club-shaped swellings. Dichotomous division was 

 frequent. 



1 The iodine reaction is admittedly inconstant in Leptothrix. According to the observa- 

 tions of Pricker (Zent. f. Bakt., 1904, xxxvi. 369), it only occurred when a medium 

 containing starch was used. The conditions under which the organism is grown certainly 

 has an influence on this reaction. The most definite characteristic of Leptothrix is that it 

 consists of unbranched and uncoiled filaments, and this has not been found in concretions 

 from the canaliculi at least, not in those cases confirmed by cultures. 



