THE CORNEA 325 



zone and in old people, as in them the superficial layers of the cornea 

 are especially liable to changes (arcus senilis). 



Up to the present Zur Nedden (Bonn) alone has given detailed 

 accounts of these bacilli. In four years he observed sixty- five cases, 

 and concluded that the disease is common in the Ehine Valley. On 

 account of the difficulty in the demonstration of the bacillus, it is 

 possible that cases occur in other places, but have not been recognized. 

 Macnab 1 has found the bacillus in three cases in London. Paul 

 records having found it in a few cases in Breslau. 



In his ' Maladies de la Cornee ' Morax gives a figure of the bacilli 

 from a case of keratitis. In spite of specially directing attention to 

 the point, we have never found this organism in Freiburg, even in 

 cases whose clinical appearances resembled those of Zur Nedden's 

 cases. 



We have no information as to the occurrence of the bacillus in 

 Nature, or the source of the infection of the eye. Zur Nedden is of 

 opinion that it does not cause a keratitis in every case in which 

 it occurs on the conjunctiva, and that with careful searching it will be 

 found on the normal conjunctiva. He is very probably correct. 



As to treatment, the common conservative procedure for keratitis 

 is usually successful ; even in the most severe cases the galvano- 

 cautery was seldom necessary. 



Herbert's Intra- Epithelial Capsulated Bacilli in Keratitis 

 Punetata Superflcialis. 



Some time ago the director of the eye hospital in Bombay, Lt.-Col. 

 Herbert, I.M.S., sent me several preparations for an opinion. They 

 contained quite peculiar bacteria, which had been only once briefly 

 described in the Ophthalmic Review, 1901, p. 339. The case was one of 

 keratitis punctata superficialis, and closely resembled the affection, 

 described in the years 1893-1894 by Fuchs, Eeuss, and Nuel. There 

 was only the slight difference that the initial irritation of the conjunc- 

 tiva in Herbert's cases was less obvious, and that in India the disease 

 almost always remained unilateral, and healed in the comparatively 

 short space of three weeks. The disease occurred in an epidemic 

 form, although the process of infection could not be demonstrated. 



When Herbert scraped the slightly uneven epithelium from the 

 punctate spots, he found in the epithelium large numbers of peculiar 

 bacilli, which were only stained with great difficulty, in the ordinary 



1 Macnab, ' Ulceration of the Cornea,' London, 1907. 



