Casey A. (Casey Albert) Wood.

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THE

AMERICAN
ENCYCLOPEDIA AND DICTIONARY

OF

OPHTHALMOLOGY



EDITED BY

CASEY A. WOOD, M. D., C. M., D. C. L.

Professor of Ophthalmology and Head of the Department, College of Medicine, University of Illinois;

Late Professor of Ophthalmology and Head of the Department, Northwestern University

Medical School; Ex-President of the American Academy of Medicine, of the American

Academy of Ophthalmology, and of the Chicago Ophthalmological Society;

Ex-Chairman of the Ophthalmic Section of the American Medical

Association; Editor of a "System of Ophthalmic Therapeutics" and

a "System of Ophthalmic Operations"; Mitglied der Oph-

thalmologischen Gesellschaft, etc.; Ophthalmic

Surgeon to St. Luke's Hospital; Consulting

Ophthalmologist to Cook County

Hospital, Chicago, 111.



ASSISTED BY A LARGE STAFF OF COLLABORATORS



FULLY ILLUSTRATED



Volume V — Conjunctivitis Phlyctenulosa Pustulosa

to Dioptrics



CHICAGO
CLEVELAND PRESS

1914



Copyright 1914

by the

CLEVELAND PRESS

All rights reserved



INTRODUCTION



In renewing his thanks to those collaborators who have given him such
valuable assistance in the preparation of the first five volumes of this
Encyclopedia, the Editor desires also to repeat an expression of his in-
debtedness to the literary and other sources of information mentioned
in the Introduction to Vol. I.

Dr. Shastid has requested permission to acknowledge once more his
great obligations to the works of Professor Julius Hirschberg, whom he
regards as almost the creator of ophthalmologic history and biography.
Further, though in less degree, is he debtor to various general histories
of medicine, especially those of Baas, Haeser and Neuburger; Atkinson's
"Physicians and Surgeons of the V. S.;" Ball's "Andreas Vesalius ;"
Book's "Die Brille und Ihre Geschichte;" Caesemaeker's "Notice sur
les Lunettes et Verves Opticiu.es;" Carpentier's "Nos Ancetres;" Cas-
tillo's " Augenheilkunde in der Romerzeit;" Caton's "Temples and
Ritual of Asklepios" and "I-em-hotcp and Ancient Egyptian Medicine;"
Oeighton's "History of Epidemics in Britain;" Frank's "Caricature
in Medicine" and "Biographical Sketch of Sonu Representativt Oph-
thalmic Surgeons" (in Wood's "System of Ophthalmic Operations");
Gerzetimc's "TJeber Medecin und Sonnencultus eles Alterthums ."
Goethe's "Farbenlehre" and "Dichtung und Wahrheit;" Hirsch's
"GeschichU der Augi nheilkundU ;" Hirsch and Gurlt's " Btographisches
Lexikon <l<r Aertzi ;" llubbell's "Ophthalmology in America;" Kelly's
"Cyclopedki of American Medical Biography" and "Som< American
Medical Botanists;" Klein's "Stempel RomiscJier Augenartze;" Mag-
nus's "Anatomic des Auges in Ihrer Geschicht. Entwickelung,"
" Augenheilkunde der Alien," and "Geschichte des Grawen staares;"
Mollet 's "La Mcdechu <h< : lis Grecs avant Hippocrate;" Mumford's
"Medicine in America;" Nutting and Dock's "A History of Nursing;"
Paekard's " History of Medicim in tin U. S.;" Pagel's " Biographisches
Lexikon; Pansier's "Histovn des Lunettes," "Histoire ele I'Ophtal-
mologie" (with True), "Histoirt <l< VOphtalmologie a I'Ecolc de Mont-
pellier;" Puschmann's "History of Medical Education;" Rosenherger's
"Geschichte der Physik;" Stone's "Biography of Emiiu ut American
Physicians and Surgeons;" Terson's "Etudes sur I'Histoin d< la

vii



viii INTRODUCTION

Chirurgie Oculaire;" "Universities and Their Sons;" Walsh's ""Old
Time Makers of Medicine," and "Education, How Old the New;" "Wiede-
mann's "TJeber die Naturwissenschaften bei den Arabern;" Wooton's
"Chronicles of Pharmacy;" also, to numerous obituaries in various oph-
thalmological journals. He also desires to acknowledge his indebtedness
to hundreds of correspondents in various portions of the world for bio-
graphical and historical information for use in this Encyclopedia.

The Editor wishes to add to the foregoing statement of Dr. Shastid
that, wherever possible and desirable, the Doctor has consulted the orig-
inal works of the ophthalmologists 'whose lives he has written for this
Encyclopedia. The list above-presented is merely that of Dr. Shastid 's
secondary authorities — tbosc to which lie feels himself indebted in a
special sense.

Casey A. Wood.



INITIALS USED IN VOLUME V, TO IDENTIFY
INDIVIDUAL CONTRIBUTORS



A. A.— Adolf Alt, M. D., M. C. P. and S. 0., St. Louis, Mo.

Clinical Professor of Ophthalmology, Washington University, St. Louis, .Mo.;
Author of Lectures on the Human Eye; Treatise on Ophthalmology for the
General Practitioner; Original Contribution Concerning the Glandular Struc-
tures Appertaining to the Human Eyt and its Appendages. Editor of the
American Journal of Ophthalmology.

A. C. C. — Alfred C. Croptan, Ph. I)., M. D., Chicago, III.

Author of Clinical Urinology and of Clinical Therapeutics, Member of the
General Staff of the Michael Reese Hospital, Chicago. Formerly Physieian-in-
ehief at St. Mary 's Hospital ; Physician to St. Elizabeth 's Hospital ; Physician
to the Chicago Post-Graduate Hospital; Pathologist to St. Luke's Hospital.
Late Professor of Medicine at the Chicago Post-Graduate College and the
Chicago Polyclinic; Assistant Professor of Clinical Medicine, College of Physi-
cians and Surgeons (University of Illinois) ; Member of the American Thera-
peutic Society.

A. E. II. — Albert E. Halstead, M. D., Chicago, III.

Professor of Clinical Surgery, Northwestern University Medical School; At-
tending Surgeon, St. Luke's and Cook County Hospitals, Chicago; Consulting
Surgeon, Illinois Charitable Eye and Ear Infirmary; Fellow American Surgical
Association.

B. C. — Burton Chance, M. D., Philadelphia. Pa.

Assistant Surgeon, Wills Hospital, Philadelphia.

C. A. O. — Charles A. Oliver (Deceased).

Joint Editor of A System of Diseases of the Eye; Writer of numerous mono-
graphs on ophthalmic subjects.

C. F. P.— Charles F. Prentice, M. E., New York City, N. Y.

President, New York State Board of Examiners in Optometry; Special Lecturer
on Theoretic Optometry, Columbia University, New York. Author of A Treatise
on Ophthalmic Lenses (1886) ; Dioptric Formula' for Combined Cylindrical
Lenses (1888) ; A Metric System of Numbering and Measuring Prisms (the
Prism-dioptry) (1890); The Iris as Diaphragm and Photostat (1895), and
other optical papers.

C. P. S.— Charles P. Small. A. M., M. 1)., Chicago, 111.

Late Clinical Assistant, Department of Ophthalmology, Push Medical College.
Author of A Probable Metastatic Hypernephroma of the Choroid.

D. H. — U'Orsay Hecht, M. D., Chicago, III.

Assistant Professor of Nervous and Mental Diseases, Northwestern University
Medical School ; Consulting Neurologist to the Cook County Institution for the
Insane at Dunning, Illinois; Attending Neurologist to the Michael Keese and
St. Elizabeth's Hospitals. Chicago.

ix



x INDIVIDUAL CONTRIBUTORS

D. W. G. — Duff Warren Greene, M. A., M. S., M. D., Dayton, Ohio

(. Deceased).

Formerly Oculist to the National Military Home, St. Elizabeth's Hospital,
and Ohio Soldiers' and Sailors' Orphans' Home, Xenia, Ohio.

E. II.— Emory Hill, A. B., M. D., Chicago, I i.e.

Late House Surgeon, Wills Eye Hospital, Philadelphia ; Assistant in Ophthal-
mology, Hush Medical College (in affiliation with the University of Chicago) ;
Assistant Ophthalmologist to the out-patient department of the Children's
Memorial Hospital, Chicago; Assistant Instructor in Ophthalmology, Chicago
Policlinic. Member of American Academy of Ophthalmology and Oto-
Laryngology.

E. K. F. EPHRAIM KlRKl'ATRICK PlNDLAY, M. D.. C. M., CHICAGO, ILL.

Assistant Clinical Professor of Ophthalmology, Medical Department, University
of Illinois; Attending Surgeon of the Illinois Charitable Eye and Ear Infirm-
ary; Assistant Oculist at the University Hospital.

E. S. T— Edgar Steiner Thomson, M. D.. New York City, N. Y.

Surgeon and Pathologist, Manhattan Eye, Ear and Throat Hospital; Professor
of Ophthalmology, New York Polyclinic Medical School and Hospital; Con-
sulting Ophthalmologist to Perth Amboy and Ossining Hospitals; Member of
the New York Academy of Medicine, New York Ophthalmological, and Ameri-
can Ophthalmological Societies. Author of Electric Appliances and Their Use
in Ophthalmic Surgery, in Wood's System of Ophthalmic Operations, and
various monographs.

F. A. — Frank Allport, M. D., LL. D., Chicago, Iee.

Ex-Professor, Ophthalmology ypid Otology, Minnesota State University; Ex-
President, Minnesota State Medical Society; Ex-Chairman and Secretary, Oph-
thalmic Section, American Medical Association; Ex -Professor, Ophthalmology
and Otology, Northwestern University Medical School; Ex-President, Chicago
Ophthalmological Society. Author of The Eye end Its Care; Co-Author of An
American Text-Book of Diseases of the Eye, Ear, Nose and Throat; A System
<>f Ophthalmic Therapeutics, and A System of Ophthalmic Operations. Eye and
Ear Surgeon to the Chicago Board of Education and to St. Luke's Hospital,
Chicago.

F.C.T.— Frank C. Todd, I). I). S., M. I).. F. A. C, S., Minneapolis,
Minn.

Professor of Ophthalmology and Chief of the Division of Eye, Ear, Nose and
Throat, University of Minnesota, Medical Department; Chief of Eye, Ear, Nose
and Throat Staff, University of Minnesota Hospitals; Eye, Ear, Nose and Throat
Surgeon to Hill Crest Hospital ; Eye Surgeon to the C. M. & St. P. E. R. Co.,
etc.; Chairman of the Section of Ophthalmology, A. M. A.; President of the
Minnesota Academy of Ophthalmology and Oto-Laryngology ; Vice-president of
the A. M. A., etc. Monographs: An Exact and Secure Tucking Operation, for
Advancing an Ocular Muscle; A Method of Performing Tenotomy which En-
ables tin Operator to Limit tlte Effect as Eequircd ; Mules' Operation; Kera-
tectasia; "Report of a Case with Transparent Cornea; The Implantation of an
Artificial Vitreous as a Substitute for Enucleation of the Eyeball; Simple
Method of Suturing the Tendons in Enucleation ; Malingering (Pretended
Blindness); The Physiological and Pathological Pupil.

F. E. B.— Frank E. Brawley, Ph. G., M. D., Chicago, III.

Co-Author of Commoner Diseases of the Eye, A System of Ophthalmic Thera-
peutics and A System of Ophthalmic Operations; formerly voluntary assistant
in the Universitaetes Angenklinik, Breslau, and the Royal London Ophthalmic
Hospital (Moot-fields); Oculist and Aurist to St. Luke's Hospital. Chicago.
Editorial Secretary of The Ophthalmic "Record.



[NDIVIDUAL CONTRIBUTORS xi

G. ('. S.— G. C. Savage, M. 1).. Nashville, Tenn.

Professor of Ophthalmology in the Medical Department of Vanderbill Uni-
versity; Ex-President of the Nashville Academy of Medicine; Ex-President
of the Tennessee State Medical Society. Author of New Truths in Ophthal-
mology and Ophthalmic Myology.

H.B.W.— Henry Baldwin Ward. A. 15.. A. M., Ph. I).. Champaign,
[ll.

Professor of Zoology, University of Illinois; Ex Dean of the College of Medi-
cine, University of Nebraska. Author of Parasitic Warms of Man and the
Domestic Animals; Data for the Determination of Human Entosoa; Tcono-
graphia Parasitorum Hominis; [finnan Paras-ites in North America.

II. I). ('. — II. Beckles Chandler. C. JVL, M. I).. Boston, Mass.

Professor Ophthalmology, Tufts Medical School, Boston; Senior Surg<

Massachusetts Charitable Eye and Ear [nfirmary.

II. (i. L. — Henry Glover Langworthy, M. I).. Dubuque, Iowa.

Surgeon to the Langworthy Eye, Ear, Nose and Throat [nfirmary, Dubuque,

Iowa; Member American Academy of Ophthalmology ami Oto Laryngology ; of
the Chicago Ophthalmologieal Society; of the American Medical Association.
etc. Writer of numerous monographs on the special subjects of eye. ear, nose
and throat.

II. s. G. — Harry Slarls Gradle, A. B., M. 1).. Chicago, III.

Professor of Ophthalmology, Chicago Eye and Ear College; Director of
Ophthalmic Clinic, West Side Free Dispensary; Member of the Ophthal-
mologische Gesellsehaft, American Medical Association, American Academy of
Ophthalmology and Oto-Laryngology.

II. V. \V. — Harry Vanderbilt Wurdemann, M. I).. Seattle, Wash.

Managing Editor, Ophthalmology, since L904; Editorial Staff of the Ophthalmic
Record, since LS!»7; Managing Editor, Annuls of Ophthalmology, 1897-1904.
Member American Medical Association; Ex-Chairman Section on Ophthal-
mology, American Medical Association; Hon. Member. Sociedad Cientifica,
Mexico; N. W. Wisconsin Medical Society and Philosophical Society. Fellow
American Academy of Ophthalmology ami Oto-Laryngology. Author of Visual
Economic* (1901); Injuries to tin Eye (1912); Bright's Diseasi and tin Eyt
(1912); and numerous monographs on the eye and its diseases. Collaborator
on many other scientific books.

J. D. L. — Joseph 1). Lewis, A. M., M. 1).. Minneapolis, Minn.

Ophthalmic ami Aural Surgeon to the Minneapolis City Hospital; Consulting
Ophthalmic and Aural Surgeon to Hopewell Hospital and Visiting Nurses'
Association; Member Minnesota Academy of Ophthalmology and Oto-Laryn-
gology; Fellow American College of Surgeons.

•I. L.M. — roiiN L. Moffat, 15. S., M. I).. <>. et A. Chir., Ithaca, X. Y.

Editor Journal of Ophthalmology, Otolcgy and Laryngology. Consulting
Ophthalmic Surgeon, Cumberland Street Hospital. New York; Member ( v.-p.
190"), 1908) American Hoimeopathic Ophthalmologieal, Otological and Laryn
gologieal Society; Member American Medical Editors' Association; Member
(Senior) American Institute of Homoeopathy; Senior Member (ex-pres.) New
York State Homoeopathic Medical Society; Senior Member (ex-pres.) Bangs
County (N. Y.) Homoeopathic Medical Society; Honorary Member N. Y. County
Homoeopathic Medical Society.

J. M. B. — Fames Moores Hall. M. I).. LL. I)., St. Louis, Mo.

Dean and Professor of Ophthalmology, American Medical College of St. Louis,
Medical Department of National University of Aits and Sciences. Author of
Modem Ophthalmology; Andreas Vesalius the Reformer of Anatomy.



xii INDIVIDUAL CONTRIBUTORS

M. S.— Myles Standish, A. M., M. D., S. D.. Boston, Mass.

Williams Professor of Ophthalmology, Harvard University; Consulting Ophthal-
mic Surgeon, Massachusetts Charitable Eye and Ear Infirmary and Carney
Hospital, Boston, Mass.

P. A. C— Peter A. Callan, M. D., New York City, N. Y.

Surgeon, New York Eye and Ear Infirmary; Ophthalmologist to St. Vincent's
Hospital; Columbus Hospital and St. Joseph's Hospital, New York.

R. I). P. — Robert D. Pettet, Chicago, III.

Author of The Mechanics of Fitting Glasses.

S. IT. McK. — Samuel Hanford McKee, B. A.. M. 1).. Montreal, Que.

Lecturer in Pathology and Bacteriology, McGrill University; Demonstrator in
Ophthalmology, McCill University; Assistant Oculist and Aurist to the Mont-
real General Hospital; Ocnlist to the Montreal Maternity Hospital; Oculist to
the Alexandra Hospital ; Member of The American Association of Pathologists
and Bacteriologists. Author of The Bacteriology of Conjunctivitis; an Analysis
of Three Hundred Cases of Morax-Axcnfeld Conjunctivitis ; Demonstration of
the Spirocheta Pallida from a Mucous Patch of the Conjunctiva ; The Patho-
logical Histology of Trachoma, and numerous other monographs.

T. H. S.— Thomas Hall Shastid, A. I'... A. M., M. I).. LL. B., F. A. C. S.,
Superior, Wis.

Honorary Professor of the History of Medicine in the American Medical College,
St. Louis, Mo., Medical Dept. of National University of Arts and Sciences.
Author of A Country Doctor; Practising in Pike; Forensic Relations of
Ophthalmic Surgery (in Wood's System of Ophthalmic Operations) ; Legal Rela-
tion* of Optithalmology (in Ball's Modern Ophthalmology) ; A History of
Medical Jurisprudence in America (in Kelly's Cyclopedia of American Medical
Biography).

W. C. P. — Wm. Campbell Posey, B. A.. M. D., Philadelphia, Pa.

Professor of Ophthalmology in the Philadelphia Polyclinic Hospital and Grad-
uate Medical School; Ophthalmic Surgeon to the Wills, Howard and Children's
Hospitals; Chairman of the Pennsylvania Commission for the Conservation of
Vision; Chairman of Section on Ophthalmology, College of Physicians, Phila-
delphia. Editor of American Edition of Nettleship's Textbook of Ophthal-
mology; Co-Editor, with Jonathan Wright, of System of Diseases of the Eye,
Ear, Nose and Throat; Co-Editor, with Wm. G. Spiller, of The Eye and the
Nervous System.

W. F. H.— William Frederic Hardy, M. D., St. Louis, Mo.

Assistant in Ophthalmology, Washington University Medical School.

W. H. W. — William Hamlin Wilder, A. M., M. D., Chicago, III.

Professor and Head of Department of Ophthalmology, Rush Medical College
(in affiliation with University of Chicago) ; Professor of Ophthalmology,
Chicago Polyclinic; Surgeon, Illinois Charitable Eye and Ear Infirmary;
Ophthalmic Surgeon, Presbyterian Hospital: Member American Ophthal-
mological Society.



LIST OF LEADING SUBJECTS IN THIS

VOLUME



Con j unctivitis, phl ycten ular

Conjunctivitis, purulent

Conjunctivitis, rare forms of

Conjunctivitis, Samoan

Conjunctivitis, squirrel-plague

Conjunctivitis, subacute catarrhal

Conjunctivitis, vernal

Connor, Leartus

Consanguinity in ophthalmology

Conscious vision

Conservation of vision

Contours, rivalry of visum, fields of

Contrast

contusio bulbi

CONUS

Con us, opticohyaloid

Convergence

Convergent squint

Copiopia

Copper in the eye

Copper-lecithin

Copper sulphate

Coppock cataract

corelysis

Cornea, acne rosacea of the

Cornea, congenital staphylom \ ok the

Cornea, deep ulcer of the

Cornea, diplobacillary ulcer ok the

Cornea, dystrophy of the

Cornea, edema of the

Cornea, fatty degeneration ok the

Cornea, fistula ok the



xiii



xiv LIST OF LEADING SUBJECTS

Cornea, hyaline degeneration of the

Cornea, internal ulcer of the

Corneal loupe

Corneal suture in cataract extraction

Cornea, melanosis of the

Cornea, Mooren's ulcer of the

Cornea, nodular opacity of the

Cornea, opacities of the

Cornea, paracentesis of the

Cornea, relapsing erosion of the

Cornea, ring clcer of the

Cornea, rupture of the

Cornea, sarcoma of the

Cornea, serpent ulcer of the

Cornea, simple ulcer of the

Cornea, staphyloma of the

Cornea, tattooing of the

Cornea, trachoma of the

Cornea, transplantation of the

Cornea, tubercle of the

Cornea, ulcer of the

Corpora quadrigemina

Corr, Albert Campbell

Cramp of retinal vessels

Cranial deformities, eye symptoms of

Crime, eyestrain and

Cryptophthalmia

Cul-de-sac, conjunctival

Curtis, Sir John Harrison

Cyanosis of the eye

Cyclitis

Cyclodialysis

Cyclophoria

Cycloplegic

Cyclops

Cyclotropia

Cysticercus cellulos.e

Cyst of the irip

Cyst of the vitreous

Cystotome

Cysts, conjunctival and subconjunctival

Cysts of the orbit



LIST OF LEADING SUBJECTS xv



Dacryocystitis

Dacryocystitis, acute

Dacryocystitis, chronic

I )acryocystorhinostom y

Damages

Dark adaptation

Daviel, Jacques

Dazzling

Deafness, ocular relations of

Death, the ophthalmic relations of

Decentration

Decompression, cerebral

Dementia pr.ecox, eye syndrome of

Dental amblyopia

Dentists, asthenopia among

Dermatitis, ocular relations of

Dermoids

Descemetitis

Desmarres, Louis Auguste

Desmonceaux

Detachment, vitreous

Development of the human eye

Diabetes insipidus, ocular relations of

Diabetes mellitus, ocular relations of

Dialysis

DlAPHANOSCOI'V
DlCHROM ASIA

Dilators

Dionin

Dioptrics



j. I



CONJUNCTIVITIS, PHLYCTENULAR 3131

Conjunctivitis, Phlyctenular. Phlyctenular ophthalmia. Scrofulous

OR STRUMOUS OPHTHALMIA. ECZEMATOUS CONJUNCTIVITIS. LYMPHATIC

ophthalmia or conjunctivitis. This is one of quite a distinct class
of eonjunctivitid.es which are to be regarded as expressions of dys-
crasise, depending not so much upon the introduction of pathological
germs from without, as the causative factor, but rather upon the
condition of the general system and the state of the nutrition as the
most important factors.

The dyscrasia known as scrofula or struma manifests itself in the
conjunctiva more frequently than any other disease of malnutrition,
and is especially frequent in children, though adults are by no means
free from it. The appearance of vesicles on the conjunctiva is not
of course a certain indication of established scrofula, as they often
occur during a temporary lowering of the nutritive powers in chil-
dren who are apparently strong and show no evidence of the dyscrasia
elsewhere, and there are cases of pronounced and severe forms of
strumous disease in which the conjunctiva is slightly or not at all
affected. Still, the appearance of these vesicles on the conjunctiva
can be accepted as a certain sign of faulty assimilation, and generally
of the impoverished condition of the blood.

It would seem probable too, that in some instances at least, the
vesicles are manifestations of a derangement at the nerve-centers an-
alogous to, if not identical with, that causing herpes zoster. We can
hardly account otherwise for the very pronounced nervous symptoms,
such as severe pain, lachrymation, and photophobia, which we not un-
commonly see. There is no other disease which varies so widely in the
intensity of its symptoms ; and what is still more remarkable, the sub-
jective symptoms do not seem to bear any direct relation to the ob-
jective manifestations. Frequently a minute vesicle, especially if
situated on the cornea or corneo-scleral margin, will be associated with
the most intense pain, photophobia, and lachrymation persisting for
days and weeks, while two or three large ones scattered over the con-
junctiva give rise to comparatively little inconvenience. This is due
both to the extreme susceptibility of the nervous system, and the
pressure made directly on the filament of a nerve by the exudation.
This latter is more apt to be the case where the vesicle is situated
on the conjunctival layer of the cornea, where the nervous supply
of the fifth pair is more generous and the arrangement of the terminal
filaments among the epithelial layers is such as to lead more readily
to such pressure. In the same way we may account for differences in
the severity of various attacks in the same person, one being mild,
and another, with the same objective appearances, very severe.
Vol. v— 1



3132 CONJUNCTIVITIS, PHLYCTENULAR

The location of the exudate may be on the conjunctiva proper, or
in the epithelial layer of the cornea which is continuous and anatom-
ically identical with that of the conjunctiva and sclera. The exudate
lies between the epithelium and the layer of Bowman. It is not, as a
rule, fluid, but consists of an aggregation of round lymphoid cells.

The epithelium at the apex soon separates, the underlying tissue
becomes softened and breaks clown, and thus a minute gray ulcer is
produced. New epithelium soon forms over the ulcer, however, and
after healing no scar remains. The characteristic pathological change
is what appears to be a vesicle varying in size, from that of a pin-head
or less, to a bleb three or four millimetres in diameter and approach-
ing that of a bulla. The associated conjunctival vascularization may
be only a bunch of fine vessels running from the equator of the ball
forward to unite at the base of the phlyctenula, the remainder of
the conjunctiva being perfectly clear, or it may be general and dif-
fuse, approaching that of a muco-purulent conjunctivitis. Though
usually single, there may be any number of these phlyctenular, and
sometimes they form a circlet around the base of the cornea. There
is frequently associated with the conjunctival disease a swollen
condition of the edges of the lids, and sometimes of the whole lid.
The discharge may be either watery or muco-purulent. The discharge
is very acrid in some cases and causes an eczema of the cheeks, lips,
and the inside of the nose. In badly nourished and ill-cared-for chil-
dren the whole face is sometimes covered with scabs and excoriations
as a result of this irritation. When there is persistent blepharospasm
as a result of the intense photophobia there will frequently be seen
excoriation and ulceration in the folds of the skin at the outer canthus.
There may be even a total eversion of the lids (ectopia conjunctivas)
when the blepharospasm is very intense and obstinate. Actual pain,
aside from the photophobia is not usually great, but the photophobia
is usually extreme in children; the patient hides in a dark corner or
buries his head in the pillow, making an examination very difficult.
The child often presents a characteristic strumous appearance, being



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