DISEASES OF THE CONJUNCTIVA 73 



It is no doubt due to some form of bacterium which 

 has not yet been definitely settled upon. The writer 

 has recently examined several cases by culture growth 

 under the strictest precautions, and found a bacilli 

 resembling the Klebs-LofHer in nearly all their pe- 

 cuharities. The disease is said to be contagious by 

 some, but this is doubted by others. It attacks the 

 scrofulous, debihtated, and otherwise poorly nourished, 

 though the writer has seen it in those who are well 

 nourished, lead outdoor lives, and have sanitary homes. 

 It is confined principally to the palpebral conjunctiva, 

 and usually involves both eyes. The initial symptoms 

 are much like those of a catarrhal conjunctivitis, and 

 in many cases the disease is well advanced before the 

 patient is aware of its real nature. A secrerion is de- 

 veloped of a mucopurulent character and folHcles are 

 numerous. These resemble sago grains, and are confined 

 to the lymphoid structure. They eventually break down, 

 discharge, and cicatrize while others are forming. A 

 gritty feeling is experienced in the act of winking, and, 

 by reason of this and an extension of the disease, the 

 upper part of the cornea becomes irritated and inflamed. 

 This is known as pannus. The thickened rissue produces 

 a shght drooping of the lid. When the conjunctiva is 

 exhausted by extensive ulceration and cicatrization a 

 degree of contracrion takes place, and the border of the 

 lid is drawn inward, producing an entropion. This is 



