CONJUNCTIVITIS 219 



ditions due to streptococci do not appear liable to be followed 

 by erysipelas. On the other hand, the connection between 

 erysipelas and puerperal septicaemia is well established clinically. 



In a case of erysipelas the streptococci are found in large 

 numbers in the lymphatics of the cutis and underlying tissues, 

 just beyond the swollen margin of the inflammatory area. As 

 the inflammation advances they gradually die out, and after a 

 time their extension at the periphery comes to an end. The 

 streptococci may extend to serous and synovial cavities and set 

 up inflammatory or suppurative change, peritonitis, meningitis, 

 and synovitis may thus be produced. 



Conjunctivitis. A considerable number of organisms are 

 concerned in the production of conjunctivitis and its associated 

 lesions. Of these a mini 

 ber appear to be speci- 

 ally associated with this 

 region. Thus a small 

 organism,generally known /- 

 as the Koch-Weeks bacil- / 

 Ins, is the most common / 

 cause of acute contagious i 

 conjunctivitis, especially 

 prevalent in Egypt, but 

 also common in this 

 country. This organism V 

 is very minute, being 

 little more than 1 /x in 

 length, and morphologic- 

 ally resembles the in- 



tinmr/.} W-illiiQ if n FIG. 60. Film preparation from a case of 



acute conjunctivitis, showing Koch- Weeks 



ditions of growth are bacilli, chiefly contained within a leucocyte. 

 even more restricted, as (From a preparation by Dr. Inglis Pollock.) 

 it rarely grows on blood x 1000< 



agar, the best medium 



b-.-ing serum agar. On this medium it produces minute 

 transparent colonies like drops of dew. The obtaining of pure 

 cultures is a matter of considerable difficulty, and it is nearly 

 always accompanied by the xerosis bacillus. It can readily be 

 found in the muco-purulent secretion by staining films with 

 weak (1:10) carbol-fuchsin, and is often to be seen in the interior 

 of leucocytes (Fig. 60). Another organism exceedingly like the 

 previous, apparently differing from it only in the rather wider 

 conditions of growth, is Miiller's bacillus. It was cultivated by 

 him in a considerable proportion of cases of trachoma, but its 



