MATERIAL FROM THE LIVING SUBJECT 235 



organisms are numerous. 1 Blood agar plates are preferable for the 

 cultivation of bacteria from the eye. Not only do the hemoglo- 

 binophilic organisms and the gonococcus grow in this medium the 

 less fastidious forms also develop rapidly. 



Subacute Conjunctivitis. The Morax-Axenfeld bacillus is a common 

 excitant of subacute conjunctivitis, particularly when the internal 

 angle is involved. The secretion is meagre and best obtained in the 

 morning. The bacilli are short aiid thick, Gram negative, and occur 

 singly and in pairs, both free and in leukocytes. They must be dis- 

 tinguished from members of the Mucosus Capsulatus Group, which are 

 comparatively common in ozena which involves the nasal ducts. The 

 latter are capsulated, which distinguishes them from the Morax-Axen- 

 feld organism. 



Corneal ulcerations may be caused by pneumococci, streptococci, 

 leprosy bacilli, and rarely by tubercle bacilli. The latter organism 

 is best detected by animal inoculation. 



Pseudomembranous conjunctivitis is frequently the result of a 

 localization and development of diphtheria bacilli, less commonly of 

 streptococci. The etiology of phlyctenular conjunctivitis is still 

 unknown. 



Bacteriological Examination of the Ear and Nose. The middle 

 ear normally is sterile, but bacteria may reach it either by extension 

 of growth from the nasopharynx through the Eustachian tube, or 

 directly from the blood and lymph channels. By far the most com- 

 mon incitant of infection of the middle ear is the streptococcus alone 

 or less frequently in association with other organisms. This organism 

 is also commonly isolated from thrombosed sinuses. The pneumo coccus 

 and Pneumococcus mucosus are also frequently isolated from otitis 

 media. Bacillus pyocyaneus or Bacillus proteus are not uncommonly 

 found in middle ear infections, particularly those containing fetid pus. 

 Bacillus coli has also been detected *in foul-smelling pus from the 

 middle ear. Staphylococci, Micrococcus catarrhalis, Micrococcus 

 tetragenus, influenza bacilli, members of the Mucosus Capsulatus 

 Group of bacilli, typhoid and diphtheria bacilli have also been isolated 

 from otitis media. 



Infection of the external auditory meatus, which contains cerumen, 

 is frequently the result of an overgrowth of various moulds, particularly 

 Aspergillus and Mucor. 



1 For a discussion of Gram-negative diplococci found in the eye, see Blue, Arch. 

 Ophthal., 1915, xliv, No. 6. 



