226 INFLAMMATION AND SUPPURATION 



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 number appear to be specially associated 

 with this region. Thus a small organism, generally known as 

 the Koch- Weeks bacillus, is the most common cause of acute 



contagious conjunctivitis, 

 especially prevalent in 

 Egypt, but also common 

 in this country. This 

 organism is very minute, 

 4 being little more than 1 //, 

 in length, and morpho- 

 logically resembles the 

 influenza bacillus ; its 

 conditions of growth are 

 \ even more restricted, as 



it rarely grows on blood 

 agar, the best medium 

 being serum agar. On 

 this medium it produces 

 minute transparent col- 



FIG. 59. -Film preparation from a case of O nies like drops of dew. 

 acute conjunctivitis, showing Koch-Weeks mi -,, f 



bacilli, chiefly contained within a leucocyte. lhe obtaining of pure 

 (From a preparation by Dr. Inglis Pollock.) 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. 59). 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 

 relation to this condition is still a matter of dispute. Another 

 bacillus which is now well recognised is the diplo-bacillus of 

 conjunctivitis first described by Morax. It is especially common 



