THE NOBMAL CONJUNCTIVA 25 



asserted that the flora of the normal conjunctiva is very variable, 

 and that, to a certain extent, there are no constant inhabitants 

 (Wolkowitsch). The flora is directly subjected to the changing influence 

 of the incidental pollution around. The beginner at the present 

 time can well appreciate this contention if he merely looks through 

 the long list of the conjunctival organisms in the literature collection 

 by Brandt. The opposite view is presented by Gelpke, who states 

 that the conjunctival sac in ladies and girls of the upper social class 

 is mostly sterile. This view, which, less definitely enunciated, recurs 

 in the literature, presumes the idea that the bacterial condition of the 

 conjunctiva is so definitely dependent on external influences that, 

 when by the customary cleanliness of these people such influences are 

 removed, the conjunctival sac will remain sterile. On the other hand, 

 it is not surprising that, with different material, other authors have 

 come to the conclusion that the conjunctival sac invariably contains a 

 considerable number of different organisms (Blagoweschenski) ; and 

 similarly we are not surprised to find that one and the same organism 

 (e.g., B. xerosis) is noted by one author as frequent, and by another 

 as never found. 



The following points must be considered if we are to arrive at a 

 correct conclusion : 



1. The flora of this area, being subject to many contaminating influ- 

 ences, can, as a matter of J act, vary in quantity and quality according to 

 the surroundings, to external conditions, and to personal habits. 



In this respect it is of interest to note that, as would be expected, Walthard, 1 

 Koblank, 2 and Cramer, 3 found the conjunctivse of newly-born infants to be sterile. 

 Organisms, however, began to appear in the first few days of life; in six days 

 (Cramer) a few Bacteria could be found, after ten days many. When any inflam- 

 mation had occurred, either at or after birth, by opening the lids during parturition, 

 or from silver nitrate, etc., the organisms appeared relatively earlier. 



After the organisms have settled down, the average flora does not materially 

 differ from that of subsequent years. We have found the condition in children one 

 year old not to differ markedly from that of adults. The statement made by Foote, 

 that he found in children 50 per cent., in young adults 33 per cent., and in old 

 people 30 per cent, of sterile conjunctive, certainly cannot be confirmed. So high a 

 percentage of sterile cases is never found present in any life period, if sufficiently 

 delicate methods are used and the material is properly collected; and the differ- 

 ences in percentage which he gives are within the limits of possible variation and 

 error. Foote's other statement that the number of organisms is greater in the 

 morning than in the evening can be considered as confirmed, for during sleep the 

 cleansing lid movements do not occur. 4 



1 Pfluger, Korrespondenzblatt f. Schweitzer Arzte, 1895. 



2 Festschrift f. Karl Ruge, Berlin, 1898, p. 141. 



3 Zentralblatt f. Gyndkol., 1899, No. 9. 



4 The findings of Marthen, Bernheim, Morax, Bach, Dalen correspond ; they showed 

 that the number of organisms increased under a bandage, which kept the lids still (and 



