CONJUNCTIVITIS 109 



subject by studying the literature, for not only do we find work which 

 is erroneous and confusing, but also the individual infective processes 

 do not correspond to any absolute type of disease. Bacteriological 

 investigation has found a different etiology for many conditions 

 clinically identical, and has brought into one class others which 

 differ clinically and were previously entirely separated. 



The fact that it is impossible, from the bacterial findings alone, to 

 come to a conclusion concerning every case, appears to many who 

 have not studied the matter, nor themselves examined many secretions, 

 to be conclusive evidence of the superfluity of such a proceeding, the 

 more so as it is not possible for every oculist to be an expert 

 bacteriologist. 



We also find that the organisms proved to be pathogenic can 

 sometimes be found on the healthy conjunctiva. How, then, can we 

 convince ourselves of their significance there ? 



As a matter of fact, the clinical utility of bacteriological examina- 

 tion in conjunctival cases is very marked in many respects. In many 

 cases a simple smear preparation is more useful than a culture, because 

 many pathogenic organisms very obvious in the former only develop 

 badly in the latter, and are overgrown by casual Bacteria of no 

 importance. 



I would first emphasize that anyone, although only possessing 

 a limited general knowledge of bacteriology, can readily attain 

 to such proficiency as will prove of practical utility; for the majority 

 of authors 1 agree that the causal agent in the case of a catarrh 

 generally is such an important object in the picture that it can 

 be readily seen in smear preparations of the secretion, if suitable 

 material be collected at a suitable stage in the condition. In many 

 cases, too, the morphology and staining reaction with Gram are 

 sufficient for diagnosis. How far this is the case and to what extent 

 this statement must be modified will appear later. 



If we ask, What is the clinical utility of examining the conjunctival 

 secretion? the answer is: Epidemics can then be defined according 

 to their cause, and prognosis, prophylaxis, and treatment decided 

 definitely. 



1 Morax, Morax and Petit, Axenfeld, Uhthoff, L. Miiller, Zur Xedden, Saeniisch, 

 Groenow, Gonin, Lundesgaard, Weeks, Diffbrd, Junius, Gasparrini, Veasey and De 

 Schweinitz, Bach and Neumann, L. Miiller, Hoffmann, Bietti, Coppez, Gourfein, Randolph, 

 D. Smith, Pollock, MacXab, Hanke, Fergus, Stirling, McKee, Tooke, G. S. Derby, 

 Jameson, Evans, Cannas, Corsini, Griffith, Monthus and Opin, Gabrielides, Schmidt 

 Rimpler, A. Knapp, Kruckenberg, Greeft', Straub, Dalen, Brown-Pusey, Zia, Stoewer and 

 Schmidt, Brewerton. Thomson, Duane and Hastings, Usher and Fraser, Butler, and 

 others. 



