110 BACTERIOLOGY OF THE EYE 



Similarly with individual cases of acute conjunctivitis. The 

 identification of the most severe cases (blennorrhoea and diphtheria) is 

 very important at their commencement, as well as at their height, and 

 often renders a specific (serum) treatment possible. 



Among cases of chronic conjunctivitis the demonstration of the 

 Diplobacillus is very useful. The varying manifestations of 

 this widespread and common infection, which often enough are 

 quite overlooked, can be definitely counteracted by suitable treat- 

 ment. 



Many conditions which clinically appear unlike infections can be 

 very infectious for others ; this would be determined by an examina- 

 tion of the secretion. Both patient and surgeon, too, are often 

 relieved to find that an apparently severe case, on examination of the 

 secretion, is really of a mild character. 



Important facts are obtained regarding operations. 



It is important to note that almost the only organisms occurring in 

 acute epidemics of catarrhal conjunctivitis are the Koch-Weeks 

 bacillus (perhaps also influenza bacilli), and the Pneumococcus (in 

 Egypt the Gonococcus also, rarely Subtilis). Other pathogenic con- 

 junctival organisms only exceptionally occur. 



Diagnosis from a simple film preparation is sufficiently accurate for 

 clinical use in the following forms of conjunctival infection : 



Gonorrhosal (with the signs of blennorrhrea), Koch-Weeks, diplo- 

 bacillary, pneumococcal, influenzal, Bac. coU, staphylococcal, strepto- 

 coccal, 1 Bac. subtilis, as well as mixed forms from these. 



Cultures must be made : (1) when Gram-negative Diplococci are met 

 with, either in a simple catarrh or on a normal conjunctiva, to decide 

 between the Gonococcus, the Micr. catarrhalis, and the rare Mcninyo- 

 coccus ; (2) for the differential diagnosis of the diphtheria bacillus 

 from the Bacillus xcrosis in pseudo-membranous conjunctivitis. 



When in either of these cases a culture cannot be made, we should 

 treat as for the worst organism in the smear that is, for a probable 

 gonorrhoaa or diphtheria. 



The diagnosis of Staphylococci in the smear (with or without xerose 

 bacilli) is of value, as showing that in a simple conjunctivitis we are 

 dealing with a non-contagious process in which the infection is only of 

 secondary importance (see ' Staphylococcal Conjunctivitis,' p. 236) ; 

 it may be a casual occurrence in cases of indeterminate bacteriology in 

 which these cocci have developed without any causal significance, such 

 as trachoma or follicular conjunctivitis. 



1 In the great majority of cases (see p. 206). 



