SPECIAL FOKMS OF CONJUNCTIVAL INFECTION 135 



difficulty in obtaining pure cultures, also to some confusion of the organism with 

 the Bacillus xerosis present along with it. (Weichselbaurn and Miiller, however, 

 go too far in their criticism when they see a contradiction in the fact that Weeks 

 never observed corneal complications, while Morax did. Such a variation in the 

 same disease is quite possible.) "Weichselbaum and Miiller obtained cultures almost 

 exclusively with human serum agar, most readily when at the same time a few 

 xerose bacilli were present in the culture. 



They obtained a positive inoculation on the human conjunctiva in ten cases, 

 mostly with pure cultures, and thus demonstrated that from apparently mild cases 

 a severe result can be produced in other people, and that a kind of latency may 

 occur, during which the bacilli lie concealed for a considerable time in an apparently 

 healthy person. 



The further examinations made by L. Miiller in Egypt are of very great interest, 

 especially with regard to trachoma and his ' trachoma bacillus ' (the influenza 

 bacillus). He demonstrated anew the morphological similarity of the Koch-Weeks 

 bacillus with his own and the influenza bacillus, and convinced himself of its ' pan- 

 demic occurrence.' 



In the extensive epidemic observed by Kamen in 1899 at Czernowitz the bacilli, 

 of which the author obtained excellent photographs, could be readily grown for 

 many generations on media containing human blood. Kamen emphasized their 

 close relationship to the influenza bacillus, with which they form a group. 



A thorough investigation was made by Hofmann in the Greifswald clinic. The 

 disease, introduced into that district by the Polish labourers, presented the peculiar 

 clinical feature of a chronic course, associated with profuse development of 

 follicles. Three inoculations of the human conjunctiva with a pure culture gave a 

 positive result. 



An extensive epidemic was observed by Markus in the elementary schools of 

 Bitterfeld ; five adults were also affected. The patients, to some extent, showed 

 marked follicular overgrowth, and in the early stages phlyctenules regularly 

 occurred, along with small haemorrhages under the conjunctiva, especially the 

 upper. 



Kymowitsch (Kasan) is very definitely in favour of the complete identity of the 

 Koch-Weeks and the influenza bacillus, an opinion also held by Jundell. The latter 

 observed an acute conjunctivitis in children, with simultaneous bronchitis, and 

 sometimes typical influenzal temperatures. The organisms in these cases agreed 

 exactly with those of influenza, and, like them, grew well on blood media. Zur 

 Nedden had previously found the influenza bacillus, which he rightly distinguished 

 from the Koch-Weeks organism. Luerssen obtained a positive result on infecting 

 his own conjunctiva with Koch-Weeks bacilli, obtained from a case of trachoma. 

 He gave a full comparison with the influenza bacillus (Miiller's bacillus), and 

 proved their separate identity. He found the Koch-Weeks bacillus in the nose, but 

 no inflammation occurred in that site. 



Further less important contributions to the subject will be shortly noted later. 



Geographical Distribution. Epidemiology. 



The preceding historical account shows that Koch- Weeks conjuncti- 

 vitis is very widespread over the earth. 



It has been demonstrated in Egypt (Koch, Kartulis, L. Miiller, Morax, Lakah 

 and Kouri, Meyerhof) ; in Palestine (Butler) ; in North Italy (Gasparrini) ; in Siena 

 (Giarre and Picchi, Corsini, Cannas) ; in Paris (Morax, Panas) ; in Amiens (Fage) ; 

 Toulouse (Mallet); in French Switzerland (Gonin); in Brussels (Coppez, Wibo); in 



