136 BACTERIOLOGY OF THE EYE 



Copenhagen (Lundsgaard) ; in Kasan (Rymowitsch) ; in Kiew (Gromakowski) ; in 

 Czernowitz (Kamen) ; in Lemberg (Dudzinski, Dziennik, Tyagda leltarzy 1900. 

 No. 3) ; in Budapest (Scholtz and Vernier) ; in Germany, Hamburg (Wilbrand, 

 Saenger, Staehlin) ; in Greifswald (Hofmann); in Rostock (Axenfeld); in Halle 

 (Markus) ; in Bonn and Cologne (Zur Nedden, Saemisch) ; in Freiburg (Axenfeld 

 here comparatively common) ; in Konigsberg (Luerssen) ; in England (Sydney 

 Stephenson, Mayou, Juler, Griffith, Thomson); in Scotland, Glasgow (Pollock); in 

 Aberdeen (Usher and Fraser) ; in North America, New York (Weeks, Duane, 

 Hastings) ; in Bridgeport (Dorland-Smith) ; in Chicago (Brown-Pusey) ; in Phila- 

 delphia (Veasey, De Schweinitz, Shumway) ; in Montreal (McKee) ; in Cuba 

 (Santos Fernandez). We have the report of Elmassian that he found it very 

 frequently in Paraguay. Subow found it in Transcaspian Asia ; and, according to 

 De Haan, it occurs also in Java ; McDill and Berry found it in the Philippines, 

 and Perry and Castellani in Ceylon. 



There is no doubt that this infection would be found in many other 

 places if carefully looked for ; perhaps no land or climate is free 

 from it. 



It would, however, be a mistake to consider it as equally distributed 

 everywhere. 



There are many trustworthy observations available, in which, in spite of numerous 

 and expert examinations 1 of large numbers of inflamed conjunctivas, the Koch- 

 Weeks bacillus, during long periods of time, was never found. Gifford (Nebraska, 

 U.S.A.), who found pneumococcal conjunctivitis very often, definitely states that, in 

 his district as opposed to New York, the Koch- Weeks bacillus did not occur. 

 Brown-Pusey reports the same in Chicago. Veasey in Philadelphia found Pneumo- 

 cocci in abundance, and Koch-Weeks bacilli much more rarely. Lundsgaard 

 reports similarly from Copenhagen. Axenfeld never found it in Marburg and 

 Breslau, and only sporadically in Rostock in Polish immigrants, though pneumo- 

 coccal conjunctivitis was common. Hanke only found it exceptionally in Vienna . 

 Bach and Neumann similarly in Wiirzburg. 



We see, then, that in the localities where Koch-Weeks conjunctivitis is observed 

 its frequency varies very much ; after a temporary epidemic period, in spite of its 

 contagiousness, it can remain for a long time in abeyance (e.g., in Hamburg), while 

 in other localities it is endemic, with a constant even frequency (e.g., in Freiburg, 

 where it has never yet been epidemic). We must therefore conclude that its 

 spread, like that of other infectious diseases, depends on particular climatic or 

 other specially predisposing circumstances which have not yet been definitely 

 determined. 2 There are also some striking differences recorded. In one place 

 (e.g., Freiburg) the Koch-Weeks bacillus only causes a very small proportion of the 

 total number of acute conjunctivitis cases, while in other places they are so very 

 commonly associated with this clinical appearance that they were at first designated 

 as the cause of acute contagious conjunctivitis : such is the case in Paris and New 

 York. In Glasgow (Pollock) in 236 cases of acute conjunctivitis 177 were due to 

 Koch-Weeks bacillus. The same is the case in Aberdeen (Usher and Fraser). 



1 It should be noted that the Koch -Weeks bacillus is just one of those organisms 

 which the beginner is liable to overlook if they are not plentiful and well stained in light 

 cells. Diffusely stained preparations must be very carefully examined. Regarding the 

 observers quoted above, we can conclude that they were familiar with the Koch-Weeks 

 bacillus. 



2 See Axenfeld, ' Ergebnisse'; Lubarsch-Ostertag, ' Bakteriologie des Auges.' 



