SPECIAL FOKMS OF CONJUNCTIYAL INFECTION 139 



people. Eecurrences very often do take place and at short intervals (Morax, Usher 

 and Fraser, Meyerhof). 



Although slight cases often heal rapidly, then: duration is not necessarily less 

 than that of the severe ones. 



According to L. Mtiller, there is a tendency in Egypt for the catarrh to be less 

 acute in those adults who have trachoma scars (Meyerhof contends that such is not 

 the case when gonorrhoea is superimposed on trachoma). In adults generally the 

 catarrh is milder in type. Sydney Stephenson states that in adults there is a ten- 

 dency for the conjunctiva bulbi to be more involved, and to be haemorrhagic. In 

 very severe cases at first the appearance is very like that of a blennorrhrea, 

 although no Gonoccocci are present; the cornea, however, is rarely involved to 

 a severe extent. The conjunctiva may become covered with a pseudo-membrane, 

 and the pre- auricular gland be greatly swollen. Peripheral corneal infiltrates occur 

 in the severe but infrequent membranous cases, and it is in this class that L. Miiller 

 would put the Egyptian ' conjoncUvite suraigue.' The corneal complications are 

 not necessarily due to mixed infections, as Weeks formerly thought, but can be 

 caused by the Koch- Weeks bacillus. Morax once recorded the simultaneous 

 outbreak of a herpes zoster frontalis. 



The disease first affects one eye, but almost always becomes double-sided, unless 

 prevented by treatment. 



The general health is only disturbed in very severe cases from pain and sleepless- 

 ness. Fever symptoms and such-like have not been described. A slight cold in 

 the head occurs during the affection, but the deeper parts of the naso-pharynx are 

 not affected (Morax). 



The Examination of the Secretions. 



The very fine, slender bacilli are found, often in large numbers, 

 daring the onset and at the maximum of the affection ; they can be 

 seen, too, in the chronic cases. The organisms lie in and between 

 the leucocytes. Of these latter, the large polynuclear predominate, in 

 contrast with the rarer large or small mononuclear, and the very rare 

 eosinophile and basophile cells (Mayou). When the bacilli are free 

 they tend to lie in clusters, but are also commonly found singly. The 

 phagocytes generally occur in large numbers, and we often see in each 

 field numerous cells which are packed full of bacilli. 



The bacilli resemble those of mouse septicaemia, and to some extent 

 too, those of influenza. They are, however, longer and thinner than 

 the latter. Their length varies : some are not much more than 0*5 

 to 1 /j, long ; others are longer, up to 2 //,. The latter resemble long 

 filaments. The short bacilli tend to occur in pairs, and even form 

 short chains ; sometimes there is a suspicion of polar staining. The 

 ends of the rods are slightly rounded. The breadth of the bacilli is 

 very constant ; they are extremely slender. Their relative positions 

 with regard to each other vary. 



The bacilli completely and rapidly decolorize in Gram's stain. They 

 stain best with very dilute carbol fuchsin (ten minutes), Nicolle's 



