152 BACTERIOLOGY OF THE EYE 



Zur Nedden therefore puts aside Jundell's identification, and, after examining 

 and comparing many examples, I thoroughly agree with him in doing so. I 

 must also insist that Koch- Weeks and influenza bacilli can with certainty be 

 differentiated in secretions by their appearance. Zur Nedden considers that ex- 

 perience of both organisms justifies such a diagnosis. Regarding this point, it is 

 worthy of note that Morax, who is both a highly skilled expert on Koch- Weeks 

 bacilli, and has also often examined cases of influenzal conjunctivitis, opposes 

 the identity of these two organisms on the same grounds as does Zur Nedden. He 

 also states that he often found the Koch-Weeks bacillus in Egypt, but never 

 L. Miiller's bacillus. On the other hand, Meyerhof found Miiller's (i.e., the 

 influenza) bacillus frequently on non-trachomatous conjunctivas in Egypt, and con- 

 sidered it to be a harmless parasite. A. Knapp holds the same view. 



Difficulties arise when both occur mixed together ; it is then quite possible that 

 only the more tractable influenza bacilli will grow on a blood medium, and thus the 

 idea of their identity would be confirmed (Plate L, Fig. II., a and c). In cultures 

 the differentiation is more difficult, as many strains of influenza grow in a somewhat 

 longer form. Luerssen also notes these occasional difficulties. 



In the discharges of forty trachoma cases A. Knapp found these bacilli four times, 

 and in the contents of the follicles of eighty cases also four times. He also found the 

 same organism (the influenza bacillus) in a very severe case of pseudo-membranous 

 conjunctivitis in a newly-born infant, in which one cornea was destroyed. 1 All these 

 bacilli were obligate Hsemophiles ( Haemoglobin ophiles) and otherwise typical in 

 morphology and in culture peculiarities. Brown-Pusey has often found them in 

 acute conjunctivitis. 



Jundell appears only to have examined cases in which the conjunctiva became 

 affected during typical febrile influenza. In young people thus affected he found, 

 many cases of conjunctivitis of varying severity, with large numbers of typical 

 influenza bacilli. He did not consider growth on serum a distinctive feature of the 

 Koch- Weeks bacillus, for the same might occur with the influenza bacillus, though 

 far less freely than when ascites and the like were used. Zur Nedden opposes 

 this, and states that it might quite well be the trace of haemoglobin occurring in 

 many human sera which makes such media occasionally able to grow the influenza 

 bacillus ; and, vice versa, when the Koch-Weeks bacillus has grown on blood, 

 it has been on human blood whose proportion of serum had rendered the growth 

 possible. 



Eymowitsch reported that certain bacilli (see Fig. 19, p. 150) which he termed 

 Koch-Weeks bacilli were identical with influenza bacilli in every respect, even 

 with regard to animal inoculation (toxicity in large doses). The bacilli were, 

 however, actually the true influenza organisms. Smitt, Giarre, and Picchi express 

 the same opinion. Morax, Demaria, and M. Neisser recently described influenza 

 conjunctivitis. These authors, as also A. Mayer, Klieneberger, and Tedesco, found 

 influenza bacilli in the conjunctival secretions of patients with measles, though not 

 as a constant condition. 



During 1896 in a small house epidemic of mild follicular conjunc- 

 tivitis, which completely subsided spontaneously, I demonstrated and 

 cultivated influenza bacilli (Plate 1., Fig. II., b). 



The more carefully I have examined for them since, and the more 

 exact the methods used, the more frequently have I met with them. 

 In my experience they are fairly frequent in the lacrymal sac, though 



1 Doetsch had already found the influenza bacillus three times in purulent keratitis in 

 adults ; this finding has been lately repeated in one case by Zur Nedden. It is rare. 



