160 BACTERIOLOGY OF THE EYE 



numerous cases could be shown them in the hospitals of their imme- 

 diate neighbourhood ; they had simply overlooked the very plentiful 

 slight cases. 



People of every age are affected, even new-born babies (Andrad, 

 Callomb) adults most commonly. In negroes Brown-Pusey observed 

 severe acute conjunctivitis, almost like a blennorrhcea. No special 

 personal disposition has been observed. A seasonal variation has so 

 far been observed in that it is more plentiful during the hot and dusty 

 seasons of the year (Gonin). This can be seen in my own material. 

 Infection occurs by direct or indirect transference of the secretion. 

 According to Biard and Erdmann, the nasal mucus of apparently 

 healthy people can contain the bacilli and act as a means of infection. 



Clinical Appearances. 



Morax gave the affection the name of ' conjonctivite subaigue.' At 

 first I called it ' chronic diplobacillary conjunctivitis,' as the untreated 

 disease appeared to last for years. When later I observed acute cases, 

 the name 'diplobacillary conjunctivitis' seemed generally more 

 preferable. Since then the name 'diplobacillary conjunctivitis' of 

 Morax or of Morax-Axenfeld has generally been used. 



As in the case of the other infectious forms of conjunctivitis, so 

 here : it is generally agreed that there is a marked tendency towards 

 a characteristic clinical appearance a blepharo-conjunctivitis. 



Putting aside the rare cases of acute onset, 1 diplobacillary conjunctivitis com- 

 mences with a slight catarrh, and almost always affects both eyes, though not 

 necessarily at the same time ; the second eye is often less severely affected. 

 During the night especially a moderately profuse greyish-yellow and rather sticky 

 secretion collects, mostly at the inner canthus. The lid margins become red, very 

 obviously so at the angles, especially the inner. This redness of the inner angle, in 

 comparison to the mild character of the conjunctival changes, often appears very 

 marked ; in cases with a profuse secretion it takes the form of a large round patch 

 surrounding the caruncle. The reddened skin is as a rule moist, slightly macerated, 

 and often covered with a white scum like an intertrigo. According to the old 

 symptomatic classification this was called by many ' ophthalmia angularis. ' 



The mucous membrane of the lids generally shows a very slight swelling, with a 

 hyperaernia chiefly affecting the parts adjacent to the lid margins and the fornix; 

 the bulbar portion appears less affected ; the superficial vessels are slightly injected 

 in the region of the canthi. Phlyctenules are rare, and only occur when scrofulous 

 persons are affected, especially children. For such scrofulous subjects treatment by 

 zinc is often especially valuable, preventing recurrences which otherwise defy treat- 

 ment. Corneal complications first develop in the form of small superficial marginal 

 infiltrates of the so-called ' catarrhal ' type. Morax, Biard, and Peters observed single 

 cases, and Petit studied them more fully. He often found the Diplobacillus in the 



1 Of. Tooke, Brown-Pusey, Duaue, Pollock, Zur Xedden, McKee. 



