162 



Biard's statement that the Diplobacillus very often occurred in the nose, and from 

 thence infected the conjunctiva, was not at first confirmed (Morax, Petit, Zur 

 Nedden). The fuller researches of Erdmann have shown that the bacillus can be 

 very often found in the nose, not only in persons who have a blepharo-conjunctivitis, 

 but also in those whose conjunctiva is healthy. Seeing that the cultural and other 

 characteristics of the bacillus obtained from the nose are identical with those of the 

 organism from the conjunctiva, and inoculation on the human conjunctiva produces the 

 same conjunctivitis, Erdmann's results cannot be doubted. In the nose he found 

 typical Diplobacilli without capsules 64 times in 142 persons whose conjunctiva! 

 secretion contained no Diplobacilli. In 26 of these cases cultures were made, and 

 18 of them showed the typical Morax-Axenfeld Diplobacillus. The fact established 

 by Erdmann that, after a diplobacillary conjunctivitis has healed, the bacilli may be 

 found for weeks in the nose is important regarding the question whether these 

 organisms can have a pathogenic action in the nose, and there multiply and persist. 

 Only a few of Erdmann's cases had a chronic rhinitis ; the majority had a healthy 

 nasal mucous membrane. Erdmann introduced some of the secretion from one of 

 these clinically healthy membranes where the conjunctiva, too, was free from 

 I)iplobacilli into the normal conjunctiva, and produced a typical conjunctivitis. 

 Cultures showed also that in the dried nasal secretion the Diplobacilli were still 

 living after seven days. 



It is worthy of note that Treacher Collins found the Diplobacillus 125 times in 

 the nasal secretions of 300 school- children who had a nasal discharge as well as 

 a conjunctivitis. He considered that the eyes were often infected from the nose, 

 and recommended that the nose should be examined and treated in school 

 epidemics. 



Many cases of diplobacillary conjunctivitis must result from infection with the 

 nasal secretion, and the suggestion of Gifford and Collins that the nose should 

 be treated is quite rational. 



The subjective symptoms are comparatively slight, even in the acute cases. 

 Peters states that headaches sometimes accompany this infection, and cease when 

 the conjunctivitis is relieved. 



The Secretion. 



In slight cases the amount of secretion is so small that no actual 

 flakes can be found ; in such cases a greyish slime occurs on the 

 caruncle. Although this angular secretion is very freely contaminated 

 with skin saprophytes, and should not be used for cultures, it gives 

 the slide diagnosis with special clearness, because the Diplobacilli 

 occur in it in great numbers, sometimes in enormous profusion. 



They either appear free or else attached to cells, especially 

 epithelial cells, which are numerous in such a secretion, and may 

 appear absolutely covered with the organisms. A true phagocytosis 

 is rarer in these cases than in Koch-Weeks or pneumococcal con- 

 junctivitis. The secretion, in fact, consists more of fibrin, and is poor 

 in leucocytes. 



The bacilli mostly lie in pairs, but longer or shorter chains occur, 

 the bacilli being then plumper and arranged in coils, though a 

 tendency for each adjacent pair to lie closer together can be noted. 



