SPECIAL FORMS OF CONJUNCTIVAL INFECTION 173 



different in form and size. On close examination a differentiation may thus be 

 established (cf. Plate C, Fig. III.). (The form of the Zur Nedden bacillus is more 

 like that of the Bacillus xerosis, from which it is distinguished by being Gram- 

 negative). In culture a difference is shown at once, as the Zur Nedden bacillus 

 (like the Bacillus coli) grows freely, as a thick slime, on all ordinary media, does not 

 liquefy blood-serum, and generally behaves quite differently. 



Stock records the pathological examination of the lids in a case of 

 diplobacillary conjunctivitis available for section at the height of the 

 affection. He found considerable hypertrophy of the epithelium in the 

 region of the lid margins and the macerated skin, with development 

 of glandular ingrowths. In the conjunctiva was a widespread 

 infiltration of the mucosa, with enormous numbers of goblet cells. 



Attempts to stain the bacilli on the surface of the conjunctiva were 

 only partly successful in sections. We cannot say how deeply they 

 penetrate into the tissues ; probably they are restricted to the surface 

 of the epithelium. Mayou stated that in this condition it was only 

 the less resistant plasma cells which were multiplied in the sub- 

 epithelial tissues. 



Morax and Petit anatomically examined a fresh ulcerated and 

 perforated leucoma adherens, and found in the infiltrated margin 

 numerous Diplobacilli, which stained best with Nicolle's carbol 

 thionin. 



Paul had the opportunity of examining a non-perforated diplo- 

 bacillary hypopyon - keratitis. The corneal process affected an 

 absolutely glaucomatous eye. The findings were analogous to those 

 of an ulcus serpens, with a progressive border on the one side and 

 epithelial growth on the other. The appearance was so far different 

 from the commonest appearance of a pneumococcal ulcer, in that the 

 floor of the ulcer was deeply infiltrated. Cultures showed the Morax- 

 Axenfeld type of Diplobacillus, which, however, Paul could not find 

 in the sections. 



The treatment with sulphate of zinc (Morax), which has such a 

 beneficial result in these cases, must be continued for weeks in order 

 to obtain healing without recurrence. Several authors (Lundsgaard, 

 Mallet) report that yellow oxide of mercury ointment is especially 

 valuable in many cases. Morax recommended it for the further 

 treatment of obstinate cases. It is remarkable how long a contact is 

 necessary for the zinc to kill the Bacteria (Paul, Silva). A direct 

 specific action therefore does not occur. 



I have been able to demonstrate that diplobacillary hypopyon- 

 keratitis is profoundly influenced by instillations of zinc. This is 

 confirmed by Paul, Erdmann, and MacNab. The contradictory 



