SPECIAL FOKMS OF CONJUNCTIVAL INFECTION 261 



SECTION 9. TEACHOMA. FOLLICULAE CONJUNCTIVITIS. 



The cause of trachoma is still quite unknown ; neither in the secre- 

 tions nor in the contents of the follicles 1 have any microbes been 

 demonstrated which can be considered to have a causal significance. 

 Even the most modern methods of staining have failed to give any 

 positive result. The latest results of Halberstaedter, Prawoczek, and 

 Greeff regarding the presence of very small granules do not furnish 

 any explanation. 



Halberstaedter, Prawoczek, and Greeff report that by means of the 

 Giemsa stain, they have recently found fine red-stained granules. In 

 many of the epithelial cells these granules coalesce and form bodies 

 which cover the nucleus like a cap. Prawoczek states that they are 

 certainly parasitic, and called them Cldamydozoa ; Greeff is more 

 reserved upon this point. For the present we must consider it doubtful 

 whether these granules are parasitic in- nature or not, and further 

 research is necessary before we can say whether they occur so 

 regularly in trachoma that they can be considered as of diagnostic 

 value. The orang-outangs inoculated by Halberstaedter and Pra- 

 woczek did not show any enlargement of the conjunctival follicles, 

 as did those of Hess, Eomer, and Bajardi ; contagiousness was 

 presumed from the fact that the granules occurred in the epithelium 

 of the inoculated orang-outangs, a conclusion which is by no means 

 certain. 



Meyerhof examined fresh cases of trachoma for the Spirocluehe by 

 means of the Giemsa stain, and Stock examined sections by means of 

 the silver methods ; neither found anything definite. The ordinary 

 saprophytes alone are commonly found, in some cases mixed with 

 the common conjunctivitis-organisms ; it is, however, quite certain that 

 these latter are not capable, even after prolonged activity, of producing 

 a true trachoma, with scar formation and pannus. 



This must be admitted, even though the common conjunctivitis 

 organisms are found in large numbers in trachomatous secretion,' 2 

 especially from the profusely secreting cases. This question has lately 

 been discussed by Kartulis, Demettriades, Gasparrini, L. Mtiller, 

 Kuhnt, Zur Nedden, Greeff, Junius, Axenfeld, Osborne, Morax, 



1 Iu order to divide the follicular material as finely as possible for purposes of culture, 

 Morax ground it up with sterile quartz sand ; he used every conceivable human medium, 

 but without result. 



2 According to Mayou, trachoma secretion, in the early stages, contains more plasma 

 cells than does that of any other form of conjunctivitis. Even in the tissues enormous 

 numbers of plasma cells lie around the follicles. 



