262 BACTEBIOLOGY OF THE EYE 



A. Knapp, and Meyerhof, and the general opinion is that such cases 

 are secondary infections, and that after their subsidence the trachoma 

 will again quietly appear, or develop independently. Such mixed 

 infections, especially with the Koch-Weeks bacillus, the Pncumococcus, 

 and the Gonococcus, give trachoma the appearance of an acute catarrh, 

 though such is not its true nature. In different places the nature 

 of the secondary infection varies, and with it also the severity of the 

 secondary catarrh. De Lietro-Vollaro found the Diplobacittus very 

 frequently in Naples, Gasparrini found the Pneumococcus in Siena, and 

 Rymowicz the same organism in Kasan. In the large series of cases 

 collected by Lakah and Kouhri (1902) in Egypt, this last organism, in 

 proportion to the Koch-Weeks bacillus and the Gonococcus, was not so 

 common. Meyerhof has lately written to me that he found (1906) the 

 Diplobacillus in 20 to 30 per cent, of all the trachoma cases in Cairo. 

 The conditions may have changed in this respect. 



Recent work on this subject has shown that acute trachoma is a 

 disease which begins acutely with profuse secretion, and in the majority 

 of cases is not a pure trachoma, but a mixed infection with an acute 

 catarrh. Only a few authors (Saemisch, Peters) report that the acute 

 onset of trachoma without the presence of conjunctivitis organisms 

 occurs freely in their districts. Uncomplicated trachoma most 

 generally begins and continues insidiously. Simple harmless con- 

 junctival follicles, such as are often found in school-children, may give 

 the impression of trachoma when they have associated with them an 

 acute catarrh e.g., a pneumococcal 1 or a Koch-Weeks infection. If 

 we wait till the acute catarrh has subsided, it is then obvious whether 

 a trachoma is present or not. 



An examination of the secretion is therefore indispensable, and it is 

 only when such infections have subsided that an opinion can be formed 

 with regard to the nature of the follicles. 



It is because of the frequency of this associated acute catarrhal 

 infection that relatively to Europe, trachoma in Egypt is more 

 commonly of the acute ' watery ' type. There is no proof that at the 

 commencement of the previous century pure trachoma presented 

 clinical features at all different from those which we see at the 

 present day, although it may have shown a more ' blennorrhoeal ' 

 course. 



There is no proof that some of these secondary infections were not 



1 In the case of the conjunctiva, the occurrence of an ' antagonism ' between trachoma 

 and the Pneumococci, such as is stated by Augstein to occur (Z. f. A., 1906, xvi. 243) in 

 the cornea (cf. section on ' Keratitis '), cannot be proved. 



