present. What was called ' Egyptian ophthalmia ' was not a definite 

 clinical picture. The records so freely quoted about ships, which, on 

 account of such conditions, could hardly reach port, are much more 

 likely to relate to attacks of acute Koch-Weeks conjunctivitis than 

 to pure trachoma ; similarly the large epidemics breaking out in 

 armies may be explained. The literature on this point requires 

 critical revision. 



From the work of Koch, Kartulis, and Demettriades, and from the 

 more prolonged researches of L. Miiller, Morax, Lakah, and Kouhri, 

 who used every aid available, it is clear that trachoma in Egypt is 

 very commonly associated with gonorrhoaa and Koch-Weeks infection, 

 the latter of which is there almost pandemic, like the trachoma itself 

 (cf. section on ' Koch-Weeks Bacillus '). Diplobacilli are not uncommon ; 

 Pneumococci are the least important. Mixed infections with these 

 organisms are common. It is the gonorrhreal mixture, not the pure 

 trachoma, which causes so much blindness. It is not unlikely that 

 such infections, more or less intermixed with trachoma, were intro- 

 duced by the returning soldiers of the Napoleonic wars, and were the 

 cause of the acute epidemics. The remarkable increase in the fre- 

 quency of this form of catarrh in Egypt during the hot season has 

 already been mentioned (p. 137) ; it varies in North and South Egypt 

 (Meyerhof), and the prevalence of the Gonococcus (July to October) 

 does not coincide with that of the Koch- Weeks (May to July). 



It is naturally quite possible that, in lands where trachoma is 

 endemic, a true trachoma can follow on a catarrhal conjunctivitis (e.g., 

 one due to the Koch-Weeks bacillus), seeing that the catarrh presents 

 a favourable opportunity for the transference of the trachoma virus. 

 The Koch-Weeks bacillus in these cases is not the true cause of the 

 trachoma, as is clearly shown for this organism, and also for others, 

 by the fact that inoculations with pure cultures have never produced a 

 trachoma. 



Gromakowski is opposed to this view ; he attributes the condition 

 to the Koch-Weeks bacilli, which he so commonly found. 



Piringer, and more recently Goldzieher and Hoor, insist that a 

 gonorrhosal infection is capable of producing a trachoma. This cannot 

 be considered as proven, provided that we understand this statement to 

 mean that the gonorrhoeal infection is the direct cause of the trachoma, 

 and not merely that it prepares the way for it. It must be admitted that 

 in many cases the sequence is very striking (Goldzieher, Sattler). One 

 of Hoor's cases is especially noteworthy : ' Gonorrhoeal urethritis, 

 severe unilateral ophthalmo - blennorrhcea, ending in papillary 



