SPECIAL FORMS OF CONJUNCTIVAL INFECTION 267 



When the Miiller bacillus occurs in a case of trachoma, it appears 

 that we have to deal with a mixed infection. The relations to the 

 Koch- Weeks bacillus are given in the chapter relating to that 

 organism. L. Miiller himself admits that there is no definite proof 

 of an etiological significance for his bacillus. 



The opinion held by True, Cazalais, Gromakowski, and Back that, 

 in people with a predisposition (lymphatic persons), any irritation, 

 continued for a long enough time, can lead to trachoma, must 

 be considered as highly improbable. The large experience which 

 we have collected with regard to conjunctivitis points in exactly 

 the opposite direction. This is beautifully shown in the case of diplo- 

 bacillary infection. This eminently chronic affection can exist for 

 years, even in scrofulous persons, without giving rise to the slightest 

 sign of trachoma. When, in trachomatous districts, it is associated 

 with a trachoma, there is no demonstrable etiological connexion 

 between the two conditions. 



Everything is in favour of trachoma being a specific infectious 

 disease, the cause of which is not yet determined. Under this name 

 we should not include every case of follicle formation, but only those 

 granule formations in the conjunctiva which, in typical cases, begin 

 insidiously, and finally fill the whole conjunctiva with granulations, 

 gradually leading to scarring, and very often to the well-known 

 pannus trachomatosus. 



Though we still find persons opposed to the contagiousness of this 

 disease, it is established beyond all doubt. There are positive inocula- 

 tions (Sattler) to prove it. Addario and Greeff transferred trachomatous 

 excised follicles into the scarified conjunctiva of blind persons. In three 

 or four days the hypersemia began, and after about eight days the 

 infiltration; the inflammation passed to the other side. By rubbing 

 fresh trachomatous material into the conjunctiva of apes, Hess and 

 Eomer produced a dense formation of follicles. (This inoculated 

 affection could be transferred to a second ape for six to seven weeks, 

 but not later.) When the affection spread to the other eye no follicles 

 formed there, but microscopically a few granules were to be seen. No 

 reaction was produced by the Berkefeld filtrate of ground-up material, 

 which acted vigorously on direct inoculation. When the ground-up 

 material is heated to 58 to 63 C. no infection results. Every attempt 

 made by these authors to stain Bacteria or Protozoa was fruitless. 

 Scar formation and other complications have not yet been observed in 

 these animals. Bajardi reports positive inoculations in the Macacus 

 and Cercopithecus. He either planted a piece of trachomatous tissue 



