SPECIAL FORMS OF CONJUNCTIVAL INFECTION 271 



ulcus serpens. Augustein (loc. cit.), on the other hand, thinks that it 

 is due to an antagonism between trachoma and Pneumococci. 



Whether a true trachoma of the nasal mucous membrane occurs, 

 as claimed by Kiiht and Hoffmann, 1 must remain uncertain as the 

 nasal changes which so often occur in trachomatous persons do not 

 present any special clinical peculiarities. Basso considers that the 

 follicular affections which occur in other parts of the body e.g., in the 

 pharynx have a direct etiological relationship to trachoma. This is 

 very unlikely, although Peters has shown many points of similarity in 

 their histology. 2 



So long as we do not know what is the cause of trachoma, it is 

 manifestly impossible, even in the conjunctiva, to define this disease 

 with exactness, and to determine whether there are abortive cases, as 

 Peters claims, in which follicles are not formed. There is no proof of 

 the existence of these follicle-free cases of trachoma, and with regard 

 to epidemiological questions this hypothesis can for the present be 

 neglected, as experience shows us more and more that an infection 

 with a trachomatous secretion will always cause a follicular affection. 

 In the same way the discovery of the cause alone will show what is 

 the relationship between mild follicular affections of the conjunctiva 

 and true trachoma. This much we know for certain : that many forms 

 of irritation chemical, mechanical, physical, and infectious can lead 

 to the formation of follicles which are not contagious, and have 

 nothing to do with trachoma. 



The so - called ' school follicle ' (' Schulfollikel,' Cohn, Schmidt- 

 Rimpler) is an example of the non-infectious, or rather non-con- 

 tagious, forms of follicle formation; this is very often seen in 

 children of the school age. It occurs without any special irritation, 

 and has often been mistaken for trachoma. Greeff and Mayweg have 

 shown that the introduction of such follicles on to the healthy con- 

 junctiva does not produce any reaction. It appears that the majority 

 of these follicle formations in the conjunctiva are the result of 

 chemico-physical insults (dust, foul air, over -strain, etc.), acting 

 simultaneously on many people, especially school-children, and thus 

 giving the impression of an epidemic affection. Saemisch called this 

 latent form ' folliculosis conjunctivas,' to distinguish it from ' con- 

 junctivitis folliculosa,' in which inflammatory symptoms are much 

 more pronounced in the conjunctiva. With the secretion of a con- 

 junctivitis folliculosa which had developed in a cavalry regiment, 

 Samperi made many inoculations of the human conjunctiva. These 



1 Inaug. Dissert., Konigsberg, 1906. - K. M, f. A., 1902, xl. 1, p. 497. 



