304 BACTERIOLOGY OF THE EYE 



Augstein confirms this, and states that an ulcus serpens with Pneumococci is 

 very rare in trachoma, even in cases with dacryocystitis, although in these patients 

 epithelial defects, both traumatic and spontaneous, frequently .occur. Augstein 

 considers this as proof that trachoma, or rather its causal agent, must have a direct 

 antagonism to the Pneumococcus. His view is not based on adequate grounds. 

 What, then, is the relation between the Pneumococci in the sac and on the con- 

 junctiva and the trachomatous process ? The irregular epidemiological distribution 

 of the affection shows that other factors may possibly be the cause of the infre- 

 quency in Egypt of pueumococcal conjunctivitis compared to other forms of 

 infection. In Italy Gasparrini and others have shown that it is very often 



1 IG. 65. UHTHOFF AND AXENFELD : PNEUMOCOCCI FROM ULCERA SERPENTIA. 

 VARIATIONS IN FORM. 



1, Pus from the infiltrate in a rabbit's cornea after inoculation, showing phagocytes and 

 involution forms ; 2, agar culture (pure) from an ulcus serpens (a) typical Diplococci, 

 (V) involution forms with short chains, (c) pronounced bacillary type ; 3, chain- 

 formation in a bouillon culture ; 4, unusual formation of capsules and chains in agar, 

 type resembling the Streptococcus mucosus. 



a complication of granular ophthalmia. And it is quite possible that vascularity 

 of a pannus and cellular infiltration of the cornea may prevent such infections, and 

 perhaps render them innocuous before they have been able to produce the disease. 



In scrofulous persons with vascularized cornea, as I have twice been able to show, a 

 pneumococcal infection can produce the appearance of a keratitis fasciculosa a snail- 

 track ulcer. This peculiar form of keratitis in scrofula is similar to ulcus serpens 

 in its method of advance in one direction, but differs in the absence of a hypopyon, 

 and in its invariable benign course ; it never takes on a severe destructive character. 

 Both facts can be explained by the great tendency in these eyes to the develop- 

 ment of vessels. A phlyctenule either of the limbus or of the cornea may become 



