(159) 



400 C. GORDON HEWITT. 



Dr. Andrew Balfour, of the Gordon College, Khartoum, in a 

 letter to me, says that the Koch-Weeks bacillus is generally 

 recognised as being the exciting cause of Egyptian ophthal- 

 mia. He says, " Ophthalmia is not nearly so common in the 

 Sudan as in Egypt, nor are flies so numerous ; doubtless the 

 two facts are associated/'' Dr. MacCallan, of the Egyptian 

 Department of Public Health, in answer to my inquiries, says 

 that acute ophthalmias are more liable to transmission by 

 flies than is trachoma. In his opinion the spread of the 

 latter is, to a comparatively small extent, through the agency 

 of flies, but it is mainly effected by direct contact of the 

 fingers, clothes, etc. 



The Koch- Weeks bacillus was first seen by Koch (1883) in 

 Egypt in cases of acute catarrhal ophthalmia. He found that 

 two distinct diseases were referred to under the name ; in the 

 severe purulent form he found diplococci, which he identified 

 as very probably Gonococci; in the more catarrhal form he 

 found small bacilli in the pus-corpuscles. He ascribed the 

 propagation of the disease to flies, which were often seen 

 covering the faces of children. Axenfeld (1908) states that 

 " almost the only organisms occurring in acute epidemics 

 of catarrhal conjunctivitis are the Koch-Weeks bacillus 

 (perhaps also influenza bacillus), and the pneumococcus (in 

 Egypt the gonococcus also, rarely subtilis). Other 

 pathogenic conjunctival organisms 1 only exceptionally occur." 

 And, further, <c Gonococci and Koch- Weeks bacilli evi- 

 dently lose their power of causing a conjunctivitis very slowly 

 indeed, and are very independent of any disposition." His 

 statement that, "on account of their great virulence and the 

 marked susceptibility to them, a very small number suffices," 

 is important in considering the relation of flies to the spread 

 of the disease, although, as he remarks, every infection does 

 not produce the disease. The fact that the Koch-Weeks 

 bacillus cannot resist dry ness cannot be urged as an argument 



1 In this connection he states (p. 236) : " We can make the general 

 statement that the staphylococcus in the conjunctiva is not conta- 

 gious.' 



