306 BROOKE. 



generally distributed, as in the case of the infection with the Koch-Weeks 

 bacillus, but Doctor Ealtray found in his cases two instances of angular 

 conjunctivitis. 



The symptoms of catarrhal ophthalmia call for little remark, and their 

 severity will vary in many cases. There is intense infection of the con- 

 junctiva;, more or less oedema of the tissues and eyelids, lachrymation and 

 mucopurulent discharge. There is a pricking and burning feeling and 

 photophobia in the worst cases. As a rule, the pain is slight. The 

 lymphoid follicles may, or may not be elevated. Normally, these follicles 

 are found scattered in the subepithelial tissue of the conjunctival reflec- 

 tions, and become widely developed in inflammatory conditions. If they 

 become prominent they are then easily visible to the naked eye, but it is 

 highly important not to mistake them for the large "sago-grain" pro- 

 minences of granular ophthalmia. 



All forms of catarrhal ophthalmia appear to be highly contagious. 

 Both eyes are usually attacked, either simultaneously or within a short 

 time after each other. If untreated, in quite a large number of cases 

 marginal corneal ulcers occur which frequently coalesce and involve 

 considerable areas, and this is a serious Eastern scourge. 



Iritis is a less common sequela. 



With regard to the treatment of catarrhal ophthalmia, there are several 

 points of interest. The condition usually yields' to treatment in one to 

 two weeks, although it occasionally tends to become chronic, especially 

 if the treatment has not properly been carried out. The essentials consist 

 in (a) removing the germ by medication; (b) taking care of the cornea; 

 (c) maintaining the patient's health. 



When a case is first seen a smear should be taken for diagnosis, as this 

 will make all the difference when choosing the drug for treatment. The 

 cornea should be thoroughly examined and continually watched. If the 

 specific organism proves to be the Koch-Weeks bacillus, I have found 

 that silver salts give the best results in treatment. Protargol and argyrol 

 cause less pain than silver nitrate, but their effect is not so good. As a 

 rule I give a few drops of silver nitrate in a strength of 0.438 gram to 

 100 cubic centimeters of water (2 grains to the ounce). The strength 

 should never be more than 2 per cent, or sloughing of the lids and 

 opacities of the cornea may result. Frequent irrigations with boric acid 

 will also be necessary to free the eyes from discharge. No bandage should 

 ever be used, but the eye should be protected by a suitable shade. 



A little weak oxide of mercury ointment should be applied to the 

 margins of the lids to prevent their sticking together. If corneal ideers 

 occur, the treatment should be even more careful and atropine may be 

 given. With corneal necrosis, eserin, 0.438 gram to 100 cubic centi- 

 meters of water (2 grains to the ounce) will help to stimulate the 

 tissues. Nourishing food and tonics are indicated. 



