NOTES ON CONTAGIOUS OPHTHALMIA. 307 



* The treatment for the cases of infection with the Gram-positive 

 organism which has been described should be on the same lines as that for 

 an infection with a Eoch-Weehs bacillus. 



However, if the causal organism prove to be the Morax-Axenfeld 

 bacillus, I have found in most of my cases that silver nitrate is worse 

 than useless and only tends to aggravate the inflammatory condition. The 

 treatment which usually gives the best, in fact almost specific results, is 

 sulphate of copper in 0.25 per cent solution. The solution is best applied 

 with a small cotton-wool mop, and the application should be less frequent 

 as the discharge diminishes. 



We now come to the subject of granular conjunctivitis or trachoma, 

 which is sometimes known as Egyptian or military ophthalmia. This 

 disease is of very wide distribution and frequently leads to very serious 

 results. Its contagious character has been proved many times by inocula- 

 tion experiments and in all such cases the early symptoms resemble those 

 of catarrhal ophthalmia. 



As its contagious character is well recognized, it follows almost certainly 

 that the infecting element is a microorganism. At different times for 

 the last fifteen years many bacilli have been described, but the correct 

 solution has not yet been found. Several spirochetal have been found 

 on the conjunctival surface, but these occur in other irritative conditions 



and are probably only saprophytic. 



• 

 During the last two years Greeff and Prowazek working independently in 

 Germany, and a medical committee of two in Iowa, have discovered in trachom- 

 atous cells certain minute bodies now known as "trachoma bodies." It is pos- 

 sible that these may be the specific cause of the disease. They are slightly ovoid 

 and smaller than any known cocci. They have been found in the contents pressed 

 out from the follicles, in desquamated epithelial cells and in the actual tissues. 

 They occur massed together near the cell nucleus, and appear to be encapsulated. 

 The capsule enlarges, causing the rupture of the cell and the discharge of the 

 granules. Whether the organism occurs in the epithelium, in the lymphoid 

 follicles or in the fibro-adenoid layer, the resultant toxic effects are most marked 

 in the adenoid layer of the tarsal conjunctiva and the retrotarsal folds. 



The symptoms are usually as follows : There is a preliminary, acute 

 congestion of the conjunctiva. Very soon small, gray spots rather smaller 

 than a pin's head in size appear in the tarsal conjunctiva of the upper lid. 

 These have been called by Von Graefe "primary granulations," but if 

 there is much congestion accompanying the conjunctivitis, they may 

 be obscured. Translucent "sago-grain" granules speedily form in the 

 culdesac and palpebral conjunctiva. The plica semilunaris and caruncle 

 are congested and chemosis may be present. There is intense photophobia 

 and considerable discharge. After a week or two the acute condition 

 passes into a chronic state, which is often highly intractable. The chief 

 sequelss (and these together are pathognomonic) are (a) corneal ulcera- 



