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BROOKE. 



tion and pannus leading to opacity; (6) formation of scar tissue, leading 

 to entropion and trichiasis; (c) conjunctival xerosis and shrinking. 



Thus it is seen that the disease is highly contagious, very chronic and 

 leads to grave results. It has frequently 'been said that trachoma is 

 extremely common in the East. My experience with over 2,000,000 

 coolies, chiefly from ports of southern China, has not supported this 

 belief. My series last year showed a percentage of only 5.1 to be trachoma. 

 In order to check this result, I looked up the records of the general and 

 pauper hospitals in Singapore, for several years, which disclosed the 

 following : 



Conjunctivitis. 



Date. 



Catarrhal 



and 

 puralent. 



Granular. 



1903 -_ ... 



122 



OS 



6 



229 



117 



Nil. 

 Nil. 

 Nil. 



2 

 "21 



1904.- 



1905 -_ - _ 



1906 



1907. _ . 





» Also a high total of M at quarantine station. 



These figures seem to support the other results. 

 The modes of treatment are multjdinous. 



1. The best results seem to be secured by — 



(a) Expressing the follicles with a flat Grady's forceps or the roller forceps 

 of Knapp. This is best done under an anesthetic. 



(o) Painting the ruptured surface with a little bichloride of mercury. 



(c) After a day or two the daily application of solid sulphate of copper should 

 be begun and continued until all traces of hypertrophy have vanished. 



The various other methods of treatment have been advocated as (2) Gale- 

 zowski's excision of retrotarsal folds ; ( 3 ) Kuhut's removal of tarsus ; ( 4 ) Merck's 

 extract of abrin (sequiritol) ; (5) X rays, introduced by Mayon in 1902; (6) 

 radium, tried by Treacher Collins in 1904. 



However, none of these methods has been as successful as the first 

 mentioned. Cases are frequently eventually cured, but seldom in less 

 than several months, often years. 



In conclusion, and to summarize the main points brought out by my 

 series of observations : 



1. The percentage of infections with the Koch- Weeks bacillus was 

 much higher than is usually supposed to be the case. 



2. A Gram-positive organism was not infrequently met with. 



3. The first stage of trachoma is an acute catarrhal ophthalmia, the 

 importance of which should not be overlooked. 



4. Trachoma would seem to be somewhat more rare in southern China 

 and Malaya than has generally been thought to be the case. 



