350 DISCUSSION. 



are about 4,000 native laborers employed there in building emplacements 

 for artillery, and during the last year and a half about 1,000 cases of 

 conjunctivitis have occurred. As many of these men have been sent 

 away incapacitated, it is probable that they are spreading infection in 

 their native towns. 



We have seen 25 cases of this disease, all presenting severe generalized 

 injection of the bulbar and palpebral conjunctiva. In several cases 

 there were ulcers of the corneal periphery, and in one a large ulcer on 

 the inner surface of one upper lid. The discharge was mucopurulent 

 and never of great amount. Smears were taken in 12 cases and in 

 each one the Koch-Weeks bacillus was demonstrated, sometimes in large 

 numbers. Cultures made on human (Filipino) serum agar gave in 

 four cases a mixed growth of staphylococci and bacilli conforming in 

 size and shape to the Koch- Weeks bacillus. We were not able to obtain 

 a pure culture. Other observers in the Islands have at times demon- 

 strated the Koch- Weeks bacillus in smears from the eye, and it is probably 

 a common and important cause of conjunctivitis here. Major Euther- 

 ford, who treated several cases of this disease at the Division Hospital, 

 found argyrol promptly effectual. Isolation is very important, as the 

 disease is extremely infectious, the spread probably being mainly by 

 direct contact and by infected droplets expelled from the mouth and nose. 



Doctor Atkinson. — I Was very much interested in Doctor Brooke's 

 paper, especially as the presence of trachoma occurring among Chinese 

 emigrants leaving Hongkong has been a very vexed question. I refer 

 especially to those proceeding to the ports of the United States. I was 

 glad to hear the confirmatory conclusions of Doctor Brooke, that trachoma 

 is a distinctly rare disease among the Chinese emigrants at Singapore. 



The presence of a Gram-positive organism in many of the cases, distinct 

 from the Koch-weeks bacillus, is also worthy of note. I would like to 

 ask Doctor Brooke whether this is easily seen in a smear of the conjunctival 

 discharge, in other words, the technique of finding it. 



Doctor Strong. — I would like to ask Doctor Brooke and any others 

 present who have studied epidemics of conjunctivitis in tropical countries 

 from a bacteriologic standpoint, as to whether they have encountered 

 the Bacillus xerosis in any of their cases ? In 1900 I studied in the First 

 Beserve Hospital in Manila a number of cases of conjuctivitis from 

 which Bacillus xerosis was isolated. This organism is easily cultivated. 

 Inoculation of animals with the Gram-positive organism described by 

 Doctor Brooke might aid in elucidating the nature of the organism. 



Doctor Castellani. — I think Doctor Brooke should be congratulated 

 on his interesting address. Sir Allan Perry and myself, in the last four 

 years in Ceylon, have investigated a large number of cases of conjuncti- 

 vitis among the natives and Europeans. In some cases we observed the 

 Koch-Weeks bacillus, which we found most difficult to cultivate. In 



