132 THOMPSON YATES LABORATORIES REPORT 
Thermal death point. — About 60° C, exposed for 10 minutes. 
Anaerob'mh. — It is an obligate anaerobe. 
Clinically it is impossible to diflferentiate the various diseases manifesting themselves in the 
acute affections of the conjunctiva. A correct diagnosis can only be arrived at with the aid of the 
microscope. By examination of numerous acute discharges it is certain that the bacillus first 
discovered by Koch, and afterwards more fully described by Weeks, is capable of exciting quite 
as acute an inflammation as the gonococcus. In many cases in which the Koch-Week's bacillus 
was the only organism discoverable the eye condition closely resembled that of gonorrhoeal 
ophthalmia. The quality and quantity of the discharge and the severity of the inflammation are 
not, therefore, certain guides to a diagnosis of acute inflammations of the eye. Acute inflammations 
of the eye are, undoubtedly, caused in many cases by gonococcus infection ; but a diplococcus, 
exactly resembling gonococcus, has been found in acute discharges and enclosed in leucocytes, 
which stains by Gram's method. 
The causal agent of muco-purulent catarrh is almost invariably the Koch-Week's bacillus; 
the discharge in the more acute cases showed great numbers of the bacillus enclosed in leucocytes. 
With a decrease in the severity of the symptoms the number of leucocytes containing the bacillus 
becomes less. 
In a true case of granular lids with a very small amount of discharge there are few 
organisms of any kind present. When a case of trachoma suddenly develops acute symptoms, the 
Koch- Week's bacillus is found in large numbers and enclosed in the leucocytes of the discharge. 
The organisms that mainly occur, such as staphylococci, xerosis bacillus, &c., when inoculated in 
healthy human eyes do not seem capable of exciting any morbid process. The sudden development 
of acute symptoms, and the presence of the Koch-Week's bacillus in large numbers in the 
discharge, is strong evidence that the acute symptoms are due to the virulent action of this bacillus. 
This development may be due to a separate infection, or to an access of virulence in an already 
existing microbe. That the microbe does exist in granular lids with very scanty discharge has 
been proved by the microscope. The tlieory of separate infection must not be disregarded, since 
the conditions for the development of muco-purulent catarrh are distinctly more favourable in a 
lid disorganised by granulations than in a previously normal one. 
The well-known infectivity of trachoma, and its occurrence in crowded communities, 
suggest that it is due to some irritant easily conveyed from person to person ; this irritant must be 
some bacterial organism. 
Authorities differ as to the presence of microbes in the granules. Sattler and Michel 
obtained from the contents of a granule a biscuit-shaped coccus, occurring in pairs, to which they 
ascribed the granular condition ; Kartulis failed to demonstrate the presence of any organisms ; 
Shongolowicz in 26 cases of trachoma (? discharge) found a short bacillus not previously 
described. In specimens obtained from the Workhouse Infirmary a slender bacillus has been 
observed in the tissues. 
A granule is a chronic inflammatory nodule consisting of small round cells and delicate 
fibrous tissue ; it ultimately becomes converted entirely into cicatricial tissue. The granular 
