Part I 
THE NORMAL FLORA 
The results given in this section are based upon an examination of 210 cases, 
in which the conjunctiva was apparently healthy. The material tor this purpose has 
been collected chiefly in the out-patient department of the Liverpool Royal Infirmary 
from persons suffering from some refractive error or other disease not affecting the con- 
junctival mucous membrane. A few of the cases were taken from amongst my 
colleagues in the laboratory, and from the wards of the Liverpool Parish Infirmary, 
these latter being mainly children. 
In collecting this series an endeavour has been made to include individuals 
differing as much as possible in age, sex, social position, and environment. 
Whilst it is obvious that the number and character of the organisms 
temporarily inhabiting the conjunctival sac will depend largely upon the number of 
bacteria in the immediate neighbourhood of the individual, a more potent cause of 
contamination will be found in neglect of personal cleanliness. Dirty fingers, face, 
etc., are more likely to infect the conjunctiva with pyogenic cocci than the atmosphere, 
and these cocci will in all probability possess more virulent properties. It might be 
expected that the number of pyogenic cocci would vary in inverse ratio to the clean- 
liness of the individual and his surroundings. My cases have shown this expectation 
to be well founded. 
Great care has been exercised in the selection of the cases. All those giving 
a history of 'gumming ' of the lids in the morning, or sensation of grit in the eyes, 
etc., being discarded, as well as those showing abnormal redness or other apparent 
sign of disease. 
The method adopted in each case was as follows : — The lower lid was everted, 
and the conjunctiva gently stroked with the loop of a sterilized platinum wire, until 
the loop had become charged with lachrymal fluid. A serum tube was inoculated by 
smearing the fluid evenly over the surface, and incubated at 38°C. 
It was occasionally very difficult to obtain even a loopful of lachrymal fluid 
but slight mechanical stimulation generally sufficed to produce a free flow of tears. 
The platinum loop was used principally on account of its convenience, and because 
it was thought that the organisms in the sample would be sufficiently representative 
of the total bacteriology of the sac. 
In some of the cases a sterile cotton-wool swab was used. With this the 
whole of the lower conjunctival fornix was swabbed out, and after being rubbed well 
over the surface of serum the swab was placed in broth. 
Although this method may remove from the sac a greater number and variety 
of organisms, it is open to some objection in that in the operation of smearing over 
