CONJUNCTIVA IN HEALTH AND DISEASE 109 
Summary of Organisms found in the Diseased Conjunctival Sac 
The varieties of organisms isolated from inflamed eyes do not differ to any 
very great extent from the organisms isolated from healthy eyes. In an individual 
inflamed eye, however, it was very common to find lour or five or even more 
varieties occurring together, whilst from a healthy eye it was very unusual to cultivate 
more than two or three different kinds or organisms. 
After an inflammation of the eye had lasted for a little time, one or other of 
the pyogenic cocci was commonly found in the discharge, and, as a result of 
inoculation in a rabbit's eye and in a guinea-pig subcutaneously, it was found to 
possess considerably more virulence than a similar organism obtained from a healthy 
sac. There is very little doubt, therefore, that the ordinary pyogenic cocci occurring 
in chronic diseases of the conjunctiva contribute in some measure to the severity and 
continuance of the inflammation, and are probably in many cases, particularly in 
chronic conjunctivitis and in chronic trachoma, the only remaining cause of the 
continued inflammation. 
In illustration of the fact that the pyogenic cocci on the inflamed 
conjunctiva possess an added virulence, I will mention a case of suppuration of the 
eye-ball following an operation for cataract. The patient had a little chronic catarrh 
of the conjunctiva with morning discharge, which was treated with antiseptics for 
some time before operation was considered advisable. The inflammation of the 
eye-ball which followed the operation shows how tenaciously suppurative organisms 
adhere to the hypertrophied conjunctiva, and how extremely difficult it is for 
antiseptics to act effectually on every corner of a roughened and pitted membrane. 
From the purulent discharge in this case cultures of B. xerosis and staphy- 
lococcus aureus were obtained. The staphylococcus inoculated on the conjunctiva of 
a rabbit caused a very intense conjunctivitis. 
A fact of aetiological significance is seen in the occurrence of certain organisms 
in the normal conjunctival sac, which, under suitable conditions, may give rise to an 
ophthalmia. B. lacunatus (Eyre), streptococcus longus, staphylococcus aureus, and 
albus, have been met with in the normal conjunctival sac and as causal agents of 
inflammatory processes. It is not improbable that the Koch-Weeks bacillus can 
reside in the healthy conjunctival sac without causing inflammation. 
Organisms Found in the Diseased Conjunctival Sac 
Gonococcus 
Koch-Weeks bacillus 
Bacillus diphtheriae 
Streptococcus pyogenes longus 
Staphylococcus pyogenes aureus 
