CONJUNCTIVA IN HEALTH AND DISEASE 119 
Conclusions 
That the normal conjunctival sac contains organisms in a large proportion of 
cases. 
That pyogenic organisms are only occasionally found in the normal sac, and, 
when they do occur, have to some extent lost their virulence. 
That pyogenic organisms obtained from the inflamed conjunctiva are usually 
considerably more virulent than similar organisms obtained from the healthy 
conjunctival sac. 
PREVIOUS WORK 
Only within the last few years has any important work contributed to our 
knowledge of the bacteriology of the normal conjunctival sac. All investigations 
have been made to determine the frequency and pathogenicity of the pyogenic cocci 
and the percentage of sterile sacs. 
Morax" believed that the normal conjunctival sac was never sterile. He 
pointed out that pathogenic organisms are rarely found, and in a series of cases 
examined by him he never found a staphylococcus aureus or a streptococcus. 
Fick 5 , in forty-nine observations, found the sac sterile six times, and in another 
series of fifty found the sac sterile thirty-six times. He isolated various bacilli which 
he had some difficulty in identifying ; he also isolated staphylococcus aureus, 
micrococcus candicans, streptococcus and sarcina lutea. 
Gasparrini states that the micrococcus of pneumonia is found in a large 
proportion of healthy eyes. He injected fresh cultures into the anterior chamber or 
vitreous of rabbits producing panophthalmitis, and a plastic iritis and atrophy of the 
eye with older cultures. 
Fraenke 6 found the healthy sac sterile in twenty-eight per cent, of his cases, 
the staphylococcus aureus or albus occurring ten times out of one hundred and fifteen 
examinations. He was unable to cultivate the xerosis bacillus, whilst Fraenkel and 
Uhthoff state that it is frequently present in normal eyes. 
Widmark 13 brought forward experimental evidence that the pus organisms 
when introduced into the conjunctival sac of rabbits did not produce catarrhal 
inflammation. On the other hand, when inoculated into the cornea an intense 
conjunctivitis resulted, together with keratitis and perforation of the cornea in fifteen 
per cent, of the cases. 
Leber and Weeks obtained no result by inoculating staphylococcus aureus in 
the human conjunctiva. 
Gayet found the staphylococcus aureus in the healthy conjunctival sac. 
Gombert, 7 with the bacteria isolated from the conjunctival sac, performed 
experiments on the rabbit's cornea ; three were found to be pathogenic, producing 
opacity of the cornea ; nine were non-pathogenic. 
