126 
THOMPSON YATES LABORATORIES REPORT 
impossible to differentiate between the two diseases ; they offered the clinical picture 
of a gonorrhoeal ophthalmia with the exception that the cornea did not seem to be 
endangered. 
In the older patients the age, the character of the discharge, the previous 
attack, the absence of corneal complications and gonorrhoeal history would lead one 
to suspect that gonorrhoeal ophthalmia was not being dealt with. With regard to 
the character of the discharge, in the two latter cases the discharge, although profuse, 
was of a whitish colour and stringy consistence, and was with difficulty removed 
from the conjunctival sac ; gonorrhoeal pus is invariably yellow and friable. 
The previous attack is a very important aid to diagnosis ; it lends colour to 
the supposition of Reinhard Hoffmann 23 that the bacillus conjunctivitis is able to 
exist and lie dormant for a long time in the slightly hypertrophied folds of the con- 
junctiva resulting from a former attack, and become a means of propagation of the 
disease to other people and a danger to the patient in recurring attacks. 
The woman must, in all probability, have been harbouring the bacillus in the 
recesses of her conjunctiva during the period between the two attacks, and, owing to 
lowered general vitality or diminished local resistance, the bacillus was able to again 
manifest its presence. In her first attack the disease remained confined to one eye, 
but in the second the other eye became involved ten days afterwards. 
This form of ophthalmia differs from the classical muco-purulent catarrh in 
the severity of the symptoms ; it is characterized by intense pain, photophobia, and 
redness of the conjunctiva, profuse discharge and often large sub-conjunctival 
ecchymoses. 
In the case of the woman, after the inflammation had subsided, the upper lid 
was everted, and the conjunctiva examined. The membrane was very congested, and 
presented a roughened appearance ; the roughness did not amount to actual miliary 
granulations. 
III. Muco-purulent Catarrh caused by the Koch-Weeks Bacillus 
The Koch-Weeks bacillus varies considerably in virulence. In the disease 
now under consideration, the invasion of the conjunctiva by the organism causes only 
a mild type of inflammation, and, in comparison with the acute ophthalmia described 
above, frequently causes only slight congestion of the* palpebral conjunctiva. 
The discharge contains a large proportion of fibrin and occasionally forms a 
pseudo-membrane. 
Microscopical films of the discharge show a large amount of fibrin enclosing 
polynuclear leucocytes, epithelial cells, and bacteria. 
In recent cases the slender bacilli are very numerous, and if the inflammation 
be fairly acute many leucocytes are seen containing bacilli. The bacilli were often 
seen adhering to epithelial cells. 
