CONJUNCTIVA IN HEALTH AND DISEASE 131 
After several weeks the inflammation became much less intense, and the 
opacity less, the cornea at last becoming perfectly clear and, apparently, in no way 
injured. 
Examination of the discharge showed only cocci, many of which were in a 
state of sub-division. The cocci stained by Gram's method. 
Repeated cultural experiments were made, and in every case a number ot 
opaque white colonies of a very virulent coccus was obtained. 
On serum the colonies grew rapidly and caused a slight depression on the 
surface. 
On agar an abundant opaque-white spreading growth was produced. 
Milk was rapidly coagulated, the reaction becoming strongly acid. 
Gelatine showed a large amount of liquefaction in twenty hours. 
Culturally the organism resembled staphylococcus pyogenes albus, only 
producing equal results with greater rapidity. 
The first attack was not investigated, but it is very improbable that the 
staphylococcus originated the disease. 
The more likely assumption is that the disorganized conjunctiva was infected 
by the staphylococcus secondarily. 
According to Flugge, 9 staphylococcus pyogenes albus is more common than 
aureus among many of the lower animals. 
VIII. Granular Ophthalmia 
The causal agent of trachoma has for a long time been involved in obscurity, 
and a series of cases has been examined to see if some light could be thrown on the 
subject. 
Sattler (1885) isolated a micrococcus from the trachomatous follicles in 
cases of Egyptian ophthalmia, and Michel (1886) who gave a more exact 
description of the coccus, made inoculation experiments which he believed established 
the etiological relationship to the form of ophthalmia with which it was associated. 
These researches have not been confirmed, and subsequent observers have not been 
able in many cases to find the micrococcus. 
Kartulis, Fuchs, and Hoor" held the theory that trachoma is often of 
gonorrhoeal origin. Demetriades'' considered Egyptian ophthalmia to be a 
combination of trachomatous disease with purulent ophthalmia as the gonococcus was 
always found in the discharge. In no instance in the series of cases described below 
was the trachomcoccus cultivated, or the gonococcus observed in the discharge. 
It was considered imperative, in order to find the exciting cause of trachoma, 
to obtain the cases in the early stage. This presented some difficulty, in that granules 
are generally of slow formation, and it was not possible to tell whether an inflammation 
