CONJUNCTIVA IN HEALTH AND DISEASE 139 
(a) Several had lasted over a year. 
(b) Discharge was scanty or even absent. 
(c) Treatment had been given in many cases. 
(d) The disease was complicated by infection by B. lacunatus (Eyre) in 
two cases. 
Moreover, when the discharge is very scanty, one or two isolated slender organisms 
cannot be definitely stated to be Koch-Weeks bacillus, and attempts to obtain cultures 
under these circumstances are usually unsuccessful. It is also extremely probable 
that, a granular condition having been set up by the Koch-Weeks bacillus, slight 
forms of irritation, microbial or otherwise, which would have little effect on the 
normal conjunctiva, are sufficient not only to cause a continuance of the inflammation, 
but also to produce an actual increase in the size of the granules. 
Additional support to the view that Koch-Weeks bacillus is the causal agent 
in trachoma, is afforded by — 
The association of muco-purulent catarrh and granular lids in 
epidemics of ophthalmia in Egypt. 
(F) The observations of many writers, that inflammations of the 
conjunctiva caused by the Koch-Weeks bacillus often leave behind 
a granular condition. 
Histology of the Trachoma Granule 
In a former paper contributed to the Thompson Yates Laboratory Reports, 
vol. ii, 1900, I have described the histological characters of trachomatous lids. 
The granules were found to be chronic inflammatory nodules, consisting of 
small round cells and a delicate reticulum of fibrous tissue enclosed by an incomplete 
capsule of bands of fibrous tissue. 
Examples of the different stages in the formation of a granule were obtained. 
Sections of an acutely inflamed conjunctiva showed a general infiltration of the tissue 
with small round cells and here and there small circumscribed masses of cells which 
did not possess a capsule. In sections of an inflamed conjunctiva in which there 
were small granules, the round cell masses were more distinctly circumscribed and, 
although not possessing a capsule, had a well-defined reticulum of fibrous tissue. A 
later development is the formation of a fibrous capsule and evident signs of 
cicatrization of the nodule. In all the cases plasma cells were abundant, and several 
appeared to have ruptured and discharged their granules into the surrounding tissue. 
With regard to the presence of organisms in the sections, no very positive 
result was obtained, but in one or two instances bodies that had a great resemblance 
to the slender bacilli were observed ; these were especially noted in a cover-glass 
preparation of a crushed follicle. 
