CONJUNCTIVA IN HEALTH AND DISEASE 141 
Hoffmann 15 states that cases which have hitherto been taken tor papillary 
trachoma are cases or conjunctivitis caused by Koch-Weeks bacillus which have 
become chronic. 
Retch" calls attention to the fact that although follicles of not specifically 
trachomatous character may be observed, we are unable to distinguish them from the 
milder forms of trachoma. 
Fulton 11 regards follicular conjunctivitis and trachoma as pathologically the 
same disease and believes in the direct contagiousness of both. 
In Coppez' 4 opinion follicular and granular conjunctivitis are identical. 
Ziegler 48 observes that follicular catarrh and trachoma are indistinguishable, 
but that follicular catarrh never quite produces the cicatricial degeneration seen in 
true trachoma. He further states that follicular catarrh can be produced by atropine 
and that it is simply the expression of a chronic irritation ; also that it seems to be 
originated by a diplococcus resembling the gonococcus, but which stains by Gram. 
Leber 2,9 describes the presence of certain large cells containing peculiarly 
formed bodies in trachoma, and he thinks that these have probably to do with the 
pathogenesis of the affection. 
Germann 12 in three cases of acute trachoma states that the infection had 
apparently been brought about by black earth in the conjunctival sac. He considers 
that the distribution of trachoma is effected by the dust of the fields and agricultural 
employments in which much dust is engendered. 
Hirsch 20 and Hirschberg 21 give some points on the distribution of trachoma 
in certain districts of Europe. Truc suggests methods for the prevention of the 
distribution of the affection. In their works no bacteriological or histological examina- 
tions were made. 
Herbert' 9 states that in trachoma and conjunctivitis the formation of adenoid 
tissue from connective tissue can be traced, and that in follicular and granular 
conjunctivitis the new formations might differ from the normal in being deficient in 
supporting stroma and blood vessels. 
Professor Guarnieri' 7 describes some bodies, staining intensely with magenta 
red, one-third to one-half the size of red blood corpuscles, which he obtained after 
grattage of trachomatous lids. He suspects that they are of a parasitic nature and 
belong to the blastomycetes ; he did not succeed in cultivating them. 
Pick 36 states that — 
(<z) The follicles are not immediately contiguous to the epithelium, but 
are separated from it by bands of fibrous tissue circularly arranged 
around the nodule. 
(b) The follicle cells are of the same kind as the round cells found in the 
conjunctival stroma. 
(c) The trachoma bodies of Burchardt are found only in the epithelium 
and have absolutely nothing to do with protozoa. 
