266 BACTERIOLOGICAL EXAMINATION OF MATERIAL 
Subacute Conjunctivitis.— The Morax-Axenfeld bacillus is a common 
excitant of subacute conjunctivitis, particularly when the internal 
angle is involved. The secretion is meagre and best obtained in the 
morning. The bacilli are short and thick, Gram-negative and occur 
singly and in pairs both free and in leukocytes. They must be 
distinguished from members of the mucosus capsulatus group, which 
are comparatively common in ozena which involves the nasal ducts. 
The latter are capsulated, which distinguishes them from the INIorax- 
Axenfeld organism. 
Corneal ulcerations may be caused by pneumococci, streptococci, 
leprosy bacilli, and rarely by tubercle bacilli. The latter organism is 
best detected by animal inoculation. 
Pseudomembranous conjunctivitis is frequently the result of a 
localization and development of diphtheria bacilli, less commonly of 
streptococci. The etiology of phlyctenular conjunctivitis is still 
somewhat in doubt. The extensive study of phlyctenules, both in 
clinical cases and experimentally in tuberculous rabbits, by Gibson^ 
suggests strongly that "tuberculosis and tuberculosis alone is the 
cause of phlyctenular disease." 
Bacteriological Examination of the Ear and Nose.— The middle ear 
normally is sterile, but bacteria may reach it either by extension of 
growth from the nasopharynx through the Eustachian tube, or directly 
from the blood and lymph channels. By far the most common incitant 
of infection of the middle ear is the streptococcus, either alone, or less 
frequently in association with other organisms. This organism is 
also frequently isolated from thrombosed sinuses. The pneumococcus 
and Pneumococcus mucosus are also frequently isolated from otitis 
media. B. pyocyaneus and B. proteus are not uncommonly found in 
middle-ear infections, particularly those containing fetid pus. B. coli 
has also been detected in foul-smelling pus from the middle ear. Sta- 
phylococci, Micrococcus catarrhalis, Micrococcus tetragenus, influenza 
bacilli, members of the mucosus capsulatus group of bacilli, typhoid 
and diphtheria bacilli have also been isolated from otitis media. 
Infection of the external auditory meatus, which contains cerumen, 
is frequently the result of an overgrowth of various moulds, particularly 
of the genera Aspergillus and Mucor. 
The normal nasal cavity, although freely exposed to the exterior 
and theoretically, at least, continually contaminated wdth bacteria 
both from the inspired air and the microorganisms washed from the 
eyes in the lacrimal secretions, is relatively free from microorganisms. 
Staphylococcus albus, non-hemolytic short-chain streptococci and 
pseudodiphtheria bacilli appear to be the more common organisms 
isolated from the healthy nasal cavity. Material for examination is 
obtained upon swabs of sterile cotton after cleaning the external nares 
with sterile salt solution. 
1 Am. Jour. Dis. Child., 1918, 15, 81. 
