364 
DEPARTMENT OF SURGERY. 
(a) In some cases the first stage begins with an acute inflam¬ 
mation, characterized by redness of the margin of the eyelid, 
and a congestion of the palpebral conjunctiva; lachrymation is 
increased, little or no mucoid secretion and generally an itching 
sensation. In the course of a week the mucoid secretion 
increases and after sleep the eyelids stick together but are usu¬ 
ally easily separated. The granulation or folds increase in size 
and in the pain and irritation becomes more intense, which 
is aggravated by the use of the eye. During this stage the 
patient must be kept away from bright light. .In the course of 
ten days or two weeks this phase terminates in the hypertro¬ 
phic stage (2), excepting when it assumes a virulent form, which 
will be mentioned elsewhere. 
(A) Another phase of the first stage of the disease which 
is very common among animals is ushered by a very severe 
acute conjunctivitis. The eyelid is extensively swollen, lach¬ 
rymation is increased and accompanied by a mucoid or muco¬ 
purulent secretion; and the palpebral conjunctiva becomes 
thickened, forming folds, which are highly congested. The 
ocular conjunctiva is also thickened and in some instances 
injected. When the eye is closed for any length of time the 
margin of the lids adhere to one another, and at the end of two 
or three weeks the first stage ends in the secopd. 
(c) A more benign phase of this stage is sometimes encoun¬ 
tered, which is introduced without any acute inflammation per¬ 
ceptible. No hypersecretion or swelling is noticed with the 
exception of a slight thickening of the margin of the eyelids. 
These cases are usually sporadic and are generally detected if 
noticed at all during this stage (1) by the frequent winking. 
When the attendant or veterinarian inverts the eyelid the pal¬ 
pebral conjunctiva is found completely covered with granula¬ 
tions. The lachrymal discharges are normal and not accom¬ 
panied by mucoid secretions as in the other phases of the 
first stage of trachoma. This phase will end in the (2) hyper¬ 
trophic stage and run the same course as the other more pain¬ 
ful phases already mentioned. This form is not contagious, 
which is probably due the scanty secretions during its course. 
2 . Hypertrophical Stage .—The three phases of the inflamma¬ 
tory stage, respectively, gradually merge into the hypertrophic 
stage. In this stage the conjunctiva which has been thickened 
by the inflammation common to the first stage becomes organ¬ 
ized, firm and non-inflammatory. The duration of this stage is 
from five to seven days. The inflammation which accompanies 
