DEPARTMENT OF SURGERY 
o65 
the closing of the first stage gradually subsides and no evidence 
of it remains at the termination of the second stage. No form 
of treatment has ever proven very effective for this stage of 
the disease excepting surgical treatment, and this should be 
done before corneal complications are noticed. Such com¬ 
plications as pannus are likely to occur before the end of this 
stage. 
3. Cicatricial Stage. —As the hypertrophy of the conjunctiva 
passes away, small strands of cicatricial tissue begin to form ; 
the granulations or folds lose their character and unite to form 
irregular masses. During this stage the conjunctiva contracts 
and in doing so it leaves hard masses or bands which greatly 
change the shape of the tarsal cartilage. As a result of this 
cicatricial contraction we frequently observe that there is a 
narrowing of the fissure which produces a partial ptosis. 
4. Atrophic Stage. —This stage is only a continuation of the 
preceding marked by a diminution of tissue. This atrophy may 
interfere with the action of the orbicularis palpebrum, forming 
an entropion. It also destroys all the depressions and elasticity 
of the conjunctiva, and reduces the size of the entire sac, which 
permits the tears and secretion to flow down the cheek. Now 
and then there remain patches of conjunctiva that partially 
moisten the surface of the eyeball, but in time the entire sur¬ 
face becomes dry ( xero-phthalmos ) ; the cornea becomes opaque 
and the irritation caused by the dryness and cicatrices of the 
conjunctiva often produce ulcers of the cornea. Vision is im¬ 
paired and sometimes totally lost. 
All trachomata mav not run the course mentioned, some 
may be more benign, while others may be more virulent. There 
is a disease of the eye found among cattle that has always ap¬ 
peared to us as a virulent type of trachoma ; if it is not, it at least 
appears trachomatous in the early stage. Dr. O. E. Dyson, In¬ 
spector in charge of the Bureau of Animal Industry, Chicago, 
Ill., is of the opinion that the disease observed among cattle is 
carcinomatous in its nature, and that it runs the course of a car¬ 
cinoma. George Jobson, M.D., V.S., Assistant Inspector of the 
Bureau of Animal Industry, has made some important investi¬ 
gations of the disease common to cattle, and wrote a series of 
articles which were published in the Journal of Comparative 
Medicine. Upon several occasions he has called our attention 
to the disease in its different stages, varying from small granu¬ 
lations at the internal canthus or on the membrana nictitans to 
a complete destruction of the eyeball. We are unable to state 
