As the secretion alone causes the in fection, therefore, the danger of in fection depends upon the strength of the secretion; the richer this is, the greater will the danger be to surround ing persons.
The transfer of secretion from one eye to another is usually accomplished by the fingers or toilet articles which are brought into contact with the eyes, as handkerchiefs, towels, sponges, etc. This is more apt to happen when num bers are crowded together and are likely to use these articles in common.
Pathology.—In trachoma we see an excessive degree of development of the papill of the mucous membrane and the formation of the granulations. Micro scopically, the granulations may have an imperfect capsule or may have no cap sule, but they seem to grow from, or in, the stroma of the conjunctiva. In the acute form the granulations consist of lymph-cells alone. They are to be re garded as new growths in the conjunc tiva, and, in addition to the lymphoid cells, the mass of cells and connective tissue is penetrated by blood-vessels. The chronic granulations consist of lymph-cells toward the surface, but their bases are formed chiefly of connective tissue. Gradually the cellular elements are transformed into connective tissue, and in this way cicatricial degeneration of the conjunctiva is brought about at each spot where a granulation was seated.
The development of the papillaa is not characteristic of trachoma, for it is pres ent in moderate degree in every lasting inflammation of the conjunctiva, as in chronic catarrh, vernal and follicular catarrh, and purulent conjunctivitis.
Prognosis.—Aeute granular conjunc tivitis, or trachoma, is characterized by its chronicity and by the serious conse quences to vision; this, added to its con: tagiousness, makes it one of the most dreaded of eye diseases. Relapses occur frequently and persistently and may occasion all of the intense inflammatory symptoms of acute granulations. Its great danger lies in its contagiousness and the great rapidity with which it spreads through schools or any institu tions where large numbers of inmates are gathered together, by the careless use of towels and common utensils. The prog
nosis is, therefore, always grave, and de mands the adoption of great precautions to prevent a disastrous epidemic.
Treatment —Prophylaxis is obviously of the greatest importance, and, as the conspicuously-dangerous element is the secretion, cleanliness, adequate air-space, and proper ventilation of the sleeping rooms must be insisted upon in all crowded institutions. Every patient ' should be provided with his own basin and towel, or, better still, should be re quired to wash under "running water." When the disease is once established, rigorous isolation of all those afflicted should be practiced.
The chief aim of the treatment must be to check the development of the hy pertrophy of the conjunctiva, and bring about absorption of the granulations in order to prevent the destruction of the mucous membrane,and to reduce the pre vious results of the disease to a mini mum.
In the early stages, frequent washings of the conjunctiva with a 10-grain solu tion of boric acid and bichloride solu tions should be employed; especially is this true of acute granulations. If there be much pain and photophobia and some haze of the cornea, atropine should be instilled in conjunction with the cleans ing lotions. A nitrate-of-silver solution should be employed so soon as the dis charge becomes marked, in the same manner and to meet the same indications as already described in the treatment of other forms of conjunctivitis.
Perfect rest indicated for trachomatous eyes. Instillations of atropine, together with use of bandages or cataract shields during the day, are of value. Before bandaging a weak iodoform ointment rnay be applied to conjunctiv(e and lids. At night the protection should be re moved and the patient kept in the dark. Properly-fitting glasses should be used IA hen the eyes are not at rest. Massage practiced every week or so by rubbing the granulations lightly with a strabis mus-hook. N. B. Jenkins (N. Y. Med. Jour., May 19, 1900).