In four cases small spots on the con junctiva observed which resembled the infarcts of Weiborn, but found to be mycosis colonies similar to actinomy cosis; some yellowish little grains col lected into small balls, sometimes cov ered with epithelium, were also seen, The symptoms were those of a slight conjunctivitis. Scraping sufficed to re move the colonies, but a culture was not obtained. Fuchs (Annal.
Sept., '99).
Etiology.—Catarrh of the conjunctiva may be originated by any of the causes of hyperzernia of the conjuiactiva. It may be the product of foul air or of poorly ventilated rooms, especially when large numbers of people are crowded together, as in tenements, etc.; professions which expose the eyes to overuse or the pro longed action of irritative gases and vapor, dispose to it, or it may be set up by contact with a lencorrliceal dis charge. It is common in warm and changeable weather, when it may assume an epidemic form. Staphylococci and streptococei are almost always present, and the diphtheritic bacillus likewise. Weeks has found small bacteria in "pink eye," which, when inoculated upon the conjunctiva of the rabbit, has produced this form of catarrhal conjunctivitis.
In subacute catarrhal conjunctivitis the germ commonly found is a diplobaeil lus, 2/3 millimetre in length by 'A milli metre in breadth. With pure cultures was able to reproduce the disease in Mall. The diplobacillus personally ob served in diverse conditions of the con junctiva. It grows readily upon pig serum and serum-agar, the serum being liquefied all along the line of growth, which broadens if the tube is kept in the oven, until in some cases the whole sur face of the slant is broken down.
in the secretion the germ, while show ing some individual variation in size, is, on the whole, quite uniform. The large, thick, double rod is the almost invariable form, each member of the pair frequently showing an indistinct subdivision at its middle. In culture there is more variety in the forms to be seen. The germ stains very readily, dilute carbol-fuchsin giving the best pictures. It is deeolorized by Gram's method.
lt is evident that the appearance of the eyes infected with this germ is anything but uniform, but in the great majority of cases the symptoms are subacute or chronic in character. They yield quickly to a 2/3-per-cent. solution of zinc chloride dropped into the ey-es. H. Gifford (An nals of Oph., vol. vii, No. 2, '98).
From epidemic occurring in Vittoria in 1S99 the following conclusions drawn: 1. Pneumococcie catarrhal conjunctivitis is a contagious affection, which occurs endemically or in epidemics, attacks in dividuals at all ages, and usually runs an acute course of about ten days' dura tion, but may become chronic. It is of a rather benign nature, and rarely af fects the eye itself. It is produced by
Fraenkel's pneurnococcus. 2. The cases personally observed during the aforesaid epidemic were essentially cases of the pneumococcic variety of conjunctivitis. G. Gonsalve (Gaz. degli Osped. e delle Clin., Sept. 30, i900).
The hinch-Weeks bacillus of conjunc tivitis may present itself in a partic ularly severe form, and be complicated by phlyetenules and even by corneal ulceration. Such eases are especially contagious, and extra precautions should bc taken to prevent their spreading, par ticularly among the school-children. As a rule, they are eontrolled by the use of mild astringent lotions, and applications of 2-per-cent. solutions of nitrate of silver. E. A. Shumway (Phila. Med. Jour., April 26, 1902).
The course of this variety of conjunc tivitis is usually favorable, uncomplicated cases recovering in from one to two weeks. In adults, however, especially if there be a history of alcoholism, albu minuria, or diabetes, the disease may as sume a chronic form. Both eyes are usually affected, either at the same time or the second eye a few days later. The disease may begin as an hypermmia and slowly go over into catarrh, or the onset may be more abrupt. In institutions where there are poor hygienic conditions, the disease usually becomes chronic and epidemic.
Treatment. — Attention should be given to the general health. Any exist ing systemic disease, such as rheuma tism, diabetes, or albuminuria, should be combated, shorter working-hours should be prescribed for professional men and more exercise recommended; the eyes must be properly protected from the light, air, and dust with smoked glasses, and they should be kept clean from discharge by frequent washings with boric-acid lotion; great relief may also be obtained from the applica tion of ice-compresses. These are best applied as follows: 1. Several pads of gauze of three or four thicknesses, about the size of a silver dollar, are laid on a block of ice. The ice should be sus pended in a receptacle with perforations in its bottom which will permit the water and any secretion from the compress to drain off into a jar beneath it. An or dinary kitchen-collander and wash-basin will answer very well for this apparatus. One of the pads is taken from the ice as soon as it has been saturated and is ap plied to the closed lids, removed in a few moments, and a fresh one substituted for it. 2. Compresses of absorbent cotton which have been soaked in ice-water may also be employed. They should be squeezed out sufficiently to prevent any of the water trickling over the patient's face and neck. 3. Cold may also be plied by means of the ordinary douche or by holding a small cake of ice directly to the eye; but these should be carded for the compress, as they can only be used intermittently.