A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen.

  • Wells, J. Soelberg (John Soelberg), -1879
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    and their experience upon these points is, therefore, of the greatest im- portance. [According to most recent investigations, granular conjunctivitis is re- garded as distinct from the follicular form of inflammation. The granula- tions consist of elevations, over which the epithelium passes, due to infiltration into the conjunctival stroma, Avhich extends to the papilla? and submucous tissue, thus ])roducing more or less organized new tissue. This infiltration is aftewards partly absorbed and partly changed into dense cicatricial tissue, which in })assing through the shrinking stage occasions much trouble. Briefly, the granulation of the conjunctiva is a neoplasm. Nettleship makes a good point in stating that it should be remembered that these prominences into the conjunctiva are not granulations in the pathological sense. Though these vesicular granulations, if neglected, tend to the development of true granular conjunctivitis, the latter is very often developed in cases where the vesicular formation was not present. Battler's investigations into the nature of trachoma are of considerable pathological interest. He regards the trachoma granules as a characteristic and specific product of the trachomatous process. In his opinion, lymph- follicles do not exist in the normal conjunctiva. He has examined the secretion from the different phases of the trachomatous process, and has never found but one form of schizomycetes, the circular micrococcus, which is of somewhat smaller size than the micrococcus of blennorrho?a, but in other respects exactly like the latter. Isolated micrococci occurred but rarely. The division of the micrococci occurred very rapidly, so that sometimes it was impossible to note it. The isolated micrococci never touched each other, and when they occurred in grou2)S, they seemed to be surrounded by a clear sac or envelope. This peculiar arrangement is characteristic of the tracho- matous secretion, as it is of the secretion in ophthalmia neonatorum. If trachoma be a localized infecting disease, and these schizomycetes the bearers as well as the producers of the infection, Ave must not look for ihe origin and place of development of these organisms in the secretion of the mucous membrane, or even in the epithelium, but in the tissue of the conjunctiva itself The same micrococci which are met with in the secretion, occur also in the trachoma granules; not only upon the nuclei, but also in the inter- vening spaces, both isolated and in groups. In the tissue surrounding the trachoma granules are to be seen small groups of nuclei, some filled with, others covered by, micrococci. Another noticeable appearance in many cases of trachoma is a more or less extensive infarction of the lymphatics with elements resembling those of infiltrated connective tissue. In old cases of trachoma, there is often seen a considerable and irregular thickening of the adventitia of the vessels; and in many, an obliteration of their calibre and convei'siou of the vessel into a solid cord. In very many cases the pro- cess eventually is a gradual disappearance of the trachoma granules, ending in atrophy of the conjunctiva. Battler thinks that it is not improbable that the exciting cause of trachoma is originally from some genital secretion, and this latter from a micrococcus. The reason why in these cases a distant infection occurs so rarely, is that the schizomycetes of conjunctival blennor- rh(ea soon lose, in a dried condition, their specific properties, or at least the latter become so modified that in the struggle for existence with other schizomycetes and cells, they die. (See the Klinische Monatsbliitter flir Augenheilkunde, Beitriige tor 1881.)—B.] But whether we accept or not the theory that vesicular granulations are the first symptoms of granular o])hthalmia, and may become developed into true granulations, there cannot be the slightest doubt that they must be
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