Trachoma is an infectious chronic conjunctivitis, causing hypertrophy of the conjunctiva, with the formation of a velvety development of papilla-on the tarsal conjunctiva and of characteristic greyish round elevations, so-called trachoma granules, especially in the fornix. On further development there are changes in the conjunctiva of the eyeball, which becomes the seat of a chronic hyperaemia and hypertrophy; also the cornea is covered over with a more or less thin vascular membrane (pannus). The changes in the eyelid often lead to scar formation and shrinking, inversion of the eyelashes (trichiasis) and of the margin of the eyelid (entropion), which, however, may be turned outward (ectropion). The cornea becomes ulcerated, and may give way to the intra-ocular pressure (staphyloma of the cornea). The conjunctiva of the eyelid and of the eyeball may become adherent from the fornix (posterior symble-pharon), or the conjunctiva may cease to secrete and become dry (xerosis). The final total destruction of the functions of the eye is not uncommon.

* Ophthalmologists are giving up the original name "spring catarrh," on the undeniably good grounds that, in the first place, the catarrhal symptoms are very slight; in the second place, the disease does not specially belong to spring, although the symptoms are then exacerbated.

After the most acute stage and before shrinking has taken place trachoma belongs rightly to the "massage diseases" *; the treatment requires great patience on the part of both doctor and patient, but it is not a thankless task. No very considerable results are, however, obtained without strong frictions, so strong that they cannot be applied over the eyeball. Keining and Klein recommend kneading the conjunctiva of the everted eyelid with a swab of cotton-wool dipped in sublimate solution (1 : 5,000 to 1 : 2,000). Michel uses sublimate vaseline (0.003 : 10). Ottava of Budapest massages with a spatula of ivory, indiarubber, or wood. I recommend a glass rod and the method spoken of above of massaging the eyelid with vigorous kneadings with the little finger of one hand placed in the conjunctival sac, with the nail against the bulb, and exerting the necessary pressure with the forefinger of the other hand on the outside of the lid. I have generally used for this a 10 per cent. yellow precipitate ointment.

When this apparently rather brutal method is persisted in, and strong, necessarily rather short seances of three-quarters of a minute on each eyelid are given, one sees after weeks or months the extremely obstinate trachoma granulations becoming flatter and diminishing and finally quite disappearing. Similarly, the papillary hypertrophy diminishes, the scars become thinner, secretion becomes more normal, whether there was too much or too little, the conjunctiva shows altogether a much healthier appearance, and, as a result of a somewhat scanty but, as I hope, well-utilised experience, during which I compared various methods for the same case, I believe that in this way one may obtain quite good results, and better than by other methods, in those cases which are not too far advanced and before shrinking has set in. For changes on the eyeball, especially pannus, one massages afterwards or beforehand in the ordinary way with and through the eyelid, and with yellow precipitate ointment. Even when one proceeds in the above way, which I am convinced is quite the best method of treating trachoma by massage, in advanced cases one must warn the patient that months may pass before real permanent benefit is obtained.

* Trachoma has been massaged for a long time, but the literature concerning the result of the treatment varies enormously. Hirschberg and Heisrath take up an intermediate position between extreme scepticism and extreme enthusiasm. The former, as early as 1883, recorded very good results obtained after the acute stage, but before advanced changes in the tissues had arisen (iodide of potassium ointment); on the other hand, he does not recommend treatment where there is shrinking. Motschultsky considers massage in trachoma to be of secondary importance. Kiaer only obtained any result in one case out of thirteen. Rohmer of Nancy has apparently a good opinion of the treatment. Costomyris is foremost among the large number of enthusiasts for massage; he maintains that he has cured several thousand cases of trachoma by massaging directly on the conjunctiva (with the eyelid everted) with boracic. Usually the "cure" took five to ten days, and was never longer than forty days !

Costomyris's enthusiasm for eye-massage is shown in that he recommends it for follicular conjunctivitis, chronic catarrh, phlyctenular conjunctivitis, spring catarrh, croupous conjunctivitis, diphtheritic conjunctivitis, blennorrhoea of the conjunctiva, scleritis and episcleritis, parenchymatous keratitis, and for corneal opacities. As long as I continued massaging trachoma by kneading the eyelid against the eyeball my results remained almost entirely negative; when I used Costomyris's method they became somewhat better, but still remained bad; when I finally went to work in the manner described above I obtained good, though still slow, results.