PATHOGENICITY FOR MAN 227 



tions already mentioned, abscesses, retinochoroiditis, and panoph- 

 thalmia may develop as secondary lesions. 



Primary pneumococcal infections of the eye have been described 

 by Mikaeljan (1931) 902 who, in a limited series of cases, found 

 pneumococci of Types I and II in panophthalmia, ulcus cornea 

 serpens, and purulent dacryocystitis, while organisms of Group 

 IV were isolated from the eye in two cases of purulent conjuncti- 

 vitis. 



In a communication appearing in 1931, Smeall 1293 tabulated the 

 pneumococcal types encountered in a variety of affections and 

 stressed the fact that the organisms most commonly found in the 

 eye and accessory sinuses belonged to Group IV and that those of 

 Type III and Group IV were present most frequently in acute 

 otitis media and mastoiditis. It is of course not improbable that a 

 similar and larger series of cases investigated in another locality 

 or country might yield different results. 



Pneumococcemia 

 From time to time bacteriologists have alleged that virulent 

 pneumococci as well as streptococci and other pathogens are to be 

 found in the circulating blood of healthy persons as well as of 

 those ill with affections to which the organisms are not related. 

 The validity of the claims is always highly questionable, and it is 

 problematical if Pneumococcus invades the circulatory system un- 

 less a specific focus of infection exists at some point in the body. 

 Since the discovery by Friedlander 489 " 90 in 1884 of pneumococci in 

 the blood of pneumonia patients, their presence has been recog- 

 nized as a frequent accompaniment of pneumococcal disease indi- 

 cating a gloomy prognosis. The literature and bedside records are 

 replete with notes on positive blood cultures taken on pneumonia 

 patients, but the percentage of positive cultures reported varies 

 with the nature of the clinical material and the skill of the techni- 

 cian. Prochaska 1111 claimed that he found pneumococci in the 



