CONJUNCTIVITIS 111 



Allied to these are the 'bacteria negative' cases, where either 

 no organisms or only single cocci and xerose bacilli are found. 



If, then, these ' bacteria negative ' cases do occur, must we not ask, 

 How can we be quite convinced that in other cases the bacteria are 

 the cause of the secretion, and, if they are, to what extent ? Cannot 

 the cause be something quite different, as indeed, it must be, in the 

 ' negative cases ' ? And may not the increase in organisms be quite 

 accidental ? 



This point is cleared up for us by a comparative study of clinical 

 experience and bacteriological research. The results of introducing 

 pure cultures into the human conjunctiva, as has been voluntarily 

 done by several people, are here of great importance. The organisms 

 utilized were certainly the cause of the artificial catarrh produced. 

 When we find them just the same in a secretion and associated with 

 an analogous clinical picture, we are justified in considering that they 

 are causal. By further observation, then, the clinical picture can be 

 completed. 



If, then, these inoculations with pure cultures of the Koch- Weeks 

 bacillus or the Morax-Axenfeld bacillus almost invariably produce 

 a conjunctivitis, and that too, in very varying people, it is strong 

 evidence that any secretion in which these organisms are to be found 

 has been caused by them. For obvious reasons, no considerable 

 experience is available concerning the inoculation of pure cultures of 

 the Gonococcus. The gonorrhoaal etiology of purulent urethritis 

 (with rare exceptions) has been absolutely proved by the inoculation 

 of pure cultures on the human urethra. From this, and from the 

 observed fact of transference of the infection from the urethra, 

 as well as from the direct inoculations carried out by Biringer, 

 it is clear that when this organism occurs on the conjunctiva in 

 a case of blennorrhcea, it can be considered as pathognomonic, just as 

 in the case of the other organisms already considered. 



The organisms mentioned must be considered to be highly infec- 

 tious for the conjunctiva, where they always produce a conjunctivitis 

 when a secretion containing them is brought into close contact with 

 it. The demonstration of a very small number of such organisms is 

 sufficient to make the diagnosis very probable. When they occur in 

 large numbers which is usually the case such a diagnosis can be 

 made positively. 



We can also form a definite opinion as to which organisms develop 

 secondarily on the inflamed conjunctiva. In examining the bacterial 

 flora of the conjunctiva in cases of iritis, or during the aseptic healing of 



