CONJUNCTIVITIS 127 



Bacteria ? Does their transport occur by the leucocytes ? Where are 

 the organisms during the period of incubation ? In connexion with 

 this last query is an interesting and peculiar fact : After the infection 

 of the human conjunctiva with DiplobaciUi the organisms first dis- 

 appear or, at any rate, are not demonstrable (Morax, Axenfeld) and 

 again show up on the third or fourth day, with the onset of the 

 inflammation. We know that during the inflammation the causal 

 organisms lie partly in the epithelial cells. Perhaps this is also the 

 case during the incubation. The reactions of the rabbit's conjunctiva, 

 which is notoriously very seldom the site of an inflammation, will 

 presumably never throw light on this question. 



When an infection occurs, and the organisms obtain a hold, they 

 develop their toxins. The researches of Morax and Elmassian, which 

 have a special theoretical interest, show that the toxins have an 

 influence on the special type of conjunctivitis which then develops. 



They continuously instilled dead and filtered cultures of organisms for hours into 

 the conjunctival sacs of rabbits. As Gonococci, Koch-Weeks bacilli, and DiplobaciUi 

 do not grow on the conjunctiva of animals, this method appeared the only way of 

 obtaining in animals results similar to those in man. 



With Gonococcus toxin, instilled every two minutes for four to five hours, they 

 obtained in twelve hours a severe inflammation, which subsided after twenty-four 

 hours. The intensity of the reaction varied with the virulence of the culture. The 

 toxin retained this action when heated to 58 C., but rapidly lost it at any higher 

 temperature. Similar, but shorter, instillations in men had the same effect. 



Morax and Elmassian then tried whether any curative action on trachoma was 

 possessed by this toxin ; they found none. 



Dead filtered cultures of Diplobacilli and Koch-Weeks bacilli had much less 

 action, and in their case, too, the irritation began several hours after the instillations 

 had ceased. 



The toxin of highly virulent Stapliylococci acted like that of the Gonococcus. 



Diphtheria toxin produced the most violent reaction. The first irritation showed 

 ten to eighteen hours after an instillation of from six to eight hours ; after about 

 twenty-four hours of severe inflammatory swelling, the first signs of a pseudo- 

 membrane occurred. The intensity of the process increased for forty-eight hours, 

 when the typical appearance of a diphtheria was presented then gradual subsidence 

 occurred, and healing in four to five days. A stronger concentration of the toxin 

 does not shorten the incubation period or the course of the inflammation ; it only 

 produces more severe general symptoms. When the epithelium is intact, the toxin 

 passes in very slowly ; when it is damaged, the passage is rapid, and a well-marked 

 keratitis develops. 



In contrast to these toxins, many other poisons act after single applications e.g., 

 snake venom and abrin. The former acts at once, the abrin only after twelve 

 hours' incubation. 



Randolph, 1 on the contrary, denies that instillations of filtered cultures continued 

 up to eight hours will produce an inflammation in the healthy conjunctiva (he 

 tested cultures of Gonococcus, Staphylococcus pyogenes aureus, Staphylococcus 



1 'Role of Toxins in Inflammations of the Eye/ Biill. Johns Hopkins Hospital, 

 Baltimore, 1903, xiv. 47. 



