130 BACTERIOLOGY OF THE EYE 



occurs ; Fournier 1 described it under the name of ' conjonctivite 

 blennorrhagique spontanee.' 



In this way he denned those cases where a conjunctivitis, usually 

 bilateral, occurred simultaneously with the outbreak and recurrence 

 of gonorrhosal rheumatism, where there were severe symptoms and 

 very marked conjunctival injection, but not the severe purulent 

 character of the common ectogenous gonorrhoea, and almost never 

 corneal complications. 2 



Halenhoff 3 in 1887 published a series of further observations 

 under the title of ' Conjonctivite blennorrhagique sans Inoculation/ 

 and drew attention to the fact that such cases principally occur in men. 



Van der Straeten 4 pointed out that they could be distinguished from 

 the ectogenous blennorrhcea by the absence of the Gonococcus in the 

 secretion. 



Morax, 5 in his exact bacteriological research into these cases, con- 

 firmed this in general. He stated that scattered Gonococci may be 

 found in such cases (the case of Nobbe is exceptional) ; Parinaud made 

 the same observations (cf. Morax), and their results were later con- 

 firmed by Van Moll. 



Naturally in a case with Gonococci present the objection can readily 

 be taken that it is not a metastasis, but an ectogenous transference of 

 infection. 



In the cases of Morax and Van Moll the endogenous nature cannot 

 be doubted, as the conjunctivitis was bilateral, began with the joint 

 effusion, ended favourably, and recurred in the same way as did the 

 rheumatism. 



The recognition of the essential nature of these cases is not hindered 

 by the fact that the contents of their secretions vary ; they are 

 generally negative (Staphylococci or xerose bacilli), but occasionally 

 show Gonococci.^ 



As Morax and Axenfeld have stated, the absence of Gonococci can 

 be explained in the same way as their frequent absence in gonorrhceal 

 joint effusions. The Gonococci lie in the tissues and vessel walls of the 

 conjunctiva, and can cause an inflammation of the mucous mem- 

 brane without themselves occurring 011 the surface. 7 We must not 



1 Gazette des ffopitaux, December, 1885. 



2 A further communication by Riickert followed (K. M. f. A., 1886). 



3 A.f. A., 1887. 



4 Arch. Med. Beiges, July, 1891. 



8 'Etiologie des Conjonctivites Aigues' (These de Paris, 1894, p. 69, and Internat. 

 Ophth. Congress, Utrecht, 1899, discussion on Van Moll). 



6 Such occurrences of Gonococci will in future require a differential diagnosis from the 

 other Gram-negative Diplococci. 



7 Noble, Ally. Wien. Med. Zcit., 1895, No. 33. 



