CONJUNCTIVITIS 131 



therefore certainly conclude, from a negative examination for 

 Gonococci, that the inflammation is due to a pure toxin metastasis, 

 and not to a metastasis of the organisms themselves (though this 

 cannot definitely be excluded, certain proof, however, is not yet 

 available). 1 Neither would it be correct to conclude when Stapliylococci 

 are found in the Gonococci-hee cases that such are mixed infections, 

 as Stapliylococci are very common on the conjunctiva, without having 

 any causal significance. 



Further information on metastatic gonorrhoeal conjunctivitis is 

 given in the papers by Peters and Gieler. 2 They make the important 

 statement that recurrences in the conjunctiva can take place without 

 any joint changes. These authors consider that in cases of acute 

 conjunctivitis of dubious etiology the possibility of an urethral origin 

 should be borne in mind. 



Scheffels and Burchardt stated that a choroido-retinitis could occur 

 at the same time. Becker records a swelling of the pinna of the ear 

 along with such a conjunctivitis. 



Wicherkiewicz and Bahr record similar observations, and the latter states that 

 he has seen the same thing occur in other joint diseases. Such confirmation of 

 the occurrence of this endogenous conjunctivitis has been given in the last few 

 years that there is now no doubt about its actual occurrence 3 (Kaldvovitz, Knapp, 

 Lechner, Kurka, etc.). 



Its frequency and pathogenesis are still, however, a subject of controversy (cf. dis- 

 cussion in the Wien. Ophth. Ges., December 6, 1905, paper by Ullmann ; Z. f. A., 

 xv., S. 92 ; also in the Ophth. Soc. of Philadelphia, November 20, 1906, paper by 

 Campbell Posey ; and Carroll, Amer. Med. Ass., 1907, Ophth. Sec., p. 121). 



Endogenous disturbances (Schddlichkeiten) are in question in many exanthe- 

 mata [scarlatina, measles, erythromelalgia (Hilbert), erythema exudativum 

 (Chaillous, Steffens, Eeis), and other diseases]. The variable non-characteristic 

 landings in measles makes us think that probably an endogenous irritation occurs. 



Giarre and Picchi reported having found influenza bacilli on the conjunctiva in 

 measles, and once or twice M. Neisser, Morax, and Schottelius similarly found 

 large quantities of Streptococci. In other cases of catarrh during measles the 

 usual conjunctivitis organisms were present, probably as complications. The 

 variety of organism which is present has naturally an influence on the course of 

 the inflammation, but they are generally not its primary cause. 



The further elucidation of these cases of conjunctivitis of obscure etiology must 

 therefore take into account the possibility of endogenous factors. I have myself 

 observed that many obscure conjunctivitis cases are either accompanied or followed 



1 A localized inflammation of the eye could not be induced in rabbits into which the 

 toxins of titaphylococcus or B. pyocyaneus had been introduced, even when severe local 

 irritation or injury was employed (cf. Shimamura). The contrary findings of Tornatola 

 arc due to experimental errors (K. M. f. A., 1901 ; cf. also Valenti, ibid., S. 117). 



2 Inaug. Dissert., Bonn, 1897. 



3 Cf. also Thorner and Greetf, Charite Annalen, 1904 and 1905, xxviii. and xxix. ; also 

 Burnett, Jour. Amer. Med. Assoc., December 23, 1905; Demaria, Archivos de Oft. Hist. 

 Amer., 1907, vii. 119. Metastatic gonorrhoeal inflammations of the lacrymal gland are 

 analogous (cf. p. 230). 



92 



