SPECIAL FORMS OF CONJUNCTIVAL INFECTION 177 



considered it impossible to distinguish the clinical appearances from 

 those due to the Koch- Weeks bacillus, Axenfeld showed that the his- 

 tory and course of a pneumococcal conjunctivitis in many cases was 

 characteristic. 



The authors mentioned established its infectiousness from clinical 

 considerations, but soon after Pichler (1896) and Gifford (1896) were 

 able to furnish definite proof from actual inoculation on the healthy 

 human conjunctiva. Veasy, Hauenschild, Baenziger and Silber- 

 schmidt also obtained positive results on inoculation. 



Confirmatory records are furnished by the work of Adler, Weich- 

 selbaum, Gonin, Junius, Morax and Petit, Bach and Neumann, 

 Hauenschild, Halle, Denig, Hertel, Veasy and De Schweinitz, Brecht, 

 Kibbe, Eymowitsch, Lundsgaard, Guignot, Pollock, Brown-Pusey, 

 Duane and Hastings, D. Smith, Usher and Eraser, Auge. 



Geographical Distribution and Occurrence. 



Although the Pneumococcus is universally distributed and can be 

 demonstrated in the buccal cavities of most people, pneumococcal 

 conjunctivitis is not so evenly distributed. 



For this reason the occurrence of extensive acute epidemics has not 

 been very often described ; we have only the records of Axenfeld 

 (Marburg and environs), Adler and Weichselbaum (Sarasdorf, in 

 Lower Austria), Junius (Konigsberg, in Prussia), Hauenschild (Wiirtz- 

 burg), Gifford (Omaha, U.S.A.), and Consalvo (Milan). Some special 

 conditions must be necessary to produce an epidemic, for the 

 endemic occurrence of single cases and small family epidemics are 

 very widespread, especially in Germany, Italy, U.S.A., Denmark 

 (Lundsgaard), England, Switzerland, and certain parts of Russia 

 (Rymowitsch, in Kasan) ; while in Egypt, for example, where acute 

 Koch- Weeks catarrh is so universally prevalent, Morax, Lakah, and 

 Khouri agree that pneumococcal conjunctivitis is very rare. Meyerhof 

 found it rather more commonly in Egypt, and Butler records it as 

 common in Palestine. Axenfeld saw it very frequently in Marburg, 

 Breslau, and Rostock ; in Freiburg, however, much less often. In 

 the last-mentioned town Koch- Weeks bacilli were common, but were 

 practically never seen in the other three places. Gasparrini, Gonin, 

 and Eymowitsch alone have recorded an approximately equal preva- 

 lence of the two chief forms of acute conjunctivitis. 



So far as we can form any conclusion from these epidemiological 

 data which still need amplification, pneumococcal conjunctivitis 



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