178 BACTERIOLOGY OF THE EYE 



appears more prevalent in Northern countries, and especially in the 

 colder months of the year (Axenfeld, Gifford, Kymowitsch). The 

 history of a ' chill ' is a common examplification of this. 



It is very noticeable how seldom a pneumococcal conjunctivitis is 

 associated with a pneumonia ; we only know of very few cases 

 (Kymowitsch, Stschegolew, Petit). It is quite rare for a severe bron- 

 chitis or an angina to accompany the conjunctival affection. The 

 other pneumococcal affections of the body have no common associa- 

 tion with pneumococcal conjunctivitis. Very often a cold in the head 

 occurs immediately before or along with it. 



Hertel had three severe cases following measles. 



Clinical Appearances. 



An acute catarrh develops very rapidly in both eyes successively. 

 It varies in intensity and duration ; there are very severe cases resem- 

 bling blennorrhosa, with intense redness, swelling, and profuse secre- 

 tion, and slight abortive cases, in which all the symptoms disappear 

 in a few days. It is clear, therefore, that the appearances are not 

 absolutely characteristic of the Pneumococcus, and that confusion with 

 other infections may occur ; nevertheless, when the whole course of 

 the disease is considered, it presents relatively characteristic features. 

 The disease in different places and at different times seems to vary 

 somewhat. Gifford and Gasparrini have seen quite a large number of 

 very severe cases in proportion to their infrequency in other places. 

 Cases of medium severity, as a rule, present the following features : 

 At first a pinkish redema of the lid margins, especially the upper 

 (held by Morax to be very characteristic) ; acute onset of the 

 conjunctival congestion, with moderate swelling, and occasionally a 

 superficial false membrane, so that within a short time the height of 

 the affection is reached ; and a profuse watery secretion, with a few 

 white purulent flakes. The redness of the conjunctiva bulbi is very 

 pronounced ; frequently small phlyctenular nodules occur at the 

 limbus corneae, and very often small haemorrhages, which tend to 

 increase, especially in the upper part of the bulbar conjunctiva in the 

 region covered by the upper lid. The haemorrhages soon take on a 

 pronounced yellowish-red colour, and rapidly disappear when the 

 affection subsides. This subsidence often occurs with great sudden- 

 ness ; very soon after the most acute stage is reached there is a 

 crisis : the Pneumococci, which have been very plentiful in the secre- 

 tion, rapidly disappear, and during the final stages only Bacillus 



