SPECIAL FORMS OF CONJUNCTIVAL INFECTION 179 



.rcrosis and titapliylococci are to be found. This distinct critical 

 termination, to which Axenfeld first called attention, comparing it 

 with the crisis in pneumonia, is often well seen in ophthalmia neona- 

 torum (cf. von Ammon, Milncli. Med. Woch., 1900, L, p. 12). 



Although these catarrhal inflammatory symptoms can also occur 

 in Koch- Weeks conjunctivitis, the peculiar critical termination, gener- 

 ally with rapid improvement and without any vigorous treatment of the 

 conjunctiva, is very characteristic of pneumococcal conjunctivitis. The 

 frequent occurrence of a severe ' cold in the head ' is not to the same 

 degree peculiar to the other forms of infection. The typical course 

 of a pneumococcal conjunctivitis occurs more often in epidemics than 

 in sporadic cases, and many authors (e.g., Pollock) who have only 

 seen single cases have never had the opportunity of observing this 

 critical course. 



In sporadic cases, however, it is often so obvious that Junius, 

 Gifford, Gonin, and Hauenschild were able from it to establish a pro- 

 visional diagnosis in the great majority of their cases. This is more 

 often possible in districts where Koch- Weeks conjunctivitis does not 

 occur; while in those districts in which both forms are plentiful 

 greater caution must be observed, as of course an etiological diag- 

 nosis from purely clinical observation can only be called probable. 



In my experience a chronic pneumococcal conjunctivitis is rare ; in 

 such cases we must carefully examine for a dacryocystitis or dacryo- 

 stenosis, which is secondarily affecting the conjunctiva. Scholtz and 

 Vernier report that they have found chronic cases rather more fre- 

 quently. In connexion with this diagnosis, the facts given on 

 p. 112 (the facultative producers of conjunctivitis) must be carefully 

 considered. 



I was able to demonstrate that a disposition for children occurs in 

 many epidemics, as, for example, in one village very many children, 

 but not a single adult, were affected, although the latter took no pre- 

 cautionary measures, and often came in contact with infected material. 

 In this sense, therefore, pneumococcal conjunctivitis is a disease of 

 children. This peculiarity does not, however, occur in all epidemics, 

 and adults are sporadically affected no less frequently. Junius and 

 Hauenschild confirm this. It is worth noting that no large epidemics 

 have yet been described amongst adults, although such are often 

 caused by the Koch- Weeks bacillus. 



It appears not improbable that a definite conjunctival immunity to 

 Pneumococci generally occurs amongst adults. 



It is quite established that a very superficial false membrane can 



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