180 BACTERIOLOGY OF THE EYE 



occur ; severe pseudo-membranous forms due to Pneumococci alone 

 are rare. Croupous and diphtheritic forms have been described by 

 Wagner, Pes, Gonin, Morax and Petit, Fruginelli, Kimpel, and Hertel. 

 A lid abscess occurred in Fruginelli's case. 



According to the observations of Bardelli, Axenfeld, and Rymo- 

 witsch, an iritis from absorption of toxins can be associated with a 

 pneumococcal conjunctivitis, and that without any affection of the 

 cornea. Gasparrini, who saw quite a large proportion of severe cases, 

 states that the iritis frequently occurs at the beginning of the affec- 

 tion ; Rymowitsch agrees in this. Those cases in which severe pain 

 and swelling of the pre-auricular gland occur resemble the clinical 

 appearances of the ' lacrymal streptococcal conjunctivitis ' described 

 by Parinaud and Morax. I can confirm the statement of Rymowitsch 

 that the iritis can outlast the conjunctivitis. 



Although a pneumococcal infection of the cornea (ulcus serpens) 

 is very common after slight injuries, it is very rare in a true pneumo- 

 coccal conjunctivitis. The experiments of Coppez show that pneumo- 

 coccal toxin has very little or no influence on the intact corneal 

 epithelium; in the absence of any casual injury, therefore, the oppor- 

 tunity for the organism to settle down can only rarely occur. 

 Gasparrini, Gifford, and Junius often saw so-called catarrhal infiltrates 

 and ulcers. Severe suppurations rarely occur (Gasparrini, Wagner, 

 Hertel), Oertzen described a severe wound infection from an inter- 

 current conjunctivitis. 



The great importance of pneumococcal infection of the conjunctiva 

 in the new-born infant, previously asserted by Morax and Parinaud, is 

 clearly shown in the works of Axenfeld, Groenouw, von Ammon, 

 Lundsgaard, and Schmidt- Rimpler. These observers agree that this 

 catarrh is considerably milder than that due to the Gonococcus. 

 Severe cases of blennorrhoea neonatorum, due to Pneumococci, are 

 certainly very rare (Gasparrini). 



In trachomatous countries records by Gasparrini, Gifford, Junius, 

 Lakah, Khouri, and Rymowitsch show that pneumococcal con- 

 junctivitis may be associated with trachoma, making it acute or 

 chronic. It is, however, peculiar that in a country (Egypt) where 

 trachoma is so frequently combined with Koch- Weeks infection a 

 mixed infection with Pneumococci is so rare. The preference of pneumo- 

 coccal conjunctivitis for cold climates is also remarkable. 



The formation of follicles in pneumococcal conjunctivitis has only 

 rarely been observed (Axenfeld, Junius). When they occur in large 

 numbers, as a rule they have existed previously, and the appearance 



