SPECIAL FORMS OP CONJUNCTIVAL INFECTION 187 



Eupprecht 1 has lately recorded a double-sided case of conjunctivitis in my own 

 clinic where a severe corneal suppuration occurred, the cultures being pure 

 Streptococci. The cultures corresponded throughout to the Schottmiiller type. 

 In the secretion a differentiation from the Pneumococcus was not possible, as 

 elongated Diplococci occurred with the round encapsulated cocci and chains, though 

 on media which was quite suitable for the growth of Pneumococci only the 

 Streptococcus mucosus grew. In the heart blood of a mouse inoculated with a 

 pure culture of Stre})tococcus mucosus the elongated forms were not entirely absent. 



Bupprecht has lately made the same observations in pus from a case of dacryo- 

 cystitis, so that I can definitely assert that morphologically the so-called Strepto- 

 coccus 'mucosus cannot be absolutely distinguished from the Pneumococcus. 



I am strongly of the opinion that the Streptococcus mucosus should be merely 

 considered as a variety of the Pneumococcus. The type is rare in the eye. 



The view that the Streptococcus mucosus is really a Pneumococcus is increasing, 

 and Levy (Virchoiu's Archives, 1897, Bd. clxxxvii., Heft 2) states that he prefers 

 to use the term Pneumococcus mucosus, an opinion which I consider justifiable 

 (cf. Cent. f. Bakt., 1907, xxxix., p. 552: Duval and Lewis). The fact that after 

 long cultivation Loncope, Beitske, and Rosenthal observed the development of the 

 ordinary characteristics of the Pneumococcus in a mucosus strain, is strongly in 

 favour of this view. In other cases this change could not be obtained (Schleuer, 

 Cent. f. Bakt., 1907, Orig., xliii., p. 332). Romer also records such transition. 



It is noteworthy that fluid cultures of the Streptococcus mucosus, like the 

 Pneumococcus, are cleared by bile or sodium taurocholate, while those of Strepto- 

 coccus pyogenes are not. 



When a strain shows the typical lancet-shaped Diplococci in a secre- 

 tion or blood-film preparation, the fact that it grows in the form 

 of chains does not affect the diagnosis of Pneumococcus. The most 

 certain test is the inoculation of an animal, and finding in its blood 

 the typical Pneumococci. Pathogenicity for mice is not a certain test, 

 as it occasionally occurs in Streptococci. 



When we have growth occurring on gelatine at room temperature, 

 it will generally indicate a Streptococcus, but there are Streptococci 

 which will not grow thus. It is only very rarely that Pneumococcus 

 strains become adapted to growth at room temperature. Human serum 

 not heated is almost always coagulated by the action of Pneumococcus. 



Pneumococci in bouillon are dissolved by the addition of a few drops 

 of taurocholate of soda ; the liquid becomes clear. Streptococci, on 

 the other hand, are not affected by it. This was first discovered by 

 Neufeld, and has since been confirmed in my laboratory by Weekers. 

 The method of differentiation by means of the fermentation of various 

 sugar media (dextrose, maltose, lactose, saccharose, mannite, dextrine) 

 is not absolutely certain. 



Norris, Charles, and Papenheimer 2 state that fermentation of His' 



1 K. M. f. A., 1907. For ' Metastatic Ophthalmia from Streptococcus mucosus,' see 

 Pagenstecher, K. M.f. A., 1906, ii. 



2 Jour, of Expcr. Med., 1905, vol. vii., No. 5. 



