204 BACTERIOLOGY OF THE EYE 



intact conjunctiva a typical pseudo-membranous conjunctivitis set 

 in. 1 This proves that the diphtheria poison alone is capable of 

 producing a pseudo-membranous conjunctivitis. This is not con- 

 tradicted by the fact that, as a general rule, virulent diphtheria bacilli 

 are only found on the human conjunctiva when the ground has been 

 first prepared for them by an eczema or scrofulous condition of the 

 lids (Uhthoff). It is of interest to note that Coppez found diphtheria 

 bacilli in an extraordinary case of chronic conjunctival diphtheria which 

 had existed for a year. The literature referring to this little-known 

 form is collected in his paper. T. H. Harlan describes a similar case 

 of several months' duration with virulent diphtheria bacilli. It is a 

 question in many cases whether a pemphigus or a herpes iris con- 

 junctive (Hanke) was not present. 



As will again be stated in the special chapters, the formation of a pseudo-mem- 

 brane can occur in a conjunctivitis due to the Koch- Weeks bacillus, the Pneumo- 

 coccus, or the Gonococcus, As a rule, this consists merely of a superficial mem- 

 brane, easily removable. Cases have been described in which a severe pseudo- 

 membranous lesion has been caused by Pneumococci (Becker, Boscher, Kimpel, 

 Hertel, Fruginelli, and Christ). If we are to consider the conjonctivite snraigue 

 of Sameh Bey as an infection with Koch-Weeks bacillus, then this organism must 

 be capable of causing necrosis of the cornea. Peters and Kruse are inclined to 

 attribute the formation of a slight pseudo-membrane e.g., after an injury to the 

 action of avirulent Bacillus xerosis; whether rightly or not is yet to be decided. 

 The results of Lor, C. Frankel, Uhthoff, and Eoscher show that occasionally the 

 Gonococcus can produce a pseudo-membrane ; slight membranes are well known to 

 occur in gonorrhoea. A similar condition occurred in a case of diplococcal infec- 

 tion described by C. Frankel (see p. 208). A similar state of the conjunctiva 

 is recorded with the exclusive presence of Staphylococcus pyogenes aureus 

 (Bietti, Christ, Guibert, Pichler, and others) ; also with Friedlander's bacillus 

 (Brayley and Eyre). A case by Taylor showed only Coli communis; 2 one by 

 Knapp enormous numbers of influenza bacilli. The coli has the power of forming 

 pseudo-membranes in other parts of the body. 



In the case of these various organisms, which are also found mixed, the clinical 

 pictures vary somewhat. 



Considering them all, we must say that the other organisms are far behind the 

 diphtheria bacilli 3 and the Streptococci in their power to produce membranous 

 conjunctivitis, especially the diphtheritic form, and that the severe necrotic forms 

 more commonly are due to Streptococci, either alone or with Loffler's bacilli. 



Finally, cases are not so very exceptional in which a well-marked croupous con- 

 junctivitis gives no bacteriological results of any value. According to the results 

 obtained by Peters and Axenfeld, this is especially the case in the so-called scrofu- 

 lous inflammations, which can reach this height without any demonstrable bacterio- 

 logical cause. 



1 The reason why Valenti, in his experiments on animals with toxins of diphtheria, only 

 obtained slight irritation was due to the fact that he did not. drop it in for a long enough 

 time. 



2 For the literature of these cases, see Lubarsch-Ostertag, ' Ergebnisse, ' 'Bakt. des 

 Auges,' 1894-1900. 



3 Sometimes a diphtheria of the skin of the lids occurs with severe necrosis (cf. chapter 

 on ' Gangrene of the Lids '). 



