SPECIAL FORMS OF CONJUNCTIVAL INFECTION 205 



Streptococci. 



(See here PLATE II., FIG. IV.) 



As we have already said, the Streptococcus pyogenes, either alone or 

 in conjunction with the B. diphthe-rue, is the most important factor in 

 those very severe diphtheritic processes, which can cause necrosis of 

 the whole conjunctiva and great danger to the cornea. These cases 

 are very dangerous to life on account of secondary sepsis. The whote 

 surface of the conjunctiva and cornea forms a culture of Streptococci. 

 Such cases are often found in the descriptions of streptococcal infection 

 by Fage, Chevallereau, Vialet, Bourgeois and Gaube, Debierre, Ville- 

 neuve, Despagnet, H. Coppez, Pichler, Darier, Vanderstraeten, 

 Lebrun, Gasparrini, Uhthoff, Gosetti and Jona, Kauffrnann, Valude, 

 0. Meyer, Martin, Pes, Howe, Weeks, Becker, Vossius, Zur Nedden, 

 Saemisch, Chartres, Hieber, Brewerton, Lawson, etc. 1 



Most of the cases were children who were badly nourished or had 

 hereditary syphilis ; others were in convalescents. [Chartres reports 

 seven cases in newly-born children, in which only one had a pseudo- 

 membrane, the other six being typical blennorrhrea. They were all 

 severe cases ; some of them had perforation of the cornea. One child 

 died of broncho-pneumonia. Except for these cases, Streptococci 

 have only rarely been described in ophthalmia neonatorum (Druais, 

 Groenouw, Haupt, Zur Nedden, Weigelin). It is possible that Chartres 

 was mistaken in his cultures, as Pncumococci also form chains.] It is 

 probable that the diphtheritic condition of the conjunctiva in measles 

 and scarlet fever belong to this class (Vialet, Uhthoff, Axenfeld, 

 Schottelius). In many epidemics of measles Streptococci are com- 

 paratively common in the secretion of the ordinary exanthematous 

 conjunctivitis without membrane formation (Schottelius) ; this should 

 raise the suspicion that we have to deal with a severe epidemic. In 

 the one which was observed by Schottelius and myself the mortality 

 was not only exceptionally high, but the number of very severe cases, 

 with subsequent eye complications and necrotic streptococcal infec- 

 tions, was also very large. Except in the cases mentioned above and 

 the following ones, it is rare for the Streptococcus to cause a primary 

 conjunctivitis which is not pseudo-membranous. A simple primary 

 conjunctivitis due to Streptococcus is an extreme rarity. The so-called 

 lacrymal streptococcal conjunctivitis (Parinaud, Morax) which follows 

 a stenosis of the nasal duct is a secondary form ; it causes a severe 



1 In one case recorded by HolteuhofF a bilateral orbital cellulitis occurred. 



