SPECIAL FOKMS OF CONJUNCTIVAL INFECTION 221 



its certainty to what extent can only be decided when we have 

 answered the questions : To what extent do these Gram-negative 

 Bacteria occur upon the conjunctiva ? Under what circumstances 

 have they been met with ? 



The general experience regarding the urethra is that other Gram- 

 negative organisms are so rare in this situation that the slide diagnosis 

 ' gonorrhoea ' is in practice almost absolutely certain. Cases are 

 hardly ever known of in which the typical microscopic appearance 

 has been caused by other organisms ; the occasional recorded finding 

 of such organisms only refers to colonies occasionally seen in cultures, 

 and easily recognized there. 



With regard to the naso-pharynx and bronchitic sputum, the Gono- 

 coccus does not come into the question ; there are no records, con- 

 firmed by culture, of its occurrence in this situation. The earlier 

 isolated records e.g., Ahlfeld and Trantenroth (Dent. Med. Woch., 

 April 6, 1894, ' Gonokokken in der Mundhohle '), Rosinsky, and 

 Leyden (Zcntr. f. Gyn. u. Geburt., 1894) refer to purely micro- 

 scopical appearances, and were most probably due to the Micrococcus 

 catarrhalis. In the nasal secretion the differential diagnosis between 

 Micrococcus catarrhalis and Meningococcus may be of importance, and 

 in the slide present some difficulty. In such cases cultures are 

 available, and render the difference apparent. 



In the eye the conditions are different from those of the urethra or 

 the respiratory tract. 



We must here state that very few indisputable demonstrations of 

 Meningococcus on the conjunctiva have yet been published. C. FrJinkel's 

 findings are claimed by Urbahn, Czaplewski,'and others to have been 

 other Diplococci, as the decolorization by Gram was not complete, and 

 the cultivated organisms grew in chains. Such imperfectly Gram- 

 negative organisms should have been readily distinguished from 

 Gonococci in the slide preparation, although their shape was similar 

 a point I was able to confirm by examining the slides which Geheimrat 

 Frankel kindly submitted to me (cf. Fig. 44, p. 208). Frankel in his 

 paper only emphasized that the differential diagnosis from the Gram- 

 positive organisms required some care. (They may show the form of 

 the Diplococci.) The organism, which Haglund describes as Meningo- 

 coccus, was exquisitely Gram-positive, formed chains in culture, and 

 must be considered as one of the Streptococci. 



According to the literature collected by Gabrielides, Koplick (Amer. Med. Assoc., 

 Washington, 1904) found the Meningococcus in the secretion of a conjunctivitis 

 which preceded a meningococcal meningitis. I also find it stated that D. Smith 



