etiological significance. Post-operative conjunctivitis is probably to be 

 better explained on the ground of mechanical and chemical (cocaine, 

 disinfection) irritation before and at the operation. The Bacteria found 

 in these cases vary very much. 1 



We have no records of definite inoculations of the conjunctiva with 

 the Micrococcns catarrlialis. (Its pathogenicity for the nose is only 

 probable on account of its enormous numbers in the secretion ; no 

 positive inoculations have been made.) The pathogenic importance 

 of the Micrococcits catarrlialis on the conjunctiva if, indeed, it has 

 any still requires further investigation, and more exact bacteriological 

 studies of these organisms would be useful. 2 



With the clinical appearances of a blennorrhcea, the practical 

 diagnosis of gonorrhoea can now be made from the Gram-stained slide 

 with so great a degree of certainty that the faint possibility of the 

 occasional presence of Meningococcus or Micrococcns catarrlialis need 

 not be taken into consideration. Mistakes are more likely to arise in 

 the slide diagnosis of very early cases. 



When we find Gram-negative cocci present in a slight catarrh, it 

 may be a case of mild gonorrhea, and when a culture diagnosis 

 cannot be made, we should in practice consider the more serious 

 condition to be present, and act accordingly ; but the possibility of 

 the Micrococcns catarrlialis must also be considered. If cultures are 

 made before a case is diagnosed as ' mild gonorrhoea,' we should then 

 be in the position to decide how frequently cases of 'mild gonorrhoea' 

 occur. The statement that, after the healing of a gonorrhoea, the 

 Gonococcus remains in the conjunctiva (Groenouw), and can cause 

 recurrences (Meyerhof), requires the same control. 



Having found large numbers of intracellular kidney-shaped, Gram- 

 negative Diplococci in a case of blennorrhoea, the clinician may con- 

 sider it as good as certain that he has to deal with gonorrhoea ; in other 

 cases the probability is that such is present. Those cases in which 

 the Micrococci both clinically and microscopically give the impression 

 that they are saprophytes, and where, in sharp contrast to the cases of 

 gonorrhoea, there is no genital lesion, according to our present know- 

 ledge, we should especially ascribe to the benign Micrococcns catar- 

 rlialis, or to one of the other varieties, and not to the Gonococcns. 



In this manner our knowledge will increase, and we shall not be 



1 I have most commonly found B. xerosis, and also white (rarely yellow) Staphylococd. 

 They have a tendency to take the form of Gram-positive, intracellular Diplococci (see 

 Plate II., Fig. VI.), and on inoculation show only moderate or very slight virulence ; 

 probably they have very little to do with the catarrh (cf. also p. 81). 



2 Duane and Hastings report in their series that they twice found the Mic. catarrlialis 

 associated with the Koch- Weeks bacillus. Such diagnoses should be verified by cultures. 



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