226 BACTEKIOLOGY OF THE EYE 



neglecting ascertained clinical and bacteriological facts, and without 

 further thought identifying the various members of the family of the 

 Gram-negative Diplococci with each other. 



The Clinical Appearances of Gonorrhoeal Infection. 1 

 Blennorrhcea. Ophthalmia Neonatorum. 



In comparison with its action on the urethra, the action of the 

 Gonococcus on the conjunctiva is peculiar in the following respects : 



1. The resulting conjunctivitis does not present a clinical picture 

 which is so peculiarly characteristic as is the case in a gonorrhceal 

 urethritis. 



2. The appearance of a blennorrhcea, classically produced by the 

 action of the Gonococcus on the conjunctiva, can also be due to other 

 agencies ; it is not so exclusively a gonorrhoeal condition as in the 

 case of the urethra. 2 



3. A true chronic gonorrhoea of the conjunctiva, comparable with 

 that so commonly found in the urethra, where the Gonococcus can be 

 found for years on the mucous membrane, has never been certainly 

 recorded (vide Groenouw's and Meyerhof's results). 



It has been established that a milder affection can result from the 

 action of the Gonococcus; such cases approach the type of a simple 

 catarrh, and are not merely the less acute stage at the onset or termina- 

 tion of the severe form. This latter possibility can occur in special cases, 

 when, before the onset of the gonorrhoea, the conjunctiva has been 

 the site of scarring. Miiller has often observed this in Egypt in the 

 case of patients with old trachoma. Even if we do not allow that 

 the Gram-negative intracellular Diplococci really were Gonococci, but 

 insist that they belonged to the allied but not identical species (vide 

 supra), we still can establish the existence of quite mild cases of 

 gonorrhceal catarrh. In 1888 Schmidt-Kimpler asserted that mild 

 cases of gonorrhceal conjunctivitis did occur. In a newly-born child 

 von Herff observed a delayed infection with Gonococci, taking the form 

 of a simple catarrh. In my own clinic Brons has recently observed 

 a mild ophthalmia neonatorum in which he demonstrated the Gono- 

 coccus microscopically and by cultures. Kalt has clearly shown that 

 the introduction of gonorrhceal secretion into the conjunctiva does not 

 always produce the action that would be expected. With a view to 



1 Metastatic gonorrhoea! conjunctivitis, mentioned on p. 130, is here excluded. 



2 The exceptional occurrence of a urethritis without Gonococci is recorded and confirmed 

 by Jadassohn (see Urbahn, A. f. A., Bd. xlv., Ergzgsh.), Goldberg (A. f. Derm. u. 



1901, Bd. Iviii., p. 113, where further literature is given), and Morax. 



