SPECIAL FORMS OF CONJUNCTIVAL INFECTION 227 



clearing up an old case of trachomatous parnius in a child, he intro- 

 duced gonorrhceal pus from the urethra without producing any reaction. 

 A record by Dalen (1897) should here be noted. In a mild acute con- 

 junctivitis in an adult he found a Gram-negative Diplococcns which 

 grew rather more freely on ascites agar than the Gonococcus usually 

 does, but otherwise was identical with it. Dalen rightly stated that it 

 could quite well be a mild gonorrhoea, but that in such cases attention 

 should be paid to the other allied organisms. 



Though rare, slight cases can occur on a conjunctiva which has 

 previously been quite healthy ; this has been specially mentioned by 

 Morax and his pupil Druais as a variation of ophthalmia neonatorum. 

 With regard to these Pseiido-f/onococci i.e., the confusion organisms, 

 the name not being intended in the sense of any special variety of 

 Bacteria it is especially desirable that in the future these cases of 

 apparently mild gonorrhoea should be carefully examined by culture. 

 The same may be said concerning the results of Morax, Miiller, and 

 Meyerhof , who state that the Gonoeoccus may lie latent and innocuous in 

 the trachomatous conjunctiva, as, for instance, Meyerhof reports having 

 found enormous numbers of Gonococci in a case of trachoma in the partly 

 scarred condition. According to Meyerhof 's latest reports, the Gonococcus 

 can ' winter ' on the trachomatous conjunctiva. Butler also reports that 

 in Palestine he saw very chronic cases with Gonococci present. Further 

 testing with cultures is necessary to decide this question. 



These occasional and exceptional departures from the typical 

 appearance of gonorrhoea present no special difficulty ; they' are only 

 examples of how the reaction of the conjunctiva varies with the 

 quantity and virulence of the infecting agent and the susceptibility 

 of the subject. It is obvious from Kalt's case, already quoted, that, 

 in spite of its extreme contagiousness, we can still speak of ' suscep- 

 tibility ' with regard to the Gonococcus. In this respect it is worthy 

 of notice that in proportion to the enormous frequency of urethral 

 gonorrhoea the conjunctival affection is rare in adults. 1 We should 

 further note that a conjunctival gonorrhoea may remain one-sided, 

 even although no precautions have been taken, or were possible, to 

 protect the other eye ; we must therefore conclude that profuse 



1 Meyerhof emphasizes the remarkable fact that in Egypt, in spite of the frequency of 

 urethral gonorrhoea, and gonorrhoea of the conjunctiva in adults and children, it is rare to 

 find a gonorrhceal ophthalmia neonatorum the very opposite to what occurs in Europe. 

 Butler says the same with regard to Palestine ; he considers that ophthalmia neonatorum 

 is practically unknown in that country, and states that urethral lesions were practically 

 never found in the many children and adults which he observed with gonorrhoea of the 

 conjunctiva. The infection must spread more from eye to eye than from urethra to eye. 

 Gonorrhceal conjunctivitis in summer is more dangerous to the cornea than in winter. 

 Gonorrhceal rheumatism and iritis were never seen by Butler in the East. 



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