SPECIAL FORMS OF CONJUNCTIVAL INFECTION 229 



neonatorum, mostly produce a simple catarrh, with mild results ; but 

 they may occasionally produce an appearance which cannot be dis- 

 tinguished clinically from the true gonorrhoea. This has lately been 

 confirmed by von Herff (' Jahresber. Basel/ 1903, p. 34). The Diplo- 

 bacillus (Morax-Axenfeld) has been found in some rare cases (Andrade, 

 Collomb ; see Druais, p. 74). Von Ammon found Friedliinder's Pncumo- 

 bacillus three times, von Herff Pyocyaneus twice. Axenfeld, McKee, 

 and Bietti found the Bacterium coli commune in large numbers and in 

 pure culture ; they stated that it probably had an action in producing 

 a conjunctivitis. Chartres, Druais, and others, found the Streptococcus 

 pyoyencs; Zur Nedden found the 'pseudo-influenza bacillus,' or, 

 rather, the influenza bacillus, pure in cases presenting the appear- 

 ance of a severe blennorrhrea ; Druais and Morax also described 

 a slight case in which they found the Pfeiffer influenza bacillus ; 

 Gasparrini described cases complicated with severe destruction of the 

 cornea, in which he found Pneumococci of high virulence ; Axenfeld, 

 Deyl, and Schmidt found pure cultures of very virulent diphtheria 

 bacilli in cases of ophthalmia neonatorum with marked membranous 

 formation, which rapidly healed under the influence of the curative 

 serum, also single cases with enormous numbers of highly virulent 

 Stapliylococcus an re us; Cramer, Schmidt-Rimpler, Groenouw describe 

 the Micrococcns lute us as present, an organism which is identical 

 with the coccus which von Herff found in a case of ophthalmia, and 

 called the Diplococcus flavus, an allied organism to the Staphylococcug 

 anreus ; Axenfeld, Cramer, Groenouw, Konigstein, Morax, and von 

 Herff agree that a typical blennorrhcea can occur without any definite 

 bacteriological findings. 



To consider, as does E. von Hippel, that in these cases the Gonococci were only 

 difficult to demonstrate, and that they might have even escaped the repeated 

 examinations, is not justifiable, as the authors mentioned examined their cases with 

 every precaution, and it is well known from experience that in gonorrhoea of the 

 conjunctiva, the cocci are freely to be seen in the pus. To avoid any error, only 

 cases which have not been treated, and are not subsiding, should be considered as 

 a test. L. Miiller has recently stated that cases of gonorrhoea of the conjunctiva 

 do occur in which the Gonococcus can neither be demonstrated in the secretion nor 

 in the culture. In such cases there is a great tendency to attribute the cause to 

 other harmless organisms which may be present. 



Fuller details of this rather surprising finding are not available. 



The etiology of those rare cases 1 (Magnus, Galezowski, Hirsch- 

 berg, Niederf, Friedenwald, Strzeminski, Cunningworth, Armaignac, 



1 Sidney Stephenson and Ford have reviewed the literature of the fifty-five cases 

 published up to date. In their own eighteen cases they found the Goiwcoccus fifteen times, 

 the Pneumococcus twice, and the Bacillus coli communis once. 



