230 BACTERIOLOGY OF THE EYE 



H. Woods, Morax, Sidney Stephenson, and R. Ford, etc.) in which a 

 child is born with either a commencing or an advanced blennorrho3a, 

 sometimes even with corneal lesions naturally intra-uterine infection 

 is not etiologically unique, as here also the Gonococcus is much the 

 most important agent, just as in the cases which begin on the first or 

 second day (see the literature by Saemisch, loc. cit., and Morax, loc. cit.}. 

 Gasparrini has described a severe case of congenital pneumococcal 

 conjunctivitis. On the other hand, the catarrh which sets in later 

 (i.e., from the seventh day on) in the great majority of cases is not 

 gonorrhoeal. 



The determination that a blennorrhoea of the conjunctiva which 

 is not gonorrho3al does sometimes occur, does not disturb to the 

 slightest degree the etiological significance of the Gonococcus in those 

 cases in which it is found in the pus. It is absolutely undoubted that 

 gonorrhoaal pus can produce a conjunctivitis, especially seeing that 

 the inoculation of pure cultures of the Gonococcus on the conjunctiva 

 has furnished definite proof ; l in the same way the occasional absence 

 of a reaction after inoculation (see Kalt) does not affect the positive 

 results. Even if in the course of time many of those organisms which 

 we now consider as Pseudo-gonococci should be proved to be merely 

 varieties of the Gonococcus, its pathological significance would remain 

 certain. 



The above facts must not be considered to indicate that there is no 

 clinical difference between gonorrhoea of the conjunctiva and other 

 forms of catarrh. On the contrary, although perhaps we cannot 

 always say on the first clinical examination, whether the case is one of 

 gonorrhoaa or not, the further course of the gonorrhoea is, as a rule, 



1 Kartulis obtained a typical urethral gonorrhcea with the pus from a conjunctival case. 



Abscesses corresponding to the peri-urethral are rarely found in the eye. In cases such 

 as that of Fuchs (' Lehrbuch,' 1905), where the lids were gangrenous, some other infection 

 probably was at work (Streptococcus, B. diphtheria;). In a few cases the lacrymal gland has 

 been affected (Seligsohn). The majority of the cases of dacryo-adenitis, with urethral 

 blennorrhoea. seem to have been certainly metastatic, and not ectogeuoui^ (Panas, Gonella, 

 Terson, Pes, Morax and Ferry, Etievant; see the literature by Pes, A. f. A., 1905, li. 157). 

 The anterior ethmoidal cells are affected in rare cases (G. F. Suker, Ann. of Ophth., April, 

 1905). In Campbell-Posey's cases the sphenoidal sinus and the nasal cavity were affected 

 (Philadelphia Ophth. Sect., November, 1906, and Ann. of Ophth., 1907, p. 71). Pus from 

 the sphenoidal sinus contained the Gonococcus; considering the prevalence of the Micr. 

 catarrhalis in the nose, cultures would have been desirable in this case. The occurrence 

 of a general infection from the conjunctiva is uncommon. Such cases of conjunctival 

 gonorrhreal rheumatism have been described by Deutschmann. Lindemann, Wicherkiewicz, 

 Sobotka, Koock, Ross, Lucas, Comba, Paulsen, Smith. Altland, Neuberger, Dahlstroem. 

 For further cases, see the literature by Pes (loc. cit., p. 161), and by Saemisch (p. 236); 

 also by Wodrig (Inaug. Dissert., Berlin, 1906). In certain of these cases the Gonococcus 

 was found in the joints (Deutschmann, Lindemann, Hoek, Sabotka, Finger, Paulsen, 

 Altland, Dahlstroem, Hocheisen). Of very rare occurrence are such cases as those of 

 Murray fatal general infection with endocarditis (Ophth. Record, 1900, p. 63) ; Stevens 

 (Ibid., 1905, p. 519), and Bremer (Deutsche Med. Woch., 1905, No. 2). 



