SPECIAL FORMS OF CONJUNCTIYAL INFECTION 231 



quite different from that of the other infections. The series of 

 Groenouw, von Ammon, and Morax confirm this. With rare excep- 

 tions, gonorrhosa lasts for weeks, requires special treatment, and is 

 very dangerous to the cornea ; l the other forms more rapidly subside, 

 especially the pneumococcal conjunctivitis. Gonococcal infection more 

 commonly leads to severe purulent blennorrhrea, non-gonorrhceal to 

 slight forms of catarrh. 



In many series (Druais) almost half the cases cannot be denned bacteriologically ; 

 in these either nothing is found or else the inevitable B. xerosis, with or without a 

 few cocci. The irritant here is probably a chemical traumatism. 



Cramer has shown that bruising of the conjunctiva often occurs during par- 

 turition, and chemical irritation can occur very easily. The use of silver nitrate 

 (Crede), so common in these cases, can also produce a profuse catarrhal secretion. 

 Cramer is of the opinion that in such damaged conjunctivas the otherwise harmless 

 Stapliylococci, which always settle down a few days after birth, can multiply and 

 produce a secretion in spite of their low virulence. Morax states that these are the 

 cases in which hereditary syphilis plays a part. That an influence which generally 

 is slight and weak can markedly affect the onset and the course of a catarrh is 

 shown by the frequency of catarrh in premature and weakly children. It is quite 

 rational to treat cases which are progressing badly by antisyphilitic measures 

 (Lagrange). 



No etiological significance can be attributed to the Bacillus xerosis, so commonly 

 found in the last-mentioned group. Groenouw examined several cases, and found 

 that the bacilli were quite avirulent when tested on animals, and did not react to the 

 Neisser stain. It is very exceptional to find virulent diphtheria bacilli in newly- 

 born infants. 



Groenouw cultivated the Gonococcns from the conjunctiva in forty- 

 one cases, and found that, as a rule, the following was characteristic : 

 the organisms grew with certainty only on serum agar ; a very slight 

 growth exceptionally occurred on the ordinary media, but only when 

 pus was removed with the organism ; they could not be propagated 

 further on these ordinary media. 



The presence of the Gonococci continues parallel with the amount of the dis- 

 charge ; when the Diplococci disappear the secretion ceases. Groenouw has, how- 

 ever, shown that cases do occur in which the Gonococci persist after the secretion 

 has ceased, even up to the twenty-fifth day. Meyerhof talks of a persistence for 

 a month. 2 This was probably due to the presence of Gonococci on a conjunctiva 

 which had practically returned to the normal condition, and suggests the develop- 

 ment of immunity, the more so as gonorrhoea of the conjunctiva always heals 

 without treatment, though in some cases only after destruction of the cornea. A 

 true chronic gonorrhoea of the conjunctiva has not yet been observed. After the 



1 Not only can the Gonococcus infect the globe of itself, penetrating into the iris 

 (Dinkier) even as far as the equator (French), but suppuration of the globe can take place 

 from the pyogedfic organisms present at the same time (Kalt, Chibret), after the toxin of 

 the Gonococci has prepared the way by loosening the corneal epithelium (experiments of 

 Coppez). Chartres says that the associated presence of Streptococci is especially dangerous. 



2 It is doubtful whether these persisting cocci did not belong to the other Gram-negative 

 groups. A careful diagnosis by cultures is to be recommended in such interesting cases. 



