SPECIAL FORMS OF CONJUNCTIVAL INFECTION 235 



In rare cases of pseudo-membranous conjunctivitis Stapliylococcm 

 anreus alone is found in enormous numbers (Gasparrini, Pichler, 

 Jessop, Coppez, Gosetti and Jona, Bietti, Roscher). These cases can 

 be both severe and lasting. It is much more common to have diph- 

 theria bacilli and Streptococci along with the Stapliylococci. 



Further research is necessary to determine the causal connexion 

 between the Stapliylococci and the so-called phlyctenular external 

 affections of the eye (eczematous and scrofulous). 



Sporadic, and usually mild, cases of catarrh are found which do 

 not show the usual conjunctivitis organisms. It is difficult to say 

 whether the Stapliylococci, which are so often found in these cases 

 along with the xerose bacilli, are causal or not. Stephenson, Eandolph, 

 Duane, -and Hastings hold the view that they are causal. Hirota 

 states that their occurrence in these cases cannot be differentiated 

 from their occurrence on the normal conjunctiva. 



Morax and Elmassian have shown by protracted instillation that 

 the toxins of the virulent Stapliylococci can produce severe irritation 

 in the conjunctival sac. Randolph produced severe inflammation 

 by their subconjunctival injection. In his latest publication Morax 

 states that a staphylococcal conjunctivitis is quite rare. In his last 

 work on conjunctivitis he insists that the Stapliylococci mostly develop 

 secondarily that is, when some other irritation has already occurred ; 

 it is quite possible that they can then increase and keep up the 

 inflammation, provided that a really virulent form is present. This 

 may explain how Meijers was able to produce a conjunctivitis in 

 rabbits by the introduction of virulent Stapliylococcus aiireus into the 

 conjunctiva, after ligaturing the lacrymal passages, and stitching the 

 lids together. Romer produced the same result when he irritated the 

 conjunctiva with dust, sand, etc., at the same time as he inoculated 

 it ; Samperi did the same ; and Cramer is of the opinion that when 

 the conjunctiva has been squeezed and made susceptible during par- 

 turition, the Stapliylococcus can act as tjae cause of an inflammation in 

 the newly-born. 



Gonin, after carefully considering this question, came to the con- 

 clusion that in some cases of pseudo-membranous conjunctivitis, 

 catarrh with eczema of the lids, etc., the Staphylococci may be con- 

 sidered as the cause, especially if present in large numbers and 

 in a virulent condition, but that in the majority of cases they cannot 

 be so considered. Lundsgaard takes the same view, and I also agree 

 with him. We must not speak of a ' mixed infection ' if along with 

 the organism causing the conjunctivitis numbers of Stapliylococci can 



