264 BACTERIOLOGY OF THE EYE 



trachoma.' Three weeks after the commencement of the blennorrhoea 

 on the right side, a typical granular trachoma appeared on the left 

 side. In the secretion of both eyes were Gonococci (Gram stain was 

 not used). Such a question as this cannot be decided in a tracho- 

 matous country like Hungary, where the possibility of a simultaneous 

 infection with trachoma cannot be excluded. It is noteworthy that in 

 countries free from trachoma such cases are not recorded. This is 

 opposed to the view that gonorrhceal secretion can produce a 

 trachoma. 



The older records of the onset of trachoma with blennorrhoea, 1 or of 

 trachoma as the direct result of gonorrhoea, can be explained thus : A 

 blenorrhoea in many of the cases only a Koch-Weeks conjunctivitis 

 may have complicated a trachoma, or else the papillary condition of 

 the conjunctiva, which persists for some time after a gonorrhoea, and 

 resembles the so-called papillary trachoma, may have been mistaken 

 for it. This ' post-blennorrhceal conjunctivitis,' as it has been called 

 by L. Miiller, is not identical with trachoma, but disappears without 

 any scarring or the formation of a typical trachomatous pannus. It 

 was customary for many text-books to use the term ' chronic blennor- 

 rhoea ' as a synonym for certain forms of trachoma ; this still persists 

 in some modern books. If by it we are to mean a gonorrhceal infec- 

 tion, then there is no proof that such a statement represents the facts. 

 Meyerhof's statement that in many trachomatous cases Gonococci 

 could be demonstrated for a long time after the subsidence of the 

 inflammation, and could cause its recurrence, is not a proof of the 

 gonorrhceal etiology of trachoma (these records should have been con- 

 trolled by cultures to exclude the other Gram-negative cocci). Meyerhof 

 also considers that these are secondary infections. 



Infection with the Koch-Weeks bacillus can lead, in chronic cases, 

 to a hypertrophy of the conjunctiva, especially the tarsal portion. 

 Weeks and Morax first described this, and the question has since 

 been more fully studied by Hoffmann. This, however, is not a true 

 trachoma, and does not lead to its characteristic complications. 2 



Micro-organisms, designated ' trachoma cocci,' have been found by 

 Michel and Sattler, and more recently by Goldschmidt, Stadarini, 



1 Trachoma was exclusively considered as due to a blennorrhceal urethral secretion. 



a Several observers have expressed the hope that a secondary infection with Pneumococci 

 might act curatively in cases of trachoma (Ferri, Gasparrini, Rymowitsch ; see chapter on 

 ' Pnenmococcal Conjunctivitis '). Nothing has yet been brought forward to prove this. It 

 is improbable that Gonococci have this action, and their toxins certainly have no curative 

 action (Morax and Elmassian). These various forms of irritation have only been shown to 

 have a clearing effect in many cases of pannus, analogous to the action of jequirity (Wecker) 

 and jequiritol (Rbmer). An improvement in a trachoma has been occasionally observed 

 from an intercurrent erysipelas (Back). 



