There are a few landmarks of clinical observation to be mentioned in considering the part played by the gonococcus in hot climates where trachoma is common or perhaps universal. The first was the recognition by Muller, in 1898, that the infiltration of the superficial layers of the cornea by trachomatous granulation tissue, or pannus, is a means of defense against damage of the cornea by ulceration caused by gonococcic conjunctivitis.
The second was the observation made by Morax, in 1901, that there is no such condition as acute trachoma, and that acute signs occurring in a trachomatous subject are the result of a superimposed infection with gonococci or other known bacteria.
It is probable, moreover, that the presence of trachomatous conjunctivitis predisposes the membrane to infection by gonococci, or, in other words, that the trachomatous conjunctiva provides an excellent culture medium for these organisms.
It is to
MacCALLAN AF. RôLE OF THE GONOCOCCUS IN PURULENT OPHTHALMIA IN WARM CLIMATES. Arch Ophthalmol. 1934;12(6):819–823. doi:10.1001/archopht.1934.00830190031002
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