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262 conjunctiva and the purulent secretion are sometimes more and sometimes less threatening. Frequently the exudation from the mucous membrane is so copious that, upon everting the lids, one can see it collect upon the surfaces while under observation. Frequently the exudate is at the same time so coagulable that it immediately forms a membrane which covers the mucous surface, and, when the lids are closed, may extend unbroken from the inner surface of one to the other. Frequently the mucous membrane shows also a great inclination to bleed, so that the eversion of the lids or the least touch suffices to provoke a hemorrhage, which, however, when the lids are returned to their normal position, generally ceases again spontaneously. This symptom has no special prognostic or therapeutic importance.

During the first days of a severe blennorrhœa neonatorum the cornea often shows a slight diffuse cloudiness throughout its whole extent; this, however, disappears entirely under suitable treatment. Any corneal affection which occurs is generally in the form of a circumscribed purulent infiltration.

Gonorrhœal blennorrhœa is caused by inoculation of the gonorrhœal secretion upon the conjunctiva, and often proves one of the severest and most dangerous forms. The inflammation may, however, assume a milder type in cases where the inoculating secretion has been diluted.

There are no special symptoms by which a gonorrhœal blennorrhœa can be recognized as such in cases where it is not possible to discover the gonorrhœa as a cause. Moreover, this etiological fact has no influence upon the prognosis or treatment of the blennorrhœa.

Blennorrhœas in which the infection is caused by inoculation with conjunctival secretions are very frequent, since all conjunctival affections accompanied by a muco-purulent secretion may be regarded as infectious. As a general thing, there is a certain agreement in type between the original and the inoculated disease. But one often sees very malignant blennorrhœas resulting by inoculation from slight conjunctival affections.

The course and prognosis of acute conjunctival blennorrhœas depend in the first place upon the degree of the inflammation. Mild cases may be cured by proper treatment in from one to two weeks; severe ones in from six to eight weeks. The most impor-