368 GONOCOCCIC INFECTIONS 



Special mention should, however, be made of such serious con- 

 ditions as ulcus serpens and other diseases of the eye, in which 

 good results have -been obtained by Allen and others. In general, 

 all localized pneumococcic diseases should be subjected to vaccine 

 treatment, if not easily amenable to surgical operation. 



Gonococcic Infections. 



Here again we have to deal with an organism which exerts its 

 pathogenic effects mainly or entirely by means of an endotoxin. 

 The lower animals are entirely refractory to infection with living 

 cultures, whereas the dead bodies of the cocci produce local 

 inflammatory changes (peritonitis, etc., according to the region 

 into which the inoculation is made), or death if the dose is suffi- 

 ciently large. The toxicity, however, is but slight, and that of 

 the filtrate from the cultures is extremely small. Several 

 observers claim to have produced a soluble exotoxin, but there is 

 considerable doubt as to the interpretation of their results, and in 

 all probability the substances present in these fluids are simply 

 traces of endotoxin, or free receptors let loose by the autolysis of 

 a few of the cocci. Analogy with other diseases would rather 

 suggest the absence of a powerful exotoxin. In the great majority 

 of cases the disease is a purely local one, and the symptoms of a 

 general intoxication very slight. The endotoxin is said to be very 

 stable, resisting the temperature of boiling water for some hours. 



The hgemic indications of immunity are but slight. Bacterio- 

 lysis has not been demonstrated, 1 but there is some evidence to 

 think that immunization may be due at least, in some cases to a 

 rise in the opsonic index, and since some part of the newly-formed 

 opsonin is, or may be, thermostable, it is possible that some small 

 amount of immune body may be produced. According to Allen, 

 the opsonic index in acute gonorrhceal infections is somewhat 

 below normal 0-6 or 07; and when spontaneous cure takes place 

 it rises gradually, going as high as 1-6. If, however, it remains 

 subnormal, the case passes on into one of intractable gleet. But 

 in acute gonorrhceal conjunctivitis in adults the index may be as 

 high as 2-5, showing, as has been already seen in other diseases, 

 that a high index is no proof of immunity. Agglutinins also occur 

 in the serum of immunized animals (Torrey treated a rabbit the 



1 Torrey has recently shown that an antigonococcic serum which he has 

 prepared possesses powerful bactericidal properties. 



