GONOCOCCUS. 553 



duced in animals; the cocci are killed without be- 

 ing permitted to proliferate. The endo toxin (gon- 

 otoxin) is fairly resistant to heat, being destroyed 

 only after prolonged exposure to a temperature of 

 100 C. 



In man the mucous membranes and endothelial 

 surfaces are more susceptible to infection than 

 other tissues. The urethra of male and female at 

 all ages, the conjunctiva in the new-born, the 

 vagina, uterus and tubes are probably the most 

 susceptible. Less susceptible are the vagina in 

 older women, especially those who have borne chil- 

 dren, the bladder and, in adults, the conjunctiva. 

 It is remarkable that there are so few cases of 

 gonorrheal ophthalmia in adults, considering the 

 opportunities for infection. Infection of the 

 mouth, nose and tear sacs is extremely rare. Ex- 

 tension from the urethra to adjacent structures 

 takes place either by way of the surfaces, as in 

 involvement of the prostate, epididymis, glands of 

 Bartholin, uterus, tubes, ovaries, peritoneum, blad- 

 der and kidneys, or by way of the lymphatics as in 

 infections of the periurethral tissue or cellular tis- 

 sue of the pelvis. Usually infections of the bladder 

 and kidney, and not infrequently of the prostate, 

 Fallopian tubes and pelvic tissue are of a mixed 

 character (staphylococcus, streptococcus), but not 

 necessarily so. Arthritis, tendovaginitis, endocar- 

 ditis, which usually is vegetative but may be ulcer- 

 ative, are the more common metastatic complica- 

 tions. Less frequent are pericarditis, pleuritis, 

 subcutaneous abscesses and iritis. As to whether 

 the cutaneous phenomena sometimes seen are due 

 to metastases or are of purely toxic origin seems to 

 be undetermined. The blood stream may be in- 



