The disease as it usually appears is seriously and often obstinately complicated by the structure of the membranes which it involves. The mucous membranes throughout the body are more than mere mucous surfaces; they are dotted with openings for the escape of glandular secretions, and nowhere is this more conspicuous than in the urethra, where many minute follicles, so called, empty tiny drops of secretion into the mucous canal. Infection may easily travel along these routes and lurk within such minute recesses long after it has apparently disappeared from the surface; and so it often happens that in the male not only the urethral follicles but the ducts leading to Cowper’s glands and prostate become involved, while in the female the follicles around the meatus, the urethra, and the vulva rarely escape. The clinical importance of this statement is of interest, as by it may be explained many of those cases where an old infection seems to have been lighted up, or where the contagion has been conveyed to another after an attack which was supposed to have been entirely cured. Nothing seems to favor outbreaks of this kind as do alcoholic and sexual excesses. The gonococcus may be scarcely regarded as an obligate pyogenic organism by itself, but the parts most often involved in this disease may be regarded as never free from the presence of other germs of greater or less activity, and by association, if not by actual symbiosis, such an intense reaction is provoked that the resulting products do not differ from true pus, save by the added presence of the specific organism most at fault. Under these circumstances abscesses may form in any tissue infected. Another expression of this fact would be the establishment of a pyarthrosis after involvement of one or more joints. Gonococci may be found in almost every abscess of truly gonorrheal origin; on the other hand, in some of the serous cavities it is possible, at least for a time, that gonococci may be present in the serous fluid without producing in it more than a disturbing effect, the fluid now appearing turbid rather than puruloid. The amount of toxemia which may be produced by gonococci without reference to formation of pus has not yet been established. It is, moreover, a difficult thing to estimate in cases of mixed infection. Occasionally there are cases of metastasis and gonorrheal invasion which are free from evidences of suppuration, and yet there may be anemia and cachexia of profound type; these can only be explained on the theory of an intoxication. Besides the serous tissues of the body the _fibrous_ structures may suffer seriously, not only in an acute manner, but also in a chronic and obstinate form.