COMPLEMENT FIXATION IN GONOCOCCUS INFECTIONS 483 



majority of cases, the degree of complement fixation is usually much less 

 than that which occurs in the syphilis reaction, and accordingly the 

 reactions are usually weaker and often indefinite. 



3. The reaction is seldom positive during the first four to six weeks 

 of an acute anterior or posterior urethritis, in the absence of complica- 

 tions. In acute exacerbations of a chronic urethritis the reaction is 

 positive in about 80 per cent, of cases. In ordinary chronic urethritis 

 with mild infection of the prostate gland the reaction is positive in from 

 30 to 40 per cent, of cases. In chronic urethritis complicated by marked 

 involvement of the prostate gland and epididymitis the reactions are 

 frequently positive, occurring in from 50 to over 80 per cent, of cases. 



The test possesses considerable value in determining the fitness of an 

 applicant for a marriage license, and will, no doubt, be employed for this 

 purpose quite extensively, as a positive reaction is now generally re- 

 garded as indicating the presence of a focus of active gonococcal 

 infection. 



4. During the course of an acute or a subacute urethritis the occur- 

 rence of an acute complication, such as prostatitis, epididymitis, etc., 

 is likely to result in a positive fixation test. 



5. A positive reaction may persist for several weeks after the patient 

 is clinically cured. Torrey 1 has shown experimentally that the antibody 

 persists in the blood of rabbits artifically immunized for from ten days 

 to six or seven weeks. Usually, under proper treatment, the reaction in 

 ordinary cases of urethritis disappears in from two to three weeks; if, 

 however, a positive reaction persists, a focus of infection is probably 

 present, and the patient should be kept under further observation and 

 the treatment persisted in. 



6. In women the reaction is seldom positive until the infection has 

 reached the cervical canal. In the case of little children, however, we 

 have known positive reactions to occur in acute and chronic vulvo- 

 vaginitis, indicating either that the disease is more severe in children, 

 with more antibody formation, or that it may reach the cervical canal. 



The reaction is positive in about 60 per cent, of cases of pyosal- 

 pingitis, and the test may prove of value in making the differentiation of 

 inflammatory lesions from certain cystic and neoplastic conditions, and 

 in establishing the gonorrheal basis of many of these infections. 



7. Cases of gonorrheal urethritis yield from 80 to 100 per cent, of 

 positive reactions, and the complement-fixation test has considerable 

 value in establishing the diagnosis of these infections. 



1 Jour. Med. Research, 1910, i, 95. 



