370 GONOCoccic INFECTIONS 



organism. A spread of the disease beyond the mucous membrane 

 of the urethra is extremely rare. Less rare, though still un- 

 common, is extension to the bladder. Hsemic infections are 

 also rare, but do occur; in them, as in other general infections, it 

 is difficult to see how the cocci can run the gauntlet of the leuco- 

 cytes. 



Diagnosis. In most cases, of course, this is made by the 

 demonstration of the specific coccus usually an easy task. If no 

 material is forthcoming (as in gonorrhceal arthritis, etc.), two 

 methods are available the opsonic index and the absorption of 

 complement. According to Allen, the normal index ranges 

 between 0-8 and 1-2, and in chronic infections it may be low 

 (down to 0-2) or high (up to 2 or more). Further, a dose of 

 75 millions of dead cocci causes but little disturbance in a non- 

 gonorrhceal patient, but a marked rise if the patient is infected. 

 The method of absorption of complement has been employed 

 with marked success by Meakins, and appears to be of great 

 value. The difficulty of the technique, however, renders it much 

 less easily available than the opsonic method. 



Treatment. The use of serum need hardly be discussed. Some 

 cases, it is true, have apparently been benefited, but it is always 

 possible that the serum may have contained specific toxic bodies 

 which acted as a vaccine. 



The vaccine treatment, on the other hand, is of the greatest 

 possible value. The dose varies between 5 and 500 millions. 

 In general, large amounts are not well tolerated, especially early 

 in the treatment. The doses may, of course, be regulated by the 

 opsonic index, but this is probably not necessary. In acute cases 

 two or three doses of 50 millions may be given ; but it is in the 

 chronic infections, especially, perhaps, in gonorrhceal arthritis, 

 that the method is of especial value. Here the dose may begin 

 with 50 millions, rising to 500 millions, or even twice this amount, 

 and the intervals may be seven to ten days. If no benefit is 

 obtained a further course of treatment under opsonic control may 

 be administered. The results are usually beneficial in. the 

 extreme. 



Gonorrhceal conjunctivitis is to be treated on the same lines as 

 acute arthritis, but here, of course, ordinary local antiseptic 

 treatment is all-important. Gonorrhceal iritis is treated like 

 gonorrhceal arthritis, and the results are usually excellent. 



