GONORRHEA AND ITS COMPLICATIONS 171 



Culver's Investigation of Gonorrheal Arthritis. These reports 

 led Culver to investigate the specificity of the therapeutic procedure. 

 He selected a series of cases suffering from gonorrhea and some com- 

 plications (arthritis, etc.) ; these were divided into four groups, the 

 first of which was treated by the intravenous injection of a gonococ- 

 cus vaccine, the second a similar dose of meningococci, the third of 

 colon bacilli, the fourth of a deutero-albumose solution. No local 

 or general treatment other than the injections was given. 



Gonococcus Vaccine. In the first series Culver gave 100 million 

 killed gonococci and repeated the dose every fourth or fifth day. The 

 greatest number of injections given one person was 6, most of them 

 received 5, one received but one injection. The injections were fol- 

 lowed by a chill of variable severity coming on in 20 minutes to 1 

 hour and lasting 15-30 minutes. The chill was at times accompanied 

 by headache, usually of short duration. Exceptionally, there was 

 nausea and vomiting during the first few hours, but never severe and 

 always transient. This occurred often in patients who had disobeyed 

 instructions by eating heartily within a few hours of the injection. 



At the onset and during the chill the patient often complained of 

 severe pain in the affected parts (focal reaction). 



Invariably the disagreeable effects of the reactions, if any appeared, 

 disappeared in about 24 hours, and for the next 24-72 hours a variable 

 degree of comfort was experienced. The pain and the tenderness, 

 together with the swelling of the joints, were much improved. This 

 prompt improvement was most likely to be of only 2-4 days' duration, 

 and then there was a stiffness of the affected joints with some pain 

 on motion, but usually in a much less severe form. 



These relapses gradually decreased in severity following succes- 

 sive injections until eventually none appeared. In some instances 

 there was no relapse, even following the first injection. 



Injections were repeated on the 3rd-5th day, or usually just as the 

 joints began to show a return to their old condition. This seems to 

 be a more efficient method of injecting than daily injections. With 

 daily injections, the patient is at all times having a reaction or just 

 recovering from one. His general condition is not so good nor does the 

 local disease respond so well. 



It is usual for the severity of the reaction to decrease following 

 repeated injections, and this decrease seemed directly proportional 

 to the number of injections previously given. 



In patients, both of whom had numerous subcutaneous injections 

 of gonococcal vaccine, there appeared immediately following each in- 

 travenous injection a very transient reaction characterized by flush- 

 ing of the face, cyanosis, dyspnea, and a tingling sensation over the 

 surface of the whole body. These reactions lasted 1-2 minutes, after 

 which the patients felt perfectly at ease until the usual reaction ap- 



