GONORRHEA AND ITS COMPLICATIONS 173 



nausea following any of the injections; also the fever and leukocytosis 

 did not reach the height produced by bacterial suspensions. Sufficient 

 experience with this solution, however, was gained to convince 

 one that the reaction and therapeutic effects are very similar and 

 equally as effective as those produced by bacterial suspensions, as 

 well as giving rise to less disagreeable reactions. 



As far as therapeutic results are concerned there was no notice- 

 able difference between the 3 bacterial suspensions or the albumose 

 solution. To produce results therapeutically a reaction is necessary. 

 That is, a chill must occur which is invariably followed by the 

 temperature and leukocyte changes noted. A dose insufficient to pro- 

 duce a definite chill was not followed by as marked a temperature 

 as the leukocytic reaction, and clinically there was not only no thera- 

 peutic benefit, but sometimes patients became more uncom- 

 fortable than before. The reactions following injections in non- 

 gonorrheal patients were not to be distinguished from those produced 

 in infected patients. 



These observations were made by injecting a series of patients 

 with chronic skin lesions with no history or indication of gonococcal 

 infections. The size of the dose required to produce a reaction, the 

 chill, temperature, and leukocytosis was alike in every way in the 

 infected and the noninfected patients. 



Thirty-one patients suffering from arthritis associated with gonor- 

 rheal urethritis were treated. Most of these cases were acute or sub- 

 acute, but some were of 5 months' duration, and many were over 

 10 weeks' duration when the treatment was begun. 



As might be expected, the most striking results were obtained in 

 the acute and subacute cases; however, the most refractory instances 

 were also in the acute class. Those suffering for long periods appeared 

 to respond more slowly to the treatment, but fortunately seemed to 

 suffer from no recurrence or new joint involvements during the course 

 of the treatment. All but 3 of the arthritic patients were apparently 

 completely cured or manifested a decided improvement. The length 

 of treatment varied from 2 days to 1 month. 



Unusual effects were seen in 3 patients with acute arthritis, so 

 severe that sedatives were necessary to give them rest for the first 2 

 days in the hospital. After a single reacting dose in each instance 

 they felt so- well that they insisted on getting out of bed, and in 3 

 days they walked from the hospital. Two of the patients had effu- 

 sions in the knee joints, which completely disappeared before their 

 discharge from the hospital. Equally striking was the instance of a 

 man who had been confined to his bed for 4 weeks with arthritis of 

 almost every joint of both lower extremities. These lesions had come 

 on during the third week of gonorrhea. After the third injection, he was 



