174 PROTEIN THERAPY 



up and walking about, and after the 6th injection he was apparently 

 completely cured. 



The 3 refractory cases mentioned were all acute, and seemed not 

 to respond at all or very slowly to this form of treatment. One would 

 show considerable improvement for a day or two, but invariably would 

 lapse back to the original condition ; a second recovered completely ex- 

 cepting one knee joint, which contained a marked effusion and seemed 

 not to be affected by repeated injections, while the third did not re- 

 spond from the first to repeated injections of albumose solution. 



Bruck noticed similar refractory cases which he explained by the 

 absence of the homologous gonococcus strain from his polyvant vac- 

 cine. It is evident that this explanation will not suffice, but whether 

 it is due to a special resisting power of the particular infecting gono- 

 coccus or to some peculiarity of the infected host, it is impossible to 

 say. Such patients react with fever and leukocytosis as do all others. 



Epididymitis. Twelve patients with acute epididymitis were 

 treated, and invariably the pain would subside after the first injection. 

 Usually not more than two injections were necessary, and indeed in 

 most instances one proved sufficient to effect a cure. The swelling 

 began to subside within 24 hours after the first injection. In no instance 

 did the patient remain in the hospital over a week, excepting in one 

 case in which an overdose was given. 



That these injections are not prophylactic against the development 

 of new complications is evidenced by the fact that occasionally one 

 sees a patient under treatment develop an acute epididymitis or an 

 involvement of a new joint. Again, a patient may leave apparently 

 cured of arthritis to return in a few weeks suffering from epididymitis. 



On account of the fact that the reaction following these injections 

 is followed by a chill and general reaction of more or less severity, 

 a very complete physical examination is necessary beforehand. Such 

 a reaction necessarily calls for increased cardiac activity, so one should 

 proceed with caution when a patient with coexisting organic heart 

 disease presents himself. The smallest reacting dose of meningococci 

 was given to one man who was suffering from mitral regurgitation of 

 long standing but perfectly compensated, together with acute epi- 

 didymitis. He passed through the chill with no distress, but in three 

 hours after the injection he became cyanotic, his pulse became irregu- 

 lar and feeble, and he had marked precordial pain. This condition 

 lasted 10-15 minutes, and he had no further inconvenience. No 

 other cardiac irregularities were noted in the entire series. Arnold 

 and Holzel cite Lewinskies case of acute cardiac insufficiency develop- 

 ing after the intravenous injection of gonococci. Heart disease was 

 not known to be present. On the other hand, Luithlen reports a case of 

 gonorrheal endocarditis successfully treated in this manner. There 

 are many instances reported, however, of cardiac symptoms develop- 

 ing in the presence of organic heart disease following these injections, 



