GONORRHEA AND ITS COMPLICATIONS 177 



specific therapy is of decided usefulness in the treatment of gonor- 

 rheal complications, either local or remote, but that in the treat- 

 ment of the primary infection of the mucous membrane itself our older 

 methods are of greater value and dependability, although certain 

 observers are of the opinion that as an adjunct method of treatment 

 it has its decided value even here. 



Keyes makes the following statement: "It is not generally ap- 

 preciated that the reason for the extreme susceptibility to recurrence 

 of joint lesions with each gonorrhea, in a patient who has once had 

 arthritis, is a susceptibility in the joint, not in the urethra. At its 

 onset the use of vaccines or serum may be worth while. Two or 

 three doses of antigonococcus serum at the moment when a joint is 

 beginning to become inflamed may abort the infection, as may also 

 a heavy dose of gonococcus vaccine; this usually by the systemic re- 

 action produced. 



"But once the joint infection is established, vaccines are not to 

 be relied on. I have tried all the specific and nonspecific forms that 

 have been commended to me, including horse serum and typhoid vac- 

 cines administered intravenously. If these are employed in suffi- 

 cient dose to give a systemic reaction, a temporary benefit may be 

 obtained, and occasionally a permanent benefit. But the rule is that 

 these treatments do not appreciably influence the course of the dis- 

 ease." 



Luithlen has had considerable experience in the treatment of gonor- 

 rheal complications, using an intravenous injection of gonococci (100 

 million to the c.c.) as a rule to elicit the reaction; he specifically 

 recommends, though, that local treatment should in no instance be 

 neglected. In the treatment of old torpid venereal ulcers, soft chancres 

 and ulcers persisting after buboes he injects about 50 million 

 organisms intravenously two or three times at intervals of several 

 days, or if intramuscular injection is preferred injects from 300 to 

 500 million, in some cases as much as 800 million organisms. 



Bloch, who recognized that the vaccine therapy as used in in- 

 travenous injections was really related to our older method of counter- 

 irritation or "Ableitungs-Therapie," has also used gonococcus vaccine 

 and typhoid vaccine in gonorrheal complications, the latter especially 

 in gonorrheal rheumatism. He obtained the best clinical result with 

 the severest clinical reaction, in some instances the temperature reach- 

 ing 106 F. 



Gow has also tried out a diphtheroid organism intravenously 

 (using first a dosage of 40 million, later 200 million) in a case of 

 gonorrheal arthritis. There was relatively little reaction from this 

 organism, a chilly sensation was noted about 14 hours after the injec- 

 tion, a rise of 2 F. in the temperature 2 hours later, and some head- 

 ache. A leukopenia followed the injection. The result was not very 

 satisfactory. 



