GONORRHEA AND ITS COMPLICATIONS 181 



injections shorten the course of the disease as well as prevent com- 

 plications. The ordinary complications are relieved in a very short 

 time and even the arthritis is very favorably influenced. 



Provocative Reaction. In a recent paper Miiller has discussed 

 a subject that is of considerable and increasing importance in the 

 genito-urinary field, namely the provocative reaction in male urethral 

 gonorrhea. While I have referred to it more fully in the chapter on 

 focal reactions, a note of it should be made at this place. 



We are familiar with the effect of alcoholic excess on the course 

 of an acute gonorrhea. Many of our modern therapeutic methods 

 are frequently followed by a similar provocation of a latent gonor- 

 rhea (such as the use of bougies, Kollmann dilatation, silver salts in 

 higher concentration, hydrogen peroxid, etc.), and their use is fol- 

 lowed by an increase in the discharge and the finding of organisms 

 in the smear. On examination it is observed that the copious leu- 

 kocytic discharge consists of fresh leukocytes, not old forms which 

 may have been present in the focus for a longer period of time. They 

 are the result of a myelotic stimulation that is induced by the re- 

 action when the gonococci are stirred up at the focus, and are there- 

 fore to be regarded in the nature of a defensive reaction. Every pro- 

 cedure that first lowers the resistance either locally as with the vari- 

 out traumas mentioned, or generally, as after alcohol, after an inter- 

 current disease, after a nonspecific vaccination is followed by this 

 myelotic stimulation and an increase in the discharge. If provoked 

 by a local method new paths may be opened for the spread of the in- 

 fection, and it therefore entails an element of danger. Miiller noticed 

 that the intracutaneous (first used by Hecht) injection of aolan 

 (casein) was followed by a marked effect on the infections of the 

 mucous membranes and in applying this to gonorrhea found that in 

 from 6 to 8 hours after the injection there was noted a distinct itch- 

 ing of the urethra, followed by an increased flow of pus and usually 

 the possibility of demonstrating the presence of the organism within 

 24 hours after the injection. Nevermann has applied this reaction 

 with success in women. 



Adnexal Inflammation. It will be recalled that Kraus in his early 

 work with heterovaccines found that he could definitely terminate 

 the fever of puerperal sepsis in a number of cases when colon vaccine 

 was injected intravenously. Since that time a number of observers 

 have been interested in treating not only such cases, but adnexal 

 inflammation in women due to other causes venereal infection, tuber- 

 culosis, etc. For this purpose several methods have been used 

 milk injections, salt injections, colloidal metals, turpentine injec- 

 tions, etc. In general it may be stated that in this form of inflamma- 

 tion the single shock dose whether milk or vaccine or colloidal 

 metal is less satisfactory than any form which is carried out over a 

 longer period of time and is milder in character. Considering the 



