Such were the theoretical considerations that led to the discovery of the serum diagnosis of syphilis. Unfortunately for the theoretical perfection of this chain of reasoning, laboratory experimentation has led to the breaking of one of its most important links, to obtain the syphilitic antigen, the poisonous matter that led to the formation of anti-syphilitic bodies according to our present views of immunity, Wassermann prepared an extract from the liver of still-born syphilitic infants. This extract served admirably the purposes of a specific antigen, but it was found that other organ extracts made up without any reference to the presence of syphilis served invitro equally well as antigen in it. An extract could be made from the heart of a guinea pig or from the liver of an ox that would act as the antigen in the actual conduct of the test. Thus it was shown that the reaction was not specific. This discovery has not, however, invalidated the clinical value of the test. While we can no longer look on the syphilitic system, as being an immunity reaction analogous to that seen in the haemolytic system, so far as the practical results are concerned, the reaction is diagnostic of syphilis and is to be thought of as being characteristic rather than specific. The tendency is now to think that the combination of some substance in luetic serum with the lipoid substances of the organ extract produce a destruction or precipitation of the complement. It was Noguchi's hope in publishing his modified technique of the Wassermann test that he had so far simplified it as to render the test applicable in the working laboratory of every physician. So far as we can see this hope seems little likely to be realized. The technical difficulties are still not inconsiderable. An abundance of time and considerable laboratory experience is necessary to the proper carrying out of the test. I wish that it were possible in the limited space alloted me to discuss some of the interesting clinical problems. which the application of this test has brought to solu tion, the demonstrations that a supposed chancre of the lip was non-specific in character, subsequent microscopical examination proving it to have been an epithelioma, the exposition of a series of miscarriages as being due to an unhealed luetic state in the father, and many others. From the many thousands of tests that have been made in the clinics of America and Europe, the fact stands forth very clearly that given a definite luetic history, the probability of getting a positive test stands in direct ratio to the duration and thoroughness of the treatment. It is certainly a great benefit that we confer on any patient to be able to assure him that the spectres of tabes and paresis no longer hover over him, that vague pains occurring here or there no longer are to be regarded as significant of a specific aortitis or hepatitis, that he may become a progenitor of untainted off-spring. It is, perhaps, an even greater benefit to be sure of our ground in insisting that he by no means remit in his efforts to be cured until the taint can be shown to be finally absent from his blood. My purpose in writing this short paper has been less with the idea of being able to offer an exposition of so difficult and extensive a problem than with the hope of calling your attention to its very great importance. THE VALUE OF GONOCOCCIC VACCINES IN THE TREATMENT OF GONORRHEAL ARTHRITIS. W. L. Champion, M.D., Atlanta, Ga. This will be a short paper to give the results obtained in my private work from the use of gonococcie "Vaccine" or "Bacterin.” Before the introduction of the vaccine and serum there was not a drug to be relied upon to cure or I might say benefit a patient with gonorrheal rheumatism, so I hailed with delight this new remedy when I noticed the favorable reports from its use. The invasion of the joints and muscles by the gonococcus is one of the most serious complications that follows an attack of gonorrhea. It is not unusual to see a patient confined to his bed for weeks and months and his joints permanently ankylosed. I recall the case of a young man I treated several years ago who was rendered helpless for three months by the involvement of a knee, ankle, toe, elbow, wrist and finger joints, and finally it was necessary to open and drain the knee to make it useful. Such results I have seen before the introduction of gonococcic vaccine and antigonococcic serum. Since I began the use of these remedies I have had a number of patients to suddenly develop rheumatism of a single joint with severe pain, swelling, temperature reach 101 to 103, and a single injection of the vaccine make the patient comfortable in a few hours, and five or six injections perfect a cure. The above results with the vaccine have convinced me that it is a specific in accute gonorrheal rheumatism. While the percentage of gonococcies that develop this complication is apparently small, I am convinced if we will listen attentively to the complaints made by these patients, of pains and soreness located in various muscles and joints, we will be convinced it is more frequent than stated. The attack may be of a mild form, lasting only a few days; the patient and doctor attributing the condition to cold or other causes when nature comes to the rescue, and the fact that gonorrheal poison has entered the circulation from the deep urethra, prostate or vesicles, is never recorded. My work is confined almost exclusively to the male side of the human family, but of the few women I have treated with gonorrhea, I have not recorded a single case of gonorrheal rheumatism. This may be accounted for from the fact that the female has no prostate, as every case I have seen in the male the prostate was involved. The prostate seems to be open to engagements to send the septic material it contains through the general circulation. During the past twenty months I have treated eleven typical cases of gonorrheal rheumatism with Mulford's gonococcic vaccine. All of the patients had severe pain, redness, swelling of the joint, elevation of temperature and rapid pulse. It is very noticeable that the pulse is rapid; out of proportion to the temperature, and remains rapid after the temperature returns to normal. In all of these cases the vaccine was used in the beginning of the complication, and had not been used previously. None of the patients had other joints to become involved after beginning the use of the vaccine. Ten of the patients were under thirty years of age, the other one forty. Of the eleven cases three had a single joint involved; two had both knees; one the right foot, and the other five had three to four joints involved. Only two of the eleven cases were confined to bed; one for six days and the other for ten. In every case there was marked improvement from the first dose of the vaccine. The dose I commence with is 25,000,000 bacteria, giving 50,000,000 on the third day, and a similar dose every four days thereafter. |