Fever Therapy in Gonococcal Infections

Abstract

SINCE 1930, the treatment of gono-coccal infections by fever therapy has made rapid progress. Whitney's discovery that short wave transmitting apparatus could be used to elevate human temperature with safety was speedily adopted for this purpose (1). Since then, many important modifications of the original technic have been made. Yet, as has been pointed out before, the technic is always secondary to the skill and judgment of the physician administering the treatment (2). The classic work done by Warren, Carpenter, and others, of the University of Rochester, who carefully established thermal death times of more than 250 strains of gonococci, furnished the bacteriologic basis for the use of fever therapy in treatment of gonorrhea and its complications (3a, b). The progress that has been made in the treatment of gonococcal infections by physically induced temperature rises has been due largely to one factor- thermola-bility of the gonococcus. This organism can be destroyed in vitro and in vivo at temperatures which human tissues can tolerate safely (4a, b, c, d). The value of temperature reactions in the treatment of gonorrhea and its complications has long been recognized. Various methods for inducing protein shock and temperature reactions were adapted to this work since Jau-regg's reports in 1918 (5). Satisfactory results with malaria (6a, b, c), typhoid (7a, b), as well as other foreign proteins (8a, b) have been described. Local heating of infected pelvic organs and gonorrheal joints with diathermy have also received favorable comment. It should be pointed out that until the advent of fever therapy, a constantly increasing variety of chemical gonococcocides as well as other methods of treatment were advocated in gonococcal infections. The number and wide range of therapeutic attempts indicated the lack of universal success of any one method. To more effectively destroy the gonococcus at its original site of invasion and spread in the pelvis, we have utilized a special combined technic. The concept of this technic was outlined by one of us in 1930 (9). The principle is to heat differentially and intensively the pelvic organs while the systemic temperature is maintained at or below 106.5° F. (41.4° C.). Among the 165 cases of gonococcal infections presented in this report, there were 125 females and 40 males, with 40 cases of gonorrheal arthritis. About one-third of the females had salpingitis. All of them before treatment had positive spreads from cervix or urethra or both. All the cases included in this report gave definite bacteriologic evidence of the disease before treatment. Among the males, the usual complications of prostatitis (17 cases), involvement of the vas deferens (five cases), and epididymitis (eight cases) were present along with a positive urethral discharge. In the gonococcal arthritics, of whom 19 were females and 21 were males, the complement fixation on many occasions was found to be of great diagnostic importance.