Treatment of gonorrhoeal arthritis by artificial fever

Abstract

Since the days of Hippocrates fever has been a major concern of physicians. Originally and for a long time it was regarded as a defensive mechanism against disease. Then, following the work of Claude Bernard , Virchow and others , who demonstrated suppos - edly harmful physiological and pathological reactions to fever, came the era of antipyresis by medical and physical means.

That fever, however, must serve some useful purpose, or nature would not have clung to it so tenaciously as a reactive process to the invasion of harmful noxa was later still the view of Welsh and others, and during the last four decades opinion has veered in favour of the view that fever has a beneficent purpose. Consequently the idea of the necessity for the combating of fever as a harmful condition by means of hydrotherapeutic applications or by antipyretic drugs has gradually been replaced by the realisation that the body increases its defence activities with the raising of systemic temperatures.

The current development of fever therapy is an indication of the wide acceptance of this view. Under certain conditions and within certain limits, hyperthermia is a state not to be prevented, but to be fostered.

Many old and new methods are being advocated for fever therapy. Since the sixteenth century curative effects in syphilis and in various forms of rheumatism have been ascribed to frequent bathing in hot volcanic water. The temperature of the water being from 113 to 128°F., it has been estimated that fevers of from 103 to 105°F. were produced thereby. (Heymann & Osborne, 1934).

It is customary to regard febrile reactions produced by the injection of foreign protein as the modern forerunner of fever therapy. The use of dead organisms (Bacillus coli or typhosus) was the next logical step, and this was eventually surpassed by Wagner-Jauregg's success with malarial therapy in neuro- syphilis.

While certain definite results have been obtained, these various methods have the disadvantage that their reactions, once initiated, are not always entirely controllable. Hence the modern view favours a return to the physical, in place of the bacterial, methods of producing fever.

Steps in the development of pyretotherapy by physical means include the use of hot baths by Philips, (1884),, Mehrtens and Poupoirt (1929) , of hot air by hosan_off (1927) , of high frequency diathermy currents by Neyman and Osborne (1929), of radiothermy by Carpenter and Page (1930) , of humidified, electrically heated cabinets by Simpson, Kislig and Sittler (1933).

Physically produced fever in the treatment of gonorrhoeal arthritis is not to be regarded as just another method of treatment to be added to the countless ones in which all physicians have been disappointed, for the results described, can be, and are being duplicated by others.

This method of treatment has been the subject of an increasing number of reports in medical literature during the past few years. Most of the reports have come from the United States of America and the large majority have described results which are satisfactory and often remarkable.

The reports indicate that good results are 'obtained by a number of different types of apparatus, and it appears to be generally accepted that the method of raising the temperature is not of primary importance provided that due regard is paid to the safety and comfort of the patient. The newer types of fever cabinets allow a degree of accuracy of control, for both height and duration of pyrexia, which was previously difficult to obtain and which contributes largely to the successful results.

The particular type of apparatus used by the writer is the Inductotherm Fever Cabinet and the treatment is known as "Inductopyrexia".