The gonococcus in the puerperium : with report of seventeen cases / by W.S. Stone and Ellice McDonald.

  • Stone, W.S.
Date:
1906
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Credit: The gonococcus in the puerperium : with report of seventeen cases / by W.S. Stone and Ellice McDonald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Surgery, Gynecology and Obstetrics, February, igo6 DR. Ellice mcdon 13 WEST 86th £ THE GONOCOCCUS IN THE PUERPERIUM, WITH REPORT OF SEVENTEEN CASES 1 By W. S. STONE, M. D., and ELLICE McDONALD, M.D. THE relation of gonorrhoeal infection to the puerperium has not been studied as fully as the importance of the subject demands. Some obstetricians have as- serted that it causes little or no morbidity, while othprs have reported cases with severe constitutional symptoms, high fever, and even death from infection in which the gonococcus was the only organism isolated. While this study has little bearing upon gonorrhoeal in- fection during pregnancy, save for a suggestion as to its relation to premature termination, the results of the study will be better understood if the literature of both conditions is briefly re- viewed. Seitz (i) states that after the disappearance of the acute stage of gonorrhoea, conception may occur, as sufficient number of normal epithe- lial cells remain in the uterine mucosa. A post- conceptional gonorrhoeal endometritis may occur during the first three months of pregnancy. Bumm (2) and Wertheim (3) think that the gonococci disappear with the further develop- ment of the pregnancy, and, when the decidua reflexa unites with the decidua vera, the cavity is free from micro-organisms. Exacerbations may occur immediately after labor from the bacteria remaining in the deep cervical glands. Sanger (4) considers a growth of gonococci to be possible during pregnancy, for he has found them in pieces removed by curettage, and small abscesses have occurred, .as a result of which hemorrhages and abortions are not in- frequent; in spite of such changes, however, pregnancy may continue. Friihenholz (5) thinks gonorrhoea is less often a hindrance to conception than is generally supposed, and that it is an infrequent cause of interruption of pregnancy, although gono- cocci have been found in the placenta by Fabre (6), Maslowsky (7), and Draghiesen (8). Frii- henholz believes the occurrence of acute symp- toms in the beginning of pregnancy to be due to the lighting up of a chronic process. This will account for both mild and severe puerperal disturbances in cases in which no vaginal ex- aminations have been made. Fehling (9) thinks that the infection usually occurs with or soon after conception, and that tubal disease develops before labor. Audebert (10) says that gonorrhoea causes pregnancy to terminate prematurely in two out of three cases. Noeggerath’s (n) classic paper, based upon his own clinical experiences before the dis- covery of the gonococcus, still forms the basis of our present knowledge of this special rela- tion of gonorrhoea, as well as that of the more general subject of chronic gonorrhoea. Noeg- gerath’s opinion of the importance and fre- quency of this infection in the puerperium was first corroborated by Sanger’s study of 230 cases in which 35 (or 15 per cent) had adnexal disease that could have been ascribed to the puerperium. He believes, however, that severe disturbance, as in the case reported by Graefe, in which the symptoms began 12 hours after labor, is rare. Steinbuchel (12) studied 328 cases of preg- nancy and found the gonococcus to be present in 70, and in three others, in which the findings were negative before labor, the gonococci were identified in the lochia during the puerperium. Sixteen per cent of these cases had a puerperal morbidity, while of 245 cases of pregnancy with negative findings, only 11 per cent had a morbidity. Of 274 cases with a normal puer- perium, gonorrhoea was diagnosticated either clinically or microscopically in 18 per cent. Kronig’s (13) study of inis subject is most complete, and contains practically all of the literature up to the year 1897. He found that in 296 cases of puerperal fever a gonorrhoeal endometritis existed in 31. He calls particular attention to die necessity of excluding the presence of other bacteria which may cause a puerperal infection; it should also be known that the fever is not caused by disease of other organs, and that the infection has spread to a hitherto intact portion of the genital tract. 1 Read before the New York Obstetrical Society, December, 1905. I