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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Licence: In copyright

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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    3 in the puerperium, and the taking of intra- uterine cultures offered an opportunity to ex- amine for the gonococcus by means of smears. In addition, many cases were examined for the gonococcus without intra-uterine cultures being taken. Among these were cases in which the fever was not high enough or too transient to offer an indication for intra-uterine examina- tion, and cases in which there were other in- dications for examination for the gonococcus. In all, 53 cases were examined for the gono- coccus, and some of these were examined many times, for, unless the organism was distinctive and characteristic, repeated smears were made until the diagnosis was decided. All our cases came under observation after labor had begun, so that we were unable to watch the effects of the disease during the course of pregnancy. Several cases had evi- dences of a possible gonorrhoea, as a history of vaginal discharge with or without the presence of condylomata and vulvo-vaginal abscess, but these were not considered in the study until the gonococci could be demonstrated microscopically, although such cases were treated at labor with great care, so as not to spread infection from the original focus. Demonstration of a biscuit-shaped intra- cellular diplococcus, of the morphology of the gonococcus and negative to Gram’s stain, was considered sufficient evidence upon which to base a diagnosis of gonorrhoea. Other diplo- cocci, negative to Gram’s and corresponding to Bumm’s coccus, were found; but it was possible, by repeated examinations and their extracellular character, to differentiate them from the-gonococcus. Smears were taken at various times in the puerperium, and it was found difficult to demonstrate the gonococcus until pus-cells appeared in numbers in the lochia. Smears taken in the early part of the puerperium were found to be obscured by blood-cells. Demonstration of the organism was seldom successful before the fifth day, and increased success was obtained as the puer- perium advanced. The site in the genital canal, which gave the greatest success in find- ing the organism, was within the cervix and about the level of the internal os. Vaginal smears were occasionally successful, but it was found difficult to distinguish the gonococcus on account of other organisms, which were more prevalent as the puerperium advanced. Several unsuccessful attempts were made to cultivate the gonococcus; in three instances there was overgrowth with other organisms. Streptococci were found associated with gono- cocci in two cases, and the colon bacillus in one case. These cases will be indicated in the tables. In three cases, intra-uterine cultures were negative, while gonococci were demon- strated in smears by special staining. In eleven cases without intra-uterine culture, the gonococcus was demonstrated upon cervical smears by special staining; in four of these it was the only organism noted, and in the other five, other organisms, as “ Gram-negative bacilli,” “ Gram-positive bacilli,” and “ Gram- negative cocci,” were found. Acute purulent conjunctivitis in the infant has been accepted in some studies as evidence of gonorrhoea in the mother.1 This was found in our investigation to be fallacious, and was only considered an indication for the thorough bacterioscopic examination of the lochia. In all institutions, in spite of great care, there is the possibility of infants acquiring gonococcus conjunctivitis by other causes than vulvar dis- charges. Every precaution was taken to pre- vent such infection, and when such infections occurred, the infants were immediately isolated. Infants with purulent conjunctival discharge, not known to be due to the gonococcus, were kept separate until a bacterioscopic examina- tion could be made. No convalescent mother was allowed to carry or touch any baby save her own, and wet-nurses were examined for gonococci before they were permitted to nurse healthy babies. All babies with infected eyes were brought by special nurses to their mothers for feeding. Their eyes were carefully ban- daged, and every precaution was taken to keep them apart from the other babies. Nurses attending mothers were not permitted to care for any of the babies, nor were the baby-nurses permitted to attend the mothers. In spite of these precautions of isolation and special care, two infants with healthy mothers acquired gonococcus, conjunctivitis during this time, and repeated bacterioscopic examinations of 1 The Influence of Gonorrhoea in the Puerperium. Transactions North of England Obstetrical and Gynecological Society, 1900.