Miss M.L., age 23, stenographer, came to us an October 18, 1928, with the following history: Menses have always been regular, last one first week in August. Coition just after this. Now 18 days overdue. Menses have always been regular, 7 days duration, with no pain of any kind. The last week in August she developed a leucorrhoea, which she had never had before.
Yellow to yellow green.
Worse during the day.
Stains linen and does not wash out easily.
There are also the following symptoms:.
Slight urinary frequency.
Eating and even the odor of food nauseates.
Chilly all the time, a new symptom, she has always been warm- blooded. The pelvic examination showed profuse discharge from the cervix, yellow-white and of a bad odor, cervix long, narrow, hard, uterus slightly enlarged and slightly tender. A smear taken at this visit, examined in the private laboratory of one of Bostons best internists, showed great numbers of pus cells loaded with gonococci. The internist himself looked at this slide and said he had never seen so many on one smear. The urine shows many W.B.C. and a slight trace of albumen.
DIAGNOSIS: Acute gonorrhoea with a question of pregnancy.
TREATMENT: None at this visit except Sac.lac.
Oct. 23, 1928. Still chilly. Desires sours. The nausea persists and this and the leucorrhoea are marked worse around 10 a.m. Her state of mind is peculiar. On the first visit she was frightened to death. She now shows a violent aversion to coition which she had desired before; she is almost indifferent to everything and keeps everything inside; she is preternaturally steady. The smear today shows the same virulent infection.
Hot water douches, Sepia 1M, one dose and Sac.lac. were prescribed on the following symptoms:.
Leucorrhoea thick, yellow green, bad odor, stains hard to wash out.
Eating, even odor of food, nauseates.
Worse around 10 a.m.
Mental state, indifferent, preternatural steadiness, aversion to coition.
Oct. 27, 1928. Menses arrived with vomiting, flooding and clots, soreness over lower abdomen, tearing pains in uterus, better lying on stomach, not with knees drawn up. All this is new. A smear taken carefully through a speculum from the cervix showed so few organisms and no pus cells that a second smear was requested. This was taken at the next visit. Sac lac.
Oct. 30, 1928. Feels normal and well in every way. Discharge hardly noticeable. No frequency. Still occasional cramp in abdomen. This is the only complaint. The smear showed very few cells, some Gram negative diplococci, very few bacilli, none intracellular. The laboratory technician says “does not suggest G. C. because of very few cells and no intracellular organisms”. He suggests another smear. The internist said, “what did you do to that girl, the smears do not seem possible?” A smear taken after the period showed an exacerbation with organisms present but not as many as in the first smear.
Nov. 2, 1928. Feels fine. Smear shows a few organisms.
Nov. 7, 1928. Normal. No discharge. Very few Gram negative intracellular diplococci seen. Pelvis normal, no discharge found.
Dec. 16, 1928. Feels well. No discharge. Has been our West one month. Smear shows rare pus cell, no intracellular organisms.
Jan. 23, 1929. Menses normal. No discharge. Smears negative.
Feb. 9, 1929. Occasional intracellular Gram negative diplococcus. Sepia 1M, one dose.
Feb. 15, 1929. Smears negative.
May 24, 1929. Patient went West to be married. On this date she writes, “Upon my arrival here I consulted another doctor and he said there was nothing wrong with me”.
DR. B.C. WOODBURY: I would like to say to Dr. Lyle that I do not know that there is any reason for objecting to hot douches, plain douches with sterile water, in the acute stage. The case I mentioned was an old chronic gonorrhoea. I have reason to believe that there were illicit relations going on in that case, which probably only made her chances for getting better worse. It was impossible to stop that, and she suffered this relapse. But i think it was more the subacute condition she was in. She had been going on so long that nature had been trying to get rid of that infection through the leucorrhoeal discharge, and she was stirring it up with those douches. She has been having illicit intercourse right along, even before the douches were used. I know that for a fact. So I think that it must have dated directly to the hot douches.
That case is still further proof that these things could be managed. But I will say this, if you can treat gonorrhoea in a man without injections, why cant it be treated just as well in a woman without even hot injections? That is my question: I would like to ask Dr. Lyle.
DR. E.B.LYLE: I do not feel that douches are necessary, but I believe they are useful in treating venereal infection. If you remember the paper Dr. Farr gave us last year, he showed the results from hot salt soaks. I think this is exactly the same thing. I am not talking about the chronic stage, I am talking about the acute stage.
I still think, Dr. Woodbury, that the stirring up of the inflammatory condition and increasing your blood supply by coition is much worse than washing with plain water. Of course, we all know that you can get slides that are negative and keep on getting slides negative but the gonorrhoea still persists.
DR. W.J.S. POWERS: I had a peculiar case. A young woman came to me saying that she thought she had had intercourse while under the influence of liquor.
In about seven days she had a profuse flow from the vagina, a yellowish-green, thick solution. She went to an allopathic doctor. He took smears and examined it and said he could not find anything, but he said, “There is no use in talking, it is gonorrhoea,” It was a tremendous shock to her. This doctor advised douches with protargol and so forth, and the secretions didnt cease. She went to another doctor, and he did the same thing.
That had been going on for two years. That girl had refused marriage on that account, and she was in a very deplorable condition when she came to me. She was absolutely without any ambition to do anything. She tired easily and had found very great difficulty in doing her work. In fact, as she expressed it, “Dr. Powers, I haven;t any interest in anything any more.” I gave her a dose of Sepia 1M, and in ten days that secretion had stopped, and she hasnt had a sign of it since.
DR. E. UNDERHILL, JR.: I havent used injections or douches of any kind on patients for gonorrhoea for over ten years, and I see no need whatever of it.
DR. PLUMB BROWN: I have one word in confirmation of Sepia. I had a young fellow a few months ago, an overseas man, who contracted gonorrhoea and syphilis and everything else abroad. He has been under allopathic treatment since the war. The armistice was in 1918, and you can figure how long he had had that treatment. He had and old gonorrhoea discharge and more or less orchitis, etc. One dose of Sepia cured him so that he was married about a month ago.