Chorea gravidarum

Chorea gravidarum

898 THE AMERICAN JOURNAL OF ORSTETRICS AXD QPSEC'OI,OtX' DR. GREENHILL, in closing, said that the patients are specifica,lly instructed not to...

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898

THE

AMERICAN

JOURNAL

OF

ORSTETRICS

AXD

QPSEC'OI,OtX'

DR. GREENHILL, in closing, said that the patients are specifica,lly instructed not to take douches on the morning they come for treatment, because sometimes the douche removes the organisms chemically or mechanically. The organisms live in any medium, acid or alkaline. Lactic acid is prescribed flora. A number of German acid before and during labor

because it tends to reestablish the normal and Russian obstetricians prescribe douches and claim they have definitely reduced their

and morbidity because of this procedure. the normal bacterial flora than anything tried alkalies some years ago but without All the patients in this series were of the discharge and only those patients given at least two months ago. DR.

ALEXANDER

(For original

M.

Lactic acid else. Dr. success. treated were

because included

read a paper see page 881.)

CAMPBELL

article

douches Greenhill

bacterial of lactic mortality

more nearly restore said he also had

they actually complained whose last treatment was

on Chorea

Gravidarum.

DISCUSSION DR. CAREY CULBERTSON said that as the speaker was inclined to put this complication on an infectious basis, a review of the whole subject of chorea is in order. Chorea has not been considered in that light and he was not aware that the neurologists have placed it in that category. Dr. Culbertson said he was interested in knowing the character of the children born of choreic mothers, and asked whether in the review of the literature the cases reported disclosed the character of the children not only anatomically but mentally. Some chore& are definitely subnormal ; some of the mild types are plainly enough intelligent and capable of education but some of them are not. Some of them are imbeciles. DR. FRED II. FALLS asked if there was any evidence in the literature of a transmission of this infection to the child; if the children had any choreic spasms shortly after birth. Hc believed ehorea was an infectious process. Rosenow recovered streptococci from the blood of choreics. Whether or not that proves to be a definite etiologic factor in the cause of chorea, time will tell. Dr. Falls cited a rare case that proved to be Huntington’s chorea. The woman went through labor and delivered the baby and the baby lived. He did not feel it was necessary t.o induce labor. &he had about the same degree of chorea when she left the service as before delivery. He had some experience with choreics at the Cook County Hospital but in none of these was a cesarean section performed. His feeling was that the danger from cesarean section with the inability to control the patient was greater than to allow her to go on and abort spontaneously in early cases or to let her deliver through the natural passages under ether when term was near. DR. J. P. GREENHILL said that at the Chicago two patients with chorea. One miscarried and the nancies and delivered spontaneously both times.

Lying-In Hospital other went through

he recalled two preg-

DR. ABRAHAM F. LASH said he saw one case of chorea gravidarum at the Cook County Hospital in 1922 of a woman in her fourth pregnancy and it was the first time she displayed symptoms of chorea. Dr. Lee aborted her vaginally and the chorea subsided. Two years later she returned to the hospital when four months ’ pregnant and again showing symptoms of chorea which rapidly became

CHICAGO

worse. sided

Dr. Hillis did up to the extent

GYNECOLOGICAL

an abdominal that she only

hysterotomy, had slight

&I.)() 1. c

SOCIETY

following movements

which in her

the left

ehorea hand.

sub-

DR. I. F. STEIN said he was not aware that there was so high a fetal (lr maternal mortality in chorea gravidarum until Dr. Campbell brought it out. 1-1~ recalled two cases of chorea occurring in two sisters who had been in and out of Michael Reese Hospital many times in many years. They both had chort?c in adolescence and both had it in two successive pregnancies. In neither was labor induced. They were treated by rest in bed and isolation from visitors and delivercil spontaneously. Hr did not think medication was important, hut rest in bed ~a.3 a necessity. He had seen no deaths in either the mothers or babies, though their series in chided perhaps five or six eases. DR. RALPH REIS said that the two sisters referred to by Dr. Stein had hali five children. The smaller one of the two was a high grade moron. She had had three children. She was met in the hallway of the hospital and a diagnosis of the third pregnancy was made on sight by the fact that she had again developed :L chorea. In this patient choreiform movements were only present during pregnancy. 1)K. (CAMPBELL, iu closing, said he found nothing in t.he literature conceruing tilts meutn,lity of the children of choreic mothers. He doubted very much vrhethel neurulogists would accept infection as a sole etiologie factor, but the work of certain (serman investigators formed the basis for this conclusion and he felt that soone! However, he would not give the UT later the neurologists would have to accept it. Poynton, Paine and Holmes impression that all cases were of infectious origin. isolated an organism, inoculated rabbits, produced choreic movements in them and recovered the organism. Dr. Campbell was not radical on cesarean section, but felt that the operatiorl The woman was of a low type mentally and was justifiable in the case cited. he preferred to do a cesarean section and sterilization at the same time. The fetal mortality of fifty per cent included the abortions, miscarriages :~t~ll From the literature, he is convinced that the m:itern:ll premature deliveries. mortality

is exceedingly

high.