William E. Barfield

The treatment of functional amenorrhea

Abstract 1. 1. A method of approach to evaluation of the amenorrheic patient with emphasis on the importance of thinking in terms of physiologic processes in arriving at a differential diagnosis of cause is presented. 2. 2. General measures, indications for therapy, and specific hormonal therapy which has been successfully employed in functional amenorrhea are discussed. 3. 3. Results of clinical observations in 328 courses of therapy administered to 123 patients with functional amenorrhea employing either (a) anhydro-hydroxyprogesterone—10 mg., (b) progesterone—30 mg., or (c) a combination of estrogenic substances—1 mg. and progesterone—30 mg., by ingestion, three times daily for 5 consecutive days are compared. These preparations were found to be equally effective by ingestion in the dosage used, and withdrawal bleeding followed therapy in (a) 90.9 per cent, (b) 90.45 per cent, and (c) 94.1 per cent of instances. 4. 4. Simultaneous oral administration of estrogen and progesterone proved slightly superior to progesterone alone but was not sufficient in the dosage used to take the place of estrogen priming in those patients with inadequate intrinsic estrogens. 5. 5. It is believed that best results in management of functional amenorrhea are obtained by cyclic administration of estrogen and progesterone in a manner which closely simulates the normal physiologic process of the ovulatory cycle.

Aureomycin in the therapy of Trichomonas vaginalis vaginitis.

Abstract The relationship of Trichomonas vaginalis to vulvovaginitis was first brought to light by Donne of Paris in 1836. 1 A reawakened interest in this subject followed DeLees contribution in 1920. 2 Much that is controversial has been written as to the pathogenesis of this organism. Fifteen hundred eighty-six references to the medical literature on Trichomonas are cited by Trussell 3 in his book published in 1947. Moench 4 believed that this flagellate was only an accidental inhabitant of the vagina incapable of producing symptoms, while Hees 5 and the Listons 6 considered Trichomonas vaginalis vaginitis a specific disease. Trussell and Plass 7 successfully reproduced the clinical picture by implantation of pure cultures of trichomonads. Others 8,9 believe, however, the presence of certain other bacteria to be essential in the causation of the vulvovaginitis. For the past two or three decades intensive search has failed to provide a completely satisfactory therapeutic agent. Literally hundreds of drugs have been recommended for treatment of this common malady. In vitro studies and clinical evaluation of various chemical agents, and more recently of the antibiotics as they have become available, have been pursued at this clinic. 10–14 Among the antibiotics studied in vitro aureomycin, tyrothricin and terramycin appeared to be the most effective trichomonacidal agents. Clinically, however, aureomycin, terramycin, and streptomycin proved more effective than the other antibiotics. Encouraging results with streptomycin, aureomycin, and other antibiotics were reported by one of us (R. B. G.) in early 1949. 10 Later, McVay and associates 15 independently found aureomycin effective. This paper deals with an extensive clinical evaluation of aureomycin in the therapy of trichomoniasis.

Priscoline in the therapy of dysmenorrhea

Abstract A review of the literature, with notes on the etiology and treatment of dysmenorrhea, is offered. Studies on the use of Priscoline in therapy of dysmenorrhea are presented.

Transmucosal administration of methyl testosterone, free testosterone, and testosterone propionate.

Abstract 1. 1. Results in 107 courses of therapy with either methyltestosterone, free testosterone, or testosterone propionate were observed and studied with an attempt toward evaluation of the comparative effectiveness of these androgenic steroids by transmucosal administration. 2. 2. The usual dosage was in the neighborhood of 15 mg. daily and a course of therapy lasted thirty days. 3. 3. Factors considered in evaluation of comparative effectiveness of the preparations were, when applicable, changes in libido, frequency of orgasm, relief of dysmenorrhea or dyspareunia, improvement of eyelic hypermenorrhea, relief of pain in mastodynia, and the incidence of ache, hoarseness, and, occasionally, mild hirsutism. Variation of response to the different preparations in individual patients was used as the basis of comparison. 4. 4. All three preparations of the androgenic steroids (methyltestosterone, free testosterone, and testosterone propionate) proved effective by ahsorption through the buccal mucous membrane in dosage of 5 to 30 mg. daily. 5. 5. In general, some statistically significant difference in effectiveness of these preparations was shown when they were administered by mucosal absorption.

Newer Methods in the Diagnosis and Treatment of Granuloma Inguinale

Granuloma inguinale, indigenous to the South of the United States, was at one time an important problem in the area accessible to the Medical College of Georgia. The wealth of clinical material afforded ample opportunity for intensive observation of the nature of this disease for 15 years. Since the introduction of the newer antibiotics, its incidence has declined so far that our greatest problem in the past year has been to find clinical material for further studies and for teaching, The systematic eradication of this disease is one of the lesser miracles in public health. Until recent years, little was learned about the nature of this enigmatic and recalcitrant infection, and little progress was made in therapy with the possible exception of the introduction of the antimonial compounds in 1913. The diagnostic methods and therapy here reviewed-which have eradicated this disease in our geographical area of investigation -are the result of 15 years of investigation by the Medical College of Georgia group working on the so-called minor venereal diseases.t

THE PREMENSTRUAL TENSION SYNDROME: A COMPREHENSIVE APPROACH TO TREATMENT WITH A PROGESTIN-DIURETIC-TRANQUILIZER COMBINATION

The premenstrual tension syndrome has been under attack for a couple or more decades. The authors believe they have had a high degree of success by attacking the hormonal, water-sodium imbalance, and derangement of the autonomic nervous system by combined therapy.