Intermittent Fe Per.
Intermittent fever during pregnancy was described by the ancients, and Jacquemier quotes from Schurigius a case in which a woman, pregnant for the third time, was, in the second month of pregnancy, seized with a very obstinate quartan fever. In the last month, before and after the paroxysm, she felt the fcetus move, quiver, and clearly turn about from one side to the other. Finally, after a violent paroxysm, she was delivered of a girl, which was seized at the same hour as the mother with very vio lent attacks of fever, which continued during seven weeks. Hoffmann and Russel have reported similar cases. Bourgeois described a case of tertian fever, accompanied by convulsive movements of the fcetus corre sponding to the maternal attacks, a fact derived from Stokes. Pitre Aubinais observed two cases of intermittent fever, which was transmitted to the children, so that they were born with enlarged spleens, and showed attacks of tertian ague, corresponding to the same days and tven the same hours as in the mother. Frank and Joubert have seen similar cases.
Grenser believes that there are forms of intermittent fever that bear a certain causal relation to pregnancy. If that were true, they would per sist after delivery, whether this occurs at term or prematurely, and would then disappear spontaneously, or would be very easily cured, while inter mittents which occur in women advanced in their pregnancy rarely disap pear before delivery under the administration of quinine or other reme dies, and in all cases they show relapses. But, if the• intermittent fever does stand in a causal relation to the pregnancy, the attacks recur regularly after delivery, just as before, without, on the whole, impeding the nor mal progress of the labor. He recommends the use of large doses of sul phate of quinine. Mendel affirms that it is impossible at the present day to admit this causal relation between intermittent fever and pregnancy, and considers it as rare. Griesinger insists that pregnant women, and. especially those who are parturient, are perhaps less predisposed to inter mittent fever than others, and cites the observations of Quadrat, who noticed at Prague only two cases among 8,639 pregnant or puerperal women, in spite of the prevalence of a severe epidemic. Aulong 37,183
women observed by various writers, only twenty cases were reported: Ritter admits that pregnancy does not insure immunity, that the malarial ca,chexia does not predispose to abortion, and that the intermit tent fever generally assumes an acute form. This acute type always dis appears for a short time during the act of delivery, to reappear during the first three weeks of convalescence. It would seem as if the tendency of the latter condition was to arouse the acute form in women who were the subjects of the chronic. Finally, according to him, the course of the acute affection is not regular, and the remission is always incomplete. Mendel follows Ritter in believing that intermittent fever is rare, even in localities in which it is indigenous. Pregnancy and the puerperal condi tion seem to predispose to it. Although typical intermittent is rare, lar val forms, especially neuralgic, are often noted. All these authorities agree on the subject of treatment; all recommend the use of sulphate of quinine in larger or smaller doses. Many writers have inveighed against • the administration of quinine during pregnancy, because of the supposed danger of producing abortion, but Cazeaux and others deny that the drug is harmful, believing that the general disturbances caused by the attacks of intermittent are far more likely to cause the premature expulsion of the fcetus tha,n the quinine. Many physicians, who have had a large practice in malarial districts, have never had cause to fear the action of quinine upon pregnant women. It is not only an innocuous remedy, but it is the surest preventive when abortion is rendered imminent by the occurrence of the fever. (Cazeaux.) . Spiegelberg affirms that intermittent fever is rare during the last months of pregnancy, and that it does not disturb its course. Intermittent, Ile thinks, when it is present in a chronic form, assumes its acute form, or a transient acuteness, during pregnancy. He believes strongly in full doses of sulphate of quinine, although this drug does not prevent the re currences which appear during the first three months after delivery. The disease is temporally arrested during delivery.