The fever which appears during pregnancy is characterized by the ab sence of intermissions, and by the presence, on the contrary, of a con tinued febrile condition, interrupted by irregular chills. The stage of apyrexia is never complete, and even in the most typical cases the inter mittence is never regular in its rhythm. The dose of sulphate of quinine should be increased still more during convalescence. Playfair calls atten tion to the transmission from the mother to the foetus; and the frequency with which hypertrophy of the spleen is found in young infants in mala rial countries, leads him to infer that the intra-uterine affection must be common. He has often noted this fact in India, without, however, having been able to convince himself that the mothers had suffered from inter mittent fever during their pregnancy.
GOth's researches differ in certain respects from the results obtained by Ritter. In the course of six years he observed 881 deliveries, in which 46 women were attacked by malaria during pregnancy, and during a period more or less extended subsequently; of these 46, only 27 went to full term, 19 being delivered prematurely.
In 41.3 per cent. of the cases, then, there was an interruption of the pregnancy. The inference from these statistics, moreover, is that the danger increases with the advancement of the pregnancy, premature de livery being more frequent than abortions. Ile agrees with Kaminski and Runge in attributing the death of the foetus to the elevation of tem perature in the mother (106° F. and above) during the prolonged attack, and attaches less importance to the maternal anannia consecutive to the disease, and to the direct infection of the foetus by the malarial poison.
G6th observed that pregnant women, after the second or third attack, complained of lumbar pains, and that slight uterine contractions could be detected, and the mortality of children who are born under these con ditions is much higher than that of other countries. They weigh at least eleven ounces less than others. As regards the labor, he has noted irregularity in the contractions, feeble pains, especially during the first stage, until the cervix is completely dilated; this stage is generally twice as long as in ordinary cases. This feebleness in the contractions, although less evident, is also present during the expulsive stage, because it was necessary to interfere more frequently in those cases (forceps, extraction of the placenta, etc.) The Influence of Labor on Malaria. —This is shown in every instance by the arrest of the attacks (Ritter). GOth, on the contrary, has seen some cases in which the attacks were, it is true, reduced to the number of one or two, but they reappeared subsequently, and in the great majority of the c,ases the attacks recurred after delivery with the same regularity as before. During convalescence women are predisposed to it. Ritter, Goth and Mendel have seen women affected after eonfinement who were free from malaria during pregnancy. Quinine acts in the same way after con finement Glith does not favor maternal nursing in these cases; it may be allowed in light, but not in severe cases.