ERUPTIVE FEVERS.
Stnall-pox.
The eruptive fevers seem to acquire an unusual severity in preg nant females, and smallpox especially, according to most authors, pro duces abortion and subsequent death of the patients. All writers agree regarding the exceptional gravity of the prognosis of small-pox occurring in a pregnant woman. Cazeaux, however, has already made an important distinction between discrete and confluent small-pox; the first almost al ways terminating in a cure, even when the pregnancy is interrupted; the second, which is so serious in the non-pregnant state, assuming, during the period of gestation, a peculiarly grave form. Abortion and death would then be the rule, almost certainly. With Jobard, we think it neces sary in this connection to distinguish the three forms of small-pox: lst. Varioloid; 2d. Discrete variola; 3d. Confluent variola.
lst. when confluent it is generally benign, and only rarely causes abortion. Mayer has, however, reported four abortions among 37 cases of varioloid. We, ourselves, have observed a case of con fluent varioloid in a woman six months pregnant. The mother was cured, the pregnancy pursued its course, and the woman was delivered at term of a living child (the fifth) who did not present any pock-marks, and who was only more emaciated than this patient's other children.
2d. Discrete is more frequent (Jobard noted four abortions in eight cases), but recovery of the mother is the rule.
3d. Confluent on the contrary, abortion is almost in variably the rule, and the death of the mother follows, in the great ma jority of the cases, during the days immediately succeeding abortion; the same result is far more likely to occur if the variola assumes the hiemor rhagic form.
This opinion is now held by all authors, but they still differ as to the period at which the abortion occurs. It is during the suppurative stage that this accident is especially seen to occur. But abortion does not always take place under the same conditions. Sometimes, in short, the fcetus is expelled dead, sometimes living, and the conditions are evidently all differ ent, so that the causes of abortion may thus be multiplied. As soon as
the condition of the maternal blood, the infectious germ of the disease, the exaggerated influence of the maternal temperature, or the infection of the fcetus by the mother, who transmits small-pox to it, cause the death of this fcetus, abortion will become inevitable; because this fcetus is no longer anything but a foreign body, of which the womb will inevi tably tend to relieve itself. But these are not the only causes, and we must take into account another phenomenon, which alone may explain the frequent abortion: it is uterine hemorrhage. Spiegelberg and others refer this to a hemorrhagic endometritis. Brouardel believes that the premature contractions of the uterus are due to an excess of carbonic acid in the blood.
Does pregnancy predispose women to contract the grave forms of the disease ? With Jobard, we think not, and claim that it is by reason of the pregnancy itself, and of the abortion, that the disease assumes a form and. a character exceptionally severe. Brouardel and others show that, in certain cases after abortion, small-pox may become hemorrhagic. Variola does not predispose to puerperal septiciemia; the latter is a serious com plication, which hastens the fatal termination. Death generally occurs from the eleventh to the fourteenth day of the disease, often before, in hemorrhagic small-pox.
The prognosis is exceedingly grave, as Meyer shows in a series of tables, of which the following is a summary: Of 29 preg-nant women, 5 or 17.2 per cent. died, 9 or 31 per cent. aborting; of 47, in another series, 18 or 38.2 per cent. died, 22 aborting. The mortality was greater in an epidemic occurring in the spring and summer.
As regards the fcetus, three alternatives may present: 1st. The child may die in the mother's womb; 2d. It may be born alive, and then it is either in good condition and grows up, or it is born alive, but succumbs a few hours or days aft,er birth; 3d. Finally, the child may be born with small-pox pustules.