1st. The Child dies in. the Mother's Womb.—We believe with Spiegel berg and others, that in order to explain this death, great importance should be assigned to the maternal temperature, and tbat if hemorrhage plays a part, it is a secondary part, so to speak, compared with that of temperature.
2d. The Child is born Alive and Survives.—It is in cases of varioloid, and discrete small-pox especially, that the fcetus escapes the danger. But, if a certain number tire born well, the majority, a,s we have observed, are usually born feeble and emaciated, which accounts for their mortality during the days immediately following birth. It is a curious fact that these infants quite frequently resist vaccine. Burkhardt, of Bale, re-vac cinated 28 pregnant women, with the following result: In 4 women at the end of their pregnancy, vaccination was successful; in 4 children it was unsuccessful, one child resisting it for six months. Vaccination seems in these cases, then, to affect both mother and child. Hence the necessity of re-vaccinating all pregnant women. If vaccine can act thus on the fcetus through the mother, so much the more reason should there be why small-pox should be transmitted in the same manner.
3d. Certain infante are born with evident marks of variola, either in the shape of fully-developed pustules, or cicatrices. 3Iany cases are on record in which children were born with small-pox, while the mothers remained uninfected; in one instance the child was apparently infected at the time of fecundation, the mother remaining well. These cases, it must be acknowledged, are really exceptions, and small-pox in the fcetus is rare. It is only when the mother is infected at the end of gestation that this has been verified; and then the fo3tus comes into the world either during the period of invasion (Gariel), or more commonly towards the end of the eruptive stage, or at the time of the suppurative fever (Chaig neau (Noblet de Rennes, Legrand). Before the ninth month cases be come more and more rare, while towards the sixth and fifth month they are almost exceptional. Male infants seem to be more predisposed to it than females.
• If the pustules in the fcetus present a striking resemblance to those of the adult, they have not the same distribution. Aside from the fact that the small-pox is usually discrete, the pustules are scattered in an irregu lar manner, and are not most numerous on the lace. Nevertheless, in some cases the variola has been confluent. The pustules contain, as a rule, a yellowish and slightly opaque, but rarely purulent, fluid. How
ever, true suppuration has been noted. Mother and child may be at tacked simultaneously; the small-pox then pursues a parallel course in the two subject& More commonly, however, this does not occur, and the small-pox is more advanced in the mother than in the fcetus. Children have been attacked three months after the mother. Some times the period of invasion seems to be indicated by a peculiar malaise, an extreme agitation of the fcetus, followed by the cessation of active movements.
The treatment consists in re-vaccinating pregnant women, beca,use the cases reported by Burckhardt, although too few to permit the drawing of a positive conclusion, prove, at least, the harmlessness of vaccination, as regards both mother and child.
Scarlet Aver.
Scarlet fever, although not absolutely rare among the complications of labor, appears on the contrary to be the exception during pregnancy, to judge from the small number of observations reported by authors. Ca zeaux never saw a case; Bourgeois, however, mentions an epidemic ob served in Vienna in 1801. Scarlatina assumes a grave, malignant type, and terminates in abortion in the case of every woman, in death in the majority. All the descriptions of writers have reference to scarlet fever occurring after delivery. A single observation of Bourgeois seems, how ever, to have related to a case of scarlet fever which occurred during the latter days of pregnancy, the woman dying five days after delivery.
Measles.
Measles is of rare occurrence during pregnancy, for only twenty or twenty-five cases at the most can be collected among different authorities. According to Levret, it equals in gravity the other eruptive fevers, and is almost al ways accompanied by abortions and premature delivery. Grisolle and Cazeaux, on the other hand, observed two cases in which the preg nancy pursued its course. Bourgeois agrees with Levret. Among fif teen cases observed by him, he noted eight abortions or premature births; of the eight children, five were non-viable (born before seven months), three at the seventh or eighth month. In women who were only between the second and fifth month of pregnancy, the disease pursued its usual course, but it bee,ame more severe as the pregnancy was more advanced. The premonitory symptoms of abortion appeared towards the end of the disease; as a rule, delivery did not occur until from one to three days later, and sometimes the disease had terminated.