When women were attacked with the disease at the end of pregnancy, premature delivery took place at the outset, accompanied by fever and serious symptoms. The fcetus was dead-born, or perished within a few hours or days after birth. The disease pursued its course and the women slowly recovered. In rare instances the children were born with measles. Bourgeois saw one case, the infant being born fifteen days before full term and living only three days. Gautier collected eleven cases, in six of which the children presented the morbillous eruption.
Measles occurring during pregnancy, therefore, may predispose to the death of the fcetus and to abortion; it does not endanger the mother. The prognosis during the puerperal state is less grave.
Ery8ipelas.
Erysipelas, like the other eruptive fevers, may attack pregnant females, and pregnancy does not seem to offer any protection from it. Facial ery sipelas, especially, has been observed several times, and if pregnancy does not seem to influence the course of the affection, the case is not the same as regards the influence of erysipelas upon pregnancy. The latter is often interrupted, either by abortion or by premature delivery, and the fcetus may be directly affected by the rise of temperature in the mother. The mother, as in cases of small-pox, may die or be cured; everything depends on the severity of the disease. However, erysipelas seems to be less seri ous than variola, and may be placed on the same level as measles. We have only seen one case: the woman, who was attacked at about the fourth month of pregnancy, presented until term (when she was delivered of a living child) a series of erysipelatous eruptions of the face, which reap peared month after month, and were remarkable by reason of the insig nificance of the febrile manifestations, although the eruption was well marked.
Typhoid Fever.
While Rokitansky and Niemeyer believe that pregnancy insures a sort of immunity from typhoid fever, others regard this opinion as being too positive, and, while agreeing in the belief that typhoid is more common after delivery than It is during pregnancy, they prove, by numerous ob servations (283), that typhoid may not only attack pregnant women, but that it does not always present the same form—that the disease may as su me the abdominal, exanthematic or recurrent type. These three vari eties, moreover, do not seem to manifest either the same frequency, or the same severity, the exanthematic and recurrent forms having been most often observed. Typhoid fever may attack women at any period of pregnancy;
however, it occurs more frequently during the first than during the last months. But the three types of the disease do not seem to possess the same gravity, and while the abdominal variety is most severe, the exan thematic and recurrent would seem to be less dangerous to women. This danger also, according to Spiegelberg, depends, perhaps, less upon the form of the disease than it does upon the period of the pregnancy at which it occurs, and upon the abortion which it produces, since the latter is inevitably followed by more severe hemorrhages during the early than during the later months, when the consequences are simply those of a premature delivery. In 322 cases the fcetus was expelled prematurely in 182.
According to Zuelzer and Wardell, exanthematic typhoid is the least serious of all, its influence on pregnancy being almost nil.
Prognosis. —This is extremely grave for the child, since not only does abortion cause its death, but in cases of premature delivery the fcetus is often dead-born, or, if it is born alive, it frequently perishes during the days succeeding its birth, either from congenital asthenia, or with symp toms of typhoid fever.
What is the true cause of the death of the fcetus? All authors agree in attributing it to the elevation of the mother's temperature. Kaminsky has shown that, as soon as the maternal temperature rises to 104°, the fcetal heart-beat is observed to become accelerated in proportion to the height of the mother's temperature, and, in addition, the fcetus executes irregular movements at 107° to 107.5°. Fcetal death is inevitable, but the danger begins at 104°. According to Kaminsky, it is the elevation of the maternal temperature, not the typhoid infection, which alone causes the death of the fcetus; its expulsion may be delayed for a longer or shorter time afterwards, even as late as the beginning of the mother's convalescence.
The prognosis as regards the mother is more favorable, and, like Spie gelberg, Fiedler believes that its gravity depends much more upon the abortion and consequent hemorrhage than upon the disease itself. The influence of pregnancy on typhoid fever seems to be obscure.