SPORADIC AFFECTIONS.
Pneumonia.
We have seen, in studying tho changes induced in the body by preg nancy, that Kuchenmeister and others have proved that the pulmontuy capacity is not lessened during this condition—that if the thok-ax is not so deep, this diminution in depth is compensated for by the increase in breadth of the base of the chest, and that after delivery the chest resumes its usual shape. Pulmonary diseases during pregnancy react seriously -upon the woman's health, and may all be observed; but, aside from pul monary congations, cedema, and hemorrhage, it is the acute affection, pneumonia, which, according to all authorities, deserves special attention, both on account of the graVity which it impresses upon the pregnancy, and its influence on gestation.
Etiology and during pregnancy, as well as in the non-pregnant stage, is due to a chill, and consequently it may occur without distinction at any period of this pregnancy; only pregnant women, according to Rican and Devilliers, are predisposed to it by reason of the changes which pregnancy causes in the composition of the blood, especi ally the excess of fibrin. Statistics presented by authorities correspond in fact to every period of pregnancy, and the important fact deduced from these observations is that pneumonia almost certainly causes abor tion, and that a considerable number of women die. Bourgeois observed twelve cases, with eight abortions and as many deaths; Grisolle reports only one recovery out of fifteen cases, six women being delivered at term, while the other nine miscarried. Wernich thinks that cardiac failure is the principal danger in cases of pneumonia during pregnancy. The weakened action of the right ventricle leads to stasis of the pulmonary circulation, and consequent emptying of the left ventricle. If the pneu monia is extensive, as the vis a tergo becomes diminished on one side (the left ventricle), while the obstruction increases on the other (the empty ing of the right ventricle becoming less and less complete), the blood stasis in the veins of the general system constantly increases--hence the danger. Considering next the influence of pneumonia upon pregnancy, and of pregnancy upon pneumonia, he presents the following conclusions: 1st. The more advanced the pregnancy, the more rapidly does pneu monia c,ause premature delivery. 2d. The more advanced the pregnancy,
the more unfavorable is the emptying of the uterus. 3d. The more ad vanced the pregnancy, the more likely is the pneumonia to terminate fatally. From a comparison of the statistics, it would seem that pneu monia affects pregnancy less than the exanthemata and typhoid fever, and on the contrary approaches cholera in its influence: 271e Influence of Pregtuzncy on during preg nancy seems to attack more often the right than the left side, which is also the rule in the non-parous, but pregnancy causes an especial aggra vation of the symptoms; the fever is marked, the temperature high, the skin hot and dry, the pulse rapid and vibrating. But the principal phe nomenon is the disturbance of the respiration, which, according to Rican, depends upon two sets of causes, one of which (pathological) is due to the pneumonia? the other (physiological) depends upon the pregnancy.
A. Causes due to Pneumonia. —1st. The pulmonary alveoli being the seat of an exudation which prevents the air'from entering them, the re spiratory surface is diminished and the circulation in the inflamed portion is retarded; 2d. HyperEemia and collateral cedema are produced in the non-inflamed portion—two conditions which directly contract the area of hEematosis (Jaccoud); 3d. The pain in the side compels the patient to - make very shallow respirations—hence a permanent diminution of the thoracic cavity; 4th. Fever, in consequence of increased combustion, leads to a greater consumption of oxygen, and an increased production of carbonic acid, at the expense of the system; this is one of the most potent causes of dyspno3a (Niemeyer.) B. Causes due to in its turn, acts in two ways: on the one hand by increasing the size of the uterus, which, after the sixth month, crowds up the intestines, the stomach and the spleen, and limits, in consequence, the contractions of the diaphragm; on the other hand, by the changes which it induces in the blood, the red discs being diminished in size, and, since these are the oxygen-carriers, the supply of this gas in the economy will be lessened, while, again, if the pulmonary lesion is very extensive, there will be disturbances of the circulation.