Chatelain, who favors the induction of abortion in bad cases of pneu- • monia, unites with Grisolle in advising venesection; this is also the Ger man method. As for emetics, he reserves these until the uterus begins to contract, when the hope of saving both mother and child is removed.
He believes, with Grisolle, Young, Parker, and Gantillon, that tartar emetic provokes uterine contractions. As long as there is no evidence of delivery, he prefers sulphuret of mercury, either alone or in combination with digitalis, which, in his opinion, is the remedy par excellence. Rican, on the contrary, does not employ venesection, or does not recommend it nnleas pneumonia is complicated by organic disease of the heart in a preg nant female. He employs tartar emetic and digitalis, giving the former in emetic doses, and reserves premature delivery as a last resource.
Pleurisy.
Pleurisy seems to be situated more frequently on the right than on the left side. It is a curious fact that, while pneumonia is one of the most serious complications of pregnancy, pleurisy (except in exceptionally severe eases) does not appear to affect either the course of pregnancy or the life of the mother. It was actually interrupted only twice in eighteen cases col lected by us, the two women who miscarried being in the last month of pregnancy. (Leopold, Budin). Besides, pleurisy may assume either of the classical types, the course of the disease apparently being influenced principally by this variability in its form. The acute, or sero-fibrinous variety, is, according to Leopold, the most favorable, although the exuda tive (whether more or less extensive) is the most common. Pneumonia is a rare disease during pregnancy, but pleurisy is still more infrequent, since we have been able to collect only eighteen eases.
As in ordinary pleurisy, the symptoms are the pleuritic " stitch," the flatness, cough, dyspncea, accompanied with pain, fever, the compression of the lung, which diminishes the area of hematosis, the compensatory congestion and cedema of the healthy lung (in the pregnant woman, espe cially during the later months, the disturbance of respiration referable t,o pregnancy itself is added to the pleuritic dyspmea), and the displace ment of the heart. As a rule, then, pleurisy in the gravid woman is be nign, and it is only in exceptional cases that it tends to become purulent (contrary to its course after delivery), because it usually runs its course in from thirty-five to forty days. But this is not always the case, as proved by the facts recorded by Leopold and Bara*tgin, for it may some times assume such a grave character that thoracentesis becomes necessary.
The pregnancy generally pursues its course, but when abortion and pre: mature delivery take place, these have not seemed to exert any special influence upon the progress of the effusion; there was not only no in creased effusion, but, on the contrary, the dyspncea and accompanying malaise disappeared rapidly, almost immediately, in spite of the presence of the exudation. Emptying of the uterus, therefore, seems in itself to relieve the oppression by freeing the thorax; this is especially true when the pregnancy is quite advanced. Pleurisy, in fact, apparently pursues its usual course, and neither influences nor is much affected bv pregnancv.
The prognosis is generally, but not always, favorable for both mother and child.
Treatment. --Grisolle advocates a most thorough and vigorous antiphlo gistic treatment. Fischl, Leopold and Baratgin confine themselves to the use of wet cups and opiates, combined with digitalis, employing large blis ters, diuretics, mild purgatives, milk, and a more or less restricted diet, as soon as the fever diminishes. But, if there is considerable effusion, intense dyspncea, and threatened asphyxia, with marked cardiac displacement, are we justified in resorting to thoracentesis? It was employed twice by Duguet, and once by Vendrant and Verneuil; no accident resulted in these three cases, and the mothers recovered more or less speedily. Others have observed satisfactory results from thoracentesis; pregnancy does not seem to contra-indicate dt.
Pulmonary Tuberculoais—Phlhisis.
The most recent and exhaustive work on pulmonary tuberculosis is the thesis of Gaulard (1880). According to him, amemia is the rule in preg nancy. He accepts entirely Peter's idea concerning the pulmonary conges tion of pregnancy, and states that four opinions are still held by scientists regarding the relations between plithisis and pregnancy, viz.: 1st. Preg nancy checks the development of phthisis, or arrests its course after it has already begun , `4.d. Pregnancy accelerates the progress of tuberculosis; 3d. Pregnancy really aggravates the disease, but the latter undergoes marked amelioration during the early months; 4th. Sometimes pregnancy interrupts, and seems to arrest the course of the disease—sometimes, on the contrary, it aggravates and hastens it Each of these views has its eminent supporters and defenders.