We are not concerned here with icterus which occurs after labor; it may be said, however, that it is very grave, because we may, with Her vieux, regard it in a great majority of cases as symptomatic of puerperal poisoning, and as one of the consequences of puerperal peritonitis.
can be no question, it is evident, as to the induc tion of abortion or even of premature labor, in the presence of the disas trous results that follow abortion in cases of icterus. We should limit our selves, then, to exclusively medical treatment. To relieve the hepatic pains by leeches and cupping, to oppose the condition of sordes by ipecac, the constipation by purgatives, the vomiting by ice and acid drinks, Vichy and Seltzer water and alkaline baths—in a word, we adapt our medicine to the symptoms, treating them as they appear, by appropriate remedies. Lavoix advises, as a prophylactic, tincture of aconite and quinine; Cazeaux change of residence.
Syphilis.
All authors agree in admitting the influence of syphilis on pregnancy, and of pregnancy on syphilis; but there is a particular factor which im parts to this mutual influence special forms—the ago of the syphilis.
1st. Sometimes a woman is pregnant when she contracts syphilis, and the infection can then occur either at the beginning, during the first months after conception, or during the latter months.
2d. Sometimes a woman becomes pregnant at the same time that she contract syphilis. The infecting coitus has also been fruitful.
3d. Pregnancy occurs in a woman who is healthy and in good condition, and who has never presented, nor does she then present, any evidence, old or recent, of syphilis, but whose husband has possessed, or still pos sesses, a syphilitic diathesis.
4th. Pregnancy occurs in a woman affected by syphilis at a time moro or less remote; it was not treated, and the woman presents or does not present traces of it.
In the first place, What are the evidences of syphilis most often met with in the pregnant female? According to all the authors who have studied the disease, these are especially the primary and secondary mani festations. The tertiary, on the contrary, are rare. These manifestations are greatly influenced in their course and in their character by gestation.
This influence of pregnancy is manifested in two ways, either locally or generally, and both chancres and syphilides are subject to the disturbing circulatory effects which exist in the pregnant woman, and which result either in passive or active congestion. According to Fournier, pregnancy complicates the pox by adding to it its own anasmia, its depressing influ ence, its neuralgic tendency, disorders of nutrition, etc. As regards the local manifestations, syphilis predisposes to the development of mucous syphilides, which assume great importance. The induration is slightly marked, being a simple hardened scale--parchment chancre; but, while in the non-pregnant woman the duration of the chancre does not gener ally exceed from four to five weeks (rarely more, often less), in the preg nant female the mean duration of the chancre is about two months and twenty days.
According to Fournier, mucous papules are not only very common, but they develop in pregnant women a remarkable exuberance, assume rap idly the budding, vegetating, or hypertrophic variety, and often form actual tumors, which invade and distort the entire vulva. Moreover, they are always more rebellious than usual, and disappear more slowly. Syphilitic ulcers are quite frequent in pregnant women; they are livid, of a violet color, excavated, and are rendered still deeper by the vascular turgescence of the parts. They usually persist for a longer or a shorter period and often tend to progress. It is sometimes extremely difficult to cause them to cicatrize before delivery. While the duration of syphilides, in the non-pregnant state, varies from two to two and one-half months, it varies from three to three and one-half during pregnancy. Garin, who agrees with Fournier on this point, affirms that during pregnancy the mucous patches increase in number, and grow in spite of general and local treatment as long as the pregnancy continues; or, that if they dis appear for a short time, they have a great tendency to return, not only on the genitals but also on the fauces, tongue, and lips. Their pershst ence, according to him, proves that treatment is not as effective as it is in the non-pregnant condition.