ACUTE OR CHRONIC GENERAL DISEASES, acting either by excess of temperature and changes in the composition of the blood or by alterations in the placenta.
Typhoid Fever. — Abortion occurs in about two-thirds of the cases of typhoid fever, and is more apt to take place dur ing the earlier than the later months of pregnancy.
Enteric fever materially influences the course of gestation, since abortion occurs in something like two-thirds of the cases. Thus, Sacquin collected 310 cases, and found abortion in 199; while Martinet found 66 abortions in 109 cases. W. For dyce (Brit. Med. Jour., Feb. 19, '9S).
The most prominent feature is uter ine haemorrhage, which is often the first symptom of impending abortion. The use of ergot is to be avoided in cases of pregnancy occurring in conjunction with typhoid fever. Other remedies, such as cold baths or even quinine, may be safely used. The history and treatment of the typhoid state proper remain unaffected by the co-existing pregnancy.
Pneumonia .—During the first months of pregnancy abortion occurs in more than one-third of the cases of pneu monia, but this complication occurs with increasing frequency the more advanced the pregnancy. Taking a general aver age of cases of abortion occurring during pneumonia, an estimate placing it at two-thirds of the cases is probably cor rect. The foetus itself may suffer from pneumonic infection, and die soon after birth from pulmonary, meningeal, endo cardial, or other lesions.
Statistics of 213 cases of pneumonia during pregnancy: In 11S cases the preg nancy wa.3 interrupted, there heing 42 abortions and 76 premature deliveries. Death of the mother occurred in 75 cases among the 213: a mortality of 35 per cent. The mortality of the mother is greater in premature deliveries than in abortion. S. Flatte (These de Paris, '92).
Influenza. — It is probable that the marked nervous phenomena play a lead ing part in the production of abortion. The vasomotors bear the brunt of the toxic effects in the majority of cases, and the secondary results of vasomotor dis turbance in the uterus, which is richly supplied with vessels, are obvious.
Report of a number of abortions or premature deliveries resulting from in fluenza. Trossat (Lyon Med., Mar. 11, '90).
Doubt whether abortion and premature labor in influenza depend upon mechan ical irritation from coughing and hyper mrnia, with local congestion. It is very probable that in such cases the cause is infection from the uterine mucosa. Case of abortion occurring during influenza in a girl 19 years old; phlegmasia alba dolens developed three days after con finement, followed on the fifteenth day by pyeemic abscesses in the sternal region. Labadie-Lagrave (La Mad. Mod., Feb. 25, '92).
illeasles.—This disease seldom occurs during pregnancy. According to some authorities measles and pregnancy have but little reciprocal influence. Of eleven cases collected by Klotz, however, nine were attended by premature delivery.
The influence of measles is but slight during the first months of pregnancy, and increases in gravity with the age of the pregnancy, the occurrence of this disease in childbed being generally fatal. Besides the danger of puerperal hmm orrhage, pneumonia is a frequent and formidable complication.
Scarlet Fever. — This disease rarely complicates pregnancy, although it is comparatively frequent in the puerperal state. The period of invasion being fre quently absent, it is probable, however, that it remains unrecognized, and that a larger proportion of cases of premature birth and abortion are caused by it than is generally supposed. In some cases the stage of incubation is prolonged to such a degree that the scarlet fever contracted during pregnancy is recognized only after delivery by the sudden develop ment of the eruption over the entire body. Of S pregnant women suffering from scarlet fever, 6 who were from 4 to 6 months with child recovered with out accident, 1 aborted at 3 months, and 1 had a premature delivery at 7 months (Legendre). The cases are generally characterized by high fever, emesis, marked congestion of the face, and sud den appearance of the eruption, which occasionally assumes a livid color.