Syphilis.—Whether contracted at the beginning or during the course of preg nancy, syphilis gives rise to very marked and widely spread initial symptoms, while the subsequent symptoms are mild.
When syphilis is contracted previous to conception, abortions occur repeat edly; but, as with time the date of the infection becomes more remote, the abortions occur at a later date in the course of the pregnancy, until premature delivery may occur, and finally delivery at term.
When conception and infection occur simultaneously, abortion is almost con stant if no treatment be given; if imme diate treatment be instituted the chances of abortion are somewhat reduced.
When infection occurs after concep tion has taken place, the nearer the two dates of conception and infection are to each other, the more will abortion be likely to occur. A thorough mercurial treatment should be inaugurated as soon as the presence of syphilis is known.
Diabetes. — This disease may compli cate pregnancy either on account of its presence before conception, or it may occur during pregnancy only. Abortion occurs in about one-third of the cases, one-fourth of these ending fatally, gen erally by collapse. The child, though viable, usually perishes. This complica tion presents itself almost invariably in multiparfe.
Disease of the heart. — The influence of cardiac disease upon pregnancy varies with the character and seat of the affec tion that may be present. Generally speaking, however, abortion and prcma ture delivery are frequently observed: i.e., in about two cases out of every five of heart trouble.
While acute pericarditis seems to bear practically no influence upon the normal course of the gestation, chronic peri carditis is a pernicious accompaniment of pregnancy, owing to the insufficient compensation afforded by the heart itself for pre-existing valvular lesions to satisfy the increased demand upon that organ. Acute endocarditis assumes increased dangers during pregnancy through a marked tendency to assume an ulcerative process, which generally ends fatally.
Mitral lesions, especially mitral steno sis and insufficiency, are considered by Germain See and Porak as the cardiac disorders most likely to cause death of the patient. If slight, however, or en
tirely compensated for, the parturition may occur without trouble. Intense passive pulmonary congestion, oedema, ascites, and metrorrhagia are to be feared in all such cases. Aortic insuffi ciency or stenosis is generally most marked in advanced pregnancy on ac count of increased arterial tension, but these untoward symptoms frequently disappear after parturition.
Pulmonary Diseases. — In the great majority of instances pregnancy hastens the development of phthisis, and pre-_ cipitates its progress. In women predis posed to phthisis the probabilities as to the occurrence of this disease are thus increased by marriage. Although they sometimes escape it during the first preg nancy. the likelihood that the disease will show itself in future pregnancies is nevertheless great. Abortion or pre mature delivery is frequent in these cases, and the viability of the child is proportionate to the condition of the mother. Every effort should be made to thoroughly nourish such cases, overfeed ing, milk, etc., forming the basis of the measures to be instituted.
Chronic pleurisy, empyema, and em physema are liable to produce dilatation of the heart and thus render it inca pable of compensating for the increased arterial tension of the parturient state. These conditions, however, are more dangerous to the mother than to the child; indeed, abortion under such cir cumstances sometimes saves the patient's life.
TuAUMATISM. — Brutal treatment of pregnant women, falls, etc., are well known causes. The farther removed from the genital organs is any trauma tism the less likelihood is there of abor tion being produced. Even small oper ations—the opening of an abscess, the extraction of teeth, etc.—have caused abortion.
Case of abortion caused by the extrac tion of a tooth thirteen days before. Labor was immediately preceded by severe hemorrhage from the dental al veolus. Poyntz (Indian Med. Record, Feb., '91).
Abortion may be due to too frequent pregnancies. Among other well-known causes may be cited long journeys or short journeys too frequently repeated; excessive walking, climbing, riding, or other physical exercise; falls, moral shocks, etc.