4. Intercurrent Disease.—Of this form of irritant the eruptive fevers furnish a familiar example. Any acute disease developing during pregnancy may not only be of a more severe type than would ordinarily occur, thus intensify ing the patient's discomfort and suffer ing, but it may even cause the death of the child or its premature delivery, either alive or dead.
In closely observing 432 cases of small pox in women under 50 years, particular note made of SO who were pregnant. Of these 15 per cent. died, while the mor tality of the non-pregnant eases was 11.0S per cent.
Pregnancy increases the predisposition of a patient to the graver forms of vari ola. In the SO cases, confluent small-pox was seen in 4 and hmmorrhagic in 6 cases; all the 10 died. In the 352 non pregnant eases the confluent form was observed in 3 and the hmmorrhagic in 11 patients; 2 of the confluent cases re covered. Two pregnant women died of milder forms; of the total, 12, there died 5 undelivered, the most of the others very shortly after birth without any trace of puerperal infection. Of the primiparm, 9 per cent. died; of the mul tipar, 17.25 per cent.; 6.25 per cent. of women attacked by small-pox early in pregnancy died, while the mortality of those who were infected later amounted to 20.83 per cent. Abortion or prema ture delivery was noted in 23 of the SO cases during the course of the attack of small-pox. In 6 the same took place after convalescence from the disease; 16 children were delivered alive in cases where the small-pox was still in progress, 8 at term, and 8 prematurely; only 3 lived longer than six months. Several died of variola; 2 were clearly born with it. Van der Willigen (Nederland. Tydschr. voor Geneesk., No. 11, '95).
Hypothesis that the occurrence of tetany during pregnancy depends pri marily upon some abnormality in the function of the thyroid gland, and it is the unusual demands made upon this organ in the later months of pregnancy which make this such a favorable time for the occurrence of the attacks.
Opinion entertained that it is prob able that tetany occurring under other conditions will in most cases be found to be due to an insufficiency, absolute or relative, in the action of the thyroid gland or like structures. H. M. Thomas
(Johns Hopkins Hosp. Bull., May, June, '95).
In last epidemic of influenza numerous cases of metritis or metroperitonitis in the last months of pregnancy were re corded. Severe hypogastric pain set in, and proved very obstinate. It became complicated within a few days or weeks with phenomena of delivery and child bed, and often proved serious in conse quence. Usually the complication passed off with an attack of herpes labialis or urticaria. Coughing was frequent, and increased the local condition; fever was never high. Quinine, morphine, rest in bed, and very careful watching during convalescence usually effected a cure. Hennig (Centralb. f. Gyn., No. 6, '96).
Influenza is generally mild in the preg nant woman. If, however, the attack is severe, pregnancy is always interrupted. Hintze (Centralb. f. Gyn., p. 1311, '96).
5. Irritating Conditions Associated with the Ovum.—Such conditions may consist in disease which has been nutted from the mother (e.g., syphilis), or there may be diseased conditions of the placenta or membranes which may react upon the mother. Especially if death of the ovum takes place and it then remains within the mother's body it may be a source of disturbance to her. One of the most distressing illustrations of such possibilities is the wide range of untoward phenomena which are con nected with ectopic gestation. There is perhaps no accident to which a preg nant woman is susceptible which brings with it such terrible consequences as this. That some women escape the serious re sults which so often happen when this condition is undiscovered and untreated by the surgeon's art is no contradiction to the truth of this assertion.
Disorders of Pregnancy.
Certain salient conditions are fre quently conspicuous and troublesome in connection with the pregnant state. These conditions will be considered un der the following category: Nausea and vomiting. Ptyalism. Displacements of the uterus. Embolism and thrombosis. Ectopic gestation. Pruritu s vulva?. (Edema of the external genitals. (Edema of the lower extremities. (Edema of the upper extremities. HTmorrhoids. Uter ine pain, or cramps. Spurious preg nancy. Concealed pregnancy.