Before closing these illustrations of the pathology of fever, it may be proper to give an example of the modifications which take place when this disease proves fatal in the state of gestation. If fever attack during pregnancy, there is the greatest possible danger of miscarriage, and the great majority of those who miscarry die. There is no complication which requires a more delicate and cautious management; and the management which experience shews to be the best will be stated in the proper place: in the mean time, the following case is given as an illustration of the morbid appearances which are found (and the appearances are very uniform) when abortion is the precursor of death.
Case CX.
Mary Cutler, æt. 37, married. Admitted on the 5th day of fever, in the commencement of which, in addition to the ordinary symptoms, there was much nausea; this feeling continues at present, and is now accompanied with vomiting; epigastrium tender; cannot lie without pain in the left side; cough frequent, and exciting uneasiness in the chest; tongue white and dry; bowels bound; some pain of head, especially in the forehead; scarcely any sleep; much pain in the extremities; pain of throat with difficult deglutition; pulse 122; skin warm; six months pregnant.
6th. Much retching and vomiting; tenderness of the epigastrium and abdomen; bowels very loose; tongue white in the middle, red at the edges; severe pain in the chest; great dyspnœa; constant, urgent cough with difficult mucous expectoration; severe pain in the head; no sleep; great restlessness; pulse 150, sharp but compressible. V. S. ad ℥xij.
7th. Buff on blood extremely firm; retching and vomiting gone; pain of side entirely removed; less cough; dyspnœa diminished; pain of head better; slept much better; pulse 120.
9th. After a tolerable night, attacked this morning with urgent dyspnœa, soon became perfectly insensible; was delivered of a fœtus six months old; at present, nearly insensible; respiration hurried and laborious; tongue brown and dry; one stool; pulse 110; skin moderately warm.
10th. Free lochial discharge; all the symptoms greatly improved; tongue white; moist; pulse 84, soft.
13th. Lochial discharge nearly ceased; no pain in head, abdomen, or any where, except the face which is attacked by erysipelas; tongue continues moist and is nearly clean; pulse 108.
14th. Erysipelas increased and extending; tongue, has again become brown and dry; pulse 110.
16th. Erysipelas extending; severe pain in epigastrium and over abdomen, much increased on pressure; distressing sense of nausea but no vomiting; tongue the same; pulse 96, weak and irregular.