34 Arch. f. Gyn., iv. p. 285.
Of the eruptive fevers, smallpox, scarlet fever, and measles are of especial clinical interest. Smallpox is observed most frequently. The eruptive fevers usually occur early in pregnancy, but the disposition to the severer forms and the mortality, as remarked by Spiegelberg, grow with the duration of gestation.
SMALLPOX.
A mutually unfavorable relation exists between smallpox and pregnancy. A distinct tendency to the hemorrhagic form of the disease is notable. Pregnancy frequently terminates in abortion or premature labor under circumstances which seriously imperil the mother's life from loss of blood. When the disease pursues its course without interrupting pregnancy, the effect upon the foetus is interesting and instructive. The child may be born alive with characteristic variolous cicatrices or in the eruptive stage. Usually the eruption appears from eight to ten days after birth. Very rarely the child may escape infection altogether. The foetus may be infected in utero, while the mother remains apparently unaffected. Fumée of Montpellier narrates the history of a remarkable case of twin pregnancy. Only one of the children showed variolous pustules.
During smallpox epidemics abortions and premature labors, accompanied by abnormally severe hemorrhages, are frequently observed when no exanthem or other sign of the disease is noticeable in the mother. The healthy child of a mother affected with variola in the course of pregnancy is usually insusceptible to vaccinia for a long time after birth.
In the event of a smallpox epidemic the vaccination or revaccination of pregnant women is advisable. The effect of the vaccination of the pregnant woman upon the foetus is still a subject of controversy. Thorburn in 1870 successfully vaccinated a number of pregnant women, and found no insusceptibility in their children. Behm35 vaccinated 33 women pregnant in the eighth, ninth, and tenth months. The vaccination was completely successful in 22 cases, partially in 7, and failed in 4. Of the 33 children, 25 were successfully vaccinated. In 8 cases vaccination was not attended with success. Failure was ascribed in 7 cases to bad lymph, leaving only 1 case of presumed protection from intra-uterine vaccination. Bollinger and Burckhardt, supported by the results of Rickett and Roloffs in the inoculation of sheep, maintain that over one-half the infants are protected from vaccinia and smallpox by the vaccination of the mother during pregnancy.
35 Centralbl. f. Gynaek., 1882.
MEASLES.
Rubeola, of infrequent occurrence in the adult generally, is a very rare complication of pregnancy. It is of serious prognostic moment, from the tendency to the hemorrhagic form of the disease, and pneumonia.
SCARLET FEVER.