A system of practical medicine. By American authors. Vol. 4

by Unknown

Scarlatina, like measles, occurs infrequently in the course of pregnancy. Olshausen has collected 7 cases. Pregnancy was interrupted in 4 out of these 7 cases, probably as the result of the elevation of maternal temperature. The renal complications also add an unfavorable element to the prognosis.

TYPHOID FEVER.

Typhoid fever occurs with greatest frequency during the early months of gestation. It is a very rare complication of the puerperium. Pregnancy is usually interrupted. Abortion rather than premature labor is observed. This tendency to the interruption of gestation is more marked than in any of the acute infectious diseases with the possible exception of smallpox. Of 98 cases collected by Kaminsky, interruption of pregnancy occurred in 63; Zülzer reports 14 interruptions of pregnancy in 24 cases; Scanzoni, 6 out of 10 cases. In about 63 per cent. of the cases collected by these observers pregnancy was interrupted. The causes of abortion or premature labor in typhoid fever are found in the elevation of maternal temperature, the hemorrhagic endometritis, and perforation (Kleinwächter). The transmission of the infection from mother to child is a disputed point. The prognosis depends largely upon the stage of the disease in which the interruption of pregnancy occurs. If abortion or premature labor occurs early in the course of the disease, before the mother is exhausted, the outlook is naturally more favorable.

RELAPSING FEVER.

Murchison states very positively that pregnancy is invariably interrupted by the occurrence of relapsing fever. Recent investigations, however, indicate that this assertion is entirely too general. Weber³⁶ has collected 63 cases of pregnancy complicated by this disease. Pregnancy was interrupted in 23 cases, or 36.5 per cent. Hemorrhagic endometritis is of less frequent occurrence than in typhoid fever. In two cases (Wyss-Ebstein and Albrecht) spirilla were found in the foetal blood, indicating the infection of the child by the mother.

³⁶ Berlin. klin. Woch., vii., 1870, p. 22.

TYPHUS FEVER.

Typhus fever manifests much less tendency to the production of hemorrhagic endometritis than typhoid and relapsing fevers. The interruption of pregnancy is the exception rather than the rule. When abortion or premature labor occurs, it is usually caused by the elevation of the maternal temperature. There is no evidence pointing to the infection of the child with the specific poison of the disease.

MALARIAL FEVER.

The popular belief that pregnant women enjoy a certain³⁷ immunity from malarial fever seems to have some foundation in fact. This apparent immunity may be due in part to the environment and freedom from exposure to the malarial poison—in part to the condition of pregnancy. In latent, chronic malarial poisoning gestation may be the cause of the explosion or acute exacerbation of the affection. The course and symptoms of malarial fever are materially modified by the coexistence of pregnancy. The attacks lose something of their rhythmical character. Chills are of irregular occurrence, and the fever assumes a remittent or continued type. In the latter months of gestation acute attacks of malarial fever are especially distressing to the patient.