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

by Unknown

³⁷ Ritter, Virchow's Archiv, 1867.

The interruption of pregnancy is not an uncommon event. Göth has recently reported 46 cases, in 19 of which either abortion or premature labor took place. When pregnancy is interrupted hemorrhage is apt to be profuse.

The communication of the disease to the foetus is a well-authenticated clinical fact. Hubbard reports an interesting case of intra-uterine malarial fever. Autopsies of infants born of mothers affected with acute or chronic malarial poisoning reveal the characteristic lesions of that pathological condition. Malarial paroxysms are usually suspended during labor, but may reappear during the lying-in period. Very rarely the fever assumes a pernicious type, and then may stand in a certain causal relation to the essential anæmia of pregnancy, of which mention has already been made.

In the TREATMENT of malarial poisoning during pregnancy large doses of quinine are indicated. Spiegelberg points out the important fact that, owing to the impairment of the digestive and assimilative functions, only a portion of the quinine is absorbed. There is no ground for fearing any untoward effect from quinine. The researches of Chiara of Milan and numerous other observers prove that even the largest therapeutic doses of quinine are not abortifacient in malarial fever or in health.

CHOLERA.

Pregnant women evince no proclivity to, nor immunity from, cholera. As in variola, the disposition to, and mortality of, the disease grow with the duration of gestation. The prospect of recovery is especially unfavorable during the sixth and seventh months. Pregnancy is usually interrupted when the woman survives the terribly rapid course of the disease. Many women die with the product of conception in the cavity of the uterus. Exceptionally, in the lighter forms of the disease recovery may occur without the interruption of gestation. The causes of premature labor or abortion may be found in the constant hemorrhagic endometritis and the changes in the pressure and constitution of the maternal blood. As the result of the operation of the two latter factors, asphyxia is usually produced. Buhl, Gütterbock, and others are of the opinion that the disease may be communicated by the mother to the foetus.

Pregnancy undoubtedly exercises an unfavorable influence on the course of the disease, chiefly from the tendency to uterine hemorrhage. Pregnancy is interrupted in over 50 per cent. of the cases. Premature labor is observed more frequently than abortion. The prognosis with reference to the life of the child is absolutely unfavorable.

In very exceptional cases the evacuation of the uterine cavity has seemed to exercise a favorable influence on the course of the disease. Upon this ground the induction of abortion or premature labor has been seriously proposed. The operation, after an extended trial, has fallen into deserved disrepute.

SYPHILIS.

Syphilis is a frequent complication of pregnancy. Sigmund³⁸ has observed and described the characters of syphilis contracted at the beginning or during the course of gestation. The duration of the stage of incubation is abbreviated. Two weeks is the rule, six weeks the exception. The initial lesions are characterized by an unusual degree of intensity, occasionally involving the vulva, vagina, cervix, nates, and inner surfaces of the thighs. The intensity of the initial lesions is due to the anatomical relations of the genitalia in the pregnant woman and the increased nutritive activity of the parts. The symptoms are marked local reaction, reddening and excoriation of the skin and mucous membrane, swelling, oedema, eczema, follicular abscesses, and necrosis of the connective tissue. Induration is not a characteristic of chancre situated about the genitalia of the pregnant woman. Phagedenic ulceration sometimes attacks the chancre, and then the case may be mistaken for one of phagedenic chancroid. The secondary symptoms are unusually mild. Condylomata appear about the genitalia, and psoriasis is noticeable on the palms of the hands and soles of the feet. Glandular infiltration follows slowly, and alopecia, iritis, laryngitis, and the skin manifestations are observed with comparative infrequency.