120 CARNEGIE INSTITUTION OF WASHINGTON. 



CLINICAL AND PATHOLOGICAL STUDIES. 



For the purpose of securing more definite information regarding 

 some of the factors in the occurrence of spontaneous abortion, a study 

 has been made during the past year by Dr. J. W. Harris of a series of 

 cases connected with the 1918 epidemic of influenza. Owing to the 

 severity and wide occurrence of the epidemic, and to the fact that it 

 was especially prevalent among young adults of the child-bearing age, 

 it offered the best opportunity we have perhaps ever had to study the 

 extent to which the progress of pregnancy is interfered with by an acute, 

 severe, infectious disease. A questionnaire was prepared which 

 included data as to the race and age of the individual, the month of 

 pregnancy, whether the disease was complicated by pneumonia, the 

 outcome for the mother (recovery or death), and whether or not preg- 

 nancy was interrupted. Copies of this blank were sent to all of the 

 physicians of the State of Maryland and also to members of the 

 American Gynecological Society, the American Association of Gyne- 

 cologists and Obstetricians, and the local obstetric societies in four 

 of the larger cities. This met with a most satisfactory response on the 

 part of the physicians, and 1,350 cases of influenza occurring in preg- 

 nant women were reported in full detail. Of these, 791 were from the 

 State of Maryland, and hence the great majority of the cases studied 

 ran their course under the same general conditions. In race the 

 patients were predominantly white, the proportion being 1,266 white, 

 82 negro, and 2 Japanese. In making this statistical study the assump- 

 tion was made that these particular cases were serious enough to 

 require medical attention, and, for the most part, did not include the 

 very mild infections. It is to be assumed further that the material 

 gathered is not representative of the number of cases falling within 

 the first two months of pregnancy, when gestation might easily escape 

 the knowledge of the physician. 



With these two reservations the results of the study show, in the 

 first place, that in the cases of influenza which were not complicated by 

 pneumonia the pregnancy was interrupted in 26 per cent, the fre- 

 quency being slightly less marked during the middle third of preg- 

 nancy. This ratio is not greatly in excess of the frequency one would 

 expect under ordinary conditions, so it is probable that many of these 

 abortions would have occurred in the absence of the disease; or, at 

 least, the disease may have served only as a terminal factor in bringing 

 about the abortion of an ovum already pathologic. On the other hand, 

 when the influenza is complicated by pneumonia, the frequency of 

 abortion is doubled, being 52 per cent in 585 cases, and is still greater 

 (62 per cent) in the cases ending fatally. 



In view of the prevailing opinion that the presence of influenzal 

 pneumonia nearly always causes an interruption of pregnancy, it is of 

 interest to note the surprising fact that in 38 per cent of the fatal 



