This post concerns a very detailed and vivid obstetric case with a bad outcome. If you are pregnant, trying to get pregnant (ever), or have a very young baby, probably better not to read this.
Maybe my M.D. friends will clarify for me if such a thing is possible. Some of the symptoms I recognize from studying other journal articles, but I wouldn’t venture a guess on what was actually wrong here.
July 7, 1883. THE MEDICAL RECORD.
A PERFECTLY DEVELOPED MALE CHILD WITHOUT A PLACENTA.
To the Editor of the Medical Record.
Thinking that a short history of this case may be of interest to many of your readers, and desiring to learn from them if any similar case has occurred in their practice (having searched the text-books in vain), I take the liberty of requesting space in your valuable journal for its insertion. November 14, 1882, I was summoned to Mrs. C_____ a well-formed and healthy woman, aged thirty-eight, a primapara [first pregnancy].
Found the patient suffering from labor pain ; pulse, 120; some vomiting ; respiration rapid, and considerable œdema of the lower extremities. Vaginal examination revealed slight dilatation of the os, the vertex presenting. A specimen of urine was obtained and examined for albumen with negative results. Previous history of patient very good, having menstruated at the age of fourteen, and continued to do so regularly without pain until fecundation occurred nine months previously. The pains being unsatisfactory, I left the patient, saying I would return soon. At 11.30 A.M., about one hour after I left the sick-room, I was called in great haste to the patient, messenger saying she had a fit. Arriving at the bed-side found her in a very violent convulsion, which I learned was the second in half an hour.
Inhalations of chloroform were resorted to, which had the effect of modifying the severity of the spasm, for the time at least; full doses of bromide of potassium and chloral were administered, but without effect; the convulsions returning about every twenty minutes. Repeated efforts to dilate the os uteri failed, Barnes’ dilators and the douche being frequently applied in vain, the uterus being anteverted, and the os extremely rigid. At 2 P.M. a hypodermic injection of sulphate of morphine combined with atropiæ sulphas was administered, the bowels having been previously moved.
A marked diminution of the spasms immediately followed the injection, the convulsions not returning up to 4 P. M., but the patient remained unconscious from the first convulsion. At 4.30 P.M. had her thirteenth convulsion. Morphia was again administered hypodermically, but œdema of the lungs set in and the respirations reduced to 14 per minute, the morphia was suspended and the convulsions returned, the patient slowly sinking. At 5 P.M. a consultation was held, when the case was deemed hopeless. All efforts to dilate the os had to be abandoned. Distinct movements of the fetus being observed up to 5 o’clock P.M., a request was made to remove the child by Cesarean section, but was refused. At 6.30 P.M., pulse 100 and feeble; respiration, 17; temperature in the axilla, 99¾; patient rapidly sinking until 7.15 P.M., when she died after her twenty-second convulsion.
In about one hour after the death of the patient I was requested to take the child from its mother, some scruples on the part of friends demanding the separation of the child before interment. I accordingly commenced the operation by abdominal section. On reaching the uterus careful section of that organ was made, when a fœtus was observed partly immersed in an inky-black liquid. An effort was now made to remove the child, but as something seemed to hold the fœtus firmly, I inserted my hand into the cavity of the uterus, when I found the cord very rigid and unyielding. Having severed this obstacle, a perfectly formed male child, weighing about twelve pounds, was removed. Search was now made for the placenta, but without success. There was no placenta. The umbilical cord was found attached to the fundus of the uterus, and the length of the cord did not exceed four inches.
Permission to remove the uterus for examination was refused, and as every movement in connection with the operation was most earnestly and critically watched, I found it impossible to gain possession even of that portion to which the cord was attached. I did succeed, however, in dividing this particular part, but failed to observe any marked difference between it and that portion of the organ previously divided. The amniotic fluid, which was excessive, measuring, I should say, over three pints, was exceedingly black, but in other respects normal.
VALENTINE BROWNE, M.D.