Post-Mortem delivery. 
BY 
EDWARD L DUER, M.D., 
Gynecologist to the Presbyterian and Philadelphia Hospitals, Member of the 
Obstetrical Society of Philadelphia, etc. 
With Table. 
Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XII., No. I., January, 1879. 
N E W Y ORK: 
WILLIAM WOOD & CO., 27 GREAT JONES STREET. 
1879. Post-Mortem delivery. 
BY 
EDWARD L. DUER, M.D., 
Gynecologist to the Presbyterian and Philadelphia Hospitals, Member of the 
Obstetrical Society of Philadelphia, etc. 
With Table. 
Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XII., No. /., January, 1879. 
NEW YORK: 
WILLIAM WOOD & CO., 27 GREAT JONES STREET. 
1879. POST-MORTEM DELIVERY. 
BY 
EDWARD L. DUER, M.D., 
Gynecologist to the Presbyterian and Philadelphia Hospitals, Member of the Obstetrical 
Society of Philadelphia, etc. 
(With table.) 
The problems involved in the death of a pregnant woman, 
whose child is viable, have commanded to a greater or lesser 
extent the attention alike of the medical profession, the state, 
and the Church for many centuries; the literature of the sub- 
ject dating back to at least 800 b.c. It is, indeed, curious to 
note how much discussion its various relations have excited, 
and in view of this fact it is certainly remarkable that no 
definite conclusions, binding as of authority, seem to have 
been reached; no recognition of responsibility as attaching to 
him who permits a chiid to die in its dead mother’s womb 
without an effort to save it. It is the purpose of this paper 
to pass in review somewhat of the literature of the subject, 
and to consider the duty of an obstetrician when confronted, 
as he is at any time liable to be, with the necessity for prompt 
decision and action in such a case. 
At a meeting of the Philadelphia Obstetrical Society, June 
3d, 1875, Dr. Jos. V. Kelly related an interesting history of 
the delivery of a living child from a dead mother. The dis- 
cussion which followed demonstrated that even obstetric spe- 4 
Duer: Post-mortem Delivery. 
cialists were not prepared to announce any operative proce- 
dure as obligatory upon the physician. 
In an able paper of so recent date as 1861, by Dr. Schwarz, 
Medicinalrath1 in Fulda,2 the following remarkable passage 
occurs : “ If a man is fortunate enough to obtain a living child 
by the Cesarean operation on a dead mother, he places himself in 
the unfortunate position of being suspected of having operated 
on a woman in a trance, or he burdens his conscience with hav- 
ing waited so long for the death of the mother that he has 
allowed the child to die.” Dr. Schwarz quotes from the 
records of his own duchy 107 cases, all having occurred in 
Kurhessen between the years 1836 and 1848, out of 336,941 
births, and “not one living child was extracted.” He quotes 
also in support of his position the assertion of Scatizoni that 
“ the fetus in utero is the same as any other internal organ of 
the woman,” and that, “ if we recognize the instant of the 
death of the mother, when all organic expression is gone, and 
organic laws yield to chemical laws, that instant we must rec- 
ognize also the death of the child.” 
Similar opinions constantly find expression in the recorded 
reports of pregnant women dying at term, without mention 
of any operative procedure to save the children, and in an 
unpublished lecture by a distinguished obstetric teacher of 
this city, it was argued that it was utterly futile to attempt 
any post-mortem measures having for their object the saving 
of the life of the fetus. 
These modern utterances are in striking contrast to the 
convictions which have been entertained by various peoples 
for many centuries. With the exception of the Chinese, the 
Jews, and the Egyptians, all the older nations had laws more 
or less stringent on this subject, and which doubtless reflected, 
to a considerable extent, the medical sentiment of their times. 
The old Homan law forbade to “ bury pregnant women before 
the fruit be taken from their bodies,” and disobedience to this 
mandate was considered as affording grounds for a “ legal sus- 
picion that a living child had been killed.” 
In 1749, Charles, King of the Sicilies, commanded that all 
physicians who should neglect to perform the Cesarean section 
on a woman dying pregnant should be arraigned for murder. 
1 A kind of public medical recorder and adviser. 
* Monatschrift fur Geburtskunde, vol. xviii., supplement. Doer: Post-mortem Delivery. 
5 
In the Carolina Journal for 1820, in “ An Essay on the 
Causes Demanding the Cesarean Section,’’ by W. Michel, 
M.D., the author, besides enumerating many mythological 
records of the operation, mentions the historical examples of 
Scipio Africanus, of Manlius Torquatus, of the Homan army ; 
of the Consul Cains Fabius, and the doubtful one of Cesar, 
all having been rescued after the death of their mothers. 
The world is also indebted to post-mortem Cesarean sections 
for the lives of the philosophers Gorgias and Hermes Trisme- 
gistus. It is not, therefore, surprising that Nuina Pompilius, 
with any one of these illustrious examples before him, should 
have issued an edict1 commanding physicians to “ open the 
bodies of dead pregnant women, with the hope of preserving 
citizens to the State.” The same law existed in Venice,8 
from 1608 to 1722, and in 1740 the Council of Ulm not only 
prescribed the law, but the formalities of its execution, and 
directed that the “stupid parent” be informed “ that if he 
omitted any possible means of saving the life of his child,” 
he “ put upon his conscience,” but “ could not be compelled to 
submit.” 
In the first half of the last century, Pope Benedict XIV. 
issued “ Church directions ” for the operation, and so tempered 
his commands as to require the measure only “ in case the 
child be living, and in order to receive the holy ordinance of 
baptism.” 
Dr. Schwarz’ essay presents also the record of the Austrian 
law of 1757, that “the operation shall be carried out with the 
same care as if the woman be living,” and the Theresian law 
of 1768—“if a pregnant woman commits suicide, open the 
body as much as necessary only, that the child shall not be 
deprived of a holy Christian burial.” Thus “ Christianity 
seems to have given fresh importance to this subject, by giving 
new value to the life of the child.” The requirements of the 
laws of various other countries are also quoted, all having for 
their object the more or less compulsory performance of the 
Cesarean section by the “ physician or other officer of the 
place.” 
In fact, some of these laws would not do violence to the 
intelligence of latter-day physiologists. In Eid und Pjlicht 
1 Legregia Diget., lib. xx., a.c. 600 
5 Schwarz, Mon. f. Geb., Snp., vol. 1861, p. 121. 6 
Du eh: Post-mortem Delivery. 
einer Sachenfrau, Heilbronn, December, 1772, Article 7th, 
the following well-digested instruction occurs: “ Since occa- 
sionally the fruit of a woman dying pregnant may be saved by 
a cut, therefore the midwife is required to attend to the fol- 
lowing points, viz.: In case the mother dies of a long, slow, 
and wasting disease, such as phthisis, the fruit dies with her 
always (?); therefore, the operation is useless. On the other 
hand, if she dies suddenly, and has borne her fruit seven 
months, the child may yet be saved, and the midwife shall 
proceed at once to operate—the relatives to the contrary not- 
withstanding.” 
With the same general objects, laws have been enacted as 
follows: By the City Council of Frankfort, in 1786; by the 
Duchy of Kurhcssen,in 1767 and 1787; the Lippe-Detmold law 
of 1789 ; by the Grand Duchy of Baden, in 1827 ; at Wurtem- 
berg, in 1755 ; at Nassau, in 1818 (“ if mother has been preg- 
nant five months ”); the old Saxon law ; the Bavarian law of 
1816 (“the midwife to treat the patient as if in a trance till 
the physician arrives ”); and the Russian law, which left all 
to “ the judgment of the physician.” 
The semi-medical reports of these cases in olden times were 
such as to have caused the enactment of absurd legal require- 
ments. In the London Hospital Reports, 1872, vol. xiv., page 
240, Dr. Aveling has collected 30 cases illustrative of the 
ignorance and superstition concerning this subject. Conspic- 
uous among these is that of the Princess Pauline de Schwartz- 
enberg, who died in consequence of several severe burns, and 
twenty-four hours after death an infant was withdrawn from her 
womb, which ultimately survived. This is cited as “ well 
known,” and “ still believed to be true.” 
Meanwhile science has been recording facts. In the Wiener 
medizin. Wochenschrift, Drs. Hyman and Lange have col- 
lected 331 seemingly authentic cases, all reported in the pres- 
ent century. Of this number, only 19 of the children were 
born living. In the Gazette Hebdomadaire for November, 
1860, M. Devilliers is quoted as having published a thesis in 
1838 on the Cesarean section practised after death, in which 
he had collected 49 cases, and classified them according to their 
results, thus: 7 infants were dead when extracted, 7 survived, 
and 37 lived from five minutes only to thirty-four hours. 
Among these were two pairs of twins. Since then, in the Duer: Post-mortem Delivery. 
7 
same journal, there lias been added a collection of 22 more 
cases, in which the results are given as follows: 9 infants 
were born dead, 6 survived, and 7 lived from a “ few minutes 
to five hours.” 
In a discussion before the Berlin Obstetrical Society, 1864, 
Dr. Boehr refers to a collection of cases in Casper'1 s Wochen- 
schrift, which I have been unable to secure, and in which, out 
of 147 cases, only three instances of living children occurred. 
For our own country, I can only find a reference to a col- 
lection of twelve cases by Dr. L. Cli. Boisliniere, of St. Louis. 
I n these, the post-mortem Cesarean section was performed within 
tifteen minutes of the mothers death, from eclampsia and 
cholera. Two children only were extracted alive, and these 
lived only for a few minutes. The discrepancy in these results 
is so great that there can be but one explanation of it. 
The great object in the collection of all these cases seems to 
have been to establish some ratio between the whole number 
of mothers operated on, and the number of children rescued 
alive. But the ratio of successful results is not material, inas- 
much as the mutilation of any number of dead bodies is as 
nothing to the saving of one living child. 
The practical questions to be considered are—the period of 
pregnancy when the child may be delivered with any favorable 
prospect; the length of time after the death of the mother 
when operation promises success; the operation indicated; the 
diseases which render operation unnecessary, and the best 
means of resuscitating the child. I will discuss these seriatim. 
1st. The Period of Pregnancy when the Child may be De- 
livered with any Favorable Prospect. The answer to this 
would seem to be sufficiently simple. Dr. Thatcher, who 
claims to have had much experience in the Cesarean section 
after death,1 and who considers it entirely too much neglected* 
regards it as the duty of every physician meeting with a case 
advanced to the seventh month of utero-gestation, when there 
are present any signs of life in the child, to give the latter the 
benefit of its “ individual vitality.” 
So, also, Dr. Berg,' in his citation of the Russian laws on 
this subject, urges the Cesarean section, or other operation, 
when the mother has advanced to the thirty-third week of ges- 
1 Transactions of the Edinburgh Meaico-Chirurgical Society, June, 18(10. 
5 Casper, xxiv. Heft, page 219. 8 
Duer: Post-mortem Delivery. 
tation, and is not more than twenty minutes dead of other 
diseases than cholera, etc. 
For all purposes of practice, it may be assumed that an 
infant, delivered by Cesarean section, is as likely to live as one 
born at the same period of pregnancy in any other way, and 
as there is incontestable evidence of children having lived who 
were delivered from a living mother at the sixth month of 
utero-gestation, and especially as we are dealing entirely with 
possibilities and not probabilities, we will be safe in the adop- 
tion of a rule—to perform forcible dilatation, or the Cesarean 
section, on all otherwise favorable cases which have attained to 
the neighborhood of the sixth month of pregnancy. 
Leaving out of view any question of Church rites—which are 
still insisted on in the Homan Church—I advocate this earlier 
month for the yet other reason, that there may occur in certain 
cases good and urgent legal motives for the preservation of 
the life of the child, even though it be only for an hour. 
2d. The Length of Time after the Death of the Mother 
when Operation Promises Success. This question is encom- 
passed by more than ordinary difficulties. It must be remem- 
bered that, all other things being equal, the sooner after the 
death of the mother the child is delivered, the greater the prob- 
ability of good results. Again, if a child is manifestly living, 
as indicated by its movements, or by the sonnd of the fetal 
heart, there can be no question of the propriety of an oper- 
ation ; but the converse of this is by no means true, and we are 
then obliged to fall back on observation or recorded experience. 
In the Hunterian Society discussion,1 Dr. Lever relates 
that he has several times seen the movements of the fetus in 
utero, half an hour after the mother's death, and was only 
restrained from efforts to rescue by objections interposed by 
the relatives. 
M. Hatin2 brought this subject before the Academy of 
Medicine of Paris in 1861, in an able paper, in which he repre- 
sented that the “French law was very deficient in respect to 
saving the life of the child.” M. Laforgue, Professor of Mid- 
wifery at Toulouse, and M. de lvergaradec, member of the 
Academy, have likewise published papers calling attention to 
this important point. 
1 London Medical Times, N. S., vol. xvi., page 507. 
2 London Lancet, vol. i., page 313. Duer: Post-mortem Delivery. 
9 
Toward the solution of this problem, with others, a tabulated 
record is offered of all the cases which the writer has been able 
to lind, which have borne the appearance of authenticity. From 
this it appears that, of 55 cases, the time that elapsed between 
the death of the mother and the removal of a living child was 
in 40 as follows: Between 1 and 5minutes, including “imme- 
diately ” and “ in a few minutes,” there were 21 cases; between 
5 and 10 minutes, none; between 10 and 15 minutes, 13 cases; 
between 15 and 23 minutes, 2 cases; after 1 hour, 2 cases, and 
after 2 hours, 2 cases. 
These latter cases it is proper to examine very carefully. 
The record of number twenty-nine comes to us through the 
American Journal of Obstetrics, Yol. IX., page 497, in a 
private letter to the Philadelphia Obstetrical Society, from 
“ P. A. Verouden, Netherlands, Member of the Physical 
Council of the Provinces of Guelderland and Utrecht,” and 
represents the mother, set. 35, to have died of hemoptysis from 
pulmonary consumption, in the sixth month of pregnancy ; 
that two hours after, the child’s heart was “heard to beat 
distinctly; ” that the child was then removed by Cesarean 
section ; “ taken to church, baptized, and lived several hours 
after the ceremony.” Whether this recorder was a physician 
or not does not appear, but is inferential from the fact that 
the inspiration of the communication came from his having 
read a report of Dr. Kelly’s case before the Philadelphia 
Obstetrical Society. The recency of this case, however, leaves 
open the opportunity of verification. The importance of the 
observer being a competent medical practitioner is readily 
apparent. 
Number thirty-one is reported by Dr. M. O’Hara, of this 
city, and appears in the Philadelphia Medical Times, vol. v., 
page 301. This mother likewise died from hemorrhage and 
advanced phthisis. The child was removed between one and 
a half and two hours after, “ gasped three times, and was bap- 
tized.” Excepting for Church or legal reasons, these two cases 
are of little value. 
Not so, however, with case number fifty-four, of the one- 
hour series. This was reported to and by a member of the 
Cincinnati Obstetrical Society, Dr. J. L. Cleveland, and appears 
both in the reported proceedings of the society, and in the Cin- 
cinnati Lancet and Clinic, July 20th, 1878. The mother is here 10 
Duer: Post-mortem Delivery. 
represented to have had convulsions (probably uremic) for 
about two weeks, and is supposed to have died in one. For 
reasons mentioned, the time which elapsed before the oper- 
ation was “ full one hour.” The child was removed asphyxi- 
ated, but the heart-beat was perceptible. It gasped in a short 
time, and in the course of an hour seemed fully restored. 
It “ was small, near full term, and is still alive, and in good 
health.” This is in all respects the most interesting case of 
the whole series. 
In the second case of the one-hour series—number twenty- 
eight of the table—there are but few particulars given. It 
was reported by Dr. J. H. Blatner, in the Transactions of the 
Albany County Medical Society, January, 1875,1 and is interest- 
ing only from the child having been born “living,but asphyxi- 
ated.” It expired in about ten minutes. No mention is made 
of the cause of the mother’s death, or the means resorted to 
to establish the vitality of the child. 
With regard to the cases rescued within twenty minutes- 
after the mother’s death, they are so numerous and well 
authenticated that no question can be raised as to their value 
in this connection. 
Efforts have been made to establish the probabilities in such 
cases oy other observations, and experiments upon the lower 
animals. Dr. Brunton8 gives an account of a fetus rescued 
alive, after having been “ retained in the membranes for a 
quarter of an hour after birth.” Weisberg, in the Dictionnaire 
<les Sc. Med., Yol. XIX., page 388, furnishes three such cases 
—one having lived seven minutes, and two others each nine 
minutes after birth in their envelopes. Buffon and Schierig 
performed many experiments on animals, which were after- 
wards confirmed by Edwards. It was found that “ pups lived 
half an hour after birth in the membranes,” and if plunged 
into warm water, continued to have a pulse-beat for many hours. 
Breslau3 likewise experimented on guinea-pigs with the same 
object. He commenced by defining the death of the mother 
as “ when the movements of the heart have sunk to the mini- 
mum ; when there is no peripheral circulation; when the 
capacity for respiration has entirely ceased; and when instinc- 
1 Ameh. Joub. Obst. , May, 1875. 
8 Transactions Obstetrical Society, London, Vol. XIII., page 88. 
3 Monatschr. f. Geburtsk., August, 18G4. Duer: Post-mortem Delivery. 
11 
tive and reflex movements no longer occur. This is death. 
But when the movements are rare and feeble, the limbs flaccid, 
respiration difficult, interrupted, and painful; the circulation 
weak, but still felt in the umbilical cord, and reaction slight 
on external irritation, the fetus is only apparently dead.” The 
results of his experiments make the possibility of living, within 
a certain short time, depend alike on the cause of the death 
of the mother and on the period of the removal of the fetus 
after death. In operating after five minutes, he did not extract 
a living fetus, and, if later than eight minutes after the 
mother’s death, not even one of the class -denominated “ appa- 
rently dead.” In applying his observations to the human 
subject, and to practical obstetrics, he remarks that “ daily 
experience proves that the power of resistance of the human 
fetus is greater than that of the brute,” but that the Cesarean 
section will even here furnish no prospect of a living or even 
an “ apparently dead child, if not performed within fifteen or 
twenty minutes after the death of the mother.” 
It may be mentioned also that this life-maintaining power 
of the fetus was recognized by Harvey, inasmuch as in his ana- 
tomical exercitations he asks: “ How cometh it to pass that 
the fetus, being new-born, and abiding still in its bag of waters, 
can subsist for some hours’ space without any danger of suffo- 
cation, yet, if he has but once attracted the air into his lungs, 
he cannot afterwards live one minute without it?” 
Such observations, however, might be quoted indefinitely. 
But we are dependent for any positive data almost entirely 
upon our table. If we accept this record, we may conclude 
that it is possible for a child to be delivered alive after its 
mother may have been dead for two hours, and for a child to 
be “ saved to the State ” from a mother dead for one hour. 
3d. What Operation is Indicated f The choice is as between 
Cesarean section and forcible delivery per vias naturales. The 
ready practicability of the one is patent; the other still sub 
judice. H. Raynes-Gringley1 asserts that he has “ no hesita- 
tion in pronouncing on the practicability of extracting a living 
child from a dead mother, per vias naturales, provided ’’ he 
“was present at the death;” and Cazeaux calls attention to 
the fact that the child may be so nearly born that, after a cut 
may have been made in the abdomen, it might be found impos- 
1 London Medical Times, Yol. I., N. S., page 155. 12 
Duer: Post-mortem Delivery. 
sible to withdraw the child, in that direction, as easily as to 
advance it in the direction in which it has already started, and 
thus valuable time have been lost. 
Barnes, in his “ Obstetric Operations,” quotes an Italian 
writer1 who lays down the rule that in cases where there is any 
doubt of the mother’s death, forced delivery should be resorted 
to as a harmless operation! ” And Dr. Esterle, Professor of 
Obstetrics at the Maggiore Hospital, Novara,2 goes so far as 
to recommend the same practice—generally by version and 
extraction—“ whenever the mother’s death is imminent.” He 
refers, in justification of this practice, to five cases of his own, 
in which forced delivery rescued four living children from 
dying mothers, and to one of Cesarean section, by Roser, per- 
formed successfully under like circumstances. ( These latter 
recommendations are quoted only for condemnation.) 
It is proper also to refer to an unfinished article on 
this subject, by Dr. Thevenot, in the last (October) number of 
the Annales de Gynecologie. His plea is for artificial delivery, 
per vias naturales, in all cases; and urges in support of its 
advantages that intervention may always be immediate; that 
the certainty of the death of the mother need not so largely 
interest us; that the Cesarean operation, of itself, is so formid- 
able that we must not resort to it except with the approval of 
the family, whose disapproval or hesitation may necessitate 
delay; and, moreover, that there are certain delaying prepara- 
tions always incident to so extensive an operation as the 
Cesarean section. 
With our knowledge of the fact that approaching death in 
pregnant women is often accompanied by relaxation of the 
cervix, and even rapid completion of labor, we must concede 
to these views a binding force in a certain number of cases. 
When, however, we remember the difficulties often encoun- 
tered in our efforts at delivery of children, through the dispro- 
portioned pelves of living mothers, the selection of the 
operation is still a question of rapidity of execution. We 
conclude then: first of all, there should be an absolute 
certainty of the mother’s death. Then, with a due appre- 
1 Probably Prof. Rizzoli, who devised this measure as promising “better 
results to the child ” and “ perhaps no distress to the dying mother.” Italy, 
Belgium, and Germany have accepted this recommendation. (Dr. Thevenot, 
Progres Med., June, 1878.) 
2 London Medical Times, Vol. I., 1862, page 441. Duer: Post-mortem Delivery. 
13 
ciation of the necessity for expedition, if the child has not 
already engaged in the pelvic brim, the Cesarean section should 
be made with the greatest possible dispatch. If the head has 
so engaged, it then becomes a question of judgment as to 
whether forcible delivery per vias naturales, or the Cesarean 
section may be most quickly accomplished. 
4th. rThe Diseases which Render Operation Unnecessary. It 
will be remembered that the cause and mode of death of the 
mothers have been noted as largely influencing the result to 
the child. Not only has this conclusion been arrived at by 
experimenters on animals, but with as much positiveness by 
bedside observers. It will also be remembered that many of 
the ancient laws on this subject were qualified by a knowledge 
of this fact. 
Professor Esterle, already referred to, evidently basing his 
inferences on purely theoretical grounds, makes the statement 
that in cholera, phthisis, hemorrhages, the acute exanthemata, 
dropsy, eclampsia, syphilis, cancer, cerebral disease, and lead 
poisoning, the death of the child usually precedes that of the 
mother, flening seems to have arrived more nearly at the 
true state of the case, when he formulated his observations 
thus: “The results of an operation performed post mortem 
matris are little favorable to the child, but it is most likely to 
succeed when death has followed some shock to the nervous 
system; less favorable to the child when the death agony has 
been prolonged, and most unfavorable of all when the mother 
has been suffocated by carbonic acid gas.” We must differ 
both from the statement of Esterle and the conclusion of 
Hening. Of the cases of children born living, as given in the 
table, the causes of death in the mother are mentioned in 
thirty-six. Of this number, eighteen died in various kinds of 
convulsions, the most of which were eclamptic; five died of 
advanced phthisis ; three more from profuse hemorrhage from 
phthisis; three of organic heart disease; two suddenly 
by accident; one of thoracic aneurism; one of chronic 
dysentery; one of metro-(?) peritonitis; one of gangrene of 
neck, and one had “ been ill a long time.” Of those born 
dead, the cause of death in the mother is given in six cases, 
viz.: two from cholera; one from severe burn; one from 
apolexy ; one from uremia, and one from suffocation. It will 
be remembered also that previous mention has been made of 14 
Dukr: Post-mortem Delivery. 
the twelve cases of Dr. Boisliniere, all of which died of 
“ cholera or eclampsia,” and the two children extracted alive 
lived but a few minutes. It is liot stated, bnt it is probable,, 
that the two latter were of the eclamptic cases, inasmuch 
as the universal testimony, elsewhere, is unfavorable to operat- 
ing at all, when the mother has died of cholera. Dr. B aloe chi, 
in the proceedings of the Societa Medico-Fisica of Florence, 
1876, as reported in the Gaz. Med. ltaliana Toscana—num- 
ber thirteen of table—questions the propriety of operation 
after death from cholera, in that, “of a large number of cases” 
so dying, “only one child was rescued alive, and that lived 
but for a short time; one was cyanosed, and in all the others 
putrefaction was more or less advanced.” The case of Dr. 
Shippen—number fifty-live of table—substantiates the same 
conclusion. The mother was a “ robust young woman, near 
her confinement,” who died of cholera, “ after a terribly short 
illness,” and was opened “immediately,” yet the child was 
dead. In this case everything was especially favorable to a 
better result. 
It may be mentioned that cholera, in its various epidemics, 
has furnished large opportunities for observation in this respect, 
and the result has been almost uniformly the same. A proper 
understanding of the cause of this will probably be found in 
in the general disintegration of the blood in cholera; and if 
such is the case, we are accordingly obliged to classify under 
this disqualifying head all of the congeners of this disease. 
We may then conclude that it is useless to operate on a woman, 
however soon after death, with any hope of securing a living 
child, who has died of any disease in which disorganization of 
the blood was a prominent factor. 
5th. The best Means of Resuscitating the Child. It is 
apparent that the necessary measures differ, in no wise, from 
those indicated in like conditions of children born in the usual 
way. It is, moreover, no part of the purpose of this paper to 
specify the various conditions under which children die in 
utero. It is only of importance to remember here that the last 
vestige of vitality may vanish for actual want of strength to 
maintain it, or for the reason that the strength is yet latent, 
because of the absence of respiratory action to develop it. 
The first condition is true of most cases of greatly premature 
deliveries; the second is represented by the asphyxia of chil- Duer: Post-mortem Delivery. 
15 
<Jren retained too long in the abdomen of the dead mothers. 
The treatment of the two classes, it will he observed, must be 
widely different, and the existence or non-existence of the 
infantile heart-beat will determine whether any efforts are to 
l>e of value in either. 
On the management of children born prematurely, these 
investigations throw no new light. The condition is well 
understood, and the conduct of such cases is a part of every- 
day practice. As to the second class—“life without respira- 
tion ”—every effort should have for its object the maintenance 
of the one to the end of establishing both. 
In the quoted experiments of Buffon and Sehierig on pups, 
it was stated that if they were plunged, still in their fetal 
envelopes, into warm water, after delivery, the pulse beat for 
several hours. Though the conditions are somewhat different, 
we may perhaps receive a valuable hint from this fact. If the 
child fails to respond to the simple and usually resorted to 
measure of alternate application of heat and cold, it is plainly 
a duty to restore and maintain any deficiency of animal heat 
that may have been thus lost. This may probably be best 
accomplished—as in case number seventeen—by the envelop- 
ment of the child in hot cloths. Immediately thereafter, 
recourse should be had to artificial respiration—preferably by 
the Silvester method—and to be effective it must be continu- 
ous, despite the most discouraging circumstances, short of the 
absolute cessation of the heart-beat. This was especially 
insisted on by the older authorities in midwifery, and it is 
much to be regretted that their teachings of the favorable 
results that may be expected from persistent artificial respira- 
tion, even after infants have failed to “respire for two or three 
hours,” should nowadays be so little emphasized. In our 
table it will be noted that this expedient was resorted to in at 
least twelve cases, and was successful in two of them after it 
had been maintained “ continuously for one hour.” In one 
other case, “ when the heart-sounds were feeble,” it was con- 
tinued for two hours, and until “ the child was able to breathe 
without assistance.” 
This valuable measure may be supplemented advantageously 
by the occasional employment of stimulating substances to the 
surface of the body, especially by a piece of ice over the 
epigastrium, and by the careful application of dilute ammo- 16 
Duer: Post-mortem Delivery. 
nia, weak vinegar, or the fumes of burning paper to the 
nostrils. 
There still remains another—perhaps least often adopted— 
measure, yet possibly of equal importance with any mentioned, 
viz., mouth-to-mouth insufflation. This may be mediate or 
immediate. The first by the introduction of a flexible tube 
into the larynx, the second by applying the mouth to tiie 
mouth of the infant. In the reported proceedings of the N. 
Y. Obst. Soc., in the last number of this Journal, Dr. Gar- 
rigues has recorded the case of an infant born in a state of 
profound asphyxia, and presenting but a few slow and feeble 
heart-beats, which was kept living for seven hours by means of 
insufflation through a flexible catheter passed into the trachea, 
whilst the child was kept enveloped in hot cloths. “Two and 
a half hours elapsed before the child gave the first respiratory 
gasp.” His commentary on this case was, “ that if only the 
heart heats, the life of the child may he saved, even if spontaneous 
respiration does not occur for hours.” Insufflation may readily 
be accomplished, as suggested by Dr. Jewett, “through the 
intervention of a coarse towel; passage of air into the stomach 
being prevented either by pressure upon the epigastrium or 
by gently forcing the larynx back against the esophagus.” 
This plan was resorted to in only eight of the tabulated cases, 
but furnished gratifying results in all. In one case—number 
twenty—when it had been omitted, and the child died on the 
seventh day of atelectasis, the operator advanced the criticism 
that, “ had mouth-to-month inflation of the lungs been substi- 
tuted for artificial respiration, possibly the child might have 
been saved.” M. Depaul recommends that from ten to twelve 
insufflations should be made in a minute. It is not impossible 
that, after the removal of mucus from the fauces, this measure 
may prove a most valuable adjunct to artificial respiration, by 
fully distending all of the pulmonary tubes, and freely opening 
the way for admittance of air to all the vesicles by artificial 
respiration. 
It will be observed that no conclusion has been indicated as 
deducible from a comparison of the number of children saved 
to the whole number of mothers operated on. With the 
scant opportunities for securing reports of unsuccessful cases, 
such a comparison is utterly useless. See, for instance, the 
tables of Lange, as showing that prior to 1700 as many as 70 Duer: Post-mortem Delivery. 
17 
per cent were saved, whilst since 1800 there has been scarce 
2 per cent. In truth, so much interest attaches to a success- 
ful case that a report of it will be quoted in almost every 
contemporary journal; and so little to an unsuccessful one, 
that the latter are seldom published at all—except, perhaps, to 
adorn a discussion originated by the former. Thus it will be 
seen there are not sufficient data upon which to found even a 
proximate conclusion. Happily, this is of small importance. 
In regard to the method of operating, little need be said. 
The ordinance of the Venetian Senate, “ to perform the Cesa- 
rean section as though the mother be living,” is said to have 
had its origin in the acknowledgment of Feu, the celebrated 
professor of midwifery of Paris, of having operated on a woman 
“ supposed to be dead, but who was not.” In this age of en- 
lightenment, one is scarcely willing to acknowledge the possibil- 
ity of so horrible a blunder. Our education leans, if possible, 
even too much toward conservatism. We can, however, well 
afford to accept the conclusion of Bouchet, whose essay on the 
subject was crowned by the prize of the French Academy, 
that “ with the last pulsation of the heart the mother dies.” 
As Dr. Blundell remarks of such matters, “ as long as we 
are surgeons, let us be men.” Our respect for the dead is 
such as to command from us, in the performance of post-mor- 
tem Cesarean section, almost, if not the same care as is bestowed 
on the living. 
As to a compulsory law having reference to this subject, it 
is referred to simply as having been operative over many of 
our transatlantic brethren, for almost all time. It would be 
at variance with the spirit of our institutions and the claimed 
status of our profession. At the same time, it is evident that 
there is an incongruity in recognizing a criminal offence in 
the production of an abortion at three months, yet failing to 
see a constructive murder in the wilful neglect to rescue a 
perfectly-developed, perhaps healthy child, vigorously strug- 
gling for escape from the abdomen of its dead mother. 
In conclusion, it would seem that the sentiment of the medi- 
cal profession should be so pronounced on this important 
subject that, in every proper case, of which the physician is to 
be the judge, no parent or other relative or friend would dare 
to interdict any measures necessary to the possible saving of a 
living child. 18 
Duer: Post-mortem Delivery. 
No. 
Journal Record and Oper- 
ator. 
Cause of Death of Mother. 
Time of 
Operation after 
Death of Mother 
Condition 
of Child when 
Born. 
Means of Resuscitation 
Adopted. 
Remarks. 
1 
Wiener med. Woch., 
August, 1874.—Dr. 
Baudl, asst, to Prof. 
Yon Braun, Vienna 
Gen. Hosp. 
Chronic peritonitis. 
5 minutes. 
Asphyxiated. 
u All attempts at re- 
suscitation.” 
Fetal heart beat about 60 per 
minute for 10 minutes. In- 
spired and died. 
2 
Revue Med., Jan., 
1830. Hopital St. 
Louis—M. Hugier, 
Interne. 
Hemoptisis. “ Died in four 
minutes at 7th month of 
pregnancy.” 
5 minutes. 
Hea r t-b eat 
scarcely 
perceptible 
Hot bath, artif. resp., 
and frictions. 
“Child now 30 days old and 
doing well.” 
3 
Heidelberger kliniscke 
Annalen,Vol. x., No. 
3. Observations on 
P. M. C. S. 
Died after operation for rick- 
ets, of metro-peritonitis on 
8th day. 
Child living. Limits to time 
for operating, ‘ ‘ 3 hours after 
mother’s death.” 
4 
Edinburgh Medico- 
Chirurgical Society 
Trans., June, 1850. 
—Dr. Harley. Read 
by Prof. Simpson. 
“Effusion into air passages 
consequent on heart disease. ” 
“ Few min.” 
“Child doing well.” 
5 
Humboldt Medical 
Archives, Yol. 4, 
1870, p. 328.—Dr. 
E. L. Fechan, St. 
Louis, Mo. 
“ Comatose after a convulsion. ” 
10 minutes. 
“No effort to 
respire for 
25 or 3 0 
min.” 
“ Usual means.” 
Child did well for months. 
G 
Le Progres Medical, 
June, 1873.—M. 
M a r c e', Interne, 
Hopital la Pitie. 
Uremic eclampsia. 
Immediately. 
Did not 
breathe. 
“Stimulated.” 
Doing well. Duer: Post-mortem Delivery. 
19 
7 
Med. Times and Ga- 
zette, July 21st, ’77. 
Trans. Lon. Obstet. 
Soc.—Dr. Buckell. 
Suddenly, of dilatation of 
aorta. 
20 to 30 min. 
“Living.” 
8 
L’A b e i 11 e Me'dicale, 
Aug. 23d, 1843.—Dr. 
Loweg of Vere. 
“Ill a long time.” 
“At once.” 
“ Apparently 
dead.” 
Hot bath and insuf- 
flations. 
Heart perceptible in a few min- 
utes, and soon respired. 
‘4 Doing well 3 months after. ” 
9 
“Upper Canada Jour- 
nal,” 1851.—E. M. 
Hodder, M.D., etc. 
Apoplexy, lasting 38 hours, 
and profound coma for 26 or 
27 hours. 
“At once.” 
“No signs of 
life.” 
Hot bath, artif. resp., 
stimulants to spine. 
At first promised little, but now 
“doing well.” Born ten 
days before full term. 
10 
N. Y. Med. Jour., Jan. 
Vol. 7, 1851.—Dr. 
Blumdell. 
Run over and died in a few 
minutes. 
“On arrival,” 
13 min. 
Artificial respiration 
for 15 minutes. 
In last months of pregnancy. 
Ultimately resuscitated com- 
pletely. 
11 
Monthly Jour, of Med. 
July, 1851.—Dr. 
Schneider. 
At once. 
“Still-born.” 
“Appar- 
ently dead.’ 
Per vias naturales. Soon re- 
vived. 
12 
N. Y. Jour, of Med., 
Vol. x., 1853.—Dr. 
F. R. Owens. 
Hemoptisis brought on by 
vomiting. Blood gushed 
out. 
Dead on arri- 
val. “Went 
for instru- 
ments and 
opera ted 
soon as 
possible ” 
A p p a r ently 
dead. 
Hot baths, art. resp., 
stimulants to n o s- 
tril, art. resp., for 
one hour. 
Weighed 5 lbs. at birth. Now 
weighs 8£ lbs., and is 7 weeks 
old and thriving. Did not 
cry till 3 hours. 
13 
Repertorio Medico- 
Chirurgico de To- 
rino. 
C. dysentery for two months. 
Died much emaciated. 
13 minutes. 
Did not cry for some time; 32 
minutes afterward began to 
suck. Now tolerably robust. 
14 
American Med. Re- 
corder, Vol. vi.— 
M. Borrone, Sur- 
geon at Salto. 
12 minutes. 
Case quoted from foreign jour- 
nal. Child living. 20 
Duer: Post-mortem Delivery, 
No. 
Journal Record and Oper- 
ator. 
Cause of Death of Mother. 
Time of 
Operation after 
Death of Mother 
Condition 
of Child when 
Born. 
Means of Resuscitation 
Adopted. 
Remarks. 
15 
Proceedings of the So- 
ciety Medico-Fisich 
of Florence, 1856. 
Cholera. 
Dead. 
Dr. Balocchi questions the pro- 
priety of operating iu chol- 
era. 
16 
Lond. Med. Times.— 
M. Campbell, In- 
terne, La Maternite. 
Died suddenly—probably from 
heart disease. 
10 minutes. 
“ Born alive.” 
Insufflation and stim- 
ulants. 
Mother in last stage of preg- 
nancy. Child “ now 55 days 
old, and in a perfectly pros- 
perous condition.” 
17 
18 
19 
Edinburgh Med. Jour. 
(Trans. Lond Obst. 
Soc.)—Peter Broth- 
erton, F.R.C.S.E. 
L’Union Me'dicale of 
the Gironde. — M 
Bonnet. 
Lond. Lancet (Trans. 
Lond. Obst. Soc.), 
1877.—Dr. Playfair. 
Syucope from concealed hem- 
orrhage. 
Apoplexy, 7th month. 
23 minutes. 
At once. 
£ hour. 
“Gave no 
signs of life 
when ex- 
tracted.” 
Mouth.to-mouth insuf- 
flation. Hot cloths. 
Artificial respiration 
for 15 minutes. 
Child deluged with blood; is 
now living, three months 
after, and as fine and healthy 
a child as was ever seen. 
Respired feebly in a few min- 
utes ; 15 minutes later, it 
groaned feebly; ultimately 
it was saved. 
Child saved. This case elicited 
in a discussion on Dr. Buck- 
ell’s case. 
20 
“ Proceedings of Med. 
Soc. of the County 
of Kings,” N. Y. S., 
Jan. ’ 78.—C. Jewett, 
M.D. 
Suddenly, of diphtheria. Im- 
mediate cause not ascertain- 
ed. 
6 minutes. 
“ Apnea.” 
Artificial respiration 
for at least half an 
hour. 
Child died 7th day of atelecta- 
sis. “Possibly child might 
have been saved by mouth- 
to-mouth insufflation.” 
21 
Unpublished case at 
Phila. Hospital, ’62. 
—Resident Physi- 
cians. Service of 
Dr. Penrose. 
Suddenly, during convales- 
cence from diphtheria. 
At once. 
Asphyxiated. 
Artificial respiration. 
Hot baths. Stimu- 
lants. 
Persistent efforts not made to 
save the child through igno- 
rance of the possibility. Duer: Post-mortem Delivery. 
21 
22 
Wiener med. Woch- 
enschr. and Memo- 
rab., No. 6, 1877. 
“ Woman sickly and died eight 
days after full term.” 
15 minutes. 
‘ ‘ Heart still 
beating.” 
Artificial respiration 
for two hours. 
When the child was “ able to 
breathe without assistance.” 
23 
Epoca Medica of Se- 
ville, March, ’73.— 
Dr. Gomez Nieto. 
Puerperal convulsions. 
“Semi- 
asphyxiated,” 
“ Means of reanima- 
tion resorted to ” 
for 15 minutes. 
Did well. 
24 
Gaz. des Hop., April 
20th, 1861. —Dr. 
Lemarley. 
Eclampsia. 
2 hours. 
“ Still-born.” 
“ Efforts to resusci- 
tate.” 
Were continued for forty min- 
utes, at end of which time 
heart ceased to beat. Aus- 
cultation detected heart- 
beat before operation. 
25 
Mon. f. Geb., July, 
’62.—Prof. Breslau. 
“Hydropericardium and soft- 
ening or pneumonia of right 
side.” 
15 minutec. 
Heart beat 
feebly. 
Weighed 4 
pounds. 
Insufflation and rub- 
bing for one hour. 
Child restored and cried loud- 
ly. Died 7 hours after of 
exhaustion. 
23 
“ Progres Me'dicale, ” 
1873.—M. Marcet. 
Sudden convulsion. Patient 
dying comatose. 
3 minutes. 
Child living. 
27 
Wiener med. Wochen- 
schrift, March, ’73. 
—Dr. Blumenfeld. 
Advanced phthisis. 
10 minutes. 
Very feeble. 
Every effort made to 
save child. 
Lived 3 hours. Child only 
weighed If pounds. 
28 
Trans. Albany County 
Med. Soc., Jan.,’75, 
Ameb. Joub. Obst., 
May, ’75. — Dr. J. 
H. Blatner. 
1 hour. 
Asphyxiated. 
Lived 10 minutes and expired. 
29 
Am. Jour. Obst., Vol. 
ix., page 497. Letter 
to Phila. Obst. Soc. 
from P. A. Verou- 
den, Netherlands. 
Hemoptisis from phthisis. 
2 hours. 
“Living.” 
f 
Sixth month, taken to church, 
baptized, and lived several 
hours after. 22 
Duek : Post-mortem Delivery. 
No. 
Journal Record and Oper- 
ator. 
Cause of Death of Mother. 
Time of 
Operation after 
Death of Mother 
Condition 
of Child when 
Born. 
Means of Resuscitation 
Adopted. 
Remarks. 
30 
Ibid. Nov. ’75. Trans. 
Phila. Obsfc. Soc.— 
Dr. Jos. B. Kelly. 
Thoracic aneurism (?). 
15 minutes. 
“ Heart-beat 
very fee- 
ble.” 
One hour’s faithful 
and continuous arti- 
ficial respiration. 
Delivered by Version. ‘4 Since 
done well.” 
31 
Phila. Med. limes, 
Yol. v., page 301.— 
Dr. M. O’Hara. 
Hemorrhage of advanced 
phthisis. 
Between l£ 
and 2 h’rs. 
44 Gasped and was baptized.” 
32 
L’Abeille Medicale, 
Oct. 14th, 1872. 
Convulsions. 
Few minutes. 
No signs of 
life when 
delivered. 
Mouth-to-mouth insuf- 
flation and artificial 
respiration. 
At first but little successful; 
but child 4 4 afterwards 
breathed and began to cry.” 
33 
Journal de Me'decine, 
Vol. xv., p. 185.— 
M. Boyrone. 
Dysentery. 
Immediately. 
“ Seeming ly 
dead.” 
Did not breathe “till twenty 
minutes after birth.” Now 
a “fine, robust child.” 
34 
Cincinnati Lancet and 
Clinic, July, 1878, 
Trans. Cincinnati 
Obst. Soc.—Dr. J. 
L. Cleveland. 
Had had convulsions for about 
two weeks, and supposed to 
have died in one—“probably 
uremic. ” 
‘A full hour. ’ 
Asphyxiated, 
but heart- 
beat per- 
ceptible. 
Child gasped in a short time, 
and in one hour fully restor- 
ed ; was small, near term, 
and is “still alive and in 
good health.” 
35 
Private from Dr. S. 
Caro, N. Y. City. 
Unpublished case. 
4 4 Albuminuric convulsions 
during delivery.” 
Immediately. 
Dead. 
Twins. Mother died during 
delivery of first child. Cesar- 
ean section immediately, but 
did not save the child. 
36 
Lond. Lancet, Vol. i., 
’37 and ’38, p. 28.— 
Wm. Dawson, Esq., 
F.R.C.S., and Lec- 
turer on midwifery. 
Obscure brain disease for four 
months. Died in convul- 
sions. Greatly emaciated. 
15 minutes. 
Child emaci- 
ated and 
very weak. 
Insufflation and arti- 
ficial respiration. 
Child lived twenty minutes. Duer: Post-mortem Delivery. 
23 
37 
Ibid. Vol. i., 1869, 
Moribund on admission. His- 
Few minutes. 
No signs of 
“ Ordinary means.” 
Child sent to the country in few 
p. 638.—Service of 
tory of convulsions. “Half 
life. 
days in charge of wet-nurse. 
M. Guyon, Hospital 
an hour in violent agony.” 
Necker. 
No albumen. 
38 
Berlin Med. Zeit., July 
Died in labor of apoplectic 
15 minutes. 
No signs of 
“Ordinary means.” 
“ Since continued well.” 
6th, No. 27. 
convulsion. Paralyzed at 
8th month. 
life. 
39 
Quebec Chronicle,’67. 
Run over by coal cart and died 
at once “ in last stage.” 
At once. 
Fine, healthy boy who appears 
—Drs. Tixier and 
in no way to feel the effect of 
Sallath. 
the accident to his mother.” 
40 
Lond. Med. Times, 
3 minutes. 
Appare n 11 y 
“ Artificial respiration 
Ultimately recovered. 
Vol. i., U. S.—Geo. 
Harley. 
dead. 
for some time.” 
41 
Lond. Med. Times, 
Vol. i., U. S.— Hy. 
Apoplexy. Died in 15 minutes 
after seizure. 
Child died whilst making fruit- 
less attempts to deliver per 
vias naturales. 
Raynes. 
42 
Ibid. Vol. xii., U. S., 
Severe bum. 
Showed n o 
’55.—‘ ‘ South Staf- 
signs o f 
fordshire Hospital.” 
vitality. 
43 
Obst. Report of “Cork 
Maternity.” Dub. 
Hemorrhage. Convulsions. 
At once. 
Twins. One 
Child lived only a short time. 
Immediate death. 
dead; one 
asphyxi- 
Med. Sciences, 
April, 1878. — Dr. 
Jones. 
Died of severe dyspnea. Had 
edema of legs. 
23 minutes. 
Child lived 10 months. 35th 
ated. 
Cord pulsat- 
ed. 
44 
Mon. f. Geburtsk., 
Dec., 1869.— Dr. 
week of pregnancy. 
45 
Pingler. (Case 1.) 
Ibid. (Case 2.) 
Berlin klinische 
Apoplexy. 
15 minutes. 
Child lived 32 minutes. 
46 
Suddenly after an attack of 
5 minutes. 
Persistent resuscitat- 
Child weighed 4 pounds. Reg- 
Wochenschr., 1869. 
convulsions. 
ing means for 2| 
ular respirations were estab- 
—Dr. Beckman. 
hours. 
lished, and the child lived. 24 
Duer: Post-mortem Delivery. 
No. 
Journal Record and Oper- 
ator. 
Cause of Death of Mother. 
Time of 
Operation after 
Death of Mother 
Condition 
of Child when 
Born. 
Means of Resuscitation 
Adopted. 
Remarks. 
47 
Archives de Tocologie, 
Jan., ’75.—Dr. Bailly. 
Eclampsia or suffocated by 
prodigiously swollen tongue. 
“ Tetanic convulsion.” 
15 minutes. 
Dead. 
Could not be resuscitated. 
48 
El Telegrapho Medico, 
Trimestre, 1848.— 
Dr. Oelestius de 
Immediately. 
Asphyxiated. 
Insufflations and fric- 
tions. 
Completely resuscitated. This 
the only success out of six 
cases by Dr. de P. 
49 
50 
Pelayo. 
Unpublished letter to 
Dr. R. P. Harris, 
from Dr. Rufus 
Woodward, Worces- 
ter, Mass., 1871. 
Ann. Univers. Maz., 
546 (caust.), Vol. iv., 
483. 
Apoplexy. “First fit.” 
Without de- 
lay. 
“ Fetal heart 
still beat- 
ing.” 
Hot bath and usual 
manipulations. 
In one hour cried lustily. Liv- 
ed 8 hours, and died by 
neglect of the family physi- 
cian—through jealousy. 
Child lived two hours. 
51 
Archiv. Gynak., ii., 1, 
I871.-Dr. Hoscheck. 
Phthisis. 
10 minutes. 
Appare n 11 y 
dead. . 
Insufflation, mouth-to- 
rn outh. 
Mother near full term. 
52 
Gaz. des Hop., lxxxi., 
“Convulsions and died in half 
Some min- 
No signs of 
Insufflation and arti- 
“ Had the happiness to hear it 
1871.—M. Molinier, 
Interne, Hopital 
Necker, Paris. 
an hour.” 
utes. 
life. 
ficial respiration for 
some time. 
cry.” (Possibly duplicate of 
37.) 
CO 
no in 
Lond. Med. Record, 
Feb., 1874. — Dr. 
Rota. 
“ Gazette Obstetri- 
cale.”—Dr. Pinnard. 
“ Anasarca.” 
Hemorrhagic central tumor. 
Died after several epileptic 
convulsions. 
Few minutes. 
5 minutes. 
Asphyxiated. 
“ Eventually lived. ” 
“ Child resuscitated with some 
little difficulty, and only lived 
3 hours. ” 
55 
Private letter from Dr. 
Edw. Shippen, Med. 
Direct., U. S. N. 
Cholera after a “terribly short 
illness.” 
Immediately. 
Dead. 
The mother, a robust young 
woman near her confinement, 
operated on by Dr. Benedict, 
physician in charge Philadel- 
phia Hospital. 
In the preparation of the above tables I wish to acknowledge valuable assist- 
ance from my young friend and pupil, Dr. Robert C. Hutchinson.