[Reprinted from TjiE Medical News, February i, 1896.] 
POST-MORTEM C/E S A R E A N SECTION, WITH 
DELIVERY OF A LIVING CHILD. 
By EDWARD P. DAVIS, A.M., M.D., 
OF PHILADELPHIA; 
PROFESSOR OF OBSTETRICS IN THE PHILADELPHIA POLYCLINIC CLINI- 
CAL PROFESSOR OF OBSTETRICS IN THE JEFFERSON MEDICAL 
COLLEGE ; ATTENDING OBSTETRICIAN TO THE 
PHILADELPHIA HOSPITAL, ETC. 
Sudden death of the mother during labor, if the 
child is living, makes it obligatory upon the attend- 
ing physician to endeavor to rescue the infant. The 
success of such an attempt will depend, first, upon 
the nature of the cause which destroys the life of 
the mother; second, upon the time chosen for the 
delivery; and, third, upon the method employed. 
Two causes of maternal death are especially fatal 
to the foetus. One is traumatism, resulting in se- 
vere hemorrhage to the mother, and the other is an 
infection, producing high fever and profound in- 
toxication. Sudden death in labor from heart- 
lesions or from mechanical injury, without great 
hemorrhage, gives conditions most favorable for the 
survival of the child. 
The time for accomplishing delivery in these cases 
is necessarily brief. A recent case is reported by 
Hoffman1 in which in an eclamptic patient he de- 
scribes the delivery of a living child by abdominal 
1 Centralblatt fi|r Gynaldblpgje, go.; 2 
and uterine incision ten minutes after the mother 
had ceased to breathe. It may scarcely be supposed 
that a longer delay than this could be borne by the 
foetus. Where high temperature is present, the time 
must be necessarily briefer in which successful deliv- 
ery may be accomplished. 
The method of performing rapid delivery in these 
cases has been variously chosen by different opera- 
tors ; while abdominal and uterine incision is un- 
doubtedly quickest, some prefer forcible dilatation 
of the uterus, and forceps or version. The prac- 
tical choice of a method must depend upon the 
condition of the birth-canal, and also the circum- 
stances and situation of the patient. Where abun- 
dant assistance is at hand, the patient can quickly 
be put in suitable posture for the forceps or version. 
Where, however, but little help can be obtained, 
and the patient cannot be placed in proper position 
readily, it is often more easy to perform abdominal 
incision. 
The survival of children so delivered will depend 
upon the vigor of the child, and also upon the na- 
ture of the cause which destroyed the mother's life. 
The acute infections are especially fatal to infants, 
not only from the action of poisonous germs con- 
veyed from mother to child, but also by reason of 
the high temperature which is often present in these 
cases. 
A recent case may serve to illustrate the foregoing 
remarks: 
The patient, Mrs. L., aged twenty-six years, a 
primipara, had been in good health during her 
pregnancy. She was of good constitution, and had 3 
always enjoyed excellent health. A few days before 
her death she had summoned her physician with the 
complaint of headache, restlessness, and nervous 
discomfort. He prescribed a sedative for her which 
somewhat relieved her symptoms. Shortly after- 
ward, while sitting with her family, she was sud- 
denly seized with convulsions, and soon became un- 
conscious. Her physician was at once summoned, 
and applied the usual methods of treatment for sub- 
duing the eclamptic seizures. These were, however, 
unsuccessful, and the patient rapidly passed into a 
comatose condition with extensive oedema of the 
lungs. I saw her in consultation about six hours 
after the first attack. She was then in deep coma, 
with a high temperature and labored breathing. 
Vaginal examination disclosed the membranes un- 
ruptured, the cervix obliterated, and the os about 
three-fourths dilated. It seemed to me possible to 
rupture the membranes, complete dilatation with the 
hand, and apply forceps, as the vertex was present- 
ing. While hastily preparing the forceps, the pa- 
tient was seized with a convulsion, at the close of 
which she expired. I hurriedly asked whether the 
family desired that an effort be made to save the 
child, and was informed that such was their wish. 
As the patient was a large, stout woman, and her 
bed so placed that she could not be put into posi- 
tion for the use of forceps without considerable dif- 
ficulty, the quickest method of delivery seemed ab- 
dominal incision. Accordingly, while one of the 
physicians held a light, the abdomen and uterus 
were rapidly opened, and a male child, weighing 7 
pounds and 12 ounces, was extracted. In the hurry 4 
of the moment, the patient's temperature had not 
been taken, but her body felt so hot to the hand that 
her temperature must have been above 104°. The 
child was asphyxiated, but speedily revived and 
breathed naturally. As the child would be without 
skilled care if left at home, he was immediately 
warmly wrapped, placed between warmed pillows, 
and taken to the Jefferson Maternity, where he was 
placed in an incubator. He was nursed by a healthy 
young woman whose child was but a few days old, 
and was given the faithful care of trained nurses. It 
was observed that the child perspired very freely 
upon entrance to the Maternity, and that the se- 
cretion of urine at first was excessive. The child 
nursed naturally, its bowels were soon emptied, and 
its appetite was excellent. It gradually developed, 
however, symptoms of toxaemia, similar to those of 
an eclamptic patient. * Its urine contained a great 
excess of uric acid, its skin became dry, and its 
bowel-movements were dark in color. The child 
was treated as would be a woman suffering from tox- 
aemia. It derived the greatest comfort from a warm 
pack. Its intestines were irrigated, and simple di- 
uretics were administered freely. The toxaemic con- 
dition considerably improved, and the child con- 
tinued to nurse regularly. It never had convulsions, 
and slept when its excretory organs were freely stim- 
ulated. At the end of two weeks, however, it de- 
veloped a purpuric condition of the skin and mucous 
membrane of the intestine, and died two weeks after 
delivery from inanition. 
This case illustrates very perfectly the pathology 
of eclampsia, and the toxaemic condition transmitted 5 
to the child which proved so fatal to the mother. It 
was most interesting to observe that all of the child's 
nervous symptoms, restlessness, and suffering were 
directly relieved by that form of treatment which 
increased its excretions. In view of the fact that 
the child survived two weeks, that it nursed, and was 
relieved fora considerable time of threatening symp- 
toms, the attempt to save its life seems to have been 
justifiable. As a post-mortem examination could 
not be obtained upon mother or child, the exact 
pathology of both cases could not be ascertained. 
Every symptom, however, pointed in mother and 
child to a profound toxaemia as the cause of the fatal 
issue. 
This case illustrates most pointedly the imperative 
necessity of watching carefully the excretory pro- 
cesses of the pregnant patient. It is not sufficient to 
ascertain simply the presence or absence of albumin 
in the urine, but the physician must know that the 
skin, kidneys, liver, intestines, and lungs of the mother 
are performing the double duty which the presence 
of the foetus entails. When this is carefully watched, 
sudden and profound intoxications like that de- 
scribed will rarely happen. An experienced observer 
will detect the effects of toxaemia upon the nervous 
system, and by suitable diet and prompt stimulation 
of the organs of excretion will, in the great majority 
of cases, succeed in averting the danger to mother 
and child. In the presence of profound toxaemia 
with eclampsia there is but a short time in which 
any form of treatment is of the slightest avail. The 
fatal line is passed so rapidly that, unless the physi- 
cian is forearmed and forewarned, he may find him- 
self in the presence of an unpreventable catastrophe.