Reports of Societies

1891 Boston Medical and Surgical Journal  
pregnant for the third time, a period of thirteen years having intervened since a miscarriage had followed soon after the birth of her firat child. During the present pregnancy she had been troubled with shortness of breath, and of late had suffered from several attacks of what she Bupposed to be asthma; her hands, feet and legs had been swollen, her hands so much so that she had been unable to close the lingera. I found the patient cyanotic, with great dyspncea, breathing sixty-five times a
more » ... ute. Coarse râles could be heard across the room, and a hasty examination of the chest allowed an alarming oedema of both lungs. The pulse was 150 and weak. Cardiac examination waa negative a decision that was subsequently confirmed. Legs, feet, hands and face were swollen and oedematous. Dr. M. D. Clarke, and later Dr. William Cogswell, saw her in consultation. They agreed with me that the trouble was in all probability nephritic in origin, and that the prognosis was bad. I remained all night, using counter-irritation over the chest and to the lower extremities, alcoholic stimulation and hypodermic injections of sulphate of atropia and of nitro-glycerine. Twice in the course of the night, the patient appeared moribund, becoming semi-comatose, and the pulse very rapid and irregular; but at live in the morning she became easier and obtained a little natural sleep. At ten, my previous consultants, with Dr. L. S. Smith, endorsed the treatment I had determined upon as soon as the condition improved manual dilatation and delivery. I had in the course of the night obtained a small specimen of urine, and found that it was opaque with albumen, and that the sediment contained finely granular casts. With the valued assistance of Drs. Clarke and Smith I began dilatation at 10.20, the patient being placed across the bed in an almost upright position, the orthopnuea preventing any other. The os was unusually firm and resistant. I learned afterwards that her first labor extended from Thursday morning to Saturday night, and also that the os had been subjected to the cautery for some time within a few years. The patient had good pluck, aud dilatation without anoesthesia was continued until, at 11.45, the tips of three fingers could be introduced. Ana;sthesia was now necessary, and a more uiipromising subject is rarely seen. Both the patient and her husband being fully informed of the circumstances of the case, chloroform was administered and the dilatation advanced as rapidly as possible, hypodermic injections of nitro-glycerine and of ether being administered meanwhile. At 12.40, after version, the child waa delivered, aoine delay being cau8ed in getting the arma as they went up above the head. The child, a female weighing four pounds, breathed after a little eucouragemeut. Hot bottles were placed around the mother and hypodermic stimulation continued. She rallied well from the anaesthetic; and was left two hours later in the hands of a trained nurse. The subsequent history of the case ia uneventful. Several attacks of slight oedema rendered anxious the first few days, and cardiac failure threatened twice. Inhalations of oxygen improved the color when cyanosia became marked, but the hypodermic injections of nitroglycerine proved all the way to give the quickest and most lasting aid. Elaterium and saline cathartics, a8 well as diuretics, were brought into service, and the respirations decreased in frequency and became of better quality while the amount of albumen in the urine gradually diminished. The ehild, while weak, still lives and takes liotch's mixture with increasing strength. On June 19th, no albumen could be detected, and a careful examination of several slides June 21st failed to bring into view any casts. The patient ia about the houae, and calls herself well. Note. -The child lived twenty-nine days, and died of exhaustion. The mother is to-day (October 1st) still in excellent health.
doi:10.1056/nejm189110291251806 fatcat:iz56yfpfrrbhzahvtwf3vj5nnm