[Reprinted from THE MEDICAL NEWS, December 10, 1892.] 
A CASE OF EXTREME PUERPERAL ANEMIA AND 
NEPHRITIS; DELIVERY AT TERM WITH 
FORCEPS APPLIED, UNDER CHLORO- 
FORM, ABOVE THE SUPERIOR 
STRAIT; RECOVERY OF 
MOTHER AND CHILD. 
By HARRIS A. SLOCUM,'M.D., 
PROFESSOR OF GYNECOLOGY IN THE PHILADELPHIA POLYCLINIC> 
VISITING GYNECOLOGIST TO ST. CLEMBNT’s. 
This case is reported to show what extremes a preg- 
nant woman may reach in those conditions that, by 
education and experience, we dread to encounter; and 
the means that, in this instance at least, were successful 
in enabling the mother to reach term and be delivered 
of a living child. 
Mrs. M. P. was married at the age of sixteen years and 
six months. Menstruation began at fifteen. Her last 
period was on January 3, 1892, conception probably 
taking place about January 14th. By the 2d of Feb- 
ruary morning sickness had begun, gradually increas- 
ing until the end of the month, when vomiting occurred 
and quickly increased, so that everything taken into the 
stomach was rejected. She rapidly lost flesh and color, 
and when I first saw her at my office on March 26th si e 
was so emaciated and weak that I was apprehensive 
about her ability to reach home in safety. 
The bowels were inactive, and a preparation of malt 
with cascara was given, with cerium oxalate for the 
nausea. The cascara was partially successful, but the 
cerium oxalate had no effect. 2 
The urine was pale, with a tinge of smoky red, and con- 
tained i per cent, ot albumin. The specific gravity was 
1004; the quantity averaged twenty ounces in twenty- 
four hours. The microscopic examination showed red 
corpuscles greatly disintegrated, small blood plaques, 
many pus and young epithelial cells, hyaline, granular, 
and epithelial casts, and hyaline disks. Severe occipital 
and frontal headache, marked pain throughout the lower 
half of the abdomen and pelvis, constant nausea and 
vomiting, and progressive emaciation and pallor, when 
considered in relation with the urine analysis, brought 
the case within the range of early operative interference. 
Having had good results from the use of theobromine 
sodio-salicylate in acute nephritis, I determined to test 
its value here, and gave her capsules containing seven 
and one-halt grains every four hours. This was fol- 
lowed so quickly by the disappearance of the pelvic and 
abdominal pains and the occipital headache, and an in- 
crease of the urine to sixty ounces, that no reasonable 
doubt exists of its having been the useful factor. 
She was put upon a strictly milk diet, but the vomit- 
ing did not cease until this was changed to peptonized 
milk. This was continued intermittently for several 
weeks, but as her sufferings diminished she became less 
careful, returning to solid food, contrary to advice, and 
paying the penalty of emesis and return of headache. 
At these returns her condition would become so alarm- 
ing that I was several times on the point of inducing 
abortion, and would probably have done so if I had not 
known of her very great desire to have a living child. 
Before leaving the city, in the summer, I carefully went 
over the case with my assistant, Dr. Homer C. Bloom, 
and he agreed to hold himself in readiness to induce 
labor should it appear necessary. 
During my absence the patient had another severe 
attack of vomiting and a return of all her old symp- 
toms, and a physician near at hand was hurriedly sum- 3 
moned, who, not having the facts of the case in his 
possession, administered morphine, which resulted in 
intensifying her distress, and almost stopping the action 
of the kidneys altogether. Finding that she was grow- 
ing rapidly worse, they sent for my assistant, who 
carried out the original treatment with success. 
During September and October, until labor began, 
the urine contained about one-half of one per cent, of 
albumin, the specific gravity fluctuated between 1004 
and 1012 and the daily amount between sixty and 
seventy-five ounces. At no time did the albumin dis- 
appear from the urine. On the contrary, the amount 
several times increased to semi-solidity on boiling, fol- 
lowing a return to solid food and the upright posture. 
On the 20th of October labor began. The pains were 
very weak but very painful, and the patient soon lost 
her self-control and exhibited general twitchings, which 
became more marked as the day went on. At about 
4.30 in the afternoon she seemed in imminent danger 
of eclampsia, and I determined to dilate and deliver 
under an anesthetic. Almost no dilatation had taken 
place since morning, the os barely admitting two fingers. 
Dr. Bloom administered chloroform, and with Barnes’s 
dilators I enlarged the os to nearly full relaxation, and 
then waited to watch the effect of a contraction. These 
passed with no effect at engaging, and I then applied 
the forceps inside the uterus above the superior strait. 
In about twenty minutes the head was at the vulva, and 
was slowly and carefully delivered, and the forceps re- 
moved. The partly asphyxiated child was quickly 
resuscitated and the placenta expressed. This had 
hardly been done when the blood poured out of the 
uterus in a stream. Compressing the uterus with one 
hand on the abdomen, the other carried the nozzle of a 
syringe into the cavity, and hot water was injected 
against the walls. All blood-clots were quickly re- 4 
moved, and the uterus shut down, only to relax and 
again fill as soon as the hand was removed. 
The same procedure was again tried with the same 
result—contraction and subsequent relaxation. Finding 
that the fundus did not rise beyond a certain point (about 
an inch below the umbilicus) I concluded to let it alone, 
and watched it for several minutes. No further enlarge- 
ment taking place, the bandage was applied and the 
chloroform taken away. The bleeding ceased. If I 
had continued to follow the general rule to empty the 
uterus, I should have soon emptied all the blood of her 
body. The uterus gradually contracted, expelling clots 
until it reached its normal size. I saw mother and child 
December i, and both are well. 
This case illustrates the following points : 
ist. A pregnant woman may present alarming symp- 
toms of nephritis with great anemia and exhaustion, and 
yet go to term. 
2d. The value of theobromine sodio-salicylate in aid- 
ing to bring this about (urea was increased by it), to- 
gether with the use of peptonized milk as a food. (I 
believe we had here a merging of the nausea of nephritis 
into the nausea of pregnancy. The theobromine sodio- 
salicylate relieved the former, but had no effect upon 
the latter.) 
3d. The danger of using morphine to relieve nausea 
in pregnancy without first ascertaining the condition of 
the kidneys. 
4th. An instance in which the golden rule in post-par- 
tum hemorrhage—to “empty the uterus”—found an 
exception; for here the uterus was exhausted, and the 
clots formed the only means for closing the sinuses. 
There was not blood enough left in the body to stimulate 
the contracting centers.