[Reprinted from the American Gynaecological and Obstetrical Journal 
for December, 1894.] 
A CASE OF SUDDEN DEATH ROLLOWING CCELIOTOMY* 
By Frank W. Talley, M. D. 
Cases of sudden death folio are of sufficient rarity 
to warrant their description. Especially is this so in cases in which 
the abdomen alone is opened with little or no disturbance of the 
abdominal contents. 
In the following case nothing was done except separation of tuber- 
cular adhesions and the fixation of the uterus. 
The patient died suddenly on the eleventh day without premoni- 
tion. Her history is as follows : 
Mary T., aged twenty-five years, fairly well nourished girl, of mark- 
edly nervous type, a dressmaker by occupation, single, was admitted 
to the Polyclinic Hospital, October io, 1894. There was no history 
of tuberculosis in parents, grandparents, brothers, or sisters, nor was 
there evidence of pulmonary or cardiac disease. She denied having 
had any acute disease except measles, which she had suffered in her 
childhood. She menstruated for the first time during her twelfth 
year. Her menses were always irregular, sometimes anticipating, at 
other times postponing. For the past three years she had suffered 
from burning, dragging pains in the left ovarian region, the pain ex- 
tending down the inside of the left thigh to the knee, dragging pain 
in the back, constipation, headache, and nervous debility. These 
symptoms were exaggerated at her menstrual epochs. 
Upon examination, the uterus was found anteflexed and retro- 
verted, fixed, both ovaries prolapsed behind the uterus, large, tender, 
and bound down by inflammatory adhesions. 
On the nth of October she was etherized, the abdomen opened 
by a median incision, and the fundus of the uterus freed from its 
adhesions, as were also the ovaries, when the fundus was directly 
fixed in the lower angle of the wound with two fine silk sutures. 
* Read before the Philadelphia Obstetrical Society, November i, 1894. 2 
Frank W. Talley, M. D. 
The first suture was introduced through the fibers of the rectus 
muscle, the lower half of the sheath of the rectus, subperitoneal fat, 
and the peritonaeum on the one side of the abdominal wound, through 
the fundus of the uterus in a direct line between the emergence of 
the two Fallopian tubes, and through the peritonaeum, subperitoneal 
fat, lower sheath of the rectus, and a few fibers of the rectus muscle 
on the other side. 
The second stitch was similarly placed through the abdominal 
wall, but half an inch higher up, and passed through the uterus half an 
inch behind the other in the posterior surface. Dotted over the peri- 
tonaeum, covering the fundus of the uterus, were a number of miliary 
tubercles ; the adhesions binding the uterus to the posterior abdomi- 
nal wall, and also the ovaries, were, no doubt, tubercular in character. 
The Fallopian tubes on both sides were pink in color, and apparently 
healthy. They were not included in the adhesions. The ovaries 
were large, scarred upon their surface with old cicatrices, but showed 
no miliary tubercular deposit upon their surfaces. 
The wound was closed in the usual manner. For the first three 
days the patient did well, but complained of a diffuse tenderness over 
the lower part of the abdomen. On the fourth day the tenderness 
disappeared under free purgation. On the eighth day the stitches 
were removed. Union by first intention had taken place throughout. 
During the next three days the patient was lively, received her 
friends, ate heartily, and was apparently entirely recovered. 
When seen at ten o'clock on the eleventh day after her operation 
she seemed in high, spirits. Two hours later she was noticed by the 
nurse to throw up her hands and apparently to suffer an epileptic fit. 
The resident physician was immediately summoned, found her cya- 
nosed, with Cheyne-Stokes respiration, strong pulse-80 to the minute. 
The patient was conscious and exclaimed that she was about to die. 
In six minutes from the onset of these symptoms her respirations 
ceased. Artificial respiration was continued for some time after- 
ward. The heart continued to beat several minutes after the respira- 
tion had ceased. 
An autopsy not being permitted, the cause of death can be only a 
matter of presumption. The wound in the abdomen was opened, the 
uterus found adherent at its lower angle, the peritonaeum healthy. 
The ovaries and tubes on both sides were removed for examination. 
Macroscopically they showed no sign of tubercular disease. The 
tubes were patulous, of normal caliber, the peritonaeum covering them 
uninvolved ; they were apparently healthy. A Case of Sudden Death following Coeliotomy. 
3 
The miliary tubercles upon the uterus were demonstrated to the 
gentlemen attending the operation, and were observed also by Dr. 
Bannister, who assisted me. 
From the rapid onset of her death and the marked respiratory 
paralysis, one would conclude that the respiratory center in the floor 
of the fourth ventricle had been the seat of some rapidly occurring 
interference. It would seem probable that an embolus, having been 
separated by the patient, perhaps, turning in bed, had entered the 
general circulation, and plugging a terminal artery supplying the res- 
piratory center, the patient had died from acute anaemia of the parts 
supplied, causing an almost immediate cessation of the respiratory 
function. 
Where such a clot should have formed, as no vessels were ligated, 
is a matter of conjecture. The fact that there existed no heart mur- 
mur would seem to preclude the theory of the separation of a vegeta- 
tion from one of the leaflets of the heart valves. 
The case is interesting from two points of view : First, as showing 
that tubercular pelvic peritonitis may occur without apparent affec- 
tion of the tubes, thus seemingly opposed to the theory lately ad- 
vanced that the tubercular disease was of tubal origin. Second, as a 
case of sudden death from some unaccountable occurrence during 
convalescence.