THE SLOANE WWR HOSPITAL 
REPORT ON THE FIRST SERIES OF ONE THOUSAND 
SUCCESSIVE CONFINEMENTS FROM JANUARY 
1st, 1888, TO OCTOBER 1st, 1890. 
BY 
JAMES W. McLANE, M.D., 
Professor of Obstetrics in the College of Physicians and Surgeons, New York; 
Physician to the Hospital. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXIV., No. 4, 1891.] 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891. THE SLOANE MATERNITY HOSPITAL 
REPORT ON THE FIRST SERIES OF ONE THOUSAND 
SUCCESSIVE CONFINEMENTS FROM JANUARY 
1st, 1888, TO OCTOBER 1st, 1890. 
BY 
JAMES W. McLAJE, M.D., 
Professor of Obstetrics in the College of Physicians and Surgeons, New York; 
Physician to the Hospital. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXIV., No. 4, 1891.] 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891. THE 
SLOANE MATERNITY HOSPITAL. 
REPORT ON THE 
FIRST SERIES OF ONE THOUSAND SUCCESSIVE CONFINEMENTS 
FROM 
JANUARY 1ST, 1888, TO OCTOBER 1ST, 1890. 
The Sloane Maternity Hospital of the College of Physi- 
cians and Surgeons of New York is situated at the corner of 
Tenth avenue and 59th street. It was erected in 1886 and 
1887 by William D. Sloane, Esq., whose wife, a daughter of 
the late William II. Vanderbilt, endowed the institution by 
making all its beds free in perpetuity. It was opened Janu- 
ary 1st, 1888, for the reception of patients, and up to Octo- 
ber 1st, 1890, 1,000 women have been confined in its wards. 
As it has been pronounced by many physicians, both in this 
country and in Europe, a model lying-in hospital, and as its 
reputation is as yet in its infancy, a short description of the 4 
• McLane: THE SLOANE MATERNITY HOSPITAL. 
building and the management of the service may not be out 
of place. 
Its dimensions are sixty-five feet by seventy-five. It is of 
three stories and an attic. It is built of brick, with mould- 
ings of granite and terra-cotta, and its construction is fire- 
proof throughout. The flooring of the halls and wainscoting 
of the stairways are of white marble ; the flooring of the wards 
and operating rooms is of white vitrified tiles. The surfaces 
of the wTalls are in hard finish and painted white. 
In the basement are located the laundry, the kitchen, the 
servants' dining room ; the coil chamber and fan for warming 
and ventilation ; a bath room where newly admitted patients 
are thoroughly cleansed before going to the wards; and a room 
fitted with lockers for the safe-keeping of the clothing worn 
by patients on admission. 
On the first floor are the rooms of the house physician, the 
assistant house physician, and the matron; a reception room, 
dining room for the staff, manager's room, and a large exami- 
nation room. 
Ou the second floor there are three wards, one containing 
nine beds, the other two four beds each; a delivery room, 
sleeping rooms for the nurses, and the drug room ; also a 
dining room for women awaiting confinement. 
On the third floor there are three wards similar to those on 
the second, a delivery room, the apartment of the principal of 
the Training School, two isolating rooms for patients requiring 
separation from the rest, and sleeping rooms for ward nurses. 
The total number of beds is thirty-nine. In the attic are the 
rooms of the house servants. 
The warming and ventilation of the building are provided 
for by a fan wfliich drives the air, warmed by steam-heated 
coils, through ducts to every part of the house. Under a 
moderate speed of the fan engine 580,000 cubic feet of air are 
supplied to the wards per hour. 
The bath rooms, sinks, and water closets are all situated in 
the northeast corner of the building, removed as far as pos- 
sible from the wards and special delivery rooms, in wfliich 
there are no pipes, not even for the supply of water. 
The lying-in wards are used in rotation. Each one, having 
been occupied by four patients, is thoroughly cleaned, the McLANE : THE SLOANE MATERNITY HOSPITAL. 
5 
furniture washed with a solution of carbolic acid, and left un- 
occupied, with open windows, for several days. 
Patients awaiting confinement are kept in wards by them- 
selves, and separate from the puerperal women. On entering 
the hospital each patient is obliged to take a full bath under 
the supervision of a nurse, plenty of soap being used and 
special attention given to the hair, which is thoroughly sham- 
pooed with delphinium or ether, or both ; or, if very dirty, 
with bichloride solution. A vaginal douche of bichloride 
(1:5,000) is given and a rectal enema of soapsuds. The woman 
is then attired in clean clothes, the property of the hospital; 
her own garments being placed in a bag and subjected to a 
heat of 250° F. in a small room specially designed for this 
purpose, and afterward stored in a locker in the basement. 
This arrangement is found very useful in protecting the wards 
from vermin. 
The patient is then permitted to enter the ward set apart 
for waiting women, and allowed the following diet: Break- 
fast, oatmeal or hominy, tea or coffee with milk and sugar, 
bread and butter. Dinner, meat, vegetables, bread and butter, 
dessert, soup three times a week. Supper, tea with milk and 
sugar, bread and butter, stewed or fresh fruit. 
All confinements take place in the special delivery rooms, 
which are located conveniently near the wards. Each of these 
rooms contains a table of special design (see Fig. 1), upon 
which all deliveries take place. Its length is five and a half 
feet; breadth, twenty-seven inches ; height, thirty inches. It 
is admirably adapted for operative procedures. The top is 
divided into two parts; the one on which the patient's head 
rests being fastened to the legs of the table, and united by 
hinges to the other part, which is movable. By means of a 
screw near the lower end, the foot of the table can be raised 
to any height desired, thus providing for the instant lowering 
of the patient's head in case of hemorrhage. When covered 
with a double blanket and sheet, it forms a very comfortable 
bed. The bedding is protected by water-proof paper, which 
has been found an excellent substitute for the ordinary india- 
rubber sheet, and is used on all the beds in the wards. It is 
a soft brown paper, very flexible, covered with a thin coating 
of tar, over which is spread a single layer of gauze, which 6 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
gives it the appearance and feel of cloth. It is made for the 
hospital by Messrs. Heald Brothers, 59 Knight rider street, 
London, and imported in rolls of one hundred yards each, fifty 
inches wide. Its cost is about six cents a yard, free of duty. 
Whenever soiled, it is removed from the beds and burned. 
Injections are given by means of fountain syringes. These 
are of agate ware, specially made for the hospital. Each can 
has a capacity of two quarts. Near the bottom of the vessel 
is a projecting nipple, over which is fitted a soft-rubber tube 
joined at the other end to a glass nozzle for insertion in the 
Fig. 1.-Delivery table. 
vagina or uterus. When not in use, these glass tubes are kept 
in jars containing a solution of bichloride. 
The house staff is composed of a resident physician, an 
assistant physician, a principal of the Training School for 
Nurses, and an assistant. By an arrangement with the New 
York Hospital, nurses are received regularly every two months 
from that institution, and given an obstetrical training before 
their graduation. This plan works admirably, and the pa- 
tients have the benefit of intelligent and skilful nursing. 
When a patient is taken in labor, she is transferred from 
CONDUCT OF LABOR. McLANE: THE SLOANE MATERNITY HOSPITAL. 
7 
the waiting ward to the delivery room, where a vaginal douche 
and rectal enema are given early in the first stage. 
Chloroform is given when necessary in the latter part of 
the second stage-to the obstetrical, not the surgical degree. 
Delivery usually takes place with the patient lying on her 
left side, if a primipara; on her back, if a multipara. 
The placenta is expressed by the Crede method at the end 
of fifteen minutes; one drachm of fluid extract of ergot then 
administered, a vaginal douche of three pints of bichloride 
solution (1: 5,000) of a temperature of 116° F. given, and the 
uterus held for one hour after delivery, when, if well con- 
tracted, the binder is applied, the patient placed upon another 
table which is provided with wheels, and removed to the 
ward where she is to remain during the puerperium. The 
Fig. 2.-Patient with abdominal and breast binder applied. 
perineum, if torn to any extent, is sutured at once with silk- 
worm gut. 
The intra-uterine douche is only given in cases of instru- 
mental delivery or where the hand has been introduced. 
The entrance to the genital canal is closed by an antiseptic 
pad, twenty-eight inches long and eight inches wide, made of 
gauze and tilled with absorbent cotton. On the first day these 
pads are changed every four hours; on subsequent days once 
in eight hours, the pads being somewhat smaller as the lochial 
discharge diminishes in quantity. 
If after-pains occur, a draught is given containing one-sixth 
of a grain of the acetate of morphia, one minim of fluid extract 
of digitalis, and one drachm of spiritus Mindereri, and repeat- 
ed if necessary. 
The diet during the first day consists exclusively of milk; 8 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
on the second and third days oatmeal or hominy with bread 
and butter are given for breakfast, soup with some vegetable 
food and a dessert for dinner, bread and butter with stewed 
fruit for supper. Milk is given between meals. After the 
third day the patient is allowed full diet, similar to that given 
to those awaiting confinement. 
The process of involution is promoted by the administration 
three times a day of 
Extract! Ergotae fiuidi Til xv. 
Extract! Digitalis fluid! 1U ii. 
Quiniae Sulphatis gr. ii. 
On the sixth day usually the patient is wrapped in blankets 
and allowed to sit up for two hours; for five or six hours on 
the seventh and eighth days. On the ninth day the binder 
is removed and patient allowed to walk. On the tenth day, 
if all has gone wrell, she is discharged-the average stay in the 
hospital being ten days in simple, uncomplicated cases. 
No visitors are allowed in the wards. Patients and nurses 
wear only clothes that can be washed, and the physicians sack 
coats of white duck. All soiled articles of clothing and bed- 
ding are put in bags and at once sent to the laundry in the 
basement by means of a copper chute, the opening being in 
the hall, near the wards, and covered by a small iron door. 
Physicians and nurses exercise the most scrupulous care in 
regard to personal cleanliness and disinfection. Before mak- 
ing a vaginal examination the hands are scrubbed and a 
nail brush used; they are then immersed in alcohol and after- 
ward in a solution of bichloride (1:2,000). Alboline, kept 
underneath a bichloride solution, is used as an emollient. No 
sponges are allowed in the hospital, being replaced by absor- 
bent cotton. 
The Newly -horn Child.-The cord is tied a few minutes after 
birth, and immediately afterward one drop yd a two-per-cent 
solution of silver nitrate is put in each eye. The rectal tem- 
perature is then taken, the child weighed, wrapped in a blanket, 
placed in a crib, and surrounded by hot-water bags. Each 
child is weighed every morning and has a full bath (tempera- 
ture 98° F.). The cord is dressed with iodoform and bismuth 
subnitrate, equal parts. The mouth is washed with saturated MCLANE : THE SLOANE MATERNITY HOSPITAL. 
9 
solution of boracic acid. The child is put to the breast of 
the mother twelve hours after birth for the first time. After 
lactation is established, the child is allowed to nurse once in 
two hours from 6 a.m. to 10 p.m., and again at 2 a.m., ten 
nursings daily. 
The following statistics are of interest: 
TABLE I. 
NATIONALITY. 
Out of the 1,000 women confined, there were born in the 
United States 377 
Ireland 320 
Germany 104 
England . 52 
Sweden 32 
Scotland 17 
Austria .... 17 
France 17 
Denmark 4 
East Indies 1 
Canada 11 
Russia 19 
Switzerland 8 
Hungary 5 
Wales 4 
Saxony 3 
Norway 3 
Poland 4 
Roumania 1 
Spain 1 
TABLE II. 
AGES. 
The oldest patient was 46 years of age, the youngest 12 
years and 10 months; 154 were under 20 years of age, 659 
were het ween the ages of 20 and 30 years, 171 between 30 
and 40, and 16 between 40 and 50. 
TABLE III. 
SHOWING THE PROPORTIONATE NUMBER OF CASES OCCURRING IN 
THE SEVERAL PREGNANCIES. 
Pregnancy, 1st. 2d. 3d. 4th. 5th. 6th. 7th. 8th. 9th. 10th. 11th 12th 17th Total 
No. of cases 547 232 91 52 25 It 14 9 10 5. 1 2 1 1000 
TABLE IV. 
PRESENTATIONS UNDER WHICH CHILDREN WERE BORN. 
Vertex 936, or 93.6 per cent. 
Breech 49, " 4.9 " 
Transverse 10, " 1. " 
Shoulder , 5, " 0.5 " 
Face 3, " 0.3 " 
Brow 2, " 0.2 " 
Foot 2, " 0.2 " 
Doubtful 6, " 0 6 " 10 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
TABLE V. 
SHOWING RELATIVE FREQUENCY OF THE FOUR POSITIONS IN VERTEX 
PRESENTATIONS. 
Position. 
No. of cases. 
L. 0. A 
610 
R. 0. A 
227 
R. 0. P 
77 
L. 0. P 
22 
TABLE VI. 
SHOWING THE NUMBER OF CASES REQUIRING OPERATIVE INTERFERENCE, 
AND OPERATIONS PERFORMED. 
Induction of labor 12 cases. 
Forceps 83 " 
Version 14 " 
Craniotomy 3 " 
Total -..112 " 
TWIN CASES. 
Of twin cases there were 13, about 1 in 77 of the whole 
number of women delivered, or 1.3 per cent. 
No. of Cases. • 
Both Males. 
Both Females. 
One of each. 
13 
2 
4 
7 
Vertex in both 6 
" and breech 4 
" " transverse.. 2 
Breech or t( 1 
13 
Presentations. 
In 7 cases there were two amniotic cavities and a single 
placenta; in 6 cases there were two amniotic cavities and a 
double placenta. In no case was there a single amniotic 
cavity. 
No. of cases. 
Living. 
- Dead. 
3 
3 
0 
FACE PRESENTATIONS. 
Two of the patients were delivered by natural efforts, one 
by forceps. In two cases the position was L. M. A.; in one 
L. M. P., rotation, however, taking place, so that it terminated 
as R. M. A. Two children were born alive; the one delivered 
by forceps was still-born. MCLANE: THE SLOANE MATERNITY HOSPITAL. 
11 
VERSION. 
This operation was performed fourteen times, or one in 
nearly seventy-one, or 1.4 per cent. The version was podalic 
in thirteen instances, cephalic in one instance. The opera- 
tion was made necessary by malpresentation in nine cases, in 
four by placenta previa. Of the malpresentations, eight 
were shoulder cases, one a compound of head and foot. Of 
the mothers, three died, or one in five nearly. Two out of 
the three who died were in labor with placenta previa ; the 
third entered the hospital moribund, with the child's arm 
prolapsed, and a ruptured uterus, and died twenty minutes 
after admission. Of the fourteen cases, six children were 
born alive, ten were still-born. Of the latter, four were pre- 
mature, two macerated. In all the cases where the mother 
died the children were still-born. Of the fourteen cases, six 
were brought by ambulance, in labor. • The versions were all 
performed by the combined external and internal methods, 
chloroform being used. Details of cases are briefly given 
below : 
Case I. Transverse Presentation; Podalic Version.- 
^Et. 29 ; Illpara. Patient came into the hospital in labor, 
the os being dilated to size of a dollar. Membranes ruptured 
spontaneously, followed by prolapse of right arm. Chloro- 
form was given, the arm returned into the uterus, and left 
foot brought down. A still-born male child was easily de- 
livered, weighing three pounds, premature and macerated. 
Mother made a good recovery. 
Case II. Twins; Shoulder Presentation; Podalic Ver- 
sion.-JEt. 29; VHpara. Patient brought by ambulance, 
after having given birth to a female child at her home. On 
examination a second child was found in an abdomino-ante- 
rior position, the right shoulder presenting, the amniotic sac 
having ruptured. Chloroform was given, hand introduced, 
shoulder pushed up, and left foot seized and brought down. 
The child, a male, was easily extracted. Both children were 
small and poorly nourished, labor being premature. Mother 
did well. 
Case III. Contracted Pelvis ; Placenta Previa.-This case 
is described under Placenta Previa (vide Case I.). 12 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
Case IV. Placenta Previa. - (Vide Case IL, Placenta 
Previa.) 
Case V. Left Shoulder Presentation.-JEt. 30; third con- 
finement. Patient brought in by ambulance, in labor, child's 
elbow being in the vagina, os fully dilated. Hand drawn 
down to determine position ; found to be the left hand, with 
head on right side. A hot douche of bichloride solution was 
given (1 :5,000), chloroform administered, hand returned 
into uterus, head pushed up by external manipulation, right 
leg seized and brought down, and head extracted by the 
Smellie-Veit method. The left arm became extended, and 
in sweeping it over the face the humerus was fractured. The 
child was living. Weight, seven pounds four ounces. Mother 
made a good recovery. 
Case VI. Twins', Compound Presentation of Second 
Child.-vEt. 30 ; third confinement. First child presented 
by the breech and was born without difficulty ; weight, five 
pounds four ounces; living. Membranes of second child* 
were ruptured, and head and foot presented. Bipolar ver- 
sion was performed, the head being pushed up and the foot 
brought down. A living male child, weighing nine pounds 
four ounces, was delivered, the after-coming head being ex- 
tracted by the Smellie-Veit method. Mother made a good 
recovery. 
Case VII. Right Shoulder LUesentation.-yEt. 28; sixth 
confinement. Membranes ruptured spontaneously. Child 
was in a dorso-anterior position, head being on left side of 
pelvis, right elbow at os uteri. Patient was put under chlo- 
roform, hand introduced into the vagina with three fingers 
passed through the cervix, and a bimanual version easily per- 
formed, the left leg being brought down. The breech was 
expelled by natural efforts. Arms became extended, but 
were drawn down without difficulty, and the after-coming 
head delivered by forceps. The child was living (a female) ; 
weight, six pounds six ounces. A hot intra-uterine and 
vaginal douche was given of bichloride (1 : 10,000). Mother 
recovered easily. 
Case VIII. Rupture of Uterus.-(Vide Case I. under that 
head.) 
Case IX. Twins ; Right Shoulder Presentation of Second McLANE : THE SLOANE MATERNITY HOSPITAL. 
13 
Child.-yEt. 24; primipara. First child presented in the 
first cranial position, and was born after labor of eighteen 
hours' duration. It wras living, and weighed five pounds two 
ounces. Uterine action then ceased. By palpation the pre- 
sence of another child in utero was discovered, but no fetal 
movements could be detected and no heart sounds heard. 
The membranes were ruptured, and the right shoulder wTas 
found presenting at the dilated os uteri. A bimanual version 
was performed and the left foot brought down. Head was 
extracted by the Smellie-Veit method. The child was still- 
born (a female), weighing four pounds four ounces. Mother 
did well. 
Case X. Shoulder Presentation; Cephalic Version.-Hit. 
27 ; fourth confinement. Patient entered hospital in labor. 
Child was in a transverse position, dorso-anterior, head to 
the left side, and right shoulder presenting. The membranes 
being unruptured, a cephalic version was performed under 
chloroform by combined external and internal manipula- 
tions, and the presentation converted into a vertex L. O. A., 
pads and a binder being employed to keep the child in this 
position, and the labor proceeded regularly, though slowly, 
until the birth of a living female child weighing four pounds 
fifteen ounces. The mother did well. 
Case XI. Placenta Previa Centralis; Version.-(Vide 
Case III., Placenta Previa.) 
Case XII. Placenta Previa.-(Vide Case IV. under that 
head.) 
Case XIII. Shoulder Presentation; Dead Fetus.-vEt. 30 ; 
fifth confinement. Patient came into the hospital in labor, 
the membranes having ruptured, and the child presenting by 
the shoulder, the elbow being at the os uteri. The uterine 
tumor was fiaccid, and the child's form could not be made 
out by palpation. No fetal movements or heart sounds could 
be detected. Patient had not " felt life " for three weeks. 
An attempt at version by the Hicks method was made, 
but, ow'ing to the contraction of the cervix and to the death 
of the child, leading to the loss of resiliency, it was unsuc- 
cessful. Hot vaginal douches were given to relax the cervix, 
and the patient allowed to rest for three hours. A second 
attempt was then made, and a macerated child, weighing 14 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
two pounds twelve ounces, extracted. A hot intra-uterine 
and vaginal douche of bichloride solution (1:10,000) was then 
given. The mother did well. 
Case XIV. Shoulder Presentation; Dorso-Posterior.- 
JEt. 39; fourth confinement. Patient brought in by am- 
bulance, in labor, having been attended at home by a midwife. 
Pains strong and recurring every five minutes. Membranes 
had ruptured. As the os was imperfectly dilated, fifteen 
grains of chloral hydrate were given. In three hours os was 
well dilated. Position of child was dorso-posterior, with 
right shoulder presenting. No fetal heart sounds heard. 
Patient was now put under chloroform to the surgical degree, 
the left hand introduced into the uterus, the left foot seized 
and drawn down, and body delivered without difficulty, the 
head being extracted by the Smellie-Veit method. The child, 
a male, weighing eight pounds one ounce, had been dead for 
some time. Uterus and vagina washed out with hot bichlo- 
ride solution. Patient convalesced without interruption and 
left hospital on tenth day. 
Out of one thousand births, labor was terminated by for- 
ceps in eighty-three, or one in about twelve, or 8.3 per cent. 
Their frequent use has saved much maternal suffering, not 
to say many lives, and greatly reduced the infant mortality. 
Out of the eighty-three cases, none of the mothers died ; of 
the eighty-four children, seventy-five were living, nine still- 
born, including premature twins. 
FORCEPS CASES. 
Males living... i... 50 
Females living 25 
75 
Males dead 5 
Females dead 2 
7 
Premature twins 2 2 
84 84 
In nearly all the cases the long curved forceps (Dr. Mc- 
Lane's pattern) were used, both in high and low operations. 
The blades of this instrument are solid instead of being 
fenestrated, which renders them more easy of introduction 
and less liable to mark the child. Experience proves that 
they do not slip more than the fenestrated variety. In two 
cases the axis-traction forceps of Tarnier were used. 
A tabular statement of all the forceps cases is appended : McLANE I THE SLOANE MATERNITY HOSPITAL. 
15 
TABULAR STATEMENT OF FORCEPS CASES. 
1 No. of Case. 
•oav 
| Para. 
Cause of interference. 
Duration 2d 
stage in hrs 
& minutes 
Position in pel- 
vis reached by 
head. 
Children. 
Mothers. 
Liv- 
ing. 
M. F. 
Dead. 
M. F. 
Recov'd. 
-z 
2 
1 
21 
1 
Inertia in second stage. . 
2 
50 
Low in cavity 
1 
1 
1 
35 
1 
Inertia in second stage.. 
3 
35 
Low in cavitv 
1 
1 
8 
20 
1 
Inertia in second stage.. 
3 
05 
At brim 
1 
1 
4 
22 
1 
Inertia in second stage 
11 
30 
Low in cavity 
i 
1 
5 
38 
1 
Powerless labor 
11 
25 
In cavity 
i 
1 
6 
27 
1 
Powerless labor 
7 
1!) 
In cavity... .. 
1 
1 
7 
28 
2 
Ext's'n of head at outlet. 
45 
Low in cavity 
i 
1 
8 
26 
2 
Inertia in second stage.. 
7 
14 
Low in cavity 
i 
1 
9 
25 
1 
Inertia in second stage.. 
4 
38 
Low in cavity 
i 
1 
10 
25 
1 
Contracted pelvis 
5 
35 
Low in cavity 
i 
1 
11 
18 
1 
Inertia in second stage.. 
4 
30 
Low in cavity 
i 
1 
12 
24 
1 
Inertia in second stage.. 
4 
15 
Low in cavity 
i 
1 
13 
29 
2 
Inertia in second stage.. 
4 
50 
Low in cavity 
1 
1 
14 
29 
2 
Placenta previa 
At brim .. .. 
i 
1 
15 
26 
1 
Inertia in second stage.. 
2 
45 
Low in cavity 
1 
1 
16 
24 
1 
Inertia in second stage.. 
4 
40 
Low in cavity 
1 
1 
17 
28 
1 
Inertia in second stage.. 
4 
Low in cavity 
1 
1 
18 
25 
1 
Inertia in second stage.. 
5 
19 
Low in cavity 
i 
.. 
1 
19 
25 
1 
Powerless labor 
3 
35 
At brim 
.. 
1 
1 
20 
29 
1 
Eclampsia 
55 
At brim.. .. 
i 
1 
21 
26 
1 
Inertia in second stage. 
4 
32 
Low in cavity 
1 
1 
22 
19 
1 
Inertia in second stage . 
2 
Low in cavity 
i 
1 
23 
29 
1 
Inertia in second stage.. 
4 
Low in cavity 
i 
1 
24 
28 
3 
Contracted pelvis 
4 
35 
Low in cavity 
1 
1 
25 
20 
1 
Inertia in second stage.. 
1 
15 
Low in cavity 
i 
1 
26 
17 
1 
Protracted labor 
50 
Low in cavity 
1 
1 
27 
35 
5 
Inertia in second stage.. 
1 
30 
Low in cavity 
1 
1 
28 
24 
1 
Powerless labor 
1 
25 
At brim 
1 
1 
29 
22 
1 
Inertia in second stage.. 
2 
45 
In cavity... . 
1 
1 
30 
26 
1 
Threatened eclampsia... 
45 
At brim 
1 
1 
31 
24 
1 
Inertia in second stage.. 
2 
Low in cavity 
1 
1 
32 
25 
1 
Inertia in second stage.. 
12 
Low in cavity 
i 
1 
33 
24 
1 
Inertia in second stage.. 
2 
35 
Low in cavity 
i 
1 
34 
29 
1 
Inertia in second stage.. 
3 
45 
Low in cavity 
i 
. - 
1 
35 
33 
1 
Pelvis encroached upon 
by tumor 
5 
20 
Low in cavity 
1 
1 
36 
24 
1 
Inertia in second stage.. 
2 
05 
Low in cavity 
i 
1 
37 
20 
2 
Protracted labor 
35 
Low in cavity 
1 
1 
38 
28 
1 
Threatened eclampsia... 
20 
At brim 
i 
1 
39 
28 
1 
Protracted labor 
2 
45 
In cavity 
i 
1 
40 
20 
1 
Protracted labor 
At brim 
1 
1 
41 
19 
1 
Inertia in second stage . 
3 
50 
In cavity.... 
i 
1 
42 
20 
1 
Inertia in second stage.. 
4 
25 
In cavity 
i 
i 
1 
43 
27 
1 
Inertia in second stage.. 
8 
20 
Low in cavity 
1 
44 
37 
3 
Inertia in second stage.. 
2 
25 
In cavity 
i 
1 
45 
20 
1 
Protracted labor 
At brim.. 
i 
1 
46 
31 
5 
Prolapse of funis 
15 
In cavity 
1 
1 
47 
21 
1 
Inertia in second stage.. 
4 
15 
In cavity.... 
i 
1 
48 
23 
1 
Inertia in second stage.. 
5 
45 
In cavity.... 
i 
1 
49 
23 
1 
Protracted labor 
30 
At brim. ... 
i 
1 
50 
33 
1 
Powerless labor 
2 
10 
In cavity. ... 
i 
1 
51 
25 
1 
Powerless labor 
2 
20 
In cavity .... 
i 
1 
52 
21 
1 
Eclampsia 
• • 
10 
At brim. ... 
1 
• • 
1 16 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
I No. of Case' 
। Age. 
Para. 
Cause of interference. 
Duration 2d 
stage in hrs 
& minutes. 
Position in pel 
vis reached by 
head. 
Children. 
Mothers. 
Liv. 
ing. 
Dead 
Recov'd 
I Died. 
M. 
F 
M. 
F 
53 
19 
1 
Powerless labor 
4'40 
Low in cavity. 
1 
1 
54 
32 
1 
Powerless labor 
1 
Low in cavity. 
1 
1 
55 
18 
] 
Inertia in second stage 
1 20 
Low iir cavity 
1 
1 
56 
20 
1 
Inertia in second, stage 
In cavity.... 
1 
1 
57 
21 
1 
Inertia, in second stage 
2 
40 
In cavity.. . . 
1 
1 
58 
35 
4 
Inertia in second stace 
21 
In cavity.. .. 
1 
1 
59 
22 
1 
Contractor] pelvis 
20 
At brim 
1 
1 
60 
25 
1 
Powerless labor 
8 
10 
In cavity 
1 
1 
1 
1 
61 
42 
3 
Eclampsia 
55 
In cavity 
1 
1 
62 
32 
1 
Inertia, in second stace 
3 
18 
In cavity 
1 
1 
63 
20 
1 
Inertia, in second sta^e 
1 
40 
In cavity 
1 
1 
64 
22 
2 
Inertia in second stao-e 
40 
In cavity.. . 
1 
.. 
1 
65 
16 
1 
Inertia in second stage.. 
3 
Low in cavity. 
1 
1 
66 
26 
1 
Inertia in second stage 
4 
Low in cavity 
1 
1 
67 
25 
1 
Inertia in second stage.. 
4 
15 
Low in cavity. 
1 
1 
68 
23 
1 
Powerless labor 
2 
34 
Low in cavity. 
1 
1 
69 
28 
1 
Powerless labor 
2 
40 
In cavity..... 
1 
1 
70 
22 
1 
Protracted labor 
2 
17 
At brim 
1 
1 
71 
23 
1 
Protracted labor. 
4 
40 
Low in cavity. 
1 
1 
72 
24 
1 
Inertia in second stage.. 
2 
19 
Low in cavity. 
1 
1 
73 
27 
1 
Inertia in second stage.. 
18 
Low in cavity. 
1 
1 
74 
30 
7 
Contracted pelvis... 
45 
At brim.... 
1 
1 
75 
37 
2 
Powerless labor 
4 
20 
At brim 
1 
1 
76 
24 
1 
Protracted labor 
10 
At brim 
1 
1 
77 
35 
o 
Powerless labor 
5 
15 
In cavity 
.1 
1 
78 
26 
1 
Protracted labor 
25 
In cavity.. . . 
1 
1 
79 
23 
2 
Inertia in second stage.. 
2 
25 
Low in cavity. 
1 
1 
80 
25 
1 
Inertia in second stage.. 
3 
02 
Low in cavity. 
1 
1 
81 
26 
1 
After coming head.... 
30 
Low in cavity. 
1 
1 
82 
32 
2 
Inertia in second stage.. 
1 
50 
Low in cavity. 
1 
1 
83 
31 
2 
Inertia in second stage.. 
1 
16 
Low in cavity 
1 
1 
TABULAR STATEMENT OF FORCEPS CASES. 
CRANIOTOMY. 
The number of cases in which the fetal head was perfo- 
rated was three, or one in three hundred and thirty-three, or 
0.3 per cent. The causes which led to the operation were in 
two cases impacted brow presentation, in one contracted pel- 
vis. In all the cases the children were dead prior to the ope- 
ration. None of the mothers died. 
Case I. Brow Presentation ; Impaction ' Cephalotripsy. 
-2Et. 37 ; ninth confinement. Patient's second labor was 
difficult, owing to hydrocephalic child ; the other seven were 
easy and normal. Brought in by ambulance, having been in 
labor five days under the care of a midwife. Labor began 
with rupture of membranes. On the second day she was 
1 Twin presentation. McLANE t THE SLOANE MATERNITY HOSPITAL. 
17 
able to get up and attend to her household duties ; during 
next two nights pains were'very severe, since which time 
they have gradually diminished. No fetal movements have 
been felt for four days. Patient's condition on admission 
exceedingly bad. Uterus retracted, and tightly contracted 
about body of child ; cervix hyperemic and edematous. 
Highly offensive discharge from uterus. Child presented by 
the brow, which was impacted ; large fontanelle collapsed ; 
child dead. Soon after admission patient had severe chill; 
rectal temperature 107°; pulse very rapid and weak. Chlo- 
roform was given, the head perforated and afterward crushed 
with Scanzoni's cephalotribe and extracted. The child was 
a female of large size. The uterus and vagina were thor- 
oughly washed out with a hot bichloride solution, and a full 
dose of opium administered. On the following morning 
the temperature was 95°, and the mother made a rapid re- 
covery without the development of any symptoms. The 
rapid fall of temperature from 107° to 95° in twelve hours, 
with no subsequent rise, and the entire disappearance of 
septic symptoms after the intra-uterine irrigation, are worthy 
of note. 
Case II. Brow Presentation ; Contracted Pelvis.-yEt. 
23 ; primipara. Patient brought in by ambulance, having 
been in labor thirty-two hours. Her physician had per- 
formed a version for the correction of a transverse presenta- 
tion, with the result of substituting for it a brow, which was 
found tightly impacted in the pelvis. Membranes ruptured 
spontaneously the day before labor set in. Uterus was re- 
tracted, and closely contracted about the body of the child. 
The following measurements were made of her pelvis : Ex- 
ternal conjugate, six and one-quarter inches; distance be- 
tween spines nine and three-eighth inches, between crests ten 
and one-half inches ; internal conjugate, two and three-quar- 
ter inches. Patient was anesthetized and head perforated 
through the right orbit. Lusk's cephalotribe was then ap- 
plied and considerable traction made, aided by external pres- 
sure over uterus. When the head had been brought low in 
pelvis, cephalotribe was removed and another perforation 
was made through the left frontal bone. The cranioclast was 
then used for the final delivery of the head; shoulders were 18 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
extracted with blunt hook. Slight hemorrhage followed. 
The vagina and uterus were thoroughly washed out with hot 
bichloride solution (1 : 10,000). The mother made a good 
recovery. 
Case III. Contracted Pelvis.-yEt. 22 ; primipara. Pelvis 
normal in shape, but the internal conjugate diameter was 
fully one inch shortened. Child presented by the vertex ; 
position L. O. A. Pains occurred at intervals of fifteen 
minutes, their strength being variable. After eight hours of 
lab^r the funis came down into the pouch of membranes in 
front of head. Patient placed in knee-chest position and 
cord pushed up into the uterus. Pains continued strong for 
several hours, then grew weaker. There was no descent of 
the head. Symptoms of exhaustion developed. No fetal 
heart sounds could be heard. Patient anesthetized and head 
perforated. Scanzoni's cephalotribe was then applied and 
the head delivered. Considerable hemorrhage followed. 
Uterus was flabby and filled with clots. Hand introduced, 
clots removed, and intra uterine douche of hot bichloride 
solution (1 : 10,000) given, which at once stopped the bleed- 
ing. Mother made a good recovery. 
Labor was induced twelve times. The indications for the 
operation were as follows : Albuminuria in four cases ; eclamp- 
sia in one case; contracted pelvis in three cases; chorea in 
one case; placenta previa in one case; death of fetus in one 
case ; accidental hemorrhage in one case. All the mothers 
recovered. Seven children were born alive ; five were still- 
born, not one of these being viable. Details of these inte- 
resting cases are given below : 
Cask I. Chorea.-2Et. 17, not married ; six months ad- 
vanced in her first pregnancy. Patient enjoyed good health 
until she was eight years old, when she had an attack of acute 
rheumatism lasting a month. Three years after she became 
fretful and at times excited, with twitching in her arms and 
legs, and since that time she has been choreic. Menstrua- 
tion began two years ago, and occurred regularly until she 
became pregnant. The chorea was greatly intensified by her 
pregnancy ; twitchings became almost constant. She slept 
INDUCTION OF PREMATURE LABOR. McLANE : THE SLOANE MATERNITY HOSPITAL. 
19 
poorly and grew very much emaciated, and finally was com- 
pelled to remain in bed. On admission patient was anemic 
and poorly nourished, and suffering from continual jactitation 
of all the muscles of the body. Pulse rapid, co-ordination 
impaired, deglutition difficult. Heart normal in size, first 
sound prolonged ; no murmur detected. Breasts large and 
flabby. Fetal movements distinct, and heart beating 150 per 
minute. After consultation with Prof. T. Gaillard Thomas 
it was decided to terminate her pregnancy. The vagina was 
washed out with a solution of bichloride (1 : 5,000), and a 
bougie passed into the uterus seven inches. Labor came on 
within twenty-four hours, and patient gave birth to a small 
fetus, the placenta and membranes coming away intact. Hot 
vaginal douche was repeated after delivery, and her conva- 
lescence was uninterrupted. The choreic movements daily 
grew less, and had nearly ceased by the tenth day when she 
left the hospital. 
Case II. Albuminuria.-^Et. 19; primipara ; eight and 
one-half months pregnant. Patient noticed two months ago 
that her legs began to swell, and soon after she suffered from 
headache, vertigo, and visual disturbances. On admission 
there was considerable edema of the feet and legs, and the pro- 
labia were enormously distended. Urine scanty, smoky, con- 
taining sixty per cent of albumin. A dose of calomel was given 
and the bowels kept freely open each day afterward by sal 
Rochelle, and patient placed on a milk diet. The albumin 
steadily increased, until in five days the urine contained 
seventy-five per cent. 
It being deemed best to induce labor, the patient was chlo- 
roformed, a bougie introduced into the uterus and kept in 
place by a vaginal tampon. Labor pains began in half an hour. 
Chloroform was given continually until the head was born. 
Duration of labor, twelve hours. After delivery a hot vaginal 
douche of bichloride (1:10,000) was given and a full dose of 
morphine administered hypodermatically. The child was a 
male, weighing six pounds nine ounces; asphyxiated when 
born, owing to the tightness of the cord around the neck, but 
resuscitated by friction with alcohol, a hot bath, and insufflation 
of lungs by catheter. On the following day eight ounces of 
urine were passed in the morning, containing twenty-five per 20 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
cent of albumin, and in the evening forty-two ounces, contain- 
ing ten per cent. During next twenty-four Hours seventy 
ounces were passed, containing no albumin. Patient left the 
hospital on the tenth day, well. 
Case III. Albuminuria.-yEt. 25 ; primipara ; pregnant 
eight and one-half months. Urine contained forty per cent 
albumin. Microscopical examination revealed nothing of 
importance. No nervous symptoms. Put on milk diet for 
three days, but quantity of albumin steadily increased. Labor 
was induced by introducing a bougie into the uterus. Pains 
began in ten hours afterwards; chloroform was given; labor 
was without complication, and terminated in fourteen hours 
and twenty-five minutes from the introduction of the bougie. 
The child was born alive, a well-nourished female, weighing 
six pounds ten ounces. Milk diet was continued, and albu- 
min steadily decreased, on the eleventh day being only five 
•per cent. She left the hospital in a few days afterward. 
Case IV. Eclampsia', Twins', Prolapse of Funis.-yEt. 
41 ; third pregnancy; advanced seven months. Patient was 
perfectly well till four weeks ago, when she began vomit- 
ing everything she took into her stomach. Had frequent 
micturition, scanty and burning. Four days ago had aconvul- 
sion, which, from the description given, was evidently eclamp- 
tic. She had several during the day, and the physician who 
was called in made hot applications to the head, gave her 
some chloroform and some " powders." During the next two 
days she had no convulsions, but suffered from severe head- 
ache. On following day she had a return of the eclamptic 
seizures, and up to the time of admission she had had twenty- 
six convulsions, one occurring while being brought to the 
hospital in the ambulance. On admission she was in a state 
of complete stupor; face flushed, pupils strongly contracted, 
respiration labored, pulse hard, temperature 98° ; face, feet, 
and vulva edematous. She was taken at once to the delivery 
room, chloroformed, and a vaginal examination made. Cervix 
one inch long,.soft, but not at all dilated; vagina hot and dry ; 
bladder contained two drachms of smoky urine, which was 
removed by catheter and found to contain thirty per cent 
albumin. 
The os was dilated moderately by finger, and membranes 21 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
ruptured, patient being still kept under chloroform. Con- 
siderable liquor amnii escaped ; rectal enema then given, fol- 
lowed by a small movement of the bowels. A Barnes' dilator 
was then introduced. Labor pains began in three hours, bag 
expelled, and funis was found prolapsed. It was replaced, 
but came down again with the next pain, and, as it was pul- 
sating well, it was left in vagina. As soon as cervix was fully 
dilated, forceps were applied and a child delivered weighing 
one pound seven ounces. The circulation was good, but re- 
spiration could not be established. On examination another 
child was found presenting by the breech. Membranes were 
ruptured and a foot brought down, and child extracted easily, 
weighing one pound nine ounces. Heart action fairly good, 
but no attempt at respiration Placenta expressed by Crede 
method; no hemorrhage. Hot intra-uterine and vaginal 
douche (1 : 10,000) given. The chloroform was supplemented 
by acetate of morphine, with spiritus Mindereri and digitalis, 
every four hours; milk diet. Patient's tongue was very 
much swollen and bitten badly. On following morning 
stupor continued ; eight ounces urine drawn by catheter ; fifty 
percent albumin ; high colored; specific gravity 1.016. Patient 
cannot see. Stupor alternating with delirium during the day. 
Next day much better; forty-eight ounces urine passed in 
twenty-four hours ; temperature 100° ; able to see and speak. 
Seventy-six ounces urine were passed on the following day, 
with only a trace of albumin ; general condition good. On 
thirteenth day she left the hospital. This case illustrates the 
immediate effect of rupturing the membranes in putting a 
stop to the convulsions. 
Case V. Ante-partum Hemorrhage.-JEt. 36; Xpara; 
washerwoman, eight and a half months pregnant. Previous 
labors normal. Patient stated that while carrying one of her 
children she slipped and fell to the floor; she remained un- 
conscious for some time, and on being put to bed it was dis- 
covered that she was bleeding; also had severe pain in the 
abdomen, but absence of all true labor pains. While being 
brought to the hospital by ambulance hemorrhage was still 
going on. Face and mucous membranes very anemic ; pulse 
138 andfeeble; os admitted finger; whiskey given every fifteen 
minutes, and pulse came down to 120. Patient could not lie 22 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
on her back, as it caused severe pain in the abdomen. Mem- 
branes were ruptured, binder applied, and liquor amnii evacu- 
ated. Bleeding now entirely ceased. Labor came on in six 
hours, and a still-born child was delivered at the end of ten 
hours. Several large clots came away after birth of child. 
Placenta was expressed. No chloroform was given ; pulse 
after delivery 132 ; no further hemorrhage. Patient left the 
hospital on sixteenth day. This plan of treatment in cases of 
hemorrhage occurring late in pregnancy, with a normally im- 
planted placenta, has uniformly stopped the bleeding. It 
allows the uterine walls to contract, and provokes labor. 
Case VI. Death of Fetus ; Albuminuria.-yEt. 43; sixth 
pregnancy, advanced eight and a half months. Patient fell 
down-stairs ten days ago, since which time she has not felt 
any life in her child. On examination upon admission, no 
fetal movements could be distinguished, no heart sounds. 
Urine contained forty per cent albumin. 
Labor was induced by the bougie passed up on the right 
side of the uterus. Pains began in four hours, membranes 
ruptured spontaneously high up, and in eleven hours she gave 
birth to a still-born child which had evidently died at the 
time of her fall. The albuminuria rapidly disappeared, and 
in forty-eight hours the urine contained only about one per 
cent. Patient discharged on tenth day. 
Case VII. Contracted Pelvis.-JEt. 26 ; native of Austria; 
primipara; pregnancy advanced eight months. When three 
years old patient had a fall, and has since had scoliosis. She 
is of short stature. Pelvic measurements as follows: Dis- 
tance between anterior superior spines, ten and a half inches ; 
distance between crests, eleven inches ; external conjugate, 
six and three-quarter inches. Promontory of sacrum tilted 
to one side and projecting inward toward symphysis. 
Labor was induced by bougie. Pains began in six hours. 
At the end of twenty-one hours, os being dilated, bougie was 
removed, a hot douche given, and the membranes were rup- 
tured. Pains now increased in frequency and force, but no 
rotation of the head took place. Its position was R. O. A. 
Chloroform was now given, forceps applied, and head de- 
livered in the left oblique diameter. Child a male, weighing 
eight pounds eleven ounces. Duration of labor, twenty-six McLANE: THE SLOANE MATERNITY HOSPITAL. 
23 
hours fifty-seven minutes. Mother and child did well and 
left the hospital in sixteen days. 
Case VIII.-Same patient; second pregnancy, advanced a 
little over eight months. Labor was induced by same method. 
Pains began one hour after the introduction of the bougie, 
and in five hours, the os being well dilated, bougie was re- 
moved and the membranes were ruptured. Pains were 
strong and frequent, but the head made little advance, the 
occiput being directed posteriorly, the head in position R. O. 
P. Chloroform was given, forceps applied, and the head 
delivered with the occiput posterior. The child a female, 
weighing seven pounds. Length of labor, five and a half 
hours. Patient left the hospital on tenth day with her 
child. 
Case IX. Albuminuria.-TEt. 20; first pregnancy, ad- 
vanced seven and a half months. Patient had been under 
treatment for albuminuria before coming to hospital. On 
admission she was suffering from no well-marked nervous 
symptoms, but her feet and legs were swollen, and the edema 
of the vulva was so great that she was unable to walk. Urine 
scanty, forty-three per cent albumin, no casts. It was neces- 
sary to puncture the labia in order to make a vaginal exami- 
nation. The cervix was soft and dilatable. Labor was induced 
by dilating the cervix and rupturing the membranes. Pains 
began soon afterward, and labor progressed regularly until 
terminated in five and a half hours by the birth of a living 
male child, well nourished, weighing four pounds ten ounces. 
Hot douche of bichloride (1: 5,000) given. On following day 
edema of vulva had nearly disappeared, and albumin in urine 
steadily decreased. She left the hospital on tenth day. 
Case X. Bright's Disease.-yEt. 25; first pregnancy, ad- 
vanced seven months. Patient had suffered for three months 
from pain in back. Three weeks ago noticed that her urine 
was very scanty and dark colored. The pain in the back be- 
came more severe and her legs began to swell. Was under 
treatment for a week before entering the hospital. On ad- 
mission, headache, visual disturbances, vomiting; urine, 
specific gravity 1.035, ninety per cent albumin, scanty, and 
loaded with granular, hyaline, epithelial, and fatty casts. Put 
on milk diet. Infusion of digitalis and citrate of potassa. 24 
McLANE I THE SLOANE MATERNITY HOSPITAL. 
At the end of five days, there being no decrease in the albu- 
min, labor was induced. Chloroform was given and bougie 
introduced. The instrument punctured the membranes high 
up and liquor amnii slowly drained away. Pains did not 
begin until evening of next day and were very feeble. On 
following day they became stronger; cervix now dilated 
rapidly, the expulsive stage lasting only eight minutes. 
Child still-born, weighing two pounds ten ounces. Patient 
was greatly benefited by the emptying of the uterus; left 
the hospital in ten days, the urine still containing albumin, 
but only twenty-five per cent. 
Case XI. Contracted Pelvis.-JEt. 28; Illpara; eight 
months pregnant. Patient delivered "by instruments" of 
her first child in England five years ago ; child was " dead." 
Two years ago was confined in Bellevue Hospital and deliv- 
ered by craniotomy by Prof. Lusk. A vesico-vaginal fistula 
followed, for which she has been operated upon several times. 
Patient is of small stature, fifty-eight inches in height. Pelvis 
generally contracted, with following measurements : Distance 
between spines, nine and one-half inches; distance between 
crests, ten and one-half inches ; external conjugate, six and 
three-quarter inches. Vaginal canal greatly obstructed by 
cicatricial tissue; no vaginal cervix, the os being apparently 
an aperture in the vaginal roof. Labor induced by bougie 
introduced on right side, and, as it showed a tendency to slip, 
it was kept in place by a tampon of cotton soaked in solution 
of bichloride. Slight pains were felt at expiration of six 
hours. Tampon removed and hot vaginal douche given. 
Cervix was somewhat dilated. Tampon replaced. On fol- 
lowingday bougie and tampon were removed and membranes 
ruptured. Pains were strong and followed one another in 
quick succession. Chloroform given. Head descended in 
transverse diameter. Caput succedaneum very large. De- 
scent of head now ceased, though pains were severe. Tem- 
perature 102.6°; pulse 144. Forceps were applied and a living- 
male child delivered weighing six pounds. The moulding of 
the head was very marked. Duration of labor: First stage, 
five hours; second, four hours thirty-five minutes; third, 
fifteen minutes. Mother and child did well and left the hos- 
pital on the seventeenth day. The following year patient McLANE : THE SLOANE MATERNITY HOSPITAL. 
25 
returned pregnant for the fourth time, with placenta previa 
(under which heading her fourth labor is described). 
Case XII. Placenta Previa; Breech Presentation.-tEL 
24; primipara; eight months pregnant. Patient brought in 
by ambulance with this history: Two weeks ago had a severe 
hemorrhage, followed by two slight ones after interval of 
several days, and then by another copious one the night be- 
fore admission. On examination, the cervix admitting the 
tip of finger, the placenta was found centrally implanted. 
Os was dilated, placenta separated on one side, both feet 
grasped and brought down, and patient rapidly delivered of a 
living child. Placenta quickly followed, with a great rush 
of fresh blood and clots. There was no hemorrhage during 
delivery of child. An intra-uterine and vaginal douche of 
bichloride solution were given, and ergot hypodermatically. 
Patient made a slow convalescence and left the hospital on 
the fifteenth day. 
Nine cases occurred, or one in one hundred and eleven, 
or 0.9 per cent. Of these, five were complete, four partial. 
Two of the mothers died, or one in 4.5, or about twenty-two 
per cent. Details of these cases and two others are given 
below. In one this fatal result was due to delay in obtaining 
medical assistance, the patient having nearly bled to death 
before coming to the hospital. In both transfusion was per- 
formed. 
Four of the children were still-born, five were delivered 
alive; of the still-births, two were premature, the child not 
being viable. Version was performed in four of the cases ; 
one child was delivered by forceps. 
Case I. Contracted Pelvis.-vEt. 30; fourth confine- 
ment. (History of third confinement, vide Case XL, Induc- 
tion of Premature Labor.) Patient was confined in this hos- 
pital in her third labor, prematurely, two years ago. Now 
again pregnant six months. On examination, pelvis found 
justo-minor; previous measurements confirmed. Cervix 
very high, two bands of cicatricial tissue in the upper part 
of vagina narrowing the canal very much. General condi- 
tion good. After being in the hospital a few days,, pa- 
tient had a severe hemorrhage, without warning or pain, 
PLACENTA PREVIA. 26 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
twenty ounces of blood being lost. Vaginal tampon was in- 
serted. In two hours tampon removed, when another gush 
of blood occurred. The cervix was undilated and very high ; 
but placenta could be felt, its attachment being nearly central. 
A second tampon was introduced ; in an hour pains began, 
tampon became saturated with blood, and some blood escaped 
from vagina. Tampon again removed, and os found dilated 
to size of silver dollar, placenta being distinctly felt. Pulse 
very rapid, 160, and weak. Stimulants were given, the 
membranes ruptured, and a version performed, both feet 
being brought down ; the funis came down with feet. Not- 
withstanding pressure made over fundus to preserve flexion 
of the head, arms became extended, but were brought down 
with little difficulty, and child extracted, still-born, showing 
a development of six months. No hemorrhage during deliv- 
ery. Placenta was removed and uterus contracted well. 
After delivery patient grew very restless; pulse 160 and 
thready. Whiskey, ether, and digitalis were given hypoder- 
matically, foot of table elevated, lower extremities bandaged. 
Temperature 101°. Transfusion was performed, a saline so- 
lution being used. Pulse became temporarily better, but soon 
again flagged; the respiration became irregular, labored, and 
rapid, restlessness intense, and patient passed into an uncon- 
scious state and soon died. 
Case II. Placenta Previa ; Version; Transfusion.-yEt. 
33; ninth confinement. Patient brought by ambulance ; had 
severe hemorrhage four weeks previous, which stopped with- 
out treatment. For two weeks past has been bleeding all the 
time more or less, and during that time has also had three flood- 
ings. On admission, pulse 140 and very feeble; respiration 
shallow, rapid, and labored ; completely exsanguinated. Cer- 
vix was partially dilated, and placenta felt completely cover- 
ing the os. Tampon was applied and a rectal enema of 
brandy administered. As soon as patient rallied a hand was 
passed into the vagina, the placenta separated from the os, 
the head pushed up from the lower segment of the uterus, 
one leg brought down, and the body delivered by traction 
upon this part. Both arms were extended over the head, 
causing some delay in the further delivery. Placenta came 
away spontaneously. During the operation whiskey was McLANE : THE SLOANE MATERNITY HOSPITAL. 
27 
given hypodermatically. Uterus contracted well and there was 
no hemorrhage during delivery. Radial pulse, however, be- 
came imperceptible, though the abdominal aorta could be felt 
pulsating 178 to the minute. Ether was now given by the 
skin and a rectal enema of brandy. Pulse improved'tempo- 
rarily. Foot of table was elevated, lower limbs bandaged, 
bags of hot water placed about the body, and a saline solu- 
tion slowly injected into the right arm. In spite of all efforts 
she gradually sank into unconsciousness and died. 
Case III.- yEt. 18; primipara. Brought in by ambulance 
with vagina tamponed, having lost " a half-bucketful " of 
blood. Pulse 108 and barely perceptible ; very restless ; ex- 
tremities cold. No fetal movements could be felt, no heart 
sounds heard. Some dribbling of blood in spite of tampon. 
As soon as she rallied from shock, tampon was removed ; 
cervix was found dilated, and the placenta centrally im- 
planted over os. Vertex presentation. Position R. O. A. 
Hand was passed into the vagina, two fingers introduced into 
the uterus and swept around without reaching edges of the 
placenta. Some bleeding now occurred. The forehead was 
pushed up, and as the knee came within reach the placenta 
was bored through on the left side, the knee seized, the leg 
brought down, and the delivery completed. The child was 
still-born. A hot intra-uterine douche of bichloride solution 
(1 : 20,000) was given. The uterus was held for two hours, 
and then a full dose of morphine was administered hypoder- 
matically. Mother made a good recovery. 
Case IV.-yEt. 22; primipara. Patient gave a history of 
having had two floodings. On examination placenta could be 
made out, occupying the lower uterine segment. A Barnes' 
bag was introduced, of the smallest size, which was expelled 
in forty-five minutes ; the next larger was inserted through 
cervix, and came away in one and three-quarter hours ; the 
largest remained in position one hour and thirty-seven min- 
utes. The cervix now being sufficiently dilated, the hand 
was introduced into the vagina, a bimanual version per- 
formed, and both feet brought down. The placenta was ex- 
pelled before the child, which was still-born. The uterus 
contracted well and there was no further hemorrhage. Mo- 
ther made a good recovery. 28 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
The plan of treatment of placenta previa adopted is to 
turn as soon as one or two fingers can be passed through the 
cervix, employing the wTell-known method of Braxton Hicks 
-combined external and internal version-and bringing 
down a leg, to tampon with it the bleeding vessels. The 
membranes are ruptured at the placental margin where this 
is possible ; but where this cannot be done, the placenta is 
bored through and the leg pulled down. 
ECLAMPSIA. 
Four cases occurred, or 1 in 250. In two the convulsions 
came on before labor, in two during labor ; in one of the 
latter the fits continued after delivery. One mother died. 
The urine was albuminous in all the cases. In one (vide 
Case IV., Induction of Labor) there were twenty-six con- 
vulsions, the children-premature twins-being still-born. 
In the three other cases the children were born living. 
Case I.-zEt. 21; primipara. On admission urine was ex- 
amined and found non-albuminous. Four hours afterward 
the membranes ruptured spontaneously, and, with the occur- 
rence of the first strong uterine contraction, patient had an 
eclamptic seizure lasting five minutes. The urine passed 
after the fit contained about thirty-five per cent of albumin. 
Pulse 130, tension high. The cervix was dilated by Barnes' 
bags, the patient being kept moderately under chloroform. 
As soon as dilatation was sufficient, forceps were applied, and 
a living male child, weighing seven pounds, delivered. Con- 
valescence was uninterrupted until the seventh day, when a 
second convulsion occurred, of an epileptiform character, fol- 
lowed by unconsciousness and stertorous breathing. Pupils 
contracted, pulse rapid and of high tension. Five hours 
afterwards a third fit occurred, lasting twenty minutes. 
Chloral was administered. After this there was no return of 
the convulsions, and the mother made a good recovery. In 
this case albuminuria did not develop until after the first fit. 
Case II.-Hit. 21 ; primipara. Patient had noticed edema 
of face and hands for three weeks ; had some visual disturb- 
ances and headache. Her urine, on admission, contained 
thirty per cent of albumin, hyaline, and granular casts. The 
membranes were ruptured and labor began soon after, the McLANE : THE SLOANE MATERNITY HOSPITAL. 
29 
pains steadily increasing in frequency and force. Fifteen 
grains of chloral were given and repeated. As os dilated 
slowly and the fetal heart sounds were faint, chloroform 
was administered, the cervix was forcibly dilated, the forceps 
were applied, and a living child delivered without diffi- 
culty. Hot douche of bichloride solution (1:10,000) was then 
given and patient put on a milk diet. Ten hours after de- 
livery symptoms of eclampsia were developed, with great 
restlessness, and a convulsion occurred, followed in an hour 
by a second one. Morphine was given hypodermatically and 
patient placed in a hot pack for three and a half hours. After 
removal she sank into a muttering delirium, with muscular 
twitchings all over the body, the eyes being turned up so that 
only the whites were visible. Pulse 88; temperature 98°; 
respiration 24. During following day delirium continued, 
and towards evening she had another fit. Temperature rose 
to 101°. Urine was freely secreted, having a specific gravity 
of 1.005, with only a trace of albumin. A dose of elaterium 
was given and she was again placed for three hours in a hot 
pack. After this there was no return of the convulsions and 
no interruption to convalescence. She left the hospital on 
the sixteenth day following confinement. 
Case III.-ALt. 28; fourth confinement. Patient had 
been in the hospital nearly two months, acting in the capacity 
of a servant while awaiting confinement, and her urine ex- 
amined regularly every week; no albumin had ever been 
found. After she had been in labor fourteen hours, with 
membranes intact and fairly good pains, she suddenly had an 
epileptiform convulsion, which began with a turning-in of the 
thumbs, rolling of eyeballs, frothing at the mouth, and grind- 
ing of the teeth, with tonic and clonic spasms followed by 
coma. The membranes were at once ruptured, and a living 
child was born in about five minutes without assistance. 
Hemorrhage was slight. Ten minutes afterward a second 
convulsion occurred. Chloroform was administered and the 
placenta expressed. Eight ounces of urine were drawn off 
by catheter, containing nearly twenty-five per cent of albu- 
min ; microscopic examination revealed the presence of many 
granular casts. A quarter .of a grain of morphine was given 
hypodermatically. Patient soon had another fit. Thirty 30 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
grains of chloral were given per rectum. Convulsions oc- 
curred at intervals of about forty-five minutes, and the coma 
gradually deepened. Dry cups applied over the kidneys and 
a dose of elaterium administered. Pulse after the eleventh 
convulsion was rapid; arterial tension high ; temperature by 
rectum, 106°. The fits continued in spite of treatment, there 
being eighteen in all. Antipyrin was freely given, but the- 
reduction of temperature was only one degree. In a few 
hours the patient died. The temperature post mortem was 
108°. 
In this case the albuminuria first appeared after the con- 
vulsion. 
POST-PARTUM HEMORRHAGE. 
The total number of cases of hemorrhage after delivery 
was fourteen, or nearly one in seventy-one, or 1.4 per cent. 
All of the mothers recovered, and only one of the children 
was still-born. In all the cases ergot was given, in the form 
of fluid extract, by the mouth, and in three cases ergotin hypo- 
dermatically. In four cases, after the failure of the ordinary 
means, vinegar was applied to the interior of the uterus, with 
the invariable result of arresting the bleeding and securing 
uterine contraction. The method of using it is as follows : 
A piece of gauze or absorbent cotton is saturated with the 
vinegar, carried with the hand into the uterus, and then 
squeezed, the vinegar flowing over the sides of the cavity, 
causing the muscle to instantly contract. This is a remedy 
of the highest value. Ice was used four times by vagina, 
with not satisfactory results. The hot intra-uterine douche 
(temperature 120°) was used in every case, and usually found 
efficacious. In eleven cases the hand was passed into the ute- 
rus to remove clots, and also for its stimulating influence 
upon the uterine muscle. Squeezing and manipulation of the 
uterus was always employed, and pressure kept up through 
the abdominal wall for a long time after the cessation of the 
bleeding, in one desperate case for three hours. The quan- 
tity of blood lost varied in these cases from two to four and a 
half pounds. Special report is given of one case. 
Case I. Adherent Placenta.-yEt. 34; fourth confine- 
ment. Labor normal and easy, of three hours and twenty- 
five minutes' duration in the first stage and twenty-five McLANE I THE SLOANE MATERNITY HOSPITAL. 
31 
minutes' in the second. All went well until the child was 
born, when hemorrhage set in. Repeated efforts to express 
the placenta were ineffectual. Hand was introduced and pla- 
centa found firmly adherent, except at the lower margin. 
Patient became blanched from the loss of fifty ounces of 
blood, very restless, and extremities cold. Placenta was de- 
tached, but uterus was in an atonic condition, and was only 
kept contracted by squeezing and pressure. Hot intra-uterine 
douche given. No further hemorrhage. Foot of table was 
elevated, hot bottles applied to extremities, lower limbs ban- 
daged, and whiskey given hypodermatically. Uterus was held 
for three hours before binder was applied. The child, a 
female, was alive and weighed seven pounds twelve ounces. 
Patient made a good recovery. 
RUPTURE OF UTERUS. 
One case occurred, or one in one thousand, details of 
which are here given. 
Case I. Transverse Presentation; Impacted Shoulder; 
Ante-partum Hemorrhage; Rupture of Uterus; Death.- 
^Et. 35 ; fourth confinement. Patient was brought to the 
hospital by ambulance in a moribund condition, having been 
in labor three days and suffered from profuse hemorrhage. 
On admission was still bleeding; no radial pulse ; extremities 
cold. The shoulder was impacted, and the arm and hand 
protruded from the vulva. Hypodermatic injections of whis- 
key, digitalis, and ether were given, the shoulder pushed up, 
a foot seized, and a still-born child easily delivered. Bleed- 
ing continued in spite of every means employed to arrest it, 
and the patient died in twenty minutes after admission. Au- 
topsy revealed a rupture of the uterus, evidently due to the 
long compression between the pelvis and the shoulder before 
patient entered the hospital. There was no uterine contrac- 
tion after delivery, the womb remaining flaccid and atonic. 
There was only one case. The patient's age, 26 ; third 
confinement; a native of the East Indies. Her labor was 
normal; duration, twelve hours thirty-two minutes. Child 
alive, small, but well nourished. 
PUERPERAL MANIA. 32 
McLANE: THE SLOANE MATERNITY HOSPITAL. 
On the second day after delivery she developed symptoms 
of insanity, was restless and sleepless, insisted on going home, 
and had hallucinations and delusions. No pyrexia. It was 
ascertained from friends that she suffered in a similar way 
after the birth of her last child, and did not recover for six 
weeks. She was removed to an asylum for the insane six 
days after confinement. 
TRANSVERSE PRESENTATION; SPONTANEOUS EVOLUTION. 
Case I.-yEL 31; twelfth pregnancy. Patient began to 
menstruate when 11 years of age. Has given birth to seven 
living children, and had three miscarriages in succession. In 
three of her labors there was a "cross-birth." Brought in by 
ambulance, having been in labor four hours, during which 
time a midwife had administered a large dose of ergot, and 
the ambulance surgeon gave her ten minims of Magendie's 
solution hypodermatically. The left arm and funis were 
found presenting and the uterus in a state of tetanic contrac- 
tion about the child. Chloroform was administered, and de- 
livery took place by spontaneous evolution, the head remain- 
ing fixed in its original position, while the fetus rotated about 
the point where the neck was jammed against the pubes, the 
body being doubled up upon itself. The labor occupied in 
all four hours fifty minutes. Perineum and cervix were 
intact. Child was dead, ecchymosed, not macerated, pre- 
mature, weighing four pounds twro ounces. Hot bichloride 
douche (1:10,000) was given. Patient rapidly convalesced 
and left hospital on ninth day. 
LABOR IN A VERY YOUNG PERSON. 
Miss , set. 12 years and 10 months, had hip-joint dis- 
ease when 5 years of age, and has always been sickly; was an 
inmate of St. Luke's Hospital for three years, and had several 
operations performed. Menstruation began in her eleventh 
year, since which time she has been "regular," being unwell 
two days. Nine months ago she became pregnant by her 
brother. On admission, general condition anemic; partial 
ankylosis of both hip-joints, most marked on left side; pel- 
vis normal; labia majora very small, labia minora large ; vul- 
var orifice diminutive. The labor was natural; the child McLANE: THE SLOANE MATERNITY HOSPITAL. 
33 
presented by the vertex, in the first position. The cervix 
dilated slowly. First stage of labor occupied twenty-five 
hours thirty-five minutes ; the second, twenty-five minutes; 
the third, fifteen minutes. The child was a male, weighing 
Fig. 3.-Pregnancy with pendulous abdomen. 
seven pounds two ounces. The cord was eighteen inches 
long. Placenta weighed one pound one ounce and had under- 
gone some calcareous degeneration. After delivery the cer- 
vix was found to have a deep laceration on the left side; the 
perineum was also torn and the labia minora lacerated 34 
McLANE : THE SLOANE MATERNITY HOSPITAL. 
transversely. The perineal wound was closed by sutures. 
Patient suckled the child, and made a good recovery. Her 
infant, being unusually comely, was taken for adoption, and 
the girl soon afterward returned to school. 
LABOR WITH PENDULOUS ABDOMEN. 
Case I.-2Et. 27 ; third confinement; previous labors nor- 
mal. On admission, abdominal walls much relaxed, pelvis 
Fig. 4. 
normal, uterus hanging down in front of pubes, the fundus 
reaching to a point opposite the middle of the thigh. 
Fig. 5. 
The position of the child is shown in Figs. 3 and 4, pa- 
tient being in the erect posture. McLANE: THE SLOANE MATEBNITV HOSPITAL. 
35 
Upon the advent of labor patient was placed on her back 
and the uterus restored to its normal position. The first stage 
of labor occupied sixteen and a half hours, the second ten 
minutes, the third fifteen minutes. Child weighed nine 
pounds ten ounces. 
Fig. 5 shows the position of the uterus after the malpo- 
sition had been rectified. Mother and child did well. 
As there has occurred no case of mastitis or mammary 
abscess, it may be of interest to describe the management of 
lactation, since the freedom of patients from inflammation of 
the breasts is believed to be due to the method of treatment. 
The breast binder (Fig. 2) is used on all patients ; it holds 
the breast well up on the front of the chest, and exerts com- 
pression if there is overdistention. It is made of unbleached 
muslin and pinned from below upward. The child is allowed 
to nurse, not over twenty minutes, once in two hours during 
the day and once in three hours during the night. The nipples 
are washed with a saturated solution of boracic acid before 
nursing, and again after the removal of the child ; they are 
then rubbed with a few drops of alcohol (fifty per cent), and 
thickly covered with a powder composed of equal parts of 
bismuth subnitrate and salicylic acid, and covered with 
a piece of lint. The mouth of the infant is thoroughly 
washed with a saturated solution of boracic acid before and 
after each suckling. Fissured nipples are touched with a 
solution of silver nitrate (gr. xl. to 3 i.), and if eroded they are 
protected by the use, during nursing, of Ware's nipple shield. 
Chronic Bright's disease 1 
Rupture of the uterus 1 
Placenta previa 1 
Placenta previa with contracted pelvis 1 
Eclampsia 1 
Septicemia 1 
Total 6 
TABLE OF FATAL CASES. 
An analysis of these cases shows that in one instance death 
was due to chronic organic disease and not to labor; in an- 
other the patient was moribund when taken from the am- 
bulance ; in a third-a case of placenta previa-the fatal 36 
MoLANE : THE SLOANE MATERNITY HOSPITAL. 
termination was owing to delay in procuring medical 
assistance, the woman having nearly bled to death before 
coming to the hospital. There was one death from puerperal 
septicemia. This patient was admitted in the second stage 
of labor, in a most filthy condition, having been examined at 
her home, and, from her symptoms and temperature, was 
believed to be in a septic condition when she entered the 
hospital. 
There were six deaths among the one thousand cases-one 
in nearly one hundred and sixty-seven, or 0.6 per cent. Tak- 
ing into consideration the character of the service; the large 
number of emergency cases brought to the hospital by ambu- 
lance, many of them well advancedin labor; the bad condition 
of many on admission, owing to neglect or unskilful treatment, 
the record of mortality is very satisfactory. The result is due 
to a combination of measures looking to the safety of the pa- 
tients, each having a certain value of its own, and in the ag- 
gregate producing a very low death rate. The small size of 
the wards, their use in rotation, the scrupulous care exercised 
to guard against all sources of infection from without and 
within, the skilful nursing, the free use of antiseptics, the 
strict cleanliness enforced, and the lavish supply of fresh air, 
are, it is believed, in great degree accountable for these 
results.