56 165 241 - 60 130 11 109 118 73 123 134 200 100 58 Intussusception, report of a case of, in a four day old infant Lymphangioma, report of a case of Mammary hyperemia, report of a case of, due to unrecognized malignant disease Medical Statistics of the Lying-In Hospital New Born, the feeding of the Obstetrics, posture in Obstetrics, the follow-up system in Puerperium, the routine use of cathartics during the Puerperium, thrombosis of the cerebral sinuses and veins as compli- Puerperal hysteria, pregnancy toxemia, or actue poliomyelitis cating pregnancy, report of a case of Report of the work done in the Babies' Class Report of some interesting cases from the out-door department State Medical Association Journal, the functions of Fetal Infection as a Cause of Stillbirth and Sundry Obstetric Theories. Posture in Obstetrics. By J. W. Markoe, M. D. Acidosis as a Factor in the Toxemias of Pregnancy. By J. R Losee, A Source of Danger in the Elective Cesarean Section Before Labor Is the Operation of Cesarean Section Indicated in the Delivery of Breech Presentation. By Ross McPherson, M.D. - Report of the Work Done in the Babies' Class. By Emelyn Lincoln Medical Statistics of the Lying-In Hospital. By Ross McPherson, wham of the "Rulletin" will be designated by the date of actual Vol. XI. of the City of New York JANUARY, 1917. No. 1 FETAL INFECTION AS A CAUSE OF STILLBIRTH, AND SUNDRY OBSTETRIC THEORIES*. BY JOSEPH B. DE LEE, M.D., F.A.C.S., Chicago. IN a recent number of the Journal of the A. M. A., I made a preliminary report of a few cases I had had which tended to prove that the fetus in utero could sicken independently of its mother and die before birth or shortly thereafter. The Many years ago I saw in consultation a mother and child. mother had a fibroid of the uterus, and at the time !w her was passing through an afebrile uncomplicated puerperium. The child had had a temperature of 101° F. immediately after birth. This had risen to 103° F. within a few hours and at the autopsy a few days later a diagnosis of streptococcus septicemia was made. About one year later I delivered the wife of a physician. She had been perfectly well during her pregnancy up to the seventh month, when eclampsia developed. Rapid delivery was made, and when the child's head was born pure pus exuded from the nostrils. It contained a pneumococcus. The mother made an afebrile recovery. Since this time several cases have strengthened my belief in the frequent occurrence of intra-uterine infection, but only lately have I been able to confirm it. Bacteriologic methods have improved so much of recent years that this particular problem is more easily solved. CASE I. Mrs. F. H., primipara. She is the second wife of her husband. The first two pregnancies of the first wife terminated prematurely with dead fetuses. She had two living children after this. She then developed heart disease of which she ultimately died. (Septic?) There is no syphilis. The woman under consideration was well until the eighth month, when she had a slight pharyngitis, for which she stayed in bed a few days. On arising she found that fetal motion had ceased. After two weeks a mild simple anemia became evident-3,952,000 reds, 10,800 whites. Hemoglobin, *Read at a meeting of the Alumni Association of the N. Y. Lying-In Hospital, November 8, 1916. 1 60%. Wassermann negative. Urine normal. 124-80 to 128-88 throughout the pregnancy. change. Blood pressure varied from After waiting four weeks I induced labor with quinine and castor oil. The bag of waters ruptured shortly before delivery. A macerated fetus was extracted by the fingers; a post partum hemorrhage required packing. The puerperium was febrile for two days then normal. From the liver, the fetal heart and the spinal cord Dr. A. M. Moody, Bacteriologist of St. Luke's Hospital, isolated a pure culture of streptococcus viridans. CASE 2. Mrs. R. P. This woman had a spontaneous premature labor in her last pregnancy, followed by a prolonged septic puerperium. Her health up to the present time has been good. She is now pregnant seven months, has no fever, feels well, but has not felt the baby for ten days. On vaginal examination the cervix was found closed and there was no unusual appearance or odor to the vaginal discharge. Crepitation of the fetal head was determined. On the next day spontaneous delivery of a macerated fetus occurred, without there having been any internal examinations. The patient had fever very soon after delivery and developed symptoms of cerebral thrombosis, dying after an exploratory spinal puncture. The report by Dr. Moody reads: "Small numbers of organisms resembling streptococci have been observed in sections of the placenta, thymus, kidney, liver and bowel. Cultures made from the placenta, spleen and liver yield a non-hemolizing streptococcus which grows best anaerobically but after being transferred grows quite well aerobically." CASE 3. Mrs. E. T. W., primipara, aet 28; had two attacks of abdominal pain which her physician ascribed to gall-bladder disease. Labor came on three weeks before term. Patient had albuminuria and casts and was so obese that we could not feel the fetus. Heart tones could not be heard and patient averred she had not felt the child for a day. A few hours before delivery I punctured the membranes and after a slow labor a dead fetus was born. The liquor amnii contained meconium which had a stale unpleasant odor-similar to that of the fetus. The mother had no fever at any time the day before, during or after labor although the placenta was removed manually, the uterus packed and the perineum stitched with buried catgut. Professor Robert Zeit performed the autopsy on the fetus. It was very pale, macerated slightly. Numerous larger and smaller hemorrhages were found in all the organs, and a pure culture of a hemolytic pneumococcus was obtained from the liver, the heart's blood, the brain and the spinal cord. His postmortem diagnosis was septicemia hemorrhagia virulenta. The placenta was full of infarcts the "placenta albumenurique" of the French. CASE IV. Mrs. S., aet 26, III para. First two children died during delivery from unknown cause. Her pelvis is normal. This is her third labor and everything proceeded normally until near the end of the second stage when the fetal heart tones became irregular and ceased. Delivery by Dr. Cornell, was accomplished within a few minutes but the child was dead. It was pale-evidently not asphyxiated. The torn perineum was sutured. There was no fever nor any sign of infection of the mother before, during, or after delivery. From the heart's blood of the fetus, a staphylococcus was recovered, from the pericardium and pleura, the pneumococcus, and staphylococcus, and from the abdominal cavity a large bacillus, probably a contamination. |