ST. MARY'S HOSPITAL, MANCHESTER.

534 influence is very conspicuous. It may be almost said that the commenced at 2 A.M. on the 17th; at 6 A.M. they had becomefemales hand down the disease, while the males are the severe ; at 7 A.M. there was an attack of hæmorrhage, onevictims of it. Grandidier has formulated the following points or two large clots accompanying it; a few minutes later in this connexion:-1. Males in bleeder families who are the membranes were ruptured spontaneously (the os uteri themselves bleeders do not as a rule beget bleeder children being nearly fully dilated); and at 7.40 A.M. a livingby women who belong to non-bleeder families; in fact, foetus of apparently between six and seven months was the children in tbio case are usually healthy. On the other expelled naturally. The placenta not having come away hand, the children of women who are themselves bleeders in due time, expression was tried, but without success. The are quite uniformly subjects of haemophilia. 2. Males in hand was accordingly introduced, and it was then found bleeder families who are not bleeders almost never beget that the placenta was partially adherent to the posterior bleeder children by women from other families. On the wall of the uterus, just above the internal os. After detachother hand, among the children of women who belong to ing and removing the placenta, the uterus was injected bleeder families without being themselves bleeders, there are with hot carbolised water. The amount of haemorrhage almost always some who suffer from haemophilia. The during the third stage of labour was considerable. In the family history of the present patient affords an interesting evening the dyspneea and cough were very troublesome, and comment upon these statements. (In the Table the actual the patient was very restless. This condition lasted for several Christian names have been preserved, while the surnames days. During the two days following confinement 160 oz. of urine were drawn off. (The average daily quantity a few days are fictitious.) It will be seen how the females of the family before labour was 25 oz.) The anasarca now became speedily were free from the disease, while nearly all the males were On March 23rd, the patient’s general condition subjects of it. So far as the pedigree extends no female had diminished. much improved, the dyspnoea having quite disappeared haemophilia until two first cousins married. The present was patient was their eldest child. It will be seen also that and the cough being much better. The amount of albumen in several instances male bleeders who married healthy in the urine was now reduced to one-sixth; the daily quantity wives had children who were the subjects of this disease; of urine was about 68 oz., and the specific gravity about 1010. while, on the other hand, by no means all the children of The colour was light yellow; no casts were discoverable. the females of the bleeder family exhibited the phe- From this time convalescence was established very rapidly. On April 10th the last trace of albumen had disappeared nomena of haemophilia. (See pedigree.) from the urine, and on the 17th the patient was discharged well. The child only survived its birth about thirtv hours. ST. MARY’S HOSPITAL, MANCHESTER. Remarks by Dr. CULLINGWORTH.—There are several points CASE OF ALBUMINURIA DURING PREGNANCY; INDUCTION of interest in this case. 1. It affords a striking illustration OF PREMATURE LABOUR; RECOVERY. of the fact, already well known, that very pronounced albuminuria may exist during pregnancy without eclampsia. (Under the care of Dr. C. J. CULLINGWORTH.) The urine here was loaded with albumen, and the oedema, For the notes of the following case we are indebted to was intense; yet not only were there no convulsions before Dr. Archibald Donald, house-surgeon and resident assistant labour, but (what is more important) none were excited by the manipulations necessary for inducing premature labour. obstetric surgeon. E. M-, aged twenty-six, a cheerful, intelligent, well- How far we have to thank the exceptionally cheerful and nourished young woman, pregnant for the first time, was placid disposition of the patient for this immunity I cannot admitted into ttie hospital, March 5th, 1886, suffering from say. It is quite possible that the absence of anything like extensive anasarca. She had been married about ten extreme previous irritability was the one fortunate circummonths, and had last menstruated on Aug. 20th, 1885. The stance that saved the patient from convulsions. 2. It is to fundus uteri reached to an inch above the umbilicus; the be noted how completely all palliative measures failed so long foetal heart sounds and uterine souffie were both audible. as the pregnancy continued. I was particularly struck with The first symptoms of swelling were noticed in the feet six ’, the utter uselessness of pilocarpine in this case. The beneficial weeks previous to her admission. Within a few days from i results obtained from its administration in puerperal eclampsia that time the swelling had become very marked over the by Horrocksand Murphy2 naturally encouraged the hope whole body, the face, bands, trunk, and legs being all that equally satisfactory effects would follow its use in cases of the acute albuminuria of pregnancy. implicated. It was not until a few days before her admission uncomplicated that she observed the urine to be scanty and high-coloured. The case here recorded seemed to afford an excellent opporShe had not felt foetal movements, and was, in fact, not tunity for teaching how far such a hope is likely to be Three injections of a freshly-made solution, Her health before this illness realised. aware that she was pregnant. obtained for the purpose, were administered in specially had been uninterruptedly good. On admission, there was very considerable oedema of the doses of one-third of a grain at intervals of about twentywhole surface of the body; the eyelids were greatly swollen, four hours. No appreciable effect followed. The result There was seems also to show that further evidence is necessary before as well as the trunk, and all the extremities. also evidence of a considerable amount of ascites. The Dr. Horrocks’s statement as to the ecbolic action of pilourine was brownish-red in colour, acid in reaction, of carpine can be accepted. 3. The prompt recovery of the as soon as the uterus was relieved of its contents sp. gr. 1020, and became almost solid on the addition of patient nitric acid. In the sediment were found blood-corpuscles, (notwithstanding the loss of blood occasioned by the faulty tube-casts (hyaline and blood), and renal epithelium. A position and adhesion of the placenta) points to the inducC3nsultation was held, and it was decided, before adopting tion of premature labour as the proper and hopeful treatment in severe cases, where other and less radical measures means to cut short the pregnancy, to try the effect of rest in bed and medicinal treatment. Accordingly, hydragogue have been fairly tried and found useless. cathartics were administered, and hot-air baths. Sub1 See THE LANCET, June 13th, 1885, and April 3rd, 1886. sequently nitrate of pilocarpine, in doses of one-third of a 2 Ib., May 29th, 1886. was a once for three grain, injected subcutaneously day days. As this had no effect whatever, the liquid extract of LIVERPOOL HOSPITAL SUNDAY FUND.-At the jaborandi was given by the mouth, with an equally disappointing result. Indeed, of all the means that were tried, meeting of the committee of this fund held last week it was dry cupping over the loins and over the bases of the lungs, reported that the total amount for disposal was £9250, as was the only one that was followed by even temporary against £8880 last year. It was unanimously resolved te benefit. The anasarca meanwhile increased, and eedema of hold over for further consideration a grant to the Hospital the lungs set in, with great dyspnoea, and a most harassing for Women in Shaw-street, hut amongst the awards granted and constant cough. The patient was unable to lie down were the following:-Royal Infirmary, X2312 10s.; Royal night or day, and became so weak that the urine was from Southern Hospital, £1387 10s.; Northern Hospital, £1202 10s.; time to time expelled involuntarily. The skin was very The Dispensaries, X647 10s.; Infirmary for Children, £555; Stanley Hospital, £462 10s.; Eye and Ear Infirmary, £462 10s.; dry. The temperature did nrt rise much above 100°. On March 16rh (eleven days after admission), matters had Hospital for Consumption, .6277 10s.: St. Paul’s Eye and Ear become so urgent that Dr. Culling worth gave directions for Hospital, .6138 15s.: Hospital for Cancer and Skin Diseases, premature labour to be induced without further delay. .692 10s.: Netherfield Institution for Infectious Diseases, £23 2s. 6d. ; St. George’s Hospital Accordingly, at 9.30 P.M, a gum-elastic bougie was passed £92 10s.; Dental Hospital, to the extent of about six inches into the uterus. Pains for Skin Diseases, X23 2s. 6d.