Cutaneous leishmaniasis; oriental sore.

H.K. , a 34-year old primigravidous patient, whose expected date of delivery was August 4, was admitted to Victoria Hospital, at 7.50 p.m. , on July 20, 1950, complaining of headache, blurred vision and swelling of face, hands and legs. A single prenatal examination on June 2 had shown no evidence of cedema, a blood pressure of 120/70 and normal urine. The patient had failed to keep further prenatal examination appointments. From her history, obtained on admission, she had apparently first noticed the swelling of her feet and ankles about three weeks previously. On admission, she showed generalized (edema, a blood prissure of 220/130 and a four plus albuminuria with granular and hyaline casts. She was placed on routine pre-eclamptic management, consisting of a high.protein, low caloric diet and sedation as indicated. The following day, patient spontaneouslywent into labour about 7 a.m. At 11 a.m. her cervix was 2 fingers dilated and the membranes were ruptured artificially. At 12.40 p.m. , she had a generalized convulsion and was given 7Y2 gr. of sodium amytal intravenously. At 2.15 p.m. , a second convulsion was treated similarly. Progress in labour practically stopped in the late afternoon and at 8.40 p.m. the cervix was still only 2 fingers dilated and thick. Under continuous spinal anaesthesia the patient was delivered by an extraperitoneal Caesarean section of a normal living baby weighing 6 lb. 8 oz. At 9.55 p.m. patient had a clonic convulsion lasting 5 minutes and was given 711⁄22 gr. of sodium amytal and also 20 c.c. of 10% magnesium sulphate intravenously. During the twenty-four hours following her delivery she was kept convulsion-free by the use of magnesium sulphate in divided doses to a total dosage of 14 gm. , and sodium amytal and luminal as indicated. There was no marked change in her condition during this period. However, about twenty-four hours after her delivery she began to deteriorate rapidly, becoming restless and irrational with an occasional minor convulsion. By 3.45 a.m., on July 23, approximately thirty hours after her delivery, it was felt that she was in extremis as evidenced by a falling blood pressure, a sharp rise in temperature to 1050 F. by axilla, a pulse rate of 160 per minute and Cheyne-Stokes respiration. The use of cortisone in treatment of eclampsia and severe pre-eclampeia has been under consideration by our group for several months, and it was felt this patient was a suitable case for clinical trial, particularly since she had failed to respond to our usual methods of treatment. The Department of Medical Research of the University of Western Ontario was consulted at this time and cortisone therapy was instituted, 100 mgm. being given in the 1st lhour in 2 divided doses, followed by 100 mgm. at 8 hour intervals, the total dosage for the first day being 300 mgm. Intravenous magnesium sulphate therapy was continued for a further 5 hours after the institution of cortisone administration. Following the initial cortisone injection, patient began to show signs of improvement. Her urinary output increased, her temperature and pulse rate decreased and she began to improve generally. A further 200 mgm. of cortisone in divided doses on July 24, and a single dose of 100 mgm. on July 25 was given. During this 2 day period she showed further clinical improvement, resuming oral feeding and returning to normal consciousness. Temperature, pulse and respirations returned to normal within 24 hours after initiation of cortisone treatment and have remained so until the time of writing. Albuminuria persists, but the casts have disappeared. Follow-up investigation of renal and hepatie function is being carried out in this case. It is worth noting that at no time within the first ten days after delivery was there any evidence of breast activity.