1698 JUNE 16, 1962

CORRESPONDENCE

BRMISH

including hydrocortisone. The electrolyte disturbances were corrected, but he developed paralytic ileus and died on
May 9. We did not have the opportunity of verifying the diagnosis by laboratory tests, but there seems little doubt that this eczematous boy died from vaccinia contracted as a result of the vaccination of the siblings.-I am, etc., Southampton Children's Hospital, JOHN L. STRUTHERS.
Southampton, Hants.

given bendrofluazide, nor with chlorothiazide; only "6 mersalyl " injections gave her relief. She had severe nocturnal pain for nearly two weeks, and when this receded she developed an area of anaesthesia to light touch and pain, involving the palmar surfaces of the index and middle fingers, which still persists, though the carpus is no longer tender to pressure.-I am, etc., M. J. F. COURTENAY. London S.W.11.

Antepartum Haemorrhage
SIR,-Mr. I. A. Donaldson (May 12, p. 1339) received an unpleasant shock when his patient had a severe accidental haemorrhage. At the end of his letter he states that the patient was " considered antenatally normal and safe." Does he really consider a gravida 7 safe ? In addition she was also booked for home delivery. The Report on Confidential Enquiries into Maternal Deaths in England and Wales, 1955-71 shows that the highest number of deaths from this condition occurred in the group with no evidence of pre-existing toxaemia (p. 12) and were commonest among the para 6+ group. Further reference shows that gravida 5+ is one of the most vulnerable groups of pregnant women for most of the complications causing death, let alone accidental haemorrhage. At a recent meeting of the Royal College of Obstetricians and Gynaecologists (November 11, 1961, p. 1283) Sir John Peel included this group in a priority list for hospital confinement. The Cranbrook Committee in their now famous report2 stated (p. 22, para. 70) that hospital beds should be provided for " those in whom an abnormality might be anticipated (this would include mothers with four or more children. . .)."-I am, etc., C. D. ELLIS. St. Helens.
REFERENCES

Intestinal Pseudo-obstruction
SIR,-Mr. Frederick 0. Stephens (May 5, p. 1248) has described a syndrome of intestinal pseudo-obstruction in man. A similar syndrome has been observed in two strains of mice maintained in two independent laboratories in Cambridge. In the Department of Genetics seven strain A mice were affected over a period of ten weeks: one young male, one old lactating female (ten months), and five young lactating females (about three months). The mice appeared to be in a distressed condition with distended abdomens. On necropsy it was found that the rectum and, in two cases, the colon were filled with a hard mass of faeces. The stomach and small gut were distended with fluid only. The venous return from the lower gut, and also the renal veins, were grossly engorged. No perinephric fat was observable, and little body fat when compared with normal strain A mice of similar age. The faecal mass was found to be homogeneous, containing no large fragments. Close examination of the anus, rectum, and colon failed to reveal any lesion or other mechanical obstruction. There had been no change in diet or other environmental conditions (such as temperature or position of the cages in the room) of any mice in this laboratory for the six months preceding and during the lifetime of these mice or since then. The syndrome appeared only in strain A mice and never in any other strains even though they might be sharing the cage with them. However, all the affected mice were closely related. Since no environmental factor could be invoked to explain the appearance of the syndrome and since the affected mice were closely related it was considered that the anomaly might be inherited. Therefore a breeding programme, designed to expose any genetic factor involved, was undertaken. There has been no recurrence of the syndrome. However, a genetic effect cannot yet be excluded. A similar syndrome has been observed in the hospital biochemistry laboratory, where four 4-month-old females of an albino stock unrelated to strain A were affected. Treatment with laxatives and enemas was tried in one instance, but was unsuccessful. Here, also, it was not possible to explain the appearance of the syndrome in terms of an environmental variable. It is possible that the symptoms derived from an aberration of water balance and this is consistent with the observations of Mr. Stephens. If this condition in mice could be studied further it might lead to the elucidation of some of the problems of intestinal pseudoobstruction. We would therefore be grateful to learn of any comparable observations in mice or men.-We are, etc., J. A. H. TATCHELL. Department of Genetics, University of Cambridge. S. G. SPICKErr.
Department of Biochemistry, University of Cambridge. S. H. H. DAVISON.

Ministry of Health, Report on Confidential Enquiries into Maternal Deaths in England and Wales, 1955-7, 1960. Reports on Public Health and Medical Subjects, No. 103. H.M.S.O., London. Ministry of Health, Report of the Maternity Services Committee, 1959. H.M.S.O., London.

Phaeochromocytoma
SIR,-We agree with Dr. H. M. Leather and his associates (May 19, p. 1373) that phaeochromocytoma may present in many different guises. In a recent case of our own, a man aged 41, the main symptom was right temporal headache, with swelling and tenderness confined to that area. Only a mild hypertension was present (160/100). A tentative diagnosis of cranial arteritis was made. Full investigation later led to the diagnosis of phaeochromocytoma; in due course this was successfully removed.-We are, etc., Royal South Hants Hospital, R. J. McGILL. Southampton. Southampton General Hospital, J. A. H. DAVIES.
Southampton.

Carpal-tunnel Syndrome
SIR,-I was very interested to read of Dr. Grenfell Bailey's case of carpal-tunnel syndrome associated with rubella (April 28, p. 1207). Since his letter was published I have also seen a case in my practice. This was in a married woman of 37 who developed a mild polyarthritis on the fourth day of the rash and on the 12th day developed a typical carpal-tunnel syndrome in her right hand. This did not improve when