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hot water, when I heard a voice say: “O you ducky thing! Nurse, do look at her. Isn't she a darling ?” I woke up with a start and saw three or four people looking down at me. They wore white aprons and caps and sort of stripy dresses. They were very wonderful, and I thought at the time that they were angels. I know better now. One of them (a very tall one) appeared to be showing me off to the others. I heard afterwards that she was responsible for my general welfare, and to do her justice, she looked after me very well. What must these tiresome people do but pull me from my nice warm bed, fondle me, paw me about, and actually kiss me! It makes me shudder to think of it! At last they were satisfied, and I was once more my
little cot. I had not been asleep five minutes when I was disturbed again. This time the tall one had two different ones with her. Their dresses were dark blue covered all over with little white spots, and they did look so important! I was quite a westruck. Each of them gave me a kiss, and insisted on holding me for some time. At last they left; I was glad. But, alas, my slumbers that night were destined to be very broken. Throughout the whole of the evening, from pine till 12.30, a constant stream of similar visitors were dropping in every two or three minutes. I was lifted about, squeezed, patted, kissed, till I felt extremely ill. I was called a “dear," a "sweet babsy," a "duckywucky thing," and I don't know how many more ridiculous names. Both stripy ones and dark blue ones came, but the dark blue ones were far the worst. Never shall I forget that night! However, it was over at last, and I sank into troubled slumber towards the small hours.
Next morning I felt a total wreck, and no wonder. Several people came in to see me, and would have lifted me up, but the tall one said, “No, I will not have her disturbed ; she had quite enough last night.” Now the wrath of the tall one is terrible, so I was left alone. Wasn't it nice of her ?
I don't think there's much more to talk about ; everyone was very attentive and kind (after the initial excitement had subsided), and my days were singularly uneventful. There was a certain monotony about my meals which, I must confess, began to pall after some time; I got to hate the sight of that old bottle !
Some day, perhaps, I shall visit St. Thomas's again, just to see that everything is going on all right. Do you think they will make as much fuss over me as they did this time? I doubt it.
A Case of Angio-Reurotic Oedema,
With SOME REMARKS ON THE PATHOLOGY OF THE DISEASE.
By G. D. FRANKLIN, B.A., M.B., B.C. CANTAB., CAPTAIN I.M.S.
XAMPLES of this disease are, I believe, of sufficient rarity to
warrant the publication of the following case, which came
under my observation before I left Shillong in February last. Dhani Ram was enlisted in Nepal in 1905-06. He belongs to the artizan class, and was specially enlisted with a view to his becoming one of the regimental armourers. Prior to his arrival in Shillong, he stated that he had never been ill except occasionally with fever, which was presumably malaria, from which practically all men recruited in Nepal have suffered at some time. He had the typical Gurkha build, and was of fine physique. Between March, 1906, and January, 1907, he came to hospital on fourteen occasions. On two of these occasions he was suffering from malarial fever only. The remaining times he complained of a swelling. On eleven occasions this swelling was situated on the face, and once the right hand only was affected. The neighbourhood of the right eye was affected three times ; that of the left
eye twice; both eyes once; the right side of the face three times, and the left side twice. Nothing abnormal was detected in the chest or abdomen. The urine was repeatedly examined, and both chemically and microscopically was normal. On none of the occasions could the swelling be attributed to an insect bite. Under these circumstances the disease was considered to be an example of angio-neurotic ædema. These attacks were unassociated with fever or any gastro-intestinal disturbance. I made very careful enquiries with regard to the latter, as to whether any special article of diet, or excess either of food or alcohol brought on an attack, but with a negative result. The man stated that none of his family had ever suffered from a similar disease. The swelling in all cases came on gradually, but there was no periodicity about the attacks, nor did they begin at any special time: sometimes coming on during the day, sometimes at night. There was no pain, but only a feeling of stiffness and heaviness over the part affected. On no occasion were there any purpuric symptoms. A variety of drugs were tried, but no drug seemed to affect the disease in any way. The pathology of this condition is obscure. Quincke, quoted by Osler, calls it a vasomotor neurosis, under the influence of which the permeability of the vessels is suddenly increased. Undoubtedly this is what occurs, but a vasomotor neurosis does not take us very far. The old idea of neurotic origin for so many processes, both physiological and pathological, is unsatisfactory when one considers the true origin of certain conditions, which were formerly considered to be of neurotic origin. I may refer to the enlargement of the mammary gland in pregnancy, formerly attributed to a nervous connection between the breast and the uterus, and now proved to be due to a chemical substance derived from the fætus and placenta (Starling), and to various pigmentations of the skin which occur in disease of various internal organs. It has been suggested lately also that the absorption of a toxic substance from the alimentary canal is the cause of leucoderma (Evans). From the similarity of this disease to urticaria and its frequent association with gastro-intestinal disturbance, which facts are commented on by most writers on the subject, one would expect that the disease might be attributable to the absorption of some toxic substance from the alimentary canal. In this particular instance, however, no such conclusion seems possible, although such a possibility cannot be overlooked, though undetected. Even if the absorption of a toxic substance be the determining cause of this disease it is difficult to explain satisfactorily why the swelling is so circumscribed ; as although the parts selected are as a rule those generally associated with ædematous conditions, the swellings by no means confine themselves to those situations, which, moreover, vary from time to time. In this case the swelling was unilateral in all but one instance. Finally, I would venture to suggest that the absorption of a toxic substance is a much more logical conclusion to arrive at as the cause of this disease than a vasomotor neurosis ; and that the curious selection of varying situations for its manifestations may be attributed to a temporarily lowered or altered resistance in the part attacked, but that until the determining factor in the localization of other diseases with skin manifestations of varying distribution (for example, leucoderma) be demonstrated, it is impossible to suggest any more definite reason.
Che medical and physical Society.
EEING that on the manner in which our present Club Caterers
are patronised depends the future success, or otherwise, of our
meals: it would perhaps not be out of place to point out that a really excellent dinner for 2s., surpassed nowhere at the price in the West End, and affording a welcome change to the daily routine fare of Lambeth, and other "digs,” can be obtained on the Thursday evening meetings of the above Society, and thoroughly deserves a more extensive patronage.
Tales from Osler.
I. CONSEQUENCES. The notorious Duchess of Cleveland met my good friend Evans in a farm house so constructed as to shut out the sunlight and fresh air, and the vestibule was thoroughly screened.
The average temperature for sixty-three days was about 76° F. She had—a sharp nose, hollow eyes, collapsed temples; the ears cold,
contracted, and their lobes turned out; the skin about the forehead being rough, distended, and parched ; the colour of the whole
face being brown, black, livid or lead coloured. He was-ruddy in countenance, but especially the cheeks; the white
of the eyes very bright and fatty ; the point of the nose flat;
the veins in the temples and neck distended.
him--three sardines à l'huile. The Consequence was--she shocked her mother and friends by constantly
using the word damn. And the world said: “The Governor of the State of San Francisco
showed an amazing stupidity, shared by not a few physicians who should have known better."
Books for Review. OPHTHALMIA NEONATORUM. With Especial Reference to Its Causation and
Prevention. By Sydney Stephenson, M.B., C.M., Ophthalmic Surgeon to
Queen Charlotte's Hospital, London ; etc. George Pulman and Sons, S.
This is the Middlemore Prize Essay for the present year, and is einbodied in a book of 246 pages.
In the introduction Mr. Stephenson handles clearly a large number of statistics from British and Foreign institutions. He considers that, since the introduction of Credé's method of prophylaxis, 1 percent.of ophthalmia neonatorum may be taken as a standard, which when exceeded calls for some explanation. The comparison is not always in our favour. It is also pointed out that the proportion of cases coming up for treatment to British eye hospitals is more than double that in America and other countries.
It is to be hope that the facts he brings forward about so preventable a disease may be widely known, and thereby help to bring about that legislation which was recommended by the Ophthalmological Society, over 20 years ago.
The etiology and prevention of the disease are discussed at length, and stress is laid on the latency of gonorrhæa both in the male and female. Twothirds of the cases, he points out, are of gonorrhæal origin. He suggests that