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ANGIONEUROTIC ŒDEMA
839 per year for single persons, 46s. for married couples, and 568. for married couples with one or more under 16. Here the advice given is to be dependants " Choose your own doctor and specialist and your own
institution " ; from which it will be gathered that the intention is to include every sort of service, whether at home, in the consulting-room, or in
hospital.
CORRESPONDENCE The oedema lasted from
few hours to 36 hours.
I
ordered SHOCK-PROOF X RAY INSTALLATIONS him peptone injections, of which he had 16. This was in To the Editor of THE LANCET May, and from this time until December he was quite free, and thought himself cured. The attacks, however, SiR,-In a leading article in the current number returned, and subsequent injections did him little good. LANCET have the two of THE stressed you most He saw me from time to time, with but little change important points in the avoidance of X ray fatalities, in his symptoms, but last spring he came again saying the factor and the (1) personal (2) notably urgent he had got great relief by taking 3 drachms of sodium need for the greater use of shock-proof apparatus. citrate. This stopped the attacks, especially if taken As the golfer aims at his swing becoming automatic, on an empty stomach. The oedema always cleared the expert radiologist and his good technical assistant, off within an hour. If not, he took a second dose, the radiographer, have the same objective. The final glance by the expert, when all is ready for his which almost immediately brought relief. It may be work, is automatic, but nevertheless of vital import- that the acid gastric attack made him think of trying I am, Sir, yours faithfully, this remedy. It would be impossible, however, for the ance. A. G. AULD. in a to be at Harley-street. W., Sept. 30th. 1933. present radiologist busy hospital every X ray examination in the wards, and it was this KETOGENIC DIET IN URINARY INFECTIONS fact among others which led some of us long ago to the found To the Editor of THE LANCET Society of Radiographers. The excellent work of members of this society have more than SIR,-I have read Drs. Fuller and Colebrook’s justified the venture. While their training naturally article in to-day’s number of THE LANCET with interest does not justify them in treading the thorny ground and admiration. One point, the use of fresh lemons of diagnosis, they are expert in the technical side for drinks, which they recommend, I should like to of the work, and the relationship between them and mention. If these are used extensively they increase the radiologist is a very happy one. the alkaline excretion in the urine to such an extent ,As you say, the ideal to be aimed at is the more as to make even a urine with a heavy ketone excretion general use of shock-proof apparatus. British manu- definitely alkaline. I was once puzzled by finding facturers have been engaged for some time in investia strongly alkaline urine (pH 8-2) in a severe diabetic the of possibilities gating making shock-proof (dare with a heavy ketone excretion. This was proved to I say "fool-proof " 1) apparatus. To-day this is be directly due to fresh lemon drinks. In cases of obtainable, and it is quite possible to make existing infections treated by ketogenic diets, not only apparatus similarly safe. No wearing of rubber urinary ketonuria but also a strongly acid urine seem desirable, shoes or other things of the kind can obviate the result so that a warning as regards unlimited lemon drinks of contact with the high tension side of the apparatus. is not out of place.--I am, Sir, yours faithfully, Indeed, were I to have to choose, I should prefer to R. D. LAWRENCE. come in contact with high tension leads without Harley-street, W.1, Sept. 30th, 1933. in the one I case might have wearing rubber soles ; THE INDIAN MEDICAL SERVICE a sporting chance, in the other certainly none. At the forthcoming annual meeting of the British To the Editor of THE LANCET Institute of Radiology, in December next, I understand SiR,—In the Students’ Number of THE LANCET, that there is to be a special feature in the exhibition dated August 26th, there appears a "Memorandum of shock-proof apparatus by British manufacturers. appointments to and conditions of Service It is clear that to-day anyone who is thinking of regarding in His Majesty’s Indian Medical Service," issued by installing portable apparatus will be wise if he decides the Military Department of the Secretary of State for upon having it shock-proof. India. This shows that recruitment for a Service It is perfectly true that fatalities such as the recent hitherto famed for work in the tropics, and for entry one are of extreme rarity, but the potential danger into which keenness in competition was for many is always there, and it would be foolish to shut one’s years more pronounced than in the Naval and Royal eyes to this fact.-I am, Sir, yours faithfully, Army Medical Corps Services, is now conducted under STANLEY MELVILLE. London, W., Oct. 2nd, 1933. the auspices of a selection committee. Pour cncourager les autres, it has been affirmed that a highly placed ANGIONEUROTIC ŒDEMA medical official has expressed satisfaction with the " To the Editor of THE LANCET material " forthcoming. It is, however, probable SIR,-Dr. Lennon’s paper in your last issue induces that a more judicious view of conditions has been me to mention a case I had about ten years ago. pronounced by Mr. Butler (Under Secretary for India), as reported in THE LANCET of July 22nd, The patient was a retired medical man, aged 62, and had suffered from angioneurotic oedema since 1916. There page 214, who "said that there had been lately a was no family history of allergy. definite improvement in the recruiting of Government He had first swellings of the lips, cheeks, tongue, and uvula. He was vaccinated medical officers so far as numbers were concerned, with Staphylococcus albus and aureus, and with streptoand on the whole the quality of the candidates had cocci, but this did no good. He sometimes developed a also improved." In the Act of 1924, which amended carbuncle on his cheek or neck, which was always followed of India Act of 1919, considerable the Government by swellings in the neighbourhood in about seven to nine days. Since the angioneurotic oedema came on he has advances towards self-government in India were had acid gastric attacks, lasting from 24 to 36 hours. made, which do not seem to have found favour with British medical men, as shown by the India Army List When he came to me he had been lately suffering from cedema of the tip of the tongue, the heel, and the instep. for April, 1933 ; here it is found that the " material " a
institution " ; from which it will be gathered that the intention is to include every sort of service, whether at home, in the consulting-room, or in
hospital.
CORRESPONDENCE The oedema lasted from
few hours to 36 hours.
I
ordered SHOCK-PROOF X RAY INSTALLATIONS him peptone injections, of which he had 16. This was in To the Editor of THE LANCET May, and from this time until December he was quite free, and thought himself cured. The attacks, however, SiR,-In a leading article in the current number returned, and subsequent injections did him little good. LANCET have the two of THE stressed you most He saw me from time to time, with but little change important points in the avoidance of X ray fatalities, in his symptoms, but last spring he came again saying the factor and the (1) personal (2) notably urgent he had got great relief by taking 3 drachms of sodium need for the greater use of shock-proof apparatus. citrate. This stopped the attacks, especially if taken As the golfer aims at his swing becoming automatic, on an empty stomach. The oedema always cleared the expert radiologist and his good technical assistant, off within an hour. If not, he took a second dose, the radiographer, have the same objective. The final glance by the expert, when all is ready for his which almost immediately brought relief. It may be work, is automatic, but nevertheless of vital import- that the acid gastric attack made him think of trying I am, Sir, yours faithfully, this remedy. It would be impossible, however, for the ance. A. G. AULD. in a to be at Harley-street. W., Sept. 30th. 1933. present radiologist busy hospital every X ray examination in the wards, and it was this KETOGENIC DIET IN URINARY INFECTIONS fact among others which led some of us long ago to the found To the Editor of THE LANCET Society of Radiographers. The excellent work of members of this society have more than SIR,-I have read Drs. Fuller and Colebrook’s justified the venture. While their training naturally article in to-day’s number of THE LANCET with interest does not justify them in treading the thorny ground and admiration. One point, the use of fresh lemons of diagnosis, they are expert in the technical side for drinks, which they recommend, I should like to of the work, and the relationship between them and mention. If these are used extensively they increase the radiologist is a very happy one. the alkaline excretion in the urine to such an extent ,As you say, the ideal to be aimed at is the more as to make even a urine with a heavy ketone excretion general use of shock-proof apparatus. British manu- definitely alkaline. I was once puzzled by finding facturers have been engaged for some time in investia strongly alkaline urine (pH 8-2) in a severe diabetic the of possibilities gating making shock-proof (dare with a heavy ketone excretion. This was proved to I say "fool-proof " 1) apparatus. To-day this is be directly due to fresh lemon drinks. In cases of obtainable, and it is quite possible to make existing infections treated by ketogenic diets, not only apparatus similarly safe. No wearing of rubber urinary ketonuria but also a strongly acid urine seem desirable, shoes or other things of the kind can obviate the result so that a warning as regards unlimited lemon drinks of contact with the high tension side of the apparatus. is not out of place.--I am, Sir, yours faithfully, Indeed, were I to have to choose, I should prefer to R. D. LAWRENCE. come in contact with high tension leads without Harley-street, W.1, Sept. 30th, 1933. in the one I case might have wearing rubber soles ; THE INDIAN MEDICAL SERVICE a sporting chance, in the other certainly none. At the forthcoming annual meeting of the British To the Editor of THE LANCET Institute of Radiology, in December next, I understand SiR,—In the Students’ Number of THE LANCET, that there is to be a special feature in the exhibition dated August 26th, there appears a "Memorandum of shock-proof apparatus by British manufacturers. appointments to and conditions of Service It is clear that to-day anyone who is thinking of regarding in His Majesty’s Indian Medical Service," issued by installing portable apparatus will be wise if he decides the Military Department of the Secretary of State for upon having it shock-proof. India. This shows that recruitment for a Service It is perfectly true that fatalities such as the recent hitherto famed for work in the tropics, and for entry one are of extreme rarity, but the potential danger into which keenness in competition was for many is always there, and it would be foolish to shut one’s years more pronounced than in the Naval and Royal eyes to this fact.-I am, Sir, yours faithfully, Army Medical Corps Services, is now conducted under STANLEY MELVILLE. London, W., Oct. 2nd, 1933. the auspices of a selection committee. Pour cncourager les autres, it has been affirmed that a highly placed ANGIONEUROTIC ŒDEMA medical official has expressed satisfaction with the " To the Editor of THE LANCET material " forthcoming. It is, however, probable SIR,-Dr. Lennon’s paper in your last issue induces that a more judicious view of conditions has been me to mention a case I had about ten years ago. pronounced by Mr. Butler (Under Secretary for India), as reported in THE LANCET of July 22nd, The patient was a retired medical man, aged 62, and had suffered from angioneurotic oedema since 1916. There page 214, who "said that there had been lately a was no family history of allergy. definite improvement in the recruiting of Government He had first swellings of the lips, cheeks, tongue, and uvula. He was vaccinated medical officers so far as numbers were concerned, with Staphylococcus albus and aureus, and with streptoand on the whole the quality of the candidates had cocci, but this did no good. He sometimes developed a also improved." In the Act of 1924, which amended carbuncle on his cheek or neck, which was always followed of India Act of 1919, considerable the Government by swellings in the neighbourhood in about seven to nine days. Since the angioneurotic oedema came on he has advances towards self-government in India were had acid gastric attacks, lasting from 24 to 36 hours. made, which do not seem to have found favour with British medical men, as shown by the India Army List When he came to me he had been lately suffering from cedema of the tip of the tongue, the heel, and the instep. for April, 1933 ; here it is found that the " material " a