aged 31, railway signalman. Family history.-Parents, one sister, wife and child, all living and healthy. Past history.-Has had no serious illness. Was medically examined on joining the Railway Company, and subsequently; nothing abnormal discovered. History of present illness.-In June, 1926, complained of " rusbes of blood to the face." July, 1926: all teeth extracted on account of pyorrhaea. September, 1926: much improved. Returned to work and remained at work, and in good health till May, 1928, when he was ill for two days, complaining of pain across the sacrum and front of the thighs, followed for several weeks by loose motions. Bloodpressure 140/90. Urine normal. June, 1928: returned to work. Remained well till summer of 1930, when he suffered from recurrent attacks of diarrhoea, flushing of the face and to a less extent of thebody, and occasional swelling of the left foot and leg. Several attacks of frequent micturition. Recently, attacks of palpitation with dyspncea. He remained at work until three months ago. His bowels may be perfectly normal for a week or more at a time, and then he has an attack of watery diarrhoea, with action of the bowels as often as every half hour, day and night. During these attacks there is often frequent painless micturition, urine being passed at least hourly. Condition on admission to St. Thomas's Hospital, September 18, 1930.-Phenomenal flushing of face, much exaggerated during emotion or during a meal. Numerous dilated venules of recent origin over the nose and cheeks. Skin of trunk is usually of a mottled mauve colour, but here, too, there is a liability to sudden changes to a 140 10
