288 THE INTERNAL SECRETIONS—1920 
constriction of the same vessels, with secondary sup- 
port and prolongation by adrenal hyperactivity, which 
vasoconstriction limits the blood supply to the affected 
part and for a continued period prevents the reabsorp- 
tion of exuded serum. 
Foreign protein in the blood stream appears to be 
the exciting cause of thyroid activity and vasodilator 
irritability and near-fatigue; nervous shock, continued 
strain and fatigue appear to be the exciting causes of 
adrenal hyperactivity. The latter are absent in simple 
urticaria, hence adrenal hyperactivity is absent and 
wheal persistence is slight; in angioneurotic edema any 
or all are present, hence adrenal hyperactivity is pres- 
ent, and wheal persistence is great. In both types of 
urticaria foreign protein absorption manifestations are 
marked. 
Being of thyroid and adrenal origin, and not a dis- 
sease of the nervous system, angioneurotic edema 
should be known as Thyro-Adrenal Urticaria. 
BIBLIOGRAPHY 
1. Osler (Sir. Wm.): “The Principles and Practice of 
Medicine,” D. Appleton & Co. (New York), 1901, 
p. 1140. 
2. Ibid., p. 1141. 
3. Hare (H. A.): “Practical Therapeutics,’ Lea & Febi- 
ger (Philadelphia) , 1918, p. 166. 
4. Schalek (A.): “Diseases of the Skin,” Lea Brothers 
& Co. (Philadelphia), 1902, p. 214. 
5. Bandler (S. W.): “Medical Gynecology,” W. B. Saun- 
ders Co. (Philadelphia), 1915, p. 200. 
6. Besredka (A.): Theories of immunity and anaphy- 
laxis, Lancet (London), 1918, ii, 462. 
7. Rogers (J.): Fatigue disease as exemplified in func- 
tional disorders of the stomach and thyroid gland, 
Arch. Int. Med. (Chicago), 1919, xxiii, 498. 
8. Bandler (S. W.): “Medical Gynecology,” W. B. Saun- 
ders Co. (Philadelphia), 1915, p. 160. 
9. Besredka (A.): Theories of immunity and anaphy- 
laxis, Lancet (London), 1913, ii, 462. 
