131 
went beyond Ngongau to visit the airstrip at Ngongau. Then we returned to the 
Dispensary at a site just before Pauta village and dropped all our supplies 
here. I elected to spend the day seeing patients with complaints. We soon saw 
three patients who had had goiters surgically removed in Honiara during the past 
decade, and five patients with the new syndrome I am now intensively pursuing of 
recurrent, painful febrile swellings that appear to be either a deep-seated 
hemorrhage, fat necrosis or myositis. These are usually multiple, they appear 
spontaneously in most of the patients, but in others appear only after 
recognizable minor trauma to the site involved. The story of trauma is missing 
in the attacks of others, and some have had spontaneous attacks in the past but 
now have episodes only secondary to minor trauma. We tracked down accounts of 
six such patients on Rennell from Wilmot, and here we have now the story of ten 
such patients, five of whom we have already seen, bled, and examined. Of these 
five, three have acute symptoms with currently raised, painful, deep-seated, 
soft tissue swellings all with the report that they will eventually be deeply 
pigmented and finally subside and fade after a course of a few days. We are 
doing hemoglobins, thin and thick blood smears, and hematocrits on all the 
patients and will do WBCs tomorrow along with X-rays. None of this will 
probably yield any leads. 
Of the five patients we have seen, two are from Rennell island, the Lake 
area, from where the Rennell cases also come. Most have had onset in their 
young adult life. One patient has a daughter who has started with the syndrome 
in her mid teens and now, at 18 and married, has had two years of such episodes. 
Two report subsidence of attacks during pregnancies. 
We have seen no cases which are ecchymotic or deeply pigmented, but those 
three with swellings are too recent. One lying at home has deeply pigmented 
lesions now, and we will see him tomorrow. One patient reports that his lesions 
do not go on to deep black pigmentation. 
At four p.m. we all returned down the road on the trailer of the tractor 
and reembarked in a deep sea loading, swimming to the shore boat in the surf. 
On the Alpha Helix all but myself decided to stay, and thus we have no one on 
shore but me. Wilmot and Milly and I have made a list of some 40 people on 
Bellona whom we can X-ray on the Alpha Helix tomorrow. They are old 
tuberculosis cases, or those currently on INH therapy (often diagnosed by 
symptoms without any laboratory study or X-ray possible). Others have been to 
Honiara for diagnosis, treatment, and even some for reevaluation. We shall also 
X-ray the multiple recurrent swellings that are active, a couple of cases of 
chronic bronchial asthma, and many family contacts of active tuberculosis cases. 
We have only 54 more large X-ray films, and this limits the total number we can 
do. All depends, of course, on the seas being calm enough for the X-raying. 
We also hope to assemble the 60-80 school children in the Adventist School, 
where there are six standards, six teachers, and perhaps 60 pupils. School is 
at present out on holidays. The headmaster, however, will try to reassemble the 
pupils tomorrow. He is Tahenlu from Ngongona village, Bellona. 
