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Dysphasia has many causes, most commonly cerebrovascular accident or transient cerebral ischaemia. Four patients presented with acute dysphasia to the Department of Emergency Medicine at Fremantle Hospital within four months. Although the aetiologies were diverse and unusual, in each case the speech disturbance resolved completely with appropriate treatment.

Objective: To study the efficacy of intramuscular midazolam in treating seizures. Design: On arrival, patients with seizures were treated with intramuscular midazolam, a stopwatch was started, and an intravenous line inserted. If the seizure had not stopped within six minutes, standard intravenous anticonvulsants were given. The time to cessation of the seizure was recorded. Setting: Department of Emergency Medicine, Fremantle Hospital, a busy emergency department (50,000 annual attendances, 18% children) in a general community teaching hospital. Main outcome measure: Time to cessation of fitting. Results: Thirty eight patients aged from 15 months to 89 years, were treated with intramuscular midazolam at an average dose of 0.12mg/kg (range 0.07–0.21mg/kg). The seizures terminated in all but two cases in an average time of 1minute 53 seconds overall (range 15 seconds to 6 minutes 7 seconds). In a subgroup of 15 patients with prolonged seizures of 36 minutes duration on average, the seizures ceased in a mean time of 2 minutes 41 seconds, with one failure. The latter time is likely to represent the true response time of seizures to intramuscular midazolam as some of the short‐lived seizures may have ceased spontaneously. All seven children treated with intramuscular midazolam ceased fitting. There were no adverse side effects in any patient. Conclusion: Midazolam given by intramuscular injection was shown to be rapidly effective for the control of generalised convulsive seizures, focal seizures and status epilepticus in adults and in children. This new therapy has exciting applications in the treatment of seizures in children and in the pre‐hospital setting. 1992 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine

Paraduodenal hernia is a rare congenital internal hernia which arises from an error of rotation of the midgut with entrapment of the small intestine beneath the developing colon. It is important as it usually presents as intestinal obstruction, and before laparotomy is often misdiagnosed. Mortality increases significantly with delays in surgical treatment. Two cases are presented: an 8 year old boy and a 52 year old man. Both presented with a short history of abdominal pain and an acute abdomen. With prompt surgical treatment, they recovered rapidly.

OBJECTIVE To describe the incidence and natural history of bites from the quokka, a small wallaby. DESIGN A prospective case series. SETTING Rottnest Island Nursing Post, a small hospital staffed by registered nurses on call 24 hours a day, located on Rottnest Island 18 km off the coast of Western Australia near Perth. PATIENTS All patients presenting after a bite from a quokka. RESULTS Seventy-two patients (30 males and 42 females) presented after a bite. All but two patients were patting or feeding a quokka at the time of being bitten, and all but two were bitten on a finger or the thumb. Sixty-one per cent of patients were followed up; all wounds healed without complications. No wound pathogens were cultured from either wound swabs or swabs of the mouths of quokkas. CONCLUSIONS Bites from quokkas heal without complications, usually in two to three weeks. Simple first aid and tetanus prophylaxis where appropriate are all that is required. Antibiotics are not indicated.

Summary This report presents studies of a case of hypoproteinemia, chylous ascites, steatorrhea, and protein-losing enteropathy due to chronic inflammatory obstruction of major intestinal lymph vessels. These studies provide further evidence in support of lymphatic obstruction as an important factor in the pathogenesis of hypoproteinemia with protein-losing enteropathy in some patients.

Among citizens of the same political community there is often a marked degree of economic and social inequality. The main rea? son for this is the fact that they are living and working in different areas, some of which are more economically developed than others. Where this situation obtains, justice and equity demand that pub? lic authority try to eliminate or reduce such inequality. It should ensure that underdeveloped areas receive such essential public services as their circumstances require, in order to bring the standard of living in these areas into line with the national average. Furthermore, a suitable economic and social policy must be de? vised, aimed at controlling the supply of labour, the drift of popula? tion, wages, taxes, credit, and the investing of money, especially in expanding industries. In short, it should be a policy designed to promote useful employment, enterprising initiative, and the ex? ploitation of local resources. But the justification of all government action is the common good. Public authority, therefore, must bear in mind the interests of the state as a whole; which means that it must promote all three areas of production?agriculture, industry and public services? simultaneously and evenly. Everything must be done to ensure that citizens of the less developed areas are treated as responsible human beings, and are allowed to play the major role in achieving their own economic, social and cultural advancement. Private enterprise too must contribute to an economic and social balance in the different zones of the same political com? munity. Indeed, in accordance with "the principle of subsidiary function," public authority must encourage and assist private enter? prise, entrusting to it, wherever possible, the continuation of eco? nomic development.1