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A Clinician's
Pearls & Myths
in Rheumatology
John H. Stone
Editor
Second Edition

123
A Clinician’s Pearls & Myths in Rheumatology
John H. Stone
Editor

A Clinician’s Pearls & Myths

in Rheumatology
Second Edition
Editor
John H. Stone
Massachusetts General Hospital
Harvard University Massachusetts General Hospital
Boston, MA, USA

ISBN 978-3-031-23487-3    ISBN 978-3-031-23488-0 (eBook)

https://doi.org/10.1007/978-3-031-23488-0

© Springer Nature Switzerland AG 2009, 2023

This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
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This Springer imprint is published by the registered company Springer Nature Switzerland AG
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To Sarah Lucretia (“Lu”) Stone
(1936–1991)
A mother holds her children’s hands for a short time, and their hearts forever.
Preface

When I was a child in the second grade, my mother developed an acutely painful index finger
on her right hand. After several sleepless nights with unrelenting pain that was disguised from
me, she was admitted to the hospital. The surgeon suspected a glomus tumor—a benign growth
that sometimes develops in the nailbed. But no tumor was found at surgery. Instead, the sur-
geon shared an astonishing observation with my father: “When I removed her fingernail, she
didn’t bleed.”
And at that point, the nature of her disease began to dawn on her doctors and on my father,
who was himself a physician. My mother had developed Raynaud’s phenomenon as a teenager.
When she and my father were newlyweds and he was a medical student, they had mused
together at the oddity of her intermittently pale white fingers, which developed sometimes
even in the summer. Around the time I was born, she suffered from a skin problem that I
learned—years later—was dermatitis herpetiformis. As a young boy, I remember her scratch-
ing her intensely itchy legs. As I grew up, I became aware of the subtle scars left on her face,
usually well-hidden with makeup.
The active skin inflammation faded after a few years, but other aspects of the autoimmune
kaleidoscope came into sharper focus. The ischemic finger in the context of her preceding
issues led to the diagnosis of scleroderma. In that light, most of the medical events in my
mother’s life make sense now. Her finger hadn’t bled at surgery because of the severity of
vasoconstriction. The shapes of her fingers that I can still see and remember dearly, including
the curved fingernail that never grew back normally, were the result of her disease. The calci-
noses and digital pitting that developed in her fingers were also consequences of her slow-­
moving but relentless illness, as were the intermittent bouts of dysphagia caused by esophageal
dysmotility. For a time, during my teens, my mother often had to excuse herself from the din-
ner table because she just couldn’t swallow her food. A painful memory for me.
Despite that, Mom led a full life and it seemed to most that nothing slowed her down: rais-
ing two rambunctious boys; being a loving wife and returning to graduate school; becoming a
devoted first-grade teacher; using her hands constantly in spite of sensitive fingers on sewing,
knitting, cooking, and playing the piano; enjoying lifelong friends; attending our soccer games
with mittens on to counter Raynaud’s attacks; and delighting in family travel.
It all came to a halt far too early. When I was a medical intern, the hospital operator paged
me to return a call from my father. Mom had developed an acute bowel obstruction because of
scleroderma gut and had been taken to surgery that morning. I flew home, to her bedside in the
intensive care unit. There, far more fragile that anyone had realized, she died twelve days later
of adult respiratory distress syndrome. The real cause, of course, was scleroderma. She was 54
years old.
It is little consolation that traumatic health events in one’s family make a physician a better
doctor. Yet it is true. My mother’s nearly lifelong struggle with scleroderma—ironically
regarded as “limited”—helps me understand the uncertainties, frustrations, and tears of my
patients and their families. Mom’s illness, of course, contributed to my becoming a rheuma-
tologist and dedicating my career to helping patients address diseases like hers. It is only fit-
ting, then, that this book is dedicated to her.

vii
viii Preface

So much has happened since the First Edition was published in 2009. New rheumatic dis-
eases have been identified. (IgG4-related disease was scarcely mentioned in the First Edition!)
Biomedical science has witnessed important advances in assessment and diagnosis, some of
which have already altered approaches to patient care. Creative new therapies have been con-
ceived and studied. Some in fact have worked, been approved, and are already improving
patients’ lives. The world has endured (and still persists in) a viral pandemic that has under-
scored the importance of vaccines and public health and forced us to re-think how we apply
many of our existing treatments. Though many challenges remain, my inherent optimism - a
trait inherited from my mother - inspires confidence that the coming years will mark growing
progress for the patients we treat.
The judgment of inspired clinicians will remain fundamental to inspiring advances and
maintaining safe speeds on the paths ahead. It is in this spirit that this book is written: by clini-
cians, for clinicians. I am grateful to the more than 200 contributors who offer guidance here
from their own approaches to our art, sharing their hard-earned and frequently elegant clinical
wisdom.

Boston, MA, USA John H. Stone

Contents

1 Rheumatoid Arthritis�������������������������������������������������������������������������������������������������   1

Kevin D. Deane, Daniel Aletaha, Joan M. Bathon, Paul Emery,
George E. Fragoulis, V. Michael Holers, T. W. J. Huizinga,
Jason R. Kolfenbach, James R. O’Dell, Duane W. Pearson, Elizabeth Park,
Josef Smolen, Yoshiya Tanaka, Peter C. Taylor, Annette van der Helm-­van Mil,
Ronald F. van Vollenhoven, and E. William St. Clair
2 Rheumatoid Vasculitis ����������������������������������������������������������������������������������������������� 25
Ashima Makol, Tanaz Kermani, Kenneth Warrington, John H. Stone,
and Eric L. Matteson
3 Adult-Onset Still’s Disease����������������������������������������������������������������������������������������� 37
Yutong Su and Chengde Yang
4 Juvenile Idiopathic Arthritis ������������������������������������������������������������������������������������� 43
Randy Q. Cron, Sangeeta Sule, Jordan T. Jones, Tristan A. Kerr,
Kimberly A. Morishita, Ross E. Petty, and Carol B. Lindsley
5 Monogenic Autoinflammatory Syndromes��������������������������������������������������������������� 55
Ivona Aksentijevich and Eldad Ben-Chetrit
6 Juvenile Spondyloarthritis����������������������������������������������������������������������������������������� 79
Dax G. Rumsey, David A. Cabral, and Shirley M. L. Tse
7 Axial Spondyloarthritis ��������������������������������������������������������������������������������������������� 87
Xenofon Baraliakos, Dennis McGonagle, and Jürgen Braun
8 Psoriatic Arthritis������������������������������������������������������������������������������������������������������� 97
Philip Helliwell, Laura C. Coates, and Dafna Gladman
9 Reactive Arthritis ������������������������������������������������������������������������������������������������������� 105
John H. Stone
10 
Systemic Sclerosis (Scleroderma) and Raynaud’s Phenomenon ��������������������������� 111
Ami A. Shah, Janet E. Pope, Dinesh Khanna, Maureen Mayes,
Virginia Steen, and Christopher Denton
11 Sjögren’s Disease��������������������������������������������������������������������������������������������������������� 133
Alan Baer, Vatinee Bunya, Ava Wu, Xavier Mariette, and Frederick Vivino
12 Systemic Lupus Erythematosus��������������������������������������������������������������������������������� 167
Michelle Petri, Martin Aringer, Isabelle Ayoub, Salem Almaani, Hermine
Brunner, Maria Dall’Era, Mengdi Jiang, Richard Furie, Jessica Greco,
Fiona Goldblatt, Jennifer Huggins, T. W. J. Huizinga, David Isenberg,
Nicholas L. Li, R. C. Monahan, Samir V. Parikh, David Pisetsky,
Abin P. Puravath, Brad Rovin, Daniel Wallace, Xuan Zhang,
and Lidan Zhao

ix
x Contents

13 Childhood-Onset
 SLE and Neonatal Lupus Erythematosus ��������������������������������� 213
Deborah M. Levy, Jill Buyon, and Earl D. Silverman
14 The Antiphospholipid Syndrome������������������������������������������������������������������������������� 225
David P. D’Cruz, Jason S. Knight, Lisa Sammaritano, Jane Salmon,
Ricard Cervera, and Munther Khamashta
15 Reproductive
 Health in the Rheumatic Diseases����������������������������������������������������� 241
Julia Sun, Laura Andreoli, Jane Salmon, Meghan Clowse, Caroline Gordon,
Jill Buyon, Rosalind Ramsay-Goldman, and Lisa Sammaritano
16 Inflammatory Myopathies����������������������������������������������������������������������������������������� 261
Chester Oddis, Vidya Limaye, Frederick Miller, and Lisa Christopher-Stine
17 Juvenile Dermatomyositis ����������������������������������������������������������������������������������������� 275
Lauren M. Pachman, Sarah Tansley, Ann M. Reed, Clarissa M. Pilkington,
Brian M. Feldman, and Lisa G. Rider
18 Vasculitic Neuropathy������������������������������������������������������������������������������������������������� 287
John H. Stone
19 Pediatric Vasculitis ����������������������������������������������������������������������������������������������������� 297
Seza Ozen, Despina Eleftheriou, Anne Rowley, and Paul Brogan
20 Behçet Syndrome�������������������������������������������������������������������������������������������������������� 311
Johannes Nowatzky, Gulen Hatemi, Vedat Hamuryudan, Hasan Yazici,
and Yusuf Yazici
21 Eosinophilic
 Granulomatosis with Polyangiitis������������������������������������������������������� 327
John H. Stone
22 Granulomatosis with Polyangiitis����������������������������������������������������������������������������� 335
John H. Stone
23 Microscopic Polyangiitis��������������������������������������������������������������������������������������������� 357
Duvuru Geetha and John H. Stone
24 Oral
 Manifestations Associated with Rheumatic Diseases������������������������������������� 369
Sonia Marino, Sook-Bin Woo, Roberta Gualtierotti, John A. G. Buchanan,
Shaiba Shandu, Francesco Spadari, and Massimo Cugno
25 Cryoglobulinemia������������������������������������������������������������������������������������������������������� 395
Franco Dammacco, Patrice Cacoub, John H. Stone, and David Saadoun
26 Polyarteritis Nodosa��������������������������������������������������������������������������������������������������� 405
John H. Stone
27 Giant
 Cell Arteritis and Polymyalgia Rheumatica ������������������������������������������������� 417
Peter M. Villiger, Lisa Christ, Luca Seitz, Godehard Scholz,
Christoph Tappeiner, Francesco Muratore, Carlo Salvarani, Sue Mollan,
Vanessa Quick, Christian Dejaco, Michael Lee, Neil Basu, Neil Miller,
and John H. Stone
28 Takayasu’s Arteritis ��������������������������������������������������������������������������������������������������� 447
Kaitlin A. Quinn, Durga P. Misra, Aman Sharma, Andrew Porter,
Justin Mason, and Peter C. Grayson
29 Central
 Nervous System Vasculitis and Reversible
Cerebral Vasoconstriction Syndrome����������������������������������������������������������������������� 465
Rula A. Hajj-Ali, David S. Younger, and Leonard H. Calabrese
Contents xi

30 Thromboangiitis Obliterans��������������������������������������������������������������������������������������� 473

Ashima Makol, Leslie T. Cooper, John H. Stone, and Eric L. Matteson
31 Less Common Vasculitides����������������������������������������������������������������������������������������� 481
Eric L. Matteson and John H. Stone
32 Relapsing Polychondritis������������������������������������������������������������������������������������������� 491
Jeremie Dion, Guillaume Moulis, and Nathalie Costedoat
33 Fibromyalgia��������������������������������������������������������������������������������������������������������������� 499
Daniel Clauw
34 
Clinical Features of Gout������������������������������������������������������������������������������������������� 505
Robert Terkeltaub, Nicola Dalbeth, Naomi Schlesinger, Brian Mandell,
and Michael Pillinger
35 Epidemiology of Gout������������������������������������������������������������������������������������������������� 513
Hyon K. Choi and John H. Stone
36 Treatment of Gout������������������������������������������������������������������������������������������������������� 519
Nicola Dalbeth, Michael Pillinger, Naomi Schlesinger, Brian Mandell,
and Robert Terkeltaub
37 
CPPD and Other Microcrystalline Disorders ��������������������������������������������������������� 531
Ann K. Rosenthal, Mariano Andres, Abhishek Abhishek, and Robert
Terkeltaub
38 Inflammatory Eye Disease����������������������������������������������������������������������������������������� 545
Bart Chwalisz, Michael Lee, Lucia Sobrin, and Suzanne K. Freitag
39 
Immune-Mediated Inner Ear Disease����������������������������������������������������������������������� 569
Soumyajit Das and Steven Rauch
40 Osteoporosis: Epidemiology and Assessment����������������������������������������������������������� 579
Mary Beth Humphrey, Bita Zahedi, Amy Warriner, Sarah Morgan,
Benjamin Z. Leder, Ken Saag, and Elaine W. Yu
41 Osteoporosis Prevention and Treatment������������������������������������������������������������������� 587
Mary Beth Humphrey, Bita Zahedi, Amy Warriner, Sarah Morgan,
Benjamin Z. Leder, Ken Saag, and Elaine W. Yu
42 
Paget’s Disease of Bone����������������������������������������������������������������������������������������������� 599
Ian R. Reid and Margaret Seton
43 Lyme����������������������������������������������������������������������������������������������������������������������������� 603
Sheila L. Arvikar, John J. Halperin, and Allen C. Steere
44 Osteoarthritis��������������������������������������������������������������������������������������������������������������� 611
Lauren King, Ian Stanaitis, and Gillian Hawker
45 Regional Musculoskeletal Problems������������������������������������������������������������������������� 621
Atul Deodhar and John H. Stone
46 
Low Back and Neck Pain������������������������������������������������������������������������������������������� 635
Rajiv K. Dixit, Daniel Tobert, and Joseph H. Schwab
47 The Ehlers-Danlos Syndromes����������������������������������������������������������������������������������� 655
Marlies Colman, Anne De Paepe, and Fransiska Malfait
48 Sarcoidosis������������������������������������������������������������������������������������������������������������������� 667
Marc A. Judson, Elyse E. Lower, Edward S. Chen, Jeffrey A. Sparks,
Jocelyn R. Farmer, and Robert P. Baughman
xii Contents

49 Amyloidosis����������������������������������������������������������������������������������������������������������������� 687
Andrew Staron, Morie Gertz, and Giampaolo Merlini
50 IgG4-Related Disease������������������������������������������������������������������������������������������������� 701
Mitsuhiro Kawano, Yoh Zen, Takako Saeki, Lingli Dong, Wen Zhang, Emanuel
Della-Torre, Philip A. Hart, Judith A. Ferry, and John H. Stone
51 Castleman Disease������������������������������������������������������������������������������������������������������� 727
Luke Chen and David C. Fajgenbaum
52 Erdheim-Chester Disease������������������������������������������������������������������������������������������� 737
Matthew J. Koster
53 Kikuchi-Fujimoto Disease ����������������������������������������������������������������������������������������� 743
Guillaume Dumas and Olivier Fain
54 Whipple’s Disease������������������������������������������������������������������������������������������������������� 749
Rima N. El-Abassi, Daniel Raines, and J. D. England
Index������������������������������������������������������������������������������������������������������������������������������������� 759
Contributors

Abhishek Abhishek University of Nottingham, Nottingham, UK

Ivona Aksentijevich Inflammatory Disease Section, National Human Genome Research
Institute, Bethesda, MD, USA
Daniel Aletaha Division of Rheumatology, Department of Medicine 3, Medical University of
Vienna, Vienna, Austria
Salem Almaani Department of Internal Medicine, The Ohio State Wexner Medical Center,
Columbus, OH, USA
Laura Andreoli Department of Clinical and Experimental Sciences, University of Brescia,
Brescia, Italy
Mariano Andres Sección de Reumatología, Hospital General Universitario de Alicante,
Departamento de Medicina Clínica, Universidad Miguel Hernández, and ISABIAL, Elche,
Spain
Martin Aringer Division of Rheumatology, Department of Medicine III, University Medical
Center and Faculty of Medicine Carl Gustav Carus, Dresden, Germany
Sheila L. Arvikar Center for Immunology and Inflammatory Diseases, Division of
Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, USA
Isabelle Ayoub Department of Medicine, Division of Nephrology, The Ohio State University
Wexner Medical Center, Columbus, OH, USA
Alan Baer Division of Rheumatology, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
Xenofon Baraliakos Rheumazentrum Ruhrgebiet, Herne, Ruhr-University Bochum, Herne,
Germany
Neil Basu Institute of Infection, Immunity, and Inflammation, University of Glasgow,
Glasgow, UK
Joan M. Bathon Columbia University Irving Medical Center, New York Presbyterian
Hospital, New York, NY, USA
Robert P. Baughman Department of Medicine, University of Cincinnati Medical Center,
Cincinnati, OH, USA
Eldad Ben-Chetrit Rheumatology Unit, Hadassah-Hebrew University Medical Center,
Jerusalem, Israel
Jürgen Braun Rheumazentrum Ruhrgebiet, Herne, Germany
Paul Brogan Great Ormond Street Hospital for Children NHS Foundation Trust, University
College London Great Ormond Street Institute of Child Health, London, UK

xiii
xiv Contributors

Hermine Brunner Cincinnati Children’s Hospital Medical Center, University of Cincinnati,

Cincinnati, OH, USA
John A. G. Buchanan Centre for Education and Innovation, Dental Institute, Barts and the
London School of Medicine and Dentistry, Queen Mary University of London, London, UK
Vatinee Bunya Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
Jill Buyon New York University School of Medicine, New York, NY, USA
David A. Cabral Department of Pediatrics, British Columbia Children’s Hospital, Vancouver,
BC, Canada
Patrice Cacoub AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal
Medicine and Clinical Immunology, Sorbonne Université, Paris, France
Leonard H. Calabrese Cleveland Clinic Center for Vasculitis Care and Research, Cleveland,
OH, USA
Ricard Cervera Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
Edward S. Chen Division of Pulmonary and Critical Care Medicine, Department of Medicine,
The Johns Hopkins University, Baltimore, MD, USA
Luke Chen Division of Hematology, The University of British Columbia, Vancouver, BC,
Canada
Hyon K. Choi Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
Lisa Christ Department of Rheumatology and Immunology, Inselspital, Bern University
Hospital, Bern, Switzerland
Lisa Christopher-Stine Division of Rheumatology, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
Johns Hopkins Myositis Precision Medicine Center of Excellence, Baltimore, MD, USA
Bart Chwalisz Harvard Medical School, Boston, MA, USA
Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital,
Boston, MA, USA
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
Daniel Clauw Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
Meghan Clowse Division of Rheumatology and Immunology, Duke University Medical
Center, Durham, NC, USA
Laura C. Coates Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal
Sciences, University of Oxford, Oxford, UK
Marlies Colman Center for Medical Genetics, Department of Biomolecular Medicine, Ghent
University and Ghent University Hospital, Ghent, Belgium
Leslie T. Cooper Department of Cardiology, Mayo Clinic, Jacksonville, FL, USA
Nathalie Costedoat UMR 1027 Inserm, University of Toulouse, Toulouse, France
Service de Médecine Interne, Hôpital Cochin, Paris, France
Randy Q. Cron University of Alabama at Birmingham, Birmingham, AL, USA
Massimo Cugno Department of Pathophysiology and Transplantation, Internal Medicine,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di
Milano, Milan, Italy
Contributors xv

David P. D’Cruz Louise Coote Lupus Unit, Guy’s Hospital, London, UK

Nicola Dalbeth Department of Medicine, University of Auckland, Auckland, New Zealand
Maria Dall’Era School of Medicine, University of California, San Francisco, CA, USA
Franco Dammacco Department of Biological Sciences and Human Oncology, Section of
Internal Medicine, University of Bari “Aldo Moro” Medical School, Bari, Italy
Soumyajit Das Department of ENT, All India Institute of Medical Sciences, Mangalagiri,
Andhra Pradesh, India
Kevin D. Deane Division of Rheumatology, University of Colorado Denver Anschutz Medical
Campus, Aurora, CO, USA
Christian Dejaco Rheumatology, Medical University Graz, Graz, Austria
Rheumatology, Hospital of Bruneck, Bruneck, Italy
Emanuel Della-Torre IRCCS San Raffaele Scientific Institute, Università Vita-Salute San
Raffaele, Milan, Italy
Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San
Raffaele Scientific Institute, Milan, Italy
Christopher Denton CL Division of Medicine, University College London, London, UK
UCL Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London,
UK
Atul Deodhar Division of Arthritis and Rheumatic Diseases, Oregon Health and Science
University, Portland, OR, USA
Anne De Paepe Center for Medical Genetics, Department of Biomolecular Medicine, Ghent
University and Ghent University Hospital, Ghent, Belgium
Jeremie Dion National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital
Cochin, AP-HP, Université Paris Descartes, Paris, France
Rajiv K. Dixit Northern California Arthritis Center, Walnut Creek, CA, USA
Lingli Dong Department of Rheumatology and Immunology, Tongji Medical College, Tongji
Hospital, Huazhong University of Science and Technology, Wuhan, China
Guillaume Dumas APHP, Service de médecine intensive et de réanimation, hôpital Saint-­
Louis, Paris, France
Center of Epidemiology and Biostatistics, INSERM, Université de Paris, UMR 1153, Paris,
France
Rima N. El-Abassi Department of Neurology, School of Medicine, Louisiana State University
Health Sciences Center, New Orleans, LA, USA
Despina Eleftheriou Infection, Immunity and Inflammation Programme Research and
Teaching Department, UCL Great Ormond Street Institute of Child Health, University College
London, London, UK
Rheumatology, Great Ormond Street Hospital, London, UK
Paul Emery Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of
Leeds, Chapel Allerton Hospital, Leeds, UK
NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS
Trust, Leeds, UK
J. D. England Department of Neurology, School of Medicine, Louisiana State University
Health Sciences Center, New Orleans, LA, USA
xvi Contributors

Olivier Fain AP-HP, service de médecine interne, Hôpital Saint Antoine, Sorbonne Université,
Paris, France
David C. Fajgenbaum Center for Cytokine Storm Treatment and Laboratory & Division of
Translational Medicine and Human Genetics, Department of Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA, USA
Jocelyn R. Farmer Department of Allergy and Immunology, Massachusetts General Hospital,
Boston, MA, USA
Brian M. Feldman Departments of Pediatrics and Medicine, IHPME, University of Toronto,
Toronto, ON, Canada
Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada
Judith A. Ferry Department of Pathology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
George E. Fragoulis Institute of Infection, Immunity and Inflammation, University of
Glasgow, Glasgow, UK
Suzanne K. Freitag Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear
Infirmary, Harvard Medical School, Boston, MA, USA
Richard Furie Division of Rheumatology, Northwell Health and Zucker School of Medicine
at Hofstra/Northwell, Great Neck, NY, USA
Duvuru Geetha Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
Morie Gertz Division of Hematology, Mayo Clinic, Rochester, MN, USA
Dafna Gladman Department of Medicine, Krembil Research Institute, University of Toronto,
Toronto Western Hospital, Toronto, ON, Canada
Fiona Goldblatt Department of Rheumatology, The Repatriation General Hospital, Adelaide,
SA, Australia
Caroline Gordon University of Birmingham, Birmingham, UK
Peter C. Grayson, MD, Mac National Institute of Arthritis and Musculoskeletal and Skin
Diseases, National Institutes of Health, Bethesda, MD, USA
Jessica Greco Department of Internal Medicine, Davis Heart and Lung Research Institute,
Ohio State University Medical Center, Columbus, OH, USA
Roberta Gualtierotti Department of Pathophysiology and Transplantation, Internal Medicine,
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di
Milano, Milan, Italy
Rula A. Hajj-Ali Department of Rheumatology/Immunology, Cleveland Clinic, Cleveland,
OH, USA
John J. Halperin Atlantic Health System, Summit, NJ, USA
Vedat Hamuryudan Division of Rheumatology, Department of Internal Medicine, School of
Medicine, Behçet’s Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
Philip A. Hart Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State
University Wexner Medical Center, Columbus, OH, USA
Gulen Hatemi Division of Rheumatology, Department of Internal Medicine, School of
Medicine, Behçet’s Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
Gillian Hawker Department of Medicine, University of Toronto, Toronto, ON, Canada
Contributors xvii

Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
Philip Helliwell Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of
Leeds, Leeds, UK
Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust,
Leeds, UK
V. Michael Holers Division of Rheumatology, University of Colorado Denver Anschutz
Medical Campus, Aurora, CO, USA
Jennifer Huggins Cincinnati Children’s Hospital Medical Center and University of Cincinnati
College of Medicine, Cincinnati, OH, USA
T. W. J. Huizinga Leiden University, Leiden, The Netherlands
Mary Beth Humphrey University of Oklahoma Health Sciences Center, Oklahoma City,
OK, USA
David Isenberg Centre for Rheumatology, Division of Medicine, University College London,
London, UK
Department of Rheumatology, University College London Hospitals NHS Foundation Trust,
London, UK
Mengdi Jiang Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai
Jiao Tong University, Shanghai, China
Jordan T. Jones University of Kansas City Medical Center, Kansas City, KS, USA
Marc A. Judson Division of Pulmonary and Critical Care Medicine, Albany Medical Center,
Albany, NY, USA
Mitsuhiro Kawano Department of Rheumatology, Graduate School of Medical Science,
Kanazawa University, Kanazawa, Japan
Tanaz Kermani Division of Rheumatology, University of California, Los Angeles, Los
Angeles, CA, USA
Tristan A. Kerr Division of Pediatric Rheumatology, BC Children’s Hospital, Vancouver,
BC, Canada
Munther Khamashta Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital,
King’s College University, London, UK
Dinesh Khanna University of Michigan, Ann Arbor, MI, USA
Lauren King University of Toronto, Toronto, ON, Canada
Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
Jason S. Knight Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
Jason R. Kolfenbach Division of Rheumatology, University of Colorado Denver Anschutz
Medical Campus, Aurora, CO, USA
Matthew J. Koster Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
Benjamin Z. Leder, MD Department of Medicine, Endocrine Unit, Massachusetts General
Hospital, Boston, MA, USA
Michael Lee Department of Ophthalmology and Visual Neurosciences, University of
Minnesota, Minneapolis, MN, USA
Department of Neurology, University of Minnesota, Minneapolis, MN, USA
Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
xviii Contributors

Deborah M. Levy Division of Rheumatology, The Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
Vidya Limaye Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide,
SA, Australia
Carol B. Lindsley University of Kansas City Medical Center, Kansas City, KS, USA
Nicholas L. Li Department of Internal Medicine, Division of Nephrology, The Ohio State
University, Columbus, OH, USA
Elyse E. Lower Department of Medicine, University of Cincinnati Medical Center, Cincinnati,
OH, USA
Ashima Makol Division of Rheumatology, Department of Internal Medicine, Mayo Clinic,
Rochester, MN, USA
Fransiska Malfait Center for Medical Genetics, Department of Biomolecular Medicine,
Ghent University and Ghent University Hospital, Ghent, Belgium
Brian Mandell Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic,
Cleveland, OH, USA
Xavier Mariette Université Paris-Saclay, INSERM, CEA, Centre de recherche en
Immunologie des infections virales et des maladies auto-immunes, Paris, France
AP-HP, Université Paris-Saclay, Hôpital Bicêtre, Rheumatology Department, Le Kremlin
Bicêtre, Paris, France
Sonia Marino Department of Biomedical Surgical and Dental Sciences, Maxillo-Facial and
Odontostomatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico,
Università degli Studi di Milano, Milan, Italy
Justin Mason Vascular Sciences and Rheumatology, Imperial Centre for Translational and
Experimental Medicine, National Heart and Lung Institute, Imperial College London,
Hammersmith Hospital, London, UK
Eric L. Matteson Division of Rheumatology and Department of Health Sciences Research,
Mayo Clinic, Rochester, MN, USA
Maureen Mayes Division of Rheumatology and Clinical Immunogenetics, University of
Texas McGovern Medical School, Houston, TX, USA
Dennis McGonagle LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
Giampaolo Merlini Amyloidosis Research and Treatment Centre, Fondazione Istituto di
Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
Department of Molecular Medicine, University of Pavia, Pavia, Italy
Frederick Miller Clinical Research Branch, National Institute of Environmental Health
Sciences, National Institutes of Health, Research Triangle Park, NC, USA
Neil Miller Johns Hopkins University School of Medicine, Baltimore, MD, USA
Durga P. Misra Department of Clinical Immunology and Rheumatology, Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow, India
Sue Mollan Metabolic Neurology, Institute of Metabolism and Systems Research, University
of Birmingham, Birmingham, UK
R. C. Monahan Department of Rheumatology, Leiden University Medical Center, Leiden,
The Netherlands
Contributors xix

Sarah Morgan Division of Clinical Immunology and Rheumatology, The University of

Alabama at Birmingham, Birmingham, AL, USA
Kimberly A. Morishita Department of Paediatrics, The University of British Columbia,
Vancouver, BC, Canada
Division of Rheumatology, British Columbia Children’s Hospital, Vancouver, BC, Canada
Guillaume Moulis Department of Internal Medicine, Toulouse University Hospital (CHU de
Toulouse), Toulouse, France
CIC 1436, Toulouse University Hospital (CHU de Toulouse), Toulouse, France
Francesco Muratore Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio
Emilia, Italy
Johannes Nowatzky Division of Rheumatology, Department of Medicine, NYU Langone
Behçet’s Disease Program, NYU Langone Ocular Rheumatology Program, New York
University Grossman School of Medicine, New York, NY, USA
James R. O’Dell Department of Internal Medicine, University of Nebraska Medical Center,
Omaha, NE, USA
Chester Oddis Division of Rheumatology and Clinical Immunology, University of Pittsburgh
School of Medicine, Pittsburgh, PA, USA
Seza Ozen Department of Paediatrics, Hacettepe University, Ankara, Turkey
Lauren M. Pachman Feinberg School of Medicine, Chicago, IL, USA
Northwestern University, Chicago, IL, USA
Department of Pediatrics, Division of Rheumatology, Ann and Robert H. Lurie Children’s
Hospital of Chicago, Chicago, IL, USA
Cure JM Center of Excellence in JM Research and Care, Chicago, LI, USA
Samir V. Parikh Division of Nephrology, Department of Internal Medicine, The Ohio State
University Wexner Medical Center, Columbus, OH, USA
Elizabeth Park Columbia University Irving Medical Center and New York Presbyterian
Hospital, New York, NY, USA
Duane W. Pearson Division of Rheumatology, University of Colorado Denver Anschutz
Medical Campus, Aurora, CO, USA
Michelle Petri Division of Rheumatology, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
Division of Rheumatology, Department of Medicine III, University Medical Center and
Faculty of Medicine Carl Gustav Carus, Dresden, Germany
Ross E. Petty Department of Paediatrics, The University of British Columbia, Vancouver,
BC, Canada
Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada
Clarissa M. Pilkington Adolescent and Pediatric Rheumatology, University College and
Great Ormond Street Hospital, London, UK
Michael Pillinger The Division of Rheumatology, New York University Grossman School of
Medicine, New York, NY, USA
The Section of Rheumatology, New York Harbor Health Care System, New York Campus of
the U.S. Department of Veterans Affairs, New York, NY, USA
xx Contributors

David Pisetsky Departments of Medicine and Immunology, Duke University Medical Center
and Medical Research Service, Veterans Administration Medical Center, Durham, NC, USA
Janet E. Pope Division of Rheumatology, St Joseph’s Hospital, Western University, London,
ON, Canada
Andrew Porter Rheumatology Department, Imperial College Healthcare NHS Trust,
Hammersmith Hospital, London, UK
Abin P. Puravath Division of Rheumatology, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
Vanessa Quick Rheumatology, Luton and Dunstable University Hospital NHS Foundation
Trust, Luton, UK
Kaitlin A. Quinn, MD, MHS National Institute of Arthritis and Musculoskeletal and Skin
Diseases, National Institutes of Health, Bethesda, MD, USA
Daniel Raines Section of Gastroenterology, Department of Medicine, Louisiana State
University Health Sciences Center, New Orleans, LA, USA
Rosalind Ramsay-Goldman Department of Medicine, Rheumatology Division, Feinberg
School of Medicine, Northwestern University, Chicago, IL, USA
Steven Rauch Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye
and Ear, Boston, MA, USA
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston,
MA, USA
Ann M. Reed Cure JM Center of Excellence in JM Research and Care, Durham, NC, USA
Department of Pediatrics, Duke University Medical School, Durham, NC, USA
Ian R. Reid Department of Medicine, Faculty of Medical and Health Sciences, University of
Auckland, Auckland, New Zealand
Auckland District Health Board, Auckland, New Zealand
Lisa G. Rider Cure JM Center of Excellence in JM Research and Care, Washington, DC, USA
Environmental Autoimmunity Group, Clinical Research Branch, National Institute of
Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
Ann K. Rosenthal Department of Medicine, Division of Rheumatology, Medical College of
Wisconsin, Milwaukee, WI, USA
Brad Rovin Department of Internal Medicine, The Ohio State Wexner Medical Center,
Columbus, OH, USA
Anne Rowley Department of Pediatrics, Northwestern University Feinberg School of
Medicine, Chicago, IL, USA
Department of Microbiology-Immunology, Northwestern University Feinberg School of
Medicine, Chicago, IL, USA
Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Dax G. Rumsey Department of Pediatrics, Division of Rheumatology, University of Alberta,
Edmonton, AB, Canada
David Saadoun AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal
Medicine and Clinical Immunology, Sorbonne Universités, Paris, France
Ken Saag University of Alabama at Birmingham, Birmingham, AL, USA
Contributors xxi

Takako Saeki Nagaoka Red Cross Hospital, Nagaoka, Japan

Jane Salmon Division of Rheumatology, Department of Medicine, Hospital for Special
Surgery and Weill Cornell Medicine, New York, NY, USA
Carlo Salvarani Rheumatology Service, Arcispedale S. Maria Nuova, Reggio Emilia, Italy
Lisa Sammaritano Weill Cornell Medicine, Hospital for Special Surgery, New York, NY,
USA
Naomi Schlesinger Division of Rheumatology, Rutgers—Robert Wood Johnson Medical
School, New Brunswick, NJ, USA
Godehard Scholz Department of Rheumatology, Immunology and Allergology, Inselspital,
Bern University Hospital, University of Bern, Bern, Switzerland
Joseph H. Schwab Massachusetts General Hospital, Boston, MA, USA
Luca Seitz Department of Rheumatology, Immunology and Allergology, Inselspital, Bern
University Hospital, University of Bern, Bern, Switzerland
Margaret Seton Boston, MA, USA
Ami A. Shah Division of Rheumatology, Johns Hopkins University School of Medicine,
Baltimore, MD, USA
Shaiba Shandu Department of Oral Medicine Infection and Immunity, Harvard School of
Dental Medicine, Boston, MA, USA
Aman Sharma Clinical Immunology and Rheumatology Services, Department of Internal
Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh,
India
Earl D. Silverman Division of Rheumatology, The Hospital for Sick Children, University of
Toronto, Toronto, ON, Canada
Josef Smolen Division of Rheumatology, Department of Medicine 3, Medical University of
Vienna, Vienna, Austria
Lucia Sobrin Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear,
Boston, MA, USA
Francesco Spadari Department of Biomedical Surgical and Dental Sciences, Maxillo-Facial
and Odontostomatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico,
Università degli Studi di Milano, Milan, Italy
Jeffrey A. Sparks Brigham and Women’s Hospital, Harvard Medical School, Boston, MA,
USA
E. William St. Clair Duke University Medical Center, Durham, NC, USA
Ian Stanaitis Women’s College Research Institute, Women’s College Hospital, Toronto, ON,
Canada
Andrew Staron Amyloidosis Center, Boston University Chobanian & Avedisian School of
Medicine, Boston Medical Center, Boston, MA, USA
Virginia Steen Georgetown University Medical Center, Washington, DC, USA
Allen C. Steere Center for Immunology and Inflammatory Diseases, Division of
Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical
School, Boston, MA, USA
John H. Stone Division of Rheumatology, Allergy, and Immunology, Massachusetts General
Hospital, Harvard University, Boston, MA, USA
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of The stroller
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
restrictions whatsoever. You may copy it, give it away or re-use it
under the terms of the Project Gutenberg License included with this
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you are located before using this eBook.

Title: The stroller

Author: Margaret St. Clair

Illustrator: Leo Morey

Release date: July 9, 2022 [eBook #68484]

Language: English

Original publication: United States: Standard Magazines, Inc, 1947

Credits: Greg Weeks, Mary Meehan and the Online Distributed

Proofreading Team at http://www.pgdp.net

*** START OF THE PROJECT GUTENBERG EBOOK THE

STROLLER ***
THE STROLLER
 By MARGARET ST. CLAIR

[Transcriber's Note: This etext was produced from

Thrilling Wonder Stories, August 1947.
Extensive research did not uncover any evidence that
the U.S. copyright on this publication was renewed.]
All sorts of things come in on a space freighter. Even in the old days
grocers were always finding twenty-foot pythons curled cozily inside
bunches of bananas from South America; and what sort of undesired
stowaways do you suppose you get when you have a cargo of
tongarus from south Venus, agatized Fyella corymbs from the district
around Aphrodition, hand-painted lumigraphs on goor fiber made in
Marsport prefecture, and golden rhnx jewelry from the canal
centers?
George Saunders, supercargo of the S.S. Trito, gave his wife a warm
kiss on the cheek.
"For Pete's sake," he hissed into her ear, "act like you're glad to see
me, can't you? The Old Man's watching us."
Marta Saunders hesitated a moment and then threw her plump body
into her husband's arms.
"Oooh, Georgie!" she squealed. "You sweet old thing! It's so
wonderful to see you again!"
"That's enough," George rumbled warningly. He was swaying a little
from the impact. "Don't want to overdo it. Let's get out of here."
They started over to the parking area of the spaceport, where their
'copter was.
"What's the matter?" Marta demanded as soon as they were out of
earshot of the ship. "What do you care what the captain thinks about
us?"
"Listen, Marta, the old fool's been riding me ever since we left
Aphrodition. Says I'm the most incompetent supercargo he's ever
had. Just before we docked today, he said he thought he'd take it up
with the union. If he does, you know what'll happen. Pynx said the
last time that if he got one more complaint about me he'd take the
case to the executive board. I'd lose my license, sure."
"Oh." Marta seemed unwillingly impressed. She got an atomizer out
of her handcase and began spraying quick-drying cosmi-lac over the
skin of her face and neck. "But what happened?" she asked an
instant later when the cosmetic had set. "Why's he so down on you?"
For a moment the fine-etched lines of irritation and petulance faded
from George Saunders' face, to be replaced by an expression of
honest perplexity.
"Marta, I—wait, here's the 'copter. I'll tell you about it after we get in.
And for the love of heaven, don't drop any pop bottles out of the
window the way you did the last time I was in port. Having the air
police after us would be the last straw, as far as my nerves are
concerned."
He slid into the driver's seat. Marta got two bottles of pop out of the
refrigerator, shoved straws into their necks, pulled a shelf out of the
paneling to hold one bottle at a convenient level under George's
nose, and began drinking out of the other herself.
"Well?" she asked after a couple of swallows.
George drank from his bottle before replying.
"It's the darnedest thing. I remember beginning to load number two
and three holds at Aphrodition, and I remember telling the longshore
leaderman to have the hatch covers put on again when the holds
were filled, but there're six or eight hours in there during the loading I
don't remember a single thing about. They're totally gone.
"Well, the way the ship handled at the take-off from Aphrodition, the
Old Man thought there must be something wrong, and when we
were out in space he went in for a look. Wow! I can see, sort of, why
he's sore. Those holds look like somebody'd stirred the things in 'em
up with a big stick. About a third of the cargo's ruined. The tongarus
have leaked all over those blasted lumigraphs, and—Well, the
insurance company is going to raise blue murder, and the owners
won't like it one little bit."
George licked his thin lips.
"What I want to know," he burst out, "is what happened to me? I
must have told the longshoremen to load the holds like that, but—
When we were two days out of Venus, I asked Sparks (he's had a
pre-medical course, and he's saving up the tuition for medical
school) to look me over. He gave me all the tests, dozens of them,
and finally told me there wasn't a thing wrong with me mentally or
physically except that I needed more rest. Rest, bushwah! I've been
sleeping ten hours a night, and I wake up tireder than when I went to
bed."
Marta studied him.
"You do look sort of tired," she observed. "Maybe you need some
vitor-ray treatments."
George ignored this comment.
"Of course, the Old Man's not such a bad guy," he said. "He never
said anything about that time I missed the ship at Marsport."
"You mean that time you were so drunk on soma? One of the times."
George gave an irritated shrug.
"Never mind that," he snapped. "I mentioned it because I asked him
to have dinner with us on Thursday, the day before we sail, and I
want you to have a real old-fashioned home-cooked meal for him.
Maybe I can soften him up. Have something nice for him. None of
this complete meal stuff out of the freezer—have something good.
Out of cans."
"You mean like my canned crab and mushroom casserole?"
"Um-hum. Have that. And what's that dessert you make with the
canned peaches and the soma? pêche flambée, or something. He
might like that."

George set the 'copter down neatly on the roof of their apartment
house.
"Remember," he said, "I've got to make a good impression on him.
Flatter him as much as you can, but use your head about it. And if
you get any kind of a chance to tell him about how reliable I usually
am, do it."
The days moved on toward Thursday. George continued to complain
of fatigue, and on Tuesday night Marta woke up shrieking with a
vague and horrible nightmare, but it was attributed to indigestion;
after a dose of antiacid, she went back to sleep. On Wednesday she
had her hallucination.
She was putting a bunch of old digests and tabloids away in the
closet in the living room when she came across the jacket George
had used four or five years ago when he went grotch hunting.
"George!" she called. "Oh, George! Can I throw your old gray jacket
away? It's full of moth holes."
"What are you yelling at me for?" George asked irritably from behind
her. He had been sitting in his study, which was only about five feet
distant from the closet, drinking soma. "I'm right here."
Marta came out of the closet and stared at him. One hand went to
her heart. The pallor of her heavy, sagging face showed through her
thick face lacquer as a muddy gray.
"Wha—I saw you go into the kitchen!" she said. "You were wearing
your brown suit. I was looking right at you, and you walked the length
of the living room and went into the kitchen and closed the door
behind you. That's why I yelled at you. You were wearing your brown
suit. You've got the blue one on now. You were wearing your brown
suit!"
"Shut up!" George said passionately. "Are you trying to drive me
crazy? I've been sitting right here all the time. What do you mean,
you saw me walk into the kitchen? You couldn't have. I've been
sitting right here all the time."
"But I saw you! You were wearing your brown suit."
"You imagined it!" her husband shrieked at her. "It's your imagination.
You shut up. What are you trying to do, get me so nervous the Old
Man will think I'm ready for the loony bin? You imagined it!"
Marta looked at him. She had to lick her lips twice before she could
answer.
"Yes. Yes, of course. That must be it. I imagined it."
George spent the rest of the day drinking soma and holding his
hands up before his eyes to see if they had stopped shaking. Marta
got a five-suit deck of cards out of the closet and played solitaire.
None of her games came out, but she was too distraught to realize
that she had left two of the cards inside their box.

Surprisingly, both George and Marta slept well. They awakened far
more cheerful than they had been the night before. Even their pre-
breakfast snapping at each other lacked its usual note of bitter
sincerity. When Marta left the apartment and started out to do her
shopping, she was humming under her breath.
The canned crab was easy enough to locate, but she had to go to
three stores before she could find the peaches and the mushrooms.
She ran them to earth at last in a little grocery on a side street. Just
as she was leaving it, her eye caught the flash of a red label on a low
shelf near the door and she triumphantly dug out two cans of tomato
soup.
"See what I got!" she said, showing her prize to George when she
got back home. "I guess I'm lucky or something. It's awfully hard to
find."
"Gosh!" George shut off the video to give her his full attention.
"That's wonderful. I happen to know the Old Man's crazy about it. His
mother used to have it all the time. I wouldn't be a bit surprised if it
makes him change his mind completely about going to the union.
Marta, you're a smart girl."
Marta spent the rest of the day at the beauty shop, getting her hair
re-garnished with galoons and her face set. She wanted to make the
best possible impression on the captain. Around five-thirty she
began getting dinner—it doesn't take long to open cans—and an
hour or so later the Old Man (his name was Kauss) was chiming at
the door.
Kauss was definitely stiff at first. He greeted Saunders with resentful
formality and gave Marta the merest flash of a smile before his face
grew hard again. When the fragrant steam from the tureen of tomato
soup Marta was bringing in blew toward him, he relaxed somewhat,
and the salad of canned string beans, onions, lettuce and
mayonnaise softened him still more. By the time he had finished two
big helpings of Marta's crab casserole, it began to look like the job
was saved. He offered George a cigar and began telling him a long
story about what the little Martian hostess at the Silver Weetarete
had said to him.
Marta went out in the kitchen to fix the pêche flambée. She cut
sponge cake into neat rounds, spread disks of hard-frozen banana
ice cream over them, and crowned the structure on each dessert
plate with half of an enormous canned clingstone peach. From a
bottle she poured soma carefully over each of the peaches, set a bit
of paper to burning by pressing it against the element in the atomic
range, and then used the paper to ignite the soma on the peaches.
"George!" she called in the direction of the dining apse. "Oh, George,
honey, help me with the plates!"
She heard him come in. She turned at his step, ready to pick up the
plates, one in each hand, and give them to him.
He was wearing his brown suit.
But—he was wearing the green one today, wasn't he, because it was
the best suit he had and he wanted to impress the captain. His green
—his green—
George's face slipped down toward the fourth button on his coat. It
wavered, solidified, flowed back into place, and then slopped down
over his lapels once more. Suddenly it solidified into a sort of
tentacle. It came falteringly toward Marta, half-blind, but purposive.
Marta tried to scream. Her throat was too constricted by terror to let
out more than a mere thread of sound, but it had carrying power.
George and Kauss, out in the dining apse, heard it.
They came running in. Kauss was quick-witted. He picked up one of
the plates with the soma burning on it and hurled it straight at the
thing that was wearing George's clothes.
There was an explosion, so loud that the plexiglass in the windows
bulged outward for a moment, and then a bright, instant column of
flame. Then nothing. George's brown suit lay collapsed and empty
on the floor.
 There was an explosion so loud the plexiglass windows bulged
outward for a moment.

"It was wearing your suit, George," Marta said hysterically. She was
leaning back against the wall, looking faint and sick. "George, it was
wearing your suit. Oh, what was it, what was it, anyway?"
Kauss was looking at the debris on the floor. A peculiar expression,
half satisfaction, half private insight, hovered around the corners of
his lips.
"It was a Mocker, I think," he answered.
"A Mocker? What—?"
"Um-hum. You still find a few of them in the wilder parts of Venus.
They're parasitic—ah—entities, that feed on the life force, as well as
the flesh, of human beings. No doubt this one came aboard the ship
at Aphrodition, in that consignment of Fyella corymbs. They're
invisible most of the time, so of course we didn't suspect it."
"But how did it get here?" George demanded. "Why did it pick on
Marta as a victim?"
"Well, you see the usual way a Mocker works is to select someone
as a host, as a sort of base of operations, and then range out from
him whenever it wants to eat. For some reason, whenever it leaves
its host, it takes on his features and body and dresses itself in his
clothes. That's what happened here. One of the first signs that a
Mocker is taking hold is a spell of amnesia, and of course that's what
happened to you, Saunders, when we were taking on cargo at
Aphrodition, though I didn't realize it at the time.
"A Mocker doesn't usually kill its host directly, but it does draw on his
life force to keep itself going, and he usually complains of feeling
worn out and tired."
Kauss halted. Marta looked down at her husband's brown suit and
the ice cream slowly melting across it.
"Please, George, pick up that stuff before it ruins your suit
completely," she said automatically. And then, to Kauss, "But what
happened when you threw the plate at it? What happened? Oh, I
was so scared!"
"Yes, the Mockers are terrifying." Kauss agreed. He seemed to
square his broad shoulders. "However, at bottom they are
unintelligent—look at the stupidity of this one in attacking you when
your husband and I were in the next room—and they are really not
especially dangerous provided you know the defense against them.
"You see, their body structure, while based on the same elements as
our own, involves large quantities of free hydrogen between the body
cells. Hydrogen ignites in ordinary air with explosive force—the end
product's water—and when I threw that burning stuff at the creature,
the hydrogen in its tissues exploded. It blew up. There's probably a
good deal more water vapor in the air in this room than there was
before I got rid of the thing."
Kauss cleared his throat.
"There's another life form," he said with a faintly professional air,
"allied to the Mocker, but with important differences, which is far
more dangerous. That's the Stroller."
"The Stroller?" Marta asked. George had put his arm around her;
they were not an affectionate couple, but the moment seemed to call
for tender demonstration. "Why do they call it that?"
"No one knows, exactly. It seems to come from the creature's own
name for itself, for its fondness for taking long, long, walks."
Kauss turned the cigar in his mouth. He poked at the suit lying on the
floor with the toe of his shoe.
"What does it do?" Marta queried. "Why is it so terribly dangerous?"
"The Stroller doesn't hunt a host, like the Mocker," Kauss replied.
"Early in life it takes over the identity of some human being, and it
remains indistinguishable from a human being to any usual test. It's
so dangerous because there's absolutely no defense against it. No
free hydrogen in its tissues. It's indestructible."
"My!" Marta said. "Goodness!"
"It feeds, like the Mocker, on both the flesh and the life force of
human beings. Fortunately"—Kauss smiled—"it's very, very rare.
There are probably only a few Strollers in the entire solar system,
and they reproduce only at widely separated intervals."
Once more Kauss halted and poked absently at the clothing on the
floor with the toe of his boot.
"There's a peculiarity about their feeding habits," he said. "They'll go
for years without feeling any desire to eat their special food, and then
something will happen which makes them—greedy, and after that
they can't be stopped before they feed."
"Goodness!" Marta said again. She hid a nervous yawn behind her
hand. "George, get me a chair, will you? I'd like to sit down." To
Kauss, she said. "How did you find out all these things? You must
have made quite a study of the subject. Why, I've read several books
about Venus, and I listen to all the casts on the video about it, but I
never heard either of these creatures mentioned before. It seems to
be a sort of hobby of yours."
George pushed a kitchen chair out for her; she sat down with a sigh
of relief.
"Not a hobby," Kauss corrected gently.
His face began to waver and flow as the Mocker's had done. Then it
snapped back into place.
He licked his lips very delicately.
"You see, I'm a Stroller myself. And, somehow, I'm feeling that I'd like
to eat."
 *** END OF THE PROJECT GUTENBERG EBOOK THE
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