Kissing the Book.

Kissing the Book.

514 KISSING THE BOOK.-A QUACK SENT TO PRISON. diagnosis of stricture of the oesophagus. The lumps felt sworn in the Scottish fashion. Every British ...

182KB Sizes 0 Downloads 62 Views

514

KISSING THE BOOK.-A QUACK SENT TO PRISON.

diagnosis of stricture of the oesophagus. The lumps felt sworn in the Scottish fashion. Every British subject is in the epigastrium seemed to point to malignant disease of supposed to be acquainted with the laws of his country, so, the cardia. But the regurgitation followed closer and closer legally speaking, a person has only himself to blame who upon deglutition and the patient was not compelled to does not avail himself of the provisions of the Act of 1888 ; diminish more and more the size of the bolus ; more- but it is difficult for the ordinary person to go against the over, the regurgitation was almost selective for liquids. apparent wish of a judge or of a magistrate that the Scottish These facts were not in accord with the existence form should not be employed. We think it would be well of a progressive malignant stricture of the lower end that all persons exercising judicial functions, if they do not The hypothesis of pressure on feel themselves bound to go so far as to give witnesses, of the oesophagus. the oesophagus by a mediastinal tumour was also enter- without their demanding it, the option of being sworn in the tained. On March 8th there was a severe attack of hsemat- Scottish fashion, should at least exhibit a notice in their - emesis; bright red blood was ejected without any effort of courts on the model of that adopted by Judge Emden. vomiting. Syncope followed and about an hour later a stool A QUACK SENT TO PRISON. consisting of black clot was passed. On the following day a similar attack of hasmatemesis occurred and proved fatal. Abraham Levine, described as a tailor, was sentenced at The necropsy showed a greatly enlarged heart and induration the recent County of London Sessions to 15 months’ hard and insufficiency of the aortic valves. The aorta was uni- labour for an assault upon an epileptic girl whom he had formly dilated from the arch to just above the diaphragm, undertaken to cure. Evidence was given that he had for its diameter being more than five centimetres. At the some time made money by pretending to treat disease, - diaphragm was a spherical aneurysm of the size of the particularly epilepsy, and also that he had obtained Z2from flst. It was intimately adherent to the oesophagus, into a woman by promising to bring back her husband who had which it had perforated. The lumen of the oesophagus was deserted her. He was certified for deportation at the but little contracted by the aneurysm. The left pneumoof his sentence. Apparently if Levine had not expiration gastric nerve was involved in the adhesions between taken advantage of the opportunity afforded to him by a the oesophagus and the aneurysm and was exposed in helpless girl being placed in his power by her mother in the communication between them. It is noteworthy that the order to assault her he would have continued to make a only symptoms of the aneurysm before rupture were the wholly dishonest livelihood undisturbed. He possessed no "oesophageal vomiting" (regurgitation) and the salivation medical qualifications, but so long as he made no pretence after taking food. M. Hirtz and M. Lemaire thought that of being a registered medical practitioner he might claim the latter was an oesophago-salivary reflex. M. Antony has to be able to cure any disease, might extract money, and pointed out the existence of this reflex in cancer of the might endanger the lives of his dupes to an extent upon .oesophagus. The survival of the patient after the rupture of which the law imposed no limits. the aneurysm (indicated by the first attack of basmatemesis) is also noteworthy. So, too, are the facts that there was no HÆMATOGENOUS ALBUMINURIA. mechanical obstacle to deglutition and that liquids were not MANY observers have recorded the fact observed in so well swallowed as solids. Dysphagia is rare in aortic cadets, children, and others, who were apparsoldiers, aneurysm. In this case both the salivation and the vomiting that albumin is occasionally found in the healthy, ently appeared to be reflex effects of irritation of the exposed urine. The same is sometimes experienced in pneumogastric nerve during deglutition. Spasm of the examinations for lifedifficulty A young man applies for insurance. ’ce-iophagus was excited and was the obstacle to deglutition. insurance. On examination is found to be satiseverything This explains the selective character of the vomiting. factory except that a trace of albumin is discovered in the urine. The urine is not continuously of low specific gravity KISSING THE BOOK. and the albumin (serum albumin) is often present only at THE question of the possibility of infection by the kissing intervals following the rise from bed or succeeding a meal. ,of the dirty copy of the Gospels in the English form of Or it comes on after muscular exertion, cold bathing, or that - taking the oath in court or elsewhere has again been the emotional strain. The late Sir Andrew Clark stated had who he albuminuria in men found young frequently subject of much correspondence in tne daily press. Our hard This been for their conexaminations. working own columns have for years borne witness to the unpleasantdition is the subject of a paper in this issue of ness and to the risk of infection which the kissing of a book which has been kissed by several hundreds of other people THE LANCET, by Dr. R. Hingston Fox, under the title - entails, and we have again and again drawn attention to the of "Hsematogenous Albuminuria." He refers to the provision of the Oaths Act of 1888, of which Section 5 runs researches of Sir A. E. Wright, who has produced strong grounds for the belief that this form of albuminuria is due as follows :If any person to whom an oath is administered desires to swear with to a disorder of the blood, the outstanding feature of uplifted hand in the form and manner in which an oath is usuallv which is lessened coagulability. Dr. Fox makes some inte- administered in Scotland he shall be permitted to do so and the oath shall be administered to him in such a form and manner without resting observations on the control of the albumin by the ’further question. use of calcium lactate. This is an important point which is Apparently, however, certain officials are still ignorant of, or not generally recognised. Dr. Fox used the test in 16 cases desire to ignore, the provisions of this Act. Thus a corre- of albuminuria indiscriminately. In seven the albumin spondent, writing in the Times of August 17th, says that he disappeared or was reduced to a small trace after the ’recently attempted to be sworn in the Scottish fashion taking of the lactate. Dr. Fox believes that these were all before a London county court judge, but that the judge instances of hsematogenous albuminuria. In the remaining showed much reluctance to accept the oath and he, the nine the albumin persisted ; in most of these cases signs of - correspondent, therefore did not press the point. About kidney disease were present. Notes of the cases are given 11 years ago his honour Judge Emden placed notices in his by Dr. Fox and for details we refer our readers to the - court drawing attention to the fact that any person who had original paper. This clinical test is of considerable importto be sworn might be so sworn in the Scottish fashion, and it was recently announced that the chief clerk of the Lambeth police court had given instructions that all witnesses are for the future to be given the option of being

ance, and if the observations can be further corroborated a valuable aid will be offered to diagnosis. This form of transient albuminuria is not immediately of serious import, but its presence is always embarrassing to the