of 1 /1
1406 probably from the peculiar principle, asparagine, and I has no reference apparently to the function of the kidneys. There are no doubt examples of persons who exhibit an idiosyncrasy towards asparagus and develop unpleasant symptoms after eating it, just as there are people who are poisoned by mutton or strawberries, but on the whole there is nothing to be said on physiological grounds against moderate indulgence in this very popular vegetable food. THE CLEARING OF THE AIR. FROM an interesting communication by Mr. A. G. B. Foulerton and Dr. A. M. Kellas, published in another column, it would appear that electrical discharges of high potential and rapid frequency are without direct effect upon micro-organisms but that indirectly these discharges destroy germs owing to the action of chemical substances formed as the result of electrical action on the atmosphere through which the discharge takes place. Amongst the products formed in the air on the passage of the discharge are nitrous and nitric acids and probably ozone and peroxide of hydrogen, all of which are powerful germicides, but more particularly so at the moment of their formation. It is well known that substances which in the free condition are comparatively inert are intensely active in the nascent state. In view of these results there seems to be little doubt that the occurrence of a thunderstorm must exert a powerful purifying influence on the air, even to the total destruction of organisms. It is often stated that a thunderstorm does good because it clears the air, but so far this statement has not received explanation in such precise pcientiuc terms. Further, it would be interesting to determine whether the production in the nascent state of nitrous acid, ozone, or peroxide of hydrogen has anything to do with the turning " of milk or the "hardening " of beer which frequently happens during the progress of a thunderstorm. The treatment of disease, as, for example, lupus, by "high- frequency " discharges may after all owe its success to the formation of these germicidal substances in the intensely active condition known as the nascent state, in which case the employment of "high-frequency" discharges would be merely a reversion to the antiseptic method but probably with more intense effect. ____ THE PATHOGENY OF DIABETES. IN THE LANCET of May 5th, p. 1229, we published a paper on the above subject read before the International Congress of Medicine at Lisbon by Dr. F. W. Pavy. The researches of Dr. Pavy into the causation of diabetes are well known and consequently any further communication from him on the subject merits most careful attention. Various theories as to the pathogeny of diabetes have been ex- pressed by competent observers from time to time but even now no unanimity of opinion can be said to exist. The kidney, the liver, and the pancreas have in turn been considered the organ in which the disease origi- nated but most authorities now point to the nervous system as playing the most important r6le in the production of glycosuria. The exact manner in which its action is brought to bear, however, appears to be doubt- ful. Dr. Pavy adduces some powerful arguments in favour of the vaso-motor system supplying the chylopo’etic viscera being mainly involved. He points out that it is in connexion with the neuropathic disposition that diabetes is most frequently found to exist and the more sensitive and highly strung the nerve organisation the more intense is the form that the disease assumes. He further remarks that a cerebral influence over the vaso- motor state is what is suggested as constituting the link between the brain and diabetes. But little is known at present of the physiology of the vaso-motor system of nerves through which cerebro-spinal influence upon vessels is exerted. Certain parts of the grey matter of the brain appear to be in touch with vascular areas and it is SUggf sted that the nerve filaments of the sympathetic system are not only connected with the spinal cord and medulla oblongata but with spots at the surface of the brain which stand in the position of cerebral vaso-motor centres. Upon these grounds Dr. Pavy considers that a chain of connexion becomes established, rendering it ros- sible for diabetes to constitute a disease belonging to the neurosis class, the difference in its case being the implication of a particular area belonging to the vaso. motor system instead of structures connected with volun- tary motion, sensation, and the mind. Morat and Dufour, from their researches, maintained that sugar forma- tion is a function of the liver cells, under the control of certain undetermined excito-secretory nerves which they considered distinct from the vaso-motor nerves. It may well be suggested that this nervous influence may be liberated by certain toxins and the pancreas may also have an in-, fluence upon this function. Doubtless other investigations will be made to corroborate or otherwise Dr. Pavy’s con- clusions but until such are concluded the pathogeny of diabetes must still remain in doubt, although his researches must be taken as being amongst the mort important and suggestive yet published. - A PATIENT’S COMPLAINTS AS EVIDENCE. ONE of the very few exceptions allowed by a court of law to the rule which rigidly excludes hearsay testimony as valid evidence is that exclamations and statements made by an injured or sick person concerning the symptoms from which he suffers may be admitted as evidence, for it is by the aid of such information that the medical adviser arrives at his diagnosis and is able to decide upon a line of treatment. Recently in the Supreme Court of Michigan there was an unsuccessful attempt to enlarge the scope of this exception. The victim of a railway accident called in the medical man who was permanently Ie- tained as the expert witness of the defendant railway company ; to him she detailed her symptoms, notably certain localised pain and tenderness were alleged by her. The court held that to admit these statements as evidence would be a breach of the rule which forbids the production of hearsay testimony. The court suggested that even if the statements of the patient were admitted the possibility of malingering would have to be discussed fully. Apart from this phase, however, the court decided that it was the design of the plaintiff to make the communications for the purpose of enhancing her claim and that fact made them inadmissible for the reason that they were not the natural expressions of present sufferings but voluntary statements for an ulterior purpose and hence they were not within the above exception to the hearsay rule. ANTE-PARTUM OPHTHALMIA. IN the Ophthalmoscope for April Mr. Sydney Stephenson and Dr. Rosa Ford have published an important paper on a condition supposed to be extremely rare but which they think occurs more frequently than is supposed-ante-partum ophthalmia. By ante-partum ophthalmia they mean an inflammation of the conjunctiva produced in utero by infection with a microbe (generally the gonococcus), the incubation period of which has elapsed completely or partially before birth. They have found recorded 37 cases, to which they add 17 cases observed by themselves. These include seven cases in which the symptoms developed within 24 hours of birth-a time which they take for the present purpose as the minimum incubation period. The majority of cases of ophthalmia neonatorum occur on the

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1406

probably from the peculiar principle, asparagine, and Ihas no reference apparently to the function of the kidneys.There are no doubt examples of persons who exhibit an

idiosyncrasy towards asparagus and develop unpleasantsymptoms after eating it, just as there are people who arepoisoned by mutton or strawberries, but on the whole thereis nothing to be said on physiological grounds againstmoderate indulgence in this very popular vegetable food.

THE CLEARING OF THE AIR.

FROM an interesting communication by Mr. A. G. B.Foulerton and Dr. A. M. Kellas, published in another

column, it would appear that electrical discharges of highpotential and rapid frequency are without direct effect uponmicro-organisms but that indirectly these discharges destroygerms owing to the action of chemical substances formed asthe result of electrical action on the atmosphere throughwhich the discharge takes place. Amongst the productsformed in the air on the passage of the discharge are nitrousand nitric acids and probably ozone and peroxide of

hydrogen, all of which are powerful germicides, but moreparticularly so at the moment of their formation. It iswell known that substances which in the free condition are

comparatively inert are intensely active in the nascent state.In view of these results there seems to be little doubtthat the occurrence of a thunderstorm must exert a powerfulpurifying influence on the air, even to the total destructionof organisms. It is often stated that a thunderstorm does

good because it clears the air, but so far this statement hasnot received explanation in such precise pcientiuc terms.

Further, it would be interesting to determine whether theproduction in the nascent state of nitrous acid, ozone, orperoxide of hydrogen has anything to do with the turning

"

of milk or the "hardening " of beer which frequentlyhappens during the progress of a thunderstorm. The

treatment of disease, as, for example, lupus, by "high-frequency " discharges may after all owe its success to theformation of these germicidal substances in the intenselyactive condition known as the nascent state, in which casethe employment of "high-frequency" discharges would bemerely a reversion to the antiseptic method but probablywith more intense effect.

____

THE PATHOGENY OF DIABETES.

IN THE LANCET of May 5th, p. 1229, we published a paperon the above subject read before the International Congressof Medicine at Lisbon by Dr. F. W. Pavy. The researchesof Dr. Pavy into the causation of diabetes are well knownand consequently any further communication from himon the subject merits most careful attention. Varioustheories as to the pathogeny of diabetes have been ex-

pressed by competent observers from time to time buteven now no unanimity of opinion can be said to exist.The kidney, the liver, and the pancreas have in turn

been considered the organ in which the disease origi-nated but most authorities now point to the nervous

system as playing the most important r6le in the

production of glycosuria. The exact manner in whichits action is brought to bear, however, appears to be doubt-ful. Dr. Pavy adduces some powerful arguments in favourof the vaso-motor system supplying the chylopo’etic viscerabeing mainly involved. He points out that it is in connexionwith the neuropathic disposition that diabetes is most

frequently found to exist and the more sensitiveand highly strung the nerve organisation the more

intense is the form that the disease assumes. Hefurther remarks that a cerebral influence over the vaso-motor state is what is suggested as constituting the

link between the brain and diabetes. But little is

known at present of the physiology of the vaso-motor

system of nerves through which cerebro-spinal influence

upon vessels is exerted. Certain parts of the grey matterof the brain appear to be in touch with vascular areas andit is SUggf sted that the nerve filaments of the sympatheticsystem are not only connected with the spinal cord andmedulla oblongata but with spots at the surface of the

brain which stand in the position of cerebral vaso-motor

centres. Upon these grounds Dr. Pavy considers that a

chain of connexion becomes established, rendering it ros-sible for diabetes to constitute a disease belonging tothe neurosis class, the difference in its case being theimplication of a particular area belonging to the vaso.

motor system instead of structures connected with volun-

tary motion, sensation, and the mind. Morat and Dufour,from their researches, maintained that sugar forma-tion is a function of the liver cells, under the control ofcertain undetermined excito-secretory nerves which theyconsidered distinct from the vaso-motor nerves. It maywell be suggested that this nervous influence may be liberatedby certain toxins and the pancreas may also have an in-,

fluence upon this function. Doubtless other investigationswill be made to corroborate or otherwise Dr. Pavy’s con-clusions but until such are concluded the pathogeny ofdiabetes must still remain in doubt, although his researchesmust be taken as being amongst the mort important andsuggestive yet published.

-

A PATIENT’S COMPLAINTS AS EVIDENCE.

ONE of the very few exceptions allowed by a court of lawto the rule which rigidly excludes hearsay testimony as validevidence is that exclamations and statements made by aninjured or sick person concerning the symptoms from whichhe suffers may be admitted as evidence, for it is by theaid of such information that the medical adviser arrivesat his diagnosis and is able to decide upon a line of

treatment. Recently in the Supreme Court of Michiganthere was an unsuccessful attempt to enlarge the scopeof this exception. The victim of a railway accidentcalled in the medical man who was permanently Ie-

tained as the expert witness of the defendant railwaycompany ; to him she detailed her symptoms, notablycertain localised pain and tenderness were alleged byher. The court held that to admit these statements as

evidence would be a breach of the rule which forbids the

production of hearsay testimony. The court suggested thateven if the statements of the patient were admitted thepossibility of malingering would have to be discussed fully.Apart from this phase, however, the court decided that it

was the design of the plaintiff to make the communicationsfor the purpose of enhancing her claim and that fact madethem inadmissible for the reason that they were not thenatural expressions of present sufferings but voluntarystatements for an ulterior purpose and hence they were notwithin the above exception to the hearsay rule.

ANTE-PARTUM OPHTHALMIA.

IN the Ophthalmoscope for April Mr. Sydney Stephenson

and Dr. Rosa Ford have published an important paper on acondition supposed to be extremely rare but which theythink occurs more frequently than is supposed-ante-partumophthalmia. By ante-partum ophthalmia they mean aninflammation of the conjunctiva produced in utero byinfection with a microbe (generally the gonococcus), theincubation period of which has elapsed completely or

partially before birth. They have found recorded 37

cases, to which they add 17 cases observed by themselves.These include seven cases in which the symptoms developedwithin 24 hours of birth-a time which they take for thepresent purpose as the minimum incubation period. The

majority of cases of ophthalmia neonatorum occur on the