Document pBD1mMML7XkgjzMy5BoRyDqe6

92 the lancet] medicine and the law [jcly 9, 1932 answer should. become available is, What steps being in unauthorised possession of the drugs. The are taken by candidates before examination at the charge of unlawfully supplying was dismissed. clinic to prevent or postpone the onset of blindness ? " It is in the sphere, however, of more purely ophthalrao- Lunacy Certification in Northern Ireland logical work that- the investigation of cases not blind The Mental Treatment Act (Northern Ireland), will probably prove most fruitful. To take but 1932, which received the Royal Assent last month' one example--among cases who have lost an eye contains a provision (Section 67) corresponding to from injury, what are the causes of defective sight Section 16 of the Mental Treatment Act passed at in the remaining eye? Is myopia or^any other Westminster two years ago. Anyone who in future disease responsible for increased susceptibility to presents a petition for a reception order in Northern, eye injuries f . ' Ireland, or signs or carries out any such order or any ' {To be concluded.) ' report, application, recommendation, or certificate under the Lunacy (Ireland) Acts or the new Act of 1932, is not to be liable to any civil or criminal MEDICINE AND THE LAW proceedings unless he has acted in bad faith or without reasonable care. As in the English precedent, no such A Profitable Infirmity proceedings are to be taken against him without- leave of the High Court ; the Court is not to give leave f Such books as those of Sir John Collie on fraudulentclaims and malingering are sometimes criticised as presenting too dark a picture of human nature. A case at the Old Bailey on June 29th shows the need of vigilance. Ernest Page, aged 51, described as a coach-builder, pleaded guilty to the charge of having unless satisfied that there is substantial ground for the l contention that the defendant has acted in bad faith f or without reasonable care. Thus in Northern Ireland i as in England the onus of proof will be on tbe plaintiff. t tThe person whom it- is sought to make the defendant' is to have notice of any application to the Court for attempted to obtain by false pretences, 127 10s. from one insurance company and 6 Ss. 0d. from another. Ten years ago, it seems. Page discovered that he had a congenital infirmity similar to a broken collar-bone. According to the police statement at the Old Bailey he has profitably exploited it. Up to 192$ he had made 20 claims on insurance companies : one claim was rejected, the rest were paid; the total of his leave to sue, and may be heard on the application. - The rest of the new Act contains provisions for temporary aud voluntary treatment on the lines of the English statute: the expressions ``lunatic," "lunatic asylum," "pauper lunatic," &<,, are to be it I discontinued also as in England. t receipts is reported to have been 22fiS. His imposture was then detected and he was sentenced to 12 months' imprisonment in the second division.. This year he GERMAN WORK ON PULMONARY ASBESTOSIS resumed operations and nearly obtained the sums in respect of which he was charged. Thanks, however, to a fortunate communication between two insurance Although physicians in Germany before the war f companies, his bogus claim was detected in time. The case suggests the need for such companies to keep a black list, and the desirability of pooling all material information as to fraudulent claims. In recounting Page's history a detective-inspector stated that medical practitioners had definitely certified the frac ture of the collar-bone- Page has now been sent to penal servitude for three years. If he should resume his troublesome imposture after release, he may cause us to regret that modern civilisation has abandoned the ancient method of branding the criminal with letters appropriate to his offence. Indelible stigmata applied to the skin over Page's supposed fracture would warn the innocent doctor that this was a case for suspicion. noted that there was something unusual in pneumo- . coniosis as seen in the asbestos worker iFahr1), f no extensive inquiries were made there until quite ? recently. Last year, however, Buunvr-Wols; f and Trillitzsch2 described eight cases from two f factories in the neighbourhood of Dresden. They * noted in the radiograms in the early stages of the t illness circumscribed patches in the lung the size of a * millet- seed or linseed, especially obvious in the lower " lobes, aud that with the progress of the disease : confluent shadowing appeared. fLe phy-ivai -iga? : developed at- a later stage; they wrre those ei a i basal bronchitis, sometimes with dry pk-uri.-y, aad ? it- was difficult to exclude the possibility of tuberca- ( iosis. The writers, like others, pointed out that ' tuberculous foci are very liable to be overlooked in t Dangerous Drugs Act Conviction all pneumoconioses, and they al.>o iound that the 1 A garage proprietor at Oxford, stated to have more serious cases did not -,:ri;y tend to g*; been formerly a chemist's assistant, was charged on worse after removal from tgrir n.im.f.ii sntr'iur.'.mgs-- June 30th with unlawfully supplying a woman with in widen their experience .;t-p--..r> to nave drrl'ercC morphia and with being in unauthorised possession from the early observativt.s A. Bur:-:':. Wood , of drugs. The police dNcovered a quantity of morphia iu this country. Examinath.'-. : thy sputum for * pills an-i ehlo.-ouyne in a tia trank in the garage. The asbestosis bodies was not ' mr Lr:rA oc-s* . woman named in the charge gave evidence on behalf and Trillitzsch did not think '.:.cir . re-erne any mot* ' of the prosecution. The facts, of the case have no evidence of disease than t:;- prei-em-c c-t d-du-t :r special interest, but vr may note her statement that the accused, who naturally pledged her to secrecy, said " if it was known, the police would give me six months quicker than a stroke of lightning." According to her further evidence he added that there were people who would give any amount of money for what he had in the sputum of eoal-miners is pro*': ant uracilis. . uj hoid'tbat asbestosis o>s its individual ch;<ra r:st:.-; almost entirely tu the cner_;<ai vompo^ition t asbest os aud to toe scape "i the uttst pnrric.e^. ax; thev raise the question wnetL-r the different types asbestos may show uihermt harmiul effects, as :t his trunk, and that " doctors who had been struck off the roil" would give him 20 for small quantities. The accused was fined 10 and ordered to pay 13 9s. fid. costs, or two months' imprisonment, tor silicosis. Shortly afterwards Krdg-r. also recorded a e-vn-ct:'-:: - : Dresden. Their wnv> , Ib-:-k;. and S;upe: .--ea .d atou::: Is rn.ir? a-t V 9, 1932 i .-jigs. The c-d. nI i ii^ud), ;st th, . ending to passed at : .. in future . i Northern L ;der or any certificate : new Act of or criminal i or without ,-nt. no such ithout leave give leave ound for the in bad faith hem Ireland the plaintiff. ie defendant' ; he Court for olication. - revisions for the lines of . " lunatic," c., are to he ; ' ONARY ef4 he war il umo- ' :*ker .hr J)( : e' until quite uttner-Wobst ' as from two esden. Tier t' stages of the r ; the size of a ; s in the lower ' f the disease . physical signs ' re those of a : pleurisy, and r ty of tubereu.ted out that overlooked is und that :hs r * tend to get ] urreundings-- have dirtere: Burton Woo.; : sputum for buTTiier-Wocs: euce any morr of coal-dust LraC0s;s. Thfcharacteris*a omposition c-` particles, aid detent types o: i effects, as " ;auy ` arou:,-s a:o THS lancet] UNITED STATES OF. AMERICA [JULY 9, 1932 03 34 females, of whom 30 showed definite changes in through the deposition, due to the solution of the the lungs. The longest exposure to the dust was asbestos, of a colloidal form of liberated silicic acid 31 years, in a worker aged 60. The commonest on the central core of the asbestos fibre. They initial complaint was dyspnoea, and there was cough regard the discrepancy between the clinical Pj 43 of the cases ; night-sweats were present in 12, appearances and symptoms on the one hand, and the and rheumatic pains, headaches, and general nervous X ray picture bn the other, as a characteristic peculiar vmptoms in 15. Further, conjunctivitis was noted to asbestosis. Even the most severe cases of asbestosis a 16 cases--a symptom which has not attracted did not give-as pronounced a radiological picture as pjuch attention in this country, though asbestos that of silicosis ; in fact, in the third stage of asbestosis flbres in laerymal secretion have been described the degree of shadowing present would have little Burton Wood and S. R. Gloyne. Sputum was clinical significance in silicosis. They believe that obtained in 23 cases and in eight of them contained in asbestosis the silicic acid acts as a chemical irritant asbestosis bodies. Among other new observations which leads to fibrosis. Connective tissue is regarded on the blood and circulation it was found that there as particularly sensitive to the action of silicic acid, ffas a fall of hemoglobin. The radiograms showed and it is suggested that when the silicates of the three stages: (1) an increase of the normal lung asbestos are dissolved in the lung tissue, silicic acid striation with the appearance of a fine not very clearly is liberated, is taken up by the connective tissue, defined network ; -(2) a thicker network with delicate, and stimulates increased growth. Gerbis and Ucko sharply defined opaque spots; (3) an intensification give no support to the statement that asbestosis is of this network to form a shadowy veil covering the formed on the soil of a tuberculous infection ; indeed, lun*. The signs are first seen and are most marked this theory is contradicted by their observations. jn the mid zone and lower lobe areas. The contour The fact that the patient suffering from asbestosis of the heart shadow becomes ill-defined in the second is more liable to pneumonia gives rise to a bad sta^e; the root shadows were not affected in this prognosis. sta^e but show enlargement in the third stage. Finally, Timmermans 6 gives a short disquisition `The statistical tables appear to indicate that on the formation of the asbestos body. He thinks moderately severe asbestosis takes some five years to the two main types of body, the " handle-form " develop, while none of the workers examined who with a knob at both ends, and the "carrot-form " hod had ten years or more exposure was. free from with one end tapering, are an indication of some signs of the disease. The most advanced cases were difference in formation. He suggests that the shape found in the spinning section of the factories. , of the asbestos body is conditioned to a large extent Beintker 4 records two cases with, an account of i by the surrounding tissue, the handle-forms being post-mortem examinations from a factory concerned produced in places where there is no movement, and with the crushing, cleansing, and spinning of the , carrot-forms where the tissue fluid is in motion. asbestos and the manufacture of insulation materials in Munster. He believes that the morbid anatomy REFERENCES of the condition depends upon the distribution of the asbestos fibres in the lung tissue, and that the fibres which gain access to the body probably do not benn 'their development into asbestos bodies until they reach the tissues. The bodies are apparently the accumulation of the silica-containing material. Gerbis and Ucko 5 record the examination of 33 1. Fabr: Mfinch. med. Woch.. 1914, Ivi., 625. 2. Buttner-Wobst, \V., and Trillitzscb, 0.: Die TuberkuJose, 1931, vi., 11. 3. Kruger, E.. Rostoski, and S&upe: Arch. t. Gewerbepatb. it. Gewerbehyg., 1931, il.. 558. 4. Beintker, E. : Ibid.. 345. 5. Gerbis and Ucko: Dent. m?d. Woch.. 1932, iviii.. 253. 6. Timmermans. F. D., Zentr. f. Gewerbehyg. und Unfallver- biitung, 1931, Tiii., 2S0 and 307. asbestos workers in another German factory in Berlin. Nearly all the cases showed the usual cvmptoms--e.g., cough and sputum with dyspncea, UNITED STATES OF AMERICA (specially on exertion or in foggy weather; 16 (FROM AN OCCASIONAL CORRESPONDENT) complained of lack of appetite, 10 of loss of weight, 5 had pain in breathing, 5 had palpitation of the heart; others complained of faintness and of increas MEDICAL BENEFITS TO EX-SOLDIERS ing pallor. Cough was present in 23 cases. The More than 8450,000,000 a year could be saved by sputum was tenacious, scanty, generally mucoid, the federal government if present benefits to ex and occasionally mucopurulent. Previous history soldiers who are not suffering from war disabilities included pulmonary catarrh in four cases, pleurisy in were eliminated from the national budget. This is the two, and peritoneal tuberculosis in one case. In conclusion of a report by its committee on public- c'.v one >a female) was there any family history of health relations, approved for publication by the tuberculosis and the authors have been unable to Council of the Xew York Academy of Medicine. The '"ce any close connexion between asbestosis and injustice and wastefulness is only fully realised." they uberc-Jos:?. The clinical and X ray fiadimrs noted add. '`when one contemplates the improvement in -Tu-.-ut to correspond closely with those of Buttner- the health or the people of the entire country which Whst and Trliiitzscli. and of Sru-rer, Rostoski. could eventually be obtained with a fraction of this ivi iaupe. The authors noted that the severity of colossal sum." disease did not appear to be dependent on the During and immediately after the war. Congress of the worker, but rather on the number of years passed legislation providing for medical care and com had been in the factory and on the amount of pensation for veterans 'as our ex-soldiers are called) '"-'"os dust inhaled, which, varies considerably in who had been sick or disabled as a result of war --'rent processes. Whenever a patient had been service. In the post-war years, however, there * r:<i::g for more than ten years, asbestosis could be developed an ex-service men's lobby, fostered by the :-:nor:st;a!ed radiologicaiiy. Personal disposition American Legion and the Veterans, of Foreign Wars, to play a part in the production of the which undertook to widen the scope of existing benefits -mges. With regard to the asbestosis bodies, and to seek others. They have been highly successful, r:'`>a::d Ucko quote the views of Beintker 4 and for there is a large ex-soldier vote as well as a popular rn-.ans e to the effect that the bodies arise patriotic sentiment which Congressmen dare not