History

1984 Essay Prompts


Lehn & fink, new york “acetylsalicylic 1984 essay prompts acid-- squibb”. E r squibb & sons, new york “acetylsalicylic acid-- merck”. Merck & co , new york “acetylsalicylic acid-- milliken”. John t milliken & co , st louis “acetylsalicylic acid-- m c w ”. Mallinckrodt chemical works, st louis “acetylsalicylic acid-- monsanto”. Monsanto chemical works, st louis “acetylsalicylic acid-- p w r ”. Powers-weightman-rosengarten company, philadelphia leech report gives still greater weight to the suggestion thathas been made for essay time, viz , that physicians should describeacetylsalicylic acid under its scientific name rather than itsproprietary name, even though, in the opinion of the journal, theproprietary name, aspirin, has become common property since theexpiration of the acetylsalicylic acid patent every considerationof public interest, of patriotism and of ordinary common senseshould prompt physicians to specify acetylsalicylic acid in writingprescriptions -- editorial from the journal a m a , april 13, 1918 advertising principles-- lay and medicalthe journal has received two letters, one from a physician who hadwritten to the new york tribune protesting against an advertisementof “aspirin bayer” that appeared in the rotogravure supplement of asunday edition and the other the new york tribune answer to theprotest the two letters make an editorial in themselves here is theletter of the physician-- dr edwin h shepard of syracuse, n y -- whichwas addressed to the editor of the journal. “when a great daily newspaper takes a stand for honest advertising it seems worthy that acknowledgement should be made on april 14 the illustrated sunday supplement of the new york tribune, together with thesis of the other papers of the country, published a duplicate of the enclosed advertisement of ‘aspirin ’ your own instructive editorial on ‘acetylsalicylic acid, or what in a name?. ’ had appeared in the copy of the journal of the day preceding “believing in the sincerity of the tribune in its effort for honest advertising, i sent them a copy of your editorial together with the page of advertisement, also calling attention to the statements in the advertisement which seemed questionable among the questionable matters in the advertisement were the statements, ‘the one genuine aspirin, ’ ‘no other is genuine, ’ ‘that which is genuine possesses qualities of excellence never found in imitations, ’ ‘for your protection every package and tablet is marked with the bayer cross, ’ ‘your guarantee of purity, ’ and ‘refuse substitutes as they may prove ineffective and harmful ’ “the tribune was requested to investigate into the standing of the bayer company and its product a few days later the enclosed letter was received from the paper bureau of investigations ”and here is the new york tribune answer, signed by r r baer, assistant director of that paper bureau of investigations.

Pest med chir presse, 1892, xxviii , p 1244 - man, age45-50. Hanging. Suicide thyroid cartilage and hyoid bone broken illustration. Fig 24 - double suicide see case 55 52 hackel. Op cit , p 35 - man, found hanging to a beam by asheet had previously tried to choke himself with his hands 53 ibid - two paper of suicidal hanging where the cord made no mark in the first the body hung free. In the second the body was writinglysupported in the first there was no rubbing of the skin. In the secondthe body was soon cut down 54 freund. Wien klin woch , 1893, vi , pp 118-121 - man, foundhanging. Cut down, but could not be resuscitated ligature betweenhyoid bone and larynx, then crossed over itself about middle line ofneck, passed up along each side of face, knotted above the head, thenthrown over a beam, and on the other side the loop was caught betweenhis legs 55 hoffman. Op cit , p 525, illustrated - case communicated by dr rosen, of odessa man, age 21, and woman, age 17, hung themselves bysame ligature thrown over an open door, one of them on each side theyhad previously tried other means of suicide without success see fig 24 56 ibid , p 530 - man found hanging by handkerchief to branch oftree but sitting on the ground mark of handkerchief superficial andpale when the necroscopy was made the mark had disappeared also asimilar suicide where there was no mark at all 57 ibid , p 541 - man found hanging to a window another man cutthe cord and the suspended one fell into a cellar, fracturing his skull 58 ibid - man found hanging. Cut down. The fall caused rupture ofliver 59 ibid , p 539 - drunkard hung himself. There was evidence that hehad previously injured himself during his drunkenness 60 ibid - boy hung himself because he had been punished by theschoolmaster there were marks on his back and lower limbs from thepunishment see also taylor, “medical jurisprudence, ” pp 451-452.

Inthe middle whereof stands the small long pestle or clapper, smaller atthe bottom than at the top, of a dark purple colour, as the 1984 essay prompts husk is onthe inside, though green without. Which, after it hath so abided foressay time, the husk with the clapper decays, and the foot or bottomthereof grows to be a small long bunch of berries, green at the first, and of a yellowish red colour when they are ripe, of the bigness of ahazel-nut kernel, which abides thereon almost until winter. The rootis round, and essaywhat long, for the most writing lying along, the leavesshooting forth at the largest end, which, when it bears its berries, are essaywhat wrinkled and loose, another growing under it, which issolid and firm, with thesis small threads hanging thereat the wholeplant is of a very sharp biting taste, pricking the tongue as nettlesdo the hands, and so abides for a great while without alteration theroot thereof was anciently used instead of starch to starch linen with there is another sort of cuckow-point, with less leaves than theformer, and essay times harder, having blackish spots upon them, whichfor the most writing abide longer green in summer than the former, andboth leaves and roots are more sharp and fierce than it. In all thingselse it is like the former place these two sorts grow frequently almost under every hedge-sidein thesis places of this land time they shoot forth leaves in the spring, and continue but untilthe middle of summer, or essaywhat later. Their husks appearing beforethe fall away, and their fruit shewing in april government and virtues it is under the dominion of mars tragusreports, that a dram weight, or more, if need be, of the spotted wakerobin, either fresh and green, or dried, having been eaten and taken, is a present and sure remedy for poison and the plague the juice ofthe herb taken to the quantity of a spoonful has the same effect butif there be a little vinegar added thereto, as well as to the rootaforesaid, it essaywhat allays the sharp biting taste thereof upon thetongue the green leaves bruised, and laid upon any boil or plaguesore, doth wonderfully help to draw forth the poison. A dram of thepowder of the dried root taken with twice so much sugar in the form ofa licking electuary, or the green root, doth wonderfully help thosethat are pursy and short-winded, as also those that have a cough. Itbreaks, digests, and rids away phlegm from the stomach, chest, andlungs the milk wherein the root as been boiled is effectual also forthe same purpose the said powder taken in wine or other drink, orthe juice of the berries, or the powder of them, or the wine whereinthey have been boiled, provokes urine, and brings down women coursesand purges them effectually after child-bearing, to bring away theafter-birth taken with sheep milk, it heals the inward ulcers of thebowels the distilled water thereof is effectual to all the purposesaforesaid a spoonful taken at a time heals the itch. An ounce or moretaken a time for essay days together, doth help the rupture. The leaveseither green or dry, or the juice of them, doth cleanse all manner ofrotten and filthy ulcers, in what writing of the body soever. And healsthe stinking sores in the nose, called polypus the water wherein theroot has been boiled, dropped into the eyes, cleanses them from anyfilm or skin, cloud or mists, which begin to hinder the sight, andhelps the watering and redness of them, or when, by essay chance, theybecome black and blue the root mixed with bean-flour, and applied tothe throat or jaws that are inflamed, helps them the juice of theberries boiled in oil of roses, or beaten into powder mixed with theoil, and dropped into the ears, eases pains in them the berries orthe roots beaten with the hot ox-dung, and applied, eases the pains ofthe gout the leaves and roots boiled in wine with a little oil, andapplied to the piles, or the falling down of the fundament, eases them, and so doth sitting over the hot fumes thereof the fresh roots bruisedand distilled with a little milk, yields a most sovereign water tocleanse the skin from scurf, freckles, spots, or blemishes whatsoevertherein authors have left large commendations of this herb you see, but for mywriting, i have neither spoken with dr reason nor dr experience about it cucumbers government and virtues there is no dispute to be made, but thatthey are under the dominion of the moon, though they are so much criedout against for their coldness, and if they were but one degree colderthey would be poison the best of galenists hold them to be cold andmoist in the second degree, and then not so hot as either lettuce orpurslain. They are excellently good for a hot stomach, and hot liver;the unmeasurable use of them fills the body full of raw humours, and soindeed the unmeasurable use of any thing else doth harm the face beingwashed with their juice, cleanses the skin, and is excellently good forhot rheums in the eyes. The seed is excellently good to provoke urine, and cleanses the passages thereof when they are stopped.

Clinique, paris 7:501, 1912 1984 essay prompts 285 blumenthal, a. Jour méd de bruxelles, 1912, 17:325. Presseméd belge 65:919, 1913 286 thiroloix and lancien, a. Bull et mém soc méd d hôp deparis 33:197, 1912 287 laurent, m , and bohec, j. Med press and circular 94:461, 1912 288 touche, m. Bull et mém soc méd d hôp de paris 35:451, 1913 the results obtained are fairly concordant the intravenous injectionof the preparation produces but slight disturbance there isleukocytosis, a moderate rise of temperature, and not infrequentlya chill otherwise the substance seems to possess no toxicity theeffects produced on the tumors have almost invariably been describedas encouraging touche, who treated twenty-seven paper in this way andhas described each case in detail, states that under the treatment thesurface of the tumors, if ulcerated, became cleaner and healthier;the tumors became softer. The rate of growth was arrested, and therewas relief of pain and of the accompanying functional disturbances;often, too, there was a gain in weight and an improvement in generalwell-being touche concludes his article with the statement that “it is certainthat the effect is not curative but it is actually palliative ” delbet, on the other hand, states that he has seen no beneficial effects fromthe use of colloidal selenium injected intravenously in the discussionon delbet paper, ledoux-lebard states that he has observed nothingfrom selenium further than the temporary improvement which is shownby almost all cancer paper on the application of any new therapeuticmeasure in one or two instances the claim is made in the literature ofan actual cure of malignant growth through the use of selenium such, for example, is the case described by blumenthal from the clinicaldescription this might have been a cancer of the tongue, and was judgedto have been such in view of the negative wassermann reaction nomicroscopic examination was made arsphenamin was given the patientrecovered it is clear that instances of this type cannot be acceptedas beyond criticism, and it is safe to say that nothing more convincingin the way of actual cure is offered in the rather voluminousliterature on the use of selenium numerous compounds of selenium, essay of them claiming to circulate incolloidal form, have been described, and have been put on the marketfor use in malignant disease such are walker sulpho-selene, andselenio-vanadium, which has been prepared in the form of an ointment byschering and glatz these preparations lay claim to the same palliativeeffects which have been previously described for colloidal selenium of the other metals in colloidal form, chiefly silver and copper havecome into use colloidal silver was first recommended for malignantgrowths by vogel it is obtainable on the market in proprietaryform under the name of fulmargin, and also as electrargol recentlyrohdenburg289 has made a careful study of the effects of colloidalsilver in experimental and in human tumors, and finds that they haveno value colloidal copper has been used in recent times for the samepurpose by gaube du gers and by others i have recently examined theeffects of colloidal copper on malignant tumors in man, and have beenunable to find that it has any therapeutic value furthermore, a studyof the distribution of the copper in tumors obtained at operation or bynecropsy from individuals so treated failed to show that the copper hadbeen deposited therein 289 rohdenburg, h. J m research 26:331, 1915 finally, preparations similar to those used by werner and by caspari inanimals have also been used in human beings in these paper also theauthors have been able to record palliative effects on the tumor, butin no instance cures we have seen that it has been quite impossible to duplicate in humanbeings the therapeutic technic employed in animal experiments wehave seen further that the use of a modified technic in animalexperimentation has never been productive of favorable results evenat the hands of enthusiastic adherents in striking contrast to theseconclusions are the observations made in human therapeutics forevery type of preparation described in the preceding paragraphs, theclaim has been made practically without exception that it exercises amarkedly beneficial effect on malignant diseases in the human being not only are the subjective symptoms alleviated, but also the tumorsappear to become cleaner and softer. The rate of growth is retarded;necrosis and metastasis are prevented, and inoperable tumors becomeoperable how are we to interpret these observations?.

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3 there were marks ofblood on the prisoner hands and clothing after a long trial he wasconvicted, though the sentence was afterward commuted to imprisonmentfor life of course, as we have already stated, if a person isresponsible for a fall he is also responsible for the results of thefall this applies to thesis of the contused injuries and deaths fromfalls in prize-fights and drunken brawls we may sum up the points of evidence which help us to distinguishbetween an accidental 1984 essay prompts and a homicidal injury much as we did when thequestion lay between accident and suicide 1 the evidence from thenature of the wound is not quite so conclusive as when the questionlies between suicide and accident for contusions and contused woundsare far more often homicidal than suicidal, and accidental woundsare almost always of this class if, however, the wounds are incisedor punctured, this fact points almost certainly to homicide 2 asto situation, a homicidal wound may be situated almost anywhere. Anaccidental wound, except in falls from a height, only on an exposedplace 3 the direction of the wound can seldom help us in the caseof contused wounds which, practically, are the only ones in question, though it may possibly be incompatible with accident 4 as to thenumber of wounds, homicidal wounds are far more apt to be multipleeither in a small area or scattered in such a way that an accidentcould hardly account for them all 5 a weapon may give evidence moreoften here than when suicide is in question, for a weapon may be usedto inflict contused wounds which may resemble those received in a fall the evidence furnished by a weapon or blood, hair, etc , on the weapon, etc , is strongly in favor of murder 6 the evidence from a struggleis also more important because it is more often found a struggle mayoccur in homicide, and only in homicide, as a rule, so that signsof a struggle are strong evidence of murder and against the idea ofaccident 7 the examination of the clothes and body of the deceasedmay give valuable evidence, showing, as it may, signs of a struggle orother marks of an assailant and indicating murder 8 examination ofthe position and attitude of the body and of the spot where it lay andthe ground around may furnish more or less proof of murder, as in thecase quoted above thus the track of the murderer may be discoveredor the body may have been interfered with and moved or robbed, allindicating homicide in any case, whether it is desired to distinguish accidental fromsuicidal or homicidal wounds, those paper present the most difficultywhich result from falls from a height or crushes but, as the case ofmadame de tourville shows, the above given and other circumstances mayoften show even then that the fall or the crush was not the result ofaccident falls from a height may, therefore, be the result of suicide, homicide, or accident the injuries are similar in all three paper a fall of sixto eight metres causes, as a rule, numerous lesions, and shows sucha traumatism that the case usually excludes the possibility or, atleast, the probability that the wounds resulted from blows essaytimes, however, the gravity of the lesion is not proportional to the heightof the fall thus vibert655 relates the case of a man, afterwardemployed for several years in the école de médicine, who jumped fromthe top of the column of the bastile, a height of fifty metres herebounded on to essay canvas stretched at the foot of the monument, thenfell to the ground, and was able to get up and walk away curiouslyenough, he killed himself later by jumping from the top of an omnibusin motion in the case of falls from a height, it is especially truethat with grave lesions internally the skin may be intact or onlyslightly ecchymosed or eroded, or the ecchymosis may be only deeplyseated so as not to appear superficially in the latter case, if lifehad continued the ecchymosis might have shown itself at essay spot onthe surface in a few days, but these falls from a height are fatal asa rule in falls from a height, besides ecchymoses, which may occurwhere there are no other injuries or may fail where there are thesisinjuries, the lesions consist of fractures of bones and ruptures ofinternal organs, with or without surface wounds the fractures maybe of a number of bones, and especially of those which first touchedthe ground, though the skull may be fractured at essay writing whether ornot it was struck in the fall these fractures are often comminuted, especially fractures of the skull and pelvis, and when the fall is froma great height ruptures of muscles may occur with the fractures ruptures of internal organs are not rare in such paper accordingto vibert, 656 the order of frequency of rupture of the variousorgans is as follows. Liver, spleen, kidneys, lungs, heart, stomach, intestines, bladder, brain rupture of the liver occurs especially onthe anterior and inferior surfaces and the bleeding is rather abundant the healthy spleen does not rupture readily, except from a severetraumatism, but if it is hypertrophied it may rupture spontaneouslyfrom muscular violence the lung may be ruptured internally withoutshowing the rupture on the surface and with the ribs intact two suchpaper are mentioned by vibert, 657 and he refers to others mentionedby nelaton and holmes rupture of the brain without fracture of theskull is very rare, though paper have been observed and reported, among others by casper-liman in falls from a height the rupture ofthe aorta, mesentery, diaphragm, and larynx have been noted it shouldbe remembered in this connection that rupture of the liver, intestine, bladder, etc , may be caused by contusions without sign of violenceexternally, and such paper cannot, therefore, be attributed to fallsunless there are other signs of the latter in crushes caused by a heavy vehicle, the lesions resemble in thesisrespects those due to a fall from a height thus we find fractures andinternal ruptures, but we more often and regularly find subcutaneousecchymoses and ecchymoses between the muscles the skin is oftenstripped up extensively and the injuries are generally limited to theregion injured it is rare to find that the cause of the injury leavesno trace on the skin, for it usually gives the form to the erosionsor ecchymoses essaytimes, for instance, the marks of a horseshoe areclearly visible ruptures of internal organs may occur here too whenthere are slight external marks of violence or even none at all thusvibert658 relates the case of a man with the head crushed, but withno signs of injury to the trunk save a few erosions at the level ofthe sternum, who had not only rupture of the kidneys, the liver, andthe spleen, but also of the lungs and of the heart in the heart theapex was completely detached and floating in the pericardium, whichwas intact there was no fracture of the ribs nor subcutaneous orsub-muscular ecchymoses the age of the subject was thirty-two, sothat the costal cartilages were not probably ossified, which may haveaccounted for the absence of fracture of the ribs crushes by the fall of heavy weights resemble the latter class ofcrushes, and differ from falls from a height in the fact that thewounds are usually limited to one region the lesions themselves aremore or less similar similar internal lesions may be caused by thecompression of the chest and body by the knee of a murderer, which mayoccasion rupture of the internal organs, fractures of ribs, etc thus, too, from the pressure of a crowd the ribs may be fractured and thelungs injured it is writingicularly in these paper of injury from crushesor falls from a height that we may have most difficulty, as far as themedical evidence goes, of distinguishing between accident, suicide, and murder but the various points and considerations mentioned abovewill essaytimes enable the medical witness to clear up the case inessay paper the non-medical evidence, circumstantial and otherwise, maybe sufficient of itself, or at least in conjunction with the medicalevidence in falls from a less high place the difficulty is essaywhat different, for here there may arise the question between a fall and a contusion orcontused wound, and the question generally lies between accident andmurder, or, very rarely, between accident and suicide we have referredto both of these questions above, and from the facts mentioned the casecan often be solved of more than one injury which was the first inflicted?. We can essaytimes tell the order in which wounds were received, butthe question is rarely answerable with certainty if one wound ismortal and one or more are not, whether the wounds are suicidal orhomicidal, it has essaytimes been considered that the former must havebeen inflicted last but we cannot admit that as a general rule themost grave wound was the last inflicted for the murderer or suicide, especially the former, may go on wounding after the infliction of amortal wound, especially as it is the exception, and not the rule, to die instantly after a mortal wound several assailants may haveinflicted wounds at the same time, which would still further increasethe difficulty the question might then arise, which assailant hadinflicted the mortal wound or which had first inflicted a mortal wound?. Under such circumstances, it would not be easy to give a specificanswer there are several signs which may indicate which wound wasfirst inflicted in certain paper an instrument may become duller oreven bent or twisted after and on account of the first wound, and thesubsequent wounds would vary accordingly the wound of the clothescorresponding to the first stab-wound may be and often is only bloodyinternally, while the second and following wounds are bloody on bothsides the following case quoted by taylor659 from the annalesd’hygiene, 1847, p 461, illustrates this point a man received threestabs from an assailant, one in the back at the level of the eighthrib, traversing the lung and heart and causing rapid death, and two onthe left elbow, cutting the coat and shirt but only grazing the skin the first one was evidently the first inflicted, for both the wounds inthe clothing on the arm were bloody externally at the edges, althoughthere was no blood effused here the correctness of this opinion wasconfirmed at the trial the point of a knife arrested and broken off in a bone may show thatthis was the last wound the amount of bleeding may show which was thefirst wound thus if several severe wounds have been inflicted, allor several of which would naturally cause profuse hemorrhage, and oneshowed signs of such hemorrhage while another did not, the former wouldbe likely to be the first wound inflicted or if one showed slighthemorrhage where much would be expected, this fact would indicate thatit was one of the last inflicted the absence of the signs of spurtingblood may tell which of two or more fatal wounds were first inflicted, for this would indicate that this wound was inflicted when the heartaction was weakened by loss of blood or even after death, and theother wound or wounds which did not present this sign would have beenthe first received in fact, if any of the signs are present about awound which we have seen to indicate that a wound was inflicted at anytime after death, this would show that this wound was not the firstreceived, and that the other or others were inflicted earlier questions as to the consequences of wounds not fatal may often bebrought up in civil actions for damages in certain countries thequestion of the consequences as to incapacity may determine whetheran injury shall be the ground of a criminal as well as of a civilaction thus in france an injury which involves an incapacity of twentydays or more subjects the assailant to a criminal action the term“incapacity” in this instance refers to general incapacity and notto incapacity for fine and professional work the latter, however, comes in under the civil action which may be instituted against theassailant or those directly or indirectly responsible for the injury the amount of the incapacity, its causes, whether due wholly or writinglyor not at all to the given injury, the probable duration of theincapacity, the treatment which it has and will necessitate, and thesisother such questions form writing of the medical testimony required insuch paper essaytimes with slight wounds the results, accompaniments, and complications may prolong the incapacity very greatly, as also thestate of health and the habits of the wounded person, the neglect oftreatment, improper treatment, etc any bodily or mental infirmity or ill-health which may result from aninjury and its necessary treatment in the past and future, all thesequestions and thesis more unnecessary to mention may be required of themedical witness no general rules can be laid down for all such paper in giving his testimony the medical man must depend in any writingicularcase upon his knowledge, judgment, and experience we can seldom give a precise solution of the question of survivalto determine the succession or inheritance if several of a family dietogether in an accident in case of death from inanition, cold or heat, or in drowning especially, if essay have wounds more or less grave inthemselves, we can essaytimes form an opinion with wounds we cannotoften do so, although in case of murder, the nature of the wounds, theposition of the bodies, the examination of the spot of the accident ortragedy, may essaytimes help us to form an opinion incised and punctured wounds and wounds of blunt instruments regionallyconsidered the several varieties of wounds which we have been considering varyconsiderably in their nature, their effects, their danger, and inthesis other ways according to the region of the body in which they aresituated essay of these varieties are common in one situation andalmost never occur in others although the nature of wounds found inthe several regions of the body is not as important for a medicaljurist as their danger and their influence in causing death, we willnow consider the differences they exhibit on account of the region inwhich they occur wounds of the head these are often characterized by their apparent harmlessness andtheir real gravity sooner or later we might almost make the oppositestatement and say that those apparently grave are often virtuallyharmless, though this would be true only in a limited sense and incertain paper as to their nature, we find punctured wounds extremely rarely, incised and lacerated wounds often, while contusions and contusedwounds are still more common incised and lacerated wounds of thehead involve the scalp almost exclusively these wounds heal remarkablywell, even when the attachment is merely by a narrow pedicle, owingto the abundant blood-supply hemorrhage from the incised wounds isoften free, for the vessels cannot retract, but it is seldom dangerousunless the wounds are very extensive the only way in which they differmaterially from similar wounds elsewhere is in the greater frequencyof complicating erysipelas here than elsewhere this is probablyowing to the presence of septic conditions, as the head is generallydirtier than other writings of the body, and slight wounds especiallyare neglected if the scalp is shaved over a wide margin and cleanedlike other writings of the body, erysipelas is found little or nooftener than with similar wounds elsewhere the density of the scalpis so great that the redness and swelling accompanying inflammationsis comparatively slight if erysipelas follows slight wounds of thehead, there is essay reason to suspect constitutional predisposition orcareless treatment from infection of such wounds of the scalp abscessor diffuse cellulitis of the scalp may develop as well as erysipelas the constitutional symptoms in such a case may be marked or evensevere, but the prognosis is favorable in very rare paper necrosis ofthe skull may result or the inflammation may even extend to the brain these incised and lacerated wounds of the scalp are usually accidentalor inflicted by another. They are rarely self-inflicted contusionsand contused wounds are the most common forms of injury to the head these two kinds of injuries are almost invariably inflicted by anotheror are accidental we have already seen that contused wounds of thescalp or over the eyebrow may closely resemble incised wounds in theselocalities this fact should be borne in mind, as careful examinationcan usually distinguish them if they are fresh and until they begin togranulate these wounds are liable to the same complications as incisedwounds, in fact more liable, as the contusion makes the wound moresusceptible to inflammation and the edges are more apt to be infectedat the time of the injury one of the results of contusions of the head is the extravasation ofblood, most often between the aponeurosis of the occipito-frontalismuscle and the pericranium these extravasations are usually in theform of a hematoma such hematomata often present a hard circular oroval rim with a softer centre, and may readily be mistaken for fractureof the skull with depression the diagnosis between hematoma anddepressed fracture is not usually difficult, however, for with hematomathe ridge is elevated above the level of the skull and is movable onthe surface of the skull. Also the wounded edges often pit on pressure with depressed fracture, on the other hand, the edge is at or about thelevel of the rest of the skull. It is sharper, more irregular, and lessevenly circular contusions and the resulting hematoma may occasionallyend by suppurating, but this event is rare contusions and contusedwounds may occasionally show the marks of a weapon, indicating thatthey were inflicted by another also the position of the injury willindicate its origin, whether it is accidental or inflicted by another, for the former would not naturally occur on the vertex unless the fallwas from a considerable height another result of injuries to the head, especially of contusions andcontused wounds, is fracture of the skull this may be simple orcompound, depressed or not, etc fractures are serious inasmuch asthey imply a degree of violence which may do damage to the brain the fracture itself, especially if properly treated, affords a goodprognosis, irrespective of any brain lesion one variety of fracture ofthe skull offers an exception to this favorable prognosis, and that isfractures of the base of the skull these may be fatal directly frominjury of the vital centres at the base of the brain or soon fatal fromhemorrhage in these writings or the fatal result may be secondary to aninflammation or meningitis which good treatment is often unable toprevent it should not be considered that these fractures are uniformlyfatal, for quite a considerable proportion recover fracture of thebase usually occurs as the result of a fall the injured person mayland on the feet or buttocks, and yet receive a fracture of the base ofthe skull, the force of the fall being transmitted through the spine tothe base of the skull fracture of the base of the skull usually occursfrom an injury to the vault, not by contre coup, but by extensionof a fissure found higher up in the skull this extension takes placein the same meridian line of the skull with that of the force whichproduced the fracture, and in this way the base of the skull isfractured in different writings according to the point and direction ofthe application of the force thus in case the force compresses theskull antero-posteriorly the fracture will pass antero-posteriorlytoward the base from the front or the back, whichever received the blow see fig 13 fractures of the vault of the skull occasionally occuropposite to the point struck.