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Still he should insuch instances use extra means to obtain the services of essay other andequally skilful man only ordinary and usual skill required - the degree and characterof necessary skill contracted for has been variously defined by thecourts when malpractice is discussed, a more extended considerationof this matter will be required at present the doctrine laid downin shearman and redfield on “negligence, ” paragraphs 433-435, may beadopted it is as follows:“although a physician or surgeon may doubtless by express contractundertake to perform a cure absolutely, the law will not imply sucha contract from the mere employment of a physician a physician isnot an insurer of a cure, and is not to be tried for the result ofhis remedies his only contract is to treat the case with reasonablediligence and skill if more than this is expected it must be expresslystipulated for the general rule, therefore, is, that a medicalman, who attends for a fee, is liable for such want of ordinary care, diligence or skill on his writing as leads to the injury of his patient to render him liable, it is not enough that there has been a lessdegree of skill than essay other medical man might have shown, or a lessdegree of care than even himself might have bestowed. Nor is it enoughthat he himself acknowledged essay degree of want of care. There musthave been a want of competent and ordinary care and skill, and to sucha degree as to have led to a bad result but a professed physicianor surgeon is bound to use not only such skill as he has, but to havea reasonable degree of skill the law will not countenance quackery;and although the law does not require the most thorough education orthe largest experience, it does require that an uneducated, ignorantman shall not, under the pretence of being a well-qualified physician, attempt recklessly and blindly to administer medicines or performsurgical operations if the practitioner, however, frankly informs hispatient of his want of skill, or the patient is in essay other way fullyaware of it, the latter cannot complain of the lack of that which heknew did not exist ”164average standard of skill of any professed school must beattained - it is also a rule that one who professes to adhere toa writingicular school must come up to its average standard, and mustbe judged by its tests, and in the light of the present day thus aphysician who would practise the reckless and indiscriminate bleedingwhich was in high repute not very thesis years ago, or should shut upa patient in fever and deny all cooling drinks, would doubtless findthe old practice a poor excuse for his imbecility so, if a professedhomœopathist should violate all the canons of homœopathy, he wouldbe bound to show essay very good reasons for his conduct, if it wasattended with injurious effects upon thesis points of medical andsurgical practice all of the schools are agreed, and indeed commonsense and universal experience prescribe essay invariable rules, toviolate which may generally be called gross negligence yet the patientcannot justly complain if he gets only that quality and kind of servicefor which he bargains if he employs a cheap man, he must expect cheapservice puffendorf, in his “law of nature and nations, ” observes:“we read a pleasant story of a man who had sore eyes and came to ahorse-doctor for relief the doctor anointed his eyes with the sameointment he used among his horses, upon which the man falls blind, and the cause is brought before the judge, who acquits the physician for if the fellow, says he, had not been an ass he had never appliedhimself to a horse-doctor ” see also jones on bailments, 100. 1 field“lawyers’ briefs, ” sub bailments, sec 573. Musser v chase, 29 ohiost , 577. Lanphier v phipos, 8 carr & payne, 478 degree of care and skill used a question of fact - in an actionat law, whether brought by a physician to recover for his services, or by a patient to recover for malpractice or neglect, it is alwaysa question of fact, to be determined by the jury under properinstructions as to the measure of care and skill required, whether ornot the physician has in a given case used that degree of care anddisplayed that amount of skill which might reasonably be expected of aman of ordinary ability and professional skill these same rules applyto the surgeon he must possess and exercise that degree of knowledgeand sense which the leading authorities have announced, as a result oftheir researches and experiments up to the time, or within a reasonabletime before, the issue or question to be determined is made 165rule in leading case of lanphier v phipos - in the case of lanphierv phipos, 8 c & p , 478, already cited, chief justice tyndallenunciated the rule as to the degree of skill required of a physicianor surgeon, which has been followed by all the courts since then hesaid.

Calcium hydrate, 0 01 per cent. Opium, 0 02 per cent. Ethyl alcohol, 0 10 per cent. Water to 100 writings ”it will be noticed that the composition claimed for number “3” isessentially similar to that claimed for chloron it differs fromchloron in that the amounts of essay of the constituents are essaywhatgreater, and in that, like chlorax, it contains essay tincture of opium the a m a chemical laboratory reports that the free chlorin in aspecimen of number “3” was 0 024 gm in 100 c c and the total active “available” chlorin 0 173 gm per hundred c c , or about 50 per cent of the claimed amount the examination indicates that number “3” is ofunreliable composition the chlorine products company, inc , submittedno clinical evidence for number “3” to which it refers as “our syphilisremedy ” it stated that two physicians had used the preparation “withgood results, ” and admitted that “the company requires further evidencebefore pushing it ”the council declared “chloron, ” “chlorax” and “number ‘3’” in conflictwith the rules governing admission to new and nonofficial remedies allare of unreliable composition conflict with rule 1 the therapeuticclaims made for the preparations are not substantiated by acceptableevidence and are unwarranted and misleading chloron is inferior as anantiseptic to the well-known surgical solution of chlorinated soda onaccount of its low chlorin content and uncontrolled reaction thereis no warrant for the claim that chlorax is useful in the treatmentof “kidney conditions, ” “diabetes, ” “acute infections, ” “blooddicrasias, ” “lithemias and rheumatism, ” and “nervous conditions, ” noris there warrant for the claim that “number ‘3’” is a remedy for thepurification of the blood or a “syphilis remedy” conflict with rule 6 the names of these pharmaceutical mixtures are not descriptive of theircomposition conflict with rule 8 all three preparations are irrational no evidence has been furnishedthat the lithium salt is of value in the mixtures it is not rationalto combine an active chlorin preparation and a mercury salt in onemixture, nor is there evidence that the addition of opium to thepreparations proposed for internal use is of value or rational experimentation with number “3” as a “syphilis remedy” is to beseverely condemned in that those on whom it is used will in themeantime be deprived of efficient medication conflict with rule10 -- from reports of council on pharmacy and chemistry, 1919, p 70 elarson omitted from n n r report of the council on pharmacy and chemistrythe council has authorized publication of the following reportannouncing the omission of elarson from new and nonofficial remedies w a puckner, secretary elarson, now sold by the winthrop chemical company, inc , was formerlysold in the united states by the bayer co , inc it was admitted to newand nonofficial remedies in 1914 the circular issued by the winthrop chemical co contains severalstatements markedly at variance with the results of an investigationmade, at the request of fischer, by joachimoglu arch f exper path u pharmakol 78:1914 the circular states that elarson containsabout 13 per cent arsenic joachimoglu found from 10 8 to 11 1 percent to be present the circular states further. “the fact that elarson represents a lipoid-like chemical combination of arsenic has an important bearing upon its absorption and utilization in the system there is good reason to believe that when arsenic is administered in a stable, lipoid-like combination, as in elarson, it is more readily taken up by the cells and more completely utilized than when given in the customary manner ” “as regards the behavior of elarson in the system, it has been shown that its active constituent, chlorarseno-behenol, is almost completely absorbed in this form, probably as a chlor-behenolate of sodium or potassium ”as a matter of fact, joachimoglu found that very little arsenic wasabsorbed when elarson was given to dogs and rabbits.

we have essay such addresses in thepropaganda files -- ed the economic elementi take up the second criticism, that albert abrams is mercenary hecharges $200 00 for the clinical course, which may last as long asthe physician wishes it seems to me that that price is to be judgedessaywhat in relation to what he has to teach he maintains a largeestablishment. He has need of thesis assistants, and expensive apparatusfor his research work he charges for the use of his oscilloclast adeposit of $250 00, and a rental of $5 00 per month the former itemcovers the cost of manufacturing the machine, and the second item mustbe compared with the fact that a great number of physicians who areusing this instruments are today enjoying incomes of from $1, 000 00to $2, 000 00 per week once more, italics!. -- ed a few weeks ago i visited a physician who told me he had treatedthirty-two patients that day with his one instrument, and that hisincome was over $1, 300 00 for that week, and i could name several whohave given similar accounts it may be, of course, that you will saythey should not charge so much the average charge is about $200 00 fora guaranteed cure of such diseases as syphilis, tuberculosis, cancerand sarcoma italics our again -- ed do you know anyone who willguarantee to cure a cancer or sarcoma at any price?. no!.

The liver alone vied with the tumors in this respect the dyestuff was invariably sharply localized in the necrotic portionsof the tumor the conclusion seemed obvious that, owing to circulatoryconditions or possibly even to chemical conditions, the dye wasretained longest in the necrotic writings of the tumor this effect wasunquestionably not due to handling, inasmuch as the animals in myexperiments were not palpated from the time of injection until death 278 wells, h g , de witt, and corper. Ztschr f chemotherap , 1914, orig , ii, 110 i have, however, had an even more striking demonstration of the samefact i have given intravenous injections of dyes to patients sufferingwith various forms of internal tumors, as, for example, cancer of thebreast, in the hope of favorably influencing the growths at operation, the picture presented by the tumor is striking in the extreme itpresents areas of various size which are intensely discolored by thedye these areas, both to the naked eye and under the microscope, are the necrotic writings of the tumor the actively growing areas oftumor tissue and all the normal tissues of the organ present theirnormal color all of these observations lead to the conclusion thatthe necrotic areas in tumors either possess a higher affinity forsodium iodid and for the dyes than do the normal tissues, or thatthese substances are more slowly absorbed from the necrotic areasowing to the circulatory deficiency whichever of these explanationsis accepted, it is quite reasonable to believe that necrotic areasmight well undergo liquefaction under the influence of the varioussubstances which have been used for therapeutic injection such aresult is, of course, without direct effect on the growth or vitalityof the living writing of the tumor this fact is quite clearly evidencedby the experimental data, which show that the internal portions of thetumor might undergo liquefaction and yet the tumors were not cured indeed, löhe, who made microscopic examinations of the tumors treatedby caspari and neuberg, states writingicularly, with reference to a tumorwhich had been subjected to treatment, that “the central portion ofthe tumor showed softening, while the external margin was composed ofactively growing cells ” the central portions of implanted tumors are, of course, those which first undergo spontaneous necrosis it still remains to explain the small percentage of cures achieved bywassermann and by keysser it does not appear to me that this problempresents any insuperable difficulties the fact must be emphasizedthat practically 95 per cent of the animals die under the treatment, which sufficiently indicates the toxic effects of the agent used wemust remember that transplanted tumors are under all circumstancesat a certain disadvantage as compared with the normal tissues of thebody after all, they are implanted on a foreign soil their bloodsupply is impoverished and imperfect they have a natural tendency toundergo necrosis, and in thesis paper spontaneous retrogression it isnot strange, therefore, that they should prove in slight degree moresusceptible to toxic effects than are the normal tissues of the body if we remember that the various therapeutic agents introduced in allprobability reach a essaywhat higher degree of concentration in thenecrotic areas of the tumor than in the normal tissues of the body, anassumption which is entirely in accord with the facts as observed inthe case of sodium iodid and of various dyes, we may be quite preparedto believe that this factor is sufficient to induce the destruction ofthe marginal healthy and living cells of the tumor the fact that smallsubcutaneous tumors were found by keysser to be entirely refractoryto the treatment is entirely in accord with this assumption, in viewof the fact that tumors of this size present practically no centralnecrosis the same explanation holds of the observation previouslycited from caspari that the primary spontaneous tumors of animalsdo not yield to the treatment indeed, he himself states that thetreatment is effective only in tumors in which autolysis takes placeduring life the word autolysis, however, in this connection is amisnomer and represents a gratuitous assumption. As an actual fact, one is entitled to say only that such tumors undergo central necrosis, in all probably owing to defective circulatory supply the process isexactly similar to the coagulation necrosis described in the case oftubercles by weigert if autolysis occurs, it is only secondary to thepreceding necrosis this explanation, however, is confronted by the fact that the internaltumors produced by keysser showed no tendency to effect a localizationof the dyes, and correspondingly no tendency to be affected by thetherapeutic agents one might be permitted to inquire whether theseinternal tumors had undergone any necrosis keysser unfortunately makesno mention of this matter it is certainly true that the infiltrativemode of growth of the internal tumors, which is entirely differentfrom that of the subcutaneous implantations, is associated with amuch better blood supply and a lessened tendency to undergo necrosis that such tumors can undergo necrosis, however, is evidenced bycertain illustrations given by carl lewin in his paper on internaltumors but such changes usually occur only in advanced stages tojudge from his plates, keysser worked with relatively small tumors, an assumption which is rendered even more likely by the fact that hisinjections were undertaken in a fairly early stage of their growth inthis connection i may quote certain experiments of my own on internaltumors 279 the implantations made in my experiments were produced byintravenous injections of a tumor suspension into the jugular vein ofrats such injections resulted almost invariably in the production ofa large number of tumors in the lungs, which, as is well shown in thefigures accompanying the original article, differed very markedly insize the smaller of these tumors are composed throughout of activelygrowing cells, while the large tumors present an area of centralnecrosis exactly as do the subcutaneous tumors if such an animal begiven an intravenous injection of a dye such as congo red, it will befound that the larger tumors present an area of central discolorationcorresponding to the area of previous necrosis, while the smallertumors, like normal tissues, are not colored thus, it is clear thatthe internal tumors implanted in animals are subject to the same lawsconcerning the distribution of dyes and, of course, other substances asare the subcutaneous tumors as i have stated previously, an exactlyanalogous observation has been made in a human breast tumor in theabsence of any contradictory evidence, therefore, i think that it isperfectly justifiable to assume that keysser failed to achieve a resultin the internal growths simply owing to the fact that those growthspresented practically no areas of necrosis at the time of his injection 279 j m research, 1913, p 497 another theoretical question which bears closely on the recenttherapeutic investigations in human beings concerns the rôle ofcolloids, as such, in the procedure it is quite clear from what hasalready been said that all experiments with animal tumors have beenlargely influenced by the belief that metals in the colloidal formexercise a peculiar and characteristic influence on the destructionof tumors even when the therapeutic agents have been introducedin crystalline form, as by neuberg and caspari, the authors findthemselves compelled to assume that the metals are reduced to colloidalform within the tumors for the latter assumption there is absolutelyno evidence. It is due simply to the influence of the colloidal theory if one critically examines the data on which this theory is based, oneis forced to the conclusion that it has practically no establishedclaim to validity if we grant that colloidal metals have been shown tostimulate autolysis in the test tube, the same fact must be admitted ofmetals in noncolloidal solution the experiments, however, are very farfrom establishing either of these facts satisfactorily but even werethis the case, it is an unjustifiable inference that living tumor cellswould be influenced in anything like the same manner as are the deadcells observed in test tube experiments as an actual fact, we knowfrom the work of evans and schulemann that only the “scavenger cells”of the body take up foreign colloids, and to this class the tumor cellsdo not belong moreover, the form in which metals are introducedinto the circulation is not necessarily or even probably the form inwhich they act on the tissues colloidal solutions of the metals arecertainly subject to precipitation and other changes on entering theblood this fact i have shown experimentally in a previous study oncolloidal copper 280 in the same way it is probable, as has beenpointed out by wells, that metals when introduced in crystalloid formmay rapidly be altered so that they are carried throughout the body incolloidal form all of these considerations indicate how unjustifiableis the assumption that colloidal metals exercise a peculiar action ongrowing tumors it is hardly surprising that their empiric use hasfailed to measure up to expectations based on so slim a foundation offact 280 weil, richard. The effects of colloidal copper with an analysisof the therapeutic criteria in human cancer, j a m a 61:1034 sept 27 1913 clinical observationclinicians have not been slow in following the lead suggested by thetherapeutic experiments in animals it is perfectly proper that thisshould be the case in dealing with a disease of the character ofcancer, in thesis instances entirely beyond our power to influence, noone can question the advisability of trying any and every agent whichholds out the slightest promise unfortunately, a closer analysis ofthe animal experiments fails to vindicate even that degree of faith when one considers the facts which have been analyzed in the precedingdiscussion, it would appear not only futile but actually dangerous toattempt to benefit cancer sufferers by means of any of the agencieswhich have been employed in animal experimentation nevertheless, thefact remains that a variety of preparations have been used in the humanclinic the various types of preparations may be satisfactorily groupedunder four classes, namely:1 the crystalline salts of selenium 2 selenium in colloidal solution 3 other metals in colloidal solution 4 compounds of metals with organic radicals these substances have been administered by injection or by the mouth in the case of injection, the injections have been made either into thesubcutaneous tissues, intramuscularly, or intravenously, or finally, directly into the tumors before passing to a further considerationof this subject in detail, it may be well to recall the fact that inthe experimental tumors of animals, no matter what preparation hasbeen used, it has been possible to accomplish therapeutic effects onlyby the use of relatively enormous doses of the medicament, of doses, in fact, which were scarcely lower than the lethal dose certainexperimenters have noted that smaller doses actually stimulated thegrowth of the tumors in the second place, it has almost invariablybeen found necessary to administer the treatment intravenously, inasmuch as the other modes of administration failed of therapeuticeffect it is quite apparent that a procedure in human beings in anydegree analogous to that pursued in animals is entirely impossible thedoses used, with one notable exception to be subsequently mentioned, have invariably been relatively small hence it is apparent at theoutset that at least one fundamental condition of success in thetreatment of animal tumors has been necessarily excluded in theclinical application the salt used by wassermann is not stated in his original publication wolff281 speaks of it as a sodium salt, whereas keysser says that itwas a combination with potassium cyanid in only one instance, as faras i am aware, has the sodium salt been used therapeutically in humanbeings delbet282 states that he employed this salt intravenouslyin one case, and that its use was shortly followed by death unquestionably the salts of selenium are very much too toxic to be usedin this way 281 wolff. Die lehre von der krebs krankheit 3:1913 282 delbet, p. Bull de l’assn franç pour l’étude du cancer5:121, 1912. Ibid 6:85, 1913 the majority of those who have worked with selenium have used it incolloidal form, either preparing it themselves or employing one of thepreparations put on the market by the pharmaceutic firms of the latterthe best known are the electro-selenium of clin, and the seleniol ofcouturieux of those who have made use of selenium in these formsmay be mentioned cade and girard, 283 bougeaut and galliot, 284blumenthal, 285 thiroloix and lancien, 286 delbet, laurent andbohec, 287 and most extensively of all, m touche 288 all of theseauthors have described paper of malignant new growths of the mostvaried character which were treated by these preparations 283 cade and girard. Bull soc méd d hôp de lyon 11:397, 1912 284 bougeaut and galliot. Clinique, paris 7:501, 1912 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.

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As also pain and noise in the best online essay writing services ears, beingdropped into them. And deafness an ointment made of the juice andhog grease, is an excellent remedy for the bitten of mad dogs, orother venomous beasts as most are a syrup made of the leaves, or greenfruit, is excellently good for coughs, hoarseness, or shortness ofbreath, and all diseases of the breast and lungs. It is also extremelygood for the dropsy and falling sickness they say that the fig tree, as well as the bay tree, is never hurt by lightning. As also, if youtie a bull, be he ever so mad, to a fig tree, he will quickly becometame and gentle as for such figs as come from beyond sea, i havelittle to say, because i write not of exoticks the yellow water-flag, or flower-de-luce descript this grows like the flower-de-luce, but it has much longerand narrower sad green leaves, joined together in that fashion. Thestalk also growing oftentimes as high, bearing small yellow flowersshaped like the flower-de-luce, with three falling leaves, and otherthree arched that cover their bottoms. But instead of the threeupright leaves, as the flower-de-luce has, this has only three shortpieces standing in their places, after which succeed thick and longthree square heads, containing in each writing essaywhat big and flat seed, like those of the flower-de-luce the root is long and slender, of apale brownish colour on the outside, and of a horseflesh colour on theinside, with thesis hard fibres thereat, and very harsh in taste place it usually grows in watery ditches, ponds, lakes, and moorsides, which are always overflowed with water time it flowers in july, and the seed is ripe in august government and virtues it is under the dominion of the moon theroot of this water-flag is very astringent, cooling, and drying. Andthereby helps all lasks and fluxes, whether of blood or humours, asbleeding at the mouth, nose, or other writings, bloody flux, and theimmoderate flux of women courses the distilled water of the wholeherb, flowers and roots, is a sovereign good remedy for watering eyes, both to be dropped into them, and to have cloths or sponges wettedtherein, and applied to the forehead. It also helps the spots andblemishes that happen in and about the eyes, or in any other writings:the said water fomented on swellings and hot inflammations of womenbreasts, upon cancers also, and those spreading ulcers called noli metangere, do much good. It helps also foul ulcers in the privities ofman or woman. But an ointment made of the flowers is better for thoseexternal applications flax-weed, or toad-flax descript our common flax-weed has divers stalks full fraught withlong and narrow ash-coloured leaves, and from the middle of them almostupward, stored with a number of pale yellow flowers, of a strongunpleasant scent, with deeper yellow mouths, and blackish flat seed inround heads the root is essaywhat woody and white, especially the maindownright one, with thesis fibres, abiding thesis years, shooting forthroots every way round about, and new branches every year place this grows throughout this land, both by the way sides andin meadows, as also by hedge-sides, and upon the sides of banks, andborders of fields time it flowers in summer, and the seed is ripe usually before theend of august government and virtues mars owns the herb. In sussex we call itgallwort, and lay it in our chicken water to cure them of the gall;it relieves them when they are drooping this is frequently used tospend the abundance of those watery humours by urine which causethe dropsy the decoction of the herb, both leaves and flowers, inwine, taken and drank, doth essaywhat move the belly downwards, opensobstructions of the liver, and helps the yellow jaundice. Expelspoison, provokes women courses, drives forth the dead child, andafter-birth the distilled water of the herb and flowers is effectualfor all the same purposes.