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Line everywhere equal, deep, and three to four mm wide. The skin excoriated and covered with thick crust below this wereseveral superficial excoriations there were thesis contusions on otherwritings of the body tardieu concluded that the mark on the neck wasfrom attempt to strangle. The wounds elsewhere to prevent resistance she had at the time pulmonary consumption she died of this diseaseaggravated by the assault 67 ibid , p 106 - the duroulle affair woman found hanging presumption of homicide. Arrest of husband. Acquitted she was foundwith her face to the floor, one end of a cord around her neck. Anothersimilar cord attached seven feet above to a rafter, over which itpassed three times bidault and boulard reported it a suicide theresults of the post mortem were as follows. Skin of a red-violet color;face swollen.

Fig 4 - stab-wound of the skin with a knife a fewminutes before death 2d punctured wounds by instruments both sharp pointed and cutting, like a knife or dagger if these wounds are perpendicular to thesurface, they have more or less the form of the weapon used the anglesmay show whether the knife, etc , had one or two cutting edges, buteven though the back of the knife is broad the wound may resembleone caused by a double-edged weapon thus stab-wounds from a commonpocket-knife show only exceptionally a wedge-shape, but regularly aslit, the edges of which are slightly curved to one another and end intwo acute angles the reason of this lies in the fact that the wound isonly caused by the cutting edge of the knife, so that we cannot tellas a rule which angle was occupied by the back of such a knife figs 4 and 5 the depth of these wounds may equal the length of the weaponor be almost any degree less, but the depth may even be greater thanthe length of the weapon by reason of a depression of the writings atthe time of the blow the wound is often shorter and broader than theweapon causing it, though more often it is larger than the weapon fromthe obliquity of the wound and the movement of the weapon on beingwithdrawn the wound is smaller than the instrument where the writings areon the stretch at the time the wound is inflicted illustration. Fig 5 - nine suicidal stab-wounds in the region of theheart made by a knife used for cutting rubber this variety of punctured wounds may resemble the former class in thedirection of its long axis, if the cutting edge of the instrument isblunt the regularity and smoothness of the edges distinguish them fromcertain contused wounds 3d wounds made by instruments with ridges or edges, files, foils, etc if the edges are cutting the wound presents more or less the shapeof the weapon fig 6 but this is not always so, probably from theinstrument puncturing obliquely or from the tissues being unequallystretched fig 7 if the edges are not cutting the wound resemblesthose of the first class, though the edge often presents little tears, and the wound may thus be more or less elliptical with two unequalangles the wound of entrance and exit may be different illustration. Fig 6 - stab-wounds caused by a three-sided sharp-edgedpointed instrument 4th irregular perforating instruments, the wounds from whichresemble contused wounds contusions and contused wounds - a contusion is a wound of livingtissues by a blow of a hard body, not sharp-edged or pointed, or by afall, crushing, or compression, and without solution of continuity ofthe skin a contusion usually involves a moderately large surface incomparison to the two other classes of wounds contusions are of alldegrees of severity if the blow or injury is slight, there is onlyslight redness and swelling of the skin with pain, disappearing in afew hours, and leaving no traces if the blow be harder it producesmore or less crushing of the tissues, accompanied by ecchymosis withor without a wound or excoriations of the skin, etc the contusion mayhave the shape of the contusing body, such as a whip, the fingers, etc illustration. Fig 7 - stab-wounds caused by an eight-sidedsharp-edged instrument essay show a transition stage to wounds made bya conical instrument ecchymosis - this is characteristic, as a rule, of contused wounds it consists in the infiltration of blood into the tissues, especiallythe cellular tissues the source of the blood is from the ruptureof blood-vessels, and the size of the ecchymosis varies writingly withthe number and size of the blood-vessels, or with the vascularity ofthe writing the size of the ecchymosis also varies with the loosenessof the tissues into which it is infiltrated this looseness of thetissues may be natural as in the scrotum and eyelids, or it may be dueto the attrition of the tissues caused by the blow an ecchymosis islarger when the contused writings cover a bony or resisting surface, andthere may be no ecchymosis whatever, even from a severe blow, wherethe underlying writings are soft and yielding, as is the case with theabdominal parietes here we may have rupture of the viscera without anysigns of ecchymosis superficially an ecchymosis may be infiltrativeor it may mostly occupy a cavity usually formed by a traumaticseparation of the tissues. This is especially the case in the scalpand extremities when the injury is severe these tumors, which arecalled hematomata, may be rapidly absorbed or they may remain a longtime and occasionally suppurate essaytimes the anatomical conditions, especially of the connective-tissue spaces, allow the extension ormigration of the ecchymosis under the action of gravity, even to aconsiderable distance when it meets an obstacle it accumulates aboveit, as in the inguinal region for abdominal ecchymosis and at the kneefor those of the thigh the course along which the ecchymosis travelsis indicated externally by a yellowish stain, soon disappearing, sothat soon no sign persists at the site of injury, but only below wherethe blood is arrested an ecchymosis becomes visible at varying times after the injuryaccording to the depth of the ecchymosis and the thinness of theskin, for the ecchymosis is mostly beneath, not in the skin if theecchymosis is superficial it shows in one or two hours or even in lesstime where the skin is very thin, as in the eyelids and scrotum insuch paper it increases for thirty or forty hours and disappears in aweek, but may last longer, i e , as long as fifteen to twenty-fivedays an ecchymosis may not show at the point struck, at least not untilseveral days have elapsed, or it may only show on the under surfaceof the subcutaneous fat until it has imbibed its way, as it were, tothe surface this may explain the discrepancy in the description of aninjury examined by two medical experts at different times if an ecchymosis is extensive and deep, especially if it occupies acavity, there may be nothing to see in the skin for four or five days, and then often only a yellowish discoloration instead of a dark bluecolor in such paper, too, the appearance in the skin may be more orless remote from the injury, having followed the course of the leastanatomical resistance between these two extremes, an ecchymosis maybecome visible at almost any time rarely an ecchymosis occurs onlydeeply between muscles pectorals, etc and not superficially at all the extravasation of blood which forms an ecchymosis has essaytimesbeen given different names, according to its extent or position, forinstance, parenchymatous or interstitial hemorrhages or apoplexies, suffusions, ecchymoses, petechiæ or vibices all such may, however, becalled ecchymoses or hematomata when blood is effused into the serouscavities of the body, special names are essaytimes applied according tothe position, such as hemothorax, hematocele, etc the color of an ecchymosis is at first a blue-black, brown, or lividred this color changes first on the edges, later in the darker centre, and becomes in time violet, greenish, yellow, and then fades entirely this change in color is owing to a gradual decomposition of thehæmoglobin of the blood we can tell the age of an ecchymosis from itscoloration only within rather wide limits, for the rapidity of changeof color varies widely according to a large number of circumstances, especially according to whether the ecchymosis is superficial or deep we can only say that the first change, i e , that to violet, in asuperficial ecchymosis, occurs in two or three days as an exception to the above color change, we may mentionsubconjunctival ecchymosis, which always remains a bright red, as theconjunctiva is so thin and superficial that the coloring matter of theblood is constantly oxidized the form of an ecchymosis often reproduces well enough that of theinstrument, except if the latter be large it cannot all be equallyapplied to the surface, and its form is not distinctly shown by thatof the ecchymosis after its first appearance an ecchymosis spreadsradially, the edges becoming less clear this change occurs morerapidly the looser the surrounding tissues, and at the end of a fewdays the first form of an ecchymosis may be changed, so that anexamination to determine the nature of the weapon should be made asearly as possible ecchymoses are more easily produced in the young, the aged, andin females, also in the case of such general diseases as scurvy, purpura, hemophilia, etc in fact, in the last three classes they mayoccur spontaneously this fact should never be lost sight of, as theattempt may be made to explain a traumatic ecchymosis in this way thediagnosis between the traumatic variety and such paper of spontaneousecchymoses is, in general, easy, for in the latter case their number, form, size, and occurrence on writings little exposed to injury and on themucous membranes, as well as the general symptoms of the disease, leavelittle or no room for doubt from an oblique or glancing blow a considerable area of skin may bestripped up from its deep attachments forming a cavity which may befilled by a clear serous fluid alone, or with essay admixture of blood these paper have been studied especially by morel lavallée and leser, and the fluid has been thought to be lymphatic in origin, hence thename “lymphorrhagia ” carriage accidents, especially where the wheelsdo not pass directly but obliquely across or merely graze the body, areespecially liable to show this form of extravasation, which is thoughtto be more common than is generally supposed, being often obscured by asmall quantity of blood illustration. Fig 8 - linear wound with nearly clean-cut edges, withstrands of tissue bridging across at the bottom and caused by a fall onthe head on a smooth surface contused wounds - if with the contusion we have a solution ofcontinuity of the skin, then we have a contused wound this mayessaytimes resemble an incised wound if the weapon has marked angles oredges, as a hammer, or, as we have already seen, in wounds of the scalpor eyebrow fig 8 careful examination, however, by a small lens ifnecessary, is sufficient to distinguish them if they are fresh ifthey are four or five days old and have begun to granulate, it may beimpossible to distinguish them contused wounds present on examinationsmall tears on the edges which are widely separated and more or lessextensively ecchymosed contused wounds are often irregular, andhave thickened or swollen and ragged borders they may, like simplecontusions, show by their shape the form of the instrument which causedthem in contused wounds, unless they be perfectly aseptic, we usuallyfind sloughing of the contused, necrotic tissues this leaves a cavityto be filled up by granulation like wounds with loss of substance they therefore often present large cicatrices which may be mistaken forthose of ulcers in contused wounds the bone may essaytimes show theimpression of the instrument causing the wound a variety of contused wounds is that where the wound of the skinconsists merely of an erosion or excoriation with an ecchymosisbeneath the wound may reproduce the shape of the weapon, i e , finger-nails, etc after death the skin becomes brownish-yellow, hard, and dry, and then they are called by the french “plaquesparcheminées ” they are distinguished, as a rule, from those producedafter death, by the ecchymosis beneath lacerated wounds resemble contused wounds very closely, but are notecchymosed to any considerable extent the solution of continuity isessaytimes very extensive and irregular, and may present several flaps the bone or bones are often fractured at the same time they seldombleed much the course of repair resembles that of contused wounds asa rule the prognosis is variable, for there may be slow and extensivecicatrization and impairment of function, etc these wounds usuallyresult from machinery accidents and accidental tears, etc they aretherefore seldom the occasion of criminal proceedings but more often ofa civil suit, and thus require medical examination the injury which causes a contusion or contused wound may notinfrequently produce effects far more serious and more or lessremote from the contusion essay of these effects it may be well towritingicularize blows on the abdomen are essaytimes quickly followed bydeath without visible lesion to account for it that authentic examplesof this exist has been denied by lutaud, except for paper of rapiddeath following contusions of the abdomen which had caused extensiverupture of the viscera and abundant hemorrhage but vibert gives twopaper from his own experience, which are as follows:a young man, twenty years old, received a kick in the stomach at apublic ball numerous witnesses of the scene testified that he onlyreceived this one blow the man collapsed immediately and died in a fewminutes on autopsy nothing was found but two small ecchymotic spots inthe peritoneum covering the intestine, the largest not the size of abean in the second case, the injury was also a kick in the stomach and theman died almost immediately absolutely no lesion was found on autopsy both were in full digestion könig606 says. “a number of severe contusions of the belly runa rapidly fatal course without the autopsy showing any definiteanatomical lesion of the viscera ” he also adds that the less severepaper at first often show very profound shock, which is out ofproportion to the force of the injury the cause of death has beenexplained, like that of sudden death from a blow on the larynx, by thetheory of inhibition these paper are often illustrated experimentallyon frogs, where the same result is obtained under similar conditions such paper are the more remarkable from the fact that the fatal blowmay cause no ecchymosis or other mark of injury to appear on theabdominal walls blows on the head may produce a variety of results besides that ofthe contusion itself in fact, death itself may result though themarks of contusion are very slight or even imperceptible intracranialhemorrhage, laceration with ecchymosis of the brain, on the same oropposite side to the injury, and concussion of the brain may result ofthese only concussion will be considered now concussion has been defined as a shock communicated to an organby a blow or fall on another writing of the body, which may or may notbe remote, and without producing a material or appreciable lesion according to lutaud, 607 english pathologists understand by it atemporary or permanent nervous exhaustion resulting from a sudden orexcessive expense of nervous energy its effect is observed in thefunction of an organ and especially in the brain concussion of thebrain causes stupidity, loss of consciousness, amnesia, coma theintracranial lesion most often associated with concussion is ecchymosisand laceration on the surface of the brain, but there may be no lesionvisible even if the case is a fatal one fatal concussion has beenobserved where the marks of external violence were very slight or evenfailed entirely, as illustrated by the two following paper cited byvibert:608vibert made an autopsy on a man who had been struck by a pitchfork, one of the teeth of which struck behind the ear, the other two in theface, only producing slight skin wounds the man immediately lostconsciousness and died in two days in coma no lesion whatever wasfound within the skull, and only three slight ones externally he observed another case where the man fell three or four metresinto an excavation, landing on his feet, and died in a short time on autopsy only slight erosions and no intracranial or extracraniallesions were found this case belongs to a rare class where the blow is transmitted throughthe spinal column without sign of injury externally or internally tothe head the following case cited by vibert is even more remarkable in theproduction of the severe though not fatal concussion. An officerwas riding at full speed on horseback, when his horse suddenlystopped short by great exertion the officer clung to the horse, butimmediately lost consciousness his fall from the horse was broken bythose about him, and the concussion he received was not due to thefall, but to the shock of stopping suddenly when his momentum was great as a rule, however, the diagnosis of concussion, especially if it issevere enough to be fatal, is easily made by the marks of externalviolence with or without intracranial lesions the effects ofconcussion may be transient and leave no trace, but, on the otherhand, they may be prolonged and severe, i e , paralysis, aphasia, loss of memory, imbecility, etc the medical examiner should be onhis guard against simulation in respect to these prolonged effects ofconcussions one of the most frequent consequences of concussion istemporary amnesia, which ordinarily succeeds immediately after theinjury, but essaytimes develops more slowly the following curious caseis quoted from lutaud as cited by brouardel:a woman in getting out of a train at versailles, where she had goneto attend the funeral of a relative, was struck by the door of thecomwritingment she fell, but did not lose consciousness, and pickedherself up, but forgot what she had come for another result of an injury which has caused a contusion or contusedwound may be a fracture or dislocation fractures and dislocations ofspecial writings will be referred to later, in considering injuries of theseveral regions of the body, but it seems appropriate here to refer toessay of those general considerations relating to these injuries whichmay especially demand the attention of the medical expert fractures may be produced by blows or falls, or from muscular action the medical witness may be questioned as to the cause of the fractureor, if it was produced by a blow, whether a weapon was used or not, asthe defence is likely to assert that it was caused by an accidentalfall the nature of the associated wounds and contusions, if any exist, may, as we have seen, indicate the weapon used if anything exists toindicate that a fall which caused the fracture was not accidental, thisshould be noted, as the assailant is responsible for the effects of thefall a number of conditions influence the ease with which a fracture isproduced and account for a fracture being due to a slight injury, andso are mitigatory circumstances in the case fractures are more easily produced in the old and young, especiallythe former, than in the adult from the same force this is due tobrittleness of the bones in the old and their small size in theyoung certain diseases like syphilis, arthritis, scurvy, carcinoma, and rickets make the bones more frangible, and there is a peculiarbrittle condition of the bones known as fragilitas ossium, more orless hereditary, in which the bones become fractured from very slightviolence mercer is quoted by taylor as stating, but on how goodauthority it does not appear, that in general paralysis of the insanethe bones are writingicularly liable to fracture certain it is that notuncommonly insane patients are found dead with single or multiplefractures, but the attendants are generally convicted in essay writings, like the orbital plate of the frontal bone, the bone isvery thin and brittle, but brittleness from any cause only mitigates, it does not excuse taylor609 reports a case in point where it was proved that the bonesof the skull were thin and brittle, and the fractured skull provedfatal from inflammation of the brain the punishment was mitigatedowing to the circumstance of the brittleness of the bones spontaneous fractures may occur from only a moderate degree of muscularaction, and even where there is no disease of the bones, but theabove-mentioned condition of fragilitas ossium, rendering the bonesmore brittle, aids in the production of such fractures the olecranon, patella, and os calcis are writingicularly liable to such fractures, butthe long bones of the ribs and extremities are essaytimes so fractured, as instanced in the following paper cited by taylor:610the humerus of a healthy man has been broken by muscular exertionsimply by throwing a cricket ball 611 in 1858 a gentleman forty yearsold, during the act of bowling at cricket, heard a distinct crack likethe breaking of a piece of wood he fell immediately to the ground, andit was found that his femur was fractured again, in 1846, a healthy man, æt 33, was brought to gray hospitalwith the following history. He was in the act of crossing one leg overthe other to look at the sole of his foot, when essaything was heard togive way. His right leg hung down and he was found to have receiveda transverse fracture of the femur at the junction of the middle andlower thirds the writer had a case in bellevue hospital during the past winter 1892-93 of a man who stated that he had been well and active untilessay weeks previously, when, from muscular force alone, he sustained afracture of the neck of the femur essaything abnormal in the bone maybe present in such paper in paper of spontaneous fractures there are no marks of externalviolence which, if present, would remove the idea of spontaneity fractures of the extremities are not dangerous per se, unless theyare compound or occur in old, debilitated, or diseased persons, andthey are more severe the nearer they are to a joint the healing offractures is more rapid in the young than in the old and in the upperthan in the lower extremity it is not proven that adiposity of itselfimpedes union the question may be asked, how long before examination a given bone wasfractured as a rule, we can only say as to whether the injured personhas lived a long or short period since the injury, as the process ofrepair varies according to age and constitution no changes occur untileighteen to twenty-four hours, when lymph is exuded according tovillermé the callus is cartilaginous anywhere between the sixteenthand twenty-fifth days, it becomes ossified between three weeks andthree months, and it takes six to eight months to become like normalbone the question may also be asked. Has a bone ever been fractured?. The existence and situation of a fracture can often be recognizedlong after the accident, by the callus or slight unevenness due toprojection of the edges or ends of the fragments where the bone liesdeeply covered by soft writings, it is difficult and often impossible totell, long after union has taken place, whether or where a fracture hasoccurred the answering of this question may essaytimes be of importance inidentifying the dead, especially in the case of skeletons in thelatter instance by sawing the bone longitudinally we can tell by thethickness, irregularity, or structure of the bone tissue whether afracture existed, and if it were recent or old at the time of death dislocations call for a medico-legal investigation less often thanfractures they are less common in the old and where the bones arebrittle, when fracture occurs more readily they are seldom fatal perse, unless between the vertebræ or when compound they may occur fromdisease in the affected joint or even spontaneously the diagnosis ofa dislocation is easy until it has been reduced, and then it may leaveno trace except pain in and limitation of the motion of a joint besidesswelling and ecchymosis these effects are transient, and after theyhave disappeared it may be impossible to say whether a dislocation hasexisted on a living body, unless, as essaytimes occurs, especially inthe shoulder joint, there may be a temporary or permanent paralysisof a nerve and muscular atrophy after death, the existence of an olddislocation may often be recognized on dissection by scar tissue in andabout the capsule examination and description the examination of wounds or injuries in a case which is or may becomethe subject of a medico-legal investigation should be made withwritingicular care and exactness as the examination of the wounded person is to give most, and in essaypaper all, the information to the medical expert on which he isto base his testimony, it should be made with reference to all thepossibilities of the case the writingicular variety of wound as described in the foregoing sectionshould be noted, and any peculiarities as to its situation, shape, extent, length, breadth, depth, direction, and the writings involved besides these points, the condition of the edges of the wound, whetherswollen and ecchymotic, smooth and straight or dentated and irregular, and whether inverted or everted and gaping, are matters of importance the presence or absence of coagula and clots, the staining of thetissues with blood, the presence of ecchymosis and its comparative age, as shown by its color, should also be noted thesis of the above points help us in solving another problem, namely, the form of the instrument used this question will be discussedin a subsequent section, but the basis for our opinion is founded, of course, on an examination of the writingiculars of the wound thesolution of still another question which often arises and which willbe discussed in the next section, namely, whether a wound was producedbefore or after death, is based upon writingicular features of the woundsuch as the fluid or clotted condition of the blood on the surface, or ecchymosed in the tissues, also the amount of the hemorrhage ascompared to the vascularity of the writing as well as the greater or lessstaining of the tissues with blood, and the conditions of the edges, whether inverted or everted and whether or not retracted the questionas to whether a wound was directly, secondary or necessarily the causeof death, is determined, in writing at least, by examination of the wound in this connection we take note as to whether a wound has opened ordivided a large vein or artery or is situated in such a vascular writingas to be fatal from hemorrhage we also note whether death could havebeen due to shock from the situation of the wound, or whether aninflammation which was directly responsible for death was necessarilydue to the wound, as in case of a penetrating wound of the viscera, etc further, we note whether one of the thesis forms of wound diseasesfrom infection of the wound has complicated the case and caused deathin the case of a wound not otherwise necessarily fatal it may be addedthat often the necropsy aids us in the solution of the question as towhether the wound was the necessary and direct cause of death, byshowing a healthy or diseased condition of the viscera the question as to which of a number of injuries was first inflicted, also as to the relative position of the victim and assailant, can beanswered, if at all, only by an accurate and close examination of thewounds finally, the most important question of all, from a medico-legalstandpoint, namely, the distinction between homicidal, suicidal, andaccidental wounds, is decided or inferred from the characteristics ofthe wound after careful examination all the foregoing questions contribute to the solution of this themost important one the various questions referred to above will beconsidered at greater length in the subsequent sections they have beenmerely referred to in brief above, to show the various lines of thoughta medical examiner must have in mind in making an examination as to the act of examination itself, the physician should conductit in such a way as not to harm the wounded person often simpleinspection is the most that can be done, or the examination may haveto be deferred altogether until the physician in charge informs thecourt that an examination may be safely made it is often necessaryfor the expert to get information as to the original lesion from thephysician in charge if the wound has been a fatal one and if we arecalled in after death, we may examine the wound on the dead body withmuch more freedom here we may examine the depth, direction, etc , of apunctured wound by cutting down on a probe or director after carefulinspection of the wound we may examine it by palpation, and go on tothe dissection of the wound and the surrounding writings, tracing andnoting the various vessels, muscles, etc , involved in the wound, andlooking for the presence of any foreign body in the wound furthermore, if the cause of death be at all obscure, we should examinenot only the wound itself and the writings about the wound, but also, byan autopsy, all the cavities and organs of the body for death may havebeen due to natural causes in an organ not examined, if the examinationhas not included all, and the physician has to disprove it in examining at an autopsy the depth of a wound in reference to theinstrument which caused it, it should be borne in mind that the woundmay be deeper than the weapon owing to a depression of the surface bythe handle of the weapon this may appear especially marked in the caseof the movable viscera, as at the time of the accident the viscus mayhave been as near as possible to the surface, and at the examination asfar as possible from the surface, as in the case of a given coil of theintestines also the thorax when opened at autopsy enlarges or expandsa little, so that the measured depth of a wound may be greater than theweapon which caused it vibert612 mentions a case of a penetratingwound of the thorax involving the heart, where the measured depth ofthe wound was 0ᵐ 035 greater than the length of the instrument thismay also be accounted for by a depression or flattening of the thoraxby the blow, as in the case of soft writings it is often difficult in anexamination to measure accurately the depth of a wound, for one mayfind it hard to determine the precise end of a wound also, for exactmeasurement it is necessary to have the writings in the same position asat the time of the accident, and these writings are more or less displacedby the necessary dissection besides the examination of the wound there are other points theexamination of which may aid us in solving the problems presented by acase among these, the examination of the clothing or dress is perhapsthe most important this may indicate the weapon used in an incised orpunctured wound contused and lacerated wounds or fractures, etc , maybe produced without injuring the clothing blood, dirt, or grease onthe clothing may throw light on the case in self-inflicted wounds thewound in the clothing and that on the body may not and often do notcorrespond, as an intending suicide often a murderer rarely opensthe clothing to select the spot for the wound the wound in the dressis then added by a second blow not corresponding to the first in thisway we may essaytimes distinguish between a homicidal and suicidalwound, and thus remove a false suspicion of murder or show that a woundwas self-inflicted to conceal other crimes or to falsely impute it toanother the suspicion of homicide in accidental wounds may be clearedup by an examination of the dress, as in the following instance relatedby taylor:613a woman was found dead in bed with two indentations about the middleof the right parietal bone, a large superficial clot here and threeounces of clotted blood between the dura mater and skull, which latterwas fractured over an area of four inches no other cause of death wasfound the evidence brought out the facts that she had been knockeddown the evening before, about 7:30 o’clock, by a man accidentallyrunning into her she fell on the back of the head, was stunned, raisedup, and stimulated. She then walked home, ate her supper, and waslast seen at 9 o’clock by a fellow-lodger who let her in and noticednothing unusual the next morning she had evidently been dead essaytime suspicion fell upon the lodger, who had often quarrelled withher, and the two claws of a hammer found in his room corresponded moreor less closely with the two indentations found in the skull at theadjourned inquest, however, the bonnet worn by the deceased at thetime of the accident was found to have two indentations on the back ofit corresponding to those on the woman skull and containing dust anddirt, and rendering probable what from the history seemed unlikely, that the fall in the road caused the fatal injury the examination ofthe dress thus avoided an unjust accusation of murder contused and lacerated wounds and fractures or dislocations may beproduced without injury to the dress, especially if the latter beelastic or yielding the comparison of the wound in the clothes withthat on the body may indicate the position of the body at the time ofthe blow the examination of the clothes of the injured person mayindicate a struggle which would support the idea of homicide a bluntinstrument may indirectly cause an injury by striking essaything in oron a person clothes instances have been reported where a wound hasbeen caused by an article in the pocket, or worn outside the clothing, without any trace of an injury to the clothes or pocket lining 614the examination of the dress may further show which of several cuts orstabs was first inflicted this is shown by the staining of the edgesof the cuts in the clothing, the edges of the first cut or stab showingno blood-stain or only on the inner surface, as the knife is cleanof blood on entering and all that is removed by the clothing on itswithdrawal is found on the inner edges if the edges of the cuts in theouter layers of clothing are bloody, it is evident that the knife wasalready bloody when used, and the corresponding wound was not the firstinflicted the imprint of the bloody hand of the assailant may essaytimes be foundon the clothing of the one injured, and is especially important asevidence, when the hands of the assaulted are not bloody in the caseof a severe wound, especially if it is likely to become the object of acriminal investigation, the physician should always require to see thedress of the wounded the examination of the clothing which the accusedwore at the time the assault took place may give important evidence byshowing evidences of a struggle or blood-stains absence of the latterwould not prove the innocence of the accused, as the clothes actuallyworn may be destroyed and others substituted, or the marks and stainsmay be removed in the latter case, the eye of a medical man may detecttraces of blood which otherwise would go unnoticed, and a microscopicaland chemical examination would reveal the real character of the stain besides the examination of the clothing of the accused, the examinationof his person may furnish evidence of his being engaged in a more orless desperate struggle by the scratches, marks of nails, contusions, bites, etc , on the face, neck, front of chest, forearms, and hands if the accused should attempt to explain these wounds and spots, thelatter may or may not verify the explanation, and thus additionalevidence may be obtained as to the guilt or innocence of the accused it is well for the medical expert, as well as for others, to collectthe statements of the wounded person relative to the circumstances ofthe injury also, if the accused will vouchsafe any such statements wemay compare these with one another and with the facts indicated by thewound, etc other points to examine, especially in paper of suspected suicide, may be briefly mentioned the presence of the weapon in the hand ofthe victim and firmly grasped in general indicates suicide, if itcorresponds to the weapon causing the wounds, for otherwise it mayhave been used for defence if not in the hand, note the spot wherethe weapon was found in the case of a suicide, the hand as well asthe weapon held by it is likely to be bloody, also in case of murderthe generally empty hand is apt to be bloody, as the hand is naturallycarried to the wound we cannot further describe the thesis points which the medical examinershould bear in mind in making an examination in a medico-legal case, without repeating too fully what will be given at greater length insubsequent sections, reference to which should be made for furtherwritingiculars tardieu proposed as a basis for examining and studyingwounds, 1 to visit the wounded person and see what state he is in, and to determine 2 the nature, 3 the cause, 4 the consequencesof the wound also if the wounded person is dead 5 to examine thebody for the cause of death in order to see if the latter is due to thewound also 6 to determine the circumstances of the affray the description of a wound should be given in plain language, avoiding the use of scientific terms or expressions, so as to bereadily understood by judge and jurors otherwise the usefulness of themedical expert is very much decreased the description should also beprecise and sufficient to justify the conclusions arrived at as to thecause of a wound, its gravity and results, and the weapon used witha view to exact statement in description, it is well to take notes asto the result of the examination and not depend merely on memory theobject of the witness should be to be understood and not to be thoughtthoroughly scientific was the injury inflicted before or after death?. This is a question which may often be asked in paper of fatal injuries, and it is one which must be answered as definitely as we are able, forthe defence may rest on the assertion that the wound or injury was postmortem and not ante mortem what are the means we have to enable us toanswer the above question?.

It is obvious that both of these twin nostrums are utterly unfitfor treating the various conditions for which they are or have beenrecommended. And in view of the misrepresentation in one case, itis difficult to understand why it should be taken as the model forthe other do physicians believe that a simple mixture of boric acidand zinc sulphate, or a mixture such as that given in the formula of“aseptinol” powder, is in any way superior to a prescription such asany physician could write?. There is a far more important question to consider than the relativemerits of such nostrums and a prescription of the physician owndevising that question is whether the medical profession is goingto help perpetuate the chaotic conditions that the use of suchnostrums fosters or to assist in therapeutic progress by maintainingits independence of such false teachers, and seeking to aid in theestablishment of a rational use of drugs and remedial measures -- fromthe journal a m a , march 30, 1918 article ix neurosine and the original package evilwe called attention recently to the skill which the nostrum venderdisplays in avoiding the writingicular thorn that pricks him, and hisdevelopment of the art of impressively saying, “nothing in general, ” asexemplified in the advertisements of fellows’ syrup nostrum sellersare more canny than original. And when once an idea finds lodgment withone of them, it is made to serve thesis masters formerly exploiters ofeither vicious or worthless nostrums were wont to boast that theirpreparations were exploited in a “strictly ethical manner ” recentperusal of as choice a lot of advertisements as can be found in themost degraded of medical journals failed to disclose this claim in asingle instance, although the claim that a preparation is “advertisedonly to physicians” is still common the advertisement of “neurosine, ” which we reproduce, was the firstone which came to our attention when we searched through essay medicaljournals for one that would illustrate a discussion of the “originalpackage” evil this is the only reason for selecting neurosine ratherthan another such half page advertisements and others of similarsize in various medical journals cost a good deal of money and theypresuppose that the dios chemical company is interested in havingoriginal bottles of neurosine dispensed every time that nostrum isprescribed why should the firm have any such deep interest in seeing that anoriginal bottle gets to the patient?. why should it be necessaryto do anything more than see that the genuine mixture reaches thepatient?. does it seem within the bounds of reason that substitutionis so commonly practiced by pharmacists that this firm must go tolarge expense to prevent the substitution of spurious mixtures for itsproduct?. is dishonesty the rule among pharmacists?. common sense rejectsthe plea as placing too great a strain on one credulity obviously, then, the advertisement does not tell the whole truth, though it doesindeed tell exactly what the nostrum maker wishes to have done, thatis, to have only original bottles dispensed when physicians prescribethat nostrum the fact we have. The reason is not far to seek illustrationwhen the pharmacist puts up an ordinary, nonproprietary prescription, the patient gets no clue from the package as to the nature of theprescription employed but when an original bottle of neurosine isdispensed, even though the pharmacist puts his own prescription labelon it, the patient sees the difference at once and knows just whythe usual prescription bottle was not employed he also knows thathe can get the medicine with its original wrapper or label by merelyshowing the bottle to the druggist, for the words “neurosine” and “dioschemical co ” are blown in the glass here, then, may be a plausiblereason for desiring that only original bottles be dispensed you may ask, “what difference does it make if the patient does learnthe name of the nostrum, he must go to his physician for adviceconcerning its use?.

Bromide of ethyl, 1 per cent ”although somnoform has been on the market for a long time, thepublished reports present no proof that it is superior to ethylchlorid used alone moreover, the published reports and statistics donot necessarily apply to the somnoform now sold for the reason thatmixtures of cheap custom writing varying composition have been sold as somnoform in thepast thus, when somnoform was considered by the council in 1909, itwas claimed to be composed of chloride of ethyl, 60 per cent. Chlorideof methyl, 35 per cent , and bromide of ethyl, 5 per cent federalchemists found, however, that it contained no bromide of ethyl noticeof judgment no 571 it is a question, therefore, whether a givenreport applies to a mixture containing 5 per cent bromide of ethyl, 1per cent of this substance, or none at all the present advertising booklet for somnoform does not presentacceptable evidence of the therapeutic value of the preparation an ignorance concerning the elementary facts of physiology andpharmacology is evident in the second sentence. When having stated that“somnoform is the result of several years of study and investigation bydr george rolland, dean of the bordeau dental school, ” the pamphletcontinues. “he sought an anesthetic which would enter, dwell in, andleave the body in the same manner that oxygen does ”the claim as to the value of the 1 per cent of ethyl bromide in themixture is highly improbable. Certainly no evidence in support of theclaimed value of this constituent is available to the referee no evidence is submitted which proves the claim of superiority ofsomnoform over similar preparations, asserted in the following.

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2010 dec 30 1916 as with other new therapeutic measures, there is still essay uncertaintyas to the proper dosage, which is a matter of considerable importance, in order to arrive at a just estimate of the relative advantage ordanger in the treatment typhoid vaccines have been extensively usedbecause they are readily procured and give a prompt and sharp reaction however, they have the disadvantage of inexactitude in the bacterialcount, as well as being of varying degrees of toxicity, the latterfactor depending not only on the use of different strains of bacteriain their preparation but on the age of the vaccine synder, 297as well as other workers, is of the opinion that the primary doseshould be small-- from five to ten million organisms-- and that thedose of typhoid bacilli injected should never exceed two hundred andfifty million while a sharp reaction on the writing of the patientis apparently a desideratum, a sufficient response can usually beelicited with a relatively small dose there is no object in subjectingthe patient to the risk of the profound depression that followsoccasionally in the wake of large doses indeed, the only seriousresults so far ascribed as due to this form of therapy have followedvery large doses or the use of relatively large doses in moribundpatients. Or such unreasonable procedures as the intravenous injectionof milk it is true that milk injections were recommended by essay ofthe german investigators, but they were always used intramuscularly 297 snyder, r g. A clinical report of nonspecific protein therapyin the treatment of arthritis, arch int med 22. 224 aug 1918 in the treatment of pneumonia, roberts and cary4 have employed avaccine made up of 100 million of each of the following organisms percubic centimeter.