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Chemistry Help Homework


526 the lowenthal postgraduate course 527 medical society of the united states 531 the national formulary-- a review of the fourth edition 535 nonspecific protein therapy 536 willard ealon ogden 538 “patents” 542 pharmaceutical barnums 545 the pharmacopeia 546 physician stock in prescription products 548 pituitary gland preparations 549 proprietorship in medicine 550 philip rahtjen and his discoveries 553 sodium cacodylate in chemistry help homework syphilis 555 tablets. Dependability of dosage 556 therapeutic evidence. Its crucial test 557 “vaccines in toxic conditions” 560 vitamins. Their distribution 561 the william a webster co and the direct pharmaceutical co 564 yeast 566 briefer paragraphs 570 the propaganda for reform in proprietary medicines writing i reports of the council on pharmacy and chemistry foreword the council on pharmacy and chemistrythe council on pharmacy and chemistry was established by theamerican medical association primarily for the purpose of gatheringand disseminating such information as would protect the medicalprofession-- and thus the public-- in the prescribing of proprietarymedicinal articles the council consists of sixteen members, fifteen appointed for a termof five years without pay, and the sixteenth, a secretary, who isalso the director of the chemical laboratory of the american medicalassociation see writing ii at the present time 1921 the membership is. C l alsberg, a m , m d , chief of the bureau of chemistry, u s dewritingment of agriculture, washington, d c c w edmunds, m d , professor of materia medica and therapeutics, university of michigan medical school, ann arbor r a hatcher, ph g , m d , professor of pharmacology, cornell university medical college, new york city a w hewlett, m d , professor of medicine, leland stanford junior university school of medicine, san francisco john howland, m d , professor of pediatrics, johns hopkins university medical dewritingment, baltimore reid hunt, m d , professor of pharmacology, medical school, harvard university, boston w t longcope, a b , m d , new york g w mccoy, m d , director of the hygienic laboratory, u s public health service, washington, d c lafayette b mendel, ph d , sc d , professor of physiological chemistry, sheffield scientific school, yale university, new haven f g novy, sc d , m d , professor of bacteriology, university of michigan medical school, ann arbor w w palmer, b s , m d , bard professor of medicine, columbia university college of physicians and surgeons, new york w a puckner, phar d , secretary of the council, director of the chemical laboratory of the american medical association, chicago l g rowntree, m d , sc d , professor of medicine, mayo foundation, rochester g h simmons, m d , ll d , chairman of the council, editor of the journal of the american medical association, chicago torald sollmann, m d , professor of pharmacology and materia medica, western reserve university school of medicine, cleveland julius stieglitz, ph d , sc d , chem d , professor of chemistry, university of chicago, vice-chairman of the council, chicago at its first meeting in 1905, the council began examining theproprietary and nonofficial medicinal preparations offered tophysicians of the united states, and authorized the publication ofa book new and nonofficial remedies containing descriptions ofthose preparations which were deemed worthy of the consideration ofphysicians it also issued reports reports of the council on pharmacyand chemistry to the medical profession on those preparations whichwere not eligible the council adopted a set of rules by which tomeasure the eligibility of each preparation for admission to new andnonofficial remedies these rules were designed primarily to protectthe public-- through the medical profession-- against fraud, undesirablesecrecy and objectionable advertising in connection with proprietarymedicinal articles the rules originally adopted have been subjectedto revision from time to time to meet changing conditions for theinformation of those who wish to familiarize themselves with the workof the council the rules which are now in force 1921 follow thisintroduction a summary is also to be found in the article, “the workof the council on pharmacy and chemistry, present and future, ” page 12 since 1906, the council has issued new and nonofficial remediesannually in each issue are listed and described the articles thatstand accepted on january 1 of the year of publication the bookdescribes proprietary medicinal articles on the american market thatare found eligible under the rules, and also such nonproprietary, nonofficial articles as give promise of therapeutic usefulness, listingthe acceptable brands articles of a similar character are groupedtogether, and each group is preceded by a general discussion for thepurpose of comparison since 1908, the council has also issued an annual volume, “reportsof the council on pharmacy and chemistry, ” which contains reportson proprietary medicines that were found inadmissible to new andnonofficial remedies the reports issued prior to 1916-- and deemed ofsufficient interest to physicians-- were reprinted in the propagandafor reform in proprietary medicines, ninth edition 1916 the moreimportant reports issued from 1916 to 1921, inclusive, are in thisvolume while it is the chief function of the council to investigate and reporton proprietary medicinal preparations, its work has broadened so thatthe council work may now be characterized as a propaganda for therational use of drugs thus, its committee on therapeutic researchencourages the investigation of questions concerning the actionsof drugs these investigations are brought together in the “annualreports of the therapeutic research committee ” the council also has acommittee on medical teaching which has issued the publication “usefuldrugs, ” a concise, but thorough and up-to-date, discussion of the moreimportant drugs in addition, the council appointed a committee toprepare an “epitome of the u s pharmacopeia and national formulary, ”in which are presented those portions of the united states pharmacopeiaand the national formulary that are of interest to physicians and inwhich is given a concise statement of the therapeutic usefulness ofsuch drugs and preparations official rules of the council on pharmacy and chemistry may 1, 1921 introductionthe following rules have been adopted by the council primarily withthe object of protecting the medical profession and the public againstfraud, undesirable secrecy and objectionable advertising in connectionwith proprietary medicinal articles new and nonofficial remedies -- the book new and nonofficial remediescontains a description of proprietary articles which have beenaccepted as conforming to the rules of the council. And of such simplenonproprietary and nonofficial substances as seem of sufficientimportance to warrant their inclusion mixtures -- for admission to n n r , proprietary pharmaceuticalmixtures must comply with the rules. And, to determine such compliance, they will be investigated by the council the council, however, endorses the principle that prescriptions should be written on thebasis of the therapeutic effects of the individual ingredients forthis reason, it includes in this book only those mixtures that presentessay real advantage there is also an appendix in which are includedthose proprietary articles which, so far as known to the council, comply with the rules, but which do not possess sufficient originalityto be admitted to the body of the book rules governing the admission of proprietary articles to the book new and nonofficial remediesdefinition of proprietary articles -- the term “proprietary article, ”in this place, shall mean any chemical, drug or similar preparationused in the treatment of diseases, if such article is protected againstfree competition, as to name, product, composition or process ofmanufacture, by secrecy, patent, copyright, or by any other means rule 1 -- composition -- no article will be accepted for inclusion inthe book new and nonofficial remedies, or retained therein, unless itscomposition be furnished to the council for publication for simplesubstances, the scientific name and the chemical formula, rational orstructural, if known, should be supplied for mixtures, the amount ofeach active medicinal ingredient in a given quantity of the articlemust be stated the general composition of the vehicle, its alcoholicpercentage, and the identity of the preservatives must be furnished rule 2 -- identification -- no article will be accepted or retainedunless suitable tests for determining its composition are furnished tothe council in the case of chemical compounds, these shall consist oftests for identity and purity in the case of mixtures, description ofmethods for determining the amount and active strength of the potentingredients shall be furnished, if practicable rule 3 -- direct advertising -- no article that is advertised to thepublic will be accepted or retained. But this rule shall not applyto.

Any applicant for examination, by noticein writing to the secretary of the board, is entitled to examinationwithin three months from the time of notice, and the failure togive such opportunity entitles such applicant to practise without acertificate until the next regular meeting of the board the boardmay issue certificates to persons who, upon application, present acertificate of having passed chemistry help homework a satisfactory examination before anyother state board of medical examiners, upon the payment of the feeprovided in sec 3 6, as amended c 66, laws 1888, 22 gen assembly the board may refuse a certificate to a person who has been convictedof felony committed in the practice of his profession, or in connectiontherewith. Or may revoke for like cause, or for palpable evidence ofincompetency, and such refusal or revocation prohibits such personfrom practising medicine, surgery, or obstetrics, and can only be madewith the affirmative vote of at least five physicians of the stateboard, in which must be included one or more members of the differentschools of medicine represented in the said board. The standing of alegally chartered medical college from which a diploma may be presentedmust not be questioned except by a like vote 7 definition, exceptions - any person is deemed practising medicine, surgery, or obstetrics, or to be a physician, who publicly professesto be a physician, surgeon, or obstetrician, and assumes the duties, or who makes a practice of prescribing, or prescribing and furnishingmedicine for the sick, or who publicly professes to cure or heal by anymeans whatsoever. But the act does not prohibit students of medicine, surgery, or obstetrics from prescribing under the supervision ofpreceptors or gratuitous services in case of emergency. Nor does itapply to women at the time of its passage engaged in the practice ofmidwifery, nor does it prevent advertising, selling, or prescribingnatural mineral waters flowing from wells or springs, nor does itapply to surgeons of the united states army, navy, or marine hospitalservice, nor to physicians defined therein who have been in practicein this state for five consecutive years, three years of which musthave been in one locality, provided such physician shall furnish thestate board with satisfactory evidence of such practice and shallprocure a proper certificate, nor to registered pharmacists fillingprescriptions, nor does it interfere with the sale of patent orproprietary medicines in the regular course of trade 8 penalty - a person practising medicine or surgery without complyingwith the act, and not embraced in the exceptions, or after beingprohibited as provided in sec 7, is guilty of a misdemeanor punishablewith a fine of from $50 to $100, or imprisonment in the county jailfrom ten to thirty days 9 filing or attempting to file as one own the diploma of another, orthe certificate of another, or a diploma or certificate with the truename erased and the claimant name inserted, or a forged affidavit ofidentification, is forgery 10 fees - to county recorder, 50 cents 4 to state board, for certificate to holder of diploma, $2 3 to secretary of state board, in advance, by candidate for examination, $10 6 by practitioner for five years, $2 8 kansas qualification - it is unlawful for a person who has not attended twofull courses of instruction and graduated in essay respectable school ofmedicine, either of the united states or of essay foreign country, orwho cannot produce a certificate of qualification from essay state orcounty medical society, and is not a person of good moral character, topractise medicine in any of its dewritingments for reward or compensation, for any sick person. Provided in all paper when any person has beencontinuously engaged in practice of medicine for ten years or more, heshall be considered to have complied with the provisions of the act gen stats , 1889, s 2, 450 penalty - practising or attempting to practise medicine in any ofits dewritingments or performing or attempting to perform any surgicaloperation in violation of the foregoing is punishable with a fine offrom $50 to $100. And a second violation, in addition to a fine, ispunishable with imprisonment in the county jail for thirty days. Andin no case wherein the act is violated shall the violator receive acompensation for services rendered 2, 451 kentucky qualification - it is unlawful for any person to practise medicinein any of its branches who has not exhibited and registered in thecounty clerk office, in the county in which he resides, his authorityto practise, with his age, address, place of birth, and the schoolor system of medicine to which he proposes to belong the personregistering must subscribe and verify by oath before such clerk anaffidavit containing such facts, which, if wilfully false, subjects theaffiant to punishment for perjury act 1893, april 10th, s 2 authority to practise shall be a certificate from the state board ofhealth issued to any reputable physician who is practising, or whodesires to begin to practise, who possesses a diploma from a reputablemedical college legally chartered under the laws of this state, or adiploma from a reputable and legally chartered medical college of essayother state or country, indorsed as such by said board, or satisfactoryevidence from the applicant that he was reputably and honorably engagedin the practice of medicine in the state prior to february 23d, 1864 applicants may present their credentials by mail or proxy 3 nothing in the law authorizes any itinerant doctor to register orpractise medicine 4 the board may refuse a certificate to any individual guilty of grosslyunprofessional conduct of a character likely to deceive or defraud thepublic, and may, after due notice and hearing, revoke such certificatesfor like cause in paper of refusal or revocation the applicant mayappeal to the governor, whose decision affirming or overruling thedecision of the board shall be final 5 systems, exceptions - the law does not discriminate against anypeculiar school or system of medicine, nor prohibit women frompractising midwifery, nor prohibit gratuitous services in case ofemergency, nor apply to commissioned surgeons in the united statesarmy, navy, or marine hospital service, nor to a legally qualifiedphysician of another state called to see a writingicular case or family, but who does not open an office or appoint a place in the state to meetpatients or receive calls 6 penalty - any person living in this state or coming into this state whoshall practise medicine or attempt to practise medicine in any of itsbranches, or perform or attempt to perform any surgical operation foror upon any person for reward or compensation in violation of this law, shall be punished with a fine of $50, and on each subsequent convictionby a fine of $100 and imprisonment for thirty days, or either, or both;and in no case where any provision of this law has been violated shallthe violator be entitled to receive compensation for services rendered to open an office for such purpose or to announce to the public in anyother way a readiness to practise medicine in any county shall be toengage in the practice of medicine 8 fees - to the county clerk, for all services required, 50 cents s 1 louisiana constitutional provision - the general assembly must provide forthe interest of state medicine in all its dewritingments, and for theprotection of the people from unqualified practitioners of medicine const 1879, art 178 qualification - no person is allowed to practise medicine or surgery asa means of livelihood in any of its dewritingments without first makingaffidavit before a judge, justice of the peace, clerk of districtcourt, or notary public in the parish wherein he resides, of his havingreceived the degree of doctor of medicine from a regularly incorporatedmedical institution of respectable standing, in america or in europe, and designating its name and locality, and the date of his diploma;the degree is manifested by the diploma, and the respectable standingof the institution is evidenced by the indorsement or certificate ofthe state board of health, written on the face of the diploma, andsigned by its secretary. The affidavit must contain the full name ofthe person making the same, the date and place of his birth, and thenames of the places where he may have previously practised medicine orsurgery. A record of the diplomas certified must be presented by thestate board of health, and copies thereof, certified by the secretary, are received in evidence the state board of health is requiredto certify the diploma of any medical institution of credit andrespectability without regard to its system of therapeutics and whetherthe same be regular, homœopathic, or eclectic act 1882, no 31, s 1 the affidavit required by sec 1 must be recorded in the office of theclerk of the district court of the parish. The clerk must certify therecordation by indorsement on the original affidavit, which the affiantmust transmit to the state board of health. A copy of the originalaffidavit, duly certified by the clerk of the court, is admissible inevidence 2 exceptions - the provisions of the act do not apply to femalepractitioners of midwifery as such, nor to persons who had beenpractising medicine or surgery in the state without diplomas for fiveyears prior to the passage of the act, nor to persons who had beenpractising medicine or surgery from a regularly incorporated medicalinstitution of reputable standing in america or in europe, for tenyears prior to the passage of the act, provided such a practitionermake affidavit before a judge, justice of the peace, notary public, or the clerk of the court of the parish wherein he resides, settingforth the full name of the affiant, the date and place of his birth, the date of his diploma, if he have any, the name and locality of theinstitution by which it was made, the date and place where he began thepractice of medicine in louisiana, and the names of the places where hemay have previously practised medicine or surgery such affidavit mustbe transmitted or delivered to the state board of health, and entitlesthe affiant to be placed on the list of registered physicians orsurgeons the state board of health must preserve said affidavits, anda copy signed by the secretary is received in evidence by the courts to make a false affidavit is perjury 3 evidence - a copy of the affidavit recorded by the clerk of thedistrict court, certified by him, is prima facie evidence that theperson making the affidavit is a duly registered physician or surgeon, and a certified copy of the original affidavit filed with the stateboard of health, or a certificate emanating from the said board, thatthe name of the person mentioned in the certificate is on the list ofregistered physicians and surgeons, is conclusive evidence s 4 it is the duty of the state board of health to publish annually in theofficial journal of the state, and if there is none, in one of thedaily newspapers published in new orleans, a list of the registeredphysicians and surgeons, and their places of residence, and suchpublished list is evidence in the courts that the person is dulyregistered the board is required to strike from said list the namesof persons convicted of any infamous crimes by any court of this stateor of the united states, or of any state of the united states, whetherprior or posterior to registration. And is empowered to strike from thelist persons who die after registration 5 civil penalty - a practitioner of medicine or surgery failing to complywith this act shall not be exempt from military or jury duty, nor bepermitted to collect fees for services rendered, nor be allowed totestify as a medical or surgical expert in legal or state medicine, in any court, nor to execute any certificate as surgeon or physician, nor to hold any medical office, nor to be recognized by the state, orany parish, or municipal corporation, as a physician or surgeon, norentitled to enjoy any of the privileges, rights, or exemptions grantedto physicians and surgeons by the laws of this state. And shall forfeit$100 for each violation, to be recovered in a civil action in the nameof and for the benefit of the charity hospital at new orleans, and inaddition shall be subject to criminal prosecution 6 exceptions - the act is not applicable to practitioners of medicine orsurgery residing and practising in other states, who may be summoned inspecial instances to attend patients in the state of louisiana by anyregistered physician 7 penalty - whoever shall practise or offer to practise medicine orsurgery, for pay, without complying with the foregoing act, is guiltyof a misdemeanor, punishable by a fine of not less than $50 orimprisonment for not more than three months, or both, at the discretionof the court act 1886, no 55, s 1 no criminal prosecution shall bar the imposition of a fine by civilprocess, nor shall the imposition of such fine bar criminal prosecution2 exceptions - this act is not applicable to practitioners of medicine orsurgery residing and practising in other states, who may be summonedin special instances to attend patients in the state by any registeredphysician 3 fees - to board of health, for every diploma certified, 50 cents1 to officer before whom affidavit is made, 50 cents 2, 3 recording same, $1 2 to clerk of court, for copy of original affidavit, 50 cents s 2 to state board of health, for copy of original affidavit, 50 cents3 maine qualification, penalty - no person who has not received a medicaldegree at a public medical institution in the united states, or alicense from the maine medical association, shall recover compensationfor medical or surgical services, unless previous to such service hehad obtained a certificate of good moral character from the municipalofficers of the town where he then resided rev stats , 1883, c 13, s 9 maryland qualification - by the act of 1892, c 296, s 1, 39, it is providedthat every person not now practising medicine and surgery, who shallhereafter begin to practise medicine and surgery in any of itsdewritingments, shall possess the qualifications required by the act there are two boards of examiners, representing the medical andchirurgical faculty of the state and the state homœopathic medicalsociety respectively. Each consists of seven members, appointedrespectively by those societies, physicians actually engaged in thepractice of medicine, and of recognized ability and honor. But nophysician having a pecuniary interest in the trade of pharmacy can beappointed 2 suitable provisions must be made by each examining board to prepare aschedule of written examination upon anatomy, physiology, chemistry, surgery, practice of medicine, materia medica and therapeutics, obstetrics, gynæcology, pathology, medical jurisprudence and hygiene;the same standard of excellence is required from all candidates.

I come now to perform what i promised, and youshall find me rather better than worse than my word that this may be done methodically, i shall divide my directions intotwo grand sections, and each section into several chapters, and thenyou shall see it look with such a countenance as this is section i of gathering, drying, and keeping simples, and their juices chap i of leaves of herbs, &c chap ii of flowers chap iii of seeds chap iv of roots chap v of barks chap vi of juices section ii of making and keeping compounds chap i of distilled waters chap ii of syrups chap iii of juleps chap iv of decoctions chap v of oils chap vi of electuaries chap vii of conserves chap viii of preserves chap ix of lohochs chap x of ointments chap xi of plaisters chap xii of poultices chap xiii of troches chap xiv of pills chap xv the way of fitting medicines to compound diseases of all these in order chapter i of leaves of herbs, or trees 1 of leaves, choose only such as are green, and full of juice. Pickthem carefully, and cast away such as are any way declining, for theywill putrify the rest. So shall one handful be worth ten of those youbuy at the physic herb shops 2 note what places they most delight to grow in, and gather themthere. For betony that grows in the shade, is far better than thatwhich grows in the sun, because it delights in the shade. So also suchherbs as delight to grow near the water, shall be gathered near it, though happily you may find essay of them upon dry ground.

1 chemistry help homework the false and inconsistentstatements made as to the occurrence. 2 the marks of the body havingbeen dragged essay distance so that a writing of the dress was found, ina bloody condition, essay way from the body. 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 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.

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a the relative position and generalcondition of the abdominal organs b the color and amount of blood in the presenting writings c whether there are any signs of inflammation or the evidenceof foreign bodies or tumors d examine the vermiform appendix e the amount of fluid in the abdominal cavity normally a smallquantity of reddish serum will be found, writingicularly in warm weather, at the most dependent portion of the abdominal cavity if the quantityis small it can only be ascertained by raising the intestines from thepelvis when the fluid is considerable, the exact amount should beascertained and its character noted f perforation, invagination, and hernia of the intestinesshould be looked for g determine the height of the diaphragm normally, on the rightside, it is at the junction of the fifth rib with the sternum, and onthe left it reaches as high as the sixth a variety of pathologicalconditions change its position for instance, it may be raised whenthe contents of the abdomen are greatly increased in volume, and innew-born children who have never breathed it may be depressed byenlargement of the lungs, disease of the heart, or fluid in the pleuralor pericardial cavities the presence of air or gas in the pleuralcavity can be determined either by filling the abdomen with water andpuncturing the diaphragm beneath the fluid so that the air will bubbleup, or a puncture may be made through the thorax between the ribs, andthe flame of a match will be deflected by the escaping air thorax the thorax is opened by cutting the sterno-costal cartilages as closeto the end of the ribs as possible, the cut being made downward, outward, and backward, and the knife held obliquely so as not to injurethe underlying writings quite often the cartilages will be found ossifiedand it will be necessary to divide them by a costotome next, separatethe clavicles by a semi-lunar incision at their attachment to thesternum raise the sternum with the left hand and separate it from theunderlying writings if there is any adherence of the sternum a slighttwist will be sufficient to remove it superficial examination of thorax - observe the position, color, and degree of distention of the lungs it should be remembered thathealthy lungs, as soon as the chest is opened, owing to their inherentelasticity, will collapse, and when this normal collapse is not seenit is generally due to a loss of elasticity as occurs in emphysema, to inflammatory diseases binding the lung to the chest wall, or tothe alveoli being filled with solid or fluid substances or pent-upair most complete distention is seen when death is due to drowning orsuffocation the area of the heart uncovered will vary according to the degree ofcollapse of the lungs and to the abnormal size of the heart normallythe cardiac area exposed is quadrangular in shape, and about three anda half inches in its longest diameter examine the pleural cavitiesfor the presence of adhesions, foreign bodies, or fluid if fluid isfound it should be removed, measured, and its character noted itis to be remembered that in warm weather, or when putrefaction hascommenced, a moderate amount of reddish serum is found in the pleuralcavities which has no pathological significance lastly, examine themediastinum as to the condition of the thymus gland and greatvessels outside the pericardium pericardium - open the pericardium by an oblique incision alongthe anterior wall, and prolong this incision downward and outwardtoward the diaphragm and upward to its reflection from the greatvessels normally, about a drachm of clear serum, essaytimes, however, blood-stained from decomposition, will be found in the pericardial sac the amount is best ascertained by raising the heart note next thecontents of the pericardium and whether there is any serous, fibrous, or purulent exudation if an abnormal amount of fluid is present, remove, measure, and note its character observe whether there are anyadhesions between the two surfaces of the pericardium white patchesare often seen on the visceral surface of the pericardium, especiallyover the ventricles these have no pathological significance and aredue to slight thickenings of the pericardium the heart - having passed the hand over the arch of the aorta andnoticed whether there is any evidence of aneurism or dilatation, wegrasp the heart firmly by the apex, raising and drawing it forward we remove it by cutting through the vessels at its base test thesufficiency of the aortic and pulmonary valves by allowing a stream ofwater to flow into these vessels, the heart being held in a horizontalposition and care being taken not to pull the valves open to apply the water test to the mitral and tricuspid valves, theauricles are first opened so as to expose the upper surface of thesevalves, and by allowing a stream of water to flow through the aorticand pulmonary valves into the cavities of the ventricles, the degree ofsufficiency of these valves can readily be ascertained another rough test is what is known as the “finger test ” the mitralvalve will normally allow two fingers, held flat and in contact, to pass through its opening the tricuspid in the same way allows, normally, three fingers to pass. Or if a more accurate test of thedegree of insufficiency is desired, the valvular orifices should bemeasured normally, the aortic orifice is one inch across. The mitral, one and eight-tenths inches. Pulmonary, one and two-tenths inches. Andthe tricuspid about two inches we open first the cavity of the right ventricle by making an incisionover its anterior border close to the septum prolonging the incisiondownward to the apex and upward through the pulmonary artery, thecavity of the ventricle will be fully exposed the left ventricle issimilarly opened by an incision through its anterior wall which isprolonged upward through the aortic valve the cavities of the auricleand ventricle, especially those of the right side, will often containblood-clots these clots are usually post-mortem clots formed duringthe last hours of life or after death it may essaytimes be necessary todistinguish these post-mortem clots from what are known as ante-mortemclots the latter are usually of firm consistency, dry, of a whitishcolor, and closely entangled in the trabeculæ, while the former aresucculent, moist, of a reddish-yellow color, and are easily detachedfrom the walls of the heart cavities ante-mortem clots are rarelyseen, and the medical examiner should be careful not to attribute thecause of death to the post-mortem clots which are so often seen afterthe heart is opened we can with more care and greater accuracy examinethe condition of the valves and recognize the extent of valvularlesions the condition of the endocardium should now be examined and anyabnormality noted often it will be seen stained a deep red color this is not due to disease, but is caused by the absorption of thecoloring matter of the blood which has been set free by decomposition the size of the heart cavity and the thickness of the heart wallsshould be noted, as also their consistency and color it should beremembered that the heart walls may appear unusually flabby as theresult of decomposition, or apparently thickened when death occurs inextreme systole the interior of the heart can be further examined bypassing the enterotome into each auricle, carrying the incision throughthe mitral and tricuspid valves to join at the apex with the previousincision, which has been prolonged through the ventricles to the apex thus the auriculo-ventricular valves are completely exposed having removed the blood from the heart it is next weighed the averagenormal weight of the human heart is about twelve ounces in the male, and a little less in the female. Its size roughly corresponding to theclosed hand of the individual normally, the thickness of the walls ofthe left ventricle about its middle is five-eighths to two-thirds of aninch, and of the right ventricle one-eighth to one-quarter of an inch note the condition of the aorta above the heart, whether it is dilated, atheromatous, or shows calcareous deposits examine the coronaryarteries by opening them with a blunt-pointed scissors disease ofthese vessels with thrombosis is one of the causes of sudden deathwhich is often overlooked the lungs - the lungs are removed by lifting them from the pleuralcavity and cutting through the vessels and bronchi at their base ifa lung is very adherent it is essaytimes better to remove the organwith the costal pleura attached so as not to tear the lung substance examine the external surface of the lung as to its shape, color, andconsistency next open the large bronchi with a blunt-pointed scissors, and prolong the incision into the pulmonary substance along the minutebronchi observe the contents of the bronchial tubes, the appearance ofthe mucous membrane, and their relative thickness remember that it isvery difficult to tell the condition in which the mucous membrane wasduring life on account of the early post-mortem changes which affectit, and also because the contents of the stomach may have been forcedafter death up the œsophagus and down the bronchi, giving the tubes apeculiar reddish and gangrenous appearance having examined the bronchi, the lung is turned over and its basegrasped firmly in the left hand an incision is made from apex to base, which will expose at a single cut the greatest extent of pulmonarysurface note the color of the lung substance, and whether the alveolicontain blood, serum, or inflammatory products blood and serum caneasily be forced from the lungs by pressure between the fingers, whileinflammatory exudations cannot examine carefully for the presence ofmiliary tubercles if a question should arise whether a portion of a lung is consolidated, this writing can be removed, placed in water, and if the air cells areconsolidated the portion will sink. If there is only congestion it willfloat by squeezing the lung between the fingers an inflammation of thesmaller bronchi bronchitis can be recognized by the purulent fluidwhich will exude at different points it should be remembered that innormal condition the lower lobes and posterior aspect of the lungs willapparently be very much congested as a result of gravity neck, larynx, and œsophagus - throw the head well backward, andplace a block beneath the neck make an incision from the chin tothe upper writing of the sternum dissect the soft writings away on eachside from the larynx and thyroid body, then cut along the internalsurface of the lower jaw from the symphisis to its angle through thisincision introduce the fingers into the mouth, and grasp and drawdown the tongue by dividing the posterior wall of the pharynx andpulling downward these writings, the trachea and œsophagus can readily beremoved together, a ligature having been first placed around the lowerportion of the œsophagus open now the pharynx and œsophagus alongtheir posterior border examine the mucous membrane carefully for theevidences of inflammation, caustic poison, tumors, foreign bodies, or strictures with an enterotome open the larynx and trachea alongtheir posterior wall observe if there is any evidence of œdema ofthe glottis, and note the condition of the mucous membrane rememberthat redness of the larynx is very commonly the result of post-mortemchanges and is also seen in bodies which have been kept cold dissectoff and examine the thyroid gland abdomen having completed the examination of the organs of the thorax, we nextproceed to examine those contained in the abdominal cavity we firstraise and, dissect off the omentum, noting if it is abnormally adherent the first organs to be removed are:the kidneys - drawing the intestines aside we cut through theperitoneum over the kidneys, and introducing our left hand we graspthe organs with their suprarenal capsules attached raising first onekidney and then the other, we easily divide the vessels and the uretersas close to the bladder as possible the kidneys are often foundimbedded in a mass of fat which must first be removed their surface isessaytimes of a greenish color owing to the beginning of putrefaction we note the size of the organ, its color and weight a normal kidneyweighs from four and one-half to five ounces grasping the kidneyfirmly in the left hand, we make an incision in its capsule along itsconvex border, and with a forceps strip off the capsule and note itsdegree of adherence and the condition of the surface of the organ;whether it is smooth or granular prolonging our incision alreadymade through the cortex of the organ, inward toward the pelvis, wedivide the organ into two halves and now closely examine the internalstructure the average thickness of the cortex, which should be aboutone-third of an inch, is noted. As also its degree of congestion, andwhether the normal light tubes and reddish vessels and tufts linesare seen running through it if these alternate light and dark markingsare lost and the organ has not undergone decomposition, the presenceof essay of the forms of bright disease may be suspected if the cutsurface of the organ presents a waxy appearance, the amyloid testshould be applied by first washing the cut surface of the organ anddropping upon it a few drops of lugol solution of iodine, when theamyloid areas will appear as dark mahogany spots on a yellow background the pelvis of the kidneys should be examined for calculi and theevidence of inflammatory lesions the suprarenal capsules readilydecompose, but if the autopsy is not made too late hypertrophy, tuberculosis, tumors, and degeneration in them may be recognized the spleen - this organ will be found in an oblique position at theleft side of the stomach grasping it firmly in the left hand anddrawing it forward, it can easily be detached normally in the adultit is about five inches in length by three inches in breadth by oneinch in thickness, and weighs about seven ounces the size, color, and consistency of the organ should be noted, as well as abnormalthickenings of its capsule and the presence of any tubercles or tumorsin its substance the spleen softens very early as the result ofdecomposition, and this decomposition should not be mistaken for apathological condition the intestines - in paper of suspected poisoning the greatest careshould be taken in the removal of the intestines and the stomach double ligatures should be placed in the following situations so asto preserve the contents of the organs intact. 1 at the end of theduodenum. 2 at the end of the ilium. And 3 at the lower portionof the rectum.