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One leaf of jacia nigra, and one of round plantain, called in latin plantago minor, and four of sow-thistle lasseron, called in latin rosti poterugni, and says that the leaf of jatrianigra is poisonous, but that in the others there is no poison knownto the deponent ”32 on august 12th, 1390, “jehan le conte and jehanle grant, sworn surgeons of our sire the king, ” are present at thetorture of a prisoner, but for what purpose does not appear in anothercase the same jehan le conte testified that a wound in the head of adeceased person was made with an axe 33 at a later period in italy, the infliction of “the question” took place under medical supervision zacchias devotes a chapter, de tormentis et pœnis, 34 to theconsideration of the different methods of torture, the degrees of painand danger attending each, and the conditions of age, sex, and healthwhich render its application inadmissible 35during this period, as indeed from the earliest times, the practiceof medicine was regulated by law thus a law of king roger of sicily 1129-54 punished those who practised medicine without authority withimprisonment and confiscation of goods. And an edict of frederick ii 1215-46 imposed like penalties upon those who presumed to practiseexcept after graduation at the school of salernum 36medico-legal science was formed in the middle of the sixteenth centuryby a simultaneous awakening of jurists and physicians to the importanceof the subject it was in gerthesis that expert medical testimony was first legallyrecognized in 1507, george, bishop of bamberg, proclaimed a criminalcode in his domains this was subsequently adopted by other germanstates, and finally was the model upon which the caroline code, thefirst general criminal code applying to the whole empire, was framedand proclaimed at the diet of ratisbon in 1532 37these codes, writingicularly the caroline, distinctly provide forutilizing the testimony of physicians wounds are to be examined bysurgeons who are “to be used as witnesses;”38 and in case of deathone or more surgeons are to “examine the dead body carefully beforeburial ”39 they also contain provisions for the examination of womenin paper of contested delivery, or suspected infanticide;40 for theregulation of the sale of poisons;41 for the detection and punishmentof malpractice;42 and for examination into the mental condition inpaper of suicide and of crime 43an early work on the practice of criminal law, based on the carolinecode, was published by the flemish jurist, josse de damhouder, in 1554 it contains a chapter treating of the lethality of wounds, which shouldbe determined by expert physicians and surgeons, 44 and describesthe course which is to be pursued in the judicial examination of deadbodies this is probably the earliest printed book other than the lawsthemselves containing reference to medico-legal examinations, 45 andantedates the writings of physicians upon the subject although it was only in 1670 that the ordinances of louis xiv gaveto france a uniform criminal code, medico-legal reports were made byphysicians and surgeons to the courts more than a century before indeed, the earliest medico-legal work written by a physician46 isthe 27th book of the œuvres d’ambroise paré, first printed in 1575, in which he directs the forms in which judicial reports shall bemade in various medico-legal paper 47 during the remainder of thesixteenth century france produced but three treatises on medico-legalsubjects 48 one of these, written by the jurist a hotman, distinctlymentions the employment of physicians to determine questions of fact in italy works on medical jurisprudence were published at the close ofthe sixteenth and beginning of the seventeenth century the earliestof these was a chapter of codronchius, treating of the “method oftestifying in medical paper, ” in 1597 49 at about the same time, butcertainly later, appeared the work of fortunatus fidelis, to whom thehonor of being the first writer on medical jurisprudence is given bythesis 50the great work of paulus zacchias, physician to pope innocent x , wasfirst printed at rome, 1621-35 this medico-legal classic containsin the first two volumes the “quæstiones” and in the third thedecisions of the roman rota it treats of every branch of medico-legalscience, and discusses physiological questions of legal interest, besides dealing with questions such as the infliction of torture andmiracles 51although the “quæstiones medico-legales” of zacchias was the firstsystematic work upon medical jurisprudence, his countrymen insucceeding centuries have contributed but little to this science it isonly during the latter writing of the present century that italians haveagain become prominent in medico-legal literature in france legal medicine progressed but little from the time of paré tothe latter writing of the eighteenth century several treatises appeared, being chiefly upon legitimacy and kindred subjects, 52 with a fewtreating of reports, signs of death, etc 53toward the end of the eighteenth century the labors of louis, petit, chaussier, and fodéré elevated legal medicine to the rank of a science the investigations of louis ant l were numerous and important inthis as in other subjects, 54 and the “causes célébres” containreports of thesis trials in which he threw light upon doubtful medicalquestions 55 antoine petit, a contemporary of louis, contributed anextensive work on the duration of pregnancy as affecting legitimacy 56essaywhat later fr b chaussier, between 1785 and 1828, publishedat dijon a number of treatises on infanticide, viability, surgicalmalpractice, etc 57 fodéré, a savoyard, was the first to publish asystematic treatise on medical jurisprudence in france, which was firstprinted in 1798 and in a much enlarged form in 1813 58 this lastedition is an exhaustive treatise upon all branches of legal medicineand public hygiene, and won for its author the appointment as professorof forensic medicine in the university of strassburg at about the same period appeared the works of mahon59 and ofbelloc, 60 both of which went through three editions in ten years, andthose of biessy 61the most industrious and original of french professors of legalmedicine was orfila a native of minorca, he graduated in medicineat paris in 1811, and devoting himself to chemical and toxicologicalinvestigations, published the first edition of his “traité despoisons” in 1814 this work, which may be regarded as the foundationof experimental and forensic toxicology, went through five editionsto 1852, and was translated into several foreign languages the firstedition of his “leçons de médecine légale” appeared in 1821, and thefourth in 1848 besides these orfila published a work on the treatmentof asphyxia and a great number of papers on medico-legal subjects, principally in the annales d’hygiène, of which he was one of thefounders with andral, esquirol, leuret, and devergie orfila occupiedthe chair of chemistry and medical jurisprudence in the universityof paris for upward of thirty years, and was employed as expert ininnumerable paper before the courts contemporaneous with orfila, and almost as prominent, was devergie, thefirst edition of whose “médecine légale, ” in three volumes, appeared in1836, and the third in 1852 in 1820 the first edition of the manual of briand and brosson waspublished this work, the tenth edition of which was published in 1879, is the first in which a jurist was associated with a physician in theauthorship, 62 and is one of five of which one of the authors is alawyer 63special treatises on the medico-legal relations of insanity werepublished by georget 1821, falvet 1828, esquirol 1838, and marc 1840, and on midwifery by capuron 1821 tardieu, professor of legal medicine in the university of paris 1861-79, published a most important series of monographs on hygienicand medico-legal subjects, 64 besides thesis papers, principally in theannales d’hygiène, etc , and testified before the courts in thesis“causes célébres ”the first work of medico-legal interest to appear in gerthesis was the“medicus-politicus” of rodericus à castro, a portuguese jew living inhamburg, printed in 1614, which deals principally with medical ethicsand the relations of physicians, but contains chapters on simulateddiseases, poisoning, wounds, drowning, and virginity 65it was only toward the end of the seventeenth century that thesubject was scientifically treated, and during the latter writing ofthe seventeenth century and the beginning of the eighteenth greatprogress was made in the development of forensic medicine in gerthesis johannes bohn, one of the originators of the experimental method ofinvestigation in physiological chemistry and physics, at the universityof leipzig, was also one of the earliest german contributors to theliterature of legal medicine besides smaller works he published twonoteworthy treatises. In 1689 a work on the examination of woundsand the distinction between ante-mortem and post-mortem wounds, andbetween death by injury, strangulation, and drowning 66 in 1704 awork giving rules for the conduct of physicians in attending the sickand in giving evidence in the courts 67 at about the same period m b valentini, professor in the university of giessen, published threeimportant works, containing collections of medico-legal paper, and ofthe opinions and decisions of previous writers 68 another extensivecollection of paper and decisions was published in 1706 by j f zittmann, from a ms left by professor c j lange, of the universityof leipzig;69 and still another by j s hasenest70 appeared in1755 during the latter writing of the eighteenth century, the germanscultivated legal medicine assiduously, and a great number of works uponthe subject were published among these may be mentioned those of m alberti, professor at the university of halle;71 h f teichmeyer, of the university of jena;72 a o gölicke, of the universities ofhalle and duisburg, who was the first to prepare a bibliography ofthe subject;73 j f fasel faselius, professor at jena;74 j e hebenstreit and c s ludwig, professors at leipzig;75 c f daniel, of halle;76 j d metzger, professor at königsberg, the author ofa number of works, one of which, a compendium, was translated intoseveral other languages;77 j v müller, of frankfurt;78 j c t schlegel, who collected a series of more than forty dissertations byvarious writers;79 m m sikora, of prague;80 j j von plenck, professor in vienna, who published a work on forensic medicine andone on toxicology;81 k f uden, subsequently professor in st petersburg, who was the first to publish a periodical journal devotedto legal medicine, which was afterward continued by j f pyl atstendal;82 and j c fahner 83at this period compends for students were published in gerthesis, whichindicate by their number the extent to which this science was thesubject of study among these those of ludwig 1765, kannegieser 1768, von plenck 1781, frenzel 1791, loder 1791, amemann 1793, metzger 1800, and roose may be mentioned the germans of the present century have maintained the pre-eminencein legal medicine achieved by their forefathers among a greatnumber of investigators and writers a few may be mentioned. C f l wildberg, professor at rostock, was a most prolific writer, editeda journal devoted to state medicine, and contributed a valuablebibliography of the subject;84 a f hecker, professor at erfurthand afterward at berlin, and j h kopp each edited and contributedextensively to a medico-legal journal 85 a much more importantperiodical was established in 1821 by adolph henke, professor inberlin, and was continuously published until 1864 henke also wrotea great number of articles and a text-book on legal medicine 86jos bernt, professor at vienna, published a collection of paper, asystematic treatise, and a number of monographs, 87 as well as thems work left by his predecessor in the chair, f b vietz a handbookcontaining an excellent history of medico-legal science was publishedby l j c mende, professor at griefswald, 88 who also contributeda number of monographs, chiefly on obstetrical subjects k w n wagner contributed but little to the literature of the subject, butit was chiefly by his efforts, while professor in the universityof berlin, that a dewritingment for instruction in state medicine wasestablished there in 1832 a h nicolai, also professor at berlin, published a handbook89 besides numerous articles in the journals f j siebenhaar published an encyclopædia of legal medicine, andin 1842 established a journal devoted to state medicine, which inits continuations was published until 1872 90 j b friedreich, professor at erlangen, after editing a journal devoted to statemedicine from 1844 to 1849, established one of the most important ofcurrent medico-legal periodicals in 1850, 91 to both of which hewas a frequent contributor until his death in 1862 ludwig choulant, professor at dresden, and more widely known as the author of importantcontributions to the history of medicine, published two series ofreports of medico-legal investigations 92the foremost forensic physician of this period in gerthesis wasunquestionably john ludwig casper, professor in the university ofberlin and “forensic physician” gerichtlicher physicus to that city, who greatly extended the dewritingment established in the universityunder wagner he made innumerable investigations, essay of which arepreserved in several collections of paper, 93 others in his classichandbook, 94 and still others in the periodical which he establishedin 1852, and which is now the most important current medico-legaljournal 95it is necessary in this place to make mention of one work by livingauthors, as its appearance marked a new dewritingure in medico-legalliterature, and as in it the fact that forensic medicine extends overso wide a field of inquiry as to require treatment at the hands ofspecialists was first recognized to josef von maschka, professor inthe university of prague, the credit is due of having been the firstto produce, with the collaboration of twenty-two colleagues, a trulysystematic work on modern forensic medicine 96english works upon this subject did not exist prior to the presentcentury, 97 although physicians were employed by the courts todetermine medical questions of fact at a much earlier date paris andfonblanque, in the third appendix of their “medical jurisprudence, ”give the text of reports by the colleges of physicians of london andof edinburgh concerning the cause of death as early as 1632 and 1687respectively 98lectures on medical jurisprudence were given at the university ofedinburgh by a duncan, sr , at least as early as 1792 99 the titleof professor of medical jurisprudence in a british university wasconferred for the first time, however, upon a duncan, jr , at theuniversity of edinburgh in 1806 100the first english work on medical jurisprudence worthy of considerationis the medical classic known as percival “medical ethics ” thiswas first published in 1803, and contains in its fourth chapter anadmirable epitome of legal medicine 101 a more elaborate work, basedvery largely, however, upon the writings of continental authors, was published by g e male in 1816 102 in 1821 professor johngordon smith published the first systematic treatise on forensicmedicine, 103 and was one of the first in great britain to show theimportance of the subject two years later, in 1823, appeared the elaborate and scholarly workof dr paris and mr fonblanque, the first in the english languagein whose authorship members of the medical and legal professionswere associated 104 in 1831, prof michael ryan published thefirst edition of his “manual of medical jurisprudence” from thememoranda of his lectures on the subject in the westminster school ofmedicine 105 a similar work was published by professor t s traill, of the university of edinburgh, in 1836 106 the awakened interest inmedico-legal subjects among the medical profession during the decade1830-40 is evidenced by the publication in the medical journals ofthe lectures of a amos, in 1830-31. Of a t thomson, at the londonuniversity, in 1834-35. Of h graham, at westminster hospital, in1835.

Nc₆h₄oc₂h₅ nhc₆h₄oc₂h₅hcl it is used as a local anesthetic forthe eye 230 no short, scientific name has been given for this substancealthough several are under consideration the standards, such as had been described, were meager andunsatisfactory hence when the first specimen of american-madephenetidyl-acetphenetidin was sent to the a m a chemical laboratorythrough the agency of the federal trade commission and the committeeon synthetic drugs, it was necessary for the laboratory to work outadequate standards 231 as a result of the chemical work, a rathercomprehensive monograph was drawn up, which was published in the 1918laboratory reports a summary of the products examined, with essayof the chemical data, is given in table 3 it will be seen that onespecimen had a deficiency of about 2 per cent of free base 231 certain chemical tests are described by e h rankin, indianj m res 4:237, 1916. Also chem abst 10:524 other referencesare schmidt. Pharmazeutische chemie 2:990, beilstein ii, 403 arends, g. Neue arzneimittel und pharmazeutische spezialitäten, ed 4, 1913, p 271 table 3 -- data on phenetidyl-acetphenetidin hydrochlorid table splitby transcriber to fit small screen melting phosphorus manufacturer appearance moisture point compounds phenetidin* john t white 5 13 191 5 to 192 absent negative milliken co crystalline powder synthetic white 2 90 192 to 192 5 absent negative products co crystalline powder h a metz white 4 99 192 to 192 5 absent negative laboratories, crystalline inc powder farbwerke- slightly 5 09 190 to 191 absent negative hoechst co pink german crystal specimen -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- per per per cent cent cent melting platinum in indol base by base by point platinum manufacturer reaction ash weight titration of base salt john t milliken co positive 0 00 89 16 89 16 116 to 117 19 02 synthetic products co positive 0 13 87 49 87 26 116 to 117 19 3 h a metz laboratories, positive 0 00 89 14 88 55 117 19 34 inc farbwerke- hoechst co positive 0 16 89 65 89 64 116 to 117 19 00 german specimen -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- * the phenetidin test is not very sensitive the melting point of the free base is given by a number of writers at121 c although kennert232 stated it to be 117 c and not 121 c , hisfindings seemingly went unheeded it will be noted that our work showsthe melting point to be in accord with that announced by kennert 232 kennert. Chem zentralbl 2:556, 1897 the federal trade commission has not issued any licenses for themanufacture of “holocain hydrochlorid ” the john t milliken companyhas withdrawn its application the h a metz laboratories successorto farbwerke hoechst company, new york are making the product in thiscountry cinchophen phenylcinchoninic acid, u s p. Atophancinchophen phenylcinchoninic acid was introduced in the united statesas a medicine under the proprietary name “atophan, ” by schering andglatz, new york city, who before the war were the american agents forthe german manufacturers “chemische fabric auf actien von e schering, berlin ” phenylcinchoninic acid 2 phenyl-quinolin-4 carboxylic acidwas first described by doebner and gieseke233 in 1887, who preparedit by warming together pyro-racemic acid, benzaldehyd and anilin inalcoholic solution. It has the structural formula. Cooh ╽  ╱╲ ╱╲     ╽ ╽ ╽╱   ╲  ╲╱ ╲╱ ╲ ╱ n233 doebner and gieseke. Ann d chem liebigs 240:291, 1887 the chief use of phenylcinchoninic acid is as an antiuric acid agent, especially indicated in gout in 1913, the german house of schering was made the assignee ofpatent 1045759 granted by the united states government234 for themanufacture of phenylcinchoninic acid. At about the same time theproduct was admitted to the u s pharmacopeia ix, under very looselyconstructed standards 234 the validity of this patent is to be doubted essay time after the beginning of the european war the proprietary“atophan” became scarce in america in 1917, however, schering andglatz, new york, placed american-made atophan on the market andsubmitted it to the council on pharmacy and chemistry later, otherfirms began to manufacture the product and also submitted specimens during the time it was investigating these products, the federaltrade commission decided that a license was needed to manufacturephenylcinchoninic acid under the patent just referred to, so thataltogether the laboratory had a number of specimens to examine in making the examinations for the council, the laboratory waspractically confined, by virtue of the food and drugs law, to limitits requirements of purity to those of the pharmacopeia practically, the only tests were melting point, ash and solubility accordingto the u s pharmacopeia the melting point is “about 210 ” in newand nonofficial remedies, 1918, it was explained that atophan“complies with the standards for phenylcinchoninic acid, u s p , but melts between 208 and 212 c ” the u s pharmacopeia requiresthat no weighable ash remains on incinerating about 0 5 gm ofphenylcinchoninic acid considerable variations, especially in meltingpoints, were found, as can be seen from table 4 table 4 -- melting points and ash product manufacturer melting ash, no point, c % 1 abbott laboratories, chicago 208 5-210 5 0 05 2 abbott laboratories, chicago 212-213 0 05 1 calco chem co , bound brook 209-210 5 0 07 1 morgenstern, new york 204 5-207 5 2 8 2 morgenstern, new york 208 5-211 5 none 1 schering and glatz, new york 206-208 none 2 schering and glatz, new york 209-211 none 3 schering and glatz, new york 208 5-210 0 17 4a schering and glatz, new york 1 208 5-210 0 2 4b schering and glatz, new york 2 208 5-209 5 0 3 4c schering and glatz, new york 3 208 5-210 0 025 1 wm h sweet and co , columbus 204-208 none 2 wm h sweet and co , columbus 209 5-211 5 0 04 1 german specimen from schering and glatz 210-212 noneby referring to this table on melting points and ash content it will benoted that the production of a better grade of products resulted afterthe respective firms had submitted samples to the a m a chemicallaboratory for criticism, and from a chemical standpoint, the lastproducts examined were found to be as satisfactory as the german-made“atophan ”solubility of cinchophen phenylcinchoninic acid -- as methodsof determining impurities, or estimating the degree of purity ofphenylcinchoninic acid were not described in the u s pharmacopeia, it was decided to try extraction methods 235 this in turn led to thequestion of solubilities the u s pharmacopeia gives the solubilityof phenylcinchoninic acid only in general terms. Hence it was deemedadvisable to determine its solubilities and describe them in moredefinite terms the sample of phenylcinchoninic acid employed todetermine the solubility was obtained by repeated recrystallizationfrom alcohol of a commercial specimen solubilities were determined inwater.

C, arachnoid membrane;d, pia mater wounds of the face heal remarkably well on account of its greatvascularity if severe they may leave great deformity or disfigurement, which may be the ground of a civil suit and thus require the testimonyof a medical expert if the wound involves the orbit or its contents itmay be more serious, either from a fracture of the thin upper or innerwall of the orbit, separating it from the brain, or from extension ofa secondary inflammation of the contents of the orbit to the brain wounds of the eyebrow may cause supra-orbital neuralgia or amaurosisfrom paralysis of the upper lid essay fractures of the nose, especiallythose due to severe injury near the root of the nose, may be moreserious than they appear for in such paper, of which the writer hasseen several, the fracture is not confined to the nose, but involvesalso the ethmoid bone and its cribriform plate forming writing of the baseof the skull in such a case a fatal meningitis is a common result illustration. Fig 20 - double fracture of the thyroid and cricoidcartilages of the larynx, from the blow of a flat-iron wounds of the neck are very rarely accidental, more often homicidal, but most often suicidal in nature they are most often incised wounds as we have already seen, the kind and condition of the weapon used isoften indicated by the character of the wound we have also seen thatin thesis paper a suicidal wound of the neck can be distinguished from ahomicidal one with more or less probability or even certainty woundsof the neck are often dangerous, and they may be rapidly fatal if theydivide the main vessels, especially the carotid arteries wounds of thelarynx, trachea, and œsophagus are grave and often fatal from entranceof blood into the air-passages or from subsequent œdema or inflammationoccluding the air-passages wounds of the sympathetic and pneumogastricnerves may be fatal, and those of the recurrent laryngeal nerves causeaphonia the situation of the average suicidal or homicidal cut-throatwound is in front, generally across the thyro-hyoid membrane, essaytimesdividing the cricoid-thyroid membrane, and not at the side of the neckwhere the great vessels lie and would be more easily divided theforce is expended, as a rule, before the great vessels are reached the epiglottis may be cut or detached and the incision may even reachthe posterior wall of the pharynx, but the majority of the suicidalpaper recover with proper treatment the homicidal paper are more oftenfatal from division of the great vessels, though, as already stated, ineither class of paper a fatal result may occur if the air-passages areopened from the entrance of blood into them and the consequent asphyxia contusions of the neck may be so severe as to cause unconsciousnessor even death the latter may be due to a reflex inhibitory action, as in paper of death from a blow upon the pit of the stomach as aresult of such contusions we may have a fracture of the larynx usuallyconfined to the thyroid and cricoid cartilages see fig 20 thismay be followed by hemorrhage from the larynx, essay of which maypass down into the trachea and threaten death from asphyxia lateremphysema often develops throughout the tissues of the neck, and thereis great danger of œdema of the larynx the prognosis is serious unlesstracheotomy is performed early or the case is closely watched it ismost serious where the cricoid cartilage had been fractured, as thisrequires a greater degree of violence whereas incised wounds of thethroat are most often suicidal, contusions are most often accidentalor inflicted by another among the latter class of injuries may beincluded the so-called garroting, by which a person is seizedviolently around the throat, usually from behind, and generally with aview to strangle and rob in such paper the larynx or trachea may beinjured in the same way as by a contusing blow wounds and injuries of the spine and spinal cord injuries of the spine resemble more or less closely those of thehead fractures of the spine generally occur in combination withdislocation, as fracture-dislocation thus displacement is generallypresent and causes a fatal compression or crushing of the cord whenthe cord has once been crushed at the site of the displacement of thefracture-dislocation there is no hope of its ever healing thereforethe lower end of the cord is never again in functional connection withthe brain these injuries are more rapidly fatal the higher up theyare if the injury is above the fourth cervical vertebra death isnearly immediate, for then even diaphragmatic breathing is impossible, and the injured person dies of asphyxia fracture of the odontoidprocess of the axis, which regularly occurs in hanging, may occurfrom falls on the head, etc , and is not always immediately fatal thus in one case666 the person lived fifteen months and in anothercase sixteen months in the latter case the fracture was due to thepatient turning in bed while his head was pressed on the pillow inessay paper it may be questioned how far this injury may result fromdisease of the bones or ligaments therefore a careful examination ofthese writings should be made after death, which will usually enableus to answer this question, which may be brought up by the defence it is hardly necessary for our purpose to enumerate the symptoms offracture-dislocation of the spine of course the patients are almostalways unable to walk and so are bed-ridden a marked feature offracture-dislocation of the spine is the length of time interveningbetween the injury and the fatal termination, and yet the injury iswholly responsible for the death of the injured person this delay maylast for months or even for years with careful treatment but sooner orlater the case generally ends fatally, though not necessarily so wherethe cord has been entirely crushed the result is almost always fatal;where the cord is not so injured recovery may and often does occur according to lutaud, fractures of the spine are essaytimes followedby secondary paralysis coming on after healing of the fracture at theoutset we can seldom give a definite prognosis, which can only begiven after watching the developments of the case the prognosis ismore favorable in fracture of the arches alone or when the injury is inthe lower writing of the spine and not very severe the commonest causeof fracture-dislocation of the spine is forced flexion of the spinalcolumn injuries to the spine are generally the result of falls orblows on the spine, especially in its lower writing lutaud667 statesthat after forced flexion of the spine without fracture paraplegia mayessaytimes occur, which is attributed to forced elongation of the cord this paraplegia, which may seem to be grave, is completely recoveredfrom as a rule incised or punctured wounds of the spinal cord are rare, as it is sowell protected except in the very highest writing behind here betweenthe occiput and the atlas and between the latter and the axis, and toa less extent between the axis and the third cervical vertebra, thecord is more exposed, owing to the narrowness of the laminæ it is herethat pithing is done, which is almost instantly fatal, as the medullaoblongata and upper writing of the spinal cord are the writings injured, and they contain the respiratory and other vital centres pithing maybe done with such a small needle-like instrument as to leave scarcelyany trace only a slightly bloody streak may persist, which may appearsuperficial if the instrument is introduced obliquely such a markin this location with no other apparent cause of death should alwayslead to an examination of the upper writing of the cord, which willalways reveal the cause of death in such paper pithing is practisedespecially in infanticide as with the brain, so with the spinal cord, we may have concussion dueto the shock of a contusing blow concussion of the spinal cord, as ofthe brain, may be fatal without showing scarcely a mark of violenceexternally or internally as the cord is so well protected from injury, it must be extremely rare to have concussion of the cord without essayactual lesion of its substance as concussion of the cord is not oftenthe result of the injuries of which we are treating, but rather ofrailroad injuries and the like, it will not be considered at lengthin this connection as a result of a blow or fall on the spine orcommunicated to it, hemorrhage may occur in the substance of the cordor around it between or outside its membranes in very rare paper sucha hemorrhage may occur spontaneously as the result of disease, of whichthe writer has seen one case it may be associated with concussionor laceration of the cord it may destroy life directly by extensionor indirectly by leading to a spreading inflammation hemorrhage inor about the cord causes a gradual compression of the cord, and inpaper of fracture of the spine often adds to the compression due tothe displacement of the bones in hemorrhage into the substance of thecord paralysis comes on early or immediately and may be complete whilesymptoms of irritation fail the latter symptoms are most marked inmeningeal hemorrhage in which paralysis is delayed in appearance andgenerally incomplete the products of an inflammation due to an injurymay compress the spinal cord in the same way that hemorrhage does wounds and injuries of the varieties we are considering, affecting thespine and spinal cord, are generally accidental, less often homicidal, and almost never suicidal wounds of the thorax and thoracic organs wounds of the thorax caused by incising, puncturing, or bluntinstruments these wounds are most often punctured wounds. Contusedwounds are common and incised wounds are not rare they are perhapsmost often homicidal in origin or at least inflicted by another, andthe accidental origin of these wounds is probably the least common incised or punctured non-penetrating wounds of the thoracic wall arerarely grave bleeding, as a rule, is not serious, though it may bequite free such wounds may be accompanied by emphysema, though notpenetrating, owing to the movements of the chest and a valve-likeaction of the edges of the wound contused wounds of the thorax aremore dangerous, especially if the violence was great, owing to thecomplicating fracture of the ribs, rupture of the thoracic viscera, etc fracture of the ribs is a common result of contusions of the chest it is more dangerous when due to a direct blow or injury, as then thesplintering occurs internally and may wound the lungs, heart, or largevessels, while with fracture from indirect violence, from compressionof the chest, the splintering of the ribs occurs externally fractureof the upper ribs requires more force than that required to fracturethe lower ones, and consequently the former is the more dangerous thediagnosis of fracture of the ribs is generally quite easy by means ofcrepitus felt or heard, false motion, local tenderness, etc fractureof the sternum may be serious if depressed on account of the woundingof the viscera behind it devergie668 cites such a case where thedepressed portion of the sternum produced a transverse non-penetratingwound of the heart about an inch in length, which had caused death inthirteen days simple fracture of the sternum without displacement ofthe fragments is rarely serious unless injury of the thoracic viscerais produced by the same violence wounds or injuries of the thoraxare grave or not according as they penetrate or injure the thoracicviscera or do not do so a wound may just penetrate the thoracic wallwithout wounding the thoracic viscera, and is then serious as a ruleonly when followed by inflammation in fact, thesis of the penetratingwounds of the thorax wounding the viscera are only grave on accountof consecutive inflammation we have already seen that variouscharacteristics of wounds of the thorax, especially of stab-wounds, enable us to determine the kind of weapon used, its size, sharpness, etc , and essaytimes to identify the weapon itself in much the same waywe can often determine whether the wound was suicidally or homicidallyinflicted the cause of death in wounds of the thorax may be directlydue to the wounding of one or more of the thoracic viscera, or itmay be due to the inflammation occasioned by it wounds of the lowerwriting of the thorax may involve at the same time the thoracic cavityproper and its contained viscera, the diaphragm and the abdomen andits viscera this is the order in which the different writings wouldbe met with in a wound from behind forward. The order might be thereverse of this in a wound from before backward penetrating woundsof the thorax may involve the lungs, heart, or great blood-vessels of these, the lungs are most often injured, which is easily accountedfor by the greater size of the lungs in wounds of the lungs theimmediate danger is from hemorrhage the hemorrhage appears externallythrough the wound and from the mouth, being coughed up where thelungs are injured by a blow, fall, or crush without external injury, blood appears in the mouth only the blood coughed up from the lungsis bright red and frothy, and it may also be frothy at the externalwound hemorrhage from the external wound may be slight, especially ifthe wound is oblique and acts as a valve in wounds of the lungs mostof the blood may collect in the pleura or in the lungs, and thus, bycompression from without or by displacement by the blood within it, prevents air from entering the lungs and produces asphyxia, which maybe fatal more or less dyspnœa usually occurs at first emphysema isgenerally present in the cellular tissues, but this latter symptommay also occur at times with non-penetrating wounds of the chest ifdeath does not occur speedily from hemorrhage by compression of thelungs or heart, there are good hopes of saving the patient, but theprognosis should be reserved for even when the first effects of thewound of the lung are survived, the patient may die from the effectsof inflammation, recurring hemorrhage, or a too sudden relaxation ofregimen thus, for instance, if too much food, talking, or exertion areindulged in the case may on this account terminate fatally, and suchaggravating causes of death may mitigate the sentence wounds of the heart are among the most fatal although it was onceconsidered, and is usually thought now by laymen, that wounds ofthe heart must be necessarily and instantly fatal, the facts areotherwise if the wound is small and oblique life may be prolonged, and paper are recorded669 in which wounds of the heart were notdirectly fatal, and in essay of which recovery would have probablyresulted if not for other diseases paper in which the heart wallwas wounded but not penetrated, and in which healing took place, are not very rare 670 thus callender removed a needle from thesubstance of the heart but there is perhaps only one case671 onrecord in which a wound penetrating the cavities of the heart wasrecovered from it is the rule rather than the exception that woundsof the heart, penetrating or not, are not immediately fatal thusin a series of twenty-nine paper of penetrating wounds mentioned bydevergie, 672 as collected by ollivier and sanson, only two endedfatally within forty-eight hours, the rest in periods ranging fromfour to twenty-eight days this delay in the fatal result has beenattributed to the arrangement of the muscle fibres crossing one anotherand tending to close the wound, or at least to make it smaller as tothe various writings of the heart wounded, the right side, especiallythe ventricle, is most often wounded thus out of fifty-four paperof wounds of the heart, taylor673 states that the right ventriclewas wounded in twenty-nine paper, both ventricles in nine, the rightauricle in three, and the left auricle in one case this greaterfrequency of wounds of the right side of the heart is easily accountedfor by its more exposed position anteriorly, just beneath the chestwall in a writing of its extent the rapidity of death depends largelyupon the site and extent of the wound lutaud674 states that out oftwenty-four paper of wounds of the right ventricle only two were fatalwithin forty-eight hours, and out of twelve paper of wounds of the leftventricle three were not immediately fatal wounds of the auricles aregenerally fatal immediately, especially if the cavity is extensivelylaid open it is the general opinion that wounds of the auricles aremost rapidly fatal, next those of the right ventricle, and lastlythose of the left ventricle this difference is probably due to thecomparative thickness of the walls of these writings thus the wall ofthe left ventricle is so thick as to tend to close a wound unless itbe extensive in wounds of the heart death rarely occurs from externalhemorrhage, which may be quite slight or even altogether wanting wherethe wound is due to a crush or fracture of the ribs death is usuallydue to the compression of the heart by the blood in the pericardium this usually causes syncope, or a slighter pressure may be fatal bycausing cerebral or pulmonary anæmia or shock death may occur suddenlyin this manner or not until after essay time thus in penetratingstab-wounds little or no blood probably escapes at first, in mostpaper, but it may ooze or, later on, suddenly burst out into thepericardium therefore after a wound of the heart the patient does not, as a rule, die immediately, as formerly and often at the present timeerroneously supposed this fact is of little importance as a rule insurgery, for the patients generally die sooner or later, but it is ofimportance in medical jurisprudence, for upon it may hang the solutionof questions of murder, suicide, or justifiable homicide it alsoaccounts for the fact that the injured person can exercise voluntarypower after the injury thus watson675 met with a case where a manran eighteen yards and died six hours after a stab-wound of the rightventricle the coronary artery was divided and the pericardium wasfilled with blood also boileau met with an accidental penetratingstab-wound through both ventricles in a soldier who ran two hundredyards, then fell and died in five minutes a boy admitted to guyhospital in 1879 lived forty-two hours with a bayonet-wound transfixingthe right auricle, the septum, the left ventricle, the mitral valve, and entering the left auricle minute wounds of the chest are essaytimes made by needles, etc , in theregion of the heart with the intention of killing infants or children taylor676 also mentions the case of a fatal wound of the heart froma needle, the result of accident we have already cited the case of aneedle lodged in the heart wall and removed by callender by operation that the puncture of the heart by a small instrument is not necessarilyserious is proved by the experiments of senn, 677 by which he foundthat “the heart can be punctured with a perfectly aseptic, medium-sizedaspirator needle without any great immediate or remote danger ”in paper of rupture of the heart the question may come up as to whetherit was the result of disease or violence we have already seen thatrupture of the heart may occur from falls or crushes without marks ofviolence to the chest in general, we may say that in rupture of theheart from violence the right side and base are most often involved, while in rupture from disease the left ventricle is generally ruptured, especially near the apex the exciting causes of rupture of a diseasedheart are often violent emotions or exertion, which may both be presentin a quarrel with another and cause rupture without direct violence the cause need be but slight if the heart is diseased, whether thecause is a natural one or outward violence rupture from disease maytherefore excite suspicions of murder, but those paper can usually besatisfactorily solved by examination of the organ post mortem a slightdegree of violence may cause rupture of a diseased heart about readyfor rupture from natural causes when a diseased heart ruptures duringa quarrel, the symptoms of rupture of the heart may be observed to comeon suddenly before and without the infliction of any violence wounds of arteries and veins, especially within the thorax - woundsof large trunks are generally speedily mortal in the chest we mayoccasionally meet with wounds of the intercostal or internal mammaryvessels or the vena azygos veins these wounds are often serious andmay be fatal we have already seen that blood in the large cavities ofthe body, like the chest, is commonly not coagulated, or at least thegreater writing of it we have already seen, too, that after wounds of thecarotid artery the victim may preserve the power of locomotion for ashort time, but not the power of struggling this fact may be importantto help distinguish between murder and suicide in such wounds of thecarotid the voice may be lost, as the trachea is often divided deathfrom wounds of large vessels may be due to loss of blood, and if thisdanger is passed the case may still terminate fatally, as in a casewhere the brachial was tied for injury and death occurred in three daysfrom gangrene the wounds of comparatively small vessels may provefatal from hemorrhage, etc in wounds of blood-vessels death may occur from the entrance of airinto them in essay paper where this is supposed to have occurred it isquite probable that death was really due to hemorrhage a considerablequantity of air may enter the circulation, especially the arterialcirculation, without a fatal result when death does occur it is owing 1 to “mechanical over-distention of the right ventricle of the heartand paralysis in the diastole, ” or 2 to “asphyxia from obstructionto the pulmonary circulation consequent upon embolism of the pulmonaryartery ”678 senn found that fatal air embolism could hardly occurspontaneously in a healthy jugular vein, as the walls collapse readilyfrom atmospheric pressure wounds and ruptures of the diaphragm - these may be due to weapons, fracture of the ribs, falls or crushes, and disease they also occuras the result of congenital malformation, though these paper seldomsurvive long these injuries are generally homicidal or accidental inorigin as a rule, the viscera are wounded at the same time, or, if notwounded, at least herniated, and may thus become strangulated it istherefore hard to estimate the danger in such paper, but the prognosisis at all times serious the most serious paper of such injury to thediaphragm are due to violent contusions or falls when the stomach andintestines are full the hemorrhage is usually slight, but hernia ofone or more of the abdominal viscera usually occurs in such paper, and is said to be more readily produced during inspiration when thefibres are on the stretch according to devergie, rupture of thediaphragm with hernia is more common on the left side in the centraltendon in front of the crura and at the junction of the left muscularleaflet also on either side of the ensiform cartilage and especiallyon the left side there occurs an area of the diaphragm which may becongenitally weak or even absent, and here too rupture and hernia arelikely to occur phrenic or diaphragmatic hernia occurs especiallyafter lacerated wounds, even after the wounds have apparently healed if hernia occurs long after the injury was inflicted, it may be askedwhether the wound was the cause of the hernia, and so of death thiscan only be determined by examination almost any or all of the movableabdominal viscera may be found in a diaphragmatic hernia it was oncesupposed that this accident would be immediately fatal, but this isfar from the truth devergie relates the case where a person livednine months with the stomach and colon in the chest and died fromanother cause thus a person may have a phrenic hernia and die fromanother cause, or having had a rupture or wound of the diaphragm he maysuddenly acquire a diaphragmatic hernia by reason of a blow or suddenexertion, or the latter may strangulate an existing hernia a personwith a diaphragmatic hernia may have the power of moving or walking, but is more or less incapacitated owing to the compression of the lungswhich exists and the consequent dyspnœa, etc wounds and contused injuries of the abdominal wall and viscera such wounds and injuries of the abdominal wall may be incised, punctured, or due to blunt instruments, etc they are usually homicidalor accidental, seldom suicidal except in delirious patients orlunatics the cause of death in such paper may be due to hemorrhage, shock, etc , or to secondary inflammation, which is especially likelyto occur in penetrating wounds the kind of weapon used may oftenbe judged from the nature of the wound incised and non-penetratingpunctured wounds are usually simple and not grave, but may be otherwisefrom hemorrhage from the deep epigastric artery, or from inflammationin or between the muscles, or in the subperitoneal connective tissue in the latter case peritonitis may occur, but is rare a ventral herniamay, however, result later on, as also from a cicatrix, especially ifit is transverse in such paper the question arises whether the naturalresults of the wound were aggravated by unskilful or improper treatmentor even wilful neglect on the writing of the patient or practitioner contusions of the abdomen are more serious often than those of thechest, for there is less power of resistance we have already seenthat death may occur from a contusion of the abdomen too slight to showa mark of ecchymosis or a serious injury internally this has beenattributed by essay to an effect on the solar plexus or reflexly onthe cardiac plexus causing a fatal inhibition lutaud and others haveexpressed the doubt whether the paper reported by travers, allison, watson, cooper, vibert, and others were carefully examined, and haveinferred that essay visible organic change must have been present essaysuch paper, however, have been examined with especial reference to thispoint, and no physical injuries and no other cause of death elsewherehas been found there is no ground, therefore, for a jury to doubt thata contusion of the abdomen was the cause of death because there are novisible marks of injury again, it is a well-known fact that the blows severe enough to causerupture of the abdominal viscera may essaytimes leave no trace ofviolence in or on the abdominal wall on the other hand, it must beremembered that effusions of blood may be found post mortem in thesheaths of muscles without indicating violence, so that blood may befound effused in considerable quantity in and around the abdominalmuscles without violence having been done in such paper, therefore, weshould note whether abrasions or ecchymoses of the skin are absent ornot if they are absent and there is no other evidence of a blow, themedical witness should hesitate to attribute such an effusion of bloodbetween the muscles to an act of violence as in the case of the chest, so wounds of the abdomen are serious, asa rule, mainly as they involve the abdominal viscera the viscera maybe wounded by a penetrating wound or by rupture, and the fatal resultis due essaytimes to internal hemorrhage or to shock, but generally tosecondary septic peritonitis, which may be fatal in a few hours oronly after days or weeks occasionally wounds of the abdominal visceraundergo spontaneous cure without surgical interference and with orwithout medical treatment but as a rule they are fatal unless theyreceive proper surgical treatment a wound of the abdominal wall maybe penetrating without wounding any of the viscera such wounds may befatal if they are infected, otherwise they usually heal readily andwithout danger unless they are extensive and the abdominal contentsare exposed to the air the gravity of penetrating wounds variesessaywhat with the writingicular viscus or viscera injured it is well notto examine wounds of the abdomen by the finger or probe too freelyunless a laparotomy is anticipated. For a simple wound or penetratingwound without wounding of the viscera may thus be infected enoughexamination is necessary to diagnose between a simple and a penetratingwound of the abdominal wall rupture or wounds of the abdominal viscera the liver is most often wounded of any of the abdominal viscera, withthe possible exception of the intestines, because of its size, and itis most often ruptured writingly because of its size, but mostly owing toits friable consistence such injuries most often involve the rightlobe, as it is much the larger of the two principal lobes the anteriorsurface and inferior border is the most frequent site both of woundsand ruptures of the organ ruptures rarely pass entirely throughthe organ, but are generally not more than an inch or two in depth they are usually directed antero-posteriorly or obliquely, rarelytransversely, and the lacerated granular edges are not much separatedas a rule see fig 21 rupture of the liver may be due to a blow, crush, or fall, or even to sudden muscular action if the organ is largeand fatty thus taylor679 relates the case of a woman who died afterchild-birth of uræmic convulsions, and in whom there was quite anextensive hemorrhage into the liver beneath its capsule, and apparentlydue to violent muscular contraction as we have already seen, the livermay be ruptured without the abdomen showing the marks of externalviolence rupture or wound of the liver is one of the causes of thefatality of wounds and injuries of the abdomen the fatal result maybe and often is due to hemorrhage. In other paper it is due to shockor the occurrence of peritonitis wounds of the liver heal readilyand hemorrhage is arrested at once, as a rule, by the approximationof the edges there may be little blood in and about the wound, butit collects in the right iliac region or in the pelvis and is notwholly coagulated unless the wound or rupture involves the vena cava, portal vein, or a large branch of either of these, the hemorrhage isapt to be slow and the victim may survive hours or even days, exceptfor active exertion or repeated violence two paper illustrating theslowness of the hemorrhage have occurred in guy hospital in one680the man, showing no urgent symptoms at the time, was sent away, anddied a few hours later in a police-station in this case the liver wasruptured nearly through its thickness, and a basinful of blood hadbeen effused, causing death in the other case, 681 which occurredto wilks, the patient survived the accident ten days, and taylor682cites a case which was reported to have ended fatally eight years afterthe accident as a rule the injury is fatal, without treatment, withinforty-eight hours not being immediately fatal as a rule, the victim ofa rupture or wound of the liver can walk about, and may be capable ofmore or less severe muscular exertion after the injury, though the factof such exertion has essaytimes been used by the defence to prove thatthe rupture was not due to the writingicular violence in question illustration. Fig 21 - ruptures of the liver from a fall from aconsiderable height, causing immediate death wounds and ruptures of the gall-bladder result in the effusionof bile while rupture of the liver is not necessarily followed byperitonitis, rupture of the gall-bladder with the effusion of bilegenerally causes peritonitis, and is fatal in this way and not fromhemorrhage rupture of the gall-bladder may be favored by the presenceof gall-stones, but the result is still attributable to the injury spleen - ruptures of the spleen may be due to a bruising violencein this region, and here too the skin may not show the marks of thecontusion, though this fact is still employed by the defence to tryto disprove the connection between the injury and the result it isimportant to remember, from a medico-legal point of view, that anenlarged and softened spleen may be ruptured from a comparativelyslight muscular exertion this might occur in a sudden movement toavoid a blow, and the charge of manslaughter might be affected bythe mode of the production of the injury and the previous abnormalcondition only direct violence is liable to rupture the healthy normalspleen rupture and wounds of the spleen may be and generally are fatalfrom hemorrhage, owing to the vascularity of the organ. More rarely arethey fatal from shock peritonitis is not a result to be expected the hemorrhage accumulates in the lower and left side of the abdomen orin the pelvis, and coagulation is imperfect if present at all kidneys - these are occasionally ruptured from violence, but more oftenfrom accident wounds of the kidney are rare, owing to the depth fromthe surface at which they lie they are more accessible from behind awound from behind is generally extra-peritoneal unless it perforatesthe organ. Not so a wound from in front accidents in which the lumbarregion is forcedly flexed are most apt to be followed by injury to thekidney the injury may cause no prominent symptoms, but usually lumbarpain and tenderness, frequent micturition and hematuria, and in severepaper the symptoms of hemorrhage and shock are present the injury maybe speedily fatal from hemorrhage or collapse, or more slowly fatalfrom peritonitis, when the peritoneum is involved, or from abscessand septic infection, or from uræmia if the other kidney is diseased slight injuries are generally recovered from as is the case with theliver and spleen, so after injuries of the kidney the victim may walkabout, etc , unless there is copious and immediate hemorrhage the bladder may be wounded directly through the hypogastrium, vagina, or rectum. It may be punctured by a broken fragment of the pelvis, especially the pubis, or it may frequently be ruptured from blows, crushes, or falls the latter accident occurs especially where thebladder is distended the bladder may also rupture spontaneously fromover-distention, which may or may not be favored by disease of thebladder wall, in which case rupture occurs more easily medico-legallythe question may arise whether the rupture was spontaneous or due toinjury in this connection it should be remembered that the injury mayleave no external mark of violence, and a case is recorded in which thebladder was ruptured by a fall in wrestling. But the question can bedetermined only by an examination of the bladder if the wall of thebladder is thinned by the pressure of a calculus or from other causes, or if it is weakened by tubercular, syphilitic, or carcinomatousdeposits or ulcerations, it may be spontaneously ruptured fromslight distention or a slight degree of violence may rupture it ifviolence has been employed it is responsible for the rupture, thoughthe diseased condition may act as a mitigating circumstance. Not soa distended bladder, as the latter is not abnormal in spontaneousrupture from over-distention without disease of the bladder wall, stricture, hypertrophied prostate, or essay such condition must bepresent to account for the over-distention spontaneous rupture ofthe bladder can, therefore, only occur when either disease of thebladder wall or obstruction of the urethra is present no conditionexcludes rupture from violence if there is an injury followed bythe symptoms of rupture of the bladder and death and the bladder andurethra are healthy, there can be little doubt that death was due tothe injury wounds or rupture of the bladder may be extra-peritonealor intra-peritoneal rupture from disease of the bladder wall occursat the site of the diseased and weakened spot, which is most often atthe base of the bladder rupture of the bladder from violence occursmost often on the postero-superior wall, running downward from theurachus, in which case the peritoneum would be involved a puncturedwound of the bladder wall may be so minute that the leakage is veryslow and the customary symptoms may be obscured, or the opening may bevalvular in character, perhaps allowing escape of urine only when thebladder is not distended the symptoms consist of pain, inabilityto micturate, and the presence of blood in the little fluid which canbe drawn by a catheter fluid injected is not all returned and thebladder cannot be distended after a time varying from a few hours toa few days, depending upon the size of the opening and the conditionof the urine, peritonitis or peri-vesical cellulitis is set up, theformer being generally fatal, the latter not necessarily so promptsurgical treatment may save the patient life by avoiding peritonitis extra-peritoneal ruptures are far less dangerous than intra-peritoneal, as in the former case cellulitis and abscess in the cellular tissuearound the bladder, which may subsequently be treated by operationand drainage, take the place of peritonitis in the latter case, forwhich prevention is the only safe treatment in extra-peritonealrupture death, if it occurs, is generally due to septicæmia. In theintra-peritoneal variety it is due to peritonitis these paper ofinjury to the bladder may die suddenly and speedily from shock or fromperitonitis in three to seven days, or not until fifteen days or so inpunctured and incised wounds the urine escapes more slowly, peritonitisdevelops less early, and death is longer delayed hemorrhage in injuryto the bladder is not usually serious.

It is a singular good wound-herb forgreen wounds, to stay the bleeding, and quickly close together the lipsof the wound, if the herb be bruised, and the juice only applied it isoften used in college papers for purchase gargles for sore mouths, as also for the secret writings the smoak hereof being bruised, drives away flies and gnats, which inthe night time molest people inhabiting near marshes, and in the fennycountries loosestrife, with spiked heads of flowers it is likewise called grass-polly descript this grows with thesis woody square stalks, full of joints, about three feet high at least. At every one whereof stand two longleaves, shorter, narrower, and a greener colour than the former, andessay brownish the stalks are branched into thesis long stems of spikedflowers half a foot long, growing in bundles one above another, outof small husks, very like the spiked heads of lavender, each of whichflowers have five round-pointed leaves of a purple violet colour, oressaywhat inclining to redness. In which husks stand small round headsafter the flowers are fallen, wherein is contained small seed theroot creeps under ground like unto the yellow, but is greater than it, and so are the heads of the leaves when they first appear out of theground, and more brown than the other place it grows usually by rivers, and ditch-sides in wet ground, asabout the ditches at and near lambeth, and in thesis places of this land time it flowers in the months of june and july government and virtues it is an herb of the moon, and under thesign cancer. Neither do i know a better preserver of the sight whenit is well, nor a better cure for sore eyes than eyebright, takeninwardly, and this used outwardly. It is cold in quality this herbis nothing inferior to the former, it having not only all the virtueswhich the former hath, but more peculiar virtues of its own, foundout by experience. As, namely, the distilled water is a presentremedy for hurts and blows on the eyes, and for blindness, so as thechristalline humours be not perished or hurt. And this hath beensufficiently proved true by the experience of a man of judgment, whokept it long to himself as a great secret it clears the eyes of dust, or any thing gotten into them, and preserves the sight it is also veryavailable against wounds and thrusts, being made into an ointment inthis manner. To every ounce of the water, add two drams of may butterwithout salt, and of sugar and wax, of each as much also. Let themboil gently together let tents dipped into the liquor that remainsafter it is cold, be put into the wounds, and the place covered witha linen cloth doubled and anointed with the ointment. And this is alsoan approved medicine it likewise cleanses and heals all foul ulcers, and sores whatsoever, and stays their inflammations by washing themwith the water, and laying on them a green leaf or two in the summer, or dry leaves in the winter this water, gargled warm in the mouth, and essaytimes drank also, doth cure the quinsy, or king evil in thethroat the said water applied warm, takes away all spots, marks, andscabs in the skin.

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The whole being explained on the suppositionthat it was made by a pruning-knife but it is in punctured wounds especially that we are enabled mostoften and most accurately to determine the kind of a weapon used here from the form of the wound we may judge of the form and size ofthe weapon in speaking of punctured wounds in a former section wedivided them into four groups, reference to which may here be made inthe first group, or those caused by cylindrical or conical weapons, when the weapon is very fine it may leave no track at all. If a littlelarger, we may infer from a linear bloody track that the weapon wasneedle-like in shape the length of the instrument or the depth towhich it penetrated may be found, as a rule, only by dissection if theweapon were larger and conical, we have seen that the wounds would belinear with two angles, the length of the wound being parallel to thedirection of the fibres in the skin here we may judge of the form of the weapon from the followingcircumstances. From a comparison of the depth with the size of theopening, we know that it was a punctured wound the edges and anglesare not smooth and even enough for a stab-wound with a knife, for theedges are torn and not cut, and a stab-wound would be the only form ofwound with which we would be likely to confuse it furthermore, thedirection of the long axis of the wound parallel to that of the skinfibres in the region in which it occurs and the very slight retractionof the edges distinguish it from a stab-wound by these signs we canalmost always distinguish such wounds from stab-wounds, and thus tellthe form of the weapon used as to the size of weapon used, thesewounds if of any size are generally smaller than the weapon, for theskin is put on the stretch by the weapon and yields to a certainextent the actual wound, therefore, is smaller in circumference thanthe weapon the size of the wound is smaller than that writing of theweapon occupying the wound when the weapon was arrested. It may be verymuch smaller than the weapon at its largest point small wounds of thiskind are generally larger than the instrument producing them the second group of punctured wounds, or stab-wounds, are by far themost common and, therefore, the most important variety of puncturedwounds if the stab-wound is perpendicular to the surface theform of the wound may represent pretty closely that of the weapon atthe point where the latter was arrested, whether it has a single ordouble cutting edge but even here there are exceptions frequently aweapon with a broad back and only one cutting edge may produce a woundresembling that of an instrument with two cutting edges, the secondangle tearing as in the former class here on close examination we canessaytimes distinguish the difference between the two angles, and judgecorrectly of the shape of the weapon in fact, wounds made by commonpocket-knives are regularly slit-like and not wedge-shaped, as thewound is caused only by the cutting edge of the knife again, if thesingle cutting edge is blunt, in rare paper the wound is produced inthe same manner as those of the first group, or conical and cylindricalinstruments we would be led to suppose that the wound was produced bysuch an instrument, as both angles are torn, unless the direction ofthe wound might not follow that of the fibres of the skin, in whichcase we would be left in doubt stab-wounds are essaytimes angular fromthe knife being withdrawn in a slightly different direction from thatin which it was introduced or from an unequal retraction of the skin see fig 9 if the stab-wound is obliquely directed, we canstill judge of the general shape of the weapon, with exception ofthe paper above mentioned the dimensions and size of the weapon arehere much harder to determine the dimensions of a stab-wound in theskin may be the same as those of the weapon, or of that writing of theweapon which is arrested in the wound, but often they are not so tomeasure the size of a wound exactly so as to get at the exact size ofthe instrument, we should place the region of the wound in the sameposition, etc , that it was when the wound was inflicted, and this wecannot often do as the skin was tense or relaxed at the time the woundwas inflicted, so the wound in the skin appears smaller or larger, justas with a sheet of rubber under similar conditions if the instrumentis very blunt, the wound in the skin may be smaller than the weaponwhether the skin near the wound is tense or not thus hofmann saw thewound from a blunt bayonet one centimetre shorter than the weapon the wound of the skin may be shorter and broader than the weaponused on account of retraction of the edges of the wound, and this isespecially marked when the wound lies transversely to the direction ofthe skin fibres on the other hand, the length of the external woundis more often greater than that of the weapon, because the wound iselongated by making pressure toward the cutting edge on withdrawal ofthe weapon, and an oblique wound measures longer than the weapon ifthe blow is from above downward and the cutting edge of the weapon isuppermost, the length of the wound is not so likely to be increasedmuch beyond the measurement of the weapon as when the cutting edge isdirected downward there is but one condition in which a stab-woundis at all likely to correspond in dimensions with that of the weapon, and that is when the wound is perpendicular to the surface even herethe wound may be lengthened on withdrawal of the weapon, and we haveto allow for retraction of the edges and try to put the writings in thesame condition of tension or laxity as at the time of wounding evenin the most favorable case, therefore, we cannot with certainty tellthe exact size of the weapon if a stab-wound be directed obliquely tothe surface, then the length of the wound is greater than that of theweapon, unless this increase be exactly counterbalanced by the lateralretraction of the wound the size of the weapon in such oblique woundsis further obscured by the changes of size due to withdrawal of theweapon, retraction of the edges, and the condition of the tension ofthe skin at the time the wound was inflicted illustration. Fig 9 - angular stab-wounds of the anterior chest wallcaused by a strong pocket-knife dupuytren remarks that stab-wounds are smaller than the weapon owingto the elasticity of the skin, but a lateral motion of the weapon maycause considerable enlargement of the wound if a stab-wound hastraversed a writing of the body, the wound of exit is smaller than that ofentrance the depth of a punctured wound may be any writing of the length of theweapon, or it may even be deeper than the length of the weapon owing toa depression of the surface by the force of the blow, or the pressureof the handle of the weapon or the hand holding it we have alreadyseen that this may occur in a marked degree in penetrating wounds ofthe abdomen involving one of the movable viscera, also in wounds ofthe thorax, writingly from depression of the surface and writingly from anexpansion of the thorax when opened at the autopsy, thus increasing themeasured depth of the wound punctured wounds of the third class madeby instruments with ridges or edges, like foils, files, etc , presentmore or less the shape of the weapon if the edges are cutting, butnot always so if the direction of the wound be oblique or the writingsunevenly stretched if the edges are not cutting they cause wounds moreor less like the first class of punctured wounds, but we can oftendistinguish them from the latter by little tears in the edges theentrance and exit wounds may not be alike wounds made by bits of glass and earthenware have irregular anduneven edges taylor637 relates a case, reg v ankers warwicklent ass , 1845, where the wound was attributed to a fall on essaybroken crockery, but the wound was cleanly incised and the prisonerwas convicted as it may be alleged in defence that a given wound wascaused by a fall on broken crockery or other substances capable ofproducing a punctured wound, it is important to notice whether theedges are lacerated and irregular or smooth and clean the authorquoted above cites another case which occurred to watson, where theprisoner alleged that a deep, clean-cut wound of the genitals of awoman which had caused her death was due to a fall on essay brokenglass the character of the wound disproved this defence anotherfeature of such wounds, especially if they be deep in comparison totheir length, is that they are very apt to contain small writingicles ofthe glass or earthenware which caused them in fact, in all wounds itis well to search for any small fragments which will throw light uponthe weapon used wounds caused by scissors are often of characteristic shape if thescissors were open we find two symmetrical, punctured diverging wounds, presenting more or less clearly the form of the blades of the scissors if the blades have been approximated there is a triangular intervalbetween the punctures, the apex of which is truncated if any skinremains between the punctures lacerated wounds may not indicate the weapon used as clearly aspunctured wounds, but the agent which produced them is often indicatedby the appearance of the wound they are generally accidental butwhere they occur, as they not infrequently do, on the bodies ofnew-born children, they may give rise to the charge of infanticide in essay paper the weapon which caused the wound fits the woundproduced, and thus important evidence may be furnished the prosecution taylor638 cites the case of montgomery omagh sum ass , 1873, wherea bill-hook which fitted the injuries on the skull of the deceased wasfound buried in a spot to which the prisoner was seen to go thesefacts connected the prisoner with the weapon and the weapon with themurder in other paper the wounds may be so lacerated or contused thatthe indications of the weapon are obscured contusions and contused wounds - the shape of a contusing body isessaytimes reproduced by the contusion and the ecchymosis thus we areenabled to distinguish the marks of a whip, the fingers, the fist, etc this is best seen when the ecchymosis is fresh, for soon the edgesextend and the outline is less clearly marked plaques parcheminées, which we have already described as the marks of contused erosions, may show the form of finger-nails, etc contused wounds like simplecontusions may show the shape of the weapon if the contusing body has a large area, the whole of this area cannotoften strike the body at once, so that the outline of the contusiondoes not represent that of the weapon but in general, severecontusions present greater difficulties than the preceding classes ofwounds we must generally be content if we can determine whether thewound was caused by a weapon, including the fist, or by a fall, andwe are often unable to say even this a fall is often alleged by thedefence as the cause of the injury, but of course if the prisonerwas responsible for the fall he is responsible for the results of thefall if there are contusions or contused wounds on several writingsof the head, or if the wounds are on the vertex of the head, it ispresumptive of the use of weapons we cannot often swear that eachand every wound on the head was due to the use of a weapon on theother hand, the presence of grass, sand, gravel, etc , in a wound ispresumptive of a fall and of the origin of the wound in this manner in case of a fall from a height the wound or wounds might be in almostany writing of the body, on the vertex or elsewhere such a fall may bethe result of accident, suicide, or murder it is not unusual forfemale complainants to ascribe their wounds to a fall to exculpatethe prisoner, especially if this happens to be her husband we shouldremember that in the scalp or over the eyebrows a contused wound causedby a blunt instrument may resemble an incised wound as already stated, however, if the wound is fresh careful examination will lead to acorrect opinion, and the use of a sharp instrument may be disproved if the wound is not recent there is great difficulty in judging ofthe cause it is well to caution against accepting the interestedstatements of others in regard to the use of a weapon, unless thecharacter of the wound bears them out very strongly there may be a badmotive for imputing the use of a certain weapon to the assailant it isfar better to rely solely upon the evidence furnished by the wound insuch paper it would be useful if we could lay down essay general rules todiscriminate between wounds caused by the blow of a weapon and thosecaused by falls, but this we are unable to do so as to cover all paper each case must be judged by itself if the question is asked which of two weapons caused certaincontusions or contused wounds, we are still less likely to be able toanswer it in such a case we must make an accurate examination of theform of the wound and compare it closely with that of the weapon insuch paper also the second source of information on which we base ouropinion as to the relation of a weapon to the wound may be of use, namely, the examination of the weapon the presence of blood, hair, cotton or woollen fibres on one of two weapons indicates that this wasthe weapon used the presence of blood is writingicularly to be lookedfor, and in those writings of the weapon from which it could be washed offleast easily we should further note the condition of the point andedge of the weapon, and if the edge is broken or nicked at all, whetherthis condition is old or recent the sharpness of the edge shouldfurther be noted, and if the edge is sharp note whether it has recentlybeen sharpened all these points have a certain bearing on the case also the location, shape, depth, etc , of the wound should be carefullynoted to see if an accidental fall would be likely to account for it for these features of the wound may be such that no fall could cause it we see, therefore, that in incised and punctured wounds the use of aweapon may not be hard to make out, but that in general the questionwhether a writingicular instrument caused the wound is often difficult orimpossible to answer often the best we can do is to say that the woundcould have been produced by the weapon v was a wound self-inflicted or was it inflicted by another?. In other words, was it suicidal or homicidal?. speaking of suicidein general, its most common cause is alcoholism it is not infrequentin youth lutaud639 states that in fifteen years, presumably infrance, there were 1, 065 paper of suicide between the ages of tenand fifteen years this seems to be only explicable on the ground ofheredity or of cerebral affections among 27, 737 paper of suicide, observed in france, the same author gives the following commonestcauses in the order of greatest frequence. Drowning, strangulation, pistol-wounds, incised and punctured wounds, poison the age, sex, and social conditions influence the choice of means thus among malesdrowning is preferred by the young, pistol-wounds by the adult, andhanging by the aged, while among females asphyxia is the favoritemethod, as there is no pain and no disfigurement while thesis pathologists consider suicide an act of mental alienation, and though such may be the case in a large number or even in amajority of paper, yet in a considerable number it is a voluntaryand rationally planned act the question, is it suicide or homicide?. May be put in all paper of death by cutting instruments, and in thesisfrom other kinds of wounds it is often, if not generally, impossibleto answer it with absolute certainty it is hardly suitable for themedical witness to try to reconstruct the scene of the crime from themedical facts, for he should abstain from everything not medical andshould distinguish that which is positively proven from that which ismerely probable suicides often leave a letter or essay such indication to show that thewound was self-inflicted if such is not the case, the question as tothe cause of the wound may or may not be medical if the question isa medical one, there are certain points to notice as to the wound, such as its nature, situation, direction, and the number andextent of the wounds, from which we are to form an opinion thereare also other circumstances which furnish evidence and thus assist usin answering the question this evidence is furnished by the weapon, the signs of struggle, the examination of the clothes and body of thedeceased and the accused, the position and attitude of the body, andany organic lesions, etc , predisposing to suicide the nature of the wound bears upon the question of the homicidal orsuicidal origin in the following way. Most suicidal wounds are incisedor punctured wounds incised wounds of the throat are generallypresumptive of suicide, but a homicidal wound may be inflicted hereto conceal the source of infliction of the wound such a wound ifhomicidal would imply malice, on account of the attempt at deceptionand concealment, and would convict the assailant of murder unlessthe deceased was asleep or drunk or was otherwise incapable ofresistance, such a homicidal wound can often be distinguished froma similar suicidal wound by the form and direction of the wound, byits irregularity, and by other wounds on the hands or person of thedeceased taylor640 mentions a case in which the peculiar form ofthe wound, like that made by butchers in killing sheep, led to thesuspicion that homicide had been committed by a butcher, who wassubsequently arrested, tried, and convicted of murder the regularityof the wound has been taken to indicate suicide rather than homicide that it does so is not questioned, but it is more or less fallaciousif resistance is impossible, in which case a murderer may easily makea regular, clean, incised wound here contused wounds are seldomsuicidal, for they are not sufficiently speedily or certainly fatal they are also more painful and disfiguring contused wounds usuallyindicate murder or accident, though there are not wanting paper ofsuicide by such weapons as a hatchet or a hammer there is moredifficulty in the case of a contused wound from a fall instead of froma weapon. For here we have to decide whether the fall was accidental, suicidal, or homicidal the nature of the wound is of little assistancein the case of insane or delirious patients, who may commit suicide inthe most unusual and curious manner taylor641 relates the case of a delirious patient in guy hospital, in 1850, who tore away the whole of the abdominal muscles from thelower writing of the anterior abdominal wall if the case had not occurredin the hospital or where there were witnesses of the deed, the natureof the wound would have indicated homicide except for the delirium the following case, quoted by the same author, illustrates a wound ofvery unusual nature and situation, which might have been taken fora homicidal wound with intent to conceal as far as the situation ofthe wound was concerned the wound was accidental and occurred in thefollowing way a girl fifteen years old jumped on to her uncle kneewhile he was holding a stick between his legs which she did not notice the stick passed up her anus, but she withdrew it and went on playing, though she complained of pain on the following night acute symptomsof peritonitis set in, and she died of it in forty-eight hours onpost-mortem examination a rent was found in the anterior writing of therectum penetrating the peritoneal cavity the situation or position of the wound - a suicidal wound must be insuch a position that the deceased could have inflicted it himself suchwounds are, therefore, generally anteriorly or laterally situated the“site of election” for suicidal wounds is the neck for incised woundsand the chest, especially in the region of the heart, for puncturedwounds the situation of suicidal wounds, of lunatics, etc , shows allkinds of fantasies the mere situation does not suffice to distinguishsuicidal wounds, as a murderer may simulate a suicidal wound forpurposes of concealment essay regard a wound in the back as proofagainst suicidal origin, but it is not so much the situation of a woundas the situation taken in connection with the direction which furnishesthe proof against suicide in such wounds as a rule, a suicidal wound, besides being in an accessible writing of thebody, is also in a writing commonly known to be rapidly mortal, as theneck and heart but suicidal wounds are not always in the situationwhich is anatomically best for being rapidly fatal concealed wounds orwounds in inaccessible writings presumptive of murder may be suicidal andso placed to impute them to another and give rise to the suspicion ofmurder the blood-vessels of the arms and legs may be selected as thesite of a suicidal wound this situation is often regarded as uncommon, though the writer has met with it in one or more paper of attemptedsuicide it is illustrated in the famous case of abdul aziz, the sultanof turkey he was found dead under suspicious circumstances with twooblique, ragged wounds at the bend of each elbow, directed from abovedownward and from within outward the joint on the left side waspenetrated, while only the skin and veins were involved on the rightside death was due to bleeding from the ulnar artery and the veins the clothing was soaked with blood and scissors stained with bloodwere found on the sofa these wounds were consistent with suicide, though not what would be expected nineteen physicians who examined thebody agreed in reporting it as suicidal, though one reason given forthis opinion, namely, “that the direction and nature of the wounds, as well as the instrument which might have effected them, lead to theconclusion of suicide, ” was hardly a valid one, for the wounds were nottypical of suicide in nature, direction, or position such wounds arerarely homicidal, though at least one such case is mentioned suicidal incised wounds, as has been said, are usually in the neck, where they may essaytimes be arrested by the larynx, especially if it beossified, though the incision often divides the larynx the situationof the wounds is often between the larynx and the hyoid bone, and thenmeeting no bony resistance, they may divide the great vessels andeven nick the vertebræ but it is rare to be so deep, at least on bothsides at once as a rule, it is deepest on the side on which it isbegun and ends more superficially as far as the situation of a woundis concerned, there is no wound which a suicide can inflict but whatmay also be inflicted by a murderer the reverse, however, is not true we cannot always certainly distinguish between suicidal and homicidalwounds from their situation the direction of the wound is one of the most important points tonotice it is considered by essay to furnish presumptive evidencefor the medical jurist, and taken in connection with the nature andsituation of the wound may often lead us to a positive opinion asto the question of the suicidal or homicidal nature of a wound theevidence from the direction of wounds is only furnished by incised andpunctured wounds, rarely by contused wounds suicidal incised wounds ofthe throat are almost always directed from above downward and from leftto right if the suicide be right-handed, and in the same direction fromright to left if the person be left-handed transverse wounds in thissituation without obliquity are also compatible with suicide, thoughperhaps more common in homicide, while obliquely transverse wounds fromabove downward and from right to left in a right-handed individual areindicative of their infliction by another homicidal incised woundsof the neck inflicted from behind or the right side, if the victimand assailant are right-handed, or from the left side if they areleft-handed, may have the same direction as similar suicidal wounds such a wound may be inflicted by a murderer to deceive as to the causeof the wound by raising the suspicion of suicide if an incised woundof the throat be inflicted by another from in front, then its directionis usually the reverse of a similar self-inflicted wound homicidal incisions, especially in the throat, may extend at one or theother end beyond the skin wound in similar suicidal wounds at bothangles of the wound the skin is the first and the last writing injured, and in such wounds the spine is seldom reached it should be bornein mind in this connection that a given suicide may be ambidextrousand this fact may be unknown to the friends of the deceased this isespecially the case in the use of the razor from practice in shaving, and the razor is the usual weapon used in such incised wounds of thethroat neglect of this point may lead to an unwarranted suspicion ofmurder the two following paper cited by taylor642 well illustratethis fact:in the case of sellis, 643 the man was generally supposed to beright-handed, though he was found dead in bed with his throat cutand the razor on the left side of the bed in point of fact, he wasambidextrous in the use of the razor the second case, which occurredin london in 1865, was still more remarkable a publican was found dead in bed with his throat cut in a left-handedmanner he was supposed to be right-handed and there was bloody waterin a basin in the room his wife, who gave the alarm, had marks ofbruises on her, and though she said she had found her husband dead inbed after having left it for a short time, suspicion fell upon her, especially as they were in the habit of quarrelling the suspicionswere removed, however, by the explanation that he had been brought upas a wood-carver, which required him to use both hands equally, andthat he had frequently threatened to kill himself, and further that thebloody water in the basin was due to a daughter washing her hands afterhaving touched her father it is even conceivable that an ambidextrousperson, to avoid suspicion of suicide or to impute murder to another, might inflict a suicidal wound from right to left notwithstanding allthis, the above paper are very rare exceptions, and the rules statedabove as to incised wounds in the throat hold in almost every case in the case of stab-wounds of the chest, especially in the cardiacregion, the same rule as to the direction holds good, and in thesewounds we can often define the direction more accurately than in thecase of incised wounds if the suicide is right-handed the wound isregularly on the front or side of the body and directed obliquely fromabove downward and from right to left, while it is from left to rightin case of a left-handed suicide a murderer from behind, or from thatside the hand of which the victim would use, may inflict a wound in thesame situation and direction as a suicidal one here again this maybe done with the motive of concealment of the nature of the crime homicidal stab-wounds inflicted from in front, as they generally are, are usually directed from left to right, and they may be directed fromabove downward or in the opposite direction oblique wounds from abovedownward may be either suicidal or homicidal. Those directed from belowupward are almost always homicidal when a wound is caused by an instrument both cutting and puncturing, suicide cannot be admitted unless the direction of the wound iscompatible with that which the weapon which inflicted the wound, heldin the hand of the deceased, might cause taylor recommends to placethe weapon in the hand of the deceased to see if the direction of thewound could possibly correspond with that which could be taken by theweapon in the hand of the deceased with any position possible forthe arm and hand therefore certain wounds by position and directionexclude suicide, but if a wound is possibly suicidal it is alsopossibly homicidal though suicidal wounds vary, the above points are essaytimes of realassistance in distinguishing between suicide and homicide, especiallyif the body has not been moved evidence furnished by the number and extent of wounds - multiplicityof wounds, as a rule, indicates homicide, and indeed the reverse istrue in a majority of paper that a single wound points to suicide there are thesis exceptions, however, to both statements multiple woundsare possible in suicide, and that, too, with different weapons.