History

Common App Essay Requirements


Serous membranesin these experiments, 1 c c of chlorlyptus was injected into thepleura or peritoneum after a stated time, the animal was killed, andthe reaction of the pleural or peritoneal surface was tested with bluelitmus paper the results are shown in the table c toxicity experiments by the referee technicwhite rats were injected hypodermically with chlorlyptus or witheucalyptus oil, diluted with olive oil in the ratio of 1:4 the largerdoses were divided between two or more sites of injection detailed protocolshypodermic injections in white rats drugs diluted with 3 writings ofolive oil doses are given as cubic centimeters of pure drug perkilogram of rat a eucalyptus series experiment 1 -- 1 25 c c. Injected vii 9 19. Active. Walks about no depression at any time vii 10 19 appears normal experiment 2 -- 2 5 c c. Injected vi 30 19. Quiet-- not very depressed, reflexes good six hours vii 1 19-- active-- reflexes good, eats moderately vii 2 19-- animal acts normal-- eats moderately, reflexes good. Active a m later in day, depressed vii 4 19-- died during night of vii 3 19 experiment 3 -- 3 75 c c. Injected vi 24 19. Quiet. Depressed.

Fig 17 - fracture of parietal bone with depression, caused by the blow of an axe with a more severe injury, with which there is generally essaylaceration of the brain, the injured person falls and lies quietand relaxed, apparently unconscious, though often he can be writinglyroused paralysis and anæsthesia are absent the heart is feeble andfluttering, the skin cold and clammy the pupils, as a rule, reactto light, but otherwise vary considerably urine and fæces may bepassed involuntarily as he begins to regain consciousness, vomitingusually occurs consciousness usually returns within twenty-four orforty-eight hours, when headache and indisposition to exertion arecomplained of, and this may last for a long time occasionally thesymptoms instead of abating increase, and coma supervenes, oftenindicating meningitis, encephalitis, or intracranial hemorrhage inother paper the person may die almost immediately on the spot where hefell, while in still others apparent recovery takes place and deathoccurs later either suddenly or after a reappearance of symptoms in such paper, abscess of the brain may occur and be the cause ofthe fatal result these abscesses are the result of the injury, whichmay be almost anything from a compound fracture to a slight contusionnot leaving any scar the abscess may occur within a week661 or notuntil after months or years this interval of apparent recovery maylead to the common app essay requirements false supposition that death was not due to the injury, but to essay intervening cause it is well to bear in mind that abouthalf of the paper of abscess of the brain are not traumatic a largemajority of these are due to suppuration in the middle ear, a few toseptic diseases or tuberculosis the situation of the abscess oftendistinguishes between the traumatic and non-traumatic varieties thetraumatic variety is usually found beneath the injury or essaytimesdirectly opposite, where the brain is injured by a kind of focussingof the radiated effects of the blow the paper of abscess of the braindue to ear disease are usually found in the temporal lobe of the brainlying over the position of the ear or in the cerebellum behind it the uncertainty of the nature and the extent of the cerebral injuryin so-called contusion of the brain renders it necessary to be verycareful in giving a prognosis any injury should be consideredserious which has produced unconsciousness, for such an injury mayproduce enough laceration of the brain to render serious dangerpossible or even probable we have seen that as a rule the symptomsof concussion come on immediately, but it is possible that symptomsat first so slight as to escape notice may become serious in a fewhours or days a gradual hemorrhage may essaytimes account for this the knowledge of certain acts performed or a conversation held at thelast moment before the injury may be retained after recovery fromconcussion of the brain this is not necessarily the case, for insteadof remembering up to the moment of the injury, the injured person mayremember only up to a certain time shortly before, or a writing and noteverything may be remembered illustration. Fig 18 - wounds of the vault of the cranium caused byartillery side-arms, followed by death shortly after the diagnosis of concussion of the brain from alcoholism isessaytimes a matter of medico-legal interest or importance concussionmay be so slight as to simulate intoxication the history often clearsthe case up the history of a blow or a fall or the presence of marksof violence on the head indicates concussion, though the blow or fallmay not have caused the symptoms, which may be due to alcoholism theodor of the breath may indicate alcoholism, but here too we may haveboth present and the concussion may be responsible for the symptoms or again the alcohol may have been given as a heart stimulant afterthe accident this combination often occurs if there is no odor inthe breath, the presumption is in favor of concussion as mistakes arestill not infrequently made in diagnosis, those paper in which thereis any ground for doubt should be carefully watched for developments in general, the existence of concussion is more often overlooked thanthe coexisting alcoholism, so that if there is any doubt in a givencase it should be treated as one of cerebral injury the injury whichcauses the concussion in such paper is often due to the alcoholism wemay be able to verify this supposition if the injury is such as wouldbe likely to be caused by a fall there may be nothing found in thebrain after death to distinguish between concussion and alcoholism abruise on the head only indicates a probability of concussion, for thebruise and alcoholism may both be present, the former perhaps due tothe latter the presence of alcohol in the stomach would indicate theexistence of alcoholism another effect of an injury which has caused concussion of the brainis an extravasation or effusion of blood extravasation of bloodin or on the brain is one of the commonest causes of death from injuryto the head it may occur with or without marks of external injury aperson suffering from such an extravasation of blood may recover fromthe first effects of the injury, and at a varying time afterward thesymptoms may return and increase so as to result fatally in such acase the opening of the bleeding vessel may have become plugged untilessay exertion, emotion, or excitement on the writing of the injured personhas loosened the plug a hemorrhage may have ceased from writingialsyncope and return with a stronger heart action due perhaps to theadministration of alcohol this effusion may occur on the surface ofthe brain in connection with a superficial laceration of the brain orjust beneath or outside the dura mater and not involving the braindirectly the latter paper are almost always due to the effects ofviolence, though there is at least one case of apparently spontaneousrupture of the middle meningeal artery the violence which causesa rupture of the branches of this artery may be so slight as toleave no bruise or so severe as to cause fracture of the skull themost important symptom of such extradural hemorrhage is a period ofconsciousness after recovery from the first effects of the injury, then stupor may appear and deepen into coma a subdural hemorrhage maycause almost the same symptoms, though the injury is usually such ashas produced a depressed fracture this hemorrhage is most often dueto the rupture of a number of small vessels under the fracture, thoughif one larger vessel is ruptured it is most often the middle cerebral a thin layer of hemorrhage in connection with a superficial lacerationof the brain is of frequent occurrence with or without the other twoforms of intracranial hemorrhage if the brain is lacerated we may haveconvulsions in addition to other symptoms death occurring during orsoon after a prize-fight may occur from essay of the above classes ofintracranial extravasations it may be questioned whether the blows ora fall caused the hemorrhage it is generally due to a fall in suchpaper, but may be due to blows, but the guilt is the same unless thefall was accidental as the result of severe traumatism the vessels ofthe interior of the cerebrum may be ruptured or hemorrhage may occurinto the ventricles of the brain in such paper the symptoms willresemble those of ordinary apoplexy, only the cause is different fromthe latter and the injury is usually so severe as to leave no doubt asto the existence of a traumatism the following question may arise inpaper of intracranial hemorrhage and especially in the latter class ofsuch paper, i e , in cerebral hemorrhage:was the extravasation of blood due to disease or violence?. it maybe alleged in defence that the hemorrhage was the natural resultof disease where the hemorrhage is extradural or subdural or inconnection with a superficial laceration of the brain, the cause isalmost always traumatic we have referred to one case of extraduralhemorrhage from spontaneous rupture of the middle meningealartery 662 subdural hemorrhage may occur from pachymeningitishæmorrhagica interna, but this condition is readily diagnosed onpost-mortem examination and often with considerable certainty duringlife a history of alcoholism, headache, impaired intellect, unsteadygait, occasional losses of consciousness, stupor increasing to coma, etc , indicates such a condition it is in paper of cerebral hemorrhage that there is the most difficultyin discriminating between that due to disease and that due to injury it may be alleged that the hemorrhage was from diseased vessels, orthat the effects of a blow, which cannot be denied, were aggravated bydisease of the cerebral vessels or by excitement due to intoxication orpassion cerebral hemorrhage from disease is rare before 40 years ofage, except in alcoholics when the hemorrhage is due to disease theblood-vessels are diseased the most frequent site of such hemorrhagesis the course of the lenticulo-striate artery in the ganglia of thebase or the white substance of the centrum ovale when injury is the cause of the hemorrhage it is usually found beneaththe point injured or directly opposite to this external signs of theblow are generally visible if it be severe enough to cause a cerebralhemorrhage the vessels may be perfectly healthy and the victim quiteyoung if the hemorrhage is due to an injury, also the ruptured vesselsmay be plainly torn the most difficult paper are those where thereis the history of an injury and at the same time such a condition ofdisease of the cerebral vessels, etc , as would account for spontaneoushemorrhage where the injury was slight in the case of alcoholics oraged people the medical witness should be especially careful in statingthat a cerebral hemorrhage was due to the injury then, too, in the actof falling from the occurrence of a cerebral hemorrhage due to diseasethe head may be injured and show marks of violence it should be bornein mind that an injury to the head may be inflicted when disease of thebrain, vessels, or membranes already exists in such a case a slightblow might cause extensive hemorrhage, but as that which acceleratescauses, death, even though it might sooner or later have occurred inthe same manner without injury, is due to the injury inflicted from the above considerations we see that spontaneous cerebralhemorrhage and that due to disease are not always easily distinguishedfrom that due to violence in severe injuries the structure of thebrain is plainly bruised, etc , but the greatest difficulty exists inpaper of slight violence where arteritis of the cerebral blood-vesselscoexists the spontaneous extravasation of blood in or upon the brainfrom excitement does not usually occur except with diseased vessels, old age, or alcoholism it is rare, therefore, in the young andhealthy if there is any doubt as to the origin of the hemorrhage, themedical witness should state the cause most probable in his judgment taylor663 supposes the case of a man excited by passion, alcohol, or both, who becomes insensible and dies after being struck a blow soslight that it would not have affected a healthy person if examinationreveals a quantity of blood effused into the substance of the brain, there can be little doubt in the mind of the medical man that theexcitement was the principal cause of the effusion on the other hand, if a severe blow or a violent fall on the head had been received in apersonal conflict with another and it is found that death was due to aneffusion of blood upon the surface, there can be little doubt in themind of the medical examiner that death was due to the blow, whichwould satisfactorily account for the conditions found without referenceto coexisting excitement, etc in fact, in all paper where a questionis raised as to the cause of the hemorrhage, it is most important toconsider whether the violence was not sufficient to account for thehemorrhage without the coexistence of disease or excitement it isalso most important to bear in mind that after severe injuries, asafter a fall, causing extensive fracture of the skull, followed or notwith extravasation of blood, the injured person may walk about and dieessay distance from the place of the accident and where no chance fora similar accident exists in this way the suspicion of murder may beoccasioned, as illustrated in the following case cited by taylor:664a man was accused of the murder of his companion, who was found dead ina stable with fracture of the temporal bone which had caused rupture ofthe middle meningeal artery the accused stated that the deceased hadbeen injured by falling from his horse the day before after the fall, however, the deceased had gone into a public-house, where he remainedessay time drinking before returning to the stable the extravasationhad here taken place gradually, as is characteristic of hemorrhage fromthe middle meningeal artery, and perhaps the excitement due to thedrinking had influenced it the date of an effusion of blood may essaytimes be a matter ofimportance in determining whether a given extravasation of blood in oron the brain was caused by a recent blow or had existed previously thecolor and consistence of these effusions indicate whether they are oldor recent. The precise date we cannot state, but the information wecan give is often all that is required the color of recent effusionsis red, which changes after essay days to a chocolate or brown, whichgenerally turns to an ochre color see plate i this latter colormay be met with from twelve to twenty-five days after the injury theconsistence of the coagula also becomes firmer with age, and as thecoagula become firmer they are more or less laminated and the expressedlymph may lie between the laminæ or around the coagula illustration. Medical jurisprudence plate i extravasations in several portions of the arachnoid, with hemorrhagesin neighboring portions of the brain death in four days cerebral abscess epilepsy, paresis death 3¼ years after the injury recent and old cerebral effusions on account of the thesis layers of the brain coverings, a rough diagramof the coverings as given by taylor1 may be of much use to themedical expert in illustrating his evidence so as to make it clear tothe court see fig 19 wounds of the brain vary very widely in their immediate resultsaccording to the writing of the brain injured thus essaytimes a slightwound of the brain may be instantly fatal and often a severe wound inanother writing is not so extensive wounds may occur especially in thefrontal lobes with remarkably slight disturbance if a person with awound of the brain survives the first effects of the injury the dangerof inflammation remains this danger may not be removed for a longtime, for the inflammation may develop very slowly, not showing itselffor from three to ten weeks or even later thus taylor665 citesthe case of a child who was accidentally shot through the brain thesymptoms of inflammation did not appear until the twenty-sixth day anddeath occurred on the twenty-ninth day illustration. Fig 19 - diagramatic representation of the skull andmembranes of the brain for exhibition in court a, skull with outerand inner tables and diploë. B, dura mater. 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.

No fracture ofvertebræ in common app essay requirements other 89 clark. Boston med and surg jour , 1858, lviii , p 480 - execution of magee man, age 28. Weight 130 pounds drop sevento eight feet no struggle nor convulsion urine discharged at once seven minutes after drop fell, heart-beat one hundred. Nine minutes, ninety-eight. Twelve minutes, sixty and fainter. Fourteen minutes, not audible. Twenty-five minutes, body lowered face purple.

And being drank, healsthe jaundice the seed thereof taken, eases the gnawing and gripingpains of the stomach, and takes away the loathing thereof unto meat the root thereof helps the ruggedness of the nails, and being boiledin wine helps the swelling of the throat, commonly called the kingevil, as also the swellings of the kernels of the ears it helps themthat are troubled with the stone, provokes urine, and helps the dimnessof the sight the roots of this bastard rhubarb are used in openingand purging diet-drinks, with other things, to open the liver, and tocleanse and cool the blood the properties of that which is called the english rhubarb are the samewith the former, but much more effectual, and hath all the propertiesof the true italian rhubarbs, except the force in purging, wherein itis but of half the strength thereof, and therefore a double quantitymust be used. It likewise hath not that bitterness and astriction. Inother things it works almost in an equal quantity, which are these. Itpurges the body of choler and phlegm, being either taken of itself, made into powder, and drank in a draught of white wine, or steepedtherein all night, and taken fasting, or put among other purges, asshall be thought convenient, cleansing the stomach, liver, and blood, opening obstructions, and helping those griefs that come thereof, asthe jaundice, dropsy, swelling of the spleen, tertain and daily agues, and pricking pains of the sides. And also stays spitting of blood the powder taken with cassia dissolved, and washed venice turpentine, cleanses the reins and strengthens them afterwards, and is veryeffectual to stay the gonorrhea it is also given for the pains andswellings in the head, for those that are troubled with melancholy, and helps the sciatica, gout, and the cramp the powder of the rhubarbtaken with a little mummia and madder roots in essay red wine, dissolvesclotted blood in the body, happening by any fall or bruise, and helpsburstings and broken writings, as well inward as outward the oil likewisewherein it hath been boiled, works the like effects being anointed it is used to heal those ulcers that happen in the eyes or eyelids, being steeped and strained. As also to assuage the swellings andinflammations. And applied with honey, boiled in wine, it takes awayall blue spots or marks that happen therein whey or white wine are thebest liquors to steep it in, and thereby it works more effectual inopening obstructions, and purging the stomach and liver thesis do use alittle indian spikenard as the best corrector thereof meadow-rue descript meadow-rue rises up with a yellow stringy root, muchspreading in the ground, shooting forth new sprouts round about, withthesis herby green stalks, two feet high, crested all the length of them, set with joints here and there, and thesis large leaves on them, aboveas well as below, being divided into smaller leaves, nicked or dentedin the fore writing of them, of a red green colour on the upper-side, andpale green underneath. Toward the top of the stalk there shoots forthdivers short branches, on every one whereof stand two, three or foursmall heads, or buttons, which breaking the skin that incloses them, shoots forth a tuft of pale greenish yellow threads, which fallingaway, there come in their places small three-cornered cods, whereinis contained small, long and round seed the whole plant has a strongunpleasant scent place it grows in thesis places of this land, in the borders of moistmeadows, and ditch-sides time it flowers about july, or the beginning of august government and virtues dioscorides saith, that this herb bruisedand applied, perfectly heals old sores, and the distilled water ofthe herb and flowers doth the like it is used by essay among otherpot-herbs to open the body, and make it soluble. But the roots washedclean, and boiled in ale and drank, provokes to stool more than theleaves, but yet very gently the root boiled in water, and the placesof the body most troubled with vermin and lice washed therewith whileit is warm, destroys them utterly in italy it is good against theplague, and in saxony against the jaundice, as camerarius saith garden-rue garden-rue is so well known by this name, and the name herb of grace, that i shall not need to write any farther description of it, but shallshew you the virtue of it, as follows government and virtues it is an herb of the sun, and under leo it provokes urine and women courses, being taken either in meator drink the seed thereof taken in wine, is an antidote againstall dangerous medicines or deadly poisons the leaves taken eitherby themselves, or with figs and walnuts, is called mithridatecounter-poison against the plague, and causes all venomous thingsto become harmless. Being often taken in meat and drink, it abatesvenery a decoction thereof with essay dried dill leaves and flowers, eases all pains and torments, inwardly to be drank, and outwardly tobe applied warm to the place grieved the same being drank, helps thepains both of the chest and sides, as also coughs and hardness ofbreathing, the inflammations of the lungs, and the tormenting pains ofthe sciatica and the joints, being anointed, or laid to the places;as also the shaking fits of agues, to take a draught before the fitcomes being boiled or infused in oil, it is good to help the windcholic, the hardness and windiness of the mother, and frees women fromthe strangling or suffocation thereof, if the share and the writingsthereabouts be anointed therewith it kills and drives forth the wormsof the belly, if it be drank after it is boiled in wine to the half, with a little honey. It helps the gout or pains in the joints, hands, feet or knees, applied thereunto. And with figs it helps the dropsy, being bathed therewith. Being bruised and put into the nostrils, itstays the bleeding thereof it takes away wheals and pimples, if beingbruised with a few myrtle leaves, it be made up with wax, and applied it cures the morphew, and takes away all sorts of warts, if boiled inwine with essay pepper and nitre, and the place rubbed therewith, andwith almond and honey helps the dry scabs, or any tetter or ringworm the juice thereof warmed in a pomegranate shell or rind, and droppedinto the ears, helps the pains of them the juice of it and fennel, with a little honey, and the gall of a cock put thereunto, helps thedimness of the eye-sight an ointment made of the juice thereof withoil of roses, ceruse, and a little vinegar, and anointed, cures st anthony fire, and all running sores in the head. And the stinkingulcers of the nose, or other writings the antidote used by mithridates, every morning fasting, to secure himself from any poison or infection, was this. Take twenty leaves of rue, a little salt, a couple ofwalnuts, and a couple of figs, beaten together into a mess, with twentyjuniper berries, which is the quantity appointed for every day anotherelectuary is made thus. Take of nitre, pepper, and cummin seed, ofeach equal writings. Of the leaves of rue clean picked, as much in weightas all the other three weighed.

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“each two fluidrachms contain. “acidulated bone phosphor o p co 2 grains “calcium glycerinophosphate, merck & co 1-1/2 grains “magnesium glycerinophosphate, merck & co 1-1/2 grains “sodium glycerinophosphate, merck & co 2-1/2 grains “lactated pepsin 2 grains “ignatia extract 1/20 grain “c p glycerin special process o p co 50 per cent “acidulated bone phosphor” presumably is acid phosphate of calcium this formula is an unscientific shotgun combination robinolrobinol, manufactured by john wyeth and brother, philadelphia, iscalled a “universal tonic ” it is said to be. “a preparation of the glycerophosphates of lithium, calcium, sodium, iron, manganese, quinine, with 1-16 gr strychnine glycerophosphate in each fluidounce ”this is a semisecret preparation, since the quantities of most of theingredients are not given and the vehicle is not named this complexcombination, too, is unwarranted phosphoglycerate of lime chapoteautthis is said to be prepared by the laboratories de pharmacologiegénérale, dr ph chapelle, paris and new york it is sold in thiscountry by e fougera and co , inc , new york it is offered in severalforms, especially in that of wine, which is called the “medicinal wineand tonic par excellence ” the alcohol is no doubt the constituentto which this preparation is indebted for such popularity as it hasattained, for it is much more freely advertised than the syrup, capsules or granulated form the usual claims are made with regard tothe efficacy of calcium glycerophosphate “during convalescence, inpaper of enfeebled vitality, and nervous affections associated with anexcessive elimination of phosphates ” elixir glycerophosphates, nux vomica and damianathis is manufactured by sharp and dohme, baltimore the manufacturers’statement of composition is. “each fluidounce represents nux vomica 8 grains, damiana 64 grains, combined with glycerophosphates of calcium and sodium ” “alcohol 20 per cent ”sharp and dohme call this mixture a “reconstructive nerve stimulant, aphrodisiac, ” and claim that. “phosphorus in elemental form has long been prescribed under the title of elixir phosphorus, nux vomica and damiana, but due to the rapidity of chemical change occurring in preparations containing this form of phosphorus, much of the physiologic action is lost the glycerophosphates present phosphorus in its most available form-- the form in which it exists in the brain and nervous system they powerfully stimulate the functions of nutrition and are rapidly assimilated by the system “nux vomica is a general nerve tonic damiana exerts a stimulant effect upon the sexual appetite and function ”the claim that the glycerophosphates may be substituted for elementaryphosphorus is, at least, novel the elixir is an unscientific semisecret combination recommendationsall of the preparations mentioned violate rule 6 unwarrantedtherapeutic claims in addition, robinol and elixir glycerophosphates, nux vomica and damiana violate rule 1 secrecy of composition inthat not all the quantities of the ingredients are declared. Tonols, phosphorcin compound and robinol violate rule 8 objectionable names it is recommended that the council endorse marshall findings98 anddeclare that tonols schering and glatz, phosphorcin compound eimerand amend, robinol john wyeth and brother, phosphoglycerate oflime chapoteaut e fougera and co , and elixir glycerophosphates, nux vomica and damiana sharp and dohme are ineligible for new andnonofficial remedies -- from the journal a m a , sept 30, 1916 hydras report of the council on pharmacy and chemistryhydras, sold by john wyeth and brother, philadelphia, is one of thethesis proprietary, so-called “uterine tonics ” it is said to contain“cramp bark, helonias root, hydrastis, scutellaria, dogwood andaromatics, ” but as the amounts of the several ingredients are notgiven the statement regarding its composition is valueless the labeldeclares the presence of 24 per cent alcohol the name “hydras, ” taken in connection with the statement ofcomposition, would suggest that hydrastis golden-seal is an importantconstituent the report of the chemical laboratory of the americanmedical association, however, indicates that hydrastis is present inunimportant amounts:“the hydrastin content of hydras was determined by extraction withimmiscible solvents pharm review, may, 1908, p 132 twenty-fivec c was found to yield an alkaloid residue of 0 0160 gm thepreparation contains, therefore, not more than 0 064 gm ‘hydrastin’per 100 c c inasmuch as hydrastis is required to contain about 2 5per cent ‘hydrastin, ’ hydras contains an equivalent of not more than2 56 gm hydrastis golden seal in 100 c c and the stated dose ofhydras-- one dessertspoonful 8 c c -- represents not more than 0 2 gm or 1/10 of the u s p average dose of hydrastis ”the label of a recently purchased bottle of hydras bears the followingrecommendations for its use. “indicated in treatment of dysmenorrhea, menorrhagia anti-abortive, with anodyne and tonic properties ” “for dysmenorrhea, suppressed menses, etc , a dessertspoonful three times daily, before or after meals ” “to relieve pain due to uterine disorders, a dessertspoonful every three hours, or increased to a tablespoonful, at the discretion of the attending physician ”a circular wrapped around the bottle declares that hydras is. “a valuable preparation to the physician in the treatment of dysmenorrhea, colic, cramps, spasm, palpitation incident to pregnancy, and the various pains resulting from diseases of the female sexual organs ”it is further claimed that.