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Providedthat the defendant may show such facts by depositions taken in the samemanner as depositions in civil paper 1, 931 the united kingdom of great britain and ireland medical acts - the act 21 and custom essay station creative solutions 22 victoria, c 90, and the amendmentsthereof and additions thereto, are generally spoken of as the medicalacts medical councils - there is a general council of medical education andregistration of the united kingdom, with branch councils for england, scotland, and ireland 21 and 22 vict , 1858, c 90, s 3, 6 members of the general council are chosen as provided in 49 and 50vict , c 48, s 7. Those representing the medical corporations must bequalified to register under this act 21 and 22 vict , c 90, s 7 the general council appoints a registrar for england, and the branchcouncils for scotland and ireland appoint respectively a registrar forscotland and ireland 10, 11 registrar - it is the duty of the registrars to keep their registerscorrect, and to erase the names of all registered persons who shallhave died, and from time to time to make the necessary alterations inthe addresses or qualifications of persons registered it is lawful forthe registrar to write a letter to any registered person, addressed tohim according to his address on the register, to inquire whether he hasceased to practise or has changed his residence, and if no answer bereturned within six months from the time of sending the letter, it islawful to erase the name of such person from the register, but it maybe restored by direction of the general council 14 qualification - persons possessed of one or more of the qualificationsdescribed in schedule a, on the payment of a fee not exceeding £5, areentitled to register on the production to the registrar of the branchcouncil for england, scotland, or ireland the document conferringor evidencing the qualification in respect whereof he seeks to beregistered, or upon transmitting by post to such registrar informationof his name and address, and evidence of his qualifications and of thetime or times at which they were obtained the several colleges andbodies mentioned in schedule a may transmit from time to time to theregistrar, under their respective seals, lists of the persons who bygrant of such colleges and bodies respectively, are for the time beingentitled to register, stating the qualifications and residences of suchpersons, and it shall be lawful for the registrar on the payment of thesaid fee to enter in the register the persons mentioned in such listswith their qualifications and places of residences as therein statedwithout other application 15 the general council is required to make orders for regulating theregisters from time to time 16 persons actually practising medicine in england before august 1st, 1815, were entitled to register under the act 17 any two or more of the colleges and bodies in the united kingdommentioned in schedule a may, with the sanction and under the directionof the general council, unite or co-operate in conducting theexaminations required for qualifications to be registered s 19, 37 and 38 vict , c 34 the privy council may suspend the right of registration in respect ofqualifications granted by any college or body 21 after such revocation, no person shall be entitled to register inrespect to any qualification granted by such college before revocation22 the privy council may issue an injunction directing any body entitledto grant qualifications to desist from imposing upon any candidatefor examination an obligation to adopt or refrain from adoptingthe practice of any writingicular theory of medicine or surgery as atest or condition of admitting him to examination or granting hima certificate. And in the event of their not complying, may orderthat such body cease to have the power of conferring a right to beregistered so long as they shall continue such practice 23 where any person entitled to be registered applies to the registrarof any branch council for that purpose, such registrar is requiredforthwith to enter in a local register the name and place of residence, and the qualifications in respect of which the person is so entitledand the date of registration. And in case of the branch council forscotland or ireland, to send to the registrar of the general council acopy of the entry, and the registrar of the general council is requiredto cause the same to be entered in the general register. And suchregistrar is required to cause all entries made in the local registerfor england to be entered in the general register 25 no qualification is entered on the register, on the first registrationor by way of addition to a regular name, unless the registrar besatisfied by proper evidence that the person claiming it is entitled toit any appeal from the decision of the registrar may be decided by thegeneral council or by the council for england, scotland, or ireland, asthe case may be any entry proved to the satisfaction of such generalcouncil or branch council to have been fraudulently or incorrectly mademay be erased from the register by an order in writing of such generalcouncil or branch council 26 medical register - the registrar of the general council is requiredto cause to be printed, published, and sold under the direction ofsuch council, every year, a correct register of the names with therespective residences and medical titles, diplomas, and qualificationsconferred by any corporation or university or by a doctorate of thearchbishop of canterbury, with the dates thereof, of all personsappearing on the general register as existing on january 1st in everyyear such register is called the medical register, and a copy ofthe medical register for the time being is evidence that the personstherein specified are registered according to the act, and the absenceof the name of any person from such copy is evidence, until thecontrary be made to appear, that such person is not so registered;provided, that in the case of any person whose name does not appearin such copy, a certified copy under the hand of the registrar of thegeneral council or a branch council of the entry of the name of suchperson on the general or local register shall be evidence that suchperson is so registered 27 if any college or body exercise any power it possess of striking offfrom its list the name of any one of its members, it shall signifyhis name to the general council and the said council may, if they seefit, direct the registrar to erase from the register the qualificationderived from such college or body in respect of which such member wasregistered, and the registrar shall note the same therein, but the nameof no person shall be erased from the register on the ground of hishaving adopted any theory of medicine or surgery 28 if any registered medical practitioner shall be convicted in england orireland of any felony or misdemeanor, or in scotland of any crime oroffence, or shall be after due inquiry judged by the general council tohave been guilty of infamous conduct in any professional respect, thegeneral council may, if they see fit, direct the registrar to erase thename of such medical practitioner from the register 29 every person registered who may have obtained any higher degree orother qualification is entitled to have it inserted in the registerin substitution for or in addition to his qualification previouslyregistered, on the payment of such fee as the council may appoint30 compensation - no person is entitled to receive for any medical orsurgical advice, or attendance, or for the performance of any operationor for any medicine which he shall have both prescribed and supplied, unless he prove upon the trial that he is registered under this act32, as amended 23 and 24 vict , c 7, s 3 definition - the words “legally qualified medical practitioner” or“duly qualified medical practitioner, ” or any words implying a personrecognized by law as a medical practitioner or member of the medicalprofession in any act of parliament, mean a person registered underthis act 34, as amended 23 and 24 vict , c 7, s 3 exemptions - if they so desire, registered persons are exempt fromserving on juries, and in all corporation, parish, ward, hundred, andtown offices, and in the militia 35 disqualifications - no unregistered person is permitted to hold anyappointment as a physician, surgeon, or other medical officer in themilitary or naval service, or in emigrant or other vessels, or in anyhospital, infirmary, dispensary, or lying-in hospital, not supportedwholly by voluntary contributions, or in any lunatic asylum, jail, penitentiary, house of correction or of industry, parochial or unionworkhouse or poor-house, parish union, or other public establishedbody or institution, or to any friendly or other society for affordingmutual relief in sickness, infirmity, or old age, or as a medicalofficer of health 36, as amended 23 and 24 vict , c 7, s 3 no certificate required by any act from any physician or surgeonlicentiate in medicine and surgery, or other medical practitioner, isvalid unless the signer be registered under this act 37, asamended 23 and 24 vict , c 7, s 3 penalty - wilfully procuring or attempting to procure one self to beregistered by making or producing or causing to be made or producedany false or fraudulent representation or declaration, or aiding orabetting therein, is a misdemeanor in england and ireland, and inscotland a crime or offence, punishable by fine or imprisonment theimprisonment cannot exceed twelve months 39 wilfully and falsely pretending to be or taking or using the nameor title of physician, doctor of medicine, licentiate in medicineand surgery, bachelor of medicine, surgeon, general practitioner, orapothecary, or any name, title, addition, or description implyingregistration under this act, or recognition by law as a physician orsurgeon or licentiate in medicine and surgery, or practitioner inmedicine, or apothecary, is punishable on summary conviction by apenalty not exceeding £20 40, 41 deceased physicians - every registrar of deaths in the united kingdom, on receiving notice of the death of any medical practitioner, isrequired to transmit to the registrar of the general council and theregistrar of the branch council a certificate of such death with thetime and place, and on the receipt of such certificate the medicalregistrar is required to erase the name of the deceased from theregister 45 exceptions - the general council was by the act empowered by specialorder to dispense with such provisions of this act or such writing of anyregulations made by its authority as to them should seem fit, in favorof persons at the time of its passage practising medicine or surgeryin any writing of her majesty dominions other than great britain andireland by virtue of any of the qualifications in schedule a, and infavor of persons practising medicine or surgery within the unitedkingdom on foreign or colonial diplomas or degrees before the passageof this act, and in favor of any persons who had held appointments assurgeons or assistant surgeons in the army, navy, or militia, or in theservice of the east india company, or who were acting as surgeons inthe public service, or in the service of any charitable institution, and in favor of medical students who commenced their professionalstudies before its passage 46 the qualifications specified in schedule a are as follows:1 fellow, member inserted 22 vict , c 21, s 4, licentiate, orextra licentiate of the royal college of physicians of london this isdeclared by 23 and 24 vict , c 66, s 1, to denote the corporation of“the president and college or commonalty of the faculty of physics inlondon” the act makes provision for a new charter with change ofname to “the royal college of physicians of england, ” or retention ofold name. S 47, as amended 23 and 24 vict , c 66, s 2 2 fellow, member inserted 22 vict , c 21, s 4, or licentiate ofthe royal college of physicians of edinburgh the act makes provisionfor the granting of a new charter to the royal college of physicians ofedinburgh, whereby its name is to be changed to “the royal college ofphysicians of scotland, ” or its old name may be retained. S 49, as amended 23 and 24 vict , c 66, s 2 3 fellow or licentiate of the king and queen college of physiciansof ireland the act makes provision for the granting of a new charterto this college, whereby its name is to be changed to “the royalcollege of physicians of ireland, ” or its old name may be retained. S 51, as amended 23 and 24 vict , c 66, s 2 4 fellow or member or licentiate in midwifery of the royal college ofsurgeons of england 5 fellow or licentiate of the royal college of surgeons of edinburgh see 6, below 6 fellow or licentiate of the faculty of physicians and surgeons ofglasgow the act makes provision for the possible amalgamation of theroyal college of surgeons of edinburgh with the faculty of physiciansand surgeons of glasgow, in which case the united corporation is to benamed “the royal college of surgeons of scotland:” s 50 7 fellow or licentiate of the royal college of surgeons in ireland 8 licentiate of the society of apothecaries, london 9 licentiate of the apothecaries’ hall, dublin 10 doctor or bachelor or licentiate of medicine, or master in surgeryof any university of the united kingdom.

The heart beating very slowly at the necroscopy the lungs filled the thorax, were full of thick dark blood and emphysematous the blood was black and fluid in the left ventricle and arteries, and in the right cavities and veins resembled molasses liver darkly congested there was no mucus in the trachea and no ecchymosis in the lungs he also p 306 tried the experiment upon a large dog of fastening boards against its thorax and tightening them by means of cords for essay minutes it was quiet, but suddenly it became much agitated, stood upon its hind legs, threw itself against the wall, rolled on the ground, and uttered frightful cries. Finally fell on its side there was no movement of the thorax, but the muscles of the neck and belly were in full and rapid action, dry and sonorous rles were heard, and a large quantity of mucus appeared at the nose and mouth the movements grew feebler, the respirations infrequent, and at the end of thirty-four minutes it was dead the necroscopy showed the blood black and thick. Heart relaxed. Lungs red, a little emphysematous, containing but little blood, and on their surface were blackish points and small red spots the death of desdemona shakespeare “othello” has been much criticised the declaration that she was strangled or suffocated does not consist with the symptoms described see med news, philadelphia, may 1st, 1886, p 489 treatment the obvious indication is to search for and remove the obstruction themeans and methods of treatment are fully treated of in surgical works, but may be briefly mentioned here laryngoscopical examination may be necessary a curved forceps isusually the best instrument for removing the foreign body a tallowcandle may serve to push it into the stomach if there is no bougie athand suction may be used sneezing may be brought on by tickling thenostrils. Coughing by tickling the glottis. Vomiting by irritating thefauces, or by emetic. The body of the subject may be inverted and inthis position the fauces may be tickled, or fingers may be passed backinto the pharynx johnson892 says that at the moment of inversion thepatient should try to take a deep inspiration. This opens the glottisand facilitates the expulsion of the foreign body the inspiratorycurrent has no appreciable effect in retarding the movement of theforeign body in the direction of gravity noble recommends inversion of the body in new-born infants in whichasphyxia may be supposed to be due to anæmia of the brain tracheotomyor laryngotomy may be necessary it may be necessary to administeroxygen foreign bodies like beards of grass and fish-heads can bewithdrawn only with difficulty because of their sharp projections intense suffering and dyspnœa in a robust subject may necessitatevenesection generally speaking it is better to bring up the foreignbody than to push it down into the stomach beveridge suggests toblow into the ear, to induce a reflex action and cause expulsion ofthe foreign body cold affusions, artificial respiration, galvanism, frictions of the limbs, artificial heat, stimulants by mouth andrectum, may one or all be needed hamilton893 says that it is useless to expect good results fromelectricity if five minutes have elapsed since life appeared to beextinct. Althaus, 894 that three hours after death the muscles willcease to respond to faradization. And richardson, 895 that a lowtemperature prolongs the sensitiveness of the muscle with regard to insufflation, le bon896 objects to it in asphyxia asbeing hurtful and not useful colin897 tamponed the trachea of ahorse. In four minutes fifty seconds it was apparently dead. The tamponwas removed and insufflation practised for fifteen to twenty minuteswithout effect he claims that artificial respiration is useless afterthe circulation ceases fell898 and o’dwyer899 recommend forced inspiration mcewen900uses a tracheal tube by the mouth dew901 offers a new method of artificial respiration in asphyxia of the new-born. Lusk902 considers the subject of life-saving in still-births.

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 custom essay station creative solutions 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.

As also, dries up oldand inveterate running sores, and is of admirable virtue in all greenwounds fig-wort, or throat-wort descript common great fig-wort sends divers great, strong, hard, square brown stalks, three or four feet custom essay station creative solutions high, whereon grow large, hard, and dark green leaves, two at a joint, harder and larger than nettleleaves, but not stinking. At the tops of the stalks stand thesis purpleflowers set in husks, which are essaytimes gaping and open, essaywhatlike those of water betony. After which come hard round heads, with asmall point in the middle, wherein lie small brownish seed the root isgreat, white, and thick, with thesis branches at it, growing aslope underthe upper crust of the ground, which abides thesis years, but keeps nothis green leaves in winter place it grows frequently in moist and shadowy woods, and in thelower writings of the fields and meadows time it flowers about july, and the seed will be ripe about a monthafter the flowers are fallen government and virtues essay latin authors call it cervicaria, because it is appropriated to the neck. And we throat-wort, because itis appropriated to the throat venus owns the herb, and the celestialbull will not deny it.

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The casewas subsequently overruled, but not on the ground urged by justicedavis 264 the number of insurance paper in which the rule has beenenforced seems to leave it beyond question that it will not be relaxedfor the purpose of establishing fraud, 265 although that announcementhas not been specifically made there seems no reason that the ruleshould be relaxed in that regard when it is not relaxed to establishthe crime of the patient. Though the mischief that may be done in suchpaper is apparent 266the witness - the statutory provisions as to the professionalstatus of the witness whose testimony is excluded have already beenshown 267 the facts which establish the relation of physicianand patient will be treated later 268 the witness is a member ofa profession, but there is very little discussion in the paper asto what constitutes a physician or surgeon 269 the language ofthe statutes as well as their policy and intent has been said toplainly embrace a physician who casually or in any way attends andprescribes for a patient, whether he be a family physician or the usualmedical attendant or not 270 the spirit of the acts would protectcommunications made to any person attending the patient in the acceptedcapacity of physician or surgeon wherever that might have happened, though the letter would confine it in essay instances to duly authorizedor duly licensed persons it does not seem to have been establishedwhether such authority or license must have been granted under thelaws of the state where the trial is conducted, nor how the severalstatutes apply to communications made elsewhere, especially in statesor countries where authority or license to practise is not required bylaw it has been said with reference to the new york law that it isabsolutely necessary that the witness should be a duly qualifiedphysician;271 and it has been held that the words “duly authorized”mean those persons who are not prohibited by the penal code frompractising, so that an unlicensed physician may be compelled todisclose confidential communications 272 whether the same rule wouldbe applied with reference to information obtained in another state bya physician duly authorized to practise there although prohibited frompractising in new york, is a question that is suggested as a casewithin the reason of the law but outside of its letter, and one whichdoes not seem to have been answered in new york, in an action by a physician for compensation for hisservices, it was held that a person who merely answered for a physicianat his office in his absence, and was not himself a physician, is not awitness whose testimony is privileged 273in missouri it has been held that a drug and prescription clerk isnot a privileged witness 274 the question arose in the same state, whether a dental surgeon is forbidden to testify under the statute, butits determination was not essential to the judgment and it was leftunanswered 275to establish the privilege it is necessary that the person who insistsupon it to exclude testimony should show by competent evidence that thewitness belongs to the class privileged under the law 276 but wherethe physician testified that he was a regular practising physician andattended in that capacity, and he was not examined further as to hisdue authority, it was held that a failure to produce his license couldnot be urged on appeal as reason for compelling him to testify 277the court said that if the privilege were the physician he might, ifthe objection were taken, be required to prove by the best evidencethat he was duly authorized, but as it is the patient privilege, inthe absence of objection to the sufficiency of the proof, the patientis entitled to the benefit of the presumption that the physician hadthe license which the law requires to entitle him to practise waiver of the privilege who may waive - those states in which the law provides for a waiverhave been enumerated;278 in others the courts have determined thatthe privilege of waiving is implied in the reason for the law inindiana it has been held that although the statute contains in termsan absolute prohibition, it creates no absolute incompetency andthe privilege may be waived by the person for whose benefit it ismade or his legal representative 279 under the michigan law itwas claimed that the physician is forbidden to reveal confidenceseven though he have his patient consent, but it has been held thatthe law only creates a privilege on the same footing with otherprivileged communications, which the public has no interest insuppressing when there is no desire for suppression on the writing ofthe person concerned 280 in missouri too the patient may waive theprivilege 281the protection vouchsafed by the law is designed for the benefit of thepatient, and therefore the physician himself cannot waive it 282 thepatient can disclose his own physical condition if he so desires 283but the physician cannot refuse to testify if the patient waives theprivilege 284the patient can waive the privilege during his life 285as it existed prior to 1891 the new york law provided that theprohibition should operate unless it was expressly waived upon thetrial or examination by the patient 286 this was interpreted to meanthat the patient himself was the only person who could make a waiver;and that, therefore, the possibility of waiver ceased with the deathof the patient, while the privilege of secrecy continued unabated, so that those claiming under the deceased patient could not waivethe privilege, nor insist upon the testimony of the physician, eventhough their interests were in jeopardy on account of his silence 287it seems, however, that a patient can during his lifetime waive theprivilege, the waiver to take effect after his death 288 the expresswaiver required by the statute may be given by the patient attorney, because of the nature of the attorney agency in conducting an actionfor the patient 289none of the other statutes are in the exact terms of the new yorkstatute, but those of california, colorado, idaho, minnesota, montana, nevada, north dakota, ohio, oregon, south dakota, utah, washington, and wyoming provide that the testimony shall not be given unless thepatient consent. In iowa, the waiver provided for is that of theperson in whose favor the prohibition is made. And in nebraska, ofthe writingy in whose favor the provision is enacted in indiana, the privilege extends beyond the death of the patient, andit may be waived by the writingy who may be said to stand in the place ofthe deceased and whose interests may be affected by the disclosure 290in michigan, what the patient may do in his lifetime, those whorepresent him after his death may also do for the protection ofthe interests which they claim under him 291 in missouri therepresentatives of the patient may waive;292 and where the disputeis between devisees and heirs at law all claiming under a deceasedpatient, either the devisees or heirs may call the attending physicianof the testator as a witness regarding information acquired by him inhis professional attendance 293 in nevada it has been said that theparents of a seven-year-old infant, may waive for the infant 294objections to the admission of privileged communications. When andby whom made - having considered who can waive the privilege, itis material to discuss also the question who may insist upon theenforcement of the law if the protection were only enforced on theclaim of privilege by the patient, the very object of the statuteswould be defeated in the large majority of instances because of theabsence of the patient and every one interested in his behalf toassert his right it rests, therefore, with any writingy to raise theobjection and assert the prohibition but it seems that the physicianhimself, unless a writingy, cannot make the objection 295 it seems tohave been thought in essay of the paper that the right to insist uponthe enforcement of the law is coupled with an interest derived fromthe patient this idea started from the language used in the earlypaper enforcing the privilege at the instance of those claiming underdeceased patients;296 and it led to essay confusion where the rightof representatives to waive the privilege was denied. But it seemsto be clear that the right to object differs from the right to waivein that the latter is necessarily and logically dependent upon therelation between the patient and his representative, while the formeris obviously suggested as the best method of enforcing the law inindiana it has been said that the statute gives to the representativeof a deceased patient the right to object;297 but that this is notby reason of the relationship appears from another case in the samestate, where on an application for a new trial the court voluntarilyrefused to grant one for newly discovered evidence disclosed to itby a physician affidavit, on the ground that if the patient shouldobject in the new trial the evidence would be excluded 298 in thisstate it has been held that the widow of the patient cannot object tothe disclosure, if his administrator with the will annexed waives theprivilege 299in michigan it has been said that the physician cannot avail himselfof the statute for his own benefit. But that was in a case where thecommunication was not really of the privileged class 300 in newyork, in proceedings to which a physician was a writingy an examinationof his books of account before trial has been refused on the ground ofprivilege, and for the same reason a motion to direct a physician toturn his books of account over to a receiver has been denied 301in montana it has been said that when the patient consents no one elsecan object to the reception of the physician testimony 302in new york it has been said that the benefits of the law are to bedispensed alike to those familiar with and those ignorant of itsexistence and applicability, and it is therefore no reason to refuseits enforcement, that the patient did not know that his communicationwas privileged 303but, as in other paper of the receipt of improper evidence, it wouldseem that the objection should be made at the time it is offered, andif the objection is not then made, it will not avail to raise it lateror on appeal 304 it should not be prematurely made 305 in newyork where in pursuance of a special feature of practice in probateproceedings, 306 certain witnesses are regarded as the surrogatewitnesses though produced at the instance of the contestant, and thecontestant, after giving notice that the evidence of physicians as suchwitnesses was material, refused to examine them, and the surrogaterequired the proponent to suggest a line of examination, it was heldthat it did not lie with the contestant to object to the physicians’testimony as privileged, because she had lost her right to object bygiving notice that the evidence of those witnesses on these points wasmaterial 307objection cannot be raised in the progress of an examination after theforbidden testimony has been in writing received without objection. Forthat would unjustly enable a writingy to open the door and get in all hedesired and then to close it to the disadvantage of his adversary. Whenthe door is once properly opened the examination may be continued untilit is complete, despite the objection of the writingy at whose instance itwas begun 308in indiana, where there was no objection, it was held that the evidenceshould not be withdrawn from the consideration of the jury or itsweight diminished by comments on its value as matter of law 309but when such evidence has already been admitted in the face ofobjection, it is not necessary for the writingy to object again, asnothing is waived by conforming with a rule already laid down 310where it is apparent that no harm is done to the objecting writingy by animproper ruling on the receipt of privileged communications, no weightwill be given to an exception to such ruling 311what constitutes a waiver of the privilege - the statutory provisionsas to what constitutes a waiver have been set forth above 312 incalifornia it has been held that cross-examination of the physicianby the patient, calling for privileged matter, is a waiver ofprivilege 313 in indiana it has been held that consent to disclosurecannot be inferred from the patient simply giving the name of hisfamily physician in applying for a policy of insurance on his life, and that a waiver in such an application should be evidenced by astipulation too plain to be misunderstood 314 and a physicianstatements of the cause of his patient death, furnished to aninsurance company, in pursuance of a stipulation of a policy thatsatisfactory proof of death shall be submitted to the company, are notrendered admissible by that stipulation 315it has also been held that consent to the evidence of one physicianis no consent that another physician may divulge confidentialcommunications;316 and that the physician cannot testify that hefound no evidence of injury on the examination of his patient, inorder to contradict her;317 the patient had already testified asto her condition and what the physician had done, but not as toanything said to her by her physician. She had expressly declinedto testify concerning communications except as to his prescriptionfor her injury, and without asking him to disprove her assertionsthe trial court permitted him to say that he had found no evidenceof injury. This was held to be error it has also been held that thetaking of a physician deposition and filing it, for the purposeof breaking the force of his testimony in a deposition taken by theopposite writingy, is no consent in itself to the reading of the otherwritingy deposition 318 but when, in an action against a physician formalpractice, the patient testifies as to the manner of treatment, thephysician is then at liberty to introduce the testimony of himself oranother physician as to the facts thus put in issue by the patient 319in iowa it has been held that the testimony of a patient regarding thecondition of his health is not a waiver of privilege, so as to allowhis opponent to introduce the testimony of his physician to contradicthim 320in michigan a physician has been allowed to contradict his patient asto the time when her trouble commenced, but on the ground that it hadnot been shown that the information was necessary to enable him toprescribe 321 but it has been held that waiver as to one physician isnot waiver as to another regarding a different time 322in missouri, the calling of a physician by the patient as a witnessto testify as to information acquired while attending, is awaiver 323 but offering one physician as a witness is not a waiverof the privilege with reference to another 324 an applicant forinsurance may, by an express waiver in his application, make anefficient waiver, binding upon any one claiming under the contract ofinsurance 325in nevada a waiver has been implied from the testimony of the patientand her mother, where the patient was an infant seven years ofage 326 and it was said that the parents of such an infant may makethe waiver in new york it has been held that reference to a family physicianwhen answering questions on an application for insurance, is not awaiver;327 nor is the presence of a third person, in aid of thepatient;328 nor is the bringing of an action for damages for aninjury;329 nor is the examination of the physician in a former trialby the opposing writingy;330 but where the ban of secrecy is onceremoved in an action and the information once lawfully made public, atthe instance of the patient, it cannot be restored, and the disclosuremay then be compelled in any subsequent action;331 it would seem, too, that a physician who becomes a witness to his patient lastwill and testament at the patient request is then subject to athorough examination on all points involving the patient testamentarycapacity 332where the patient testified herself and called an attending physicianto prove her physical condition, this was not a consent to theexamination of another attending physician, and it was said that theopposite writingy by tactics on cross-examination could not compel thepatient to abandon a privilege which she refused to waive 333 fish, j , in delivering the opinion of the court in the last-mentioned case, said of the operation of the statute, that it allows the patient touse the testimony of the attending physician if he thinks his evidencewill benefit his case, and to object and exclude it in case he thinksit will not benefit him. He may call to his aid the testimony of anyone whose views he approves and exclude that of another whose testimonymight tend to controvert that given with the consent of the patient;that in this case the excluded witness was the best witness and couldtell nothing else than the patient had disclosed if she had told thetruth and it would relate solely to what she and the other physicianhad described, but that the court could not consider whether thestatute tended to promote the cause of justice, and he distinguishedmckinney v grand street railroad company, 334 on the ground thatthere the consent had been that the same physician should disclose whathe knew, while here the waiver of the excluded physician testimonyhad been constantly withheld a decision which seems to be at variance with record v village ofsaratoga springs is treanor v manhattan railway company, 335 whereit was said that the patient cannot promulgate and uncover his maladiesand infirmities in court and keep his physician under obligations tosilence, and that he cannot, to mulct another in damages, inflame ajury with a false or exaggerated story of his injuries and sufferingsand preclude the physician from making a truthful statement of the case but where the patient testifies as to what passed between him and hisphysician, the physician may testify on the same subject, as a waiveris inferred from the circumstances.