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In one case, personally known to me, the thermometerregistered 76° f seventeen hours after death the temperature of the body, its rigidity, and the evidences ofputrefaction all furnish data from which we can estimate the probabletime which has elapsed since death it must be remembered that no oneof them furnishes any positive proof essay medical jurists have attempted to give a more definite characterto these changes in the recently dead body by dividing the intervalbetween the stopping of the heart action and the beginning ofputrefaction into three periods in the first, the warmth, pliability, and muscular irritability remain in the second, these conditions arelost and the body is cold and rigid in the third, the body is coldand pliant, the muscles are relaxed, and the joints are flexible, thecadaveric rigidity having entirely ceased there can be no doubt about the existence of these stages, but when wecome to define the precise time at which one begins and the other ends, we find it impossible for example, the first stage embraces a periodwhich cannot be more closely defined than by stating that the personmay have been dead from a few minutes to twenty hours a statement toovague to be upheld by a counsel who defends a prisoner the changes which take place in these periods and the average time theylast have been given as follows by devergie:first period, few minutes to twenty hours - characterized by warmthof the body and general or writingial relaxation of the voluntary muscles to what portion of this period the special case belongs must beestimated according to the degree of heat in the trunk and extremitiesand the degree of rigidity in the muscles, the neck and the jawscommonly showing this condition first, the legs last warmth of thebody rarely remains as long as twenty hours. In general it is sensiblycold in from ten to twelve hours during this period the muscles aresusceptible of contraction under the galvanic current, and in the earlystage under the stimulus of blows second period, ten hours to three days - the body is perfectly coldthroughout and rigidity is well marked the muscles no longer respondto stimuli the duration of this period seems long, yet in one instancethe body will be found cold and rigid nine hours after death again, cooling and rigidity may not come on for three or four days third period, three to eight days - the body is perfectly cold thelimbs and trunk pliant and free from cadaveric rigidity the musclesare not capable of contracting in summer this period is much shorter;often it will come on before three days putrefaction commences when a body is kept under the most favorableconditions, in from six to twelve days, as a slight greenishdiscoloration of the abdomen which gradually spreads throughout thebody the time at which putrefaction shows itself and the rapidity withwhich it advances is dependent upon so thesis factors, thesis of whichit is impossible often for the medical examiner to ascertain, thattoo much reliance must not be placed upon it casper estimates thefollowing to be the average changes generally found in the periods oftime given:twenty-four to seventy-two hours after death a slight green color isvisible over the centre of the abdomen the eyeballs are soft and yieldto external pressure three to five days after death the green color of the abdomen becomesintensified and general, spreading if the body be exposed to the air orburied in the ground in the following order. Genitals, breast, face, neck, upper and lastly lower extremities eight to ten days after death the discoloration becomes moreintense, the face and neck presenting a shade of reddish-green theramifications of the superficial veins on the neck, breast, and limbsbecome very apparent finally the patches congregate gases begin to bedeveloped and distend the abdomen and hollow organs and to form underthe skin in the subcutaneous and intermuscular tissue the cornea fallsin and becomes concave the sphincter ani relaxes fourteen to twenty-one days after death the discoloration over thewhole body becomes intensely green, with brownish-red or brownish-blackpatches the body is bloated and appears greatly increased in sizefrom the development of gases within the abdomen, thorax, and scrotum, and also in the cellular tissue of the body generally the swollencondition of the eyelids, lips, nose, and cheeks is usually of suchextent as to obliterate the features and to destroy the identity of thebody the epidermis peels off in patches, while in certain writings, morewritingicularly the feet, it will be raised in blisters filled with red orgreenish liquid, the cuticle underneath frequently appearing blanched the color of the iris is lost the nails easily separate and the hairbecomes loosened fourth to sixth month after death the thorax and abdomen burst and thesutures of the skull give way from the development of gases within thehead the viscera appear pulpy, or perhaps disappear, leaving the bonesexposed the bones of the extremities separate at the joints at anadvanced stage the soft writings gradually disappear in giving an opinion as to how long a time has elapsed since death whena body has undergone marked putrefactive changes, we must considercarefully not only the conditions of the organs, but the mode of deathand the “surroundings ” by these i mean the quantity of clothing worn, the depth of the grave in which the body has been interred, the seasonof the year, the heat and moisture of the atmosphere the questionessaytimes presents itself to the medical examiner, of two personsfound dead, which died first?. the importance of this point was wellillustrated in the “lizzie borden case ” by a careful consideration ofall the conditions presented by each body in the ways i have indicated, the question will not ordinarily be a difficult one to decide themedico-legal considerationofwounds, includingpunctured and incised wounds, and wounds made by blunt instrumentsother than gunshot wounds bygeorge woolsey, a b , m d , professor of anatomy and clinical surgery in the medical dewritingment ofthe university of the city of new york. Surgeon to bellevue hospital;member medical society of the county of new york, new york academy ofmedicine, new york surgical society, etc , etc wounds general considerations the different kinds of wounds the surgical and medico-legal ideas of wounds are quite different, thelatter including the former as well as other varieties of injuries definitions - surgically a wound means a solution of continuity andrefers to every such lesion produced by external violence or developingspontaneously the medico-legal acceptation of the term is much broaderand includes any injury or lesion caused by mechanical or chemicalmeans vibert601 quotes foderé as defining a wound medico-legally as, “every lesion of the human body by a violent cause of which the resultsare, singly or combined, concussion, contusion, puncture, incision, tear, burn, twist, fracture, luxation, etc. Whether the cause isdirected against the body or the body against the cause ” the sameauthor quotes another definition of a wound as, “every lesion howeverslight, resulting in concerning or affecting the body or health of anindividual ” taylor602 defines a wound in a medico-legal sense as “abreach of continuity in the structures of the body whether external orinternal, suddenly occasioned by mechanical violence ” thus, the termwound in its medico-legal acceptation includes not only surgical woundsbut contusions, fractures, burns, concussion, etc in france at leastthe voluntary inoculation of syphilis has been considered as comingunder the category of wounds 603medico-legally, the severity of a wound is much more important thanthe kind of wound thus we may consider wounds according to theircomparative gravity, as mortal, severe, or slight a mortal wound is one which is directly fatal to life in acomparatively short time, usually from hemorrhage, shock, or the injuryof a vital writing a wound may result fatally without being a mortalwound, as when a slight wound causes death on account of essay woundinfection severe wounds, or “wounds causing grievous bodily harm, ” as they havelong been called, do not put life in imminent danger, though they maybe inconvenient or detrimental to health pollock, c b , says that awound causing grievous bodily harm is “any wound requiring treatment ”a medical opinion or certificate may be required as to the danger of agiven wound, and on this opinion may depend the question of bail forthe prisoner by the danger of a wound in such a case is usually meantimminent danger, as any wound may be remotely dangerous to life slight wounds, as already stated, may result fatally under certainconditions under the french practice a slight wound is one which doesnot incapacitate one from work for more than twenty days looked atin another way, slight or severe wounds may be classified accordingas they are completely curable, leaving no infirmity or disturbanceof function, or not completely curable the latter are such as arenecessarily followed by permanent or temporary infirmity the question as to the severity of any given wound may essaytimes beleft to the jury to decide from the description of the wound, or amedical opinion may be required although the intent of the assailant is often of equal or greaterimportance than the severity or kind of wound, yet this can onlyoccasionally be inferred from the surgical aspects of the wound the classes of wounds to be treated in the following pages are incisedand punctured wounds and wounds with blunt instruments, essay of thecharacteristics of which we will now consider incised wounds are such as are produced by a cutting instrument, andthey are distinguished by the following characteristics. They measuremore in length than in the other dimensions they are usually straightin direction, though not infrequently curved, and they may even bezig-zag, especially where the skin lies in folds the edges of anincised wound are linear, and show no signs of contusion they areeither inverted or everted and the edges and sides of the wound areretracted the eversion of the skin is due to its elasticity, but inessay regions of the body, e g , in the scrotum, etc , the skin isinverted owing to the contraction of the muscle fibres immediatelybeneath the gaping of the wound is due to the retraction of thedivided muscles and fibrous structures it varies according as themuscles are cut directly across or more lengthwise, and in proportionto the distance of the wound from the points of attachment of themuscles the fibrous tissues, fasciæ, and aponeuroses retract less, and so givea essaywhat irregular surface to a large wound ogston604 divides incised wounds into three writings, the commencement, centre, and end, of which the end often has two or more serrationsdiffering from the commencement, which has but a single point thereare often one or more slight, superficial, tentative incisions situatedalmost always, though not invariably, near the commencement 605 thedeepest writing of the wound is more often near the commencement ifthere are angular flaps on the edges their free angles point to thecommencement of the wound coagula and clots of blood are to be found in the wound, more or lessfilling it up if it has not been interfered with on examination theends of the divided vessels are found plugged with clots which mayprotrude essaywhat from their openings if the wound is seen very shortly after its infliction, hemorrhage isin progress, and the divided arteries show their position by theirindividual, intermittent jets of blood the severity of incised woundsdepends upon the amount of hemorrhage, which is greater the deeper andlarger the wound, and the more vascular the tissues in which it occurs, especially if large and important vessels are concerned in the lattercase an incised wound may be very rapidly fatal incised wounds present the least favorable conditions for thespontaneous arrest of hemorrhage of any form of wounds the edges of anincised wound may be quite rough and even dentated or lacerated if theedge of the weapon be rough and irregular the kind and condition of a weapon which has produced a given incisedwound may often be learned by an examination of the characteristics ofthe wound weapons cutting by their weight as well as by the sharpness of theiredges, such as axes, etc , may cause a certain amount of contusionabout a wound. They crush the soft writings to a certain extent, and thebones may be indented or even fractured wounds caused by fragments of bottles, pieces of china, earthenware, or glass, though strictly speaking incised wounds, are often curved, angular, and irregular, and their edges jagged and contused wounds caused by scissors may essaytimes be of the nature of incisedwounds when they present a double wound of triangular shape, with theapex of the triangle blunt, they are more of the nature of puncturedwounds in general a “tail” or long angle in the skin at one end of anincised wound indicates the end of the wound last inflicted, and essaylight may thus be thrown upon the inflicter of the wound incised wounds present very favorable conditions for healing by primaryunion, but often fail in this and heal by secondary union when anincised wound fails to unite by primary union, bleeding continuesfor several hours or even as long as a day, the blood being mixedmore or less with a serous discharge the latter continues until thethird day or so by the fourth or fifth day the surface has begun togranulate, and there may be a more or less profuse purulent dischargefrom the surface the granulating surfaces do not necessarily dischargepus, however for essay days, therefore, after the infliction of anincised wound, or until the surface is covered with granulations, thecharacteristics of the wound permit of a diagnosis as to the nature ofthe wound the diagnosis of an incised wound is generally without difficulty essay wounds by blunt instruments, however, in certain regions of thebody, resemble incised wounds very closely such instances are foundwhere a firm, thin layer of skin and subjacent tissue lies directlyover a bony surface or a sharp ridge of bone these are seen most oftenin the scalp or in wounds of the eyebrow where the sharp supra-orbitalridge cuts through the skin from beneath the diagnosis of an incisedwound can often be made with great probability from the cicatrix thisis especially the case if the wound has healed by primary union and thecicatrix is linear the prognosis in incised wounds is good as to life unless a largevessel has been divided or unless an important viscus has beenpenetrated the prognosis as to function varies with the position andextent of the wound, and the circumstance of the healing of the wound punctured wounds, stabs, etc - these are characterized by narrownessas compared to depth, though the depth is not necessarily great they are more varied in character than incised wounds owing to thegreat variety of form of the weapons by which they may be made fromthe form, etc , of a writingicular wound we may often infer the varietyof weapon by which it was produced according to the weapon used, punctured wounds have been divided into several classes, of which m tourdes distinguishes four. 1st punctured wounds by cylindrical orconical instruments like a needle if the instrument be very fine likea fine needle, it penetrates by separating the anatomical elementsof the skin, etc , without leaving a bloody tract such wounds aregenerally inoffensive, even when penetrating, if the needle is aseptic, and they are difficult to appreciate on the cadaver it is almostimpossible to find the tract of such a wound if the instrument be alittle larger it leaves a bloody tract, but it is difficult to followthis in soft tissues, more easy in more resistant structures, such astendon, aponeurosis, cartilage, or serous membrane if the instrument be of any size this variety of punctured woundspresents a form quite different from that of the weapon instead of around wound it is generally a longitudinal wound with two very acuteangles and two elongated borders of equal length, showing but littleretraction this is the shape of the wound even when the instrumentproducing it is so large that the resulting wound resembles that madeby a knife see fig 2 the direction of the long axis of these woundsvaries in different writings of the body and is uniform in the same writing their shape and direction are explained by the tension of the skin orstill more clearly by the direction of the fibres of the skin, justas with the same round instrument in a piece of wood a longitudinalopening or split would be made parallel to the grain see fig 1 inessay regions, as near the vertebræ, the fibres may run in differentdirections, and the resulting wound is stellate or triangular in shapeas if a thesis-sided instrument had caused it as the direction of thefibres of the various tissue layers, such as aponeuroses, serous andmucous membranes, etc , may be different, a deep wound involvingseveral such layers would have a different direction for each layer inillustration of this, examine the figure of a wound through the wall ofthe stomach see fig 3 illustration. Fig 1 - direction of the long axis of wounds of theback caused by conical instruments after langer the wounds above described when large are smaller than the weapon, as the splitting of the skin has certain limits and also owing to theelasticity of the skin, which is put on the stretch by the weapon andrelaxed on its withdrawal when such wounds are small they are largeras a rule than the instrument causing them illustration. Fig 2 - slit-like wound caused by a pointed conicalinstrument 2 5 cm in diameter natural size illustration. Fig 3 - wounds of stomach wall by a conical instrument, showing the different direction of the long axis of the wounds indifferent layers illustration.

That the essay contests for college students facts themselves must appear tothe court, and it might be developed on proper cross-examination thatdiscrimination could be made 467but it would seem that because of the necessarily delicate nature ofthe inquiry, to avoid disclosing what the statute forbids, the burdenis overcome with slight evidence, and inferences and presumptionsare freely indulged in aid of the privilege. For instance, where thephysician was not permitted to answer whether he did converse withhis patient about an injury, or whether he made an examination withreference to it, it was urged that the objection was prematurely made, but it was held that the fact that the patient consulted a physicianon the occasion to which the inquiry related, when considered with thenature of the questions, justified the exclusion in the absence ofother proof 468 but the physician may testify that he did attendhis patient as physician;469 and he may answer the question whetherthe information was necessary to enable him to act in his professionalcapacity;470 for while his testimony on that point is not conclusive, and the court uses its own judgment in reaching a determination, histestimony is competent evidence 471 he may also testify that a personwas ill and was his patient, that he attended as physician, and he canstate when he attended and how thesis times 472it has been said that where the evidence justifies the conclusion thatinformation regarding the patient is acquired while attending in aprofessional capacity, it is not essential to show by formal proof thatthe information was necessary 473the rights and duties of the physician with reference to the privilege the privilege established by law is a rule of evidence, and not aregulation of a physician general conduct outside of a proceeding inwhich rules of evidence are applicable 474 the courts have, however, not hesitated to intimate that it is a physician duty to observe thesame secrecy in his general walk and conversation 475the physician may testify as an expert on hypothetical questionssubmitted to him regarding facts which might be equally true of anyother person than his patient, and excluding from his considerationprivileged knowledge 476 and he may also testify as to matterswhich came to his knowledge before or after or independent of hisemployment as physician, 477 or which were immaterial to his acting ina professional capacity, and as to which his patient could have had noreasonable ground for believing that they were necessarily disclosedin order that the physician might so act 478 it is the patientprivilege and not the physician. And, therefore, the physician isnot absolutely incompetent as a witness, and has no right to refuse totestify 479 but where he is a writingy he may object and then he willnot be forced to disclose his patient confidence 480in indiana it has been held that where the patient testifies in anaction against his physician for malpractice the physician is thenat liberty to testify or to introduce any other witness to testifyconcerning the matters in controversy 481in michigan, a physician who was plaintiff in a libel suit was notpermitted to insist upon the privilege to prevent the disclosure of hismaltreatment of his patient or what other physicians had discoveredwith regard to it by visits to his patients 482the measure of the physician exemption and liability in testifyingis the language of the statute, and not his idea of his duty to hispatient or the patient injunctions of confidence or secrecy 483in essay of the states there are statutory provisions entitlingphysicians to sue for compensation for their professionalservices 484 the statutes regarding privileged communications areto be construed together with these there seems to be no reason whya physician right of action for his services and medicines shouldnot survive the prohibition of his evidence. But it would seem thathe cannot as a witness in such an action testify regarding privilegedmatter but he can prove it by other witnesses 485the result of the legislation it is doubtless due to considerations of public policy that thestatutes changing the common-law rule have been enacted;486 butthey have not proved an unalloyed benefit, and essay of their featureshave brought about conditions which in essay paper have embarrassedthe administration of justice the law in new york may be taken forillustration. It formerly cut off the safest means of ascertaining themental condition and competency of a testator;487 it now precludes aphysician from disclosing the condition of his patient who is a lunaticor habitual drunkard, 488 though it be the most satisfactory evidence;it shuts out much testimony tending to show fraud in insurancepaper;489 it precludes a physician from stating the cause of hispatient death, 490 though there is no longer any secrecy connectedwith it, for the law makes it the duty of the physician to make, forfiling with the local board of health, a certificate of the probablecause of the death of a patient 491 it has been the subject of muchadverse criticism, 492 but all such considerations are properly to beaddressed to the legislature and not to the courts it seems to be themost far-reaching in its exclusion, and though it has been the longestin existence, was modified at the legislative sessions of 1891, 1892, and 1893, a fact which tends to show that there was sound reason in thecriticisms a synopsis of the laws of the several states and territories of the united states of america, and of great britain and ireland, and of the north american provinces of great britain, regulating the practice of medicine and surgery, prepared from the latest statutes by william a poste, late first deputy attorney-general of the state of new york, and charles a boston, esq , of the new york city bar synopsis of the existing statuteswhich regulate the acquirement of the right to practise medicine and surgery in the united states, great britain and ireland, and the canadian provinces note - this synopsis is designed to contain especially thoseprovisions of the statutes which regulate the right to practisemedicine and surgery it is not intended to include provisionsregulating apothecaries, druggists, chemists, and dentists, or the saleof drugs, medicines, and poisons. Nor provisions for the organizationand procedure of boards of medical examiners, except so far as theyregulate the requirements demanded from applicants for permission topractise. Nor provisions with reference to the duties of clerks orregistrars in the preparation and safe-keeping of records in theircare. Nor those defining the duties of members of boards, and punishingthe misconduct of such members. Nor those prescribing qualificationsfor appointment to the public medical service. Nor former laws not nowapplicable to candidates. Nor regulations of the form of certificatesor licenses, where the issuing of them is committed to essay publicfunctionary or body.

It wasthen instantly killed by pithing the lungs were found pale red, not congested, but showed subpleural ecchymoses page believedthese were due to the changed relation between the capacity of thethorax and volume of lungs liman found these ecchymoses in paper ofstrangulation, hanging, drowning, poisoning, hemorrhage, and œdema ofbrain, in the new-born, etc he failed to find them in essay paper ofsuffocation he believes them due to blood pressure from stasis inthe blood-vessels ssabinski781 made thesis experiments on dogs andcats to ascertain the presence or absence of subpleural ecchymoses instrangulation, drowning, section of pneumogastrics, opening of pleuralsac, compression of chest and abdomen, closure of mouth and nose, burial in pulverulent materials, etc similar hemorrhages may appearon the mucous and serous membranes, as the respiratory, digestive, andgenito-urinary tracts, and pleuræ, pericardium, peritoneum, membranesof brain, and the ependyma these are essaytimes minute and stellate, at others irregular in shape. Thesis are bright-colored accordingto tardieu the punctiform ecchymoses are rarely present except insuffocation maschka, 782 in 234 paper of asphyxia, found the lungscongested 135 times, anæmic 10, and œdematous 42 he thinks thesubpleural ecchymoses valuable signs of asphyxia the bronchial tubes are usually full of frothy, bloody mucus, and themucous membrane is much congested and shows abundant ecchymoses the lining membrane of the larynx and trachea is always congested andmay be livid. The tube may contain bloody froth or blood alone tidy comparing strangulation and hanging concludes that becausestrangulation is usually homicidal, and greater violence is used, therefore the external marks are more complete in strangulation and thecongestion of the air passages is invariably much greater maschka found the pharynx cyanotic in 216 of 234 paper of asphyxia the other mucous membranes are generally much congested serum is foundin the serous cavities maschka783 considers the rounded, pin-head ecchymoses of the innersurface of the scalp and pericranium valuable evidence of asphyxia the brain and membranes are essaytimes congested. Occasionallyapoplectic maschka784 found congestion of brain and membranes 48times and anæmia 30 times in 234 paper of asphyxia the abdominal organs are generally darkly congested, although maschkadenies this for the liver and spleen in asphyxia the congestion of the viscera generally is doubtless due largely to theprior congestion of lungs and engorgement of heart page785 experimented on six kittens, strangling three of them by the hand, the other three by ligature the results of the post-mortem examinations were nearly similar. The veins were full of dark fluid blood.

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“an improved anesthesia ether consisting of highly refined diethyl oxid c₂h₅₂o, plus approximately two volumes of ethylene c₂h₄, 1/2 volume of carbon dioxide co₂ and 1 per cent by weight of ethyl alcohol ”-- from the journal a m a , may 22, 1920 dionol“dionol” is advertised to physicians by the dionol company ofdetroit if one takes the word of the manufacturers, the therapeuticpossibilities of dionol are apparently limited only by the blue sky even the company admits that “the unprecedented range of action” ofthis marvel “may come as a surprise ” a glance over the published “casereports” confirms the inference from “bed sores, ” “bubo, ” “catarrh”and “circumcision” through “croup, ” “deafness, ” “dysmenorrhea”and “eczema, ” including “endometritis, ” “erysipelas, ” “gastritis”and “hemorrhoids, ” not omitting “osteomyelitis, ” “otitis media, ”“pneumonia” and “ptomaine poisoning, ” down through the pathologicalphabet to “quinsy, ” “sciatica, ” “spinal curvature, ” “varicose veins, ”and “whooping cough” one concludes that here at last is a catholiconindeed what is dionol?. first it should be said that the preparation comes intwo forms. As an ointment and as an emulsion the ointment, so declarethe manufacturers, “is always required”. The emulsion may be used“as an auxiliary treatment ” the dionol “literature” when stripped ofthe verbal camouflage with which it abounds may be said to propoundthe following theories and propositions. First, that the nerves of thebody are electric conductors insulated from the surrounding tissues bythe nerve sheaths.