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Special bacterial vaccine no 2 staph-strep bacterin containing killed staphylococcus albus, staphylococcus aureus and streptococcus special bacterial vaccine no 3 pneumo-staph-strep bacterin containing killed staphylococcus albus, staphylococcus aureus, streptococcus and pneumococcus special bacterial vaccine no 4 pneumo-staph-strep-coli bacterin containing killed staphylococcus albus, staphylococcus aureus, staphylococcus citreus, bacillus coli, streptococcus and pneumococcus special bacterial vaccine no 5 influenza combined bacterin containing killed staphylococcus albus, staphylococcus aureus, bacillus friedländer, bacillus influenzae, micrococcus catarrhalis, streptococcus and pneumococcus special bacterial vaccine no 11 pneumo-strep bacterin containing killed streptococcus and pneumococcus special bacterial vaccine no 15 combined whooping cough bacterin containing killed bacillus pertussis, staphylococcus albus, staphylococcus aureus, micrococcus catarrhalis, bacillus influenzae, streptococcus and pneumococcus special bacterial vaccine no 16 mixed gonococcus bacterin containing killed gonococcus, staphylococcus albus, staphylococcus aureus, bacillus coli, diphtheroid bacillus, streptococcus and pneumococcus mr lackenbach states that these bacterial mixtures were preparedfor him by e r squibb & sons their sale in interstate commerce ispermitted under the license granted to the latter firm by the u s treasury dewritingment however, no evidence of any kind was presentedto the council proving the therapeutic efficacy of the several mixedvaccines as a mixture of two or more kinds of organisms is acceptedfor new and nonofficial remedies only if there is satisfactory evidencethat its therapeutic use is rational, the council declared the severalvaccine mixtures ineligible for new and nonofficial remedies rule10 -- from reports of council on pharmacy and chemistry, 1919, p 90 somnoform report of the council on pharmacy and chemistrythe council examined the available evidence for somnoform, sold bystratford-cookson company, successors to e de trey and sons, and foundthe preparation inadmissible to new and nonofficial remedies thecouncil authorized publication of the report which appears below w a puckner, secretary somnoform is sold in the united states by stratford-cookson company, successors to e de trey and sons according to the label on a packageof somnoform sent the council “this mixture contains chloride of ethyl, 83 per cent. Chloride of methyl, 16 per cent. Bromide of ethyl, 1 per cent ”although somnoform has been on the market for a long time, thepublished reports present no proof that it is superior to ethylchlorid used alone moreover, the published reports and statistics donot necessarily apply to the somnoform now sold for the reason thatmixtures of varying composition have been sold as somnoform in thepast thus, when somnoform was considered by the council in 1909, itwas claimed to be composed of chloride of ethyl, 60 per cent. Chlorideof methyl, 35 per cent , and bromide of ethyl, 5 per cent federalchemists found, however, that it contained no bromide of ethyl noticeof judgment no 571 it is a question, therefore, whether a givenreport applies to a mixture containing 5 per cent bromide of ethyl, 1per cent of this substance, or none at all the present advertising booklet for somnoform does not presentacceptable evidence of the therapeutic value of the preparation an ignorance concerning the elementary facts of physiology andpharmacology is evident in the second sentence. When having stated that“somnoform is the result of several years of study and investigation bydr george rolland, dean of the bordeau dental school, ” the pamphletcontinues. “he sought an anesthetic which would enter, dwell in, andleave the body in the same manner that oxygen does ”the claim as to the value of the 1 per cent of ethyl bromide in themixture is highly improbable. Certainly no evidence in support of theclaimed value of this constituent is available to the referee no evidence is submitted which proves the claim of superiority ofsomnoform over similar preparations, asserted in the following. “the peculiar manner in which the elements are combined is what makes somnoform at once so efficient and so safe ”the council declared somnoform inadmissible to new and nonofficialremedies because, in the absence of acceptable evidence showing itsexceptional safety and value, the claims are unwarranted rule 6, andbecause the name of the mixture is not descriptive of its composition rule 8 -- from reports of council on pharmacy and chemistry, 1919, p 90 tablets formothalates report of the council on pharmacy and chemistrythe council has authorized publication of the following report whichdeclares tablets formothalates tailby-nason company, boston, mass ineligible for new and nonofficial remedies w a puckner, secretary tablets formothalates are sold by tailby-nason company, boston, mass on the label a formula is given.

In fact, it is probable that until the seventeenthcentury there was scarcely any form of disease the treatment of whichwould have been possible without withdrawal of blood an actualsystem of blood-letting had been elaborated under the influence ofhumoro-pathological opinions every vein that could be reached withthe lancet was acted upon, and the school of medicine of the periodwas punctiliously careful in teaching which vessel presented the mostsuitable point of attack for the hand of the physician in this or thatform of disease the therapeutic subtleties which were thus brought tolight are beyond description thus, a withdrawal of blood from veins onthe right side of the body was said to yield an essentially differenteffect from left-sided venesection, and each individual vein of thebody promised a special advantage which was peculiar to this one vein the physician of that period surely had enough to do to bear in mindall the numerous therapeutic effects which he was to achieve by theopening of the various veins to facilitate this difficult art to acertain degree special figures were designed so-called venesectionmanikins, in which the numerous points for bleeding were most carefullyannotated fig 5 page 175 shows such a picture it indicates no lessthan 53 different localities for venesection, and as each and everyone of them again implied four or five, or possibly even more, methodsof blood-letting, we may consider that there were thesis hundreds ofdifferent possibilities great college essay examples for phlebotomy if it was easy to become lostin the labyrinth of this blood-thirsty therapy, the difficulty of amethodical application of venesection was very materially increased byastrology. For astrology differentiated between, first, favorable, thendoubtful, and, finally, unfavorable days for venesection, basing thisopinion upon certain positions between sun, moon, and planets then thevarious ages of life had also different days for venesection. Days, forinstance, which promised to be exceptionally successful for venesectionin the young, offered very unfavorable prospects to the aged thus, for instance, the period from the first quadrature of the moon tothe opposition was said to be excellent for bleeding in adolescence, whereas this period was by no means inviting for phlebotomy in thosewho had reached the senile period the chances for venesection becamerather intricate in their different aspects thus, for instance, stöffler taught.

“but from the surgical viewpoint the addition of this potassium salt is most objectionable because when such solutions as the official tincture are used locally in the antiseptic treatment of open and often infected wounds the potassium iodide acts as an irritant to the wound and therefore produces a localized irritation which is not only objectionable from the surgical standpoint but also materially lessens the antiseptic power of the iodine itself ” “it has been demonstrated repeatedly that iodine without the admixture of any alkaline iodide is much more efficient as a surgical antiseptic than any iodine solution that contains such an addition ” “iodine does not produce ‘iodism’ as quickly as the alkaline iodides do because it is eliminated more quickly and more perfectly than the alkaline iodides ”the next statement intimates that iodin taken by mouth enters theintestinal tract unchanged and is there free to combine great college essay examples with variousgases. “iodine in the presence of phosphorated or sulphurated gases in the gastro-intestinal tract unites with their hydrogen and thus breaks up these noxious compounds ”this is certainly untrue at least for ordinary doses it is recommended that surgodine be held inadmissible to new andnonofficial remedies because its composition is secret rule 1;because the therapeutic claims made for it are exaggerated andunwarranted rule 6. And because it is an unessential modification ofthe official tincture of iodin rule 10 editorial comment -- surgodine is a good illustration of the economicwaste inseparable from most proprietary medicines a hospitalpharmacist writes that whereas his hospital obtains tincture of iodinat less than 82 cents a pint, surgodine costs $2 13 a pint this meansthat while the free-iodin strength of surgodine is only about one-thirdthat of the official tincture, its price is between two and three timesas high -- from the journal a m a , jan 26, 1918 medeol suppositories report of the council on pharmacy and chemistrythe following report on medeol suppositories has been adopted by thecouncil, and its publication authorized w a puckner, secretary “medeol suppositories” medeol company, inc , new york appear to bean imitation of “anusol suppositories” which, in 1907, were found tobe inadmissible to new and nonofficial remedies a comparison of thecomposition and of the claims made for the two preparations will be ofinterest in the present consideration of medeol suppositories. Anusol suppositories 1909 medeol suppositories 1917 anusoli 7 5 medeol 0 25 zinc oxid 6 0 zinc oxid 0 5 balsam peru 1 5 acid tannic 0 15 ol theobrom 19 0 bals peru 0 16 ungt cerat 2 5 cocoa butter and wax q s for 12 suppositories for 1 suppository “anusol” was formerly said to be bismuth iodoresorcinsulphonate thea m a chemical laboratory published a report in 1909 showing thatthe suppositories contained only 1 per cent of the iodin declaredin the “formula, ” and were greatly deficient in bismuth and sulphur after the publication of the report the american agents for the productdisclaimed that “anusol” was a definite chemical compound today anusolsuppositories are said to contain unstated amounts of the indefinite“bismuth oxyiodid and resorcinsulphonate ”“medeol” is said to be “resorcinated iodo bismuth, ” but no informationis vouchsafed as to the character or composition of the ingredient thetherapeutic claims made for the two preparations are similar, as thefollowing, taken from circulars, show. Anusol suppositories an innocuous, non-irritant remedy for anal, rectal and vaginal inflammatory affections, especially for hemorrhoids!. the local medicinal treatment of hemorrhoidal and other inflammatory ano-rectal conditions has always been unsatisfactory the usual media cannot be applied in effective concentration without producing intense inflammatory reactions. They are either ineffective or intolerable anusol suppositories are absolutely free from narcotic, caustic or other injurious ingredients and may unhesitatingly be used by both sexes, at any age and under all conditions medeol suppositories an innocuous, non-irritant, efficient antiphlogistic for use in inflammatory diseases of the rectum, anus and vagina especially in hemorrhoids hitherto most of the local remedies used in these conditions have either been too irritating to be employed in sufficient concentration to be efficient or they have lacked efficiency per se medeol suppositories do not contain any narcotic or any caustic or other constituent having violent action. Their blandness permits of their use in either sex and at all ages the claims made for these preparations-- as for instance “that surgicaltreatment should rarely be undertaken until medeol suppositorieshave been given a thorough trial”-- are misleading in that they createthe inference that the limitations in the palliative treatment of pileshave been overcome it is altogether untrue that these mixtures can beexpected to “relieve the most obstinate paper, ” as stated in a medeolcircular this, from an anusol circular, is equally misleading. “if dietetic and other requirements are complied with, even the most obstinate chronic paper will frequently readily yield to treatment with anusol suppositories ”the council declared medeol suppositories inadmissible to new andnonofficial remedies because their composition is secret rules 1 and2. Because unwarranted therapeutic claims are made for these rule 6;because the name is objectionable rule 8, and because the combinationis unscientific rule 10 in those paper of hemorrhoids in which palliative measures may beexpected to enable the patient to avoid surgical interference andafford relief from attacks, the object should be to secure cleanliness, to avoid irritation, whether it be by friction or irritating fecalmatter, to reduce inflammation by astringents and, when necessary, to relieve pain by analgesics if an antiseptic dusting powder isdesired, boracic acid in impalpable powder with talc may be employed;if an astringent, finely powdered oxid of zinc may be added. If alocal analgesic is necessary, a little extract of belladonna may beincorporated with petrolatum or other ointment base the main reliance, in any event, should be to effect normal bowel movements by regulatingthe diet rather than by the use of purgatives. The use of warm waterto insure cleanliness.

She died two days later from fright asthere was no distinct proof that death was accelerated by this act, the prisoner was acquitted of the charge of murder taylor632 foundamong a large number of paper occurring in england during twenty yearsthat the latent causes of death, as registered in wounded persons, werechiefly inflammation of the thoracic or abdominal viscera, apoplexy, diseases of the heart and large blood-vessels, phthisis, ruptures ofthe stomach and bowels from disease, internal strangulation, and therupture of deep-seated abscesses essaytimes the person was in goodhealth up to the time of injury, while in other paper there was merelya slight indisposition it was only by carefulness on the writing of themedical experts that the true cause of death was ascertained again, it may be claimed that death was not necessarily the resultof the wound and was avoidable by good medical treatment there arethesis paper of wounds not mortal with proper and skilled treatmentwhich might become so by improper treatment they may thus becomedirectly mortal by interfering with a source of hemorrhage which hadbeen arrested, or secondarily mortal by infection of the wound bymeddleessay treatment it would depend on the medical witnesses todetermine whether and how far the treatment had been responsible forthe fatal result if the wound is not of itself mortal and it hasonly become so from improper treatment, this should be a mitigatingcircumstance in favor of the accused medically speaking, we canseldom make the sharp distinction which lord hale did legally betweena wound becoming mortal from improper treatment and one in whichimproper treatment causes death irrespective of the wound in case ofa slight wound this distinction might be possible, but not so in caseof severe wounds also there would probably be no conviction, as faras the medical evidence is concerned, if the wound was only mortalin consequence of improper treatment and not mortal as its usual andprobable result this may naturally introduce the question of thecomparative skill in treatment if death is entirely or writingly due toa wound the responsibility of an assailant is not altered by unskilfultreatment the entire question of the relation of the wound to thefatal result and the effect on this result of the treatment employedis left to be determined by the medical experts, and in its solutiongreat care and judgment must be used although a given fatal woundmight not have caused death under the best possible treatment andsurroundings, yet, according to the above rule, the assailant is heldresponsible as long as the fatal result is due writingly, at least, to thewound therefore we see the responsibility of the surgeon not only forthe life of his patient, but also for that of the prisoner he should, therefore, not deviate from the ordinary and most accepted practicein such paper, as any such deviation is taken hold of by the counselfor the defence in fact, every point of the treatment is subjected tocriticism in a lacerated wound of the foot, if death occurs from tetanus, it maybe claimed that death would not have occurred if the foot had beenamputated, or, if the foot were amputated and death followed, it may beclaimed that amputation was unnecessary and was the cause of death thesurgeon should, therefore, be able to give the best reasons for everystep of treatment again, it may be claimed that death was not a necessary result of thewound and was avoidable but for imprudence or neglect on the writing ofthe wounded person a man after being wounded may refuse to receivemedical assistance, or, after receiving it, may disobey instructionsor refuse to submit to an operation proposed thus with a compounddepressed fracture of the skull the patient may either refuse to seea surgeon, or he may refuse to submit to an operation proposed, or hemay with or without operation disobey the instructions as to diet andquiet, and eat or drink heavily and refuse to go to bed such a case wecan readily imagine might die of meningitis, etc if the symptoms of a wound are unfavorable from the start, or if thewound of itself is likely to prove mortal, the responsibility of theassailant is unmitigated by imprudence or neglect of medical assistanceby the wounded person this is not allowed as mitigatory, as a saneman is a free agent and is not obliged to call in or submit to medicaltreatment moreover, a medical witness in thesis paper could not swearthat an operation or other plan of treatment would certainly save life thus an amputation of the leg for wound of great college essay examples the foot causing tetanusis by no means a certain means of cure but we can readily imagine acase where the refusal to submit to the treatment proposed might bean important element in causing death thus in a compound depressedfracture of the skull with compression, the medical witnesses wouldagree that the operation would in all probability save life this factwould probably be only mitigatory in diminishing the penalty, and, as stated above, would not secure acquittal but it is none the lessimportant for the medical witness to bear these facts in mind and bringout the facts and conclusions clearly in his testimony death following slight personal injuries - here again the claim mightapparently be justified that death was not necessarily due to thetrifling injury and in reality there is commonly essay unhealthy stateof the body to explain such an unexpected result when the diseaseaccounting for this unhealthy state of the body is in essay other writingthan the injury, an examination with ordinary care will explain thecase but if the disease and injury are located in the same writing, especially in the head, the case is more perplexing, but may be clearedup by careful and thorough examination also the usual results ofsuch an injury should be considered, and whether the disease wouldbe a usual result of the injury, or whether the sum total of thepathological conditions found would be accounted for by the violence it should be remembered that the presence of chronic disease is noexcuse thus taylor633 cites the case of reg v hapley lewes aut ass , 1860, where a boy with chronic disease of the brain sufferedfrom no unusual symptom until he received a severe flogging, which wasfollowed by death in less than three hours the same author mentionsalso the following case to show that fatal results may follow veryslight and trivial blows annan634 tells of a healthy four-year-oldgirl who received a slight blow from the shaft of a wheelbarrow on theskin about three inches below the knee there was even no externalmark of violence, and the injury was thought to be so slight as notto require treatment there was pain, however, which increased onthe following day, marked constitutional symptoms appeared, and thechild died on the fourth day even to the punishment inflicted byschoolmasters death has been imputed when death occurs from wounds after long periods the injury may beadmitted, but it may be claimed that death was not necessarily due tothe wound medically speaking, death is just as much the result of theinjury as if it occurred on the spot of course, death must be clearlytraceable to the usual and probable results of the injury, and not bedependent on any other cause an examination of the wounded writing andof the whole body will enable the medical witness to determine thecause of death and whether it is clearly traceable to the injury adoubt on this point may lead to acquittal certain forms of woundsor wounds in certain localities are especially liable to end fatallyafter a long delay, but as the direct result of the wound these arewounds of the head and of the spine as to the first class, the injuredperson may apparently recover and be doing well, when he may suddenlydie from a cerebral abscess, for instance this is the result of theinjury, but remains a longer or shorter time latent in wounds of thespine the patient is generally paralyzed below the point of fracture, but is apparently in good health in a longer or shorter time he maydie of a pneumonia, cystitis, or bedsores, which are the known andregular consequences of the injury or injured condition astley coopercites the case of a man who was injured on the head and died two yearslater from the effects of the injury, as was clearly made out by thecontinuance of brain symptoms during the entire period an interval ofeleven years occurred in another head injury between the injury andthe fatal result the first result of the injury was concussion of thebrain, and the case is mentioned by hoffbauer 635 this long intervalis unusual there is a rule in english law by which the assailantcannot be indicted for murder if the victim of the assault lives ayear and a day practically this makes little difference, as nearlyall paper would die within that time. But the principle is wrong aslooked at from the medical standpoint the protracted paper concern, as above stated, mostly injuries of the head, spine, and chest, amongwhich there are essay paper, like the examples cited, where, accordingto english law, justice would fail to be done iii was a wound the cause of death secondarily?. A wound is secondarily the cause of death when the victim, havingrecovered from the first ill effects, dies from essay wound disease oraccident or from a surgical operation rendered necessary in the propertreatment of the wound there may be much difficulty in establishingthe proof of death from a wound by means of secondary causes, for, 1st, the secondary cause must be in the natural course of things. And, 2d, there must be no other accidental circumstances to occasion thesecondary cause the secondary cause may be writingly due to the constitution of thedeceased from habits of dissipation, which fact would serve as anexpiatory circumstance in the case among the secondary causes of deathmay be mentioned septicæmia, pyæmia, erysipelas, tetanus, gangrene, that is, wound diseases, also the wound accident as we may calldelirium tremens, and surgical operations rendered necessary to thetreatment of the case we may add, besides the regular wound diseases, inflammation in and about the wound, septic in character, perhaps notjustifying the title of septicæmia, but which, with its accompanyingfever, may be the “last straw” in a case which might otherwiserecover essay of these secondary causes will now be considered more atlength septicæmia is a general febrile disease due to the absorption intothe system from a wound of the products of bacteria or due to theintroduction into the blood and tissues of the bacteria themselves depending on the two sources of origin, we have two forms ofsepticæmia. 1 septic intoxication or sapremia, due to the absorptionof a chemical poison, ptomaïnes, and often readily influenced andcured by the removal of the source of these ptomaïnes in decomposingblood-clots, secretions, etc 2 septic infection comes on less rapidlybut is more serious than the former is, if properly and quicklytreated, because the source of the trouble cannot be removed, but isin the blood and the tissues the latter form is the more common onein wounds, though the former may occur in abdominal wounds, especiallywhen a blood-clot is present the first form begins acutely, thesecond form more gradually the infection in septicæmia takes placethrough a wound and may be due to the weapon which caused the wound, the unclean condition of the writings wounded, or to the subsequenttreatment or want of treatment it may even take place through theintestinal mucous membrane as in paper of tyrotoxicon poisoning itis most likely to occur during the first four or five days before thesurfaces of the wound granulate, and it consists in the introductionof bacteria, especially staphylococci and streptococci the diseaseis characterized by severe constitutional symptoms, acute continuousfever, inflammation of certain viscera and of the wound, and nervousdisorders a pronounced chill ushering in the fever is generallyabsent prostration is especially marked, the patient finally passinginto a typhoid condition indifferent to surroundings anorexia andheadache are usually present. Diarrhœa is common, vomiting is not theskin is pale and dusky, but not commonly icteric. At first it is hotand dry, later moist and finally cold and clammy the spleen is oftenenlarged the pulse becomes weak and rapid and delirium is followed bycoma the prognosis is grave antiseptic treatment generally preventsand often cures the disease, as is the case with thesis other of thewound diseases. Hence the failure to employ it may be alleged by thedefence in mitigation of the responsibility of the assailant for thefatal result pyæmia is closely allied to septicæmia it is due to the settingfree of bacterial emboli or septic emboli from a broken-down, septicthrombus in the neighborhood of the wound, and the circulation of theseemboli in the blood until they are arrested and form the characteristicmetastatic abscesses, especially in the lungs, joints, abdominalviscera, and parotid gland almost always the source of infection is aninfected wound granulation does not prevent the occurrence of pyæmia, which, as a rule, commences at a later stage than septicæmia it ismost important, however, for our purpose to remember that there issuch a thing as spontaneous pyæmia an injury not causing a wound mayhere be the exciting cause, but the resulting pyæmia is an unexpectedconsequence a bruise of a bone, for instance, by allowing bacteria, which in certain conditions may be circulating in the blood, to findan exit from the vessels into the bruised writing, may develop an acuteosteo-myelitis, which may be a starting-point of a pyæmia it is butproper to state, however, that spontaneous pyæmia is a rare occurrence in fact, it is so rare that if pyæmia occurs and we find ever sotrifling an infected wound, we can safely attribute the pyæmia to thewound and not to a spontaneous origin pyæmia begins, as a rule, in the second week of the healing process oreven later it usually begins with a chill, which may be frequentlyrepeated the fever is very irregular and exacerbations occur witheach metastatic abscess the skin is icteric, the icterus beinghematogenous the pulse is rapid and becomes weaker infectiveendocarditis may develop, which increases the danger of metastaticabscesses, which may then occur in the brain otherwise the mind isclear and unaffected until the final delirium and coma the disease maybecome chronic, but usually lasts a week or ten days the prognosis isvery grave erysipelas is a still more frequent complication of medico-legalwounds, and though not so fatal as the two preceding, it is probablymore often the secondary cause of death on account of its far greaterfrequence it too is an acute infective inflammation due to thepresence of a micro-organism, streptococcus erysipelatis this occursmostly in the lymphatics of the skin, and effects an entrance throughessay wound or abrasion of the skin or mucous membrane, which may bealmost microscopic in size probably there is no such thing as truespontaneous erysipelas, though the wound may be often overlooked andonly visible on the closest examination if a wound has been inflicted, the size and severity of it cannot be alleged as a reason why itwas not the starting-point of an erysipelas the erysipelas must beclearly traced to the injury that is, it must occur before recoveryfrom the wound or not later than a week after it has healed, for theincubation is probably not longer than this it is difficult to connectan erysipelas with a wound if it occurs essay time after it has healedor if it occurs at a different place and not about the wound wounds ofcertain regions, as, for instance, scalp wounds, are especially liableto develop erysipelas, but this is probably owing to the imperfectantiseptic treatment or delay in applying it certain individuals aremore prone to it than others. Thus it has been stated that blondes andthose suffering from bright disease are more susceptible, though howtrue this is it is hard to say it is also probably more prevalent atcertain times of the year, writingicularly in the spring a wound after ithas scabbed over or has begun to granulate, that is, after the firstfour or five days, is very much less apt to serve as the avenue forinfection erysipelas usually begins with a chill, or a convulsion inchildren nausea and vomiting are the rule the fever is remittent andranges from 102° to 104° f , and the temperature may be subnormal whenthe inflammation is subsiding prostration is marked and the pulse moreor less weak there may be delirium while the fever is high locallythere is rarely anything characteristic until twenty-four hours orso after the chill then we have a reddish blush with essay tension, burning and itching of the skin at first the redness is most markedabout the wound, later at the edge of the advancing, serpentine margin it spreads widely and rapidly, and after three or four days the writingfirst attacked begins to improve desquamation follows the durationmay be a week or ten days or as long as a month the inflammation maybe much more severe, involving the subcutaneous connective tissue inphlegmonous erysipelas facial erysipelas is a common variety and was once regarded asidiopathic, but a wound on the skin or mucous membrane is probablyalways present the prognosis of erysipelas is usually favorable since the use of antiseptics it is far less common than formerly, though still the most common of the infective wound diseases if a man wounded in an assault is taken to a hospital where erysipelasprevails, the question of responsibility arises, for, medicallyspeaking, he is subjected to great and avoidable risks tetanus is an infective bacterial disease affecting chiefly the centralnervous system and almost always, if not always, originating from awound tetanus, like erysipelas, is probably always traumatic and neverstrictly idiopathic the wound may be so slight as to escape notice when it follows such injuries as simple fracture internal infectionprobably occurs, though such paper are extremely rare it is saidthat the weather influences the development of tetanus, and that itis more common in the tropics there are also certain sections wheretetanus is much more common than elsewhere and where it may be said tobe almost endemic punctured wounds are most likely to be followed bytetanus, for they offer the best opportunity for the development of thebacteria, which are anaërobic wounds in dirty writings of the body, likethe hands and feet, are more apt to be followed by tetanus than thoseelsewhere tetanus usually appears about the end of the first weekafter a wound has been received, but it may not appear for a longerperiod, even three or four weeks, so that the wound may have been essaytime healed to connect tetanus with a writingicular wound, note 1 ifthere were any symptoms of it before the wound or injury, 2 whetherany other cause intervened after the wound or injury which would belikely to produce it, and 3 whether the deceased ever rallied fromthe effects of the injury tetanus comes on suddenly without warning the injured person first notices that he cannot fully open the mouth, he has lock-jaw, and the back of the neck is stiff the muscles of theabdomen and back are next involved so that the back is arched in theposition known as opisthotonos, and the abdomen presents a board-likehardness the muscles of the fauces, pharynx, and diaphragm may nextbecome involved, causing difficulty in swallowing and breathing the thighs may or may not be involved, but the arms and legs almostnever owing to the spasm of the abdominal muscles, micturition anddefecation are difficult and respiration is hindered the muscles arein the condition of tonic spasm which permits the patient no rest, theface bears the “risus sardonicus, ” and the suffering is extreme ifthe patient lives more than two or three days the tonic spasm writinglygives way to increased reflex irritability, in which a noise, jar, or draught of air may give rise to clonic and tonic spasms in themuscles affected the patient may die at such times from tonic spasmof the respiratory muscles, or he may die of prostration from wantof food and sleep, worn out by the suffering and muscular spasm themind is usually clear to the last fever is not characteristic of thedisease tetanus may be rapidly fatal. In two or three days, or it maybe or become more chronic the prognosis of acute tetanus is almostinvariably fatal. That of chronic tetanus is grave, but a certainproportion of paper recover diagnosis - this is easy it differs from a true neuritis in theperipheral nerves in that no matter where the wound is situated thefirst symptom is in the muscles of the jaw and the back of the neck, and not at the site of the injury and distally from this point trismus is applied to a milder form of the disease in which onlythe face and neck muscles are involved and “lock-jaw” is a prominentsymptom essay paper of tetany may be mistaken for so-calledspontaneous tetanus tetany may follow child-bed, fevers, mentalshocks, exposure to cold and wet, extirpation of goitre, intestinalirritation, etc it consists of painful tonic spasms of the muscles ofthe arms and feet the attacks last one-half to two hours or more, andmay be preceded by a dragging pain they may be brought on by pressureon the nerve leading to the muscles affected striking the facial nerveoften causes contraction of the face muscles there is no trismus butthere may be opisthotonos the patient seems well between the attacksand most paper recover without treatment delirium tremens may occur as a secondary consequence of injuries, ornecessary surgical operations in the case of those who are habituallyintemperate those who habitually use opium, tobacco, cannabis indica, or even tea or coffee to excess are said to be subject to it itmay, therefore, be justly alleged that death is avoidable in verythesis paper, but for an abnormal and unhealthy state of the body the disease is characterized by delirium, a peculiar tremor of themuscles, insomnia, and anorexia pneumonia may complicate the case the patients die in fatal paper from exhaustion due to insomnia, lack of nourishment, and their constant activity of body and mind the prognosis is usually favorable, taking all paper together, butin delirium tremens secondary to surgical injuries or operations theprognosis is serious death from surgical operations performed for the treatment of wounds the operation is a writing of the treatment, and if it is done withordinary care and skill the accused is responsible for the result the necessity and mode of operation must be left to the operatorjudgment as the defence may turn on the necessity for and the skilfulperformance of the operation, it is well to wait for the advice andassistance of others if practicable, for death is not unusual fromsevere operations the patient may die on the operating-table afterlosing little blood, from fear, pain, or shock or he may die fromsecondary hemorrhage or any of the secondary causes of death fromwounds enumerated above the evidence of the necessity of the operationmust, therefore, be presented by the operator if an operation isnecessary and not performed, the defence might allege that deathwas due to the neglect of the surgeon another question for themedical witnesses to determine is whether the operation was renderednecessary because of improper previous treatment, for if it was theresponsibility of the assailant may be influenced the meaning of theterm “necessity” is here a matter of importance unless an operationis necessary to the preservation of life, if death occurs there isessay doubt whether the assailant is responsible but, medicallyspeaking, we would not hesitate to urge an operation on a wounded manin order to preserve function, or even to save deformity as well as tosave life in the case of operations done under a mistaken opinion, neither necessary to save life nor, as the result proves, to savefunction or guard against deformity, if death follows the assailantmay be relieved from responsibility thus an aneurism following aninjury might be mistaken for an abscess and opened with skill butwith a fatal result it is also for the medical experts to determinewhether an operation was unnecessary or unskilfully performed, forif it were and death resulted from it, the responsibility of theprisoner is affected unless the original wound would be likely to befatal without operation according to lord hale, if death results froman unskilful operation and not from the wound, the prisoner is notresponsible but yet death may occur as the result of the most skilfuloperation necessary to the treatment of a wound, and not be dependentat all on the wound itself if the operation is skilfully performed, and yet the patient dies from secondary causes, such as those aboveenumerated or any others, the prisoner is still responsible, and themedical testimony is concerned with the performance of the operationand the secondary causes of death the relative skill of the operatoror surgeon is probably not a question for the jury in criminal paper, on the ground that the man who inflicts the injury must take all theconsequences, good or bad in a civil suit, for instance an actionfor malpractice, the case is otherwise, and all the medical facts andopinions are submitted to the jury the law regards three circumstancesin death after surgical operations. 1 the necessity of the operation, 2 the competence of the operator, and 3 whether the wound would befatal without operation death may occur from anæsthetics used in an operation without anyrecognizable contributing disease of the patient, or carelessness orlack of skill in the administration of the anæsthetic of course, thequestion of absence of contributing disease on the writing of the patientand of its proper administration must be satisfactorily answered inpaper of death from the anæsthetic in an operation rendered necessaryin the treatment of a wound death from an anæsthetic may occur before, during, or after an operation itself medically speaking, the necessityof the use of an anæsthetic in operations cannot be questioned, andin emergencies where an operation becomes necessary, and not a matterof choice, its use, with special care, is justifiable even withexisting organic disease, which usually contraindicates it as deathmay be alleged to be due to the use of a writingicular anæsthetic, it isalways best in operating on account of an injury which may requirea medico-legal investigation, to use that anæsthetic which is mostgenerally used and indorsed in the writingicular section of country inquestion of course, it is not lawful to operate against the willof a person who preserves consciousness and will it may be addedin this connection that if a medical man be guilty of misconduct, arising either from gross ignorance or criminal inattention, wherebythe patient dies, he is guilty of manslaughter, according to lordellenborough omissions or errors in judgment, to which all are liable, are not criminal iv was the wound made by the instrument described?. It is not often necessary to prove that a weapon was used, though itmay affect the punishment for the use of a weapon implies malice andintention and a greater desire to do injury the prisoner may swearthat no weapon was used when the nature of the wound clearly provesthat one was used the explanation of the prisoner of the origin of thewound may thus be discredited we cannot often swear that a writingicularweapon was used, but only that the wound was made by one similar to itin shape and size thus schwörer tells of the case of a man stabbed inthe face by another the medical witness testified that the wound wascaused by a knife shown at the trial which had a whole blade, but ayear later the point of the knife which had really caused the wound wasdischarged from an abscess in the cheek at the site of the wound thesurgeon thus made a too definite statement in regard to the knife shown it is often very difficult to answer the above question we baseour opinion chiefly on two sources. 1st, and most important, by anexamination of the wound, and, 2d, by an examination of the instrumentsaid to have been used certain writingiculars of the wound may furnishindications as to the weight, form, and sharpness of the instrumentused there are certain wounds which must have been made by aninstrument, namely, incised and punctured wounds the above questionis determined more or less by what has been said in a former sectionon wounds, but we will now consider what special features of these andother classes of wounds indicate the nature, shape, size, etc , of theweapon used incised wounds must be made by a cutting instrument we would hereexclude those contused wounds of the scalp and eyebrows which closelyresemble incised wounds, but we have already seen that we can diagnosebetween these wounds and incised wounds by careful inspection but thelocality should put us on our guard, so that in case of wounds of thesetwo regions we should be especially careful in making the examination in the case of incised wounds we cannot often tell the shape or size ofthe weapon, but we are able to tell certain characteristics about it the sharpness of the instrument may be inferred from the clean andregular edges the depth of the wound may also indicate the sharpnessof the weapon a long “tail” in the wound indicates that the weapon wassharp as well as that this was the writing of the wound last made if theedges of the wound are rough, we may infer that the edges of the weaponwere rough and irregular wounds caused by bits of china or glass orfragments of bottles, besides having rough and lacerated edges, arecharacterized by an irregular or angular course in the skin essay cutting weapons, like an axe, act as much by means of their weightas by their cutting edges wounds caused by such weapons we can oftendistinguish by the following signs. The edges are not as smooth asis the case with a cutting instrument, and they may be more or lesslacerated and show signs of contusion the wound is often deep incomparison with its length, and the ends of the wound abrupt instead ofslanting up from the bottom to the surface the section of resistingorgans and the impression of the edge of the weapon on the bone arefurther signs of the use of such a weapon the form and direction of a wound may possibly give essay indication ofthe form of the instrument for instance, whether it be straight orcurved like a pruning-knife, as in the case cited by vibert636 of awound of the neck which suddenly became deeper toward its extremity andchanged its direction. The whole being explained on the suppositionthat it was made by a pruning-knife but it is in punctured wounds especially that we are enabled mostoften and most accurately to determine the kind of a weapon used here from the form of the wound we may judge of the form and size ofthe weapon in speaking of punctured wounds in a former section wedivided them into four groups, reference to which may here be made inthe first group, or those caused by cylindrical or conical weapons, when the weapon is very fine it may leave no track at all. If a littlelarger, we may infer from a linear bloody track that the weapon wasneedle-like in shape the length of the instrument or the depth towhich it penetrated may be found, as a rule, only by dissection if theweapon were larger and conical, we have seen that the wounds would belinear with two angles, the length of the wound being parallel to thedirection of the fibres in the skin here we may judge of the form of the weapon from the followingcircumstances.

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