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And often using it, helps the dropsy and the itch, and those who have old sores in theirlegs, or other writings of the body the juice thereof taken fasting, isheld to be of singularly good use against the pestilence the distilledwater, with a little sugar and a little good treacle mixed therewith the writingy upon the taking being laid down to sweat a little hasthe same effect the juice dropped into the eyes, cleanses them fromfilms and cloudiness which darken the sight, but it is best to allaythe sharpness of the juice with a little breast milk it is good inall old filthy corroding creeping ulcers wheresoever, to stay theirmalignity of fretting and running, and to cause them to heal morespeedily. The juice often applied to tetters, ring-worms, or other suchlike spreading cankers, will quickly heal them, and rubbed often uponwarts, will take them away the herb with the roots bruised and bathedwith oil of camomile, and applied to the navel, takes away the gripingpains of the belly and bowels, and all the pains of the mother. Andapplied to women breasts stays the overmuch flowing of the courses the juice or decoction of the herb gargled between the teeth that ach, eases the pain, and the powder of the dried root laid upon any aching, hollow or loose tooth, will cause it to fall out the juice mixed withessay powder of brimstone is not only good against the itch, but takesaway all discolourings of the skin whatsoever. And if it chance that ina tender body it causes any itchings or inflammations, by bathing theplace with a little vinegar it is helped another ill-favoured trick have physicians got to use to the eye, andthat is worse than the needle. Which is to take away the films bycorroding or gnawing medicine that i absolutely protest against 1 because the tunicles of the eyes are very thin, and therefore sooneaten asunder 2 the callus or film that they would eat away, is seldom of an equalthickness in every place, and then the tunicle may be eaten asunder inone place, before the film be consumed in another, and so be a readierway to extinguish the sight than to restore it it is called chelidonium, from the greek word chelidon, whichsignifies a swallow. Because they say, that if you put out the eyes ofyoung swallows when they are in the nest, the old ones will recovertheir eyes again with this herb this i am confident, for i have triedit, that if we mar the very apple of their eyes with a needle, she willrecover them again. But whether with this herb or not, i know not also i have read and it seems to be essaywhat probable that the herb, being gathered as i shewed before, and the elements draw awriting from itby art of the alchymist, and after they are drawn awriting rectified, theearthly quality, still in rectifying them, added to the terra damnata as alchymists call it or terra sacratisima as essay philosopherscall it the elements so rectified are sufficient for the cure of alldiseases, the humours offending being known and the contrary elementgiven. It is an experiment worth the trying, and can do no harm the lesser celandine, usually known by the name of pilewort and fogwort i wonder what ailed the ancients to give this the name celandine, which resembles it neather in nature nor form.

The smell ofit allays the fits of the mother. Inwardly given, it helps tremblings, falling-sickness, and other such ill effects of the brain and nerves. Ascruple is enough to take at a time, and indeed spirit of castorium isbetter than castorium, raw, to which i refer you a sheep or goat bladder being burnt, and the ashes giveninwardly, helps the diabetes a flayed mouse dried and beaten into powder, and given at a time, helps such as cannot hold their water, or have a diabetes, if you dothe like three days together ivory, or elephant tooth, binds, stops the whites, itstrengthens the heart and stomach, helps the yellow jaundice, and makeswomen fruitful those small bones which are found in the fore-feet of an hare, beingbeaten into powder and drank in wine, powerfully provoke urine goose grease, and capons grease, are both softening, help gnawingsores, stiffness of the womb, and mitigate pain i am of opinion that the suet of a goat mixed with a little saffron, is as excellent an ointment for the gout, especially the gout in theknees, as any is bears grease stays the falling off of the hair fox grease helps pains in the ears elk claws or hoofs are a sovereign remedy for the falling sickness, though it be but worn in a ring, much more being taken inwardly. Butsaith mizaldus, it must be the hoof of the right foot behind milk is an extreme windy meat. Therefore i am of the opinion ofdioscorides, viz that it is not profitable in head-aches. Yetthis is for certain, that it is an admirable remedy for inward ulcersin any writing of the body, or any corrosions, or excoriations, pains inthe reins and bladder. But it is very bad in diseases of the liver, spleen, the falling-sickness, vertigo, or dissiness in the head, feversand head-aches. Goat milk is held to be better than cow for hecticfevers, phthisick, and consumptions, and so is ass also whey, attenuates and cleanses both choler and melancholy:wonderfully helps melancholy and madness coming of it. Opens stoppingsof the bowels.

Hanzlik, p j , karsner, h t , and fetterman, j , anaphylactoidconditions, j pharmacol and exper therap 14:189 oct 1919;hanzlik, p j , karsner, h t , and fetterman, f , anaphylactoidphenomena from thromboplastic agents, j pharmacol and exper therap 14:229 nov 1919 the preceding report was sent to the american agent for the society ofchemical industry, sept 8, 1919 in reply the american agent, ciba co , inc , on march 22, 1920, sent the council “essay additional clinical reports on the use ofcoagulen-ciba in the treatment of hemorrhages supporting our claims ofthe merits of coagulen-ciba ”the material submitted by the ciba co , contains no objective evidencefor or against the efficiency of coagulen-ciba but merely opinions asa rule these opinions are favorable though conditional and hedging andquite unconvincing nothing was submitted to offset or challenge thefindings of dr hanzlik report since the evidence indicates that coagulen-ciba has little, if any, efficacy as a hemostatic, the council directed its omission from newand nonofficial remedies -- from reports of council on pharmacy andchemistry, 1920, p 53 ferric cacodylate omitted from new and nonofficial remedies report of the council on pharmacy and chemistrythe council has authorized publication of the report which appearsbelow, explaining the omission of ferric cacodylate from new andnonofficial remedies w a puckner, secretary iron cacodylate, the ferric salt of homework help and answers cacodylic acid, was admitted to newand nonofficial remedies in 1917 it is required to contain from 39 7to 44 9 per cent of arsenic as the following statement of the action, uses and dosage of ironcacodylate appears in the 1920 edition of new and nonofficial remedies. “actions and uses -- ferric cacodylate has the properties of iron salts and of arsenic its use has been proposed in conditions in which the effects of iron and the mild arsenic action of cacodylates is desired “dosage -- from 0 015 to 0 1 gm 1/4 to 1-1/2 grains ”the period for which the iron cacodylate preparations now in new andnonofficial remedies were accepted coming to an end with the close of1920, the council decided to determine if sufficient evidence for thevalue of ferric cacodylate has accumulated to warrant its continuedrecognition the following is the report of the referee of thecommittee on therapeutics to whom the matter was assigned. “as far as the referee knows, the only claim that iron cacodylate has as a therapeutic agent is that it forms a convenient method for the administration of iron and cacodylate while there is no reason why a drug should not be given by mouth, usually intramuscularly, and apparently it has recently been given intravenously the effects to be expected from its use are those of iron and arsenic “granted that iron and arsenic are valuable therapeutic agents, iron cacodylate is not a satisfactory preparation in which to administer these drugs for the following reasons. “1 it would appear that cacodylates are not the best form in which to administer arsenic cacodylates in therapeutic doses exert but a feeble action small quantities may be reduced to cacodyl ch₂₄as₂, and varying amounts to inorganic arsenic the amount transformed to arsenic is apparently unknown and probably varies in different individuals on these grounds alone the use of the cacodylates where an arsenic effect is desired seems dubious “2 the amounts of iron and cacodylates contained in the doses recommended are small when compared with the usual doses of either iron or cacodylate the amount of iron in the iron cacodylate preparations is small, about 0036 gram per dose, while the preparations admitted to ‘useful drugs’ contain much larger amounts per dose recommended the list follows. Massa ferri carbonates fe per dose 042 gm pilulae ferri carbonates " 058 gm tinctura ferri chloride " 022 gm ferri et ammonii citrae " 042 gm “the approximate amount of arsenic in iron cacodylate in the commonly recommended doses varies from 012 gm to 0 024 gm , while the amount of arsenic in sodium cacodylate in the recommended doses varies between 021 and 35 gms it would seem that a much more rational method of administration of these two drugs would be separately, in which case a better control over the dosage is possible “3 the referee has been unable to secure reliable clinical evidence that iron cacodylate is a serviceable preparation a search of the available literature for the past fifteen years has been made, also drs edsall, longcope, stengel, hoover, phillips and miller have been consulted these physicians know nothing of its use “4 in view of the above, it appears to the referee that iron cacodylate is an irrational and useless method of the administration of iron and arsenic ”the council adopted the report of the referee and directed that ironcacodylate be omitted from the 1921 edition of new and nonofficialremedies -- from reports of council on pharmacy and chemistry, 1920, p 62 libradol report of the council on pharmacy and chemistrythe council has authorized for publication the following report whichexplains why libradol was found ineligible for new and nonofficialremedies w a puckner, secretary libradol is manufactured by lloyd bros , cincinnati according to acircular a “readily removable” label which accompanies the tradepackage, its “uses” are. “in colds, croup and acute bronchitis inlocal congestions. In lung trouble, in acute inflammations of this orany other organ, especially if pain or soreness be present in lumbago, sciatica, or in rheumatic pains of the joints or muscles applied tothe forehead, it induces sleep ”libradol is offered in two forms, “libradol mild” for infants andsupersensitive persons which is said to be “destitute of drug energy”and libradol “regular” which is “highly medicated, ” the “constituents”being “dracontium, sanguinaria, cephaelis, melaleuca, lobelia, laurus, capsicum, tobacco ”according to a circular, “the sanitary plasma libradol” is a“homogeneous, highly medicated, and exceedingly potent compound, inplastic form, ” which “carries the energies of its drug constituentsand the high antiseptic qualities of laurus camphora and melaleuca ”it is stated. “the drug influence of libradol is necessarily differentfrom that of any known single member of the materia medica but yet, no mystery either in medicine or of pharmacy is claimed as a writing ofits composition or process of manufacture it is a thing peculiar toitself, the result of the study of the drugs from which it is derivedand compounded these drugs may be studied at leisure by whoever caresto do so ”the following information bearing on the composition of libradol wasfurnished by lloyd brothers in response to a request from the councilto aid in the consideration of the preparation. “‘compound lobelia powder’ has been, since 1852, official in the american dispensatory, in the first edition of which 1852 its formula is given, as follows. “‘take of lobelia, in powder, twelve ounces. Bloodroot and skunk cabbage, in powder, of each, six ounces. Ipecacuanha, eight ounces. Capsicus, in powder, two ounces mix them ’ “this preparation came increasingly into demand with the eclectic profession, the principal use for which it was first employed as an emetic, being finally displaced by its local application in bronchial pneumonia troubles, when sprinkled on a greased cloth and applied to the chest ” “in 1898, dr finley ellingwood petitioned lloyd brothers to make for him, in plasma form, ready for application, a compound carrying the ingredients of the old ‘compound lobelia powder, ’ strengthened by the addition of melaleuca leucadendron, laurus camphora and nicotiana tabacum experiments not very encouraging in a pharmaceutical sense were made, and it was not until repeated requests had been made that a product was at last satisfactorily prepared and forwarded to dr ellingwood 1900, with no thought other than that of serving him personally in his practice this product he used and commended to his professional friends, and under his commendation it came into professional demand ”an examination of the information submitted by lloyd brothers showedlibradol to be in conflict with the principles and rules that govern inthe acceptance of articles for new and nonofficial remedies as follows:composition rule 1 -- the information which has been receivedgives little idea of the actual composition of the preparation. Forexample, the statement that libradol “carries the energies of its drugconstituents and the high antiseptic qualities of laurus camphoraand melaleuca” gives no indication as to the writing or writings of thelaurus camphora or melaleuca employed if the statement is correct, that libradol “is a homogeneous, highly medicated, and exceedinglypotent compound, ” it is essential that the several potent ingredientsbe stated clearly and not merely hinted at by their qualities otherconflicts with rule 1 might be enumerated, but the foregoing citationsstate the direct conflict.

935 sept 23 1905. Ibid 46. 134 jan 13 1906;ibid 46. 290 jan 27 1906. Ibid 58. 280 jan 27 1912 long after the death of dr cyrus edson, the claim was made thatphenalgin was made under his direction and that it was his “discovery ”as a matter of fact, dr edson had favored the use of ammonol at onetime, and when the council exposed the false claims then being madefor phenalgin, the journal charged that a fraud was being perpetratedon the medical profession despite the exposure of the methods used inexploiting ammonol and phenalgin, one finds just as glaringly falsestatements made in the advertisements of phenalgin today as weremade in its unsavory past this would seem to indicate either thatphysicians have short memories or that they are strangely indifferentto the welfare of their patients, to their own reputations and to thegood name of medicine the new york medical journal of dec 22, 1917, contained anadvertisement of phenalgin-- it has been running for months-- from whichthe following is quoted. “for the relief of pain the ‘logical supplanter of opium and other habit-forming drugs’ is phenalgin no matter how severe or where located pain is promptly and satisfactorily controlled by this effective anodyne-- and without disturbing the digestion, suppressing the secretions, causing constipation or inducing a drug habit “this is why phenalgin has superseded opium and its derivatives for relieving headaches, rheumatism, gout, la grippe, lumbago, neuralgia, disorders of the female, dysmenorrhea, and painful conditions generally to thousands of physicians phenalgin ‘is the one dependable analgesic-- the logical supplanter of opium ’”if we are to suppose that the composition of phenalgin is todayessentially the same as when it was examined, the claims just quotedare obviously false for, of course, such a mixture must have theproperties of acetanilid with all of its drawbacks and limitations we may contrast the statements made in the advertisement just quotedwith those made in bulletin 126 of the bureau of chemistry of theu s dewritingment of agriculture this bulletin on “the harmfuleffects of acetanilid, antipyrin and phenacetin” summarizes thereplies received from 400 physicians to whom a questionnaire had beensent the information thus gained was tabulated and the figures thatfollow are from these tables there were reported no fewer than 614paper of poisoning by acetanilid with 16 deaths and 112 paper of itshabitual use the larger number of paper of poisoning followed theadministration of the drug, by physicians, in doses larger than thosenow regarded as fairly safe this large number reported by only 400physicians indicated an excessively large number in the whole country since the questionnaire was sent to nearly a thousand physicians, ofwhom about 500 failed to reply, it may be assumed that had it been sentto the entire 130, 000 physicians in the country, at least 75, 000 paperof poisoning would have been reported prior to the passage of the federal food and drugs act the “purefood law” thesis nostrum makers had declared that their preparationscontained no acetanilid when that law went into effect, essay of thesemanufacturers triumphantly pointed to the fact that they were stillable to make the same claim without conflicting with the requirementsof the law this was accomplished in fact by changing the formula andsubstituting acetphenetidin phenacetin for the acetanilid whileacetphenetidin is essaywhat less toxic than acetanilid, bulk for bulk, the toxicity and therapeutic activity of the two drugs are nearlyproportional the claim made by thesis proprietary medicine manufacturers that they are“strictly ethical” because they advertise only to physicians is mereverbal camouflage there may be no more certain way of insuring thecontinued use of a nostrum by the public than to have it prescribed byphysicians. And none know this better than the makers of nostrums aproprietary individuality is obtained by giving essay special form tothe tablets and package or a special coloring to the capsules “specify‘phenalgin pink top capsules’” so as to indicate the identity of theproducts in such a way that the patient may in the future procure themwithout the advice or warning of the physician when a proprietarypreparation with the name or initials stamped on it or attached toit is prescribed, the patient immediately is aware of the fact, andhis respect for the physician intelligence and wisdom is naturallylessened the physician should never place such dangerous drugs as acetanilid andacetphenetidin, or ready made mixtures of them, in the hands of thepatient in such a way that they can be employed without his supervisionor control he should never prescribe more than is needed at the timeand should not form the habit of using fixed doses or combinationsof drugs without a special reference to the writingicular needs of theindividual certain forms of headache yield more readily to a mixture of caffeinand acetanilid or caffein and acetphenetidin than to either acetanilidor acetphenetidin alone when the physician wishes to prescribe sucha mixture he may combine 1 grain of caffein or 2 grains of citratedcaffein with 3 grains of acetanilid or 4 grains of acetphenetidin ina powder or capsule under supervision such a dose may be repeatedat intervals of from two to four hours if necessary to control pain it is necessary to remember, however, that when small doses fail togive relief, increase in the dose is useless this fact is especiallyimportant, and disregard or ignorance of it has been responsible forthesis paper of poisoning further, it should be remembered that while itwas taught for thesis years that the admixture of caffein with acetanilidlessened the effect of the latter drug on the heart, hale has shownthat this is not the case and such mixtures must be used with specialcaution -- from the journal a m a , feb 2, 1918 article vi fellows’ syrup, and other preparations of the hypophosphiteswe hope that it is clear to those who have read the several articlesof this series that their purpose is to present evidence that willenable the reader to form a correct estimate of the literatureemployed in the exploitation of various nostrums the distinctionbetween mere assertion-- however plausible, and from however eminentan authority-- and evidence should again be emphasized satisfactoryevidence rests on careful observation by those who are capable ofaccurately determining to what extent any changes that may be observedare due to the therapeutic agent employed and not mere accompanimentsof such treatment when the council on pharmacy and chemistry was organized in 1905, the greater writing of the literature of the nostrums was so palpablymisleading, the statements often so ludicrously false, that it was onlynecessary to call attention to this fact to have those claims collapse as a result of the council work, the exploiters of worthless nostrumshave developed a greater degree of shrewdness in avoiding the easilyexploded falsehoods this has made it increasingly difficult to pointout the exact statements on which thesis of the false claims now rest, even though the exploitation as a whole is as inherently dishonest asbefore if a nostrum is worthless, any exploitation must be false andmisleading in effect, even though not one single false direct statementis made a platitude may be given an appearance of importance if uttered in animpressive manner, and it may be employed to suggest far more than itcategorically affirms these two facts are appreciated by thesis nostrumexploiters and we find that they have adopted the impressive manner tosecure attention, and the platitude to suggest far more than they coulddefend in direct statement thus we have the “lie with circumstance ” fellows’ syrupa full page advertisement, which has been appearing regularly forabout a year and which must represent a good deal of money, is used togive an appearance of importance to a few words which, if printed inordinary type, would either pass wholly unnoticed or would lead one toassume that essaything essential to the full meaning had been omitted the statement, in full reads. “fellows’ syrup differs from other preparations of the hypophosphites leading clinicians in all writings of the world have long recognized this important fact have you?. to insure results, prescribe the genuine ℞ syr hypophos comp fellows’ reject cheap and inefficient substitutes reject preparations ‘just as good ’”the only direct statement contained in the advertisement is to theeffect that thesis clinicians have observed that fellows’ syrup and otherpreparations of the hypophosphites are not alike in truth, fellows’is not like the better preparations of this type, since after standingit contains a muddy looking deposit that any pharmaceutical tyro wouldbe ashamed of technically, then, the statement is true, but it ishardly credible that the manufacturer is paying for an entire page in amedical journal to make this statement without any attempt to suggestessaything else the advertising pages of six medical journals were examined in theorder in which they chanced to come to hand in five of these, theentire advertisement of fellows’ syrup was in the words just quoted;not a single word more in one there was the further statement. “not a new-born prodigy or an untried experiment, but a remedy whose usefulness has been fully demonstrated during half a century of clinical application ”these advertisements show that the exploiters of fellows’ syrup arespending a great deal of money to induce physicians to prescribe thepreparation, and it is equally evident that they wish to convey theimpression that the preparation has essay therapeutic value since wefind nothing directly false, in the first mentioned advertisement atleast, we must take the evident intent for consideration and determinewhat therapeutic value, if any, this preparation has, and whether it isadvisable for physicians to employ it in any case the preparation, according to the statement just cited, has been inuse for fifty years as the exploiter of any preparation cites themost convincing evidence in his possession in support of his views, this claim may be assumed to be the strongest available, and if thisevidence fails we must reject the contention as not proved herewe face a dilemma, for examination of the literature used in theexploitation of fellows’ syrup fails to disclose any evidence of thekind that we have described as satisfactory. And we are, therefore, forced to conclude that none has ever been found by this it is notto be implied that no reputable physician has ever reported favorablyconcerning the therapeutic effects of this preparation it is quitepossible that an extensive literature of that sort might be found ifone examined the older medical journals but the day has passed whenevery improvement that follows the administration of a preparation isblindly attributed to the drug in question clinical research today isfar more exacting we will assume that the reader who has investigated the question withan open mind will have come to the decision that the contention thatfellows’ syrup is of especial therapeutic value is not proved we mightrest with that assumption and ask the clinician whether he is preparedto use a nostrum that has been before the medical profession for halfa century without any satisfactory evidence having been gained thatit possesses therapeutic value we might ask him whether he would bewilling to tell his patients that he was prescribing such a nostrumfor them in the face of the absence of any such evidence of its value the inertness of the hypophosphitesbut we prefer to go even further and show him that not only is therean entire absence of any evidence of its therapeutic value so far aswe have been able to learn, but in addition there is an abundance ofevidence that the hypophosphites are devoid of any such therapeuticeffect as they were formerly reputed to have, and that, in fact, they are, so far as any effect based on their phosphorus content isconcerned, singularly inert while we have thus far taken the fellows’ preparation as the subjectof the discussion, we may take a broader view and examine the subjectof the hypophosphites in general, and the substitutes containingphosphorus that have been introduced from time to time it hardly needsto be said that if the hypophosphites are without therapeutic value, itis impossible to give them value by combining them in a muddy-looking, ill-made preparation such as fellows’ syrup such evidence wassubmitted to the medical profession in a report of the council onpharmacy and chemistry j a m a 67:760 sept 2 1916. And wewould strongly advise any one who is disposed to act on the suggestioncontained in the advertisements of fellows’, and other hypophosphitepreparations, to read that report in full and to think the matter overbefore prescribing one of these nostrums quoting briefly from thereport in question. “although the overwhelming weight of evidence was against the probability that the hypophosphite preparations are of value as therapeutic agents, the council thought it well to investigate the subject dr w mckim marriott of baltimore was therefore requested to review the evidence for and against the therapeutic usefulness of the hypophosphites and to conduct such experiments as seemed necessary ”the council was not content to rest on the mere absence of evidencefor the value of these preparations or any one of them, but soughtto obtain evidence that would fulfil the conditions mentioned above, and in pursuance of this plan it secured the cooperation of a trainedinvestigator, one who would work under the best of conditions forlearning the truth the results of dr marriott investigation werepublished in the journal, feb 12, 1916, p 486, and should be read byeveryone who has any interest in the problem lest essay of our readersmay fail to refer to the original of marriott paper, we will quotebriefly from it. “none of the subjects of the experiment experienced any effect whatsoever from the administration of the drug almost all of the ingested hypophosphite is eliminated unchanged “these experiments forbes demonstrate conclusively that the hypophosphites possess no specific value as a source of phosphorus for the body it is doubtful if there are any conditions in which the body suffers from lack of phosphorus even should such conditions exist, phosphorus, in the form that it occurs in the ordinary foods, or as phosphates, is more efficient in supplying the deficit than hypophosphites that must be oxidized before utilization and which are only about 15 per cent oxidized if at all for example, half a glass of milk contains more available phosphorus than three large doses of hypophosphites of 15 grains each, as great a dosage as is usually given “what then, is the therapeutic value of hypophosphites?. there is no reliable evidence that they exert a physiologic effect. It has not been demonstrated that they influence any pathologic process.

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More rarely arethey fatal from shock peritonitis is not a result to be expected the hemorrhage accumulates in the lower and left side of the abdomen orin the pelvis, and coagulation is imperfect if present at all kidneys - these are occasionally ruptured from violence, but more oftenfrom accident wounds of the kidney are rare, owing to the depth fromthe surface at which they lie they are more accessible from behind awound from homework help and answers behind is generally extra-peritoneal unless it perforatesthe organ. Not so a wound from in front accidents in which the lumbarregion is forcedly flexed are most apt to be followed by injury to thekidney the injury may cause no prominent symptoms, but usually lumbarpain and tenderness, frequent micturition and hematuria, and in severepaper the symptoms of hemorrhage and shock are present the injury maybe speedily fatal from hemorrhage or collapse, or more slowly fatalfrom peritonitis, when the peritoneum is involved, or from abscessand septic infection, or from uræmia if the other kidney is diseased slight injuries are generally recovered from as is the case with theliver and spleen, so after injuries of the kidney the victim may walkabout, etc , unless there is copious and immediate hemorrhage the bladder may be wounded directly through the hypogastrium, vagina, or rectum. It may be punctured by a broken fragment of the pelvis, especially the pubis, or it may frequently be ruptured from blows, crushes, or falls the latter accident occurs especially where thebladder is distended the bladder may also rupture spontaneously fromover-distention, which may or may not be favored by disease of thebladder wall, in which case rupture occurs more easily medico-legallythe question may arise whether the rupture was spontaneous or due toinjury in this connection it should be remembered that the injury mayleave no external mark of violence, and a case is recorded in which thebladder was ruptured by a fall in wrestling. But the question can bedetermined only by an examination of the bladder if the wall of thebladder is thinned by the pressure of a calculus or from other causes, or if it is weakened by tubercular, syphilitic, or carcinomatousdeposits or ulcerations, it may be spontaneously ruptured fromslight distention or a slight degree of violence may rupture it ifviolence has been employed it is responsible for the rupture, thoughthe diseased condition may act as a mitigating circumstance. Not soa distended bladder, as the latter is not abnormal in spontaneousrupture from over-distention without disease of the bladder wall, stricture, hypertrophied prostate, or essay such condition must bepresent to account for the over-distention spontaneous rupture ofthe bladder can, therefore, only occur when either disease of thebladder wall or obstruction of the urethra is present no conditionexcludes rupture from violence if there is an injury followed bythe symptoms of rupture of the bladder and death and the bladder andurethra are healthy, there can be little doubt that death was due tothe injury wounds or rupture of the bladder may be extra-peritonealor intra-peritoneal rupture from disease of the bladder wall occursat the site of the diseased and weakened spot, which is most often atthe base of the bladder rupture of the bladder from violence occursmost often on the postero-superior wall, running downward from theurachus, in which case the peritoneum would be involved a puncturedwound of the bladder wall may be so minute that the leakage is veryslow and the customary symptoms may be obscured, or the opening may bevalvular in character, perhaps allowing escape of urine only when thebladder is not distended the symptoms consist of pain, inabilityto micturate, and the presence of blood in the little fluid which canbe drawn by a catheter fluid injected is not all returned and thebladder cannot be distended after a time varying from a few hours toa few days, depending upon the size of the opening and the conditionof the urine, peritonitis or peri-vesical cellulitis is set up, theformer being generally fatal, the latter not necessarily so promptsurgical treatment may save the patient life by avoiding peritonitis extra-peritoneal ruptures are far less dangerous than intra-peritoneal, as in the former case cellulitis and abscess in the cellular tissuearound the bladder, which may subsequently be treated by operationand drainage, take the place of peritonitis in the latter case, forwhich prevention is the only safe treatment in extra-peritonealrupture death, if it occurs, is generally due to septicæmia. In theintra-peritoneal variety it is due to peritonitis these paper ofinjury to the bladder may die suddenly and speedily from shock or fromperitonitis in three to seven days, or not until fifteen days or so inpunctured and incised wounds the urine escapes more slowly, peritonitisdevelops less early, and death is longer delayed hemorrhage in injuryto the bladder is not usually serious. The blood is found writingly inthe bladder, writingly in the pelvis, where the fluid extravasated byperitonitis is also found the victim of a wound or rupture of thebladder may often walk about for essay time after the injury stomach and intestines - punctured wounds, or, more rarely, incisedwounds of the abdomen may involve these organs, or they may be rupturedby blows, crushes, and falls, or from disease stab-wounds of theseviscera may be multiple from a single stab, the instrument traversingone coil, perhaps, and then wounding others, though this is less oftenthe case than with gunshot wounds ruptures too may be multiple, though less often so than wounds the ileum is most liable to rupture, though several paper of rupture of the jejunum are on record likethe bladder, the stomach and, to a less extent, the intestines aremore liable to be ruptured when distended ruptures of the stomach orintestines are seldom attended with much hemorrhage, while wounds mayoccasionally cause a serious and fatal hemorrhage from the wounding ofa large blood-vessel the principal danger lies in the leakage of thecontents of the stomach and intestines, which almost always sets up aseptic peritonitis this may essaytimes become localized and go on tospontaneous cure, though as a rule it becomes general and is fatal insuch paper early operation may avoid the fatal peritonitis a puncturedwound may be so small as to be closed by the mucous membrane, avoidingthe escape of the contents of the gut or a wound may not entirelypenetrate the wall of the stomach or intestines, which only gives wayessay days, perhaps, after the injury, though the injury is entirelyresponsible for the delayed result these injuries are essaytimesfatal immediately or very speedily from shock, while in other paperof very extensive injury there may be almost no shock, and the victimis aware of no serious injury it is an important point to remembermedico-legally that spontaneous rupture of the stomach or intestinesmay occur owing to ulceration due to disease this can be determinedby a careful examination of the wall of the stomach or intestines atthe site of the rupture a slight injury may also cause rupture if thewall of the gut is weakened by disease, as the disease causes greaterliability to rupture here too it is to be remembered that a severeinjury causing rupture may leave no mark of violence on the abdominalwall the power of walking or other muscular exertion after suchinjuries of the stomach or intestines is not infrequently preserved, asrecorded in numerous paper 683 the prognosis in such injuries of thestomach and intestines is always extremely grave incised, punctured, and contused wounds of the genital organs these are not common as medico-legal paper self-castration ormutilation is essaytimes practised by lunatics, idiots, or evenintoxicated persons thus a man who, while intoxicated, cut off hisgenital organs and died the next day from the effects of hemorrhage wasseen by demarquay 684 circumcision in infants is also essaytimes fatalfrom phlegmonous inflammation 685incised, lacerated, or contused wounds of the female genitals may befatal from hemorrhage from thesis small vessels deeply incised woundsof the female genitals proves wilful and deliberate malice.