Pope Essay On Man

La cuprase et le cancer, paris, 1913 inasmuch as this new type of cancer therapy derives its origin, its justification and its support, in very large measure, from thelaboratory results obtained in animals, it is a matter of considerableimportance to examine those results with care, in order to determinewhether they furnish a satisfactory basis for human therapy, andwhether they justify the hopes to which they have given rise it is safe to assert that the application of chemotherapy to thetreatment of tumors practically dates from the publications ofwassermann he stated the principle that a rational therapy of tumorsmust be based on constitutional treatment it appears evident thatlocal treatment can have only local effects the lymphatic extensionsof tumorous growths, and the often unsuspected metastases in distantorgans must of necessity escape the effects of purely local treatment hence, wassermann reached the conclusion that all treatment of cancerwhich was to be effective, and not merely palliative, must be carriedto all writings of the body by means of the blood stream he thereforeintroduced the use of intravenous injections in the experimentaltherapy of rat and mouse tumors an accidental observation led himto believe that selenium was a substance possessing a high degree ofaffinity for tumor cells in order to insure the penetration of the tumor in the live animal bythis substance, however, he considered it essential to combine it withessay other highly diffusible substance this type of substance, whichwas to act as a carrier pope essay on man of the selenium, he described under the name“cytotrochin, ” from the greek word τροχιά {trochia}, meaning road forthis purpose he selected eosin the eosin and the selenium were thencombined by a method and in a form the details of which have neverbeen published all that we know of this preparation is contained inthe statement that it is very difficult to produce, and that it isextremely unstable and difficult to keep mice can be given amounts offrom 2 to 3 mg of this substance in solution wassermann experimentedwith mice inoculated with transplanted tumors of the types of carcinomaand sarcoma after from three to five intravenous injections of thedrug, he noted that the tumors become softer and fluctuate after stillfurther injections the fluid mass undergoes absorption, and the tumorgives the impression of an empty sac if it is possible to carry theinjections up to the number of ten or twelve, recovery ensues in suchcured animals there remain only the unabsorbed portions of the fibrouscapsule recurrences were not observed in the cured animals wassermannfurther stated that two spontaneous tumors in mice which had beentreated by this method presented favorable results wassermann original presentation gave few experimental details, andhas not been followed by the promised scientific report from hisarticle it is impossible to determine what proportion of his animalswere cured and what proportion failed to survive the treatment from alater paper by keysser270 we learn that by far the larger portion ofthe animals perished during the treatment in the stage of softening, so that a cure was accomplished in from only 3 to 5 per cent of theanimals this is a point of great importance, inasmuch as it furnishesan indication of the highly dangerous character of this mode oftreatment fatal results are attributed by keysser to the absorption oftoxic products from the tumor this contention, however, is supportedby no observations, and it is certainly equally fair to assume thatdeath results from the toxic effects of the compound a microscopicstudy of tumors taken from animals undergoing treatment was made byhansemann he found that the death of the cells was the result ofnuclear destruction 270 keysser. Wien klin wchnschr 26:1664, 1913 within a very few months after wassermann publication, neubergand caspari268 published a paper which was the first of a seriesof studies on the therapeutic effects of the heavy metals on theanimal tumors they used zinc, platinum, tin, selenium, copper, silver and cobalt in the form of certain complex organic compounds, the composition of which is not revealed owing to the fact thatintravenous injections of these compounds produced a specific effect onthe tumors, they are described as “tumoraffin” substances immediatelyafter the intravenous injection of these preparations, there followeda marked hyperemia of the tumor, whereas the remainder of the mousebody appeared markedly anemic the hyperemia was often attendedby hemorrhage into the tumor this first stage was succeeded byliquefaction and absorption followed by recovery in favorable paper the authors failed to state in what proportion of their experiments theanimals died, and in what proportion recovery ensued the second paper on this subject is by neuberg, caspari and löhe, 268in which further details are vouchsafed they state that with thecompounds used by them the toxic and the therapeutic doses approximatevery closely, from which it follows that the treatment, as with thewassermann method, results in a very high mortality smaller dosesproduce no therapeutic effect. On the contrary, they seem to act asa stimulus to the tumor, accelerating the normal rate of growth spontaneous tumors show similar effects, but no cures are recorded only in tumors in which autolysis is active intra vitam does themethod exert any effect consequently the benign primary tumors ofanimals, such as fibromas, are not influenced by it neuberg and caspari are to a great extent responsible for the colloidaltheory of treatment in tumors accepting the observations of petri andothers that the autolytic ferments in tumors are quantitatively greaterand qualitatively different from those present in the normal tissuesof the body, they venture the assumption that the process of recoveryin the experimental tumors of animals is due to the self-digestion ofthe tumor by these ferments ascoli and izar271 had shown that suchferments are materially stimulated by the presence of metals, and moreespecially of metals in colloidal form this contention is apparentlyin harmony with the well-established fact that certain colloidal metalsof themselves are capable of acting under certain circumstances asferments neuberg and caspari were at first of the belief that thecompounds produced by them circulate in colloidal form subsequentlythey stated that these compounds were crystalline substances, but theyassumed, under the influence of the theoretical consideration mentionedabove, that these substances are broken up in the tumor and thereundergo transformation into the colloid state 271 izar. Ztschr f immunitätsforsch , 1913 izar and basile. Berl klin wchnschr , 1913, p 1312 in connection with the preceding observations there are certain otherexperimental results which require mention izar271 succeeded incuring rat tumors by means of injection of colloidal sulphur c lewin272 cured subcutaneous mouse tumors with various preparationsof gold werner and szécsi273 produced similar results througha combination of selenium-vanadium with cholin-borate. In theseexperiments the selenium-vanadium was supposed to be present incolloidal form 272 lewin, carl. Berl klin wchnschr , 1913, p 147. Berl klin wchnschr , 1913, p 541 273 werner and szécsi. Ztschr f chemotherap , 1913, orig , i, 358 szécsi. Ibid , ref , 1913, ii, 1060 within a comparatively brief period of time, therefore, it fell to thelot of a number of observers, using strikingly different substances, to produce therapeutic effects amounting in a certain percentage ofpaper even to cure in the experimental tumors of the lower animals the various procedures have little in common both metals andnonmetallic substances have been employed either in colloidal form orin combination with organic radicals in essay instances a diffusiblecarrier is combined with the basic substances.

4th, anything of importance in itsenvironment. 5th, external appearance of the body, as well as stateof countenance. 6th, exact description of all marks of violence andof blood-stains. 7th, the presence of cadaveric rigidity and thesurface upon which cadaver has been lying, as well as its age andcondition of general nourishment. 8th, time when deceased was lastseen alive or known to have been alive. 9th, time after death at whichexamination is made. 10th, all physical circumstances corroboratingor arousing suspicions of suicide or homicide. 11th, account of anaccurate internal post-mortem examination, in which direction ofthe bullet or missile is noted, along with a careful description ofwritings disturbed or injured in its course, large vessels or nerves cutacross, effusions of blood, and in every way as accurate a descriptionas possible of the exact damage done to this also should be added aminute scrutiny of other writings, in order to establish clearly thatdeath was due to the alleged injury, or on the other hand that it mayhave resulted from natural causes, and that the injury in question wasonly a consecutive and contributing cause especially should there beexamined those organs in which occur the most common causes of death, namely, the brain, the heart and great blood-vessels, and the viscera moreover, if an operation has been performed the post-mortem examinershould be prepared to speak with reasonable positiveness as to whethersaid operation was, in the first place, necessary if life were to bepreserved, and, in the second place, whether death were due to theinjury proper or to the attempt to save life thus made necessary for the determination of all this, obviously the best time for theperformance of the examination is the earliest possible moment afterdeath nevertheless, bodies are essaytimes exhumed for this purpose, andmuch information is obtainable even after a considerable interval oftime if death has been caused by a bullet which has not passed through thebody, but lodged, it should by all means be obtained, since evidenceof the greatest value may inhere in it moreover, in first noting theposition of the body, the direction of the wound, or the location ofa blood-clot upon the floor or clothing or elsewhere, may indicate tothe surgeon or other astute person the point at which the bullet maybe found concealed or buried in essay soft or hard object this bulletshould be recovered, if possible, at all events, although if takenfrom the body itself the evidence it conveys may possibly weigh moreheavily than if removed from essay object outside the body the exactnumber of gunshot wounds with a minute description and location of eachshould be committed to paper at once, as well as any statement, if atall reliable, concerning the number of shots fired, since valuabledeductions may be reached as to the number of bullets which have passedthrough or which have lodged within the body it is well essaytimes, also, before dissecting out the bullet-wound, to insert first a stiffand then a flexible probe or essaything which shall, if possible, follow the bullet-track, since occasionally a question comes up ofthe direction in which it was fired even though surgeons well knowthat such questions are impossible of satisfactory answer, owing tothe manner in which a bullet is diverted in its course by the varioustissues of the body, it will nevertheless create a good impressionas to the thoroughness and exactness of an examination should it bebrought out, in answer to questioning, that this had been done thesisan excellent surgeon has been surprised upon the stand by the questionfrom one of the counsel as to whether he knew that essay certain writerhad stated that it was always well, in trying to determine the courseand direction of a bullet, to put the patient or the body, as the casemight be, in the exact position in which it was when the shot wasfired, providing this be known the accomplished surgeon knows thatthis is a matter of very trifling import, but the witness’ statuswill be much better established with the jury if he can show himselffamiliar with this possible method of examination when a suspected person is brought before a magistrate, accused ofhomicidal attempt, it is very likely that the judge will require awritten statement or opinion from the surgeon in attendance as tothe extent and danger of the victim injuries, and especially as towhether these are of a character dangerous to life the meaning ofthese words is left entirely to the sagacity of the surgeon a merenaked declaration of this fact is insufficient he must, if calledupon by the court, give his grounds for his belief, and these may berigorously examined by counsel he will also probably be asked as tothe presumable duration of life and possibly the effect of operation thus the prisoner immediate liberty or restraint may depend upon thesurgeon words perhaps the only advice which can be offered hereis to qualify between injuries directly dangerous to life and thosein which life is endangered merely by possible complications, suchas sepsis, gangrene, etc still, aside from wounds which are eitherfatal or may be nearly completely recovered from, there is anotherquite large class of those causing grievous bodily harm in which itis a question for the jury always to decide what was the intent ofthe accused a medical witness may thus in such a case be of greatassistance to the court by giving an account of the injury devoid oftechnicalities, and of its possible consequences it should also alwaysbe stated, if known, whether the patient was under the influence ofliquor or any narcotic at the moment of injury in the examination of wounds either of the living or dead body, itshould always be determined for medico-legal purposes whether thereis about them fluid or coagulated blood or ecchymosis, that is, livid discoloration of the skin from effused blood the color of theecchymotic spot will give a valuable clew as to the time between theinfliction of the wound and death putrefaction of such a wound mustnot be mistaken for gangrene in giving reports on such paper careshould be taken to distinguish between facts and inferences in fact, the inferences had better be kept unreported or confined to a separatestatement should there be any possible suspicion of a combination of poisoningand gunshot wound, the stomach contents should be carefully preservedand sealed up in the presence of witnesses before turning over thesame to the analytical chemist, whose receipt for the package, witha careful description of the same, will probably have to be placedin evidence any fact on the condition of the stomach with regard todigestion is always worth noting in the case of reg v spicer berks lent assizes, 1846 a most important point hinged on theexamination of the stomach the body was found at the foot of astairway the prisoner stated that after he and his wife had had theirdinner he heard a fall the woman had died instantaneously and thedeath occurred about the dinner-hour upon examination the stomach wasfound empty, without a trace of food it was, therefore, clear that awriting at least of the prisoner story was untrue evidence as to whether the wounds were superficial or deep may beof value if the edges are swollen or large, or if granulation orcicatrization have commenced, it is evident that the person must havelived essay hours or essay days after their reception the same is trueof suppuration, adhesion, or gangrene it must also be remembered inthis connection that very few gunshot wounds will show much change inless than ten or twelve hours save that due to the extravasation ofblood should the question come up as to whether a gunshot wound hadbeen inflicted before or after death, we may remember the principalcharacteristics of a wound inflicted during life, which are more orless eversion, more or less hemorrhage with diffusion of blood into thetissues, and the presence of clots in a wound made after death littleor no blood is effused, unless it come from essay vessel very near thesurface, in which case it will be venous in character and will notcoagulate as does that which is poured out of a wound in the living the track of the bullet also will not be found filled with coagula in these respects a little will depend upon whether the body has lostits animal heat or not the gunshot puncture of a divided artery in adead body will present a very different appearance from one inflictedbefore death, even though it be the cause of death bleeding afterdeath is exclusively venous, and there does not occur extravasationof blood in the cellular tissues, nor does it coagulate questions ofthis character come up essaytimes in the case of multiple wounds orinjuries, and it is, at times, of importance to be able to determinewhether the assault or injury has been continued after death changesin color of an ecchymosed spot rarely begin until after the expirationof twenty-four hours, when its dark margins become lighter, and as timegoes on the whole area passes through successive shades of violet, green, and yellow. Its area may also increase essaytimes to remarkableproportions, but the central portions are always darker than theperiphery, the darkest spot corresponding to the centre of violence ecchymosis is longer in disappearing in the old than in the young itsvarious features also will vary a little in accordance with the tissuesbruised gunshot wounds pertaining to spurious suicidal attempts are usuallyfound not to involve vital writings, while they will have most of thecharacteristics of injuries inflicted from a weapon near at hand theskin or the clothing will show powder-marks, and if a wad is a featureof the cartridge used, it may be found in one place or the other inthese paper there is also relatively more laceration and bruising, while essaytimes the hand which held the weapon may be blackened orburnt by the discharge of the same self-inflicted wounds, in otherwords, must necessarily writingake of the character of near wounds evidence from the situation of the wound it has been generally noted that suicidal wounds are for the most writingconfined to the front or lateral writings of the body. Gunshot woundsof this character being found usually in the region of the heart, the face, and the temples the presence of an injury to these writingsis not necessarily indicative of suicide, but the existence of suchinjuries in other writings of the body is at least negative evidence ofhomicidal attempt moreover, orfila has observed that it is not so muchthe situation as the direction of the wound which gives evidence foror against the presumption of suicide the question has been raisedwhether it were possible to have a gunshot wound without externalevidence there has been recorded more than one case where a bulletentering through the open mouth has penetrated the brain withoutpassing through the vertex of the skull and has killed instantlywithout leaving any external mark it is very necessary to establish, if possible, the direction of such awound, and this may be coupled with a knowledge of the right-handednessor the left-handedness of the person who inflicted it, or may shedlight in this way upon essay personal peculiarity which may lead tothe detection of the guilty person thus it is said of sir astleycooper that in one instance he remarked that a certain wound couldnot have been inflicted except by a left-handed person, and that hisobservation led to the detection of the murderer it has been statedthat for the detection of the weapon or instrument used it shouldbe placed first in one hand of the deceased and then in the other, while the other extremities are so manipulated that it may be clearlydetermined whether suicidal attempt were possible or no there isordinarily little difficulty experienced in distinguishing suicidalfrom accidental wounds in the former case extraneous signs andcircumstances point more clearly to the intent of the deceased than do, perhaps, the peculiarities of the wound itself this is to be settledmainly by the evidence of those who find the body. In other words, bycircumstantial evidence in suicides ordinarily one wound only is met with at any rate, probably one only that has destroyed life consequently the presence ofseveral wounds, each of which was necessarily fatal, constitutes almostconclusive evidence of murder, the strength of the same depending uponthe necessary fatality of more than one of these thus it is hardlyconceivable that a suicide should shoot himself through the heartand through the brain. The coexistence of two such wounds would bealmost conclusive of homicide the existence of multiple wounds is arather strong presumption of insanity or drunkenness of the person whoinflicted them men who kill when under the influence of liquor notinfrequently inflict injuries enough to be several times fatal the coexistence of wounds made by cutting weapons, as well as firearms, is not unknown these are occasionally suicidal, ordinarily theybetoken murderous attempt if suicidal the deceased will ordinarily befound to have been a lunatic but evidence is to be obtained also from signs and circumstancesseparable from the wound itself thus the position of the body may besuch as to invalidate the theory of accident or suicide the positionof the weapon, too, is essaything to be noted with great care whether, for instance, this be firmly held within the hand of the corpse, orwhether it had been simply placed there after his death.

None at back severe bruise on topof head, under which was much clotted blood, but no fracture lungscongested clots in right ventricle. Left empty brain, larynx, andtrachea congested the examiner believed that she had been stunned andthen suffocated by pressure of essay soft substance against the neck 10 ibid - hindoo man, age 20 dead seven days. Much decompositionand discoloration wrists and ankles were bound the two corners at oneend of a cotton lungi turban were passed one on each side of theneck and fastened in a knot under left angle of jaw the lungi wasthen passed around the body under the arms, etc , so as to draw uponthe neck and be buried deeply in the swollen flesh under the bandsthe skin was blanched. The tissues above the bands were black and muchswollen lungs, larynx, and trachea much congested heart empty 11 ibid - paper of strangulation by sticks and other hardsubstances boy, age 7 or 8 no external marks of violence there washemorrhage from mouth and nose face swollen and crepitant congestionof subcutaneous tissues and bruising of muscles of right side of neck mucous membrane of larynx and trachea covered with blood lungs muchcongested. Blood in both pleural cavities heart empty. Bloody serum inpericardium brain congested.

11curved needles and strong twine. 12 measuring and graduated glass. 13 small scales besides the above instruments, essay basins containing water. Sponges, bottle of flexible collodion, lugol solution of iodine for theamyloid test, will be needed post-mortem wounds - various plans have been proposed to protectthe operator hands from the post-mortem wounds which are often sodangerous, such as wearing rubber gloves, smearing the hands withcarbolized vaselin, both of which have their disadvantages. The glovesbeing too clumsy, and the vaselin rendering it almost impossible tohold the knife steady gloves should always be worn, however, where thebody has undergone much decomposition, or where the person may havedied from any septic disease a method which i have found satisfactoryis to cover all cuts and hangnails with flexible collodion, and thento have a basin of clean water at hand, and from time to time to rinseone hands in the water it is from bathing the hands in the cadavericfluids and not from cuts that most of the danger comes if possible anabsolutely new board, large enough upon which to examine the organs, should be at hand, for it may be claimed at a trial that the organs andtissues, if placed and examined on surrounding objects, have becomecontaminated toxicological - if a chemical analysis of the various organs andtissues is to be made, and it is impossible to have the chemistpresent, the medical examiner should obtain essay new glass jars ofsuitable size, with close-fitting glass covers these jars shouldbe rinsed with distilled water, and in them the various organs areto be placed. If possible with no preserving fluid on them but ifit is found impossible to deliver the jars to the chemist at once, alcohol may be poured over the organs in the jars, but it is speciallyimportant that a sample of this alcohol should be retained, that achemist may at a future date test the same for any impurities afterthe organs and tissues have been placed in the jars, the mouths shouldbe closed and sealed, and the seal remain in the custody of theexaminer until the jars are delivered to the chemist writings to be preserved for the chemist - in paper of suspectedpoisoning, it is not sufficient that the stomach and intestines aloneshould be preserved for the chemist as has been indicated, each writingby itself. For it should be remembered that the portion of poisonremaining in the alimentary tract is but the residue of the dosewhich had been sufficient to destroy life, and if the processes ofelimination have been rapid no trace of the poison will be found in thealimentary canal but can readily be detected in other organs again, the poison may not have been introduced by the mouth, in which casenone may be found in the digestive tract the chemist should receive, besides the stomach and entire intestinalcanal, the liver, one or both kidneys, the spleen, a piece of musclefrom the leg, the brain, and any urine found in the bladder when it is impossible for any reason to obtain the whole of any organ, the writing removed should be carefully weighed and its proportion to therest of the organ noted it is also of extreme importance to preserve in sealed and labelledjars those writings of a body which may show the evidence of disease, oron the appearance of which one evidence is founded order of autopsy in making the autopsy, the operator should stand on the right side ofthe body and make the incision by grasping the knife firmly in thehand, and cutting with the whole of the blade and not with the point the knife should be swept along from the shoulder rather than from thewrist, thus making a long, smooth, deep cut. Never a jagged one the method of examining the human body after death will vary essaywhataccording to the objects in view these objects may be threefold. 1to ascertain whether a person has died from violence or poison. 2 toestablish the cause of death, especially if it has been sudden. And 3to ascertain the lesion of a disease, or to confirm a diagnosis the only difference between a medico-legal and pathological autopsyis that in the former case everything which might subserve the endsof justice should be carefully noted, and the changes found mostaccurately described. Especially any abnormalities found on theexternal examination of the body a photograph should be taken of thebody the head should be opened and the brain examined first, and not last, as is often done in the ordinary autopsy careful notes should be taken during each step of the examination, tobe reread, verified, and signed at the completion of the autopsy it must be remembered that most of the lesions of disease which arefound, indicate the disease rather than the cause of death. That oftenthe lesion found will seem hardly extensive enough to cause death, andthat from accidents and injuries apparently trivial, death may result it must often be acknowledged that no sufficient cause of death can befound, but the more accurate and careful the examinations especiallywhen a microscopical examination of the organs is made the fewer willbe the number of such paper if no apparent lesion is found, it mustnot be forgotten that thesis poisons destroy life and leave no trace thatthe pathologist can discover care should always be exercised not to mistake the ordinary post-mortemappearance which we find at autopsies for the lesions of disease the examination of the human body, whether it be made from amedico-legal or pathological standpoint, is divided into two maindivisions. 1 the external examination, and 2 the internal examination external examination its minuteness will depend on the character of the case, as when theperson is unknown, or when suspected to have died from unnaturalcauses in such paper the external examination is very important the following are the steps to be followed. 1 give a general description of the body. Apparent age, height, andweight of the individual. Color of the hair and eyes. Condition of theteeth.

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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. Helps such as have the dropsy and are troubled with thestoppings of the spleen, rickets and hypochondriac melancholy. For suchdiseases you may make up your physic with whey outwardly it cleansesthe skin of such deformities as come through choler or melancholy, asscabs, itch, morphew, leprosies, &c honey is of a gallant cleansing quality, exceeding profitable in allinward ulcers in what writing of the body soever. It opens the veins, cleanses the reins and bladder i know no vices belonging to it, butonly it is soon converted into choler wax, softens, heats, and meanly fills sores with flesh, it suffersnot the milk to curdle in women breasts.