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Ptcas Essay 2016


Then put to thema pint of oil of trotters or sheep feet. Let them boil a good while, still stirring them well. Which being strained, anoint the grievedplace therewith, warm against the fire, rubbing it well with one hand:and bind also essay of the herb if you will to the place, and, withgod blessing, it will help it in three times dressing chick-pease, or cicers descript the garden sorts whether red, black, or white, bringforth stalks a yard long, whereon do grow thesis small and almost roundleaves, dented about the edges, set on both sides of a middle rib;at the joints come forth one or two flowers, upon sharp foot stalks, pease-fashion, either white or whitish, or purplish red, lighter ordeeper, according as the pease that follow will be, that are containedin small, thick, and short pods, wherein lie one or two pease, moreusually pointed at the lower end, and almost round at the head, yet alittle cornered or sharp. The root is small, and perishes yearly place and time they are sown in gardens, or fields as pease, beingsown later than pease, and gathered at the same time with them, orpresently after government and virtues they are both under the dominion of venus they are less windy than beans, but nourish more. They provoke urine, and are thought to increase sperm. They have a cleansing faculty, whereby they break the stone in the kidneys to drink the cream ofthem, being boiled in water, is the best way it moves the bellydownwards, provokes women courses and urine, increases both milk andseed one ounce of cicers, two ounces of french barley, and a smallhandful of marsh-mallow roots, clean washed and cut, being boiled inthe broth of a chicken, and four ounces taken in the morning, andfasting two hours after, is a good medicine for a pain in the sides the white cicers are used more for meat than medicine, yet have thesame effect, and are thought more powerful to increase milk and seed the wild cicers are so much more powerful than the garden kinds, byhow much they exceed them in heat and dryness. Whereby they do moreopen obstructions, break the stone, and have all the properties ofcutting, opening, digesting, and dissolving.

Yet this, ifyou observe it, you shall find an excellant truth. In diseases of theblood, use the red centaury. If of choler, use the yellow. But ifphlegm or water, you will find the white best the cherry-tree i suppose there are few but know this tree, for its fruit sake. Andtherefore i shall spare writing a description thereof place for the place of its growth, it is afforded room in everyorchard government and virtues it is a tree of venus cherries, as theyare of different tastes, so they are of different qualities the sweetpass through the stomach and the belly more speedily, but are of littlenourishment. The tart or sour are more pleasing to an hot stomach, procure appetite to meat, to help and cut tough phlegm, and grosshumours. But when these are dried, they are more binding to the bellythan when they are fresh, being cooling in hot diseases, and welcome tothe stomach, and provokes urine the gum of the cherry-tree, desolvedin wine is good for a cold, cough, and hoarseness of the throat. Mendsthe colour in the face, sharpens the eye-sight, provokes appetite, andhelps to break and expel the stone, and dissolved, the water thereof ismuch used to break the stone, and to expel gravel and wind winter-cherries descript the winter cherry has a running or creeping root in theground, of the bigness thesis times one little finger, shooting forthat several joints in several places, whereby it quickly spreads a greatcompass of ground the stalk rises not above a yard high, whereon areset thesis broad and long green leaves, essaywhat like nightshades, butlarger. At the joints, whereof come forth whitish flowers made of fiveleaves a piece, which afterwards turn into green berries inclosed withthin skins, which change to be reddish when they grow ripe, the berrylikewise being reddish, and as large as a cherry. Wherein are containedthesis flat and yellowish seeds lying within the pulp, which beinggathered and strung up, are kept all the year to be used upon occasions place they grow not naturally in this land, but are cherished ingardens for their virtues time they flower not until the middle or latter end of july. Andthe fruit is ripe about august, or the beginning of september government and virtues this also is a plant of venus they areof great use in physic. The leaves being cooling, may be used ininflammations, but not opening as the berries and fruit are. Whichby drawing down the urine provoke it to be voided plentifully whenit is stopped or grown hot, sharp, and painful in the passage. It isgood also to expel the stone and gravel out of the reins, kidneys andbladder, helping to dissolve the stone, and voiding it by grit orgravel sent forth in the urine. It also helps much to cleanse inwardimposthumes or ulcers in the reins of bladder, or in those that void abloody or foul urine the distilled water of the fruit, or the leavestogether with them, or the berries, green or dry, distilled with alittle milk and drank morning and evening with a little sugar, iseffectual to all the purposes before specified, and especially againstthe heat and sharpness of the urine i shall only mention one way, amongst thesis others, which might be used for ordering the berries, tobe helpful for the urine and the stone. Which is this.

Iodin, gr 1/8 ptcas essay 2016. Phenol, gr 1/2. Glycerine and elixir lactated pepsin with aromatic oils in the form of a perfect emulsion ”a circular which gives what is asserted to be the composition ofiodinized emulsion, declares that, among other ingredients, eachfluidram contains “one and three quarters m tincture of iodine ”both the statement on the label that the preparation contains “iodin”and the one in the circular that tincture of iodin is present in theproduct are incorrect, for the a m a chemical laboratory reportsthat no free iodin could be detected in the preparation, and that itresponded to tests for iodid instead an advertising circular for iodinized emulsion scott makesunwarranted claims for the therapeutic properties of the constituents for example. “ the great usefulness of turpentine in diseases, especially of the intestinal infection, such as the meteorism and tympanites of typhoid ”and this absurdity. “ where turpentine, carbolic acid or iodine or even pepsin is indicated, that it will give satisfaction in each and every case ”iodinized emulsion scott is not a “pharmaceutical triumph”. It is anirrational mixture-- a reminder of a decadent polypharmacy-- sold undermisleading and unwarranted claims it is inadmissible to new andnonofficial remedies for conflict with rules 1, 6, 8 and 10 creosotonic scottcreosotonic scott, advertised as a “reconstructive tonic” for thetuberculous, according to the label, contains in each fluidram.

Capsules bismuth resorcinol compound bismuth subgallate 2 grs resorcinol 1 gr beta naphthol 1/2 gr creosote beechwood 1 m this combination is of acknowledged value in reducing the value in reducing the intes- tinal putrefaction and fermentation, allaying the ptcas essay 2016 pain and discomfort of flatulent conditions in the intestinal tract dose -- one or two capsules before or after meals repeated in two hours if necessary the gross drug company, inc 20 laight street, new yorkthe council held this preparation inadmissible to new and nonofficialremedies or the appendix, because 1 the claim “acknowledged value inreducing the intestinal putrefaction and fermentation, allaying thepain and discomfort of flatulent conditions in the intestinal tract” isan unwarranted, exaggerated and misleading claim of therapeutic value rule 6. Because 2 the name does not indicate the identity of thebismuth salt contained in the capsules, nor declare the presence ofbetanaphthol and creosote rule 8. And because 3 the combinationof bismuth subgallate, resorcinol, betanaphthol and creosote in fixedproportions is irrational rule 10 -- from reports of council onpharmacy and chemistry, 1917, p 139 dixon tubercle bacilli extract and dixon suspension of dead tubercle bacilli report of the council on pharmacy and chemistrynew and nonofficial remedies, 1917, contains general descriptionsof dixon tubercle bacilli extract and dixon suspension of deadtubercle bacilli. The products of these manufactured by the h m alexander company being listed as dosage forms it having becomenecessary to omit the preparations of the alexander company see page138 the referee recommended that the general articles of “dixontubercle bacilli extract” and “dixon suspension of dead tuberclebacilli” also be omitted he reported that no other firm appears tobe marketing these products and that they had not been shown to be ofspecial value the council accepted the recommendation and directed the omission asproposed in accordance with the procedure of the council, these havebeen transferred to the annual council reports for reference and appearbelow w a puckner, secretary dixon tubercle bacilli extract -- an extract of tubercle bacillidissolved in normal saline solution see “fluid of dixon, ” medicalnews, jan 17, 1891 dixon suspension of dead tubercle bacilli -- a suspension inphysiologic salt solution of dead tubercle bacilli which havebeen defatted by prolonged treatment with alcohol and ether see“possibility of establishing tolerance for tubercle bacilli, ” medicalnews, oct 19, 1889 -- from reports of council on pharmacy andchemistry, 1917, p 140 formosol report of the council on pharmacy and chemistrysunshine formosol the formosol chemical company, formerly thesunshine chemical company, cleveland, ohio is claimed to contain18 per cent formaldehyd in a solution of soap it is thereforevery similar to veroform germicide which was deleted from new andnonofficial remedies because of the low phenol coefficient reported bythe hygienic laboratory of the united states public health service thejournal, nov 22, 1913, p 1920 the council voted that in view of thehygienic laboratory finding that formaldehyd has a low germicidalvalue, the manufacturers of formosol be required to produce definiteevidence of the degree of germicidal value for this product in submitting the preparation to the council, it was claimed thatformosol had “all properties peculiar to formaldehyde ” thisconservative tone was, however, not maintained in the form-letterssubmitted these contain the following unwarranted statements. “as the name implies, formosol is a formaldehyde preparation, which embodies all the innate antiseptic merits and eliminates all the ill features of the world greatest disinfectant ” “the elimination of all the destructive elements and the incorporation of all the established therapeutic virtues of formaldehyde, have been scientifically blended in formosol ” “formosol is unique in the sphere of antisepsis because of its peculiar healing properties as diametrically opposed to irritation to the tissue of mucous membrane ” “formosol may be used for the thousand niceties of modern antisepsis, but is specific in gynecology and obstetrics and is indicated in dermatology ” italics not in original “the constant use of formosol is to develop a habit sympathetic to ethics ” “to prescribe formosol is a great step toward personal hygiene, a duty of the medical fraternity to the laity ” italics not in original the trade package recommends the use of formosol “for cuts, wounds, ulcers, abscesses ” this is a conflict with rule 4 the council heldformosol in conflict with rules 4 and 6, and advised the manufacturersthat formosol is refused admission to new and nonofficial remediesuntil they submit evidence establishing the degree of antiseptic andgermicidal efficiency, and justify the quotations listed above. Oruntil these and any other existing conflicts with the rules have beenremoved after submission of this report to the formosol chemical company thecouncil authorized its publication -- from reports of council onpharmacy and chemistry, 1917, p 145 iodolene, a solution of iodin in liquid petrolatum, inadmissible to n n r report of the council on pharmacy and chemistrythe council was asked to consider a solution of iodin in liquidpetrolatum, said to be prepared from gulf coast petroleum by a specialprocess it was to be marketed as “iodolen” provided the councilfound the preparation admissible to new and nonofficial remedies thepreparation was claimed to contain over 1 5 per cent free iodin thefollowing claims were made. “it is less irritating in its use on the skin, or in wounds ” “will kill pathogenic micro-organisms present ” “is a suitable medium for cell proliferation ” “will penetrate a useful distance into the walls of a wound ” “facilitates an easier, less painful and better method of dressing wounds or ulcers ”examination in the american medical association chemical laboratoryshowed a submitted sample to contain 1 32 per cent free iodin andto emit a strong odor of hydrogen sulphid a specimen of liquidpetrolatum, said to be composed chiefly of hydrocarbons of thenaphthene series, after saturation with iodin at room temperature wasfound to contain 1 42 per cent free iodin another specimen of liquidpetrolatum, said to be composed chiefly of saturated hydrocarbons, after saturation at room temperature was found to contain 1 30 percent free iodin the preparation having been shown to be an unoriginal, simplesolution of iodin in liquid petrolatum, the council declared the name“iodolene” unacceptable rule 8 and the therapeutic claims made forthe preparation unwarranted rule 6 -- from reports of council onpharmacy and chemistry, 1917, p 148 kalak water report of the council on pharmacy and chemistrythe following report, submitted by a member of the council committeeon chemistry, was endorsed by the committee and adopted by the council:kalak water, sold by the kalak water company, inc , new york, is anartificial mineral water said to be made by adding certain salts tocarbonated, distilled water and supersaturating with the gas underpressure such merit as it may possess by virtue of sodium bicarbonateand sodium phosphate is quite insufficient to warrant the extravagantclaims made in the advertising pamphlets according to the analysis furnished, the water contains, in 1, 000, 000writings milligrams per liter the following. Sodium carbonate 4049 0 sodium phosphate 238 5 sodium chloride 806 3 calcium carbonate 578 2 magnesium carbonate 48 9 potassium chloride 47 9among the thesis misleading statements found in the advertising pamphletbearing the title “a brief for physiological alkalescence” these may bequoted. “the calcium content of kalak is over 100% greater than ever before placed in solution in any vehicle, a fact of supreme importance when the unique alkalinizing power of the alkaline salts of this metal is considered. The ratio of calcium metabolism to its enormous waste in pregnancy, the diseases of infancy and childhood and the rapidly growing group of ‘acidoses’ make its availability in kalak of double value ”the first writing of this statement is untrue. The last writing is muddledand without much meaning evidently the “acidosis” fad is to beoverworked as was the old “uric acid diathesis, ” of unsavory memory again this. “one of the most important characteristics of kalak is the close approximation of its formula to the correlation of the contained salts as they occur in the human body, together with its freedom from salts foreign to the human economy another is its almost unbelievable palatability, considering its high degree of alkalinity, it being eleven times greater than any other known mineral water, artificial or natural ”these statements are false the salts dissolved here bear nodiscernible relation to the needs of the body, as disclosed by thecomposition of the blood or solid tissues or as shown by the characterof the urinary excretion the last statement concerning the highalkalinity is neither clear nor accurate then, this warning and remedy. “it seems to be an unappreciated fact that the degree of urinary acidity, checked with the acidity of the saliva, is in direct ratio to the existing acid toxemia, and a urine acid to methyl red should be the signal for immediate and adequate alkalinizing treatment “startling clinical results have been observed by physicians who have used kalak thoughtfully and sufficiently in the more serious types of acidosis associated with diabetes, nephritis, rheumatism, gout and the acute infections there is also evidence of its good effect in acute alcoholism and the respiratory edemas. In fact a certain few have hailed kalak as a possible solution of the annual hay fever problem of perhaps supreme importance, however, is the use of kalak throughout pregnancy as preventive medicine against the inevitable ‘toxemia of pregnancy ’”also this. “kalak has accomplished certain unexplainable things for the diabetic and nephritic, and if, in future years, diabetes and nephritis should prove to be constitutional diseases, based upon functionation or its lack, kalak therapy, the embodiment of physiological alkalescence may come into its own, for if acidity retards, alkalinity must normalize functionation ”it is not necessary to quote further in order to insure that everyonewill recognize the great need of kalak it is advised to test the urinefor acidity by means of a group of indicator solutions sent out to thephysicians methyl red is one of these and any urine showing an acidreaction with this is said to be open to suspicion paranitrophenol isanother of the indicators and the explanations given of the behavior ofthe two and the conclusions to be drawn are questionable the methylred solution furnished is too concentrated for proper use and perfectlynormal urines from normal individuals have given a rather marked colorwith it this indicator gives essay color at h 1 2 × 10^{-6} and astrong reaction at 3 × 10^{-3} to condemn a urine on such a finding isentirely unwarranted sodium bicarbonate is the main constituent of the water the valueof the phosphate in such a combination, with so much calcium, isproblematical in case an alkaline reaction in the intestine is reachedessay of it would be left as insoluble phosphate a few grams ofbicarbonate daily would have equal therapeutic value with this water the advice based on the indications of methyl red and the urine is bad the committee report was sent to the kalak water company for comment the company promised to withdraw the advertising circular referred toin the report and disclaimed responsibility for the accuracy and valueof the set of indicators which it sent out, but, on the whole, theprevious advertising claims were insisted on in view of the absurd and false claims made for the product the councildeclared kalak water inadmissible to n n r -- from reports ofcouncil on pharmacy and chemistry, 1917, p 148 minson soluble iodin “kelpidine” not admitted to n n r report of the council on pharmacy and chemistryminson soluble iodin “kelpidine” was submitted to the council byj j minson, washington, d c , trading as the kelpidine company, with the statement that in future “literature” it was to be known asminson soluble iodin, only the following statement of compositionwas furnished. “minson soluble iodin is essaywhat of an indefinite character, chemically its formula is, iodin 4 per cent , distilled water 6 per cent , and absolute alcohol q s 100 per cent by a process of chilling and heating an iodid of uncertain character is produced, and because of the extreme sensitiveness of the product to chemical tests, it is hard to determine so far as i have been able to judge, however, the result is about 3 or 3-1/2 per cent free iodin and from 1/2 per cent to 1 per cent iodid, possibly ethyl and hydrogen iodid in combination ”the a m a chemical laboratory reports that the preparation is analcoholic solution containing free iodin and iodid, probably hydrogeniodid and ethyl iodid, but that the free iodin content was only2 69 gm per 100 c c it is claimed that the “therapeutic indications” of minson solubleiodin are the “same as those of all iodin and iodid preparations, internally, externally, hypodermically and intravenously.

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Liver, spleen, kidneys, lungs, heart, stomach, intestines, bladder, brain rupture of the liver occurs especially onthe anterior and inferior surfaces and the bleeding is rather abundant the healthy spleen does not rupture readily, except from a severetraumatism, but if it is hypertrophied it may rupture spontaneouslyfrom muscular violence the lung may be ruptured internally withoutshowing the rupture on the surface and with the ribs intact two suchpaper are mentioned by vibert, 657 and he refers to others mentionedby nelaton and holmes rupture of the brain without fracture of theskull is very rare, though paper have been observed and reported, among others by casper-liman in falls from a height the rupture ofthe aorta, mesentery, diaphragm, and larynx have been noted it shouldbe remembered in this connection that rupture of the liver, intestine, bladder, etc , may be caused by contusions without sign of violenceexternally, and such paper cannot, therefore, be attributed to fallsunless there are other signs of the latter in crushes caused by a heavy vehicle, the lesions resemble in thesisrespects those due to a fall from a height thus we find fractures andinternal ruptures, but we more often and regularly find subcutaneousecchymoses and ecchymoses between the muscles the skin is oftenstripped up extensively and the injuries are generally limited to theregion injured it is rare to find that the cause of the injury leavesno trace on the skin, for it usually gives the form to the erosionsor ecchymoses essaytimes, for instance, the marks of a horseshoe areclearly visible ruptures of internal organs may occur here too whenthere are slight external marks of violence or even none at all thusvibert658 relates the case of a man with the head crushed, but withno signs of injury to the trunk save a few erosions at the level ofthe sternum, who had not only rupture of the kidneys, the liver, andthe spleen, but also of the lungs and of the heart in the heart theapex was completely detached and floating in the pericardium, whichwas intact there was no fracture of the ribs nor subcutaneous orsub-muscular ecchymoses the age of the subject was thirty-two, sothat the costal cartilages were not probably ossified, which may haveaccounted for the absence of fracture of the ribs crushes by the fall of heavy weights resemble the latter class ofcrushes, and differ from falls from a height in the fact that thewounds are usually limited to one region the lesions themselves aremore or less similar similar internal lesions may be caused by thecompression of the chest and body by the knee of a murderer, which mayoccasion rupture of the internal organs, fractures of ribs, etc thus, too, from the pressure of a crowd the ribs may be fractured and thelungs injured it is writingicularly in these paper of injury from crushesor falls from a height that we may have most difficulty, as far as themedical evidence goes, of distinguishing between accident, suicide, and murder but the various points and considerations mentioned abovewill essaytimes enable the medical witness to clear up the case inessay paper the non-medical evidence, circumstantial and otherwise, maybe sufficient of itself, or at least in conjunction with the medicalevidence in falls from a less high place ptcas essay 2016 the difficulty is essaywhat different, for here there may arise the question between a fall and a contusion orcontused wound, and the question generally lies between accident andmurder, or, very rarely, between accident and suicide we have referredto both of these questions above, and from the facts mentioned the casecan often be solved of more than one injury which was the first inflicted?. We can essaytimes tell the order in which wounds were received, butthe question is rarely answerable with certainty if one wound ismortal and one or more are not, whether the wounds are suicidal orhomicidal, it has essaytimes been considered that the former must havebeen inflicted last but we cannot admit that as a general rule themost grave wound was the last inflicted for the murderer or suicide, especially the former, may go on wounding after the infliction of amortal wound, especially as it is the exception, and not the rule, to die instantly after a mortal wound several assailants may haveinflicted wounds at the same time, which would still further increasethe difficulty the question might then arise, which assailant hadinflicted the mortal wound or which had first inflicted a mortal wound?. Under such circumstances, it would not be easy to give a specificanswer there are several signs which may indicate which wound wasfirst inflicted in certain paper an instrument may become duller oreven bent or twisted after and on account of the first wound, and thesubsequent wounds would vary accordingly the wound of the clothescorresponding to the first stab-wound may be and often is only bloodyinternally, while the second and following wounds are bloody on bothsides the following case quoted by taylor659 from the annalesd’hygiene, 1847, p 461, illustrates this point a man received threestabs from an assailant, one in the back at the level of the eighthrib, traversing the lung and heart and causing rapid death, and two onthe left elbow, cutting the coat and shirt but only grazing the skin the first one was evidently the first inflicted, for both the wounds inthe clothing on the arm were bloody externally at the edges, althoughthere was no blood effused here the correctness of this opinion wasconfirmed at the trial the point of a knife arrested and broken off in a bone may show thatthis was the last wound the amount of bleeding may show which was thefirst wound thus if several severe wounds have been inflicted, allor several of which would naturally cause profuse hemorrhage, and oneshowed signs of such hemorrhage while another did not, the former wouldbe likely to be the first wound inflicted or if one showed slighthemorrhage where much would be expected, this fact would indicate thatit was one of the last inflicted the absence of the signs of spurtingblood may tell which of two or more fatal wounds were first inflicted, for this would indicate that this wound was inflicted when the heartaction was weakened by loss of blood or even after death, and theother wound or wounds which did not present this sign would have beenthe first received in fact, if any of the signs are present about awound which we have seen to indicate that a wound was inflicted at anytime after death, this would show that this wound was not the firstreceived, and that the other or others were inflicted earlier questions as to the consequences of wounds not fatal may often bebrought up in civil actions for damages in certain countries thequestion of the consequences as to incapacity may determine whetheran injury shall be the ground of a criminal as well as of a civilaction thus in france an injury which involves an incapacity of twentydays or more subjects the assailant to a criminal action the term“incapacity” in this instance refers to general incapacity and notto incapacity for fine and professional work the latter, however, comes in under the civil action which may be instituted against theassailant or those directly or indirectly responsible for the injury the amount of the incapacity, its causes, whether due wholly or writinglyor not at all to the given injury, the probable duration of theincapacity, the treatment which it has and will necessitate, and thesisother such questions form writing of the medical testimony required insuch paper essaytimes with slight wounds the results, accompaniments, and complications may prolong the incapacity very greatly, as also thestate of health and the habits of the wounded person, the neglect oftreatment, improper treatment, etc any bodily or mental infirmity or ill-health which may result from aninjury and its necessary treatment in the past and future, all thesequestions and thesis more unnecessary to mention may be required of themedical witness no general rules can be laid down for all such paper in giving his testimony the medical man must depend in any writingicularcase upon his knowledge, judgment, and experience we can seldom give a precise solution of the question of survivalto determine the succession or inheritance if several of a family dietogether in an accident in case of death from inanition, cold or heat, or in drowning especially, if essay have wounds more or less grave inthemselves, we can essaytimes form an opinion with wounds we cannotoften do so, although in case of murder, the nature of the wounds, theposition of the bodies, the examination of the spot of the accident ortragedy, may essaytimes help us to form an opinion incised and punctured wounds and wounds of blunt instruments regionallyconsidered the several varieties of wounds which we have been considering varyconsiderably in their nature, their effects, their danger, and inthesis other ways according to the region of the body in which they aresituated essay of these varieties are common in one situation andalmost never occur in others although the nature of wounds found inthe several regions of the body is not as important for a medicaljurist as their danger and their influence in causing death, we willnow consider the differences they exhibit on account of the region inwhich they occur wounds of the head these are often characterized by their apparent harmlessness andtheir real gravity sooner or later we might almost make the oppositestatement and say that those apparently grave are often virtuallyharmless, though this would be true only in a limited sense and incertain paper as to their nature, we find punctured wounds extremely rarely, incised and lacerated wounds often, while contusions and contusedwounds are still more common incised and lacerated wounds of thehead involve the scalp almost exclusively these wounds heal remarkablywell, even when the attachment is merely by a narrow pedicle, owingto the abundant blood-supply hemorrhage from the incised wounds isoften free, for the vessels cannot retract, but it is seldom dangerousunless the wounds are very extensive the only way in which they differmaterially from similar wounds elsewhere is in the greater frequencyof complicating erysipelas here than elsewhere this is probablyowing to the presence of septic conditions, as the head is generallydirtier than other writings of the body, and slight wounds especiallyare neglected if the scalp is shaved over a wide margin and cleanedlike other writings of the body, erysipelas is found little or nooftener than with similar wounds elsewhere the density of the scalpis so great that the redness and swelling accompanying inflammationsis comparatively slight if erysipelas follows slight wounds of thehead, there is essay reason to suspect constitutional predisposition orcareless treatment from infection of such wounds of the scalp abscessor diffuse cellulitis of the scalp may develop as well as erysipelas the constitutional symptoms in such a case may be marked or evensevere, but the prognosis is favorable in very rare paper necrosis ofthe skull may result or the inflammation may even extend to the brain these incised and lacerated wounds of the scalp are usually accidentalor inflicted by another. They are rarely self-inflicted contusionsand contused wounds are the most common forms of injury to the head these two kinds of injuries are almost invariably inflicted by anotheror are accidental we have already seen that contused wounds of thescalp or over the eyebrow may closely resemble incised wounds in theselocalities this fact should be borne in mind, as careful examinationcan usually distinguish them if they are fresh and until they begin togranulate these wounds are liable to the same complications as incisedwounds, in fact more liable, as the contusion makes the wound moresusceptible to inflammation and the edges are more apt to be infectedat the time of the injury one of the results of contusions of the head is the extravasation ofblood, most often between the aponeurosis of the occipito-frontalismuscle and the pericranium these extravasations are usually in theform of a hematoma such hematomata often present a hard circular oroval rim with a softer centre, and may readily be mistaken for fractureof the skull with depression the diagnosis between hematoma anddepressed fracture is not usually difficult, however, for with hematomathe ridge is elevated above the level of the skull and is movable onthe surface of the skull. Also the wounded edges often pit on pressure with depressed fracture, on the other hand, the edge is at or about thelevel of the rest of the skull. It is sharper, more irregular, and lessevenly circular contusions and the resulting hematoma may occasionallyend by suppurating, but this event is rare contusions and contusedwounds may occasionally show the marks of a weapon, indicating thatthey were inflicted by another also the position of the injury willindicate its origin, whether it is accidental or inflicted by another, for the former would not naturally occur on the vertex unless the fallwas from a considerable height another result of injuries to the head, especially of contusions andcontused wounds, is fracture of the skull this may be simple orcompound, depressed or not, etc fractures are serious inasmuch asthey imply a degree of violence which may do damage to the brain the fracture itself, especially if properly treated, affords a goodprognosis, irrespective of any brain lesion one variety of fracture ofthe skull offers an exception to this favorable prognosis, and that isfractures of the base of the skull these may be fatal directly frominjury of the vital centres at the base of the brain or soon fatal fromhemorrhage in these writings or the fatal result may be secondary to aninflammation or meningitis which good treatment is often unable toprevent it should not be considered that these fractures are uniformlyfatal, for quite a considerable proportion recover fracture of thebase usually occurs as the result of a fall the injured person mayland on the feet or buttocks, and yet receive a fracture of the base ofthe skull, the force of the fall being transmitted through the spine tothe base of the skull fracture of the base of the skull usually occursfrom an injury to the vault, not by contre coup, but by extensionof a fissure found higher up in the skull this extension takes placein the same meridian line of the skull with that of the force whichproduced the fracture, and in this way the base of the skull isfractured in different writings according to the point and direction ofthe application of the force thus in case the force compresses theskull antero-posteriorly the fracture will pass antero-posteriorlytoward the base from the front or the back, whichever received the blow see fig 13 fractures of the vault of the skull occasionally occuropposite to the point struck. This may occur by contre coup, but notalways so, as not infrequently in such rare paper a close examinationmay reveal an extension of a fissure from the point injured to theopposite pole of the skull the shape and rarely the size of a fractureof the skull, especially if punctured in character, may show the shapeand more rarely the size of the instrument or object which producedit awriting from fracture of the base, the prognosis in fracture of theskull is serious, mainly on account of the danger of inflammation, which is greater in compound fractures, and also on account of the moreremote danger of irritation from depressed fragments causing epilepsy, insanity, etc , at a later period illustration.