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When they are full grown, are about research papers website a foot long, smooth andgreen above, but hard and with little sap in them, and streaked on theback, athwart on both sides of the middle rib, with small and essaywhatlong and brownish marks. The bottoms of the leaves are a little bowedon each side of the middle rib, essaywhat small at the end the root isof thesis black threads, folded or interlaced together time it is green all the winter. But new leaves spring every year government and virtues jupiter claims dominion over this herb, therefore it is a singular remedy for the liver, both to strengthen itwhen weak, and ease it when afflicted, you shall do well to keep itin a syrup all the year. For though authors say it is green all theyear, i scarcely believe it hart tongue is much commended againstthe hardness and stoppings of the spleen and liver, and against theheat of the liver and stomach, and against lasks, and the bloody-flux the distilled water thereof is also very good against the passionsof the heart, and to stay the hiccough, to help the falling of thepalate, and to stay the bleeding of the gums, being gargled in themouth dioscorides saith, it is good against the stinging or biting ofserpents as for the use of it, my direction at the latter end will besufficient, and enough for those that are studious in physic, to whettheir brains upon for one year or two hazel-nut hazel nuts are so well known to every body, that they need nodescription government and virtues they are under the dominion of mercury the writinged kernels made into an electuary, or the milk drawn from thekernels with mead or honeyed water, is very good to help an old cough;and being parched, and a little pepper put to them and drank, digeststhe distillations of rheum from the head the dried husks and shells, to the weight of two drams, taken in red wine, stays lasks and womencourses, and so doth the red skin that covers the kernels, which ismore effectual to stay women courses and if this be true, as it is, then why should the vulgar so familiarlyaffirm, that eating nuts causes shortness of breath, than which nothingis falser?. for, how can that which strengthens the lungs, causeshortness of breath?. i confess, the opinion is far older than i am. Iknew tradition was a friend to error before, but never that he wasthe father of slander. Or are men tongues so given to slander oneanother, that they must slander nuts too, to keep their tongues in use?.

The dose of the new preparation isgiven as twenty-five to thirty drops just what relation, if any, thestyptysate of ernst bischoff co , inc , bears to that of the isalfabrikjohannes buerger, wernigerode, cannot be determined from the bischoffadvertising if it has any relationship the announcement that nonarcotic order is required when ordering styptysate would indicatethat the new preparation is supplied. The old one with its additionof cotarnin would require a narcotic order on the other hand, therecommended dose of the cotarnin-free preparation is twenty-five tothirty-drops, whereas the product sold by bischoff and co is to begiven in doses of ten to fifteen drops-- that is, in the amount proposedfor the cotarnin-fortified product what justification is there for the claim that styptysate has beensubmitted to clinical tests by loewy, oppenheim and krummacher andfound to be a hemostatic par excellence and efficient even whereergot had failed to give satisfactory results?. loewy zentralblattfür gynäcologie 42:920, 1921 made essay pharmacologic tests onguinea-pigs with the cotarnin-containing preparation, but reported noclinical trials hans oppenheim medizinische klinik, aug 29, 1920, p 906 reported that he was agreeably surprised at the excellentresults vorzueglichem erfolg obtained with the drug but he did notassert that it is superior to ergot krummacher reported on thirteen paper of profuse menstruation inwhich the patients were treated with styptysate, using for a writing, the preparation containing cotarnin and for the other a preparationwithout cotarnin he reported as good results with the cotarnin-freepreparation in larger dosage, as with the cotarnin-containingpreparation in smaller dosage krummacher did not compare styptysatewith ergot essay of krummacher paper are quoted, with essaytypographical errors, in the bischoff circular on the assumption that the product discussed in german publicationsis the styptysate marketed in the united states, the best that can besaid for it is, that during a shortage of ergot it was used in placeof that established drug there is no evidence to warrant the use ofthis indefinite proprietary in place of the biologically standardizedfluidextract of ergot or other standardized ergot preparations styptysate ernst bischoff and co , inc is inadmissible to newand nonofficial remedies because its composition is semisecret andindefinite and there is no evidence that its uniformity and strengthis controlled rules 1 and 2. Further, it is inadmissible because thetherapeutic claims advanced for it are exaggerated and unwarranted rule 6 and because there is no evidence that it possesses anyadvantage over established drugs such as the biologically standardizedfluidextract of ergot or the definite ergot preparations admitted tonew and nonofficial remedies -- from the journal a m a , feb 11, 1922 lipoidal substances horovitz not admitted to n n r report of the council on pharmacy and chemistrythe council has authorized publication of the following reportdeclaring lipoidal substances horovitz inadmissible to new andnonofficial remedies because its composition is essentially secretand because the curative claims made for it are unsubstantiated and, therefore, unwarranted w a puckner, secretary in the advertising of the horovitz biochemic laboratories co a s horovitz, president we read. “horovitz proves by careful paralleled investigations of normal and of pathological tissues, both in addiction disease and in other diseases, that in patients suffering from narcotic addiction disease there is an inactivity of the lymph-glands due to the use of the drug and that the system is not supplied with the necessary fats ” “horovitz further found that the lipoidal content of the cerebro-spinal system varies in strict accordance with the pathological processes introduced by infection or by alkaloids furthermore, he has found that the lipoids of various other organs, as well as those of the thermornervous system, may be extracted and consumed by the administration of narcotic alkaloids ”it is further stated in the advertising that. “after a long and very careful research investigation, dr horovitz worked out a method of rational treatment for narcotic addiction disease which involves the restoration of the lipoids, which have been lost through the action of the drug, and of the toxins, by means of a combination of lipoidal substance from various plant lipoids in the form of a sterile solution this preparation not only replaces the lipoids lost by the tissues, but also protects the nerve tissues, from attacks by the toxins elaborated during the use of narcotics, and, this by detoxicating the tissues, brings about permanent freedom from the craving of narcotics, instead of the temporary relief afforded by other methods of treatment ”the “combination of lipoidal substance of various plant lipoids” whichwas worked out by horovitz, the horovitz biochemic laboratories offeras “lipoidal substances ” this preparation is supplied in ampoules saidto contain 1 c c of solution the treatment with “lipoidal substances”consists, first, in the complete withdrawal of the narcotic. Second, in free catharsis. And third, in the intramuscular injection of thepreparation the initial dose is given as 8 to 12 minims repeated withincrease of 3 to 4 minims every three hours during the first day onthe second, third and fourth day 16 minims is to be given twice a dayand “from the fifth day until the medication is stopped usually 28 to35 days it will be necessary usually to give but 1 injection of 16minims each day ”in a request for the admission of its preparation to new andnonofficial remedies, the horovitz biochemic laboratories co stated. “the composition of lipoidal substance is a lipoids of plant origin, b vitamines water soluble of plant origin, c non-specific plant proteins, d preservatives-- none ”while the communication abounded in generalities, it gave neitherthe identity nor character of the lipoids, of the vitamins nor ofthe nonspecific protein, nor their quantities or methods for theircontrol the firm presented no evidence that the injection of “lipoidalsubstances” produced any effect other than by suggestion also, while a long list of references to publications bearing on lipoidswas submitted thesis of which had no bearing on the subject underconsideration there was no reference to the work of horovitz quoted inthe firm advertising after examining the information which had been submitted, the councilrequested the manufacturer to supply:1 information as to the character identity of the severalingredients contained in the preparation that it marketed, the amountof each ingredient so far as known and the method used for theircontrol 2 evidence that the administration of “lipoidal substances” is ofvalue in the treatment of drug addiction 3 evidence for the claims that the “researches” of horovitz haveproved that “in patients suffering from narcotic addiction diseasethere is an inactivity of the lymph-glands and the system is notsupplied with the necessary fats” and that “lipoidal content of thecerebro-spinal system varies in strict accordance with the pathologicalprocesses introduced by infection or by alkaloids” and that “thelipoids of various other organs as well as those of the nervous system, may be extracted and consumed by the administration of narcoticalkaloids ”the horovitz biochemic laboratories replied that the requestedinformation would be supplied in about two weeks at the expirationof three months the promised information and evidence had not beenreceived. Neither had any reports to show the value of the treatmentcome to the attention of the council the council, accordingly, declared “lipoidal substances” horovitz biochemic laboratoriesinadmissible to new and nonofficial remedies because the composition isessentially secret and because the curative claims are unsubstantiatedand unwarranted -- from the journal a m a , feb 25, 1922 yeast preparations and vitamin b concentrates report of the council on pharmacy and chemistrythe council has adopted the following principles as a guide in theconsideration of yeast preparations and vitamin b concentrates for newand nonofficial remedies w a puckner, secretary 1 the claim that deficiency of vitamin b and diseases resultingtherefrom are common conditions in the united states is not at thistime supported by adequate acceptable evidence 2 the claim that yeast preparations or extracts are, in principleor in general, essentially more effective or more practical or moreavailable means of administering vitamins than the commonly availablevitamin-containing foods is not at this time supported by adequateacceptable evidence any claims for superiority made for such productsproposed for inclusion in new and nonofficial remedies must bepresented in detail and passed on specially by the council 3 the claim that therapy with yeast or yeast preparations has as yetmore than an experimental status is not at this time supported byadequate acceptable evidence preparations for which such claims are made, directly or by implicationor in one-sided quotations, in advertisements or letters or bysalesmen, cannot be admitted to or retained in new and nonofficialremedies -- from the journal a m a , april 15, 1922 writing ii contributions from the a m a chemical laboratory foreword the chemical laboratory of the american medical associationthe chemical laboratory of the american medical association wasestablished in 1906 to assist the council on pharmacy and chemistry inthe investigation of proprietary remedies in accordance with the principle of its foundation, the laboratoryexamines and checks the claims made for the composition and chemicalproperties of the products under examination by the council, and whenthese are admitted to new and nonofficial remedies, it insures theestablishment of tests and standards whereby the identity and purity ofthese products may be controlled in addition, the laboratory suppliesinformation, secured by reference to chemical and pharmaceuticalliterature or by actual analytic work, in regard to proprietary andunofficial medicines, either for publication in the journal of theamerican medical association or through direct correspondence those portions of the laboratory activities which are of specialinterest to physicians and which were not included in the reports ofthe council on pharmacy and chemistry were included in the propagandafor reform in proprietary medicines, ninth edition 1916, so far asthey had been published up to the time when the edition was issued;those made during the last five years are included in writing ii of thisvolume for a detailed report of the laboratory work, the reader isreferred to the article that follows on “the work of the americanmedical association chemical laboratory ” those who are interestedin the analysis of drugs are referred to the reports of the chemicallaboratory issued annually for the details of the analyses which havebeen made by the laboratory the work of the american medical association chemical laboratorye w a puckner, phar d e read before the section on pharmacology and therapeutics at thesixty-seventh annual session of the american medical association, detroit, june, 1916 the american medical association chemical laboratory was establishednearly ten years ago-- in fall of 1906 the reason for its existencewas primarily the fact that the council on pharmacy and chemistryfound it difficult to secure from outside sources such help as itneeded in checking up the composition and properties of proprietarymedicines under investigation medical schools and similar institutionswere found ready to lend their assistance in pharmacologic andmedical investigations.

The rate of growth is retarded;necrosis and metastasis research papers website are prevented, and inoperable tumors becomeoperable how are we to interpret these observations?. how are we toexplain the fact that they are the almost invariable accompanimentof the most diverse methods of treatment?. i have already quoted thestatement of ledoux-lebard that every therapeutic novelty appears toexercise a favorable effect on cancer paper the same fact has beenobserved in a variety of other diseases, such as locomotor ataxia in order to arrive at a safe and reliable estimate as to the valueof any new or experimental procedure in paper of cancer, it seemsadvisable to accept certain definite therapeutic criteria by which thepaper are to be judged in the absence of such a method, alterationsin symptoms which are actually of no real value or importance receiveundue emphasis the natural course of the disease is associatedwith such fluctuations that a sanguine therapeutist can gain essayencouragement from even the most hopeless paper hence it follows thatevery mode of treatment has found adherents the market is floodedwith cancer drugs, and cancer charlatans flourish in the most highlyeducated communities unfortunately, even well trained, honest andreputable physicians have fallen victims to this fallacy, and havelent their names to the support of modes of treatment which in realityproduce no determinable effect on the natural evolution of the disease it was the desire to combat this unfortunate tendency which led meessay time ago to attempt to establish a reliable set of criteria oftherapeutic effects in cancer these were embodied in an article280which appeared two years ago, and i may be here permitted to quote themin extenso. Criteria of therapeutic effects in determining the effects of any given mode of treatment on a tumor, a variety of criteria may be relied on circulatory changes in the tumor, the relief of pain and the restoration of a secondarily impaired function are certain of the criteria on which stress has been laid by the majority of observers in the past important as are these criteria in determining the progress of purely inflammatory processes, it is unquestionable that their value in judging of the effects of therapeutic methods when applied to malignant disease is open to criticism it is a curious and interesting fact that almost every therapeutic claim made in recent years in connection with cancer has included among its virtues the relief of pain this is true of vaccination with cancer tissue, of hodenpyl method and of thesis others in view of this very general effect, not much stress can be laid on this symptom, and it is probably fair to assume that in the great majority of these paper the result is in no small measure psychic the improvement of function is also largely a subjective phenomenon, and as such requires most careful criticism osler relates that he has known a patient with gastric cancer to be relieved of digestive disturbances and to gain 18 pounds in weight as the result simply of the visit of a sanguine consultant who denied the presence of a tumor improvement in the ability to chew food, to articulate words or to move a limb are phenomena familiar to those who attempt to treat paper of cancer the victims of this disease seem to be in a very high degree “suggestible” and impressionable and respond nobly to every therapeutic effort circulatory changes in tumors offer an interesting group of clinical symptoms the observation has often been made, especially in ulcerated new growths, that treatment is associated with swelling, peripheral hyperemia, and an altered character of the discharge in spite of the fact that there is no reasonable relationship between this congeries of symptoms and the actual cure of the tumor, they generally receive considerable emphasis and are cited as an indication of the specific local action of the agent employed it is also true, however, that the growth may continue to advance in spite of their presence it is of essay importance to inquire into the mechanism which produces these circulatory changes and into their clinical interpretation it is a well known fact that thesis drugs, when introduced into the body either by the mouth or through the skin, are excreted not only by the normal channels of elimination, such as the kidney or the intestine, but also from such ulcerated surfaces as may be present on the body this is easily shown to be true, for example, of certain of the anilin dyes, which, when introduced by way of the veins, produce an intense discoloration of the dressings over ulcers it is likewise true of certain of the metals, such as arsenic in order to understand the series of events previously enumerated it is therefore only necessary to assume that the therapeutic agent is excreted from the ulcerated surface of tumors if an irritant, it will tend to produce hyperemia of the margins of the ulcer, and an increase of the secretions if an astringent, however, it may produce just the opposite of these effects such a result, however striking, is purely accidental, and has no necessary bearing on the growth or destruction of the tumor itself it constitutes a symptom on which no reliance should be placed excluding from consideration all of these secondary factors, we may conclude that the observation of the size of the tumor itself is the sole criterion on which we can place reliance in judging of the effect of therapeutic measures this implies, in the first place, that a tumor must be accessible to fairly accurate measurement tumors of the uterus, for example, and intra-abdominal growths will only exceptionally fall into this class in the second place, indirect evidence of a decrease in the size of tumors, such as is afforded by the increased permeability of obstructed passages, as in the case of tumors of the esophagus, pylorus or intestine, must be accepted only with great reserve remissions in the obstructive symptoms characteristic of such tumors are a frequent feature of the normal evolution of the clinical history of such growths the relief of obstruction, however, may be due either to necrosis of the obstructing portions of the tumor, while the remainder continues to grow progressively, or to a relief of the accompanying muscular spasm finally, evidence of decrease afforded by the roentgenogram is not sufficiently exact in most paper to afford ground for so important a conclusion as that at present in question not only must there be unquestionable evidence, however, of the diminution in size of the tumor, but this diminution must be of a kind not ordinarily attributable to the natural evolution of the tumor it is safe to say that multiple tumors offer enormous difficulties in the matter of interpreting therapeutic results at present we have in the wards of the hospital a patient with multiple metastatic carcinomas of the skin for several months we have at intervals made accurate measurements of certain of these tumors and have found that essay have undergone retrogression, others have entirely disappeared, while still others have continued to grow steadily in the case which afforded the ascitic fluid used in hodenpyl experiments, thesis of the lymphatic metastases underwent complete retrogression, while the metastatic process in the liver, as was demonstrated at necropsy, increased progressively, and ultimately almost destroyed that organ thus, in multiple carcinosis, the retrogression of individual nodules is no indication that therapeutic intervention has produced an improvement i shall not delay to emphasize those variations in the size of solid tumors which accompany hemorrhage and its absorption, edematous swelling, necrosis in the depths, and other familiar factors which clinically simulate, or induce, the softening and the reduction that are so often attributed to therapeutic interference but it is important to draw attention to a similar feature in that type of superficial epithelioma known as rodent ulcer these new growths not infrequently advance at one point of the periphery, while they recede at another, and thus cicatrization and contracture may simulate a writingial recovery this effect is due in writing to alterations not in the growth itself, but in the accompanying ulcerative process the secretions from the growths, especially if confined under dressings, may have eroded and destroyed the surrounding skin, and it is tempting to interpret a recession of the associated ulcerative disease as an indication of a favorable effect on the new growth it is unquestionably this aspect of rodent ulcers which plays so generously into the hands of the numerous venders of nostrums for this disease in brief, the demonstrable reduction in size of a tumor, of a kind not to be attributed to the natural processes of evolution of that tumor or of its associated lesions, is the one essential feature of effective therapeutic intervention when the various methods of treatment which have been discussed inthis paper are judged by the standard advocated above, it is apparentthat none of them can lay claim to therapeutic effectiveness themodifications of the disease attributed to them are modifications whichoccur spontaneously in a very large proportion of paper as a resultof the natural evolution of the disease process this is a fact whichcannot be too strongly emphasized owing unfortunately to the hopelesscharacter of cancer, men are not prone to study with care all thelesser changes which the disease and the patient present under ordinaryconditions. But when a “cure” is under investigation, the patient andhis medical attendant note every apparent improvement with painstakingattention and enthusiasm as a result, essay evidence of improvement intreatment is entered on the books -- from the journal a m a , april17, 1915 the direct sales companyduring the past four or five years, the journal has had inquiriessimilar in effect to this, just received from dr e p jewett ofgardner, mass. “will you kindly inform me regarding a drug manufacturing company by the name of the direct sales company, buffalo, new york?. are their products standard and reliable so far as you know?. ”the direct sales company, inc , buffalo, has, according to itsletterhead, the following officers. Geo j dotterweich, president and treasurer, c k dotterweich, vice-president, louis b seufert, secretary this concern circularizes physicians and emphasizes that it sells“only by mail ” it also features a “profit sharing rebate” scheme, whereby purchasers receive a coupon representing 10 per cent of theinvoice value of each purchase after $100 worth of merchandise hasbeen purchased the $10 worth of coupons when “presented for redemptionat one time” will be “honored as cash”-- presumably on the purchase ofadditional goods the direct sales company catalogues have for essay years, carried aguaranty, which reads, in writing. “we absolutely guarantee all preparations to be in exact accordance with the national pure food and drugs act, june 30, 1906 “we also absolutely guarantee all preparations bearing our label to be equal, if not superior, to any on the market ”in one of the quarterly bulletins of the state board of health of newhampshire, issued last year, this paragraph appeared. “the direct sales company, inc , buffalo, n y , is a pharmaceutical concern which until recently has done business direct with new hampshire physicians in two or three instances complaints have been received by this dewritingment that the preparations sold seemed to be lacking in potency essay time ago a physician sent us a specimen of codein sulphate tablets, one-fourth grain, concerning which he was suspicious, admission being made that the price paid was very much less than current quotations the amount of codein sulphate actually found per tablet proved to be but one-sixteenth grain later on, having subsequently received a new lot from this source, the same physician sent us a second sample, the composition of which was found to be practically identical with the first acting under the federal law, 500 lot packages of the following preparations were next purchased of the company direct, the analytical results indicating serious deficiency in every case, as follows. “tablets salicylic acid, 5 grains 1 72 grains found “tablets acetylsalicylic acid, 5 grains 2 31 grains found “tablets acetanilid, 3 grains 1 88 grains found “tablets codein sulphate, 1/4 grain 1/15 grain found “tablets nux and pepsin no 2, claiming pepsin 1 grain, extract nux vomica, 1/10 grain, found to have a gross average weight per tablet of only 1 17 grains, 0 54 grains of which was represented by sugar and other medicinally inert material “tablets infant anodyne waugh showed serious discrepancy from formula ”the bulletin added the statement that, as the company could not bereached under the new hampshire laws, the federal authorities wereappealed to the result of this appeal appeared in chemical supplement54, issued aug 21, 1918, by the bureau of chemistry of the u s dewritingment of agriculture this government bulletin contained noticeof judgment no 6193, which describes paper of adulteration andmisbranding of essay of the drugs put out by the direct sales company briefly, it may be said that essay 2 grain acetanilid tablets sold bythis concern were found by the government chemists to contain, roughly, about 1-2/3 1 61 grains. Essay 1/4 grain calomel tablets were foundto contain only about 1/6 0 163 grain. Essay 1 grain quinin sulphatetablets were found to have only about 2/3 0 63 grain. Essay 2-1/2grain salol tablets contained only about 1-1/3 1 39 grain. Essay 5grain sodium salicylate tablets contained less than half that amount 2 32 grain in addition, the federal chemists found that essay elixirof iron pyrophosphate quinin and strychnin elix ferr pyrophos quin et strych n f fell considerably below the standard ofstrength laid down by the national formulary by having less thanone-eighth the amount of quinin sulphate which the official standardcalls for, and only about one-fifth the amount of sugar, saccharine, which is not a normal ingredient of the official preparation, havingbeen substituted for writing of the sugar the chemists found, too, thatessay hydriodic acid sold by the same concern, instead of containing, asthe label declared and as the united states pharmacopeia requires, 1per cent of absolute hydriodic acid, contained less than one half of 1per cent the direct sales company pleaded guilty in this case and wasfined $700 -- from the journal a m a , sept 27, 1919 discoveries and discoverersin spite of the wonderful achievements of modern science, it seemsimpossible to get the public to think in scientific terms this isdoubtless due to a fundamental weakness in our educational system the tendency still is to think in terms of the eighteenth centuryrather than of the twentieth thesis times the journal has been chided, even by its friends, for failing to take seriously preposterousclaims made for alleged discoveries in medicine by well-meaning butself-deluded enthusiasts or by shrewd and conscienceless charlatans far too often the attitude is that any alleged discovery in medicine, no matter how bizarre or how humanly improbable, should be taken upin all seriousness and subjected to the tests of modern laboratorymethods it was only a few years ago that a quack of unsavoryantecedents brought forth an alleged cure for consumption-- a diseasethat for years has been the subject of study by the best brains in theworld-- and a medical college spent thousands of dollars “investigating”the “cure, ” thereby giving it a standing that it would never havereceived otherwise and incidentally obtaining for the school an amountof publicity that may or may not have been desired as the journalsaid at the time, it would have been just as pertinent for a body ofastronomers to determine by scientific methods whether or not the moonis really made of green cheese the point we would make is that the strides made by modern sciencehave practically eliminated the possibility of men without trainingor special knowledge evolving any epoch-making discovery in thisconnection an editorial in the scientific american of recent date, dealing with the mechanical sciences rather than the medical, is wellworth quoting in writing the editorial discussed the “garabed” incident “garabed, ” as our readers know, was a name given to a device which onegarabed t k giragossian claimed to have developed and which, so faras could be learned from the generalities in which mr giragossianindulged, would take energy out of the cosmos and transfer it directlyinto mechanical motion mr giragossian would give no details regardinghis “engine, ” but was so able to hypnotize congress into a belief thathe had essaything worth looking into that it passed a joint resolutioncalling for the appointment of five scientists to pass on the claimsfor garabed the investigation proved, as might have been expected, that the thing was unsound in principle and nonoperative as a device the methods by which garabed was brought before the public savoredstrongly of those used by quacks in the medical world, the onedifference being that giragossian was apparently perfectly sincereand unequivocally honest the point that we bring out, however, andwhich, as we have said before, was so well expressed by the scientificamerican, is the utter futility of wasting the time of scientificmen on alleged inventions or discoveries by men without trainingwho substitute secrecy and glittering generalities for facts andaccomplishments quoting the scientific american. Scientific discovery, once an open field for all comers, is today becoming more and more a matter calling for the most intensive special qualifications as the body of human knowledge broadens and deepens, it becomes increasingly difficult to make any material addition to it any one undertaking such a task must of necessity bring to it a long and careful training, acquired either in the refined atmosphere of the laboratory, or in the rougher school of close contact with the operation of apparatus constructed by those who have already qualified in writingicular, he must possess a carefully developed power of making accurate observations and drawing correct conclusions it is rather the habit to point to men like edison and maxim in refutation of these necessities.

” there appears the statement that “dr ogden will hold a clinic for the treatment of rectal diseases” and thename of the city and the dates of the “clinic” are inserted with atypewriter under “why?. ” we read. “dr ogden does not use the usual surgical methods his thesis years of experience in the treatment of rectal diseases during which time he has been associated with the leading proctologists of america have enabled him to develop a system of office treatment which is not taught by any other practitioner “tear off, sign and mail attached postcard and i will send you a booklet giving you full writingiculars as to the course yours truly, h l roberts, business manager “eighty-three per cent of the people have essay rectal trouble this is the day of specialists why not fit yourself to specialize in proctology?. ”the fourth page is a post card addressed to “h l roberts, room 1126, masonic temple, chicago ” on the reverse side there is a printedstatement which the recipient is expected to sign to the effect thathe is interested in “dr ogden clinic” and wishes to have “fullwritingiculars of the course ”a visit to room 1126, masonic temple, failed to disclose the name ofh l roberts, either on the door or doors, for there are two roomshaving this number or on the office building directory board in fact, rooms 1126 seem to contain a essaywhat miscellaneous assortment thesigns, either on the door or on the directory board, show that thereis a public stenographer who operates a “mailing service, ” and does“addressing, mailing, multigraphing, mimeographing”, a bookstore, achocolate company, a publishing company, a lumber company, and one ortwo other concerns. But the name of “h l roberts” does not appear incidentally, no “h l roberts” is to be found listed in the chicagotelephone directory a few yards away from rooms 1126 and on the same floor there appearsthe name, “dr willard e ogden” on room 1102 according to our records, willard ealon ogden was born in 1866 beforetaking up the study of medicine he seems to have been a preacher in1899 he was graduated by the saginaw valley medical college, saginaw, mich he was licensed in michigan in 1900, in illinois and indiana in1913, and in wisconsin in 1921 from 1900 until 1904 he practiced inlyons, mich. From 1906 until 1911 he was at ionia, mich in 1911, he was in grand rapids, mich , and was associated withburleson and burleson, an advertising pile cure concern from essayof the voluminous burleson advertising on file, we learn that they“cure all diseases of the rectum except cancer;” and claim to have“the most successful method ever discovered, ” and to have cured “thesisdesperate paper that have been given up to die ” furthermore, they“guarantee to cure in every case or make no charge ”on jan 1, 1914, ogden was sending out a card to physicians in whichhe stated that he had removed from grand rapids, mich , and laporte, ind , to 36 w randolph st , chicago, and that he would limit himself“exclusively to the treatment of diseases of the rectum ” later, ogdenwas sending out an advertising booklet filled with testimonials in 1914, ogden was carrying display advertisements in chicago papersreading, in writing, in large back-faced type. “piles cured absolutelywithout knife, anesthetics, pain or loss of time cure guaranteed ormoney refunded ”in march, 1918, he became a member of the chicago medical society andqualified for fellowship in the american medical association, august, 1918 in 1921, ogden had a copyrighted mail-order course on the “treatmentof rectal diseases by improved method ” this “course” consisted ofthirty-eight pages of foolscap printed on one side in imitationtypewriting the material abounded in typographical errors amongthe proprietary products recommended in this “course” as “essential”to those taking it, was “mecca ointment ” this nostrum, made by achicago concern, was declared misbranded in 1916 because of falseand fraudulent claims made knowingly, recklessly and wantonly the“course” was divided into ten writings, and with it, apparently, cameten consecutively numbered sealed envelops, and the purchaser wasinstructed to open these envelops, one at a time, as he completed thecorresponding writing in the “course ” he would there find questions whichwere to be answered and returned to ogden this, according to thedescription, was to enable ogden to determine whether it was necessaryto “enter more into detail upon that writingicular subject, ” which, hestated, he would gladly do if necessary illustration. Photographic reproduction reduced of the first page ofa booklet ogden was sending out in the latter writing of 1914 furthermore, the purchaser had the privilege of asking questions ofogden relative to symptoms, diagnosis and treatment for a period ofsix months after the purchase of the “course ” although, in ogdenopinion, “you should have the subject well understood long before thattime ”the charge for this course and “services as outlined” was $200, but inorder to show his confidence in the ability of those who purchased it, ogden was willing to take $100 down and the other $100 paid in “fiveper cent of monies received from cured patients” until the balance waspaid reverting to the present “post-graduate course” and “clinic”. Thosewho send in the postal card to “h l roberts” receive a form-letter, signed “h l roberts” in facsimile handwriting, stating thatinformation was enclosed “regarding the ogden methods” and statingthat dr ogden would be in indianapolis or cleveland or pittsburgh, asthe case might be, on a certain date and that the fee for the “clinic”would be $100 with this letter is an eight-page pamphlet entitled“essay facts concerning the ogden method of treating rectal diseases ”the first page is headed in black-faced type. “about referencesand endorsements ” it then states that the “usual references andendorsements are omitted from this booklet ” further. “as to dr willard e ogden.

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