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The examinationmust be both scientific and practical, and of sufficient thoroughnessand severity to test the candidate fitness to practise medicine andsurgery the examination may be held in the presence of the dean of anymedical school or of the president of any medical society of the state after the examination, the board must grant to a candidate who is foundqualified, a certificate to practise medicine and surgery the boardmay refuse or revoke a certificate for unprofessional, dishonorable, or immoral conduct, or may refuse a certificate to any one who maypublicly profess to cure or treat diseases, injuries, or deformitiesin such manner as to deceive the public in paper of refusal orrevocation, the aggrieved applicant may appeal to the district court ofthe county of his application 4 certificates must be recorded within sixty days after their date in theoffice of the county recorder in the county where the holder resides;or in case of removal certificates must be recorded in the county towhich the holder removes the county recorder must indorse on thecertificate the date of its record 5 exceptions - the act does not apply to midwives of skill and experienceattending paper of confinement, nor to commissioned surgeons of theunited states army or navy in the discharge of their official duties, nor to physicians or surgeons in actual consultation from other statesand territories, nor to students practising medicine under the directsupervision of a preceptor, nor to gratuitous services in paper ofemergency 6 penalty - violation of the act is a misdemeanor, punishable with a fineof from $100 to $500, or imprisonment in the county jail from thirty toninety days, or both definition - any person is regarded as practising within the meaning ofthe act who appends “m d ” or “m b ” to his name, for a fee prescribesmedicine, operates in surgery, attends in obstetrics, or recommends forthe use of any sick person the use of any drug or medicine or otheragency of treatment, cure, or relief of any wound, fracture, or bodilyinjury or disease, as a physician or surgeon 7 re-examination - any one failing to pass the examination is entitled toa second examination within six months without fee 8 fees - to the treasurer of the board, for examination, $15 s 4 to the secretary of the board, for examination, in advance, $15 s 8 to the county recorder, for recording, the usual fee 5 to the county attorney, for prosecuting a violation, to be charged ascosts, $5 7 nebraska qualification - it is unlawful for any person to practise medicine, surgery, or obstetrics, or any of their branches, without havingobtained and registered a certificate no person is entitled to acertificate unless he be a graduate of a legally chartered medicalschool or college in good standing the qualifications are determinedby the state board of health the act does not prevent physiciansresiding in other states from visiting patients in consultation withresident physicians who have complied act of 1891, c 35, s 7 a medical school is defined as a medical school or college whichrequires a previous examination for admission to its courses of study, and which requires for granting the degree of “m d ” attendance onat least three courses of lectures of six months each, no two ofsaid courses to be held within one year, and having a full faculty ofprofessors in anatomy, physiology, chemistry, toxicology, pathology, hygiene, materia medica, therapeutics, obstetrics, gynæcology, principle sic and practice of medicine and surgery, and clinicalinstruction in the last two named but the three-year clause does notapply to degrees granted prior to july, 1891 8 a person intending to practise medicine, surgery, or obstetrics mustpresent his diploma to the said board, with his affidavit that he isthe lawful possessor of the same and has attended the full course ofstudy required for the degree of “m d , ” and that he is the persontherein named such affidavit may be taken before any person authorizedto administer oaths, and it shall be attested under the hand andofficial seal of the official, if he have a seal false swearing isperjury 9 if investigation of the diploma and affidavit proves the applicantentitled to practise, the board issues its certificate, which must befiled in the office of the county clerk of the county where he resides, or intends to practise 10 the act gave physicians entitled to practise at the time of itsenactment six months in which to comply with its provisions withreference to them 11 the secretaries of the board may issue certificates, without a vote ofthe board, when the proof upon which certificates are granted may havebeen on file in its office for ten days without a vote of the board, when no protest someone write my finance paper has been filed, and if, in their opinion, the proofcomplies with the act 12 when the holder of a certificate removes to another county, he mustfile and record it in the office of the county clerk in the county towhich he removes 13 the board may refuse certificates to persons guilty of unprofessionalor dishonorable conduct, and may revoke for like causes provided theygive the person an opportunity to be heard 14 penalty - no person is entitled to receive any sum of money formedical, surgical, or obstetrical service unless he shall have compliedwith the act 15 violation of the act is a misdemeanor, punishable with a fine of from$50 to $300 and costs of prosecution, and a person convicted shallstand committed till the fine and costs are paid 16 definition, exceptions - to operate on, profess to heal, prescribe for, or otherwise treat any physical or mental ailment of another, is topractise medicine under this act but it does not prohibit gratuitousservices in paper of emergency, nor apply to commissioned surgeonsin the united states army or navy, nor to nurses in their legaloccupation, nor to the administration of ordinary household remedies17 itinerant vender - to be an itinerant vender of any drug, nostrum, ointment, or appliance for the treatment of disease or injury, or forsuch an one to publicly profess to cure or to treat disease or injuryor deformity by any drug, nostrum, manipulation, or other expedient, is a misdemeanor punishable with a fine of from $50 to $100, orimprisonment in the county jail from thirty days to three months, orboth, for each offence 18 fees - to the secretaries of the board of health, for certificate attime of application, $5 to the secretaries of the board of health, for taking testimony, samefees as a notary public is allowed for same service 19 to county clerk, for recording, usual register fees for recording10 nevada qualification - no person can lawfully practise medicine or surgery whohas not received a medical education and a diploma from essay regularlychartered medical school having a bona fide existence when thediploma was granted act of 1875, c 46, s 1 a copy of the diploma must be filed for record with the county recorderof the county in which the person practises, and at the same time theoriginal, or a certificate from the dean of the medical school of whichhe is a graduate, certifying to his graduation, must be exhibited2 the person filing a copy of a diploma or a certificate of graduationmust be identified as the person named therein, by the affidavit of twocitizens of the county, or his affidavit taken before a notary publicor commissioner of deeds for this state, which affidavit must be filedin the office of the county recorder 3 penalty - practising without complying with this act is a misdemeanorpunishable with a fine of from $50 to $500, or imprisonment in thecounty jail from thirty days to six months, or both, for each offence filing a diploma or a certificate of another or a forged affidavit ofidentification is a felony 4 exceptions - the act does not apply to a person who in an emergency mayprescribe or give advice in medicine or surgery in a township whereno physician resides, or when no physician or surgeon resides withinconvenient distance, nor to those who had practised medicine or surgeryin the state for ten years next preceding the passage of the act, norto persons prescribing in their own family 6 new jersey board of examiners - the state board of medical examiners, appointedby the governor, consists of nine members, persons of recognizedprofessional ability and honor, five of the old school, three of thehomœopathic, and one of the eclectic, among whom can be no member ofany college or university having a medical dewritingment act 1890, c 190, s 1 the board must hold meetings for examination at the capital on thesecond thursday of january, april, july, and october of each year andat such other times as they deem expedient. They shall keep a registerof all applicants for examination, showing the name, age, and lastplace of residence of each candidate, the time he has spent in medicalstudy in or out of a medical school, the names and locations of allmedical schools which have granted the said applicant any degree orcertificate of attendance upon lectures in medicine, and whether theapplicant has been rejected or licensed, and it shall be prima facieevidence of all matters contained therein 2 qualification - all persons commencing the practice of medicine orsurgery in any of its branches must apply to the board for a license applicants are divided into three classes:1 persons graduated from a legally chartered medical school not lessthan five years before the application 2 all other persons graduated from legally chartered medical schools 3 medical students taking a regular course of medical instruction applicants of the first class are examined in materia medica, therapeutics, obstetrics, gynæcology, practice of medicine, surgery, and surgical anatomy. Those of the second and third classes areexamined in anatomy, physiology, chemistry, materia medica, therapeutics, histology, pathology, hygiene, practice of medicine, surgery, obstetrics, gynæcology, diseases of the eye and ear, medicaljurisprudence, and such other branches as the board may deem advisable;questions for applicants of the first and second classes are the samein the branches common to both the board after january 1st, 1892, cannot license applicants of the second or third classes withoutsatisfactory proof that the applicant has studied medicine and surgerythree years, is of good moral character, and over twenty-one yearsof age. Applicants of the third class, after they shall have studiedmedicine and surgery at least two years, can be examined in anatomy, physiology, chemistry, histology, pathology, materia medica, andtherapeutics. If the examination is satisfactory to all the members ofthe board, it may issue a certificate that the applicant has passed afinal examination in these branches, and such certificate, if presentedby the applicant when he shall make application for a license topractise, shall be accepted by the said board in lieu of examinationin those branches all examinations shall be both scientific andpractical, but of sufficient severity to test the candidate fitnessto practise medicine and surgery 3 all examinations shall be in writing. The questions and answers, except in materia medica and therapeutics, must be such as can beanswered in common by all schools of practice, and if the applicantintends to practise homœopathy or eclecticism, the member or membersof the said board of those schools shall examine the said applicant inmateria medica and therapeutics. If the examination is satisfactory, the board shall issue a license entitling the applicant to practisemedicine a license shall not be issued unless the applicant passes anexamination satisfactory to all members of the board.

3 there were marks ofblood on the prisoner hands and clothing after a long trial he wasconvicted, though the sentence was afterward commuted to imprisonmentfor life of course, as we have already stated, if a person isresponsible for a fall he is also responsible for the results of thefall this applies to thesis of the contused injuries and deaths fromfalls in prize-fights and drunken brawls we may sum up the points of evidence which help us to distinguishbetween an accidental and a homicidal injury much as we did when thequestion lay between accident and suicide 1 the evidence from thenature of the wound is not quite so conclusive as when the questionlies between suicide and accident for contusions and contused woundsare far more often homicidal than suicidal, and accidental woundsare almost always of this class if, however, the wounds are someone write my finance paper incisedor punctured, this fact points almost certainly to homicide 2 asto situation, a homicidal wound may be situated almost anywhere. Anaccidental wound, except in falls from a height, only on an exposedplace 3 the direction of the wound can seldom help us in the caseof contused wounds which, practically, are the only ones in question, though it may possibly be incompatible with accident 4 as to thenumber of wounds, homicidal wounds are far more apt to be multipleeither in a small area or scattered in such a way that an accidentcould hardly account for them all 5 a weapon may give evidence moreoften here than when suicide is in question, for a weapon may be usedto inflict contused wounds which may resemble those received in a fall the evidence furnished by a weapon or blood, hair, etc , on the weapon, etc , is strongly in favor of murder 6 the evidence from a struggleis also more important because it is more often found a struggle mayoccur in homicide, and only in homicide, as a rule, so that signsof a struggle are strong evidence of murder and against the idea ofaccident 7 the examination of the clothes and body of the deceasedmay give valuable evidence, showing, as it may, signs of a struggle orother marks of an assailant and indicating murder 8 examination ofthe position and attitude of the body and of the spot where it lay andthe ground around may furnish more or less proof of murder, as in thecase quoted above thus the track of the murderer may be discoveredor the body may have been interfered with and moved or robbed, allindicating homicide in any case, whether it is desired to distinguish accidental fromsuicidal or homicidal wounds, those paper present the most difficultywhich result from falls from a height or crushes but, as the case ofmadame de tourville shows, the above given and other circumstances mayoften show even then that the fall or the crush was not the result ofaccident falls from a height may, therefore, be the result of suicide, homicide, or accident the injuries are similar in all three paper a fall of sixto eight metres causes, as a rule, numerous lesions, and shows sucha traumatism that the case usually excludes the possibility or, atleast, the probability that the wounds resulted from blows essaytimes, however, the gravity of the lesion is not proportional to the heightof the fall thus vibert655 relates the case of a man, afterwardemployed for several years in the école de médicine, who jumped fromthe top of the column of the bastile, a height of fifty metres herebounded on to essay canvas stretched at the foot of the monument, thenfell to the ground, and was able to get up and walk away curiouslyenough, he killed himself later by jumping from the top of an omnibusin motion in the case of falls from a height, it is especially truethat with grave lesions internally the skin may be intact or onlyslightly ecchymosed or eroded, or the ecchymosis may be only deeplyseated so as not to appear superficially in the latter case, if lifehad continued the ecchymosis might have shown itself at essay spot onthe surface in a few days, but these falls from a height are fatal asa rule in falls from a height, besides ecchymoses, which may occurwhere there are no other injuries or may fail where there are thesisinjuries, the lesions consist of fractures of bones and ruptures ofinternal organs, with or without surface wounds the fractures maybe of a number of bones, and especially of those which first touchedthe ground, though the skull may be fractured at essay writing whether ornot it was struck in the fall these fractures are often comminuted, especially fractures of the skull and pelvis, and when the fall is froma great height ruptures of muscles may occur with the fractures ruptures of internal organs are not rare in such paper accordingto vibert, 656 the order of frequency of rupture of the variousorgans is as follows. 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 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. Fig 13 - several fractures of the left half of thebase of the skull, running parallel to one another and approaching oneanother, also separation of the mastoid suture the injury was causedby a fall on the left side of the back of the head a circumstance that taylor660 says is connected with fracture of theskull with depression namely, that the person, sensible as long as theobject producing the fracture remained wedged in, became insensible andbegan to manifest other fatal symptoms as soon as it was removed mustbe extremely exceptional it may be explained, if it occurs, by theoccurrence of hemorrhage after the object which occluded an openvessel by its presence or its pressure was removed for it should beremembered that the symptoms of compression in a depressed fractureof the skull are very rarely due to the compressing effect of thedepressed bone, but rather to an injury of the brain, intracranialhemorrhage, or a local and temporary interference with the circulation illustration. Fig 14 - “terraced” fracture of the left parietal bonenear the sagittal suture, caused by the lower writing of the rim of around-headed hammer the blow was struck from the right side ½ naturalsize we may truly say that wounds of the head are dangerous in proportion asthey affect the brain the existence of affection of the brain may behard to tell from the appearances, for an injured person may recoverfrom the first effects of a comparatively slight wound and yet diesuddenly later concussion is the name applied to one of the effects on the brainof a more or less violent blow directly on the head or transmittedindirectly to the head though the term “concussion” implies afunctional rather than an organic lesion, yet in the majority of paperit is equivalent to laceration of the brain with laceration of thebrain there is usually more or less effusion of blood which may belimited to a very thin layer concussion may exist without lacerationof the brain even death has been known to occur from concussion ofthe brain without any visible signs of injury to the brain, so thatthe concussion must have been functional and the fatal result due toshock of the nervous system fatal concussion does not, therefore, necessitate the existence of compression or visible injury of thebrain concussion may essaytimes be due to a violent fall upon the feet, in which case the shock is transmitted through the spinal column tothe head with or without fracture of the base of the skull it was inthis way that the duke of orleans, the son of louis philippe, died illustration. Fig 15 - fractures of the skull caused by a four-sidedhammer one caused by the corner, the other by the end of the head ofthe hammer ¼ natural size illustration.

Good resultsfrom the efforts of the medical contingent are to be observed here andthere, as in the deletion of elixir of the phosphates of iron, quininand strychnin and of emulsion of cod liver oil with hypophosphites that these instances were not expressions of policy on the writing of thecommittee on revision, but merely deviations from policy, may be seenby a glance at the contents of the new pharmacopeia these includesubstances which have been shown to be inert, like the hypophosphites calcium, potassium and sodium hypophosphites, complex and obsoletemixtures, like the compound syrup of sarsaparilla, and drugs whichhave been tried and found wanting, like saw palmetto berries evensubstances seldom used by the medical profession, but chiefly oraltogether by the public, like sassafras, hops and peppermint theherb, are standardized and made official it seems difficult todiscover any principle by which the sphere of the pharmacopeia may bedefinitely marked off from that of the national formulary there isone great advantage in specifying u s p drugs and preparations:physicians who do so invoke legal standards of purity and identity theonly way to be sure of obtaining substances of therapeutic efficiency, however, is to exercise discrimination the pharmacopeia is no guide being prepared mainly by pharmacists to meet the needs of pharmacists, the pharmacopeia of course contains much matter of little interest tophysicians and entirely foreign to scientific medicine -- editorialfrom the journal a m a , sept 2, 1916 303 j a m a 67:764 sept 2 1916 review of ninth revisionthe ninth revision of the united states pharmacopeia, which has beenin the hands of the committee of revision for more than six years, hasjust appeared as was someone write my finance paper to be expected, the desire of medical men on thecommittee of revision to have therapeutic value made a requirement foradmission to the pharmacopeia has not been fully realized. It remainsa book of standards for therapeutically good, bad and indifferentremedies among the drugs of little or no therapeutic importanceor value are musk, arnica, eriodictyon, quassia, pumpkin seed, sawpalmetto berries, sarsaparilla and couch grass thesis superfluousdrugs and preparations are included for instance, of the nine formsof quinin described quinin alkaloid, bisulphate, dihydrochlorid, hydrobromid, hydrochlorid, salicylate, sulphate and tannate, and quininand urea hydrochlorid, at least four might well have been eliminated two insoluble forms the alkaloid and the tannate, two soluble forms the hydrochlorid and quinin and urea hydrochlorid, and a moderatelysoluble form the sulphate are all that could reasonably be demandedby even the most extreme writingisans of the doctrine of “pharmaceuticnecessity ” further, the use of quinin salicylate for its salicylicacid content and of quinin hydrobromid for its bromid content isunscientific the inclusion of these salts in the pharmacopeia isregrettable those interested in the promotion of rational therapy will also regretthe inclusion of a number of fluidextracts of violently toxic drugs, such as aconite and gelsemium dose 1/2 minim each, belladonna root, digitalis, nux vomica and ipecac dose 1 minim each, and lobelia dose2-1/2 minims the more diluted forms, the tinctures, of these drugsare preferable the inclusion of such fluidextracts in the pharmacopeiais playing into the hands of certain pharmaceutical manufacturers, whorecommend the tincture be prepared from fluidextracts-- an unscientificprocedure the efforts of the medical members of the committee, however, havenot been entirely fruitless of the articles described in the u s pharmacopeia viii, 243 have been deleted. Sixty-seven new articles havebeen added the loss of 167 titles may be set down as a gain moreover, most of the new substances give promise of therapeutic usefulness thirty-six are taken over from new and nonofficial remedies. Nineteenare substances which are in the edition of useful drugs now in thepress it cannot be said, however. That all of the additions have beenjudiciously selected it is an infelicitous time to add calcium andsodium glycerophosphate just when grave doubts of their therapeuticefficiency are being felt the addition of the extracts of aconite, hydrastis and viburnum prunifolium is likewise unfortunate all aresuperfluous preparations, the first because a drug so powerful thatan average dose of the extract is only 10 mg or 1/6 grain is bettergiven in the form of tincture. The second because hydrastis is a drugof uncertain value, already represented by three preparations, and thethird because viburnum prunifolium has been discarded and discreditedby the best therapeutic authorities it must be accounted clear gain, on the other hand, that the deletions include thesis inert, obsoleteor superfluous substances like bismuth citrate, kaolin cataplasm, pipsissewa, coca leaves, ladyslipper, wahoo, cotton root bark, compound acetanilid powder and compound syrup of hypophosphites, not tomention nine salts of iron and thirty-eight fluidextracts of variousdrugs wines, unmedicated and medicated, whisky and brandy are alsoamong the articles dropped a number of new features are introduced, such as microscopic standardsfor powdered drugs, standard abbreviations for titles, the use ofthe term “mil” instead of “cubic centimeter, ” and a chapter each onsterilization, diagnostic reagents, biologic assays, electrolyticdetermination of metals and the determination of alcohol, the meltingpoint, the boiling point and the congealing point the chemical nomenclature is substantially the same as that adopted inthe previous revision. So is the nomenclature of drugs the addition ofofficial abbreviations for the latin titles of drugs will doubtless befound a useful feature less commendable is the change from the familiar “cc ” to “mil ” theterm “cubic centimeter” is so thoroughly established and so widelyused, wherever the metric system is employed, that it cannot beexpected that it will be universally displaced by the word “mil ” thelatter is therefore only a superfluous synonym, and as such out ofharmony with the simplicity of the metric system perhaps it may evenbe taken for the abbreviation of “millimeter, ” “milligram” or otherwords derived from “mille, ” which would be equally entitled to the sameabbreviation -- book review in the journal a m a , sept 2, 1916 physician stock in prescription productsthe letter that follows comes from a physician who feels that he has agrievance regarding a company in which he holds stock:“in 1914, i bought essay stock of the -- -- -- -- company, and in 1917bought essay more stock in the same company i notice that the companyadvertises in the journal of the american medical association, and ibelieve it does this not so much to acquaint the medical professionwith its product, as to acquaint physicians with its name in order thatits stock salesmen can keep on unloading more stock to members of themedical profession “the company gets the doctors’ money through the sale of stocks, itgets its product on the market with the doctors’ assistance and throughtheir influence, and it looks to me as if the doctors were getting verylittle in return, as the dividend checks have been few and far betweensince i have known anything of the company “it is not my idea to criticize the product. But i do believe and feelthat the stockholders are entitled to a square deal from a companywhich in turn is expecting so much from them, and again i feel that thepublishers of the journal should be made aware of these conditions sothat they do not either consciously or unconsciously foster a concernthat is depriving the physician of his hard-earned money “if this letter is unfair, i am willing to be shown otherwise kindlypublish it in the journal, omitting my name and address ”the company to which our correspondent refers put out a proprietaryproduct prescribed by physicians and used by the public essay years agothe company in question advertised its product in the journal until itsstock-selling scheme was brought to the attention of the journal. Theadvertisements were then rejected essay years later, on evidence thatthe company had discontinued its stock-selling methods to physicians, its product was again admitted to the advertising pages of the journal our correspondent says that he believes that the physicians who holdstock in this company “are entitled to a square deal ” what about thepublic?.

If alocal analgesic is necessary, a little extract of belladonna may beincorporated with petrolatum or other ointment base the main reliance, in any event, should be to effect normal bowel movements by regulatingthe diet rather than by the use of purgatives. The use of warm waterto insure cleanliness. The avoidance of irritation, especially thatcaused by friction and secretions. A mild astringent to reduceinflammation -- from the journal a m a , march 9, 1918 guaiodine report of the council on pharmacy and chemistrythe following report on guaiodine, marketed by the intravenous productscompany, denver, has been adopted by the council and its publicationauthorized w a puckner, secretary a referee of the committee on pharmacology, in submitting to thecouncil a report from the a m a chemical laboratory on guaiodine, advises that the laboratory examination shows that instead ofcontaining free “colloidal” iodin as claimed, the preparation isessentially an iodated fatty oil, containing only combined iodin equally misleading, in view of the laboratory findings, are theimplied claims that the antiseptic action of guaiodine corresponds tothat of free iodin guaiodine is advertised mainly for the treatment of gonorrhea whileit may be true that the guaiacol contained in guaiodine has essaybeneficial effect, especially when preceded by potassium permanganateirrigation as advised, the advertised claim that “guaiodine acts as aspecific for gonorrhea in a majority of paper” is utterly false the “case records” offered to establish the therapeutic value ofguaiodine are in themselves sufficient to condemn the “evidence ” thefollowing are fair samples.

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Being bruised and put into the nostrils, itstays the bleeding thereof it takes away wheals and pimples, if beingbruised with a few myrtle leaves, it be made up with wax, and applied it cures the morphew, and takes away all sorts of warts, if boiled inwine with essay pepper and nitre, and the place rubbed therewith, andwith almond and honey helps the dry scabs, or any tetter or ringworm the juice thereof warmed in a pomegranate shell or rind, and droppedinto the ears, helps the pains of them the juice of it and fennel, with a little honey, and the someone write my finance paper gall of a cock put thereunto, helps thedimness of the eye-sight an ointment made of the juice thereof withoil of roses, ceruse, and a little vinegar, and anointed, cures st anthony fire, and all running sores in the head. And the stinkingulcers of the nose, or other writings the antidote used by mithridates, every morning fasting, to secure himself from any poison or infection, was this. Take twenty leaves of rue, a little salt, a couple ofwalnuts, and a couple of figs, beaten together into a mess, with twentyjuniper berries, which is the quantity appointed for every day anotherelectuary is made thus. Take of nitre, pepper, and cummin seed, ofeach equal writings. Of the leaves of rue clean picked, as much in weightas all the other three weighed. Beat them well together, and put asmuch honey as will make it up into an electuary but you must firststeep your cummin seed in vinegar twenty four hours, and then dryit, or rather roast it in a hot fire-shovel, or in an oven and is aremedy for the pains or griefs in the chest or stomach, of the spleen, belly, or sides, by wind or stitches. Of the liver by obstructions;of the reins and bladder by the stopping of urine. And helps also toextenuate fat corpulent bodies what an infamy is cast upon the ashesof mithridates, or methridates as the augustines read his nameby unworthy people they that deserve no good report themselves, love to give none to others, viz that renowned king of pontusfortified his body by poison against poison he cast out devils bybeelzebub, prince of the devils what a sot is he that knows notif he had accustomed his body to cold poisons, but poisons would havedispatched him?.