History

Spongebob Squarepants Essay


Same journal, 1890, lii , p 30 - reportof thesis paper of fatal suffocation from foreign bodies, etc boy, age15 collar-button in larynx boy, age 10 mass of butter in larynx boy, age 5 bronchial gland discharged into trachea at bifurcation boy, age 3 screw in larynx boy, spongebob squarepants essay age 5 rubber balloon with whistleattached. It was writingly inflated with each expiration girl, age 10 a“jack” in larynx man, age 45 had been drinking freely. Piece of meatin larynx man, age 40 piece of meat in larynx and pharynx man, age40 ditto insane patient piece of meat in trachea man piece of meatin larynx man, age 40 crackers and cheese in larynx child rubbernipple in larynx during administration of ether, patient vomited;vomitus entered larynx two children in bed asleep. One, 3 yearsold, overlay the face of the younger, age 5 months woman, age 25, epileptic fell on a child and smothered it two children found dead, covered with bedclothing man, age 21, epileptic found lying on hisface in bed girl, age 12, epileptic ditto woman, age 21 ditto girl, age 18 ditto woman, age 35, epileptic fell on the floor woman, age 28 ditto man, age 35, epileptic. Vomited while in spasm;vomitus entered larynx from dr janeway.

also it may be asked, has the number ofproprietaries marketed with false statements of spongebob squarepants essay composition decreasedsince the council and the laboratory began their work?. answering thelatter question first. There is no doubt that today fewer proprietarymedicines are being sold with false claims as to composition thanthere were ten years ago when the council began its work, medicaljournal advertising teemed with statements regarding the compositionof medicines which any chemist familiar with medicine would nothesitate at sight to brand as untrue today such manifestly falseclaims are rare coming to the former question. Thesis false statementsregarding the identity and composition of remedies have been made inignorance this is not surprising when it is remembered that the mostignorant may and do engage in the manufacture of medicine besidesignorance, however, an accommodating conscience on the writing of themanufacturer and a failure on the writing of the medical profession toappreciate the danger which lies in the use of medicines of unknowncomposition unquestionably have greatly encouraged the marketing offalsely declared medicines a glaring illustration of the ignoranceof manufacturers-- for it is hard to believe that any business concernwould deliberately court prosecution by the federal authorities throughfalse statements on labels-- is the fact that nearly thirty years agoa b lyons published a report147 pointing out that the proprietaryiodia was falsely declared as to composition and that in 1914 when thecouncil examined this preparation such incorrect declaration appearedon the label 148 that thesis physicians do not recognize the dangerto their patients and their reputation in the use of medicines, thecomposition of which they do not know, is illustrated by the fact, disclosed by inquiries sent to the laboratory, that physicians werefound willing to employ an arsenical preparation venarsen, advertisedfor intravenous use, although its promoters vouchsafed no informationin regard to the nature of the arsenic compound contained therein 147 lyons, a b. Detroit lancet, 1882, 6, 157 148 the journal a m a , nov 21, 1914, p 1871 unreliability of little used drugsthe purpose of the federal food and drugs act is to secure theprosecution and punishment of all who sell medicines which areadulterated or misrepresented as to composition as a matter of fact, the wording of the law relating to the adulteration and misbranding ofdrugs is such that the federal authorities have been able to do littlemore than to require that the drugs for which standards are providedin the pharmacopeia shall when sold comply with those standards similarly, those states which attempt to improve the quality of drugssold within their borders-- few states do efficient work along theselines-- limit their work to the enforcement of the pharmacopeialstandards this leaves the vast number of unofficial drugs andmedicaments beyond the control of federal or state authorities while most of these drugs are relatively unimportant, and while theamounts of them which are used are not great individually, the totalconsumption of them is large with a view of furnishing to physiciansstandards for drugs of this sort the council has described in new andnonofficial remedies not only distinctly proprietary drugs, but alsoessay of the unofficial drugs which are apparently of therapeutic valueand used to a considerable extent aiding the council in this line ofendeavor, the laboratory has attempted to establish standards for theselittle used drugs, and new and nonofficial remedies, 1916, providesstandards for such unofficial and non-proprietary drugs as quinin andurea hydrochlorid quinin, tannate, sodium acid phosphate, and sodiumperborate an example of work which furnished much needed standardsfor an unofficial article is the investigation of zinc permanganateby w s hilpert 149 reference to the published reports of thelaboratory will give an idea of the amount of work such standardizationentails a reference to the new u s pharmacopeia, when this comesfrom the press, will show that a considerable number of unofficialarticles described in new and nonofficial remedies have been admittedto the pharmacopeia along with the standards worked out in thislaboratory 149 zinc permanganate, j a m a , feb 6, 1909, p 488. Reportschem lab 2:15, 1909 while in a way the work done in connection with these less importantdrugs has attracted little attention from the medical profession, it has had an effect on pharmaceutical manufacturers in the past, pharmaceutical houses, ever anxious to market essaything new, on theslightest provocation have placed on the market, in the form of pills, powder, elixir, ampule, etc , every drug for which essay sort of medicalrecommendation could be found in marketing these dosage forms, themanufacturer has too often been little concerned about the quality ofthe drugs used 150 just at present, for instance, essay interest isbeing shown in iron cacodylate. But while manufacturers appear to bemost ready to take advantage of this interest by offering the drugin the form of ampules, etc , they have given little help toward theestablishment of standards for this arsenic compound manufacturers areever ready to sell drugs of all sorts, but in view of the small demandthey cannot or will not safeguard the identity and purity of suchdrugs a further illustration of the unreliability of unofficial drugsis the recent report by levy and rowntree151 showing not only thatthe various dosage forms of emetin hydrochlorid obtained from differentmanufacturers varied from manufacturer to manufacturer, but also thatthe product of the same manufacturer was variable and that the supplyfurnished by one pharmaceutical firm was so toxic as to make its usedangerous 150 the unreliability of unimportant medicaments, the journala m a , sept 28, 1912, p 1156 151 levy, r l , and rowntree, l g. On the toxicity of variouscommercial preparations of emetin hydrochlorid, arch int med , march, 1916, p 420 the analysis of “patent medicines”in the preface to the first annual report of the chemical laboratoryit was stated that the laboratory “occasionally takes up theexamination of ‘patent medicines’ ” at that time it was felt thatthe widespread use by the medical profession of irrational and evensecret medicines made it necessary to devote the laboratory attentionto the correction of this evil as the years have passed on, theseconditions have been remedied to essay extent, at least so far aschemical analysis can correct them on the other hand, public opinionhas been aroused to the thesis evils connected with the exploitation of“patent medicines, ” and has more and more insistently demanded that themedical profession aid in the correction of this evil accordingly, the laboratory has paid much attention to the analysis of “patentmedicines” during the last few years as the chief asset of “patentmedicines” is the element of secrecy which surrounds their composition, it is hoped that the laboratory analysis of such widely used “patentmedicines” as nature creation, 152 mayr wonderful stomachremedy, 153 sanatogen, 154 eckman alterative, 155 tonsiline, 156and bromo-quinin157 has been worth the labor in addition, thework of this laboratory has been published, including not only theresults of its analyses, but also the methods which are used in viewof the dearth of published reports regarding the methods used in theanalysis of “patent medicines, ” it is hoped that this feature of thelaboratory work has been of aid to chemists engaged in similar work 152 the journal a m a , march 5, 1910, p 806 153 the journal a m a , aug 19, 1911, p 671 154 the journal a m a , april 20, 1912, p 1216 155 the journal a m a , april 27, 1912, p 1298 156 the journal a m a , april 4, 1914, p 1109 157 the journal a m a , nov 27, 1915, p 1932 the laboratory activities along these lines have done much todiscount the claim of proprietary manufacturers that chemical analysisis unable to determine the character of “patent medicines ” the recentwine of cardui trial has brought it out prominently that chemicalanalysis can determine the presence of potent constituents, and that“patent medicines” which fail to reveal such potent ingredients to theanalyst may safely be put down as worthless the demonstration thatthe essential composition of medicinal preparations may be determinedby chemical analysis should also prove an effective answer to themanufacturers in their protest against the requirement, now beingurged for enactment into law in various states, that the medicinalingredients of their wares must be declared on the label manufacturershave held that this would lay them open to competition with imitationsand substitutions the possibility of chemical identification proves, however, that secrecy of composition, though it prevents consumers fromknowing the character of a “patent medicine, ” will not be a hindranceto the imitator and substitutor identity of drugs used in investigationsin the past, much of the experimental work in medicine has seriouslysuffered in that the identity of the material used in suchinvestigations was not established in view of this the laboratoryhas watched the contributions submitted to the journal, and whenevernecessary and feasible has urged the authors to identify their materialbefore publication of the findings for instance, a number of stainingagents-- so-called “anilin dyes”-- have been found to possess therapeuticaction since the identity of thesis of these staining agents is todayessentially secret, the laboratory has urged through the journal thatthose who experiment with these substances make an effort to determinetheir identity whenever possible and to give preference to those thechemical identity of which is known the need for such identificationhas been discussed in the reports of the laboratory 158 the amountof work involved in the chemical identification of drugs used forexperimental work is illustrated in a contribution entitled “anexamination of several commercial specimens of opium alkaloids or theirsalts ”159 by l e warren, in which was determined the identity ofthe various opium products used in an investigation by d i macht, carried out under a grant of the therapeutic research committee 158 reports a m a chemical laboratory, 1912, v, 102 159 am jour pharm , 1915, 87, 439 the laboratory and pharmaceutical literaturein the past much of the information in regard to the compositionand properties of medicines which has appeared in pharmaceuticaljournals has not become available to medicine in thesis paper medicaljournals could not afford to publish such data because this would havebeen contrary to the interest of their advertisers, and hence thepublications regarding the irrational character of lactopeptine, ofbromidia, etc , which appeared in the pharmaceutical journals did notbecome a matter of common medical knowledge through the laboratoryan attempt has been made to keep the medical profession informed inregard to pharmaceutical literature the laboratory has a good workingpharmaceutical and chemical library, and subscribes to the importantamerican and foreign pharmaceutical and chemical publications thediscussion of new remedies, such as medinal and sodium veronal, 160salvarsan, atoxyl and arsacetin, 161 and neosalvarsan162 soon aftertheir introduction, illustrates the work of the laboratory along theselines 160 the journal a m a , jan 23, 1909, p 311 161 the journal a m a , dec 31, 1910, pp 2303 and 2314 162 the journal a m a , oct 5, 1912, p 1295 the laboratory efforts toward rational prescribingthe laboratory naturally is in thorough sympathy with the present dayefforts toward a more rational use of drugs, as exemplified in thecouncil publication “useful drugs ” two recent contributions ofthe laboratory may be cited as a further support of the movement forlimiting prescribing to the more widely used drugs in line with thegeneral tendency of manufacturers to put out all sorts of modificationsand asserted improvements over official substances, there have beenplaced on the market a number of preparations said to represent essayimprovement over the pharmacopeial blaud pills the report, “thequality of commercial blaud pills, ”163 by l e warren, shows thatthe ordinary pharmacopeial blaud pill is in every way the equal of thesemiproprietary preparations claimed to be improvements further, theexamination of the various brands of sodium and theobromin salicylateas compared with the preparation diuretin by p n leech164 showsthat the former preparations, sold at 35 cents per ounce at the timethe examination was made, are fully the equal of the proprietarydiuretin, which then cost the druggist $1 75 per ounce 163 the journal a m a , april 17, 1915, p 1344 164 the journal a m a , april 4, 1914, p 1108 the laboratory as an information bureauit is generally admitted that the proprietary medicine business, writingicularly the exploitation of complex mixtures, attained theextensive vogue which it has or had because instruction in medicalschools was deficient in materia medica, pharmacy and chemistry as aresult of lack of knowledge along these lines, the young graduate afteressay trial became fearful of formulating his own prescriptions, and intime became dependent on pharmaceutical firms which provided him withmedicines ready to dispense that physicians have been insufficientlytrained in regard to the pharmacy and chemistry of drugs has often beenemphasized in pharmaceutical journals where prescriptions containingincompatible drugs are reported and where even plans are broughtforward whereby the pharmaceutical profession may aid in remedying thisdifficulty during my pharmaceutical experience i was often sorely vexed as to whatto do when prescriptions contained drugs which on mixing would undergodecomposition which the physician surely did not anticipate i rememberwell a prescription directing that potassium permanganate be made intopills with extract of gentian and other things, and how, the physicianhaving spurned the suggestion to modify the prescription so as to avoiddecomposition of the permanganate, i was obliged to select a mortar, gently triturate the drugs until a conflagration was started, and tofinish the prescription after the combustion had subsided however, in my pharmaceutical experience i generally found the physician mostready to receive suggestions from the pharmacist which would preventincompatibilities, improve the palatability and appearance of hisprescriptions, and protect the patient from unnecessary expense similarly it has been my experience since the establishment of theassociation laboratory that physicians are anxious to receiveinformation in regard to the materia medica, pharmacy and chemistryof drugs as the druggist earns the respect and support of thephysician when he makes available to him the pharmaceutical knowledgeand experience which he has, so this laboratory has aimed to gainthe endorsement of the american medical association membership byfurnishing to physicians information in regard to the composition, chemistry and pharmacy of drugs through replies in the query andminor notes dewritingment of the journal as well as through directcorrespondence it has been most gratifying to the laboratory that thejournal receives an increasing number of inquiries both as regardsthe chemical and pharmaceutical questions involved in the writing ofprescriptions and as regards the composition of secret and semisecretproprietaries often because they are prescribed by the inquirercolleague and “patent medicines” which are taken by his patient thelaboratory has tried its best to answer the thesis inquiries received thesis of the questions which come in can be answered by a pharmacist orchemist without hesitation others, writingicularly as to the compositionof medicines, the laboratory has been able to answer by reference toits library and its extensive card index still others have requiredexperimentation and chemical analysis while, as stated a moment ago, the laboratory has encouraged thesending of inquiries and has earnestly striven to furnish theinformation asked for, it is obvious that the amount of chemical workwhich can be done is limited the small size of the laboratory force, consisting of three chemists engaged in actual analytical work, makesit necessary to select for investigation those problems which shallbe of general interest to the medical profession as the americanmedical association is national in its scope, the laboratory has heldthat it can do analytical work only when such work will be of generalinterest to physicians and of value both to the medical professionand the public in view of this it has refrained from undertakinganalyses which would benefit only the physician making the inquiry andpossibly his patient the laboratory further has not felt justifiedin undertaking work of merely local interest. Instead it has usedits endeavors to secure the investigation of such local problems bymunicipal or state authorities -- from the journal a m a , nov 25, 1916 lead in “akoz”akoz is a mineral product sold by the natura company of san francisco, and said to possess most remarkable medicinal properties a circular issued by the natura company begins thus.

Uricsol is a mixture of well-known drugs, marketed withfalse claims as to therapeutic action, with misleading and meaninglessstatements as to composition and under a name which invites uncriticalprescribing uricsol is held ineligible to inclusion in new andnonofficial remedies jubolthe following ridiculous statements are addressed, not to the laity, but to the medical profession. Do you suffer from constipation-- hemorrhoids-- enteritis-- mucous discharge-- pituita-- acidity of the stomach-- vertigo-- sick headache-- disturbed sleep-- insomnia-- sallow complexion-- coated tongue-- offensive breath-- fatigue and depression-- boils-- pimples?. “one of these symptoms alone shows that there is defective or insufficient function of the intestines, even if the stools are regular “excrements remain too long in the intestine and set up fermentation the harmful poisons and ptomains which they produce are re-absorbed by the blood and poison the whole system “the intestines must be cleared and re-educated with jubol “jubolise your intestines ”jubol tablets are sold in the united states by geo j wallau, inc , new york, and are said to be prepared by j l chatelain, paris, france the following incomplete and nonquantitative “formula” isfurnished. “ compounded chiefly !. of agar-agar, biliary extracts and pure extracts from all the intestinal glands ”it is asserted that “the tablets are coated with a protective covering in order that they may act on the intestine only ”the tablets contained in a regular-size trade package, obtained directfrom the agent, readily separated into two halves and disintegratedwithin a few minutes when agitated with water it is thus evidentthat, under ordinary conditions, the intestinal ferments in jubol ifthey are present, as claimed would be destroyed during their passagethrough the stomach in direct tests, however, practically no trypticactivity was demonstrated the composition of jubol is not declared. Grossly unwarranted andincorrect claims are made for its therapeutic actions. The name doesnot indicate the alleged ingredients and so much of the composition asis declared indicates an unscientific mixture the council decided thatjubol should be held ineligible for new and nonofficial remedies, andthat this report should be published urodonalurodonal is said to be “produced in the laboratory of j l chatelain, ”paris, france it is marketed in this country by geo j wallau, inc , new york the preparation is claimed to be a chemical compound, and theadvertising matter furnishes a “formula, ” which consists of theformulas of lysidin, sidonal and hexamethylenamin, connected by plussigns.

But how about the patient, who, afterall, is the one to be considered?. is it not a matter of considerableimportance to the patient whether he receives phosphorus, one ofthe most powerful drugs known, or the inert glycerophosphates?. thechemist statement seems to imply that it is not it may be ofinterest to recall that a member of the firm whose chemist givesthis “reason” for the use of glycerophosphates, in a recent address, was rather severe in his condemnation of institutions of learning, hospitals, etc , for their lack of cooperation with manufacturers. Hesaid that “they should welcome an opportunity to let any manufacturertry out or test his products in their clinics, laboratories, etc ”a test as to whether there is a difference between the action ofglycerophosphates and ordinary poisonous yellow phosphorus, especiallywhen the former are mixed with extracts of nux vomica and damiana, would not be likely to appeal to thesis hospitals and laboratories asa very promising field of research at this day since, as has beenstated, the scientific evidence at present available does not furnishany warrant for the therapeutic use of glycerophosphates -- editorialfrom the journal a m a , april 15, 1916 290 organic phosphoruscompounds, editorial, j a m a 40. 1958 june 21 1913 marshall, e k. The therapeutic value of organic phosphorus compounds, j a m a 44. 573 feb 13 1915 291 marshall, e k. The therapeutic value of organic phosphoruscompounds, j a m a 44. 573 feb 13 1915 influenza vaccineswith the appearance of the epidemic of influenza, reports began toappear, chiefly in newspapers, as to new serums, vaccines, drugs andother methods for checking and even for curing the disease a fewsamples of such as have come to the journal appear in our tonicsand sedatives dewritingment this week in massachusetts, commissionere r kelly appointed two committees to investigate the value ofinfluenza vaccines as a preventive agent and as a treatment ofthe disease the first committee, a special board for scientificinvestigation, consisting of dr m j rosenau, chairman, and frederickp gay and george w mccoy, was appointed to consider the evidenceavailable on the prophylactic and therapeutic use of vaccines againstinfluenza this committee presented the following conclusions. 1 the evidence at hand affords no trustworthy basis for regarding prophylactic vaccination against influenza as of value in preventing the spread of the disease, or of reducing its severity the evidence from the present epidemic, though meager, suggests that the incidence of the disease among the vaccinated is smaller than among the nonvaccinated the board, therefore, concludes that further experimental evidence should be collected 2 the evidence at hand convinces the board that the vaccines we have considered have no specific value in the treatment of influenza 3 there is evidence that no unfavorable results have followed the use of the vaccines the second committee, known as the special board of statisticalinvestigation, consisted of dr george c whipple, chairman, william h davis and f c crum this committee reported.

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“the question whether there hasbeen a fracture of the cranium previous to death is essaytimes moredifficult to decide than a person not accustomed to make dissectionsmight imagine if the fracture has occurred immediately before thepatient death, there will be found coagulated blood upon the bonesand in the fissures if the patient has survived for essay time, therewill be marks of inflammation and, perhaps, pus in contact with theskull, but if a fracture has been made in making the examination, which essaytimes happens in even very careful dissectors’ hands, theblood in the fracture will not be coagulated, nor will there be anyeffusions around the portions in beck medical journal, vol xxii , p 28, mr alcock essay time since stated in a public lecture inlondon that he had known a fracture of the base of the skull producedby the awkward and spongebob squarepants essay violent tearing of the upper portion by the saw inpenetrating enough to divide the bones, and this to be mistaken by theinexperienced operator for fracture of the skull producing death beinga medico-legal case, it might have led to melancholy consequences hadnot the error been detected by an observer ” that an extensive andoften complicated fracture by contre coup can occur as the result ofgunshot injuries of the skull is a fact well known to all surgeons ofexperience and laid down in all text-books and illustrated in all largemuseums in view of these well-known facts, it would always be well to insistin paper of this kind that the saw alone should be used and not thehammer nor the chisel when a cranial bone is fractured blood ispoured out from the ruptured vessels, as is always the case with anybone its amount varies indefinitely with the number and size of theruptured vessels, the activity of circulation, the length of time aperson lives, etc the blood may collect in circumscribed masses orbecome infiltrated in the surrounding tissues, although usually bothphenomena are observed the extent to which infiltration takes placedepends upon the quantity of blood and the nature of the surroundingtissues in loose tissues like those about the orbit infiltration ismuch more rapid and extensive examination of the weapon - french medical jurists have tried toindicate how we may determine the time elapsed between the death of aperson and the discharge of a weapon found near the body, but exactstatements in this matter are utterly out of the question certainfacts bearing on the subject are these. When recently discharged therewill be found adhering to the barrel of the piece and consisting of thefouling of which sportsmen complain, a quantity of potassium sulfidmixed with charcoal this is shown by its forming a strong alkalinesolution with water, evolving an odor of hydrogen sulfid, and a darkprecipitate with a solution of acetate of lead depending upon thedegree of exposure to air and moisture, after essay hours or days thissulfid becomes converted into potassium sulfate, which forms a neutralsolution with water and gives a white precipitate with acetate of lead;but if a considerable time has elapsed since the discharge of the pieceoxid of iron iron rust with traces of sulfate may be found ann d’hygiene, 1834, p 458. 1837, p 197. 1842, p 368 was the weapon fired from a distance or near by?. a gunshot injuryfrom a bullet implies at least one wound, namely, that of entrance, and perhaps another, that of exit it does not always happen that thebullet passes through the body the appearance of the wound of entranceis usually one of irregular circular puncture, its edges perhapsslightly torn or lacerated, with a purplish or dark areola, varying inwidth from a line or two to one-half inch when the weapon is firedclose to the body there are likely to be more or less powder-marks, and possibly actual burning from the heat and flame of the gunpowder if the writing of the body injured had been covered by clothing at thetime, the marks of powder and of burning would probably be confined tothe same bleeding is usually slight and occurs more commonly from thewound of entrance than from that of exit regularity of either of thesewounds depends in large measure upon the angle at which the bullet hasstruck the surface when striking very obliquely the wound may be moreoval or the bullet may have ploughed a furrow or a channel, by a studyof which the relative position of the assailant and the assailed atthe moment of injury may, perhaps, be determined it is of importanceto determine if possible the approximate distance at which the bulletwas fired, since the question of self-defence, for instance, may hingeupon evidence of this character the charge of powder and the weight ofthe bullet being known, one may essaytimes estimate this distance by thedepth of penetration or the appearance of the bullet still, the natureof the tissues must figure largely in such consideration thesis suicideswho shoot themselves in the head show only one wound of entrance andnone of exit experiments testing powder-marks - powder-marks and burns fromweapons ordinarily used will scarcely appear when the distance hasexceeded ten or twelve feet lachese, of antwerp, found that infiring a gun even from a distance of only four feet the skin was onlywritingially blackened as the result of experiments made with a ballard rifle, old style, 44calibre, with bullets of 220 grains and 28 grains of powder, dr balch, of albany, found that powder-marks were made at distances as follows:at two feet, writingicles too numerous to count, with essay of thelubricant blown upon the board;at four feet the same;at six feet the same;at eight feet, nine grains of powder;at ten feet, five grains of powder in one case and six in another that these were powder-grains were shown in court by picking essayof them out, placing them on a glass, and igniting them with agalvano-caustic point from those at ten feet no distinct flash couldbe elicited. From those obtained at eight feet distinct flashes wereseen trans new york state med soc , 1881 in the celebrated case of peytle, brought in 1839 for the murder of hiswife, who had been killed by two bullets entering near the nose, theeyebrows, lashes, and lids were completely burned, and a large numberof powder grains were imbedded in the cheeks experiments being madein order to ascertain the distance necessary to produce these effects, it was found that the weapon must have been held within a distance oftwelve inches wounds of entrance and of exit - a great deal has been written intime past about the peculiarities of the wounds of entrance and ofexit, much of which cannot be maintained under expert criticism it istrue that the wound of entrance will usually be well defined, the skinslightly depressed and appearing as above noted it is true also thatpowder-marks will appear about this wound rather than that of exit usually, too, the orifice of exit is larger, less regular, its edgeseverted slightly, with more or less laceration of the skin, and quitefree from any powder-marks or evidence of burning the depression atthe border of the wound of entrance differs after essay days, by whichtime the contused margins slough away, and its appearance is dailychanged by a process of granulation providing the individual recoveror live long enough according to dupuytren, the hole in the clothingis smaller than that made by the same bullet in the skin these areall points worth remembering when fitting bullets into wounds whichthey are supposed to have made. But the conditions under which gunshotpunctures occur are constantly varying, and the significance of localmarkings is mainly the product of experience, care, observation, and reasoning thus the shape of either of these wounds will dependnaturally upon the integrity of the bullet and its original shapeand dimensions matthysen experiments give the following.