Substance Abuse Essay

”the “junk” referred to comprised, in writing, an advertising leaflet on“eli 606 capsules, ” another leaflet on “eli vaginal capsules, ” stillanother on “eli ‘vim’ restorative;” then there was reference to theinevitable nostrum for intravenous use. “ampoules eli venhydrarsen ” afour-page leaflet, headed in large and very black letters “confidentialguide to live wire physicians only, ” expressed its key-note in theopening paragraph. “how to make money as well as reputation in the treatment of all chronic ailments and all types, forms and sequella of venereal diseases ”the “eli ‘vim’ restorative” is said to be a “tonic aphrodisiac ” the“action” of the product is to “arouse sexual ardor and desire influxblood supply to the genital organs ” a postscript to the “guide” urgesphysicians. “if you do not already use intravenous serums, by all means get an outfit, if for no other reason than to meet the popular demand ”a “special note” in the “confidential guide” advises physicians who“have to deal with hysteria” to “write the author of this guide, whowill explain by personal letter a method of cooperation by which suchconvulsions may be at once and forever stopped there will be $100for you from every case treated ” one physician wrote to the “author ofthis guide”-- eli h dunn, m d -- asking for further information on thistreatment for hysteria he received in reply two letters both signedeli h dunn. One was to be shown to the patient, the other was for thedoctor own information the letter for the patient to see describedthe marvelous effects of “dunn intravenous and restorative treatment”in hysteria and recommended it “with the utmost confidence in everycase able to pay you the fee commensurate with the service you render ”then followed these two paragraphs. “the cost of the treatment when administered by yourself is $300 cash with orders which includes one complete outfit and technique for administering “should you call me personally in consultation an additional fee of $150 per diem covering the time i am away from my kansas city office. Fees to be collected and held until i arrive ”the letter that was intended only for the doctor eye declared. “you are to have $100 of the fee and $50 of the per diem ”it explained that the “complete outfit” referred to in the “patientletter” would “consist in writing of a tube of intravenous medication” anddoses of “restorative capsules” and “eli 606 capsules ”eli h dunn seems to have had a essaywhat varied and spectacular career after being graduated in 1885 he apparently started practice in orion, ill during the nineties he was practicing at elma, iowa, and about1900 he seems to have moved to kansas city, mo during 1906 and 1908, he also had an additional office at denver, col about this time he wasexploiting “dunn uterine evacuant” which was “a strictly legitimate”product which could “be injected within the uterus with perfect safetyand immediate effect ” this stuff was advertised both from the kansascity and the denver offices the “personal column” of a kansas citypaper in 1910 carried the message to “ladies” that “dr dunn” was a“regular physician for women only, ” dunn violation of the postal lawsin 1911 and of the federal food and drugs act in 1912 need not be goneinto at this time the journal would feel like apologizing for devoting space to such apreposterous scheme were it not for the fact that physicians, beinghuman, essaytimes “fall for” preposterous schemes essay, we know, havenibbled at dunn bait. Others may do so the gross commercialism thatpermeates the advertising matter sent out by dunn again emphasizesthe fact that the fad for intravenous medication offers an attractivefield for those who would exploit our profession -- from the journala m a , nov 22, 1919 glover cancer serumscores of letters have reached-- and are reaching-- the journal officesimilar in effect to the following.

He was in the act of crossing one leg overthe other to look at the sole of his foot, when essaything was heard togive way. His right leg hung down and he was found to have receiveda transverse fracture of the femur at the junction of the middle andlower thirds the writer had a case in bellevue hospital during the past winter 1892-93 of a man who stated that he had been well and active untilessay weeks previously, when, from muscular force alone, he sustained afracture of the neck of the femur essaything abnormal in the bone maybe present in such paper in paper of spontaneous fractures there are no marks of externalviolence which, if present, would remove the idea of spontaneity fractures of the extremities are not dangerous per se, unless theyare compound or occur in old, debilitated, or diseased persons, andthey are more severe the nearer they are to a joint the healing offractures is more rapid in the young than in the old and in the upperthan in the lower extremity it is not proven that adiposity of itselfimpedes union the question may be asked, how long before examination a given bone wasfractured as a rule, we can only say as to whether the injured personhas lived a long or short period since the injury, as the process ofrepair varies according to age and constitution no changes occur untileighteen to twenty-four hours, when lymph is exuded according tovillermé the callus is cartilaginous anywhere between the sixteenthand twenty-fifth days, it becomes ossified between three weeks andthree months, and it takes six to eight months to become like normalbone the question may also be asked. Has a bone ever been fractured?. The existence and situation of a fracture can often be recognizedlong after the accident, by the callus or slight unevenness due toprojection of the edges or ends of the fragments where the bone liesdeeply covered by soft writings, it is difficult and often impossible totell, long after union has taken place, whether or where a fracture hasoccurred the answering of this question may essaytimes be of importance inidentifying the dead, especially in the case of skeletons in thelatter instance by sawing the bone longitudinally we can tell by thethickness, irregularity, or structure of the bone tissue whether afracture existed, and if it were recent or old at the time of death dislocations call for a medico-legal investigation less often thanfractures they are less common in the old and where the bones arebrittle, when fracture occurs more readily they are seldom fatal perse, unless between the vertebræ or when compound they may occur fromdisease in the affected joint or even spontaneously the diagnosis ofa dislocation is easy until it has been reduced, and then it may leaveno trace except pain in and limitation of the motion of a joint besidesswelling and ecchymosis these effects are transient, and after theyhave disappeared it may be impossible to say whether a dislocation hasexisted on a living body, unless, as essaytimes occurs, especially inthe shoulder joint, there may be a temporary or permanent paralysisof a nerve and muscular atrophy after death, the existence of an olddislocation may often be recognized on dissection by scar tissue in andabout the capsule examination and description the examination of wounds or injuries in a case which is or may becomethe subject of a medico-legal investigation should be made withwritingicular care and exactness as the examination of the wounded person is to give most, and in essaypaper all, the information to the medical expert on which he isto base his testimony, it should be made with reference to all thepossibilities of the case the writingicular variety of wound as described in the foregoing sectionshould be noted, and any peculiarities as to its situation, shape, extent, length, breadth, depth, direction, and the writings involved besides these points, the condition of the edges of the wound, whetherswollen and ecchymotic, smooth and straight or dentated and irregular, and whether inverted or everted and gaping, are matters of importance the presence or absence of coagula and clots, the staining of thetissues with blood, the presence of ecchymosis and its comparative age, as shown by its color, should also be noted thesis of the above points help us in solving another problem, namely, the form of the instrument used this question will be discussedin a subsequent section, but the basis for our opinion is founded, of course, on an examination of the writingiculars of the wound thesolution of still another question which often arises and which willbe discussed in the next section, namely, whether a wound was producedbefore or after death, is based upon writingicular features of the woundsuch as the fluid or clotted condition of the blood on the surface, or ecchymosed in the tissues, also the amount of the hemorrhage ascompared to the vascularity of the writing as well as the greater or lessstaining of the tissues with blood, and the conditions of the edges, whether inverted or everted and whether or not retracted the questionas to whether a wound was directly, secondary or necessarily the causeof death, is determined, in writing at least, by examination of the wound in this connection we take note as to whether a wound has opened ordivided a large vein or artery or is situated in such a vascular writingas to be fatal from hemorrhage we also note whether death could havebeen due to shock from the situation of the wound, or whether aninflammation which was directly responsible for death was necessarilydue to the wound, as in case of a penetrating wound of the viscera, etc further, we note whether one of the thesis forms of wound diseasesfrom infection of the wound has complicated the case and caused deathin the case of a wound not otherwise necessarily fatal it may be addedthat often the necropsy aids us in the solution of the question as towhether the wound was the necessary and direct cause of death, byshowing a healthy or diseased condition of the viscera the question as to which of a number of injuries was first inflicted, also as to the relative position of the victim and assailant, can beanswered, if at all, only by an accurate and close examination of thewounds finally, the most important question of all, from a medico-legalstandpoint, namely, the distinction between homicidal, suicidal, andaccidental wounds, is decided or inferred from the characteristics ofthe wound after careful examination all the foregoing questions contribute to the solution of this themost important one the various questions referred to above will beconsidered at greater length in the subsequent sections they have beenmerely referred to in brief above, to show the various lines of thoughta medical examiner must have in mind in making an examination as to the act of examination itself, the physician should conductit in such a way as not to harm the wounded person often simpleinspection is the most that can be done, or the examination may haveto be deferred altogether until the physician in charge informs thecourt that an examination may be safely made it is often necessaryfor the expert to get information as to the original lesion from thephysician in charge if the wound has been a fatal one and if we arecalled in after death, we may examine the wound on the dead body withmuch more freedom here we may examine the depth, direction, etc , of apunctured wound by cutting down on a probe or director after carefulinspection of the wound we may examine it by palpation, and go on tothe dissection of the wound and the surrounding writings, tracing andnoting the various vessels, muscles, etc , involved in the wound, andlooking for the presence of any foreign body in the wound furthermore, if the cause of death be at all obscure, we should examinenot only the wound itself and the writings about the wound, but also, byan autopsy, all the cavities and organs of the body for death may havebeen due to natural causes in an organ not examined, if the examinationhas not included all, and the physician has to disprove it in examining at an autopsy the depth of a wound in reference to theinstrument which caused it, it should be borne in mind that the woundmay be deeper than the weapon owing to a depression of the surface bythe handle of the weapon this may appear especially marked in the caseof the movable viscera, as at the time of the accident the viscus mayhave been as near as possible to the surface, and at the examination asfar as possible from the surface, as in the case of a given coil of theintestines also the thorax when opened at autopsy enlarges or expandsa little, so that the measured depth of a wound may be greater than theweapon which caused it vibert612 mentions a case of a penetratingwound of the thorax involving the heart, where the measured depth ofthe wound was 0ᵐ 035 greater than the length of the instrument thismay also be accounted for by a depression or flattening of the thoraxby the blow, as in the case of soft writings it is often difficult in anexamination to measure accurately the depth of a wound, for one mayfind it hard to determine the precise end of a wound also, for exactmeasurement it is necessary to have the writings in the same position asat the time of the accident, and these writings are more or less displacedby the necessary dissection besides the examination of the wound there are other points theexamination of which may aid us in solving the problems presented by acase among these, the examination of the clothing or dress is perhapsthe most important this may indicate the weapon used in an incised orpunctured wound contused and lacerated wounds or fractures, etc , maybe produced without injuring the clothing blood, dirt, or grease onthe clothing may throw light on the case in self-inflicted wounds thewound in the clothing and that on the body may not and often do notcorrespond, as an intending suicide often a murderer rarely opensthe clothing to select the spot for the wound the wound in the dressis then added by a second blow not corresponding to the first in thisway we may essaytimes distinguish between a homicidal and suicidalwound, and thus remove a false suspicion of murder or show that a woundwas self-inflicted to conceal other crimes or to falsely impute it toanother the suspicion of homicide in accidental wounds may be clearedup by an examination of the dress, as in the following instance relatedby taylor:613a woman was found dead in bed with two indentations about the middleof the right parietal bone, a large superficial clot here and threeounces of clotted blood between the dura mater and skull, which latterwas fractured over an area of four inches no other cause of death wasfound the evidence brought out the facts that she had been knockeddown the evening before, about 7:30 o’clock, by a man accidentallyrunning into her she fell on the back of the head, was stunned, raisedup, and stimulated. She then walked home, ate her supper, and waslast seen at 9 o’clock by a fellow-lodger who let her in and noticednothing unusual the next morning she had evidently been dead essaytime suspicion fell upon the lodger, who had often quarrelled withher, and the two claws of a hammer found in his room corresponded moreor less closely with the two indentations found in the skull at theadjourned inquest, however, the bonnet worn by the deceased at thetime of the accident was found to have two indentations on the back ofit corresponding to those on the woman skull and containing dust anddirt, and rendering probable what from the history seemed unlikely, that the fall in the road caused the fatal injury the examination ofthe dress thus avoided an unjust accusation of murder contused and lacerated wounds and fractures or dislocations may beproduced without injury to the dress, especially if the latter beelastic or yielding the comparison of the wound in the clothes withthat on the body may indicate the position of the body at the time ofthe blow the examination of the clothes of the injured person mayindicate a struggle which would support the idea of homicide a bluntinstrument may indirectly cause an injury by striking essaything in oron a person clothes instances have been reported where a wound hasbeen caused by an article in the pocket, or worn outside the clothing, without any trace of an injury to the clothes or pocket lining 614the examination of the dress may further show which of several cuts orstabs was first inflicted this is shown by the staining of the edgesof the cuts in the clothing, the edges of the first cut or stab showingno blood-stain or only on the inner surface, as the knife is cleanof blood on entering and all that is removed by the clothing on itswithdrawal is found on the inner edges if the edges of the cuts in theouter layers of clothing are bloody, it is evident that the knife wasalready bloody when used, and the corresponding wound was not the firstinflicted the imprint of the bloody hand of the assailant may essaytimes be foundon the clothing of the one injured, and is especially important asevidence, when the hands of the assaulted are not bloody in the caseof a severe wound, especially if it is likely to become the object of acriminal investigation, the physician should always require to see thedress of the wounded the examination of the clothing which the accusedwore at the time the assault took place may give important evidence byshowing evidences of a struggle or blood-stains absence of the latterwould not prove the innocence of the accused, as the clothes actuallyworn may be destroyed and others substituted, or the marks and stainsmay be removed in the latter case, the eye of a medical man may detecttraces of blood which otherwise would go unnoticed, and a microscopicaland chemical examination would reveal the real character of the stain besides the examination of the clothing of the accused, the examinationof his person may furnish evidence of his being engaged in a more orless desperate struggle by the scratches, marks of nails, contusions, bites, etc , on the face, neck, front of chest, forearms, and hands if the accused should attempt to explain these wounds and spots, thelatter may or may not verify the explanation, and thus additionalevidence may be obtained as to the guilt or innocence of the accused it is well for the medical expert, as well as for others, to collectthe statements of the wounded person relative to the circumstances ofthe injury also, if the accused will vouchsafe any such statements wemay compare these with one another and with the facts indicated by thewound, etc other points to examine, especially in paper of suspected suicide, may be briefly mentioned the presence of the weapon in the hand ofthe victim and firmly grasped in general indicates suicide, if itcorresponds to the weapon causing the wounds, for otherwise it mayhave been used for defence if not in the hand, note the spot wherethe weapon was found in the case of a suicide, the hand as well asthe weapon held by it is likely to be bloody, also in case of murderthe generally empty hand is apt to be bloody, as the hand is naturallycarried to the wound we cannot further describe the thesis points which the medical examinershould bear in mind in making an examination in a medico-legal case, without repeating too fully what will be given at greater length insubsequent sections, reference to which should be made for furtherwritingiculars tardieu proposed as a basis for examining and studyingwounds, 1 to visit the wounded person and see what state he is in, and to determine 2 the nature, 3 the cause, 4 the consequencesof the wound also if the wounded person is dead 5 to examine thebody for the cause of death in order to see if the latter is due to thewound also 6 to determine the circumstances of the affray the description of a wound should be given in plain language, avoiding the use of scientific terms or expressions, so as to bereadily understood by judge and jurors otherwise the usefulness of themedical expert is very much decreased the description should also beprecise and sufficient to justify the conclusions arrived at as to thecause of a wound, its gravity and results, and the weapon used witha view to exact statement in description, it is well to take notes asto the result of the examination and not depend merely on memory theobject of the witness should be to be understood and not to be thoughtthoroughly scientific was the injury inflicted before or after death?. This is a question which may often be asked in paper of fatal injuries, and it is one which must be answered as definitely as we are able, forthe defence may rest on the assertion that the wound or injury was postmortem and not ante mortem what are the means we have to enable us toanswer the above question?. the most important factor is the conditionof the blood and the changes that it undergoes after death for essayhours after death the body retains its animal heat as long as this isretained rigor mortis does not set in and the blood is more or lessfluid this period varies, but on the average it does not last longerthan eight or ten hours before this time, however, the blood has begunto undergo certain changes these changes result in the inability ofthe blood from a post-mortem wound to coagulate completely at firstthe greater writing may coagulate, but after a time coagulation is lessand less complete, and the coagula are not as firm as those from theblood of a living person the period at which these changes occur alsovaries, but they may generally be clearly noticed in from three to fourhours after death, or even sooner in the first two to four hours afterdeath, therefore, as far as the condition of the blood is concerned, itmay be difficult or impossible to say whether a wound was made beforeor soon after death in other words, this difficulty exists as long asthe tissues of the body live after the body as a whole is dead there are certain general pathological or occasional conditions of thebody in which the blood during life does not coagulate at all or onlyimperfectly, as in scurvy and in the case of the menstrual blood alsoblood in a serous cavity, especially if it be abundant or there existsinflammation, is found not to coagulate or only imperfectly postmortem the blood remains liquid long after death in paper of death bydrowning, asphyxia, etc , and in such paper hemorrhage may be free in awound made essay time after death furthermore, after putrefaction hasset in the blood again becomes more or less liquid, and may flow awayfrom a wound like a hemorrhage, but it no longer coagulates the principal signs of a wound inflicted during life are 1hemorrhage, 2 coagulation of the blood, 3 eversion of the lips ofthe wound, and 4 retraction of its sides 1 hemorrhage varies in amount with the size of the wound, thevascularity of the writing, and the number and size of the large vesselsinvolved in incised or punctured wounds the amount, as a rule, isquite considerable if there is a free exit most of the blood runsoff. The rest stays in the wound, where it soon coagulates with theexceptions mentioned above but besides writingly filling the wound inthe form of a clot, the edges of the wound are deeply stained withthe coloring matter of the blood, and this stain cannot be removed bywashing this staining involves especially the muscular and cellulartissues further, a hemorrhage during life is an active and not a passive one;the blood is forced into the interspaces of the tissues in the vicinityof the wound, and is found infiltrated in the cellular tissue, themuscles, the sheaths of the vessels, etc it is here incorporated, as it were, with the tissues so that it cannot be washed away in anante-mortem wound the arterial nature of the hemorrhage may show bythe marks of the jets of blood about the wound or on the clothes orsurrounding objects when a large vessel has been divided and theexit for the blood is free, this may run off without infiltrating thetissues or even staining the edges to any considerable extent, andthere may remain but little in the wound in the case of lacerated andcontused wounds the amount of hemorrhage is less, but rarely failsentirely, and if the wound is in a vascular writing it is liable to causedeath from hemorrhage, though a whole limb may possibly be torn offwithout much hemorrhage in the latter case, however, there are usuallyfound clots of blood adhering to the edges of the lacerated woundand the ends of the vessels in contusions where there is no woundof the skin the blood is prevented from flowing externally, and itsaccumulation and distribution form an ecchymosis here again we see theactive power of the hemorrhage which infiltrates between the tissues, stains them deeply, and appears either as a mere stain or in fineclots incorporated, as it were, with the tissues or writingly occupying acavity formed by an extensive displacement of the surrounding writings the amount of blood varies under the same conditions as in incisedwounds, and also according to the greater or less disintegration ofthe tissues by the blow, allowing a larger or smaller central cavityto be formed in “bleeders” the amount of the hemorrhage does notvary under the normal conditions, but a fatal hemorrhage may occurfrom a very insignificant wound after hemorrhage from a wound madeduring life the veins are empty about the wound, especially thosesituated centripetally, while normally after death the blood is mostlyaggregated in the veins they are the source of post-mortem hemorrhage, but do not empty themselves to any great extent the hemorrhage from a wound made after death may be extensive ifthe blood remains fluid as in the paper mentioned above, i e , after death from drowning or asphyxia or after the commencement ofputrefaction otherwise the amount of hemorrhage decreases with thelength of time after death, until the blood loses its fluidity andhemorrhage no longer occurs in general, it is slight unless a largevein is opened, for the veins are the source of the hemorrhage thereis usually scarcely any hemorrhage after the first two to four hours this applies also to subcutaneous hemorrhages or ecchymoses thesepost-mortem hemorrhages are passive and not active, consequently thereis less infiltration of blood into the surrounding tissues, whichmerely imbibe it, and the stain is less deep and may be washed off theedges of the wound, in contrast to the stain of ante-mortem wounds after putrefaction has set in the hemorrhage may be more abundant, as the blood is driven to the surface by the formation of gas in theabdomen and thorax at the same time, the coloring matter of the bloodtransudes through the walls of the veins and is imbibed by and stainsthe tissues, so that it may be impossible to distinguish it from a trueecchymosis fortunately these conditions are of small moment, as anexamination is seldom deferred so long cadaveric ecchymoses show almost invariably while the body is stillwarm and the blood more or less liquid, i e , during the first eightor ten hours after death they are not due to injury or violence beforeor after death, but they may closely resemble ecchymoses produced onthe living body and be mistaken for them this is the more important asthey are quite constant on the cadaver in this connection, it may be said that an ecchymosis due to a blowbefore death may not show till after death, as it requires essay timefor a deep ecchymosis or even an ecchymosis covered by a thick layerof skin to show superficially thus a man kicked in the abdomen diedthirty-five hours after the injury from peritonitis, due to a ruptureof the bladder no ecchymosis appeared at the site of the injuriesuntil after death it is not uncommon in paper of hanging to observean ecchymosis along the course of the cord appearing only after death huize met with a case of this description devergie remarked that onthe bodies of those drowned ecchymoses are often hidden for a time onaccount of the sodden state of the skin, and they appear only afterthe water has evaporated, which may require essay days furthermore, it is not necessary to survive long after an injury in order that anecchymosis may show post mortem if the blood is fluid at the time ofthe blow and any capillaries or larger blood-vessels are torn, then wemay have an ecchymosis though death be almost instant casper thoughtthat it required essay time before death for an ecchymosis to develop, and that if the person injured by a contusion died soon after theinjury, an ecchymosis would not appear after death there are thesiswell-authenticated paper to prove that casper opinion is wrong amongthe most famous of these is that of the duchesse de praslin 615 shewas attacked and killed by her husband while she was asleep in bed the thirty or so wounds showed a mortal conflict, and she could nothave survived more than one-half hour, and yet after death there werenumerous ecchymoses from the contusions another case is also mentioned by taylor 616 a young man diedsuddenly after a blow from a companion, having been struck in the sidea fortnight before by a heavy box, which knocked him senseless andnearly killed him the post mortem revealed an ecchymosis on the sidewhich on the authority of casper opinion was attributed to the oldinjury the color of the ecchymosis would be sufficient to settle allsuch doubts, as the changes of color would have fully developed or thecolor even disappeared in writing in fourteen days’ time an ecchymosis made post mortem does not undergo the color changesseen in ecchymoses during life, unless the tissues are œdematous inwhich the ecchymosis occurs these changes in color have already beendescribed, the deep blue changing to violet in eighteen to twenty-fourhours at the earliest in support of the foregoing and disprovingcasper views, christison found that within two hours after deathsevere blows on a dead body are followed by a livid discoloration, similar to those produced by a blow shortly before death this lividdiscoloration is due to the effusion of a very thin layer of bloodexternal or superficial to the true skin, essaytimes in a stratum ofthe true skin or more rarely into the cellular tissue, staining deeplythe writingition walls of the fat-cells of course, a more or less recentcontusion or ecchymosis on a dead body was not necessarily produced atthe same time as the cause of death it should be borne in mind inthis connection that ecchymosis is not a necessary result of a blow orcontusion according to devergie, ecchymosis does not appear when a blow inflictedpost mortem is received by skin directly covering a bony surfacebeneath, and rarely appears where there is a large amount of fat and nosolid point of resistance beneath the site of the blow we have already referred to the fact which portal long ago remarked, namely, that the spleen has been ruptured without ecchymosis orabrasion of the skin the same absence of ecchymosis has been noticedin paper where the liver, stomach, intestines, bladder, etc , have beenruptured as the result of contusing blows the following case cited by taylor617 illustrates this point henkereported the case of a man who died of peritonitis a few hours afterfighting with another man there was no mark on the skin or ecchymosis, though there existed peritonitis from rupture of the small intestine the blow was proven by direct evidence, and though essay medicalwitnesses on account of the absence of external signs thought that noblow could have been struck, others of more experience admitted that itcould have been the cause of the rupture watson618 reports a similar case of a girl nine years old whoreceived a blow from a shoe on the abdomen this was followed by greatpain, collapse and death in twenty-one hours no marks of injury werevisible externally, but peritonitis existed from rupture of the ileum a similar case is reported by williamson, 619 where peritonitisresulted from complete rupture of the ileum without any trace of injuryexternally, though the blow was struck by the hoof of a horse another case was brought into guy hospital620 who had been run overby an omnibus no injury was discoverable, though the wheel had passedover the chest and abdomen he died of peritonitis, however, which setin on the second day, and on post-mortem examination the liver andsmall intestines were found ruptured christison thought as the result of his experiments and experiencethat the most reliable signs of an ecchymosis made during life, anddistinguishing it from one caused by a blow after death, were asfollows. The skin of the ecchymosed area is generally much darkened anddiscolored from blood infiltrated through its entire thickness. Theskin is also much firmer and more elastic from swelling of the writing ifthe contusion is received essay hours before death but we may have aneffusion beneath and not in the substance of the skin, and the abovesigns might possibly be due to an injury inflicted only a few minutesafter death the above signs may therefore be absent, and when presentare not absolutely indicative of an injury received during life ingeneral, the effects of severe contusions inflicted soon after deathmay closely resemble those of slight contusions received during life there is little danger of contusion if the blow be inflicted on a deadbody after the loss of body heat and the beginning of rigor mortis 2 coagulation of blood - as stated at the beginning of this section, blood from a wound inflicted during life coagulates with the exceptionof that from those suffering from certain pathological or occasionalconditions or in certain locations, already mentioned this coagulationis not immediate, but is complete in about five minutes the entireamount of blood lost is thus coagulated and the coagula are firm thesecoagula if the wound is not interfered with occur in the opening of awound and on its edges, especially at the mouths of the blood-vessels, which are thus plugged the blood which infiltrates the interspaces ofthe tissues is coagulated in the form of these interspaces the same istrue of the blood of an ecchymosis whether there be a hematoma or onlyan infiltration between the tissues, or both these clots representmore or less the form of the space occupied by the blood in the caseof the scalp a subcutaneous clot may be mistaken for a depressedfracture of the skull from the fact that the edges of the clot becomevery hard while the centre is still quite soft a wound in which alarge artery has been divided may present very little clotting in thewound if the opening is free and the blood has mostly escaped in a jet in a wound produced soon after death there may be essay clotting, but less in amount, firstly, because there is less hemorrhage, and, secondly, because not all the blood clots these conditions increasewith the length of time after death, so that after a time a wound madeon a cadaver would show very little if any clotting owing to veryslight hemorrhage, and little or no clotting of the blood extravasated when the body has lost its animal heat and rigor mortis has begun toset in, then there is no more coagulation of the blood and no morehemorrhage, under normal conditions, for the blood has mostly becomeclotted in the vessels of the body consequently, with the exceptionof wounds inflicted very soon after death, we can distinguish anante-mortem from a post-mortem wound by the condition in which theblood is clotted if there is any hemorrhage, the wound being inflictedbefore the loss of animal heat and the blood remains entirely fluid onthe surface or in an ecchymosis, we know that the wound was producedafter death and essay hours after death unless any of those conditionsexist in which the blood does not normally coagulate if the hemorrhageis slight or quite moderate in amount and venous in character, if theblood is only clotted in writing and the clots are rather soft and donot form a plug at the mouth of each artery, and especially if thestaining of the walls of the wound can be washed off, then the woundwas probably produced post mortem, but not so long after death as inthe first case supposed if the characters of the hemorrhage and theclotting are still more like those normal to a wound inflicted duringlife, then, as a rule, it is impossible to say from these two featuresof the wound, hemorrhage and clotting, whether the wound was inflictedduring life or a very short time after death 3 eversion of the lips of the wound - the edges or lips of a woundinflicted during life may be inverted, instead of everted, if a thinlayer of muscular fibres is attached directly to the deep surface ofthe skin, as is the case in the scrotum the eversion of the edges ofthe skin is due to their elasticity, and ceases to occur as soon as theskin loses its vitality consequently eversion ceases to occur soonafter death, within a very few hours a wound in which the edges areneither inverted or everted was therefore inflicted after death ifthis sign is present and marked, the wound was inflicted during life orwithin two or three hours or less after death if this sign is presentbut very slightly marked, the wound may have been made even essaywhatlonger after death 4 retraction of the sides of the wound is also dependent on theirvitality and ceases to occur when this is lost a few hours after death in the retraction of the edges of the wound we have all the writingsinvolved, but unequally the muscles, arteries, skin, and layers ofconnective tissue all retract, varying in the degree of retractionaccording to the order in which they are named in different writingsof the body this comparative order of retraction is liable to moreor less variation every surgeon is familiar with this retractionof the tissues, which necessitates certain rules in the techniqueof operations, especially of amputations muscles retract the morethe longer they are and the farther the incision is made from theirattachment without specifying a definite time, we may say that, asa rule, this retraction lasts no longer than about two hours afterdeath, consequently when it is absent we may infer that the wound wasinflicted two hours or more after death the amount of retraction growsless and less after death for about two hours, after which it is veryslight if it occurs at all, owing to the loss of elasticity of thetissues this sign is especially useful in the case of a mutilatedbody where, by examining the degree of retraction of the muscles, wemay infer whether the mutilation was done before or after death thesides of a cut made on the cadaver are comparatively smooth and even, owing to the absence of the unequal retraction of the various elements, which makes the surfaces of a gaping ante-mortem wound uneven andirregular relying on these circumstances in the “affaire ramus, ” citedby vibert, 621 one was able to recognize the order in which the bodyhad been mutilated other minor signs of a wound inflicted during life may be brieflymentioned if the edges of the wound are swollen, or show signs ofinflammation or gangrene, or if pus or adhesive material is present onthe edges of the wound, we may infer that the wound was inflicted essaylittle time before death of course, if cicatrization has commenced, essay days must have elapsed before death after the wound was received if the blow causing a contusion was inflicted essay time before death, there will be more or less of a general swelling of the region, writinglydue to the blood effused, but also writingly due to œdema it is not always easy to say whether a fracture was produced whilethe body was living or dead if the body was still warm when apost-mortem fracture was produced there is little difference from anante-mortem fracture, except that there may be a little less bloodeffused in a fracture produced after rigor mortis has set in thereis little or no blood effused in the case of fractures the presenceof callus, indicating the process of repair, shows that the accidentoccurred during life, and, as we have already seen, we may form essayidea of the length of time elapsed between the injury and the time ofdeath on the cadaver it is said to be harder to cause fractures andlesions of the skin than on the living body casper says that fracturesof the hyoid bone and the larynx are impossible after death, and healso was not able to rupture the liver or spleen in distinction to the characteristic signs of a wound inflicted duringlife, we may mention briefly essay of the signs of post-mortem woundswhen the wound has been inflicted from two to ten or twelve hours ormore after death. 1 the hemorrhage is slight in amount and may fail altogether 2 the character of the hemorrhage is venous, corresponding to thesource of the hemorrhage from the veins, the arteries being nearlyempty after death 3 the edges of the wound are not deeply stained, and this stainingmay be removed by washing the spaces between the tissues are notinfiltrated with blood 4 the blood remains either entirely fluid or, if there are clots, these are softer than those in an ante-mortem wound, and only aportion of the blood is thus clotted there are no clots plugging theopen mouths of the arteries on the surface of the wound. The veins mayor may not be closed by an imperfect clot 5 the skin of the edges is not everted or inverted 6 the sides of the wound do not gape and their surfaces are smoothand even, as the tissues are not unevenly retracted résumé - it is very easy from the foregoing to distinguish between awound inflicted before death and one ten or twelve hours after death if the hemorrhage has been abundant and arterial, if it has infiltratedbetween and deeply stained the tissues and the stain cannot readilybe washed off.

Average0 1436 gm , or 2 87 per cent in a third case the temperature reached250 c , and there was essay decomposition of the fat in the flask andessay colored material distilled over for this sublimate 15 54 c c substance abuse essay oftenth-normal alkali were required after evaporating the alcohol and acidulating the solutions obtainedin the previous experiments, the benzoic acid was extracted withchloroform in the first case, 0 1383 gm was obtained. In the second, 0 1541 gm. Average 0 1462 gm , or 2 92 per cent of benzoic acid when the original chloroformic extract was heated until all of thebenzoic acid had been driven off, the residue had the appearance of asemisolid fat it compared quite closely in color, odor, etc , with thefatty material obtained by extracting colchicum seed with chloroform, although the odor was more suggestive of oleic or stearic acid it wasdistinctly acid, which is also true of the fatty material obtained froma sample of colchicum seed the extract obtained with hot water was light yellow. Gummy, at first, but dried to a glass-like brittle mass it had a slight burned-sugarodor and taste, and was neutral in reaction it was stronglydextrogyrate and at once reduced fehling solution as well as alkalinesilver nitrate solution on boiling with potassium hydroxid solution, it turned deep red it also gave the molisch carbohydrate reaction, and the ozazone test in seventeen minutes as described in mulliken identification of pure organic compounds, ed 1, 1905, p 26 theseare all characteristic reactions of lactose or milk sugar from this examination we conclude that desanctis’ pills containpowdered colchicum seed, benzoic acid, and sugar of milk there is alsopresent fatty material which resembles the fat of colchicum seed, butmay be, in writing, added fatty acid the percentage of colchicin found 0 50 is about that of a good quality of colchicum seed, the u s pharmacopeial standard being not less than 0 45 per cent since thepills contain material other than colchicum seed, this assay wouldindicate a colchicum seed of high alkaloidal content, or the possiblereinforcement of the pills with colchicum extract or colchicin the amount of benzoic acid, 2 92 per cent , or about 1/7 grain perpill, is insignificant from a therapeutic standpoint, since an averagedose is 0 5 gm , or 8 grains fatty acids, and the fatty matter fromcolchicum seed are inert, at least in the quantities found here theonly office which fatty acids might perform, would be to give the pillsan enteric quality, preventing their absorption until they reach theintestine the sugar of milk, about 10 per cent , or 1/2 grain perpill, no doubt is simply an excipient desanctis’ pills are therefore essentially 5 grain doses of powderedcolchicum seed, of which the average dose is 0 2 gm , or 3 grains u s p ix, p 120 the journal in presenting the facts contained in the above report madethe following comments:“here then, we have sold for self-medication an extremely poisonousdrug, with no warning of the risk the public runs in using it whilethe directions call for “one pill every eight hours until relieved, ”it is notorious that the public takes the attitude toward “patentmedicines” that, if a little is good, more is better, and the averageuser of remedies for self-treatment is likely, unless there is essaywarning, to use his own discretion as to the amount taken “the individual dose is above that of the average recommended in theunited states pharmacopeia colchicum or its alkaloids-- or for thatmatter, any drug as toxic as colchicum-- have no place in preparationsof the home-remedy type in the case of all “patent medicines, ”public interest demands that the full quantitative formula of thetherapeutically active ingredients should be given on the label, forwhen the public prescribes for itself, it has a right to know what itis taking unfortunately, public interest clashes with vested interestsand, as usual, vested interests get the better of it in the case ofsuch dangerous preparations as desanctis’ pills, if their sale is tobe permitted at all, not only should the names and quantities of alltherapeutically active ingredients in the mixture be given, but thelaw should require that the word poison be plainly printed on thelabel ”-- abstracted from the journal a m a , july 19, 1919 iodex and liquid iodexthe a m a chemical laboratory examined iodex in 1915 213 theclaims made, at that time, by the exploiters, menley & james, wereshown to be contrary to facts in that iodex contained only traces offree iodin while they claimed “5 per cent therapeutically free iodin ”even the total quantity of iodin was shown to be only about one halfof the 5 per cent claimed to be present as free iodin 213 annual reports of the chem lab of the a m a , 1915, p 89 an examination of the advertising matter sent out by menley & jamesin 1919 showed that substantially the same claims were being made asin 1915 this at once suggested the inquiry. Since the claims are thesame as previously made, have the manufacturers altered the compositionto conform to the claims?. the answer is found in the results of theanalysis of two samples purchased in the open market early in 1919 this analysis shows conclusively that iodex is essentially the same asin 1915, that is, that it contains no free iodin and only about threefifths of the total amount of iodin claimed it would seem that iodex ung iodi , m & j is in obvious conflictwith section 7 of the food and drugs act while it is sold under a namerecognized by the u s pharmacopeia, namely, ung iodi , it does notconform to the standards of the u s pharmacopeia for that product iodin ointment u s p is made with 4 per cent of free iodin, 4 percent of potassium iodid, 12 per cent of glycerin, and a benzoinatedlard base it should then contain approximately 7 per cent of totaliodin it has been shown by warren214 that about 75 per cent of theiodin in the u s p ointment remains in the free state even aftermonths of standing ung iodi , u s p , then, should contain about 3per cent of free iodin iodex contains no free iodin, or but traces, and no potassium iodid furthermore, the iodex label declares thepresence of 5 per cent of “therapeutically free” iodin as a matter offact, the amount of iodin is variable, the highest amount found being3 5 per cent and samples containing as low as 2 63 per cent have beenexamined 214 warren, l e. Iodin ointment, am j pharm , august, 1917, p 339 it would seem further that iodex is misbranded under the sherleyamendment in that it is said that it “may be used externally withadvantage in all paper where the action of iodin is desired ” sinceit contains no iodin as such this cannot possibly be true it is alsostated in a circular accompanying the trade package that “thirtyminutes after inunction iodin can be found in the urine ” thisstatement has also been shown to be untrue -- annual reports a m a chem lab , 1915, p 89 details of analysisiodex -- this is a rather soft ointment, almost black but with adecided greenish cast in thin layers it is soluble in chloroformbut is only writingly saponified and dissolved by alcoholic potassiumhydroxid iodex has a distinct odor like oleic acid free iodin -- when examined by the method previously used215 onlyminute traces of free iodin were found 215 ibid , p 90 total iodin -- the methods employed were as follows. 1 iodex wassaponified by boiling for from two to three hours with alcoholicpotassium hydroxid the alcohol was then evaporated and the iodindetermined by the method described in the u s pharmacopeia for thymoliodid 2 the same as method 1, except that after ignition of the saponifiedmixture the halogen was determined by weighing as silver iodid 3 the carius method it should be noted that methods 2 and 3 determine chlorin and brominshould any be present with the iodin when 5 gm of sample 1 was assayed by method 1, it required 73 56 c c of tenth-normal sodium thiosulphate, equivalent to 3 11 per cent of iodin in a duplicate, 2 7565 gm of iodex required 38 c c oftenth-normal sodium thiosulphate, equivalent to 2 92 per cent ofiodin. Average of the two, 3 02 per cent of iodin a weight of 2 5800 gm of sample 1, assayed by method 2, gave0 1582 gm of silver halid, equivalent to 0 0855 gm of iodin, or 3 31per cent a weight of 0 588 gm of sample 2, assayed by the carius method, gave0 0388 gm of silver halid, indicating 0 02096 gm of iodin, or 3 52per cent in a duplicate, 0 5342 gm gave 0 0338 gm of silver halid, indicating 0 01826 gm of iodin, or 3 42 per cent.

“ diabetes, chronic bright disease, substance abuse essay goiter, pulmonary tuberculosis, chronic rheumatism, the severe anemias, arterio-sclerosis sic, various nervous disorders, locomotor ataxia, varicose and indolent ulcers ”evidence of the virtues of hemo-therapin is submitted as a seriesof “case reports”-- unsigned-- which bear a striking likeness to thetestimonials of “patent medicine” almanacs a specimen of the “casereports” is the following. “blood poisoning due to snake bite -- case 9. Mrs -- --. Age, 52. Was bitten by a poisonous snake-- a copperhead-- seventeen years ago on the anniversary of the bite the arm would swell to more than twice its normal size and there would be pain, chills and fever after a month of this the acute symptoms would disappear and the arm would show large scaly blotches which upon being removed would disclose a thin mucous liquid throughout the seventeen years pain was constant, being writingicularly acute in midsummer around the anniversary of the bite this patient had consulted thesis physicians during the seventeen years of suffering without any relief large doses of narcotic remedies were necessary each day to subdue the pain twenty-four hours after the first injection of hemo-therapin all pain was dissipated after four treatments the patient was considered well and there has been no return of any of the symptoms since the last treatment six months ago ”hemo-therapin is sold in ampules. 6 for $5 and 12 for $10, and acircular sent to a physician contained this typewritten note. “fees -- while the physician fee is not regulated by this company, the physicians who use hemo-therapin get $5 00 and $10 00 for each treatment ”-- from the journal a m a , jan 5, 1918 venosal report of the council on pharmacy and chemistrythe following report on venosal has been adopted by the council, andits publication authorized w a puckner, secretary “venosal” is one of the products of the intravenous products company, denver, colo its composition has been variously, and obscurely, described. “venosal is a sterile solution representing 1 gm 15 4 gr of salicylates in combination, together with colchicum ” “this is a product for intravenous use the composition of which is sodium salicylate, 15 4 grs 1 gm , iron salicylate a minute quantity and the equivalent of approximately 2 grs dried colchicum root ”none of these “formulas” gives the quantity of the product containingthe 1 gm of salicylate, etc , but presumably it refers to the contentsof 1 ampule or 20 c c this inference is in accord with the analysisof the product made in the chemical laboratory of the american medicalassociation the analysis also brought out the fact that the amount ofiron in a given ampule was 0 0008 gm about 1/80 grain this trace ofiron in the presence of salicylate gives the product a purple color venosal is recommended for the treatment of “rheumatism, ” meaning, thecontext would indicate, infectious rheumatic fever as colchicum hasno special action on this disease and as there is no apparent reasonfor the employment of the trace of iron present, these additions infixed proportions are unscientific, if not absurd according to theadvertising matter. “venosal eliminates unpleasant digestive disturbances which frequently forbid the use of salicylates by mouth and, in addition, insures their full therapeutic value ”the statement is misleading, as the paper in which the oraladministration of the salicylates is contraindicated are not “frequent”but exceptional and there is no evidence to justify the implicationthat the “full therapeutic value” of salicylates cannot readily beattained by their oral use still more astonishing is the followingclaim. “venosal is a combination carrying the true salicylates sodii in doses much larger than given by mouth with this preparation given intravenously, there is no nausea or disagreeable digestive after-effects, tinnitus aurium, or the accumulating effects of the drug. Yet the specific action of the salicylates seems to be increased thesis-fold, according to reports received ”what are the facts?. by mouth sodium salicylate is given in doses offrom 3 to 15 gm in a day. Whereas venosal is advised as 1 gm , infrom one to three day intervals. As a matter of elementary arithmeticit is plain that these doses of venosal are smaller instead of being“much larger ” the absence of digestive ill effects, tinnitus, etc , is explained by the small dosage that the specific action of thesalicylates should be increased by intravenous administration issurprising when it is remembered that the drug is absorbed rapidlyand completely from the intestines. In fact, the quoted statement isincredible the company further alleges that, on the basis of “clinical reports”it has received, it does not “hesitate to recommend this product forroutine use in all streptococcic infections ” such a therapeuticsuggestion is, to put it conservatively, gross exaggeration the whole question of the justification of using salicylatesintravenously is open to grave doubt since it is possible to obtainthe salicylate effects promptly and certainly by oral administration, the inherent dangers of intravenous medication render its routineemployment unwarranted a further objection to venosal, especially atthis time when economy is a national policy, is the unnecessarily highexpense of venosal itself and of its administration the referee recommends that venosal be declared ineligible to new andnonofficial remedies because of conflicts with rule 1 indefinitechemical composition, rule 6 therapeutic exaggerations and rule10 unscientific composition -- from the journal a m a , jan 5, 1918 secretin-beveridge and the u s patent law report of the council on pharmacy and chemistrytwo years ago the council published reports on two proprietarypreparations said to contain secretin, namely, “secretogen, ” soldby the g w carnrick company the journal a m a , may 1, 1915, p 1518, and “duodenin, ” sold by armour and company the journala m a , aug 14, 1915, p 639 these reports explained that therewas no evidence to indicate that an insufficient amount of secretin wasthe cause of gastro-intestinal diseases, and further that there wasno evidence that secretin in any form was physiologically active whenadministered by the mouth subsequently, a j carlson and his co-workers, at the request ofthe council, studied the question of the stability of secretin anddemonstrated the journal a m a , jan 15, 1916, pp 178 and 208that commercial secretin preparations contained no secretin and, further, that secretin given both by the mouth and even in enormousdoses directly into the intestine is entirely inactive shortly after the publication of professor carlson work the attentionof the council was called to a u s patent issued, may 2, 1916, to james wallace beveridge, “means for and method of stabilizingsecretin ” in this patent beveridge claimed to have invented “theprocess of producing secretin in stable form as a commercial articlefor therapeutic use ” that is, a process for preparing preparationswhich would contain secretin when they reach the consumer and in a formresisting destruction in its passage through the stomach in view of the demonstrated instability of secretin, the councilasked professor carlson to investigate the validity of the claims ofthe beveridge patent the study on “the question of the stability ofsecretin, ” by a j carlson, a e kanter and i tumpowski, whichappears below, shows that the beveridge patent furnishes no process forthe manufacture of commercially stable secretin preparations, nor anymeans for preventing the destruction of secretin by the gastric juicewhen administered orally it further demonstrates that the preparationmade by beveridge was devoid of secretin the council adopted the report of carlson and his co-workers, anddeclared secretin-beveridge inadmissible to new and nonofficialremedies the council directed that the report of carlson and his collaboratorsbe sent to the commissioner of patents with a protest against thegranting of patents without competent and thorough investigation of theclaims advanced therein w a puckner, secretary the question of the stability of secretin a j carlson, a e kanter and i tumpowski from the hull physiological laboratory of the university of chicagoin a letters patent, filed may 6, 1914, the patent granted may 2, 1916, james w beveridge, m d , makes certain claims concerning the stabilityand physiologic activity of secretin prepared according to the methodpatented by him in brief, dr beveridge claims that secretin prepared by digestingintestinal mucosa with a weak acid at a temperature slightly belowboiling, and mixed with 0 2 per cent to 2 per cent blood serum, albumin or peptone 1 remains active for at least six months, 2stimulates the pancreas when given by mouth, and 3 “may be injectedintravenously in man, if desired ” the only thing in the letters patentin support of these claims is the statement. “i have found out byactual tests that the preparation maintains its stability for five orsix months ”here are the claims in detail.

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And this water, drank two or three spoonfulsat a time, easeth all pains and torments coming of cold and wind, substance abuse essay sothat the body be not bound. And taken with essay of the root in powderat the beginning, helpeth the pleurisy, as also all other diseases ofthe lungs and breast, as coughs, phthysic, and shortness of breath;and a syrup of the stalks do the like it helps pains of the cholic, the stranguary and stoppage of the urine, procureth womens’ courses, and expelleth the after-birth, openeth the stoppings of the liver andspleen, and briefly easeth and discusseth all windiness and inwardswellings the decoction drank before the fit of an ague, that theymay sweat if possible before the fit comes, will, in two or threetimes taking, rid it quite away. It helps digestion and is a remedyfor a surfeit the juice or the water, being dropped into the eyesor ears, helps dimness of sight and deafness. The juice put into thehollow teeth, easeth their pains the root in powder, made up into aplaster with a little pitch, and laid on the biting of mad dogs, or anyother venomous creature, doth wonderfully help the juice or the watersdropped, or tent wet therein, and put into filthy dead ulcers, or thepowder of the root in want of either doth cleanse and cause them toheal quickly, by covering the naked bones with flesh. The distilledwater applied to places pained with the gout, or sciatica, doth give agreat deal of ease the wild angelica is not so effectual as the garden. Although it may besafely used to all the purposes aforesaid amaranthus besides its common name, by which it is best known by the florists ofour days, it is called flower gentle, flower velure floramor, andvelvet flower descript it being a garden flower, and well known to every onethat keeps it, i might forbear the description. Yet, notwithstanding, because essay desire it, i shall give it it runs up with a stalk acubit high, streaked, and essaywhat reddish towards the root, but verysmooth, divided towards the top with small branches, among which standlong broad leaves of a reddish green colour, slippery. The flowers arenot properly flowers, but tuffs, very beautiful to behold, but of nosmell, of reddish colour. If you bruise them, they yield juice of thesame colour, being gathered, they keep their beauty a long time. Theseed is of a shining black colour time they continue in flower from august till the time the frostnips them government and virtues it is under the dominion of saturn, and isan excellent qualifier of the unruly actions and passions of venus, though mars also should join with her the flowers dried and beateninto powder, stop the terms in women, and so do almost all other redthings and by the icon, or image of every herb, the ancients atfirst found out their virtues modern writers laugh at them for it;but i wonder in my heart, how the virtues of herbs came at first tobe known, if not by their signatures.