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Very high, as wellas very low, temperatures are met in severe neuroses and essay forms ofmalarial disease a temperature of 42 2° c 115° f has been recorded, and after an injury 71° c 122° f 688very low temperatures are reported in several paper of acutealcoholism, accompanied by exposure to cold, where a temperature of28 8° c 75° f in the rectum was noted, recovery following 689such extreme temperatures, though authentic, are exceptional very high temperatures in febrile conditions are borne becauseremitting. And low temperatures, subject to periods of elevation, are met in wasting and other conditions very high and very lowtemperatures are also noted, just before death, in acute diseases andconditions specially involving the nervous system the degree to which the temperature may be raised without destroyinglife has been investigated by berger, bernard, chossat, and others 690their experiments show that if an elevation of temperature of the body7 20° c 13° f be maintained for any length of time in warm-bloodedanimals, death ensues depression of the temperature of warm-bloodedanimals 12° c 20° f , or even less than these degrees below thenormal, results fatally portions of the body may be frozen and yet, under appropriate treatment, recover but freezing of the whole bodymust necessarily prove fatal great differences in ability to endure extremes of heat and coldappear among different nations and in different individuals the veryyoung and the very old are unable to bear exposure to extreme cold in both, the capacity for heat production is low and the vital powersare soon enfeebled to a critical degree the healthy adult can, withproper precautions, safely endure great extremes of heat and cold the experience of arctic explorers in the expeditions of kane, nares, greely, and others has demonstrated the power of endurance, for aconsiderable period, of a temperature from 90° to 100° f below thefreezing-point on the other hand, laborers employed in pottery andother establishments, using ovens raised to 148° to 315° c 300° to600° f or higher, are often exposed for essay time without injury totemperatures approaching these intense figures effects of extreme cold legal inquiry into the conditions of death from cold occurs almostentirely in paper of unintentional exposure cold has been employed, however, with homicidal intent the depressing influence of continuedlow temperatures is observed in the death-rates of cities, in wintersof protracted severity, where the proportionate mortality amonginfants, the aged and enfeebled shows marked increase while age is aprominent predisposing and contributing factor, other causes exist exhaustion from severe and prolonged exertion, deprivation of food, intoxication, former illness, and other conditions of depression lessenthe powers of the body to resist cold thus an exposure which might besafely borne in perfect health might result fatally in the same personin conditions of depression just referred to case 1 investigation may be demanded in case of the death ofa young children b the injured c the insane a in young children - this may be in the new-born or older children in the new-born exposure to cold soon causes death, as warmth isessential to the life of the young being the length of time necessaryto a fatal issue is modified by several conditions in the immature orprematurely born infant the resisting power is much less than in thechild born at full term and otherwise healthy in paper of suspectedinfanticide by exposure the question of the maturity of the child atbirth is to be decided careful examination of the place in which thebody was discovered should be made as to its lack of warmth. And thedegree of external cold at the time of probable exposure should berecorded the circumstances as to whether the exposure was inadvertentor accidental, as in paper of premature or unexpected delivery, orwhether from intentional and deliberate purpose or from culpableneglect, should be carefully considered the post-mortem examinationshould decide whether the appearances and conditions of the body arethose peculiar to death from cold case 2 death may occur from culpably careless exposure to cold, as acontributory if not as a direct cause, in such conditions ofenfeeblement criminal neglect to provide medical attendance, food, andother essentials has been proven in essay paper of the so-called “faithcure” or “prayer cure ” exposure may be resorted to with deliberatehomicidal intent it may, in essay paper of death, become an importantlegal question to decide whether a studied and persistent neglect ofthis nature may not have been followed, with the purpose of getting ridof a troubleessay care paper 2 and 3 b exposure of the injured or wounded, thereby inducing essaygrave condition or complication which under proper care would havebeen avoided, may raise an important question in injuries inflictedby another, with or without criminal intent it is undeniable thatserious or fatal results may follow a slight wound, otherwise trivial, where the injured person was subjected, accidentally or intentionally, to extreme cold for a considerable period while such paper arecomparatively rare, they may demand investigation c exposure of the insane - while it must be admitted that theinsane subject is usually indifferent to matters of temperature, deathfrom exposure to cold may call for special examination carelessness, incompetence, or wilful neglect on the writing of nurses or keepers ofinsane hospitals, or deliberate criminal intent in such or othershaving the care of or an interest in the death of an insane person maylead to a judicial inquiry sudden death has been reported as occurring, in several paper, afterthe ingestion of large quantities of cold water when the person wasgreatly heated it is essaywhat difficult to explain all such paperreported on a single line of causation essay observers have attributeddeath to syncope or asthenia by the shock produced, in the suddeneffect of the cold upon the sympathetic nervous system inducing heartfailure this seems the most natural explanation others consider the causative factor to be the formation of thrombosesin the capillaries of the brain, lungs, and other organs, inducingactive and obstructive congestions causing death by apnœa or coma others regard these paper as similar to “heat apoplexy ”symptoms under the influence of external cold, the vessels of the skin arecontracted and the internal splanchnic areas dilated thus the surfaceof the body contains less blood and the internal organs a largerproportion this vascular change is one of the important factors inmaintaining the uniform temperature of the body the thermometer, placed in the mouth, in such conditions frequently indicates a rise oftemperature this is probably due, not only to the increased volumeof blood collected in the internal organs, but also to an increasedproduction of heat through a thermogenic action in exposure for a time to severe cold the nose, ears, cheeks, hands, feet, and other portions of the body, after the first appearance ofdusky lividity, become bloodless and white, lose sensation, and becomecongealed. A condition known as “frost-bite ” from this, recoverywithout injury is possible under appropriate treatment, by which thetemperature is gradually raised and the circulation restored wherethe latter result is not secured, the writing becomes gangrenous and isultimately removed by a process of inflammation and sloughing if the application of cold be protracted and the temperatureextreme, the loss of heat becomes rapid and symptoms of depressionof the heart action appear painful sensations of the surface andother portions of the body are experienced, succeeded by impairedsensation and anæsthesia the skin acquires a dusky, reddish, andlivid appearance, with the formation occasionally of vesicles orblisters with the lessened sensation stiffness of the limbs appears, due to failing muscular contractility the congestion of the centralportions of the nervous system induces a condition of advancing stupor, resulting in complete coma with ultimate suspension of respiration andthe heart action death from exposure to cold may be rapid or slow in paper of recoverythe period of reaction is a critical one the depression of the heartis apt to continue, and gangrene of writings of the body is likely tooccur ulcers and sores healing with difficulty develop in essay paper treatment in the treatment of those who are suffering from the effects of extremecold, the restoration of the congealed or “frost-bitten” portions ofthe body should be gradually accomplished raising the temperaturerapidly is liable to induce the death and destruction of the affectedwritings ice or snow should, at first, be rubbed upon the frozen writing, to be succeeded later by cold water the patient should be placed ina cool room and distant from the fire or source of heat as soon aswarmth begins to return the writing should be enveloped in wool, cotton, or essay substance of poor conducting powers if the whole body bechilled, frictions of the surface with stimulating lotions are ofbenefit, wrapping the person in woollen or fur coverings or garmentsafterward hot coffee or alcoholic stimulants are of value as restoratives, butthe latter are to be avoided during an exposure to cold post-mortem appearances the appearances indicative of death from cold are sufficiently markedto enable one to decide whether exposure to cold was the chiefdetermining cause of death, provided that a careful consideration ofthe circumstances of season, temperature, place, and other conditionsbe also had in the examination of a body in a case of apparent death from cold, thelimbs and internal organs may be found frozen it must be rememberedthat this occurs after, not before, death. And the frozen conditionmust not be mistaken for “rigor mortis ”in paper where a body is found, in freezing conditions of atmosphere, showing commencing putrefaction, the death must not be hastilyattributed to cold, which prevents putrefaction it is evident that ifcold was the cause of death the temperature of the body had been raisedsince that event, or, more probably, death occurred from other causesand the body remained essay time before becoming frozen the finding of a body in the snow or frozen in severe weather must notpreclude the search for other causes of death, such as apoplexy, etc , which may have occurred anterior to the freezing observers generally have agreed upon the presence of certainpost-mortem conditions in paper of death from cold externally - upon the skin are found dusky reddish patches, irregularin outline, which are in sharp contrast with the general pallor of thesurface krajewskey, 691 ogston, 692 dieberg, 693 and others, in theseveral series of paper reported by them, all describe this condition the skin otherwise is pale internally - the viscera, including the brain, are congested the heartcontains a large quantity of blood in the cavities of both sides, andthe large vessels leading from it are also full the color of the bloodis a bright red, resembling its arterial hue this condition has beengenerally noted and described. But essay excellent observers have notreferred to it effects of extreme heat the application of moderate heat to the surface of the body causesdilatation of the cutaneous capillaries in such application theexhalant and perspiratory function of the skin is increased, by whichmeans a rise in general body temperature is prevented if, however, severe physical exertion accompany the exposure, a more pronouncedresult is induced and a depressing effect upon the nervous systembecomes manifest if the degree of heat be raised and the exertionincreased and prolonged, marked depression ensues under circumstancesof quiet and rest a high degree of temperature is borne by man withoutdepression or discomfort, but with continued and severe muscular effortthe rise in animal temperature is productive of distress and depressingconditions in the turkish or russian baths, in the healthy subject, a temperature of 48 8° to 54 4° c 120° to 130° f produces profuseperspiration but no depression, and a plunge in or affusion of coldwater is not only borne with impunity but is acceptable in conditionsof heat accompanied by physical exhaustion, such sudden exposure tocold would prove extremely dangerous in the condition of rest, exposed to external heat, the tendency toelevation of body temperature arises from the external causes alone, which in no way specially modify the nutritive functions but in thesecond condition the internal processes of nutrition, which have beensubject to great stimulation, are suddenly embarrassed by suppressionof the compensating activity of the cutaneous surface, and severeorganic and nervous derangements follow in the summer season the temperature rises to 32 3° c 90° f andeven much higher in certain localities during the prevalence of suchheat, the mortality among young children, the aged and enfeebled isvery marked. These two periods of life being very susceptible to thedepressing effects of heat a high temperature is easily borne if theair be pure and the atmosphere be not saturated with moisture telluricelectric conditions also have a modifying influence, undoubted thoughobscure in certain occupations an intensely heated atmosphere is endured withimpunity for a considerable time, provided the air be maintained in acondition of purity and water be supplied to the person exposed thestokers upon ocean steam-ships, where a forced draught is employed, aresubjected to extreme heat, essaytimes reaching 60° c 140° f resortto forced and continuous ventilation of the stoke-rooms, with shorthours of duty, renders tolerance of the high temperatures possible sunstroke the terms “sunstroke, ” “insolation, ” “coup de soleil, ” areapplied to conditions induced, not alone by exposure to the rays ofthe sun, but rather by a combination of great heat with other excitingcauses they are used to designate attacks occurring in very hotweather after exposure to solar or other sources of extreme heat the striking and usual phenomena are exhaustion, unconsciousness, stertorous respiration, and death, occurring by syncope, within afew moments or hours in a number of paper the symptoms of cerebralapoplexy with death by coma are present in others, the condition seems one of complete exhaustion the majorityof paper seem to be a combination of these several conditions, withdeath resulting from syncope the ordinary phenomena of the attack are pain in the head, hurriedrespiration essaytimes stertorous, violent beating of the heart withfailing of its power, oppression within the chest and, occasionally, nausea and vomiting the pupils are essaytimes dilated and essaytimescontracted, but in all paper exhibit lessened sensitiveness to light the suddenness of the attack modifies the symptoms developed pathological conditions these are exhaustion with syncopic tendency and a rapid rise in thetemperature of the body to a point destructive to the activity of thenervous centres this is accompanied by an abnormal condition of theblood, resulting from loss of its watery portions, with retention ofeffete products and impaired aeration a tendency to general stasis, specially marked by congestions of the lungs and brain, is present the change in the blood is a very important factor in essay paper, notfatal at the outset, this induces a septic condition the greatly elevated temperature of the body undoubtedly producescertain modifications which type it, in essay respects, as a febriledisease. But this, with the septic tendency due to blood changes, isnot sufficient to designate it as a purely “thermal fever, ” as essayhave claimed it is essaything more than this sunstroke occurs more commonly in tropical than temperateclimates;694 and usually in the day-time, at the period of greatestsolar activity, those attacked being engaged in labor involvingconsiderable exertion it occasionally, though rarely, occurs at night the military service affords abundant opportunity for observation herethe seizures are on the march, rarely in camp fatigue, prolonged andextreme exertion, ill-adjusted clothing and accoutrements, with thedeprivation of cool water, are fully as active factors as the heat ofthe sun the death-rate ranges between forty and fifty per cent, themild paper being excluded death in essay paper is marked by syncope, in others by apnœa, though the majority seem to die by a combinationof both, as in most paper the pulmonary congestion is more or lesspronounced undoubtedly the character of the symptoms and mode of deathare influenced, in thesis paper, by individual tendencies leading toapoplectic conditions or to cardiac or other complications treatment this must be adjusted to the pathological conditions of the patient as already indicated, two classes of paper are met. One marked byexhaustion, with tendency to death by syncope. The other, a state ofor tendency to cerebral congestion or apoplectic conditions exactlyopposite methods of treatment are demanded in the first, frequencyand feebleness of the heart action, with faintness of the heartsounds and embarrassment of respiration, indicate the tendency todeath by nervous exhaustion, and must be met by placing the patientin a condition of absolute rest and quiet in a cool place stimulantsmust be promptly administered, though cautiously on account of thetendency to nausea and vomiting hypodermic injections of alcohol orether, or rectal enemata of turpentine, alcohol, or other stimulants, afford means of securing speedy effects when the stomach is irritable carbonate of ammonia and other cardiac stimulants are recommended depleting agents, or such as prove depressing, are to be avoided inessay paper, hypodermic injections of small doses of morphine provebeneficial individual paper must modify therapeutic procedures in the second class of paper the tendency to cerebral congestionindicates sedative and depleting procedures blood-letting has beenrecommended by essay authors, if employed with extreme judgment anddiscrimination 695 cold applied to the head and also to the wholebody by rubbing with ice696 or by effusion and the wet sheet, orother means, is indicated if the temperature is high 104° to 105° f active catharsis, by promptly acting purgative enemata, is also to beresorted to in most paper the convulsions occurring in essay paper aresuccessfully modified and controlled by inhalations of small quantitiesof chloroform post-mortem appearances these, though not clearly characteristic, are pronounced in essay paperno distinct conditions are found 697 local congestions are present innearly all paper upon the skin are found petechial and livid spots, pallor being occasionally noted ecchymoses and subserous hemorrhagesare also common these conditions have been described as resemblingthose of spotted typhus levick rigor mortis is marked and occurs early, putrefaction beginning soonafter death the lungs are highly congested and often œdematous, andeffusions of serum are frequently found in the pleural cavities 698the heart is usually changed in color and consistence, with the leftventricle contracted and the aorta empty, while the right ventricleand pulmonary arteries are dilated and engorged the blood is fluidand dark 699 the large vessels of the pia and dura are full ofdark blood congestion of the cerebral mass is not always noted theventricles contain serum.

Germans, 1, 448 c c. French, 1, 403 to 1, 461 c c. South african negroes, 1, 372c c.

We have felt that it is not wholly satisfactory to discourage the useof a given nostrum without making an effort to assist the physician inchoosing wisely in the treatment of the condition for which the nostrumis claimed to be useful in the present instance, however, we fear thatwould prove a task beyond our powers, for the hypophosphites have beenused in such a variety of conditions that the discussion would have toinclude nearly the whole materia medica if we were to follow our usualprocedure -- from the journal a m a feb 16, 1918 article vii shotgun nostrumsformerly it was customary to prescribe mixtures of thesis drugs on theassumption that if one of the ingredients missed the mark anothermight be expected to hit it, just as a poor marksman is more likelyto hit a target at short range with a blunderbuss than with a highpowered rifle increased precision in every branch of science hasbecome the outstanding feature of civilization the soldier todaymust shoot straight with a rifle that sends a single ball there isnone of the disposition to rely on chance as when the blunderbuss wasused a capable physician directs his drug straight at the seat of thetrouble, and we now have thesis drugs that can be depended on to exertdefinite actions the complex mixture is just as preposterous in moderntherapeutics as the blunderbuss would be on a modern battlefield every drug exerts undesired side actions, and it is the aim of themodern physician to try to select the one which will have a maximum oftherapeutic with a minimum of undesired actions when a complex mixtureis employed, it is obvious that only the best is utilized, whereas allthe undesired side actions come into play we do not pretend that eventhe best studied drug has not much to be learned about it. But thenostrum maker who exploits a complex mixture either knows practicallynothing of the side actions that it will exert, or, if he knows, heconceals that knowledge he knows that massive doses of hydratedchloral combined with various narcotics can be relied on to causeunconsciousness in nearly all paper, but he prefers to speak of thisas a hypnotic action this is plain gambling with human life when thepatient dies, it is difficult to prove that death was caused by themixture alone the council on pharmacy and chemistry has expended a great deal of timeand energy in combating the “shotgun” nostrum evil it is easy tounderstand the disadvantages of such mixtures but it is not so easy todemonstrate the misleading character of the claims made, with an entiredisregard of the truth, for these mixtures no one believes that a potof gold lies at the end of the rainbow, but no one has actually gonethere to see for himself bromidiathere are thesis types of “shotgun” nostrum essay are dangerous, as in the case of “bromidia”. Essay are preposterous, therapeuticmonstrosities which excite the contempt of educated physicians, as inthe case of “tongaline”.

Bdellium, benzoin, camphire, caranna, colophonia, juice of maudlin, euphorbium, lees of wine, leesof oil, gums of galbanum, amoniacum, anime, arabick, cherry trees, copal, elemy, juniper, ivy, plumb trees, cambuge, hypocystis, labdanum, lacca, liquid amber, manna, mastich, myrrh, olibanum, opium, opopanax, pice-bitumen, pitch of the cedar of greece, liquid and dry rozins offir-tree, larch-tree, pine tree, pine-fruit, mastich venice and cyprusturpentine sugar, white, red, and christaline, or sugar candy whiteand red, sagapen, juniper, gum, sanguis draconis, sarcocolla, scamony, styrax, liquid and calamitis, tacha, mahacca, tartar, frankincense, olibanum, tragaganth, birdlime culpeper that my country may receive more benefit than ever thecollege of physicians intended them from these, i shall treat of themseverally 1 of the juices 2 of the gums and rosins concrete juices, or juices made thick, are eithertemperate, as, juice of liquorice, white starch hot in the first degree sugar in the second labdanum in the third benzoin, assafœtida cold in the third degree sanguis draconis, acacia in the third hypocistis in the fourth opium, and yet essay authors think opium is hot becauseof its bitter taste aloes and manna purge choler gently. And scamony doth purge cholerviolently, that it is no ways fit for a vulgar man use, for itcorrodes the bowels opopoanax purges flegm very gently white starch gently levigates or makes smooth such writings as arerough, syrup of violets being made thick with it and so taken on thepoint of a knife, helps coughs, roughness of the throat, wheezing, excoriations of the bowels, the bloody-flux juice of liquorice helps roughness of the trachea arteria, whichis in plain english called the windpipe, the roughness of which causescoughs and hoarseness, difficulty of breathing, &c it allays the heatof the stomach and liver, eases pains, soreness and roughness of thereins and bladder, it quencheth thirst, and strengthens the stomachexceedingly. It may easily be carried about in one pocket, and eat alittle now and then sugar cleanses and digests, takes away roughness of the tongue, itstrengthens the reins and bladder, being weakened. Being beaten intofine powder and put into the eyes, it takes away films that grow overthe sight labdanum is in operation, thickening, heating and mollifying, itopens the passage of the veins, and keeps the hair from falling off;the use of it is usually external. Being mixed with wine, myrrh, andoil of mirtles, and applied like a plaister, it takes away filthyscars, and the deformity the small pox leaves behind them. Being mixedwith oil of roses, and dropped into the ears, it helps pains there;being used as a pessary, it provokes the menses, and helps hardness orstiffness of the womb it is essaytimes used inwardly in such medicinesas ease pains and help the cough. If you mix a little of it with oldwhite wine and drink it, it both provokes urine and stops looseness orfluxes dragons blood, cools, binds, and repels acasia, and hyposistis, do the like the juice of maudlin, or, for want of it costmary, which is the samein effect, and better known to the vulgar, the juice is made thick forthe better keeping of it.

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The actual iodin content is only about half of that claimed 2 the action of iodex is not essentially that of free iodin, although that is the impression conveyed by the advertising 3 the assertion that iodin may be found in the urine shortly after iodex has been rubbed on the skin has been experimentally disproved at the time the laboratory reported its findings, it pointed out theobvious contradiction in the claim that iodex is not only an “effectivefree iodine application without drawbacks” but also a means of “reallyefficient external iodine therapy without stain or irritation ” it isimpossible to have free iodin present in sufficient quantities to betherapeutically efficient and not get skin stains and irritation in a recent issue of the house organ, pharmacal advance, therewas a large display advertisement of iodex under the heading. “forprophylaxis and to ‘double cross’ disease, ” with the claims. “free iodine ” “rub through skin ” “does not irritate nor stain ”on other pages of the same issue these claims appeared.