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“it is sufficient to prove that the death of aperson was write my assignment accelerated by the malicious acts of the person, althoughthe former labored under a mental disease at the time of the act theintent of the accused may often be judged by the character of the woundand the means of its infliction drunkenness of the victim admits ofno excuse when his assailant is aware, or ought to have been aware, of the condition of his victim it is held that the assailant oughtto have known that violence of any kind to such a person is likely tobe attended by dangerous results it is known also that a wound whichaccelerates death causes death ” the commissioners who were appointedto define criminal law on the subject of homicide have thus expressedthemselves. “art 3 it is homicide although the effect of the injurybe merely to accelerate the death of one laboring under essay previousinjury or infirmity, for although if timely remedies or skilfultreatment had been applied, death might have been prevented” taylor, p 327 death from surgical operations necessitated by gunshot wound - themodern treatment of serious or so-called penetrating gunshot woundswhere the cranium, thoracic viscera, or the abdominal viscera, especially the intestines, have been perforated one or more times, calls for surgical procedures which are of severity and danger inproportion to the gravity of the wound which necessitates them, andwhich, while they often save life, must necessarily often fail indeed, such operations may prove fatal upon the operating-table, i e , patients may die before the conclusion of the operation the questionmay, therefore, arise whether the person who inflicted the wound shouldbe held responsible for his act, or whether by the intervention ofthe surgeon the responsibility may not at least be shifted from theshoulders of the accused the law in this respect is explicit andregards such operation as the outcome of necessity and a legitimatewriting of treatment, so that if it be undertaken in good faith, withreasonable care and skill, the accused will be held responsible, be theresult what it may the question of necessity and the plan of operationare left to the judgment of the surgeon in charge considering theresponsibility involved in such paper and the possibility of a suitbeing raised, we should always advise the operator to secure thecounsel of other surgeons or practitioners in his vicinity theverdict of such a counsel of talent will always stand according tolord hale, when death takes place from an unskilful operation undersuch circumstances, and not from the wound, the responsibility ofthe prisoner naturally ceases, but the burden of proof that such hasbeen unskilfully performed rests naturally with the defence it ismuch better also in these paper that the primary responsibility beborne by one surgeon from the beginning of the case, though he mayassociate with himself as thesis others as he chooses, since the endsof justice have more than once been defeated by a division of suchresponsibilities should it be made to appear that the surgeon incharge has not availed himself of such means as are supposed to be inthe hands of every competent practitioner and has neglected ordinaryantiseptic precautions, it would not be difficult to show that theoperation had been unskilfully performed, and the prisoner wouldnaturally get the benefit of such defence at the present date ofwriting there exists a large class of the profession who still continueto do surgery according to the views and practices of twenty or thirtyyears ago, and who, while perhaps carrying out essay of the forms ofantiseptic surgery, are still ignorant of its fundamental principlesand consequently guilty of neglect, since there is now no reason whyall should not practise them the writer holds to the view that if itcan be shown that these precautions were not adopted when others wouldhave adopted them, it constitutes criminal neglect on the other hand, circumstances may arise where a simple or a moreserious operation would have saved life, as, for instance, in paperof hemorrhage, and where a surgeon from timidity or carelessnesshas failed to take the necessary steps such neglect as this shouldinure to the benefit of the accused, but when at any time it can beshown that the possible benefits of operation have been offered tothe deceased before his death and have been declined, the surgeon atleast is relieved of all further responsibility among the dangers ofoperations under these circumstances are of course to be reckoned thosepertaining to the use of anæsthetics the surgeon in charge, however, is responsible for the selection of his assistants, at least whenassistants are at hand, and must be regarded as equally competent inthis as in other features of the operation. And even though the patientdie from collapse or the anæsthetic, the burden of proof must rest withthe defence to show that it had been unskilfully administered note - the assistance which the microscope may afford in theprocurement of evidence in paper of gunshot wound is beautifullyillustrated in the expert testimony reported by dr james, of st louis, in the presidential address before the american society ofmicroscopists, in washington, august, 1891, printed in vol xiii ofits transactions it occurred in st louis, in the case of the peoplev vail, who had a pistol in his pocket at the instant when his wifefell from a wagon against him, knocking him, as he claimed, againstthe wheel of the wagon, the pistol being discharged by accident bya minute study of the fibres of the various textures making up hisovercoat and of the effect of the explosion of powder upon textilefabrics almost in contact with it, he was enabled to establish theaccident and secure the acquittal of the accused death by heat and cold, including insolation in its medico-legal aspects by enoch v stoddard, a m , m d , emeritus professor of materia medica and hygiene in the university of buffalo. Member of the medical society of the state of new york and of the central new york medical association. Fellow of the new york academy of medicine and of the american academy of medicine. Late surgeon 65th regt n y vols. Late health commissioner, rochester, n y. Etc , etc death by heat and cold temperature of the body the production and regulation of heat in the body is a problem byno means elucidated we consider heat production to be of internalorigin, by a complex process involving tissue metamorphosis, chemicalchanges in nutrient elements, muscular movements, etc heat regulationis accomplished, not only by variation in the loss of heat by thebody, but by what is more important, variations in the amount of heatgenerated it is an accepted physiological conclusion that there existsin the body a thermotaxic nervous mechanism which controls its normal, as well as its abnormal, manifestations of heat the average temperature of the body in health is 37° c 98 6° f , inthe axilla taken in the vagina or rectum, 9° c 1 3° f higher isnoted the daily average range of variation is about 1° c 1 8° f in disease or injury considerable variations occur.

Each consists of seven members, appointedrespectively by those societies, physicians actually engaged in thepractice of medicine, and of recognized ability and honor. But nophysician having a pecuniary interest in the trade of pharmacy can beappointed 2 suitable provisions must be made by each examining board to prepare aschedule of written examination upon anatomy, physiology, chemistry, surgery, practice of medicine, materia medica and therapeutics, obstetrics, gynæcology, pathology, medical jurisprudence and hygiene;the same standard of excellence is required from all candidates. Intherapeutics and practice, the questions must be in harmony with thetenets of the school selected by the candidate. And the standardof acquirements therein is established by each board itself theexamination must be fundamental in character and such as can beanswered in common by all schools of practice 1, 42 application for license is made in writing to the president of eitherboard of medical examiners which the applicant may elect, withsatisfactory proof that the applicant is more than twenty-one years ofage, is of good moral character, has obtained a competent common-schooleducation, and has either received a diploma conferring the degreeof doctor of medicine from essay legally incorporated medical collegein the united states, or a diploma or license conferring the fullright to practise all the branches of medicine and surgery in essayforeign country, and has also both studied medicine three years andattended three courses of lectures in different years in essay legallyincorporated medical college or colleges prior to the granting ofthe diploma or foreign license. Two courses of medical lectures bothbegun or completed within the same calendar year do not satisfy therequirement. This condition is not applicable to students who shall bein their second year in a medical college, nor to physicians practisingat the time of the passage of the act such proof is made, if required, upon affidavit, upon making the application and proof and payment ofthe fee the president of the board, if satisfied, must direct thesecretary to issue an order for examination, and when the applicantshall have passed an examination as to proficiency satisfactory to theboard, the president must grant a license to practise medicine andsurgery 1, 43 all of the examinations are conducted so that the name, school ofgraduation, and preparatory training of the applicant shall not be madeknown to the board till his examination papers have been graded anapplicant receiving a majority of the votes of the board is consideredto have passed a satisfactory examination and is entitled to a license1, 44 the board must refuse a license to an applicant radically deficient inany essential branch in case of a failure, the candidate must havethe privilege, after the expiration of one year from his rejection, ofanother examination by the board to which his application was firstmade 1, 46 a license, or a certified copy, must be filed with the clerk of thecircuit court of the county or city in which the licensee may practise;the number of the book and page containing the recorded copy must benoted in the body of license evidence - the records have the same weight as evidence that is givento the record of conveyances of land 1, 48 exceptions - the act does not apply to commissioned surgeons of theunited states army, navy, or marine hospital service, to physiciansor surgeons in actual consultation from other states, nor to personstemporarily practising under the supervision of an actual medicalpreceptor, nor to a midwife or person who may render gratuitousservices in case of emergency 1, 49, 51 penalty - practising, or attempting to practise, without a license isa misdemeanor punishable with a fine of from $50 to $200 for eachoffence, with confinement in jail, in default of payment, till fineand costs are paid. A person so practising is debarred from recoveringcompensation 1, 50 fees - to secretary of board, before examination, $10 1, 45 to clerk of court, for registration, $1 1, 48 massachusetts in massachusetts there is no statute upon this subject michigan qualification - it is unlawful to practise medicine or surgery or anybranch except dentistry, without the prescribed qualifications andregistration in the office of the county clerk laws 1883, c 167, s 1 a person who was practising when the law took effect, and had beenpractising continuously for at least five years prior thereto in thestate, is deemed qualified to practise medicine after registration2, as amended 1887, c 268 a graduate of a legally authorized medical college in the state, orany of the united states, or any other country, is deemed qualified topractise medicine and surgery in all dewritingments after registration a student or undergraduate is not prohibited from practising withand under the immediate supervision of a person legally qualified topractise medicine and surgery ib a person qualified registers by filing with the county clerk of thecounty where he practises, or intends to practise, a sworn statementsetting forth, if actually engaged in practice, the length of timehe has been engaged in such continuous practice. If a graduate of amedical college, the name and location of the same, when he graduatedand how long he attended the same, and the school of medicine to whichhe belongs. If a student or undergraduate, how long he has been engagedin the study of medicine and where, and if he has attended a medicalcollege, its name and location and the length of his attendance, and when, and the name and residence of the physician under whoseinstruction he is practising, or intends to practise the statement isto be recorded by the clerk ib penalty - no person practising medicine, surgery, or midwifery cancollect pay for professional services unless at the time of renderingsuch services he was duly qualified and registered 4 advertising, or holding out to the public, as authorized to practisemedicine or surgery, when not authorized, is a misdemeanor punishablewith a fine of from $5 to $50 for each offence 7 fees - to county clerk, for recording statement, 50 cents 2 minnesota board of examiners - the governor appoints a board of medicalexaminers of nine members, no one of whom can be a member of a collegeor university having a medical dewritingment, and two of whom must behomœopathic physicians act 1887, c 9, s 1 qualification - persons commencing the practice of medicine and surgeryin any of its branches must apply to the board for a license, and atthe time and place designated by the board, or at a regular meeting, submit to an examination in anatomy, physiology, chemistry, histology, materia medica, therapeutics, preventive medicines, practice ofmedicine, surgery, obstetrics, diseases of women and children, of thenervous system, of the eye and ear, medical jurisprudence, and suchother branches as the board deems advisable, and present evidence ofhaving attended three courses of lectures of at least six months each;the examination must be scientific and practical, but of sufficientseverity to test the candidate fitness to practise medicine andsurgery when desired, the examination may be conducted in the presenceof the dean of any medical school or the president of any medicalsociety of this state after examination, the board must grant, withthe consent of at least seven members, a license to practise medicineand surgery, which may be refused or revoked for unprofessional, dishonorable, or immoral conduct. And in case of refusal or revocation, the applicant may appeal to the governor 3 the license must be recorded with the clerk of the district court inthe county in which the licensee resides. If he moves into anothercounty he must procure a certified copy of his license from the saidclerk and file it with the clerk of the district court in the lattercounty 4 penalty - to practise without a license is a misdemeanor, punishableby a fine of from $50 to $100, or imprisonment in county jail fromten to ninety days, or both appending “m d ” or “m b ” to name, orprescribing, directing, or recommending for use any drug or medicine orother agency for the treatment, care, or relief of any wound, fracture, or bodily injury, infirmity, or disease, is regarded as practisingmedicine exceptions - the act is not applicable to dentists 6, norto commissioned surgeons of the united states army or navy, nor tophysicians or surgeons in actual consultation from other states orterritories, nor to actual medical students practising medicine underthe direct supervision of a preceptor 5 all persons licensed under the act of 1883, c 125, are regarded aslicensed under this act 7 fees - to treasurer of board, for examination, $10 mississippi qualification - a practitioner of medicine must obtain a license fromthe state board of health code 1892, s 3, 243 application is made in writing.

“ the remedy was submitted to a selected body of skilled physicians, recognized for their skill and care in making therapeutic observations these men represented widely varying conditions, climatic and otherwise those who said ten years ago that anti-tuberculous lymph compound has a specific immunizing influence upon the tuberculosis patient, find the same to be true today ”careful reading of the matter just quoted will reveal its ambiguityand inherent lack of frankness the inference conveyed is that the“selected body of skilled physicians” have unqualifiedly endorsedanti-tuberculous lymph compound sweeny-- but it does not say so!. It is the history of all such preparations, introduced to the medicalprofession with the usual blare of trumpets, that a certain number offavorable testimonials can be obtained it is also the history of suchproducts that one has but to wait a few years and the physicians whohad written most enthusiastically regarding the preparation-- in thefirst flush of their optimism following its use and the perusal of themanufacturers’ literature-- will acknowledge that they were mistakenin their original estimate and are no longer using the agent inthis connection an investigation of essay of the old testimonials foranti-tuberculous lymph compound by the propaganda dewritingment of thejournal is instructive in a essaywhat elaborate booklet published in 1907 by sweeny, an indianaphysician was said to have reported favorable results following theadministration of the “lymph ” a letter written to this physician inoctober, 1919, asking for his present opinion on the product broughtthis reply, in writing. “ it being twelve years since using the serum and no reference or repeated orders since should surely suffice as evidence of my lack of faith in the serum ”an illinois physician was reported in the same booklet to havedescribed a case of a young man with an active tuberculosis, who wasgiven injections of the “lymph” in february, 1907 the patient, it wasclaimed, showed immediate improvement and the sweeny booklet publishedin august, 1907 stated that “improvement in this case continued andterminated in complete recovery ” a letter written to the physician inoctober, 1919, brought out the fact that the young man in question, after receiving “anti-tuberculous lymph compound” and other treatmentwas removed “on a stretcher” “to new mexico, where he remained forthree or four years” and recovered the doctor adds. “i do not think that the anti-tuberculous lymph had anything to do with the man recovery, although i realize the difficulty of definitely analyzing just what did effect the cure i did since that time use that preparation in several other paper without beneficial results so that i gave it up a good thesis years ago adding it to that large heap of pharmaceutical material ‘weighed and found wanting ’”a physician in texas also reported in the 1907 booklet as having hadvery satisfactory results with the anti-tuberculous lymph compound inone case of pulmonary tuberculosis was written to in october, 1919 hereplied. “i will state that subsequent use of this compound did not bear out the apparent good results from its use in the first case or two ”in a “bulletin” issued by the sweeny concern in 1912, a pennsylvaniaphysician was quoted as having treated three paper with anti-tuberculinlymph compound with resultant cures this physician was written to inoctober, 1919, and he replied. “i have no knowledge of the use of my name by any pittsburgh concern and know nothing of a lymph of the name of sweeny. Neither do i recollect ever curing three paper of tuberculosis with any lymph ”the same “bulletin” quoted the alleged statement by a delawarephysician to the effect that he believed anti-tuberculous lymphcompound to be the most successful treatment of tuberculosis extant this in 1912 to an inquiry sent in october, 1919, this physicianbriefly replied. “am not using it now ”the result of the propaganda dewritingment questionnaire was what mighthave been expected every physician who answered the inquiry regardinghis previous and present opinions of anti-tuberculous lymph compound sweeny declared, in effect, that he had long since ceased to havefaith in its value or efficacy according to claims made in sweeny literature, “anti-tuberculous lymphcompound exercises its immunizing power through a specific action uponthe blood cells ” the statement that “it destroys the tuberculosisgerm when this is present in the system of the patient” is untrue the facts are, no serum or lymph has thus far been proved to haveany value in the treatment of tuberculosis even when fortified by “asmall proportion of chloride of gold and soda” as one circular tellsus the “lymph” is in spite of research by competent investigators, weare still without any aid in the form of a serum in the treatment oftuberculosis anti-tuberculous lymph compound sweeny is one of those preparationsthat need no elaborate laboratory tests, nor even exact therapeuticresearch, to convince any clear-thinking person that it is patently andobviously worthless one would hesitate before asking any reputableclinician to test a preparation of this sort it is a constant sourceof surprise that essay physicians allow themselves to be persuaded byadvertising literature that is obviously uncritical and unscientific, to use preparations which have no more reasonable foundation than thisone the council declares anti-tuberculous lymph compound sweeny notacceptable for new and nonofficial remedies anti-syphilitic compound sweenythis preparation also is made by or under the direction of the samedr gilliford b sweeny whose researches ?. led to the production andevolution of the anti-tuberculous lymph compound sweeny according tothe data at hand, this preparation is made by suspending benzoate ofmercury in lymph from the bullock case reports are given of allegedcures of syphilis after two months of treatment. Indeed, the circularexploiting the agent makes the statement that it is seldom necessaryto continue the treatment beyond two months, which, if one chose to becredulous, would indicate extraordinary power for the mercury mercury of course has a proper place in the treatment of syphilis, but that any physician could be induced to place his trust in thispreparation is almost unthinkable though testimonials-- which the“national laboratories” claim to have received from physicians-- arepublished they all stamp the writers as not only gullible but alsoincompetent the tenor of the claims is on a par with those made forthe anti-tuberculous lymph compound. They do not justify the timerequired for detailed consideration the council declares anti-syphilitic lymph compound sweeny notacceptable for n n r -- from the journal a m a , april 3, 1920 syrup leptinol formerly syrup balsamea report of the council on pharmacy and chemistrythe council has authorized publication of the following reporton “syrup leptinol” formerly “syrup balsamea” the product isinadmissible to “new and nonofficial remedies, ” first, because themanufacturers fail to give the profession information regarding eitherthe amount of the potent ingredient or the method of determiningits identity and uniformity. Second, because of the unwarrantedrecommendation for its use in such infectious diseases as pneumonia andepidemic influenza and for lack of satisfactory supporting evidence ofits alleged therapeutic efficacy in other diseases and, third, becausethe recommendations for its use appearing on and in the trade packageconstitute an indirect advertisement to the public w a puckner, secretary syrup leptinol is sold by the balsamea co of san francisco it wasfirst introduced as syrup balsamea in recent advertising, syrupleptinol is also referred to simply as “leptinol ”according to the statements of the balsamea co , syrup leptinol isprepared from the root of a species of leptotaenia a plant belongingto the parsnip family which grows in nevada and which has heretoforenot been used in medicine the manufacturer states that the botanistswho have been consulted have been unable to agree on the botanicalclassification of the plant the dried root of this unclassifiedspecies of leptotaenia is extracted with alcohol and from the extractso obtained the syrup is made, but no information has been furnishedto show how the alcohol-soluble material is incorporated in the syrup further, the manufacturer has not announced tests whereby the identityand uniformity of the finished preparation may be determined a booklet contains the following. “the species of leptotaenia from which leptinol is produced was first used in medicine by dr e t krebs, who, after thorough laboratory investigation and clinical application over a period of several months, which resulted in the perfecting of leptinol, prescribed the preparation for influenza during the epidemic of that disease in 1918 with remarkably good results since this first use, leptinol has been exhaustively tested by clinicians in private practice and in hospitals in the treatment of pneumonia, influenza bronchitis, etc , and has been universally endorsed ”in a circular letter it is asserted that the use of “leptinol” duringthe “influenza epidemic” of 1918-1919 “demonstrated its almost specificaction in respiratory affections”. That “during this epidemic it provedto be five times as efficacious as any other treatment in pneumonia ”. And that “it is now as firmly fixed in the mind of thesis doctorsfor respiratory diseases as quinine is for malaria and the salicylatesfor rheumatism ”in the booklet it is further stated that the therapeutic action ofthe preparation is primarily that of a “stimulating expectorant” andsecondarily as a “sedative expectorant”.

Or the decoction of the green herbin wine or water drank, or used to the outward place, to wash or bathethem, or to have tents dipped therein and put into them, are effectual write my assignment moonwort descript it rises up usually but with one dark green, thick andflat leaf, standing upon a short foot-stalk not above two fingersbreadth. But when it flowers it may be said to bear a small slenderstalk about four or five inches high, having but one leaf in the middlethereof, which is much divided on both sides into essaytimes five orseven writings on a side, essaytimes more. Each of which writings is smalllike the middle rib, but broad forwards, pointed and round, resemblingtherein a half-moon, from whence it took the name. The uppermost writingsor divisions being bigger than the lowest the stalks rise above thisleaf two or three inches, bearing thesis branches of small long tongues, every one like the spiky head of the adder tongue, of a brownishcolour, which, whether i shall call them flowers, or the seed, i wellknow not which, after they have continued awhile, resolve into a mealydust the root is small and fibrous this hath essaytimes divers suchlike leaves as are before described, with so thesis branches or topsrising from one stalk, each divided from the other place it grows on hills and heaths, yet where there is much grass, for therein it delights to grow time it is to be found only in april and may. For in june, whenany hot weather comes, for the most writing it is withered and gone government and virtues the moon owns the herb moonwort is coldand drying more than adder tongue, and is therefore held to be moreavailable for all wounds both inward and outward the leaves boiledin red wine, and drank, stay the immoderate flux of women courses, and the whites it also stays bleeding, vomiting, and other fluxes it helps all blows and bruises, and to consolidate all fractures anddislocations it is good for ruptures, but is chiefly used, by mostwith other herbs, to make oils or balsams to heal fresh or greenwounds as i said before either inward or outward, for which it isexcellently good moonwort is an herb which they say will open locks, and unshoe suchhorses as tread upon it. This essay laugh to scorn, and those no smallfools neither. But country people, that i know, call it unshoe thehorse besides i have heard commanders say, that on white down indevonshire, near tiverton, there were found thirty horse shoes, pulledoff from the feet of the earl of essex horses, being there drawn upin a body, thesis of them being but newly shod, and no reason known, which caused much admiration. The herb described usually grows uponheaths mosses i shall not trouble the reader with a description of these, since myintent is to speak only of two kinds, as the most principal, viz ground moss and tree moss, both which are very well known place the ground moss grows in our moist woods, and at the bottomof hills, in boggy grounds, and in shadowy ditches and thesis other suchlike places the tree moss grows only on trees government and virtues all sorts of mosses are under the dominionof saturn the ground moss is held to be singularly good to break thestone, and to expel and drive it forth by urine, being boiled in wineand drank the herb being bruised and boiled in water, and applied, eases all inflammations and pains coming from an hot cause. And istherefore used to ease the pains of the gout the tree mosses are cooling and binding, and writingake of a digesting andmolifying quality withal, as galen saith but each moss writingakes of thenature of the tree from whence it is taken. Therefore that of the oakis more binding, and is of good effect to stay fluxes in man or woman;as also vomiting or bleeding, the powder thereof being taken in wine the decoction thereof in wine is very good for women to be bathed in, that are troubled with the overflowing of their courses the same beingdrank, stays the stomach that is troubled with casting, or hiccough;and, as avicena saith, it comforts the heart the powder thereoftaken in drink for essay time together, is thought available for thedropsy the oil that has had fresh moss steeped therein for a time, andafterwards boiled and applied to the temples and forehead, marvellouslyeases the head-ache coming of a hot cause. As also the distillations ofhot rheums or humours in the eyes, or other writings the ancients muchused it in their ointments and other medicines against the lassitude, and to strengthen and comfort the sinews. For which, if it was goodthen, i know no reason but it may be found so still motherwort descript this hath a hard, square, brownish, rough, strong stalk, rising three or four feet high at least, spreading into thesis branches, whereon grow leaves on each side, with long foot-stalks, two atevery joint, which are essaywhat broad and long, as if it were roughor crumpled, with thesis great veins therein of a sad green colour, anddeeply dented about the edges, and almost divided from the middle ofthe branches up to the tops of them which are long and small grow theflowers round them at distances, in sharp pointed, rough, hard husks, of a more red or purple colour than balm or horehound, but in thesame manner or form as the horehound, after which come small, round, blackish seeds in great plenty the root sends forth a number of longstrings and small fibres, taking strong hold in the ground, of a darkyellowish or brownish colour, and abides as the horehound does.

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Fig 7 - stab-wounds caused by an eight-sidedsharp-edged instrument essay show a transition stage to wounds made bya conical instrument ecchymosis - this is characteristic, as a rule, of contused wounds it consists in the infiltration of blood into the tissues, especiallythe cellular tissues the source of the blood is from the ruptureof blood-vessels, and the size of the ecchymosis varies writingly withthe number and size of the blood-vessels, or with the vascularity ofthe writing the size of the ecchymosis also varies with the loosenessof the tissues into which it is infiltrated this looseness of thetissues may be natural as in the scrotum and eyelids, or it may be write my assignment dueto the attrition of the tissues caused by the blow an ecchymosis islarger when the contused writings cover a bony or resisting surface, andthere may be no ecchymosis whatever, even from a severe blow, wherethe underlying writings are soft and yielding, as is the case with theabdominal parietes here we may have rupture of the viscera without anysigns of ecchymosis superficially an ecchymosis may be infiltrativeor it may mostly occupy a cavity usually formed by a traumaticseparation of the tissues. This is especially the case in the scalpand extremities when the injury is severe these tumors, which arecalled hematomata, may be rapidly absorbed or they may remain a longtime and occasionally suppurate essaytimes the anatomical conditions, especially of the connective-tissue spaces, allow the extension ormigration of the ecchymosis under the action of gravity, even to aconsiderable distance when it meets an obstacle it accumulates aboveit, as in the inguinal region for abdominal ecchymosis and at the kneefor those of the thigh the course along which the ecchymosis travelsis indicated externally by a yellowish stain, soon disappearing, sothat soon no sign persists at the site of injury, but only below wherethe blood is arrested an ecchymosis becomes visible at varying times after the injuryaccording to the depth of the ecchymosis and the thinness of theskin, for the ecchymosis is mostly beneath, not in the skin if theecchymosis is superficial it shows in one or two hours or even in lesstime where the skin is very thin, as in the eyelids and scrotum insuch paper it increases for thirty or forty hours and disappears in aweek, but may last longer, i e , as long as fifteen to twenty-fivedays an ecchymosis may not show at the point struck, at least not untilseveral days have elapsed, or it may only show on the under surfaceof the subcutaneous fat until it has imbibed its way, as it were, tothe surface this may explain the discrepancy in the description of aninjury examined by two medical experts at different times if an ecchymosis is extensive and deep, especially if it occupies acavity, there may be nothing to see in the skin for four or five days, and then often only a yellowish discoloration instead of a dark bluecolor in such paper, too, the appearance in the skin may be more orless remote from the injury, having followed the course of the leastanatomical resistance between these two extremes, an ecchymosis maybecome visible at almost any time rarely an ecchymosis occurs onlydeeply between muscles pectorals, etc and not superficially at all the extravasation of blood which forms an ecchymosis has essaytimesbeen given different names, according to its extent or position, forinstance, parenchymatous or interstitial hemorrhages or apoplexies, suffusions, ecchymoses, petechiæ or vibices all such may, however, becalled ecchymoses or hematomata when blood is effused into the serouscavities of the body, special names are essaytimes applied according tothe position, such as hemothorax, hematocele, etc the color of an ecchymosis is at first a blue-black, brown, or lividred this color changes first on the edges, later in the darker centre, and becomes in time violet, greenish, yellow, and then fades entirely this change in color is owing to a gradual decomposition of thehæmoglobin of the blood we can tell the age of an ecchymosis from itscoloration only within rather wide limits, for the rapidity of changeof color varies widely according to a large number of circumstances, especially according to whether the ecchymosis is superficial or deep we can only say that the first change, i e , that to violet, in asuperficial ecchymosis, occurs in two or three days as an exception to the above color change, we may mentionsubconjunctival ecchymosis, which always remains a bright red, as theconjunctiva is so thin and superficial that the coloring matter of theblood is constantly oxidized the form of an ecchymosis often reproduces well enough that of theinstrument, except if the latter be large it cannot all be equallyapplied to the surface, and its form is not distinctly shown by thatof the ecchymosis after its first appearance an ecchymosis spreadsradially, the edges becoming less clear this change occurs morerapidly the looser the surrounding tissues, and at the end of a fewdays the first form of an ecchymosis may be changed, so that anexamination to determine the nature of the weapon should be made asearly as possible ecchymoses are more easily produced in the young, the aged, andin females, also in the case of such general diseases as scurvy, purpura, hemophilia, etc in fact, in the last three classes they mayoccur spontaneously this fact should never be lost sight of, as theattempt may be made to explain a traumatic ecchymosis in this way thediagnosis between the traumatic variety and such paper of spontaneousecchymoses is, in general, easy, for in the latter case their number, form, size, and occurrence on writings little exposed to injury and on themucous membranes, as well as the general symptoms of the disease, leavelittle or no room for doubt from an oblique or glancing blow a considerable area of skin may bestripped up from its deep attachments forming a cavity which may befilled by a clear serous fluid alone, or with essay admixture of blood these paper have been studied especially by morel lavallée and leser, and the fluid has been thought to be lymphatic in origin, hence thename “lymphorrhagia ” carriage accidents, especially where the wheelsdo not pass directly but obliquely across or merely graze the body, areespecially liable to show this form of extravasation, which is thoughtto be more common than is generally supposed, being often obscured by asmall quantity of blood illustration. Fig 8 - linear wound with nearly clean-cut edges, withstrands of tissue bridging across at the bottom and caused by a fall onthe head on a smooth surface contused wounds - if with the contusion we have a solution ofcontinuity of the skin, then we have a contused wound this mayessaytimes resemble an incised wound if the weapon has marked angles oredges, as a hammer, or, as we have already seen, in wounds of the scalpor eyebrow fig 8 careful examination, however, by a small lens ifnecessary, is sufficient to distinguish them if they are fresh ifthey are four or five days old and have begun to granulate, it may beimpossible to distinguish them contused wounds present on examinationsmall tears on the edges which are widely separated and more or lessextensively ecchymosed contused wounds are often irregular, andhave thickened or swollen and ragged borders they may, like simplecontusions, show by their shape the form of the instrument which causedthem in contused wounds, unless they be perfectly aseptic, we usuallyfind sloughing of the contused, necrotic tissues this leaves a cavityto be filled up by granulation like wounds with loss of substance they therefore often present large cicatrices which may be mistaken forthose of ulcers in contused wounds the bone may essaytimes show theimpression of the instrument causing the wound a variety of contused wounds is that where the wound of the skinconsists merely of an erosion or excoriation with an ecchymosisbeneath the wound may reproduce the shape of the weapon, i e , finger-nails, etc after death the skin becomes brownish-yellow, hard, and dry, and then they are called by the french “plaquesparcheminées ” they are distinguished, as a rule, from those producedafter death, by the ecchymosis beneath lacerated wounds resemble contused wounds very closely, but are notecchymosed to any considerable extent the solution of continuity isessaytimes very extensive and irregular, and may present several flaps the bone or bones are often fractured at the same time they seldombleed much the course of repair resembles that of contused wounds asa rule the prognosis is variable, for there may be slow and extensivecicatrization and impairment of function, etc these wounds usuallyresult from machinery accidents and accidental tears, etc they aretherefore seldom the occasion of criminal proceedings but more often ofa civil suit, and thus require medical examination the injury which causes a contusion or contused wound may notinfrequently produce effects far more serious and more or lessremote from the contusion essay of these effects it may be well towritingicularize blows on the abdomen are essaytimes quickly followed bydeath without visible lesion to account for it that authentic examplesof this exist has been denied by lutaud, except for paper of rapiddeath following contusions of the abdomen which had caused extensiverupture of the viscera and abundant hemorrhage but vibert gives twopaper from his own experience, which are as follows:a young man, twenty years old, received a kick in the stomach at apublic ball numerous witnesses of the scene testified that he onlyreceived this one blow the man collapsed immediately and died in a fewminutes on autopsy nothing was found but two small ecchymotic spots inthe peritoneum covering the intestine, the largest not the size of abean in the second case, the injury was also a kick in the stomach and theman died almost immediately absolutely no lesion was found on autopsy both were in full digestion könig606 says. “a number of severe contusions of the belly runa rapidly fatal course without the autopsy showing any definiteanatomical lesion of the viscera ” he also adds that the less severepaper at first often show very profound shock, which is out ofproportion to the force of the injury the cause of death has beenexplained, like that of sudden death from a blow on the larynx, by thetheory of inhibition these paper are often illustrated experimentallyon frogs, where the same result is obtained under similar conditions such paper are the more remarkable from the fact that the fatal blowmay cause no ecchymosis or other mark of injury to appear on theabdominal walls blows on the head may produce a variety of results besides that ofthe contusion itself in fact, death itself may result though themarks of contusion are very slight or even imperceptible intracranialhemorrhage, laceration with ecchymosis of the brain, on the same oropposite side to the injury, and concussion of the brain may result ofthese only concussion will be considered now concussion has been defined as a shock communicated to an organby a blow or fall on another writing of the body, which may or may notbe remote, and without producing a material or appreciable lesion according to lutaud, 607 english pathologists understand by it atemporary or permanent nervous exhaustion resulting from a sudden orexcessive expense of nervous energy its effect is observed in thefunction of an organ and especially in the brain concussion of thebrain causes stupidity, loss of consciousness, amnesia, coma theintracranial lesion most often associated with concussion is ecchymosisand laceration on the surface of the brain, but there may be no lesionvisible even if the case is a fatal one fatal concussion has beenobserved where the marks of external violence were very slight or evenfailed entirely, as illustrated by the two following paper cited byvibert:608vibert made an autopsy on a man who had been struck by a pitchfork, one of the teeth of which struck behind the ear, the other two in theface, only producing slight skin wounds the man immediately lostconsciousness and died in two days in coma no lesion whatever wasfound within the skull, and only three slight ones externally he observed another case where the man fell three or four metresinto an excavation, landing on his feet, and died in a short time on autopsy only slight erosions and no intracranial or extracraniallesions were found this case belongs to a rare class where the blow is transmitted throughthe spinal column without sign of injury externally or internally tothe head the following case cited by vibert is even more remarkable in theproduction of the severe though not fatal concussion. An officerwas riding at full speed on horseback, when his horse suddenlystopped short by great exertion the officer clung to the horse, butimmediately lost consciousness his fall from the horse was broken bythose about him, and the concussion he received was not due to thefall, but to the shock of stopping suddenly when his momentum was great as a rule, however, the diagnosis of concussion, especially if it issevere enough to be fatal, is easily made by the marks of externalviolence with or without intracranial lesions the effects ofconcussion may be transient and leave no trace, but, on the otherhand, they may be prolonged and severe, i e , paralysis, aphasia, loss of memory, imbecility, etc the medical examiner should be onhis guard against simulation in respect to these prolonged effects ofconcussions one of the most frequent consequences of concussion istemporary amnesia, which ordinarily succeeds immediately after theinjury, but essaytimes develops more slowly the following curious caseis quoted from lutaud as cited by brouardel:a woman in getting out of a train at versailles, where she had goneto attend the funeral of a relative, was struck by the door of thecomwritingment she fell, but did not lose consciousness, and pickedherself up, but forgot what she had come for another result of an injury which has caused a contusion or contusedwound may be a fracture or dislocation fractures and dislocations ofspecial writings will be referred to later, in considering injuries of theseveral regions of the body, but it seems appropriate here to refer toessay of those general considerations relating to these injuries whichmay especially demand the attention of the medical expert fractures may be produced by blows or falls, or from muscular action the medical witness may be questioned as to the cause of the fractureor, if it was produced by a blow, whether a weapon was used or not, asthe defence is likely to assert that it was caused by an accidentalfall the nature of the associated wounds and contusions, if any exist, may, as we have seen, indicate the weapon used if anything exists toindicate that a fall which caused the fracture was not accidental, thisshould be noted, as the assailant is responsible for the effects of thefall a number of conditions influence the ease with which a fracture isproduced and account for a fracture being due to a slight injury, andso are mitigatory circumstances in the case fractures are more easily produced in the old and young, especiallythe former, than in the adult from the same force this is due tobrittleness of the bones in the old and their small size in theyoung certain diseases like syphilis, arthritis, scurvy, carcinoma, and rickets make the bones more frangible, and there is a peculiarbrittle condition of the bones known as fragilitas ossium, more orless hereditary, in which the bones become fractured from very slightviolence mercer is quoted by taylor as stating, but on how goodauthority it does not appear, that in general paralysis of the insanethe bones are writingicularly liable to fracture certain it is that notuncommonly insane patients are found dead with single or multiplefractures, but the attendants are generally convicted in essay writings, like the orbital plate of the frontal bone, the bone isvery thin and brittle, but brittleness from any cause only mitigates, it does not excuse taylor609 reports a case in point where it was proved that the bonesof the skull were thin and brittle, and the fractured skull provedfatal from inflammation of the brain the punishment was mitigatedowing to the circumstance of the brittleness of the bones spontaneous fractures may occur from only a moderate degree of muscularaction, and even where there is no disease of the bones, but theabove-mentioned condition of fragilitas ossium, rendering the bonesmore brittle, aids in the production of such fractures the olecranon, patella, and os calcis are writingicularly liable to such fractures, butthe long bones of the ribs and extremities are essaytimes so fractured, as instanced in the following paper cited by taylor:610the humerus of a healthy man has been broken by muscular exertionsimply by throwing a cricket ball 611 in 1858 a gentleman forty yearsold, during the act of bowling at cricket, heard a distinct crack likethe breaking of a piece of wood he fell immediately to the ground, andit was found that his femur was fractured again, in 1846, a healthy man, æt 33, was brought to gray hospitalwith the following history. 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?.