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Nervous and irritable. Reflexesincreased the headache was accompanied by insomnia which continued forthree days, after which it disappeared, and he resumed work apparentlynone the worse for his accident the palmar surfaces of both handsand the anterior surfaces of the forearms were blackened from the tipsof the fingers to a point midway between the wrists and the elbows, and these writings were exceedingly sensitive to the touch the leastirritation of the muscles would cause them to contract violently thiscondition ceased on the second day the current was from a fifty-lightarc circuit of about 2, 100 volts. 6 8 amperes the accident took placeout-of-doors on a very rainy night the amount of electricity which thepatient received was, as in all such paper, very uncertain fatal current the amount of current which will produce a fatal effect varies withthe character of the current and with the points of contact currentspassing through the head or those which affect the pneumogastric nervesare much more dangerous than others of the same character and equalstrength passing through one extremity, for example the same current will, of course, also produce different effects, according to the facility of its conduction into and through the body, and this depends again on the completeness of the contact and whetherthe body or the portion thereof concerned enters directly into thecircuit or only forms, as it were, a writingial conductor and diverts acertain portion only of the current to itself again, the condition ofthe epidermis, whether dry or wet, and the position of the person inrelation to good conductors, metallic or otherwise, has much effect if the skin and clothes be wet, the resistance to the current islessened and it passes more readily into the body in the same way, ifa person stands in close relation to a good conductor and places hishand on one wire of a high-tension electric circuit, he will receive amuch more severe shock than if not connected with such conductor thusa person standing in a pool of water water is a good conductor, andmore strongly if standing on the metallic rail of a railway track, andtouching one wire of an electric circuit with one hand, receives a muchstronger shock than if he were standing on dry land, or if his bootswere rubber or he was otherwise insulated the accidents most frequent in practice are those in which the currenthas been writingially diverted from its original course and the person hasnot entered fully into the circuit in such paper it is not usuallypossible to estimate accurately or even approximately the amount ofcurrent which the person has received no calculations can, therefore, be based on these accidents again, we find that a person may beseriously or even fatally injured by a current which another personseems to bear with impunity d’arsonval in 1887, in france, advised 500 volts as the maximum forthe continuous current and 60 volts as the maximum for the alternatingcurrent which might be employed without special permission our only accurate knowledge in regard to fatal currents comes from theexperience derived from electrocutions from these it appears that analternating current of 1, 500 volts is deadly if it passes through thebody for more than a few seconds and if the contact is perfect death - death may ensue immediately as the result of an electricshock without any evident preliminary symptoms, or it may occur later, either as the direct result of the shock or as the consequence of theexhaustion produced by the burns and other injuries, or directly fromthe injuries themselves if death does not occur immediately and ifappropriate means of aid are at hand, the sufferer usually survivesand the effect of the electric shock gradually passes away the dangerafter this arises from the burns and other injuries, and almost all thedeaths not immediate are the results of these electrocution electricity has been adopted in the state of new york as the agentfor the execution of condemned criminals this has given rise to muchdiscussion as to what form of current were the best adapted for thispurpose and as to what amount were required to produce death at onceand painlessly these questions may now be regarded as practicallysettled, at least so far as regards the purposes mentioned, and weshall only refer incidentally to the discussions and their results early in 1890 a committee consisting of dr carlos f macdonald, dr a d rockwell, and prof l h landy made a report to the superintendentof prisons at albany in regard to the efficiency of the electricalappliances and dynamos placed in the state prisons of sing sing, auburn, and clinton this report gave details of various experimentsmade on animals to determine the amount of current and the timerequired to produce a fatal result on the 6th of august, 1890, occurred the first electrocution, that ofwilliam kemmler, alias john hart, at auburn prison dr macdonald inhis official report to the governor in relation to this says. “it isconfidently believed that when all the facts in the case are rightlyunderstood the first execution by electricity will be regarded asa successful experiment as might have been expected at the firstexecution by this method, there were certain defects of a minorcharacter in the arrangement and operation of the apparatus but inspite of these defects the important fact remains that unconsciousnesswas instantly effected and death was painless ”the efficiency, rapidity, and painlessness of this form of executionhave been confirmed by the later experiences up to the present date may 26th, 1892 eight condemned criminals have been executed in thestate of new york apparently all the officials who are intrusted withthe care and inspection of this subject seem satisfied that this is, onthe whole, the wisest, easiest, and most effective form of death thusfar practised among civilized nations the medico-legal journal ofnew york, in printing the official report of the recent executions offour men made by drs c f macdonald and s b ward to the warden ofsing sing prison, states that it furnishes “indisputable evidence ofthe fact 1 that the deaths were painless and the victims unconsciousfrom the instant of contact. 2 that they were certain and unattendedwith any of the revolting scenes so frequently witnessed at thescaffold. 3 that the method is humane so far as inflicting physicalpain or suffering, and from all sides considered infinitely preferableto the death by hanging. And that so long as capital punishment formurder exists in new york, we need not desire to change the method ofpunishment ” these claims would seem to be thus far substantiated the value of this method of execution is now beyond doubt whenproperly performed it is rapid, painless, and not repulsive thecriminal has probably no physical sensation of pain or discomfort dueto the mode of death from the moment the first shock occurs since therapidity of the transmission of the electric current through the bodyis in these paper much greater than the rapidity of the transmissionof sensation, it seems just to conclude that no sensation from theelectricity reaches the consciousness the only distress sufferedby the criminal is the unavoidable mental suffering natural to hisposition the mechanical means employed in electrocution are practically thesame at sing sing, clinton, and auburn prisons a special room isprovided for the purpose, which should be, if possible, in thebasement with a concrete floor.

“unlessa physician wishes to cater to the concern owning the bayer rights andto aid in perpetuating what was a monopoly for seventeen years, heshould be careful to prescribe the drug under the term ‘acetylsalicylicacid, ’ the court now places the responsibility directly on the medicalprofession avoid ‘aspirin’-- write ‘acetylsalicylic acid ’-- from thejournal a m a , june 11, 1921 the allied medical associations of america another rocket in the pyrotechnics of quasimedical organizationsit was once said, in the days when diploma mills flourished, thatit seemed easier to start a “university” than it was to open a grogshop a study of quasimedical organizations convinces one that it iseasier to found a “medical society” than it is to establish a peanutstand most reputable practitioners of medicine who care to affiliatethemselves with medical organizations are members of the americanmedical association, its component societies, or similar scientificbodies it is not surprising then, that those who live and move inthe twilight zone of professionalism, from visionaries riding bizarremedical hobbies to those who have special interests to exploit, shouldcreate and make use of hybrid medical organizations such organizationsmultiply as rapidly as rabbits they flourish for a while, obtain moreor less newspaper and other publicity-- usually more, because of thesensational methods of those controlling them-- then, having served thepurpose of those who brought them into being, they lapse into innocuousdesuetude the official accouchement of the allied medical associations of americaoccurred, according to that organization report, may 18, 1918 onthe official stationery of the allied medical writing finance paper help associations of americain use in may, 1919, we find the names of the “officers, ” “censors, ”etc these constitute, presumably, the more prominent members of thisorganization we give briefly, essay data regarding essay of these sothat a rational perspective may be obtained:l m ottofy, m d , st louis, mo -- dr ottofy seems to have beenthe chief organizer, if not, indeed, the founder he has been its“secretary-treasurer” since its inception. He is also “editor” ofits journal ottofy, according to our records, was born in 1865 atbudapest, hungary, and was graduated in 1888 by the homeopathic medicalcollege of missouri in polk medical directories for 1914 and 1917, ottofy has those extended notices which any physician can obtain whocares to pay for them according to these notices, ottofy is, or hasbeen, affiliated with the following “societies”. President of the international cancer research society ex-president of the st louis society of medical research second vice president of the missouri institute of homeopathy general secretary of the american association of progressive medicine chairman of the board of censors of the missouri institute of homeopathy member of the american institute of homeopathy member of the southern homeopathic association member of the american association of orificial surgeons member of the southern homeopathic medical society member of the kansas city society of medical research honorary member of the chicago society of medical research in december, 1911, numerous newspaper clippings show that dr ottofy was obtaining much publicity relative to his antivaccinationactivities at that time the papers reported that ottofy was suing thest louis board of education for $25, 000 damages, because the boardwould not admit to the schools of the city a child he had “internally”vaccinated in november, 1913, the st louis republic reported thatottofy had claimed to have discovered a serum for the cure of cancer, and quoted ottofy as claiming “a record of 72 per cent of cures” in“selected paper ” in february, 1914, the newspapers reported thatottofy was making a trip east “on the trail of radium for use in hispractice in the cure of cancer” and quoted him as stating, “i havelearned on good authority that there is radium in missouri, and justwhere i refuse to divulge at this time ” in january, 1915, the st louis republic reported that ottofy, at a meeting of the “st louissociety of medical research, ” had announced that he had perfected aserum treatment for cancer, which “is curing patients who have beenpronounced incurable by so-called ‘cancer experts ’” in january, 1916, the st louis star reported that ottofy had sought an injunctionagainst the board of education of st louis to restrain it from usingits funds for “the maintenance of a board of hygiene ” in july, 1916, st louis papers recorded that ottofy, who was then running forcoroner, had been cited to appear before the prosecuting attorney toexplain a charge of passing out, at a political meeting, a card allegedto have borne an indecent drawing of president wilson the prosecutingattorney was said to have instructed ottofy to bring the plates fromwhich the cards were printed to his office two days later the papersstated that ottofy had sent the cards and plates by messenger to theprosecuting attorney office n la doit johnson, m d , chicago -- dr johnson name appears as the“first vice-president” of the allied medical associations of america a few years ago, dr johnson name also appeared as the “dean of thefaculty” of the “american post graduate school ” this “school” wasa mail-order concern which, according to the “annual announcement, ”would grant diplomas and confer degrees as follows. “master ofsurgery, ” “bachelor of medicine, ” “bachelor of science, ” “master ofelectro-therapy, ” “doctor of osteopathy, ” “doctor of psychology, ”“master of massage, ” etc h m goehring, d o , m d , pittsburgh, pa -- the “secondvice-president, ” according to the letterheads of the “association”carries the letters d o , m d , after his name so far as our recordsshow, and they are most complete and based on official data, h m goehring is an osteopath, but not a doctor of medicine a e erling, m d , milwaukee, wis -- a e erling, according to thestationery, is “chairman” of “censors ” our records fail to show thaterling ever graduated in medicine the health dewritingment of milwaukee, however, says that erling, when interviewed, claimed to have “a diplomafrom the german medical college of chicago, but refused to show orpresent the same ” the american medical directory has this item.

Compt rend soc de biol 67:36, 1909 writing finance paper help zunz. Arch internat de physiol 8:181, 1909 lalou. Jour de physiol 14:465, 1912 analogy to epinephrin -- the analogy of secretin to epinephrindoes not generally receive enough emphasis both substances arenonspecific in distribution, but specific chemically, and especiallyphysiologically, epinephrin acting on the myoneural junctions, secretinon intestinal digestion they are both relatively simple substancesof low molecular weight, and subject to rapid oxidation whereby theirproperties disappear the action in both paper is very transient theyare the two examples of what starling calls the “acute hormones, ” inwhich it is essential that reaction take place immediately, and shalldisappear as soon as the exciting cause is removed 6363 starling. Proc roy soc med , 8, no 4, 1914, therap and pharm section, p 29 clinical use of secretindiabetes mellitus -- moore, edie and abram64 were the first tosuggest a therapeutic value for secretin, having obtained favorableresults with secretin administration in diabetes they argued that theinternal secretion of the pancreas may be stimulated by secretin, and that essay paper of diabetes may be due to lack of this necessaryexcitant owing to the importance of the question, their announcementwas followed quickly by numerous investigations by other observers previously, spriggs, at the suggestion of starling, had triedintravenous injections of secretin free from depressor substance in adiabetic patient, and had obtained negative results moore, edie andabram gave their secretin by mouth over long periods of the five papercited in their first paper, two were negative the third was that of aman, aged 25, who received daily 30 c c of secretin after a latentperiod of three weeks, the sugar suddenly fell, and after four monthsthe urine was sugar-free six months later a relapse occurred with thedevelopment of phthisis and death the other two patients were a boy, aged 7, and a girl, aged 9, whose urine in from three to five weeksbecame sugar free during the secretin treatment in spite of severediabetes one of these patients later relapsed 65 bainbridge andbeddard66 gave secretin a thorough trial in three paper with negativeresults, and are disposed to attribute the results of moore to dieting dakin and ransom67 cited one case, secretin being given for twelveweeks, with negative results. Foster, 65 nine paper, all negative;charles, 68 three paper, all negative crofton, 69 however, gavesecretin a trial in one case with favorable results moore, edie andabram, in a later paper, 70 report a large number of paper tried withthe majority of results negative, though in essay paper an improvementin the digestion, and in certain paper an increase of weight was noted 64 moore, edie and abram. Biochem jour , 1:28, 1906 65 foster. Jour biol chem , 2:297, 1906 66 bainbridge and beddard.

The pointsthereof are little or nothing prickly, and at the top usually but onehead, yet essaytimes from the bosom of the uppermost leaves there shootsforth another small head, scaly and prickly, with thesis reddish thrumbsor threads in the middle, which being gathered fresh, will keep thecolour a long time, and fades not from the stalk a long time, while itperfects the seed, which is of a mean bigness, lying in the down theroot hath thesis strings fastened to the head, or upper writing, which isblackish, and perishes not there is another sort little differing from the former, but that theleaves are more green above, and more hoary underneath, and the stalkbeing about two feet high, bears but one scaly head, with threads andseeds as the former place they grow in thesis moist meadows of this land, as well in thesouthern, as in the northern writings time they flower about july or august, and their seed ripensquickly after government writing finance paper help and virtues it is under capricorn, and therefore underboth saturn and mars, one rids melancholy by sympathy, the other byantipathy their virtues are but few, but those not to be despised. Forthe decoction of the thistle in wine being drank, expels superfluousmelancholy out of the body, and makes a man as merry as a cricket;superfluous melancholy causes care, fear, sadness, despair, envy, and thesis evils more besides. But religion teaches to wait upon godprovidence, and cast our care upon him who cares for us what a finething were it if men and women could live so?. and yet seven years’care and fear makes a man never the wiser, nor a farthing richer dioscorides saith, the root borne about one doth the like, and removesall diseases of melancholy modern writers laugh at him. Let themlaugh that win. My opinion is, that it is the best remedy against allmelancholy diseases that grows. They that please may use it our lady thistle descript our lady thistle hath divers very large and broad leaveslying on the ground cut in, and as it were crumpled, but essaywhat hairyon the edges, of a white green shining colour, wherein are thesis linesand streaks of a milk white colour, running all over, and set with thesissharp and stiff prickles all about, among which rises up one or morestrong, round, and prickly stalks, set full of the like leaves up tothe top, where at the end of every branch, comes forth a great pricklythistle-like head, strongly armed with prickles, and with bright purplethumbs rising out of the middle. After they are past, the seed grows inthe said heads, lying in soft white down, which is essaywhat flattishin the ground, and thesis strings and fibres fastened thereunto all thewhole plant is bitter in taste place it is frequent on the banks of almost every ditch time it flowers and seeds in june, july, and august government and virtues our lady thistle is under jupiter, andthought to be as effectual as carduus benedictus for agues, and toprevent and cure the infection of the plague. As also to open theobstructions of the liver and spleen, and thereby is good against thejaundice it provokes urine, breaks and expels the stone, and is goodfor the dropsy it is effectual also for the pains in the sides, andthesis other inward pains and gripings the seed and distilled wateris held powerful to all the purposes aforesaid, and besides, it isoften applied both outwardly with cloths or spunges to the region ofthe liver, to cool the distemper thereof, and to the region of theheart, against swoonings and the passions of it it cleanses the bloodexceedingly. And in spring, if you please to boil the tender plant butcut off the prickles, unless you have a mind to choak yourself it willchange your blood as the season changes, and that is the way to be safe the woollen, or, cotton thistle descript this has thesis large leaves lying upon the ground, essaywhatcut in, and as it were crumpled on the edges, of a green colour on theupper side, but covered over with a long hairy wool or cotton down, setwith most sharp and cruel pricks. From the middle of whose heads offlowers come forth thesis purplish crimson threads, and essaytimes white, although but seldom the seed that follow in those white downy heads, is essaywhat large and round, resembling the seed of lady thistle, butpaler the root is great and thick, spreading much, yet usually diesafter seed time place it grows on divers ditch-banks, and in the corn-fields, and highways, generally throughout the land, and is often growing ingardens government and virtues it is a plant of mars dioscorides and plinywrite, that the leaves and roots hereof taken in drink, help those thathave a crick in their neck, that they cannot turn it, unless they turntheir whole body galen saith, that the roots and leaves hereof aregood for such persons that have their bodies drawn together by essayspasm or convulsion, or other infirmities. As the rickets or as thecollege of physicians would have it, rachites, about which name theyhave quarrelled sufficiently in children, being a disease that hinderstheir growth, by binding their nerves, ligaments, and whole structureof their body the fuller thistle, or teasle it is so well known, that it needs no description, being used with theclothworkers the wild teasle is in all things like the former, but that the pricklesare small, soft, and upright, not hooked or stiff, and the flowersof this are of a fine blueish, or pale carnation colour, but of themanured kind, whitish place the first grows, being sown in gardens or fields for the useof clothworkers. The other near ditches and rills of water in thesisplaces of this land time they flower in july, and are ripe in the end of august government and virtues it is an herb of venus dioscorides saith, that the root bruised and boiled in wine, till it be thick, and keptin a brazen vessel, and after spread as a salve, and applied to thefundament, doth heal the cleft thereof, cankers and fistulas therein, also takes away warts and wens the juice of the leaves dropped intothe ears, kills worms in them the distilled water of the leavesdropped into the eyes, takes away redness and mists in them thathinder the sight, and is often used by women to preserve their beauty, and to take away redness and inflammations, and all other heat ordiscolourings treacle mustard descript it rises up with a hard round stalk, about a foot high, writinged into essay branches, having divers soft green leaves, longand narrow, set thereon, waved, but not cut into the edges, broadesttowards the ends, essaywhat round pointed. The flowers are white thatgrow at the tops of the branches, spike-fashion, one above another;after which come round pouches, writinged in the middle with a furrow, having one blackish brown seed on either side, essaywhat sharp in taste, and smelling of garlick, especially in the fields where it is natural, but not so much in gardens. The roots are small and thready, perishingevery year give me leave here to add mithridate mustard, although it may seem moreproperly by the name to belong to m, in the alphabet mithridate mustard descript this grows higher than the former, spreading more andhigher branches, whose leaves are smaller and narrower, essaytimesunevenly dented about the edges the flowers are small and white, growing on long branches, with much smaller and rounder vessels afterthem, and writinged in the same manner, having smaller brown seeds thanthe former, and much sharper in taste the root perishes after seedtime, but abides the first winter after springing place they grow in sundry places in this land, as half a mile fromhatfield, by the river side, under a hedge as you go to hatfield, andin the street of peckham on surrey side time they flower and seed from may to august government and virtues both of them are herbs of mars the mustardsare said to purge the body both upwards and downwards, and procurewomen courses so abundantly, that it suffocates the birth it breaksinward imposthumes, being taken inwardly. And used in clysters, helpsthe sciatica the seed applied, doth the same it is an especialingredient in mithridate and treacle, being of itself an antidoteresisting poison, venom and putrefaction it is also available in thesispaper for which the common mustard is used, but essaywhat weaker the black thorn, or sloe-bush it is so well known, that it needs no description place it grows in every county in the hedges and borders of fields time it flowers in april, and essaytimes in march, but the fruitripens after all other plums whatsoever, and is not fit to be eatenuntil the autumn frost mellow them government and virtues all the writings of the sloe-bush are binding, cooling, and dry, and all effectual to stay bleeding at the nose andmouth, or any other place. The lask of the belly or stomach, or thebloody flux, the too much abounding of women courses, and helpsto ease the pains of the sides, and bowels, that come by overmuchscouring, to drink the decoction of the bark of the roots, or moreusually the decoction of the berries, either fresh or dried theconserve also is of very much use, and more familiarly taken for thepurposes aforesaid but the distilled water of the flower first steepedin sack for a night, and drawn therefrom by the heat of balneum andanglico, a bath, is a most certain remedy, tried and approved, toease all manner of gnawings in the stomach, the sides and bowels, or any griping pains in any of them, to drink a small quantity whenthe extremity of pain is upon them the leaves also are good to makelotions to gargle and wash the mouth and throat, wherein are swellings, sores, or kernels. And to stay the defluctions of rheum to the eyes, or other writings. As also to cool the heat and inflammations of them, and ease hot pains of the head, to bathe the forehead and templestherewith the simple distilled water of the flowers is very effectualfor the said purposes, and the condensate juice of the sloes thedistilled water of the green berries is used also for the said effects thorough wax, or thorough leaf descript common thorough-wax sends forth a strait round stalk, twofeet high, or better, whose lower leaves being of a bluish colour, aresmaller and narrower than those up higher, and stand close thereto, not compassing it.

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Diarrhœa is writing finance paper help common, vomiting is not theskin is pale and dusky, but not commonly icteric. At first it is hotand dry, later moist and finally cold and clammy the spleen is oftenenlarged the pulse becomes weak and rapid and delirium is followed bycoma the prognosis is grave antiseptic treatment generally preventsand often cures the disease, as is the case with thesis other of thewound diseases. Hence the failure to employ it may be alleged by thedefence in mitigation of the responsibility of the assailant for thefatal result pyæmia is closely allied to septicæmia it is due to the settingfree of bacterial emboli or septic emboli from a broken-down, septicthrombus in the neighborhood of the wound, and the circulation of theseemboli in the blood until they are arrested and form the characteristicmetastatic abscesses, especially in the lungs, joints, abdominalviscera, and parotid gland almost always the source of infection is aninfected wound granulation does not prevent the occurrence of pyæmia, which, as a rule, commences at a later stage than septicæmia it ismost important, however, for our purpose to remember that there issuch a thing as spontaneous pyæmia an injury not causing a wound mayhere be the exciting cause, but the resulting pyæmia is an unexpectedconsequence a bruise of a bone, for instance, by allowing bacteria, which in certain conditions may be circulating in the blood, to findan exit from the vessels into the bruised writing, may develop an acuteosteo-myelitis, which may be a starting-point of a pyæmia it is butproper to state, however, that spontaneous pyæmia is a rare occurrence in fact, it is so rare that if pyæmia occurs and we find ever sotrifling an infected wound, we can safely attribute the pyæmia to thewound and not to a spontaneous origin pyæmia begins, as a rule, in the second week of the healing process oreven later it usually begins with a chill, which may be frequentlyrepeated the fever is very irregular and exacerbations occur witheach metastatic abscess the skin is icteric, the icterus beinghematogenous the pulse is rapid and becomes weaker infectiveendocarditis may develop, which increases the danger of metastaticabscesses, which may then occur in the brain otherwise the mind isclear and unaffected until the final delirium and coma the disease maybecome chronic, but usually lasts a week or ten days the prognosis isvery grave erysipelas is a still more frequent complication of medico-legalwounds, and though not so fatal as the two preceding, it is probablymore often the secondary cause of death on account of its far greaterfrequence it too is an acute infective inflammation due to thepresence of a micro-organism, streptococcus erysipelatis this occursmostly in the lymphatics of the skin, and effects an entrance throughessay wound or abrasion of the skin or mucous membrane, which may bealmost microscopic in size probably there is no such thing as truespontaneous erysipelas, though the wound may be often overlooked andonly visible on the closest examination if a wound has been inflicted, the size and severity of it cannot be alleged as a reason why itwas not the starting-point of an erysipelas the erysipelas must beclearly traced to the injury that is, it must occur before recoveryfrom the wound or not later than a week after it has healed, for theincubation is probably not longer than this it is difficult to connectan erysipelas with a wound if it occurs essay time after it has healedor if it occurs at a different place and not about the wound wounds ofcertain regions, as, for instance, scalp wounds, are especially liableto develop erysipelas, but this is probably owing to the imperfectantiseptic treatment or delay in applying it certain individuals aremore prone to it than others. Thus it has been stated that blondes andthose suffering from bright disease are more susceptible, though howtrue this is it is hard to say it is also probably more prevalent atcertain times of the year, writingicularly in the spring a wound after ithas scabbed over or has begun to granulate, that is, after the firstfour or five days, is very much less apt to serve as the avenue forinfection erysipelas usually begins with a chill, or a convulsion inchildren nausea and vomiting are the rule the fever is remittent andranges from 102° to 104° f , and the temperature may be subnormal whenthe inflammation is subsiding prostration is marked and the pulse moreor less weak there may be delirium while the fever is high locallythere is rarely anything characteristic until twenty-four hours orso after the chill then we have a reddish blush with essay tension, burning and itching of the skin at first the redness is most markedabout the wound, later at the edge of the advancing, serpentine margin it spreads widely and rapidly, and after three or four days the writingfirst attacked begins to improve desquamation follows the durationmay be a week or ten days or as long as a month the inflammation maybe much more severe, involving the subcutaneous connective tissue inphlegmonous erysipelas facial erysipelas is a common variety and was once regarded asidiopathic, but a wound on the skin or mucous membrane is probablyalways present the prognosis of erysipelas is usually favorable since the use of antiseptics it is far less common than formerly, though still the most common of the infective wound diseases if a man wounded in an assault is taken to a hospital where erysipelasprevails, the question of responsibility arises, for, medicallyspeaking, he is subjected to great and avoidable risks tetanus is an infective bacterial disease affecting chiefly the centralnervous system and almost always, if not always, originating from awound tetanus, like erysipelas, is probably always traumatic and neverstrictly idiopathic the wound may be so slight as to escape notice when it follows such injuries as simple fracture internal infectionprobably occurs, though such paper are extremely rare it is saidthat the weather influences the development of tetanus, and that itis more common in the tropics there are also certain sections wheretetanus is much more common than elsewhere and where it may be said tobe almost endemic punctured wounds are most likely to be followed bytetanus, for they offer the best opportunity for the development of thebacteria, which are anaërobic wounds in dirty writings of the body, likethe hands and feet, are more apt to be followed by tetanus than thoseelsewhere tetanus usually appears about the end of the first weekafter a wound has been received, but it may not appear for a longerperiod, even three or four weeks, so that the wound may have been essaytime healed to connect tetanus with a writingicular wound, note 1 ifthere were any symptoms of it before the wound or injury, 2 whetherany other cause intervened after the wound or injury which would belikely to produce it, and 3 whether the deceased ever rallied fromthe effects of the injury tetanus comes on suddenly without warning the injured person first notices that he cannot fully open the mouth, he has lock-jaw, and the back of the neck is stiff the muscles of theabdomen and back are next involved so that the back is arched in theposition known as opisthotonos, and the abdomen presents a board-likehardness the muscles of the fauces, pharynx, and diaphragm may nextbecome involved, causing difficulty in swallowing and breathing the thighs may or may not be involved, but the arms and legs almostnever owing to the spasm of the abdominal muscles, micturition anddefecation are difficult and respiration is hindered the muscles arein the condition of tonic spasm which permits the patient no rest, theface bears the “risus sardonicus, ” and the suffering is extreme ifthe patient lives more than two or three days the tonic spasm writinglygives way to increased reflex irritability, in which a noise, jar, or draught of air may give rise to clonic and tonic spasms in themuscles affected the patient may die at such times from tonic spasmof the respiratory muscles, or he may die of prostration from wantof food and sleep, worn out by the suffering and muscular spasm themind is usually clear to the last fever is not characteristic of thedisease tetanus may be rapidly fatal. In two or three days, or it maybe or become more chronic the prognosis of acute tetanus is almostinvariably fatal. That of chronic tetanus is grave, but a certainproportion of paper recover diagnosis - this is easy it differs from a true neuritis in theperipheral nerves in that no matter where the wound is situated thefirst symptom is in the muscles of the jaw and the back of the neck, and not at the site of the injury and distally from this point trismus is applied to a milder form of the disease in which onlythe face and neck muscles are involved and “lock-jaw” is a prominentsymptom essay paper of tetany may be mistaken for so-calledspontaneous tetanus tetany may follow child-bed, fevers, mentalshocks, exposure to cold and wet, extirpation of goitre, intestinalirritation, etc it consists of painful tonic spasms of the muscles ofthe arms and feet the attacks last one-half to two hours or more, andmay be preceded by a dragging pain they may be brought on by pressureon the nerve leading to the muscles affected striking the facial nerveoften causes contraction of the face muscles there is no trismus butthere may be opisthotonos the patient seems well between the attacksand most paper recover without treatment delirium tremens may occur as a secondary consequence of injuries, ornecessary surgical operations in the case of those who are habituallyintemperate those who habitually use opium, tobacco, cannabis indica, or even tea or coffee to excess are said to be subject to it itmay, therefore, be justly alleged that death is avoidable in verythesis paper, but for an abnormal and unhealthy state of the body the disease is characterized by delirium, a peculiar tremor of themuscles, insomnia, and anorexia pneumonia may complicate the case the patients die in fatal paper from exhaustion due to insomnia, lack of nourishment, and their constant activity of body and mind the prognosis is usually favorable, taking all paper together, butin delirium tremens secondary to surgical injuries or operations theprognosis is serious death from surgical operations performed for the treatment of wounds the operation is a writing of the treatment, and if it is done withordinary care and skill the accused is responsible for the result the necessity and mode of operation must be left to the operatorjudgment as the defence may turn on the necessity for and the skilfulperformance of the operation, it is well to wait for the advice andassistance of others if practicable, for death is not unusual fromsevere operations the patient may die on the operating-table afterlosing little blood, from fear, pain, or shock or he may die fromsecondary hemorrhage or any of the secondary causes of death fromwounds enumerated above the evidence of the necessity of the operationmust, therefore, be presented by the operator if an operation isnecessary and not performed, the defence might allege that deathwas due to the neglect of the surgeon another question for themedical witnesses to determine is whether the operation was renderednecessary because of improper previous treatment, for if it was theresponsibility of the assailant may be influenced the meaning of theterm “necessity” is here a matter of importance unless an operationis necessary to the preservation of life, if death occurs there isessay doubt whether the assailant is responsible but, medicallyspeaking, we would not hesitate to urge an operation on a wounded manin order to preserve function, or even to save deformity as well as tosave life in the case of operations done under a mistaken opinion, neither necessary to save life nor, as the result proves, to savefunction or guard against deformity, if death follows the assailantmay be relieved from responsibility thus an aneurism following aninjury might be mistaken for an abscess and opened with skill butwith a fatal result it is also for the medical experts to determinewhether an operation was unnecessary or unskilfully performed, forif it were and death resulted from it, the responsibility of theprisoner is affected unless the original wound would be likely to befatal without operation according to lord hale, if death results froman unskilful operation and not from the wound, the prisoner is notresponsible but yet death may occur as the result of the most skilfuloperation necessary to the treatment of a wound, and not be dependentat all on the wound itself if the operation is skilfully performed, and yet the patient dies from secondary causes, such as those aboveenumerated or any others, the prisoner is still responsible, and themedical testimony is concerned with the performance of the operationand the secondary causes of death the relative skill of the operatoror surgeon is probably not a question for the jury in criminal paper, on the ground that the man who inflicts the injury must take all theconsequences, good or bad in a civil suit, for instance an actionfor malpractice, the case is otherwise, and all the medical facts andopinions are submitted to the jury the law regards three circumstancesin death after surgical operations.