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Unknown  |  1994-03-02  |  28.1 KB

open in: MacOS 8.1     |     Win98     |     DOS

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This file was not able to be converted.
This format is not currently supported by dexvert.

ConfidenceProgramDetectionMatch TypeSupport
10% dexvert Degas High Resolution Picture (PI) (image/degasHiPI) magic Supported
100% file data default
100% TrID DEGAS hi-res bitmap default (weak)



hex view
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|00000fe0| 67 6f 6f 64 2d 73 69 7a | 65 64 20 73 6b 75 6c 6c |good-siz|ed skull|
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|000019d0| 20 20 20 20 3c 4c 65 73 | 73 6f 6e 20 30 33 35 3e | <Les|son 035>|
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|00001aa0| 2e 20 54 68 69 73 20 77 | 69 6c 6c 20 68 65 6c 70 |. This w|ill help|
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|00004460| 6e 20 30 39 38 3e 00 3c | 4c 65 73 73 6f 6e 20 30 |n 098>.<|Lesson 0|
|00004470| 39 39 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 30 30 3e |99>.<Les|son 100>|
|00004480| 00 3c 4c 65 73 73 6f 6e | 20 31 30 31 3e 00 3c 4c |.<Lesson| 101>.<L|
|00004490| 65 73 73 6f 6e 20 31 30 | 32 3e 00 3c 4c 65 73 73 |esson 10|2>.<Less|
|000044a0| 6f 6e 20 31 30 33 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 103>.|<Lesson |
|000044b0| 31 30 34 3e 00 3c 4c 65 | 73 73 6f 6e 20 31 30 35 |104>.<Le|sson 105|
|000044c0| 3e 00 3c 4c 65 73 73 6f | 6e 20 31 30 36 3e 00 3c |>.<Lesso|n 106>.<|
|000044d0| 4c 65 73 73 6f 6e 20 31 | 30 37 3e 00 3c 4c 65 73 |Lesson 1|07>.<Les|
|000044e0| 73 6f 6e 20 31 30 38 3e | 00 3c 4c 65 73 73 6f 6e |son 108>|.<Lesson|
|000044f0| 20 31 30 39 3e 00 3c 4c | 65 73 73 6f 6e 20 31 31 | 109>.<L|esson 11|
|00004500| 30 3e 00 3c 4c 65 73 73 | 6f 6e 20 31 31 31 3e 00 |0>.<Less|on 111>.|
|00004510| 3c 4c 65 73 73 6f 6e 20 | 31 31 32 3e 00 3c 4c 65 |<Lesson |112>.<Le|
|00004520| 73 73 6f 6e 20 31 31 33 | 3e 00 3c 4c 65 73 73 6f |sson 113|>.<Lesso|
|00004530| 6e 20 31 31 34 3e 00 3c | 4c 65 73 73 6f 6e 20 31 |n 114>.<|Lesson 1|
|00004540| 31 35 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 31 36 3e |15>.<Les|son 116>|
|00004550| 00 3c 4c 65 73 73 6f 6e | 20 31 31 37 3e 00 3c 4c |.<Lesson| 117>.<L|
|00004560| 65 73 73 6f 6e 20 31 31 | 38 3e 00 3c 4c 65 73 73 |esson 11|8>.<Less|
|00004570| 6f 6e 20 31 31 39 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 119>.|<Lesson |
|00004580| 31 31 30 3e 00 3c 4c 65 | 73 73 6f 6e 20 31 32 31 |110>.<Le|sson 121|
|00004590| 3e 00 3c 4c 65 73 73 6f | 6e 20 31 32 32 3e 00 3c |>.<Lesso|n 122>.<|
|000045a0| 4c 65 73 73 6f 6e 20 31 | 32 33 3e 00 3c 4c 65 73 |Lesson 1|23>.<Les|
|000045b0| 73 6f 6e 20 31 32 34 3e | 00 3c 4c 65 73 73 6f 6e |son 124>|.<Lesson|
|000045c0| 20 31 32 35 3e 00 3c 4c | 65 73 73 6f 6e 20 31 32 | 125>.<L|esson 12|
|000045d0| 36 3e 00 3c 4c 65 73 73 | 6f 6e 20 31 32 37 3e 00 |6>.<Less|on 127>.|
|000045e0| 3c 4c 65 73 73 6f 6e 20 | 31 32 38 3e 00 3c 4c 65 |<Lesson |128>.<Le|
|000045f0| 73 73 6f 6e 20 31 32 39 | 3e 00 3c 4c 65 73 73 6f |sson 129|>.<Lesso|
|00004600| 6e 20 31 33 30 3e 00 3c | 4c 65 73 73 6f 6e 20 31 |n 130>.<|Lesson 1|
|00004610| 33 31 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 33 32 3e |31>.<Les|son 132>|
|00004620| 00 3c 4c 65 73 73 6f 6e | 20 31 33 33 3e 00 3c 4c |.<Lesson| 133>.<L|
|00004630| 65 73 73 6f 6e 20 31 33 | 34 3e 00 3c 4c 65 73 73 |esson 13|4>.<Less|
|00004640| 6f 6e 20 31 33 35 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 135>.|<Lesson |
|00004650| 31 33 36 3e 00 3c 4c 65 | 73 73 6f 6e 20 31 33 37 |136>.<Le|sson 137|
|00004660| 3e 00 3c 4c 65 73 73 6f | 6e 20 31 33 38 3e 00 3c |>.<Lesso|n 138>.<|
|00004670| 4c 65 73 73 6f 6e 20 31 | 33 39 3e 00 3c 4c 65 73 |Lesson 1|39>.<Les|
|00004680| 73 6f 6e 20 31 34 30 3e | 00 3c 4c 65 73 73 6f 6e |son 140>|.<Lesson|
|00004690| 20 31 34 31 3e 00 3c 4c | 65 73 73 6f 6e 20 31 34 | 141>.<L|esson 14|
|000046a0| 32 3e 00 3c 4c 65 73 73 | 6f 6e 20 31 34 33 3e 00 |2>.<Less|on 143>.|
|000046b0| 3c 4c 65 73 73 6f 6e 20 | 31 34 34 3e 00 3c 4c 65 |<Lesson |144>.<Le|
|000046c0| 73 73 6f 6e 20 31 34 35 | 3e 00 3c 4c 65 73 73 6f |sson 145|>.<Lesso|
|000046d0| 6e 20 31 34 36 3e 00 3c | 4c 65 73 73 6f 6e 20 31 |n 146>.<|Lesson 1|
|000046e0| 34 37 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 34 38 3e |47>.<Les|son 148>|
|000046f0| 00 3c 4c 65 73 73 6f 6e | 20 31 34 39 3e 00 3c 4c |.<Lesson| 149>.<L|
|00004700| 65 73 73 6f 6e 20 31 35 | 30 3e 00 3c 4c 65 73 73 |esson 15|0>.<Less|
|00004710| 6f 6e 20 31 35 31 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 151>.|<Lesson |
|00004720| 31 35 32 3e 00 3c 4c 65 | 73 73 6f 6e 20 31 35 33 |152>.<Le|sson 153|
|00004730| 3e 00 3c 4c 65 73 73 6f | 6e 20 31 35 34 3e 00 3c |>.<Lesso|n 154>.<|
|00004740| 4c 65 73 73 6f 6e 20 31 | 35 35 3e 00 3c 4c 65 73 |Lesson 1|55>.<Les|
|00004750| 73 6f 6e 20 31 35 36 3e | 00 3c 4c 65 73 73 6f 6e |son 156>|.<Lesson|
|00004760| 20 31 35 37 3e 00 3c 4c | 65 73 73 6f 6e 20 31 35 | 157>.<L|esson 15|
|00004770| 38 3e 00 3c 4c 65 73 73 | 6f 6e 20 31 35 39 3e 00 |8>.<Less|on 159>.|
|00004780| 3c 4c 65 73 73 6f 6e 20 | 31 36 30 3e 00 3c 4c 65 |<Lesson |160>.<Le|
|00004790| 73 73 6f 6e 20 31 36 31 | 3e 00 3c 4c 65 73 73 6f |sson 161|>.<Lesso|
|000047a0| 6e 20 31 36 32 3e 00 3c | 4c 65 73 73 6f 6e 20 31 |n 162>.<|Lesson 1|
|000047b0| 36 33 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 36 34 3e |63>.<Les|son 164>|
|000047c0| 00 3c 4c 65 73 73 6f 6e | 20 31 36 35 3e 00 3c 4c |.<Lesson| 165>.<L|
|000047d0| 65 73 73 6f 6e 20 31 36 | 36 3e 00 3c 4c 65 73 73 |esson 16|6>.<Less|
|000047e0| 6f 6e 20 31 36 37 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 167>.|<Lesson |
|000047f0| 31 36 38 3e 00 3c 4c 65 | 73 73 6f 6e 20 31 36 39 |168>.<Le|sson 169|
|00004800| 3e 00 3c 4c 65 73 73 6f | 6e 20 31 37 30 3e 00 3c |>.<Lesso|n 170>.<|
|00004810| 4c 65 73 73 6f 6e 20 31 | 37 31 3e 00 3c 4c 65 73 |Lesson 1|71>.<Les|
|00004820| 73 6f 6e 20 31 37 32 3e | 00 3c 4c 65 73 73 6f 6e |son 172>|.<Lesson|
|00004830| 20 31 37 33 3e 00 3c 4c | 65 73 73 6f 6e 20 31 37 | 173>.<L|esson 17|
|00004840| 34 3e 00 3c 4c 65 73 73 | 6f 6e 20 31 37 35 3e 00 |4>.<Less|on 175>.|
|00004850| 3c 4c 65 73 73 6f 6e 20 | 31 37 36 3e 00 3c 4c 65 |<Lesson |176>.<Le|
|00004860| 73 73 6f 6e 20 31 37 37 | 3e 00 3c 4c 65 73 73 6f |sson 177|>.<Lesso|
|00004870| 6e 20 31 37 38 3e 00 3c | 4c 65 73 73 6f 6e 20 31 |n 178>.<|Lesson 1|
|00004880| 37 39 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 38 30 3e |79>.<Les|son 180>|
|00004890| 00 3c 4c 65 73 73 6f 6e | 20 31 38 31 3e 00 3c 4c |.<Lesson| 181>.<L|
|000048a0| 65 73 73 6f 6e 20 31 38 | 32 3e 00 3c 4c 65 73 73 |esson 18|2>.<Less|
|000048b0| 6f 6e 20 31 38 33 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 183>.|<Lesson |
|000048c0| 31 38 34 3e 00 3c 4c 65 | 73 73 6f 6e 20 31 38 35 |184>.<Le|sson 185|
|000048d0| 3e 00 3c 4c 65 73 73 6f | 6e 20 31 38 36 3e 00 3c |>.<Lesso|n 186>.<|
|000048e0| 4c 65 73 73 6f 6e 20 31 | 38 37 3e 00 3c 4c 65 73 |Lesson 1|87>.<Les|
|000048f0| 73 6f 6e 20 31 38 38 3e | 00 3c 4c 65 73 73 6f 6e |son 188>|.<Lesson|
|00004900| 20 31 38 39 3e 00 3c 4c | 65 73 73 6f 6e 20 31 39 | 189>.<L|esson 19|
|00004910| 30 3e 00 3c 4c 65 73 73 | 6f 6e 20 31 39 31 3e 00 |0>.<Less|on 191>.|
|00004920| 3c 4c 65 73 73 6f 6e 20 | 31 39 32 3e 00 3c 4c 65 |<Lesson |192>.<Le|
|00004930| 73 73 6f 6e 20 31 39 33 | 3e 00 3c 4c 65 73 73 6f |sson 193|>.<Lesso|
|00004940| 6e 20 31 39 34 3e 00 3c | 4c 65 73 73 6f 6e 20 31 |n 194>.<|Lesson 1|
|00004950| 39 35 3e 00 3c 4c 65 73 | 73 6f 6e 20 31 39 36 3e |95>.<Les|son 196>|
|00004960| 00 3c 4c 65 73 73 6f 6e | 20 31 39 37 3e 00 3c 4c |.<Lesson| 197>.<L|
|00004970| 65 73 73 6f 6e 20 31 39 | 38 3e 00 3c 4c 65 73 73 |esson 19|8>.<Less|
|00004980| 6f 6e 20 31 39 39 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 199>.|<Lesson |
|00004990| 32 30 30 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 30 31 |200>.<Le|sson 201|
|000049a0| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 30 32 3e 00 3c |>.<Lesso|n 202>.<|
|000049b0| 4c 65 73 73 6f 6e 20 32 | 30 33 3e 00 3c 4c 65 73 |Lesson 2|03>.<Les|
|000049c0| 73 6f 6e 20 32 30 34 3e | 00 3c 4c 65 73 73 6f 6e |son 204>|.<Lesson|
|000049d0| 20 32 30 35 3e 00 3c 4c | 65 73 73 6f 6e 20 32 30 | 205>.<L|esson 20|
|000049e0| 36 3e 00 3c 4c 65 73 73 | 6f 6e 20 32 30 37 3e 00 |6>.<Less|on 207>.|
|000049f0| 3c 4c 65 73 73 6f 6e 20 | 32 30 38 3e 00 3c 4c 65 |<Lesson |208>.<Le|
|00004a00| 73 73 6f 6e 20 32 30 39 | 3e 00 3c 4c 65 73 73 6f |sson 209|>.<Lesso|
|00004a10| 6e 20 32 31 30 3e 00 3c | 4c 65 73 73 6f 6e 20 32 |n 210>.<|Lesson 2|
|00004a20| 31 31 3e 00 3c 4c 65 73 | 73 6f 6e 20 32 31 32 3e |11>.<Les|son 212>|
|00004a30| 00 3c 4c 65 73 73 6f 6e | 20 32 31 33 3e 00 3c 4c |.<Lesson| 213>.<L|
|00004a40| 65 73 73 6f 6e 20 32 31 | 34 3e 00 3c 4c 65 73 73 |esson 21|4>.<Less|
|00004a50| 6f 6e 20 32 31 35 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 215>.|<Lesson |
|00004a60| 32 31 36 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 31 37 |216>.<Le|sson 217|
|00004a70| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 31 38 3e 00 3c |>.<Lesso|n 218>.<|
|00004a80| 4c 65 73 73 6f 6e 20 32 | 31 39 3e 00 3c 4c 65 73 |Lesson 2|19>.<Les|
|00004a90| 73 6f 6e 20 32 31 30 3e | 00 3c 4c 65 73 73 6f 6e |son 210>|.<Lesson|
|00004aa0| 20 32 32 31 3e 00 3c 4c | 65 73 73 6f 6e 20 32 32 | 221>.<L|esson 22|
|00004ab0| 32 3e 00 3c 4c 65 73 73 | 6f 6e 20 32 32 33 3e 00 |2>.<Less|on 223>.|
|00004ac0| 3c 4c 65 73 73 6f 6e 20 | 32 32 34 3e 00 3c 4c 65 |<Lesson |224>.<Le|
|00004ad0| 73 73 6f 6e 20 32 32 35 | 3e 00 3c 4c 65 73 73 6f |sson 225|>.<Lesso|
|00004ae0| 6e 20 32 32 36 3e 00 3c | 4c 65 73 73 6f 6e 20 32 |n 226>.<|Lesson 2|
|00004af0| 32 37 3e 00 3c 4c 65 73 | 73 6f 6e 20 32 32 38 3e |27>.<Les|son 228>|
|00004b00| 00 3c 4c 65 73 73 6f 6e | 20 32 32 39 3e 00 3c 4c |.<Lesson| 229>.<L|
|00004b10| 65 73 73 6f 6e 20 32 33 | 30 3e 00 3c 4c 65 73 73 |esson 23|0>.<Less|
|00004b20| 6f 6e 20 32 33 31 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 231>.|<Lesson |
|00004b30| 32 33 32 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 33 33 |232>.<Le|sson 233|
|00004b40| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 33 34 3e 00 3c |>.<Lesso|n 234>.<|
|00004b50| 4c 65 73 73 6f 6e 20 32 | 33 35 3e 00 3c 4c 65 73 |Lesson 2|35>.<Les|
|00004b60| 73 6f 6e 20 32 33 36 3e | 00 3c 4c 65 73 73 6f 6e |son 236>|.<Lesson|
|00004b70| 20 32 33 37 3e 00 3c 4c | 65 73 73 6f 6e 20 32 33 | 237>.<L|esson 23|
|00004b80| 38 3e 00 3c 4c 65 73 73 | 6f 6e 20 32 33 39 3e 00 |8>.<Less|on 239>.|
|00004b90| 3c 4c 65 73 73 6f 6e 20 | 32 34 30 3e 00 3c 4c 65 |<Lesson |240>.<Le|
|00004ba0| 73 73 6f 6e 20 32 34 31 | 3e 00 3c 4c 65 73 73 6f |sson 241|>.<Lesso|
|00004bb0| 6e 20 32 34 32 3e 00 3c | 4c 65 73 73 6f 6e 20 32 |n 242>.<|Lesson 2|
|00004bc0| 34 33 3e 00 3c 4c 65 73 | 73 6f 6e 20 32 34 34 3e |43>.<Les|son 244>|
|00004bd0| 00 3c 4c 65 73 73 6f 6e | 20 32 34 35 3e 00 3c 4c |.<Lesson| 245>.<L|
|00004be0| 65 73 73 6f 6e 20 32 34 | 36 3e 00 3c 4c 65 73 73 |esson 24|6>.<Less|
|00004bf0| 6f 6e 20 32 34 37 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 247>.|<Lesson |
|00004c00| 32 34 38 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 34 39 |248>.<Le|sson 249|
|00004c10| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 35 30 3e 00 3c |>.<Lesso|n 250>.<|
|00004c20| 4c 65 73 73 6f 6e 20 32 | 35 31 3e 00 3c 4c 65 73 |Lesson 2|51>.<Les|
|00004c30| 73 6f 6e 20 32 35 32 3e | 00 3c 4c 65 73 73 6f 6e |son 252>|.<Lesson|
|00004c40| 20 32 35 33 3e 00 3c 4c | 65 73 73 6f 6e 20 32 35 | 253>.<L|esson 25|
|00004c50| 34 3e 00 3c 4c 65 73 73 | 6f 6e 20 32 35 35 3e 00 |4>.<Less|on 255>.|
|00004c60| 3c 4c 65 73 73 6f 6e 20 | 32 35 36 3e 00 3c 4c 65 |<Lesson |256>.<Le|
|00004c70| 73 73 6f 6e 20 32 35 37 | 3e 00 3c 4c 65 73 73 6f |sson 257|>.<Lesso|
|00004c80| 6e 20 32 35 38 3e 00 3c | 4c 65 73 73 6f 6e 20 32 |n 258>.<|Lesson 2|
|00004c90| 35 39 3e 00 3c 4c 65 73 | 73 6f 6e 20 32 36 30 3e |59>.<Les|son 260>|
|00004ca0| 00 3c 4c 65 73 73 6f 6e | 20 32 36 31 3e 00 3c 4c |.<Lesson| 261>.<L|
|00004cb0| 65 73 73 6f 6e 20 32 36 | 32 3e 00 3c 4c 65 73 73 |esson 26|2>.<Less|
|00004cc0| 6f 6e 20 32 36 33 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 263>.|<Lesson |
|00004cd0| 32 36 34 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 36 35 |264>.<Le|sson 265|
|00004ce0| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 36 36 3e 00 3c |>.<Lesso|n 266>.<|
|00004cf0| 4c 65 73 73 6f 6e 20 32 | 36 37 3e 00 3c 4c 65 73 |Lesson 2|67>.<Les|
|00004d00| 73 6f 6e 20 32 36 38 3e | 00 3c 4c 65 73 73 6f 6e |son 268>|.<Lesson|
|00004d10| 20 32 36 39 3e 00 3c 4c | 65 73 73 6f 6e 20 32 37 | 269>.<L|esson 27|
|00004d20| 30 3e 00 3c 4c 65 73 73 | 6f 6e 20 32 37 31 3e 00 |0>.<Less|on 271>.|
|00004d30| 3c 4c 65 73 73 6f 6e 20 | 32 37 32 3e 00 3c 4c 65 |<Lesson |272>.<Le|
|00004d40| 73 73 6f 6e 20 32 37 33 | 3e 00 3c 4c 65 73 73 6f |sson 273|>.<Lesso|
|00004d50| 6e 20 32 37 34 3e 00 3c | 4c 65 73 73 6f 6e 20 32 |n 274>.<|Lesson 2|
|00004d60| 37 35 3e 00 3c 4c 65 73 | 73 6f 6e 20 32 37 36 3e |75>.<Les|son 276>|
|00004d70| 00 3c 4c 65 73 73 6f 6e | 20 32 37 37 3e 00 3c 4c |.<Lesson| 277>.<L|
|00004d80| 65 73 73 6f 6e 20 32 37 | 38 3e 00 3c 4c 65 73 73 |esson 27|8>.<Less|
|00004d90| 6f 6e 20 32 37 39 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 279>.|<Lesson |
|00004da0| 32 38 30 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 38 31 |280>.<Le|sson 281|
|00004db0| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 38 32 3e 00 3c |>.<Lesso|n 282>.<|
|00004dc0| 4c 65 73 73 6f 6e 20 32 | 38 33 3e 00 3c 4c 65 73 |Lesson 2|83>.<Les|
|00004dd0| 73 6f 6e 20 32 38 34 3e | 00 3c 4c 65 73 73 6f 6e |son 284>|.<Lesson|
|00004de0| 20 32 38 35 3e 00 3c 4c | 65 73 73 6f 6e 20 32 38 | 285>.<L|esson 28|
|00004df0| 36 3e 00 3c 4c 65 73 73 | 6f 6e 20 32 38 37 3e 00 |6>.<Less|on 287>.|
|00004e00| 3c 4c 65 73 73 6f 6e 20 | 32 38 38 3e 00 3c 4c 65 |<Lesson |288>.<Le|
|00004e10| 73 73 6f 6e 20 32 38 39 | 3e 00 3c 4c 65 73 73 6f |sson 289|>.<Lesso|
|00004e20| 6e 20 32 39 30 3e 00 3c | 4c 65 73 73 6f 6e 20 32 |n 290>.<|Lesson 2|
|00004e30| 39 31 3e 00 3c 4c 65 73 | 73 6f 6e 20 32 39 32 3e |91>.<Les|son 292>|
|00004e40| 00 3c 4c 65 73 73 6f 6e | 20 32 39 33 3e 00 3c 4c |.<Lesson| 293>.<L|
|00004e50| 65 73 73 6f 6e 20 32 39 | 34 3e 00 3c 4c 65 73 73 |esson 29|4>.<Less|
|00004e60| 6f 6e 20 32 39 35 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 295>.|<Lesson |
|00004e70| 32 39 36 3e 00 3c 4c 65 | 73 73 6f 6e 20 32 39 37 |296>.<Le|sson 297|
|00004e80| 3e 00 3c 4c 65 73 73 6f | 6e 20 32 39 38 3e 00 3c |>.<Lesso|n 298>.<|
|00004e90| 4c 65 73 73 6f 6e 20 32 | 39 39 3e 00 3c 4c 65 73 |Lesson 2|99>.<Les|
|00004ea0| 73 6f 6e 20 33 30 30 3e | 00 3c 4c 65 73 73 6f 6e |son 300>|.<Lesson|
|00004eb0| 20 33 30 31 3e 00 3c 4c | 65 73 73 6f 6e 20 33 30 | 301>.<L|esson 30|
|00004ec0| 32 3e 00 3c 4c 65 73 73 | 6f 6e 20 33 30 33 3e 00 |2>.<Less|on 303>.|
|00004ed0| 3c 4c 65 73 73 6f 6e 20 | 33 30 34 3e 00 3c 4c 65 |<Lesson |304>.<Le|
|00004ee0| 73 73 6f 6e 20 33 30 35 | 3e 00 3c 4c 65 73 73 6f |sson 305|>.<Lesso|
|00004ef0| 6e 20 33 30 36 3e 00 3c | 4c 65 73 73 6f 6e 20 33 |n 306>.<|Lesson 3|
|00004f00| 30 37 3e 00 3c 4c 65 73 | 73 6f 6e 20 33 30 38 3e |07>.<Les|son 308>|
|00004f10| 00 3c 4c 65 73 73 6f 6e | 20 33 30 39 3e 00 3c 4c |.<Lesson| 309>.<L|
|00004f20| 65 73 73 6f 6e 20 33 31 | 30 3e 00 3c 4c 65 73 73 |esson 31|0>.<Less|
|00004f30| 6f 6e 20 33 31 31 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 311>.|<Lesson |
|00004f40| 33 31 32 3e 00 3c 4c 65 | 73 73 6f 6e 20 33 31 33 |312>.<Le|sson 313|
|00004f50| 3e 00 3c 4c 65 73 73 6f | 6e 20 33 31 34 3e 00 3c |>.<Lesso|n 314>.<|
|00004f60| 4c 65 73 73 6f 6e 20 33 | 31 35 3e 00 3c 4c 65 73 |Lesson 3|15>.<Les|
|00004f70| 73 6f 6e 20 33 31 36 3e | 00 3c 4c 65 73 73 6f 6e |son 316>|.<Lesson|
|00004f80| 20 33 31 37 3e 00 3c 4c | 65 73 73 6f 6e 20 33 31 | 317>.<L|esson 31|
|00004f90| 38 3e 00 3c 4c 65 73 73 | 6f 6e 20 33 31 39 3e 00 |8>.<Less|on 319>.|
|00004fa0| 3c 4c 65 73 73 6f 6e 20 | 33 31 30 3e 00 3c 4c 65 |<Lesson |310>.<Le|
|00004fb0| 73 73 6f 6e 20 33 32 31 | 3e 00 3c 4c 65 73 73 6f |sson 321|>.<Lesso|
|00004fc0| 6e 20 33 32 32 3e 00 3c | 4c 65 73 73 6f 6e 20 33 |n 322>.<|Lesson 3|
|00004fd0| 32 33 3e 00 3c 4c 65 73 | 73 6f 6e 20 33 32 34 3e |23>.<Les|son 324>|
|00004fe0| 00 3c 4c 65 73 73 6f 6e | 20 33 32 35 3e 00 3c 4c |.<Lesson| 325>.<L|
|00004ff0| 65 73 73 6f 6e 20 33 32 | 36 3e 00 3c 4c 65 73 73 |esson 32|6>.<Less|
|00005000| 6f 6e 20 33 32 37 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 327>.|<Lesson |
|00005010| 33 32 38 3e 00 3c 4c 65 | 73 73 6f 6e 20 33 32 39 |328>.<Le|sson 329|
|00005020| 3e 00 3c 4c 65 73 73 6f | 6e 20 33 33 30 3e 00 3c |>.<Lesso|n 330>.<|
|00005030| 4c 65 73 73 6f 6e 20 33 | 33 31 3e 00 3c 4c 65 73 |Lesson 3|31>.<Les|
|00005040| 73 6f 6e 20 33 33 32 3e | 00 3c 4c 65 73 73 6f 6e |son 332>|.<Lesson|
|00005050| 20 33 33 33 3e 00 3c 4c | 65 73 73 6f 6e 20 33 33 | 333>.<L|esson 33|
|00005060| 34 3e 00 3c 4c 65 73 73 | 6f 6e 20 33 33 35 3e 00 |4>.<Less|on 335>.|
|00005070| 3c 4c 65 73 73 6f 6e 20 | 33 33 36 3e 00 3c 4c 65 |<Lesson |336>.<Le|
|00005080| 73 73 6f 6e 20 33 33 37 | 3e 00 3c 4c 65 73 73 6f |sson 337|>.<Lesso|
|00005090| 6e 20 33 33 38 3e 00 3c | 4c 65 73 73 6f 6e 20 33 |n 338>.<|Lesson 3|
|000050a0| 33 39 3e 00 3c 4c 65 73 | 73 6f 6e 20 33 34 30 3e |39>.<Les|son 340>|
|000050b0| 00 3c 4c 65 73 73 6f 6e | 20 33 34 31 3e 00 3c 4c |.<Lesson| 341>.<L|
|000050c0| 65 73 73 6f 6e 20 33 34 | 32 3e 00 3c 4c 65 73 73 |esson 34|2>.<Less|
|000050d0| 6f 6e 20 33 34 33 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 343>.|<Lesson |
|000050e0| 33 34 34 3e 00 3c 4c 65 | 73 73 6f 6e 20 33 34 35 |344>.<Le|sson 345|
|000050f0| 3e 00 3c 4c 65 73 73 6f | 6e 20 33 34 36 3e 00 3c |>.<Lesso|n 346>.<|
|00005100| 4c 65 73 73 6f 6e 20 33 | 34 37 3e 00 3c 4c 65 73 |Lesson 3|47>.<Les|
|00005110| 73 6f 6e 20 33 34 38 3e | 00 3c 4c 65 73 73 6f 6e |son 348>|.<Lesson|
|00005120| 20 33 34 39 3e 00 3c 4c | 65 73 73 6f 6e 20 33 35 | 349>.<L|esson 35|
|00005130| 30 3e 00 3c 4c 65 73 73 | 6f 6e 20 33 35 31 3e 00 |0>.<Less|on 351>.|
|00005140| 3c 4c 65 73 73 6f 6e 20 | 33 35 32 3e 00 3c 4c 65 |<Lesson |352>.<Le|
|00005150| 73 73 6f 6e 20 33 35 33 | 3e 00 3c 4c 65 73 73 6f |sson 353|>.<Lesso|
|00005160| 6e 20 33 35 34 3e 00 3c | 4c 65 73 73 6f 6e 20 33 |n 354>.<|Lesson 3|
|00005170| 35 35 3e 00 3c 4c 65 73 | 73 6f 6e 20 33 35 36 3e |55>.<Les|son 356>|
|00005180| 00 3c 4c 65 73 73 6f 6e | 20 33 35 37 3e 00 3c 4c |.<Lesson| 357>.<L|
|00005190| 65 73 73 6f 6e 20 33 35 | 38 3e 00 3c 4c 65 73 73 |esson 35|8>.<Less|
|000051a0| 6f 6e 20 33 35 39 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 359>.|<Lesson |
|000051b0| 33 36 30 3e 00 3c 4c 65 | 73 73 6f 6e 20 33 36 31 |360>.<Le|sson 361|
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|00005270| 6f 6e 20 33 37 35 3e 00 | 3c 4c 65 73 73 6f 6e 20 |on 375>.|<Lesson |
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|00006080| 6d 61 6c 69 74 69 65 73 | 20 66 6f 72 20 6d 69 67 |malities| for mig|
|00006090| 72 61 69 6e 65 20 70 61 | 74 69 65 6e 74 73 2e 00 |raine pa|tients..|
|000060a0| 54 68 65 20 6f 6e 6c 79 | 20 65 66 66 65 63 74 69 |The only| effecti|
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|00006140| 68 20 74 68 65 20 73 6b | 75 6c 6c 20 61 6e 64 20 |h the sk|ull and |
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|00006160| 61 75 73 65 64 20 62 79 | 20 61 6e 20 69 6e 6a 75 |aused by| an inju|
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|000061b0| 68 20 69 74 2e 00 48 65 | 6d 61 74 6f 6d 61 73 20 |h it..He|matomas |
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|00006340| 75 73 74 20 62 65 20 6f | 70 65 72 61 74 65 64 20 |ust be o|perated |
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|00006370| 72 6f 6d 20 74 68 65 20 | 62 6c 65 65 64 69 6e 67 |rom the |bleeding|
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|000063b0| 6e 20 63 61 75 73 65 73 | 20 77 65 61 6b 6e 65 73 |n causes| weaknes|
|000063c0| 73 20 61 6e 64 20 6c 6f | 73 73 20 6f 66 20 73 65 |s and lo|ss of se|
|000063d0| 6e 73 61 74 69 6f 6e 20 | 6f 6e 20 6f 6e 65 20 73 |nsation |on one s|
|000063e0| 69 64 65 20 6f 66 20 74 | 68 65 20 62 6f 64 79 2e |ide of t|he body.|
|000063f0| 20 41 6c 6c 20 6f 74 68 | 65 72 20 64 69 61 67 6e | All oth|er diagn|
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