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It will also be found a valuable remedy in chronic metritis buy discount nimodipine 30 mg online, with uterine leucorrhœa order nimodipine 30 mg on-line. In one case with profuse watery discharge from the uterus, it proved curative after other plans of treatment had failed. I would suggest a tincture of the recent bark, in dilute alcohol, and in the proportion of ℥viij. It undoubtedly influences the cerebro-spinal centers, controlling epileptiform movements. It has been administered in cases of epilepsy with success, though the discoloration of the skin caused by the large doses given, was a serious objection. It also exerts an influence in chronic gastritis and enteritis, and has been given in some cases of dysentery with advantage. It has been employed in ague and malarial disease, when there was marked confusion of intellect, with headache and burning of the face and eyes. In ague the chill is prolonged, with great pain in the bones, and a feeling as if bruised. In large doses it has been extensively used as a stimulant diaphoretic, and is a most excellent remedy. In small doses it is indicated by a relaxed atonic skin, cold extremities, cold perspiration, difficult respiration, and difficult deglutition. It is not necessary to refer to the common local use of this agent, or discuss the question whether a tincture of arnica is preferable to alcohol alone as a local application. It is a valuable stimulant in many grave diseases where a stimulant is most required. But if used as a general stimulant, like alcohol, it would be as apt to do harm as good. It is a specific stimulant to the spinal nervous system, and will be found useful where there is want of innervation from this. I have seen most marked benefit from it in advanced stages of disease, where there was feeble respiratory power; difficulty of sleeping from impeded respiration; want of control over the discharge of urine and feces, etc. I have frequently prescribed it for lame back, back-ache, and feelings of debility and soreness, in the small of the back. It is only useful in those cases where there is feebleness, with deficient circulation; but in these the influence is direct and permanent. The cases reported, so far as I can learn, were asthenic with an enfeebled circulation. The use of Arsenic in the early part of this century, though limited, was in large and many times poisonous doses. Being a powerful excitant to the vegetative nerves, this use, if continued long, would produce a peculiar form of fever - “febris arsenicum” - with its attendant impairment of vital function. Finally, with impaired blood-making and nutrition, there would be developed arsenical dropsy, and in some rare cases death was the result. The arsenical fever bears a very close resemblance to quinism, or quinine poisoning, in its symptoms, though there is not, in a majority of cases, such disturbance of the nervous system. We have long since determined that the mere matter of dose in medicine might be the difference between a poison and a remedy. If, for instance, we give one grain of Strychnia, we poison our patient, whilst if the dose had been but the fortieth or thirtieth of a grain, it would have proven a vital stimulant. If we administer five grains of morphia, the result is death; whilst a medicinal dose of one-fourth of a grain would have produced refreshing sleep. If we give large doses of Aconite, (say five drops of a tincture of the root,) frequently repeated, it increases the frequency of the pulse, impairs the circulation, and irritates the nervous system. But, in medicinal doses, it lessens the frequency of the pulse, gives freedom to the circulation, and relieves irritation of the nervous system. If we give large doses of Veratrum, it impairs the circulation, arrests vital processes, and produces death; whilst medicinal doses give increased freedom to the circulation and diminish the frequency of the pulse. It seems strange to me that these things have not had due consideration, and that the remedial action of drugs has not been kept distinct from their poisonous effects when given in large doses. We have already seen, that the dose of medicine should be the smallest quantity that will give the desired influence, and that in a rational system of medicine, its influence should always be to restore normal function, and not as a disturbing element. A drug which may be poisonous in health, or in some conditions of disease, will be curative in other conditions of disease. Thus we regard the disease as antagonizing the remedy, quite as much as the remedy antagonizes the disease, and the influence is toward the restoration of healthy function. Thus, if we give Quinine to cure malarial fever, its influence is kindly, but if there is no malarial disease, it causes irritation of the nervous system. If we give Belladonna when there is an enfeebled capillary circulation, the influence is kindly and curative, but it is the reverse if we already have capillary spasm.

In diphtheria cheap 30mg nimodipine, with dark redness of mucous membranes cheap nimodipine 30 mg, and fullness with relaxation, there is no local remedy equal to sulphurous acid spray. It is equally beneficial in those cases of cynanche maligna, with dark redness of mucous membranes. Whilst in ordinary sore throat from cold, with dusky discoloration, it offers one of the best local applications in the materia medica. The Bittersweet has the reputation of being a good alterative, in cutaneous diseases, syphilis, scrofula, and inflammatory deposits, and we conclude that it increases waste and excretion. It exerts a marked influence upon the cerebro-spinal centers, when used in large doses, but this has not been studied. I would advise the employment of the remedy in small doses in those cases of chronic disease in which the circulation is feeble, the hands and feet cold and purplish, with fullness of tissues and tendency to œdema. I do not know that it will prove better than other remedies, but it deserves investigation. Its action is very similar to Belladonna, being a stimulant to the capillary circulation. It may be employed in congestion of the nerve centers, of the abdominal viscera, and of the kidneys. It relieves irritation of stomach and bowels, colic, and is said to promote the menstrual flow. It may be employed as a stimulant to the cerebro-spinal centers, when there is a defect of reflex action, imperfect respiration, and threatened paralysis. It also relieves the excited innervation from atony, and thus gives rest and sleep. It may be used in inflammation of the mouth and throat, and in disease in which this is a continuous complaint, or where there is profuse secretion of saliva (not mercurial. It relieves irritation of the urinary passages, influences the prostate gland, checks gleet and prostatorrhœa, and may be employed in chronic inflammation of the cervix uteri, and in chronic vaginitis with leucorrhœa. I give the formula for the preparation of a tincture of burnt sponge, not because I think it possesses all the properties attributed to it by Homœopaths, but that it may be tested. I have used it in some cases with seeming advantage, and have seen results following its prescription by others, that in the ordinary use of medicine we would call remarkable cures. A quotation from Jahr’s Repertory will show the Homœopathic uses: “Diseases of the lymphatic vessels and glands; heat, with dry, hot skin, thirst, headache and delirium; redness of the eyes, with burning and lachrymation; frequent eructations, with cutting and tearing in the stomach; relaxed feeling in the stomach, as if the stomach were open; orchitis; induration of testes; pain in the larynx on touching it and turning the head; burning in the larynx and trachea; dryness, husky and hoarse voice; inflammation of the larynx, trachea and bronchi; croup; laryngeal and tracheal phthisis; cough, deep from the chest, with soreness and burning, or chronic cough with yellowish expectoration and hoarseness; wheezing inspirations, asthma with amenorrhœa; goitre; hard goitre. The Staphylea has been confounded with the Ptelea, until we hardly know whether a writer in the olden times was describing one or the other. Jones, and valued so highly by him as a tonic, was the article under consideration. At least it would be well for some of our friends who know the article, to procure specimens and thoroughly test it. Jones claimed that it was a pure unirritating tonic, having a soothing influence upon mucous membranes. He employed it in the convalescence from fevers and inflammations, and whenever the stomach was feeble and irritable. The marsh rosemary is an excellent astringent, and at the same time relieves irritation of mucous membranes. It may be used in atonic dyspepsia, in diarrhœa, chronic dysentery, hemorrhage from the lungs, bronchorrhœa, sore throat, chronic laryngitis, and in any catarrhal disease with profuse secretion. Stillingia increases waste and excretion, but its principal action probably is upon the lymphatic system, favoring the formation of good lymph, hence good blood and nutrition. Experience shows that it favorably influences the system in secondary syphilis, in some forms of scrofula, and in cases of chronic disease where the tissues are feeble and not readily removed and renewed. I believe it to be more especially useful in those cases where there is predominant affection of mucous membranes, and secondly, where the skin is involved. In these cases I have used the simple tincture as above, largely diluted with water, with much better results than I have obtained from any of the compounds of Stillingia or alterative syrups. Evidently in the ordinary manufacture of “Compound Syrup of Stillingia,” the virtues of Stillingia, if it has any, are wholly lost, simply because water or dilute alcohol is not a proper menstruum. Stillingia exerts a specific influence upon the mucous membranes of the throat, larynx, and bronchii, relieving irritation and favoring normal nutrition and functional activity. Some cases of chronic pharyngitis of years’ standing, have been relieved by this remedy, after other treatment had failed. It is an excellent remedy in the treatment of some cases of chronic laryngitis, speedily relieving the irritation and cough, and we also employ it in chronic bronchitis with like good results. Now if it is possible to determine the class of cases in which it is thus beneficial, the reader may use it with advantage. So far as my experience extends, they are those with tumid, red, glistening mucous membranes, with scanty secretion.

These compounds are selectively phosphorylated intracellularly to the 5′-triphosphate derivatives which inhibit the viral reverse transcriptase cheap 30mg nimodipine. Drug delivery and targeting is a key area which will benefit from cell and tissue-based information 30mg nimodipine with mastercard. It seems reasonable to expect similarly sophisticated drug delivery end-points to be achievable through design or screening approaches, given an understanding of the tissue-specific expression of particular activating enzymes, possibly mirroring those already exploited by naturally occurring viruses. The storage of genomic and protein sequences in easily searchable databases to allow comparison of protein and genomic sequences is essential if companies are to maximize the value of their biological data. There are now a number of high quality protein and genetic databases documenting the protein and gene expression of specific cell types under different conditions. Such databases have proved invaluable to companies investigating specific disease states. With the increasing automation of drug discovery with respect to combinatorial chemistry, high- throughput screening, proteomics and genomics, informatics has developed an increasingly important role. The integration of robotics and informatics with databases correlating molecular properties with biological properties is becoming increasingly important for the management of compound libraries. Such informatic systems allow companies to readily search compound libraries and identify agents with potential activity against other therapeutic targets. Robotic automation provides a means of extracting these libraries or further screening from storage as necessary. The combination of biological and chemical data in relational databases provides useful data for the computer-based database searching and advanced quantitative structure-activity-relationship studies. The power of these databases in identifying potential lead compounds against new disease states will increase with the integration of proteomic data. For example, knowing that a specific compound class interacts strongly with a particular peptide motif at various receptors/catalytic sites will facilitate the identification of lead compounds for receptors/enzymes with similar motifs. Generic approaches towards the identification of new targets for human drug discovery are now routinely practised within pharmaceutical companies. Simply trawling these databases for potential targets expressed in diseased tissue has already yielded novel homologs of key enzymes and receptors, many of which have been patented as drug discovery targets. We are still at an early stage of understanding the full complexity of the mammalian and human genetic vocabulary. A more pharmaceutically oriented approach is to search for novel members of certain key receptor families which are already known from pharmacological studies to be present in a target tissue. This combination of pharmacology and molecular biology is proving particularly interesting, identifying far greater heterogeneity amongst targets than had previously been thought, with both receptor subtypes and the differential splicing of individual genes contributing to this complexity. The effective management of chemical and biological data underpins the effectiveness of any drug discovery group. All these aspects of drug discovery will impinge on drug delivery and targeting in the future. Furthermore, combinatorial chemistry and high-throughput screening will provide targeting molecules for disease-associated surface-expressed receptors and ligands. These may be linked to therapeutic drug molecules to increase epithelial transport by active transport processes and drug targeting selectivity. Describe the potential roles of proteomics and genomics in drug delivery and targeting. Identify two ways in which combinatorial chemistry may impinge on drug delivery and targeting. The preceding chapters in the last part of this book have highlighted the recent developments in gene therapy, drug discovery, genomics and proteomics as a consequence of the recent developments in molecular biology and chemistry. This chapter concludes this text by examining how the advances in chemistry and biology are providing opportunities for more effective site-specific drug targeting and bioresponsive pulsatile drug delivery. The chapter considers the development of prodrug-based technologies for cell-specific drug delivery, provides an overview of the use of smart polymeric systems, microchips and genetically engineered cell-based implants in addressing the challenges of chronopharmacology, and offers a perspective of the future of drug delivery and targeting in this new millennium. In the discovery process opportunities exist, as illustrated in Chapter 15, to identify cell-specific enzymes and ligands which may be used to target drugs to these cells. The integration of the considerations for drug delivery and targeting into the drug design process may ultimately allow the development of drugs which are not just potent and non-toxic but offer the advantage that their chemical structure dictates the targeting of the drug to its particular site of action through enzyme-based chemical delivery systems using prodrugs. A prodrug is a pharmacacologically inactive compound which undergoes chemical or enzymatic metabolism to the active. Some of the early pharmaceuticals were found to be prodrugs and this finding has led to the subsequent introduction of the metabolite itself into therapy, particularly in cases where the active metabolite is less toxic or has fewer side-effects than the parent prodrug. The administration of the active metabolite may also reduce variability in clinical response between individuals due to differences in pharmacogenetics. Most chemically designed prodrugs consist of two components; the active drug chemically linked to a pharmacologically inert moiety. The prodrug must be sufficiently stable to withstand the pharmaceutical formulation while permitting chemical or enzymatic cleavage at the appropriate time or site. After administration or absorption of the prodrug, the active drug is usually released by either chemical or enzymatic, hydrolytic or reductive processes. Prodrugs are most commonly used to overcome the biological and pharmaceutical barriers which separate the site of administration of the drug from the site of action (Figure 16. Prodrug design has been used to address a wide range of pharmaceutical problems including: • unpalatability • gastric irritation • pain on injection • insolubility • instability.

Sir Alfred Webb-Johnson – Maryland Medical Journal :  () British surgeon The main cause of this unparalleled progress in The well equipped clinician must possess the physiology 30 mg nimodipine free shipping, pathology purchase 30mg nimodipine visa, medicine and surgery has qualities of the artist, the man of science, and the been the fruitful application of the experimental humanist, but he must exercise them only in so method of research. Collected Papers Attributed John Webster – English dramatist Welsh proverbs Death hath ten thousand several doors For men to take their exits. Otto Weininger – Lancet :  () With the woman, thinking and feeling are identical, for man they are in opposition. Motto on the seal of the New Jersey College Primitive Physic: Or an Easy and Natural Method of Curing Most Diseases London () George F. But to lose Personal reply to Clovis Vincent, famous neurosurgeon one’s teeth is a catastrophe. Samuel Wilberforce – A Little Night Music British churchman James McNeil Whistler – I would like to ask the gentleman... British Association for the Advancement of Science, Oxford, Explaining why he had been born in a small  June () unfashionable Massachusetts town and not fashionable New York or London. Daedulus Winter () Harper’s Magazine November () Oscar Wilde – In a man’s middle years there is scarcely a part of the body he would hesitate to turn over to the Irish writer and wit proper authorities. Illness is hardly a thing to be encouraged in The Second Tree from the Corner ‘A Weekend with the Angels’ others. The Importance of Being Earnest Act  Raymond Whitehead – One can survive everything nowadays, except British pathologist death. A Woman of No Importance I Medicine is not a field in which sheep may safely graze. Ah well, I suppose I shall have to die beyond my British Medical Journal :  () means. Attributed Katherine Whitehorn – Heredity is the last of the fates, and the most British journalist terrible. One is due to wax and they will die of something else later, and the and is curable; the other is not due to wax and is slower and the costlier. Always look for a doctor who is Dictionary of Medical Eponyms (nd edn), Firkin and hated by the best doctors, Always seek out a bright Whitworth. Wilkie – William Withering – The real public health problem, of course, is English physician and discoverer of digitalis poverty. Mark’s Hospital, London Poisons in small doses are the best medicines; and Children are not little adults but paediatricians useful medicines in too large doses are poisonous. Ltd, London () Humbert Wolfe – English poet and critic The doctors are a frightful race. Leonard Williams – I can’t see how they have the face Harley Street physician and author to go on practising their base The crime of our civilisation is gluttony. Cursory Rhymes ‘Poems Against Doctors’ I John Wilson (Christopher North) Paul Hamilton Wood – – British cardiologist, London Scottish poet, essayist and critic. The best history taker is he who can best interpret Doctors are generally dull dogs. It is Maxwell Wintrobe – just as it was the first time, I am always hearing voices. March     ·    World Medical Association Francis BrettYoung – I will maintain the utmost respect for human life English novelist and physician from the time of conception. Half the patients who get you up in the middle of Declaration of Geneva () the night and think they are dying are suffering If at all possible, consistent with patient from wind! Bradley Remembers () freely given consent after the patient has been It was a son’s duty to see his father into the grave. London () Declaration of Helsinki () Henry Youngman – Almroth Wright – I was so ugly when I was born, the doctor slapped British immunologist, St. A one liner quoted in the British Press from this Microbial infections are conveniently divided into contemporary comedian at time of his death septicaemias and intoxications. In the case of the former the bacteria multiply freely in the blood and produce their poisons there. New York Times Magazine  October () Zeta (Sir (Vincent) Zachary Cope –) Carl August Wunderlich – Surgeon, St. Mary’s Hospital, London German Professor of Medicine, Leipzig The diagnostic problem of to-day Latter-day medicine recognises its tasks and its Has greatly changed—the change has come to duties as part of the immeasurably extensive and stay; sublime science of nature. We know in addition We all have to confess, though with a sigh that genuine facts and trustworthy data are solely On complicated tests we much rely attainable by means of the strictest attention to And use too little hand and ear and eye. Lewis () continually bearing in mind the possible sources Acute abdominal disease of fallacy. Is sometimes diagnosed with ease Vienna and Paris Concluding paragraphs () But oft the best attempts will meet A knowledge of the course of temperature in With sad and sorrowful defeat. Not every acute abdomen requires Preface to Medical Thermometry and Human Temperature Immediate operation for its cure (1871) And each good surgeon eagerly desires To make the needs for operation fewer. Mozon, California, June () To the average professional officer, the military doctor is an unwillingly tolerated noncombatant who takes sick call, gives cathartic pills, makes transportation troubles, complicates tactical Yiddish proverb plans, and causes the water to smell bad. A cross-sectional, correlational non-experimental study was conducted with a convenience sample of 80 Black women who were taking antihypertensive prescription medications for blood pressure control. Almost one-third 30% (n=24) of the participants reported household incomes levels at or below the federal poverty level.