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By K. Tangach. Rush University. 2019.

Roundworms are round like earthworms even though they may be as thin as hairs (threadworms 100 mg zudena can erectile dysfunction cause prostate cancer, filaria) or micro- scopically small (like Trichinella) purchase 100mg zudena visa impotence urban dictionary. They have a way to attach themselves sometimes with the head (scolex) like tapeworms zudena 100mg generic erectile dysfunction medications and drugs, sometimes with a special sucker like flukes 100mg zudena with mastercard erectile dysfunction pill. Worms Flatworms Roundworms Tapeworms Flukes Threadworms Pinworms Hookworms Worm parasites go through stages of development that can look very, very different from the adult. The favorite organ for Dirofilaria (dog heartworm) is the heart (even human heart). My tests show Dirofilaria can live in other organs, too, if they are sufficiently polluted with solvents, metals and other toxins. If you are a meat eater, you could eat such a cyst if it happens to be lodged in the meat you are eating! The little larva is swallowed and tries to attach itself to your intestine with its head. They come out of their metacercarial cyst as a small adult and quickly attach themselves to the intestine with a sucker. Four common flukes are: human intestinal fluke, human liver fluke, sheep liver fluke, pancreatic fluke of cattle. Has cilia, can swim vigorously and must find intermediate snail host in one to two hours or may be too exhausted to in- vade. Those are "mother" redia, and each one bears "daughter" redia for up to 8 months, all still inside the snail, and living on the fluids in the lymphatic spaces. If the snail is feeding on a plant, cercaria can latch onto plant with sucker mouth and start to encyst (form a "cocoon") within minutes. But as you eat the plant it is stuck to, the least pressure will break it, leaving the cyst in the mouth. The "almost unbreakable" inner cyst wall protects it from chewing, and the keratin-like coat prevents digestion by stomach juices. However when it reaches the duodenum, contact with intestinal juices dissolves away the cyst-wall and frees it. It then fastens itself to the intestinal lining and begins to develop into an adult. Note that the adult is the only stage that “normally” lives in the human (and then only in the intestine). Fasciolopsis depends on a snail, called a secondary host, for part of its life cycle. If propyl alcohol is the solvent, the intestinal fluke is invited to use another organ as a secondary host—this organ will become cancerous. If xylene (or toluene) are the solvents, I typically see any of four flukes using the brain as a secondary host. I call the diseases caused by fluke stages in inappropriate locations Fluke Disease; it is discussed in more detail later (page 249). Pollutants can invade your body via the air you breath, the foods and beverages you eat, and the products you put on your skin. The one who did not assumes the cream is not harmful to them…that they are like a bank vault, impreg- nable to that product. A better assumption is that the face cream is somewhat toxic, as evidenced by the rash that can develop, and they escaped the rash only because they had a stronger im- mune system. The immune system is like money, paid out of the bank vault, for every toxic invasion. Most other solvents dissolve fats and are life threatening, because fats form the membrane wall around each of our cells, especially our nerve cells. Metal Pollution Biochemists know that a mineral in raw element form always inhibits the enzyme using that mineral. Inorganic copper, like you would get from a copper bottomed kettle or copper plumbing, is 3 carcinogenic. We put metal jewelry on our skin, eat bread baked in metal pans, and drink water from metal plumbing. Mercury amalgam fillings, despite the assurances of the American Dental Association, are not safe. And sometimes the mercury is polluted with thallium, even more toxic than mercury! Gold and silver seem to have fewer harmful effects, but no one should have any pure metal in or on their body. Other prevalent toxic metals include lead and cadmium from soldered and galvanized plumbing, nickel and chromium from dentalware and cosmetics, and aluminum from food and drink cans, and cooking pots. From Carcinogenicity and Metal Ions, volume 10, page 61, of a series called Metal Ions in Biological Systems, edited by Helmut Sigel, 1980. One small moldy fruit or vegetable can pol- lute a huge batch of juice, jam or other product. Although molds are alive, and can be killed by zapping, mycotoxins are not, and must be detoxified by your liver. But because mycotoxins are so extremely poisonous, a tiny amount can incapacitate a part of the liver for days! For that reason I am always cautioning people to eat only perfect citrus fruit, and never drink commercial fruit juice. Of the thousands of oranges that go into the batch of orange juice you drink, one is sure to be moldy, and that is all it takes to give your liver a setback. It also helps get rid of aflatoxin before it is consumed, right in the food container. So keep a plastic shaker of vitamin C powder handy and use it like salt on all your food. Physical Toxins Breathing in dust is quite bad for you so your body rejects it by sneezing, coughing, spitting up and out. But because it is sharp it gets caught in your tissue, then works its way deeper and deeper. We are unaware that it fills our homes when fiberglass insulation is left imperfectly sealed off. Any hole made through the ceiling or wall, even if covered with cloth, lets swarms of broken glass bits into the house air. Of course, fiberglass should never be used in home construction, draperies, or around water heaters. The best advice is to have it all removed while you are away and then vacuum and dust. Chronic exposure from a single small hole in the ceiling does a lot of harm, leading to cyst formation. And that cyst is a perfect place for parasites and bacteria to settle and multiply. Asbestos is another tiny bit, sharp as glass, that moves through your body like a swordfish, impaling your cells until it, too, gets routed into a cyst. We have been led to believe that we no longer have asbestos in our homes because we have outlawed the fireproofing mate- rials it was used in. While that may be true, the source I find most often is all too prevalent: the clothes dryer belt. As it gets hot the belt releases a blast of asbestos particles that are forced through the seams of your dryer, and also openings in your exhaust hose, by the high pressure formed inside. By the time your air conditioner or refrigerator needs recharging, you have been exposed for a long time. Our diligent scientists have studied the mechanism of arsenic poisoning in great detail. Then why are we allowed to put it on our lawns to be carried into our carpets via shoes?

Higher doses (85–400 mg) are associated with severe headaches proven zudena 100 mg erectile dysfunction treatment muse, hypertensive crisis purchase 100 mg zudena with mastercard impotence quoad hoc meaning, and occasionally vomiting (Frewin et al 100mg zudena otc impotence for erectile dysfunction causes. The course of pregnancy following hormonal agent overdoses has not been published generic 100 mg zudena with mastercard erectile dysfunction and smoking. Nonspecific supportive therapy should be given because no specific antidote to hormonal agents is available. Near-therapeutic amounts of these drugs cross the placenta and can be detected in the fetus. The effects of a poten- Anticonvulsant overdoses 271 tially toxic dose of hormonal agents are unknown, but fetal adrenal suppression should be anticipated based upon known pharmacology and physiology. One overdose of misoprostol and trifluoperazine has been reported (Bond and Van Zaa, 1994). Signs of toxicity included hypertonic uterine contraction with fetal death, hyperthermia, rhabdomyolysis, hypoxemia, respiratory alkalosis, and metabolic acido- sis. The clinical impression was that misoprostol was being used as an illegal abortifa- cient. The clinical details of the course of pregnancy following antidepressant agent overdoses have not been reported and therapy is mostly supportive. The toxic systemic effects (tachycardia, dry mouth, dilated pupils, and urinary retention) as well as the central nervous system effects (agitation, hallucina- tions, and hyperpyrexia) are anticholinergic in nature (Burks et al. For this rea- son, physostigmine (an anticholinesterase) has been used in the diagnosis and antidotal therapy of poisoning with amitriptyline and other tricyclic antidepressants (Burks et al. Large doses of antidepressants are associated with coma in nonpregnant adults and cardiac toxicity has been reported with acute ingestion of high doses of these drugs. Although these drugs cross the placenta to reach the fetus, the effects of a potentially toxic dose are unknown. Half-lives in the post-absorptive period for dox- epin and amitriptyline are 8–25 h and 8–51 h, respectively (Baselt, 1978). Pregnancy outcome following anticonvulsant agent overdoses has been published in one isolated case report. A case of carbamazepine megadose in attempted suicide with more than 10 g of carbamazepine during early preg- nancy resulted in a fetus with a large meningomyelocele and frontal lobe necrosis that was electively aborted. The mother recovered without complication following nonspe- cific therapy and coma for 5 days (Little et al. Damage to the embryo or fetus is probable because the two anticonvulsants listed (phenytoin, carbamazepine) are known human teratogens. Anticonvulsant agents have no specific antidote, and supportive therapy should be given. Near-therapeutic amounts of these drugs cross the placenta and achieve significant concentrations in the fetus. It is known that phenytoin may induce fetal hepatic enzymes, but the effects of a potentially toxic dose are unknown. Phenytoin’s half-life ranges from 8–60 h and is dose dependent because each individual has a threshold plasma concentration beyond which the drug exhibits zero-order kinetics (Arnold and 272 Drug overdoses during pregnancy Gerber, 1970; Kostenbauder et al. Details of the clinical course of pregnancy after overdoses of any of these agents have not been pub- lished. It is known that signif- icant amounts of these drugs cross the placenta to reach near-therapeutic levels in the fetus. Camphorated oil Camphor, a gastrointestinal irritant and central nervous system stimulant, was used in four suicide attempts during pregnancy that have been published (Blackmon and Curry, 1957; Jacobziner and Raybin, 1962; Riggs et al. Uniformly, maternal seizures occurred and should apparently be expected with camphor ingestion. The fourth pregnancy was compromised by preeclampsia, abruptio placenta, and other serious complications, and the infant died less than 1 h after delivery. Clinical experience with camphor overdose is very limited and no specific antidote is available. Therefore, the nonspecific antidote regimen should be given and supportive therapy provided. Even limited experience with gravid women who have ingested cam- phor is sufficient to begin antiseizure medication as a component of the antidote regi- men in anticipation that seizures may ensue. Turpentine and ammonia No details of the course of pregnancy following poisoning with these nondrug chemi- cals have been reported. No specific antidote to these poisons is available and nonspe- cific antidote regimens and supportive therapy should be given. Quinine overdose An attempt to induce abortion should be suspected when quinine overdose is encoun- tered in pregnant women. Among 70 published cases of pregnant women taking quinine at Summary 273 high doses in an attempt to induce abortion suggest the drug may be teratogenic (Dannenberg et al. At least 11 women died as a result of quinine overdose and many who did not expire experienced toxic effects of the drug. No fewer than 41 infants with major congenital anomalies were born to women who took large doses of quinine during pregnancy. Causality cannot be proven using these data because the information comprised of only case reports. Nonetheless, large doses of quinine appear to pose an increased risk of some specific abnormalities that parallel toxicity from the drug often seen in adults. Eighteen of 60 infants (30 percent) born to women who ingested large amounts of quinine during pregnancy were congenitally deaf (Dannenberg et al. Ototoxicity is a common and well-documented complication of quinine therapy in adults. Large doses of quinine during the first trimester of pregnancy are anecdotally associ- ated with major congenital anomalies, including central nervous system anomalies (especially hydrocephalus or otolithic damage), limb defects, cardiac defects, and gas- trointestinal tract anomalies (Nishimura and Tanimura, 1976). No characteristic pattern of anomalies or syndrome was identified, and the association of these anomalies with maternal quinine ingestion remains empirically uncertain, but seems plausible. Nonspecific antidote treatment and supportive therapy should be given because no specific antidote for quinine overdose is available. Ergotamine overdose Overdose of ergotamine during pregnancy was published in a case report of a woman at 35 weeks’ gestation who took 10 tablets of ergotamine tartrate in a suicide gesture. Two hours later uterine contractions began with no relaxation between contractions. Two weeks after the over- dose, a macerated stillbirth with no gross abnormality was delivered. Impaired placen- tal perfusion and fetal anoxia associated with ergotamine was speculated to have caused the fetal death (Au et al. Spontaneous onset of preterm labor following ingestion of ergot also occurred with therapeutic levels of the drugs, but at usual therapeutic levels prematurity was the only complication, and there were no fetal deaths. Two antidotes to ergot alkaloid overdose (prazosin and nitroprusside) are now available that were unavailable to patients described above (Au et al. Nitroprusside should be avoided during pregnancy because it conjugates to cyanide and accumulates in the fetal liver. If there is no specific antidote, a nonspecific aggressive treatment should be instituted as early as possible (see Appendix). Homicide and other injuries as causes of maternal death in New York City, 1987 through 1991. No tocolytic agent is uni- versally effective, although more than 100 000 pregnancies will receive tocolysis ther- apy. Pregnant women treated with tocolytics are at increased risk for serious cardiopulmonary com- plications that are directly attributed to the tocolytic drug. Tocolytic therapy invariably occurs outside embryogenesis, so congenital anomalies are not an issue.

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Although some of this extreme variability in the latter study could be the result of events pre- ceding the procurement of tissue (i purchase 100mg zudena fast delivery erectile dysfunction cure. Given the inaccessibility of the intestinal site of metabolism discount zudena 100mg erectile dysfunction treatment methods, it is understandable that most of the in vivo evidence is indirect in nature buy 100mg zudena otc impotence tumblr. The usual approach is to assume that systemic clearance represents hepatic clear- ance for drugs that are extensively metabolized discount zudena 100 mg amex outcome erectile dysfunction without treatment, and that intestinal metabolism does not contribute to systemic clearance. For most drugs that are readily released from the oral formulation and have high intestinal permeability, Fa is often assumed to be unity. The assumption that intestinal mucosa does not contribute to systemic clearance (i. However, the entire dose released from the dosage form is exposed to the mucosal enzymes during its obligatory passage through the intestinal epithelium and, thus, the more relevant comparison is the intracellular enzyme concentration and intrinsic clearance (i. In studies that offer comparative metabolic kinetics between hepatic and intestinal (duodenal or jejunal) microsomes, mean intrinsic clearance for intestinal microsomes varied from 20% to as high as 200% of that for liver microsomes; the list of drugs include cyclosporine (41), eryth- romycin (15), indinavir (44,45), irinotecan (46), lovastatin (48), midazolam (8), quazepam (50), rifabutin (51), saquinavir (53), and tacrolimus (55). For many of these drug substrates, mucosal intrinsic clearances are comparable to the cor- responding mean hepatic intrinsic clearance. Whether there will be a similar intestinal and hepatic first-pass extraction for the aforementioned drugs is more difficult to predict since intestinal first-pass extraction is dependent on a number of other factors, including total oral dose, rate of drug absorption, enzyme saturability (Km), the absorptive region, mucosal barrier permeability, and binding to blood components. For example, should the dose be high enough to cause enzyme saturation, it is possible that a drug with a high hepatic and intestinal intrinsic clearance could largely escape intestinal first-pass extraction but not hepatic extraction. Also, if the basolateral membrane represents the rate-limiting barrier to the passage of drug across the intestinal epithelium, the residence time of the drug substrate within the enterocytes would increase and result in a greater metabolic first-pass loss than a comparable substrate with better permeability (6,68). A number of studies have shown that induction of midazolam elimination is highly route dependent (75–77). Although systemic clearance (Cl) of midazolam was also induced by rifampin, the effect was modest by comparison; i. This rem- arkable route dependency in the induction of midazolam clearance can be explained by induction of sequential first pass at the intestinal mucosa and the liver after oral administration, whereas only hepatic extraction is operative and inducible after intravenous administration. It should also be appreciated that the increase in systemic or hepatic clearance of midazolam following rifampin is limited to some extent by the ceiling of liver blood flow, as hepatic extraction of midazolam is increased from around 0. The inductive effects at the two sites appeared not to be concordant; in fact, the extent of induction was high at either the hepatic or intestinal site, but not both. Of note, all the drugs listed for which unambiguous data are available exhibit incomplete oral bioavailability. In addition, where both intravenous and oral administration have been studied, rifampin appears to increase the extent of intestinal first-pass metabolism and decrease intestinal bioavailability substan- tially; for example, alfentanil, Fgm ¼ 0. John’s wort, a widely used herbal supplement for the treatment of mild to moderate depression, has also attracted considerable interest. John’s wort on intestinal extraction was slightly greater than that on hepatic extraction. The difference can be attributed to the much higher peak cir- culating rifampin concentrations (8 mM) (86), compared with that of hyperforin (0. There is evidence indicating that micro- somal enzyme inducers can simultaneously act as inhibitors. These investigators proposed that the inductive effect of rifampin was masked by its simultaneous inhibition of repaglinide metabolism when repaglinide clearance was assessed immediately after concurrent rifampin administration when the circulating concentration of rifampin was high. The inductive effect of rifampin was fully revealed after the washout of rifampin by 24 hours. It stands to reason that the masking of an inductive effect by simultaneous inhibition is more likely to occur with intestinal first-pass metabolism; however, supportive evidence is lacking. The interplay between induction and inhibition also means that the outcomes of interaction studies with enzyme inducers may depend on study design; that is the relative timing of the inducer and substrate administrations. Although some of the pharmacokinetic changes observed were surely the result of an interaction in the liver, it is likely that the enzyme/ transporter barrier at the intestinal mucosa was also affected by ketoconazole. These interactions can conveniently be grouped according to the mechanism of inhibition, namely those involving reversible (i. For example, in an earlier study of the interaction between ketoconazole and tirilazad, Fleishaker et al. Moreover, ketoconazole inhibited intestinal and hepatic extraction to nearly the same extent; the hepatic availability (Fh) increased from 0. It should be noted that mechanism- based inhibitors also act as competitive inhibitors. Accordingly, clarithromycin has been shown to be an effective inhibitor of both hepatic and intestinal mid- azolam metabolism in vivo. Overall, the inhibition of intestinal metabolism by clarithromycin had a much greater impact on the systemic availability of midazolam than it did on the inhibition of hepatic midazolam metabolism. Thus, saquinavir treatment resulted in a near complete inhibition of first-pass intestinal extraction and a lesser inhibition of hepatic extraction of midazolam. The model predictions were within twofold of the in vivo observations for 26 cases involving the macrolide anti- biotics. There were 11 overpredictions, curiously all belonging to interactions involving diltiazem and especially notable for the substrates cyclosporine and buspirone. In addition, like all of the models for a mechanism-based interaction, it requires knowledge of the endogenous in vivo enzyme half-life (i. All of these alternative methods are subject to error, yield only approximations of the true enzyme half- life in the human enterocyte (or hepatocyte) in vivo and, thus, must be used with that limitation in mind. Simultaneous inhibition of intestinal first-pass metabolism and stimulation or induction of hepatic first-pass metabolism has been reported for the interac- tion between the herbal supplement echinacea (Echinacea purpurea root) and 490 Thummel et al. The masking of a strong inhibitory effect on intestinal extraction by an opposing effect on hepatic extraction or systemic clearance certainly complicates the interpretation of interaction data involving sequential first-pass metabolism at the two sites. In addition, the magnitude of the grapefruit juice interaction clearly depends on the strength of the juice and the frequency of administration. Likewise, the effect of 200 mL of normal strength juice taken once a day in the morning for two days caused only a 3. A listing of two or more doses indicates that multiple doses of juice were given on the same pharmacokinetic study day. In contrast, consumption of double-strength grapefruit juice thrice daily for three days significantly increased oral midazolam Cmax (2. The identity of the inhibitory components of grapefruit juice has been clarified in recent years [see recent review by Saito et al. Early studies suggested that the inhibitory com- ponents of grapefruit juice might be flavonoids, specifically naringin or its aglycone naringenin, and quercetin (112,113). However, feeding of commer- cially available pure naringin showed little effect on nisoldipine or nifedipine pharmacokinetics (127,128). More recent studies in vitro and in vivo implicated furanocoumarins, namely 6 ,7 -dihydroxybergamottin0 0 (129–131), bergamottin (132–135), and dimers of furanocoumarins (133,136). Moreover, Paine et al (126) recently showed that removal of furanocoumarins from grapefruit juice abol- ished its inhibitory effect on oral felodipine clearance, establishing their importance in the interaction in vivo. Role of the Gut Mucosa in Metabolically Based Drug-Drug Interactions 493 The maximum inhibitory effect appears to require consumption of more than one glass of normal- or double-strength juice. Several studies have investigated the time it takes for the inhibitory effect of grapefruit juice to dissipate (137–140). P-gp is expressed prominently on the apical (luminal) membrane of intestinal epithelia. As discussed in Chapters 8 and 12, it can function to delay or limit the oral absorption of its substrates, depending on the relative magnitude of the secretory and diffusional clearances. Specifically, they sug- gest that P-gp-mediated cell efflux increases the probability of a drug being exposed to the biotransformation enzyme through successive cycles of absorp- tion and efflux, which increases intracellular residence time and enhances the probability that it will undergo first-pass metabolism. Interestingly, their kinetic analysis of the data indicated that the effect was mediated primarily by a disproportionate increase in the rate constant for verapamil transport from tissue into mesenteric blood, with no change in the apparent rate constant for verapamil metabolism. The authors proposed that saturation of intracellular verapamil binding as a consequence of P-gp inhibition and buildup in enterocyte concentration led to the change in verapamil transport.

It is used in a few cases after surgical operations generic 100mg zudena overnight delivery impotence treatment after prostate surgery, after labor on the second or third day generic zudena 100 mg overnight delivery erectile dysfunction drugs canada, and after taking vermifuges zudena 100 mg on-line smoking and erectile dysfunction causes, and whenever a simple cheap zudena 100 mg on line impotence word meaning, prompt agent is needed to evacuate the primae viae. Specific Symptomatology—The tonic and astringent properties of this remedy are underestimated. It is an acceptable and prompt astringent in diarrheas of infancy, where the evidences of relaxation and enfeeblement of the mucous coats of the stomach and bowels are marked, and where there is deficient action of all glandular organs, especially of the liver, the patient being pale, feeble, without appetite. Therapy—In those cases of diarrhea where there are large, watery, clay- colored discharges three or four times each day, an infusion of blackberry root will sometimes correct this entire train of symptoms. It is a renal depurant and general alterative of much value when ulceration of mucous surfaces or disease of the skin results from impure blood. It acts directly in its restorative influence, purifying the blood, removing morbific material, and quickly cures the disease conditions. It is valuable in ulcerative stomatitis, in nursing sore mouth, and in ulceration of the stomach with great lack of tone, combined with quercus or other tonic astringent, it has no equal in these conditions. It has been used also in the treatment of syphilis and scrofula with good results. Vassar of Ohio believes that Yellow Dock is the best remedy known to prevent the inroads made by cancer on the human system. I have mentioned the fact that this remedy will absorb iron from the soil very rapidly and carry a much larger proportion than normal, thus rendering the iron organic. Vassar knew of a blacksmith who raised Yellow Dock root, cultivating it in a soil which he kept constantly saturated with the washing from his cooling tubs, and scattered all the iron filings and rust over it. It is possible that other inorganic medicines can be made organic in larger quantities by being artificially forced through the growth and development of plants in the natural exercise of their vital powers. The doctor thinks that the preservation of an absolutely normal cell condition of the human body if possible will prevent the development of cancer. He uses Yellow Dock hypodermically and thinks that there are mild early cases of cancer that can be cured Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 383 with this remedy alone. Specific Symptomatology—Sexual irritability with lascivious dreams, sexual erethrism, libidinous thoughts, extreme sexual excitability with uncontrollable desire; erotomania, nymphomania, and satyriasis, prostatitis, with cystic irritation; acute prostatic enlargement, with cystitis, ovaritis, orchitis and other sexual disorders resulting from excess and abuse. Therapy—This to an extent is antimalarial and like the other agents of this class it improves the tone of the gastro-intestinal tract and the glandular organs. It corrects impaired conditions of all mucous membranes and is thus of value in excessive catarrhal discharges from these membranes, being freely given in bronchorrhea, gastric catarrh, catarrhal diarrhea and in leucorrhea, in all cases acting more promptly if malarial conditions have caused the existing debility. It has antiseptic properties, of course, if antimalarial, and is a good remedy in protracted fevers. It has a mild influence in controlling passive hemorrhages, but cannot be depended upon if they are severe. Its antiseptic properties are apparent in its ability to correct the fetor of wounds and offensive discharges when locally applied. Felter and Lloyd, in the American Dispensatory, make the following statement concerning the action of this remedy, which is important. Its field of action in those functional wrongs of the reproductive organs is due most largely to undue irritability of the parts and thought to be less due to mental or emotional causes. However, sexual passion from any functional cause is moderated by it, and it is especially adapted to the disorders of the sexually intemperate male or female and of the youth, subject day or night to libidinous suggestions and lascivious dreams terminating in pollutions, while for those extreme forms of sexual perversion, satyriasis, erotomania, and nymphomania, it is more nearly specific than any other agent. Not only does salix nigra act as a check to Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 384 sexual passion and misuse, but it proves a useful tonic and sedative to many conditions following in the wake of sexual intemperance, among which may be mentioned spermatorrhea, in its varied forms, prostatitis, cystitis and ovaritis. Specific Salix Nigra Aments is a unique preparation and contains the full properties of the drug. The agent was brought to the attention of the profession through its influence in controlling sexual hyperesthesia and undue sexual excitement. It is a remedy for satyriasis, erotomania and nympho-mania, more particularly from local irritation. It relieves spermatorrhea when dependent upon these or similar causes, and quiets the general nervous system. It is a remedy for ovarian congestion, ovarian neuralgia and hyperesthesia, also for ovarian irritation in hysteria. It will exercise a direct and satisfactory influence in many cases of hysteria, overcoming the extreme excitability and nervousness, headache and the globus hystericus, and will permit quiet, restful sleep. It will serve an excellent purpose in these cases in combination with general nerve tonics and restoratives, greatly enhancing their influence. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 385 Therapy—The strong infusion is diaphoretic and stimulating. The agent has also alterative, cathartic and diuretic properties which are of value in urinary inactivity, with excretion of renal sand, accompanied with muscular aching, stiffness, or rheumatic pains. Cases are reported in which extreme general dropsy seemed to threaten immediate death, where relief was quickly and permanently obtained by the use of this remedy. Dose: Its best medicinal influence is obtained from small doses; from ten to twenty drops in a four ounce mixture, a teaspoonful every hour or two. Physiological Action—In excessive doses bloodroot is a gastric irritant, and a depressant; it produces burning and racking pains in the digestive canal from the mouth to the stomach; insatiable thirst, dilated pupils, nausea, an anxious countenance, coldness of the extremities, cold sweats more or lea diminution of the pulse, with irregularity. Specific Symptomatology—The influence of sanguinaria is restricted to rather narrow lines. In harsh, dry cough with relaxed tissues of the pharynx, larynx and bronchi, with a sense of constriction and constant irritation and uneasiness or tickling in the throat, this agent is useful. It stimulates the capillaries and overcomes congestion of the lung structure, after a severe cold in the chest from exposure. An improvised syrup made from adding a dram of the tincture of sanguinaria and two drams of vinegar to two ounces of simple syrup will relieve the chest sensations quickly if taken in teaspoonful doses every half hour or hour. It is not as useful a remedy in diseases of children as ipecac or lobelia, as the harshness of its action in full doses is not well borne. If combined with either of these agents, and given in small doses for exactly the same purposes for which they are suggested, it will furnish the tonic and stimulant influence of the combination. There will be less nausea from Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 386 the ipecac and less general relaxation from lobelia. Given with the syrup of ipecac in hoarse bronchial coughs, or stridulous laryngitis, or in the early stage of croup, it will enhance the expectorant influence of ipecac, and prevent, in part, the cold skin and depressing influence of that agent. It equalizes the circulation of the entire system, inducing warmth in the skin and in the extremities. In membranous croup its use is an excellent auxiliary to the treatment, but it is not to be depended upon alone. It may be given in small doses, not sufficient, to produce emesis, until the membrane is separated, then the dose may be increased until the membrane is removed. It is a good remedy in atonic conditions of the lungs or bronchi with imperfect circulation and relaxed mucous membranes, with general inactivity of the nervous system and lack of nerve force. It should not be prescribed during active inflammation, but will be of service when the more acute symptoms have abated. It will assist in overcoming hepatization of lung structure and restoring normal tone and normal functional action. The powdered drug in small doses in a capsule, may be combined with hydrastis or quinine with excellent effect when those agents are indicated as restoratives. It is said to act upon the stomach, liver and portal circulation, as a stimulant, and to the glandular organs and structures of the intestinal canal, and to exercise an alterative influence within the blood. The tincture in full doses, is an emmenagogue, restoring the menses when suppressed from cold. It is not to be given if menstrual deficiency is due to anemia, although it is tonic and stimulant in its influence upon the reproductive organs. The nitrate of sanguinaria is a soluble salt, as useful and less irritating than any other form of sanguinaria. It is serviceable in chronic nasal catarrh, in chronic ulcerations of the throat, and in fissures and ulcerations of the anus. It will act in this concentrated form as an escharotic and is of much service as an application to epithelioma, lupus Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 387 and to other growths of a similar nature.

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