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There is dullness and oppression of the brain cheap 140 mg malegra fxt with visa, but without the tendency to sleep; in a further advanced stage malegra fxt 140 mg cheap, coma buy cheap malegra fxt 140mg line. I carry this remedy as a local application for phlegmons showing enfeebled capillary circulation, and as a dressing to open wounds when the pus is fetid and ichorous. Ten grains to the ounce makes a dressing for the abortion of a phlegmon; ten grains to one drachm in a pint of water makes an excellent antiseptic dressing. Do not use Morphia as a narcotic; that is, the dose of the medicine as I use it is always stimulant. Though the patient may be restless and sleepless, there is no inclination to wandering of the mind. I am not sure but the Santonine had better be triturated with Podophyllin, in numerous sections of country, as its principal use will be as a worm medicine. The dose of the trituration would be one grain for a child two to four years of age. As a remedy for retention of urine in children, it would be better in many cases with the Podophyllin out, and yet in this form it will serve the purpose. I employ the phosphate because it is the most soluble, as well as the best preparation of the Hydrastis. One grain to the ounce is an excellent collyrium, gargle in sore throat, wash for sore mouth, or injection in gonorrhœa or leucorrhœa. Used in these small quantities, the remedy is cheap, portable, and easily dispensed. It is a valuable remedy in diseases of the stomach and upper intestinal canal with increased secretion of mucus. Be careful not to make the dose too large - one grain to four ounces of water is sufficiently strong; dose a teaspoonful. I employ a tincture of Rhubarb to relieve irritation of the stomach, and to aid digestion. Violet color of the tongue is the indication; and whilst I should use Nitric Acid if the color was deep, I should use Nitrate of Soda if the color was light. I employ the tincture of Phosphorus for two purposes: to arrest inflammatory processes in the lungs, and to arrest low grades of inflammatory action in kidneys, prostate gland, testes and ovaries. Languor, debility, impairment of mind, and want of acute evidences of disease in the part, may be regarded as the indications. Thus we have filled up our three rows of forty bottles, and yet the reader will find that some favorite remedy is left out. We want Muriatic, Nitric, and Sulphurous Acids, Phosphate of Soda, Sulphite of Soda, Bicarbonate of Soda, a convenient emetic, and these are more or less bulky and difficult to carry. We have filled up our pocket case, and left some of the essentials out, and I hardly know how we will carry them. It is not so difficult to arrange for the bulky agents, Sulphite of Soda, Bicarbonate of Soda, Phosphate of Soda, Acetate of Potash, etc. I will take it for granted that we must have another case, and we will make it of ten vials, with rubber corks, and we will have the manufacturer see that these vials are of extra strength. It is a pity that he can not devise a cork- retainer, like the modern soda-water bottle. I saw a physician with one the other day, and it served the purpose and looked well. We commence this list with the acids, which are very important remedies, and have well defined indications, and in some seasons will be in very common use. As Acids, the special indications are, deep-redness of mucous tissues or skin if blood shows freely. Here we may use Muriatic Acid, hard cider, or whey, and sometimes lemonade or other vegetable acids. This remedy is indicated by the deep-redness of the tongue, contracted, with coatings of a brownish color, inclined to grow darker as the disease advances. The indication is a violet coloration of tongue, and of other parts where blood shows freely. In the best marked cases the violet color seems but a film upon the surface, and you seem to look through it to the natural, or rather deeper than natural color of parts below. I usually prescribe it in the following proportion, when I send the prescription to a drug store: ℞ Nitric Acid, gtt. It is one of our group of antiseptics, and is indicated by full tissues and dirty color of coatings of tongue, and of other secretions and excretions. In our other case we had a preparation of Iron, Rademacher’s Tincture, or Iron by Hydrogen; in this it is well to have the old standard. It is the remedy for erysipelas when the redness is deep and the pain has not so much of the burning character. Nutrition is impaired, digestion poor, tissues relaxed, tongue shows more the usual deep-redness, with possibly a tinge of blue. This is the antiseptic, where there is a fetor resembling an unpleasant lochial discharge, or decomposing animal matter. Chlorate of Potash is especially the antiseptic in puerperal diseases, and my readers are all familiar with its common application in simple sore throats, and other diseases of mucous membranes. Sulphite of Soda is one of our most valuable remedies, as an antiseptic and a destroyer of the germs of low animal and vegetable organisms. The physician will find this one of his most useful remedies in some seasons, preparing the way for the kindly action of other agents, or sometimes effecting a cure itself. The indication for its use is pallor of mucous membranes - a broad, pallid tongue. Add it to water in small quantity so as to make a pleasant alkaline drink, and let the patient have as much as he desires. Make two-grain powders, and give one every ten or fifteen minutes in a wine- glass of warm water. If it is a case where an acetous emetic would be preferable acidulate the water with vinegar. It is the very best injection to remove the debris of tissue in an abscess, and to stimulate the restorative process, as it is the very best escharotic in caries of bone.

Franzen discount malegra fxt 140mg line, November () I advised abdominal section and found the abdomen full of clot malegra fxt 140 mg without prescription. The right Fallopian tube William Temple – was ruptured and from it a placenta was Archbishop of Canterbury protruding malegra fxt 140 mg cheap. Balliere Tindall and Cox () Essays and Studies by Members of the English Association When in doubt, drain. In eating, a third of the stomach should be filled Locksley Hall with food, a third with drink, and the rest left empty. Terence –  (Publius Terentius After) Gittin Carthage-born Roman comic poet A physician who heals for nothing is worth Old age is an illness in itself. Attributed Dylan Thomas – Welsh poet Wine is the foremost of all medicines— wherever wine is lacking medicines become An alcoholic is someone you don’t like who drinks necessary. Fontana London () Do not go gentle into that good night, Old age should burn and rave at close of day; A. British historian Do not go gentle into that good night The greatest problem about old age is the fear that When I take up assassination, I shall start with it may go on too long. Observer () The Doctor and the Devils     ·    Sir Henry Thompson – Stephen E. Michael Joseph, London (), Journal of the History of Ideas :  () explaining the absence of infection for the lithotomy on the Belgian king Leopold Hamish Thomson – Henri Toulouse-Lautrec – British surgeon, Gloucester French painter It is one of life’s little ironies that surgical disease I can drink without danger, I am so near to the when not afflicting the unmentionable tends to ground. Attributed The twentieth century will be remembered chiefly, not as an age of political conflicts and technical Jurgen Thorowald ? The status and progress of medicine ought always Attributed to be judged primarily from the point of view of the suffering patient, and never from the point of view of one who has never been ill. The processes of All happy families resemble one another, but each disease aim not at the destruction of life, but at unhappy family is unhappy in its own way. He supplies the perennial demand for comfort, the Anthony Trollope – craving for sympathy that every human sufferer English novelist feels. Authority, Observation and Experiment in Medicine Théodore Tronchin – Swiss physician from Geneva and discoverer of lead Jesse Torrey – poisoning Coffee, though a useful medicine, if drunk In medicine, sins of commission are mortal, sins of constantly, will at length induce a decay of health, omission venial. Quoted in the Lancet 2:  () Surgeons and anatomists see no beautiful women in all their lives, but only a ghastly stack of bones Disease often tells its secrets in a casual parenthesis. All knowledge comes from noticing resemblances Letter to the Alta Californian, San Francisco,  May and recurrences in the events that happen () around us. Man gets his through months only afford to your understandings an and months of cruel torture; he will never get a opportunity of bringing forth fruit, and of set which can really be depended on ’till a elevating you to the high position of a man of art. Cable to the Associated Press  June (), in Mark Twain, Clinical Medicine Vol. Addison’s disease Attributed Medicine consists of science and art in a certain relationship to each other, yet wholly distinct. David Tweedle – Science can be learned by anyone, even the British surgeon mediocre. Attributed Surgeons have little knowledge of bacteriology and continue to use rituals without scientific Tung-su Pai evidence. Bacteriologists are out of touch with Chinese sage clinical reality and propose investigative and A dirty cook gives diarrhoea quicker than rhubarb. Clemens) Maximilianus Urentius – – Wherein differs the surgeon from the doctor? Whiskey is the most popular of all the remedies Codice Atlantico  in The Notebooks of Leonardo da Vinci that won’t cure a cold. Paul Valéry – Codice Atlantico  French writer If you are mindful that old age has wisdom for its The object of psychology is to give us a totally food, you will so exert yourself in youth, that your different idea of the things we know best. Tel Quel Codice Atlantico  Marcos Varro st century  Iron rusts from disuse; stagnant water loses its purity and in cold weather becomes frozen; even Roman physician so does inaction sap the vigour of the mind. In damp places there grow tiny creatures, too Codice Atlantico  small for us to see, which make their way into Life well spent is long. I) De re rustica As a well-spent day brings happy sleep, so life well Thorsten Veblen – used brings happy death. Jean Paul Richter)    ·    Rudolf Virchow – It was his part to learn the powers of medicine German pathologist and the practice of healing, and careless of fame, to exercise the quiet art. Rather, Stanford University Press, ) Time carries all things, even our wits, away. Rather, Stanford University Press, ) German zoologist At that time we attempted to shake off the spell which philosophy, nature-philosophy in particular, The brain secretes thought as the stomach secretes had for a long period cast over science. Rather, Stanford University Press, ) I reject the feeling expressed in England in their There can be no scientific dispute with respect to preference for colostomy over resection of the faith, for science and faith exclude one another. Disease, Life, and Man ‘On Man’ Beitragen Zur Chirurgie, Leipzig , quoted by Marvin The physicians are the natural attorneys of the Corman in Diseases of the Colon and Rectum : – poor and the social problems should largely be () solved by them. Ackernecht) French writer and philosopher Marriages are not normally made to avoid having children. Garrison, Bulletin of Letter () the New York Academy of Medicine October: – () Men who are occupied in the restoration of health The touchstone of science is power of to other men, by the joint exertion of skill and performance, for it is a truism that what can, also humanity, are above all the great of the earth. They even partake of divinity, since to preserve Quoted in ‘Medical Proverbs’ by F. Attributed Medical instruction does not exist to provide individuals with an opportunity of learning how A physician is one who pours drugs of which he to make a living, but in order to make possible the knows little into a body of which he knows less. The convolutions of the brain, which was rather soft It is therefore reasonable to think that anyone and oedematous, seemed to be twice as deep and who has spent a long professional life in medicine twice as numerous as normal. I would like to remind those responsible for the Perspectives in Biology and Medicine :  () treatment of tuberculosis that Keats wrote his best poems while dying of this disease. In my opinion Izaak Walton – he would never have done so under the influence English writer of modern chemotherapy. Wilson Look to your health: and if you have it, praise God, and value it next to a good conscience; The Compleat Angler Pt , Ch. Professor of Anatomy, University College, London Attributed The immediate origins of misery and suffering need immediate attention.

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Obligate intracellular pleomorphic gram-negative coccobacilli occurring in single quality malegra fxt 140 mg, pairs generic 140 mg malegra fxt with visa, short rods and filaments order malegra fxt 140 mg otc. Antigenic structure: Group-specific antigens Species-specific antigens Clinical Features: Clinical illness is due to the invasion and multiplication of rickettsiae in the endothelial cells of small blood vessels. It manifests with fever, headache, malaise, skin rash and enlargement of liver and spleen. Hosts and vectors of the medically important rickettsiae Organism Disease Hosts Vectors 1. It causes epidemic or louse-borne typhus and the milder recrudescence form, Brill-Zinser disease. Clinical Features: It is transmitted by self-inoculation of the organism by scratching after bite by infected louse(Pediculous humanus corporis and pediculous humanus capitis). The illness manifests with sudden onset of fever, headache, malaise, prostration and skin rash. Epidemics of the disease are associated with overcrowding, cold weather, lack of washing facilities and fuel, famine and war. The disease is milder than louse-borne typhus and occurs in those individuals living or working in highly rat-infested area. Laboratory diagnosis: Specimen: Serum for serological tests The serological tests to diagnose typhus are: 1. The smallest living micro-organism capable of free living in nature self-replicating on laboratory media. Highly pleomorphic due to absence of rigid cell wall, instead bounded by a triple-layered “unit membrane”. Have enzyme systems and make their own proteins, lipids, nucleic acids and vitamins. The elementary body is reorganized into reticulate body in the host cell which is specifically adapted for intracellular growth. The reticulate body grows and divides many times to form inclusions in the host cell cytoplasm. With in 24-48 hours of developmental cycle, the reticulate bodies rearrange them selves into infective elementary bodies and released after host cell rupture. Antigenic structure: Group-specific antigen Species-specific antigen Chlamydia trachomatis. Appearance in giemsa’s stain Elementary body -------- Purple Reticulate body---------- Blue Host cell cytoplasm----- Blue. Appearance in iodine stain Brown inclusions in host cell cytoplasm because of glycogen matrix surrounding the particle. Incubation period is 3-10 days Route of transmission is through indirect contact like eye-to- eye by infected fingers or sharing towels. It manifests as a chronic keratoconjunctivitis producing scarring and deformity of the eyelids, corneal vascularization and opacities which may lead to blindness. Laboratory diagnosis: Specimen: Conjunctival scraping from upper tarsal conjunctivae. Culture: Mac coy cells or embryonated eggs Serology: Immunofluorescent tests Treatment: Erythromycin Tetracycline Control measures:. Females------ Urethritis Cervicitis Pelvic inflamatory diseases If complicated in females, it causes infertility and ectopic pregnancy. Neonatal inclusion conjunctivitis and neonatal pneumonia Transmission is during passage through the infected birth canal. Laboratorydiagnosis: Specimen: Endocervical scraping Culture: mac coy cells Serology: Enzyme immunoassay for group-specific antigen. On the basis of their life habits, microorganism is classified as saprophytes or parasites. Saprophytes : Mode of life of free-living organisms which obtain their nourishment from soil and water. Commensalism: The ability to live on the external or internal surface of the body with out causing disease. Invasiveness of micro-organism A high degree of bacterial invasiveness is usually associated with severe infection. Mode of release from bacteria Excreted by released on bacterial death 295 living cell (Integral part of cell wall) 4. Collagenase: Degrade collagen, which is major protein of fibrous connective tissue. Hyaluronidase: (Early spreading factor) hydrolyzes hyaluronidic acid, which is the ground substance of connective tissue. Lecithinase: Splits lecithin of cell membrane into phosphorylcholine and glycerides. Many layered impermeable barrier to invasion of the tissues by microorganisms from the environment. Lysozyme: An enzyme which lyses the mucopeptide (peptidoglycan) of the Gram-positive bacteria. Respiratory secretion: Traps bacteria and constantly moves them upward propelled by cilia on the cells of the epithelium. Phagocytosis: The process by which microorganisms are ingested and destrrroyed by phagocytic cells. Act as an early defense against infection and are the “pus cells” seen in the exudate from acute infection. Produced in the bone marrow and found in blood stream as monocyte and in tissue as fixed macrophage. Phagolysosome: Fusion ofphagosome and lysozyme (bag of hydrolytic and proteolytic enzymes found in phagocytic cells). Specific defense mechanisms There are two main mechanisms by which the host mounts a specific immune response against bacterial infection. The cell mediated response The humoral response Antibodies are proteins produced by B-lymphocytes in response to antigens (foreign substance which induces and binds with antibody). Bacterial Lysis The cell mediated response It is important in killing of intracellular pathogenic bacteria. T-lymphocytes are population of lymphocytes conferring cell mediated immunity due to release of hormone-like mediators (lymphokines). Inhibition of macrophage migration: Localizes macrophage to the site of infection. Chemotactic attraction of lymphocytes, macrophages and polymorphs to the site of infection.

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Sir James Paget – Address cheap malegra fxt 140 mg mastercard, Classical Association buy cheap malegra fxt 140mg line, Oxford malegra fxt 140 mg, May () English surgeon Patients rarely die of the disease from which they As no two persons are exactly alike in health so suffer. Bartholomew’s Hospital Reports :  () estimate of the personal character, or the constitution of the patient. Did we not believe Galen implicitly for 1500 years and Hippocrates more than 2000? Stephen Paget – Attributed English surgeon, writer and reformer Talk of the patience of Job, said a Hospital nurse, Job was never on night duty. Constable and Co Ltd, London () Walter Lincoln Palmer – Whether we should destroy the mother to save the Don’t refer a patient to a psychiatrist as if you are child is a deplorable dilemma which should telling him to go to hell. So he whose belly swells with dropsy, the more he Attributed as his last words drinks, the thirstier he grows. A clear conscience, Enough Rope ‘News Item’ Desire to learn and to gather experience, A gentle heart and a cheerful spirit, James Parkinson – Moral manner of life and sobriety in all things, Greater interest in being useful to his patient than English general practitioner to himself. Norbert Guterman in Selected that a physician seldom obtains bread by his Writings) profession until he has no teeth to eat it. Symonds () does not consist of compounding pills and plasters; Involuntary tremulous motion, with lessened it deals with the very processes of life, which must muscular power, in parts not in action and even be understood before they may be guided. Therefore it behoves medicine to thinking, the pre-eminence must be assigned in follow the will of nature. Attributed Caleb Parry – Knowledge makes the physician, not the name or English physician and researcher the school. It is as important to know what sort of person has Attributed the disease as to know what sort of disease the All things are poisonous and there is nothing that person has. Attributed Pashto proverb Until he gets over smallpox, parents do not count Ambroise Paré – their child their own. French surgeon Always give the patient hope, even when death Boris Pasternak – seems at hand. Russian novelist Attributed At the moment of child-birth, every woman has I dressed him and God healed him. Science proceeds by successive answers to Attributed questions more and more subtle, coming nearer Better a tried remedy than a new-fangled one. Dubos) When gangrene is pronounced, nothing will help Wine is the most healthful and most hygienic of but the knife. B    ·    When moving forward toward the discovery of the No one ever lacks a good reason for suicide. Ivan Pavlov – Quoted by René Dubos in Louis Pasteur, Free Lance of Science Russian experimental physiologist To him who devotes his life to science, nothing can School yourself to demureness and patience. Some Reflections on Science in France Pt  Experimental Psychology and Other Essays Pt X, Essay  When meditating over a disease, I never think of (transl. Belsky) finding a remedy for it, but, instead, a means of Only by passing through the fire of experiment preventing it. One does not ask of one who suffers: What is your Experimental Psychology and Other Essays Pt X, Essay  country and what is your religion? Belsky) says: You suffer, this is enough for me: you belong to me and I shall help you. First of all be systematic, learn to do drudgery, second comes modesty; pride will deprive you of Speech to the Philanthropic Society,  June () the ability to be objective, and the third thing In the field of observation, chance only favours necessary is passion – be passionate in your work the prepared mind. Inaugural address as Professor and Dean of the new Dictionary of Medical Eponyms (nd edn), p. The Germ Theory and its Applications to Medicine and Surgery Frank Payne – Ch. British medical historian All things are hidden, obscure and debatable if the This basis of medicine is sympathy and the desire cause of the phenomena be unknown, but to help others, and whatever is done with this end everything is clear if this cause be known. The Germ Theory and Its Application to Medicine and English Medicine in the Anglo-SaxonTimes. The Care of the Patient Paul of Aegina – There is no more contradiction between the Alexandria-trained physician science of medicine and the art of medicine than between the science of aeronautics and the art of All those who have cataract see the light more or flying. Francis Adams) at once affects and is affected by what we call the emotional life. Cesare Pavese – The Care of the Patient Italian writer One of the essential qualities of the clinician is One stops being a child when one realises that interest in humanity, for the secret of the care of telling one’s trouble does not make it better. The Business of Living: Diaries – The Care of the Patient   ·     John Pearson – Thomas Percival – English surgeon, London English physician and medical ethicist He who reduces the province of a Surgeon to the The invention of an hypothesis is a work of no performance of operations, and consequently difficulty to a lively imagination. I ‘The manner to the less splendid parts of his profession, Empiric’ may learn the art of mutilating his fellow creatures, but will never deserve to be treated as a Meyer A. If your time hasn’t come, not even a doctor can Principles of Surgery Preface kill you. Attributed Charles Péguy – French nationalist, publisher and poet Persian proverb When a man lies dying, he does not die from the When there are two midwives, the baby’s head is disease alone. Doctor and layman alike must learn wisdom in their employment of science, whether Jo Peters – this applies to atom bombs or blood transfusion. British surgeon The Second Career ‘A Doctor’s Philosophy’ Laparoscopic surgery—up a steep learning curve There are times when compassion should prompt to a plateau of ignorance. Personal communication The Second Career ‘A Doctor’s Philosophy’ It is fair to say that science provides no method of John Punnett Peters – controlling the mind. Dartmouth Convocation on The Great Issues of Conscience Too much attention has been paid to the excretory in Modern Medicine () offices of the kidney to the neglect of its conservative services. Penn – British clinical pharmacologist, London Petrarch – The medical herbalist is at fault for clinging to Italian poet and scholar outworn historical authority and for not assessing his drugs in terms of today’s knowledge, and the It is by poultices, not by words, that pain is ended, orthodox physician is at fault for a cynical although pain is by words both eased and scepticism with regard to any healing discipline diminished. Fruits of Solitude Maxim  Satyricon  Samuel Pepys – Heinrich von Pfolspeundt th English diarist century German war surgeon Thanks be to God, since my leaving drinking of wine, I do find myself much better and do mind A wound should be bound with clean white my business better, and do spend less money, and bandages, else there be harmful effects. Diary  January () Buch der Bundth-Erntznei    ·  Thomas Phaer ? Médecine, Paris The Book of Children Every illness has its natural course, with which it behoves the doctor to become acquainted. Contemporary British journalist Letter to Fanny Burney,  November () Behind many of the most agonising dilemmas in modern medicine, behind the emotional and bitter Walter B. Harvester Press () Many people are better off with grave handicaps than with trifling ones. The grave handicaps Medical ethics are a bargain that has to be struck release copious energies.