Mark Corson

By I. Treslott. University of Saint Thomas, Saint Paul.

It is the remedy for the general relaxation of the gastro-intestinal tract in childhood purchase midamor 45mg online, with protracted diarrhea generic 45mg midamor amex. In catarrhal gastritis discount midamor 45 mg free shipping, where there is profuse secretion with a tendency to ulceration, with, perhaps a mild hemorrhage, this agent is Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 236 very useful. It has been claimed that incipient gastric cancer has been cured with geranium, and there is no doubt that it takes precedence over many other remedies, when a diagnosis between severe gastric ulcer and incipient cancer cannot be made without exploratory operation. Its range seems much wider than that of a simple astringent, as it controls pain and rapidly improves the general condition. It has an influence over passive hemorrhage unlike that of other agents, but in violent cases of recent origin it is not the best remedy. The author treated a case of haematuria for nearly two years with absolutely no permanent impression upon the condition. Tubercular bacilli were found in abundance in the blood, which was usually arterial in character and steady in quantity. Finally fifteen drops of geranium were given every two hours, and in two weeks the blood was absent and had not returned at the end of three years, except mildly when the patient persistently overworked. The patient improved slowly in general health and so continued after several years. They claim that all the symptoms are retarded by its use, and that it improves the general tone and overcomes night sweats. It may have a subtle influence upon tubercular bacilli or the conditions induced by them, not understood, which would account for its phenomenal action in the conditions referred to. It is a positive tonic to the mucous linings of the entire intestinal tract, especially in colliquative diarrhea. I used geranium in a case of cirrhosis of the liver with ulceration of the duodenum, with fine results. Davy treated a case of habitual menorrhagia with geranium associated with trillium. Of all concentrations, he would add one-half to one grain to each dose rubbed up with a little sugar, three or four times a day during Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 237 the menstrual periods, continuing through the period in bad cases in slightly increased doses. Therapy—The agreeable taste of liquorice in any form covers to a practical extent the taste of very many disagreeable remedies. A syrup made by adding two parts of the fluid extract to fourteen parts of simple syrup, will disguise the bitter or otherwise unpleasant taste of a large proportion of the fluid extracts. Its demulcent properties render it useful in inflammation, or irritation of the mucous membranes of the lungs and bronchi. In combination with ipecac, lobelia, squill, sanguinaria, or ammonium chloride, an excellent expectorant mixture or cough syrup may be extemporized, as this agent modifies any acrid or irritating influence the other agents may exhibit. The virtue of the Compound Liquorice Powder of the dispensatory does not depend upon the properties of the liquorice, only as it imparts to the whole a pleasant taste. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 238 Therapy—The influence of the agent is exercised directly upon the stomach as a tonic and corrective of perverted action. It is of service in gastric ulcer and in the early stages of cancer of the stomach, for which it was originally lauded as a cure. It will be found of service, probably, in catarrhal gastritis with extreme atonicity and threatened ulceration. In these cases its virtues as a tonic and restorative will find exercise to the full extent of their influence. A Homeopathic writer gave condurango internally to a man 74 years of age who had small crusts forming on his lower lip for a long time suggesting the beginning of cancer. This remedy being recommended externally should be tried internally for other cancerous conditions. In the above case a chronic catarrh of the stomach where there was vomiting of a green slime after dinner with hyperacidity and emaciation was inadvertently cured with the treatment as stated. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 239 It has a wide reputation among the slave women of the South as an abortifacient. It was used by them in the form of a strong infusion of the green root and is of value in suppression of the menses from whatever cause. It produces firm, regular and strong uterine contractions, much resembling ustilago maydis and cimicifuga in its action. It may be used in uterine inertia to increase the natural expulsive power of the womb and prevent the dangers of post-partum hemorrhage. It is a hemostatic of some power being used principally to control the hemorrhage of uterine fibroids and incipient cancer. It is a valuable agent for metrorrhagia and menorrhagia, but is not in general use, as the uterine tonics and stimulants in common use accomplish these results in their wider beneficial influence. Physiological Action—The influence of the agent is exhibited on the heart, at first by a quickened pulse, subsequently by retarding it. In overdoses it is toxic, the specific influence of the agent on the respiratory nerves being shown by paralysis of the muscles of respiration. It must be given in full and frequent doses, and the effects, although not striking from a single dose, are soon evident and are more or less permanent. It soon relieves the effort of breathing and produces expectoration, but on continued use the entire train of symptom slowly abate, and if persisted in the paroxysms do not soon recur. Therapy—In spasmodic asthma, pure and simple, with complete relief between attacks, it is not the remedy. It is an excellent antispasmodic expectorant in all chronic spasmodic bronchial coughs, and in chronic bronchitis, Asthmatic bronchitis is often benefited, from the first dose, by its use.

The remedy is valuable in the treatment of disorders of the mucous lining of the bronchial tubes order midamor 45mg mastercard. It is beneficial in ulcerative forms of sore throat discount midamor 45mg without prescription, where the secretions are fetid in character midamor 45mg discount. It may be inhaled in chronic bronchitis, bronchorrhea; bronchitis, with offensive discharge; chronic nasal catarrh. A number of cases of spermatorrhea have been cured since our previous report on this remedy. It is beneficial when the urine seems to burn or scald in the passing, when there is local soreness in the urethra or neck of the bladder, when the bladder tolerates but little urine at a time, and the patient must rise frequently during the night. Homeopathists give thuja where the rectum is diseased; where there is a slimy discharge streaked with blood with dark blotches on the adjoining tissues; where there is itching and constant inclination without power to expel feces; sharp sticking pains in the rectum. In cases of verucca on the genitalia or rectum, this agent is advantageously used, especially if preceded by a mild escharotic. In prolapsus of the rectum, especially in cases depending upon paralysis, this agent, may be diluted and injected. The injection of thuja into nevi that are of a non-pulsating character, or those not too venous in structure, has been recently practiced. One case was cured in three weeks, where the nevus looked like a ring worm, and was of a fiery red color. One physician cured a case of ulcerated stomach with thuja in four-drop doses, alternated with sub-nitrate of bismuth every two hours. Anything warm produced great Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 437 distress. Another physician advised the agent in pruritus, whether of the anus or vulva, especially when accompanied by fissures. Another physician reports a case of extreme prolapsus of the bowel in a child which he cured with a five per cent solution of thuja. A wet dressing was applied and a small quantity of the remedy was injected into the bowel. A greatly enlarged and relaxed uterus in a woman of fifty with severe metrorrhagia was treated with injections of thuja. A doctor reports the cure of a urinary fistula by giving two drops of thuja internally every four hours. The use of the oil of thuja in confluent smallpox given internally and applied externally was advised by Dr. Thuja will prove an excellent remedy for all forms of sore mouth, especially if combined with echinacea and a mild antiseptic astringent. Gibbs reports a case where a number of varicose enlargements about the ankle of an old washer woman broke down. He made a 50 per cent solution of thuja and applied it freely with bandages, covering the whole with roller bandages, and produced a cure. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 438 Therapy—Trifolium has been used as a cancer remedy by virtue of specific alterative properties said to exist in it. It is given where a cancerous diathesis is known to be present, and its use is persisted in for months. Improvement in objective phenomena is reported from a number of excellent observers. The agent is also prescribed in irritable conditions of the larynx and air passages, especially if evidenced by spasmodic cough. It has served a good purpose in whooping cough, in the cough of measles, and in general bronchial or pulmonary irritation. Lambert is of the opinion that trifolium has a direct action in improving the nutrition of the brain. He thinks it is demanded when the patient is overworked; when there is general mental failure, with loss of memory of words, or when there is confusion of ideas of functional causes; also when there is weakness of the lower extremities, or of the feet from deficient capillary circulation. It soothes the cough of incipient phthisis, especially where there is a tendency to hemorrhage, over which it has a marked controlling influence. It controls uterine hemorrhage of a passive character to an excellent advantage, especially menorrhagia and metrorrhagia. Therapy—A mild nerve tonic claimed to be valuable in the treatment of sexual impotence. Some of our physicians praise it highly for its influence in sexual neurasthenia, and it is said to correct frigidity in the female. It had long enjoyed a local reputation as a stimulant tonic of the sexual apparatus among the natives of Mexico, before it attracted the attention of the profession. Besides its peculiar action on the sexual appetite and function, it is a general tonic, somewhat cathartic, and is slightly cholagogue. The midwives and women of loose morals of Western Mexico also attribute emmenagogue properties to it. Reid uses Damiana in all conditions where a general tonic is needed, especially if there be enfeeblement of the central nervous system. It is valuable in renal and cystic catarrh and in general irritation of the urinary passages, through its influence in soothing irritation of mucous membranes. This latter property renders it valuable in the treatment of respiratory disorders, especially those accompanied with profuse secretion. In the line of the action of this remedy in its influence upon the reproductive organs, Dr. Reid mentions dysmenorrhea, headache, at the menstrual epoch, bad complexion, rough or discolored patches on the skin with acne, especially of a severe type, depending upon uterine Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 440 irritation. Watkins gives as its further indications, delayed or suppressed menstruation in young girls, irregularity at the beginning of menstruation, amenorrhea in very young girls.

When si- nustachycardia develops generic 45 mg midamor mastercard, the heart rate gradually increases from the basic (resting)sinus rate;when sinustachycardiasubsides purchase 45 mg midamor mastercard, the rate likewise decreases gradually buy 45 mg midamor fast delivery. Similarly, automatic tachyarrhythmias oftendisplay “warm-up” and “warm-down” in rate when the arrhythmiabeginsand ends. Mechanismsofcardiac tachyarrhythmias 13 Also, analogoustosinustachycardia, automatic tachyarrhythmias often have metabolic causes, suchasacute cardiacischemia, hypox- emia, hypokalemia, hypomagnesemia, acid–base disturbances, high sympathetic tone, or the use of sympathomimetic agents. The balm of antiarrhythmic drugs is occasionally helpful, but the primary treatment of these arrhythmias should always be directed towardidentifying and treating the under- lying metabolic cause. Reentry The mechanism of reentry accounts for most clinically significant tachyarrhythmias. Recognition of thisfactand of the fact that reen- trant arrhythmias are amenable to study in the laboratory led to the widespreadproliferation of electrophysiology laboratories in the 1980s. The mechanism of reentry, although less intuitive than the mech- anism of automaticity, can still be reduced to a few simple con- cepts. First, tworoughly parallel conducting pathways must be connectedproximally and distally by conducting tissue, thus forming a potential electrical circuit. Third, the pathway with the shorter refractory periodmust conduct electrical impulses more slowly thandoes the opposite pathway. If all these seemingly implausible conditions are met, reentry can be initiated by introducing an appropriately timedpremature im- pulse to the circuit(Figure 1. The premature impulse must en- ter the circuit early enough that the pathway with the long refrac- tory periodisstill refractory from the latest depolarization,but late 14 Chapter 1 A B Figure 1. An anatomic circuit must be present in whichtwo portionsofthecircuit(pathways A and B) have electrophysio- logic properties that differ from oneanother in a critical way. In this example, pathway A conducts electrical impulses more slowly thanpathway B;path- way B has a longer refractory period thanpathway A. The im- pulse enters the pathway with the shorter refractory period but is conducted slowly because that pathway has the electrophysiologic property of slowconduction. By the time the impulse reaches the long-refractory-periodpathway from below, that pathway has had timetorecover and is able to conduct the impulse in the retrograde direction. If the retrograde impulse now reenters the first pathway and is conducted antegradely (as islikely because of the short re- fractory period of the first pathway), a continuously circulating im- pulse is established, which rotates around and around the reentrant Mechanismsofcardiac tachyarrhythmias 15 A B Figure 1. Because conductiondown pathway A is slow, pathway B has timetorecover, allowing the impulse to conduct retrogradely up path- way B. All that is necessary for the reentrant impulse to usurp the rhythm of the heart is for the impulse to exit from the circuitat some point during eachlap and thereby depolarize the remaining myocardium outside the circuit. Because reentry dependsoncritical differences in the conduction velocities and refractory periodsamong the various pathways of the circuit, and because conduction velocities and refractory periods, as we have seen, are determined by the shape of the actionpotential, the actionpotentials of the two pathways in any reentrant circuit 16 Chapter 1 must be different from oneanother. Thus, drugs that change the shape of the actionpotential might be useful in the treatmentof reentrant arrhythmias. Reentrant circuits, while always abnormal, occur with some fre- quency in the human heart. Some reentrant circuits are present at birth, notably those causing supraventricular tachycardias (e. However, reentrant circuits that cause ventricular tachycar- dias are almost never congenital, but come into existenceascardiac disease develops during life. In the ventricles, reentrant circuits arise in areas in which normal cardiac tissuebecomes interspersedwith patches of fibrous(scar) tissue, thus forming potential anatomic cir- cuits. Thus, ventricular reentrant circuits usually occuronly when fibrosis develops in the ventricles, such as after a myocardial infarc- tion or with cardiomyopathic diseases. Theoretically, if all anatomic and electrophysiologic criteria for reentry are present, any impulse that enters the circuit at the ap- propriate instant in time induces a reentranttachycardia. The time from the end of the refractory period of the shorter-refractory-period pathway to the end of the refractory period of the pathway with a longer refractory time, during which reentry can be induced, is called the tachycardia zone. Treating reentrant arrhythmias ofteninvolves trying to narrow or abolish the tachycardia zone with antiarrhyth- mic drugs (by using a drug that, onehopes, might increase the re- fractory period of the shorter-refractory-periodpathway, or decrease the refractory period of the longer-refractory-periodpathway). Because reentrant arrhythmias can be reproducibly induced (and terminated)byappropriately timed impulses, these arrhythmias are ideal for study in the electrophysiology laboratory. Inmany instances (very commonly with supraventricular arrhythmias, butonly occa- sionally with ventricular arrhythmias), the pathways involvedinthe reentrant circuit can be precisely mapped, the effectofvarious ther- apies can be assessed,and critical portions of the circuit can even be ablated through the electrode catheter. The channelopathies In recent years, some varieties of tachyarrhythmias have been at- tributed to genetic abnormalities in the channels that mediate ionic fluxes across the cardiaccell membrane. Such “channelopathies”— abnormally functioning channels duetoinheritable mutations—can affectany electrically active cell and are not limited to the heart. For Mechanismsofcardiac tachyarrhythmias 17 instance, some varieties of migraine, epilepsy, periodic paralysis, and muscle disorders are apparently duetochannelopathies. While several distinctive cardiac arrhythmias are now thought to be caused by channelopathies, the most clinically relevantand the most commonchannelopathic arrhythmias are those related to triggered activity. Triggered activity Triggered activity is caused by abnormal fluxes of positive ions into cardiaccells. These ionic fluxes producean abnormal “bump” in the actionpotential during late phase 3 or early phase 4 (Figure 1. Inmost if not all cases, afterdepolarizations are thought to be duetoinherited abnormalities in the channels that control the movementofcalcium ionsacross the cell membrane. If the afterdepolarizations are of sufficientam- plitude, they can trigger the rapid sodium channels (which, as noted, are voltage dependent), and thus cause another actionpotential to be generated.