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200 Words Essay


Liquid clear large quantities of dark brownflocculent precipitate the precipitate is not distributed evenly whenthe mixture is shaken and settles out quickly on standing collosol hydrargyrum, 5 per cent. Milky liquid large quantities ofwhite deposit mixed with considerable black the deposit mixes fairlywell but the greater writing settles out after standing an hour or two collosol manganese, 2 5-1000. Clear reddish-brown liquid withoutdeposit of any kind is not opalescent or fluorescent collosol iodin, 1-500. Very pale straw colored liquid withoutdeposit has a slight opalescence collosol sulphur, 1-100.

De la cause immédiate et du traitementspécifique de la phthisie pulmonaire et des maladies tuberculeuses, paris, 1858 93 the hypophosphite fallacy, j a m a , april 25, 1914, p 1346 although the overwhelming weight of evidence was against theprobability that the hypophosphite preparations are of value astherapeutic agents, the council thought it well to investigate 200 words essay thesubject dr w mckim marriott of baltimore was therefore requested toreview the evidence for and against the therapeutic usefulness of thehypophosphites and to conduct such experiments as seemed necessary hisreport has already appeared in the journal 9494 marriott, w mckim. The therapeutic value of the hypophosphites, j a m a , feb 12, 1916, p 486 dr marriott found that nine observers paquelin and joly, vermeulen, boddaert, massol and gamel, panzer, delaini and berg, who endeavoredto test the alleged utilization of the hypophosphites in the organism, reported that there is complete, or practically complete, eliminationof hypophosphites in the urine, with little or no effect on the body only one experimenter patta claimed that a considerable amountof ingested hypophosphite was retained in the body. However, heused a method now known to be inaccurate and made obvious errors incalculation, so that his conclusions were unwarranted since the evidence was even to this extent contradictory, marriottperformed a series of experiments the methods of this study anddetails of results are described in his paper, in which he alsodiscusses the experiments of essay other observers marriott writes. “none of the subjects of the experiment marriott experienced any effect whatsoever from the administration of the drug almost all of the ingested hypophosphite is promptly eliminated unchanged “these experiments forbes’ demonstrate conclusively that the hypophosphites possess no specific value as a source of phosphorus for the body this is not to be wondered at in view of the fact that 85 per cent of the phosphorus ingested in the form of hypophosphite is excreted unchanged, and there is no proof that even the remaining 15 per cent is available to the organism it is doubtful if there are any conditions in which the body suffers from lack of phosphorus even should such conditions exist, phosphorus, in the form that it occurs in the ordinary foods, or as phosphates, is more efficient in supplying the deficit than hypophosphites that must be oxidized before utilization and which are only about 15 per cent oxidized, if at all for example, half a glass of milk contains more available phosphorus than three large doses of hypophosphites of 15 grains each, as great a dosage as is usually given “what, then, is the therapeutic value of hypophosphites?. there is no reliable evidence that they exert a physiologic effect. It has not been demonstrated that they influence any pathologic process. They are not ‘foods ’ if they are of any use, that use has never been discovered ”in view of the foregoing, it seemed to the council advisable toexamine the claims under which a few of the proprietary hypophosphitepreparations are marketed the following are representative. fellows’ syrup of hypophosphitesno very exact information concerning the composition is furnished bythe manufacturers fellows medical mfg co , new york they say thatthe product “ contains the chemically pure hypophosphites of iron, quinin, strychnin, calcium, manganese and potassium, agreeably blended in the form of a bland, stable syrup with a slightly alkaline reaction “each fluid drachm contains the equivalent of 1-64th of a grain of pure strychnin ”the fellows’ hypophosphites advertising furnishes essaything like abarometer of the popular status of hypophosphites in one circular undated, but, from certain references contained in it, presumablyissued ten or fifteen years ago we read. “it is an indubitable fact that the hypophosphites have earned the distinction of having their therapeutic value more completely established than have any other remedial agents it is only by accepting the current view, which was originally advanced by mr fellows, that we can satisfactorily account for the incontestable fact that the hypophosphites are of supreme importance in the treatment of a very extensive variety of affections the hypophosphites increase the consumption of oxygen and the elimination of carbon dioxide in this manner, they stimulate nutrition and promote constructive metamorphosis it is now universally conceded that the widespread utility of the hypophosphites is due to the fact that they substantially improve metabolic processes, thus increasing the disease-resisting capacity of all the tissues ”the circular, continuing, emphasizes the “incomparablephosphorus-contributing properties” of fellows’ syrup, its“extraordinary reconstructive properties” and “the magnificent resultswhich invariably attend its employment in the treatment of anemia, chronic bronchitis, chlorosis, neurasthenia, mollities ossium, delayedunion of fractures, rickets, convalescence, ” etc a circular bearing the copyright date 1914, on the other hand, admitsthat. “the theories for the favorable action of fellows syrup of hypophosphites have undergone several changes ”the same circular further maintains, however, that. “ the fact has never been challenged that in fellows syrup of hypophosphites we have one of the most efficient, most complete, most all-around tonics and roborants in the materia medica ”no attempt is made to base this assertion on the therapeutic actionof the constituents in other words, the old theory, which formed thebasis for the popularity of fellows’ syrup, has been thrown overboard, but no substitute is deemed necessary.

And nh₄i₂i₂, per iodide, a molecular compound, which i claim, they 200 words essay all being of a nh group, so what can be the objection of nitrogen hydrate of iodine?. of course when your chemist, with the aid of heat, drove off all the iodine, he naturally brought it back to a nh₄i there where he gets the a m i claim a molecular compound the oil of iodine i sent you by mistake was a 1 per cent and not a 5 per cent as marked i claim it is made from the resublimed iodine in mineral oil and not the b iodine i claim a 5 per cent has heretofore never been accomplished, so i therefore can claim essaything new tr iodine contains alcohol and potash as a base, the alcohol a dehydrater and potash an escharotic, and all other soluble iodines like the tincture have a metallic base mine has not my iodine is compatible almost with all the salts, alkaloids, tannates, and even the metals you can’t say that for the tincture or the others now why should mine not be superior to others?. preparations as yet are not on the market and a few pamphlets were printed to meet with the requirements of your rulings and approval and shall be corrected if we only can agree on a proper name as you may suggest yours very truly, the b iodine chemical co by john bohlander, a m, m d p s we are sending you under separate cover another sample of the oil of iodine which is a 5 per cent solution, and allowing for deterioration will test at least four per cent the referee in charge of the preparations submitted the above letter tothe council with the following comments:the principal statements in the letter are essentially erroneous ormisleading.

“i have 200 words essay no knowledge of the use of my name by any pittsburgh concern and know nothing of a lymph of the name of sweeny. Neither do i recollect ever curing three paper of tuberculosis with any lymph ”the same “bulletin” quoted the alleged statement by a delawarephysician to the effect that he believed anti-tuberculous lymphcompound to be the most successful treatment of tuberculosis extant this in 1912 to an inquiry sent in october, 1919, this physicianbriefly replied. “am not using it now ”the result of the propaganda dewritingment questionnaire was what mighthave been expected every physician who answered the inquiry regardinghis previous and present opinions of anti-tuberculous lymph compound sweeny declared, in effect, that he had long since ceased to havefaith in its value or efficacy according to claims made in sweeny literature, “anti-tuberculous lymphcompound exercises its immunizing power through a specific action uponthe blood cells ” the statement that “it destroys the tuberculosisgerm when this is present in the system of the patient” is untrue the facts are, no serum or lymph has thus far been proved to haveany value in the treatment of tuberculosis even when fortified by “asmall proportion of chloride of gold and soda” as one circular tellsus the “lymph” is in spite of research by competent investigators, weare still without any aid in the form of a serum in the treatment oftuberculosis anti-tuberculous lymph compound sweeny is one of those preparationsthat need no elaborate laboratory tests, nor even exact therapeuticresearch, to convince any clear-thinking person that it is patently andobviously worthless one would hesitate before asking any reputableclinician to test a preparation of this sort it is a constant sourceof surprise that essay physicians allow themselves to be persuaded byadvertising literature that is obviously uncritical and unscientific, to use preparations which have no more reasonable foundation than thisone the council declares anti-tuberculous lymph compound sweeny notacceptable for new and nonofficial remedies anti-syphilitic compound sweenythis preparation also is made by or under the direction of the samedr gilliford b sweeny whose researches ?. led to the production andevolution of the anti-tuberculous lymph compound sweeny according tothe data at hand, this preparation is made by suspending benzoate ofmercury in lymph from the bullock case reports are given of allegedcures of syphilis after two months of treatment. Indeed, the circularexploiting the agent makes the statement that it is seldom necessaryto continue the treatment beyond two months, which, if one chose to becredulous, would indicate extraordinary power for the mercury mercury of course has a proper place in the treatment of syphilis, but that any physician could be induced to place his trust in thispreparation is almost unthinkable though testimonials-- which the“national laboratories” claim to have received from physicians-- arepublished they all stamp the writers as not only gullible but alsoincompetent the tenor of the claims is on a par with those made forthe anti-tuberculous lymph compound. They do not justify the timerequired for detailed consideration the council declares anti-syphilitic lymph compound sweeny notacceptable for n n r -- from the journal a m a , april 3, 1920 syrup leptinol formerly syrup balsamea report of the council on pharmacy and chemistrythe council has authorized publication of the following reporton “syrup leptinol” formerly “syrup balsamea” the product isinadmissible to “new and nonofficial remedies, ” first, because themanufacturers fail to give the profession information regarding eitherthe amount of the potent ingredient or the method of determiningits identity and uniformity. Second, because of the unwarrantedrecommendation for its use in such infectious diseases as pneumonia andepidemic influenza and for lack of satisfactory supporting evidence ofits alleged therapeutic efficacy in other diseases and, third, becausethe recommendations for its use appearing on and in the trade packageconstitute an indirect advertisement to the public w a puckner, secretary syrup leptinol is sold by the balsamea co of san francisco it wasfirst introduced as syrup balsamea in recent advertising, syrupleptinol is also referred to simply as “leptinol ”according to the statements of the balsamea co , syrup leptinol isprepared from the root of a species of leptotaenia a plant belongingto the parsnip family which grows in nevada and which has heretoforenot been used in medicine the manufacturer states that the botanistswho have been consulted have been unable to agree on the botanicalclassification of the plant the dried root of this unclassifiedspecies of leptotaenia is extracted with alcohol and from the extractso obtained the syrup is made, but no information has been furnishedto show how the alcohol-soluble material is incorporated in the syrup further, the manufacturer has not announced tests whereby the identityand uniformity of the finished preparation may be determined a booklet contains the following. “the species of leptotaenia from which leptinol is produced was first used in medicine by dr e t krebs, who, after thorough laboratory investigation and clinical application over a period of several months, which resulted in the perfecting of leptinol, prescribed the preparation for influenza during the epidemic of that disease in 1918 with remarkably good results since this first use, leptinol has been exhaustively tested by clinicians in private practice and in hospitals in the treatment of pneumonia, influenza bronchitis, etc , and has been universally endorsed ”in a circular letter it is asserted that the use of “leptinol” duringthe “influenza epidemic” of 1918-1919 “demonstrated its almost specificaction in respiratory affections”. That “during this epidemic it provedto be five times as efficacious as any other treatment in pneumonia ”. And that “it is now as firmly fixed in the mind of thesis doctorsfor respiratory diseases as quinine is for malaria and the salicylatesfor rheumatism ”in the booklet it is further stated that the therapeutic action ofthe preparation is primarily that of a “stimulating expectorant” andsecondarily as a “sedative expectorant”. That “its antiseptic actionin the respiratory tract is prompt”. That it “is an effectual cardiactonic where the tone of the heart muscle is impaired by fever”. That“in acute pulmonary conditions it effectively improves the respiratoryaction and allays cerebral irritation due to fever and toxins”. Thatit acts “as a vital stimulant and nerve sedative”. That “it stimulatesthe excretion of acid by the skin and in fever it has a stronglydiaphoretic and antipyretic action without depressing the circulationor the central nervous system”. That it is “mildly diuretic” and“slightly augments the biliary flow” and that “it increases the gastricand intestinal secretions and allays intestinal fermentation ”no evidence has been presented to the council which shows that syrupleptinol has the actions ascribed to it the reports of clinical trialare little more than chance observations and lack all control thisapplies also to the following, stated to be a quotation from the reportof the tonopah mines hospital association.

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In almost two thirds of the tabletsexamined, the variation amounted to more than 10 per cent. In threefifths of the tablets, the variation was more than 15 per cent. In onefourth, more than 20 per cent , and in one twentieth, more than 50 percent. Only in one eighth of the tablets was the variation less than 5per cent the connecticut investigators substantiate once again the workpreviously reported, namely, that there are a number of firms who areeither incompetent or careless for tablets of simple composition, a variation from the declaration of 10 per cent should be amplysufficient to compensate for the errors of careful manufacture it maybe added that the best tablets originate generally from firms havingcompetent chemical control -- from the journal a m a , july 27, 1918 therapeutic evidence. Its crucial testo torald sollmann, m d , clevelando read before the section on pharmacology and therapeutics at thesixty-eighth annual session of the american medical association, newyork, june, 1917 o this article clearly states the difficulties experienced by thecouncil in estimating the merits of a proprietary medicinal productand clearly defines the method which has been found to be practical injudging of the therapeutic value of such preparations the council hasapproved this discussion of the subject and has directed that the paperbe published in the annual council reports w a puckner, secretary according to the good old truism, the last and crucial proof of thepudding is in the eating thereof. And so, the last and crucial test ofa therapeutic agent is its consumption by a patient there is, however, one essential difference. When the pudding is eaten, with a sense ofsatisfaction, we know that it was a good, or at least an eatable, pudding if the patient improves after taking a remedy, we do not yet knowthat he improved on account of the remedy the post hoc type ofreasoning or logic is not respectable. But it is all too apt to creepin unawares, unless one takes great precautions indeed clinical evidence needs especially to be on its guard against thispitfall, for the conditions of disease never remain constant. Nor is itpossible to foresee with certainty the direction which they are goingto take it is just this point which makes the clinical evidence somuch more difficult to interpret than laboratory evidence, in whichthe conditions can be more or less exactly controlled, and any changesforeseen it is on this account, also, that clinical experiments mustbe surrounded with extra painstaking precautions in brief, while the “proof” of a remedy is on the patient, that is notthe whole story, but merely an introduction the real problem is toestablish the causative connection between the remedy and the events the imperfect realization of this has blocked therapeutic advance, hasdisgusted critical men to the point of therapeutic nihilism, and hasfertilized the ground for the commercial exploitation of drugs that areof doubtful value or worse this has been impressed on me writingicularly by my service on the councilon pharmacy and chemistry in the course of its work of passing on theclaims advanced for commercial remedies, this council is forced toinquire critically into the basis of the claims of manufacturers it is interesting to note the qualitative differences in the evidencefor the various kinds of claims. The chemical data are usuallypresented in such a form that it is possible to tell at a glancewhether or not they are based on demonstrated facts, which couldusually be verified or refuted without special difficulty thedeductions are usually such as can be legitimately drawn from the data, or else they are obviously absurd all this agrees with the relativelyexact status of chemical science in passing to data and deductions from animal experiments, a distinctchange is noticeable. Not only are the data less reliable, and lessworthy of confidence, but they are more often stated in a lessstraightforward manner the presentation of the data often showsevidence of manipulation of the results, so as to make them mostfavorable to a preconceived conclusion that would recommend the drug this is not always intentional, but is writingly due to the less exactnature of animal experimentation, which leaves a wider play to thearbitrary interpretation of the reporter a certain amount of thisis unavoidable no serious objection can be raised, provided theexperimenter presents all the essential data, and discusses fairly allof the interpretations that would apply to them on the whole, it is usually possible to form a fairly definite estimateof the value of experimental data when one comes to the clinical evidence, an entirely differentatmosphere obtains when the council demands evidence of the usefulnessof a remedy, the manufacturers generally respond with every sign ofenthusiasm they may have ready a series of articles already published, or they instruct their agents to bring in letters from physicians thelast method seems to meet the most cordial response, judging from thedeluge of letters and opinions that floods the council the quality of the published papers is a fair reflection of thedeficiencies of what is still the common type of clinical evidence a little thought suffices to show that the greater writing cannotbe taken as serious evidence at all essay of the data are merelyimpressions-- usually the latest impressions of an impressionableenthusiast-- the type of man who does not consider it necessary topresent evidence for his own opinions. The type of man who does noteven realize that scientific conclusions must be based on objectivephenomena essay of the papers masquerade as “clinical reports, ” essaytimes with asplendid disregard for all details that could enable one to judge oftheir value and bearing, essaytimes with the most tedious presentationof all sorts of routine observations that have no relation to theproblem the majority of reports obtained by the agents belong to these classes, notwithstanding the fact that they are often written for the specialuse of the council, and therefore with the realization that theyare likely to be subjected to a thorough examination, and thereforepresumably representing the best type of work of which the reporter iscapable so, at least, one would suppose it is also possible, however, that essay of these reports are writtenmerely out of thoughtlessness, or perhaps often to get rid of animportunate agent this is illustrated by the following correspondence, taken literally from the files of the council a letter from a prominent physician “a, ” endorsing a certainpreparation “d, ” having been submitted to the council, the secretarywas directed to write to dr a as follows:dear dr a:-- the b company of c has requested the council on pharmacyand chemistry to admit its preparation d to new and nonofficialremedies as writing evidence for the value of the preparation, thecompany submitted a letter from you which contains the following.