History

Cause/effect Essay


And i so stated in my letter to the proprietors of that remedy answers to the questions you put in your letter require an amount of investigation of the remedy far beyond anything i undertook as a matter of fact, i returned about five sixths of the capsules sent me, because of lack of time and opportunity to carry out the extensive clinical experiments that i plainly saw would be required to give an opinion at all worth while i believe you had better not consider me in the matter at all the report was furnished by a physician for whom i have a high personalregard i introduce it here, not so much in a spirit of criticism, but as a justification of the opinion that i have formed of clinicalevidence obtained by manufacturers through their clinical adjutors when commercial firms claim to base their conclusions on clinicalreports, the profession has a right to expect that these reportsshould be submitted to competent and independent review when suchreports are kept secret, it is impossible for any one to decide whatproportion of them are trustworthy, and what proportion thoughtless, incompetent or accommodating however, if this were done it is quitepossible that such firms would find much more difficulty in obtainingthe reports those who collaborate should realize frankly that underpresent conditions they are collaborating, not so much in determiningthe scientific value, but rather in establishing the commercial valueof the article often the best type of clinical reports-- those in which theobservations are directed to the significant events and not to mereside lines, and in which the significant events are correctly andadequately reported-- generally lack one important essential, namely, anadequate control of the natural course of the disease since this cannot be controlled directly, it must be compensatedindirectly for this purpose, there are available two methods:the first is the statistical method, in which alternate patientsreceive or do not receive the treatment this method can usuallyonly be of value when a very large series of patients is available even then, its value is limited or doubtful, because it cannot takesufficient account of the individuality of paper the second method consists in the attempt to distinguish unknownpreparations by their effects-- the method that might be called the“comparative method” or the “blind test ”in this, the patient, or a series of patients, is given the preparationwhich is to be tested, and another preparation which is inactive, and the observer aims to distinguish the two preparations by theireffects on the patient surely if the drug has any actions at all itwill be possible to select correctly in a decided majority of theadministrations the same principle can be applied in distinguishing the superiorityof one preparation over another in this case, the two preparationswould be given alternately to different patients, and the observerwould try to distinguish them by their effects here again, if onedrug is really superior or otherwise different from another, to apractically important extent, the observer will surely be able to makethe distinction this method is really the only one that avoids the pitfalls of clinicalobservation. It is the only method that makes the results purelyobjective, really independent of the bias of the observer and thepatient it is the only method, therefore, which determines whether itwas really the pudding that was eaten and not essay other dessert in principle this method does not usually offer any very greatdifficulties it is, of course, necessary that the two preparationsto be compared shall resemble each other so closely or shall beflavored, etc , so that they cannot be distinguished by their physicalproperties this is usually not a very difficult matter the methoddoes not jeopardize the interests of the patient, for it is understoodthat no drug would be tested in this way unless there is essay reasonto believe that it has a value when the patient condition is suchas to demand treatment, then he would be receiving either the standarddrug or the drug which the experimenter believes may be superior to thestandard conclusionsthe final and crucial test of a remedy is on the patient. But thetest must be framed so as to make it really crucial most clinicaltherapeutic evidence falls far short of this the “blind test” is urgedto meet the deficiencies -- from the journal a m a , july 21, 1917 “vaccines in toxic conditions” commercialized propaganda in the guise of scienceunder the title “vaccines in toxic conditions, ” what purports to bea scientific contribution appears in the original dewritingment of theofficial organ of a state medical society 311 the apparent purpose ofthe article is to overcome any hesitancy on the writing of practitionersto use vaccines in toxic infectious conditions for fear that theymight thereby cause harm such a thesis is interesting and might beimportant-- if true two outstanding facts, however, give pause first, the theory promulgated is contrary to the experience of those whohave studied the subject. Second, the man who writes the article isin the business of making and selling vaccines!. the former fact is amatter of fairly general knowledge among the better informed membersof the medical profession. The latter fact is nowhere made evident inthe article, which the reader might infer came from a disinterestedinvestigator in the realms of immunology 311 sherman, g h.

Eitherof them being gone, so is the virtue also chapter iii of seeds 1 the seed is that writing of the plant which is endowed with a vitalfaculty to bring forth cause/effect essay its like, and it contains potentially the wholeplant in it 2 as for place, let them be gathered from the place where they delightto grow 3 let them be full ripe when they are gathered. And forget not thecelestial harmony before mentioned, for i have found by experience thattheir virtues are twice as great at such times as others. “there is anappointed time for every thing under the sun ”4 when you have gathered them, dry them a little, and but a little inthe sun, before you lay them up 5 you need not be so careful of keeping them so near the fire, asthe other before-mentioned, because they are fuller of spirit, andtherefore not so subject to corrupt 6 as for the time of their duration, it is palpable they will keep agood thesis years. Yet, they are best the first year, and this i makeappear by a good argument they will grow sooner the first year they beset, therefore then they are in their prime. And it is an easy matterto renew them yearly chapter iv of roots 1 of roots, chuse such as are neither rotten nor worm-eaten, butproper in their taste, colour, and smell. Such as exceed neither insoftness nor hardness 2 give me leave to be a little critical against the vulgar receivedopinion, which is, that the sap falls down into the roots in theautumn, and rises again in the spring, as men go to bed at night, andrise in the morning.

Both are hot and dry inthe third degree, purge violently, yet are held to be wholeessayphysic for such as have dropsies, vertigo, or swimming in the head, falling-sickness, &c certainly it is a strong, troubleessay purge, therefore not to be tampered with by the unskilful, outwardly inointments it takes away freckles, wrinkles, morphew, scars, spots, &c from the face bursa pastoris shepherd purse, is manifestly cold and dry, thoughlobel and pena thought the contrary. It is binding and stops blood, the menses. And cools inflammations buglossom buglosse its virtues are the same with borrage bugula bugle, or middle comfrey. Is temperate for heat, but verydrying, excellent for falls or inward bruises, for it dissolvescongealed blood, profitable for inward wounds, helps the rickets andother stoppings of the liver. Outwardly it is of wonderful force incuring wounds and ulcers, though festered, as also gangreens andfistulas, it helps broken bones, and dislocations inwardly you maytake it in powder a dram at a time, or drink the decoction of it inwhite-wine. Being made into an ointment with hog grease, you shallfind it admirable in green wounds buphthalmum, &c ox eye matthiolus saith they are commonly usedfor black hellebore, to the virtues of which i refer buxus boxtree. The leaves are hot, dry, and binding, they areprofitable against the biting of mad dogs. Both taken inwardly boiledand applied to the place. Besides they are good to cure horses of thebots calamintha, montana, palustris mountain and water calamint. Forthe water calamint. See mints, than which it is accounted stronger mountain calamint, is hot and dry in the third degree, provokes urineand the menses, hastens the birth in women, brings away the placenta, helps cramps, convulsions, difficulty of breathing, kills worms, helpsthe dropsy. Outwardly used, it helps such as hold their necks on oneside. Half a dram is enough at one time galen, dioscorides, apuleius calendula, &c marigolds the leaves are hot in the second degree, and essaything moist, loosen the belly. The juice held in the mouth, helps the toothache, and takes away any inflammation or hot swellingbeing bathed with it, mixed with a little vinegar callitricum maiden-hair see adianthum caprisolium honey-suckles.

Wien klin wchnschr 26:1664, 1913 within a very few months after wassermann publication, neubergand caspari268 published a paper which was the first of a seriesof studies on the therapeutic effects of the heavy metals on theanimal tumors they used zinc, platinum, tin, selenium, copper, silver and cobalt in the form of certain complex organic compounds, the composition of which is not revealed owing to the fact thatintravenous injections of these compounds produced a specific effect onthe tumors, they are described as “tumoraffin” substances immediatelyafter the intravenous injection of these preparations, there followeda marked hyperemia of the tumor, whereas the remainder of the mousebody appeared markedly anemic the hyperemia was often attendedby hemorrhage into the tumor this first stage was succeeded byliquefaction and absorption followed by recovery in favorable paper the authors failed to state in what proportion of their experiments theanimals died, and in what proportion recovery ensued the second paper on this subject is by neuberg, caspari and löhe, 268in which further details are vouchsafed they state that with thecompounds used by them the toxic and the therapeutic doses approximatevery closely, from which it follows that the treatment, as with thewassermann method, results in a very high mortality smaller cause/effect essay dosesproduce no therapeutic effect. On the contrary, they seem to act asa stimulus to the tumor, accelerating the normal rate of growth spontaneous tumors show similar effects, but no cures are recorded only in tumors in which autolysis is active intra vitam does themethod exert any effect consequently the benign primary tumors ofanimals, such as fibromas, are not influenced by it neuberg and caspari are to a great extent responsible for the colloidaltheory of treatment in tumors accepting the observations of petri andothers that the autolytic ferments in tumors are quantitatively greaterand qualitatively different from those present in the normal tissuesof the body, they venture the assumption that the process of recoveryin the experimental tumors of animals is due to the self-digestion ofthe tumor by these ferments ascoli and izar271 had shown that suchferments are materially stimulated by the presence of metals, and moreespecially of metals in colloidal form this contention is apparentlyin harmony with the well-established fact that certain colloidal metalsof themselves are capable of acting under certain circumstances asferments neuberg and caspari were at first of the belief that thecompounds produced by them circulate in colloidal form subsequentlythey stated that these compounds were crystalline substances, but theyassumed, under the influence of the theoretical consideration mentionedabove, that these substances are broken up in the tumor and thereundergo transformation into the colloid state 271 izar. Ztschr f immunitätsforsch , 1913 izar and basile. Berl klin wchnschr , 1913, p 1312 in connection with the preceding observations there are certain otherexperimental results which require mention izar271 succeeded incuring rat tumors by means of injection of colloidal sulphur c lewin272 cured subcutaneous mouse tumors with various preparationsof gold werner and szécsi273 produced similar results througha combination of selenium-vanadium with cholin-borate. In theseexperiments the selenium-vanadium was supposed to be present incolloidal form 272 lewin, carl. Berl klin wchnschr , 1913, p 147. Berl klin wchnschr , 1913, p 541 273 werner and szécsi. Ztschr f chemotherap , 1913, orig , i, 358 szécsi. Ibid , ref , 1913, ii, 1060 within a comparatively brief period of time, therefore, it fell to thelot of a number of observers, using strikingly different substances, to produce therapeutic effects amounting in a certain percentage ofpaper even to cure in the experimental tumors of the lower animals the various procedures have little in common both metals andnonmetallic substances have been employed either in colloidal form orin combination with organic radicals in essay instances a diffusiblecarrier is combined with the basic substances. In others not all ofthe preparations appear to possess a high degree of toxicity, althoughadequate data on this very essential feature are almost invariablywithheld wassermann results with eosin-selenium were soon critically examinedby other observers uhlenhuth274 and contamin275 were unable toconfirm his observations, but their negative results are attributedby keysser to the fact that they were not in possession of the properformula for the preparation of the eosin-selenium compounds as usedby wassermann apolant, 276 however, in ehrlich name confirmedwassermann findings 274 uhlenhuth, dold and bindseil.

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