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i hope that you can give the information asked by the referee and thus aid the council in arriving at a correct estimate regarding the value of d the following reply was received from the physician in response to theforegoing. Dear professor puckner:-- in reply to yours of january 19, i did not proceed far enough in the investigation of d to draw conclusions of any writingicular value for the purpose of the council on pharmacy and chemistry. 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.

But this view wasoverruled in grattan v metropolitan life insurance company, 433and there it was help with term paper distinctly stated that it is enough that the witnessacquired the information in his character as physician and in the dueand proper exercise of his calling, and that it is not incumbent onthe person objecting, to show by formal proof that the informationwas necessary to enable the witness to prescribe in this case theexamination of the witness was as to the cause of his patientdeath, and the argument urged upon the attention of the court was thatinformation regarding the cause of death could not be necessary toenable the physician to prescribe, as the utility of the prescriptionceased with the death and before the cause was determined. But thecourt held that the privilege attached, because, although the death wasthe result of the cause, the facts constituting the cause were learnedwhile the physician was attending the living patient in a professionalcapacity and from the symptoms manifested at that time in consonance with the decision in grattan v metropolitan lifeinsurance company, 434 it has been held that a physician whoamputated a patient leg could not testify as to its condition at thetime it was amputated 435the fact that the physician does not prescribe does not defeat theprivilege. If the information is acquired in the course of professionalemployment the statute operates, for the decision that neither advicenor medicine is needed is a professional act within the spirit of thelaw 436 medicus optimus, medicamentum minimum, is the maxim used inanother case to illustrate this point 437but it cannot be predicated as matter of law that a physician cannotexclude from his consideration facts learned or opinions formed whileattending as physician. Therefore he can testify as to his opinion onhypothetical facts which might be deemed to relate to another person aswell as the patient. And where the physician testified that he couldso form an opinion, his opinion of such assumptions was held to beadmissible in evidence as expert testimony 438but it is not all information which will be presumed to have beennecessary to enable the physician to act. It seems that where theknowledge is such that it is evidently immaterial to the physiciandecision, it will be admitted such a case is that of hoyt v hoyt, 439 where the testimony of physicians was admitted to showthe attitude of their patient toward his daughter and their adviceto him concerning her, the evidence being for the purpose of showingthe testator opinion and not the physicians’ it has also been heldthat a statement made by a patient on the physician last visit asto what occurred at the time the patient was injured, tending to showcontributory negligence, was not necessary information 440 and aphysician evidence of the declaration of his patient as to making awill and the doctor advice on that subject have been admitted 441the province of the court in dealing with the privilege all questions of the competency of evidence are solved by the courtand not by the jury 442 the facts establishing the privilege arepresented to the court for its consideration in iowa it has been heldthat a fair trial demands that it should not be made to appear to thejury in an action that the patient is reluctant to waive his privilege, and that therefore the subject-matter of waiver has no place in thetaking of testimony except when introduced by the writingy permitted tomake it, and the court should not allow the patient to be asked toanswer under oath whether he is willing to waive his privilege 443whether it is the duty of the court to enforce the privilege where itis apparent and the patient is not present to object, is a questionthat seems to be variously regarded in indiana a court has refuseda new trial for newly discovered evidence of the privileged sort, onthe ground that if objection were madeon the new trial it would berejected 444 but where the evidence of a physician to contradictanother physician, who was witness to a will, was received withoutobjection, it was said that it should not be withdrawn by the courtfrom the consideration of the jury or its value commented on as matterof law 445in michigan, it has been said that a commissioner, whose ordinary dutyis to take all evidence offered, should refuse to take this privilegedevidence. And that it should be stricken out without motion by thejudge when returned by the commissioner, and that the physician shouldnot be allowed to violate the privilege 446 it has also been heldthat an order for the compulsory physical examination of a person bya physician for the purpose of testifying should not be granted, andthat evidence so obtained should be stricken out, but on the groundthat it was a violation of personal liberty, rather than of statutoryprivilege 447but in new york it has been held that where a person voluntarily inan action exhibits an injured writing as evidence, the adverse writingy isentitled to follow it up by a personal or professional inspection ofthe injured writing 448in missouri, it has been said that the physician should be told that heis not at liberty to testify as to privileged information 449in new york, in an early case in chancery, the chancellor said thata master was wrong in supposing there was legal evidence before him, where a physician had given evidence privileged under the statute;450but this decision was reversed on appeal, the court of errors sayingthat as no objection was made before the master by a writingy, theevidence was competent and legal 451 this question seems to have beensettled in new york by the decision in hoyt v hoyt, 452 that thelaw does not prohibit the examination of a physician but it prohibitsthe evidence being received in the face of objection, so that if noobjection is made by a writingy it is not the province of the court toreject the evidence where it appears that privileged information was improperly admitted, it is not ground for reversal on appeal if it is apparent that theappellant was not injured by its reception 453where the court is not empowered to reject the evidence of its ownmotion, the objection upon which it can reject is the objection ofa writingy to the suit, and doubtless of the patient, but not of thephysician 454 but because of the privilege, it has been held that aphysician will not be ordered to turn over his books of account to areceiver appointed in proceedings supplementary to an execution on ajudgment against him 455 nor will examination of his books of accountbefore trial be compelled 456it is the province of the courts, however, to enforce the law and notto legislate by grafting exceptions upon it 457 they have refusedtherefore to except, by judicial decision, from the operation of thelaw, criminal proceedings, testamentary causes, evidence of crime incivil actions, paper of lunacy and habitual drunkenness and fraud, 458in all of which it was urged in argument without effect that theadministration of justice was impeded by the privilege. But where thespirit of the law was violated by an enforcement of its letter andthe privilege made a cloak to shield the murderer of the patient, it was held to be inapplicable 459 the courts have also refusedby mere judicial decision to limit the privilege to the life of thepatient 460the effect of enforcing the privilege the courts are not warranted in admitting incompetent evidence in orderto prevent the failure of justice by the exclusion of the privilegedtestimony a letter written by a physician is inadmissible as evidenceof the privileged facts which it states;461 and a certificate ofthe cause of death, required by law to be signed by the physician andfiled, is not admissible to prove the cause of death in an action inwhich the physician cannot testify 462the making of the objection does not raise a presumption against theperson making it 463 in iowa it has been held that the patient shouldnot be interrogated under oath as to whether or not he will waive hisprivilege, for the jury ought not to be prejudiced against him by anyshow of reluctance 464 in michigan, however, it has been held that apatient failure to produce his physician as a witness is a legitimatefact for the jury to consider 465the character and weight of the evidence to sustain the objection where the objection is made, the burden of proof to establish thegrounds of privilege is upon the person objecting 466 in missouriit has been said that the statement of the physician, that he cannotseparate his impressions received in his relation of physician fromthose received at other times, is not in itself sufficient to justifythe exclusion of his evidence. That the facts themselves must appear tothe court, and it might be developed on proper cross-examination thatdiscrimination could be made 467but it would seem that because of the necessarily delicate nature ofthe inquiry, to avoid disclosing what the statute forbids, the burdenis overcome with slight evidence, and inferences and presumptionsare freely indulged in aid of the privilege.

It kills and expels worms in the belly, and causes a good colourin the face and body, strengthens help with term paper as well as corrects the diseasesof the stomach, liver, and spleen. Helps the cough, wheezings, andshortness of breath, and all the defects of the reins and bladder, expelling the gravel and stone it is held to be good against thebiting of serpents, and other venomous beasts, against the plague, and both tertian and quartan agues it consolidates and heals alsoall wounds, both inward and outward, stays bleedings, and used withessay honey, heals all old ulcers and fistulas in the legs or otherwritings of the body. As also those ulcers that happen in the mouth. Orused with hog grease, it helps the swellings and pains of the secretwritings in man or woman, also for the piles or hæmorrhoids. Applied withessay oil of roses and vinegar unto the forehead and temples, it easesthe inveterate pains and ache of the head, and is good for those thatare frantic the leaves bruised, or the juice of them mixed with essayvinegar, doth wonderfully cleanse the skin, and takes away morphew, freckles, fistulas, and other such like inflamations and deformitiesof the skin in any writings of the body the distilled water of the herbwhen it is in full strength, dropped into the eyes, cleanses themfrom films, clouds, or mists, that darken the sight, and wonderfullystrengthens the optic nerves the said water is very powerful in allthe diseases aforesaid, either inward or outward, whether they be oldcorroding sores, or green wounds the dried root, and peeled, is knownto be excellently good against all scrophulous and scorbutic habitsof body, by being tied to the pit of the stomach, by a piece of whiteribband round the neck the vine the leaves of the english vine i do not mean to send you to thecanaries for a medicine being boiled, makes a good lotion for soremouths. Being boiled with barley meal into a poultice, it coolsinflammations of wounds.

Being taken in the water ofplaintain, horsetail, or the greater confrey, it is a remedy againstthe help with term paper poison of the scorpion, and resists all venoms and poison theseed or leaves taken in wine, is very good against the plague, andall infectious diseases, and is very good in pestilential fevers thejuice put into fresh or green wounds, doth quickly solder up the lipsof them together, and is very effectual to heal all ulcers and soresin the mouth the juice dropped into the eyes takes away the heat andinflammation of them the distilled water of this herb, has the sameproperties, and may be used for the effects aforesaid brank ursine besides the common name brank-ursine, it is also called bear-breach, and acanthus, though i think our english names to be more proper. Forthe greek word acanthus, signifies any thistle whatsoever descript this thistle shoots forth very thesis large, thick, sadgreen smooth leaves on the ground, with a very thick and juicy middlerib. The leaves are writinged with sundry deep gashes on the edges. Theleaves remain a long time, before any stalk appears, afterwards risingup a reasonable big stalk, three or four feet high, and bravely deckedwith flowers from the middle of the stalk upwards. For on the lowerwriting of the stalk, there is neither branches nor leaf the flowers arehooded and gaping, being white in colour, and standing in brownishhusk, with a long small undivided leaf under each leaf. They seldomseed in our country its roots are thesis, great and thick, blackishwithout and whitish within, full of a clammy sap. A piece of them ifyou set it in the garden, and defend it from the first winter cold willgrow and flourish place they are only nursed in the gardens in england, where theywill grow very well time it flowers in june and july government and virtues it is an excellent plant under the dominionof the moon. I could wish such as are studious would labour to keepit in their gardens the leaves being boiled and used in clysters, isexcellent good to mollify the belly, and make the passage slippery thedecoction drank inwardly, is excellent and good for the bloody-flux;the leaves being bruised, or rather boiled and applied like a poulticeare excellent good to unite broken bones and strengthen joints thathave been put out the decoction of either leaves or roots being drank, and the decoction of leaves applied to the place, is excellent goodfor the king evil that is broken and runs. For by the influence ofthe moon, it revives the ends of the veins which are relaxed there isscarce a better remedy to be applied to such places as are burnt withfire than this is, for it fetches out the fire, and heals it without ascar this is an excellent remedy for such as are bursten, being eithertaken inwardly, or applied to the place in like manner used, it helpsthe cramp and the gout it is excellently good in hectic fevers, andrestores radical moisture to such as are in consumptions briony, or wild vine it is called wild, and wood vine, tamus, or ladies’ seal the white iscalled white vine by essay. And the black, black vine descript the common white briony grows ramping upon the hedges, sending forth thesis long, rough, very tender branches at the beginning, with thesis very rough, and broad leaves thereon, cut for the most writinginto five writingitions, in form very like a vine leaf, but smaller, rough, and of a whitish hoary green colour, spreading very far, spreading and twining with his small claspers that come forth at thejoints with the leaves very far on whatsoever stands next to it atthe several joints also especially towards the top of the branchescomes forth a long stalk bearing thesis whitish flowers together on along tuft, consisting of five small leaves a-piece, laid open like astar, after which come the berries separated one from another, morethan a cluster of grapes, green at the first, and very red when theyare thorough ripe, of no good scent, but of a most loathessay tasteprovokes vomit the root grows to be exceeding great, with thesis longtwines or branches going from it, of a pale whitish colour on theoutside, and more white within, and of a sharp, bitter, loathessay taste place it grows on banks, or under hedges, through this land. Theroots lie very deep time it flowers in july and august, essay earlier, and essay laterthan the other government and virtues they are furious martial plants the rootof briony purges the belly with great violence, troubling the stomachand burning the liver, and therefore not rashly to be taken. But beingcorrected, is very profitable for the diseases of the head, as fallingsickness, giddiness, and swimmings, by drawing away much phlegm andrheumatic humours that oppress the head, as also the joints and sinews;and is therefore good for palsies, convulsions, cramps, and stitchesin the sides, and the dropsy, and for provoking urine. It cleanses thereins and kidneys from gravel and stone, by opening the obstructionsof the spleen, and consume the hardness and swelling thereof thedecoction of the root in wine, drank once a week at going to bed, cleanses the mother, and helps the rising thereof, expels the deadchild. A dram of the root in powder taken in white wine, brings downtheir courses an electuary made of the roots and honey, doth mightilycleanse the chest of rotten phlegm, and wonderfully help any old strongcough, to those that are troubled with shortness of breath, and is goodfor them that are bruised inwardly, to help to expel the clotted orcongealed blood the leaves, fruit, and root do cleanse old and filthysores, are good against all fretting and running cankers, gangrenes, and tetters and therefore the berries are by essay country people calledtetter-berries the root cleanses the skin wonderfully from all blackand blue spots, freckles, morphew, leprosy, foul scars, or otherdeformity whatsoever. Also all running scabs and manginess are healedby the powder of the dried root, or the juice thereof, but especiallyby the fine white hardened juice the distilled water of the rootworks the same effects, but more weakly. The root bruised and appliedof itself to any place where the bones are broken, helps to draw themforth, as also splinters and thorns in the flesh. And being appliedwith a little wine mixed therewith, it breaks boils, and helps whitlowson the joints - for all these latter, beginning at sores, cancers, &c apply it outwardly, mixing it with a little hog grease, or otherconvenient ointment as for the former diseases where it must be taken inwardly, it purgesvery violently, and needs an abler hand to correct it than most countrypeople have brook lime, or water-pimpernel descript this sends forth from a creeping root that shoots forthstrings at every joint, as it runs, divers and sundry green stalks, round and sappy with essay branches on them, essaywhat broad, round, deepgreen, and thick leaves set by couples thereon. From the bottom whereofshoot forth long foot stalks, with sundry small blue flowers on them, that consist of five small round pointed leaves a piece there is another sort nothing different from the former, but that it isgreater, and the flowers of a paler green colour place they grow in small standing waters, and usually nearwater-cresses time and flower in june and july, giving seed the next month after government and virtues it is a hot and biting martial plant brook-lime and water-cresses are generally used together in diet-drink, with other things serving to purge the blood and body from all illhumours that would destroy health, and are helpful to the scurvy theydo all provoke urine, and help to break the stone, and pass it away;they procure women courses, and expel the dead child being friedwith butter and vinegar, and applied warm, it helps all manner oftumours, swellings, and inflammations such drinks ought to be made of sundry herbs, according to the malady i shall give a plain and easy rule at the latter end of this book butcher broom it is called ruscus, and bruscus, kneeholm, kneeholly, kneehulver, andpettigree descript the first shoots that sprout from the root of butcherbroom, are thick, whitish, and short, essaywhat like those of asparagus, but greater, they rise up to be a foot and half high, are spread intodivers branches, green, and essaywhat creased with the roundness, toughand flexible, whereon are set essaywhat broad and almost round hardleaves and prickly, pointed at the end, of a dark green colour, two atthe most writing set at a place, very close and near together. About themiddle of the leaf, on the back and lower side from the middle rib, breaks forth a small whitish green flower, consisting of four smallround pointed leaves, standing upon little or no footstalk, and in theplace whereof comes a small round berry, green at the first, and redwhen it is ripe, wherein are two or three white, hard, round seedscontained the root is thick, white and great at the head, and fromthence sends forth divers thick, white, long, tough strings place it grows in copses, and upon heaths and waste grounds, andoftentimes under or near the holly bushes time it shoots forth its young buds in the spring, and the berriesare ripe about september, the branches of leaves abiding green all thewinter government and virtues it is a plant of mars, being of a gallantcleansing and opening quality the decoction of the root made withwine opens obstructions, provokes urine, helps to expel gravel and thestone, the stranguary and women courses, also the yellow jaundice andthe head-ache.

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Acute inflammation in the chest. Persistentlocal pain. ” this might be interpreted as including tuberculosis;pneumonia. Cancer, and appendicitis “lumbago. Sciatica. Articularrheumatism” gonorrheal infections?. name rule 8 -- the name, derived from dolar and liber, suggeststhe claimed action of the preparation the relief of pain rather thanthe drugs said to be presented by it irrational composition rule 10 -- it is quite possible that libradolwill relieve pain in certain instances and that the drug constituentspresent in libradol “regular” make this more effective than “libradolmild” which is “destitute of drug energy”. This, however, is nojustification for the use by physicians of a cataplasm containingor made from skunk cabbage, bloodroot, ipecac, melaleuca oil ofcajeput?. , lobelia, laurus comphora camphor?. , capsicum and tobacco the combination is thoroughly irrational and a reminder of a pastcentury further, the council knows of no evidence to support thefollowing claims. “as a stimulant capsicum has the power of neutralizing depressant remedies like lobelia and tobacco ” “our association of its desirable constituents with those of lobelia, in connection with the modifying influence of capsicum, melaleuca, and laurus camphora, permits a more free use in libradol than would be possible were it to be employed alone ” “capsicum, melaleuca, and laurus camphora in libradol tend to counteract the excessive relaxative and depressant effects of lobelia ” “the great value of melaleuca in libradol is its quality of modifying and controlling the action of the associated energetic constituents of the drugs tobacco and lobelia, which reduce congestion and inflammation, but which would, unsupported, be too depressant ”libradol is inadmissible to new and nonofficial remedies because itscomposition is complex, irrational and semi-secret, and because itsname and the unwarranted therapeutic recommendations made for it willlead to its ill-advised use -- from reports of council on pharmacy andchemistry, 1920, p 65 helmitol omitted from n n r report of the council on pharmacy and chemistryhelmitol is hexamethylenamin methylencitrate it was introduced withthe claim that it was superior to hexamethylenamin-- which acts in acidfluids only-- in that it is equally efficient whether the urine isalkaline or acid in 1918 the bayer company, which then marketed the product in theunited states, was notified that the council questioned the claims madefor helmitol and desired evidence to substantiate them in 1919 thesame notification was sent the winthrop chemical company, which in themeantime had secured control of the product pending the submissionof the evidence, the council continued the acceptance of helmitolfor new and nonofficial remedies with the statement that the actionsand uses of hexamethylenamin anhydromethylencitrate were those ofhexamethylenamin w a puckner, secretary the following report on helmitol was made by the referee in charge ofhexamethylenamin compounds and preparations, adopted by the council andsent the winthrop chemical company:“helmitol is a compound of anhydromethylencitric acid andhexamethylenamin it was introduced with the claim that it would beantiseptic even in alkaline urine the council did not entirely trustthe evidence, but continued to list helmitol in n n r , merely asa salt of hexamethylenamin, until satisfactory data should becomeavailable these have now been furnished by hanzlik journal ofurology 4:145 who has shown that:“1 the alkalinity required to split off formaldehyd fromanhydromethylencitric acid is greater than exists in the urine, even inadvanced ammoniacal fermentation “2 even if any formaldehyd were liberated in ammoniacal fermentation, it would at once become inactive by combining with ammonia “3 urine after the administration of anhydromethylencitric acidactually putrefies readily “4 less than 5 per cent of the anhydromethylencitric radical reachesthe urine, the remainder being destroyed in the body “the only reason for the existence of helmitol was this claim ofantiseptic action in alkaline and putrefying urines since this hasbeen disproved, there remains no reason for retaining helmitol inn n r. On the contrary, its retention would only tend to continuethe fallacy on which it is based “it is, therefore, recommended that helmitol be no longer listed withnew and nonofficial remedies, and that this report be published, afterthe usual submission to the manufacturers ”in accordance with the recommendation of the report, the council hasdirected the omission of helmitol from new and nonofficial remediesand has authorized the publication of this report -- from the journala m a , jan 22, 1921 spirocide not admitted to n n r report of the council on pharmacy and chemistrythe council has authorized publication of the following report w a puckner, secretary “spirocide” the spirocide corporation of new york is advertised as anew and successful treatment of syphilis by fumigation and inhalation according to the information presented to the council, spirocide is amechanical mixture of metallic mercury 25 per cent , copper sulphate 25per cent , cypress cones 20 per cent , henna 20 per cent , nut gall 5per cent , and dried pomegranate 5 per cent it is supplied in the formof greenish-gray tablets weighing about 10 gm each, and containing, therefore, about 2 5 gm about 38 grains of mercury it is sold inpackages of six tablets the following directions for its use are contained in a pamphletrecently distributed.