By V. Umbrak. University of Rio Grande. 2018.
For example effective wellbutrin sr 150mg mood disorder rapid cycling, more than 60 percent of gravidas had never heard of fetal alcohol syndrome and were not aware of the adverse effects of alcohol on pregnancy in several surveys safe wellbutrin sr 150 mg depression jokes one liners. Patient education prior to concep- tion is obviously the best intervention, but very little funding is available for this. In addition, social and cultural barriers must also be overcome for the patient education process to be successful. Even the most well-educated obstetrical patients have culturally based ‘folk etiologies’ that they believe explain the occurrence of birth defects and other adverse pregnancy outcomes that are usually not correlated with medically founded causes. The author has counseled gravid physicians who were not entirely correct in their understanding of pre- natal development and how the environment can be a disruptive influence. Folk or cul- ture-specific explanations and educational background must therefore be considered when counseling the obstetrical patient of specific risks to pregnancy, including expo- sures to medications, drugs, and chemicals. Prevalence of medication use varied from less than 10 percent of pregnant women to Clinical evaluation 3 more than 95 percent. For example, in one comprehensive study in the United States of tens of thousands of patients, women received an average of 3. The high end estimates are probably closer to the prevalence in 2004, and this is an international pattern and problem. However, safety may be questionable or simply unknown in many instances (Polifka and Friedman, 2002), primarily because of the paucity of clini- cal teratology research conducted over the last two decades (Lo and Friedman, 2002). Three scenarios describe inadvertent drug exposure during pregnancy: (1) some med- ications are taken before the pregnancy is recognized; (2) some medications are taken without the physician’s advice once the pregnancy is recognized; and (3) some are taken with physician’s advice. In practice, the predominant case is for physicians to be faced with determining whether or not a medication or drug may be harmful to a pregnant woman or her unborn child after the exposure has occurred. Nonmedical exposures to drugs during pregnancy occur in suicide gestures (technically a subcategory of substance abuse) and substance abuse (i. Substance abuse during pregnancy is much more prevalent than suicide gestures, and is discussed in Chapter 15. Briefly, an estimated 10–20 percent of pregnant women use an illicit substance and/or alcohol dur- ing their pregnancies. Marked differences in the physiology of these components exist because of dif- ferences in the purposes of the cells, or the end points of cell division (replacement versus morphogenesis versus hyperplastic growth) and the metabolic capabilities of the mother and the developing conceptus. In the embryo, organs are being formed, and drugs cannot be metabolized at adult or fetal rates, if at all. Most of the fetal period is occupied with growth in size of organs, not usually their formation, and these are growing very rapidly. Fetal enzyme systems involved in drug metabolism are only beginning to function, and some will not be active until after the neonatal period (e. Pregnant women have the full enzyme complement for metabolizing drugs, but most such systems have lower activity during pregnancy, as does cholinesterase (Pritchard, 1955), which metab- olizes cocaine. Therefore, the responses of adults, fetuses, embryos, and pregnant women to drugs (pharmacodynamics, pharmacokinetics) differ markedly (Little, 1999). Therefore, it is important to differentiate the effects of drugs and chemicals upon these distinctly dif- ferent components of pregnancy. We shall repeatedly observe that many drugs and chem- icals have different effects on these three components of pregnancy. Teratogenic maternal diseases include disorders such as diabetes mellitus and phenylketonuria. Agents that cause defects during the postem- bryonic (fetal) period are termed to have the potential for producing adverse ‘fetal effects. A simplified overview of the differences between the embryonic and fetal periods should be presented during consultation to clarify status for the patient. The period of the embryo should be described as the growth of cells that all look alike (i. These specialized cell lines or lineages grow in number and change in struc- ture and arrangement, giving rise to organs and tissues.
From the medical point of view discount wellbutrin sr 150mg otc depression cherry lyrics, antifungal drugs are con- sidered dermatophytic proven 150 mg wellbutrin sr depression lack of motivation, mucocutaneous, and systemic. Amphotericin B: Amphotericin B, [1R(1R∗,3S∗,5R∗,6R∗,9R∗,11R∗,15S∗,16R∗,17R∗, 18S∗,19E∗,21E∗,23∗,25E∗,27E∗,29E∗,31E∗,33R∗,35S∗,36R∗,37S∗)]-33-[3-amino-3,6- dideoxy-β-D-mannopyranosyl)-oxy]-1,3,5,6,9,11,17,37-octahydroxy-15,16,18-trimethyl- 13-oxo-14,39-dioxabicyclo [33. The antifungal activity of amphotericin B is exhibited because it binds with sterols, in particular with ergosterol in the cellular membrane of sensitive fungi. This reaction makes pores in the membrane and increases the perme- ability of the membrane to small molecules, thus reducing the function of the membrane as an osmotic barrier and making the cells more sensitive to being destroyed. However, this compound is not highly selective and reacts with host mammalian cells. Despite the many side effects, amphotericin B remains the primary drug for treating severe, acute systemic fungal infections. It is used for generalized fungal infections, such as can- didomycosis, aspergillosis, histoplasmosis, cryptococcosis, coccidioidomycosis, blasto- mycosis, and pulmonary mycoses. The mechanism of antifungal activity is similar to the mechanism of action of ampho- tericin B. It is used for preventing and treating candida infections of the skin and mucous membranes. In terms of preventative action, it is used for preventing the development of candidomycosis during prolonged treatment with penicillin drugs and antibiotics of other group, especially during oral use of tetracycline antibiotics, levomecytin, and others. Synonyms of this drug are biofanal, moronal, nicporil, fazigin, candex, and others. Natamycin: Natamycin, a mixture of stereoisomeric 22-[(3-amino-3,6-dideoxy-β-D- mannopyranosyl)oxy]-1,3,26-trihydroxy-12-methyl-10-oxo-6,11,28-trioxatricy- clo[22. It exhibits especially pronounced activity against a few strains of Fusarium and Cefalosporium. Natamycin is a drug for treating superficial fun- gal infections, and it is used only for ophthalmologic purposes. They are ketoconazole, miconazole, clotrimazole, econazole, butoconazole, and others. Antifungal Drugs The antifungal activity of imidazole derivatives is currently explained by their ability to selectively raise the permeability of the membrane of fungal cells by interfering with the biosynthesis of sterins, in particular ergosterin, by inhibiting its synthesis and by changing the lipid content of the membrane. However, unlike amphotericin B, benzimidazole deriv- atives are active only against growing cells. This drug does not affect host cells because mammals use exogenic sterols for their vital functions. Acylating the hydroxyl group of this compound with benzoyl chloride, and then alkylating the resulting compound with imidazole gives the derivative (35. Next, alkaline hydrolysis removes the benzoyl group, and a reaction with methanesulfonyl chloride gives a mesylate (35. Finally, alkylating the resulting 1-acetyl-4-(4-hydroxyphenyl)piperazine gives ketoconazole (35. It possesses fungicidal and fungistatic activity with respect to dermatophytes, yeast fungus, dimorphous fungi, and eumycetes. It is effective for chronic diseases, treating fungal infections of the gas- trointestinal tract, sex organs, skin, hair, and nails. It is used in combination with shampoo for treating and preventing mycelial fungi, seborrheic dermatitis, and dandruff. Reducing the carbonyl group in this molecule with sodium borohydride gives 1-(2,4-dichlorophenyl)-3-(1-imidazolyl)-ethanol (35. It differs in the presence of a single chlorine atom in the benzyl part of the molecule, and it is synthesized in the same manner, except that it uses 4-chlorobenzylchloride in the last stage instead of 2,4-dichlorobenzylbromide [22–24]. It differs in the replacement of the etheral oxygen bridge (which connects the 4-chlorobenzyl part of the molecule with phenethylimidazole) for a thioether bond. The corresponding changes in the synthesis of this drug are the replacement of the hydroxyl group in 1-(2,4-dichlorophenyl)-2-(1-imidazolyl)-ethanol (35. The hydroxyl group in the last is replaced with a chlorine atom upon reaction with thionyl chloride, which is then by the reaction with 2,6- dichlorothiophenol butoconazole [27,28], is obtained. It is believed that butocona- zole, like miconazole, econazole, and other “pure” representatives of the imidazole class, also inhibits the biosynthesis of estrosterin in the cytoplasmatic membrane of fungi; how- ever, it is very possible that this is not the only mechanism of its action. It is synthesized from 2,4-dichloroacetophenone, which is reacted with glycerol in the presence of p-toluenesulfonic acid to make a ketal, 2-(2,4-dichlorophenyl)- 2-methyl-4-hydroxymethyl-1,3-dioxolane (35.
Inspect visually for particulate matter or discolor- ation prior to administration and discard if present wellbutrin sr 150 mg without a prescription depression symptoms hindi. Technical information Incompatible No information with Compatible with Flush: NaCl 0 buy cheap wellbutrin sr 150mg online depression symptoms spanish. Monitoring Measure Frequency Rationale Observe For acute dystonias: the * To ensure that treatment is effective. Additional information Common and serious undesirable effects Common: Constipation, nausea, dry mouth, blurred vision, urinary retention. Action in case of overdose Symptoms to watch for: Agitation, restlessness and severe sleeplessness lasting 24 hours or more. Active measures such as the use of cholinergic agents or haemodialysis are unlikely to be of value. This assessment is based on the full range of preparation and administration options described in the monograph. Progesterone | 713 Progesterone 50mg/mL oily solution in 1-mL and 2-mL ampoules * Progesterone is a natural hormone that acts on the endometrium. Pre-treatment checks * Avoid in undiagnosed vaginal bleeding, missed or incomplete abortion, mammary or genital tract carcinoma, thrombophlebitis, cerebral haemorrhage, severe hepatic dysfunction. Technical information Incompatible Not relevant with Compatible with Not relevant pH Not relevant -- oily injection Sodium content Nil Excipients Contains benzyl alcohol. Visual disturbances On presentation * If unexplained, sudden or gradual, partial or complete loss of vision, proptosis or diplopia, papilloedema, retinal vascular lesions or migraine occur, the drug should be discontinued and appropriate diagnostic and therapeutic measures instituted. Additional information Common and serious Injection-related: Local: pain and swelling at the injection site. Action in case of Observe and if required symptomatic and supportive measures should be overdose provided. This assessment is based on the full range of preparation and administration options described in the monograph. Promethazine hydrochloride | 715 Prom ethazine hydrochloride 25mg/mL solution in 1-mL and 2-mL ampoules * Promethazine hydrochloride is a phenothiazine derivative. It acts as a sedating antihistamine with significant sedative, antimuscarinic, and some serotonin-antagonist properties. Pre-treatment checks * Avoid inpatientstakingmonoamine oxidaseinhibitors upto14dayspreviouslybecauseof "risk of extrapyramidal side-effects. Dose in hepatic impairment: avoid in severe liver disease, may precipitate coma and is hepatotoxic. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Take care to avoid extravasation or inadvertent intra-arterial injection (can cause necrosis and peripheral gangrene). Additional information Common and serious Immediate: Anaphylaxis and other hypersensitivity reactions have undesirable effects been reported very rarely. Other: Drowsiness, dizziness, restlessness, headaches, nightmares, tiredness, disorientation, blurred vision, dry mouth, urinary retention, rash, pruritus. Antidote: No known antidote; stop administration and give supportive therapy as appropriate. This assessment is based on the full range of preparation and administration options described in the monograph. Propranolol hydrochloride 1mg/mL solution in 1-mL ampoules * Propranolol hydrochloride is a non-cardioselective beta-adrenoceptor blocker. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Monitoring Measure Frequency Rationale Heart rate Continuously * Consider withholding therapy if pulse drops to 50-- 55 bpm or lower. Respiratory function After initial dosing * May cause bronchoconstriction in susceptible or oxygen saturation individuals, e. Antidote: Stop administration and give supportive therapy as appropriate (may include atropine, bronchodilators, glucagon, dopamine -- see relevant entries). Counselling Patients may experience fatigue and cold extremities during therapy, and should report wheezing.
It is soothing to irritable bronchial coughs and laryngeal spasm order wellbutrin sr 150mg mood disorder tbi, and in coughs from tickling in the throat; also in whooping cough and in spasmodic coughs of whatever character wellbutrin sr 150 mg line anxiety high blood pressure. Co-operatives—The agent acts similarly in a general way to opium, gelsemium, passiflora, the bromides, chloral and hyoscyamus. Therapy—The agent has been noted for its influence in haematuria and other mild forms of passive hemorrhage. It is of some benefit as a mild diuretic, soothing irritation of the renal or vesical organs. In cases of uncomplicated chronic menorrhagia it has accomplished permanent cures, especially if the discharge be persistent and devoid of much color. The agent is also useful where uric acid or insoluble phosphates or carbonates produce irritation of the urinary tract. In the treatment of mild forms of intestinal hemorrhage or gastric hemorrhage from simple ulceration, the agent has been used with some benefit, also in atonic dyspepsia, diarrhea, both acute and chronic, and in dysentery and bleeding piles. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 92 Externally the bruised herb has been applied to bruised and strained parts, to rheumatic joints, and where there was ecchymosis or extravasations within or beneath the skin. Heinen of Toledo treats non-malignant abdominal tumors in women with better results by adding five drops of capsella three times a day to the other indicated treatment. In large doses it causes vomiting, purging and inflammation of the stomach and bowels, with dizziness, intoxication and feebleness of the nervous power. It produces rapid capillary determination of the blood to the part, and if taken into the stomach it promotes its own absorption and thus continues its further influence through the nerve centers. Belonging as it does to the solanaceae, its influence upon the nerve centers, although insidious and not in all its field of exercise readily distinguishable, is nevertheless active and most important, demanding its classification among the diffusible cerebral stimulants. It produces an increase of tone and a marked and comfortable sensation of warmth in the entire system, and a glow and sensation of increased nerve influence and more active circulation. The general or systemic influence is better obtained from the tincture or from the hot infusion, while local stomach or intestinal effects follow promptly upon the administration of the powder. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 93 Its influence upon the circulation is more marked in its local than its constitutional or central effects, although it does influence general capillary tone. It barely increases the pulse beat, although it materially alters its character and it does not influence the appreciable temperature. Specific Symptomatology—It is directly indicated in general enfeebled conditions, with impairment of nerve influence. In general atonic conditions, with relaxation of muscular fiber; in plethoric conditions and lethargic affections, with general impairment of tone, with deficiency of functional force, energy or activity—in these conditions, because of its local and general effects, it is markedly different from other stimulants. The indications are marked nervous depression, tendency to capillary stasis; dry, harsh tongue, with brown coating; scanty and glutinuous buccal secretion, tendency to tympanitic distension, cool extremities and gastric uneasiness. Furthermore with quinine in malarial troubles, with small doses of hydrochloric acid, excellent results have been obtained in rheumatism of malarial origin, coming on periodicidly. Therapy—Its influence upon the nervous system is shown by the fact that in general paresis, and in some cases of paralysis, local and general of central origin, it has rapidly promoted cures without the use of other agents. In one case after passive cerebral congestion, it was given in strong infusion, and the tincture applied to the paralyzed arm and muscles, and restoration of nerve influence followed in a few days with a generally improved condition of the nervous system. It certainly deserves a more extended use in these cases, because of the possibility of its being pushed to the extreme without danger of disturbance of function or structure, or impairment or derangement of any organ. It is a harmless agent, however used; if concentrated, local irritation should be avoided. It has long been combined with tonics, stimulants and general restoratives in seriously impaired nerve tone of the dipsomaniac, with results which were ascribed to other agents used. It has an influence in these cases which resembles that of strychnine, and yet is quite unlike it although fully as important. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 94 In delirium tremens it produces a sedative influence, which results in quiet, rest, and frequently in deep sleep. In these cases it is best in hot infusion combined with warm beef-tea or other hot nutritious liquid food. If its use be continued it will replace the alcohol, and in its satisfaction of the unnatural demands of the stomach, will enable the patient, with proper adjuvants, to permanently overcome the taste for liquor. It must be given in conjunction with persistent and concentrated nutrition, and may be combined with hydrastine or strychnine or other nerve stimulants and tonics. It is also of much service in the treatment of the opium and morphine habits, and also that of cocaine.
Intermittent intravenous infusion Preparation and administration See Special handling below buy wellbutrin sr 150 mg without a prescription mood disorder essays. If this is not possible then flush the line thoroughly with a compatible solution between drugs buy wellbutrin sr 150mg online depression test german. Withdraw the required dose and add to a suitable volume of compatible infusion fluid (usually 100mL NaCl 0. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Intramuscular injection Preparation and administration See Special handling below. Technical information Incompatible with Co-fluampicil is incompatible with Hartmann’s. Adrenaline (epinephrine), amikacin, amiodarone, amphotericin, benzylpenicillin, calcium gluconate, ciprofloxacin, cisatracurium, clarithromycin, diazepam, dobutamine, dopamine, erythromycin lactobionate, fluconazole, gentamicin, hydralazine, hydrocortisone sodium succinate, metoclopramide, midazolam, ofloxacin, ondansetron, tobramycin, verapamil. Stability after Reconstituted vials and infusions prepared in Gluc 5% or Gluc-NaCl should be preparation used immediately. Monitoring Measure Frequency Rationale Renal function Periodically, * There is no guidance on dose reduction in renal especially if impairment, so this product may be unsuitable in treatment prolonged these circumstances. Prothrombin time * Prolongation of bleeding time and defective platelet function may occur (monitor closely if anticoagulated). Effects can last several months and are not related to either dose or route of administration. Older patients and those receiving more than two weeks treatment are at higher risk. Signs of Throughout treatment * May result in the overgrowth of non-susceptible supra-infection or organisms - appropriate therapy should be superinfection commenced; treatment may need to be interrupted. Development of rash * A maculopapular rash sometimes occurs (often appearing more than 7 days after commencing treatment) which may or may not be related to a hypersensitivity reaction. Additional information Common and serious Immediate: Anaphylaxis and other hypersensitivity reactions have been undesirable effects reported. Other: Diarrhoea, urticaria, fever, joint pains, rashes, maculopapular rashes (often appearing >7 days after commencing treatment), angioedema, anaphylaxis, serum sickness-like reaction, nausea, vomiting and diarrhoea (pseudomembranous reported rarely). Counselling Women taking the combined contraceptive pill should be advised to take additional precautions during and for 7 days after the course. This assessment is based on the full range of preparation and administration options described in the monograph. Pre-treatment checks * Do not give if there is known hypersensitivity to colistimethate sodium or to polymyxin B and in patients with myasthenia gravis. Doseinrenalimpairment:doseisadjustedaccordingtoCrCl andthen furtheradjusted according to blood levels and evidence of toxicity. Intermittent intravenous infusion (preferred route) Preparation and administration 1. Withdraw the required dose and add to a suitable volume of compatible infusion fluid (usually 100mL NaCl 0. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Nebulisation Preparation and administration Nebulisationshouldtakeplaceinawell-ventilatedroom;theoutput fromthenebulisershouldbe vented to the open air or a filter may be fitted. Technical information Incompatible with Erythromycin lactobionate, hydrocortisone sodium succinate. Displacement value Negligible Special handling See notes above under administration by nebulisation. From a microbiological point of view, should be used immediately; however: * Reconstituted vials may be stored at 2--8 C for 24 hours. Renal function Periodically * Dose adjustment may be needed if renal function changes.
It will yet be found applicable in the treatment of cerebral engorgements of a chronic character order wellbutrin sr 150mg with mastercard depression no motivation, and in the treatment of hyperaemia of those organs cheap 150mg wellbutrin sr mastercard depression research, in the cases in which ergot is used. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 255 It is valuable in from one-fourth to one-half teaspoonful doses of the fluid Hydrastis, or colorless Hydrastis, in water, in prostrating night sweats. In its power over the nutrition of muscular structure, it is a most important remedy in many disorders of the womb. It produces contraction of the unstriped muscular fibers, slowly but permanently stimulating the removal of excess of growth. In parturition it is not so immediate or forceful as ergot, but acts mildly in the same manner. In uterine subinvolution, in menorrhagia or metrorrhagia from this cause, it is the best remedy we have. It is useful also in post-partum hemorrhage, but is rather slow in its action when immediate results are demanded. In the incipient stage of the development of tumors within the uterine structure, or fibroid growths, it is not excelled by ergotine. It may be used hypodermically in these cases, and its results are comparatively permanent. He uses the mother tincture in conjunction with conium, giving five drops at a dose three or four times a day, the hydrastis before, the conium after meals. He says: “Sometimes, I mix them and give ten drops of the mixture three times a day. Where the swelling is soft or undulated and painful on pressure, and pain extending into the axilla, we find phytolacca in the same doses better than either. Sometimes, all three remedies are good together, and none of them is valuable in the open cancer. The remedies must be continued a long time to make a decided impression, and their effect is even increased by the same remedies being applied externally in the form of a plaster. In all catarrhal conditions, especially if there be muscular relaxation and general enfeeblement, it is a useful remedy. It is used locally in solution and is of much value as an application wash, irrigating fluid or gargle in all such catarrhal, ulcerating, aphthous, indolent and otherwise unhealthy conditions of mucous surfaces. It is a most useful gargle in aphthous or ulcerated sore mouth, in conditions where the gums are spongy or loosened from the teeth or bleed easily. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 256 Ten minims of a fluid preparation, to the ounce, may be used, or a solution of the hydrochlorate of hydrastine in nasal catarrh, in inflammation of the eyes and in gonorrhea One grain of the hydrochlorate in an ounce of rose water, with or without five grains of the sulphate of zinc, is of superior value in purulent conjunctivitis. The same preparation, diluted, is useful in gonorrhea Five drops of the solution in a dram of warm water is the proper strength. The colorless hydrastis in a solution with a small quantity of the potassium chlorate is sometimes superior in nasal catarrh. It is the best of washes in leucorrhea, whatever the cause, and it can be used freely without danger and in various strengths—from one dram to three, to the pint of hot water. It is of much service when the discharge is thick, yellow, and the membranes relaxed and feeble. It forms an excellent wash in eczema of the anus, with ulcers or fissures within the rectum. Its use may be followed with the application of a zinc ointment, with twenty-five per cent its weight of bismuth subnitrate. In mild solutions of the hydrochlorate of the alkaloid one-fourth grain to the ounce, it is serviceable in catarrh of the bladder, as an irrigating fluid. We find in addition to the tonic influence of this remedy, that it has been used in a number of cases of gall stone, with curative results. Professor Farnum claims to have cured a number of cases with the powdered hydrastis. The cases which he regards amenable to this treatment are, first, ordinary cases of cholelithiasis, where the symptoms are transient and not severe; second, acute inflammatory cases, usually attended with fever, and catarrhal conditions of the gall ducts; third, cases ordinarily called biliary colic. Those, of course, where organic change has not taken place, or where the stones are not impacted, in the gall bladder or in the ducts. He uses it as an efficient remedy in catarrhal jaundice where there is no pain to indicate the presence of gall stones in the ducts. This is in harmony with its influence on general catarrhal conditions of the gastro-intestinal tract. Goss claimed that it had direct catalytic power, and aided the digestion, while it corrected the biliary function.
In spasmodic urethral stricture generic 150mg wellbutrin sr amex great depression america definition, where pain is excruciating and nothing but a catheter will apparently do any good generic wellbutrin sr 150mg without prescription anxiety ridden, gelsemium in full doses is often all sufficient. I have had two marked cases where the catheter could not be passed, in one case, even under chloroform, where full repeated doses of gelsemium relieved the irritation and retention within two hours. I give from two to five drops of the Specific Medicine every twenty or thirty minutes, even if mild physiological symptoms appear. In Gonorrhoea, in the acute stages, it is a very prompt remedy, especially if used in conjunction with irrigation of the urethra. Spasmodic types of ovarian neuralgia and neuralgic dysmenorrhea are controlled with gelsemium. It relieves uterine colic and exercises a satisfactory influence in many cases as an emmenagogue, where nervous excitability is present. Henderson has given ten drops of gelsemium hypodermically in extreme cases, controlling the vomiting when the physiological influence appeared. In confinement it dilates a rigid os uteri, especially when the parts are dry and hot, and the edges of the os are hard, thin and unyielding, where nervous excitability is present. It soothes the general nervous system at this time, overcomes erratic, sharp, cutting, nagging pains, that seem to Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 230 be of no benefit, preserves the integrity of the nerve force, and if the pains are exaggerated, and the labor does not advance, the labor is sometimes satisfactorily suspended or retarded until all parts are ready for the expulsive effort. It is a most soothing remedy after labor, relieving nervous excitability preventing or controlling after pains, but I do not consider it a proper or safe remedy with which to control these pains, as I am confident that its influence upon the normal muscular contractility of the uterine fibre, causes relaxation, permits uterine hemorrhage, and retards normal involution. In pregnant women with frequently recurring paroxysms, cimicifuga, in small doses, will facilitate its action, as will viburnum or aletris. Bloyer says “if the use of gelsemium be extended to those parts of the organism involving unstriped muscular fiber, we will find that it acts directly upon this class of muscles. These occur in the liver and its ducts; in the kidneys and the ureter, the bladder and the urethra, as we find also, on the womb and ovaries and in the heart. In excitable mania it exercises a controlling influence, and if sleeplessness be present its influence is enhanced by combination with hyoscyamus. It has exercised a beneficial influence in epilepsy, especially in those cases where acute cerebral hyperiemia is present. This agent has its place in chorea, but only when its specific indications are present, not in those cases characterized by anemia. In the treatment of facial neuralgia, especially of the fifth pair, its influence is pronounced. It should be used hypodermically over the sciatic nerves in the treatment of sciatica. It controls headaches from cerebral engorgement with nervous irritability and excitability. In persistent Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 231 stitchlike pains, in the deep muscles of the back, which often completely incapacitate a man for work of any kind, full doses, just short of its apparent physiological action, will act in a most specific manner. In rheumatic stiffness of the muscles of the neck, often accompanied with sharp pain, this agent should be freely given. Given in connection with aconite, bryonia or rhus tox, as these are indicated, no better treatment can be instituted. The cases are those of rapid heart from over excitability; from irritability, with exaltation of nerve force, but where the patient is in full strength. It is especially useful in the irritable heart of hysteria, influencing the entire train of symptoms at once. It is contra- indicated in weak heart, and where there are valvular lesions of any considerable character. A teaspoonful of a mixture of thirty drops in four ounces of water is taken at the time of sailing, and repeated hourly the first day. In this connection, be it said, in sea-sickness the remedy that cures one person may fail in another, and it is not to be expected that gelsemium will affect all alike. I am inclined to the belief that in the South, its natural habitat, the conditions assumed by acute disease are more directly and specifically influenced by gelsemium than in the colder climates. Perhaps those factors of disease in which gelsemium is specifically indicated are more frequently induced or increased by the climatic influences of that locality. At least, our physicians in the South, who use the remedy to any extent, use it much more freely, and seem to find its indications present more often than we do in the North. Recently a number of observations have been made on the action of gelsemium in epilepsy. One writer used it with veratrum in his cases, and has had unusually good results.