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Anatomic_Terms

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Essential Anatomic Terms 
and Anatomic Images 
     2      3      4          6         8

 

 
Aponeurosis
: expanded tendon for the attachment of a flat muscle..   Artery (a.): a vessel carrying blood from the heart through the body.   Articulation: connection between bones.   Autonomic nervous system: for the innervation of smooth muscle, heart muscle, and glands, consisting of a craniosacral (parasympathetic) and thoracolumbar (sympathetic) portion.  
Belly:
fleshy part of a muscle.   Body: broadest or longest mass of a bone.   Bone: inflexible structure composing skeleton.  
Capillary
: anatomic units connecting the arterial and venous systems; minute vessels, func­tional units of the circulatory system.   Cartilage: substance from which some bone ossifies; gristle.   Cell: the structural and functional body unit.   Central nervous system (C.N.S.): the brain and spinal cord.   Condyle: polished articular surface, usually rounded.   Crest: ridge or border.  
Diaphysis:
the shaft of a long cylindrical bone..  
Eminence:
low convexity just perceptible.   Endocrine: internal secretion without the use of glandular ducts.     Epicondyle: elevation near and above a condyle.   Epiphyseal plate (line): growth center for elongation of bone, found between shaft and extremities of the bone.   Epiphysis: the extremity or head of a long bone.   Exocrine: secretion discharged by way of a duct system.  
Facet
:
small articular area, often a pit.   Fascia: fibrous envelopment of muscle structures and other tissues.   Foramen: hole, perforation.   Fossa: shallow depression.  
Ganglion
: group of nerve cell bodies outside the central nervous system.   
Head:
enlarged round end of a long bone; knob.  
Insertion:
relatively movable part of a muscle attachment.  
Joint:
connection between bones.  
Ligament:
fibrous tissue binding bones together or holding tendons and muscles in place.   Lymph vessels: like veins but walls are thinner and valves more numerous; drain tissue spaces.  
Mesentery:
a double layer of peritoneum (mesothelium), usually supporting organs.   Muscle (m.): contractile organ capable of producing movement.  
Neck
: constriction of a bone near head.   Nerve (n.): a group of fibers outside the central nervous system.   Neuron: nerve cell body plus its processes.   Nucleus: group of nerve cell bodies within the central nervous system.  
Omentum:
a fold of peritoneum connecting abdominal viscera with the stomach.   Organ: 2 or more tissues grouped together to perform a highly specialized function.   Origin: relatively fixed part of a muscle attachment.  
Peripheral nervous system (P.N.S.):
cerebrospinal nerves and the peripheral parts of the autonomic nervous system.   Process: projection (can be grasped with fingers).   Protuberance: a swelling (can be felt under fingers).  
Ramus:
plate like branch of a bone; branch of a vessel or nerve.   Ramus communicans: a nerve branch from the anterior root of a spinal nerve to the sympa­thetic chain of ganglia; white-nerve to chain; gray-chain back to spinal nerve.  
Shaft:
body of a long bone.   Sheath: protective covering.   Spine: pointed projection or sharp ridge.   Suture: interlocking of teeth like edges.   Symphysis: union of right and left sides in the midline.   System: group of organs acting together to perform a highly complex but specialized function, such as nervous, skeletal, muscular, circulatory, respiratory, digestive, urinary, endocrine, and reproductive.   Tendon: fibrous tissue securing a muscle to its attachment.   Tissue: differentiation and specialization of groups of cells bound together to perform a special function, e.g., epithelial, connective, muscular, and nervous.   Trochanter: 1 or 2 processes on the upper part of the femur below neck.   Trochlea: spool-shaped articular surface.   Tubercle: small bump (can be felt under finger).   Tuberosity: large and conspicuous bump.  
Vein (v):
a vessel returning blood to the heart.       Anatomical Terms of Direction and Movement.
 
  Abduction (abd.): draws away from midline.   Adduction (add.): draws toward the midline. Anatomic position: standing erect with arms at the sides and palms of the hands turned forward.   Anterior (ant.) or ventral (vent.): situated before or in front  
Corrugator
: that which wrinkles skin, draws skin in.  
Deep:
farther from the surface (in a solid form).   Depressor: that which lowers.   Distal (dist.): farther from the root.   Dorsal (dors.): toward the rear, back; also back of hand and top of foot.  
Erector:
that which draws upward.   Evert (ever.): turn outward (as foot at ankle joint).   Extension (ext.): straightening.   External (extern.): outside, refers to wall of cavity or hollow form).  
Flexion (flex.):
bending or angulation.   Frontal (front.) or coronal (coron.): vertical; at right angles to sagittal; divides body into anterior and posterior parts  
Horizontal (horiz.):
at right angles to vertical.  
Inferior (inf.):
lower, farther from crown of head.   Internal (int.): inside (refers to wall of cavity or hollow form).   Inverted (invert.): turned inward (as foot at ankle joint).  
Lateral (lat.):
.): farther from midline (or center plane).   Levator (lev.): that which raises.   Longitudinal (longit.): refers to long axis.  
Medial (med.):
nearer to midline (or center plane).   Median: midway, being in the middle   Midline: divides body into a right and left side.   Midsagittal: vertical plane at midline dividing body into right and left halves  
Palmar (palm.) or volar (vol.):
palm side of hand   Plantar (plant.): sole side of foot   Posterior (post.) or dorsal (dors.): rear or back   Pronator (pronat.): that which turns palm of hand downward.   Prone: forearm and hand turned palm side down; body lying face down.   Proximal (prox.): nearer to limb root.  
Rotator (rotat.):
that which causes to revolve  
Sagittal (sagit.):
vertical plane or section dividing body into right and left portions.   Sphincter: that which regulates closing of aperture.   Superficial (superf.): nearer to surface (refers to solid form).   Superior (sup.): upper, nearer to crown of head.   Supinator (supinat.): that which turns palm of hand upward.   Supine: forearm and hand turned palm side up; body lying face up.  
Tensor (tens.):
that which draws tight   Transverse (trans.): at right angles to long axis; body divided into upper and lower parts.   Ventral (vent.) or anterior (ant.): situated before or in front of.   Vertical (vert.): refers to long axis in erect position.   Volar (vol.) or palmar (palm.): palm side of hand.   Library

Anatomic Images
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Categories
Articles

The Official Volatile Oils. BP 1958


 

Denstons Textbook of Pharmacognosy.
Compiled by Ivor Hughes

Part 2 of 2.

OIL OF ROSEMARY
Official Source:
The flowering plant, Rosmarinus officinalis Linn. Fam.: Labiatae.
Geographical Source: S. France, and the islands off the Dalmatian coast.
Preparation: By distillation in steam.
Constituents: Borneol, 8 -18 %, official requirement being not less than 9-0 per cent w/w. Bornyl Acetate, 1-6 %, the official requirement being not less than 2-0 per cent w/w.
Cineole, limited by an official test to an apparent content of 33-0 % Subsidiary constituents are the terpenes pinene and camphene, and camphor.
Adulteration: Both French and Dalmatian oil normally satisfy the official requirements. The chief substitute is an impure or commercial oil produced in large amounts in Spain by distilling together rosemary, spike lavender, and a high proportion of sage—spike lavender yielding an oil rich in borneol, and sage yielding an oil with an ester content of 6-20 per cent. Hence Spanish oil of Rosemary contains alcohols (chiefly borneol) and esters, and usually fulfils the official requirements. The optical rotation of oil of rosemary is officially – 5° to + 10°, that of oil of sage + 70° to + 24°, hence Spanish oil of rosemary usually has an optical rotation higher than that of genuine oil; this, with other factors, serves to detect substitution. Oil of camphor has also been reported as an adulterant; it is detected by the limit test for cineole.

 

OIL OF SANDALWOOD (East-Indian Sandalwood Oil)
Botanical Source:
The heartwood of Santalum album Linn. Fam.: Santalaceae.
Geographical Source: India (principally Mysore).
Preparation: By slow distillation in steam or with water, the process taking a considerable time for completion owing to the density of the wood; yield 2-5 per cent.
Constituents: Santalol sesquiterpene alcohols, with other alcohols totaling 92-98 per cent, the B.P.C. requirement being not less than 90 per cent w/w. Subsidiary constituents are the terpenes, santalene, and esters, chiefly santalyl acetate, about 2 per cent.
Adulteration: The standard of not less than 90 per cent of alcohols calculated as santalol ensures rejection of grossly adulterated oil. The principal adulterant is castor oil, which is not easily detected in small proportions, as its solubility in alcohol and its viscosity are similar to those of sandalwood oil.
Other adulterants: sometimes, oil of cedar wood, oil of copaiba, benzyl alcohol, and glyceryl acetate.

4. Oils containing Aldehydes.

 

Name

Aldehyde

Av. Content

Official Requirements

Oleum Cinnamomi

Cinnamic aldehyde

58 – 70%

55 – 70% w/w BP1953

Oleum Limonis

Citral

4 – 5.5%

4% w/w BP 1953

Oleum AmygdalaeVolatile Purificata

Benzaldehyde

95 – 98%

95% w/w or more. BP 1958

Principle of Estimation
The estimation of Aldehydes is based on the fact that hydroxylamine combines quantitatively with aldehydes to form aldoximes –

C9H15CHO + H2NOH, HC1    –» C9H15CHNOH + HC1 + H2O
Citral              Hydroxylamine        Citraldoxim
                        hydrochloride

A known weight of oil is shaken in a stoppered tube with a known excess of an alcoholic solution of hydroxylamine hydrochloride which has been rendered first yellow* to methyl orange. The above reaction occurs partially with liberation of hydrochloric acid, and change in colour to red. Semi-normal solution of potassium hydroxide is added to change the colour to yellow. Upon further shaking, more aldehyde combines and the red colour re-appears and is again discharged. This shaking and neutralization is repeated until the yellow colour of the lower layer remains unchanged after 2 minutes of vigorous shaking, followed by separation of the oil, indicating that all the aldehyde has combined. The total volume of semi-normal solution of potassium hydroxide needed for the above processes is noted and gives an approximate value for the aldehyde. The test is repeated using as the standard for the end-point the reaction mixture obtained previously, to which a defined excess of semi-normal solution of potassium hydroxide has been added. The result is calculated from the second determination (vide B.P., Appendix XI).

* The solution contains, as a result, a small proportion of free hydroxylamine. The latter is a weak base, the pH of the hydrochloride being 3-2. The orange colour range of methyl orange lies between pH 2-9-4-0, hence if a neutral solution of hydroxylamine hydrochloride were used in the test, adjustment to the particular shade of orange corresponding to pH 3-2 would be necessary. This is difficult, hence a constant error is introduced by starting with a solution of hydroxylamine hydrochloride at about pH 9-0 (the pale yellow of methyl orange) and finishing at the same point—in this way an accurate end-point is obtained without affecting the result.

OIL OF CINNAMON
Official Source :
The dried inner bark of coppiced trees of Cinnamomum zeylandicum Nees, and is known in commerce as Ceylon Cinnamon.
Preparation : By distillation in steam; yield about 0-5-1-0 per cent.
Constituents : Cinnamic Aldehyde, 58-76 per cent, the official requirement being 55-0-70-0 per cent w/w.
Eugenol, 4-8 per cent.
Subsidiary constituents are the terpenes cymene and caryophyllene
Tests and Adulteration : The two most important chemical tests are —
1. Determination of aldehyde (vide B.P., Appendix XI).
2. Limit-test for Eugenol. This test is designed to detect adulteration of oil of cinnamon with cinnamon leaf oil or cassia oil: the test is —

0.l ml. dissolved in 10 ml. of alcohol (90 per cent) assumes a slight green, but not a deep brown or blue coloration, on the addition of 0-1 ml. of test-solution of ferric chloride. Eugenol alone, and also cinnamon leaf oil which is rich in it, gives a blue colour with ferric chloride; cassia oil and its principal constituent cinnamic aldehyde gives a brown colour; the official oil of cinnamon, which contains both, produces a pale green colour, the test being, in effect, a limit-test for eugenol.

The high price of the oil has led to considerable adulteration and substitution, which chemical examination may fail to detect. The two principal adulterants are —
1. A factitious oil prepared by mixing suitable proportions of —
(a) Artificial cinnamic aldehyde, to give the correct content of this.
(b) Cinnamon leaf oil, which consists largely of eugenol, and is therefore quite different in composition from the official oil prepared from the bark. The latter contains from 4 to 8 per cent only of eugenol, which, in the factitious oil, is supplied by a suitable proportion of cinnamon leaf oil.
(c) Genuine oil of cinnamon to modify the odour of the above two constituents, and thereby make the product simulate genuine oil.

This factitious oil answers the official quantitative test for cinnamic aldehyde, and also the above qualitative test for limit of eugenol.

2. Cassia oil, obtained from the bark of Cinnamomum Cassia Blume, which contains about 75—90 per cent of cinnamic aldehyde, but no eugenol, hence the colour produced with test-solution of ferric chloride is brown. The adulteration of oil of cinnamon with a large proportion of oil of cassia would be revealed by an abnormally high content of cinnamic aldehyde, and by the failure to give the characteristic pale green colour in the qualitative test. The addition of 20 per cent or less of oil of cassia cannot usually be detected by either test, as the cinnamic aldehyde is not necessarily outside the official range, and with the qualitative test the intensity of the green colour, though reduced, is not masked.

From the above it will be seen that a factitious oil, or genuine oil containing less than 20 per cent of oil of cassia may fulfill the official chemical requirements, and considerable reliance must be placed on odour. The official oil contains a small proportion of substances not present in either the factitious oil or oil of cassia, and these substances modify the odour of the cinnamic aldehyde and eugenol, rendering it distinctively delicate by comparison.

OIL OF LEMON
Botanical Source :
Sicily, Spain, Portugal, Italy and California.
Preparation : By expression, yield about 0-8 gm. per lemon.
Constituents : Citral — 4-5-5-0 per cent, the official requirement being not less than 4-0 per cent of aldehydes calculated as citral. Traces of other aldehydes, e.g. octyl aldehyde, monyl aldehyde, and esters, e.g. geranyl and linalyl acetates, are also present, and no doubt slightly modify the odour.
Subsidiary constituents are the terpenes d-limonene (citrene) 80 per cent, accompanied by a small proportion of l-limonene and sesquiterpenes. Machine-made oil is usually inferior in odour and taste and has a lower citral content and an appreciable proportion of resinous substances.
Tests : The principal test is the estimation of the aldehydes.

Mention has been made of terpeneless oils, of which terpeneless oil of lemon is the principal, being produced in large amounts. The terpenes separated in this process play an important part in the adulteration of oil of lemon. As obtained from lemons, the oil contains upwards of 5-5 %* of aldehydes, and one method of adulteration commonly practiced is to dilute the oil to a 4 per cent content (the B.P. minimum) with these terpenes. The product still fulfils all the official requirements, and detection is impossible because the diluent is a normal constituent of oil of lemon.

* From winter-collected lemons; summer-collected lemons yield less.

Another method of adulteration is the admixture of citral from other sources, e.g. oil of lemon grass with the above-mentioned lemon terpenes, to give a product containing 4 per cent of citral. An admixture of this factitious oil with genuine oil of lemon is very difficult to detect because the chemical and physical constants are normal, and odour is the sole method of detection — oil of lemon grass giving a distinctive odour to the admixture.

PURIFIED VOLATILE OIL OF BITTER ALMOND
Botanical Source :
The cake left after pressing out the fixed oil from bitter almonds, peach kernels or apricot kernels.
Fam.: Rosaceae.
Geographical Source : Southern France, Sicily, and Northern Africa.
Preparation : This oil does not pre-exist in the seeds. It is prepared by crushing the seeds and freeing them from fixed oil, e.g. Sweet Oil of Almond, of which they contain about 40 per cent. The residual cake is re-crushed, mixed with water, enzyme action allowed to proceed for some hours at about 40° C., and the mixture then distilled. The interacting substances are the glycoside amygdaline and the enzyme emulsin, the latter causing hydrolysis of the former as follows —

Amygdalin + Water ——> Benzaldehyde + Hydrocyanic acid + Dextrose
                              (Emulsin)

Benzaldehyde and hydrocyanic acid are both volatile, and the oil which separates from the aqueous portion of the distillate consists chiefly of benzaldehyde, with about 2-4 per cent of hydrocyanic acid, of which part is free and part combined with the benzaldehyde in the form of an additive compound called benzaldehyde-cyanhydrin. The proportion of hydrocyanic acid present renders this oil very poisonous, hence prior to sale for pharmaceutical or domestic purposes the acid is removed as follows —

The oil is mixed with milk of lime, whereby the hydrocyanic acid, both free and combined, is converted into calcium cyanide. Ferrous sulphate is next added, and this converts the calcium cyanide into calcium ferrocyanide — a compound not decomposed in the subsequent distillation. The mixture is then distilled in a current of steam, and the oil which separates from the aqueous portion of the distillate consists almost entirely of benzaldehyde, and is known as Oleum Amygdalae Essentiale sine Acido Prussico. On account of its high cost it has been largely replaced by synthetic benzaldehyde. The yield is 0-5-1-0 per cent.
Constituents :
Benzaldehyde, about 90 per cent. Hydrocyanic Acid, 2-4 per cent 5 m the original oil. The purified oil should contain not less than 95-0 per cent of benzaldehyde.

5. Oils containing Ketones.
Two official oils owe their value to the ketone carvone, though the odour of each is modified by accompanying substances.

 

Name

Ketone

Av. Content

Official Requirement

Oleum Cari

Carvone

50 – 60%

53 -63% w/w B.P.C

Oleum Anethi

Carvone

35 – 60%

43 – 63% w/w B.P.C

Principle of Estimation: Ketones, like aldehydes, combine with hydroxylamine, and form ketox-imes. The method of estimating ketones follows therefore, in outline, that described for aldehydes.

OIL OF CARAWAY
Botanical Source :
Holland and Germany.
Preparation : By distillation in steam ; yield 4-6 per cent.
Constituents : Carvone, 50-60 percent, the B.P.C. standard being 53-0-63-0 per cent w/w. d-Limonene (carvene), constitutes the remainder of the oil.

OIL OF DILL
Official Source :
Germany, Rumania. England.
Preparation : By distillation in steam; yield 3-4 per cent.
Constituents : Carvone, 35-60 per cent, the official standard being 43-63 per cent w/w. d-Limonene is the principal terpene present, phellandrene and others being present in small proportion.
Adulteration : Two other varieties of oil of dill occur in commerce. One, oil of Indian dill, from Anethum Sowa Roxb. (Peucedanum Sowa Kurz), has a different composition containing dill-apiol. The sp. gr. of oil of Indian dill is 0-946—0970, whereas that of oil of dill is 0-900-0-915, hence the addition of a proportion of the former oil to the latter will raise the sp. gr. and give prima facie evidence of adulteration, probably with oil of Indian dill. The other variety is oil of dill of Spanish origin. This oil contains less carvone than the official oil, and substitution would be revealed by the lowered sp. gr., and by estimation of the carvone.

6. Oils containing Phenols
Only one official oil owes its value to a phenol, namely Oil of Clove, which is officially required to contain 85-0-90-0 per cent v/v of the phenol, eugenol.

Principle of Estimation. Estimation is based on the fact that phenols combine with caustic alkalis to form water-soluble compounds. Hence the difference in volume between the oil used and that remaining uncombined represents the amount of phenol present in the portion tested. The estimation is carried out in a special flask, called a Hirschsohn or Cassia flask, which is stoppered and has a long neck graduated like a burette. The oil and alkali are shaken thoroughly at intervals for a prescribed period, and the uncombined oil is then raised to the graduated neck by the addition of more alkali. After standing for 24 hours or more for complete separation to ensue, the volume of uncombined oil is read off. The percentage v/v of phenols is calculated from the data obtained.

OIL OF CLOVE

Official Source: Madagascar, Zanzibar, Pemba, Penang.

Preparation : By distillation in steam; yield about 15 per cent.

The oil can be fractionated into the two main constituents, eugenol (sp. gr. 1-072) and caryophyllene (sp. gr. 0-9085). In commercial distillation, however, the whole of the oil sinks to the bottom of the receiver. The first runnings of oil distilled from the buds possess quite a distinct character and are used in the perfumery trade.

Constituents : Eugenol, 76-90 per cent, the official requirement being 85-0-90-0 per cent v/v, determined as described above.

The remainder of the oil consists almost entirely of the terpene caryophyllene. Other constituents include furfuraldehyde (the provable cause of darkening on storage), methylamylketone and acetyleugenol.

7. Oils containing Oxides
Two official oils owe their value to cineole, which is chemically an inner ether, or lactone; it is also known as eucalyptol or cajuputol.

 

Name

Main Constituent

Av. Content

Official Requirement

Oleum Cajuputi

Cineole

45 – 55%

50 – 65% w/w B.C.P.

Oleum Eucalypti

Cineole

Upwards 80%

Min 70% w/w

Principle of Estimation. The estimation is based on the fact that cineole combines with o-cresol to form a solid compound melting at 55-2° C. The other constituents lower the melting point according to the proportion present.

A prescribed weight of dry oil and pure dry o-cresol are mixed in a test tube, the contents warmed gently to melt the mixture, and the freezing point determined under prescribed conditions. The freezing point is re-determined by re-melting and cooling until two consecutive concordant results are obtained. The proportion of cineole which this represents is then found from a table (B.P., Appendix XI).

OIL OF CAJUPUT
Botanical Source :
The fresh leaves and twigs of Melaleuca Leucadendron Linn. Fam.: Myrtaceae.
Geographical Source : Malay Archipelago (Molucca Islands).
Preparation : By distillation in steam, followed by rectification.
Constituents : Cineole, 45-55 per cent, the official requirement being 50-65 per cent w/w, determined by the process described above.
Subsidiary constituents are the terpene Z-pinene, and certain aldehydes.

OIL OF EUCALYPTUS
Official Source :
The fresh leaves of various species of Eucalyptus. Fam.: Myrtaceae.
Geographical Source : Tasmania, Eastern Australia, and, to a small extent, Southern Europe.
Preparation : By distillation in steam, followed by rectification; yield 1-3 per cent. The foliage of the undergrowth produces the best oil. The Australian season for cutting the leaves and distilling extends from January to June.
Constituents: Cineole, 50-80 per cent, the official requirement being not less than 70-0 per cent w/w, determined as described above.
Tests : Limit of Phellandrene. There are many species of Eucalyptus, most of which yield an essential oil. The principal species used are E. polybractea and E. Smithii. Both yield an oil rich in cineole, averaging about 80 per cent in E. polybractea. Official standardization at not less than 70 per cent w/w of cineole has reduced admixture of oils rich in cineole with others containing but little. Certain of the latter, e.g. the oils yielded by E. Amygdalina, E. Baileyana, are not only poor in cineole but contain a considerable proportion of the sesquiterpene phellandrene, which is objectionable for medicinal use, and is therefore limited in the official specification. The limit-test is based on the combination of phellandrene with nitrous acid to form a crystalline compound insoluble in petroleum spirit. The test is carried out in the following manner.

“Mix 1 ml. of oil, 2 ml. of glacial acetic acid, 5 ml. of light petroleum, and 2 ml. of saturated solution of sodium nitrite, and shake gently.” The formation of a crystalline precipitate in the upper layer indicates the presence of oils containing an undue proportion of phellandrene.

Limit of Aldehydes. Eucalyptus maculata var. citriodora Hook, yields an oil containing 84-90 per cent of the aldehyde citronellal. The latter has a lemon-like odour and, the above oil is therefore known as “lemon-scented” eucalyptus oil. The official limit test for aldehydes limits the use of this oil, and others containing citronellal or other aldehydes, for the purpose of diluting oils rich in cineole to the official standard. The test is carried out as for aldehydes in volatile oils.

8. Oils containing Peroxides
Only one medicinal oil owes its value to a peroxide, namely Oil of Chenopodium, which is required to contain not less than 65-0 per cent w/w of the peroxide ascaridole.

Principle of Estimation : Estimation is based on the fact that peroxides liberate iodine quantitatively from an acidified solution of potassium iodide, and the iodine so formed can be ascertained by titration with standard solution of sodium thiosulphate. In the case of ascaridole, the estimation is complicated by a number of factors and the official details (B.P. 1953) must be rigidly followed in order to obtain concordant results. The latter are calculated from an empirical factor based on the results of a large number of determinations of pure ascaridole. (T. T. Cocking and F. C. Hymans, Analyst, 1930, 55, 180.)

OIL OF CHENOPODIUM
Synonym :
Oil of American Wormseed.
Botanical Source : The fresh flowering and fruiting plants, excluding roots, of Chenopodium ambrosioides Luin var. anthelminticum Gray. Pam.: Chenopodiaceae.
Geographical Source : U.S.A., Central America, and West Indies.
Preparation : By distillation in steam. The process must be carried out rapidly, using special plant, since ascaridole is decomposed by slow distillation.
Constituents : Ascaridole, not less than 65-0 per cent w/w. (B.P. 1953.) Subsidiary constituents are the terpenes, cymene and terpinene. Due to the fact that ascaridole is a peroxide, the oil is a powerful oxidizing agent and therefore reacts, often very violently, with reducing agents.
The oil explodes on heating.

9. Oils with Miscellaneous Constituents.

OIL OF NUTMEG
Botanical Source :
East Indies. Penang. West Indies (Grenada)
Preparation : By distillation in steam, broken and damaged nutmegs being used; yield 8-15 per cent.
Constituents : d-Camphene, up to 80 per cent, and other terpenes, including d-pinene and dipentene.
Alcohols
* including linalol, terpineol, geraniol, and borneol, 6 per cent.
Phenols including safrole, eugenol, and iso-eugenol, 0-8 per cent.
Myristicin (a methoxy derivative of safrole), 4 per cent, responsible for the toxic effects of large doses of the oil.
* According to Power and Salway.

Official Fractions of Volatile Oils.
The substances camphor (a ketone), menthol (an alcohol), and thymol (a phenol) are solid fractions, and eucalyptol (an oxide) is a liquid fraction of certain volatile oils. The solid compounds were at one time called stearoptenes, a term indicating that portion of a volatile oil which separated upon thorough cooling, the portion remaining liquid being called an elaeoptene. Although lacking chemical precision, these terms are still used for descriptive purposes. Camphor, menthol, thymol, and eucalyptol are prepared by widely different methods, and will therefore be described separately.

CAMPHOR
Camphor may be prepared either from natural sources or by synthesis.

Natural Camphor.
Official Source : The tree, Cinnamomum Camphora (Linn.) Nees and Eberm. Fam.: Lauraceae.
Geographical Source : Formosa (produces about 75 per cent of the world’s requirements). China (provinces on the straits of Formosa) producing the remainder.

Camphor production is a large industry in these areas; the quantity used in medicine, although important, represents only a small fraction of the output, a considerably larger quantity being used in the production of celluloid. In Formosa replanting has been carried out to ensure continuous and increasing supplies. In China, replanting has been neglected, with consequent diminution of yield. Most parts of the tree contain oil-cells in which volatile oil is secreted, averaging 3 to 6 per cent. This oil contains 10-50 per cent of camphor, the highest proportion being found in the oil contained in the older parts of the tree, e.g. the root and trunk. It has been stated (T. Yahagi, Jap. J. Ghem., 1928, 3, 109) that the formation of camphor is due to the action of an enzyme, possibly a peroxidase, on certain cell-constituents, and that enzyme activity is greatest in the actively-growing parts, notably in the layer of wood tissue just within the cambium. Hence each zone of wood, as formed, becomes rich in camphor which remains there as growth proceeds ; consequently, the woody tissue of root and trunk from mature trees becomes the principal camphor-containing part of the tree, and in Formosa distillation is mainly from the wood of trees 40 to 50 years old. The average yield of camphor is about 5 kilogram. per tree.

 

COMPOSITION OF NATURAL OIL OF CAMPHOR
The natural oil obtained from the camphor tree contains a large number of compounds. This oil may be separated by fractional distillation into three main fractions;

1. A Light Fraction. This is collected up to about 200° C. It consists chiefly of terpenes together with cineole. This oil is known as light oil of camphor and sometimes by the misleading name of essential oil of camphor.

2. A Middle Fraction. This is collected from about 200 to 230° C. It consists chiefly of camphor.

3. A Heavy Fraction. This is collected from about 230° C. It contains a high proportion of safrol. Upon refrigeration, safrole crystallizes out, the other substances remaining liquid. This liquid is drained off and the crystalline mass pressed. The latter is then allowed to liquefy, and purified by re-refrigeration. The product is almost pure safrole. The latter has almost entirely replaced Oil of Sassafras, and is also used for the manufacture of heliotropin, a substance having the odour of heliotrope and used in perfumery. The natural oil usually contains sufficient camphor to render it semi-solid at ordinary temperatures. When pressed, the liquid portion can be expelled leaving behind a solid mass consisting of crude camphor.

Preparation : The trunk and branches of the felled tree are cut into chips which are placed on the perforated false bottom of a still, connected by a pipe to a water-cooled receiver. Beneath the false bottom water is heated, or steam passed in, whereupon the oil is volatilized, passing with the steam into the condenser. If the whole of the oil is collected without interruption, a semi-solid product is obtained, from which the liquid portion is removed by draining and pressing, leaving behind crude camphor. Alternatively, the receiver may be changed when most of the terpenes have distilled over, and the crude camphor collected separately. These processes are carried out in the area of collection, and the crude camphor is then taken to refineries for purification. In one process of purification, the crude camphor is mixed with lime (to absorb the water present) and sand, and then sublimed in large vats, each fitted with a cone-shaped lid, provided with a flat, partial diaphragm. Upon heating, the sublimate of pure camphor collects on the lid in blocks, which are then cut for export into slabs weighing about 2 lb. In the other purification process the still is connected to very large cooled receivers. The hot camphor vapour condenses in the enclosed atmosphere in the form of small detached crystals (camphor flowers), which collect on the floor of the receiver.

Synthetic Camphor.
Camphor may be synthesized from pinene, the terpene which forms the bulk of oil of turpentine. The pinene is converted through bornyl chloride to the alcohol borneol and this is oxidized to the ketone camphor. Synthetic camphor is optically inactive, being a mixture of equal amounts of the laevo- and dextro-compounds; natural camphor consists only of the latter and is therefore optically active. Pure synthetic camphor is identical in appearance with natural camphor but is more waxy to the touch. Moreover the synthetic material is liable to contain as impurity a small proportion of iso-borneol due to the last stage in the synthesis not going to completion and the difficulty of removing all unchanged iso-borneol on account of the similarity in certain properties.

MENTHOL
Official Source :
Various species of Mentha, or prepared synthetically. Fam.: Labiates.
Geographical Source : Brazil, Japan, principally the northern island, Hokkaido. China produces a relatively small amount.
The official oil of peppermint, from M. piperita grown in the U.S.A. and England is but little used for the preparation of menthol. The latter is obtained from Japanese peppermint oil yielded by M. arvensis Linn. var. piperascens Holmes, Chinese peppermint oil obtained from M. arvensis Linn. var. glabrata, and Brazilian peppermint oil. The herbs yield about 0-3 per cent of volatile oil of which the Japanese is the richest in menthol; it contains 70 – 90 per cent, the oil being a crystalline mass at room temperature due to crystallization of the menthol.

Preparation : The oil is steam-distilled from the cut herb after it has partially withered a condition found by experience to produce the highest yield. Upon freezing the oil, rather more than half of the menthol separates as crystals, and these are drained from the liquid portion of the oil, and then re-crystallized from alcohol.

The separated liquid portion is known as Japanese dementholized peppermint oil, and still contains 40-54 per cent of menthol, and 5-17 per cent of esters of menthol. By boiling with solution of sodium hydroxide these esters may be decomposed to form menthol, and, upon further freezing, the saponified oil yields a second crop of menthol crystals. However, most of the oil is exported without further treatment, to be used in the manufacture of confectionery and cordials.

Synthetic Menthol.
The molecule of menthol contains three asymmetric carbon atoms and consequently various isomeric forms are possible. Natural menthol is laevo-rotatary and the Pharmacopoeia also recognizes synthetic menthol in its laevo and racemic forms.

THYMOL
Thymol may be prepared either from natural sources or by synthesis.
Natural Thymol.
Official Sources :
The volatile oils of the following plants :

 

Plant Name

Part

Source

Oil Yeild

Thymol content

Trachyspermum Ammi* Linn Sprague. Fam. Umbelliferae

Fruits

India, Seychelles,

Montserrat

3-4%

45-55%

Monarda punctata Linn. Fam. Labiatae

Leaves

U.S.A., Montserrat

0-3-0-4%

60-70%

Thymus vulgaris Linn. Fam. Labiatae

Flowering plant

Spain and France

0-4-0-5%

30-40%

* Yielding Indian Ajowan Seed, formerly important but now little cultivated.

It has also been prepared from the stem and leaves of Ocimum gratissimum (Fam. Labiatae), grown in India, Ceylon and Java. This source yields about 0-5 per cent of oil containing about 55 per cent of thymol.

Preparation : After separation by steam-distillation, the oil is subjected to fractional distillation in order to separate the bulk of the hydrocarbons (low boiling-point fraction), and thereby raise the content of thymol. The hydrocarbon-free oil is then shaken with solution of sodium hydroxide, with which the thymol combines to form a water-soluble compound called sodium thymate — analogous to sodium phenate. Upon standing, the mixture resolves into two layers, an oily layer now free from thymol, and an aqueous layer containing sodium thymate. The latter is separated and acidified with hydrochloric acid, which decomposes the sodium thymate, re-forming thymol. The latter is practically insoluble in water and separates as an oily liquid — the presence of impurities preventing crystallization. Crystallization is induced by sowing a few crystals of thymol in the liquid. The product thereby obtained is next dissolved in the minimum of alcohol, the solution decolorized by filtration through animal charcoal, and after dilution with water it is set aside, whereupon thymol crystallizes out in the form of large rhombic prisms.

Synthetic Thymol.
Thymol is chemically 3-methyl-6-isopropylphenol and is prepared by the oxidation of piperitone, derived from Javan Citronella Oil or from Australian
Eucalyptus dives oil. Other synthetic methods start from p-cymene (derived from turpentine) or m-cresol (a coal tar product) which is condensed with iso-propyl alcohol or propylene in the presence of phosphoric acid.

EUCALYPTOL
Synonym :
Cineole.
Official Source : As for Oil of Eucalyptus,
Preparation : Preparation is usually based on the fact that at low temperatures eucalyptol combines with phosphoric acid to form a solid additive compound from which the non-eucalyptol fluid portion of the oil can be almost completely separated by pressure. Subsequent treatment of the solid compound with warm water resolves it into phosphoric acid and eucalyptol, the latter separating as an oily layer. The latter is then purified.
The Pharmacopoeia requires eucalyptol to have a freezing-point not lower than 0°.

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Addendum to Tutorial 3 year two



The Beautiful image is of of Shaftsbury,
in the Southern County of Dorset, England

THE CATECHISM OF PARACELSUS

Adam Mclean had this to say about the catechism 

In his Ritual de la Haute Magie, chapter 19, Eliphas Levi, describes a manuscript of Paracelsus supposedly in the Vatican, entitled “the Chemical Pathway or Manual”. He claims that a this was transcribed by Sendivogius and used by Baron Tschoudy when composing the Hermetic Catechism in his L’Etoile Flamboyant ou la Société des Franc-Maçons considerée sous tous les aspects, 1766. I have not been able to locate the Paraclesus work in the Vatican nor Sendivogius’ transcription, however, the Hermetic Catechism of Baron Tschoudy is a fine piece of hermetic philosophy. The version here has been taken from A.E. Waite’s translation published in the two volume Hermetic and Alchemical Writings of Paracelsus, which he heavily edited of masonic remarks of Tschoudy.

A SHORT CATECHISM OF ALCHEMY.

Q. What is the chief study of a Philosopher?

A. It is the investigation of the operations of Nature.

Q. What is the end of Nature?

A. God, Who is also its beginning.

Q. Whence are all things derived?

A. From one and indivisible Nature.

Q. Into how many regions is Nature separated?

A. Into four palmary regions.

Q. Which are they?

A. The dry, the moist, the warm, and the cold, which are the four elementary qualities, whence all things originate.

Q. How is Nature differentiated?

A. Into male and female.

Q. To what may we compare Nature?

A. To Mercury.

Q. Give a concise definition of Nature.

A. It is not visible, though it operates visibly; for it is simply a volatile spirit, fulfilling its office in bodies, and animated by the universal spirit-the divine breath, the central and universal fire, which vivifies all things that exist.

Q. What should be the qualities possessed by the examiners of Nature?

A. They should be like unto Nature herself. That is to say, they should be truthful, simple, patient, and persevering.

Q. What matters should subsequently engross their attention?

A. The philosophers should most carefully ascertain whether their designs are in harmony with Nature, and of a possible and attainable kind; if they would accomplish by their own power anything that is usually performed by the power of Nature, they must imitate her in every detail.

Q. What method must be followed in order to produce something which shall be developed to a superior degree than Nature herself develops it.

A. The manner of its improvement must be studied, and this is invariably operated by means of a like nature. For example, if it be desired to develop the intrinsic virtue of a given metal beyond its natural condition, the chemist must avail himself of the metallic nature itself, and must be able to discriminate between its male and female differentiations.

Q. Where does the metallic nature store her seeds?

A. In the four elements.

Q. With what materials can the philosopher alone accomplish anything?

A. With the germ of the given matter; this is its elixir or quintessence, more precious by far, and more useful, to the artist, than is Nature herself. Before the philosopher has extracted the seed, or germ, Nature, in his behalf, will be ready to perform her duty.

Q. What is the germ, or seed, of any substance?

A. It is the most subtle and perfect decoction and digestion of the substance itself; or, rather, it is the Balm of Sulphur, which is identical with the Radical Moisture of Metals.

Q. By what is this seed, or germ, engendered?

A. By the four elements, subject to the will of the Supreme Being, and through the direct intervention of the imagination of Nature.

Q. After what manner do the four elements operate?

A. By means of an incessant and uniform motion, each one, according to its quality, depositing its seed in the centre of the earth, where it is subjected to action and digested, and is subsequently expelled in an outward direction by the laws of movement.

Q. What do the philosophers understand by the centre of the earth?

A. A certain void place where nothing may repose, and the existence of which is assumed.

Q. Where, then, do the four elements expel and deposit their seeds?

A. In the ex-centre, or in the margin and circumference of the centre, which, after it has appropriated a portion, casts out the surplus into the region of excrement, scoriae, fire, and formless chaos.

Q. Illustrate this teaching by an example.

A. Take any level table, and set in its centre a vase filled with water; surround the vase with several things of various colours, especially salt, taking care that a proper distance intervenes between them all. Then pour out the water from the vase, and it will flow in streams here and there; one will encounter a substance of a red colour, and will assume a tinge of red; another will pass over the salt, and will contract a saline flavour; for it is certain that water does not modify the places which it traverses, but the diverse characteristics of places change the nature of water. In the same way the seed which is deposited by the four elements at the centre of the earth is subject to a variety of modifications in the places through which it passes, so that every existing substance is produced in the likeness of its channel, and when a seed on its arrival at a certain point encounters pure earth and pure water, a pure substance results, but the contrary in an opposite case.

Q. After what manner do the elements procreate this seed?

A. In order to the complete elucidation of this point, it must be observed that there are two gross and heavy elements and two that are volatile in character. Two, in like manner, are dry and two humid, one out of the four being actually excessively dry, and the other excessively moist. They are also masculine and feminine. Now, each of them has a marked tendency to reproduce its own species within its own sphere. Moreover, they are never in repose, but are perpetually interacting, and each of them separates, of and by itself, the most subtle portion thereof. Their general place of meeting is in the centre, even the centre of the Archeus, that servant of Nature, where coming to mix their several seeds, they agitate and finally expel them to the exterior.

Q. What is the true and the first matter of all metals?

A. The first matter, properly so called, is dual in its essence, or is in itself of a twofold nature; one, nevertheless, cannot create a metal without the concurrence of the other. The first and the palmary essence is an aerial humidity, blended with a warm air, in the form of a fatty water, which adheres to all substances indiscriminately, whether they are pure or impure.

Q. How has this humidity been named by Philosophers?

A. Mercury.

Q. By what is it governed?

A. By the rays of the Sun and Moon.

Q. What is the second matter?

A. The warmth of the earth -otherwise, that dry heat which is termed Sulphur by the Philosophers.

Q. Can the entire material body be converted into seed?

A. Its eight-hundredth part only-that, namely, which is secreted in the centre of the body in question, and may, for example, be seen in a grain of wheat.

Q. Of what use is the bulk of the matter as regards its seed?

A. It is useful as a safeguard against excessive heat, cold, moisture, or aridity, and, in general, all hurtful inclemency, against which it acts as an envelope.

Q. Would those artists who pretend to reduce the whole matter of any body into seed derive any advantage from the process, supposing it were possible to perform it?

A. None; on the contrary, their labour would be wholly unproductive, because nothing that is good can be accomplished by a deviation from natural methods.

Q. What, therefore, should be done?

A. The matter must be effectively separated from its impurities, for there is no metal, how pure soever, which is entirely free from imperfections, though their extent varies. Now all superfluities, cortices, and scoriae must be peeled off and purged out from the matter in order to discover its seed.

Q. What should receive the most careful attention of the Philosopher?

A. Assuredly, the end of Nature, and this is by no means to be looked for in the vulgar metals, because, these having issued already from the hands of the fashioner, it is no longer to be found therein.

Q. For what precise reason?

A. Because the vulgar metals, and chiefly gold, are absolutely dead, while ours, on the contrary, are absolutely living, and possess a soul.

Q. What is the life of metals?

A. It is no other substance than fire, when they are as yet imbedded in the mines.

Q. What is their death?

A. Their life and death are in reality one principle, for they die, as they live, by fire, but their death is from a fire of fusion.

Q. After what manner are metals conceived in the womb of the earth?

A. When the four elements have developed their power or virtue in the centre of the earth, and have deposited their seed, the Archeus of Nature, in the course of a distillatory process, sublimes them superficially by the warmth and energy of the perpetual movement.

Q. Into what does the wind resolve itself when it is distilled through the pores of the earth?

A. It resolves itself into water, whence all things spring; in this state it is merely a humid vapour, out of which there is subsequently evolved the principiated principle of all substances, which also serves as the first matter of the Philosophers.

Q. What then is this principiated principle, which is made use of as the first matter by the Children of Knowledge in the philosophic achievement?

A. It is this identical matter, which, the moment it is conceived, receives a permanent and unchangeable form.

Q. Are Saturn, Jupiter, Mars, Venus, the Sun, the Moon, etc., separately endowed with individual seed?

A. One is common to them all; their differences are to be accounted for by the: locality from which they are derived, not to speak of the fact that Nature completes her work with far greater rapidity in the procreation of silver than in that of gold, and so of the other metals, each in its own proportion.

Q. How is gold formed in the bowels of the earth?

A. When this vapour, of which we have spoken, is sublimed in the centre of the earth, and when it has passed through warm and pure places, where a certain sulphureous grease adheres to the channels, then this vapour, which the Philosophers have denominated their Mercury, becomes adapted and joined to this grease, which it sublimes with itself; from such amalgamation there is produced a certain unctuousness, which, abandoning the vaporous form, assumes that of grease, and is sublimised in other places, which have been cleansed by this preceding vapour, and the earth whereof has consequently been rendered more subtle, pure, and humid; it fills the pores of this earth, is joined thereto, and gold is produced as a result.

Q. How is Saturn engendered?

A. It occurs when the said unctuosity, or grease, passes through places which are totally impure and cold.

Q. How is Venus brought forth?

A. She is produced in localities where the earth itself is pure, but is mingled with impure sulphur.

Q. What power does the vapour, which we have recently mentioned, possess in the centre of the earth?

A. By its continual progress it has the power of perpetually rarefying whatsoever is crude and impure, and of successively attracting to itself all that is pure around it.

Q. What is the seed of the first matter of all things?

A. The first matter of things, that is to say, the matter of principiating principles is begotten by Nature, without the assistance of any other seed; in other words, Nature receives the matter from the elements, whence it subsequently brings forth the seed.

Q. What, absolutely speaking, is therefore the seed of things?

A. The seed in a body is no other thing than a congealed air, or a humid vapour, which is useless except it be dissolved by a warm vapour.

Q. How is the generation of seed comprised in the metallic kingdom?

A. By the artifice of Archeus the four elements, in the first generation of Nature, distil a ponderous vapour of water into the centre of the earth ; this is the seed of metals, and it is called Mercury, not on account of its essence, but because of its fluidity, and the facility with which it will adhere to each and every thing.

Q. Why is this vapour compared to sulphur?

A. Because of its internal heat.

Q. From what species of Mercury are we to conclude that the metals are composed?

A. The reference is exclusively to the Mercury of the Philosophers, and in no sense to the common or vulgar substance, which cannot become a seed, seeing that, like other metals, it already contains its own seed.

Q. What, therefore, must actually be accepted as the subject of our matter?

A. The seed alone, otherwise the fixed grain, and not the whole body, which is differentiated into Sulphur, or living male, and into Mercury, or living female.

Q. What operation must be afterwards performed

A. They must be joined together, so that they may form a germ, after which they will proceed to the procreation of a fruit which is conformed to their nature.

Q. What is the part of the artist in this operation?

A. The artist must do nothing but separate that which is subtle from that which is gross.

Q. To what, therefore, is the whole philosophic combination reduced?

A. The development of one into two, and the reduction of two into one, and nothing further.

Q. Whither must we turn for the seed and life of meals and minerals?

A. The seed of minerals is properly the water which exists in the centre

And the heart of the minerals.

Q. How does Nature operate by the help of Art?

A. Every seed, whatsoever its kind, is useless, unless by Nature or Art it is placed in a suitable matrix, where it receives its life by the coction of the germ! and by the congelation of the pure particle, or fixed grain.

Q. How is the seed subsequently nourished and preserved?

A. By the warmth of its body.

Q. What is therefore performed by the artist in the mineral kingdom?

A. He finishes what cannot be finished by Nature on account of the crudity of the air, which has permeated the pores of all bodies by its violence, but on the surface and not in the bowels of the earth.

Q. What correspondence have the metals among themselves?

A. It is necessary for a proper comprehension of the nature of this correspondence to consider the position of the planets, and to pay attention to Saturn, which is the highest of all, and then is succeeded by Jupiter, next by Mars, the Sun, Venus, Mercury, and, lastly, by the Moon. It must be observed that the influential virtues of the planets do not ascend but descend, and experience teaches us that Mars can be easily converted into Venus, not Venus into Mars, which is of a lower sphere. So, also, Jupiter can be easily transmuted into Mercury, because Jupiter is superior to Mercury, the one being second after the firmament, the other second above the earth, and Saturn is highest of all, while the Moon is lowest. The Sun enters into all, but it is never ameliorated by its inferiors. It is clear that there is a large correspondence between Saturn and the Moon, in the middle of which is the Sun; but to all these changes the Philosopher should strive to administer the Sun.

Q. When the Philosophers speak of gold and silver, from which they extract their matter, are we to suppose that they refer to the vulgar gold and silver?

A. By no means; vulgar silver and gold are dead, while those of the Philosophers are full of life.

Q. What is the object of research among the Philosophers?

A. Proficiency in the art of perfecting what Nature has left imperfect in the mineral kingdom, and the attainment of the treasure of the Philosophical Stone.

Q. What is this Stone?

A. The Stone is nothing else than the radical humidity of the elements, perfectly purified and educed into a sovereign fixation, which causes it to perform such great things for health, life being resident exclusively in the humid radical.

Q. In what does the secret of accomplishing this admirable work consist?

A. It consists in knowing how to educe from potentiality into activity the innate warmth, or the fire of Nature, which is enclosed in the centre of the radical humidity.

Q. What are the precautions which must be made use of to guard against failure in the work?

A. Great pains must be taken to eliminate excrements from the matter, and to conserve nothing but the kernel, which contains all the virtue of the compound.

Q. Why does this medicine heal every species of disease?

A. It is not on account of tile variety of its qualities, but simply because it powerfully fortifies the natural warmth, which it gently stimulates, while other physics irritate it by too violent an action.

Q How can you demonstrate to me the truth of the art in the matter of the tincture?

A. Firstly, its truth is founded on the fact that the physical powder, being composed of the same substance as the metals, namely, quicksilver, has the faculty of combining with these in fusion, one nature easily embracing another which is like itself. Secondly, seeing that the imperfection of the base metals is owing to the crudeness of their quicksilver, and to that alone, the physical powder, which is a ripe and decocted quicksilver, and, in itself a pure fire, can easily communicate to them its own maturity, and can transmute them into its nature, after it has attracted their crude humidity, that is to say, their quicksilver, which is the sole substance that transmutes them, the rest being nothing but scoriae and excrements, which are rejected in projection.

Q. What road should the Philosopher follow that he may attain to the knowledge and execution of the physical work?

A. That precisely which was followed by the Great Architect of the Universe in the creation of the world, by observing how the chaos was evolved.

Q. What was the matter of the chaos?

A. It could be nothing else than a humid vapour, because water alone enters into all created substances, which all finish in a strange term, this term being a proper subject for the impression of all forms.

Q. Give me an example to illustrate what you have just stated.

A. An example may be found in the special productions of composite substances, the seeds of which invariably begin by resolving themselves into a certain humour, which is the chaos of the particular matter, whence issues, by a kind of irradiation, the complete form of the plant. Moreover, it should be observed that Holy Scripture makes no mention of anything except water as the material subject whereupon the Spirit of God brooded, nor of anything except light as the universal form of things.

Q. What profit may the Philosopher derive from these considerations, and what should he especially remark in the method of creation which was pursued by the Supreme Being?

A. In the first place he should observe the matter out of which the world was made; he will see that out of this confused mass, the Sovereign Artist began by extracting light, that this light in the same moment dissolved the darkness which covered the face of the earth, and that it served as the universal form of the matter. He will then easily perceive that in the generation of all composite substances, a species of irradiation takes place, and a separation of light and darkness, wherein Nature is an undeviating copyist of her Creator. The Philosopher will equally understand after what manner, by the action of this light, the empyrean, or firmament which divides the superior and inferior waters, was subsequently produced; how the sky was studded with luminous bodies; and how the necessity for the moon arose, which was owing to the space intervening between the things above and the things below; for the moon is an intermediate torch between the superior and the inferior worlds, receiving the celestial influences and communicating them to the earth. Finally he will understand how the Creator, in the gathering of the waters, produced dry land.

Q. How many heavens can you enumerate?

A. Properly there is one only, which is the firmament that divides the waters from the waters. Nevertheless, three are admitted, of which the first is the space that is above the clouds. In this heaven the waters are rarefied, and fall upon the fixed stars, and it is also in this space that the planets and wandering stars perform their revolutions. The second heaven is the firmament of the fixed stars, while the third is the abode of the supercelestial waters.

Q. Why is the rarefaction of the waters confined to the first heaven?

A. Because it is in the nature of rarefied substances to ascend, and because God, in His eternal laws, has assigned its proper sphere to everything.

Q. Why does each celestial body invariably revolve about an axis?

A. It is by reason of the primeval impetus which it received, and by virtue of the same law which will cause any heavy substance suspended from a thread to turn with the same velocity, if the power which impels its motion be always equal.

Q. Why do the superior waters never descend?

A. Because of their extreme rarefaction. It is for this reason that a skilled chemist can derive more profit from the study of rarefaction than from any other science whatsoever.

Q. What is the matter of the firmament?

A. It is properly air, which is more suitable than water as a medium of light.

Q. After the separation of the waters from the dry earth, what was performed by the Creator to originate generation?

A. He created a certain light which was destined for this office; He placed it in the central fire, and moderated this fire by the humidity of water and by the coldness of earth, so as to keep a check upon its energy and adapt it to His design.

Q. What is the action of this central fire?

A. It continually operates upon the nearest humid matter, which it exalts into vapour; now this vapour is the mercury of Nature and the first matter of the three kingdoms.

Q. How is the sulphur of Nature subsequently formed?

A. By the interaction of the central fire and the mercurial vapour.

Q. How is the salt of the sea produced?

A. By the action of the same fire upon aqueous humidity, when the aerial humidity, which is contained therein, has been exhaled.

Q. What should be done by a truly wise Philosopher when he has once mastered the foundation and the order in the procedure of the Great Architect of the Universe in the construction of all that exists in Nature?

A. He should, as far as may be possible, become a faithful copyist of his Creator. In the physical chaos he should make his chaos such as the original actually was; he should separate the light from the darkness : he should form his firmament for the separation of the waters which are above from the waters which are below, and should successively accomplish, point by point, the entire sequence of the creative act.

Q. With what is this grand and sublime operation performed?

A. With one single corpuscle, or minute body, which, so to speak, contains nothing but faeces, filth, and abominations, but whence a certain tenebrous and mercurial humidity is extracted, which contains in itself all that is required by the Philosopher, because, as a fact, he is in search of nothing hut the true Mercury.

Q. What kind of mercury, therefore, must he make use of in performing the work? A. Of a mercury which, as such, is not found on the earth, but is extracted from bodies, yet not from vulgar mercury, as it has been falsely said.

Q. Why is the latter unfitted to the needs of our work?

A. Because the wise artist must take notice that vulgar mercury has an insufficient quantity of sulphur, and he should consequently operate upon a body created by Nature, in which Nature herself has united the sulphur and mercury that it is the work of the artist to separate.

Q. What must he subsequently do?

A. He must purify them and join them anew together.

Q. How do you denominate the body of which we have been speaking?

A. The RUDE STONE, Or Chaos, or Iliaste, or Hyle–that confused mass which is known but universally despised.

Q. As you have told me that Mercury is the one thing which the Philosopher must absolutely understand, will you give me a circumstantial description of it, so as to avoid misconception?

A. In respect of its nature, our Mercury is dual–fixed and volatile; in regard to its motion, it is also dual, for it has a motion of ascent and of descent; by that of descent, it is the influence of plants, by which it stimulates the drooping fire of Nature, and this is its first office previous to congelation. By its ascensional movement, it rises, seeking to be purified, and as this is after congelation, it is considered to be the radical moisture of substances, which, beneath its vile scoriae, still preserves the nobility of its first origin.

Q. How many species of moisture do you suppose to be in each composite thing?

A. There are three–the Elementary, which is properly the vase of the other elements; the Radical, which, accurately speaking, is the oil, or balm, in which the entire virtue of the subject is resident–lastly, the Alimentary, the true natural dissolvent, which draws up the drooping internal fire, causing corruption and blackness by its humidity, and fostering and sustaining the subject.

Q. How many species of Mercury are there known to the Philosophers?

A. The Mercury of the Philosophers may be regarded under four aspects; the first is entitled the Mercury of bodies, which is actually their concealed seed; the second is the Mercury of Nature, which is the Bath or Vase of the Philosophers, otherwise the humid radical; to the third has been applied the designation, Mercury of the Philosophers, because it is found in their laboratory and in their minera. It is the sphere of Saturn; it is the Diana of the Wise; it is the true salt of metals, after the acquisition of which the true philosophic work may be truly said to have begun. In its fourth aspect, it is called Common Mercury, which yet is not that of the Vulgar, but rather is properly the true air of the Philosophers, the true middle substance of water, the true secret and concealed fire, called also common fire, because it is common to all minerae, for it is the substance of metals, and thence do they derive their quantity and quality.

Q. How many operations art comprised in our work?

A. There is one only, which may be resolved into sublimation, and sublimation, according to Geber, is nothing other than the elevation of the dry matter by the mediation of fire, with adherence to its own vase.

Q. What precaution should be taken in reading the Hermetic Philosophers ?

A. Great care, above all, must be observed upon this point, lest what they say upon the subject should be interpreted literally and in accordance with the mere sound of the words: For the letter killeth, but the spirit giveth life.

Q. What books should be read in order to have an acquaintance with our science?

A. Among the ancients, all the works of Hermes should especially be studied; in the next place, a certain book, entitled The Passage of the Red Sea, and another, The Entrance into the Promised Land. Paracelsus also should be read before all among elder writers, and, among other treatises, his Chemical Pathway, or the Manual of Paracelsus, which contains all the mysteries of demonstrative physics and the most arcane Kabbalah. This rare and unique manuscript work exists only in the Vatican Library, but Sendivogius had the good fortune to take a copy of it, which has helped in the illumination of the sages of our order. Secondly, Raymond Lully must be read, and his Vade Mecum above all, his dialogue called the Tree of Life, his testament, and his codicil. There must, however, be a certain precaution exercised in respect to the two last, because, like those of Geber, and also of Arnold de Villanova, they abound in false recipes and futile fictions, which seem to have been inserted with the object of more effectually disguising the truth from the ignorant. In the third place, the Turba Philosophorum which is a collection of ancient authors, contains much that is materially good, though there is much also which is valueless. Among mediaeval writers Zachary, Trevisan, Roger Bacon, and a certain anonymous author, whose book is entitled The Philosophers, should be held especially high in the estimation of the student. Among moderns the most worthy to be prized are John Fabricius, Francois de Nation, and Jean D’Espagnet, who wrote Physics Restored, though, to say the truth, he has imported some false precepts and fallacious opinions into his treatise.

Q. When may the Philosopher venture to undertake the work?

A. When he is, theoretically, able to extract, by means of a crude spirit, a digested spirit out of a body in dissolution, which digested spirit he must again rejoin to the vital oil.

Q. Explain me this theory in a clearer manner.

A. It may be demonstrated more completely in the actual process; the great experiment may be undertaken when the Philosopher, by the medium of a vegetable menstruurn, united to a mineral menstruum, is qualified to dissolve a third essential menstruum, with which menstruum united he must wash the earth, and then exalt it into a celestial quintessence, to compose the sulphureous thunderbolt, which instantaneously penetrates substances and destroys their excrements.

Q. Have those persons a proper acquaintance with Nature who pretend to make use of vulgar gold for seed, and of vulgar mercury for the dissolvent, or the earth in which it should be sown?

A. Assuredly not, because neither the one nor the other possesses the external agent–gold, because it has been deprived of it by decoction, and mercury because it has never had it.

Q. In seeking this auriferous seed elsewhere than in gold itself, is there no danger of producing a species of monster, since one appears to be departing from Nature?

A. It is undoubtedly true that in gold is contained the auriferous seed, and that in a more perfect condition than it is found in any other body; but this does not force us to make use of vulgar gold, for such a seed is equally found in each of the other metals, and is nothing else but that fixed grain which Nature has infused in the first congelation of mercury, all metals having one origin and a common substance, as will be ultimately unveiled to those who become worthy of receiving it by application and assiduous study.

Q. What follows from this doctrine?

A. It follows that, although the seed is more perfect in gold, it may be extracted much more easily from another body than from gold itself, other bodies being more open, that is to say, less digested, and less restricted in their humidity.

Q. Give me an example taken from Nature.

A. Vulgar gold may be likened to a fruit which, having come to a perfect maturity, has been cut off from its tree, and though it contains a most perfect and well-digested seed, notwithstanding, should anyone set it in the ground, with a view to its multiplication, much time, trouble, and attention will be consumed in the development of its vegetative capabilities. On the other hand, if a cutting, or a root, be taken from the same tree, and similarly planted, in a short time, and with no trouble, it will spring up and produce much fruit.

Q. Is it necessary that an amateur of this science should understand the formation of metals in the bowels of the earth if he wishes to complete his work ?

A. So indispensable is such a knowledge that should anyone fail, before all other studies, to apply himself to its attainment, and to imitate Nature point by point therein, he will never succeed in accomplishing anything but what is worthless.

Q. How, then, does Nature deposit metals in the bowels of the earth, and of what does she compose them ?

A. Nature manufactures them all out of sulphur and mercury, and forms them by their double vapour.

Q. What do you mean by this double vapour, and how can metals be formed thereby?

A. In order to a complete understanding of this question, it must first be stated that mercurial vapour is united to sulphureous vapour in a cavernous place which contains a saline water, which serves as their matrix. Thus is formed, firstly, the Vitriol of Nature; secondly, by the commotion of the elements, there is developed out of this Vitriol of Nature a new vapour, which is neither mercurial nor sulphureous, yet is allied to both these natures, and this, passing through places to which the grease of sulphur adheres, is joined therewith, and out of their union a glutinous substance is produced, otherwise, a formless mass, which is permeated by the vapour that fills these cavernous places. By this vapour, acting through the sulphur it contains, are produced the perfect metals, provided that the vapour and the locality are pure. If the locality and the vapour are impure, imperfect metals result. The terms perfection and imperfection have reference to various degrees of concoction.

Q. What is contained in this vapour?

A. A spirit of light and a spirit of fire, of the nature of the celestial bodies, which properly should be considered as the form of the universe.

Q. What does this vapour represent?

A. This vapour, thus impregnated by the universal spirit, represents, in a fairly complete way, the original Chaos, which contained all that was required for the original creation, that is, universal matter and universal form.

Q. And one cannot, notwithstanding, make use of vulgar mercury in the process?

A. No, because vulgar mercury, as already made plain, is devoid of external agent.

Q. Whence comes it that common mercury is without its external agent?

A. Because in the exaltation of the double vapour, the commotion has been so great and searching, that the spirit, or agent, has evaporated, as occurs, with very close similarity, in the fusion of metals. The result is that the unique mercurial part is deprived of its masculine or sulphureous agent, and consequently can never be transmuted into gold by Nature.

Q. How many species of gold are distinguished by the Philosophers?

A. Three sorts :–Astral Gold, Elementary Gold, and Vulgar Gold.

Q. What is astral gold?

A. Astral Gold has its centre in the sun, which communicates it by its rays to all inferior beings. It is an igneous substance, which receives a continual emanation of solar corpuscles that penetrate all things sentient, vegetable, and mineral.

Q. What do you refer to under the term Elementary Gold ?

A. This is the most pure and fixed portion of the elements, and of all that is composed of them. All sublunary beings included in the three kingdoms contain in their inmost centre a precious grain of this elementary gold.

Q. Give me some description of Vulgar Gold ?

A. It is the most beautiful metal of our acquaintance, the best that Nature can produce, as perfect as it is unalterable in itself.

Q. Of what species of gold is the Stone of the Philosophers ?

A. It is of the second species, as being the most pure portion of all the metallic elements after its purification, when it is termed living philosophical gold. A perfect equilibrium and equality of the four elements enter into the Physical Stone, and four things are indispensable for the accomplishment of the work, namely, composition, allocation, mixture, and union, which, once performed according to the rules of art, will beget the lawful Son of the Sun, and the Phoenix which eternally rises out of its own ashes.

Q. What is actually the living gold of the Philosophers?

A. It is exclusively the fire of Mercury, or that igneous virtue, contained in the radical moisture, to which it has already communicated the fixity and the nature of the sulphur, whence it has emanated, the mercurial character of the whole substance of philosophical sulphur permitting it to be alternatively termed mercury.

Q. What other name is also given by the Philosophers to their living gold ?

A. They also term it their living sulphur, and their true fire; they recognize its existence in all bodies, and there is nothing that can subsist without it.

Q. Where must we look for our living gold, our living sulphur, and our true fire ?

A. In the house of Mercury.

Q. By what is this fire nourished?

A. By the air.

Q. Give me a comparative illustration of the power of this fire ?

A. To exemplify the attraction of this interior fire, there is no better comparison than that which is derived from the thunderbolt, which originally is simply a dry, terrestrial exhalation, united to a humid vapour. By exaltation, and by assuming the igneous nature, it acts on the humidity which is inherent to it; this it attracts to itself, transmutes it into its own nature, and then rapidly precipitates itself to the earth, where it is attracted by a fixed nature which is like unto its own.

Q. What should be done by the Philosopher after he has extracted his Mercury ?

A. He should develop it from potentiality into activity.

Q. Cannot Nature perform this of herself?

A. No; because she stops short after the first sublimation, and out of the matter which is thus disposed do the metals engender.

Q. What do the Philosophers understand by their gold and silver?

A. The Philosophers apply to their Sulphur the name of Gold, and to their Mercury the name of Silver.

Q. Whence are they derived?

A. I have already stated that they are derived from a homogeneous body wherein they are found in great abundance, whence also Philosophers know how to extract both by an admirable, and entirely philosophical, process.

Q. When this operation has been duly performed, to what other point of the practice must they next apply themselves?

A. To the confection of the philosophical amalgam, which must be done with great care, but can only be accomplished after the preparation and sublimation of the Mercury.

Q. When should your matter be combined with the living gold?

A. During the period of amalgamation only, that is to say, Sulphur is introduced into it by means of the amalgamation, and thenceforth there is one substance; the process is shortened by the addition of Sulphur, while the tincture at the same time is augmented.

Q. What is contained in the centre of the radical moisture ?

A. It contains and conceals Sulphur, which is covered with a hard rind.

Q. What must be done to apply it to the Great Work?

A. It must be drawn, out of its bonds with consummate skill, and by the method of putrefaction.

Q. Does Nature, in her work in the mines, possess a menstruum which is adapted to the dissolution and liberation of this sulphur?

A. No; because there is no local movement. Could Nature, unassisted, dissolve, putrefy, and purify the metallic body, she would herself provide us with !he Physical Stone, which is Sulphur exalted and increased in virtue.

Q. Can you elucidate this doctrine by an example?

A. By an enlargement of the previous comparison of a fruit, or a seed, which, in the first place, is put into the earth for its solution, and afterwards for its multiplication. Now, the Philosopher, who is in a position to discern what is good seed, extracts it from its centre, consigns it to its proper earth, when it has been well cured and prepared, and therein he rarefies it in such a manner that its prolific virtue is increased and indefinitely multiplied.

Q. In what does the whole secret of the seed consist ?

A. In the true knowledge of its proper earth.

Q. What do you understand by the seed in the work Of the Philosophers ?

A. I understand the interior heat, or the specific spirit, which is enclosed in the humid radical, which, in other words, is the middle substance of living silver, the proper sperm of metals, which contains its own seed.

Q. How do you set free the sulphur from its bonds?

A. By putrefaction.

Q. What is the earth of minerals ?

A. It is their proper menstruum.

Q. What pains must be taken by the Philosopher to extract that part which he requires?

A. He must take great pains to eliminate the fetid vapours and impure sulphurs, after which the seed must be injected.

Q. By what indication may the Artist be assured that he is in the right road at the beginning of his work?

A. When he finds that the dissolvent and the thing dissolved are converted into one form and one matter at the period of dissolution.

Q. How many solutions do you count in the Philosophic Work?

A. There are three. The first solution is that which reduces the crude and metallic body into its elements of sulphur and of living silver; the second is that of the physical body, and the third is the solution of the mineral earth.

Q. How is the metallic body reduced by the first solution into mercury, and then into sulphur?

A. By the secret artificial fire, which is the Burning Star.

Q. How is this operation performed?

A. By extracting from the subject, in the first place, the mercury or vapour of the elements, and, after purification, by using it to liberate the sulphur from its bonds, by corruption, of which blackness is the indication.

Q. How is the second solution performed ?

A. When the physical body is resolved into the two substances previously mentioned, and has acquired the celestial nature.

Q. What is the name which is applied by Philosophers to the Matter during this period?

A, It is called their Physical Chaos, and it is, in fact, the true First Matter, a name which can hardly be applied before the conjunction of the male–which is sulphur–with the female–which is silver.

Q. To what does the third solution refer?

A. It is the humectation of the mineral earth and it is closely bound up with multiplication.

Q. What fire must be made use of in our work ?

A. That fire which is used by Nature.

Q. What is the potency of this fire?

A. It dissolves everything that is in the world, because it is the principle of all dissolution and corruption.

Q. Why is it also termed Mercury ?

A. Because it is in its nature aerial, and a most subtle vapour, which partakes at the same time of sulphur, whence it has contracted some contamination.

Q. Where is this fire concealed ?

A. It is concealed in the subject of art.

Q. Who is it that is familiar with, and can produce, this fire?

A. It is known to the wise, who can both produce it and purify it.

Q. What is the essential potency and characteristic of this fire ?

A. It is excessively dry, and is continually in motion; it seeks only to disintegrate and to educe things from potentiality into actuality; it is that, in a word, which coming upon solid places in mines, circulates in a vaporous form upon the matter, and dissolves it.

Q. How may this fire be most easily distinguished?

A. By the sulphureous excrements in which it is enveloped, and by the saline environment with which it is clothed.

Q. What must be added to this fire so as to accentuate its capacity for incineration in the feminine species?

A. On account of its extreme dryness it requires to be moistened.

Q. How many philosophical fires do you enumerate ?

A. There are in all three–the natural, the unnatural, and the contra-natural.

Q. Explain to me these three species of fires.

A. The natural fire is the masculine fire, or the chief agent; the unnatural is the feminine, which is the dissolvent of Nature, nourishing a white smoke, and assuming that form. This smoke is quickly dissipated, unless much care be exercised, and it is almost incombustible, though by philosophical sublimation it becomes corporeal and resplendent. The contra-natural fire is that which disintegrates compounds and has the power to unbind what has’ been bound very closely by Nature.

Q. Where is our matter to be found?

A. It is to be found everywhere, but it must specially be sought in metallic nature, where it is more easily available than elsewhere.

Q. What kind must be preferred before all others ?

A. The most mature, the most appropriate, and the easiest; but care, before all things, must be taken that the metallic essence shall be present, not only potentially but in actuality, and that there is, moreover, a metallic splendour.

Q. Is everything contained in this subject?

A. Yes; but Nature, at the same time, must be assisted, so that the work may be perfected and hastened, and this by the means which are familiar to the higher grades of experiment.

Q. Is this subject exceedingly precious ?

A. It is vile, and originally is without native elegance; should anyone say that it is saleable, it is the species to which they refer, but, fundamentally, it is not saleable, because it is useful in our work alone.

Q. What does our Matter contain?

A. It contains Salt, Sulphur, and Mercury.

Q. What operation is it most important to be able to perform?

A. The successive extraction of the Salt, Sulphur, and Mercury.

Q. How is that done ?

A. By sole and perfect sublimation.

Q. What is in the first place extracted ?

A. Mercury in the form of a white smoke.

Q. What follows?

A. Igneous water, or Sulphur.

Q. What then?

A. Dissolution with purified salt, in the first place volatilising that which is fixed, and afterwards fixing that which is volatile into a precious earth, which is the Vase of the Philosophers, and is wholly perfect.

Q. When must the Philosopher begin his enterprise ?

A. At the moment of daybreak, for his energy must never be relaxed.

Q. When may he take his rest?

A. When the work has come to its perfection.

Q. At what hour is the end of the work ?

A. High noon, that is to say, the moment when the Sun is in its fullest power, and the Son of the Day-Star in its most brilliant splendour.

Q. What is the pass-word of Magnesia?

A. You know whether I can or should answer:–I reserve my speech.

Q. Give me the greeting of the Philosophers.

A. Begin ; I will reply to you.

Q. Are you an apprentice Philosopher?

A. My friends, and the wise, know me.

Q. What is the age of a Philosopher ?

A. From the moment of his researches to that of his discoveries, the Philosopher does not age.

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Articles

Vegetable Expectorants.

                                                                                                                  Martindale’s 24th.

Compiled and edited by Ivor Hughes

-::-

IPECACUANHA and other VEGETABLE EXPECTORANTS
Ipecacuanha (B.P., I.P.). Ipecac.; Ipecacuanha Root; Brechwurzel.
Foreign Pharmacopeias: In all pharmacopoeias examined except Chin.
Chil., Mex., and U.S. specify not less than 2% of ether-soluble alkaloids.

  The dried root, or rhizome and root, of Cephaelis ipecacuanha (= Uragoga ipecacuanha) (Rubiaceae), known in commerce as Rio or Brazilian ipecacuanha, and cultivated in Brazil, Selangor, Bengal and Burma, or of C. acuminata, known as Cartagena, Nicaragua or Panama ipecacuanha, cultivated in Colombia and Costa Rica; or it may be a mixture of both species. Good samples contain 2 to 3% of total alkaloids, the principal alkaloids being emetine and cephaëline. In Rio ipecacuanha 50 to 70% of the total alkaloid is emetine, and in Cartagena about 20 to 40% is emetine. Rio , Matto Grosso, Minas and Manaos varieties come from Brazil ; Indian and Johore come from Burma and Malaya ; Cartagena , Nicaragua and Panama come chiefly from Central America .

  The B.P. specifies not less than 2% of total alkaloids, calculated as emetine. I.P. specifies not less than 2% of total alkaloids of which not less than 60% consists of non-phenolic alkaloids. Note. When Ipecacuanha, Ipecacuanha Pulvis or Powdered Ipecacuanha is prescribed, Prepared Ipecacuanha must be dispensed.

Uses. In small doses ipecacuanha is an expectorant, but large doses are irritant to the gastric mucosa and produce vomiting and diarrhoea. It is employed in small doses as an expectorant in acute bronchitis when the sputum is scanty, and it gives relief in the dry cough of laryngitis and tracheitis. It is well tolerated by children. Combined with opium, as in Dover’s powder, it is of value as a diaphoretic in the early stages of febrile affections and especially for aborting incipient colds. Larger doses are used for their emetic action and although this is somewhat slow, not taking effect for 20 to 30 minutes, the drug is probably the safest of the emetics. Powdered ipecacuanha was formerly employed in the treatment of amoebic dysentery but has been replaced by the salts of emetine.

Prepared Ipecacuanha (B.P., Ind.P.). Ipecacuanha Pulverata; Pulvis Ipecacuanhae Radicis Standardisatus (I.P., Egyp. P.).
Dose:
30 to 120 mg. ( ½ to 2 grains); as an emetic, 1 to 2 g. (15 to 30 grains). Powdered ipecacuanha adjusted with exhausted ipecacuanha or powdered lactose to contain 2% of total alkaloids, calculated as emetine, of which I.P. and Egyp. P. specify not less than 60% consists of non-phenolic alkaloids, calculated as emetine. Protect from moisture in a cool place.

Extracts:
Extractum Ipecacuanha (Fr. P.).
A firm alcoholic extract containing 6 to 8% of total alkaloids. Max. single dose: 300 mg. (5 grains). Cz. P., Pol. P., and Swiss P. include a dry extract containing 2% of total alkaloids.

Ipecac Fluidextract (U.S.P., Mex. P.). A liquid extract containing 2% w/v of ether-soluble alkaloids. Usual dose: 0’5 ml. (8 minims); range: 0’5 to 1 ml.

Liquid Extract of Ipecacuanha (B.P., Ind. P.). Ext. Ipecac. Liq. Prepared by percolation with alcohol (80%) and adjusted to contain 2% w/v of total alkaloids; about 1/25 gr. in 2 m.
Dose: 0-03 to 0-12 ml. ( ½to 2 minims); emetic dose: 0-6 to 2ml. (10 to 30 minims).

Linctus:
Linct. Ipecac, c. Scill. pro Inf. (B.N.F.). “Ipecacuanha and Squill Linctus for Infants. Tincture of ipecacuanha 2 m., tincture of Squill 2 m., compound spirit of orange 1/8 m., syrup of blackcurrant 30 m., syrup to 60 m.
Dose: 4 ml. (60 minims). The B.N.F. directs that this linctus be dispensed when Mist. Tuss. Rubra pro Inf. is prescribed.

Lozenges:
Troch. Ipecac. (B.P.C. 1949). Lozenges of Ipecacuanha. Each contains ¼ gr. of prepared ipecacuanha in simple basis (about 1/200 gr of total alkaloids).

Mixtures:
Alkaline Mixture of Ipecacuanha (B.P.C.). Mist. Ipecac. Alk. (B.N.F.).; Mist. Expect. Alk. Tincture of ipecacuanha 20 m., sodium bicarbonate 10 gr., ammonium bicarbonate 3 gr., chloroform water to 1/2 fl. oz.
Dose: 15 ml. ( ½ fl. oz.).

Mist. Ipecac. Ammon. pro Inf. (B.N.F.). Tincture of ipecacuanha 2½ m., ammonium bicarbonate ½ gr, sodium bicarbonate 2 gr., syrup of tolu 10 m., anise water to 60 m.
Dose: 4 ml. (60 minims).

Mist. Ipecac. Ammon. pro Infant. (N.W.F. 1947). Tincture of ipecacuanha 2½ m., ammonium bicarbonate ½ gr., sodium bicarbonate 3 gr., syrup 10 m., caraway water to 60 m.
Dose: 4 ml. (60 minims).

Mist. Ipecac, et Bellad. pro Infant. (N.W.F. 1947). Tincture of ipecacuanha 2½ m, tincture of belladonna 4 m., syrup 10 m., water to 60 m. Dose: 4 ml. (60 minims).

Mist. Ipecac, et Codein. (N.F. 1955). Tincture of ipecacuanha 10 m., codeine phosphate ¼ gr., camphorated tincture of opium 30 m., syrup of tolu 30 m., chloroform water to ½ fl oz.
Dose: 15 ml. ( ½ fl. oz.). The N.F. 1955 directs that this mixture be dispensed when Mist. Pectoral. Sed. is prescribed.

Mixture of Ipecacuanha and Morphine (B.P.C.). Mist. Ipecac, et Morph. (B.N.F.); Mist. Morph. et Ipecac.; Mist. Tuss. Nig. Tincture of ipecacuanha 5 m., tincture of chloroform and morphine 10m., liquid extract of liquorice 15m., water to ½ fl. oz. It contains in ½  fl. oz. about 1/65 gr of anhydrous morphine.
Dose: 15 ml. ( ½.fl.oz.).

Mixture of Ipecacuanha for Infants (B.P.C.). Mist. Ipecac, pro Inf. (B.N.F.); Mist. Tuss. pro Inf. Tincture of ipecacuanha 2½ m., sodium bicarbonate 2 gr., syrup of tolu 15 m., liquid extract of liquorice 5 rn., anise water to 60 m.
Dose: 4 to 8 ml. (60 to 120 minims). The B.N.F. directs that when  Mist. Ipecac. Opiat. pro Inf. is prescribed, Mist. Ipecac, pro Inf. containing camphorated tincture of opium, 2½ m. in each 60 m., be dispensed.

Powders
Powder of Ipecacuanha and Opium (B.P., Egyp. P., Ind. P.). Pulv. Ipecac, et Opii; Ipecac and Opium Powder (U.S.N.F.); Dover’s Powder; Compound Ipecacuanha Powder. Prepared ipecacuanha 10 g,, powdered opium 10 g., lactose 80 g. It contains 1% of anhydrous morphine. Dose: 300 to 600 mg. (5 to 10 grains). Many foreign pharmacopoeias include a similar powder, sometimes with potassium sulphate or with equal parts of potassium nitrate and potassium sulphate in place of lactose; max. single dose 1 to 1 -5 g. and max. in 24 hours 4 to 6 g.

Syrup
Ipecac Syrup (U.S.P.).  Ipecac fluidextract 7 ml., glycerin 10 ml., syrup to 100 ml. Usual dose (emetic): 8 ml. (120 minims).

Tablets
Tablets of Ipecacuanha and Opium (B.P., Ind. P.). Tab. Ipecac, et Opii (B.N.F.); Dover’s Powder Tablets. Unless otherwise specified tablets each containing 5 grains of powder of ipecacuanha and opium are supplied.

Tinctures and Wines
Tinctura Ipecacuanhas (I.P.).
Prepared by percolation with alcohol (70%) and adjusted to contain 0-2% w/v of total alkaloids of which not less than 60% consists of non-phenolic alkaloids. A similar tincture is included in many foreign pharmacopoeias.

Tincture of Ipecacuanha (B.P., Ind. P.). Tinct. Ipecac. Liquid extract of ipecacuanha 5 ml., dilute acetic acid 1.65 ml., alcohol (90%) 21 ml., glycerin 20 ml., distilled water to 100 ml. Set aside for not less than 24 hours and filter. It contains 0-1 % w/v of total alkaloids; about 1/30th  gr. in 30 m.
Dose: 0-6 to 2 ml. (10 to 30 minims); emetic dose: 15 to 30 ml. ( ½ to 1 fl. oz.). Note: When Ipecacuanha Wine or Vinum Ipecacuanhas is prescribed, Tincture of Ipecacuanha is dispensed.

Vinum   Ipecacuanha;   (B.P.   1914).   Ipecacuanha   Wine.   Liquid   extract of  ipecacuanha 5 ml., and sherry 95 ml. Set aside for 48 hours and filter.
Dose: 0-6 to 2 ml. (10 to 30 minims); emetic dose: 15 to 24 ml. (240 to 360 minims).

Vinegar
Acet. Ipecac. (B.P.C. 1949).
Vinegar of Ipecacuanha. Liquid extract of ipecacuanha 5 ml., alcohol (90%) 10 ml., dilute acetic acid 60 ml., water to 100 ml. Allow to stand 48 hours and filter. Dose: 0-6 to 2 ml. (10 to 30 minims).

Other Vegetable Expectorants.
Adhatoda (B.P.C. 1949). Adhat.; Arusha; Vasaka (
Ind. P.).
Dose:
1 to 2 g. (15 to 30 grains). The fresh or dried leaves of Adhatoda vasica (Acanthaceae). It contains a bitter crystalline alkaloid, vasicine (peganine), and an organic acid, adhatodic acid.
Uses. It is used in India as an expectorant; in large doses it is irritant and causes vomiting and diarrhoea. It is usually employed as a liquid extract or syrup. The dried leaves have been smoked in cigarettes for the relief of asthma.

Liquid Extract of Vasaka ( Ind. P.). Ext. Vasak. Liq.; Liquid Extract of Adhatoda. 1 in 1; prepared by percolation with alcohol (60%).
Dose: 1 to 2 ml. (15 to 30 minims). The Indian Pharmacopoeial List, 1946, included a 2 in 1 liquid extract with the same dose as the above extract.

Syrup of Vasaka ( Ind. P.). Syr. Vasak.; Syrup of Adhatoda. Liquid extract of vasaka 50 ml., glycerin 10 ml., syrup to 100 ml.
Dose: 2 to 4 ml. (30 to 60 minims).

Angelica. Archangelica.
Dose:
0-6 to 2 g. (10 to 30 grains). The dried ripe fruits or the dried rhizome and roots of Angelica archangelica (Umbelliferae). Both the fruits (Angelica Fructus) and the rhizome and roots (Angelica; Radix) were included in the B.P.C. 1934. The fruits contain about 1% and the rhizome and roots about 0-3 to 1 % of volatile oil. Foreign Pharmacopoeias: Belg., Cz. Fr., Ger. , and Swiss include the rhizome and roots. Fr. also includes the leaf. Uses. Angelica has diaphoretic and expectorant properties. It is administered as a powder or as an infusion (1 in 20).

Cocillana (B.P.C.). Cocill.; Grape Bark; Guapi Bark; Huapi Bark. Dose: 0.5 to 1 g. (8 to 15 grains). The dried bark of Guarea rusbyi (Meliaceae) containing not less than 3.5 % of alcohol (60%)-soluble extractive.
Uses. Cocillana is stated to equal ipecacuanha in expectorant properties and to be, in addition, laxative. Large doses are emetic. It is administered as liquid extract or syrup, frequently with other expectorants.

Liquid Extract of Cocillana (B.P.C.). Ext. Cocillan. Liq. 1 in 1; prepared by percolation with alcohol (60%).
Dose: 0-3 to 1 ml. (5 to 15 minims).  

Syr. Cocillan. Co. (B.P.C. 1949). Compound Syrup of Cocillana. Liquid extract of cocillana 1 m., liquid extract of euphorbia 2½ m., liquid extract of senega ¼ m., liquid extract of squill ¼ m., antimony potassium tartrate 1/128 gr., codeine phosphate ⅛ gr., menthol 1/96 gr., spirit of chloroform 2⅛ m., water 3¾ m., glycerin 10 m., syrup to 60 m.
Dose: 2 to 4 ml. (30 to 60 minims).

Eriodictyon (B.P.C. 1934, U.S.N.F.). Eriodict.; Yerba Santa; Mountain Balm.
Dose: 1 to 4 g. (15 to 60 grains). The dried leaves of Eriodictyon californicum ( = E. glutinosum) (Hydrophyllaceae). It has an aromatic odour and a balsamic bitter taste which becomes sweetish and slightly acrid. Uses. Eriodictyon has been used as a bitter and as an expectorant. It has the property of masking the taste of quinine and many other bitter drugs and it is chiefly used for this purpose, usually in the form of an aromatic syrup.

Aromatic Eriodictyon Syrup (U.S.N.F.). Syrupus Corrigens. Eriodictyon fluidextract 3.2 ml., potassium hydroxide solution (1 in 20) 2.5 ml., compound cardamom tincture 6.5 ml., sassafras oil 0.05 ml., lemon oil 0.05 ml., clove oil 0.1 ml., alcohol 3.2 ml., sucrose 80 g., magnesium carbonate 500 mg., water to 100 ml. 
Usual dose: 8 ml. (120 minims).

Eriodictyon Fluidextract (U.S.N.F.). Yerba Santa Fluidextract. 1 in 1; prepared by percolation with a mixture of alcohol 4 vol. and water 1 vol. Dose: 1 to 4 ml. (15 to 60 minims).

Euphorbia (B.P.C., Ind. P.C.). Euphorb.; Euphorbia Herb; Euphorbia Pilulifera; Australian Snake Weed; Cat’s Hair. The dried entire plant of Euphorbia hirta ( =E, pilulifera) (Euphorbiaceae) containing not less than 16% of alcohol (45%)-soluble extractive.
Uses. It has been used in the form of a liquid extract or tincture in the treatment of coughs and asthma.

Ext. Euphorb. Liq. (B.P.C. 1949). Liquid Extract of Euphorbia. 1 in 1; prepared by percolation with alcohol (45%).
Dose: 0.12 to 0.3 ml. (2 to 5 minims).

Tinct. Euphorb. (B.P.C. 1923). Tincture of Euphorbia. 1 in 5; prepared by percolation with alcohol (60%).
Dose: 0-6 to 2 ml. (10 to 30 minims). 

Note. Euphorbium (B.P.C. 1934, Belg. P., Fr. P., Ger. P., Jug. P., Span. P., Swiss P.) is the dried latex from the stem of Euphorbia resinifera. It is emetic and powerfully purgative but it is not used internally on account of its violent action and its tendency to cause acute nephritis. The powder is violently sternutatory. Externally, it acts as a vesicant and was used for this purpose in veterinary medicine.

  Grindelia (B.P.C. 1949). Grindel.; Grindelia Robusta; Gum Plant; Gumweed; Tar Weed. The dried leaves and flowering tops of the field gumweed, Grindelia camporum (Composite) containing not less than 20% of alcohol (90%)-soluble extractive. Store in a cool dry place. Foreign Pharmacopoeias: In Fr. and Span. In U.S.N.F. which allows also the dried leaves and flowering tops of the marsh gumweed, G. humilis, and of the curly-cup gumweed, G. squarrosa.  

Uses. Grindelia has expectorant properties and has been said to exert an antispasmodic effect. It is used in the treatment of asthma and bronchitis and it has also been used in cystitis and in catarrh of the genito-urinary tract. Large doses sometimes cause renal irritation. It is administered as a liquid extract; its nauseous taste may be masked with chloroform or glycerin.

  Ext. Grindel. Liq. (B.P.C. 1949). Liquid Extract of Grindelia. Grindelia 100 g. is exhausted by percolation with alcohol (90%), the alcohol is removed by distillation and the residue is dissolved in water 50 ml. to which 10 g. of sodium bicarbonate has previously been added; after effervescence has ceased, the solution is adjusted to 100 ml. with alcohol (90%) and filtered.
Dose: 0-6 to 1-2 ml. (10 to 20 minims).

 

Grindelia Fluidextract (U.S.N.F.). 1 in 1; prepared by percolation with a mixture of alcohol 3 vol. and water 1 vol.
Usual dose: 2 ml. (30 minims).

Mist. Grindeliae (N.F. 1939). Liquid extract of grindelia 10 m., ethereal tincture of lobelia 7½ m., tincture of belladonna 5 m., liquid extract of liquorice 10 m., mucilage of acacia 30 m., chloroform water to ½ fl. oz.
Dose: 15 ml. (½ fl. oz.).

Horehound (B.P.C. 1949). Marrubium; Marrub.; Hoarhound; White Horehound; Marrubii Herba (Hung. P.).
Dose: 1 to 2 g. (15 to 30 grains).
The dried leaves and flowering tops of Marrubium vulgare (Labiatae). Store in a cool dry place. Uses. Horehound is expectorant and, in large doses, laxative. It may be administered as an infusion or syrup.

Inf. Marrub. Conc. (B.P.C. 1934). Concentrated Infusion of Horehound. Macerate horehound 40 g. with alcohol (25%) 100 ml. for 48 hours, press, add alcohol (25%) 40 ml. to the pressed marc, macerate for 24 hours and press. Mix the liquids from the two pressings, allow to stand for at least 14 days, and filter.
Dose: 2 to 4 ml. (30 to 60 minims).

Syr. Marrub. (B.P.C. 1949). Syrup of Horehound. Cover horehound 42.5 g. with boiling water and digest on a water-bath for one hour; strain, press, evaporate on a water-bath to about 45 ml., cool, and filter; dissolve sucrose 85 g. in the filtrate with the aid of heat and adjust with water to a wt per ml. of 1.33 g.
Dose: 2 to 4 ml. (30 to 60 minims).

Sanguinaria (B.P.C. 1934, U.S.N.F.). Sanguin.; Bloodroot; Red Indian Paint; Red Puccoon; Tetterwort.
Dose: 60 to 300 mg. (1 to 5 grains). The dried rhizome of Sanguinaris canadensis (Papaveraceae). It is sternutatory, has a slight odour and a persistently acrid taste. Uses. Sanguinaria is a local irritant which, in large doses, produces nausea and vomiting. It has been used as an expectorant in chronic bronchitis, usually as a tincture (1 in 10; dose: 1 ml.), but its value for this purpose is doubtful. It is an ingredient of Compound White Pine Syrup of the U.S.N.F.

Senega (B.P.C.). Seneg.; Senega Root; Seneca Snakeroot; Rattlesnake Root; Polygala.. The dried root of Polygala senega (Polygalaceae) containing not less than 27% of alcohol (20%)-soluble extractive.
Foreign Pharmacopoeias: In Belg., Chil., Dan., Egyp., Fr.,
Ger. , Hung., Jap., Jug., Mex., Nor., Span., Steed., and Swiss. Also in U.S.N.F.
Polygala (Chin, and Jap.} is the dried root of Polygala tenuifolia and Chinensis (
Ind. ), Chinensis Root or Indian Senega, is the dried root of P. chinensis; they are used for the same purposes as senega. Uses. Senega contains glycosidal saponins which are not absorbed but irritate the gastric mucosa and give rise to the reflex secretion of mucus in the bronchioles. It is used, frequently with other expectorants, in the treatment of chronic bronchitis.

Concentrated Infusion of Senega (B.P.C.). Inf. Seneg. Cone. 1 in 2.5; prepared by percolation with alcohol (25%) and made faintly alkaline by the addition of dilute solution of ammonia.
Dose: 2 to 4 ml. (30 to 60 minims). Infusion of Senega is prepared by diluting 1 vol. of this concentrated infusion to 8 vol. with water.

Inf. Seneg. Rec. (B.P.C. 1949). Fresh Infusion of Senega. Senega 5 g. and boiling water 100 g., infused in a covered vessel for 30 minutes and strained. 
Dose: 15 to 30 ml. ( ½ to 1 fl. oz.).

Liquid Extract of Senega (B.P.C.). Ext. Seneg. Liq.; Senega Fluidextract (U.S.N.F.). 1 in 1; prepared by percolation with alcohol (60%) and made faintly alkaline with dilute solution of ammonia.
Dose: 0.3 to 1 ml. (5 to 15 minims).

Senega Syrup (U.S.N.F.). Senega fluidextract 20 ml., diluted ammonia solution 1 ml., syrup to 100 ml.
Usual dose: 4 ml. (60 minims).

Tincture of Senega (B.P.C.). Tinct. Seneg. Liquid extract of senega 20 ml., alcohol (60%) to 100 ml.
Dose: 2 to 4 ml. (30 to 60 minims). Egyp. P. and Mex. P. include a similar tincture.

Squill (B.P.C., I.P.). Scilla; White Squill; Scilla: Bulbus (I.P.); Scille; Meerzwiebel; Bulbo de escila.
Dose: 60 to 200 mg. (1 to 3 grains); I.P. max. single dose 500 mg. and max. in 24 hours 1 g. The dried sliced bulb of the white or Mediterranean squill, Urginea maritima (= U. scilla) (Liliaceae;), with the membranous outer scales removed, and containing not less than 65% of alcohol (60%)-soluble extractive. Store in a dry place. Powdered squill is very hygroscopic and should be stored in a desiccated atmosphere.
Foreign Pharmacopoeias: In Belg., Chil., Cz., Egyp., Fr.,
Ger. , Hung., Nor., Span., Swed., and Swiss. In U.S.N.F. which allows also the bulb of Indian squill, U. indica ( = Urginea, B.P.C. 1949,). Toxic Effects. These include nausea and vomiting, violent purging and collapse. The heart may be slowed owing to vagal stimulation. Antidotes. Empty stomach by emetic or stomach tube (if copious vomiting has not already occurred). Keep patient lying down and warm. Give stimulants and treat collapse. Contra-indications. It is contra-indicated in renal disease and gastrointestinal irritation. Uses. Squill has a digitalis-like action on the heart, but it is not a good substitute for digitalis because the glycosides it contains are poorly absorbed from the alimentary tract. It is now seldom employed for this purpose. Since its action is short and it is rapidly excreted there is little danger of cumulative poisoning. Squill in small doses, through mild gastric irritation, produces a reflex secretion from the bronchioles, and its chief use is as an expectorant in the treatment of cough. It is too irritating to the bronchial mucous membrane for use in acute bronchitis, but is of value in chronic bronchitis when secretion is scanty. In larger doses it has an emetic action. The powdered drug, and extracts made from it, have been largely used as rat poisons, but red squill is usually preferred for this purpose.

RAT POISONING. During a campaign in Alexandria to poison rats in order to eradicate plague-carrying fleas, the most effective preparation was the following tallow bait: white squill 60 g., flour 180 g., tallow 60 g., common salt 500 mg. The ingredients were well mixed with sufficient water and provided enough for 300 baits. — A. G. Hussein, Bull. World Hlth Org., 1955, 13, 27.

Compound Squill Syrup (U.S.N.F.). Hive Syrup; Coxe’s Hive Syrup. Squill fluidextract 8 ml., senega fluidextract 8 ml., antimony potassium tartrate 200 mg., sucrose 72 g., water to 100 ml. Expectorant.
Usual dose: 2 ml. (30 minims).

Expectorant Mixture (U.S.N.F.). Stake’s Expectorant. Squill fluidextract 3-5 ml., ammonium carbonate 1-8 g., senega fluidextract 3-5 ml., camphorated opium tincture 17-5 ml., water 8-5 ml., tolu balsam syrup to 100 ml.
Usual dose: 4 ml. (60 minims).

Linct. Scill. (B.P.C. 1949). Linctus of Squill. Equal volumes of oxymel of squill, glycerin, and syrup. 
Dose:
2 to 4 ml. (30 to 60 minims).

Liquid Extract of Squill (B.P.C.). Ext. Scill. Liq.; Squill Fluidextract (U.S.N.F.). 1 in 1; prepared by percolation with alcohol (70%).
Dose: 0-03 to 0-2 ml. ( ½ to 3 minims).

Mist. Expect. Nig. (N.F. 1939). Liquid extract of squill 2 m., ammonium carbonate 3½ gr., camphorated tincture of opium 15 m., syrup of tolu 15 m., solution of burnt sugar 7½m., chloroform water to ½ fl- oz.
Dose: 15 ml. ( ½ fl. oz.).

Mist. Oxymellis (N.F. 1939). Oxymel of squill 30 m., liquid extract of ipecacuanha ½ m – glycerin 20 m., dilute sulphuric acid 4m., solution of Bordeaux B 2½m., water to ½ fl. oz. 
Dose: 15 ml. ( ½ fl- oz-)

Oxymel of Squill (B.P.C.). Oxymel Scill.; Acetum Scille Mellitus (Egyp. P.). Contains the equivalent of 5% w/v of squill in acetic acid, honey, and water.
Dose: 2 to 4 ml. (30 to 60 minims).

Pil. Scill. Co. (B.P.C. 1949). Compound Pills of Squill. Each contains squill 1 gr., ginger 5/6 gr., ammoniacum 5/6 gr., and hard soap 3/5 gr., massed with syrup of liquid glucose.
Dose: 1 or 2 pills.

Syrup of Squill (B.P.C.). Syr. Scill. Vinegar of squill 45 ml., sucrose 80 g., water to 100 ml.
Dose: 2 to 4 ml. (30 to 60 minims).

Tincture of Squill (B.P.C., I.P.). Tinct. Scill. 1 in 10; prepared by maceration with alcohol (60%).
Dose: 0-3 to 2 ml. (5 to 30 minims). A similar tincture is included in several foreign pharmacopoeias.

Vinegar of Squill (B.P.C., Egyp. P., U.S.N.F.). Acet. Scill. 1 in 10; prepared by maceration with dilute acetic acid.
Dose: 0-6 to 2 ml. (10 to 30 minims).

Red Squill, a red variety of Urginea maritima, contains, in addition to cardiac glycosides, an active principle, scilliroside, which is very toxic to rats and is incorporated in many rat pastes; it acts on the central nervous system. A rat paste containing powdered red squill 5 g., sucrose 15 g., cornflour 150 g., and sufficient water to form a paste, is described.-in Fr. P. Scilliroside, the toxic principle for rats in red squill, is obtained as a crystalline substance; m.p. 168° to 170°, with decomposition. It is readily soluble in lower alcohols, ethylene glycol, dioxan, glacial acetic acid; less soluble in acetone; very slightly soluble in water, hydrocarbons, chloroform, ether, and ethyl acetate. It acts on the frog heart in a manner similar to scillaren A, and is a convulsant poison of high toxicity for rodents.—A. Stoll and J. Renz, Bull. Sci. pharm., 194’J, 47, 65.

Urginea (B.P.C. 1949). Urgin.; Indian Squill.
Dose: 60 to 200 mg. (1 to 3 grains). The dried sliced bulb of Indian squill, Urginea indica (Liliaceae), with the membranous outer scales removed and containing 20 to 40% of alcohol (60%)-soluble extractive. Store in a dry place. Powdered urginea is very hygroscopic and should be stored in a desiccated atmosphere. Foreign Pharmacopoeias: In Ind. Squill (U.S.N.F.) is from U. maritima or U. indica. Uses. Urginea has similar properties and is used for the same purposes as squill. It is used in India as a substitute for squill.

White Pine (B.P.C. 1934, U.S.N.F.). Pinus Alba; White Pine Bark. The dried inner bark of the Weymouth pine, Pinus strobus (Pinaceae).
Uses. It is used in conjunction with other medicaments in cough syrups.

Compound White Pine Syrup (U.S.N.F.). Prepared, by percolation, from white pine 8-5 g., wild cherry 8-5 g., aralia 1 g., poplar bud 1 g., Sanguinaria 800 mg., sassafras 1 g., amaranth solution 1 ml., chloroform 0-6 ml., sucrose 62-5 g., glycerin 10 ml., alcohol and water to 100 ml.
Usual dose: 4 ml. (60 minims).

Compound White Pine Syrup with Codeine (U.S.N.F.). Codeine phosphate 200 mg., water 1 ml., compound white pine syrup to 100 ml. Usual dose: 4 ml. (60 minims).

Ext. Pini Alb. Liq. (B.P.C. 1934). Liquid Extract of White Pine. 1 in 1; prepared by percolation with alcohol (25%).
Dose: 1 to 4 ml. (15 to 60 minims).

Wild Cherry Bark (B.P.C.). Prunus Serotina; Prun. Serot.; Virginian Prune; Virginian Prune Bark; Wild Black Cherry Bark; Wild Cherry (U.S.P.). The dried bark of the wild or black cherry, Prunus serotina (Rosaceae), containing not less than 10% of water-soluble extractive. It contains ( + )-mandelonitrile glycoside (prunasin) and an enzyme system, which interact in the presence of water yielding benzaldehyde, hydrogen cyanide, and glucose. Good specimens of the bark yield 0-075 to 0-16% of HCN. Store in a cool dry place. Uses. Wild cherry bark has a mild sedative action. It is administered as Syrup of Wild Cherry for the relief of cough in bronchitis.

Syrup of Wild Cherry (B.P.C.). Syr. Prun. Serot.; Syrup of Virginian Prune. Prepared from wild cherry bark 15 g., sucrose 80 g., glycerin 5 ml., and water to 100 ml. by percolation with the water and dissolving the sucrose and glycerin in the percolate without the aid of heat. Store in a cool place.
Dose: 2 to 8 ml. (30 to 120 minims).

Tinct. Prun. Serot. (B.P.C. 1949). Tincture of Wild Cherry; Tincture of Virginian Prune. Wild cherry bark 20 g., alcohol (90%) 55 ml., water 37-5 ml., and glycerin 10 ml. Macerate the bark with the water for 24 hours, add the alcohol and complete the maceration process, adding the glycerin to the product.
Dose: 2 to 4 ml. (30 to 60 minims).

Wild Cherry Fluidextract (U.S.N.F.). 1 in 1; prepared by percolation with a mixture of glycerin, water, and alcohol.
Usual dose: 2 ml. (30 minims).

Wild Cherry Syrup (U.S.P.). Wild cherry bark 15 g., glycerin 15 ml., sucrose 67-5 g., alcohol 2 ml,, water to 100 ml., prepared similarly to the B.P.C. syrup

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Articles

EPSOM SALTS – MAGNESIUM SULPHATE

                                                                                        


Compiled and Edited by Ivor Hughes

  United States Dispensatory 21st Edition 1926.
Martindales 24th Edition 1958
Boericke’s Homeopathic Materia Medica.

USD 21st 1926
MAGNESII SULPHAS.  U. S. , Br. MAGNESIUM SULPHATE Mag. Sulph.  [Epsom Salt]

” Magnesium Sulphate contains not less than 48.60 per cent, and not more than 53.45 per cent, of MgSO4, corresponding to not less than 99.5 per cent, of the crystallized salt [MgSO4.,7H2O].” U.S. ” Magnesium Sulphate may be obtained by the interaction of the native magnesium carbonates and diluted sulphuric acid; or by purifying the native sulphate. It contains not less than 97.4 per cent, of pure magnesium sulphate, MgSO4,7H20.” Br.

Sal Amarum, Sal Epsomense, Sal Anglicum, Sal Sedlicense, Sulphas Magnesicus; Sulphate of Magnesia; Sulfate de Magnesie, Fr. Cod.; Sel d’Epsom, Sel de Sedlitz, Sol. amer, Fr.; Magnesium Sulfuricum, P. G.; Magnesiumsulfat, Schwefeleaures Magnesia, Bittersalz, G.; Solfato di magnesio, Suifato magnesico, Sp.

Magnesium Sulphate is a constituent of sea water, and of some saline springs. It also occurs native, either crystallized in slender, prismatic, adhering crystals, or as an efflorescence on certain rocks and soils which contain magnesia and a sulphate or sulphide. In the United States it is found in the great caves so numerous to the west of the Allegheny Mountains . In one of these caves, near Corydon in Indiana , it formed a stratum on the bottom several inches deep, or appeared in masses sometimes weighing ten pounds, or disseminated in the earth of the cavern, one bushel of which yielded from four to twenty-five pounds of the sulphate. It also appeared on the walls of the cavern, and, if it was removed, acicular crystals again appeared in a few weeks. ( Cleveland .) An enormous deposit has been reported at Basque, British Columbia .

Under the name of kieserite, a mineral is obtained from the saline deposits at Stassfurt, in Germany , which consists chiefly of impure magnesium sulphate. It is used as a source for preparing magnesium sulphate, and is exported from Germany ; for a historical paper on Epsom salt by M. I. Wilbert, see Proc. A. Ph. A., 1904, 351.

Magnesium sulphate was originally procured by evaporating the waters of saline springs at Epsom, in England . Grew prepared it in this manner in 1675. It was afterwards discovered that the brine remaining after the crystallization of common salt from sea water furnished by careful evaporation precisely the same salt, and, as this was a much cheaper product, it superseded the former for a time. At present, in the neighborhood of Genoa and Nice, magnesium sulphate is prepared in large quantities from a schistose rock containing magnesia and iron sulphide. The mineral is roasted, and exposed in heaps for some months to the action of air and water. It is then lixiviated, the ferrous sulphate decomposed by lime water, and the salt obtained pure by repeated solution and crystallization. It is also extensively manufactured in Baltimore and Philadelphia from a siliceous magnesium hydroxide. This mineral occurs in veins in the serpentine and other magnesian rocks which abound in the neighborhood of Baltimore and in the southern counties of Pennsylvania . The mineral is reduced to a fine powder and saturated with sulphuric acid. The mass is then dried and calcined at a red heat, in order to convert any ferrous sulphate which may be present into ferric oxide. It is then dissolved in water, and calcium sulphide added to separate any remaining portion of iron. The salt is crystallized and dissolved a third time, in order to purify it. The sulphate prepared by this process is generally very pure and clean, although it sometimes contains a trace of ferrous sulphate. A very pure magnesium sulphate free from chloride is obtained as a by-product in the manufacture of carbon dioxide from magnesite when sulphuric acid is used to decompose the carbonate. This industry at one time assumed large proportions because of the demand for liquefied carbon dioxide in the manufacture of aerated and effervescing mineral waters. In the modern method of making carbon dioxide, however, acid is not used, the CO2 being evolved by simply heating the magnesite (magnesium carbonate) to a little over 300° C. Magnesium sulphate is also obtained from kieserite and kainite from the Stassfurt mines, Germany . There are deposits of native magnesium sulphate, epsomite, in Wyoming , Utah , Washington and California . Dolomite (a native magnesio-calcium carbonate) is also used for the manufacture of magnesium sulphate, calcium sulphate being obtained as a by-product.

Description and Physical Properties. — “Small, colorless, prismatic needles or rhombic prisms, without odor, and having a cooling, saline, and bitter taste. One Gm. of Magnesium Sulphate is soluble in 1.3 cc. of water and in about 1.1 cc. of glycerin, at 25° C. One Gm. is soluble in about 0.2 cc. of boiling water. It is sparingly soluble in alcohol at 25° C. When exposed to warm air, the salt loses some of its water of crystallization and is converted into a white powder. Further heating removes more water, and at a temperature somewhat above 200° C. it is rendered anhydrous.

“An aqueous solution of the salt (1 in 20) responds to the reactions for magnesium and for sulphates. An aqueous solution of the salt (1 in 20) is neutral to litmus paper. ” One Gm. of the salt shows no more chloride than corresponds to 0.2 cc. of fiftieth-normal hydrochloric acid. An aqueous solution of the salt meets the requirements of the test for heavy metals. An aqueous solution of the salt meets the requirements of the test for arsenic. ” Preserve in well-closed containers.”    U. S.

” In small, colorless, transparent, rhombic prisms. Taste bitter. Soluble in 1 part of water. Yields the reactions characteristic of magnesium and of sulphates. When 0.5 gramme is dissolved in 50 millilitres of water, and to the solution 20 millilitres of solution of ammonium chloride, 20 millilitres of strong solution of ammonia, and excess of solution of sodium phosphate are added in succession, the mixture, after well stirring and setting aside for twelve hours, yields a precipitate which, when collected, washed with strong solution of ammonia diluted with three times its volume of water, dried and heated to redness, weighs not less than 0.220 and not more than 0.226 gramme. Yields no characteristic reactions for zinc, and not more than the slightest reactions for chlorides. Lead limit 5 parts per million. Arsenic limit 5 parts per million. 10 grammes dissolved in 20 millilitres of water, and heated on a water-bath for one hour in a closed flask, yield a clear, colorless solution (absence of insoluble impurities and of more than traces of iron).” Br.

Assay.
—” Dissolve about 1 Gm. of Magnesium Sulphate, accurately weighed in 100 cc. of distilled water, gradually add to the solution, with constant stirring, an excess of sodium phosphate T.S. (about 20 cc.), allow the mixture to stand for ten minutes, then add 30 cc. of ammonia T.S., and let stand for four hours. Collect the precipitate on a filter, wash it with dilute ammonia T.S. (1 volume of ammonia T.S. to 19 volumes of distilled water) until the washings are free from sulphates. Dry, and ignite to constant weight. The weight of magnesium pyrophosphate (Mg2P2O7) when multiplied by 1.081 indicates its equivalent in MgSO4. Each Gm. of Magnesium Sulphate corresponds to not less than 0.4495 Gm. and not more than 0.4944 Gm. of magnesium pyrophosphate (Mg2P207).” U. S.

It usually occurs in small acicular crystals, which are produced by agitating the solution while crystallizing. It slowly effloresces in the air. Exsiccated magnesium sulphate is employed in some localities under the title Magnesium Sulphuricum Siccum. It is a fine white powder of which about 65 parts represents 100 parts of the crystallized salt.

Magnesium sulphate is completely decomposed by potassium and sodium hydroxides and their carbonates, by lime, barium and strontium oxides, and their soluble salts. Ammonia partially decomposes it, and forms with the remainder a double sulphate. Potassium and sodium bicarbonates do not decompose it, except by the aid of heat. An economic use which has been recommended of magnesium sulphate is the addition of a strong solution to ordinary white-wash, whereby a beautiful whiteness may be given to walls and ceilings. A little of it, moreover, added to starch considerably increases its stiffening properties, and at the same time in some degree resists the action of fire.

Uses. — Magnesium sulphate is an active cathartic operating with but little pain or nausea, and producing watery stools. Its cathartic action is due in part to its attraction for water, but it seems also to exercise a direct stimulant effect upon the glands of the intestinal tract. It has but little direct effect upon peristalsis, the increased movements of the intestinal muscles being due chiefly to the over distention with the fluid. It may be used whenever it is desired to clean out the alimentary canal, especially when a prompt action is desired, as in cases of poisoning or certain types of acute enteritis. It is a valuable remedy when it is desired to encourage the elimination of metabolic poisons through the bowel, as in gout or uremia. It is also highly esteemed for the evacuation of dropsical effusions. As an habitual laxative, although widely used, it is generally inferior to the vegetable cathartics.

When injected into the circulation magnesium sulphate acts as a violent poison, lessening respiration and depressing the circulation by a direct action upon the heart. It also paralyzes the peripheral ends of the motor nerves and, according to Meltzer and Auer (A. J. Phys., 1905, xiv, p. 366, and xvii, p. 313), also the sensory nerves. Guthrie and Eyan (A. J. Phys., 1910, xxiv, p. 329) dispute the conclusions of Meltzer and Auer that it has a true anesthetic action, believing that the apparent anesthesia is due to the motor paralysis, but the experiments of Wiki (A. I. P. T., 1911, xxi, p. 415) seem to demonstrate that when applied locally it is a paralyzant to the sensory nerves. -As an internal remedy it has been employed by intraspinal injection as an anesthetic and in the treatment of tetanus. Its action in tetanus appears to be solely that of an antieonvulsant, not a true curative, and whether it has any superiority over other methods of controlling the convulsions is at present uncertain. As an antitetanic fifteen to thirty grains (1-2 Gm.) may be injected daily into the subarachnoid space in 10 per cent, solution. For intraspinal anesthesia, although it has been used with apparent success in a few cases, it appears to have no advantage over the cocaine series and has shown itself distinctly irritant to the kidney.

As a local remedy magnesium sulphate has proven useful in a large number of inflammatory conditions, its value probably to be attributed to its osmotic influence. Because of the fact that it does not diffuse readily, it attracts more •water to itself than other salts. Not only is it

widely employed as a local dressing in sprains and bruises, but Tucker (T. G., 1907) and a number of subsequent investigators as Freese (N. T. M. J., Feb. 14, 1914) have reported favorable results in erysipelas, cellulitis, epi-didymitis, lymphangitis and similar external inflammations. Meltzer (J. P. Ex. T., 1918, xii), from experiments upon rabbits as well as in observations on human beings, found a 25 per cent, solution to be of great value in the treatment of burns of both first and second degree. Morrison and Tulloch (Brit. Journ. Surgery, Oct., 1915, p. 276) have even recommended the local use of a sterilized solution of magnesium sulphate in septic wounds.

Following the suggestion of Meltzer that the intra-duodenal application of magnesium sulphate produced a relaxation of the sphincter of the common bile duct, Lyon (/. A. M. A., 1919, Ixxii, p. 980) applied the drug by means of a duodenal tube in the diagnosis and treatment of cholecystitis. While the method has been more or less favorably commented on by several writers, Frazer (/. A. M. A., 1922, Ixxix, p. 1594) in experiments upon dogs was unable to note any constant action upon the flow of bile either from the liver or gall bladder. As Christison reported the case of a boy ten years old who was said to have been killed by two ounces of the salt without the induction of purgation, it is possible that, under some circumstances, when very large amounts of magnesium sulphate are given by the mouth, sufficient may be absorbed to produce poisonous effects.

Dose, one to eight drachms (3.9 – 31 Gm.).

Off. Prep. — Infusum Sennae Compositum, U. S.; Magnesii Sulphas Effervescens, N. F., Br.; Mistura Sennee Composita, Br.; Liquor Magnesii Sulphatis Effervescens, NF.; Sal Kissingense Factitium Effervescens, N. F.; Sal Viohyanum Factitium, N. F.; Sal Vichyanum Factitium Effervescens, N. F.


Martindales 24th Edition 1958 (Br)
Magnesium Sulphate (B.P.). 
Mag. Sulph.; Epsom Salts; Sel Anglais; Sel de Sedlitz. MgSO4,7H2O = 246-5.
Dose: 2 to 16 g. (30 to 240 grains).
Foreign Pharmacopeias: In all pharmacopoeias examined.

Colourless odourless efflorescent crystals with a cool saline bitter taste. A solution in water is neutral to litmus.
Soluble 1 in 1-5 of water and 1 in less than 0-2 of boiling water; sparingly soluble in alcohol. Slowly soluble 1 in 1.5 of glycerin; for extemporaneous preparation dissolve 70 g. in 15 ml. of boiling water and add glycerin to 120 ml. Solutions are sterilised by autoclaving or by filtration. Incompatible with sodium and potassium tartrates, with soluble phosphates and arsenates, and with alkali carbonates and bicarbonates unless in dilute solution; with potassium or ammonium bromide concentrated solutions give a precipitate of the double sulphate. Protect from air and moisture in a cool place.

Toxic Effects. The magnesium ion is toxic when high concentrations accumulate in the extra cellular fluid. Although magnesium is poorly absorbed following oral administration, if given to a patient with impaired renal function there may be sufficient accumulation to cause poisoning. The use of magnesium sulphate by injection as a central and neuromuscular depressant may give rise to respiratory failure.

Death may occur within 2 hours of oral or rectal administration of magnesium sulphate in children with intestinal worms, or in other patients whose gut has become unusually permeable to magnesium sulphate. Extreme thirst and a feeling of heat are signs of poisoning. 1 g. of calcium gluconate should be injected intravenously as soon as possible.—D. W. Fawcett and J. P. Gens, /. Amer. med. Ass., 1943, 123, 1028.
Antidotes. Calcium gluconate or chloride should be given intravenously.

Contra-indications. Its use is inadvisable in the presence of renal disease and in children with intestinal parasitic diseases.
Uses. Magnesium sulphate administered in dilute solution is a prompt and efficient evacuant, producing watery stools with little or no griping. The injection, directly into the duodenum by means of a duodenal tube, of an ounce of a 25% solution causes relaxation of the sphincter of the gallbladder and permits the collection of the bile for study, or, when this does not appear, indicates obstruction of the gut (Meltzer-Lyon Test); this procedure has also been used for gall-bladder evacuation in cholecystitis.

Because of its osmotic and anaesthetic action it is widely employed for wet dressings, a 25 % solution being used in various inflammatory conditions such as sprains, bruises, orchitis, cellulitis, insect bites, epididymitis and erysipelas; it is employed as a paste in carbuncles and boils.
When introduced into the circulation, magnesium sulphate acts as a depressant to the central nervous system, and intravenous or intramuscular injections of 10 to 25 ml. of a 10% solution have been used to control eclamptic convulsions.
Cholesal (Oppenheimer). Granules containing magnesium sulphate and peptone. For hepatic and biliary congestion. Dose: 1 to 3 teaspoonfuls dissolved in not more than half a tumberful of hot water, at least ‘/a hour before breakfast.

Exsiccated Magnesium Sulphate (B.P.). Mag. Sulph. Exsic.; Dried Epsom Salts.
Dose: 2 to 12 g. (30 to 180 grains).
Foreign Pharmacopoeias: In Belg., Chin., Cz., Dan., Ger., Hung., Ind,, Jug., Nor., Pol., Swed., and Swiss.
A white odourless powder with a bitter saline taste, containing 62 to 70% of MgSO4. Soluble 1 in 2 of water; more rapidly soluble in hot water. Protect from moisture.
Uses. Exsiccated magnesium sulphate is used in the preparation of powders and granules, and of Paste of Magnesium Sulphate.

Balneum Magnesii Sulphatis (B.P.C. 1949). 
Magnesium Sulphate Bath. Magnesium sulphate 1 lb. in 30 gal. of water.

Eau Saline Purgative (Fr. P.). 
Magnesium sulphate 35 g., sodium sulphate 35 g., water to 1000 g.

Enema of Magnesium Sulphate (B.P.C.). 
Enem. Mag. Sulph. (B.N.F.). Magnesium sulphate 50% w/v in warm water. 
Dose: 60 to 180 ml. (2 to 6 fl. oz.).

Gran. Mag. Sulph. Efferv. (B.P.C. 1949). 
Effervescent Granules of Magnesium Sulphate. Prepared from exsiccated magnesium sulphate 38.5 g., citric acid 12.5 g., tartaric acid 19 g., sodium bicarbonate 36 g., sucrose 10.5 g. A more palatable form of magnesium sulphate. Protect from moisture. 
Dose. For single administration, 15 to 30 g. (½ to 1 oz.); for repeated administration, 4 to 12 g. (60 to 180 grains).

Magnesium Sulphate Injection (U.S.N.F.)
A sterile solution in Water for Injection, usually available in various strengths from 5 to 50% w/v. Dan. P. includes a 20% w/v and Chil. P. a 25% w/v injection.

Mist. Chandos (Charing Cross Hosp.). 
Magnesium sulphate 120 gr., tincture of ginger 10 m., chloroform water to 1 fl. oz. —  Pharm. J. ii/1948, 126.

Mist. Mag. Sulph. Alb. pro Infant. (N.W.F. 1947)
Mist. Alb. pro Infant. Magnesium sulphate 10 gr., light magnesium carbonate 1 gr., syrup 10 m., peppermint water to 60 m. 
Dose: 60 minims.

Mixture of Magnesium Sulphate (B.P.C.).  Mist. Mag. Sulph. (B.N.F.); 
White Mixture; White Mixture of Magnesium Sulphate; Mist. Alb.; Mist. Mag. Sulph. Alb. Magnesium sulphate 60 gr., light magnesium carbonate 10 gr., peppermint water to ½ oz
Dose: 15 to 30 ml. (½ to 1 fl. oz.).

DISGUISING THE TASTE. The following are suggested for disguising the taste of mixture of magnesium sulphate: emulsion of peppermint (to intensify the peppermint flavour of the mixture), syrup, liquorice, fruit syrups, and syrup of ginger. Alternatively the mixture may be iced or magnesium sulphate may be given in the form of effervescent granules or with soda water.—Brit. med. J., ii/1956, 668.

Paste of Magnesium Sulphate (B.P.C.). Past. Mag. Sulph. (B.N.F.); 
Morison’s Paste. Exsiccated magnesium sulphate, heated at 120° for one hour and cooled, 45 g., glycerin, heated at 120° for one hour and cooled, 55 g., and phenol 500 mg. Store in well-closed containers which prevent access of moisture, or in collapsible tubes.

This paste was originally advocated for the treatment of wounds, later for boils and carbuncles. It is applied to the boil or carbuncle and covered with lint or gauze and a waterproof material. The dressing is renewed at intervals until a slough has separated.
Morison’s original paste was prepared by mixing l½ lb. of exsiccated magnesium sulphate with 11 oz. of a 10% w/w solution of phenol in glycerin. The phenol was at first included for its analgesic properties, but its inclusion was later found to be unnecessary.—A. E. Morison, Brit. med. J., i/1918, 342.


Boericke’s Homeopathic Materia Medica.
MAGNESIA SULPHURICA (Epsom Salt)

The skin, urinary, and female symptoms are most marked. The purgative action of Sulphate of Magnesia is not a quality of the drug, but a quality of its physical state, which renders its absorption impossible. The properties inherent in the substance itself can only be discovered by attenuation. (Percy Wilde.)

Head.—Apprehensive; vertigo; head heavy during menses. Eyes burn, noises in ears.

Stomach.—Frequent eructations, tasting like bad eggs. Rising of water in mouth.

Urinary.—Stitches and burning the orifice of the urethra after urinating. Stream intermits and dribbles. The urine passed in the morning copious, bright yellow, soon becomes turbid, and deposits a copious red sediment. The urine is greenish as -passed; is of a clear color, and in a large quantity. Diabetes. [Phos. oc.: Loct. ac.; Ars. brom.]

Female.—Thick leucorrhoea, as profuse as the menses, with weary pain in the small of the back and thighs, on moving about. Some blood from the vagina between the menses. Menstruation returned after fourteen days; the discharge was thick, black, and profuse. Menses too early, intermit.

Neck and Back.—Bruised and ulcerative pain between the shoulders, with a feeling as of a lump as large as the fist, on which account she could not lie upon her back or side; relieved by rubbing. Violent pain in the email of the back, as if bruised, and as before menstruation.

Extremities.—The left arm and foot fall asleep in bed, in the morning after waking.

Skin.—Small pimples over the whole body, that itch violently. Suppressed itch. [Sulph.] Crawling in the tips of the fingers of the left hand; better on rubbing. Wmts. Eyrsipelaa (applied locally as a saturated solution). Dropsy (physiological doses).

Fever.—Chill from 9 to 10 a. m. Shuddering in back; heat in one part and chill in another.

Relationship.—It is claimed that the addition of a small amount of Magnes. Sulph. to the usual hypodermic of Morphine increases the value of the hypodermic from 50 to 100%.

Physiologic Dosage.—Magnes. Sulph. is of diagnostic and therapeutic value in Gallstone colic. From 2 to 4 teaspoonfuin glass hot water taken at onset of a colicky attack may abort or stop the colic.

Epsom salt is one of the most active saline cathartics, operating with little pain or nausea, especially if pure. It has but little if any effect on intestinal peristalsis, its action causing a rush of fluid into the intestine, which by producing a distention of the bowel produces evacuation. It causes little or no irritation in the intestine. In common with the other salines, it is the classical evacuant to be employed in connection with mercurials and anthelmintics and in cases of poisoning. Epsom salt usually acts within from one to two hours, more quickly if taken in hot water and in the morning before breakfast. The ordinary dose as a mild laxative is a heaping teaspoonful; as a cathartic, two to four teaspoonfuls. The taste may be improved, if necessary, by the addition of a little lemon juice and sugar.

Besides its chief use as a saline cathartic, magnesium sulphate is used to a considerable extent externally in saturated solution as an antiphlogistic and antipruritic in erysipelas, ivy poisoning, cellulitis and other local inflammations. Use on compresses saturated with solution.

Dose.—The pure salt to the third potency. Locally 1:4 in water in septic conditions, erysipelas, orchitis, boils, etc.

Use the search box at the top right hand of the page or else peruse the Herbdata Library for further information on Epsom Salts.

 

Categories
Articles

DEATH BY MEDICINE October 2003


Gary Null PhD, Carolyn Dean MD ND,
Martin Feldman MD, Debora Rasio MD,
Dorothy Smith PhD.

ABSTRACT
A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. (1) Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million.
Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.

(2, 2a) The number of unnecessary medical and surgical procedures performed annually is 7.5 million. (3) The number of people exposed to unnecessary hospitalization annually is 8.9 million. (4) The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251. (5)

TABLES AND FIGURES (see Section on Statistical Tables and Figures, below, for exposition)

ANNUAL PHYSICAL AND ECONOMIC COST OF MEDICAL INTERVENTION

Condition Deaths Cost Author
Adverse Drug Reactions 106,000 $12 billion Lazarou (1) Suh (49)
Medical error 98,000 $2 billion IOM (6)
Bedsores 115,000 $55 billion Xakellis (7) Barczak (8)
Infection 88,000 $5 billion Weinstein (9) MMWR (10)
Malnutrition 108,800 ———– Nurses Coalition (11)
Outpatients 199,000 $77 billion Starfield (12) Weingart (112)
Unnecessary Procedures 37,136 $122 billion HCUP (3,13)
Surgery-Related 32,000 $9 billion AHRQ (85)
              TOTAL 783,936 $282 billion  

We could have an even higher death rate by using Dr. Lucien Leape’s 1997 medical and drug error rate of 3 million. (14) Multiplied by the fatality rate of 14% (that Leape used in 1994 (16)) we arrive at an annual death rate of 420,000 for drug errors and medical errors combined. If we put this number in place of Lazorou’s 106,000 drug errors and the Institute of Medicine’s (IOM) 98,000 medical errors, we could add another 216,000 deaths making a total of 999,936 deaths annually.

Condition Deaths Cost Author
ADR/med error 420,000 $200 billion Leape 1997 (14)
             TOTAL 999,936    

ANNUAL UNNECESSARY MEDICAL EVENTS STATISTICS

Unnecessary Events People Affected Iatrogenic Events
Hospitalization 8.9 million (4) 1.78 million (16)
Procedures 7.5 million (3) 1.3 million (40)
              TOTAL 16.4 million 3.08 million

The enumerating of unnecessary medical events is very important in our analysis. Any medical procedure that is invasive and not necessary must be considered as part of the larger iatrogenic picture. Unfortunately, cause and effect go unmonitored. The figures on unnecessary events represent people (“patients”) who are thrust into a dangerous healthcare system. They are helpless victims. Each one of these 16.4 million lives is being affected in a way that could have a fatal consequence. Simply entering a hospital could result in the following:

  1. In 16.4 million people, 2.1% chance of a serious adverse drug reaction, (1) (186,000)
  2. In 16.4 million people, 5-6% chance of acquiring a nosocomial infection, (9) (489,500)
  3. In16.4 million people, 4-36% chance of having an iatrogenic injury in hospital (medical error and adverse drug reactions). (16) (1.78 million)
  4. In 16.4 million people, 17% chance of a procedure error. (40) (1.3 million)

All the statistics above represent a one-year time span. Imagine the numbers over a ten-year period. Working with the most conservative figures from our statistics we project the following 10-year death rates.

TEN-YEAR DEATH RATES FOR MEDICAL INTERVENTION

Condition 10-Year Deaths Author
Adverse Drug Reaction 1.06 million (1)
Medical error  0.98 million (6)
Bedsores 1.15 million (7,8)
Nosocomial Infection 0.88 million (9,10)
Malnutrition 1.09 million (11)
Outpatients 1.99 million (12, 112)
Unnecessary Procedures 371,360 (3,13)
Surgery-related 320,000 (85)
              TOTAL 7,841,360 (7.8 million)  

Our projected statistic of 7.8 million iatrogenic deaths is more than all the casualties from wars that America has fought in its entire history.
Our projected figures for unnecessary medical events occurring over a 10-year period are also dramatic.

TEN-YEAR STATISTICS FOR UNNECESSARY INTERVENTION

Unnecessary Events 10-year Number Iatrogenic Events
Hospitalization 89 million (4) 17 million
Procedures  75 million (3) 15 million
              TOTAL 164 million  

These projected figures show that a total of 164 million people, approximately 56% of the population of the United States, have been treated unnecessarily by the medical industry – in other words, about half a million people per day.

INTRODUCTION
Never before have the complete statistics on the multiple causes of iatrogenesis been combined in one paper. Medical science amasses tens of thousands of papers annually – each one a tiny fragment of the whole picture. To look at only one piece and try to understand the benefits and risks is to stand one inch away from an elephant and describe everything about it. You have to pull back to reveal the complete picture, such as we have done here. Each specialty, each division of medicine, keeps their own records and data on morbidity and mortality like pieces of a puzzle. But the numbers and statistics were always hiding in plain sight. We have now completed the painstaking work of reviewing thousands and thousands of studies. Finally putting the puzzle together we came up with some disturbing answers.

Is American Medicine Working?
At 14% of the Gross National Product, healthcare spending reached $1.6 trillion in 2003. (15) Considering this enormous expenditure, we should have the best medicine in the world. We should be reversing disease, preventing disease, and doing minimal harm. However, careful and objective review shows the opposite. Because of the extraordinary narrow context of medical technology through which contemporary medicine examines the human condition, we are completely missing the full picture. Medicine is not taking into consideration the following monumentally important aspects of a healthy human organism: (a) stress and how it adversely affects the immune system and life processes; (b) insufficient exercise; (c) excessive caloric intake; (d) highly-processed and denatured foods grown in denatured and chemically-damaged soil; and (e) exposure to tens of thousands of environmental toxins. Instead of minimizing these disease-causing factors, we actually cause more illness through medical technology, diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this therapeutic strategy is the result of little effort or money being appropriated for preventing disease.

Under-reporting of Iatrogenic Events
As few as 5% and only up to 20% of iatrogenic acts are ever reported. (16,24,25,33,34) This implies that if medical errors were completely and accurately reported, we would have a much higher annual iatrogenic death rate than 783,936. Dr. Leape, in 1994, said his figure of 180,000 medical mistakes annually was equivalent to three jumbo-jet crashes every two days. (16) Our report shows that 6 jumbo jets are falling out of the sky each and every day.

Correcting a Compromised System
What we must deduce from this report is that medicine is in need of complete and total reform: from the curriculum in medical schools to protecting patients from excessive medical intervention. It is quite obvious that we can’t change anything if we are not honest about what needs to be changed. This report simply shows the degree to which change is required. We are fully aware that what stands in the way of change are powerful pharmaceutical companies, medical technology companies, and special interest groups with enormous vested interests in the business of medicine. They fund medical research, support medical schools and hospitals, and advertise in medical journals. With deep pockets they entice scientists and academics to support their efforts. Such funding can sway the balance of opinion from professional caution to uncritical acceptance of a new therapy or drug. You only have to look at the number of invested people on hospital, medical, and government health advisory boards to see conflict of interest. The public is mostly unaware of these interlocking interests. For example, a 2003 study found that nearly half of medical school faculty, who serve on Institutional Review Boards (IRB) to advise on clinical trial research, also serve as consultants to the pharmaceutical industry. (17) The authors were concerned that such representation could cause potential conflicts of interest. A news release by Dr. Erik Campbell, the lead author, said, “Our previous research with faculty has shown us that ties to industry can affect scientific behavior, leading to such things as trade secrecy and delays in publishing research. It’s possible that similar relationships with companies could affect IRB members’ activities and attitudes.” (18)

Medical Ethics and Conflict of Interest in Scientific Medicine
Jonathan Quick, Director of Essential Drugs and Medicines Policy for the World Health Organization wrote in a recent WHO Bulletin: “If clinical trials become a commercial venture in which self-interest overrules public interest and desire overrules science, then the social contract which allows research on human subjects in return for medical advances is broken.” (19)

Former editor of the New England Journal of Medicine (NEJM), Dr. Marcia Angell, struggled to bring the attention of the world to the problem of commercializing scientific research in her outgoing editorial titled “Is Academic Medicine for Sale?” (20) Angell called for stronger restrictions on pharmaceutical stock ownership and other financial incentives for researchers. She said that growing conflicts of interest are tainting science. She warned that, “When the boundaries between industry and academic medicine become as blurred as they are now, the business goals of industry influence the mission of medical schools in multiple ways.” She did not discount the benefits of research but said a Faustian bargain now existed between medical schools and the pharmaceutical industry.

Angell left the NEMJ in June, 2000. Two years later, in June, 2002, the NEJM announced that it will now accept biased journalists (those who accept money from drug companies) because it is too difficult to find ones that have no ties. Another former editor of the journal, Dr. Jerome Kassirer, said that was just not the case, that there are plenty of researchers who don’t work for drug companies. (21) The ABC report said that one measurable tie between pharmaceutical companies and doctors amounts to over $2 billion a year spent for over 314,000 events that doctors attend.

The ABC report also noted that a survey of clinical trials revealed that when a drug company funds a study, there is a 90% chance that the drug will be perceived as effective whereas a non-drug company-funded study will show favorable results 50% of the time. It appears that money can’t buy you love but it can buy you any “scientific” result you want. The only safeguard to reporting these studies was if the journal writers remained unbiased. That is no longer the case.

Cynthia Crossen, writer for the Wall Street Journal in 1996, published Tainted Truth: The Manipulation of Fact in America, a book about the widespread practice of lying with statistics. (22) Commenting on the state of scientific research she said that, “The road to hell was paved with the flood of corporate research dollars that eagerly filled gaps left by slashed government research funding.” Her data on financial involvement showed that in l981 the drug industry “gave” $292 million to colleges and universities for research. In l991 it “gave” $2.1 billion

THE FIRST IATROGENIC STUDY
Dr. Lucian L. Leape opened medicine’s Pandora’s box in his 1994 JAMA paper, “Error in Medicine”. (16) He began the paper by reminiscing about Florence Nightingale’s maxim – “first do no harm.” But he found evidence of the opposite happening in medicine. He found that Schimmel reported in 1964 that 20% of hospital patients suffered iatrogenic injury, with a 20% fatality rate. Steel in 1981 reported that 36% of hospitalized patients experienced iatrogenesis with a 25% fatality rate and adverse drug reactions were involved in 50% of the injuries. Bedell in 1991 reported that 64% of acute heart attacks in one hospital were preventable and were mostly due to adverse drug reactions. However, Leape focused on his and Brennan’s “Harvard Medical Practice Study” published in 1991. (16a) They found that in 1984, in New York State, there was a 4% iatrogenic injury rate for patients with a 14% fatality rate. From the 98,609 patients injured and the 14% fatality rate, he estimated that in the whole of the U.S. 180,000 people die each year, partly as a result of iatrogenic injury. Leape compared these deaths to the equivalent of three jumbo-jet crashes every two days.

Why Leape chose to use the much lower figure of 4% injury for his analysis remains in question. Perhaps he wanted to tread lightly. If Leape had, instead, calculated the average rate among the three studies he cites (36%, 20%, and 4%), he would have come up with a 20% medical error rate. The number of fatalities that he could have presented, using an average rate of injury and his 14% fatality, is an annual 1,189,576 iatrogenic deaths, or over ten jumbo jets crashing every day.

Leape acknowledged that the literature on medical error is sparse and we are only seeing the tip of the iceberg. He said that when errors are specifically sought out, reported rates are “distressingly high”. He cited several autopsy studies with rates as high as 35-40% of missed diagnoses causing death. He also commented that an intensive care unit reported an average of 1.7 errors per day per patient, and 29% of those errors were potentially serious or fatal. We wonder: what is the effect on someone who daily gets the wrong medication, the wrong dose, the wrong procedure; how do we measure the accumulated burden of injury; and when the patient finally succumbs after the tenth error that week, what is entered on the death certificate?

Leape calculated the rate of error in the intensive care unit. First, he found that each patient had an average of 178 “activities” (staff/procedure/medical interactions) a day, of which 1.7 were errors, which means a 1% failure rate. To some this may not seem like much, but putting this into perspective, Leape cited industry standards where in aviation a 0.1% failure rate would mean 2 unsafe plane landings per day at O’Hare airport; in the U.S. Mail, 16,000 pieces of lost mail every hour; or in banking, 32,000 bank checks deducted from the wrong bank account every hour.

Analyzing why there is so much medical error Leape acknowledged the lack of reporting. Unlike a jumbo-jet crash, which gets instant media coverage, hospital errors are spread out over the country in thousands of different locations. They are also perceived as isolated and unusual events. However, the most important reason that medical error is unrecognized and growing, according to Leape, was, and still is, that doctors and nurses are unequipped to deal with human error, due to the culture of medical training and practice. Doctors are taught that mistakes are unacceptable. Medical mistakes are therefore viewed as a failure of character and any error equals negligence. We can see how a great deal of sweeping under the rug takes place since nobody is taught what to do when medical error does occur. Leape cited McIntyre and Popper who said the “infallibility model” of medicine leads to intellectual dishonesty with a need to cover up mistakes rather than admit them. There are no Grand Rounds on medical errors, no sharing of failures among doctors and no one to support them emotionally when their error harms a patient.

Leape hoped his paper would encourage medicine “to fundamentally change the way they think about errors and why they occur”. It’s been almost a decade since this groundbreaking work, but the mistakes continue to soar.

One year later, in 1995, a report in JAMA said that, “Over a million patients are injured in U.S. hospitals each year, and approximately 280,000 die annually as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual automobile accident mortality rate of 45,000 and accounts for more deaths than all other accidents combined.” (23)

At a press conference in 1997 Dr. Leape released a nationwide poll on patient iatrogenesis conducted by the National Patient Safety Foundation (NPSF), which is sponsored by the American Medical Association. The survey found that more than 100 million Americans have been impacted directly and indirectly by a medical mistake. Forty-two percent were directly affected and a total of 84% personally knew of someone who had experienced a medical mistake. (14) Dr. Leape is a founding member of the NPSF.

Dr. Leape at this press conference also updated his 1994 statistics saying that medical errors in inpatient hospital settings nationwide, as of 1997, could be as high as three million and could cost as much as $200 billion. Leape used a 14% fatality rate to determine a medical error death rate of 180,000 in 1994. (16) In 1997, using Leape’s base number of three million errors, the annual deaths could be as much as 420,000 for inpatients alone. This does not include nursing home deaths, or people in the outpatient community dying of drug side effects or as the result of medical procedures.

ONLY A FRACTION OF MEDICAL ERRORS ARE REPORTED
Leape, in 1994, said that he was well aware that medical errors were not being reported. (16) According to a study in two obstetrical units in the U.K., only about one quarter of the adverse incidents on the units are ever reported for reasons of protecting staff or preserving reputations, or fear of reprisals, including law suits. (24). An analysis by Wald and Shojania found that only 1.5% of all adverse events result in an incident report, and only 6% of adverse drug events are identified properly. The authors learned that the American College of Surgeons gives a very broad guess that surgical incident reports routinely capture only 5-30% of adverse events. In one surgical study only 20% of surgical complications resulted in discussion at Morbidity and Mortality Rounds. (25) From these studies it appears that all the statistics that are gathered may be substantially underestimating the number of adverse drug and medical therapy incidents. It also underscores the fact that our mortality statistics are actually conservative figures.

An article in Psychiatric Times outlines the stakes involved with reporting medical errors. (26) They found that the public is fearful of suffering a fatal medical error, and doctors are afraid they will be sued if they report an error. This brings up the obvious question: who is reporting medical errors? Usually it is the patient or the patient’s surviving family. If no one notices the error, it is never reported. Janet Heinrich, an associate director at the U.S. General Accounting Office responsible for health financing and public health issues, testifying before a House subcommittee about medical errors, said that, “The full magnitude of their threat to the American public is unknown.” She added, “Gathering valid and useful information about adverse events is extremely difficult.” She acknowledged that the fear of being blamed, and the potential for legal liability, played key roles in the under-reporting of errors. The Psychiatric Times noted that the American Medical Association is strongly opposed to mandatory reporting of medical errors. (26) If doctors aren’t reporting, what about nurses? In a survey of nurses, they also did not report medical mistakes for fear of retaliation. (27)

Standard medical pharmacology texts admit that relatively few doctors ever report adverse drug reactions to the FDA. (28) The reasons range from not knowing such a reporting system exists to fear of being sued because they prescribed a drug that caused harm. (29) However, it is this tremendously flawed system of voluntary reporting from doctors that we depend on to know whether a drug or a medical intervention is harmful.

Pharmacology texts will also tell doctors how hard it is to separate drug side effects from disease symptoms. Treatment failure is most often attributed to the disease and not the drug or the doctor. Doctors are warned, “Probably nowhere else in professional life are mistakes so easily hidden, even from ourselves.” (30) It may be hard to accept, but not difficult to understand, why only one in twenty side effects is reported to either hospital administrators or the FDA. (31, 31a)

If hospitals admitted to the actual number of errors and mistakes, which is about 20 times what is reported, they would come under intense scrutiny. (32) Jerry Phillips, associate director of the Office of Post Marketing Drug Risk Assessment at the FDA, confirms this number. “In the broader area of adverse drug reaction data, the 250,000 reports received annually probably represent only 5% of the actual reactions that occur.” (33) Dr. Jay Cohen, who has extensively researched adverse drug reactions, comments that because only 5% of adverse drug reactions are being reported, there are, in reality, five million medication reactions each year. (34)

It remains that whatever figure you choose to believe about the side effects from drugs, all the experts agree that you have to multiply that by 20 to get a more accurate estimate of what is really occurring in the burgeoning “field” of iatrogenic medicine.

A 2003 survey is all the more distressing because there seems to be no improvement in error-reporting even with all the attention on this topic. Dr. Dorothea Wild surveyed medical residents at a community hospital in Connecticut. She found that only half of the residents were aware that the hospital had a medical error-reporting system, and the vast majority didn’t use it at all. Dr. Wild says this does not bode well for the future. If doctors don’t learn error-reporting in their training, they will never use it. And she adds that error reporting is the first step in finding out where the gaps in the medical system are and fixing them. That first baby step has not even begun. (35)

PUBLIC SUGGESTIONS ON IATROGENESIS
In a telephone survey, 1,207 adults were asked to indicate how effective they thought the following would be in reducing preventable medical errors that resulted in serious harm: (36)

  1. giving doctors more time to spend with patients: very effective 78%
  2. requiring hospitals to develop systems to avoid medical errors: very effective 74%
  3. better training of health professionals: very effective 73%
  4. using only doctors specially trained in intensive care medicine on intensive care units: very effective 73%
  5. requiring hospitals to report all serious medical errors to a state agency: very effective 71%
  6. increasing the number of hospital nurses: very effective 69%
  7. reducing the work hours of doctors-in-training to avoid fatigue: very effective 66%
  8. encouraging hospitals to voluntarily report serious medical errors to a state agency: very effective 62%

DRUG IATROGENESIS
Drugs comprise the major treatment modality of scientific medicine. With the discovery of the “Germ Theory” medical scientists convinced the public that infectious organisms were the cause of illness. Finding the “cure” for these infections proved much harder than anyone imagined. From the beginning, chemical drugs promised much more than they delivered. But far beyond not working, the drugs also caused incalculable side effects. The drugs themselves, even when properly prescribed, have side effects that can be fatal, as Lazarou’s study (1) shows. But human error can make the situation even worse.

Medication Errors
A survey of a 1992 national pharmacy database found a total of 429,827 medication errors from 1,081 hospitals. Medication errors occurred in 5.22% of patients admitted to these hospitals each year. The authors concluded that a minimum of 90,895 patients annually were harmed by medication errors in the country as a whole. (37)

A 2002 study shows that 20% of hospital medications for patients had dosage mistakes. Nearly 40% of these errors were considered potentially harmful to the patient. In a typical 300-patient hospital the number of errors per day were 40. (38)

Problems involving patients’ medications were even higher the following year. The error rate intercepted by pharmacists in this study was 24%, making the potential minimum number of patients harmed by prescription drugs 417,908. (39)

Recent Adverse Drug Reactions
More recent studies on adverse drug reactions show that the figures from 1994 (published in Lazarou’s 1998 JAMA article) may be increasing.A 2003 study followed four hundred patients after discharge from a tertiary care hospital (hospital care that requires highly specialized skills, technology, or support services). Seventy-six patients (19%) had adverse events. Adverse drug events were the most common at 66%. The next most common events were procedure-related injuries at 17%. (40)

In a NEJM study an alarming one-in-four patients suffered observable side effects from the more than 3.34 billion prescription drugs filled in 2002. (41) One of the doctors who produced the study was interviewed by Reuters and commented that, “With these 10-minute appointments, it’s hard for the doctor to get into whether the symptoms are bothering the patients.” (42) William Tierney, who editorialized on the NEJM study, said “… given the increasing number of powerful drugs available to care for the aging population, the problem will only get worse.” The drugs with the worst record of side effects were the SSRIs, the NSAIDs, and calcium-channel blockers. Reuters also reported that prior research has suggested that nearly 5% of hospital admissions – over 1 million per year – are the result of drug side effects. But most of the cases are not documented as such. The study found one of the reasons for this failure: in nearly two-thirds of the cases, doctors couldn’t diagnose drug side effects or the side effects persisted because the doctor failed to heed the warning signs.

Medicating Our Feelings
We only need to look at the side effects of antidepressant drugs, which give hope to a depressed population. Patients seeking a more joyful existence and relief from worry, stress, and anxiety, fall victim to the messages blatantly displayed on TV and billboards. Often, instead of relief, they also fall victim to a myriad of iatrogenic side effects of antidepressant medication.

Also, a whole generation of antidepressant users has resulted from young people growing up on Ritalin. Medicating youth and modifying their emotions must have some impact on how they learn to deal with their feelings. They learn to equate coping with drugs and not their inner resources. As adults, these medicated youth reach for alcohol, drugs, or even street drugs, to cope. According to the Journal of the American Medical Association, “Ritalin acts much like cocaine.” (43) Today’s marketing of mood-modifying drugs, such as Prozac or Zoloft, makes them not only socially acceptable but almost a necessity in today’s stressful world.

Television Diagnosis
In order to reach the widest audience possible, drug companies are no longer just targeting medical doctors with their message about antidepressants. By 1995 drug companies had tripled the amount of money allotted to direct advertising of prescription drugs to consumers. The majority of the money is spent on seductive television ads. From 1996 to 2000, spending rose from $791 million to nearly $2.5 billion. (44) Even though $2.5 billion may seem like a lot of money, the authors comment that it only represents 15% of the total pharmaceutical advertising budget. According to medical experts “there is no solid evidence on the appropriateness of prescribing that results from consumers requesting an advertised drug.” However, the drug companies maintain that direct-to-consumer advertising is educational. Dr. Sidney M. Wolfe, of the Public Citizen Health Research Group in Washington, D.C., argues that the public is often misinformed about these ads. (45) People want what they see on television and are told to go to their doctor for a prescription. Doctors in private practice either acquiesce to their patients’ demands for these drugs or spend valuable clinic time trying to talk patients out of unnecessary drugs. Dr. Wolfe remarks that one important study found that people mistakenly believe that the “FDA reviews all ads before they are released and allows only the safest and most effective drugs to be promoted directly to the public.” (46)

How Do We Know Drugs Are Safe?
Another aspect of scientific medicine that the public takes for granted is the testing of new drugs. Unlike the class of people that take drugs who are ill and need medication, in general, drugs are tested on individuals who are fairly healthy and not on other medications that can interfere with findings. But when they are declared “safe” and enter the drug prescription books, they are naturally going to be used by people on a variety of other medications and who also have a lot of other health problems. Then, a new Phase of drug testing called Post-Approval comes into play, which is the documentation of side effects once drugs hit the market. In one very telling report, the General Accounting Office (an agency of the U.S. Government) “found that of the 198 drugs approved by the FDA between 1976 and 1985… 102 (or 51.5%) had serious post-approval risks… the serious post-approval risks (included) heart failure, myocardial infarction, anaphylaxis, respiratory depression and arrest, seizures, kidney and liver failure, severe blood disorders, birth defects and fetal toxicity, and blindness.” (47)

The investigative show NBC’s “Dateline” wondered if your doctor is moonlighting as a drug rep. After a year-long investigation they reported that because doctors can legally prescribe any drug to any patient for any condition, drug companies heavily promote “off-label” and frequently inappropriate and non-tested uses of these medications in spite of the fact that these drugs are only approved for specific indications they have been tested for. (48)

The leading causes of adverse drug reactions are antibiotics (17%), cardiovascular drugs (17%), chemotherapy (15%), and analgesics and anti-inflammatory agents (15%). (49)

Specific Drug Iatrogenesis: Antibiotics
Dr. Egger, in a recent editorial, wrote that after fifty years of increasing use of antibiotics, 30 million pounds of antibiotics are used in America per year. (50) Twenty-five million pounds of this total are used in animal husbandry. The vast majority of this amount, twenty-three million pounds, is used to try to prevent disease, the stress of shipping, and to promote growth. Only 2 million pounds are given for specific animal infections. Dr. Egger reminds us that low concentrations of antibiotics are measurable in many of our foods, rivers, and streams around the world. Much of this is seeping into bodies of water from animal farms.

Egger says overuse of antibiotics results in food-borne infections resistant to antibiotics. Salmonella is found in 20% of ground meat but constant exposure of cattle to antibiotics has made 84% of salmonella resistant to at least one anti-salmonella antibiotic. Diseased animal food accounts for 80% of salmonellosis in humans, or 1.4 million cases per year. The conventional approach to dealing with this epidemic is to radiate food to try to kill all organisms but keep using the antibiotics that cause the original problem. Approximately 20% of chickens are contaminated with Campylobacter jejuni causing 2.4 million human cases of illness annually. Fifty-four percent of these organisms are resistant to at least one anti-campylobacter antimicrobial.

A ban on growth-promoting antibiotics in Denmark began in 1999, which led to a decrease from 453,200 pounds to 195,800 pounds within a year. Another report from Scandinavia found that taking away antibiotic growth promoters had no or minimal effect on food production costs. Egger further warns that in America the current crowded, unsanitary methods of animal farming support constant stress and infection, and are geared toward high antibiotic use. He says these conditions would have to be changed along with cutting back on antibiotic use.

In America, over 3 million pounds of antibiotics are used every year on humans. With a population of 284 million Americans, this amount is enough to give every man, woman and child 10 teaspoons of pure antibiotics per year. Egger says that exposure to a steady stream of antibiotics has altered pathogens such as Streptococcus pneumoniae, Staplococcus aureus, and entercocci, to name a few.

Almost half of patients with upper respiratory tract infections in the U.S. still receive antibiotics from their doctor. (51) According to the CDC, 90% of upper respiratory infections are viral and should not be treated with antibiotics. In Germany the prevalence for systemic antibiotic use in children aged 0-6 years was 42.9%. (52)

Data taken from nine U.S. health plans between 1996-2000 on antibiotic use in 25,000 children found that rates of antibiotic use decreased. Antibiotic use in children, aged 3 months to under 3 years, decreased 24%, from 2.46 to 1.89 antibiotic prescriptions per/patient per/year. For children, 3 years to under 6 years, there was a 25% reduction from 1.47 to 1.09 antibiotic prescriptions per/patient per/year. And for children aged 6 to under 18 years, there was a 16% reduction from 0.85 to 0.69 antibiotic prescriptions per/ patient /per year. (53) Although there was a reduction in antibiotic use, the data indicate that on average every child in America receives 1.22 antibiotic prescriptions annually.

Group A beta-hemolytic streptococci is the only common cause of sore throat that requires antibiotics, penicillin and erythromycin being the only recommended treatment. However, 90% of sore throats are viral. The authors of this study estimated there were 6.7 million adult annual visits for sore throat between 1989 and 1999 in the U.S. Antibiotics were used in 73% of visits. Furthermore, patients treated with antibiotics were given non-recommended broad-spectrum antibiotics in 68% of visits. The authors noted, that from 1989 to 1999, there was a significant increase in the newer and more expensive broad-spectrum antibiotics and a decrease in use of penicillin and erythromycin, which are the recommended antibiotics. (54) If antibiotics were given in 73% of visits and should have only been given in 10%, this represents 63%, or a total of 4.2 million visits for sore throat that ended in unnecessary antibiotic prescriptions between1989-1999. In 1995, Dr. Besser and the CDC cited 2003 cited much higher figures of 20 million unnecessary antibiotic prescriptions per year for viral infections. (2) Neither of these figures takes into account the number of unnecessary antibiotics used for non-fatal conditions such as acne, intestinal infection, skin infections, ear infections, etc.

The Problem with Antibiotics: They are Anti-Life
On September 17, 2003 the CDC relaunched a program, started in 1995, called “Get Smart: Know When Antibiotics Work”. (55) This is a $1.6 million campaign to educate patients about the overuse and inappropriate use of antibiotics. Most people involved with alternative medicine have known about the dangers of overuse of antibiotics for decades. Finally the government is focusing on the problem, yet they are only putting a miniscule amount of money into an iatrogenic epidemic that is costing billions of dollars and thousands of lives. The CDC warns that 90% of upper respiratory infections, including children’s ear infections, are viral, and antibiotics don’t treat viral infection. More than 40% of about 50 million prescriptions for antibiotics each year in physicians’ offices were inappropriate. (2) And using antibiotics, when not needed, can lead to the development of deadly strains of bacteria that are resistant to drugs and cause more than 88,000 deaths due to hospital-acquired infections. (9) However, the CDC seems to be blaming patients for misusing antibiotics even though they are only available on prescription from a doctor who should know how to prescribe properly. Dr. Richard Besser, head of “Get Smart,” says “Programs that have just targeted physicians have not worked. Direct-to-consumer advertising of drugs is to blame in some cases.” Dr. Besser says the program “teaches patients and the general public that antibiotics are precious resources that must be used correctly if we want to have them around when we need them. Hopefully, as a result of this campaign, patients will feel more comfortable asking their doctors for the best care for their illnesses, rather than asking for antibiotics.” (56)

And what does the “best care” constitute? The CDC does not elaborate and patently avoids the latest research on the dozens of nutraceuticals scientifically proven to treat viral infections and boost the immune system. Will their doctors recommend vitamin C, echinacea, elderberry, vitamin A, zinc, or homeopathic oscillococcinum? No, they won’t. The archaic solutions offered by the CDC include a radio ad, “Just Say No – Snort, sniffle, sneeze – No antibiotics please.” Their commonsense recommendations, that most people do anyway, include resting, drinking plenty of fluids, and using a humidifier.

The pharmaceutical industry claims they are all for limiting the use of antibiotics. In order to make sure that happens, the drug company Bayer is sponsoring a program called, “Operation Clean Hands”, through an organization called LIBRA. (57) The CDC is also involved with trying to minimize antibiotic resistance, but nowhere in their publications is there any reference to the role of nutraceuticals in boosting the immune system nor to the thousands of journal articles that support this approach. This recalcitrant tunnel vision and refusal to use available non-drug alternatives is absolutely inappropriate when the CDC is desperately trying to curb the nightmare of overuse of antibiotics. The CDC should also be called to task because it is only focusing on the overuse of antibiotics. There are similar nightmares for every class of drug being prescribed today.

Drugs Pollute Our Water Supply
We have reached the point of saturation with prescription drugs. We have arrived at the point where every body of water tested contains measurable drug residues. We are inundated with drugs. The tons of antibiotics used in animal farming, which run off into the water table and surrounding bodies of water, are conferring antibiotic resistance to germs in sewage, and these germs are also found in our water supply. Flushed down our toilets are tons of drugs and drug metabolites that also find their way into our water supply. We have no idea what the long-term consequences of ingesting a mixture of drugs and drug-breakdown products will do to our health. It’s another level of iatrogenic disease that we are unable to completely measure. (58-67)

Specific Drug Iatrogenesis: NSAIDs
It’s not just America that is plagued with iatrogenesis. A survey of 1072 French general practitioners (GPs) tested their basic pharmacological knowledge and practice in prescribing NSAIDs. Non-steroidal anti-inflammatory drugs (NSAIDs) rank first among commonly prescribed drugs for serious adverse reactions. The results of the study suggested that GPs don’t have adequate knowledge of these drugs and are unable to effectively manage adverse reactions. (68)

A cross-sectional survey of 125 patients attending specialty pain clinics in South London found that possible iatrogenic factors such as “over-investigation, inappropriate information, and advice given to patients as well as misdiagnosis, over-treatment, and inappropriate prescription of medication were common.” (69)

Specific Drug Iatrogenesis: Cancer Chemotherapy
In 1989, a German biostatistician, Ulrich Abel PhD, after publishing dozens of papers on cancer chemotherapy, wrote a monograph “Chemotherapy of Advanced Epithelial Cancer”. It was later published in a shorter form in a peer-reviewed medical journal. (70) Dr. Abel presented a comprehensive analysis of clinical trials and publications representing over 3,000 articles examining the value of cytotoxic chemotherapy on advanced epithelial cancer. Epithelial cancer is the type of cancer we are most familiar with. It arises from epithelium found in the lining of body organs such as breast, prostate, lung, stomach, or bowel. From these sites cancer usually infiltrates into adjacent tissue and spreads to bone, liver, lung, or the brain. With his exhaustive review Dr. Abel concludes that there is no direct evidence that chemotherapy prolongs survival in patients with advanced carcinoma. He said that in small-cell lung cancer and perhaps ovarian cancer the therapeutic benefit is only slight. Dr. Abel goes on to say, “Many oncologists take it for granted that response to therapy prolongs survival, an opinion which is based on a fallacy and which is not supported by clinical studies.”

Over a decade after Dr. Abel’s exhaustive review of chemotherapy, there seems no decrease in its use for advanced carcinoma. For example, when conventional chemotherapy and radiation has not worked to prevent metastases in breast cancer, high-dose chemotherapy (HDC) along with stem-cell transplant (SCT) is the treatment of choice. However, in March 2000, results from the largest multi-center randomized controlled trial conducted thus far showed that, compared to a prolonged course of monthly conventional-dose chemotherapy, HDC and SCT were of no benefit. (71) There was even a slightly lower survival rate for the HDC/SCT group. And the authors noted that serious adverse effects occurred more often in the HDC group than the standard-dose group. There was one treatment-related death (within 100 days of therapy) in the HDC group, but none in the conventional chemotherapy group. The women in this trial were highly selected as having the best chance to respond.

There is also no all-encompassing follow-up study like Dr. Abel’s that tells us if there is any improvement in cancer-survival statistics since 1989. In fact, we need to research whether chemotherapy itself is responsible for secondary cancers instead of progression of the original disease. We continue to question why well-researched alternative cancer treatments aren’t used.

Drug Companies Fined
Periodically, a drug manufacturer is fined by the FDA when the abuses are too glaring and impossible to cover up. The May 2002 Washington Post reported that the maker of Claritin, Schering-Plough Corp., was to pay a $500 million dollar fine to the FDA for quality-control problems at four of its factories. (72) The FDA tabulated infractions that included 90%, or 125 of the drugs they made since 1998. Besides the fine, the company had to stop manufacturing 73 drugs or suffer another $175 million dollar fine. PR statements by the company told another story. The company assured consumers that they should still feel confident in its products.

Such a large settlement serves as a warning to the drug industry about maintaining strict manufacturing practices and has given the FDA more clout in dealing with drug company compliance. According to the Washington Post article, a federal appeals court ruled in 1999 that the FDA could seize the profits of companies that violate “good manufacturing practices.” Since that time Abbott Laboratories Inc. paid $100 million for failing to meet quality standards in the production of medical test kits, and Wyeth Laboratories Inc. paid $30 million in 2000 to settle accusations of poor manufacturing practices.

The indictment against Schering-Plough came after the Public Citizen Health Research Group, lead by Dr. Sidney Wolfe, called for a criminal investigation of Schering-Plough, charging that the company distributed albuterol asthma inhalers even though it knew the units were missing the active ingredient.

UNNECESSARY SURGICAL PROCEDURES

Summary:
1974: 2.4 million unnecessary surgeries performed annually resulting in 11,900 deaths at an annual cost of $3.9 billion. (73,74)

2001: 7.5 million unnecessary surgical procedures resulting in 37,136 deaths at a cost of $122 billion (using 1974 dollars). (3)

It’s very difficult to obtain accurate statistics when studyingunnecessary surgery. Dr. Leape in 1989 wrote that perhaps 30% of controversial surgeries are unnecessary. Controversial surgeries include Cesarean section, tonsillectomy, appendectomy, hysterectomy, gastrectomy for obesity, breast implants, and elective breast implants. (74)

Almost thirty years ago, in 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. They found that 17.6% of recommendations for surgery were not confirmed by a second opinion. The House Subcommittee on Oversight and Investigations extrapolated these figures and estimated that, on a nationwide basis, there were 2.4 million unnecessary surgeries performed annually, resulting in 11,900 deaths at an annual cost of $3.9 billion. (73)

In 2001, the top 50 medical and surgical procedures totaled approximately 41.8 million. These figures were taken from the Healthcare Cost and Utilization Project within the Agency for Healthcare Research and Quality. (13) Using 17.6% from the 1974 U.S. Congressional House Subcommittee Oversight Investigation as the percentage of unnecessary surgical procedures, and extrapolating from the death rate in 1974, we come up with an unnecessary procedure number of 7.5 million (7,489,718) and a death rate of 37,136, at a cost of $122 billion (using 1974 dollars).

Researchers performed a very similar analysis, using the 1974 ‘unnecessary surgery percentage’ of 17.6, on back surgery. In 1995, researchers testifying before the Department of Veterans Affairs estimated that of 250,000 back surgeries in the U.S. at a hospital cost of $11,000 per patient, the total number of unnecessary back surgeries each year in the U.S. could approach 44,000, costing as much as $484 million. (75)

The unnecessary surgery figures are escalating just as prescription drugs driven by television advertising. Media-driven surgery such as gastric bypass for obesity “modeled” by Hollywood personalities seduces obese people to think this route is safe and sexy. There is even a problem of surgery being advertised on the Internet. (76) A study in Spain declares that between 20 and 25% of total surgical practice represents unnecessary operations. (77)

According to data from the National Center for Health Statistics from 1979 to 1984, there was a 9% increase in the total number of surgical procedures, and the number of surgeons grew by 20%. The author notes that there has not been a parallel increase in the number of surgeries despite a recent large increase in the number of surgeons. There was concern that there would be too many surgeons to share a small surgical caseload. (78)

The previous author spoke too soon – there was no cause to worry about a small surgical caseload. By 1994, there was an increase of 38% for a total of 7,929,000 cases for the top ten surgical procedures. In 1983, surgical cases totaled 5,731,000. In 1994, cataract surgery was number one with over two million operations, and second was Cesarean section (858,000 procedures). Inguinal hernia operations were third (689,000 procedures), and knee arthroscopy, in seventh place, grew 153% (632,000 procedures) while prostate surgery declined 29% (229,000 procedures). (79)

The list of iatrogenic diseases from surgery is as long as the list of procedures themselves. In one study epidural catheters were inserted to deliver anesthetic into the epidural space around the spinal nerves to block them for lower Cesarean section, abdominal surgery, or prostate surgery. In some cases, non-sterile technique, during catheter insertion, resulted in serious infections, even leading to limb paralysis. (80)

In one review of the literature, the authors demonstrated “a significant rate of overutilization of coronary angiography, coronary artery surgery, cardiac pacemaker insertion, upper gastrointestinal endoscopies, carotid endarterectomies, back surgery, and pain-relieving procedures.” (81)

A 1987 JAMA study found the following significant levels of inappropriate surgery: 17% of cases for coronary angiography, 32% for carotid endarterectomy, and 17% for upper gastrointestinal tract endoscopy. (82) Using the Healthcare Cost and Utilization Project (HCUP) statistics provided by the government for 2001, the number of people getting upper gastrointestinal endoscopy, which usually entails biopsy, was 697,675; the number getting endarterectomy was 142,401; and the number having coronary angiography was 719,949. (13) Therefore, according to the JAMA study 17%, or 118,604 people had an unnecessary endoscopy procedure. Endarterectomy occurred in 142,401 patients; potentially 32% or 45,568 did not need this procedure. And 17% of 719,949, or 122,391 people receiving coronary angiography were subjected to this highly invasive procedure unnecessarily. These are all forms of medical iatrogenesis.

MEDICAL AND SURGICAL PROCEDURES
It is instructive to know the mortality rate associated with different medical and surgical procedures. Even though we must sign release forms when we undergo any procedure, many of us are in denial about the true risks involved. We seem to hold a collective impression that since medical and surgical procedures are so commonplace, they are both necessary and safe. Unfortunately, partaking in allopathic medicine itself is one of the highest causes of death as well as the most expensive way to die.

Shouldn’t the daily death rate of iatrogenesis in hospitals, out of hospitals, in nursing homes, and psychiatric residences be reported like the pollen count or the smog index? Let’s stop hiding the truth from ourselves. It’s only when we focus on the problem and ask the right questions can we hope to find solutions.

Perhaps the word “healthcare” gives us the illusion that medicine is about health. Allopathic medicine is not a purveyor of healthcare but of disease-care. Studying the mortality figures in the Healthcare Cost and Utilization Project (HCUP) within the U.S. government’s Agency for Healthcare Research and Quality, we found many points of interest. (13) The HCUP computer program that calculates the annual mortality statistics for all U.S. hospital discharges is only as good as the codes that are put into the system. In an email correspondence with HCUP, we were told that the mortality rates that were indicated in tables and charts for each procedure were not necessarily due to the procedure but only indicated that someone who received that procedure died either from their original disease or from the procedure.

Therefore there is no way of knowing exactly how many people died from a particular procedure. There are also no codes for adverse drug side effects, none for surgical mishap, and none for medical error. Until there are codes for medical error, statistics of those people who are dying from various types of medical error will be buried in the general statistics. There is a code for “poisoning & toxic effects of drugs” and a code for “complications of treatment.” However, the mortality figures registered in these categories are very low and don’t compare with what we know from studies such as the JAMA 1998 study (1) that said there were an average of 106,000 prescription medication deaths per year.

WHY AREN’T MEDICAL AND SURGICAL PROCEDURES STUDIED?
In 1978, the U.S. Office of Technology Assessment (OTA) reported that, “Only 10%-20% of all procedures currently used in medical practice have been shown to be efficacious by controlled trial.” (83) In 1995, the OTA compared medical technology in eight countries (Australia, Canada, France, Germany, Netherlands, Sweden, United Kingdom, and the United States) and again noted that few medical procedures in the U.S. had been subjected to clinical trial. It also reported that infant mortality was high and life expectancy was low compared to other developed countries. (84) Although almost ten years old, much of what was said in this report holds true today. The report lays the blame for the high cost of medicine squarely at the feet of the medical free-enterprise system and the fact that there is no national health care policy. It describes the failure of government attempts to control health care costs due to market incentive and profit motive in the financing and organization of health care including private insurance, hospital system, physician services, and drug and medical device industries. Whereas we may want to expand health-care, expansion of disease-care is the goal of free enterprise. “Health Care Technology and Its Assessment in Eight Countries” is also the last report prepared by the OTA, which was shut down in 1995. It’s also, perhaps, the last honest, in-depth look at modern medicine. Because of the importance of this 60-page report, we enclose a summary in the Appendix.

SURGICAL ERRORS FINALLY REPORTED
Just hours before completion of this paper, statistics on surgical-related deaths became available. A October 8, 2003 JAMA study from the U.S. government’s Agency for Healthcare Research and Quality (AHRQ) documented 32,000 mostly surgery-related deaths costing $9 billion and accounting for 2.4 million extra days in the hospital in 2000. (85) In a press release accompanying the JAMA study, the AHRQ director, Carolyn M. Clancy, M.D., admitted, “This study gives us the first direct evidence that medical injuries pose a real threat to the American public and increase the costs of health care.” (86) Hospital administrative data from 20% of the nation’s hospitals were analyzed for eighteen different surgical complications including postoperative infections, foreign objects left in wounds, surgical wounds reopening, and post-operative bleeding. In the same press release the study’s authors said that, “The findings greatly underestimate the problem, since many other complications happen that are not listed in hospital administrative data.” They also felt that, “The message here is that medical injuries can have a devastating impact on the health care system. We need more research to identify why these injuries occur and find ways to prevent them from happening.” One of the authors, Dr. Zhan said that improved medical practices, including an emphasis on better hand-washing, might help reduce the morbidity and mortality rates. An accompanying JAMA editorial by health-risk researcher Dr. Saul Weingart of Harvard’s Beth Israel Deaconess Medical Center said, “Given their staggering magnitude, these estimates are clearly sobering.” (87)

UNNECESSARY X-RAYS
When X-rays were discovered, no one knew the long-term effects of ionizing radiation. In the 1950’s monthly fluoroscopic exams at the doctor’s office were routine. You could even walk into most shoe stores and see your foot bones; looking at bones was an amusing novelty. We still don’t know the ultimate outcome of our initial escapade with X-rays.

It was common practice to use X-rays in pregnant women to measure the size of the pelvis, and make a diagnosis of twins. Finally, a study of 700,000 children born between 1947 and 1964 was conducted in thirty-seven major maternity hospitals. The children of mothers who had received pelvic X-rays during pregnancy were compared with the children of mothers who had not been X-rayed. Cancer mortality was 40% higher among the children with X-rayed mothers. (88)

In present-day medicine, coronary angiography combines an invasive surgical procedure of snaking a tube through a blood vessel in the groin up to the heart. To get any useful information during the angiography procedure X-rays are taken almost continuously with minimum dosage ranges between 460 – 1,580 mrem. The minimum radiation from a routine chest X-ray is 2 mrem. X-ray radiation accumulates in the body and it is well-known that ionizing radiation used in X-ray procedures causes gene mutation. We can only obtain guesstimates as to its impact on health from this high level of radiation. Experts manage to obscure the real effects in statistical jargon such as, “The risk for lifetime fatal cancer due to radiation exposure is estimated to be 4 in one million per 1,000 mrem.” (89)

However, Dr. John Gofman, who has been studying the effects of radiation on human health for 45 years, is prepared to tell us exactly what diagnostic X-rays are doing to our health. Dr. Gofman has a PhD in nuclear and physical chemistry and is a medical doctor. He worked on the Manhattan nuclear project, discovered uranium-2323, was the first person to isolate plutonium, and since 1960, he’s been studying the effects of radiation on human health. With five scientifically documented books totaling over 2800 pages, Dr. Gofman provides strong evidence that medical technology, specifically X-rays, CT scans, mammography, and fluoroscopy, are a contributing factor to 75% of new cancers. His 699-page report, updated in 2000, “Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population” (90), shows that as the number of physicians increases in a geographical area with an increase in the number of X-ray diagnostic tests, there is an associated increase in the rate of cancer and ischemic heart disease. Dr. Gofman elaborates that it’s not X-rays alone that cause the damage but a combination of health risk factors including: poor diet, smoking, abortions, and the use of birth control pills. Dr. Gofman predicts that 100 million premature deaths over the next decade will be the result of ionizing radiation.

In his book, “Preventing Breast Cancer,” Dr. Gofman says that breast cancer is the leading cause of death among American women between the ages of forty-four and fifty-five. Because breast tissue is highly radiation-sensitive, mammograms can cause cancer. The danger can be heightened by a woman’s genetic makeup, preexisting benign breast disease, artificial menopause, obesity, and hormonal imbalance. (91)

Even X-rays for back pain can lead someone into crippling surgery. Dr. Sarno, a well-known New York orthopedic surgeon, found that X-rays don’t always tell the truth. In his books he cites studies on normal people without a trace of back pain that have spinal abnormalities on X-ray. Other studies have shown that some people with back pain have normal spines on X-ray. So, Dr. Sarno says there is not necessarily any association between back pain and spinal X-ray abnormality. (92) However, if a person happens to have back pain and an incidental abnormality on X-ray, they may be treated surgically, sometimes with no change in back pain, or worsening of back pain, or even permanent disability.

In addition, doctors often order X-rays as protection against malpractice claims to give the impression that they are leaving no stone unturned. It appears that doctors are putting their own fears before the interests of their patients.

UNNECESSARY HOSPITALIZATION
Summary:
8.9 million (8,925,033) people were hospitalized unnecessarily in 2001. (4)

In a study of inappropriate hospitalization 1,132 medical records were reviewed by two doctors. Twenty-three percent of all admissions were inappropriate and an additional 17% could have been handled in ambulatory out-patient clinics. Thirty-four percent of all hospital days were also inappropriate and could have been avoided. (93) The rate of inappropriate admissions in 1990 was 23.5%. (94) In 1999, another study confirmed the figure of 24% inappropriate admissions indicating a consistent pattern from 1986 to 1999 (95), showing steady reporting of approximately 24% inappropriate admissions each year. Putting these figures into present-day terms using the HCUP database, the total number of patient discharges from hospitals in the U.S. in 2001 was 37,187,641. (13) The above data indicate that 24% of those hospitalizations need never have occurred. It further means that 8,925,033 people were exposed to unnecessary medical intervention in hospitals and therefore represent almost 9 million potential iatrogenic episodes. (4)

WOMEN’S EXPERIENCE IN MEDICINE
Briefly, we will look at the medical iatrogenesis of women in particular. Dr. Martin Charcot (1825-1893) was world-renowned, the most celebrated doctor of his time. He practiced in the Paris hospital La Salpetriere. He became an expert in hysteria diagnosing an average of ten hysterical women each day, transforming them into… “iatrogenic monsters,” turning simple ‘neurosis’ into hysteria. (96) The number of women diagnosed with hysteria and hospitalized rose from 1% in 1841 to 17% in 1883. Hysteria is derived from the Latin “hystera” meaning uterus. Dr. Adriane Fugh-Berman stated very clearly in her paper that there is a tradition in U.S. medicine of excessive medical and surgical interventions on women. Only one hundred years ago male doctors decided that female psychological imbalance originated in the uterus. When surgery to remove the uterus was perfected it became the “cure” for mental instability, effecting a physical and psychological castration. Dr. Fugh-Berman noted that U.S. doctors eventually disabused themselves of that notion but have continued to treat women very differently than they treat men. (97) She cites the following:

  1. Thousands of prophylactic mastectomies are performed annually.
  2. One-third of U.S. women have had a hysterectomy before menopause.
  3. Women are prescribed drugs more frequently than are men.
  4. Women are given potent drugs for disease prevention, which results in disease substitution due to side effects.
  5. Fetal monitoring is unsupported by studies and not recommended by the CDC. (98) It confines women to a hospital bed and may result in higher incidence of Cesarean section. (99)
  6. Normal processes such as menopause and childbirth have been heavily medicalized.
  7. Synthetic hormone replacement therapy (HRT) does not prevent heart disease or dementia. It does increase the risk of breast cancer, heart disease, stroke, and gall bladder attack. (100)

We would add that as many as one-third of postmenopausal women use HRT. (101,102) These numbers are important in light of the much-publicized Women’s Health Initiative Study, which was forced to stop before its completion because of a higher death rate in the synthetic estrogen-progestin (HRT) group. (103)

Cesarean Section
In 1983, 809,000 Cesarean sections (21% of live births) were performed, making it the most common obstetric and gynecologic (OB/GYN) surgical procedure. The second most common OB/GYN operation was hysterectomy (673,000), and diagnostic dilation and curettage of the uterus (632,000) was third. In 1983, OB/GYN operations represented 23% of all surgery completed in this country. (104)

In 2001, Cesarean section is still the most common OB/GYN surgical procedure. Approximately 4 million births occur annually, with a 24% C-Section rate, i.e., 960,000 operations. In the Netherlands only 8% of babies are delivered by Cesarean section. Assuming human babies are similar in the U.S. and in the Netherlands, we are performing 640,000 unnecessary C-Sections in the U.S. with its three to four times higher mortality and 20 times greater morbidity than vaginal delivery. (105)

The Cesarean section rate was only 4.5% in the U.S. in 1965. By 1986 it had climbed to 24.1%. The author states that obviously an “uncontrolled pandemic of medically unnecessary Cesarean births is occurring.” (106) VanHam reported a Cesarean section postpartum hemorrhage rate of 7%, a hematoma formation rate of 3.5%, a urinary tract infection rate of 3%, and a combined postoperative morbidity rate of 35.7% in a high-risk population undergoing Cesarean section. (107)

NEVER ENOUGH STUDIES
Scientists used the excuse that there were never enough studies revealing the dangers of DDT and other dangerous pesticides to ban them. They also used this excuse around the issue of tobacco, claiming that more studies were needed before they could be certain that tobacco really caused lung cancer. Even the American Medical Association (AMA) was complicit in suppressing results of tobacco research. In 1964, the Surgeon General’s report condemned smoking, however the AMA refused to endorse it. What was their reason? They needed more research. Actually what they really wanted was more money and they got it from a consortium of tobacco companies who paid the AMA $18 million over the next nine years, during which the AMA said nothing about the dangers of smoking. (108)

The Journal of the American Medical Association (JAMA), “after careful consideration of the extent to which cigarettes were used by physicians in practice,” began accepting tobacco advertisements and money in 1933. State journals such as the New York State Journal of Medicine also began to run Chesterfield ads claiming that cigarettes are, “Just as pure as the water you drink… and practically untouched by human hands.” In 1948, JAMA argued “more can be said in behalf of smoking as a form of escape from tension than against it… there does not seem to be any preponderance of evidence that would indicate the abolition of the use of tobacco as a substance contrary to the public health.” (109) Today, scientists continue to use the excuse that they need more studies before they will lend their support to restrict the inordinate use of drugs.

OVERVIEW OF STATISTICAL TABLES AND FIGURES
Adverse Drug Reactions

The Lazarou study (1) was based on statistical analysis of 33 million U.S. hospital admissions in 1994. Hospital records for prescribed medications were analyzed. The number of serious injuries due to prescribed drugs was 2.2 million; 2.1% of in-patients experienced a serious adverse drug reaction; 4.7% of all hospital admissions were due to a serious adverse drug reaction; and fatal adverse drug reactions occurred in 0.19% of in-patients and 0.13% of admissions. The authors concluded that a projected 106,000 deaths occur annually due to adverse drug reactions.

We used a cost analysis from a 2000 study in which the increase in hospitalization costs per patient suffering an adverse drug reaction was $5,483. Therefore, costs for the Lazarou study’s 2.2 million patients with serious drug reactions amounted $12 billion. (1,49)

Serious adverse drug reactions commonly emerge after Food and Drug Administration approval. The safety of new agents cannot be known with certainty until a drug has been on the market for many years. (110)

Bedsores
Over one million people develop bedsores in U.S. hospitals every year. It’s a tremendous burden to patients and family, and a $55 billion dollar healthcare burden. (7) Bedsores are preventable with proper nursing care. It is true that 50% of those affected are in a vulnerable age group of over 70. In the elderly bedsores carry a fourfold increase in the rate of death. The mortality rate in hospitals for patients with bedsores is between 23% and 37%. (8) Even if we just take the 50% of people over 70 with bedsores and the lowest mortality at 23%, that gives us a death rate due to bedsores of 115,000. Critics will say that it was the disease or advanced age that killed the patient, not the bedsore, but our argument is that an early death, by denying proper care, deserves to be counted. It is only after counting these unnecessary deaths that we can then turn our attention to fixing the problem.

Malnutrition in Nursing Homes
The General Accounting Office (GAO), a special investigative branch of Congress, gave citations to 20% of the nation’s 17,000 nursing homes for violations between July 2000 and January 2002. Many violations involved serious physical injury and death. (111)

A report from the Coalition for Nursing Home Reform states that at least one-third of the nation’s 1.6 million nursing home residents may suffer from malnutrition and dehydration, which hastens their death. The report calls for adequate nursing staff to help feed patients who aren’t able to manage a food tray by themselves. (11) It is difficult to place a mortality rate on malnutrition and dehydration. This Coalition report states that malnourished residents, compared with well-nourished hospitalized nursing home residents, have a five-fold increase in mortality when they are admitted to hospital. So, if we take one-third of the 1.6 million nursing home residents who are malnourished and multiply that by a mortality rate of 20% (8,14), we find 108,800 premature deaths due to malnutrition in nursing homes.

Nosocomial Infections
The rate of nosocomial infections per 1,000 patient days has increased 36% – from 7.2 in 1975 to 9.8 in 1995. Reports from more than 270 U.S. hospitals showed that the nosocomial infection rate itself had remained stable over the previous 20 years with approximately five to six hospital-acquired infections occurring per 100 admissions, which is a rate of 5-6%. However, because of progressively shorter inpatient stays and the increasing number of admissions, the actual number of infections increased. It is estimated that in 1995, nosocomial infections cost $4.5 billion and contributed to more than 88,000 deaths – one death every 6 minutes. (9) The 2003 incidence of nosocomial mortality is quite probably higher than in 1995 because of the tremendous increase in antibiotic-resistant organisms. Morbidity and Mortality Report found that nosocomial infections cost $5 billion annually in 1999. (10) This is a $0.5 billion increase in four years. The present cost of nosocomial infections might now be in the order of $5.5 billion.

Outpatient Iatrogenesis
Dr. Barbara Starfield in a 2000 JAMA paper presents us with well-documented facts that are both shocking and unassailable. (12)

  1. The U.S. ranks twelfth out of 13 countries in a total of 16 health indicators. Japan, Sweden, and Canada were first, second, and third.
  2. More than 40 million people have no health insurance.
  3. 20% to 30% of patients receive contraindicated care.

Dr. Starfield warns that one cause of medical mistakes is the overuse of technology, which may create a “cascade effect” leading to more treatment. She urges the use of ICD (International Classification of Diseases) codes which have designations called: “Drugs, Medicinal, and Biological Substances Causing Adverse Effects in Therapeutic Use” and “Complications of Surgical and Medical Care” to help doctors quantify and recognize the magnitude of the medical error problem. Starfield says that, at present, deaths actually due to medical error are likely to be coded according to some other cause of death.

She concludes that against the backdrop of our abysmal health report card compared to the rest of the Westernized countries, we should recognize that the harmful effects of health care interventions account for a substantial proportion of our excess deaths.

Starfield cites Weingart’s 2000 article, “Epidemiology of Medical Error” on outpatient iatrogenesis. And Weingart, in turn, cites several authors and provides statistics showing that between 4% to 18% of consecutive patients in outpatient settings suffer an iatrogenic event leading to: (112)

  1. 116 million extra physician visits
  2. 77 million extra prescriptions
  3. 17 million emergency department visits
  4. 8 million hospitalizations
  5. 3 million long-term admissions
  6. 199,000 additional deaths
  7. $77 billion in extra costs

Unnecessary Surgeries
There are 12,000 deaths per year from unnecessary surgeries. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations, the fraction that are unwarranted could be as high as 30%. (74)

IT’S A GLOBAL ISSUE
A survey published in the Journal of Health Affairs pointed out that between 18% and 28% of people who were recently ill had suffered from a medical or drug error in the previous two years. The study surveyed 750 recently-ill adults in five different countries. The breakdown by country showed 18% of those in Britain, 25% in Canada, 23% in Australia, 23% in New Zealand, and the highest number was in the U.S. at 28%. (113)

HEALTH INSURANCE
A recent finding by the Institute of Medicine is that the 41 million Americans without health insurance have consistently worse clinical outcomes than those that are insured, and are at increased risk for dying prematurely (114)

Insurance Fraud
When doctors bill for services they do not render, advise unnecessary tests, or screen everyone for a rare condition, they are committing insurance fraud. The U.S. General Accounting Office (GAO) gave a 1998 figure of $12 billion dollars lost to fraudulent or unnecessary claims, and reclaimed $480 million in judgments in that year. In 2001, the Federal government won or negotiated more than $1.7 billion in judgments, settlements, and administrative impositions in healthcare fraud cases and proceedings. (115)

WAREHOUSING OUR ELDERS
It is only fitting that we end this report with acknowledgement of our elders. The moral and ethical fiber of society can be judged by the way it treats its weakest and most vulnerable members. Some cultures honor and respect the wisdom of their elders, keeping them at home – the better to continue participation in their community. However, American nursing homes, where millions of our elders die, represent the pinnacle of social isolation and medical abuse.

Important Statistics about Nursing Homes

  1. In America, at any one time, approximately 1.6 million elderly are confined to nursing homes. By 2050 that number could be 6.6 million. (11,116)
  2. A total of 20% of all deaths from all causes occur in nursing homes. (117)
  3. Hip fractures are the single greatest reason for nursing home admissions. (118)
  4. Nursing homes represent a reservoir for drug-resistant organisms due to overuse of antibiotics. (119)

Congressman Waxman reminded us that “as a society we will be judged by how we treat the elderly” when he presented a report that he sponsored, “Abuse of Residents is a Major Problem in U.S. Nursing Homes,” on July 30, 2001. The report uncovered that one third – 5,283 of the nations’ 17,000 nursing homes – were cited for an abuse violation in the two-year period studied, January 1999 – January 2001. (116) Waxman stated that “the people who cared for us, deserve better.” He also made it very clear that this was only the tip of the iceberg and there is much more abuse occurring that we don’t know about or ignore. (116a)

The major findings of “Abuse of Residents is a Major Problem in U.S. Nursing Homes,” were:

  1. Over 30% of nursing homes in the U.S. were cited for abuses, totaling more than 9,000 abuse violations.
  2. 10% of nursing homes had violations that caused actual physical harm to residents, or worse.
  3. Over 40%, or 3,800 abuse violations were only discovered after a formal complaint was filed, usually by concerned family members.
  4. Many verbal abuse violations were found.
  5. Occasions of sexual abuse.
  6. Incidents of physical abuse causing numerous injuries such as fractured femur, hip, elbow, wrist, and other injuries.

Dangerously understaffed nursing homes lead to neglect, abuse, overuse of medications, and physical restraints. An exhaustive study of nurse-to-patient ratios in nursing homes was mandated by Congress in 1990. The study was finally begun in 1998 and took four years to complete. (120) Commenting on the study, a spokesperson for The National Citizens’ Coalition for Nursing Home Reform said, “They compiled two reports of three volumes each thoroughly documenting the number of hours of care residents must receive from nurses and nursing assistants to avoid painful, even dangerous, conditions such as bedsores and infections. Yet it took the Department of Health and Human Services and Secretary Tommy Thompson only four months to dismiss the report as ‘insufficient.’” (121) Bedsores occur three times more commonly in nursing homes than in acute care or veterans’ hospitals. (122) But we know that bedsores can be prevented with proper nursing care. It shouldn’t take four years for someone to find out that proper care of bedsores requires proper staffing. In spite of such urgent need in nursing homes where additional staff could solve so many problems, we hear the familiar refrain “not enough research” – one that merely buys time for those in charge and relegates another smoldering crisis to the back burner.

Since many nursing home patients suffer from chronic debilitating conditions, their assumed cause of death is often unquestioned by physicians.†Some studies show that as many as 50% of deaths due to restraints, falls, suicide, homicide, and choking in nursing homes may be covered up. (123,124) It is quite possible that many nursing home deaths are attributed, instead, to heart disease, which, until our report, was the number one cause of death. In fact, researchers have found that heart disease may be over-represented in the general population as a cause of death on death certificates by 7.9% to 24.3%. In the elderly the over-reporting of heart disease as a cause of death is as much as two-fold (125)

When elucidating iatrogenesis in nursing homes, some critics have asked, “To what extent did these elderly people already have life-threatening diseases that led to their premature deaths anyway?” Our response is that if a loved one dies one day, one week, one year, a decade, or two decades prematurely, thanks to some medical misadventure, that is still a premature, iatrogenic death. In a legalistic sense perhaps more weight is placed on the loss of many potential years compared to an additional few weeks, but this attitude is not justified in an ethical or moral sense.

The fact that there are very few statistics on malnutrition in acute-care hospitals and nursing homes shows the lack of concern in this area. A survey of the literature turns up very few American studies. Those that do appear are foreign studies in Italy, Spain, and Brazil. However, there is one very revealing American study conducted over a 14-month period that evaluated 837 patients in a 100-bed sub-acute-care hospital for their nutritional status. Only 8% of the patients were found to be well nourished. Almost one-third (29%) were malnourished and almost two-thirds (63%) were at risk of malnutrition. The consequences of this state of deficiency were that 25% of the malnourished patients required readmission to an acute-care hospital compared to 11% of the well-nourished patients. The authors concluded that malnutrition reached epidemic proportions in patients admitted to this sub-acute-care facility. (126)

Many studies conclude that physical restraints are an underreported and preventable cause of death. Whereas administrators say they must use restraints to prevent falls, in fact, they cause more injury and death because people naturally fight against such imprisonment. Studies show that compared to no restraints, the use of restraints carries a higher mortality rate and economic burden. (127-129) Studies found that physical restraints, including bedrails, are the cause of at least 1 in every 1,000 nursing-home deaths. (130-132)

However, deaths caused by malnutrition, dehydration, and physical restraints are rarely recorded on death certificates. Several studies reveal that nearly half of the listed causes of death on death certificates for older persons with chronic or multi-system disease are inaccurate. (133) Even though 1-in-5 people die in nursing homes, the autopsy rate is only 0.8%. (134) Thus, we have no way of knowing the true causes of death.

Over-medicating Seniors
The CDC may be focused on reducing the number of prescriptions for children but a 2003 study finds over-medication of our elderly population. Dr. Robert Epstein, chief medical officer of Medco Health Solutions Inc. (a unit of Merck & Co.), conducted the study on drug trends. (135) He found that seniors are going to multiple physicians and getting multiple prescriptions and using multiple pharmacies. Medco oversees drug-benefit plans for more than 60 million Americans, including 6.3 million senior citizens who received more than 160 million prescriptions. According to the study, the average senior receives 25 prescriptions annually. In those 6.3 million seniors, a total of 7.9 million medication alerts were triggered: less than one-half that number, 3.4 million, were detected in 1999. About 2.2 million of those alerts indicated excessive dosages unsuitable for senior citizens, and about 2.4 million alerts indicated clinically inappropriate drugs for the elderly. Reuters interviewed Kasey Thompson, director of the Center on Patient Safety at the American Society of Health System Pharmacists, who said, “There are serious and systemic problems with poor continuity of care in the United States.” He says this study shows “the tip of the iceberg” of a national problem.

According to Drug Benefit Trends, the average number of prescriptions dispensed per non-Medicare HMO member per year rose 5.6% from 1999 to 2000 – from 7.1 to 7.5 prescriptions. The average number dispensed for Medicare members increased 5.5% – from 18.1 to 19.1 prescriptions. (136) The number of prescriptions in 2000 was 2.98 billion, with an average per person prescription amount of 10.4 annually. (137)

In a study of 818 residents of residential care facilities for the elderly, 94% were receiving at least one medication at the time of the interview. The average intake of medications was five per resident; the authors noted that many of these drugs were given without a documented diagnosis justifying their use. (138)

Unfortunately, seniors, and groups like the American Association for Retired Persons (AARP), appear to be dependent on prescription drugs and are demanding that coverage for drugs be a basic right. (139) They have accepted the overriding assumption from allopathic medicine that aging and dying in America must be accompanied by drugs in nursing homes and eventual hospitalization with tubes coming out of every orifice. Instead of choosing between drugs and a diet-lifestyle change, seniors are given the choiceless option of either high-cost patented drugs or low-cost generic drugs. Drug companies are attempting to keep the most expensive drugs on the shelves and to suppress access to generic drugs, in spite of stiff fines of hundreds of millions of dollars from the government. (140,141) In 2001 some of the world’s biggest drug companies, including Roche, were fined a record £523 million ($871 million) for conspiring to increase the price of vitamins. (142)

We would urge AARP, especially, to become more involved in prevention of disease and not to rely so heavily on drugs. At present, the AARP recommendations for diet and nutrition assume that seniors are getting all the nutrition they need in an average diet. At most, they suggest extra calcium and a multiple vitamin/mineral supplement. (143) This is not enough, and in our next report we will show how to live a healthier life without unnecessary medical intervention.

We would like to send the same message to the Hemlock Society, which offers euthanasia options to chronically ill people, especially those in severe pain. What if some of these chronic diseases are really lifestyle diseases caused by deficiency of essential nutrients, lack of care, inappropriate medication, or lack of love? This question is extremely important to consider when you are depressed or in pain. We must look to healing those conditions before offering up our lives.

Let’s also look at the irony of under use of proper pain medication for patients that really need it. For example, in one particular study pain management was evaluated in a group of 13,625 cancer patients, aged 65 or over, living in nursing homes. Overall, almost 30%, or 4,003 patients, reported pain. However, more than 25% received absolutely no pain relief medication; 16% received a World Health Organization (WHO) level-one drug (mild analgesic); 32% a WHO level-two drug (moderate analgesic); and only 26% received adequate pain relieving morphine. The authors concluded that older patients and minority patients were more likely to have their pain untreated. (144)

The time has come to set a standard for caring for the vulnerable among us – a standard that goes beyond making sure they are housed and fed, and not openly abused.†We must stop looking the other way and we, as a society, must take responsibility for the way in which we deal with those who are unable to care for themselves.

WHAT REMAINS TO BE UNCOVERED
Our ongoing research will continue to quantify the morbidity, mortality, and financial loss due to:

  1. X-ray exposures: mammography, fluoroscopy, CT scans.
  2. Overuse of antibiotics in all conditions.
  3. Drugs that are carcinogenic: hormone replacement therapy (*see below), immunosuppressive drugs, prescription drugs.
  4. Cancer chemotherapy: If it doesn’t extend life, is it shortening life? (70)
  5. Surgery and unnecessary surgery: Cesarean section, radical mastectomy, preventive mastectomy, radical hysterectomy, prostatectomy, cholecystectomies, cosmetic surgery, arthroscopy, etc.
  6. Discredited medical procedures and therapies.
  7. Unproven medical therapies.
  8. Outpatient surgery.
  9. Doctors themselves: when doctors go on strike, it appears the mortality rate goes down.

*Part of our ongoing research will be to quantify the mortality and morbidity caused by hormone replacement therapy (HRT) since the mid-1940’s. In December 2000, a government scientific advisory panel recommended that synthetic estrogen be added to the nation’s list of cancer-causing agents. HRT, either synthetic estrogen alone or combined with synthetic progesterone, is used by an estimated 13.5 to 16 million women in the U.S. (145) The aborted Women’s Health Initiative Study (WHI) of 2002 showed that women taking synthetic estrogen combined with synthetic progesterone have a higher incidence of ovarian cancer, breast cancer, stroke, and heart disease and little evidence of osteoporosis reduction or prevention of dementia. WHI researchers, who usually never give recommendations, other than demanding more studies, are advising doctors to be very cautious about prescribing HRT to their patients. (100,146-150)

Results of the “Million Women Study” on HRT and breast cancer in the U.K were published in the Lancet, August, 2003. Lead author, Professor Valerie Beral, Director of the Cancer Research UK Epidemiology Unit, is very open about the damage HRT has caused. She said, “We estimate that over the past decade, use of HRT by UK women aged 50-64 has resulted in an extra 20,000 breast cancers, oestrogen-progestagen (combination) therapy accounting for 15,000 of these.” (151) However, we were not able to find the statistics on breast cancer, stroke, uterine cancer, or heart disease due to HRT used by American women. The population of America is roughly six times that of the U.K. Therefore, it is possible that 120,000 cases of breast cancer have been caused by HRT in the past decade.

CONCLUSION
When the number one killer in a society is the healthcare system, then, that system has no excuse except to address its own urgent shortcomings. It’s a failed system in need of immediate attention. What we have outlined in this paper are insupportable aspects of our contemporary medical system that need to be changed – beginning at its very foundations.

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APPENDIX

OFFICE OF TECHNOLOGY ASSESSMENT (OTA)

Health Care Technology and Its Assessment in Eight Countries, 1995.
General Facts

  1. In 1990 life expectancy in the U.S. was 71.8 years for men and 78.8 for women, among the lowest of the developed countries.
  2. The 1990 infant mortality rate was 9.2 per 1,000 live births. This was in the bottom half of the distribution among all developed countries. (OTA comments on the frustration of poor statistics and high healthcare spending.)
  3. Health status is correlated with socioeconomic status.
  4. Healthcare is not universal.
  5. Healthcare is based on the free market system with no fixed budget or limitations on expansion.
  6. Healthcare accounts for 14% of the U.S. GNP, which was over $800 billion in 1993.
  7. The federal government does no central planning. It is the major purchaser of health care for older people and some poor people.
  8. Americans have a lower level of satisfaction with their healthcare system than people in other developed countries.
  9. U.S. medicine specializes in expensive medical technology. Some major U.S. cities have more MRI scanners than most countries.
  10. Huge public and private investment in medical research and pharmaceutical development drives this “technological arms race.”
  11. Any efforts to restrain technological developments in healthcare are opposed by policy makers concerned about negative impacts on medical-technology industries.

Hospitals

  1. In 1990 there were: 5,480 acute-care hospitals, 880 specialty hospitals (psychiatric, long-term care, rehab) and 340 federal hospitals (military, vets and Native Americans) providing 2.7 hospitals per 100,000 population.
  2. In 1990 the average length of stay for an annual 33 million admissions was 9.2 days. Bed occupancy rate was 66%. Lengths of stay were shorter and admission rates lower than other countries.
  3. In 1990 there were 615,000 physicians, 2.4 per 1,000; 33% were primary care (family medicine, internal medicine, and pediatrics) and 67% were specialists.
  4. In 1991 government-run healthcare spending was $81 billion.
  5. Total healthcare spending was $752 billion in 1991, an increase from $70 billion in 1950. Spending grew five-fold per capita.
  6. Reasons for increased healthcare spending:
    a. The high cost of defensive medicine, with an escalation in services solely to avoid malpractice litigation.

    b. U.S. healthcare based on defensive medicine costs nearly $45 billion per year, or about 5% of total healthcare spending, according to one source.

    c. The availability and use of new medical technologies have contributed the most to increased healthcare spending, argue many analysts. OTA admits that these costs are impossible to quantify.

  7. The reasons government attempts to control healthcare costs have failed:

d. Market incentive and profit-motive involvement in the financing and organization of healthcare including private insurance, hospital system, physician services, and drug and medical device industries.

e. Expansion is the goal of free enterprise.

Health-Related Research and Development

  1. The U.S. spends more than any other country on R & D.
  2. $9.2 billion was spent in 1989 by the federal government; U.S. industries spent an additional $9.4 billion.
  3. There was a 50% rise in total national R & D expenditures between 1983 and 1992.
  4. NIH receives about half of the government funding.
  5. NIH spent more on basic research ($4.1 billion in 1989) than for clinical trials of medical treatments on humans ($519 million in 1989).
  6. Most of the trials evaluate new cancer treatment protocols and new treatments for complications of AIDS and do not study existing treatments, even though the effectiveness of many of them is unknown and questioned.
  7. The NIH in 1990 had just begun to do meta-analysis and cost-effectiveness analysis.

Pharmaceutical and Medical Device Industry

  1. About two-thirds of the industry’s $9.4 billion budget went to drug research; the remaining one-third was spent by device manufacturers.
  2. In addition to R & D, the medical industry spent 24% of total sales on promoting their products and only 15% of total sales on development.
  3. Total marketing expenses in 1990 were over $5 billion.
  4. Many products provide no benefit over existing products.
  5. Public and private healthcare consumers buy these products.
  6. If healthcare spending is perceived as a problem, a highly profitable drug industry exacerbates the problem.

Controlling Health Care Technology

  1. The FDA ensures the safety and efficacy of drugs, biologics, and medical devices.
  2. The FDA does not consider costs of therapy.
  3. The FDA does not consider the effectiveness of a therapy.
  4. The FDA does not compare a product to currently marketed products
  5. The FDA does not consider non-drug alternatives for a given clinical problem.
  6. Drug development costs $200 million to bring a new drug to market. AIDS-drug interest groups forced new regulations that speed up the approval process.
  7. Such drugs should be subject to greater post-marketing surveillance requirements. But as of 1995 these provisions had not yet come into play.
  8. Many argue that reductions in the pre-approval testing of drugs opens the possibility of significant undiscovered toxicities.

Health Care Technology Assessment

  1. Failure to evaluate technology was a focus of a 1978 report from OTA with examples of many common medical practices supported by limited published data. (10-20%)
  2. In 1978 congress created the National Center for Health Care Technology (NCHCT) to advise Medicare and Medicaid.
  3. With an annual budget of $4 million NCHCT published three broad assessments of high-priority technologies and made about 75 coverage recommendations to Medicare.
  4. NCHCT was put out of business by Congress in 1981—a political casualty. The medical profession opposed it from the beginning. The AMA testified before Congress in 1981 that “clinical policy analysis and judgments are better made—and are being responsibly made—within the medical profession. Assessing risks and costs, as well as benefits, has been central to the exercise of good medical judgment for decades.”
  5. The medical device lobby also opposed government oversight by NCHCT.

Examples of Lack of Proper Management of HealthCare

1. Treatments for Coronary Artery Disease

  1. Since the early 1970’s the number of coronary artery-bypass surgeries (CABGS) has risen rapidly without government regulation and without clinical trials.
  2. Angioplasty for single vessel disease was introduced in 1978. The first published trial of angioplasty versus medical treatment was in 1992.
  3. Angioplasty did not cut down on the number of CABGS as was promoted.
  4. Both procedures increase in number every year as the patient population grows older and sicker.
  5. Rates of use are higher in white patients, in private insurance patients, and there is great variation in different geographic regions. Such facts imply that use of these procedures is based on non-clinical factors.
  6. At the time of this report, 1995, the NIH consensus program had not assessed CABGS since 1980 and had never assessed angioplasty.
  7. RAND researchers evaluated CABGS in New York in 1990. They reviewed 1,300 procedures and found 2% were inappropriate, 90% appropriate, and 7% uncertain. For 1,300 angioplasties, 4% were inappropriate and 38% uncertain. Using RAND methodologies a panel of British physicians rated twice as many procedures “inappropriate” as did a U.S. panel rating the same clinical cases. The New York numbers are in question because New York State limits the number of surgery centers, and the per-capita supply of cardiac surgeons in New York is about one-half the national average.
  8. The estimated five-year cost is $33,000 for angioplasty and $40,000 for CABGS. So, angioplasty did not lower costs. This was because of high failure rates of angioplasty.

2. Computed Tomography CT

  1. The first CT scanner in the U.S. was installed at the Mayo Clinic in 1973. In 1992 the number of operational CT scanners was 6,060. By comparison, in 1993 there were 216 CT units in Canada.
  2. There is little information available on how CT scan improves or affects patient outcome.
  3. In some institutions up to 90% of scans performed were negative.
  4. Approval by the FDA was not required for CT scanners. No evidence of safety or efficacy was required.

3. MRI

  1. The first MRI was introduced in 1978 in Great Britain; the first U.S. scanner in 1980. By 1988 there were 1,230 units; by 1992 between 2,800 and 3,000.
  2. A definitive review published in 1994 found less than 30 studies out of 5,000 that were prospective comparisons of diagnostic accuracy or therapeutic choice.
  3. American College of Physicians assessed MRI studies and rated 13 out of 17 trials as “weak” – meaning the absence of any studies on therapeutic impact or patient outcomes.
  4. The OAT concludes that, “It is evident that hospitals, physician-entrepreneurs, and medical device manufacturers have approached MRI and CT as commodities with high-profit potential, and decision-making on the acquisition and use of these procedures has been highly influenced by this approach. Clinical evaluation, appropriate patient selection, and matching supply to legitimate demand might be viewed as secondary forces.”

4. Laparoscopic Surgery

  1. Laparoscopic cholecystectomy was introduced at a professional surgical society meeting in late 1989. In 1992, five years after introduction, 85% of all cholecystectomies were performed laparoscopically.
  2. There was an associated increase of 30% in the number of cholecystectomies performed.
  3. Because of the increased volume of gall bladder operations, the total costs increased 11.4% between 1988 and 1992, in spite of a 25.1% drop in the average cost per surgery.
  4. The mortality rate for gall bladder surgeries also did not decline as a result of the lower risk because so many more were performed.
  5. When studies were finally done on completed cases, the results showed that laparoscopic cholecystectomy was associated with reduced in-patient duration, decreased pain, and shorter period of restricted activity. But there were increased rates of bile duct and major vessel injuries and a suggestion that these rates were worse for people with acute cholecystitis. There were still no clinical trials to clarify this issue.
  6. Patient demand, fueled by substantial media attention, was a major force in promoting rapid adoption.
  7. The video, which introduced the procedure in 1989, was produced by the major manufacturer of laparoscopic equipment.
  8. Doctors were given two-day training seminars before performing the surgery on patients.

Infant Mortality

  1. In 1990 the U.S. ranked twenty-fourth in infant mortality out of 38 developed countries with a rate of 9.2 deaths per 1,000 live births.
  2. U.S. black infant mortality is 18.6 per 1,000 live births and 8.8 for whites.

Screening for Breast Cancer

  1. There has always been a debate over mammography screening in women under 50.
  2. In 1992 the Canadian National Breast Cancer Study of 50,000 women showed that mammography had no effect on mortality for younger women, aged 40-50.
  3. The National Cancer Institute (NCI) refused to change its recommendations on mammography.
  4. The American Cancer Society decided to wait for more studies on mammography.
  5. Then, in December 1993 NCI announced that women over 50 should have routine screening every one to two years but younger women would have no benefit from having mammography.

Summary

The OTA concluded that, “There are no mechanisms in place to limit dissemination of technologies regardless of their clinical value.” Shortly after this report, the OTA was disbanded.

Library

 

Categories
Articles

Earth – Air – Fire and Water

Artwork by Rosanna Hughes, BA Dip Ed.

The Pharmageddon Herbal

Chapter 12.
 Spagyria 
Ivor Hughes

Introduction
The history and development of pharmacy, is bound to the development of its solvents and carrier substances. Without them, pharmacy would have remained little more than a primitive art.

The development of those substances is inextricably bound to alchemy, and they are far older than is allowed by the party line advanced by orthodox pharmacy, e.g. Dioscorides is credited with introduction of wine as a solvent for medicinal substances, and closely followed by Galen, with vinegar, in the 1st and 2nd centuries AD.

The ‘Iliad‘ of Homer is dated circa 750 BC, and in which Helen of Troy is said to have cast a substance called ‘Nepenthes’ (Opium) into wine. The resulting potion was a specific to banish woes and sorrows. This we know is correct.

We may see that wine was in use as a solvent almost 1,000 years before Dioscorides. Orthodox pharmacy credits the introduction of alcohol (spirits of wine), to two Spanish alchemists of the 13th century AD, i.e., Arnold of Villanova and Raymond Lully, whose knowledge was based on that of the Arabic School of Alchemy, which in turn was influenced by the Egyptian, Greek, Indian and Chinese schools, they all had sophisticated records, dating back circa 800 BC.

     The Exemplar Paracelsus
Spagyric Pharmacy, sometimes called Herb Alchemy, is the Royal Road of Medicine. Paracelsus stated that the true purpose of Alchemy, was not for the vulgar purpose of Gold making, but rather for the production of medicines. The term ‘Spagyria’ is said to have been coined by Paracelsus, from the Greek. The essential meaning of which, was to draw out and then to bind.

‘Solve et Coagula, et habebis magisterium’
Dissolve and recombine and you have the magistery.

The Medical Establishment of his day were followers of Galen the Greek, who was physician to the Roman Emperor Marcus Aurelius (121 – 180AD)

Let it be said, that Galen as Physician to the Emperor, would undoubtedly have been up with the latest medical vogue of the day. He also introduced a few innovations of his own. Wine vinegar as a solvent for herbal medicines is a good example.
 

The following is extracted from USD 1926 Monograph on Vinegar.


 
    The series of changes which occur during the acetous fermentation is called acidification. The following equations represent this change:

C2H6O + O = C2H4O + H2O
C2H4O + O – C2H4O
2

     Vinegar, when good, is of an agreeable, penetrating odor, and a pleasant acid taste. According to the Magnes-Lahens, wine vinegar always contains a little aldehyde. The better sorts of vinegar have a grateful aroma, probably due to the presence of an ethereal substance, perhaps acetic ether. The color of vinegar varies from water white to deep red. When long kept, especially when exposed to the air, it becomes ropy, acquires an unpleasant odor, putrefies, and loses its acidity.  The essential ingredients of vinegar are acetic acid and water, but, besides these, it contains various other substances derived from the particular vinous


 liquor from which it may have been prepared. 
     The Principal foreign substances which vinegar is liable to contain are sulphuric and sulphurous acids, and copper and lead, derived from improper vessels used in its manufacture.  Tin has been found in it after standing a short time in tin vessels.  The testing of vinegar for genuineness and purity involves so many complex factors that a  work on food analysis, such as that of Leach, should be consulted.
     Vinegar is at present used as a medicine only for its local astringent properties, and in the form of an enema diluted with three times it’s bulk of water to kill seat worms. In the dermatitis produced by exposure to the sun made into a paste with glycerin, bismuth and starch, it is very effective.  In hemotemesis one ounce to a tumbler of water often acts very advantageously, and may be taken freely. At one time vinegar was largely used in pharmacy as a menstrumm, but on account of its tendency to undergo decomposition it has been replaced by diluted acetic acid in both the American and British Pharmacopeias.

Vinegar is a fine solvent of minerals, which makes it harshness in this realm, too fierce for the delicate structures found in plants. A herb contains hundreds of specific molecular structures which are linked to each other in harmonic patterns. Dilute Acetic Acid of the British Pharmacopoeia is 6% w/w with the limits between 5.7 and 6.3%. Those figures are the equivalent strength of the finest of the Malt and the Wine Vinegars. However it contains none of the virtues.

Plant structures are easily disrupted or rearranged thus destroying the natural synergy. The compounds are easily damaged or destroyed by excessive heat i.e. temperatures in excess of 60 Celsius and in some cases even lower. Remember that heat accelerates a reaction. The herb is also sensitive to the type of solvent used to extract its virtues. If the wrong solvent is used it may cause a precipitation reaction whereby the molecules clump and are thrown out of solution; Or worse still the constituents complex, and rearrange themselves into different entities. Consequently the temperatures employed and the type of solvent used are of vital importance if the extract is to remain viable. Complexing is also the consequence of the mixing of two or more plant drugs. Consequently such preparations are of dubious antecedents. These type of Galenic preparations were part of the orthodox medicine of the time.

Paracelsus, in front of his students, burnt the works of Galen. Let us not confuse the symbolism of this act, as some kind of petty attack upon the reputation of Galen, but rather as an attack on the Medical Establishment of the day. Who by their slavish following of academic diktat, totally ignored the evidence that Paracelsus had placed before them. This in the same manner, as the Establishment slavishly followed the ‘Phlogiston Theory’.

Paracelsus denounced Galenic Practice, and thus drew down upon his head the wrath of the Medical Establishment of his day. So once again he took to the road, healing as he went, dispensing his charity to the poor and oppressed. From his sickbed and two days before he died, he called the public notary to his bedside and dictated his will to distribute his meager possessions to the poor. 

The names of those that hounded Paracelsus to his death, have long since been consigned to obscurity, and are heard no more. Whereas the name of Paracelsus grows ever more luminous with the passing of the years. Who was Paracelsus ? Much has been written, but much lies hidden. The true import of his teachings are only now being realized, some 500 years after his death. Let Paracelsus speak for himself with some selected aphorisms;


Between heaven and earth there is a unity, reflected on one hand, in the real or supposed influence of the sun, stars and planets on the life of plants, animals and men, also on the medicines derived from them. On the other hand, in the repetition of the structures from which sprang the notions of Macrocosm and Microcosm.

The reason for this is that man does not know himself and does not know the energies hidden within him, and does not know that he carries the stars within, and that he is the Microcosm and thus within carries the whole firmament with all its influences.

To be a Physician means to receive a mission from God and to carry out His orders, or to fail without recourse.

If Nature is your Teacher your Soul will awaken

Everything that is within can be known by that which is without.

Medicine should be based upon truth and not verbal sleight of hand. Practice should not be based upon speculative theory; Theory should be derived from practice.

The nature and force of a disease must be discovered by their cause and not by their symptoms.

To give to each Nation its own type of medicine, the theoricam best suited to it, as it behooves. For I can well realize that my prescriptions may turn out to be ineffectual among the foreign Nations, and that foreign recipes may turn out to be ineffectual in our Nation. That is to say that I write for Europe, and I do not know whether Asia and Africa may profit from it.

The art of medicine is rooted in the heart. If your heart is false, you will also be a false physician; If your heart is just, you will also be a true physician.

All the remedies are on earth but we lack the men to gather them. They are ready to be harvested, but the reapers have not come. But one day the reapers of the right remedies shall come.

Blessed and thrice blessed is the physician who recognizes the Medicines in their living action, who knows how to obtain them and who knows that they are not dead. There are many medicines in the world which are already dead.

The Remedy is nothing but a seed which you must develop into that which it is destined to be.

In all things there is a poison, and there is nothing without a poison. It depends only on the dose whether a poison is a poison or not.

The Art of medicine consists in the extracting and not in the compounding, it consists of the discovery of that which is concealed in things, and not in compounding various things and piecing them together.

In one herb there is more force and power than all the papers. that are read in High College and are not fated to live long.

Nature is the physician not you. From her you must learn, not from yourself. She compounds the remedies not you. See to it that you find out where Nature has her pharmacies, where her virtues have been written down, and in what boxes they are stored.

And since the fit manner is not to be found in pharmaceutics, we explore further; that is to say that we must learn from Alchemian or Spagyria.   
Paracelsus 1493 – 1541


The Basis of Works 12.1
No system of knowledge can be fully understood, without first examining the body of ideas in which it is embedded. The core language of alchemy is based on seven philosophical pillars, i.e. four elements and three principles.

The four philosophical elements refer to the states of matter as follows;

The Philosophical Elements. Table 12.1A

Sign

Substance

Earth

Air

Fire

Water

State

Solid

Gaseous

Radiant

Liquid

By manipulating the philosophical elements, all manner of chemical tasks may be effected, and as testified by Carl Jung, the language of alchemy was precise, as well as beautiful. The three philosophical principles refer to the triad in all matter, animate or inanimate, they refer to the life principle in man and plants as follows;

The Philosophic Principles. Table 12.1B

Principle

Man

Plant

Condition

Operation

Mercury

Soul

Alcohol

Etheric

Distillation

Sulphur

Mind

Extractive

Mutable

Extraction

Salt

Body

Salts

Fixed

Calcination

By using the signs of the seven philosophical pillars in various combinations, precise operational instructions may be given to the adept, irrespective of language or culture. In addition to the elements and principles, there were approximately 300 other signs to cover the equipment and physical substances, upon which the alchemist operated. The possible permutations between 7 and 300 runs into the millions. It can be seen that 7 philosophic principles are the very epitome of ‘Occam’s Razor’.

To repeat;

No system of knowledge can be fully understood without first examining the body of ideas in which it is embedded. The examination is such a seemingly simple thing. Yet it is difficult, because it involves placing the ego to one side, and without prejudice, allowing the ideas to work upon the psyche. In this respect, the following quotation has relevance.

” To seek in Alchemy either a crude chemistry or a psychology in the modern sense of the word is to remain blind to the sacred view of nature and the doctrine of the unicity of the Cosmos which forms the foundations of all the traditional sciences, especially Alchemy which stands at the antipodes of the segmented and secularized world which forms the object or subject of study of both modern chemistry and psychology ”

Professor Seyyed Hossein Nasr.
Islamic Science

If our meditation is successful, we may verify by direct experience, that Professor Carl Gustav Jung was indeed correct in his assertion that, the ‘Collective Unconscious’ performs its transactions by the use of Alchemical Symbolism to project archetypal patterns onto matter. This Spiritual Homeopathy brings matter to life by the transfer of what Jung called the ‘Anima Mundi’ meaning the soul of the world. The point to be made here, is that the Masters of old had penetrated the portals of the psyche, and bought to the surface of the consciousness its existential basis, which is spirituality and not scientific materialism.

Metal and Mineral Transmutation 12.2
All is flux, all is in motion, all is transformation. The ‘raison d’etre’ of Alchemy is transformation or transmutation, whether it be spirit or gross matter. By direct intervention, the object, or subject is raised to that which it is destined to be. The term ‘Transmutation’, is no longer a bone of contention.

In the realm of minerals or metals, gold and diamonds have been manufactured. What is in contention, is the level of energy required to bring about the transmutation. According to Science, high levels of energy are required, hence, the antagonistic furore over the matter of ‘Cold Fusion’ . Which ignores the fact that all around us at bio-temperatures (37°C and under), Nature performs transmutations.

The science of chemistry is concerned with electron transfer. Nature deals with proton and electron transfer. Chemistry considers that elementary particles are made of the same stuff, e.g., protons are made of proton stuff, and Electrons are made of electron stuff. Therefore, the difference in the physical properties of the elements, are accounted for by the elements atomic weight, i.e., the number of protons and neutrons in the nucleus of the atom. Consider that the Gold makers traditionally used Mercury or Lead as the starting material for the production of gold. The following table shows the close relationship between Gold, Mercury and Lead.

Table 12.1A

Common Name Atomic Number Chemical Symbol Atomic Mass
Gold 79 Au 196 . 97
Mercury 80 Hg 200 . 59
Lead 82 Pb 207 . 19

Biological Transmutation 12.2a
Each one of us, every single manifestation of life, from the tiniest microbe, to the staggering complexity of the animal frame, is a miracle of transmutation. Who … when holding, and gazing into the knowing eyes, of a new born child who is a miracle of transmutation, can deny the undeniable ?

The following is an extract from a book by a distinguished French Scientist;


“Classical agriculture ( by this I mean the science that is taught in schools), is a huge imposture, which is frightening in its cynicism. It recommends the use of complete fertilizers, the word “complete” being identified with ‘N’ ‘P’ and ‘K’, as if these three elements were the only ones to be found in plants. Its basic postulate is to restore in quality and quantity, the soil’s elements taken from it by the yearly harvest. One may say that this agriculture has enclosed itself in a dilemma:

A. If the law of restitution is to be satisfied (whereby one implicitly recognizes that elements other than N, P, and K are taken away at harvest) , the plant would have to find these other elements in the soil in limitless amounts.

B. Or, plants themselves must make these elements found at harvest and not provided for by the soil. Implicit in this alternative, is a transmutation of elements through a biological channel.”

Professor C. Louis Kervran
1901-1983

Nominated for the 1975 Nobel Prize in Physiology.

The quotation was taken from the English translation of his book.

Biological Transmutations by Professor C. Louis Kervran,
translation and adaptation by Michel Abehsera,
Happiness Press, ISBN 0-916508-47-1


Dr. Kervran was not the first to conduct experiments relating to biological transmutation. Some of the recorded historical experiments were carried out in the 19th century, some of which are listed below:

In 1822 an Englishman named William Prout, conducted an experiment whilst studying the incubation of chicken eggs. His findings demonstrated that the bodies of chicks, hatched in an incubator, contained more calcium than was originally found in the egg.

The founders of the Agricultural Research Station at Rothamstead, Lawes and Gilbert, in a series of classic experiments, found that plants appeared to extract more elements from the soil, than the soil actually contained.

In 1873, the analytic chemist, Albrecht von Herzeele, published a book entitled ‘The Origin of Inorganic Substances., which offered proof that plants transmute the elements, for example, Phosphorous into Sulphur – Calcium into Phosphorous – Magnesium into Calcium – Carbonic acid into Magnesium, and Nitrogen.

The publication of Professor Kervran’s work caused considerable controversy. Nonetheless, many scientists corroborated his experimental findings. For example ;

Professor Hisatoki Komaki, an agronomist at the Institute for Biological Agriculture (Otsu, Japan), presented a paper entitled: ‘Observations on Non-Radioactive Biological Cold Fusion, Using Saccharomyces Cerevisiae’, at the seventh International Conference on Cold Fusion in 1998. (Yeast of the sugar fungi tribe)

The paper describes how Komaki and his team performed a number of carefully controlled experiments, and were able to successfully verify that certain types of fungus can create iron and magnesium, by transmuting other elements.

Many other scientists have produced similar results from numerous experiments. The only workable hypothesis that can be derived from the combined results, would suggest that Enzymes, using some elements as the catalyst, have been performing proton chemistry, or transmutation on numerous elements of the Periodic Table. Quite obviously, these results present a problem for the keepers of the scientific sacred cows. They cannot do that, and neither do they know how it is done

Circadian Rhythms 12.3
The word ‘Circadian’, is from the Latin meaning ‘round about’, and it refers to those physiological rhythms that occur at least once every 24 hours, in the whole of nature. The knowledge of such rhythms is very ancient, and has been the subject of much study down the ages.

The Science of Biochronometry, or the measurements of life rhythms, is relatively new, and has developed its own language to hide the embarrassment caused by its root. For example, ‘ Zeitgeber ‘, which is German for ‘ Time giver ‘. The time giver is a so called biological clock. Science postulates that this clock resides somewhere within a living organism. However, so far science has not been able to identify or locate such a clock within any organism. The parent of Biochronometry, is Astrology.

Astrology and Circadian Rhythms 12.4
Astrology in its purest form is the study of rhythms, terrestrial and cosmic. Those rhythms are fundamental to our existence, irrespective of our sphere of activity.

By studying the organic patterns of heaven and earth
a fool can become a sage. So by watching the times
and seasons of natural phenomena we can become
true philosophers.

Li Chuan 735 AD.

A prerequisite for the establishment of a settled agricultural society, would be a knowledge of those organic patterns. A perusal of early writings on the subject will be sufficient to understand, that, irrespective of lack of instrumentation, that the knowledge was of high order, and applied as a matter of course to the affairs of our kind, and in particular to medicine. The following quotation is abstracted from; 

 ‘On Airs, Waters, and Places ‘. Attributed to Hippocrates, and Translated by Frances Adams.

Whoever wishes to investigate medicine properly, should proceed thus: in the first place, to consider the seasons of the year, and what effects each of them produces, for they are not at all alike, but differ much from themselves in regard to their changes.

Then the winds, the hot and the cold, especially such as are common to all countries, and then, such as are peculiar to each locality. We must also consider the qualities of the waters, for as they differ from one another in taste and weight, so also do they differ much in their qualities.

From these things he must proceed to investigate everything else. For if one knows all these things well, or at least the greater part of them, he cannot miss knowing, when he comes into a strange city, either the diseases peculiar to the place, or the particular nature of common diseases, so that he will not be in doubt as to the treatment of the diseases, or commit mistakes, as is likely to be the case provided one had not previously considered these matters.

And in particular, as the season and the year advances, he can tell what epidemic diseases will attack the city, either in summer or in winter, and what each individual will be in danger of experiencing from the change of regimen. For knowing the changes of the seasons, the risings and settings of the stars, how each of them takes place, he will be able to know beforehand what sort of a year is going to ensue.

Having made these investigations, and knowing beforehand the seasons, such a one must be acquainted with each particular, and must succeed in the preservation of health, and be by no means unsuccessful in the practice of his art. And if it shall be thought that these things belong rather to meteorology, it will be admitted, on second thoughts, that astronomy contributes not a little, but a very great deal, indeed, to medicine. For with the seasons the digestive organs of men undergo a change.
Hippocrates 400 BC.

 

 

Hermetic Philosophy and Astrology. 12.5
Biochronometry grapples with its subject matter on the basis of an internal zeitgeber, or biological clock, that controls the rhythms of an organism. This supposition has produced more questions than answers. The Hermetic hypothesis postulates that the zeitgeber is a Cosmic Clock. It further considers that man is a microcosm of the macrocosm. Each organ system, and its corresponding controlling endocrine gland, is triggered by a planet. The following diagram will illustrate the hypothesis.

             Man as Microcosm. Figure 12.5A

The rising and falling hormonal tides are orchestrated by the pineal gland. By the same analogy the Sun is also considered a microcosm of a macrocosm, and that our sun revolves around its own sun. 

By what force are our hormonal buttons triggered? The short and simple answer is, ‘By Magnetism’. Each celestial body and each biological entity has its own magnetic field.

Voltage and Amperage, when introduced to a conducting wire, creates an electro magnetic field around the wire. This phenomenon is utilised by step up and step down electrical transformers.

If this magnetic field cuts across a conducting medium, it will cause a measurable current to flow in the conducting medium.

Thus, as the magnetic sheathing of our planet cuts across that of the other solar bodies, magnetic currents and their harmonics are induced and registered by our glands. The Chakras are the glands on the etheric level.

The diagram is from, ‘The Theory of Celestial Influence by Rodney Collin’

‘Each Endocrine Gland or its associated Nerve Plexus is sensitive to the magnetism of a particular Planet’
Rodney Collin 

The Hermetic Hypothesis and Scientific Corroboration. 12.6a


 ‘The Scientific Basis of Astrology‘ by Dr  Percy Seymour. 
Published by W. Foulsham. Slough, U.K.

When this book was published, Dr. Seymour was the Principal Lecturer in Astronomy at the University of Plymouth, UK. In an interview, Dr. Seymour made the following statement;

“I am a scientist. As such I cannot propose or understand a model of reality which does not take account of scientific data. I am not an astrologer, in fact this theory developed out of an examination of the arguments that astrology cannot work!

As a theoretical astrophysicist, with an interest in the relationship between fundamental physics and the large-scale structure of the universe, I am searching, as are many others, for a model to explain the current anomalies and paradoxes in these areas that are beyond the domain of astrophysics i.e. biology, chemistry, and to my amazement, astrology.”

The following are selected quotes from the book;

“It is now accepted by almost all scientists that the sunspot cycle effects the magnetic field of Earth, and the agency responsible for this effect, the solar wind, has been detected”.

It is also beyond doubt that the moon causes tides in the upper atmosphere which give rise to electric currents, and these generate the lunar daily magnetic variation.

There is also plenty of evidence that both the steady state as well as the fluctuating behaviour of the geomagnetic field can be used by organisms, including man, for purposes of finding direction and keeping internal body time. This much is all well documented, and widely accepted.

There is evidence, largely ignored, that positions and movements of planets as seen from the sun, play a major role in the solar cycle. Furthermore, there is some evidence, highly controversial but difficult to dismiss, that some positions of the planets, as seen from Earth at time of birth and are linked to personality characteristics of individuals.

“This evidence exists. What my theory does, is to prepare an interpretation, based on this evidence, which can be scientifically tested. Very briefly the steps are:”

1. Planets effect the solar cycle in specific ways.
2. The solar cycle effects the geomagnetic field.
3. The geomagnetic field affects life on Earth in certain observed ways.
4. Specifically, many species, including man, can be influenced by particular states of the geomagnetic field.
5. The particular influences appear to correlate with the planetary positions.
6. I propose that the behaviour of the foetus, at the time of birth, is linked to the cycles within the geomagnetic field, which in turn are influenced by the solar cycle and positions of the planets. Resonance is the phenomenon by which the foetus is phase locked to specific cycles.

To put this in more specific terms, my theory proposes that the planets Jupiter, Saturn, Uranus and Neptune, control the direction of the convective motions within the Sun, which generate the solar magnetic field.

They do so because they play the major role in moving the sun about the common centre of mass of the solar system. As the solar cycle builds up to a maximum, so certain configurations of all the planets, at different stages, play a part in the disrupting the magnetic field of the sun, by means of the tidal tug (due to gravitation), of the planets on the hot gases in the Sun.

Thus, the planets play a role in the modulation of Earth’s magnetic field by the solar wind. I am also proposing that the tidal tug of the planets on the hot gases trapped within our magnetosphere will, because of resonance, lock some of the vibrations of the Earth’s field in step with the planetary movements.

The resulting fluctuations of Earth’s field, are picked up by the nervous system of the foetus, which acts like an antenna, and these synchronise the internal biological clocks of the foetus, which control the moment of birth.

The tuning of the foetal magnetic antenna is carried on by the genes which it inherits, and these, to some extent will determine its basic genetically inherited personality characteristics.

Thus, the positions of the planets at birth are not altering what we have inherited genetically, but are labelling our basic inherited personality characteristics.


Dr Seymour has not said anything, that science does not already know. What his words do is to underline the intellectual dishonesty which is so much in evidence in all of the present day scientific disciplines. He is a courageous and intellectually honest man who has challenged a shibboleth of science. A major problem for most of those disciplines is the rigid hierarchical structure that will bully or ruin those that would dare to step outside of its tightly controlled fiefdom. Any whiff of Vitalism is suppressed in case Academia has to rewrite its carefully structured mythology.

‘All professions are a conspiracy against the laity’
George Bernard Shaw
1856 – 1950


The Solar Heartbeat. 12.6

To everything there is a season, and a time to every purpose under heaven;
A time to be born and a time to die, a time to plant, and a time to pluck up
that which is planted; A time to kill and a time to heal; a time to break down
and a time to build up.
Ecclesiastes 3 : 1-3.

From the most ancient of times, the rising of a certain star or constellation would herald the time to plant. Whilst the progression across the night sky would measure out the seasons until it was time to pluck up that which had been planted. The ancients knew when the natural sown healing plants were at their maximum potency, and gathered them thus. The later Masters knew that there was a time to break the plant down and a time to build it up. A specific time for each and every chemical step.

Consider the modern day ‘Sorcerer Apprentice’, in their clean white coveralls, hovering round their stainless steel fermenting vats. Microbes for nutrition and production; antibiotics and vitamins. Microbes in the service of man. Life in the service of life. They know how the carefully controlled, bubbling ferments may inexplicably slow or stop, and then for no apparent reason, recommence. Dr. Seymour has pointed, in the language of science, to the mechanism, whereby these common phenomena occur in living organisms.

But what of the countless laboratory technicians who have suppressed annoyance when a routine non organic chemical reaction fails to react. Then mysteriously, the reaction occurred later, with no intervention on their part. Eastern philosophy makes no distinction between animate or inanimate, between life and non life. It is considered that all is imbued with consciousness. Orthodoxy has drawn lines where no lines exist. The line that was drawn between life and non life, has become blurred.

All substances are magnetic. The science of physics has divided substances into 3 magnetic categories, they are;

1. Diamagnetic, e.g., Copper, Silver, Water
2. Paramagnetic, e.g., Air, Liquid Oxygen, Platinum.
3. Ferromagnetic, e.g., Magnetic Iron, Nickel, Permalloy.

Ferromagnetic substances exert strong lines of force when exposed to a magnetic field, for example, the familiar magnetic compass. Whereas the effect of Diamagnetic and Paramagnetic substances are so minute, that they need instrumentation for detection.

             The Magnetosphere of Earth. Figure 12.6A

The point to be made here, is that all matter, irrespective of its atomic composition, is affected by magnetic fields. Everything in our known universe is constantly bathed in fluctuating magnetic fields.

The transmission and reception of that electronic matter here on earth, has far reaching effects upon the whole realm of nature. Some of these effects are immediately obvious, such as light and heat. But what of those cycles which are linked to the 11 year Sun Spot cycle. Those great magnetic storms which buffet the magnetosphere of our own planet?

Moon as Magnetic Modulator 12.7
In Paragraph 12.6 the principle of electromagnetic induction was touched upon. A brief explanation of that principle is in order.

 

In 1820, a Danish physicist, Hans Christian Oersted, discovered that a magnetised needle is deflected, when placed next to a wire through which current is passing. This simple observation, led to speculation that a reverse effect also existed, i.e. that a current can be caused to flow in a conductor exposed to a magnetic field.

Eleven years later, in 1831, the English chemist and physicist, Michael Faraday, demonstrated that this was indeed true. Faraday also demonstrated that plane polarised light was rotated in a strong magnetic field, the significance of this is that it demonstrated the connection between light and magnetism. The following diagram illustrates the principle of electromagnetic induction.

           Electromagnetic Induction Figure 12.7A
The letter ‘A’, represents a coil connected to a sensitive galvanometer at ‘B’, which registers the strength and direction of a current. The letter ‘C’, represents the North pole of a bar magnet.

When the bar magnet is introduced into the coil, and whilst in motion, a current is induced in the coil, which registers on the galvanometer.

When the bar magnet is at rest, the current ceases to flow. If the bar magnet is then removed, the current will again flow, but in the reverse direction, as shown on the galvanometer.

The significance of this is, that an Electro Motive Force (EMF) is induced in a conductor whenever the magnetic flux is changed.

Thus we have an image of our star, the Sun pouring out electronic matter, whilst the moon passing across the face of the earth, interrupts or modulates the Solar Flux. The moon also performs the same function when it interrupts the flux of those stars that form our Zodiac.

Solar Eclipse and the Saros Cycle. 12.8
The moon produces the phenomenon that we call a solar eclipse. At such times, the solar outpouring of electronic matter is, to all intents and purposes, halted or deflected. As an analogy, we may think of an electric bulb and a switch. The moon performing the function of the solar switch.

The interruptions of the solar flux occur on a cyclic basis and are, therefore, predictable. The discovery of this cycle has been attributed to the Chaldean civilisation, and named by them, ‘Saros’ . The cycle of Saros lasts for 18 years and 11 days, after which, it repeats itself. During that cycle, 28 total eclipses are observed in different parts of the world. In addition to that figure, we must also take into account the partial eclipses.

Chapter 12 of the Pharmageddon Herbal consists of two modules. This first module has been concerned with giving an outline of the body of ideas within which the Pharmacy of Spagyria is performed, and why timing of the various operations are set by the Cosmic Biological Clock. As the Hermetic Dictum states .. ‘Ever follow the footsteps of Nature and let her be your guide’. The Pharmaceutical operations follow.

Spagyric Part 2.
Spagyric Part 3.

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Chapter 11 part 02

Earth Air Fire and Water
The Pharmageddon Herbal

Compounding
Ivor Hughes

Chapter 11B Continues.

Methodology for Lotions and Creams 11.21
By definition, lotions and creams are emulsions. Lotions are oil in water (O/W) The Creams are water in oil (W/O). It is necessary to study the formula to decide which type of emulsion it is. Because each type needs to be mixed (homogenised) by a different methods to prevent cracking or creaming.

Calculate the oils, fats and waxes as a percentage of the total formula. Then calculate as a percentage, the total of the water, and water soluble constituents. If the oil phase is the greater, then the more viscous the product, and will tend to be a cream. If the water phase is the greater, then the product will tend to be a lotion.

O/W preparations may be homogenised by an egg whisk or an electric mixer. W/O preparations will need to be slowly stirred, either by hand or by a paddle mixer set a slow speed. The reason is that, if air bubbles are introduced during the mixing process, then the preparation may crack or cream.

The following formula is an O/W moisturising cream. It is a variation on an ancient formula, originally attributed to Galen. It is found in many of the older pharmacopoeias under the name of Galens Cerate. Borax was the usual emulsifying agent specified. Borax is toxic and damaging to the skin. In the formula below, mucilage of Quince seed is the emulsifying agent

Bees Wax 115g
Palm Kernel Oil 110g
Oil of Almond 550g
Mucilage of Quince 20g
Distilled Water 195g
Gum Benzoin Extract 10ml
Essential oil of Rose 1.0ml

Understand that the above formula will needto be adjusted because of the provenance of your materials. Prepare a water bath and add the first three ingredients. Grate the bees wax into small pieces and add them to the oil phase. Stir until all of the oil phase is in a homogenised state.

Add the mucilage to the distilled water and mix. Take the temperature of the oil and heat the distilled water to the same temperature. Then stirring steadily, slowly add the water phase to the oil phase.

Remove from the heat, and add the Benzoin extract and oil of rose. Then beat or mix vigorously until cool.

The above formula is an Emollient, and may be suitably medicated or lightly perfumed, according to its end use. As a general rule of thumb, add the waxes to the oil. A word of warning, never heat the oil phase over direct heat and then add water. This will cause the hot oil to erupt with possible dire consequences.Always use a water bath or double boiler.

The methodology described may be considered as standard. . If compounding from a Pharmacopeia or Dispensatory, any deviations or special requirements will be clearly stated.

The Ointments (Unguentum) 11.22
The ointments, as a class of medicament, have a long and venerable history. As a compound, the ointment is ingenious, and may be made to serve many different purposes.

1. As an emollient to soften or soothe the skin.

2. As a protective barrier for the skin against noxious substances, insects or ultra violet rays.

3. As a vehicle for medicinal substances which are to be;

A. An application to the skin for antiseptic or anaesthetic purposes.

B. Absorbed through the skin for introduction of the medicament to the circulation.


Ointment bases are also used for suppositories and pessaries, for rectal or vaginal administration of a medicament. When beeswax is specified in a formula for medicinal purposes, it should be taken to mean yellow unbleached wax. (Cera Flava), and not the bleached wax (Cera Alba) .White wax finds use in cosmetics purely because it presents a better appearance.

Experience has demonstrated that preparations made with yellow, unbleached wax has better keeping qualities. No doubt because it has not been chemically altered.

The ointments are of great variety and serve as a vehicle for hundreds of different substances. The ointments in turn, are made from a wide variety of base materials which may be ;

(A) Animal fats. (B) Insect exudations. (C) Vegetable exudations. (D) Mineral oils and wax. (E) Synthetics.

Substances which fall under the head of A, D and E, should as a general rule, be avoided, because there is the possibility of the uptake of undesirable substances, and in the case of the Animal fats, there are also some unresolved questions relating to hormones and the allopathic antibiotics.

When compounding an ointment from published formulae, then substitutions for undesirable substances may need to be made. Accordingly, the purpose of the ointment must be considered, i.e., is the ointment, abarrier, an emollient, or is it to introduce medicaments to the circulation?. In addition, consideration must be given to climatic temperatures, Tropical, Temperate or Cold. Therefore, the two factors are Absorbency and Melting Point, of the selected substance.

Table 11.22A

Vehicle Melting Point Absorbency
Beeswax (Cera flava) 57 to 64C Minimal
Coconut or Palm oil 25 to 29C Readily
Vegetable Oils ……………. Readily
Paraffin Wax 50 to 60C Minimal
Lanolin (Wool fat) 40 to 41C Readily with oil
Petrolatum 40 to 46C Minimal
Purified Lard 36 to 40C Readily
Purified Suet 44 to 45C Readily
Theobroma (Coco butter) 30 to 35C Readily

Methodology of Preparation 11.23
Prepare a water bath.
If the compound calls for a fixed oil, then add the oil first and melt the other ingredients in it. If the formula is comprised of waxes and fats, then add the substance with the highest melting point first, and then melt the other substances in it. Remove from the heat, then stir or use an electric mixer until the ointment has cooled.

Adding the Medicament 11.24
The incorporation of ground plant material to an ointment base, is sloppy practice and leads to many uncertainties, e.g. the degree of extraction obtained by the ointment base materials is an unknown, therefore, it presents a problem of posology. Secondly, unless a paint or shear mill is used in the incorporation process, then a grittiness is bound to occur.

The medicament is most easily prepared from a 1 : 1 Extract, by evaporation over a water bath, or by distillation under reduced pressure. It should be reduced to a soft or pasty extract for incorporation into the ointment base. Gently heat the base until it is easily worked, but not in a molten state. The temperature should not exceed 30C. The medicament may then be incorporated into the ointment. At this stage, unless there is a problem of compatibility, a suitable inhibitor should also be added. It must be thoroughly mixed until an even dispersion has been achieved. Allow the finished ointment to congeal. It is then ready for use. To pour it into jarsto set warm the ointment until it is pourable. Seal the jar with an airtight lidand allow to solidify.

Ointment Posology 11.25
The degree of absorption of a medicament from an ointment base, cannot be known with any certainty, because of the variables involved, e.g. the strength of the extract, the skin type involved, individual idiosyncrasy and the absorbency of the base. Therefore, the medicament must not exceed 10% of the total product, i.e., 1 :10.We arrive at the correct amount of soft extract to use by the following method;

Firstly, calculate the mass of the total finished ointment, then convert the mass to volume. Then calculate10% of that figure, which is the amount in millilitres of a 1 : 1 extract, that must be added to the ointment base.

Reduce the liquid to a soft extract, and then incorporate it into the ointment. There will be exceptions, for example, strongly irritant substances such as extract of Capsicum, in which case the soft extract must be prepared in the same manner as a homoeopathic ointment, i.e., from a Mother Tincture of 1 :10. If following the instructions from a Pharmacopeia or Dispensatory, the quantities will be stated.

Useful Formulae 11.26
The following formulae will be found useful for a variety of purposes. If a preparation is to contain large amounts of liquid or water, then those formulae that contain Lanolin will absorb the liquid in a satisfactory manner. When preparing an ointment, the compounder is urged to ensure that the base will meet the criteria required. This is simply achieved by testing the ointment on themselves. If the ointment is too stiff, then it may be rectified by the addition of more oil, or a substance which is of a lower melting point than that of the beeswax. If it is too soft, then the addition of a substance of higher melting point will stiffen the product.

Simplex Basic Barrier  Soft
Beeswax……1 Beeswax……1 Theobroma..1 Beeswax……1
Oil…………….1 Lanolin……..1 Beeswax…….1 Lanolin……..1
…………………. Oil…………….1 Oil……………..2.5 Palm Oil……6

Pessaries, Suppositories and Bougies. 11.27
Pessaries and Suppositories are designed for insertion into the rectal and vaginal orifices of the human body. For practical purposes,there is no difference between the two. However, by convention,Pessaries are for vaginal insertion and the Suppositories are for rectal insertion. The purpose is to introduce medicaments to the mucous membrane of the orifice.

As a vehicle for the medicament, it is essential that the melting pointshould not exceed 37 Centigrade. Nor yet so low that it would melt at lower temperatures. Theobroma is the substance that meets the criteria. For children, the weight of the vehicle should not exceed 1g and for adults, 4g.

The bougie is designed for nasal insertion. There is no reason why such products may not be suitably medicated for insertion in a cleaned ear. 

The pessaries, suppositories and bougies are formed in moulds. These may be conveniently made from tin foil or alternatively, from polythene syringes from which the nozzle has been cut. The method of preparation is the same as that of the ointments.

The product may be poured into the moulds in a molten state, or they may be formed by hand when the substance is in a suitably plastic state.

Salve Sticks 11.28
Salve sticks are almost identical to the suppositories in shape and base composition. They are designed for the topical placements of medication to a specific area of the skin. In the same way that lipstick is applied. The following formulae for a cold sore salve will outline the principle.

Propolis Salve Melissa Salve
Almond Oil …………………… 30ml Almond Oil …………………… 30ml
Beeswax………………………….30gm Beeswax………………………….30gm
Theobroma………………………30gm Theobroma………………………30gm
Propolis Tincture (1.4) …….10ml Oil of Melissa ……………………1ml

Capsules, Pills and Tablets. 11.29
A most convenient form of oral administration of a medicament, is by the use of tinctures or liquid extracts. However, there are occasions when that form is contra-indicated. In which case, a capsule, pill or tablet would be the choice of vehicle.. The incorporation of a powdered crude drug into a carrier substance, is bad practice and should be avoided.

Capsules may also be used as suppositories or pessaries. The end of the capsule may be removed with a sharp blade or alternatively pierced with a needle to facilitate the release of the medicament. The excipients and mass used must be hydrophilic (water loving), in order to enhance the bio availability of the medicament.

Capsules; The medicament may be in granular or soft extract form, which is enclosed in a 2 part capsule, made either from vegetable gel or keratin (gelatine). Given the current problems that are surfacing over the use of cattle by products.. It must be remembered that, there are no specific tests for BSE whilst it is in the incubation period, therefore, it would be wise and ethical to avoid the use of gelatine capsules.

The specifications for some common capsules are as follows;
Table 11.29A

Specification

Size 0l

Size 0

Size 1

Size 2

Size 3

Size 4

Joined length in mm

24.44

21.93

19.61

18.03

15.95

14.56

Empty weight mg

112

100

78

62

51

41

Capsule capacity cc

0.835

0.750

0.540

0.420

0.310

0.250

N.B. Tolerance limit for weight is ± 10 %. Tolerance limit for length is ± 03 mm.
Capsules should disintegrate in not more than 8 minutes in a solution of 0.5% w/w HCI, at 36° to 38° C.
The pH should be between 5 and 7.

Enteric Coated Capsules 11.30
Enteric coatings are used to delay or prevent the release of a medicament until it reaches the duodenum. The stomach environment is acid and the duodenum alkaline. Suitable materials that will dissolve over an alkaline gradient are the natural waxes, either vegetable or insect, e.g. beeswax. Shellac is also widely used. Shellac (lac) is a resinous substance produced by a scale insect, which encrusts the twigs of trees, upon whose sap it feeds. The coating may be prepared from 2 partsof the resin and one part of warmed alcohol 90%.

Coating the Capsules 11.31
When coating capsules by hand there are 2 methods in general use:

1. By Rotation This method is most suitable for wax coatings. Warm a glass flask or beaker in a water bath and add a small quantity of wax. When it has melted remove the flask or beaker from the water bath, add some capsules and gently rotate the flask by hand until an even coating has been applied. The rotation of the flask or beaker will prevent the capsules from sticking or clumping. Continue to rotate the flask until the wax has all solidified. Be sure to checkfor compatibilities when choosing a wax..

2. By Spraying This is the preferred method for shellac coatings. A suitable sprayer may be purchased from a hobbyists model shop. Drying of the coating may be achieved by the judicious use of a hair dryer applied at a distance. Warm the shellac over a water bath. Introduce it to the sprayer. Place the capsules on a stainless steel mesh in a well ventilated place. Spray and dry. Extra coatings may be employed if required.

Pills and Pill Mass 11.32
The use of pills in conventional pharmacy practice has been replaced by the capsule or tablet. Nonetheless, they lend themselves to herbal compounding and are most conveniently made.

The pill is in 3 parts.

1. The medicament which may be either liquid, soft or dry.

2. The mass or bulking agent. This should be an emollient substance which will not interact with the medicament. For example: powdered Marshmallow Root, Liquorice Root or a starch such as Arrowroot or rice flour. Wheat or Cornflour should be avoided, in case of gluten allergies.

3. The excipient or binding agent. If the medicament is in the form of a liquid or soft extract, then that in itself will be sufficient to form the pill mass. Suitable excipients are, distilled water, ethanol, syrups, honey, or mucilage of acacia.

A lubricant will be needed, which is usually the powdered Talc specified by a pharmacopeia. This is natural magnesium silicate which has been suitably purified and is neutral to litmus. The lubricant prevents the mass from sticking to the die. The talc is used to dust the die and punch.

The whole must be thoroughly mixed and sheared in a suitable mortar (levigated) to ensure an even dispersion of the medicament throughout the mass. When the mass is in a suitable state it may be pressed into moulds. The mass is pushed into the mould by use of a spatula.

A suitable mould may be made from a stainless steel bar (The die), in which appropriate size holes are drilled. The pills may then be ejected by a rod (The punch) that matches the die. The pills may then be lightly dusted and either left as they are, or formed into a sphere by lightly rolling it in a circular motion, either between the gloved hands or between a concave and convex surface.

Tablets ( Tabellae )11.33
Tablets are of two types.

1. A dry compressed substance.
2. A dry moulded substance.

Both of which serve the same function as a Pill.

Moulded Tablets 11.34
Moulded tablets are prepared from a medicament and an extender, such as lactose or dextrose powder. If the medicament is a liquid or a soft extract, then the ingredients should be placed in a mortar and thoroughly triturated with sufficient extender to render the whole into a stiff paste.

If the medicament is in dried form, it must be powdered and thoroughly triturated with the chosen extender. Then sufficient Alcohol (60%) is added to produce a stiff pliable mass. The mass is pushed into the holes of a die of suitable size with a spatula. They are then removed with the punch and allowed to dry at room temperature.

Ideally, a non coated tablet should be thoroughly dissolved within 15 minutes of ingestion. If the tablets are coated with a substance to hide the taste, then they should dissolve within a maximum of 1 hour. If the tablet is enteric coated, that does not apply.

Moulded tablets are less time consuming to prepare. However, there are problems with disintegration times. As a general rule, the method should be reserved for pastilles or troches, which will be covered later in the text.

Compressed Tablets 11.35
There are two methods of preparation which are suitable for the manufacture of compressed tablets; they are;

1. Dry Granulation.
2. Moist Granulation.

If using the dry method, the medicinal extract must be in granulated form. Lightly dust the granules with purified talc for lubricant purposes, and pass the granules through a number 16 mesh sieve.

If there is an insufficiency of granules to form a tablet, then an extender or mass may be used. The mass should not exceed 10% of the total weight. Load the die with the ingredients. Place the punch in each hole in turn and give a smart tap with a mallet. The tablet is then formed. The compressed tablets are then ejected with the punch.

The moist method may employ either granules or a soft extract. If granules are to be used, then add to them the mass and the excipient. The whole is then thoroughly levigated to produce a barely cohesive mass.

The excipient should be 60% alcohol, which will evaporate readily. Care must be taken to ensure that the mass is barely moistened, and that it will pass through a 16 mesh sieve without sticking. The resulting granules may then be dried at a temperature not exceeding 60 centigrade. Lightly dust the granules with talc by rotating them in a flask or a beaker. The excess talc is removed by sieving. The granules are then ready for compression If a soft extract is used instead of scales or granules, then the excipient should be omitted.

Tablet Disintegration Test 11.36
Extemporaneous preparations,
that is, those for which no formula is used, will of necessity, undergo a disintegration test to ensure that the tablets dissolve in the correct portion of the digestive tract. The following simple test is extracted from the British Pharmacopoeia 1958.

Figure 11.36A

Lozenges or Troches 11.37
As a preparation, lozenges and troches are of great antiquity and thus of great service. Culpeper’s Complete Herbal, contains numerous formulae.

The purpose is to deliver analgesic, anti-bacterial, astringent or demulcent substances, to the mucous membrane of the mouth or throat. They are formulated to slowly dissolve in the mouth by salivary action.

A sustained release of the medicament is assured. Essentially, the method of preparation is the same as that for the moulded tablets. However, to make the lozenge more acceptable, it is usual to add flavourings or even colourings to the base.


There are numerous published formulas which use a boiled sugar base, which are then poured into moulds to cool and harden. Many of these types of lozenges contain synthetic food colouring and flavourings. Such preparations need to be avoided for ethical reasons. For example, the heat involved with the boiling syrup is likely to destroy the integrity of the medicament. There are some very large question marks against the synthetic colourings and flavourings


A Simple Moulded Lozenge Base 11.38
The following Rx is from the British Pharmaceutical Codex 1963.

For 100 lozenges take :
Sucrose in fine powder …… 100g
Acacia in fine powder …….. 7g
Distilled Water ………………. A sufficient quantity.

Mix the medicaments intimately with the sucrose and acacia. Make the mixture into a paste with the water. Divide into 100 equal lozenges and dry.

It will be apparent that if the medicament is in liquid or soft extract form, then a minimum of water will be required to form the cohesive mixture. The ideal consistency is that of bread dough, which may be rolled flat and the lozenges cut with a device similar to a pastry cutter, but of a smaller size. Such a device may be simply made with tin snips and pliers. Alternatively, the mass may be rolled into a pipe and suitably subdivided.

Lozenges with a Flavoured Base. 11.39
Suitable flavouring bases which will also lend colour, may be prepared from fruit juices free from preservatives by reducing them to a soft extract. Alternatively, use may be made of essential oils or oleo resins. Remember that pharmacy is as much art as it is science. Lozenges which are pleasant to the palate may be made from essences or extracts of rose, violet, aniseed, liquorice or peppermint. These are just a few of the possibilities open to a herbal pharmacist.

Simple Flavouring Syrup. 11.40
Heat 450ml of distilled water to boiling. Add gradually, by stirring, 675g of pure cane sugar. Continue stirring over a low heat until all the sugar has dissolved. Filter, and then adjust the syrup with distilled water to measure 1000 ml. The simple syrup may be flavoured with essential oils or extracts. Ensure that such substances arenot antagonistic to any medicament which the syrup contains.

Elixirs (Elixeria) 11.41
The elixirs,
as a Galenic preparation, are aromatic, sweetened, spiritous liquids, which contain a medicinal substance. As a pharmacy item, they are rarely encountered nowadays.

The popular recreational beverages known as Liqueurs, are in point of fact, the only commercial survivors of this true class of preparation, e.g., Chartreuse and Benedictine. These medieval Elixirs are usually of blunderbuss proportions. Due to the commercial value of such preparations, the recipes are closely guarded secrets. When a recipe contains a large number of medicinal plants, then it is inevitable that the question of incompatibilities and antagonists will arise.

The modern elixirs, as employed in pharmaceutical practice, are used purely as a flavoured vehicle to disguise the nauseous taste of a medicament. The following recipe is extracted from the United States Dispensatory, 21st Edition 1926. It will illustrate the principle.

Figure 11.41A
The Insufflation ( Snuff )11.42
The origin of insufflation is to be found in Shamanic practice. The present day South American shamanic cultures have an unusual delivery system which consists of a long hollow tube. One end of which is a mouth piece and the other in the shape of a small spoon in which a powdered plant drug is placed.

The crude drug is usually a mind altering substance. The shaman lies flat and the spoon end of the insufflator is introduced to his nostril. The acolyte then delivers the drug by blowing hard down the tube.

Tobacco snuff was fashionable until the late 1950,s. Snuff takers will attest to the speed and efficacy of this method of drug administration. Pharmaceutical practice makes use of a powder blower or insufflator to administer the powdered drug to the nasal passages. For best results, the drug must be reduced by trituration, so that it will pass a 60 or 80 mesh sieve.

The Inhalants 11.43
The use of steam, to introduce volatile medicinal substances to the human system, is an ancient practice. We normally associate that practice with the introduction of vapours to the nasal or bronchial passages.

In some cultures the vapour is introduced to the mucous membrane by squatting over steam. Another method is by the use of sauna or sweat lodges. The medicament may be most conveniently used either as a solution such as a volatile oil introduced to hot water in a basin. The head and basin are covered by a towel and the rising vapours inhaled., alternatively, a 1:1 extract may be used at a ratio of 1ml to 100ml of hot water.

It is common to use a nebuliser that will reduce a solution to fine droplets for inhalation, either from a face mask or a tent. For self administration, a few drops of the medicament in a volatile form may be sprinkled onto a clean gauze pad. A more sophisticated commercial offering is the Nasal Inhaler, which is simply a wadded pad impregnated with a volatile medicament, which is contained in a tube for insertion into the nostril.

Homeopathic Preparations 11.44
There are 3 classes of preparations for the administration of Homoeopathic drugs :

1. As the Mother Tincture and its attenuations.

2. Preparations of ointments and creams.

3. As the Triturations. This class may be administered either as a solution of the medicinal substance, or in tablets and pilules of various types, i.e., globules or granules.

Triturations 11.45
Triturations were once official in the US Pharmacopeia. The following figure is extracted from the
U.S. Dispensatory 21st Edition 1926.

Figure 11.45A
The Hahnemann Method. Organon 6th Edition
One-third of one hundred grains sugar of milk is put in a glazed porcelain mortar, the bottom dulled previously by rubbing it with fine, moist sand.

Upon this powder is put one grain of the powdered drug to be triturated. The sugar of milk used for dynamization must be of that special pure quality that is crystallized on strings and comes to us in the shape of long bars.

For a moment the medicines and powder are mixed with a porcelain spatula and triturated rather strongly, six to seven minutes, with the pestle rubbed dull, then the mass is scraped from the bottom of the mortar and from the pestle for three to four minutes, in order to make it homogeneous.

This is followed by triturating it in the same way 6 or 7 minutes without adding anything more and again scraping 3 or 4 minutes from what adhered to the mortar and pestle.

The second third of the sugar of milk is now added, mixed with the spatula and again triturated 6 or 7 minutes, followed by the scraping for 3 or 4 minutes and trituration without further addition for 6 or 7 minutes.

The last third of sugar of milk is then added, mixed with the spatula and triturated as before 6 or 7 minutes with most careful scraping together. The powder thus prepared is put in a vial, well corked, protected from direct sunlight to which the name of the substance and the designation of the first product marked /100 is given.

In order to raise this product to /10000, one grain of the powdered /100 is mixed with the third part of 100 grains of powdered sugar of milk and then proceed as before, but every third must be carefully triturated twice thoroughly each time for 6 or 7 minutes and scraped together 3 or 4 minutes before the second and last third of sugar of milk is added.

After each third, the same procedure is taken. When all is finished, the powder is put in a well corked vial and labeled /10000, i.e., (I), each grain containing 1/1,000,000 the original substance.

Accordingly, such a trituration of the three degrees requires six times six to seven minutes for triturating and six times 3 or 4 minutes for scraping, thus one hour for every degree.

After one hour such trituration of the first degree, each grain will contain 1/000; of the second 1/10,000; and in the third 1/1,000,000 of the drug used.

-::-::-

It will be understood from the description of the process, and the final remarks in the US methodology (Fig 11.45A) that a certain amount of friction existed between the Allopathic and Homoeopathic schools. It will also be obvious that the Allopathic school have not grasped the essentials of Homoepathy and the Hahnemann method.

Chapter 12

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Chapter 11

Earth Air Fire and Water
The Pharmageddon Herbal
Ivor Hughes
Chapter 11A
Compounding

Introduction. The Dawn of Medicine
We may only speculate on the conceptual view of the natural world held by the early hunter gatherers. Such evidence as there is, seems to suggest that they were Shamanistic and employed a homoeopathic magical type of consciousness.

Survival, for most species, depends upon keen senses and a sharp eye. Our early ancestors’ powers of observation would have been cultivated to a far higher level than is usual in modern societies. Very little would have escaped their attention.

In that respect, it may be conjectured that the animals were our first teachers. In the mythology of all cultures, there is a good leavening of mythical beasts, both sacred and symbolic. This totemism is clearly in evidence in all of the earlier civilisations. In particular those of the Egyptian, Greek and Assyrian and Babylonian. To this we must also add those lost civilisations of the Far East and the Americas.
 

It is commonplace to see the domestic cat and ingesting various types of grass in order to induce the vomiting of hair balls. Those sharp human eyes would have noted, that other species, when ailing, would have ingested various types of plants. In that context, it is interesting to note that the goat in European pagan mythology is known as the herbalist of the animal world.

For a large proportion of herd animals, the changes of the seasons would bring with it a reoccurring pattern of migration. Perhaps the declination of the Sun produced a subtle change of light that released hormonal messengers to signal that it was time to make the long trek, upon which survival depended.

The herd animals are excellent cartographers who will unerringly find their way over or around obstacles, whilst on the way from one watering hole to the next. Untold thousands of sharp hooves would have cut and tamped man kinds earliest trails and tracks. For those early people who tracked the herds, the changing vegetation would be noted. and added to the store of survival knowledge.

Tenuous as it is, Shanidar, is the earliest known link to a proto-system of medicine. The pollen samples recovered represented 8 genera of flowering plants. This has led some writers to speculate that the motive for the flowering plants was pathos. I would like to suggest that the motive was pragmatism. For the following reasons;

1. Stone and bone tools were also recovered from the site. Those tools took considerable labour and skill to produce. Therefore, as barter goods they would have high value and would not be abandoned, unless there was some compelling reason. That reason may have been a journey of the soul to another region. The tools were survival artefacts for the soul on its journey to another world.

2. The pollen samples of the 8 different genera, were representative of medicinal herbs, which are still in use today. Therefore, the 2 main ingredients for survival on a long journey to the other side, were left at the burial site. Tools as survival artefacts and Plants as medicine. The remnants of Neolithic cultures and their practices exist today.

Medicinal herbs are prepared by beating the fresh plant between 2 stones, either as a single plant, or as a compound of plants. The herbs are reduced to a paste. The paste may be applied externally as a poultice.

Alternatively, crude pills may be formed from the paste, however, the ingestion of plants was the exception, rather than the rule, in those Neolithic cultures. The reason was very simple, the dermal route of administration was the safest.

Early Celtic herbalists used Foxglove ointment to cure dropsy. The problems of posology were minimised and a potentially lethal herb was tamed. The early roots of compounding are to be found in the dust of the Neolithic peoples.

The founding date of the Sumerian City States, scattered along the banks of the Euphrates and the Tigris, is not known. However, a carved stone frieze, which depicts the hand pollination of date palms, has been dated, between 8 and 9000 years old. This indicates a sophisticated knowledge of plant reproduction techniques.

Wherever people gather together in large numbers, problems of logistics and supply will arise. Not the least of these, would be the provision of medical care and medicines. We may be certain that the compounding of medicinal plants had advanced far beyond the Neolithic practices.

The earliest written records have been dated at 5000 years. The records were in the form of baked clay tablets. Some of the tablets were pharmaceutical recipes. The construction of those recipes display a fine grasp of the art of compounding. It should be said, that we have no firm knowledge of the early development of those City States.

Compounding may lay claim to be the foremost of the pharmaceutical arts, and is the foundation upon which pharmacy, both ancient and modern, rests. Compounding is the combining of two or more ingredients, in a suitable vehicle, for administration to a patient. This seemingly simple operation, would in fact, need a good leavening of skill and knowledge. Overcoming incompatibilities in ingredients, and the vehicle used to administer a remedy, is the crux of the matter.

Until the mid 18th century Europe’s economic activity was all but dominated by the trade in herbs and spice. The birth of the Renaissance, the wealth and intellectual activity of Venice as she led Europe out of the dark ages, was due to the patronage of many whose vast fortunes were founded on the trade in them.

The Spanish, Portuguese, Dutch and British fought wars and founded empires in quest of them. Not unnaturally they held a very important place in the domestic economy.

In Northern Europe, Autumn was a time of intense activity as people laid down food supplies to sustain life through the cold dark winter.

The preservation and palatability of many foods were dependent on the knowledgeable use of herbs and spice. For the peasant and artisan who lived from the brine and pickle barrel, they were the only means of maintaining a modicum of health.

By the mid 18th century many of those households that could afford to employ servants also maintained a distilling room (Still room). This would represent the modern day high technology kitchen. The mistress of the house would oversee or perform the various operations. The recipes and formulae were usually guarded secrets, being passed from mother to daughter down the generations. Leaves, flowers, roots, barks, gums and resins all skilfully transformed into medicines, perfumes fumigants, toiletries, inks and dyes.

The art of the stillroom reached its apogee with the advent of the Industrial Revolution. Thereafter it went into rapid decline, resulting in the fragmentation of a long chain of patiently accumulated domestic knowledge. The supply of those items normally produced from household resources, then became the province of trade and medical guilds.

Our physical world today is very different from what it was then. Science and technology has provided vast gains for our species, but it is our children who will be left to count the cost. It should come as no surprise that; for all of our toy making activity and gadgetry, that our Spiritual, emotional and physical needs in nature, have not changed one iota.

Classification of Compound Remedies 11.1
There are two types;

1. The Simplex or Simple, e.g., the Homoeopathic or Spagyric remedy. A simplex is a single ingredient which is incorporated into a carrier or vehicle. A tincture or an extract is a simplex. A pill or capsule that contains only one herb is a simplex.

2. The Compound is two or more bio- active ingredients, which are incorporated into a carrier or vehicle.

In the days of eclectic medicine, remedies that contained 4 or more herbs or active ingredients, were called Shotgun (scatter) remedies. This droll description is accurate. It will stand to reason that when such a remedy is administered, a cascade of physiological effects will ensue. Couple that with biological idiosyncrasy, and what we have is a complexity beyond our understanding.

The Compound Remedy 11.2
A well made compound remedy attempts to emulate the natural synergy of one herb. When constructing a compound, the following outline should be adhered to;

1. Basis : The principle drug.

2. Adjuvant : Increases or aids the effect of the principle drug.

3. Corrective : Modifies the action of the basis or adjuvant.

4. Vehicle : The carrier of the active ingredients.

5. Signature : Instructions as to use and dose. The signature is also needed for a simplex.

Your attention is drawn to Sections 8.22 through 8.29, which deals with incompatibilities

The Shelf Life of a Remedy 11.3
I
f a product is alcohol based, the strength should be a minimum of 20% by volume. Below that strength, spoilage will occur. Glycerine or Acetic acid is not suitable for herb based products, because it causes decomposition of the molecular structure of the herb. If the remedy is a solid or semi solid for external application, a suitable inhibitor, such as Gum Benzoin should be added. This precaution will protect the remedy against spoilage organisms. The product must also be correctly stored to exclude light, moisture and air. The final container, when dispensing the product, should be so constructed that it does not react with the remedy.

Climatic Temperature Range 11.4
A remedy must remain viable across a wide range of temperatures. For example, if it is a product designed for application to the skin, it would have a different vehicle formula for cold, temperate, or tropical conditions, e.g. the vehicle for a tropical ointment would be stiffer in consistency, than would be the case for a colder climate.

Integrity of the Remedy 11.5
If the product is an ointment or an emulsion, it
should, if possible, remain homogenous and not separate out if left standing or exposed to fluctuating temperatures.

 

The technical term for such a separation is called ‘Cracking’. Unless the remedy is badly constructed, this rarely happens with an ointment. It is, however, common with emulsions. If the problem cannot be overcome without the addition of a noxious chemical, the signature should contain the instruction, ‘Shake well before use’.

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Chapter 10 part 02

Earth Air Fire and Water
The Pharmageddon Herbal
Ivor Hughes
Chapter 10B continues

Homoeopathic Mother Tinctures 10.28
“We gain possession of the powers of indigenous plants and of such as may be had in a fresh state in the most complete and certain manner by mixing their freshly expressed juice immediately with equal parts of spirits of wine of a strength sufficient to burn a lamp.

After this has stood a day and a night in a close stoppered bottle and deposited the fibrinous and albuminous matters, the clear superincumbent fluid is then to be decanted off for medicinal use. All fermentations of the vegetable juice will be at once checked by the spirits of wine mixed with it and rendered impossible for the future, and the entire medicinal power of the vegetable juice is thus retained perfect and uninjured for ever by keeping the preparation in well corked bottles further protected with wax to prevent evaporation and excluded from the sun light”

Hahnemann
Organon of Medicine – Aphorism 267.

In the light of advancing knowledge we may understand that Hahnemann’s method of obtaining the plant magistery takes no account of seasonal availability or for that matter the composition of the juice and its ratio of water to soluble constituents and thus on the 57% spirits of wine.


 “but the really important point is, not what they regarded as
 fact, but how ? And in what spirit they interpreted their facts ? “
Rudolph Steiner