By P. Rocko. Howard Payne University.

For example discount aurogra 100 mg otc, many people who suffer from back pain caused by physical reasons often feel very frustrated by the experience generic aurogra 100mg visa. Frustration is an emotional stressor—which as you may have guessed buy 100mg aurogra otc, can slow blood flow and make preexisting back pain even worse cheap aurogra 100mg online. This is another reason why it’s so important to solve your back pain as quickly as possible—so the pain will not become chronic. If we try to go about “life as usual,” we’ll probably fail to give our bodies (and minds) the attention they need to heal properly, and then we’ll be saddled with pain for weeks, months, even years. This is a dangerous situation because it can be much harder to fix chronic pain than it is to fix pain that has existed for only a short time. Once chronic pain takes hold, it becomes much harder to fend off emotions like frustration and anxiety, which only make the pain hang around longer. Is there some pain in the past when they don’t cure the problem, they’ve actually made it that could be causing you trouble? If you were to ask the pain worse by ratcheting up the anxiety surrounding the whole where it comes from, what would it say? Oftentimes, simply acknowledging the psychological aspect of In the next section of this book, we’ll cover methods you the pain and identifying the offending emotion can diminish can use to address back pain caused by some mental or its power within days. Emotions and Back Pain: The Vicious Cycle Even if back pain is caused by physical factors, emotions can delay recovery. For example, many people who suffer from back pain caused by physical reasons often feel very frustrated by the experience. Frustration is an emotional stressor—which as you may have guessed, can slow blood flow and make preexisting back pain even worse. This is another reason why it’s so important to solve your back pain as quickly as possible—so the pain will not become chronic. If we try to go about “life as usual,” we’ll probably fail to give our bodies (and minds) the attention they need to heal properly, and then we’ll be saddled with pain for weeks, months, even years. This is a dangerous situation because it can be much harder to fix chronic pain than it is to fix pain that has existed for only a short time. Once chronic pain takes hold, it becomes much harder to fend off emotions like frustration and anxiety, which only make the pain hang around longer. These three things can occur as a result of problems in your physical body, mind, and/or diet. In this chapter, we’re going to discuss diet—particularly, how food and water can either make your back pain better or worse. Most of us, on a daily basis, eat too much of foods that increase the likelihood of back pain, and too little of what prevents it. The effects can often slow down the digestive system, blood flow, or transportation of waste. What you may not realize is that these secondary effects can have a direct effect on back pain. What if the fuel was contaminated with dirt, foreign chemicals, or even chocolate chips? You may not notice the effects immediately, but soon you’d hear the telltale clicking and coughing of mechanical parts grinding down, sticking together, and losing force and propulsion. If you fix the problem, clean out the engine, replace a few parts, and add clean fuel, you’ll probably go on all right. Yet we do this very thing to our bodies, which are also machines, just of the organic variety. We don’t feed them enough, feed them too much, or stuff them with things that only clog up our internal parts. You may have chuckled at the idea of car fuel contaminated with chocolate chips, but many of the things you ingest every day are just as foreign to your body as chocolate chips would be to your gas tank! I’m not just talking about eating “healthy” here, to lose weight, for instance, or to trim unwanted belly fat to relieve pressure from your back. Most people think of food in terms of “healthiness”— healthful food versus junk food, for example. You may think of foods that make you fat as unhealthful and foods that keep your body lean and strong as healthful. While conceptually this thinking is mostly correct, there’s an entirely different way to look at food that’s relevant for back pain. Instead of the traditional notion of eating healthful versus unhealthful foods, you also want to think of foods in terms of their ability to enhance or reduce pain. These are the only things sensitive to pain and can increase the severity of it—especially your body has to help it perform optimally. Other foods actually reduce pain levels and Imagine if you “fed” your car something other than gas. What if the fuel was contaminated with dirt, foreign chemicals, or even chocolate chips? You may not notice the Why People Feel Pain effects immediately, but soon you’d hear the telltale clicking and coughing of mechanical parts grinding down, sticking Before we get into how food can cause or keep you in pain, together, and losing force and propulsion. If you fix the problem, everything in the body, it’s a physical and chemical response, clean out the engine, replace a few parts, and add clean fuel, governed by nerve fibers that we can imagine as telephone you’ll probably go on all right. Surely you wouldn’t expect it to keep fibers, much like the thousands of telephone wires that performing? At one end of a single Yet we do this very thing to our bodies, which are also fiber is a pain receptor, which we can think of as the phone in machines, just of the organic variety. We don’t feed them your house, and at the other end is the receiver—the enough, feed them too much, or stuff them with things that “operator”—set up in the spinal cord. You may have chuckled at the When the body senses something is wrong, the nerve idea of car fuel contaminated with chocolate chips, but many endings, or receptors, send a message. The message travels as of the things you ingest every day are just as foreign to your an electronic signal along the nerve fibers to the spinal cord. There, either the “operator” transmits the message to the I’m not just talking about eating “healthy” here, to lose brain—in which case you feel the pain—or the “operator” weight, for instance, or to trim unwanted belly fat to relieve fails to send the message and you don’t feel the pain. Of course that may help, but it’s and when the signal reaches the brain are you consciously only part of the story. Most people think of food in terms of “healthiness”— As you already know, all pain isn’t the same. One is in reaction to an injury, like a broken of foods that make you fat as unhealthful and foods that keep bone, burnt finger, or tissues eroded by cancer. Instead of the traditional notion of eating healthful but resolves quickly when the problem is solved. Finally, there versus unhealthful foods, you also want to think of foods in is chronic pain, which goes on and on for a long time.

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Its symptoms are sim- ilar to those of barbiturate withdrawal: weariness quality 100mg aurogra, nervousness discount aurogra 100 mg with mastercard, perspiration aurogra 100 mg for sale, tremors aurogra 100 mg line, vomiting, cramps, high blood pressure, accelerated heartbeat, con- vulsions, and hallucinations. Women tend to be more affected by alcohol than men are because, among other reasons, the drug has more bioavailability in females (more of a given dose is used in females, so they need less quantity than men do in order to reach the same level of effect). Alcohol lengthens the duration of effects from chlordi- azepoxide, diazepam, and lorazepam. When rats receiving morphine or methadone drink alcohol, the alcohol blood level takes longer to increase but then lasts longer, a result suggesting that a human opiate user might have to drink more in order to get an alcohol effect and would then stay intoxicated longer than someone who does not use opiates. Rat studies indicate that steady opiate consumption may intensify alcohol dependence. In rats, alcohol, chlordiazepoxide, and pen- tobarbital all have cross-tolerance with one another, meaning that one will substitute for the other to some extent. So many drugs interact dangerously with alcohol that a person should always check information labels on drug containers before using the substances simultaneously with alcohol. Most laboratory tests give no indication that alcohol has a potential for causing cancer. Nonetheless, mice experimentation indicates that long-term use of alcohol can cause liver cancer. Women who take more than two drinks a day have an increased risk of breast cancer. A study of 8,006 Japanese men in Hawaii found an association between alcohol and cancer of the lungs and rectum, but “association” is not the same as cause and effect. Evidence indicates that saliva might transform alcohol in ways that promote oral cancer. A study of 430 couples in Denmark found fertility to decline among women as their alcohol consumption increased, but no effect was ob- served on male fertility. In contrast, a study of farm couples in Canada found no difference in fertility between women who did or did not drink alcohol. Still another study, in the Netherlands, found male alcohol consumers to have higher fertility as consumption increased, with no difference in fertility rate between women who drank different amounts. Such findings of sometimes yes, sometimes no, are a classic sign of an “invalid variable,” which in this case would mean that no difference in fertility can be attributed to alcohol (although more studies would be needed to reach a firm conclusion, and some authorities say the trend of research indicates that alcohol does reduce female fertility). A study found that premature infants were more likely among pregnant teenagers who drank alcohol than among those who did not. Other research has noted lower birthweights among children delivered by pregnant alcohol consumers. A human experiment documented fetal response to two glasses of wine drunk by women whose pregnancies were close to time of delivery: In that experiment fetal respiration and sleep were disturbed—which did not surprise researchers because heavy consumers of alcohol frequently give birth to in- fants having sleep difficulties. In mice the substance is known to cause a facial deformity called holoprosencephaly, and a human case report suggests that heavy dosage can do the same in humans. Less dra- matic facial characteristics are common after substantial prenatal exposure to alcohol. Other human birth defects attributed to alcohol include kidney, heart, and brain trouble. Male exposure to some drugs can produce birth defects, and researchers have found problems in behavior and thinking skills among children of alcoholic fathers as well as among offspring of pregnant alcoholics. The syndrome may include low birthweight, defective vision, delayed devel- opment, specific facial characteristics, trouble with muscles and joints, heart abnormality, and mental retardation. Prenatal exposure to alcohol can delay motor skill development in children, cause difficulties in maintaining balance, and limit growth in 40 Alcohol height. Some researchers believe that fetal exposure to alcohol has more to do with teenage drinking than family envi- ronment does. Comparing adults with heavy prenatal alcohol exposure to those without such exposure, a small study measured significant psychiatric differences, particularly with the alcohol subjects being more depressed and fearful. Fetal damage from maternal alcohol use is unquestionable, but the amount of use necessary to cause damage is less certain and can be affected by a woman’s general physical condition and lifestyle (including nutrition and other drug usage). Occasional binge drinking and routine heavy drinking are certainly hazardous to fetal development, but for many years pregnant women have used alcohol in moderation without apparent effect on offspring. None- theless, in general, women are now advised to avoid any alcohol consumption during pregnancy. Experimenters note that alcohol consumption reduces mothers’ milk pro- duction but does not affect energy provided by the milk. A nursing infant may be sickened by milk from a mother who abuses alcohol—an infant has not yet developed the proper body chemistry to break down alcohol, so a dose lasts longer in an infant than in an older child or adult. Alcohol is also probably the most familiar drug, used so freely that many persons regard it solely as a beverage rather than as a drug. Indeed, for many years excessive drunkenness was considered a moral failing rather than a disease, and not until the 1950s was alcoholism officially recognized as an affliction appropriate for medical treatment. Temperance societies, organizations whose members pledged to avoid beverage alcohol and to discourage consumption by other persons, became politically powerful. Before the Civil War such groups had been able to get laws passed outlawing the sale of beverage alcohol in various communities and sometimes throughout entire states. Shortly after World War I this agi- tation culminated in the Eighteenth Amendment to the Constitution of the United States, giving the federal government power to ban manufacture and sale of beverage alcohol. Although purchase and consumption remained legal, the majority of Americans became so displeased with Prohibition that the Twenty-first Amendment to the Constitution was passed in the 1930s repeal- ing the earlier one. This calming and sleep-inducing substance is probably the most fre- quently prescribed drug in the benzodiazepine class. Alprazolam is used mainly to help persons suffering from panic attacks and other anxiety disor- ders, but it is not recommended for posttraumatic stress disorder. Theoretical reasons and results from a rat experiment suggest that alprazolam may help maintain bone mass. That action may be especially important to athletes and elderly women, who commonly suffer loss of bone mass—an affliction making breakage easier. The drug has been tested as an asthma treatment with encouraging results, though reasons for success are unclear. In an experiment measuring alprazolam’s pain-relieving properties, the drug re- duced the severity but not the frequency of chronic tension headaches. The compound has antidepressant and anticonvulsant properties, has been used to treat ringing in the ears and to alleviate tremors and catatonia, and has been found useful in easing alcohol withdrawal symptoms in alcoholics. A rat study suggests that alprazolam may also have a place in treating cocaine addiction. Measurements find the drug worsens snoring but improves quality of sleep (at least for the snorers). Experiments show that the drug reduces startle response in hu- mans, which may mean drivers are less alert or respond less vigorously to situations. Case reports tell of alprazolam (alone and in combination with other medicine) causing the skin to become extra sensitive to sunlight.

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There have been many efforts to establish other causative agents purchase aurogra 100mg free shipping, including elevations of homocysteine generic aurogra 100 mg amex, but the most important factors in atherosclerosis continue to be the “classic” ones: serum lipid levels aurogra 100 mg amex, hypertension purchase aurogra 100 mg without a prescription, diabetes, smoking, family history, age, and male sex. Vulnerable to injury from common agents like smoking, abnormal serum lipids, homocysteine levels, etc. Progression of Atherosclerotic lesions: Lesions Of Blood Vessels - Andrew Connolly, M. Thrombosis is a regular feature of ulcerated plaques, and organization of mural thrombi may contribute to bursts of plaque thickening. Sudden ischemic events are due to thrombosis at sites of atherosclerotic plaque degeneration (Plaque rupture or erosion). Removal of risk factors can slow progression, and convert vulnerable plaques to stable plaques. Fixed Stenosis: critical narrowing with malfunction or atrophy of supplied tissues. If tissue demand for oxygen goes up and supply of oxygen cannot, this can lead to ischemia or infarction (e. Plaque rupture: atherosclerotic plaque ruptures causing immediate thrombosis due to blood mixing with thrombogenic atheromatous debris. Dissection: blood enters intimal defect under pressure and splits tissue planes, often in the media. Statins improve lipoprotein profile and possibly decrease inflammation in atheromas. Surgical management is recommended for larger diameter ones, which are at risk for catastrophic rupture. Stanford (Types A & B): Stanford A originates within or proximal to the aortic arch and usually requires surgery; Stanford B originates after the arch and can usually be managed medically. Intimal tear usually connects with a dissection plane along outer 2/3 of medial layer. Complications include hemorrhage, rupture, compression of nearby viscera, and branch occlusion, leading to the associated signs and symptoms. Rupture: Note: A “false aneurysm” is really a contained perivascular hematoma that communicates with the lumen and mimics an aneurysm. Aortic Dissections Stanford Types A and B: Thromboembolic Disease - Andrew Connolly, M. Some of the consequences of these diseases are due to local changes around the blood vessel, such as edema and hemorrhage, while other consequences are due to changes in tissue perfusion. The most common cause of severe morbidity and mortality in our society is inadequate tissue perfusion due to arterial lesions, causing heart attacks, strokes, pulmonary emboli, renal failure and blindness. As a final common pathway, inadequate tissue perfusion is usually the ultimate cause of death. All tissues require nourishment; hence any may be affected by changes in the blood vessels meant to supply them. In this lecture we will cover obstructions from components of the blood, while obstructions from changes in the vessel wall will be covered more in the second lecture. The steps in hemostasis have negative regulators in the blood and blood vessel wall that limit the extent of propagation, preventing excessive vascular occlusion. Varieties of blood coagulation: Hemostatic Plug Thrombus Hematoma* Blood Clot From blood coagulation From blood coagulation From blood loss into From blood loss to at site of trauma at site of vascular tissues outside the body or into pathology a body cavity Associated with blood Associated with blood Extravascular but in Ex vivo or in a cavity. Vasoconstriction mediated by stimulation of vascular smooth muscle by peripheral nerves and factors released by platelets. Primary Hemostasis mediated by initial platelet deposition on exposed extracellular matrix. Secondary Hemostasis mediated by the coagulation cascade with formation of thrombin and fibrin. Resolution with cessation of hemostatic cascades and lysis of loosely adherent platelets and fibrin. This is abnormal in Thrombosis, leading to pathologic amounts of coagulation in the lumen. Types of emboli: Emboli are classified as solid (detached thrombi, tissue fragments, clumps of tumor cells, etc. A paradoxical embolus is one which arises in the venous circulation but enters the arterial or vice versa, through an Arterio-Venous (A-V) fistula or septal defect in the heart. Pulmonary embolism: Originate commonly from thrombi in veins of lower extremities, pelvis and right heart. These range from tiny, involving arterioles, to massive, involving the main pulmonary artery or its major branches. The possible effects of pulmonary embolism include sudden death, infarction, or hemorrhage of the lung. Systemic arterial emboli: Are usually derived from mural thrombi in the left atrium or left ventricle, vegetations on mitral or aortic valves, atheromatous plaques or aortic aneurysms. Vascular occlusions are most frequent in the spleen, kidneys, brain, bowel, heart, and lower extremities, leading to infarction. Amniotic fluid embolism: An uncommon complication of childbirth which results in embolism of epithelial squamous cells, mucus and lanugo hairs to pulmonary vessels of the mother. Air embolism: Pulmonary air embolism occurs when air is sucked into thoracic veins (at negative pressures during inspiration) as a result of cannulation, surgery or injury. The effect depends on the amount: 100-150 cc is required to produce death in an adult. Systemic air embolism occurs when air enters the left-sided circulation during penetrating wounds, surgery, etc. In life this is manifested by bubbles in retinal vessels, skin mottling and tongue pallor. Decompression sickness (“bends”) is due to gas emboli created by desaturation bubbles of nitrogen gas. Other types of embolism: Placental fragments, clumps of tumor cells, bacteria, parasites, foreign bodies, bullets, shrapnel, barium sulfate (from radiology), catheter tips, etc. Some emboli are created purposely in arteries supplying tumors or vascular malformations by interventional radiologists using thrombogenic material. Arterial Embolism: Sources: Infarcts: Thromboembolic Disease - Andrew Connolly, M. Those tissues with higher metabolic rate, like renal tubules and myocardium, are more vulnerable to damage during ischemia, as are those with only terminal vasculature. Morphology of Infarcts: Infarcts may be recent or old, bland or infected (septic). The shape of infarcts depends on the distribution of tissue downstream from the occlude vessel. They are often wedge-shaped with the wide base towards the periphery of the organ. Infarcts are usually pale but may become hemorrhagic if there is either a minor collateral circulation (e. When an infarct extends to a serosal surface, it is covered by fibrinous (fibrin- containing) exudate initially, which may then cause fibrous (collagen- containing) adhesions as it heals. In most infarcts, inflammatory cells are noted in the periphery of large lesions, because that is where the remaining arterial circulation allows delivery of leukocytes.

Note—In the early editions of my work on Materia Medica cheap 100mg aurogra with amex, this agent was classed from our knowledge of its action per os purchase aurogra 100mg, as a nauseating expectorant and respiratory sedative purchase aurogra 100 mg free shipping. Since that time buy aurogra 100 mg with amex, the very wide observations made of its action hypodermically have changed the most of our ideas concerning it, and have placed it in an entirely different class. Given hypodermically but very few patients are nauseated by it, and almost the whole number, notwithstanding its sedative and anti-spasmodic influence, experience a physical uplift from its action. I have thought best, however, to leave this agent in its original class, until laboratory experiments have proven its exact influence upon the nervous and circulatory systems. Tinctura Lobeliae, Tincture of Lobelia; dose, from five to thirty Specific Medicine Lobelia; dose, from one to twenty minims. Subculoid (hypodermic) Lobelia; dose, from two to sixty minims; usually from ten or thirty minims repeated as occasion demands. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 275 The preparation of lobelia which is to be used hypodermically, must be selected with great care. If the agent be given internally, any good fluid preparation is effective, but in its hypodermic use, local irritation, nausea, severe vomiting, even general prostration occur more frequently from the ordinary fluid preparations. If depression with the above complications can be properly antagonized, and is not objectional in a sthenic patient. Extended and persistent experimentation has been made nearly as possible a perfect fluid preparation for hypodermic use. This is devoid to a very large extent of the objectionable features of the other preparations, and so nearly devoid of emetic properties that this is now considered a negligible quality. It is always best however to use any preparation hypodermically warmed, the parts aseptic, and to apply a hot compress over the seat of the application immediately for a few minutes. Except for its local effects, there is but little difference between the Subculoid lobelia and the specific medicine lobelia. Administration—Given by mouth for the various purposes for which it has long been used, the dosage of the specific medicine should be small, and frequently repeated. If no untoward results occur after the first dose, and the condition demands it, a more or less frequent dose and an increase in the size of the dose is justified by the severity of the symptoms, and by the demand for its influence. But in its antispasmodic and relaxing influence it is not narcotic in the same sense as opium. It exercises a soothing influence over nerve irritability, and a distinct anodyne result ensues. The pain from renal or hepatic stone is more quickly relieved by it and more permanently, often, than by morphine because of the general relaxation. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 276 As used by the mouth, prior to our knowledge of its peculiar action hypodermically, it was determined that lobelia in toxic doses causes extreme prostration, burning pain in the esophagus, rapid, feeble pulse, fall of temperature, collapse, coma or convulsions and death from respiratory failure. In doses of twenty grains it is a prompt emetic, but emesis is accompanied by excessive prostration, relaxation and a feeble pulse. Like other narcotics, a small dose stimulates, while a large dose depresses the nervous system. Although usually classed among emetics, lobelia is a nerve sedative of great power, and in this influence as an antispasmodic it is exceeded by but few remedies. Death has occurred in a very few cases from excessive doses of the remedy, but toxic effects are not apparent where the medicinal dose is prescribed. Where death has occurred, its influence as a nerve depressant has been plainly shown in the profound, general muscular relaxation, with greatly impaired muscular power, general trembling, shallow respiration, cold, clammy skin, feeble and depressed heart action. The observations made of its physiological action when the remedy is used hypodermically are, that so used, the direct local influence of the agent upon the stomach is avoided and if the remedy is properly prepared, emesis, violent vomiting, profound relaxation, with prostration and depression, which were found present from that local influence are all absent. Used in a medicinal dose, it softens the pulse, slows the respiration, quiets the nervous system, and produces a freedom of the respiration and circulation. One of our writers claims that he believes that the agent introduced by the stomach acts upon the pneumogastric nerve, while, when introduced hypodermically and absorbed, it acts more directly upon the sympathetic nervous system. Lobelia acts directly upon the regulating centers of the system; those of heat, of the circulation, of nerve influences, both motor and sensory. It Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 277 supports the heart; it overcomes excessive blood pressure, and restores normal tension. Whatever the cause of any great depression, we cannot yet define the marvelous improvement observed from this agent. We hardly call it stimulation, and yet the improved condition is such as would ultimately follow the action of the very best, most natural stimulants or tonics. It is hard indeed to express the apparently contradictory influence exercised on the above named depression, which has been overcome in its most extreme form—(in fact, in some cases where the skin was so cold and the process of life so feeble as to cause one to think that death had occurred and yet the reaction appears very promptly)—between this condition and its influence in profound heat stroke, as one doctor reports, where the temperature was 110 degrees, and others have reported from 106 degrees and up. Jentzsch who is enthusiastic about the action of this remedy in heat stroke, hesitates in claiming that lobelia is a stimulant, pure and simple, as we understand the action of stimulants. Unlike brandy or strychnine or digitalis, the immediate and sharp, stimulating, or whipping-up effects do not appear in the same way to be lost when the effect of the medicine is gone. The improvement on all conditions is plainly marked, but the restoration is nearly that of a full normal condition obtained in a smooth and satisfactory manner. It is more like an increase of vital force, which remains to a large extent, in the improved condition of all the functions after the remedy has had time to be fully eliminated. From my own personal observations and from the conclusions I have drawn from the observations of others, I would say that lobelia seems at once to supply a subtle but wholly sufficient force, power, or renewed vital influence, by which the nervous system and the essential vital force within the system again reassert themselves and obtain complete control of the functional action of every organ. From this influence, in a natural and sufficient manner, a complete harmonious operation of the whole combined forces is at once resumed, in some cases in an almost startling manner. Other agents stimulate, prop up, whip up or temporarily increase the force and power of one or another function, while this remedy with this peculiar power at once assumes control of the whole, and succeeds against all the opposing influences. Specific Symptomatology—This remedy is specific given in irritable, Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 278 spasmodic and oppressed breathing, and in respiratory disorders from exalted nerve force and nerve irritation. It is contraindicated in general relaxation and in dyspnea from enlarged or fatty heart, or from hydropericardium, or enfeebled heart, with valvular incompetence. It is specific in threatened spasm with exalted nerve action—a high degree of nerve tension with great restlessness and excitability, flushed face and contracted pupils. Therapy—In spasmodic asthma, if given in a dose of from thirty minims to one dram during the paroxysm, the benefit is apparent almost immediately. This full dose may be once repeated, but this is seldom necessary, and a single dose seldom produces vomiting. When continued with other agents it must be given in doses not to exceed ten minims three or four times a day. It is a reliable expectorant, and either alone or in combination with other indicated remedies, is useful in all cases of dry, hard, barking cough, or where the expectoration is difficult to raise, in spasmodic croup, and in membranous croup without depression. It is not so commonly used at the present time for that purpose as ipecac, as the irritation, nausea and general depression are usually greater than is necessary. It resembles tobacco in this and in many other particulars, producing a burning sensation in the fauces which is persistent and unpleasant. Either alone or combined with tincture of capsicum, it has long been used to overcome spasms of all characters, from infantile convulsions to puerperal eclampsia and epilepsy. It has been given in tetanus with benefit, and with success in the spasm of hydrophobia and of strychnia poisoning.

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