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Cialis Jelly

By Z. Gamal. Rhode Island College.

Synonyms of this drug are farmitrexate cialis jelly 20 mg erectile dysfunction treatment medications, ledertrexate safe 20mg cialis jelly low libido erectile dysfunction treatment, ematexate, maxtrex, folex, mexate, and others. These compounds inhibit synthesis of purine nucleotides, which are made up of purine bases and phosphorylated ribose. Both compounds must be transformed into nucleotides by adding a phosphoribosyl fragment. Upon reacting phosphorous pentachlo- ride with uric acid, 2,6,8-trichloropurine (30. The three chlorine atoms in trichloropurine differ significantly in terms of reactivity for nucleophilic substitution. The chlorine atom at C6 is much more active than the chlorine atom at C2, and this is more active than the chlorine atom at C8, which allows subsequent manipulation by them. Upon reaction with phosphorous pentasulfide, hypoxanthine is transformed into mercaptopurine (30. Mercaptopurine is used for treatment of lymphobastomas, myeloblastoma leucosis, and to treat neuroleukemia. Replacement of the hydroxyl group with a mercapto group at C6 is carried out by reacting it with phosphorous pentasulfide, which forms thioguanine (30. Mercaptopurine is important as a drug of supportive therapy in treatment of both adults and children. Thioguanine may have specific clinical use, or may be used in combination with other drugs in severe myelogenous therapy. This action is accom- panied by formation of an active metabolite, 5-fluorodeoxyuridinomonophosphate from both fluorouracil and fluoxuridine. This complex inhibits thymidylate sythetase and reduces methylation of 2-deoxyuridine acid for formation of thymidylic acid. Antineoplastics 5-fluorouracid is direct fluorination of uracil with fluorine or trifluoromethylhypofluoride [23–28]. Fluorouracil is used to treat carcinomas of the head, neck, colon, rectum, breast, stom- ach, bladder, pancreas, and for actinic and solar creatitis. Synonyms of this drug are efflu- derm, fludix, fluoroblastin, arumel, benton, lifril, and others. Like other pyrimidine antimetabolites, cytarabine must be “activated” by initially transforming into the corre- sponding nucleotide. In principle, however, alkylation can occur and occurs at O6 or N3 of guanine, at N1,N3, or N7 of adenine, or at N3 of cytosine. The schematic mechanism of the action of alkylating drugs, mechlorethamine for exam- ple, the most simple of them all, can be explained by the following scheme. They can be classified as nitrogen-containing mustard derivatives (mechorethamine, chlorambucil, melfalan, cyclophosphamide, ifos- famide), derivatives of ethylenimine (thiotepa), nitrosoureas (carmustine, lomustine, strep- tozocin), alkylsulfonates (busulfan), and derivatives of platinum (cisplatin, carboplatin). Synonyms of this drug are azotoyperit, chlorethamine, chlorethazide, mustine, and many others. In the first stage of synthesis, acetanilide is acylated by succinic anhydride, giving 4-(4-acetaminophenyl)-4-ketobutyric acid (30. The keto group in this compound is reduced by hydrogen in a methanol solution using palla- dium on carbon as a catalyst. This results in the formation of the methyl ester of 4-(4-aceta- minophenyl)-butyric acid (30. This is treated with an alkali in order to hydrolyze both the amide and ester parts of the molecule, which forms 4-(4-aminophenyl)butyric acid (30. Replacing all of the hydroxyl groups in this compound using phosphoryl chloride and subsequent treatment with water to hydrolyze the resulting intermediate acid chloride to an acid gives chlorambucil (30. Reacting this with an ethanol in the presence of hydrogen chloride gives the hydrochloride of 4-nitro-L-phenylalanine ethyl ester (30. The nitro group in this molecule is reduced to an amino group using palladium on calcium carbonate as a catalyst. The hydroxy groups in this molecule are replaced with chlorine atoms upon reaction with thionyl chloride, after which treatment with hydrochloric acid removes the phthalamide protection, giving melphalan (30. The racemic form of this drug, D,L-3-[p-[bis-(2-chloroethyl)amino]phenyl]alanine, is also widely used under the name sarcolysine or racemelfalan. Present in the blood, it is practically inactive, although upon penetrating cancerous cells 398 30. Antineoplastics and reacting with a relatively large number of phosphamidases, it cleaves, essentially releasing a cytostatic substance, bis-(2-chloroethyl)amine. This means that the alkylating action of this drug is specifically directed toward can- cerous cells. It is used for chronic lym- phatic leukemia, Hodgkin’s disease, Burkitt’s lymphoma, multiple myeloma, and cancer of the breast, neck, ovaries, and so on. Synonyms of this drug are endoxan, cyclostin, cytoxan, cyclophosphane, and others. Ethyenimines exhibit cytostatic action and suppress development of proliferating, as well as malignant tissues. They are used for breast and ovarian cancer, nonoperable tumors, and other reoccurrences and metastases. It is used for chronic lymphatic leukemia, lymphogranulomatosis, and lymphosarcomatosis. It is used for reducing the number of reoccurances and metastases, and in complex treatment of various forms of cancer. Busulfan selectively alkylates position N7 of guanine, and also alkylates the sulfhydryl group of glutathione and cysteine. Unlike other alkylating agents, it has little effect on lymphocytes and exhibits much less immunosuppressive ability. Synonyms of this drug are cyto- sulfan, leukosulfan, myelosan, mytostan, and others. There are also other drugs of this group (nimustine, semustine, and others), and they differ only in the presence of a different R group, which is shown in the scheme below. It is believed that in the body, nitrosoureas break down to β-chloroethanol and alkylisocyanate. The resulting β-chloroethanol is a highly reactive alkylating agent, and the alkylisocyanates are carbamoylating agents for proteins, which also exhibit certain cytotoxic activity. The probable scheme of decomposition of nitrosourea in the body into active compo- nents is shown below. Upon reaction with thionyl chloride, the hydroxyl group in it is replaced with a chlorine atom, giving 1-(2-chloroethyl)-3-cyclohexylurea (30. This is nitrated in non-aqueous conditions with formic acid and sodium nitrite to give lomus- tine (30. It is used for central nervous system tumors, brain, throat, and larynx tumors, lym- phogranulomatosis, non-Hodgkin’s lymphoma, and lung and gastrointestinal tract cancer. It also does not have carbamoy- lating activity, which is present in other nitrosoureas, as a result of quickly occurring intramolecular reactions of cyclization of glycosylisocyanate, which is made during the transformation of streptozocin in the body; however, it inhibits synthesis of amino acids necessary for making proteins in cancer cells. It is highly reactive with carci- nomas of the testicles, ovaries, heat, neck, spleen, lungs, and so on. Synonyms of this drug are platinol, platiblastin, platinex, neoplatin, and others.

Iloprost | 443 * Many centres have their own protocols for dosing and handling iloprost by infusion and these should be followed where available cheap 20 mg cialis jelly fast delivery erectile dysfunction medication risks. Pre-treatment checks * Caution in concomitant anticoagulant therapy or drugs that "risk of bleeding generic cialis jelly 20 mg fast delivery erectile dysfunction doctor in pune. Primary pulmonary hypertension (unlicensed): 1--8 nanograms/kg/minute for 6 hours daily. Alternatively, iloprost may be given via nebuliser (licensed product) at a dose of 2. Dose in renal or hepatic impairment: in liver cirrhosis or in renal impairment requiring dialysis the dose may need to be halved. Calculation of infusion rate (see also Table I3): Dose ðnanograms=kg=minuteÞÂbodyweight ðkgÞÂ60 Infusion rate ðmL=hourÞ¼ Concentration of infusion ðnanograms=mLÞ Table I3 Iloprost rate of infusion using a 2000 nanograms/mL solution Infusion rate (nanograms/kg/minute) 0. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. If adverse effects occur stop the infusion and review; may be recommenced after 1 hour at half the previous rate if appropriate. Technical information Incompatible with No information, but do not mix with any other drug. Significant * The following may "iloprost levels or effect (or "side-effects): interactions other anticoagulants or antiplatelet agents, antihypertensives and vasodilators. Action in case of Reduce the dose or discontinue the infusion and initiate appropriate supportive overdose measures as necessary, e. This assessment is based on the full range of preparation and administration options described in the monograph. Im ipenem w ith cilastatin 500-mg dry powder vials * Imipenem is a semisynthetic carbapenem beta-lactam antibacterial that is always given with cilastatin (which inhibits the renal metabolism of imipenem) in a ratio of 1:1 by weight. Pre-treatment checks * Do not give if there is known hypersensitivity to any carbapenem antibacterial agent or cilastatin, or previous immediate hypersensitivity reaction to penicillins or cephalosporins. Severe and/or life-threatening infections due to less sensitive organisms (primarily some strains of P. Dose in renal impairment: adjusted according to creatinine clearance: * CrCl 31--70mL/minute: 500mg every 6--8 hours. Intermittent intravenous infusion Preparation and administration Imipenem with cilastatin should not be directly mixed with Hartmann’s (incompatible with lactate) but may be co-administered via Y-site. Inspect visually for particulate matter or discoloration prior to administration and discard if present. The infusion rate should be slowed if the patient develops nausea during the infusion. Technical information Incompatible with Imipenem with cilastatin should not be directly mixed with Hartmann’s (incompatible with lactate) but may be co-administered via Y-site. Amiodarone, amphotericin, drotrecogin alfa (activated), fluconazole, lorazepam, midazolam, sodium bicarbonate. Displacement value Negligible Stability after From a microbiological point of view, should be used immediately; however, preparation prepared infusions may be stored at 2--8 C and infused (at room temperature) within 24 hours. Monitoring Measure Frequency Rationale Renal function Periodically if on * Transient "Cr and "U may occur. Development of Throughout treatment * Development of severe, persistent diarrhoea may diarrhoea be suggestive of Clostridium difficile-associated diarrhoea and colitis (pseudomembranous colitis). Additional information Common and serious Immediate: Anaphylaxis and other hypersensitivity reactions have been undesirable effects reported. Other: Nausea, vomiting, diarrhoea, taste disturbances, tooth or tongue discoloration, hearing loss, blood disorders, positive Coombs’ test, rash, pruritus,urticaria,Stevens--Johnsonsyndrome,rarelytoxicepidermalnecrolysis, exfoliative dermatitis, myoclonic activity, convulsions, confusion, mental disturbances. This assessment is based on the full range of preparation and administration options described in the monograph. Inflixim ab 100-mg dry powder vial Infliximab should be used under specialist supervision only. Pre-treatment checks * Screen for tuberculosis, do not give to patients with active tuberculosis or other severe infections. If the condition has responded, maintenance of either 5mg/kg 6 weeks after initial dose, then 5mg/kg every 8 weeks or a further dose of 5mg/kg if signs and symptoms recur. If the condition has responded, consult product literature for guidance on further doses. If there is no response at 6 weeks, no additional treatment with infliximab should be given. If there is no response after 14 weeks, no additional treatment with infliximab should be given. Confirm the patient’s details on the prepared bag, and that the correct dose has been supplied. Inspect visually for particulate matter or discoloration prior to administration and discard if present. Technical information Incompatible with No information Compatible with Flush: NaCl 0. However, prepared infusions are known to be stable if stored at 2--8 C and infused (at room temperature) within 24 hours. Monitoring Measure Frequency Rationale Close observation For 1--2 hours post * Most hypersensitivity reactions are reported for hypersensitivity infusion during this period. Additional information Common and serious Immediate (or with a few hours of administration): Anaphylaxis and other undesirable effects hypersensitivity reactions have been reported. Other: Viral infection, serum sickness-like reaction, headache, vertigo, dizziness, flushing, lower and upper respiratory tract infection, abdominal pain, diarrhoea, nausea, dyspepsia, "transaminases, urticaria, rash, pruritus, hyperhidrosis, dry skin, chest pain, fatigue, fever, blood dyscrasias. This assessment is based on the full range of preparation and administration options described in the monograph. Insulins Insulin 100 units/mL solution in 10-mL vials 3-mL pen cartridges and 3-mL pre-filled pens (see chart below) Restricted use: insulin 500 units/mL solution in 10-mL vials * Insulin is a hormone produced by the pancreas that is crucial in the regulation of carbohydrate, protein and fat metabolism. It is secreted when blood glucose levels start to rise; its action is opposed byglucagon; catecholamines,glucocorticoidsand growth hormone (thecounter-regulatory hormones), and others. Decreased or absent insulin secretion results in the development of diabetes mellitus, although patients with insulin resistance may be markedly hyperinsulinaemic as well as hyperglycaemic. If used it must be kept completely separate from all other insulins, be clearly labelled, and only be administered by staff who have had specific training in its use. Insulin is used in combination with aggressive rehydration, potassium supplementation and many other supportive measures, alongside intensive monitoring. Insulin is used in combination with rehydration, potassium and other supportive measures, alongside intensive monitoring. Once the patient is biochemically stable and able to eat/drink, the usual therapy for diabetes treatment should be resumed or started. Moderate to severe hyperkalaemia (unlicensed): calcium gluconate is given to stabilise the myocardium (see Calcium gluconate monograph) followed by 5--10 units of soluble insulin with Insulins | 453 50mL Gluc 50% over 5--15 minutes.

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Action in case of Antidote: No known antidote; stop administration and give supportive therapy overdose as appropriate 20mg cialis jelly with visa erectile dysfunction drug stores. This assessment is based on the full range of preparation and administration options described in the monograph discount cialis jelly 20mg on-line erectile dysfunction rap. Paricalcitol 5 micrograms/mL solution in 1-mL and 2-mL ampoules * Paricalcitol is an analogue of calcitriol, the active form of vitamin D. Pre-treatment checks Do not give to patients with hypercalcaemia, including hypercalcaemia of malignancy. Inspect visually for particulate matter or discolor- ation prior to administration. Technical information Incompatible with Haemodialysis access: heparin sodium (give through a different injection port because the propylene glycol component of paricalcitol injection neutralises the effect of heparin). Contains propylene glycol (adverse effects seen in #renal function, may interact with disulfiram and metronidazole). Pharmacokinetics The mean half-life in patients with chronic renal failure requiring haemodialysis is about 15 hours. Significant Injectable preparationcontains ethanol and propylene glycol: mayinteractwith interactions disulfiram and metronidazole. Action in case of Stop treatment if "Ca develops until plasma Ca levels return to normal. Counselling Advise patients to report symptoms of "Ca: persistent constipation or diarrhoea, constant headache, vertigo, loss of appetite, polyuria, thirst, sweating. This assessment is based on the full range of preparation and administration options described in the monograph. Pegfilgrastim 10mg/mL (expressed as filgrastim) solution in pre-filled syringe: 6mg/0. It acts primarily on neutrophil precursors to increase neutrophil levels and has a more sustained action than filgrastim. Pre-treatment checks * Contraindicated in chronic myeloid leukaemia, secondary acute myeloid leukaemia, and myelodysplastic syndromes. Pegfilgrastim | 657 Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible Storage Store at 2--8 C in original packaging (accidental freezing for < 24 hours does not affect stability). Bone pain Ongoing * Relatively common adverse effect due to "haemopoietic activity -- usually transient. Spleen size (by If indicated, * Splenomegaly is common, and usually physical potentially at each asymptomatic. Pharmacokinetics Elimination half-life is 15--80 hours (neutrophil-mediated clearance, so serum concentrations decline in accordance with neutrophil recovery). Significant * Lithium may "pegfilgrastim effect (or "side-effects): potential "neutrophil interactions release -- more frequent monitoring of neutrophil counts is recommended. This assessment is based on the full range of preparation and administration options described in the monograph. Pegvisom ant 10-mg, 15-mg, 20-mg dry powder vials plus solvent * Pegvisomant is a genetically modified analogue of human growth hormone and is a highly selective growth hormone receptor antagonist. Pegvisomant | 659 Pre-treatment checks * The vial stopper contains natural rubber latex which may cause latex-sensitivity reactions in susceptible individuals. Do not shake vigorously, as this might cause denaturation of the active ingredient. After reconstitution, vials contain 10mg/mL, 15mg/ mL or 20mg/mL dependent on vial size. Discard the product if the resulting solution is cloudy or contains particulate matter. Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible Storage Store at 2--8 C in original packaging. Displacement value Negligible Stability after Use the prepared solution immediately. Tumour growth Assess each time the * Growth hormone-secreting pituitary tumours may patient is reviewed sometimes expand, causing serious complications (for example, visual field defects). Additional information Common and serious Injection-related: Local: erythema, soreness, bruising, bleeding, undesirable effects hypertrophy, lipohypertrophy. Significant interactions Cross-reaction with commercially available growth hormone assays. Counselling Instructions for proper storage, preparation, and injection technique. Stress the importance for women of informing clinicians if they are, or plan to become, pregnant or plan to breast feed. Pentam idine isetionate (pentam idine isethionate) 300-mg dry powder vials * Pentamidine isetionate is an antiprotozoal agent. Pentamidine isetionate is toxic and personnel must be adequately protected during handling and administration -- consult product literature. Alternatively give 600mg via nebuliser once daily for 3 weeks (consult product literature for suitable equipment to be used). Prevention of Pneumocystis jiroveci (Pneumocystis carinii) pneumonia: 300mg via nebuliser every 4 weeks or 150mg every 2 weeks. Dose in renal impairment: adjusted according to creatinine clearance:1 * CrCl >20--50mL/minute: dose as in normal renal function. Withdraw the require dose and discard any remainder in accordance with local protocol. Volume of diluent 3mL 4mL 5mL added Approximate 100mg/mL 75mg/mL 60mg/mL concentration of pentamidine 2. Nebulisation Consult product literature for detailed guidance on administration and protection of bystanders. Technical information Incompatible with Do not mix with other drugs during infusion. Stability after Reconstituted vials should be used immediately (risk of precipitation particularly preparation if refrigerated). From a microbiological point of view, it should be used immediately; however, prepared infusions may be stored at 2--8 C and infused (at room temperature) within 24 hours. Additional information Common and serious Injection/infusion-related: Local: Pain, induration, abscess formation and undesirable effects muscle necrosis. On inhalation: Bronchoconstriction (may be prevented by prior use of bronchodilators), cough, and shortness of breath. Significant drug * Pentamidine may "risk of ventricular arrhythmias with the following drugs: interactions amiodarone (avoid combination), amisulpride (avoid combination), antidepressants-tricyclic, droperidol (avoid combination), erythromycin- parenteral, ivabradine, moxifloxacin (avoid combination), phenothiazines. This assessment is based on the full range of preparation and administration options described in the monograph. Pentazocine | 665 Pentazocine 30mg/mL solution 1-mL and 2-mL ampoules * Pentazocine lactatehasbothopioidagonistandantagonistproperties. If usedincombinationwith other opioids it may precipitate withdrawal symptoms including the re-emergence of pain.

No order cialis jelly erectile dysfunction quad mix, I left it unmentioned because it is improper order cialis jelly with a visa impotence research, yea, hurtful to speak or write of things still immature. Not until the year I827 did I communicate the essentials of the discovery to two of my pupils, who had been of the greatest service to the art of Homoeopathy, for their own benefit and that of their patients, so that the whole discovery might not be lost to the world if perchance a higher call to eternity had called me away before the completion of the book - an event not so very improbable in my seventy- third year. This fact gave me the first clew that the Homoeopathic physician with such a chronic (non- venereal) case, yea in all cases of (non-venereal) chronic disease, has not only to combat the disease presented before his eyes, and must not view and treat it as if it were a well-defined disease, to be speedily and permanently destroyed and healed by ordinary homoeopathic remedies but that he has always to encounter only some separate fragment of a more deep-seated original disease. The great extent of this is shown in the new symptoms appearing from time to time; so that the Homoeopathic physician must not hope to permanently heal the separate manifestations of this kind in the presumption, hitherto entertained, that they are well-defined, separately existing diseases which can be healed permanently and completely. He, therefore, must first find out as far as possible the whole extent of all the accidents and symptoms belonging, to the unknown Primitive malady before he can hope to discover one or more medicines which may homoeopathically cover the whole of the original disease by means of its peculiar symptoms. By this method he may then be able victoriously to heal and wipe out the malady in its whole extent, consequently also its separate members; that is, all the fragments of a disease appearing in so many various forms. But that the original malady sought for must be also of a miasmatic, chronic nature clearly appeared to me from this circumstance, that after it has once advanced and developed to a certain degree it can never be removed by the strength of any robust constitution, it can never be overcome by the most wholesome diet and order of life, nor will it die out of itself. But it is evermore aggravated, from year to year, through a transition into other and more serious symptoms,* even till the end of manÕs life, like every other chronic, miasmatic sickness; e. This latter, also never passes away of itself, but, even with the most correct mode of life and with the most robust bodily constitution, increases every year and unfolds evermore into new and worse symptoms, and this, also, to the end of manÕs life. So also with similar chronic patients who did not confess such an infection, or, what was probably more frequent, who had, from inattention, not perceived it,. After a careful inquiry it usually turned out that little traces of it (small pustules of itch, herpes, etc. It then became manifest to me, through the aid afforded when using these medicines in similar chronic diseases, in which the patient was unable to show a like cause, that also these cases in which the patient remembered no infection of this kind were of necessity caused by a Psora with which he had been infected, perhaps, even in his cradle, or in some other way that had escaped his memory; and this often received corroboration on a more careful inquiry with the parents or aged relatives. Most painstaking observations as to the aid afforded by the anti-psoric remedies which were added in the first of these eleven years have taught me evermore, how frequently not only the moderate, but also the more severe and the most severe, chronic diseases are of this origin. This observation taught me that not only most of the many cutaneous eruptions which Willan distinguishes with such extreme care from one another, and which have received separate names, but also almost all adventitious formations, from the common wart on the finger up to the largest sarcomatous tumor, from the malformations of the finger-nails up to the swellings of the bones and the curvature of the spine, and many other softenings and deformities of the bones, both at an early and at a more advanced age, are caused by the Psora. So, also, frequent epistaxis, the accumulation of blood in the veins of the rectum and the anus, discharges of blood from the same (blind or flowing piles), haemoptysis, hematemesis, hematuria, and deficient as well as too frequent menstrual discharges, night-sweats of several yearsÕ duration, parchment-like dryness of the skin, diarrhoea of many years, standing, as well as permanent constipation and difficult evacuation of the bowels, long-continued erratic pains, convulsions occurring repeatedly for a number of years, chronic ulcers and inflammations, sarcomatous enlargements and tumors, emaciation, excessive sensitiveness as well as deficiencies in the senses of seeing, hearing, smelling, tasting and feeling; excessive as well as extinguished sexual desire; diseases of the mind and of the soul, from imbecility up to ecstasy, from melancholy up to raging insanity; swoons and vertigo; the so-called diseases of the heart; abdominal complaints and all that is comprehended under hysteria and hypochondria - in short, thousands of tedious ailments of humanity called by pathology with various names, are, with few exceptions, true descendants of this many-formed Psora alone. I was thus instructed by my continued observations, comparisons and experiments in the last years, that the ailments and infirmities of body and soul which, in their manifest complaints, differ, so radically and which, with different patients, appear so very unlike (if they do not belong to the two venereal diseases, syphilis and sycosis), are but partial manifestations of the ancient miasma of leprosy and itch; i. Thus in the year 1813 one patient would be prostrated with only a few symptoms of this plague, a second patient showed only a few but different ailments, while a third, fourth, etc. Then the one or two remedies,* found to be Homoeopathic, healed the whole epidemy, and therefore showed themselves specifically helpful with every patient, though the one might be suffering from symptoms differing from those of others, and almost all seemed to be suffering from different diseases. Thus they never pass away of themselves, but increase and are aggravated even till death. They must therefore all have for their origin and foundation constant chronic miasms, whereby their parasitical existence in the human organism is enabled to continually rise and grow. And, if we except those diseases which have, been created by a perverse medical practice or by deleterious labors in quicksilver, lead, arsenic, etc. At that time and later on among the Israelites the disease seems to have mostly kept the external parts of the body for its chief seat. This was also true of the malady as it prevailed in uncultivated Greece, later in Arabia and, lastly in Europe during the Middle Ages. The different names which were given by different nations to the more or less malignant varieties of leprosy, (the external symptom of Psora) which in many ways deformed the external parts of the body, do not concern us and do not affect the matter, since the nature of this miasmatic itching eruption always remained essentially the same. The talmudic interpreter, Jonathan, explained it as dry itch spread over the body; while the expression, yalephed, is used by Moses for lichen, tetter, herpes (see M. The commentators in the so-called English Bible-work also agree with this definition, Calmet among others saying: Ò Leprosy is similar to an inveterate itch with violent itching. AnthonyÕs Fire), reassumed the form of leprosy through the leprosy which was brought back by the returning crusaders in the thirteenth century. And though it thus spread in Europe even more than before, (for in the year 1226 there were in France alone 2,000 houses for the reception of lepers), this Psora, which now raged as a dreadful eruption, found at least an external alleviation in the means conducive to cleanliness, which also were brought by the crusaders from the Orient; namely, the (cotton? Through both of those means, as well as through the more exquisite diet and refinement in the mode of living introduced by increased cultivation, the external horrors of the Psora within the space of several centuries were at last so far moderated, that, at the end of the fifteenth century it appeared only in the form of the common eruption of itch, just at the time when the other miasmatic chronic disease, syphilis, began (in 1493) to raise its dreadful head. But the state of mankind was not improved thereby; in many respects it grew far worse. For, although in ancient times the eruption of psora appearing as leprosy was very troublesome to those suffering from it, owing to the lancinating pains in, and the violent itching all around the tumors, and scabs, the rest of the body enjoyed a fair share of general health. This was owing to the obstinately persistent eruption on the skin which served as a substitute for the internal psora. And what is of more importance, the horrible and disgusting appearance of the lepers made such a terrible impression on healthy people that they dreaded even their approach; so that the seclusion of most of these patients, and their separation in leper hospitals, kept them apart from other human society and infection from them was thus limited and comparatively rare. In consequence of the very much milder form of the psora during the fourteenth and fifteenth centuries, when it appeared as itch, the few pustules appearing after infection made but little show and could easily be concealed. Nevertheless they were scratched continually because of their unbearable itching, and thus the fluid was diffused around, and the psoric miasma was communicated more certainly and more easily to many other persons, the more it was concealed. For the things rendered unclean by the psoric fluid infected the persons who unwittingly touched them, and thus contaminated far more persons than the lepers, who, on account of their horrible appearance, were carefully avoided. For the miasm has usually been communicated to others before the one from whom it emanates has asked for or received any external repressive remedy against his itching eruption (lead-water, ointment of the white precipitate of mercury), and without confessing that he had an eruption of itch, often even without knowing it himself; yea, without even the physicianÕs or surgeonÕs knowing the exact nature of the eruption which has been repressed by the lotion of lead, etc. It may well be conceived that the poorer and lower classes, who allow the itch to spread on their skin for a long time, until they become an abomination to all around them and are compelled to use something to remove it, must have in the meanwhile infected many. Mankind, therefore, is worse off from the change in the external form of the psora, - from leprosy down to the eruption of itch - not only because this is less visible and more secret and therefore more frequently infectious, but also especially because the Psora, now mitigated externally into a mere itch, and on that account more generally spread, nevertheless still retains unchanged its original dreadful nature. Now, after being more easily repressed, the disease grows all the more unperceived within, and so, in the last three centuries, after the destruction* of its chief symptom (the external skin-eruption) it plays the sad role of causing innumerable secondary symptoms; i. Syphilis and sycosis both have an advantage over the itch disease, in this, that the chancre (or bubo) in the one and the fig-wart in the other never leave the external until they have been either mischievously destroyed through external repressive remedies or have been in a rational manner removed through the simultaneous internal cure of the whole disease. The venereal disease cannot, therefore, break out so long as the chancre is not artificially destroyed by external applications, nor can the secondary ailments of sycosis break out so long as the fig-wart has not been destroyed by faulty practice; for these local symptoms, which act as substitutes for the internal disease, remain standing even until the end of manÕs life, and prevent the breaking out of the internal disease. Then we may be quite certain that we have thoroughly cured the internal disease; i. This good feature psora has lost in the present more and more mitigated nature of its chief symptom, which has changed from leprosy to itch in the last three centuries. The eruption of itch by no means remains as persistently in its place on the skin as the chancre and the fig-wart. Even if the eruption of itch has not (as is nearly always the case) been driven away from the skin through the faulty practices of physicians and quacks by means of desiccating washes, sulphur ointments, drastic purgatives or cupping, it frequently disappears, as we say, of itself; i. It often disappears through some unlucky physical or psychical occurrence, through a violent fright, through continual vexations, deeply-affecting grief, through catching a severe cold, or through a cold temperature (see below, observation 67); through cold, lukewarm and warm river baths or mineral baths, by a fever arising from any cause, or through a different acute disease. The secondary ailments of the internal psora and any one of the innumerable chronic diseases flowing from this origin will then break out sooner or later. But let no one think that the psora which has been thus mitigated in its local symptom, its cutaneous eruption, differs materially from ancient leprosy.

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