Pharmacological and other studies

[OCR failure

Epidural analgesia during labour: its influences on pain relief, progress of labour, mode of delivery, maternal and foetal

Background: Today, the availability of regional anaesthesia for labour is considered a reflection of standard obstetric care. This study is to be conducted in a tertiary care centre with all facilities available for proposed end of proving that epidural analgesia is a safe and effective method for both parturient and the foetus in abolishing pain during labour.Methods: A total of 60 parturients were studied. they were randomly divided into two groups Group 1 includes 30 parturients. In this group parturient received epidural analgesia. The loading dose consisted of 10 ml of Bupivacaine 0.1% and Fentanyl 0.0002% (20 mcg). The top up doses were 10 ml of 0.1% Bupivacaine and Fentanyl 0.0002%, administered whenever the parturient complained of pain. When parturients enters into second stage a further 12-15 ml was injected with parturient in sitting position or semi-sitting position. Group 2 - (control group) Includes 30 parturients. In this group parturient was monitored without any analgesia.Results: This prospective study was done to assess the effect of epidural analgesia on the progress of labour and its outcome, to evaluate its efficacy as an analgesic technique and to study the maternal and fetal outcome. The total number of 60 parturients were selected and randomly categorized into two groups. CASE-Those who received epidural analgesia, CONTROL-Those who did not receive any analgesia.Conclusions: Epidural analgesia provides a versatile method of administering effective and satisfactory pain relief to parturient women. The technique should not be considered as a single entity, because the type and the dose of epidural medication can be altered as needed

Study of analeptics

The improvement of lowered conditions of vitality brought on by disease or poisoning must have been a problem engaging the serious attention of people practising the healing art from the earliest days of human civilisation. This led to the use of various agencies, supposed to possess reviving powers, some of which survived through long periods of usage. Therapeutics in early days was purely empirical. Even after considerable advances in the knowledge of the pathology of these lowered conditions of vitality, very little attention was paid to enquiring into the nature of the reviving power of these agencies(by which was perhaps meant the improvement of some symptoms of lowered conditions). In many cases the improvement was due to the strong local irritant action of alcohol and other irritant constituents of the medicaments on the gastric mucosa, setting up a strong reflex stimulation of the respiratory and vasomotor centres and also perhaps partly to alcoholic contents thereof, acting as a diffusible stimulant, and supplying ready nutrition to tissues. A few did act after absorption, and some of these caused improvements in lowered conditions by improving the circulation as cardio -vascular stimulants and a few others really acted through the nervous system, especially through the respiratory and other vital centres.Development of modern surgery brought in its train the use of anaesthetics which have their risks of extreme depression. This inspired an increased study of the nature of reviving drugs. With the rapid increase in the use of barbiturates as basal narcotics and anaesthetics, and also with the occurrence of poisoning, following their therapeutic administration, self- medication or suicidal attempts, the study of analeptic drugs has, in recent years, been engaging a good deal of attention of pharmacologists. Of the older drugs, picrotoxin and strychnine have been very thoroughly investigated, as also coramine and cardiazol amongst the newer synthetic drugs. Caffeine, cocaine, ephedrine, lobeline and a few others have also received some attention.The clinical use of some of these still persists in spite of their questionable status as judged by experimental evidences.No doubt a good number of therapeutic agents are of more or less symptomatic value in combating some of the effects of hypnotics and narcotics. But there is still a good deal of lack of unanimity regarding their usefulness in different stages of depression produced by the narcotics. The importance of the subject therefore called for further study of the analeptics.Moreover, methods employed for the study of the problem were diverse in nature, and most of them had some unsatisfactory feature or other. For a truer evaluation and determination of the comparative worth of these drugs it was found necessary to evolve an efficient method free from those unsatisfactory features. Investigations undertaken for these purposes form the subject of this thesis.Appendix - Two reprints from Quart. J. exper.Physiol. (a) Antagonism of evipan by picrotoxin, coramine and cardiazol. 1939 . 29, 355. || (b) (with J. Raventos). The Clearance of sodium evipan. 1939. 29, 343

Bodily Pain, Combat, and the Politics of Memoirs: Between the American Civil War and the War in Vietnam

This article analyses the languages of wartime pain as seen in British and American memoirs from the American Civil War to the present. How did the rhetoric of wounding in these war memoirs change over time? One of the central shifts lies in the way that wounded men presented themselves as stoic in spite of severe wounding. From 1939, and in an even more dramatic fashion by the war in Vietnam, physical suffering remained a test of manliness, but the tone was defiant and aggressive rather than stoic or resigned. The article also looks at the role of individual publishers and the introduction of psychological dimensions of wounding in latter memoirs. Cet article analyse le langage de la douleur des blessures de guerre par le prisme des mémoires britanniques et américains de la guerre de Sécession à nos jours. Comment le discours sur les blessures a-t-il évolué dans ces mémoires de guerre au fil du temps? L’un des changements pivots est la transformation qu’a subie l’image d’êtres stoïques malgré de graves blessures que se donnaient les hommes blessés. La souffrance physique a toujours été un symbole de virilité, mais à compter de 1939, et de façon nettement plus marquée au moment de la guerre du Vietnam, le ton allait cesser d’être stoïque et résigné pour devenir rebelle et agressif. L’article examine également le rôle de certains éditeurs et l’apparition de dimensions psychologiques des blessures dans les mémoires ultérieurs

Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950

This dissertation considers the differences, as well as the similarities, between midwifery and childbirth practices in Ontario and in Britain in the first half of the twentieth century. Addressing the modernization of medical practices on either side of the Atlantic, the periodization of this project reflects the increasing concerns about maternal and infant morbidity and mortality alongside medical and political attempts to ensure the involvement of trained medical professionals during pregnancy and childbirth. In Britain, the establishment of the 1902 Midwives Act regulated midwifery so that only midwives approved by the Central Midwives’ Board were allowed to practice. British midwives helped to improved maternal and infant health and welfare by making childbirth a co-operative, medically-managed event in conjunction with physicians. The medical training of midwives and physician support meant that British midwives thus participated in, and contributed to, advances in obstetrics through their access to obstetrical medicine and technology. In contrast, physicians in Ontario worked to exclude midwives from participation in the modernization of birth management, emphasizing a physician-exclusive concept of “medicalization”. Under Ontario legislation, only physicians were legally allowed to act as primary attendants during childbirth, and nurses and midwives were prohibited from practicing midwifery. Nurses and midwives in Ontario, unlike their counterparts in Britain, were excluded from developments in obstetrics. This study challenges the medical profession’s claims that the exclusion of midwives in Ontario was necessary for maternal safety or the medicalization of childbirth. The British alternative, where midwives were seen as partners rather than obstacles, illustrates that medicalization in the interest of maternal and infant safety could be integrated, effectively and efficiently, with the work of midwives. By ensuring that midwives were trained medical professionals with access to obstetrical medicine and technology, greater numbers of British women had widespread access to affordable medical attention during childbirth, at an earlier date, than was possible for Ontario mothers having to deal with the physician-centred model. Comparative maternal and infant mortality statistics for the first half of the twentieth century indicate which was the more effective approach in saving mothers and babies

Modernizing Midwifery: Managing Childbirth in Ontario and the British Isles, 1900–1950

This dissertation considers the differences, as well as the similarities, between midwifery and childbirth practices in Ontario and in Britain in the first half of the twentieth century. Addressing the modernization of medical practices on either side of the Atlantic, the periodization of this project reflects the increasing concerns about maternal and infant morbidity and mortality alongside medical and political attempts to ensure the involvement of trained medical professionals during pregnancy and childbirth. In Britain, the establishment of the 1902 Midwives Act regulated midwifery so that only midwives approved by the Central Midwives’ Board were allowed to practice. British midwives helped to improved maternal and infant health and welfare by making childbirth a co-operative, medically-managed event in conjunction with physicians. The medical training of midwives and physician support meant that British midwives thus participated in, and contributed to, advances in obstetrics through their access to obstetrical medicine and technology. In contrast, physicians in Ontario worked to exclude midwives from participation in the modernization of birth management, emphasizing a physician-exclusive concept of “medicalization”. Under Ontario legislation, only physicians were legally allowed to act as primary attendants during childbirth, and nurses and midwives were prohibited from practicing midwifery. Nurses and midwives in Ontario, unlike their counterparts in Britain, were excluded from developments in obstetrics. This study challenges the medical profession’s claims that the exclusion of midwives in Ontario was necessary for maternal safety or the medicalization of childbirth. The British alternative, where midwives were seen as partners rather than obstacles, illustrates that medicalization in the interest of maternal and infant safety could be integrated, effectively and efficiently, with the work of midwives. By ensuring that midwives were trained medical professionals with access to obstetrical medicine and technology, greater numbers of British women had widespread access to affordable medical attention during childbirth, at an earlier date, than was possible for Ontario mothers having to deal with the physician-centred model. Comparative maternal and infant mortality statistics for the first half of the twentieth century indicate which was the more effective approach in saving mothers and babies

Off the Bloodied Grounds: The Civil War and the Professionalization of American Medicine

This dissertation uses the Civil War as a fulcrum to talk about the professionalization of American Medicine. Tracking doctors, nurses, hospitals, surgery, and other treatments, this dissertation describes their progression and professionalization over the nineteenth century. It argues that the Union and Confederacy deal with the Civil War in different ways, with the Confederacy pushing away from standardization and the Union embracing it

Observations on the action of ergotamine

The search for the active principle of ergot was started soon after the introduction of the drug in medicine. Tanret (1875) was the first to crystallise ergotinine in a state of purity, and from the mother liquors of the crystalline alkaloid he obtained an active principle but failed to recognise that it was a separate substance and regarded it as amorphous ergotinine. Later, Kobert (1884) and Jacobi (1897) described the active principle as sphacelinic acid and ch.rysotoxine, Kobert (1884) indeed distinguished a second active principle - the amorphous alkaloid cornutine - which he claimed had pharmacological activity of a different kind and was very toxic. This preparation was not, however, chemically pure and owed its activity to a. single alkaloid, a hydrate of ergotinine. Barger and Carr (1907) first isolated a principle in the form of a crystalline salt, from the caustic liquor from which ergotiniñe had been extracted, and named it ergotoxine.. A little later, _raft (1906) recognised that the amorphous substance left after crystallising out the ergotinine was not identical with the latter but was a second alkaloid. He showed that it could be formed from ergotinine and could be reconverted into the latter. He called it hydro-ergotinine. Barger and Carr (1907) showed by analysis that the two alkaloids, ergotinine and ergotoxine, did differ by a mol. of water. Stoll (1920) discovered a third ergot alkaloid, ergotamine, which crystallised readily and had a physiological activity indistinguishable from that of ergotoxine. This alkaloid could be converted into an inactive isomeride ergotaminine. So four distinct alkaloids of ergot have been found out, viz., ergotinine, ergotoxine (which was isolated as hydrate of ergotinine), ergotamine and ergotaminine. Of the two alkaloids, ergotamine and ergotaminine, the latter had no physiological action. These alkaloids were evidently closely related to ergotinine and ergotoxine. Although the two less soluble ones, i.e. ergotinine and ergotaminine, had very slight physiological activity, they could, however, be changed into the active forms ergotoxine and ergotamine. The various pharmacological effects given by the alkaloids, ergotoxine and ergotamine, were of equal intensity within experimental errors end it was thought by some investigators that they were identical. But physical and chemical evidences showed that the four alkaloids were all quite different and had separate existence