Geriatric Medicine

 

Ignatz Leo Nascher MD, 1863-1944, Chief of Clinic at the Mount Sinai Hospital, New York City. Considered “Father” of geriatrics in the United States.

 

 

The Canon of Medicine, written by Avicenna in 1025, was the first book to offer instruction in the care of the aged, foreshadowing modern gerontology and geriatrics. In a chapter entitled “Regimen of Old Age,” Avicenna was concerned with how “old folk need plenty of sleep” and how their bodies should be anointed with oil, and recommended exercises such as walking or horse-riding. Thesis III of the Canon discussed the diet suitable for old people, and dedicated several sections to elderly patients who become constipated.

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The famous Arabic physician, Ibn Al-Jazzar Al-Qayrawani (Algizar, circa 898-980), also wrote a special book on the medicine and health of the elderly, entitled Kitab Tibb al-Machayikh.He also wrote a book on sleep disorders and another one on forgetfulness and how to strengthen memory and a treatise on causes of mortality. Another Arabic physician in the 9th century, Ishaq ibn Hunayn (died 910), the son of Hunayn Ibn Ishaq, wrote a Treatise on Drugs for Forgetfulness.

 

The first modern geriatric hospital was founded in Belgrade, Serbia in 1881 by doctor Laza Lazarevic. In 1909, the term geriatrics was proposed by Dr. Ignatz Leo Nascher, former Chief of Clinic in the Mount Sinai Hospital Outpatient Department (New York City) and a “Father” of geriatrics in the United States.

 

Modern geriatrics in the United Kingdom really began with the “Mother” of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care of older people. Using her experiences as a physician in a London Workhouse infirmary, she believed that merely keeping older people fed until they died was not enough; they needed diagnosis, treatment, care, and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment. The practice of geriatrics in the UK is also one with a rich multi-disciplinary history. It values all the professions, not just medicine, for their contributions in optimizing the well-being and independence of older people.

 

Another “hero” of British Geriatrics is Bernard Isaacs, who described the “giants” of geriatrics mentioned above: immobility and instability, incontinence, and impaired intellect.Isaacs asserted that, if examined closely enough, all common problems with older people relate back to one or more of these giants. The care of older people in the UK has been advanced by the implementation of the National Service Frameworks for Older People, which outlines key areas for attention.

 

In the United States, geriatricians are primary-care physicians who are board-certified in either family medicine or internal medicine and who have also acquired the additional training necessary to obtain the Certificate of Added Qualifications (CAQ) in geriatric medicine. Geriatricians have developed an expanded expertise in the aging process, the impact of aging on illness patterns, drug therapy in seniors, health maintenance, and rehabilitation. They serve in a variety of roles including hospital care, long-term care, home care, and terminal care. They are frequently involved in ethics consultations to represent the unique health and diseases patterns seen in seniors. The model of care practiced by geriatricians is heavily focused on working closely with other disciplines such as nurses, therapists, social workers, and pharmacists.

 

In the United Kingdom, most geriatricians are hospital physicians, whereas some focus on community geriatrics. While originally a distinct clinical specialty, it has been integrated as a specialization of general medicine since the late 1970s.Most geriatricians are, therefore, accredited for both. In contrast to the United States, geriatric medicine is a major specialty in the United Kingdom; geriatricians are the single most numerous internal medicine specialists.

 

Few psychiatrists know the name I.L. Nascher, M.D. Wrote Ewald Busse, M.D., and Dan Blazer, M.D., Ph.D., in their Textbook of Geriatric Psychiatry, published by American Psychiatric Publishing Inc., that Nascher is frequently considered the father of geriatrics and has been credited with coining the word“ geriatrics.”

Ignatz Leo Nascher, M.D., coined the term“ geriatrics.”

Credit: Courtesy of the NYU School of Medicine, Ehrman Medical Library Archives

In an article headlined “Geriatrics” in the New York Medical Journal in 1909, Nascher wrote that the word geriatrics is from the Greek word “geras, meaning old man, and iatrikos, relating to the [word] physician….” In Greek mythology, Geras is an old, shriveled man who represents the spirit of old age; his mother was Nyx, the so-called goddess of the night.

So the term geriatrics means a physician who specializes in the medical care of individuals in old age—the opposite of the term“ pediatrics,” relating to the medical care of children.

Senility “is a distinct period of life,” Nascher wrote,“ a physiological entity … a period of life where degeneration and decay are natural and physiological…. [S]enility and its diseases should be considered apart from maturity and assigned to a separate place in medicine.”

Ignatz Leo Nascher was born in Vienna, Austria, and was brought to the United States as an infant. His formal schooling in New York City led to a degree in pharmacy in 1882 and his M.D. in 1885 from the Department of Medicine of New York University.

He entered medical practice in New York and served in the outpatient clinics of Mt. Sinai Hospital. Years later, in 1916, he took a position at the Department of Public Welfare, then at the Department of Hospitals. In 1931, at his request, he was put in charge of the 1,200-bed City Farm Colony on Roosevelt Island in Manhattan. That facility later became Goldwater Hospital and today is named Coler-Goldwater Memorial Hospital.

He lectured on geriatrics at several medical schools in New York, Boston, and Chicago. He organized the New York Geriatric Society, though its existence was short-lived.

In 1914 Nascher published a 500-page textbook, Geriatrics: The Diseases of Old Age and Their Treatment, which included physiological home and institutional care and medical-legal relations. A second edition was published in 1916. The book is said to be the first publication on geriatrics since the 1881 book by J.M. Charcot, M.D., and Alfred L. Loomis, M.D. titled Clinical Lectures on the Diseases of Old Age. An introduction to Nascher’s book was written by Abraham Jacobi, M.D., president of the New York Academy of Medicine. Jacobi is credited with coining the word“ pediatrics” and establishing pediatrics as a separate medical discipline.

Nascher’s bibliography includes more than 70 titles (among them “The Senile State,” “Senile Debility,” and “The Senile Mentality”) published in various medical journals.

In 1944 he read a paper on chronic brain syndrome at the annual meeting of the recently organized American Geriatric Society, which dedicated the meeting to Nascher and made him an honorary president.

Nascher divided the span of life into three distinct periods: development, maturity, and senescence. His writings constantly emphasized that maturity and senility are different entities and that diseases of each phase require different treatment. Drugs reactions in maturity are different from those in old age, he said. He viewed old age as a period of degenerating and decaying cells and tissues, where the goal is not to cure disease as in maturity, but to return the old person to the previous physiological degenerating phase and retard death.

“Senile degeneration is not a pathology and cannot be halted, though it may be retarded,” he wrote.

He was aware of the social implications of aging and urged that old individuals be encouraged to feel young, maintain a good appearance and positive attitude, and keep occupied. “Courtship and marriage between an old person and one much younger … will produce marked mental rejuvenation.”

In the 1995 book Profiles in Gerontology: A Biographical Dictionary by W. Andrew Achenbaum, Ph.D., and D.M. Albert, the authors wrote that Nascher “was a prophet in every sense of the word.”▪

Brain-Activated Muscle Stimulation Restores Monkeys’ Hand Movement After Paralysis

 

Functional electrical stimulation (FES) devices are currently used for foot drop, a clinical condition seen in patients with stroke or partial spinal cord injury where weak or paralyzed muscles cause the toes to catch on the ground while walking, leading to trips and falls. FES can be activated with shoe sensors, or coordinated with walking movements, to stimulate muscles and lift the toes at the appropriate time during a step. Other FES devices in current clinical use take advantage of the patient’s residual muscle activity. For example, a prosthetic arm can use sensors built into the shoulder, sensing a shrugging motion that is used to stimulate muscles to open or close the hand. However, this is a less precise and less natural method of control, and it is not an option for patients with higher level spinal cord injuries and little or no shoulder and arm movement. For these patients, the creation of a brain-controlled FES device that connects brain activity directly to muscle stimulation would provide an opportunity to restore hand function.

 

According to an article published online in the journal Nature (18 April 18, 2012), an artificial connection between the brain and muscles was able to restore complex hand movements in monkeys following paralysis. The study combined two pieces of technology to create a neuroprosthesis – a device that replaces lost or impaired nervous system function. One piece was a multi-electrode array implanted directly into the brain which served as a brain-computer interface (BCI). The array allowed the study team to detect the activity of about 100 brain cells and decipher the signals that generate arm and hand movements. The second piece was a FES device that delivered electrical current to the paralyzed muscles, causing them to contract. The brain array activated the FES device directly, bypassing the spinal cord to allow intentional, brain-controlled muscle contractions and restore movement. Prior to testing the neuroprosthesis, the authors recorded the brain and muscle activity of two healthy monkeys as the animals performed a task requiring them to reach out, grasp a ball, and release it. The authors then used the data from the brain-controlled FES device to determine the patterns of muscle activity predicted by the brain activity.

 

To test the device, the researchers gave monkeys an anesthetic to locally block nerve activity at the elbow, causing temporary paralysis of the hand. With the aid of the neuroprosthesis, both monkeys regained movement in the paralyzed hand, could pick up and move the ball in a nearly routine manner and complete the task as before. The study also performed grip strength tests, and found that their system restored precision grasping ability. The device allowed voluntary and intentional adjustments in force and grip strength, which are keys to performing everyday tasks naturally and successfully.

 

This new research moves beyond earlier work showing that a similar neuroprosthesis restores monkeys’ ability to flex or extend the wrist despite paralysis. In 2008, a team led by Eberhard Fetz, Ph.D. at the University of Washington in Seattle coupled the activity of single neurons to an FES device similar to the one used for the present study. Monkeys learned to activate individual neurons to control the FES device and move a joystick, and could adapt neurons previously unassociated with wrist movement to complete the task. The authors suggested that this process of learning and adaption plays an important role in how the BCI translates the brain’s activity patterns into adaptive control of the FES device.

ONCOLOGY

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Radiotherapy with or without Chemotherapy in Muscle-Invasive Bladder Cancer

 

Radiotherapy is an alternative to cystectomy in patients with muscle-invasive bladder cancer. In other disease sites, synchronous chemotherapy and radiotherapy has been associated with increased local control and improved survival, as compared with radiotherapy alone. As a result, a study published in the New England Journal of Medicine (2012; 366:1477-1488), was performed to evaluate clinical outcomes when radiotherapy is combined with chemotherapy in muscle-invasive bladder cancer.

 

The multicenter clinical trial randomly assigned 360 patients with muscle-invasive bladder cancer to undergo radiotherapy with or without synchronous chemotherapy. The regimen consisted of fluorouracil (500 mg per square meter of body-surface area per day) during fractions 1 to 5 and 16 to 20 of radiotherapy and mitomycin C (12 mg per square meter) on day 1. Patients were also randomly assigned to undergo either whole-bladder radiotherapy or modified-volume radiotherapy (in which the volume of bladder receiving full-dose radiotherapy was reduced) in a partial 2-by-2 factorial design. The primary end point was survival free of loco-regional disease. Secondary end points included overall survival and toxic effects.

 

Results showed that at 2 years, rates of loco-regional disease-free survival were 67% in the chemo-radiotherapy group and 54% in the radiotherapy group. With a median follow-up of 69.9 months, the hazard ratio in the chemo-radiotherapy group was 0.68; P=0.03). Five-year rates of overall survival were 48% in the chemo-radiotherapy group and 35% in the radiotherapy group (hazard ratio, 0.82; P=0.16). Grade 3 or 4 adverse events were slightly more common in the chemo-radiotherapy group than in the radiotherapy group during treatment (36% vs. 28%, P=0.07) but not during follow-up (8% vs. 16%; P=0.07).

 

According to the authors, synchronous chemotherapy with fluorouracil and mitomycin C combined with radiotherapy significantly improved loco-regional control of bladder cancer, as compared with radiotherapy alone, with no significant increase in adverse events.

ONCOLOGY

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Carboplatin and Paclitaxel with vs. without Bevacizumab in Older Patients with Advanced Non-Small Cell Lung Cancer

 

An earlier randomized clinical trial demonstrated that adding bevacizumab (Avastin) to carboplatin and paclitaxel improved survival in advanced non-small cell lung cancer (NSCLC). However, longer survival was not observed in the subgroup of patients aged 65 years or older.

 

As a result, a study published in the Journal of the American Medical Association (2012;307:1593-1601) was performed to examine whether adding bevacizumab to carboplatin and paclitaxel chemotherapy is associated with improved survival in older patients with NSCLC.

 

The investigation was a retrospective cohort study of 4,168 Medicare beneficiaries aged 65 years or older with stage IIIB or stage IV non-squamous cell NSCLC diagnosed in 2002-2007 in a Surveillance, Epidemiology, and End Results (SEER) region. Patients were categorized into 3 cohorts based on diagnosis year and type of initial chemotherapy administered within 4 months of diagnosis: (1) diagnosis in 2006-2007 and bevacizumab-carboplatin-paclitaxel therapy; (2) diagnosis in 2006-2007 and carboplatin-paclitaxel therapy; or (3) diagnosis in 2002-2005 and carboplatin-paclitaxel therapy. The main outcome measure was overall survival measured from the first date of chemotherapy treatment until death or the censoring date of December 31, 2009.

 

Results showed that the median survival estimates were 9.7 months for bevacizumab-carboplatin-paclitaxel, 8.9 months for carboplatin-paclitaxel in 2006-2007, and 8.0 months for carboplatin-paclitaxel in 2002-2005. One-year survival probabilities were 39.6% for bevacizumab-carboplatin-paclitaxel vs. 40.1% for carboplatin-paclitaxel in 2006-2007 and 35.6% for carboplatin-paclitaxel in 2002-2005. The statistical analysis did not demonstrate a survival advantage for bevacizumab-carboplatin-paclitaxel compared with carboplatin-paclitaxel cohorts alone.

 

According to the authors, adding bevacizumab to carboplatin and paclitaxel chemotherapy was not associated with better survival among Medicare patients with advanced NSCLC.

TARGET HEALTH excels in Regulatory Affairs. Each week we highlight new information in this challenging area.

 

Draft Guidance Issued on Nanotechnology

 

Nanotechnology is an evolving technology that allows scientists to create, explore, and manipulate materials on a scale measured in nanometers – particles so small that they cannot be seen with a regular microscope. The technology has a broad range of potential applications, such as  sophisticated delivery systems targeting specific diseased organs of the body,  packaging of food or altering the look and feel of cosmetics.

 

FDA has issued 2 draft guidance documents that address the use of nanotechnology by the food and cosmetics industries. The two draft guidance documents are: “Assessing the Effects of Significant Manufacturing Process Changes, Including Emerging Technologies, on the Safety and Regulatory Status of Food Ingredients and Food Contact Substances, Including Food Ingredients that are Color Additives“ and “Safety of Nanomaterials in Cosmetic Products.”

 

The food draft guidance describes the factors manufacturers should consider when determining whether changes in manufacturing processes, including those involving nanotechnology, create a significant change that may:

 

  • affect the identity of the food substance;
  • affect the safety of the use of the food substance;
  • affect the regulatory status of the use of the food substance; or
  • warrant a regulatory submission to FDA.

 

The cosmetic product draft guidance discusses the FDA’s current thinking on the safety assessment of nanomaterials when used in cosmetic products. Key points include:

 

  • The legal requirements for cosmetics manufactured using nanomaterials are the same as those for any other cosmetics. While cosmetics are not subject to premarket approval, companies and individuals who market cosmetics are legally responsible for the safety of their products and they must be properly labeled.
  • To conduct safety assessments for cosmetic products containing nanomaterials, standard safety tests may need to be modified or new methods developed.

 

Both guidances encourage manufacturers to consult with the agency before taking their products to market. Such consultation can help FDA experts address questions related to the safety or other attributes of nanotechnology products, or answer questions about their regulatory status. Strong science is critical to FDA’s ongoing review of the products it regulates. FDA is investing in an FDA-wide nanotechnology regulatory science program to further enhance FDA’s scientific capabilities, including developing necessary data and tools to identify properties of nanomaterials and assess the impact they may have on products.

 

The FDA’s current thinking concerning nanomaterials for food and cosmetics uses, explained in the two guidance documents, is not intended to provide guidance to manufacturers about the use of nanomaterials in other products, such as drugs or medical devices, regulated by the FDA. In order to ensure that FDA considers comments on these draft guidances in developing the final guidances, electronic or written comments should be submitted within 90 days of the publication of the notices of availability in the Federal Register. The FDA will carefully consider all relevant, substantive comments during the development of the final guidance documents. Electronic comments can be submitted. Written comments should be submitted to the Division of Dockets Management, (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Room 1061, Rockville, MD 20852.

First Week of April 2012, NYC Central Park

 

Second Week in April 2012, Spring Flowers, Conservatory Garden, Central Park, New York City

 

April 2012, Bethesda Fountain with Spring Flowers Blooming In The Foreground – Central Park; New York City, New York

 

Second Week in April 2012, Spring in Central Park, NYC

 

Third Week in April 2012, Spring Flowers in Central Park, NYC

 

Right now, April 2012, Glorious Spring in Central Park, NYC

 

April 2012, Typical Spring Weekend in Central Park, NYC

Biostatistics at Target Health

 

 

Leigh Ren, Director of Biostatistics at Target Health, leads a team of 4 fulltime biostatisticians at our offices in NY. Leigh Ren started at Target Health in 2002, and in addition to multiple statistical analysis plans (SAPs) and analyses supporting integrated summaries of safety (ISS) and clinical study reports, the Leigh Ren Team has been directly responsible for the statistical planning and analysis for four regulatory approvals in the areas of head lice, emergency contraception, adhesion prevention in cardiac surgery and periodontal disease. There will be many more statistical accomplishments to come.

 

For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website at www.targethealth.com

Snake Venom Reveals Cure for Pain Itself

 

Texas coral snake

 

 

Examining venom from a variety of poisonous snakes, a group of researchers at the University of California, San Francisco has discovered why the 1) ___ of one small black, yellow and red serpent called the Texas coral snake can be so painful. The finding offers insights into chronic and acute pain — and provides new research tools that may help pharmaceutical companies design drugs to combat 2) ___. The venom contains a toxic mixture of chemicals that includes two special proteins that join together, glom tightly onto tiny detectors on human nerve endings and don’t let go. These detectors normally sense acid burns, and after the snake bites, the victim’s brain receives unrelenting signals of an acid-like burn.

 

“Bites from this snake are associated with really intense, unremitting pain,” said David Julius, PhD, the Morris Herzstein Chair in Molecular Biology & Medicine at UCSF, who led the research. “This work helps to explains why and gives us new tools for examining how our 3) ___ perceive pain.” The work, published in Nature, teases apart the components of the Texas coral snake’s 4) ___ and shows how they work in the human body.

 

While common in Texas and Louisiana, the 5) ___ is not considered a major threat to humans. It does not bite people often — doing so only defensively when trapped. When it does, however, its neurotoxic venom is so potent that those bitten often have to be hospitalized and given large doses of morphine and other drugs to dampen the intense pain, which can last for weeks.

 

Venom, Pain, and the Brain

Many of the venoms and toxins in the natural world work by triggering normal mechanisms in the human body designed to detect things like temperature, pressure, and other physical and chemical factors in our 6) ___. All the information the brain receives about sights, smells, textures and tastes comes through molecular detectors. Found at the ends of 7) ___ fibers, these detectors are simply tiny protein channels that can alternatively open or close if they perceive the proper stimulus from a chemical, heat, cold or the pressure of touch. When they do, and when the right balance of openings and closings occurs all over a nerve ending, that nerve will fire, ultimately passing a signal along the nerve 8) ___ that connect the brain with our eyes, noses, fingers, tongues and other surfaces on our bodies.

 

Those various signals say to the brain “hot,” “cold,” “hard,” “soft” or “bitter” — cues that give life to our perception of the world around us. This basic physiology both enables us to experience all the soft, warm, pleasant things in life but also warns our brains about 9) ___. Pain is one of the most important alerts for our brain that we are at risk of 10) ___, causing us to wince, squint, gasp or otherwise pull away to protect ourselves. At the same time, pain often outlives its usefulness as a warning system. In many people with disease or injuries, the pain can become chronic and debilitating. Moreover, not all pain is accurately perceived by the brain. Numerous plants, insects, reptiles and other creatures have evolved the ability to produce 11) ___ or venoms for hunting or to protect themselves against predation. These venoms co-opt the human sensory systems and can trigger severe pain.

 

The venom of the Texas coral snake may be an example of this.. Presumably these toxins have evolved as anti-predatory mechanisms to protect the animal. The research follows up on earlier discoveries made involving the spice of chili peppers, wasabi and mint, and how their chemicals work in the body.

 

How the Venom Works

In the study, Julius’ graduate student Christopher J. Bohlen screened venom taken from numerous snakes and provided by collaborator Elda E. Sanchez of the National Natural Toxins Research Center at Texas A&M University. By exposing neurons cultured in 12) ___ dishes to the various venoms, Bohlen found that the venom from the Texas coral snake targets a receptor protein found on nerve endings all over the body that is sensitive to acid. Our nerves are very sensitive to acid — think lemon juice on a paper cut — and for good reason: 13) ___ is often an early warning sign for injury.

 

The researchers found that the snake venom contains two proteins that bind to each other and attach themselves to the human acid receptors much tighter than acid itself does. The proteins also resist being degraded, which may account for their ability to remain on the channels for a long period of time — much longer than acid would. According to Julius, this accounts for the prolonged, intense pain suffered by people bitten by the coral viper.

 

The toxin provides a tool for looking at the physiological effects of pain 14) ___, he said. It also suggests that naturally produced components of the human body might be able to mimic the effect of the toxin as part of the normal physiology of modulating pain through these receptors. Having an activator for this channel, like the snake venom, will help researchers search for such natural products and use them in the design of new compounds to block pain. Moreover the snake venom was found to target a human protein known as the acid-sensing ion channel 1 (ASIC1). For years, work in the field has focused on a similar receptor called ASIC3. The work on the Texas coral snake has suggested for the first time that ASIC1 may be a viable target for painkillers.

 

ANSWERS: 1) bite; 2) pain; 3) brains; 4) venom; 5) snake; 6) environment; 7) nerve; 8) fibers; 9) dangers; 10) injury; 11) toxins; 12) Petri; 13) acid; 14) receptors

Snakebite Cures

 

Moses had the first recorded snake bite cure. Moses lifts up the brass snake, curing the Israelites of snakebites. Hezekiah called the snake Nehushtan.

 

 

The Nehushtan in the Hebrew Bible, was a sacred object in the form of a snake of brass upon a pole. The priestly source of the Torah says that Moses used a ‘fiery serpent’ to cure the Israelites from snakebites. (Numbers 21:4-9). King Hezekiah (reigned 715 – 687 BCE) instituted a religious iconoclastic reform and destroyed “the brazen serpent that Moses had made; for unto those days the children of Israel did offer to it; and it was called Nehushtan.” (2 Kings 18:4) The tradition of naming it Nehushtan is no older than the time of Hezekiah.

 

In 1508 Michelangelo’s image of the Israelites deliverance from the plague of serpents by the creation of the bronze serpent on the ceiling of the Sistine Chapel.

 

 

Snake cults had been well established in Canaan in the Bronze Age: archaeologists have uncovered serpent cult objects in Bronze Age strata at several pre-Israelite cities in Canaan: two at Megiddo,one at Gezer, one in the sanctum sanctorum of the Area H temple at Hazor, and two at Shechem. According to Lowell K. Handy, the Nehushtan was originally the symbol of a minor god of snakebite-cure within the Temple. The name of this god is unknown, however, the use of “brazen serpent” is a subtle play on words that are based on the metal that the snake is made of (nachash) means “serpent”, while nachoshet means “brass” or “bronze”.

 

The Israelites set out from Mount Hor, where Aaron was buried, to go to the Red Sea. However they had to detour around the land of Edom (Numbers 20:21, 25). Frustrated and impatient, they complained against Yahweh and Moses (Num. 21:4-5). and God sent “fiery serpents“ among them. For the sake of repentant ones, Moses was instructed by God to build a “serpent of bronze” that was used to heal those who looked upon it (Numbers 21:4-9).

 

Snakes were both revered and worshipped and feared by early civilizations. The ancient Egyptians recorded prescribed treatments for snakebites as early as the 13th dynasty in the Brooklyn Papyrus, which includes at least seven venomous species common to the region today, such as the horned vipers. In Judaism, the Nehushtan was a pole with a snake made of copper wrapped around it, similar in appearance to the Rod of Asclepius. The object was considered sacred with the power to heal bites caused by the snakes which had infested the desert, with victims merely having to touch it in order to save themselves from imminent death.

 

Historically, snakebites were seen as a means of execution in some cultures. In medieval Europe, a form of capital punishment was to throw people into snake pits, leaving victims to die from multiple venomous bites. A similar form of punishment was common in Southern Han during China’s Five Dynasties and Ten Kingdoms Period and in India.Snakebites were also used as a form of suicide, most notably by Egyptian queen Cleopatra VII, who reportedly died from the bite of an asp – likely an Egyptian cobra – after hearing of Mark Antony’s death.

 

Snakebite as a surreptitious form of murder has been featured in stories such as Sir Arthur Conan Doyle’s The Adventure of the Speckled Band, but actual occurrences are virtually unheard of, with only a few documented cases.It has been suggested that Boris III of Bulgaria, who was allied to Nazi Germany during World War II, may have been killed with snake venom,although there is no definitive evidence. At least one attempted suicide by snakebite has been documented in medical literature involving a puff adder bite to the hand.

 

The 1861 Prairie Traveler book features a handful of state of the art snakebite treatments that colonial people could use. It was written by Capt Randolf Marcy of the US Army in 1859 as a handbook of instructions for colonists who were heading west in covered wagons. Today it is an interesting source book that reveals the lives of pioneers and settlers. The following snakebite cures are from the Prairie Traveler:

 

Use Plantain and Tobacco: “placing the wounded finger in her mouth, (she) sucked the poison from the puncture for some minutes, repeatedly spitting out the saliva; after which she chewed and mashed some plantain leaves and applied to the wound. Over this she sprinkled some finely-powdered tobacco, and wrapped the finger up in a rag”. For the Native Americans and settlers, plantain had more medicinal functions than can ever be listed. In some Native American languages its name meant “Life Medicine” and it was used for almost everything. Its use in snakebite treatment was so well known to the pioneers and settlers that plantain was commonly known as “snakeweed”. These days we know that plantain is full of a chemical called Aucubin, which is a powerful anti-toxin. Tobacco has been used as a kind of poultice for stings but a more common use is as a coagulant on wounds. It stops bleeding fast and that’s probably how it was being used in the plantain/tobacco snakebite treatment.

 

Use Hartshorn: “Hartshorn applied externally to the wound, and drunk in small quantities diluted with water whenever the patient becomes faint or exhausted from the effects of the poison”. Hartshorn or “hart’s horn” are the horns of the male red deer. Shavings of the horns could be made into oil of hartshorn, salt of hartshorn and spirit of hartshorn, all of which feature ammonia as the active ingredient. True hartshorn was replaced by other compounds of ammonia that didn’t require the rare horns of a red deer stag. The pioneers and settlers of the 1800s almost certainly would have been carrying hartshorn salt with them, or baker’s ammonia. It was the baking powder of the day and is probably the version of hartshorn being recommended in this snakebite cure. It can still be purchased as a baking ingredient.

 

Use a Turtle: “The blood of the turtle was much dried up, which, on account of this extraordinary virtue, the inhabitants dry in the form of small scales or membranes, and carry about them when they travel in this country. Whenever anyone is wounded by a serpent, he takes a couple of pinches of the dried blood internally, and applies a little of it to the wound”.

 

Use lots of Chickens: “An incision having been made in the breast of a living fowl, the bitten part is applied to the wound. If the poison be very deadly, the bird soon evinces symptoms of distress, becomes drowsy, droops its head, and dies. It is replaced by a second, a third, and more if requisite. When, however, the bird no longer exhibits any of the signs just mentioned, the patient is considered to be out of danger. A frog similarly applied is supposed to be equally efficacious”. The 1861 Prairie Traveler book features one snakebite cure that has been widely used in South and Central America for a very long time.

 

 

The snakebite treatment relies on the seed of the cedron tree. It has sometimes been called the rattlesnake bean.

 

Cedron is a large tree that grows 30 to 50 feet high. Its seeds can be up to five inches long. Cedron has been used to treat malaria and fever as well as spasms and convulsions. But it is mostly known for its use treating snakebite. It first came to notice in Britain in 1699.

From the Prairie Traveler: “Cedron, which is a nut that grows on the Isthmus of Panama, and which is sold by the druggists in New York, is said to be an infallible antidote to serpent-bites. In the Bullet. de l’Acad. de Med. for February, 1858, it is stated that a man was bitten at Panama by a coral snake, the most poisonous species on the Isthmus. During the few seconds that it took him to take the cedron from his bag, he was seized with violent pains at the heart and throat; but he had scarcely chewed and swallowed a piece of the nut about the size of a small bean, when the pains ceased as by magic. He chewed a little more, and applied it externally to the wound, when the pains disappeared, and were followed by a copious evacuation of a substance like curdled milk.” The Earthnotes Herb Database advises that to treat snake envenomation, cedron is more commonly used as a tea taken four times a day at one tablespoon per dose. A cloth is also soaked in the tea and applied externally to the wound. To make the tea, steep one ounce of crushed cedron seed in one pint of boiling water for 10 to 15 minutes. The Aztecs also used an infusion of cedron leaves as an antispasmodic and to improve appetite and digestion.

Test Links Strains of Common Parasite to Severe Illness in the Newborn

 

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. The parasite infects most genera of warm-blooded animals, including humans, but the primary host is the cat family. Animals are infected by eating infected meat, by ingestion of feces of a cat that has itself recently been infected, or by transmission from mother to fetus. Cats are the primary source of infection to human hosts, although contact with raw meat, especially pork, is a more significant source of human infections in some countries. Fecal contamination of hands is a significant risk factor. At least 15 distinct T. gondii strain types have been found throughout the world.

 

Pregnant women can become infected with T. gondii through contact with cat feces that contain infectious forms of the parasite or by eating undercooked meat. Women who become infected while pregnant may miscarry, give birth prematurely, or have babies with eye or brain damage.

 

According to an article published online in Clinical Infectious Diseases (11 April 2012; DOI: 10.1093/cid/cis258), strains of the Toxoplasma gondii parasite have been identified that are most strongly associated with premature births and severe birth defects. The research team used a new blood test developed by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, to pinpoint T. gondii strains that children acquire from their acutely infected mothers while in the womb.

 

Currently available blood tests can determine whether a person has ever been infected with any strain of Toxoplasma parasite. The experimental test developed at NIAID improves upon the older tests because it can detect the presence of strain-specific antibodies that distinguish infecting strains from one another. Using the new test, the study found evidence of either type II or NE-II infections in 183 of the mother-child pairs in the national congenital toxoplasmosis study. Statistical analysis revealed that NE-II parasites were more likely to be associated with premature birth, and infants infected with these strains were more likely to have severe manifestations of disease than infants infected by type II parasites. For example, severe eye damage was seen in 67% of NE-II cases (59 out of 88), while such eye damage was present in only 39% of type II cases (18 out of 46). The authors noted, however, that the association is not absolute, and that mild, moderate or severe disease can result regardless of the infecting strain.

 

When the congenital toxoplasmosis study was started in 1981, optimal drug treatment regimens were unknown. Now, thanks in part to controlled clinical trials run under the auspices of the current study, the toxoplasmosis can be successfully treated and many babies who are diagnosed before or shortly after birth and who are treated, suffer few or no ill effects. When the authors looked at the clinical histories of those children in the long-term study who had been diagnosed with congenital toxoplasmosis during gestation and whose mothers had received drug treatment prior to giving birth, the association between NE-II and severe disease at birth vanished The study demonstrated that outcomes are equally good following postnatal treatment for type II and NE-II parasites, although not all outcomes were favorable for all children.

 

In France, all pregnant women are screened for Toxoplasma infection. Prompt treatment is offered to any woman who becomes infected while pregnant, thus lessening the chance that the parasite will damage the fetus. In the United States, obstetrical screening for Toxoplasma infection is rarely practiced. This new study underscores the value of identifying all patients who will benefit from treatment and suggests that widespread screening and treatment of pregnant women who are infected could prevent infants from suffering eye and brain damage due to congenital toxoplasmosis. Unlike in France, where type II is the most common strain detected, the new study found that NE-II parasites predominated (61%) in the United States over the three-decade span of the national collaborative study. NE-II parasites were more common than type II along the Gulf Coast, the Pacific coast and in Hawaii. NE-II strains were also more common among lower-income and rural populations.

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