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Matthew :  Ecclesiasticus :  They that be whole need not a physician generic 30 mg accutane with amex skin care shiseido, but they The Lord hath created medicines out of the earth; that are sick buy discount accutane 10 mg line acne 40 year old woman. Matthew :  Ecclesiasticus :  And if the blind lead the blind cheap 5 mg accutane fast delivery skin care clinique, both shall fall into Honour a physician with the honour due unto him the ditch. Ecclesiasticus : – Proverbs :  And God said, Let us make man in our image, after The wringing of the nose shall bring forth blood. Genesis :  Man’s days shall be to one hundred and twenty Xavier Bichat – years. French surgeon, Paris Genesis :  Life is the sum of the functions that resist death. But the men of Sodom were wicked and sinners Attributed before the Lord exceedingly. We cannot therefore deny that a change in just Genesis :  one of an organ’s tissues is frequently enough to Ye shall circumcise the flesh of your foreskin; and it disturb the functions in all the others; yet likewise, shall be a token of the covenant betwixt me and you. Genesis :  Attributed    ·   August Bier – The education of the doctor which goes on after German professor of surgery he has his degree, is, after all, the most important part of his education. A smart mother makes often a better diagnosis Boston Medical and Surgical Journal :  () than a poor doctor. Attributed It has been considered from the point of view of Medical scientists are nice people, but you should the hygienist, the physician, the architect, the not let them treat you. Medicine is like a woman who changes with the Public Health Reports :  (–) fashions. Attributed The public is not always sagacious, but in the long run, it does somehow contrive to find out who are In America there exist professional anaesthetists. A weak person who yields to the It is quite correct to distinguish between medical temptation of denying himself a pleasure. A prestidigitator who, putting metal into your mouth, pulls coins out of your pocket. Can there be a better preparatory school for the The Devil’s Dictionary physician than the study of the natural sciences? A place in which the dead are laid to It is a most gratifying sign of the rapid progress of await the coming of the medical student. The physician can do all he has to do with speed Epigrams and precision, but he must never appear to be in a hurry, and never absent-minded. The Medical Sciences in the German Universities When we know that a case is self-limited or incurable, we are to consider how far it is in our Solitary, meditative observation is the first step in power to palliate or diminish sufferings which we the poetry of research, in the formation of are not competent to remove. Biggs – knife when these chances are lacking is to Professor of Medicine, New York prostitute the splendid art of surgery, and to The human body is the only machine for which render it suspect among the laity and among there are no spare parts. Radio Talk (quoted in Doctor’s Legacy) Quoted in The Great Doctors—A Biographical History of Medicine p. Ltd, ) British reformer Statistics are like women; mirrors of purest You cannot legislate a new layer of cortical gray virtue and truth, or like whores to use as one matter into, or a cirrhosed liver out of, a man. Little, learn more in a year than by abstract reasoning in Brown and Company, Boston () an age. Give the worker the right to work as he is healthy, Atrocis, nec Descipti Prius, Morbi Historia transl. A good Doctor can foresee the fatal outcome Attributed of an incurable illness, when he cannot help, the experienced Doctor will take care not to Sir William Blackstone ‒ aggravate the sick person’s malady by tiring English jurist and injurious efforts; and in an impossible case he will not frustrate himself further with Mala praxis is a great misdemeanor and offence at ineffective solicitude. The Mental Traveller We are convinced that the only genuine medical insurance for this country lies in making the benefits of science available to all practitioners Sir John Bland-Sutton ‒ and to all patients. President of the Royal College of Surgeons of England Foreword to Medial Research, A Mid-century Survey I divided my life into three parts: in the first I learned my profession, in the second I taught it, in the third I enjoy it. Book of Common Prayer The Story of a Surgeon Man that is born of woman, hath but a short time to live. The most dangerous items in a surgical operation Burial of the Dead were the instruments and the surgeon’s fingers. Little, It is extremely difficult for a physician who puts Brown and Company, Boston () too much trust in what he reads to form a proper decision from what he sees. Giovanni Boccaccio ‒ Italian writer To the cure of this disease, neither the knowledge of George Borrow ‒ medicine nor the power of drugs was of any effect, English author whether because the disease was itself fatal or If you must commit suicide, always contrive because the physicians, whose number was to do it as decorously as possible; the decencies, increased by quacks and woman pretenders, could whether of life or of death, should never be lost discover neither cause nor cure, and so few escaped. Independent  October () Richard Bright ‒ William Boyd ‒ English physician, Guy’s Hospital, London British-born Canadian pathologist, Toronto To connect accurate and faithful observations Of all the ailments which may blow out life’s little after death with symptoms displayed during life candle, heart disease is the chief. Bradley ‒ Describing a test for nephritis in  Professor of Poetry, Oxford, England Research, though toilsome, is easy; imaginative Anthelme Brillat-Savarin ‒ vision, though delightful, is difficult. French gastronome Oxford Lectures on Poetry, ‘Shakespeare’s Theatre and Audience’ Tell me what you eat, and I will tell you what you are. Brahmanic saying La Physiologie du Goût () In illness the physician is a father; in convalescence, a friend; when health is restored, Edouard Brissaud ‒ he is a guardian. Russell, Lord Brain   A symptom that cannot be simulated cannot be a ‒ symptom of hysteria. British neurologist Attributed In the post-mortem room we witness the final result of disease, the failure of the body to solve its problems, and there is an obvious Paul Broca ‒ limit to what one can learn about normal business French surgeon and anthropologist transactions from even a daily visit to the Private practice and marriage—those twin bankruptcy court. Canadian Medical Association Journal :  () Letter,  April () Freud’s discovery of unconscious motivation, and the importance of the experiences of early A. Gerard Brom ‒ infancy for the subsequent development of the personality, has profoundly influenced our It is with coarctation surgery as with love: rather conception of human nature, and had lasting easy to do but difficult to understand. Journal of Thoracic and Cardiovascular Surgery :  () Doctors Past and Present ‘The Doctor’s Place in Society’ () The doctor occupies a seat in the front row of the Jacob Bronowski ‒ stalls of the human drama, and is constantly Polish-born British biologist and broadcaster watching, and even intervening in, the tragedies, At bottom, the society of scientists is more comedies and tragi-comedies which form the raw important than their discoveries. Symptoms and Signs in Tropical Medicine In: Manson’s I do not believe that any man fears to be dead, but Tropical Diseases (th edn), G. Saunders () An Essay on Death François Joseph Victor Broussais The ancient Inhabitants of this Island were less troubled with Coughs when they went naked, and ‒ slept in Caves and Woods, than Men now in Paris physician and protagonist of the erroneous Chambers and Feather beds. What determines the feel not themselves dying, and therefore still hope difference between particular diseases is nothing but to live. Ltd () No one should approach the temple of science with the soul of a money changer. Austrian physiologist Journal of Bacteriology :  () Teleology is a lady without whom no biologist can live. Edinburgh physician and author Bulletin of the Johns Hopkins Hospital :  () It is not a case we are treating; it is a living, palpitating, alas, too often suffering fellow creature. Jean de La Bruyère ‒ Lancet :  () French author Symptoms are the body’s mother tongue; signs are There are but three events which concern man: in a foreign language. They are unconscious of Horae Subsecivae Series I, Introduction their birth, they suffer when they die, and they Science and Art are the offspring of light and neglect to live. A long illness seems to be placed between life and Attributed death, in order to make death a comfort both to those who die and to those who remain. Quoted with reference to osteopathy by Reginald Pound in Characters ‘Of Mankind’ (transl. Address,  March () English writer, non-conformist preacher, and philosopher The captain of all these men of death that came William Buchan ‒ against him to take him away was the Scottish physician and medical reformer consumption; for it was that brought him down to the grave.

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Chloramphenicol-induced thrombocytopenia is usually dose-related and proven 5 mg accutane acne x-ray treatments, if not associated with aplastic anemia trusted accutane 10mg skin care for winter, is reversible following discontinuation of the drug accutane 20mg with amex acne jeans shop. Coagulation Malnutrition, renal failure, hepatic failure, malignancy, and medications can all predispose critically ill patients to bleeding. Although many studies have found an association between antibiotics and clinical bleeding (53), in-depth, statistically validated investigations may be necessary to establish causation in complex patients with multiple underlying diseases (54). Dysfunctional platelet aggregation, an important mechanism by which selected antibiotics may cause bleeding, is mostly noted with penicillins. Among penicillins, it is most likely with penicillin G and advanced-generation penicillins (55). The problem is dose- related, may be exacerbated by renal failure, and is additive to other factors seen in critically ill patients that could, in their own right, be associated with dysfunctional platelet aggregation (55,56). Most commonly, the reason for dysfunctional platelet aggregation is that carboxyl groups on the acyl side chain block binding sites located on the platelet surface resulting in the inability of platelet agonists such as adenosine diphosphate to affect aggregation (55). All of these products contain an N-methylthiotetrazole side chain that can interfere with hepatic prothrombin synthesis (59). Sulfonamides can displace warfarin from its binding site on albumin and thereby enhance its bioavailability. Virtually any antimicrobial agent may cause a rash, but this problem occurs most commonly with b-lactams, sulfonamides, fluoroquinolones, and vancomycin (60). Factors that should lead the clinician to suspect a serious drug reaction include facial edema, urticaria, mucosal involvement, palpable or extensive purpura, blisters, fever, or lymphaden- opathy. Maculopapular eruptions associated with antibiotics are especially common, usually occurring within one to two weeks after starting the offending agent and often becoming generalized and pruritic. In patients with thrombocytopenia or other coagulopathies, hemorrhage into the skin may modify the appearance of the rash. In some instances, the likely offending agent can be continued and the rash will stabilize or disappear. In patients with penicillin-induced mild or moderately severe maculopapular rashes, it is generally safe to use cephalosporins (61). If the rash is severe or associated with mucosal lesions or exfoliation, the offending agent should almost always be discontinued. The most commonly implicated antibiotics are the aminopenicillins and sulfonamides. Clinically, the rash can present as symmetrical target lesions, maculopapular and urticarial plaques, and/or vesicular lesions. Stevens–Johnson syndrome can involve mucosae of the eyes, mouth, entire gastrointestinal tract, and the genitourinary tract. Infections (for which the offending antibiotic may have been prescribed), including pneumococcal, mycoplasmal, and staphylococcal infections can cause a similar rash. Stevens–Johnson syndrome can evolve into toxic epidermal necrolysis; mortality of this condition is 30% (62). Sulfonamides are the antibiotics most often associated with toxic epidermal necrolysis. Although the benefits of corticosteroid therapy are unproven, these products are often used for treatment. Severe cases have been associated with angioedema, hypotension, chest pain, and rarely, severe cardiac toxicity and death (20). Incidence may be as high as 47% in patients and is substantially higher in human volunteers (64). One study documented a dose-related increase in circulating histamine concentrations that correlated with the severity of the reaction (65). Histamine antagonists may abort the syndrome in patients who require 548 Granowitz and Brown vancomycin and who continue to have red man syndrome despite slow administration of the drug (63,66). Both may be associated with redness, heat, tenderness and a “cord” at the peripheral catheter site. Therapy for the former is removal of the catheter and appropriate antibacterial agents, while the latter is treated with catheter removal and moist heat. Presence of lymphangitic streaking or purulent drainage from the catheter site generally indicates infection. Antibiotics most likely to cause phlebitis include potassium penicillin, cephalosporins, vancomycin, streptogramins, and amphotericin B. Although routine audiography has been promulgated for some hospitalized patients given potentially ototoxic drugs (67), in practice such testing is not routinely employed. Therefore, the clinician must recognize the circumstances that could result in ototoxicity and take steps to decrease its likelihood. Erythromycin and azithromycin can cause bilateral hearing loss and/or labyrinthine dysfunction that is usually reversible within two weeks of discontinuating the agent (68,69). These complications are dose- related and usually occur in the presence of renal and/or hepatic dysfunction (71). A prospective study in patients with pneumonia documented sensorineural hearing loss in approximately 25% of patients treated with 4 g of erythromycin daily, while no patients who received lesser doses or control agents developed this condition (68). Aminoglycosides cause ototoxicity or vestibular dysfunction in 10% to 22% of patients and it can be permanent (24,72). Cumulative dose is important and clinicians should be wary of administering repeated courses of aminoglyco- sides. Use of an early vancomycin preparation was associated with sensorineural hearing loss (76). Other Neurotoxicities Antibiotics can also occasionally cause peripheral nerve or acute central nervous system dysfunction (e. Most peripheral neuropathies occur with prolonged administration of selected antibiotics (e. Hallucinations, twitching, and seizures can be caused by penicillin, imipenem/cilastatin, ciprofloxacin, and rarely by other b-lactam antibiotics (78,79). Seizures may be the result of b-lactams interfering with the function of the inhibitory neurotransmitter g-aminobutyric acid (80). Intravenous aqueous penicillin G may cause central nervous system toxicity when normal-sized adults are given more than 20 to 50 million units per day (78). Patients with abnormal renal function, hyponatremia, or preexisting brain lesions can experience neuro- toxicity at lower doses. The maximum recommended dose of imipenem-cilastatin in adults with normal renal function is 4 g/day. Animal studies confirm that neurotoxicity with imipenem/cilastatin may be noted at substantially lower blood levels than with other b-lactams (80). Our practice has been to virtually never employ imipenem/cilastatin in doses of >2 g/day unless treating Pseudomonas aeruginosa infections. Seizures have not been noted in more than two decades of regular use at the authors’ institution. Fluoroquinolone use has been associated with central nervous system adverse effects including headache and seizures in 1% to 2% of recipients (83).