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A combi- naton of sulphur and salicylic acid 25mg lopressor visa hypertension case study, which has an additonal antmicrobial acton cheap lopressor 100 mg on-line arrhythmia course certification, is also efectve cheap lopressor 12.5mg overnight delivery arteria fibrillation. Ichthyosis: In ichthyosis discount lopressor 100mg amex arrhythmia headaches, emollients such as aqueous creams and emul- sifying creams should be applied daily (or more frequently in severe cases) to afected skin. Lichen Planus: Lichen planus is a chronic, papular, pruritc skin erupton that occurs typically in middle age and later life; the conditon is ofen mild and may need no treatment. In more severe cases, when the underlying cause cannot be identfed, a topical cortcosteroid ofers the only prospect of remission. Pityriasis Rosea: In pityriasis rosea, a common self-limitng dermatosis that is probably of infectve origin, calamine loton helps to relieve pruritus in most cases. If it does not, topical applicaton of hydro- cortsone in a concentraton not exceeding 1% is worth trying. Betamethasone* Pregnancy Category-C Schedule H Indicatons Severe infammatory skin conditons inluding contact dermatts, atopic dermatts (eczema), seborrhoeic dermatts, lichen planus, psoriasis of the scalp, hands and feet, intractable pruritus; Addison’s disease, Simmond’s disease, bursits. Dose Adult and child- Infammatory skin conditons, over 2 years of age: apply small quantty to the afected area 1 to 2 tmes daily untl improvement occurs, then less frequently. Contraindicatons Untreated skin infectons or broken skin; rosacea; acne; perioral dermatts; systemic infectons unless specifc ant-infectve therapy is employed. Adverse Efects Exacerbaton of local infecton; local atrophic changes partcularly on the face and in skinfolds; characterized by thinning of the dermis; depigmentaton; dilataton of superfcial blood vessels and formaton of striae; perioral dermatts; acne at site of applicaton; suppression of the hypothalamic-pituitary-adrenal axis with prolonged or widespread use (partcularly under occlusion); subcapsular cataract; osteoporosis; glaucoma; intracranial hypertension; psychic instability. Dose Infammatory skin conditons: apply a small quantty to the afected area 1 to 2 tmes daily untl improvement occurs, then less frequently. Contraindicatons Untreated skin infectons or broken skin; rosacea; acne; perioral dermatts. Adverse Efects Exacerbaton of local infecton; atrophic changes (see under Betamethasone) less likely with mild cortcosteroids; but infants and children partcularly susceptble; fuid retenton; hypokalaemia; osteoporosis; impaired wound healing; increased intracranial and intraoccular pressure;negatve nirogen balance. Mild acne is characterized by comedones and a few pustules which heal without scarring, and usually responds to topical therapy alone. In moderate acne, where there are more extensive pustules causing mild scar- ring, oral antbiotcs such as a tetracycline or erythromycin are commonly used. In severe acne, widespread pustules are accom- panied by nodular abscesses and cysts, requiring treatment with estrogens, antandrogens, or retnoids. Since scarring of the skin resultng from severe nodular acne causes major distress, acne should always be treated as soon as possible. Exposure to substances suspected of causing or aggravatng the conditon should be avoided. Systemic treatment must be contnued for several months before a response can be antcipated. During this tme, topical preparatons should be applied to the afected areas to prevent the development of new lesions. Benzoyl peroxide is a keratolytc drug with bacteriostatc actvity against Propionibacterium acnes; treatment is usually started at a lower strength and increased as tolerance develops to the inital irritant reacton. Preparatons containing sulphur, which is bactericidal and promotes desquamaton, are ofen used, and may be combined with salicylic acid, which is a keratolytc agent. However, treatment must be maintained for 2 to 3 months before any beneft is seen and this prolonged course carries the risk of selecton and spread of antbiotc- resistant organisms. Psoriasis: Psoriasis, which afects people of all ages in all countries, is one of the most common chronic dermatoses in industrial- ized countries, and is characterized by epidermal thickening and scaling. Considerable local variatons in its prevalence have been variously atributed to genetc, climatc, nutritonal and ecological factors. Various biological events may trigger psoriasis, such as streptococcal or viral infecton, an emotonal crisis or pregnancy. Psoriasis vulgaris (chronic plaque psoriasis) is the most common form of the conditon, usually afectng extensor surfaces of the limbs and the scalp. Gutate psoriasis, commonly seen in children, is ofen caused by a streptococcal infecton; lesions may disappear following antmicrobial treat- ment. The conditon is also known to resolve spontaneously but more commonly transforms into chronic plaque psoriasis. Dithranol restores the normal rate of epidermal cell prolif- eraton and keratnizaton, and localized psoriasis vulgaris can frequently be cleared by daily applicatons for a period of 2 to 4 weeks. A short contact method of applicaton causes litle, if any, irritaton or staining of normal skin, and is partcularly useful for outpatent management. Good results are ofen obtained when daily applica- tons or baths are combined with exposure to ultraviolet light or sunlight. Emollients containing low concentratons of salicylic acid (1-2%) are a useful adjunct to treatment, partcularly where there is thick scaling. A preparaton containing urea 10%, which has moisturizing, keratolytc and antmitotc propertes, may prove more efectve than an emollient. A mild cortcosteroid such as hydrocortsone may be used on the face and fexures, whereas a potent cortcosteroid such as betamethasone is most appropriate for the scalp, hands and feet. However, when extensive areas of the body surface are involved or when there is erythrodermic psoriasis, sufcient may be absorbed to cause adrenal suppression; also rebound ofen occurs afer stopping treatment, resultng in a more unstable form of psoriasis. Actnic Keratosis: The lesions of actnic keratosis are distributed primarily over sun-exposed areas. Horny growths, which are ofen covered by light brown scales, are usually asymptomatc but can be disfguring. They respond to light cautery and cryosurgery or topical applicaton of 5-fuorouracil over a three-week period. They may regress spontaneously at any tme within months or years of their frst appearance; however, partcularly in immunosup- pressed patents, they may spread and be difcult to cure. Many common, plane and plantar warts can reasonably be lef untreated, but painful or unsightly lesions generally respond to applicaton of preparatons containing salicylic acid. Where available, cryotherapy using liquid nitrogen applied with a coton-tp or a spray is highly efectve; however, freezing the skin can produce temporary or permanent depigmentaton (partcularly on dark skin), and should be used with cauton. Anogenital warts are usually transmited by sexual contact; they should always be treated, although they frequently recur, because of the increased risk of cervical cancer. Podo- phyllum resin, a caustc antmitotc agent, may be applied to small external lesions. The risk of extensive local necrosis and of systemic toxicity excludes the use of podophyllum resin on larger surfaces. Where podophyllum is contraindicated or inefectve surgical removal, electrocautery, cryosurgery and laser therapy are possible optons. Topical applicaton of 5-fuorouracil has been reported to be of value in resistant cases but the treatment is expensive and efcacy is stll under investgaton. Coaltar* Pregnancy Category-C Indicatons Chronic psoriasis, either alone or in combinaton with exposure to ultraviolet light; eczema. Dose Psoriasis: apply 1 to 4 tmes daily, preferably startng with lower strength preparaton.

Opportunistic identification of drug use purchase lopressor 12.5 mg pulse pressure wave qrs complex, and provision of brief health advice generic lopressor 12.5 mg visa blood pressure going up, may be useful in triggering individuals to reflect on safe 12.5mg lopressor blood pressure chart xls, and sometimes to modify discount lopressor 12.5mg without a prescription heart attack while running, their use of drugs. The appropriate response may involve provision of information about health risks and harms, or referral for management. Screening and brief advice from physicians can affect the motivation for change among patients, including those with substance dependence. The doctor must also consider the impact the drug use may be having on children and young people. Relevant information will include family risk factors, such as drug and alcohol misuse, or previous instances of abuse or neglect, but you should not usually share complete records. This section looks at strategies to reduce use in those who are already using drugs. McCambridge and Strang tested brief interventions in young people,16 and found that a single session of motivational interviewing (including discussing illicit drug use) led successfully to reduction in use of these drugs among young people. The intervention took place across 10 further education colleges across inner London, with 200 young people aged 16-20 years who were currently using illegal drugs. Those randomised to motivational interviewing reduced their use of cannabis (and cigarettes and alcohol). Those most at risk benefited the most: for cannabis, the effect was greater among heavier users. The effect of reduction in cannabis use was also greater among youth usually considered vulnerable or high risk according to other criteria – for example young male individuals who smoked cannabis the most frequently, were in receipt of benefits, and had a prior history of selling drugs. In the group that received additional counselling, there was half the rate of drug injection at 6-month follow-up, four times the likelihood of abstinence (confirmed by urinalysis), and significantly lower arrest rates. It requires medical management of the drug use and its sequelae, but also includes referring to other disciplines, such as social services, that can help with the wider aspects of improving quality of life. Medical management of dependent drug use focuses directly on treating physical and mental health issues and may involve prescribing. This section presents some of the safety issues that are important in this context. It considers the appropriate and safe prescribing of drugs of dependence and ways to minimise the risks of diversion, misuse and iatrogenic dependence. Misuse of, and dependence on, prescribed drugs (in particular opioids and benzodiazepines) is a rapidly growing public health problem in many jurisdictions internationally. In addition to minimising misuse, diversion and iatrogenic dependence, the medical professional must consider the physical safety of the prescribed drugs, as is the case in all prescribing. The impact of injudicious prescribing is illustrated in a study from Melbourne, Australia, where researchers investigated the medical attendances of young people who had died of opioid overdoses. Such withdrawal is characterised by autonomic overactivity (tachycardia, hypertension, tremor and sweating), cognitive changes (confusion, agitation, sometimes psychosis) and perceptual disturbances (formication – a tactile hallucination of insects crawling on or in the skin, illusions, visual hallucinations). One role of therapeutic detoxification from illicit drugs is management of a clinical emergency, stabilising the individual and slowing the rate of change to allow their physiology to adapt. A second role is to decrease the distressing or uncomfortable symptoms of withdrawal, and, through this, a third role is to enhance engagement and increase the likelihood of continued abstinence. It is also essential that the medical professional promotes continued engagement and continues to provide support after the detoxification process is complete. This is relevant in considering illicit drug use, as it is usual for people who become dependent on illicit drugs to misuse a range of drugs, including alcohol and benzodiazepines. Where withdrawal from most illicit drugs is not associated with severe morbidity, withdrawal from benzodiazepines often poses a greater risk. Withdrawal symptoms come on within two to three half-lives of the particular benzodiazepine (eg 2-3 days after short- and medium-acting compounds and 7-10 days after long- acting compounds) and usually subside within a few weeks. Others can be managed by specialists, with high-dose diazepam and baclofen, titrated against withdrawal severity in ambulatory settings, but this needs to be backed up with access to inpatient treatment if required, because of the possible severity of the withdrawal symptoms. Methadone or buprenorphine are offered as the first-line treatment in opioid detoxification. Following successful opioid detoxification, patients should be offered and engaged in continued support and monitoring designed to maintain abstinence. The medical professional must also educate the patient regarding the loss of opioid tolerance following detoxification, and the ensuing increased risk of overdose and death if opioids are used again during this period. While the two syndromes are distinct, they share symptoms, including dysphoric mood, fatigue, vivid or unpleasant dreams, insomnia or hypersomnia, increased appetite and psychomotor agitation or retardation. The medical professional should also be aware of the possible responses of patients aiming to reduce their withdrawal symptoms, including relapsing42 and self-medication with other substances. There was a strong, significant correlation between distress experienced during withdrawals and the use of other substances to relieve the distress. The medical professional must also address relapse prevention strategies with those undergoing detoxification. Its use requires significant motivation for compliance and thus its use as an effective therapeutic strategy is limited. A Cochrane review addressing the use of psychostimulants to maintain abstinence from cocaine use found studies in this area to be currently inconclusive. Individuals with cocaine and/or opioid dependence and who are in close contact with a non-drug-using partner benefit from behavioural couples therapy, both during treatment and at follow-up. The earlier members of this population are able to access treatment services, the better the outcome will be for their general physical health, the pregnancy and the neonate. A sensitive, non-judgemental approach is essential in engaging this population and optimising treatment effectiveness. Medical professionals have a role to play not only in portraying this through their own clinical care and manner, but in leading their clinical teams to be approachable, non-judgemental and patient centred in this situation. This will include attention not only to physical healthcare and management of drug use, but sensitive attention to the coexistent psychological difficulties and social concerns that the patient may be experiencing. The medical professional and the full multidisciplinary team will need to address the woman’s fears about the involvement of children’s services; anxiety and guilt about the potential impact of their drug use on their baby;62 and concerns the patient may have about finances, support networks, and coping strategies during pregnancy and their forthcoming parenthood. They also recommend that a variety of methods (eg text messaging) should be used to maintain contact and engagement, and to remind women of upcoming and missed appointments. Multiagency team work is also essential, working with social care professionals and ensuring seamless communication between general practice and the specialist services involved in the patient’s antenatal care, including obstetrics, specialist drug services and any other specialist healthcare services. Multiagency case conferences, with prospective parents invited as participating attendees, will facilitate good inter-team communication and optimise clinical care. Her family were very strict and she was not allowed to have friends outside the community. Between the ages of 10 and 13 she was subjected to regular sexual abuse by an uncle who lived with the family. She once told her mother about the abuse but was told to keep it quiet and not tell anyone, as it would bring shame on the family. She did well at school and started work in a local estate agent’s office when she left school.

In the chromatogram ob- tained with solution (1) the sum of the area of any peak eluting before the principal peak is not greater than the area of the principal peak in the chromatogram obtained with solution (2) (1 cheap lopressor 12.5mg prehypertension headaches. Procedure : The chromatographic procedure may be performed using (a) a column (60 cm × not less than 7 12.5 mg lopressor free shipping heart attack humor. Adjust the sensitivity of the detector so that the height of the principal peak in the chromatogram obtained with solution (2) is 50 to 70% of full-scale deflection lopressor 12.5 mg sale prehypertension cdc. In the chromatogram obtained with solution (1) the sum of the areas of any peaks eluting before the principal peak is not greater than the area of the principal peak in the chromatogram obtained with solution (2) (1 discount lopressor 100mg amex blood pressure cuff. Not more than 10% of the total nitrogen is present in the combined fraction associated with non-retained proteins. Radioimmunoassay was primarily developed by Berson and Yalow* (1959) for the quantitative measurement of insulin in human plasma, which eventually not only revolutionized endocrinilogy as such but also paved the way for the clinical chemistry laboratory practice in general. Before the emergence of radioimmunoassay as an acceptable analytical technique, a number of other methods were employed for the analysis of ‘drugs’ in the plasma. The above methods, undoubtedly, have certain advantages to their credit ; however, the disadvantages outnumbered the advantages, as stated below : Disadvantages (1) Non-specificity of the technique, (2) Non-sensitivity of the method, (3) Involvement of the processes of extraction, purification and concentration of the specimen under investigation, (4) Heat treatment of the specimen resulted invariably in degradation and destruction of the substances, and (5) Many processes involved ultimately make the analysis rigorous and unnecessarily sluggish. It has also proved to be equally important in pharmacokinetic studies and in acute monitoring of patient drug therapy according to Mule et al* (1974). Small molecules (micromolecular) for instance : drugs that may serve as haptens and can normally be made antigenic by coupling them chemically to a macromolecular substance, such as : protein polysaccharide, carbohydrate etc. Animals normally develop antibodies••••• to the injected immunogenic substance as part of their natural immune response. By specificity, is meant the lowest concentration of a compound which can be detected in undiluted body fluid. Sensitivity defines the degree to which an assay can distinguish one compound from another of the same nature and animmunoassay is a function of the particular antibody molecules contained in the antiserum. Specificity of the antiserum is a function of the particular antigen used to immunize the animal. Titer refers to the concentration level of, in the context of the usage, antibody contained in the obtained serum. Immunological reactions by virtue of their specificity allow the discrete identification of single molecular entities in the presence of many-fold higher concentrations of either multiple or chemically identical molecular entities. However, it is pertinent to be noted here that both immunological and immunochemical techniques are capable of providing the much sought after assay systems for pharmaceutical substances present in complex mixtures without the necessity of undergoing through the tedious and cumbersome process of prior extraction and purification required frequently for their respective biological and chemical tests. Interestingly, the radioimmunochemical methods possess the additional advantages of offering exquisite sensitivity as well as enhanced specificity*. Nevertheless, the animal should be genetically a responder with regard to the specific macromolecule carrier and even so to the micromolecule moiety of the immunogenic conjugate. Apparently, it may appear as the most efficient and easiest means to hook-up the micromolecule being made haptenic by any of its available chemically reactive functional groups to the selected carrier molecule. But unfortunately, no matter how many competent animals are immunized with such an immunogenic conjugate, the antisera thus generated cannot contain a population in the total antibody immunoglobulin (IgG) pool that will recognize the chemically reactive group used for coupling to the carrier portion of the conjugate moiety. In case, only a small quantum of antigenic determinants** exist in the hapten before conju- gation to macromolecule the loss of even one functional group can turn out to be critical. Example : Blockade of a single hydroxyl group of morphine in the preparation of morphine immunogen results in an antiserum that is entirely unable to distinguish homologous morphine formsfrom itscorresponding surrogates with unavailable hydroxyl(s)***. Further, the antiserum produced by immunization with such a morphonyl immunogen reacts with codeine either equally or better than morphine. Nevertheless, the antibody and labelled antigen are always present as limiting factors and the concentration of unlabelled antigen (present either as standard solution or as sample under examination) is increased continually. It has been observed that the percentage of antibody-bound labelled antigen declines progressively as a consequence of saturation of the combining sites on the antibody molecule. Antigen Antibody Bound antibody Free antigen (a) + (b) + (c) + Key = Labelled antigen = Unlabelled antigen = Antibody with three binding sites Figure 32. In order to fulfill the requirements of an ideal behaviour the following criteria must be accomplished, namely : (i) The non-radioactive antigen (A) and radioactive antigen (A*) are indistinguishable chemically i. It is usually accomplished by saturating the antibody binding sites with radioactive or labelled antigen, adding known concentration of the non-radioactive (hapten) antigen, in standard solution, to the reaction mixture for the unlabelled antigen from its binding site on the antibody. It is a normal practice, to measure radioactivity with each known unlabelled antigen added (concentration) which is plotted along the X-axis against the radioactivity Y-axis. If a radioactive-labelled form of a substrate (A*) is added to a plasma containing unlabelled-substrate (A) and a limited amount of its specific binding antibody (P), then assuming a dynamic equilibrium exists between (A) and (P), (A*) shall distribute itself evenly among the unlabelled substrate (A). If the binding affinity between (A) and (P) is very high, virtually all the (A*) added will be found until (P) is saturated and at equilibrium. Thus, we have : (A – P + A* – P) A* – P A – P or and Total (A + A*) Total A * Total A where, (A* – P) = Antibody labelled antigen-complex, and = (A – P) = antibody unlabelled antigen-complex. At this juncture, if further (A) is added, it will also compete for the same binding site so that (A* – P) shall be reduced. Still further additions of (A) will cause the (A* – P) concentration to be reduced further. Under these prevailing circumstances the reduction in (A* – P) complex concentration taking place may be predicted as follows : Assuming that P (antibody) has 200 binding sites available and at the initial stage only 20 molecules of (A) is present, sufficient (A*) is added so as to saturate P i. Therefore, virtually all are bound so that : (A – P + A* – P) 100 × = 99 to 100% Total (A + A*) 1 If, then 100 molecules of A are added, there is a total of 300 molecules of (A* + A) competing for 200 binding sites on the antibody (P). Now, when an equilibrium is established, the percentage bound is given by the expression, : (A – P + A* – P) 100 200 100 A*− P 100 × = × Total (A + A*) 1 300 1 Total A * 1 120 100 or = × = 66. However, this particular condition may be tested and verified by making multiple dilutions of an unknown sample and subsequently determining whether the curve of competitive inhibition of binding is superimposable on the standard curve employed for the respective assay. Failure to fulfill this condition precludes a truly quantitative estimation+, and (c) A crude hormone preparation is found to be satisfactory enough both for immunization and for use as a standard, but for the purpose of comparison of values collected from various laboratories, a generally available reference preparation must be used as a standard solution. However, the former type is preferred because of the fact that here the pellet is formed at the bottom of the test tube and the supernatant layer is more easily removed in comparison to the latter type where the pellet is formed at an angle. In case, a centrifuge having relatively less gravitational force is employed then it is absolutely necessary to enhance the centrifugation time until suitable pellets are formed duly. Gamma Counters These are used invariably for the gamma-energy emitting isotopes, for instance : 125I-the more com- mon iodine-isotope. Scintillation Counters These are mostly used for counting beta-energy-emitting isotopes, such as : tritium 3H and 14C-(Carbon-14) isotopes. First and foremost, radioimmunoassays were universally based on the 3H or 14C isotope labelling tech- nique, but this has the main disadvantage of using liquid-scintillation counting. Therefore, the comparatively much simpler technique of gamma-ray counting by labelling compounds with 124I, 125I, or 131I is now being increasingly utilized wherever such labelling is practically feasible. Hence, the experimental condi- tions of incubation of standards and unknowns must be identical for any factors that might affect the extent of the immunochemical reaction, pH, ionic composition, protein content or any other substances of inter- est. However, these conditions may be tested conveniently and can be controlled effectively by preparing standards in hormone free plasma at the same dilution at which unknowns are assayed. It has attained wide recognition and application both in vitro andin vivomeasurements of compounds of interest like insulin, gastrin, glucagon, and growth hormones on one hand ; whereas drugs like : Morphine — Narcotic analgesic, Hydromorphone and — Narcotic analgesic, antitussive and antipyretic, Hydrocodone on the other hand.

To an extent cheap 50mg lopressor free shipping arrhythmia exam, the evaluation of Grabe also incorporated broad public participation in the very extensive and thorough 26 On these issues discount lopressor 25 mg with amex hypertension 5 year old, see Nils Freytag buy cheap lopressor 25mg blood pressure medication heart rate, „Zauber- 12.5 mg lopressor amex hypertension 15090, Wunder-, Geister- und sonstiger Aberglauben“. Preußen und seine Rheinprovinz zwischen Tradition und Moderne (1815-1918), Munich 1998 and Eric J Engstrom, Magnetische Versuche in Berlin, 1789-18 5: Zur Entkörperung magnetischer Glaubwürdigkeit. Ein Beitrag zur Geschichte der gemeinnützig-ökonomischen Presse in Deutschland von 1768 bis 1780. Internationales Archiv für Sozialgeschichte der Literatur 12 (1987), 107-1 , Holger Böning, Pressewesen und Aufklärung - Intelligenzblätter und Volksaufklärer. On enlightenment medicine, see Gunter Mann, Medizin der Aufklärung: Begriff und Abgrenzung. More than the half of all journals dealt with medicine, agriculture, and home economics (Böning 1987, 9 ). As in the case of Reich’s trials (see below), the methods used to create empirical evidence anticipated a public that, after the trials had been completed, would be informed of the results. Hence, the effects of the public can be seen not in the sense of an ‚actor’ on an historical stage, but rather indirectly in the conduct of offcials. Administrative actions addressed a public, even though that public may have been only a fgment of the bureaucrats’ imagination. Prussian bureaucrats got involved just as the public debate had produced a consensus: in various letters to the Reichsanzeiger, Reich’s insistence on material remuneration was questioned on moral grounds, because Reich – as an academic and a member of the republic of letters – was obliged to serve the public good. One commentator weighed „Professor Reich’s responsibilities to humanity“ against his „responsibilities to himself“ and society’s responsibilities to him. Consequently, here again it would be a mistake simply to reduce this enlightened public to the specifc readers of the Reichsanzeiger, i. Although it served a relatively small readership of only two to three thousand subscribers, it’s contributors still understood themselves as speaking for humanity as a whole. They wrote not as readers of the 30 The history of clinical trials remains inadequately researched. As Tröhler 1988 has shown, in Great Britain clinical trial dating back to the 18th century were employed by medical outsiders (Quakers, Scots, and Unitarians). These groups were unable to base their judgments on personal authority or scientifc recognition. The work of Tröhler’s students on numerical arguments in contemporary journals shows that most clinical observations were based at most on four cases (Ulrich Tröhler, Die wissenschaftliche Begründungen therapeutischer Entscheide - oder ‚Evidence-Based Medicines‘ - im Lauf der Geschichte. Results for trials at the Charité hospital have not yet been published (Hess, Engstrom and Thoms 2006). History of Science 36 (1998), 123-149; Harold Mah, Phantasies of the Public Sphere: Rethinking the Habermas of Historians. Journal of Modern History 7 ( 000), 15 -8 ; Thomas Broman, Wie bildet man eine Experten-Sphäre heraus? Instead, as voices of anonymous reason, the contributors lent their voice to the “reasonable and right thinking portions of the public. In this way, Reich’s claim to derive economic advantage from his fever cure was negotiated “under the eyes of the entire nation”, without distinguishing between general, exoteric vs. Ultimately, readers of the Reichsanzeigers agreed that Reich should be remunerated by way of a public subscription. This public in the Habermasian sense rejected state intervention as an illegitimate and arbitrary abuse of power: „The just claims of a humble and well-meaning man such as Prof. And indeed, the clinical trials for which Reich was summoned to Berlin were viewed suspiciously from the outset. The appointed commission made every effort to ensure impartiality and objectivity. Whereas the stable-boy from Torgau had been subject to rigorous scrutiny, Reich was more or less able to design his clinical trials as he saw ft: he oversaw the selection of probands, daily therapy, and the documentation of the treatments. The commission also insisted on the utmost secrecy once it had been informed by Reich of the composition of the remedy and the theoretical basis for its effectiveness. In its fnal report, the commission contributed only a general introduction, leaving it to Reich to write up the summary of the trials’ results. What’s more, the members of the royal commission didn’t even see to their responsibilities as state offcials: although they unanimously confrmed that Reich was a “learned physician and upstanding man” and hence a member of the critical public, they explicitly refrained from passing judgment on the trial results. They concluded that Reich’s remedy had produce “some good, some ambiguous, and some poor results. Indeed, thanks to the new media, the entire medical community participated directly in the trials, even though they were carried out behind the walls of the Charité hospital. The criteria that were laid out were geared toward transparency and public participation, regardless of whether the public was imagined to be a great danger (as was the case for Grabe) or whether it was evoked by the „remedy’s manufacturer” (as was the case for Reich’s fever remedy). Unlike the usual casuistic descriptions of the time, they differed in that they were serial in nature, they compensated for subjective factors, they verifed the results and ensured that they were correctly presented and published. Now criteria of inclusion and exclusion were clearly formulated, whereas before one relied on good fortune. Now only the course of the illness was documented, whereas before verbose interpretations of individual cases and detailed descriptions of every detail was common practice. Now every effort was made to exclude subjective factors, whereas before the personal authority of the observer had ensured the validity of the observation. Now documentation of the trial procedures was authorized by the signature of the proband, before it was eloquence and reputation of the author that attested to it. However, both cases are typical for the concession procedures that evolved over the next three decades for secret remedies. Administrative regulation In the archival fles, we found a continuous tradition of this practice dating from the 18 0s. For earlier decades, there are only a few special cases which provide insight into the regulatory practice (see table 1). Much of the evidence suggests that the administrative regime was established and formalized in the age of the Prussian reforms. The medical offcials who advocated these reforms frst set out to reorganize Berlin, ebefore moving on to Prussia as a whole. Two agencies were involved in these reforms: The Medical Department in the ministry for cultural affairs; and the Scientifc Deputation, to which the capital’s most prominent physicians and scientists were appointed. Because every petitionwas sent to the Medical Department, it functioned as the acting authority over the procedure. The offcers in the Medical Department were rarely impressed by the fabulous stories of miracle cures, altruism, and charity. Offcials demanded that they be sent a sample of the remedy and its formula in a sealed envelope, insisting that they would “keep the secret in strictest confdence”. However, if applicants did agree, then the Medical Department was true to its word and passed the sample on for further testing (step 2 and 3). In general, the Scientifc Deputation initiated a “technical assessment” of the sample. If this theoretical assessment was favorable, the remedies were subjected to practical clinical trials. In general, these trials were conducted neither by the Medical Department nor by the Scientifc Deputation. Instead, chief physicians at the Charité hospital were ordered to carry out the clinical trials.