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[Blood circulation and the trinity. Medical antitrinitarians Michael Servet (1511-1553) and Giorgio Biandrata (1515-1588)].

This paper centers on the relationship between renaissance medicine and antitrinitarianism forming an important part of the radical reformation in 16th century. Antitrinitarians denied the theological concept of the triune Christian God. Modern antitriniarianism was first formulated by Michael Servetus, a Spanish physician. The doctrine soon won disciples in northern Italy (Padua, Pisa, Rome) and in some countries of eastern central Europe (Poland, Moravia, Transylvania). Physicians who believed in or sympathized with antitrinitarianism revolutionized the theory of blood flow. They developed new concepts leading to Harvey's theory of the circulation of the blood. Parts of Servet's theory looked like Paracelsus's mystical idea of the eternal flesh of the body of Christ (Latin limbus aeternus), but later the medicine and natural philosophy of antitrinitarian physicians tended to be empiristic, rational and sometimes materialistic. They contributed heavily to the diffusion and physiological foundation of antitrinitarian concepts like unitarianism, tolerance and irenism.

Blood Circulation↗

[Antiparacelism and Trinity: medical antitrinitarism from Thomas Erastus (1524-1583) to Ernst Soner (1572-1605)].

There were close relationships between Renaissance medicine and antitrinitarianism in 16th and 17th century. Forming an important part of the radical reformation antitrinitarianism won many disciples in the Holy Roman Empire and proved its attraction for physicians. This paper centers on two public scandals in Heidelberg and Altdorf involving the reknown university professors and physicians Thomas Erastus and Ernst Soner. Michael Servetus' new concept of the blood flow through the lungs was discussed in Heidelberg. In Altdorf Caspar Hofmann, Soner's colleague, developed a special theory of the blood flow and corresponded with William Harvey. Erastus and Soner sharply critisized the hermectical and neoplatonical ideas of Paracelsus. Although sympathizing with antitrinitarianism they denounced the Paracelsians as heretics. The Polish antitrinitarians were called Socinians, from Faustus Socinus. Their doctrine tended to be Aristotelic and rationalistic. Soner combined a socinian theology with a heterodox Aristotelianism referring to Andrea Cesalpino. Again after Soner's death some of his pupils and other physicians advocated socinianism in Gdansk (Martin Ruar, Florian Krause, Daniel Zwicker, Valentin Baumgart).

Blood Circulation↗

[Botulinum toxin: from poison to drug. A historical review].

Botulinumtoxin (BTX) is a neurotoxin produced from Clostridium botulinum under anaerobic conditions and is responsible for botulism, a notifiable, bacterial form of food poisoning. The first case of botulism is believed to have occurred in 1735. An epidemic in Southern Germany in 1793 claimed the death of over the half of those patients who had become ill through eating uncooked blood sausages. The term "pharmakon" is Greek and implicates that a drug originates from poison (potion, remedy). Theophrastus Bombast von Hohenheim known as Paracelsus (1493/94-1541) first described this duality with his dictum "alle ding sind gift und nichts on gift; alein die dosis macht das ein ding kein gift ist" (only the dose makes a remedy poisonous). In Baden-Württemberg in 1817, the poet and physician Dr. Justinus Christian Kerner described the symptoms of botulism, so that at this time botulism was also called Kerner disease. Until the turn of the century the reason for poisoning was not known. Van Ermengem succeeded in isolating the anaerobic bacterium causing botulism, but the specific mechanism of BTX was only established after the second World War. In the late seventies the ophthalmologist Dr. Alan Scott used BTX the first time in the treatment of strabismus. The drug was then used in the treatment of several muscle spasticities such as, for example, torticollis or hemifacial spasm. Only recently BTX has been successfully used for focal hyperhidrosis. We review the history of botulinum toxin from its discovery in the nineteenth century and the research into its effect in the middle of the 20th century up to its clinical use at the present time.

Botulinum Toxins↗

Toxicology then and now.

A review of the history of the evolution of the science of toxicology from the original concepts of Paracelsus through the early development of analytical chemistry and its contributions to the detection of toxic substances in foods and drugs as these have led to modern regulatory rules for public protection is presented. The legal actions taken to protect against adulteration of food prior to the early steps by the U.S. Department of Agriculture that concluded with the passage of the 1906 Food and Drug Act are systematically documented. The history is reviewed of the Food and Drug Administration's role in the use of animal toxicity studies to develop reasonable criteria for safety of foods and drugs for man. Modern concepts of molecular distribution, metabolism, and excretion of substances in the animal body are discussed as these impinge on the so-called "protection index." The legal and often litigious controversies over the claimed carcinogenicity of chemical substances is documented with comments on the Delaney dilemma and the role of in vitro tests in toxicology. The review concludes with a discussion of the hazards of use of stochastic mathematical models to assess carcinogenicity and suggests that the criteria employed in the report of the Scientific Committee of the Food Safety Council are properly structured to give a contemporary evaluation of all the currently available data. References give documentation of events over the past 200 years that explain the present state of toxicology as a discipline.

Europe↗

Toxicology: then and now.

Toxicology is "the science of poisons"; more specifically the chemical and physical properties of poisons, their physiological or behavioral effects on living organisms, qualitative, and quantitative methods for their analysis and the development of procedures for the treatment of poisoning. Although the history of poisons dates to the earliest times, the study and the science of toxicology can be traced to Paracelsus (1493-1541) and Orfila (1757-1853). Modern toxicology is characterized by sophisticated scientific investigation and evaluation of toxic exposures. The 20th century is marked by an advanced level of understanding of toxicology. DNA and various biochemicals that maintain cellular functions were discovered. Our level of knowledge of toxic effects on organs and cells is now being revealed at the molecular level. This paper will review the historical progress of clinical and forensic toxicology by exploring analytical techniques in drug analysis, differing biological matrices, clinical toxicology, therapeutic drug management, workplace drug testing, and pharmacodynamic monitoring and pharmacogenetics.

Drug Monitoring↗

Early history and iconography of lupus erythematosus.

In analyzing the history of a certain disease, not only must the particular disease be investigated, but related pathological conditions that exist in a population at a given time must also be addressed. Also, the prevalence of other diseases should be explored, which may have a bearing on the problem under discussion. The history of medicine can help in this respect, revealing the circumstances or the environment when certain diseases (dis)appeared. Terminology must also be explored, and is the point with which we will begin. With regard to lupus, this again is the case (Latin for wolf; lykos ___ in Greek). Taboo and fantasy border semantics because in the naming of the wolf, the image of "tearing apart" or "pulling or ripping off" (a destructive phenomenon) comes into play. Even the Sanskrit word allows such a relation (v_ik, varkate, v_íkah [symbols: see text]). As a consequence, processes of various origin but characterized by ulceration or necrosis (neoplastic, infectious, traumatic, etc), were labeled lupus before the mid-19th century, and no specific pathogenesis was implied. This resulted in considerable confusion, as the books of Willan, Alibert, Cazenave, Schedeland, Hebra, and others prove. We see no purpose in delving further into the history of ulcerative lesions and what was understood early on to be their presumed cause, eg, back to Paracelsus and to the Old Testament ("shekhin" [see text] Hebrew, meaning "ulcer"); or, "cancer," another such descriptive term relating to destruction, taken from the Greek).

Dermatology↗

Anterior chamber angle biometry with ultrasound biomicroscopy after diode laser thermal keratoplasty.

PURPOSE: To evaluate the effect of diode laser thermal keratoplasty (DTK) on the geometry of the anterior chamber angle with ultrasound biomicroscopy (UBM). SETTING: Department of Ophthalmology and Optometry, Paracelsus Private Medical University, Salzburg, Austria. METHODS: In 9 eyes, a Rodenstock DTK (ProLaser Medical Systems) was used to correct hyperopia (n = 6) or hyperopic astigmatism (n = 3). Hyperopia was treated with a single- or double-ring pattern and hyperopic astigmatism, with additional spots in each of the flat half meridians. Ultrasound biomicroscopy measurements of the chamber angle were obtained preoperatively and 3 months postoperatively using a Humphrey UBM 840 system with a 50 MHz transducer. Quantitative measurements were performed at 3-, 6-, 9-, and 12-o'clock positions using a standardized method. RESULTS: No statistically significant differences between the preoperative and postoperative chamber angle measurements were detected. CONCLUSIONS: The results of the UMB measurements were surprising given the flattening of the corneal periphery found by computerized topography, a finding that suggests narrowing of the chamber angle. Shortening of the corneal tissue may result in centripetal traction that affects the trabecular meshwork and results in a relative opening of the chamber angle structures.

Adult↗

Dynamic corneal imaging.

PURPOSE: To determine the clinical practicability of in vivo dynamic corneal imaging (DCI) to assess the individual elastic properties of normal human eyes, eyes with abnormal findings, and eyes after refractive surgery. SETTING: University Eye Clinic, Paracelsus Private Medical University, Salzburg, Austria. METHODS: The DCI method uses sagittal, stepwise, central indentation of the cornea with electronically controlled microprecision motors and sequential registration of videotopography images. The indentation steps are preselected and range from 50 to 800 mum. The computerized analysis of the videotopography images captured during the process uses Zernike polynomials to establish a newly defined flexing curve for normal eyes and eyes with abnormal findings. RESULTS: Dynamic corneal imaging was done in 187 eyes of 103 patients who had clinically healthy corneas, distinct keratoconus, or previous refractive surgery. The method rapidly evaluated artificially and reversibly induced changes in corneal topography in a clinical setting using a modified Placido disk-based computer-assisted videokeratography system with a small cone. In early analysis, the flexing curve showed a significant correlation with the applied indentation depth. Factors influencing the shape of the curve were central corneal thickness, intraocular pressure, and patient age. The DCI method also allowed easy examination of keratoconic corneas and corneas after refractive surgery. CONCLUSIONS: Dynamic corneal imaging induced a reproducible and reversible change in corneal topography corresponding to the different indentation depths. The results indicate that several clinical parameters are correlated with corneal elastic behavior in vivo and that the technology could increase the predictability of refractive corneal surgery and help in the early diagnosis of corneal diseases and with newly developed therapies.

Adult↗

Steroid-protein interaction: from past to present.

In this review, the association between biologically active compounds and proteins is seen in the light of axioms expressed by Paracelsus and Paul Ehrlich long ago, and the physiological significance of the interactions is pointed out. Of the various types of proteins that form noncovalent complexes with steroid hormones, only the serum proteins will be discussed. Recent results, obtained in several laboratories, on the physicochemical properties of the human corticosteroid-binding globulin (CBG, transcortin) makes this glycoprotein perhaps the best known one among the steroid-binding serum proteins. Influence of pH on stability of the complexes, kinetics of the associations and their significance, as well as thermodynamic parameters of complex formation are being discussed. Characteristics of the binding sites are deduced from specificity studies. Influence of the entrance of hydrophilic or hydrophobic substituents into the steroid molecule illuminates the difference between typically hydrophobic binders such as the progesterone-binding globulin (PBG) of the pregnant guinea-pig and typically hydrophilic binders such as CBG. Complete elucidation of the steroid-binding proteins awaits the determination of the amino acid sequence and the X-ray crystallographic analysis of the steroid-protein complex.

Animals↗

St. John's wort and depression: efficacy, safety and tolerability-an update.

St. John's wort (Hypericum perforatum L.) is a medicinal plant traditionally used, both externally and internally, in all Europe for many pathologies. Paracelsus named it "arnica of the nerves" because of its empirical use in nervous diseases. In the last two decades many studies have proved the efficacy of some St. John's wort extracts in mild to moderate depression and it has been successful as an antidepressant both in Europe and the US. Its high efficacy and tolerability is unquestionable and from the clinical studies the activity is comparable to other antidepressants while lacking major side effects, making it a safe antidepressant.However, recently its potential to induce the metabolism of co-administered medications has been reported because it may potentate certain enzymes of the cytochrome P450 enzyme system. This resulted in a lowering of serum concentration of a number of concomitant drugs, including warfarin, digoxin, theophylline, cyclosporin, and indinavir. Many drugs and also several common foods and drinks can influence this enzyme system. So, even if its safety has been well established, physicians should be aware that St. John's wort administration might significantly affect other prescribed medicines.

Depression↗

A scientific reappraisal of the 'principle of similarity'.

In the history of therapeutics, the 'principle of similarity'--the treatment of 'same by same' or of 'like by like'--may be traced back to a number of medical traditions, including the systems of Hippocrates, Paracelsus and Hahnemann. Although in recent years we have witnessed a renaissance of interest in traditional medicines and 'holistic' medical practices, the reliability of the principle of similarity has still to be demonstrated on experimental grounds, and very few studies have been conducted to understand the underlying mechanism(s). Acceptance of this phenomenon requires supporting evidence of possible mechanisms and high-quality studies exploring its effectiveness in clinical medicine. The aim of this work is to provide a rational approach to the analysis of the various aspects of this historical yet also modern medical principle, in order to construct a plausible framework of ideas capable of facilitating further basic and clinical research into this field.

Animals↗

Quantitative definition of toxicity: a mathematical description of life and death with dose and time as variables.

This manuscript raises some fundamental issues about the role of time as a variable in toxicology, with implications for all biological sciences and also for disciplines dealing with inanimate systems. The dose-response has taken center stage ever since its formulation by Paracelsus. Time-responses have been considered in the past in various contexts such as time to tumor development or half-life of a compound in an organism. However, there has been, to my knowledge, no successful attempt to tie together dose and time in a generalizable theory. This paper describes toxicity by the minimum number of variables (dose and time) from a macroscopic point of view. Interestingly, these fundamental considerations of the dose- and time-dependence of toxicity led to a simple mathematical formulation, which consists of parts previously recognized as valid under specific conditions of experimentation (Haber's Law of Inhalation Toxicology, Druckrey's Law of Cancer Development).

Animals↗

Transmuting alpha helices and beta sheets.

Protein architecture involves two main secondary structural classes: alpha helices and beta sheets. Some natural proteins alter their fold in response to changes in solution conditions or as a consequence of mutation. Here, we discuss recent attempts to induce such conformational changes by design: specifically, the motivation and success of efforts to change one protein fold into a different one in response to the 'Paracelsus Challenge'. The results of such efforts may provide a better understanding of the processes that underlie conformational plasticity in proteins.

Amino Acid Sequence↗

Protein alchemy: changing beta-sheet into alpha-helix.

For most proteins the amino acid sequence determines the tertiary structure. The relative importance of the individual amino acids in specifying the fold, however, remains unclear. To highlight this, Creamer and Rose put forth the 'Paracelsus challenge': Design a protein with 50% sequence identity to a protein with a different fold. We have met this challenge by designing a sequence which retains 50% identity to a predominantly beta-sheet protein, but which now adopts a four helix bundle conformation and possesses the attributes of a native protein. Our results emphasize that a subset of the amino acid sequence is sufficient to specify a fold, and have implications both for structure prediction and design.

Amino Acid Sequence↗

Place makes the poison: Wesolowski Award Lecture - 1999.

Paracelsus, the Renaissance figure often called the father of toxicology, is given that credit partly for being the first to note that "the dose makes the poison." Modern understanding of the importance of personal exposure in determining dose, however, indicates that to a large extent as well, "place makes the poison." The relative proximity of a pollution source to people has just as big an impact on its importance as a hazard as does the relative toxicity (including chemical nature and size distribution) of its emissions. The exposure effectiveness (or intake fraction) of common air pollution sources, for example, varies over nearly four orders of magnitude. A place-makes-the-poison perspective not only identifies new relationships and priorities among known sources, but also reveals an entirely new landscape of sources and potential control measures. It, thus, has profound economic and policy implications, which will be examined in the context of particle air pollution in different parts of the world.

Air Pollutants↗

'Healthy' prescribing for the elderly. How to minimize adverse drug effects and prevent 'dementia in a bottle'.

Despite constituting only 11% to 12% of the US population, the elderly use 31% of all prescription and over-the-counter drugs and, unfortunately, are most vulnerable to the adverse effects of drug therapy. Because of age-related physiologic changes and the likelihood of intercurrent disease, elderly patients need individualized prescribing. This requires the practitioner to be familiar with a few drugs in each class that are tolerated by and effective in elderly patients and to adhere to the principles of healthy prescribing, which have application in any setting. In conclusion, the words of Paracelsus (1493-1541) are worth recalling: "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy."

Aged↗

A perspective on the safety of cosmetic products: a position paper of the American Council on Science and Health.

Over the years, some activist groups have targeted cosmetics as possible human health threats, claiming that cosmetic ingredients are not adequately tested for safety and may pose risks to consumers. The groups allege that industry practices related to safety testing are flawed, that there is little government oversight, and that cosmetics contain cancer-causing chemicals and other toxicants. A critical review of the scientific data related to these claims indicates the following: (1) Industry has the primary responsibility to ensure that all ingredients, preservatives, and coformulants used in products are safe for their intended uses. (2) The U.S. Food and Drug Administration (FDA) has regulatory oversight of the cosmetic industry. Its authority includes the banning or restriction of ingredients for safety reasons. (3) The Cosmetic Ingredient Review (CIR), an independent, scientific review board, critically evaluates chemical ingredients used in cosmetics and publishes the results of its findings in the peer-reviewed literature. (4) Health-related allegations about cosmetic ingredients are generally based on the results of high-dose laboratory testing in animals and have little relevance for humans. As true now as when Paracelsus said it in the 16th century, "It is the dose that makes the poison." (5) The health-related allegations involving specific chemicals (e.g., phthalates, parabens, and 1,3-butadiene) fail to consider important scientific studies and recent regulatory conclusions about these chemicals, which have found that they are not hazardous. (6) Animal and human physiology differ in crucial ways, further invalidating simplistic attempts to extrapolate rodent testing to human health risks. The cosmetic industry should be encouraged to publish more of its toxicity studies and safety evaluations, which would aid in dispelling the uncertainty that some consumers have about cosmetic safety.

Animals↗

Current and historical concepts of opiate treatment in psychiatric disorders.

In recent years psychiatric research has rediscovered the theoretical and clinical importance of opiates, especially for the understanding of depressive disorders. However, opiate treatment is not a new therapeutic concept in psychiatry. The use of opium for "melancholia" and "mania" may be traced to ancient classical medicine. After Paracelsus and Sydenham, the psychiatry of the German Romantic Era widely discussed therapeutic opium use with the Engelken family going on to develop a structured opium treatment of depression in the first half of the nineteenth century. Although the underlying scientific problems of psychiatric opium therapy were never solved, it gained an outstanding position as a practical treatment for over 100 years.

Depressive Disorder↗