Mujeres hipnotizadoras, entre la femme fatale y la bruja en la ficción literaria de Arthur Conan Doyle / Hypnotizing women, between the femme fatale and the witch in Arthur Conan Doyle’s literary fiction

La historiografía sobre el mesmerismo y la hipnosis demuestra que hubo pocas mujeres que pusieran en práctica estos conocimientos. Así las cosas, la mujer que hipnotiza a un hombre se convierte en una revolucionaria, en un caso subversivo que da la vuelta no solo a una relación hipnótica clásica sino a una situación social e histórica de claro dominio patriarcal. En este trabajo analizo dos relatos de Arthur Conan Doyle (1859-1930) protagonizados por mujeres hipnotizadoras: John Barrington Cowles (1884) y El parásito (1894). En el caso de John Barrington Cowles la mujer hipnotizadora está basada en el estereotipo literario y fílmico de la femme fatale, que será muy usado en diferentes formatos narrativos durante todo el siglo XX llegando a la actualidad; por otra parte, en el caso de El parásito la mujer hipnotizadora está mucho más cerca del estereotipo literario y folclórico de la bruja. En este sentido, apunto el papel fundamental que el estereotipo de mujer hipnotizadora tiene para los recientes estudios culturales de género. (AU)

The historiography on mesmerism and hypnosis shows that there were few women who put this knowledge into practice. In this sense, it is significant that there are few images of a woman hypnotizing a man and no images of a woman hypnotizing another woman. Thus, the woman who hypnotizes a man becomes a revolutionary, a subversive case that turns around not only a classic hypnotic relationship but also a social and historical situation of clear patriarchal domination. In this paper, I analyze two stories by Arthur Conan Doyle (1859-1930) featuring female hypnotists: John Barrington Cowles (1884) and The Parasite (1894). In the case of John Barrington Cowles, the hypnotizing woman is based on the literary and filmic stereotype of the femme fatale, which will appear in many different narrative formats throughout the 20th century up to the present day. In the case of The Parasite, however, the hypnotizing woman is much closer to the literary and folkloric stereotype of the witch. In this sense, I point out the fundamental role that the stereotype of the hypnotizing woman has played in recent cultural gender studies. (AU)

The Death of Sodium Pentothal: The Rise and Fall of an Anesthetic Turned Lethal.

For nearly a century, sodium pentothal was the undisputed king of anesthetics. Anesthesiologists were not, however, the sole consumers of pentothal, as psychiatrists used it to treat acute anxiety during psychoanalysis. The associated drug-induced inhibitions were attractive not only to psychotherapists, but also to a new generation of policing and Cold War espionage searching for the elusive truth serum. Cameo appearances of pentothal in media, film, and popular culture propagated the anesthetic's negative public image. While legal challenges to the admissibility of pentothal-induced confessions and congressional investigations of clandestine truth serum programs may have tainted the popular anesthetic, it was pentothal's widespread adaptation as part of the lethal injection cocktail that finally killed the king of anesthetics as pharmaceutical companies around the world refused to manufacture what had been transformed into a largely unprofitable drug, associated with capital punishment.

How amytal changed psychopharmacy: off-label uses of sodium amytal (1920-40).

In the early 1930s, American neurologist and psychiatrist William Bleckwenn used sodium amytal to render catatonic patients responsive, so that he could engage in talk therapy. Bleckwenn found a new, 'off-label' use for this anaesthetic and anxiolytic medication in psychiatry and, in doing so, allowed for important discoveries in the diagnosis and treatment of catatonia. Pharmacological textbooks reveal a 'label', while the Index-Catalogue of the Library of the Surgeon-General's Office reveals explorations 'off label' of barbiturates. The 'off-label' use of barbiturates facilitated talk therapy, heralding an important shift in psychopharmacy. Drugs previously only used as chemical restraints became a form of treatment for specific psychiatric diseases. The current strictures against off-label prescribing are overprescriptive and close off innovative new uses.

Evidence of mechanism in the evaluation of streptomycin and thalidomide.

This paper considers what evidence is needed to establish the effectiveness and safety of a drug therapy. The claim that A cures D is a particular case of a causal claim in medicine. So the paper begins with a general analysis of the evidence for causal claims in medicine. Such evidence is divided into two types: statistical evidence and evidence of mechanism. These are further divided into observational and interventional, producing a 2x2 classification. It is shown that historically there have different assessments of the importance of these different types of evidence. Evidence-based medicine (EBM) puts forward the thesis that claims of the form 'A cures D without harming the patient' can be established using only randomized controlled trials or RCTs. This thesis of EBM is criticized by considering two historical examples: streptomycin and thalidomide. Generalizing from these, it is claimed that the effectiveness and safety of a drug therapy can only be established by using both statistical evidence and evidence of mechanism. This is a specific instance of the Russo-Williamson thesis.

[Not Available] / Randnotizen als Lebensspuren?

Are marginal notes marginal? Backed by a book from the private library of Emil von Behring the paper reflects whether annotations are peripheral sources or whether they can give some hints concerning biographical details. Behring's traces of reading are exposed and discussed by using the example of Otto Rot's Arzneimittel der heutigen Medicin (1877). The marginal notes demonstrate Behring's intensive work on hypnotics, sedativs, and analgetics which were possibly used for the therapy of others or himself. The findings will be compared to other sources of Behring's personal papers.

The History of Target-Controlled Infusion.

Target-controlled infusion (TCI) is a technique of infusing IV drugs to achieve a user-defined predicted ("target") drug concentration in a specific body compartment or tissue of interest. In this review, we describe the pharmacokinetic principles of TCI, the development of TCI systems, and technical and regulatory issues addressed in prototype development. We also describe the launch of the current clinically available systems.

Lethal Lullabies: A History of Opium Use in Infants.

Poppy extract accompanied the human infant for more than 3 millenia. Motives for its use included excessive crying, suspected pain, and diarrhea. In antiquity, infantile sleeplessness was regarded as a disease. When treatment with opium was recommended by Galen, Rhazes, and Avicenna, baby sedation made its way into early medical treatises and pediatric instructions. Dabbing maternal nipples with bitter substances and drugging the infant with opium were used to hasten weaning. A freerider of gum lancing, opiates joined the treatment of difficult teething in the 17th century. Foundling hospitals and wet-nurses used them extensively. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were marketed under names such as soothers, nostrums, anodynes, cordials, preservatives, and specifics and sold at the doorstep or in grocery stores. Opium's toxicity for infants was common knowledge; thousands of cases of lethal intoxication had been reported from antiquity. What is remarkable is that the willingness to use it in infants persisted and that physicians continued to prescribe it for babies. Unregulated trade, and even that protected by governments, led to greatly increased private use of opiates during the 19th century. Intoxication became a significant factor in infant mortality. As late as 1912, the International Hague Convention forced governments to implement legislation that effectively curtailed access to opium and broke the dangerous habit of sedating infants.

O uso da talidomida em seres humanos e animais ­ passado, presente e futuro / The use of thalidomide in people and animals ­ past, present and future / El uso de talidomida en seres humanos y animales ­ pasado, presente y futuro

A talidomida foi desenvolvida na década de 50 do século XX, e foi amplamente utilizada como um sedativo-hipnótico e como fármaco contra enjoos durante a gestação. No final da década de 60 ela foi retirada do mercado devido ao seu catastrófico efeito colateral de teratogenicidade. Contudo, o próprio mecanismo que é basicamente responsável pela sua teratogenicidade é também responsável por uma de suas muitas propriedades farmacológicas potencialmente benéficas e desejáveis, a anti-angiogênese. Felizmente, as pesquisas dos efeitos terapêuticos da droga não se cessaram e em 1998 o fármaco foi aprovado pelo Food and Drug Administration (FDA) para tratamento do eritema nodoso leproso e em 2006 para tratamento de mieloma múltiplo. Hoje, quase 40 anos depois, a mesma temida talidomida ressurge como fármaco de propriedades imunomoduladoras e antiangiogênicas, com potencial para tratamento de doenças inflamatórias, infecciosas e neoplásicas. Na medicina veterinária ainda pouco se sabe sobre os efeitos terapêuticos do fármaco, entretanto, o sucesso terapêutico do fármaco já fora observado em diversas situações clínicas em pessoas e em testes com animais, podendo existir indicação nas doenças homólogas na medicina veterinária. Este artigo traz uma revisão de literatura sobre a talidomida e suas aplicações reais e potenciais em medicina veterinária.(AU)

Thalidomide was developed in the 1950's and was broadly used as a hypnotic-sedative drug and against nausea during pregnancy. At the end of the 1960's, the drug was withdrawn from the market due to its catastrophic side effect, teratogenicity. However, the anti-angiogenic action, which is the mechanism of action that is responsible for thalidomide´s teratogenicity is also responsible for one of the several potentially useful and desired pharmacologic properties. Fortunately, investigations on the therapeutic effects of thalidomide did not cease and in 1998, the drug was approved by the Food and Drug Administration (FDA) to treat erythema nodosum leprosum and, in 2006, for treating multiple myeloma. Nowadays, almost 40 years later, the same feared thalidomide is reborn as a pharmacologic agent with immunomodulatory and anti-angiogenic properties, with potential to treat inflammatory, infectious and neoplastic diseases. In veterinary medicine, very little is known about the useful healing effects of thalidomide. However, the drug therapeutic success has already been noted in several clinical situations in both animal tests and investigations with medical patients. This paper presents a literature review of thalidomide's real and potential applications in veterinary medicine.(AU)

La talidomida fue desarrollada en los años 50 del siglo XX, y fue ampliamente empleada como sedativo e hipnótico y como fármaco contra nauseas durante el embarazo. A finales de los años 60 ella fue retirada del mercado debido a su efecto secundario catastrófico de teratogenicidad. Sin embargo, el propio mecanismo que es básicamente responsable por su teratogenicidad es también responsable por una de las muchas propiedades farmacológicas potencialmente beneficiosas y deseables, la antiangiogénesis. Afortunadamente, las investigaciones de los efectos terapéuticos de la droga nunca se ha cesado y en 1998 el medicamento fue aprobado por Food and Drug Administration (FDA) para tratamiento del eritema nudoso leproso, y en 2006 para tratamiento del mieloma múltiple. Hoy, casi 40 años después, la misma y temida talidomida reaparece como medicamento con propiedades inmunomoduladoras y antiangiogénicas, con potencial para el tratamiento de enfermedades inflamatorias, infecciosas y neoplásicas. En medicina veterinaria, se sabe poco sobre los efectos terapéuticos del fármaco, sin embargo, el éxito terapéutico del medicamento se ha observado en varias situaciones clínicas en personas y en ensayos con animales, y puede ser indicado en las enfermedades homólogas en medicina veterinaria. Este artículo trae una revisión de literatura sobre la talidomida y sus aplicaciones reales y potenciales en medicina veterinaria.(AU)

Pioneering early Intensive Care Medicine by the 'Scandinavian Method' of treatment for severe acute barbiturate poisoning.

Between the 1920s and the mid-1950s, barbiturates were the sedative-hypnotic agents most used in clinical practice. Their ready availability and narrow therapeutic margin accounted for disturbingly high rates of acute poisoning, whether suicidal or accidental. Until the late 1940s, medical treatment was relatively ineffective, with mortality subsequently high - not only from the effects of coma, respiratory depression and cardiovascular shock with renal impairment, but also from complications of the heavy use in the 1930s and 1940s of analeptic stimulating agents. Incidence of barbiturate intoxication increased substantially following World War II and this paper details development of what became known as the 'Scandinavian Method' of treatment, which contributed substantially to the earliest establishment of intensive care units and to the practice and methods of intensive care medicine. Three names stand out for the pioneering of this treatment. Successively, psychiatrist, Aage Kirkegaard, for introducing effective anti-shock fluid therapy; anaesthetist, Eric Nilsson, for introducing anaesthesiologic principles, including manual intermittent positive pressure ventilation into management; and, psychiatrist, Carl Clemmesen, for introducing centralisation of seriously poisoned patients in a dedicated unit. Clemmesen's Intoxication Unit opened at the Bispebjerg Hospital, Copenhagen, on 1 October 1949. ICU pioneer Bjørn Ibsen suggested it was the initial ICU, while noting that it supplied Intensive Therapy for one type of disorder only (as had HCA Lassen's Blegdam Hospital unit for Denmark's 1952 to 1953 polio epidemic). Treatment for barbiturate poisoning during the 1950s in some other Scandinavian hospitals will also be considered briefly.

The evil of the unknown--risk-benefit evaluation of new synthetic drugs in the 19th century.

In the 19th century, synthetic chemistry discovered completely new chemical entities for medicinal use, which dramatically enriched the therapeutic armamentarium. However, no information was available regarding the safety of these new drugs, which were unrelated to most of the medicinal agents formerly known. Therefore, the question arises, if and how far, considerations regarding the relationship between benefit and risks were made. In this study, chloroform, phenazone (antipyrine) and sulfonal, were investigated as examples for drugs newly introduced in the 19th century. The results revealed that these drugs were provided by the manufacturer, tested by the physicians in a multicentre pattern and side effects were published in the medical literature soon after. Within a few years, several hundred cases were reported but the data were rarely summarized statistically. Therefore, physicians needed to stay updated with the medical literature because neither systematic industrial research nor regulatory authorities existed. The number of case reports within the first years were sufficient to detect common (> 1/100 to < 1/10) side effects but rare events were also reported. An extraordinary example is the drug-induced toxic epidermal necrolysis, which is commonly known as the Lyell syndrome or its less severe form, the Stevens-Johnson syndrome. This reaction has been clearly described by Baruch Spitz (1854-1932) as a side effect of antipyrine in 1887, several decades before Stevens, Johnson and particularly Lyell.

[On the history of barbiturates]. / Pionerer bag barbituraterne.

Throughout the history of humanity, numerous therapeutic agents have been employed for their sedative and hypnotic properties such as opium, henbane (Hyoscyamus niger) and deadly nightshade (Atropa belladonna), but also alcohol and wine. In the 19th century potassium bromide was introduced as a sedative - and antiepileptic drug and chloral hydrate as sedative-hypnotics. A new era was reached by the introduction of barbiturates. The story started with the chemist Adolf von Baeyer. His breakthrough in the synthesis of new agents as barbituric acid and indigo and his education of young chemists was of great importance for the science of organic chemistry and the development of the dye and medicine industry in the late 19th century. The next important step was the development of barbiturates. The pioneers were Josef von Mering and Emil Fischer. Using the Grimaux-method they synthesized various barbiturates. It was von Mering who got the idea of introducing ethyl groups in the inactive barbituric acid to obtain sedatives, but the synthesis was succeeded by the chemist Emil Fischer. Experiments with dogs clearly showed sedative and hypnotic effect of the barbiturates and the oral administration of barbital (Veronal) confirmed the effect in humans. Barbital was commercialized in 1903 and in 1911 phenobarbital (Luminal) was introduced in the clinic, and this drug showed hypnotic and antiepileptic effects. Thereafter a lot of new barbiturates appeared. Dangerous properties of the drugs were recognized as abuse, addiction, and poisoning. An optimum treatment of acute barbiturate intoxication was obtained by the "Scandinavian method", which was developed in the Poison Centre of the Bispebjerg Hospital in Copenhagen. The centre was established by Carl Clemmesen in 1949 and the intensive care treatment reduced the mortality of the admitted persons from 20% to less than 2%. To-day only a few barbiturates are used in connection with anaesthesia and for the treatment of epilepsy, and chemists are focusing on drugs with more selective effects.

The pharmacology of medieval sedatives: the "Great Rest" of the Antidotarium Nicolai.

ETHNOPHARMACOLOGICAL RELEVANCE: Past practices of compound drugs from different plant ingredients enjoyed remarkable longevity over centuries yet are largely dismissed by modern science as subtherapeutic, lethal or fanciful. AIM OF THE STUDY: To examine the phytochemical content of a popular medieval opiate drug called the "Great Rest" and gauge the bioavailability and combined effects of its alkaloid compounds (morphine, codeine, hyoscyamine, scopolamine) on the human body according to modern pharmacokinetic and pharmacodynamic parameters established for these compounds. CALCULATIONS AND THEORY: We reviewed the most recent studies on the pharmacodynamics of morphine, codeine, hyoscyamine and scopolamine to ascertain plasma concentrations required for different physiological effects and applied these findings to dosage of the Great Rest. RESULTS: Given the proportional quantities of the alkaloid rich plants, we calculate the optimal dose of Great Rest to be 3.1±0.1-5.3±0.76 g and reveal that the lethal dose of Great Rest is double the therapeutic concentration where all three alkaloid compounds are biologically active. CONCLUSION: This study helps establish the effective dose (ED50), toxic dose (TD50) and lethal dose (LD50) rates for the ingestion of raw opium, henbane and mandrake, and describes their probable combined effects, which may be applied to similar types of pre-modern pharmaceuticals to reveal the empirical logic behind past practices.

'Rapid tranquillisation': an historical perspective on its emergence in the context of the development of antipsychotic medications.

This paper examines factors involved in the theory and practice of emergency sedation for behavioural disturbance in psychiatry in the mid-twentieth century, and the emergence of the concept of 'rapid tranquillisation'. The practice received little attention until the arrival of antipsychotic drugs, which replaced older sedatives and became the agents most strongly associated with the treatment of aggression and challenging behaviour. Emergency sedation was subsequently portrayed in psychiatric literature and advertising as a therapeutic and diagnosis-driven endeavour, and the concept of rapid tranquillisation emerged in this context in the 1970s. Use of non-antipsychotic sedatives, like the benzodiazepines, is barely visible in contemporary sources, and the research suggests that antipsychotics became the mainstay of rapid tranquillisation strategies because of beliefs about their specific therapeutic properties in psychosis and schizophrenia, and not because of demonstrated superiority over other agents.

Insomnio y muerte de Marilyn Monroe. Parte II: muerte / No disponible

Objetivo: Evaluar las circunstancias de la muerte de Marilyn Monroe (MM) desde un punto de vista médico, e intentar reconstruir el tratamiento prescrito para su insomnio crónico. Material y métodos: Documentación original de la investigación policial y médico-forense sobre su muerte, recetas de medicamentos y otros documentos de interés, testimonios directos de los testigos principales y valoración de conflictos de intereses. Resultados: MM falleció la noche del sábado 4 de agosto de 1962 a causa de una sobredosis de fármacos hipnóticos. Existió una divergencia entre la investigación policial, que valoró la muerte como accidental, y la forense, que prevaleció, y que la clasificó de "probable suicidio". Este dictamen se apoyó en una "autopsia psicológica", externa a la investigación oficial, llevada a cabo por especialistas en salud mental relacionados profesionalmente con el Dr. Greenson, psiquiatra de MM y fuente principal de esta investigación, la cual ignoró los hallazgos policiales. Parece probable que sus médicos mintieran sobre la hora y circunstancias de la muerte y retrasaran el aviso a la policía, que el cuerpo fuera cambiado de posición durante ese tiempo y que se intentara justificar la presencia de una cantidad de pentobarbital que no figuraba en ninguna parte. El Dr. Engelberg prescribió al menos diez fármacos psicoactivos en los dos últimos meses de vida de MM, aunque después lo negaría. Las conclusiones de la investigación forense parecen contaminadas por un problema de corporativismo médico. El tratamiento prescrito para el insomnio fue inadecuado, incluso para los estándares de la época (AU)

Objective: To evaluate the circumstances of Marilyn Monroe’s death from a medical perspective, and to try to reconstruct the treatment prescribed to her for chronic insomnia. Material and methods. Original documents from the police and forensic investigations on her death, drug prescriptions and other valuable documents, direct accounts from the main witnesses and assessment of conflicts of interest. Results. MM died on the night of August 4, 1962 from an overdose of hypnotic drugs. There was a divergence between the police investigation, which labelled the death as accidental, and the forensic one, which prevailed and described it as a ‘probable suicide’. This opinion relied on a ‘psychological autopsy,’ external to the official investigation, carried out by mental health specialists professionally related to Dr. Greenson, MM’s psychiatrist and the major source for this investigation, which ignored police findings. It seems likely that her doctors lied about the hour and circumstances of her death, and delayed the call to the police, that the position of the body was changed during this time, and that they tried to justify the presence of an unaccounted for quantity of pentobarbital. Dr. Engelberg prescribed al least ten different psychoactive drugs during the last two months of MM’s life, although he would later deny it. The conclusions of the forensic investigation seem contaminated by a problem of medical corporatism. The treatment prescribed for insomnia was inadequate, even for the period standards (AU)

Insomnio y muerte de Marilyn Monroe. Parte I: Insomnio / No disponible

Objetivo: Conocer la historia clínica del insomnio de Marilyn Monroe (MM) y de quiénes, y con qué criterio, cuidaron del mismo. Material y métodos: Empleo de información gráfica (documentos y fotografías) de origen contrastado, testimonios directos de testigos verificables y valoración de conflictos de intereses. Resultados: MM daba importancia al sueño nocturno para presentar un buen aspecto en su trabajo. Desarrolló insomnio durante su ascenso a la fama en el contexto de un problema de pánico escénico y su adicción a barbitúricos pudo iniciarse por la facilidad para obtenerlos. Se interesó por el psicoanálisis como vía de autoconocimiento personal y mejora interpretativa. Sus psiquiatras basaron su tratamiento en el psicoanálisis freudiano y un uso intensivo de fármacos, sobre todo barbitúricos, pero esta estrategia fracasó. La relación médico-paciente con su último psiquiatra, el Dr. Greenson, fue particularmente anómala. En sus últimos meses de vida, MM fue tratada con cerca de una docena de psicofármacos, sobre todo barbitúricos, pero también otros hipnóticos y ocasionalmente anfetaminas. Discusión: Los fármacos complicaron la evolución del insomnio de MM y ejercieron un efecto negativo sobre su salud general y su comportamiento, situación que suelen ignorar los diversos diagnósticos psiquiátricos que se le otorgan. Dada la falta de control médico, la presencia de intereses espurios, y una paciente que creía tener bajo un control razonable su consumo de fármacos, la aparición de una complicación grave sólo era cuestión de tiempo(AU)

Objective: To understand Marilyn Monroe’s (MM) insomnia clinical history, and how and by whom it was managed. Materials and method: Use of graphic information (documents and photographs) from verified sources, direct accounts from reliable witnesses, and assessment of conflicts of interest. Results: MM valued nocturnal sleep as a way to keep her good looks at work. She developed insomnia during her raise to fame in the context of stage fright, and might have become addicted to barbiturates because she had an easy access to them. She became interested in psychoanalysis as a way of self-knowledge and acting improvement. Her psychiatrists based their treatment in Freudian psychoanalysis and an intensive use of drugs, mostly barbiturates, but this approach failed. The doctor-patient relationship with her last psychiatrist, Dr. Greenson, was particularly anomalous. During the last months of her life, MM was prescribed close to a dozen different psychoactive drugs, mostly barbiturates, but also other hypnotic drugs, and occasionally amphetamines. Discussion: Drugs complicated the course of MM’s insomnia and had a negative effect on her general health and behaviour, a situation that is usually ignored by the various psychiatric diagnoses given to her. Due to a lack of real medical control, the presence of spurious interests, and a patient who thought she had reasonable control on her drug intake, a severe problem was just a matter of time(AU)

Sodium amobarbital: historical perspectives and neurorehabilitation clinical caveats.

The sodium amobarbital (amytal) (SA) interview is a technique that has been utilized in the treatment of a variety of disorders since its introduction in 1929. Since that time, there has been an assortment of research conducted showing its value in both differential diagnosis and treatment of multiple conditions. Notwithstanding the substantive amount of experience with the technique and its application to a myriad number of clinical conditions, it remains a seldom used procedure in clinical practice and certainly in neurorehabilitation. This paper will review the history of SA, as well as summarize the literature published over the past two decades on the clinical applications of SA to provide readers with a foundation for the utility of this agent, as well as the sodium amytal interview (SAI) in neurorehabilitation clinical practice. Special emphasis will be placed on the use of the SAI in individuals with functional disorders that may be seen in the neurorehabilitation setting, as well as various classes of pain disorders.