ANALGESICS

Definition

Analgesics are medicines that relieve pain.

Purpose

Analgesics are those drugs whose primary purpose is pain relief. The primary classes of analgesics are the narcotics, including additional agents that are chemically based on the morphine molecule but have minimal abuse potential; nonsteroidal anti-inflammatory drugs (NSAIDs) including the salicylates; and acetaminophen. Other drugs, notably the tricyclic antidepressants and anti-epileptic agents such as gabapentin, have been used to relieve pain, particularly neurologic pain, but are not routinely classified as analgesics. Analgesics provide symptomatic relief, but have no effect on causation, although clearly the NSAIDs, by virtue of their dual activity, may be beneficial in both regards.

Description

Pain has been classified as "productive" pain and "non-productive" pain. While this distinction has no physiologic meaning, it may serve as a guide to treatment. "Productive" pain has been described as a warning of injury, and so may be both an indication of need for treatment and a guide to diagnosis. "Non-productive" pain by definition serves no purpose either as a warning or diagnostic tool.

Although pain syndromes may be dissimilar, the common factor is a sensory pathway from the affected organ to the brain. Analgesics work at the level of the nerves, either by blocking the signal from the peripheral nervous system, or by distorting the interpretation by the central nervous system. Selection of an appropriate analgesic is based on consideration of the risk-benefit factors of each class of drugs, based on type of pain, severity of pain, and risk of adverse effects. Traditionally, pain has been divided into two classes, acute and chronic, although severity and projected patient survival are other factors that must be considered in drug selection.

Acute pain

Acute pain is self limiting in duration, and includes post-operative pain, pain of injury, and childbirth. Because pain of these types is expected to be short term, the long-term side effects of analgesic therapy may routinely be ignored. Thus, these patients may safely be treated with narcotic analgesics without concern for their addictive potential, or NSAIDs with only limited concern for their ulcerogenic risks. Drugs and doses should be adjusted based on observation of healing rate, switching patients from high to low doses, and from narcotic analgesics to non-narcotics when circumstances permit.

An important consideration of pain management in severe pain is that patients should not be subject to the return of pain. Analgesics should be dosed adequately to assure that the pain is at least tolerable, and frequently enough to avoid the anxiety that accompanies the anticipated return of pain. Analgesics should never be dosed on a "prn" (as needed) basis, but should be administered often enough to assure constant blood levels of analgesic. This applies to both the narcotic and non-narcotic analgesics.

Chronic pain

Chronic pain, pain lasting over three months and severe enough to impair function, is more difficult to treat, since the anticipated side effects of the analgesics are more difficult to manage. In the case of narcotic analgesics this means the addiction potential, as well as respiratory depression and constipation. For the NSAIDs, the risk of gastric ulcers may be dose limiting. While some classes of drugs, such as the narcotic agonist/antagonist drugs bupronophine, nalbuphine and pentazocine, and the selective COX-2 inhibitors celecoxib and rofecoxib represent advances in reduction of adverse effects, they are still not fully suitable for long-term management of severe pain. Generally, chronic pain management requires a combination of drug therapy, life-style modification, and other treatment modalities.

Narcotic analgesics

The narcotic analgesics, also termed opioids, are all derived from opium. The class includes morphine, codeine, and a number of semi-synthetics including meperidine (Demerol), propoxyphen (Darvon) and others. The narcotic analgesics vary in potency, but all are effective in treatment of visceral pain when used in adequate doses. Adverse effects are dose related. Because these drugs are all addictive, they are controlled under federal and state laws. A variety of dosage forms are available, including oral solids, liquids, intravenous and intrathecal injections, and transcutaneous patches.

NSAIDs, non-steroidal anti-inflammatory drugs, are effective analgesics even at doses too low to have any anti-inflammatory effects. There are a number of chemical classes, but all have similar therapeutic effects and side effects. Most are appropriate only for oral administration; however ketorolac (Toradol) is appropriate for injection and may be used in moderate to severe pain for short periods.

Acetaminophen is a non-narcotic analgesic with no anti-inflammatory properties. It is appropriate for mild to moderate pain. Although the drug is well tolerated in normal doses, it may have significant toxicity at high doses. Because acetaminophen is largely free of side effects at therapeutic doses, it has been considered the first choice for mild pain, including that of osteoarthritis.

Recommended dosage

Appropriate dosage varies by drug, and should consider the type of pain, as well as other risks associated with patient age and condition. For example, narcotic analgesics should usually be avoided in patients with a history of substance abuse, but may be fully appropriate in patients with cancer pain. Similarly, because narcotics are more rapidly metabolized in patients who have used these drugs for a long period, higher than normal doses may be needed to provide adequate pain management. NSAIDs, although comparatively safe in adults, represent an increased risk of gastrointestinal bleeding in patients over the age of 60.

Precautions

Narcotic analgesics may be contraindicated in patients with respiratory depression. NSAIDS may be hazardous to patients with ulcers or an ulcer history. They should be used with care in patients with renal insufficiency or coagulation disorders. NSAIDs are contraindicated in patients allergic to aspirin.

Side effects

Review adverse effects of each drug individually. Drugs within a class may vary in their frequency and severity of adverse effects.

The primary adverse effects of the narcotic analgesics are addiction, constipation, and respiratory depression. Because narcotic analgesics stimulate the production of enzymes that cause the metabolism of these drugs, patients on narcotics for a prolonged period may require increasing doses. This is not the same thing as addiction, and is not a reason for withholding medication from patients in severe pain.

NSAIDs are ulcerogenic and may cause kidney problems. Gastrointestinal discomfort is common, although in some cases, these drugs may cause ulcers without the prior warning of gastrointestinal distress. Platelet aggregation problems may occur, although not to the same extent as if seen with aspirin.

Interactions

Interactions depend on the specific type of analgesic. See specific references.

Key Terms

Acute pain
Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection.
 
Analgesic
Medicine used to relieve pain.
 
Chronic pain
Pain that lasts more than three months and threatens to disrupt daily life.
 
Inflammation
Pain, redness, swelling, and heat that usually develop in response to injury or illness.
 
Osteoarthritis
Joint pain resulting from damage to the cartilage.
 
For  more  information: Please  consult  your  physician  on  your  next  visit.

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ACETOMINOPHEN

Definition

Acetaminophen is a medicine used to relieve pain and reduce fever.

Purpose

Acetaminophen is used to relieve many kinds of minor aches and pains--headaches, muscle aches, backaches, toothaches, menstrual cramps, arthritis, and the aches and pains that often accompany colds.

Description

This drug is available without a prescription. Acetaminophen-or APAP-is sold under various brand names, including Tylenol, Panadol, Aspirin Free Anacin, and Bayer Select Maximum Strength Headache Pain Relief Formula. Many multi-symptom cold, flu, and sinus medicines also contain acetaminophen. Check the ingredients listed on the container to see if acetaminophen is included in the product.

Studies have shown that acetaminophen relieves pain and reduces fever about as well as aspirin. But differences between these two common drugs exist. Acetaminophen is less likely than aspirin to irritate the stomach. However, unlike aspirin, acetaminophen does not reduce the redness, stiffness, or swelling that accompanies arthritis.

Recommended Dosage

The usual dosage for adults and children age 12 and over is 325-650 mg every 4-6 hours as needed. No more than 4 grams (4000 mg) should be taken in 24 hours. Because the drug can potentially harm the liver, people who drink alcohol in large quantities should take considerably less acetaminophen and possibly should avoid the drug completely.

For children ages 6-11 years, the usual dose is 150-300 mg, three to four times a day. Check with a physician for dosages for children under age 6 years.

Precautions

Never take more than the recommended dosage of acetaminophen unless told to do so by a physician or dentist.

Patients should not use acetaminophen for more than 10 days to relieve pain (5 days for children) or for more than 3 days to reduce fever, unless directed to do so by a physician. If symptoms do not go away--or if they get worse--contact a physician. Anyone who drinks three or more alcoholic beverages a day should check with a physician before using this drug and should never take more than the recommended dosage. A risk of liver damage exists from combining large amounts of alcohol and acetaminophen. People who already have kidney or liver disease or liver infections should also consult with a physician before using the drug. So should women who are pregnant or breastfeeding.

Smoking cigarettes may interfere with the effectiveness of acetaminophen. Smokers may need to take higher doses of the medicine, but should not take more than the recommended daily dosage unless told by a physician to do so.

Many drugs can interact with one another. Consult a physician or pharmacist before combining acetaminophen with any other medicine. Do not use two different acetaminophen-containing products at the same time.

Acetaminophen interferes with the results of some medical tests. Before having medical tests done, check to see whether taking acetaminophen will affect the results. Avoiding the drug for a few days before the tests may be necessary.

Side Effects

Acetaminophen causes few side effects. The most common one is lightheadedness. Some people may experience trembling and pain in the side or the lower back. Allergic reactions do occur in some people, but they are rare. Anyone who develops symptoms such as a rash, swelling, or difficulty breathing after taking acetaminophen should stop taking the drug and get immediate medical attention. Other rare side effects include yellow skin or eyes, unusual bleeding or bruising, weakness, fatigue, bloody or black stools, bloody or cloudy urine, and a sudden decrease in the amount of urine.

Overdoses of acetaminophen may cause nausea, vomiting, sweating, and exhaustion. Very large overdoses can cause liver damage. In case of an overdose, get immediate medical attention.

Interactions

Acetaminophen may interact with a variety of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Among the drugs that may interact with acetaminophen are alcohol, nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, oral contraceptives, the antiseizure drug phenytoin (Dilantin), the blood-thinning drug warfarin (Coumadin), the cholesterol-lowering drug cholestyramine (Questran), the antibiotic Isoniazid, and zidovudine (Retrovir, AZT). Check with a physician or pharmacist before combining acetaminophen with any other prescription or nonprescription (over-the-counter) medicine.

Key Terms

Arthritis
Inflammation of the joints. The condition causes pain and swelling.
 
Fatigue
Physical or mental weariness.
 
Inflammation
A response to irritation, infection, or injury, resulting in pain, redness, and swelling.
 
For More Information: Please ask your attending physician on your next visit

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Anthrax, NIAID Fact Sheet

About the Microbe
Anthrax is an acute infectious disease caused by the spore-forming, rod-shaped bacterium Bacillus anthracis. Predominantly a cause of livestock disease, B. anthracis forms durable spores that can lie dormant in the soil for years. Once eaten by a grazing animal, the spores are activated and the bacteria reproduce. After the bacteria spread, they typically kill the infected animal and return to the soil or water once again as spores.

The bacterium's destructive properties are due largely to toxins, which consist of three proteins: protective antigen, edema factor, and lethal factor.

Protective antigen (PA) binds to select cells of an infected person or animal and forms a channel that permits edema factor and lethal factor to enter those cells.
Edema factor (EF), once inside the cell, causes fluid to accumulate at the site of infection. EF can contribute to a fatal buildup of fluid in the cavity surrounding the lungs. It also can inhibit some of the body's immune functions.
Lethal factor (LF), once inside the cell, disrupts a key molecular switch that regulates the cell's functions. LF can kill infected cells or prevent them from working properly.
About the Disease

People rarely contract anthrax from healthy animals. Contact with infected livestock or their products such as leather and wool does, however, cause a limited number of anthrax cases throughout the world. In the United States, only 236 anthrax cases were reported between 1955 and 1999, an average of about five per year. Most of those cases were occupational exposures in people who work with animal carcasses or products. The treatable cutaneous (skin) form of the disease is most common. Worldwide incidence is unknown, but anthrax occurs more frequently in developing countries, especially those without strong veterinary public health programs. Anthrax is not transmitted from person to person.

Human anthrax occurs primarily in three forms: cutaneous, gastrointestinal, and inhalation.

Cutaneous anthrax occurs when the bacteria, usually from infected animal products, enter a break in the skin. The skin reddens and swells, much like an insect bite, then develops a painless blackened lesion or ulcer that may form a brown scab. If left untreated, the infection can spread through the body. Cutaneous anthrax is the most common form of the diseases and responds well to antibiotics. It is rarely fatal if treated before it becomes invasive.
Gastrointestinal anthrax may arise when a person eats contaminated food. The infection often causes fever accompanied by gastrointestinal problems such as vomiting, abdominal pain, diarrhea, or loss of appetite. In some cases, lesions may form in the nose and throat instead of the lower digestive tract. In both cases, gastrointestinal anthrax can spread through the body and is often fatal if not treated immediately. This form of anthrax, however, is not known to have occurred in the United States.
Inhalation anthrax, sometimes called respiratory or pulmonary anthrax, occurs when the bacterial spores are inhaled. The early symptoms resemble those of a common cold or sore throat. The spores travel from the lungs to immune cells called macrophages in the nearby lymph nodes. There they begin to reproduce and secrete their toxins, causing severe breathing problems and shock. Treatment is difficult once the bacteria have reached that stage, and death often ensues. Naturally occurring inhalation anthrax is rare. Prior to the bioterrorist attack of 2001, the last known case of inhalation anthrax in the United States occurred in 1976 in a California craftsman who apparently contracted the infection from contaminated, imported yarn.
Treatment and Prevention

Antibiotics

Several different antibiotics kill B. anthracis as it reproduces within people and animals. If diagnosed early, anthrax can be treated. Unfortunately, infected people often confuse early symptoms with more common infections and do not seek medical help until severe symptoms appear. At that point the destructive anthrax toxins, which are not affected by antibiotics, have risen to high levels, making treatment difficult. Although cutaneous anthrax has telltale signs and symptoms making diagnosis easy, early stage gastrointestinal and inhalation anthrax are more likely to be mistaken for common maladies.

Vaccine
An anthrax vaccine is licensed for limited use. The vaccine is currently used to protect members of the military and individuals most at risk for occupational exposure to the bacteria, such as abattoir workers, veterinarians, laboratory workers, and livestock handlers. The vaccine consists of filtered proteins and other components of a weakened B. anthracis strain adsorbed to aluminum hydroxide. PA is the major component of the vaccine that provides protection against infection. The vaccine contains no whole bacteria.

Health experts currently do not recommend the vaccine for general use by the public due to the rarity of anthrax and the potential for adverse side effects. Researchers have not determined the safety and efficacy of the vaccine in children, the elderly, and people with weakened immune systems. In addition, the recommended vaccination schedule is 6 doses given over an 18-month period, so the vaccine would likely offer little protection in response to a bioterrorist attack. For these reasons, a new anthrax vaccine is needed.

NIAID Basic Research
Several biologic factors contribute to B. anthracis's ability to cause disease. By uncovering the molecular pathways that enable the bacterium to form spores, survive in people, and cause illness, NIAID hopes to identify new ways to diagnose, prevent, and treat anthrax.

Toxin Biology
Scientists are studying the anthrax toxins to learn how to block their production or action. Recently, NIAID grantees determined the three-dimensional structure of the LF protein as it attaches to its target inside cells. The research showed for the first time that LF uses a long groove on its side to latch onto that target. At the same time, another group of researchers identified a protein receptor on the surface of host cells to which PA attaches. Using a specific fragment of that receptor protein, the researchers were able to block the attachment of PA, thereby preventing formation of the PA channel and inhibiting the toxic effects of LF and EF in test-tube experiments. Other investigators have engineered mutant, inactive PAs that prevent bacteria-produced PAs from forming the channel. The studies of PA and LF should enable researchers to develop small molecules that can be used as therapeutics to treat anthrax by inhibiting its toxins.

The Anthrax Bacterium Genome
The instructions that dictate how a microbe works are encoded within its genes. Bacteria often contain genes at two locations. The bacterial chromosome is a long stretch of DNA that houses most of those genes, but smaller loops of DNA called plasmids also carry genes that can be exchanged between different bacteria. Because plasmids often contain genes for toxins and antibiotic resistance, knowing their DNA sequence is important.

In B. anthracis, the genes for PA, LF, and EF are found on plasmids that have already been sequenced. In addition, researchers recently reported the complete chromosomal DNA sequence of two B. anthracis isolates, including the bacterium that infected a Florida victim of the recent anthrax attack. Genome sequencing of more than a dozen other B. anthracis strains and related bacteria has already begun.

By comparing the DNA blueprints of different B. anthracis strains, researchers hope to learn why some strains are more virulent than others. Small variations among the genomes of different strains may also help investigators pinpoint the origin of an anthrax outbreak. Knowing the genetic fingerprint of B. anthracis might lead to gene-based detection mechanisms that can alert scientists to the bacteria in the environment or allow rapid diagnosis of anthrax in infected people. Variations between strains might also point to differences in antibiotic susceptibility, permitting doctors to immediately determine the appropriate treatment.

DNA sequencing also opens the door to functional genomics, in which the B. anthracis genome will be analyzed to determine the function of each of its genes and how they interact with each other or with host-cell components to cause disease. Genes are the instructions for making proteins, which in turn build components of the cell or carry out its biochemical processes. Knowing the sequence of B. anthracis genes therefore helps scientists discover key bacterial proteins that can then be targeted by new drugs or vaccines.

Spore Biology
B. anthracis spores are essentially dormant and therefore must wake up, or germinate, to become reproductive, disease-causing bacteria. Researchers are therefore studying the germination process to learn more about the signals that cause spores to become active once inside an animal. Efforts are underway to develop models of spore germination in laboratory animals; scientists hope those models will enable discoveries leading to drugs that block the germination process.

Host Immunity
People who contract anthrax produce antibodies to PA, and similar antibodies appear to protect animals from infection. Recent studies also suggest that some animals can produce antibodies to components of B. anthracis spores. Those antibodies, when studied in a test tube, prevent spores from germinating and increase their uptake by the immune system's microbe-eating cells. It therefore might be possible to develop a vaccine that can be given after exposure to fight both the reproductive form of B. anthracis and any spores that may linger in the lungs following antibiotic treatment.

As part of NIAID's strategic plan, researchers will study how both the innate and adaptive immune responses are triggered by a B. anthracis infection. The adaptive immune response consists of B cells and T cells which specifically recognize components of the anthrax bacterium. The innate immune system, however, responds more generally to a wide range of microbial invaders and likely plays a key role in the body's front-line defenses. Scientists will conduct studies of how those two arms of the immune system act to counter infection, including how B. anthracis spore germination affects individual immune responses.

NIAID Therapeutics Research
Following the recent discoveries of how PA and LF interact with their cellular targets, researchers are screening thousands of small molecules in hopes of finding a compound that is practical for use as an anti-anthrax drug. In addition, NIAID is working with the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Department of Defense (DoD) to accelerate testing of collections of compounds for their effectiveness against inhalation anthrax. Many of those compounds have already been approved by FDA for other indications and therefore could quickly be approved for use in treating anthrax should they prove effective.

NIAID is seeking new drugs that attack B. anthracis at many levels. These include agents that prevent the bacterium from attaching to cells, compounds that inhibit spore germination, and inhibitors that block the activity of key enzymes such as anthrax lethal factor. The Institute will also develop the capacity to synthesize promising anti-anthrax compounds in sufficient purity and quantity for preclinical testing.

NIAID Vaccine Research
Researchers are working on new, improved anthrax vaccines that may be more easily given to a diverse population. NIAID is collaborating with DoD to develop a next-generation vaccine based on a laboratory-produced, or recombinant, PA variant. Antibodies to PA also appear to recognize some components of the bacterial spore, making PA-based vaccines promising candidates for broad protection against anthrax. The Institute will supervise phase I and phase II trials of the recombinant PA vaccine in different formulations.

To help move potential vaccines into clinical testing, NIAID will develop the infrastructure to produce pilot lots of promising candidates and expand the Institute's testing capacity. To assist in its vaccine research efforts, NIAID will establish a centralized immunology laboratory to assess the efficacy of different vaccine candidates.

NIAID Diagnostics Research
Research is underway to develop improved techniques for spotting B. anthracis in the environment and diagnosing it in infected individuals. A key part of that research is the functional genomic analysis of the bacterium, which should lead to new genetic markers for sensitive and rapid identification. Genomic analysis will also reveal differences in individual B. anthracis strains that may affect how those bacteria cause disease or respond to treatment.

Anthrax and Bioterrorism
CDC has classified B. anthracis as a Category A agent. Those agents are considered the highest threat to national security due to their ease of transmission, high rate of death or serious illness, and potential for causing public panic.

In October 2001, anthrax spores were sent through the U.S. mail and caused 18 confirmed cases of anthrax (11 inhalation, 7 cutaneous). Five individuals with inhalation anthrax died; none of the cutaneous cases was fatal.

More Information
National Institute of Allergy and Infectious Diseases
National Institutes of Health
31 Center Drive, MSC 2520
Bethesda, MD 20892-2520
http://www.niaid.nih.gov/newsroom/releases/anthraxspec.htm

National Library of Medicine
MEDLINEplus
8600 Rockville Pike
Bethesda, MD 20894
1-800-338-7657
http://www.nlm.nih.gov/medlineplus/anthrax.html

U.S. Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-888-232-3228
http://www.bt.cdc.gov/Agent/Anthrax/Anthrax.asp

World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
(00 41 22) 791 21 11
http://www.who.int/emc/diseases/anthrax/

U.S. Department of Agriculture
Washington, D.C. 20250
http://www.usda.gov/homelandsecurity/anthraxfs.htm

U.S. Food and Drug Administration
Food and Drug Administration
5600 Fishers Lane
Rockville, Maryland 20857
1-888-INFO-FDA (1-888-463-6332)
http://www.fda.gov/oc/opacom/hottopics/bioterrorism.html

Johns Hopkins University Center for Civilian Biodefense Studies
http://www.hopkins-biodefense.org/pages/agents/agentanthrax.html

NIAID is a component of the National Institutes of Health (NIH). NIAID supports basic and applied research to prevent, diagnose, and treat infectious and immune-mediated illnesses, including HIV/AIDS and other sexually transmitted diseases, illness from potential agents of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma and allergies.

Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

U.S. Department of Health and Human Services

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Our search started with ancient texts and journals and continue to the present time. The source of most of the information summarized on this CD, and the others in the series, have been obtained from original articles from the journals listed below. Additional information has been obtained from secondary sources (books) given at the end of this list:

Journals
Abhandlungen der Kaiserlichen Leopoldinisch-Carolinischen Deutschen Akademie der Naturforscher.
Abhandlungen der Physikalish-Medizinischen Societat zu Erlangen.
Academie de Medecine, Paris (Memoires).
Acta Anatomica Nippon.
Acta Chirurgica Scandinavica.
Acta Morphologica Neerlando-Scandinavica
Acta Physico- Medica Academiae Caesareae Leopoldino-Carolinae Naturae
Curiosorum Exhibentia Ephemerides.
Acta Paediatrica.
Aichi Igakkai Zasshi
American Family Physician.
American Journal of Anatomy.
American Journal of Clinical Pathology.
American Journal of Diseases of Children.
American Journal of Neuroradiology.
American Journal of Physical Anthropology.
American Journal of Sports Medicine.
Anais Paulistas de Medicina e Cirurgia.
Anales dell Circulo Médico Argentino.
Anatomica e Chirurgia.
Anatomica Clinica.
Anatomische Hefte.
Anatomischer Anzieger (Centralblatt für die Gesamte Wissenschaftlichen Anatomie).
Annales d'Anatomie Pathologique et d' Anatomie Normale Médico-Chirurgicale.
Annales de Radiologie.
Annales Medico-Psychologiques.
Annals of Anatomy and Surgery.
Annals of Clinical Medicine.
Annals of Internal Medicine.
Annals of Neurology.
Annals of Surgery.
Annals of the Royal College of Surgeons of England.
Arbeite aus Anatomie Institut Sendai
Archiv für Anatomie (Zeitschrift für anatomie und Entwickelungsgeschichte).
Archiv fur Anatomie, Physiologie und Wissenschaftliche Medizin (Continuation of Reil's, Reil und Autenrieth's, J.F. Meckel's, Joh. Muller's, und Reichert und DuBois-Reymonds's Archiv).
Archiv für die Gesammte Physiologie des Menschen und der Thiere.
Archiv für die Physiologie (Reil).
Archiv für Kinderheilkunde.
Archiv für Klinische Chirurgie (von Langenbeck's).
Archiv für Orthopädische und Unfall-Chirurgie.
Archiv für Orthopädie, Mechanotherapie und Unfallchirurgie.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medizin (Virchow's).
Archiv Nauk. Antropologicznich (Warsaw).
Archiv für Psychiatric und Nervenkrankheiten (Berlin).
Archives d'Anatomie, d'Histology et d'Embryologie.
Archives de Médecine des Enfants.
Archives de Physiologie Normale et Pathologique.
Archives Franco-Belges de Chirurgie.
Archives Générales de Médecine.
Archives Italiennes de Biologie.
Archives of Internal Medicine Archives of Neurology and Psychiatry.
Archives of Pathology.
Archives of Pediatrics.
Archives of Surgery.
Archives of the Diseases of Childhood.
Archivio di Ortopedia (Milan).
Archivio Italiano di Anatomia e Embriologia.
Archivio Per Le Scienze Mediche.
Arquivo de Anatomia e Antropolgia.
Atti dell'Accademia dei fisiocritici in Siena.
Atti dell'Accademia Gioenia de Scienze Naturali in Catania.
Atti della Reale Accademia Medico-Chirurgica di Napoli.
Atti della Societa Dei Naturalisti e Matematici di Modena
Atti del Reale Istituto Veneto di Scienze, Lettere ed Arti.
Atti Reale Accademia Peloritana, Messina.
Australian and New Zealand Journal of Surgery.
Beiträge zür Klinischen Chirurgie (Bruns).
Beiträge zür Pathologischen Anatomie und zür Allgemeinen Pathologie (Ziegler).
Bericht über die Fortschritte der Anatomie und Physiologie.
Berliner Klinische Wochenschrift.
Bibliographie Anatomique.
Biologisches Centralblatt.
Bollettino della Societa dei Naturalisti in Napoli
Bollettino/Societa tru e Cultori delle Scienze Mediche in Siena.
British Journal of Plastic Surgery.
British Medical Journal.
Bulletin Biologique de la France et de Belgique.
Bulletin de l'Académe Impériale des Sciences de St. Peterbourg.
Bulletin de l'Academie de Medecine.
Bulletins de la Société d'Anthropologie de Paris.
Bulletins de la Société de Pédiatrie de Paris.
Bulletins et Memoires de la Société Anatomique de Paris.
Bulletins et Memories de la Société de Chirurgie de Paris.
California and Western Medicine.
California Medicine.
Canadian Journal of Surgery.
Canadian Medical and Surgical Journal.
Canadian Medical Association Journal.
Centralblatt für Allgemeine Pathologie und Pathologische Anatomie (Ziegler).
Centralblatt für die Medizinischen Wissenschaften.
Chiba Igakki Zasshi
Chirurgica.
Chiryo to Keiken
Circulation.
Clinical Anatomy.
Clinical Genetics.
Clinical Neurosurgery.
Clinical Orthopedics.
Clinical Radiology.
Clinical Society of London (Transactions).
Commentarii Academiae Scientiarum Imperialis Petropolitanae
Correspondenz-Blatt für Schweizer Aerzte.
Delaware State Medical Journal.
Der Nervenartz.
Deutsche Medizinische Wochenschrift.
Deutsche Zeitschrift für Chirurgie.
Dai Sankai Igakkai Zasshi.
Diseases of the Chest.
Edinburgh Medical Journal.
Exerpta Medica.
Fakultät Okayama
Folia Morphologica (Warsaw).
Folia Morphologica (Prague).
Formosan Medical Association Journal.
Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin.
Fortschritte der Medicin.
Frankfurter Zeitschrift für Pathologie.
Fukuoka Ikadaigaku Zasshi.

Gaillard's Medical Journal.
Gazette des Hôpitauz Civils et Militaires (Lancet Francaise).
Gazette Hebdomadaire des Sciences Medicales de Bordeaux.
Gazzetta Medica Italiana: Provincie Venete.
Giornale della Accademia di Medicina di Torino.
Glasgow Medical Journal.
Gun-idan Zasshi.
Guy's Hospital Reports.
Hand.
Hand Clinics. Handlingar av Svenska Veternskapsademien.
Heart.
Helvetica Paediatrica Acta.
Henle u. Pfeufer Zeitschrift (Zeitschrift für Rationelle Medicin).
Hiroshima Daigaku Igakubu Kaibogaku Daiichi Koza Gyosekishu.
Hiroshima Igakubu Kaibogaku Daiichikoza Gyosekishu.
Hokuetsu Igakkai Zasshi. Human Biology.
Hygiea (Stockholm).
Igaku Kenkyu.
Ijishinbun.
Ikaishuho.
Il Policlinico (Sezione Chirurgica, Medica, Pratica).
Illinois Medical Journal.
Industrial Medicine.
International Clinics.
International College of Surgeons.
International Surgery.
Internationale Klinische Rundschau.
Internationale Monatsschrift für Anatomie und Physiologie.
Iwate Igakusenmongakko Zasshi.
Iwate Ikadaigaku Kaibogakukyoshitsu Gyosekishu.
Jahrbuch für Kinderheilkunde und Physische Erziehung.
Jahres-Bericht der Schlesischen Gesellschaft für vaterländische Cultur.
Jahresberichte über die Fortschritte der Anatomie und Physiologie (Schwalbe).
Japanese Journal of Medical Sciences.
Japanese Journal of Orthopedics and Traumatology
Jenaische Zeitschrift für Medicin und Naturwissenschaft.
Jicchi Ika to Rinsho.
Jikeikai Ikadaigaku Kaibogakukyoshitsu Gyosekishu.
Jinruigaku, Jinruiidengaku, Taishitsugaku Ronbumshu.
Jinruigaku Shuho.
Jinruigaku Zasshi.
Johns Hopkins Hospital Bulletin.
Johns Hopkins Hospital Reports.
Jordan Medical Journal.
Journal de Chirurgie.
Journal de l'Anatomie et de la Physiologie Normale et Pathologie de l'Homme et des Animaux.
Journal de Médecine, Chirurgie, Pharmacie, etc.
Journal de Médecine de Bordeaux et du Sud-Ouest.
Journal de Radiologie d'Electrologie et de Médecine Nucléaire.
Journal des Sciences Medicales de Montpellier.
Journal of Anatomy and Physiology (Journal of Anatomy).
Journal of Arkansas Medical Society.
Journal of Hand Surgery.
Journal of Nervous and Mental Diseases.
Journal of Neurosurgery.
Journal of Pediatrics.
Journal of the American Medical Association.
Journal of the Anatomical Society of India.
Journal of the International College of Surgeons.
Journal of the Kuwait Medical Association.
Juzenkai Igaku Zasshi.
Juzenkai Zasshi.

Kagoshima Daigaku Igaku Zasshi.
Kagoshima Igakkai Zasshi.
Kaibogaku Zasshi (Journal of Anatomy).
Kanazawa Daigaku Igakubu Kaibogakubu Kyoshitsu Gyosekishu.
Kanazawa Ikadaigaku Kaibogakukyoshitsu Gyosekishu.
Kansai Ikadaigaku Zasshi.
Keio Igaku Zasshi.
Kokubyori Gakkai Zasshi.
Kokukaibogaku Kenkyu.
Kumamoto Daigaku Igakubu Daiichi Kaibogakukyoshitsu Gyosekishu.
Kumamoto Daigaku Igakubu Kaibogakukyoshitsu Gyosekishu.
Kumamoto Igakkai Zasshi
Kurume Igakkai Zasshi.
Kyushi Gakuho.
Kyushu Igakusenmongakko Igakkai Zasshi.
Kyushu Shikagakkai Zasshi.
La Chirurgia degli Organi de Movimento.
Lancet
L'Osservatore Gazzeta delle Cliniche (Torino).
La Pediatria.
La Presse Médicale.
La Radiologia Medica.
La Reforma Medica.
La Sémaine Medicale.
La Société de Biologie Comptes Rendus Hebdomadaires des Séances et Memoires.
La Association des Anatomiste, Comptes Rendus.
London Medical Gazette.
Louisville Medical News.
Lyon Chirurgical.
Lyon Medical.
Mayo Clinic, Proceedings of the Staff Meetings.
Medical and Surgical Reporter.
Medical Clinics of North America.
Medical Journal of Shinshu University.
Medical Record.
Medical Times.
Medico-Chirurgical Transactions (Royal Medical and Chirurgical Society of Edinburgh).
Medico-Chirurgical Transactions (Royal Medical and Chirurgical Society of London).
Medizinische Jahrbücher (Wien).
Memoires de la Societe d'Anthropologie de Paris.
Mémoires de L'Académie Impériale des Sciences de Saint-Pétersbourg.
Memorie della Royal Accademia della Scienze dell'Istituto di Bologna.
Minerva Pediatrica.
Minnesota Medicine.
Minzoku Eisei.
Mitteilungen aus den Grenzgebieten der Medizin und Chirurgie.
Monatsschrift für Kinderheilkunde.
Monatsschrift für Unfallheilkunde und Versicherungsmedizin.
Montpellier Médical.
Montreal General Hospital (Annual Reports).
Münchener Medizinische Wochenschrift.
Muscle and Nerve.
Nagasaki Igakkai Zasshi.
Nagoya Igakkai Zasshi.
Nagoya Journal of Medical Sciences.
Nederlands Archief Voor Genees- En Natuurkunde.
Nederlandsch Lancet.
Neurologisches Centralblatt.
Neurology (Minneapolis).
Neurosciences Research Program Bulletin.
New York Medical Journal.
New York State Journal of Medicine.
Nihon Byorigakkai Zasshi.
Nihon Daigaku Igaku Zasshi.
Nihon Ikadaigaku Zasshi
Nordisk Medicin.
Nouvelles Archives du Museum National d'Histoire Naturelle.
Orthopaedic Review.
Oesterreichische Medicinische Wochenschrift.
Oesterreichische Zeitschrift für Praktische Heilkunde.
Okajimas' Folia Anatomica Japonica.
Okayama Igaku Zasshi.
Otozure (Osaka Joshi Kotoigaku senmongakko Dosokai).

Paris Médical.
Pediatrics Pester Medizinisch-Chirurgische Presse.
Pester Medizinisch-Chirurgische Presse.
Philadelphia Medical Journal.
Philosophical Transactions, Royal Society of London.
Physiological Reviews.
Plastic and Reconstructive Surgery.
Postgraduate Medicine.
Prager Medizinische Wochenschrift.
Prensa Médica Argentina.
Proceedings of the New York Pathological Society.
Proceedings of the Royal Society of Medicine.
Quarterly Bulletin of Northwestern University Medical School.
R. Accademia Peloritana, Messina. Atti.
Radiologia Clinica.
Radiology.
Resoconto delle Adunanze e dei Lavori della Reale Accademia Medico-Chirurgica di Napoli.
Revista Brasileira de Cirurgia.
Revista da Associacao Paulista de Medicina.
Revista de la Facultad de Medicina de la Universidad National, Columbia
Revue Canadienne de Biologie.
Revue d'Anthropologie.
Revue Neurologique.
Revue d'Orthopédie et de Chirurgie de l'Appareil Moteur (Paris).
Ricerche fatti nel Laboratorio di Anatomia Normale della R.
Universita di Roma ed in Altri Laboratoria Biologici.
Riforma Medica.
Rinsho Sanka-Fujinka.
Revista Internazionale di Medicina e Chirurgia. 4:337-344
Röntgenpraxis.
Rozhledy V Chirurgii (Praha)
Rozhlchir. Proha

St. Bartholomews Hospital Reports.
St. Thomas's Hospital Reports.
Scandinavian Journal of Plastic and Reconstructive Surgery.
Schmidt's Jahrbücher de In- und Ausländischen Gesammten Medicin.
Schweizerische Medizinische Wochenschrift.
Science.
Seiikai Zasshi.
Seminars in Roentgenology.
Shika Gakuho.
Shonikagaku Zasshi.
Sicilia Medica.
Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften (Wien)., Mathmatisch-Naturwissenschaftliche Klasse.
Société de Anatomie et de Physiologie Normale et Pathologique.
Société de Biologie (et de ses Fillales), Comptes Rendus Hebdomadaires des Séances et Memoires.
Société de Pédiatrie de Paris.
Société des Sciences de Nancy, Memoires.
Société Médicale des Hopitaux de Paris, Bulletin et Memories.
Sotai taiji no kaibogakuteki kenkyu.
Southern Medical Journal.
Sperimentale, Firenza.
Surgery.
Surgery, Gynecology and Obstetrics.
Texas State Journal of Medicine.
The American Journal of Medicine.
The American Journal of Pathology.
The American Journal of Roentgenology and Radium Therapy.
The American Journal of Surgery.
The American Journal of the Medical Sciences.
The American Surgeon, (Southern Surgeon).
The Anatomical Record.
The Ausrtralian and New Zealand Journal of Surgery.
The Boston Medical and Surgical Journal.
The British and Foreign Medico-Chirurgical Review or Quarterly Journal of Practical Medicine and Surgery.
The British Journal of Children's diseases.
The British Journal of Radiology.
The British Journal of Surgery.
The Charlotte Medical Journal.
The Chinese Medical Journal.
The Gunma Journal of Medical Sciences.
The Journal of Bone and Joint Surgery.
The Journal of Comparative Neurology.
The Journal of Laboratory and Clinical Medicine.
The Journal of Medical Research.
The Journal of Mental Science.
The Journal of Pediatric Surgery.
The Journal of the Kansas Medical Society.
The Journal of the Missouri State Medical Association.
The Journal of the Oklahoma State Medical Association.
The Journal of Pathology and Bacteriology.
The Journal of Thoracic and Cardiovascular Surgery.
The Kurume Medical Journal.
The Medical Journal of Australia.
The Medico-Chirurgical Review and Journal of Practical Medicine.
The New England Journal of Medicine.
The New York Medical Journal.
The Ohio State Medical Journal.
The Quarterly Journal of Medicine.
The Quarterly Review of Biology.
The South African Journal of Medical Sciences.
The Surgical Clinics of North America.
The Transactions of the Medico-Chirurgical Society of Edinburgh.
The Transactions of the Royal Irish Academy (Science).
The University Studies of the University of Nebraska.
The Western Journal of Surgery, Obstetrics and Gynecology.
The Wisconsin Medical Journal.
The Yale Journal of Biology and Medicine.
Tohoku Igakkai Zasshi.
Tokyo Igakai Zasshi.
Tokyo Ikadaigaku Zasshi.
Tokyo Jikeikai Ikadaigaku Kaibogaku Kyoshitsu Gyosekishu.
Tokyo Jikeikai Ikadaigaku Zasshi.
Tokyo Shikadaigaku Kaibogaku kyoshitsu Gyosekishu.
Transactions of the American Surgical Association.
Transactions of the Chicago Pathological Society.
Transactions of the Linnean Society of London.
Transactions of the Pan-Am Medical Congress.
Transactions of the Pathological Society of London.
Transactions of the Pathological Society of Philadelphia.
Transactions of the Royal Academy of Medicine in Ireland.
Transactions of the Royal Irish Academy of Science.
Transactions of the Royal Society, Edinburgh.
Transactions of the Royal Society, London.
Transactions of the Royal Society of Tropical Medicine and Hygiene.
University of Pennsylvania Medical Bulletin (University Medical Magazine).
Union Medicale du Nord-Est.
Upsala Läkareforenings Forhandlingar.

Verelagen en Mededeelingen der Koninklijke Akademie van Wetenschappen, Afdeeling Natuurkunde.
Verhandlungen der Deutschen Pathologischen Gesellschaft.
Verhandlungen der Physikalisch-Medicinische Gesellschaft in Wurzburgh
Virginia Medical Monthly.
Viertljahrschrift f.d. Prakt.
Western Journal of Surgery, Obstetrics and Gynecology.
Wiener Archiv für Innere Medizin.
Wiener Klinische Wochenschrift.
Wiener Med. Jahrbücher
Zeitschrift der kais. Kön. Gesellschaft der Aerzte zu Wien.
Zeitschrift für die Gesamte Anatomie:
Part 1) Zeitschrift für Anatomie und Entwicklungsgeschichte.
Part 2) Zeitschrift für Kontstitutionslehre.
Zeitschrift für Klinische Medicin.
Zeitschrift für Kreislaufforschung: Zugleich Forsetzung von Zentralblatt für Herz- und Gefasskrankenheiten.
Zeitschrift für Menschliche Vererbungs- und Kontstitutionslehre.
Zeitschrift für Morphologie und Anthropologie.
Zeitschrift für Morphology und Pathologie.
Zeitschrift für die Organische Physik.
Zeitschrift für Orthopädie und ihre Grenzgebiete.
Zeitschrift für Orthopädische Chirurgie.
Zeitschrift für Rationelle Medicin (Henle u. Pfeufer Zeitschrift).
Zentralblatt für Chirurgie.
Zentralblatt für de Gesamte Neurologie und Psychiatrie.
(398 titles)

Books
Albinus, B.S. (1734) Historia Musculorum Hominis, Apud Theodorum Haak & Henricum Mulhovium, Leidae Batavorum.

Anson, B.J., Ed. (1966) Morris' Human Anatomy, The Blakiston Division, McGraw-Hill Book Company, New York.

Henle, J. (1871) Handbuch der Muskellehre des Menschen, in Handbuch der systematischen Anatomie des Menschen. Verlag von Friedrich Vieweg und Sohn, Braunschweig.

Huber, C.G., Ed. (1930) Piersol's Human Anatomy, 9th ed., L.B. Lippincott Company, Philadelphia.

Hyrtl, J. (1887) Lehrbuch der Anatomie des Menschen, 19th ed. Wilhelm Braunmüller, Wien.

Kopsch, F. (1908) Rauber's Lehrbuch der Anatomie des Menschen. Georg Thieme, Leipzig.

Latarjet, A. (1948) Testut's Traité d'Anatomie Humaine, 9th ed., G. Doin & Cie., Paris.

LeDouble, A.F. (1897) Traité des Variations du Système Musculaire de l'Homme et Leur Signification au Point de Vue de l'Anthropolgie Zoologique. Libraire C. Reinwald, Schleicher Freres, Paris.

Schaefer, E.A., Symington, J. and T.H.Bryce, Eds., Quain's Anatomy, 11th ed., Longmans, Green and Co., London.

Testut, L. (1884) Les Anomalies Musculaires Chez l'Homme Expliques par l'Anatomie Comparée. Masson, Paris.

Toldt, C. (1928) An Atlas of Human Anatomy for Students and Physicians. The Macmillian Company, New York.
Vesalius, A. (1543) De Humani Corporis Fabrica Libri Septem, Ex officina Joannis Oporini, Basel.

Miscellaneous Sources
In addition to the primary and secondary references, numerous anatomic variations are reported that were found in the dissecting rooms of The Johns Hopkins Medical School, American University of Beirut Faculty of Medicine, and The University of Iowa College of Medicine by indefatigable first year medical students, over a period of many years.



Vesalius' dissecting tools

Examples of Some Very Early References
As interesting examples from very early references, we provide a few here:

In regard to the male gonads, the Bible states;
" For there are eunuchs who have been so from birth, and there are eunuchs who have been made eunuchs by men, and there are eunuchs who have made themselves eunuchs for the sake of the kingdom of Heaven." Matthew 19:12, @ 80 AD.

In regard to the skeleton,
"And there was again war at Gath, where there was a man of great stature, who had six fingers on each hand, and six toes on each foot, twenty-four in number; and he also was descended from the giants." 2 Samuel 21:20.

And, from the early medical literature;
Sir Thomas Brown in his Pseudodoxia Epidemica or Commentaries on Vulgar Errors (Second Edition, London, 1660, p.292) speaks of the heated discussion over the biblical story, which arose from the description by Columbus of a female skeleton which possessed a supernumerary rib. "That a man hath one Rib lesse than a Woman, is a common conceit derived from the history of Genesis, wherein it stands delivered, that Eve was framed out of a Rib of Adam; whence 'tis concluded the sex of Man still wants that rib our Father lost in Eve. And this is not only passant with the many, but was urged against Columbus in an Anatomy of his at Pisa; where having prepared the sceleton of a Woman that chanced to have thirteen ribs on one side, there arose a party that cried him down, and even unto oathes affirmed, this was the rib wherein a woman exceeded. Were this true, it would autoptically silence that dispute out of which side Eve was framed; it would determine the opinion of Oleaster, that she was made out of the ribs of both sides; or such as from the expression of the text maintain there was a pleurality required, and might indeed decry the parabolicall exposition of Origen, Cajetan, and such as fearing to concede a monstrosity, or mutilate the integrity of Adam; preventively conceive the creation of thirteen ribs."



God taking a rib from Adam to create Eve.
From the front of the Cathedral at Orvieto, Italy.

The authors have read many thousands of references and have included a summary of these papers in the sections to follow. We wish to make it clear that only a brief summary of these papers can be included here for reasons of time and space. We have provided references in as many as 7 languages and much duplication of data can be seen. Nevertheless, the references provided are accurate and complete and we recommend that they be consulted for many details that may have been inadvertently overlooked. Our treatment of the variations is primarily anatomic but interesting clinical observations are also included. We have included synonyms for all structures having them; these are compared with the current usage given in the Nomina Anatomica. We hope that these listings will make reading in the older literature a bit easier and comprehensible.

There are five books in this series; 1) Muscular System, 2) Cardiovascular System, 3) Nervous System, 4) Organ Systems, and 5) the Skeletal System.
This book is the first of the series.

Read more...

Our search started with ancient texts and journals and continue to the present time. The source of most of the information summarized on this CD, and the others in the series, have been obtained from original articles from the journals listed below. Additional information has been obtained from secondary sources (books) given at the end of this list:

Journals
Abhandlungen der Kaiserlichen Leopoldinisch-Carolinischen Deutschen Akademie der Naturforscher.
Abhandlungen der Physikalish-Medizinischen Societat zu Erlangen.
Academie de Medecine, Paris (Memoires).
Acta Anatomica Nippon.
Acta Chirurgica Scandinavica.
Acta Morphologica Neerlando-Scandinavica
Acta Physico- Medica Academiae Caesareae Leopoldino-Carolinae Naturae
Curiosorum Exhibentia Ephemerides.
Acta Paediatrica.
Aichi Igakkai Zasshi
American Family Physician.
American Journal of Anatomy.
American Journal of Clinical Pathology.
American Journal of Diseases of Children.
American Journal of Neuroradiology.
American Journal of Physical Anthropology.
American Journal of Sports Medicine.
Anais Paulistas de Medicina e Cirurgia.
Anales dell Circulo Médico Argentino.
Anatomica e Chirurgia.
Anatomica Clinica.
Anatomische Hefte.
Anatomischer Anzieger (Centralblatt für die Gesamte Wissenschaftlichen Anatomie).
Annales d'Anatomie Pathologique et d' Anatomie Normale Médico-Chirurgicale.
Annales de Radiologie.
Annales Medico-Psychologiques.
Annals of Anatomy and Surgery.
Annals of Clinical Medicine.
Annals of Internal Medicine.
Annals of Neurology.
Annals of Surgery.
Annals of the Royal College of Surgeons of England.
Arbeite aus Anatomie Institut Sendai
Archiv für Anatomie (Zeitschrift für anatomie und Entwickelungsgeschichte).
Archiv fur Anatomie, Physiologie und Wissenschaftliche Medizin (Continuation of Reil's, Reil und Autenrieth's, J.F. Meckel's, Joh. Muller's, und Reichert und DuBois-Reymonds's Archiv).
Archiv für die Gesammte Physiologie des Menschen und der Thiere.
Archiv für die Physiologie (Reil).
Archiv für Kinderheilkunde.
Archiv für Klinische Chirurgie (von Langenbeck's).
Archiv für Orthopädische und Unfall-Chirurgie.
Archiv für Orthopädie, Mechanotherapie und Unfallchirurgie.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medizin (Virchow's).
Archiv Nauk. Antropologicznich (Warsaw).
Archiv für Psychiatric und Nervenkrankheiten (Berlin).
Archives d'Anatomie, d'Histology et d'Embryologie.
Archives de Médecine des Enfants.
Archives de Physiologie Normale et Pathologique.
Archives Franco-Belges de Chirurgie.
Archives Générales de Médecine.
Archives Italiennes de Biologie.
Archives of Internal Medicine Archives of Neurology and Psychiatry.
Archives of Pathology.
Archives of Pediatrics.
Archives of Surgery.
Archives of the Diseases of Childhood.
Archivio di Ortopedia (Milan).
Archivio Italiano di Anatomia e Embriologia.
Archivio Per Le Scienze Mediche.
Arquivo de Anatomia e Antropolgia.
Atti dell'Accademia dei fisiocritici in Siena.
Atti dell'Accademia Gioenia de Scienze Naturali in Catania.
Atti della Reale Accademia Medico-Chirurgica di Napoli.
Atti della Societa Dei Naturalisti e Matematici di Modena
Atti del Reale Istituto Veneto di Scienze, Lettere ed Arti.
Atti Reale Accademia Peloritana, Messina.
Australian and New Zealand Journal of Surgery.
Beiträge zür Klinischen Chirurgie (Bruns).
Beiträge zür Pathologischen Anatomie und zür Allgemeinen Pathologie (Ziegler).
Bericht über die Fortschritte der Anatomie und Physiologie.
Berliner Klinische Wochenschrift.
Bibliographie Anatomique.
Biologisches Centralblatt.
Bollettino della Societa dei Naturalisti in Napoli
Bollettino/Societa tru e Cultori delle Scienze Mediche in Siena.
British Journal of Plastic Surgery.
British Medical Journal.
Bulletin Biologique de la France et de Belgique.
Bulletin de l'Académe Impériale des Sciences de St. Peterbourg.
Bulletin de l'Academie de Medecine.
Bulletins de la Société d'Anthropologie de Paris.
Bulletins de la Société de Pédiatrie de Paris.
Bulletins et Memoires de la Société Anatomique de Paris.
Bulletins et Memories de la Société de Chirurgie de Paris.
California and Western Medicine.
California Medicine.
Canadian Journal of Surgery.
Canadian Medical and Surgical Journal.
Canadian Medical Association Journal.
Centralblatt für Allgemeine Pathologie und Pathologische Anatomie (Ziegler).
Centralblatt für die Medizinischen Wissenschaften.
Chiba Igakki Zasshi
Chirurgica.
Chiryo to Keiken
Circulation.
Clinical Anatomy.
Clinical Genetics.
Clinical Neurosurgery.
Clinical Orthopedics.
Clinical Radiology.
Clinical Society of London (Transactions).
Commentarii Academiae Scientiarum Imperialis Petropolitanae
Correspondenz-Blatt für Schweizer Aerzte.
Delaware State Medical Journal.
Der Nervenartz.
Deutsche Medizinische Wochenschrift.
Deutsche Zeitschrift für Chirurgie.
Dai Sankai Igakkai Zasshi.
Diseases of the Chest.
Edinburgh Medical Journal.
Exerpta Medica.
Fakultät Okayama
Folia Morphologica (Warsaw).
Folia Morphologica (Prague).
Formosan Medical Association Journal.
Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin.
Fortschritte der Medicin.
Frankfurter Zeitschrift für Pathologie.
Fukuoka Ikadaigaku Zasshi.

Gaillard's Medical Journal.
Gazette des Hôpitauz Civils et Militaires (Lancet Francaise).
Gazette Hebdomadaire des Sciences Medicales de Bordeaux.
Gazzetta Medica Italiana: Provincie Venete.
Giornale della Accademia di Medicina di Torino.
Glasgow Medical Journal.
Gun-idan Zasshi.
Guy's Hospital Reports.
Hand.
Hand Clinics. Handlingar av Svenska Veternskapsademien.
Heart.
Helvetica Paediatrica Acta.
Henle u. Pfeufer Zeitschrift (Zeitschrift für Rationelle Medicin).
Hiroshima Daigaku Igakubu Kaibogaku Daiichi Koza Gyosekishu.
Hiroshima Igakubu Kaibogaku Daiichikoza Gyosekishu.
Hokuetsu Igakkai Zasshi. Human Biology.
Hygiea (Stockholm).
Igaku Kenkyu.
Ijishinbun.
Ikaishuho.
Il Policlinico (Sezione Chirurgica, Medica, Pratica).
Illinois Medical Journal.
Industrial Medicine.
International Clinics.
International College of Surgeons.
International Surgery.
Internationale Klinische Rundschau.
Internationale Monatsschrift für Anatomie und Physiologie.
Iwate Igakusenmongakko Zasshi.
Iwate Ikadaigaku Kaibogakukyoshitsu Gyosekishu.
Jahrbuch für Kinderheilkunde und Physische Erziehung.
Jahres-Bericht der Schlesischen Gesellschaft für vaterländische Cultur.
Jahresberichte über die Fortschritte der Anatomie und Physiologie (Schwalbe).
Japanese Journal of Medical Sciences.
Japanese Journal of Orthopedics and Traumatology
Jenaische Zeitschrift für Medicin und Naturwissenschaft.
Jicchi Ika to Rinsho.
Jikeikai Ikadaigaku Kaibogakukyoshitsu Gyosekishu.
Jinruigaku, Jinruiidengaku, Taishitsugaku Ronbumshu.
Jinruigaku Shuho.
Jinruigaku Zasshi.
Johns Hopkins Hospital Bulletin.
Johns Hopkins Hospital Reports.
Jordan Medical Journal.
Journal de Chirurgie.
Journal de l'Anatomie et de la Physiologie Normale et Pathologie de l'Homme et des Animaux.
Journal de Médecine, Chirurgie, Pharmacie, etc.
Journal de Médecine de Bordeaux et du Sud-Ouest.
Journal de Radiologie d'Electrologie et de Médecine Nucléaire.
Journal des Sciences Medicales de Montpellier.
Journal of Anatomy and Physiology (Journal of Anatomy).
Journal of Arkansas Medical Society.
Journal of Hand Surgery.
Journal of Nervous and Mental Diseases.
Journal of Neurosurgery.
Journal of Pediatrics.
Journal of the American Medical Association.
Journal of the Anatomical Society of India.
Journal of the International College of Surgeons.
Journal of the Kuwait Medical Association.
Juzenkai Igaku Zasshi.
Juzenkai Zasshi.

Kagoshima Daigaku Igaku Zasshi.
Kagoshima Igakkai Zasshi.
Kaibogaku Zasshi (Journal of Anatomy).
Kanazawa Daigaku Igakubu Kaibogakubu Kyoshitsu Gyosekishu.
Kanazawa Ikadaigaku Kaibogakukyoshitsu Gyosekishu.
Kansai Ikadaigaku Zasshi.
Keio Igaku Zasshi.
Kokubyori Gakkai Zasshi.
Kokukaibogaku Kenkyu.
Kumamoto Daigaku Igakubu Daiichi Kaibogakukyoshitsu Gyosekishu.
Kumamoto Daigaku Igakubu Kaibogakukyoshitsu Gyosekishu.
Kumamoto Igakkai Zasshi
Kurume Igakkai Zasshi.
Kyushi Gakuho.
Kyushu Igakusenmongakko Igakkai Zasshi.
Kyushu Shikagakkai Zasshi.
La Chirurgia degli Organi de Movimento.
Lancet
L'Osservatore Gazzeta delle Cliniche (Torino).
La Pediatria.
La Presse Médicale.
La Radiologia Medica.
La Reforma Medica.
La Sémaine Medicale.
La Société de Biologie Comptes Rendus Hebdomadaires des Séances et Memoires.
La Association des Anatomiste, Comptes Rendus.
London Medical Gazette.
Louisville Medical News.
Lyon Chirurgical.
Lyon Medical.
Mayo Clinic, Proceedings of the Staff Meetings.
Medical and Surgical Reporter.
Medical Clinics of North America.
Medical Journal of Shinshu University.
Medical Record.
Medical Times.
Medico-Chirurgical Transactions (Royal Medical and Chirurgical Society of Edinburgh).
Medico-Chirurgical Transactions (Royal Medical and Chirurgical Society of London).
Medizinische Jahrbücher (Wien).
Memoires de la Societe d'Anthropologie de Paris.
Mémoires de L'Académie Impériale des Sciences de Saint-Pétersbourg.
Memorie della Royal Accademia della Scienze dell'Istituto di Bologna.
Minerva Pediatrica.
Minnesota Medicine.
Minzoku Eisei.
Mitteilungen aus den Grenzgebieten der Medizin und Chirurgie.
Monatsschrift für Kinderheilkunde.
Monatsschrift für Unfallheilkunde und Versicherungsmedizin.
Montpellier Médical.
Montreal General Hospital (Annual Reports).
Münchener Medizinische Wochenschrift.
Muscle and Nerve.
Nagasaki Igakkai Zasshi.
Nagoya Igakkai Zasshi.
Nagoya Journal of Medical Sciences.
Nederlands Archief Voor Genees- En Natuurkunde.
Nederlandsch Lancet.
Neurologisches Centralblatt.
Neurology (Minneapolis).
Neurosciences Research Program Bulletin.
New York Medical Journal.
New York State Journal of Medicine.
Nihon Byorigakkai Zasshi.
Nihon Daigaku Igaku Zasshi.
Nihon Ikadaigaku Zasshi
Nordisk Medicin.
Nouvelles Archives du Museum National d'Histoire Naturelle.
Orthopaedic Review.
Oesterreichische Medicinische Wochenschrift.
Oesterreichische Zeitschrift für Praktische Heilkunde.
Okajimas' Folia Anatomica Japonica.
Okayama Igaku Zasshi.
Otozure (Osaka Joshi Kotoigaku senmongakko Dosokai).

Paris Médical.
Pediatrics Pester Medizinisch-Chirurgische Presse.
Pester Medizinisch-Chirurgische Presse.
Philadelphia Medical Journal.
Philosophical Transactions, Royal Society of London.
Physiological Reviews.
Plastic and Reconstructive Surgery.
Postgraduate Medicine.
Prager Medizinische Wochenschrift.
Prensa Médica Argentina.
Proceedings of the New York Pathological Society.
Proceedings of the Royal Society of Medicine.
Quarterly Bulletin of Northwestern University Medical School.
R. Accademia Peloritana, Messina. Atti.
Radiologia Clinica.
Radiology.
Resoconto delle Adunanze e dei Lavori della Reale Accademia Medico-Chirurgica di Napoli.
Revista Brasileira de Cirurgia.
Revista da Associacao Paulista de Medicina.
Revista de la Facultad de Medicina de la Universidad National, Columbia
Revue Canadienne de Biologie.
Revue d'Anthropologie.
Revue Neurologique.
Revue d'Orthopédie et de Chirurgie de l'Appareil Moteur (Paris).
Ricerche fatti nel Laboratorio di Anatomia Normale della R.
Universita di Roma ed in Altri Laboratoria Biologici.
Riforma Medica.
Rinsho Sanka-Fujinka.
Revista Internazionale di Medicina e Chirurgia. 4:337-344
Röntgenpraxis.
Rozhledy V Chirurgii (Praha)
Rozhlchir. Proha

St. Bartholomews Hospital Reports.
St. Thomas's Hospital Reports.
Scandinavian Journal of Plastic and Reconstructive Surgery.
Schmidt's Jahrbücher de In- und Ausländischen Gesammten Medicin.
Schweizerische Medizinische Wochenschrift.
Science.
Seiikai Zasshi.
Seminars in Roentgenology.
Shika Gakuho.
Shonikagaku Zasshi.
Sicilia Medica.
Sitzungsberichte der Kaiserlichen Akademie der Wissenschaften (Wien)., Mathmatisch-Naturwissenschaftliche Klasse.
Société de Anatomie et de Physiologie Normale et Pathologique.
Société de Biologie (et de ses Fillales), Comptes Rendus Hebdomadaires des Séances et Memoires.
Société de Pédiatrie de Paris.
Société des Sciences de Nancy, Memoires.
Société Médicale des Hopitaux de Paris, Bulletin et Memories.
Sotai taiji no kaibogakuteki kenkyu.
Southern Medical Journal.
Sperimentale, Firenza.
Surgery.
Surgery, Gynecology and Obstetrics.
Texas State Journal of Medicine.
The American Journal of Medicine.
The American Journal of Pathology.
The American Journal of Roentgenology and Radium Therapy.
The American Journal of Surgery.
The American Journal of the Medical Sciences.
The American Surgeon, (Southern Surgeon).
The Anatomical Record.
The Ausrtralian and New Zealand Journal of Surgery.
The Boston Medical and Surgical Journal.
The British and Foreign Medico-Chirurgical Review or Quarterly Journal of Practical Medicine and Surgery.
The British Journal of Children's diseases.
The British Journal of Radiology.
The British Journal of Surgery.
The Charlotte Medical Journal.
The Chinese Medical Journal.
The Gunma Journal of Medical Sciences.
The Journal of Bone and Joint Surgery.
The Journal of Comparative Neurology.
The Journal of Laboratory and Clinical Medicine.
The Journal of Medical Research.
The Journal of Mental Science.
The Journal of Pediatric Surgery.
The Journal of the Kansas Medical Society.
The Journal of the Missouri State Medical Association.
The Journal of the Oklahoma State Medical Association.
The Journal of Pathology and Bacteriology.
The Journal of Thoracic and Cardiovascular Surgery.
The Kurume Medical Journal.
The Medical Journal of Australia.
The Medico-Chirurgical Review and Journal of Practical Medicine.
The New England Journal of Medicine.
The New York Medical Journal.
The Ohio State Medical Journal.
The Quarterly Journal of Medicine.
The Quarterly Review of Biology.
The South African Journal of Medical Sciences.
The Surgical Clinics of North America.
The Transactions of the Medico-Chirurgical Society of Edinburgh.
The Transactions of the Royal Irish Academy (Science).
The University Studies of the University of Nebraska.
The Western Journal of Surgery, Obstetrics and Gynecology.
The Wisconsin Medical Journal.
The Yale Journal of Biology and Medicine.
Tohoku Igakkai Zasshi.
Tokyo Igakai Zasshi.
Tokyo Ikadaigaku Zasshi.
Tokyo Jikeikai Ikadaigaku Kaibogaku Kyoshitsu Gyosekishu.
Tokyo Jikeikai Ikadaigaku Zasshi.
Tokyo Shikadaigaku Kaibogaku kyoshitsu Gyosekishu.
Transactions of the American Surgical Association.
Transactions of the Chicago Pathological Society.
Transactions of the Linnean Society of London.
Transactions of the Pan-Am Medical Congress.
Transactions of the Pathological Society of London.
Transactions of the Pathological Society of Philadelphia.
Transactions of the Royal Academy of Medicine in Ireland.
Transactions of the Royal Irish Academy of Science.
Transactions of the Royal Society, Edinburgh.
Transactions of the Royal Society, London.
Transactions of the Royal Society of Tropical Medicine and Hygiene.
University of Pennsylvania Medical Bulletin (University Medical Magazine).
Union Medicale du Nord-Est.
Upsala Läkareforenings Forhandlingar.

Verelagen en Mededeelingen der Koninklijke Akademie van Wetenschappen, Afdeeling Natuurkunde.
Verhandlungen der Deutschen Pathologischen Gesellschaft.
Verhandlungen der Physikalisch-Medicinische Gesellschaft in Wurzburgh
Virginia Medical Monthly.
Viertljahrschrift f.d. Prakt.
Western Journal of Surgery, Obstetrics and Gynecology.
Wiener Archiv für Innere Medizin.
Wiener Klinische Wochenschrift.
Wiener Med. Jahrbücher
Zeitschrift der kais. Kön. Gesellschaft der Aerzte zu Wien.
Zeitschrift für die Gesamte Anatomie:
Part 1) Zeitschrift für Anatomie und Entwicklungsgeschichte.
Part 2) Zeitschrift für Kontstitutionslehre.
Zeitschrift für Klinische Medicin.
Zeitschrift für Kreislaufforschung: Zugleich Forsetzung von Zentralblatt für Herz- und Gefasskrankenheiten.
Zeitschrift für Menschliche Vererbungs- und Kontstitutionslehre.
Zeitschrift für Morphologie und Anthropologie.
Zeitschrift für Morphology und Pathologie.
Zeitschrift für die Organische Physik.
Zeitschrift für Orthopädie und ihre Grenzgebiete.
Zeitschrift für Orthopädische Chirurgie.
Zeitschrift für Rationelle Medicin (Henle u. Pfeufer Zeitschrift).
Zentralblatt für Chirurgie.
Zentralblatt für de Gesamte Neurologie und Psychiatrie.
(398 titles)

Books
Albinus, B.S. (1734) Historia Musculorum Hominis, Apud Theodorum Haak & Henricum Mulhovium, Leidae Batavorum.

Anson, B.J., Ed. (1966) Morris' Human Anatomy, The Blakiston Division, McGraw-Hill Book Company, New York.

Henle, J. (1871) Handbuch der Muskellehre des Menschen, in Handbuch der systematischen Anatomie des Menschen. Verlag von Friedrich Vieweg und Sohn, Braunschweig.

Huber, C.G., Ed. (1930) Piersol's Human Anatomy, 9th ed., L.B. Lippincott Company, Philadelphia.

Hyrtl, J. (1887) Lehrbuch der Anatomie des Menschen, 19th ed. Wilhelm Braunmüller, Wien.

Kopsch, F. (1908) Rauber's Lehrbuch der Anatomie des Menschen. Georg Thieme, Leipzig.

Latarjet, A. (1948) Testut's Traité d'Anatomie Humaine, 9th ed., G. Doin & Cie., Paris.

LeDouble, A.F. (1897) Traité des Variations du Système Musculaire de l'Homme et Leur Signification au Point de Vue de l'Anthropolgie Zoologique. Libraire C. Reinwald, Schleicher Freres, Paris.

Schaefer, E.A., Symington, J. and T.H.Bryce, Eds., Quain's Anatomy, 11th ed., Longmans, Green and Co., London.

Testut, L. (1884) Les Anomalies Musculaires Chez l'Homme Expliques par l'Anatomie Comparée. Masson, Paris.

Toldt, C. (1928) An Atlas of Human Anatomy for Students and Physicians. The Macmillian Company, New York.
Vesalius, A. (1543) De Humani Corporis Fabrica Libri Septem, Ex officina Joannis Oporini, Basel.

Miscellaneous Sources
In addition to the primary and secondary references, numerous anatomic variations are reported that were found in the dissecting rooms of The Johns Hopkins Medical School, American University of Beirut Faculty of Medicine, and The University of Iowa College of Medicine by indefatigable first year medical students, over a period of many years.



Vesalius' dissecting tools

Examples of Some Very Early References
As interesting examples from very early references, we provide a few here:

In regard to the male gonads, the Bible states;
" For there are eunuchs who have been so from birth, and there are eunuchs who have been made eunuchs by men, and there are eunuchs who have made themselves eunuchs for the sake of the kingdom of Heaven." Matthew 19:12, @ 80 AD.

In regard to the skeleton,
"And there was again war at Gath, where there was a man of great stature, who had six fingers on each hand, and six toes on each foot, twenty-four in number; and he also was descended from the giants." 2 Samuel 21:20.

And, from the early medical literature;
Sir Thomas Brown in his Pseudodoxia Epidemica or Commentaries on Vulgar Errors (Second Edition, London, 1660, p.292) speaks of the heated discussion over the biblical story, which arose from the description by Columbus of a female skeleton which possessed a supernumerary rib. "That a man hath one Rib lesse than a Woman, is a common conceit derived from the history of Genesis, wherein it stands delivered, that Eve was framed out of a Rib of Adam; whence 'tis concluded the sex of Man still wants that rib our Father lost in Eve. And this is not only passant with the many, but was urged against Columbus in an Anatomy of his at Pisa; where having prepared the sceleton of a Woman that chanced to have thirteen ribs on one side, there arose a party that cried him down, and even unto oathes affirmed, this was the rib wherein a woman exceeded. Were this true, it would autoptically silence that dispute out of which side Eve was framed; it would determine the opinion of Oleaster, that she was made out of the ribs of both sides; or such as from the expression of the text maintain there was a pleurality required, and might indeed decry the parabolicall exposition of Origen, Cajetan, and such as fearing to concede a monstrosity, or mutilate the integrity of Adam; preventively conceive the creation of thirteen ribs."



God taking a rib from Adam to create Eve.
From the front of the Cathedral at Orvieto, Italy.

The authors have read many thousands of references and have included a summary of these papers in the sections to follow. We wish to make it clear that only a brief summary of these papers can be included here for reasons of time and space. We have provided references in as many as 7 languages and much duplication of data can be seen. Nevertheless, the references provided are accurate and complete and we recommend that they be consulted for many details that may have been inadvertently overlooked. Our treatment of the variations is primarily anatomic but interesting clinical observations are also included. We have included synonyms for all structures having them; these are compared with the current usage given in the Nomina Anatomica. We hope that these listings will make reading in the older literature a bit easier and comprehensible.

There are five books in this series; 1) Muscular System, 2) Cardiovascular System, 3) Nervous System, 4) Organ Systems, and 5) the Skeletal System.
This book is the first of the series.

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Medicine card spreads

Medicine Cards spreads

Medicine card spread is used depending on the medicine one is seeking or or the problem one is trying to heal.

The cards that come with medicine card spread each has a number and an animal on its inside face .If its number and face are upside down the card is said to be in reverse position. Therefore the card has two meanings , one for right side up and one for the reverse. It is best to right all cards before beginning. In seeking to find one's animal medicine one could choose to use one are all of the various spread listed below.

Medicine wheel spread

Pathway Spread

Butterfly spread

Father sky mother earth spread

Moon Lodge Spread

Sun lodge Spread.

Medicine Wheel spread

1 East card reveals where your spiritual strength lies and indicate the direction your spiritual Path is taking. It can reveal the major challenge in seeking clarity in your present position.
2 South card describes how animal medicine is teaching the child within you or your adult self. It is what you need to trust in yourself and what you need to nurture in your growing self.
3 West card gives internal solutions to your present life challenge it indicates where you goals need challenge.
4 North card teaches you how you may spiritually apply and interrogate the lessons of the other directions. The animal medicine of this card is the key to walking in wisdom knowing the teacher within and connecting to the higher self.
5 The sacred mountain card ask you to look at the present .This card Indicates how your physical and spiritual realities melded to produce at the present moment
Each medicine card has a number and a picture of an animal on its face. If the medicine card is reverse its number and face are upside down. Two lessons are therefore presented with each card one for right side up and one for reverse. It is therefore best to right all cards before beginning.

You can choose one card for daily medication by spreading cards on the table and choose one.

Pathway Spread

The pathway spread gives information about the pathway of life. Seven cards are used for this spread. The cards are laid out as follows.

1. Row one is made up of two cards and are the cards of the 6th and 4th cards chosen .the 6th card farthest to left and the 4th to the right of it.

2. Row two is the middle row ,it is made up of three cards and is laid exactly below row one with the 3rd card chosen to the extreme left , the 2nd card chosen in the middle , the 1st card to the right of the 2nd card beside it.

3. Row three is made up of two cards. Laid out under row three the 5th card goes exactly under 2nd card of row two and the 7th card goes under 1st of the row two.

NB. Row two the middle row is the first to be constructed. Rows one and three are constructed at the same timeThe cards of these position represent the following

1st position your past
2nd position your future
3rd position your future
4th position the pattern or set of life lessons that is moving through your life now
5th position the challenge you have conquered or the lesson you have completed.
6th position what is working for you
7th position what is working against you.
Butterfly spread

The butterfly is used to determined the outcome of projects or group enterprises. Four cards are used for this medicine. They are drawn from the pack and place downwards on the four cardinal points of the medicine wheel classic directional level position, in the order of East, south, west , north. These cards indicate the various phases that the project activity will move through right to its conclusion.

1. East card is known as the egg card or egg position. You view this card as the nucleus or seed of your project or activity.
2. South Card is known as the lava card or lava position. It is about early doings, what is needed to be done how and who best to be responsible, and if there will be enough energy to carry through the project. .

3. West card the cocoon card or cocoon position is where the highest transformation will take place.
4. North card butterfly card or butterfly position is likely to tell you if the great spirit will walk hand in hand with the group or project. Look at the cards to tell what type of rewards you will gain financially. Look at the cards to tell what type of rewards you will receive.

Father Sky Mother Earth spread

This spread is a method of balancing yourself when times are hectic and you need to rid yourself of the confusion. Everyone has two sides male or warrior energy side -right side ruled by the left brain or the mother earth side of the body - the left side ruled by the right brain or intuitive side of the mind which allows the process of all things and time.

To use this spread merely pick one card with the right hand and one with the left. Hold them in front of you and focus on the balance of your male self (right)and your female self left(left)and observe silently the connection or lack of connection between the female and the male and above, To help balance them you may call upon the medicine of the creature one at a time . Be sure to enter the silence and allow the animal to speak.

Contrary cards indicate an unbalanced in the medicine of the cards. Its position in the spread give future information.

Moon Lodge Spread

The moon lodge is a mirror of one's own unconsciousness. It is laid out in the same manner as the medicine wheel spread. This is used to uncover what is within you,

1. East card is the whirling spirit card, it unlocks your spiritual nature.

2. South New growth, is the seed card ,here one looks for possible beginning in personal relationship or in relationship to the environment. It may reveal the true feeling for someone or something.

3. West card this is the dream within the dream. It may lead you to your real purpose in life so study it well.

4. North card this indicate the inner wisdom you may not have recognized in yourself study this card with the intent of knowing your self.

5. Central card this indicate the integration point of all the directional medicine of your personal unconsciousness. It is the power shield of the real self. This is the card of the circle of the knowing within and knowing the true self and non can ever fool you.

Sun Lodge Spread

The sun lodge spread determines how others see you.

It is the spread of outward relationship. It is laid out as the medicine wheel spread. It is different as you are required to hold the image of the person you are seeking about in your mind.

1. East card, this is an indication of how the person sees you spiritually.
2. South card is an indication of how the person see you in the relation to the material world.
3. West card indicates how the person is likely to interact with you in response toyour deep desire.
4. North card this is the card of how the person views you intellectually.
5. Central card this is an indication of the total view of what the person has of you.
It suggests how the person will immediately respond to your pressures. how much you will gain financially.

Look for the continuation of this topic on the follow up webpage. Credit is given to Jamie Sams and David Carson for giving to humanity these information. Purchase one of their books on this page to learn more and to show your gratefulness.What you read on thes web pages are not even the tip of the iceberge.

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Chinese Herbal Medicine - The History of Chinese Herbalism

Mention Chinese medicine to anyone today, especially in Western countries, and visions of acupuncture are the first thing that springs to mind for most people.

The truth is, Chinese medicine is so much more. Even more true, is the fact that Chinese medicine very often surpasses and is the foundation for Western medical practices.

Since practically the beginning of time, if it could be said that one culture literally wrote the book on herbalism -- only the Chinese could claim the prize of having the longest unbroken belief and traditions in herbal medicine.

It has always seems odd to me that the herbal medicine practices of Asian cultures, should be considered alternative medicine,while today's science of synthetic drugs (Western medicine) should be the standard.


Chinese Medicine
Roughly three thousand years ago, it is recorded history that the Chinese knew about three hundred different plants for herbal medicine. By then, they had already recorded descriptions of the plants, how to preserve them, and how to administer them correctly, all according to Chinese medicine practices of the time.

The wondrous thing is that many of these practices are still in use today and make up the foundation of herbal medicine as we now know it.

Let's Take A Look At How Chinese Medicine Came About

The Emperor Shen Nung (2698 B.C.)
The Emperor Shen Nung was a big fan or perhaps the "father" of Chinese medicine. He had the Canon of Herbs written, recording in precise detail three hundred and sixty-five plants, minerals, and animals. He further described how to preserve them for medicinal use, along with details on how to administer them.

The Canon of Herbs, is also known as the Shen-nung pen ts'ao ching (Divine Husbandman's Materia Medica), Legend has it, that he wrote it, but who actually penned his body of work is unknown.

One thing is certain, this Father of Chinese medicine is who introduce the technique of acupuncture to the common people of China.

He didn't just trust his theories and beliefs and the testing of them to others, he personally is said to have tasted at least one hundred of these traditional Chinese medicines.

He was quite a busy Emperor, because he additionally taught his people how to cultivate grains as food, solely for the purpose of killing less animals.


What Is Holistic Thinking?
Chinese medicine has a lot to do with holistic thinking. Holistic thinking is something most herbal practitioners (both Western and Eastern) follow in their approach to medicine. So what is holistic thinking?

It could be compared to waves from a pebble dropped in water, ever spreading outward. It's the same thing with plants, if you consider the whole plant is greater than the sum of it's parts, a person's whole lifestyle and physical.

Haung Ti - The Yellow Emperor (2550 B.C.)
One hundred years after Emperor Shen Nung, Emperor Huang Ti (aka the Yellow Emperor) developed a central theory that in Chinese medicine that really understood human disease far better than any other culture during that time.

This one quote from his Nei Ching says it all:

"In treating illness, it is necessary to examine the entire context, scrutinize the symptoms, observe the emotions, and attitudes. If one insists on the presence of ghosts and spirits one cannot speak of therapeutics."

This optimistic viewpoint in his book, shows what today we know as, holistic medicine, being a concept a few thousand years old. The book was popular, even being updated in the 6th century, and then again in the 7th century.

The works also went into introduction to the then known concepts about living matter, medical physiology, known anatomy, and developments in acupuncture.

Su Jing
In the 7th century, a young man named Su Jing, went to the Tang Dynasty and asked for sponsorship to revised and update Emperor Huang Ti's Nei Ching. The court was so intrigued that it provided him with twenty experts to give him input, documentation, and even illustrations of useful herbs that they knew.

Two years later, the result was A Revised Canon of Herbs being published. When you think about it, this was an amazing feat because this was over eight hundred years beforethe Western printing press was invented -- the Tang Dynasty, not only printed it, they distributed it throughout China.


Li Shizhen (Li Shih-chen) - 1518 to 1593
The well known Ming Dynasty (1368 AD to 1644 AD) produced another great Chinese medicine work, written by Li Shih-chen. It was titled, Pen ts'ao kang mu (The Great Herbal). It took him twenty-seven years to write this book. It is a practical and scientific manual with over eleven thousand recipes or compounds.

Here was a man who was very determined from childhood as he helped his father collect herbs and copy prescriptions.

Inside it, is pretty much the sum total of herbal medicine known at the time. It contains descriptions of over eighteen hundred plants, animal parts, minerals, and metals that made up Chinese medicine for the time. The best part of Li Shih-chen's body of work in Chinese medicine is the fact that it is so revered, that it is updated and revised still to this day.


Chang Chung-ching - The Physician
During the time of the Han Dynasty (206 BC to 220 AD) one practitioner of Chinese medicine, stands far above the rest -- Chang Chung-ching. He was considered the greatest physician of his era. He would forever go down in Chinese history as the Hippocrates of China.

He wrote Shang han lun (Treatise on Colds and Fevers), which profoundly affected Chinese medicine

Traditional Chinese Medicine

A Few Words of Caution
There is a misguided notion among some people, that just because something is natural, like herbs made from plants -- that it is somehow safer. The truth is that plants can be very potent drugs and sometimes can even be deadly.

An equally important truth is that synthesized drugs made from isolated plant principles are all around us in today's drugs. Two examples are:

Aspirin
Morphine
Just like synthetic drugs, the correct and accurate dosage of herbs, should never be taken in excessive amounts. It is also important just like you should always consult a doctor if you have a serious or recurring complaint, or doubts, you should also consult a trained herbalist.

If You'd Like To Know More!
A potted history: Emperor Shen Nung started it all when some leaves fell in his water. Dolly Dhingra
He has the refined manners of a character in an E M Forster novel, a surname that sounds like a Hindu god and his mission is to educate us to understand that the pleasures of drinking tea and coffee cannot be gained in an instant. He is Edward Bramah
Active Herb - Chinese Medicine
Chinese Herbs and Chinese Herbal Medicine Based On Traditional Chinese Medicine
Chinese herbs and Chinese medicine for common health conditions, including health and nutritional supplements, news, and articles about traditional Chinese herbs and Chinese herbal medicine.
Chinese Medicine
Explores general information regarding Chinese medicine, acupuncture, and Chinese medicine for diabetes
Chinese medicine news and articles
East Earth Trade Winds Suppliers of Unique Chinese Herb Products
Over four hundred Chinese herbs in stock. Hundreds of unique Chinese herbal remedies, Chinese medicine books, essential oils, incense, and much more are in stock and ready to ship from our store!
Tea: A Story of Serendipity
Tea is second only to water in worldwide consumption, and Americans drink their fair share.
The Chinese Medicine Sampler & Online Diagnosis - Treatment by Root & Branch
Traditional Chinese Medicine Information

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Caffeine Danger: 5 Negative Effects Caffeine for Health

Caffeine is a natural substance found in various plants.

In humans, caffeine acts as a stimulant on the central nervous system and metabolic system.

Caffeine is consumed worldwide, usually contained in a drink made from coffee beans or tea leaves.

Unlike other types of stimulants, caffeine is legal and there are no laws regulating the caffeine.

Negative effects that can be caused by caffeine:

1. Caffeine Poisoning

Caffeine intoxication is a condition or state of anxiety due to too much coffee or other caffeine-containing beverages.

A sense of nervous and excited, trembling, rapid heartbeat, increased frequency of urination, and sometimes problems in the digestive system is a condition that indicates an overdose of caffeine.

This condition is caused by caffeine doses greater than 300 mg. However, increasing tolerance doses of caffeine require more than this amount to achieve the same effect.

For caffeine overdose can be lethal, a person should drink about 80 to 100 cups of coffee in a certain period.

2. Anxiety and Sleep Disorders

American Psychological Association associate certain forms of anxiety and sleep disorders with the effects of caffeine.

Both these disorders are the result of caffeine intake in the long term so that disrupt sleep and normal brain patterns.

Symptoms of anxiety caused by caffeine including diataranya are panic attacks and other psychological problems including obsessive behavior and schizophrenia.

3. Withdrawal

Caffeine addiction can lead to withdrawal symptoms (symptoms of addiction) if caffeine use is stopped.These effects can range from mild to severe, including among others are headache, confusion, depression, nausea, and fatigue.

4. Ulcers and GERD

Caffeine can cause the stomach to produce extra acid that can cause problems in the digestive tract.

The National Digestive Disease Information Clearinghouse (NDDIC) reported that the gastrointestinal tract problems caused by excess consumption of caffeine, including ulcers (sores) in the stomach and esophagus.

Acid reflux that go up into the esophagus that comes out of the stomach causing acid reflux disease, otherwise known as gastroesophageal reflux disease (GERD).

5. Caffeine and Heart

Effects of caffeine on the heart is still under investigation. If consumed in moderate amounts, caffeine does not seem to have a positive or negative effects on the heart.

However, according to the findings of the European Society of Cardiology (ESC), heavy coffee drinkers showed increased blood pressure associated with heart disease and increased risk of heart attack or stroke.

ESC findings also show that heavy coffee drinkers prone to heart palpitations and fatigue, and increased risk of heart attacks and strokes later in life.

This risk is greater if they are low-fat diet and healthy grains, and the consumption of saturated fats from red meat and dairy products are relatively high.

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Safety Tips Caffeine: 6 How to Neutralize Excess Caffeine Effects

After missing the stimulating effects, caffeine also canreduce the body's energy reserves.

Immediately neutralized the effects of excess intake ofcaffeine if you feel the effects it causes.

A few simple steps, from relaxation to eat certain foods, can be done to help calm the mind and body that is too active (overactivated) because of excesscaffeine.

Here are some tips to neutralize the effects due to excess intake of caffeine:

1. Doing activities that can make relaxing.

Here are some things you can do to calm the body and mind:

a. Sit or lie down alone in a quiet room

b. Take a stroll in the park

c. Listen to soothing music

d. Reading books

e. Closing the eyes while inhaling a deep breath

f. Bathing with aromatherapy oils, eg lavender oil which has soothing properties

Relaxing will help calm nerves and refocus your mind.

2. Drink at least two full glasses of water.

Water will help the rehydration of the body, cleanse toxins from the body, and restore the lost minerals.

3. Take supplements of vitamin C.

Vitamin C helps the body break down caffeine.

4. Take anti-diarrhea medicine.

Drinking anti-diarrhea drugs, such as Norit or Imodium if the intake of caffeine has caused diarrhea, can helpstop diarrhea.

5. Drinking a small glass of wine.

Alcohol can slow down brain activity. A glass of wine will help overcome the stimulant properties owned bycaffeine. However, avoid drinking too much alcohol because it can interfere with the process of re-normaliasibody.

6. Eating healthy foods that warm, especially if the head feels dizzy.

Caffeine may be eliminating hunger, but it is a good idea to eat something.

Avoid sugar, because sugar will just stimulate the body again. The food will absorb the caffeine and restorelost body energy.

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