Hospitals & Asylums 








Fall Equinox Edition

Vol. 13, No. 3


By Anthony J. Sanders


Nehum 3:18-19

18 King of Assyria, your shepherds slumber;
    your nobles lie down to rest.
Your people are scattered on the mountains
    with no one to gather them.
19 Nothing can heal you;
    your wound is fatal.
All who hear the news about you
    clap their hands at your fall,
for who has not felt
    your endless cruelty?

Habakkuk 1:1-7


1 The prophecy that Habakkuk the prophet received.

Habakkuk’s Complaint

2 How long, Lord, must I call for help,
    but you do not listen?
Or cry out to you, “Violence!”
    but you do not save?
3 Why do you make me look at injustice?
    Why do you tolerate wrongdoing?
Destruction and violence are before me;
    there is strife, and conflict abounds.
4 Therefore the law is paralyzed,
    and justice never prevails.
The wicked hem in the righteous,
    so that justice is perverted

The Lord’s Answer

5 “Look at the nations and watch—
    and be utterly amazed.
For I am going to do something in your days
    that you would not believe,
    even if you were told.
6 I am raising up the Babylonians,[a]
    that ruthless and impetuous people,
who sweep across the whole earth
    to seize dwellings not their own.
7 They are a feared and dreaded people;
    they are a law to themselves
    and promote their own honor.


Pulmonology HA-18-7-13


The respiratory system includes the nose, mouth, a pair of lungs, the tubes or airway to the lungs, chest bones and muscles.  Oxygen is pumped into the lungs by the respiratory muscles and is brought into close contact with blood, into which it passively diffuses, at the level of the pulmonary capillaries in the alveoli.  Carrier molecules in the blood, hemoglobin, bind the Oto make blood, pumped by the heart, as efficient as the air in transporting O2.  Each cell in the body is equipped with a specialized furnace, the mitochondria, which burns carbohydrates with Oto produce the high-energy ATP molecules that fuel the cells' functions, and ultimately maintain the life of the whole organism. Ois transformed into water by this process and with carbon dioxide (CO2) is returned to the external environment where it is recycled by plants into O2 and carbohydrate by solar energy.  Humans can tolerate only 5 minutes of oxygen (O2) deprivation without irreversible damage and death.  Any change in pH, whether produced by respiratory or metabolic changes, alters O2 affinity.  Under pathologic conditions, blood pH can deviate markedly from pH 7.4 and have profound implications in oxygen delivery. Low pH may hamper oxygen uptake in the lung.  Addition of COto blood causes pH to fall by 0.03 to 0.05 units.  Sputum has a pH of 7.0 and must be removed through daily naso-bronchial hygiene.  Ascent to high altitudes produces both hypoxemia and respiratory alkalosis.  Alkalinity can be prevented by administration of acetazolamide.  Acidosis is often corrected by hyperventilating through pursed lips and its cure is dependent on the excretion of acid by the kidneys.  Bicarbonate therapy is most effective when plasma bicarbonate is low and there is little be gained when the initial (HCO3- ) is above 20 to 1 mEq/liter.


The treatment of cough is successful in over 95% of cases.  All narcotic antitussives are effective cough suppressants. Dextromethorphan hydrobromide is the most common nonnarcotic cough suppressant, it is slightly less effective.  Around 2010 the FDA removed some 600 different types of flu remedies from the market.  The FDA has approved Allegra (Sanofi-Aventis) and Children's Allegra (fexofenadine) and Allegra-D (fexofenadine and pseudoephedrine) product lines to be marketed over-the-counter. The two prescription antivirals for the flu are Oseltamivir (Tamiflu) and Zanamivir (Relenza), for Haemophilus influenza the antiviral Amantadine (Symmetrel) and anbimicrobials ampicillin (Principen) or levofloxacin (Levaquin) are also used. Winter 2012-2013 the flu vaccine was reported to be only 8% effective.  Respiratory syncytial virus (RSV) infections are treated with NSAIDS such as acetaminophen or ibuprofen and corticosteroids may be administered if the pneumonia worsens.  Antibiotics should be administered if an ear infection (otitis media) or pneumonia develop.  For Severe Acute Respiratory Syndrome (SARS), a coronavirus, the treatment with no fatalities was to ventilate the patient and medicate with the antibiotic levofloxacin (Levaquin), and corticosteroids methylprednisolone IV and then prednisone. Vaccines are the greatest achievement of modern preventive medicine.  Polio and smallpox have been eradicated and one more generation of vaccines will eliminate whooping cough, measles and mumps as threats to our children. Allergies have become more common since vaccines and GM crops saturated the market.  Antihistamines are sedative and 100 immunotherapy injections is a lot.  Herbal medicine is successful in the treatment of viral and allergic illnesses.  For allergic rhinitis the best treatment is the essential oils of fresh Lavender, Lemonbalm, and Peppermint in the nose, or as drops on the tongue or mix the oils in a ¼ cup of juice or water, swish 10-20 seconds in the mouth and swallow, relief should be instant, use must continue.  Eucalyptus oil kill dust mites, a common household allergen.  Take Vitamin C 200-1,000 mg daily to shorten duration of cold.  Oranges, echinacea and elderberry are high in vitamin C and very good at treating colds.


Initial therapy for acute asthma and chronic obstructive pulmonary disease (COPD) should include supplemental oxygen and inhaled beta-adrenergic drugs.  Corticosteroids are indicated if the initial response is insufficient or if the patient has had several recent asthma attacks.  There are two chief types of bronchodilator drugs: adrenergic agents (Ephedra aquisetina and E. sinica and synthetics) and those derived from theophylline (originally isolated from tea, Camellia sinensis) which act directly on the bronchial muscle to relieve obstructions, increase coronary blood flow and stimulate respiration centrally.  Tea as an oral treatment of 100 patients for 20 days proved effective in 93% of cases, of which 58% could be described as excellent.  During the course of treatment, sputum decreased in 91% of the cases, cough in 85% and asthmatic symptoms in 58.1%. Streptococcus pneumoniae is the most common bacterial cause of pneumonia.  Pneumococcus, Haemophilus influenzaeLegionella pnemonphilaMycoplasma and viruses abound in the community and gram-negative bacteria and Staphylococcus species in hospitals.  Cystic fibrosis patients are frequently infected with Pseudomonas and Staphylococcus.  COPD patients are vulnerable to the typical community-acquired infections.  The bacterium Legionella pneumophila causes both Legionnare’s disease and Pontiac fever and is an occupational hazard contaminating air-conditioning units and water reservoirs. Empiric therapy for the majority of immune-compromised patients with a presumed pulmonary infection includes antibiotic coverage for both gram-positive and gram-negative organisms (usually a semi-synthetic penicillin or a cephalosporin plus an aminoglycoside.  Penicillin by mouth and corticosteroids by mouth or nebulizer may be effective in simple lung abscesses. Inpatient treatment of lung abscess, especially the putrid variety, should be 2 to 6 million U crystalline penicillin G intravenously daily; 600,000 U procaine penicillin G intramuscularly every 6 hours for 4 weeks may be sufficient in milder cases.  In the presence of serious penicillin hypersensitivity, clindamycin 600 mg 4 times daily, lincomycin 600 mg intramuscularly every 6 hours, or erythromycin 2 gm/day may also be used.  Some observers are in favor of adding streptomycin 1 gm intramuscularly daily for at least the first 7 to 10 days, or tetracycline 2 gm daily to 3 to 5 days, then 1 gm daily. If Staphylococcus aureus is found and believed to be a causative agent, intravenous methicillin, or an equivalent drug such as nafcillin, 8 to 16 gm daily, if penicillin resistant.  Vancomycin, 500 mg intravenously every 6 hours is an effective anti-staphylococcus drug but has significant toxicity, resistance and probably should seldom be used.  Antimicrobial treatment should be continued for at least 2 to 3 months, sometimes even longer.  Oral doxycycline 100 mg the once a day antibiotic, for the treatment of methicillin resistant S. aureus (MRSA), seems more ideal than hospital treatment for a hospital acquired infection. If Klebsiella organisms are found and are the causative agent, the initial therapy should include kanamycin, 15 mg/kg/day intramuscularly in 2 or 3 divided doses, the total dose being decreased if renal insufficiency is present or appears.  Metronidazole (Flagyl ER) is a safer and possibly more effective alternative but clinical trials are needed for the FDA to indicate its effectiveness against Klebsiella and E. coli.  When Pseudomonas is clearly the causative organisms, gentamycin or tobramycin should be used.  Metronidazole (Flagyl ER) is indicated for the treatment of Bacteroides spp. (e.g. B. fragilis).  Doxycycline, the once a day antibiotic, should be prescribed at hospital discharge to prevent hospital acquired staph infections. Although azithromycin (Zmax), the world's best-selling antibiotic, may be more a day or two more effective in most cases, pencillin or ampicillin (Principen) are the standard treatment for pneumonia, meningitis and upper respiratory infections, and erythromycin, a streptomycin like Zmax, is the traditional generic alternative for patients allergic to penicillin.  Metronidazole is a uniquely effective antibiotic at curing gastrointestinal infections without side-effects, that is also effective against bone and joint infections lower than the middle of the thorax. In 1989 ten drugs were used for the treatment of tuberculosis and non-tubercular mycobacteria (NTM), the four most important are isoniazid (INH), rifampin, pyrazinamide, and ethambutol with 95% cure rates in a 6 to 9 month short course of multiple drug chemotherapy. 


Corticosteroids, sporanox (itraconazole) oral and amphotericin B are the only medicines indicated for Aspergillus spp (i.e. A. niger sold to academic laboratories) which causes invasive pulmonary aspergillosis, and releases a most highly carcinogenic aflotoxin, as well as the other fungi also treated by ketoconazole Coccidiodes immitisCryptococcus neoformansCandida organisms, Histoplasma capsulatum, and Blastomyces dermatitidis. Hypoxemia can be effectively corrected by using controlled oxygen enrichment by double nasal cannula or Venturi masks.  Expectorants and mucolytics such as guafenesin or the herb mullein help liquefy secretions and allow one to cough up mucus more easily.  One of the best expectorants is water.  Drinking an adequate amount of water, about one quart per day, will make clearing phlegm easier, which may lead to improved breathing. Lung cancer has a 10-15% five year survival rate.  The probability of contracting lung cancer is 12 times higher in smokers and 50 times higher in smokers who have been exposed to asbestos, a fiber that only causes cancer in smokers.  The most active single antineoplastic agents are methotrexate and cisplatin.  Each produces response rate of approximately 30% (mostly partial responses) of 4 to 6 months' duration.  Cisplatin responses usually occur more promptly.  Cisplatin is an effective drug whose major route of excretion is renal, and its use should be limited to patents with a creatinine clearance that is more than 50 ml/minute.  The standard dose is 100 mg/mevery 3 weeks. Methotrexate is generally given at 40 mg/mintravenously weekly.  Methotrexate 2.5 mg, once a week, might be more effective with fewer side-effects, exposure to community and hospital acquired infections and carcinogens and at 70 cents a pill, lower cost.  Don't lose weight, extra rations for physical labor, pregnancy and respiratory disease.


Oncology HA-19-9-13


The skin is the largest organ. No one calls insect bites or chickenpox tumors, but by strict medical definition they are.  The skin is about one millimeter thick.  There are about 100,000 hairs on the scalp of which about 70 are shed each day.  Hairs on the scalp grow up to 0.015 inch every day, a half an inch a month.  Fingernails grow continuously and average between 0.02 and 0.05 inch per week.  Toenails grow about a third more slowly.Histology is the study of the microscopic anatomy of four basic tissue types: 1) epithelia, 2) connective, 3) muscle, and 4) nervous tissues. Eczema is an inflammation of the skin that causes the sensation of itch and makes the sufferer want to scratch.  An alternative name for eczema is dermatitis – the two terms mean exactly the same thing and it is not uncommon for some doctors to use the term eczema to describe the problem in babies and dermatitis in older children and adults.  The most common reason for a dermatologic doctor visit is the overtreatment of contact dermatitis; hydrocortisone ointment, available for $1, has the broadest spectrum of activity without the side-effects of more powerful corticosteroids.  Acne is most common in teens but can strike at any age.  Almost 100 percent of people between 12 and 17 years old have at least an occasional blemish.  More than 40 percent of cases are severe enough to require treatment by a doctor.  About 15 million people in the United States have some form of eczema, including 10 to 20 percent of babies.  In about half of these babies, the condition will largely clear up between the ages of 5 and 15.  This condition usually appearas during infancy.  About 5 percent of the U.S. population has foot infections ,including athlete's foot, other fungal infections and warts every year.  Psoriasis affects more than 7 million Americans, about 2.6 percent of the population.  More than 150,000 new cases are reported every year, 20,0000 of them in children under 10.  It is most commonly diagnosed between ages 15 and 35.  About 1 to 2 percent of the world's population, 40 to 50 million people, suffer from vitiligo, 2 to 5 million in the U.S.  It generally develops before age 40 and affects all races and genders equally. Most skin cancer is non-melanoma cancer, such as basal or squamous cell carcinoma.  More than 1 million of these cases are diagnosed every year.  About 54,000 melanomas are diagnosed every year, causing 7,500 deaths.  About 2,000 die from non-melanoma skin cancer.  Skin cancer is the most common cancer.  About 1.5 million Americans have a form of lupus.  Lupus is much more prevalent among people of color, and 90 percent of cases occur in women.  Systemic lupus usually develops between ages 15 and 45.


Acne vulgaris is a very common skin condition of adolescents and young adults; characterized by any combination of comedones (blackheads), pustules, cysts, and scarring of varying severity; it is treated by washing with water and Dial soap, Benzoyl peroxide, resorcinol, Retin-A or Accutane for severely scarring cases, for infection topical clindamycin or erythromycin ointment or oral doxycycline, the once a day antibiotic, is cheap and highly effective for the treatment of the skin and greatly accelerates wound healing when the powder is applied to topically.  Keratosis are pre-cancerous skin lesions mostly found in people over 40 when the skin begins to dry out and becomes sun sensitive, requiring moisturizer, sunscreen, avoidance of the sun between noon and 3 pm, best treated with the topical antineoplastic exfoliator 5-fluourouracil (5-FU).  The three kinds of malignant skin cancer are squamous cell carcinoma, basal cell carcinoma and malignant melanoma, which has lethal metastatic potential, are best treated by avoiding sunlight and wide surgical excision.  Aside from general anesthesia, no pain medication will completely remove a severe burn patient's pain until they have completely healed; surgical skin grafting and reconstructive techniques have become highly developed.  Bacterial skin infections such as impetigo are best treated with doxycycline, that is effective against hospital acquired methicillin resistant staphylococcus aureus (MRSA).  Mycobacterial diseases such as leprosy and tuberculosis require special treatment with Dapsone (diaminodiphenyl sulfone, DDS), rifampin, and isoniazid.  Herpes simplex virus cold sores of mouth and genitalia are treated with Acyclovir (Zovirax).  Zovirax ointment (5%), Neo-Synalar or other antibiotic-corticosteroid ointment and Burow's solution wet compress for 20 minutes three times a day to relieve much of the pain and irritation.  Warts, or verrucae, are very common small tumors of the skin caused by the human papilloma virus (HPV.  There are 30 to 40 types of HPV that will affect an estimated 75% of 80% of males and females in their lifetime.  For most, HPV clears on its own, but, for others HPV could cause cervical cancer in females and other types of HPV could cause genital warts and oropharyngeal cancer in both males and females.  Common warts of the skin are best removed with electrosurgery.  Warts around the nails tend to recur and are treated with Salicylic acid and trimmed with a scissors.  Plantar warts of the foot are treated with trichloroacetic acid solution, fluorinated corticosteroid-occlusive dressing, or cantharidin tincture and the wart is removed curettage.  Filliform warts, flat warts, are snipped off with a small scissors. Moist warts (condylomata acuminate) appearing in the anogenital areas are treated with podophyllum resin in alcohol.  Gardasil helps protect against 4 types of HPV.  In girls and young women ages 9 to 26 Gardasil helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts in both boys and girls.  Topical fungal infections, usually Tinea (pedisversicolor etc.) are treated with athlete's foot crème (clotimazole) that can be purchased for $1.  Cutaneous candida and sporotrichosis are treated with oral ketoconazole. Male pattern hair loss must be differentiated from patchy hair loss from alopecia areata or trichotillomania.  Treatment for lice, pediculosis capitis and pubis, is lindane shampoo (Kwell or Scabene).  Scabies from mites is treated with lindane lotion (Kwell or Scabene).  There are a number of treatments for psoriasis for which fluorinated corticosteroid cream is the mainstay.  Discoid and systemic lupus erythomatosus are characterize by a butterfly rash on the cheeks and both are sensitive to sunlight and are treated with corticosteroids but the systemic form affects all organs and dramatically shortens life-expectancy. 


Virtually every cell type in the body can become cancerous.  Carcinomas, leukemia, lymphomas and the various sarcomas account for more than 95 percent of all human cancers.  Malignant tumors of the epithelial cells are known as carcinomas, benign tumors adenomas.  White blood cell cancer of the bone marrow is known as leukemia.  Cancer of the lymphatic system lymphoma.  Cancer of the connective tissues are known as sarcomas. For example, cancer of the colon could be a cancer of the epithelial cells of the colon (carcinoma of the colon), or of connective tissue cells of the colon (fibrosarcoma of the colon), or even of the muscle cells in the colon (leiomyosarcoma of the colon).  General symptoms caused by many different types of cancer are (1) persistent tiredness for no obvious reason, (2) progressive loss of weight for no obvious reason, (3) progressive paleness of the tongue or fingernail beds, especially if accompanying fatigue, can signify anemia from blood loss, (4) persistent loss of appetite, (5) fracture of a bone without any obvious trauma.  According to the American Cancer Society, approximately 1.4 million Americans will be diagnosed with cancer in 2006, and altogether some 10.5 million Americans alive today have had a cancer diagnosis at some time in their lives.  In 2006 nearly 550,000 people will die of cancer, which is second only to heart disease as the leading cause of death in the United States.  One out of every five people in the United States and many other countries in the world is expected to die of cancer.  Any child born in the United States in 1985 has a more than one in three chance of eventually developing some form of invasive cancer.   An exhaustive epidemiologic study in 1981 estimated that tobacco was responsible for about 30 percent of all American cancers, diet was responsible for another 35 percent, infection perhaps 10 percent, reproductive and sexual behavior about 7 percent, occupational hazards about 5 percent, geophysical factors such as sunlight 3 percent, alcohol 3 percent, pollution 2 percent, medicine and medical practices 1 percent and food additives and industrial products less than 1 percent each.  A no protein diet of mostly vegetables and fruit is highly curative for many but sufficient caloric intake must be maintained, including the 5% minimum of dietary calories from protein, usually satisfied with the accidental or intentional mixing of vegetable amino acids.  Standard cancer treatment involves surgery, radiation therapy and chemotherapy and the low survival rates are not only depressing but indicative that more research is needed.  Most patients with early stage cancer are exclusively treated with surgery and/or radiation and chemotherapy is reserved for advanced metastatic cancers.  Radiation treatment is very expensive and administered at ten time the lethal whole body doses precisely to the cancerous area, but may be lethal to patients whose cancer was caused by radiation poisoning such as the laser from a CD-ROM drive.  Major surgery involving general anesthetic and endotracheal tube is inherently dangerous and expensive and many patients complain that they are denied chemotherapy.  Intravenous chemotherapy in high doses is very toxic and expensive.  A new protocol must be developed to provide cancer patients with low dose oral chemotherapy, namely methotrexate 2.5 mg costing about 70 cents, once a week, for the FDA approved purpose of treating rheumatism, while they research curative treatment at the biohazard dumpster, doctor and oncologist's office, college and public library, athletic exercise program, organic kitchen and herb garden.       


Book 2 Attorney General Ethics (AGE)


To amend Chapter 2 Soldier’s and Airmen’s Home §41-70.  The American Legal System has failed, lawyers are either behind bars or drunk on power. In 2001, the majority of the 93 million judicial cases filed, were processed by 15,555 state trial courts operating under the supervision of the county; 13,515 of limited jurisdiction and 2,040 of general jurisdiction, operated by 29,266 judges.  There were 55.7 million traffic cases filed, 15.8 million cases were filed with the civil division, 14.1 million Criminal cases, Domestic Relations processed 5.3 million cases, 2 million criminal cases were filed in Juvenile Courts and 276,408 cases were filed with the Appellate Courts.  A civil law system must be instituted by lowering law school entrance to high school graduates and the bar exam to BA and terminate the licenses of all lawyers who are elected or appointed to public, commercial or social office, a Civil-law Amendment III to the Annotated United States Constitution calls for 4 year terms for elected federal judges, with a two term limit for justices, and one year term for chief justice, to repeal the constitutional right to bear arms and quartering of troops in people’s homes, to change the name of prosecutor to district attorney, elect licensed social workers to adjudicate traffic, divorce, mental illness, substance abuse, tenant-landlord and small claims, and funeral directors to avoid Probate, to abolish the death penalty, to change the name of the Drug Enforcement Agency (DEA) to Drug Evaluation Agency (DEA) and transfer to the Food and Drug Administration (FDA), to change the name of the Court of International Trade of the United States (CoITUS) to Customs Court (CC), to change the name of the Office of Violence Against Women to Office of Women’s Rights and transfer to Social Work Administration (SWA) when established, to ratify Optional Human Rights Protocols, to appoint a new Attorney General, to transfer the Justice Assistance Grant (JAG) and other extra-jurisdictional finance entirely to halfway house programs, primarily financed by up to 7.7% of the Supplemental Security Income (SSI) program for poor people on probation and parole, to safely reduce the jail and prison population to less than 250 per 100,000 residents legal limit within a decade, to separate the lawyers who are behind bards from those who are drunk on power; Quiz…218 


Book 5 Customs (CC)


To amend Chapter 5 Columbia Institution for the Deaf §231-250.  The Millennium Development, MDGs for 1990-2015, cut in half the number of hungry people to 622 million people and percent of people in poverty to 22.75% by 2015 from 45.5% in 1990.  In 2005 843 million people, 12.5% of the population, were hungry and over a billion lived on less than $1.25 a day, in 2009 after the economic crisis the number of hungry people rose to 18%, 1.2 billion people, and the number of people living on less than $1.25 a day rose from 21.5% in 2007 to 22.9% in 2009.  The other goals, education, gender equality, and water and sanitation are on track and the spread of the HIV/AIDS pandemic has been reversed.  Official Development Assistance (ODA) growth must be sustained to achieve the intermediate target of 0.7% of GDP on the way to a 1% social security style payroll tax for international development.  Change voting at the Bretton Woods institutions from contribution based to population based, a one person one vote system.  To end dependency upon the U.S. dollar as the international reserve currency IMF Special Drawing Rights (SDR) shall be the international reserve currency.  To improve global public health, diplomacy and reputation the U.S. shall change the name of Title 6 of the US Code and CFR from Domestic Security and Homeland Security to Customs, amend Title 22 Foreign Relations and Intercourse (a-FRaI-d) to Foreign Relations (FR-ee), change the name of the Court of International of the United States (COITUS) to Customs Court (CC).  To terminate financing the Israeli/Egyptian US military finance race, to cease obstructing Palestinian statehood, to purchase a quota from an Afghan Opium Agency, to terminate all international offices of the DEA, to hold NATO and UN peacekeeping mission war profiteers accountable for their crimes, to terminate the UN Peacekeeping Mission in Haiti, to expel the prosecutors from the Hague, under Monroe doctrine non-entanglement in European colonial affairs. Furthermore, it is resolved to set down the General of the United Nations (GUN), elect a Secretary of the UN (SUN), abolish the Permanent Membership to the Security Council, change ECOSOC to Socio-Economic Administration, General Assembly to Assembly, Trusteeship to Human Rights Council and establish an International Tax Administration by ratifying the Charter of the States of the United Nations (SUN); to perfect the law and Customs; Quiz…671