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Combination effect of kampo medicines If only one component herb is replaced in a formulation generic tadapox 80mg mastercard erectile dysfunction causes yahoo, the clinical applica- tion may be greatly changed buy discount tadapox 80 mg on-line erectile dysfunction doctors rochester ny. Maoto purchase tadapox 80 mg free shipping impotence use it or lose it, Makyokansekito and Makoyokkanto are similar kampo formulations consisting of four component herbs. Three of the herbs (Ephedrae herba, Ameniacae semen and Glycyrrhizae radix) are common to both formulations but their indications for use are quite different (Table 8. Maoto, Makyokansekito and Makyoyokkanto have all been used for the treatment of influenza, asthma and rheumatoid conditions, respectively. However Maoto is indicated where the patient has no sweating, high fever, muscle and joint pains, whereas Makyokansekito is indicated where there is natural sweating, cough and asthma. It consists of 10 component herbs, but when just one of component herbs was omitted from the original formulation, its activity became negligible. Examples of studies on specific formulae Three kampo formulae are introduced as examples of current pharmaco- logical studies of kampo medicines. Japanese kampo medicine | 239 240 | Traditional medicine Effects of Juzentaihoto on immunological and haematopoietic systems Clinical effects of Juzentaihoto expect that it may improve constitution of the diseases related to immunological system. In vivo animal study suggests that Juzentaihoto has potent immunomodulating activity, such as stimulation of antibody production,16 and the active ingredients were clarified to be 22 different pectic polysaccharides. As kampo medicines have generally been taken orally, active ingredients may not only act by absorption from the intestine but also affect the mucosal immune system. The effect of the active ingredients of Juzentaihoto on intestinal immune system-modulating activities was linked to a lignin–carbohydrate complex and a polysaccharide-containing arabinogalactan. Juzentaihoto also enhances peripheral blood counts in cancer patients who have been administered phase-specific drugs and/or have received radi- ation therapy. Oral administration of Juzentaihoto prolongs the survival of tumour-bearing mice injected with mitomycin C, and enhances proliferation of bone marrow stem cells, which may induce recovery from anaemia and reduce side effects of anti-cancer agents caused by bone marrow injury. As the result, production of antigen-specific secretory IgA antibody is enhanced in local mucus if the antigen such as for influenza virus, is recognised. There- fore a mucosal immune system-enhancing activity may help respiratory infection and endogenous infection. When the influenza vaccine was immu- nised intranasally, antigen-specific secretory IgA antibody is produced in the nasal cavity. Oral administration of Hochuekkito may partly contribute to enhancement of the IgA immune response against intestinal antigen through an increased population of L- selectin-positive B lymphocytes. Improving effect of Kamiuntanto on brain cognitive function The population of older people has been increased by improving health conditions. As a ‘compensation’ for longevity, chronic diseases, senile dementia, osteoporosis, general malaise and complex diseases (diabetes, hypertension, hyperlipidaemia, etc. For the diagnosis and treatment of these diseases imbalance of the whole body must be seen. Therefore kampo medicines would be suitable drugs for the treat- ment of older patients. Alzheimer’s disease and cerebrovascular disorders are popular forms of dementia among older people, with the former char- acterised by memory loss and a progressive global impairment of intellect. Despite the great scientific advances in recent years, effective treatments for Alzheimer’s disease are still limited. Some kampo medicines and herbal extracts were reported to improve the lesion of cognitive function in animal models for dementia, and memory-related behaviour and intellectual function of Alzheimer’s disease patients. When Kamiuntanto and donepezil, which is an anti-Alzheimer’s disease drug, were taken together, after 12 weeks’ treatment, a significant improvement in cognition was noted only in the combination therapy group, not in the monotherapy group. A significant increase in cerebral blood flow was also seen in the frontal region and lenticular nucleus only in patients who received the combination therapy. Therefore the combination of donepezil plus Kamiuntanto is safe and more effective in maintaining cognitive function than monotherapy. The pharmacological activities of widely used kampo medicines are listed in Table 8. Clinical studies The Japanese Ministry of Health and Welfare requested clinical re-evaluation of eight kampo formulations by double-blind, placebo-controlled study in 1991. For the double-blind, placebo-controlled study, it is necessary to prepare placebo granules with similar taste and colour as the active preparation. Three formulae have been re-evaluated: • Shosaikoto (Xiao-Chai-Hu-Tang) was evaluated for efficacy in chronic active hepatitis. Rikkunshito (Liu-Jun-Zi-Tang) and Shakuyakukanzoto (Shao-Yao-Gan- Cao-Tang) were also reported as being effective for the treatment of dysmotility-like dyspepsia and the muscle cramps accompanying cirrhosis, respectively. In the case of Rikkunshito, a low-dose preparation was used as a placebo control because of difficulty in developing control granules. In a separate double-blind, controlled study for re-evaluation, Chotosan (Siao-Tang-San) was also shown to have a beneficial clinical effect in the treatment of vascular dementia. However, kampo medicines have traditionally been used according to the disturbed pathophysiological conditions of the patient (so-called sho clinically), so clin- ical study of kampo medicines needs to consider the concept of sho. Most reliable scientific proofs are obtained by re-evaluation of kampo extract preparations, objective clinical study and the importance of universality. Safety Side effects of kampo medicines If the sho diagnosis was correct, and the correct formulation was given to the patient, kampo medicines show relatively lower adverse reactions compared with western medicines. However, kampo medicines are also drugs, so they must be considered to have certain side effects depending on how they are used. Ephedrae herba Ephedrae herba contains the adrenergic ephedrine, which activates both the sympathetic and central nervous systems, and may produce unwanted symptoms such as insomnia, palpitations, rapid pulse, excitement, elevation of blood pressure, hyperhidrosis, and dysuria. Glycyrrhizin metabolises to the aglycone, glycyrrhetic acid, after oral administration, and glycyrrhetic acid facilitates potassium excretion and lowers total serum potassium. Japanese kampo medicine | 247 Rhei rhizoma Rhei rhizoma contains sennosides that are prodrugs of rhein-anthrone, having cathartic activity. Drug–drug interactions Some western medicines are known to have potent adverse reactions, e. The use of western medicine with kampo medicines classified as tonic, such as Juzentaihoto, Hochuekkito, Ninjinyoeito and Rikkunshito, can reduce the adverse reaction to western anticancer drugs in patients and increase their quality of life. As one mech- anism of action, it has been reported that Juzentaihoto enhances the prolif- eration of haematopoietic stem cells, and recovery of the haematopoietic system. Steroids also have side effects such as moon face (swelling), thrombus, infection and menopausal disorders. Kampo medicines, such as Shosaikoto, Saireito and Saibokuto, can reduce these adverse reactions. It is also possible to decrease the daily dose of steroid and even to stop its use. It has been reported that these kampo medicines increase endogenous corticosterone concentrations in the body by affecting steroid metabolism.

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This is characterized by disorganized thinking and feelings of loss buy cheapest tadapox erectile dysfunction bathroom, grief discount tadapox 80mg on-line erectile dysfunction treatment boston medical group, helplessness and despair cheap tadapox 80 mg amex erectile dysfunction 33 years old. Shontz argued that this stage is characterized by denial of the problem and its implications and a retreat into the self. According to Shontz, retreat is only a temporary stage and denial of reality cannot last for ever. Therefore, the retreat stage acts as a launch pad for a gradual reorientation towards the reality of the situation and as reality intrudes the individual begins to face up to their illness. Therefore, this model of coping focuses on the immediate changes following a diagnosis, suggesting that the desired outcome of any coping process is to face up to reality and that reality orientation is an adaptive coping mechanism. Coping with the crisis of illness In an alternative approach to coping with illness, Moos and Schaefer (1984) have applied ‘crisis theory’ to the crisis of physical illness. Crisis theory has been generally used to examine how people cope with major life crises and transitions and has traditionally provided a framework for understanding the impact of illness or injury. The theory was developed from work done on grief and mourning and a model of developmental crises at transition points in the life cycle. In general, crisis theory examines the impact of any form of disruption on an indi- vidual’s established personal and social identity. It suggests that psychological systems are driven towards maintaining homeostasis and equilibrium in the same way as physical systems. Within this framework any crisis is self-limiting as the individual will find a way of returning to a stable state; individuals are therefore regarded as self-regulators. Physical illness as a crisis Moos and Schaefer (1984) argued that physical illness can be considered a crisis as it represents a turning point in an individual’s life. They suggest that physical illness causes the following changes, which can be conceptualized as a crisis: s Changes in identity: illness can create a shift in identity, such as from carer to patient, or from breadwinner to person with an illness. In addition, the crisis nature of illness may be exacerbated by factors that are often specific to illness such as: s Illness is often unpredicted: if an illness is not expected then the individual will not have had the opportunity to consider possible coping strategies. Therefore, illness is infrequent and may occur to individuals with limited prior experience. This lack of experience has implications for the development of coping strategies and efficacy based on other similar situations (e. Many other crises may be easier to predict, have clearer meanings and occur to indi- viduals with a greater degree of relevant previous experience. Within this framework, Moos and Schaefer considered illness a particular kind of crisis, and applied crisis theory to illness in an attempt to examine how individuals cope with this crisis. The coping process Once confronted with the crisis of physical illness, Moos and Schaefer (1984) described three processes that constitute the coping process: (1) cognitive appraisal; (2) adaptive tasks; and (3) coping skills. Process 1: Cognitive appraisal At the stage of disequilibrium triggered by the illness, an individual initially appraises the seriousness and significance of the illness (e. Factors such as knowledge, previous experience and social support may influence this appraisal process. In addition, it is possible to integrate Leventhal’s illness cognitions at this stage in the coping process as such illness beliefs are related to how an illness will be appraised. Process 2: Adaptive tasks Following cognitive appraisal, Moos and Schaefer describe seven adaptive tasks that are used as part of the coping process. This task involves dealing with symptoms such as pain, dizziness, loss of control and the recognition of changes in the severity of the symptoms. This task involves dealing with medical interventions such as mastectomy, chemotherapy and any related side effects. Becoming ill requires a new set of relationships with a multitude of health professionals. This involves compensating for the negative emotions aroused by illness with sufficient positive ones. This involves maintaining social support networks even when communication can become problematic due to changes in location and mobility. Process 3: Coping skills Following both appraisal and the use of adaptive tasks, Moos and Schaefer described a series of coping skills that are accessed to deal with the crisis of physical illness. These coping skills can be categorized into three forms: (1) appraisal-focused coping; (2) problem-focused coping; and (3) emotion-focused coping (see Table 3. Appraisal-focused s Logical analysis and mental preparation s Cognitive redefinition s Cognitive avoidance or denial Problem-focused s Seeking information and support s Taking problem-solving action s Identifying rewards Emotion-focused s Affective regulation s Emotional discharge s Resigned acceptance Table 3. Three sets of appraisal-focused coping skills have been defined: 1 Logical analysis and mental preparation, involving turning an apparently unmanageable event into a series of manageable ones. Three types of problem-focused coping skills have been defined: 1 Seeking information and support, involving building a knowledge base by accessing any available information. Emotion-focused coping involves managing emotions and maintaining emotional equilibrium. Three types of emotion-focused coping skills have been defined: 1 Affective, involving efforts to maintain hope when dealing with a stressful situation. Therefore, according to this theory of coping with the crisis of a physical illness, individuals appraise the illness and then use a variety of adaptive tasks and coping skills which in turn determine the outcome. However, not all individuals respond to illness in the same way and Moos and Schaefer (1984) argued that the use of these tasks and skills is determined by three factors: 1 Demographic and personal factors, such as age, sex, class, religion. Implications for the outcome of the coping process Within this model, individuals attempt to deal with the crisis of physical illness via the stages of appraisal, the use of adaptive tasks and the employment of coping skills. The types of tasks and skills used may determine the outcome of this process and such outcome may be psychological adjustment or well-being, or may be related to longevity or quality of life (see Chapter 16). According to crisis theory, individuals are motivated to re-establish a state of equilibrium and normality. Crisis theory differentiates between two types of new equilibrium: healthy adaptation, which can result in maturation and a maladaptive response resulting in deterioration. Within this perspective, healthy adaptation involves reality orientation and adaptive tasks and constructive coping skills. Therefore, according to this model of coping the desired outcome of the coping process is reality orientation. Based on a series of interviews with rape victims and cardiac and cancer patients, they suggested that coping with threatening events (including illness) consists of three processes: (1) a search for meaning; (2) a search for mastery; and (3) a process of self-enhancement. They argued that these three processes are central to developing and maintaining illusions and that these illusions constitute a process of cognitive adaptation. Again, this model describes the individual as self-regulatory and as motivated to maintain the status quo. In addition, many of the model’s components parallel those described earlier in terms of illness cognitions (e. This theoretical perspective will be described in the context of their results from women who had recently had breast cancer (Taylor et al.

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Usage subject to terms and conditions of license 50 2 Basic Principles of Immunology system also contains non-specific defense mechanisms cheap 80 mg tadapox free shipping erectile dysfunction pills for high blood pressure, including the com- plement system (see “Immune response and effector mechanisms buy 80 mg tadapox erectile dysfunction protocol book download,” p 80 mg tadapox fast delivery erectile dysfunction treatment centers. These immunoglobulins comprise a number of classes and subclasses, as well as numerous different specificities, but share a common structure 2 (Fig. The five corresponding im- munoglobulin classes are designated as IgM, IgD, IgG, IgA, or IgE, depending on which type of heavy chain they use (Fig. A special characteristic of the immunoglobulin classes IgA and IgM is that these comprise a basic monomeric structure that can be doubled or quintupled (i. The upper half of the figure shows the intact monomer consisting of two L and two H chains. Follow- ing pepsin digestion (right), the Fc portion is fragmented, but the Fab fragments remain held together by disulfide bonds. These consist of the variable domains of the H and L chains, joined covalently by a synthetic linker peptide. IgM, IgD, IgG, IgA, and IgE are differentiated by their respective heavy chains (l, d, c, a, e). IgA (a chain) forms dimers held together by the J (joining) chain; the secretory (S) piece facilitates transport of secretory IgA across epithelial cells, and impairs its enzymatic lysis within secre- tions. The B-Cell System 51 Immunoglobulins contain numerous domains, as illustrated by the struc- ture of IgG. In monomeric IgG each domain consists of a protein segment which is approximately 110 amino acids in length. Both light chains possess two such domains, and each heavy chain possesses four or five domains. In this way a high level of sequence variability was revealed to be contained within the N-terminal domain (variable domain, V), whilst such variability was comparably absent within the other domains (constant do- mains, C). In contrast, the heavy chains are roughly 440–550 amino acids in length, and consist of four to five domains. Disulfide bonds link the light chains to the heavy chains and the heavy chains to one another. The binding site—a decisive structure for an epitope reaction—is formed by the combination of variable domains from both chains. Since the two light chains, and the two heavy chains, con- tain identical amino acid sequences (this includes the variable domains), each Kayser, Medical Microbiology © 2005 Thieme All rights reserved. An area within the antibody consisting of 12–15 amino acids contacts the peptide region contained within the antigen and consisting of approximately 5–800 A˚ 2 (Table 2. Diversity within the Variable Domains of the Immunoglobulins The specificity of an antibody is determined by the amino acid sequence of the variable domains of the H and L chains, and this sequence is unique for each corresponding cell clone. How has nature gone about the task of produ- cing the needed diversityof specific amino acid sequences within a biochemi- cally economical framework? The genetic variety contained within the B-cell population is ensured bya process of continuous diversification of the geneti- cally identical B-cell precursors. Thus the germ line does not contain one gene governing the variable domain, but rather gene segments which each encode fragments of the necessary information. The major factors governing immunoglobulin diversity include: & Multiple V gene segments encoded in the germ lines. In theory, the potential number of unique immunoglobulin structures that could be generated by a combination of these processes exceeds 1012, how- ever, the biologically viable and functional range of immunoglobulin specifi- cities is likely to number closer to 104. The designations for the gene segments in the variable part of the H chain are V (variable), D (diversity), and J (joining). The segments designated as l, d, c, a, and e code for the constant region and determine the immunoglobulin class. The V segment occurs in several hun- dred versions, the D segment in over a dozen, and the J segment in several forms. Various different V, D, and J gene segments (for b and d), V and J gene segments (for a and c) are available for the T-cell re- ceptor chains. Usage subject to terms and conditions of license The B-Cell System 55 Rearrangement of the B- and T-Cell Receptor Genes 2 Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license 56 2 Basic Principles of Immunology regions encoding the H chain segments Cl, Cd, Cc, Ca, and Ce, in consecutive order. Following this event, the B cell no longer produces H chains of the IgM or IgD classes, but is instead committed to the production of IgG, IgA, or IgE—thus allowing secre- tion of the entire range of immunoglobulin types (Table 2. This process is known as class switching, and results in a change of the Ig class of an antibody whilst allowing its antigen specificity to be retained. The use of different heavy or light chain constant regions results in new immunoglobulin classes known as isotypes. Individual Ig classes can also differ, with such genetically determined variations in the con- stant elements of the immunoglobulins (which are transmitted according to the Mendelian laws) are known as allotypes. Variation within the variable region results in the formation of determinants, known as idiotypes. The idiotype determines an immunoglobulins antigenic specificity, and is unique for each individual B-cell clone. IgM and IgD act as B-cell receptors in their earlier transmembrane forms, although the function of IgD is not entirely clear. The first antibodies produced in the primary immune response are IgM pentamers, the action of which is directed largely against micro-organisms. The immunoglobulin class which is most abundant in the serumis IgG,with particularlyhigh titers of this isotype beingfoundfollowing secondary stimulation. IgG antibodies pass through the placenta and so pro- vide the newborn with a passive form of protection against those pathogens for which the mother exhibits immunity. In certain rare circumstances such antibodies may also harm the child, for instance when they are directed against epitopes expressed by the child’s own tissues which the mother has reacted against immunologically (the most important clinical example of this is rhesus factor incompatibility). High concentrations of IgA antibodies are found in the intestinal tract and contents, saliva, bronchial and nasal se- cretions, and milk—where they are strategically positioned to intercept infec- tious pathogens (particularly commensals) (Fig. IgE antibodies bind to high-affinity Fce receptors present on basophilic granulocytes and mast cells. Cross-linking of mast cell bound IgE antibodies by antigen results in cellular degranulation and causes the release of highly active biogenic amines (his- tamine, kinines). IgE antibodies are produced in large quantities following parasitic infestations of the intestine, lung or skin, and play a significant role in the local immune response raised against these pathogens. This probably enhances Tcell-dependent activation of IgA-producing B cells, which are preferentially recruited to the mucosal regions (“homing”) via local adhesion molecules and antigen depots, resulting in a type of geographic specificity within the immune response. The diversity of T-cell receptors is also achieved by means of genetic rearrangement of V, D, and J segments (Fig. However, the T-cell receptor is never secreted, and instead remains membrane-bound. Each T-cell receptor consists of two transmembrane chains, of either the a and b forms, or the c and d forms (not to be confused with the heavy Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license 58 2 Basic Principles of Immunology chains of Ig bearing the same designations). Both chains have two extracel- lular domains, a transmembrane anchor element and a short intracellular ex- tension.

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Films for the Humanities and tained by positioning electrodes on the head and ampli- Sciences buy tadapox 80 mg amex erectile dysfunction and icd 9, 1994-95 discount 80mg tadapox otc impotence nutrition. Its A systematic discount tadapox 80 mg impotence bicycle seat, coercive effort to alter an individual’s short-term and long-term effectiveness in actually alter- beliefs and attitudes, usually by physical and/or psychological means; also referred to as “thought ing an individual’s beliefs—both within the brainwash- control. Intense Brainwashing has been used predominantly in refer- effort and complete control over the victim are required, ence to severe programs of political indoctrination, al- and must be exercised over a period of years. Conse- though it is used occasionally in connection with certain quently, many of the brainwashing efforts made during religious, especially cultic, practices. Brainwashing the Korean War were ineffective, with the prisoners ei- works primarily by making the victim’s existing beliefs ther resisting change or merely becoming confused in- and attitudes nonfunctional and replacing them with new stead of indoctrinated. In addition, certain attitudes on ones that will be useful in the environment created by the the part of prisoners proved particularly resistant to captor. Due to these limitations, many psychologists be- Basically, the techniques of brainwashing involve lieve it would be impossible to brainwash large popula- the complete removal of personal freedom, indepen- tions, even with the use of mass media. The protagonist, Win- from, and destruction of loyalties to, former friends and ston Smith, is subjected to isolation, humiliation, physi- associates; the absolute obedience to authority in all mat- cal deprivation and violence, and constant threats of fur- ters; intense physical abuse and threats of injury, death, ther violence. He is also forced to make false confes- and permanent imprisonment; and the constant presenta- sions which include implicating and denouncing others. Confes- most memorably demonstrated in his final capitulation sions of imagined past crimes are often part of the brain- to the view that two plus two equals five. Other captives who have already been brainwashed may be used to reinforce the process, Further Reading criticizing the victim and supporting the captors and Hyde, Margaret. Once the process begins to take hold, threats and punishments are replaced by rewards. The victim is allowed increased physical comfort and given psychological reinforcement in the form of approval and friendship. Berry Brazelton ing his or her new identity, based on the new set values 1918- and beliefs provided by the captor. Well-known pediatrician, writer, researcher, and The study of the techniques and effects of brain- educator. They con- Berry Brazelton has earned a nationwide reputation as a fessed to imagined crimes, including the waging of germ trusted expert on child care, reaching a mass audience warfare, and refused to be repatriated when the war through books, personal appearances, newspaper ended. The unit provides medical students and other professionals the opportunity to research early child de- velopment and also prepare for clinical work with parents and children. Brazelton’s first book, Infants and Mothers (1969), has sold more than a million copies and has been translated into 18 languages. It has been followed by a dozen more, including Toddlers and Parents (1974), On Becoming a Family (1981), and Working and Caring (1984), as well as a series of videotapes on child develop- ment. Brazelton also writes a syndicated newspaper ad- vice column and since 1984 has had his own program, What Every Baby Knows, on cable television. Rosalie Wieder Josef Breuer 1842-1925 Austrian physician, physiologist, and a founder of psychoanalysis. By the sixth grade he had decided on a career in appear when these underlying causes became part of the pediatrics. His residency differing levels of consciousness are very important in was served at Massachusetts General Hospital in Boston, both normal and abnormal mental processes. Although where he completed an additional residency in child psy- Freud eventually rejected this concept, it is now believed chiatry at the James Jackson Putnam Children’s Center in to be of great significance. Brazelton opened his own private practice in most important physiologists of the nineteenth century. Cambridge, Massachusetts, in 1950 and became an in- Breuer was born in Vienna, Austria, in 1842. Breuer’s mother died when he was quite ents with the goal of helping parents better understand young, and he was raised by his maternal grandmother and interact with their children. He has focused on individual differences among newborns; graduated from the Akademisches Gymnasium of Vien- parent-infant attachment during the first four months of na in 1858 and then studied at the university for one life; and the effects of early intervention on at-risk in- year, before enrolling in the medical school of the Uni- fants. The test, popularly called and went to work as assistant to the internist Johann Op- “the Brazelton,” uses visual, auditory, and tactile stimuli polzer at the university. Studies physiological processes Brazelton’s interest in shifting the focus of pediatric Breuer’s first important scientific work was pub- study from disease to infant development led him to lished in 1868. It was one of the their work and, two years later, the book which marked first examples of a feedback mechanism in the autonom- the beginning of psychanalytic theory, Studien über Hys- ic nervous system of a mammal. At about the same time, their collaboration—and changed the way scientists viewed the relationship of the their friendship—came to an end. Apparently Breuer’s lungs to the nervous system, and the mechanism is still ambivalence concerning the value of their work fueled known as the Hering-Breuer reflex. However their final break came about over the question of childhood memories of seduction. At the In 1868, Breuer married Matilda Altmann, and they time, Freud believed that most of his patients had actual- eventually had five children. Still, he found Breuer was correct in believing these to be memories of time for scientific study. Turning his at- tention to the physiology of the ear, he discovered the Breuer dropped his study of psychoanalysis, where- function of the semicircular canals. This work provided as Freud continued to develop his theories independent- the foundation for our modern understanding of how ly. However, among other concepts, Breuer usually is sensory receptors detect position and movement. In all, credited with having first suggested that perception and Breuer published approximately 20 papers on physiolo- memory are different psychic processes and with having gy over a period of 40 years. Breuer’s back- ulty of internal medicine at the University of Vienna in ground in physiology had a profound influence on the 1875, his relationships there were strained; he resigned development of his theories and it is likely that his influ- his position in 1885. Some physicians, the “Breuerians,” continued for a time to use Breuer’s original cathartic techniques with- The story of Anna O. It was in 1880 that Breuer first observed the devel- Breuer was regarded as one of the finest physicians opment of a severe mental illness in one of his patients, and scientists in Vienna. Breuer died in Vienna in of Anna’s symptoms by encouraging her to describe her 1925. Other called a series of memories back to a traumatic memory, members of his family emigrated. Soon, Breuer was treating Margaret Alic Anna with hypnosis twice a day and eventually all of her symptoms were gone. Breuer drew two important con- clusions from his work with Anna: that her symptoms Further Reading were the result of thoughts that were buried in her un- Cranefield, Paul F. However, he taught his methods to Sigmund Freud and, together, they began to develop this new form of psychotherapy.