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The UK intelligence services were also aware that the Soviets were planning to deploy an extensive surface-to-air missile (SAM) system around Moscow. The system had been developed to fend off a WWII-style attack by 1,000 low-speed aircraft, like those raids carried out by RAF Bomber Command. Known in the west as the SA-1 "Guild", the system was partially based on World War 2 research in the German "Wasserfall" program and its V-300 missiles had limited range around at best. Expected to be deployed in the late 1950s, approaching the target for attack with gravity bombs would become increasingly dangerous after that time. At the time, the Soviet defences were at their best between and , and the existing V-bombers had the required performance to fly over this altitude. But the introduction of the SAMs would make this increasingly unlikely to work as more and more of the missiles were installed. There were two general solutions to this problem. One was to fly higher and faster, but the leap in performance needed to overfly the missiles, with altitudes on the order of could not be met until the mid-1960s at the minimum. This would leave a gap between around 1961 and 1965 when the V-force could not be expected to successfully perform its mission.
The conclusion of this paper, and other reports like it, was that the situation could be greatly improved through the combination of improved electronic countermeasures (ECM) to disrupt fighter operations, and a standoff missile to allow the bombers to turn back before approaching within the range of the SAMs. It was expected that this combination would allow the V force to remain effective until 1965 at least. Beyond that time a new supersonic bomber would be required, a requirement that would ultimately be taken up as the Avro 730. OR.1132. On 3 September 1954 the Air Staff issued Operational Requirement OR.1132 for the standoff weapon. This was essentially issued to the Royal Aircraft Establishment (RAE), whose Guided Weapon Department had been studying such a system for a while and had produced a series of "W weapons" of different layouts. These had been designed to address the problem that the Atomic Weapons Research Establishment (AWRE) could not guarantee the size of the warhead. Accordingly, the W weapons were designed to the maximum possible size that each of the bombers could carry, diameter for the Vickers Valiant and for Avro Vulcan and Handley Page Victor.
The Ministry of Supply (MoS) did not feel that development should remain at the RAE, and had canvassed the bomber builders asking for comments on the RAE's concepts, considering both a shorter-range and longer-ranged weapon. Avro, having recently given the go-ahead on the 730, appeared cool on the long-range concept and was primarily interested in a short-range weapon of perhaps range, which would allow it to avoid the most heavily defended areas. Vickers Armstrong and Handley Page were much more interested, proposing longer-ranged weapons that would extend the life of their existing V bomber designs. Handley Page's concept rejected the MoS's shorter range and offered a design of using ramjet power. However, the Ministry noted that the inertial navigation system (INS) being developed by Elliott Automation would not be accurate enough to fly this distance and hit its targets within the desired circular error probable (CEP). Vickers, who had worked on the somewhat similar Blue Boar and Red Rapier projects would seem like the natural choice for the contract, and planned to have their weapon in operation two years earlier than the other teams. But the Ministry had a cold relationship with Vickers after their Red Dean efforts. Avro appears to have been selected due to a number of RAE personnel having been hired by the company to form their design department, the Weapons Research Division, including the Chief Engineer, R.H. Fransis. On 4 May 1955 the Ministry of Supply issued the G/Proj/6220/GW35A contract with Avro and assigned it the rainbow code "Blue Steel".
Avro's concept. At the time, nuclear weapon design was still in its early stages, and the intended weapon for the missile was a boosted fission weapon known as "Green Bamboo". To achieve the desired 1 MT yield, the implosion had to be extremely symmetrical, and this required a 72-point explosive system that led to the weapon being in diameter and massing an estimated . This weapon was secret and only the diameter and mass were revealed to prospective entrants. It was the large size of the warhead, and the resulting diameter fuselage needed to carry it, that led Avro to the use of a rocket motor when most standoff weapons to that point were jet or ramjet powered. Avro simply could not find a place to put an air intake on the missile which did not result it in being too large in some other dimension, typically length. The engine, the Armstrong Siddeley Stentor Mark 101, had two chambers, one for cruising at about Mach 1, and a second larger one that was ignited close to the target to increase speed to Mach 3 for a final dash.
At Mach 3, skin friction will heat the fuselage to around , which is higher than the temperature that will cause aluminium to become soft. This is the reason that most high-speed aircraft are generally limited to about Mach 2.4 or lower, flying above this speed risks damage to the airframe. Those aircraft that do operate above this speed have to use other materials, and for this role, Avro chose stainless steel. The difficulties encountered bending sheets of stainless steel led to initial designs for the weapon that were very "linear", with the fuselage made of a single sheet rolled into a cylinder and a second sheet rolled into a cone to form the nose area. Avro's initial response, in late 1955, outlined a four-stage development effort. In Stage 1, the weapon would be powered by a two-chamber rocket engine that would provide the required range at speeds up to Mach 2.5. The Stage 2 would use an improved engine and more fuel to provide range up to at speeds up to Mach 4.5. Stage 3 would weigh in at and include both disposible boosters and a drop-off fuel tank with range up to . For the future Avro 730, a new delta wing design of 18 to 26,000 lbs would offer range up to .
Considering their submissions, the Ministry responded by ordering Avro to work only on the OR.1137 requirements, and ignore the long-term developments. This produced the first complete design, W.100. They proposed building the missile from AF.520 stainless steel, expecting to learn how to do so using the 730 contract to build testbeds. A series of smaller designs, W.101 through 104, would be made from a variety of materials and used to test the flight dynamics, autopilot and INS. As part of ongoing industry-wide research, the design underwent several evolutionary changes. The wings and canards became deltas and the experience of the Bristol 188 gave Avro confidence in construction of rounded surfaces using stainless steel and the design became much more aerodynamic with a boat tail and ogive nose. Delays. Avro began work proper in 1955, with the assigned Rainbow Code name of "Blue Steel" which it would keep in service. With Elliots working on the guidance system, Armstrong Siddeley would develop the liquid fuel engine. The design period was protracted, with various development problems exacerbated by the fact that designers lacked information on the actual size and weight of the proposed Green Bamboo, or its likely thermonuclear successor derived from the Granite series.
The program ran into delays almost immediately. All of the systems - missile, navigation and motor - ran into problems and this resulted in the companies pointing fingers at each other. By the late 1950s it was clear the missiles would not be ready for their 1962 initial operational introduction, leading to significant critism of Avro on the part of the Ministry of Supply and the Air Ministry. By this time it was clear that the Soviets were going to install an even more extensive missile system that originally believed, one that would cover the approach routes to the targets and even have sites on the Russian coastline, well outside the range of the missile. Avro proposed that Blue Steel would evolve over time, subsequent versions increasing speed (to Mach 4.5) and range. The ultimate Blue Steel would be a range weapon that could be launched by the supersonic Avro 730 under development. They were told to limit themselves to the specification of OR.1132. The project was delayed by the need to develop the required stainless steel fabrication techniques; this would have been gained in building the Avro 730 but that had been cancelled by then. The Elliots guidance system was plagued by accuracy problems, delaying test flights.
As it turned out, neither of the originally-proposed UK-designed warheads were actually fitted, being superseded by Red Snow, an Anglicised variant of the U.S. W-28 thermonuclear warhead of 1.1 Mt yield. Red Snow was smaller and lighter than the earlier warhead proposals. The missile was fitted with a state-of-the-art inertial navigation unit. This system allowed the missile to strike within 100 metres of its designated target. In addition, the pilots of the Avro Vulcan or Handley Page Victor bombers could tie their systems into those of the missile and make use of the guidance system to help plot their own flight plan, since the unit in the missile was more advanced than that in the aircraft. On launch the rocket engine's first chamber developing thrust would power the missile along a predetermined course to the target at around Mach 1.5. Once close to the target, the second chamber of the engine (6,000 lbf) would accelerate the missile to Mach 3. Over the target the engine would cut out and the missile would free-fall before detonating its warhead as an air burst.
To speed the trials at Woomera, the test rounds were flown there by Victors and Vulcans in Operation Blue Ranger. The trials began in 1960 about the time the original requirement expected the weapon to be in service. The missiles were prepared at the Weapons Research Establishment near Salisbury South Australia, and flown to be launched at the Woomera range from RAAF Edinburgh. A specialist unit, No. 4 Joint Services Trials Unit RAF, was established to carry out preparatory and operational tasks. Blue Steel finally entered service in February 1963, carried by Vulcans and Victors, although its limitations were already apparent. The short range of the missile meant that the V bombers were still vulnerable to enemy surface-to-air missiles. A replacement for Blue Steel, the Mark 2, was planned with increased range and a ramjet engine, but was cancelled in 1960 to minimise delays to the Mk.1. The UK sought to acquire the much longer-ranged United States AGM-48 Skybolt air-launched ballistic missile and was greatly frustrated when that weapon was cancelled in late 1962.
Blue Steel required up to seven hours of launch preparation, and was highly unreliable. The Royal Air Force estimated in 1963 that half the missiles would fail to fire and would have to be dropped over their targets, contradicting their purpose of serving as standoff weapons. Even as it deployed Blue Steel as a high-altitude weapon, that year the government decided that because of anti-aircraft missiles' increasing effectiveness, V bombers would have to convert from high-altitude to low-altitude attacks. These trials were conducted in 1964 and concluded in 1965 With no effective long-range weapon the original Blue Steel served on after a crash programme of minor modifications to permit a low-level launch at , even though its usefulness in a hot war was likely limited. A stop-gap weapon (WE.177B) was quickly produced to extend the life of the V-bomber force in the strategic role until the Polaris missile was deployed. This WE.177 laydown weapon supplemented the remaining modified Blue Steel missiles, using a low-level penetration followed by a pop-up manoeuvre to release the weapon at . One live operational round was deployed on each of forty-eight Vulcan and Victor bombers, and a further five live rounds were produced as operational spares. An additional four non-nuclear rounds were produced for various RAF requirements, and there were sixteen other unspecified training rounds. Blue Steel was officially retired on 31 December 1970, with the United Kingdom's strategic nuclear capacity passing to the submarine fleet.
Branch Davidians The Branch Davidians (or the General Association of Branch Davidian Seventh-day Adventists) are a Christian cult founded in 1955 by Benjamin Roden. They regard themselves as a continuation of the General Association of Davidian Seventh-Day Adventists, established by Victor Houteff in 1935. They have often been described as a doomsday cult. Houteff, a Seventh-day Adventist, wrote a series of tracts entitled the "Shepherd's Rod" that called for reform of the Seventh-day Adventist Church. After his ideas were rejected, Houteff and his followers formed the group that became known as "Davidians", and some moved onto land outside Waco, Texas. They built a community called the Mount Carmel Center, which served as headquarters for the movement. After Houteff's death in 1955, his wife Florence took control of the organization. That same year, Benjamin Roden, a follower of Houteff, proclaimed what he believed to be a new message from God and wrote letters presenting it to Davidians. He signed these letters "The Branch", believing that to be the new name Jesus had taken to reflect a new stage of his work in the heavenly sanctuary. Those who accepted Benjamin Roden's teachings became known as Branch Davidians Seventh Day Adventists.
In 1957, Florence sold the Mount Carmel Center and purchased near Elk, Texas – northeast of Waco – naming it New Mount Carmel Center. After the failure of Florence's prophecy of apocalyptic events on or near April 22, 1959, she dissolved the Davidian Association in 1962 and sold all but of the New Mount Carmel property. Benjamin Roden took possession of it in 1962 and began efforts to purchase the remaining . On February 27, 1973, New Mount Carmel was sold to Benjamin, his wife Lois Roden, and their son George Roden. From then on, the property was simply known as Mount Carmel. Upon the death of Benjamin Roden in 1978, Lois became the next Davidian prophet at the compound. In 1981, a young man named Vernon Howell, later known as David Koresh, came to Mount Carmel and studied biblical prophecy under Lois Roden. By 1983, Howell (Koresh) had gained a group of followers that separated from Lois' organization to form "The Davidian Branch Davidian Seventh Day Adventist Association". Meanwhile, Lois continued to operate the Branch Davidian Seventh Day Adventist Association from Mt. Carmel Center near Waco. Koresh's group and the Branch Davidians (Lois's group) were two separate organizations with different leaders, names, and locations from 1983. It was not until 1987, after Lois died, that Koresh filed a document claiming to be the president of the Branch Davidian Seventh Day Adventist Association. Koresh and followers, further, went to Mt. Carmel center, engaging in a shootout with George Roden that eventually resulted in Koresh's group occupying the land. These actions are regarded by Branch Davidians who remained loyal to Lois Roden as an act of identity theft against them.
Koresh's leadership ended at the Waco siege of 1993, a fifty-one–day standoff between the sect and federal agents. Four agents of the U.S. Bureau of Alcohol, Tobacco, and Firearms (ATF) and two residents were killed by the sect during the initial raid, while four sect members were killed by ATF agents on February 28, 1993. Seventy-six members of Koresh's group, including many children, died in a fire that erupted during the siege on April 19, 1993. Early history. In 1929, Victor Houteff, a Bulgarian immigrant and a Seventh-day Adventist Sabbath School teacher from southern California, claimed that he had a new message for the entire Adventist church. He presented his views in a book, "The Shepherd's Rod: The 144,000 – A Call for Reformation". The Adventist leadership rejected Houteff's views as contrary to the church's basic teachings, and local church congregations disfellowshipped Houteff and his followers. In 1934, Houteff established his headquarters to the west of Waco, Texas, and his group became known as the Davidians. In 1942, he renamed the group the General Association of Davidian Seventh-day Adventists 'Davidian' which indicated its belief in the restoration of the Davidic Kingdom of Israel. Following Houteff's death in 1955, his wife Florence usurped the leadership believing herself to be a prophet. Convinced that an apocalypse would occur in 1959, a date which is not found in her husband's original writings, Florence and her council gathered hundreds of their faithful followers at the Mount Carmel Center, the group's compound which was located near Waco, for the fulfillment of the prophecy which is written in Ezekiel 9.
The anticipated events did not occur, and following this disappointment, Benjamin Roden formed another group which he called the Branch Davidians and succeeded in taking control of Mount Carmel. The name of this group is an allusion to the anointed 'Branch' (mentioned in Zechariah 3:8; 6:12). When Benjamin Roden died in 1978, he was succeeded by his wife Lois Roden. Members of the Branch Davidians were torn between allegiance to Ben's wife or to his son, George. After Lois died, George assumed the right to the Presidency. However, less than a year later, Vernon Howell rose to power and became the leader over those in the group who sympathized with him. Rise of David Koresh. Howell's arrival at Mount Carmel in 1981 was well received by nearly everyone at the Davidian commune. He had engaged in an affair with Lois Roden while he was in his early 20s and she was in her late 60s. Howell wanted to father a child with her, who, according to his understanding, would be the Chosen One. When she died, George Roden inherited the positions of prophet and leader of the sect. A power struggle ensued between Roden and Howell, who soon gained the loyalty of the majority of the Davidians. In 1984, Howell and his followers left Mount Carmel after Roden accused Howell of having started a fire that consumed a $500,000 administration building and press, which Roden subsequently renamed "Rodenville". Another splinter group, led by Charlie Pace, left and settled in Alabama.
As an attempt to regain support, Roden challenged Howell to raise the dead, going so far as to exhume the corpse of a two-decades–deceased Davidian in order to demonstrate his spiritual supremacy. (Roden denied this, saying he had only been moving the community cemetery.) This illegal act gave Howell an opportunity to attempt to file charges against Roden, but he was told that he needed evidence in order to substantiate the charges. On November 3, 1987, Howell and seven of his followers raided Mount Carmel, equipped with five .223-caliber semi-automatic rifles, two .22-caliber rifles, two 12-gauge shotguns, and nearly four hundred rounds of ammunition, in an apparent attempt to retake the compound. Although Howell's group claimed that it was trying to obtain evidence of Roden's illegal activities, its members did not take a camera with them. The trial ended with the jury finding Howell's followers not guilty, but the jury members were unable to agree on a verdict for Howell himself. After his followers were acquitted, Howell invited the prosecutors to Mount Carmel for ice cream.
It is claimed that Howell was never authorized to name his breakaway sect the "Branch Davidians", and the church which bears that name continues to represent the members of the Branch church who did not follow him. As a spiritual leader. Howell, who acquired the position of spiritual leader from Roden, asserted it by changing his name to David Koresh, suggesting that he had ties to the biblical King David and Cyrus the Great (Koresh is the Hebrew version of the name Cyrus). He wanted to create a new lineage of world leaders. This practice later served as the basis for allegations that Koresh was committing child abuse, which contributed to the siege by the ATF. Interpreting Revelation 5:2, Koresh identified himself with the Lamb mentioned therein. This is traditionally believed to symbolize Jesus Christ; however, Koresh suggested that the Lamb would come before Jesus and pave the way for his Second Coming. By the time of the 1993 Waco siege, Koresh had encouraged his followers to think of themselves as "students of the Seven Seals," rather than as "Branch Davidians." During the standoff, one of his followers publicly announced that he wanted them to thereafter be identified by the name "Koreshians".
Federal siege. On February 28, 1993, at 4:20 am, the Bureau of Alcohol, Tobacco, and Firearms attempted to execute a search warrant relating to alleged sexual abuse charges and illegal weapons violations. The ATF attempted to breach the compound for approximately two hours until their ammunition ran low. Four ATF agents (Steve Willis, Robert Williams, Todd McKeehan, and Conway Charles LeBleu) were killed and another sixteen agents were wounded during the raid. The five Branch Davidians killed in the 9:45 a.m. raid were Winston Blake (British), Peter Gent (Australian), Peter Hipsman, Perry Jones, and Jaydean Wendell; two were killed by the Branch Davidians. Almost six hours after the ceasefire, Michael Schroeder was shot dead by ATF agents who alleged he fired a pistol at agents as he attempted to re-enter the compound with Woodrow Kendrick and Norman Allison. His wife said he was merely returning from work and had not participated in the day's earlier altercation. After the raid, ATF agents established contact with Koresh and others inside of the compound. The FBI took command after the deaths of federal agents, and managed to facilitate the release of nineteen children (without their parents) relatively early into the negotiations. The children were then interviewed by the FBI and the Texas Rangers.
On April 19, 1993, the FBI moved for a final siege of the compound using large weaponry such as .50 caliber (12.7 mm) rifles and armored combat engineering vehicles (CEV) to combat the heavily armed Branch Davidians. The FBI attempted to use tear gas to flush out the Branch Davidians. Officially, FBI agents were only permitted to return any incoming fire, not to actively assault the Branch Davidians. When several Branch Davidians opened fire, the FBI's response was to increase the amount of gas being used. Around noon, three fires broke out simultaneously in different parts of the building. The government maintains that the fires were deliberately started by Branch Davidians. Some Branch Davidian survivors maintain that the fires were started either accidentally or deliberately by the assault. Of the eighty-five Branch Davidians in the compound when the final siege began, seventy-six died on April 19 in various ways, from falling rubble to suffocating effects of the fire, or by gunshot from fellow Branch Davidians. The siege had lasted fifty-one days.
Aftermath. In all, four ATF agents were killed, sixteen were wounded, and six Branch Davidians died in the initial raid on February 28. Seventy-six more died in the final assault on April 19. The events at Waco spurred criminal prosecution and civil litigation. A federal grand jury indicted twelve of the surviving Branch Davidians — including Clive Doyle, Brad Branch, Ruth Riddle, and Livingstone Fagan — charging them with aiding and abetting in murder of federal officers, and unlawful possession and use of various firearms. Eight Branch Davidians were convicted on firearms charges, five convicted of voluntary manslaughter, and four were acquitted of all charges. As of July 2007, all Branch Davidians had been released from prison. Civil suits were brought against the United States government, federal officials, former governor of Texas Ann Richards, and members of the Texas Army National Guard. The bulk of these claims were dismissed because they were insufficient as a matter of law or because the plaintiffs could advance no material evidence in support of them. One case, "Andrade v. Chojnacki", made it to the Fifth Circuit, which upheld a previous ruling of "take-nothing, denied".
After the siege. There are several groups that claim descent from the Branch Davidians today. The group that retains the original name "Branch Davidian Seventh Day Adventist" regards Lois Roden's immediate successor to have been Doug Mitchell (who joined the Branch Davidians in 1978 and led the group from 1986 until his death in 2013) and Mitchell's successor to be Trent Wilde (who has led the group since 2013). This group never followed David Koresh. Another group exists under the leadership of Charles Pace, called The Branch, The Lord Our Righteousness. It is a legally recognized denomination with twelve members. Pace, while regarding Koresh as appointed by God, says that Koresh twisted the Bible's teachings by fathering more than a dozen children with members' wives. Pace believes that the Lord "has anointed me and appointed me to be the leader", but he says he is "not a prophet" but "a teacher of righteousness". Others, once led by Clive Doyle, continue to believe Koresh was a prophet and await his resurrection, along with the followers who were killed. Both of these groups are still waiting for the end times. Doyle died in June 2022.
Flag. The original Davidian flag, as described in the "Catalog-Syllabus" (1942), showed a red lion inside a black six-pointed star, surrounded by five-pointed stars, on a green field. On February 28, 1993, the day of their initial confrontation with the ATF, a similar flag made of fringed satin was visible hanging in a front window of the compound. This flag had a pink six-pointed star surrounded by five-pointed stars, on a gold field. It had been presented to Benjamin Roden by northern Branch Davidians, but Roden never flew it because "the colors were wrong". Koresh, however, decided to hang it, and although it was destroyed on the first day it continued to hang in tatters throughout the siege. The Waco sect hoisted a different flag on their flagpole on March 1, 1993, after being surrounded by federal agents. This flag was also made of satin and was sewn in part by Kathy Jones. Steve Schneider described it as containing a "stylistic Star of David" and the fiery flying serpent mentioned in Isaiah 14. According to Koresh, the flag signified Mount Carmel's status as a sovereign power. This flag ripped off its pole during the Mount Carmel compound fire, and the ATF replaced it with an American flag, a Texas flag, and their own flag.
Carol Howe reported that a Branch Davidian flag was hanging in Elohim City as of January 1995, before the Oklahoma City bombing. Relationship with Seventh-Day Adventists. The Seventh-day Adventist Church, the main church in the Adventist tradition, rejected Victor Houteff's teachings and revoked his membership in 1930. Houteff then went on to found the Davidian Seventh Day Adventist Association (an offshoot which is also known as the Shepherd's Rod). The Branch Davidians are an offshoot of the Davidians and they are also a product of a schism which was initiated by Benjamin Roden, after Houteff's death and in light of Florence's (Houteff's wife) usurpation of power. Florence believed that she was a prophet. But her prediction of the demise of the Seventh Day Adventist Church, which according to her should have occurred forty-two months after Houteff's death (1959) failed to materialize. Likewise, Ben Roden believed that he was a prophet as well as a rightful heir to the leadership of the Davidians. While they were still formally members of the Seventh-day Adventist Church, the Branch Davidian leaders demanded a reform of the church and when their demand was met with opposition (by both the Seventh-day Adventists and the Davidians), they decided to leave that denomination and at the same time, they widely distanced themselves from the Davidians.
The Seventh-day Adventist Church deprived both the Branch Davidians and the Davidians of their membership in the denomination, in spite of this fact, the Branch Davidians actively continued to "hunt" members of the Seventh-day Adventist Church, and encourage them to leave it and join their group. The Seventh-day Adventists were reportedly "apprehensive" about the group's views because Branch Davidians claimed that they were the "only rightful continuation of the Adventist message", based on their belief that Victor Houteff was the divinely selected prophet and the successor of Ellen G. White. Both the Davidians and the Branch Davidians claimed that Houteff was their spiritual inspiration, as the founder of the Davidians. The Seventh-day Adventist Church issued warnings about the Branch Davidian sect's views to its members on a regular basis. Schisms within the Branch Davidian sect. There is documented evidence (FBI negotiation transcripts, during the standoff, with Kathryn Shroeder and Steve Schneider with interjections from Koresh himself) that David Koresh and his followers did not call themselves Branch Davidians. In addition, David Koresh, through forgery, stole the identity of the Branch Davidian Seventh-day Adventists for the purpose of obtaining the New Mount Carmel Center's property.
Burwash Hall Burwash Hall refers to both Burwash Dining Hall and Burwash Hall proper, the second oldest of the residence buildings at Victoria University in Toronto, Canada. Construction began in 1911 and was completed in 1913. It was named after Nathanael Burwash, president of Victoria from 1887 to 1912. The building is an extravagant Neo-Gothic work with turrets, gargoyles, and battlements. The architects were Messrs. Sproatt & Rolph. History. In 1910, seven years after the opening of the women's residence, Annesley Hall, the administrators of Victoria University began plans for an elaborate men's residence building on the campus. The project was funded by the estate of Mr. Hart A. Massey, an alumnus from Victoria's early days in Cobourg. The full cost of the project is unknown to the public, but the asset was valued at $450,000 in 1913.Famous residents of Burwash include Vincent Massey, Lester B. Pearson, Don Harron, and Donald Sutherland. Architecture. The building is described as Collegiate Gothic, intended to include all the developments of the Tudor style. Burwash Hall was designed to resemble the residences in Oxford and Cambridge, with modifications to the stair-case system and the division of houses. Sproatt & Rolph avoided architecture of commercial appearance, envisioning a structure that was academic in feeling. Burwash Hall was not intended to replicate Oxford buildings, but to "prove that academic Gothic can be indigenous in Canada as well as in England, and that it can be perfectly adapted to the exigencies of [Canada's] climate and life". Constructed of Bedford Indiana cut stone and Georgetown rubble masonry, the residence houses and adjoined dining hall intended to prove that beauty and efficiency were not antithetical.
Design. The building is divided between the large dining hall in the northwest and the student residence proper. The residence area is divided into two sections: the Upper Houses, built in 1913, and the Lower Houses, built in 1931. To the west the Upper Houses look out on the Vic Quad and the main Victoria College building across it. West of the Lower Houses is the new Lester B. Pearson Garden of Peace and International Understanding and the E.J. Pratt Library beyond it. From the eastern side of the building, the Upper Houses look out at Rowell Jackman Hall and the Lower Houses see the St. Michael's College residence of Elmsley. The only exception is the view from Gate House Tower which looks down St. Mary's Street. Burwash Dining Hall. The dining hall is perhaps the best known part of the building to outsiders. It is the University of Toronto's largest, holding some 250 students and sixteen large tables. Hanging on the western wall is Queen Victoria's burial flag, given to the college soon after her death. Under the flag is the high table where the professors and college administration lunch. Historically, the Upper Houses each had their own table. Gate sat in the southwest corner, Middle sat in the far northeast, South sat in the table to the west of Middle, while North sat to the west of the southeast corner. The only lower house to have had a designated table was Caven, in the northwest corner beside the alumni table. (Note that prior to the 1995 renovations, some of these houses, particularly North and Caven, 'traditionally' sat elsewhere).
Upper Houses. Adjoined to Burwash Dining Hall and completed in 1913, the upper houses were originally known as the "Men's Residences." The four houses are: North House, Middle House, Gate House, and South House. The upper houses were gutted and renovated in 1995. Each Upper House consists of three floors. The lower floor contains a common room equipped with kitchen facilities, couches and a television. The upper floors each have their own kitchen and dining area. All houses have a very high bathroom ratio, with many single-use washrooms and a communal washroom on each floor. Upper Houses are divided between double rooms and singles, with about sixty percent of the population being in doubles. Unlike the Lower Houses, the hallways of each Upper House are connected, a feature that was added in the 1995 renovations. There is typically an upper-year Residence Don for each of the Upper Houses. This has been the case since the building's construction in 1913, when specific rooms were included for Dons. The original location of these rooms has since changed with recent renovations.
North House. At the corner of Burwash Dining Hall and the Upper Houses lies North House. The emblem of North House is an oil lamp, originally used to represent Victoria's Faculty of Theology, established in 1871. North has an extended hallway and larger common room than the other Upper Houses due to its position on the corner of the building. Middle House. The largest of the Upper Houses due to its incorporation of two battlements which divide North and Gate House, Middle House is the centre of the Upper Houses. The owl is the emblem of Middle House, sourced from the Victoria College coat of arms, and originally used to represent the Faculty of Arts. The Don's room in Middle House was originally the room reserved for the Dean of Men at Victoria, fit with a fireplace and seating area. Gate House. Gate House is one of the four Upper Houses of the Burwash Hall residence. Until 2007, when Victoria administration made it co-ed, Gate House was one of the last remaining all-male residence building in the University of Toronto. The Gate House emblem is the Phoenix, visible in the bottom-right corner of the Victoria College insignia.
Gate House, with the rest of Upper Burwash, opened in 1913 and has held students every year since then except 1995, when it was renovated. As an all-male residence from 1913 to 2007 it held a number of unique traditions. For 20 years Gate House hosted an annual party called Novemberfest in the Burwash dining hall. The Victoria Dean of Students cancelled Novemberfest in 2003, when police discovered widespread underage drinking and over 800 people in the dining hall, in violation of the fire code. Another Gate House tradition that no longer occurs is the "stirring the chicken," a dinner and keg party where house members cook chicken fajitas for hundreds of guests. Until 2007, Gate House held secretive first-year initiation ceremonies called Traditionals, which involved writing slogans on campus buildings in chalk, singing songs to the all-women's residence (who would then sing back to them), and leading first-years around the house blindfolded. Since Novemberfest, Gate House continued to have conflict with the Administration. In 2004 the Dean evicted three Gate House residents for allegedly "hog-tying" a first-year student. In 2007 President Paul W. Gooch wrote that Gate House undertook an "escalating series of actions" that were "defiant" and "disparaging of women", in response to Gate members constructing a 2.5-metre snow penis and placing a cooked pig's head in an Annesley bathroom. As punishment, during the fall exam period Gooch evicted two residents and relocated the remainder of Gate House to other places in the residence system, banned all current Gate House students from entering the building in 2008. Since this decision Gate House has become a co-ed residence identical to the other Upper Burwash houses. Notable residents of Gate House include Lester B. Pearson, former Prime Minister of Canada, and Simon Pulsifer, who "Time" magazine nicknamed "The Duke of Data" for his contributions to Wikipedia.
During its 93 years as a men's residence, Gate House developed a distinct character and reputation. These antics included pranks, toga parties, streaking, caroling to other residences, hazing rituals, "beer bashes" and "incessant pounding" on the Gate House table in the dining hall. Paul Gooch wrote that these traditions gave Gate House an "ethos" that contradicted his vision of residence life. The all-male Gate House was known as a social centre and spirited, tight-knit community. According to Grayson Lee, who created the snow penis sculpture in 2007, most of its residents were "heartbroken" to leave. Former Gate House President Dave Ruhl commented that "the Gate House camaraderie is unique" and that living there was "one of the most important parts of the university experience" for many. The Reuters news agency nicknamed Gate House "U of T's Animal House" because Donald Sutherland's memories of its parties are said to have influenced the script of the 1978 movie. The Toronto Star described Gooch's decision to put an end to its traditions, activities and distinguishing characteristics as "neutering Animal House."
Gate House has three floors which house 28 students, as well as a don and the Victoria College Residence Life Co-ordinator. Above the gate there is a tower that rises three stories higher and has a turret-style roof. The first floor has one double room and one bathroom available to students. About half of the floor is taken up by the apartment of the Residence Life Coordinator. Lastly, on the first floor there is a house common room with a kitchen and two couches. The second floor has three double rooms and seven single rooms. It has three single washrooms and one larger communal one, as well as its own kitchen. This floor is home to the residence don, who has a larger room with a private washroom. The third floor is identical to the second except that in place of the don's room there are two single rooms. South House. Adjoining St. Mary's Arch and Lower Houses, South House is the furthest Upper House from Burwash Dining Hall. The emblem of the house is a sphinx, which was originally used to represent Victoria's Faculty of Law, established in 1860.
Lower Houses. The Lower Houses, originally the "Emmanuel College Residences," were intended to house theology students at Emmanuel College, whose current building was opened the same year. Ryerson House (renamed to First House in 2021), Nelles House, Caven House, Bowles-Gandier House are now mostly home to undergraduate arts and science students. One story lower than the Upper Houses, they consist of four floors in order to reach the same height. All five houses are connected underground via the basement. The lower houses have only been partially upgraded. Before the renovations the entire building was exclusively male, but now every house is co-ed. The Lower Houses each have four floors, but are much narrower with each level having only four rooms. Each level also has its own kitchen, but these are much smaller than in the Upper Houses. The Lower Houses do have far larger and better fitted common rooms that are similar to the ones the Upper Houses had before the renovations. The rooms in the Lower Houses are also considered more luxurious with hardwood floors and large sizes. Rooms in the Lower Houses are more expensive, however. Until 2003 the Lower Houses were restricted to upper year students but with the double cohort of graduates from Ontario schools many of the rooms were transformed into doubles and now hold first years.
There is typically one upper-year Residence Don for First, Nelles, and Caven House, and a second upper-year Residence Don for Bowles-Gandier House. First House (Ryerson House). First House connects the Upper and Lower Houses, and was originally named after the first principal of Victoria College, Egerton Ryerson. The house was renamed for the 2021–2022 school year, after an investigation into the legacy of Ryerson and his role in the Canadian residential school system. The Victoria University Students' Administrative Council initially called for a renaming in February 2019, which was followed by the Victoria University Research Panel on the Legacy of Egerton Ryerson in 2020, and ultimately the Presidential Report on the Legacy of Egerton Ryerson in 2021 which resulted in the change. Although the house had been named "Ryerson" since 1933, all five Lower Houses were temporarily named First House, Second House, Third House, Fourth House, and Fifth House from 1931 until 1933. The Board of Regents used these placeholder names until they decided upon better alternatives. In 2021, the name of Ryerson House was reverted to its original title, First House.
Nelles House. Named for Victoria principal, president, and chancellor Samuel S. Nelles, Nelles House echoes the position of Middle House amongst the Upper Houses. Like Middle, Nelles House sits between the first and third houses in the set. However, Nelles is the exact same size and shape as Ryerson and Caven House. Caven House. The only Lower House to not be named after a Victoria College student or administrator, Caven House comes from presbyterian minister William Caven, the second principal of Knox College, Toronto. Although he was not directly involved with the affairs of Victoria, he consulted President Nathanael Burwash and Rev. Alfred Gandier about the division of Arts and Theology at Victoria. After great discussion, this spawned Emmanuel College, Victoria's Faculty of Theology. Since the Lower Houses were originally built for Emmanuel students, it is likely that this is the reason for naming the House after William Caven. Bowles-Gandier House. Name. Bowles House is named after Victoria president and chancellor Richard Pinch Bowles, the first-cousin once-removed of Lester B. Pearson.
Gandier House is named after Alfred Gandier, the first principal of Emmanuel College. Exterior Design. The very last house in Burwash Hall has a unique style to the other three Lower Houses. Rather than continuing the trend of Upper and Lower Houses in a straight line on the East side of the property, Bowles-Gandier House, colloquially "BG", juts out on the West side of the Southern edge of Burwash Hall. Enclosing the residence structure along the property line where Victoria meets St. Michael's College, the house forms an L shape with the other three Lower Houses. Interior Layout. Unlike Ryerson, Nelles, and Caven House—which are all identical in layout—Bowles-Gandier is the amalgamation of Gandier House and Bowles House, which operated independently until the 1995 renovations. The floor plan for Bowles-Gandier varies from the other Lower Houses, with a significantly larger common room and two triple-bedrooms on the main floor: each with an in-suite kitchen and bathroom. The Bowles and Gandier stairwells are connected by a hallway on the second, third, and fourth floors. Each of these floors has a shared kitchen, and two bedrooms at the end of each hall with a connected bathroom, much like the other Lower Houses. They also have two double-rooms in the middle of the hall, which have a connected bathroom and kitchen, meaning BG has the highest kitchen-to-student ratio in Burwash. Vic One Program. Bowles-Gandier is sometimes referred to as the Vic One House, since it is mostly reserved for students in the Vic One program. While not a requirement to live in BG, it has historically consisted of > 80% Vic One students.
Benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of CNS depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, insomnia, and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955, and was made available in 1960 by Hoffmann–La Roche, which followed with the development of diazepam (Valium) three years later, in 1963. By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide. Benzodiazepines are depressants that enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties. High doses of many shorter-acting benzodiazepines may also cause anterograde amnesia and dissociation. These properties make benzodiazepines useful in treating anxiety, panic disorder, insomnia, agitation, seizures, muscle spasms, alcohol withdrawal and as a premedication for medical or dental procedures. Benzodiazepines are categorized as short, intermediate, or long-acting. Short- and intermediate-acting benzodiazepines are preferred for the treatment of insomnia; longer-acting benzodiazepines are recommended for the treatment of anxiety.
Benzodiazepines are generally viewed as safe and effective for short-term use of two to four weeks, although cognitive impairment and paradoxical effects such as aggression or behavioral disinhibition can occur. According to the Government of Victoria's (Australia) Department of Health, long-term use can cause "impaired thinking or memory loss, anxiety and depression, irritability, paranoia, aggression, etc." A minority of people have paradoxical reactions after taking benzodiazepines such as worsened agitation or panic. Benzodiazepines are associated with an increased risk of suicide due to aggression, impulsivity, and negative withdrawal effects. Long-term use is controversial because of concerns about decreasing effectiveness, physical dependence, benzodiazepine withdrawal syndrome, and an increased risk of dementia and cancer. The elderly are at an increased risk of both short- and long-term adverse effects, and as a result, all benzodiazepines are listed in the Beers List of inappropriate medications for older adults. There is controversy concerning the safety of benzodiazepines in pregnancy. While they are not major teratogens, uncertainty remains as to whether they cause cleft palate in a small number of babies and whether neurobehavioural effects occur as a result of prenatal exposure; they are known to cause withdrawal symptoms in the newborn.
In an overdose, benzodiazepines can cause dangerous deep unconsciousness, but are less toxic than their predecessors, the barbiturates, and death rarely results when a benzodiazepine is the only drug taken. Combined with other central nervous system (CNS) depressants such as alcohol and opioids, the potential for toxicity and fatal overdose increases significantly. Benzodiazepines are commonly used recreationally and also often taken in combination with other addictive substances, and are controlled in most countries. Medical uses. Benzodiazepines possess psycholeptic, sedative, hypnotic, anxiolytic, anticonvulsant, muscle relaxant, and amnesic actions, which are useful in a variety of indications such as alcohol dependence, seizures, anxiety disorders, panic, agitation, and insomnia. Most are administered orally; however, they can also be given intravenously, intramuscularly, or rectally. In general, benzodiazepines are well tolerated and are safe and effective drugs in the short term for a wide range of conditions. Tolerance can develop to their effects and there is also a risk of dependence, and upon discontinuation a withdrawal syndrome may occur. These factors, combined with other possible secondary effects after prolonged use such as psychomotor, cognitive, or memory impairments, limit their long-term applicability. The effects of long-term use or misuse include the tendency to cause or worsen cognitive deficits, depression, and anxiety. The College of Physicians and Surgeons of British Columbia recommends discontinuing the usage of benzodiazepines in those on opioids and those who have used them long term. Benzodiazepines can have serious adverse health outcomes, and these findings support clinical and regulatory efforts to reduce usage, especially in combination with non-benzodiazepine receptor agonists.
Panic disorder. Because of their effectiveness, tolerability, and rapid onset of anxiolytic action, benzodiazepines are frequently used for the treatment of anxiety associated with panic disorder. However, there is disagreement among expert bodies regarding the long-term use of benzodiazepines for panic disorder. The views range from those holding benzodiazepines are not effective long-term and should be reserved for treatment-resistant cases to those holding they are as effective in the long term as selective serotonin reuptake inhibitors (SSRIs). American Psychiatric Association (APA) guidelines, published in January 2009, note that, in general, benzodiazepines are well tolerated, and their use for the initial treatment for panic disorder is strongly supported by numerous controlled trials. APA states that there is insufficient evidence to recommend any of the established panic disorder treatments over another. The choice of treatment between benzodiazepines, SSRIs, serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and psychotherapy should be based on the patient's history, preference, and other individual characteristics.
The choice of treatment between benzodiazepines, SSRIs, serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and psychotherapy should be based on the patient's history, preference, and other individual characteristics. Selective serotonin reuptake inhibitors are likely to be the best choice of pharmacotherapy for many patients with panic disorder, but benzodiazepines are also often used, and some studies suggest that these medications are still used with greater frequency than the SSRIs. One advantage of benzodiazepines is that they alleviate the anxiety symptoms much more quickly than antidepressants, and therefore may be preferred in patients for whom rapid symptom control is critical. However, this advantage is offset by the possibility of developing benzodiazepine dependence. APA does not recommend benzodiazepines for persons with depressive symptoms or a recent history of substance use disorder. APA guidelines state that, in general, pharmacotherapy of panic disorder should be continued for at least a year, and that clinical experience supports continuing benzodiazepine treatment to prevent recurrence.
APA guidelines state that, in general, pharmacotherapy of panic disorder should be continued for at least a year, and that clinical experience supports continuing benzodiazepine treatment to prevent recurrence. Although major concerns about benzodiazepine tolerance and withdrawal have been raised, there is no evidence for significant dose escalation in patients using benzodiazepines long-term. For many such patients, stable doses of benzodiazepines retain their efficacy over several years. Guidelines issued by the UK-based National Institute for Health and Clinical Excellence (NICE), carried out a systematic review using different methodology and came to a different conclusion. They questioned the accuracy of studies that were not placebo-controlled. And, based on the findings of placebo-controlled studies, they do not recommend use of benzodiazepines beyond two to four weeks, as tolerance and physical dependence develop rapidly, with withdrawal symptoms including rebound anxiety occurring after six weeks or more of use. Nevertheless, benzodiazepines are still prescribed for long-term treatment of anxiety disorders, although specific antidepressants and psychological therapies are recommended as the first-line treatment options with the anticonvulsant drug pregabalin indicated as a second- or third-line treatment and suitable for long-term use. NICE stated that long-term use of benzodiazepines for panic disorder with or without agoraphobia is an unlicensed indication, does not have long-term efficacy, and is, therefore, not recommended by clinical guidelines. Psychological therapies such as cognitive behavioural therapy are recommended as a first-line therapy for panic disorder; benzodiazepine use has been found to interfere with therapeutic gains from these therapies.
Benzodiazepines are usually administered orally; however, very occasionally lorazepam or diazepam may be given intravenously for the treatment of panic attacks. Generalized anxiety disorder. Benzodiazepines have robust efficacy in the short-term management of generalized anxiety disorder (GAD) when standardized measures of anxiety are used as the outcome variable, but did not demonstrate a favorable dropout rate compared to placebo in one meta-analysis. A newer meta-analysis showed that benzodiazepines are significantly more effective than serotonergic agents, regardless of treatment length. More research is needed, but unfortunately, newer randomized controlled trials are scarce for the off patent benzodiazepines. According to National Institute for Health and Clinical Excellence (NICE), benzodiazepines can be used in the immediate management of GAD, if necessary. However, they should not usually be given for longer than 2–4 weeks. The only medications NICE recommends for the longer term management of GAD are antidepressants.
Likewise, Canadian Psychiatric Association (CPA) recommends benzodiazepines alprazolam, bromazepam, lorazepam, and diazepam only as a second-line choice, if the treatment with two different antidepressants was unsuccessful. Although they are second-line agents, benzodiazepines can be used for a limited time to relieve severe anxiety and agitation. CPA guidelines state that after 4–6 weeks the effect of benzodiazepines may decrease to the level of placebo, and that benzodiazepines are less effective than antidepressants in alleviating ruminative worry, the core symptom of GAD, but that in some cases, a prolonged treatment with benzodiazepines as the add-on to an antidepressant may be justified. Evidence from reviews of benzodiazepine tolerance mechanisms and clonazepam use in psychiatric disorders is strongly discordant with the claim that benzodiazepines lose anxiolytic efficacy over a period of weeks, as these reviews present RCT evidence of continued anxiolytic efficacy at up to 22 weeks and observational (open-label) evidence of continued efficacy at up to 3 years.
A 2015 review found a larger effect with medications than talk therapy. Medications with benefit include serotonin-noradrenaline reuptake inhibitors, benzodiazepines, and selective serotonin reuptake inhibitors. Insomnia. Benzodiazepines can be useful for short-term treatment of insomnia. Their use beyond 2 to 4 weeks is not recommended due to the risk of dependence. The Committee on Safety of Medicines report recommended that where long-term use of benzodiazepines for insomnia is indicated then treatment should be intermittent wherever possible. It is preferred that benzodiazepines be taken intermittently and at the lowest effective dose. They improve sleep-related problems by shortening the time spent in bed before falling asleep, prolonging the sleep time, and, in general, reducing wakefulness. However, they worsen sleep quality by increasing light sleep and decreasing deep sleep. Other drawbacks of hypnotics, including benzodiazepines, are possible tolerance to their effects, rebound insomnia, and reduced slow-wave sleep and a withdrawal period typified by rebound insomnia and a prolonged period of anxiety and agitation.
The list of benzodiazepines approved for the treatment of insomnia is fairly similar among most countries, but which benzodiazepines are officially designated as first-line hypnotics prescribed for the treatment of insomnia varies between countries. Longer-acting benzodiazepines such as nitrazepam and diazepam have residual effects that may persist into the next day and are, in general, not recommended. Since the release of nonbenzodiazepines, also known as z-drugs, in 1992 in response to safety concerns, individuals with insomnia and other sleep disorders have increasingly been prescribed nonbenzodiazepines (2.3% in 1993 to 13.7% of Americans in 2010), less often prescribed benzodiazepines (23.5% in 1993 to 10.8% in 2010). It is not clear as to whether the new non benzodiazepine hypnotics (Z-drugs) are better than the short-acting benzodiazepines. The efficacy of these two groups of medications is similar. According to the US Agency for Healthcare Research and Quality, indirect comparison indicates that side-effects from benzodiazepines may be about twice as frequent as from nonbenzodiazepines. Some experts suggest using nonbenzodiazepines preferentially as a first-line long-term treatment of insomnia. However, the UK National Institute for Health and Clinical Excellence did not find any convincing evidence in favor of Z-drugs. NICE review pointed out that short-acting Z-drugs were inappropriately compared in clinical trials with long-acting benzodiazepines. There have been no trials comparing short-acting Z-drugs with appropriate doses of short-acting benzodiazepines. Based on this, NICE recommended choosing the hypnotic based on cost and the patient's preference.
Older adults should not use benzodiazepines to treat insomnia unless other treatments have failed. When benzodiazepines are used, patients, their caretakers, and their physician should discuss the increased risk of harms, including evidence that shows twice the incidence of traffic collisions among driving patients, and falls and hip fracture for older patients. Seizures. Prolonged convulsive epileptic seizures are a medical emergency that can usually be dealt with effectively by administering fast-acting benzodiazepines, which are potent anticonvulsants. In a hospital environment, intravenous clonazepam, lorazepam, and diazepam are first-line choices. In the community, intravenous administration is not practical and so rectal diazepam or buccal midazolam are used, with a preference for midazolam as its administration is easier and more socially acceptable. When benzodiazepines were first introduced, they were enthusiastically adopted for treating all forms of epilepsy. However, drowsiness and tolerance become problems with continued use and none are now considered first-line choices for long-term epilepsy therapy. Clobazam is widely used by specialist epilepsy clinics worldwide and clonazepam is popular in the Netherlands, Belgium and France. Clobazam was approved for use in the United States in 2011. In the UK, both clobazam and clonazepam are second-line choices for treating many forms of epilepsy. Clobazam also has a useful role for very short-term seizure prophylaxis and in catamenial epilepsy. Discontinuation after long-term use in epilepsy requires additional caution because of the risks of rebound seizures. Therefore, the dose is slowly tapered over a period of up to six months or longer.
Alcohol withdrawal. Chlordiazepoxide is the most commonly used benzodiazepine for alcohol detoxification, but diazepam may be used as an alternative. Both are used in the detoxification of individuals who are motivated to stop drinking, and are prescribed for a short period of time to reduce the risks of developing tolerance and dependence to the benzodiazepine medication itself. The benzodiazepines with a longer half-life make detoxification more tolerable, and dangerous (and potentially lethal) alcohol withdrawal effects are less likely to occur. On the other hand, short-acting benzodiazepines may lead to breakthrough seizures, and are, therefore, not recommended for detoxification in an outpatient setting. Oxazepam and lorazepam are often used in patients at risk of drug accumulation, in particular, the elderly and those with cirrhosis, because they are metabolized differently from other benzodiazepines, through conjugation. Benzodiazepines are the preferred choice in the management of alcohol withdrawal syndrome, in particular, for the prevention and treatment of the dangerous complication of seizures and in subduing severe delirium. Lorazepam is the only benzodiazepine with predictable intramuscular absorption and it is the most effective in preventing and controlling acute seizures.
Other indications. Benzodiazepines are often prescribed for a wide range of conditions: Contraindications. Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, alcohol or drug-dependent individuals and individuals with comorbid psychiatric disorders. Because of their muscle relaxant action, benzodiazepines may cause respiratory depression in susceptible individuals. For that reason, they are contraindicated in people with myasthenia gravis, sleep apnea, bronchitis, and COPD. Caution is required when benzodiazepines are used in people with personality disorders or intellectual disability because of frequent paradoxical reactions. In major depression, they may precipitate suicidal tendencies and are sometimes used for suicidal overdoses. Individuals with a history of excessive alcohol use or non-medical use of opioids or barbiturates should avoid benzodiazepines, as there is a risk of life-threatening interactions with these drugs. Pregnancy. In the United States, the Food and Drug Administration has categorized benzodiazepines into either category D or X meaning potential for harm in the unborn has been demonstrated.
Exposure to benzodiazepines during pregnancy has been associated with a slightly increased (from 0.06 to 0.07%) risk of cleft palate in newborns, a controversial conclusion as some studies find no association between benzodiazepines and cleft palate. Their use by expectant mothers shortly before the delivery may result in a floppy infant syndrome. Newborns with this condition tend to have hypotonia, hypothermia, lethargy, and breathing and feeding difficulties. Cases of neonatal withdrawal syndrome have been described in infants chronically exposed to benzodiazepines in utero. This syndrome may be hard to recognize, as it starts several days after delivery, for example, as late as 21 days for chlordiazepoxide. The symptoms include tremors, hypertonia, hyperreflexia, hyperactivity, and vomiting and may last for up to three to six months. Tapering down the dose during pregnancy may lessen its severity. If used in pregnancy, those benzodiazepines with a better and longer safety record, such as diazepam or chlordiazepoxide, are recommended over potentially more harmful benzodiazepines, such as temazepam or triazolam. Using the lowest effective dose for the shortest period of time minimizes the risks to the unborn child.
Elderly. The benefits of benzodiazepines are least and the risks are greatest in the elderly. They are listed as a potentially inappropriate medication for older adults by the American Geriatrics Society. The elderly are at an increased risk of dependence and are more sensitive to the adverse effects such as memory problems, daytime sedation, impaired motor coordination, and increased risk of motor vehicle accidents and falls, and an increased risk of hip fractures. The long-term effects of benzodiazepines and benzodiazepine dependence in the elderly can resemble dementia, depression, or anxiety syndromes, and progressively worsens over time. Adverse effects on cognition can be mistaken for the effects of old age. The benefits of withdrawal include improved cognition, alertness, mobility, reduced risk of incontinence, and a reduced risk of falls and fractures. The success of gradual-tapering benzodiazepines is as great in the elderly as in younger people. Benzodiazepines should be prescribed to the elderly only with caution and only for a short period at low doses. Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and temazepam. The high potency benzodiazepines alprazolam and triazolam and long-acting benzodiazepines are not recommended in the elderly due to increased adverse effects. Nonbenzodiazepines such as zaleplon and zolpidem and low doses of sedating antidepressants are sometimes used as alternatives to benzodiazepines.
Long-term use of benzodiazepines is associated with increased risk of cognitive impairment and dementia, and reduction in prescribing levels is likely to reduce dementia risk. The association of a history of benzodiazepine use and cognitive decline is unclear, with some studies reporting a lower risk of cognitive decline in former users, some finding no association and some indicating an increased risk of cognitive decline. Benzodiazepines are sometimes prescribed to treat behavioral symptoms of dementia. However, like antidepressants, they have little evidence of effectiveness, although antipsychotics have shown some benefit. Cognitive impairing effects of benzodiazepines that occur frequently in the elderly can also worsen dementia. Adverse effects. The most common side-effects of benzodiazepines are related to their sedating and muscle-relaxing action. They include drowsiness, dizziness, and decreased alertness and concentration. Lack of coordination may result in falls and injuries particularly in the elderly. Another result is impairment of driving skills and increased likelihood of road traffic accidents. Decreased libido and erection problems are a common side effect. Depression and disinhibition may emerge. Hypotension and suppressed breathing (hypoventilation) may be encountered with intravenous use. Less common side effects include nausea and changes in appetite, blurred vision, confusion, euphoria, depersonalization and nightmares. Cases of liver toxicity have been described but are very rare.
The long-term effects of benzodiazepine use can include cognitive impairment as well as affective and behavioural problems. Feelings of turmoil, difficulty in thinking constructively, loss of sex-drive, agoraphobia and social phobia, increasing anxiety and depression, loss of interest in leisure pursuits and interests, and an inability to experience or express feelings can also occur. Not everyone, however, experiences problems with long-term use. Additionally, an altered perception of self, environment and relationships may occur. A study published in 2020 found that long-term use of prescription benzodiazepines is associated with an increase in all-cause mortality among those age 65 or younger, but not those older than 65. The study also found that all-cause mortality was increased further in cases in which benzodiazepines are co-prescribed with opioids, relative to cases in which benzodiazepines are prescribed without opioids, but again only in those age 65 or younger. Compared to other sedative-hypnotics, visits to the hospital involving benzodiazepines had a 66% greater odds of a serious adverse health outcome. This included hospitalization, patient transfer, or death, and visits involving a combination of benzodiazepines and non-benzodiapine receptor agonists had almost four-times increased odds of a serious health outcome.
In September 2020, the US Food and Drug Administration (FDA) required the boxed warning be updated for all benzodiazepine medicines to describe the risks of abuse, misuse, addiction, physical dependence, and withdrawal reactions consistently across all the medicines in the class. Cognitive effects. The short-term use of benzodiazepines adversely affects multiple areas of cognition, the most notable one being that it interferes with the formation and consolidation of memories of new material and may induce complete anterograde amnesia. However, researchers hold contrary opinions regarding the effects of long-term administration. One view is that many of the short-term effects continue into the long-term and may even worsen, and are not resolved after stopping benzodiazepine usage. Another view maintains that cognitive deficits in chronic benzodiazepine users occur only for a short period after the dose, or that the anxiety disorder is the cause of these deficits. While the definitive studies are lacking, the former view received support from a 2004 meta-analysis of 13 small studies. This meta-analysis found that long-term use of benzodiazepines was associated with moderate to large adverse effects on all areas of cognition, with visuospatial memory being the most commonly detected impairment. Some of the other impairments reported were decreased IQ, visiomotor coordination, information processing, verbal learning and concentration. The authors of the meta-analysis and a later reviewer noted that the applicability of this meta-analysis is limited because the subjects were taken mostly from withdrawal clinics; the coexisting drug, alcohol use, and psychiatric disorders were not defined; and several of the included studies conducted the cognitive measurements during the withdrawal period.
Paradoxical effects. Paradoxical reactions, such as increased seizures in epileptics, aggression, violence, impulsivity, irritability and suicidal behavior sometimes occur. These reactions have been explained as consequences of disinhibition and the subsequent loss of control over socially unacceptable behavior. Paradoxical reactions are rare in the general population, with an incidence rate below 1% and similar to placebo. However, they occur with greater frequency in recreational abusers, individuals with borderline personality disorder, children, and patients on high-dosage regimes. In these groups, impulse control problems are perhaps the most important risk factor for disinhibition; learning disabilities and neurological disorders are also significant risks. Most reports of disinhibition involve high doses of high-potency benzodiazepines. Paradoxical effects may also appear after chronic use of benzodiazepines. Long-term worsening of psychiatric symptoms.
Physical dependence, withdrawal and post-withdrawal syndromes. Tolerance. Tolerance and dependence are risks of chronic benzodiazepine use, and can result in doses within the therapeutic range ceasing to offer meaningful symptomatic relief after prolonged use. Tolerance develops at different rates and to different degrees to the sedative, hypnotic, anticonvulsant, muscle relaxant and anxiolytic effects of benzodiazpines. A review of benzodiazepine tolerance concluded that it ""appears that tolerance develops relatively quickly for the sedative and anticonvulsant actions of benzodiazepines, whereas tolerance to anxiolytic and amnesic effects probably does not develop at all"," although the included randomized controlled trial evidence is limited to 22 weeks. A review of clonazepam in the treatment of psychiatric disorders concluded that there is longitudinal data supporting anxiolytic benefit without tolerance during long-term use, including an open-label study finding continued benefit at 3 years. However, the review concludes that long-term RCT evidence is scant. A study of benzodiazepine sensitivity found that patients treated chronically with alprazolam did not differ from untreated patients in terms of anxiolytic response to diazepam, suggesting a lack of anxiolytic tolerance.
However, controversy remains regarding tolerance to anxiolytic effects, with some publications reporting that there is little evidence of continued efficacy beyond 4–6 months or that dependence phenomena are common. However, some of these references were published prior to the in-depth scoping reviews of benzodiazepine tolerance, and lack citations of RCT evidence of tolerance. Studies reporting on voluntary benzodiazepine cessation and withdrawal include patient reports of tolerance and worsening anxiety. The question of tolerance to the amnesic effects of benzodiazepines is, likewise, unclear. Some evidence suggests that partial tolerance does develop, and that, "memory impairment is limited to a narrow window within 90 minutes after each dose".
Withdrawal symptoms and management. Discontinuation of benzodiazepines or abrupt reduction of the dose, even after a relatively short course of treatment (two to four weeks), may result in two groups of symptoms, rebound and withdrawal. Rebound symptoms are the return of the symptoms for which the patient was treated but worse than before. Withdrawal symptoms are the new symptoms that occur when the benzodiazepine is stopped. They are the main sign of physical dependence. The most frequent symptoms of withdrawal from benzodiazepines are insomnia, gastric problems, tremors, agitation, fearfulness, and muscle spasms. The less frequent effects are irritability, sweating, depersonalization, derealization, hypersensitivity to stimuli, depression, suicidal behavior, psychosis, seizures, and delirium tremens. Severe symptoms usually occur as a result of abrupt or over-rapid withdrawal. Abrupt withdrawal can be dangerous and lead to excitotoxicity, causing damage and even death to nerve cells as a result of excessive levels of the excitatory neurotransmitter glutamate. Increased glutamatergic activity is thought to be part of a compensatory mechanism to chronic GABAergic inhibition from benzodiazepines. Therefore, a gradual reduction regimen is recommended.
Symptoms may also occur during a gradual dosage reduction, but are typically less severe and may persist as part of a protracted withdrawal syndrome for months after cessation of benzodiazepines. Approximately 10% of patients experience a notable protracted withdrawal syndrome, which can persist for many months or in some cases a year or longer. Protracted symptoms tend to resemble those seen during the first couple of months of withdrawal but usually are of a sub-acute level of severity. Such symptoms do gradually lessen over time, eventually disappearing altogether. Benzodiazepines have a reputation with patients and doctors for causing a severe and traumatic withdrawal; however, this is in large part due to the withdrawal process being poorly managed. Over-rapid withdrawal from benzodiazepines increases the severity of the withdrawal syndrome and increases the failure rate. A slow and gradual withdrawal customised to the individual and, if indicated, psychological support is the most effective way of managing the withdrawal. Opinion as to the time needed to complete withdrawal ranges from four weeks to several years. A goal of less than six months has been suggested, but due to factors such as dosage and type of benzodiazepine, reasons for prescription, lifestyle, personality, environmental stresses, and amount of available support, a year or more may be needed to withdraw.
Withdrawal is best managed by transferring the physically dependent patient to an equivalent dose of diazepam because it has the longest half-life of all of the benzodiazepines, is metabolised into long-acting active metabolites and is available in low-potency tablets, which can be quartered for smaller doses. A further benefit is that it is available in liquid form, which allows for even smaller reductions. Chlordiazepoxide, which also has a long half-life and long-acting active metabolites, can be used as an alternative. Nonbenzodiazepines are contraindicated during benzodiazepine withdrawal as they are cross tolerant with benzodiazepines and can induce dependence. Alcohol is also cross tolerant with benzodiazepines and more toxic and thus caution is needed to avoid replacing one dependence with another. During withdrawal, fluoroquinolone-based antibiotics are best avoided if possible; they displace benzodiazepines from their binding site and reduce GABA function and, thus, may aggravate withdrawal symptoms. Antipsychotics are not recommended for benzodiazepine withdrawal (or other CNS depressant withdrawal states) especially clozapine, olanzapine or low potency phenothiazines, e.g., chlorpromazine as they lower the seizure threshold and can worsen withdrawal effects; if used extreme caution is required.
Withdrawal from long term benzodiazepines is beneficial for most individuals. Withdrawal of benzodiazepines from long-term users, in general, leads to improved physical and mental health particularly in the elderly; although some long term users report continued benefit from taking benzodiazepines, this may be the result of suppression of withdrawal effects. Controversial associations. Beyond the well established link between benzodiazepines and psychomotor impairment resulting in motor vehicle accidents and falls leading to fracture; research in the 2000s and 2010s has raised the association between benzodiazepines (and Z-drugs) and other, as of yet unproven, adverse effects including dementia, cancer, infections, pancreatitis and respiratory disease exacerbations. Dementia. A number of studies have drawn an association between long-term benzodiazepine use and neuro-degenerative disease, particularly Alzheimer's disease. It has been determined that long-term use of benzodiazepines is associated with increased dementia risk, even after controlling for protopathic bias.
Infections. Some observational studies have detected significant associations between benzodiazepines and respiratory infections such as pneumonia where others have not. A large meta-analysis of pre-marketing randomized controlled trials on the pharmacologically related Z-Drugs suggest a small increase in infection risk as well. An immunodeficiency effect from the action of benzodiazepines on GABA-A receptors has been postulated from animal studies. Cancer. A meta-analysis of observational studies has determined an association between benzodiazepine use and cancer, though the risk across different agents and different cancers varied significantly. In terms of experimental basic science evidence, an analysis of carcinogenetic and genotoxicity data for various benzodiazepines has suggested a small possibility of carcinogenesis for a small number of benzodiazepines. Pancreatitis. The evidence suggesting a link between benzodiazepines (and Z-Drugs) and pancreatic inflammation is very sparse and limited to a few observational studies from Taiwan. A criticism of confounding can be applied to these findings as with the other controversial associations above. Further well-designed research from other populations as well as a biologically plausible mechanism is required to confirm this association.
Overdose. Although benzodiazepines are much safer in overdose than their predecessors, the barbiturates, they can still cause problems in overdose. Taken alone, they rarely cause severe complications in overdose; statistics in England showed that benzodiazepines were responsible for 3.8% of all deaths by poisoning from a single drug. However, combining these drugs with alcohol, opiates or tricyclic antidepressants markedly raises the toxicity. The elderly are more sensitive to the side effects of benzodiazepines, and poisoning may even occur from their long-term use. The various benzodiazepines differ in their toxicity; temazepam appears most toxic in overdose and when used with other drugs. The symptoms of a benzodiazepine overdose may include; drowsiness, slurred speech, nystagmus, hypotension, ataxia, coma, respiratory depression, and cardiorespiratory arrest. A reversal agent for benzodiazepines exists, flumazenil (Anexate), itself belonging to the chemical class of benzodiazepines. Its use as an antidote is not routinely recommended because of the high risk of resedation and seizures. In a double-blind, placebo-controlled trial of 326 people, 4 people had serious adverse events and 61% became resedated following the use of flumazenil. Numerous contraindications to its use exist. It is contraindicated in people with a history of long-term use of benzodiazepines, those having ingested a substance that lowers the seizure threshold or may cause an arrhythmia, and in those with abnormal vital signs. One study found that only 10% of the people presenting with a benzodiazepine overdose are suitable candidates for treatment with flumazenil.
Interactions. Individual benzodiazepines may have different interactions with certain drugs. Depending on their metabolism pathway, benzodiazepines can be divided roughly into two groups. The largest group consists of those that are metabolized by cytochrome P450 (CYP450) enzymes and possess significant potential for interactions with other drugs. The other group comprises those that are metabolized through glucuronidation, such as lorazepam, oxazepam, and temazepam, and, in general, have few drug interactions. Many drugs, including oral contraceptives, some antibiotics, antidepressants, and antifungal agents, inhibit cytochrome enzymes in the liver. They reduce the rate of elimination of the benzodiazepines that are metabolized by CYP450, leading to possibly excessive drug accumulation and increased side-effects. In contrast, drugs that induce cytochrome P450 enzymes, such as St John's wort, the antibiotic rifampicin, and the anticonvulsants carbamazepine and phenytoin, accelerate elimination of many benzodiazepines and decrease their action. Taking benzodiazepines with alcohol, opioids and other central nervous system depressants potentiates their action. This often results in increased sedation, impaired motor coordination, suppressed breathing, and other adverse effects that have potential to be lethal. Antacids can slow down absorption of some benzodiazepines; however, this effect is marginal and inconsistent.
Pharmacology. Pharmacodynamics. Benzodiazepines work by increasing the effectiveness of the endogenous chemical, GABA, to decrease the excitability of neurons. This reduces the communication between neurons and, therefore, has a calming effect on many of the functions of the brain. GABA controls the excitability of neurons by binding to the GABAA receptor. The GABAA receptor is a protein complex located in the synapses between neurons. All GABAA receptors contain an ion channel that conducts chloride ions across neuronal cell membranes and two binding sites for the neurotransmitter gamma-aminobutyric acid (GABA), while a subset of GABAA receptor complexes also contain a single binding site for benzodiazepines. Binding of benzodiazepines to this receptor complex does not alter binding of GABA. Unlike other positive allosteric modulators that increase ligand binding, benzodiazepine binding acts as a positive allosteric modulator by increasing the total conduction of chloride ions across the neuronal cell membrane when GABA is already bound to its receptor. This increased chloride ion influx hyperpolarizes the neuron's membrane potential. As a result, the difference between resting potential and threshold potential is increased and firing is less likely.
Different GABAA receptor subtypes have varying distributions within different regions of the brain and, therefore, control distinct neuronal circuits. Hence, activation of different GABAA receptor subtypes by benzodiazepines may result in distinct pharmacological actions. In terms of the mechanism of action of benzodiazepines, their similarities are too great to separate them into individual categories such as anxiolytic or hypnotic. For example, a hypnotic administered in low doses produces anxiety-relieving effects, whereas a benzodiazepine marketed as an anti-anxiety drug at higher doses induces sleep. The subset of GABAA receptors that also bind benzodiazepines are referred to as benzodiazepine receptors (BzR). The GABAA receptor is a heteromer composed of five subunits, the most common ones being two "α"s, two "β"s, and one "γ" (α2β2γ1). For each subunit, many subtypes exist (α1–6, β1–3, and γ1–3). GABAA receptors that are made up of different combinations of subunit subtypes have different properties, different distributions in the brain and different activities relative to pharmacological and clinical effects.
different distributions in the brain and different activities relative to pharmacological and clinical effects. Benzodiazepines bind at the interface of the α and γ subunits on the GABAA receptor. Binding also requires that alpha subunits contain a histidine amino acid residue, (i.e., α1, α2, α3, and α5 containing GABAA receptors). For this reason, benzodiazepines show no affinity for GABAA receptors containing α4 and α6 subunits with an arginine instead of a histidine residue. Once bound to the benzodiazepine receptor, the benzodiazepine ligand locks the benzodiazepine receptor into a conformation in which it has a greater affinity for the GABA neurotransmitter. This increases the frequency of the opening of the associated chloride ion channel and hyperpolarizes the membrane of the associated neuron. The inhibitory effect of the available GABA is potentiated, leading to sedative and anxiolytic effects. For instance, those ligands with high activity at the α1 are associated with stronger hypnotic effects, whereas those with higher affinity for GABAA receptors containing α2 and/or α3 subunits have good anti-anxiety activity.
GABAA receptors participate in the regulation of synaptic pruning by prompting microglial spine engulfment. Benzodiazepines have been shown to upregulate microglial spine engulfment and prompt overzealous eradication of synaptic connections. This mechanism may help explain the increased risk of dementia associated with long-term benzodiazepine treatment. The benzodiazepine class of drugs also interact with peripheral benzodiazepine receptors. Peripheral benzodiazepine receptors are present in peripheral nervous system tissues, glial cells, and to a lesser extent the central nervous system. These peripheral receptors are not structurally related or coupled to GABAA receptors. They modulate the immune system and are involved in the body response to injury. Benzodiazepines also function as weak adenosine reuptake inhibitors. It has been suggested that some of their anticonvulsant, anxiolytic, and muscle relaxant effects may be in part mediated by this action. Benzodiazepines have binding sites in the periphery, however their effects on muscle tone is not mediated through these peripheral receptors. The peripheral binding sites for benzodiazepines are present in immune cells and gastrointestinal tract.
Pharmacokinetics. A benzodiazepine can be placed into one of three groups by its elimination half-life, or time it takes for the body to eliminate half of the dose. Some benzodiazepines have long-acting active metabolites, such as diazepam and chlordiazepoxide, which are metabolised into desmethyldiazepam. Desmethyldiazepam has a half-life of 36–200 hours, and flurazepam, with the main active metabolite of desalkylflurazepam, with a half-life of 40–250 hours. These long-acting metabolites are partial agonists. Chemistry. Benzodiazepines share a similar chemical structure, and their effects in humans are mainly produced by the allosteric modification of a specific kind of neurotransmitter receptor, the GABAA receptor, which increases the overall conductance of these inhibitory channels; this results in the various therapeutic effects as well as adverse effects of benzodiazepines. Other less important modes of action are also known. The term "benzodiazepine" is the chemical name for the heterocyclic ring system (see figure to the right), which is a fusion between the benzene and diazepine ring systems. Under Hantzsch–Widman nomenclature, a diazepine is a heterocycle with two nitrogen atoms, five carbon atom and the maximum possible number of cumulative double bonds. The "benzo" prefix indicates the benzene ring fused onto the diazepine ring.
Benzodiazepine drugs are substituted 1,4-benzodiazepines, although the chemical term can refer to many other compounds that do not have useful pharmacological properties. Different benzodiazepine drugs have different side groups attached to this central structure. The different side groups affect the binding of the molecule to the GABAA receptor and so modulate the pharmacological properties. Many of the pharmacologically active "classical" benzodiazepine drugs contain the 5-phenyl-1"H"-benzo["e"] [1,4]diazepin-2(3"H")-one substructure (see figure to the right). Benzodiazepines have been found to mimic protein reverse turns structurally, which enable them with their biological activity in many cases. Nonbenzodiazepines also bind to the benzodiazepine binding site on the GABAA receptor and possess similar pharmacological properties. While the nonbenzodiazepines are by definition structurally unrelated to the benzodiazepines, both classes of drugs possess a common pharmacophore (see figure to the lower-right), which explains their binding to a common receptor site.
Not all benzodiazepines increase the conductance of the GABAA receptor. Flumazenil, an imidazobenzodiazepine, is an antidote for some benzodiazepine overdoses. The structual scaffold can even be used to target receptors other than GABAA. History. The first benzodiazepine, chlordiazepoxide ("Librium"), was synthesized in 1955 by Leo Sternbach while working at Hoffmann–La Roche on the development of tranquilizers. The pharmacological properties of the compounds prepared initially were disappointing, and Sternbach abandoned the project. Two years later, in April 1957, co-worker Earl Reeder noticed a "nicely crystalline" compound left over from the discontinued project while spring-cleaning in the lab. This compound, later named chlordiazepoxide, had not been tested in 1955 because of Sternbach's focus on other issues. Expecting pharmacology results to be negative, and hoping to publish the chemistry-related findings, researchers submitted it for a standard battery of animal tests. The compound showed very strong sedative, anticonvulsant, and muscle relaxant effects. These impressive clinical findings led to its speedy introduction throughout the world in 1960 under the brand name "Librium". Following chlordiazepoxide, diazepam marketed by Hoffmann–La Roche under the brand name "Valium" in 1963, and for a while the two were the most commercially successful drugs. The introduction of benzodiazepines led to a decrease in the prescription of barbiturates, and by the 1970s they had largely replaced the older drugs for sedative and hypnotic uses.
The new group of drugs was initially greeted with optimism by the medical profession, but gradually concerns arose; in particular, the risk of dependence became evident in the 1980s. Benzodiazepines have a unique history in that they were responsible for the largest-ever class-action lawsuit against drug manufacturers in the United Kingdom, involving 14,000 patients and 1,800 law firms that alleged the manufacturers knew of the dependence potential but intentionally withheld this information from doctors. At the same time, 117 general practitioners and 50 health authorities were sued by patients to recover damages for the harmful effects of dependence and withdrawal. This led some doctors to require a signed consent form from their patients and to recommend that all patients be adequately warned of the risks of dependence and withdrawal before starting treatment with benzodiazepines. The court case against the drug manufacturers never reached a verdict; legal aid had been withdrawn and there were allegations that the consultant psychiatrists, the expert witnesses, had a conflict of interest. The court case fell through, at a cost of £30 million, and led to more cautious funding through legal aid for future cases. This made future class action lawsuits less likely to succeed, due to the high cost from financing a smaller number of cases, and increasing charges for losing the case for each person involved.
Although antidepressants with anxiolytic properties have been introduced, and there is increasing awareness of the adverse effects of benzodiazepines, prescriptions for short-term anxiety relief have not significantly dropped. For treatment of insomnia, benzodiazepines are now less popular than nonbenzodiazepines, which include zolpidem, zaleplon and eszopiclone. Nonbenzodiazepines are molecularly distinct, but nonetheless, they work on the same benzodiazepine receptors and produce similar sedative effects. Benzodiazepines have been detected in plant specimens and brain samples of animals not exposed to synthetic sources, including a human brain from the 1940s. However, it is unclear whether these compounds are biosynthesized by microbes or by plants and animals themselves. A microbial biosynthetic pathway has been proposed. Society and culture. Legal status. In the United States, benzodiazepines are Schedule IV drugs under the Federal Controlled Substances Act, even when not on the market (for example, flunitrazepam), with the exception of flualprazolam, etizolam, clonazolam, flubromazolam, and diclazepam which are placed in Schedule I.
In Canada, possession of benzodiazepines is legal for personal use. All benzodiazepines are categorized as Schedule IV substances under the Controlled Drugs and Substances Act. In the United Kingdom, benzodiazepines are Class C controlled drugs, carrying the maximum penalty of 7 years imprisonment, an unlimited fine or both for possession and a maximum penalty of 14 years imprisonment, an unlimited fine or both for supplying benzodiazepines to others. In the Netherlands, since October 1993, benzodiazepines, including formulations containing less than 20 mg of temazepam, are all placed on List 2 of the Opium Law. A prescription is needed for possession of all benzodiazepines. Temazepam formulations containing 20 mg or greater of the drug are placed on List 1, thus requiring doctors to write prescriptions in the List 1 format. In East Asia and Southeast Asia, temazepam and nimetazepam are often heavily controlled and restricted. In certain countries, triazolam, flunitrazepam, flutoprazepam and midazolam are also restricted or controlled to certain degrees. In Hong Kong, all benzodiazepines are regulated under Schedule 1 of Hong Kong's Chapter 134 "Dangerous Drugs Ordinance". Previously only brotizolam, flunitrazepam and triazolam were classed as dangerous drugs.
Internationally, benzodiazepines are categorized as Schedule IV controlled drugs, apart from flunitrazepam, which is a Schedule III drug under the Convention on Psychotropic Substances. Recreational use. Benzodiazepines are considered major addictive substances. Non-medical benzodiazepine use is mostly limited to individuals who use other substances, i.e., people who engage in polysubstance use. On the international scene, benzodiazepines are categorized as Schedule IV controlled drugs by the INCB, apart from flunitrazepam, which is a Schedule III drug under the Convention on Psychotropic Substances. Some variation in drug scheduling exists in individual countries; for example, in the United Kingdom, midazolam and temazepam are Schedule III controlled drugs. British law requires that temazepam (but "not" midazolam) be stored in safe custody. Safe custody requirements ensures that pharmacists and doctors holding stock of temazepam must store it in securely fixed double-locked steel safety cabinets and maintain a written register, which must be bound and contain separate entries for temazepam and must be written in ink with no use of correction fluid (although a written register is not required for temazepam in the United Kingdom). Disposal of expired stock must be witnessed by a designated inspector (either a local drug-enforcement police officer or official from health authority). Benzodiazepine use ranges from occasional binges on large doses, to chronic and compulsive drug use of high doses.
Benzodiazepines are commonly used recreationally by poly-drug users. Mortality is higher among poly-drug users that also use benzodiazepines. Heavy alcohol use also increases mortality among poly-drug users. Polydrug use involving benzodiazepines and alcohol can result in an increased risk of blackouts, risk-taking behaviours, seizures, and overdose. Dependence and tolerance, often coupled with dosage escalation, to benzodiazepines can develop rapidly among people who misuse drugs; withdrawal syndrome may appear after as little as three weeks of continuous use. Long-term use has the potential to cause both physical and psychological dependence and severe withdrawal symptoms such as depression, anxiety (often to the point of panic attacks), and agoraphobia. Benzodiazepines and, in particular, temazepam are sometimes used intravenously, which, if done incorrectly or in an unsterile manner, can lead to medical complications including abscesses, cellulitis, thrombophlebitis, arterial puncture, deep vein thrombosis, and gangrene. Sharing syringes and needles for this purpose also brings up the possibility of transmission of hepatitis, HIV, and other diseases. Benzodiazepines are also misused intranasally, which may have additional health consequences. Once benzodiazepine dependence has been established, a clinician usually converts the patient to an equivalent dose of diazepam before beginning a gradual reduction program.
A 1999–2005 Australian police survey of detainees reported preliminary findings that self-reported users of benzodiazepines were less likely than non-user detainees to work full-time and more likely to receive government benefits, use methamphetamine or heroin, and be arrested or imprisoned. Benzodiazepines are sometimes used for criminal purposes; they serve to incapacitate a victim in cases of drug assisted rape or robbery. Overall, anecdotal evidence suggests that temazepam may be the most psychologically habit-forming (addictive) benzodiazepine. Non-medical temazepam use reached epidemic proportions in some parts of the world, in particular, in Europe and Australia, and is a major addictive substance in many Southeast Asian countries. This led authorities of various countries to place temazepam under a more restrictive legal status. Some countries, such as Sweden, banned the drug outright. Temazepam also has certain pharmacokinetic properties of absorption, distribution, elimination, and clearance that make it more apt to non-medical use compared to many other benzodiazepines.
Veterinary use. Benzodiazepines are used in veterinary practice in the treatment of various disorders and conditions. As in humans, they are used in the first-line management of seizures, status epilepticus, and tetanus, and as maintenance therapy in epilepsy (in particular, in cats). They are widely used in small and large animals (including horses, swine, cattle and exotic and wild animals) for their anxiolytic and sedative effects, as pre-medication before surgery, for induction of anesthesia and as adjuncts to anesthesia.
Bell curve (disambiguation) The bell curve is typical of the normal distribution. Bell curve may also refer to:
Body mass index Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms (kg) and height in metres (m). The BMI may be determined first by measuring its components by means of a weighing scale and a stadiometer. The multiplication and division may be carried out directly, by hand or using a calculator, or indirectly using a lookup table (or chart). The table displays BMI as a function of mass and height and may show other units of measurement (converted to metric units for the calculation). The table may also show contour lines or colours for different BMI categories. The BMI is a convenient rule of thumb used to broadly categorize a person as based on tissue mass (muscle, fat, and bone) and height. Major adult BMI classifications are "underweight" (under 18.5 kg/m2), "normal weight" (18.5 to 24.9), "overweight" (25 to 29.9), and "obese" (30 or more). When used to predict an individual's health, rather than as a statistical measurement for groups, the BMI has limitations that can make it less useful than some of the alternatives, especially when applied to individuals with abdominal obesity, short stature, or high muscle mass.
BMIs under 20 and over 25 have been associated with higher all-cause mortality, with the risk increasing with distance from the 20–25 range. History. Adolphe Quetelet, a Belgian astronomer, mathematician, statistician, and sociologist, devised the basis of the BMI between 1830 and 1850 as he developed what he called "social physics". Quetelet himself never intended for the index, then called the Quetelet Index, to be used as a means of medical assessment. Instead, it was a component of his study of , or the average man. Quetelet thought of the average man as a social ideal, and developed the body mass index as a means of discovering the socially ideal human person. According to Lars Grue and Arvid Heiberg in the Scandinavian Journal of Disability Research, Quetelet's idealization of the average man would be elaborated upon by Francis Galton a decade later in the development of Eugenics. The modern term "body mass index" (BMI) for the ratio of human body weight to squared height was coined in a paper published in the July 1972 edition of the "Journal of Chronic Diseases" by Ancel Keys and others. In this paper, Keys argued that what he termed the BMI was "if not fully satisfactory, at least as good as any other relative weight index as an indicator of relative obesity".
The interest in an index that measures body fat came with observed increasing obesity in prosperous Western societies. Keys explicitly judged BMI as appropriate for "population" studies and inappropriate for individual evaluation. Nevertheless, due to its simplicity, it has come to be widely used for preliminary diagnoses. Additional metrics, such as waist circumference, can be more useful. The BMI is expressed in kg/m2, resulting from mass in kilograms and height in metres. If pounds and inches are used, a conversion factor of 703 (kg/m2)/(lb/in2) is applied. (If pounds and feet are used, a conversion factor of 4.88 is used.) When the term BMI is used informally, the units are usually omitted. formula_1 BMI provides a simple numeric measure of a person's "thickness" or "thinness", allowing health professionals to discuss weight problems more objectively with their patients. BMI was designed to be used as a simple means of classifying average sedentary (physically inactive) populations, with an average body composition. For such individuals, the BMI value recommendations are as follows: 18.5 to 24.9 kg/m2 may indicate optimal weight, lower than 18.5 may indicate underweight, 25 to 29.9 may indicate overweight, and 30 or more may indicate obese. Lean male athletes often have a high muscle-to-fat ratio and therefore a BMI that is misleadingly high relative to their body-fat percentage.
Categories. A common use of the BMI is to assess how far an individual's body weight departs from what is normal for a person's height. The weight excess or deficiency may, in part, be accounted for by body fat (adipose tissue) although other factors such as muscularity also affect BMI significantly (see discussion below and overweight). The WHO regards an adult BMI of less than 18.5 as underweight and possibly indicative of malnutrition, an eating disorder, or other health problems, while a BMI of 25 or more is considered overweight and 30 or more is considered obese. In addition to the principle, international WHO BMI cut-off points (16, 17, 18.5, 25, 30, 35 and 40), four additional cut-off points for at-risk Asians were identified (23, 27.5, 32.5 and 37.5). These ranges of BMI values are valid only as statistical categories. Children and youth. BMI is used differently for people aged 2 to 20. It is calculated in the same way as for adults but then compared to typical values for other children or youth of the same age. Instead of comparison against fixed thresholds for underweight and overweight, the BMI is compared against the percentiles for children of the same sex and age.
A BMI that is less than the 5th percentile is considered underweight and above the 95th percentile is considered obese. Children with a BMI between the 85th and 95th percentile are considered to be overweight. Studies in Britain from 2013 have indicated that females between the ages 12 and 16 had a higher BMI than males of the same age by 1.0 kg/m2 on average. International variations. These recommended distinctions along the linear scale may vary from time to time and country to country, making global, longitudinal surveys problematic. People from different populations and descent have different associations between BMI, percentage of body fat, and health risks, with a higher risk of type 2 diabetes mellitus and atherosclerotic cardiovascular disease at BMIs lower than the WHO cut-off point for overweight, 25 kg/m2, although the cut-off for observed risk varies among different populations. The cut-off for observed risk varies based on populations and subpopulations in Europe, Asia and Africa. Hong Kong. The Hospital Authority of Hong Kong recommends the use of the following BMI ranges:
Japan. A 2000 study from the Japan Society for the Study of Obesity (JASSO) presents the following table of BMI categories: Singapore. In Singapore, the BMI cut-off figures were revised in 2005 by the Health Promotion Board (HPB), motivated by studies showing that many Asian populations, including Singaporeans, have a higher proportion of body fat and increased risk for cardiovascular diseases and diabetes mellitus, compared with general BMI recommendations in other countries. The BMI cut-offs are presented with an emphasis on health risk rather than weight. United Kingdom. In the UK, NICE guidance recommends prevention of type 2 diabetes should start at a BMI of 30 in White and 27.5 in Black African, African-Caribbean, South Asian, and Chinese populations. Research since 2021 based on a large sample of almost 1.5 million people in England found that some ethnic groups would benefit from prevention at or above a BMI of (rounded): United States. In 1998, the U.S. National Institutes of Health brought U.S. definitions in line with World Health Organization guidelines, lowering the normal/overweight cut-off from a BMI of 27.8 (men) and 27.3 (women) to a BMI of 25. This had the effect of redefining approximately 25 million Americans, previously "healthy", to "overweight".
This can partially explain the increase in the "overweight" diagnosis in the past 20 years, and the increase in sales of weight loss products during the same time. WHO also recommends lowering the normal/overweight threshold for southeast Asian body types to around BMI 23, and expects further revisions to emerge from clinical studies of different body types. A survey in 2007 showed 63% of Americans were then overweight or obese, with 26% in the obese category (a BMI of 30 or more). By 2014, 37.7% of adults in the United States were obese, 35.0% of men and 40.4% of women; class 3 obesity (BMI over 40) values were 7.7% for men and 9.9% for women. The U.S. National Health and Nutrition Examination Survey of 2015–2016 showed that 71.6% of American men and women had BMIs over 25. Obesity—a BMI of 30 or more—was found in 39.8% of the US adults. Consequences of elevated level in adults. The BMI ranges are based on the relationship between body weight and disease and death. Overweight and obese individuals are at an increased risk for the following diseases:
Among people who have never smoked, overweight/obesity is associated with 51% increase in mortality compared with people who have always been a normal weight. Applications. Public health. The BMI is generally used as a means of correlation between groups related by general mass and can serve as a vague means of estimating adiposity. The duality of the BMI is that, while it is easy to use as a general calculation, it is limited as to how accurate and pertinent the data obtained from it can be. Generally, the index is suitable for recognizing trends within sedentary or overweight individuals because there is a smaller margin of error. The BMI has been used by the WHO as the standard for recording obesity statistics since the early 1980s. This general correlation is particularly useful for consensus data regarding obesity or various other conditions because it can be used to build a semi-accurate representation from which a solution can be stipulated, or the RDA for a group can be calculated. Similarly, this is becoming more and more pertinent to the growth of children, since the majority of children are sedentary.
Cross-sectional studies indicated that sedentary people can decrease BMI by becoming more physically active. Smaller effects are seen in prospective cohort studies which lend to support active mobility as a means to prevent a further increase in BMI. Legislation. In France, Italy, and Spain, legislation has been introduced banning the usage of fashion show models having a BMI below 18. In Israel, a model with BMI below 18.5 is banned. This is done to fight anorexia among models and people interested in fashion. Relationship to health. A study published by "Journal of the American Medical Association" ("JAMA") in 2005 showed that "overweight" people had a death rate similar to "normal" weight people as defined by BMI, while "underweight" and "obese" people had a higher death rate. A study published by "The Lancet" in 2009 involving 900,000 adults showed that "overweight" and "underweight" people both had a mortality rate higher than "normal" weight people as defined by BMI. The optimal BMI was found to be in the range of 22.5–25. The average BMI of athletes is 22.4 for women and 23.6 for men.
High BMI is associated with type 2 diabetes only in people with high serum gamma-glutamyl transpeptidase. In an analysis of 40 studies involving 250,000 people, patients with coronary artery disease with "normal" BMIs were at higher risk of death from cardiovascular disease than people whose BMIs put them in the "overweight" range (BMI 25–29.9). One study found that BMI had a good general correlation with body fat percentage, and noted that obesity has overtaken smoking as the world's number one cause of death. But it also notes that in the study 50% of men and 62% of women were obese according to body fat defined obesity, while only 21% of men and 31% of women were obese according to BMI, meaning that BMI was found to underestimate the number of obese subjects. A 2010 study that followed 11,000 subjects for up to eight years concluded that BMI is not the most appropriate measure for the risk of heart attack, stroke or death. A better measure was found to be the waist-to-height ratio. A 2011 study that followed 60,000 participants for up to 13 years found that waist–hip ratio was a better predictor of ischaemic heart disease mortality.
Limitations. The medical establishment and statistical community have both highlighted the limitations of BMI. Racial and gender differences. Part of the statistical limitations of the BMI scale is the result of Quetelet's original sampling methods. As noted in his primary work, A Treatise on Man and the Development of His Faculties, the data from which Quetelet derived his formula was taken mostly from Scottish Highland soldiers and French Gendarmerie. The BMI was always designed as a metric for European men. For women, and people of non-European origin, the scale is often biased. As noted by sociologist Sabrina Strings, the BMI is largely inaccurate for black people especially, disproportionately labelling them as overweight even for healthy individuals. A 2012 study of BMI in an ethnically diverse population showed that "adult overweight and obesity were associated with an increased risk of mortality ... across the five racial/ethnic groups". Scaling. The exponent in the denominator of the formula for BMI is arbitrary. The BMI depends upon weight and the "square" of height. Since mass increases to the "third power" of linear dimensions, taller individuals with exactly the same body shape and relative composition have a larger BMI. BMI is proportional to the mass and inversely proportional to the square of the height. So, if all body dimensions double, and mass scales naturally with the cube of the height, then BMI doubles instead of remaining the same. This results in taller people having a reported BMI that is uncharacteristically high, compared to their actual body fat levels. In comparison, the Ponderal index is based on the natural scaling of mass with the third power of the height.
However, many taller people are not just "scaled up" short people but tend to have narrower frames in proportion to their height. Carl Lavie has written that "The B.M.I. tables are excellent for identifying obesity and body fat in large populations, but they are far less reliable for determining fatness in individuals." For US adults, exponent estimates range from 1.92 to 1.96 for males and from 1.45 to 1.95 for females. Physical characteristics. The BMI overestimates roughly 10% for a large (or tall) frame and underestimates roughly 10% for a smaller frame (short stature). In other words, people with small frames would be carrying more fat than optimal, but their BMI indicates that they are "normal". Conversely, large framed (or tall) individuals may be quite healthy, with a fairly low body fat percentage, but be classified as "overweight" by BMI. For example, a height/weight chart may say the ideal weight (BMI 21.5) for a man is . But if that man has a slender build (small frame), he may be overweight at and should reduce by 10% to roughly (BMI 19.4). In the reverse, the man with a larger frame and more solid build should increase by 10%, to roughly (BMI 23.7). If one teeters on the edge of small/medium or medium/large, common sense should be used in calculating one's ideal weight. However, falling into one's ideal weight range for height and build is still not as accurate in determining health risk factors as waist-to-height ratio and actual body fat percentage.
Accurate frame size calculators use several measurements (wrist circumference, elbow width, neck circumference, and others) to determine what category an individual falls into for a given height. The BMI also fails to take into account loss of height through ageing. In this situation, BMI will increase without any corresponding increase in weight. Muscle versus fat. Assumptions about the distribution between muscle mass and fat mass are inexact. BMI generally overestimates adiposity on those with leaner body mass (e.g., athletes) and underestimates excess adiposity on those with fattier body mass. A study in June 2008 by Romero-Corral et al. examined 13,601 subjects from the United States' third National Health and Nutrition Examination Survey (NHANES III) and found that BMI-defined obesity (BMI ≥ 30) was present in 21% of men and 31% of women. Body fat-defined obesity was found in 50% of men and 62% of women. While BMI-defined obesity showed high specificity (95% for men and 99% for women), BMI showed poor sensitivity (36% for men and 49% for women). In other words, the BMI will be mostly correct when determining a person to be obese, but can err quite frequently when determining a person not to be. Despite this undercounting of obesity by BMI, BMI values in the intermediate BMI range of 20–30 were found to be associated with a wide range of body fat percentages. For men with a BMI of 25, about 20% have a body fat percentage below 20% and about 10% have body fat percentage above 30%.
Body composition for athletes is often better calculated using measures of body fat, as determined by such techniques as skinfold measurements or underwater weighing and the limitations of manual measurement have also led to alternative methods to measure obesity, such as the body volume indicator. Variation in definitions of categories. It is not clear where on the BMI scale the threshold for "overweight" and "obese" should be set. Because of this, the standards have varied over the past few decades. Between 1980 and 2000 the U.S. Dietary Guidelines have defined overweight at a variety of levels ranging from a BMI of 24.9 to 27.1. In 1985, the National Institutes of Health (NIH) consensus conference recommended that overweight BMI be set at a BMI of 27.8 for men and 27.3 for women. In 1998, an NIH report concluded that a BMI over 25 is overweight and a BMI over 30 is obese. In the 1990s the World Health Organization (WHO) decided that a BMI of 25 to 30 should be considered overweight and a BMI over 30 is obese, the standards the NIH set. This became the definitive guide for determining if someone is overweight.
One study found that the vast majority of people labelled 'overweight' and 'obese' according to current definitions do not in fact face any meaningful increased risk for early death. In a quantitative analysis of several studies, involving more than 600,000 men and women, the lowest mortality rates were found for people with BMIs between 23 and 29; most of the 25–30 range considered 'overweight' was not associated with higher risk. Alternatives. Corpulence index (exponent of 3). The corpulence index uses an exponent of 3 rather than 2. The corpulence index yields valid results even for very short and very tall people, which is a problem with BMI. For example, a tall person at an ideal body weight of gives a normal BMI of 20.74 and CI of 13.6, while a tall person with a weight of gives a BMI of 24.84, very close to an overweight BMI of 25, and a CI of 12.4, very close to a normal CI of 12. New BMI (exponent of 2.5). A study found that the best exponent E for predicting the fat percent would be between 2 and 2.5 in formula_2.
An exponent of 5/2 or 2.5 was proposed by Quetelet in the 19th century: In general, we do not err much when we assume that during development the squares of the weight at different ages are as the fifth powers of the height This exponent of 2.5 is used in a revised formula for Body Mass Index, proposed by Nick Trefethen, Professor of numerical analysis at the University of Oxford, which minimizes the distortions for shorter and taller individuals resulting from the use of an exponent of 2 in the traditional BMI formula: formula_3 The scaling factor of 1.3 was determined to make the proposed new BMI formula align with the traditional BMI formula for adults of average height, while the exponent of 2.5 is a compromise between the exponent of 2 in the traditional formula for BMI and the exponent of 3 that would be expected for the scaling of weight (which at constant density would theoretically scale with volume, i.e., as the cube of the height) with height. In Trefethen's analysis, an exponent of 2.5 was found to fit empirical data more closely with less distortion than either an exponent of 2 or 3.
BMI prime (exponent of 2, normalization factor). BMI Prime, a modification of the BMI system, is the ratio of actual BMI to upper limit optimal BMI (currently defined at 25 kg/m2), i.e., the actual BMI expressed as a proportion of upper limit optimal. BMI Prime is a dimensionless number independent of units. Individuals with BMI Prime less than 0.74 are underweight; those with between 0.74 and 1.00 have optimal weight; and those at 1.00 or greater are overweight. BMI Prime is useful clinically because it shows by what ratio (e.g. 1.36) or percentage (e.g. 136%, or 36% above) a person deviates from the maximum optimal BMI. For instance, a person with BMI 34 kg/m2 has a BMI Prime of 34/25 = 1.36, and is 36% over their upper mass limit. In South East Asian and South Chinese populations (see § international variations), BMI Prime should be calculated using an upper limit BMI of 23 in the denominator instead of 25. BMI Prime allows easy comparison between populations whose upper-limit optimal BMI values differ. Waist circumference.
Waist circumference is a good indicator of visceral fat, which poses more health risks than fat elsewhere. According to the U.S. National Institutes of Health (NIH), waist circumference in excess of for men and for (non-pregnant) women is considered to imply a high risk for type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease CVD. Waist circumference can be a better indicator of obesity-related disease risk than BMI. For example, this is the case in populations of Asian descent and older people. for men and for women has been stated to pose "higher risk", with the NIH figures "even higher". Waist-to-hip circumference ratio has also been used, but has been found to be no better than waist circumference alone, and more complicated to measure. A related indicator is waist circumference divided by height. A 2013 study identified critical threshold values for waist-to-height ratio according to age, with consequent significant reduction in life expectancy if exceeded. These are: 0.5 for people under 40 years of age, 0.5 to 0.6 for people aged 40–50, and 0.6 for people over 50 years of age.
Surface-based body shape index. The Surface-based Body Shape Index (SBSI) is far more rigorous and is based upon four key measurements: the body surface area (BSA), vertical trunk circumference (VTC), waist circumference (WC) and height (H). Data on 11,808 subjects from the National Health and Human Nutrition Examination Surveys (NHANES) 1999–2004, showed that SBSI outperformed BMI, waist circumference, and A Body Shape Index (ABSI), an alternative to BMI. formula_4 A simplified, dimensionless form of SBSI, known as SBSI*, has also been developed. formula_5 Modified body mass index. Within some medical contexts, such as familial amyloid polyneuropathy, serum albumin is factored in to produce a modified body mass index (mBMI). The mBMI can be obtained by multiplying the BMI by serum albumin, in grams per litre.
Behistun Inscription The Behistun Inscription (also Bisotun, Bisitun or Bisutun; , Old Persian: Bagastana, meaning "the place of god") is a multilingual Achaemenid royal inscription and large rock relief on a cliff at Mount Behistun in the Kermanshah Province of Iran, near the city of Kermanshah in western Iran, established by Darius the Great (). It was important to the decipherment of cuneiform, as it is the longest known trilingual cuneiform inscription, written in Old Persian, Elamite, and Babylonian (a variety of Akkadian). Authored by Darius the Great sometime between his coronation as king of the Persian Empire in the summer of 522 BC and his death in autumn of 486 BC, the inscription begins with a brief autobiography of Darius, including his ancestry and lineage. Later in the inscription, Darius provides a lengthy sequence of events following the death of Cambyses II in which he fought nineteen battles in a period of one year (ending in December 521 BC) to put down multiple rebellions throughout the Persian Empire. The inscription states in detail that the rebellions were orchestrated by several impostors and their co-conspirators in various cities throughout the empire, each of whom falsely proclaimed himself king during the upheaval following Cambyses II's death. Darius the Great proclaimed himself victorious in all battles during the period of upheaval, attributing his success to the "grace of Ahura Mazda".
The inscription is approximately high by wide and up a limestone cliff from an ancient road connecting the capitals of Babylonia and Media (Babylon and Ecbatana, respectively). The Old Persian text contains 414 lines in five columns; the Elamite text includes 260 lines in eight columns, and the Babylonian text is in 112 lines. A copy of the text in Aramaic, written during the reign of Darius II, was found in Egypt. The inscription was illustrated by a life-sized bas-relief of Darius I, the Great, holding a bow as a sign of kingship, with his left foot on the chest of a figure lying supine before him. The supine figure is reputed to be the pretender Gaumata. Darius is attended to the left by two servants, and nine one-meter figures stand to the right, with hands tied and rope around their necks, representing conquered peoples. A Faravahar floats above, giving its blessing to the king. One figure appears to have been added after the others were completed, as was Darius's beard, which is a separate block of stone attached with iron pins and lead.
Name. The name Behistun is derived from usage in Ancient Greek and Arabic sources, particularly Diodorus Siculus and Ya'qubi, transliterated into English in the 19th century by Henry Rawlinson. The modern Persian version name is Bisotun. History. After the fall of the Persian Empire's Achaemenid Dynasty and its successors, and the lapse of Old Persian cuneiform writing into disuse, the nature of the inscription was forgotten, and fanciful explanations became the norm. In 1598, Englishman Robert Sherley saw the inscription during a diplomatic mission to Safavid Persia on behalf of Austria, and brought it to the attention of Western European scholars. His party incorrectly came to the conclusion that it was Christian in origin. French General Gardanne thought it showed "Christ and his twelve apostles", and Sir Robert Ker Porter thought it represented the Lost Tribes of Israel and Shalmaneser of Assyria. In 1604, Italian explorer Pietro della Valle visited the inscription and made preliminary drawings of the monument.
Translation efforts. German surveyor Carsten Niebuhr visited in around 1764 for Frederick V of Denmark, publishing a copy of the inscription in the account of his journeys in 1778. Niebuhr's transcriptions were used by Georg Friedrich Grotefend and others in their efforts to decipher the Old Persian cuneiform script. Grotefend had deciphered ten of the 37 symbols of Old Persian by 1802, after realizing that unlike the Semitic cuneiform scripts, Old Persian text is alphabetic and each word is separated by a vertical slanted symbol. In 1835, Sir Henry Rawlinson, an officer of the British East India Company army assigned to the forces of the Shah of Iran, began studying the inscription in earnest. As the town of Bisotun's name was anglicized as "Behistun" at this time, the monument became known as the "Behistun Inscription". Despite its relative inaccessibility, Rawlinson was able to scale the cliff with the help of a local boy and copy the Old Persian inscription. The Elamite was across a chasm, and the Babylonian four meters above; both were beyond easy reach and were left for later. In 1847, he was able to send a full and accurate copy to Europe.