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The number of unnecessary antibiotics prescribed annually for viral infections is 20 million per year order lasuna 60 caps otc. The number of unnecessary medical and surgical procedures performed annually is 7 lasuna 60 caps with visa. The most stunning statistic discount 60caps lasuna mastercard, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year. The article uncovered so many problems with conventional medicine however, that it became too long to fit within these pages. We placed this article on our website to memorialize the failure of the American medical system. By exposing these gruesome statistics in painstaking detail, we provide a basis for competent and compassionate medical professionals to recognize the inadequacies of today’s system and at least attempt to institute meaningful reforms. Natural medicine is under siege, as pharmaceutical company lobbyists urge lawmakers to deprive Americans of the benefits of dietary supplements. Drug-company front groups have launched slanderous media campaigns to discredit the value of healthy lifestyles. These attacks against natural medicine obscure a lethal problem that until now was buried in thousands of pages of scientific text. In response to these baseless challenges to natural medicine, the Nutrition Institute of America commissioned an independent review of the quality of “government-approved” medicine. The startling findings from this meticulous study indicate that conventional medicine is “the leading cause of death” in the United States. The Nutrition Institute of America is a nonprofit organization that has sponsored independent research for the past 30 years. What you are about to read is a stunning compilation of facts that documents that those who seek to abolish consumer access to natural therapies are misleading the public. A definitive review of medical peer-reviewed journals and government health statistics shows that American medicine frequently causes more harm than good. Besser spoke in terms of tens of millions of unnecessary antibiotics prescribed annually. By comparison, approximately 699,697 Americans died of heart in 2001, while 553,251 died of cancer. Any invasive, unnecessary medical procedure must be considered as part of the larger iatrogenic picture. The figures on unnecessary events represent people who are thrust into a dangerous health care system. Simply entering a hospital could result in the following: In 16. Working with the most conservative figures from our statistics, we project the following 10-year death rates. Table 3: Estimated 10-Year Death Rates from Medical Intervention 10-Year Condition Author Deaths Adverse Drug Reaction 1. Our projected figures for unnecessary medical events occurring over a 10-year period also are dramatic. Medical science amasses tens of thousands of papers annually, each representing a tiny fragment of the whole picture. To look at only one piece and try to understand the benefits and risks is like standing an inch away from an elephant and trying to describe everything about it. Each specialty, each division of medicine keeps its own records and data on morbidity and mortality. We have now completed the painstaking work of reviewing thousands of studies and putting pieces of the puzzle together. Because of the extraordinarily narrow, technologically driven context in which contemporary medicine examines the human condition, we are completely missing the larger picture. Medicine is not taking into consideration the following critically important aspects of a healthy human organism: (a) stress and how it adversely affects the immune system and life processes; (b) insufficient exercise; (c) excessive caloric intake; (d) highly processed and denatured foods grown in denatured and chemically damaged soil; and (e) exposure to tens of thousands of environmental toxins. Instead of minimizing these disease-causing factors, we cause more illness through medical technology, diagnostic testing, overuse of medical and surgical procedures, and overuse of pharmaceutical drugs. The huge disservice of this therapeutic strategy is the result of little effort or money being spent on preventing disease. Underreporting of Iatrogenic Events As few as 5% and no more than 20% of iatrogenic acts are ever reported. In 1994, Leape said his figure of 180,000 medical mistakes resulting in death annually was equivalent to three jumbo-jet crashes every two days. What we must deduce from this report is that medicine is in need of complete and total reform—from the curriculum in medical schools to protecting patients from excessive medical intervention. It is obvious that we cannot change anything if we are not honest about what needs to be changed. We are fully aware of what stands in the way of change: powerful pharmaceutical and medical technology companies, along with other powerful groups with enormous vested interests in the business of medicine. They fund medical research, support medical schools and hospitals, and advertise in medical journals. Such funding can sway the balance of opinion from professional caution to uncritical acceptance of new therapies and drugs. You have only to look at the people who make up the hospital, medical, and government health advisory boards to see conflicts of interest. Erik Campbell, the lead author, said, "Our previous research with faculty has shown us that ties to industry can affect scientific behavior, leading to such things as trade secrecy and delays in publishing research. Marcia Angell struggled to bring greater attention to the problem of commercializing scientific research. In June 2002, the New England Journal of Medicine announced that it would accept journalists who accept money from drug companies because it was too difficult to find ones who have no ties. Jerome Kassirer, said that was not the case and that plenty of researchers are available who do not work for drug companies. Cynthia Crossen, a staffer for the Wall Street Journal, i n 1996 published Tainted Truth : The Manipulation of Fact in America , a book about the widespread practice of lying with statistics. In 1981 Steel reported that 36% of hospitalized patients experienced iatrogenesis with a 25% fatality rate, and adverse drug reactions were involved in 50% of the injuries. In 1991, Bedell reported that 64% of acute heart attacks in one hospital were preventable and were mostly due to adverse drug reactions. Leape focused on the “Harvard Medical Practice Study” published in 1991, (16a) which found a 4% iatrogenic injury rate for patients, with a 14% fatality rate, in 1984 in New York State. From the 98,609 patients injured and the 14% fatality rate, he estimated that in the entire U. Why Leape chose to use the much lower figure of 4% injury for his analysis remains in question. Using instead the average of the rates found in the three studies he cites (36%, 20%, and 4%) would have produced a 20% medical error rate. The number of iatrogenic deaths using an average rate of injury and his 14% fatality rate would be 1,189,576. Leape acknowledged that the literature on medical errors is sparse and represents only the tip of the iceberg, noting that when errors are specifically sought out, reported rates are “distressingly high. First, he found that each patient had an average of 178 “activities” (staff/procedure/medical interactions) a day, of which 1. This may not seem like much, but Leape cited industry standards showing that in aviation, a 0. In trying to determine why there are so many medical errors, Leape acknowledged the lack of reporting of medical errors. Medical errors occur in thousands of different locations and are perceived as isolated and unusual events. But the most important reason that the problem of medical errors is unrecognized and growing, according to Leape, is that doctors and nurses are unequipped to deal with human error because of the culture of medical training and practice. Medical mistakes are therefore viewed as a failure of character and any error equals negligence. Leape cites McIntyre and Popper, who said the “infallibility model” of medicine leads to intellectual dishonesty with a need to cover up mistakes rather than admit them.

This preference great-grandparents cheap 60 caps lasuna visa, especially their great- is reinforced by greater longevity generic 60 caps lasuna with visa, expanded grandmothers buy 60 caps lasuna free shipping. However, while the number of surviving The ultimate impact of these changing family generations in a family may have increased, patterns on health is unknown. On divorce, and remarriage; and blended and the other hand, older people are also a resource stepfamily relations. In addition, more adults for younger generations, and their absence may are choosing not to marry or have children at create an additional burden for younger family all. Long-Term Care Many of the oldest-old lose their ability to live The future need for long-term care services independently because of limited mobility, (both formal and informal) will largely be frailty, or other declines in physical or cognitive determined by changes in the absolute number functioning. Many require some form of long- of people in the oldest age groups coupled with term care, which can include home nursing, trends in disability rates. Further, the an established and affordable long-term care narrowing gap between female and male life infrastructure, this cost may take the form expectancy reduces widowhood and could mean of other family members withdrawing from a higher potential supply of informal care by employment or school to care for older relatives. A key aspect of this Valuable new information is coming from new international community of researchers is nationally representative surveys, often panel that data are shared very soon after collected studies that follow the same group of people with all researchers in all countries. These sources include, for example, similar large-scale, longitudinal studies the International Database on Aging, involving of their own populations. In addition, coordinated multi- 2006 Global Burden of Disease and Risk country panel studies are effectively building Factors initiative, which is strengthening an infrastructure of comprehensive and the methodological and empirical basis for comparable data on households and individuals undertaking comparative assessments of to understand individual and societal aging. The burden and costs of chronic diseases in low-income and middle-income countries. Prevalence of dementia in the United States: The aging, demographics, and memory study. The association of childhood socioeconomic conditions with healthy longevity at the oldest old ages in China. Suggested Resources 25 Web Resources English Longitudinal Study of Ageing http://www. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World27 Health Organization be liable for damages arising from its use. Björnsson Department of Internal Medicine, Division of Gastroenterology and Hepatology, The National University Hospital of Iceland and The Faculty of Medicine, The University of Iceland, 108 Reykjavik, Iceland; einarsb@landspitali. Information on the documented hepatotoxicity of drugs has recently been made available by a website that can be accessed in the public domain: LiverTox (http://livertox. According to critical analysis of the hepatotoxicity of drugs in LiverTox, 53% of drugs had at least one case report of convincing reports of liver injury. In a recent prospective study, liver injury due to amoxicillin-clavulanate was found to occur in approximately one out of 2300 users. Apart from exclusion of competing etiologies, an important element in the diagnostic process is the information about the known and potential hepatotoxicity of the agent. All drugs approved by regulatory authorities are accompanied by package inserts, called the “patient information” leaflet in Europe and “prescribing information” in the United States [1,2]. Adverse liver reactions are often mentioned in these product labels (package inserts) as a part of the prescribing information. However, it is not always clear whether this is related to enzyme elevations in clinical trials and/or clinically apparent liver injury. Thus, from package inserts of prescribed medications the clinician can get the idea that adverse drug reactions are side effects of most drugs. It has recently been demonstrated that this information is insufficient and even misleading [3]. There was also a substantial discrepancy in the official package inserts and liver disease labeling between Europe and the United States [3]. The documentation of the hepatotoxicity of drugs in the medical literature is very variable. Some drugs have been convincingly documented to cause liver injury in numerous case reports and case series. Many such drugs have a known clinical signature (phenotype) of liver injury and causality has been further documented by instances of a positive rechallenge [4,5]. However, with some drugs, although marketed for many decades, only a single case report or very few reports of liver injury have been published. Case reports are often not well described and critical clinical information is frequently lacking [7]. A recent study found that reports of drug-induced liver diseases often did not provide the data needed to determine the causes of suspected adverse effects [7]. Although a case report has been published, it does not prove that the drug is hepatotoxic. In LiverTox® there is data on almost all medications marketed in the United States, both on those who have been reported to cause liver injury and those without reports of liver injury. Although in LiverTox® a thorough literature search has been undertaken and is provided, no attempt has been made to judge the quality of the published reports or the causality of the suspected liver injury reported. In a recently published paper, drugs in LiverTox® were classified into categories, using all reports in this website [9]. In this critical analysis, many of the published reports did not stand up to critical review and currently there is no convincing evidence for some drugs with reported hepatotoxicity to be hepatotoxic [9]. Although certain drugs have a distinct phenotype such as isoniazid, which generally leads to a hepatocellular pattern or chlorpromazine cholestatic liver damage, many drugs can lead to both hepatocellular and cholestatic injury. Listing all types of patterns that have been reported for all these drugs is unfortunately not possible in this paper. Categories of Hepatotoxicity In the creation of LiverTox, drugs were arbitrarily divided into four different categories of likelihood for causing liver injury based on reports in the published literature [8]. Category A with >50 published reports, B with >12 but less than 50, C with >4 but less than 12, and D with one to three cases. In the Hepatology paper, drugs were categorized based on these numbers and another category, T, was added for agents leading to hepatotoxicity mainly in higher-than-therapeutic doses [9]. The analysis was based mainly on published case reports, but case series were used if a formal causality assessment had been undertaken. In the analysis of the hepatotoxicity of drugs found in LiverTox, fewer drugs than expected had documented hepatotoxicity. Among 671 drugs available for analysis, 353 (53%) had published convincing case reports of hepatotoxicity. Thus, overall, 47% of the drugs listed in LiverTox did not have evidence of hepatotoxicity. This is at odds with product labeling which very frequently lists liver injury as adverse reaction to drugs [3]. It has to be taken into consideration that 116/863 (13%) of marketed agents had be excluded from the analysis. New drugs approved within the last five years were not included as most instances of hepatotoxicity appear in the post-marketing phase [11]. Metals (iron, nickel, arsenic), illegal substances (cocaine, opium, heroin), and infrequently used and/or not available (not marketed currently) drugs were also excluded [9]. Herbal and dietary supplements listed in LiverTox were not included in the category analysis. Among the 671 drugs available for analysis, the proportions of the drugs in the different categories were: A, 48 (14%); B, 76 (22%); C, 96 (27%); and D, 126 (36%). In general, drugs in categories A and B were more likely than those in C and D to have been marketed for a long time, and both were more likely to have at least one fatal case of liver injury and reported cases of positive rechallenge. However, in categories C and D with one to 12 cases reported, it is still not clear whether these agents are really hepatoxic drugs.

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It should work to mobilize and facilitate a grassroots movement among community stakeholders lasuna 60 caps cheap, including health-care provid- ers 60 caps lasuna overnight delivery, employers cheap lasuna 60 caps without a prescription, mainstream and ethnic media, community-based organiza- tions, and students. The lack of knowledge and awareness about hepatitis B and hepatitis C in the general population suggests that integration of viral-hepatitis and liver-health education into existing health-education curricula in schools will help to eliminate the stigma of those chronically infected and improve prevention of viral hepatitis. There is evidence that adolescents are unaware of hepatitis B and hepatitis C risks and how to prevent becoming infected (Moore-Caldwell et al. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Some 30% of the programs were supported by local government funding, 27% by state fund- ing, and 10% by federal funding. Other sources include pharmaceutical and insurance companies, research and service grants, community hospitals, and other private funding sources (Rein et al. Education and prevention programs should be expanded to provide services in underserved regions of the United States given that the highest rates of acute hepatitis B incidence are in the south (Daniels et al. The major risk factors for viral hepatitis in people in correctional facilities are injection-drug use, tattooing, and sexual activity (see Chapters 4 and 5 for additional information about incarcerated populations). Increased knowledge and awareness about the dis- eases will lead to a greater understanding among inmates about how to prevent them, the advantages of hepatitis B vaccination, why they should be tested for chronic hepatitis B and hepatitis C, and what to do about a positive test result for either infection. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The addition of hepatitis education to existing peer-based inmate educational programs is feasible and will prob- ably incur minimal additional cost. Women and young people who inject drugs are less likely than others to attend needle-exchange and drug-treatment programs (Bluthenthal et al. Novel programs are needed that will access the hidden injectors, and outreach and peer-education programs are potentially effective ways to achieve this goal. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. The women should be given culturally and linguistically ap- propriate educational information about the importance of administration of the birth dose of the hepatitis B vaccine and hepatitis B immunoglobulin within 12 hours of birth if needed, completion of the hepatitis B vaccine series by the age of 6 months, and postvaccination testing. There is a need to develop a novel program to educate pregnant women in perinatal-care facilities about hepatitis B to prevent perinatal transmission, to refer women who are chronically infected for medical care, and to refer family and household contacts for testing, vaccination, and care if needed. Hepatocellular carcinoma inci-Hepatocellular carcinoma inci- dence, mortality, and survival trends in the United States from 1975 to 2005. Screening and counseling practices reported by obstetrician-gynecologists for patients with hepatitis C virus infec- tion. The ef- fect of syringe exchange use on high-risk injection drug users: A cohort study. Hepatitis B virus: A comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis C virus transmission from an antibody-negative organ and tissue donor—United States, 2000-2002. Transmission of hepatitis B and C viruses in outpatient settings—New York, Oklahoma, and Nebraska, 2000-2002. Transmission of hepatitis B virus among persons undergoing blood glucose moni- toring in long-term-care facilities—Mississippi, North Carolina, and Los Angeles county, California, 2003-2004. Screening for chronic hepatitis B among Asian/Pacifc Islander populations— New York City, 2005. Acute hepatitis C virus infections attributed to unsafe injection practices at an endoscopy clinic—Nevada, 2007. Hepatitis C virus transmission at an outpatient hemodialysis unit—New York, 2001-2008. Building partnerships with traditional Chinese medicine practitioners to increase hepatitis B awareness and prevention. The Jade Rib- bon Campaign: A model program for community outreach and education to prevent liver cancer in Asian Americans. Low hepatitis B knowledge among peri- natal healthcare providers serving county with nation’s highest rate of births to mothers chronically infected with hepatitis B. Hepatitis B and liver cancer beliefs among Korean immigrants in western Washington. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Hepatitis B virus screening practices of Asian-American primary care physicians who treat Asian adults living in the United States. Organizational climate, staffng, and safety equipment as predictors of needlestick injuries and near-misses in hospital nurses. Living with chronic hepatitis C means “you just haven’t got a normal life any more. The next plague: Stigmatization and discrimination re- lated to Hepatitis C virus infection in Australia. Are primary care clinicians knowl- edgeable about screening for chronic hepatitis B infection? The impact of iatrogenically acquired Hepatitis C infec- tion on the well-being and relationships of a group of Irish women. Impact of four urban perinatal hepatitis B prevention programs on screening and vaccination of infants and household members. Hepatitis B surface antigen prevalence among pregnant women in urban areas: Implications for testing, reporting, and preventing perinatal transmission. Family physi- cians’ knowledge and screening of chronic hepatitis and liver cancer. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Focus-on-teens, sexual risk-reduction intervention for high-school adolescents: Impact on knowledge, change of risk-behaviours, and prevalence of sexually transmitted diseases. Incidence and risk factors for acute hepatitis B in the United States, 1982-1998: Implications for vaccination programs. Self-reported hepatitis C virus antibody status and risk behavior in young injectors. Creation of a safety culture: Reducing workplace injuries in a rural hospital setting. Reducing liver cancer disparities: A community-based hepatitis-B preven- tion program for Asian-American communities. Knowledge about hepatitis B and predictors of hepatitis B vaccination among Vietnamese American college students. A randomized intervention trial to reduce the lending of used injection equipment among injection drug users infected with hepatitis C. Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C http://www. Why we should routinely screen Asian Ameri- can adults for hepatitis B: A cross-sectional study of Asians in California. Secondary syringe exchange among users of 23 California syringe exchange programs. Risk perceptions and barriers to hepatitis B screening and vaccination among Vietnamese immigrants. Knowledge, attitudes, and behaviors of hepatitis B screening and vaccination and liver cancer risks among Vietnamese Americans. Knowledge, attitudes, and behaviors of Chinese hepatitis B screening and vaccination. Awareness and use of hepatitis B vaccine among homosexual male clients of a Boston community health center. A comparison of trends in the in- cidence of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in the United States. The perceptions and aspirations illicit drug users hold toward health care staff and the care they receive.

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Constantine came from North Africa purchase lasuna 60 caps amex, perhaps from Tunis buy 60caps lasuna free shipping, and was thus a native speaker of Ara- bic buy lasuna 60 caps line. Constantine arrived in Salerno around the year  but soon, at the recommendation of Alfanus, moved to the Benedic- tine Abbey of Monte Cassino, with which Alfanus had intimate ties. Constan- tine became a monk and spent the rest of his life in the rich, sheltered confines of the abbey, rendering his valuable cache of Arabic medical texts into Latin. He translated at least twenty works, including the better part of ‘Alī ibn al- ‘Abbās al-Majūsī’s Pantegni (a large textbook of general medicine) plus smaller, more specialized works on pharmaceutics, urines, diets, fevers, sexual inter- course, leprosy, and melancholy. Written by a physician from Qayrawān (in modern-day Tunisia) Introduction  named Abū Ja‘far Aḥmad b. Its sixth book was devoted to diseases of the reproductive organs and the joints, and it was upon this that the author of the Salernitan Conditions of Women would draw most heavily. Beyond their length, they had introduced into Europe a rich but difficult vocabulary, a wealth of new pharmaceuticals, and a host of philo- sophical concepts that would take medical thinkers years to fully assimilate. Yet ultimately, the availability of this sizable corpus of new medical texts would profoundly change the orientation of Salernitan medicine. The medical writings of twelfth-century Salerno fall into two distinct categories. Embodying the dictum that ‘‘medicine is divided into two parts: theory and practice,’’ twelfth-century Salernitan writings can be classified as either theoretical or practical. Salernitan medicine was distinguished by its em- phasis on what can properly be called a ‘‘philosophical medicine. A curriculum of basic medi- cal texts to be used for introductory instruction seems to have formed just after . Later to be called the Articella (The little art), this corpus initially comprised five texts, among which were Constantine’s translations of Ḥunayn ibn Isḥāq’s Isagoge (a short handbook that introduced the student to the most basic principles of medical theory) and the Hippocratic Aphorisms and Prog- nostics. Two additional works recently translated from Greek—Philaretus’s On Pulses and Theophilus’s On Urines—were also included. Gariopontus’s Pas- sionarius may have served as the first text to be subjected to this kind of intense analysis, though at least by the second or third decade of the century extended commentaries were being composed on the Articella as well. The reintroduction of alphabeti- zation for pharmaceutical texts, for example, made it possible for Salernitan writers to absorb some small portion of the wealth of pharmacological lore that Constantine had rendered into Latin. The organizational benefits that written discourse provided were equally evident in the Salernitan masters’ Practicae. These were veritable medical en- cyclopedias, usually arranged in head-to-toe order, encompassing all manner of diseases of the whole body. Copho in the first half of the twelfth century, Johannes Platearius in the middle of the century, and Archimattheus, Bar- tholomeus, Petrus Musandinus, Johannes de Sancto Paulo, and Salernus in the latter half of the century all wrote their own compendia of cures. These practi- cae replicated the Arabic encyclopedias in including sections on women’s dis- eases (usually placed after diseases of the male genitalia), yet at the same time they showed considerable originality in devising their own therapeutic pro- grams. None of these male writers, however, broke new ground in his catego- rization of gynecological disease. Salernitan anatomical writers did de- vote considerable attention to the anatomy of the uterus and the ‘‘female tes- ticles’’; that these descriptions became increasingly more detailed over time owes not to inspection of women’s bodies, however, but to the assimilation of bits and pieces of anatomical and physiological lore from a variety of other written sources. Nicholaus, the author of the most important text on compound medicines, promised his readers that by dispensing the medicines described in his text, ‘‘they would have an abundance of money and be glorified by a multitude of friends. These men began to style themselves as ‘‘healer and physician’’ (medicus et physicus) and later simply as ‘‘physician. Yet even as cer- tain practitioners were able to enhance their social status through their learn- ing, there continued to exist in Salerno traditions of medical practice that par- took little or not at all in the new learned discourses. It is clear that religious and even magical cures continued to coexist alongside the rationalized prac- tices of physical medicine. There were, moreover, as we shall see in more detail later, some women in Salerno who likewise engaged in medical practice; these women apparently could not avail themselves of the same educational privi- leges as men and are unlikely to have been ‘‘professionalized’’ in the same way as their male counterparts. There was, in any case, no regulation of medical practice in this period (licensing was still a thing of the future),59 so to that degree the ‘‘medical marketplace’’ was open. The context in which the three Salernitan texts on women’s medicine came into being thus was quite expansive and open to a variety of influences and practices. These texts share to varying degrees the characteristics of ‘‘main- stream’’ Salernitan medical writings, Conditions of Women with its attempts to assimilate Arabic medicine, Treatments for Women with its collection of tra- ditional local practices. Women’s Cosmetics is most interesting as an example of how traditional empirical practices could be adopted by learned physicians and deployed as another strategy in re-creating the ideal of the ancient city physician whose success lay largely in the reputation he was able to cultivate. Clearly, women were among the patients whose patronage these practitioners wanted to earn. The Lombard princess Sichelgaita seems to have had her own personal physician, Peter Borda, in the s,60 and there is ample evidence that women regularly figured in the clientele of male practitioners. Neverthe- less, as was noted above, gynecology and obstetrics were areas of medical prac- tice that saw relatively little innovation by male medical writers. Male physi- cians clearly diagnosed and prescribed for gynecological conditions, and they  Introduction recommended a wide variety of potions and herbs for difficult birth. But it is doubtful that they ever directly touched the genitalia of their female patients. This limitation of male gynecological and obstetrical practice left room for the existence of female practitioners whose access to the female body was less restricted. As we have seen, women had no higher social position here and they may well have been less literate than women in neighboring areas. Few specialized texts on women’s medicine existed in Arabic, and nonewere translated by Constantine. The larger intellectual currents of Salernitan medicine—the concern to system- atically analyze and explain, the eagerness to incorporate new pharmaceutical products, and, most important, the desire to capture all this new knowledge in writing—provided the spark that would make Salernitan women’s medicine different from anything that had gone before it. Women’s Medicine P-S G Had it been possible to draw up an inventory of European medical writings on women in the third quarter of the eleventh century, that list would have included at least two dozen different texts. But such an inventory would be insufficient to assess the varying im- Introduction  portance of these texts, for even though copies might be found in this library or that, an individual text’s usefulness may have been minimal, either because its Latin (often interlarded with Greek terminology) had been corrupted over the course of several centuries of copying or because its theoretical precepts were no longer adhered to or even understood. The gynecological literature in western Europe prior to the late eleventh century represented two ancient medical traditions. First was the Hippocratic tradition, embodied in a corpus of anonymous Greek writings composed be- tween the fifth and fourth centuries . The gynecologi- cal materials of the Hippocratic Corpus constituted as much as one-fifth of that vast collection of writings. The abbreviated translation of Diseases of Women  laid out the basic physiology of women (especially as it related to pregnancy), then moved on to alterations of the womb, impedi- ments to conception, disorders of gestation, causes of miscarriage, difficulties of birth, and subsequent problems. The longer version, called by its modern editor On the Diverse Afflictions of Women, addresses questions of etiology, diagnosis, and prognosis, as well as the more routine matters of basic pathology and ther- apy in its ninety-one subheadings. Three other texts (Book on the Afflictions of Women, Book on the Female Affliction, and Book on Womanly Matters) also derive from Diseases of Women ; these are fairly brief and often redundant recipe col- lections rather than organized medical treatises. Just as influential in dissemi- nating Hippocratic views of the female body were the Aphorisms, a collection of pithy verities about the nature of the physician’s craft, the symptoms of dis- ease, prognostic signs, and so forth. The fifth (or in some versions the sixth) of the seven sections of the Aphorisms was devoted primarily to women and their diseases; it was on occasion accompanied by an extensive commentary. Here, a reader would find such statements as ‘‘If the menses are deficient, it is a good thing when blood flows from the nostrils,’’ or ‘‘If in a woman who is pregnant the breast suddenly dries up, she will abort. Soranus of Ephesus, a Greek physician from Asia Minor who practiced in Rome in the late first and early second century . All the physician needed to know was that therewere three basic states of the human body: the lax, the con- stricted, and a combination of the two. Upon diagnosing which of the three states was manifest in any given case, the physician’s therapeutic response was to treat by opposites: to relax the constricted, constrict the lax, and do both in mixed cases, treating the more severe symptoms first. Soranus’s views of female physiology and pathology in particular seem to have been novel. He argued, for example, that menstruation, sexual activity, and pregnancy were harmful to women, in contrast to the Hippocratic tradition, which asserted (as we shall see in more detail later) that these three processes were not only salubrious but actually vital to women’s health. Soranus’s Greek Gynecology was adapted into Latin several times in the late antique period, in every instance (though to varying degrees) being stripped of its more theoretical elements. The most influential of these Latin Soranian texts was the Gynecology of Muscio, who had deliberately abbreviated and sim- plified his translation of Soranus (using, he says, ‘‘women’s words’’) so that he would not overburden the allegedly weaker minds of midwives, to whom the work was addressed. In its first book, Muscio’s Gynecology set out in question- and-answer form basic information on female anatomy (originally with an accompanying diagram of the uterus), physiology, and embryology and de- scribed in detail how normal birth and neonatal care should be handled.

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Mustard gas can also cause suppression of the bone marrow; if this occurs in an austere situation death is likely from infection. Unroof large blisters ( remove the loose overlying skin) and irrigate frequently with water and soap. Eyes should be irrigated with copious amounts of saline initially then daily irrigations. For mustard gas there is a specific decontamination powder but it is not readily available. Certainly this can be effective but like anything it carries a risk if not done properly; poor healing, infection, and reactions to the suture material. Many wounds that we currently suture will heal very well without any intervention, and suturing is mostly done to speed up wound healing and for cosmetic reasons. However, suturing isn’t hard and only requires adherence to a few basic principles. A number of the books listed in the reference section provide detailed instruction on suture techniques. An area which is poorly covered and where there is a great deal of inaccurate information is regarding suture materials and needles. In a pinch your fishing line and a normal sewing needle may be ok, but they are far from ideal. The manufacturers of suture material have a wealth of material available on their websites: Ethicon: http://www. Absorption is how long it takes for the suture material to be absorbed by the body. Sutures are classified as: Absorbable natural or synthetic Or Non-absorbable natural or synthetic And Monofilaments – suture made of a single strand Or Braided – suture made of several filaments twisted together • Natural absorbable: Surgical Gut: Collagen material derived from the submucosal layer of sheep or the serosal layer of cattle intestines. Several types: - 128 - Survival and Austere Medicine: An Introduction Plain gut: Tensile strength for 5-7 days, absorption within 42 days. Versatile material commonly used for closing bowel, uterus, and episiotomy/tear repairs; ok for skin but not first choice. Much better products available Surgical linen: Braided multifilament obtained from flax; not commonly used. Stainless steel: commonly used either as staples for the skin, for wiring the sternum following cardiac surgery, or for tendon repairs • Synthetic Absorbable: Most are synthetic protein polymers. Exact names vary with which company has produced them but each company has equivalent products. Very versatile suture, useful for most things: Skin, internal tissues, episiotomy/tear repairs. Most versatile general purpose needle o Cutting: Triangular-shaped needle point with a cutting edge on the inside curvature of the needle. If the area is under a lot of stress such as the abdominal wall or over a joint or active muscle then 7-10 days. Alternative methods: Staples: Staples can be used interchangeably with sutures for closing skin wounds. Their main drawback is that from a cosmetic standpoint they are inferior to sutures. Glue: Glue is useful for small, superficial skin lacerations; lacerations only partial thickness or just into the subcutaneous layer. It should not be used around the eyes or mouth, and it is less effective in hairy areas. The wound should be cleaned, and hair along the edges of the wound formed into bundles, and then opposite bundles tied across the wound to bring the edges together. Alternative suture material: A number of materials can be substituted for commercial suture material in austere situation. Possible suture materials include – fishing and sewing nylon, dental floss, and cotton, and in an absolute worse case horse hair or home made “gut” sutures. If you only have improvised suture material available - 130 - Survival and Austere Medicine: An Introduction you should seriously consider if suturing is the right thing to do. Anything which is organic has a much greater chance of causing tissue irritation and infection. Alternative needles: Consider small sail makers, glove makers or upholsters needles. In theory any sewing needle can be used – but curved ones are obviously easier to use. Summary: Our view is that the most versatile material is a synthetic absorbable suture like Vicryl (or an equivalent), in a variety of sizes with a 1/3 circle taper needle. If Vicryl is unobtainable or too expensive then we recommend stocking nylon and simple gut in a variety of sizes. It is also worth considering disposable staplers if your finances stretch to that. It is limited in the details of its coverage of dental anaesthesia and modern filling material, but, otherwise, is an excellent and easy to understand introduction to dental care. There are several other good web-based resources: Common Dental Emergencies: http://www. Much of this information is useless without detailed anatomical knowledge and instruction in actual techniques. We are not trying to teach dentistry here but are providing an overview of what is possible in austere situation, and helping you focus your preparations, and further education. The basics of dentistry can simplistically be broken down into 7 areas: Preventive dentistry: Like preventive medicine the importance of preventive dentistry cannot be over emphasised. Before finding yourself in an austere environment get in the habit of daily brushing, and flossing, and regular dental check-ups, and appropriate treatments. When access to regular dental care is no longer possible then continuing with daily flossing and brushing is vital. High sugar foods and drinks particularly between main meals should be discouraged. While regular cleaning and flossing will minimise and slow plaque build-up it will still occur. This takes the form of mineralised deposits at the edges of the teeth and the gums, and just below the gum margins. Scaling is the process where this material is scraped off using a scaler or dental pick. The tooth is usually not sensitive to percussion or palpation but maybe sensitive to heat, cold, sweets. Management is by symptom control with oral antiinflammatories, and pain medications, local nerve blocks, cold packs, saline gargles, and soft diet. This management is standard for a number of conditions and will be referred to as “standard dental first aid” in the rest of this chapter. Periapical Inflammation – Inflammation, but not infection, at the apex (root base) The involved tooth is usually is easily located. Usually there is no obvious external swelling as is the usual case with infection. Aphthous Ulcers – Lesion on oral mucus membranes, cause unclear There are often multiple ulcers lasting 7 – 15 days.

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