By B. Kirk. Adrian College.
Keeping healthy boundaries is often automatic triggering an angry and defensive reaction discount 1pack slip inn herbs chicken soup, is widely acknowl- and usually easy but can at times be diffcult for both patient and edged not to be harmful buy cheap slip inn 1pack on line herbals scappoose oregon. It is important for the profession to have detailed guidelines and limits for appropriate boundary behaviour and Boundary crossings may, at times, simply be communication equally important to allow the for the doctor-patient relation- blunders. At other times, they indicate an innovative or an in- ship to be reasonably fexible—in keeping with any genuine tuitive departure from the common treatment protocol. Boundaries elucidate the roles and expectations addressing each other using frst names could be fne in many involved in the physician–patient relationship. Boundaries thus defne the limits of the therapeutic than simply as “Gertrude”, or worse yet: “Gertie”). Therapeutic frame Occasionally, physicians are required to negotiate diffcult and Boundaries between doctor and patient are particularly impor- sensitive boundaries. At times this is described as “dancing tant since they defne the therapeutic frame. These principles are as follows: here is that treatment must take place within a structural and 1. Physicians should remember that it is for the patients’ conceptual space defned by certain parameters. When physicians self-disclose they should always and “the norms” of the therapeutic encounter, which help de- consider the current stage the relationship is in (later fne a therapeutic milieu that is benefcial to the development in the doctor-patient relationship somewhat more of a therapeutic experience. Physicians should not disclose those things that are a successful, high-quality treatment. Physicians should think about how their self-disclosure zone” (or more optimistically a “pastel zone”) that is somewhat would sound to other people. Entering this gray or pastel zone may, at times, be Summary helpful, yet it is always risky and certainly could be detrimental. By Although most boundary transgressions are conceptualized setting, and then following reasonably clear and appropriate as being “over” the boundary (the doctor is intrusive or the boundaries, physicians make their life easier and simpler, and abusive), it is important to realize that sometimes the doctor increase their sense of joy in the practice of medicine. Case resolution The resident is an outstanding resident with no history of Guthiel and Gabbard’s article, The concept of boundaries in clinical boundary issues. The resident agrees that this particular practice: Theoretical and risk-management dimensions, is an excellent incident was a boundary crossing, and if not well managed overview of boundary issues. There are acknowledges that the wording of the comment was pertinent boundaries for the many various facets of the doctor awkward, inappropriate and clearly it was not helpful to patient relationship. In reviewing the principles of physician self- limited to disclosure, the resident realizes that what was disclosed did • social role, not sound appropriate to either the patient or her parents. The • money, meeting is tense but helpful; the family express that the • gifts and services, comments were seen as inappropriate and harmful but also • clothing, acknowledge that it was intended to support the patient and • language, normalize her self-image. The resident acknowledges that • self-disclosure, and the words were hurtful and demonstrates how to handle • physical contact. The complaint is dropped, Since self-disclosure is such an important boundary and since the resident is more mindful of their use of language in the case included an unwise self-disclosure it is worthwhile to discussing sensitive subjects, and the patient remains in the briefy cover this topic. Physician self-disclosure Most physicians would agree that sharing some personal details Key references with a patient is necessary and even helpful. The concept of bound- ing personal information may lead to disclosing increasingly aries in clinical practice: Theoretical and risk-management intimate and potentially sensitive information. At a basic level, medical education must occur in a life, such as intimate relationships, plans to have a family, health specifc sequence for the learner to move successfully from issues and the needs of family members. At the same time, the learning and acquisition of experience through which students become Self-refection on the personal and professional implications residents and then practising physicians is multi-layered. It will aid in planning the stages of that all physicians develop basic core competencies in all of training and in ensuring personal and professional satisfaction their Roles (Medical Expert, Communicator, Collaborator, with outcomes. That being said, there can be many chooses to emphasize each of these Roles within their career, roads to the same goal. Personal refections on a career of transi- cian are the move from medical school training to residency, tions. Journal of the American Academy of Psychiatry and the Law from residency to practice, and from active practice to eventual Online.
Whence Hippoc- rates says that if a woman needs purging or bloodletting [during pregnancy] 1pack slip inn visa herbs for weight loss, she ought not be purged or let blood before the fourth month buy 1pack slip inn with visa herbs montauk. But in the ﬁfth or sixth month, she can be purged or let blood, but nevertheless gently and carefully with a medicine that purges bile or a decoction, and only as much as the strength of the patient is able to tolerate. And so the fetus is expelled from its bed, that is to say the afterbirth, by the force of Nature. On Diﬃculty of Birth  But there are some women who are so aﬄicted in the function of birth that hardly ever or never do they deliver themselves, which has to come about ¶a. Quandoque ab ipsa muliere calor totus euaporatur et sine uiribus relinquitur, et non suﬃcit eik ut sel expediat. Inungantur latera, uenter, coxe et uulua cum oleo uiolaceo uel rosaceo, friceturc fortiteret detur in potu oxizaccara et de puluere mente et absinthii, et detur unciad. Sometimes extraneous heat supervenes around the inner organs, whence they are excessively constricted in birth. Sometimes the exit of the womb is too small, either because the woman is too fat, or sometimes because the fetus is dead and cannot aid Nature in its movement. And this last condition happens to a young woman giving birth in thewinter when naturally she has a tight oriﬁce of the womb, made more so on account of the coldness of the season, for she is more constricted by the coldness of the air. Some- times from the woman herself all the heat evaporates and she is left without any strength, and she has none left to help herself [in giving birth]. It is expedient for a woman giving birth with diﬃculty that she be bathed in water in which mallow, fenugreek, linseed, and barley have been cooked. Let her sides, belly, hips, and vagina be anointed with oil of violets or rose oil. Let her be rubbed vigorously and let oxizaccara35 be given in a drink and some powder of mint and wormwood, and let one ounce be given. This whole mixture, having been ground and given in wine, is good [for this condition], or [when it is given] with water in which lupins have been cooked. Fiat lexiuia de cinere facto de fraxino et puluerisa seminis malueb commisceanturc drachma. Book on the Conditions of Women  But if birth is up to now still delayed or if the fetus is dead inside her and she is not delivered of it, let her drink ‘‘a. Let them be ground with some oil and a little sugar and place this upon the pubic area or upon the navel, and it works even better. There- fore, let sneezing be provoked, and let this be done with the mouth and nose closed. On the Signs of Pregnancy  In order to know whether a woman is carrying a male or a female, take water from a spring and let the woman extract two or three drops of blood or illius mulieris incontinenti B. Prouideat sibia mulier in tribus ultimis mensibus ita ut in dieta utatur leuibus cibis [va] et digestibilibus, ut per hec membra dilatentur,b ut sunt uitella ouorum, carnes etc uisculad pullorum et minorum auium, scilicet perdicum, fasianorum, et piscium squamosorum cum bono condimento. Fugiat balneumf aerium et stupham, et cum de balneo exierit, inungaturg unguentis calidis, ut oleo laurish et de oleo seminisi lini et auxungia anserisj uel anatis uel galline, et hec inunctiok ﬁat ab umbilico inferius cum predictis unguentis calidis. Deinde detur eig de- coctio fenugreci, muscillago, linih et psillii, ueli parum cyriace uel dyatessaron cum decoctione arthimesie in ui[vb]no. Ad hoc ualent species odorifere, ut muscus, ambra, lignum aloes, et similia, et herbe odorifere, ut menta, fenicu- lus, origanum, et similia. Book on the Conditions of Women milk from her right side and let these be dropped in the water. And if they fall to the bottom, she is carrying a male; if they ﬂoat on top, a female. Let the woman herself see to it that in the last three months [of pregnancy] her diet consists of light and digestible foods, so that by means of these the organs are dilated. Such foods are the yolks of eggs, the ﬂesh and innards of young fowl and small birds, that is, partridges and pheasants, and scaly ﬁsh with good sauces. And if softening herbs are added to the bath, such as marsh mallowand the like, so much the better. Let her avoid open-air baths and steambaths, and when she comes out of the bath, let her be anointed with hot unguents, such as oil of lau- rel and oil of linseed and goose or duck or hen’s grease. And let this anointing be done from the navel down with the above-mentioned hot unguents. On the Regimen for a Woman Giving Birth  When the time of birth arrives, let the woman prepare herself as is cus- tomary, and likewise the midwife should do the same with great care.
Because data are generally available regarding intakes of nutrients in human populations buy slip inn 1pack mastercard komal herbals, the data on nutrient toxicity may not be subject to the same uncertainties as are data on non- essential chemical agents cheap 1pack slip inn overnight delivery herbals himalaya. When data are lacking on chronic exposures, scientific judgment is necessary to determine whether chronic exposures are likely to lead to adverse effects at lower intakes than those producing effects after subchronic exposures (exposures of shorter duration). Generally, any age group adjustments are made based solely on differ- ences in body weight, unless there are data demonstrating age-related dif- ferences in nutrient pharmacokinetics, metabolism, or mechanism of action. The risk assessment requires explicit consideration and discussion of all choices made regarding both the data used and the uncertainties accounted for. Insufficient Evidence of Adverse Effects The scientific evidence relating to adverse effects of nutrient excess varies greatly among nutrients. For saturated and trans fatty acids and dietary cholesterol, for example, there is evidence that any intake greater than zero will increase serum levels of low density lipoprotein cholesterol, an established risk for cardiovascular disease. A policy decision is needed to determine whether efforts should be made to reduce risk. For risk management decisions, it is useful to evaluate the public health significance of the risk, and information contained in the risk char- acterization is critical for this purpose. See text for a discussion of additional factors necessary to judge the significance of the risk. Thus, the significance of the risk of excessive nutrient intake cannot be judged only by reference to Figure 4-4, but requires careful consider- ation of all of the above factors. The use of a safety factor in setting health- based permissible levels for occupational exposure. The energy in foods is released in the body by oxidation, yielding the chemical energy needed to sustain metabolism, nerve transmission, respiration, circulation, and physical work. Energy balance in an individual depends on his or her dietary energy intake and energy expenditure. Imbalances between intake and expenditure result in gains or losses of body components, mainly in the form of fat, and these determine changes in body weight. This energy is generated by the oxidation of various organic substances, primarily carbohydrates, fats, and amino acids. In 1780, Lavoisier and LaPlace measured the heat produc- tion of mammals by calorimetry (Kleiber, 1975). They demonstrated that it was equal to the heat released when organic substances were burned, and that the same quantities of oxygen were consumed by animal metabo- lism as were used during the combustion of the same organic substrates (Holmes, 1985). Indeed, it has been verified by numerous experiments on animals and humans since then that the energy produced by oxidation of carbohydrates and fats in the body is the same as the heat of combustion of these substances (Kleiber, 1975). Hydrolysis of these high- energy bonds can then be coupled to various chemical reactions, thereby driving them to completion, even if by themselves they would not proceed (Lipmann, 1941). Typically, the rates of energy expenditure in adults at rest are slightly less than 1 kcal/min in women (i. One kcal/min corresponds approximately to the heat released by a burning candle or by a 75-watt light bulb (i. Energy Yields from Substrates Carbohydrate, fat, protein, and alcohol provide all of the energy sup- plied by foods and are generally referred to as macronutrients (in contrast to vitamins and elements, usually referred to as micronutrients). The amount of energy released by the oxidation of carbohydrate, fat, protein, and alcohol (also known as Heat of Combustion, or ∆H) is shown in Table 5-1. When alcohol (ethanol or ethyl alcohol) is consumed, it promptly appears in the circulation and is oxidized at a rate determined largely by its concentration and by the activity of liver alcohol dehydrogenase. The phenomenon has been precisely measured by indirect calorimetry in human subjects, in whom ethanol consumption was found to primarily reduce fat oxidation (Suter et al. The thermic effect of alcohol is about twice the thermic effect of carbohydrate, but less than the thermic effect of protein (see later section, “Thermic Effect of Food”). Reported food intake in individuals consuming alcohol is often similar to that of individuals who do not consume alcohol (de Castro and Orozco, 1990). As a result, it has sometimes been questioned whether alcohol con- tributes substantially to energy production. However, the biochemical and physiological evidence about the contribution made by ethanol to oxidative phosphorylation is so unambiguous that the apparent discrepancies between energy intake data and body weights must be attributed to inaccuracies in reported food intakes.
Corrections or expunctions in the hand of the original scribes have not been specially ﬂagged purchase 1pack slip inn free shipping queen herbals; the text has simply been read as corrected proven slip inn 1pack herbals bestellen. It is meant not only to indicate the obvi- ous grammatical and topical breaks (and in this I have respected the manu- scripts’ readings as much as possible) but also to reﬂect the original compo- nent parts of the texts. Thus, strings of recipes will often be separated except in those instances (such as ¶) where they all come uninterrupted from a single source. More detailed information on when, exactly, this material entered the ensemble and on internal transpositions of material within the texts can be found in my essay on the subject. B’s orthography displays certain Italianate features, such as a characteristic doubling of consonants (e. The text has been carefully corrected by a contemporary hand (B2), who notes a few omissions in the margins or interlinearly. The original scribe entered the text of the rubrics at the bottom of the page; these were then written in by the same hand. Contents: Johannes de Sancto Paolo, De simpli- cium medicinarum virtutibus; treatise on preparation of colors; Petrus His- panus, Liber de egritudinibus oculorum; idem, Tractatus secundus, i. Zacharias, Tractatus de passionibus oculorum; Trotula, standardized ensemble; Magister Petrus Lumbardus, Cure. Owner: original owner(s) unknown; apparently owned in the late ﬁf- teenth century by Henricus de Sutton, who added some additional reme- dies at the end of the book, including one that he claims to have employed for pain in the penis and breasts. Contents: Isaac Israeli, De dietis particularibus; list of prebends in Laon, held predominantly by Italian canons, between and ; Trotula, standardized ensemble; Richardus Anglicus, Anathomia. Owners: an unidentiﬁed male surgeon (partially erased owner’s mark: Iste liber est. Contents: Bernard de Gordon, Lilium medi- Introduction cine; table of contents of whole codex; Alphita; Nicholaus, Synonima; Quid pro quo; Tabule Salerni; Nicholaus, De dosibus; Walter, De dosibus; Johannes Stephanus, De medicinis purgantibus; Trotula, standardized en- semble; Thadeus, Experimenta; idem, Practica disputata (an. Contents: Antidotarium Nicolai; Additiones Anthidotarii; Walter, De dosibus; Johannes Stephanus, De dosibus; Walter, De febribus; De conferentibus et nocentibus; He ben Mesue, De simplicibus medicinis; De medicinis solutivis in speciali; He ben Mesue, Liber graduum, followed by list of Arabic words and their deﬁnitions; Johannes Damascenus Nafra- nus, ﬁlius Mesuhe Calbdei, Agregatio vel antidotarium electuorum con- fectionum; Avicenna, Flebotomia; Rhazes, Flebotomia; Constantinus Afri- canus, Flebotomia; Lectura Johannis de Sancto Amando supra Antidotarium Nicolai; Ricardus Anglicus, De signis pronosticis; Rogerina maior; Rogerina minor; Trotula, standardized ensemble; Practica puerorum (inc. Contents: Mattheus Platearius, Circa instans;WalterAgi- lon, Conferentibus et nocentibus; Gerard of Montpellier, Summa de modo medendi; Walter Agilon, De dosibus; Trotula, standardized ensemble; Rhazes, Passiones sive Practica puerorum;RogerBaron,Rogerina maior; idem, Rogerina minor; Johannes de S. Because they reﬂect nothing about the thirteenth-century uses of the text, the rubrics of this Introduction manuscript (which frequently agree little with the sense of the chapters) have not been noted in the apparatus. Contents: consists of ﬁve separate manuscripts, brought together by the ﬁfteenth century at the latest. Owner: whole codex of ﬁve manuscripts owned in the ﬁfteenth century by Johannes Spenlin of Rothenburg (d. Many rubrics illegible on ﬁlm; upper parts of several folios damaged by water or acid, thus occasionally obscuring the text of the top – lines. Codex composed of two sepa- rate sections that were brought together by Johannes Medici alias Patz- ker, master of arts from Paris, provost and canon of Sanctus Johannes Maior, and cantor of the Church of the Holy Cross in Wrocław in the ﬁf- teenth century. T T In the translation that follows, I have aimed for clarity above all. I have resisted the temptation to ‘‘diagnose’’ the conditions described and have preferred to replicate the sometimes loose phrasing of the Latin rather than oﬀer more pre- Introduction cise readings that presume the ideological framework of modern western bi- ology and medicine. Readers can decide for themselves if, for example, they wish to interpret infertility accompanied by dry lips and incessant thirst (¶) as a description of diabetes. I have also retained the grammatical voice of most instructions—that is, I have rendered passive constructions passivelyand active actively. Although admittedly this results in a somewhat uneven text, it has the virtue of reﬂecting some remnants of the distinctive tone of address of the three original texts. On the one hand, the names used by the authors of the origi- nal Trotula texts in twelfth-century southern Italy often became deformed in transmission (I have ﬂagged only the major deviations in the notes to the edi- tion), or they may have referred to several diﬀerent plants. Some species may now be extinct or their chemical properties may have changed slightly over the past eight hundred years. On the other hand, there are instances when mul- tiple Latin names seem to refer to the same plant, for example, altea, bismalua, euiscus, malua, and maluauiscus, all of which seem to refer to marsh mallow (Althaea oﬃcinalis L. Having said this, I also feel my objective as translator is to attempt to bring a world long since disappeared back to life for the reader. This, it seems to me, can best be accomplished byattempting to identify plants, animals, and other materia medica by signiﬁers we use today. Since I am neither a botanist nor a phytopharmacologist, I have availed myself of the work of linguists and historical botanists in translating the medieval Latin terms with modern English common names (and, for the sake of readers whose native language may not be English, in cross-identifying those common names with their Linnaean classiﬁcations in the Index Verborum). Any investi- gators, either historical or pharmaceutical, who wish to use these texts as the basis for scientific research should refer to the Latin text.
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