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Here we may assume that the rationale was that all the other ‘‘hot’’ substances effec- tively negated the minor cooling action of the mallow 160mg super viagra sale, thus allowing one of its secondary properties—that of provoking the menses—to come into play generic super viagra 160 mg line. In contrast to the attention paid to the elemental qualities ‘‘hot’’ and ‘‘cold,’’ humoral theory per se receives scant attention in Treatments for Women. Aside from the passing reference to ‘‘phlegmatic’’ thin women in ¶, a hu- moral causation is ascribed to only one condition, dysentery (¶). Here, dysentery is differentiated into that caused by phlegm and that caused by bile; the therapies differ accordingly. In defining ‘‘the diseases of women,’’ Treatments for Women includes most of the same categories as had Conditions of Women: menstrual irregularities, uterine prolapse, problems of fertility, difficulty of birth. Some are matters of nuance; others are more substantivelydis- tinctive conceptions of what kinds of problems women really have. Of princi- pal concern to the authorof Treatments forWomen is the promotion of women’s fertility. We see this emphasis already in the opening lines, quoted above, on the necessityof distinguishing hot women from cold. Heat and cold are of con- cern because they are impediments to conception; as stated explicitly in ¶, by use of the prescribed suffumigation women ‘‘will be found cleansed of this awful excess [of cold] and [will be made] ready for conception. Here we see more of Conditions of Women’s notion of menstrua- tion as ‘‘woman’s flower’’—that is, the necessary prelude to conception—than the view that it is a purgation vital in and of itself for women’s health. Given this continual emphasis on promoting fertility, it is perhaps not surprising that Treatments for Women nowhere mentions contraceptives. A chapter devoted to the effects of sexual abstinence (¶) says that continent women—vowed women, nuns, and widows—will incur ‘‘grave suffering’’ if they are not able to sate their desire. Unlike Condi- tions of Women and every other Salernitan textbook of the period, however— where uterine suffocation is a regular feature of the canon of gynecological dis- eases—Treatments forWomen employs the term ‘‘uterine suffocation’’ just once, and this only in passing in a completely different context. The latter is an al- most aphoristic statement: ‘‘Certain girls seem as if they are suffering from the falling sickness, which comes about from uterine suffocation compressing the respiratory organs’’ (¶). The passage just quoted immediately follows an assertion that the breast pain that some young women experience occurs upon eruption of the menses (i. This might suggest an association of suffocation with menstruation, yet none of the three chapters devoted to menstrual retention (¶¶, , and –) mentions suffocation. Likewise, the metaphorical description of the womb in another chapter (¶, on postnatal uterine pain and displacement) asbeing‘‘asifitwerewild. This view of sexuality is, after all, implicit in ¶ when it identifies abstinence as a possible prelude to disease. Yet there is equal acknowl- edgment that heterosexual activity might be painful in and of itself, or that it can lead to other disorders. According to ¶, prolapse of the uterus can be caused by the excessive size or length of the penis; ¶ suggests that the vagina can swell up because of coitus. In ¶, one of many remedies for pain in the womb, it is suggested that sexual activity is capable of desiccating the womb and heating it to an inordinate degree. One chapter (¶) specifically implicates retained semen as the culprit in a certain disorder: a piece of flesh hanging from the womb. This occurs not from the woman’s own seed being retained due to lack of intercourse but rather ‘‘because women do not clean themselves after coitus,’’ thereby allowing the semen (whose is unspecified) to be retained and trapped within the uterus. In ¶, the author of Treatments for Women ac- knowledges the cause of the discomforts of sexual abstinence not as retained or corrupted semen but as physical and perhaps even emotional desire itself: ‘‘Such women,when they have immoderate desire to have intercourse and they do not do so, if they do not satiate the desire they incur grave suffering. The therapy advocated by Treatments for Women is tra- ditional in that it employs ‘‘sweet-smelling’’ substances to be applied to the vagina (laurel or musk oil, or the compound medicine trifera magna—made of opium, cinnamon, cloves, etc. The intended effect, however, is neither to lure the uterus back into place nor to expel the collected and corrupted menses or seed; rather, the text says unambiguously that ‘‘this constrains the lust and sedates the pain. With its concern about chastity, ¶ may, in fact, have more to do with social ‘‘realities’’ than medical theory. When s/he spoke of ‘‘some widows who  Introduction are not permitted to take a second vow,’’150 the author of Treatments forWomen may have been referring to the fact that, in Salerno in this period, widows living under traditional Lombard law would have been under special pressure, more so than women living under Roman law, to keep their late husband’s bed ‘‘chaste. Given that remarriage would have threatened a woman with loss of her property and perhaps guardianship of her children as well, maintenance of chastity may well have been a pressing concern. Five recipes are given as a group (¶¶– and –),153 with a sixth comment on the subject later (¶). The main group of remedies opens with a straightforward and non- apologetic statement: ‘‘A constrictive for the vagina, so that women may be found to be as though they were virgins, is made in this manner. The third recipe (¶) shows that not every kind of deception was ap- proved: ‘‘There are some filthy and corrupt prostitutes who desire to be found more than virgins. They make a certain constrictive for this, but they are ill advised for they render themselves bloody and they wound the male member. They take glass and natron and reduce them to a powder and place them in the vagina.

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Time cheap 160mg super viagra with amex, pressure purchase super viagra 160mg with visa, and altitude: Do not begin timing until the pressure cooker is at full steam. You can test to see when all air is evacuated by attaching a rubber tube to the vent with the other end underwater. Time this and in the future you can make sure the pressure cooker has this much “warm up” time before you start timing. Run at 121 C (250 F) for 30 minutes at 15 pounds pressure at sea level add 5 for every 500 ft gain in elevation. Some media will experience shifts in pH or destruction of some components if over-autoclaved. Cooling off: The time required to cool off is load dependent; glass (can shatter) and culture media (which can boil and spatter) take the longest cooling time. Quick cooling is possible by running cold water over it – but with glass inside this increases the chance of shattering. Chemical: Ethanol: You can ferment and distil your own although care needs to be taken so you don’t produce toxic alcohols (e. Good for small cuts, surface preparation (including skin prep for surgery – toxic to deeper tissues and will sting ++), and instrument sterilisation. For instruments it is recommended that soaking in > 70% (ideal is >95%) solution for >12 hrs is ideal. This time can be shortened to several hours by the addition of formaldehyde solution to the alcohol. Polyvidone-iodine (Betadine): There are some military reports of using to sterilise water for drinking. For soaking instruments 1 part 10% solution (Betadine) to 3 parts water for 15 min. Soak for 15 min but no longer than 30 min – bleach solutions are corrosive to metal instruments. Bleach breaks down relatively rapidly and most commercial solutions will have lost their active ingredients after 12-18 months. Start with a dilute concentration initially (1:60) if pain results from this concentration dilute it again by the same volume (out to 1:120), and increase the contact time. Other chemical disinfectant agents: Tosylchloramide Chloramine T 2% solution, 20g/litre for 15 min Ethanol 70%, 8 parts of 90% ethanol in 2 parts water for 15 min. Other options: Wines prepared from grapes may be useful as wound washes and antiseptics. If pain results from application of a small amount of wine to a wound the wine should be diluted using clean water until it can be applied without undue pain. The antiseptic effects of wine are due both to the ethanol present in the wine and to the presence of some antibiotic materials. Absent any other disinfectant or sterilising remember “the solution to pollution is dilution;" wash the instruments with soap and copious amounts of water or lavage a wound with large amounts of water. When you need to repeatedly wash a wound out making the last wash a normal saline wash can help maintain the right osmolality but this is not essential - 54 - Survival and Austere Medicine: An Introduction Chapter 7 The Basic Laboratory The basics of a diagnosis can generally be reached by a careful history and physical examination. However there are some simple laboratory tests which can be performed with very little equipment or chemicals. The problem is that even basic tests require some equipment ranging from simple test strips to a microscope and a few chemicals. Obviously what you are preparing for will dictate what tests you may want to be able to perform. These can test for the presence of protein, glucose, ketones, nitrates, red blood cells, and white blood cells. The strips can be used to diagnose urinary infections, toxaemia in pregnancy, dehydration, diabetes (outside pregnancy), and renal stones/colic. The following is a quote on analysing urine from a book to be published on the practice of medicine under relatively primitive conditions. Visual and olfactory - 55 - Survival and Austere Medicine: An Introduction examination of a urine sample alone can provide considerable information. Urine which is pink, red, or red-orange may contain blood although it is important to remember that these colors may also be seen in those who have eaten certain foods such as beets, blackberries, or rhubarb. Urine which is green or blue-green, or which takes on these hues on standing may indicate diseases of the liver or gall bladder. Bright yellow or yellow-orange urine is indicative of kidney dysfunction (if there is no reason for the urine to be concentrated and if the colour is maintained for several days). Cloudy urine may result from abnormally high levels of phosphates or carbonates in the urine, and may be a precursor of kidney stones. Cloudy urine may also indicate the presence of an infection particularly if the fresh urine has an odour of ammonia or other disagreeable odour (note that urine will develop an ammonia odour on standing). It is possible to approximately localize an infection that is producing cloudy urine by using the three-glass test. This test requires three clean containers (glasses) of which at least one (the second used) will need a capacity of at least 500 ml. In this test, the first 5 ml is voided into the first container, the second container is used until the patient is almost done, and then the third container is used to collect the last 5 ml.

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