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High amounts of calcium or lead or the lack of ascorbic acid or amino acids in the meal can impair iron absorption order seroquel. This patient should be advised to make sure he does not take his iron tablet at the same time as his calcium tablet generic 50 mg seroquel with mastercard. If there are any nonseminomatous components order seroquel 100mg line, the treatment follows that of a nonseminomatous germ cell tumor. However, between 20 and 50% of these patients will have disease in the retroperitoneal lymph nodes. Hormonal therapy is effective for prostate cancer and receptor positive breast cancer but has no role in testicular cancer. While tobacco is associated with more cardiovascular deaths than cancer deaths, it is associated with malignancies in the mouth, lung, esophagus, kidney, bladder, pancreas, and stomach. The degree of smoke exposure as well as the degree of inhalation is correlated with risk of lung cancer mortality. Smokeless tobacco is the fast- est growing part of the tobacco industry and carries with it a substantial risk for dental and gingival disease as well as oral and esophageal cancers. Most Americans who quit smoking cigarettes, however, do so without involvement in a cessation program. The differential diagnosis would include lymphoma, testicular cancer, and, less likely, tuberculosis or histoplasmosis. These tumors tend to present centrally, be derived from neuroendocrine tissues, and be much more chemo-and radiosensitive than non-small cell cancer. Histologic subtypes of non-small cell cancer include adenocarcinoma (which has a more often peripheral presen- tation), large cell cancer, bronchoalveolar cell cancer, and squamous cell (or bronchogenic) lung cancer. In the relatively uncommon patient who presents with a small non-small cell primary lesion and no lymph node involvement, surgery alone may be curative. Patients with small-cell lung cancer are divided into two staging groups: those with limited disease who have tumors generally con- fined to one hemithorax encompassable by a single radiation port and all others who are said to have extensive disease. About 20 percent of patients who present with limited-stage small-cell lung cancer are curable with a combination of radiation therapy and chemother- apy, with cisplatin and etoposide being the two most active agents. Esophageal cancer is a deadly cancer with a very high mortality rate, regardless of cell type. This is because diagnosis is usually made well after patients develop symptoms, meaning that the mass is often large with frequent spread to the mediastinum and paraaortic lymph nodes, by the time that endoscopy is considered for diagnosis. Smoking and alcohol consumption are synergistic risks for squamous cell carcinoma, not adenocarcinoma. Other risks for squamous cell carcinoma include nitrites, smoked opiates, mucosal injury (including ingestion of hot tea), and achalasia. The major risk for adenocarcinoma is chronic gastric reflux, gastric metaplasia of the esophagus (Barrett’s esophagus). These adenocarcinomas account for 60% of esophageal carcinomas and behave like gastric carcinomas. In recent years, the incidence of squamous carcinoma of the esophagus has declined while the incidence of adenocarci- noma has increased, particularly in white men. Approximately 10% of esophageal carci- nomas arise in the upper third, 35% in the middle third, and 55% in the lower third. Surgery, radiation therapy, and chemother- apy are all options, but usually these interventions are palliative. Down’s syndrome, or trisomy 21, is characterized clinically by a variety of features, including moderate to se- vere learning disability, facial and musculoskeletal deformities, duodenal atresia, congeni- tal heart defects, and an increased risk of acute leukemia. There is a higher incidence of cancer, with leukemia and myelodysplasia being the most common cancers. Fragile X is a condition associated with chro- mosomal instability of the X chromosome. These patients have mental retardation, typical morphologic features including macroorchidism and prognathia, behavioral problems, and occasionally seizures. Unfortunately, there is no clonal marker that can reliably distinguish it from more common nonclonal, reactive forms of thrombocytosis. Common causes of secondary thrombocytosis in- clude infection, inflammatory conditions, malignancy, iron deficiency, hemorrhage, and postsurgical states. Similarly, myelodysplastic syndromes, particularly the 5q- syndrome, may cause thrombocytosis. Pernicious anemia caused by vitamin B12 defi- ciency does not typically cause thrombocytosis. However, correction of B12 deficiency or folate deficiency may cause a “rebound” thrombocytosis. Similarly, cessation of chronic ethanol use may also cause a rebound thrombocytosis. Low concentrations of D-dimer are considered to indicate the absence of thrombosis. Patients over the age of 70 will frequently have elevated D-dimers in the absence of thrombosis, making this test less predictive of acute disease. Other common causes of drug-induced neutro- penia include alkylating agents such as cyclophosphamide or busulfan, antimetabolites including methotrexate and 5-flucytosine, penicillin and sulfonamide antibiotics, anti- thyroid drugs, antipsychotics, and anti-inflammatory agents. Prednisone, when used systemically, often causes an increase in the circulating neutrophil count as it leads to demargination of neutrophils and bone marrow stimulation. Ranitidine, an H2 blocker, is a well-described cause of thrombocytopenia but has not been implicated in neutropenia. Efavirenz is a non-nucleoside reverse transcriptase inhibitor whose main side effects in- clude a morbilliform rash and central nervous system effects including strange dreams and confusion. Common side effects include a maculopapular rash and lipodystrophy, a class effect for all protease inhibitors. Such a complaint warrants upper endos- copy, particularly if the patient falls in a high-risk group for esophageal cancer, with care- ful examination of the stomach, trachea, and larynx. Odynophagia with chest pain is more reminiscent of ulcerative disease of the esophagus due to either infection, such as cytomegalovirus or Candida, or pill esophagitis. Liquid phase dysphagia often implies a func- tional disorder of the esophagus rather than a mass-like obstruction. A barium swallow- ing study or cine-esophagram in conjunction with a thorough history and physical examination may prove diagnostic. Oropharyngeal dysphagia usually localizes disease quite specifically to the oropharynx. Early satiety is often due to gastric obstruction or ex- trinsic compression of the stomach (splenomegaly is a common reason for this), or to a functional gastric disorder such as gastroparesis.

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Outbreaks have been traced to contaminated water buy seroquel online, milk cheap seroquel 200mg with mastercard, frozen raspber- ries and strawberries seroquel 100 mg free shipping, green onions, and shellfish. An inacti- vated vaccine has decreased the incidence of the disease, and it is recommended for all U. Passive immuniza- tion with immune globulin is also available, and it is effective in preventing clinical dis- ease before exposure or during the early incubation period. Anal fissures are often diagnosed by history alone, with severe anal pain made worse with defecation. There is often mild associated bleeding, but less than that seen with hemorrhoidal bleed- ing. Asso- ciated conditions include constipation, trauma, Crohn’s disease, and infections, including tuberculosis and syphilis. Acute anal fissures appear like a linear laceration, whereas chronic fissures show evidence of hypertrophied anal papillae at the proximal end with a skin tag at the distal end. Often the circular fibers of the internal anal sphinc- ter can be seen at the base of the fissure. Acute anal fissures are treated conservatively with increased dietary fiber intake, topical anesthetics or glucocorticoids, and sitz baths. Treat- ment for chronic anal fissures is aimed at finding methods to decrease anal sphincter tone. In some cases sur- gical therapy becomes necessary with lateral internal sphincterotomy and dilatation. This patient has pseudodiarrhea, based on frequent stools, but not diarrhea as they are not loose. The differential diagnosis for pseudodiarrhea includes proctitis and irritable bowel syndrome. Neuromuscular syndromes are linked most closely with fecal incontinence, and hypothyroid most commonly leads to constipation. Ulcerative colitis presents with a broad spectrum of symptoms and cannot be entirely ruled out, but bloody diarrhea, fevers, and pain are more typical. Viral gastroenteritis is acute, self-resolving, and causes diarrhea and often nausea. For each mole- cule of hydrochloric acid produced, a bicarbonate ion is released into the gastric venous circulation, creating the “bicarbonate tide. Postganglionic vagal fibers stimulate muscarinic receptors on parietal cells to increase acid secretion. In addition, cholinergic stimulation increases gastrin release from antral G cells as well as increasing the sensitiv- ity of parietal cells to circulating gastrin. Gastrin is the most potent stimulus of gastric acid secretion and is released from antral G cells in response to cholinergic stimuli. The most important protein produced in the stomach for inhibition of acid secretion is somatostatin. Further inhibition of gastric acid secretion is medi- ated by intestinal peptides secreted from the duodenum in response to acid pH. These peptides include gastric inhibitory peptide and vasoactive intestinal peptide. Finally, hy- perglycemia and hypertonic fluids in the duodenum also inhibit gastric acid secretion through mechanisms that are unknown. These diseases present typically with watery diarrhea in 50-to 60-year- old patients. Collagenous colitis is markedly more common in women, whereas lympho- cytic colitis has an equal sex distribution. Collagenous colitis features increased subepithelial collagen deposition and inflammation with increased intraepithelial lymphocytes. In lymphocytic colitis, there is no collagen deposition and there are greater numbers of intraepithelial lymphocytes than is the case in collagenous colitis. Treatment for collagenous colitis ranges from sulfasalazine or mesalamine to glucocorticoids, depending on severity. As more sensitive immunoassays have been developed, this window period has become less prevalent. The figure below demonstrates the time course of serum markers and clinical symptoms in acute hepatitis B. Endo- scopic ultrasonography is useful in locating the gastrin-secreting tumor once the positive secretin test is obtained. Genetic testing for mutations in the gene that encodes the menin protein can detect the fraction of patients with gastrinomas that are a manifestation of Multiple Endocrine Neoplasia type I (Wermer’s syndrome). Gastrinoma is the second most common tumor in this syndrome behind parathyroid adenoma, but its peak inci- dence is generally in the third decade. Alarm features warrant further investigation to rule out other gastrointestinal disorders such as diverticular disease or in- flammatory bowel disease. Although these patients are hypersensitive to colonic stimuli, this does not carry over to the peripheral nervous system. Elevated venous pressure leads to congestion of the hepatic sinusoids and of the central vein and centrilobular hepatocytes. Centrilobular fibrosis de- velops, and fibrosis extends outward from the central vein, not the portal triads. Budd- Chiari syndrome, or occlusion of the hepatic veins or inferior vena cava, may be confused with congestive hepatopathy. However, the signs and symptoms of congestive heart fail- ure are absent in patients with Budd-Chiari syndrome, and these patients can be easily distinguished clinically from those with heart failure. Venoocclusive disease may result from hepatic irradiation and high-dose chemotherapy in preparation for hematopoietic stem cell transplantation. Al- though echocardiography is a useful tool for assessing left and right ventricular function, findings may be unimpressive in patients with constrictive pericarditis. Cardiac magnetic resonance imaging may also be helpful in determining which patients should proceed to cardiac surgery. Somatic nerves supplying the parietal peritoneum transmit the pain stimulus, allowing localization. The pain of peritoneal in- flammation is invariably accentuated by pressure or changes in tension of the peritoneum. Asking a patient to cough will increase the intraabdominal pressure and lead to rebound tenderness without palpating the abdomen.

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Acquisition was in a 64 x 64 x 16 matrix cheap seroquel 100mg online, following uniformity correction purchase seroquel 200 mg without a prescription, and transaxial images were generated with back projection and a Hamming filter with a 1 order seroquel mastercard. The scintigraphic images were analysed in relation to the number of lesions and their localization. Mandell and Harcke [7] reviewed the use of scintigraphy in spinal disorders in adolescents. They concluded that scintigraphy is useful in helping to differentiate between a variety of developmental, infectious, neoplasic and traumatic lesions of the spine. A group of patients was selected comprising 12 adults with chronic knee pain and 11 children with disorders which might affect growth cartilage. These results are important in that they may directly influence the decision whether or not to proceed with orthopaedic treatment or surgery, the aim being to prevent or predict dysmetrias and secondary deformities caused by various pathologies. Se selecciona un grupo de pacientes compuesto por 12 adultos con dolor crónico de rodillas y 11 niños con trastornos susceptibles de afectar los cartílagos de crecimiento. Se destaca la importancia de estas indicaciones por la posibilidad de incidencia directa en la indicación ortopédica, quirúrgica o no, con la finalidad de impedir o pronosticar dosimetrías y deformaciones secundarias a patologías variadas. Estas carac­ terísticas especiales son: 1) Predominio de huesos largos, que en el centelleograma óseo del adulto presentan una concentración relativamente baja del metildifosfonato mar­ cado con "Tcm y en los que las lesiones hiperradiactivas muestran una marcada diferencia de captación con el hueso normal. En el primer análisis surge una diferencia significativa entre adultos (N = 12) y niños (N = 11) a consecuencia del órgano especial del esqueleto del niño que es el cartílago de crecimiento (fisis). Las patologías que inciden sobre este órgano determinarán estímulos o inhibiciones totales o parciales que provocarán dismetrías y/o deformaciones y su consecuente repercusión funcional. El centelleograma óseo permite valorar el cartílago de crecimiento, ya que su captación es proporcional a su actividad, lo que permite extraer conclusiones de valor para la conducta terapéutica. Todos presentaban dolor crónico en rodillas, uni o bilateral, que en tres casos se había agudizado en las últimas semanas. La paraclínica (velocidad de eritrosedimentación, proteinograma y factor reumatoideo) era normal en todos menos en dos casos, que mostraron alteraciones coincidentes con el diagnóstico de poliartritis reumatoidea. Otros dos casos presenta­ ron en su evolución derrame intra-articular de líquido citrino, de rápida reaparición, injertado en un cuadro clínico compatible con el diagnóstico de artrosis. La radiología mostró rodillas normales o con alteraciones típicas de trastornos degenerativos inespecíficos. El origen de estos trastornos fue en tres casos traumático, en dos infeccioso, en uno post-operatorio, en otro congénito y en cuatro idiopático o no aclarado. Las alteraciones radiológicas observadas fueron múltiples y estuvieron en razón con las diferentes patologías y alteraciones mencionadas. La selección de pacientes se efectuó en el Servicio de Ortopedia Pediátrica y fue orientada por la clínica y la radiología. En todos estos pacientes se partió de una dosis intravenosa de metildifosfonato marcado con "Tcm, calculada en base a 350 /¿Ci por kilo de peso. En estos casos, los niños fueron premedicados 30 min antes de comenzar la tomografía con 2 mg/kg de pentobarbital sódico por vía oral. Adquisición de imágenes Se utilizaron en todos los casos gammacámaras de detector único rectangular, y 96 fotomultiplicadores con matriz de corrección de uniformidad para el "Tcm. Para tibiotarsianas se utilizaron órbitas de 360° con 64 pasos y de 180° con 32 pasos con fines comparativos, ambas ajustadas al contorno corporal (Cuadro I). En tibiotarsianas se utilizó zoom en la adquisición dado el pequeño tamaño de las fisis, a fin de evitar utilizar demasiado factor de zoom durante el procesamiento, lo que puede introducir artefactos. Se utilizó un colimador universal para baja energía, con la finalidad de aumen­ tar el número de cuentas. En dos casos se repitió el estudio con el colimador de muy alta resolución para bajas energías con fines comparativos. Se procesaron los estudios mediante algoritmo de retroproyección filtrada usando un filtro Butterworth de orden 4 con una frecuencia de corte de 0,25. No se efectuó corrección por atenuación, usando zoom y sustracción de fondo para adecuación de las imágenes obtenidas. Como post-procesa- miento especial, en el estudio de las fisis en niños se utilizó el procesamiento en tres dimensiones, sacando ventaja de la diferencia de captación entre la fisis y el hueso maduro. Esta forma de demostración de imágenes facilita la visualización de las zonas de cartílago de crecimiento desde cualquier dirección. Los 12 adultos seleccionados mostraron todos áreas hipercaptantes anormales en varias localizaciones, en la rodilla afectada, coincidiendo con lo hallado por radiología normal o con signos de afección degenerativa similares a los de la rodilla contralateral (Cuadro П). Los pacientes afectados de poliartritis reumatoidea agregaron signos radio­ lógicos de desmineralización regional. En este grupo de pacientes, dada la diferencia de captación ósea observada, probablemente vinculada a la edad y metabolismo óseo, fue necesario introducir variaciones en el procesamiento a fin de lograr mejores imágenes y evitar artefactos. Estas variaciones consistieron en cambios de filtro de reconstrucción o, en algunos casos, en pasaje de matrices de 128 x 128 a 64 x 64, lo que introduce un efecto filtrador moderado. Uno de estos últimos casos, por encontrarse hipocaptación central y simétrica en ambas fisis tibiales proximales en una niña de 16 años, fue interpretado como resultado del cierre normal fisario sin relación con la patología (Fig. Secuela de fractura metafiso- epifisaria que muestra puentes óseos en fisis derecha. La comparación con la radio­ logía permitió diferenciar entre modificaciones degenerativas radiológicas sin sufri­ miento actual y lesiones activas. Se observa también que aparecen zonas de actividad lesional en regiones sin elementos patológicos radiológicos. De uno de estos últimos casos resultó una osteonecrosis aséptica de cóndilo femoral interno en una rodilla radiológicamente indemne. Este área hipercaptante aparece como redondeada y no toma la disposición subcondral frecuente en las lesiones activas correspondientes a sufrimiento óseo degenerativo. A esto se agrega la característica de monopolar, en tanto que en el sufrimiento de tipo artrósico la regla es la hipercaptación subcondral bipolar siguiendo la inter­ línea articular que a veces es difícil de definir en forma exacta. En estos casos el tejido óseo normal aparece hiporradiactivo, en relación a la intensa captación fisaria, lo que favorece el procesamiento post­ reconstrucción en tres dimensiones (Fig. Por esta razón y por ser el cartílago una estructura de potencial, los efectos de las alteraciones se manifestarán en esqueletos jóvenes y en el futuro.

Thus Empedocles cheap 200mg seroquel, Democritus purchase seroquel 300 mg with amex, Parmenides order seroquel without prescription, Pythagoras, Philolaus, Plato, Aristotle, Theophrastus, Strato, but also later thinkers such as Sextus Em- piricus, Alexander of Aphrodisias, Nemesius of Emesa and John Philoponus took an active interest in subjects we commonly associate with medicine, such as the anatomy and the physiology of the human body, mental ill- ness, embryology and reproduction, youth and old age, respiration, pulses, fevers, the causes of disease and of the effects of food, drink and drugs on the body. As we shall see in chapter 3, according to one major, authori- tative ancient source, the Roman author Celsus (first century ce), it was under the umbrella of ‘philosophy’ (studium sapientiae) that a theoretical, scientific interest in health and disease first started, and it was only when the physician Hippocrates ‘separated’ the art of healing from this theoret- ical study of nature that medicine was turned into a domain of its own for the first time – yet without fully abandoning the link with ‘the study of the nature of things’, as Celsus himself recognises when reflecting on developments in dietetics during the fourth century bce. This perception of the early development of medicine and its overlap with philosophy was more widely shared in antiquity, both by medical writers and by ‘philosophers’. This is testified, for example, by ancient historiographical and doxographical accounts of the history of medicine and philosophy, which tend to provide an illuminating view of the ‘self-perception’ of ancient thinkers. Introduction 11 of their own subject, medical authors such as Galen – who wrote a trea- tise advocating the view that the best doctor is, or should be, at the same time a philosopher – and the so-called Anonymus Londiniensis (the first-century ce author of a medico-doxographical work preserved on pa- pyrus) treated Plato’s views on the human body and on the origins of diseases as expounded in the Timaeus on a par with the doctrines of ma- jor Greek medical writers; and Aristotle and Theophrastus continued to be regarded as authorities in medicine by medical writers of later antiq- uity such as Oribasius and Caelius Aurelianus. Conversely, as we shall see in chapter 6, a philosopher such as Aristotle commented favourably on the contributions by ‘the more distinguished doctors’ to the area of ‘natural philosophy’. And in the doxographical tradition of ‘Aetius’,¨ in the context of ‘physics’ or ‘natural philosophy’, a number of medi- cal writers such as Diocles, Herophilus, Erasistratus and Asclepiades are cited alongside ‘philosophers’ such as Plato, Aristotle and the Stoics for their views on such topics as change, the soul, the location of the ruling part of the soul (see chapter 4), dreams, respiration, monstrosities, fertility and sterility, twins and triplets, the status of the embryo, mules, seventh-month children, embryonic development, and the causes of old age, disease and fever. It is no co- incidence that Aristotle’s comments on the overlap between ‘students of nature’ and ‘doctors’ are made in his own Parva naturalia, a series of works on a range of psycho-physiological topics – sense-perception, memory, sleep, dreams, longevity, youth and old age, respiration, life and death, health and disease – that became the common ground of medical writers and philosophers alike. And, not surprisingly, Aristotle makes similar re- marks in his zoological works concerning questions of anatomy, such as the parts of the body and structures like the vascular system, and embryology, especially the question of the origins of life, the mechanisms of repro- duction and the ways in which inherited features are passed on from one generation to another, the question of the male and female contribution to the reproductive process, the origin of the semen, questions of fertility and infertility (see chapter 9), stages of embryonic development, the way the embryo is nourished, twins and triplets, and suchlike. This whole area was referred to in later antiquity as ‘the nature of man’, particularly man’s physical make-up, ranging from the lowest, most basic level of ‘principles’ 19 See Runia (1999). We perceive this ‘agenda’ in texts as early as the Hippocratic works On Fleshes, On the Nature of Man and On Regimen, or in such later works as Nemesius’ On the Nature of Man, Vindicianus’ On the Nature of the Human Race and in the treatise On the Seed, preserved in a Brussels manuscript and attributed to Vindicianus, and there are similar points of overlap in the doxographical tradition. Even a philosopher like Plato, who seems to have had very little reason to be interested in mundane matters like disease or bodily waste products, deals at surprising length and in very considerable detail with the human body and what may go wrong with it, using an elaborate clas- sification of bodily fluids and types of disease (physical as well as mental) according to their physiological causes. Plato was of course not a doctor, but he was clearly aware of the medical doctrines of his time and took them sufficiently seriously to incorporate them into this account of the nature of the world and the human body as set out in the Timaeus. Yet interaction was not confined to matters of content, but also took place in the field of methodology and epistemology. As early as the Hip- pocratic medical writers, one finds conceptualisations and terminologi- cal distinctions relating to such notions as ‘nature’ (phusis), ‘cause’ (aitia, prophasis), ‘sign’ (semeion¯ ), ‘indication’ (tekmerion¯ ), ‘proof’ (pistis), ‘faculty’ (dunamis), or theoretical reflection on epistemological issues such as causal explanation, observation, analogy and experimentation. This is continued in fourth-century medicine, with writers such as Diocles of Carystus and Mnesitheus of Athens, in whose works we find striking examples of the use of definition, explanation, division and classification according to genus and species relations, and theoretical reflection on the modalities and the ap- propriateness of these epistemological procedures, on the requirements that have to be fulfilled in order to make them work. In Hellenistic medicine, authors such as Herophilus and Erasistratus made important theoretical points about causation, teleological versus mechanical explanation, and horror vacui, and in the ‘sectarian’ debates between Empiricists, Dogma- tists and Methodists major theoretical issues were raised about the nature of knowledge and science. Subsequently, in the Imperial period, we can observe the application and further development of logic and philosophy of science in writers such as Galen (chapter 10) and Caelius Aurelianus (chapter 11). And again, it is by no means the case that the medical writers Introduction 13 were exclusively on the receiving end: theories about causation or inference from signs constitute good examples of areas in which major theoretical and conceptual distinctions were first formulated in medical discourse and subsequently incorporated in philosophical discussions. To the Greek thinkers, areas such as those mentioned above represented aspects of natural and human reality just as interesting and significant as the movements of the celestial bodies, the origins of earth- quakes or the growth of plants and trees, and at least equally revealing of the underlying universal principles of stability and change. Nor were their interests in the medical area limited to theoretical study or the pursuit of knowledge for its own sake without extending to ‘clinical’ or ‘therapeutic’ practice. Some are known to have put their ideas into practice, such as Empedocles, who seems to have been engaged in considerable therapeutic activity, or Democritus, who is reported to have carried out anatomical research on a significant scale, or, to take a later example, Sextus Empiricus, who combined his authorship of philosophical writings on Scepticism with medical practice. Such connections between theory and practical application, and such combinations of apparently separate activities, may still strike us as re- markable. Nevertheless we should bear in mind, first, that especially in the period up to about 400 bce (the time in which most of the better-known Hippocratic writings are believed to have been produced), ‘philosophy’ was hardly ever pursued entirely for its own sake and was deemed of considerable practical relevance, be it in the field of ethics and politics, in the techni- cal mastery of natural things and processes, or in the provision of health and healing. Secondly, the idea of a ‘division of labour’ which, sometimes implicitly, underlies such a sense of surprise is in fact anachronistic. We may rightly feel hesitant to call people such as Empedocles, Democritus, Pythagoras and Alcmaeon ‘doctors’, but this is largely because that term conjures up associations with a type of professional organisation and spe- cialisation that developed only later, but which are inappropriate to the actual practice of the care for the human body in the archaic and classical period. The evidence for ‘specialisation’ in this period is scanty, for doctors 20 See, e. As we get to the Hellenistic and Imperial periods, the evidence of specialisation is stronger, but this still did not prevent more ambitious thinkers such as Galen or John Philoponus from crossing boundaries and being engaged in a number of distinct intellectual activities such as logic, linguistics and grammar, medicine and meteorology. It is no exaggeration to say that the history of ancient medicine would have been very different without the tremendous impact of Aristotelian science and philosophy of science throughout antiquity, the Middle Ages and the early modern period. Aristotle, and Aristotelianism, made and facilitated major discoveries in the field of comparative anatomy, physiology, embryology, pathology, therapeutics and pharmacology. They provided a comprehensive and consistent theoretical framework for re- search and understanding of the human body, its structure, workings and failings and its reactions to foods, drinks, drugs and the environment. They further provided fruitful methods and concepts by means of which medical knowledge could be acquired, interpreted, systematised and com- municated to scientific communities and wider audiences. And through their development of historiographical and doxographical discourse, they placed medicine in a historical setting and thus made a major contribu- tion to the understanding of how medicine and science originated and developed. Aristotle himself was the son of a distinguished court physician and had a keen interest in medicine and biology, which was further developed by the members of his school. Aristotle and his followers were well aware of earlier and contemporary medical thought (Hippocratic Corpus, Diocles of Carystus) and readily acknowledged the extent to which doctors con- tributed to the study of nature. This attitude was reflected in the reception of medical ideas in their own research and in the interest they took in the historical development of medicine. It was further reflected in the extent to which developments in Hellenistic and Imperial medicine (especially the Alexandrian anatomists and Galen) were incorporated in the later history of Aristotelianism and in the interpretation of Aristotle’s works in late anti- quity. Aristotelianism in turn exercised a powerful influence on Hellenistic and Galenic medicine and its subsequent reception in the Middle Ages and early modern period. Introduction 15 Yet although all the above may seem uncontroversial, the relationship between Aristotelianism and medicine has long been a neglected area in scholarship on ancient medicine. The medical background of Aristotle’s biological and physiological theories has long been underestimated by a majority of Aristotelian scholars – and if it was considered at all, it tended to be subject to gross simplification. These attitudes appear to have been based on what I regard as a misun- derstanding of the Aristotelian view on the status of medicine as a science and its relationship to biology and physics, and on the erroneous belief that no independent medical research took place within the Aristotelian school. Aristotle’s distinction between theoretical and practical sciences is sometimes believed to imply that, while doctors were primarily concerned with practical application, philosophers only took a theoretical interest in medical subjects. It is true that Aristotle was one of the first to spell out the differences between medicine and natural philosophy; but, as I argue in chapters 6 and 9, it is often ignored that the point of the passages in which he does so is to stress the substantial overlap that existed between the two areas. And Aristotle is making this point in the context of a theoretical, physicist account of psycho-physical functions, where he is wearing the hat of the phusikos, the ‘student of nature’; but this seems not to have prevented him from dealing with more specialised medical topics in different, more ‘practical’ contexts. That such more practical, specialised treatments existed is suggested by the fact that in the indirect tradition Aristotle is credited with several writings on medical themes and with a number of doctrines on rather specialised medical topics.

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