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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 purchase nootropil 800 mg on-line treatment thesaurus. They make a certain constrictive for this purchase nootropil 800mg free shipping medicine 029, but they are ill advised for they render themselves bloody and they wound the male member purchase nootropil 800 mg fast delivery medications high blood pressure. They take glass and natron and reduce them to a powder and place them in the vagina buy discount nootropil 800mg on line symptoms zoloft dosage too high. The desire of women, ‘‘honest’’ or ‘‘dishonest,’’ to ‘‘restore’’ their virginity suggests acknowledgment by at least some medical practitioners that women’s honor in this Mediterra- nean culture, to a degree that would never have been true for men, was bound up intimately with their sexual purity. If successful, these recipes may well have made the difference for some women between marriage and financial security, on the one hand, and social ostracization and poverty, on the other. From recognition of difficulties of bladder control (a common affliction of older women, exacerbated by frequent childbearing, ¶) to cracked lips caused by too much kissing (¶) to breast pain during lactation (¶) to instructions for cutting the umbilical cord (¶), we sense the mundane but nonetheless pressing concerns of women. Care of obstetrical problems, especially those consequent to birth, is a particularly frequent concern (¶¶, –, , and –). Here, the only recommendations are to bathe, fumigate, and offer sternutatives (substances that induce sneezing) to women giving birth (¶) and to give a potion and fumigate with vinegar to aid birth and help expel the afterbirth (¶). This absence is perhaps to be explained by the au- thor’s belief that childbirth in and of itself is not pathological. It does not, in other words, demand the attention of a medical practitioner; what needs to be known about aiding labor is already part of the common knowledge of the women (relatives and neighbors) who would normally attend the birth. In ¶, for instance, we find ‘‘a very useful unguent for sunburn and any kind of lesions, but espe- cially those caused by the wind, and for the blemishes on the face which Saler- nitan women make [while mourning] for the dead. Having realized that her husband had reached the end of his life, she delivered an impassioned speech of grief, all the while ‘‘ripping her cheeks with her nails and tearing at her disheveled hair. To the extent that these are mostly uro- genital and otherconditions of the pelvic region that men sharewith women— infertility caused by obesity or emaciation (¶¶–), hemorrhoids (¶),167 kidney and bladder stones (¶¶–), and intestinal pain (¶)—their pres- ence is understandable. Yet the author not merely mentions that men have these same disorders but (with the exception of two cases, where the ther- apy is not differentiated) s/he provides full details of the differing treatments needed for men. Moreover, there are two remedies exclusively for men: ¶ on swelling of the penis and lesions of the prepuce and ¶ on swollen tes- ticles. The inclusion of this material probably reflects more than the mere cate- gorical affinity of gynecological and andrological diseases. In his mid-twelfth- century compendium of medical practices, the Salernitan physician Johannes Platearius credited ‘‘Salernitan women’’ with a remedy for pustules of the penis very similar to that described in ¶. I will have more to say about the Salerni- tan women momentarily; here it should simply be noted that Platearius’s cita- tion suggests that it was not considered problematic for female practitioners to treat both men’s and women’s reproductive complaints. Copho is credited with the statement that sneezing can aid obstructed birth by rupturing the ‘‘cotyledons’’ (¶). He is also mentioned as the ‘‘author’’ of a special powder used for treatment of impetigo (a skin condition). Both place greatest stress on maintaining (or attempting to maintain) regular menstruation;171 both are concerned to remedy displacements and lesions of the uterus; both offer sug- gestions for aiding difficult childbirth. In this respect, it is quite understand- able that the two texts should have been brought together at the end of the twelfth century and ultimately ascribed to a single author (see below). While Conditions of Women is thor- oughly bookish, having little material beyond what the author has found in other tracts (which he readily admits in his prologue), Treatments for Women ranges more broadly, covering well over twice as many gynecological disease entities as its counterpart, not to mention its considerable material on cos- Introduction  metics and other topics. Despite their differences, both texts are equally rep- resentative of twelfth-century Salernitan medicine, though of two clearly dif- ferent varieties. While Conditions of Women embraces the new Arabic medicine and reflects the more learned, literate direction that Salernitan medical writing began to take in the early and middle decades of the twelfth century, Treat- ments of Women reflects an alternate, practical and probably largely oral tra- dition. It advocates a medicine that depends upon access to the international trade routes that brought into the Mediterranean basin spices and other ex- pensive substances like cloves and frankincense,172 and in its references to the treatments or theories of certain Salernitan masters it shows itself aware of a larger realm of medical discourse and practice. Yet on many other levels it is sui generis, independent of the growing theoretical and pharmaceutical sophisti- cation embraced by contemporary authors. There were, these texts suggest, at least two distinct subcultures of medicine in twelfth-century Salerno. The third of the three Trotula texts, On Women’s Cosmetics, reflects a point of intersection between them. Women’s Cosmetics Women’s Cosmetics does not participate in any theoretical system of explana- tion. Though often very detailed in its therapeutic prescriptions, listing down to the finest detail how to prepare this or that mixture, how to test when it is ready, and how to apply it, the text’s sole organizing principle is to arrange the recommended cosmetics in head-to-toe order. Then there are recipes forcare of the hair: for making it long and dark, thick and lovely, or soft and fine. For care of the face there are recipes for removing unwanted hair, whitening the skin, removing blemishes and abscesses, and exfoliating the skin, plus general facial creams. For the lips, there is a special unguent of honey to soften them, plus colorants to dye the lips and gums. For care of the teeth and prevention of bad breath, there are five different recipes. The final chapter is on hygiene of the genitalia: ‘‘There are some women who because of the magnitude of their instrument [i. The author gives detailed instructions on how to apply the water just  Introduction prior to intercourse, together with a powder that the woman is to rub on her chest, breasts, and genitalia. She is also to wash her partner’s genitals with a cloth sprinkled with the same sweet-smelling powder. It also employs a variety of mineral substances: orpiment (a compound of arsenic), quicklime, quicksilver, sulfur, natron, and white lead. White or rosy skin (or both together),177 black or blonde hair seem equally prized. As the figure of the bathing woman in a late-twelfth-century copy of a Salernitan pharmaceutical text shows (fig. One therapy the author even claims to have witnessed himself: ‘‘I saw a certain Saracen woman in Sicily curing infinite numbers of people [of mouth odor] with this medicine alone. What we have here in Women’s Cosmetics, it seems, is confirmation of Ibn Jubayr’s observation of Christian women’s adoption of Muslim cosmetic practices in Sicily. It was, in fact, precisely the Women’s Cosmetics author’s recognition of this demand for knowledge of cosmetics that (by his own account) induced him, a male physi- cian, to strengthen his account ‘‘with the rules of women whom I found to be practical in practicing the art of cosmetics. The portable cauldron is reminiscent of equip- ment in the bathhouse of the Salernitan monastery of Santa Sofia, while the covered box and bag no doubt hold unguents orcosmetics. Two Anglo- Norman writers of the twelfth century, Orderic Vitalis and Marie de France, each tell different stories of a Norman (or, in Marie’s case, possibly English) traveler journeying to Salerno and finding there a woman very learned in medi- cine. The necrology of the cathedral of Salerno lists a woman healer (medica) named Berdefolia,who died in . The motherof Pla- tearius (one of several members of a veritable medical dynasty of that name) is said to have cured a certain noblewoman of uterine suffocation. Moreover, sev- eral male medical writers of the twelfth century who either taught or studied at Salerno refer frequently to the medical practices of the mulieres Salernitane,the ‘‘Salernitan women. In all, more than five dozen such references to the Salernitan women can be found in medical texts of the twelfth and early thirteenth centuries.

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Professional secrecy was no longer a binding precept discount 800mg nootropil visa medications identification, as the public good had to take precedence over individual interest cheap 800 mg nootropil fast delivery symptoms synonym. The misuse of tobacco and alcohol were the greatest threats to the national health discount 800 mg nootropil fast delivery medicine 6 year in us, for which the liberalism of the pre-Nazi era was blamed purchase nootropil 800mg amex medications like tramadol. The criteria of a useful life were in men, the ability to fight for the fatherland, and in women, to bear healthy, racially pure 35 children. Tobacco manufacturers were prohibited from advertising their products by appealing to women, sports- 36 men, or car-drivers. Even the leisure time of workers needed state supervision, in a system called Freizeitgestaltung (organisation of free-time). Communist medicine was first outlined in Voyage en Icarie by Etienne Cabet (1788-1856), a French revolutionary and a follower of Babeuf. In Icaria, the ideal communist state, the doc- tor did not have to depend on private practice as he was a salaried member of the community and medical service was free for all. Intemperate drinking and eating, lack of exercise, sexual overindulgence or tobacco smoking (about which Cabet had particularly strong feelings) were not tolerated. Only those individuals who had desirable mental and physical qualities were allowed to have children. None of this required imposition from above, as it was supported by a national democratic consensus. The results of decades of health promotion in communist countries should be carefully studied and evaluated by those who intend to introduce similar principles in Western democracies. What benefits, for example, have been observed in state-organised, compul- sory cervical cancer screening programmes in communist countries? When a delegation of prominent British physicians visited Russia in 1960, they were impressed by the Soviet emphasis on health promotion. While many middle-aged men and women appear drab and weary, the children and young people seem to be healthy, happy, and friendly. Von Mises makes the point that the difference between communism and fascism on the one hand, and socialism on the other is only 39 in the means by which to achieve identical ends. This per- manent tutelage, which von Mises called etatism, and British commentators call the nanny state, exists, as yet, in Western democracies only in a diluted version because of various con- stitutional, philosophical, moral and political obstacles. As Talmon showed, the Left starts from the premise that man is perfectible, as Rousseau believed, and by changing the unhealthy environment, created by an unfettered capitalism, man can be made healthy and happy, even though at times some degree of coercion might become necessary. For example, the poor are known to suffer more from diseases and have shorter life-expectancy, but should this be blamed on their lifestyle or on the political conditions which are the causes of poverty? By linking poverty with disease (which is not unreasonable on its own), Marxists promise that in a classless society the health of the poor will improve. Furthermore, the Left, in their various health manifestos, propose increased powers to prescribe healthy activities and proscribe unhealthy activities. To maintain the nation in a high state of readiness to defend the supremacy of the race, people should be responsible for their own health. Typical political statements are contained in Department of Health documents which see health as a matter over which the individual has control and responsibility. It makes little difference to the citizen whether statements such as the list of national targets for physical activity in England, issued by the Faculty of Public Health Medicine in February 1993, emanate from the Left or the Right, as in either case the citizen is threatened by the tyranny of the majority, if he chooses not to fulfil his quota of exercise. Any prescriptive system to make man free, or healthy, ends by enslaving him, or by taking health away from him. Those who conform, whether out of greed, cowardice, stupidity or genuine enthusiasm. Fascism and communism are histori- cal forms of totalitarianism which are unlikely to re-emerge in the same form in Western democracies, and even less so under the same name. The brave new world of the year 2000 is being heralded in the name of medical science, genetics, and the promise of longevity. The criminalisation of motherhood was dis- cussed by Ernest Drucker, professor of epidemiology and social medicine at Montefiore Medical Center in the Bronx, where about a quarter of all women who give birth use drugs, 46 such as cocaine. About half of the newborn babies who test positive for drugs are removed from their mothers and placed in foster care. Drucker illustrated this practice in a case of a poor Puerto-Rican woman, whose baby was taken away from her after birth. She had a complication of pregnancy known as placenta praevia and the baby died shortly after birth. Annas asked: Does it make any sense to decree that the pregnant woman must, in effect, live for her foetus? That she commits a crime if she does not eat only healthy foods; smokes cigarettes or drinks alcohol; takes drugs (legal or illegal); has intercourse with her husband? Favouring the foetus radically devalues the pregnant woman, and treats 158 Coercive medicine her like an inert incubator, or as a culture medium for the foetus. Women have always been unequal citizens, at least in medical eyes, but this has been obscured by the rhetoric of equality. Women have been barred from employment that was con- sidered harmful to a foetus, even if they were not pregnant. In 1978, American Cyanamid banned all women of childbear- ing age (defined as 16 to 50) from their plant in West Virginia, unless they could prove that they had been sterilised. Free sterilisation was offered and five women accepted it rather 48 than being dismissed. A Nevada woman who drank some beer the day 49 before she went into labour lost custody of her child. The New England Journal of Medicine reported 21 such cases in women who were, as a rule, single, poor, and coloured; Acceptance of forced caesarean sections, hospital deten- tions, and intra-uterine transfusions may trigger demands for court-ordered pre-natal screening, foetal surgery, and restrictions on the diet, work, athletic activity and sexual 50 activity of pregnant women. The woman did not consent, so she was brought to court, where her doctor claimed that there was a 99 per cent probability that the child would die and a 50 per cent probability that the mother would die, if a caesarian section was not performed. She won an appeal to the Georgia Supreme Court and, shortly after- wards, delivered a healthy baby without surgical inter- 52 vention. While some women may be forced to keep their pregnancy against their will others may be prevented from becoming pregnant. It usually takes some 15-20 years before American fashions in public health are adopted in Britain. Yet a High Court in London, in October 1992, ordered an emergency caesarean section on a 30-year-old woman, who refused the operation on religious grounds. In 1992, in Erlangen, Germany, an 18-year-old woman was killed in a car accident and since she was carrying a four-month-old 160 Coercive medicine foetus it was decided to keep the brain-dead woman on a life-support machine until the baby could be delivered. Police powers may even extend to forcing women to undergo a gynaecological examination if there is a suspicion that they have had an illegal abortion abroad. According to a study carried out in 1991 by the Max Planck Institute for Foreign and International Law in Freiburg, there were about ten such cases a year, especially in women returning to Ger- 58 many from the Netherlands. As early as 1963, Erwin Goffman noted that: Only one completely unblushing male in America is a young, married, white, urban, northern, heterosexual Protestant father of college education, fully employed, of good complexion, weight and height and a recent record 60 of sports. Medical screening of healthy humans is the latest addition to collecting information on private citizens. It is the apparent benevolence of the purposes of health screening - to prevent disease and to prolong life - which makes it particularly dangerous, as its more sinister aspects go unnoticed.

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