Aleve

William P. Grant, DPM, FACFAS

• Instructor of Surgery
• Eastern Virginia Medical School
• Norfolk, Virginia
• Fellowship Director, Diabetic Limb Salvage
• Tidewater Foot and Ankle Center
• Virginia Beach, Virginia

It grossly presents as a pearly papule arch pain treatment running cheap aleve 250mg free shipping, often with overlying telangiectatic ve ssels pain treatment center lexington ky fax number buy genuine aleve line. It is characterized by clusters of darkly staining basaloid cells with a typical palisade arrangement ofthe nuclei of the cells at the periphery of the tumor cell clusters pain treatment for bursitis buy aleve 500 mg visa. Basal cell carcinoma can be locally aggressive spine diagnostic pain treatment center generic 500mg aleve with mastercard, ulcerate treatment for nerve pain in dogs purchase cheap aleve on-line, and bleed; however northside hospital pain treatment center atlanta ga generic 500mg aleve fast delivery, it almost never metastasizes. Radial (initial phase) (1) Growth occurs in all directions but is predominantly lateral within the epidermis and papillary zone of the dermis. Malignant melanomas have a better prognosis when characterized by a long period ofradial growth than when associated with an early vertical growth phase. The most important clinical variants include: (1) Lentigo maligna melanoma occurs on sunexposed skin. The radial growth phase predominates initially; most often develops from preexisting lentigo maligna (Hutchinson freckle). The lesion is irregularly bordered with variegated pigmentation; most fre quent locations are the trunk and extremities. Directions: Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. A 70yearold retired farm worker is seen for evaluation of a pearlyappearing papule on the face just below and lateral to the left eye. A excisional biopsy is performed, and the microscopic appearance is similar to that seen in the fgure. Excisional biopsy is performed, and the histologic appearance is similar to that shown in the figure. An 80yearold man presents with sharply (0) Uncommon skin tumor demarcated, light brown, fat macules varying markedly in size. A 20yearold woman presents with appearance of being "stuck on" or "pasted a skin rash. The rash is localized to the on, " and they are particularly numerous on extensor surfaces of her elbows and the trunk. She (A) Seborrheic keratosis states that several family members have a (8) Dermatofibroma similar rash. An 8yearold boy presents with an is properly termed a intensely pruritic ve sicular rash and fever. A 70yearold man presents with a scaling, (A) Physical scratching ofthe skin indurated, ulcerated nodule on the back of (8) IgG autoantibodies directed against his left hand. He states that the nodule has the epidermal intercellular cement been growing larger over time. The patient substance has had much direct sun exposure in the (e) IgA antibody deposits localized to the past. Which of the following is the most likely tips of dermal papillae histologic finding in this patients skin lesionfi A 55yearold man presents with a islands of neoplastic epidermal cells, large, blackcolored, asymmetric skin lesion I I i often with "keratin pearls" with illdefined borders on his back. Which of the following clinical nuclei of the cells at the periphery of the variants ofmalignant melanoma has the clusters poorest prognosisfi Unlike squamous cell carcinoma, this tumor does not originate in preexisting actinic keratosis. The lesion shown in the figure is a welldifferentiated squamous cell carcinoma demonstrating sheets of neoplastic epidermal cells with keratin "pearls, " a very common skin tumor. There is a marked predilection for sunexposed areas, and most lesions occur on the lower part of the face or the back of the hands. Metastasis occurs in fewer than 5% of cases, because most of these lesions are discovered early and are cured by ablative therapy. Psoriasis is a chronic inflammatory skin disease characterized by erythematous plaques covered with a silvery scale. Histologic findings include epidermal proliferation with acanthosis, parakeratosis, and Munro abscesses (minute neutrophilic abscesses). Psoriasis is sometimes associated with a rheumatoid arthritislike condition termed psoriatic arthritis. Chickenpox (varicella), caused by the varictllazoster virus, is a viral infection of childhood characterized by fever and a predominantly vesicular rash. Following overt varicella, the virus can remain latent for years in dorsal root ganglia and reappear several years later as herpes zoster (shingles). Erythema multiforme manifests as a variegated group of lesions: macules, papules, and vesicles. The disorder is thought to be due to hypersensitivity, often to coexistent stimuli, such as infectious agents or drugs, or to a concomitant connective tissue disorder or an associated malignancy. This neoplasm is manifest by sharply demarcated, raised papules or plaques with a "pastedon" appearance on the head, trunk, and extremities. Nevus cells are derived from melanocytes and ordinarily occur in clusters or nests. Lentigo maligna is characterized by atypical melanocytes at the epidermaldermal junction and is a precursor to lentigo maligna melanoma. Vitiligo is an acquired loss of melanocytes in discrete areas of skin that appear as depigmented white patches. Squamous cell carcinoma is a common skin tumor associated with excessive sun exposure. Clusters of darkly staining basaloid cells with a palisading arrangement ofnucleiare characteristic of basal cell carcinoma. A keloid is a tumorlike scar resulting from abnormal proliferation ofconnective tissue with deranged arrangement of collagen fibers. Ofthe clinical variants of malignant melanoma, nodular melanoma has the worst prognosis. Malignant melanomas have a better prognosis when characterized by a long period ofradial (superficial) growth, as opposed to early vertical growth (as in nodular melanoma). Theyare diferentiated by age ofonset, muscle groups involved, and mode ofinheritance. Increased serum activities ofcreatine kinase (eK and other muscle enzymes derived fom degenerating muscle fibers are characteristic. Although nonspecific, the muscle biopsy fndings are helpful in distinguishing dystrophies from abnormalities secondary to denervation or fom entities characterized by specifc morphologic changes 2. Duchenne muscular dystrophy is the most common and most severe of the muscular dystrophies. The dystrophy exhibits Xlinked inheritance; as many as one third of cases resulting from de novo mutation. Histologic characteristics include random variation in muscle fiber size, necrosis of individual muscle fibers, and replacement ofnecrotic fibers by fibrofatty tissue. Duchenne muscular dystrophy presents initially in proximal muscles of the extremities. Becker muscular dystrophy is clinically similar to , but less severe than, Duchenne muscular dystrophy. The dystrophin abnormality is caused by segmental deletions within the gene that do not cause a coding frameshift. It is associated with a slowly progressive, nondisabling course and an almost normal life expectancy. Characteristics include a weakness associated with myotonia (inability to relax muscles once contracted), c. Associated features include cataracts, as well as testicular atrophy and baldness in men. It is an example of a disorder caused by an increased number oftrinucleotide repeats. A loss of mitochondria and other organelles in the central portion of type I muscle fibers occurs. This disease is characterized by muscle weakness and hypotonia, but afected infants eventually become ambulatory. This disease demonstrates tangles of small rodshaped granules, predominantly in type I fibers. It varies clinically from a mild, nonprogressive disease to severe weakness ending in death from respiratory failure. They may be characterized by a ragged red appearance ofmuscle fibers and by various mitochondrial enzyme or coenzyme defects. For example, the KearnsSayre syndrome is characterized by ophthalmoplegia, pigmentary retinopathy, heart block, cerebellar ataxia, and an exclusively maternal mode of transmission. This autoimmune disorder is caused by autoantibodies to acetylcholine receptors of the neuromuscular junction. Characteristics include muscle weakness intensifed by muscle use, with recovery on rest. Clinical manifestations include efortassociated weakness involving the extraocular and facial muscles, muscles of the extremities, and other muscle groups. Presenting features frequently include ptosis or diplopia, or difculty inchewing, speaking, or swallowing. The disorder is frequently associated with tumors of the thymus or with thymic hyperplasia. This paraneoplastic disorder (most commonly associated with small cell carcinoma of the lung) has clinical manifestations similar to those of myasthenia gravis. It may be due to acquired autoantibodies that react with presynaptic voltagegated calcium channels. Metabolic bone disease is usually characterized by osteopenia (diffuse radiolucency of bone) or alterations in serum calcium, phosphorus, and alkaline phosphatase (Table 221). The cause may be impaired synthesis or increased resorption ofbone matrix protein. It results in bone structures inadequate for weight bearing; fractures commonly occur, especially compression fractures of the vertebrae that cause spinal deformity (most typically kyphosis) and shortened stature. Clinical associations include: (1) Postmenopausal state (estrogen deficiency is a presumptive cause) (2) Physical inactivity (3) Hypercorticism (4) Hyperthyroidism (5) Calcium deficiency 2. Laboratory manifestations of hyperparathyroidism, high serum calcium, low serum phosphorus, and high serum alkaline phosphatase occur. Diffuse radiolucency, which can mimic osteoporosis, is characteristic radiographically. This disorder is of unknown etiology; a viral etiology is suggested by ultrastructural intranuclear inclusions in osteoclasts; studies suggest the possible role of a slow virus infection by a paramyxovirus. Abnormal bone architecture caused by increases in both osteoblastic and osteoclastic activity is characteristic. Paget disease of bone most commonly involves the spine, pelvis, calvarium of the skull, femur, and tibia. Clinical manifestations may include a marked increase in serum alkaline phosphatase (a manifestation of osteoblastic activity) and normal serum calcium and phosphorus.

Inherited gene mutations Some gene mutations can be passed from generation to generation (inherited) and are found in all cells in the body pain relief medication for uti generic aleve 250 mg free shipping. Inherited gene changes are thought to play a role in about 10% of prostate cancers shingles pain treatment natural order cheapest aleve. Cancer caused by inherited genes is called hereditary 6 American Cancer Society cancer fremont pain treatment center discount 500mg aleve visa. Inherited mutations in these genes more commonly cause breast and ovarian cancer in women pain management for dogs after spay generic aleve 500mg with mastercard. Inherited mutations in this gene might let abnormal cells live longer than they should coccyx pain treatment nhs discount aleve 250mg mastercard, which can lead to an increased risk of prostate cancer sinus pain treatment natural purchase cheapest aleve. Mutations in this gene have been linked to earlyonset prostate cancer (prostate cancer diagnosed at a young age) that runs in some families. Other inherited gene mutations may account for some hereditary prostate cancers, and research is being done to find these genes. In general, the more quickly prostate cells grow and divide, the more chances there are for mutations to occur. Therefore, anything that speeds up this process may make prostate cancer more likely. For example, androgens (male hormones), such as testosterone, promote prostate cell growth. Having higher levels of androgens might contribute to prostate cancer risk in some men. As mentioned in Prostate Cancer Risk Factors, some studies have found that inflammation in the prostate might be linked to prostate cancer. Last Medical Review: August 1, 2019 Last Revised: August 1, 2019 Can Prostate Cancer Be Preventedfi But there are some things you can do that might lower your risk of prostate cancer. Some studies have found that men who are overweight or obese have a higher risk of developing advanced prostate cancer or prostate cancer that is more likely to be fatal. Although not all studies agree, several have found a higher risk of prostate cancer in men whose diets are high in dairy products and calcium. For now, the best advice about diet and activity to possibly reduce the risk of prostate cancer is to: q Get to and stay at a healthy weight. It may also be sensible to limit calcium supplements and to not get too much calcium in the diet. Vitamin, mineral, and other supplements Vitamin E and selenium: Some early studies suggested that taking vitamin E or selenium supplements might lower prostate cancer risk. In fact, men in the study taking the vitamin E supplements were later found to have a slightly higher risk of prostate cancer. Soy and isoflavones: Some early research has suggested possible benefits from soy proteins (called isoflavones) in lowering prostate cancer risk. Several studies are now looking more closely at the possible effects of these proteins. Large studies of both of these drugs have been done to see if they might also be useful in lowering prostate cancer risk. In these studies, men taking either drug were less likely to develop prostate cancer after several years than men getting an inactive placebo. When the results were looked at more closely, the men who took these drugs had fewer lowgrade prostate cancers, but they had about the same (or a slightly higher) risk of highergrade prostate cancers, which are more likely to grow and spread. These drugs can cause sexual side effects such as lowered sexual desire and erectile dysfunction (impotence), as well as the growth of breast tissue in some men. Still, men who want to know more about these drugs should discuss them with their doctors. Aspirin Some research suggests that men who take a daily aspirin might have a lower risk of getting and dying from prostate cancer. Longterm aspirin use can have side effects, including an increased risk of bleeding in the digestive tract. Other drugs Other drugs and dietary supplements that might help lower prostate cancer risk are now being studied. But so far, no drug or supplement has been found to be helpful in studies large enough for experts to recommend them. Vitamin E and the risk of prostate cancer: 11 American Cancer Society cancer. Last Medical Review: August 1, 2019 Last Revised: June 9, 2020 Written by the American Cancer Society medical and editorial content team ( I make these promises in the full spirit of the tradition established by the ancient Oath of Hippocrates, with awareness of the changing responsibilities of medicine over the ages, and with the deep appreciation that the honor of being a physician carries with it these kinds of obligations to my fellow men and to society. Altruism: which is acting in the best interest of patients instead of selfinterest. Excellence: which is committing to exceed ordinary expectations and to lifelong learning. Practicebased Learning and Improvement including Lifelong Learning & SelfAppraisal 5. D Degree of Maturity Degree of Motivation Direct Listening (Self) Directed Learning 2. Page 8 Page 8 Docent Responsibilities Provide two hours per week didactic time with the students to learn more about themselves; understand professionalism, humanism, and altruism; learn patientcentered and doctor centered interviewing; and practice their interviewing skills. They can build their interviewing abilities in Years 1&2, making them more prepared to interview patients when they start clinical assessments in Year 3. The student interacts with patients they meet in their docent group experiences in an appropriately compassionate fashion. I have an illness or condition that made me change the kind and/or amount of food I eat. Reprinted with permission of the Nutrition Screening Initiative, a project of the American Academy of Family Physicians, the American Dietetic Association, and the National Council on Aging, Inc. Below 25, the scores can indicate a degree of mental or cognitive impairment (dementia): severe (fi9 points), moderate (1020 points) or mild (2124 points). A pregnancy can be a live birth, miscarriage, premature birth (less than 37 weeks of gestation), or an abortion. Page 26 Page 26 Obstetrics Details about each live birth are noted, including birthweight of the infant, sex, number of weeks at delivery, and type of delivery. The patient should be asked about any pregnancy complications (diabetes, hypertension, and preeclampsia). Pediatrics Developmental milestones A set of functional skills or agespecifc tasks most children can perform at a certain age range. Used to check how a child is developing; each milestone has an age level, the actual age when a normally developing child reaches that milestone can vary quite a bit. Information on how to fle a vaccine Hepatitis B vaccine HepB EngerixB injury claim is available at Do not restart or add doses to vaccine series if there are extended intervals between doses. See notes for infuenza; hepatitis B; measles, mumps, and rubella; and varicella vaccinations. This booklet is in no way intended to replace, dictate or fully defne evaluation and treatment by a qualifed physician. It is intended solely as an aid for patients seeking general information on issues in reproductive medicine. For girls, the beginning of their reproductive years is marked by the onset of ovulation and menstruation. It is commonly understood that after menopause women are no longer able to become pregnant. Generally, reproductive potential decreases as women get older, and fertility can be expected to end 5 to 10 years before menopause. Even though women today are healthier and taking better care of themselves than ever before, improved health in later life does not offset the natural agerelated decline in fertility. It is important to understand that fertility declines as a woman ages due to the normal age related decrease in the number of eggs that remain in her ovaries. Normally, only one of those follicles will reach maturity and release an egg (ovulate); the remainder gradually will stop growing and degenerate. Pregnancy results if the egg becomes fertilized and implants in the lining of the uterus (endometrium). If pregnancy does not occur, the endometrium is shed as the menstrual fow and the cycle begins again. In their early teens, girls often have irregular ovulation resulting in irregular menstrual 3 cycles, but by age 16 they should have established regular ovulation resulting in regular periods. When a woman has not had a menstrual period for 1 full year, she is said to be in menopause. As women age, fertility declines due to normal, agerelated changes that occur in the ovaries. Unlike men, who continue to produce sperm throughout their lives, a woman is born with all the eggcontaining follicles in her ovaries that she will ever have. Of the follicles remaining at puberty, only about 300 will be ovulated during the reproductive years. The majority of follicles are not used up by ovulation, but through an ongoing gradual process of loss called atresia. Atresia is a degenerative process that occurs regardless of whether you are pregnant, have normal menstrual cycles, use birth control, or are undergoing infertility treatment. Each month that she tries, a healthy, fertile 30yearold woman has a 20% chance of getting pregnant. That means that for every 100 fertile 30yearold women trying to get pregnant in 1 cycle, 20 will be successful and the other 80 will have to try again. The average age for menopause is 51, but most women become unable to have a successful pregnancy sometime in their mid40s. The agerelated loss of female fertility happens because both the quality and the quantity of eggs gradually decline. Sperm quality deteriorates somewhat as men get older, but it generally does not become a problem before a man is in his 60s. Though not as abrupt or noticeable as the changes in women, changes in fertility and sexual functioning do occur in men as they grow older. Despite these changes, there is no maximum age at which a man cannot father a child, as evidenced by men in their 60s and 70s conceiving with younger partners. As men age, their testes tend to get smaller and softer, and sperm morphology (shape) and motility (movement) tend to decline. Aging men may develop medical illnesses that adversely affect their sexual and reproductive function. Not all men experience signifcant changes in reproductive or sexual functioning as they age, especially men who maintain good health over the years. If a man does have problems with libido or erections, he should seek treatment through his primary care provider and/or urologist. An important change in egg quality is the frequency of genetic abnormalities called aneuploidy (too many or too few chromosomes in the egg). At fertilization, a normal egg should have 23 chromosomes, so that when it is fertilized by a sperm also having 23 chromosomes, the resulting embryo will have the normal total of 46 chromosomes. As a woman gets older, more and more of her eggs have either too few or too many chromosomes. That means that if fertilization occurs, the embryo also will have too many or too few chromosomes. Most people are familiar with Down syndrome, a condition that results when the embryo has an extra chromosome 21. Most embryos with too many or too few chromosomes do not result in pregnancy at all or result in miscarriage. This helps explain the lower chance of pregnancy and higher chance of miscarriage in older women.

Some went to larger A reconstruction of the towns to study as apprentices; others georgia pain treatment center canton order 500mg aleve mastercard, especially on the island of Cos pain medication for dogs at home cheap aleve, were taught Asclepieion of Cos pain treatment for arthritis on the hip discount 250mg aleve amex. One of the main shrines of Asclepius pain treatment center suny upstate generic aleve 500mg with visa, it within their families; still others relied entirely on their own skills and what they was largely rebuilt around ad could pick up by observing or listening to medical debates in the marketplace pain treatment center clifton springs buy 500 mg aleve visa. However pain management for dogs otc cheap aleve 500mg, the state did not intervene in the relationship terraces on the hillside, the shrine would have been between doctor and patient, and although such civic doctors might voluntarily impressive as well as beautiful. The medicine that these doctors practised was based primarily on dietetics that is, regulating the whole lifestyle. Drugs were used (those from Egypt had a great reputation), but surgery was very much a treatment of last resort. Comparisons with animals or everyday objects took the place of careful observation. Hippocratic prognosis also acted as an insurance: collections of case notes; some depend on close observation, provided the doctor distinguished between what he could others are highly speculative. The art thought of the body as a constant battleground between the involves three things disease, the diseased, and the two, in which the mind was also affected phlegm causes doctor. The diseases epilepsy, bile frenzy and in which environment, seasonal must join with the doctor in combating the disease. The body was from the top right, are the sanguine, the phlegmatic, environment to explain physical viewed as inherently unstable, the choleric, and the melancholic. The Rise of Medicine 59 the Hippocratic Oath I swear by Apollo the healer, by Aesculapius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise to the best of my ability and judgement. A medieval Greek manuscript of the I will not cut, even for the stone, but I will leave such Hippocratic Oath. The breakthrough into human anatomy came outside Greece, in the newly founded city of Alexandria at the mouth of the Nile in Egypt. Although his empire fragmented at his death, his sucessors maintained their Greek (Hellenistic) culture. The Cam bridge Illustrated H istory of M edicine Here, perhaps freed from some of the constraints on mutilating a corpse known in Greece, two Greek physicianscientists almost simultaneously around 280 bc began to investigate the internal body. Herophilus examined carefully the layout and organs of the body, giving names to the duodenum, and other anatomical structures. He dissected the eye, and, following his master Praxagoras of Cos, studied the pulse as a guide to illness. He had little time for humours, and thought that the arteries contained only air, pneuma, a form of refined air produced in the heart. He rejected equally strongly the view of Plato and Aristotle that everything was created for a purpose (teleology), favouring a mechanical development. The Greek world from 250 bc onwards fell more and more under the military power of Rome, which extended its control over Italy, southern France, and Spain, and, by ad 100, ruled from southern Scotland, the Rhine and Danube, to the Sahara, Israel, and the borders of modern Iraq. However much Roman chauvinist politicians might have deplored the arrival of Greek medicine and its newfangled theories, along with luxurious furniture and silk dresses, by 80 bc Greek doctors and Greek ideas were common in Italy, especially in Rome. There even grew up a new medical sect, the Methodists, who from around ad 60 were dominant in Latin medicine. They combined a view of the body made up of atoms and pores, and of illness as an imbalance between them, with propaganda stressing the simplicity and effectiveness of their diagnoses and cures. These catered for two social groups, domestic slaves (100 bc ad 70), and soldiers in permanent forts in newly conquered territory (9 bc ad 220). Large fortress hospitals, as at Chester (England) or Inchtuthil (Scotland), were for legionaries (not locals), and were designed on a plan of rooms opening off a square corridor. Situated usually many miles behind the frontier, they catered for the sick rather than those seriously wounded in battle. A few small forts housing the Rise of Medicine 61 noncitizen soldiers at, for example, Fendoch in Scotland had hospitals on a reduced scale, but a change in military strategy around 220 to reliance on a mobile fieldforce put an end to these permanent hospitals. Galen set a new agenda for medicine in the Greekspeaking world, from which alternative views to his were gradually extruded. Medical writers continued to add their own discoveries, but more often they produced large encyclopedias of past learning or elegant restatements of the Romans were famous for their public engineering works that helped keep towns and cities clean and healthy. His diagnostic as doctor to the gladiators, he moved to Rome in 162, where methods included palpation, pulsetaking, and occasionally he quickly made a name for himself. Galen tells how, one day out walking, I know of nothing more disgraceful than this: a man I came upon a man surrounded by a crowd of fools. He cannot distinguish between regular it smoking in the open mouth of the patient, who could and irregular developments. He remained in experiments on the spinal cord, using pigs, goats, and apes, court employment for the rest of his long life. From all, he unfounded), his powerful rhetoric, his near impeccable logic, derived his idea of the good doctor as philosopher, and of his abundant learning on the most unlikely of topics, and his the unity of reason and experience. Opposite: the fathers of medicine and pharmacology, from the frontispiece of a fifteenthcentury manuscript by the Italian Giohanne Cademosto. Clockwise, from the top left, are Asclepius, Hippocrates, Avicenna (Ibn Sina), Rhazes (arRazi), Aristotle, Galen, Macer, Albertus Magnus, Dioscorides, Mesue (Yuhanna ibn Masawayh), and Serapion. Oribasius, for example, in the fourth century produced at least four separate Synopses. The preservation of sound learning in an increasingly impoverished age, when medical texts had to be copied laboriously by hand and drugs and surgical instruments were hard to find, is praiseworthy. The second development was a growing split between medical theory and practice, with the former being treated with somewhat greater respect. Like Judaism, from which it took much, Christianity had an ambiguous attitude towards medicine. Some preachers, expounding the healing miracles in the Gospels, emphasized the power of faith to cure disease (although few went so far as to claim that that was sufficient), and, especially from 370 onwards, the shrines of saints and martyrs became places of pilgrimage for the sick, vying with, and ultimately replacing, the pagan temples of Asclepius. It was, for example, important to prepare the patient for a good death, leading to an eternal life in heaven, and hence to involve a priest at the bedside as well as a doctor. Irksome though this intervention might occasionally appear, the church viewed medicine positively on the whole. Although church institutions offered a potential source of conflict with medicine, this was outweighed by the ways in which, increasingly, the church acted as the preserver of learning, including medicine. Nowhere was this more evident than in a new institution, the hospital, the product of Jewish and Christian ideas on charity. The Jews and Christians broadened this to include their fellowbelievers and, in the case of Christians, all who might be in need, for all were potential Christians. By ad 60 the Jews had built hostels for those on pilgrimage to the Temple at Jerusalem, in at least one of which medical assistance was available. By 400 they were common in Asia Minor (modern Turkey) and the Holy Land, and by 450 had spread to Italy, North Africa, and southern France. At the same time, church laws throughout the Middle East specified that each community should set aside a room for looking after those in need. As the variety of names used for them shows, they catered for many different groups the sick, the old, the poor, and the stranger; sometimes together, sometimes not. Some institutions specifically excluded the maimed and sick, others treated them in separate wards. Increasing size brought administrative specialization, into wards, by sex, and, by 600 in one hospital at Constantinople, by illness. From the fourth century onwards, doctrinal splits within the Christian church contributed towards the very gradual political and military disintegration of the Roman Empire. The Western half, Latinspeaking and centred on Rome, had by 570 become an amalgam of barbarian states. In the East, the central government of Constantinople continued to exercise control over the eastern Mediterranean until the Arab conquests of the seventh century restricted it largely to the Aegean basin and Asia Minor. By 531 the texts of Galen that formed the basis for philosophy, an essential part the Alexandrian medical curriculum had been translated into Syriac, and medical of medical training. The ready availability of Syriac translations of Aristotle helped to confirm the authority of Galen, so often an Aristotelian in his ideas and prejudices. Although the Arabs had their own medicine, based on herbs and chants, they were not numerous enough to impose it on their new subjects. The Rise of Medicine 67 Here, the practice of medicine long continued as a nonMuslim speciality, families of Christian or Jewish physicians attending the ruling families for centuries.

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