By L. Dawson. Smith College. 2019.
See also gas- mur does not represent any disease or condition troesophageal reflux disease effective zudena 100 mg. There are many forms of heart murmurs heart-lung machine A machine that does the representing a variety of heart conditions buy zudena no prescription. Each type work both of the heart and of the lungs: pumping of murmur is characterized by its location generic zudena 100 mg on-line, timing, and oxygenating blood. Blood returning to the heart duration, as well as the intensity and quality of the is diverted through a heart-lung machine before being returned to arterial circulation. See also heat rash A red or pink rash usually found on airway obstruction; tracheostomy. Heat rash is most common in babies, but may affect adults in hot, Helicobacter heilmannii A bacterium that humid climates. Most cases of heat rash heal by infects most cats, dogs, and pigs and causes them themselves, and treatment is directed toward the stomach inflammation (gastritis). This bacterium is the most Heberden’s node A small fixed bony enlarge- common cause of ulcers worldwide. A tion may be acquired from contaminated food and Heberden’s node is a calcified spur of the bone of water or through person-to-person contact. It is that joint (distal interphalangeal joint) and is asso- common in people who live in crowded conditions ciated with osteoarthritis. Infected persons which short, tight muscles make it impossible to usually carry H. Also known as trismus pseudo- down of red blood cells (hemolysis; the H in the camptodactyly syndrome. Heimlich maneuver An emergency treatment Increased fluid in the tissues (edema) is also com- for obstruction of the airway in adults. Occasionally, coma can result maneuver may be needed when someone chokes on a piece of food that has “gone down the wrong way. To perform the Heimlich maneuver, a rescuer Treatment depends upon the stage of pregnancy, the severity of the condition, and the overall health sta- stands behind the victim, wraps his or her arms around the victim’s waist, makes a fist with one tus of the patient and may include corticosteroid hand, and holds the fist with the thumb side just medications, blood transfusions, antihypertensive medications, and antiseizure medications. The rescuer places his or her other hand over the delivery is required if the health of the fetus is com- fist and uses it to pull sharply into the top of the vic- promised or if the mother’s health is at serious risk. The Heimlich maneuver should can also develop during the early period after be repeated as necessary. The breakage may be spontaneous, as in the case of an aneurysm, or caused by trauma. The hemangioma, capillary A type of hemangioma blood is usually clotted or partially clotted, and it that is composed almost entirely of tiny capillary exists within an organ or in a soft tissue space, such vessels. Treatment depends on the location and where on the body but are most common on the size of the hematoma but usually involves draining face, scalp, back, and chest. They usually grow quickly and then remain fixed in size and, with time, spontaneously subside. The vast hematoma, epidural A hematoma between the majority are gone by the time the patient is age 10. Epidural hematoma is usually include strawberry hemangiomas, strawberry caused by a full-on blow to the head and is often marks, and salmon patches. Treatment is trepanation: hemangioma, cavernous A type of heman- drilling through the skull to drain the excess blood. A cavernous henangioma is raised and red or hematoma, intracerebral A hematoma within purplish. The normal hematoma, subdural A hematoma between the ranges for Hct depend on the age and, after adoles- brain and its covering, the dura. The values returned impaired gait, and dizziness may result and on Hct tests may vary slightly between laboratories. Subdural An abnormally low level of Hct is referred to as ane- hematomas can be caused by minor accidents to the mia and can come from bleeding, iron deficiency, head, major trauma, or the spontaneous bursting of breakage of red blood cells (hemolysis), and many a blood vessel in the brain (aneurysm). An abnormally high level of Hct is dural hematomas are usually due to severe head http://www. Chronic subdural hematomas may be very to 50 years of age in males and after menopause in insidious. The excess iron gives the skin a bronze 2 to 4 weeks: When they do cause problems, the color and damages the liver, causing liver scarring incident that caused the bleeding is often long past. Symptoms include increasing daily headache, fluc- Diabetes also occurs due to damage to the pan- tuating drowsiness or confusion, and mild weakness creas. Early diagnosis and treatment before symp- drilling through the skull to drain the excess blood. Hemochromatosis is inherited in an auto- hematopoiesis The production of all types of somal recessive manner. Also known as bronze dia- blood cells including formation, development, and betes and hereditary hemochromatosis. Prenatally, hematopoiesis occurs in the yolk sack, then in the hemodialysis See dialysis. In the normal situation, hematopoiesis in adults occurs in the hemoglobin The oxygen-carrying protein pig- bone marrow and lymphatic tissues. All types of ment in the blood, specifically in the red blood blood cells are derived from primitive cells (stem cells. Hb is usually measured as cells) that are pluripotent (they have the potential to total Hb expressed as the amount of Hb in grams develop into all types of blood cells). The normal ranges are approximately 14 to 17 gm/dl for adult hematuria See blood in the urine. Values returned on Hb tests may vary slightly between lab- hematuria, gross Blood in the urine that can be oratories. Hematuria may or may not be accompanied by pain, but it is always abnormal hemoglobin A Normal adult hemoglobin, the and should be further investigated. The left concentration: The higher the glucose concentra- hemidiaphragm is more often subject to rupture tion in blood, the higher the level of HbA1c. See also diaphragm; of HbA1c are not influenced by daily fluctuations in diaphragmatic hernia. Measurement of HbA1c is a useful indicator of how well the blood glucose level has been controlled in hemiplegia Paralysis on one side of the body. Also known as glycosy- hemizygous Having only a single copy of a gene lated or glucosylated hemoglobin. All the genes on the single X chromosome in the male are hemoglobin E Normal embryonic hemoglobin, hemizygous. The E stands for embryonic and also for hemochromatosis An inherited disorder char- epsilon, a chain that is unique to embryonic hemo- acterized by abnormally high absorption of iron by globin.
Fingernail lesions such as pitting generic zudena 100mg otc, onycholysis order zudena 100 mg on line, or nail thickening or subungual hy- perkeratosis are present in 50% of patients purchase zudena mastercard. Topical treatment options for psoriasis include mid-potency glucocorticoids, vitamin D analogues, retinoids, and ultraviolet light. Oral glucocorticoids should not be used for the treatment of psoriasis due to the life-threatening risk of devel- oping pustular psoriasis when therapy is discontinued. They typically begin on the trunk and consist of symmetric macules and pap- ules that may become conﬂuent. In contrast to Stevens-Johnson syndrome and toxic shock syndrome, involvement of the mucus mem- branes is uncommon. The rash usually develops within 1 week of initiation of therapy and resolves with discontinuation. The most common drugs that cause morbilliform eruptions in- clude penicillin derivatives, allopurinol, sulfonamides, and nonsteroidal anti-inﬂamma- tories. Pemphigus is an autoimmune bullous disease of the skin and mucus membranes that is rarely associated with drugs such as penicillin. Biopsy of this lesion would show neutrophil-rich inﬁl- trates in the dermal papillae. There is no associ- ation with carpal tunnel syndrome or type 1 diabetes mellitus. Tinea pedis is commonly associated with tinea manuum, unguium, or cruris (dermato- phytosis of the hands, nails, or groin, respectively). Candidal onychomy- cosis usually occurs only in the immunocompromised host or with chronic mucocutane- ous candidiasis. The lesions are usually erythematous papules or plaques with a thick scale that occludes hair follicles. If that is ineffective, systemic therapy with an aminoquinoline antimalarial may be indicated. Systemic glucocorticoids or immunosuppressives are not indicated for local- ized disease. Although malignant melanoma may take on myriad appearances, the loca- tion, progress, and description of this lesion is more suggestive of discoid lupus, therefore, surgical excision and lymph node dissection are not indicated at this time. Multiple primary lesions, regional adenopathy, and secondary bacterial infection are variably present. Leishmania parasites are transmitted by the bite of the female phlebotomine sandﬂy. While probing for a blood meal, sandﬂies regurgitate the parasite’s ﬂagellated promasti- gote stage into the host’s skin, which eventually get phagocytized by macrophages. The larvae of Trichinella spiralis are found in undercooked pork and game meat and cause the syndrome of trichonosis. Inhalation of the spores of Bacillus anthracis causes the pulmo- nary form of anthrax infection. The tsetse ﬂy is the vector for the trypanosome parasite, which can cause sleeping sickness. Mosquito bites transmit a number of infections, most notably malaria and a variety of viral infections such as viral encephalitis. With terbinaﬁne therapy, there is also a risk of drug-drug interaction with drugs that require the P450 enzyme for metabolism. Most treatment courses require se- rial monitoring of liver enzymes to avoid drug-induced hepatitis or liver failure. Lancet 360: ple index for prediction of cardiac risk of major noncar- 187–195, 2002 diac surgery. N Engl J Med 325:1621–1629, 1991 travenous unfractionated heparin in the initial treatment of Collaborative Group on Hormonal Factors in Breast Cancer: pulmonary embolism. Arch Intern stroke, and venous thrombosis in apparently healthy Med 166:391–397, 2006 men. Professor Department of Integrated Biology and Pharmacology and Graduate School of Biomedical Sciences Assistant Dean for Education Programs University of Texas Medical School at Houston Houston, Texas David S. Associate Professor Department of Integrated Biology and Pharmacology and Graduate School of Biomedical Sciences University of Texas Medical School at Houston Houston, Texas With special contributions by Medina Kushen, M. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care which should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages and precautions. Printed in the United States of America Library of Congress Cataloging-in-Publication Data Rosenfeld, Gary C. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. If you have comments or suggestions regarding this Lippincott Williams & Wilkins title, please contact us at the appropriate customer service number listed below, or send correspondence to book_comments@lww. If possible, please remember to include your mailing address, phone number, and a reference to the book title and author in your message. To purchase additional copies of this book call our customer service department at (800) 638-3030 or fax orders to (301) 824-7390. Preface to the Fifth Edition This concise review of medical pharmacology is designed for medical students, dental stu- dents, and others in the health care professions. This book presents condensed and succinct descriptions of relevant and current Board-driven information pertaining to phar- macology without the usual associated details. It is not meant to be a substitute for the comprehensive presentation of information and difficult concepts found in standard phar- macology texts. Other chapters discuss autocoids, ergots, anti-inflammatory and immunosuppressive agents, drugs used to treat anemias and disorders of hemostasis, infectious diseases, cancer, and toxicology. Each chapter includes a presentation of specific drugs with a discussion of their gen- eral properties, mechanism of action, pharmacologic effects, therapeutic uses, and adverse effects. A drug list, tables, and figures summarize essential drug information included in all chapters. This examination serves as a self-assessment tool to help students determine their fund of knowledge and diagnose any weaknesses in pharmacology. Nondiuretic Inhibitors of Tubular Transport 66 Review Test 68 vii viii Contents 4. Drug Poisoning 319 Review Test 321 Comprehensive Examination 324 Index 341 General Principles of chapter 1 Drug Action I. Drug effects are produced by altering the normal functions of cells and tissues in the body via one of four general mechanisms: 1. Interaction with receptors, naturally occurring target macromolecules that mediate the effects of endogenous physiologic substances such as neurotransmitters and hormones a. Figure 1-1 illustrates the four major classes of drug–receptor interactions, using specific examples of endogenous ligands. Figure 1-1A illustrates acetylcholine interacting with a nicotinic receptor that is a nonspecific Na+/K+ transmembrane ion channel.
Unexplained changes in the symptoms are not always signs of cancer; they can appearance of the skin that last longer than 2 weeks result from less serious conditions order zudena 100 mg mastercard. The cure rate cancer cause little or no discomfort until the disease for skin cancer could be 100 percent if all skin can- is far advanced cheap 100mg zudena, so it is important to see a physician cers were brought to a physician’s attention before for regular checkups rather than wait for problems they had a chance to spread buy 100 mg zudena free shipping. Candida albicans A yeast-like fungal organism cancer, stomach See cancer, gastric. Normally kept in check by the body’s own cancer, testicular A malignant tumor of the male helpful bacteria, C. It is one of the most common didiasis of the intestinal tract or yeast infections of cancers in young men. The risk of testicular cancer is increased in males candidiasis Disease caused by the yeast Candida whose testicles did not move down normally into the albicans. Candida albicans can cause vaginal yeast scrotum during childhood (undescended testicles). Candidiasis ticle (orchiectomy) and examination of the tissue tends to develop when the normal balance of bacte- under a microscope. Testicular cancer is almost ria is upset, as sometimes occurs with the use of always curable if it is found early. Prevention measures include the use of probiotics, and in some cases, dietary changes. Candidiasis is usually a minor and easily hormone, which is important to the normal regula- addressed problem, but it can be an important tion of the metabolism in the body. Persons who received radiation to the head or neck in childhood canker sore A common small, frequently painful should be examined by a physician for thyroid can- and sensitive crater in the lining of the mouth. Sores typically last for 10 of thyroid cancer is a lump, or nodule, that can be to 14 days and generally heal without scarring. The only certain way to tell whether a thyroid lump is cancer is by examining thyroid tis- cannabis Marijuana (Cannibis sativa), a drug sue obtained via biopsy. Use of cancer, uterine A malignant tumor of the uterus cannabis produces a mild sense of euphoria, as well (womb), which occurs most often in women as impairments in judgment and lengthened between the ages of 55 and 70. The walls of capillaries act as semi- of topical creams) and, in severe cases, surgical permeable membranes that permit the exchange of drainage. Others include cancer of the pancreas, carbohydrate One of the three nutrient com- stomach, breast, and lung, as well as certain types of pounds, along with fat and protein, used as energy thyroid and ovarian cancer. Carbohydrates take before therapy are associated with cancer that has the form of simple sugars or of more complex already metastasized (spread). Intake of com- plex carbohydrates, when they are substituted for carcinogen A substance or an agent that causes saturated fat, can lower blood cholesterol. The International Agency for Research on Carbohydrates produce 4 calories of energy per Cancer has classified many substances and gram. When eaten, all carbohydrates are broken processes as probably or definitely causing cancer down into the sugar glucose. The agency has divided these substances and processes into three categories: agents (such as carbon monoxide poisoning A potentially arsenic, asbestos, and benzene); mixtures (such as deadly condition caused by breathing carbon in coal tars, tobacco products, and smoke); and monoxide gas, which prevents oxygenation of the exposures (such as in aluminum production, shoe blood. Common causes of carbon monoxide poison- manufacturing and repair, and the rubber industry). Carbon monoxide is also emitted by automobile and other engines, so these should not carcinogenic Having a cancer-causing potential. Inexpensive alarms are available that can carcinoma Cancer that begins in the skin or in detect dangerous buildups of carbon monoxide. Examples are treatment for carbon monoxide poisoning is imme- carcinoma of the breast, colon, liver, lung, pan- diate reoxygenation of the blood in a hospital. Carboxyhemoglobin carcinoma, squamous cell Cancer that begins is formed in carbon monoxide poisoning and leads in squamous cells, which are thin, flat cells that to oxygen deficiency in the body. Squamous cells are found in carbon monoxide may be exhaust (such as from a the tissue that forms the surface of the skin and the car, truck, boat, or generator), smoke from a fire, lining of some organs of the body. This system generates electrical impulses and conducts them throughout the muscle carcinoma in situ Cancer that has stayed in the of the heart. The hallmark is a persistent, progressive, certain types of abnormal heart rhythms (arrhyth- slightly raised, red, scaly, or crusted plaque that may mias) and correct them by delivering precisely cal- occur anywhere on the skin surface or on mucosal ibrated and timed electrical shocks to restore a surfaces, such as in the mouth. Defibrillators continuously mon- scope, atypical squamous cells are seen to have pro- itor the heart rhythm in order to detect overly rapid liferated through the whole thickness of the life-threatening arrhythmias, such as ventricular epidermis (the outer layer of the skin) but not tachycardia (rapid regular beating of the ventricles, beyond. Squamous cell carcinoma in situ is com- the bottom chambers of the heart) or ventricular monly caused by sun exposure, but can be from fibrillation (rapid irregular beating of the ventri- prolonged exposure to arsenic. It is the most the left ventricle ejects into the systemic circulation common form of breast cancer. On a mammogram, in one minute, measured in liters per minute invasive ductal carcinoma is usually visualized as a (l/min). Cardiac output is indexed to a patient’s mass with fine spikes radiating from the edges body size by dividing by the body surface area to (spiculation). Infiltrating lobular carcinoma starts in the sels, such as the artery walls) and skeletal muscle glands that secrete milk (lobules). Cardiac muscle is responsible gram, a lobular carcinoma can look similar to a for pumping blood throughout the body. Lobular carcinoma can The amount of blood put out by the left ventricle of occur in more than one site in the breast or in both the heart in one contraction is called the stroke vol- breasts at the same time. That portion of the cardiac arrest A heart attack in which the heart septum that separates the two upper chambers (the suddenly stops pumping sufficient blood. A cardiac right and left atria) of the heart is termed the atrial arrest that results in the death of heart muscle is (or interatrial) septum; the portion that lies referred to as a myocardial infarction. See also between the two lower chambers (the right and left myocardial infarction, acute. Cardioversion can be accomplished by using medications or by electrical cardiomyopathy Disease of the heart muscle shock with a special defibrillator. See also cardiac defibrillator, of the wall of the left ventricle, the largest of the four implantable. Cardioplegia may be done using chemicals, cold (cryocardioplegia), or electrical stimulation. Small caries may through a heart-lung machine (a pump-oxygenator) not cause pain, and may not be noticed by the before it is returned to the arterial circulation. Larger caries can collect food, and the inner machine does the work of both the heart and the pulp of the affected tooth can become irritated by lungs, by pumping blood as well as supplying oxy- bacterial toxins or by foods that are cold, hot, sour, gen to red blood cells. Caries are caused by the Streptococcus bacteria, which produces an cardiopulmonary resuscitation A life-saving enamel-dissolving acid as it devours carbohydrate emergency procedure that involves breathing for the deposits (plaque) on the teeth. To prevent caries, victim and applying external chest compression to one should brush and floss the teeth daily, use a make the heart pump. In the early bacteriocidal mouthwash, and have regular dental stages of a heart attack, death can often be avoided cleanings by a professional. Carotenemia is most com- monly seen in infants fed too much mashed carrots cardiovascular Relating to the circulatory sys- and adults consuming high quantities of carrots, tem, which comprises the heart and blood vessels carrot juice, or beta carotene in supplement form. Cardiovascular diseases are con- area near that key artery, which is located in the ditions that affect the heart and blood vessels and front of the neck.
The verb diaitan (diaitn) is often used by Hippocratic authors to describe a treatment consisting of measures characteristic of what we would call dietetics effective 100mg zudena, such as foods and drinks discount zudena 100mg, walking purchase 100 mg zudena with amex, baths, exercise and sleep. But sometimes it just seems to be equivalent to ‘treatment’, as in a well-known statement of the doctor’s primary requirements in Epidemics 3. It could be argued that it should rather be deﬁned more generally as a care for the body both – and perhaps predominantly – in healthy states as well as (perhaps secondarily) in unhealthy states, or on the interface between the two, as seems to be the position of the author of On Regimen. If Celsus is correct in portraying dietetics as a relatively late development in Greek therapeutics,45 this must refer to dietetic medicine, the application of dietetic principles to the treatment of diseases. Rather than thinking that dietetics was originally a part of medicine and was only later, under the inﬂuence of changing social and cultural circumstances,46 divided into a therapeutic part (the treatment of diseases) and a hygienic part (the preservation of health and hygiene), one may also defend the view that dietetics as a way of looking after the body was of an older origin and had, by the ﬁfth century bce, developed into an established corpus of knowledge primarily based on experience which was subsequently applied to the treatment of diseases. For the ambivalence just noted – preser- vation of health, or treatment of disease, or providing palliative care – is, in a way, characteristic of Hippocratic approaches to health and disease as a whole. Here the need for terminological clariﬁcation makes itself particu- larly felt, for neither the Greek qerape©a nor its English derivative ‘therapy’ is speciﬁc with regard to this question about the aim(s) to be achieved. This brings us to a consideration of the terms in which the doctor’s activities are referred to in the Hippocratic Corpus. As Nadia van Brock has shown,48 among the various words used to signify the doctor’s activity – such as «¦sqai (‘cure’), qerapeÅein (‘treat’), meletn (‘care’), Ýfele±n (‘help, beneﬁt’), bohqe±n (‘remedy, assist’), meleda©nein (‘care’), metaceir©zesqai (‘treat’), fulssein (‘protect’) – perhaps pal- lssein (‘set free, release’), Ëgizein (‘make healthy’), and the passive Ëg©hv 43 See On Regimen in Acute Diseases 41 (2. But the former is the starting-point, and came before the latter (rc d ke©nh ¡ pr»teron genomnh). To help, or to do no harm 115 g©nesqai (‘get healthy’) and Ëpekfuggnein (‘be released from’) are the only terms that really indicate a full restoration of health;49 and of the vari- ous translations available for these words (e. Accordingly, recommendations of particular modes of treatment are often expressed in terms such as sumfrei (‘it is proﬁtable’), pitdei»n sti (‘it is suitable’), rgei (‘it is appropriate’) and rm»zei (‘it is ﬁtting’). As such, these terms and expressions provide a good illustration of the way in which the principle ‘to help, or to do no harm’ is interpreted in prac- tice. We can see this principle at work particularly in the actual treatment advocated by the authors of the nosological works (On Diseases 1, 2, 3, On Internal Affections). In these works symptomatology, causal explanation and therapy of diseases are fairly consistently adopted as distinctive categories – and as such they resemble the apparently even more systematic discussion of diseases and their treatment as offered by Diocles in the work Affec- tion, Cause, Treatment mentioned above. Reading through the therapeutic sections of these works, three points are particularly striking. The ﬁrst is that on several occasions in On Internal Affections and On Diseases 2 and 3 a course of treatment is recommended in the full awareness of the lethal nature of the disease. The idea that Hippocratic doctors did not engage, or were reluctant to engage, in treatment of hopeless cases – though not without some textual support, e. If treated in such a way, the patient will fare best in the disease; the disease is usually mortal, and few escape it. But still treat as is appropriate for pneumonia, if the lower cavity cooperates with you. The outcome is sometimes said to be that the patient will become healthy again;58 but there are also several cases in which the result is left vague. The tentative, by no means rigid character of Hippocratic treatment is indicated by expressions such as ‘if you wish’, ‘if you think it is right’, ‘if you treat him’, ‘if you wish to treat him’,60 ‘if you do not want to give him the drug’. To help, or to do no harm 117 ‘to die with’ (sunapoqnskein),63 the patient – which reminds one of what is sometimes said about incurable but non-fatal conditions (such as chronic fatigue syndrome): ‘It is not that you die of it, you die with it. This comprehensive approach to therapeutics is continued and further de- veloped by Diocles, whose dietetic fragments, in their meticulous attention to even the slightest detail, display an impressive degree of sophistication – some might say decadence. This is further reﬂected in a fragment of Diocles’ con- temporary Mnesitheus of Athens, who divided medicine into two branches, the preservation of health and the dispelling of disease. For the Hippocratic and Dioclean conception of medical care, combined with a growing awareness of the need for preven- tion of disease by means of a healthy lifestyle, seems to have led to a rapid expansion of the territory for which Greek physicians claimed expertise. Such a ‘medicalisation’ of daily life was strengthened by the intellectual cachet and rhetorical elegance of medicine which Celsus refers to, and to which the extant fragments of Diocles’ works certainly testify; but it is easy to see how it may have met with resistance – an unease which is reﬂected, as far as the application of dietetic principles to the treatment of diseases is concerned, by Plato’s well-known attack on dietetics in the Republic. This is illustrated by the fragment of Diocles’ contemporary Mnesitheus just quoted, and also by a fragment of Erasistra- tus,70 in which a distinction between medicine («atrik) and the care for health (t Ëgiein) is connected with a distinction between two different practitioners: the ‘healer’ («atr»v) and the ‘health specialist’ (Ëgiein»v). It is also illustrated ﬁve centuries later by Galen’s treatise Thrasybulus, which deals with the question ‘Whether the care for the healthy body belongs to medicine or to gymnastics’. But this specialisation, or indeed compart- mentalisation, of medical care meant that the unity of therapeutics which the Hippocratic doctors had insisted on, was gradually lost: the distance between patient and doctor steadily increased – a development that has continued up to the present day, and which clearly goes against what I would still call the spirit of Hippocratic medicine. His main reason for doing so is to show the contrast between his own and only correct treatment of the disease and the general confusion among other doctors: What part [of the body] is affected in phrenitis? This question has been raised particularly by leaders of other sects so that they may apply their treatments ac- cording to the different parts affected and prepare local remedies for the places in question. Now some say that the brain is affected, others its fundus or base, which we may translate sessio [‘seat’], others its membranes, others both the brain and its membranes, others the heart, others the apex of the heart, others the mem- brane which incloses the heart, others the artery which the Greeks call aorte, others the thick vein (Greek phleps pacheia), others the diaphragm. But why continue in this way when we can easily clarify the matter by stating what these writers really had in mind? For in every case they hold that the part affected in phrenitis This chapter was ﬁrst published in Dutch in Gewina 18 (1995) 214–29. The epistemological principles of the Methodists are discussed by Frede (1983) and by Lloyd (1983) 182–200. Now we hold that in phrenitis there is a general affection of the whole body, for the whole body is shaken by fever. And fever is one of the signs that make up the general indication of phrenitis, and for that reason we treat the whole body. We do hold, however, that the head is more particularly affected, as the antecedent symptoms indicate, e. But there are those who argue as follows: ‘We determine the part affected on the basis of the theory of nature (Greek phusiologia), for we know in advance that the ruling part of the soul is located in the head, and conclude that that must be the source of mental derangement. But the number and variety of symptoms occurring in the head have shown us that this organ is more particularly affected than the rest of the body. This discussion was to a certain extent determined by a lack of clarity about the evidential value of the etymological relation between the name of the disease and the Greek word phrenes, which had been used since Homer to indicate the midriff (later, the common term for this became diaphragm, as used here by Caelius). Some advocates of the location in the diaphragm appealed to this etymology,4 others were of the opinion that the name of the disease should not be related to any part of the body (be it affected or not), but to the faculty that was affected (phronein, phronesis¯ , standard terms in Greek for what we would call ‘intelligence’ or ‘consciousness’). Another signiﬁcant fact is that Caelius Aurelianus criticises his predeces- sors’ strong desire to locate the condition in one particular place in the body, and their presupposition that this place should also be the seat of the mind (the faculty affected in the case of phrenitis). Heart, brain, blood, pneuma 121 any particular place, but that the entire body is ill and therefore the entire body requires treatment. Another characteristic of the Methodists is that speculations on the location of the mind are rejected for being pointless, as it is impossible to reach conclusions on the matter on empirical grounds, and the doctor should abstain from expressing any opinions (‘ﬁrst of all it is still uncertain which part of the body is the leading part’). This attitude is inspired by the close connection between the epistemological views of the Methodists and those of the philosophical school of the Sceptics, who on principle refuse to express opinions on any non-perceptible matters. In addition, the Methodists consider such questions irrelevant to therapeutic practice, which they regard as the focus of medical science. Whether Caelius Aurelianus does justice to all his medical predecessors by presenting matters as he does is very much the question. Recent research into the principles and methods of doxography (the description of the doxai, the characteristic doctrines of authorities in a certain subject) has revealed that the question ‘What is the leading principle in man and where is it located? It became a favourite subject for practising argumentation techniques (comparable to questions such as ‘Is an embryo a living being? Such ‘dialectic’ staging of a debate bears little relation to a historically faithful rendition of a debate that actually took place in the past.