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By I. Irmak. Villanova University.

In Hippocratic and Galenic thought buy 10 mg ramipril visa pulse pressure uptodate, ab- sence of menstruation—or rather ramipril 10mg generic hypertension bench, retention of the menses generic 5mg ramipril fast delivery blood pressure medication ok for pregnancy, for the waste ma- terial was almost always thought to be collecting whether it issued from the body or not—was cause for grave concern generic 2.5mg ramipril fast delivery lennox pulse pressure test kit, for it meant that one of the major purgative systems of the female body was inoperative. It is for this reason that the largest percentage of prescriptions for women’s diseases in most early medi- eval medical texts (which reflected the Hippocratic tradition only) were aids for provoking the menses. Between the ages of fourteen (‘‘or a little earlier or a little later, depending on how much heat abounds in her’’)84 and thirty-five to sixty Introduction  (upped to sixty-five in the standardized ensemble), a woman should be men- struating regularly if she is to remain healthy. In overall length, the four sections on menstruation (¶¶– on the general physiology and pathology of menstruation, ¶¶– on menstrual retention, ¶¶– on paucity of the menses, and ¶¶– on excess men- struation) constitute more than one-third of the text of the original Conditions of Women. Throughout these long sections on menstruation, the author is adhering closely to his sources: the Viaticum for overall theory and basic therapeutics and the Book on Womanly Matters for supplemental recipes. In ¶, the author tells us that the menses are commonly called ‘‘the flowers’’ because just as trees without their flowers will not bear fruit, so, too, women without their ‘‘flowers’’ will be deprived of off- spring. This reference to ‘‘women’s flowers’’ has no precedent in the Viaticum (the source for the rest of this general discussion on the nature of the menses) nor in any earlier Latin gynecological texts, which refer to the menses solely as menstrua (literally, ‘‘the monthlies’’). Theterm‘‘flower’’(flos) had been used systematically throughout the Trea- tise on the Diseases of Women (the ‘‘rough draft’’ of Conditions of Women, which had employed frequent colloquialisms), and at least fourteen of the twenty- two different vernacular translations of the Trotula (including Dutch, English, French, German, Hebrew, and Italian) employ the equivalent of ‘‘flowers’’ when translating the Latin menses. But just as a tree which lacks viridity is said to be unfruitful, so, too, the woman who does not have the viridity of her flowering at the proper age is called infertile. Menstrual blood is like the flower: it must emerge before the fruit—the baby—can be born. In the Hippocratic writings themselves, although there is discussion of suffocation caused by the womb, the actual term ‘‘uterine suffocation’’ (in Greek, hysterike pnix) is never used. It was only out of loose elements of Hip- pocratic disease concepts (which were always very vaguely defined and iden- tified) that the etiological entity of uterine suffocation was created, probably sometime before the second century . Such movement was thought to be caused by retention of the menses, excessive fatigue, lack of food, lack of (hetero)sexual activity, and dryness or lightness of the womb (particu- larly in older women). When these conditions obtain, the womb ‘‘hits the liver and they go together and strike against the abdomen—for the womb rushes and goes upward towards the moisture. When the womb hits the liver, it produces sudden suffocation as it occupies the breathing passage around the belly. For example, when the womb strikes the liver or abdomen, ‘‘the woman turns up the whites of her eyes and becomes chilled; some women are livid. If the womb lingers near the liver and the abdomen, the woman dies of the suffocation. Multiple means of treat- ment were employed, including the recommendation that, when the womb moves to the hypochondria (the upper abdomen or perhaps the diaphragm), young widows or virgins be urged to marry (and preferably become preg- nant). This was premised, apparently,on the belief that thewombwas capable of sensing odors. Fetid odors (such as pitch, burnt hair, or castoreum) were applied to the nos- trils to repel the womb from the higher places to which it had strayed, while sweet-smelling substances were applied to the genitalia to coax the uterus back into its proper position. Not all the symptoms were listed every time uterine movement was men- tioned by the Hippocratic writers, nor did all cases of pnix involve uterine movement. Whenanattack occurs, sufferers from the disease collapse, show aphonia, labored breathing, a seizure of the senses, clenching of the teeth, stridor, convulsive contraction of the extremities (but sometimes only weakness), upper abdominal distention, retraction of the uterus, swelling of the thorax, bulging of the network of ves- sels of the face. The whole body is cool, covered with perspiration, the pulse stops or is very small. Critical to his views, and to all contemporary criticisms of the ‘‘wandering womb’’ (in- cluding Galen’s, as we shall see in a moment) were the anatomical discover- ies made at Alexandria in the third century . The womb ‘‘does not issue forth like a wild animal from the lair’’ but is instead ‘‘drawn together because of the stricture caused by the inflammation’’ of these uterine ligaments. Soranus also adamantly rejected the Hippocratic odoriferous therapy, or at least the part of it that employed foul- smelling substances. Yet for all his modifi- cations, Soranus never questioned the disease category itself. On the contrary, his thorough engagement with it was to help render it canonical in almost all later gynecological texts up through the Renaissance. Galen, active only a generation after Soranus, was more accommodating of traditional Hippocratic perspectives. Himself a highly experienced anato- mist,103 Galen no more than Soranus could accept the possibility that the womb actually wandered to various parts of the body since the diaphragm, if nothing else, absolutely prohibited movement to the thorax. He did not, however, question the by now traditional litany of symptoms, let alone the existence of the disease category. He, like Soranus, thought the womb could appear to be drawn up slightly because of inflammation of the ligaments. Yet to explain apnoia hysterike (difficulty of breathing caused by the uterus), Galen offered something of a compromise that would explain how the uterus, with- out moving to the upper parts, could still affect them. He posited a sympa- thetic poisonous reaction caused by either the menses or the woman’s own semen being retained in her uterus. Notable here is Galen’s shift in ideas about how semen and sexuality played into this dis- ease: for Galen, it was not her lack of semen provided by a man that made the widow susceptible, but the buildup of her own seed. Despite these dis- agreements,Galen maintained elements of the traditional odoriferous therapy, though he complemented this with bloodletting, massage, and a host of other treatments. Both Soranus and Galen represented the very highest theoretical tradi- tions of Greek medicine, catering as they did to the elite, Hellenized urban classes of Rome. Their views never eradicated what were apparently deeply rooted popular beliefs that the womb did indeed wander. Even Muscio, in the fifth or sixth century when hewas rendering Soranus into Latin, slipped in the more than suggestive phrase ‘‘when the womb moves upwards toward the chest’’ when referring to uterine suffocation; as he repeated this several times, it seems that he, too, thought the womb capable of more than ‘‘distension caused by the ligaments. One is written into a blank space of a late-ninth-century medical volume by a tenth-century Introduction  hand. Having invoked the aid of the Holy Trinity, the nine orders of the an- gels, the patriarchs, prophets, apostles, martyrs, confessors, virgins, and ‘‘all the saints of God,’’ the priest is to command the womb to cease tormenting the afflicted woman: I conjure you, womb, by our lord Jesus Christ, who walked on the water with dry feet, who cured the infirm, shunned the demons, resuscitated the dead, by whose blood we are redeemed, by whose wounds we are cured, by whose bruise[s] we are healed, by him I conjure you not to harm this maidservant of God, [her name is then to be filled in], nor to hold on to her head, neck, throat, chest, ears, teeth, eyes, nostrils, shoulders, arms, hands, heart, stomach, liver, spleen, kidneys, back, sides, joints, navel, viscera, bladder, thighs, shins, ankles, feet,or toes, but to quietly remain in the placewhich God delegated to you, so that this handmaiden of God, [her name], might be cured. The chief vehicle for Galen’s views in the twelfth century was, of course, Ibn al-Jazzār’s Viaticum. In discussing uterine suffo- cation in book , Ibn al-Jazzār had echoed Galen in asserting that ‘‘the sperm increases, corrupts, and becomes like a poison. Ibn al-Jazzār postulated that the putrefying menses and/or semen in the uterus produced ‘‘a cold vapor’’ that rose to the diaphragm. In the main chapter on uterine suffocation (¶¶– ), the author closely follows the Viaticum in laying out the standard litany of symptoms, recounting Galen’s cure (from On the Affected Parts), and positing the same causation: corrupted semen (or menses) is turned into a ‘‘venom- ous nature,’’ and it is this ‘‘cold fumosity’’ that ascends up to ‘‘the parts which are commonly called the corneliei, which because they are close to the lungs and the heart and the other organs of the voice, produce an impediment of speaking. This chapter (¶) is drawn from the alternate source, the Hippocratic Book on Womanly Matters. In the ‘‘rough draft’’ of Con- ditions of Women,theTreatise on the Diseases of Women, it was stated very clearly that movement of the womb to the upper body was possible: ‘‘Sometimes the womb [moves] from its place, so that it ascends up to the horns of the lungs, that is, the pennas [feathers], and [sometimes] it descends so that it goes out  Introduction of [the body] and then it produces pain in the left side. And it ascends to the stomach and swells up so much that nothing can be swallowed. The sign of this is that she feels pain in the left side, and she has distention of the limbs, difficulty swallowing, cramping, and rumbling of the belly. What this change in phrasing from the first draft does is dis- tinguish three nosological conditions: movement up to the respiratory organs (discussed in ¶¶–), prolapse downward, sometimes with complete extru- sion (¶¶–), and this third intermediate condition where it goes neither up nor all the way down. Conditions of Women’s allusions suggest that the ‘‘wandering womb’’ was indeed part of the general belief structure in southern Italyat this time. The ten- sion between, on the one hand, the Galenic/Arabic view of uterine suffocation as caused by either a sympathetic link between uterus and respiratory organs or the actual physical transmission of a noxious vapor and, on the other hand, the traditional Hippocratic idea of the ‘‘wandering womb’’ finds a graphic ex- pression in the work of Johannes Platearius, another Salernitan writer working at perhaps the same time that Conditions of Women was composed. Johannes Platearius had interpreted Ibn al-Jazzār’s reference to ‘‘fumes’’ as meaning that the fumes filled the uterus and caused it to move upward to the respiratory organs. Interestingly, he asserts that it is women who say they ‘‘have their womb in their stomach’’ or in their throat or at their heart. It was a gen- eral medical assumption throughout most of the medieval period that women needed regular sexual activity in order to remain healthy.

Netherlands Saudi Arabia Netherlands Antilles Seychelles New Caledonia Slovakia New Zealand Trinidad and Tobago Northern Mariana Islands Uruguay Norway Venezuela (Bolivarian Republic of) Portugal Qatar Republic of Korea San Marino Singapore Slovenia Spain Sweden Switzerland United Arab Emirates United Kingdom United States of America United States Virgin Islands 168 Annex 3 cheap 10mg ramipril free shipping heart attack vol 1 pt 3. Three main approaches were initially considered: (1) Estimation of the economic impact was based on projec- econometric estimation and projections order ramipril 5 mg amex blood pressure chart age 60; (2) economet- tions to 2015 for nine countries: Brazil 5 mg ramipril free shipping blood pressure 80 60, Canada discount ramipril 10 mg on-line blood pressure is highest in the, China, ric estimation and calibration; and (3) straightforward India, Nigeria, Pakistan, the Russian Federation, the calibration using information on variables from various United Kingdom and the United Republic of Tanzania. The third approach was adopted for this phase The focus was on heart disease, stroke and diabetes. K = capital accumulation Historical savings rates, depreciation, were obtained from L = labour inputs the World Bank Development Index database. There was difficulty in obtaining data for capital accumulation in the Russian Federation; this was then set to the average of countries. World Bank Economic Review, changes in population health in the assessment of 2001, 15:177–219. Sources of economic growth: an extensive accounting or changes in life expectancy from disease, estimated exercise. This would correspond to a rate of decrease in economic welfare due to mortality increase of 2% per annum. This approach, which may seem more complete than the previous approaches, does not account for the total value of the changes in health. It is, however, useful in that it demonstrates fuller returns to investment in health compared to the above approaches. Estimation should be of interest to country development strategists and policy-makers in the health and finance sectors, and also useful for international comparison. The model was programmed to compute output if there were no deaths due to chronic disease (the counterfactual) against out- put given the projected deaths from chronic disease on an annual basis. This procedure was then repeated for estimating the global goal of an additional 2% annual reduction in chronic disease death rates over and above baseline projections, over 10 years from 2006 to 2015. All the variables in the Cobb-Douglas model were sub- jected to univariate and multivariate analysis (Monte Carlo) using Crystal Ball software. These contributions have been vital to the project, both in creating and enriching the report. The production of this publication was made possible through the generous financial support of the Government of Canada, the Government of Norway and the Government of the United Kingdom. Expert and Tropical Medicine, United Stéfanie Durivage reviewers do not necessarily endorse Kingdom Amanda Marlin the full contents of the final version. Klumbiene, Kaunas University of Auckland, New Zealand Office for Europe Medicine, Lithuania I. Sklodowska-Curie Josie d’Avernas, Health Promotion Health Institute, Finland Memorial Cancer Center and Institute Consulting, Canada Otaliba Libânio de Morais, Ministry of of Oncology, Poland Jarbas Barbosa da Silva Júnior, Health, Brazil Ministry of Health, Brazil V. Mohan, Madras Diabetes Research Ashley Bloomfield, Ministry of Health, Foundation, India New Zealand A. Nissinen, National Public Health Antonio Carlos Cezário, Ministry of Institute, Finland Health, Brazil C. Shanthirani, Madras Diabetes Deborah Carvalho Malta, Ministry of Research Foundation, India Health, Brazil Sania Nishtar, Heartfile, Pakistan Rhona Hanning, University of Waterloo, Rafael Oganov, State Research Centre Canada for Preventive Medicine, Russian Lenildo de Moura, Ministry of Health, Federation Brazil J. Dzerve, National Institute of for Preventive Medicine, Russian Cardiology, Latvia Federation Brodie Ferguson, Stanford University, R. Overall, this set of photographs Steve Ewart and stories from five diverse countries demonstrates that chronic diseases are Maryvonne Grisetti widespread in low and middle income countries and are an underappreciated Peter McCarey source of poverty, requiring comprehensive and coordinated responses. Namperumalsamy, Aravind Eye Reda Sadki Silvio Mariotti Hospital, Madurai Gopal Prasad Pokharel A. Saguti, Ministry of Health, Diego Neri Oliveira e Silva Mzurisana Mosses United Republic of Tanzania, Marystella M. Sarswathy Stephanie Cruickshank Kaushik Ramaiya, International Mana Sekaran Martin Hession Diabetes Federation, Dar es Salaam Menaka Seni Melanie Keane Ramadhan Mongi, International A. Department of Health and Human Services 2 Global Health and Aging Photo credits front cover, left to right (Dreamstime. Rose Maria Li Contents Preface 1 Overview Humanity’s Aging 4 Living Longer 6 New Disease Patterns 9 Longer Lives and Disability 12 New Data on Aging and Health 16 Assessing the Cost of Aging and Health Care 18 Health and Work 20 Changing Role of the Family 22 Suggested Resources 25 3 4 Global Health and Aging Preface The world is facing a situation without precedent: We soon will have more older people than children and more people at extreme old age than ever before. As both the proportion of older people and the length of life increase throughout the world, key questions arise. Will population aging be accompanied by a longer period of good health, a sustained sense of well-being, and extended periods of social engagement and productivity, or will it be associated with more illness, disability, and dependency? Are these futures inevitable, or can we act to establish a physical and social infrastructure that might foster better health and wellbeing in older age? How will population aging play out differently for low-income countries that will age faster than their counterparts have, but before they become industrialized and wealthy? A better understanding of the changing relationship between health with age is crucial if we are to create a future that takes full advantage of the powerful resource inherent in older populations. And research needs to be better coordinated if we are to discover the most cost-effective ways to maintain healthful life styles and everyday functioning in countries at different stages of economic development and with varying resources. Managing population aging also requires building needed infrastructure and institutions as soon as possible. The longer we delay, the more costly and less effective the solutions are likely to be. We are only just beginning to comprehend its impacts at the national and global levels. As we prepare for a new demographic reality, we hope this report raises awareness not only about the critical link between global health and aging, but also about the importance of rigorous and coordinated research to close gaps in our knowledge and the need for action based on evidence-based policies. Since the beginning of recorded parasitic diseases that most often claimed history, young children have outnumbered the lives of infants and children. A World Health Organization expectancy over the past century were part analysis in 23 low- and middle-income countries of a shift in the leading causes of disease estimated the economic losses from three and death. At the dawn of the 20th century, noncommunicable diseases (heart disease, Figure 1. Young Children and Older People as a Percentage of Global Population: 1950-2050 Source: United Nations. The limits to life expectancy and and health conditions is one key to holding lifespan are not as obvious as once thought. The health And there is mounting evidence from cross- and economic burden of disability also can national data that—with appropriate policies be reinforced or alleviated by environmental and programs—people can remain healthy characteristics that can determine whether and independent well into old age and can an older person can remain independent continue to contribute to their communities despite physical limitations. Prevalence of dementia rises and ill health in developing countries will be sharply with age. An estimated 25-30 percent entering old age in coming decades, potentially of people aged 85 or older have dementia. Aging is taking place alongside other broad social trends that will affect the lives of older people. Economies are globalizing, people are more likely to live in cities, and technology is evolving rapidly. Demographic and family changes mean there will be fewer older people with families to care for them. People today have fewer children, are less likely to be married, and are less likely to live with older generations. By 2050, this number is expected to fell with surprising speed in many less developed nearly triple to about 1. Between 2010 and 2050, the number of older Most developed nations have had decades to people in less developed countries is projected to adjust to their changing age structures. In contrast, many less This remarkable phenomenon is being driven developed countries are experiencing a rapid by declines in fertility and improvements in increase in the number and percentage of older longevity. With fewer children entering the people, often within a single generation (Figure population and people living longer, older 2).

Secundum magistrum Ferrarium buy ramipril 5mg overnight delivery hypertension yoga poses,45 accipe magnam nucem et decoque sub cinere eta nucleum tere ramipril 2.5 mg low cost heart attack quiz questions, et fissure appone apposito tartaro et sanabitur purchase ramipril 5mg overnight delivery arrhythmia triggers. Facimuse eis recipere uinum in ore in quo bullieritf zinziber cheap 10 mg ramipril fast delivery pulse pressure 63, galangam, et post ablutionem circa dentes puluerem olibani superaspergimus,g et cumh eodem uino facimusi osj abluere hiisk qui habent palatum excorti- catum, et post alumen cum zucchara46 apponamus. Puluis zinziberis, pi- retri, et cynamomi decoquimus in uino et facimus gargarizare, et puluerem horum calidorum apponimus uuule. Pulueres uerod etiame predictos in posterioribus facimus insufflare per nares ne tume- scant. Accipe albu- minab ouorum51 et distempera cum aqua in qua coctum sit pulegium et huius- modi herbe [rb] calide et panno nouo linic intinctod bis uel ter in diee uuluef ¶a. On Treatments for Women  [] Likewise there are other women who suffer fissures caused by the air and the wind and similar causes. For these, then, we anoint the lips with honey, and afterward we sprinkle on powdered Greek pitch. And after tartar has been put on, apply [the walnut] to the fissure and it will be healed. On Loosening of the Teeth [] There are somewomen in whom the teeth are loosened by the cold. We make them take in their mouth wine in which gin- ger and galangal have been boiled, and after this ablution we sprinkle powder of frankincense around the teeth. And for those who have an excoriated palate, we have the mouth washed with this same wine, and afterward we apply alum with sugar. We cook a powder of ginger, pellitory, and cinnamon in wine and we make them gargle, and we apply a powder of these hot things to the uvula. On Prolapse of the Vagina of Women [] In prolapse of the vagina after birth we place a tampon, pressing it so that it does not come out except when she urinates. Also we make the powders mentioned above in later [chapters] be blown through the nostrils lest they become swollen. Take the whites of eggs40 and mix them with water in which pennyroyal and hot herbs of this kind have been cooked, and with a new linen cloth dipped ¶a. Et nota quod prius abluenda est bene cum eademi aqua calida cum qua fuerint ista distemperata. Accipe gallas, rosas, sumac, plantaginem, consolidam maio- rem, bolum armenicum, alumen,a chimoleam, ana unciam. On Treatments for Women  in it, place it in the vagina two or three times a day. And note that prior to this the vagina ought to be washed well with the same warm water with which these things were mixed. Having ground it, dis- solve it with rainwater, and with a linen or cotton cloth place it in the vagina in the above-mentioned manner. Let the woman sit in water where there have been cooked marsh mallows and pennyroyal, and she will be freed. For Swelling of the Face [] For sudden swelling of the face, a fumigation of hot water alone suffices. Ad hoc facimusb ma- turatiuum de malua et maluauisco, absinthio, arthimesia, et auxungia, et cum caputc apparuerit,d contere nucleose et appone. Et sif non rumpitur cum flebo- tomo aperiatur, et exprimeg parum in principio ne subita euacuatione malum fiat, et inpone licinium singulis diebus bis uel ter, illinitum cum uitello oui. Istis facimus pannum in uino intinctum in quob bullierint folia mirtilli, uelc ipsa herba ueld ipsi mirtilli. On Treatments for Women  On Pain of the Breasts [] For pain of the breasts caused by milk, we should mix clay with vinegar and make a plaster; this diminishes the pain and constricts the milk. On Lesions of the Breasts [] There are some women who have lesions in the breasts. For this we make a maturative from marsh mallow and mayweed, wormwood, mugwort, and animal grease, and when the head [of the lesion] appears, grind together nuts and apply them. And if it does not rupture let it be opened with a lancet, and press out a little in the beginning lest by a sudden evacuation it becomes bad, and each day apply a piece of lint twice or three times smeared with egg yolk. For this cleans every fistula and makes it become necrotic, as long as it is not between any bones. On Foul-Smelling Sweat [] There are some women who have sweat that stinks beyond measure. For these we prepare a cloth dipped in wine in which there have been boiled leaves of bilberry, or the herb itself or the bilberries themselves. Accipe pulegium, policariam, quatuor frondes lauri, et bullianta in aqua, et facias eam sedere in aqua ista, et postb fac de omni- bus fumigium. On Treatments for Women  On Swelling of the Vagina [] For swelling of the vagina. Take pennyroyal, fleabane, and four fronds of laurel, and boil them in water, and you should make her sit in this water, and afterward make a fumigation from all these [herbs]. For Antlike Itching and Itch-Mites [] For antlike itches and itch-mites wherever they might be in the body, especially in the face and on the forehead, we mix grain with wine, and with a powder of frankincense applied in the manner of a plaster, we place it on the [afflicted] spot. On Pain of the Eyes [] For pain of the eyes, take marsh mallow, the herb of violets, tips of bramble, dried roses, vervain, and sermountain. OnW eboftheEye [] If there is a web in the eye, take conch and frankincense and burn them. Take two parts of aloe, and as much frank- incense and plaster of Paris as of the aloe; pulverize them finely and prepare them with fresh animal grease and anoint the place. On Cancer of the Nose [] For cancer of the nose, take lungwort, sage, Greek tar, wild garlic, and ‘‘blacking,’’ that is, earth of the countryside,45 and pulverize them all equally. Et cum exierit de balneo, pista maluam,e arthimesiam, camphoram, et eas pistatas in olla calefacias, et informa magdaleones cum oleo laurino uelf pulegino pauco, et suppone. Tunc accipe tribu- los marinos et coque in aqua marina uelb salsa, et [vb] fumiga pedes sepe, et post fumigium cum fomentumc erit tepidum, lauabis pedes. Postea accipe semen urtice et cornu cerui, et da puluerem inde factum ad bibendum cum uino. Afterward, grind root of delicate willow and root of madder, and give the juice to the patient with wine. Cook all these herbs in water thoroughly, and make the patient sit in it up to her breasts. And when she exits from the bath, pound marsh mal- low, mugwort, and camphor, and warm these pounded things in a pot, and make lozenges with laurel oil or a little pennyroyal oil, and insert them as a suppository. On Swelling of the Feet [] Sometimes it happens that the feet are swollen due to pain of the womb. Then take sea brambles and cook them in sea- or saltwater, and fumigate the feet often. And after the fumigation, when the mixture has become lukewarm, you will wash the feet. Afterward, take nettle seed and buck’s-horn plantain, and give a powder made of this to drink with wine. Accipe paleam auenea et combure in cineres, post apponatur aqua calida quantum patiens sustinere poterit, et intus teneat pedes quous- que infrigidentur. Accipe pinguedinem anguillarum recentium que apparet post decoctionem illarum, et [rb] succum caprifolii, et barbe Iouis, et ouorum formicarum plenam palmam, tere et cola,b et hec omnia simulc cum oleo misceanturd et decoquantur. On Treatments for Women  [On Cutting the Umbilical Cord] [] When the umbilical cord of the child is cut, you should say as follows, holding the stump extended: ‘‘Jesus Christ is dead, he was pierced by the lance, and he took no thought of any ointment or of his pain or of any unguent.

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