By D. Roland. State University of New York College of Environmental Science and Forestry. 2019.

The patient should be placed on a reduced fat diet and use 12 dietary fats high in polyunsaturated or monosaturated fatty acids (e effective 5 mg enalapril blood pressure ranges in pregnancy. Foods 14 with both added refined sugar and saturated fatty acids should be strictly 15 avoided purchase enalapril 5mg without a prescription blood pressure monitor walmart. Therapy should be combined with regular aerobic exercise for best 16 results enalapril 5mg without prescription hypertension 16080, according to recent research discount enalapril 10 mg mastercard blood pressure zetia. Their therapeutic action is directed against important mechanisms in- 20 volved in the development of atherosclerosis. Moreover, they are 23 not covered by most health care insurers when used primarily for prophy- 24 lactic purposes. In- 15 creased venous pressure and oxygen free radicals render the venous walls in- 16 creasingly permeable, allowing fluids, leukocytes, and proteins to escape into 17 the adjacent tissues. This results in edema formation and a reduced supply of 18 nutrients and oxygen to the surrounding tissues. Ointments penetrate into the deeper tis- 50 sues and are therefore more suitable for inflammatory processes. The therapeutic effects 11 should develop within around 3 to 5 days of oral administration. High-dose horse-chestnut formulations should 14 not be used in the last two trimesters of pregnancy or when nursing a baby 15 unless absolutely necessary. Individuals with congenitally narrow sinuses or narrowing of 19 the sinuses due to chronic allergy-related inflammation are especially 20 prone to sinusitis. The membranes start to 24 produce a very thick discharge (dyscrinism) that is an ideal breeding 25 ground for bacteria. The mucociliary clearance mechanisms responsible 26 for transporting the discharge out of the mucous membranes become 27 inactivated. The condi- 31 tion can become chronic if acute episodes do not fully subside before the 32 next bout. They do not damage the mucous membranes of the 45 nose, even when used for long periods of time, if administered at low doses. In 46 the case of sinusitis, a qualified physician should determine whether antibiotic 47 treatment is necessary. If this is not 13 possible, administer chamomile nose drops or chamomile cream to each 14 nostril, 3 to 4 times a day. They also have secretolytic, antimicrobial, and antiviral 23 effects, but do not reduce swelling of the mucous membranes. Infants and small children should not inhale peppermint oil or use 28 nasal ointments containing menthol. These herbal remedies should never 36 be applied to the face or to large areas of the chest or back of infants and 37 small children. Cam- 44 phor: Apply the ointment directly to the chest, several times a day, to inhale 45 the vapors. The immunostimulatory effect of echinacea develops over a few 6 days of oral administration. The expected ben- 15 efits of treatment must clearly outweigh the potential risks. The roots, leaves, 18 seeds, or flowers are included in many products, and are sometimes 19 blended. Pregnant women should 38 not use echinacea unless directed by a qualified health care practitioner. Viral and secondary 5 bacterial infections are especially common in individuals with temporary 6 or permanent asthenia of the unspecific (congenital) or specific (acquired) 7 immune system. When the body (especially 10 lower body) is subjected to hypothermia or ischemia, it responds by reduc- 11 ing the blood flow to the mucous membranes in the upper respiratory pas- 12 sages. This and the drying of the mucous membranes due to excessive room 13 heating promote the growth of pathogens. Nasal douches, throat wraps, inhalation, sweat-inducing agents 18 (diaphoretics), and baths with aromatic herbs have proved to be effective. Activated macro- 49 phages secrete interleukin-1, interleukin-6, and tumor necrosis factor-α, 50 5. These mechanisms are activated when the pa- 3 thogen comes in contact with the oral mucous membranes. In those who already have a cold, 11 the course of the infection is less severe and the symptoms subside more 12 quickly. Since many antibiotics can suppress the immune system, these 13 herbal remedies should be helpful in patients with bacterial infections. Their effectiveness is not proven with clinical trials; they 8 fall more into the realm of pleasant-tasting home remedies. It can prevent the outbreak of a cold 18 if treatment by footbath is started early enough. When used for footbaths, add enough warm water 24 to cover the feet and ankles (see p. Prolonged exposure can cause skin irritation 27 and blistering, especially in patients with sensitive skin. The efficacy of 2 the herbal remedy is questionable when treatment is started at the climax 3 of the disease. Products 9 manufactured from the fresh, or recently-dried plants are preferred by most 10 herbalists. Oral administration of alcoholic ex- 13 tracts and homeopathic tinctures (mother tinctures to D2 tinctures) is report- 14 ed to be more effective than other preparations. The current data suggest that 15 preparations combining echinacea with other herbs are more effective than 16 echinacea alone. Supposed risks must be carefully 21 weighed against the expected but unproven benefits of treatment. In the early phases 26 of manifest disease, administer for a period of no less than 6 days and no 27 more than 14 days. The bronchial passages become ob- 7 structed owing to the thick mucous secretions and inflammation. The viscosity of the mucus starts to decrease over the 13 course of time (2 to 3 weeks). The damaged 21 membranes provide a foundation for further complications, such as pul- 22 monary emphysema, bronchiectasis, and bronchopneumonia. The bronchial glands are swol- 28 len, and large quantities of neutrophil granulocytes and macrophages 29 are present, even in the alveolar fluid. In mild cases, the patient should 32 drink large quantities of tea made from herbs selected according to the type 33 of cough. Expecto- 35 rants, preferably those with antispasmodic or immunostimulatory effects, 36 can be prescribed later if necessary. Eating large amounts of 27 eucalyptus candy can induce nausea and vomiting in children. Horseradish root can 21 cause isolated allergic side effects; higher doses of the herbal remedy can 22 cause gastrointestinal upsets. These pro- 17 ducts are safe to use, even by patients on concomitant antibiotic treatment.

The subspecialty exams; however enalapril 5 mg otc arrhythmia technology institute south carolina, the exact subspecialty of maternal-fetal medicine 55 proportion is not specified discount enalapril 5mg fast delivery blood pressure and age. Also 64 one-half percent of the forensic psychiatry across a range of medical specialties enalapril 10 mg on-line blood pressure chart in europe. The role and six percent of the psychosomatic of the addiction medicine physician discount 10 mg enalapril otc blood pressure chart bottom number, as a medicine subspecialty exams are devoted to member of an interdisciplinary team of health 59 professionals, includes examining patients to substance use/addiction. Substance use/addiction also is listed as a subtopic in establish the presence or absence of a diagnosis of addiction; assessing associated health * conditions that are brought on or exacerbated by Subspecialty certifications in the same area may be the use of addictive substances; participating in offered by more than one medical board. For the development and management of an example, the geriatric medicine subspecialty certification administered by the American Board of integrated treatment plan; prescribing and Internal Medicine also can be obtained by physicians monitoring patients’ use of addiction treatment specializing in family medicine; the adolescent medications and therapies; providing direct medicine certification administered by the American treatment and disease management for Board of Pediatrics also can be obtained by individuals with severe cases of addiction and physicians specializing in internal medicine and providing consultation to other primary and family medicine; the pediatric emergency medicine 65 specialty care providers. To become certified exam administered by the American Board of in addiction medicine, applicants must meet Pediatrics also can be obtained by physicians specific educational and clinical requirements specializing in emergency medicine; and the sports including: medicine subspecialty certification administered by the American Board of Family Medicine also can be obtained by physicians specializing in internal medicine, pediatrics and emergency medicine. The American Board of from a school of osteopathic medicine Psychiatry and Neurology, Inc. The precise scope of their practice varies according to the regulations of each state. Other delegate prescription privileges to physician research found that many nursing education 82 assistants and all states except Florida and programs do not teach current information 87 Kentucky allow physician assistants to prescribe related to addiction. The National League for certain controlled substances under medical Nursing Accrediting Commission and the 83 supervision. Yet physician assistants, like Commission on Collegiate Nursing Education, other medical professionals, receive little the two main accrediting agencies for nursing training in addiction in spite of the fact that they schools, do not require addiction to be part of † 88 can prescribe controlled substances. States offer several categories of topics on the licensing exams for registered and 89 licensing in the nursing profession, each with practical/vocational nurses. The American different standards, practice limitations and Academy of Nursing recently published new supervision requirements. They include agencies and professional boards for specific knowledge about the disease of addiction, licensing standards for nurses. Licensed clinical and counseling addiction as a licensed psychologist for at least 97 psychologists must obtain a doctorate degree one year. They also must pass a national licensing examination, the Examination continues to support the credential for for Professional Practice in Psychology, previously-certified psychologists who maintain administered by the Association of State and their certification by engaging in appropriate 94 continuing education. Vermont and West Virginia offer a psychologist license at the discontinue the certification program for new * applicants was based in part on insufficient master’s level. All 99 and universities or specialty addiction treatment states license mental health counselors and, programs--clinical and counseling psychologists with the exception of the “professional †† encounter many patients who engage in risky counselor” license in Illinois, all states require substance use or have addiction. Psychologists at least a master’s degree in counseling or a often hold administrative and supervisory related field. The complete at least a semester course in addiction significance of these categories depends on the state’s detection and treatment. The master addictions programs in counseling offer elective courses counselor certification requires (1) a minimum but do not require substance use/addiction- of 12 semester hours of graduate coursework in related course work. Most counseling and (3) a passing score on the examination for degree programs do not provide any addiction 103 107 master addictions counselor. Marriage and certification exam if they pass the national family therapists either must have a master’s 104 exam. Each state widespread use, there is very little research determines the examination required for supporting the efficacy of auricular acupuncture licensure. In Alabama -that require social workers to complete and North Dakota, which do not have licensure † 113 coursework in addiction. A 1998 survey similarly found that 56 percent of licensed addiction counselors 126 Addiction counselors, also known as Substance have at least a master’s degree. Similar to addiction treatment provider staff in facilities the licensure process, certification recognizes providing addiction treatment in the United that addiction counselors have met what the 122 organization deems to be minimum standards of States. In some Addiction counselors can be licensed, certified states addiction counselors must be certified 123 129 or both. The state education qualifications for licensure vary training standards for the credentialing of ‡ 125 addiction counselors--each state certification greatly. The highest level usually documentation; and professional and ethical requires a master’s or doctorate degree. Requirements In spite of the limited education and training include: (1) a current state certificate or license requirements and the apprenticeship model of as an addiction counselor; (2) 270 contact hours training, the essential practice dimensions of of addiction counseling training; (3) three years addiction counseling are defined as including of full-time work experience or 6,000 hours of clinical evaluation; treatment planning; referral; supervised experience as an addiction counselor; service coordination; and individual, group, 138 and (4) successful completion of a written family and couples counseling --practices that 135 examination. In many states, counselors who meet only the † In states where no degree is required, certification minimum education requirements must be requirements typically include 270 hours of supervised. For no other health condition are such exemptions from  Requirements related to services to be routine governmental oversight considered delivered; or acceptable practice. District of Columbia), including the use of the Participation is voluntary and the survey does not Lexis/Nexis database to supplement information represent all treatment providers. A national The federal government does not regulate study of state-run treatment programs found that, addiction treatment facilities or programs, with excluding programs provided or operated by the the exception of those that provide opioid state addiction treatment agencies, only about 149 maintenance therapy. Like state licensing laws, these provisions include requirements regarding  13 states report that their juvenile justice staffing, services and quality assurance system operates treatment programs, with mechanisms. To be eligible to receive Medicare/Medicaid reimbursement, most treatments must be  Seven states identify their departments of provided by or under the supervision of a 151 child and family services as operating physician. State Medicaid programs have the treatment programs, with only four requiring option of covering addiction treatment under the 147 Medicaid rehabilitation option, Medicaid clinic adherence to state licensing standards. The Medicare/Medicaid programs, but in only 11 states are these Conditions of Participation impose extensive programs required to adhere to state requirements on participating facilities including 148 staffing, services and quality assurance licensing standards. While most states do not appear explicitly to address faith-based programs in their laws or regulations, some states explicitly exempt such † programs from regulation. Accreditation generally is required by federal law to obtain certification considered a higher standard of oversight than from the U. While adopting these standards maintenance programs found that voluntary 156 accreditation was strongly related to adoption of largely is voluntary, some states grant licenses 157 these practices; however, after accreditation to programs that have been accredited, such that the program is deemed to have met the state became mandatory in 2000, this relationship licensure requirements because it has been disappeared. The authors speculated that † 158 programs that voluntarily seek accreditation tend approved by a national accrediting body. By granting “deemed status” licenses to accredited to be resource-rich (in funds, staff and training) programs, the state essentially delegates to the and more motivated to improve their quality of accrediting body its responsibility for ensuring care, and therefore more likely to adopt 165 that the facility or program meets state licensure evidence-based practices. Accreditation standards are more detailed than state licensing requirements The five organizations that accredit addiction and while some require facilities and programs treatment programs and facilities in the United to use evidence-based practices or to analyze States are: 160 patient outcomes, not all do. Similarly, facilities voluntarily responding to a national federal requirements stipulate that some types of † survey: care must be provided under the supervision of a physician, while services such as “rehabilitation  56. The categories are Dentists and other health professionals may be not mutually exclusive, as programs and facilities responsible for services they are qualified to perform may have multiple accreditations. Among the 21 medical services are defined as detoxification, states that specify the minimum educational/ opioid replacement therapy or the assessment, training requirements for this position, few have diagnosis and treatment of co-occurring medical particularly high standards: or mental health conditions, not as addiction 181  Eight states require a minimum of a master’s treatment itself. Few states require non-hospital- based programs that do not provide opioid  One state requires an associate’s degree; and maintenance therapy to have a physician serving as medical director or on staff; 10 states require  One state simply requires the person to residential treatment programs to have a demonstrate competence to perform certain physician either as a medical director or on staff services. Without a physician as A national survey of treatment professionals medical director or on staff, addiction treatment conducted in 1998 found that 60. Organizations that seek percent had some college or an associate’s elective accreditation for assertive community ‡ degree and 1. In states that The Joint Commission allows programs to provide addiction treatment using Medicaid define the qualifications required for staff to funding, hospital and clinic services must be perform their job and requires staff who provide 187 provided under the direction of a physician, care to be licensed, certified or registered “in but if states choose to provide services under the accordance with the law.

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All texts invariably construct the discourse of human culpability and active agency in connection with God’s pestilential punishment by for example reiterating references to human ‘wilful consenting’ to 4 I have not modernized the spelling in my quotations from early texts or cor- rected any printing mistakes safe enalapril 10 mg blood pressure zetia. The first is to further prayer and repentance: writings which elaborate on wilful sinning aim to stimulate energetic personal initiatives towards reformation order enalapril 10 mg fast delivery arrhythmia signs and symptoms. Indeed buy enalapril 10 mg otc blood pressure medication to treat acne, great care is always taken to associate descriptions of plague as God’s scourge with accents on its quality as a just and deserved retribution enalapril 5 mg without prescription blood pressure medication pills, a pesti- lential visitation sent by a just God to his creatures who have ‘justly deserved’ it (Grindal 1563: 484). A text of exceptional persuasive cha- racter and capillary dissemination, the collection of plague prayers published in 1563 by the Bishop of London Edmund Grindal for use in each English church and household, includes this invocation: “turn away from us this his plague and punishment, most justly poured upon us for our sins and unthankfulness” (1563: 78). The discourse of divine clemency and fairness in association with open or implied references to human culpability is furthered by stress on divine patience: God has repeatedly forgiven sinners and has urged repentance; only “at length” has he begun “to stretch forth his v punishing hande” (Pullein 1608: D2 ). Other writings propose the same notion of a merciful God by presenting plague as the product of divine love: “God most mercifully chastiseth his Children for their sinnes […] that they might […] flee vnto him for help” (I. Semantic fields in the discourse of plague Within the discourse of plague as punishment, two semantic fields ‒ one concerning communication, the other law ‒ are worth noting. As regards the first, the disease is frequently presented as God’s means of communication with his disobedient creatures, as a sort of “messen- Ideological Uses of Medical Discourses in Early Modern English 53 ger” (Hooper 1553: A2). An evocative treatment of this function of pestilence is found in the first-hand account of the great London epi- demic of 1665 by the nonconforming preacher Thomas Vincent. In a passage characterized by a didactic and pedantic tone, the London minister points out that “God being a Spirit, hath no Mouth nor Tongue properly as men have, […] therefore his way of speaking is not like ours”; indeed, he speaks “by terrible things” and his voice is “loud and full of terrour”. As if reading a list of charges in court, authors compile long and detailed catalogues of sins which have occasioned an “awakening judgment” (Vincent 1667: 21), a “fearfull iudgement of the Lord” (Pullein 1608: E) in the form of a pestilential 5 visitation. Metaphors used to describe plague often include terms from the judicial area: plague is an “extra ordinary magistrate to v reforme and punish […] synne” (Hooper 1553: B3 ) and a “Nimble v executioner of the Diuine Iustice” (Dekker 1630: A4 ). While all texts, in connection with characterizations of plague as punishment, refer to some extent to divine wrath, some writings inflect this theme and depict the terrible image of a pitiless, blood- thirsty God at war with humanity. As with the discourse of human cul- pability discussed above, emphases on God’s fearfulness are generally more numerous and forceful in texts designed, by rousing terror, to convince people of the extreme virulence of the present epidemic requiring an extraordinary effort in terms of universal prayer and fasting, or in writings, especially by nonconformist ministers, which lay stress exclusively or predominantly on the supernatural origin of plague. I suggest that frequent and often particularly vehement refer- ences to God’s cruelty and fearfulness may also function as more or 5 Interesting lists are found in Vincent (1667: 51) and Church of England (1603: C3v). Drawing inspiration from and at the same time adding to a repertoire of scriptural images, numerous plague writings lay stress on God’s bellicose attitude. Hence, the epidemiolo- gical weaponry of the pestilential bacillus ─ the intensity of pain, the horror of signs, the rapid demise of victims ─ is transfigured in depic- tions of God’s weapons: sharp arrows, for a precise, mortal wound, a sword, a rod. The semantic field of military operations is evoked by frequent occurrences of expressions within the battle domain: thus God is cast as a “furious enemy” (Vincent 1667: 176) who negotiates “the retrait from the battell” (Pullein 1608: E) with his afflicted creatures. The terrifying sounds of the battlefield echo in plague writings which often include mentions of the “drum of God’s wrath” and the “Trumpet vnto the Lord’s battels” (Pullein 1608: E). This image of a bellicose God is a commonplace of all texts, including those by lay authors, like Kellwaye, a “Gentleman” writing for “the loue and benefit of his fellow countrymen”, who warns that God “hath determined to strike vs at the quicke” (1593: A3). Plague writings seem to document a general attempt to make sense of the enormity of the calamity in recognizable and acceptable terms as a no quarter war declared by God who typically destroys, smites, strikes, slaughters, slays and kills. He is an invincible enemy whose records on the battlefield include the annihilation of thousands in just three days with a pestilential visitation in response to David’s trespasses as Bishop Grindal reminds the English people (1563: 479). Military vocabulary and imagery extend to God’s ministers: since their vehement urgings to repent and hence parry the divine blow have fallen on deaf ears, they have joined the exterminating army: “now must you heare vs strike vp the drum of God’s wrath, and sound out the Trumpet vnto the Lords battels” (Pullein 1608: E). In addition to these volunteer drummers and trumpeters, God’s army in- Ideological Uses of Medical Discourses in Early Modern English 55 cludes redoubtable fighters like “venimous Aspes, and bloodie Lyons, Sathan and his wicked spirites” (Holland 1603: 53). The discourse of God’s enmity and bellicosity had universal currency, conveyed as it was not just through repeated elaborations in sermons and miscellaneous texts on Scriptural warnings that “the ar- rowes of the Lord are drunke with blood and his sword doth not cease deuoring of mans flesh” (Pullein 1608: E), but also in the iconogra- phical apparatus of widely circulated broadsheets and bills of morta- lity which was characterized by a version of the medieval danse macabre: God’s angel brandishes a sword and hovers from a pesti- lential cloud over cities and villages while a triumphant Death with his usual attributes, the hourglass and dart, is surrounded by coffins and corpses. As Sheils points out: “explanations of disease in terms of God’s will to punish and in terms of natural pheno- mena could be reconciled by theories of primary and secondary causa- tion” (1982: 89). Unsurprisingly, the balance between supernatural and natural explanations fluctuates in a remarkable way according to the characters and purposes of texts. Hence surgeon William Boras- ton, after a prefatory mention of sin as plague’s primary cause, first enlarges on the secondary means used by God to infect villages and cities, “astrall Impression”, “the coniunction of Saturne and Mars”, “Eclipses”, then alerts readers on the role of “the breath, heat, sweat, smell, habitation, and garments from the sicke” in contagion (1630: 1- 3). Bishop Hooper, on the other hand, while allowing for causes 56 Paola Baseotto v “naturall and consonaunte to reason” (1553: A3 ) like corrupt air which generates pestilential vapours from water or unbalance of the four humours, lays great stress on the supernatural origin of plague when he admonishes that “yuell humors” cannot be “engendered of any meates, were not the man that useth them corrupte and first infected with sinne; […] and soo altereth not by chaunce, nor by the influence of starres, the holesomnes of the ayer intoo pestylente and contagyouse infectyon” but because of “synne and contempte of v gooddes holye woorde” (1553: B3, B3 ). Some writings transcend the discourse of primary and seconda- ry causes by postulating the existence of two kinds of plague, one ut- terly supernatural, the other entirely natural. The first proceeds direct- ly from God’s blow and therefore is not infectious, the other is spread by natural means like corrupt air and contact with victims. Hence for in- stance Bradwell subtly distinguishes a “simple” kind of plague de- riving from the “immediate stroke of Gods punishing Angell” and en- tailing no “distemper of Blood, putrifaction of Humors, or influence of Starres” and a “putrid” kind (1636: 2). In their endorsements of this thesis some influential churchmen went as far as to argue that “wilfull sinners” catch the supernatural kind of plague, an “incurable […] pestilence” against which no medicine is effective (Hooper 1553: C1). Because the idea of a wholly supernatural type of the disease implied inefficacy of natural remedies, a compromise was found to allow for both supernatural and natural salves: the two kinds of plague, often occurring at the same time and in the same geographical area, were generally declared to be hardly distinguishable one from the other. While official writings like plague orders by the Privy Council and specific forms of prayers by Church of England authorities ac- commodate both natural and supernatural explanations allowing for natural and supernatural remedies ─ medicaments and quarantine, prayers and fasts respectively ─ other texts, especially by non- conforming preachers, are markedly biased in favour of the super- natural element and further a providential and predestinarian view of plague. This view encouraged fatalistic attitudes and presented medi- Ideological Uses of Medical Discourses in Early Modern English 57 cal and governmental measures as ineffective and ungodly: “they see many preserued in the midst of the plague, who haue vsed no phisicall meanes. Typical of such writings are general pronouncements which depict epidemics as a matter-of-fact divine initiative requiring godly submission, rather than resistance: “that so many thousands dies [sic] […] of pestilence, it is fore-ordained in heaven. The randomness of the disease, which wiped out whole households and spared their neighbours, devastated some geographical areas and was absent or hardly present in others, is also frequently re- ferred to as proof of its providential nature. Worth careful note are interpretations and descriptions of the physiological marks of plague in spiritual terms aimed at propagating the notion of the utterly supernatural quality of the disease requiring spiritual salves only. Recalling the etymology of plague from Latin plaga, a stroke or blow, and offering a literal reading of Scriptural metaphors, some passages describe buboes as marks left by God’s sword or arrows, as the visible tokens of sin which is the source of 6 infection. Clapham reports that many “so smitten, haue felt and heard the noyse of a blow and some of them haue upon such a blow found the plain print of a blew hand left behind upon the flesh”. His account closes with a telling cause-and-effect statement: “the Angels stroke so is the Cause, the plague-sores and marks arising and appearing are the v effect” (1603: B ). Drawing on the dominant metaphor used in connection with plague, that of war, he typifies it as a victorious “Captaine” or “Tyraunt” who “displayes his Ensignes on the Wals of our bodies” (1608: E4). Pullein goes on to describe with scientific accuracy the swift transformation of the buboes, the captain’s ensigns, from their 6 “Our word plague is derived from the Latin word plaga, which originally meant a blow or a stroke, but which acquired in late Latin the additional meaning of pestilence, because a pestilence – irrespective of its nature – was regarded by the pagan Romans as a blow from the gods and by the Christiani- zed Romans as a stroke expressive of the divine wrath” (Shrewsbury 1970: 1). Other expressive spiritual readings of the epide- miological realities of plague include transcriptions of public orders regarding burial of victims at night with “no neighbours nor friends […] to accompany the Coarse” (Royal College of Physicians 1636: H2) in order to prevent the spread of contagion, as retribution for sin. Capitalizing on well-established fears of anomalous and dishonour- able burial, some authors in their exhortations to repentance invite people to visualize their own funeral: “Which of your neighbors will accompany your corpes to the graue? Views on medicine and official policies of epidemics containment Some writings by the champions of providential attitudes to plague include noteworthy uses of language illustrative of conflicting views. Binary oppositions of terms in the natural and supernatural fields, less frequently in the terrestrial and celestial fields, are of particular interest. Significant examples are found in the Epistle of the Calvinist divine Henoch Clapham who served a prison term for his vehement attacks on the 1603 plague orders.

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