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Alienation of mind, claimed proponents of moral treatments, was not a physical disease like smallpox, but a psychological disorder, the product of wretched education, bad habits, and personal affliction a traumatic bereavement, bankruptcy, or religious horrors like fear of hell. As already hinted, these new psychological approaches had deeper foundations on which to build. From Sophocles to Shakespeare, playwrights has dramatized the passions, showing the inner torments of desire and duty, guilt and grief, that tore personalities apart. For they do not appear to me to have lost the Faculty of Reasoning: but having joined together some Ideas very wrongly, they mistake them for Truths; and they err, as Men do, that argue right from wrong Principles. For by the violence of their Imaginations, having taken 4 their Fancies for Realities, they make right deduction from them. First, patients had to be subdued; then they had to be motivated through manipulation of their passions their hopes and fears, their need for esteem. Such ideas were taken several stages further around 1790 by the emancipatory visions of Vincen zio Chiarugi in Italy, Philippe Pinel in Paris, the Tukes at the York Retreat, and, perhaps more ambiguously, by Johann Reil and other Romantic psychiatrists in 292 The Cam bridge Illustrated H istory of M edicine the York Retreat concentrating on the mind the York Retreat was opened in 1796 by a group of Quakers, led by a York teamerchant, William Tuke, to provide a refuge for mentally disordered Friends. He had been afflicted several times before; and so constantly, during the present attack, had he been kept chained, that his clothes were contrived to be taken off and put on by means of strings, without removing his manacles. He was desired to join in the repast, during which he behaved with tolerable propriety. Finding that medicines did duct would render it unnecessary for him to have little good, they believed that insanity could he cured by recourse to coercion. The maniac was sensible of the reason, mildness, and the support offered by a true sense kindness of his treatment. At the start, almost all patients stay, no coercive means were ever employed towards were Quakers, like the Tukes themselves, but later the him. They needed to be treated like obstreperous children, who required rigorous mental discipline and retraining in thinking and feeling.

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Women are key contributors to the economy and to combating poverty through both remunerated and unremunerated work at home, in the community and in the workplace. Growing numbers of women have achieved economic independence through gainful employment. One fourth of all households world wide are headed by women and many other households are dependent on female income even where men are present. Female maintained households are very often among the poorest because of wage discrimination, occupational segregation patterns in the labour market and other genderbased barriers. Family disintegration, population movements between urban and rural areas within countries, international migration, war and internal displacements are factors contributing to the rise of femaleheaded households. Recognizing that the achievement and maintenance of peace and security are a precondition for economic and social progress, women are increasingly establishing themselves as central actors in a variety of capacities in the movement of humanity for peace. Their full participation in decisionmaking, conflict prevention and resolution and all other peace initiatives is essential to the realization of lasting peace. Religion, spirituality and belief play a central role in the lives of millions of women and men, in the way they live and in the aspirations they have for the future. The right to freedom of thought, conscience and religion is inalienable and must be universally enjoyed. This right includes the freedom to have or to adopt the religion or belief of their choice either individually or in community with others, in public or in private, and to manifest their religion or belief in worship, observance, practice and teaching. In order to realize equality, development and peace, there is a need to respect these rights and freedoms fully. However, it is acknowledged that any form of extremism may have a negative impact on women and can lead to violence and discrimination. The United Nations Decade for Women (19761985) was a worldwide effort to examine the status and rights of women and to bring women into decisionmaking at all levels. In 1979, the General Assembly adopted the Convention on the Elimination of All Forms of Discrimination against Women, which entered into force in 1981 and set an international standard for what was meant by equality between women and men. In 1985, the World Conference to Review and Appraise the Achievements of the United Nations Decade for Women: Equality, Development and Peace adopted the Nairobi Forwardlooking Strategies for the Advancement of Women, to be implemented by the year 2000. Many Governments have enacted legislation to promote equality between women and men and have established national machineries to ensure the mainstreaming of gender perspectives in all spheres of society. Nongovernmental organizations have played an important advocacy role in advancing legislation or mechanisms to ensure the promotion of women. Many Governments have increasingly recognized the important role that nongovernmental organizations play and the importance of working with them for progress. Yet, in some countries, Governments continue to restrict the ability of nongovernmental organizations to operate freely. Women, through nongovernmental organizations, have participated in and strongly influenced community, national, regional and global forums and international debates. Since 1975, knowledge of the status of women and men, respectively, has increased and is contributing to further actions aimed at promoting equality between women and men. In several countries, there have been important changes in the relationships between women and men, especially where there have been major advances in education for women and significant increases in their participation in the paid labour force. The boundaries of the gender division of labour between productive and reproductive roles are gradually being crossed as women have started to enter formerly maledominated areas of work and men have started to accept greater responsibility for domestic tasks, including child care.

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Excellent for the intercranial, climacteric disturbances, or due to menstrual suppression. Abdomen Constipation with itching, painful haemorrhoids, with pinching in abdomen before and after stool. Glycerinum (glycerine) * Used homoeopathically, dynamized Glycerine seems to act deeply and long, building up tissue, hence of great use in marasmus, debility, mental and physical, diabetes, etc. It disturbs nutrition in its primary action, and, secondarily, seems to improve the general state of nutrition. Gnaphalium polycephalum (cudweed)old balsam * A remedy of unquestioned benefit in sciatica, when pain is associated with numbness of the part affected. Euphorbia Prostata(Used by Indians as an infallible remedy against bites of poisonous insects and snakes, especially the rattlesnake). Gossypium herbaceum (cottonplant) * A powerful emmenagogue, used in physiological doses. Head Pain in cervical region with tendency for head to draw backward with nervousness. Granatum (pomegranate) * As a vermifuge for the expulsion of tapeworm, and homoeopathically for the following symptomatic indications. Relationship Compare: Pelletierine (one of its constituents an anthelmintica, especially for tapeworm); Cina; Kousso. Graphites (black lead)plumbago * Like all the carbons, this remedy is an antipsoric of great power, but especially active in patients who are rather stout, of fair complexion, with tendency to skin affections and constipation, fat, chilly, and costive, with delayed menstrual history, take cold easily. Head Rush of blood to head with flushed face also with nose bleed and distension and flatulence. Female Menses too late, with constipation; pale and scanty, with tearing pain in epigastrium, and itching before. Male Sexual debility, with increased desire; aversion to coition; too early or no ejaculation; herpetic eruption on organs. Respiratory Constriction of chest; spasmodic asthma, suffocative attacks wakes from sleep; must eat something. Stomach Vertigo during and after meals; hunger and feeling of emptiness after meals. Stool Diarrhoea; green, frothy water, followed by anal burning, forcibly without pain. Grindelia robusta (rosinwood) * Both Grindelia robusta and Grindelia squarrosa have been used for the symptoms here recorded. Squarrosa is credited with more splenic symptoms, dull pains and fullness in left hypochondrium; chronic malaria; gastric pains associated with splenic congestion. Acts on the cardiopulmonary distribution of the pneumogastric in dry catarrh (Tart Emetic in mucopurulent). An effective antidote to Rhuspoisoning, locally and internally; also for burns, blisters, vaginal catarrh and herpes zoster. Respiratory An efficacious remedy for wheezing and oppression in bronchitic patients. Guajacum officinale (resin of lignum vitae) * Chief action on fibrous tissue, and is especially adapted to the arthritic diathesis, rheumatism, and tonsillitis. Female Ovaritis in rheumatic patients, with irregular menstruation and dysmenorrhoea, and irritable bladder. Modalities Worse, from motion, heat, cold wet weather; pressure, touch, from 6 p. Relationship Guaiacol (in the treatment of gonorrhoeal epididymitis, 2 parts to 30 vaselin, locally). Gymnocladus canadensis (american coffeetree) * Sore throat, dark livid redness of fauces, and erysipelatous swelling of face are most marked. Stomach Painful digging from abdomen to throat, causing pain in region of heart with oppression. Hamamelis virginiana (witchhazel) * Venous congestion, haemorrhages, varicose veins, and haemorrhoids, with bruised soreness of affected parts, seem to be the special sphere of this remedy. Eyes Painful weakness; sore pain in eyes; bloodshot appearance; inflamed vessels greatly injected. Nose Bleeding from nose profuse; flow passive, noncoagulable, with tightness in bridge of nose. Hedeoma pulegioides (pennyroyal) * Female symptoms are most marked; usually associated with nervous disturbances.

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In terms of primary venous drainage, glucocorticoidproducing pathways (similar the right adrenal gland is drained via the right to 21hydroxylase defciency). In con can act as a weak mineralocorticoid, producing trast, the left adrenal gland is drained via the masculinization, hypertension, and salt reten left adrenal vein into the left renal vein, which tion. The abdominal aorta cholecalciferol in the kidney, leading to hy plays no role in the vascular drainage of any percalcemia. The portal vein is supe are consistent with hypoparathyroidism, com rior and anterior to the adrenal and renal vas monly caused by surgical removal of the thy culature and is not involved in the drainage of roid or congenital absence, such as in a patient either of the adrenal glands. The right gonadal vein reabsorption), and increased phosphate reten drains the testes or ovaries directly into the in tion. Patients with hypoparathyroidism gen ferior vena cava but does not drain the right erally present with increased neuromuscular adrenal gland in either sex. The hypercalcemia and imaging fndings cium reabsorption, and increased phosphate suggest a parathyroid adenoma, which is a excretion. They are the most com are low due to the hypercalcemia, but all other mon cause of primary hyperparathyroidism. Parathyroid adenomas are often asymptomatic, but may present with the classic tetrad of Answer C is incorrect. In the case of chronic depression, lethargy, and eventually seizures renal failure, a decreased glomerular fltration (psychic moans). Imaging studies are often rate leads to decreased phosphate excretion used for diagnosis. Hyper operative scintigraphy is useful in distinguish phosphatemia in turn decreases ahydroxylase ing adenomas from parathyroid hyperplasia, activity, lowering 1, 25dihydroxycholecalciferol in which more than one gland would demon production and decreasing serum calcium. Conn syndrome is de this patient and have other metabolic imbal fned as a chronic excess of aldosterone secre ances, such as acidosis, hyperkalemia, and hy tion from an aldosteronesecreting adenoma pertension. This is an autosomal serum potassium, low serum renin, and in dominant disease caused by a defective Gs pro creased serum aldosterone. A pheochromocytoma Impaired mentation is also found in about is neoplasm of the chromaffn cells (neural half of patients with pseudohypoparathyroid crest derivatives that synthesize and release ism. In addition, this condi with hypertension, headache, tremor, sweat tion generally presents before age 42 years, and ing, and a sense of apprehension. The hyper hypocalcemia, not hypercalcemia, would be tension may occur in isolated bursts or chroni found. The three classic fndings as decreased levels of sodium, chloride, and bi sociated with Graves disease are hyperthyroid carbonate. Decreased levels of cortisol lead to ism, ophthalmopathy, and dermopathy/pretib decreased glucose levels. Plummer disease is similar to those of 17ahydroxylase defciency, characterized by a nodular goiter that has a hy manifesting as hypertension and hypokalemia; perfunctioning nodule, causing hyperthyroid however, virilization would also be present. As opposed to Graves disease, Plummer disease is not accompanied by ophthalmopathy Answer A is incorrect. The medulla produces causes hypothyroidism, manifested with signs catecholamines (epinephrine and norepineph and symptoms that include intolerance to cold rine); neither 17ahydroxylase nor 21bhydrox weather, weight gain, and mental and physical ylase is required for the synthesis of catechol slowness. Cortisol is produced the thyroid, the most common form of thyroid in the zona fasciculata of the adrenal cortex. Sex hormones are pro (as opposed to symptoms of hyper or hypothy duced in the zona reticularis. Radiation is a common cause of thy sex hormones requires 17ahydroxylase, but roid cancer. This is ticosterone production and excess production coupled with increased mineralocorticoid of sex hormones and 11deoxycorticosterone. Aldosterone is pro tory infection likely increased her insulin re duced in the zona glomerulosa. Aldosterone quirements, precipitating fat breakdown and synthesis requires 21bhydroxylase but not ketogenesis.

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The immune complexes bind complement, which is highly chemotactic for neutrophils. The neutrophils release lysosomal enzymes, resulting in tissue damage, which can also result from other substances released by neutrophils, including prostaglandins, kinins, and free radicals. Serum sickness is a systemic deposition of antigenantibody complexes in multiple sites, especially the heart, joints, and kidneys. Because of the danger of serum sickness, this mode of therapy is no longer employed. Systemic lupus erythematosus is also an example of a multisystem immune complex disease. Arthus reaction is a localized immune complex reaction that occurs when exogenous antigen is introduced, either by injection or by organ transplant, in the presence ofan excess of preformed antibodies. Polyarteritis nodosa is a generalized immune complex disease especially involving small and mediumsized arteries. Adverse immune responses can be suppressed by immunosuppressant drugs, radiation, or recipient Tcell depletion. Three basic patterns of graft rejection are well illustrated by rejection following kidney transplantation. Rejection is a localized Arthus reaction marked by acute infammation, fibrinoid necro sis of small vessels, and extensive thrombosis. When antibodymediated mechanisms are prominent, it may show evidence of arteritis with thrombosis and cortical necrosis. Rejection is characterized histologically bymarked vascular fibrointimal proliferation, often resulting in a small, scarred kidney. This is a significant problem in bone marrow transplantation because immunocompetent cells are transplanted in this procedure. The rejection of "foreign" host cells by engrafted T and B cells is characteristic. This disorder occurs in male infants butusually is not manifest clinically until after 6 months of age because of the persistence of maternal antibodies. Failure of antibody synthesis caused by a block in maturation of preB cells to B cells due to a mutation in the B cell tyrosine kinase (Btk) gene. Absence of plasma cells in tissue results in virtual absence of serum immunoglobulins. A propensity for recurrent bacterial infections with organisms, such as pneumococci, streptococci, staphylococci, and Haemophilus inJluenzae. Most often, the disorder is asymptomatic, but it may be characterized by occasional anaphylactic reactions to transfused blood. Common variable immunodeficiency, this diverse group of disorders is caused by failure of terminal Bcell maturation, resulting in diminution in the number of plasma cells and thus hypogammaglobulinemia. This congenital Tcell deficiency results from aberrant embryonic development of the third and fourth branchial arches, leading to hypoplasia of the thymus and parathyroid glands, as well as abnormalities ofthe mandible, ear, and aortic arch. Clinical manifestations include recurrent viral and fungal infections and tetany from hypoparathyroidism with hypocalcemia.