Z. Makas. The Rockefeller University.
Most of all it There are few people who have not beneﬁted in carries accountability buy discount levitra professional 20mg on-line erectile dysfunction doctors baton rouge, not only for the future of a some way purchase line levitra professional erectile dysfunction san francisco, either directly or indirectly, from great profession but for the very lives of our fellow advances made in surgical research. Royal College of Surgeons of Journal of Medical Education : () England Nicholas de Belleville – Pierre de Beaumarchais – French dramatist When you are called to a sick man, be sure you know what the matter is—if you do not know, That which distinguishes man from the beast is nature can do a great deal better than you can drinking without being thirsty and making love at guess. You cannot make him out at all, Notebook But many sanguine people hope To see him through a microscope More Beasts for Worse Children ‘The Microbe’ () Simone de Beauvoir – French feminist writer Stephen Vincent Benét – One is not born a woman, one becomes one. You could die very nearly as privately in that happens to a man is ever natural, since his a modern hospital as you could in the Grand presence calls the world into question. A Very Easy Death Tales of our Time ‘No Visitors’ Samuel Becket – Alan Bennet – Irish novelist and playwright British dramatist and actor We are all born mad. Scottish physician (Dundee) British comedian In the practice of medicine more mistakes are made from lack of accurate observation and You can’t part the skin of a sausage, deduction than from lack of knowledge. Experimental Physiology And you can’t part the hair on a bald-headed man, For there’ll be no parting there. John Bell – Quoted from Bennett’s monologue Daddy () Edinburgh surgeon Jeremy Bentham – Of the two forms of arthritis or articular inﬂammation, rheumatism is the tax most English philosopher and reformer frequently paid by the vulgar dram and grog Nature has placed mankind under the drinker; gout, that incurred by the genteel and governances of two sovereign masters, pain and sometimes the literary wine-bibber. Experiment is fundamentally only induced Introduction to the Principles of Morals and Legislation Ch. Introduction to the Study of Experimental Medicine () Bernard Berenson – Pt , Sect. Manuscript College de France Claude Bernard – Medicine is destined to get away from empiricism French physiologist and founder of experimental medicine little by little; like all other sciences, it will get Put off your imagination as you take off your away by scientiﬁc method. Attributed Introduction to the Study of Experimental Medicine () I consider the hospital to be a vestibule for True science teaches us to doubt and, in scientiﬁc medicine; it is the ﬁrst ﬁeld of ignorance, refrain. Introduction to the Study of Experimental Medicine () However, the laboratory is the temple of science. A theory is merely a In pathology, as in physiology, the true worth of an scientiﬁc idea controlled by experiment. Council has called on his colleagues for quicker Introduction to the Study of Experimental Medicine () identiﬁcation and treatment for alcoholic doctors. Our hospital organization has grown up with no Introduction to the Study of Experimental Medicine () plan, with no system. I would rather be kept alive in Men who have excessive faith in their theories or the efﬁcient if cold altruism of a large hospital than ideas are not only ill prepared for making expire in a gush of warm sympathy in a small one. Introduction to the Study of Experimental Medicine () Attributed to Bevan in Harley Street p. Beveridge – Isaac was old, and his eyes were dim, so that he Professor of veterinary science could not see. Genesis : People whose minds are not disciplined by training often tend to notice and remember events that Give me children or else I die. Genesis : The Art of Scientiﬁc Investigations Preface Let us eat and drink; for tomorrow we die. Isaiah : Probably the majority of discoveries in biology and medicine have been come upon unexpectedly, or at We have made a covenant with death. V the anguish, for joy that a man is born into the He is a bold man who submits his paper for world. But Ahijah could not see; for his eyes were set by The Art of Scientiﬁc Investigation Ch. Ecclesiasticus : Matthew : and Luke : Be not slow to visit the sick: for that shall make The light of the body is the eye. Matthew : Ecclesiasticus : They that be whole need not a physician, but they The Lord hath created medicines out of the earth; that are sick. Matthew : Ecclesiasticus : And if the blind lead the blind, both shall fall into Honour a physician with the honour due unto him the ditch. Ecclesiasticus : – Proverbs : And God said, Let us make man in our image, after The wringing of the nose shall bring forth blood. Genesis : Man’s days shall be to one hundred and twenty Xavier Bichat – years. French surgeon, Paris Genesis : Life is the sum of the functions that resist death. But the men of Sodom were wicked and sinners Attributed before the Lord exceedingly. We cannot therefore deny that a change in just Genesis : one of an organ’s tissues is frequently enough to Ye shall circumcise the ﬂesh of your foreskin; and it disturb the functions in all the others; yet likewise, shall be a token of the covenant betwixt me and you. Genesis : Attributed · August Bier – The education of the doctor which goes on after German professor of surgery he has his degree, is, after all, the most important part of his education. A smart mother makes often a better diagnosis Boston Medical and Surgical Journal : () than a poor doctor. Attributed It has been considered from the point of view of Medical scientists are nice people, but you should the hygienist, the physician, the architect, the not let them treat you. Medicine is like a woman who changes with the Public Health Reports : (–) fashions. Attributed The public is not always sagacious, but in the long run, it does somehow contrive to ﬁnd out who are In America there exist professional anaesthetists. A weak person who yields to the It is quite correct to distinguish between medical temptation of denying himself a pleasure. A prestidigitator who, putting metal into your mouth, pulls coins out of your pocket. Can there be a better preparatory school for the The Devil’s Dictionary physician than the study of the natural sciences? A place in which the dead are laid to It is a most gratifying sign of the rapid progress of await the coming of the medical student. The physician can do all he has to do with speed Epigrams and precision, but he must never appear to be in a hurry, and never absent-minded. The Medical Sciences in the German Universities When we know that a case is self-limited or incurable, we are to consider how far it is in our Solitary, meditative observation is the ﬁrst step in power to palliate or diminish sufferings which we the poetry of research, in the formation of are not competent to remove. Biggs – knife when these chances are lacking is to Professor of Medicine, New York prostitute the splendid art of surgery, and to The human body is the only machine for which render it suspect among the laity and among there are no spare parts. Radio Talk (quoted in Doctor’s Legacy) Quoted in The Great Doctors—A Biographical History of Medicine p. Ltd, ) British reformer Statistics are like women; mirrors of purest You cannot legislate a new layer of cortical gray virtue and truth, or like whores to use as one matter into, or a cirrhosed liver out of, a man. Little, learn more in a year than by abstract reasoning in Brown and Company, Boston () an age. Give the worker the right to work as he is healthy, Atrocis, nec Descipti Prius, Morbi Historia transl. A good Doctor can foresee the fatal outcome Attributed of an incurable illness, when he cannot help, the experienced Doctor will take care not to Sir William Blackstone ‒ aggravate the sick person’s malady by tiring English jurist and injurious efforts; and in an impossible case he will not frustrate himself further with Mala praxis is a great misdemeanor and offence at ineffective solicitude. The Mental Traveller We are convinced that the only genuine medical insurance for this country lies in making the beneﬁts of science available to all practitioners Sir John Bland-Sutton ‒ and to all patients. President of the Royal College of Surgeons of England Foreword to Medial Research, A Mid-century Survey I divided my life into three parts: in the ﬁrst I learned my profession, in the second I taught it, in the third I enjoy it. Book of Common Prayer The Story of a Surgeon Man that is born of woman, hath but a short time to live.
In many cases buy cheap levitra professional 20mg online erectile dysfunction drugs bangladesh, a drug must be transported across one or more biologic membranes to reach the bloodstream 20mg levitra professional with visa erectile dysfunction questions to ask. Diffusion of un-ionized drugs is the most common and most important mode of traversing bio- logic membranes; drugs diffuse passively down their concentration gradient. Diffusion can be influenced significantly by the lipid–water partition coefficient of the drug, which is the ratio of solubility in an organic solvent to solubility in an aqueous solution. In general, absorption increases as lipid solubility (partition coefficient) increases. Other factors that also can influ- ence diffusion include the concentration gradient of the drug across the cell membrane, and the surface area of the cell membrane. The degree of ionization of a weak acid or base is determined by the pK of the drug and pH of its environment according to the Henderson-Hasselbalch equation. Number of individuals (as percent- age of the population) who require the indicated drug dose to exhibit an identi- 20 cal response. When the pK of a drug equals the pH of the surroundings, 50% ionization occurs; that is, equal numbers of ionized and un-ionized species are present. The pH of the biologic fluid in which the drug is dissolved affects the degree of ionization and, therefore, the rate of drug transport. Active transport is an energy-dependent process that can move drugs against a concentration gradient, as in protein-mediated transport systems. It is usually the mode of transport for drugs that resemble actively transported endogenous substances such as sugars, amino acids, and nucleosides. Filtration is the bulk flow of solvent and solute through channels (pores) in the membrane. Fil- tration is seen with small molecules (usually with a molecular weight less than 100) that can pass through pores. Some substances of greater molecular weight, such as certain proteins, can be filtered through intercellular channels. Facilitated diffusion is carrier mediated, specific, and saturable; it does not require energy. Oral administration is the most convenient, economical, and common route of administration; it is generally safe for most drugs. Sites of absorption (1) Stomach (a) Lipid-soluble drugs and weak acids, which are normally un-ionized at the low pH (1 to 2) of gastric contents, may be absorbed directly from the stomach. The bioavailability of a drug is the fraction of drug (administered by any route) that reaches the bloodstream unaltered (bioavailability ¼ 1 for intravenous administration). Bioequiva- lence refers to the condition in which the plasma concentration versus time profiles of two drug formulations are identical. After absorption from the stomach or small intestine, a drug must pass through the liver before reaching the general circulation and its target site. If the capacity of liver metabolic enzymes to inactivate the drug is great, only limited amounts of active drug will escape the process. Some drugs are metabolized so extensively as a result of hepatic metabolism during the first pass that it precludes their use. A decreased emptying time generally decreases the rate of absorption because the intestine is the major absorptive site for most orally administered drugs. The absorption of small, very lipid-soluble molecules is ‘‘blood flow limited,’’ whereas highly polar molecules are ‘‘blood flow independent. Parenteral administration generally results in more predictable bioa- vailability than oral administration. It represents the most rapid means of introducing drugs into the body and is particularly use- ful in the treatment of emergencies when absolute control of drug administration is essential. Inhalation results in rapid absorption because of the large surface area and rich blood sup- ply of the alveoli. Inhalation is frequently used for gaseous anesthetics, but it is generally not practical. Inhalation may be useful for drugs that act on the airways, such as epineph- rine and glucocorticoids, which are used to treat bronchial asthma. Sublingual administration is useful for drugs with high first-pass metabolism, such as nitro- glycerin, since hepatic metabolism is bypassed. Intrathecal administration is useful for drugs that do not readily cross the blood–brain barrier. Rectal administration minimizes first-pass metabolism and may be used to circumvent the nausea and vomiting that sometimes result from oral administration. Use of rectal adminis- tration may be limited by inconvenience or patient noncompliance. Topical administration is used widely when a local effect is desired or to minimize systemic effects, especially in dermatology and ophthalmology. Distribution of drugs is the process by which a drug leaves the bloodstream and enters the extracellular fluids and tissues. A drug must diffuse across cellular membranes if its site of action is intracellular. In most tissues, drugs can leave the circulation readily by diffusion across or between capil- lary endothelial cells. Thus, the initial rate of distribution of a drug depends heavily on blood flow to various organs (brain, liver, kidney > muscle, skin > fat, bone). At equilibrium, or steady state, the amount of drug in an organ is related to the mass of the organ and its properties, as well as to the properties of the specific drug. Volume of distribution (Vd) is the volume of total body fluid into which a drug ‘‘appears’’ to dis- tribute after it reaches equilibrium in the body. Volume of distribution is determined by administering a known dose of drug (expressed in units of mass) intravenously and measuring the initial plasma concentration (expressed in units of mass/volume): Vd = amount of drug administered(m/g)/initial plasma concentration(mg/L) Volume of distribution is expressed in units of volume. Standard values of volumes of fluid compartments in an average 70-kg adult are as follows: plasma ¼ 3 liters; extracellular fluid ¼ 12 liters; and total body water ¼ 41 liters. Features of volume of distribution: (1) Vd values for most drugs do not represent their actual distribution in bodily fluids. The use of Vd values is primarily conceptual; that is, drugs that distribute extensively have relatively large Vd values and vice versa. A very high value may indicate that the drug is extensively bound to tissue sites. Drug redistribution describes when the relative distribution of a drug in the body changes with time. This is usually seen with highly lipophilic drugs such as thiopental that initially enter tis- sues with high blood flow (e. Placental barrier (1) Lipid-soluble drugs cross the placental barrier more easily than polar drugs; drugs with a molecular weight of less than 600 pass the placental barrier better than larger molecules.
Promote further study of the pregraduation examinations by the clinical testing agencies and encourage the testing agencies and dental schools to work together to offer the pregraduation examinations to the extent possible purchase generic levitra professional pills erectile dysfunction 34 year old male. Promote the acceptance by all licensing jurisdictions of the National Board Dental Examination in lieu of a separate written examination on oral diagnosis and treatment planning order levitra professional 20mg visa erectile dysfunction medications injection. The objectives were endorsed by the American Dental Association, the American Association of Dental Examiners, the American Association of Dental Schools, and the American Student Dental Association. This allows the candidate to dictions also have created individual requirements utilize more fully the dental school resources during for licensure without examination, thereby reducing the examination and to enter practice more rapidly the uniformity among the requirements. Graduates of Licensure by credentials, or licensure without these accredited Canadian dental programs face examination, is now an acceptable pathway in more minimal additional examinations for licensure, since than 30 licensing jurisdictions. Credentialing allows licensing representatives are part of the accredita- many established dentists and dental hygienists to tion process. This system relies almost wholly on obtain a license to practice without repeating a clin- the accreditation process and faculty evaluations, ical performance examination. The goal of accreditation is to which requires practiced skill, as well as a science. The accreditation added to their didactic curriculum, often having to process evaluates the educational programs and the reduce the clinical experiences for the students to do physical facilities, not the clinical skills of the graduat- so. This can lead to poor test results on of these schools must meet individual state require- the initial competency exam. A 1995 Institute of Medicine study (Field, 1995) rec- Most states will not license a graduate of a non- ommended that reform in the accreditation process accredited school unless that individual attends an should focus on educational outcomes and on stan- accredited school for a specified period of time and is dards and methods that will identify and improve those either granted a degree or certified as equivalently edu- schools that are not educating their students effectively. Only California, Hawaii, and Ohio license a graduate of a non-accred- Continuing Competency ited dental school without these requirements. In solve medical problems with new science and technolo- addition, other organizations, such as the Academy of gy have provided additional impetus for protective reg- General Dentistry, have programs that grant fellowship ulations. The consequent cost is significant; it is esti- and mastership status to general dentists who achieve mated that the cost of federal regulation to a family of milestones in continuing professional education. Accounting procedures, the protection of rule, which was written largely with the hospital patient records, and the use of specific equipment in environment in mind, have had significant cost certain clinical procedures are the more apparent implications for dental care. In each case, laws and areas where there are efforts to regulate details of the attendant regulations were created to respond to clinical practice (Palmer, 2000a and 2000c; and problems and address perceived needs. Regulation of the dental practice case, these laws and regulations have had unfore- is so extensive today that new entrepreneurial enti- seen consequences, some of which have worked ties have emerged offering courses to teach dental counter to original intentions. Regulations become less favorable for such sweeping regula- governing the dental practice range from local zon- tions, especially when promulgating them has ing requirements regarding parking lot require- dramatic cost implications for the affected sector ments, to requirements for apparel worn in public and its consumers without identifying offsetting places that could be contaminated from the work- funding. That action was a response In the United States, government has traditionally to vigorous opposition to the rule. As health insurance became Purported benefits are difficult to estimate accurate- commonplace, the third party payer entered into the ly. The resulting complex of responsibilities, costs are more easily developed and should be avail- relationships and priorities created a mandate for regu- able for any regulation. Regulation of the dental workplace technology, education, and workforce that best is intended to protect the safety of dental practice serve the public interest. There will be Two examples that pose this possibility in the increased demand for continued development of near term are a promulgated but not yet enforced computer-based simulation as a valid method for rule on medical information privacy and a guidance testing clinical skills. Alternatives to professionals must provide translation services to traditional licensure and state-specific licensure will non-English speaking patients. The recent trend in on in-depth clinical competency for the initial com- dental office design has been toward exactly this type petency examination. These are but two examples of why the regu- late more uniform scopes of practice among the latory pendulum will likely continue to swing between state statutes and regulations. A critical under-supply of laboratory techni- cians will occur in the future unless the number of students in this field is increased. The exponential- ly expanding aspects of technology will provide new materials and procedures that will initiate expanded functions for allied personnel. The complexities and interrelations of oral and systemic diseases will continue to evolve and require more extensive examination and diagnosis by a licensed dentist for every dental patient. The liferation of ideas and assumptions, both correct expansion of the predoctoral curriculum has limited and incorrect, must not be allowed to lead to leg- the dental schools ability to teach their students the islative initiatives or regulations without scientific laboratory skills that were traditionally taught in the validation. Dentistry must proactively promote dental labo- to ensure that valid science is the basis for necessary ratory technology as an attractive career choice, as and appropriate regulation. It appears very likely well as increasing the availability of education for den- that one of the greatest issues of today––access to tal laboratory technicians. States should also assure that all regulation is based regulations and overlap of scope may render it diffi- on valid scientific evaluation and solutions. All tal professionals should serve as advocates and resources licensing jurisdictions should meet basic psychome- for developing regulatory policy development. Accreditation of the evaluation process for allied dental personnel through innovative licensure examinations should be investigated. If approaches to education, strengthened standards and when the accreditation process includes out- for continuing education credits, and outcome come assessments of the clinical skills of dental assessments for relicensure and recertification. Increased recruitment efforts will be necessary to Alternatives to live-patient examinations should assure sufficient numbers of dental hygienists, den- continue to be investigated. If successful, the profession will be able to Dental professionals have many opportunities to continue its service to the public unimpeded by meet competency requirements in a positive and ben- unnecessary regulation. The challenge is to find more effective The ability of the profession to influence public and efficient ways to continue to improve the process. Representa- dents more clinical experiences and remediation tives of the practicing dental community must be when needed. Currently, residency programs are involved in the decision-making process as Medicare, available only to the highest-ranking students. This time of great change may ics that serve populations of low socioeconomic sta- introduce operating systems that are not well thought tus. Funding of this additional educational experi- out and certainly are not well tested. Time- The profession must be proactive to ensure that proven, value-driven systems may be destroyed and the policies promoted by advocacy groups are based lives hurt in the process unless there is an appropriate on scientific fact, not anecdotal information. For deliberative process for the institution of regulatory example, increased federal regulation and the geo- change. Regulation will be beneficial if it adds safety graphic mobility of dentists have stimulated the and value to the services provided. References Outcome assessments could be a surrogate for relicensure and/or recertification. Chicago: American Dental ments as an integral part of relicensure or continued Association; 2001.
Versnel has suggested to me order 20mg levitra professional mastercard erectile dysfunction pump how to use, to interpret the sentence as an extreme statement of the author’s belief (expressed in 1 purchase levitra professional 20mg visa impotence questions. There is still another possible interpretation which might be considered, which makes the sentence apply to the practice of temple medicine: ‘while entering the temple [for the healing of a disease], we sprinkle ourselves, not as if we were polluted [by the disease, i. This would suit the author’s aim of distinguishing between moral transgressions (which are, in his opinion, forms of pollution, mismata) and physical diseases (which are not) and would make sense of the words ¢ ti peponq»v in 1. However, on this interpretation pr»teron is difﬁcult, and it would presumably require a perfect participle (memiasmnoi) instead of the present miain»menoi. On the Sacred Disease 67 is wrong to regard epilepsy (or any other disease) as a pollution (this seems to be the point of the words ãsper m©asm ti contav in 1. He obviously thinks that no moral factor (punishment for crime or transgressions) is involved,53 and that, as a consequence, one should not believe that it can be cured by the gods alone. As for the author’s religious notions, we may deduce from these passages that he believes in gods who grant men puriﬁcation of their moral trans- gressions and who are to be worshipped in temples by means of prayer and sacriﬁce. It is difﬁcult to see how this conception of ‘the divine’ (to theion) can be incorporated within the naturalistic theology with which he has often been credited. But instead of concluding, therefore, that the statements of the ﬁrst chapter are merely rhetorical remarks which do not reﬂect the author’s own religious opinion (which is apparently the course taken by most interpreters), I would throw doubt on the reality of this ‘naturalistic theology’ – for which I have given other reasons as well. It seems better to proceed in the opposite direction, which means starting from the religious assertions of the ﬁrst chapter and then trying to understand the statements about the divine character of the disease. In this way, the text can be un- derstood as motivated by two interrelated purposes. First, by claiming that epilepsy is not god-sent in the traditional sense, the author does not intend to reject the notion of divine dispensation as such; his statements are to be regarded as a form of corrective criticism of a traditional religious idea. The author claims that it is blasphemous to hold that a holy and pure being like a god would send diseases as a form of pollution; thus his re- marks may be compared with statements by Plato which aim at correcting and modifying the traditional concept of divine dispensation (theia moira) without questioning the existence of this divine dispensation as such. To a certain extent this may be viewed as an attempt to ‘secularise’ the sacred disease; and from this point of view the positive statements about the divine character of the disease may be regarded as reluctant or even derogatory concessions rather than as proclamations of a new advanced theology. And from this perspec- tive it can further be understood why the author states that epilepsy is not more divine than the other diseases instead of saying that all diseases are just as divine as epilepsy. As we have seen, on the ﬁrst interpretation of the divine character of the disease (which posits its divine character in its being caused by climatic factors), this restricted con- ception of divinity may well be connected with the fact that the inﬂuence of these factors is rather limited (and with the use of the word prophasis). On the second interpretation (and on the reading taÅth d’stª qe±a, ‘in this respect they [i. On both views the derogatory tone of the statements can be understood from the author’s attempt to mark off the boundaries between medicine and religion and to purify the concept of divine dispensation. And it can now also be understood why he deﬁnes the divinity of the disease only in those contexts where he tries to point out the difference between the sense in which his opponents believe it to be divine and the sense in which he himself believes it to be so. This does not imply that the sincerity of the author’s statements about the divine character of the disease should be doubted. Nor should their relationship with developments in natural philosophy and with other con- temporary ideas on religion and the divine be questioned. It is precisely the philosophical search for unity and regularity in natural phenomena, the enquiry into cause and effect, and the belief, expressed by at least some of these philosophers, that in manifesting regularity and constancy these phenomena have a divine aspect, which may have led the author to assign a divine character to the disease in question. But the danger of stressing this relationship with natural philosophy is that we read into the text ideas 56 Contra Norenberg (¨ 1968) 26 and 49, who ignores the rhetorical impact of these statements. This danger is increased when this reading is guided by modern ideas about what is ‘primitive’ or ‘mythic’ and what is ‘advanced’ and ‘rational’, so that by labelling an author as advanced or enlightened we are too much guided in our interpretation of the text by what we expect him to say. Nowhere in On the Sacred Disease do we ﬁnd statements such as that ‘Nature is divine’; nowhere do we ﬁnd an explicit rejection of divine intervention in natural processes or of divine dispen- sation as such. It is important to distinguish between the corrective, ‘cathartic’ criticism of traditional religious beliefs and the exposition of a positive theology. It seems that the author of On the Sacred Disease has been regarded too much as an exponent of the latter, and that he has been regarded more as a philosopher or a theologian than as a physician. Instead, I propose to regard as the author’s primary concern the disengagement of epilepsy from the religious domain (which implies claiming it as an object of medicine) and his accusations of impiety as one rather successful way to achieve this goal; in this way the corrective criticism of a traditional idea (viz. Even if this interpretation is convincing, it cannot be denied that there remains a tension between the author’s belief in gods who cleanse men from their moral transgressions and his statements about the divine character of the disease. This tension becomes especially manifest when we confront his categorical rejection of the idea that holy beings like gods send diseases (which he labels as highly blasphemous) with his assertion, ten lines further down, that diseases are divine in virtue of having a nature. The problem is how this ‘being divine’ of diseases is related to the purifying inﬂuence of the gods mentioned in 1. The author does not explain this, and we may wonder whether he, if he was aware of this problem, would have been capable of solving it. Of course, there are several possible solutions which we might suggest, and we could speculate about the author’s unexpressed ideas on theodicy and on the relation between the gods and the world in terms of providence, deism, determinism, and so on. Thivel draws an almost Aristotelian picture of the author’s world-view: ‘ces dieux... But it will by now have become clear for what reasons (apart from those mentioned ad loc. We have seen that the interpretation of the author’s statements about the divine character of the disease, as well as the attempt to deduce his theological ideas from these statements, involved many problems. We have also seen the difﬁculties involved in the evaluation of the author’s accusations of asebeia, and I have shown that it is possible to discern, in spite of the hypothetical character of most of these accusations, elements of the author’s own conviction. If the results of this discussion (especially my views on the range and on the rhetorical impact of the assertions about the divinity of diseases) are convincing, the discrepancy noted at the beginning of this paper has decreased considerably, though it has not disappeared. Yet we are now in a much better position to formulate the problem more adequately and to look for an explanation that is more to the point than the one offered in section 1. It is certainly wrong to hold that the author of On the Sacred Disease systematically exposes his religious beliefs and his ideas on the nature of divine causation in this text. The writer believes in gods who grant men puriﬁcation of their transgressions pr»fasin), et le monde celeste, sejour des dieux incorruptibles, qui habitent sans doute les astres. On the Sacred Disease 71 and who are to be worshipped in temples by means of prayer and sacriﬁce. The text is silent on the author’s conception of the nature of these gods, but there is, at least, no textual evidence that he rejected the notion of ‘personal’ or even ‘anthropomorphic’ gods. Diseases are not the effects of divine dispensation; nevertheless they have a divine aspect in that they show a constant and regular pattern of origin and development. How this ‘being divine’ is related to ‘the divine’ (or, the gods) which cleanses men from moral transgressions is not explained. The idea of divine dispensation as such is nowhere questioned in the text of On the Sacred Disease. Gods are ruled out as causes of diseases; whether they are ruled out as healers as well is not certain, since the text is silent on this subject. As I remarked earlier, the author does not believe that epilepsy can be cured by natural means in all cases: on two occasions (2. Of course we can only speculate what he would do in such cases, but it does not seem alien to Hippocratic medicine to make an appeal to the gods in such hopeless cases. Nor is the combination of ‘natural’ therapeutic measures with prayers and sacriﬁces unattested in the Hippocratic collection.