By L. Porgan. Pomona College.
There may be excessive inter-observer variability in deciding on which trials to evaluate doxycycline 100 mg, and how much weight to give to each trial 200mg doxycycline. These issues ought to be addressed by the authors and difference in the results explained doxycycline 200mg. In many cases 100 mg doxycycline, the methodolo- gies will contribute biases that can be uncovered in the meta-analysis process 200 mg doxycycline. Cumulative are combined with the ones done before to give a new estimate of the effect size doxycycline 100mg. You can see where in the progression of studies the results become statistically signiﬁcant doxycycline 200 mg. If they only become statistically signiﬁcant after the vast majority of the studies had been done 100mg doxycycline, the results are not as strong as if they had become statistically signiﬁcant after only a few studies . This implies that there is a difference between the two groups , but that difference is relatively small clin- ically, even though eventually it becomes statistically signiﬁcant. The chrono- logical cumulative meta-analysis by Lau and colleagues of therapeutic trials of streptokinase in myocardial infarction showed statistical signiﬁcance after the sixth trial was completed, of a total of 33 studies (Fig. The Cochrane Collaboration is now a worldwide network of interested clinicians, epidemiolo- gists, and scientists who perform systematic reviews and meta-analyses of clini- cal questions. Their reviews are standardized, of the highest quality, and updated regularly as more information becomes available. Additional guidelines for meta-analysis There are some additional guidelines for creating and reviewing meta-analyses that were published in 1985 by Green and Hall and are still very useful to follow. This may lead to substantive and conceptual issues such as how to handle a study with missing or incomplete data. The coding categories should be developed in a manner that will accommodate the largest proportion of the iden- tiﬁed literature. The following characteristics should be coded: type and length of the intervention, sample characteristics, research design characteristics and quality, source of the study (e. Multiple independent and dependent variables should be separately evalu- ated using a sensitivity analysis. Interactions between variables outside the prin- cipal relationship being reviewed should be looked for. If the studies are found to be het- erogeneous, a sensitivity analysis should be performed to identify the outlier study. The effect size should be speciﬁed and level of signiﬁcance or conﬁdence intervals given. Where necessary, nonparametric and parametric effect size esti- mates should be calculated. In the conclusions, the authors should examine other approaches to the same problem. Quantitative evaluation of all studies should be combined with qualita- tive reviews of the topic. This should look at the comparability of treatment and control groups from study to study. They should also look at other potentially interesting and worthwhile studies that are not part of the quantitative review. Finally, the limitations of the review and ideas for future research should be 2 B. For the reader, it is well to remember that “data analysis is an aid to thought, not a substitute. It should be an aid to thought, and an encouragement to integrate the science of medical research into clinical practice. There is a great tendency to accept meta-analyses as the ultimate word in evidence. The results of such an analysis are only as good as the evidence upon which it is based. We will always be faced with making difﬁcult decisions in the face of uncertainty. In that setting, it takes our clinical experience, intuition, common sense, and good communications with our patients to decide upon the best way to use the best evidence. Exam is equivocal with large tonsils with exudate, but no cervical nodes or scarlatiniform rash, and only slight coryza. If no exudate this drops to about 10%, and if also tender cervical nodes it increases to 40%. Potential harm from antibiotic treatment 4–5% of patients will get a rash or diar- rhea, both of which are uncomfortable but not life-threatening. Anaphylaxis (life- threatening allergy) is very rare (< 1 : 200 000) and will not be counted in the analy- sis. It could be greater if the patient modeled swimwear and a rash would put him or her out of work for those days. Impact of improvement Since treatment results in relief of symptoms about 1 day sooner, this should be similar to the harm impact, 0. Action or treatment threshold (Harm × harm impact) / (improvement × improve- ment impact) = (0. This is below the action (treatment) threshold (5%) and so treatment would not be initiated if the test were negative. Tuberculosis Now let’s consider a different problem in an Asian man with lung lesions, fever, and cough, and let’s use a slightly different methodology. Making Medical Decisions: an Approach to Clinical Decision Making for Practicing Physicians. If B is very high and R is very low, you will almost always treat regardless of the test result. If the converse (R high and B low) you will be much less likely to treat without fairly high degree of evidence of the target disorder. Absolute risk The percentage of subjects in a group that experiences a discrete outcome. Adjustment Changing the probability of disease as a result of performing a diagnostic maneuver (additional history, physical exam, or diagnostic test of some kind). Algorithm A preset path which takes the clinician from the patient’s presenting complaints to a ﬁnal management decision through a series of predetermined branching decision points. All-or-none case series In previous studies all the patients who were not given the intervention died and now some survive, or many of the patients previously died and now none die. Alternative hypothesis There is a difference between groups or an association between predictor and outcome variables. Example: the patients being treated with a newer antihypertensive drug will have a lower blood pressure than those treated with the older drug. Anchoring The initial assignment of pretest probability of disease based upon elements of the history and physical. Applicability The degree to which the results of a study are likely to hold true in your practice setting. Synonymous with differential diagnosis or hypotheses of cause of the underlying problems. Availability heuristic The ability to think of something depends upon how recently you studied that fact. Bayes’ theorem What we know after doing a test equals what we knew before doing the test times a modiﬁer (based on the test results). Bias Any factor other than the experimental therapy that could change the study results in a non-random way. The validity of a study is integrally related to the degree to which the results could have been affected by biased factors. Blinding Masking or concealment from study subjects, caregivers, observers, or others involved in the study of some or all details of the study. Process by which neither the subject nor the research team members who have contact with the subject know to which treatment condition the subject is assigned. Single-blind means that one person (patient or physician) does not know what is going on. Double-blind means that at least two people (usually patient and treating physician) don’t know what’s going on. Triple-blind means that patient, treating physician, and person measuring outcome don’t know to which group patient is assigned. Case–control study Subjects are grouped by outcome, cases having the disease or outcome of interest and controls. Case report or case series One or a group of cases of a particular disease or outcome of interest with no control group. Clinical signiﬁcance Results that make enough difference to you and your patient to justify changing your way of doing things. Cochrane collaboration An internationally organized effort to catalog and systematically evaluate all existing clinical studies into systematic reviews easily accessible to practicing clinicians so as to facilitate the process of using the best clinical evidence in patient care. Cohort study Subjects are grouped by the risk factor, and those with and without the risk factor are followed to see who develops the disease and who doesn’t. Cointervention A treatment that is not under investigation given to a study patient. Competing-hypotheses heuristic A way of thinking in which all possible hypotheses are evaluated for their likelihood and ﬁnal decision is based on the most likely hypothesis modiﬁed by secondary evaluations. Conﬁdence intervals An interval around an observed parameter guaranteed to include the true value to some level of conﬁdence (usually 95%). Continuous test results A test resulting in an inﬁnite number of possible outcome values. Control group The subjects in an experiment who do not receive the treatment procedure being studied. Controlled clinical trial Any study that compares two groups for exposure to different therapies or risk factors. A true experiment in which one group is given the experimental intervention and the other group is a control group. Cost-effectiveness (or cost–beneﬁt) analysis Research study which determines how much more has to be paid in order to achieve a given beneﬁt of preventing death, disability days, or another outcome. Criterion-based validity How well a measurement agrees with other approaches for measuring the same characteristic. Critical value Value of a test statistic to which the observed value is compared to determine statistical signiﬁcance. The observed test statistic indicates signiﬁcant differences or associations exist if its value is greater than the critical value. Decision analysis Systematic way in which the components of decision making can be incorporated to make the best possible clinical decision using a mathematical model. Decision node A point on a branching decision tree at which the clinician must make a decision to either perform a clinical maneuver (diagnosis or management) or not. Degrees of freedom (df) A number used to select the appropriate critical value of a statistic from a table of critical values. Dependent variable The outcome variable that is inﬂuenced by changes in the independent variable of a study. Descriptive research Study which summarizes, tabulates, or organizes a set of measures (i. Descriptive statistics The branch of statistics that summarizes, tabulates, and organizes data for the purpose of describing observations or measurements. Diagnostic test characteristics Those qualities of a diagnostic test that are important to understand how valuable it would be in a clinical setting. Diagnostic tests Modalities which can be used to increase the accuracy of a clinical assessment by helping to narrow the list of possible diseases that a patient can have. Dichotomous outcome Any outcome measure for which there are only two possibilities, like dead/alive, admitted/discharged, graduated/sent to glue factory. Beware of potentially fake dichotomous outcome reports such as “improved/not improved”, particularly when derived from continuous outcome measures. For example, if I deﬁne a 10-point or greater increase in a continuous variable as “improved,” I may show what looks like a tremendous beneﬁt when that result is clinically insigniﬁcant. Differential diagnosis A list of possible diseases that your patient can have in descending order of clinical probability. Effect size The amount of change measured in a given variable as a result of the experiment. In meta-analyses when different studies have measured somewhat different things, a statistically derived generic size of the combined result. Effectiveness How well the proposed intervention works in a clinical trial to produce a desired and measurable effect in a well-done clinical trial. Event rate The percentage of events of interest in one or the other of the groups in an experiment. The value of each arm of the decision tree or the entire decision tree (sum of P × U). Experimental group(s) The subjects in an experiment who receive the treatment procedure or manipulation that is being proposed to improve health or treat illness. Explanatory research – experimental Study in which the independent variable (usually a treatment) is changed by the researcher who then observes the effect of this change on the dependent variable (usually an outcome). Explanatory research – observational Study looking for possible causes of disease (dependent variable) based upon exposure to one or more risk factors (independent variable) in the population. A drug, a surgical procedure, risk factor, even a diagnostic test can be an exposure. In therapy, prognosis, or harm studies the “exposure” is the intervention being studied. Framing effect How a question is worded (or framed) will inﬂuence the answer to the question. Functional status An outcome which describes the ability of a person to interact in society and carry on with their daily living activities (e. Gold standard The reference standard for evaluation of a measurement or diagnostic test. The “gold-standard” test is assumed to correctly identify the presence or absence of disease 100% of the time.
No study could be found that investigated dietary protein intervention in twin pregnancy 100 mg doxycycline. On the basis of these data 100mg doxycycline, it seems prudent to provide women carrying twins with protein intakes of an additional 50 g/d beginning in the second trimester 200 mg doxycycline, along with sufficient energy to utilize the protein as efficiently as possible doxycycline 200mg. While it appears that the concentration of protein in human milk is not influenced by diet or body composition even in undernourished mothers (Lönnerdal 1986) doxycycline 200 mg, protein intakes of 1 g/kg of body weight/d promoted the conservation of skeletal muscle in order to maintain good milk production in lactating mothers (Motil et al doxycycline 100mg. Lactating women with these protein intakes appear to adapt by down-regulating protein metabolism (Motil et al 200mg doxycycline. The factorial approach is utilized for determining the protein require- ment during lactation doxycycline 100 mg. In this approach , it is assumed that the process of lactation does not alter the maintenance protein requirement of the nonlactating woman and that the protein and amino acid requirements are increased in proportion to milk production . It is important to empha- size that human milk is characterized by a relatively high concentration of nonprotein nitrogenous substances, which contribute approximately 20 to 27 percent of total milk nitrogen (Butte et al. Whether this merely reflects a diversion of urea loss from urine (plus some colonic fermentation) to milk is not known, but in the calculations it is assumed that part of the increased nitrogen needs of the lactating woman will of necessity be derived from her dietary protein. The additional protein requirement for lactation therefore is defined as the output of total protein and nonprotein nitrogen in milk. This table shows the factorial estimate of the increase in protein requirement associated with lactation and assumes that the incremental efficiency of nitrogen utilization of 0. It is assumed that the cost of making protein for maintenance requirements is the same as that for growth and lactation. When the absolute increase was converted to weight-specific intakes by using the reference weights of adolescent girls 14 to 18 years (54 kg) and adult women 19 to 50 years (57 kg) from Chapter 1 (Table 1-1), the numbers were quite close, so the highest value (that for the 14- to 18-year-old category) is provided as the overall recom- mendation. Adding the average requirement for additional protein needed is calculated as +21. Again, given the closeness of the values, one value is recommended for all age groups. Whether or not this is true has significance not only for athletes, but also for those with muscle wasting who wish to preserve muscle mass by training, such as elderly or immobile adults, or those suffering from muscle-wasting dis- eases. The available literature includes studies of both resistance (body- building) and endurance training. Endurance training does not result in muscle building, which would increase muscle protein deposition, but it is well recognized that endurance exercise is accompanied by an increase in the oxidation of branched chain amino acids (Lemon et al. However, these were acute studies performed around the time of the exercise itself, and did not take into account the remaining part of the day. An examination of leucine oxidation over a 24-hour period, including exercise during each of the fed and fasting periods, showed that the increase in oxidation, although statistically significant, was small in relation to the total daily amount of oxidation (4 to 7 percent) (El-Khoury et al. Moreover, the increase in leucine oxidation was proportionally similar with diets containing 1 or 2. Neither leucine nor nitrogen balance was significantly negative, suggesting that the exercise did not compromise body protein homeostasis at either level of protein intake. Although no control group without exercise was studied, the results were similar to those reported previously from individuals at an intake of 1 g/kg/d of protein undergoing the same experimental proce- dures without exercise (El-Khoury et al. Similarly, a study designed to determine the protein requirement of endurance-trained men led to an average requirement estimate in young and older men of 0. However, as no controls without exercise were included in the study, it is not possible to conclude that the exercise led to a higher protein requirement. The effects of resistance training on nitrogen bal- ance have been investigated in older adults (8 men and 4 women, aged 56 to 80 years) at one of two levels of protein intake, 0. Before training began, the mean corrected nitro- gen balance was not significantly different from zero in the three men and three women receiving the lower protein intake, and was positive in the five men and one woman receiving the higher intake, suggesting a require- ment about 0. However, after 12 weeks of resistance training, nitrogen balance became more positive by a similar amount at the two intakes, which the authors suggested was the result of an increased effi- ciency of protein retention that was more pronounced in those on the lower protein diet as a percent of protein intake. In particular, the improve- ment in nitrogen balance was independent of the protein intake. A similar study was performed by Lemon and coworkers (1992), which compared protein intakes of 1. However, this estimate of requirement cannot be taken as realistic, because the positive nitrogen balance of 8. Measure- ments of body composition showed no changes in lean body mass, creatinine excretion, or biceps muscle nitrogen content in either dietary group. In addition, although there were increases in some measurements of strength, there was no effect attributable to diet. Therefore, the available data do not support the conclusion that the protein requirement for resistance training individuals is greater than that of nonexercising subjects. In view of the lack of compelling evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise. Plant proteins are generally less digestible than animal proteins; however, digestibility can be altered through processing and preparation. Therefore, consuming a varied diet ensures an adequate intake of protein for vegetarians. Adult vegetarians consume less protein in their diet than non- vegetarians (Alexander et al. However, only one of these studies indicated that total protein intakes of 10 of the 25 vegan women were potentially inadequate (Haddad et al. As was shown in Table 10-13, the nitrogen requirement for adults based on high- quality plant food proteins as determined by regression analysis was not significantly different than the requirement based on animal protein or protein from a mixed diet. In conclusion, available evidence does not support recommending a separate protein requirement for vegetarians who consume complementary mixtures of plant proteins. However, nitrogen balance could not be applied to histidine since individuals take 56 days or more to go into negative nitrogen balance on a low histidine or histidine-free diet (Cho et al. The amino acid requirements thus developed are used as the basis for recommended protein scoring patterns discussed in a subsequent section. Further, there are no reports of healthy full-term infants exclusively and freely fed human milk who manifest any sign of amino acid or protein deficiency (Heinig et al. Four recent studies on the indispensable amino acid composition of human milk and their mean are shown in Table 10-18. The indispensable amino acid intake on a mg/L basis was calculated from the mean of the amino acid composition of mixed human milk proteins expressed as mg amino acid/g protein (Table 10-18) times the average protein content of human milk of 11. Children Ages 7 Months Through 18 Years Evidence Considered in Estimated the Average Requirement Nitrogen Balance. The only data derived directly from experiments to determine the indispensable amino acids requirements of children have been obtained by studying nitrogen balance. Pineda and coworkers (1981) conducted nitrogen balance studies in 42 Guatemalan children ranging in age from 21 to 27 months. Their mean amino acid estimates were reported to be: lysine, 66 mg/kg/d; threonine, 37 to 53 mg/kg/d; tryptophan, 13 mg/kg/d; methionine + cysteine, 28 mg/kg/d; isoleucine, 32 mg/kg/d; and valine, 39 mg/kg/d. Unfortunately, with the exception of lysine, no estimates of variance were published. For older children, the only data are those published by Nakagawa and coworkers in the 1960s (1961a, 1961b, 1962, 1963, 1964) on Japanese boys 10 to 12 years of age. Although these data seem to be accurate as there was uniformly negative nitrogen balance when the test amino acid was at zero, the maximum rate of nitrogen retention found when the amino acids were given in adequate quantities was 33 ± 14 mg/kg/d. Thus, it is likely that the values generated in this series of studies are overestimates of the actual requirement. Similar problems of interpreting nitrogen balance studies are apparent in the data for infants aged 0 to 6 months from a number of detailed studies in which infants were given multiple levels of amino acids (Pratt et al. With these studies also, the measured nitrogen balance was higher than what would be expected from the growth rates observed or estimated. Nonlinear regression analysis was used to fit the data for nitrogen balance versus amino acid intake to various curves, such as exponential, sigmoid, and bilinear crossover, in order to detect an approach to an asymptote or a breakpoint that could be equated with a requirement. How- ever, these attempts did not lead to interpretable results, which proved to be too sensitive to the specific criteria employed to define the point on the curve that would identify a requirement. In view of the reservations expressed above, the data from nitrogen balance studies in children were not utilized. Instead, the factorial approach was employed for children from 7 months through 18 years of age. In view of the doubts about the accuracy of the values generated by the empirical data, the factorial approach using data for growth (and its amino acid composition) and maintenance was utilized to determine requirements. In this model, the growth component was estimated from estimates of the rate of protein deposition at different ages (Table 10-9), the amino acid composition of whole body protein (Table 10-19), and incremental efficiency of protein utilization as derived from the studies in Table 10-8. The obligatory need for protein deposition (growth) was calculated as the product of the rate of protein deposition (Table 10-9) and the amino acid composition of whole body protein (Table 10-19). It is also necessary to determine a maintenance amino acid require- ment since by 7 months of age, the dietary requirement necessary to main- tain the body in nitrogen equilibrium accounts for more than 50 percent of the total indispensable amino acid requirement. First, estimates of the amino acid requirements needed for mainte- nance were calculated based on estimates of the obligatory nitrogen loss, which is the total rate of loss of nitrogen by all routes (urine, feces, and miscellaneous) in children receiving a protein-free or very low protein intake. Assuming that each individual amino acid contributed to this loss in proportion to its content in body protein, and that this represents the minimal rate of loss for this amino acid, the amount of this amino acid that must be given to replace the loss and achieve nitrogen balance is taken as the maintenance requirement when corrected for the efficiency of nitrogen utilization. Thus, the lysine requirement for maintenance for children 7 months through 13 years of age is calculated by multiplying the obligatory nitrogen loss of 57. Then this is divided by the slope of the regression line of protein intake versus nitrogen balance, which represents the efficiency protein utilization of 0. A second method for estimating maintenance requirements is to assume that at nitrogen equilibrium, the relative requirement of each indispensable amino acid is in proportion to its contribution to body protein. Thus, the maintenance protein requirement of 688 mg/kg/d (110 mg of N/kg/d for children through age 13 in Table 10-8 × 6. This method is mathemati- cally equivalent to the method described above, but because the values for obligatory loss and maintenance protein requirement were taken from the regression of protein intake against nitrogen balance, for statistical reasons they give slightly different results, and both are given in the Table 10-20. This difference is predictable because of the imperfec- tions in the factorial approach. It is likely that the obligatory loss of one amino acid is higher than that for other amino acids in relation to their content in body protein. If this loss cannot be reduced further under basal conditions, then this amino acid will determine the obligatory loss for all other amino acids, which can no longer be used for anabolic processes. In theory, this “limiting” amino acid should be identified as having the lowest ratio between the requirement estimates from maintenance and by direct measurement, which is isoleucine in this report (Table 10-20). The important conclusion from the above discussion is that the cal- culation of the maintenance requirement in adults from the obligatory nitrogen loss gives values in adults that are in general higher than the measured values, and therefore appear to overestimate true maintenance. Moreover, as the maintenance protein requirement is estimated to be the same per kilogram of body weight in adults and children, it is reasonable to conclude that the amino acid values for maintenance needs derived from the obligatory nitrogen loss are likely to be overestimates in children as well as in adults. A coefficient of varia- tion of 43 percent for protein deposition was determined in the study of Butte and coworkers (2000), and this varied little with age and gender. An explanation of each of these indicators is found in the section, “Selection of Indicators for Estimating the Requirement for Individual Amino Acids. All of the above five methods are based on measuring a change in the particular endpoint in response to graded levels of the test amino acid. A key observation regarding nitrogen balance as an endpoint is that there is a curvilinear relationship between nitrogen balance and test amino acid intake, so that nitrogen retention (nitrogen balance) becomes less efficient as zero balance is approached (Figure 10-7) (Rand and Young, 1999). Furthermore, the earlier work did not include miscella- neous losses in their nitrogen balances. Finally, most studies did not attempt to consider the effect of between-individual variance. Only two studies were found in which several individuals were studied at four or more different levels of intake of the test amino acid (Jones et al. They also examined the effect of adding either 5 or 8 mg/kg/d of miscellaneous nitrogen losses. Whereas Jones and coworkers (1956) had concluded, based on their data, that the lysine requirement was 8 mg/kg/d, the reanalysis by Rand and Young (1999) came to the conclusion that the lysine requirement was in the range of 17 to 36 mg/kg/d, and that the data strongly support a requirement of about 30 mg/kg/d. As shown in Table 10-22, 24-hour amino acid balance studies have been completed for four amino acids: leucine (El-Khoury et al. The 24-hour balance model is regarded as being the best from a theoretical point of view, especially when performed with the indicator approach. However, from a practical point of view, the 24-hour amino acid balance studies are very labor intensive with the result that only three or four levels of intake of the test amino acid have been studied for each of leucine, lysine, phenylalanine + tyrosine, and threonine. Nonlinear regression was used on two sets of nitrogen balance data as shown by Rand and Young (1999). The first was for lysine in which the original data were in women, each of whom were studied at two to five levels (Jones et al. This data set was reanalyzed using nonlinear regression, including the addition of 5 or 8 mg of nitrogen/kg/d as miscellaneous losses (Rand and Young, 1999), and these reanalyzed data are included in Table 10-22. Using a similar approach, the data of Reynolds and coworkers (1958) for methionine + cysteine were reanalyzed, and these data are included in Table 10-22. The result is consistent with the data of Zezulka and Calloway (1976a, 1976b), who studied the effect on nitrogen balance of three levels of methionine added to soy protein at a constant and adequate level of total nitrogen. Since there are no direct estimates of the isoleucine requirement, it is estimated from the leucine and valine estimates. The isoleucine requirement was therefore calculated by multiplying the isoleucine requirement calculated from the protein requirement (Table 10-20) by 1. This approach is weakest with the phenylalanine + tyrosine requirements where there is a large range—from 15. Given the very few studies available, separate requirements could not be determined for women versus men, or for young and older adults. However, an approximate standard devia- tion was calculated as half of the distance from the 16th to the 84th per- centile of the protein requirement distribution as estimated from the log normal distribution of requirements. The quality of a source of protein (or more specifically the source of nitrogen, since dietary protein is generally measured analytically in terms of nitrogen) is an expression of its ability to provide the nitrogen and amino acid requirements for growth, mainte- nance, and repair. In practice, protein quality is principally determined by two factors: digestibility and the amino acid composition of the protein in question. In food as opposed to relatively pure protein, the contribution of all of the indispensable amino acids to the total nitrogen content of the food has to be considered in assessing the overall protein quality of the diet.
Take two ounces of meerschaum11 and one-half ounce each of frankincense and cuttle- ﬁsh bones 100 mg doxycycline. Reduce the meerschaum and the frankincense to a powder and 100mg doxycycline, ﬁnely scraping the cuttleﬁsh bone doxycycline 100mg, put this on the eyes doxycycline 200 mg. Take the middle bark of boxwood 200mg doxycycline, ﬂower of broom doxycycline 100 mg, crocus doxycycline 200mg, and egg yolks 200 mg doxycycline, and cook them in water . Recipe oua formicarum , auri- pigmentum rubeum et gumi hedere, cum aceto misce, et loca frica. Recipe radicem celidonie et rubee maioris, ana tere, et cum oleo in quo diligenter ciminum et rasura buxi et celidoniaa et parum crocib sint cocta, caput unge,c et unctum maneat die ac nocte, et laua de lexiuia cineris caulis et paleed ordei. Accipea agrimoniam et corticem ulmi, radi- cemb uerbene, radicem salicis, abrotanum,c semen lini combustum et pulueri- zatum, radicem canne. Post appone [va] ciminum benec tritumd et masticem et uitella ouorum benee cocta et simulf parumg misce. Recipe mirte, geneste, gallitrici, et in aceto coquea ad aceti consumptionem, et ex eo assidue extrema capillorum frica. Lupinos amaros pulueriza et in aceto bullias,a et inde capillos frica inter manus. Take ants’ eggs, red orpiment, and gum of ivy, mix with vinegar, and rub the areas. Take root of greater celandine and madder, grind each and with oil in which cumin and boxwood shavings and greater celandine and a little bit of crocus have been carefully cooked, anoint the head. And let it stay anointed day and night, and wash it with a cleanser of cabbage ash and barley chaﬀ. Grind root of danewort with oil and anoint the head, and tie it on the head with leaves. Take agrimony and elm bark, root of vervain, root of willow, southernwood, burnt and pulverized linseed, [and] root of reed. Cook all these things with goat milk or water, and wash the area (having ﬁrst shaved it). Let cabbage stalks and roots be pulverized, and let pul- verized shavings of boxwood or ivory be mixed with them, and it should be pure yellow. Grind root of marsh mallow with pork grease, and you should make it boil for a long time in wine. Afterward put in well- ground cumin and mastic and well-cooked egg yolks, and mix them together a little. After they have been cooked, strain [this mixture] through a linen cloth and set it aside until it becomes cold. Then take the fatty residue which ﬂoats on the top and, having washed the head well, you should anoint it with it. Take myrtleberry, broom, [and] clary, and cook them in vinegar until thevinegar has been consumed, and with this rub the ends of the hair vigorously. Primo abluatc faciemd cum sapone gallico et cum aqua calida optime et cum colatura fur- furis abluat se in balneo. Recipe tartarum pera frustra et in peciab noua inuolue et intingatur in forti aceto, ita ut totum sit madidum,c et tunc ponatur ad ignem donec carbonescat. Postead ponatur in scutella ferrea et inter digitos commisceatur cum oleo, et sic per tres uel quatuor noctese aeri expo- natur, et stet in una parte decliuis ita quod oleum manare possit. Accipeb frumentum uel ordeum recens dumc adhuc est in lacte, et in mortario fortiter tere, et pista, et pone aquam in triplo, et ibi dimitte donec putreﬁat. Postea totum exprime et soli exponed donec aqua ex totoe desiccetur et hoc usui reserua. Post inunc- tionem psilotri, eat ad balneum, et facieme bene siccatam cum panno, illiniat hocf psilotro, quod sic ﬁt. Et hiis resolutis, addatur gutta parua galbani,b diu coquanturc mouendo cum spatula. Hoc facto, ab igne deponatur, et cum fuerit tepidum, faciem suam liniat,e tamen caueat a superciliis. On Women’s Cosmetics On Adornment of Women’s Faces  After beautifying the hair, the face ought to be adorned, [because] if its adornment is done beautifully, it embellishes even ugly women. First of all, let her wash her face very well with French soap and with warm water, and with a straining of bran let her wash herself in the bath. Take tartar and [break] it into little bits, and wrap it in a new piece [of cloth] and dip it in strong vinegar so that it be- comes thoroughly soaked, and then let it be placed on the ﬁre until it turns to coals. Then let it be placed on an iron bowl and let it be mixed together be- tween the ﬁngers with oil. And thus for three or four nights leave it exposed to the air, and let it stay in an inclined spot so that the oil is able to ﬂow out. Having collected this oil in a jug, let thewoman anoint her face for seven nights and as many days, and even for ﬁfteen days if she has an abscessed and freckled complexion. And if she is embarrassed to anoint her face during the day, let her anoint it at night, and in the morning let her wash it with warm water in which fatty residue of starch is dissolved in order to soften it. Take grain or fresh barley while it is still in milk, and grind it vigorously in a mortar, and pound it, and put in three parts water, and let it stay there until it putreﬁes. Then press out the whole thing and expose it to the sun until the water is thoroughly evaporated and reserve this for [later] use. Afterward, let her wash her face, just as we previously prescribed the whole body should be washed. After the anointing with the depilatory, let her go to the baths again and, having dried it well with a cloth, let her smear her face with this depilatory, which is made as follows. And these things having been dissolved, let a small drop of galbanum be added, [and] let them cook for a long time, stirring with a spatula. Likewise, take mas- tic, frankincense, and gum arabic, and let them be mixed with the rest. Having done this, let it be removed from the ﬁre, and when it is lukewarm let her smear ¶a. Illudf cutem subtiliat, et pulchram reddit faciem, et pilos remouet, et om- nem spurciciamg reddit coloratam et lucidam. Eleuata autem cute, sepumd hyrcinum recens faciei superpone,e et postea eleuatam [rb] cutem remoueas. Resoluatur cera albissima, tunc apponatur albumen oui et admisceatur puluis ceruse bene puluerizate et cribellate, et iterum parum decoquatur, deinde coletur per pannum, et huic colature frigide addatur cam- phor, nucem muscatam, et. Recipe rasuramg brasilii et ponatur in testa oui parumh continentis aque rosacee, et ponaturi ibidem parumj aluminis, et hoc tali ungat bombacem et imprimat super faciem et reddatk eam rubeam. Reso- luatur cera in uase ﬁctili et accipe ampullam plenam aquaa frigida, uel ﬁat hoc cum alia formula, et sic multociens facto, tota cera extrahaturb folia extra- [va]hendo. On Women’s Cosmetics her face; but let her take care [not to touch] the eyebrows. This reﬁnes the skin and makes the face beautiful, and it removes hairs and renders every blemish well colored and clear. Having raised the skin, place on the face fresh goat tallow and then you should remove the raised skin. Let oil of violets or rose oil with hen’s grease be placed in a clay vessel so that it boils. Let very white wax be dissolved, then let egg white be added and let powder of well-powdered and sifted white lead be mixed in, and again let it be cooked a little. Then let it be strained through a cloth, and to this strained cold mixture let camphor, nutmeg, and three or four cloves be added. Take shaving of brazilwood and let it be placed in an eggshell containing a little rose water, and let there be placed in the same place a little alum, and with this let her anoint some cotton and press it on her face and it should make her red. And having done this many times over, let the whole of the wax be extracted pulling it out leaf by leaf. And let this be done for one day, and it will become white just like a linen cloth. Reduce to a pow- der sowbread cleaned of the exterior and dried in the sun, or in a hot oven. But ﬁrst she should prepare her face, and she should make red a whitened face, as we said. Take crystals, varnish, eglantine, borax, gum tragacanth, and camphor with a little bit of white lead. Misce hos pulueres,a23 et succum pone uniu- scuiusque ad mensuram oui anserisb uel dimidii. Deinde accipec parum ceruse cum aqua ad solem mundate, et aqua rosacea calefacta predictis admisce, [vb] et parum fac bullire lento igni, et post mediam ebullitionem appone zinziber tritum, olibanum, sinapis albe siue agrestis, cimini ana. Deinde in aliam aquamc cola, et colatum diu cum manibus moueatur, et tunc habeatur puluis cristalli et uernicis. Postea cum muliera uadit ad balneum,b unum uel duo de ouisc distempereturd cum radice contusa et dimit- tat. Faciec lota in aqua tepida et fur- fure ter in ebdomada, et in die dominicad de hoc unguento unge. Recipe cam- phoram,e radicem lilii in aqua elixam,f et auxungiam porcinam recentem. Recipe lapa- cium accutum,b olibanum, dragunteam, osc sepie, ana fac puluerem, ter in ebdomada frica, prius tamen facie bene lota in aqua furfuris, et in die sabbati ¶a. On Women’s Cosmetics ony, bistort, and cuckoo-pint, together with skimmed honey. Mix these pow- ders,14 and put in the juice of each [substance] in the amount of a goose egg or a half. Then take a little white lead cleaned in the sun with water, and add heated rose water to the above-mentioned things, and make it boil a little on a slow ﬁre, and after it is half-boiled add ground ginger, frankincense, white or wild mustard, [and] cumin in equal amounts. And in the morning let her wash herself vigorously with bread- crumbs, or with a powder made from beans or with ﬂour of lupins. Then strain it into another water and, once it is strained, stir it for a long time with the hands, and then let her add powder of crystal and varnish. Then, when the woman goes to the baths, let her mix one or two of the eggs with the ground- up root and leave it. Then let her anoint the face, and when she wishes to leave the bath, let her wash herself well. Grind bistort or marsh mallow, or pound red or white bryony vigorously, and then mix it with white honey, and make it boil for two hours. And at the end of the cooking, add powder of camphor, borax, and rock salt, stirring a long while with a spatula, and save for [later] use. With the face having been washed in warm water and with bran three times during the week, on Sunday anoint with this ointment. Take some each of red dock, frankincense, bistort, and cuttleﬁsh bone; make a powder, rub [it on] three times during the week, ﬁrst having ¶a. Post accipe furfur et infunde in aqua bullienti,c et inde laua locum patientem, et postea desiccetur,d et face tale unguentum. Mundamus radicem lilii, et cum aqua decoquimus, qua cocta fortiter terimus et auxungiam liquefactam ad ignem et af sale mundatam et dis- temperatamg superinfundimus, post in aqua rosacea inponimus predictumh puluerem. Et notandum quod ualet contra adustionem solis et ﬁssurasi labio- rum et quaslibetj pustulas in facie, et ad excoriationes et ad preseruationem earum. Hoc cutem eleuat et pulcre decorat, nec in mane siuel loturis uel aliquom modo estn remouendum, quia colori non derogat. Istoo unguento mulieres28 solump unguntq faciemr contra cataractas29 pro mortuiss factas. Accipe folium caulis ru- bei,b et semen radicis rubee maioris, ana terantur, et in uino decoquantur op- timoc ad. And on Saturday wash the face well with egg white and starch, and let it remain for one hour, but ﬁrst wash it with fresh water and smear it on. Take a little bit of red dock and pound it vigorously, and rub the aﬄicted area for a long time. Afterward, take bran and pour in boiling water, and wash the aﬄicted area with this, and then let it be dried. And make this ointment: take some well-chopped elecampane and cook it for a long time in vinegar. Afterward, pound it vigorously and mix in powder of three ounces each of frankincense, mastic, litharge, aloe, orpi- ment, cumin, and quicksilver extinguished with saliva, plus cuttleﬁsh bone, soap, and grease. Then take one ounce each of mastic powder and frankincense, two scruples each of camphor and white lead, pork grease with which it should be prepared, and let it be prepared likewise with rose water, and keep it for [later] use. Having cooked it, we pound it vigorously, and we pour on fat liqueﬁed on the ﬁre and cleaned of salt and mixed. And it ought to be noted that this is good against sunburn and ﬁssures of the lips and any kind of pustules in the face, and for excoriations and for preventing them. In the evening the woman ought to anoint herself in front of the ﬁre, so that in the morning she is freed from all the above-mentioned aﬄictions. This elevates the skin and embellishes it beautifully, nor need it be removed in the morning with either washings or by any other means, for it does not detract from the color. Take leaf of red cabbage and seed of madder root, let each of these be pounded and let them be cooked in very good wine until reduced to a third. Tamen qui- dam testantur quod talia possunt curari exc sola agrimonia ex multo usu habita, siue in potu siue in puluere. Lauant in nocte cum aqua calida et mane; idg cutem labiorum consolidat, subtiliat, et eam reddit tenerrimam, et ab omni ulceratione preseruat, et si ulcerationesh in eis ﬁant, sanat. Colatured addatur brasilium frustatim incisum, et iterum bulliat,e et iterum dimittatur infrigidari, et cum tepidum fuerit, apponatur puluis aluminis, et tunc in ampulla aureaf uel uitrea pona- tur et usui reseruetur. Hoc modo intinguntg mulieres Sarracenumh facies suas, quibus unctis et desiccatis, ponunt ad dealbandum faciem aliquid predictorum ut cerotum uel aliquid aliud, et apparet color pulcherrimus admixtus rubori et albedini. Nevertheless, certain people20 claim that such things can be cured from agrimony alone when used habitually, either in a potion or in a powder. They have skimmed honey, to which they add a little white bryony, red bryony, squirting cucumber, and a little bit of rose water.
9 of 10 - Review by L. Porgan
Votes: 338 votes
Total customer reviews: 338