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Organisms have to live long enough and be healthy enough to reproduce and to promote the survival of their offspring kamagra 50 mg on-line, but that is all purchase kamagra 50 mg free shipping. Physicians and their patients regularly confront tradeoffs and constraints, when they are forced to weigh the risks, benefits, and costs of treatment options, 176 Perspectives in Biology and Medicine Evolution and Medicine but they usually view these tradeoffs as practical problems rather than as in- escapable facts of life. In contrast, evolutionists recognize that tradeoffs and constraints limit the ability of natural selection to optimize fitness and believe that they play a large role in evolutionary processes. Individual organisms are the products of two distinct histories—their own life history, or ontogeny, and the evolutionary history of their species, or phylogeny. Biologists often divide the causes of biological phenomena into proximate causes, causes that operate during the lifetime of an individual, and ultimate causes, causes that operated during the evolutionary history of the species (Mayr 1988b). Proximate causes are sometimes said to answer “how” questions—for example, how (by what physiological mechanisms) do we raise our body tem- perature in response to infection? The Dutch ethologist Nikolaas Tinbergen (1963) pointed out that traits have two distinct proximate causes and two ultimate causes. The proximate causes of a trait include its development during an organism’s ontogeny and the physiological or molecular mechanisms that produce it; the ultimate causes are its phylogenetic origin and its adaptive significance. Physicians have traditionally been concerned with proximate causes of disease because these are the causal pathways that are amenable to medical intervention. In contrast, evolutionists want to understand ultimate causes of biological phenomena. Recent advances in evolutionary development biology, or “evo-devo,” have called attention to the relationship between evolution and development and have led to a blurring of the distinction between proximate and ultimate causes (Laland et al. As discussed below, there is currently great interest in understanding the ways in which our evolved mechanisms of development may predispose us to disease in adult life. To a great extent, medicine has tried to separate humans from the rest of nature and protect us from species that might cause disease. Evolutionists, on the other hand, view populations as embedded in ecological communities that comprise a myriad of interrelated and interacting species, all of which are subject to natural selection and are therefore coevolving. Physicians certainly recognize environmental causes of disease, espe- cially infectious diseases and diseases due to environmental toxins. Nonetheless, medical research has focused on the inner workings of human beings, on the physiological and pathophysiological mechanisms that promote health or lead to disease. Medicine is concerned with what Claude Bernard (1957) termed the “internal environment,” the blood and extracellular fluids that provide the immediate environment in which our cells and organs function. In this view, health involves the maintenance of constant, or nearly constant, conditions in the internal environment—conditions that enable cells and organs to function prop- spring 2013 • volume 56, number 2 177 Robert L. Perlman erly—while diseases are manifest by deviations from these “normal” conditions. Evolutionary biologists appreciate that the physiological mechanisms that main- tain homeostasis are adaptations that enhance fitness, but they are more inter- ested in studying the interactions of organisms with their external environments, because it is these ecological interactions that shape the struggle for existence and natural selection. Appreciation of the physiological functions and patho- physiological effects of the human microbiome, the communities of microor- ganisms that inhabit our skin, intestines, and other body cavities, has led to the recognition that humans are ecological communities. Indeed, study of the microbiome is a growing area of research in which the interests of physicians and evolutionists are converging (Turnbaugh et al. Finally, medicine and evolutionary biology have different ways of thinking about variation. Physicians distinguish between “normal” values of traits, values that are associ- ated with good health or that are common in the population, and “abnormal” values, values that are associated with an increased risk of disease. In a medical context, this distinction between normal and abnormal often makes good sense. Many deviations from normal values—elevated blood pressure, blood choles- terol, and body mass index, for example—are risk factors for diseases that may be prevented or postponed by medical interventions. Occasionally, however, extreme values of a trait—short stature, for example—may be labeled abnormal even if they do not have implications for health. Since the rise of the Human Genome Project, physicians are certainly aware of and concerned about genetic variations among their patients. But medicine is still influenced by an essential- ist view of biology that tends to view phenotypic variations as deviations from a normal, healthy, or ideal state. This medical understanding of variation differs from that of evolutionary biologists, who view variation as a fundamental prop- erty of biological populations.

Angell M (1997) Anti-polymer antibodies 50mg kamagra overnight delivery, silicone breast implants buy kamagra 100mg otc, and I would like to acknowledge the support of P. This is an open-access article distributed under the Mangalore, Karnataka, India terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author B. Manipal Academy of Higher Education Funding: The authors received no specific funding for this article. Manipal, Karnataka, India References Competing Interests: The authors have declared that no competing interests exist. T e rotu la A edieval Com pendium of W om en’s edicine Edited and Translated by M onica. The city of Salerno as depicted in an eighteenth- century engraving  Figures  and . A case of uterine suffocation from a late thirteenth-century English manuscript – Figures  and . Fumigation pots and pessaries from a fifteenth-century Dutch translation of the Trotula – Figure . A private bath for a woman; from a late twelfth-century copy of the Salernitan Antidotarium magnum  Figure . Opening page of the standardized Trotula ensemble  This page intentionally left blank Preface I    as in histories of medicine, readers often find a passing reference to a mysterious person called Trotula of Salerno. She is also alleged to have been the first female professor of medicine, teaching in the southern Italian town of Salerno, which was at that time the most important center of medical learning in Europe. Other sources, however, assert that ‘‘Trotula’’ did not exist and that the work attributed to her was written by a man. Any figure who could generate such diametrically opposed opinions about her work and her very existence must surely be a mystery. Yet the mys- tery of ‘‘Trotula’’ is inevitably bound up with the text ‘‘she’’ is alleged to have written. The Trotula (for the word was originally a title, not an author’s name) was indeed the most popular assembly of materials on women’s medicine from the late twelfth through the fifteenth centuries. Written in Latin and so able to circulate throughout western Europe where Latin served as the lingua franca of the educated elites, the Trotula had also by the fifteenth century been trans- lated into most of the western European vernacular languages, in which form it reached an even wider audience. The Latin Trotula was edited for publication only once, in the sixteenth century, under the title The Unique Book of Trotula on the Treatment of the Diseases of Women Before, Dur- ing, and After Birth,2 and the only modern translations available are based on this same Renaissance edition. The Renaissance editor, undoubtedly with the best of intentions, added what was to be the last of many layers of editorial ‘‘improvements. True, they were all probably of twelfth-century Salernitan origin, but they reflected the work of at least three authors with distinct perspectives on women’s diseases and cosmetic concerns. The first and third of these texts, On the Conditions of Women and On Women’s Cosmetics, were anonymous. The sec- ond, On Treatments for Women, was attributed even in the earliest manuscripts to a Salernitan woman healer named Trota (or Trocta). Each of the texts went through several stages of revision and each circulated independently through- out Europe through the end of the fifteenth century, when manuscript culture began to give way to the printed book. By the end of the twelfth century, an anonymous compiler had brought the three texts together into a single ensemble, slightly revising the wording, adding new material, and rearranging a few chapters. This ensemble was called the Summa que dicitur ‘‘Trotula’’ (The CompendiumWhich Is Called the ‘‘Tro- tula’’), forming the title Trotula (literally ‘‘little Trota’’ or perhaps ‘‘the abbre- viated Trota’’) out of the name associated with the middle text, On Treatments for Women. The appellation was perhaps intended to distinguish the ensemble from a general, much longer medical compilation, Practical Medicine, com- posed by the historical woman Trota. The Trotula ensemble soon became the leading work on women’s medicine, and it continued to be the object of ma- nipulation by subsequent medieval editors and scribes, most of whom under- stood ‘‘Trotula’’ not as a title but as an author’s name. He rewrote certain passages, suppressed some material and, in his most thorough editorial act, reorganized all the chapters so as to eliminate the text’s many redundancies and inconsis- tencies (due, we know now, to the fact that several authors were addressing the same topics differently). There is no way that a reader of this emended printed text could, without reference to the manuscripts, discern the presence of the three discrete component parts. Hence when some twenty years later a debate over the author’s gender and identity was initiated (and it has continued to the present day), it was assumed that there was only one author involved. What can they reveal about the impact of the new Arabic medicine that began to infiltrate Europe in the late eleventh century? Is there, in fact, a female author behind any of the texts and, if so, what can she tell us about medieval women’s own views of their bodies and the social circumstances of women’s healthcare either in Salerno or elsewhere in Europe?

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