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Books > Ayurveda > Ayurveda > Clinical Ayurveda > Principles and Practice of Ayurvedic Rheumatology
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Principles and Practice of Ayurvedic Rheumatology
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From the Jacket

Principles and Practice of Ayurvedic Rheumatology is a real time approach to understand practical criticality faced by the Ayurvedic physicians while dealing with subject. Increasing interest in Ayurvedic medicine among the people world over has given Ayurvedic physicians an opportunity to prove themselves and to stand apart within the realm of a logical, scientific, reproducible and evidence based medical system. This is note-worthy to see that among the people now looking at Ayurveda, it is not only the patient suffering from the diseases which are found untreatable through conventional systems but also the scientist from different streams and the physicians from conventional system of medicine who are trying to get a clue to the conditions and their management where they don’t have much to offer to their patients.

This is the first book in the field of Ayurveda produced so far where the philosophical and mystical stains of Ayurveda were tried to be kept at minimum and the emphasis was given upon its logical understanding along with the addition of recent concepts of quality management in the field of medicine.

The book can prove to be of help for interns, postgraduate students and practicing physicians of Ayurveda in India and aboard. This would be indispensable for any one who is willing to make a carrier in Ayurvedic rheumatology.

About the Author

Dr. Sanjeev Rastogi is an outstanding postgraduate of Ayurvedic medicine from prestigious Banaras Hindu University. Rheumatology has been his area of interest for over a decade and this inclination has resulted in few monumental works in the field of Ayurvedic rheumatology. Besides over 10 research papers published in national and international journals regarding the joint diseases and their management, Understanding rheumatoid arthritis and Advances in Ayurvedic medicine (Joint Diseases) are the monographs which have added to his credit. He is the only Ayurvedic clinics. To establish Rheumatology, as an independent branch of study in Ayurveda is his mission and to establish a quality oriented, reproducible and responsible approach in Ayurvedic system of medicine is his vision. He has visited many neighbouring countries including China to give impetus to his vision.

Presently he is working as a consultant physician and lecturer in Dept. of Kaya chikitsa at Bundelkhand Govt. Ayurvedic College, Jhansi, India and is honorary advisor to Dept. of Holistic Medicine, Vatsala Hospital, Lucknow India.

Foreword

Ayurveda is known to be one of the oldest systems of medicine in the world. Every medial student in India knows the names of its legendary physician Charaka and surgeon Sushruta. According to Ayurveda, a preponderance of any one or a combination of three basic humours Vata, Pitta and Kapha is the cause of disease in the human body. It is reminiscent of old English view which says that a relative proportion of four elemental fluids of the body i.e. blood, phlegm, black bile and yellow bile determine a person’s physical and mental constitution and also disease.

Ayurveda lost to modern medicine because Ayurvedic practitioners erroneously believed that the lat word on the subject has been written, consequently o further research was done and hence no good statistical data is available about the curative value of an Ayurvedic drug on a particular disease and its effect on the body as a whole. When such a view is held and the mind are closed then no further research is possible. It is only when we begin to think with Tennyson that “Thousand things are hidden still and not a hundred are known” that we will make an effort to find those hidden things, and then only will some progress be made. The last word on any stream of learning will never be written, and therefore there always exists a scope for further improvement.

In the present book, the author has kept an open mind and has made bold and commendable effort to study arthritis in a spiritual of scientific enquiry. He has tried to integrate Ayurveda with modern concepts of medicine and has used the same methodology that allopathic doctors arrive at a conclusion. The symptoms, diagnosis and prognosis of various rheumatic diseases are naturally the same in all systems. Regarding treatment the author is aware of its limitations. In addition to medicine he also has laid stress upon physiotherapy and has recommended various exercises to improve mobility of joints. The exercises have been explained pictorially too. Besides medicine and physio-therapy he also advised changes in life style and diet.

The book on the whole, will be of use to students of Rheumatology in whatever system of medicine.

Preface

Complementory and alternative medicine (CAM) has generated a global interest in past few years. Its reported use has been increased phenomenaly in many developed countries claiming for an over 60% population using alternative medicine in some way. The unreported use may account even for higher and this would not be exaggerating to say that we all use alternative remedies in some way either deliberately through prescriptions or unknowingly in the form of supplements or through modifications in our living style by regular observation of the things, which we feel as not good to our health.

India, the motherland of the most ancient health maintenance system Ayurveda, has also witnessed these changes occurring globally. From its phase of relative darkness, Ayurveda is now gearing up to take greater responsibilities of health care in a more dependable manner. To bring Ayurveda into the mainstream of medicine, there are certain hurdles, which are still to be overcome. A better analytical understanding of the philosophical part of the subject, a better knowledge of pharmacological properties of the drugs and procedures, standardization of the drug formulary and formulation of guidelines to clinical practice are the areas requiring further refining to cut the edge.

In the bewildering field of medicine, there are certain areas, claimed to be of special significance to Ayurveda. Diseases of gastrointestinal system including hepatobilliary diseases, musculoskeletal diseases, neurological disorders and psychosomatic illnesses are presumed as to have a better cure in Ayurveda. Though there are not much scientific trials to back up these claims, a general look into the Ayurvedic OPD seems standing by the side in support of this presumption. Majority of patients visiting Ayurvedic OPD are referring to these systems and of the belief of finding an end to their ailments through Ayurveda.

This phenomena of expectations when combines with global reawakening and information boom of complementory medicine, puts an Ayurvedic physician under tremendous pressure. The utmost pressure he faces is to reproduce the results of claimed cures and this is often added with the logical explanations of the pathologies and working principle of the interventions made. In case if it is resolved, he is further supposed to see the economic viability of the therapy and to see its practical applicability in vulnerable groups of patients like those at extremes of ages, with pregnancy or with terminal illnesses.

Subject of rheumatology deserves a special mention in this context, as it comprises a substantial share of the patients commonly see in Ayurvedic OPD. Ayurvedic physicans dealing with joint diseases never find themselves in a comfortable position partly because of complexity of the pathology and partly because of poor understanding of drugs and diagnosis in rheumatology of Ayurveda. Very scarce literature is available to these physicians which can actually guide them in dealing with these patients who are already failure of other systems in providing a sustainable relief to them. Joint diseases presenting in Ayurvedic OPD actually forms a very special group of patients with distinct psychological and physical requirements. Without having a concern for these factors, merely giving a prescription never works as is witnessed by most Ayurvedic physicians working in the field of rheumatology. Apart from Ayurveda, arthritis patients are being helped through many other nonpharmacological ways, which compliment to the drug therapy in palliating the symptoms and speeding the recovery. Physical therapy, exercise therapy, hydrotherapy, dietary manipulation, meditation, relaxation and stress management are few commonly utilized modalities adding value to the Ayurveda if utilized in coherence to enhance its therapeutic effects. An Ayurvedic rheumatologist is supposed to be well worsed in these supportive techniques, which can help his patient for an earlier recovery. Proper diagnosis remains the benchmark of a good clinical practice and a determinant of the future course of illness and its recovery. Ayurveda unfortunately lags behind in having the proper diagnostic tools for the rapid screening of an illness. In cases where the diagnostic clues are available; they are wrapped in philosophical covers and are difficult to be uniformly utilized philosophical covers and are difficult to be uniformly utilized by every physician. Individualisation of the therapy as per the status of the patient as well as of the disease is often projected as the specialty of Ayurveda making it superior to the other prevailing systems. Unfortunately this truth has become the achilis tendon to Ayurveda for now as this has permitted the individual opinions and views to float over the general understanding of diagnosis and therapy causing only difficulties for arriving at a consensus which is essential if the reproducibility from the therapy is to be looked for. Propositions to the other side of rheumatology have not been easier either. Musculoskeletal diseases have been among the most baffling situations in medical practice remained un-answered in most part of the modern medical practice in past few decades. Failure in reaching at a consoling solution has produced many new and triky ways to evade the actual suffering of the patient and making himself responsible for his miseries. Theories of patient education, psychotherapy and a more stress upon the symptom palliation through involvement of various nonpharmacological methods are the ways of respite to tired modern rheumatologists who despite of their un-ability to crack the nut are not ready to give up the challenge. Proclaimation of a decade for bone and joint diseases between 2002-2011 by US president is the biggest evidence of this warriorship which says us for not to giveup till we reach at our targets.

This monograph tries to pick these special issues of rheumatology in their relevance to Ayurvedic physicians. It discusses issues of routine concern in joint diseases and tries to find a workable solution to meet the practical requirements. The book may work as a tool to post graduate and graduate students of Ayurveda looking for a carrier in Ayurvedic rheumatology. This can also work as a guide to practicing physicians of Ayurveda in India and abroad and can help them solving some of their intricate problems of rheumatology, which have remained unanswered so far. A prescription for some joint disease made by an Ayurvedic physician in the remote of northern India, when honoured, validated and proves effective to a similar patient in the farthest of south, would be the time to say that we have arrived at par with what the scientific medicine has achieved. This book is brought forward as a step towards this ultimate goal.

Sushruta, the Father of Surgery, wrote his Samhita (treatise) about 2500 years ago in Sanskrit at Varanasi and classified it into six shtanas (cantos) bearing 186 chapters.

As Sushruta Samhita deals with anatomy & surgery and deliberates on many contexts of contemporary interest such as plastic surgery, it continued to be on high demand of English readers. Inspired by such demands Prof. G. D. Singhal the then Professor & Head Department of Paediatric surgery of Banaras Hindu University along with a team of senior Ayurvedic experts from the same university, took the task of translating Sushruta Samhita in English. After several years of team work the book was published in 10 volumes during seventies.

In the mean time the initial print of the book exhausted and several volumes became out of print warranting republication of this important work. Considering the high demand and good quality of this work produced by the team of experts inclusive of both Ayurveda and modern surgery, the publisher decided to take up the work of republication in an improved format pooling in three parts to make it easy to handle. The work is now being published in new print and in new format pooling the 10 volumes of first edition into only three parts as mentioned below:

Part – 1 : Sutra & Nidan-sthan (Fundamental, Plastic Surgery, Pharmaceutical & Diagnostic considerations)
Part – 2 : Sharir, Chikitsa & Kalpa-sthan (Anatomical, Obstetric, Operative, Non-operative & Toxicological Considerations)
Part – 3 : Uttartantra (Ophthalmic, Otorhinolaryngological, Paediatric, Gynaecological, Medical and Psychiatric Considerations & Aphorisms)

The present edition of Sushruta Samhita is endowed with authentic translation of the text in good English with scientific temper, appropriate notes, chapter summary and identification of probable research areas in each chapter. The work is easy to read and grasp the contents in contemporary contexts. This work will be of renewed interest among the seekers of sushrutarian wisdom and expertise.

 

Contents

 

  Foreword (vii)
  Preface (ix)
1. Introduction 1-8
2. Pre-treatment work-up 9-49
  2.1 Diagnosis 9
  2.2 Prognosis 27
  2.3 Psychological status of patient 38
  2.4 Co existing illnesses 46
3. Treatment work-up 50-140
  3.1 Planning of treatment 50
  Non-pharmacological approach-  
  Rest & Exercise 52
  Physical therapy 57
  Panchakarma 68
  Diet and fasting 80-92
  Psychotherapy 100
  Lifestyle modification 107
  Pharmacological approach-  
  External applications 111
  Internal applications 114
  3.2 Duration of treatment 132
  3.3. Cost-effective analysis 133
  3.4. Selection of therapy 137
4 Peri-treatment work-up 141-146
  4.1. Monitoring of physical facilities and human resource 141  
  4.2. Monitoring of the therapy 145
  Monitoring for the effect 145
  Monitoring for the compliance 145
5 Post-treatment work-up 147-174
  5.1. Code of ethics in Ayurvedic  
  rheumatology practice 147
  5.2. Follow-up assessment 152
  Epidemiology 152
  Clinical presentation 153
  Benefit 154
  Adverse reaction 154
  Drop outs/Withdrawal 160
  Failures 161
  Documentation and reporting 161
  Dissemination 162
  5.3. Referral 168
  Higher Ayurvedic centers 170
  Rheumatology Clinics 171
  5.4. Public awareness 171
  Epilogue 175-176
  Appendices 177-193
  1. Bone and joint decade (2002-2011) proclaimation 177
  2. Differential traints of Sattva 180
  3. Yoga exercise scheduled for joint diseases 181
  4. Diet recommendations for inflammatory arthritis 189
  5. Estimating the probability of food allergy causing joint symptoms 191
  6. Ayurvedic constitutional analysis 192
  Bibliography 194-202
  Index 203-208

 

Sample Pages


Principles and Practice of Ayurvedic Rheumatology

Item Code:
NAB720
Cover:
Hardcover
Edition:
2009
ISBN:
8170844097
Size:
8.8 inch X 5.8 inch
Pages:
208 (20 B/W Illustrations)
Other Details:
a54_books
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$27.50   Shipping Free
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From the Jacket

Principles and Practice of Ayurvedic Rheumatology is a real time approach to understand practical criticality faced by the Ayurvedic physicians while dealing with subject. Increasing interest in Ayurvedic medicine among the people world over has given Ayurvedic physicians an opportunity to prove themselves and to stand apart within the realm of a logical, scientific, reproducible and evidence based medical system. This is note-worthy to see that among the people now looking at Ayurveda, it is not only the patient suffering from the diseases which are found untreatable through conventional systems but also the scientist from different streams and the physicians from conventional system of medicine who are trying to get a clue to the conditions and their management where they don’t have much to offer to their patients.

This is the first book in the field of Ayurveda produced so far where the philosophical and mystical stains of Ayurveda were tried to be kept at minimum and the emphasis was given upon its logical understanding along with the addition of recent concepts of quality management in the field of medicine.

The book can prove to be of help for interns, postgraduate students and practicing physicians of Ayurveda in India and aboard. This would be indispensable for any one who is willing to make a carrier in Ayurvedic rheumatology.

About the Author

Dr. Sanjeev Rastogi is an outstanding postgraduate of Ayurvedic medicine from prestigious Banaras Hindu University. Rheumatology has been his area of interest for over a decade and this inclination has resulted in few monumental works in the field of Ayurvedic rheumatology. Besides over 10 research papers published in national and international journals regarding the joint diseases and their management, Understanding rheumatoid arthritis and Advances in Ayurvedic medicine (Joint Diseases) are the monographs which have added to his credit. He is the only Ayurvedic clinics. To establish Rheumatology, as an independent branch of study in Ayurveda is his mission and to establish a quality oriented, reproducible and responsible approach in Ayurvedic system of medicine is his vision. He has visited many neighbouring countries including China to give impetus to his vision.

Presently he is working as a consultant physician and lecturer in Dept. of Kaya chikitsa at Bundelkhand Govt. Ayurvedic College, Jhansi, India and is honorary advisor to Dept. of Holistic Medicine, Vatsala Hospital, Lucknow India.

Foreword

Ayurveda is known to be one of the oldest systems of medicine in the world. Every medial student in India knows the names of its legendary physician Charaka and surgeon Sushruta. According to Ayurveda, a preponderance of any one or a combination of three basic humours Vata, Pitta and Kapha is the cause of disease in the human body. It is reminiscent of old English view which says that a relative proportion of four elemental fluids of the body i.e. blood, phlegm, black bile and yellow bile determine a person’s physical and mental constitution and also disease.

Ayurveda lost to modern medicine because Ayurvedic practitioners erroneously believed that the lat word on the subject has been written, consequently o further research was done and hence no good statistical data is available about the curative value of an Ayurvedic drug on a particular disease and its effect on the body as a whole. When such a view is held and the mind are closed then no further research is possible. It is only when we begin to think with Tennyson that “Thousand things are hidden still and not a hundred are known” that we will make an effort to find those hidden things, and then only will some progress be made. The last word on any stream of learning will never be written, and therefore there always exists a scope for further improvement.

In the present book, the author has kept an open mind and has made bold and commendable effort to study arthritis in a spiritual of scientific enquiry. He has tried to integrate Ayurveda with modern concepts of medicine and has used the same methodology that allopathic doctors arrive at a conclusion. The symptoms, diagnosis and prognosis of various rheumatic diseases are naturally the same in all systems. Regarding treatment the author is aware of its limitations. In addition to medicine he also has laid stress upon physiotherapy and has recommended various exercises to improve mobility of joints. The exercises have been explained pictorially too. Besides medicine and physio-therapy he also advised changes in life style and diet.

The book on the whole, will be of use to students of Rheumatology in whatever system of medicine.

Preface

Complementory and alternative medicine (CAM) has generated a global interest in past few years. Its reported use has been increased phenomenaly in many developed countries claiming for an over 60% population using alternative medicine in some way. The unreported use may account even for higher and this would not be exaggerating to say that we all use alternative remedies in some way either deliberately through prescriptions or unknowingly in the form of supplements or through modifications in our living style by regular observation of the things, which we feel as not good to our health.

India, the motherland of the most ancient health maintenance system Ayurveda, has also witnessed these changes occurring globally. From its phase of relative darkness, Ayurveda is now gearing up to take greater responsibilities of health care in a more dependable manner. To bring Ayurveda into the mainstream of medicine, there are certain hurdles, which are still to be overcome. A better analytical understanding of the philosophical part of the subject, a better knowledge of pharmacological properties of the drugs and procedures, standardization of the drug formulary and formulation of guidelines to clinical practice are the areas requiring further refining to cut the edge.

In the bewildering field of medicine, there are certain areas, claimed to be of special significance to Ayurveda. Diseases of gastrointestinal system including hepatobilliary diseases, musculoskeletal diseases, neurological disorders and psychosomatic illnesses are presumed as to have a better cure in Ayurveda. Though there are not much scientific trials to back up these claims, a general look into the Ayurvedic OPD seems standing by the side in support of this presumption. Majority of patients visiting Ayurvedic OPD are referring to these systems and of the belief of finding an end to their ailments through Ayurveda.

This phenomena of expectations when combines with global reawakening and information boom of complementory medicine, puts an Ayurvedic physician under tremendous pressure. The utmost pressure he faces is to reproduce the results of claimed cures and this is often added with the logical explanations of the pathologies and working principle of the interventions made. In case if it is resolved, he is further supposed to see the economic viability of the therapy and to see its practical applicability in vulnerable groups of patients like those at extremes of ages, with pregnancy or with terminal illnesses.

Subject of rheumatology deserves a special mention in this context, as it comprises a substantial share of the patients commonly see in Ayurvedic OPD. Ayurvedic physicans dealing with joint diseases never find themselves in a comfortable position partly because of complexity of the pathology and partly because of poor understanding of drugs and diagnosis in rheumatology of Ayurveda. Very scarce literature is available to these physicians which can actually guide them in dealing with these patients who are already failure of other systems in providing a sustainable relief to them. Joint diseases presenting in Ayurvedic OPD actually forms a very special group of patients with distinct psychological and physical requirements. Without having a concern for these factors, merely giving a prescription never works as is witnessed by most Ayurvedic physicians working in the field of rheumatology. Apart from Ayurveda, arthritis patients are being helped through many other nonpharmacological ways, which compliment to the drug therapy in palliating the symptoms and speeding the recovery. Physical therapy, exercise therapy, hydrotherapy, dietary manipulation, meditation, relaxation and stress management are few commonly utilized modalities adding value to the Ayurveda if utilized in coherence to enhance its therapeutic effects. An Ayurvedic rheumatologist is supposed to be well worsed in these supportive techniques, which can help his patient for an earlier recovery. Proper diagnosis remains the benchmark of a good clinical practice and a determinant of the future course of illness and its recovery. Ayurveda unfortunately lags behind in having the proper diagnostic tools for the rapid screening of an illness. In cases where the diagnostic clues are available; they are wrapped in philosophical covers and are difficult to be uniformly utilized philosophical covers and are difficult to be uniformly utilized by every physician. Individualisation of the therapy as per the status of the patient as well as of the disease is often projected as the specialty of Ayurveda making it superior to the other prevailing systems. Unfortunately this truth has become the achilis tendon to Ayurveda for now as this has permitted the individual opinions and views to float over the general understanding of diagnosis and therapy causing only difficulties for arriving at a consensus which is essential if the reproducibility from the therapy is to be looked for. Propositions to the other side of rheumatology have not been easier either. Musculoskeletal diseases have been among the most baffling situations in medical practice remained un-answered in most part of the modern medical practice in past few decades. Failure in reaching at a consoling solution has produced many new and triky ways to evade the actual suffering of the patient and making himself responsible for his miseries. Theories of patient education, psychotherapy and a more stress upon the symptom palliation through involvement of various nonpharmacological methods are the ways of respite to tired modern rheumatologists who despite of their un-ability to crack the nut are not ready to give up the challenge. Proclaimation of a decade for bone and joint diseases between 2002-2011 by US president is the biggest evidence of this warriorship which says us for not to giveup till we reach at our targets.

This monograph tries to pick these special issues of rheumatology in their relevance to Ayurvedic physicians. It discusses issues of routine concern in joint diseases and tries to find a workable solution to meet the practical requirements. The book may work as a tool to post graduate and graduate students of Ayurveda looking for a carrier in Ayurvedic rheumatology. This can also work as a guide to practicing physicians of Ayurveda in India and abroad and can help them solving some of their intricate problems of rheumatology, which have remained unanswered so far. A prescription for some joint disease made by an Ayurvedic physician in the remote of northern India, when honoured, validated and proves effective to a similar patient in the farthest of south, would be the time to say that we have arrived at par with what the scientific medicine has achieved. This book is brought forward as a step towards this ultimate goal.

Sushruta, the Father of Surgery, wrote his Samhita (treatise) about 2500 years ago in Sanskrit at Varanasi and classified it into six shtanas (cantos) bearing 186 chapters.

As Sushruta Samhita deals with anatomy & surgery and deliberates on many contexts of contemporary interest such as plastic surgery, it continued to be on high demand of English readers. Inspired by such demands Prof. G. D. Singhal the then Professor & Head Department of Paediatric surgery of Banaras Hindu University along with a team of senior Ayurvedic experts from the same university, took the task of translating Sushruta Samhita in English. After several years of team work the book was published in 10 volumes during seventies.

In the mean time the initial print of the book exhausted and several volumes became out of print warranting republication of this important work. Considering the high demand and good quality of this work produced by the team of experts inclusive of both Ayurveda and modern surgery, the publisher decided to take up the work of republication in an improved format pooling in three parts to make it easy to handle. The work is now being published in new print and in new format pooling the 10 volumes of first edition into only three parts as mentioned below:

Part – 1 : Sutra & Nidan-sthan (Fundamental, Plastic Surgery, Pharmaceutical & Diagnostic considerations)
Part – 2 : Sharir, Chikitsa & Kalpa-sthan (Anatomical, Obstetric, Operative, Non-operative & Toxicological Considerations)
Part – 3 : Uttartantra (Ophthalmic, Otorhinolaryngological, Paediatric, Gynaecological, Medical and Psychiatric Considerations & Aphorisms)

The present edition of Sushruta Samhita is endowed with authentic translation of the text in good English with scientific temper, appropriate notes, chapter summary and identification of probable research areas in each chapter. The work is easy to read and grasp the contents in contemporary contexts. This work will be of renewed interest among the seekers of sushrutarian wisdom and expertise.

 

Contents

 

  Foreword (vii)
  Preface (ix)
1. Introduction 1-8
2. Pre-treatment work-up 9-49
  2.1 Diagnosis 9
  2.2 Prognosis 27
  2.3 Psychological status of patient 38
  2.4 Co existing illnesses 46
3. Treatment work-up 50-140
  3.1 Planning of treatment 50
  Non-pharmacological approach-  
  Rest & Exercise 52
  Physical therapy 57
  Panchakarma 68
  Diet and fasting 80-92
  Psychotherapy 100
  Lifestyle modification 107
  Pharmacological approach-  
  External applications 111
  Internal applications 114
  3.2 Duration of treatment 132
  3.3. Cost-effective analysis 133
  3.4. Selection of therapy 137
4 Peri-treatment work-up 141-146
  4.1. Monitoring of physical facilities and human resource 141  
  4.2. Monitoring of the therapy 145
  Monitoring for the effect 145
  Monitoring for the compliance 145
5 Post-treatment work-up 147-174
  5.1. Code of ethics in Ayurvedic  
  rheumatology practice 147
  5.2. Follow-up assessment 152
  Epidemiology 152
  Clinical presentation 153
  Benefit 154
  Adverse reaction 154
  Drop outs/Withdrawal 160
  Failures 161
  Documentation and reporting 161
  Dissemination 162
  5.3. Referral 168
  Higher Ayurvedic centers 170
  Rheumatology Clinics 171
  5.4. Public awareness 171
  Epilogue 175-176
  Appendices 177-193
  1. Bone and joint decade (2002-2011) proclaimation 177
  2. Differential traints of Sattva 180
  3. Yoga exercise scheduled for joint diseases 181
  4. Diet recommendations for inflammatory arthritis 189
  5. Estimating the probability of food allergy causing joint symptoms 191
  6. Ayurvedic constitutional analysis 192
  Bibliography 194-202
  Index 203-208

 

Sample Pages


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