In at least two recent reports there were no increases in malformations from their use (Jick et al cheap antabuse uk treatment 0f gout. Butoconazole buy antabuse on line amex symptoms 0f a mini stroke, terconazole generic antabuse 500mg without prescription medicine 3 sixes, and ketoconazole There are no large studies of the use of these three antifungal agents during pregnancy. Butoconazole is a category B drug, and the other two are listed as category C by their 36 Antimicrobials during pregnancy Box 2. It seems unlikely that these agents would have significant, if any, terato- genic risks. Fluconazole Fluconazole is an azole antifungal similar to ketoconazole and is utilized for both local and systemic fungal infections (Hollier and Cox, 1995). It is useful in the treatment of vaginal, oral, and systemic candidiasis, as well as for prophylaxis and treatment of cryp- tococcal infections in immunocompromised patients (i. Among 239 women who took single low doses of fluconazole, 60 took it during the first trimester of pregnancy. Antifungals 37 However, four cases of craniosynostosis with radial-humeral bowing and tetrology of Fallot have occurred following repeated high-dose fluconazole for cocci meningitis (Aleck and Bartley, 1996; Lee et al. In one study of 226 pregnancies exposed to fluconazole during the first trimester, the frequency of congenital anomalies was not increased (Mastroiacovo et al. Maternal side effects may include headache, dizziness, or gastroin- testinal upset. Ciclopirox This is a relatively new, topical antifungal agent effective against various dermatophytes such as Trichophyton species and Candida albicans. There is little, if any, information regarding its use during pregnancy but, according to its manufacturer, it was not terato- genic in various animal studies. Tolnaftate, undecylenic, and terbinafine Both tolnaftate (Tinactin) and undecylenic acid (Desenex) are utilized for dermatophyte infections such as tinea pedis and tinea corporis, but are not effective against yeast (Davis, 1995). There are no reports of these agents being teratogenic, and it would seem reasonable to classify them as category B agents at the present time. Amphotericin B Amphotericin B is an antifungal agent that is used primarily to treat systemic mycotic infections. However, in a review of case reports by Ismail and Lerner (1982), there was no evidence of teratogenicity of amphotericin B. Griseofulvin Griseofulvin is an antifungal agent used primarily to treat mycotic infections of the skin, nails, and hair. It is incorporated in the keratin of the epidermis and nails and is fungista- tic (Davis, 1995). There are no adequately controlled studies of this antifungal agent during pregnancy. However, Rosa and associates (1987b) reported two cases of con- joined twins born to mothers who took griseofulvin during early pregnancy. A variety of central nervous system malformations and skeletal anomalies have been observed in the offspring of animals treated with several times the human dose of griseofulvin dur- ing pregnancy (Klein and Beall, 1972; Scott et al. Because of these reports, grise- ofulvin is not recommended for use during pregnancy. Acyclovir and valacyclovir Acyclovir is an antiviral agent used primarily in the treatment and prophylaxis of her- pes simplex infections. The active metabolite of valacyclovir is acyclovir, and the use of valacyclovir during pregnancy will have risks similar to those of acyclovir. It has also been used in the treatment of other herpes infections, including varicella. However, in one review of seven women who received acyclovir during the second half of pregnancy, there were no congenital abnormalities detected (Leen et al. Moreover, according to the manufacturer, acyclovir was not teratogenic in a variety of animals tested. In a review of 239 pregnan- cies in which acyclovir was utilized in the first trimester (Andrews et al. Of 168 liveborn neonates, 159 had no congenital anomalies and of the nine neonates who did, no distinctive pattern of anom- alies could be identified (Andrews et al. Acyclovir has also been used success- fully during pregnancy to treat varicella pneumonia, disseminated herpes infection, and herpes hepatitis (Johnson and Saldana, 1994; Petrozza et al. Recently, acyclovir has been used during the last 4 weeks of pregnancy to pre- vent recurrent herpes infections and prevent the need for cesarean delivery (Scott et al. Ganciclovir is more toxic than acyclovir, and there is no information regarding its use during pregnancy. Some of the maternal side effects secondary to the drug are difficult to distinguish from those caused by the disease process itself. None of these drugs has been adequately studied during human pregnancy, but clearly the benefit (life-saving) of their use outweighs any theoretical risk. Idoxuridine Idoxuridine is an ophthalmic antiviral agent used primarily for the treatment of herpes simplex eye infections. To date, there have been no reports of congenital anomalies in Antiparasitics 41 infants born to women treated with this agent during pregnancy, but there have been no adequately controlled scientific studies in humans. Idoxuridine has been reported to be associated with both eye and skeletal malformations in the offspring of pregnant rabbits who received this local antiviral agent in usual human doses (Itoi et al. Amantadine Amantadine is an antiviral agent used in the treatment and prophylaxis of influenza. However, this particular agent was not shown to be teratogenic in rats or rabbits. Pandit and associates (1994) did report that one of four fetuses exposed to amantadine had tetralogy of Fallot. Hillard and colleagues (1982) reported on the use of this drug late in pregnancy for dis- seminated herpes simplex infections. Although there are no reports of congen- ital abnormalities in well-controlled human studies, ribavirin has been reported to cause a variety of congenital anomalies in commonly used laboratory animals (Ferm et al. Other antivirals Other antivirals (idofovir, docosanol, famciclovir, penciclovir, foscarnet, valganciclovir, osteltamivir, zabamivir) have not been studied during pregnancy, or assessed for the pos- sible association with birth defects following use during the first trimester. Metronidazole, the only effective antiparasitic agent for tri- chomoniasis, has already been discussed (p. Of these, lindane (cream, lotion, or shampoo) is probably the most commonly used agent for both mites and lice. According to its manufacturer, lindane was not teratogenic in a variety of animals, although there are no adequate human reproduction studies. Lindane may be related to an increase in stillbirths in some animal studies (Faber, 1996). However, lindane may be absorbed systemically, which on rare occasions may lead to central nervous system toxicity (Feldman and Maibach, 1974; Orkin and Maibach, 1983). Although this adverse effect could also theoretically occur in the fetus, it would appear to be very unlikely and to date has not been reported.
This assessment is based on the full range of preparation and administration options described in the monograph buy antabuse once a day symptoms 10 days before period. Dose in hepatic impairment: severe impairment (Child--Pugh Class C) maximum 20mg daily antabuse 250mg on line symptoms multiple myeloma. Inspect visually for particulate matter or discoloration prior to administration and discard if present generic antabuse 250 mg on line medications not to crush. Inspect visually for particulate matter or discoloration prior to administration and discard if present. Inspect visually for particulate matter or discoloration prior to administration and discard if present. Technical information Incompatible with No information Compatible with Flush: NaCl 0. Displacement value Negligible Stability after From a microbiological point of view, should be used immediately; however, preparation reconstituted vials and prepared infusions may be stored at room temperature and used within 12 hours of preparation (6 hours if Gluc 5% is used). Vitamin B12 * Malabsorption of cyanocobalamin (vitamin B12) has been reported due to long duration (>3 years) of acid suppressant therapy. Signs of infection Throughout treatment * Use of antisecretory drugs may "risk of infection, e. Additional information Common and serious Immediate: Hypersensitivity reactions including anaphylaxis and undesirable effects bronchospasm have been reported very rarely. Injection/infusion-related: Local: Administration site reactions, particularly with prolonged infusion. Other: Nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation, headache, dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Esomeprazole overdose is extensively plasma protein bound and is therefore not readily dialysable. This assessment is based on the full range of preparation and administration options described in the monograph. Etanercept 25-mg dry powder vials with solvent; 25-mg and 50-mg pre-filled syringes; 50-mg pre-filled pens * Etanercept is a cytokine modulator; it must only be used under specialist supervision. Pre-treatment checks * Do notgiveifthepatient hasanyactiveinfectionsincludingchronicorlocalisedinfections;record results on a patient alert card. There is a risk of false-negative tuberculin skin test results in patients who are severely ill or immunocompromised. Alternatively, 50mg may be given twice weekly for a maximum of 12 weeks followed, if required, by 25mg twice weekly or 50mg once weekly. For all presentations: Either withdraw the required dose or select the appropriate pre-filled syringe. Do not remove the needle cover on pre-filled syringes until room temperature is reached. Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible Excipients Pre-prepared solutions contain L-arginine (maycause hypersensitivityreactions). Displacement value Negligible Stability after From a microbiological point of view, should be used immediately; however, preparation reconstituted vials may be stored at 2--8 C for a maximum of 6 hours. Monitoring Measure Frequency Rationale Injection-site Post injection * Reactions including bleeding, bruising, erythema, itching, reactions pain, and swelling have been commonly reported. Infections During and after * Serious infections including tuberculosis may occur. Additional information Common and serious Injection-related: Local: Injection-site reactions including bleeding, bruising, undesirable effects erythema, itching, pain, swelling. Other: Infections (including upper respiratory tract infections, bronchitis, cystitis, skin infections), pruritus. This assessment is based on the full range of preparation and administration options described in the monograph. Ethanolam ine oleate (m onoethanolam ine oleate) 5% solution in 2-mL and 5-mL ampoules * Ethanolamine oleate is a sclerosing agent that, when injected into a vein, irritates the endothe- lium, resulting in thrombus formation and occlusion of the vein. Pre-treatment checks * Do not give in local or systemic infection, marked arterial or cardiac disease or severe renal impairment. Treatment may be given in the initial management of bleeding varices, then repeated at intervals (usually after 1 week, 6 weeks, 3 months and 6 months as indicated) until all varices are occluded. Slowly inject the prepared volume of solution into affected section(s) of varicose vein, or into oesophageal varix/varices, taking care not to leak solution into surrounding tissue (extravasation may cause necrosis of tissues, and there is a risk of sloughing and ulceration). Ethanolamine oleate | 331 Technical information Incompatible with Not relevant Compatible with Not relevant pH 8--9 Sodium content Nil Excipients Contains benzyl alcohol (must not be used in neonates). Monitoring Measure Frequency Rationale Observation of During injection and in * Extravasation may cause tissue damage, injection site immediate post-injection and potentially necrosis. Endoscopy Every 3--6 months or as * Monitor for recurrent bleeding, effective (for oesophageal indicated. Renal function Regular intervals * Acute nephrotoxicity reported in overdose -- throughout treatment monitor trends in renal function from baseline. Additional information Common and serious Immediate: Allergic reactions and anaphylaxis have been reported following undesirable effects use of sclerosing agents. Injection-related: Local: Extravasation can cause sloughing, ulceration, necrosis. Pharmacokinetics Systemic absorption is not expected, as ethanolamine oleate is a locally acting agent. Counselling Report injection site reactions, in order to detect tissue damage at earliest possible opportunity. This assessment is based on the full range of preparation and administration options described in the monograph. Exenatide 5 micrograms/dose and 10 micrograms/dose solution in pre-filled pen * Exenatide is a synthetic form of exendin-4, a 39-amino-acid peptide isolated from the venom of the Gila monster lizard. It is an incretin mimetic that "insulin secretion, #glucagon secretion, and slows gastric emptying. Pre-treatment checks * Do not use in type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. The dose can then be increased to 10 micrograms twice daily to further improve glycae- mic control. The solution should be clear and colourless, do not use if cloudy or discoloured or if particles are present. Although not specifically recommended by the manufacturer, it would be wise to vary the site of the injection. Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible Excipients Contains metacresol which may cause hypersensitivity reactions. Monitoring Measure Frequency Rationale Hypersensitivity At the start of * May very rarely cause hypersensitivity reactions reactions treatment including anaphylaxis. Capillary blood As clinically * Has caused hypoglycaemia with concomitant glucose appropriate sulfonylurea therapy. Action in case of Symptoms to watch for: Severe nausea, severe vomiting and rapidly declining overdose blood glucose concentrations.
The agent is beneficial in chronic splenitis cheap antabuse amex 714x treatment, pancreatic disease and disease of the other glandular organs; also in the incipient stages of nephritis buy antabuse now medicine for the people. It influences the stomach in the process of digestion; it exerts a beneficial cheap 250mg antabuse free shipping 6 medications that deplete your nutrients, stimulating effect upon the entire glandular apparatus. Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 120 Prof. Ralph Morrill gives the following as important in the application of this remedy: In the obstruction of the bile ducts, due to inflammation of the duodenum, this remedy is directly indicated. He believes its influence is exercised by its stimulating effect upon the flow of the bile. He has had clinical evidence of its undoubted value in many difficulties of the gastro-intestinal tract, which are cured by this important influence. He combines it in some cases of gastro-intestinal atony, with nux vomica and podophyllum, in the following prescription: Nux vomica, fifteen drops; chionanthus, two and a half drams, podophyllum, one and a half drams; elixir of lactated pepsin, sufficient quantity to make four ounces. In perverted functional action of the liver, resulting in the excretion of an abnormal quantity of uric acid, which interferes with the evolution of proper metabolism present in the formation of urea, and its products, it is a valuable remedy. It is thus of much importance in the treatment of acute lithemia—toxemia, from excess of urea or uric acid, and the rheumatic diathesis. Macrotin or Cimicifugin, which possesses all the medicinal properties of the root, is a resinous powder of a dark-brown or yellowish color, a bitter, acrid taste, and slight odor. Physiological Action—Cimicifuga in large doses produces general relaxation, dimness of vision, dizziness, tremors, slowing of the pulse, fall Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 121 of arterial pressure, vomiting or gastric irritation; it stimulates expectoration and perspiration, causes intense headache and prostration. These phenomena are caused by the action of the drug on the vasomotor centers and the cardiac ganglia. The headache is chiefly frontal; in some persons the drug causes pain in the joints and limbs similar to rheumatism. The agent is certainly an efficient nerve sedative, although its most pronounced action is on the unstriped muscles. It acts in very many cases where these muscles are involved, with general nervous irritation, in an immediate and positive manner. In such cases if the nerve irritation is dominant, its efficiency is greatly increased by combining it with gelsemium. An overdose is promptly signalled by the appearance of the characteristic headache, which assumes a bursting, tearing character, with injected conjunctivae and flushed face. Specific Symptomatology—Muscular aching, local and general, aching pains as from overworked, overstrained muscles, great muscular aching with chilliness and rapidly increasing temperature. It is the agent for hysteria with flushed face and heat in the head, with restless and nervous excitement and general muscular aching. Therapy—In the premonitory stage of acute fevers, or of acute inflammatory troubles of whatever character, a common symptom is a general tired feeling with aching of the muscles. In these cases there is usually a chill or chilliness, with more or less fever with the aching. One drop of the tincture of cimicifuga every hour will relieve this aching in from six to twelve hours. If given with aconite for the fever and belladonna for the rigors, the time may be reduced to three or four hours. When indicated, its influence upon the nervous system will probably abridge many of the other symptoms. Through its influence upon the vasomotor centers and upon the nerve ganglia, it has a beneficial influence upon the heart. In rheumatic carditis or pericarditis it is a sovereign remedy acting directly in the line of its physiological influence. In neuralgia of the heart—angina pectoris and functional irregularity of the heart from exalted nerve influence, either alone or combined with gelsemium, it is prompt and reliable, and Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 122 should be by no means neglected. King advised this agent in coughs, and its value through its influence upon the nerve centers has been confirmed by many practitioners. It soothes the cough of excessive nerve irritation, and the reflex cough; the irritable cough of acute bronchitis is relieved by it, as it increases bronchial secretions to a notable extent. A homeopathic writer says that in pleurisy, there are often strong indications for cimicifuga where it works in harmony with aconite and bryonia. It is given by many as a stomachic tonic, and it improves digestion by relieving excess of nerve influence over the functional operations of the digestive apparatus. Given in fifteendrop doses of the tincture four or five times daily, it is superior to any other known remedy. Its effects are permanent if the anemia and other concomitant conditions are correctly controlled by proper medication at the same time. It may be combined with scutellaria lateriflora, with valerian or gelsemium, as the indications demand, with superb results. The writer has aired intractable cases by alternating it with minute doses of exalgine. The characteristic aching pains above described are very constant in acute rheumatism and rheumatic fevers. Cimicifuga is certainly a royal remedy in these cases, and has become universally popular. If the condition be absolutely confined to the joint and does not involve muscular structure, it is not of as much value. The agent, however, has a specific influence in overcoming lithemia and in preventing and curing conditions resulting from an excess of uric acid conditions existing in the uric acid diathesis. It is therefore of value with auxiliary treatment in acute or subacute rheumatic arthritis with lithemia. It will be found indicated in rheumatic neuralgia, in sciatica, in muscular rheumatism of the chest walls, in achings of the deep muscles Ellingwood’s American Materia Medica, Therapeutics and Pharmacognosy - Page 123 of the back, in myalgia, in severe colds, in neuralgia from cold, in rheumatic headache, and in neuralgia of the ovaries; also with women in the intense muscular aching preceding the menses. In the female it is valuable as above indicated, in dysmenorrhea of a congestive character always, and in amenorrhea. In these cases aconite will aid its action greatly, if the condition be induced by sudden cold; and pulsatilla will do likewise if the conditions be caused by nervous shock or functional irregularity extending over a longer period. Helonias may be given with it, if there be weight and dragging in the lower abdominal region. In the aggravating rheumatic pains of parturition, or of the later stages of pregnancy, which deceive by closely simulating those of labor in some ladies of rheumatic diathesis, this is positive and prompt. In hysterical conditions of the menstrual epoch, in hypochrondriasis or melancholia at these times, with congestive dysmenorrhea with the above indications, it is specific. In puerperal hysteria with great nervous excitement and the above conditions, or with excitable mania or incipient puerperal insanity, it is a most efficient remedy, having a desirable sedative influence on the nerves of the womb. The agent is excellent in relieving irregular pains and uterine distress occurring during the course of pregnancy. It may be given in small doses, and it thus prepares the patient for parturition and undoubtedly contributes largely to a short, easy and uncomplicated labor. The agent, either as the fluid extract, or from two to five grains of the resinoid, is a most efficient partus accelerator.
There were not enough clergy to offer the last rites or give support and help to the victims 250mg antabuse overnight delivery medications with sulfur. The church could offer no reason for the deadly disease and beliefs were sorely tested cheap antabuse 250mg amex symptoms 0f food poisoning. This had such a devastating effect that people started to question religion and such doubts ultimately led to the English reformation order antabuse 250 mg visa medicine world nashua nh. Consequences and Effects of the Black Death plague The Consequences and effects of the Black Death plague were far reaching in England: Prices and Wages rose Greater value was placed on labor Farming land was given over to pasturing, which was much less labor-intensive This change in farming led to a boost in the cloth and woolen industry Peasants moved from the country to the towns The Black Death was therefore also responsible for the decline of the Feudal system People became disillusioned with the church and its power and influence went into decline This resulted in the English reformation The End of the Plague and the spread of sugar Nostradamus was a healer of sort and he said for people to clean their houses, open the windows and let in good sunshine and clean air. In the recipe listings of "Le Menagier de Paris", 1393, sugar in many various forms is listed 72 separate times. Honey by comparison is only mentioned 24 times, and the price for candied orange peel, made with honey, is precisely the same as that for sugared almonds (10 sous/lb). So, in a quick survey of Europe in the 13th and 14th centuries, sugar was widely available in England, France, Spain, and Italy in powdered form as well as block, in cooking as well as medicinally, and more widely used than honey! Special traffic regulations had been needed for the transport of firewood and cane. So valuable was sugar for the economy that the law allowed compulsory purchase of land for it, and water could be taken from whatever source; workers were also bound to the industry by law and were free from arrest during the season when the refineries were working. During the 42 years following the accession of Alfonso in 1416, "On one occasion Alfonso personally seems to have cornered the market in sugar exports to Flanders," Smith tells us. Kilns for boiling the liquid and ceramic molds to crystallize the sugar into loaves/cones. The perception that all medieval sugar consisted of burnt black cones is a common misapprehension brought on by the experience of those of us who have been part of the Early American historical groups. Do-it-yourself pioneers in America produced some really bad sugars in an effort to be self sufficient, but that should not be projected to our thoughts about Medieval times where industrial production and transport was common. Though some bought the cheaper loaf and saved money by grinding it themselves, powdered sugar was common, and the quality was high. In 1492 Christopher Columbus stopped at the Canary Islands on his famous journey, for rest and provisions for a few days, but ended up staying a month. When he finally left he was given cuttings of sugar cane which became the first to reach the New World. Therefore much later Sugar Cane came to be cultivated in the New World, and as a side effect became multi-sourced particularly due to British Colonial policies (you see how this all links up now) and influence throughout the geographical coverage of the empire in the mid 1600s to mid 1700s. This is really the key point along the timeline where sugar, outside Asia, became commonly available and no longer a rare indulgence of the wealthy. Notably, this was also closely linked to the international slave trade - African slaves became the dominant plantation workers in North America, partly because they turned out to be naturally resistant to Yellow Fever and Malaria, and as a result the British imported over 4 million slaves to the West Indies. At this point (the mid to late 1700s) the Caribbean was the world’s largest producer of sugar, and due to high death rates anyway on sugar plantations, there were only 400,000 African people left alive in the West Indies by the time slavery ended. In 1772 Slavery was declared illegal in England, including overseas slaves not living in England. Poor Blacks are grossly mistreated and paid almost nothing to harvest a dealy product. Later Barbados and the British Leewards were extremely successful in the production of sugar because it counted for 93% and 97% respectively of each island’s exports, largely due to changes in the eating habits of many Europeans. Whereby we may see the sequel of things not always, but very seldom, to be such as is pretended in the beginning. As we can see from the above, when sugar was half a crown for a pound, cinnamon was fourpence the ounce. Imported goods rose and fell with various import laws, but were eminently reasonable in price at all times. Also, we can see that in relationship to other commodities, sugar has come down dramatically in price as well. This would perhaps account for all those description from foreign ambassadors about the English having bad teeth! By the Elizabethian period, the best sugar was considered to be that of Madiera, with those of Barbary (Morocco) or the Canaries a close second. When he saw they were English he ran off , and going ashore, they discovered, "many sorts of sweetmeats and conserves, with great store of sugar, being provided to serve the fleet returning to Spain. In 1585, says "Francis Drake-The Lives of a Hero" of Drake from 2-11 October, "The fleet stayed in the Ria de Vigo, pillaging a few small vessels, including a French ship with sugar and wine from the Azores... Thus, while it was a bit expensive for peasants, it was easily available to Bughers and Merchant classes. Big sugar has a history of Death, Plague, Immune-deficiency, War, Slavery, Deceit, Cancer, Tooth decay, Obesity and is responsible for much of mankind’s most serious problems. Dextrose sugar has spread across the world doing harm and leaving a wake of disease in its path. Mack Smith, and Christopher Duggan "The Sicilian Vespers" by Steven Runciman, Cambridge University Press, 1958 "The Other Conquest" by John Julius Norwich, Harper ∓ Row, 1967 "The Barrier and the Bridge-Historic Sicily" copyright by Alfonso Lowe, Published for America by W. Coulson,"A Source Book for Medieval Economic History", (Milwaukee: The Bruce Publishing Co. New York: for The Early English Text Society by the Oxford University Press, 1985. Guilds and Trade "Les Livres de comptes des freres Bonis" , and "The Book of the Wares and Usages of Diverse Countries", and "The Practice of Commerce", can all be found in "Medieval Trade in the Mediterranean World", R. Mack Smith, Published by The Viking Press "The History of Sugar" by Noel Deere, Chapman ∓ Hall, Ltd. The fate and fortune of Venice were founded on sugar and the trade in silks and spices. The civic archives of Narbonne tell us that in 1153 a toll on sugar was introduced, called the lende: eight deniers per quintal if the goods arrived by sea, 14 deniers if they arrived by land. Marseilles instituted the lesde in 1228, and the Count of Provence added sugar to his toll tariff 25 years later. It should be remembered that alcohol and alembic are words of Arabic origin, although the Koran forbade alcohol and all fermented drinks. The alembic was a still, and was already known to the author of the first part of the Roman de la Rose, Guillaume de Lorris, around 1236. Hammond, 1993, Alan Sutton Publishing Limited, Phoenix Mill, Far Thrupp, Stroud, Gloucestershire, England: "Sugar and spices played an important part in food in the Middle Ages.... Prices remained very similar to this until well into the sixteenth century, although the actual figure depended on the degree of refinement. Very large amounts of sugar were used by the royal household before the end of the thirteenth century (6,258 lb in 1288), and from then on increasing amounts were imported. One ship alone, which entered Bristol from Lisbon in 1480, carried nearly 10 tons.