In health care, a charge is the monetary amount that is billed to the user of a product or service by the provider.
Applications of radionuclides to diagnosis The use of radionuclides in diagnosis is based on the fact that it is possible to tag many of the substances normally present in the body with a radioactive label. Certain synthetic radioactive elements, such as technetium, can also be used. Because it is possible to detect minute quantities of radioactive material, only very small doses are needed, making the procedure a safe one. Furthermore the body pool of the material is therefore not appreciably altered, and metabolism is not disturbed. Thus in studies of iodine metabolism the ratio of radioactive atoms administered to stable atoms in the body pool is of the order of 1:1,000 million. By measuring radioactivity in the body, in blood samples, or in the excreta it is possible to gain information about the fate of the labelled substance, and hence of the chemically identical inactive material. Therefore it is theoretically possible to trace the absorption, distribution and excretion of any substance normally present in the body, provided that it can be tagged with a suitable radioactive label.
If the investigation necessitates tracing the path of the material through the body by means of external counting over the body surface, it is obviously essential to use an isotope that emits gamma radiation or positrons. If, however, only measurements on blood sample or excreta are required, it is possible to use pure beta emitters. Whole-body counters measure the total radioactivity in the body, and these are of great value in absorption studies.
Moving images can provide information on body functions such as the movements of the heart, blood ?ow, bile ?ow in the liver, and urine in the kidneys. The development of COMPUTED TOMOGRAPHY or CT scanning has replaced radionuclide scanning for some imaging procedures.
Five main groups of diagnostic uses may be de?ned:
(1) METABOLIC STUDIES The use of radioactive materials in metabolic studies is based on the fundamental property that all isotopes of an element are chemically identical. The radioactive isotope is used as a true isotope tracer – that is, when introduced into the body (in whatever form) it behaves in the same way as the inactive element. For example, isotopes of iodine are used to measure thyroid function (see THYROID GLAND), and isotopes of calcium enable kinetic studies of bone formation and destruction to be performed.... isotope
The acidity of blood and other body fluids depends on the level of hydrogen cations, which are produced by metabolic processes. To prevent the fluids from becoming too acidic, hydrogen cations are neutralized by bicarbonate
anions in the extracellular fluid and blood, and by phosphate anions inside cells (see acid–base balance).... ion
In recent years persistent child abuse in some children’s homes has come to light, with widespread publicity following o?enders’ appearances in court. Local communities have also protested about convicted paedophiles, released from prison, coming to live in their communities.
In England and Wales, local-government social-services departments are central in the prevention, investigation and management of cases of child abuse. They have four important protection duties laid down in the Children Act 1989. They are charged (1) to prevent children from suffering ill treatment and neglect; (2) to safeguard and promote the welfare of children in need; (3) when requested by a court, to investigate a child’s circumstances; (4) to investigate information – in concert with the NSPCC (National Society for the Prevention of Cruelty to Children) – that a child is suffering or is likely to suffer signi?cant harm, and to decide whether action is necessary to safeguard and promote the child’s welfare. Similar provisions exist in the other parts of the United Kingdom.
When anyone suspects that child abuse is occurring, contact should be made with the relevant social-services department or, in Scotland, with the children’s reporter. (See NONACCIDENTAL INJURY (NAI); PAEDOPHILIA.)... child abuse
The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.
The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’
Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.
Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.
How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.
By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction
– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.
Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.
About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)
The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.
Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.
Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.
Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.
For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.
(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence
In one part of the body there is a further complication. The veins coming from the bowels, charged with food material and other products, split up, and their blood undergoes a second capillary circulation through the liver. Here it is relieved of some food material and puri?ed, and then passes into the inferior vena cava, and so to the right atrium. This is known as the portal circulation.
The circle is maintained always in one direction by four valves, situated one at the outlet from each cavity of the heart.
The blood in the arteries going to the body generally is bright red, that in the veins dull red in colour, owing to the former being charged with oxygen and the latter with carbon dioxide (see RESPIRATION). For the same reason the blood in the pulmonary artery is dark, that in the pulmonary veins is bright. There is no direct communication between the right and left sides of the heart, the blood passing from the right ventricle to the left atrium through the lungs.
In the embryo, before birth, the course of circulation is somewhat di?erent, owing to the fact that no nourishment comes from the bowels nor air into the lungs. Accordingly, two large arteries pass out of the navel, and convey blood to be changed by contact with maternal blood (see PLACENTA), while a large vein brings this blood back again. There are also communications between the right and left atria, and between pulmonary artery and aorta. The latter is known as the ductus arteriosus. At birth all these extra vessels and connections close and rapidly shrivel up.... circulatory system of the blood
Prescriptions for drugs should be printed or written clearly in ink and signed and dated by the prescriber (computer-generated facsimile signatures do not meet legal requirements). They should include the patient’s name, address and age (obligatory for children under 12), the name of the drug to be supplied, the dose and dose frequency, and the total quantity to be supplied. Any special instructions (e.g. ‘after food’) should be stated. There are special regulations about the prescription of drugs controlled under the Misuse of Drugs Regulations 1985 (see CONTROLLED DRUGS). A pharmacist can advise about which drugs are available without prescription, and is able to recommend treatment for many minor complaints. Information about exemption from prescription charges in the NHS can be obtained from health visitors, general practitioners, or social security o?ces.... drugs
Since April 1993, local social-services departments have been responsible for assessing what help people need from community-care services: these can include home helps, meals on wheels, sheltered housing, etc. Recipients of such services are means-tested and make variable contributions towards the costs. Policies on charging vary from one area to another and there are wide geographical variations in the range of services provided free and the charges levied for others.
People with complex needs may be assigned a case manager to coordinate the care package and ensure that appropriate responses are made to changing circumstances. The success of community care hinges on e?ective coordination of the services of an often large number of providers from the health and social-services sectors. Poor communication between sectors and inadequate coordination of services have been among the most common complaints about the community-care reforms.
Health care for people being cared for in the community remains largely free under the NHS arrangements, although there are regular debates about where the boundaries should be drawn between free health services and means-tested social care. A distinction has been made between necessary nursing care (funded by the state) and normal personal care (the responsibility of the patient), but the dividing line often proves hard to de?ne.
As care has shifted increasingly into the community, previous hospital facilities have become redundant. Vast numbers of beds in long-stay geriatric hospitals and in-patient psychiatric wards have been closed. There is now concern that too few beds remain to provide essential emergency and respite services. In some areas, patients ?t for discharge are kept in hospital because of delay in setting up community services for the elderly, or because of the inability of the local authority to fund appropriate care in a nursing home or at home with community-care support for other patients; the resulting BED-BLOCKING has an adverse e?ect on acutely ill patients needing hospital admission.
Community care, if correctly funded and coordinated, is an excellent way of caring for people with long-term needs, but considerable work is still needed in Britain to ensure that all patients have access to high-quality community care when they need it. Problems in providing such are are not con?ned to the UK.... community care
Habitat: Throughout India, up to 1,700 m on the hills and in Andaman Island; also grown in gardens.
English: Candahar tree, White Teak.Ayurvedic: Gambhaari, Kaash- mari, Kaashmarya, Sarvatobhadraa, Bhadra, Mahaabhadraa, Sadaab- hadraa, Madhuparnikaa, Sriparni, Pitarohini, Hiraa, Bhadraparni, Trishati.Siddha/Tamil: Kattanam, KumizhamAction: Leaf—demulcent, bechic. Used for removing foetid dis charges from ulcers. Root— stomachic, laxative, antibilious, demulcent, galactagogue. Bark— anticephalalgic. Root and bark— febrifuge.
The Ayurvedic Pharmacopoeia ofIn- dia recommends the use of the bark and stem in inflammatory diseases and oedema; the fruit in dysuria and haem- orrhagic diseases.The heartwood contains lignans, ar- borone, 7-oxodihydrogmelinol, pau- lownin acetate and epieudesmin; me- trans-p-methoxycinnamate and trans- p-hydroxycinnamic acid.Alcoholic extract of stem bark showed anti-inflammatory activity comparable to phenylbutazone.Dosage: Root, root bark—20-30 g for decoction. (API Vol. I.)The leaves show antibiotic activity against E. coli and Staphylococcus aureus.... gmelina arboreaTea. Skullcap 1; Oats 2; Valerian half. Mix. 1 teaspoon to each cup boiling water. 1 cup as desired.
Life Drops. Few drops in tea.
Lime flower tea, at night.
Ginkgo. For brain fatigue.
Diet. Avoid strong tea, coffee, alcohol. ... manager’s stress
Ionizers that produce negative ions can be used to neutralize positive ions in the atmosphere.
Some people believe that use of an ionizer reduces symptoms, such as headaches and fatigue, that may result from a build-up of positive ions generated by electrical machines.... ionizer
The name originates from the ancient idea that hysteria – a Greek-based word for ‘UTERUS’
– was in some way associated with the womb. Hence the old-fashioned association of hysteria with women, and with supposed sexual disturbances. Doctors should make sure there is not a physical disease present to explain the symptoms before diagnosing a dissociative disorder. Most subside spontaneously, but if not, the individual needs psychiatric advice. Treatment is di?cult. Reasons for stress should be explored and, if possible, resolved. Hypnosis (see HYPNOTISM) to help the person to relive stressful episodes – known as ABREACTION – may be of value.... hysteria
It is used to estimate the unaccounted-for anions in the blood in cases of metabolic disturbance. The normal anion gap is 12–16 mmol/l.... anion
Habitat: North America ; cultivated in Salt Lake City.
Features ? A biennial herb, in height from twelve to eighteen inches, the stem is angular and slightly hairy. One to three inches long, the leaves are alternate, sessile, and ovate-lanceolate, with small, whitish glands on the edge. The fruit is in the form of a flat, oval capsule, which contains ovate-oblong seeds about one eighth of an inch long, brown in colour, with a reticulated, pitted surface. The root is fibrous, and the plant bears a small blue, pointed flower. The taste is burning and acrid like tobacco, the odour slight. Part used ? Herb and seeds are used.Action: Emetic, stimulant, antispasmodic, expectorant, and diaphoretic.
Lobelia inflata has for many years been one of the most widely discussed and hotly debated articles used in medicine. While many herbalists contend that it is the most valuable of all botanic remedies, official medicine in England classifies it as a poison. Herbalists who use Lobelia insist that it is most certainly not a poison, and that it can be administered by them in large doses with perfect safety. They use it chiefly as an emetic, and, as its administration brings about the prompt removal of accumulations of mucus, the action in bronchial complaints is speedy and beneficial. Coffin's comments in this connection are enthusiastic ? "Lobelia is decidedly the most certain and efficient emetic known, and is at the same time safe in its operations. Unlike most emetics from the mineral kingdom, it produces its specific effect without corroding the stomach or producing morbid irritation and inflammation of the mucous membrane of this organ, which are so common in the use of antimony, zinc, and the sulphate of copper. Lobelia may emphatically be said to 'operate in unison with the laws of life'."In view of the controversy surrounding its use, the history of Lobelia is interesting. North American Indians had apparently long been acquaintedwith its properties, but its first introduction to general use was due to the efforts of the famous American, Samuel Thomson. His disciple, Dr. Coffin, brought the herb to this country and used it extensively in his practice for over forty years, apparently with great success "in almost every form of disease, and from the tender infant to the aged," to quote Coffin himself. In both America and Britain herbalists have been tried on charges of causing death by administering Lobelia, but in no instance has a verdict been obtained against them.... lobeliaHabitat: Cultivated in Punjab and Rajasthan.
English: Date Palm.Ayurvedic: Kharjuura, Kharjuuraka, Kharjuurikaa. Pindakharjuurikaa. Chhuhaaraa (dry date). Pindakhar- juura is the fruit of Phoenix acaulis Roxb.Unani: Khurmaa, Khajuur, Chhuharaa.Siddha/Tamil: Perichchankay, Ita.Action: Fruit pulp—antitussive, expectorant, demulcent, laxative, diuretic, restorative. Sap—cooling, laxative. Gum—used in diarrhoea and genitourinary diseases.
The fruit contains ascorbic acid (vitamin C), carotene (as vitamin A), nicotinic acid, riboflavin, thiamine, sugars (60-80%). Besides sucrose and invert sugars, rhamnose, xylose, ara- binose, ribose, galactose and galac- turonic acid have been identified in the fruit. Invert sugar predominates in the soft dates; sucrose in dry varieties. The dried date, used in Ayurvedic and Unani compositions, contains protein 2.5-3, fat 0.5, carbohydrates 75.882.9% and calcium 35.9, phosphorus 129.3 and iron 3.4 mg/100 g. Presence of sterols of ergosterol group, and esterone has been reported from dried date seeds.Charged C-glycosylflavones and caf- feylshikimic acid, leucocyanidin are characteristically present in the plant. Flavonol glycosides are also common. Several uncharged C-glycosylflavones were also detected.Dosage: Fresh fruit—10-50 g, dried fruit—10-15 g. (API, Vol. IV.)... phoenix dactyliferaIonising radiation comprises X-RAYS, GAMMA RAYS and particle radiation. X-rays are part of the continuous electromagnetic-wave spectrum: this also includes gamma rays, infra-red radiation, ultraviolet light and visible light. They have a very short wavelength and very high frequency, and their ability to penetrate matter depends upon the electrical energy generating them. X-rays that are generated by 100,000 volts can pass through body tissue and are used to produce images – popularly known as X-rays. X-rays, generated at several million volts can destroy tissue and are used in RADIOTHERAPY for killing cancer cells. Gamma rays are similar to X-rays but are produced by the decay of radioactive materials. Particle radiation, which can be produced electrically or by radioactive decay, comprises parts of atoms which have mass as well as (usually) an electrical charge.
Non-ionising radiation includes ultraviolet light, radio waves, magnetic ?elds and ULTRASOUND. Magnetic ?elds are used in magnetic resonance imaging (MRI) and ultrasound, which is inaudible high-frequency sound waves, and is used for both diagnoses and treatment in medicine.... radiation
The resting level of spontaneous neuronal activity in the hearing system is only just below that at which sound enters a person’s consciousness – a consequence of the ?ne-tuning of normal hearing; so it is not, perhaps, surprising that normally ‘unheard’ neuronal activity becomes audible. If a patient suffers sensorineural deafness, the body may ‘reset’ the awareness threshold of neural activity, with the brain attempting greater sensitivity in an e?ort to overcome the deafness. The condition has a strong emotional element and its management calls for a psychological approach to help sufferers cope with what are, in e?ect, physically untreatable symptoms. They should be reassured that tinnitus is not a signal of an impending stroke or of a disorder of the brain. COGNITIVE BEHAVIOUR THERAPY can be valuable in coping with the unwanted noise. Traditionally, masking sounds, generated by an electrical device in the ear, were used to help tinnitus sufferers by, in e?ect, making the tinnitus inaudible. Even with the introduction of psychological retraining treatment, these maskers may still be helpful; the masking-noise volume, however, should be kept as low as possible or it will interfere with the retraining process. For patients with very troublesome tinnitus, lengthy counselling and retraining courses may be required. Surgery is not recommended.
Under the auspices of the Royal National Institute for Deaf People, the RNID Tinnitus Helpline has been established. Calls are charged at local rates. (See also MENIÈRE’S DISEASE.)... tinnitus
Elecampane (Inula) has a direct effect on TB bacilli, controlling night sweats and localising the disease. Agents yielding salicylates (mild analgesics) Meadowsweet, White Willow, etc are of value. Echinacea increases phagocytic power of the leucocytes and may normalise percentage count of neutraphiles. To meet individual needs, it will be necessary to vary treatment many times during the course of the disease.
Alternatives. Echinacea, Elecampane, Balm of Gilead buds (Hyde), Gotu Kola, Comfrey root, Iceland Moss. Rupturewort promotes elasticity of lung tissue.
Decoction. Equal parts: Iceland Moss, Comfrey root, Elecampane root, Liquorice. Mix. 1oz to 1 pint water gently simmered 20 minutes in a covered vessel. Dose: Half a cup thrice daily.
Alternative formulae:– Powders. White Willow 2; Comfrey 1; Echinacea 1; Ginger quarter. Mix. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Tinctures. White Willow 2; Echinacea 1; Blue Cohosh half; White Poplar half; Tincture Capsicum quarter. Mix. 1 teaspoon thrice daily before meals.
Tincture Krameria (Rhatany root), Dose: 30-60 drops in water thrice daily.
Fenugreek seed tea.
Comfrey. Potential benefit of Comfrey root outweighs risk.
Topical. Compresses: Mullein leaves, Lobelia, Comfrey root or Fenugreek. Evening Primrose oil. No massage to affected joints.
Diet. Low carbohydrate. Oily fish.
Supplements. Vitamins A, B6, B12, D, Niacin, Calcium, Iron, Phosphorus.
General. Tuberculosis is a notifiable disease for which specific medical treatment is available. Failure to comply may expose a practitioner to a charge of negligence. ... arthritis – tuberculous
A radical is a group of atoms which can combine in the same way as single atoms to make a molecule. Free means uncombined. A free radical is a state in which a radical can exist before it combines – an incomplete molecule containing oxygen which has an uneven electrical charge. High energy oxygen atoms are known to form atheroma.
As well as being substances that take part in a process of metabolism, free radicals can be found in industrial fumes and cigarette smoke. They are oxidants and have an anti-bacterial effect. But their activity is not confined to bacteria alone. When produced in large amounts as in inflammation and infection, they may have a damaging effect upon the lining of blood vessels and other tissues. An excess is produced in ischaemic heart disease. They have been shown to be involved in jet lag, Alzheimer’s disease, rheumatoid arthritis, thrombosis, heart failure, cancer, irradiation sickness and a weak immune system. Damaging to the DNA, they are probably the greatest single cause of ill health. They hasten the ageing process. Vitamins A, C, E, being antioxidants and the mineral Selenium stimulate certain enzyme systems to limit damage done by these destructive elements.
Losing weight is believed to generate free radicals – a metabolic side-effect of dieting. See: ANTIOXIDANTS. ... free radicals
(a) The practitioner must supply remedies from premises (apart from a shop) in private practice ‘so as to exclude the public’. He is not permitted to exceed the maximum permitted dose for certain remedies, or to prescribe POM medicines.
(b) The practitioner must exercise his judgement in the presence of the patient, in person, before prescribing treatment for that person alone.
(c) For internal treatment, remedies are subject to a maximum dose restriction. All labels on internal medicines must show clearly the date, correct dosage or daily dosage, and other instructions for use. Medicines should not be within the reach of children.
(d) He may not supply any remedies appearing in Schedule 1. Neither shall he supply any on Schedule 2 (which may not be supplied on demand by retail).
He may supply all remedies included in the General Sales List (Order 2129).
(e) He must observe requirements of Schedule III as regards remedies for internal and external use.
(f) He must notify the Enforcement Authority that he intends to supply from a fixed address (not a shop) remedies listed in Schedule III.
(g) Proper clinical records should be kept, together with records of remedies he uses under Schedule III. The latter shall be available for inspection at any time by the Enforcement Authority.
The practitioner usually makes his own tinctures from ethanol for which registration with the Customs and Excise office is required. Duty is paid, but which may later be reclaimed. Accurate records of its consumption must be kept for official inspection.
Under the Medicines Act 1968 it is unlawful to manufacture or assemble (dispense) medicinal products without an appropriate licence or exemption. The Act provides that any person committing such an offence shall be liable to prosecution.
Herbal treatments differ from person to person. A prescription will be ‘tailored’ according to the clinical needs of the individual, taking into account race as well as age. Physical examination may be necessary to obtain an accurate diagnosis. The herbalist (phytotherapist) will be concerned not only in relieving symptoms but with treating the whole person.
If a person is receiving treatment from a member of the medical profession and who is also taking herbal medicine, he/she should discuss the matter with the doctor, he being responsible for the clinical management of the case.
The practitioner can provide incapacity certificates for illness continuing in excess of four days for those who are employed. It is usual for Form CCAM 1 5/87 to be used as issued on the authority of the Council for Complementary and Alternative medicine.
General practitioners operating under the UK National Health Service may use any alternative or complementary therapy they choose to treat their patients, cost refunded by the NHS. They may either administer herbal or other treatment themselves or, if not trained in medical herbalism can call upon the services of a qualified herbalist. The herbal practitioner must accept that the GP remains in charge of the patient’s clinical management.
See: MEDICINES ACT 1968, LABELLING OF HERBAL PRODUCTS, LICENSING OF HERBAL REMEDIES – EXEMPTIONS FROM. ... herbal practitioner
Acute encephalitis, acute meningitis, acute poliomyelitis, anthrax, cholera, diphtheria, dysentery (amoebic and bacillary), food poisoning, infective jaundice, leprosy, leptospirosis, lassa fever, mumps, malaria, marburg disease, measles, German measles, ophthalmia neonatorum, paratyphoid fever, plague, rabies, relapsing fever, scarlet fever, smallpox, tetanus, tuberculosis, typhoid fever, typhus, viral haemorrhagic fever, whooping cough and yellow fever.
Six communicable diseases are internationally notifiable to the World Health Organisation: yellow fever, plague, cholera, smallpox, louse-borne relapsing fever, louse-borne typhus.
Notification has to be made to local and central Government authorities. Certain occupational diseases and all cases of cancer must be registered and notified.
It is required that the above diseases and certain others receive modern medical therapy in a hospital or treatment under the supervision of a qualified physician. Failure to conform may expose a practitioner, registered or unregistered, to a charge of negligence. ... notifiable diseases
NHS Business Services Authority website... nhs business services authority
Hippocrates was aware of the universal law similia similibus curentur (like cures like). He taught that some diseases were cured by similars, and others by contraries. Stahl (1738) was also aware of this law of healing: “diseases will yield to and be cured by remedies that produce a similar affection”. But it was Samuel Hahnemann (1755-1843) who proved to the world this doctrine held the key to the selection of specifically acting medicines. His early experiments with nux vomica, arnica, ignatia and veratrum showed how the medicine which cured produced a similar condition in healthy people.
While no one has yet discovered the ‘modus operandi’ of the science, it has grown up largely through empiric experience, especially during certain historical epidemics in different parts of the world. For example, in 1836 cholera raged through most of the cities of Austria. Orthodox medicine could do little.
Out of desperation, the Government commissioned the aid of homoeopathy. A crude hospital was hastily prepared and patients admitted. Results convinced the most hardened sceptics. Physician-in-charge, Dr Fleischman, lost only 33 per cent, whereas other treatments showed a death rate of over 70 per cent.
It is said that reduction of inflammatory fevers by homoeopathic Aconite, Gelsemium, Baptisia and Belladonna played no small part in reducing the practice of blood-letting in the early 19th century.
Since Hahneman, homoeopathy has been the object of intense professional bitterness by its opponents but since the 1968 Medicines Act (UK) provision has been made for homoeopathic treatment on the “National Health Service”. Conversion of medical opinion has been gradual and today many registered medical practitioners also use the therapy.
“It is the general theory that the process of dilution and succussion (a vigorous shaking by the hand or by a machine) “potentises” a remedy.
“To prepare. A remedy is first prepared in solution as a “mother tincture”. In the decimal system of dilution a small quantity is then diluted ten times by the addition of nine parts by volume of diluent – either alcohol or water and then shaken vigorously by hand or machine (succussion). A small quantity of this is then diluted to one tenth and succussed a second time; this process is repeated again and again, producing solutions identified as 3x, 6x, 30x according to the number of times diluted. It may even be continued a thousand times (1 M). The resulting solutions are adsorbed on to an inert tablet or granules, usually of lactose, and in this form it is claimed that they remain therapeutically active indefinitely.
“For higher dilutions the centesimal system is used, when each dilution is by 1 in 100. The resulting solutions or tablets are referred to as 3C, 6C, 12C etc according to the number of times diluted.
“When dealing with a remedy which is insoluble, e.g. Carbo Veg, the first three dilutions and succussions are done in powder form, i.e. to “3x” beyond which the remedy is sufficiently soluble for further dilutions to proceed in liquid form.
“In homoeopathy a remedy may in some cases be given in a dilution so great that no single molecule of the original substance remains. The concept of “memory laden” water implies that the effect lies in a pattern impressed on the water molecules and that this is carried over from one dilution to the next.” (John Cosh MD., FRCP)
Homoeopathic medicines can stand most tests for safety, since it is widely held that they are completely safe and non-addictive, with no side-effects. ... homoeopathy
Scores of different chemicals fulfil this function in different parts of the nervous system. Many neurotransmitters act as both neurotransmitters and hormones, being released into the bloodstream to act on distant target cells.
One of the most important neurotransmitters is acetylcholine, which causes skeletal muscles to contract when it is released by neurons connected to the muscles. Acetylcholine is also released by neurons that control the sweat glands and the heartbeat, and transmits messages between neurons in the brain and spinal cord.
Another chemical, noradrenaline (norepinephrine), aids the nervous control of heartbeat, blood flow, and the body’s response to stress. Dopamine plays an important role in parts of the brain that control movement. Serotonin is one of the main neurotransmitters found in parts of the brain concerned with conscious processes.
Another group of neurotransmitters is called the neuropeptides.
This group includes the endorphins, which are used by the brain to control sensitivity to pain.... neurotransmitter
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