The meaning of the symbols of clothing seen in a dream.

This is a form of sexual deviation in which the person becomes sexually stimulated by parts of the body, such as the feet, which are not usually regarded as erotogenic. Some people are sexually aroused by items of clothing or shoes.... fetishism

This results from the action of extreme cold (below 0 °C) on the skin. VASOCONSTRICTION results in a reduced blood – and hence, oxygen

– supply, leading to NECROSIS of the skin and, in severe cases, of the underlying tissues. Chie?y affecting exposed parts of the body, such as the face and the limbs, frostbite occurs especially in people exercising at high altitudes, or in those at risk of peripheral vascular disease, such as diabetics (see DIABETES MELLITUS), who should take particular care of their ?ngers and toes when in cold environments.

In mild cases – the condition sometimes known as frostnip – the skin on exposed parts of the body, such as the cheeks or nose, becomes white and numb with a sudden and complete cessation of cold and discomfort. In more severe cases, blisters develop on the frozen part, and the skin then gradually hardens and turns black until the frozen part, such as a ?nger, is covered with a black shell of dead tissue. Swelling of the underlying tissue occurs and this is accompanied by throbbing and aching. If, as is often the case, only the skin and the tissues immediately under it are frozen, then in a matter of months the dead tissue peels o?. In the most severe cases of all, muscles, bone and tendon are also frozen, and the affected part becomes cold, swollen, mottled and blue or grey. There may be no blistering in these severe cases. At ?rst there is no pain, but in time shooting and throbbing pains usually develop.

Prevention This consists of wearing the right clothing and never venturing on even quite short expeditions in cold weather, particularly on mountains, without taking expert advice as to what should be worn.

Treatment Frostnip is the only form of frostbite that should be treated on the spot. As it usually occurs on exposed parts, such as the face, each member of the party should be on the lookout for it in another. The moment that whitening of the skin is seen, the individual should seek shelter and warm the affected part by covering it with his or her warm hand or a glove until the normal colour and consistency of the affected part are restored. In more severe cases, treatment should only be given in hospital or in a well-equipped camp. In essence this consists of warming the affected part, preferably in warm water, against a warm part of the body or warm air. Rewarming should be done for spells of 20 minutes at a time. The affected part should never be placed near an open ?re. Generalised warming of the whole body may also be necessary, using hot drinks, and putting the victim in a sleeping bag.... frostbite

Disposable sanitary towels or tampons (see TAMPON) used to protect clothing from bloodstains during MENSTRUATION. They are available in different absorbencies to meet women’s individual needs.... sanitary protection

A core body temperature of less than 35 °C. As the temperature of the body falls, there is increasing dysfunction of all the organs, particularly the central nervous and cardiovascular systems. The patient becomes listless and confused, with onset of unconsciousness between 33–28 °C. Cardiac output at ?rst rises with shivering but then falls progressively, as do the oxygen requirements of the tissues. Below 17– 26 °C, cardiac output is insu?cient even to supply this reduced demand for oxygen by the tissues. The heart is susceptible to spontaneous ventricular FIBRILLATION below 28 °C. Metabolism is disturbed and the concentration of blood GLUCOSE and POTASSIUM rises as the temperature falls. Cooling of the kidneys produces a DIURESIS and further ?uid loss from the circulation to the tissues causes HYPOVOLAEMIA.

Severe hypothermia is sometimes complicated by gastric erosions and haemorrhage, as well as pancreatitis (see PANCREAS, DISORDERS OF). Infants and the elderly are less e?cient at regulating temperature and conserving heat than other age groups, and are therefore more at risk from accidental hypothermia during cold weather if their accommodation is not warm enough. Approximately half a million elderly people are at risk in Britain each winter from hypothermia. The other major cause of accidental hypothermia is near-drowning in icy water. Deliberate hypothermia is sometimes used to reduce metabolic rate so that prolonged periods of cardiac arrest may occur without tissue HYPOXIA developing. This technique is used for some cardiac and neurosurgical operations and is produced by immersion of the anaesthetised patient in iced water or by cooling an extracorporeal circulation.

Treatment of hypothermia is by warming the patient and treating any complications that arise. Passive warming is usual, with conservation of the patient’s own body heat with insulating blankets. If the core temperature is below 28 °C, then active rewarming should be instituted by means of warm peritoneal, gastric or bladder lavage or using an extracorporeal circulation. Care must be taken in moving hypothermic patients, as a sudden rush of cold peripheral blood to the heart can precipitate ventricular ?brillation. Prevention of hypothermia in the elderly is important. Special attention must be paid to diet, heating the home and adequate clothing in several layers to limit heat loss.... hypothermia

A non-venereal spirochaetal infection caused by Treponema pertenue ; it was formerly widespread in most tropical and subtropical regions amongst the indigenous population, ?orid disease being more common in children than adults. The term is of Carib-Indian (native to north-eastern South America, the east coast of Central America, and the lesser Antilles) origin. It is directly contagious from person to person; infection is also transmitted by ?ies, clothing, and living in unclean huts. Clinically, the primary stage is characterised by a granulomatous lesion, or papule (framboesioma or ‘mother yaw’) at the site of infection – usually the lower leg or foot; this enlarges, crusts, and heals spontaneously. It appears some 2–8 weeks after infection, during which time fever, malaise, pains, and pruritus may be present. In the secondary stage, a granulomatous, papular, macular or squamous eruption occurs; periostitis may also be present. The late, or tertiary stage (which appears 5–10 years later), is characterised by skin plaques, nodules, ulcers, hyperkeratosis (thickening of the skin of the hands and feet) and gummatous lesions affecting bones. Recurrence of infection in individuals suffering from a concurrent infection (e.g. SYPHILIS or TUBERCULOSIS) renders the infection more serious. Diagnosis is by demonstration of T. pertenue in exudate from a suspected lesion. Treatment is with PENICILLIN, to which T. pertenue is highly sensitive. Extensive eradication campaigns (initiated by the WHO in 1949) have been carried out in endemic areas; therefore, the early stages of the infection are rarely counted; only tertiary stages come to the attention of a physician. Failure of surveillance can lead to dramatic local recurrences.... yaws

Nutritional Profile Energy value (calories per serving): Moderate Protein: Low Fat: High Saturated fat: High Cholesterol: None Carbohydrates: Moderate Fiber: High to very high Sodium: Low Major vitamin contribution: Vitamins A, folate, vitamin C Major mineral contribution: Potassium

About the Nutrients in This Food The avocado is an unusual fruit because about 16 percent of its total weight is fat, primarily monounsaturated fatty acids. Like many other fruits, avo- cados are high in fiber (the Florida avocado is very high in fiber), a good source of the B vitamin folate, vitamin C, and potassium. The edible part of half of one average size avocado (100 g/3.5 ounces) provides 6.7 g dietary fiber, 15 g fat (2.1 g saturated fat, 9.7 g monoun- saturated fat, 1.8 g polyunsaturated fat), 81 mcg folate (20 percent of the R DA), 20 mg vitamin C (26 percent of the R DA for a woman, 22 percent for a man), and 485 mg potassium (the equivalent of one eight-ounce cup of fresh orange juice). The edible part of one-half a Florida avocado (a.k.a. alligator pear) has eight grams dietary fiber, 13.5 g fat (2.65 g saturated fat), 81 mcg folate (41 percent of the R DA for a man, 45 percent of the R DA for a woman), 12 mg vitamin C (20 percent of the R DA), and 741 mg potassium, 50 percent more than one cup fresh orange juice.

Diets That May Exclude or Restrict This Food Controlled-potassium diet Low-fat diet

Buying This Food Look for: Fruit that feels heavy for its size. The avocados most commonly sold in the U.S. are the Hass—a purple-black bumpy fruit that accounts for 85 percent of the avocados shipped from California—and the smooth-skinned Florida avocado (“alligator pear”). The oval, midwinter Bacon; the pear-shaped, late-fall Fuerte; the Gwen, a slightly larger Hass; Pinkerton, pear-shaped with a smaller seed; the round summer Reed; and the yellow-green, pear-shaped Zutano. Avoid: Avocados with soft dark spots on the skin that indicate damage underneath.

Storing This Food Store hard, unripened avocados in a warm place; a bowl on top of the refrigerator will do. Avocados are shipped before they ripen, when the flesh is hard enough to resist bruising in transit, but they ripen off the tree and will soften nicely at home. Store soft, ripe avocados in the refrigerator to slow the natural enzyme action that turns their flesh brown as they mature even when the fruit has not been cut.

Preparing This Food When you peel or slice an avocado, you tear its cell walls, releasing polyphenoloxidase, an enzyme that converts phenols in the avocado to brownish compounds that darken the avocado’s naturally pale green flesh. You can slow this reaction (but not stop it completely) by brushing the exposed surface of the avocado with an acid (lemon juice or vinegar). To store a cut avocado, brush it with lemon juice or vinegar, wrap it tightly in plastic, and keep it in the refrigerator—where it will eventually turn brown. Or you can store the avocado as guacamole; mixing it with lemon juice, tomatoes, onions, and mayonnaise (all of which are acidic) is an efficient way to protect the color of the fruit.

Medical Uses and/or Benefits Lower risk of some birth defects. As many as two of every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their moth- ers’ not having gotten adequate amounts of folate during pregnancy. The current R DA for folate is 180 mcg for a healthy woman and 200 mcg for a healthy man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking folate supple- ments before becoming pregnant and through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Woman’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, from either food or supplements, more than twice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the analysis, the results are assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to ascertain whether taking folic acid supplements reduces the risk of cardiovascular disease. Lower levels of cholesterol. Avocados are rich in oleic acid, a monounsaturated fat believed to reduce cholesterol levels. Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potas- sium supplement—about the amount of potassium in one avocado—reduced the incidence of stroke by 60 percent.

Adverse Effects Associated with This Food Latex-fruit syndrome. Latex is a milky fluid obtained from the rubber tree and used to make medical and surgical products such as condoms and protective latex gloves, as well as rubber bands, balloons, and toys; elastic used in clothing; pacifiers and baby-bottle nipples; chewing gum; and various adhesives. Some of the proteins in latex are allergenic, known to cause reactions ranging from mild to potentially life-threatening. Some of the pro- teins found naturally in latex also occur naturally in foods from plants such as avocados, bananas, chestnuts, kiwi fruit, tomatoes, and food and diet sodas sweetened with aspar- tame. Persons sensitive to these foods are likely to be sensitive to latex as well. NOT E : The National Institute of Health Sciences, in Japan, also lists the following foods as suspect: A lmonds, apples, apricots, bamboo shoots, bell peppers, buckwheat, cantaloupe, carrots, celer y, cherries, chestnuts, coconut, figs, grapefruit, lettuce, loquat, mangoes, mushrooms, mustard, nectarines, oranges, passion fruit, papaya, peaches, peanuts, peppermint, pine- apples, potatoes, soybeans, strawberries, walnuts, and watermelon.

Food/Drug Interactions MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of enzymes that break down the amino acid tyramine so it can be eliminated from the body. Tyramine is a pressor amine, a chemical that constricts blood vessels and raises blood pressure. If you eat a food such as avocado that contains tyramine while you are taking an M AO inhibitor you cannot eliminate the pressor amine, and the result may be abnormally high blood pressure or a hypertensive crisis (sus- tained elevated blood pressure). False-positive test for tumors. Carcinoid tumors (which may arise from tissues in the endo- crine system, the intestines, or the lungs) secrete serotonin, a natural chemical that makes blood vessels expand or contract. Because serotonin is excreted in urine, these tumors are diagnosed by measuring the levels of serotonin by-products in the urine. Avocados contain large amounts of serotonin; eating them in the three days before a test for an endocrine tumor might produce a false-positive result, suggesting that you have the tumor when in fact you don’t. (Other foods high in serotonin are bananas, eggplant, pineapples, plums, tomatoes, and walnuts.)... avocados

Nutritional Profile Energy value (calories per serving): Moderate Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Moderate Sodium: Low Major vitamin contribution: B vitamins, vitamin C Major mineral contribution: Potassium, magnesium

About the Nutrients in This Food A banana begins life with more starch than sugar, but as the fruit ripens its starches turn to sugar, which is why ripe bananas taste so much better than unripe ones.* The color of a banana’s skin is a fair guide to its starch/ sugar ratio. When the skin is yellow-green, 40 percent of its carbohydrates are starch; when the skin is fully yellow and the banana is ripe, only 8 per- cent of the carbohydrates are still starch. The rest (91 percent) have broken down into sugars—glucose, fructose, sucrose, the most plentiful sugar in the fruit. Its high sugar content makes the banana, in its self-contained packet, a handy energy source. Bananas are a high-fiber food with insoluble cellulose and lignin in the tiny seeds and soluble pectins in the flesh. They are also a good source of vitamin C and potassium. One small (six-inch) banana or a half-cup of sliced banana has 2.6 g dietary fiber and 8.8 mg vitamin C (12 percent of the R DA for a woman, 10 percent of the R DA for a man), plus 363 mg potassium.

The Most Nutritious Way to Serve This Food Fresh and ripe. Green bananas contain antinutrients, proteins that inhibit the actions of amylase, an enzyme that makes it possible for us to digest * They are also more healt hful. Green bananas contain proteins t hat inhibit amy- lase, an enzyme t hat makes it possible for us to digest complex carbohydrates. starch and other complex carbohydrates. Raw bananas are richer in potassium than cooked bananas; heating depletes potassium.

Buying This Food Look for: Bananas that will be good when you plan to eat them. Bananas with brown specks on the skin are ripe enough to eat immediately. Bananas with creamy yellow skin will be ready in a day or two. Bananas with mostly yellow skin and a touch of green at either end can be ripened at home and used in two or three days. Avoid: Overripe bananas whose skin has turned brown or split open. A grayish yellow skin means that the fruit has been damaged by cold storage. Bananas with soft spots under the skin may be rotten.

Storing This Food Store bananas that aren’t fully ripe at room temperature for a day or two. Like avocados, bananas are picked green, shipped hard to protect them from damage en route and then sprayed with ethylene gas to ripen them quickly. Untreated bananas release ethylene natu- rally to ripen the fruit and turn its starches to sugar, but natural ripening takes time. Artificial ripening happens so quickly that there is no time for the starches to turn into sugar. The bananas look ripe but they may taste bland and starchy. A few days at room temperature will give the starches a chance to change into sugars. Store ripe bananas in the refrigerator. The cold air will slow (but not stop) the natural enzyme action that ripens and eventually rots the fruit if you leave it at room temperature. Cold storage will darken the banana’s skin, since the chill damages cells in the peel and releases polyphenoloxidase, an enzyme that converts phenols in the banana peel to dark brown compounds, but the fruit inside will remain pale and tasty for several days.

Preparing This Food Do not slice or peel bananas until you are ready to use them. When you cut into the fruit, you tear its cell walls, releasing polyphenoloxidase, an enzyme that hastens the oxidation of phenols in the banana, producing brown pigments that darken the fruit. (Chilling a banana produces the same reaction because the cold damages cells in the banana peel.) You can slow the browning (but not stop it completely) by dipping raw sliced or peeled bananas into a solution of lemon juice or vinegar and water or by mixing the slices with citrus fruits in a fruit salad. Overripe, discolored bananas can be used in baking, where the color doesn’t matter and their intense sweetness is an asset.

What Happens When You Cook This Food When bananas are broiled or fried, they are cooked so quickly that there is very little change in color or texture. Even so, they will probably taste sweeter and have a more intense aroma than uncooked bananas. Heat liberates the volatile molecules that make the fruit taste and smell good.

How Other Kinds of Processing Affect This Food Drying. Drying removes water and concentrates the nutrients and calories in bananas. Bananas may be treated with compounds such as sulfur dioxide to inhibit polyphenoloxi- dase and keep the bananas from browning as they dry. People who are sensitive to sulfites may suffer severe allergic reactions, including anaphylactic shock, if they eat these treated bananas. Freezing. Fresh bananas freeze well but will brown if you try to thaw them at room tem- perature. To protect the creamy color, thaw frozen bananas in the refrigerator and use as quickly as possible.

Medical Uses and/or Benefits Lower risk of stroke. Various nutrition studies have attested to the power of adequate potassium to keep blood pressure within safe levels. For example, in the 1990s, data from the long-running Harvard School of Public Health/Health Professionals Follow-Up Study of male doctors showed that a diet rich in high-potassium foods such as bananas, oranges, and plantain may reduce the risk of stroke. In the study, the men who ate the higher number of potassium-rich foods (an average of nine servings a day) had a risk of stroke 38 percent lower than that of men who consumed fewer than four servings a day. In 2008, a similar survey at the Queen’s Medical Center (Honolulu) showed a similar protective effect among men and women using diuretic drugs (medicines that increase urination and thus the loss of potassium). Improved mood. Bananas and plantains are both rich in serotonin, dopamine, and other natural mood-elevating neurotransmitters—natural chemicals that facilitate the transmis- sion of impulses along nerve cells. Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potas- sium supplement—about the amount of potassium in one banana—reduced the incidence of stroke by 60 percent.

Adverse Effects Associated with This Food Digestive Problems. Unripe bananas contain proteins that inhibit the actions of amylase, an enzyme required to digest starch and other complex carbohydrates. Sulfite allergies. See How other kinds of processing affect this food. Latex-fruit syndrome. Latex is a milky fluid obtained from the rubber tree and used to make medical and surgical products such as condoms and protective latex gloves, as well as rub- ber bands, balloons, and toys; elastic used in clothing; pacifiers and baby bottle-nipples; chewing gum; and various adhesives. Some of the proteins in latex are allergenic, known to cause reactions ranging from mild to potentially life-threatening. Some of the proteins found naturally in latex also occur naturally in foods from plants such as avocados, bananas, chestnuts, kiwi fruit, tomatoes, and food and diet sodas sweetened with aspartame. Persons sensitive to these foods are likely to be sensitive to latex as well. NOTE : The National Insti- tute of Health Sciences, in Japan, also lists the following foods as suspect: Almonds, apples, apricots, bamboo shoots, bell peppers, buckwheat, cantaloupe, carrots, celery, cherries, chestnuts, coconut, figs, grapefruit, lettuce, loquat, mangoes, mushrooms, mustard, nectar- ines, oranges, passion fruit, papaya, peaches, peanuts, peppermint, pineapples, potatoes, soybeans, strawberries, walnuts, and watermelon.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. There have been some reports in the past of such reactions in people who have eaten rotten bananas or bananas stewed with the peel. False-positive test for tumors. Carcinoid tumors—which may arise from tissues of the endo- crine system, the intestines, or the lungs—secrete serotonin, a natural chemical that makes blood vessels expand or contract. Because serotonin is excreted in urine, these tumors are diagnosed by measuring the levels of serotonin by-products in the urine. Bananas contain large amounts of serotonin; eating them in the three days before a test for an endocrine tumor might produce a false-positive result, suggesting that you have the tumor when in fact you don’t. (Other foods high in serotonin are avocados, eggplant, pineapple, plums, tomatoes, and walnuts.)... bananas

Linn.

Family: Asteraceae.

Habitat: Cultivated mainly as an oil-seed crop in Madhya Pradesh, Maharashtra.

English: Safflower.

Ayurvedic: Kusumbha, Vahin- shikhaa, Vastraranjaka, Kusum.

Unani: Qurtum.

Siddha/Tamil: Chendurakam.

Action: Oil—aids prevention of arteriosclerosis, coronary heart disease and kidney disorders as a polyunsaturated fat. Flowers— stimulant, sedative, diuretic, emmenagogue; used in fevers and eruptive skin conditions, measles.

Charred safflower oil is used in rheumatism and for healing sores.

Key application: Dried flowers— in cardiovascular diseases, amen- orrhoea, dysmenorrhoea and retention of lochia; also in wounds and sores with pain and swelling. (Pharmocopoeia of the People's Republic of China, 1997.)

Safflower contains carthamone, lig- nans and a polysaccharide. The polysaccharide, composed of xylose, fructose, galactose, glucose, arabinose, rhamnose and uronic acid residues, stimulates immune function in mice. It induced antibody formation in mice following peritoneal injection. Extracts of flowers have also been tested in China on blood coagulation, where a prolongation of clothing time was observed and platelet aggregation inhibited. Chinese research indicates that Safflower flowers can reduce coronary artery disease, and lower cholesterol levels. Flowers and seeds exhibit lipase activity. The flower extract also exhibited anti-inflammatory, sedative and analgesic effect and inhibitory effect on spontaneous motor activity.

The plant contains a propanetriol derivative, which can be used for the treatment of circulatory disorders.

Recent research suggests that improving the lipid profile might not be as important to reducing the risk of cardiovascular disease as suggested. (Natural Medicines Comprehensive Database, 2007.)

Safflower is contraindicated in pregnancy, gastric disorders, excessive menstruation, haemorrhagic diseases.

Wild and thorny Safflower, growing in the arid tract of Haryana and Punjab (locally known as Kantiaari, Poli, Poiyan) is equated with C. oxy- cantha Bieb. The plant is diuretic. Seed oil is applied topically to ulcers. The plant contains a sesquiterpene gly- coside. Aerial parts contain hinesol- beta-D-fucopyranoside. The plant also contains luteolin-7-glucoside.

Dosage: Leaf—3-6 g powder. (CCRAS.)... carthamus tinctorius

Chilblain, or erythema pernio (see under ERYTHEMA), is an in?amed condition of the hands or feet, or occasionally of the ears, and should not be confused with cracked or CHAPPED HANDS. Most commonly found in childhood and old age, it may be associated with generally poor health, though there may also be a genetic predisposition. Prevention with good food, warm clothing, a warm environment, and regular exercise to maintain the circulation, is the best treatment.... chilblain

A noxious gas used for riot control which causes irritation of the eyes and respiratory tract. Symptoms usually subside within 20 minutes but, if they persist, the victim should be removed to a well-ventilated area, contaminated clothing removed, the affected skin washed with soap and water and the eyes irrigated with water or physiological saline. (CONTACT LENSES should be removed and washed, if hard; dis-carded, if soft.) If respiratory complications develop, the victim should be admitted to hospital.... cs gas

Cyanide inhibits cellular RESPIRATION by binding rapidly and reversibly with the ENZYME, cytochrome oxidase. E?ects of poisoning are due to tissue HYPOXIA. Cyanide is toxic by inhalation, ingestion and prolonged skin contact, and acts extremely quickly once absorbed. Following inhalation of hydrogen cyanide gas, death can occur within minutes. Ingestion of inorganic cyanide salts may produce symptoms within 10 minutes, again proceeding rapidly to death. On a full stomach, effects may be delayed for an hour or more. Signs of cyanide poisoning are headache, dizziness, vomiting, weakness, ATAXIA, HYPERVENTILATION, DYSPNOEA, HYPOTENSION and collapse. Loss of vision and hearing may occur, then COMA and CONVULSIONS. Other features include cardiac ARRHYTHMIA and PULMONARY OEDEMA. Patients may have a lactic ACIDOSIS. Their arterial oxygen tension is likely to be normal, but their venous oxygen tension high and similar to that of arterial blood.

Treatment Administration of oxygen when available is the most important ?rst-aid management. Rescuers should be trained, must not put themselves at risk, and should use protective clothing and breathing apparatus. In unconscious victims, establish a clear airway and give 100 per cent oxygen. If breathing stops and oxygen is unavailable, initiate expired-air resuscitation. If cyanide salts were ingested, mouth-to-mouth contact must be avoided and a mask with a one-way valve employed instead. Some commercially available ?rst-aid kits contain AMYL NITRATE as an antidote which may be employed if oxygen is unavailable.

Once in hospital, or if a trained physician is on the scene, then antidotes may be administered. There are several di?erent intravenous antidotes that may be used either alone or in combination. In mild to moderate cases, sodium thiosulphate is usually given. In more severe cases either dicobalt edetate or sodium nitrite may be used, followed by sodium thio-sulphate. Some of these (e.g. dicobalt edetate) should be given only where diagnosis is certain, otherwise serious adverse reations or toxicity due to the antidotes may occur.... cyanide poisoning

A term applied to the occurrence of animal parasites in the intestine, hair or clothing.... infestation

(See also FIT; SEIZURE.) Epilepsy is the name given to any condition in which a person suffers repeated ?ts or seizures. It is present in one in 200 (0·5 per cent) of the population and up to 5 per cent of all children will have had a ?t by the age of 12, although most of these are harmless accompaniments of an acute feverish illness.

It is a recurrent and paroxysmal disorder starting suddenly and ceasing spontaneously due to occasional sudden excessive rapid and local discharge of the nerve cells in the grey matter (cortex) of the BRAIN. Epilepsy always arises in this way from the brain, but its origin is often of microscopic size. It is diagnosed by the clinical symptoms based on the observations of witnesses. Its cause can sometimes be established by laboratory tests, and brain scanning. Fits can be the ?rst sign of a tumour, or follow a stroke, brain injury or infection, but in the large majority no underlying cause is found – so-called idiopathic epilepsy.

A single epileptic ?t is not epilepsy. Of those people who have a single seizure, a signi?cant minority (20 per cent) have no further attacks.

Major (generalised) seizures have a sudden, often unprovoked onset; the patient emits a cry, then falls to the ground, rigid, blue, and then twitching or jerking both sides of the body: the tonic-clonic convulsion. Drowsiness and confusion may last for some hours after recovering consciousness. Some experience a momentary warning (AURA): a smell, or sensation in the head or abdomen, vision, or déjà vu.

Partial seizures: focal motor (Jacksonian) begin with twitching of the angle of the mouth, the thumb, or the big toe. If the seizure discharge then spreads, the twitching or jerking spreads gradually through the limbs. Consciousness is preserved unless the seizure spreads to produce a secondary generalised ?t. In some attacks the eyes and head may turn, the arm may rise, and the body may turn, while some patients feel tingling in the limbs.

Complex partial seizures (temporal lobe epilepsy) The patient usually appears blank, vacant and may be unable to talk, or may mumble or chatter – though later they often have no memory of this period. They may be able to carry out complex tasks, taking o? gloves or clothes, and may smack their lips or rub repeatedly on one limb (automatisms). A sense of strangeness supervenes: unreality, or a feeling of having experienced it all before (déja vu). There may be a sense of panic. Strange unpleasant smells and tastes are olfactory and gustatory hallucinations. The visual hallucinations evoke complex scenes. An initial rising sense of warmth or discomfort in the stomach, or ‘speeding-up’ of thoughts are common psychomotor symptoms. All these strange symptoms are brief, disappearing within a few seconds or up to 3–4 minutes.

Minor seizures (petit mal) Attacks start in childhood. They last a few seconds. The child ceases what he or she is doing, stares, looks a little pale, and may ?utter the eyelids. The head may drop forwards. Attacks are commonly provoked by overbreathing. The child and parents may be unaware of the attacks

– ‘just daydreaming’. Major ?ts develop in one-third of subjects. By contrast with other types of epilepsy, the ELECTROENCEPHALOGRAM (EEG) is diagnostic.

Precautions Children with epilepsy should take normal school exercises and games, and can swim under supervision. Adults must avoid working at heights, with exposed dangerous machinery, and driving vehicles on public roads. Current legislation allows driving after two years of complete freedom from attacks during waking hours; those who for more than three years have had a history of attacks only while asleep may also drive.

Treatment identi?es, and avoids where possible, any factors (such as shortage of sleep or excessive ?uids) which aggravate or trigger attacks. If ?ts are very infrequent, treatment may not be recommended. However, frequent ?ts may be embarassing, may cause injury or may cause long-term brain damage so treatment is advisable. Anti-epileptic drugs are usually necessary for several years under medical supervision. Carbamazepine and sodium valproate are the most frequently prescribed. The dose is governed by the degree of control of ?ts and sometimes drug levels can be monitored by blood tests to check on dosage. Strict adherence to the drug schedule gives a reasonable chance of total suppression of ?ts, especially in younger patients whose ?ts have started recently. The table summarises anticonvulsant drugs in use. Interactions can occur between anti-epileptics and, if drug treatment is changed, the patient needs careful monitoring. In particular, abrupt withdrawal of a drug should be avoided as this may precipitate severe rebound seizures.

Indications First-choice drugs: Ethosuximide PM, JME Phenobarbitone M, P Phenytoin M, P, CP Carbamazepine M, P, CP Valproate M, PM, JME Second-line drugs: Primidone M, P, CP Clobazam M, CP Vigabatrin M, P, CP Lamotrigine M, P, CP Gabapentin M, P, CP Topirimate P

M = major generalised tonic-clonic; P = partial or focal; CP = complex partial (temporal lobe); PM = petit mal; JME = juvenile myoclonic epilepsy.

Anticonvulsant drugs

As all anticonvulsant drugs have an e?ect on the brain, it is not surprising that there may be side-effects, especially inolving alertness or behaviour. In each case careful assessment is necessary for doctor and patient to agree on the best compromise between stopping ?ts and avoiding ill-effects of medication.

Patients who have an epileptic seizure should not be restrained or have a gag or anything else placed in their mouths; nor should they be moved unless in danger of further injury. Any tight clothing around the neck should be loosened and, when the seizure has passed, the person should be placed in the recovery position to facilitate a return to consciousness (see APPENDIX 1: BASIC FIRST AID).

Patients with epilepsy and their relatives can obtain further advice and information from the British Epilepsy Association or Epilepsy Action Scotland.... epilepsy

Also known as actinic keratosis; a rough, scaly area on exposed skin caused by chronic solar damage from exposure to sun. The face and backs of the hands are most commonly affected. (See also MELANOMA; PHOTODERMATOSES.) CRYOTHERAPY is e?ective, but prevention by appropriate clothing and sun-blocking creams is a better strategy.... keratosis

When LYSOL is swallowed it burns the mouth and throat. Brown discoloration of the affected tissues, accompanied by the characteristic smell of lysol on the breath, is typical.

Treatment This is urgent. If the skin has been contaminated with the lysol, it must be washed with water, and any lysol-contaminated clothing must be taken o?. Do not make the victim vomit if he or she has swallowed a corrosive substance such as lysol or phenol. Call an ambulance and say what the victim has taken. See APPENDIX 1: BASIC FIRST AID.... lysol poisoning

A parasitic infestation of the head, the hairy parts of the body and the clothing by adult lice, larvae and nits (eggs), which often results in severe itching and excoriation of the scalp and body. Secondary infection can occur. Infesting agents include Pediculus capitis, the head louse, P. humanus, the body louse, and Pthirus pubis, the crab louse, which usually infest the pubic region, but may also infest the hair of the face, axillae and the bodysurfaces.... pediculosis

A condition resulting from environmental temperatures which are too high for compensation by the body’s thermo-regulatory mechanism(s). It is characterised by hyperpyrexia, nausea, headache, thirst, confusion, and dry skin. If untreated, COMA and death ensue. The occurrence of heat stroke is sporadic: whereas a single individual may be affected (occasionally with fatal consequences), his or her colleagues may remain unaffected. Predisposing factors include unsatisfactory living or working conditions, inadequate acclimatisation to tropical conditions, unsuitable clothing, underlying poor health, and possibly dietetic or alcoholic indiscretions. The condition can be a major problem during pilgrimages – for example, the Muslim Hadj. Four clinical syndromes are recognised:

Heat collapse is characterised by fatigue, giddiness, and temporary loss of consciousness. It is accompanied by HYPOTENSION and BRADYCARDIA; there may also be vomiting and muscular cramps. Urinary volume is diminished. Recovery is usual.

Heat exhaustion is characterised by increasing weakness, dizziness and insomnia. In the majority of sufferers, sweating is defective; there are few, if any, signs of dehydration. Pulse rate is normal, and urinary output good. Body temperature is usually 37·8–38·3 °C.

Heat cramps (usually in the legs, arms or back, and occasionally involving the abdominal muscles) are associated with hard physical work at a high temperature. Sweating, pallor, headache, giddiness and intense anxiety are present. Body temperature is only mildly raised.

Heat hyperpyrexia is heralded by energy loss and irritability; this is followed by mental confusion and diminution of sweating. The individual rapidly becomes restless, then comatose; body temperature rises to 41–42 °C or even higher. The condition is fatal unless expertly treated as a matter of urgency.

Treatment With the ?rst two syndromes, the affected individual must be removed immediately to a cool place, and isotonic saline administered – intravenously in a severe case. The fourth syndrome is a medical emergency. The patient should be placed in the shade, stripped, and drenched with water; fanning should be instigated. He or she should be wrapped in a sheet soaked in cool water and fanning continued. When rectal temperature has fallen to 39 °C, the patient is wrapped in a dry blanket. Immediately after consciousness returns, normal saline should be given orally; this usually provokes sweating. The risk of circulatory collapse exists. Convalescence may be protracted and the patient should be repatriated to a cool climate. Prophylactically, personnel intended for work in a tropical climate must be very carefully selected. Adequate acclimatisation is also essential; severe physical exertion must be avoided for several weeks, and light clothes should be worn. The diet should be light but nourishing, and ?uid intake adequate. Those performing hard physical work at a very high ambient temperature should receive sodium chloride supplements. Attention to ventilation and air-conditioning is essential; fans are also of value.... heat stroke

(body louse) di?ers from the head and crab louse in that it lives in clothing and only goes on to the body to feed. Infestation is found in vagabonds, armies in the ?eld, or prisoners in conditions where even minimal hygiene is impossible. The lice are found in the seams of clothing together with multiple eggs. Typically excoriation and pigmentation are seen on the back of the infested person. Replacement of clothing or autoclaving or hot ironing of the clothes is curative.... pediculus humanus var. corporis

A device that enables hospital staff members to monitor their exposure to radiation. Film badges are worn by those people who work in X-ray and radiotherapy departments. A badge consists of a piece of photographic film in a holder worn on the clothing. The film has a fast (sensitive) emulsion on 1 side and a slow emulsion on the other. Small doses of radiation blacken only the fast emulsion; higher doses start to blacken the slow emulsion and make the fast emulsion opaque.... film badge

Gonorrhoea is an in?ammatory disease caused by Neisseria gonococcous, affecting especially the mucous membrane of the URETHRA in the male and that of the VAGINA in the female, but spreading also to other parts. It is the most common of the SEXUALLY TRANSMITTED DISEASES (STDS). According to the WHO, 200 million new cases are noti?ed annually in the world. In the UK the incidence has been declining since 1991; in 1999 the rate per million of population was 385 for males (599.4 in 1991) and 171.3 for females (216.5 in 1991).

Causes The disease is directly contagious from another person already suffering from it – usually by sexual intercourse, but occasionally conveyed by the discharge on sponges, towels or clothing as well as by actual contact. The gonococcus is found in the discharge expressed from the urethra, which may be spread as a ?lm on a glass slide, suitably stained, and examined under the microscope; or a culture from the discharge may be made on certain bacteriological media and ?lms from this, similarly examined under the microscope. Since discharges resembling that of gonorrhoea accompany other forms of in?ammation, the identi?cation of the organism is of great importance. A gram-stained smear of urethral discharge enables rapid identi?cation of the gonococcus in around 90 per cent of men.

Symptoms These di?er considerably, according to whether the disease is in an acute or a chronic stage.

MEN After an incubation period of 2–10 days, irritation in the urethra, scalding pain on passing water, and a viscid yellowish-white discharge appear; the glands in the groin often enlarge and may suppurate. The urine when passed is hazy and is often found to contain yellowish threads of pus visible to the eye. After some weeks, if the condition has become chronic, the discharge is clear and viscid, there may be irritation in passing urine, and various forms of in?ammation in neighbouring organs may appear – the TESTICLE, PROSTATE GLAND and URINARY BLADDER becoming affected. At a still later stage the in?ammation of the urethra is apt to lead to gradual formation of ?brous tissue around this channel. This contracts and produces narrowing, so that urination becomes di?cult or may be stopped for a time altogether (the condition known as stricture). In?ammation of some of the joints is a common complication in the early stage – the knee, ankle, wrist, and elbow being the joints most frequently affected – and this form of ‘rheumatism’ is very intractable and liable to lead to permanent sti?ness. The ?brous tissues elsewhere may also develop in?ammatory changes, causing pain in the back, foot, etc. In occasional cases, during the acute stage, SEPTICAEMIA may develop, with in?ammation of the heart-valves (ENDOCARDITIS) and abscesses in various parts of the body. The infective matter occasionally is inoculated accidentally into the eye, producing a very severe form of conjunctivitis: in the newly born child this is known as ophthalmia neonatorum and, although now rare in the UK. has in the past been a major cause of blindness (see EYE, DISORDERS OF). WOMEN The course and complications of the disease are somewhat di?erent in women. It begins with a yellow vaginal discharge, pain on urination, and very often in?ammation or abscess of the Bartholin’s glands, situated close to the vulva or opening of the vagina. The chief seriousness, however, of the disease is due to the spread of in?ammation to neighbouring organs, the UTERUS, FALLOPIAN TUBES, and OVARIES, causing permanent destructive changes in these, and leading occasionally to PERITONITIS through the Fallopian tube with a fatal result. Many cases of prolonged ill-health and sterility or recurring miscarriages are due to these changes.

Treatment The chances of cure are better the earlier treatment is instituted. PENICILLIN is the antibiotic of choice but unfortunately the gonococcus is liable to become resistant to this. In patients who are infected with penicillin-resistant organisms, one of the other antibiotics (e.g. cefotaxime, cipro?oxacin or spectinomycin) is used. In all cases it is essential that bacteriological investigation should be carried out at weekly intervals for three or four weeks, to make sure that the patient is cured. Patients attending with gonorrhoea are asked if they will agree to tests for other sexually transmitted infections, such as HIV (see AIDS/HIV) and for assistance in contact tracing.... gonorrhoea

Inanimate objects, such as bed linen, clothing, books, or a telephone receiver, that are not harmful in themselves but may be capable of harbouring harmful microorganisms or parasites and thus convey an infection from one person to another. Fomites mainly transmit respiratory infections, such as influenza. The singular form of the word is fomes.... fomites

Diseases of the SKIN for which sunlight is partially or wholly responsible. In su?cient dosage, short-wave ultraviolet light (UVB – see ULTRAVIOLET RAYS (UVR)) always causes ERYTHEMA. Higher doses progressively cause OEDEMA and blistering; this is acute sunburn. Graduated exposure to UVB causes pigmentation (tanning). Prolonged chronic exposure to sunlight eventually accelerates ageing of the exposed skin with LENTIGO formation and loss of COLLAGEN and elastic tissue. After decades of such exposure, epidermal DYSPLASIA and CANCER may supervene.

Drugs given orally or topically may induce phototoxic reactions of various types. Thus, TETRACYCLINES exaggerate sunburn reactions. and the diuretic FRUSEMIDE may cause blistering reactions. Psoralens induce erythema and pigmentation. AMIODARONE also induces pigmentation. (See also PHOTOCHEMOTHERAPY.)

Phytophotodermatitis is a streaky, blistering photodermatosis typically seen on the limbs of children playing in grassy meadows in summer. The phototoxic reaction is caused by psoralens in weeds.

Berlocque dermatitis is a pattern of streaky pigmentation usually seen on women’s necks, caused by a reaction to psoralens in perfumes.

Certain rare metabolic diseases may lead to photosensitisation. They include the PORPHYRIAS and PELLAGRA. Other skin diseases such as lupus erythematosus (see under LUPUS) and ROSACEA may be aggravated by light exposure. Sometimes, in the absence of any of these factors, some people spontaneously develop a sensitivity to light causing various patterns of DERMATITIS or URTICARIA. The most common pattern is ‘polymorphic light eruption’ which typically appears within a day or two of arrival at a sunny holiday destination and persists until departure. Continuously exposed areas, such as the hands and face, may be ‘hardened’ and unaffected.

Treatment Appropriate clothing and headgear, sunscreen creams and lotions are the main preventative measures.... photodermatoses

The following are described under their separate dictionary entries: FAECES; HAEMORRHOIDS; FISTULA; DIARRHOEA; CONSTIPATION.

Imperforate anus, or absence of the anus, may occur in newly born children, and the condition is relieved by operation.

Itching at the anal opening is common and can be troublesome. It may be due to slight abrasions, to piles, to the presence of threadworms (see ENTEROBIASIS), and/or to anal sex. The anal area should be bathed once or twice a day; clothing should be loose and smooth. Local application of soothing preparations containing mild astringents (bismuth subgallate, zinc oxide and hamamelis) and CORTICOSTEROIDS may provide symptomatic relief. Proprietary preparations contain lubricants, VASOCONSTRICTORS and mild ANTISEPTICS.

Pain on defaecation is commonly caused by a small ulcer or ?ssure, or by an engorged haemorrhoid (pile). Haemorrhoids may also cause an aching pain in the rectum. (See also PROCTALGIA.)

Abscess in the cellular tissue at the side of the rectum – known from its position as an ischio-rectal abscess – is fairly common and may produce a ?stula. Treatment is by ANTIBIOTICS and, if necessary, surgery to drain the abscess.

Prolapse or protrusion of the rectum is sometimes found in children, usually between the ages of six months and two years. This is generally a temporary disorder. Straining at defaecation by adults can cause the lining of the rectum to protrude outside the anus, resulting in discomfort, discharge and bleeding. Treatment of the underlying constipation is essential as well as local symptomatic measures (see above). Haemorrhoids sometimes prolapse. If a return to normal bowel habits with the production of soft faeces fails to restore the rectum to normal, surgery to remove the haemorrhoids may be necessary. If prolapse of the rectum recurs, despite a return to normal bowel habits, surgery may be required to rectify it.

Tumours of small size situated on the skin near the opening of the bowel, and consisting of nodules, tags of skin, or cauli?ower-like excrescences, are common, and may give rise to pain, itching and watery discharges. These are easily removed if necessary. Polypi (see POLYPUS) occasionally develop within the rectum, and may give rise to no pain, although they may cause frequent discharges of blood. Like polypi elsewhere, they may often be removed by a minor operation. (See also POLYPOSIS.)

Cancer of the rectum and colon is the commonest malignancy in the gastrointestinal tract: around 17,000 people a year die from these conditions in the United Kingdom. Rectal cancer is more common in men than in women; colonic cancer is more common in women. Rectal cancer is a disease of later life, seldom affecting young people, and its appearance is generally insidious. The tumour begins commonly in the mucous membrane, its structure resembling that of the glands with which the membrane is furnished, and it quickly in?ltrates the other coats of the intestine and then invades neighbouring organs. Secondary growths in most cases occur soon in the lymphatic glands within the abdomen and in the liver. The symptoms appear gradually and consist of diarrhoea, alternating with attacks of constipation, and, later on, discharges of blood or blood-stained ?uid from the bowels, together with weight loss and weakness. A growth can be well advanced before it causes much disturbance. Treatment is surgical and usually this consists of removal of the whole of the rectum and the distal two-thirds of the sigmoid colon, and the establishment of a COLOSTOMY. Depending upon the extent of the tumour, approximately 50 per cent of the patients who have this operation are alive and well after ?ve years. In some cases in which the growth occurs in the upper part of the rectum, it is now possible to remove the growth and preserve the anus so that the patient is saved the discomfort of having a colostomy. RADIOTHERAPY and CHEMOTHERAPY may also be necessary.... rectum, diseases of

The branch of medicine concerned with the law, especially criminal law.

The forensic pathologist is a doctor who specializes in the examination of bodies when circumstances suggest death was unnatural.

Forensic pathologists may also examine victims of alleged sexual assault.

Forensic scientists use laboratory methods to study body fluids (such as blood and semen) found on or near the victim and compare them with those from suspects.

They are also trained in ballistics and the identification of fibres from clothing.

In addition, forensic scientists may advise on blood groups and genetic fingerprinting in legal investigations.... forensic medicine

Death due to work-related disease or injuries.

Annual death rates (deaths per million at risk) vary widely between occupations, ranging from 5 in clothing and footwear manufacture to about 1,650 in offshore oil and gas industries.

More than 1,000 per year are due to work-related diseases, mainly pneumoconiosis and cancers.... occupational mortality

A poison is any substance which, if absorbed by, introduced into or applied to a living organism, may cause illness or death. The term ‘toxin’ is often used to refer to a poison of biological origin. Toxins are therefore a subgroup of poisons, but often little distinction is made between the terms. The study of the effects of poisons is toxicology and the effects of toxins, toxinology.

The concept of the dose-response is important for understanding the risk of exposure to a particular substance. This is embodied in a statement by Paracelsus (c.1493–1541): ‘All substances are poisons; there is none which is not a poison. The right dose di?erentiates a poison and a remedy.’

Poisoning may occur in a variety of ways: deliberate – SUICIDE, substance abuse or murder; accidental – including accidental overdose of medicines; occupational; and environmental

– including exposure during ?re.

Ingestion is the most common route of exposure, but poisoning may also occur through inhalation, absorption through the skin, by injection and through bites and stings of venomous animals. Poisoning may be described as acute, where a single exposure produces clinical effects with a relatively rapid onset; or chronic, where prolonged or repeated exposures may produce clinical effects which may be insidious in onset, cumulative and in some cases permanent.

Diagnosis of poisoning is usually by circumstantial evidence or elimination of other causes of the clinical condition of the patient. Some substances (e.g. opioids) produce a characteristic clinical picture in overdose that can help with diagnosis. In some patients laboratory analysis of body ?uids or the substance taken may be useful to determine or con?rm the o?ending agent. Routine assays are not necessary. For a very small number of poisons, such as paracetamol, aspirin, iron and lead, the management of the patient may depend on measuring the amount of poison in the bloodstream.

Accurate statistics on the incidence of poisoning in the UK are lacking. Mortality ?gures are more reliable than morbidity statistics; annually, well over 100,000 cases of poisoning are admitted to hospital. The annual number of deaths from poisoning is relatively small – about 300 – and in most cases patients die before reaching hospital. Currently, CARBON MONOXIDE (CO) is by far the most common cause of death due to poisoning. The most common agents involved in intentional or accidental poisoning are drugs, particularly ANALGESICS, ANTIDEPRESSANT DRUGS and SEDATIVES. Alcohol is also commonly taken by adults, usually in combination with drugs. Children frequently swallow household cleaners, white spirit, plant material – such as belladonna (deadly nightshade) and certain mushrooms; for example, death cap and ?y agaric – aftershave and perfume as well as drugs. If possible, the suspect container, drug or plant should be taken with the victim to the hospital or doctor. The use of child-resistant containers has reduced the number of admissions of children to hospital for treatment. Bixtrex® is an intensely bitter-tasting agent which is often added to products to discourage ingestion; however, not everybody is able to taste it, nor has any bene?cial e?ect been proven.

Treatment of poisoning usually begins with decontamination procedures. For ingested substances this may involve making the patient sick or washing the stomach out (GASTRIC LAVAGE): this is usually only worthwhile if performed soon after ingestion. It should be emphasised that salt (sodium chloride) water must never be given to induce vomiting, since this procedure is dangerous and has caused death. For substances spilt on the skin, the affected area should immediately be thoroughly washed and all contaminated clothing removed. Following eye exposure, the affected eye/s should be thoroughly irrigated with saline or water.

Treatment thereafter is generally symptomatic and supportive, with maintenance of the victim’s respiratory, neurological and cardiovascular systems and, where appropriate, monitoring of their ?uid and electrolyte balance and hepatic and renal function. There are speci?c antidotes for a few substances: the most important of these are PARACETAMOL, iron, cyanide (see CYANIDE POISONING), opioids (see OPIOID), DIGOXIN, insecticides and some heavy metals. Heavy-metal poisoning is treated with CHELATING AGENTS – chemical compounds that form complexes by binding metal ions: desferrioxamine and pencillinamine are two such agents. The number of people presenting with paracetamol overdose – a common drug used for attempted suicide – has fallen sharply since restrictions were placed on its over-thecounter sales.

When a patient presents with an illness thought to be caused by exposure to substances at work, further exposure should be limited or prevented and investigations undertaken to determine the source and extent of the problem. Acutely poisoned workers will usually go to hospital, but those suffering from chronic exposure may attend their GP with non-speci?c symptoms (see OCCUPATIONAL HEALTH, MEDICINE AND DISEASES).

In recent years, legislation has been enacted in the UK to improve safety in the workplace and to ensure that data on the hazardous constituents and effects of chemicals are more readily available. These o?cial controls include the Control of Substances Hazardous to Health (COSHH) and the Chemicals (Hazard Information and Packaging) Regulations (CHIP) and are UK legislation in response to European Union directives.

The National Poisons Information Service is a 24-hour emergency telephone service available to the medical profession and provides information on the likely effects of numerous agents and advice on the management of the poisoned patient. The telephone numbers are available in the medical literature. In the UK this is not a public-access service. People who believe they, or their relatives, have been poisoned should seek medical advice from their GPs or attend their local hospital.

Toxbase The National Poisons Information Service provides a primary clinical toxicology database on the Internet: www.spib.axl.co.uk. This website provides information about routine diagnosis, treatment and management of people exposed to drugs, household products and industrial and agricultural products.

(See also APPENDIX 1: BASIC FIRST AID.)... poisons

A drug that has an antiseptic and astringent effect; and is useful in the treatment of dermatitis.

It can occasionally cause irritation and can stain skin and clothing.... potassium permanganate

The sudden, unexpected death of an infant that cannot be explained.

Possible risk factors include: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low birth weight; and poor socioeconomic background.

Preventive measures include: ensuring that the baby sleeps on its back at the foot of the cot; regulating the baby’s temperature (using the same amount of clothing and blankets that an adult would need); and stopping smoking.... sudden infant death syndrome

So-called because of the characteristic temperature chart showing recurring bouts of fever, this is an infectious disease caused by SPIROCHAETE. There are two main forms of the disease.

Louse-borne relapsing fever is an EPIDEMIC disease, usually associated with wars and famines, which has occurred in practically every country in the world. For long confused with TYPHUS FEVER and typhoid fever (see ENTERIC FEVER), it was not until the 1870s that the causal organism was described by Obermeier. It is now known as the Borrelia recurrentis, a motile spiral organism 10–20 micrometres in length. The organism is transmitted from person to person by the louse, Pediculus humanus.

Symptoms The incubation period is up to 12 days (but usually seven). The onset is sudden, with high temperature, generalised aches and pains, and nose-bleeding. In about half of cases, a rash appears at an early stage, beginning in the neck and spreading down over the trunk and arms. JAUNDICE may occur; and both the LIVER and the SPLEEN are enlarged. The temperature subsides after ?ve or six days, to rise again in about a week. There may be up to four such relapses (see the introductory paragraph above).

Treatment Preventive measures are the same as those for typhus. Rest in bed is essential, as are good nursing and a light, nourishing diet. There is usually a quick response to PENICILLIN; the TETRACYCLINES and CHLORAMPHENICOL are also e?ective. Following such treatment the incidence of relapse is about 15 per cent. The mortality rate is low, except in a starved population.

Tick-borne relapsing fever is an ENDEMIC disease which occurs in most tropical and sub-tropical countries. The causative organism is Borrelia duttoni, which is transmitted by a tick, Ornithodorus moubata. David Livingstone suggested that it was a tick-borne disease, but it was not until 1905 that Dutton and Todd produced the de?nitive evidence.

Symptoms The main di?erences from the louse-borne disease are: (a) the incubation period is usually shorter, 3–6 days (but may be as short as two days or as long as 12); (b) the febrile period is usually shorter, and the afebrile periods are more variable in duration, sometimes only lasting for a day or two; (c) relapses are much more numerous.

Treatment Preventive measures are more di?cult to carry out than in the case of the louse-borne infection. Protective clothing should always be worn in ‘tick country’, and old, heavily infected houses should be destroyed. Curative treatment is the same as for the louse-borne infection.... relapsing fever

This is due to prolonged exposure of the feet to water – particularly cold water. Trench warfare is a common precipitating factor, and the condition was rampant during World War I. Cases also occurred during World War II and during the Falklands campaign. (The less common form, due to warm-water immersion, occurred with some frequency in the Vietnam war.) It is characterised by painful swelling of the feet accompanied in due course by blistering and ulceration which, in severe, untreated cases, may progress to GANGRENE. In mild cases recovery may be complete in a month, but severe cases may drag on for a year. (See also IMMERSION FOOT.)

Treatment Drying of the feet overnight, where practicable, is the best method of prevention, accompanied by avoidance of constrictive clothing and tight boots, and of prolonged immobility. Frequent rest periods and daily changing of socks also help. The application of silicone grease once a day is another useful preventive measure. In the early stages, treatment consists of rest in bed and warmth; in more severe cases treatment is as for infected tissues and ulceration. ANALGESICS are usually necessary to ease the pain. Technically, smoking should be forbidden, but the adverse psychological effects of this in troops on active service may outweigh its advantages.... trench foot

Juglans species

Description: Walnuts grow on very large trees, often reaching 18 meters tall. The divided leaves characterize all walnut spades. The walnut itself has a thick outer husk that must be removed to reach the hard inner shell of the nut.

Habitat and Distribution: The English walnut, in the wild state, is found from southeastern Europe across Asia to China and is abundant in the Himalayas. Several other species of walnut are found in China and Japan. The black walnut is common in the eastern United States.

Edible Parts: The nut kernel ripens in the autumn. You get the walnut meat by cracking the shell. Walnut meats are highly nutritious because of their protein and oil content.

Other Uses: You can boil walnuts and use the juice as an antifungal agent. The husks of “green” walnuts produce a dark brown dye for clothing or camouflage. Crush the husks of “green” black walnuts and sprinkle them into sluggish water or ponds for use as fish poison.... walnut

Also called cross-dressing, a persistent desire by a man to dress in women’s clothing.... transvestism

the administration of insulin by continuous infusion into the subcutaneous tissue via a small pump worn under the clothing and connected to the skin by a tube and a fine needle. The insulin is delivered at a precalculated background rate, but patient-activated *boluses can be administered at meal times. This method is particularly appropriate (as an alternative to regular injections) for patients with repeated or unpredictable episodes of hypoglycaemia.... continuous subcutaneous insulin infusion

n. the process of eliminating infective microorganisms from contaminated instruments, clothing, or surroundings by using physical means or chemicals (*disinfectants).... disinfection

n. the use of gases or vapours to bring about *disinfestation of clothing, buildings, etc. Sulphur dioxide, formaldehyde, and chlorine are common fumigating agents.... fumigation

n. (pl. lice) a small wingless insect that is an external parasite of humans. Lice attach themselves to hair and clothing using their well-developed legs and claws. Their flattened leathery bodies are resistant to crushing and their mouthparts are adapted for sucking blood. Lice thrive in overcrowded and unhygienic conditions; they can infest humans (see pediculosis) and they may transmit disease. See also Pediculus; Phthirus.... louse

An infective disease of worldwide distribution, the manifestations of which vary in di?erent localities. The causative organisms of all forms of typhus fever belong to the genus RICKETTSIA. These are organisms which are intermediate between bacteria and viruses in their properties, and measure 0·5 micrometre or less in diameter.

Louse typhus, in which the infecting rickettsia is transmitted by the louse, is of worldwide distribution. More human deaths have been attributed to the louse via typhus, louse-borne RELAPSING FEVER and trench fever, than to any other insect with the exception of the MALARIA mosquito. Louse typhus includes epidemic typhus, Brill’s disease – which is a recrudescent form of epidemic typhus – and TRENCH FEVER.

Epidemic typhus fever, also known as exanthematic typhus, classical typhus, and louse-borne typhus, is an acute infection of abrupt onset which, in the absence of treatment, persists for 14 days. It is of worldwide distribution, but is largely con?ned today to parts of Africa. The causative organism is the Rickettsia prowazeki, so-called after Ricketts and Prowazek, two brilliant investigators of typhus, both of whom died of the disease. It is transmitted by the human louse, Pediculus humanus. The rickettsiae can survive in the dried faeces of lice for 60 days, and these infected faeces are probably the main source of human infection.

Symptoms The incubation period is usually 10–14 days. The onset is preceded by headache, pain in the back and limbs and rigors. On the third day the temperature rises, the headache worsens, and the patient is drowsy or delirious. Subsequently a characteristic rash appears on the abdomen and inner aspect of the arms, to spread over the chest, back and trunk. Death may occur from SEPTICAEMIA, heart or kidney failure, or PNEUMONIA about the 14th day. In those who recover, the temperature falls by CRISIS at about this time. The death rate is variable, ranging from nearly 100 per cent in epidemics among debilitated refugees to about 10 per cent.

Murine typhus fever, also known as ?ea typhus, is worldwide in its distribution and is found wherever individuals are crowded together in insanitary, rat-infested areas (hence the old names of jail-fever and ship typhus). The causative organism, Rickettsia mooseri, which is closely related to R. prowazeki, is transmitted to humans by the rat-?ea, Xenopsyalla cheopis. The rat is the main reservoir of infection; once humans are infected, the human louse may act as a transmitter of the rickettsia from person to person. This explains how the disease may become epidemic under insanitary, crowded conditions. As a rule, however, the disease is only acquired when humans come into close contact with infected rats.

Symptoms These are similar to those of louse-borne typhus, but the disease is usually milder, and the mortality rate is very low (about 1·5 per cent).

Tick typhus, in which the infecting rickettsia is transmitted by ticks, occurs in various parts of the world. The three best-known conditions in this group are ROCKY MOUNTAIN SPOTTED FEVER, ?èvre boutonneuse and tick-bite fever.

Mite typhus, in which the infecting rickettsia is transmitted by mites, includes scrub typhus, or tsutsugamushi disease, and rickettsialpox.

Rickettsialpox is a mild disease caused by Rickettsia akari, which is transmitted to humans from infected mice by the common mouse mite, Allodermanyssus sanguineus. It occurs in the United States, West and South Africa and the former Soviet Union.

Treatment The general principles of treatment are the same in all forms of typhus. PROPHYLAXIS consists of either avoidance or destruction of the vector. In the case of louse typhus and ?ea typhus, the outlook has been revolutionised by the introduction of e?cient insecticides such as DICHLORODIPHENYL TRICHLOROETHANE (DDT) and GAMMEXANE.

The value of the former was well shown by its use after World War II: this resulted in almost complete freedom from the epidemics of typhus which ravaged Eastern Europe after World War I, being responsible for 30 million cases with a mortality of 10 per cent. Now only 10,000–20,000 cases occur a year, with around a few hundred deaths. E?cient rat control is another measure which reduces the risk of typhus very considerably. In areas such as Malaysia, where the mites are infected from a wide variety of rodents scattered over large areas, the wearing of protective clothing is the most practical method of prophylaxis. CURATIVE TREATMENT was revolutionised by the introduction of CHLORAMPHENICOL and the TETRACYCLINES. These antibiotics altered the prognosis in typhus fever very considerably.... typhus fever

A wound is any breach suddenly produced in the tissues of the body by direct violence. An extensive injury of the deeper parts without corresponding injury of the surface is known as a bruise or contusion.

Varieties These are classi?ed according to the immediate e?ect produced: INCISED WOUNDS are usually in?icted with some sharp instrument, and are clean cuts, in which the tissues are simply divided without any damage to surrounding parts. The bleeding from such a wound is apt to be very free, but can be readily controlled. PUNCTURE WOUNDS, or stabs, are in?icted with a pointed instrument. These wounds are dangerous, partly because their depth involves the danger of wounding vital organs; partly because bleeding from a stab is hard to control; and partly because they are di?cult to sterilise. The wound produced by the nickel-nosed bullet is a puncture, much less severe than the ugly lacerated wound caused by an expanding bullet, or by a ricochet, and, if no clothing has been carried in by the bullet, the wound is clean and usually heals at once. LACERATED WOUNDS are those in which tissues are torn, such as injuries caused by machinery.

Little bleeding may occur and a limb can be torn completely away without great loss of blood. Such wounds are, however, especially liable to infection. CONTUSED WOUNDS are those accompanied by much bruising of surrounding parts, as in the case of a blow from a cudgel or poker. There is little bleeding, but healing is slow on account of damage to the edges of the wound. Any of these varieties may become infected.

First-aid treatment The ?rst aim is to check any bleeding. This may be done by pressure upon the edges of the wound with a clean handkerchief, or, if the bleeding is serious, by putting the ?nger in the wound and pressing it upon the spot from which the blood is coming.

If medical attention is available within a few hours, a wound should not be interfered with further than is necessary to stop the bleeding and to cover it with a clean dry handkerchief or bandage. When expert assistance is not soon obtainable, the wound should be cleaned with an antiseptic such as CHLORHEXIDINE or boiled water and the injured part ?xed so that movement is prevented or minimised. A wounded hand or arm is ?xed with a SLING, a wounded leg with a splint (see SPLINTS). If the victim is in SHOCK, he or she must be treated for that. (See also APPENDIX 1: BASIC FIRST AID.)... wounds

Charts relating height to age have been devised, and give an indication of the normal rate of growth. (See APPENDIX 6: MEASUREMENTS IN MEDICINE for more details.) The wide variation in normal children is immediately apparent on studying such charts. Deviations from the mean of this wide range are called percentiles. Centile or percentile charts describe the distribution of a characteristic in a population. They are obtained by measuring a speci?c characteristic in a large population of at least 1,000 of each sex at each age. For each age there will be a height, above and below which 50 per cent of the population lies: this is called the 50th centile. The 50th centile thus indicates the mean height at a particular age. Such tables are less reliable around the age of PUBERTY, because of variation in age of onset.

Minor variations from the mean do not warrant investigation, but if the height of an individual falls below the third centile (3 per cent of normal children have a height that falls below the third centile) or above the 97th centile, investigation is required. Changes in the rate of growth are also important, and skeletal proportions may provide useful information. There are many children who are normal but who are small in relation to their parents; the problem is merely growth delay. These children take longer to reach maturity and there is also a proportional delay in their skeletal maturation – so that the actual height must always be assessed in relation to maturity. The change in skeletal proportions is one manifestation of maturity, but other features include the maturing of facial features with the growth of nose and jaw, and dental development. Maturity of bone can readily be measured by the radiological bone age.

Failure to gain weight is of more signi?cance. Whilst this may be due to some underlying disease, the most common cause is a diet containing inadequate calories (see CALORIE). Over the last six decades or so there has been quite a striking increase in the heights and weights of European children, with manufacturers of children’s clothing, shoes and furniture having to increase the size of their products. Growth is now completed at 20–21 years, compared with 25 at the turn of the century. It has been suggested that this increase, and earlier maturation, have been due to a combination of genetic mixing as a result of population movements, with the whole range of improvement in environmental hygiene – and not merely to better nutrition.

In the case of adults, views have changed in recent years concerning ‘ideal’ weight. Life-insurance statistics have shown that maximal life expectancy is obtained if the average weight at 25–30 years is maintained throughout the rest of life. These insurance statistics also suggest that it is of advantage to be slightly over the average weight before the age of 30 years; to be of average weight after the age of 40; and to be underweight from ages 30–40. In the past it has been usual, in assessing the signi?cance of an adult’s weight, to allow a 10 per cent range on either side of normal for variations in body-build. A closer correlation has been found between thoracic and abdominal measurements and weight.... weight and height

n. the egg of a *louse. The eggs of head lice are firmly cemented to the hair, usually at the back of the head; those of body lice are fixed to the clothing. Nits, 0.8 × 0.3 mm, are visible as light white specks.... nit

n. a widely distributed genus of lice. The crab (or pubic) louse, P. pubis, is a common parasite of humans that lives permanently attached to the body hair, particularly that of the pubic or perianal regions but also on the eyelashes and the hairs in the armpits. Crab lice are not known to transmit disease but their bites can irritate the skin (see pediculosis). An infestation may be acquired during sexual intercourse or from hairs left on clothing, towels, and lavatory seats.... phthirus

n. a genus of widely distributed mites – the harvest mites. The six-legged parasitic larvae (chiggers) are common in fields during the autumn and frequently attack humans, remaining attached to the skin for several days while feeding on the lymph and digested skin tissues. Their bite causes intense irritation and a severe dermatitis. Various repellents, e.g. benzyl benzoate, can be applied to clothing. Trombicula larvae transmit scrub typhus in southeast Asia.... trombicula

n. a device for applying pressure to a hernia to prevent it from protruding. It usually consists of a pad attached to a belt with straps or spring strips and it is worn under the clothing.... truss

a large non-bloodsucking fly, Cordylobia anthropophaga, widely distributed in tropical Africa. The female fly lays its eggs on ground contaminated with urine or excreta or on clothing tainted with sweat or urine. The maggots are normally parasites of rats, but if they come into contact with humans they penetrate the skin, producing boil-like swellings (see also myiasis). The maggots can be gently eased out by applying oil to the swellings.... tumbu fly

Chronic glomerulonephritis. The final stage. May follow the sub- acute stage or repeated attacks of the acute stage. Kidneys small and white due to scar tissue. Amount of urine passed is considerably increased, pale and low specific gravity. Kidneys ‘leak’ protein in large quantities of water passed, their efficiency as filters greatly impaired. Tissues of eyelids and ankles waterlogged. Symptoms include loin pain, anaemia, loss of weight, progressive kidney damage.

A constant fear is the onset of uraemia caused by accumulation in the blood of waste by-products of protein digestion, therefore the patient should reject meat in favour of fish. Eggs and dairy products taken in strict moderation.

Where urea accumulates in the circulation ‘sustaining’ diuretics are indicated; these favour excretion of solids without forcing the discharge of more urine: including Shepherd’s Purse, Gravel root, or Uva Ursi when an astringent diuretic is needed for a show of blood in the urine. According to the case, other agents in common practice: Dandelion root, Yarrow, Hawthorn, Marigold, Stone root, Hydrangea. Parsley Piert, Buchu, Hawthorn, Golden Rod.

The patient will feel the cold intensely and always be tired. Warm clothing and ample rest are essential. Heart symptoms require treatment with Lily of the Valley or Broom.

This condition should be treated by or in liaison with a qualified medical practitioner.

Treatment. As kidney damage would be established, treatment would be palliative; efforts being to relieve strain and obtain maximum efficiency. There may be days of total bed-rest, raw foods and quiet. Consumption of fluids may not be as abundant as formerly. Soothing herb teas promote well-being and facilitate elimination. Oil of Juniper is avoided.

Efforts should be made to promote a rapid absorption – to restore the balance between the circulation and the lymphatics. For this purpose Mullein is effective. A few grains of Cayenne or drops of Tincture Capsicum enhances action.

Indicated. Antimicrobials, urinary antiseptics, diuretics, anti-hypertensives. For septic conditions add Echinacea.

Of Therapeutic Value. Alfalfa, Broom, Buchu, Couchgrass, Cornsilk, Dandelion, Lime flowers, Marigold, Mullein, Marshmallow, Parsley Piert, Periwinkle (major), Wild Carrot, Water Melon seed tea. Tea. Combine equal parts: Couchgrass, Dandelion, Mullein. 2 teaspoons to each cup boiling water. Infuse 5-15 minutes. 1 cup freely.

Powders. Combine equal parts: Stone root, Hydrangea, Hawthorn. Dose: 500mg (two 00 capsules or one-third teaspoon) 3 or more times daily in water or cup Cornsilk tea. A few grains Cayenne enhances action. Formula. Buchu 2; Mullein 2; Echinacea 1; Senna leaves half. Mix. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or cup Cornsilk tea 3 or more times daily. 2-3 drops Tincture Capsicum to each dose enhances action.

Diffusive stimulant for the lymphatic vessels. Onion milk is an effective potassium-conserving diuretic and diaphoretic. Onions are simmered gently in milk for 2 hours and drunk when thirsty or as desired – a welcome alternative to water. May be eaten uncooked.

Diet. Salt-free, low fat, high protein. Spring water. Raw goat’s milk, potassium broth. Fish oils. Avoid eggs and dairy products. No alcohol.

Supplements. Vitamins A, B-complex, C plus bioflavonoids, B6, D, E, Magnesium, Lecithin. Herbal treatment offers a supportive role. ... bright’s disease (chronic)

Scalds are caused by moist heat and burns by dry heat but their treatment is the same. There are six degrees of burns; anything beyond the first degree (skin not broken) and second degree (blisters and broken skin) should receive hospital treatment.

All burns are serious. Vulnerary herbs are available to promote healing and cell growth, including: Aloe Vera, Comfrey, Fenugreek, Marigold, Marshmallow, Slippery Elm, Chickweed, Myrrh (powder).

Even hospital authorities may find these effective, enhancing healing, reducing risk of infection, and often concluding with a minimum of scar tissue. Echinacea – to mobilise the immune system.

Exclude air from affected parts as soon as possible. Remove no clothing adhering to wound; cut round. For corrosive alkalis: bathe with cider vinegar (2-4 teaspoons to teacup water). Follow with honey: apply lint and bandage. Honey has a long traditional reputation for burns. The following are analgesic and antiseptic, keeping wounds clean and free from pus. Apply sterile dressings.

Tea for internal use: Nettles 1; Valerian 1; Comfrey leaf 2. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup every 2 hours. Or, cup of ordinary tea laced with 2-3 drops Life Drops.

Topical. (1) Tea Tree oil: 1 part to 20 parts Almond oil. (2) Strong Nettle tea – pain killer. (3) St John’s Wort oil. (4) Aloe Vera – cut off piece of leaf and pulp; or, gel. (5) Slippery Elm – Powder mixed with little milk to form a paste. (6) Pierce Vitamin E capsule and anoint area. (7) Distilled extract of Witch Hazel. (8) Cod liver oil.

Compress. Apply piece of suitable material steeped in teas of any of the following: Chamomile, Chickweed, Comfrey, Cucumber, Elderflowers, Marigold, Plantain, St John’s Wort.

Alcohol should not be taken.

Supplementation. Vitamins A, B-complex, C, D, E. Potassium. Zinc. ... burns & scalds

Seizure, fit. Muscular spasms with alternate contraction and relaxation of muscles arising from brain disturbance. Epilepsy. Occurs when serum calcium, serum magnesium, or blood sugar is low. Feverish conditions are responsible for most convulsions in children. This is where herbal anti- febrile agents are helpful: Chamomile, Peppermint, Catnep, etc. Many parents unwittingly help to provoke a febrile convulsion.

Treatment would depend on diagnosis which may be one of a number of conditions: alcoholism, toxic drugs, meningitis, epilepsy, diabetic coma, dentition, expanding brain tumour, excessive crying or coughing – as in whooping cough, bowel irritation, emotional upset.

Symptoms. Aura, crying out, heavy breathing, loss of consciousness, rigidity, incontinence of urine and faeces.

Treatment. Cause the body to lose heat. For insulin coma give glucose, honey, or something sweet. Remove tight clothing. If the case is a child, lay on its side; sponge with cold water. If available, insert Valerian or other relaxant herb suppository. Catnep tea enema brings relief (Dr J. Christopherson).

Teas. Any one: German Chamomile, Hops, Lobelia, Motherwort, Passion flower, Skullcap, Wood Betony.

Decoctions. Any one: Cramp bark, Black Cohosh, Blue Cohosh, Skunk Cabbage, Valerian, Lady’s Slipper.

Tinctures. Any one: Cramp bark, Black Cohosh, Blue Cohosh, Lobelia, Valerian, Wild Yam, Lady’s Slipper. OR: Formula – Equal parts: Black Cohosh, Blue Cohosh, Valerian. Dose: 1 teaspoon in hot water, every half hour.

Camphor, Tincture or spirits of: 2-5 drops in honey or bread bolus offers a rapid emergency measure for adults. Inhalant also.

Peppermint, Oil. 1-2 drops in honey or milk.

Practitioner. Tincture Gelsemium BPC 1983. Dose: 0.3ml in water.

Supplements, for prevention: Calcium lactate 300mg 6 daily. Magnesium. Vitamin B6. ... convulsions

 Redness and possible blistering caused by a sensitive substance such as chromium, nickel, other metals, rubber, paints, cosmetic materials, plants (primula), house dust mites, aerosols, deodorants, photocopying, dyes in clothing, etc. A patch test establishes diagnosis. A suspected irritant is applied to the skin and after two days its reaction is noted. If inflammation is present the test is positive. Symptoms may include vesicles with weeping, scaling, and presence of dropsy.

In a study of 612 patients attending the Royal Hallamshire Hospital, Sheffield, more than half of the women who had ears pierced reported skin reactions to metallic jewellery, while a third had sensitivity to nickel. (British Journal of Dermatology, Jan 1992)

Treatment. Remove article or cause of irritation. Garlic is claimed to be successful, either in diet or by capsule when the condition is caused by histamines. Other agents: Betony, Burdock leaves, Chickweed, Dandelion, Figwort, Gotu Kola, Plantain, Red Clover.

Internal. Burdock tea. Clivers tea.

Tablets/capsules. Garlic, Devil’s Claw, Blue Flag.

Topical. Avoid use of Calamine, if possible. Creams or salves: Aloe Vera, Comfrey, Evening Primrose, Witch Hazel, Jojoba. All are alternatives to corticosteroids.

Tamus (Black Bryony) tincture. Distilled extract of Witch Hazel. ... dermatitis, contact

Cardiac or vasomotor syncope. A temporary arrest of flow of blood through the brain leading to loss of consciousness. (a) Due to slowing of the heart beat by temporary emotional experience, pain, low blood pressure, blood loss, fluid loss, drug effects. (b) Heart-shock, heart-block or sudden distress.

In the elderly fainting can be associated with adverse drug reactions.

Symptoms. Dilated pupils, pallor, sweating, yawning.

Treatment. Towards recovery: cup of Chamomile tea. Life Drops in tea. Elevation of legs to restore circulation.

Topical. Whiff of Camphor or oil of Rosemary to the nose. Smelling salts. Sponge-down with Cider Vinegar (1) and water (20). Wipe face with Witch Hazel, distilled extract.

General. Remove tight clothing about the neck. Dash water in face. Recovery in ‘heart-cases’ should be followed by investigation in a cardiac care unit. ... fainting

A burning sensation in the gullet, as felt behind the breastbone, caused by a laxity of the oesophago-gastric sphincter, with acid rising from the stomach. May be due to bending, tight clothing, hiatus hernia, acid dyspepsia or gastritis. Bitter acid taste in the mouth.

Alternatives. Most antacids relieve heartburn and gastric reflux in conditions such as acid dyspepsia, gastritis and hiatus hernia. Teas selected from Barberry, Black Horehound, Centuary, (Dr A. Vogel) Dandelion, Chamomile tea. (Charles Wesley) Marshmallow, Meadowsweet.

To give mucosal protection: Irish Moss, Iceland Moss, Slippery Elm. St John’s Wort. (Dr A. Vogel) Powders. Alternatives. (1) Meadowsweet 2; Galangal 1. (2) Equal parts: Dandelion root, Fennel. Doses: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Alternatives. (1) Dandelion 1; Meadowsweet 2; Liquorice root half. (2) Meadowsweet 2; Black Horehound 1. Liquorice half. Dose: One 5ml teaspoon in water thrice daily before meals. Tablets/capsules. Sarsaparilla, St John’s Wort. Meadowsweet. Iceland Moss. Slippery Elm.

Aloe Vera juice. 1-2 tablespoons juice from crushed leaves.

Nervous stomach. German Chamomile tea.

From alcohol and tobacco habit. Liquid Extract Stone root: 15-60 drops, (or Tincture BPC (1934) 30- 120 drops) in water thrice daily.

For heartburn of pregnancy – see PREGNANCY. Diet. Dandelion coffee. See: THE HAY DIET.

Avoid bending and stooping, eat small regular meals. Avoid hot spicy foods.

Avoid wearing tight clothing, cut out smoking. If suffering is at night, prop up head end of mattress by 4-6”. ... heartburn

A mild form of neurosis which cannot be defined as mental illness. Often related to an individual’s personality and which may manifest as physical illness. Children may demand attention and display exaggerated behaviour. Sometimes a person may have ‘hysterics’, usually in the presence of others. Unresolved sexual tension may predispose (Agnus Castus).

Symptoms. May be many and varied; acute outbreaks of temper tantrums (Valerian); episodes of self-pity, paranoia; apparent paralysis; preparing for examinations. Subjects may be in constant need of reassurance. May be associated with loss of speech, muscle weakness, migraine, backache, ‘pain-in-the- neck’. Painful menses (Raspberry leaves, Motherwort).

Alternatives. General practice: Asafoetida, Betony, Cowslip, Hyssop, Lime flowers, Passion flower, Pulsatilla, Rosemary, Skullcap, Valerian, Vervain BHP (1983). Blue Cohosh, Oats, Ladies Slipper, Mistletoe. (Priest)

Combination: Blue Cohosh, Squaw Vine, Wild Yam. (Priest)

Tea: Mix, equal parts: Betony, Skullcap, Lime flowers. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup freely.

Traditional. Equal parts, Skullcap, Valerian and Mistletoe. Mix. 1-2 teaspoons to each cup water. Bring to boil; remove vessel when boiling point is reached. Half-1 cup thrice daily.

Formula. Black Cohosh 2; Liquorice 1; Asafoetida quarter. Doses: Powders: 375mg (quarter of a teaspoon). Liquid Extracts: 15-30 drops. Tinctures: 30-60 drops. In water or honey, thrice daily. Antispasmodic Drops.

Serious cases: Lobelia tea enema.

Practitioner: Liquid Extract Gelsemium, 1-3 drops, in water, when necessary.

Local. Hot foot bath. Cold water to head. Loosen tight clothing. Divert blood from the brain. Electric blanket. ... hysteria

Shallow of carcinoma ulcer the skin pigment melanin. The risk is reduced by avoiding overexposure to strong sunlight, using sunscreens, and wearing protective clothing and sun hats. Without treatment, the carcinoma gradually invades and destroys surrounding tissues but virtually never spreads to other parts of the body. Treatment is usually with surgery (or in some cases radiotherapy) and is often completely successful. Plastic surgery may also be needed, however, depending on the size and site of the tumour. People who have had a basal cell carcinoma may develop new tumours and should be alert to any changes in their skin. (See also melanoma, malignant; squamous cell carcinoma; sunlight, adverse effects of.)... raised edge

A group of tropical diseases, caused by various parasitic worms or their larvae, which are transmitted to humans by insect bites.

Some species of worm live in the lymphatic vessels. Swollen lymph nodes and recurring fever are early symptoms. Inflammation of lymph vessels results in localized oedema. Following repeated infections, the affected area, commonly a limb or the scrotum, becomes very enlarged and the skin becomes thick, coarse, and fissured, leading to a condition known as elephantiasis. The larvae of another type of worm invade the eye, causing blindness (see onchocerciasis). A third type, which may sometimes be seen and felt moving beneath the skin, causes loiasis, characterized by irritating and sometimes painful areas of oedema called calabar swellings.

The diagnosis of filariasis is confirmed by microscopic examination of the blood. The anthelmintic drugs diethylcarbamazine or ivermectin most often cure the infection but may cause side effects such as fever, sickness, muscle pains, and increased itching. Diethylcarbamazine can be given preventively, and the use of insecticides and protective clothing help to protect against insect bites. (See also roundworms; insects and disease.)... filariasis

A life-threatening condition in which overexposure to heat coupled with a breakdown of the body’s heatregulating mechanisms cause the body to become dangerously overheated.

Heatstroke is most commonly caused by prolonged, unaccustomed exposure to the sun in a hot climate. Strenuous activity, unsuitable clothing, overeating, and drinking too much alcohol are sometimes contributory factors.

Heatstroke is often preceded by heat exhaustion, which consists of fatigue and profuse sweating. With the onset of heatstroke, the sweating diminishes and may stop entirely. The skin becomes hot and dry, breathing is shallow, and the pulse is rapid and weak. Body temperature rises dramatically and, without treatment, the victim may lose consciousness and even die.

Heatstroke can be prevented by gradual acclimatization to hot conditions (see heat disorders). If heatstroke develops, emergency treatment is required. This consists of cooling the victim by wrapping him or her in a cold, wet sheet, fanning, sponging with water, and giving salt solution.... heatstroke

Relatively few insect species cause disease directly in humans. Some parasitize humans, living under the skin or on the body surface (see lice; chigoe; myiasis). The most troublesome insects are flies and biting insects. Flies can carry disease organisms from human or animal excrement via their feet or legs and contaminate food or wounds.

A number of serious diseases are spread by biting insects.

These include malaria and filariasis (transmitted by mosquitoes), sleeping sickness (tsetse flies), leishmaniasis (sandflies), epidemic typhus (lice), and plague (rat fleas).

Mosquitoes, sandflies, and ticks can also spread illnesses such as yellow fever, dengue, Lyme disease, and some types of viral encephalitis.

Organisms picked up when an insect ingests blood from an infected animal or person are able to survive or multiply in the insect.

Later, the organisms are either injected into a new human host via the insect’s saliva or deposited in the faeces at or near the site of the bite.

Most insect-borne diseases are confined to the tropics and subtropics, although tick-borne Lyme disease occurs in some parts of the.

The avoidance of insect-borne disease is largely a matter of keeping flies off food, discouraging insect bites by the use of suitable clothing and insect repellents, and, in parts of the world where malaria is present, the use of mosquito nets and screens, pesticides, and antimalarial tablets.... insects and disease

Nursing procedures (also called barrier nursing) designed to prevent a patient from infecting others or from being infected. The patient is usually isolated in a single room.

Complete isolation is used if a patient has a contagious disease, such as Lassa fever, that can be transmitted to others by direct contact and airborne germs. In this case, all bedding, equipment and clothing are either sterilized or incinerated after use. Partial isolation is carried out if the disease is transmitted in a more limited way (by droplet spread, as in tuberculosis, for example).

Reverse isolation, also called reverse barrier nursing, is used to protect a patient whose resistance to infection is severely lowered by a disease or treatment such as chemotherapy.

The air supply to the room is filtered.

All staff and visitors wear caps, gowns, masks, and gloves.

Occasionally, long-term reverse isolation is needed for patients with severe combined immunodeficiency (see immunodeficiency disorders).... isolation

Soreness of the nipple caused by clothing rubbing against it, usually during sports such as jogging or long-distance running. Both men and women can be affected. Prevention is by applying petroleum jelly to the nipple before prolonged running.

joint The junction between 2 or more bones. Many joints are highly mobile, while others are fixed or allow only a small amount of movement.

Joints in the skull are fixed joints firmly secured by fibrous tissue. The bone surfaces of mobile joints are coated with smooth cartilage to reduce friction. The joint is sealed within a tough fibrous capsule lined with synovial membrane (see synovium), which produces a lubricating fluid. Each joint is surrounded by strong ligaments that support it and prevent excessive movement. Movement is controlled by muscles that are attached to bone by tendons on either side of the joint. Most mobile joints have at least one bursa nearby, which cushions a pressure point.

There are several types of mobile joint. The hinge joint is the simplest, allowing bending and straightening, as in the fingers. The knee and elbow joints are modified hinge joints that allow some rotation as well. Pivot joints, such as the joint between the 1st and 2nd vertebrae (see vertebra), allow rotation only. Ellipsoidal joints, such as the wrist, allow all types of movement except pivotal. Ball-and-socket joints include the hip and shoulder joints. These allow the widest range of movement (backwards or forwards, sideways, and rotation).

Common joint injuries include sprains, damage to the cartilage, torn ligaments, and tearing of the joint capsule.

Joint dislocation is usually caused by injury but is occasionally congenital.

A less severe injury may cause subluxation (partial dislocation).

Rarely, the bone ends are fractured, which may cause bleeding into the joint (haemarthrosis) or effusion (build-up of fluid in a joint) due to synovitis (inflammation of the joint lining).

Joints are commonly affected by arthritis.

Bursitis may occur as a result of local irritation or strain.... jogger’s nipple

Small, wingless insects that feed on human blood. There are 3 species:PEDICULUS HUMANUS CAPITIS (the head louse), PEDICULUS HUMANUS CORPORIS (the body louse), and PHTHIRUS PUBIS (the crab, or pubic, louse). All have flattened bodies and measure up to 3 mm across.

Head lice live on the scalp and their bite causes intense itching.

They are spread by direct contact.

Their tiny eggs (nits) attach to hairs close to the scalp.

Body lice live and lay eggs on clothing next to the skin.

They can transmit epidemic typhus and relapsing fever.

Crab lice live in pubic hair or, more rarely, in armpits, beards, or eyelashes; they are usually transmitted during sexual contact (see pubic lice).

Various preparations can be applied to kill lice and eggs.... lice

An infestation by fly larvae, which is primarily restricted to tropical areas. In Africa, the tumbu fly lays eggs on wet clothing left outside; the larvae hatch and penetrate the skin to cause boil-like swellings. Other flies may lay eggs in open wounds, on the skin, or in the ears or nose. Sometimes, larvae penetrate deeply into the tissues. Intestinal infestation can occur after eating contaminated food. Preventative measures include keeping flies away from food, covering open wounds, and ironing clothes that have been dried outdoors.

Myiasis of the skin is treated by placing drops of oil over the swelling. The larva comes to the surface, where it can be removed with a needle. In deeper tissues, surgery may be needed. Intestinal myiasis is treated with a laxative. myo- A prefix denoting a relationship to muscle (as in myocarditis).... myiasis

Highly poisonous agricultural insecticides that are harmful when absorbed through the skin, by inhalation, or by swallowing. Among the many possible symptoms are nausea, vomiting, abdominal cramps, diarrhoea, blurred vision, excessive sweating, headache, confusion, and twitching. Severe poisoning may cause breathing difficulty, palpitations, seizures, and unconsciousness. If left untreated, death may result.

Treatment may include washing out the stomach (see lavage, gastric) or removing soiled clothing and washing contaminated skin.

Injections of atropine may be given, and oxygen therapy and/or artificial ventilation may be needed.

With rapid treatment, people may survive doses that would otherwise have been fatal.

Long term effects of organophosphates in sheep dips are thought to be responsible for debilitating illness with neural, muscular, and mental symptoms.... organophosphates

n. an inflammatory condition of the skin caused by outside agents (compare eczema, an endogenous disease in which such agents do not play a primary role, although some use the two terms interchangeably). Irritant contact dermatitis may occur in anyone who has sufficient contact with such irritants as acids, alkalis, solvents, and (especially) detergents. It is the commonest cause of occupational dermatitis in hairdressers, nurses, cooks, etc. (See also napkin rash.) In allergic contact dermatitis skin changes resembling those of eczema develop as a delayed (type IV) reaction to a particular allergen, which may be present at low concentrations. Common examples include nickel dermatitis (from costume jewellery, clothing fasteners, zips, etc.) and fragrance allergy (from toiletries, deodorants, perfumes, etc.). Treatment of dermatitis depends on identifying the allergen by *patch testing and removing the cause, which is not always possible.

Dermatitis herpetiformis is an uncommon very itchy rash with symmetrical blistering, especially on the knees, elbows, buttocks, and shoulders. It is associated with *gluten sensitivity and responds well to treatment with dapsone or a gluten-free diet.... dermatitis

n. a skin infection caused by the mite *Sarcoptes scabiei. Scabies is typified by severe itching (particularly at night), red papules, and often secondary infection. The female mite invades the skin to lay her eggs and the newly hatched mites pass from person to person by close prolonged contact. The intense itching represents a true allergic reaction to the mite, its eggs, and its faeces. Commonly infected areas are the penis, nipples, and the finger webs. Treatment is by application of a scabicide, usually *permethrin or *malathion, to all areas of the body from the neck down; benzyl benzoate may be used but is more irritant. All members of a family need treatment, but clothing and bedding need not be disinfested.... scabies