Diphtheria Health Dictionary

A toxin secreted by certain bacterial species or strains into the surrounding medium during growth. Often cause clinical features very specific to the disease (eg tetanus, diphtheria, cholera). Exotoxins secreted by enteric organisms often termed ‘enterotoxins’.... exotoxin

A preparation of dead particulate or weakened bacteria or viruses prepared for injection into the body so that antibodies are formed to prevent disease (eg polio). Detoxi fied but genetically potent toxins (called toxoids) can also be used (e.g. tetanus and diphtheria)... vaccine

The genus of Gram positive bacilli including Corynebacterium diphtheriae, the cause of diphtheria in humans. Genus also includes C. minutissimum, the cause of erythrasma in humans and the diphtheroids which are commensal corynebacteria making up part of the human respiratory tract normal flora.... corynebacterium

A chemical substance that harms nervous tissue, causing symptoms of numbness or weakness of the body part supplied by the damaged NERVE. The venom of some snakes contains neurotoxic substances, and bacteria may produce neurotoxins: examples are those that cause DIPHTHERIA and TETANUS. Arsenic and lead are examples of inorganic neurotoxins.... neurotoxin

Often called the TRIPLE VACCINE, the injections produce immunity against DIPHTHERIA, whooping cough (PERTUSSIS) and TETANUS. The vaccine is given as a course of three injections to infants around the ages of two, three and four months, together with haemophilus in?uenza B and meningococcal C vaccine as well as oral polio vaccine. A booster injection is given at school entry (see schedule in IMMUNISATION).... dpt vaccine

A toxin (see TOXINS) which has been rendered non-toxic by certain chemicals, or by heat, or by being partly neutralised by antitoxin. The best-known example is DIPHTHERIA toxoid. (See also IMMUNITY.)... toxoid

Also known as tracheotomy. The operation in which the TRACHEA or windpipe is opened from the front of the neck, so that air may be directly drawn or passed into the lower AIR PASSAGES. The opening is made through the second and third rings of the trachea.

Reasons for operation The cause of laryngeal obstruction should be treated but, if obstruction is acute and endangering the patient’s life, urgent intervention is necessary. In most cases the insertion of an endotracheal tube either through the nose or mouth and down the pharynx through the larynx to bypass the obstruction is e?ective (see ENDOTRACHEAL INTUBATION). If not, tracheostomy is performed. The majority of tracheostomies performed nowadays are for patients in intensive-therapy-unit situations. These patients require airway intervention for prolonged periods to facilitate arti?cial ventilation which is performed by means of a mechanical ventilator. The presence of a tube passing through the larynx for a prolonged period of time is associated with long-term damage to the larynx, and therefore any patients requiring prolonged intubation usually undergo a tracheostomy to prevent further damage. Endotracheal intubation is also the preferred method of airway-intervention for acute in?ammatory disorders of the upper airway (as opposed to tracheostomy); tracheostomy in these cases is performed only in the emergency situation if facilities for endotracheal intubation are not available or if they are unsuccessful. Tracheostomy may also be performed for large tumours which obstruct the larynx until some form of treatment is instituted. Similarly it may be needed in conditions whereby the nerve supply to the larynx has been jeopardised, impairing its protective function of the upper airway and its respiratory function.

Tracheostomy tubes When the trachea has been opened – by an incision through the skin between the Adam’s apple and the clavicles; another through the THYROID GLAND followed by a small vertical incision in the trachea

– a metal or plastic tube is inserted to maintain the opening. There is always an outer tube which is ?xed in position by tapes passing round the neck, and an inner tube which slides freely out of and into the other, so that it may be removed at any time for cleansing, and is readily coughed-out should it happen to become blocked by mucus.

After-treatment When the operation has been performed for some permanent obstruction, the tube must be worn permanently; and the double metal tube is in such cases replaced after a short time by a soft plastic single one. When the operation has relieved some obstruction caused, say, by diphtheria, the tube is left out now and then for a few hours, and ?nally, at the end of a week or so, is removed altogether, after which the wound quickly heals up.... tracheostomy

Ailanthus tea was at first used only in Asia, but nowadays, due to its healthy properties, it is consumed worldwide. It can be a natural option in treating diarrhea or diphtheria, but not only. Ailanthus Tea description Ailanthus, or “the tree of life”, is native to Asia and has a long history, being first mentioned in ancient Chinese literature. This tree is said to be an intrusive plant, known for breaking into gardens and cracking walls in the process. It has been used as an ornamental plant, but also as an herbal remedy for a variety of ailments and diseases. Studies revealed that ailanthus bark has bitter, astringent and cooling properties. In traditional Chinese medicine, the bark is associated with the governing meridians of the large intestines, the stomach and the liver. Ailanthus tea is a beverage used mainly in Chinese traditional medicine.  It can either be made of the bark or the flowers of the plant. The bark is acknowledged to “clear heat” and stop bleeding while the flowers are considered to help in the treatment of infectious diseases. Ailanthus Tea brewing To brew Ailanthus tea:

• put the granules into a cup
• put 50-100ml boiling water into the cup and stir it with a spoon
• drink it when it is lukewarm

The dosage is for adults, one sachet each time, twice a day. For children, the dosage should be reduced according to the weight. Ailanthus Tea benefits Ailanthus tea is successfully used in treatingglandular fever. The brew has proved its efficiency in:

• treating diarrhea
• fighting malaria
• fighting asthma
• helping in the treatment of uterine bleeding or menorrhagia
• fighting scarlet fever
• fighting diphtheria
• fighting typhoid fever
• fighting palpitations, asthma and epilepsy

Ailanthus Tea side effects There have been no side effects associated with intaking Ailanthus tea. However, consumers should consult a licensed health care provider before drinking it. Ailanthus tea is benefic in treating a large array of diseases, being an important ingredient in the pharmaceutical industry.... ailanthus tea: a healing tea

Any one of various preparations that contain ANTIBODIES which combine and neutralise the effects of a particular toxin (see TOXINS) released into the bloodstream by BACTERIA. Examples are the toxins produced by DIPHTHERIA and TETANUS. Antitoxins are produced from the blood of humans or animals that have been exposed to a particular toxin – whether by INFECTION or by INOCULATION – and thus have produced antibodies against it. They are usually given by intramuscular injection.... antitoxin

Asphyxia means literally absence of pulse, but is the name given to the whole series of symptoms which follow stoppage of breathing and of the heart’s action. Drowning is one cause, but obstruction of the AIR PASSAGES may occur as the result of a foreign body or in some diseases, such as CROUP, DIPHTHERIA, swelling of the throat due to wounds or in?ammation, ASTHMA (to a partial extent), tumours in the chest (causing slow asphyxia), and the external conditions of su?ocation and strangling. Placing the head in a plastic bag results in asphyxia, and poisonous gases also cause asphyxia: for example, CARBON MONOXIDE (CO) gas, which may be given o? by a stove or charcoal brazier in a badly ventilated room, can kill people during sleep. Several gases, such as sulphurous acid (from burning sulphur), ammonia, and chlorine (from bleaching-powder), cause involuntary closure of the entrance to the larynx, and thus prevent breathing. Other gases, such as nitrous oxide (or laughing-gas), chloroform, and ether, in poisonous quantity, stop the breathing by paralysing the respiration centre in the brain.

Symptoms In most cases, death from asphyxia is due to insu?ciency of oxygen supplied to the blood. The ?rst signs are rapid pulse and gasping for breath. Next comes a rise in the blood pressure, causing throbbing in the head, with lividity or blueness of the skin, due to failure of aeration of the blood, followed by still greater struggles for breath and by general CONVULSIONS. The heart becomes overdistended and gradually weaker, a paralytic stage sets in, and all struggling and breathing slowly cease. When asphyxia is due to charcoal fumes, coal-gas, and other narcotic in?uences, there is no convulsive stage, and death ensues gently and may occur in the course of sleep.

Treatment So long as the heart continues to beat, recovery may be looked for with prompt treatment. The one essential of treatment is to get the impure blood aerated by arti?cial respiration. Besides this, the feeble circulation can be helped by various methods. (See APPENDIX 1: BASIC FIRST AID – Choking; Cardiac/respiratory arrest.)... asphyxia

Casts of hollow organs are found in various diseases. Membraneous casts of the air passages are found in diphtheria and in one form of bronchitis, and are sometimes coughed up entire. Casts of the interior of the bowels are passed in cases of mucous colitis associated with constipation, and casts of the microscopic tubules in the kidneys passed in the urine form one of the surest signs of glomerulonephritis. (See KIDNEYS, DISEASES OF.)... casts

The schedule laid down by most countries to recommend which routine immunizations should be given to children and the intervals at which boosters should be administered. Such routine immunizations usually include tetanus, diphtheria, pertussis, polio, Hepatitis B, Haemophilus influenzae type b (H.I.B.) and after one year of age, measles, rubella and mumps vaccines.... childhood immunization schedule

A genus of aerobic and anaerobic gram-positive (see GRAM’S STAIN) bacteria, widely distributed and best known as parasites and pathogens in humans. C. diphtheria, a prime example, causes diphtheria.... corynebacteria

Double vision. It is due to some irregularity in action of the muscles which move the eyeballs, in consequence of which the eyes are placed so that rays of light from one object do not fall upon corresponding parts of the two retinae, and two images are produced. It is a symptom of several nervous diseases, and often a temporary attack follows an injury to the eye, intoxication, or some febrile disease like DIPHTHERIA.... diplopia

A VIRUS which invades a bacterium (see BACTERIA). Containing either single-stranded or double-stranded DNA or RNA, a particular phage generally may infect one or a limited number of bacterial strains or species. After infection, once phage nucleic acid has entered the host cell, a cycle may result whereby the bacteria are programmed to produce viral components, which are assembled into virus particles and released on bacterial lysis (disintegration). Other (temperate) phages induce a non-lytic, or lysogenic, state, in which phage nucleic acid integrates stably into and replicates with the bacterial chromosome. The relationship can revert to a lytic cycle and production of new phages. In the process the phage may carry small amounts of donor bacterial DNA to a new host: the production of diphtheria toxin by Corynebacterium diphtheriae and of erythrogenic toxin by Streptococcus pyogenes are well-known examples of this e?ect.... bacteriophage

Breathlessness, or dyspnoea, may be due to any condition which renders the blood de?cient in oxygen, and which therefore produces excessive involuntary e?orts to gain more air. Exercise is a natural cause, and acute anxiety may provoke breathlessness in otherwise healthy people. Deprivation of oxygen – for example, in a building ?re – will also cause the victim to raise his or her breathing rate. Disorders of the lung may diminish the area available for breathing – for example, ASTHMA, PNEUMONIA, TUBERCULOSIS, EMPHYSEMA, BRONCHITIS, collections of ?uid in the pleural cavities, and pressure caused by a TUMOUR or ANEURYSM.

Pleurisy causes short, rapid breathing to avoid the pain of deep inspiration.

Narrowing of the air passages may produce sudden and alarming attacks of di?cult breathing, especially among children – for example, in CROUP, asthma and DIPHTHERIA.

Most cardiac disorders (see HEART, DISEASES OF) cause breathlessness, especially when the person undergoes any special exertion.

Anaemia is a frequent cause.

Obesity is often associated with shortness of breath. Mountain climbing may cause breathlessness

because, as altitude increases, the amount of oxygen in the air falls (see ALTITUDE SICKNESS). (See also LUNGS and RESPIRATION.)... breathlessness

This is an infectious or contagious disease which can be passed from one person to another. Direct physical contact, the handling of an infected object, or the transfer by droplets coughed or breathed out are all ways in which micro-organisms can be transmitted. The government produces a list of NOTIFIABLE DISEASES, which includes all the dangerous communicable diseases from anthrax, cholera and diphtheria through meningitis, rabies and smallpox to typhoid fever and whooping-cough (see respective entries). The UK’s Public Health (Control of Diseases) Act 1984 and subsequent regulations in 1988 oblige a doctor who suspects that a patient has a noti?able disease to report this to the local consultant in communicable disease. Expert support is provided by the Public Health Laboratory Service via surveillance centres and specialist laboratories.... communicable disease

The time or times during which the infectious agent may be transferred directly or indirectlyfrom an infected person to another person, from an infected animal to human, or from an infected human to an animal, including arthropods. In diseases such as diphtheria and scarlet fever, in which mucous membranes are involved from the first entry of the pathogen, the period of communicability is from the date of first exposure to a source of infection until the infective microorganism is no longer disseminated from the involved mucous membranes, ie, from the period before the prodromata until termination of a carrier stage, if this develops. Most diseases are not communicable during the earlyincubation period or after full recovery. In diseases transmitted by arthropods, such as malaria and yellow fever, the periods of communicability are those during which the infectious agent occurs in infective form in the blood or other tissues of the infected person in sufficient numbers to permit vector infections. A period of communicability is also to be distinguished for the arthropod vector - namely, that time during which the agent is present in the tissues of the arthropod in such form and locus (infective stage) as to be transmissible.... communicable period

See IMMUNITY.

Age Disease and mode of administration

3 days BCG (Bacille Calmette-Guerin) by injection if tuberculosis in family in past 6 months.

2 months Poliomyelitis (oral); adsorbed diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

3 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

4 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

12–18 months Measles, mumps, and rubella (German measles)4 (given together live by injection).

(SCHOOL ENTRY)

4–5 years Poliomyelitis (oral); adsorbed diphtheria and tetanus (given together by injection); give MMR vaccine if not already given at 12–18 months.

10–14 females Rubella (by injection) if they have missed MMR.

10–14 BCG (Bacille Calmette-Guerin) by injection to tuberculin-negative children to prevent tuberculosis.

15–18 Poliomyelitis single booster dose (oral); tetanus (by injection).

1 Pertussis may be excluded in certain susceptible individuals.

2 Known as DPT or triple vaccine.

3 Haemophilus in?uenzae immunisation (type B) is being introduced to be given at same time, but di?erent limb.

4 Known as MMR vaccine. (Some parents are asking to have their infants immunised with single-constituent vaccines because of controversy over possible side-effects – yet to be con?rmed scienti?cally – of the combined MMR vaccine.)

Recommended immunisation schedules in the United Kingdom... immune system

See BRAIN; CROUP; DIPHTHERIA; labour (under PREGNANCY AND LABOUR).... membranes

The term applied to symptoms or effects which are liable to follow certain diseases. For example, BRONCHITIS and other chest complaints may be sequelae of MEASLES; heart disease is often a sequelae of RHEUMATIC FEVER; PARALYSIS may follow DIPHTHERIA.... sequelae

Screening and surveillance uncover problems which then need careful attention. Most NHS districts have a CDT to carry out this task – working from child development centres – usually separate from hospitals. Various therapists, as well as consultant paediatricians in community child health, contribute to the work of the team. They include physiotherapists, occupational therapists, speech therapists, psychologists, health visitors and, in some centres, pre-school teachers or educational advisers and social workers. Their aims are to diagnose the child’s problems, identify his or her therapy needs and make recommendations to the local health and educational authorities on how these should be met. A member of the team will usually be appointed as the family’s ‘key worker’, who liaises with other members of the team and coordinates the child’s management. Regular review meetings are held, generally with parents sharing in the decisions made. Mostly children seen by CDTs are under ?ve years old, the school health service and educational authorities assuming responsibility thereafter.

Special needs The Children Act 1989, Education Acts 1981, 1986 and 1993, and the Chronically Sick and Disabled Persons Legislation 1979 impose various statutory duties to identify and provide assistance for children with special needs. They include the chronically ill as well as those with impaired development or disabilities such as CEREBRAL PALSY, or hearing, vision or intellectual impairment. Many CDTs keep a register of such children so that services can be e?ciently planned and evaluated. Parents of disabled children often feel isolated and neglected by society in general; they are frequently frustrated by the lack of resources available to help them cope with the sheer hard work involved. The CDT, through its key workers, does its best to absorb anger and divert frustration into constructive actions.

There are other groups of children who come to the attention of child health services. Community paediatricians act as advisers to adoption and fostering agencies, vital since many children needing alternative homes have special medical or educational needs or have behavioural or psychiatric problems. Many see a role in acting as advocates, not just for those with impairments but also for socially disadvantaged children, including those ‘looked after’ in children’s homes and those of travellers, asylum seekers, refugees and the homeless.

Child protection Regrettably, some children come to the attention of child health specialists because they have been beaten, neglected, emotionally or nutritionally starved or sexually assaulted by their parents or carers. Responsibility for the investigation of these children is that of local-authority social-services departments. However, child health professionals have a vital role in diagnosis, obtaining forensic evidence, advising courts, supervising the medical aspects of follow-up and teaching doctors, therapists and other professionals in training. (See CHILD ABUSE.)

School health services Once children have reached school age, the emphasis changes. The prime need becomes identifying those with problems that may interfere with learning – including those with special needs as de?ned above, but also those with behavioural problems. Teachers and parents are advised on how to manage these problems, while health promotion and health education are directed at children. Special problems, especially as children reach secondary school (aged 11–18) include accidents, substance abuse, psychosexual adjustment, antisocial behaviour, eating disorders and physical conditions which loom large in the minds of adolescents in particular, such as ACNE, short stature and delayed puberty.

There is no longer, in the UK, a universal school health service as many of its functions have been taken over by general practitioners and hospital and community paediatricians. However, most areas still have school nurses, some have school doctors, while others do not employ speci?c individuals for these tasks but share out aspects of the work between GPs, health visitors, community nurses and consultant paediatricians in child health.

Complementing their work is the community dental service whose role is to monitor the whole child population’s dental health, provide preventive programmes for all, and dental treatment for those who have di?culty using general dental services – for example, children with complex disability. All children in state-funded schools are dentally screened at ages ?ve and 15.

Successes and failures Since the inception of the NHS, hospital services for children have had enormous success: neonatal and infant mortality rates have fallen by two-thirds; deaths from PNEUMONIA have fallen from 600 per million children to a handful; and deaths from MENINGITIS have fallen to one-?fth of the previous level. Much of this has been due to the revolution in the management of pregnancy and labour, the invention of neonatal resuscitation and neonatal intensive care, and the provision of powerful antibiotics.

At the same time, some children acquire HIV infection and AIDS from their affected mothers (see AIDS/HIV); the prevalence of atopic (see ATOPY) diseases (ASTHMA, eczema – see DERMATITIS, HAY FEVER) is rising; more children attend hospital clinics with chronic CONSTIPATION; and little can be done for most viral diseases.

Community child health services can also boast of successes. The routine immunisation programme has wiped out SMALLPOX, DIPHTHERIA and POLIOMYELITIS and almost wiped out haemophilus and meningococcal C meningitis, measles and congenital RUBELLA syndrome. WHOOPING COUGH outbreaks continue but the death and chronic disability rates have been greatly reduced. Despite these huge health gains, continuing public scepticism about the safety of immunisation means that there can be no relaxation in the educational and health-promotion programme.

Services for severely and multiply disabled children have improved beyond all recognition with the closure of long-stay institutions, many of which were distinctly child-unfriendly. Nonetheless, scarce resources mean that families still carry heavy burdens. The incidence of SUDDEN INFANT DEATH SYNDROME (SIDS) has more than halved as a result of an educational programme based on ?rm scienti?c evidence that the risk can be reduced by putting babies to sleep on their backs, avoidance of parental smoking, not overheating, breast feeding and seeking medical attention early for illness.

Children have fewer accidents and better teeth but new problems have arisen: in the 1990s children throughout the developed world became fatter. A UK survey in 2004 found that one in ?ve children are overweight and one in 20 obese. Lack of exercise, the easy availability of food at all times and in all places, together with the rise of ‘snacking’, are likely to provoke signi?cant health problems as these children grow into adult life. Adolescents are at greater risk than ever of ill-health through substance abuse and unplanned pregnancy. Child health services are facing new challenges in the 21st century.... child development teams (cdts)

Paediatrics is the branch of medicine which deals with diseases of children, but many paediatricians have a wider role, being employed largely outside acute hospitals and dealing with child health in general.

History Child health services were originally designed, before the NHS came into being, to ?nd or prevent physical illness by regular inspections. In the UK these were carried out by clinical medical o?cers (CMOs) working in infant welfare clinics (later, child health clinics) set up to ?ll the gap between general practice and hospital care. The services expanded greatly from the mid 1970s; ‘inspections’ have evolved into a regular screening and surveillance system by general practitioners and health visitors, while CMOs have mostly been replaced by consultant paediatricians in community child health (CPCCH).

Screening Screening begins at birth, when every baby is examined for congenital conditions such as dislocated hips, heart malformations, cataract and undescended testicles. Blood is taken to ?nd those babies with potentially brain-damaging conditions such as HYPOTHYROIDISM and PHENYLKETONURIA. Some NHS trusts screen for the life-threatening disease CYSTIC FIBROSIS, although in future it is more likely that ?nding this disease will be part of prenatal screening, along with DOWN’S (DOWN) SYNDROME and SPINA BIFIDA. A programme to detect hearing impairment in newborn babies has been piloted from 2001 in selected districts to ?nd out whether it would be a useful addition to the national screening programme. Children from ethnic groups at risk of inherited abnormalities of HAEMOGLOBIN (sickle cell disease; thalassaemia – see under ANAEMIA) have blood tested at some time between birth and six months of age.

Illness prevention At two months, GPs screen babies again for these abnormalities and start the process of primary IMMUNISATION. The routine immunisation programme has been dramatically successful in preventing illness, handicap and deaths: as such it is the cornerstone of the public health aspect of child health, with more potential vaccines being made available every year. Currently, infants are immunised against pertussis (see WHOOPING COUGH), DIPHTHERIA, TETANUS, POLIOMYELITIS, haemophilus (a cause of MENINGITIS, SEPTICAEMIA, ARTHRITIS and epiglottitis) and meningococcus C (SEPTICAEMIA and meningitis – see NEISSERIACEAE) at two, three and four months. Selected children from high-risk groups are o?ered BCG VACCINE against tuberculosis and hepatitis vaccine. At about 13 months all are o?ered MMR VACCINE (measles, mumps and rubella) and there are pre-school entry ‘boosters’ of diphtheria, tetanus, polio, meningococcus C and MMR. Pneumococcal vaccine is available for particular cases but is not yet part of the routine schedule.

Health promotion and education Throughout the UK, parents are given their child’s personal health record to keep with them. It contains advice on health promotion, including immunisation, developmental milestones (when did he or she ?rst smile, sit up, walk and so on), and graphs – called centile charts – on which to record height, weight and head circumference. There is space for midwives, doctors, practice nurses, health visitors and parents to make notes about the child.

Throughout at least the ?rst year of life, both parents and health-care providers set great store by regular weighing, designed to pick up children who are ‘failing to thrive’. Measuring length is not quite so easy, but height measurements are recommended from about two or three years of age in order to detect children with disorders such as growth-hormone de?ciency, malabsorption (e.g. COELIAC DISEASE) and psychosocial dwar?sm (see below).

All babies have their head circumference measured at birth, and again at the eight-week check. A too rapidly growing head implies that the infant might have HYDROCEPHALUS – excess ?uid in the hollow spaces within the brain. A too slowly growing head may mean failure of brain growth, which may go hand in hand with physically or intellectually delayed development.

At about eight months, babies receive a surveillance examination, usually by a health visitor. Parents are asked if they have any concerns about their child’s hearing, vision or physical ability. The examiner conducts a screening test for hearing impairment – the so-called distraction test; he or she stands behind the infant, who is on the mother’s lap, and activates a standardised sound at a set distance from each ear, noting whether or not the child turns his or her head or eyes towards the sound. If the child shows no reaction, the test is repeated a few weeks later; if still negative then referral is made to an audiologist for more formal testing.

The doctor or health visitor will also go through the child’s developmental progress (see above) noting any signi?cant deviation from normal which merits more detailed examination. Doctors are also recommended to examine infants developmentally at some time between 18 and 24 months. At this time they will be looking particularly for late walking or failure to develop appropriate language skills.... child health

Also known as DPT vaccine, this is an injection that provides IMMUNITY against DIPHTHERIA, pertussis (whooping-cough) and TETANUS. It is given as a course of three injections at around the ages of two, three and four months. A booster dose of diphtheria and tetanus is given at primary-school age. Certain infants – those with a family history of EPILEPSY, or who have neurological disorders or who have reacted severely to the ?rst dose – should not have the pertussis element of DPT. (See MMR VACCINE; IMMUNISATION.)... triple vaccine

Narrowing or blockage of the respiratory passages. The obstruction may be due to a foreign body, such as a piece of food, that becomes lodged in part of the upper airway and may result in choking. Certain disorders, such as diphtheria and lung cancer, can cause obstruction. Additionally, spasm of the muscular walls of the airway, as occurs in bronchospasm (a feature of asthma), results in breathing difficulty.... airway obstruction

The number of deaths of infants under one year of age. The IMR in any given year is calculated as the number of deaths in the ?rst year of life in proportion to every 1,000 registered live births in that year. Along with PERINATAL MORTALITY, it is accepted as one of the most important criteria for assessing the health of the community and the standard of the social conditions of a country.

The improvement in the infant mortality rate has occurred mainly in the period from the second month of life. There has been much less improvement in the neonatal mortality rate – that is, the number of infants dying during the ?rst four weeks of life, expressed as a proportion of every 1,000 live births. During the ?rst week of life the main causes of death are asphyxia, prematurity, birth injuries and congenital abnormalities. After the ?rst week the main cause of death is infection.

Social conditions also play an important role in infant mortality. In England and Wales the infant mortality rate in 1930–32 was: Social Class I (professional), 32·7; Social Class III (skilled workers), 57·6; Social Class V (unskilled workers), 77·1. Many factors come into play in producing these social variations, but overcrowding is undoubtedly one of the most important.

1838–9 146 1950–52 30 1851–60 154 1960–62 22 1900–02 142 1970–72 18 1910–12 110 1980–82 12 1920–22 82 1990–92 7 1930–32 67 1996 6·2 1940–42 59 1999 5.8 2000 5.6

It is thus evident that for a reduction of the infant mortality rate to the minimum ?gure, the following conditions must be met. Mothers and potential mothers must be housed adequately in healthy surroundings, particularly with regard to safe water supplies and sewage disposal. The pregnant and nursing mother must be ensured an adequate diet. E?ective antenatal supervision must be available to every mother, as well as skilled supervision during labour (see PREGNANCY AND LABOUR). The newborn infant must be adequately nursed and fed and mothers encouraged to breast feed. Environmental and public-health measures must be taken to ensure adequate housing, a clean milk supply and full availability of medical care including such protective measures as IMMUNISATION against diphtheria, measles, poliomyelitis and whooping-cough. (See also PERINATAL MORTALITY.)... infant mortality rate (imr)

The process by which a disease is transmitted via micro-organisms from one person to another. The micro-organism may be a bacterium (see BACTERIA), a RICKETTSIA, a VIRUS, a protozoon – single-celled animal organism – or a metazoon – multicellular animal organism. Invasion of the body by a metazoon (e.g. by an intestinal worm) is more often known as an infestation.

The skin is an important protection against micro-organisms entering the body tissues. A large measure of protection is a?orded by the factors which ensure IMMUNITY against diseases.

Modes of infection The infective material may be transmitted to the person by direct contact with a sick person, when the disease is said to be contagious, although such a distinction is purely arti?cial. Di?erent diseases are especially infectious at di?erent periods of their course. Protecting people can be di?cult, since some diseases are infectious before the patient shows any symptoms (see INCUBATION).

Infection may be conveyed on dust, in drinking-water, in food (particularly milk), in the body’s waste products and secretions, or even on clothes and linen which have been in contact with the infected individual (called fomites).

Some people who have recovered from a disease, or who have simply been in contact with an infectious case, harbour the infectious agent. This is particularly the case in typhoid fever (see ENTERIC FEVER), the bacillus continuing to develop in the gall-bladder of some people who have had the disease for years after the symptoms have disappeared. In the case of CHOLERA, which is ENDEMIC in some developing countries with hot climates, 80 per cent or more of the population may harbour the bacillus and spread infection when other circumstances favour this. Similarly in the case of DYSENTERY, people who have completely recovered may still be capable of infecting dust and drinking-water by their stools. DIPHTHERIA and meningococcal MENINGITIS, which is particularly liable to infect children, are other examples.

Flies can infect milk and other food with the organisms causing typhoid fever and food poisoning. Mosquitoes carry the infective agents of MALARIA, DENGUE and YELLOW FEVER, these undergoing part of their development in the body of the mosquito. Fleas convey the germ of plague from rats to humans, and lice are responsible for inoculating TYPHUS FEVER and one form of RELAPSING FEVER by their bite. A tick is responsible for spreading another form of relapsing fever, and kala-azar (LEISHMANIASIS) is spread by the bites of sand?ies.

Noti?able diseases Certain of the common and most serious infectious diseases are noti?able in the United Kingdom. A doctor diagnosing someone infected by a noti?able disease must inform the authorities. For the current list of noti?able infectious diseases in the UK, see the main entry for NOTIFIABLE DISEASES.

Prevention is an important aspect of the control of infectious diseases, and various steps can be taken to check the spread of such infections as dysentery, tuberculosis, malaria and others. (See also IMMUNITY; INCUBATION.)... infection

A common condition in infants and young children in which narrowing and inflammation of the airways causes hoarseness, stridor (a grunting noise during breathing), and a barking cough.

Croup may be caused by a viral or bacterial infection that affects the larynx, epiglottis (see epiglottitis), or trachea. Other causes include diphtheria, allergy, spasm caused by deficient calcium in the blood, and inhalation of a foreign body. Most cases are due to a viral infection and are mild.

Humidifying the air can help to make breathing easier. Nebulized corticosteroid drugs (see nebulizer) and oxygen may be prescribed. Infections are treated with antibiotic drugs.... croup

Diseases prevalent in the tropics because of living conditions and diet include malnutrition, measles, diphtheria, tuberculosis, typhoid fever, shigellosis, cholera, amoebiasis, and tapeworm infestation.

Diseases spread through the tropics by insects include malaria, yellow fever, sleeping sickness, and leishmaniasis.

Exposure to strong sunlight in the tropics causes an increased tendency to skin cancer, and may lead to pinguecula and pterygium.... tropical diseases

n. any substance used in conjunction with another to enhance its activity. Aluminium salts are used as adjuvants in the preparation of vaccines from the toxins of diphtheria and tetanus: by keeping the toxins in precipitated form, the salts increase the efficacy of the toxins as antigens.... adjuvant

The study of all aspects of micro-organisms (microbes) – that is, organisms which individually are generally too small to be visible other than by microscopy. The term is applicable to viruses (see VIRUS), BACTERIA, and microscopic forms of fungi, algae, and PROTOZOA.

Among the smallest and simplest microorganisms are the viruses. First described as ?lterable agents, and ranging in size from 20–30 nm to 300 nm, they may be directly visualised only by electron microscopy. They consist of a core of deoxyribonucleic or ribonucleic acid (DNA or RNA) within a protective protein coat, or capsid, whose subunits confer a geometric symmetry. Thus viruses are usually cubical (icosahedral) or helical; the larger viruses (pox-, herpes-, myxo-viruses) may also have an outer envelope. Their minimal structure dictates that viruses are all obligate parasites, relying on living cells to provide essential components for their replication. Apart from animal and plant cells, viruses may infect and replicate in bacteria (bacteriophages) or fungi (mycophages), which are damaged in the process.

Bacteria are larger (0·01–5,000 µm) and more complex. They have a subcellular organisation which generally includes DNA and RNA, a cell membrane, organelles such as ribosomes, and a complex and chemically variable cell envelope – but, unlike EUKARYOTES, no nucleus. Rickettsiae, chlamydia, and mycoplasmas, once thought of as viruses because of their small size and absence of a cell wall (mycoplasma) or major wall component (chlamydia), are now acknowledged as bacteria; rickettsiae and chlamydia are intracellular parasites of medical importance. Bacteria may also possess additional surface structures, such as capsules and organs of locomotion (?agella) and attachment (?mbriae and stalks). Individual bacterial cells may be spheres (cocci); straight (bacilli), curved (vibrio), or ?exuous (spirilla) rods; or oval cells (coccobacilli). On examination by light microscopy, bacteria may be visible in characteristic con?gurations (as pairs of cocci [diplococci], or chains [streptococci], or clusters); actinomycete bacteria grow as ?laments with externally produced spores. Bacteria grow essentially by increasing in cell size and dividing by ?ssion, a process which in ideal laboratory conditions some bacteria may achieve about once every 20 minutes. Under natural conditions, growth is usually much slower.

Eukaryotic micro-organisms comprise fungi, algae, and protozoa. These organisms are larger, and they have in common a well-developed internal compartmentation into subcellular organelles; they also have a nucleus. Algae additionally have chloroplasts, which contain photosynthetic pigments; fungi lack chloroplasts; and protozoa lack both a cell wall and chloroplasts but may have a contractile vacuole to regulate water uptake and, in some, structures for capturing and ingesting food. Fungi grow either as discrete cells (yeasts), multiplying by budding, ?ssion, or conjugation, or as thin ?laments (hyphae) which bear spores, although some may show both morphological forms during their life-cycle. Algae and protozoa generally grow as individual cells or colonies of individuals and multiply by ?ssion.

Micro-organisms of medical importance include representatives of the ?ve major microbial groups that obtain their essential nutrients at the expense of their hosts. Many bacteria and most fungi, however, are saprophytes (see SAPROPHYTE), being major contributors to the natural cycling of carbon in the environment and to biodeterioration; others are of ecological and economic importance because of the diseases they cause in agricultural or horticultural crops or because of their bene?cial relationships with higher organisms. Additionally, they may be of industrial or biotechnological importance. Fungal diseases of humans tend to be most important in tropical environments and in immuno-compromised subjects.

Pathogenic (that is, disease-causing) microorganisms have special characteristics, or virulence factors, that enable them to colonise their hosts and overcome or evade physical, biochemical, and immunological host defences. For example, the presence of capsules, as in the bacteria that cause anthrax (Bacillus anthracis), one form of pneumonia (Streptococcus pneumoniae), scarlet fever (S. pyogenes), bacterial meningitis (Neisseria meningitidis, Haemophilus in?uenzae) is directly related to the ability to cause disease because of their antiphagocytic properties. Fimbriae are related to virulence, enabling tissue attachment – for example, in gonorrhoea (N. gonorrhoeae) and cholera (Vibrio cholerae). Many bacteria excrete extracellular virulence factors; these include enzymes and other agents that impair the host’s physiological and immunological functions. Some bacteria produce powerful toxins (excreted exotoxins or endogenous endotoxins), which may cause local tissue destruction and allow colonisation by the pathogen or whose speci?c action may explain the disease mechanism. In Staphylococcus aureus, exfoliative toxin produces the staphylococcal scalded-skin syndrome, TSS toxin-1 toxic-shock syndrome, and enterotoxin food poisoning. The pertussis exotoxin of Bordetella pertussis, the cause of whooping cough, blocks immunological defences and mediates attachment to tracheal cells, and the exotoxin produced by Corynebacterium diphtheriae causes local damage resulting in a pronounced exudate in the trachea.

Viruses cause disease by cellular destruction arising from their intracellular parasitic existence. Attachment to particular cells is often mediated by speci?c viral surface proteins; mechanisms for evading immunological defences include latency, change in viral antigenic structure, or incapacitation of the immune system – for example, destruction of CD 4 lymphocytes by the human immunode?ciency virus.... microbiology

adj. resembling diphtheria (especially the membrane formed in diphtheria) or the bacteria that cause it.... diphtheroid

(dTaP/IPV) a booster vaccine given to children between 3 years 4 months and 5 years of age. It tops up protection against diphtheria, tetanus, pertussis (whooping cough), and polio.... dtap/ipv

a primary *immunization given to infants typically at 2, 3, and 4 months of age. It protects against six diseases: diphtheria (D), tetanus (T), pertussis (whooping cough) acellular component (aP), polio (inactivated polio vaccine) IPV, Haemophilus influenzae type b infection (Hib) (see Hib vaccine), and Hepatitis B (HepB).... dtap/ipv/hib/hepb

the branch of medicine whose main aim is the prevention of disease. This is a wide field, in which workers tackle problems ranging from the immunization of persons against infectious diseases, such as diphtheria or whooping cough, to finding methods of eliminating *vectors, such as malaria-carrying mosquitoes. See primary prevention; secondary prevention; tertiary prevention. See also World Health Organization.... preventive medicine

A combined vaccine o?ering protection against MEASLES, MUMPS and RUBELLA (German measles), it was introduced in the UK in 1988 and has now replaced the measles vaccine. The combined vaccine is o?ered to all infants in their second year; health authorities have an obligation to ensure that all children have received the vaccine by school entry – it should be given with the pre-school booster doses against DIPHTHERIA, TETANUS and POLIOMYELITIS, if not earlier – unless there is a valid contra-indication (such as partial immunosuppression), parental refusal, or evidence of previous infection. MMR vaccine may also be used in the control of measles outbreaks, if o?ered to susceptible children within three days of exposure to infection. The vaccine is e?ective and generally safe, though minor symptoms such as malaise, fever and rash may occur 5–10 days after immunisation. The incidence of all three diseases has dropped substantially since MMR was introduced in the UK and USA.

A researcher has suggested a link between the vaccine and AUTISM, but massive studies of children with and without this condition in several countries have failed to ?nd any evidence to back the claim. Nonetheless, the publicity war has been largely lost by the UK health departments so that vaccine rates have dropped to a worryingly low level.

(See IMMUNISATION.)... mmr vaccine

Diseases, usually of an infectious nature, which are required by law to be made known to a health o?cer or local authority. (See INFECTION.) Certain occupational diseases are also noti?able.

Noti?able diseases in the UK (For more information on a speci?c disease, refer to the separate dictionary entry.) Acute encephalitis Acute poliomyelitis Anthrax Cholera Diphtheria Dysentery (amoebic or bacillary) Ebola virus disease Food poisoning Lassa fever Leprosy (reported to Chief Medical O?cer at the Department of Health) Leptospirosis Malaria Marburg disease Measles Meningitis Meningococcal septicaemia (without meningitis) Mumps Ophthalmia neonatorum Paratyphoid fever Plague Rabies Relapsing fever Rubella Scarlet fever Smallpox Tetanus Tuberculosis Typhoid fever Typhus Viral haemorrhagic fever (including Lassa fever) Viral hepatitis Whooping cough Yellow fever

Reporting AIDS is voluntary (and in con?dence) to the Director, Communicable Diseases Surveillance Centre (PHLS).... notifiable diseases

A method of sterilising milk (see also MILK – Preparation of milk). In many parts of the world, pasteurisation has done away with milk-borne infections, of which the most serious is bovine TUBERCULOSIS, affecting the glands, bones and joints of children. Other infections conveyed by milk are SCARLET FEVER, DIPHTHERIA, ENTERIC FEVER (typhoid and paratyphoid), undulant fever (BRUCELLOSIS), and food poisoning (e.g. from CAMPYLOBACTER, or the toxins of the STAPHYLOCOCCUS).

High-temperature short-time (HTST) pasteurisation consists of heating the milk at a temperature not less than 71·7 °C (161 °F) for at least 15 seconds, followed by immediate cooling to a temperature of not more than 10 °C (50 °F).

Low-temperature pasteurisation, or ‘holder’ process, consists in maintaining the milk for at least half an hour at a temperature between 63 and 65 °C (145–150 °F), followed by immediate cooling to a temperature of not more that 10 °C (50 °F). This has the e?ect of considerably reducing the number of bacteria contained in the milk, and of preventing the diseases conveyed by milk as referred to above.... pasteurisation

Tonsillitis is the in?ammation of the TONSILS. The disorder may be the precurosor of a virus-induced infection of the upper respiratory tract such as the COMMON COLD, INFLUENZA or infectious MONONUCLEOSIS, in which case the in?ammation usually subsides as other symptoms develop. Such virus-induced tonsillitis does not respond to treatment with antibiotics. This section describes tonsillitis caused by bacterial infection.

Acute tonsillitis The infection is never entirely con?ned to the tonsils; there is always some involvement of the surrounding throat or pharynx. The converse is true that in many cases of ‘sore throat’, the tonsils are involved in the generalised in?ammation of the throat.

Causes Most commonly caused by the ?haemolytic STREPTOCOCCUS, its incidence is highest in the winter months. In the developing world it may be the presenting feature of DIPHTHERIA, a disease now virtually non-existant in the West since the introduction of IMMUNISATION.

Symptoms The onset is usually fairly sudden with pain on swallowing, fever and malaise. On examination, the tonsils are engorged and covered with a whitish discharge (PUS). This may occur at scattered areas over the tonsillar crypts (follicular tonsillitis), or it may be more extensive. The glands under the jaw are enlarged and tender, and there may be pain in the ear on the affected side: although usually referred pain, this may indicate spread of the infection up the Eustachian tube to the ear, particularly in children. Occasionally an ABSCESS, or quinsy, develops around the affected tonsil. Due to a collection of pus, it usually comes on four to ?ve days after the onset of the disease, and requires specialist surgical treatment.

Treatment Most cases need no treatment. Therefore, it is advisable to take a throat swab to assess the nature of any bacterial treatment before starting treatment. Penicillin or erythromycin are the drugs of choice where betahaemolytic streptococci are isolated, together with paracetamol or aspirin, and plenty of ?uids. Removal of tonsils is indicated: when the tonsils and adenoids are permanently so enlarged as to interfere with breathing (in such cases the adenoids are removed as well as the tonsils); when the individual is subject to recurrent attacks of acute tonsillitis which are causing signi?cant debility, absence from school or work on a regular basis (more than four times a year); when there is evidence of a tumour of the tonsil. Recurrent sore throat is not an indication for removing tonsils.... tonsillitis

n. any means taken to prevent disease, such as immunization against diphtheria or whooping cough, or *fluoridation to prevent dental decay in children. —prophylactic adj.... prophylaxis

n. a false membrane, consisting of a layer of exudate on the surface of the skin or a mucous membrane. In diphtheria a pseudomembrane forms in the throat. In pseudomembranous colitis, a disease caused by *Clostridium difficile that usually follows antibiotic therapy, pseudomembranes develop in the colon, resulting in profuse diarrhoea.... pseudomembrane

Poisons produced by BACTERIA. (See also IMMUNITY; IMMUNOLOGY; MICROBIOLOGY.) Toxins are usually soluble, easily destroyed by heat, sometimes of the nature of crystalline substances, and sometimes ALBUMINS. When injected into animals in carefully graduated doses, they bring about the formation of substances called antitoxins which neutralise the action of the toxin. These antitoxins are generally produced in excessive amount, and the SERUM of the animal when withdrawn can be used for conferring antitoxic powers upon other animals or human beings to neutralise the disease in question. The best known of these antitoxins are those of DIPHTHERIA and TETANUS. Toxins are also found in many plants and in snake venom.

Some toxins are not set free by bacteria, but remain in the substance of the latter. They are known as endotoxins and are not capable of producing antitoxins.... toxins

Wax Myrtle. Myrica cerifera L. Root bark. German: Wachsgagel. French: Cirier. Spanish: Arraya?n. Italian: Mirica cerifera. Indian: Ka?iphala. Malayan: Maru tam toli.

Action. Diffusive circulatory stimulant, Deobstruent, Tonic. Astringent (local). Diaphoretic (in hot infusion). Bactericidal, Spermatocidal.

Uses: Mucous colitis, diarrhoea. Congestive catarrhal conditions of mucous membranes. Leucorrhoea, prolapse of the womb. Tuberculosis diathesis. To stimulate a sluggish circulation. Colds and fevers to promote sweating. Nasal polypi (powdered bark snuff). Bleeding from lungs, stomach and bowels. Candidiasis (douche). Leg ulcers (dusting powder). Diphtheria (local application to throat).

An essential ingredient of Dr Thomson’s Composition powder. Combination: with Turkey Rhubarb, Goldenseal, Slippery Elm or Fenugreek seeds for chronic stomach/intestine disorders and irritable bowel syndrome.

Preparations: Thrice daily.

Decoction: 1 teaspoon powdered bark to each cup water; remove vessel when boiling point is reached: dose, quarter to half a cup.

Liquid extract BHP (1983). 1:1 in 45 per cent alcohol: dose, 0.6-2ml. Powdered bark, dose 0.6-2g.

Poultices, powdered bark for ulceration.

Peerless Composition Essence (Potter’s). Ingredient. ... bayberry bark

a test to determine whether a person is susceptible to diphtheria. A small quantity of diphtheria toxin is injected under the skin; a patch of reddening and swelling shows that the person has no immunity and – if at particular risk – should be immunized. With safer *toxoids, this test is no longer necessary. [B. Schick (1877–1967), US paediatrician]... schick test

a booster vaccine given to children aged 14 years to top up immunity against tetanus, diphtheria, and polio. See immunization.... td/ipv

n. inflammation of the *trachea, usually secondary to bacterial or viral infection in the nose or throat. Tracheitis causes soreness in the chest and a painful cough and is often associated with bronchitis. In babies it can cause asphyxia, particularly in *diphtheria. Treatment includes appropriate antibacterial drugs, humidification of the inhaled air or oxygen, and mild sedation to relieve exhaustion due to persistent coughing.... tracheitis

Blue gum tree. Eucalyptus globulus, Labill. Oil distilled from the fresh leaves. Keynote: general antiseptic. French: eucalyptus. German: blauer gommibaum. Italian: eucalypto. Constituents: flavonoids, volatile oil.

Action: acts powerfully upon mucous membrane; antibiotic, anti-viral, anti-fungal, antispasmodic, stimulant restorative. Said to have the power of destroying miasma in fever-stricken areas, arresting the spread of pestilential fever. Widely used by the aborigines of Australia. Hypoglycaemic.

Uses: Early stage of fever, colds, asthma, nasal catarrh, sinusitis, sore throat and respiratory disorders generally as an inhalant or internal medicine. Senile bronchitis as a chest rub. For lung conditions, may be inhaled or used in pastilles. Once used for diphtheria and relief of tubercula cough. Diabetes mellitis. Congestive headache, pyrrhoea and bleeding gums.

In Arabian medicine a few drops of the oil in wine dispelled offensive odours as from growths and infected wounds. The leaves have been smoked for relief of asthma.

Chinese Barefoot medicine: a cleansing douche made from 15-30 drops in 2 pints warm water for sexual transmitted disease. Reduction of caruncle at vaginal opening.

Preparations: Thrice daily before meals or, in acute cases, as necessary. 2-5 drops of the oil in honey. Decoction: 3-4 leaves to each cup water gently simmered 10 minutes in a covered vessel. Dose: half-1 cup.

Spray or vaporiser: 5-10 drops of oil in 1oz Olive oil.

Chest rub: 3-5 drops oil in 2 teaspoons Almond or Olive oil.

Antiseptic wash: a strong decoction made from a handful of leaves to 1 pint water simmered 20 minutes offers a healing cleansing wash for leg ulcers, discharging wounds; and as an enema for worms and amoebic dysentery.

Powder: capsules, powdered leaves, 250mg: 2 capsules between meals thrice daily.

Note: Not given with Goldenseal with which it is antagonistic. ... eucalyptus

Citrus limonum. Refreshing and fragrant essential oil.

Constituents: flavonoids, coumarins, mucilage, Vitamin C, calcium oxalate.

Action: prevention and treatment of scurvy, anti-infective, anti-inflammatory, anti-fat, antihistamine.

Contains citric acid which is an anti-bacterial capable of destroying some viruses and bacteria.

Uses: Coughs, colds, influenza and onset of fevers generally. Traditionally a whole lemon was roasted or baked in a moderate oven for half an hour and as much juice drunk as tolerated. Sore throat (gargle). Diphtheria: impressive cures reported. Persist until false membrane is detached: Neat lemon juice gargle hourly, swallowing 1-2 teaspoons. If too strong, may be diluted. Often overlooked for hiccoughs. Dropsy: lemon fast. 3-4 days on lemon juice alone: no solid food, tea, stimulants, etc. Biliousness, sick headache: juice of a lemon morning and evening; sweeten with honey if necessary. Malaria: half a teacup juice in water every 2-3 hours. Rheumatism: juice of half lemon before meals and at bedtime; may be diluted. For rheumatism, anecdotal success has been reported by combining equal parts lemon juice and molasses: tablespoon thrice daily before meals. Cellulitis. A lemon mask helps to fade spots.

External: erysipelas, corns, lesions of scurvy. “For a felon (whitlow) cut off end of a lemon; insert finger and bind securely. In the morning remove exudation of matter.” (Chinese Barefoot doctor)

Preparations: Tincture Limonis P (1948) (dose, 2-4ml) is sometimes available but recorded successes have been chiefly due to use of the juice. Oil Lemon BP. Used also in Aromatherapy.

Note: When drinking lemon juice care should be taken to see juice does not come in direct contact with the teeth, the enamel of which it erodes. The juice may remove some calculi from the body, but after having cleared the bloodstream it leeches calcium from the teeth and bones. It is a known cause of arthritis, inducing dryness and subsequent erosion of cartilage of the joints. ... lemon

Notifiable diseases under the Public Health (Control of Disease Act, 1984) are:–

Acute encephalitis, acute meningitis, acute poliomyelitis, anthrax, cholera, diphtheria, dysentery (amoebic and bacillary), food poisoning, infective jaundice, leprosy, leptospirosis, lassa fever, mumps, malaria, marburg disease, measles, German measles, ophthalmia neonatorum, paratyphoid fever, plague, rabies, relapsing fever, scarlet fever, smallpox, tetanus, tuberculosis, typhoid fever, typhus, viral haemorrhagic fever, whooping cough and yellow fever.

Six communicable diseases are internationally notifiable to the World Health Organisation: yellow fever, plague, cholera, smallpox, louse-borne relapsing fever, louse-borne typhus.

Notification has to be made to local and central Government authorities. Certain occupational diseases and all cases of cancer must be registered and notified.

It is required that the above diseases and certain others receive modern medical therapy in a hospital or treatment under the supervision of a qualified physician. Failure to conform may expose a practitioner, registered or unregistered, to a charge of negligence. ... notifiable diseases

Also known as triple vaccine, an injection that provides immunity against diphtheria, pertussis (whooping cough), and tetanus; The vaccine causes the body to produce antibodies against these infections. It is given as a course of 3 injections at 2, 3, and 4 months, followed by a preschool booster dose. Before leaving school, a further diphtheria and tetanus booster is given. The vaccine does not provide complete immunity to diphtheria or pertussis but reduces risk of serious illness.

Protection against pertussis and tetanus gradually wanes. In adults, pertussis is mild but can be transmitted to children. Since tetanus is serious at any age, boosters are recommended at the time of any dirty, penetrating injury if there has not been a vaccination in the past 10 years.

Reactions to the diphtheria and tetanus parts of the vaccine are rare.

The pertussis vaccine often causes slight fever and irritability for a day or so.

More serious reactions are extremely rare and include seizures and an allergic reaction, which may lead to sudden breathing difficulty and shock.

Permanent damage from the vaccine is even rarer.

Doctors are now agreed that for most children, the benefits of outweigh the minimal risk from the vaccine.

The pertussis element of the vaccine should not be given to children who have reacted severely to a preceding dose of the vaccine, or who have a progressing brain abnormality.... dpt vaccination

The process of inducing immunity as a preventive measure against infectious diseases. Immunization may be active or passive. In the passive form,antibodies are injected into the blood to provide immediate but short-lived protection against specific bacteria, viruses, or toxins. Active immunization, also called vaccination, primes the body to make its own antibodies and confers longer-lasting immunity.

Routine childhood immunization programmes exist for diseases such as diphtheria, pertussis, and tetanus (see DPT vaccination), haemophilus influenza (Hib), measles, mumps, and rubella (see MMR vaccination), meningitis C, and poliomyelitis. Additional immunizations before foreign travel may also be necessary (see travel immunization).

Most immunizations are given by injection, and usually have no after effects. However, some vaccines cause pain and swelling at the injection site and may produce a slight fever or flu-like symptoms. Some may produce a mild form of the disease. Very rarely, severe reactions occur due, for example, to an allergy to 1 of the vaccine’s components. Not all vaccines provide complete protection. Cholera and typhoid fever vaccinations, in particular, give only partial protection.

People with immunodeficiency disorders, widespread cancer, those taking corticosteroid drugs, or those who have previously had a severe reaction to a vaccine should not be immunized. Some vaccines should not be given to young children or during pregnancy.... immunization

a disease that must be reported to a proper officer of the local authority so that prompt control and preventive action may be undertaken if necessary. The ‘proper officer’ duty is often delegated by local authorities to a *Consultant in Health Protection within *Public Health England. Notifiable diseases in England include anthrax, diphtheria, food poisoning, malaria, measles, rabies, tetanus, tuberculosis, and whooping cough. The list varies for different countries, including the other parts of the United Kingdom. Some diseases are internationally notifiable through the *World Health Organization; these include cholera, plague, relapsing fever, typhus, and yellow fever. The appropriate reporting of notifiable diseases is legally required by the Health Protection (Notification) Regulations 2010 (and similar legislation in the other parts of the UK).

#list-of-notifiable-diseases

• List of notifiable diseases in England and guidance on how to report them... notifiable disease

Allium sativum

FAMILY: Amaryllidaceae or Liliaceae

SYNONYMS: Common garlic, allium, poor man’s treacle!

GENERAL DESCRIPTION: A strongly scented perennial herb up to 1.2 metres high with long, flat, firm leaves and whitish flowering stems. The bulb is made up of several cloves pressed together within a thin white skin.

DISTRIBUTION: It is said to have originated in south west Siberia and then spread to Europe and Central Asia. It is naturalized in North America and cultivated worldwide. Major oil-producing countries include Egypt, Bulgaria, France, China, Germany and Japan.

OTHER SPECIES: Closely related to the wild or wood garlic (A. ursinum) also known as ‘ramsons’. There are also many other wild species with similar but less pronounced properties.

HERBAL/FOLK TRADITION: It has been used for thousands of years for its medicinal virtues: for respiratory and urinary tract infections; digestive disorders and infestations; skin eruptions; heart disease, high blood pressure and arteriosclerosis, as well as epidemics and fever. It was used in the First World War for preventing gangrene and sepsis.

It has a high reputation in the East: in China it is used for diarrhoea, dysentery, tuberculosis, diphtheria, hepatitis, ringworm, typhoid and trachoma, among others. It is also held in high regard in the West: specific in the British Herbal Pharmacopoeia for chronic bronchitis. Its properties have been attested to by modern experimental and clinical research.

ACTIONS: Amoebicidal, anthelmintic, antibiotic, antimicrobial, antiseptic, antitoxic, antitumour, antiviral, bactericidal, carminative, cholagogue, hypocholesterolemic, depurative, diaphoretic, diuretic, expectorant, febrifuge, fungicidal, hypoglycaemic, hypotensive, insecticidal, larvicidal, promotes leucocytosis, stomachic, tonic.

EXTRACTION: Essential oil by steam distillation from the fresh crushed bulbs.

CHARACTERISTICS: A colourless to pale yellow mobile liquid with a strong, unpleasant, familiar garlic-like odour.

PRINCIPAL CONSTITUENTS: Allicin, allylpropyl disulphide, diallyl disulphide, diallyl trisulphide, citral, geraniol, linalol, phellandrene, among others.

SAFETY DATA: Generally non-toxic and non-irritant, although it has been known to irritate the stomach; may also cause sensitization in some individuals.

AROMATHERAPY/HOME: USE Due to its unpleasant and pervasive smell, the oil is not often used externally. However, the capsules may be taken internally according to the instructions on the label for respiratory and gastro-intestinal infections, urinary tract infections such as cystitis, heart and circulatory problems, and to fight infectious diseases in general.

OTHER USES: The oil is made into capsules and also included in many health food products mainly to help reduce high blood pressure and protect against heart disease. Extensively employed as a flavour ingredient in most major food categories, especially savouries.... garlic

Liquidambar orientalis

FAMILY: Hamamelidaceae

SYNONYMS: Balsam styracis, oriental sweetgum, Turkish sweetgum, asiatic styrax, styrax, storax, liquid storax.

GENERAL DESCRIPTION: A deciduous tree up to 15 metres high with a purplish-grey bark, leaves arranged into five three-lobed sections, and white flowers. The styrax is a pathological secretion produced by pounding the bark, which induces the sapwood to produce a liquid from beneath the bark. It hardens to form a semi-solid greenish-brown mass with a sweet balsamic odour.

DISTRIBUTION: Native to Asia Minor. It forms forests around Bodrum, Milas, Mugla and Marmaris in Turkey.

OTHER SPECIES: Very similar to the American styrax (L. styraciflua) or red gum, which produces a natural exudation slightly darker and harder than the Levant type. There are also many other types of styrax; Styrax officinale produced the styrax of ancient civilizations. NB: Styrax benzoin is the botanical name for benzoin, with which it shares similar qualities.

HERBAL/FOLK TRADITION: In China it is used for coughs, colds, epilepsy and skin problems, including cuts, wounds and scabies. In the West it has been recommended as a remedy for catarrh, diphtheria, gonorrhoea, leucorrhoea, ringworm, etc. A syrup made from the bark of the American styrax is used for diarrhoea and dysentery in the western USA.

ACTIONS: Anti-inflammatory, antimicrobial, antiseptic, antitussive, bactericidal, balsamic, expectorant, nervine, stimulant.

EXTRACTION: Essential oil by steam distillation from the crude. (A resinoid and absolute are also produced by solvent extraction).

CHARACTERISTICS: A water-white or pale yellow liquid with a sweet-balsamic, rich, tenacious odour. It blends well with ylang ylang, jasmine, mimosa, rose, lavender, carnation, violet, cassie and spice oils.

PRINCIPAL CONSTITUENTS: Mainly styrene with vanillin, phenylpropyl alcohol, cinnamic alcohol, benzyl alcohol and ethyl alcohol, among others.

SAFETY DATA: Non-toxic, non-irritant, possible sensitization in some individuals. Frequently adulterated.

AROMATHERAPY/HOME: USE

Skin care: Cuts, ringworm, scabies, wounds.

Respiratory system: Bronchitis, catarrh, coughs.

Nervous system: Anxiety, stress-related conditions.

OTHER USES: Used in compound benzoin tincture, mainly for respiratory conditions. The oil and resinoid are used as fixatives and fragrance components mainly in soaps, floral and oriental perfumes. The resinoid and absolute are used in most major food categories, including alcoholic and soft drinks.

ACTIONS: Anthelmintic, antispasmodic, bactericidal, carminative, diaphoretic, emmenagogue, fungicidal, stomachic.... styrax, levant