(Latin) One who is sleeping Dorrma, Dorrmah, Dormah
Causes The disease occurs in epidemics affecting especially children under the age of ten years. It is due to the varicella zoster virus, and the condition is an extremely infectious one from child to child. Although an attack confers life-long immunity, the virus may lie dormant and manifest itself in adult life as HERPES ZOSTER or shingles.
Symptoms There is an incubation period of 14–21 days after infection, and then the child becomes feverish or has a slight shivering, or may feel more severely ill with vomiting and pains in the back and legs. Almost at the same time, an eruption consisting of red pimples which quickly change into vesicles ?lled with clear ?uid appears on the back and chest, sometimes about the forehead, and less frequently on the limbs. These vesicles appear over several days and during the second day may show a change of their contents to turbid, purulent ?uid. Within a day or two they burst, or, at all events, shrivel up and become covered with brownish crusts. The small crusts have all dried up and fallen o? in little more than a week and recovery is almost always complete.
Treatment The fever can be reduced with paracetamol and the itching soothed with CALAMINE lotion. If the child has an immune disorder, is suffering from a major complication such as pneumonia, or is very unwell, an antiviral drug (aciclovir) can be used. It is likely to be e?ective only at an early stage. A vaccine is available in many parts of the world but is not used in the UK; the argument against its use is that it may delay chickenpox until adult life when the disease tends to be much more severe.... chickenpox
Symptoms: Two-to-four-day fever precedes a red rash which develops into clear blisters. Blisters dry up to form scabs that drop off leaving scars. Lesions and pain follow the path of the infected nerve. Pain described as intense, burning, itching: may persist for months as post-herpetic neuralgia. When virus affects the fifth cranial nerve vision will be impaired. In the elderly it may reveal some underlying malignancy. Patients having chemotherapy or radiotherapy are at risk.
Alternatives. Specific anti-viral therapy. Remedies in general use: Asafoetida, Jamaica Dogwood, Marigold, Mistletoe, Nettles, Passion flower, Poke root, Queen’s Delight, Valerian, Wild Lettuce, Wild Yam. St John’s Wort plays a role in reducing the long-lasting neuralgia. Echinacea imparts strength to endure the ordeal. The addition of a stomachic remedy (Gentian) to a prescription may prove beneficial. Mild short-term analgesics include: Oats, Valerian, Asafoetida, Passion flower, Wild Lettuce, Hops.
Tea. Formula. Equal parts: Oats, Nettles, St John’s Wort.
Decoction. Formula. Echinacea root 2; Valerian half; St John’s Wort 1.
Tablets. Formula. Hops BHP (1983) 45mg; Passion flower BHP (1983) 100mg; Extract Valerian 5:1 20mg. (Gerard 99)
Powders. Combine: Echinacea 2; Jamaican Dogwood 1; Gentian root 1. 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Tinctures. Alternatives. (1) Formula. Equal parts Goldenseal and Lupulin (Hops). Or, (2) Formula. Queen’s Delight 1; Valerian quarter; Goldenseal quarter; Asafoetida quarter. Dose: 1 teaspoon in water thrice daily.
Practitioner. Tincture Gelsemium: 5 drops (0.3ml) in water, as indicated, for pain.
Formula. Liquid Extract Hops, half an ounce; Liquid Extract Echinacea, 1oz; Tincture Goldenseal, 30 drops; Tincture Rhubarb BP, 1oz. Essence of Peppermint 20 drops. Water to 8oz. Dose: 2 teaspoons in water after meals. (Arthur Barker, FNIMH)
Topical. Aloe Vera. Houseleek – fresh juice or pulp. Evening Primrose oil. Wash with decoction of seaweed (Bladderwrack, Kelp): follow with Zinc and Castor oil cream or ointment. Slippery Elm made into a paste (powder mixed with few teaspoons of milk): apply after cleaning with Olive oil. Castor oil compress. Dilute Tea Tree oil. Ice-cube – 10 minutes on, 5 minutes off.
Russian study. Liquorice powder ointment.
Diet: Oatmeal porridge. Muesli with oats. Yoghurt. Wholefoods.
Supplementation. One high potency multivitamin daily. Anti-herpes amino acid L-lysine; one 500mg tablet, twice daily. Vitamin B12, 10mg daily. Upon relief, reduce L-lysine to one daily. (Dr L. Mervyn) Minerals: Calcium, Selenium, Zinc.
Self-Care. Resist temptation to touch sores. No sharing of face cloths, towels, etc.
Note: The chicken-pox virus is believed to lie dormant in nerve cells around the spine for many years, after people catch the childhood infection. Virgorous massage of the spine may trigger an attack by activating the dormant virus.
Information. Herpes Association, 41 North Road, London N7 9DP, UK. Send SAE. ... herpes zoster
Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.
SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.
The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.
HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper
limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.
Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.
Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.
The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.
Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.
with plaster of Paris. If closed traction does not work, then open reduction of the fracture may
be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.
External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.
Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.
Complications of fractures are fairly common. In non-union, the fracture does not unite
– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.
Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.
Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:
subcapital where the neck joins the head of the femur.
intertrochanteric through the trochanter.
subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur
need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.
In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.
Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.
Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.
The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.
Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).
Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.
Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.
Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.
By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.
Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.
Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.
Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.
Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.
With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.
Further information is available from the National Osteoporosis Society.
Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.
If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.
For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.
Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.
EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.
MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.
OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.
OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of
In cutaneous anthrax, a raised, itchy, area develops at the site of entry of the spores, progressing to a large blister and finally a black scab, with swelling of the surrounding tissues.
This is treatable with penicillin in its early stages.
Without treatment, the infection may spread to lymph nodes and the bloodstream, and may be fatal.
Pulmonary anthrax causes severe breathing difficulty and is fatal in most cases.... anthrax
In many cases, an outbreak of cold sores is preceded by tingling in the lips, followed by the formation of small blisters that enlarge, causing itching and soreness. Within a few days they burst and become encrusted. Most disappear within a week. The antiviral drug aciclovir in a cream may prevent cold sores if used at the first sign of tingling.... cold sore
Symptoms. Low backache, bleeding after intercourse, between periods or after ‘the change’. Abdominal swelling after 40 years of age. Sixty per cent of patients have no symptoms. Malodorous vaginal discharge. A positive cervical “pap” smear or cone-shaped biopsy examined by a pathologist confirms. Vaginal bleeding occurs in the later stages.
A letter in the New England Journal of Medicine suggests a strong link between increased risk of cervical cancer and cigarette smoking, nicotine being detected in the cervical fluids of cigarette smokers. This form of cancer is almost unknown in virgins living in closed communities such as those of the Church.
Conventional treatment is usually hysterectomy. Whatever treatment is adopted little ground is lost by supportive cleansing herbal teas. Mullein for pain.
Sponges loaded with powdered Goldenseal held against the cervix with a contraceptive cap can give encouraging results. Replace after three days. Vitamin A supplements are valuable to protect against the disease. The vitamin may also be applied topically in creams.
This form of cancer resists chemical treatment, but has been slowed down and halted by Periwinkle (Vinchristine) without damaging normal cells.
G.B. Ibotson, MD, reported disappearance of cancer of the cervix by infusions of Violet leaves by mouth and by vaginal injection. (Lancet 1917, i, 224)
In a study group of cervical cancer patients it was found that women with carcinoma in situ (CIS) were more likely to have a total Vitamin A intake below the pooled median (3450iu). Vitamin A supplementation is indicated together with zinc. (Bio-availability of Vitamin A is linked with zinc levels.) Vitamin A and zinc may be applied topically in creams and ointments.
Orthodox treatment: radiotherapy, chemotherapy, hysterectomy. As oestrogen can stimulate dormant cells the surgeon may wish to remove ovaries also. Whatever the decision, herbal supportive treatment may be beneficial. J.T Kent, MD, recommends Thuja and Shepherd’s Purse. Agents commonly indicated: Echinacea, Wild Indigo, Thuja, Mistletoe, Wild Yam. Herbal teas may be taken with profit. Dr Alfred Vogel advises Mistletoe from the oak (loranthus europaeus).
Other alternatives:– Teas. Red Clover, Violet, Mistletoe, Plantain, Clivers. 1-2 teaspoons to each cup boiling water. Infuse 15 minutes. 1 cup freely.
Decoctions. White Pond Lily. Thuja. Echinacea. Wild Yam. Any one.
Tablets/capsules. Echinacea. Goldenseal. Wild Yam. Thuja.
Formula No. 1. Red Clover 2; Echinacea 1; Shepherd’s Purse 1; Thuja quarter. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Formula No. 2. Equal parts: Poke root, Goldenseal, Mistletoe. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons.
Diet. Women who eat large quantities of meat and fatty foods are up to four times the risk of those eating mainly fruit and vegetables.
Vaginal injection. 1. Strong infusion Red Clover to which 10-15 drops Tincture Goldenseal is added. Follow with tampon smeared with Goldenseal Salve.
2. Strong decoction Yellow Dock to which 10-15 drops Tincture Goldenseal is added. Follow with tampon smeared with Goldenseal salve.
If bleeding is severe douche with neat distilled extract of Witch Hazel.
Chinese Herbalism. See – CANCER: CHINESE PRESCRIPTION. Also: Decoction of ssu-hsieh-lu (Galium gracile) 2-4 liang.
Advice. One-yearly smear test for all women over 40.
Diet. See: DIET – CANCER.
Treatment by a general medical practitioner or hospital oncologist. ... cancer – womb
Most people are infected with HSV1 at some point in their lives, usually during childhood. The initial infection may be symptomless, or may cause a flu-like illness with mouth ulcers. Thereafter, the virus remains dormant in nerve cells in the facial area. In many people, the virus is periodically reactivated, causing cold sores. Rarely, the virus infects the fingers, causing a painful eruption called a herpetic whitlow. HSV1 may produce eczema herpeticum (an extensive rash of skin blisters) in a person with a preexisting skin disorder, such as eczema. Eczema herpeticum may require hospital admission. If the virus gets into an eye, it may cause conjunctivitis or a corneal ulcer. Rarely, HSV1 spreads to the brain, leading to encephalitis. The virus may cause a potentially fatal generalized infection in a person with an immunodeficiency disorder or in someone taking immunosuppressant drugs. HSV2 is the usual cause of sexually transmitted genital herpes (see herpes, genital).
Treatment of herpes simplex depends on its type, site, and severity.
Antiviral drugs, such as aciclovir, may be helpful, particularly if used early in an infection.... herpes simplex
In about another 5 per cent of cases, bacteria held in a dormant state by the immune system become reactivated months, or even years, later. The infection may then progressively damage the lungs, forming cavities.
The primary infection is usually without symptoms. Progressive infection in the lungs causes coughing (sometimes bringing up blood), chest pain, shortness of breath, fever and sweating, poor appetite, and weight loss. Pleural effusion or pneumothorax may develop. The lung damage may be fatal.
A diagnosis is made from the symptoms and signs, from a chest X-ray, and from tests on the sputum. Alternatively, a bronchoscopy may also be carried out to obtain samples for culture.
Treatment is usually with a course of 3 or 4 drugs, taken daily for 2 months, followed by daily doses of isoniazid and rifampicin for 4–6 months. However, bacteria are increasingly resistant to the drugs used in treatment, and others may have to be used and treatment carried out for a longer period. If the full course of drugs is taken, most patients recover.
can be prevented by BCG vaccination, which is offered routinely at birth or age 10–14.
Any contacts of an infected person are traced and examined, and, if infected, are treated early to reduce the risk of the infection spreading.... tuberculosis
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