The term is also a street drug name for an amphetamine derivative, 3, 4-methylenedioxymethamphetamine or MDMA, increasingly used as a ‘recreational’ drug. It is classi?ed as a class A drug under the Misuse of Drugs Act 1971. MDMA is structurally similar to endogenous CATECHOLAMINES and produces central and peripheral sympathetic stimulation of alpha and beta ADRENERGIC RECEPTORS. It is taken into nerve terminals by the serotonin transporter and causes release of the NEUROTRANSMITTER substances serotonin and dopamine. Following this, SEROTONIN depletion is prolonged. As serotonin plays a major part in mood control, this leads to the characteristic ‘midweek depression’ experienced by MDMA users.

Several fatalities in young people have been attributed to adverse reactions resulting from MDMA use/abuse and possibly accompanying alcohol consumption. The principal effects are increase in pulse, blood pressure, temperature and respiratory rate. Additional complications such as cardiac ARRHYTHMIA, heatstroke-type syndrome, HYPONATRAEMIA and brain haemorrhage may occur. There is also concern over possible effects on the mental concentration and memory of those using ecstasy.

Management of patients who get to hospital is largely symptomatic and supportive but may include gastric decontamination, and use of DIAZEPAM as the ?rst line of treatment as it reduces central stimulation which may also reduce TACHYCARDIA, HYPERTENSION and PYREXIA.... ecstasy

Habitat: Moist meadows and pasture land.

Action: Diaphoretic, expectorant and diuretic.

Percutaneous nephroscope used for examining the interior of the kidney. It is passed into the pelvis of the kidney through a track from the surface of the skin. (The track is made with a needle and guide wire.) Instruments can be passed through the nephroscope under direct vision to remove calculi.

ANUS. Enemas may be given to clear the intestine of faeces prior to intestinal surgery or to relieve severe constipation. They may also be used to give barium for diagnostic X-rays as well as drugs such as CORTICOSTEROIDS, used to treat ULCERATIVE COLITIS. The patient is placed on his or her side with a support under the hips. A catheter (see CATHETERS) with a lubricated end is inserted into the rectum and warmed enema ?uid gently injected. Disposable enemas and miniature enemas, which can be self-administered, are widely used; they contain preprepared solution.... enema

Redness of the skin due to dilatation of dermal blood vessels. It may be transient or chronic, localised or widespread, and it can be blanched by pressure. Erythema may be caused by excessive exposure to heat or ultraviolet light, or by in?ammation of the skin due to infection, DERMATITIS, and various allergic reactions – for example, to drugs. It may be emotional (e.g. as in ?ushing), mediated by the autonomic nervous system.

Erythema ab igne is a ?xed redness of the skin caused by chronic exposure to heat from a domestic ?re or radiator.

Erythema pernio (See CHILBLAIN.) Redness induced by spasm of the skin arterioles due to cold. It affects the hands, feet or calves in winter. The red swollen areas are cooler than normal.

Erythema nodosum A singular pattern of red, tender nodules occurring on the shins, often lasting several weeks. It may be caused by a streptococcal throat infection, primary tuberculosis, SARCOIDOSIS, or may be drug-induced.

Erythema multiforme is an acute allergic eruption of the extremities characterised by circular areas of erythema, purpura and blistering, which resolve over two or three weeks, caused by infections or drugs. In severe forms the mucous membranes of the eyes, mouth and genitalia may be involved.

Erythema infectiosum is an acute contagious disease of children caused by a parvo-virus (see PARVOVIRUSES). In young children a bright erythema of the face gives a ‘slapped cheek’ appearance.

Habitat: Woods and hedges throughout Europe.

Action: Diaphoretic, emollient, alterative, diuretic.

Eruptions may be acute or chronic. Most of the acute eruptions belong to the exanthemata (see EXANTHEM): that is, they are bright in col-our and burst out suddenly like a ?ower. These are the eruptions of SCARLET FEVER, measles, German measles (see RUBELLA), SMALLPOX and chickenpox. In general, the severity of these diseases can be measured by the amount of eruption. Some eruptions are very transitory, like nettle-rash, appearing and vanishing again in the course of a few hours. (See also SKIN, DISEASES OF.)... eruption

Universal in?ammation of the skin may cause heart failure, particularly in elderly people with pre-existing heart disease. It may lead to HYPOTHERMIA due to excessive heat loss from the skin and protein de?ciency caused by the shedding of large quantities of skin scales containing keratin. Rarely, these complications can be fatal.

Treatment depends on the cause, but in eczematous erythroderma, oral CORTICOSTEROIDS (PREDNISOLONE) in full dosage may be needed.... erythroderma

Exophthalmos may also occur as a result of OEDEMA, injury, cavernous venous THROMBOSIS or a tumour at the back of the eye, pushing the eyeball forwards. In this situation it is always unilateral.... exophthalmos

(2) The term is also a colloquialism for public exposure by a man of his genitals to achieve sexual grati?cation.... exposure

Diseases There are several diseases that result from lesions to the extrapyramidal system, of which the most common is PARKINSONISM. Others include WILSON’S DISEASE, KERNICTERUS, CHOREA and ATHETOSIS.... extrapyramidal system

Habitat: Plentiful on commons, heaths, and in meadows, as well as on sea cliffs, but varies considerably in growth and development with the richness of the soil.

Action: Astringent and tonic.

Already genetic engineering is contributing to easing the problems of diagnosis. DNA analysis and production of MONOCLONAL ANTIBODIES are other applications of genetic engineering. Genetic engineering has signi?cantly contributed to horticulture and agriculture with certain characteristics of one organism or variant of a species being transfected (a method of gene transfer) into another. This has given rise to higher-yield crops and to alteration in colouring and size in produce. Genetic engineering is also contributing to our knowledge of how human genes function, as these can be transfected into mice and other animals which can then act as models for genetic therapy. Studying the effects of inherited mutations derived from human DNA in these animal models is thus a very important and much faster way of learning about human disease.

Genetic engineering is a scienti?c procedure that could have profound implications for the human race. Manipulating heredity would be an unwelcome activity under the control of maverick scientists, politicians or others in positions of power.... genetic engineering

Treatment Severe pre-eclampsia is an emergency, and urgent admission to hospital should be arranged. Treatment should be given to control the hypertension; the fetal heart rate carefully monitored; and in very severe cases urgent CAESAREAN SECTION may be necessary.... pre-eclampsia

Scrapie. Notifiable disease. Fatal disease in the nervous system of cattle, unknown before 1985. Microscopic holes appear in the brain giving a spongiform appearance, but with little inflammation. Can spread from one animal to another: sheep, goats, deer, mules, mink, hamsters, mice, pigs and monkeys. Cause: not a virus. Animals itch and scrape themselves against trees or posts for relief. May spread from animals to humans, with brain infection after the character of polio.

Symptoms. (Human). Speech impairment, short-term-memory-loss, difficulty in controlling body movements. Zinc deficiency.

Treatment. Hospitalisation.

Suggested treatment for human infection, unproven.

Tinctures. Echinacea 5; Black Cohosh 3; Yarrow 2; Senna leaf 1.2-3 teaspoons in water (or cup hot Yarrow tea) 3-4 times daily. For headache: Gelsemium.

Supplement: Zinc.

To be treated by a general medical practitioner or hospital specialist. ... bovine spongiform encephalopathy

Before the practitioner comes: instil into the ear: few drops Onion or Garlic juice, Houseleek, Aloe Vera or Plantain juice; oils of Mullein, St John’s Wort or Almond. Moistened Chamomile flower sachet; apply to ear to ease pain.

Feverfew. A traditional way to relieve was to hold the ear over hot steaming Feverfew tea.

Supportive: A number of strong yawns while pinching the nostrils and blowing the nose vigorously may free obstruction and normalise pressure on both sides of the drum. Hot foot baths divert blood from the head and reduce pain. ... earache

Constituents: indole alkaloids, tyramine, acetylcholine.

Action: abortifacient, parturient, haemostatic, hypertensive, uterine stimulant, oxytocic. Uses. Obstetrics.

Difficult childbirth. Applied to excite uterine contractions in the third stage of labour. Preparations. Liquid Extract. BPC 1954, dose, 0.6 to 1.2ml.

Registered medical practitioner only. ... ergot

Indicated: antibacterials. Pulsatilla (American Dispensary)

Alternatives. Teas. Cornsilk, Marshmallow leaves.

Decoction. Marshmallow root.

Tablets/capsules. Pulsatilla, Saw Palmetto. Echinacea. Goldenseal.

Powders. Formula. Equal parts, Saw Palmetto, Pulsatilla, Black Willow, pinch of Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) 3-4 times daily.

Liquid extracts. Alternatives. (1) Formula: equal parts: Black Willow, Echinacea, Pulsatilla. Dose: 30- 60 drops. (2) Echinacea 2; Saw Palmetto 2; Thuja 1. Dose: 30-60 drops. 3-4 times daily.

Topical. Scrotal ice packs. Cold Dogwood poultice. ... epididymitis

Symptoms: heavy sweating, failure of surface circulation, low blood pressure, weakness, cramps, rapid heartbeat, face is pale, cool and moist. Collapse. Recovery after treatment is rapid.

Alternatives. Cayenne pepper, or Tincture Capsicum, to promote peripheral circulation and sustain the heart. Prickly Ash bark restores vascular tone and stimulates capillary circulation. Bayberry offers a diffusive stimulant to promote blood flow, and Cayenne to increase arterial force.

Decoction. Combine equal parts Prickly Ash and Bayberry. 1 teaspoon to each cup water gently simmered 20 minutes. Half a cup (to which 3 drops Tincture Capsicum, or few grains red pepper is added). Dose: every 2 hours.

Tablets/capsules. Prickly Ash. Bayberry. Motherwort. Cayenne.

Tinctures. Formula. Prickly Ash 2; Horseradish 1; Bayberry 1. 15-30 drops in water every 2 hours. Traditional. Horseradish juice or grated root, in honey.

Life Drops. ... heat exhaustion

Symptoms (SLE): Loss of appetite, fever. Weight loss, weakness. Thickened scaly red patches on face (butterfly rash). May invade scalp and cause loss of hair. Sunlight worsens. Anaemia. Joint pains. Enlarged spleen. Heart disorders. Kidney weakness, with protein in the urine. Symptoms worse on exposure to sunlight. Low white blood cell count. Many patients may also present with Raynaud’s phenomenon while some women with silicone breast implants may develop lupus.

Treatment. Anti-virals. Alteratives. Anti-inflammatories, anticoagulants. Alternatives. Teas: Lime flowers, Gotu Kola, Ginkgo, Aloe Vera, Boneset.

Decoctions: Burdock. Queen’s Delight. Helonias.

Tablets/capsules. Echinacea. Blue Flag root. Wild Yam. Ginkgo.

Formula. Dandelion 1; Black Haw 1; Wild Yam half; Poke root half. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Topical. Sunlight barrier creams: Aloe Vera, Comfrey. Horsetail poultice. Garlic ointment. Castor oil packs.

Diet. See: DIET – SKIN DISORDERS.

Supplements. Calcium pantothenate, Vitamin A, Vitamin E, Selenium.

Note: The disorder is frequently misdiagnosed as rheumatoid arthritis, multiple sclerosis or ME. Lupus antibodies have been linked with premature heart disease in women and transient strokes. ... lupus erythematosus

Ben: Kesutthe, Kesraj;

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: High Saturated fat: Moderate Cholesterol: High Carbohydrates: Low Fiber: None Sodium: Moderate to high Major vitamin contribution: Vitamin A, riboflavin, vitamin D Major mineral contribution: Iron, calcium

About the Nutrients in This Food An egg is really three separate foods, the whole egg, the white, and the yolk, each with its own distinct nutritional profile. A whole egg is a high-fat, high-cholesterol, high-quality protein food packaged in a high-calcium shell that can be ground and added to any recipe. The proteins in eggs, with sufficient amounts of all the essential amino acids, are 99 percent digestible, the standard by which all other proteins are judged. The egg white is a high-protein, low-fat food with virtually no cholesterol. Its only important vitamin is riboflavin (vitamin B2), a vis- ible vitamin that gives egg white a slightly greenish cast. Raw egg whites contain avidin, an antinutrient that binds biotin a B complex vitamin for- merly known as vitamin H, into an insoluble compound. Cooking the egg inactivates avidin. An egg yolk is a high-fat, high-cholesterol, high-protein food, a good source of vitamin A derived from carotenes eaten by the laying hen, plus vitamin D, B vitamins, and heme iron, the form of iron most easily absorbed by your body. One large whole egg (50 g/1.8 ounce) has five grams fat (1.5 g satu- rated fat, 1.9 g monounsaturated fat, 0.7 g polyunsaturated fat), 212 mg cholesterol, 244 IU vitamin A (11 percent of the R DA for a woman, 9 percent * Values are for a whole egg. of the R DA for a man), 0.9 mg iron (5 percent of the R DA for a woman, 11 percent of the R DA for a man) and seven grams protein. The fat in the egg is all in the yolk. The protein is divided: four grams in the white, three grams in the yolk.

The Most Nutritious Way to Serve This Food With extra whites and fewer yolks to lower the fat and cholesterol per serving.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet

Buying This Food Look for: Eggs stored in the refrigerated dair y case. Check the date for freshness. NOTE : In 1998, the FDA and USDA Food Safety and Inspection Service (FSIS) proposed new rules that would require distributors to keep eggs refrigerated on the way to the store and require stores to keep eggs in a refrigerated case. The egg package must have a “refrigera- tion required” label plus safe-handling instructions on eggs that have not been treated to kill Salmonella. Look for: Eggs that fit your needs. Eggs are graded by the size of the yolk and the thick- ness of the white, qualities that affect appearance but not nutritional values. The higher the grade, the thicker the yolk and the thicker the white will be when you cook the egg. A Grade A A egg fried sunny side up will look much more attractive than a Grade B egg prepared the same way, but both will be equally nutritions. Egg sizes ( Jumbo, Extra large, Large, Medium, Small) are determined by how much the eggs weigh per dozen. The color of the egg’s shell depends on the breed of the hen that laid the egg and has nothing to do with the egg’s food value.

Storing This Food Store fresh eggs with the small end down so that the yolk is completely submerged in the egg white (which contains antibacterial properties, nature’s protection for the yolk—or a developing chick embryo in a fertilized egg). Never wash eggs before storing them: The water will make the egg shell more porous, allowing harmful microorganisms to enter. Store separated leftover yolks and whites in small, tightly covered containers in the refrigerator, where they may stay fresh for up to a week. Raw eggs are very susceptible to Salmonella and other bacterial contamination; discard any egg that looks or smells the least bit unusual. Refrigerate hard-cooked eggs, including decorated Easter eggs. They, too, are suscep- tible to Salmonella contamination and should never be left at room temperature.

Preparing This Food First, find out how fresh the eggs really are. The freshest ones are the eggs that sink and lie flat on their sides when submerged in cool water. These eggs can be used for any dish. By the time the egg is a week old, the air pocket inside, near the broad end, has expanded so that the broad end tilts up as the egg is submerged in cool water. The yolk and the white inside have begun to separate; these eggs are easier to peel when hard-cooked. A week or two later, the egg’s air pocket has expanded enough to cause the broad end of the egg to point straight up when you put the egg in water. By now the egg is runny and should be used in sauces where it doesn’t matter if it isn’t picture-perfect. After four weeks, the egg will float. Throw it away. Eggs are easily contaminated with Salmonella microorganisms that can slip through an intact shell. never eat or serve a dish or bever age containing r aw fr esh eggs. sa lmonella is destroyed by cooking eggs to an inter nal temper atur e of 145°f ; egg-milk dishes such as custar ds must be cooked to an inter nal temper atur e of 160°f. If you separate fresh eggs by hand, wash your hands thoroughly before touching other food, dishes, or cooking tools. When you have finished preparing raw eggs, wash your hands and all utensils thoroughly with soap and hot water. never stir cooked eggs with a utensil used on r aw eggs. When you whip an egg white, you change the structure of its protein molecules which unfold, breaking bonds between atoms on the same molecule and forming new bonds to atoms on adjacent molecules. The result is a network of protein molecules that hardens around air trapped in bubbles in the net. If you beat the whites too long, the foam will turn stiff enough to hold its shape even if you don’t cook it, but it will be too stiff to expand natu- rally if you heat it, as in a soufflé. When you do cook properly whipped egg white foam, the hot air inside the bubbles will expand. Ovalbumin, an elastic protein in the white, allows the bubble walls to bulge outward until they are cooked firm and the network is stabilized as a puff y soufflé. The bowl in which you whip the whites should be absolutely free of fat or grease, since the fat molecules will surround the protein molecules in the egg white and keep them from linking up together to form a puff y white foam. Eggs whites will react with metal ions from the surface of an aluminum bowl to form dark particles that discolor the egg-white foam. You can whip eggs successfully in an enamel or glass bowl, but they will do best in a copper bowl because copper ions bind to the egg and stabilize the foam.

What Happens When You Cook This Food When you heat a whole egg, its protein molecules behave exactly as they do when you whip an egg white. They unfold, form new bonds, and create a protein network, this time with molecules of water caught in the net. As the egg cooks, the protein network tightens, squeez- ing out moisture, and the egg becomes opaque. The longer you cook the egg, the tighter the network will be. If you cook the egg too long, the protein network will contract strongly enough to force out all the moisture. That is why overcooked egg custards run and why overcooked eggs are rubbery. If you mix eggs with milk or water before you cook them, the molecules of liquid will surround and separate the egg’s protein molecules so that it takes more energy (higher heat) to make the protein molecules coagulate. Scrambled eggs made with milk are softer than plain scrambled eggs cooked at the same temperature. When you boil an egg in its shell, the air inside expands and begins to escape through the shell as tiny bubbles. Sometimes, however, the force of the air is enough to crack the shell. Since there’s no way for you to tell in advance whether any particular egg is strong enough to resist the pressure of the bubbling air, the best solution is to create a safety vent by sticking a pin through the broad end of the egg before you start to boil it. Or you can slow the rate at which the air inside the shell expands by starting the egg in cold water and letting it warm up naturally as the water warms rather than plunging it cold into boiling water—which makes the air expand so quickly that the shell is virtually certain to crack. As the egg heats, a little bit of the protein in its white will decompose, releasing sulfur that links up with hydrogen in the egg, forming hydrogen sulfide, the gas that gives rot- ten eggs their distinctive smell. The hydrogen sulfide collects near the coolest part of the egg—the yolk. The yolk contains iron, which now displaces the hydrogen in the hydrogen sulfide to form a green iron-sulfide ring around the hard-cooked yolk.

How Other Kinds of Processing Affect This Food Egg substitutes. Fat-free, cholesterol-free egg substitutes are made of pasteurized egg whites, plus artificial or natural colors, flavors, and texturizers (food gums) to make the product look and taste like eggs, plus vitamins and minerals to produce the nutritional equivalent of a full egg. Pasteurized egg substitutes may be used without additional cooking, that is, in salad dressings and eggnog. Drying. Dried eggs have virtually the same nutritive value as fresh eggs. Always refrigerate dried eggs in an air- and moistureproof container. At room temperature, they will lose about a third of their vitamin A in six months.

Medical Uses and/or Benefits Protein source. The protein in eggs, like protein from all animal foods, is complete. That is, protein from animal foods provides all the essential amino acids required by human beings. In fact, the protein from eggs is so well absorbed and utilized by the human body that it is considered the standard by which all other dietary protein is measured. On a scale known as biological value, eggs rank 100 ; milk, 93; beef and fish, 75; and poultry, 72. Vision protection. The egg yolk is a rich source of the yellow-orange carotenoid pigments lutein and zeaxanthin. Both appear to play a role in protecting the eyes from damaging ultraviolet light, thus reducing the risk of cataracts and age-related macular degeneration, a leading cause of vision of loss in one-third of all Americans older than 75. Just 1.3 egg yolks a day appear to increase blood levels of lutein and zeaxanthin by up to 128 percent. Perhaps as a result, data released by the National Eye Institute’s 6,000-person Beaver Dam ( Wisconsin) Eye Study in 2003 indicated that egg consumption was inversely associated with cataract risk in study participants who were younger than 65 years of age when the study started. The relative risk of cataracts was 0.4 for people in the highest category of egg consumption, compared to a risk of 1.0 for those in the lowest category. External cosmetic effects. Beaten egg whites can be used as a facial mask to make your skin look smoother temporarily. The mask works because the egg proteins constrict as they dry on your face, pulling at the dried layer of cells on top of your skin. When you wash off the egg white, you also wash off some of these loose cells. Used in a rinse or shampoo, the pro- tein in a beaten raw egg can make your hair look smoother and shinier temporarily by filling in chinks and notches on the hair shaft.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Although egg yolks are high in cholesterol, data from several recent studies suggest that eating eggs may not increase the risk of heart disease. In 2003, a report from a 14-year, 177,000-plus person study at the Harvard School of Public Health showed that people who eat one egg a day have exactly the same risk of heart disease as those who eat one egg or fewer per week. A similar report from the Multiple R isk Factor Intervention Trial showed an inverse relationship between egg consumption and cholesterol levels—that is, people who ate more eggs had lower cholesterol levels. Nonetheless, in 2006 the National Heart, Lung, and Blood Institute still recommends no more than four egg yolks a week (including the yolk in baked goods) for a heart-healthy diet. The American Heart Association says consumers can have one whole egg a day if they limit cholesterol from other sources to the amount suggested by the National Cholesterol Education Project following the Step I and Step II diets. (Both groups permit an unlimited number of egg whites.) The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Food poisoning. Raw eggs (see above) and egg-rich foods such as custards and cream pies are excellent media for microorganisms, including the ones that cause food poisoning. To protect yourself against egg-related poisoning, always cook eggs thoroughly: poach them five minutes over boiling water or boil at least seven minutes or fry two to three minutes on each side (no runny center) or scramble until firm. Bread with egg coating, such as French toast, should be cooked crisp. Custards should be firm and, once cooked, served very hot or refrigerated and served very cold. Allergic reaction. According to the Merck Manual, eggs are one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach. The others are berries (blackberries, blueberries, raspberries, strawberries), choco- late, corn, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).

Food/Drug Interactions Sensitivity to vaccines. Live-virus measles vaccine, live-virus mumps vaccine, and the vac- cines for influenza are grown in either chick embryo or egg culture. They may all contain minute residual amounts of egg proteins that may provoke a hypersensitivity reaction in people with a history of anaphylactic reactions to eggs (hives, swelling of the mouth and throat, difficulty breathing, a drop in blood pressure, or shock).... eggs

The ?rst ‘test-tube baby’ – to use the popular, and widely used, term for such a child – was born by CAESAREAN SECTION in England on 25 July 1978. Many other children conceived in this manner have since been born, and, though only 10 per cent of women conceive at the ?rst attempt, the overall success rate is improving. Embryo transplantation and research are controversial procedures and in many countries, including the UK, are controlled by legislation. Embryo transfer and research using embryos are regulated by the Human Fertilisation & Embryology Authority (see ASSISTED CONCEPTION; APPENDIX 7: STATUTORY ORGANISATIONS).... embryo transfer

Adrenal glands These two glands, also known as suprarenal glands, lie immediately above the kidneys. The central or medullary portion of the glands forms the secretions known as ADRENALINE (or epinephrine) and NORADRENALINE. Adrenaline acts upon structures innervated by sympathetic nerves. Brie?y, the blood vessels of the skin and of the abdominal viscera (except the intestines) are constricted, and at the same time the arteries of the muscles and the coronary arteries are dilated; systolic blood pressure rises; blood sugar increases; the metabolic rate rises; muscle fatigue is diminished. The super?cial or cortical part of the glands produces steroid-based substances such as aldosterone, cortisone, hydrocortisone, and deoxycortone acetate, for the maintenance of life. It is the absence of these substances, due to atrophy or destruction of the suprarenal cortex, that is responsible for the condition known as ADDISON’S DISEASE. (See CORTICOSTEROIDS.)

Ovaries and testicles The ovary (see OVARIES) secretes at least two hormones – known, respectively, as oestradiol (follicular hormone) and progesterone (corpus luteum hormone). Oestradiol develops (under the stimulus of the anterior pituitary lobe – see PITUITARY GLAND below, and under separate entry) each time an ovum in the ovary becomes mature, and causes extensive proliferation of the ENDOMETRIUM lining the UTERUS, a stage ending with shedding of the ovum about 14 days before the onset of MENSTRUATION. The corpus luteum, which then forms, secretes both progesterone and oestradiol. Progesterone brings about great activity of the glands in the endometrium. The uterus is now ready to receive the ovum if it is fertilised. If fertilisation does not occur, the corpus luteum degenerates, the hormones cease acting, and menstruation takes place.

The hormone secreted by the testicles (see TESTICLE) is known as TESTOSTERONE. It is responsible for the growth of the male secondary sex characteristics.

Pancreas This gland is situated in the upper part of the abdomen and, in addition to the digestive enzymes, it produces INSULIN within specialised cells (islets of Langerhans). This controls carbohydrate metabolism; faulty or absent insulin production causes DIABETES MELLITUS.

Parathyroid glands These are four minute glands lying at the side of, or behind, the thyroid (see below). They have a certain e?ect in controlling the absorption of calcium salts by the bones and other tissues. When their secretion is defective, TETANY occurs.

Pituitary gland This gland is attached to the base of the brain and rests in a hollow on the base of the skull. It is the most important of all endocrine glands and consists of two embryologically and functionally distinct lobes.

The function of the anterior lobe depends on the secretion by the HYPOTHALAMUS of certain ‘neuro-hormones’ which control the secretion of the pituitary trophic hormones. The hypothalamic centres involved in the control of speci?c pituitary hormones appear to be anatomically separate. Through the pituitary trophic hormones the activity of the thyroid, adrenal cortex and the sex glands is controlled. The anterior pituitary and the target glands are linked through a feedback control cycle. The liberation of trophic hormones is inhibited by a rising concentration of the circulating hormone of the target gland, and stimulated by a fall in its concentration. Six trophic (polypeptide) hormones are formed by the anterior pituitary. Growth hormone (GH) and prolactin are simple proteins formed in the acidophil cells. Follicle-stimulating hormone (FSH), luteinising hormone (LH) and thyroid-stimulating hormone (TSH) are glycoproteins formed in the basophil cells. Adrenocorticotrophic hormone (ACTH), although a polypeptide, is derived from basophil cells.

The posterior pituitary lobe, or neurohypophysis, is closely connected with the hypothalamus by the hypothalamic-hypophyseal tracts. It is concerned with the production or storage of OXYTOCIN and vasopressin (the antidiuretic hormone).

PITUITARY HORMONES Growth hormone, gonadotrophic hormone, adrenocorticotrophic hormone and thyrotrophic hormones can be assayed in blood or urine by radio-immunoassay techniques. Growth hormone extracted from human pituitary glands obtained at autopsy was available for clinical use until 1985, when it was withdrawn as it is believed to carry the virus responsible for CREUTZFELDT-JAKOB DISEASE (COD). However, growth hormone produced by DNA recombinant techniques is now available as somatropin. Synthetic growth hormone is used to treat de?ciency of the natural hormone in children and adults, TURNER’S SYNDROME and chronic renal insu?ciency in children.

Human pituitary gonadotrophins are readily obtained from post-menopausal urine. Commercial extracts from this source are available and are e?ective for treatment of infertility due to gonadotrophin insu?ciency.

The adrenocorticotrophic hormone is extracted from animal pituitary glands and has been available therapeutically for many years. It is used as a test of adrenal function, and, under certain circumstances, in conditions for which corticosteroid therapy is indicated (see CORTICOSTEROIDS). The pharmacologically active polypeptide of ACTH has been synthesised and is called tetracosactrin. Thyrotrophic hormone is also available but it has no therapeutic application.

HYPOTHALAMIC RELEASING HORMONES which affect the release of each of the six anterior pituitary hormones have been identi?ed. Their blood levels are only one-thousandth of those of the pituitary trophic hormones. The release of thyrotrophin, adrenocorticotrophin, growth hormone, follicle-stimulating hormone and luteinising hormone is stimulated, while release of prolactin is inhibited. The structure of the releasing hormones for TSH, FSH-LH, GH and, most recently, ACTH is known and they have all been synthesised. Thyrotrophin-releasing hormone (TRH) is used as a diagnostic test of thyroid function but it has no therapeutic application. FSH-LH-releasing hormone provides a useful diagnostic test of gonadotrophin reserve in patients with pituitary disease, and is now used in the treatment of infertility and AMENORRHOEA in patients with functional hypothalamic disturbance. As this is the most common variety of secondary amenorrhoea, the potential use is great. Most cases of congenital de?ciency of GH, FSH, LH and ACTH are due to defects in the hypothalamic production of releasing hormone and are not a primary pituitary defect, so that the therapeutic implication of this synthesised group of releasing hormones is considerable.

GALACTORRHOEA is frequently due to a microadenoma (see ADENOMA) of the pituitary. DOPAMINE is the prolactin-release inhibiting hormone. Its duration of action is short so its therapeutic value is limited. However, BROMOCRIPTINE is a dopamine agonist with a more prolonged action and is e?ective treatment for galactorrhoea.

Thyroid gland The functions of the thyroid gland are controlled by the pituitary gland (see above) and the hypothalamus, situated in the brain. The thyroid, situated in the front of the neck below the LARYNX, helps to regulate the body’s METABOLISM. It comprises two lobes each side of the TRACHEA joined by an isthmus. Two types of secretory cells in the gland – follicular cells (the majority) and parafollicular cells – secrete, respectively, the iodine-containing hormones THYROXINE (T4) and TRI-IODOTHYRONINE (T3), and the hormone CALCITONIN. T3 and T4 help control metabolism and calcitonin, in conjunction with parathyroid hormone (see above), regulates the body’s calcium balance. De?ciencies in thyroid function produce HYPOTHYROIDISM and, in children, retarded development. Excess thyroid activity causes thyrotoxicosis. (See THYROID GLAND, DISEASES OF.)... endocrine glands

The purpose of enteral feeding is to give a liquid, low-residue food through a naso-gastric feeding tube. It has the advantage over parenteral nutrition that the septic complications of insertion of CATHETERS into veins are avoided. Enteral feeding may either take the form of intermittent feeding through a large-bore naso-gastric tube, or of continuous gravity-feeding through a ?ne-bore tube.

A number of proprietary enteral foods are available. Some contain whole protein as the nitrogen source; others – and these are called elemental diets – contain free amino acids. DIARRHOEA is the most common problem with enteral feeding and it tends to occur when enteral feeding is introduced too rapidly or with too strong a preparation.... enteral feeding

Dental erosion is the loss of tooth substance due to a cause other than decay or trauma. This is usually as a result of the presence of acid; for example, frequent vomiting or the excessive intake of citrus fruits. The teeth appear very smooth and later develop saucer-shaped depressions.... erosion

Habitat: The plant is seen only on the sand dunes of the sea shore.

Action: Eryngo root is a diaphoretic, diuretic and expectorant.

(e.g. arsenic, mercury and thallium). Treatment is unsatisfactory but aspirin provides sympomatic relief.... erythromelalgia

Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.

Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.

A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.

Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.

An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.

The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.

In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics

(2) The act of dying.... expiration

– Local anaesthetics: epidural.)... extradural

In cases of prolongation of the ?rst stage of labour, the ventouse may be used to accelerate dilatation of the cervix – provided that the cervix is already su?ciently dilated to allow application of the cup. The ventouse cannot be applied to the breech or face; in urgent cases of fetal distress the operation takes too long, and forceps delivery is preferred. There is some doubt about its safety when used on premature babies; many obstetricians feel that forceps delivery reduces the risk of intracranial haemorrhage. The vacuum extractor, while resulting in a slower delivery than when forceps are used, has a lower risk of damage to the mother’s birth canal. (See PREGNANCY AND LABOUR – Some complications of labour.)... vacuum extractor

ERUPTION. A lesion on the skin, red and raised above the surface. See appropriate skin disease. ERUCTATION. See: REFLUX. ... erotomania

Tre atme nt. Bedrest where necessary. Treat underlying cause which may be ulcerative colitis, tuberculosis, toxicity from The Pill, drug reactions.

Alternatives:– Tea. Red Clover, Gotu Kola, Clivers. Combine. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes; half-1 cup thrice daily.

Tablets/capsules. Blue Flag root, Devil’s Claw, Poke root, Seaweed and Sarsaparilla, Wild Yam. Formula. Burdock 1; Dandelion 2; Sarsaparilla 1. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water.

Diet. See: DIET – SKIN DISEASES.

Note: Erythema nodosum associated with Crohn’s disease, more frequently recognised in childhood. ... erythema nodosum

internal bleeding or to cut off the blood supply to a tumour. In the latter case, the technique can relieve pain; cause the tumour to shrivel, making surgical removal easier; or stop the tumour from spreading. Embolization can also be used to block flow through vascular abnormalities such as haemangiomas both in the skin and the internal organs. A catheter is introduced into a blood vessel near the one to be blocked and the embolus that will block the vessel is released through the catheter. Emboli are made of materials such as bloodclotting agents or silicone.... embolization

Causes: fungal or bacterial infections acquired when swimming, scratching with dirty fingernails, diabetes mellitus, eczema or excessive sweating.

Symptoms: earache, itching, discharge, moderate deafness.

Alternative Treatment:– Tea. Combine equal parts: Nettles, Clivers, Red Clover. 1-2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.

Tablets/capsules. Echinacea. Blue Flag. Garlic. Poke root. Red Clover. Devil’s Claw. Thuja.

Powders. Combine parts: Echinacea 2; Blue Flag 1; Thuja quarter; Liquorice quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Combine parts: Echinacea 2; Devil’s Claw 1; Goldenseal quarter; Liquorice quarter. Dose: 1-2 teaspoons, thrice daily.

Evening Primrose. 4 × 500mg capsules daily.

Cider Vinegar: 2-3 teaspoons in glass water, 2-3 times daily.

Topical. Dry conditions: Jojoba oil, Mullein oil. Evening Primrose oil.

Moist suppurative conditions: Goldenseal Drops (see entry).

Simple inflammation without discharge: warm drops Houseleek juice. Pack external ear with saturated cotton wool.

Diet and supplements: same as for otitis media. ... otitis externa

Common endodontic procedures are root-canal treatment and pulpotomy.... endodontics

Disorders of the elbow include arthritis and injuries to the joint and its surrounding muscles, tendons, and ligaments. Repetitive strain on the tendons of the muscles of the forearm, where they attach to the elbow, can result in an inflammation that is known as epicondylitis. There are 2 principle types of epicondylitis: tennis elbow and golfer’s elbow. Alternatively, a sprain of the ligaments may occur. Olecranon bursitis develops over the tip of the elbow in response to local irritation. Strain on the joint can produce an effusion or traumatic synovitis. A fall on to the hand or on to the elbow can cause a fracture or dislocation.elderly, care of the Appropriate care to help minimize physical and mental deterioration in the elderly. For example, failing vision and hearing are often regarded as inevitable in old age, but removal of a cataract or use of a hearing-aid can often improve quality of life. Isolation or inactivity leads to depression in some elderly people. Attending a day-care centre can provide social contact and introduce new interests.

Many elderly people are cared for by family members. Voluntary agencies can often provide domestic help to ease the strain on carers. Sheltered housing allows independence while providing assistance when needed. Elderly people who have dementia or physical disability usually require supervision in a residential care or hospital setting. (See also geriatric medicine.)... elbow

OENOTHERA BIENNIS, commonly known as the evening primrose. The oil contains an anti-inflammatory substance called gamolenic acid, and is believed by some to be of benefit in treating eczema and premenstrual syndrome.... evening primrose oil

When a viral infection such as a cold causes blockage of the eustachian tube, equalization cannot occur, resulting in severe pain and temporary impairment of hearing. A person with a blocked eustachian tube who is subjected to rapid pressure changes may suffer from barotrauma. Glue ear or chronic otitis media may occur if the tube is blocked, preventing adequate drainage from the middle ear. These conditions, which often result in partial hearing loss are more common in children. This is partly because their adenoids are larger and more likely to cause a blockage if they become infected and partly because children’s eustachhian tubes are shorter than those of adults.... eustachian tube

The sarcoma is diagnosed by X-rays and a biopsy.

If cancer is found, the whole skeleton is examined by X-rays and radionuclide scanning, and the lungs viewed by CT scanning, to determine if, and how far, the cancer has spread.

Treatment is with radiotherapy and anticancer drugs.

If the cancer has not spread, the outlook is good.... ewing’s sarcoma

The eyelids are held in place by ligaments attached to the socket’s bony edges.

They consist of thin plates of fibrous tissue (called tarsal plates) covered by muscle and a thin layer of skin.

The inner layer is covered by an extension of the conjunctiva.

Along the edge of each lid are two rows of eyelashes.

Immediately behind the eyelashes are the openings of the ducts leading from the meibomian glands, which secrete the oily part of the tear film.

The lids act as protective shutters, closing as a reflex action if anything approaches the eye.

They also smear the tear film across the cornea.... eyelid

The experience, which is thought to be due to disturbance of brain function, is reported by some patients following a general anaesthetic or a medical emergency.... out-of-body experience

PET scanning.... positron emission tomography

• boil the dried roots of the plant ( 20 to 25 minutes)
• allow the mix to steep (5 minutes)
• drink it slowly

• fight kidney stones and bladder infections
• alleviate fever
• counter jaundice
• ease symptoms of arthritis and rheumatism
• fight gonorrhea
• treat anemia

A&E Medicine is a relatively new specialty in the UK and there are still inadequate numbers of consultants and trainees, despite an inexorable rise in the number of patients attending A&E departments. With a similar rise in hospital admissions there is often no bed available immediately for casualties, resulting in backlogs of patients waiting for treatment. A major debate in the specialty is about the likely need to centralise services by downgrading or closing smaller units, in order to make the most e?cient use of sta?.

See www.baem.org.uk... accident and emergency medicine

Habitat: The Himalayas from Kashmir to West Bengal at 9003,000 m, and in Arunachal Pradesh, Nagaland and Meghalaya.

Action: Astringent, anti- inflammatory, hepatic, cholagogue, diuretic, mild haemostatic, antibacterial. Used for irritations and infections of the intestinal tract, gallbladder diseases, hyperacidity, colic, urinary disorders (bed- wetting, incontinence), sluggish liver, mucus membrane inflammations; externally for ulcerated and discharging skin, psoriasis and seborrhoic eczemas.

Habitat: Temperate Himalaya from Kashmir to Kumaon at 600-2700 m.

Action: Plant—febrifuge; used as a substitute for Swertia chirayita.

Habitat: Bihar, Madhya Pradesh, Gujarat, Orissa and southern India.

Action: Bark—bitter, astringent, febrifuge, anthelminitic, antispas- modic, expectorant (used in asthma, bronchitis). Also used for dysentery as a substitute for Holarrhena antidysenterica.

Habitat: Assam and Arunachal Pradesh.

Action: Resin—carminative, stomachic, antiscorbutic expectorant, antipyretic, anti-inflammatory, antistress, hepatoprotective. Externally used in scabies and leucoderma.

Habitat: Warmer parts of India. Folk: Ranchimani (Maharashtra).

Action: Febrifuge, diuretic.

Habitat: Punjab and western Rajasthan.

Action: Roots—diuretic. Used for urinary discharges and dys- menorrhoea. Seeds—deobstruent, resolvent, diuretic (used in strangury and sexual debility). Powdered plant is applied locally on infections of the genitals and on burns.

Habitat: Uttar Pradesh, Maharashtra, Karnataka, Tamil Nadu, Kerala.

Action: Juice of the herb— carminative. A warm infusion of leaves is given as a sudorific, while a cold infusion is considered diuretic and emmenagogue. The oil possesses significant antibacterial and antifungal properties. The oil also shows insecticidal activity.

• add one teaspoonful of dried bugleweed herbs to a cup of boiling water
• allow the mixture to steep for 10-15 minutes

• treat hyperthyroidism
• alleviate cyclic breast pain in women by moderating estrogen levels
• sedate and calm the nerves
• suppress cough and fighting tuberculosis and other disorders of the lungs
• moderate a rapid heart rate
• remove excess fluid in the body and promote better circulation
• accelerate the healing of bruises and other wounds (when applied topically)

Habitat: Peninsular India, up to 1,800 m.

Action: Root—antidiabetic (used in milder chronic diabetic cases), astringent, liver tonic. Frequently adulterated with the roots of Salacia chinensis Linn. and S. macrosperma Wight.

Habitat: Cultivated in coastal regions of Peninsular India.

Action: Bark—astringent, an- tidiarrhoeal. Leaf—antispasmodic, used in colic. Aerial parts— hypoglycaemic.

Habitat: Native to the Mediterranean region, cultivated mainly in Northern India.

Action: Plant—antibilious. Root— demulcent, febrifuge, diuretic; used in dyspepsia; as a tonic for liver and digestive system. Milder than C. intybus.

Habitat: Cultivated throughout India.

Action: Juice from petiole—styptic, rubefacient. Juice of corn—used in alopaecia.

Eadah, Eadia, Eadea, Eadiah, Eadeah, Eadda, Eaddah... eada

Eadburgah, Edburga, Eadburgia, Eadburgea, Edburgia, Edburgea... eadburga

Habitat: Punjab, Uttar Pradesh, Bihar, West Bengal, Gujarat, Madhya Pradesh and Peninsular India.

Action: Laxative. Root used during later stages of dysentery and chronic mucous enteritis; also in syphilitic rheumatism. The herb shows no apparent effect on acute dysentery.

The new Council for Healthcare Regulatory Excellence will help to promote the interests of patients and to improve co-operation between the existing regulatory bodies – providing, in e?ect, a quality-control mechanism for their activities. The government and relevant professions will nominate individuals for this overarching council. The new council will not have the authority to intervene in the determination by the eight regulatory bodies of individual ?tness-to-practise cases unless these concern complaints about maladministration.... council for healthcare regulatory excellence

Habitat: A parasitic climber, occuring in Europe, Asia, South Africa.

Action: Hepatic, laxative, carminative.

Habitat: Indigenous to West Asia and North Africa; occurring scattered from Punjab to Nilgiri hills as a grass-like sedge. English: Earth Almond, Chufa, Rush Nut, Tiger Nut. (Tuber is called Nut.) Ayurvedic: Chichoda.Folk: Chichodaa, Kaseru (Punjab). Also equated with Naagaramustaka.

Action: A digestive tonic (used for indigestion, flatulence, colic, diarrhoea, dysentery); promotes diuresis and menstruation. The juice is taken for treating ulcers of the mouth and gums.Tiger Nut is used in debility and as a nervine tonic due to its high crude lipid and carbohydrate contents and fairly good essential amino acid composition.... cyperus esculentus

Habitat: Madhya Pradesh, Uttar Pradesh, Orissa, Bengal, Assam and the Andamans.

Action: Tubers are starchy and free from dioscorine, contain 71.29% carbohydrates, 10.82% albuminoids.... dioscorea esculenta

Ealasayd, Ealasaida, Ealasayda... ealasaid

Earli, Earlie, Earley, Earlee, Earleigh, Earlea, Earleah... early

Habitat: Orissa and South India.

Action: Plant—astringent, attenuant, lithontriptic.

Habitat: Throughout India in shady wet places and near streams.

Action: Fruit and stem bark— astringent. Infusion of fruits—used as gargle in aphthae and sore throat. Fruit juice—used as application for wounds and ulcers. Oil of seeds— given in diarrhoea and dysentery Ether extract of fruit—antibacterial. Bark—astringent and styptic, used in menorrhagia, diarrhoea, dysentery and intermittent fevers.

Eathelreda, Eathellredia, Eathellredea, Eathelredia, Eathelredea, Ethelreda, Ethellreda... eathellreda

Ebbah, Ebby, Ebbie, Ebbee, Ebbi, Ebbey, Ebbe, Ebb, Ebbea, Ebbeah... ebba

Treatment As the disease can be neither prevented nor cured, treatment is supportive, with strict anti-infection procedures essential as human-to-human transmission can occur via skin and mucous-membrane contacts. Incubation period is 5–10 days. Fever with MYALGIA and headache occur initially, often accompanied by abdominal and chest symptoms. Haemorrhagic symptoms soon develop and the victim either starts to improve in the second week or develops multi-organ failure and lapses into a coma. Mortality ranges from 25 to 90 per cent.... ebola virus disease

Ebrell, Ebrele, Ebrelle, Ebriel, Ebriell, Ebriele, Ebrielle... ebrel

Ebrona, Ebronna, Ebronnah, Ebronia, Ebronea, Ebroniah, Ebroneah... ebronah

Eastere, Eastre, Eastir, Eastar, Eastor, Eastera, Easteria, Easterea... easter

Eathelyn, Eathelinn, Eathelynn, Eathelina, Eathelyna, Ethelin, Ethelyn, Eathelen, Eathelena... eathelin

Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.

Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).

The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.

There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.

Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.

If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.

About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.

Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.

Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.

Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.

Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders

Habitat: Mediterranean region and Western Asia.

Action: Hydragogue; employed for the evacuation of dropsy, especially in nephritic patients. Root—used to treat skin diseases and parasitic scalp diseases; also for scirrhous eruptions.

Habitat: Northeastern Peninsular India.

Action: Plant—used in gout and dysuria; decoction of leaves for stricture. Roots—given in jaundice, menorrhagia and rheumatism.... ecbolium linneanum

Echidnia, Echidnea, Ekidna, Eckidna, Ekidnea, Eckidnea... echidna

Habitat: Cultivated in Maharashtra, Madhya Pradesh, Uttar Pradesh, Karnataka, Tamil Nadu, Bihar and Andhra Pradesh.

Action: Diuretic.

Habitat: Cultivated mainly in Maharashtra, Madhya Pradesh, Karnataka, Tamil Nadu and Andhra Pradesh.

Action: Whole plant—used for diseases of the spleen and for checking haemorrhage.

Habitat: Cultivated mainly in Karnataka, Tamil Nadu, Uttar Pradesh and Madhya Pradesh.

Action: Plant—cooling and digestible, considered useful in biliousness and constipation.

Habitat: Throughout India.

Action: Alterative, diuretic, nerve tonic (used in hoarse cough, dyspepsia, scrofula, hysteria.)

Habitat: Throughout India, up to 2,000 m on the hills.

Action: Deobstruent, antihepato- toxic, anticatarrhal, febrifuge. Used in hepatitis, spleen enlargements, chronic skin diseases. Leaf—promotes hair growth. Its extract in oil is applied to scalp before bed time in insomnia. The herb is also used as an ingredient in shampoos.

Edaleen, Edaleene, Edalena, Edaleena, Edalyne, Edalyna, Edaline, Edalina, Ediline, Edilyne, Edilina, Edilyna, Edaleana, Edaleane... edalene

Ednah, Edena, Edenah... edna

Edrah, Edrea, Edreah, Edria, Edriah... edra

Edrinah, Edryna, Edrynah, Edreena, Edreenah... edrina

Egeriah, Egerea, Egereah, Egeriya, Egeriyah... egeria

Eglantyne, Eglanteene, Eglantina, Eglantyna, Eglanteena, Eglanteane, Eglanteana, Eglantiene, Eglantiena, Eglanteina, Eglanteine... eglantine

Egzanthe, Egzantha, Egzanthia, Egzanthea, Egzanthiya, Egzanthya... egzanth

Habitat: Common in dry scrub forests of the Deccan Peninsula.

Action: Root—alterative in cachexia and syphilis; an antidote to vegetable poisoning. Dried leaves—pectic and stomachic.

Eila, Eileene, Eilena, Eilene, Eilin, Eilleen, Eily, Eilean, Eileane, Eileine, Eilein, Eilien, Eiliene, Eilyn, Eilyne... eileen

Eileithyea, Eilithia, Eileithia, Eileithiya... eileithyia

Elined, Eiluneda, Elineda, Eluned, Eluneda... eiluned

Eireen, Eireene, Eiren, Eir, Eireine, Eirein, Eirien, Eiriene, Eirean, Eireane, Eiryn, Eiryne... eirene

Eiriann, Eiriane, Eiriana, Eirianne, Eirianna... eirian

Habitat: Throughout India, also grown along roadsides.

Action: Root—used in venereal diseases. A decoction of bark is used internally and as gargle in throat infections.

Habitat: Native to tropical South America; naturalized all over India.

Action: Flower—antifungal. Used in skin diseases.

Habitat: West Bengal, Madhya Pradesh, Maharashtra, Orissa, Andhra Pradesh, Western Ghats.

Action: Fruit—used for epileptic fits and headache. Powdered fruits (0.5 g) mixed with warm water are given two/three times daily in asthma. Stem bark— hypoglycaemic.

Action: Bark—stomachic, antibil- ious. Used in haematemesis. Nut— antiepileptic, antirheumatic.

Ellaine, Ellayne, Elaina, Elayna, Elayne, Elaene, Elaena, Ellaina... elaine

Elamah, Elamma, Elamia, Elamea, Elamiah, Elameah... elama

Habitat: Eastern Himalayas and Western Ghats up to 1,000 m. English: Wild Olive tree, Ceylon Olive.

Action: Leaf—antirheumatic. Fruit—antidysenteric. Aerial parts—CVS and CNS active.

Habitat: Throughout India, also planted as an ornamental.

Action: Astringent, anti- inflammatory, emetic.

Habitat: Western Ghats from Kanara southwards. Ayurvedic: Rudraaksha (var.).... elaeocarpus tuberculatus

Elburta, Elbyrta, Elbirta, Elbertina, Elbertine, Elbrette, Elberte, Elberteen, Elbertyna, Elbertyne... elberta

Eleanora, Eleni, Eleonora, Eleonore, Elinor, Elnora, Eleanore, Elinora, Elenora, Elenore, Eilidh, Eilinora, Eilinore, Eilionoir, Eilionoira, Elie, Elienor, Elienora, Eleinor, Eleinora, Elinore, Ellinor, Ellnora, Ellinora, Ellenor, Ellenora, Ellie, Elly, Elli, Ellee... eleanor

In Britain there are an average of 110 deaths a year from electrocution, half of these occurring in the home.

Treatment No electrical apparatus or switch should be touched by anyone who is in metallic contact with the ground, such as through a metal pipe, especially, for example, from a bath. The ?rst action is to break the current. This can sometimes be done by turning o? a switch. If the victim is grasping or in contact with a live wire, the contact may be severed with safety only by someone wearing rubber gloves or rubber boots; but as these are not likely to be immediately available, the rescuer’s hands may be protected by a thick wrapping of dry cloth, or the live wire may be hooked or pushed out of the way with a long wooden stick such as a broom-handle. If the injured person is unconscious, and especially if breathing has stopped, arti?cial respiration should be applied as described in APPENDIX 1: BASIC FIRST AID – Electrocution. When the patient begins to breathe again, he or she must be treated for shock and professional help obtained urgently.... electrical injuries

Electrocardiography

A method of recording the electrical activity of the heart muscles. Electrodes from a recording machine (electrocardiograph) are placed on the skin of the chest wall, arms and legs. The record of the electrical changes is called an ECG (electrocardiogram). The number of electrodes used depends on the complexity of the heart disorder being monitored. The procedure can be done in hospital, doctors’ surgeries and the patient’s home, and should not cause any discomfort.

In certain circumstances – for example, where a person has had bouts of chest pain – an exercise ECG may be performed under medical supervision. The patient walks on a treadmill while the ECG is recorded continuously.... electrocardiogram (ecg)

Before treatment, the patient will have been fasted for at least eight hours. After checking for any potential drug ALLERGY or interactions, the patient is given a general anaesthetic and muscle relaxants. Depending on the side of the patient’s dominance, either unilateral (on the side of the non-dominant hemisphere of the BRAIN) or bilateral (if dominance is uncertain,

e.g. in left-handed people) positioning of electrodes is used. Unilateral ECT has the advantage of being associated with less anterograde AMNESIA. When the current passes, the muscles will contract for approximately 10 seconds, with further tonic spasms lasting up to a minute. The patient should then be put in the COMA or recovery position and observed until fully conscious. Up to 12 treatments may be given over a month, improvement usually showing after the third session. Widely used at one time, the treatment is now given only rarely. It can be extremely frightening for patients and relatives and is not recommended for children.... electroconvulsive therapy (ect)

– electroencephalograms – are useful in DIAGNOSIS: for example, the abnormal electroencephalogram occurring in EPILEPSY is characteristic of this disease. The normal waves, known as alpha waves, occur with a frequency of 10 per second. Abnormal waves, with a frequency of 7 or fewer per second, are known as delta waves and occur in the region of cerebral tumours and in the brains of epileptics. An electroencephalogram can assess whether an individual is awake, alert or asleep. It may also be used during surgery to monitor the depth of unconsciousness in anaesthetised patients.... electroencephalography (eeg)

Eleftheriah, Eleftherea, Elefthereah, Elefteria, Elefteriah, Elefterea, Eleftereah, Elepheteria, Elephteria... eleftheria

Elenah, Eleena, Eleenah, Elyna, Elynah, Elina, Elinah, Eleni, Elenie, Elene, Eleene, Elenitsa, Eleyn, Elenea, Eleneah... elena

Habitat: Widely cultivated in China. Sold in Kolkata under the name Singapuri Keysur.

Action: Tuber—antidysenteric, antileucorrhoeic, antibacterial.

Elfyn, Elfan, Elfun, Elfee, Elfy, Elfey, Elfea, Elfie, Elfi, Elfe... elfin

Elfridah, Elfreda, Elfredah, Elfryda, Elfrydah, Elfrieda, Elfriedah, Elfreida, Elfreidah, Elfreada, Elfreadah... elfrida

Eleana, Eli, Elia, Eliane, Elianna, Elianne, Eliann, Elyana, Elyanna, Elyann, Elyan, Elyanne, Elyane... eliana

Elidah, Elyda, Eleeda, Eleda, Elieda, Eleida, Eleada... elida

Habitat: Throughout warmer parts of India.

Action: Plant—astringent, cardiac tonic, diuretic, mucilaginous, emmolient (used in dysuria, diarrhoea, dysentery. Leaves—

Habitat: Cultivated either as pure plantation crop, or as subsidiary to coffee and arecanut in hilly forests regions of Western Ghats in Karnataka and Kerala, and in parts of Madurai, the Nilgiris and Tirunelveli in Tamil Nadu.

Action: Carminative antiemetic, stomachic, orexigenic, anti-gripe, antiasthmatic, bechic, Oil— antispasmodic, antiseptic. Used for flatulence, loss of appetite, colic, bronchitis, asthma. Paste used as balm for headache, husk for rheumatism.

Habitat: A grain crop of Karnataka; also grown on large scale in Tamil Nadu, Andhra Pradesh and Maharashtra.

Action: Seeds—cooling, astringent. Nutritive value of ragi is higher than that of rice and equal to that of wheat. White ragi is superior to the pigmented type. A nourishing food for infants, growing children, expectant mothers and aged people. Ragi is considered an ideal food for diabetics because of slow release of sugars to the body. A decoction of leaves and stems is drunk to ease vaginal bleeding.

Elishka, Elyska, Elyshka... eliska

Habitat: Australia, North America; throughout the warmer parts of the world. In India, in wet plains and low hills and pasture grounds.

Action: Used for biliary disorders. In Vietnamese traditional medicine, a decoction of the whole plant is used as stomachic, diuretic, febrifuge, and in sprains.

Elin, Elleen, Ellena, Ellene, Ellyn, Elynn, Elen, Ellin... ellen

Ellianne, Ellyanna, Ellianna, Ellyann, Elliann, Ellyan, Ellian... ellyanne

Ellecia, Ellice, Ellisha, Ellison, Elyce, Ellesse, Ellis... ellyce

Elminah, Elmeena, Elmeenah, Elmyna, Elmynah, Elmine, Elmyne, Elmeene, Elmeina, Elmeinah, Elmiena, Elmienah, Elmeana, Elmeanah... elmina

Eloise, Eloiza, Eloisee, Eloize, Eloizee... eloisa

Elpidah, Elpyda, Elpeeda, Elpieda, Elpeida, Elpeada, Espe, Elpydah, Elpeedah, Elpiedah, Elpeidah, Elpeadah... elpida

Elvera, Elvita, Elvyra, Elvirah, Elvyrah, Elwira... elvira

Habitat: The Himalayas and Assam up to 3,000 m, introduced into the Nilgiris (Tamil Nadu).

Action: Carminative, stomachic, astringent. Leaf—diuretic, antipyretic. Neutralizes after effects... elsholtzia cristata

Habitat: The Deccan Peninsula, extending northwards to eastern Himalayas.

Action: Leaves—decoction prescribed in fever, also in venereal diseases. Root—used in mammary tumours and abscesseses, pneumonia and infantile diarrhoea. Plant infusion is used as a cough remedy for infants.... elytraria crenata

Habitat: Throughout India.

Action: Ascaricidal, anthelmintic, carminative, diuretic, astringent, anti-inflammatory, antibacterial, febrifuge. Used in diseases of chest and skin. Active principles are found to be oestrogenic and weakly progestogenic. Root—bechic, antidiarrhoeal. Seed—spermicidal, oxytocic, diuretic. The plant is also used for its blood purifying properties. It is an ingredient in cough syrups, preparations for anaemia, genitourinary tract infections, diarrhoea and diseases of the liver.

Habitat: Throughout greater part of India.

Action: Fruit—antispasmodic, carminative, anthelmintic, antibacterial. Powdered fruit—used in dysentery. Plant—used in weak pulse rate.

Emberlyn, Emberlyne, Emberlynne, Emberline, Emberlin, Emberlinn, Emberlinne, Emberlen, Emberlenn, Emberlenne... emberlynn

Habitat: Native to tropical Southeast Asia; distributed throughout India; also planted in public parks.

Action: Fruit—antianaemic, anabolic, antiemetic, bechic, astringent, antihaemorrhagic, antidiarrhoeal, diuretic, antidiabetic, carminative, antioxidant. Used in jaundice, dyspepsia, bacillary dysentery, eye trouble and as a gastrointestinal tonic. Juice with turmeric powder and honey is prescribed in diabetes insipidus. Seed—antibilious, antiasthmatic. Used in bronchitis. Bark—astringent. Leaf—juice is given in vomiting.

Emell, Emel, Emele, Emella, Emela... emelle

Habitat: Throughout India, ascending to 1,350 m in the hills.

Action: Plant—sudorific, febrifuge, antiseptic. Used in infantile tympanitis and bowel complaints. Root—antidiarrhoeal. Leaf—used for otitis media under medical supervision.

Emilee, Emilie, Emilia, Emelia, Emileigh, Emeleigh, Emeli, Emelie, Emelee, Emiley, Emalei, Emilei, Emalee, Emalia, Emely, Emelye, Emele, Emere, Emera, Emmly, Emilea, Emileah... emily

Emmy, Emmajean, Emmalee, Emmi, Emmie, Emmaline, Emelina, Emeline, Emaline, Emmalyn, Emmeline, Em, Emiline, Emelyn, Emelin, Emlyn... emma

Emmaws, Emmas... emmaus

Uses They are used in various in?ammatory conditions such as eczema (see DERMATITIS), when the skin becomes hard, cracked, and painful. They may be used in the form of a dusting powder, an oil or an ointment.... emollients

Emmylinda, Emylynda, Emmilinda, Emmilynda, Emilinda, Emilynda... emylinda

Since the BSE epidemic in cattle developed in the UK in the 1980s, however, a new variant of CJD has been identi?ed and is believed to be the result of consumption of the meat of BSE-infected cattle. Studies in transgenic mice have con?rmed that BSE caused variant CJD. The new variant has affected younger people and may have a shorter incubation period. If this incubation period turns out to be the same as for the other types of CJD, however, it could be 2005– 2010 before the peak of this outbreak is reached. Over 148 people had died, or were dying, from variant CJD in the UK by the year 2005.

The appearance of BSE in cattle is believed to have been caused by a gene mutation (see GENETIC DISORDERS), although whether this mutation ?rst occurred in cattle or in some other animal remains uncertain. Although the ?rst case of BSE was o?cially reported in 1985, the ?rst cattle are thought to have been infected in the 1970s. BSE spread to epidemic proportions because cattle were fed meat and bone meal, made from the o?al of cattle suffering from or incubating the disease. Mother-to-calf transfer is another likely route of transmission, although meat and bone meal in cattle feed were the main cause of the epidemic. The epidemic reached its peak in 1992 when the incidence of newly diagnosed cases in cattle was 37,545.

A two-year UK government inquiry into the BSE epidemic concluded that BSE had caused a ‘harrowing fatal disease in humans’, and criticised o?cials for misleading the public over the risk to humans from BSE. Consequently, a compensation package for patients and relatives was made available. Meanwhile, a ban on the export of UK beef and restrictions on the type of meat and products made from beef that can be sold to the public were put in place. Although initially thought to be a problem primarily con?ned to the UK, several other countries – notably France, Germany, Spain, Switzerland and the United States – have also discovered BSE in their cattle.... encephalopathy (bse)

Aims and objects. To develop a coordinated scientific framework to assess phytopharmaceuticals. To promote acceptance of phytopharmaceuticals, especially within the therapy of general medical practitioners. To support and initiate clinical and experimental research in phytotherapy. To improve and extend the international accumulation of scientific and practical knowledge.

National associations represented.

Federal Republic of Germany: Gesellschaft fu?r Phytotherapie e.V.

The Netherlands: Nederlandse Vereniging voor Fytotherapie.

Belgium: Socie?te? Belge de Phytothe?rapie, Belgische Vereniging voor Phytotherapie. France: Institut Francais de Phytothe?rapie.

United Kingdom: British Herbal Medicine Association.

Switzerland: Schweizerische Medizinische Gesellschaft fu?r Phytotherapie.

The Scientific Committee, with two delegates from each member country, has embarked on a programme of compiling proposals for European monographs on the medicinal uses of plant drugs. This task is expected to take about ten years to complete.

In preparing monographs the Committee assesses information from published scientific literature together with national viewpoints as expressed by delegates or included in the results of national reviews. Leading researchers on specific plant drugs are invited to relevant meetings and their contributions substantially assist the Committee’s work. Draft monographs prepared by the Scientific Committee are circulated for appraisal and comment to an independent Board of Supervising Editors, which includes eminent academic experts in the field of phytotherapy.

The monographs are offered to regulatory authorities as a means of harmonising the medicinal uses of plant medicines within the EC and in a wider European context. Phytotherapy (Herbalism) makes an important contribution to European medicine. ... escop

EFA deficiency may be caused by alcohol, particularly Omega-6. Deficiencies may be responsible for a wide range of symptoms from foul-smelling perspiration to psoriasis, pre-menstrual tension and colic. EFAs are precursors of prostaglandin formation.

EFAs are present in oily fish and reduce the adhesion of platelets and the risk of heart disease. They reduce blood cholesterol and increase HDLs.

Common sources: cold pressed seeds, pulses, nuts and nut oils. Evening Primrose oil (15-20 drops daily). The best known source is Cod Liver oil (1-8 teaspoons daily); (children 1 teaspoon daily to strengthen immune system against infection); bottled oil preferred before capsules. To increase palatability pour oil into honey jar half filled with orange or other fruit juice, shake well and drink from the jar.

Margarines, salad dressings, cooking and other refined vegetable oils inhibit complete absorption of EFAs and should be avoided. EFAs require the presence of adequate supply of Vitamins A, B, C, D, E and minerals Calcium, Iron, Magnesium and Selenium. ... essential fatty acids (efa)

Alfalfa tea freely.

Of value: Kelp, Irish Moss, Iceland Moss.

Diet. Vitamin A foods, carrots, bilberries, Cod Liver oil.

Supplements. Vitamin A, Beta-carotene. C (2g), E (400iu). B-complex, B2, Niacin, Zinc. ... eyes  - night blindness

Alternatives. Plantain, Ginkgo. Teas, tablets, etc.

Topical. Cold compress: Witch Hazel.

Supplements. Daily. Vitamins C (500mg); E (400iu). Beta-carotene. Palming. ... eyes – pain

Eustachian catheters are small catheters that are passed along the ?oor of the nose into the Eustachian tube in order to in?ate the ear.

Nasal catheters are tubes passed through the nose into the stomach to feed a patient who cannot swallow – so-called nasal feeding.

Rectal catheters are passed into the RECTUM in order to introduce ?uid into the rectum.

Suprapubic catheters are passed into the bladder through an incision in the lower abdominal wall just above the pubis, either to allow urine to drain away from the bladder, or to wash out an infected bladder.

Ureteric catheters are small catheters that are passed up the ureter into the pelvis of the kidney, usually to determine the state of the kidney, either by obtaining a sample of urine direct from the kidney or to inject a radio-opaque substance preliminary to X-raying the kidney. (See PYELOGRAPHY.)

Urethral catheters are catheters that are passed along the urethra into the bladder, either to draw o? urine or to wash out the bladder.

It is these last three types of catheters that are most extensively used.... endotracheal catheters are used to pass

Engedie, Engedy, Engedey, Engedea, Engedeah, Engedee... engedi

Habitat: Hills of Bihar, West Bengal and Assam.

Action: Leaf—antibilious, laxative, demulcent, antidermatosis. Used in dyspepsia, diseases of the nervous system and cutaneous affections.

Habitat: Throughout India, from Punjab and Gangetic Plain to Kanyakumari up to 500 m.

Action: Bitter tonic, carminative, blood purifier, antirheumatic, anti-inflammatory, antipsychotic, anthelmintic, cardiostimulant.

Enrika, Enricka, Enryca, Enryka, Enrichetta, Enrichette, Enriqua, Enriqueta, Enriquetta... enrica

Habitat: Eastern Himalayas, hills of Bihar, Orissa and South India.

Action: Seed—carminative, anodyne, spasmolytic bechic, anti-inflammatory, anthelmintic, antiperiodic. Used in liver complaints, glandular swellings, debility, skin diseases. The seed, stems and bark are poisonous. A paste of the seeds is applied locally for inflammatory glandular swellings. The juice of wood and bark is used as an external application for ulcers. The leaves are reported to be free from the toxic saponins. After soaking in water and roasting toxic principles can be removed from the white kernels of the seeds.

Health has driven much of environmental policy since the work of Edwin Chadwick in the early 1840s. The ?rst British public-health act was introduced in 1848 to improve housing and sanitation with subsequent provision of puri?ed water, clean milk, food hygiene regulations, vaccinations and antibiotics. In the 21st century there are now many additional environmental factors that must be monitored, researched and controlled if risks to human health are to be well managed and the impact on human morbidity and mortality reduced.

Environmental impacts on health include:

noise

air pollution

water pollution

dust •odours

contaminated ground

loss of amenities

vermin

vibration

animal diseases

Environmental risk factors Many of the major determinants of health, disease and death are environmental risk factors. Some are natural hazards; others are generated by human activities. They may be directly harmful, as in the examples of exposure to toxic chemicals at work, pesticides, or air pollution from road transport, or to radon gas penetrating domestic properties. Environmental factors may also alter people’s susceptibility to disease: for example, the availability of su?cient food. In addition, they may operate by making unhealthy choices more likely, such as the availability and a?ord-ability of junk foods, alcohol, illegal drugs or tobacco.

Populations at risk Children are among the populations most sensitive to environmental health hazards. Their routine exposure to toxic chemicals in homes and communities can put their health at risk. Central to the ability to protect communities and families is the right of people to know about toxic substances. For many, the only source of environmental information is media reporting, which often leaves the public confused and frustrated. To bene?t from public access to information, increasingly via the Internet, people need basic environmental and health information, resources for interpreting, understanding and evaluating health risks, and familiarity with strategies for prevention or reduction of risk.

Risk assessment Environmental health experts rely on the principles of environmental toxicology and risk assessment to evaluate the environment and the potential effects on individual and community health. Key actions include:

identifying sources and routes of environmental exposure and recommending methods of reducing environmental health risks, such as exposure to heavy metals, solvents, pesticides, dioxins, etc.

assessing the risks of exposure-related health hazards.

alerting health professionals, the public, and the media to the levels of risk for particular potential hazards and the reasons for interventions.

ensuring that doctors and scientists explain the results of environmental monitoring studies – for example, the results of water ?uoridation in the UK to improve dental health.

National policies In the United Kingdom in 1996, an important step in linking environment and health was taken by a government-initiated joint consultation by the Departments of Health and Environment about adding ‘environment’ as a key area within the Health of the Nation strategy. The ?rst UK Minister of State for Public Health was appointed in 1997 with responsibilities for health promotion and public-health issues, both generally and within the NHS. These responsibilities include the implementation of the Health of the Nation strategy and its successor, Our Healthy Nation. The aim is to raise the priority given to human health throughout government departments, and to make health and environmental impact assessment a routine part of the making, implementing and assessing the impact of policies.

Global environmental risks The scope of many environmental threats to human health are international and cannot be regulated e?ectively on a local, regional or even national basis. One example is the Chernobyl nuclear reactor accident, which led to a major release of radiation, the effects of which were felt in many countries. Some international action has already been taken to tackle global environmental problems, but governments should routinely measure the overall impacts of development on people and their environments and link with industry to reduce damage to the environment. For instance, the effects of global warming and pollution on health should be assessed within an ecological framework if communities are to respond e?ectively to potential new global threats to the environment.... environment and health

Eoland, Eolanda, Eolandia, Eolandea... eolande

Habitat: The drier regions of the temperate and alpine Himalayas from Kashmir to Sikkim from 2,350 to 5,350 m.

Action: Circulatory stimulant, bron- chodilator, vasodilator, antiallergic, antiasthmatic (usualy given with expectorants), diaphoretic. Not prescribed with antidepressants.

Eponah, Eponna, Eponia, Eponea, Eponnah, Eponiah, Eponeah... epona

Habitat: The Himalayas at high altitudes.

Action: Haemostatic, haemopoietic, astringent, diuretic. Used for genitourinary affections (urethritis, enuresis, cystitis, prostatitis), internally as an antihaemorrhagic and externally as a styptic.

Erantha, Eranth, Eranthia, Eranthea... eranthe

Erela, Erelia, Erelea, Ereliah, Ereleah... erelah

Erendirah, Erendiria, Erendirea, Erendyra, Erendyria, Erendyrea, Erendeera, Erendiera, Erendeira, Erendeara... erendira

Family: Compositae; Asteraceae.

Habitat: Punjab, Upper Gangetic Plain, Assam, Western Ghats and Western Himalayas.

Action: Astringent, haemostatic, antirheumatic, diuretic. Used for diarrhoea, kidney disorders, bronchitis and for bleeding piles, wounds, bruises. Essential oil— used in bronchial catarrh and cystitis.

Habitat: Native to China; now cultivated mainly in Saharanpur, Dehradun, Muzaffarnagar, Meerut, Kanpur, Bareilly districts of Uttar Pradesh, Amritsar, Gurdaspur and Hoshiarpur districts of Punjab.

Action: Leaves—used in China and India for the treatment of diabetes mellitus and skin diseases. Fruit— sedative, antiemetic. Flower— expectorant.

Eriss, Erisse, Erys, Eryss, Erysse... eris

Ermah, Ermelinda, Ermalinda, Ermelinde, Ermalinde, Ermintrude, Ermyntrude... erma

Habitat: Cultivated in Uttar Pradesh, Punjab, Delhi and Madhya Pradesh.

Action: Tender leaf—stimulant, stomachic, diuretic, antiscorbutic, rubefacient. Seed—vesicant, antibacterial.

Habitat: Throughout the sub- Himalayan tract from Garhwal eastwards to Assam and Bengal, extending southwards to North Circars.

Action: Topically anodyne; chewed for relief of toothache; administered as a vermicide. Various parts of the plant are used in the indigenous system of medicine for skin diseases and cancer.

Habitat: Throughout India, common in Uttar Pradesh.

Action: Bark—anticholerin. Ripe fruit eaten in constipation. Pounded root prescribed internally in fever. Bark is used in cholera.

Habitat: Kashmir and Western Himalayas.

Action: Root—nervine, stimulant, haematinic, diuretic, diaphoretic, expectorant. Ash of the plant— antiseptic, anti-inflammatory (used in haemorrhoids).

Habitat: Assam up to 1,700 m, found as a garden plant in Dehra Dun.

Action: Root—stomachic. Plant— galactagogue, diuretic. Fresh leaves are used as a vegetable and flavouring agent.

Erythia, Erythea, Eritheia, Erithia, Erithea... erytheia

Habitat: Sub-tropical and temperate regions.

Habitat: Grown as an ornamental.

Action: Leaf—cathartic, diuretic, antiseptic, anti-inflammatory. Applied externally for dispersing venereal buboes. Bark—antibilious, anthelmintic, febrifuge, astringent, expectorant. (E. variegata is an adulterant to the Ayurvedic drug Rohitaka.) Different parts of the plant are used as nervine sedative, antiepileptic, astringent, antiasthmatic and antiseptic. Bark is used in liver ailments, fever and rheumatism.

Habitat: Assam, Manipur, West Bengal and South India.

Action: Bark—antibilious, an- tirheumatic, febrifuge, antiasth- matic, antiepileptic, antileprotic. Flowers—antidote to poison. In Assam, the juice of the root bark is given to children in threadworm infection.

Habitat: Indigenus to Peru and Bolivia, introduced and experimentally cultivated in Assam, West Bengal, Bihar, Uttar Pradesh, Tamil Nadu and Kerala.

Action: Mydriatic and toxic. (Coca leaf extract, after removing cocaine, is used as a flavouring agent for soft drinks. Maximum use level: 0.055%.) Coca leaves contain a large number of alkaloids including cocaine, tropa- cocaine, cinnamoylcocaine, truxillines and benzoylecgonine. (alkaloid content varies from 0.5 to 1.5%). The bark and seeds also contain cocaine.

Habitat: South India, up to 1,000 m.

Action: Leaf—diaphoretic, stimulant, diuretic, stomachic. A decoction is used for malarial fever. Bark and wood—febrifuge.

Essdey, Esdee, Esdea, Esdy, Esdey, Esdi, Esdie, Esday, Esdai, Esdae, Esdaye... esdey

Eshanah, Eshanna, Eshania, Eshanea, Eshannah, Eshaniah, Eshaneah... eshana