Habitat: Common in English gardens; native of South America.

Action: Diaphoretic, stimulant, antispasmodic.

Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.

Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.

Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.

A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.

Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production

– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).

Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.

Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.

Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.

Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).

Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;

(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.

Complications The risks of complications increase with duration of disease.

Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.

Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.

Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.

Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).

Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.

Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.

Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.

Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.

Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;

(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.

Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.

Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.

However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.

Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.

Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.

Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.

A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.

Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus

Uses Compounds of magnesia are used to correct hyperacidity of the stomach and as a laxative (see LAXATIVES).... magnesium

(b) active movements, which are performed with the combined assistance of masseur/masseuse and patient. Massage is also often combined with baths and gymnastics in order to strengthen various muscles. It helps to improve circulation, prevent adhesions in injured tissues, relax muscular spasm, improve muscle tone and reduce any oedema. (See also CARDIAC MASSAGE.)

Massage for medical conditions is best done by trained practitioners. A complete list of members of the Chartered Society of Physiotherapy can be obtained on application to the Secretary of the Society.... massage

Breast reconstructive surgery (MAMMOPLASTY) may be done at the same time as the mastectomy – the preferred option – or, if that is not feasible, at a later date. Where the whole breast has been excised, some form of arti?cial breast (prosthesis) will be provided. This may be an external prosthesis ?tted into a specially made brassiere, or an internal implant – perhaps a silicone bag, though there has been controversy over the safety of this device. Reconstructive techniques involving the transfer of skin and muscle from nearby areas are also being developed. Post-operatively, patients can obtain advice from Breast Cancer Care.... mastectomy

Epidemiology There has been a dramatic fall in the number of sufferers from 1986, when more than 80,000 cases were reported. This is due to the introduction in 1988 of the measles, mumps and rubella vaccine (MMR VACCINE – see also IMMUNISATION); 1990, when the proportion of children immunised reached 90 per cent, was the ?rst year in which no deaths from measles were reported. Even so, fears of side-effects of the vaccine against measles – including scienti?cally unproven and discredited claims of a link with AUTISM – mean that some children in the UK are not being immunised, and since 2002 local outbreaks of measles have been reported in a few areas of the UK. Side-effects are, however, rare and the government is campaigning to raise the rate of immunisation, with GPs being set targets for their practices.

There are few diseases as infectious as measles, and its rapid spread in epidemics is no doubt due to the fact that this viral infection is most potent in the earlier stages. Hence the dif?culty of timely isolation, and the readiness with which the disease is spread, which is mostly by infected droplets. In developing countries measles results in the death of more than a million children annually.

Symptoms The incubation period, during which the child is well, lasts 7–21 days. Initial symptoms are CATARRH, conjunctivitis (see EYE, DISORDERS OF), fever and a feeling of wretchedness. Then Koplik spots – a classic sign of measles – appear on the roof of the mouth and lining of the cheeks. The macular body rash, typical of measles, appears 3–5 days later. Common complications include otitis media (see under EAR, DISEASES OF) and PNEUMONIA. Measles ENCEPHALITIS can cause permanent brain damage. A rare event is a gradual dementing disease (see DEMENTIA) called subacute sclerosing panenecephalitis (SSPE).

Treatment Isolation of the patient and treatment of any secondary bacterial infection, such as pneumonia or otitis, with antibiotics. Children usually run a high temperature which can be relieved with cool sponging and antipyretic drugs. Calamine lotion may alleviate any itching.... measles

(2) A drug used to treat an individual with an illness or injury (see MEDICINES).

(3) The diagnosis and treatment of those diseases not normally requiring surgical intervention.

Defensive medicine Diagnostic or treatment procedures undertaken by practitioners in which they aim to reduce the likelihood of legal action by patients. This may result in requests for investigations that, arguably, are to provide legal cover for the doctor rather than more certain clinical diagnosis for the patient.... medicine

Menstruation depends upon a functioning ovary (see OVARIES) and this upon a healthy PITUITARY GLAND. The regular rhythm may depend upon a centre in the HYPOTHALAMUS, which is in close connection with the pituitary. After menstruation, the denuded uterine ENDOMETRIUM is regenerated under the in?uence of the follicular hormone, oestradiol. The epithelium of the endometrium proliferates, and about a fortnight after the beginning of menstruation great development of the endometrial glands takes place under the in?uence of progesterone, the hormone secreted by the CORPUS LUTEUM. These changes are made for the reception of the fertilised OVUM. In the absence of fertilisation the uterine endometrium breaks down in the subsequent menstrual discharge.

Disorders of menstruation In most healthy women, menstruation proceeds regularly for 30 years or more, with the exceptions connected with childbirth. In many women, however, menstruation may be absent, excessive or painful. The term amenorrhoea is applied to the condition of absent menstruation; the terms menorrhagia and metrorrhagia describe excessive menstrual loss – the former if the excess occurs at the regular periods, and the latter if it is irregular. Dysmenorrhoea is the name given to painful menstruation. AMENORRHOEA If menstruation has never occurred, the amenorrhoea is termed primary; if it ceases after having once become established it is known as secondary amenorrhoea. The only value of these terms is that some patients with either chromosomal abnormalities (see CHROMOSOMES) or malformations of the genital tract fall into the primary category. Otherwise, the age of onset of symptoms is more important.

The causes of amenorrhoea are numerous and treatment requires dealing with the primary cause. The commonest cause is pregnancy; psychological stress or eating disorders can cause amenorrhoea, as can poor nutrition or loss of weight by dieting, and any serious underlying disease such as TUBERCULOSIS or MALARIA. The excess secretion of PROLACTIN, whether this is the result of a micro-adenoma of the pituitary gland or whether it is drug induced, will cause amenorrhoea and possibly GALACTORRHOEA as well. Malfunction of the pituitary gland will result in a failure to produce the gonadotrophic hormones (see GONADOTROPHINS) with consequent amenorrhoea. Excessive production of cortisol, as in CUSHING’S SYNDROME, or of androgens (see ANDROGEN) – as in the adreno-genital syndrome or the polycystic ovary syndrome – will result in amenorrhoea. Amenorrhoea occasionally follows use of the oral contraceptive pill and may be associated with both hypothyroidism (see under THYROID GLAND, DISEASES OF) and OBESITY.

Patients should be reassured that amenorrhoea can often be successfully treated and does not necessarily affect their ability to have normal sexual relations and to conceive. When weight loss is the cause of amenorrhoea, restoration of body weight alone can result in spontaneous menstruation (see also EATING DISORDERS – Anorexia nervosa). Patients with raised concentration of serum gonadotrophin hormones have primary ovarian failure, and this is not amenable to treatment. Cyclical oestrogen/progestogen therapy will usually establish withdrawal bleeding. If the amenorrhoea is due to mild pituitary failure, menstruation may return after treatment with clomiphene, a nonsteroidal agent which competes for oestrogen receptors in the hypothalamus. The patients who are most likely to respond to clomiphene are those who have some evidence of endogenous oestrogen and gonadotrophin production. IRREGULAR MENSTRUATION This is a change from the normal monthly cycle of menstruation, the duration of bleeding or the amount of blood lost (see menorrhagia, below). Such changes may be the result of an upset in the balance of oestrogen and progesterone hormones which between them control the cycle. Cycles may be irregular after the MENARCHE and before the menopause. Unsuspected pregnancy may manifest itself as an ‘irregularity’, as can an early miscarriage (see ABORTION). Disorders of the uterus, ovaries or organs in the pelvic cavity can also cause irregular menstruation. Women with the condition should seek medical advice. MENORRHAGIA Abnormal bleeding from the uterus during menstruation. A woman loses on average about 60 ml of blood during her period; in menorrhagia this can rise to 100 ml. Some women have this problem occasionally, some quite frequently and others never. One cause is an imbalance of progesterone and oestrogen hormones which between them control menstruation: the result is an abnormal increase in the lining (endometrium) of the uterus, which increases the amount of ‘bleeding’ tissue. Other causes include ?broids, polyps, pelvic infection or an intrauterine contraceptive device (IUD – see under CONTRACEPTION). Sometimes no physical reason for menorrhagia can be identi?ed.

Treatment of the disorder will depend on how severe the loss of blood is (some women will become anaemic – see ANAEMIA – and require iron-replacement therapy); the woman’s age; the cause of heavy bleeding; and whether or not she wants children. An increase in menstrual bleeding may occur in the months before the menopause, in which case time may produce a cure. Medical or surgical treatments are available. Non-steroidal anti-in?ammatory drugs may help, as may tranexamic acid, which prevents the breakdown of blood clots in the circulation (FIBRINOLYSIS): this drug can be helpful if an IUD is causing bleeding. Hormones such as dydrogesterone (by mouth) may cure the condition, as may an IUD that releases small quantities of a PROGESTOGEN into the lining of the womb.

Traditionally, surgical intervention was either dilatation and curettage of the womb lining (D & C) or removal of the whole uterus (HYSTERECTOMY). Most surgery is now done using minimally invasive techniques. These do not require the abdomen to be cut open, as an ENDOSCOPE is passed via the vagina into the uterus. Using DIATHERMY or a laser, the surgeon then removes the whole lining of the womb. DYSMENORRHOEA This varies from discomfort to serious pain, and sometimes includes vomiting and general malaise. Anaemia is sometimes a cause of painful menstruation as well as of stoppage of this function.

In?ammation of the uterus, ovaries or FALLOPIAN TUBES is a common cause of dysmenorrhoea which comes on for the ?rst time late in life, especially when the trouble follows the birth of a child. In this case the pain exists more or less at all times, but is aggravated at the periods. Treatment with analgesics and remedying the underlying cause is called for.

Many cases of dysmenorrhoea appear with the beginning of menstrual life, and accompany every period. It has been estimated that 5–10 per cent of girls in their late teens or early 20s are severely incapacitated by dysmenorrhoea for several hours each month. Various causes have been suggested for the pain, one being an excessive production of PROSTAGLANDINS. There may be a psychological factor in some sufferers and, whether this is the result of inadequate sex instruction, fear, family, school or work problems, it is important to o?er advice and support, which in itself may resolve the dysmenorrhoea. Symptomatic relief is of value.... menstruation

Bacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.

Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.

Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.

Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.

Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.

Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.

Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.

Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.

The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)

Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.... meningitis

It usually begins at puberty – although young children can be affected – and tends to stop in middle age: in women, for example, attacks often cease after MENOPAUSE. It frequently disappears during pregnancy. The disorder tends to run in families. In susceptible individuals, attacks may be provoked by a wide variety of causes including: anxiety, emotion, depression, shock, and excitement; physical and mental fatigue; prolonged focusing on computer, television or cinema screens; noise, especially loud and high-pitched sounds; certain foods – such as chocolate, cheese, citrus fruits, pastry; alcohol; prolonged lack of food; irregular meals; menstruation and the pre-menstrual period.

Anything that can provoke a headache in the ordinary individual can probably precipitate an attack in a migrainous subject. It seems as if there is an inherited predispostion that triggers a mechanism whereby in the migrainous subject, the headache and the associated sickness persist for hours, a whole day or even longer.

The precise cause is not known, but the generally accepted view is that in susceptible individuals, one or other of these causes produces spasm or constriction of the blood vessels of the brain. This in turn is followed by dilatation of these blood vessels which also become more permeable and so allow ?uid to pass out into the surrounding tissues. This combination of dilatation and outpouring of ?uid is held to be responsible for the headache.

Two types of migraine have been recognised: classical and common. The former is relatively rare and the headache is preceded by a slowly extending area of blindness in one or both eyes, usually accompanied by intermittent ‘lights’. The phenomenon lasts for up to 30 minutes and is followed by a bad, often unilateral headache with nausea, sometimes vomiting and sensitivity to light. Occasionally, passing neurological symptoms such as weakness in a limb may accompany the attack. The common variety has similar but less severe symptoms. It consists of an intense headache, usually situated over one or other eye. The headache is usually preceded by a feeling of sickness and disturbance of sight. In 15–20 per cent of cases this disturbance of sight takes the form of bright lights: the so-called AURA of migraine. The majority of attacks are accompanied by vomiting. The duration of the headache varies, but in the more severe cases the victim is usually con?ned to bed for 24 hours.

Treatment consists, in the ?rst place, of trying to avoid any precipitating factor. Patients must ?nd out which drug, or drugs, give them most relief, and they must always carry these about with them wherever they go. This is because it is a not uncommon experience to be aware of an attack coming on and to ?nd that there is a critical quarter of an hour or so during which the tablets are e?ective. If not taken within this period, they may be ine?ective and the unfortunate victim ?nds him or herself prostrate with headache and vomiting. In addition, sufferers should immediately lie down; at this stage a few hours’ rest may prevent the development of a full attack.

When an attack is fully developed, rest in bed in a quiet, darkened room is essential; any loud noise or bright light intensi?es the headache or sickness. The less food that is taken during an attack the better, provided that the individual drinks as much ?uid as he or she wants. Group therapy, in which groups of around ten migrainous subjects learn how to relax, is often of help in more severe cases, whilst in others the injection of a local anaesthetic into tender spots in the scalp reduces the number of attacks. Drug treatment can be e?ective and those a?icted by migraine may ?nd a particular drug or combination of drugs more suitable than others. ANALGESICS such as PARACETAMOL, aspirin and CODEINE phosphate sometimes help. A combination of buclizine hydrochloride and analgesics, taken when the visual aura occurs, prevents or diminishes the severity of an attack in some people. A commonly used remedy for the condition is ergotamine tartrate, which causes the dilated blood vessels to contract, but this must only be taken under medical supervision. In many cases METOCLOPRAMIDE (an antiemetic), followed ten minutes later by three tablets of either aspirin or paracetamol, is e?ective if taken early in an attack. In milder attacks, aspirin, with or without codeine and paracetamol, may be of value. SUMATRIPTAN (5-hydroxytryptamine [5HT1] AGONIST – also known as a SEROTONIN agonist) is of value for acute attacks. It is used orally or by subcutaneous injection, but should not be used for patients with ischaemic heart disease. Naratriptan is another 5HT1 agonist that is an e?ective treatment for acute attacks; others are almotriptan, rizariptan and zolmitriptan. Some patients ?nd beta blockers such as propranolol a valuable prophylactic.

People with migraine and their relatives can obtain help and guidance from the Migraine Action Association.... migraine

Preparation of milk Milk may be prepared for food in various ways. Boiling destroys the bacteria, especially any Mycobacteria tuberculosis which the milk may contain. It also partly destroys vitamin C and thiamine, as does pasteurisation. Curdling of milk is e?ected by adding rennet, which carries out the initial stage of digestion and thus renders milk more suitable for people who could not otherwise tolerate it. Souring of milk is practised in many countries before milk is considered suitable for food; it is carried out by adding certain organisms such as the LACTIC ACID bacillus, the Bulgarian bacillus, and setting the milk in a warm place for several hours. Sterilisation, which prevents fermentation and decomposition, is usually carried out by raising the milk to boiling temperature (100 °C) for 15 minutes and then hermetically sealing it. Condensed, unsweetened milk – usually known as evaporated milk – is concentrated in vacuo at low temperature; the milk is then placed in tins, which are sealed, and is sterilised by heat at a temperature of 105 °C. This destroys 60 per cent of the vitamin C and 30–50 per cent of the thiamine. Sweetened condensed milk is not exposed to such a high temperature. The sugar, which prevents the growth of micro-organisms, is added before the condensing, and ?nally reaches a concentration of about 40 per cent.

Dried milk is prepared by evaporating all the ?uid so that the milk is reduced to the form of powder. Humanised milk is cow’s milk treated to render it closely similar to human milk.... milk

Habitat: Hedgerows and about walls.

Action: Emmenagogue, diuretic, diaphoretic.

has no connection with foot and mouth disease in cattle, deer, pigs and sheep.... hand, foot and mouth disease

Habitat: Low-lying meadows, sides of ditches.

Action: Astringent, diuretic, aromatic, tonic.

Two types of sperm cells are produced: one contains 22 autosomes and a Y sex chromosome (see SEX CHROMOSOMES); the other, 22 autosomes and an X sex chromosome. All the ova, however, produced by normal meiosis have 22 autosomes and an X sex chromosome.

Two divisions of the NUCLEUS occur (see also CELLS) and only one division of the chromosomes, so that the number of chromosomes in the ova and sperms is half that of the somatic cells. Each chromosome pair divides so that the gametes receive only one member of each pair. The number of chromosomes is restored to full complement at fertilisation so that the zygote has a complete set, each chromosome from the nucleus of the sperm pairing up with its corresponding partner from the ovum.

The ?rst stage of meiosis involves the pairing of homologous chromosomes which join together and synapse lengthwise. The chromosomes then become doubled by splitting along their length and the chromatids so formed are held together by centromeres. As the homologous chromosomes – one of which has come from the mother, and the other from the father – are lying together, genetic interchange can take place between the chromatids and in this way new combinations of GENES arise. All four chromatids are closely interwoven and recombination may take place between any maternal or any paternal chromatids. This process is known as crossing over or recombination. After this period of interchange, homologous chromosomes move apart, one to each pole of the nucleus. The cell then divides and the nucleus of each new cell now contains 23 and not 46 chromosomes. The second meiotic division then occurs, the centromeres divide and the chromatids move apart to opposite poles of the nucleus so there are still 23 chromosomes in each of the daughter nuclei so formed. The cell divides again so that there are four gametes, each containing a half number (haploid) set of chromosomes. However, owing to the recombination or crossing over, the genetic material is not identical with either parent or with other spermatozoa.... meiosis

These membranes bear the blood vessels which nourish the surface of the brain and the interior of the skull. Meningeal haemorrhage from these vessels forms one of the chief dangers arising from fracture of the skull.... meninges

MOTH REPELLENT. Sew into small linen bags any of the following: Cinnamon, Sandalwood chips, Camphor, Cloves. Add: sprinkle of Cedarwood for greater potency. MOTHER SEIGEL’S SYRUP. See: SHAKERS, The. ... morning sickness

Uses In the past, mercuric salts were used as ANTISEPTICS, anti-parasitic agents and fungicides. Mercury has been widely used in dental amalgams for ?lling teeth. Because of their toxicity, mercury compounds must not be taken internally.

Mercury has traditionally been used in thermometers for recording body temperature, and in sphygmomanometers for measuring a person’s BLOOD PRESSURE. These instruments have been largely replaced in the UK by electronic devices that do not require mercury.... mercury

Side-effects include suppression of myelocytes in bone marrow, in?ammation of mucous membranes, and, rarely, PNEUMONITIS. It should be avoided whenever signi?cant renal impairment is present, while signi?cant pleural e?usion or ascites is also a contraindication. Blood counts should be carefully monitored whenever intrathecal methotrexate is given. Oral or parenteral folinic acid helps to prevent, or to speed recovery from, myelosuppression or mucositis.

Methotrexate is used in dermatology, where it may be indicated for cases of severe uncontrolled PSORIASIS unresponsive to conventional therapy; it may also be indicated for severe active RHEUMATOID ARTHRITIS. Because of its potentially severe haematological, pulmonary, gastrointestinal, and other toxicities it should be used only by specialists and appropriate renal and liver function tests carried out before and during treatment. It should be avoided in pregnancy, and conception should be avoided for at least six months after stopping, as should breast feeding. Concurrent administration of aspirin or other NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS) reduces methotrexate excretion, increasing its toxicity, and should therefore be avoided whenever possible.... methotrexate

Caution is indicated in prescribing metoclopramide for elderly and young patients, and whenever hepatic or renal impairment is present, and it should be avoided in pregnancy or cases of PORPHYRIAS. Adverse effects include extrapyramidal effects (see under EXTRAPYRAMIDAL SYSTEM) and HYPERPROLACTINAEMIA with occasional TARDIVE DYSKINESIA on prolonged administration. There have also been occasional reports of drowsiness, restlessness, diarrhoea, depression and neuroleptic malignant syndrome, with rare cardiac conduction abnormalities following intravenous administration.... metoclopramide

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

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

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

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

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

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

– for example, PILOCARPINE or OPIUM – have the same e?ect.... miosis

Habitat: Parasitic on the Oak, Hawthorn, Apple and many other trees.

Action: Highly valued as a nervine and antispasmodic.

Habitat: Heaths, moorlands; occasionally meadows and pastures.

Action: Laxative, cathartic.

Under normal conditions the surface of a mucous membrane is lubricated by only a small quantity of mucus; the appearance of large quantities is a sign of in?ammation.... mucus

Habitat: Flourishes in sandy and gravelly waste ground, and is sometimes noticed under garden cultivation.

Action: Demulcent, pectoral and astringent.

Structure of muscle Skeletal or voluntary muscle forms the bulk of the body’s musculature and contains more than 600 such muscles. They are classi?ed according to their methods of action. A ?exor muscle closes a joint, an extensor opens it; an abductor moves a body part outwards, an adductor moves it in; a depressor lowers a body part and an elevator raises it; while a constrictor (sphincter) muscle surrounds an ori?ce, closing and opening it. Each muscle is enclosed in a sheath of ?brous tissue, known as fascia or epimysium, and, from this, partitions of ?brous tissue, known as perimysium, run into the substance of the muscle, dividing it up into small bundles. Each of these bundles consists in turn of a collection of ?bres, which form the units of the muscle. Each ?bre is about 50 micrometres in thickness and ranges in length from a few millimetres to 300 millimetres. If the ?bre is cut across and examined under a high-powered microscope, it is seen to be further divided into ?brils. Each ?bre is enclosed in an elastic sheath of its own, which allows it to lengthen and shorten, and is known as the sarcolemma. Within the sarcolemma lie numerous nuclei belonging to the muscle ?bre, which was originally developed from a simple cell. To the sarcolemma, at either end, is attached a minute bundle of connective-tissue ?bres which unites the muscle ?bre to its neighbours, or to one of the connective-tissue partitions in the muscle, and by means of these connections the ?bre affects muscle contraction. Between the muscle ?bres, and enveloped in a sheath of connective tissue, lie here and there special structures known as muscle-spindles. Each of these contains thin muscle ?bres, numerous nuclei, and the endings of sensory nerves. (See TOUCH.) The heart muscle comprises short ?bres which communicate with their neighbours via short branches and have no sarcolemma.

Plain or unstriped muscle is found in the following positions: the inner and middle coats of the STOMACH and INTESTINE; the ureters (see URETER) and URINARY BLADDER; the TRACHEA and bronchial tubes; the ducts of glands; the GALL-BLADDER; the UTERUS and FALLOPIAN TUBES; the middle coat of the blood and lymph vessels; the iris and ciliary muscle of the EYE; the dartos muscle of the SCROTUM; and in association with the various glands and hairs in the SKIN. The ?bres are very much smaller than those of striped muscle, although they vary greatly in size. Each has one or more oval nuclei and a delicate sheath of sarcolemma enveloping it. The ?bres are grouped in bundles, much as are the striped ?bres, but they adhere to one another by cement material, not by the tendon bundles found in voluntary muscle.

Development of muscle All the muscles of the developing individual arise from the central layer (mesoderm) of the EMBRYO, each ?bre taking origin from a single cell. Later on in life, muscles have the power both of increasing in size – as the result of use, for example, in athletes – and also of healing, after parts of them have been destroyed by injury. An example of the great extent to which unstriped muscle can develop to meet the demands made on it is the uterus, whose muscular wall develops so much during pregnancy that the organ increases from the weight of 30–40 g (1–1••• oz.) to a weight of around 1 kg (2 lb.), decreasing again to its former small size in the course of a month after childbirth.

Physiology of contraction A muscle is an elaborate chemico-physical system for producing heat and mechanical work. The total energy liberated by a contracting muscle can be exactly measured. From 25–30 per cent of the total energy expended is used in mechanical work. The heat of contracting muscle makes an important contribution to the maintenance of the heat of the body. (See also MYOGLOBIN.)

The energy of muscular contraction is derived from a complicated series of chemical reactions. Complex substances are broken down and built up again, supplying each other with energy for this purpose. The ?rst reaction is the breakdown of adenyl-pyrophosphate into phosphoric acid and adenylic acid (derived from nucleic acid); this supplies the immediate energy for contraction. Next phosphocreatine breaks down into creatine and phosphoric acid, giving energy for the resynthesis of adenyl-pyrophosphate. Creatine is a normal nitrogenous constituent of muscle. Then glycogen through the intermediary stage of sugar bound to phosphate breaks down into lactic acid to supply energy for the resynthesis of phosphocreatine. Finally part of the lactic acid is oxidised to supply energy for building up the rest of the lactic acid into glycogen again. If there is not enough oxygen, lactic acid accumulates and fatigue results.

All of the chemical changes are mediated by the action of several enzymes (see ENZYME).

Involuntary muscle has several peculiarities of contraction. In the heart, rhythmicality is an important feature – one beat appearing to be, in a sense, the cause of the next beat. Tonus is a character of all muscle, but particularly of unstriped muscle in some localities, as in the walls of arteries.

Fatigue occurs when a muscle is made to act for some time and is due to the accumulation of waste products, especially sarcolactic acid (see LACTIC ACID). These substances affect the end-plates of the nerve controlling the muscle, and so prevent destructive overaction of the muscle. As they are rapidly swept away by the blood, the muscle, after a rest (and particularly if the rest is accompanied by massage or by gentle contractions to quicken the circulation) recovers rapidly from the fatigue. Muscular activity over the whole body causes prolonged fatigue which is remedied by rest to allow for metabolic balance to be re-established.... muscle

It is a classical example of an autoimmune disease (see AUTOIMMUNITY). The body develops ANTIBODIES which interfere with the working of the nerve endings in muscle that are acted on by ACETYLCHOLINE. It is acetylcholine that transmits the nerve impulses to muscles: if this transmission cannot be e?ected, as in myasthenia gravis, then the muscles are unable to contract. Not only the voluntary muscles, but those connected with the acts of swallowing, breathing, and the like, become progressively weaker. Rest and avoidance of undue exertion are necessary, and regular doses of neostigmine bromide, or pyridostigmine, at intervals enable the muscles to be used and in some cases have a curative e?ect. These drugs act by inhibiting the action of cholinesterase – an ENZYME produced in the body which destroys any excess of acetylcholine. In this way they increase the amount of available acetylcholine which compensates for the deleterious e?ect of antibodies on the nerve endings.

The THYMUS GLAND plays the major part in the cause of myasthenia gravis, possibly by being the source of the original acetylcholine receptors to which the antibodies are being formed. Thymectomy (removal of the thymus) is often used in the management of patients with myasthenia gravis. The incidence of remission following thymectomy increases with the number of years after the operation. Complete remission or substantial improvement can be expected in 80 per cent of patients.

The other important aspect in the management of patients with myasthenia gravis is IMMUNOSUPPRESSION. Drugs are now available that suppress antibody production and so reduce the concentration of antibodies to the acetylcholine receptor. The problem is that they not only suppress abnormal antibody production, but also suppress normal antibody production. The main groups of immunosuppressive drugs used in myasthenia gravis are the CORTICOSTEROIDS and AZATHIOPRINE. Improvement following steroids may take several weeks and an initial deterioration is often found during the ?rst week or ten days of treatment. Azathioprine is also e?ective in producing clinical improvement and reducing the antibodies to acetylcholine receptors. These effects occur more slowly than with steroids, and the mean time for an azathioprine remission is nine months.

The Myasthenia Gravis Association, which provides advice and help to sufferers, was created and is supported by myasthenics, their families and friends.... myasthenia gravis

The disease is rare under the age of 30, frequency increasing with age to peak between 60 and 70 years. There may be a long preclinical phase, sometimes as long as 25 years. When symptoms do occur, they tend to re?ect bone involvement, reduced immune function, renal failure, anaemia or hyperviscosity of the blood. Vertebral collapse is common, with nerve root pressure and reduced stature. The disease is eventually fatal, infection being a common cause of death. Local skeletal problems should be treated with RADIOTHERAPY, and the general disease with CHEMOTHERAPY

– chie?y the ALKYLATING AGENTS melphalan or cyclophosphamide. Red-blood-cell TRANSFUSION is usually required, together with plasmapheresis (see PLASMA EXCHANGE), and orthopaedic surgery may be necessary following fractures.... myelomatosis

Myrtilla, Myrtisa, Myrtis, Mertice, Mertis, Mertle, Mirtie, Myrta, Myrtia, Myrtice, Myrtie, Myrtiece, Myrteace, Myrtee... myrtle

– an early graded return to activity gives the best long-term results, but doing too much too soon runs the risk of exacerbating the original injury.

Chronic (overuse) injuries affecting the bones (see BONE), tendons (see TENDON) or BURSAE of the JOINTS are common in many sports. Examples include chronic INFLAMMATION of the common extensor tendon where it

attaches to the later EPICONDYLE of the humerus – common in throwers and racquet sportspeople – and stress fractures of the TIBIA or METATARSAL BONES of the foot in runners. After an initial period of rest, management often involves coaching that enables the athlete to perform the repetitive movement in a less injury-susceptible manner.

Exercise physiology is the science of measuring athletic performance and physical ?tness for exercise. This knowledge is applied to devising and supervising training regimens based on scienti?c principles. Physical ?tness depends upon the rate at which the body can deliver oxygen to the muscles, known as the VO2max, which is technically di?cult to measure. The PULSE rate during and after a bout of exercise serves as a good proxy of this measurement.

Regulation of sport Sports medicine’s role is to minimise hazards for participants by, for example, framing rule-changes which forbid collapsing the scrum, which has reduced the risk of neck injury in rugby; and in the detection of the use of drugs taken to enhance athletic performance. Such attempts to gain an edge in competition undermine the sporting ideal and are banned by leading sports regulatory bodies. The Olympic Movement Anti-Doping Code lists prohibited substances and methods that could be used to enhance performance. These include some prohibited in certain circumstances as well as those completely banned. The latter include:

stimulants such as AMPHETAMINES, bromantan, ca?eine, carphedon, COCAINE, EPHEDRINE and certain beta-2 agonists.

NARCOTICS such as DIAMORPHINE (heroin), MORPHINE, METHADONE HYDROCHLORIDE and PETHIDINE HYDROCHLORIDE.

ANABOLIC STEROIDS such as methandione, NANDROLONE, stanazol, TESTOSTERONE, clenbuterol, androstenedone and certain beta-2 agonists.

peptide HORMONES, mimetics and analogues such as GROWTH HORMONE, CORTICOTROPHIN, CHORIONIC GONADOTROPHIC HORMONE, pituitary and synthetic GONADOTROPHINS, ERYTHROPOIETIN and INSULIN. (The list produced above is not comprehen

sive: full details are available from the governing bodies of relevant sports.) Among banned methods are blood doping (pre-competition administration of an athlete’s own previously provided and stored blood), administration of arti?cial oxygen carriers or plasma expanders. Also forbidden is any pharmacological, chemical or physical manipulation to affect the results of authorised testing.

Drug use can be detected by analysis of the URINE, but testing only at the time of competition is unlikely to detect drug use designed to enhance early-season training; hence random testing of competitive athletes is also used.

The increasing professionalism and competitiveness (among amateurs and juveniles as well as professionals) in sports sometimes results in pressures on participants to get ?t quickly after injury or illness. This can lead to

players returning to their activity before they are properly ?t – sometimes by using physical or pharmaceutical aids. This practice can adversely affect their long-term physical capabilities and perhaps their general health.... sports medicine

(2) The second meaning (also called test feed) applies to a diagnostic procedure for congenital PYLORIC STENOSIS, whereby a paediatrician feels over the baby’s abdomen while he or she is feeding. The pyloric mass can be felt as a ?rm swelling with the consistency of a squash ball, which comes and goes under the examiner’s ?ngers.... test meal

Features: long fingers and arm span, high palate, kyphosis, etc.

Symptoms. Backache, pain in joints, dislocations.

Alternatives. Alfalfa, Fenugreek, Irish Moss, Kelp, Horsetail, Marshmallow, Bamboo gum.

Teas. Alfalfa, Comfrey leaves, Horsetail, Plantain, Silverweed. Any one: 1 heaped teaspoon to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.

Decoction. Fenugreek seeds 2; Horsetail 1; Bladderwrack 1; Liquorice half. Prepare: 3 heaped teaspoons to 1 pint (500ml) water gently simmered 10 to 20 minutes. 1 wineglass thrice daily. Fenugreek seeds decoction.

Diet. High protein, oily fish.

Supplements. Calcium, Dolomite, Zinc. ... marfan’s syndrome

Symptoms: Mastoid bone behind the ear is tender to touch. Feverishness, red flush over mastoid area, deafness with throbbing earache, malaise, heavy discharge from the ear through perforated eardrum. Diagnostic sign: pinna (external ear) is displaced.

Treatment. Indicated: anti-microbials, anti-bacterials, alteratives with nervines as supportives. Yarrow tea.

Decoction. Combine: Echinacea 3; Wild Indigo 2; Poke root 1. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup every 2 hours with pinch of Cayenne.

Formula. Echinacea 2; Wild Indigo 1; Pulsatilla 1; few grains of Cayenne or Tincture Capsicum drops. Dose: Liquid Extracts: 30-60 drops (2-4ml). Tinctures: 4-8ml. Powders: 500mg (two 00 capsules or one- third teaspoon). Every 2 hours according to age. Children under 5 years – one-quarter dosage; under 12 years – half dosage.

Vitamin C. Copious fluids: fruit juices. Yarrow tea.

Topical. Goldenseal Ear Drops. Oil of Mullein, Sage or Lavender. Gentle massage with Tea Tree oil or Rosemary oil around the mastoid bone and in front of the ear 3/4 times daily.

Treatment by or in liaison with a general medical practitioner. ... mastoiditis

Etiology. Obscure; though cases may be traced to auto-toxaemia, Vitamin B deficiency, menstruation, malaria drugs (chloroquine).

Symptoms: dizziness, nausea, vomiting, tinnitus, sound distortions, heavy sweating, loss of hearing; usually in one ear only. Early diagnosis essential for effective treatment. This may mean reference to a department of otolaryngology or otoneurology.

Treatment. Antispasmodics. Nervines. Sometimes a timely diuretic reduces severity – Uva Ursi, Dandelion root, Wild Carrot.

Alternatives. Current European practice: Betony, German Chamomile, Passion flower, Hawthorn, Hops, Feverfew, White Willow.

Tea. Combine, equal parts: Valerian, Wild Carrot, Agrimony. 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup every 2 hours during attack; thrice daily thereafter.

Decoction. Mistletoe: 2 teaspoons to each cup cold water steeped overnight. Bring to boil. Allow to cool. Half-1 cup, as above.

Tablets/capsules. Feverfew, Mistletoe, Prickly Ash.

Formula. Ginkgo 2; Dandelion 1; Black Cohosh 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Feverfew tincture. See: FEVERFEW.

Dr J. Christopher: inject into ears, at night, few drops oil of Garlic (or contents of Garlic capsule).

Cider vinegar. 2 teaspoons to glass water: as desired.

Aromatherapy. Inhalants: Eucalyptus or Rosemary oils.

Diet: gluten-free, low salt; good responses observed. High fibre. Avoid dairy products and chocolate. Vitamins: B-complex, B1; B2; B6; E; F. Brewer’s yeast, Niacin.

Minerals: Calcium. Magnesium. Phosphorus. Dolomite. ... meniere’s disease

Cup of Chamomile, Balm, or Meadowsweet tea. Liquorice helpful, but most popular is Ginger taken in the form of Ginger wine, or powdered root (quarter to half a teaspoon). Chrystalised Ginger from sweetshop is one of the safest and cheapest: 2-3 pieces sucked or chewed half hour before journey and at intervals thereafter.

Avoid tobacco which reduces oxygen count. Potter’s Ginger root capsules.

Peppermint. Before travelling, glass water with 2 drops.

Aromatherapy. Inhalant. 2-3 drops Peppermint oil on tissue.

Diet. No alcohol or fatty foods. Accept Papaya fruit, Lemons or Lemon juice, Honey, Acidophilus. Supplements. Alternatives to the above. Seven days before journey: B-complex, magnesium 200mg, calcium 400mg. ... motion sickness

Disorders that can be helped or even cured include certain types of LEUKAEMIA and many inherited disorders of the immune system (see IMMUNITY).... bone marrow transplant

Habitat: Ditches, by waterways, and in wet places generally; also cultivated in gardens.

Action: Astringent, diuretic, diaphoretic.

The disease usually appears within the ?rst three years of life, beginning in the pelvic girdle and lower limbs and later spreading to the shoulder girdle. The calf muscles become bulky (pseudohypertrophy). The weakness gives rise to a characteristic waddling gait and, when rising from the supine position, the child rolls on to his face and then uses his arms to push himself up. Death usually occurs by the middle of the second decade from respiratory infections. Prenatal screening of female carriers using gene probes is increasingly available. (See DYSTROPHY; MUSCLES, DISORDERS OF – Myopathy.)... duchenne muscular dystrophy

Treatment includes the full gamut of neonatal intensive care, as well as speci?c therapy with PULMONARY SURFACTANT.... hyaline membrane disease

– see also EYE.... macropsia

Magnoliya, Magnoliah, Magnolea, Magnoleah, Magnoliyah, Magnolya, Magnolyah... magnolia

Habitat: A common plant in the United States and Canada, the root is imported into this country in large quantities for medicinal purposes.

Habitat: Marshes near the sea.

Action: The root is preferred, as the demulcent, emollient, diuretic and expectorant properties are present here in greater strength.

Habitat: Waste places.

Action: Carminative, emollient.

During registration, information from the sense organs and the cerebral cortex is put into codes for storage in the short-term memory system. The codes are usually acoustic (based on the sounds and words that would be used to describe the information) but may use any of the ?ve senses. This system can take only a few chunks of information at a time: for example, only about seven longish numbers can be retained and recalled at once – the next new number displaces an earlier one that is then forgotten. And if a subject is asked to describe a person just met, he or she will recall only seven or so facts about that person. This depends on attention span and can be improved by concentration and rehearsal – for example, by reciting the list of things that must be remembered.

Material needing storage for several minutes stays in the short-term memory. More valuable information goes to the long-term memory where it can be kept for any period from a few minutes to a lifetime. Storage is more reliable if the information is in meaningful codes – it is much easier to remember people’s names if their faces and personalities are memorable too. Using techniques such as mnemonics takes this into account.

The ?nal stage is retrieval. Recognising and recalling the required information involves searching the memory. In the short-term memory, this takes about 40-thousandths of a second per item – a rate that is surprisingly consistent, even in people with disorders such as SCHIZOPHRENIA.

Most kinds of forgetting or AMNESIA occur during retrieval. Benign forgetfulness is usually caused by interference from similar items because the required information was not clearly coded and well organised. Retrieval can be improved by recreating the context in which the information was registered. This is why the police reconstruct scenes of crimes, and why revision for exams is more e?ective if facts are learnt in the form of answers to mock questions.

Loss of memory or amnesia mainly affects long-term memory (information which is stored inde?nitely) rather than short-term memory which is measured in minutes. Short-term memory may, however, be affected by unconsciousness caused by trauma. Drivers involved in an accident may be unable to recall the event or the period leading up to it. The cause of amnesia is disease of or damage to the parts of the brain responsible for memory. Degenerative disorders such as ALZHEIMER’S DISEASE, brain tumours, infections (for example, ENCEPHALITIS), STROKE, SUBARACHNOID HAEMORRHAGE and alcoholism all cause memory loss. Some psychiatric illnesses feature loss of memory and AGEING is usually accompanied by some memory loss, although the age of onset and severity vary greatly.... memory

Mercury has an affinity for the central nervous system. Soon it concentrates in the kidney causing tubular damage. A common cause is the mercurial content (50 per cent) in the amalgam fillings in teeth which, under certain conditions, release a vapour. Fortunately, its use in dentistry is being superceded by an alternative composite filling.

A common cause of poisoning was demonstrated in 1972 when 6,000 people became seriously ill (600 died) from eating bread made from grain treated with a fungicide containing methylmercury. For every fungus in grain there is a mercuric compound to destroy it. The seed of all cereal grain is thus treated to protect its power of germination.

Those who are hypersensitive to the metal should as far as possible avoid button cells used in tape recorders, cassette players, watch and camera mechanisms. As the mercury cells corrode, the metal enters the environment and an unknown fraction is converted by micro organisms to alkylmercury compounds which seep into ground waters and eventually are borne to the sea. When cells are incinerated, the mercury volatilises and enters the atmosphere. (Pharmaceutical Journal, July 28/1984)

Mercury poisoning from inhalation of mercury fumes goes directly to the brain and pituitary gland. Autopsies carried out on dentists reveal high concentrations of mercury in the pituitary gland. (The Lancet, 5-27-89,1207 (letter))

Treatment. For years the common antidote was sulphur, and maybe not without reason. When brought into contact sulphur and mercury form an insoluble compound enabling the mercury to be more easily eliminated from the body. Sulphur can be provided by eggs or Garlic.

Old-time backwoods physicians of the North American Medical School used Asafoetida, Guaiacum and Echinacea. German pharmacists once used Bugleweed and Yellow Dock. Dr J. Clarke, USA physician recommends Sarsaparilla to facilitate breakdown and expulsion from the body.

Reconstructed formula. Echinacea 2; Sarsaparilla 1; Guaiacum quarter; Asafoetida quarter; Liquorice quarter. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Chelation therapy.

Formula. Tinctures. Skullcap 2-15 drops; Pleurisy root 20-45 drops; Horehound 5-40 drops. Mercurial salivation. Thrice daily. (Indian Herbology of North America, by Alma Hutchens) Dental fillings: replace amalgam with safe alternative – ceramic, etc. Evidence of a link between tooth fillings containing mercury and ME has caused the use of dental amalgam to be banned in Sweden. ... mercury poisoning

Mesah, Messa, Messah... mesa

There are also more than 200 identi?ed disorders described as inborn errors of metabolism. Some cause few problems; others are serious threats to an individual’s life. Individual disorders are, fortunately, rare – probably one child in 10,000 or 100,000; overall these inborn errors affect around one child in 1,000. Examples include GALACTOSAEMIA, PHENYLKETONURIA, porphyrias, TAY SACHS DISEASE and varieties of mucopolysaccharidosis, HOMOCYSTINURIA and hereditary fructose (a type of sugar) intolerance.... metabolic disorders

(2) MIND: The National Association for Mental Health, a voluntary charitable body that works in the interests of those with MENTAL ILLNESS, advising, educating and campaigning for and supporting them.... mind

(2) An internationally agreed unit (see SI UNITS) for measuring the quantity of a substance at molecular level.... mole

Moina, Monah, Monalisa, Monalissa, Monna, Moyna, Monalysa, Monalyssa... mona

M. leprae cause, respectively, TUBERCULOSIS and LEPROSY.... mycobacterium

Action: Hips—applied to wounds, injuries, sprains and foul ulcers.

See: BRUCELLOSIS. ... mediterranean fever

Carbon monoxide binds with haemoglobin and prevents the transportation of oxygen to body tissues.

The initial symptoms of acute high-level carbon monoxide poisoning are dizziness, headache, nausea, and faintness.

Continued inhalation of the gas may lead to loss of consciousness, permanent brain damage, and even death.

Low-level exposure to carbon monoxide over a period of time may cause fatigue, nausea, diarrhoea, abdominal pain, and general malaise.... carbon monoxide

Since the barefoot doctors (paramedics) have been grafted into the public Health Service, mass preventative campaigns with public participation of barefoot doctors have led to a reduction in the mortality of infectious disease.

Chinese doctors were using Ephedra 5000 years ago for asthma. For an equal length of time they used Quinghaosu effectively for malaria. The Chinese first recorded goose-grease as the perfect base for ointments, its penetrating power endorsed by modern scientific research.

While Western medicine appears to have a limited capacity to cure eczema, a modern Chinese treatment evolved from the ancient past is changing the lives of many who take it. The treatment was brought to London by Dr Ding-Hui Luo and she practised it with crowded surgeries in London’s Chinatown.

Chinese herbalism now has an appeal to general practitioners looking for alternative and traditional therapies for various diseases where conventional treatment has proved to be ineffective.

See entry: BAREFOOT DOCTOR’S MANUAL.

Address. Hu Shilin, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medicine, Beijing, China. ... chinese medicine

Most microorganisms are too small to be seen by the naked eye.... microorganism

Adverse effects include confusion, drowsiness, and dizziness.

If benzodiazepines are taken for a long period, dependence may result.... midazolam

The midbrain is also called the mesencephalon.... midbrain

Many people suffered severe nerve damage and some died.... minamata disease

Of the 2 types of macular degeneration that may occur, one type is usually remedied by laser treatment.

There is no treatment for the other form, although the affected person may benefit from aids such as magnifying instruments.... macular degeneration

Malocclusion usually develops during childhood. It is inherited, or is caused by thumb-sucking or a mismatch betweenthe teeth and jaws – for example, the combination of large teeth and a small mouth (see overcrowding, dental).

Orthodontic appliances (braces) may be used to move teeth into the proper position, and if there is dental overcrowding, some teeth may be extracted. Orthognathic surgery is used to treat severe recession or protrusion of the lower jaw. Treatment is best carried out in childhood or adolescence.... malocclusion

Marsupialization is used to treat certain types of cysts affecting the pancreas and liver, and cysts affecting the Bartholin’s glands at the entrance to the vagina.... marsupialization

In an allergic response, mast cells release histamine.... mast cell

The tumour usually arises from the cerebellum, which is concerned with posture, balance, and coordination.

It grows rapidly and may spread to other parts of the brain and to the spinal cord.

A morning headache, repeated vomiting, and a clumsy gait develop.

There are also frequent falls.

The tumour is diagnosed by CT scanning or MRI and often responds to radiotherapy.

Surgery and anticancer drugs may also be needed.... medulloblastoma

The prefix megalo- has the same meaning.... mega-

Possible adverse effects of megestrol include swollen ankles, weight gain, nausea, dizziness, headache, rash, and, rarely, raised blood calcium level. ... megestrol

There may also be speech loss or visual disturbance. If the tumour invades the skull bone, there may be thickening and bulging of the skull.

Meningiomas can be detected by X-ray or CT scanning, and MRI of the skull, and can often be completely removed by surgery. Otherwise, treatment is by radiotherapy.... meningioma

For example, a 13 year-old child with learning difficulties may have a mental age of 5.... mental age

Act (1983) details the rights of patients with mental illness and the grounds for detaining mentally ill people against their will. It also outlines forms of legal guardianship for such patients.

When a person is endangering his or her own or other people’s health or safety (for example, threatening harm or suicide) because of a recognized mental illness, he or she may be compulsorily taken into hospital to be given treatment.

If a person breaks the law because of a mental disorder, the courts may remand him or her to hospital.... mental health act

Arthroscopy may be carried out to confirm and locate the damage, and the damaged area removed by instruments passed through the arthroscope.

Alternatively, the meniscus may be removed through an incision at the side of the patella (kneecap).

In either case, there may be an increased risk of osteoarthritis in later life, but this is less than if the damaged meniscus had been left in place.... meniscectomy

Methadone is used under supervision to relieve withdrawal symptoms in people undergoing a heroin or morphine detoxification programme.

Side effects may include nausea, vomiting, constipation, dizziness, and dry mouth.... methadone

The most common type of motor neuron disease is amyotrophic lateral sclerosis ( or Lou Gehrig’s disease). It usually affects people over the age of 50 and is more common in men. Some cases run in families. Usually, symptoms start with weakness in the hands and arms or legs, and muscle wasting. There may be irregular muscle contractions, and muscle cramps or stiffness. All four extremities are soon affected.

Progressive muscular atrophy and progressive bulbar palsy both start with patterns of muscle weakness different from but usually develop into.There are 2 types of motor neuron disease that first appear in childhood or adolescence. In most cases, these conditions are inherited. Werdnig–Hoffman disease affects infants at birth or soon afterwards. In almost all cases, progressive muscle weakness leads to death within several years. Chronic spinal muscular atrophy begins in childhood or adolescence, causing progressive weakness but not always serious disability.

There are no specific tests for motor neuron disease. Diagnosis is based on careful clinical examination by a neurologist. Tests including EMG, muscle biopsy, blood tests, myelography, CT scanning, or MRI may be performed.

The disease typically goes on to affect the muscles involved in breathing and swallowing, leading to death within 2–4 years. However, about 10 per cent of sufferers survive for 10 years.

Nerve degeneration cannot be slowed down, but physiotherapy and the use of various aids may help to reduce disability. The drug riluzole is used to extend life (or the time until mechanical ventilation is required).... motor neuron disease

Features may include abnormalities of the skeleton and/or the central nervous system, with learning difficulties and, in some cases, a characteristic facial appearance. There may also be clouding of the cornea, liver enlargement, and joint stiffness. No specific treatment is available. However, a bone marrow transplant may successfully be used to treat Hurler’s syndrome.

Mild forms of mucopolysaccharidoses allow a child to have a relatively normal life.

More severe types usually cause death during childhood or adolescence.... mucopolysaccharidosis

The usual complaints are abdominal pain, bleeding, neurological symptoms, rashes, and fever. Sufferers typically invent dramatic histories and behave disruptively in hospital. Many have detailed medical knowledge and scars from self-injury or previous treatment. In Munchausen’s syndrome by proxy, parents cause factitious disorders in their children.

Treatment consists of protecting sufferers from unnecessary operations and drug treatments.... munchausen’s syndrome

It usually occurs on one limb, producing a hard swelling and a discharge of pus.

Infections caused by actinomycetes are treated with antibiotic drugs.

Surgical removal of diseased tissue may be necessary for a fungal infection.... mycetoma

The acquired form may develop after a bony injury, especially around the elbow; it causes severe pain and a swelling, which hardens. Treatment with diathermy, coupled with gentle, active movements, may be helpful.... myositis ossificans

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

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

It is usually complete after about 12 hours; the stiffness then disappears over the next 48–60 hours.

Physical exertion before death makes rigor mortis begin sooner.

The sooner rigor mortis begins, the quicker it passes.

These facts are used to help assess the time of death.... rigor mortis

The manoeuvre occurs naturally when an attempt is made to breathe out while holding the vocal cords tightly together.

This happens, for example, at the beginning of a sneeze.

When performed deliberately by pinching the nose and holding the mouth closed, the manoeuvre can prevent pressure damage to the eardrums (see barotrauma).... valsalva’s manoeuvre

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 western Himalayas from Kashmir to Kumaon.

Action: Anti-inflammatory, anti- spasmodic (used in cold, flatulent colic, heartburn), emmenagogue, cicatrizant, antidysenteric, anti- haemorrhagic, antipyretic, diaphoretic, diuretic, urinary antiseptic.

Habitat: The plains and submountain regions of India, ascending to an altitude of 1,200 m in the western Himalayas; cultivated all over India.

Action: Stomachic, antimicrobial (specific for diarrhoea, colitis, dysentery and enteric infections), digestive, astringent, spasmolytic, hypoglycaemic.

Habitat: Native to Afghanistan. (A bulbous plant related to onion.)

Action: Anabolic and gastrointestinal tonic.... allium macleanii

Habitat: Native to tropical Africa; cultivated in Indian gardens.

Action: Roots possess cardamomlike tasteand aregivenasadecoction for constipation; also as a vermifuge for tapeworms. Juice of young leaves—styptic. The seeds contain an alkaloid, piperine; also gingerol, paradol, shogaol and zingerone.

• place about 5 grams of mushrooms in 1 liter of cold water
•  let the mushrooms soak in 1 liter of water until they are re-hydrated
• when the mushrooms are dry and you start to boil the water, they will just float on top and will not extract as quickly
• bring the mixture to a boil
• once it starts to boil, reduce the flame and let it simmer at low flame for about 20 to 30 minutes until the mixture has been reduced about 1/4 or when you have about 750ml of liquid left
• let the mixture cool

• lowering the diabetes risk
• lowering the risk of cardiovascular ailments
• mitigating stomach ulcers and ulcerative colitis
• fighting against osteoporosis
• reducing digestive ailments
• fighting against diseases affecting the bloodstream

Habitat: The evergreen forests of western Ghats from Konkan southwards.

Action: Bark—febrifuge, carminative (given in typhoid, dyspepsia and constipation). Oleo resin— used for dysentery and bronchitis.

Habitat: Eastern Himalayas, Assam, Khasi Hills, Meghalaya, up to 1,500 m, and western Ghats of Kerala.

Action: Rhizome—employed to cure sores. Fruits—emetic (used with salt).

Habitat: Native to China; now mostly grown on the tea estates of Kangra Valley in Himachal Pradesh, and also in Assam and Bengal to provide shade for tea bushes.

Action: Oil from seeds—purgative; employed externally in rheumatism; ulcers; also as a hair tonic. Leaves— applied in acute rheumatism. Fruit—carminative and expectorant. Bark and flowers—used for asthma.

Habitat: Cultivated in Jammu and Himachal Pradesh.

Action: Source of xanthotoxin, a drug employed in the treatment of leucoderma. Dried fruit powder or extract of the plant is used topically in vitiligo.

Habitat: All over India.

Action: Roots—refrigerant, febrifuge, diaphoretic, stimulant, stomachic and emmenagogue; used in strangury, colic, flatulence, obstinate vomiting; paste used as a cooling application in fevers.

Habitat: Around ledges and roadsides.

Action: Demulcent, mucilaginous, pectoral.

Habitat: The western Ghats from Maharashtra to Karnataka; Andhra Pradesh, Kerala and Tamil Nadu.

Action: Antispasmodic (used in dyspepsia, colic), antipyretic, diaphoretic, antiperiodic, emme- nagogue, antirheumatic. The oil is used externally as an embrocation in rheumatic arthritis.

Pharmaceutical manufacturers usually give proprietary (brand) names to the drugs they develop, though doctors in the NHS are expected to prescribe using approved – nonproprietary or generic – titles. Most nonproprietary titles are those in the European Pharmacopoeia, British Pharmacopoeia Commission or the British Pharmaceutical Codex. The USA has its own legislation and arrangements covering the naming and prescribing of medicines. (See PROPRIETARY NAME; GENERIC DRUG; PATENT.)... approved names for medicines

Habitat: Native to America; naturalized throughout India.

Action: Seed—responsible for epidemic dropsy. Causes diarrhoea and induces toxicity. Oil, leaf juice and root—used externally for indolent ulcers and skin diseases.

Habitat: The western Himalayas from Kashmir to Kumaon.

Action: Deobstructant, stomachic, anthelmintic (effective against roundworms), antifungal.

British National Formulary (BNF)

A pocket-book for those concerned with the prescribing, dispensing and administration of medicines in Britain. It is produced jointly by the Royal Pharmaceutical Society and the British Medical Association, is revised twice yearly and is distributed to NHS doctors by the Health Departments. The BNF is also available in electronic form.... british medical association (bma)

Habitat: Throughout India, especially in Assam, Meghalaya and Andaman Islands.

Action: Oil from leaves and berry— antibacterial, antifungal. Leaves— a decoction is applied to cutaneous affections. Fruit—juice, antibilious.... atalantia monophylla

Habitat: Throughout the plains of India in damp marshy areas.

Action: Adaptogenic, astringent, diuretic, sedative, potent nervine tonic, anti-anxiety agent (improves mental functions, used in insanity, epilepsy), antispasmodic (used in bronchitis, asthma and diarrhoea).

Habitat: The Himalayas, Assam, Khasi Hills, Bengal, Madhya Pradesh, Bihar and Peninsular India, ascending to 1,800 m.

Action: Seed—purgative. Leaves— purgative (also used in dropsy), antiasthmatic (decoction is given in asthma). Latex—used for body ache and pain of joints. Root and seed oil—cathartic, antidropsical.

Habitat: Rajasthan, Madhya Pradesh, Assam, Andhra Pradesh, Karnataka.

Action: Oleo-gum-resin—used for reducing obesity and in rheumatoid arthritis, osteoarthritis, sciatica.

Habitat: Arabia, Somaliland.

Action: Oleo-gum-resin—em- menagogue (used for irregular menstruation and painful periods), anti-inflammatory (on pharyngitis and gingivitis), antiseptic, bacteriostatic, antiviral, astringent, stimulant, expectorant, stomachic, carminative (in dyspepsia), a leuco- cytogenic agent (increases number of white cells in the blood). Used externally for treating acne, boils and pressure sores, internally as a blood purifier.

Habitat: South India, Assam and Bengal.

Action: Antidysenteric.

• Place a handful of leaves in a pot of boiling water
• Boil the mix until the water turns green
• Let the mix steep for about 5 minutes

• abdominal gas and colic
• liver problems
• ulcers in different parts of the body
• digestion (It may also help ease symptoms of dyspepsia and constipation)

• the symptoms of menopause and menstrual discomfort (hot flashes, mood swings and vaginal dryness)
• infertility
• rheumatism
• cough
• high cholesterol levels, as well as hardening of the arteries
• osteoporosis
• muscle aches

Habitat: The sub-Himalayan tract from Kashmir eastwards to Assam, and in Bihar, Orissa and Andhra Pradesh.

Action: Bark and Root—astringent, anthelmintic. Used in the treatment of bone fracture.

Habitat: Throughout India, up to 1,200 m except in very arid regions.

Action: Bark—astringent, styptic (prescribed in bleeding piles, ulcers, haemorrhages, menstrual disorders), anthelmintic. Flowers— astringent, diuretic, emmenagogue (also given for leucorrhoea). A decoction of flowers is given in diarrhoea and haematuria, also to puerperal women. Seeds—clinical use of seeds as an anthelmintic drug is not considered safe in humans.

Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its effects within the home, but most cases are unrecognised, unreported and untreated, even though victims may suffer from long-term effects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments suffering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.

Clinical effects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are affected to a great extent. Common effects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may suffer neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.

First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical effects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to

0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... carbon monoxide (co)

Eva Maria, Eva Mary, Eva Mariah... eva marie

Habitat: Dense moist forests throughout India up to 1,500 m altitude.

Action: Powdered root and stems— laxative, antibilious.

Habitat: North-eastern region up to 1,500 m in Assam and Tripura.

Action: Fruit—cardiotonic. Leaves, flowers and rind—used as a sedative in nervous affections. Leaves— used in convulsive cough, chorea, epilepsy, also in the treatment of haemorrhagic diseases. A lotion of boiled leaves used hot in painful swellings. The essential oil from fresh leaves exhibits dermatophytic, and fungistatic activity.

The University of Exeter Centre for Complementary Health Studies report, published in 2000, estimated that there are probably more than 60,000 practitioners of complementary and alternative medicine in the UK. In addition there are about 9,300 therapist members of organisations representing practitioners who have statutory quali?cations, including doctors, nurses (see NURSING), midwives, osteopaths and physiotherapists; chiropractors became fully regulated by statute in June 2001. There are likely to be many thousands more health sta? with an active interest or involvement in the practice of complementary medicine – for example, the 10,000 members of the Royal College of Nursing’s Complementary Therapy Forum. It is possible that up to 20,000 statutory health professionals regularly practise some form of complementary medicine including half of all general practices providing access to CAMs – most commonly manipulation therapies. The report from the Centre at Exeter University estimates that up to 5 million patients consulted a practitioner specialising in complementary and alternative medicine in 1999. Surveys of users of complementary and alternative practitioners show a relatively high satisfaction rating and it is likely that many patients will go on to use such therapists over an extended period. The Exeter Centre estimates that, with the increments of the last two years, up to 15–20 million people, possibly 33 per cent of the population of the country, have now sought such treatment.

The 1998 meeting of the British Medical Association (BMA) agreed to ‘investigate the scienti?c basis and e?cacy of acupuncture and the quality of training and standards of con?dence in its practitioners’. In the resulting report (July 2000) the BMA recommended that guidelines on CAM use for general practitioners, complementary medicine practitioners and patients were urgently needed, and that the Department of Health should select key CAM therapies, including acupuncture, for appraisal by the National Institute for Clinical Medicine (NICE). The BMA also reiterated its earlier recommendation that the main CAM therapies, including acupuncture, should be included in familiarisation courses on CAM provided within medical schools, and that accredited postgraduate education should be provided to inform GPs and other clinicians about the possible bene?ts of CAM for patients.... complementary and alternative medicine (cam)

Habitat: North temperate regions.

Action: Sedative, anodyne, antispasmodic. Used for relief in whooping cough, asthma; paralysis; epilepsy. Antidote to strichnine poisoning and other poisons of the same class. Highly toxic. Mother tincture of Hemlock is used in homoeopathy for prevention of immature cataract.

Habitat: Throughout India, wild and often planted.

Action: Fruit—astringent, demulcent, expectorant, diuretic, anthelmintic, mucilaginous. Used in the diseases of the chest and urinary passage. Bark—used in dyspepsia and fevers. Kernels— externally applied to ringworm. Leaf—decoction used in cough and cold.

Habitat: Cultivated in Punjab and Uttar Pradesh.

Action: Seeds—cooling, diuretic; used in painful micturition and suppression of urine.

Habitat: Cultivated throughout India.

Action: Fruit pulp—sedative, emollient and refrigerant; used as poultice, applied to burns, inflammations, boils, and burns. Seeds—diuretic, anthelmintic (for tapeworm). Because of their zinc content and antimitotic effect, seeds are used to arrest enlargement of prostate gland. Also used in cystitis and minor kidney dyfunction.

Habitat: Native to Central America. Cultivated in warmer climate than that required for C. maxima.

Action: Fruit—used in headache, bronchitis, asthma; as diuretic in genitourinary disorders; as anthelmintic against tapeworms. Dried pulp is administered in haemptysis.

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

About the Nutrients in This Food Like other animal foods, game meat has high-quality proteins with suf- ficient amounts of all the essential amino acids. Some game meat has less fat, saturated fat, and cholesterol than beef. All game meat is an excellent source of B vitamins, plus heme iron, the form of iron most easily absorbed by your body, and zinc. For example, one four-ounce serving of roast bison has 28 g protein, 2.7 g fat (1.04 g saturated fat), 93.7 mg cholesterol, 3.88 mg iron (25.8 percent of the R DA for a woman of childbearing age), and 4.1 mg zinc (27 percent of the R DA for a man). The Nutrients in Roasted Game Meat (4-ounce serving)

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Vitamin C increases the absorption of iron.

Diets That May Restrict or Exclude This Food Low-protein diet (for kidney disease)

Buying This Food In American markets, game meats are usually sold frozen. Choose a package with no leaks or stains to suggest previous defrosting.

Storing This Food Keep frozen game meat well wrapped in the freezer until you are ready to use it. The packaging protects the meat from oxygen that can change its pigments from reddish to brown. Freezing prolongs the freshness of the meat by slowing the natural multiplication of bacteria that digest proteins and other substances on the surface, converting them to a slimy film. The bacteria also change the meat’s sulfur-containing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Large cuts of game meat can be safely frozen, at 0°F, for six months to a year.

Preparing This Food Defrost the meat in the refrigerator to protect it from spoilage. Trim the meat to dispose of all visible fat, thus reducing the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with hot soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the way meat looks and tastes, alters its nutritional value, makes it safer, and extends its shelf life. Browning meat before you cook it does not “seal in the juices,” but it does change the flavor by caramelizing proteins and sugars on the surface. Because meat’s only sugars are the Game Meat  

63 small amounts of glycogen in muscle tissue, we add sugars in marinades or basting liquids that may also contain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (NOTE : Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When meat is heated, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat. They turn brown, the natural color of well-done meat. At the same time, the fats in the meat are oxidized, a reaction that produces a characteristic warmed-over flavor when the cooked meat is refrigerated and then reheated. Cooking and storing the meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers and other vitamin-C rich vegetables—reduces fat oxidation and lessens the warmed-over flavor. Meat reheated in a microwave oven is also less likely to taste warmed-over.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to air in a cold room evaporates moisture and shrinks the meat slightly. At the same time, bacterial action on the surface of the meat breaks down proteins, producing an “aged” flavor. (See below, Food/drug interactions.) Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solu- tion. The salt or sugar used in curing dissolve in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the micro-organisms and protecting the meat from bacterial damage. Salt-cured meat is higher in sodium than fresh meat. Smoking. Hanging fresh meat over an open fire slowly dries the meat, kills microorgan- isms on its surface, and gives the meat a rich, smoky flavor. The flavor varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Artificial smoke flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Like all foods from animals, game meats are a source of cholesterol. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. 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-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meat con- taminated with other bacteria, viruses, or parasites poses special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; to 165°F, E. coli, and to 212°F, Listeria monocytogenes. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia that is excreted through the kidneys. In laboratory animals, a sustained high-pro- tein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... game meat

Habitat: In drier parts of India; in Maharashtra, Andhra Pradesh, Karnataka, Madhya Pradesh and Uttar Pradesh. The most important centers of Rosha Grass oil production are Betul and Mimar in Madhya Pradesh and Nasik in Maharashtra.

Action: Essential oil is used externally for stiff joints and lumbago, skin diseases, and in the treatment of baldness. Given internally in small doses in bilious complaints.

Habitat: Throughout India, particularly in waste place.

Action: Various plant parts are used in headache, hemiplegia, epilepsy, delirium, convulsions, cramps, rigid thigh muscles, rheumatism. Leaf— antitumour, antirheumatic. Leaf and corolla—anti-inflammatory. Flower—antiasthmatic. Seed, leaf and root—anticatarrhal, febrifuge, antidiarrhoeal, antidermatosis; also used in cerebral complications. Seeds—used in asthma. Limited use in kinetosis (excessive salivation, nausea and vomiting).

Habitat: Throughout the plains of India, as a weed in cultivated fields.

Action: Astringent, antibilious. Laxative in large doses. Flowers and seeds—diuretic; given for urinary discharges.

Habitat: Madhya Pradesh, Maharashtra, Orissa, Bihar, Uttar Pradesh and West Peninsula.

Action: Leaves—carminative, laxative, diuretic, styptic. Bark— astringent. Used in dyspepsia and diarrhoea. Unripe fruit— carminative and astringent. Ripe fruit—antibilious. Dried flowers— used in anaemia, inflammation of spleen, also in leucorrhoea. Leaf and dried flower—used in dyspepsia and diarrhoea, topically in scabies. Aerial parts—hypotensive.

Herbal Manual

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The average macrobiotic diet is made up approximately of the proportions: whole grains 45 per cent; vegetables 25 per cent; beans, legumes and seeds 10 per cent; nuts 5 per cent; fruit 5 per cent; seaweeds 5 per cent; poultry 2.5 per cent; fish 2.5 per cent.

Whole grains: wheat, barley, rye, oats, brown rice, buckwheat, millet, corn. Vegetables: green leaves and roots – grown organically. Beans, legumes and seeds: all beans, aduki, lentils, chickpeas. Seeds: sesame, sunflower, etc. Seaweeds: hiziki, wakama, dulse, Carragheen moss, kelp. Very low sugar. Moderate fats and oils. ... diet - macrobiotic

A preliminary therapeutic trial in patients with ageing macular degeneration or diabetic retinopathy showed that supplementation with Beta-carotene, Vitamin C, Vitamin E and Selenium halted the progression of degenerative changes and in some cases even brought some improvement. (Age and Ageing 1991, 20(1) 60-9). Bilberries.

Referral to a consultant ophthalmologist. ... eyes  - macular degeneration

Lead disrupts neurotransmitters in the brain and disposes to nervous excitability, aggression and hyperactivity. Aluminium is associated with senile dementia and Alzheimer’s disease, accumulating in the brain. Cadmium induces changes in behaviour with reduced mental ability. Mercury is present in the amalgam used in dental surgery as part-filling for teeth. Arsenical poisoning may occur in food contamination or paints.

An internal chelating or cleansing of tissues of the lungs, urinary system, blood and lymph may be assisted by a combination of relative expectorants, diuretics, hepatics and adaptogens among which are: Barberry, Blue Flag root, Chaparral, Burdock, Echinacea, Red Clover, Yellow Dock. To bind with metals and assist their passage through the intestinal canal to the outside of the body: Irish Moss, Iceland Moss or Slippery Elm. Garlic.

The Medicines Control Agency of the Ministry of Health (UK) has given consideration to the content of heavy metal impurities and rules that a limit of 75 micrograms of total heavy metals shall be the acceptable maximum daily intake.

Licence-holders are required to carry out tests on all incoming material. Some seaweeds may be heavily polluted with mercury, arsenic and radioactive particles as a result of micro-biological contamination. The MCA requires Bladderwrack and other seaweeds to contain minimum levels. ... heavy metal toxicity

Constituents: tannins.

Action: powerful styptic and astringent because of its high tannin content. Haemostatic. Alterative. Drying and binding. Menstrual regulator.

Uses: Excessive menstruation. Non-menstrual bleeding of the womb between periods. Children’s summer diarrhoea, colitis with bleeding. Gastric and duodenal ulcer. Children’s convulsions. (Swedish traditional)

Not used in pregnancy.

Combinations. (1) with Avens for gastritis and mucous colitis. (2) with Agnus Castus for menstrual disorders.

Preparations: Average dose: 2-4g. Thrice daily. Tea: 1-2 teaspoons to each cup boiling water; infuse 15 minutes. One cup.

Liquid extract BHP (1983) 1:1 in 25 per cent alcohol. Dose: 2-4ml.

Powdered root. Dose, 2-4g.

Vaginal douche: 2oz to 2 pints (60g to 1 litre) boiling water. Infuse 30 minutes. Inject warm for leucorrhoea, Candida, inflammation; or as a lotion for pruritus.

Decoction (roots) offer a powerful deterrant to passive bleeding. ... lady’s mantle

Of historic interest only, as a cholagogue, emmenagogue and diuretic. No longer used in medicine.

Used in the dyeing industry as Turkey Red. ... madder

Tea. Skullcap 1; Oats 2; Valerian half. Mix. 1 teaspoon to each cup boiling water. 1 cup as desired.

Life Drops. Few drops in tea.

Lime flower tea, at night.

Ginkgo. For brain fatigue.

Diet. Avoid strong tea, coffee, alcohol. ... manager’s stress

Uses: Herpes simplex virus (HSV-1). ... mango leaves

Habitat: Throughout the greater part of India.

Action: Various plant parts are used in fever, puerperal fever, neuralgia, pleurisy, pneumonia, menorrhagia, dysurea. Fruits are applied externally to boils.

• Helps relieve dry cough.
• May help in the treatment of epilepsy and rheumatism.
• Can be used as a remedy for asthma.
• Relieves indigestion and flatulence.
• Prevents spasm in the digestive tract.

Habitat: The temperate Western Himalaya in Kashmir from 2,1002,400 m.

Action: Seeds—Febrifuge, carminative, astringent, demulcent, vulnerary. Used is cephalalgia, neurological disorders, as a cardiac tonic, brain tonic and deobstruent in Unani medicine.

Herbal Medical

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Habitat: Konkan and North Kanara, throughout dry forests of Tamil Nadu.

Action: Root—anti-inflammatory, febrifuge; disperses swellings.... hugonia mystax

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.

Indian Medicinal Plants

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The imaging systems of COMPUTED TOMOGRAPHY (CT) and magnetic resonance imaging (see MRI) have powerful computer techniques underlying them.

Computerised statistical analysis of study data, population databases and disease registries is now routine, leading to enhanced understanding of the interplay between diseases and the population. And the results of research, available on computerised indexes such as MEDLINE, can be obtained in searches that take only seconds, compared with the hours or days necessary to accomplish the same task with its paper incarnation, Index Medicus.

Medical informatics The direct computerisation of those activities which are uniquely medical – history-taking, examination, diagnosis and treatment – has proved an elusive goal, although one hotly pursued by doctors, engineers and scientists working in the discipline of medical informatics. Computer techniques have scored some successes: patients are, for example, more willing to be honest about taboo areas, such as their drug or alcohol consumption, or their sexual proclivities, with a computer than face to face with a clinician; however, the practice of taking a history remains the cornerstone of clinical practice. The examination of the patient is unlikely to be supplanted by technological means in the foreseeable future; visual and tactile recognition systems are still in their infancy. Skilled interpretation of the result by machine rather than the human mind seems equally as remote. Working its way slowly outwards from its starting point in mathematical logic, ARTIFICIAL INTELLIGENCE that in any way mimics its natural counterpart seems a distant prospect. Although there have been successes in computer-supported diagnosis in some specialised areas, such as the diagnosis of abdominal pain, workable systems that could supplant the mind of the generalist are still the dream of the many developers pursuing this goal, rather than a reality available to doctors in their consulting rooms now.

In therapeutics, computerised prescribing systems still require the doctor to make the decision about treatment, but facilitate the process of writing, issuing, and recording the prescription. In so doing, the system can provide automated checks, warning if necessary about allergies, potential drug interactions, or dosing errors. The built-in safety that this process o?ers is enhanced by the superior legibility of the script that ensues, reducing the potential for error when the medicine is dispensed by the nurse or the pharmacist.

Success in these individual applications continues to drive development, although the process has its critics, who are not slow to point to the lengthier consultations that arise when a computer is present in the consulting room and its distracting e?ect on communication with the patient.

Underlying these many software applications lies the ubiquitous personal computer – more powerful today than its mainframe predecessor of only 20 years ago – combined with networking technology that enables interconnection and the sharing of data. As in essence the doctor’s role involves the acquisition, manipulation and application of information – from the individual patient, and from the body of medical knowledge – great excitement surrounds the development of open systems that allow di?erent software and hardware platforms to interact. Many problems remain to be solved, not least the fact that for such systems to work, the whole organisation, and not just a few specialised individuals, must become computer literate. Such systems must be easy to learn to use, which requires an intuitive interface between user(s) and system(s) that is predictable and logical in its ordering and presentation of information.

Many other issues stand in the way of the development towards computerisation: standard systems of nomenclature for medical concepts have proved surprisingly di?cult to develop, but are crucial for successful information-sharing between users. Sharing information between existing legacy systems is a major challenge, often requiring customised software and extensive human intervention to enable the previous investments that an organisation has made in individual systems (e.g. laboratory-result reporting) to be integrated with newer technology. The beginnings of a global solution to this substantial obstacle to networking progress is in sight: the technology that enables the Internet – an international network of telephonically linked personal computers – also enables the establishment of intranets, in which individual servers (computers dedicated to serving information to other computers) act as repositories of ‘published’ data, which other users on the network may ‘browse’ as necessary in a client-server environment.

Systems that support this process are still in early stages of development, but the key conceptualisations are in place. Developments over the next 5–10 years will centre on the electronic patient record available to the clinician on an integrated clinical workstation. The clinical workstation – in essence a personal computer networked to the hospital or practice system – will enable the clinician to record clinical data and diagnoses, automate the ordering of investigations and the collection of the results, and facilitate referral and communication between the many professionals and departments involved in any individual patient’s care.

Once data is digitised – and that includes text, statistical tables, graphs, illustrations and radiological images, etc. – it may be as freely networked globally as locally. Consultations in which live video and sound transmissions are the bonds of the doctor-patient relationship (the techniques of telemedicine) are already reality, and have proved particularly convenient and cost-e?ective in linking the patient and the generalist to specialists in remote areas with low population density.

As with written personal medical records, con?dentiality of personal medical information on computers is essential. Computerised data are covered by the Data Protection Act 1984. This stipulates that data must:

be obtained and processed fairly and lawfully.

be held only for speci?ed lawful purposes.

•not be used in a manner incompatible with those purposes.

•only be recorded where necessary for these purposes.

be accurate and up to date.

not be stored longer than necessary.

be made available to the patient on request.

be protected by appropriate security and backup procedures. As these problems are solved, concerns about

privacy and con?dentiality arise. While paper records were often only con?dential by default, the potential for breaches of security in computerised networks is much graver. External breaches of the system by hackers are one serious concern, but internal breaches by authorised users making unauthorised use of the data are a much greater risk in practice. Governing network security so that clinical users have access on a need-to-know basis is a di?cult business: the software tools to enable this – encryption, and anonymisation (ensuring that clinical information about patients is anonymous to prevent con?dential information about them leaking out) of data collected for management and research processes – exist in the technical domain but remain a complex conundrum for solution in the real world.

The mushroom growth of websites covering myriad subjects has, of course, included health information. This ranges from clinical details on individual diseases to facts about medical organisations and institutes, patient support groups, etc. Some of this information contains comments and advice from orthodox and unorthodox practitioners. This open access to health information has been of great bene?t to patients and health professionals. But web browsers should be aware that not all the medical information, including suggested treatments, has been subject to PEER REVIEW, as is the case with most medical articles in recognised medical journals.... information technology in medicine

Habitat: Deccan, West Coast, Western Ghats and in the Nilgiris.

Action: See Jasminum sambac.... jasminum malabaricum

Habitat: West Bengal, Bihar, Central and Peninsular India and Andaman Islands. Grown in gardens, and as an avenue tree. Quite common in New Delhi.

Action: Bark—antibilious. Leaf— antispasmodic. Root bark and leaf— used in preparations of oils and ointments for ulcers, skin diseases, oedema and inflammations.... ficus microcarpa

Habitat: Deccan, Konkan and Karnataka.

Action: Antiseptic, bitter tonic.... lamprachaenium microcephalum

Habitat: Western India, Punjab and Sind.

Action: Plant—galactagogue. A decoction is administered in constipation.... launaea mucronata

Habitat: Native to Malaysia. Now cultivated mainly on lower slopes of the Nilgiris.

Action: Fruit—antileucorrhoeic, astringent, antifungal, antibacterial; used in cystitis, diseases of the genitourinary tract, diarrhoea, tropical dysentery and fevers. Pericarp—used externally for eczema and other skin diseases. Leaves—anti-inflammatory, anti- immunosuppressive, antiprotozoal, antimicrobial.

Habitat: Throughout southern India, also in Assam and West Bengal, up to 1,000 m

Action: Gum-resin—hydragogue, cathartic, anthelmintic. Used in dropy and amenorrhoea. Causes nausea, vomiting and griping in large doses.

The Council is funded by doctors’ annual fees and is responsible to the Privy Council. Substantial reforms of the GMC’s structure and functions have been and are still being undertaken to ensure that it operates e?ectively in today’s rapidly evolving medical and social environment. In particular, the Council has strengthened its supervisory and disciplinary functions, and among many changes has proposed the regular revalidation of doctors’ professional abilities on a periodic basis. The Medical Register, maintained by the GMC, is intended to enable the public to identify whom it is safe to approach to obtain medical services. Entry on the Register shows that the doctor holds a recognised primary medical quali?cation and is committed to upholding the profession’s values. Under revalidation requirements being ?nalised, in addition to holding an initial quali?cation, doctors wishing to stay on the Register will have to show their continuing ?tness to practise according to the professional attributes laid down by the GMC.

Once revalidation is fully established, there will be four categories of doctor:

Those on the Register who successfully show their ?tness to practise on a regular basis.

Those whose registration is limited, suspended or removed as a result of the Council’s disciplinary procedures.

Those who do not wish to stay on the Register or retain any links with the GMC.

Those, placed on a supplementary list, who do not wish to stay on the main Register but who want to retain a formal link with the medical profession through the Council. Such doctors will not be able to practise or prescribe.... general medical council (gmc)

Habitat: Throughout hotter parts of India.

Action: Astringent, anodyne, styptic, antiseptic. Root tubers— astringent, mucilaginous; applied to wounds and sores; used for ringworm and guineaworm.... leea macrophylla

Habitat: Bihar and South India.

Action: Plant—an infusion is given for colds and gastrointestinal troubles.... leucas martinicensis

Habitat: Tropical Himalayas from Nepal to Bhutan, Assam and Meghalaya.

Action: Seed oil—antirheumatic. Plant— antiperiodic. Leaves— piscic.

• Bring cold water to a rolling boil.
• Place 1 teaspoon of tea for each cup into the teapot.
• Pour the boiling water into the teapot.
• Cover the teapot and let it steep between 3 and 7 minutes according to taste (the longer the soaking time the stronger the tea). Milk and sugar could be added.

• Place 6 teaspoons of tea into a teapot or heat resistant pitcher.
• Pour 1 1/4 cups of boiled water over the tea. Steep it for about 5 minutes.
• Quarter fill a serving pitcher with cold water.
• Pour the tea into the serving pitcher straining the leaves.
• Add ice and top up the pitcher with cold water.
• Sugar could be added.

• digestive system
• stressful moods
• senses
• metabolic processes

Habitat: Throughout the greater part of India.

Action: Leaf—stomachic, antispas- modic, sedative, emmenagogue, deobstruent, antiseptic. Used in amenorrhoea.

Habitat: Native to tropical Africa. Cultivated in Madhya Pradesh, Andhra Pradesh, Karnataka and Orissa.

Habitat: Western Ghats from Konkan southwards.

Action: See G. sylvertre.

Habitat: Native to China; planted in the hedges of gardens.

Action: Flower—used in pectoral and pulmonary affections. Leaf and flower—expectorant, bechic, anodyne. Used in menorrhagia, dysuria, swellings, fistulae, wounds and burns.

Machara, Macharia, Macharea... macha

caves

Machpela, Machpellah, Machpella... machpelah

Mackendra, Mackennah, McKenna, McKendra, Makenna, Makennah... mackenna

Habitat: North-western Himalayas. Cultivated on limited scale in North Indian plains.

Action: Sedative.

• Helps treating bronchitis.
• Cough remedy.
• Helps combat irritable bowel infections, gastritis and dysentery.
• Prevents congestion.
• Fights infestation of intestinal worms.

• Over consumption can be unsafe, because the dried Iceland moss plant can be contaminated with lead.
• Pregnant and breastfeeding women should avoid drinking Iceland Moss Tea. During pregnancy, it can be harmful to the mother and to the unborn child.
• It can cause ulcers in the stomach or small intestine.
• Iceland Moss Tea may interact with the effects of some medications, so make sure you always consult your doctor before drinking Iceland Moss Tea or any kind of herbal tea.
• It can cause nausea and liver problems.

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

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

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

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

The principle of one-to-one, 24-hours-a-day care for seriously ill patients has been widely adopted and developed for the initial treatment of many patients with life-threatening conditions. Thus, severely injured patients – those with serious medical conditions such as coronary thrombosis or who have undergone major surgery, and individuals suffering from potentially lethal toxic affects of poisons – are treated in an INTENSIVE THERAPY UNIT (ITU). Patients whose respiratory or circulatory systems have failed bene?t especially by being intensively treated. Most patients, especially post-operative ones, leave intensive care when their condition has been stabilised, usually after 24 or 48 hours. Some, however, need support for several weeks or even months. Since 1952, intensive medicine has become a valued specialty and a demanding one because of the range of skills needed by the doctors and nurses manning the ITUs.... intensive care medicine

Habitat: Throughout India in the plains, especially on the bank of stream and rivers.

Action: Used as a single drug for curing sterility in women, and for promoting fertility and virility.

Habitat: The Himalayas, West Bengal, Bihar, Orissa, Maharashtra and South India.

Action: Purgative, febrifuge. Seeds—cardiac depressant, spasmolytic, hypotensive, antibacterial, antifungal. Plant juice destroys bedbugs.

Habitat: Sub-Himalayan tract and in moist forests of Western Ghats.

Action: Diuretic, emetic. Boiled bark—applied on burns.

Madox, Madoxx, Maddoxx... maddox

Madiera, Madera, Madira, Madyra, Madeera, Madeara... madeira

Habitat: Native to South America. Naturalized in various parts of India.

Action: Seeds—purgative, emetic. Fruits—poisonous. Leaves—used for scabies. Latex—applied to wounds and ulcers.

Habitat: The Himalayas from Kashmir to Kumaon.

Action: Roots—used as incense. Stimulant, given in colic, also in fever after child birth. Bruised roots are applied to eruptions.

Habitat: Hedgerows and waysides.

Action: Astringent, nervine, antispasmodic.

• Relieves menstrual cramps and discomfort during menopause.
• When applied on skin, it can heal wounds, cuts, burns or other skin conditions.
• Helps relieving nausea.
• Effective in treating diarrhea and gastroenteritis.
• May heal bleeding gums.

• Do not drink Lady’s Mantle Tea if you are pregnant or breastfeeding.
• Stop drinking Lady’s Mantle tea if you experience weakness or fatigue.
• It may interact with the effects of some medications, so always consult your doctor before drinking any herbal tea, including Lady’s Mantle Tea.

Madelharie, Madelhary, Madelharey, Madelharee, Madelharea... madelhari

Maddison, Madisen, Madisson, Madisyn, Madyson... madison

Habitat: Assam and Eastern Himalayas, also Tamil Nadu.

Action: Bark—stimulant, astringent, spasmolytic, stomachic, antidiarrhoeal. Root—applied externally for pains, bruises and contusions.

Habitat: A dioecious palm, cultivated in gardens as an ornamental.

Action: The water of the green fruit and its soft kernel—antacid and antibilious.

Habitat: Gujarat.

Action: Used for diseases of liver and spleen. In folk medicine, as a substitute for Rakta-Rohitaka. (Rohitaka is equated with Tecomel- lia undulata Seem., synonym Tecoma undulata G. Don, Bignoni- aceae.)

Action: Fat used as ointment in rheumatism, for chapped hands and feet during winter.

Madonnah, Madona, Madonah... madonna

Madrie, Madry, Madrey, Madree, Madrea... madri

• Helps providing energy without over-stimulating the body’s systems.
• Enhances libido and helps in the treatment of erectile dysfunction.
• Increases the production of sperm.
• Helps relieving the symptoms of menopause.
• Strengthens your immune system.
• Balances and stabilizes the body’s cardiovascular, nervous, muscular and lymphatic systems.

Habitat: Found in sub-Himalayan tract from Kumaon to Bhutan.

Habitat: A large tree, cultivated mainly in Uttar Pradesh, Bihar.

Action: Flowers—stimulant, demulcent, laxative, anthelmintic, bechic. Seed oil—galactogenic, anticephalgic, emetic. Used in pneumonia, skin diseases, piles. Bark—astringent, emollient. Used for tonsilitis, gum troubles, diabetes, ulcers. Bark, seed oil and gum— antirheumatic.

Habitat: Cultivated in Uttar Pradesh, Bihar, Andhara Pradesh, Karnataka, Bengal and Maharas- tra.

Action: Same as that of Madhuca indica.

Habitat: Punjab, Sind, Gujarat, Central and Southern India.

Action: Root—used for bleeding piles, as alterative in fevers; as a tonic in muscular debility.

Magnild, Magnilda, Magnilde, Magnhild, Magnhilde, Maganhildi, Maganhildie, Maganhilde, Maganhilda... magnhilda

eyes Mahah... maha

Mahadevie, Mahadevy, Mahadevey, Mahadevee, Mahadevea... mahadevi

Mahall, Mahale, Mahalle... mahal

Mahalia, Mahalah, Mahlah, Mahla, Mahalea, Mahaliah, Mahaleah... mahala

Mahanaime, Mahanaima, Mahanayme, Mahanaym, Mahanayma, Mahanaem, Mahanaema... mahanaim

Mabubi, Mahbubee, Mahbubie, Mabubie, Mabubee, Mahbubey, Mabubey... mahbubi

Habitat: Native to North America; found in the Himalayas and the Nilgiri hills up to 2,100 m.

Action: Bark—anti-inflammatory, stimulant, diaphoretic. Wood— toxic. Plant is used against cold, headache and stomach-ache. Leaf extract—fungitoxic.

Maheo, Maheonia, Maheonea... maheona

Maheena, Mahyna, Maheana, Maheyna, Mahiena, Maheina... mahina

Mahmude, Mahmudee, Mahmoude, Mamoudee... mahmoode