The meaning of the symbols of dreams/ seen in a dream.

Causes Oedema is not a disease, it is a sign – usually of underlying local or systemic disease. It may sometimes be visible as a swelling. Oedema occurs when the normal mechanisms for maintaining a balance between ?uid in the tissues and in the blood are upset. That balance depends mainly on the blood pressure that keeps the blood ?owing through the circulatory system – thus forcing ?uid out of the capillaries

– and the osmotic drawing force of the blood proteins which pulls water into the bloodstream. The KIDNEYS also have an essential role in maintaining this balance.

Among the disorders that may disturb this balance are heart failure, NEPHROTIC SYNDROME, kidney failure, CIRRHOSIS of the liver and a diet de?cient in protein. Injury may also cause oedema and ascites (?uid in the abdominal cavity) can occur as a result of cirrhosis of the liver or cancer in the abdominal organs.

Treatment The underlying cause of oedema should be treated and, if this is not feasible or e?ective, the excess ?uid should be excreted by boosting the output of the kidney. Restriction of sodium in the diet and the administration of DIURETICS are e?ective methods of achieving this.... oedema

Habitat: Under field cultivation.

Action: Nervine, tonic, stimulant, antispasmodic.

Oestradiol is responsible for the development of the female sexual characteristics, of the BREASTS, and of part of the changes that take place in the UTERUS before MENSTRUATION.... oestradiol

The importation into Britain of opium is strictly regulated under the Dangerous Drugs Acts. Similar regulations govern the sale and distribution of any preparation of morphine or diamorphine (heroin) stronger than 1 part in

500. (See DEPENDENCE.)

Action The action of opium varies considerably, according to the source of the drug and the preparation used.

In small doses, opium produces a state of gentle excitement, the person ?nding their imagination more vivid, their thoughts more brilliant, and their power of expression greater than usual. This stage lasts for some hours, and is succeeded by languor. In medicinal doses this stage of excitement is short and is followed by deep sleep. When potentially poisonous doses are taken, sleep comes on quickly, and passes into coma and death (see OPIOID POISONING). The habitual use of opium produces great TOLERANCE, so that opium users require to take large quantities daily before experiencing its pleasurable effects. The need for opium also confers tolerance, so that people suffering great pain may take, with apparently little e?ect beyond dulling the pain, quantities which at another time would be dangerous.... opium

ARTHROPLASTY) and the treatment of bone tumours. (See BONE, DISORDERS OF; JOINTS, DISEASES OF.)... orthopaedics

The primary problem is seen as a change in structure of cartilage and BONE, rather than an in?ammatory SYNOVITIS. Osteoarthritis usually implies a loss of the central load-bearing area of articular hyaline cartilage, with outgrowth of cartilage at the articular margin and subsequent ossi?cation to form bony outgrowths known as OSTEOPHYTES. Osteophytes form with increasing age, whether or not there is signi?cant cartilage loss, and in the elderly may lead to local frictional symptoms, and in the spine, to nerve compression.

The condition has a wide range of causes, of which some, like dysplasia and trauma, are known and others have yet to be identi?ed. The main clinical problems occur in the hip and knee. The cartilage loss in the hip usually occurs in the sixth or seventh decade. It may affect both hips in fairly rapid succession, or only one hip; such patients often have no problems in other joints. Cartilage loss in the knee occurs from the ?fth decade onwards and is often associated with cartilage loss in small joints in the hand and elsewhere. Cartilage loss in the distal interphalangeal joints of the hand is associated with the formation of bony swellings known as Heberden’s nodes.

Treatment Management is largely directed at maintaining activity, with physical and social support as necessary. ANALGESICS may be of some value, particularly in the management of night pain. NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) may help patients with early-morning sti?ness and may also reduce pain on movement and night pain. Their bene?t, however, tends to be less marked than in RHEUMATOID ARTHRITIS and their long-term usage has considerable toxicity problems. Advanced cartilage loss is best treated by joint replacement. Hip- and knee-joint replacements – with a wide variety of arti?cial joints – are now common surgical procedures which greatly improve the mobility of affected individuals. (See ARTHROPLASTY.)

People with arthritis and their relatives can obtain help and advice from Arthritis Care.... osteoarthritis

Oxygen is essential for life. It is absorbed via the lungs (see RESPIRATION) and is transported by HAEMOGLOBIN within the ERYTHROCYTES to the tissues. Within the individual cell it is involved in the production of adenosine triphosphate (ATP), a compound that stores chemical energy for muscle cells, by the oxidative metabolism of fats and carbohydrates. HYPOXIA causes anaerobic metabolism with a resulting build-up in LACTIC ACID, the result of muscle cell activity. If severe enough, the lack of ATP causes a breakdown in cellular function and the death of the individual.

When hypoxia occurs, it may be corrected by giving supplemental oxygen. This is usually given via a face mask or nasal prongs or, in severe cases, during ARTIFICIAL VENTILATION OF THE LUNGS. Some indications for oxygen therapy are high altitude, ventilatory failure, heart failure, ANAEMIA, PULMONARY HYPERTENSION, CARBON MONOXIDE (CO) poisoning, anaesthesia and post-operative recovery. In some conditions – e.g. severe infections with anaerobic bacteria and CO poisoning – hyperbaric oxygen therapy has been used.... oxygen

Causes: reflux of acid from the stomach due to incompetence of sphincter muscle. This muscle can be weakened by drugs, coffee, smoking, alcohol, piping-hot drinks or the presence of hiatus hernia. Treatment: same as for HEARTBURN. ... oesophagitis

The oestrogenic hormones of the ovary are OESTRADIOL and oestrone. The rapid degradation of natural oestrogens limits their use as therapeutic agents. Chemical substitution of the steroid molecule, as in ethinyl oestradiol, or the use of a non-steroidal synthetic oestrogen such as STILBOESTROL, greatly reduces the rate of degradation and enhances the therapeutic action. A further development has been the use of compounds which are not actually oestrogenic themselves, but which are slowly metabolised to oestrogenic substances, or substances such as chlorotrianisene, which are taken up in the body fat and then slowly released into the circulation. There is in fact little to choose between the various synthetic oestrogens. Ethinyl oestradiol is the most potent oral oestrogen, being 20 times more active than stilboestrol.

Other commonly used oestrogen drugs are dienoestrol and oestrol. The use of oestrogens in hormone replacement therapy (HRT) is dealt with in the entry on the MENOPAUSE.... oestrogens

Action: Emmenagogue, antispasmodic, carminative, expectorant. Leaves and seed— astringent, antispasmodic. Warm infusion of herb—promotes suppressed menstrual flow.

Habitat: Cultivated in Northern Italy and Morocco.

The condition is caused by an imbalance between LUTEINISING HORMONE (LH) and FOLLICLE-STIMULATING HORMONE (FSH); this imbalance stops OVULATION and varies the TESTOSTERONE output of the ovaries. The treatment may be with CLOMIPHENE; with a PROGESTOGEN drug; with LUTEINISING HORMONE-RELEASING HORMONE (LHRH); or with oral contraceptives (see under CONTRACEPTION – Non-barrier methods). The treatment chosen depends on the severity of the disease and whether the woman wants to conceive. Rarely a section of ovarian tissue is surgically removed.... polycystic ovary syndrome

Symptoms: distension, dehydration, atony, vomiting, constipation.

Alternatives. Wild Yam. Calamus. Papaya.

Condition may have to be resolved by surgery. Simple obstruction: large doses (4-8 teaspoons) Isphaghula seeds. Lime flower tea. See: COLITIS. ... intestinal obstruction

Selenium 50mcg and Vitamin E 400iu are recommended by Jonathan Wright MD, for decreasing the pain of disease, decreasing over 3 months. (Health Update USA, June 1990) ... osgood schlatter disease

Angelica, Bearberry, Beth root, Black Cohosh, Blue Cohosh, Castor oil, Goldenseal, Juniper berries, Raspberry leaves, Rue, Squaw Vine, Wild Ginger. ... oxytocic

Bowel and kidney function should be investigated, as body odour is not normally offensive when these organs are healthy. Zinc is a powerful deodorant – zinc and castor oil cream being a traditional combination of pharmacy. Key herbal agent is Thuja, but it is sometimes advisable to add to this an agent for liver and kidneys.

Alternatives. Teas: Sage, Pennyroyal, Thyme, Betony. Decoctions: Sarsaparilla, Wild Yam.

Tablets/capsules. Seaweed and Sarsaparilla. Wild Yam, Thuja.

Formula: equal parts: Dandelion Root, Clivers, Thuja. Dosage – Powders: One-third teaspoon. Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons in water, thrice daily.

Topical. Dilute oil of Sage, or Sage tea, to under-arms, hands, feet.

Diet. Lacto-vegetarian. Safflower oil.

Vitamins. B-complex.

Minerals. Zinc. Dolomite. ... body odour

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

Nitric oxide causes blood vessels to dilate, affecting the flow of oxygenated blood and regulating blood pressure.

Overproduction of nitric oxide is associated with various disorders, including toxic shock, rheumatoid arthritis, and diabetes mellitus; underproduction may cause impotence and angina.

The control of nitric oxide is an important element of many drug treatments.... nitric oxide

Causes: emotional tension, hiatus hernia, food allergy and the damaging potential of hot drinks. Alternatives. Acute case: Cramp bark. German Chamomile tea, freely. Phytomedicines for chronic condition or as preventatives: Passion flower, Skullcap, Wild Yam, Lobelia, Mistletoe, Valerian. Formula. Cramp bark 2; Chamomile 1; Peppermint 1. Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) 3 or more times daily.

Milk. Drink whole glass cold milk, with or without 1 drop oil Peppermint, immediately on onset of pain. May relieve spasms in seconds. ... oesophageal spasm

Causes: injury, scarring by chemical medicines, drugs swallowed with insufficient water, antacids for heartburn, piping-hot tea. It is important to exclude oesophageal cancer.

Those with ‘gullet-reflex’ such as the elderly, are at risk. A relationship exists between toothlessness and this condition. Eating of soft fibreless foods does not expand the tube down which food passes. Alternatives. Horsetail, Irish Moss. Echinacea. Marshmallow. Goldenseal. Sarsaparilla. Calendula (Marigold), Chamomile.

Tea. Formula – equal parts, Horsetail, Chamomile, Marshmallow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.

Tablets/capsules. Echinacea, Goldenseal, Sarsaparilla, Chamomile.

Formula. Irish Moss 1; Comfrey 1; Calendula half; Goldenseal quarter. Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) in water before meals.

Diet. High fibre. Raw carrots with prolonged mastication. Hot drinks are potentially damaging. ... oesophageal stricture

Adverse effects of nitrous oxide and oxygen may include nausea and vomiting during the recovery period.... nitrous oxide

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

Given by injection, octreotide is used mainly in the treatment of acromegaly and hormone-secreting intestinal tumours.

Octreotide is also used to prevent complications following pancreatic surgery.

Side effects may include various gastrointestinal disturbances such as nausea, vomiting, abdominal pain and bloating, flatulence, and diarrhoea.... octreotide

The crisis may be associated with muscle spasm of the tongue, mouth, and neck, and is often triggered by stress.

It may also occur following encephalitis and in parkinsonism, or may be induced by drugs, such as phenothiazine derivatives.... oculogyric crisis

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

Symptoms: earache, itching, discharge, moderate deafness.

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

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

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

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

Evening Primrose. 4 × 500mg capsules daily.

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

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

Moist suppurative conditions: Goldenseal Drops (see entry).

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

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

It is usually taken in tablet form to treat infections that have not responded to other drugs but is also given by intravenous infusion for severe systemic infections.

Side effects may include nausea, vomiting, diarrhoea, and abdominal pain.... ofloxacin

Varices develop as a consequence of portal hypertension.

Blood in the portal vein, passing from the intestines to the liver, meets resistance due to liver disease.

The increased blood pressure causes blood to be diverted into small veins in the walls of the oesophagus and stomach.

These veins may become distended and rupture, causing vomiting of blood and black faeces.

There are usually other symptoms of chronic liver disease.

To control acute bleeding, a balloon catheter may be passed into the oesophagus to press on the bleeding varices.

The varices may be treated with an intravenous injection of vasopressin and/or by injection, via an endoscope, of a sclerosant that seals off the affected veins.... oesophageal varices

Surgical removal of the tumour can, in some cases, lead to a total cure.... oligodendroglioma

It is taken as tablets or suppositories, or given by injection.

Side effects may include constipation, headache, and hiccups.... ondansetron

The infection is treated with antibiotic drugs.... ophthalmia neonatorum

Types of ophthalmitis include ophthalmia neonatorum and sympathetic ophthalmitis: a rare condition in which a penetrating injury to one eye is followed by severe uveitis that can cause blindness in the other eye.

Sympathetic ophthalmitis can be treated with corticosteroid drugs, but removal of the injured eye is sometimes necessary to save the sight of the other.... ophthalmitis

In chemistry, “organic” refers to certain compounds that contain carbon.

In medicine, the term indicates the presence of disease.

(See also inorganic.)... organic

Bacteria and viruses are disease-causing microorganisms.... organism

If a fragment has not completely separated from the bone, the joint may be immobilized in a plaster cast to allow reattachment. Loose bone or cartilage fragments in the knee are removed during arthroscopy. Disruption to the smoothness of the joint surface increases the risk of osteoarthritis.... osteochondritis dissecans

In newborn babies, the diaphysis (shaft) has begun to ossify and is composed mainly of bone, while the epiphyses are made of cartilage that gradually hardens. In children, growth plates produce new cartilage to lengthen the bones, and further bone forms at secondary ossification centres in the epiphyses. By the age of 18, the shafts, growth plates, and epiphyses have all ossified and fused into continuous bone.... ossification

Types of osteodystrophy include rickets; osteomalacia; osteoporosis due to Cushing’s syndrome or excessive intake of corticosteroid drugs; and bone cysts and bone mass reduction associated with chronic kidney failure or hyperparathyroidism.

In adults, an osteodystrophy is usually reversible if the underlying cause is treated before bone deformity occurs.... osteodystrophy

Surgical removal may be necessary if an osteoma causes symptoms by pressing on surrounding structures.... osteoma

Most treatments for osteopetrosis aim to reduce the severity of symptoms. Bone marrow transplants of cells from which healthy bone cells might develop are undertaken in some cases.... osteopetrosis

Localized osteosclerosis may be caused by a severe injury that compresses the bone, osteoarthritis, chronic osteomyelitis, or an osteoma.

Osteosclerosis occurs throughout the body in the inherited bone disorder osteopetrosis.... osteosclerosis

Ovarian cysts are often symptomless, but some cause abdominal discomfort, pain during intercourse, or irregularities of menstruation such as amenorrhoea, menorrhagia, or dysmenorrhoea. Severe abdominal pain, nausea, and fever may develop if twisting or rupture of a cyst occurs. This condition requires surgery.An ovarian cyst may be discovered during a routine pelvic examination and its position and size confirmed by ultrasound or laparoscopy. In many cases, simple ovarian cysts – thin-walled or fluid-filled cysts – resolve themselves. However, complex cysts (such as dermoid cysts) usually require surgical removal. If an ovarian cyst is particularly large, the ovary may need to be removed (see oophorectomy).... ovarian cyst

It usually results from thrombosis in the affected vein, and is more common in people who have glaucoma.

Retinal vein occlusion may cause visual disturbances, glaucoma, or blindness.... retinal vein occlusion

An international organization established in 1948 as an agency of the United Nations with responsibilities for international health matters and public health. The headquarters are in Geneva, Switzerland.

The has campaigned effectively against some infectious diseases, most

notably smallpox, tuberculosis, and malaria.

Other functions include sponsoring medical research programmes, organizing a network of collaborating national laboratories, and providing expert advice and specific targets to its 160 member states with regard to health matters.... world health organization

whipworm infestation Small, cylindrical whip-like worms, 2.5–5 cm long, that live in the human large intestine. Infestation occurs worldwide but is most common in the tropics. Light infestation causes no symptoms; heavy infestation can cause abdominal pain, diarrhoea, and, sometimes, anaemia, since a small amount of the host’s blood is consumed every day.

Diagnosis is through the identification of whipworm eggs in the faeces. Treatment is with anthelmintic drugs, such as mebendazole. A heavy infestation may require more than 1 course of treatment. whitehead A very common type of skin blemish (see milia).... whipple’s operation

Naturally occurring and synthetic oestrogens are used to treat *amenorrhoea and menopausal symptoms (see hormone replacement therapy), as well as androgen-dependent cancers (e.g. cancer of the prostate). Synthetic oestrogens are a major constituent of *oral contraceptives. Side-effects of oestrogen therapy may include nausea and vomiting, headache and dizziness, irregular vaginal bleeding, fluid and salt retention, and feminization in men. Oestrogens should not be used in patients with a history of cancer of the breast, uterus, or genital tract. —oestrogenic adj.... oestrogen

Habitat: Artocarpus interifolia, indigenous to the western Ghats.

Action: Prevents excessive salivation. Also given internally in dysentery, diarrhoea, stomatitis; as a paste to gums in apthae.... agaricus ostreatus

Habitat: Native to China; cultivated in northern India.

Action: Rhizome—a circulatory stimulant and carminative.

Habitat: Native to eastern Europe; found in Kashmir and Himachal Pradesh.

Action: Demulcent, emollient, antitussive (used for cough, bronchitis, gastritis, enteritis and cystitis), antilithic, diuretic.

Habitat: Native to tropical America, from Mexico to Peru and Brazil. Cultivated largely in Malabar, Kerala, Karnataka, Tamil Nadu and Andhra Pradesh, and to some extent in Maharashtra, Goa, Orissa and West Bengal.

Action: Leaves and bark—fungi- cidal, vermicidal, protozoicidal, antimicrobial (used for toothache, sore gums). Karnel—eaten for its high protein content. Cashew apple—antiscorbutic. Resinous juice contained in the seeds—used in cases of mental derangement, memory disturbances, palpitation of heart, rheumatic pericarditis, sexual debility.

Habitat: Native to Europe; thrives in dry grassland in central and northern parts of the continent.

Action: Nervine and sedative (used for anxiety neurosis, nervous exhaustion, tension, headache, migraine, insomnia), antispasmodic (in catarrh); used for amenorrhoea, inflammation of ovaries, painful menstruation and genito-urinary infections. The rootstock is given with milk for concussions. The seeds cause vomiting and purging.

Habitat: A tree occurring in salt marshes and tidal creeks.

Action: Stem/bark—astringent. Pulp of unripe fruit—used for healing skin lesions of smallpox; fruits and immature seeds, used as cicatrizant of abscesses and ulcers.

Habitat: Found in countries on both sides of Red Sea.

Action: Used in diseases of the urinary tract. Balsams are diuretic and stimulate mucous tissues in small doses (nauseatic and purgative in large doses).

Habitat: Native to Central America, often cultivated in Madhya Pradesh and South India.

Action: Plant—astringent, antibil- ious, antiemetic, blood purifier. Leaves—infusion is given in jaundice, also in dysentery. Externally, scar-preventive. Root bark— febrifuge, antiperiodic. Seed pulp— haemostatic, antidysenteric, diuretic, laxative. Fruit—antidysenteric.

Habitat: Central, Western and Southern India, also eastwards to Bengal.

Action: Same as that of C. tiglium.... croton oblongifolius

Habitat: South India; throughout the hills of Deccan.

Action: Used externally for reducing swellings.... dioscorea oppositifolia

Habitat: The Mediteranean region, Europe and Asia.

Action: Fresh herb (compounded with water)—refreshing, restorative and nervine tonic. Leaves and flowers—diuretic, febrifuge, expectorant, demulcent, emollient; promote the activity of kidneys; alleviate pulmonary affections.

Habitat: Throughout India; wild in Punjab.

Action: Flowers—antiinflammatory, antiseptic, stimulant, antispasmodic, emmenagogue, antihaemorrhagic, styptic. Used in gastric and duodenal ulcers and dysmenorrhoea; externally for cuts, bruises, burns, scalds. Plant—antiprotozoal. Flower— antimicrobial. Essential oil— antibacterial.

Habitat: Throughout warmer regions of India, as a weed.

Action: Used in adenitis, scrofula, syphilis; also in cough, bronchitis and asthma.... fimbristylis ovata

Habitat: Throughout the country in dry regions, especially in Punjab and Kashmir.

Action: Plant—cardiotonic. Root— purgative.

Habitat: Punjab, Delhi, Rajasthan, Madhya Pradesh, Gujarat, Maharashtra, Karnataka, Kerala and Tamil Nadu.

Action: An adulterant of the true senna. Leaves and seeds—purgative and anthelmintic.... cassia obovata

Habitat: From Jammu and Himachal Pradesh to West Bengal, also in central and western India, up to an altitude of 1,200 m.

Action: Pods—Antidysenteric, antibacterial, antifungal. Seeds— used for ringworm and skin diseases also for cough, cold, asthma, and as a mild purgative in liver complaints.... cassia obtusifolia

Habitat: Throughout India, up to an altitude of 1,500 m.

Action: Purgative, diuretic, febrifugal, expectorant, stomachic. Leaves—used internally and externally in scabies, ringworm and other skin diseases. A hot decoction is given as an antiperiodic. Seeds— used for cough, whooping cough and convulsions. Roasted seeds (roasting destroys the purgative property) are mixed with coffee for strength.

Habitat: In damp places throughout the plains and low hills in India.

Action: Used for the treatment of rhinitis, sinusitis, nasopharyngeal tumors and obstructions, asthma and cold; also used in hemicrania.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

Habitat: Cultivated in West Bengal and Tamil Nadu.

Action: Antimalarial, febrifuge, astringent, orexigenic, sapasmolytic. Also prescribed in amoebic dysentery, jaundice, atonic dyspepsia, night cramps. Sometimes causes gastric and intestinal irritation.

Habitat: British and European hedge plant, met with in the temperate Himalayas of Kashmir and Himachal Pradesh at an altitude of 1,800-3,000 m. (The plant does not thrive in the plains of India.)

Action: Coronary vasodilator (strengthens heart muscle without increasing the beat in coronary arteries), antispasmodic, antihypertensive, sedative to nervous system, diuretic.

Habitat: Sub-tropical Himalayas from Kumaon eastwards; Western Ghats from Konkan Southwards.

Action: Nervine, adaptogenic, sedative, anticonvulsive, androgenic, anti-inflammatory and diuretic. Used in Jaundice, urinary disorders, skin diseases and asthma. Mucilaginous.

Habitat: Cultivated in Punjab, Kashmir and the Nilgiri hills.

Action: Fruit pulp and seeds— soothing and demulcent; used in irritable bowel syndrome, diarrhoea, dysentery, constipation, and in irritable conditions of the mucous membrane. Leaf, bud and bark—astringent. Fruit— expectorant. Mucilage—used externally for scalds, ulcers and burns.

Habitat: The Western Himalayas and Kashmir at 1,000-3,000 m.

Action: Active principles are attracting scientific interest. The orthoesters are co-carcinogenic and mezerein antileukaemic in experimental studies. Bark— used as an ointment for inducing discharge from indolent ulcers. Bark, root and root bark—used mainly for obstinate cutaneous diseases, especially for eczema with severe itching and copious exudation (weeping eczema).

Habitat: The Western Ghats.

Action: Juice of fresh plant—stomachic, carminative, antispasmodic, laxative, liver tonic. (excites the bile). A related species, Dendrobium crumenatum Sw., occurs in Andaman Islands. Pounded leaves are used in Malaya for poulticing boils and pimples. Traces of alkaloids have been reported to be present in the pseudobulbs and leaves.

Obaxx, Obaxe, Obaxa, Obaxia, Obaxea... obax

Obeedience, Obediance, Obedienne, Obedianne, Obey, Obeye, Obede, Obedi, Obedie, Obedy, Obedey, Obedee, Obedea... obedience

Obeliah, Obeliya, Obelea, Obelie, Obeli, Obeley, Obely, Obeleah... obelia

Obiomah, Obeoma, Obeomah, Obyoma, Obyomah... obioma

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

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

Habitat: Native to Europe and North America. Found at high altitudes in Nilgiris and Salem (Tamil Nadu).

Action: Antispasmodic and amphicholeretic. Stimulant to liver and gall bladder; used for eczema and other skin diseases. Also diuretic and mild laxative.

Gastro-oesophageal disease should be diagnosed in those patients who are at risk of physical complications from the re?ux. Diagnosis is usually based on the symptoms present or by monitoring the production of acid using a pH probe inserted into the oesophagus through the mouth, since lesions are not usually visible on ENDOSCOPY. Severe heartburn, caused by the lining of the oesophagus being damaged by acid and PEPSIN from the stomach, is commonly confused with DYSPEPSIA. Treatment should start with graded doses of one of the PROTON PUMP INHIBITORS; if this is not e?ective after several months, surgery to remedy the re?ux may be required, but the effects are not easily predictable.... gastro-oesophageal reflux

Habitat: Konkan and Western Ghats.

Action: Leaves—stomachic, appetizer.

Action: Seed—anticatarrhal (used in consumption), antigonorrhoeic (used in gleet and chronic cystitis). Root—febrifuge. Plant (especially leaf)—uterine stimulant.

Habitat: Introduced from the West Indies; grown as an ornamental.

Action: Antirheumatic, anti- inflammatory, mild laxative, diuretic, diaphoretic, fungistatic (During the sixteenth century it was used as a cure for syphilis.)

Habitat: Eastern Himalayas, Khasi Hills and Sikkim.

Action: Oil from seed used in psoriasis, eczema, scrofula, gout, rheumatic affections.

Habitat: Native to Europe and temperate Asia. Occurs in West Himalyas from Kashmir to Kumaon.

Action: Stimulant, carminative, sedative, antispasmodic, diuretic, pectoral. Used for bronchitis, coughs and colds. Induces heavy sweating in fevers, increases blood pressure. Emmenagogue. Used externally for bruises, discoloured contusions and cuts.

Habitat: Throughout greater parts of India.English: Wild Indigo, Mysore Panicled Indigo.Ayurvedic: Bana-Nila, Dill, Jhill.Unani: Vasmaa.Siddha/Tamil: Kattukkarchamathi.Folk: Jhil (Gujarat).

Action: Plant—antisyphilitic. All parts of the plant are found useful in enlargement of liver and spleen.The leaves gave apigenin 7-rhamno- glucoside, apigenin 7, 4'-diglucoside, kaempferol-3-neohesperidoside and rhoifolin, along with protocatechuic, p-coumaric, p-hydroxybenzoic, salicylic and vanillic acid.... indigofera oblongifolia

Habitat: North-Western Himalayas and Persia; cultivated in Kumaon, Uttar Pradesh, Rajasthan, Madhya Pradesh; in gardens throughout India.

Action: Flowers—calming and sedative, CNS depressant, astringent and mild anaesthetic. A syrup prepared from the flowers is used for coughs, hoarsenesses and other disorders of the chest. Plant—diuretic, anthelmintic, emmenagogue; used for healing chronic ulcers and skin diseases. Oil—externally relaxing.

Occupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.

In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.

The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.

Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.

The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.

Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.

Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.

Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.

Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).

Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.

In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:

the nature of the work.

how the tasks are performed in practice.

the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).

what control measures are in place and the extent to which these are adhered to.

previous occupational and non-occupational exposures.

whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,

for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.

Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that

19.5 million working days were lost as a result. The ten most frequently reported disease categories were:

stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.

back injuries: 508,000.

upper-limb and neck disorders: 375,000.

lower respiratory disease: 202,000.

deafness, TINNITUS or other ear conditions: 170,000.

lower-limb musculoskeletal conditions: 100,000.

skin disease: 66,000.

headache or ‘eyestrain’: 50,000.

traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.

vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu

pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.

While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:

CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.

hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.

LEPTOSPIROSIS – infection with Leptospira (various listed occupations).

viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.

LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.

asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.

mesothelioma from exposure to asbestos.

In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.

There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.

The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.

Inhaled materials

PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.

Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).

The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)

Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.

Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)

Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.

Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.

Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.

Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.

Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).

Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.

Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.

Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.

Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury

(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... occupational health, medicine and diseases

Oceania, Ocean, Oceanea, Oceane... oceana

• Keemun Gongfu or Congou which has thin, dark and tight shaped leaves.
• Keemun Mao Feng which has slightly twisted leaf buds and a smoother flavor. For a proper taste, it is recommended to brew a smaller quantity of this type of tea and let it steep for 7 minutes.
• Keemun Xin Ya - a type of tea with a less bitter taste.
• Keemun Hao Ya

• Accelerates your metabolism and allows you to burn fat much easier and faster. With a balanced diet and regular exercise,Keemun tea is a strong allied in the process of weight loss.
• Keemun tea can be a good alternative for coffee. The caffeine in the black tea will give you the energy that you need in the morning and will make you feel full of energy all day long.
• Improves your digestion by dissolving the excess acidity.
• Inhibits the growth of cancer cells and the development of rheumatoid arthritis.

Habitat: Native to Asia Minor.

Action: Balsam—anti-inflammatory, stimulating expectorant, antipara- sitic, antiseptic, antimicrobial. Used externally in scabies, ringworm and other skin diseases. Used for coughs and bronchitis as an inhalation.

Odandah, Odandia, Odandea, Odande... odanda

Oddfride, Oddfrida, Oddfreid, Oddfreide, Oddfreida, Odd, Oddfryd, Oddfryda... oddfrid

Habitat: Kashmir and Kumaon, at altitudes of 1,500-2,700 m.

Action: Leaves—sedative. Seeds— diuretic, lithotriptic. A decoction of roots and twigs is given in the form of syrup in eruptive diseases, such as smallpox and measles.

Habitat: Outer Himalayas from Kashmir to Sikkim, at 1,000 to 2,500 m, and in Khasi hills between 1,200 to 2,000 m.

Action: Young leaves and buds— used externally for cutaneous affections. Leaves—insectici- dal. Honey from flowers— poisonous.

Habitat: Ladakh, at 3,000-4,000 m, also cultivated.

Action: Plant—astringent, wound healer, styptic, anti-inflammatory, sedative, mild analgesic, anticoagulant, spasmolytic. Flower and leaf—diuretic, analgesic, anti- inflammatory, smooth muscle relaxant, vasodilator. Seed—used in cold.

Odela, Odelet, Odelette, Odelina, Odeline, Odell, Odella, Odelle, Odeletta, Odelyn, Odelyna... odele

Odissa, Odyssa, Odessia, Odissia, Odyssia, Odysseia... odessa

Odile, Odilia, Odolia, Odilea, Odola, Odalis, Odalys... odila

Odinah, Odeena, Odeene, Odeen, Odyna, Odyne, Odynn, Odeana, Odeane... odina

An excessive accumulation of monoamines can induce a dangerous reaction characterised by high blood pressure, palpitations, sweating and a feeling of su?ocation. Hence the care with which MAOI drugs are administered. What is equally important, however, is that in no circumstances should a patient receiving any MAOI drug eat cheese, yeast preparations such as Marmite, tinned ?sh, or high game. The reason for this ban is that all these foodstu?s contain large amounts of tyramine which increases the amount of certain monoamines such as noradrenaline in the body. (See MENTAL ILLNESS.)

There are also certain drugs, such as AMPHETAMINES and PETHIDINE HYDROCHLORIDE, which must not be taken by a patient who is receiving an MAOI drug. The MAOIs of choice are phenelzine or isocarboxazid because their stimulant effects are less than those of other MAOIs, making them safer.... monoamine oxidase inhibitors (maois)

Habitat: Cultivated in Bengal, Orissa and Punjab.

Action: Leaves—antiscorbutic, expectorant (used in catarrh of the respiratory organs), diuretic (used in kidney and bladder disorders), detoxifying. A lotion of leaves is applied to blotches, spots and blemishes. Fresh herb is used as a blood purifier.

Habitat: Throughout India, in tanks.

Action: Astringent, refrigerant.

Habitat: Native to Mediterranean region; grown in Indian gardens.

Action: See N. indicum. (The white- and red-flowered varieties are equated with Nerium oleander; both possess similar properties. The yellow-flowered variety is equated with Thevetia peruviana.)

Habitat: Assam, Bihar, Orissa and Deccan Peninsula. Often cultivated in parks and gardens.

Action: Bark—digestive tonic. Root—a decoction is used in asthma, tuberculosis and in menstrual disorders. Leaves— boiled and used as emollient cataplasm; used as a poultice in lumbago.

Habitat: Evergreen forests of Western India from Khandala southwards to Malabar and Coim- batore.

Action: Flowerbuds—cooling, stomachic, analgesic, antibacterial; used for gastritis, haemorrhoids, blood diseases, leprosy, leucoder- ma.

Habitat: Lower hills of Punjab; cultivated throughout India.

Action: Flower—stimulant, carminative, antispasmodic, diuretic, demulcent. Seed—antidysenteric. Juice of the plant—antibacterial. Essential oil—antibacterial, antifungal, insecticidal.

Habitat: Plains and lower hills of India.

Action: Plant—stimulant, carminative, diaphoretic. Leaf—bechic, febrifuge; used in cold, bronchitis, catarrh, externally in skin diseases. Essential oil—antifungal. Seeds— hypoglycaemic; also used in the treatment of leucorrhoea and other diseases of urinogenital system.

Habitat: Throughout India.

Action: Plant—used in neurological and rheumatic affections, in seminal weakness and in aphthae of children. Seed—used in cephalalgia and neuralgia. Essential oil— antibacterial, antifungal.

Habitat: Native of Kenya. Cultivated on a small scale in West Bengal, Assam, Tamil Nadu, Karnataka, Kerala and Dehr Dun.

Action: Plant—spasmolytic, antibacterial. Decamphorized oil— insecticidal, mosquito repellent.

Habitat: Throughout India; grown in houses, gardens and temples.

Action: Leaf—carminative, stomachic, antispasmodic, antiasthmatic, antirheumatic, expectorant, stimulant, hepatoprotective, antiperiodic, antipyretic and diaphoretic. Seed— used in genitourinary diseases. Root—antimalarial. Plant—adap- togenic, antistress. Essential oil— antibacterial, antifungal.

Habitat: Native to Africa; introduced into India.

Action: Leaves—febrifugal. Used as a remedy for coughs and fevers. Oil—antiseptic.

Habitat: Marshy places and river banks in North India from Kashmir to Assam.

Action: The plant extract showed strong antimutagenic and antitu- mour activity.

A still more serious and frequent cause of oesophageal stricture is that due to cancer, which may occur at any part, but is most common at the lower end, near the entrance into the stomach. The chief symptoms of this condition are increasing di?culty in swallowing, increasing debility, together with enlargement of the glands in the neck. The condition usually occurs in middle age or beyond and around 5,000 people are diagnosed with such cancer every year in the United Kingdom. In many cases treatment can only be palliative, but recent advances in surgery are producing promising results. In some cases treatment with irradiation or anti-cancer drugs produces relief, if not cure. In those in whom neither operation nor radiation can be performed, life may be prolonged and freedom from pain obtained by ?uid food which is either swallowed or passed down a tube. In cases of achalasia (see above), the passage of a special bougie down the oesophagus to dilate the sphincter may be e?ective.

Strictures of the oesophagus may also be produced by the pressure of tumours or aneurysms within the cavity of the chest but external to the gullet.

Finally, di?culty in swallowing sometimes occurs in certain serious nervous diseases from paralysis affecting the nerves supplying the muscular coats of the PHARYNX, which thus loses its propulsive power (bulbar paralysis).

Foreign bodies which lodge in the respiratory part of the throat – i.e. at the entrance to, or in the cavity of, the larynx – set up immediate symptoms of CHOKING. Those which lodge in the gullet, on the contrary, do not usually set up any immediately serious symptoms, although their presence causes considerable discomfort. Medical attention is usually required.... oesophagus, diseases of

Oksanah, Oksanna, Oksania, Oksanea, Oksaniya, Oksanochka... oksana

Olabisie, Olabisy, Olabisey, Olabisee, Olabisea... olabisi

Habitat: Native to Chile; cultivated as a garden plant in South Australia. Introduced into Indian gardens.

Action: Oil from seeds—prescribed for eczema (in children); premenstrual syndrome and cyclical breast pain.

Habitat: Sub-Himalayas tract of Kumaon and Bihar, Orissa, Madhya Pradesh, Deccan and Western Ghats.

Action: Bark—used in anaemia and as a supporting drug in diabetes; also in the treatment of fever.... olax scandens

Habitat: Bihar, Orissa, Travancore. Cultivated on the Coromandel coast.

Action: Leaves and roots—used in bronchitis, asthma, consumption.

Oldwinn, Oldwinne, Oldwina, Oldwinna, Oldwyn, Oldwynn, Oldwynne, Oldwyna, Oldwynna, Oldwen, Oldwenn, Oldwenne, Oldwenna... oldwin

Oldedah, Oleta, Olita, Olida, Oletah, Olitah, Olidah... oleda

Habitat: Native of Mediterranean region; cultivated in Jammu and Kashmir and Himachal Pradesh.

Action: Leaves and bark— febrifugal, astringent, diuretic, antihypertensive.

Olenah, Olenia, Olenya, Olinija, Olinia... olena

Olgah, Olenka, Olia, Oliah, Olya... olga

Olindah, Olynda, Olynda, Olenda, Olendah... olinda

Olwenn, Olwin, Olwyn, Olwynne, Olwynn, Olwenne, Olwinn, Olwinne, Olwena, Olwenna, Olwina, Olwinna, Olwyna, Olwynna... olwen

Olympiah, Olimpe, Olimpia, Olimpiada, Olimpiana, Olypme, Olympie, Olympi, Olympy, Olympey, Olimpi, Olimpie, Olympas... olympia

Omemea, Omemi, Omemie, Omemey, Omemy... omemee

Omphaile, Omphayle, Omfale, Omfaile, Omfayle, Omphael, Omphaele, Omphaela... omphale

Onata, Onatia, Onatiah, Onatea, Onateah... onatah

Onour, Onoria, Onor, Onorata, Onoratas, Onnor, Onorina, Onorine, Onore, Onoree, Onori, Onorie, Onory, Onouri, Onourie, Onoury, Onoura, Onouria, Onoure, Ohnicio, Omora, Omorra... onora

Habitat: Kashmir and Kumaon.

Action: Cooling, astringent, diuretic, cardiac tonic. Used for cold, cough, bronchial affections; insomnia, depression, mental exhaustion; constipation, misperistalsis, jaundice; dysuria, urethral discharges; fevers.

Habitat: Kashmir and Kumaon up to 1,000-1,500 m.

Action: Astringent and styptic. Root—bruised and used as application to eruptions. An ingredient of ointments for ulcers, scrofula, burns. Flowers—stimulant, cardiac tonic.

Ontinah, Onteena, Onteenah, Onteana, Onteanah, Ontiena, Ontienah, Onteina, Onteinah, Ontyna, Ontynah... ontina

Habitat: Throughout India up to 1,000 m; occasionally grown in gardens.

Action: Root—purgative, antiinflammatory (particularly used in rheumatic and paralytic affections; also in fevers, oedema, hepatic and haemophilic diseases).

Ofelia, Ofilia, Ophelie, Ophelya, Ophilia, Ovalia, Ovelia, Opheliah, Ofeliah, Ophelie... ophelia

Habitat: From Konkan to Kerala at 1,500-2,000 m.

Action: A substitute for S. chirayita and Gentiana lutea L.

Habitat: Moist meadows in Great Britain. Found in the Himalayas, Bihar, Assam, Pune (Maharashtra), Annamalai and Shevaroy hills (South India); up to an altitude of 2,700 m.

Action: Fern—antiseptic, styptic, vulnerary, detergent, emetic. The mucilaginous and astringent decoction of the fern is used in angina in Reunion. An ointment, prepared by boiling the herb in oil or fat, is used for wounds.

Habitat: Khasi Hills up to 600700 m, in Western Ghats and the Andaman Islands.

Action: Root—bitter tonic. Leaves— used for dressing ulcers.

Ofra, Ofrit, Ophra, Oprah, Orpa, Orpah, Ofrat, Ofrah... ophrah

The most common effects of opioid overdose are vomiting, drowsiness, pinpoint pupils, BRADYCARDIA, CONVULSIONS and COMA. Respiratory depression is common and may lead to CYANOSIS and respiratory arrest. HYPOTENSION occurs occasionally and in severe cases non-cardiogenic pulmonary oedema and cardiovascular collapse may occur. Cardiac ARRHYTHMIA may occur with some opioids. Some opioids have a HISTAMINE-releasing e?ect which may result in an urticarial rash (see URTICARIA), PRURITUS, ?ushing and hypotension. Activated CHARCOAL should be given following overdose and NALOXONE administered to reverse respiratory depression and deep coma.... opioid poisoning

Habitat: Indian gardens. Introduced into India towards the end of the 18th century.

Action: Fruits—emollient, bechic. Mucilaginous joints—used as poultices in cases of articular rheumatism, inflammations, scalds, burns and skin diseases.... opuntia cochinellifera

Habitat: Native of Mexico; well- acclimatized throughout India.

Action: Leaves—applied as poultice to allay inflammation and heat. Fruit—baked and given in whooping cough.

Habitat: Throughout the greater part of India.

Action: In homoeopathy, a tincture made from the flowers and wood, is given for diarrhoea and splenomegaly.

In developed countries ORT is useful in treating gastroenteritis. There are a number of proprietary preparations, often dispensed as ?avoured sachets, including Dioralyte® and Rehydrate®.... oral rehydration therapy (ort)

Oraleydah, Oraleida, Oraleidah, Oralida, Oralidah, Oralyda, Oralydah, Oraleda, Oraledah, Oralieda, Oraliedah... oraleyda

• Fill a teapot with about 16 ounces of water
• Boil the water
• Place about two tablespoons of the leaves in a teapot
• Take the pot out of the water
• Let the mix stand for about 5 to 7 minutes
• Strain and drink it slowly

• strengthens the immune system
• helps lower the risk of cardiovascular diseases
• helps in the prevention of certain cancers
• contributes to preventing colds, cough and flu
• helps in calming and relaxing the senses
• stimulates blood circulation
• increases concentration and memory levels
• warms the body (especially during winter)

Orbelinah, Orbeleena, Orbeleenah, Orbeleana, Orbeleanah, Orbelyna, Orbelynah, Orbie, Orbi, Orby, Orbey, Orbee, Orbea... orbelina

Orfelynda, Orphelinda, Orphelynda, Orfelenda, Orphelenda... orfelinda

Treatment After contamination with insecticides, decontaminate (remove clothes, wash skin). Those treating should wear gloves, mask, apron and goggles. For symptoms give 2 mg of ATROPINE IV every 30 minutes until full atropinisation (dry mouth, pulse >70). Up to three days’ treatment may be needed. Severe poisoning may require pralidoxine mysalate: available from designated centres, this drug should be given intravenously within 24 hours of exposure.... organophosphorus

Habitat: Kashmir to Nepal at altitudes of 2,500-5,000 m in damp places.

Action: Considered aphrodisiac and nervine tonic by Unani physicians. Tuber—nutritive, demulcent, restorative. Given

Habitat: Native to Europe and Great Britain.

Orrinthia, Orenthia, Orna, Ornina, Orinthea, Orenthea, Orynthia, Orynthea... orinthia

Oreolle, Oriolle, Oreole, Oriola, Oriolla, Oriol, Oreola, Oreolla... oriole

Orthiah, Orthea, Ortheah, Orthiya, Orthiyah... orthia

Habitat: Manipur, Naga and Lushai hills, Chota Nagpur, Western Ghats.

Action: Leaves—diuretic, used in nephrosis and severe cases of oedema. An infusion of leaves is given as a specific in the treatment of various kidney and bladder diseases including nephrocirrhosis and phosphaturia, also in rheumatism and gout.

Habitat: Orissa, Gujarat, South India, ascending up to 1,000 m in the hills.

Action: Plant—a decoction is given in diarrhoea. Leaves—applied externally to cuts and wounds.... orthosiphon tomentosus

Habitat: Cultivated all over India as a food crop.

Action: Rice-water (a water decoction of rice)—demulcent and refrigerant in febrile and inflammatory diseases and in dysuria. Also used as a vehicle for compound preparations used for gynaecological disorders. It is regarded as cooling in haematemesis and epistaxis, and as diuretic.

Orzorah, Orzorra, Orzorrah, Orzoria, Orzorea... orzora

Habitat: The Himalayas from Garhwal to Bhutan, North Bengal, Bihar and Khasi, Aka and Lushai hills.

Action: Plant—anodyne, antipyretic, anti-inflammatory.

Habitat: Native to China and Japan. Found in Kumaon, Garhwal and Sikkim.

Action: Diuretic, genitourinary tract disinfectant.

Habitat: The Himalayas, Khasi hills and the Western Ghats at altitudes of 1,500-3,000 m.

Action: Fern—antispasmodic, astringent, an aqueous extract is administered for intestinal gripe; used externally in rheumatism; also prescribed in muscular debility Fonds enter into diuretic drinks used for treating body swellings. Root—mucilaginous, styptic, stimulant.

Osykah, Osika, Osikah, Oseka, Osekah... osyka

Habitat: Sub-tropical Himalaya, Madhya Pradesh, Tamil Nadu.

Action: Leaf—emetic.

Otzarah, Otzarra, Otzarrah, Ozara, Ozarra... otzara

Habitat: Outer Himalayas and sub-Himalayan tract from Jammu to Bhutan up to an altitude of 1,500 m, and extending through the whole of northern and central India into the greater part of Deccan Peninsula.

Action: Bark—febrifuge, anti- diarrhoeal, spasmolytic.

Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.

Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.

In young women the most common benign tumour is a dermoid cyst, while in older women, ?broma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.

Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.

Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.... ovaries, diseases of

Habitat: Temperate Himalayas from Kashmir to Sikkim from 2,500 to 4,000 m and Nilgiris in Tamil Nadu.

Action: Diuretic and refrigerant. Used for urinary affections and fevers. (Sorrel is equated with Rumex acetosa Linn.)

Habitat: Throughout the warmer parts of India.

Action: Plant—boiled with butter milk is a home remedy for indigestion and diarrhoea in children. Used for tympanitis, dyspepsia, biliousness and dysentery; also for its anti-inflammatory, analgesic, antipyretic and antiscorbutic activities. Leaf paste is applied over forehead to cure headache.

– from anaerobic metabolism which is ultimately oxidised after conversion to citrate and metabolism via the citric acid cycle. The increased amount of oxygen above resting concentrations which needs to be consumed to perform this metabolism is known as the oxygen debt or de?cit.... oxygen deficit

Habitat: The Himalayas from Kashmir to Sikkim, in the alpine region at altitudes of3,000-6,000 m.

Action: Refrigerant, antiscorbutic.... oxyria digyna

Oziomah, Ozeoma, Ozeomah, Ozyoma, Ozyomah... ozioma

Habitat: Throughout the plains and lower hills of India, including paddy fields and hedges rear semi-marshy places.

Action: Herb—antiseptic, depura- tive, galactogogue; decoction used as a gargle in stomatitis and sore throat. Latex—vulnerary. Fresh root—prescribed in jaundice.

Habitat: Central and Eastern Himlayas extending to Assam, West Bengal, Bihar, Orissa.

Action: Leaf—carminative, antiinflammatory, astringent, spasmolytic, antidiarrhoeal, diuretic, an- tilithic. Root— anti-inflammatory. Used for rheumatic affections, piles, inflammations of the liver, spleen and chest.

P... ozora

Habitat: Indigenous to Great Britain.

Action: Root—antispasmodic, sedative, smooth muscle relaxant, vasodilatory, hypotensive, anti-inflammatory, analgesic, em- menagogue, hepatoprotective. Flower—used for diseases of mucous membranes, fissures, anal fissures associated with haemorrhoids, also for ailments of the respiratory tract, nervous conditions and skin diseases. Root— used for arthritis, neuralgia, neurasthenia, migraine, epilepsy, allergic disorders, whooping cough and painful spasms.

Habitat: North-West India, Bengal and Konkan.

Action: Plant—anti-inflammatory and spasmolytic. Used in rheumatic affections. Root—stomachic, astringent, demulcent. Used in dysentery, haemorrhages from intestines; ulcers and bleeding disorders.

Forsk

Habitat: Cultivated In Parts Of Rajasthan And Maharashtra.

Action: Seed And Husk—Laxative, Diuretic, Demulcent, Bechic, Cholinergic. Used In Inflammatory Conditions Of The Mucous Membrane Of Gastrointestinal And Genitourinary Tract, Chronic Amoebic And Bacillary Dysentery; Also In Hypercholesterolemia.

Habitat: Native to eastern Mediterranean region; cultivated in Kashmir and North-western Himalayas at 1,200-2,400 m.

Action: Bark—antidiarrhoeal, antiscorbutic, antirheumatic. Leaf—astringent. Buds—antiseptic, used for urinary infection.

Habitat: South India.

Action: Juice of the plant—used topically in haemorrhagic diseases and piles.... rivea ornate

Habitat: Rain forests of Western Ghats from Konkan to Kerala.

Action: Root bark—used for the treatment rheumatism; also for gonorrhoea, swellings and skin diseases. Plant—mildly antiseptic.... salacia oblonga

Habitat: On the old trunks of various coniferous trees.

Action: Used in the treatment of sweats in wasting diseases such as phthisis (it checks profuse sweats); also as an expectorant and diuretic.

Habitat: All over India, cultivated as a vegetable.

Action: Refrigerant (reduces body heat), mild spasmodic, diuretic, antiscorbutic. Used in scurvy and in diseases of liver, spleen, kidney and bladder; also in dysuria, stomatitis and dysentery. A paste of leaves is applied to swellings, erysipelas, burns and scalds. Seeds—diuretic, antidysenteric; applied externally to burns and scalds.

Habitat: Southeast Tibet, West and Northwest China.

Action: Astringent and cathartic (anthraquinones are laxative and tannins astringent), stomachic, aperient, cholinergic, gastric stimulant, antispasmodic, anti-inflammatory, antiseptic. Used for indigestion, diarrhoea, dysentery and disorders of liver and gallbladder.

Habitat: The Himalayas from Kashmir to Sikkim at 4,2005,000 m.

Action: Roots—antiseptic, styptic, anti-inflammatory. Applied to wounds and cuts.

Habitat: Tropical Himalayas from Kumaon eastwards to Khasi, Garo and Naga Hills, and in Bihar.

Action: Roots—used as a blood purifying drug.... smilax ornata

Habitat: Native to the Mediterranean region, cultivated in Nilgiri Hills.

Action: Essential oil from flowers and leaves—anti-inflammatory, astringent, antiseptic, stomachic, carminative; used externally in circulatory disorders. Flowering tops and leaves—carminative, diuretic, emmenagogue; vapor baths afford relief in incipient catarrh, rheumatism and muscular affections.

Habitat: Uttar Pradesh, Bihar and Punjab.

Action: Cane Juice—restorative, cooling, laxative, demulcent, diuretic, antiseptic. Used in general debility, haemophilic conditions, jaundice and urinary diseases.

Habitat: Tropical parts of India.... smilax ovalifolia

Habitat: Native to Europe; cultivated in Kashmir.

Habitat: The arid regions of Punjab, Rajasthan and western India.

Action: Leaf—bechic. Bark— vesicant. Fruit—febrifuge (in low fever), used in enlarged spleen. Oil from seed—applied in rheumatic affections and after child birth.

Habitat: Native to the Mediterranean region; grown as an ornamental.

Action: Plant—astringent, anti- inflammatory, carminative, anti- spasmodic, antiseptic. Leaf and flower—cholagogue, hypogly- caemic, antiasthmatic (used for respiratory allergy), cholagogue, emmenagogue, antisudoriferous, antiseptic. Leaf—diaphoretic, antipyretic. Used for sore throat, laryngitis, tonsillitis, stomatitis.

Habitat: Native to temperate region of Europe; introduced in Indian gardens.

Action: Roots—blood purifier, cholagogue, expectorant, diuretic, diaphoretic. Roots and leaves— used for scrofula and skin diseases. Sap used as a depurative for scabies, furuncles, hepatic eruptions and venereal ulcers (as a lotion). Plant— employed for jaundice (to increase bile flow); also in respiratory disorders (bronchitis, sore throat).

Habitat: The sub-Himalayan tract from Kashmir to West Bengal; Bihar, Punjab, Madhya Pradesh, southwards to Peninsular India.

Action: Bark—astringent; mixed with oil, applied externally in skin eruptions. Seed oil—used for massage in rheumatism and applied in alopecia, itch and acne; stimulates hair growth. (Tree is an important host of Kusmi lac.)

Habitat: Bihar, West Bengal and Kerala. (The plant parasitizing Strychnos nux-vomica tree are used in Indian medicine.)

Action: Used as a substitute for nux-vomica. Poultice of leaves is used for neuralgia; ashes of the plant for the treatment of skin diseases.... viscum orientale

Habitat: Tropical Himalayas, Bengal, southwards to Andhra Pradesh and the Andamans.

Action: Fruits—stimulant, carminative, diaphoretic, anthelmintic, antidiarrhoeal. Decoction is used as an expectorant in asthma. Fruits and shoots—hypoglycaemic. Fruit pulp—applied externally in rheumatism.

Habitat: Throughout India up to 2,000 m.

Action: Plant—antiscorbutic, sial- agogue, cardiotonic, diaphoretic. Used for the treatment of rheumatism, renal colic and ague. Also used as a lotion for gangrenous ulcers and sores, syphilis, leprosy, ringworm.

Habitat: Waste places throughout India, up to elevation of 2,400 m.

Action: Galactagogue, febrifuge, sedative, vermifuge. Used in indigestion and in the treatment of diseases of the liver. An ointment is made from the decoction for wounds and ulcers.

Habitat: Introduced from Brazil; often cultivated in Indian gardens.

Action: Flowers—used against scurvy, gum troubles, toothache and against bladder pains and gout.

Constituents: Urtica urens herba tincture (1:2) 9.5 per cent. Arnica montana planta tincture (1:2) 0.5 per cent. (Weleda) ... combudoron ointment

Habitat: Native to South-west Asia; cultivated throughout India.

Action: Seeds—cooling and laxative; given during jaundice. Spinach, as a potherb, is rich in nitrogenous substances, hydrocarbons and iron sesqui-oxide.

Constituents: 100g contains: Ananarsa fruct. 5g; Larch Resin 2g in a base containing Lanolin and yellow soft paraffin. (Weleda) ... larch resin ointment

Ingredients: Amber oil 4 per cent; Clove oil BP 1 per cent; Eucalyptus oil BP 4 per cent; Linseed oil 10 per cent; Methyl sal BP 4 per cent; Volatile Mustard oil 0.03 per cent; Turpentine oil BP 12.3 per cent; Thyme oil 2 per cent; Peppermint oil BP 2.1 per cent; Arachis oil BP to 100. ... nine rubbing oils

Habitat: A native to Asia minor and Syria.

Action: Balsam is used for cough and respiratory tract catarrh. Turushka was obtained from Styrax officinale. Due to scarcity, it was replaced by the exudation of Liquidamber orientalis Mill. Balsam obtained from Altingia excelsa Noronha is used as a substitute for Silhaka and is known as Silaarasa (occurs in Assam and Arunachal Pradesh).

Habitat: Europe and from the Mediterranean to Caucasian region. Russian Comfrey or Blue Comfrey has been introduced in Simla; Prickly Camfrey is cultivated in Western India.

Action: Vulnerary (The British Herbal Pharmacopoeia), astringent, demulcent, haemostatic, tissue- restorative (repairs broken bones and lacerated flesh, promotes formation of a callus).

Habitat: Temperate Himalayas, Khasi Hills, Mishmi Hills, Gujarat and in hills of South India.

Action: Root—diuretic, cholagogue, pancreatic and bile duct stimulant, stimulant to portal circulation, choleretic, urinary antiseptic, detoxicant, promotes elimination of plasma cholesterol. Used chiefly in kidney and liver disorders, for rheumatism and as a general tonic. A decoction is given for infective hepatitis.

Ingredients: Cajuput oil 18.5 per cent, Clove oil 10 per cent; Eucalyptus oil 35.45 per cent, Juniper berry oil 2.7 per cent, Menthol 10 per cent, Peppermint oil 25.45 per cent, Wintergreen oil 3.7 per cent. (Lane’s, UK) ... olbas oil

Constituents: neriodorin, neriodorein, essential oil.

Action: has a digitalis-like effect. Cardioactive. Diuretic. Seldom used in modern herbalism. ... oleander