Habitat: This common English wild plant was formerly cultivated in gardens, but is now rarely seen away from the borders of fields and waysides.

Habitat: Hedgerows and cornfields.

Action: Hepatic, alterative, astringent, detergent.

Gene therapy is currently used to treat disorders caused by a fault in a single recessive gene, when the defect can remedied by introducing a normal ALLELE. Treating disorders caused by dominant genes is more complicated. CYSTIC FIBROSIS is an example of a disease caused by a recessive gene, and clinical trials are taking place on the e?ectiveness of using LIPOSOMES to introduce the normal gene into the lungs of someone with the disorder. Trials are also underway to test the e?ectiveness of introducing tumour-suppressing genes into cancer cells to check their spread.

Gene therapy was ?rst used in 1990 to treat an American patient. Eleven European medical research councils (including the UK’s) recommended in 1988 that gene therapy should be restricted to correcting disease or defects, and that it should be limited to somatic cells. Interventions in germ-line cells (the sperm and egg) to e?ect changes that would be inherited, though technically feasible, is not allowed (see CLONING; HUMAN GENOME).... gene therapy

– resistant CTEV – which is harder to correct; and the infant has reduced calf-muscle bulk and abnormally shaped bones.

Treatment should be started at birth with the foot corrected to an improved position and then maintained in plaster of Paris or strapping

– a procedure performed weekly or more often. If the deformity is not corrected by around six weeks of age, a decision has to be made about whether to carry out surgical correction. If a deformity persists to maturity, a triple arthrodosis – fusion of three affected joints – may be required.... talipes

Tamoxifen is also used to treat INFERTILITY, being taken on certain days of the menstrual cycle (see MENSTRUATION).... tamoxifen

Tendon injuries are one of the hazards of sports (see SPORTS MEDICINE). They usually result from indirect violence, or overuse, rather than direct violence.

Rupture usually results from the sudden application of an unbalanced load. Thus, complete rupture of the Achilles tendon is common in taking an awkward step backwards playing squash. There is sudden pain; the victim is often under the impression that he or she has received a blow. This is accompanied by loss of function, and a gap may be felt in the tendon.

Partial Rupture is also accompanied by pain, but there is no breach of continuity or complete loss of function. Treatment of a complete rupture usually means surgical repair followed by immobilisation of the tendon in plaster of Paris for six weeks. Partial rupture usually responds to physiotherapy and immobilisation, but healing is slow.... tendon

(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

The radio-isotope (see ISOTOPE) thallium201 is used as a tracer during special imaging studies of blood ?ow through the heart muscle in the diagnosis of myocardial ischaemia (see HEART, DISEASES OF.)... thallium

– and the embolism lodges in the pulmonary (lung) circulation. PULMONARY EMBOLISM is a potentially fatal condition and requires urgent anticoagulant treatment (see ANTICOAGULANTS) and sometimes surgery. Extended periods lying in bed or prolonged sitting in a con?ned position such as a car or aeroplane can cause DVT; venous thromboses in the legs may occur after surgery and preventive anticoagulant treatment with HEPARIN and warfarin is often used. Similar treatment is needed if a thrombus develops. STREPTOKINASE is also used to treat thromboembolism.... thromboembolism

Function The chief function of the thyroid gland is to produce a hormone (see HORMONES) rich in iodine – THYROXINE, which controls the rate of body METABOLISM. Thus, if it is de?cient in infants they fail to grow and suffer LEARNING DISABILITY, a condition formerly known as CRETINISM. If the de?ciency develops in adult life, the individual becomes obese, lethargic, and develops a coarse skin, a condition known as hypothyroidism (see under THYROID GLAND, DISEASES OF). Overactivity of the thyroid, or hyperthyroidism, results in loss of weight, rapid heart action, anxiety, overactivity and increased appetite. (See THYROID GLAND, DISEASES OF – Thyrotoxicosis.)

The production of the thyroid hormone is controlled by a hormone of the PITUITARY GLAND – the thyrotrophic hormone.... thyroid gland

– Hypothyroidism).... thyroxine

The resting level of spontaneous neuronal activity in the hearing system is only just below that at which sound enters a person’s consciousness – a consequence of the ?ne-tuning of normal hearing; so it is not, perhaps, surprising that normally ‘unheard’ neuronal activity becomes audible. If a patient suffers sensorineural deafness, the body may ‘reset’ the awareness threshold of neural activity, with the brain attempting greater sensitivity in an e?ort to overcome the deafness. The condition has a strong emotional element and its management calls for a psychological approach to help sufferers cope with what are, in e?ect, physically untreatable symptoms. They should be reassured that tinnitus is not a signal of an impending stroke or of a disorder of the brain. COGNITIVE BEHAVIOUR THERAPY can be valuable in coping with the unwanted noise. Traditionally, masking sounds, generated by an electrical device in the ear, were used to help tinnitus sufferers by, in e?ect, making the tinnitus inaudible. Even with the introduction of psychological retraining treatment, these maskers may still be helpful; the masking-noise volume, however, should be kept as low as possible or it will interfere with the retraining process. For patients with very troublesome tinnitus, lengthy counselling and retraining courses may be required. Surgery is not recommended.

Under the auspices of the Royal National Institute for Deaf People, the RNID Tinnitus Helpline has been established. Calls are charged at local rates. (See also MENIÈRE’S DISEASE.)... tinnitus

Structure The substance of the tongue consists almost entirely of muscles running in various directions. The tongue also has numerous outside attachments: one muscle on each side unites it to the lower jaw-bone just behind the chin, and this muscle serves to protrude the tongue from the mouth; other muscles, which retract the tongue, attach it to the hyoid bone, the larynx, the PALATE, and the styloid process on the base of the SKULL.

The mucous membrane on the undersurface of the tongue is very thin. In the middle line, a fold of mucous membrane, the frenum, passes from the under-surface to the ?oor of the mouth; when this frenum is attached too far forwards towards the tip of the tongue, the movements of the organ are impeded – the condition being known as tongue-tie. On the upper surface or dorsum of the tongue, the mucous membrane is thicker, and in its front two-thirds is studded with projections or papillae, most of which are conical. Some of them end in long ?laments, and are then known as ?liform papillae. On the tip, and towards the edges of the tongue, small, red, rounded fungiform papillae are seen, which act as end-organs for the sense of taste – as do circumvallate papillae, each of which is surrounded by a trench along which open numerous taste-buds. These taste-buds are also found in the fungiform papillae, scattered over

the throat, FAUCES, and palate. Five nerves, originating from the ?fth, seventh, ninth, tenth and 12th cervical nerves supply the tongue.... tongue

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

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

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

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

Torsion is also the term applied to the twisting of the small arteries severed at an operation, by which bleeding from them is stopped.... torsion

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

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

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

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

Transfusion of blood is a technique that has been used since the 17th century – although, until the 20th century, with a subsequent high mortality rate. It was only when incompatibility of BLOOD GROUPS was considered as a potential cause of this high mortality that routine blood-testing became standard practice. Since the National Blood Transfusion Service was started in the United Kingdom (in 1946), blood for transfusion has been collected from voluntary, unpaid donors: this is screened for infections such as SYPHILIS, HIV, HEPATITIS and nvCJD (see CREUTZFELDT-JAKOB DISEASE (CJD)), sorted by group, and stored in blood-banks throughout the country.

In the UK in 2004, the National Blood Authority – today’s transfusion service – announced that it would no longer accept donations from anyone who had received a blood transfusion since 1980 – because of the remote possibility that they might have been infected with the PRION which causes nvCJD.

A standard transfusion bottle has been developed, and whole blood may be stored at 2–6 °C for three weeks before use. Transfusions may then be given of whole blood, plasma, blood cells, or PLATELETS, as appropriate. Stored in the dried form at 4–21 °C, away from direct sunlight, human plasma is stable for ?ve years and is easily reconstituted by adding sterile distilled water.

The National Blood Authority prepares several components from each donated unit of blood: whole blood is rarely used in adults. This permits each product, whether plasma or various red-cell concentrates, to be stored under ideal conditions and used in appropriate clinical circumstances – say, to restore blood loss or to treat haemostatic disorders.

Transfusion of blood products can cause complications. Around 5 per cent of transfused patients suffer from a reaction; most are mild, but they can be severe and occasionally fatal. It can be di?cult to distinguish a transfusion reaction from symptoms of the condition being treated, but the safe course is to stop the transfusion and start appropriate investigation.

In the developed world, clinicians can expect to have access to high-quality blood products, with the responsibility of providing blood resting with a specially organised transfusion service. The cause of most fatal haemolytic transfusion reactions is a clerical error due to faulty labelling and/or failure to identify the recipient correctly. Hospitals should have a strict protocol to prevent such errors.

Arti?cial blood Transfusion with blood from donors is facing increasing problems. Demand is rising; suitable blood donors are becoming harder to attract; the processes of taking, storing and cross-matching donor blood are time-consuming and expensive; the shelf-life is six weeks; and the risk of adverse reactions or infection from transfused blood, although small, is always present. Arti?cial blood would largely overcome these drawbacks. Several companies in North America are now preparing this: one product uses puri?ed HAEMOGLOBIN from humans and another from cows. These provide oxygen-carrying capacity, are unlikely to be infectious and do not provoke immunological rejections. Yet another product, called Oxygene®, does not contain any animal or human blood products; it comprises salt water and a substance called per?ubron, the molecules of which store oxygen and absorb carbon dioxide more e?ectively than does haemoglobin. Within 24 hours of being transfused into a person’s bloodstream, per?ubron evaporates and is harmlessly breathed out by the recipient. Arti?cial blood is especially valuable in that it contains no unwanted proteins that can provoke adverse immunological reactions. Furthermore, it is disease-free, lasts for up to three years and is no more expensive than donor blood. It could well take the place of donor blood within a few years.

Autologous transfusion is the use of an individual’s own blood, provided in advance, for transfusion during or after a surgical operation. This is a valuable procedure for operations that may require large transfusions or where a person has a rare blood group. Its use has increased for several reasons:

fear of infection such as HIV and hepatitis.

shortages of donor blood and the rising cost of units of blood.

substantial reduction of risk of incompatible transfusions. In practice, blood transfusion in the UK is

remarkably safe, but there is always room for improvement. So, in the 1990s, a UK inquiry on the Serious Hazards of Transfusion (SHOT) was launched. It established (1998) that of 169 recently reported serious hazards following blood transfusion, 81 had involved a blood component being given to the wrong patient, while only eight were the result of viral or bacterial infections.

There are three ways to use a patient’s own blood in transfusion:

(1) predeposit autologous donation (PAD) – taking blood from a patient before operation and transfusing this blood back into the patient as required during and after operation.

(2) acute normovalaemic haemodilution (ANH) – diluting previously withdrawn blood and thus increasing the volume before transfusion.

(3) perioperative cell salvage (PCS) – the use of centrifugal cell separation on blood saved during an operation, particularly spinal surgery where blood loss may be considerable.

The government has urged NHS trusts to consider the introduction of PCS as a possible adjunct or alternative to banked-blood transfusion. In one centre (Nottingham), PCS has been used in the form of continuous autologous transfusion for several years with success.

Exchange transfusion is the method of treatment in severe cases of HAEMOLYTIC DISEASE OF THE NEWBORN. It consists of replacing the whole of the baby’s blood with Rh-negative blood of the correct blood group for the baby.... transfusion

Traveller’s diarrhoea is an all-toocommon a?iction of the traveller, which basks in a multiplicity of names: for example, Aden gut, Aztec two-step, Basra belly, Delhi belly, Gippy tummy, Hong Kong dog, Montezuma’s revenge, Tokyo trots, turista. It is caused by a variety of micro-organisms, usually E. coli. Some people seem to be more prone to it than others, although for no good cause. Obvious preventive measures include the avoidance of salads, unpeeled fruit and ice cream, and never drinking unboiled or unbottled water. If diarrhoea occurs, co-phenotrope and loperamide are often used to reduce the frequency of bowel movements in adults. Prophylactic antibacterial drugs are not advisable.... travel sickness

Treatment Drying of the feet overnight, where practicable, is the best method of prevention, accompanied by avoidance of constrictive clothing and tight boots, and of prolonged immobility. Frequent rest periods and daily changing of socks also help. The application of silicone grease once a day is another useful preventive measure. In the early stages, treatment consists of rest in bed and warmth; in more severe cases treatment is as for infected tissues and ulceration. ANALGESICS are usually necessary to ease the pain. Technically, smoking should be forbidden, but the adverse psychological effects of this in troops on active service may outweigh its advantages.... trench foot

Prevention is based on thorough inspection of meat in slaughterhouses; even cooking, unless the meat is in slices, is not an e?cient protection. Pigs should not be fed on unboiled garbage. Rats may be a source of sporadic outbreaks, as infected rats have been found near piggeries. The disease is widely distributed throughout the Americas, Asia, Africa and the Arctic. Sporadic cases and epidemics occur and outbreaks also appear in Europe, although rarely in Britain.

Treatment Thiabendazole or mebendazole are usually e?ective, while STEROID treatment helps patients with systemic illness and muscle tenderness.... trichinosis

Before applying a truss the wearer must make certain that the hernia has been reduced; this may mean lying down beforehand. A truss will rarely control a hernia satisfactorily, and it should be considered as a temporary measure only until surgical correction is possible. In the past, trusses have been supplied to patients considered too frail for surgery, but modern anaes-thetic techniques mean that most people can have their hernias surgically repaired.... truss

The weight loss and wasting associated with tuberculosis before treatment was available led to the disease’s popular name of consumption. Enlargement of the glands in the neck, formerly called scrofula, was known also as the ‘king’s evil’ from the supersition that a touch of the royal hand could cure the condition. Lupus vulgaris (see under LUPUS) is another of the skin manifestations of the disease.

The typical pathological change in tuberculosis involves the formation of clusters of cells called granulomas (see GRANULOMA) with death of the cells in the centre producing CASEATION.

It is estimated that there are 7–8 million new cases of tuberculosis worldwide each year, with 2–3 million deaths. The incidence of tuberculosis in developed countries has shown a steady decline throughout the 20th century, mainly as a result of improved nutrition and social conditions and accelerated by the development of antituberculous chemotherapy in the 1940s. Since the mid-1980s the decline has stopped, and incidence has even started to rise again in inner-city areas. In 2002, 7,239 cases of tuberculosis were noti?ed in the UK compared with 6,442 a decade earlier; more than 390 deaths in 2003 were attributed to the disease. Factors involved in this rise are immigration from higher-prevalence areas, poorer social conditions and homelessness in some urban centres and the association with HIV infection and drug abuse. The incidence of tuberculosis is also rising in many developing countries because of the emergence of resistant strains of the tubercle bacillus (see below). In the UK recently there have been serious outbreaks in a handful of urban-based schools.... tuberculosis

Characteristic white streaks appear on the optic fundi (see EYE). Molecular genetic testing can identify up to 90 per cent of individuals with a tuberin gene. Genetic counselling of families is helpful. Relatives of those with this condition can obtain help and guidance from the Tuberous Sclerosis Association of Great Britain.... tuberous sclerosis

A lack of oestrogen induces hot flushes, night sweats, thinning of the bones (osteoporosis) with possible fractures, and a wide range of physical and emotional disorders.

HRT also prevents the increased frequency of coronary disease which may follow the menopause. With oestrogen only, HRT appears to increase the incidence of cancer of the uterine body. Use of oestrogen and progestogen avoids this.

HRT is available as a tablet, transdermal patch, implant or topical cream. Most women notice temporary improvement in their appearance and hot flushes as long as treatment is continued. HRT is not prescribed by the herbal practitioner. Soya and Hops are a mild alternative.

Side-effects of such treatment include blood pressure rise, weight gain and periods probably continue with a monthly bleed. Elderly women taking HRT for osteoporosis may develop bleeding problems, the risk of blood clot and gall bladder diseases.

Helonias has proved a useful alternative, effective in eliminating excess fluids, reducing hot flushes, and relieving that bloated feeling, thus helping the older woman to live a normal life.

Damiana. 1 heaped teaspoon leaves to each cup boiling water; infuse 5-10 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Sarsaparilla. 1oz (30g) root in 1 pint (500ml) water; simmer gently 20 minutes; strain. 1 cup 2-3 times daily for 3-6 weeks.

Supplementation. Daily. Vitamin E, 400iu. Vitamin B-complex (high potency). Evening Primrose oil capsules, 500mg morning and evening. Dolomite, for Calcium and Magnesium, 2 tablets morning and evening.

Note: An extensive study of breast cancer risks with HRT revealed a positive link between the risk of cancer and length of use. Risk of the disease increased with all types of women using HRT with every year of use. Pre-menstrual women were more than twice at risk. It would appear that oestrogens cannot be taken without risk. (Centre for Disease Control, Atlanta, USA) See: OESTROGENS. ... hormone replacement therapy (hrt)

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

Computed tomography can distinguish soft tissues from cysts or fat, but in general soft-tissue masses have similar appearances, so that distinguishing an in?ammatory mass from a malignant process may be impossible. The technique is particularly useful in patients with suspected malignancy; it can also de?ne the extent of the cancer by detecting enlarged lymph nodes, indicating lymphatic spread. The main indications for computed tomography of the body are: mediastinal masses, suspected pulmonary metastases, adrenal disease, pancreatic masses, retroperitoneal lymph nodes, intra-abdominal abscesses, orbital tumours and the staging of cancer as a guide to e?ective treatment.... computed tomography

The earliest attempt at surgical separation is said to have been made by Dr Farius of Basle in 1689. The ?rst successful separation in Great Britain was in 1912: both twins survived the operation and one survived well into adult life. This is said to be the ?rst occasion on which both twins survived the operation. The success of the operation is largely dependent upon the degree of union between the twins. Thus, if this is only skin, subcutaneous tissue and cartilage, the prospects of survival for both twins are good; but if some vital organ such as the liver is shared, the operation is much more hazardous. (See MULTIPLE BIRTHS.)... conjoined twins

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

The general term, psychoanalysis, is applied, in the ?rst place, to the method of helping the patient to recover buried memories by free association of thoughts. In the second place, the term is applied to the body of psychological knowledge and theory accumulated and devised by Sigmund Freud (1856–1939) and his followers. The term ‘psychoanalyst’ has traditionally been applied to those who have undergone Freudian training, but Freud’s ideas are being increasingly questioned by some modern psychiatrists.... freudian theory

Habitat: U.S.A

Action: Alterative, hepatic, diuretic, tonic.

Eggs are obtained and mixed with the partner’s semen, then introduced into the woman’s Fallopian tubes for fertilisation to take place. The fertilised egg travels to the uterus where IMPLANTATION occurs and pregnancy proceeds. A variation of GIFT is zygote intrafallopian transfer (ZIFT) in which early development of the fertilised eggs happens in the laboratory before the young embryo is transferred to the Fallopian tubes. GIFT is best used in couples with unexplained infertility or with minor degrees of male or female cervical factor infertility. The success rate is about 17 per cent. (See also ARTIFICIAL INSEMINATION.)... gamete intrafallopian transfer (gift)

Action: Although more popular among the old herbalists than among those of to-day. Holy Thistle is still valued for its tonic, stimulant and diaphoretic properties.

The haemagglutination inhibition test This, and the subsequent tests to be mentioned, are known as immunological tests. They are based upon the e?ect of the urine from a pregnant woman upon the interaction of red blood cells, which have been sensitised to human gonadotrophin, and anti-gonadotrophin serum. They have the great practical advantage of being performed in a test-tube or even on a slide. Because of their ease and speed of performance, a result can be obtained in two hours.

Enzyme-linked immunosorbent assay (ELISA) This is the basis of many of the pregnancy-testing kits obtainable from pharmacies. It is a highly sensitive antibody test and can detect very low concentrations of human chorionic gonadotrophin. Positive results show up as early as ten days after fertilisation – namely, four days before the ?rst missed period.

Ultrasound The fetal sac can be detected by ULTRASOUND from ?ve weeks, and a fetal echo at around six or seven weeks (see also PRENATAL SCREENING OR DIAGNOSIS).... pregnancy tests

Static lung volumes and capacities can be measured: these include vital capacity – the maximum volume of air that can be exhaled slowly and completely after a maximum deep breath; forced vital capacity is a similar manoeuvre using maximal forceful exhalation and can be measured along with expiratory ?ow rates using simple spirometry; total lung capacity is the total volume of air in the chest after a deep breath in; functional residual capacity is the volume of air in the lungs at the end of a normal expiration, with all respiratory muscles relaxed.

Dynamic lung volumes and ?ow rates re?ect the state of the airways. The forced expiratory volume (FEV) is the amount of air forcefully exhaled during the ?rst second after a full breath – it normally accounts for over 75 per cent of the vital capacity. Maximal voluntary ventilation is calculated by asking the patient to breathe as deeply and quickly as possible for 12 seconds; this test can be used to check the internal consistency of other tests and the extent of co-operation by the patient, important when assessing possible neuromuscular weakness affecting respiration. There are several other more sophisticated tests which may not be necessary when assessing most patients. Measurement of arterial blood gases is also an important part of any assessment of lung function.... pulmonary function tests

In the case of infestation with Taenia saginata, the host may not have any symptoms and only become aware that he or she is infested upon sight of the tapeworm – or rather, part of it – in the stools (FAECES). In the case of Taenia solium the outlook is more serious because the eggs, when swallowed, are liable to migrate into the tissues of the body (as they do in the pig) and cause hydatid cysts. If these occur in the muscles they may cause little trouble but, if they occur in the brain or liver, they can prove very serious.

Hydatid cysts often grow to a great size, budding o? smaller cysts in their interior. The symptoms produced by a hydatid cyst depend mainly upon the effects of its size and consequent pressure.

Treatment of tapeworm infestation is the administration (on a named-patient basis) of niclosamide or praziquantal. Hydatid disease is treated by surgical removal, sometimes in coordination with albendazole.... taeniasis

Action: Whole plant—infusion useful in cold and bronchitis, also in the treatment of rheumatism.

A target cell is also a cell that is the focus of attack by macrophages (killer cells – see MACROPHAGE) or ANTIBODIES; it may also be the site of action of a speci?c hormone (see HORMONES).... target cell

In order to reduce the health hazards, tattooists – along with acupuncturists, cosmetic skinpiercers and hair electrolysers – are required by UK legislation to register their premises with health and local authorities before starting business. The practitioners have to satisfy the authorities that adequate precautions have been taken to prevent the transmission of infections.... tattooing

applied in the evening and continued for up to six weeks. Tazarotene is not suitable for those aged under 18.... tazarotene

Structure Each tooth is composed of enamel, dentine, cement, pulp and periodontal membrane. ENAMEL is the almost translucent material which covers the crown of a tooth. It is the most highly calci?ed material in the body, 96–97 per cent being composed of calci?ed salts. It is arranged from millions of long, six-sided prisms set on end on the dentine (see below), and is thickest over the biting surface of the tooth. With increasing age or the ingestion of abrasive foods the teeth may be worn away on the surface, so that the dentine becomes visible. The outer sides of some teeth may be worn away by bad tooth-brushing technique. DENTINE is a dense yellowish-white material from which the bulk and the basic shape of a tooth are formed. It is like ivory and is harder than bone but softer than enamel. The crown of the tooth is covered by the hard protective enamel and the root is covered by a bone-like substance called cement. Decay can erode dentine faster than enamel (see TEETH, DISORDERS OF – Caries of the teeth). CEMENT or cementum is a thin bone-like material which covers the roots of teeth and helps hold them in the bone. Fibres of the periodontal membrane (see below) are embedded in the cement and the bone. When the gums recede, part of the cement may be exposed and the cells die. Once this has happened, the periodontal membrane can no longer be attached to the tooth and, if su?cient cement is destroyed, the tooth-support will be so weakened that the tooth will become loose. PULP This is the inner core of the tooth and is

composed of a highly vascular, delicate ?brous tissue with many ?ne nerve-?bres. The pulp is very sensitive to temperature variation and to touch. If the pulp becomes exposed it will become infected and usually cannot overcome this. Root-canal treatment or extraction of the tooth may be necessary. PERIODONTAL MEMBRANE This is a layer of ?brous tissue arranged in groups of ?bres which surround and support the root of a tooth in a bone socket. The ?bres are interspersed with blood vessels and nerves. Loss of the membrane leads to loss of the tooth. The membrane can release and re-attach the ?bres to allow the tooth to move when it erupts, or (to correct dental deformities) is being moved by orthodontic springs.

Arrangement and form Teeth are present in most mammals and nearly all have two sets: a temporary or milk set, followed by a permanent or adult set. In some animals, like the toothed whale, all the teeth are similar; but in humans there are four di?erent shapes: incisors, canines (eye-teeth), premolars (bicuspids), and molars. The incisors are chisel-shaped and the canine is pointed. Premolars have two cusps on the crown (one medial to the other) and molars have at least four cusps. They are arranged together in an arch in each jaw and the

cusps of opposing teeth interdigitate. Some herbivores have no upper anterior teeth but use a pad of gum instead. As each arch is symmetrical, the teeth in an upper and lower quadrant can be used to identify the animal. In humans, the quadrants are the same: in other words, in the child there are two incisors, one canine and two molars (total teeth 20); in the adult there are two incisors, one canine, two premolars and three molars (total 32). This mixture of tooth-form suggests that humans are omnivorous. Anatomically the crown of the tooth has mesial and distal surfaces which touch the tooth next to it. The mesial surface is the one nearer to the centre line and the distal is the further away. The biting surface is called the incisal edge for the anterior teeth and the occlusal surface for the posteriors.

Development The ?rst stage in the formation of the teeth is the appearance of a down-growth of EPITHELIUM into the underlying mesoderm. This is the dental lamina, and from it ten smaller swellings in each jaw appear. These become bell-shaped and enclose a part of the mesoderm, the cells of which become specialised and are called the dental papillae. The epithelial cells produce enamel and the dental papilla forms the dentine, cement and pulp. At a ?xed time the teeth start to erupt and a root is formed. Before the deciduous teeth erupt, the permanent teeth form, medial to them. In due course the deciduous roots resorb and the permanent teeth are then able to push the crowns out and erupt themselves. If this process is disturbed, the permanent teeth may be displaced and appear in an abnormal position or be impacted.

Eruption of teeth is in a de?nite order and at a ?xed time, although there may be a few months’ leeway in either direction which is of no signi?cance. Excessive delay is found in some congenital disorders such as CRETINISM. It may also be associated with local abnormalities of the jaws such as cysts, malformed teeth and supernumerary teeth.

The usual order of eruption of deciduous teeth is:

Middle incisors 6–8 months Lateral incisors 8–10 months First molars 12–16 months Canines (eye-teeth) 16–20 months Second molars 20–30 months

The usual order of eruption of permanent teeth is:

First molars 6–7 years Middle incisors 6–8 years Lateral incisors 7–9 years Canines 9–12 years First and second premolars 10–12 years Second molars 11–13 years Third molars (wisdom teeth) 17–21 years

The permanent teeth of the upper (top) and lower (bottom) jaws.

Teeth, Disorders of

Teething, or the process of eruption of the teeth in infants, may be accompanied by irritability, salivation and loss of sleep. The child will tend to rub or touch the painful area. Relief may be obtained in the child by allowing it to chew on a hard object such as a toy or rusk. Mild ANALGESICS may be given if the child is restless and wakens in the night. A serious pitfall is to assume that an infant’s symptoms of ill-health are due to teething, as the cause may be more serious. Fever and ?ts (see SEIZURE) are not due to teething.

Toothache is the pain felt when there is in?ammation of the pulp or periodontal membrane of a tooth (see TEETH – Structure). It can vary in intensity and may be recurring. The commonest cause is caries (see below) when the cavity is close to the pulp. Once the pulp has become infected, this is likely to spread from the apex of the tooth into the bone to form an abscess (gumboil – see below). A lesser but more long-lasting pain is felt when the dentine is unprotected. This can occur when the enamel is lost due to decay or trauma or because the gums have receded. This pain is often associated with temperature-change or sweet foods. Expert dental advice should be sought early, before the decay is extensive. If a large cavity is accessible, temporary relief may be obtained by inserting a small piece of cotton wool soaked, for example, in oil of cloves.

Alveolar abscess, dental abscess or gumboil This is an ABSCESS caused by an infected tooth. It may be present as a large swelling or cause trismus (inability to open the mouth). Treatment is drainage of the PUS, extraction of the tooth and/or ANTIBIOTICS.

Caries of the teeth or dental decay is very common in the more a?uent countries and is most common in children and young adults. Increasing awareness of the causes has resulted in a considerable improvement in dental health, particularly in recent years; this has coincided with a rise in general health. Now more than half of ?ve-year-old children are caries-free and of the others, 10 per cent have half of the remaining carious cavities. Since the start of the National Health Service, the emphasis has been on preventive dentistry, and now edentulous patients are mainly found among the elderly who had their teeth removed before 1948.

The cause of caries is probably acid produced by oral bacteria from dietary carbohydrates, particularly re?ned sugar, and this dissolves part of the enamel; the dentine is eroded more quickly as it is softer (see TEETH – Structure). The exposed smooth surfaces are usually protected as they are easily cleaned during normal eating and by brushing. Irregular and overcrowded teeth are more at risk from decay as they are di?cult to clean. Primitive people who chew coarse foods rarely get caries. Fluoride in the drinking water at about one part per million is associated with a reduction in the caries rate.

Prolonged severe disease in infancy is associated with poor calci?cation of the teeth, making them more vulnerable to decay. As the teeth are formed and partly calci?ed by the time of birth, the diet and health of the mother are also important to the teeth of the child. Pregnant mothers and children should have a good balanced diet with su?cient calcium and vitamin

D. A ?brous diet will also aid cleansing of the teeth and stimulate the circulation in the teeth and jaws. The caries rate can be reduced by regular brushing with a ?uoride toothpaste two or three times per day and certainly before going to sleep. The provision of sweet or sugary juices in an infant’s bottle should be avoided.

Irregularity of the permanent teeth may be due to an abnormality in the growth of the jaws or to the early or late loss of the deciduous set (see TEETH – Development). Most frequently it is due to an imbalance in the size of the teeth and the length of the jaws. Some improvement may take place with age, but many will require the help of an orthodontist (specialist dentist) who can correct many malocclusions by removing a few teeth to allow the others to be moved into a good position by means of springs and elastics on various appliances which are worn in the mouth.

Loosening of the teeth may be due to an accident or in?ammation of the GUM. Teeth loosened by trauma may be replaced and splinted in the socket, even if knocked right out. If the loosening is due to periodontal disease, the prognosis is less favourable.

Discoloration of the teeth may be intrinsic or extrinsic: in other words, the stain may be in the calci?ed structure or stuck on to it. Intrinsic staining may be due to JAUNDICE or the antibiotic tetracycline. Extrinsic stain may be due to tea, co?ee, tobacco, pan (a mixture of chuna and betel nuts wrapped in a leaf), iron-containing medicines or excess ?uoride.

Gingivitis or in?ammation of the gum may occur as an acute or chronic condition. In the acute form it is often part of a general infection of the mouth, and principally occurs in children or young adults – resolving after 10–14 days. The chronic form occurs later in life and tends to be progressive. Various microorganisms may be found on the lesions, including anaerobes. Antiseptic mouthwashes may help, and once the painful stage is past, the gums should be thoroughly cleaned and any calculus removed. In severe conditions an antibiotic may be required.

Periodontal disease is the spread of gingivitis (see above) to involve the periodontal membrane of the tooth; in its ?orid form it used to be called pyorrhoea. In this, the membrane becomes damaged by the in?ammatory process and a space or pocket is formed into which a probe can be easily passed. As the pocket becomes more extensive, the tooth loosens. The loss of the periodontal membrane also leads to the loss of supporting bone. Chronic in?ammation soon occurs and is di?cult to eradicate. Pain is not a feature of the disease but there is often an unpleasant odour (halitosis). The gums bleed easily and there may be DYSPEPSIA. Treatment is largely aimed at stabilising the condition rather than curing it.

Dental abscess is an infection that arises in or around a tooth and spreads to involve the bone. It may occur many years after a blow has killed the pulp of the tooth, or more quickly after caries has reached the pulp. At ?rst the pain may be mild and intermittent but eventually it will become severe and a swelling will develop in the gum over the apex of the tooth. A radiograph of the tooth will show a round clear area at the apex of the tooth. Treatment may be by painting the gum with a mild counter-irritant such as a tincture of aconite and iodine in the early stages, but later root-canal therapy or apicectomy may be required. If a swelling is present, it may need to be drained or the o?ending teeth extracted and antibiotics given.

Injuries to teeth are common. The more minor injuries include crazing and the loss of small chips of enamel, and the major ones include a broken root and avulsion of the entire tooth. A specialist dental opinion should be sought as soon as possible. A tooth that has been knocked out can be re-implanted if it is clean and replaced within a few hours. It will then require splinting in place for 4–6 weeks.

Prevention of dental disease As with other disorders, prevention is better than cure. Children should be taught at an early age to keep their teeth and gums clean and to avoid re?ned sugars between meals. It is better to ?nish a meal with a drink of water rather than a sweetened drink. Fluoride in some of its forms is useful in the reduction of dental caries; in some parts of the UK natural water contains ?uoride, and in some areas where ?uoride content is low, arti?cial ?uoridation of the water supply is carried out. Overcrowding of the teeth, obvious maldevelopment of the jaw and persistent thumbsucking into the teens are all indications for seeking the advice of an orthodontist. Generally, adults have less trouble with decay but more with periodontal disease and, as its onset is insidious, regular dental inspections are desirable.... teeth

Telemedicine is useful for remote locations, such as the Antartic, or on board ships, or aeroplanes, where it may be di?cult or impossible to get a doctor to the patient. It can also speed up the referral process, reduce unnecessary referrals and improve communication between professionals. It has potential value in pilot projects of ‘hospital at home’ care.... telemedicine

In humans the ‘normal’ temperature is around 37 °C (98·4 °F). It may rise as high as 43 °C or fall to 32 °C in various conditions, but the risk to life is only serious above 41 °C or below 35 °C.

Fall in temperature may accompany major loss of blood, starvation, and the state of collapse (see SHOCK) which may occur in severe FEVER and other acute conditions. Certain chronic diseases, notably hypothyroidism (see THYROID GLAND, DISEASES OF), are generally accompanied by a subnormal temperature. Increased temperature is a characteristic of many acute diseases, particularly infections; indeed, many diseases have a characteristic pattern that enables a provisional diagnosis to be made or acts as a warning of possible complications. In most cases the temperature gradually abates as the patient recovers, but in others, such as PNEUMONIA and TYPHUS FEVER, the untreated disease ends rapidly by a CRISIS in which the temperature falls, perspiration breaks out, the pulse rate falls, and breathing becomes quieter. This crisis is often preceded by an increase in symptoms, including an epicritical rise in temperature.

Body temperature is usually measured on the Celsius scale, on a thermometer reading from 35 °C to 43·3 °C. Measurement may be taken in the mouth (under the tongue), in the armpit, the external ear canal or (occasionally in infants) in the rectum. (See also THERMOMETER.)

Treatment Abnormally low temperatures may be treated by application of external heat, or reduction of heat loss from the body surface. High temperature may be treated in various ways, apart from the primary treatment of the underlying condition. Treatment of hyperthermia or hypothermia should ensure a gradual return to normal temperature (see ANTIPYRETICS.... temperature

Although the risks are nil or very small with most drugs, no medication should be given to a pregnant woman, particularly during the ?rst few months of pregnancy, unless it is absolutely essential for her health or that of her unborn child. Alcohol is regarded as ‘medication’ in this context.... teratogenesis

All the preparations are virtually identical, being active against both gram-negative and gram-positive bacteria (see GRAM’S STAIN). Derived from cultures of streptomyces bacteria, their value has lessened owing to increasing resistance to the group among bacteria. However, they remain the treatment of choice for BRUCELLOSIS, LYME DISEASE, TRACHOMA, PSITTACOSIS, Q FEVER, SALPINGITIS, URETHRITIS and LYMPHOGRANULOMA INGUINALE, as well as for infections caused by MYCOPLASMA, certain rickettsiae (see RICKETTSIA) and CHLAMYDIA. Additionally they are used in the treatment of ACNE, but are not advised in children under 12 as they may produce permanent discoloration of the teeth. Tetracyclines must not be used if a woman is pregnant as the infant’s deciduous teeth will be stained.... tetracyclines

All thiazides are active by mouth with an onset of action within 1–2 hours, and a duration of 12–24 hours. Chlorthalidone is a thiazide-related compound that has a longer duration of action and only requires to be given on alternate days. The other thiazide drugs available include bendro?uazide, cyclopenthiazide, hydrochlorothiazide, hydro?umethiazide, indapamide, mefruside, methychlothiazide, metolazone, polythiazide and xipamide.... thiazides

Touch sense proper, by which we perceive a touch or stroke and estimate the size and shape of bodies with which we come into contact, but which we do not see.

Pressure sense, by which we judge the heaviness of weights laid upon the skin, or appreciate the hardness of objects by pressing against them.

Heat sense, by which we perceive that an object is warmer than the skin.

Cold sense, by which we perceive that an object touching the skin is cold.

Pain sense, by which we appreciate pricks, pinches and other painful impressions.

Muscular sensitiveness, by which the painfulness of a squeeze is perceived. It is produced probably by direct pressure upon the nerve-?bres in the muscles.

Muscular sense, by which we test the weight of an object held in the hand, or gauge the amount of energy expended on an e?ort.

Sense of locality, by which we can, without looking, tell the position and attitude of any part of the body.

Common sensation, which is a vague term used to mean composite sensations produced by several of the foregoing, like tickling, or creeping, and the vague sense of well-being or the reverse that the mind receives from internal organs. (See the entry on PAIN.)

The structure of the end-organs situated in the skin, which receive impressions from the outer world, and of the nerve-?bres which conduct these impressions to the central nervous system, have been described under NERVOUS SYSTEM. (See also SKIN.)

Touch affects the Meissner’s or touch corpuscles placed beneath the epidermis; as these di?er in closeness in di?erent parts of the skin, the delicacy of the sense of touch varies greatly. Thus the points of a pair of compasses can be felt as two on the tip of the tongue when separated by only 1 mm; on the tips of the ?ngers they must be separated to twice that distance, whilst on the arm or leg they cannot be felt as two points unless separated by over 25 mm, and on the back they must be separated by more than 50 mm. On the parts covered by hair, the nerves ending around the roots of the hairs also take up impressions of touch.

Pressure is estimated probably through the same nerve-endings and nerves that have to do with touch, but it depends upon a di?erence in the sensations of parts pressed on and those of surrounding parts. Heat-sense, cold-sense and pain-sense all depend upon di?erent nerve-endings in the skin; by using various tests, the skin may be mapped out into a mosaic of little areas where the di?erent kinds of impressions are registered. Whilst the tongue and ?nger-tips are the parts most sensitive to touch, they are comparatively insensitive to heat, and can easily bear temperatures which the cheek or elbow could not tolerate. The muscular sense depends upon the sensory organs known as muscle-spindles, which are scattered through the substance of the muscles, and the sense of locality is dependent partly upon these and partly upon the nerves which end in tendons, ligaments and joints.

Disorders of the sense of touch occur in various diseases. HYPERAESTHESIA is a condition in which there is excessive sensitiveness to any stimulus, such as touch. When this reaches the stage when a mere touch or gentle handling causes acute pain, it is known as hyperalgesia. It is found in various diseases of the SPINAL CORD immediately above the level of the disease, combined often with loss of sensation below the diseased part. It is also present in NEURALGIA, the skin of the neuralgic area becoming excessively tender to touch, heat or cold. Heightened sensibility to temperature is a common symptom of NEURITIS. ANAESTHESIA, or diminution of the sense of touch, causing often a feeling of numbness, is present in many diseases affecting the nerves of sensation or their continuations up the posterior part of the spinal cord. The condition of dissociated analgesia, in which a touch is quite well felt, although there is complete insensibility to pain, is present in the disease of the spinal cord known as SYRINGOMYELIA, and a?ords a proof that the nerve-?bres for pain and those for touch are quite separate. In tabes dorsalis (see SYPHILIS) there is sometimes loss of the sense of touch on feet or arms; but in other cases of this disease there is no loss of the sense of touch, although there is a complete loss of the sense of locality in the lower limbs, thus proving that these two senses are quite distinct. PARAESTHESIAE are abnormal sensations such as creeping, tingling, pricking or hot ?ushes.... touch

(2) A band of CONNECTIVE TISSUE passing from the outer part of an organ to the interior, separating the organ into discrete chambers.... trabecula

The pioneering success was achieved with transplantation of the kidney in the 1970s; this has been most successful when the transplanted kidney has come from an identical twin. Less successful have been live transplants from other blood relatives, while least successful have been transplants from other live donors and cadaver donors. The results, however, are steadily improving. Thus the one-year functional survival of kidneys transplanted from unrelated dead donors has risen from around 50 per cent to over 80 per cent, and survival rates of 80 per cent after three years are not uncommon. For a well-matched transplant from a live related donor, the survival rate after ?ve years is around 90 per cent. And, of course, if a transplanted kidney fails to function, the patient can always be switched on to some form of DIALYSIS. In the United Kingdom the supply of cadaveric (dead) kidneys for transplantation is only about half that necessary to meet the demand.

Other organs that have been transplanted with increasing success are the heart, the lungs, the liver, bone marrow, and the cornea of the eye. Heart, lung, liver and pancreas transplantations are now carried out in specialist centres. It is estimated that in the United Kingdom, approximately 200 patients a year between the ages of 15 and 55 would bene?t from a liver transplant if an adequate number of donors were available. More than 100 liver transplants are carried out annually in the United Kingdom and one-year-survival rates of up to 80 per cent have been achieved.

The major outstanding problem is how to prevent the recipient’s body from rejecting and destroying the transplanted organ. Such rejection is part of the normal protective mechanism of the body (see IMMUNITY). Good progress has been made in techniques of tissue-typing and immunosuppression to overcome the problem. Drugs are now available that can suppress the immune reactions of the recipient, which are responsible for the rejection of the transplanted organ. Notable among these are CICLOSPORIN A, which revolutionised the success rate, and TACROLIMUS, a macrolide immunosuppressant.

Another promising development is antilymphocytic serum (ALS), which reduces the activity of the lymphocytes (see LYMPHOCYTE) cells which play an important part in maintaining the integrity of the body against foreign bodies.

Donor cards are now available in all general practitioners’ surgeries and pharmacies but, of the millions of cards distributed since 1972, too few have been used. The reasons are complex but include the reluctance of the public and doctors to consider organ donation; poor organisation for recovery of donor kidneys; and worries about the diagnosis of death. A code of practice for procedures relating to the removal of organs for transplantation was produced in 1978, and this code has been revised in the light of further views expressed by the Conference of Medical Royal Colleges and Faculties of the United Kingdom on the Diagnosis of Brain Death. Under the Human Tissue Act 1961, only the person lawfully in possession of the body or his or her designate can authorise the removal of organs from a body. This authorisation may be given orally.

Patients who may become suitable donors after death are those who have suffered severe and irreversible brain damage – since such patients will be dependent upon arti?cial ventilation. Patients with malignant disease or systemic infection, and patients with renal disease, including chronic hypertension, are unsuitable.

If a patient carries a signed donor card or has otherwise recorded his or her wishes, there is no legal requirement to establish lack of objection on the part of relatives – although it is good practice to take account of the views of close relatives. If a relative objects, despite the known request by the patient, sta? will need to judge, according to the circumstances of the case, whether it is wise to proceed with organ removal. If a patient who has died is not known to have requested that his or her organs be removed for transplantation after death, the designated person may only authorise the removal if, having made such reasonable enquiry as may be practical, he or she has no reason to believe (a) that the deceased had expressed an objection to his or her body being so dealt with after death, or (b) that the surviving spouse or any surviving relative of the deceased objects to the body being so dealt with. Sta? will need to decide who is best quali?ed to approach the relatives. This should be someone with appropriate experience who is aware how much the relative already knows about the patient’s condition. Relatives should not normally be approached before death has occurred, but sometimes a relative approaches the hospital sta? and suggests some time in advance that the patient’s organs might be used for transplantation after death. The sta? of hospitals and organ exchange organisations must respect the wishes of the donor, the recipient and their families with respect to anonymity.

Relatives who enquire should be told that some post-mortem treatment of the donor’s body will be necessary if the organs are to be removed in good condition. It is ethical (see ETHICS) to maintain arti?cial ventilation and heartbeat until removal of organs has been completed. This is essential in the case of heart and liver transplants, and many doctors think it is desirable when removing kidneys. O?cial criteria have been issued in Britain to recognise when BRAIN-STEM DEATH has occurred. This is an important protection for patients and relatives when someone with a terminal condition

– usually as a result of an accident – is considered as a possible organ donor.... transplantation

Triage is now operated in accident and emergency departments by a ‘triage nurse’ who allocates a degree of priority so that patients are seen in order of severity rather than according to their time of arrival.... triage

The following diseases and conditions are treated under their separate dictionary entries: ANCYLOSTOMIASIS; BERIBERI; BLACKWATER FEVER; CHOLERA; DENGUE; DRACONTIASIS; DYSENTERY; ELEPHANTIASIS; FILARIASIS; HEAT STROKE; LEISHMANIASIS; LEPROSY; LIVER, DISEASES OF; MALARIA; ORIENTAL SORE; PLAGUE; PRICKLY HEAT; SCHISTOSOMIASIS; SLEEPING SICKNESS; STRONGYLOIDIASIS; SUNBURN; YAWS; YELLOW FEVER.... tropical diseases

(2) A drug that has helped some patients with resistant DEPRESSION. Used as a supporting drug with other treatment, tryptophan was withdrawn because of side-effects; it has, however, been reintroduced for use in hospital for patients for whom no alternative treatment is suitable. (See also MENTAL ILLNESS.)... tryptophan

– is conjugated or unconjugated. If conjugated, this indicates that HAEMOLYSIS is causing the jaundice; if unconjugated, disease of the LIVER or BILE DUCT is the likely diagnosis.... van den bergh test

Cause: Septicaemia or infected embolism conveyed from elsewhere – veins of the face, sinuses, head. May be a complication of meningitis.

Symptoms: headache, nausea, swelling of eyelids and forehead, pupils distended, veins of temples prominent, fever with severe constitutional disturbance.

Prognosis: usually fatal in the absence of orthodox antibiotics, but anti-staphylococcal herbs are helpful. Tinctures. Formula. Echinacea 3; Goldenseal 2; Myrrh (Tincture) 1. 1 teaspoon in water every 2 hours (acute). Thrice daily (chronic).

Treatment by or in liaison with general medical practitioner. ... cavernous sinus thrombosis

Alternatives. Teas. Lime flowers, Nettles, Horsetail, Ginkgo, Oats, Mistletoe, Yarrow.

Tea. Mix equal parts: Ginkgo, Hawthorn, Yarrow. One heaped teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup thrice daily.

Tablets/capsules. Ginkgo, Hawthorn, Prickly Ash.

Diet. See: DIET–HEART AND CIRCULATION.

Supplements. Daily: Vitamin E 1000mg; B6 50mg; B12 2mcg. Selenium 200mcg; Zinc 15mg. Strict bedrest; regulate bowels; avoid excessive physical and mental exertion. ... cerebral thrombosis

Symptoms include muscle weakness, loss of vision, or other sensory disturbances, speech difficulties, and epileptic seizures. Increased pressure within the skull can cause headache, visual disturbances, vomiting, and impaired mental functioning. Hydrocephalus may occur.

When possible, primary tumours are removed by surgery after opening the skull (see craniotomy).

In cases where a tumour cannot be completely removed, as much as possible of it will be cut away to relieve pressure.

For primary and secondary tumours, radiotherapy or anticancer drugs may also be given.

Corticosteroid drugs are often prescribed temporarily to reduce the size of a tumour and associated brain swelling.... brain tumour

The tumour is hard, with a well-defined edge.

The tumours occur most frequently in women who have had children.

They may also arise at the sites of old surgical incisions.

Surgical removal is the usual treatment.... desmoid tumour

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

The tube opens into the uterus at one end, and the other end, which is divided into fimbriae (finger-like projections), lies close to the ovary. The tube has muscular walls lined by cells with cilia (hair-like projections). The fimbriae take up the egg after it is expelled from the ovary. The beating cilia and muscular contractions propel the egg towards the uterus. After intercourse, sperm swim up the fallopian tube from the uterus. The lining of the tube and its secretions sustain the egg and sperm, encouraging fertilization, and nourish the egg until it reaches the uterus.

Salpingitis is inflammation of the fallopian tube, usually the result of a sexually transmitted bacterial infection, that can lead to infertility.

An ectopic pregnancy (development of an embryo outside the uterus) most commonly occurs in the fallopian tube.... fallopian tube

It starts in childhood with repetitive grimaces and tics.

Involuntary barks, grunts, or other noises may appear as the disease progresses.

In some cases, the sufferer has episodes of issuing foul language.

The syndrome is more common in males.

It is usually of lifelong duration, but antipsychotic drugs can help in some cases.... gilles de la tourette’s syndrome

The cause is overgrowth of the nerve structures that normally control blood flow and temperature in the skin.

The tumours are harmless but are surgically removed.... glomus tumour

Episodes occur during (nonrapid eye movement) sleep, usually half an hour to 3 and a half hours after falling asleep. Sufferers wake up screaming in a semiconscious state and remain frightened for some minutes. They do not recognize familiar faces or surroundings, and usually cannot be comforted. The sufferer gradually falls back to sleep and has no memory of the event the following day.

Night terror in children has no serious significance, but, in adults, is likely to be associated with an anxiety disorder.... night terror

PET scanning.... positron emission tomography

Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.

Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.

There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.

Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder

The blood is more acidic than normal, and the urine less acidic.

Causes include kidney damage due to disease, drugs, or a genetic disorder; but in many cases the cause is unknown.

The acidosis may result in osteomalacia, kidney stones (see calculus, urinary tract), nephrocalcinosis, and hypokalaemia (an abnormally low level of potassium in the blood).... renal tubular acidosis

The pulp is removed through a hole drilled in the crown. An antibiotic paste and a temporary filling are packed in. A few days later, the filling is removed and the canals are checked for infection. When no infection is detected the cavity is filled and the roots are sealed with cement. If the cavity is not filled completely, periodontitis may occur.

Treated teeth may turn grey but their appearance can be restored by bonding (see bonding, dental), fitting an artificial crown (see crown, dental), or by bleaching (see bleaching, dental).... root-canal treatment

Side effects include low blood pressure, drowsiness, dry mouth, and gastrointestinal disturbances.... tamsulosin

Tarsorrhaphy may be used as part of the treatment of corneal ulcer, or to protect the corneas of people who cannot close their eyes or those with exophthalmos.

The eyelids are later cut apart and allowed to open.... tarsorrhaphy

The cause is a defective response of the body tissues to testosterone.

The causative genes are carried on the X chromosome, and so females can be carriers. Affected individuals appear to be girls throughout childhood, and most develop female secondary sexual characteristics at puberty; but amenorrhoea occurs, and a diagnosis is usually made during investigations to find its cause. Chromosome analysis shows the presence of male chromosomes and blood tests show male levels of testosterone. Treatment of testicular feminization syndrome involves surgical removal of the testes, to prevent cancerous change in later life, and therapy with oestrogen drugs. An affected person is not fertile but can live a normal life as a woman.... testicular feminization syndrome

There are 2 types of thoracotomy: lateral and anterior. In a lateral thoracotomy the chest is opened between 2 ribs to provide access to the lungs, major blood vessels, and the oesophagus. In an anterior thoracotomy, an incision down the sternum (breastbone) provides access to the heart and the coronary arteries.... thoracotomy

The thymus lies behind the sternum and consists of 2 lobes that join in front of the trachea.

Each lobe is made of lymphoid tissue consisting of lymphocytes, epithelium, and fat.

The thymus conditions lymphocytes to become T-cells.

It plays a part in the immune response until puberty, gradually enlarging during this time.

After puberty, it shrinks, but some glandular tissue remains until middle-age.... thymus

Timolol may also be given after a myocardial infarction.

It is used as eye-drops to treat glaucoma.

Possible side effects, such as cold hands and feet, are typical of other beta-blockers.

Eye-drops may cause irritation, blurred vision, and headache.... timolol

Four tocopherols (alpha, beta, gamma, and delta) and several tocopherol derivatives together make up the vitamin.... tocopherol

The weakness may last for minutes, hours, or even days, but there is no lasting effect.

The cause is thought to be temporary damage to the motor cortex (the area of the brain that controls movement).... todd’s paralysis

It is less likely to cause dependence with long-term use than most opioids.

Possible side effects include nausea, vomiting, drowsiness, confusion, and impaired consciousness.... tramadol

Light from a small torch is shone on 1 side of the lump; if it can be seen on the other side, the lump contains clear fluid.... transillumination

TIAs may be caused by a blood clot (see embolism) temporarily blocking an artery that supplies the brain, or by narrowing of an artery as a result of atherosclerosis.

After a TIA, tests such as CT scanning, blood tests, ultrasound scanning, or angiography may be needed to determine a cause. In some cases, the heart is studied as a possible source of blood clots. Treatment is aimed at preventing stroke, which occurs within 5 years in up to one third of patients with TIA. Treatments include endarterectomy, anticoagulant drugs, or aspirin.... transient ischaemic attack

Possible side effects include drowsiness, constipation, dry mouth, dizziness, and, rarely, priapism.... trazodone

Possible adverse effects include nausea, vomiting, weakness, and rash.... triamterene

Tricyclic antidepressants prevent neurotransmitters in the brain from being reabsorbed, thereby increasing their level.

Examples are amitriptyline, clomipramine, and imipramine.... tricyclic antidepressants

The most common trisomy is of chromosome 21 (Down’s syndrome). Trisomy 18 (Edward’s syndrome) and trisomy 13 (Patau’s syndrome) are less common; trisomy 8 and trisomy 22 are very rare. Partial trisomy, with only part of a chromosome in triplicate, also occurs. Full trisomies cause abnormalities such as skeletal and heart defects and learning difficulties. Except in Down’s syndrome, babies usually die in early infancy. The effects of partial trisomies depend on the amount of extra chromosomal material present.

Diagnosis is made by chromosome analysis of cells, which may be obtained from the fetus by amniocentesis or after the birth. There is no specific treatment. Parents of an affected child should seek genetic counselling.... trisomy

Treatment with growth hormone from infancy helps girls with Turner’s syndrome to achieve near normal height. Coarctation of the aorta is treated surgically. Treatment with oestrogen drugs induces menstruation, but it does not make affected girls fertile.... turner’s syndrome

It is caused by an abnormally fast heart-rate due to serious heart disease, such as myocardial infarction or cardiomyopathy.

It may last for a few seconds or for several days.

Diagnosis is confirmed by ECG.

Emergency treatment is with defibrillation and an antiarrhythmic drug.... ventricular tachycardia

Habitat: Throughout India in the dry and intermediate zones; ascending to an altitude of about 1,200 m in the Himalayas.

Action: Flower—emmenagogue. Bark—anti-inflammatory, antiseptic (in skin diseases). Bark contains 17% tannins, triterpene alcohol, saponins of acacic acid, lupeol and a steroid, acaciol. An alkaloid, tryptamine, is present in the root and stem bark.

Habitat: Cultivated in Central and southern Europe.

Action: Astringent, antimicrobial (used for indolent ulcers, wounds, erysipelas).

• place 1 or 2 teaspoons of dried allspice fruit (or powder) in 1 cup of boiling water
• steep them for 10 to 20 minutes
• drink the tea (sugar or honey might be added)

• facilitate and promote good digestion
• help bloating, belching and flatulence
• help in preventing allergies
• help lower blood sugar
• help relieve toothache and muscle/joint pain
• help uplift the mood and relax the body

Habitat: Cultivated throughout India.

Action: Astringent (in menorrhagia, leucorrhoea, dysentery, diarrhoea, haemorrhagic colitis); also used in cough, bronchitis and consumption; externally emollient.

Habitat: Assam, Bengal, southwards to Andhra Pradesh and western Ghats.

Action: Stembark—febrifugal, antidiuretic, anthelmintic, hypo- glycaemic. Fruit—cooling; anti- catarrhal, blood purifier, analgesic.

Habitat: Western Ghats from Konkan southwards to Trivandrum, up to 600 m.

Action: Seed—febrifuge, antidysen- teric (in minute doses). Latex— circulatory stimulant (in minute doses.)

Absent CORNEAL REFLEX

Absent VESTIBULO-OCULAR REFLEX

No cranial motor response to somatic (physical) stimulation

Absent gag and cough re?exes

No respiratory e?ort in response to APNOEA despite adequate concentrations of CARBON DIOXIDE in the arterial blood.... b nosed. the test for brain-stem death are:

For adults with acute diarrhoea, short-term symptomatic treatment can be achieved with antimotility drugs such as codeine phosphate, co-phenotrope or loperamide hydrochloride. Adsorbent drugs, for example, KAOLIN, should not be used in acute diarrhoea, but bulk-forming drugs – ispaghula or methylcellulose

– can help to control the consistency of faeces in patients with ileostomies and colostomies (see ILEOSTOMY; COLOSTOMY), or those with diarrhoea caused by DIVERTICULAR DISEASE.

Irritable bowel syndrome, malabsorption syndrom, ulcerative colitis, Crohn’s disease and diverticular disease are often accompanied by diarrhoea; for more information on these conditions, see under separate entries.

ANTIBIOTICS may sometimes cause diarrhoea and this side-e?ect should be borne in mind when the cause of the condition is being investigated.... antidiarrhoeal treatments

Habitat: Peninsular India, Orissa, West Bengal.

Action: Root—diuretic (used in Siddha medicine for dropsy and rheumatism). Leaves—stimulant (used in rheumatism); expectorant, antispasmodic (used in cough and asthma); given to women after confinement. Bark—antiperiodic, astringent, expectorant.

Habitat: Southern India, Assam and Bihar.

Action: Antidysenteric. Fruit— diuretic. Bark—astringent. Root bark—vermifuge. A decoction of the root bark is prescribed for liver diseases. Seed—used for wound healing.

• Place 2 to 3 teaspoonfuls in a cup and pour on boiling water.
• Cover the mix and allow it to steep for 10 minutes.
• Drink the tea about three times a day.

• Place a teaspoon of dried birch bark in a cup of boiling water.
• Allow it to steep for 15 minutes.
• Drink the tea twice or thrice a day.

• alleviate joint pain related to rheumatoid arthritis and osteoarthritis
• combat gout
• fight urinary disorders
• increase urination
• treat melanoma
• help fighting skin breakouts and other dermatological problems (applied topically as a wash or added to bath water)
• soothe sore muscles

• treat digestive problems, like gas, constipation and stomach upset
• improve appetite
• detoxify the body
• support liver and gallbladder
• stimulate menstrual flow

• stomach irritation and vomiting
• liver disease
• gastrointestinal and liver problems and esophageal or nasal cancer

Habitat: The sub-Himalayan tract from Dehra Dun to Assam.

Action: See C. rotang.... calamus tenuis

Habitat: Deccan peninsula, from Malabar to Travancore.

Action: Tender leaves are used in dyspepsia, biliousness and as an anthelmintic. See C. rotang.... calamus travancoricus

Habitat: Cultivated mainly as an oil-seed crop in Madhya Pradesh, Maharashtra.

Action: Oil—aids prevention of arteriosclerosis, coronary heart disease and kidney disorders as a polyunsaturated fat. Flowers— stimulant, sedative, diuretic, emmenagogue; used in fevers and eruptive skin conditions, measles.

Habitat: The Himalayas from Kashmir to Nepal, ascending to 1,000 m; throughout tropical India.

Action: Root—hypoglycaemic. Root bark is used as a tonic in anaemic conditions.

Habitat: Throughout India as a weed.

Action: Leaves—taken internally to prevent skin diseases; applied against eczema and ringworm; pounded and applied on cuts, act like tincture of iodine. Seeds, soaked in water, are taken for spermatorrhoea. A paste made of equal parts of leaves and seeds is given for jaundice. Pods are used in dysentery.

Habitat: Sub-Himalayan tract, Assam and throughout hilly regions of Central and South India.

Action: Bark—astringent, an- tidysenteric, antiperiodic. Flow- ers—emmenagogue. Leaf— spasmolytic, hypoglycaemic, an- tiprotozoal.

Habitat: Central and Peninsular India up to 1,350 m.

Action: Dried tubers are used as tonic.

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

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

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

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

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

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

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

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

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

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

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

Habitat: A native of Peru and Brazil.

Action: Diuretic (used for chronic inflammation of urinary passages, calculus affections, jaundice, dropsy); also for leucorrhoea, rheumatism.

Habitat: Hills of Sikkim, Maharashtra, Tamil Nadu and the Andamans.

Action: Bark—astringent, febrifuge, antidiarrhoeic, spasmolytic, diuretic. The plant is used in skeltal fractures.

Habitat: The subtropical Himalayas, Khasi and Jaintia Hills.

Action: Leaf—Carminative, antidiarrhoeal, spasmolytic, an- tirheumatic, hypoglycaemic. Essential oil—fungicidal.

An appreciation of the need to account for chance and bias has led to development of methods where new treatments are compared to either a PLACEBO or to the standard treatment (or both) in a controlled, randomised clinical trial. ‘Controlled’ means that there is a comparison group of patients not receiving the test intervention, and ‘randomised’ implies that patients have been assigned to one or other treatment group entirely by chance and not because of their doctor’s preference. If possible, trials are ‘double-blind’ – that is, neither the patient nor the investigator knows who is receiving which intervention until after the trial is over. All such trials must follow proper ethical standards with the procedure fully explained to patients and their consent obtained.

The conduct, e?ectiveness and duplication of clinical trials have long been subjects of debate. Apart from occasional discoveries of deliberately fraudulent research (see RESEARCH FRAUD AND MISCONDUCT), the structure of some trials are unsatisfactory, statistical analyses are sometimes disputed and major problems have been the – usually unwitting – duplication of trials and non-publication of some trials, restricting access to their ?ndings. Duplication occurs because no formal international mechanism exists to enable research workers to discover whether a clinical trial they are planning is already underway elsewhere or has been completed but never published, perhaps because the results were negative, or no journal was willing to publish it, or the authors or funding authorities decided not to submit it for publication.

In the mid 1980s a proposal was made for an international register of clinical trials. In 1991 the NHS launched a research and development initiative and, liaising with the COCHRANE COLLABORATION, set out to collect systematically data from published randomised clinical trials. In 1994 the NHS set up a Centre for Reviews and Dissemination which, among other responsibilities, maintains a database of research reviews to provide NHS sta? with relevant information.

These e?orts are hampered by availability of information about trials in progress and unpublished completed trials. With a view to improving accessibility of relevant information, the publishers of Current Science, in 1998, launched an online metaregister of ongoing randomised controlled trials.

Subsequently, in October 1999, the editors of the British Medical Journal and the Lancet argued that the case for an international register of all clinical trials prior to their launch was unanswerable. ‘The public’, they said, ‘has the right to know what research is being funded. Researchers and research funders don’t want to waste resources repeating trials already underway.’ Given the widening recognition of the importance to patients and doctors of the practice of EVIDENCE-BASED MEDICINE, the easy availability of information on planned, ongoing and completed clinical trials is vital. The register was ?nally set up in 2005.... clinical trials

Habitat: Throughout India in tropical areas; also cultivated in hedges.

Action: Root—cathartic like jalap. Roots cause gripe and tenesmus, hence not recommended as purgative. Used in ascites. Root bark—diuretic (infusion used in irritation of bladder and urethra). Root juice—given in cold milk to liquefy phlegm in chronic bronchitis. The root, bark, seeds and leaves—used for gastric acidity. The root is administered with honey as a general tonic to children for improving mental faculty.

Research has shown that cognitive therapy is very e?ective in depression and that it can also help in anxiety, OBSESSIVE COMPULSIVE DISORDER, and EATING DISORDERS such as anorexia and bulimia nervosa. This therapy is also proving useful in helping people cope with HALLUCINATIONS and other symptoms of SCHIZOPHRENIA.... cognitive behaviour therapy

Habitat: Native to Africa and Asia, found in north-western and southern India.

Action: Febrifuge (used in febrile attacks after childbirth. Applied locally to putrescent wounds.

Habitat: Kashmir, above 2,350 m.

Action: Root—purgative. Latex— used in eruptions and other skin diseases.... euphorbia thomsoniana

Habitat: Mishmi Hills in Arunachal Pradesh. Cultivated commercially in China.

Action: Stomachic, antiperiodic, antibacterial, antifungal. Prescribed in debility, convalescence, intermittent fevers, dyspepsia, dysentery and intestinal catarrh. Used as a local application in thrush.

Habitat: Native to South-East Asia. Now cultivated in Assam, Bengal and South India.

Action: Cathartic, rubefacient, irritant. Used in ascites, anasarca, dropsy and enlargement of abdominal viscera.

Habitat: Wild throughout the drier upland tracts of India. Ayurvedic: Indravaaruni (var.). Siddha/Tamil: Kattutumatti. Folk: Vishlumbha, Bhakuraa.

Action: Pulp of fruit—drastic purgative. Decoction of roots— milder in purgative action. Seeds— cooling, astringent; useful in bilious disorders. The fruit is used as a substitute for Colocynth.

Habitat: Cultivated throughout India, particularly in Haryana, Punjab, Rajasthan, Uttar Pradesh and Orissa.

Action: Laxative, antibilious. Gum—hypoglycaemic, hypolipi- daemic, appetite depressor (weight loss not observed), reduces glyco- suria during gum supplementation.

• Use water that is free of chlorine, iron, salt and other type of impurities, because otherwise it can completely ruin the taste orDarjeeling tea.
• An important detail that most people ignore is using the right teapot. That is why it is recommended the use of China porcelain teapots and cups.
• For proper infusion, the Darjeeling tea leaves should be placed into the pot and then pour hot water on it.
• And last, Darjeeling tea connoisseurs advise not to put any kind of milk, honey or sugar in it since they change the aromatic flavor of Darjeeling tea. Also, milk reduces the benefits of this tea.

• Darjeeling tea strengthens your immune system, lowers cholesterol, fights dental plaque and maintains a healthy heart.
• Provides relaxation because of the L-theanine (amino - acid) that reduces mental and physical stress. That is why, people who suffer from depression or have anxiety attacks are advised to drink Darjeeling tea since it offers a feeling of well-being.
• It gives you energy, even though it has a small amount of caffeine. The L-theanine amino- acid softens caffeine’s speedy and uneven effects so that a person who is consuming Darjeeling tea feels relaxed and energized in the same time.
• Darjeeling tea contains antioxidants called flavonoids that protect cells from free radical damage.
• Reduces stroke risks and improves the function of blood vessels.

• People with anemia and iron deficiency should avoid drinking Darjeeling black tea.
• In cases of diabetes, even though Darjeeling tea’s caffeine content is softened by the the L-theanine amino - acid, still might affect blood sugar.
• People who present calcium deficit shouldn’t drink black tea, including Darjeeling tea, since it could produce dizziness and the sensation of fainting.
• Also, pregnant women are advised not to drink black tea.

Habitat: Peninsular India.

Action: Bark—antileprotic (used for ulcers and venereal diseases). Aerial parts exhibit diuretic, spasmolytic, CNS depressant and hypothermic activity.... ficus talbotii

Habitat: Throughout India, in the plains ascending to 1,200 m in Kumaon and 1,800 m in Kashmir.

Action: Fresh leaves—used internally as galactagogue and for diarrhoea; applied externally to wounds and abscesses. Root— diuretic. Also used for cough, asthma.

DDT has thus had a wide use in medicine, public health, veterinary medicine, horticulture, and agriculture. Unfortunately, the indiscriminate use of DDT is potentially hazardous, and its use is now restricted or banned in several countries, including the United Kingdom.

The danger of DDT is that it enters the biological food chain with the result that animals at the end of the food chain such as birds or predators may build up lethal concentrations of the substance in their tissues.

In any case, an increasing number of species of insects were becoming resistant to DDT. Fortunately, newer insecticides have been introduced which are toxic to DDT-resistant insects, but there are doubts whether this supply of new insecticides can be maintained as insects develop resistance to them.... dichlorodiphenyl trichloroethane

Habitat: Sub-Himalayan tract from Ravi to Nepal, also in Rajasthan, Madhya Pradesh, Bihar and Orrisa.

Action: Astringent, anti- inflammatory, styptic. Various plant parts are used for dry cough, bronchitis, pleurisy, pneumonia, dysuria, fistula, tumours, bleeding gums, haemorrhagic conditions.

Habitat: The Andamans and Assam.

Action: Oleo-resin (known as Gurjan Oil or Gurjan Balsam)— stimulant to genitourinary system, diuretic, spasmolytic; used externally on ulcers, ringworm and other cutaneous affections. Bark—a decoction is prescribed rheumatism.

Habitat: Throughout India, also planted as an ornamental.

Action: Astringent, anti- inflammatory, emetic.

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

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

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

Habitat: Tropical Himalayas from Simla to Bhutan between 2,150 and 3,200 m, and in Assam.

Action: Cholagogue, laxative, diuretic, circulatory stimulant. Used for constipation, torpidity of liver, gall bladder disorders, jaundice and dyspepsia. Bark is used in diseases of the eye.

Habitat: Native to Brazil; naturalized in many parts of India; grown in gardens of Maharashtra.

Action: Cardiac stimulant, laxative, emetic, expectorant, bechic, antiscorbutic, alterative. Used in ague, also in dyspepsia. Leaf— anticholerin, haemostatic.

Habitat: Smaller var., equated with E. thymifolia, is found in tropical plains and low hills of India, ascending to 1,750 m. Bigger var., E. pilulifera/E. hirta Linn. is found in warmer parts of India from Punjab eastwards, and southwards to Kanyakumari.

Action: Plant—antispasmodic, bronchodilator, antiasthmat- ic (used in bronchial asthma), galactagogue (also used for spermatorrhoea). Root—used in amenorrhoea. Latex—used in ringworm, dandruff. Leaf, seed and latex—purgative. A decoction of the plant, with honey, is given to treat haematuria.

Habitat: Native to Africa; naturalized in the warmer parts of India.

Action: Purgative, emetic, antiasthmatic, bechic. Used for whooping cough, asthma, dyspepsia, biliousness, jaundice, enlargement of spleen, leucorrhoea. Latex—applied externally on warts.

as the organ of the sense of taste, and as an organ provided with a delicate sense of touch; and

to play a part in the production of speech. (See VOICE AND SPEECH.) It is usual to classify any taste as: sweet, bitter,

salt and acid, since ?ner distinctions are largely dependent upon the sense of smell. The loss of keenness in taste brought about by a cold in the head, or even by holding the nose while swallowing, is well known. Sweet tastes seem to be best appreciated by the tip of the tongue, acids on its edges, and bitters at the back. There are probably di?erent nerve-?bres and end-organs for the di?erent varieties of taste. Many tastes depend upon the ordinary sensations of the tongue.

Like other sensations, taste can be very highly educated for a time, as in tea-tasters and wine-tasters, but this special adaptation is lost after some years.... functions the chief uses of the tongue are:

Habitat: Throughout greater parts of India.

Action: Astringent, antileucor- rhoeic, antirheumatic, alterative, restorative.

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: Throughout the greater part of India, up to 1,360 m

Action: Root—used as a remedy for indigestion in children. Fruits— used in affections of the mammary glands. Pounded pulp is applied to forehead in fever.

Habitat: Upper Gengetic plain, Bihar, Bengal, Central and Peninsular India.

Action: Bark—antidysenteric. Stem bark—semen coagulant. Plant— used in fractures.

Habitat: Watery and swampy places in Bihar and Orissa and in some parts of South India.

Action: See J. suffruticosa.

Habitat: Cultivated in many parts of India.

Action: Plant—antiseptic, hepato- protective, hypoglycaemic, nervine tonic. Used in enlargement of liver and spleen, skin diseases, leucoder- ma, burns, ulcers, piles, nervous disorders, epilepsy, asthma, lumbago, gout. Leaf—anti-inflammatory. Used in blennorrhagia. Root— diuretic. Used in hepatitis. Root and stem—laxative, expectorant, febrifuge, anticephalalgic, anti- tumour, anthelmintic, promote growth of hair.

Habitat: Native to Japan; grows in Indian gardens.

Action: Used for obstinate skin diseases.

Habitat: Native to North America; introduced into hill stations in India.

Action: Bark—antipyretic, diaphoretic; used in rheumatism, dyspepsia and as antimalarial.

Habitat: Native to Afghanistan and Western Tibet. Now cultivated as an ornamental.

Action: Plant—used in the form of an ointment for ulcers, oedematous and malignant tumours. Leaves— antimicrobial, antifungal.

Habitat: Deccan, Mysore southwards.

Action: Leaves—cooling, aperient; given for smallpox to children, bruised leaves applied to contusions.

Habitat: Peru, Bolivia. Reported to be imported into India.

Action: Astringent, styptic, antidiarrhoeal, vulnerary. Used for menorrhagia; topically for wounds, haemorrhoids and chilblains; as a lozenge, gargle or mouthwash for gingivitis and pharyngitis.

Habitat: Northwestern India, Gujarat, Rajasthan and South India.

Action: Root—febrifuge and antidermatosis. Also used for diabetes.

• Helps fight asthma in children.
• Prevents infections caused by viruses, fungi or bacteria.
• Provides relaxation.
• It can be gargled and used as a deodorizing mouthwash.
• Facilitates good digestion.
• Boosts your immune system.

• If you suffer from allergies, avoid drinking Lemon Thyme Tea.
• Do not drink Lemon Thyme Tea if you are pregnant or breastfeeding.
• Avoid over-consumption

Habitat: North-west Himalayas and Sikkim and from Bihar to central, western and southern India.

Action: Plant—bitter tonic. Used for rheumatic affections. (Raasnaa is equated with Pluchea lanceolata.)

Habitat: Native to China and Japan; cultivated in Indian gardens.

Action: Bulbs—used as a cardiac tonic. Flowers—used for ovarian neuralgia, also recommended in myoptic astigmia.

Action: Dried bulb scales— demulcent; used like salep in pectoral complaints.... lilium tigrinum

A localised (focal) form of liver disease in all tropical/subtropical countries results from invasive Entamoeba histolytica infection (amoebic liver ‘abscess’); serology and imaging techniques assist in diagnosis. Hydatidosis also causes localised liver disease; one or more cysts usually involve the right lobe of the liver. Serological tests and imaging techniques are of value in diagnosis. Whilst surgery formerly constituted the sole method of management, prolonged courses of albendazole and/or praziquantel have now been shown to be e?ective; however, surgical intervention is still required in some cases.

Hepato-biliary disease is also a problem in many tropical/subtropical countries. In southeast Asia, Clonorchis sinensis and Opisthorchis viverini infections cause chronic biliary-tract infection, complicated by adenocarcinoma of the biliary system. Praziquantel is e?ective chemotherapy before advanced disease ensues. Fasciola hepatica (the liver ?uke) is a further hepato-biliary helminthic infection; treatment is with bithionol or triclabendazole, praziquantel being relatively ine?ective.... liver disease in the tropics

Habitat: The Western Himalayas, Punjab and Upper Gangetic Plain.

Action: Sedative.

Behavioural therapy and cognitive therapy, often carried out by psychologists, attempt to clarify with the patient speci?c features of behaviour or mental outlook respectively, and to identify step-by-step methods that the patient can use for controlling the disorder. Behaviour therapy is commonly used for AGORAPHOBIA and other phobias, and cognitive therapy has been used for depression and anxiety. (See MENTAL ILLNESS.)... long-term supportive psychotherapy

Habitat: Himalayas from Kumaon to Assam, up to 1,500 m, Madhya Pradesh, Bihar, Deccan Peninsula.

Action: Root—purgative, antispas- modic, mild CNS depressant; used in colic.

Habitat: Native to Britain and Europe; found in Kashmir.

Action: Bitter tonic, deobstruent. Laxative in large doses. Used for diseases of liver and gallbladder, and rheumatism. (Contraindicated in diarrhoea, dysentery and colitis.)

Habitat: Upper Gangetic Plain, Bihar, Orissa, West Bengal, South India and Gujarat.

Action: Laxative, astringent, anti-inflammatory. Used in piles, swellings, rheumatic affections, stiffness of the joints, hemiplegia and urinary affections.

Habitat: Maharashtra and Tamil Nadu, in bushes along the banks of water courses. (It is not cultivated.)

Action: Tuberous root—emmena- gogue, abortifacient; acrid; contains a bitter glycoside.... momordica tuberosa

Depression, giddiness, nausea and vomiting are the most prominent.

Causes Although the vast majority of people appear to be liable to this ailment at sea, they do not all suffer alike. Many endure acute distress, whilst others are simply conscious of transient feelings of nausea and discomfort. A smaller proportion of people suffer from air and car sickness. The symptoms are a result of over-stimulation of the organs of balance in the inner EAR by continuous changes in the body’s position. The movements of the horizon worsen this situation.

Symptoms The symptoms generally show themselves soon after the journey has started, by the onset of giddiness and discomfort in the head, together with a sense of nausea and sinking at the stomach, which soon develops into intense sickness and vomiting. Most people recover quickly when the motion stops.

Treatment Innumerable preventives and remedies have been proposed. Cinnarizine 30 mg orally is useful 2 hours before travel, then 15 mg every 8 hours during the journey if necessary. Dimenhydrinate and promethazine are also commonly taken for motion sickness.... motion (travel) sickness

Habitat: All over Europe. Grown in Indian gardens.

Action: Bulbs—powerfully emetic, diuretic, purgative. Poisonous. Oil is applied for curing baldness.

II. Optic, to the eye (sight).

III. Oculomotor

Trochlear, to eye-muscles.

Abducent

VI. Trigeminal, to skin of face.

VII. Facial, to muscles of face.

VIII. Vestibulocochlear, to ear (hearing and balancing).

IX. Glossopharyngeal, to tongue (taste).

X. Vagus, to heart, larynx, lungs, and stomach.

XI. Spinal accessory, to muscles in neck.

XII. Hypoglossal, to muscles of tongue.... nerves twelve nerves come off the brain:

The symptoms depend upon the site of the infection. General symptoms such as fever, weight loss and night sweats are common. In the most common form of pulmonary tuberculosis, cough and blood-stained sputum (haemoptysis) are common symptoms.

The route of infection is most often by inhalation, although it can be by ingestion of products such as infected milk. The results of contact depend upon the extent of the exposure and the susceptibility of the individual. Around 30 per cent of those closely exposed to the organism will be infected, but most will contain the infection with no signi?cant clinical illness and only a minority will go on to develop clinical disease. Around 5 per cent of those infected will develop post-primary disease over the next two or three years. The rest are at risk of reactivation of the disease later, particularly if their resistance is reduced by associated disease, poor nutrition or immunosuppression. In developed countries around 5 per cent of those infected will reactivate their healed tuberculosis into a clinical problem.

Immunosuppressed patients such as those infected with HIV are at much greater risk of developing clinical tuberculosis on primary contact or from reactivation. This is a particular problem in many developing countries, where there is a high incidence of both HIV and tuberculosis.

Diagnosis This depends upon identi?cation of mycobacteria on direct staining of sputum or other secretions or tissue, and upon culture of the organism. Culture takes 4–6 weeks but is necessary for di?erentiation from other non-tuberculous mycobacteria and for drug-sensitivity testing. Newer techniques involving DNA ampli?cation by polymerase chain reaction (PCR) can detect small numbers of organisms and help with earlier diagnosis.

Treatment This can be preventative or curative. Important elements of prevention are adequate nutrition and social conditions, BCG vaccination (see IMMUNISATION), an adequate public-health programme for contact tracing, and chemoprophylaxis. Radiological screening with mass miniature radiography is no longer used.

Vaccination with an attenuated organism (BCG – Bacillus Calmette Guerin) is used in the United Kingdom and some other countries at 12–13 years, or earlier in high-risk groups. Some studies show 80 per cent protection against tuberculosis for ten years after vaccination.

Cases of open tuberculosis need to be identi?ed; their close contacts should be reviewed for evidence of disease. Adequate antibiotic chemotherapy removes the infective risk after around two weeks of treatment. Chemoprophylaxis – the use of antituberculous therapy in those without clinical disease – may be used in contacts who develop a strong reaction on tuberculin skin testing or those at high risk because of associated disease.

The major principles of antibiotic chemotherapy for tuberculosis are that a combination of drugs needs to be used, and that treatment needs to be continued for a prolonged period – usually six months. Use of single agents or interrupted courses leads to the development of drug resistance. Serious outbreaks of multiply resistant Mycobacterium tuberculosis have been seen mainly in AIDS units, where patients have greater susceptibility to the disease, but also in developing countries where maintenance of appropriate antibacterial therapy for six months or more can be di?cult.

Streptomycin was the ?rst useful agent identi?ed in 1944. The four drugs used most often now are RIFAMPICIN, ISONIAZID, PYRAZINAMIDE and ETHAMBUTOL. Three to four agents are used for the ?rst two months; then, when sensitivities are known and clinical response observed, two drugs, most often rifampicin and isoniazid, are continued for the rest of the course. Treatment is taken daily, although thrice-weekly, directly observed therapy is used when there is doubt about the patient’s compliance. All the antituberculous agents have a range of adverse effects that need to be monitored during treatment. Provided that the treatment is prescribed and taken appropriately, response to treatment is very good with cure of disease and very low relapse rates.... nature of the disease tuberculosis has

Habitat: Native to tropical America; cultivated mainly in Andhra Pradesh, Maharashtra, Karnataka, Uttar Pradesh, West Bengal.

Action: Leaves—decoction is locally applied for muscle relaxation in dislocation, strangulated hernia and orchitis. Also for arthralgia, lumbago, rheumatism and gout (an ointment is made by simmering the leaves in lard). Not used internally as a medicine.

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)

Habitat: Outer Himalaya, Assam, West Bengal; cultivated in many parts of India.

Action: Leaves—bitter tonic, chola- gogue, febrifuge, anti-inflammatory, antispasmodic, hypotensive, respiratory stimulant. Used for fevers, rheumatism, obstinate sciatica.

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).

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: Native to West Indies; cultivated as an ornamental.

Action: Latex—used for warts, leucoderma, venereal diseases. Root—emetic (used in West Indies as Ipecacuanha).

Habitat: Sikkim, Bengal, Manipur, Khasi and Jaintia hills.

Action: Root—(macerated in water) diuretic.... piper thomsoni

– may be dried and in powder form kept almost inde?nitely; when wanted it is reconstituted by adding sterile distilled water. In powder form it can be transported easily and over long distances. Transfusion of plasma is especially useful in the treatment of SHOCK. One advantage of plasma transfusion is that it is not necessary to carry out testing of blood groups before using it.... plasma transfusion

Habitat: Throughout India, up to an elevation of 2,100 m in the northeast.

Action: Whole plant—febrifuge. Leaves—sedative, cooling, an- tibilious. A decoction is used in intermittent fever. The plant contains friedelin, epifriedelin, stigmasterol and tannins. The bean contains methionine, tryptophan and tyrosine; also strepogenin, uridine, diphosphate-galacturonic acid. The seed protein contained lysine, valine, leucine and phenyl- alanine.

Habitat: The sub-tropical Himalayas, Upper Gangetic Plain, Bihar, North Bengal and Assam.

Action: Whole plant—used like Adhatoda vasica in whooping cough and menorrhagia. Fruits and leaves—burnt and prescribed for fevers. The leaves are reported to contain diterpene lactone, phlogantholide A and its glucoside.

Habitat: Native to Mexico; cultivated for ornamental use.

Action: Flowers and bulbs— diuretic. Externally used for skin eruptions. The bulbs are rubbed with turmeric and butter and applied over red pimples of infants. The bulbs are reported to contain an alkaloid, lycorin, which causes vomiting.

Habitat: Peninsular India, near sea-coasts.

Action: Leaves—an infusion is given internally in dysuria; externally applied to erysipelas. The herb shows diuretic, calculolythic, analgesic and antipyretic properties.

Habitat: Peninsular India and Bihar up to 1,200 m.

Action: Bark and essential oil of root—used in stomach disorders. Leaf—diuretic, vulnerary; prescribed as a tonic after child birth; used in dropsical affections. Pounded leaves—vulnerary.

Habitat: Punjab, Western Uttar Pradesh, Central India.

Action: Tuber—diuretic, cardiac tonic, galactagogue. Also used for fertility control. Root—used as a demulcent, and refrigerant in fevers, as cataplasm for swelling of joints, as galactagogue.

Habitat: Kashmir to Sikkim.

Action: Herb—used in intermittent fevers, rheumatism and asthma.

Habitat: Abundant in moist and warm regions of West Bengal, particularly in 24 Parganas and Howrah, and Kerala (as a weed).

Action: Root—sedative, hypotensive. Plant juice, mixed with castor oil, is applied to skin diseases and to destroy parasites.

Habitat: The Himalayas from Kashmir to Sikkim; commonly grown in gardens.

Action: Plant—used for the treatment of paralysis in Bihar. The crushed leaves and stems are applied to wounds infested with maggots.... rauvolfia tetraphylla

In 1997 the Royal College of Psychiatrists in the UK produced a comprehensive report which was sceptical about the notion that the awareness of recurrent severe sexual abuse in children could be pushed entirely out of consciousness. The authors did not believe that events could remain inaccessible to conscious memory for decades, allegedly provoking vague non-speci?c symptoms to be recovered during psychotherapy with resolution of the symptoms. Supporting evidence pointed to the lack of any empirical proof that unconscious dissociation of unpleasant memories from conscious awareness occurred to protect the individual. Furthermore, experimental and natural events had shown that false memories, created through suggestion or in?uence, could be implanted. Many individuals who had claimed to have recovered memories of abuse subsequently withdrew and, often, non-speci?c symptoms allegedly linked to suppression worsened rather than improved as therapy to unlock memories proceeded. The conclusion is that recovered memory therapy should be viewed with great caution.... repressed memory therapy

Habitat: China.

Action: Aperient, stomachic, astringent, tonic.

Habitat: Native to Southern Europe and parts of Asia; also found in Kashmir.

Action: Root—used for menstrual and urinary disorders and liver diseases.

Habitat: Native to central America; grown in Indian gardens.

Action: Herb—emetic; used as a substitute for ipecacuanha. A decoction is given in chronic bronchitis; also used as a diuretic for the treatment of stones in the bladder.... ruellia tuberosa

Habitat: Hills of Assam, in damp places and in the Andamans.

Action: Leaf—carminative, eaten to relieve flatulence and stomachache. A poultice is used after parturition.... saprosma ternatum

Habitat: Marshy areas and on the banks of streams up to an altitude of 3,000 m.

Action: Tuberous root—astringent, diuretic, laxative.

Habitat: Throughout the plains of India.

Action: Plant—discutient, anti- galactagogue, astringent, antiinflammatory. Tuber—used for cutaneous diseases. Leaves—powder dusted in pruritus; mashed with molasses used in sore throat and inflammation of the breasts.

Habitat: Throughout the greater part of India, along the banks of rivers and streams.

Action: Dried leaves—antiinflammatory, given in rheumatism, swellings, piles. Bark—febrifuge.

Habitat: The Himalayas from Kashmir to Nepal at altitudes of 1,800-4,200 m.

Action: Roots—sedative, analgesic.

Habitat: Nilgiris, as ornament. (A common garden plant in Britain and Europe.)

Action: Leaves—refrigerant, astringent, antispasmodic; applied as poultice to inflammatory conditions of skin. Juice of the leaves is applied topically for treating corns.

The incidence of STDs rose sharply during World War II but the advent of PENICILLIN and subsequent antibiotics meant that syphilis and gonorrhoea could be treated e?ectively. The arrival of oral contraception and more tolerant public attitudes to sexual activities resulted in an increase in the incidence of sexually transmitted infections. The diagnosis of NONSPECIFIC URETHRITIS (NSU), once given to many patients whose symptoms were not due to the traditional recognised infections, was in the 1970s realised to be wrong, as the condition was proved to be the result of infection by chlamydia.

Most STDs are treatable, but herpes is an infection that could become chronic, while hepatitis B and, of course, AIDS/HIV are potentially fatal – although treatment of HIV is now proving more e?ective. As well as the treatment and subsequent monitoring of patients with STDs, one of the important functions of clinics has been the tracing, treatment and follow-up of sexual contacts of infected individuals, a procedure that is conducted con?dentially.

Apart from AIDS/HIV, the incidence of STDs fell during the 1980s; however in some countries the agents causing syphilis and gonorrhoea began to develop resistance to antibiotics, which showed the continued importance of practising safe sex – in particular by restricting the number of sexual partners and ensuring the regular use of condoms. In the United Kingdom the rates per million of the male population infected by syphilis rose from 8.8 in 1991 to 9.7 in 1999; in females the ?gures were 4.0 to 4.5, respectively. For gonorrhoea, the ?gures for men were 399.4 in 1991 and 385 in 1999, with women also showing a reduction, from

216.5 to 171.3. In 1991, 552.6 per million of men had chlamydia, a ?gure which rose to

829.5 in 1999; for women in the same period the incidence also rose, from 622.5 to 1,077.1 per million. For genital herpes simplex virus, the infection rate for men fell from 236.6 per million to 227.7, whereas the ?gures for women showed a rise, 258.5 to 357. The incidence of AIDS/HIV is given under the relevant entry. (These ?gures are based on information in United Kingdom Health Statistics, 2001 edition, UKHSI, published by the O?ce of National Statistics.)... sexually transmitted diseases (stds)

Habitat: Throughout tropical parts of India, in waste places.

Action: Plant—digestive, diuretic, sedative. Leaves—haemostatic. Fruits—useful in liver and spleen enlargement (cooked and eaten as a vegetable); decoction used for cough. Root—used for poulticing cracks in feet.

Habitat: Deccan Peninsula.

Action: Berries and flowers—a decoction is used for cough and chronic bronchitis.

Habitat: Native to South America; grown almost throughout India.

Action: Potatoes are consumed as food. Extract of leaves is used as antispasmodic in cough. Potato juice is given as an adjuvant in the treatment of peptic ulcer for bringing relief from pain and acidity. Starch and very small quantities of atropine alkaloids reduce digestive secretions and stomach acids. Potatoes are good for patients suffering from hyperacidity; boiled potatoes make an excellent diet for those having hypertension.... solanum tuberosum

Habitat: Grown in gardens for its bright-yellow flowers.

Action: Seeds—dangerously emetocatharitc, toxic, febrifugal, stomachic. Seeds yield a fatty oil with expectorant properties. Decoction of seeds and roots is given in bilious disorders. Leaves— emetocathartic.

Tariq, Taarique, Tarique... taariq

Tabban, Tabann, Tabanne, Tabana, Tabanna... taban

Habitat: Sub-Himalayan tract. Cultivated in gardens.

Action: Leaves—milky juice, antiinflammatory; applied to wounds. Flowers—mixed with oil, used in skin diseases. Root—acrid, anodyne; relieves toothache, also used as a vermicide.

Habitat: Western Ghats at low elevations.

Action: Seed, leaves, bark— purgative. Latex—cathartic.

Tablitah, Tableta, Tableeta, Tablyta, Tableyta, Tableata... tablita

Taborrie, Taborry, Taborrey, Taborree, Tabori, Taborie, Tabory, Taborey, Taboree, Taborea... taborri

Synonym: T. leontopetaloides (Linn.) Kuntze.

Habitat: Native to Mexico; cultivated in gardens all over India.... tacca pinnatifida

Habitat: Aka hills in Arunachal Pradesh.

Action: Tuber—nutritive and digestive; applied to haemorrhagic diathesis, cachexia, leprosy and other cutaneous affections.

Habitat: Entire Deccan Peninsula, extending into Madhya Pradesh and Bihar.

Action: Tuber—acrid, astringent, carminative, anthelmintic. Used in the treatment of piles, haemophilic conditions, internal abscesses, colic, enlargement of spleen, vomiting, asthma, bronchitis, elephantiasis and intestinal worms.

Tacincalah, Tacyncala, Tacyncalah, Tacincalla, Tacyncalla... tacincala

Tacitah, Taceta, Tacyta, Taycita, Taycyta, Tasita, Tacey, Taci, Tacie, Tacy, Tacee, Tacea, Taicey, Taici, Taicie, Taicee, Taicy, Taicea, Taycey, Taycy, Tayci, Taycie, Taycee, Taycea... tacita

Taditah, Tadeta, Tadyta, Taditta, Tadetta, Tadytta, Tadeeta, Tadeata... tadita