See DELIRIUM; ECSTASY; HYSTERIA; MENTAL ILLNESS.
The speciality of anaesthesia broadly covers its provision for SURGERY, intensive therapy (intensive care), chronic pain management, acute pain management and obstetric analgesia. Anaesthetists in Britain are trained specialists with a medical degree, but in many countries some anaesthetists may be nurse practitioners working under the supervision of a medical anaesthetist.
The anaesthetist will assess the patient’s ?tness for anaesthesia, choose and perform the appropriate type of anaesthetic while monitoring and caring for the patient’s well-being, and, after the anaesthetic, supervise recovery and the provision of post-operative pain relief.
Anaesthesia may be broadly divided into general and local anaesthesia. Quite commonly the two are combined to allow continued relief of pain at the operation site after the patient awakens.
General anaesthesia is most often produced by using a combination of drugs to induce a state of reversible UNCONSCIOUSNESS. ‘Balanced’ anaesthesia uses a combination of drugs to provide unconsciousness, analgesia, and a greater or lesser degree of muscle relaxation.
A general anaesthetic comprises induction, maintenance and recovery. Historically, anaesthesia has been divided into four stages (see below), but these are only clearly seen during induction and maintenance of anaesthesia using inhalational agents alone.
(1) Onset of induction to unconsciousness
(2) Stage of excitement
(3) Surgical anaesthesia
(4) Overdosage
Induction involves the initial production of unconsciousness. Most often this is by INTRAVENOUS injection of a short-acting anaesthetic agent such as PROPOFOL, THIOPENTONE or ETOMIDATE, often accompanied by additional drugs such as ANALGESICS to smooth the process. Alternatively an inhalational technique may be used.
Maintenance of anaesthesia may be provided by continuous or intermittent use of intravenous drugs, but is commonly provided by administration of OXYGEN and NITROUS OXIDE or air containing a volatile anaesthetic agent. Anaesthetic machines are capable of providing a constant concentration of these, and have fail-safe mechanisms and monitors which guard against the patient’s receiving a gas mixture with inadequate oxygen (see HYPOXIC). The gases are adminstered to the patient via a breathing circuit either through a mask, a laryngeal mask or via ENDOTRACHEAL INTUBATION. In recent years, concerns about side-effects and pollution caused by volatile agents have led to increased popularity of total intravenous anaesthesia (TIVA).
For some types of surgery the patient is paralysed using muscle relaxants and then arti?cially ventilated by machine (see VENTILATOR). Patients are closely monitored during anaesthesia by the anaesthetist using a variety of devices. Minimal monitoring includes ELECTROCARDIOGRAM (ECG), blood pressure, PULSE OXIMETRY, inspired oxygen and end-tidal carbon-dioxide concentration – the amount of carbon dioxide breathed out when the lungs are at the ‘empty’ stage of the breathing cycle. Analgesic drugs (pain relievers) and local or regional anaesthetic blocks are often given to supplement general anaesthesia.
Volatile anaesthetics are either halogenated hydrocarbons (see HALOTHANE) or halogenated ethers (iso?urane, en?urane, des?urane and sevo?urane). The latter two are the most recently introduced agents, and produce the most rapid induction and recovery – though on a worldwide basis halothane, ether and chloroform are still widely used.
Despite several theories, the mode of action of these agents is not fully understood. Their e?cacy is related to how well they dissolve into the LIPID substances in nerve cells, and it is thought that they act at more than one site within brain cells – probably at the cell membrane. By whatever method, they reversibly depress the conduction of impulses within the CENTRAL NERVOUS SYSTEM and thereby produce unconsciousness.
At the end of surgery any muscle relaxant still in the patient’s body is reversed, the volatile agent is turned o? and the patient breathes oxygen or oxygen-enriched air. This is the reversal or recovery phase of anaesthesia. Once the anaesthetist is satis?ed with the degree of recovery, patients are transferred to a recovery area within the operating-theatre complex where they are cared for by specialist sta?, under the supervision of an anaesthetist, until they are ready to return to the ward. (See also ARTIFICIAL VENTILATION OF THE LUNGS.) Local anaesthetics are drugs which reversibly block the conduction of impulses in nerves. They therefore produce anaesthesia (and muscle relaxation) only in those areas of the body served by the nerve(s) affected by these drugs. Many drugs have some local anaesthetic action but the drugs used speci?cally for this purpose are all amide or ester derivatives of aromatic acids. Variations in the basic structure produce drugs with di?erent speeds of onset, duration of action and preferential SENSORY rather than MOTOR blockade (stopping the activity in the sensory or motor nerves respectively).
The use of local rather than general anaesthesia will depend on the type of surgery and in some cases the unsuitability of the patient for general anaesthesia. It is also used to supplement general anaesthesia, relieve pain in labour (see under PREGNANCY AND LABOUR) and in the treatment of pain in persons not undergoing surgery. Several commonly used techniques are listed below:
LOCAL INFILTRATION An area of anaesthetised skin or tissue is produced by injecting local anaesthetic around it. This technique is used for removing small super?cial lesions or anaesthetising surgical incisions.
NERVE BLOCKS Local anaesthetic is injected close to a nerve or nerve plexus, often using a peripheral nerve stimulator to identify the correct point. The anaesthetic di?uses into the nerve, blocking it and producing anaesthesia in the area supplied by it.
SPINAL ANAESTHESIA Small volumes of local anaesthetic are injected into the cerebrospinal ?uid through a small-bore needle which has been inserted through the tissues of the back and the dura mater (the outer membrane surrounding the spinal cord). A dense motor and sensory blockade is produced in the lower half of the body. How high up in the body it reaches is dependent on the volume and dose of anaesthetic, the patient’s position and individual variation. If the block is too high, then respiratory-muscle paralysis and therefore respiratory arrest may occur. HYPOTENSION (low blood pressure) may occur because of peripheral vasodilation caused by sympathetic-nerve blockade. Occasionally spinal anaesthesia is complicated by a headache, perhaps caused by continuing leakage of cerebrospinal ?uid from the dural puncture point.
EPIDURAL ANAESTHESIA Spinal nerves are blocked in the epidural space with local anaesthetic injected through a ?ne plastic tube (catheter) which is introduced into the space using a special needle (Tuohy needle). It can be used as a continuous technique either by intermittent injections, an infusion or by patient-controlled pump. This makes it ideal for surgery in the lower part of the body, the relief of pain in labour and for post-operative analgesia. Complications include hypotension, spinal headache (less than 1:100), poor e?cacy, nerve damage (1:12,000) and spinal-cord compression from CLOT or ABSCESS (extremely rare).... anaesthesia
Habitat: Native to Malaysia; cultivated throughout the country.
English: Bilimbi, Tree Sorrel.Ayurvedic: Karmaranga (var.).Unani: Belambu (a variety of Kamrakh).Siddha/Tamil: Pilimbi, Pulichakkai.Action: A syrup made from the fruits is used in febrile excitement, haemorrhages and internal haemorrhoids; also in diarrhoea, bilious colic and hepatitis. The fruit is used for scurvy. An infusion of flowers is given for cough.... averrhoa bilimbi
Habitat: Subtropical Himalayas, Nepal, Sikkim, Assam and Khasi Hills at 700-1,350 m.
English: Ngai Camphor.Ayurvedic: Kukundara, Gangaapa- tri.Unani: Kakarondaa.Action: Tranquilizer (used in excitement and insomnia), expectorant, sudorific. Given in intestinal diseases, colic, diarrhoea. Essential oil from leaves—hypotensive.
The plant is a source of Ngai or Blumea Camphor. Camphor occurs in all parts of the plant, but is generally extracted from leaves. Ngai Camphor oil consists almost entirely of l-borneol. It is redistilled to obtain the refined camphor for use in medicine.The dried leaves contain sesquiter- pene lactones. These lactones exhibit antitumour activity against Yoshida sacoma cells in tissue culture.The plant exhibits moderate antibacterial activity against E. coli.... blumea balsamiferaHabitat: Cultivated all over the country. Commonly occurs in waste grounds, along road side, often becoming gregarious along the irrigation channels of gardens.
English: Hemp, Indian Hemp.Ayurvedic: Vijayaa, Bhangaa, Maadani, Maatulaani, Indraasana, Trailokya-vijayaa, Tribhuvana- vijayaa, Shukranaashana, Ganjaa, Bhangaa. (Bhangaa is consumed orally; Ganjaa and charas are usually smoked.)Unani: Bhang, Charas, Qinnab.Siddha/Tamil: Ganja.Folk: Bhaanga.Action: Hallucinogenic, hypnotic, sedative, analgesic, anti- inflammatory, Hemp derivatives are suggested for treating glaucoma and as an antiemetic in cancer chemotherapy. All variants produce initial excitement followed by depression.
Cannabis yields 421 chemicals of various classes—cannabinoids, canna- bispirans and alkaloids. More than 60 cannabinoids have been isolated, the most important one is delta-9- tetrahydrocannabinol (THC).Toxic constituents are readily absorbed, excreted in urine and feces, stored in lipid tissues, especially CNS, crosses placenta. High doses in animals have damaged developing embryos and resulted in birth defects. (Francis Brinker.)Dosage: Dried leaves, after removing turbity—125-250 mg powder. (API Vol. I.)... cannabis sativaThe 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
Orbelinah, Orbeleena, Orbeleenah, Orbeleana, Orbeleanah, Orbelyna, Orbelynah, Orbie, Orbi, Orby, Orbey, Orbee, Orbea... orbelina
Uses: Delayed menses. Nervous excitement from menstrual disorders. Preparations: Thrice daily.
Tea: 1 teaspoon to each cup boiling water; infuse 15 minutes. Dose: Half a cup. Liquid Extracts: 30-60 drops in water. ... arrach
Keynote: fevers (early stages).
Action: febrifuge, diaphoretic, relaxant.
Uses: Once used widely in North American medicine for fevers, the rational being to induce a heavy sweat to reduce a high body temperature and relieve arterial excitement. Pleurisy. Typhoid fever. Preparations. Tea. Not given in this form, losing its strength on application of heat.
Tablets/capsules. 200mg. Two, every two hours, acute cases. Tincture. 30-60 drops. ... crawley root
Habitat: Native to Europe and Asia. Occurs in the temperate Himalayas from Kashmir to Garhwal.
English: Indian Henbane, Black Henbane.Ayurvedic: Paarsika-yavaani, Yavaani, Madkaarini, Turushkaa, Khuraashaanikaa, Khuraasaani Ajwaayin.Unani: Barz-ul-Banj, Khuraasaani Ajwaayin.Siddha/Tamil: Paarseekayavani, Khurasani Omam.Action: Sedative. Narcotic drug. Used for convulsions. Action similar to Belladonna.
Key application: In spasms of gastrointestinal tract. (German Commission E, The British Herbal Pharmacopoeia.)The leaves and flowering tops contain tropane alkaloids, 0.045-00.14%, the principal ones being hyoscyamine and hyoscine. The alkaloids are para- sympatholytic, with similar actions to Belladonna, although with less cerebral excitement.The seeds show inhibitory activity against digestive enzyme, lipase in vitro.Contraindicated in tachycardias, prostatic hyperplasia, narrow-angle glaucoma, acute pulmonary oedema, stenosis of gastrointestinal tract, maga colon.Dosage: Seed—3-5 g powder. (CCRAS.)... hyoscyamus nigerHabitat: United States of America.
Features ? Flower supposed to resemble a lady's shoe in form. Rhizome about quarter- inch diameter, many cupshaped scars on top surface; wavy, thickly-matted roots underneath. Fracture short and white.Part used ? Rhizome.Action: Antispasmodic, tonic, nervine.
Combined with other tonics in the relief of neuralgia, and to allay paingenerally. Of use in hysteria and other nervous disorders. Dose, 1 drachm of the powdered rhizome. Like other medicines of a similar nature, it is of little use unless the cause of the nervous excitement is traced and removed.The remarks of Rafinesque, then Professor of Medical Botany in the University of Transylvania, are interesting in view of the "orthodox" attitude towards remedies of the herbalists ? "I am enabled to introduce, for the first time, this beautiful genus into our materia medica ; all the species are equally remedial. They have long been known to the Indians, who called them moccasin flower, and were used by the empyrics of New England, particularly Samuel Thomson. Their properties, however, have been tested and confirmed by Dr. Hales, of Troy; Dr. Tully, of Albany, etc.. . . They produce beneficial effects in all nervous diseases and hysterical affections by allaying pain, quieting the nerves and promoting sleep. They are preferable to opium in many cases, having no baneful or narcotic effect."Professor Rafinesque, however, goes even further than would Thomson and his successors when he announces that "all the species are equally remedial."... ladies' slipperIt usually begins at puberty – although young children can be affected – and tends to stop in middle age: in women, for example, attacks often cease after MENOPAUSE. It frequently disappears during pregnancy. The disorder tends to run in families. In susceptible individuals, attacks may be provoked by a wide variety of causes including: anxiety, emotion, depression, shock, and excitement; physical and mental fatigue; prolonged focusing on computer, television or cinema screens; noise, especially loud and high-pitched sounds; certain foods – such as chocolate, cheese, citrus fruits, pastry; alcohol; prolonged lack of food; irregular meals; menstruation and the pre-menstrual period.
Anything that can provoke a headache in the ordinary individual can probably precipitate an attack in a migrainous subject. It seems as if there is an inherited predispostion that triggers a mechanism whereby in the migrainous subject, the headache and the associated sickness persist for hours, a whole day or even longer.
The precise cause is not known, but the generally accepted view is that in susceptible individuals, one or other of these causes produces spasm or constriction of the blood vessels of the brain. This in turn is followed by dilatation of these blood vessels which also become more permeable and so allow ?uid to pass out into the surrounding tissues. This combination of dilatation and outpouring of ?uid is held to be responsible for the headache.
Two types of migraine have been recognised: classical and common. The former is relatively rare and the headache is preceded by a slowly extending area of blindness in one or both eyes, usually accompanied by intermittent ‘lights’. The phenomenon lasts for up to 30 minutes and is followed by a bad, often unilateral headache with nausea, sometimes vomiting and sensitivity to light. Occasionally, passing neurological symptoms such as weakness in a limb may accompany the attack. The common variety has similar but less severe symptoms. It consists of an intense headache, usually situated over one or other eye. The headache is usually preceded by a feeling of sickness and disturbance of sight. In 15–20 per cent of cases this disturbance of sight takes the form of bright lights: the so-called AURA of migraine. The majority of attacks are accompanied by vomiting. The duration of the headache varies, but in the more severe cases the victim is usually con?ned to bed for 24 hours.
Treatment consists, in the ?rst place, of trying to avoid any precipitating factor. Patients must ?nd out which drug, or drugs, give them most relief, and they must always carry these about with them wherever they go. This is because it is a not uncommon experience to be aware of an attack coming on and to ?nd that there is a critical quarter of an hour or so during which the tablets are e?ective. If not taken within this period, they may be ine?ective and the unfortunate victim ?nds him or herself prostrate with headache and vomiting. In addition, sufferers should immediately lie down; at this stage a few hours’ rest may prevent the development of a full attack.
When an attack is fully developed, rest in bed in a quiet, darkened room is essential; any loud noise or bright light intensi?es the headache or sickness. The less food that is taken during an attack the better, provided that the individual drinks as much ?uid as he or she wants. Group therapy, in which groups of around ten migrainous subjects learn how to relax, is often of help in more severe cases, whilst in others the injection of a local anaesthetic into tender spots in the scalp reduces the number of attacks. Drug treatment can be e?ective and those a?icted by migraine may ?nd a particular drug or combination of drugs more suitable than others. ANALGESICS such as PARACETAMOL, aspirin and CODEINE phosphate sometimes help. A combination of buclizine hydrochloride and analgesics, taken when the visual aura occurs, prevents or diminishes the severity of an attack in some people. A commonly used remedy for the condition is ergotamine tartrate, which causes the dilated blood vessels to contract, but this must only be taken under medical supervision. In many cases METOCLOPRAMIDE (an antiemetic), followed ten minutes later by three tablets of either aspirin or paracetamol, is e?ective if taken early in an attack. In milder attacks, aspirin, with or without codeine and paracetamol, may be of value. SUMATRIPTAN (5-hydroxytryptamine [5HT1] AGONIST – also known as a SEROTONIN agonist) is of value for acute attacks. It is used orally or by subcutaneous injection, but should not be used for patients with ischaemic heart disease. Naratriptan is another 5HT1 agonist that is an e?ective treatment for acute attacks; others are almotriptan, rizariptan and zolmitriptan. Some patients ?nd beta blockers such as propranolol a valuable prophylactic.
People with migraine and their relatives can obtain help and guidance from the Migraine Action Association.... migraine
An excessive accumulation of monoamines can induce a dangerous reaction characterised by high blood pressure, palpitations, sweating and a feeling of su?ocation. Hence the care with which MAOI drugs are administered. What is equally important, however, is that in no circumstances should a patient receiving any MAOI drug eat cheese, yeast preparations such as Marmite, tinned ?sh, or high game. The reason for this ban is that all these foodstu?s contain large amounts of tyramine which increases the amount of certain monoamines such as noradrenaline in the body. (See MENTAL ILLNESS.)
There are also certain drugs, such as AMPHETAMINES and PETHIDINE HYDROCHLORIDE, which must not be taken by a patient who is receiving an MAOI drug. The MAOIs of choice are phenelzine or isocarboxazid because their stimulant effects are less than those of other MAOIs, making them safer.... monoamine oxidase inhibitors (maois)
The nervous system can be likened to a computer. The central processing unit – which receives, processes and stores information and initiates instructions for bodily activities – is called the central nervous system: this is made up of the brain and SPINAL CORD. The peripheral nervous system – synonymous with the cables that transmit information to and from a computer’s processing unit – has two parts: sensory and motor. The former collects information from the body’s many sense organs. These respond to touch, temperature, pain, position, smells, sounds and visual images and the information is signalled to the brain via the sensory nerves. When information has been processed centrally, the brain and spinal cord send instructions for action via motor nerves to the ‘voluntary’ muscles controlling movements and speech, to the ‘involuntary’ muscles that operate the internal organs such as the heart and intestines, and to the various glands, including the sweat glands in the skin. (Details of the 12 pairs of cranial nerves and the 31 pairs of nerves emanating from the spinal cord are given in respective texts on brain and spinal cord.)
Functional divisions of nervous system As well as the nervous system’s anatomical divisions, the system is divided functionally, into autonomic and somatic parts. The autonomic nervous system, which is split into sympathetic and parasympathetic divisions, deals with the automatic or unconscious control of internal bodily activities such as heartbeat, muscular status of blood vessels, digestion and glandular functions. The somatic system is responsible for the skeletal (voluntary) muscles (see MUSCLE) which carry out intended movements initiated by the brain – for example, the activation of limbs, tongue, vocal cords (speech), anal muscles (defaecation), urethral sphincters (urination) or vaginal muscles (childbirth). In addition, many survival responses – the most powerfully instinctive animal drives, which range from avoiding danger and pain to shivering when cold or sweating when hot – are initiated unconsciously and automatically by the nervous system using the appropriate neural pathways to achieve the particular survival reaction required.
The complex functions of the nervous system include the ability to experience emotions, such as excitement and pleasure, anxiety and frustration, and to undertake intellectual activities. For these experiences an individual can utilise many built-in neurological programmes and he or she can enhance performance through learning – a vital human function that depends on MEMORY, a three stage-process in the brain of registration, storage and recall. The various anatomical and functional divisions of the nervous system that have been unravelled as science has strived to explain how it works may seem confusing. In practical terms, the nervous system works mainly by using automatic or relex reactions (see REFLEX ACTION) to various stimuli (described above), supplemented by voluntary actions triggered by the activity of the conscious (higher) areas of the brain. Some higher functions crucial to human activity – for example, visual perception, thought, memory and speech – are complex and subtle, and the mechanisms are not yet fully understood. But all these complex activities rest on the foundation of relatively simple electrochemical transmissions of impulses through the massive network of billions of specialised cells, the neurones.... nervous system
The importation into Britain of opium is strictly regulated under the Dangerous Drugs Acts. Similar regulations govern the sale and distribution of any preparation of morphine or diamorphine (heroin) stronger than 1 part in
500. (See DEPENDENCE.)
Action The action of opium varies considerably, according to the source of the drug and the preparation used.
In small doses, opium produces a state of gentle excitement, the person ?nding their imagination more vivid, their thoughts more brilliant, and their power of expression greater than usual. This stage lasts for some hours, and is succeeded by languor. In medicinal doses this stage of excitement is short and is followed by deep sleep. When potentially poisonous doses are taken, sleep comes on quickly, and passes into coma and death (see OPIOID POISONING). The habitual use of opium produces great TOLERANCE, so that opium users require to take large quantities daily before experiencing its pleasurable effects. The need for opium also confers tolerance, so that people suffering great pain may take, with apparently little e?ect beyond dulling the pain, quantities which at another time would be dangerous.... opium
The clinical picture is characterised by TREMOR, rigidity and poverty of spontaneous movements. The loss of natural play of expression in the face produces a mask-like expression. Rigidity of the larynx, tongue and lips produces a ?at, expressionless voice. The most common symptom is tremor, often affecting one hand, spreading to the leg on the same side, then to the other limbs. It is more pronounced in resting limbs and is exaggerated by excitement, stopping during sleep. It may interfere with eating and dressing. Limb rigidity leads to an increasing tendency to stoop. The patient has a shu?ing walk with a peculiar running gait.
Treatment Several drugs are used to keep the condition under control. None is curative, all have side-effects, and ?nding the most suitable one for any individual depends largely on understanding cooperation between family doctor and patient. Dopaminergic and antimuscarinic (see ANTIMUSCARINE) drugs are used in treatment. Levodopa, a precursor of dopamine, is a long-used example of the former; it produces spectacular improvement in one-?fth and moderate improvement in two-?fths of patients. Benzhexol hydrochloride is one of several antimuscarinic drugs used in Parkinson’s disease; selegiline is a monoamine-oxidase inhibitor used in severe parkinsonism in conjunction with levodopa to reduce ‘end-of-dose’ deterioration. Adverse effects include HYPOTENSION, nausea and vomiting, confusion, and agitation. Some drugs used to treat other disorders produce Parkinsonian side-effects. Patients seeking further advice and help, together with their relatives, are advised to contact the Parkinson’s Disease Society of the UK.... parkinsonism
Idiopathic stammering begins at some time between the onset of speech and puberty, mostly between 2–5 years of age. Acquired stammering at a later age due to brain damage is rare. The prevalence of stammering (the percentage of the population actually stammering at any point in time) is approximately 0·9 per cent. Three times as many boys as girls stammer. About 70 per cent of stammering children recover with little or no therapy. Stammerers have not been shown to demonstrate di?erences in personality from non-stammerers; there are, however, indications that at least some stammerers show minimal di?erences from ?uent speakers in cerebral processing of verbal material.
There is a genetic predisposition towards stammering. The risk of stammering among ?rst-degree relatives of stammerers is more than three times the population risk. In 77 per cent of identical twins, either both stammer or both are ?uent. Only 33 per cent of non-identical twins agree in this way. As there are identical twins who di?er for stammering, environmental factors must be important for some stammerers. There are relatively large numbers of stammerers in highly competitive societies, where status and prestige are important and high standards of speech competence are valued.
Di?erent treatments have been demonstrated to produce considerable bene?t, their basic outline being similar. A long period of time is spent in training stammerers to speak in a di?erent way (?uency-shaping techniques). This may include slowing down the rate of speech, gentle onset of utterance, continuous ?ow with correct juncturing, etc. When the targets have been achieved within the clinic, a series of planned speech assignments outside the clinic is undertaken. In these assignments, and initially in everyday situations, the ?uency-enchancing techniques have to be used conscientiously. Gradually speech is shaped towards normality requiring less and less e?ort. Therapy may also include some work on attitude change (i.e. helping the client to see him or herself as a ?uent speaker) and possibly general communicative skills training.
For information about organisations concerned with stammering, see Appendix 2.... stammering
The chief object of perspiration is to maintain an even body temperature by regulating the heat lost from the body surface. Sweating is therefore increased by internally produced heat, such as muscular activity, or external heat. It is controlled by two types of nerves: vasomotor, which regulate the local blood ?ow, and secretory (part of the sympathetic nervous system) which directly in?uence secretion.
Eccrine sweat is a faintly acid, watery ?uid containing less than 2 per cent of solids. The eccrine sweat-glands in humans are situated in greatest numbers on the soles of the feet and palms of the hands, and with a magnifying glass their minute openings or pores can be seen in rows occupying the summit of each ridge in the skin. Perspiration is most abundant in these regions, although it also occurs all over the body.
Apocrine sweat-glands These start functioning at puberty and are found in the armpits, the eyelids, around the anus in association with the external genitalia, and in the areola and nipple of the breast. (The glands that produce wax in the ear are modi?ed apocrine glands.) The ?ow of apocrine sweat is evoked by emotional stimuli such as fear, anger, or sexual excitement.
Abnormalities of perspiration Decreased sweating may occur in the early stages of fever, in diabetes, and in some forms of glomerulonephritis (see KIDNEYS, DISEASES OF). Some people are unable to sweat copiously, and are prone to HEAT STROKE. EXCESSIVE SWEATING, OR HYPERIDROSIS, may be caused by fever, hyperthyroidism (see THYROID GLAND, DISEASES OF), obesity, diabetes mellitus, or an anxiety state. O?ensive perspiration, or bromidrosis, commonly occurs on the hands and feet or in the armpits, and is due to bacterial decomposition of skin secretions. A few people, however, sweat over their whole body surface. For most of those affected, it is the palmar and/or axillary hyperhidrosis that is the major problem.
Conventional treatment is with an ANTICHOLINERGIC drug. This blocks the action of ACETYLCHOLINE (a neurotransmitter secreted by nerve-cell endings) which relaxes some involuntary muscles and tightens others, controlling the action of sweat-glands. But patients often stop treatment because they get an uncomfortably dry mouth. Aluminium chloride hexahydrate is a topical treatment, but this can cause skin irritation and soreness. Such antiperspirants may help patients with moderate hyperhidrosis, but those severely affected may need either surgery or injections of BOTULINUM TOXIN to destroy the relevant sympathetic nerves to the zones of excessive sweating.... perspiration
Habitat: In, or very near, waterways, lakes, ponds, ditches, and in marshes and swampy places.
Features ? The largest of all the Docks, reaching up to six or seven feet. Stem erect, thick, striated, hollow, branched. Leaves very large, some two feet in length, pale green turning to reddish-brown, broad and sharp-pointed, point turning over towards the water. Flowers (July and August) small, greenish-yellow, with white threads which become brown. Root large, reddish brown, porous bark, large pith with honeycomb-like cells.Part used ? Root.Action: Alterative, detergent.
Of value in skin diseases and sluggish liver, in which latter case it should be given in combination with a mild laxative. The dose is 3-4 tablespoonfuls of the decoction of 1 ounce to 1 pint after simmering from1 1/2 pints. This may be used as a mouthwash for ulcers, etc., and the powder makes a first-rate medicinal cleanser for the teeth.Hool highly esteems Water Dock, and says ? "It operates kindly and without excitement, being slow but sure in promoting a healthy action of the depurative functions of the system." He also claims diuretic and tonic qualities for the root.... water dockCauses: thyrotoxicosis, valvular or coronary disease. Present in mitral stenosis and myocarditis. Precursor of heart failure. Carrying a bucket of coal upstairs may be sufficient to precipitate an attack. Symptoms. Pulse irregular in time and force, breathlessness, visible pulse in neck, excessive heart beats of sudden onset or permanent, with breathlessness often from emotional excitement.
Treatment. Patient should avoid excessive physical exercise or give way to anxiety and depression. Alternatives:– Tea. Equal parts: Hawthorn (berries or blossoms), Broom, Valerian. 1-2 teaspoons in each cup boiling water; infuse 5-15 minutes; dose – half-1 cup thrice daily.
Tablets/capsules. Hawthorn, Valerian, Motherwort.
Formula. Hawthorn 2; Passion flower 2; Broom 3. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water or honey thrice daily. Practitioner. Tincture Gelsemium (BPC 1973): 2-5 drops. Tincture Lily of the Valley: 0.5-1ml.
Undue violence. Tincture Gelsemium 1; Tincture Cactus 2. Mix. Dose: 5-10 drops. Where heart muscle is damaged, add 1 part Liquid Extract Black Cohosh.
Broom. Spartiol Drops, 20 drops thrice daily. (Klein)
Diet. See: DIET – HEART AND CIRCULATION. ... atrial fibrillation
Cardio-actives. Herbs exercising a direct action on the heart due to the cardiac glycosides they contain. They increase output by sustaining the heart muscle without a demand for more oxygen. This group includes: Motherwort, Hawthorn, Broom, Lily of the Valley, Figwort, Bugleweed, Squills.
Cardiac glycosides, especially those of the Foxglove (digitalis) which is administered by a physician only, tend to accumulate in the body and may prove toxic when their elimination is retarded. The most important cardio-active used by the Consulting Herbalist is Lily of the Valley which has an action similar to Foxglove but without toxic effect. It is a reliable alternative to Foxglove for failure of the heart with retention of water in the body.
Cardio-tonics. Herbalists use other plants that do not contain cardiac glycosides but which have an indirect effect upon the heart. These dilate arteries and peripheral vessels, speeding the circulation, reducing high blood pressure, relieving any back-pressure on the heart caused by accumulation of blood in the lungs. There are peripheral dilators to resolve any hold-up in the circulation and others that assist a failing heart by eliminating obstruction in the bowel (laxatives), liver and kidneys (hepatics and diuretics), skin (diaphoretics and alteratives, chief of which is Figwort). The heart also may feel the benefit of a timely relaxing nervine such as Skullcap or Lime flowers. Even treatment of varicose veins indirectly assists. All of these reduce the work-load of the muscle and tend to ‘normalise’ function of the heart. Cardio-tonics include Ephedra, Motherwort, Rosemary, Mistletoe, Hawthorn, Lime flowers, Cayenne, Yarrow, Garlic, Balm.
Bugleweed is often overlooked as a cardiac sedative to relax capillaries and soothe arterial excitement. ... cardiac
Described as “seems as if my head was bursting, with a flash of light”. Reaction is one of fear and violent heart beat. Attacks unrelated to alcohol or excitement of the previous evening. No circulatory changes in the brain or cerebrospinal fluid are known to cause such a symptom.
Treatment. Cup of one of the following teas at bedtime: Buckwheat, Yarrow, Hawthorn flowers, Skullcap, Oats. Morning and evening: one 500mg Evening Primrose capsule; one 400iu Vitamin E capsule.
Diet: low-salt. Cholesterol-rich foods should be kept to a minimum. ... exploding head synrome (ehs)
Causes may also be psychological: worry, excitement, emotional crises such as school exams. Where the trouble is persistent attention should be focussed on the bladder (cystitis), inflammation of the kidneys, even the presence of stone.
Simple frequency may arise from cold weather, nervous excitement, or early pregnancy. Other predisposing factors are: diabetes mellitis, enlarged prostate gland, stone in the kidney or bladder. Alternatives. Teas. American Cranesbill, Agrimony, Cornsilk, Horsetail, Passion flower, Plantain, Skullcap, Uva Ursi, Huang Qi (Chinese). Saw Palmetto (prostate gland).
Tablets/capsules. Cranesbill (American), Gentian, Liquorice.
Powders. Equal parts: Cranesbill, Horsetail, Liquorice. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.
Tinctures. Equal parts: Cramp bark and Horsetail. Dose: 30-60 drops, thrice daily.
Practitioner. Tinctures. Alternatives:–
Formula 1. Ephedra 30ml; Geranium 20ml; Rhus aromatica 20ml; Thuja 1ml. Aqua to 100ml. Sig: 5ml (3i) tds aq cal pc.
Formula 2. Equal parts: Ephedra and Horsetail. 15-60 drops thrice daily; last dose bedtime.
A. Barker FNIMH. Dec Jam Sarsae Co Conc BPC 1 fl oz (30ml) . . . Liquid extract Rhus 240 minims (16ml) . . . Liquid extract Passiflora 60 minims (4ml) . . . Syr Althaea 2 fl oz (60ml) . . . Aqua to 8oz (240ml). Dose: 2 teaspoons thrice daily; last dose bedtime.
Tincture Arnica. German traditional. 1 drop in honey at bedtime.
Pelvic exercises. Alternate hot and cold Sitz baths. Swimming, Cycling.
Address. Incontinence Advisory Service, Disabled Living Foundation, 380-384 Harrow Road, London W9 2HU. ... frequency of urine
Affects more women than men, ages 20 to 40 years. Most cases have a history of rheumatic fever as a child. Thickening of the valves renders them less efficient in regulating the flow of blood through the heart thus allowing leakage by improper closure. Increased effort is required from the heart muscle to pump blood through the narrowed valves giving rise to fatigue and possible heart failure.
Prolapsus of the mitral valve is now recognised as predisposing to bacterial endocarditis. It is concluded that herbal antibiotic prophylaxis is justified in heart patients undergoing dental extraction, or other surgery where there is exposure to infection.
Symptoms: Breathlessness on exertion. Swelling of legs and ankles, palpitations, fainting, blue tinge to the skin and a permanent pink flush over the cheek bones. Clubbing of fingers. Enlarged spleen. Stethoscope reveals valvular regurgitation. The most common organism remains streptococcus viridans, by mouth. It may reach the heart by teeth extraction, scaling and intensive cleaning which may draw blood, posing a risk by bacteria.
Treatment. Acute conditions should be under the authority of a heart specialist in an Intensive Care Unit.
Absolute bedrest to relieve stress on the heart’s valves. For acute infection: Penicillin (or other essential antibiotics). Alternatives, of limited efficacy: Echinacea, Myrrh, Wild Indigo, Nasturtium, Holy Thistle. Avoid: excitement, chills, colds, fatigue and anything requiring extra cardiac effort. Convalescence will be long (weeks to months) during which resumption to normal activity should be gradual.
Aconite. With full bounding pulse and restless fever. Five drops Tincture Aconite to half a glass (100ml) water. 2 teaspoons hourly until temperature falls.
To sustain heart. Tincture Convallaria (Lily of the Valley), 5-15 drops, thrice daily.
To stimulate secretion of urine. Tincture Bearberry, 1-2 teaspoons, thrice daily.
Rheumatic conditions. Tincture Colchicum, 10-15 drops, thrice daily.
Various conventional treatments of the past can still be used with good effect: Tincture Strophanthus, 5 to 15 drops. Liquid Extract Black Cohosh, 15 to 30 drops. Spirits of Camphor, 5 to 10 drops. Bugleweed (American), 10 to 30 drops. To increase body strength: Echinacea. To sustain heart muscle: Hawthorn. Endocarditis with severe headache: Black Cohosh.
Teas: single or in combination (equal parts) – Nettles, Motherwort, Red Clover flowers, Lime flowers. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.
Decoction: equal parts: Hawthorn berries, Echinacea root, Lily of the Valley leaves. Mix. 2 teaspoons to each 2 cups water in a non-aluminium vessel, gently simmer 10 minutes. Dose: 1 cup 2-3 times daily. Formula. Echinacea 20; Cactus 10; Hawthorn 10; Goldenseal 2. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily.
Diet. See entry: DIET – HEART AND CIRCULATION. Pineapple juice. Treatment by or in liaison with general medical practitioner or cardiologist. ... endocarditis
Constituents: alkaloids, coumarins, tannins, iridoids.
Action: powerful relaxant to the central nervous system, vasodilator, analgesic; to calm down physical violence in hysteria and reduce a dangerously high pulse rate. Antispasmodic, hypotensive (transient). Tranquilliser. Combines well with Hawthorn for cardiac arrhythmias. No evidence of dependence in clinical use.
Use s. Pressive nervous headache (constrictive migraine). Facial neuralgia, cramp, intermittent claudication, pain in womb and ovaries, temporal arteritis. Pain in tail bone at base of the spine (coccydynia). Spasm of the osteopathic lesion. Great restlessness, convulsions, contracted pupils and circulatory excitement.
Avoid in heart disease and low blood pressure. Practitioner use. Tincture Gelsemium, 2-5 drops, 2-3 times daily. Pharmacy only sales.
A weaker tincture may frequently be used with good effect: 5 drops to 100ml water – 1 teaspoon hourly. (Dr Finlay Ellingwood) ... gelsemium
Alternatives. Teas: Balm, Motherwort, Hawthorn flowers or leaves. Tablets: Hawthorn, Motherwort, Mistletoe, Valerian.
Tincture Lily of the Valley: 8-15 drops when necessary.
Broom: Spartiol drops. (Klein) 20 drops thrice daily.
Broom decoction. 1oz to 1 pint water gently simmered 10 minutes. 1 cup morning and evening. ... heart – extra beats
The hypothalamus controls the sympathetic nervous system (part of the autonomic nervous system). In response to sudden alarm or excitement, signals are sent from higher regions of the brain to the hypothalamus, initiating sympathetic nervous system activity. This causes a faster heartbeat, widening of the pupils, an increase in breathing rate and blood flow to muscles.
Other nerve cells in the hypothalamus are concerned with the control of body temperature, thirst, and appetite for food. The hypothalamus is also involved in regulating sleep, motivating sexual behaviour, and determining mood and emotions. It indirectly controls many endocrine glands through its influence on the pituitary gland.
Disorders of the hypothalamus are usually due to an intracerebral haemorrhage or a pituitary tumour. They have diverse effects, ranging from hormonal disorders to disturbances in temperature regulation, and increased or decreased need for food and sleep.... hypothalamus
Individual variations are common. Muscular exertion and emotional factors, such as fear, stress, and excitement, all raise systolic blood pressure (see hypertension). Systolic blood pressure is normally at its lowest during sleep. Severe shock may lead to an abnormally low blood pressure and possible circulatory failure (see hypotension). Blood pressure is adjusted to its normal level by the *sympathetic nervous system and hormonal controls.... blood pressure
Health Encyclopedia