(Welsh) Surrounded by light
The injured arm may be supported horizontally or held elevated, depending on the injury.
slipped disc See disc prolapse.... sling
Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Moderate Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, phosphorus, zinc
About the Nutrients in This Food Like fish, pork, poultry, milk, and eggs, beef has high-quality proteins, with sufficient amounts of all the essential amino acids. Beef fat is slightly more highly saturated than pork fat, but less saturated than lamb fat. All have about the same amount of cholesterol per serving. Beef is an excellent source of B vitamins, including niacin, vitamin B6, and vitamin B12, which is found only in animal foods. Lean beef pro- vides heme iron, the organic iron that is about five times more useful to the body than nonheme iron, the inorganic form of iron found in plant foods. Beef is also an excellent source of zinc. One four-ounce serving of lean broiled sirloin steak has nine grams fat (3.5 g saturated fat), 101 mg cholesterol, 34 g protein, and 3.81 mg iron (21 percent of the R DA for a woman, 46 percent of the R DA for a man). One four-ounce serving of lean roast beef has 16 g fat (6.6 g saturated fat), 92 mg cholesterol, and 2.96 mg iron (16 percent of the R DA for a woman, 37 percent of the R DA for a man).
The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Ascorbic acid increases the absorption of iron from meat. * These values apply to lean cooked beef.
Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet (for some forms of kidney disease)
Buying This Food Look for: Fresh, red beef. The fat should be white, not yellow. Choose lean cuts of beef with as little internal marbling (streaks of fat) as possible. The leanest cuts are flank steak and round steak; rib steaks, brisket, and chuck have the most fat. USDA grading, which is determined by the maturity of the animal and marbling in meat, is also a guide to fat content. U.S. prime has more marbling than U.S. choice, which has more marbling than U.S. good. All are equally nutritious; the difference is how tender they are, which depends on how much fat is present. Choose the cut of meat that is right for your recipe. Generally, the cuts from the cen- ter of the animal’s back—the rib, the T-Bone, the porterhouse steaks—are the most tender. They can be cooked by dry heat—broiling, roasting, pan-frying. Cuts from around the legs, the underbelly, and the neck—the shank, the brisket, the round—contain muscles used for movement. They must be tenderized by stewing or boiling, the long, moist cooking methods that break down the connective tissue that makes meat tough.
Storing This Food Refrigerate raw beef immediately, carefully wrapped to prevent its drippings from contami- nating other foods. Refrigeration prolongs the freshness of beef by slowing the natural multi- plication of bacteria on the meat surface. Unchecked, these bacteria will convert proteins and other substances on the surface of the meat to a slimy film and change meat’s sulfur-contain- ing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Fresh ground beef, with many surfaces where bacteria can live, should be used within 24 to 48 hours. Other cuts of beef may stay fresh in the refrigerator for three to five days.
Preparing This Food Trim the beef carefully. By judiciously cutting away all visible fat you can significantly reduce the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.
What Happens When You Cook This Food Cooking changes the appearance and flavor of beef, alters nutritional value, makes it safer, and extends its shelf life. Browning meat after you cook it does not “seal in the juices,” but it does change the fla- vor by caramelizing sugars on the surface. Because beef’s only sugars are the small amounts of glycogen in the muscles, we add sugars in marinades or basting liquids that may also con- tain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When beef is cooked, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat and turn brown, the natural color of well-done meat. At the same time, the fats in the beef are oxidized. Oxidized fats, whether formed in cooking or when the cooked meat is stored in the refrigerator, give cooked meat a character- istic warmed-over flavor. Cooking and storing meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers, and other vitamin C-rich vegetables—reduces the oxidation of fats and the intensity of warmed-over flavor. Meat reheated in a microwave oven also has less warmed-over flavor. An obvious nutritional benefit of cooking is the fact that heat lowers the fat content of beef by liquif ying the fat so it can run off the meat. One concrete example of how well this works comes from a comparison of the fat content in regular and extra-lean ground beef. According to research at the University of Missouri in 1985, both kinds of beef lose mass when cooked, but the lean beef loses water and the regular beef loses fat and cholesterol. Thus, while regular raw ground beef has about three times as much fat (by weight) as raw ground extra-lean beef, their fat varies by only 5 percent after broiling. To reduce the amount of fat in ground beef, heat the beef in a pan until it browns. Then put the beef in a colander, and pour one cup of warm water over the beef. Repeat with a second cup of warm water to rinse away fat melted by heating the beef. Use the ground beef in sauce and other dishes that do not require it to hold together. Finally, cooking makes beef safer by killing Salmonella and other organisms in the meat. As a result, cooking also serves as a natural preservative. According to the USDA, large pieces of fresh beef can be refrigerated for two or three days, then cooked and held safely for another day or two because the heat of cooking has reduced the number of bacteria on the surface of the meat and temporarily interrupted the natural cycle of deterioration.
How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to the air, in a refrigerated room, reduces the moisture content and shrinks the meat slightly. As the meat ages enzymes break down muscle pro- teins, “tenderizing” the beef. Canning. Canned beef does not develop a warmed-over flavor because the high tempera- tures in canning food and the long cooking process alter proteins in the meat so that they act as antioxidants. Once the can is open, however, the meat should be protected from oxygen that will change the flavor of the beef. Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solution. The salt or sugar used in curing dissolves in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the microor- ganisms and protecting the meat from bacterial damage. Salt-cured meat is much higher in sodium than fresh meat. Freezing. When you freeze beef, the water inside its cells freezes into sharp ice crystals that can puncture cell membranes. When the beef thaws, moisture (and some of the B vitamins) will leak out through these torn cell walls. The loss of moisture is irreversible, but some of the vitamins can be saved by using the drippings when the meat is cooked. Freezing may also cause freezer burn—dry spots left when moisture evaporates from the surface of the meat. Waxed freezer paper is designed specifically to hold the moisture in meat; plastic wrap and aluminum foil are less effective. NOTE : Commercially prepared beef, which is frozen very quickly at very low temperatures, is less likely to show changes in texture. Irradiation. Irradiation makes meat safer by exposing it to gamma rays, the kind of high- energy ionizing radiation that kills living cells, including bacteria. Irradiation does not change the way meat looks, feels or tastes, or make the food radioactive, but it does alter the structure of some naturally occurring chemicals in beef, breaking molecules apart to form new com- pounds called radiolytic products (R P). About 90 percent of R Ps are also found in nonirradiated foods. The rest, called unique radiolytic products (UR P), are found only in irradiated foods. There is currently no evidence to suggest that UR Ps are harmful; irradiation is an approved technique in more than 37 countries around the world, including the United States. Smoking. Hanging cured or salted meat over an open fire slowly dries the meat, kills micro- organisms on its surface, and gives the meat a rich, “smoky” flavor that varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Meats treated with “artificial smoke flavoring” are not, since the flavoring is commercially treated to remove tar and a-benzopyrene.
Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements. One cooked 3.5- ounce hamburger provides about 2.9 mg iron, 16 percent of the R DA for an adult woman of childbearing age. Possible anti-diabetes activity. CLA may also prevent type 2 diabetes, also called adult-onset diabetes, a non-insulin-dependent form of the disease. At Purdue University, rats bred to develop diabetes spontaneously between eight and 10 weeks of age stayed healthy when given CLA supplements.
Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, beef contains cholesterol and saturated fats that increase the amount of cholesterol circulating in your blood, raising your risk of heart disease. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: • Existing cardiovascular disease • High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) • Obesity • Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) • Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Increased risk of some cancers. According the American Institute for Cancer Research, a diet high in red meat (beef, lamb, pork) increases the risk of developing colorectal cancer by 15 percent for every 1.5 ounces over 18 ounces consumed per week. In 2007, the National Can- cer Institute released data from a survey of 500,000 people, ages 50 to 71, who participated in an eight-year A AR P diet and health study identif ying a higher risk of developing cancer of the esophagus, liver, lung, and pancreas among people eating large amounts of red meats and processed meats. Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meats con- taminated with other bacteria, viruses, or parasites pose special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; 165°F, the E. coli organism; and 212°F, Listeria monocytogenes. Antibiotic sensitivity. Cattle in the United States are routinely given antibiotics to protect them from infection. By law, the antibiotic treatment must stop three days to several weeks before the animal is slaughtered. Theoretically, the beef should then be free of antibiotic residues, but some people who are sensitive to penicillin or tetracycline may have an allergic reaction to the meat, although this is rare. Antibiotic-resistant Salmonella and toxoplasmosis. Cattle treated with antibiotics may pro- duce meat contaminated with antibiotic-resistant strains of Salmonella, and all raw beef may harbor ordinary Salmonella as well as T. gondii, the parasite that causes toxoplasmosis. Toxoplasmosis is particularly hazardous for pregnant women. It can be passed on to the fetus and may trigger a series of birth defects including blindness and mental retardation. Both Salmonella and the T. gondii can be eliminated by cooking meat thoroughly and washing all utensils, cutting boards, and counters as well as your hands with hot soapy water before touching any other food. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia, which is excreted through the kidneys. In laborator y animals, a sustained high-protein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.
Food/Drug Interactions Tetracycline antibiotics (demeclocycline [Declomycin], doxycycline [ Vibtamycin], methacycline [Rondomycin], minocycline [Minocin], oxytetracycline [Terramycin], tetracycline [Achromycin V, Panmycin, Sumycin]). Because meat contains iron, which binds tetracyclines into com- pounds the body cannot absorb, it is best to avoid meat for two hours before and after taking one of these antibiotics. Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking a M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Theophylline. Charcoal-broiled beef appears to reduce the effectiveness of theophylline because the aromatic chemicals produced by burning fat speed up the metabolism of the- ophylline in the liver.... beef
Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.
SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.
The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.
HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper
limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.
Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.
Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.
The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.
Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.
with plaster of Paris. If closed traction does not work, then open reduction of the fracture may
be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.
External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.
Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.
Complications of fractures are fairly common. In non-union, the fracture does not unite
– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.
Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.
Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:
subcapital where the neck joins the head of the femur.
intertrochanteric through the trochanter.
subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur
need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.
In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.
Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.
Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.
The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.
Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).
Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.
Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.
Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.
By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.
Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.
Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.
Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.
Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.
With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.
Further information is available from the National Osteoporosis Society.
Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.
If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.
For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.
Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.
EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.
MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.
OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.
OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of
It is important for a paediatrician to determine that such events are not epileptic (see EPILEPSY). Generally they require no treatment other than reassurance, as recovery is spontaneous and rapid – although a small number of severely affected children have been helped by a PACEMAKER. Parents should avoid dramatising the attacks.... breath-holding
Action: Diuretic, tonic, and slightly aperient.
While a Dandelion decoction of 1 ounce to 1 pint (reduced from 1 1/2 pints) may be taken alone and drunk freely with benefit, the properties of the herb are better utilised in combination with other agents. The root is a constituent of many prescriptions for dropsical and urinary complaints, and in atonic dyspepsia and rheumatism. Contrary to widely-held belief.Dandelion root would seem to have little or no action on the liver.The most popular use for Dandelion root, after roasting and grinding, is as a substitute for coffee, to which beverage it bears a remarkable resemblance. Prepared like coffee, but using only about half the quantity, and drunk regularly, it acts as a mild laxative in habitual constipation, without any of the disadvantages which attend coffee drinking. The fresh leaf is best taken in salads. Juice of either flower stalk or leaf, freshly gathered, is of help in removing warts.... dandelionThe dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.
The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’
Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.
Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.
How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.
By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction
– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.
Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.
About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)
The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.
Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.
Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.
Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.
For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.
(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence
The outer coat consists of the sclera and the cornea; their junction is called the limbus. SCLERA This is white, opaque, and constitutes the posterior ?ve-sixths of the outer coat. It is made of dense ?brous tissue. The sclera is visible anteriorly, between the eyelids, as the ‘white of the eye’. Posteriorly and anteriorly it is covered by Tenons capsule, which in turn is covered by transparent conjunctiva. There is a hole in the sclera through which nerve ?bres from the retina leave the eye in the optic nerve. Other smaller nerve ?bres and blood vessels also pass through the sclera at di?erent points. CORNEA This constitutes the transparent, colourless anterior one-sixth of the eye. It is transparent in order to allow light into the eye and is more steeply curved than the sclera. Viewed from in front, the cornea is roughly circular. Most of the focusing power of the eye is provided by the cornea (the lens acts as the ‘?ne adjustment’). It has an outer epithelium, a central stroma and an inner endothelium. The cornea is supplied with very ?ne nerve ?bres which make it exquisitely sensitive to pain. The central cornea has no blood supply – it relies mainly on aqueous humour for nutrition. Blood vessels and large nerve ?bres in the cornea would prevent light from entering the eye. LIMBUS is the junction between cornea and sclera. It contains the trabecular meshwork, a sieve-like structure through which aqueous humour leaves the eye.
The middle coat (uveal tract) consists of the choroid, ciliary body and iris. CHOROID A highly vascular sheet of tissue lining the posterior two-thirds of the sclera. The network of vessels provides the blood supply for the outer half of the retina. The blood supply of the choroid is derived from numerous ciliary vessels which pierce the sclera in front and behind. CILIARY BODY A ring of tissue extending 6 mm back from the anterior limitation of the sclera. The various muscles of the ciliary body by their contractions and relaxations are responsible for changing the shape of the lens during ACCOMMODATION. The ciliary body is lined by cells that secrete aqueous humour. Posteriorly, the ciliary body is continuous with the choroid; anteriorly it is continuous with the iris. IRIS A ?attened muscular diaphragm that is attached at its periphery to the ciliary body, and has a round central opening – the pupil. By contraction and relaxation of the muscles of the iris, the pupil can be dilated or constricted (dilated in the dark or when aroused; constricted in bright light and for close work). The iris forms a partial division between the anterior chamber and the posterior chamber of the eye. It lies in front of the lens and forms the back wall of the anterior chamber. The iris is visible from in front, through the transparent cornea, as the ‘coloured part of the eye’. The amount and distribution of iris pigment determine the colour of the iris. The pupil is merely a hole in the centre of the iris and appears black.
The inner layer The retina is a multilayered tissue (ten layers in all) which extends from the edges of the optic nerve to line the inner surface of the choroid up to the junction of ciliary body and choroid. Here the true retina ends at the ora serrata. The retina contains light-sensitive cells of two types: (i) cones – cells that operate at high and medium levels of illumination; they subserve ?ne discrimination of vision and colour vision; (ii) rods – cells that function best at low light intensity and subserve black-and-white vision.
The retina contains about 6 million cones and about 100 million rods. Information from them is conveyed by the nerve ?bres which are in the inner part of the retina, and leave the eye in the optic nerve. There are no photoreceptors at the optic disc (the point where the optic nerve leaves the eye) and therefore there is no light perception from this small area. The optic disc thus produces a physiological blind spot in the visual ?eld.
The retina can be subdivided into several areas: PERIPHERAL RETINA contains mainly rods and a few scattered cones. Visual acuity from this area is fairly coarse. MACULA LUTEA So-called because histologically it looks like a yellow spot. It occupies an area 4·5 mm in diameter lateral to the optic disc. This area of specialised retina can produce a high level of visual acuity. Cones are abundant here but there are few rods. FOVEA CENTRALIS A small central depression at the centre of the macula. Here the cones are tightly packed; rods are absent. It is responsible for the highest levels of visual acuity.
The chambers of the eye There are three: the anterior and posterior chambers, and the vitreous cavity. ANTERIOR CHAMBER Limited in front by the inner surface of the cornea, behind by the iris and pupil. It contains a transparent clear watery ?uid, the aqueous humour. This is constantly being produced by cells of the ciliary body and constantly drained away through the trabecular meshwork. The trabecular meshwork lies in the angle between the iris and inner surface of the cornea. POSTERIOR CHAMBER A narrow space between the iris and pupil in front and the lens behind. It too contains aqueous humour in transit from the ciliary epithelium to the anterior chamber, via the pupil. VITREOUS CAVITY The largest cavity of the eye. In front it is bounded by the lens and behind by the retina. It contains vitreous humour.
Lens Transparent, elastic and biconvex in cross-section, it lies behind the iris and in front of the vitreous cavity. Viewed from the front it is roughly circular and about 10 mm in diameter. The diameter and thickness of the lens vary with its accommodative state. The lens consists of: CAPSULE A thin transparent membrane surrounding the cortex and nucleus. CORTEX This comprises newly made lens ?bres that are relatively soft. It separates the capsule on the outside from the nucleus at the centre of the lens. NUCLEUS The dense central area of old lens ?bres that have become compacted by new lens ?bres laid down over them. ZONULE Numerous radially arranged ?bres attached between the ciliary body and the lens around its circumference. Tension in these zonular ?bres can be adjusted by the muscles of the ciliary body, thus changing the shape of the lens and altering its power of accommodation. VITREOUS HUMOUR A transparent jelly-like structure made up of a network of collagen ?bres suspended in a viscid ?uid. Its shape conforms to that of the vitreous cavity within which it is contained: that is, it is spherical except for a shallow concave depression on its anterior surface. The lens lies in this depression.
Eyelids These are multilayered curtains of tissue whose functions include spreading of the tear ?lm over the front of the eye to prevent desiccation; protection from injury or external irritation; and to some extent the control of light entering the eye. Each eye has an upper and lower lid which form an elliptical opening (the palpebral ?ssure) when the eyes are open. The lids meet at the medial canthus and lateral canthus respectively. The inner medial canthus is ?xed; the lateral canthus more mobile. An epicanthus is a fold of skin which covers the medial canthus in oriental races.
Each lid consists of several layers. From front to back they are: very thin skin; a sheet of muscle (orbicularis oculi, whose ?bres are concentric around the palpebral ?ssure and which produce closure of the eyelids); the orbital septum (modi?ed near the lid margin to form the tarsal plates); and ?nally, lining the back surface of the lid, the conjunctiva (known here as tarsal conjunctiva). At the free margin of each lid are the eyelashes, the openings of tear glands which lie within the lid, and the lacrimal punctum. Toward the medial edge of each lid is an elevation known as the papilla: the lacrimal punctum opens into this papilla. The punctum forms the open end of the cannaliculus, part of the tear-drainage mechanism.
Orbit The bony cavity within which the eye is held. The orbits lie one on either side of the nose, on the front of the skull. They a?ord considerable protection for the eye. Each is roughly pyramidal in shape, with the apex pointing backwards and the base forming the open anterior part of the orbit. The bone of the anterior orbital margin is thickened to protect the eye from injury. There are various openings into the posterior part of the orbit – namely the optic canal, which allows the optic nerve to leave the orbit en route for the brain, and the superior orbital and inferior orbital ?ssures, which allow passage of nerves and blood vessels to and from the orbit. The most important structures holding the eye within the orbit are the extra-ocular muscles, a suspensory ligament of connective tissue that forms a hammock on which the eye rests and which is slung between the medial and lateral walls of the orbit. Finally, the orbital septum, a sheet of connective tissue extending from the anterior margin of the orbit into the lids, helps keep the eye in place. A pad of fat ?lls in the orbit behind the eye and acts as a cushion for the eye.
Conjunctiva A transparent mucous membrane that extends from the limbus over the anterior sclera or ‘white of the eye’. This is the bulbar conjunctiva. The conjunctiva does not cover the cornea. Conjunctiva passes from the eye on to the inner surface of the eyelid at the fornices and is continuous with the tarsal conjunctiva. The semilunar fold is the vertical crescent of conjunctiva at the medial aspect of the palpebral ?ssure. The caruncle is a piece of modi?ed skin just within the inner canthus.
Eye muscles The extra-ocular muscles. There are six in all, the four rectus muscles (superior, inferior, medial and lateral rectus muscles) and two oblique muscles (superior and inferior oblique muscles). The muscles are attached at various points between the bony orbit and the eyeball. By their combined action they move the eye in horizontal and vertical gaze. They also produce torsional movement of the eye (i.e. clockwise or anticlockwise movements when viewed from the front).
Lacrimal apparatus There are two components: a tear-production system, namely the lacrimal gland and accessory lacrimal glands; and a drainage system.
Tears keep the front of the eye moist; they also contain nutrients and various components to protect the eye from infection. Crying results from excess tear production. The drainage system cannot cope with the excess and therefore tears over?ow on to the face. Newborn babies do not produce tears for the ?rst three months of life. LACRIMAL GLAND Located below a small depression in the bony roof of the orbit. Numerous tear ducts open from it into predominantly the upper lid. Accessory lacrimal glands are found in the conjunctiva and within the eyelids: the former open directly on to the surface of the conjunctiva; the latter on to the eyelid margin. LACRIMAL DRAINAGE SYSTEM This consists of: PUNCTUM An elevated opening toward the medial aspect of each lid. Each punctum opens into a canaliculus. CANALICULUS A ?ne tube-like structure run-ning within the lid, parallel to the lid margin. The canaliculi from upper and lower lid join to form a common canaliculus which opens into the lacrimal sac. LACRIMAL SAC A small sac on the side of the nose which opens into the nasolacrimal duct. During blinking, the sac sucks tears into itself from the canaliculus. Tears then drain by gravity down the nasolacrimal duct. NASOLACRIMAL DUCT A tubular structure which runs down through the wall of the nose and opens into the nasal cavity.
Visual pathway Light stimulates the rods and cones of the retina. Electrochemical messages are then passed to nerve ?bres in the retina and then via the optic nerve to the optic chiasm. Here information from the temporal (outer) half of each retina continues to the same side of the brain. Information from the nasal (inner) half of each retina crosses to the other side within the optic chiasm. The rearranged nerve ?bres then pass through the optic tract to the lateral geniculate body, then the optic radiation to reach the visual cortex in the occipital lobe of the brain.... eye
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
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)
The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.
In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)
Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of
Habitat: Moist meadows and pasture land.
Features ? The stem. growing up to three feet, is branched, furrowed, and downy above; egg-shaped, serrate leaves embrace the stem. The calyx is also egg-shaped and leafy, and the flowers, blooming in July and August, are large, solitary and terminal, brilliantly yellow in colour. The root is light grey, hard, horny and cylindrical. The whole plant is similar in appearance to the horseradish, its taste is bitter and acrid, and the odour reminiscent of camphor.Part used ? Root.Action: Diaphoretic, expectorant and diuretic.
In combination with other remedies it is made up into cough medicines, and can be of service in pulmonary disorders generally. Skillfully compounded, slight alterative and tonic qualities are noticed. Wineglass doses are taken of a 1 ounce to 1 pint (reduced) decoction.These modest present-day claims for Elecampane are far exceeded by Culpeper's exuberance. In his view, the root "warms a cold and windy stomach or the pricking therein, and stitches in the side caused by the spleen; helps the cough, shortness of the breath, and wheezing of the lungs. . . . Profitable for those that have their urine stopped. . . . Resisteth poison, and stayeth the venom of serpents, as also of putrid and pestilential fevers, and the plague itself." When we are also told by the same author that it kills and expels worms, fastens loose teeth, arrests dental decay, cleanses the skin from morphew, spots and blemishes, we realize in what esteem Elecampane was held in the seventeenth century! But here again germs of truth are hidden among manifold exaggerations.... elecampaneOccupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.
In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.
The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.
Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.
The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.
Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.
Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.
Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.
Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).
Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.
In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:
the nature of the work.
how the tasks are performed in practice.
the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).
what control measures are in place and the extent to which these are adhered to.
previous occupational and non-occupational exposures.
whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,
for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.
Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that
19.5 million working days were lost as a result. The ten most frequently reported disease categories were:
stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.
back injuries: 508,000.
upper-limb and neck disorders: 375,000.
lower respiratory disease: 202,000.
deafness, TINNITUS or other ear conditions: 170,000.
lower-limb musculoskeletal conditions: 100,000.
skin disease: 66,000.
headache or ‘eyestrain’: 50,000.
traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.
vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu
pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.
While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:
CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.
hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.
LEPTOSPIROSIS – infection with Leptospira (various listed occupations).
viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.
LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.
asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.
mesothelioma from exposure to asbestos.
In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.
There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.
The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.
Inhaled materials
PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.
Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).
The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)
Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.
Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)
Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.
Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.
Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.
Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.
Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).
Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.
Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.
Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.
Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury
(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... occupational health, medicine and diseases
Secondly – and more commonly termed the ‘At-risk register’ – this is a list held by social-service departments, and accessible to doctors in A&E departments, of children whom a local-authority social-services case conference has deemed to have been harmed or to be at risk of harm from mental, physical or sexual abuse (see also CHILD ABUSE).... risk register
Genes carry, in coded form, the detailed speci?cations for the thousands of kinds of protein molecules required by the cell for its existence, for its enzymes, for its repair work and for its reproduction. These proteins are synthesised from the 20 natural AMINO ACIDS, which are uniform throughout nature and which exist in the cell cytoplasm as part of the metabolic pool. The protein molecule consists of amino acids joined end to end to form long polypeptide chains. An average chain contains 100–300 amino acids. The sequence of bases in the nucleic acid chain of the gene corresponds in some fundamental way to the sequence of amino acids in the protein molecule, and hence it determines the structure of the particular protein. This is the genetic code. Deoxyribonucleic acid (see DNA) is the bearer of this genetic information.
DNA has a long backbone made up of repeating groups of phosphate and sugar deoxyribose. To this backbone, four bases are attached as side groups at regular intervals. These four bases are the four letters used to spell out the genetic message: they are adenine, thymine, guanine and cystosine. The molecule of the DNA is made up of two chains coiled round a common axis to form what is called a double helix. The two chains are held together by hydrogen bonds between pairs of bases. Since adenine only pairs with thymine, and guanine only with cystosine, the sequences of bases in one chain ?xes the sequence in the other. Several hundred bases would be contained in the length of DNA of a typical gene. If the message of the DNA-based sequences is a continuous succession of thymine, the RIBOSOME will link together a series of the amino acid, phenylalanine. If the base sequence is a succession of cytosine, the ribosome will link up a series of prolines. Thus, each amino acid has its own particular code of bases. In fact, each amino acid is coded by a word consisting of three adjacent bases. In addition to carrying genetic information, DNA is able to synthesise or replicate itself and so pass its information on to daughter cells.
All DNA is part of the chromosome and so remains con?ned to the nucleus of the cell (except in the mitochondrial DNA). Proteins are synthesised by the ribosomes which are in the cytoplasm. DNA achieves control over pro-tein production in the cytoplasm by directing the synthesis of ribonucleic acid (see RNA). Most of the DNA in a cell is inactive, otherwise the cell would synthesise simultaneously every protein that the individual was capable of forming. When part of the DNA structure becomes ‘active’, it acts as a template for the ribonucleic acid, which itself acts as a template for protein synthesis when it becomes attached to the ribosome.
Ribonucleic acid exists in three forms. First ‘messenger RNA’ carries the necessary ‘message’ for the synthesis of a speci?c protein, from the nucleus to the ribosome. Second, ‘transfer RNA’ collects the individual amino acids which exist in the cytoplasm as part of the metabolic pool and carries them to the ribosome. Third, there is RNA in the ribosome itself. RNA has a similar structure to DNA but the sugar is ribose instead of deoxyribose and uracil replaces the base thymine. Before the ribosome can produce the proteins, the amino acids must be lined up in the correct order on the messenger RNA template. This alignment is carried out by transfer RNA, of which there is a speci?c form for each individual amino acid. Transfer RNA can not only recognise its speci?c amino acid, but also identify the position it is required to occupy on the messenger RNA template. This is because each transfer RNA has its own sequence of bases and recognises its site on the messenger RNA by pairing bases with it. The ribosome then travels along the chain of messenger RNA and links the amino acids, which have thus been arranged in the requisite order, by peptide bonds and protein is released.
Proteins are important for two main reasons. First, all the enzymes of living cells are made of protein. One gene is responsible for one enzyme. Genes thus control all the biochemical processes of the body and are responsible for the inborn di?erence between human beings. Second, proteins also ful?l a structural role in the cell, so that genes controlling the synthesis of structural proteins are responsible for morphological di?erences between human beings.... genetic code
The eyelids are held in place by ligaments attached to the socket’s bony edges.
They consist of thin plates of fibrous tissue (called tarsal plates) covered by muscle and a thin layer of skin.
The inner layer is covered by an extension of the conjunctiva.
Along the edge of each lid are two rows of eyelashes.
Immediately behind the eyelashes are the openings of the ducts leading from the meibomian glands, which secrete the oily part of the tear film.
The lids act as protective shutters, closing as a reflex action if anything approaches the eye.
They also smear the tear film across the cornea.... eyelid
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.
Mainly used in digestive troubles, the 1 ounce to 1 pint infusion, given warm in wineglass doses several times daily, is also found capable of breaking up obstinate colds. As it is held to stimulate the mammary glands, the infusion has been given with the object of promoting the secretion of milk.Tilke is enthusiastic in his praise of the herb ? "I have found it such a clarifier of the blood, that by drinking an infusion once or twice a day, sweeted with honey, instead of tea, it would be a perfect cure for the headache, or what is commonly called the meagrims." The same writer recommends it as a salad "instead of watercresses."The medicinal use of Holy Thistle goes back far beyond the days of Tilke, or even Johnson. William Turner, Domestic Physician to the Lord Protector Somerset in the reign of King Edward VI, in his Herbal published 1568, agrees with Tilke that the herb is "very good for the headache and the megram."... holy thistleAerosols Asthmatic patients (see ASTHMA) ?nd aerosol devices to be of value in controlling their attacks. They provide an e?ective and convenient way of applying drugs directly to the bronchi, thus reducing the risks of unwanted effects accompanying SYSTEMIC therapy. BRONCHODILATOR aerosols contain either a beta-sympathomimetic agent or ipratropium bromide, which is an ANTICHOLINERGIC drug.
ISOPRENALINE was the ?rst compound to be widely used as an aerosol. It did however stimulate beta1 receptors in the heart as well as beta2 receptors in the bronchi, and so produced palpitations and even dangerous cardiac arrhythmias. Newer beta-adrenoceptor agonists are speci?c for the beta2 receptors and thus have a greater safety margin. They include SALBUTAMOL, TERBUTALINE, rimiterol, fenoterol and reproterol. Unwanted effects such as palpitations, tremor and restlessness are uncommon with these, more speci?c preparations. In patients who get insu?cient relief from the beta-adrenoreceptor agonist, the drug ipratropium bromide is worth adding. Salmeterol is a longer-acting choice for twice-daily administration: it is not intended for the relief of acute attacks, for which shorter-acting beta2 stimulants such as salbutamol should be used. Salmeterol should be added to existing corticosteroid therapy (see CORTICOSTEROIDS), rather than replacing it.
Patients must be taught carefully and observed while using their inhalers. It is important for them to realise that if the aerosol no longer gives more than slight transient relief, they should not increase the dose but seek medical help.... inhalants
Habitat: Pastures and meadows.
Features ? Stem grows from one to two feet, angular, tough, very much branched on alternate sides. Leaves dull green, hard appearance, downy underneath, irregularly notched edges, upper sessile, lower stalked. Flowers thistle-shaped ; reddish-purple, hair-like petals grow from nearly black, scaly knob. Fruit without pappus, surrounded by bristles. Taste, slightly salty.Part used ? Herb.Action: Tonic, diaphoretic, diuretic.
As a general tonic for most of the purposes for which Gentian is used. Knapweed is held in some quarters to equal Gentian in all-round efficacy, but the latter is much more frequently prescribed. The ounce to pint infusion is taken in wineglass doses.... knapweedThrill is caused by turbulent blood flow in an artery or the heart.
The term is also used to describe the feeling produced by fluid within the abdominal cavity in ascites.... thrill
Wrist-drop is caused by damage to the radial nerve, either by prolonged pressure in the armpit (see crutch palsy) or by fracture of the humerus (see humerus, fracture of).
Treatment involves holding the wrist straight.
This may be achieved by means of a splint, but if damage to the radial nerve is permanent, the usual treatment is arthrodesis (surgical fusion) of the wrist bones in a straight position.... wrist-drop
Normal values for a 60 kg man are (in ml):
Total lung capacity (TLC) The volume of air that can be held in the lungs at maximum inspiration.
Tidal volume (TV) The volume of air taken into and expelled from the lungs with each breath.
Inspiratory reserve volume (IRV) The volume of air that can still be inspired at the end of a normal quiet inspiration.
Expiratory reserve volume (ERV) The volume of air that can still be expired at the end of a normal quiet expiration.
Residual volume (RV) The volume of air remaining in the lungs after a maximal expiration.
Vital capacity (VC) The maximum amount of air that can be expired after a maximal inspiration.
Functional residual capacity (FRC) The volume of air left in the lungs at the end of a normal quiet expiration.... lung volumes
Two types of sperm cells are produced: one contains 22 autosomes and a Y sex chromosome (see SEX CHROMOSOMES); the other, 22 autosomes and an X sex chromosome. All the ova, however, produced by normal meiosis have 22 autosomes and an X sex chromosome.
Two divisions of the NUCLEUS occur (see also CELLS) and only one division of the chromosomes, so that the number of chromosomes in the ova and sperms is half that of the somatic cells. Each chromosome pair divides so that the gametes receive only one member of each pair. The number of chromosomes is restored to full complement at fertilisation so that the zygote has a complete set, each chromosome from the nucleus of the sperm pairing up with its corresponding partner from the ovum.
The ?rst stage of meiosis involves the pairing of homologous chromosomes which join together and synapse lengthwise. The chromosomes then become doubled by splitting along their length and the chromatids so formed are held together by centromeres. As the homologous chromosomes – one of which has come from the mother, and the other from the father – are lying together, genetic interchange can take place between the chromatids and in this way new combinations of GENES arise. All four chromatids are closely interwoven and recombination may take place between any maternal or any paternal chromatids. This process is known as crossing over or recombination. After this period of interchange, homologous chromosomes move apart, one to each pole of the nucleus. The cell then divides and the nucleus of each new cell now contains 23 and not 46 chromosomes. The second meiotic division then occurs, the centromeres divide and the chromatids move apart to opposite poles of the nucleus so there are still 23 chromosomes in each of the daughter nuclei so formed. The cell divides again so that there are four gametes, each containing a half number (haploid) set of chromosomes. However, owing to the recombination or crossing over, the genetic material is not identical with either parent or with other spermatozoa.... meiosis
Originally quarantine, as its name implies, involved detention for 40 days; but the period now covers the incubation period of the disease, the presence of which is suspected.
Numerous international conferences upon the subject have been held with the view of arriving at a uniform practice as regards quarantine in di?erent countries. The diseases to which quarantine applies are CHOLERA, YELLOW FEVER, PLAGUE, SMALLPOX, TYPHUS FEVER and RELAPSING FEVER.
The general practice with regard to quarantine is that when a serious disease breaks out in any country, the government of that country noti?es surrounding governments as to the ports and other places that have become centres of infection. Any people travelling from these centres and attempting to enter another country, are subject to measures prescribed in the appropriate regulations. These measures vary with the disease involved.... quarantine
A range of research investigations has developed within medical education. These apply to course monitoring, audit, development and validation, assessment methodologies and the application of educationally appropriate principles at undergraduate and postgraduate levels. Research is undertaken by medical educationalists whose backgrounds include teaching, social sciences and medicine and related health-care specialties, and who will hold a medical or general educational diploma, degree or other appropriate postgraduate quali?cation.
Development and validation for all courses are an important part of continuing accreditation processes. The relatively conservative courses at both undergraduate and postgraduate levels, including diplomas and postgraduate quali?cations awarded by the specialist medical royal colleges (responsible for standards of specialist education) and universities, have undergone a range of reassessment and rede?nition driven by the changing needs of the individual practitioner in the last decade. The stimuli to change aspects of medical training have come from the government through the former Chief Medical O?cer, Sir Kenneth Calman, and the introduction of new approaches to specialist training (the Calman programme), from the GENERAL MEDICAL COUNCIL (GMC) and its document Tomorrow’s Doctors, as well as from the profession itself through the activities of the British Medical Association and the medical royal colleges. The evolving expectations of the public in their perception of the requirements of a doctor, and changes in education of other groups of health professionals, have also led to pressures for changes.
Consequently, many new departments and units devoted to medical education within university medical schools, royal colleges and elsewhere within higher education have been established. These developments have built upon practice developed elsewhere in the world, particularly in North America, Australia and some European countries. Undergraduate education has seen application of new educational methods, including Problem-Based Learning (PBL) in Liverpool, Glasgow and Manchester; clinical and communications skills teaching; early patient contact; and the extensive adoption of Internet (World Wide Web) support and Computer-Aided Learning (CAL). In postgraduate education – driven by European directives and practices, changes in specialist training and the needs of community medicine – new courses have developed around the membership and fellowship examinations for the royal colleges. Examples of these changes driven by medical education expertise include the STEP course for the Royal College of Surgeons of England, and distance-learning courses for diplomas in primary care and rheumatology, as well as examples of good practice as adopted by the Royal College of General Practitioners.
Continuing Professional Development (CPD) and Continuing Medical Education (CME) are also important aspects of medical education now being developed in the United Kingdom, and are evolving to meet the needs of individuals at all stages of their careers.
Bodies closely involved in medical educational developments and their review include the General Medical Council, SCOPME (the Standing Committee on Postgraduate Medical Education), all the medical royal colleges and medical schools, and the British Medical Association through its Board of Medical Education. The National Health Service (NHS) is also involved in education and is a key to facilitation of CPD/CME as the major employer of doctors within the United Kingdom.
Several learned societies embrace medical education at all levels. These include ASME (the Association for the Study of Medical Education), MADEN (the Medical and Dental Education Network) and AMEE (the Association for Medical Education in Europe). Specialist journals are devoted to research reports relating to medical educational developments
(e.g. Academic Medicine, Health Care Education, Medical Education). The more general medical journals (e.g. British Medical Journal, New England Journal of Medicine, The Lancet, Annals of the Royal College of Surgeons) also carry articles on educational matters. Finally, the World Wide Web (WWW) is a valuable source of information relating to courses and course development and other aspects of modern medical education.
The UK government, which controls the number of students entering medical training, has recently increased the quota to take account of increasing demands for trained sta? from the NHS. More than 5,700 students – 3,300 women and 2,400 men – are now entering UK medical schools annually with nearly 28,600 at medical school in any one year, and an attrition rate of about 8–10 per cent. This loss may in part be due to the changes in university-funding arrangements. Students now pay all or part of their tuition fees, and this can result in medical graduates owing several thousand pounds when they qualify at the end of their ?ve-year basic quali?cation course. Doctors wishing to specialise need to do up to ?ve years (sometimes more) of salaried ‘hands-on’ training in house or registrar (intern) posts.
Though it may be a commonly held belief that most students enter medicine for humanitarian reasons rather than for the ?nancial rewards of a successful medical career, in developed nations the prospect of status and rewards is probably one incentive. However, the cost to students of medical education along with the widespread publicity in Britain about an under-resourced, seriously overstretched health service, with sta? working long hours and dealing with a rising number of disgruntled patients, may be affecting recruitment, since the number of applicants for medical school has dropped in the past year or so. Although there is still competition for places, planners need to bear this falling trend in mind.
Another factor to be considered for the future is the nature of the medical curriculum. In Britain and western Europe, the age structure of a probably declining population will become top-heavy with senior citizens. In the ?nancial interests of the countries affected, and in the personal interests of an ageing population, it would seem sensible to raise the pro?le of preventive medicine – traditionally rather a Cinderella subject – in medical education, thus enabling people to live healthier as well as longer lives. While learning about treatments is essential, the increasing specialisation and subspecialisation of medicine in order to provide expensive, high-technology care to a population, many of whom are suffering from preventable illnesses originating in part from self-indulgent lifestyles, seems insupportable economically, unsatisfactory for patients awaiting treatment, and not necessarily professionally ful?lling for health-care sta?. To change the mix of medical education would be a di?cult long-term task but should be worthwhile for providers and recipients of medical care.... medical education
It usually begins at puberty – although young children can be affected – and tends to stop in middle age: in women, for example, attacks often cease after MENOPAUSE. It frequently disappears during pregnancy. The disorder tends to run in families. In susceptible individuals, attacks may be provoked by a wide variety of causes including: anxiety, emotion, depression, shock, and excitement; physical and mental fatigue; prolonged focusing on computer, television or cinema screens; noise, especially loud and high-pitched sounds; certain foods – such as chocolate, cheese, citrus fruits, pastry; alcohol; prolonged lack of food; irregular meals; menstruation and the pre-menstrual period.
Anything that can provoke a headache in the ordinary individual can probably precipitate an attack in a migrainous subject. It seems as if there is an inherited predispostion that triggers a mechanism whereby in the migrainous subject, the headache and the associated sickness persist for hours, a whole day or even longer.
The precise cause is not known, but the generally accepted view is that in susceptible individuals, one or other of these causes produces spasm or constriction of the blood vessels of the brain. This in turn is followed by dilatation of these blood vessels which also become more permeable and so allow ?uid to pass out into the surrounding tissues. This combination of dilatation and outpouring of ?uid is held to be responsible for the headache.
Two types of migraine have been recognised: classical and common. The former is relatively rare and the headache is preceded by a slowly extending area of blindness in one or both eyes, usually accompanied by intermittent ‘lights’. The phenomenon lasts for up to 30 minutes and is followed by a bad, often unilateral headache with nausea, sometimes vomiting and sensitivity to light. Occasionally, passing neurological symptoms such as weakness in a limb may accompany the attack. The common variety has similar but less severe symptoms. It consists of an intense headache, usually situated over one or other eye. The headache is usually preceded by a feeling of sickness and disturbance of sight. In 15–20 per cent of cases this disturbance of sight takes the form of bright lights: the so-called AURA of migraine. The majority of attacks are accompanied by vomiting. The duration of the headache varies, but in the more severe cases the victim is usually con?ned to bed for 24 hours.
Treatment consists, in the ?rst place, of trying to avoid any precipitating factor. Patients must ?nd out which drug, or drugs, give them most relief, and they must always carry these about with them wherever they go. This is because it is a not uncommon experience to be aware of an attack coming on and to ?nd that there is a critical quarter of an hour or so during which the tablets are e?ective. If not taken within this period, they may be ine?ective and the unfortunate victim ?nds him or herself prostrate with headache and vomiting. In addition, sufferers should immediately lie down; at this stage a few hours’ rest may prevent the development of a full attack.
When an attack is fully developed, rest in bed in a quiet, darkened room is essential; any loud noise or bright light intensi?es the headache or sickness. The less food that is taken during an attack the better, provided that the individual drinks as much ?uid as he or she wants. Group therapy, in which groups of around ten migrainous subjects learn how to relax, is often of help in more severe cases, whilst in others the injection of a local anaesthetic into tender spots in the scalp reduces the number of attacks. Drug treatment can be e?ective and those a?icted by migraine may ?nd a particular drug or combination of drugs more suitable than others. ANALGESICS such as PARACETAMOL, aspirin and CODEINE phosphate sometimes help. A combination of buclizine hydrochloride and analgesics, taken when the visual aura occurs, prevents or diminishes the severity of an attack in some people. A commonly used remedy for the condition is ergotamine tartrate, which causes the dilated blood vessels to contract, but this must only be taken under medical supervision. In many cases METOCLOPRAMIDE (an antiemetic), followed ten minutes later by three tablets of either aspirin or paracetamol, is e?ective if taken early in an attack. In milder attacks, aspirin, with or without codeine and paracetamol, may be of value. SUMATRIPTAN (5-hydroxytryptamine [5HT1] AGONIST – also known as a SEROTONIN agonist) is of value for acute attacks. It is used orally or by subcutaneous injection, but should not be used for patients with ischaemic heart disease. Naratriptan is another 5HT1 agonist that is an e?ective treatment for acute attacks; others are almotriptan, rizariptan and zolmitriptan. Some patients ?nd beta blockers such as propranolol a valuable prophylactic.
People with migraine and their relatives can obtain help and guidance from the Migraine Action Association.... migraine
Nursing is changing rapidly, and today’s nurses are expected to take on an extended role – often performing tasks which were once the sole preserve of doctors, such as diagnosing, prescribing drugs and admitting and discharging patients.
There are four main branches of nursing: adult, child, mental health and learning disability. Student nurses qualify in one of these areas and then apply to go on the nursing register. This is held by nursing’s regulatory body, the Council for Nursing and Midwifery. Nurses are expected to abide by the Council’s Code of Professional Conduct. The organisation’s main role is protecting the public and it is responsible for monitoring standards and dealing with allegations of misconduct. There are more than 637,000 quali?ed nurses on the Council’s register, and this is the main pool from which the NHS and other employers recruit.
The criticisms about nurses’ education being too academic, and persisting problems of recruitment of nurses into the NHS, were among factors prompting a strategic government review of the status, training, pay and career opportunities for nurses and other health professionals. The new model emphasises the practical aspects of the education programme with a better response to the needs of patients and the NHS. It also o?ers nurses a more ?exible career path and education linked more closely with practice development and research, so as to provide greater scope for continuing professional education and development.
About 60 per cent of RNs work in NHS hospitals and community trusts. But an increasing number are choosing to work elsewhere, either in the private sector or in jobs such as school nursing, occupational health or for NHS Direct, the nurse-led telephone helpline. Others have dropped out of nursing altogether. The health service is facing a shortage of quali?ed nurses and many trust employers have resorted to overseas recruitment drives. The government has launched a major nurse recruitment and retention campaign and is promoting family-friendly employment practices to lure those with a nursing quali?cation currently working outside the NHS back into the workforce. Nursing is a mainly female profession and a third of nurses work part-time.
Nurses’ pay has for long compared unfavourably with other professional employment opportunities, despite being determined by an independent Pay Review Body. With the recruitment of nurses a perennial problem, the government’s strategy, Making a Di?erence, is to set up a new pay system o?ering greater ?exibility and opportunities for nurses and other health-service sta?. In 2005, a newly quali?ed sta? nurse earned around £16,000 a year, while one of the new grade of consultant nurses could command an annual salary of between £27,000 and £42,000. Nurse consultants were introduced in spring 2000 as a means of allowing nurses to progress up the career ladder while maintaining a clinical role.
The nurse of today is increasingly likely to be part of a multidisciplinary team, working alongside a range of other professionals from doctors and physiotherapists to social workers and teachers. A further sign of the times is that many registered nurses are being asked to act in a supervisory role, delegating tasks to nonregistered nurses working as health-care assistants and auxiliaries. In recognition of the latter’s increasing role, the Royal College of Nursing, the main professional association and trade union for nurses, has now agreed to extend membership to health-care assistants with a Scottish/National Vocational Quali?cation at level three.
Midwifery Midwives (see MIDWIFE) are practitioners who o?er advice and support to women before, during and after pregnancy. They are regulated by the Council for Nursing and Midwifery (formerly the UK Central Council for Nursing, Midwifery and Health Visiting). Registered nurses can take an 18month course to become a midwife, and there is also a three-year programme for those who wish to enter the profession directly. Midwifery courses lead to a diploma or degree-level quali?cation. Most midwives work for the NHS and, as with nursing, there are problems recruiting and retaining sta?.
Health visiting Health visitors are registered nurses who work in the community with a range of groups including families, the homeless and older people. They focus on preventing ill-health and o?er advice on a range of topics from diet to child behavioural problems. They are employed by health trusts, primary-care groups and primary-care trusts.... nursing
Ben: Dalim;
Tam: Madalai, Madalam;Mal: Urumampazham, Matalam, Talimatala m, Matalanarakam; Kan :Dalimbe;Tel: Dadima; Mar: Dalimba;Guj: Dadam; Ass: DalinImportance: Pomegranate has long been esteemed as food and medicine and as a diet in convalescence after diarrhoea. The rind of the fruit is highly effective in chronic diarrhoea and dysentery, dyspepsia, colitis, piles and uterine disorders. The powdered drug boiled with buttermilk is an efficacious reme dy for infantile diarrohoea. The root and stem bark are good for tapeworm and for strengthening the gums. The flowers are useful in vomiting, vitiated conditions of pitta, ophthalmodynia, ulcers, pharyngodynia and hydrocele. An extract of the flowers is very specific for epistaxis. The fruits are useful in anaemia, hyperdipsia, pharyngodynia, ophthalmodynia, pectoral diseases, splenopathy, bronchitis and otalgia. The fruit rind is good for dysentery, diarrhoea and gastralgia. Seeds are good for scabies, hepatopathy and splenopathy. The important preparations using the drug are Dadimadighrtam, Dadimastaka churnam, Hinguvacadi churnam, Hingvadi gulika, etc (Sivarajan et al, 1994, Warrier et al, 1995).Distribution: Pomegranate is a native of Iran, Afghanistan and Baluchistan. It is found growing wild in the warm valleys and outer hills of the Himalaya between 900m and 1800m altitude. It is cultivated throughout India, the largest area being in Maharastra.Botany: Punica granatum Linn. belongs to the family Punicaceace. It is a large deciduous shrub up to 10m in height with smooth dark grey bark and often spinescent branchlets. Leaves are opposite, glabrous, minutely pellucid-punctuate, shining above and bright green beneath. Flowers are scarlet red or sometime yellow, mostly solitary, sometimes 2-4 held together. Stamens are numerous and inserted on the calyx below the petals at various levels. Fruits are globose, crowned by the persistent calyx. Rind is coriaceous and woody, interior septate with membraneous walls containing numerous seeds. Seeds are angular with red, pink or whitish, fleshy testa (Warrier et al, 1995).Agrotechnology: Pomegranate is of deciduous nature in areas where winters are cold, but on the plains it is evergreen. A hot dry summer aids in the production of best fruits. Plants are grown from seeds as well as cuttings. Mature wood pieces cut into lengths of about 30cm are planted for rooting. The rooted plants are planted 4.5-6m apart. When planted close, they form a hedge which also yields fruits. Normal cultivation and irrigation practices are satisfactory for the pomegranate. An application of 30-45kg of FYM annually to each tree helps to produce superior quality fruits. The pomegranate may be trained as a tree with a single stem for 30-45cm or as a bush with 3 or 4 main stems. In either case suckers arising from the roots and similar growths from the trunk and main branches are removed once a year. Shortening of long slender branches and occasional thinning of branches should be done. The fruit has a tough rind and hence transportation loss is minimum (ICAR, 1966).Properties and activity: Pomegranate fruit rind gives an ellagitannin named granatin B, punicalagin, punicalin and ellagic acid. Bark contains the alkaloids such as iso-pelletierine, pseudopelletierine, methyl isopelletierine, methyl pelletierine, pelletierine as well as iso-quercetin, friedelin, D- mannitol and estrone. Flowers give pelargonidin-3, 5-diglucoside apart from sitosterol, ursolic acid, maslinic acid, asiatic acid, sitosterol- -D-glucoside and gallic acid. Seeds give malvidin pentose glycoside. Rind gives pentose glycosides of malvidin and pentunidin. Fluoride, calcium, magnesium, vitamin C and phosphate are also reported from fruits. Leaves give elligatannins-granatins A and B and punicafolin.Rind of fruit is astringent, fruit is laxative. Bark of stem and root is anthelmintic, and febrifuge. Rind of fruit and bark of stem and root is antidiarrhoeal. Pericarp possesses antifertility effect. Fixed oil from seeds are antibacterial. Bark, fruit pulp, flower and leaf are antifungal. Aerial part is CNS depressant, diuretic and hypothermic. The flower buds of pomegranate in combination with other plants showed excellent response to the patients of Giardiasis (Mayer et al, 1977; Singhal et al, 1983).... pomegranateHabitat: Woods and shady places.
Features ? Stem nearly simple, reddish, furrowed, up to two feet high. Leaves radical, palmate, long-stalked, glossy green above, paler underneath, serrate, nearly three inches across. White, sessile flowers, blooming in June and July. Taste astringent, becoming acrid.Part used ? Herb.Action: Astringent, alterative.
With more powerful alteratives in blood impurities. As an astringent in diarrhea and leucorrhea. Wineglass doses of the ounce to pint (boiling water) infusion are taken. Claims have been made for this herb in the treatment of consumption, and Skelton has given publicity to alleged cures. These cases are not now considered to have been proved.SARSAPARILLA, JAMAICA. Smilax ornata. N.O. Liliaceae.Synonym: Smilax medica, Smilax officinalis.Habitat: Sarsaparilla is imported from the West Indies and Mexico. Features ? The root, which is the only part used medicinally, is of a rusty-
brown colour and cylindrical in shape. It is a quarter of an inch to half an inch in diameter, has many slender rootlets, is deeply furrowed longitudinally, and the transverse section shows a brown, hard bark with a porous central portion. The taste is rather acrid, and there is no smell.The "Brown" Jamaica Sarsaparilla comes from Costa Rica. The Honduras variety reaches us in long, thin bundles with a few rootlets attached, and further supplies are imported from Mexico.First introduced by the Spaniards in 1563 as a specific for syphilis, this claim has long been disproved, although the root undoubtedly possesses active alterative principles. It is consequently now held in high regard as a blood purifier, and is usually administered with other alteratives, notably Burdock.Compound decoctions of Sarsaparilla are very popular as a springtime medicine, and Coffin's prescription will be found in the Herbal Formulas section of this volume.... sanicleDevelopment of such mechanical and biomechanical devices points the way to a much wider use of e?ective prostheses, enabling people who would previously have died or been severely handicapped to lead normal or near normal lives. The technical hazards that have already been overcome provide a sound foundation for future successes. Progress so far in producing prostheses should also ensure that organ replacement is free from the serious ethical problems that surround the use of genetic manipulation to cure or prevent serious diseases (see ETHICS).
Limbs These are best made to meet the individual’s requirements but can be obtained ‘o? the shelf’. Arti?cial joints normally comprise complex mechanisms to stimulate ?exion and rotation movements. Leg prostheses are generally more useful than those for arms, because leg movements are easier to duplicate than those of the arm. Modern electronic circuitry that enables nerve impulses to be picked up and converted into appropriate movements is greatly improving the e?ectiveness of limb prostheses.
Eyes Arti?cial eyes are worn both for appearance and for psychological reasons. They are made of glass or plastic, and are thin shells of a boat-shape, representing the front half of the eye which has been removed. The stump which is left has still the eye-muscles in it, and so the arti?cial eye still has the power of moving with the other. A glass eye has to be replaced by a new one every year. Plastic eyes have the advantage of being more comfortable to wear, being more durable, and being unbreakable. Research is taking place aimed at creating a silicon chip that stimulates the visual cortex and thus helps to restore sight to the blind.
Dental prostheses is any arti?cial replacement of a tooth. There are three main types: a crown, a bridge and a denture. A crown is the replacement of the part of a tooth which sticks through the gum. It is ?xed to the remaining part of the tooth and may be made of metal, porcelain, plastic or a combination of these. A bridge is the replacement of two or three missing teeth and is usually ?xed in place. The replacement teeth are held in position by being joined to one or more crowns on the adjacent teeth. A denture is a removable prosthesis used to replace some or all the teeth. The teeth are made of plastic or porcelain and the base may be of plastic or metal. Removable teeth may be held more ?rmly by means of implants.
Heart The surgical replacement of stenosed or malfunctioning heart-valves with metal or plastic, human or pig valves has been routinely carried out for many years. So too has been the insertion into patients with abnormal heart rhythms of battery-driven arti?cial pacemakers (see CARDIAC PACEMAKER) to restore normal function. The replacement of a faulty heart with an arti?cial one is altogether more challenging. The ?rst working attempt to create an arti?cial heart took place in the early 1980s. Called the Jarvik-7, it had serious drawbacks: patients had to be permanently connected to apparatus the size of an anaesthetic trolley; and it caused deaths from infection and clotting of the blood. As a result, arti?cial hearts have been used primarily as bridging devices to keep patients alive until a suitable donor heart for transplantation can be found. Recent work in North America, however, is developing arti?cial hearts made of titanium and dacron. One type is planted into the chest cavity next to the patient’s own heart to assist it in its vital function of pumping blood around the body. Another replaces the heart completely. Eventually, it is probable that arti?cial hearts will replace heart transplants as the treatment of choice in patients with serious heart disorders.
Liver Arti?cial livers work in a similar way to kidney dialysis machines (see DIALYSIS). Blood is removed from the body and passed through a machine where it is cleaned and treated and then returned to the patient. The core of the device comprises several thousand ?exible membrane tubules on which live liver cells (from pigs or people) have been cultured. There is an exchange of biological molecules and water with the ‘circulating’ blood, and the membrane also screens the ‘foreign’ cells from the patient’s immune system, thus preventing any antagonistic immune reaction in the recipient.
Nose The making of a new nose is the oldest known operation in plastic surgery, Hindu records of such operations dating back to 1,000 BC. Loss of a nose may be due to eroding disease, war wounds, gun-shot wounds or dog bites. In essence the operation is the same as that practised a thousand years before Christ: namely the use of a skin graft, brought down from the forehead. Alternative sources of the skin graft today are skin from the arm, chest or abdomen. As a means of support, the new nose is built round a graft of bone or of cartilage from the ear.... prosthesis
Habitat: Indigenous to the United States, the plant is also found in England on the banks of streams and in wet ditches.
First introduced by the Spaniards in 1563 as a specific for syphilis, this claim has long been disproved, although the root undoubtedly possesses active alterative principles. It is consequently now held in high regard as a blood purifier, and is usually administered with other alteratives, notably Burdock.Compound decoctions of Sarsaparilla are very popular as a springtime medicine, and Coffin's prescription will be found in the Herbal Formulae section of this volume.... scullcapHabitat: Hedges and woods.
Features ? The upright, woody but slender stem, branching from the upper part only, attains a height of between one and two feet. The leaves are stalkless and elliptical in shape, about half an inch long, grow in pairs on opposite sides of the stem and branches and, in addition to the transparent dots noticed above, are sometimes marked with black spots on the under side. Numerous bright yellow flowers, dotted and streaked with dark purple, cluster, in June and July, at the ends of side branches and stem. A bitter, astringent taste is remarked.Action: Expectorant, diuretic and astringent.
Indicated in coughs, colds, and disorders of the urinary system. It was prescribed more often by the English herbal school of a hundred years ago than it is to-day, and was noticed as far back as Culpeper for "wounds, hurts and bruises." Indeed, an infusion of the fresh flowers in Olive oil, to make the "Oil of St. John's Wort," is still used as an application to wounds, swellings, and ulcers. Internally, the infusion of 1 ounce of the herb to 1 pint of boiling water is taken in wineglass doses.In America St. John's Wort grows freely in the cornfields, which proximity was held by Tilke to operate beneficially upon both herb and grain. Discussing American wheat which has grown among quantities of St. John's Wort he tells us ? "It is well known, by almost every baker who works in his business, that this flour improves the quality of the bread, byhaving a small quantity of it in every batch, particularly in seasons when the English flour is of inferior quality. A clever author informs us that it contains one-fourth more gluten than our famous wheats grown in Gloucestershire, known by the name of 'rivets.' " Tilke was himself a baker in his early days.... st. john's wortHabitat: Waste places and on roadsides, particularly near buildings.
Features ? The tough, wiry, quadrangular, many-branched stem averages eighteeninches high. Roughish, pinnately-lobed, serrate leaves grow distantly and opposite in pairs ; the upper ones clasp the stem. while the lower ones are stalked. Small, light lilac-coloured flowers bloom in May, along thin, wiry spikes. Very bitter in taste, a slightly aromatic odour is given off when rubbed.Action: Nervine, tonic, emetic and sudorific.
The herb was held in high repute by those who brought the Thomsonian system to this country. Coffin, writing ninety years ago, says ? "As an emetic it ranks next to lobelia ; it is also one of the strongest sweating medicines in nature. It is good for colds, coughs and pain in the head, and some years ago was highly esteemed as a remedy for consumption. As an emetic it supersedes the use of antimony and ipecacuanha, to both of which it is superior, since it not only produces all the good effects ascribed to the others, but it operates without any of the dangerous consequences that ever attend the use of antimonial preparations, and cramps, and even death have been known to follow their use. . . . Vervain will relieve and cure those complaints in children which generally accompany teething; it likewise destroys worms. Administered as a tea, it powerfully assists the pains of labour ; as a diuretic it increases the urinary discharge."The ounce to pint infusion is now used, and taken in wineglass doses. As a nervine, Scullcap and Valerian are usually added.... vervainTouch 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
Action: antiseptic, antifungal, gastric tonic, nutritive, mild sedative. Oil has mild bactericidal and anti- fungal properties. Anti-dandruff, Carminative, Cholagogue, Vermifuge.
Uses: Weak digestion, poor appetite; hot and soothing to a ‘cold’ stomach. Urinary infections (decoction). Chest infections (berries). Rheumatic pains (seed oil, externally).
Reportedly used in cancer. (J.L. Hartwell, Lloydia, 32, 247, 1969)
Boosts insulin activity. (American Health, 1989, Nov 8, p96)
Preparations: Average dose: 2-4 grams. Thrice daily.
Decoction. 1oz crushed leaves to 1 pint water simmered down to three-quarters of its volume. Dose. Half a cup thrice daily.
Bay bath. Place crushed leaves in a small muslin bag and steep in hot water.
Diet: taken as a culinary herb with potatoes, salads, soups, etc. A source of oleic acid and linoleic acid.
Contact dermatitis may sometimes occur as an allergy on handling the oil. ... bay leaves
Symptoms. Morning stiffness and pain wearing off later. Easy fatigue and decline in health. Nodules on surface of bones (elbows, wrists, fingers). Joint fluids (synovia) appear to be the object of attack for which abundant Vitamin C is preventative. Anaemia and muscle wasting call attention to inadequate nutrition, possibly from faulty food habits for which liver and intestine herbs are indicated.
Treatment. Varies in accord with individual needs. May have to be changed many times before progress is made. Whatever treatment is prescribed, agents should have a beneficial effect upon the stomach and intestines to ensure proper absorption of active ingredients. (Meadowsweet)
It is a widely held opinion that the first cause of this condition is a bacterial pathogen. An anti- inflammatory herb should be included in each combination of agents at the onset of the disease. See: ANTI-INFLAMMATORY HERBS. Guaiacum (Lignum vitae) and Turmeric (Curcuma longa) have a powerful anti-inflammatory action and have no adverse effects upon bone marrow cells or suppress the body’s immune system. Breast feeding cuts RA death rate.
Of therapeutic value according to the case. Agrimony, Angelica root, Balmony, Black Cohosh (particularly in presence of low back pain and sciatica), Bogbean, Boldo, Burdock, Celery, Cramp bark, Devil’s Claw, Echinacea (to cleanse and stimulate lymphatic system), Ginseng (Korean), Ginseng (Siberian), Liquorice, Meadowsweet, Poke root, Prickly Ash bark, White Poplar bark, White Willow bark, Wild Yam.
Tea. Formula. Equal parts. Alfalfa, Bogbean, Nettles. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes, 1 cup thrice daily.
Decoction. Prickly Ash bark 1; Cramp bark 1; White Willow bark 2. Mix. 1oz to 1 pint water gently simmered 20 minutes. Dose: Half-1 cup thrice daily.
Tablets/capsules. Black Cohosh, Celery, Cramp bark, Devil’s Claw, Feverfew, Poke root, Prickly Ash, Wild Yam, Ligvites.
Alternative formulae:– Powders. White Willow bark 2; Devil’s Claw 1; Black Cohosh half; Ginger quarter. Mix. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Liquid extracts. White Willow bark 2; Wild Yam half; Liquorice half; Guaiacum quarter. Mix. Dose: 1-2 teaspoons thrice daily.
Tinctures. Cramp bark 1; Bogbean 1; Prickly Ash half; Meadowsweet 1; Fennel half. Mix. Dose: 1-3 teaspoons thrice daily.
Ligvites. (Gerard House)
Cod Liver oil. Contains organic iodine, an important factor in softening-up fibrous tissue, to assist metabolism of uric-acid, help formation of haemoglobin, dilate blood vessels; all related to arthritics. The oil, taken internally, can reach and nourish cartilage by the process of osmosis; its constituents filter into cartilage and impart increased elasticity.
Topical. Evening Primrose oil, Wintergreen lotion, Comfrey poultice. Hydrotherapy: hot fomentations of Hops, Chamomile or Ragwort. Cold water packs: crushed ice or packet of frozen peas in a damp towel applied daily for 10 minutes for stiffness and pain. See: MASSAGE OIL.
Aromatherapy. Massage oils, any one: Cajeput, Juniper, Pine or Rosemary. 6 drops to 2 teaspoons Almond oil.
Supportives: under-water massage, brush baths, sweat packs, Rosemary baths, exposure of joints to sunlight.
Diet. Low salt, low fat, oily fish, Mate tea, Dandelion coffee. On exacerbation of the disease cut out all dairy products.
Supplements. Daily. Evening Primrose capsules: four 500mg; Vitamin C (1-3g); Bromelain 250mg between meals; Zinc 25mg.
General. Residence in a warm climate. Yoga. Disability and deformity may be avoided by a conscientious approach to the subject. ... arthritis – rheumatoid
Constituents: alkaloids, flavonoids.
Action: cardiac stimulant, increasing force of the heart beat. Central nervous system stimulant. Tonic to sympathetic nervous system. Increases size of the heart-beat and reduces its frequency. Not an emergency agent such as Digitalis; requires time for action. Not a depressant.
Uses: Heart weakness with low blood pressure and valvular insufficiency. Rapid pulse with loss of body strength. “Chest held in a vice”. Unstable angina or coronary disease. Numbness of left arm. Relieves difficult breathing or congestion of the lungs of heart causation. As it has no known side-effects it enables heart sufferers to face the world with renewed confidence. Aneurism. Cholesterolised arteries, arteritis (temporal), heart murmur. Sexual neurasthenia, masturbation palpitation. Secondary prophylaxis following myocardial infarction.
Preparations: Thrice daily.
Tea. 2-3 flowers to each cup boiling water; infuse 15 minutes. Dose, one-third to half a cup. Liquid Extract: 1-8 drops.
Combination: Action is enhanced by addition of Motherwort and Oatstraw (equal parts). Tincture of Cereus, BPC 1934: dose 0.12 to 2ml (2-30 drops) in water. ... cactus
1. Agrimony. Those who suffer considerable inner torture which they try to dissemble behind a facade of cheerfulness.
2. Aspen. Apprehension and foreboding. Fears of unknown origin.
3. Beech. Critical and intolerant of others. Arrogant.
4. Centaury. Weakness of will; those who let themselves be exploited or imposed upon – become subservient; difficulty in saying ‘no’. Human doormat.
5. Cerato. Those who doubt their own judgement, seeks advice of others. Often influenced and misguided.
6. Cherry Plum. Fear of mental collapse/desperation/loss of control and fear of causing harm. Vicious rages.
7. Chestnut Bud. Refusal to learn by experience; continually repeating the same mistakes.
8. Chicory. The over-possessive, demands respect or attention (selfishness), likes others to conform to their standards. makes martyr of oneself.
9. Clematis. Indifferent, inattentive, dreamy, absent-minded. Mental escapist from reality.
10. Crab Apple. Cleanser. Feels unclean or ashamed of ailments. Self disgust/hatred. House proud.
11. Elm. Temporarily overcome by inadequacy or responsibility. Normally very capable.
12. Gentian. Despondent. Easily discouraged and dejected.
13. Gorse. Extreme hopelessness – pessimist – ‘Oh, what’s the use?’.
14. Heather. People who are obsessed with their own troubles and experiences. Talkative ‘bores’ – poor listeners.
15. Holly. For those who are jealous, envious, revengeful and suspicious. For those who hate.
16. Honeysuckle. For those with nostalgia and who constantly dwell in the past. Homesickness.
17. Hornbeam. ‘Monday morning’ feeling but once started, task is usually fulfilled. Procrastination.
18. Impatiens. Impatience, irritability.
19. Larch. Despondency due to lack of self-confidence; expectation of failure, so fails to make the attempt. Feels inferior though has the ability.
20. Mimulus. Fear of known things. Shyness, timidity.
21. Mustard. Deep gloom like an overshadowing dark cloud that descends for no known reason which can lift just as suddenly. Melancholy.
22. Oak. Brave determined types. Struggles on in illness and against adversity despite setbacks. Plodders.
23. Olive. Exhaustion – drained of energy – everything an effort.
24. Pine. Feelings of guilt. Blames self for mistakes of others. Feels unworthy.
25. Red Chestnut. Excessive fear and over caring for others especially those held dear.
26. Rock Rose. Terror, extreme fear or panic.
27. Rock Water. For those who are hard on themselves – often overwork. Rigid minded, self denying. 28. Scleranthus. Uncertainty/indecision/vacillation. Fluctuating moods.
29. Star of Bethlehem. For all the effect of serious news, or fright following an accident, etc.
30. Sweet Chestnut. Anguish of those who have reached the limit of endurance – only oblivion left.
31. Vervain. Over-enthusiasm, over-effort; straining. Fanatical and highly-strung. Incensed by injustices. 32. Vine. Dominating/inflexible/ambitious/tyrannical/autocratic. Arrogant Pride. Good leaders.
33. Walnut. Protection remedy from powerful influences, and helps adjustment to any transition or change, e.g. puberty, menopause, divorce, new surroundings.
34. Water Violet. Proud, reserved, sedate types, sometimes ‘superior’. Little emotional involvement but reliable/dependable.
35. White Chestnut. Persistent unwanted thoughts. Pre-occupation with some worry or episode. Mental arguments.
36. Wild Oat. Helps determine one’s intended path in life.
37. Wild Rose. Resignation, apathy. Drifters who accept their lot, making little effort for improvement – lacks ambition.
38. Willow. Resentment and bitterness with ‘not fair’ and ‘poor me’ attitude.
39. Rescue Remedy. A combination of Cherry Plum, Clematis, Impatiens, Rock Rose, Star of Bethlehem. All purpose emergency composite for causes of trauma, anguish, bereavement, examinations, going to the dentist, etc. ... bach remedies
Action: Haemostatic, astringent, anti-inflammatory, vulnerary, styptic tonic, antiseptic. A vaso- compressor to increase the vital potency of living matter of the ganglionic neurones. Anti-diarrhoea. For over-relaxed conditions.
Uses: Urinary system: frequency, incontinence in the young and aged, bed-wetting, blood in the urine. An ingredient of Captain Frank Roberts’ prescription for ulceration of stomach, duodenum and intestines. Ulceration of mouth and throat (tea used as a mouth wash and gargle). Irritable bowel. Summer diarrhoea of children.
Combines with Beth root (equal parts) as a vaginal douche for leucorrhoea or flooding of the menopause; with tincture Myrrh for cholera and infective enteritis.
Dr Wm Winder reported in the 1840s how the Indians of Great Manitoulin Island held it in high favour as a healing styptic antiseptic, “the powdered root being placed on the mouth of the bleeding vessel . . . Internally, they considered it efficacious for bleeding from the lungs”. (Virgil J. Vogel, University of Oklahoma Press, USA)
Preparations: Thrice daily.
Tea. Half-2 teaspoons dried herb to each cup boiling water; infuse 15 minutes. Half-1 cup.
Decoction. Half-1 teaspoon dried root to each cup water simmered gently 20 minutes. Half a cup.
Tablets BHP 270mg. (Gerard House)
Liquid extract: 15-30 drops.
Tincture BHP (1983). 1 part root to 5 parts 45 per cent alcohol. Dose: 2-4ml (30-60 drops).
Powdered root, as a snuff for excessive catarrh and to arrest bleeding from the nose.
Vaginal douche. 1oz root to 2 pints water simmered 20 minutes. Strain and inject. ... cranesbill, american
Symptoms. Low backache, bleeding after intercourse, between periods or after ‘the change’. Abdominal swelling after 40 years of age. Sixty per cent of patients have no symptoms. Malodorous vaginal discharge. A positive cervical “pap” smear or cone-shaped biopsy examined by a pathologist confirms. Vaginal bleeding occurs in the later stages.
A letter in the New England Journal of Medicine suggests a strong link between increased risk of cervical cancer and cigarette smoking, nicotine being detected in the cervical fluids of cigarette smokers. This form of cancer is almost unknown in virgins living in closed communities such as those of the Church.
Conventional treatment is usually hysterectomy. Whatever treatment is adopted little ground is lost by supportive cleansing herbal teas. Mullein for pain.
Sponges loaded with powdered Goldenseal held against the cervix with a contraceptive cap can give encouraging results. Replace after three days. Vitamin A supplements are valuable to protect against the disease. The vitamin may also be applied topically in creams.
This form of cancer resists chemical treatment, but has been slowed down and halted by Periwinkle (Vinchristine) without damaging normal cells.
G.B. Ibotson, MD, reported disappearance of cancer of the cervix by infusions of Violet leaves by mouth and by vaginal injection. (Lancet 1917, i, 224)
In a study group of cervical cancer patients it was found that women with carcinoma in situ (CIS) were more likely to have a total Vitamin A intake below the pooled median (3450iu). Vitamin A supplementation is indicated together with zinc. (Bio-availability of Vitamin A is linked with zinc levels.) Vitamin A and zinc may be applied topically in creams and ointments.
Orthodox treatment: radiotherapy, chemotherapy, hysterectomy. As oestrogen can stimulate dormant cells the surgeon may wish to remove ovaries also. Whatever the decision, herbal supportive treatment may be beneficial. J.T Kent, MD, recommends Thuja and Shepherd’s Purse. Agents commonly indicated: Echinacea, Wild Indigo, Thuja, Mistletoe, Wild Yam. Herbal teas may be taken with profit. Dr Alfred Vogel advises Mistletoe from the oak (loranthus europaeus).
Other alternatives:– Teas. Red Clover, Violet, Mistletoe, Plantain, Clivers. 1-2 teaspoons to each cup boiling water. Infuse 15 minutes. 1 cup freely.
Decoctions. White Pond Lily. Thuja. Echinacea. Wild Yam. Any one.
Tablets/capsules. Echinacea. Goldenseal. Wild Yam. Thuja.
Formula No. 1. Red Clover 2; Echinacea 1; Shepherd’s Purse 1; Thuja quarter. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Formula No. 2. Equal parts: Poke root, Goldenseal, Mistletoe. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons.
Diet. Women who eat large quantities of meat and fatty foods are up to four times the risk of those eating mainly fruit and vegetables.
Vaginal injection. 1. Strong infusion Red Clover to which 10-15 drops Tincture Goldenseal is added. Follow with tampon smeared with Goldenseal Salve.
2. Strong decoction Yellow Dock to which 10-15 drops Tincture Goldenseal is added. Follow with tampon smeared with Goldenseal salve.
If bleeding is severe douche with neat distilled extract of Witch Hazel.
Chinese Herbalism. See – CANCER: CHINESE PRESCRIPTION. Also: Decoction of ssu-hsieh-lu (Galium gracile) 2-4 liang.
Advice. One-yearly smear test for all women over 40.
Diet. See: DIET – CANCER.
Treatment by a general medical practitioner or hospital oncologist. ... cancer – womb
Cases of Down’s have followed use of nonoxynol-9 (vaginal contraceptive device) such as the polyurethane sponge. The sponge. when left in situ for a long time, may cause Down’s to follow.
Certain physical characteristics are present. The most important feature is impaired mental development. Almost all are coeliacs.
Symptoms. Low IQ, short fingers, small flat head, flattened nose, low-set ears. May be subject to umbilical hernia, and heart disease. No treatment can cure, but certain herb teas rich in minerals (Alfalfa, Red Clover) together with Kelp (either in tablet or powder form) may help children, with possible improvements in IQ. Vitamin supplements – A, D, Thiamine, Riboflavin, B6, B12, C and E improve a child’s physical and mental health – as do also the minerals: Magnesium, Calcium, Zinc, Manganese, Copper, Iron and Iodine.
Children with Down’s syndrome run an increased risk of coeliac disease, due to disturbed immunity. A substantial evidence is held in America that links a low level of Selenium in the mother. Unnecessary X- rays should be avoided. Ensure fitness before conception by gentle exercise and nutrients: Folic Acid, Selenium and Zinc.
Children with the condition are noted for their happy disposition and warmth of feeling towards others. ... down’s syndrome
Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.
Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.
The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.
For cholesterol control target the liver. Coffee is a minor risk factor.
Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)
Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)
Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.
Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.
Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.
Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.
Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.
Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.
Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.
Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.
Prevention: Vitamin E – 400iu daily.
Diet. See: DIET – HEART AND CIRCULATION.
Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.
Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease
Symptoms: difficult breathing. Breathing-in is noisy, spasmodic and prolonged. Effusion of a plastic-like material which coagulates to form a false membrane. Fretfulness. Symptoms of a ‘cold’ disappear but towards evening skin becomes hot, pulse rises, and a sense of anxiety takes over.
Laryngeal muscles are held in spasm, calling for antispasmodics. If the course of the disease has not been arrested on the third or fourth day a crisis is at hand and modern hospital treatment necessary. The condition is always worse at night. Treatment varies with each individual case. Stimulating diaphoretics induce gentle sweating, de-toxicate, and relieve tension on respiration.
Lobelia is unsurpassed as a croupal remedy and may be given alone either by infusion (tea) liquid extract or acid tincture. Given as a powder it works too slowly in a condition where speed saves lives.
While copious drinks of Catnep (Catmint) tea help, stronger medicines are indicated. Where resistance runs low, add Echinacea. Should any of these induce vomiting, it would be regarded as a favourable sign after which a measure of relief is felt.
Alternatives. Liquid extracts. Formula. Pleurisy root 2; Lobelia 1; Ginger half. Dose: one 5ml teaspoon in hot water every 2 hours. Infants: 10-30 drops.
Tinctures. Formula: Pleurisy root 2; Blue Cohosh 1; Lobelia 1. One to two 5ml teaspoons in hot water every 2 hours. Infants 10-20 drops.
Practitioner. Formula: 2 drops Tincture Belladonna BP 1980, 4 drops Tincture Ipecuanha BP 1973. Water to 2oz. One 5ml teaspoon in water every 15 minutes for 2 or 3 doses to enable child to sleep until morning; then once every hour or two for 3 days. Not to press medicines on children feeling comfortable. Inhalant. Friar’s Balsam. Steam kettle on hand. Or:–
Aromatherapy. Inhale. Drops. Thyme 1; Eucalyptus 2; Hyssop 1. In bowl of boiling water at the bedside at night or when necessary.
Drowsiness requires diffusive stimulants: Tinctures: Echinacea 2; Ginger quarter; Pleurisy root 1. One to two 5ml teaspoons in hot water every 2 hours; infants 5-20 drops according to age.
Collapse. When confronted with an ashen face, depression and collapse, powerful stimulants are necessary: tinctures – Formula. Prickly Ash bark 3; Blue Cohosh 2; Ginger 1. One 5ml teaspoon in hot water every 10 minutes; (infants 5-20 drops).
Topical. Relaxing oil. Ingredients: 3oz olive oil; half an ounce Liquid Extract or tincture Lobelia; Tincture Capsicum (Cayenne) 20 drops. Shake vigorously. Rub freely on throat, winding round a strip of suitable material wrung out in hot water. Cover with protective bandage or plastic film. Renew hot flannel every 10-15 minutes until paroxysms subside.
Poultice. Dissolve coffeespoon Cayenne powder or chillies in cup cider vinegar. Simmer gently 10 minutes. Strain. Saturate a piece of suitable material and wind round throat to relieve congested blood vessels.
Diet: No dairy foods which increase phlegm. No solid meals. Herb teas, vegetable and fruit juices only.
Steam kettle on hand, or Friar’s Balsam inhalation. See: FRIAR’S BALSAM. Regulate bowels. The condition is worsened in a dry hot atmosphere; reduce central heating to ensure adequate ventilation. Many a serious stridor and cough have been relieved by running some hot water into a bath or basin and sitting the child in a homemade Turkish bath.
Treatment by or in liaison with a general medical practitioner. ... croup
When elimination of body wastes is held up by a chronically-overloaded bowel general health may suffer. A constipated colon, with accumulations of hard faeces, obstructs peristalsis and loses its ability to evacuate effectively. Toxaemia follows, with gross interference of digestion of food.
As contents putrefy, toxins are re-absorbed, poisoning the blood. Such self-induced disease may lie at the root of sluggish liver function, skin disease, blood pressure, and aches in muscles similating rheumatism.
To clean out a clogged colon, injection of a herbal tea into the rectum not only proves effective but brings about a healthful purgation and release from tension. 2-3oz herb is brought to the boil in 1 gallon water, simmered for one minute, and allowed to cool. The tea is strained when warm and injected.
Enema herbs include: Soapwort, Chamomile, Marshmallow, Catmint, Raspberry leaves, Chickweed. Alternative: 20-30 drops Tincture Myrrh added to boiled water allowed to cool. ... hydrotherapy, colon
To establish efficacy of treatment for a named specific disease by herbs, the DHSS requires scientific data presented to the Regulatory authorities for consideration and approval.
A product is not considered a herbal remedy if its active principle(s) have been isolated and concentrated, as in the case of digitalis from the Foxglove. (MAL 2. Guidance notes)
A herbal product is one in which all active ingredients are of herbal origin. Products that contain both herbal and non-vegetable substances are not considered herbal remedies: i.e. Yellow Dock combined with Potassium Iodide.
The British Government supports freedom of the individual to make an informed choice of the type of therapy he or she wishes to use and has affirmed its policy not to restrict the general availability of herbal remedies. Provided products are safe and are not promoted by exaggerated claims, the future of herbal products is not at risk. A doctor with knowledge and experience of herbal medicine may prescribe them if he considers that they are a necessary part of treatment for his patient.
Herbalism is aimed at gently activating the body’s defence mechanisms so as to enable it to heal itself. There is a strong emphasis on preventative treatment. In the main, herbal remedies are used to relieve symptoms of self-limiting conditions. They are usually regarded as safe, effective, well-tolerated and with no toxicity from normal use. Some herbal medicines are not advised for children under 12 years except as advised by a manufacturer on a label or under the supervision of a qualified practitioner.
World Health Organisation Guidelines
The assessment of Herbal Medicines are regarded as:–
Finished, labelled medicinal products that contain as active ingredients aerial or underground parts of plants, or other plant material, or combinations thereof, whether in the crude state or as plant preparations. Plant material includes juices, gums, fatty oils, essential oils, and any other substances of this nature. Herbal medicines may contain excipients in addition to the active ingredients. Medicines containing plant material combined with chemically defined active substances, including chemically defined, isolated constituents of plants, are not considered to be herbal medicines.
Exceptionally, in some countries herbal medicines may also contain, by tradition, natural organic or inorganic active ingredients which are not of plant origin.
The past decade has seen a significant increase in the use of herbal medicines. As a result of WHO’s promotion of traditional medicine, countries have been seeking the assistance of WHO in identifying safe and effective herbal medicines for use in national health care systems. In 1989, one of the many resolutions adopted by the World Health Assembly in support of national traditional medicine programmes drew attention to herbal medicines as being of great importance to the health of individuals and communities (WHA 42.43). There was also an earlier resolution (WHA 22.54) on pharmaceutical production in developing countries; this called on the Director-General to provide assistance to the health authorities of Member States to ensure that the drugs used are those most appropriate to local circumstances, that they are rationally used, and that the requirements for their use are assessed as accurately as possible. Moreover, the Declaration of Alma-Ata in 1978 provided for inter alia, the accommodation of proven traditional remedies in national drug policies and regulatory measures. In developed countries, the resurgence of interest in herbal medicines has been due to the preference of many consumers for products of natural origin. In addition, manufactured herbal medicines from their countries of origin often follow in the wake of migrants from countries where traditional medicines play an important role.
In both developed and developing countries, consumers and health care providers need to be supplied with up-to-date and authoritative information on the beneficial properties, and possible harmful effects, of all herbal medicines.
The Fourth International Conference of Drug Regulatory Authorities, held in Tokyo in 1986, organised a workshop on the regulation of herbal medicines moving in international commerce. Another workshop on the same subject was held as part of the Fifth International Conference of Drug Regulatory Authorities, held in Paris in 1989. Both workshops confined their considerations to the commercial exploitation of traditional medicines through over-the-counter labelled products. The Paris meeting concluded that the World Health Organisation should consider preparing model guidelines containing basic elements of legislation designed to assist those countries who might wish to develop appropriate legislation and registration.
The objective of these guidelines, therefore, is to define basic criteria for the evaluation of quality, safety, and efficacy of herbal medicines and thereby to assist national regulatory authorities, scientific organisations, and manufacturers to undertake an assessment of the documentation/submission/dossiers in respect of such products. As a general rule in this assessment, traditional experience means that long-term use as well as the medical, historical and ethnological background of those products shall be taken into account. Depending on the history of the country the definition of long-term use may vary but would be at least several decades. Therefore the assessment shall take into account a description in the medical/pharmaceutical literature or similar sources, or a documentation of knowledge on the application of a herbal medicine without a clearly defined time limitation. Marketing authorisations for similar products should be taken into account. (Report of Consultation; draft Guidelines for the Assessment of Herbal Medicines. World Health Organisation (WHO) Munich, Germany, June 1991) ... herbal medicine
Hippocrates was aware of the universal law similia similibus curentur (like cures like). He taught that some diseases were cured by similars, and others by contraries. Stahl (1738) was also aware of this law of healing: “diseases will yield to and be cured by remedies that produce a similar affection”. But it was Samuel Hahnemann (1755-1843) who proved to the world this doctrine held the key to the selection of specifically acting medicines. His early experiments with nux vomica, arnica, ignatia and veratrum showed how the medicine which cured produced a similar condition in healthy people.
While no one has yet discovered the ‘modus operandi’ of the science, it has grown up largely through empiric experience, especially during certain historical epidemics in different parts of the world. For example, in 1836 cholera raged through most of the cities of Austria. Orthodox medicine could do little.
Out of desperation, the Government commissioned the aid of homoeopathy. A crude hospital was hastily prepared and patients admitted. Results convinced the most hardened sceptics. Physician-in-charge, Dr Fleischman, lost only 33 per cent, whereas other treatments showed a death rate of over 70 per cent.
It is said that reduction of inflammatory fevers by homoeopathic Aconite, Gelsemium, Baptisia and Belladonna played no small part in reducing the practice of blood-letting in the early 19th century.
Since Hahneman, homoeopathy has been the object of intense professional bitterness by its opponents but since the 1968 Medicines Act (UK) provision has been made for homoeopathic treatment on the “National Health Service”. Conversion of medical opinion has been gradual and today many registered medical practitioners also use the therapy.
“It is the general theory that the process of dilution and succussion (a vigorous shaking by the hand or by a machine) “potentises” a remedy.
“To prepare. A remedy is first prepared in solution as a “mother tincture”. In the decimal system of dilution a small quantity is then diluted ten times by the addition of nine parts by volume of diluent – either alcohol or water and then shaken vigorously by hand or machine (succussion). A small quantity of this is then diluted to one tenth and succussed a second time; this process is repeated again and again, producing solutions identified as 3x, 6x, 30x according to the number of times diluted. It may even be continued a thousand times (1 M). The resulting solutions are adsorbed on to an inert tablet or granules, usually of lactose, and in this form it is claimed that they remain therapeutically active indefinitely.
“For higher dilutions the centesimal system is used, when each dilution is by 1 in 100. The resulting solutions or tablets are referred to as 3C, 6C, 12C etc according to the number of times diluted.
“When dealing with a remedy which is insoluble, e.g. Carbo Veg, the first three dilutions and succussions are done in powder form, i.e. to “3x” beyond which the remedy is sufficiently soluble for further dilutions to proceed in liquid form.
“In homoeopathy a remedy may in some cases be given in a dilution so great that no single molecule of the original substance remains. The concept of “memory laden” water implies that the effect lies in a pattern impressed on the water molecules and that this is carried over from one dilution to the next.” (John Cosh MD., FRCP)
Homoeopathic medicines can stand most tests for safety, since it is widely held that they are completely safe and non-addictive, with no side-effects. ... homoeopathy
Oxytocic herbs for sustaining vigorous contractions are effective and may be used when necessary. Chief among them is Goldenseal (which is never used during pregnancy); dose, Liquid Extract 5 drops in water, or honey, every 20 minutes. A number of Indian tribes including the Potawatomis, held Blue Cohosh in high esteem, as an effective parturient. Dose: same as for Goldenseal.
False labour pains: Black Cohosh, Blue Cohosh, Black Horehound, Cramp bark, Motherwort, Helonias, Valerian, Wild Lettuce, Wild Yam.
Premature labour pains: Black Horehound, Blue Cohosh, Motherwort, Black Haw bark BHP (1983). Prolonged labour: to relax os. Feverfew, Lobelia, Ladyslipper, Blue Cohosh.
Practitioner use: Tincture Gelsemium 5 drops.
Labour contractions alarmingly inefficient: Black Cohosh, Blue Cohosh.
Post partum haemorrhage. To be given before completion of delivery: Marigold, Witch Hazel, Bayberry, Goldenseal. Dr T.J. Lyle strongly advises Beth root. ... labour
Symptoms. Spastic colon: colon held in spasm. The two main symptoms are abdominal pain and altered bowel habit. Pain relieved on going to stool or on passing wind. Diarrhoea with watery stools on rising may alternate with constipation. Sensation that the bowel is incompletely emptied. Flatulence. Passing of mucus between stools. The chronic condition may cause anaemia, weight loss and rectal blood calling for treatment of the underlying condition.
Indicated: astringents, demulcents, antispasmodics.
Treatment. If possible, start with 3-day fast.
Alternatives. Teas. (1) Combine equal parts; Agrimony (astringent), Hops (colon analgesic), Ephedra (anti-sensitive). (2) Combine equal parts; Meadowsweet (astringent) and German Chamomile (nervine and anti-inflammatory). Dose: 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup freely, as tolerated. Bilberry tea. 2 tablespoons fresh or dried Bilberries in 1 pint water simmered 10 minutes. Half-1 cup freely.
Note: Old European: Chamomile and Caraway seed tea. 1 cup morning and evening.
Decoction. Formula. Tormentil root 2; Bistort root 2; Valerian root 1. Dose: 2 teaspoons to each cup water simmered 20 minutes. Half-1 cup 3-4 times daily.
Tablets/capsules. Calamus. Cramp bark. Goldenseal. Slippery Elm, Cranesbill.
Formula. Cranesbill 2; Caraway 2; Valerian half. Dose: Powders: 750mg or half a teaspoon). Liquid Extracts: 1-2 teaspoons. Tinctures: 2-4 teaspoons. Thrice daily.
Practitioner. RX tea: equal parts herbs Peppermint, Balm and German Chamomile. Infuse 1-2 teaspoons in cup boiling water and add 3 drops Tincture Belladonna.
Formula. Tinctures. Black Catechu 2; Cranesbill 1; Hops quarter. Dose: 1-2 teaspoons in water or honey, thrice daily.
Psyllium seeds (Ispaghula). 2-5 teaspoons taken with sips of water, or as Normacol, Isogel, etc. For pain in bowel, Valerian.
Fenugreek seeds. 2 teaspoons to cup water simmered 10 minutes. Half-1 cup freely. Consume seeds. Cinnamon, tincture or essence: 30-60 drops in water 3-4 times daily.
Menstrual related irritable bowel. Evening Primrose.
Irritable Bowel Syndrome, with neurosis. Treat thyroid gland (Bugleweed, Kelp, etc).
With severe nerve stress: add CNS (central nervous system) relaxant (Hops, Ladies Slipper, Roman Chamomile)
Oil of Peppermint. A simple alternative. 3-5 drops in teaspoon honey, or in enteric-coated capsule containing 0.2ml standardised Peppermint oil B.P., (Ph.Eur.)
Intestinal antispasmodics: Valerian, Chamomile, Balm, Rosemary.
Diet. “People with IBS should stop drinking coffee as it can induce a desire to defecate.” (Hallamshire Hospital Research Team)
Dandelion coffee. Fenugreek tea. Carrot juice. Bananas mashed into a puree with Slippery Elm powder. Yoghurt. Gluten-free diet.
Supplements. Calcium lactate tablets: 2 × 300mg thrice daily at meals. Floradix. Lactobacillus acidophilus to counteract toxic bacteria. Vitamin C (2-4g). Zinc. Linusit.
Note: Serious depression may underlay the condition. Anti-depressants sometimes relieve symptoms dramatically.
Chronic cases. Referral to Gastrology Outpatient Department. ... irritable bowel syndrome (ibs)
Constituents: tannin, resin.
Action: nerve relaxant, autonomic regulator, mild pain-killer, thymoleptic. A fine brain and spinal remedy and should be at the hand of every spinal manipulator. Antidote to caffeine poisoning.
Use s. Nervous excitability, insomnia, irritability, neuralgia, muscle twitching, anxiety states, schizophrenia, pressive headache, nerve tension, epilepsy, pre-menstrual tension, spermatorrhoea, post- influenzal depression, weepiness.
“Yellow Lady’s Slipper was held in big esteem by the Indians as a sedative and an antispasmodic, acting like Valerian in alleviating nervous symptoms . . . said to have proved itself in hysteria and chorea.” (Virgil Vogel)
Combinations. (1) with Oats and Skullcap for anxiety states and (2) with Hops for insomnia with depression BHP (1983).
Preparations: Average dose: 2-4g. Thrice daily.
Tea. Half-1 teaspoon to each cupful water; bring to boil; simmer 2-3 minutes in covered vessel; infuse 15 minutes. Half-1 cup.
Liquid Extract BHP (1983) 1:1 in 45 per cent alcohol. Dose: 2-4ml.
Powder. Dose, 2-4g. ... lady’s slipper
Constituents: cardioactive glycosides, flavonoid glycosides.
Action: increases force of the heart, regularises the beat for distension of the ventricles. Restores an irritable heart. Increases size and strength of the pulse; slows down a rapid feeble pulse; restores regular deep breathing. Is a secondary diuretic which eliminates fluid retained in the tissues (oedema), leaving no depression or depletion of potassium. Cardiac stimulant. Mild gastric tonic.
Uses: Left ventricular failure, mitral insufficiency, sense that “the chest is held in a vice”. Congestive heart failure, endocarditis, cardiac dropsy with swollen ankles, cardiac asthma, renal hypertension. Effective in painful and silent ischaemic episodes. Bradycardia.
Combines well with Motherwort and Selenicereus grandiflorus for heart disease BHP (1983). With Echinacea and Poke root for endocarditis. Never combine with Gotu Kola. (Dr John Heinerman, Texas, USA)
Preparations: Maximum dose: 150mg dried leaf. Thrice daily.
Tea: 1 teaspoon shredded leaves to each cup water gently simmered 10 minutes. One-third of a cup. Liquid Extract BPC 1934: dose: 0.3-0.6ml (5 to 10 drops).
Tincture BHP (1983): 1:5 in 40 per cent alcohol; dose – 0.5 to 1ml (8 to 15 drops).
Juice. Fresh leaves passed through a juicer. 3-5 drops thrice daily.
Contra-indicated in high blood pressure. Sale: Pharmacy Only. ... lily of the valley
Constituents: flavonoids, volatile oil, allicin, vitamins, sterols, phenolic acids.
Action: hypoglycaemic, antibiotic, anticoagulant, expectorant, hypotensive, antibacterial, antisclerotic, anti-inflammatory, diuretic. Shares some of the properties of Garlic. Mild bacterical (fresh juice). Promotes bile flow, reduces blood sugar, stimulates the heart, coronary flow and systolic pressure.
Uses: Oedema, mild dropsy, high blood pressure. Inclusion in daily diet for those at risk from heart attack or stroke through low HDLs (high-density lipoprotein) levels.
“An Onion a day keeps arteriosclerosis at bay.” (Dr Victor Gurewich, Professor of Medicine, Tuft’s University, Boston, USA)
Onions clear arteries of fat which impedes blood flow. Of value for sour belching, cystitis, chilblains, insect bites, freckles. Two or three drops juice into the auditory meatus for earache and partial deafness. Burns and scalds (bruised raw Onion). Claimed that juice rubbed into the scalp arrests falling hair.
“I have observed that families using Onions freely as an article of diet have escaped epidemic diseases, although their neighbours might be having scarlet fever, etc. I believe Onions are reliable prophylactics. I have prevented the spread of contagious disease in the same household by their timely use.” (Dr L. Covert)
The traditional roasted Onion is still used as a poultice for softening hard tumours and pains of acute gout.
Preparations: Decoction. Water in which Onions are boiled is a powerful diuretic and may also be used for above disorders.
Home tincture. Macerate Onions for 8 days in Holland’s gin, shake daily; strain, bottle. 2-3 teaspoons in water, thrice daily for oedema, dropsy or gravel.
Note: A research team at the National Cancer Institute, China, has shown that the Onion family (Chives, Onions, Leeks and Garlic) can significantly reduce the risk of stomach cancer. ... onion
In normal, quiet breathing, only about a 10th of the air in the lungs passes out to be replaced by the same amount of fresh air (tidal volume). This new air mixes with the stale air (residual volume) already held in the lungs. The normal breathing rate for an adult at rest is 13–17 breaths per minute. (See also respiration.) At high altitudes, the lungs have to work harder in order to provide the body with sufficient oxygen (see mountain sickness). Breathlessness may occur in severe anaemia because abnormal or low levels of the oxygen-carrying pigment haemoglobin means that the lungs need to work harder to supply the body with oxygen. Breathing difficulty that intensifies on exertion may be caused by reduced circulation of blood through the lungs. This may be due to heart failure, pulmonary embolism, or pulmonary hypertension. Breathing difficulty due to air-flow obstruction may be caused by chronic bronchitis, asthma, an allergic reaction, or lung cancer. Breathing difficulty may also be due to inefficient transfer of oxygen from the lungs into the bloodstream. Temporary damage to lung tissue may be due to pneumonia, pneumothorax, pulmonary oedema, or pleural effusion. Permanent lung damage may be due to emphysema. Chest pain (for example, due to a broken rib) that is made worse by chest or lung movement can make normal breathing difficult and painful, as can pleurisy, which is associated with pain in the lower chest and often in the shoulder tip of the affected side. Abnormalities of the skeletal structure of the thorax (chest), such as severe scoliosis or kyphosis, may cause difficulty in breathing by impairing normal movements of the ribcage.... breathing
Divers with decompression sickness are immediately placed inside a recompression chamber. Pressure within the chamber is raised, causing the bubbles within the tissues to redissolve. Subsequently, the pressure in the chamber is slowly reduced, allowing the excess gas to escape safely via the lungs. If treated promptly, most divers with the “bends” make a full recovery. In serious, untreated cases, there may be long-term problems, such as paralysis.... decompression sickness
During a routine dental examination, the dentist uses a metal instrument to
probe for dental cavities, chipped teeth, or fillings. Dental X-rays are sometimes carried out to check for problems that may not be visible. Dentists also check how well the upper and lower teeth come together. Regular examinations in children enable the monitoring of the replacement of primary teeth by permanent, or secondary, teeth. Referral for orthodontic treatment may be made. dental extraction See tooth extraction. dental X-ray An image of the teeth and jaws that provides information for detecting, diagnosing, and treating conditions that can threaten oral and general health. There are 3 types of dental X-ray: periapical X-ray, bite-wing X-ray, and panoramic X-ray.
Periapical X-rays are taken using X-ray film held behind the teeth. They give detailed images of whole teeth and the surrounding tissues. They show unerupted or impacted teeth, root fractures, abscesses, cysts, and tumours, and can help diagnose some skeletal diseases. Bite-wing X-rays show the crowns of the teeth and can detect areas of decay and changes in bone due to periodontal disease. Panoramic X-rays show all the teeth and surrounding structures on one large film. They can show unerupted or impacted teeth, cysts, jaw fractures, or tumours. The amount of radiation received from dental X-rays is extremely small. However, dental X-rays should be avoided during pregnancy.... dental examination
In about another 5 per cent of cases, bacteria held in a dormant state by the immune system become reactivated months, or even years, later. The infection may then progressively damage the lungs, forming cavities.
The primary infection is usually without symptoms. Progressive infection in the lungs causes coughing (sometimes bringing up blood), chest pain, shortness of breath, fever and sweating, poor appetite, and weight loss. Pleural effusion or pneumothorax may develop. The lung damage may be fatal.
A diagnosis is made from the symptoms and signs, from a chest X-ray, and from tests on the sputum. Alternatively, a bronchoscopy may also be carried out to obtain samples for culture.
Treatment is usually with a course of 3 or 4 drugs, taken daily for 2 months, followed by daily doses of isoniazid and rifampicin for 4–6 months. However, bacteria are increasingly resistant to the drugs used in treatment, and others may have to be used and treatment carried out for a longer period. If the full course of drugs is taken, most patients recover.
can be prevented by BCG vaccination, which is offered routinely at birth or age 10–14.
Any contacts of an infected person are traced and examined, and, if infected, are treated early to reduce the risk of the infection spreading.... tuberculosis
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