Symptoms may include extravagant spending, repeatedly starting new tasks; sleeping less; increased appetite for food, alcohol, sex, and exercise; outbursts of inappropriate anger, laughter, or sudden socializing; and delusions of grandeur. If symptoms are mild, the condition is called hypomania.
Severe mania usually needs treatment in hospital with antipsychotic drugs. Relapses may be prevented by taking lithium or carbamazepine.... mania
Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.
Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.
There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.
Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder
Neuroblastomas are the most common extracranial (outside the skull), solid tumour of childhood. Most cases develop during the first 10 years of life, especially in the first 5.
Common symptoms include a lump in the abdomen, tiredness, weight loss, aches and pains, paleness, and irritability. Diarrhoea, high blood pressure, and flushing of the skin sometimes occur.
The diagnosis of a neuroblastoma is from MRI and CT scanning, blood tests, urine tests, and biopsy of the bone marrow and any accessible tumours. Treatment consists of surgical removal of the tumour, followed by radiotherapy. Anticancer drugs and a bone marrow transplant may also be required. The outlook varies because neuroblastomas range from being relatively harmless to aggressively cancerous.... neurasthenia
Habitat: The alpine Himalayas from Sikkim to Garhwal and Assam.
English: Indian Aconite, Wolfsbane, Monkshood.Ayurvedic: Vatsanaabha, Visha, Amrita, Vajraanga, Sthaavaravisha, Vatsanaagaka, Shrangikavisha, Garala.Unani: Bish, Bishnaag.Siddha/Tamil: Vasanaavi, Karunaab- hi.Folk: Bacchanaag, Bish, Mithaa Zahar, Telia Visha.Action: Narcotic, sedative, antilepro- tic, anti-inflammatory. Extremely poisonous. (Roots possess depressant activity, but after mitigation in cow's milk for 2-3 days, they exhibit stimulant activity.)
Key application: In neuralgia. (Aconitum napellus L. has been listed by German Commission E among unapproved herbs.)The root contains diterpenoid alkaloids, which act as a powerful poison that affects the heart and central nervous system. Aconitine has a shortlived cardiotonic action followed byHabitat: Cultivated at Manali and Rahla in Himachal Pradesh. Also found in northwestern Himalayas at altitudes ranging from 2,000 to 4,000 m.
English: Atis Root, Aconite.Ayurvedic: Ativishaa, Arunaa, Vishaa, Shuklakandaa, Bhanguraa, Ghunapriyaa, Ghunavallabhaa, Kaashmiraa, Shishubhaishajyaa (indicating its use in paediatrics), Vishwaa.Unani: Atees.Siddha/Tamil: Athividayam.Folk: Patis.Action: Often regarded as non- poisosnous, antiperiodic, anti- inflammatory, astringent (used in cough, diarrhoea, dyspepsia), tonic (used after fevers), febrifuge, antispasmodic (used in irritability of stomach and abdominal pains).
Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the dried, tuberous root in emesis and helminthi- asis.The roots yield 0.79% of total alkaloids, of which atisin is 0.4%. Atisine is much less toxic than aconitine and pseudoaconitine. (The inert character of the plant is well known to the hill people, who often use it as a vegetable.) The plant possesses potent immuno- stimulant properties.Dosage: Root—0.6-2.08 g. (API Vol. I.)... aconitum heterophyllumPregnancy lasts about 280 days and is calculated from the ?rst day of the last menstrual period – see MENSTRUATION. Pregnancy-testing kits rely on the presence of the hormone beta HUMAN CHORIONIC GONADOTROPHIN (b HCG) which is excreted in the woman’s urine as early as 30 days from the last menstrual period. The estimated date of delivery can be accurately estimated from the size of the developing fetus measured by ULTRASOUND (see also below) between seven and 24 weeks. ‘Term’ refers to the time that the baby is due; this can range from 38 weeks to 41 completed weeks.
Physical changes occur in early pregnancy – periods stop and the abdomen enlarges. The breasts swell, with the veins becoming prominent and the nipples darkening. About two in three women will have nausea with a few experiencing such severe vomiting as to require hospital admission for rehydration.
Antenatal care The aim of antenatal care is to ensure a safe outcome for both mother and child; it is provided by midwives (see MIDWIFE) and doctors. Formal antenatal care began in Edinburgh in the 1930s with the recognition that all aspects of pregnancy – normal and abnormal – warranted surveillance. Cooperation between general practitioners, midwives and obstetricians is now established, with pregnancies that are likely to progress normally being cared for in the community and only those needing special intervention being cared for in a hospital setting.
The initial visit (or booking) in the ?rst half of pregnancy will record the history of past events and the results of tests, with the aim of categorising the patients into normal or not. Screening tests including blood checks and ultrasound scans are a routine part of antenatal care. The ?rst ultrasound scan is done at about 11 weeks to date the pregnancy, with a further one done at 20 weeks – the anomaly scan – to assess the baby’s structure. Some obstetric units will check the growth of the baby with one further scan later in the pregnancy or, in the case of twin pregnancies (see below), many scans throughout. The routine blood tests include checks for ANAEMIA, DIABETES MELLITUS, sickle-cell disease and THALASSAEMIA, as well as for the blood group. Evidence of past infections is also looked for; tests for RUBELLA (German measles) and SYPHILIS are routine, whereas tests for human immunode?ciency virus (see AIDS/ HIV below) and HEPATITIS are being o?ered as optional, although there is compelling evidence that knowledge of the mother’s infection status is bene?cial to the baby.
Traditional antenatal care consists of regular appointments, initially every four weeks until 34 weeks, then fortnightly or weekly. At each visit the mother’s weight, urine and blood pressure are checked, and assessment of fetal growth and position is done by palpating the uterus. Around two-thirds of pregnancies and labours are normal: in the remainder, doctors and midwives need to increase the frequency of surveillance so as to prevent or deal with maternal and fetal problems.
Common complications of pregnancy
Some of the more common complications of pregnancy are listed below.
As well as early detection of medical complications, antenatal visits aim to be supportive and include emotional and educational care. Women with uncomplicated pregnancies are increasingly being managed by midwives and general practitioners in the community and only coming to the hospital doctors should they develop a problem. A small number will opt for a home delivery, but facilities for providing such a service are not always available in the UK.
Women requiring more intensive surveillance have their management targeted to the speci?c problems encountered. Cardiologists will see mothers-to-be with heart conditions, and those at risk of diabetes are cared for in designated clinics with specialist sta?. Those women needing more frequent surveillance than standard antenatal care can be looked after in maternity day centres. These typically include women with mildly raised blood pressure or those with small babies. Fetal medicine units have specialists who are highly skilled in ultrasound scanning and specialise in the diagnosis and management of abnormal babies still in the uterus. ECTOPIC PREGNANCY Chronic abdominal discomfort early in pregnancy may be caused by unruptured ectopic pregnancy, when, rarely, the fertilised OVUM starts developing in the Fallopian tube (see FALLOPIAN TUBES) instead of the uterus. The patient needs hospital treatment and LAPAROSCOPY. A ruptured ectopic pregnancy causes acute abdominal symptoms and collapse, and the woman will require urgent abdominal surgery. URINARY TRACT INFECTIONS These affect around 2 per cent of pregnant women and are detected by a laboratory test of a mid-stream specimen of urine. In pregnancy, symptoms of these infections do not necessarily resemble those experienced by non-pregnant women. As they can cause uterine irritability and possible premature labour (see below), it is important to ?nd and treat them appropriately. ANAEMIA is more prevalent in patients who are vegetarian or on a poor diet. Iron supplements are usually given to women who have low concentrations of HAEMOGLOBIN in their blood (less than 10.5 g/dl) or who are at risk of becoming low in iron, from bleeding, twin pregnancies and those with placenta previa (see below). ANTEPARTUM HAEMORRHAGE Early in pregnancy, vaginal bleedings may be due to a spontaneous or an incomplete therapeutic ABORTION. Bleeding from the genital tract between 24 completed weeks of pregnancy and the start of labour is called antepartum haemorrhage. The most common site is where the PLACENTA is attached to the wall of the uterus. If the placenta separates before delivery, bleeding occurs in the exposed ‘bed’. When the placenta is positioned in the upper part of the uterus it is called an abruption. PLACENTA PRAEVIA is sited in the lower part and blocks or partly blocks the cervix (neck of the womb); it can be identi?ed at about the 34th week. Ten per cent of episodes of antepartum bleeding are caused by placenta previa, and it may be associated with bleeding at delivery. This potentially serious complication is diagnosed by ultrasound scanning and may require a caesarean section (see below) at delivery. INCREASED BLOOD PRESSURE, associated with protein in the urine and swelling of the limbs, is part of a condition known as PRE-ECLAMPSIA. This occurs in the second half of pregnancy in about 1 in 10 women expecting their ?rst baby, and is mostly very mild and of no consequence to the pregnancy. However, some women can develop extremely high blood pressures which can adversely affect the fetus and cause epileptic-type seizures and bleeding disorders in the mother. This serious condition is called ECLAMPSIA. For this reason a pregnant woman with raised blood pressure or PROTEIN in her urine is carefully evaluated with blood tests, often in the maternity day assessment unit. The condition can be stopped by delivery of the baby, and this will be done if the mother’s or the fetus’s life is in danger. If the condition is milder, and the baby not mature enough for a safe delivery, then drugs can be used to control the blood pressure. MISCARRIAGE Also called spontaneous abortion, miscarriage is the loss of the fetus. There are several types:
threatened miscarriage is one in which some vaginal bleeding occurs, the uterus is enlarged, but the cervix remains closed and pregnancy usually proceeds.
inevitable miscarriage usually occurs before the 16th week and is typi?ed by extensive blood loss through an opened cervix and cramp-like abdominal pain; some products of conception are lost but the developing placental area (decidua) is retained and an operation may be necessary to clear the womb.
missed miscarriages, in which the embryo dies and is absorbed, but the decidua (placental area of uterine wall) remains and may cause abdominal discomfort and discharge of old blood.
THERAPEUTIC ABORTION is performed on more than 170,000 women annually in England and Wales. Sometimes the woman may not have arranged the procedure through the usual health-care channels, so that a doctor may see a patient with vaginal bleeding, abdominal discomfort or pain, and open cervix – symptoms which suggest that the decidua and a blood clot have been retained; these retained products will need to be removed by curettage.
Septic abortions are now much less common in Britain than before the Abortion Act (1967) permitted abortion in speci?ed circumstances. The cause is the passage of infective organisms from the vagina into the uterus, with Escherichia coli and Streptococcus faecalis the most common pathogenic agents. The woman has abdominal pain, heavy bleeding, usually fever and sometimes she is in shock. The cause is usually an incomplete abortion or one induced in unsterile circumstances. Antibiotics and curettage are the treatment. INTRAUTERINE GROWTH RETARDATION describes a slowing of the baby’s growth. This can be diagnosed by ultrasound scanning, although there is a considerable margin of error in estimates of fetal weight. Trends in growth are favoured over one-o? scan results alone. GESTATIONAL DIABETES is a condition that is more common in women who are overweight or have a family member with diabetes. If high concentrations of blood sugar are found, e?orts are made to correct it as the babies can become very fat (macrosomia), making delivery more di?cult. A low-sugar diet is usually enough to control the blood concentration of sugars; however some women need small doses of INSULIN to achieve control. FETAL ABNORMALITIES can be detected before birth using ultrasound. Some of these defects are obvious, such as the absence of kidneys, a condition incompatible with life outside the womb. These women can be o?ered a termination of their pregnancy. However, more commonly, the pattern of problems can only hint at an abnormality and closer examination is needed, particularly in the diagnosis of chromosomal deformities such as DOWN’S (DOWN) SYNDROME (trisomy 21 or presence of three 21 chromosomes instead of two).
Chromosomal abnormalities can be de?nitively diagnosed only by cell sampling such as amniocentesis (obtaining amniotic ?uid – see AMNION – from around the baby) done at 15 weeks onwards, and chorionic villus sampling (sampling a small part of the placenta) – another technique which can be done from 12 weeks onwards. Both have a small risk of miscarriage associated with them; consequently, they are con?ned to women at higher risk of having an abnormal fetus.
Biochemical markers present in the pregnant woman’s blood at di?erent stages of pregnancy may have undergone changes in those carrying an abnormal fetus. The ?rst such marker to be routinely used was a high concentration of alpha-fetol protein in babies with SPINA BIFIDA (defects in the covering of the spinal cord). Fuller research has identi?ed a range of diagnostic markers which are useful, and, in conjunction with other factors such as age, ethnic group and ultrasound ?ndings, can provide a predictive guide to the obstetrician – in consultation with the woman – as to whether or not to proceed to an invasive test. These tests include pregnancy-associated plasma protein assessed from a blood sample taken at 12 weeks and four blood tests at 15–22 weeks – alphafetol protein, beta human chorionic gonadotrophin, unconjugated oestriol and inhibin A. Ultrasound itself can reveal physical ?ndings in the fetus, which can be more common in certain abnormalities. Swelling in the neck region of an embryo in early pregnancy (increased nuchal thickness) has good predictive value on its own, although its accuracy is improved in combination with the biochemical markers. The e?ectiveness of prenatal diagnosis is rapidly evolving, the aim being to make the diagnosis as early in the pregnancy as possible to help the parents make more informed choices. MULTIPLE PREGNANCIES In the UK, one in 95 deliveries is of twins, while the prevalence of triplets is one in 10,000 and quadruplets around one in 500,000. Racial variations occur, with African women having a prevalence rate of one in 30 deliveries for twins and Japanese women a much lower rate than the UK ?gure. Multiple pregnancies occur more often in older women, and in the UK the prevalence of fertility treatments, many of these being given to older women, has raised the incidence. There is now an o?cial limit of three eggs being transferred to a woman undergoing ASSISTED CONCEPTION (gamete intrafallopian transfer, or GIFT).
Multiple pregnancies are now usually diagnosed as a result of routine ultrasound scans between 16 and 20 weeks of pregnancy. The increased size of the uterus results in the mother having more or worse pregnancy-related conditions such as nausea, abdominal discomfort, backache and varicose veins. Some congenital abnormalities in the fetus occur more frequently in twins: NEURAL TUBE defects, abnormalities of the heart and the incidence of TURNER’S SYNDROME and KLINEFELTER’S SYNDROME are examples. Such abnormalities may be detected by ultrasound scans or amniocentesis. High maternal blood pressure and anaemia are commoner in women with multiple pregnancies (see above).
The growth rates of multiple fetuses vary, but the di?erence between them and single fetuses are not that great until the later stages of pregnancy. Preterm labour is commoner in multiple pregnancies: the median length of pregnancy is 40 weeks for singletons, 37 for twins and 33 for triplets. Low birth-weights are usually the result of early delivery rather than abnormalities in growth rates. Women with multiple pregnancies require more frequent and vigilant antenatal assessments, with their carers being alert to the signs of preterm labour occurring. CEPHALOPELVIC DISPROPORTION Disparity between the size of the fetus and the mother’s pelvis is not common in the UK but is a signi?cant problem in the developing world. Disparity is classi?ed as absolute, when there is no possibility of delivery, and relative, when the baby is large but delivery (usually after a dif?cult labour) is possible. Causes of absolute disparity include: a large baby – heavier than 5 kg at birth; fetal HYDROCEPHALUS; and an abnormal maternal pelvis. The latter may be congenital, the result of trauma or a contraction in pelvic size because of OSTEOMALACIA early in life. Disproportion should be suspected if in late pregnancy the fetal head has not ‘engaged’ in the pelvis. Sometimes a closely supervised ‘trial of labour’ may result in a successful, if prolonged, delivery. Otherwise a caesarean section (see below) is necessary. UNUSUAL POSITIONS AND PRESENTATIONS OF THE BABY In most pregnant women the baby ?ts into the maternal pelvis head-?rst in what is called the occipito-anterior position, with the baby’s face pointing towards the back of the pelvis. Sometimes, however, the head may face the other way, or enter the pelvis transversely – or, rarely, the baby’s neck is ?exed backwards with the brow or face presenting to the neck of the womb. Some malpositions will correct naturally; others can be manipulated abdominally during pregnancy to a better position. If, however, the mother starts labour with the baby’s head badly positioned or with the buttocks instead of the head presenting (breech position), the labour will usually be longer and more di?cult and may require intervention using special obstetric forceps to assist in extracting the baby. If progress is poor and the fetus distressed, caesarean section may be necessary. HIV INFECTION Pregnant women who are HIV positive (see HIV; AIDS/HIV) should be taking antiviral drugs in the ?nal four to ?ve months of pregnancy, so as to reduce the risk of infecting the baby in utero and during birth by around 50 per cent. Additional antiviral treatment is given before delivery; the infection risk to the baby can be further reduced – by about 40 per cent – if delivery is by caesarean section. The mother may prefer to have the baby normally, in which case great care should be taken not to damage the baby’s skin during delivery. The infection risk to the baby is even further reduced if it is not breast fed. If all preventive precautions are taken, the overall risk of the infant becoming infected is cut to under 5 per cent.
Premature birth This is a birth that takes place before the end of the normal period of gestation, usually before 37 weeks. In practice, however, it is de?ned as a birth that takes place when the baby weighs less than 2·5 kilograms (5••• pounds). Between 5 and 10 per cent of babies are born prematurely, and in around 40 per cent of premature births the cause is unknown. Pre-eclampsia is the most common known cause; others include hypertension, chronic kidney disease, heart disease and diabetes mellitus. Multiple pregnancy is another cause. In the vast majority of cases the aim of management is to prolong the pregnancy and so improve the outlook for the unborn child. This consists essentially of rest in bed and sedation, but there are now several drugs, such as RITODRINE, that may be used to suppress the activity of the uterus and so help to delay premature labour. Prematurity was once a prime cause of infant mortality but modern medical care has greatly improved survival rates in developing countries.
Labour Also known by the traditional terms parturition, childbirth or delivery, this is the process by which the baby and subsequently the placenta are expelled from the mother’s body. The onset of labour is often preceded by a ‘show’ – the loss of the mucus and blood plug from the cervix, or neck of the womb; this passes down the vagina to the exterior. The time before the beginning of labour is called the ‘latent phase’ and characteristically lasts 24 hours or more in a ?rst pregnancy. Labour itself is de?ned by regular, painful contractions which cause dilation of the neck of the womb and descent of the fetal head. ‘Breaking of the waters’ is the loss of amniotic ?uid vaginally and can occur any time in the delivery process.
Labour itself is divided into three stages: the ?rst is from the onset of labour to full (10 cm) dilation of the neck of the womb. This stage varies in length, ideally taking no more than one hour per centimetre of dilation. Progress is monitored by regular vaginal examinations, usually every four hours. Fetal well-being is observed by intermittent or continuous monitoring of the fetal heart rate in relation to the timing and frequency of the contractions. The print-out is called a cardiotocograph. Abnormalities of the fetal heart rate may suggest fetal distress and may warrant intervention. In women having their ?rst baby (primigravidae), the common cause of a slow labour is uncoordinated contractions which can be overcome by giving either of the drugs PROSTAGLANDIN or OXYTOCIN, which provoke contractions of the uterine muscle, by an intravenous drip. Labours which progress slowly or not at all may be due to abnormal positioning of the fetus or too large a fetus, when prostaglandin or oxytocin is used much more cautiously.
The second stage of labour is from full cervical dilation to the delivery of the baby. At this stage the mother often experiences an irresistible urge to push the baby out, and a combination of strong coordinated uterine contractions and maternal e?ort gradually moves the baby down the birth canal. This stage usually lasts under an hour but can take longer. Delay, exhaustion of the mother or distress of the fetus may necessitate intervention by the midwife or doctor. This may mean enlarging the vaginal opening with an EPISIOTOMY (cutting of the perineal outlet – see below) or assisting the delivery with specially designed obstetric forceps or a vacuum extractor (ventouse). If the cervix is not completely dilated or open and the head not descended, then an emergency caesarean section may need to be done to deliver the baby. This procedure involves delivering the baby and placenta through an incision in the mother’s abdomen. It is sometimes necessary to deliver by planned or elective caesarean section: for example, if the placenta is low in the uterus – called placenta praevia – making a vaginal delivery dangerous.
The third stage occurs when the placenta (or afterbirth) is delivered, which is usually about 10–20 minutes after the baby. An injection of ergometrine and oxytocin is often given to women to prevent bleeding.
Pain relief in labour varies according to the mother’s needs. For uncomplicated labours, massage, reassurance by a birth attendant, and a warm bath and mobilisation may be enough for some women. However, some labours are painful, particularly if the woman is tired or anxious or is having her ?rst baby. In these cases other forms of analgesia are available, ranging from inhalation of NITROUS OXIDE GAS, injection of PETHIDINE HYDROCHLORIDE or similar narcotic, and regional local anaesthetic (see ANAESTHESIA).
Once a woman has delivered, care continues to ensure her and the baby’s safety. The midwives are involved in checking that the uterus returns to its normal size and that there is no infection or heavy bleeding, as well as caring for stitches if needed. The normal blood loss after birth is called lochia and generally is light, lasting up to six weeks. Midwives o?er support with breast feeding and care of the infant and will visit the parents at home routinely for up to two weeks.
Some complications of labour All operative deliveries in the UK are now done in hospitals, and are performed if a spontaneous birth is expected to pose a bigger risk to the mother or her child than a specialist-assisted one. Operative deliveries include caesarean section, forceps-assisted deliveries and those in which vacuum extraction (ventouse) is used. CAESAREAN SECTION Absolute indications for this procedure, which is used to deliver over 15 per cent of babies in Britain, are cephalopelvic disproportion and extensive placenta praevia, both discussed above. Otherwise the decision to undertake caesarean section depends on the clinical judgement of the specialist and the views of the mother. The rise in the proportion of this type of intervention (from 5 per cent in the 1930s to its present level of over 23 per cent
P
of the 600,000 or so annual deliveries in England) has been put down to defensive medicine
– namely, the doctor’s fear of litigation (initiated often because the parents believe that the baby’s health has suffered because the mother had an avoidably di?cult ‘natural’ labour). In Britain, over 60 per cent of women who have had a caesarean section try a vaginal delivery in a succeeding pregnancy, with about two-thirds of these being successful. Indications for the operation include:
absolute and relative cephalopelvic disproportion.
placenta previa.
fetal distress.
prolapsed umbilical cord – this endangers the viability of the fetus because the vital supply of oxygen and nutrients is interrupted.
malpresentation of the fetus such as breech or transverse lie in the womb.
unsatisfactory previous pregnancies or deliveries.
a request from the mother.
Caesarean sections are usually performed using regional block anaesthesia induced by a spinal or epidural injection. This results in loss of feeling in the lower part of the body; the mother is conscious and the baby not exposed to potential risks from volatile anaesthetic gases inhaled by the mother during general anaesthesia. Post-operative complications are higher with general anaesthesia, but maternal anxiety and the likelihood that the operation might be complicated and di?cult are indications for using it. A general anaesthetic may also be required for an acute obstetric emergency. At operation the mother’s lower abdomen is opened and then her uterus opened slowly with a transverse incision and the baby carefully extracted. A transverse incision is used in preference to the traditional vertical one as it enables the woman to have a vaginal delivery in any future pregnancy with a much smaller risk of uterine rupture. Women are usually allowed to get up within 24 hours and are discharged after four or ?ve days. FORCEPS AND VENTOUSE DELIVERIES Obstetric forceps are made in several forms, but all are basically a pair of curved blades shaped so that they can obtain a purchase on the baby’s head, thus enabling the operator to apply traction and (usually) speed up delivery. (Sometimes they are used to slow down progress of the head.) A ventouse or vacuum extractor comprises an egg-cup-shaped metal or plastic head, ranging from 40 to 60 mm in diameter with a hollow tube attached through which air is extracted by a foot-operated vacuum pump. The instrument is placed on the descending head, creating a negative pressure on the skin of the scalp and enabling the operator to pull the head down. In mainland Europe, vacuum extraction is generally preferred to forceps for assisting natural deliveries, being used in around 5 per cent of all deliveries. Forceps have a greater risk of causing damage to the baby’s scalp and brain than vacuum extraction, although properly used, both types should not cause any serious damage to the baby.
Episiotomy Normal and assisted deliveries put the tissues of the genital tract under strain. The PERINEUM is less elastic than the vagina and, if it seems to be splitting as the baby’s head
moves down the birth canal, it may be necessary to cut the perineal tissue – a procedure called an episiotomy – to limit damage. This is a simple operation done under local anaesthetic. It should be done only if there is a speci?c indication; these include:
to hasten the second stage of labour if the fetus is distressed.
to facilitate the use of forceps or vacuum extractor.
to enlarge a perineum that is restricted because of unyielding tissue, perhaps because of a scar from a previous labour. Midwives as well as obstetricians are trained
to undertake and repair (with sutures) episiotomies.
(For organisations which o?er advice and information on various aspects of childbirth, including eclampsia, breast feeding and multiple births, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP.)... pregnancy and labour
Alcohol depresses the central nervous system and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person’s re?exes and concentration; potentially dangerous effects when, for example, driving or operating machinery. Drunkenness causes slurred speech, muddled thinking, amnesia (memory loss), drowsiness, erectile IMPOTENCE, poor coordination and dulled reactions – thereby making driving or operating machinery especially dangerous. Disinhibition may lead to extreme euphoria, irritability, misery or aggression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to COMA and respiratory failure.
Persistent alcohol misuse leads to physical, mental, social and occupational problems, as well as to a risk of DEPENDENCE (see also ALCOHOL DEPENDENCE). Misuse may follow several patterns: regular but controlled heavy intake, ‘binge’ drinking, and dependence (alcoholism). The ?rst pattern usually leads to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease and impotence. The second is most common among young men and usually leads to mainly social and occupational problems – getting into ?ghts, jeopardising personal relationships, overspending on alcohol at weekends, and missing days o? work because of hangovers. The third pattern – alcohol dependence – is the most serious, and can severely disrupt health and social stability.
Many researchers consider alcohol dependence to be an illness that runs in families, with a genetic component which is probably passed on as a vulnerable personality. But it is hard to disentangle genetic, environmental and social factors in such families. In the UK there are estimated to be around a million people suffering from alcohol dependence and a similar number who have di?culty controlling their consumption (together about 1:30 of the population).
Alcohol causes tolerance and both physical and psychological dependence (see DEPENDENCE for de?nitions). Dependent drinkers classically drink early in the morning to relieve overnight withdrawal symptoms. These symptoms include anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threatening delirium tremens (DTs), with severe tremor, hallucinations (often visual – seeing spiders and monsters, rather than the pink elephants of romantic myth), and CONVULSIONS. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe INCOORDINATION and double-vision, can occur in WERNICKE’S ENCEPHALOPATHY, a serious neurological condition due to lack of the B vitamin thiamine (whose absorption from the stomach is markedly reduced by alcohol). If not treated urgently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsako?’s psychosis, with severe amnesia. Finally, prolonged alcohol misuse can cause a form of dementia.
In addition to these severe neurological disorders, the wide range of life-threatening problems caused by heavy drinking includes HEPATITIS, liver CIRRHOSIS, pancreatitis (see PANCREAS, DISEASES OF), gastrointestinal haemorrhage, suicide and FETAL ALCOHOL SYNDROME; pregnant women should not drink alcohol as this syndrome may occur with more than a glass of wine or half-pint of beer a day. The social effects of alcohol misuse – such as marital breakdown, family violence and severe debt – can be equally devastating.
Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are treated in the short term by doctors who fail to spot, or never ask about, heavy drinking. Second, attempts at treating alcohol dependence by detoxi?cation or ‘drying out’ (substituting a tranquillising drug for alcohol and withdrawing it gradually over about a week) are not always followed-up by adequate support at home, so that drinking starts again. Home support by community alcohol teams comprising doctors, nurses, social workers and, when appropriate, probation o?cers is a recent development that may have better results. Many drinkers ?nd the voluntary organisation Alcoholics Anonymous (AA) and its related groups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from alcohol is encouraged by intensive psychological and social support from fellow ex-drinkers.
Useful contacts are: Alcoholics Anonymous; Al-Anon Family Groups UK and Eire (including Alateen); Alcohol Concern; Alcohol Focus Scotland; and Alcohol and Substance Misuse.
1 standard drink =1 unit
=••• pint of beer
=1 measure of spirits
=1 glass of sherry or vermouth
=1 glass of wine
Limits within which alcohol is believed not to cause long-term health risks:... alcohol
Structure Each tooth is composed of enamel, dentine, cement, pulp and periodontal membrane. ENAMEL is the almost translucent material which covers the crown of a tooth. It is the most highly calci?ed material in the body, 96–97 per cent being composed of calci?ed salts. It is arranged from millions of long, six-sided prisms set on end on the dentine (see below), and is thickest over the biting surface of the tooth. With increasing age or the ingestion of abrasive foods the teeth may be worn away on the surface, so that the dentine becomes visible. The outer sides of some teeth may be worn away by bad tooth-brushing technique. DENTINE is a dense yellowish-white material from which the bulk and the basic shape of a tooth are formed. It is like ivory and is harder than bone but softer than enamel. The crown of the tooth is covered by the hard protective enamel and the root is covered by a bone-like substance called cement. Decay can erode dentine faster than enamel (see TEETH, DISORDERS OF – Caries of the teeth). CEMENT or cementum is a thin bone-like material which covers the roots of teeth and helps hold them in the bone. Fibres of the periodontal membrane (see below) are embedded in the cement and the bone. When the gums recede, part of the cement may be exposed and the cells die. Once this has happened, the periodontal membrane can no longer be attached to the tooth and, if su?cient cement is destroyed, the tooth-support will be so weakened that the tooth will become loose. PULP This is the inner core of the tooth and is
composed of a highly vascular, delicate ?brous tissue with many ?ne nerve-?bres. The pulp is very sensitive to temperature variation and to touch. If the pulp becomes exposed it will become infected and usually cannot overcome this. Root-canal treatment or extraction of the tooth may be necessary. PERIODONTAL MEMBRANE This is a layer of ?brous tissue arranged in groups of ?bres which surround and support the root of a tooth in a bone socket. The ?bres are interspersed with blood vessels and nerves. Loss of the membrane leads to loss of the tooth. The membrane can release and re-attach the ?bres to allow the tooth to move when it erupts, or (to correct dental deformities) is being moved by orthodontic springs.
Arrangement and form Teeth are present in most mammals and nearly all have two sets: a temporary or milk set, followed by a permanent or adult set. In some animals, like the toothed whale, all the teeth are similar; but in humans there are four di?erent shapes: incisors, canines (eye-teeth), premolars (bicuspids), and molars. The incisors are chisel-shaped and the canine is pointed. Premolars have two cusps on the crown (one medial to the other) and molars have at least four cusps. They are arranged together in an arch in each jaw and the
cusps of opposing teeth interdigitate. Some herbivores have no upper anterior teeth but use a pad of gum instead. As each arch is symmetrical, the teeth in an upper and lower quadrant can be used to identify the animal. In humans, the quadrants are the same: in other words, in the child there are two incisors, one canine and two molars (total teeth 20); in the adult there are two incisors, one canine, two premolars and three molars (total 32). This mixture of tooth-form suggests that humans are omnivorous. Anatomically the crown of the tooth has mesial and distal surfaces which touch the tooth next to it. The mesial surface is the one nearer to the centre line and the distal is the further away. The biting surface is called the incisal edge for the anterior teeth and the occlusal surface for the posteriors.
Development The ?rst stage in the formation of the teeth is the appearance of a down-growth of EPITHELIUM into the underlying mesoderm. This is the dental lamina, and from it ten smaller swellings in each jaw appear. These become bell-shaped and enclose a part of the mesoderm, the cells of which become specialised and are called the dental papillae. The epithelial cells produce enamel and the dental papilla forms the dentine, cement and pulp. At a ?xed time the teeth start to erupt and a root is formed. Before the deciduous teeth erupt, the permanent teeth form, medial to them. In due course the deciduous roots resorb and the permanent teeth are then able to push the crowns out and erupt themselves. If this process is disturbed, the permanent teeth may be displaced and appear in an abnormal position or be impacted.
Eruption of teeth is in a de?nite order and at a ?xed time, although there may be a few months’ leeway in either direction which is of no signi?cance. Excessive delay is found in some congenital disorders such as CRETINISM. It may also be associated with local abnormalities of the jaws such as cysts, malformed teeth and supernumerary teeth.
The usual order of eruption of deciduous teeth is:
Middle incisors 6–8 months Lateral incisors 8–10 months First molars 12–16 months Canines (eye-teeth) 16–20 months Second molars 20–30 months
The usual order of eruption of permanent teeth is:
First molars 6–7 years Middle incisors 6–8 years Lateral incisors 7–9 years Canines 9–12 years First and second premolars 10–12 years Second molars 11–13 years Third molars (wisdom teeth) 17–21 years
The permanent teeth of the upper (top) and lower (bottom) jaws.
Teeth, Disorders of
Teething, or the process of eruption of the teeth in infants, may be accompanied by irritability, salivation and loss of sleep. The child will tend to rub or touch the painful area. Relief may be obtained in the child by allowing it to chew on a hard object such as a toy or rusk. Mild ANALGESICS may be given if the child is restless and wakens in the night. A serious pitfall is to assume that an infant’s symptoms of ill-health are due to teething, as the cause may be more serious. Fever and ?ts (see SEIZURE) are not due to teething.
Toothache is the pain felt when there is in?ammation of the pulp or periodontal membrane of a tooth (see TEETH – Structure). It can vary in intensity and may be recurring. The commonest cause is caries (see below) when the cavity is close to the pulp. Once the pulp has become infected, this is likely to spread from the apex of the tooth into the bone to form an abscess (gumboil – see below). A lesser but more long-lasting pain is felt when the dentine is unprotected. This can occur when the enamel is lost due to decay or trauma or because the gums have receded. This pain is often associated with temperature-change or sweet foods. Expert dental advice should be sought early, before the decay is extensive. If a large cavity is accessible, temporary relief may be obtained by inserting a small piece of cotton wool soaked, for example, in oil of cloves.
Alveolar abscess, dental abscess or gumboil This is an ABSCESS caused by an infected tooth. It may be present as a large swelling or cause trismus (inability to open the mouth). Treatment is drainage of the PUS, extraction of the tooth and/or ANTIBIOTICS.
Caries of the teeth or dental decay is very common in the more a?uent countries and is most common in children and young adults. Increasing awareness of the causes has resulted in a considerable improvement in dental health, particularly in recent years; this has coincided with a rise in general health. Now more than half of ?ve-year-old children are caries-free and of the others, 10 per cent have half of the remaining carious cavities. Since the start of the National Health Service, the emphasis has been on preventive dentistry, and now edentulous patients are mainly found among the elderly who had their teeth removed before 1948.
The cause of caries is probably acid produced by oral bacteria from dietary carbohydrates, particularly re?ned sugar, and this dissolves part of the enamel; the dentine is eroded more quickly as it is softer (see TEETH – Structure). The exposed smooth surfaces are usually protected as they are easily cleaned during normal eating and by brushing. Irregular and overcrowded teeth are more at risk from decay as they are di?cult to clean. Primitive people who chew coarse foods rarely get caries. Fluoride in the drinking water at about one part per million is associated with a reduction in the caries rate.
Prolonged severe disease in infancy is associated with poor calci?cation of the teeth, making them more vulnerable to decay. As the teeth are formed and partly calci?ed by the time of birth, the diet and health of the mother are also important to the teeth of the child. Pregnant mothers and children should have a good balanced diet with su?cient calcium and vitamin
D. A ?brous diet will also aid cleansing of the teeth and stimulate the circulation in the teeth and jaws. The caries rate can be reduced by regular brushing with a ?uoride toothpaste two or three times per day and certainly before going to sleep. The provision of sweet or sugary juices in an infant’s bottle should be avoided.
Irregularity of the permanent teeth may be due to an abnormality in the growth of the jaws or to the early or late loss of the deciduous set (see TEETH – Development). Most frequently it is due to an imbalance in the size of the teeth and the length of the jaws. Some improvement may take place with age, but many will require the help of an orthodontist (specialist dentist) who can correct many malocclusions by removing a few teeth to allow the others to be moved into a good position by means of springs and elastics on various appliances which are worn in the mouth.
Loosening of the teeth may be due to an accident or in?ammation of the GUM. Teeth loosened by trauma may be replaced and splinted in the socket, even if knocked right out. If the loosening is due to periodontal disease, the prognosis is less favourable.
Discoloration of the teeth may be intrinsic or extrinsic: in other words, the stain may be in the calci?ed structure or stuck on to it. Intrinsic staining may be due to JAUNDICE or the antibiotic tetracycline. Extrinsic stain may be due to tea, co?ee, tobacco, pan (a mixture of chuna and betel nuts wrapped in a leaf), iron-containing medicines or excess ?uoride.
Gingivitis or in?ammation of the gum may occur as an acute or chronic condition. In the acute form it is often part of a general infection of the mouth, and principally occurs in children or young adults – resolving after 10–14 days. The chronic form occurs later in life and tends to be progressive. Various microorganisms may be found on the lesions, including anaerobes. Antiseptic mouthwashes may help, and once the painful stage is past, the gums should be thoroughly cleaned and any calculus removed. In severe conditions an antibiotic may be required.
Periodontal disease is the spread of gingivitis (see above) to involve the periodontal membrane of the tooth; in its ?orid form it used to be called pyorrhoea. In this, the membrane becomes damaged by the in?ammatory process and a space or pocket is formed into which a probe can be easily passed. As the pocket becomes more extensive, the tooth loosens. The loss of the periodontal membrane also leads to the loss of supporting bone. Chronic in?ammation soon occurs and is di?cult to eradicate. Pain is not a feature of the disease but there is often an unpleasant odour (halitosis). The gums bleed easily and there may be DYSPEPSIA. Treatment is largely aimed at stabilising the condition rather than curing it.
Dental abscess is an infection that arises in or around a tooth and spreads to involve the bone. It may occur many years after a blow has killed the pulp of the tooth, or more quickly after caries has reached the pulp. At ?rst the pain may be mild and intermittent but eventually it will become severe and a swelling will develop in the gum over the apex of the tooth. A radiograph of the tooth will show a round clear area at the apex of the tooth. Treatment may be by painting the gum with a mild counter-irritant such as a tincture of aconite and iodine in the early stages, but later root-canal therapy or apicectomy may be required. If a swelling is present, it may need to be drained or the o?ending teeth extracted and antibiotics given.
Injuries to teeth are common. The more minor injuries include crazing and the loss of small chips of enamel, and the major ones include a broken root and avulsion of the entire tooth. A specialist dental opinion should be sought as soon as possible. A tooth that has been knocked out can be re-implanted if it is clean and replaced within a few hours. It will then require splinting in place for 4–6 weeks.
Prevention of dental disease As with other disorders, prevention is better than cure. Children should be taught at an early age to keep their teeth and gums clean and to avoid re?ned sugars between meals. It is better to ?nish a meal with a drink of water rather than a sweetened drink. Fluoride in some of its forms is useful in the reduction of dental caries; in some parts of the UK natural water contains ?uoride, and in some areas where ?uoride content is low, arti?cial ?uoridation of the water supply is carried out. Overcrowding of the teeth, obvious maldevelopment of the jaw and persistent thumbsucking into the teens are all indications for seeking the advice of an orthodontist. Generally, adults have less trouble with decay but more with periodontal disease and, as its onset is insidious, regular dental inspections are desirable.... teeth
Teas. Cowslip flowers, St John’s Wort flowers, Passion flower, Valerian, Hops, Lime flowers, Balm, Motherwort, Woodruff, Skullcap, Oats.
Formula, tea: equal parts, Balm, Motherwort, Passion flower. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes. 1 cup thrice daily.
Tablets. Valerian. Pulsatilla. Natracalm. (English Grains) 500mg Passion flower tablets: 1 tablet thrice daily.
See: SEDATIVES. ... nerve tension
Action. Diuretic, immune-stimulant, tonic. Kidney regulator.
Uses: Mild kidney disorders, menopause, irritability, hyperactivity. Recovery after hysterectomy. ... nu zhen zi
A baby with an attack of colic cries or screams incessantly, draws up the legs towards the stomach, and may become red in the face and pass wind.
Colic tends to be worse in the evenings.
The condition is distressing but harmless.
Usually, it first appears at 3–4 weeks and clears up without treatment by the age of 12 weeks.... colic, infantile
(See anxiety; anxiety disorders.)... generalized anxiety disorder
The chorea usually affects the face, arms, and trunk, resulting in random grimaces and twitches, and clumsiness. Dementia takes the form of irritability, personality and behavioural changes, memory loss, and apathy.
At present, there is no cure for Huntington’s disease, and treatment is aimed at reducing symptoms with drugs.... huntington’s disease
There is an abrupt onset of irritability and fever.
The temperature drops to normal after 4 or 5 days.
About the same time, a rash appears on the trunk, often spreading to the neck, face, and limbs, before clearing up within 1–2 days.
Other symptoms may include a sore throat and enlargement of lymph nodes in the neck.
Convulsions (see convulsion, febrile) may occur during the fever, but there are no serious effects.
The only treatment is to keep the child cool and give paracetamol.... roseola infantum
Irritability and a shortened attention span may occur after a short night’s sleep.
Longer periods without sleep leave a person increasingly unable to concentrate or perform normal tasks.
Three or more sleepless nights may lead to hallucinations and, in some cases, to paranoia.... sleep deprivation
Severe head injuries cause unconsciousness for hours or many days, followed by loss of memory before and after that period of unconsciousness. The skull may be fractured; there may be ?ts in the ?rst week; and there may develop a blood clot in the brain (intracerebral haematoma) or within the membranes covering the brain (extradural and subdural haematomata). These clots compress the brain, and the pressure inside the skull – intracranial pressure – rises with urgent, life-threatening consequences. They are identi?ed by neurologists and neurosurgeons, con?rmed by brain scans (see COMPUTED TOMOGRAPHY; MRI), and require urgent surgical removal. Recovery may be complete, or in very severe cases can be marred by physical disabilities, EPILEPSY, and by changes in intelligence, rational judgement and behaviour. Symptoms generally improve in the ?rst two years.
A minority of those with minor head injuries have complaints and disabilities which seem disproportionate to the injury sustained. Referred to as the post-traumatic syndrome, this is not a diagnostic entity. The complaints are headaches, forgetfulness, irritability, slowness, poor concentration, fatigue, dizziness (usually not vertigo), intolerance of alcohol, light and noise, loss of interests and initiative, DEPRESSION, anxiety, and impaired LIBIDO. Reassurance and return to light work help these symptoms to disappear, in most cases within three months. Psychological illness and unresolved compensation-claims feature in many with implacable complaints.
People who have had brain injuries, and their relatives, can obtain help and advice from Headwat and from www.neuro.pmr.vcu.edu and www.biausa.org... brain injuries
Habitat: Western temperate Himalayas from 2,500 to 4,000 m.
English: American cowslip, Marsh Marigold, Water Buttercup.Folk: Mamiri (Punjab).Family: Theaceae.Habitat: Cultivated in Assam, Darjeeling, Travancore, the Nilgiris, Malabar, Bengal, Dehra Dun and Kumaon.
English: Tea.Unani: Chaai, Shaahi, Shaayi.Siddha/Tamil: Thaeyilai.Action: Stimulant, diuretic, astringent. In China, used for diarrhoea and dysentery (causes gastrointestinal upsets and nervous irritability when consumed in excess). Green tea: anticancer effects have been observed in Chinese green tea, Camellia thea, extract; the extract of Japanese green tea showed antihepatotoxic effects.
Important constituents of leaf buds and very young leaves are: caffeine, with a much smaller amount of other xanthines (theophylline and theo- bromine); tannins (the main tannin in green tea is (-)-epigallocatechin); flavonoids, quercetin, kaempferol. The stimulant and diuretic are due to caffeine content, the astringency due to the tannins.Drinking tea lowers thiamine and thiamine diphosphate losses in urine and blood serum respectively but increases niacin losses. Hot water extract of black tea facilitates Ca absorption in the body experimentally. Tea may decrease zinc bioavailability.The tea, if added to the meal, significantly lower the availability of iron. Milk is as effective as ascorbic acid in countering the depressing effect of tea on iron availability (in vitro).The green tea catechin inhibited car- cinogenesis in small intestines when given during or after carcinogen treatment to experimental rats. (-)-epi- gallocatechin gallate and theaflavin di- gallate from green tea inhibited the in- fectivity of both influenza A and B virus (in vitro).Green tea, when added to a lard- cholesterol diet, decreased the cholesterol and triglyceride levels in fowls. Tea polyphenols exhibit hypocholes- terolaemic activity.Tea polyphenols—(-)-epicatechin gallate, (-)-epigallocatechine galate, theaflavin monogallate A or B, and or theaflavin digallate—are used for treating hyperglycaemia.Saponins from tea are used as an- tiulcer agents.Concurrent use of tea and beta- adrenergic agonists may increase the risk of cardiac arrhythmias. Caffeine, a component of tea, may increase insulin resistance. (Sharon M. Herr.)... camellia sinensisu... tyrosinosis
Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its effects within the home, but most cases are unrecognised, unreported and untreated, even though victims may suffer from long-term effects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments suffering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.
Clinical effects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are affected to a great extent. Common effects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may suffer neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.
First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical effects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to
0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... carbon monoxide (co)
Heat collapse is characterised by fatigue, giddiness, and temporary loss of consciousness. It is accompanied by HYPOTENSION and BRADYCARDIA; there may also be vomiting and muscular cramps. Urinary volume is diminished. Recovery is usual.
Heat exhaustion is characterised by increasing weakness, dizziness and insomnia. In the majority of sufferers, sweating is defective; there are few, if any, signs of dehydration. Pulse rate is normal, and urinary output good. Body temperature is usually 37·8–38·3 °C.
Heat cramps (usually in the legs, arms or back, and occasionally involving the abdominal muscles) are associated with hard physical work at a high temperature. Sweating, pallor, headache, giddiness and intense anxiety are present. Body temperature is only mildly raised.
Heat hyperpyrexia is heralded by energy loss and irritability; this is followed by mental confusion and diminution of sweating. The individual rapidly becomes restless, then comatose; body temperature rises to 41–42 °C or even higher. The condition is fatal unless expertly treated as a matter of urgency.
Treatment With the ?rst two syndromes, the affected individual must be removed immediately to a cool place, and isotonic saline administered – intravenously in a severe case. The fourth syndrome is a medical emergency. The patient should be placed in the shade, stripped, and drenched with water; fanning should be instigated. He or she should be wrapped in a sheet soaked in cool water and fanning continued. When rectal temperature has fallen to 39 °C, the patient is wrapped in a dry blanket. Immediately after consciousness returns, normal saline should be given orally; this usually provokes sweating. The risk of circulatory collapse exists. Convalescence may be protracted and the patient should be repatriated to a cool climate. Prophylactically, personnel intended for work in a tropical climate must be very carefully selected. Adequate acclimatisation is also essential; severe physical exertion must be avoided for several weeks, and light clothes should be worn. The diet should be light but nourishing, and ?uid intake adequate. Those performing hard physical work at a very high ambient temperature should receive sodium chloride supplements. Attention to ventilation and air-conditioning is essential; fans are also of value.... heat stroke
Symptoms Symptoms vary with the age of infection. In young infants, herpes simplex may cause a generalised infection which is sometimes fatal. In young children the infection is usually in the mouth, and this may be associated with enlargement of the glands in the neck, general irritability and fever. The condition usually settles in 7–10 days. In adults the vesicles may occur anywhere in the skin or mucous membranes: the more common sites are the lips, mouth and face, where they are known as cold sores. The vesicles may also appear on the genitalia (herpes genitalis) or in the conjunctiva or cornea of the EYE, and the brain may be infected, causing ENCEPHALITIS or MENINGITIS. The ?rst sign is the appearance of small painful swellings; these quickly develop into vesicles which contain clear ?uid and are surrounded by a reddened area of skin. Some people are particularly liable to recurrent attacks, and these often tend to be associated with some debilitating condition or infection, such as pneumonia.
Except in the case of herpes of the cornea, the eruption clears completely unless it becomes contaminated with some other organism. In the case of the cornea, there may be residual scarring, which may impair vision.
Treatment Aciclovir is e?ective both topically as cream or eye drops or orally. In severe systemic infections it can be given intravenously.... herpes simplex
Anxiety, phobias and depression are fairly common. For instance, surveys show that up to
2.5 per cent of children and 8 per cent of adolescents are depressed at any one time, and by the age of 18 a quarter will have been depressed at least once. Problems such as OBSESSIVE COMPULSIVE DISORDER, ATTENTION DEFICIT DISORDER (HYPERACTIVITY SYNDROME), AUTISM, ASPERGER’S SYNDROME and SCHIZOPHRENIA are rare.
Mental-health problems may not be obvious at ?rst, because children often express distress through irritability, poor concentration, dif?cult behaviour, or physical symptoms. Physical symptoms of distress, such as unexplained headache and stomach ache, may persuade parents to keep children at home on school days. This may be appropriate occasionally, but regularly avoiding school can lead to a persistent phobia called school refusal.
If a parent, teacher or other person is worried that a child or teenager may have a mental-health problem, the ?rst thing to do is to ask the child gently if he or she is worried about anything. Listening, reassuring and helping the child to solve any speci?c problems may well be enough to help the child feel settled again. Serious problems such as bullying and child abuse need urgent professional involvement.
Children with emotional problems will usually feel most comfortable talking to their parents, while adolescents may prefer to talk to friends, counsellors, or other mentors. If this doesn’t work, and if the symptoms persist for weeks rather than days, it may be necessary to seek additional help through school or the family’s general practitioner. This may lead to the child and family being assessed and helped by a psychologist, or, less commonly, by a child psychiatrist. Again, listening and counselling will be the main forms of help o?ered. For outright depression, COGNITIVE BEHAVIOUR THERAPY and, rarely, antidepressant drugs may be used.... mental health problems in children
Habitat: Native of South-east America; grown in Indian gardens.
English: Wild Passion Flower, Maypop.Action: Flowering and fruiting dried herb—mild sedative, hypnotic, tranquilizer, hypotensive, vasodilator, antispasmodic, anodyne, anti-inflammatory,
Key application: In nervous restlessness, irritability and difficulty in falling asleep. (German Commission E, ESCOP, The British Herbal Compendium, The British Herbal Pharmacopoeia, WHO.) The British Herbal Compendium also indicated it in neuralgia, dysmenorrhoea, and nervous tachycardia.The herb contains flavonoids (up to 2.5%), in particular C-glycosylflavones; cyanogenic glycoside, gynocardine.The alkaloid harman has been isolated, but the presence of harmine, har- maline, harmol and harmalol has been disputed. The alkaloid and flavonoids are reported to have sedative activity in animals. Apigenin exhibits antispasmodic and anti-inflammatory activity.Passion Flower was formerly approved as an OTC sedative in the USA, but it was taken off the market in 1978 because safety and effectiveness had not been proven. An animal study in 1977 suggested that apigenin binds to central benzodi-zepine receptors (possibly causing anxiolytic effects). (Natural Medicines Comprehensive Database, 2007.)The drug is used in homoeopathic medicine for epilepsy.The herb exhibits a motility-inhi- biting effect in animal experiments.Passion Flower, used as an adjunct to clonidine, was superior to clonidine for mental symptoms of opiate withdrawal. (Sharon M. Herr.)... passiflora incarnataBacterial meningitis is life-threatening: in the United Kingdom, 5–10 per cent of children who contract the disease may die. Most cases of acute bacterial meningitis in the UK are caused by two bacteria: Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae (pneumococcus); other bacteria include Haemophilus in?uenzae (a common cause until virtually wiped out by immunisation), Escherichia coli, Mycobacterium tuberculosis (see TUBERCULOSIS), Treponema pallidum (see SYPHILIS) and Staphylococci spp. Of the bacterial infections, meningococcal group B is the type that causes a large number of cases in the UK, while group A is less common.
Bacterial meningitis may occur by spread from nearby infected foci such as the nasopharynx, middle ear, mastoid and sinuses (see EAR, DISEASES OF). Direct infection may be the result of penetrating injuries of the skull from accidents or gunshot wounds. Meningitis may also be a complication of neurosurgery despite careful aseptic precautions. Immuno-compromised patients – those with AIDS or on CYTOTOXIC drugs – are vulnerable to infections.
Spread to contacts may occur in schools and similar communities. Many people harbour the meningococcus without developing meningitis. In recent years small clusters of cases, mainly in schoolchildren and young people at college, have occurred in Britain.
Symptoms include malaise accompanied by fever, severe headache, PHOTOPHOBIA, vomiting, irritability, rigors, drowsiness and neurological disturbances. Neck sti?ness and a positive KERNIG’S SIGN appearing within a few hours of infection are key diagnostic signs. Meningococcal and pneumococcal meningitis may co-exist with SEPTICAEMIA, a much more serious condition in terms of death rate or organ damage and which constitutes a grave emergency demanding rapid treatment.
Diagnosis and treatment are urgent and, if bacterial meningitis is suspected, antibiotic treatment should be started even before laboratory con?rmation of the infection. Analysis of the CEREBROSPINAL FLUID (CSF) by means of a LUMBAR PUNCTURE is an essential step in diagnosis, except in patients for whom the test would be dangerous as they have signs of raised intracranial pressure. The CSF is clear or turbid in viral meningitis, turbid or viscous in tuberculous infection and turbulent or purulent when meningococci or staphylococci are the infective agents. Cell counts and biochemical make-up of the CSF are other diagnostic pointers. Serological tests are done to identify possible syphilitic infection, which is now rare in Britain.
Patients with suspected meningitis should be admitted to hospital quickly. General pracitioners are encouraged to give a dose of intramuscular penicillin before sending the child to hospital. Treatment in hospital is usually with a cephalosporin, such as ceftazidime or ceftriaxone. Once the sensitivity of the organism is known as a result of laboratory studies on CSF and blood, this may be changed to penicillin or, in the case of H. in?uenzae, to amoxicillin. Local infections such as SINUSITIS or middle-ear infection require treatment, and appropriate surgery for skull fractures or meningeal tears should be carried out as necessary. Tuberculous meningitis is treated for at least nine months with anti-tuberculous drugs (see TUBERCULOSIS). If bacterial meningitis causes CONVULSIONS, these can be controlled with diazepam (see TRANQUILLISERS; BENZODIAZEPINES) and ANALGESICS will be required for the severe headache.
Coexisting septicaemia may require full intensive care with close attention to intravenous ?uid and electrolyte balance, control of blood clotting and blood pressure.
Treatment of close contacts such as family, school friends, medical and nursing sta? is recommended if the patient has H. in?uenzae or N. meningitidis: RIFAMPICIN provides e?ective prophylaxis. Contacts of patients with pneumococcal infection do not need preventive treatment. Vaccines for meningococcal meningitis may be given to family members in small epidemics and to any contacts who are especially at risk such as infants, the elderly and immuno-compromised individuals.
The outlook for a patient with bacterial meningitis depends upon age – the young and old are vulnerable; speed of onset – sudden onset worsens the prognosis; and how quickly treatment is started – hence the urgency of diagnosis and admission to hospital. Recent research has shown that children who suffer meningitis in their ?rst year of life are ten times more likely to develop moderate or severe disability by the age of ?ve than contemporaries who have not been infected. (See British Medical Journal, 8 September 2001, page 523.)
Prevention One type of bacterial meningitis, that caused by Haemophilus, has been largely controlled by IMMUNISATION; meningococcal C vaccine has largely prevented this type of the disease in the UK. So far, no vaccine against group B has been developed, but research continues. Information on meningitis can be obtained from the Meningitis Trust and the Meningitis Research Foundation.... meningitis
One of the major problems of the menopause which does not give rise to symptoms until many years later is osteoporosis (see BONE, DISORDERS OF). After the menopause, 1 per cent of the bone is lost per annum to the end of life. This is a factor in the frequency of fractures of the femur in elderly women as a result of osetoporosis, but it can be prevented by hormone replacement therapy (see below).
Hormone replacement therapy (HRT) This term has become synonymous with the scienti?cally correct term ‘OESTROGENS replacement therapy’ to signify the treatment of menopausal symptoms and signs with oestrogens, now usually combined with PROGESTOGEN. Oestrogen and combined treatment relieve the short-term symptoms such as hot ?ushes, sweats and vaginal dryness. Atrophic vaginitis and vulvitis (shrinking of the tissues of VULVA and VAGINA due to fall in natural oestrogen levels) also usually respond to treatment with oestrogens.
Cyclical therapy is necessary to avoid abnormal bleeding in women who have reached the menopause. If oestrogens are given alone, there is an increased risk of endometrial hyperplasia (overgrowth of the ENDOMETRIUM) which may lead to endometrial cancer, so these are restricted to women who have had a hysterectomy and are no longer at risk. Other women can be given oestrogen-progestogen combinations.
There is good evidence that oestrogen alone or in combination can prevent the bone-loss associated with the menopause by reducing the demineralisation of bone which normally occurs after the menopause; and, if it is started early and continued for years, it may prevent the development of osteoporosis. Oestrogen is far more e?ective than calcium supplements and has been shown greatly to reduce fractures affecting the spine, wrists and legs after the age of 50.
However, HRT is no longer licensed for ?rst-line treatment to prevent osteoporosis, as increased risk of stroke, breast cancer and coronary heart disease cannot justify treatment for long periods – unless the woman has severe menopausal symptoms. HRT is recommended for short-term use only in menopausal women whose lives are inconvenienced by vasomotor instability (severe ?ushes, etc.) or vaginal atrophy, although the latter may respond to local oestrogen treatment – creams or pessaries. In terms of oestrogenic activity, natural oestrogen such as oestradiol, oestrone and oestriol are more appropriate for HRT than synthetic oestrogens like ethinyloestradiol, mestranol and diethylstilboestrol.
Many experts believe that controversy surrounding the risks and bene?ts of HRT have been settled by a large randomised trial (the Women’s Health Initiative), published in 2003, which showed that combined treatment increases the risk of breast tumours, stroke and coronary heart disease (in the ?rst year). Oestrogen alone (given to women who have had a hysterectomy) also increases the risk of stroke. Five years of combined treatment may double the risk of breast cancer, and the heart-disease risk is nearly doubled during the ?rst year of use. This is in spite of the bene?cial effects of HRT on blood lipids. However, there are others who consider that di?erent dose combinations of di?erent hormones may one day prove bene?cial, so research continues.
HRT can also provoke minor adverse effects such as breast tenderness, ?uid retention, leg cramps and nausea. The risk of abnormal blood clotting means that HRT is not normally recommended for women who smoke heavily or have had THROMBOSIS, severe HYPERTENSION, stroke or liver disease. HRT has, however, brought symptomatic bene?ts to many menopausal women, who can then justify taking the other increased risks – only fully understood since the large trial results were published.
As the evidence stands at present, careful consideration of each woman’s medical history and the severity of her menopausal symptoms is necessary in deciding what combination of drugs should be given and for how long. In general, the indications should be severe menopausal symptoms that can be controlled by the lowest dose for the shortest time. Using HRT to alleviate mild symptoms, or to prevent future bone loss, is probably of insu?cient bene?t to counter the other risks described above.... menopause
Action Physostigmine produces the same e?ect as stimulation of the PARASYMPATHETIC NERVOUS SYSTEM: i.e. it constricts the pupil of the eye, stimulates the gut, increases the secretion of saliva, stimulates the bladder, and increases the irritability of voluntary muscle. In poisonous doses it brings on a general paralysis.
Uses It is used in medicine in the form of eye drops or ointment to treat GLAUCOMA.... physostigmine
The disease is ENDEMIC in dogs and wolves in some countries; an EPIDEMIC may occasionally occur. It also occurs in foxes, coyotes and skunks, as well as in vampire bats. Thanks to QUARANTINE measures, since 1897 rabies has been rare in Great Britain, which still retains strict measures (the Rabies Act) to prevent the entry of infected animals into the country, including a six-month quarantine period and vaccination (see IMMUNISATION). This policy was relaxed somewhat in 2001 with the launch of the Pet Travel Scheme; this allows cats and dogs to enter the UK from speci?ed countries without the need for quarantine, as long as stringent conditions as to microchipping and vaccinations are met. Full details can be obtained from the Department for the Environment, Food and Rural A?airs (DEFRA) or from a veterinary surgeon engaged in operating the scheme. Six months has to elapse between vaccination against rabies and a positive blood test before the ‘pet passport’ can be issued.
Rabies is highly infectious from the bite of an animal already affected, but the chance of infection from di?erent animals varies. Thus only about one person in every four bitten by rabid dogs contracts rabies, whilst the bites of rabid wolves and cats almost invariably produce the disease.
Symptoms In animals there are two types of the disease: mad rabies and dumb rabies. In the former, the dog (or other animal) runs about, snapping at objects and other animals, unable to rest; in the latter, which is also the ?nal stage of the mad type, the limbs become paralysed and the dog crawls about or lies still.
In humans the incubation period is usually 6–8 weeks, but may be as short as ten days or as long as two years. The disease begins with mental symptoms, the person becoming irritable, restless and depressed. Fever and DYSPHAGIA follow. The irritability passes into a form of MANIA and the victim has great di?culty in swallowing either food or drink.
Treatment The best treatment is, of course, preventive. Local treatment consists of immediate, thorough and careful cleansing of the wound-surfaces and surrounding skin. This is followed by a course of rabies vaccine therapy.
Only people bitten (or in certain circumstances, licked) by a rabid animal or by one thought to be infected with rabies need treatment; this is with rabies vaccine and antiserum and one of the IMMUNOGLOBULINS. A person previously vaccinated against rabies who is subsequently bitten by a rabid animal should be given three or four doses of the vaccine. The vaccine is also used to give protection to those liable to infection, such as kennel-workers and veterinary surgeons. Those who develop the disease require intensive care with ventilatory support, despite which the death rate is very high.... rabies
Habitat: The Western Himalayas and Kashmir at elevation of 3,0003,900 m.
Folk: Poshkar, Hatermuula (Kashmir).Action: Root—nervine tonic. Used as an adulterant of Saussurea lappa.
Whole plant extract gave senecio- nine.Habitat: The Nilgiris and Uttar Pradesh. Introduced into Indian gardens
English: Groundsel.Action: Formerly used as a diuretic, diaphoretic and emmenagogue, in dysmenorrhoea and bilious pains. No more recommended for internal use due to high concentration of hepatotoxic alkaloids. Infusion is used as a lotion in chronic mastitis, gout and haemorrhoids. Extracts of the plant are haemostatic.
From the dried plant material alkaloids (0.053-00.095%) have been isolated, including, seneciphylline, sene- cionine and retrorsine. Senecionine and retrorsine have been demonstrated to induce hepatic necrosis in experimental animals. The plant contains 950 mcg/kg of iodine on fresh basis.A related species used in Western herbal, Senecio aureus Linn. (Golden Groundsel, Squaw Weed) is a uterine relaxant, stimulant to gravid uterus and a soothing drug for nervous and vascular irritability, menopausal symptoms, hot flushes. Alkaloids include senecifo- line, senescine, senecionine and otose- nine—pyrrolizidine alkaloids, in isolation, are highly toxic to liver. The plant is recommended only for external use as a douche for excessive vaginal discharge.... senecio jacquemontianusHabitat: Throughout the hotter parts of India, ascending to an altitude of 1,350 m.
English: Prickly Sida.Ayurvedic: Naagabalaa, Balaa- kantakini, Gangaati.Siddha/Tamil: Arivalmanai-poondu.Folk: Gulasakari, Gangeti, Jangali- methi.Action: Root—nervine tonic and diaphoretic; used in debility and fevers. Decoction given as a demulcent in irritability of bladder and genitourinary tract. Leaves—demulcent and refrigerant; used for scalding urine.
The root contains alkaloids—beta- phenethylamine, ephedrine, si-ephed- rine, vasicinol, vasicinone, vasicine, choline, hypaphorine, methyl ester, hy- paphorine and betaine. These alkaloids are present in aerial parts as well.Ethanolic extract of the plant exhibits hypoglycaemic activity. It depressed the normal blood pressure and lowered the activity ofsmooth muscles of the ileum of experimental animals.... sida spinosaHabitat: Indigenous to southern United States; introduced into Indian gardens.
English: Adam's Needle.Action: Rhizomes and leaves—used for the treatment of glandular and liver and gallbladder disorders; in bilious headaches accompanied by yellow tongue; in despondency and irritability. Root—tincture is used in the treatment of rheumatism; a poultice or salve is used in inflammations.
The leaves contain steroidal sapo- genins sarsasapogenin, gitogenin, tigogenin, diosgenin, kammogenin, yuccagenin, hecogenin, manogenin, mexogenin, chlorogenin and smila- genin. The rhizomes contain mainly sarsasapogenin.Tincture of the herb is used in Homoeopathic medicine for bilious symptoms with headache.... yucca filamentosaContains aucubin and agnuside (iridoid glycosides), flavonoids, castin (bitter), fatty and ethereal oils. Action: acts on the anterior pituitary gland, reducing FSH (follicle-stimulating-hormone) and increasing LSH (luteum-stimulating-hormone). Stimulates production of progesterone but reducing that of oestrogen. “Has a corpus luteum hormone effect” (Dr Weiss 1974 322. New herbal Practitioner, March 1977). Alternative to hormone replacement therapy (HRT).
Uses: Symptoms caused by excess FSH and low progesterone output. used as substitution therapy for primary and secondary corpus luteum deficiency. Pre-menstrual symptoms, especially nervous tension, irritability, mood-swings, depression, anxiety, crying, forgetfulness, insomnia. Amenorrhoea (by regulating sex hormones). Pain in breasts. To promote breast milk in nursing mothers; assist bust development. Acne vulgaris (to restore sex hormone balance). Water-retention (pre-menstrual) caused by oestrogen excess or progesterone deficiency. “Regular bleeding between periods decreased following temporary increase” (Dr W. Amann, Bundesanzeiger, No 90, 15/5/1985). Premature old age from sexual excess and masturbation. Agnus lowers sexual vitality; reduces nervous excitability. By opposing excess oestrogen it lessens the risk, however small, of endometrial carcinoma. For symptoms of the menopause and of withdrawal on giving-up The Pill.
Preparations: Extracts made from crushed roots.
Tablets: 300mg; 2 tablets after meals thrice daily.
Liquid Extract: 1:1 in 25% alcohol. Dose: 2-4ml.
Caution: Not taken in the presence of progesterone drugs.
Contra-indications and interaction with other drugs: None known.
Tincture: 10-20 drops daily morning dose during second half of menstrual cycle. ... agnus castus
Herbal alternatives exist but may be of limited efficacy: menstrual pain (Helonias root), muscular rheumatism (Black Cohosh), tension headaches (Ginkgo), Angina pectoris (Cramp bark), eye-strain (Eyebright), facial neuralgia (German Chamomile), swollen glands (Poke root), chest pain (Elecampane), cough (Iceland Moss), simple abdominal pain (Fenugreek).
Cures for relief of painful limbs run into hundreds. Gentle massage to release endorphins which block pain waves offers an external approach. Arthritic knees are less painful on application of Castor oil packs or one of the many preparations commended under poultices, liniments, lotions, etc.
During trials at Long Island University, USA, 189 cases of rheumatic knees and elbows were rendered painless by pollen poultices. Dissolve one tablespoon bee pollen pellets in warm water; immerse small handtowel; squeeze out excess moisture; bind over affected joint.
Cold water packs are advised by hydrotherapists for headache, stiff neck, shoulders, back and legs. Sodium bicarbonate is the safest and most effective antidote for aspirin overdose.
Aspirin therapy almost halves the risk of venous thrombosis and pulmonary embolism in patients
undergoing surgery, according to a major study. (BMJ Jan 22 1994)
Studies show that deaths from heart attack can be halved by prescribing half tablet daily together with a clot-dissolving remedy (Nettles, Vitamin E, etc). As an anti-coagulant aspirin is matched by Garlic. In alternative medicine the use of aspirin is discouraged. ... aspirin
Action. Antispasmodic, carminative, galactagogue, sedative (mild), stomachic, antibacterial, vermifuge, anti-depressant. Adrenal stimulant.
Uses: Nervous irritability, increase secretion of milk in nursing mothers, nausea, vomiting. Little used in present-day UK herbalism. Stomach cramp (China). Recovery after hysterectomy.
Combines well with Lemon Balm for depression.
Preparations: Tea. 1 teaspoon dried (2 teaspoons fresh) herb to each cup boiling water. Infuse 10 minutes. Dose: One-third-1 cup thrice daily.
Salads: addition of 2-3 fresh leaves as a nerve sustainer.
External. Basil oil protects against some types of fungus. Fresh juice – lotion for warts, stings.
No longer used in Aromatherapy, or in pregnancy. ... basil
Abscess, Alzheimer’s Disease, anoxia (oxygen starvation), coma, concussion, haemorrhage, Down’s syndrome, epilepsy, tumour, hydrocephalus (water on the brain), meningitis, multiple sclerosis, stroke (rupture of blood vessel), spina bifida, syphilis (general paralysis of the insane), sleepy sickness.
Poor circulation through the brain due to hardening of the arteries: Ginkgo, Ginseng. Ginseng stimulates the hypothalmic/pituitary axis of the brain and favourably influences its relationship with the adrenal glands.
Congestion of the brain – Cowslip (Boerwicke). Irritability of brain and spine – Hops. Oats. Inflammation of the brain (encephalitis) as in viral infection, poliomyelitis, rabies, sleepy sickness, etc: Echinacea, Passion flower, Skullcap and Lobelia. Gelsemium acts as a powerful relaxant in the hands of a practitioner: Tincture BPC (1973): dose 0.3ml.
Brain storm from hysteria, locomotor ataxia, etc – Liquid Extract Lobelia: 5ml teaspoon in water when necessary (Dr Jentzsch, 1915, Ellingwood) Supplement with Zinc, Vitamins C and E.
Blood clot, thrombosis: Yarrow. Neurasthenia: Oats, Basil, Hops.
Brain fag and jet-lag: Chamomile, Skullcap, Oats, Ginseng, Ginkgo.
Tumour may be present years before manifesting: Goldenseal.
Mental state: depression, anxiety, schizophrenia.
Tea. Formula. Skullcap, Gotu Kola and German Chamomile; equal parts. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Strain. 1 cup thrice daily.
Unspecified tensive state. Formula. Tinctures. Hops 1; Passion flower 2; Valerian 2. Dose: 2 teaspoons thrice daily until diagnosis is concluded.
Unspecified torpor. Formula. Tinctures. Ginseng 1; Kola 1; Capsicum quarter. 2 teaspoons in water thrice daily until diagnosis is concluded.
Brain weakness in the elderly: Ginkgo. See: ALZHEIMER’S DISEASE.
Fluid on the brain: see HYDROCEPHALUS.
Abscess of the brain: see ABSCESS.
Brain restoratives. Black Haw, True Unicorn root, Galangal, Oats, Oatstraw, False Unicorn root, Kola, Hops. Vitamin B6. Magnesium.
Cerebral thrombosis. See entry.
Note: Cold water may help victims to survive: rapid loss of body heat protects the brain. (Child Health Department, University of Wales)
Treatment by or in liaison with general medical practitioner or hospital specialist. ... brain disorders
It is a disease of the slaughter house, veterinary surgeon, farm and meat trade worker. Young males are particularly at risk. In cows, infection may precipitate abortion of a calf but it does not affect the foetus in humans. May produce a rash on the arm of a vet handling a case.
Resembles glandular fever in the acute stage, with fever and high temperature, shivering, headache, profuse sweating, fatigue and anxiety-depression. Symptoms include enlargement of the spleen, liver, lymph glands, sore throat, possible rash, tremor and irritability. In long-standing cases a reactive arthritis may attack the joints. Often, it assumes an attack of influenza, its real nature remaining undiagnosed. Treatment. By medical practitioner. Herbal antibiotics may be regarded as a supportive role. Antibacterials: Garden Thyme, Garlic, Elecampane, Burdock root, Pulsatilla, Echinacea, Poke root, Myrrh, Goldenseal.
Tinctures. Formula. Blue Flag root 30ml; Poke root 15ml; Fringe Tree 30ml; Echinacea 60ml. Dose: 1-2 teaspoons in water every 2 hours (acute); 1 teaspoon thrice daily (chronic condition). ... brucellosis
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
Alternatives: Ginseng, Gotu Kola, Guarana tea, German Chamomile.
Caffeine is the most widely used drug in the world. Studies show that abstinence induces a withdrawal syndrome of fatigue, headache and drowsiness within 24 hours and lasts about a week, on giving up the habit. ... caffeine
Symptoms. Bladder irritability; increased frequency during the night. Feeble forked stream of urine. Sometimes blood. Three quarters of such tumours are located in the posterior lobe of the prostate gland – readily accessible to the examining finger through the front wall of the rectum. Rectal examination reveals a hard rugged prostate. Cystoscopy confirms. Bone pains in the low back or pelvis reflect a stage where the tumour has already spread. Anaemia, weight loss, urgency.
All symptoms are worse by alcohol and spicy foods.
Harvard University scientists report: heavy consumption of animal fat, especially the fat in red meat appears to increase the chance that a man will develop advanced prostate cancer.
Of therapeutic value. Comfrey, Echinacea, Horsetail, Poke root, Thuja, Cornsilk, Goldenseal.
Tea. Combination. Comfrey leaves, Horsetail, Cornsilk. Equal parts. 2-3 teaspoons to each cup boiling water. Drink freely.
Formula No. 1. Echinacea 2; Comfrey 1; Poke root half; Thuja half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or cup of Cornsilk tea.
Formula No. 2. (Alternative) Echinacea 2; Goldenseal 1; Gotu Kola 1; Poke root half. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons in water or cup of Cornsilk tea.
Bee pollen. Of value.
Garlic. Of value.
Diet. See: DIET – CANCER.
There is a very low incidence of prostate cancer in countries where Soya products are widely consumed – Soya contains a female hormone which is a protector factor.
Supplements. Morning and evening.
Vitamin A 7500iu or more. Large doses may be required. Vitamin C 1-2g. Vitamin E 200iu. Calcium 500mg. Selenium 100mcg. Zinc.
Study. Men with prostate cancer may not need to undergo radical prostatectomy (removal of the prostate gland). A 10-year follow-up study of men with early prostate cancer left untreated showed that 10 years later only 8.5 per cent of the 223 patients had died from prostate cancer. The survival rate of 86.8 per cent in the untreated group was nearly identical to a subgroup who met all the conditions for radical prostatectomy. (Journal of American Medical Association, 22/29 April 1992)
Commonly treated with female sex hormone or by orchidectomy.
It would appear that surgical removal of the gland offers little benefit, and possibly a disadvantage to patients wishing to leave well alone, particularly the elderly. Treatment by a general medical practitioner or oncologist. ... cancer – prostate gland
Constituents: sesquiterpene lactones, flavonoids.
Action: antispasmodic, analgesic (mild), anti-inflammatory (simple acute), bitter, carminative, de- sensitiser (skin), tranquilliser (mild), anti-convulsant, anti-emetic, sedative (mild). One of the chief medicinal plants used by the phytotherapist.
Uses: Children’s convulsions, physical stress, hyperactive children. Indigestion in excitable females. Nausea and indigestion from emotional upset. Facial neuralgia. Insomnia. Meniere’s syndrome. Gastro- intestinal irritation with diarrhoea. Travel sickness (cup hot tea). Wind. Vomiting of pregnancy. Loss of appetite. Sore mouth, nasal catarrh. Infertility (sometimes successful). The oil is active against staphylococcus aureus and Candida albicans. Skin disorders (steam face with hot tea). Autonomic imbalance. Hot tired feet (strong tea used as a footbath). Hair loss: strong tea, externally. Inflammation of the skin. Psychosomatic:– keynote: irritability. “Cannot bear it”; temper, everything seems intolerable, uncivil, impatient in sickness.
Preparations: As necessary. 4-6 flowerheads to each cup boiling water infuse 15 minutes; half-1 cup. Tincture BHC Vol 1. 1:5, 45 per cent ethanol. Dose: 3-5ml.
Oil of Chamomile. Prepare as for OILS, IMPREGNATED. For cracked lips, dry hands and feet, massage or deodorant.
Essential oil (Aromatherapy): widely used as an inhalant.
Compress. Half-1oz flowers to small muslin or linen bag; immerse in half a pint boiling water; wring out and apply bag over affected area. Repeatedly moisten bag when dry.
Large doses emetic. Not used in pregnancy. Enema. See: GERMAN CHAMOMILE.
Chamomile ointment. Nappy rash, dry skin, irritation. ... chamomile flowers (roman)
Greater incidence of the condition is found in women. By interfering with the hormone balance The Pill raises the female body to a constant state of false pregnancy. This affects the character of vaginal secretions and favours growth of fungi. Oestrogens in contraceptive pills create a tissue climate conducive to Candida. Vaginal deodorants and scented soaps irritate. Because of its effect upon the Fallopian tubes it is a common cause of infertility.
Symptoms. Vulva itching, soreness, white discharge of watery to cheesy consistency. Urination painful, recurring cystitis, irritability, premenstrual and menstrual problems, anxiety, heartburn and dyspepsia. Alternatives. Teas. Agnus Castus, Balm, Barberry bark, Chamomile, La Pacho (Pau d’arco), Sage, Thyme.
Tablets/capsules. Agnus Castus, Goldenseal, Pulsatilla, Poke root, Thuja, Garlic, La Pacho.
Tincture Thuja. 15-30 drops in water, once daily.
Tinctures. Combination for the average case. Echinacea 30ml; Calendula 15ml; Goldenseal 15ml; Ladysmantle 15ml. Dose: one 5ml teaspoon thrice daily. (Brenda Cooke MNIMH, Mansfield, Notts) Topical. Tea Tree oil pessaries/cream. Alternative:– (1) Impregnate tampon with plain yoghurt and insert into vagina. Or: inject with spermicidal cream applicator or cardboard tampon applicator 2-3 teaspoons yoghurt into vagina 2-3 times daily. The theory is that the lacto-bacilli in the yoghurt competes with the candida and finally reduces it to normal levels.
(2) 2-3 teaspoons Distilled Extract Witch Hazel to cup of water for cooling antiseptic lotion.
(3) 1-2 drops Eucalyptus oil well-shaken in 4oz (120ml) Distilled Extract Witch Hazel. Reputed to kill colonies of candida albicans and allay irritation.
(4) Aloe Vera gel.
(5) Capricin.
(6) Cloves are anti-fungal and may be chewed.
(7) Calendula and Hydrastis pessaries.
Avoid surgical spirit antiseptics. A smear of Olive oil or yoghurt or No 3 above to allay irritation. Frequent washing, hot baths and use of soap at first soothe, but later exacerbate. Use water only. When washing, wipe from front to back to avoid spreading spores from bowel. No smoking.
Diet. Gluten-free, low fat, high fibre.
Acidophilus. A large mixed salad once daily. Cooked vegetables, seafood, Vitamin A foods. Replace salt with Celery, Garlic or Kelp powders. All meats, game and chicken to be from animals raised on steroid-free fodder. Replace alcohol with fresh fruit and vegetable juices. Eggs.
Reject: Dairy products (butter, cheese, milk). Brewer’s yeast. Foods and drinks with which yeast has been associated: bread, beer, homemade wines. Dried fruit, mushrooms, monosodium glutamate, pickles and preserves, smoked fish and meats, foods known to be allergic to the patient, sugar, syrup, sweeteners, chocolate, puddings, pastry, white flour products.
Supplements. Daily. Vitamin A 7500iu, Vitamin C 200mg. Zinc. ... candida, vaginal
Symptoms: Slight fever with temperature rising 39°-40° (102°-104°), sore throat, heavy nasal discharge, rashes come in crops soon to progress to milky white blisters which shrivel into scabs. Irritability. The virus may lie latent in the ganglia of sensory and somatic nerves for many years to manifest later as shingles.
Object of the therapy is to reduce the temperature and promote a healthy outcropping of the rash.
Alternatives. Ensure adequate fluid intake. Antihistamine herbs: Lobelia, Goldenseal root, Parsley root, Juniper. Mucous membranes: spots on: Goldenseal, Myrrh. Ears: spots in: Instil oil Mullein or contents of Vitamin E capsule.
Teas: Boneset, Elderflowers and Peppermint, Marigold, Chamomile.
Tea. Formula. Equal parts: Red Clover, Boneset, Yarrow.
Maria Treben’s tea. Marigold 3; Nettles 1; Yarrow 1. Prepare: all teas, one heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup freely.
Tinctures. Alternatives. (1) Combine, Echinacea 2; Poke root 1; Goldenseal 1. (2) Combine, Wild Indigo 2; Marigold 1; Myrrh quarter; Dose: as many drops as the age of the child, in a little water. (Adults: One 5ml teaspoon) Dose: 3-4 times daily.
Gargle and Mouthwash, where spots appear on mucous membranes: 5 drops Tincture Myrrh or Goldenseal (or combined), in warm water.
Topical. Aloe Vera. Evening Primrose oil. Oil from Vitamin E capsule. Wash with distilled extract Witch Hazel, Lavender water, or Chamomile tea.
Cayenne. Pinch Cayenne in teas, or few drops Tincture Capsicum in tinctures heightens action.
Note: For restlessness add, equal parts, Skullcap or Chamomile. For severe itching, wash with potato water or Chamomile tea.
Diet. Commence 3-day fast, with herb teas and fruit juices only. Vitamins A and C. Carrot juice.
High Temperature. If serious: tinctures – Pleurisy root 1; Lobelia 1; Catnep 2; Valerian 1. One 5ml teaspoon every 2 hours. Reduced to thrice daily when temperature abates.
Patients suffer less itching if kept cool. ... chicken pox
Anti-depressants should not be given for bed-wetting, drugs for sleep problems or strong laxatives for the chronically constipated. Mild herbal alternatives exist. Fresh carrot juice daily helps a child to avoid some complaints. Some herbs are not advised for children under 12, except under the care of a qualified practitioner.
Parental smoking habits are known to be responsible for crying and digestive symptoms in infants. Sleeplessness. German Chamomile or Balm tea: children 2-10 years quarter to half a cup; over 10 years: 1 cup. Babies: 3-6 teaspoons in feeding bottle – sweeten with honey if necessary.
Night seizures, with screaming: Passion Flower tea. 1 heaped teaspoon to cup boiling water; infuse 5-15 minutes. Strain. A few teaspoons at bedtime. When a brain storm starts place pinch of salt on the tongue. Calcium deficiency. Nettle tea. Carrot juice. Cod Liver oil with fresh orange juice.
Colic. Any tea: Dill, Catnep, Spearmint or Fennel. Few teaspoons frequently. Abdominal massage: 3 drops Chamomile oil in teaspoon olive oil.
Constipation. Prune or carrot juice. Dandelion coffee.
Cough. Oil of Thyme – few drops in water.
Crusta Lacta (milk rash). Weak teas: Plantain, Heartsease, Red Clover. Anoint with St John’s Wort oil. Buttermilk, Wheatgerm.
Diarrhoea. Teas: Yarrow, Tormentil. Breast feeding during the first 4-6 months of life reduces the risk of children’s diarrhoea.
Digestion, weak. Teas: Fennel, Caraway, Dill. 1 teaspoon crushed seeds to cup boiling water. Infuse 15 minutes in a covered vessel. Teaspoon doses for under 2s; half-1 cup thereafter. Also for flatulence. Feverishness. Alarm at a baby’s fever and fractiousness may attract complete medical treatment including nose drops, cough linctus, antipyretics and antibiotics, together with something to let the parents get some sleep. Avoid where possible. Mild fevers: teas – Yarrow, Marigold, Thyme, Elderflowers and Peppermint, Catmint, Carragheen Moss. Sweeten with honey. Topical: Flannels wrung out in these hot teas. Zinc can cut short the common cold. Echinacea tablets/capsules offer antiviral protection.
It is common for a child to convulse with fever. A feverish child, kept cool, is less likely to have convulsions. Remove most of child’s clothes so he can lose heat through the skin. Fruit juices (Vitamin C) in abundance. Do not feed solid foods. Wash in lukewarm (not cold) water.
Eyes. Deep hollows under the eyes reveal exhaustion, for which blood and nerve tonics and iron supplements are indicated.
Growth problems. Under-developed children respond well to herbal aids: Gentian, Ginseng, Horsetail, Marigold, Oats, German Chamomile, Wood Betony, Kelp, Alfalfa. Supplementation with brewer’s yeast, Calcium, Pollen and Zinc yield convincing results.
Hyperactivity. Nerve restoratives for highly-strung children: Teas: Lime flowers, Chamomile, Lemon Balm, B-vitamins. Porridge. Tablets: Passion flower, Valerian, Skullcap. Vitamins B6 and C. Powders: formula. Passion flower 2; Valerian 1; Liquorice 1. Dose: 250mg (one 00 capsule or one-sixth teaspoon) thrice daily.
Irritability and impaired school performance may be due to Tartrazine and other additives, sugar, and anticonvulsant drugs. See previous paragraph.
Infection. Infection of the upper respiratory tract may manifest as inflammation of the middle ear, nasal discharge or tonsillitis. Echinacea tablets, powder or liquid extract indicated. For specific infection such as measles, see under MEASLES, or other appropriate entry.
Skin. Reject cow’s in favour of goat’s milk. See appropriate entry for each skin disease (ECZEMA, etc). Care of skin after bathing: St John’s Wort oil, Evening Primrose oil. ... children
Deficiency. Rare. Hypoglycaemia, arteriosclerosis, heart disease. Depression, irritability, sudden mood swings. A lack of Chromium may result in diabetes in young adults, and a craving for sweet foods (sugar, chocolate).
Body effects. Metabolism of sugars and fats. Blood sugar regulator. Builds up muscle. Lowers cholesterol levels. Encourages the body’s insulin to perform effectively. Suppresses appetite – especially craving for sugar, chocolate etc. Sportsperson’s mineral to build muscle and reduce fat.
Sources. Red meat, liver, kidney, cheese, mushrooms, wholegrain cereals, brewer’s yeast, fresh fruits, nuts, honey, molasses, corn oil, raisins, grapes, beets, peppers, shellfish. ... chromium
Symptoms. Sudden drawing-up of knees, nausea, vomiting, pallor, shallow breathing, prostration, weak heart beat, irritability, amnesia.
Treatment. Bed rest. Protection of eyes against light. Admission to hospital in case of deep brain damage. Quietness. Tranquillisers, sedatives and alcohol aggravate symptoms. If patient can swallow, alternatives as follows:–
Teas. St John’s Wort (concussion of the spine). Skullcap (to ease headache). Ginkgo (cerebral damage). Powders. Formula. Combine, St John’s Wort 3; Skullcap 2; Oats 2; Trace of Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) two-hourly.
Tinctures. Formula as above, but with few drops Tincture Capsicum in place of Cayenne powder: 1-2 teaspoons in water hourly.
Tincture Arnica. (European practise) 2-5 drops in hot water usually sufficient to hasten recovery.
Topical. Distilled Extract Witch Hazel saturated pad over eyes and to wipe forehead.
Supplements. Vitamin B-complex. B6, C. ... concussion
Constituents: coumarins, hydroquinones.
Keynote: cramp.
Action: antispasmodic, astringent, nerve and muscle relaxant, sedative.
Uses: Muscular cramp, spasmodic pains in abdomen, womb, ovaries, back, stomach, intestines, bladder. Convulsions in children. Epididymitis. Painful menstruation, flooding menses of the menopause. Polymyalgia. Nervous irritability. Heart cramp (angina), intermittent claudication, arteritis, palpitation. Earache. Acute bronchitis, asthma. Muscular rheumatism. Bedwetting.
Preparations: Thrice daily.
Tablets. Two 200mg tablets before meals.
Decoction. 1-2 teaspoons to each cup water: simmer 15 minutes: dose, half-1 cup.
Powder. 2-5g.
Liquid extract. Half-2 teaspoons in water.
Tincture BHP (1983) 1 part bark to 5 parts 70 per cent alcohol. Dose: 5-10ml in water. ... cramp bark
Alternatives. Teas. Hops, Passion flower. Motherwort (with heart symptoms). Oats.
Tablets/capsules. Motherwort, Passion flower. Mistletoe.
Powders. Formula. Passion flower 2; Hops (lupulin) 1; Jamaica Dogwood 1. Dose: 750mg (three 00 capsules or half a teaspoon) every 2 hours.
Tinctures. Formula. Equal parts: Passion flower; Hops; Oats. Dose: one to three 5ml teaspoons in water, every 2 hours.
Practitioner. Tincture Stramonium, Dr Fyfe, Eclectic Medical Review, advises: “With mania present in acute inflammation. Furious, noisy, raving: one drop Tincture Stramonium every two hours.”
Tincture Cinchona (Peruvian bark) BPC (1949). 2-4ml 2-3 times daily. 2-3 drops Tincture Capsicum enhances its action.
German traditional. Arnica. Suggest: Tincture Arnica, 2-5 drops in water 2-3 times daily. ... delirium tremens
Two types: (1) multiple pockets with no pain. (2) hypertrophy of muscles of the colon with chronic spasmodic pain. Also an occupational hazard of saxophone players.
Symptoms. Continuous cramp-like pain in the left abdomen (iliac fossa), distension, flatulence, incomplete emptying of rectum. Colon is tender to touch and mass may be palpated. Constipation and left- sided pain are the hallmarks. Complications include abscess, faecal peritonitis from burst pouch. Differential diagnosis. On rectal examination, ulcerative colitis has fever, abdominal pain, and bloody diarrhoea.
Alternatives. Tea. Equal parts, herbs: Agrimony (to stimulate a healthy flow of bile). Avens (to check excessive secretion by toning-up of bowel tissue). Hops (an alvine nervine for strengthening the walls). Liquorice (to support the immune system). Red Clover (anti-neoplastic to discourage malignancy).
For local sepsis. Suggested by high white cell count. Echinacea, Wild Indigo or Goldenseal. Where general toxaemia co-exists: Myrrh. For the chronic case with a silent abdomen, Fenugreek seeds relieve in most cases.
Fenugreek Seeds. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily, seeds consumed as well as the liquor.
For constipation. Ispaghula seeds, (psyllium) in the form of Isogel, Normacol, Regulan or other brand. To increase bulk, soften and render stools easier to pass.
For abdominal discomfort. Peppermint oil: 1-2 drops in honey or milk.
Tinctures. Formula. Wild Yam 2; Marshmallow 1; Elderflowers (to reduce inflammation) 1; Ginger quarter. Dose: one teaspoon before meals thrice daily; every two hours acute cases.
Aloe Vera. Good responses observed.
Diet. The Hay Diet. Fluid intake important. For acute inflammatory cases food should be bland. Little muesli without bran. Bran makes an irritable bowel worse, fibre husk increasing irritability. Oatmeal porridge oats with mashed banana, molasses and honey. Arrowroot, Slippery Elm drinks. Fruit juices, grapes (no seeds), papaya fruit.
Avoid: ham, bacon, fried foods, pickles, caffeine drinks and alcohol. In chronic, non-inflammatory cases, bran relieves, producing soft easy-passing stool. On passing of the acute inflammatory stage the patient should gradually take into the diet fibre-rich foods with sufficient protein. See: DIET: HIGH- FIBRE.
Supplementation. Vitamin B-complex, Vitamin C, folic acid, Bromelain enzymes. Bioflora, Lactoflora. Surgical operative measures may be necessary. ... diverticulosis
Symptoms: diarrhoea, abdominal swelling and pain, irritability, inability to gain weight, neuritis, ulcers on tongue and mouth, low blood pressure, debility, lactase-deficiency. Breast-feeding stops coeliac disease.
Alternatives. Tea. Mix, equal parts: Raspberry leaves, Agrimony, Lemon Balm. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup freely.
Tablets/capsules. Goldenseal, Slippery Elm. Calamus. Fenugreek seeds, Papaya. Wild Yam.
Powders, Liquid Extracts, Tinctures. Formula. Equal parts: Sarsaparilla, Wild Yam, Stone root. Dose. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons. In water, banana mash or honey, thrice daily.
Papaya (papain) digests wheat gluten and assists recovery. Half-1g with meals.
Aloe Vera juice. Promotes improved bowel motility, increases stool specific gravity, and reduces indication of protein putrefaction, flatulence and bloating after meals. (J. Bland PhD. JAM June 1985, p.11)
Topical. Warm hip baths of Lemon Balm, Chamomile, etc. (Alfred Vogel)
Diet. Gluten-free. Rice. Unpasteurised yoghurt. Buttermilk. Sweet acidophilus milk. Raw carrot juice. Bananas mashed with a little Slippery Elm or dried milk powder, carob bean powder and Soya milk. Supplementation. Vitamins A, B-complex, B6, B12, Folic acid, C, D, E, K (Alfalfa tea). Calcium, Iron and Magnesium orotates. ... gluten-sensitive disease
Symptoms. Dry mouth, thirst, increased output of urine, fatigue, irritability. Alcohol increases REM (rapid eye movement) during sleep. Brain cell excitability is followed by depression.
Potassium loss may be severe, as also loss of Vitamins B, B6 and C. Bananas are rich in potassium. Alternatives. Tea. 1-2 cups Chamomile tea. Ginger. Gin-and-tonic with juice of lemon, plus teaspoon honey.
Morning-after tea. Meadowsweet (antacid) 1; Centuary (bitter) 1; Black Horehound (antiemetic) 1; Gentian (tonic) quarter; Ginger (stomach settler) quarter. Mix. 2 teaspoons to each cup boiling water; infuse 10 minutes. Drink freely.
Diet. Honey for energy. Slippery Elm gruel. Avoid coffee.
Supplements. B-complex, C, E. Essential fatty acids. Potassium, Magnesium, Selenium, Zinc.
Note: Alcohol is a strong diuretic which drains the body and brain cells of vital fluids. Alcohol also contains congeners, the chemical by-products of fermentation which have a poisonous effect upon the body. The most important treatment is water – long drinks to rehydrate the body and brain. Water also helps the kidneys and liver to wash out the poisons. ... hangover
Constituents: oestrogens, volatile oil, resin.
Action: sedative, sustaining nervine, hypnotic, mild analgesic, spasmolytic on smooth muscle, bitter, tonic, astringent, antimicrobial (externally), liver and gall bladder relaxant, anaphrodisiac, diuretic.
Uses: Nervous anxiety, hysteria, nervous diarrhoea, nervous stomach, Crohn’s disease, intestinal cramps, nervous bladder, insomnia, neuralgia, excessive sexual excitability. Loss of appetite, menopause, restless legs.
Chinese medicine – tuberculosis of the lungs.
“Of value in cancer.” (J.L. Hartwell, Lloydia, 33, 97, 1970)
Combination. Combines well with Passion flower and Valerian.
Preparations: Average dose: half-1 gram. Thrice daily.
Tea. 1 teaspoon to each cup boiling water; infuse 15 minutes. Dose: half cup.
Liquid Extract: 0.5-1ml.
Tincture BHC Vol 1. One part to 5 parts 60 per cent ethanol. Dose: 1-2ml.
Popular tablet/capsule: powdered Hops BHP (1983) 45mg; powdered Passiflora BHP (1983) 100mg; powdered Extract Valerian 5:1 20mg. For minor stresses and strains, irritability and nervous headaches. For over-activity of children over 12 years. (Gerard House)
Diet: young shoots cooked as Asparagus.
Hop pillow: for healthful sleep.
Fresh Hops require careful handling on drying to prevent loss of pollen. May cause an allergic dermatitis in those susceptible.
Contra-indication: depression.
Powder. 250mg. One 00 capsule or one-sixth teaspoon. ... hops
Differential diagnosis: arterio-sclerosis, Sydenham’s chorea.
Action. Emotional instability ranging from apathy to irritability. Complicated by menstrual problems (Motherwort, Helonias, Black Cohosh). Regresses into dementia. No cure possible, but anti-convulsants may reduce contortions and restlessness. Institutional care may be necessary. Scientists claim the gene that causes Huntingdon’s disease has been identified.
Alternatives. Of Therapeutic Value. Betony, Black Cohosh, Chamomile (German), Cramp bark, Helonias, Ladyslipper, Motherwort, Oats, Passion flower, Sarsaparilla, Skullcap, Valerian, Feverfew. Tablets/capsules. Motherwort, Passion flower, Skullcap, Valerian.
Formula. Combine: equal parts, Black Cohosh, Mistletoe, Helonias. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extract: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.
Traditional, UK. Combine equal parts, Skullcap, Valerian, Mistletoe. 1oz (30g) to 1 pint (500ml) water; bring to boil; remove vessel when boiling point is reached. Dose: half-1 cup thrice daily.
Diet. Lacto-vegetarian. Yoghurt. Low salt. Oatmeal porridge, Muesli, regular raw food days. Supplements. Vitamin B-complex, Vitamin B6, Kelp, Calcium, Magnesium, Zinc.
Note: It would appear the Ginkgo would be an object of scientific study for the complaint. Treatment by or in liaison with general medical practitioner only. ... huntingdon’s chorea
From food we eat, sugar (glucose) is converted into glycogen which is stored in the liver and muscles. To ensure its removal from the bloodstream to storage areas a balancing mechanism causes the pancreas to produce insulin for this purpose. Exhaustion of the pancreas may follow too frequent release of insulin for reducing high levels of sugar. All symptoms are temporarily relieved by eating sweet foods, chocolate, etc, or by drinking stimulating beverages: tea, coffee, cola, alcohol, etc.
Convincing evidence shows how large amounts of refined and concentrated sugars overwork the pancreas, causing wide swings in blood sugar levels. This is the reverse of diabetes which occurs from a lack of insulin.
Another factor is over-stimulation of the adrenal glands that produce adrenalin which has the power to release stored sugars. When adrenalin is discharged too frequently into the bloodstream the conversion of glycogen to glucose is impaired. This leads to a craving for sweet foods and stimulating beverages.
Symptoms are numerous and often confuse the doctor: constant hunger, tightness in the chest, dizziness, headaches, twitching of limbs, digestive disorders, fatigue, weakness in legs, irritability, migraine, nervous tension, nervous mannerisms, insomnia, memory lapses, phobia – sense of panic, cold sweats. Cold hands and feet, visual disturbances, vague aches and pains and depression.
Life becomes a succession of erratic rises and falls of the blood sugar. Symptoms are worse when the person is passing through a ‘low’ period. All this is reflected upon the sympathetic nervous system and affects the emotional life. A special blood test is carried out to assess the situation; the Glucose Tolerance Test.
Alternatives. To raise low blood sugar levels: Avens, Balmony, Bayberry, Calamus, Centuary, Chamomile (German), Dandelion root, Echinacea, Feverfew, Gentian (Yellow), Ginger, Ginseng, Goldenseal, Holy Thistle, Hops, Horehound (White), Liquorice, Quassia, Southernwood, Betony.
Teas. Chamomile (German), Ginseng, Avens, Centuary, Hops, Betony.
Decoctions. Yellow Gentian (cold infusion), Calamus (cold infusion), Dandelion root (hot infusion), Angustura bark (hot infusion).
Tablets/capsules. Calamus, Dandelion, Ginseng, Goldenseal, Echinacea, Liquorice, Kelp.
Powders. Formula. Balmony 2; Bayberry 2; White Poplar 1; Ginger 1. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.
Liquid Extracts. Formula. Goldenseal 10ml; Dandelion root 20ml; Holy Thistle 20ml; Cayenne 1ml. 30- 60 drops thrice daily in water before meals.
Tinctures. Same formula, double dose.
Angostura wine. Wineglassful daily.
Diet: Herb teas, juices and mineral water instead of tea, coffee and other drinks containing caffeine. Honey. Wholefoods. Adequate protein intake. Small meals throughout the day. Avoid: alcohol, sugary snacks, white flour and white sugar products.
Supplementation. Daily. B-complex, B6 50mg, E 200iu, C 1g, Chromium 125mcg, Calcium Pantothenate 500mg, Kelp, Lecithin, Zinc.
Notes: Brewer’s yeast tablets contain chromium which assists sugar metabolism. Smoking causes both glucagon and insulin to be released thus aggravating the condition. Diabetics should carry in their pocket some form of sugar against emergency. ... hypoglycaemia
Symptoms: Always tired. Lethargy. Irregular heart-beats from heart-muscle irritability. Possible cardiac arrest. Breathlessness.
Alternatives. Teas. Plantain, Chamomile, Mullein, Coltsfoot. Mistletoe. Nettles, Gotu Kola, or Yarrow. Decoction. Irish Moss, Agar-Agar, Kelp, Dandelion root.
Powders. Formula. Dandelion, Hawthorn, Liquorice. Equal parts. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Tinctures. Formula. Equal parts: Hawthorn, Dandelion, Liquorice. Dose: 1-2 teaspoons, thrice daily. Diet. Bananas: (fruit with highest potassium). Dates, Raisins. Oily fish. Figs. Prunes, Carrot leaves, Cider vinegar (impressive record), Black Molasses. ... hypokalaemia
Symptoms. Feeble appetite, irritable bowel, oedema, nervous irritability.
Alternatives. Teas. Alfalfa, Nettles, Oats, Betony, Red Clover. Irish Moss.
Tablets/capsules. Echinacea, Kelp, Slippery Elm, Seaweed and Sarsaparilla.
Formula. Echinacea 2; Gentian 1; Ginger 1. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Thrice daily before meals. Diet. High protein. Sugar-free. Salt-free. Slippery Elm gruel.
Supplementation. All vitamins. Intramuscular injections of B12. Chromium, Copper, Iron, Magnesium, Selenium. ... kwashiorkor
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
Alternatives. Stomach wash-out (acute cases). Chelating herbs assist in removal of lead from tissues: Comfrey, Slippery Elm, Quince seeds, Marshmallow root, Aloe Vera, Houseleek.
Teas. Catmint, St John’s Wort, Chorella, Chickweed, German Chamomile.
Decoctions. Irish Moss, Iceland Moss, Fenugreek seeds, Dandelion root, Echinacea root, Yellow Dock. Tablets/capsules. Echinacea. Poke root. Dandelion. Comfrey. Slippery Elm. Iceland Moss.
Formula. Fringe Tree 1; Ginkgo 1; German Chamomile 1; Goldenseal quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Thrice daily.
Diet. Lacto vegetarian. Low salt. 2/3 fatty meals weekly. Guar gum preparations.
Supplementation. Vitamins: A, B-complex, B12, C, D. Minerals: Iodum (Kelp), Chromium, Selenium, Magnesium, Zinc.
Note: Cholesterol and fats are metabolised by the liver while metals are excreted by the kidneys. Potential benefits of Comfrey for this condition outweigh possible risk. ... lead poisoning
Constituents: lobeline, resin, wax, gum, lignin, fixed oil.
Action: antasthmatic, antispasmodic, mild sedative and gentle relaxant. Expectorant, diaphoretic, anti- cough. Broncho-dilator containing the alkaloid lobeline. Claimed to destroy pneumococcus. Amphoteric. Emetic. Smoking deterrent (tablets). Respiratory stimulant.
Uses: Broad spectrum therapy: chest, throat, sinuses, middle ear, urinary tract, chronic bronchitis. An effective means of controlling difficult breathing without risk of serious side-effects: croup, whooping cough, pleurisy, etc. For deteriorating asthma where there has been a declining response to routine broncho-dilator treatment. Well tolerated by those allergic to penicillin and for side-effects arising from that therapy. Tetanus (Dr H. Hart, Chi Med Journal). Irritability and hypersensitivity. Nicotine addiction. External. Use of tincture or liquid extract for gouty joints, big toe, etc.
Ear troubles in children: Inject 2 drops Oil Lobelia.
Preparations: Thrice daily.
Dried herb, 50 to 200mg in infusion (BHC Vol 1).
Liquid Extract: 0.2 to 0.6ml (3 to 10 drops).
Tincture Lobelia acid: 1 part to 10 parts cider vinegar; macerate 8 days; decant. Dose: 5 to 10ml (1-2 teaspoons).
Simple Tincture Lobelia BPC (1949), 1:8 in 60 per cent alcohol. Dose, 0.6 to 2ml.
Tablets/capsules. Lobelia compound. Powdered Lobelia BP 60mg; Powdered Gum Ammoniacum BPC 30mg; Powdered extract Squill 2:1, 30mg. Respiratory stimulant for blocked sinuses, catarrh and coughs. Contra-indicated: feeble pulse or nerve response, pregnancy, shock, paralysis. Large doses induce vomiting. ... lobelia
Where the menarche is delayed, Raspberry leaf tea or Chamomile tea may be all required. Other agents in general use: Mugwort, Pennyroyal, Ginseng, Kelp, Peppermint, Marjoram, Sage, Squaw Vine, Blue Cohosh.
Where long delayed. Formula. Motherwort 2; Helonias 2; add few grains powder or drops of tincture Ginger. Dose: Liquid Extracts: 1-4ml; Tinctures: 4-8ml; Powders: 500mg (two 00 capsules or one-third teaspoon) thrice daily in water or honey.
Diet. High fibre, low fat, low sugar.
Vitamins. B-complex, B6, C, E, F.
Minerals. Calcium, Iodine, Iron, Zinc.
Supportive. A mother’s friendly advice helps allay anxiety in this dramatic change in a girl’s life. ... menarche
Indicated: astringents, nerve relaxants.
Teas. Hops, Vervain, Chamomile, Cranesbill.
Tablets/capsules. Chamomile, Calamus, Wild Yam, Fenugreek.
Formula. Bayberry 2; Wild Yam 1; Valerian half. Dose: Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Thrice daily.
Tincture. Black Catechu BHP (1983). 1:5 in 45 per cent alcohol. Dose 2.5 to 5ml in water, thrice daily. Fenulin. (Gerard House)
Diet. Slippery Elm gruel.
Supplements. Vitamins A, B6, C, Calcium, Dolomite. ... nervous bowel syndrome
Constituents: glycosyl flavones, proteins, Vitamin E, oil, proteins.
Action: nerve restorative, antidepressant, tranquilliser, brain tonic. Cardiac tonic BHP (1983). Nutrient with selective action on brain and nerve cells. Source of minerals. Thymoleptic. Improves performance of athletes and stamina.
“Oats have the highest content of iron, zinc and manganese of all grain species.” (Dr A. Vogel)
Uses: Benzodiazepine, Valium or other drug addiction – with Valerian and Skullcap to assist withdrawal. Alcoholism. Nerve and physical weakness with depression and anxiety. Debility following illness; recovery from surgical operation. Neurasthenia. Tension and irritability through overwork. Headache with pain at back of the neck; sleeplessness, shingles, hyperactivity in children. Nerve tremor in the aged not caused by Parkinson’s or other nerve degenerative diseases. May be taken with benefit for general well-being in chronic nerve dyscrasies but with limited improvement in basic condition. Sometimes proves of benefit for schizophrenic tendency. Sexual weakness with night losses and impotence. Combines well with Saw Palmetto for spermatorrhoea. Combines with Valerian and Wood Betony for nerve weakness, to minimise attacks of petit mal, chorea and other convulsive states. Does not combine well with Passion flower or Cypripedium.
Contra-indicated in cases sensitive to gluten.
Preparations: Average dose, 1-2 grams or equivalent. Thrice daily. An older generation of herbalists prepared their tinctures and extracts from the green flowering unripe wild Oats as the effective constituent is unstable. Taken hot, effects are more immediate.
Tea: oatstraw: 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Drink freely.
Tincture BHP (1983) 1 part to 5 parts 45 per cent alcohol. Macerate and shake daily for 8 days; dose, 1- 5ml.
Extracts, groats and oatmeal products are all beneficial but are not of the same efficacy as the fresh green plant.
Oatstraw bath: 2-3 handfuls oatstraw. Simmer in 2-3 litres water for 5 minutes; strain; add to bathwater. Liquid Extract: dose: 1-2ml in water.
Traditional combination: equal parts – Oats, Passion flower, Hops and Valerian. Diet. Porridge, but not to be eaten by the gluten intolerant.
Side-effects: none known. ... oats
Even as too low body fluids may kindle emotions of anger and irritability, so too much water has a depressing effect, bringing about an emotional state simulating paranoia. Administration of a timely diuretic (Parsley or Juniper berry tea) is sometimes known to raise the spirits.
Pulsatilla. (N. Gosling FNIMH, Herbal Practitioner, Apr 1979, p.11) ... paranoia
The main symptoms of dementia are progressive memory loss, disorientation, and confusion. Sudden outbursts or embarrassing behaviour may be the first signs of the condition. Unpleasant personality traits may be magnified; families may have to endure accusations, unreasonable demands, or even assault. Paranoia, depression, and delusions may occur as the disease worsens. Irritability or anxiety gives way to indifference towards all feelings. Personal habits deteriorate, and speech becomes incoherent. Affected people may eventually need total nursing care.
Management of the most common
Alzheimer-type illness is based on the treatment of symptoms. Sedative drugs may be given for restlessness or paranoia. Drugs for dementia, for example donepezil, can slow mental decline in some people with mild to moderate Alzheimer’s disease (see acetylcholinesterase inhibitors).... dementia
Protection against pertussis and tetanus gradually wanes. In adults, pertussis is mild but can be transmitted to children. Since tetanus is serious at any age, boosters are recommended at the time of any dirty, penetrating injury if there has not been a vaccination in the past 10 years.
Reactions to the diphtheria and tetanus parts of the vaccine are rare.
The pertussis vaccine often causes slight fever and irritability for a day or so.
More serious reactions are extremely rare and include seizures and an allergic reaction, which may lead to sudden breathing difficulty and shock.
Permanent damage from the vaccine is even rarer.
Doctors are now agreed that for most children, the benefits of outweigh the minimal risk from the vaccine.
The pertussis element of the vaccine should not be given to children who have reacted severely to a preceding dose of the vaccine, or who have a progressing brain abnormality.... dpt vaccination
Health Encyclopedia