See PREGNANCY AND LABOUR.
The control centre of the whole nervous system is the brain, which is located in the skull or cranium. As well as controlling the nervous system it is the organ of thought, speech and emotion. The central nervous system controls the body’s essential functions such as breathing, body temperature (see HOMEOSTASIS) and the heartbeat. The body’s various sensations, including sight, hearing, touch, pain, positioning and taste, are communicated to the CNS by nerves distributed throughout the relevant tissues. The information is then sorted and interpreted by specialised areas in the brain. In response these initiate and coordinate the motor output, triggering such ‘voluntary’ activities as movement, speech, eating and swallowing. Other activities – for example, breathing, digestion, heart contractions, maintenance of BLOOD PRESSURE, and ?ltration of waste products from blood passing through the kidneys – are subject to involuntary control via the autonomic system. There is, however, some overlap between voluntary and involuntary controls.... brain
Contents The principal contents of the abdominal cavity are the digestive organs, i.e. the stomach and INTESTINE, and the associated glands, the LIVER and PANCREAS. The position
of the stomach is above and to the left when the individual is lying down, but may be much lower when standing. The liver lies above and to the right, largely under cover of the ribs, and occupying the hollow of the diaphragm. The two KIDNEYS lie against the back wall on either side, protected by the last two ribs. From the kidneys run the URETERS, or urinary ducts, down along the back wall to the URINARY BLADDER in the pelvis. The pancreas lies across the spine between the kidneys, and on the upper end of each kidney is a suprarenal gland
(see ADRENAL GLANDS). The SPLEEN is positioned high up on the left and partly behind the stomach. The great blood vessels and nerves lie on the back wall, and the remainder of the space is taken up by the intestines or bowels (see INTESTINE). The large intestine lies in the ?anks on either side in front of the kidneys, crossing below the stomach from right to left, while the small intestine hangs from the back wall in coils which ?ll up the spaces between the other organs. Hanging down from the stomach in front of the bowels is the OMENTUM, or apron, containing much fat and helping to protect the bowels. In pregnancy the UTERUS, or womb, rises up from the pelvis into the abdomen as it increases in size, lifting the coils of the small intestine above it.
The PELVIS is the part of the abdomen within the bony pelvis (see BONE), and contains the rectum or end part of the intestine, the bladder, and in the male the PROSTATE GLAND; in the female the uterus, OVARIES, and FALLOPIAN TUBES.... abdomen
Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.
SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.
The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.
HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper
limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.
Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.
Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.
The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.
Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.
with plaster of Paris. If closed traction does not work, then open reduction of the fracture may
be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.
External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.
Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.
Complications of fractures are fairly common. In non-union, the fracture does not unite
– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.
Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.
Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:
subcapital where the neck joins the head of the femur.
intertrochanteric through the trochanter.
subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur
need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.
In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.
Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.
Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.
The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.
Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).
Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.
Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.
Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.
By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.
Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.
Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.
Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.
Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.
With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.
Further information is available from the National Osteoporosis Society.
Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.
If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.
For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.
Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.
EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.
MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.
OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.
OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of
Adrenal glands These two glands, also known as suprarenal glands, lie immediately above the kidneys. The central or medullary portion of the glands forms the secretions known as ADRENALINE (or epinephrine) and NORADRENALINE. Adrenaline acts upon structures innervated by sympathetic nerves. Brie?y, the blood vessels of the skin and of the abdominal viscera (except the intestines) are constricted, and at the same time the arteries of the muscles and the coronary arteries are dilated; systolic blood pressure rises; blood sugar increases; the metabolic rate rises; muscle fatigue is diminished. The super?cial or cortical part of the glands produces steroid-based substances such as aldosterone, cortisone, hydrocortisone, and deoxycortone acetate, for the maintenance of life. It is the absence of these substances, due to atrophy or destruction of the suprarenal cortex, that is responsible for the condition known as ADDISON’S DISEASE. (See CORTICOSTEROIDS.)
Ovaries and testicles The ovary (see OVARIES) secretes at least two hormones – known, respectively, as oestradiol (follicular hormone) and progesterone (corpus luteum hormone). Oestradiol develops (under the stimulus of the anterior pituitary lobe – see PITUITARY GLAND below, and under separate entry) each time an ovum in the ovary becomes mature, and causes extensive proliferation of the ENDOMETRIUM lining the UTERUS, a stage ending with shedding of the ovum about 14 days before the onset of MENSTRUATION. The corpus luteum, which then forms, secretes both progesterone and oestradiol. Progesterone brings about great activity of the glands in the endometrium. The uterus is now ready to receive the ovum if it is fertilised. If fertilisation does not occur, the corpus luteum degenerates, the hormones cease acting, and menstruation takes place.
The hormone secreted by the testicles (see TESTICLE) is known as TESTOSTERONE. It is responsible for the growth of the male secondary sex characteristics.
Pancreas This gland is situated in the upper part of the abdomen and, in addition to the digestive enzymes, it produces INSULIN within specialised cells (islets of Langerhans). This controls carbohydrate metabolism; faulty or absent insulin production causes DIABETES MELLITUS.
Parathyroid glands These are four minute glands lying at the side of, or behind, the thyroid (see below). They have a certain e?ect in controlling the absorption of calcium salts by the bones and other tissues. When their secretion is defective, TETANY occurs.
Pituitary gland This gland is attached to the base of the brain and rests in a hollow on the base of the skull. It is the most important of all endocrine glands and consists of two embryologically and functionally distinct lobes.
The function of the anterior lobe depends on the secretion by the HYPOTHALAMUS of certain ‘neuro-hormones’ which control the secretion of the pituitary trophic hormones. The hypothalamic centres involved in the control of speci?c pituitary hormones appear to be anatomically separate. Through the pituitary trophic hormones the activity of the thyroid, adrenal cortex and the sex glands is controlled. The anterior pituitary and the target glands are linked through a feedback control cycle. The liberation of trophic hormones is inhibited by a rising concentration of the circulating hormone of the target gland, and stimulated by a fall in its concentration. Six trophic (polypeptide) hormones are formed by the anterior pituitary. Growth hormone (GH) and prolactin are simple proteins formed in the acidophil cells. Follicle-stimulating hormone (FSH), luteinising hormone (LH) and thyroid-stimulating hormone (TSH) are glycoproteins formed in the basophil cells. Adrenocorticotrophic hormone (ACTH), although a polypeptide, is derived from basophil cells.
The posterior pituitary lobe, or neurohypophysis, is closely connected with the hypothalamus by the hypothalamic-hypophyseal tracts. It is concerned with the production or storage of OXYTOCIN and vasopressin (the antidiuretic hormone).
PITUITARY HORMONES Growth hormone, gonadotrophic hormone, adrenocorticotrophic hormone and thyrotrophic hormones can be assayed in blood or urine by radio-immunoassay techniques. Growth hormone extracted from human pituitary glands obtained at autopsy was available for clinical use until 1985, when it was withdrawn as it is believed to carry the virus responsible for CREUTZFELDT-JAKOB DISEASE (COD). However, growth hormone produced by DNA recombinant techniques is now available as somatropin. Synthetic growth hormone is used to treat de?ciency of the natural hormone in children and adults, TURNER’S SYNDROME and chronic renal insu?ciency in children.
Human pituitary gonadotrophins are readily obtained from post-menopausal urine. Commercial extracts from this source are available and are e?ective for treatment of infertility due to gonadotrophin insu?ciency.
The adrenocorticotrophic hormone is extracted from animal pituitary glands and has been available therapeutically for many years. It is used as a test of adrenal function, and, under certain circumstances, in conditions for which corticosteroid therapy is indicated (see CORTICOSTEROIDS). The pharmacologically active polypeptide of ACTH has been synthesised and is called tetracosactrin. Thyrotrophic hormone is also available but it has no therapeutic application.
HYPOTHALAMIC RELEASING HORMONES which affect the release of each of the six anterior pituitary hormones have been identi?ed. Their blood levels are only one-thousandth of those of the pituitary trophic hormones. The release of thyrotrophin, adrenocorticotrophin, growth hormone, follicle-stimulating hormone and luteinising hormone is stimulated, while release of prolactin is inhibited. The structure of the releasing hormones for TSH, FSH-LH, GH and, most recently, ACTH is known and they have all been synthesised. Thyrotrophin-releasing hormone (TRH) is used as a diagnostic test of thyroid function but it has no therapeutic application. FSH-LH-releasing hormone provides a useful diagnostic test of gonadotrophin reserve in patients with pituitary disease, and is now used in the treatment of infertility and AMENORRHOEA in patients with functional hypothalamic disturbance. As this is the most common variety of secondary amenorrhoea, the potential use is great. Most cases of congenital de?ciency of GH, FSH, LH and ACTH are due to defects in the hypothalamic production of releasing hormone and are not a primary pituitary defect, so that the therapeutic implication of this synthesised group of releasing hormones is considerable.
GALACTORRHOEA is frequently due to a microadenoma (see ADENOMA) of the pituitary. DOPAMINE is the prolactin-release inhibiting hormone. Its duration of action is short so its therapeutic value is limited. However, BROMOCRIPTINE is a dopamine agonist with a more prolonged action and is e?ective treatment for galactorrhoea.
Thyroid gland The functions of the thyroid gland are controlled by the pituitary gland (see above) and the hypothalamus, situated in the brain. The thyroid, situated in the front of the neck below the LARYNX, helps to regulate the body’s METABOLISM. It comprises two lobes each side of the TRACHEA joined by an isthmus. Two types of secretory cells in the gland – follicular cells (the majority) and parafollicular cells – secrete, respectively, the iodine-containing hormones THYROXINE (T4) and TRI-IODOTHYRONINE (T3), and the hormone CALCITONIN. T3 and T4 help control metabolism and calcitonin, in conjunction with parathyroid hormone (see above), regulates the body’s calcium balance. De?ciencies in thyroid function produce HYPOTHYROIDISM and, in children, retarded development. Excess thyroid activity causes thyrotoxicosis. (See THYROID GLAND, DISEASES OF.)... endocrine glands
Habitat: Low-lying, marshy lands.
Features ? Stem and stalk soft and pithy. Thin, brittle, dark green leaves with long stalks and three obovate leaflets, about two inches long by one inch broad, entire edges. Very bitter taste.Part used ? Herb.Action: Tonic, deobstruent.
Of special use as a bitter tonic; with suitable alteratives, etc., in rheumatism and skin diseases. Frequent wineglass doses of the 1 ounce to1 pint infusion. Coffin recommends for dyspepsia.... buckbeanHabitat: Low-lying meadows and damp waysides.
Features ? Stem thick, nearly one foot high. Leaves, appearing after the flowers, very large, cordate, downy underneath. Pink flowers on short stalks bloom in early spring in thick spikes. Rhizome quarter-inch thick, furrowed longitudinally, purplish- brown, pithy.Part used ? Rhizome.Action: Stimulant, diuretic.
Now little used except locally. Was formerly valued in feverish colds and urinary complaints.... butter-burThe cerebrospinal ?uid (CSF) provides useful information in various conditions and is invaluable in the diagnosis of acute and chronic in?ammatory diseases of the nervous system. Bacterial MENINGITIS results in a large increase in the number of polymorphonuclear LEUCOCYTES, while a marked lymphocytosis is seen in viral meningitis and ENCEPHALITIS, tuberculous meningitis and neurosyphilis. The total protein content is raised in many neurological diseases, being particularly high with neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE) and Guillan-Barré syndrome, while the immunoglobulin G fraction is raised in MULTIPLE SCLEROSIS (MS), neurosyphilis, and connective-tissue disorders. The glucose content is raised in diabetes (see DIABETES MELLITUS), but may be very low in bacterial meningitis, when appropriately stained smears or cultures often de?ne the infecting organism. The CSF can also be used to measure immune proteins produced in response to infection, helping diagnosis in cases where the organism is not grown in the laboratory culture.... cerebrospinal fluid
Habitat: Annual grass introduced into India from South Africa; cultivated in tropical and subtropical low-lying areas where rainfall is less than 125 cm.
English: Giant Rhodes, RhodesGrass.Folk: Rhoolsoohullu (Karnataka).Action: A proteinaceous factor, phytotrophin, isolated from the grass, was found to have antigenic properties similar to those of animal sex hormones and human chorionic gonadotrophin.
A related species, Chloris incompleta Roth., known as Bamnaa in Rajasthan and Mathania in Uttar Pradesh, has been equated with Ayurvedic classical herbs Manthaanakand Trnaaddhip. Another species, C. virgata Benth. & Hook. f., known as Gharaniyaa-ghass in Rajasthan, is used for the treatment of colds and rheumatism.... chloris gayanaHabitat: Extensively farmed for the brewing industry, and is found growing wild in hedges and open woods.
Features ? Stem rough, very long, will twist round any adjacent support. Leaves in pairs, stalked, rough, serrate, cordate, three- or five-lobed. Flowers or catkins (more correctly called strobiles) consist of membranous scales, yellowish-green, roundish, reticulate-veined, nearly half-inch long, curving over each other. These are the fertile flowers which are used medicinally and industrially.Action: Tonic, diuretic.
As a tonic in prescriptions for debility, nervous dyspepsia, and general atony. Although usually given in combination with other herbs, the ounceto pint infusion of hops taken thrice daily makes quite a good tonic medicine for those feeling "run-down." Lying on a pillow stuffed with hops is an old-fashioned way of dealing with insomnia.... hops– the corpus callosum. Other clefts or ?ssures (sulci) make deep impressions, dividing the cerebrum into lobes. The lobes of the cerebrum are the frontal lobe in the forehead region, the parietal lobe on the side and upper part of the brain, the occipital lobe to the back, and the temporal lobe lying just above the region of the ear. The outer 3 mm of the cerebrum is called the cortex, which consists of grey matter with the nerve cells arranged in six layers. This region is concerned with conscious thought, sensation and movement, operating in a similar manner to the more primitive areas of the brain except that incoming information is subject to much greater analysis.
Numbers of shallower infoldings of the surface, called furrows or sulci, separate raised areas called convolutions or gyri. In the deeper part, the white matter consists of nerve ?bres connecting di?erent parts of the surface and passing down to the lower parts of the brain. Among the white matter lie several rounded masses of grey matter, the lentiform and caudate nuclei. In the centre of each cerebral hemisphere is an irregular cavity, the lateral ventricle, each of which communicates with that on the other side and behind with the third ventricle through a small opening, the inter-ventricular foramen, or foramen of Monro.
BASAL NUCLEI Two large masses of grey matter embedded in the base of the cerebral hemispheres in humans, but forming the chief part of the brain in many animals. Between these masses lies the third ventricle, from which the infundibulum, a funnel-shaped process, projects downwards into the pituitary body, and above lies the PINEAL GLAND. This region includes the important HYPOTHALAMUS.
MID-BRAIN or mesencephalon: a stalk about 20 mm long connecting the cerebrum with the hind-brain. Down its centre lies a tube, the cerebral aqueduct, or aqueduct of Sylvius, connecting the third and fourth ventricles. Above this aqueduct lie the corpora quadrigemina, and beneath it are the crura cerebri, strong bands of white matter in which important nerve ?bres pass downwards from the cerebrum. The pineal gland is sited on the upper part of the midbrain.
PONS A mass of nerve ?bres, some of which run crosswise and others are the continuation of the crura cerebri downwards.
CEREBELLUM This lies towards the back, underneath the occipital lobes of the cerebrum.
MEDULLA OBLONGATA The lowest part of the brain, in structure resembling the spinal cord, with white matter on the surface and grey matter in its interior. This is continuous through the large opening in the skull, the foramen magnum, with the spinal cord. Between the medulla, pons, and cerebellum lies the fourth ventricle of the brain.
Structure The grey matter consists mainly of billions of neurones (see NEURON(E)) in which all the activities of the brain begin. These cells vary considerably in size and shape in di?erent parts of the brain, though all give o? a number of processes, some of which form nerve ?bres. The cells in the cortex of the cerebral hemispheres, for example, are very numerous, being set in layers ?ve or six deep. In shape these cells are pyramidal, giving o? processes from the apex, from the centre of the base, and from various projections elsewhere on the cell. The grey matter is everywhere penetrated by a rich supply of blood vessels, and the nerve cells and blood vessels are supported in a ?ne network of ?bres known as neuroglia.
The white matter consists of nerve ?bres, each of which is attached, at one end, to a cell in the grey matter, while at the other end it splits up into a tree-like structure around another cell in another part of the grey matter in the brain or spinal cord. The ?bres have insulating sheaths of a fatty material which, in the mass, gives the white matter its colour; they convey messages from one part of the brain to the other (association ?bres), or, grouped into bundles, leave the brain as nerves, or pass down into the spinal cord where they end near, and exert a control upon, cells from which in turn spring the nerves to the body.
Both grey and white matter are bound together by a network of cells called GLIA which make up 60 per cent of the brain’s weight. These have traditionally been seen as simple structures whose main function was to glue the constituents of the brain together. Recent research, however, suggests that glia are vital for growing synapses between the neurons as they trigger these cells to communicate with each other. So they probably participate in the task of laying down memories, for which synapses are an essential key. The research points to the likelihood that glial cells are as complex as neurons, functioning biochemically in a similar way. Glial cells also absorb potassium pumped out by active neurons and prevent levels of GLUTAMATE – the most common chemical messenger in the brain – from becoming too high.
The general arrangement of ?bres can be best understood by describing the course of a motor nerve-?bre. Arising in a cell on the surface in front of the central sulcus, such a ?bre passes inwards towards the centre of the cerebral hemisphere, the collected mass of ?bres as they lie between the lentiform nucleus and optic thalamus being known as the internal capsule. Hence the ?bre passes down through the crus cerebri, giving o? various small connecting ?bres as it passes downwards. After passing through the pons it reaches the medulla, and at this point crosses to the opposite side (decussation of the pyramids). Entering the spinal cord, it passes downwards to end ?nally in a series of branches (arborisation) which meet and touch (synapse) similar branches from one or more of the cells in the grey matter of the cord (see SPINAL CORD).
BLOOD VESSELS Four vessels carry blood to the brain: two internal carotid arteries in front, and two vertebral arteries behind. These communicate to form a circle (circle of Willis) inside the skull, so that if one is blocked, the others, by dilating, take its place. The chief branch of the internal carotid artery on each side is the middle cerebral, and this gives o? a small but very important branch which pierces the base of the brain and supplies the region of the internal capsule with blood. The chief importance of this vessel lies in the fact that the blood in it is under especially high pressure, owing to its close connection with the carotid artery, so that haemorrhage from it is liable to occur and thus give rise to stroke. Two veins, the internal cerebral veins, bring the blood away from the interior of the brain, but most of the small veins come to the surface and open into large venous sinuses, which run in grooves in the skull, and ?nally pass their blood into the internal jugular vein that accompanies the carotid artery on each side of the neck.
MEMBRANES The brain is separated from the skull by three membranes: the dura mater, a thick ?brous membrane; the arachnoid mater, a more delicate structure; and the pia mater, adhering to the surface of the brain and containing the blood vessels which nourish it. Between each pair is a space containing ?uid on which the brain ?oats as on a water-bed. The ?uid beneath the arachnoid membrane mixes with that inside the ventricles through a small opening in the fourth ventricle, called the median aperture, or foramen of Magendie.
These ?uid arrangements have a great in?uence in preserving the brain from injury.... divisions
Divisions The intestine is divided into small intestine and large intestine. The former extends from the stomach onwards for 6·5 metres (22 feet) or thereabouts. The large intestine is the second part of the tube, and though shorter (about 1·8 metres [6 feet] long) is much wider than the small intestine. The latter is divided rather arbitrarily into three parts: the duodenum, consisting of the ?rst 25–30 cm (10–12 inches), into which the ducts of the liver and pancreas open; the jejunum, comprising the next 2·4–2·7 metres (8–9 feet); and ?nally the ileum, which at its lower end opens into the large intestine.
The large intestine begins in the lower part of the abdomen on the right side. The ?rst part is known as the caecum, and into this opens the appendix vermiformis. The appendix is a small tube, closed at one end and about the thickness of a pencil, anything from 2 to 20 cm (average 9 cm) in length, which has much the same structure as the rest of the intestine. (See APPENDICITIS.) The caecum continues into the colon. This is subdivided into: the ascending colon which ascends through the right ?ank to beneath the liver; the transverse colon which crosses the upper part of the abdomen to the left side; and the descending colon which bends downwards through the left ?ank into the pelvis where it becomes the sigmoid colon. The last part of the large intestine is known as the rectum, which passes straight down through the back part of the pelvis, to open to the exterior through the anus.
Structure The intestine, both small and large, consists of four coats, which vary slightly in structure and arrangement at di?erent points but are broadly the same throughout the entire length of the bowel. On the inner surface there is a mucous membrane; outside this is a loose submucous coat, in which blood vessels run; next comes a muscular coat in two layers; and ?nally a tough, thin peritoneal membrane. MUCOUS COAT The interior of the bowel is completely lined by a single layer of pillar-like cells placed side by side. The surface is increased by countless ridges with deep furrows thickly studded with short hair-like processes called villi. As blood and lymph vessels run up to the end of these villi, the digested food passing slowly down the intestine is brought into close relation with the blood circulation. Between the bases of the villi are little openings, each of which leads into a simple, tubular gland which produces a digestive ?uid. In the small and large intestines, many cells are devoted to the production of mucus for lubricating the passage of the food. A large number of minute masses, called lymph follicles, similar in structure to the tonsils are scattered over the inner surface of the intestine. The large intestine is bare both of ridges and of villi. SUBMUCOUS COAT Loose connective tissue which allows the mucous membrane to play freely over the muscular coat. The blood vessels and lymphatic vessels which absorb the food in the villi pour their contents into a network of large vessels lying in this coat. MUSCULAR COAT The muscle in the small intestine is arranged in two layers, in the outer of which all the ?bres run lengthwise with the bowel, whilst in the inner they pass circularly round it. PERITONEAL COAT This forms the outer covering for almost the whole intestine except parts of the duodenum and of the large intestine. It is a tough, ?brous membrane, covered upon its outer surface with a smooth layer of cells.... intestine
A troublesome condition often found in the knee – and common among athletes, footballers and other energetic sportspeople – consists of the loosening of one of the ?bro-cartilages lying at the head of the tibia, especially of that on the inner side of the joint. The cartilage may either be loosened from its attachment and tend to slip beyond the edges of the bones, or it may become folded on itself. In either case, it tends to cause locking of the joint when sudden movements are made. This causes temporary inability to use the joint until the cartilage is replaced by forcible straightening, and the accident is apt to be followed by an attack of synovitis, which may last some weeks, causing lameness with pain and tenderness especially felt at a point on the inner side of the knee. This condition can be relieved by an operation
– sometimes by keyhole surgery (see MINIMALLY INVASIVE SURGERY (MIS)) – to remove the loose portion of the cartilage. Patients whose knees are severely affected by osteoarthritis or rheumatoid arthritis which cause pain and sti?ness can now have the joint replaced with an arti?cial one. (See also ARTHROPLASTY; JOINTS, DISEASES OF.)... knee
Form The liver is divided into four lobes, the greatest part being the right lobe, with a small left lobe, while the quadrate and caudate lobes are two small divisions on the back and undersurface. Around the middle of the undersurface, towards the back, a transverse ?ssure (the porta hepatis) is placed, by which the hepatic artery and portal vein carry blood into the liver, and the right and left hepatic ducts emerge, carrying o? the BILE formed in the liver to the GALL-BLADDER attached under the right lobe, where it is stored.
Position Occupying the right-hand upper part of the abdominal cavity, the liver is separated from the right lung by the DIAPHRAGM and the pleural membrane (see PLEURA). It rests on various abdominal organs, chie?y the right of the two KIDNEYS, the suprarenal gland (see ADRENAL GLANDS), the large INTESTINE, the DUODENUM and the STOMACH.
Vessels The blood supply di?ers from that of the rest of the body, in that the blood collected from the stomach and bowels into the PORTAL VEIN does not pass directly to the heart, but is ?rst distributed to the liver, where it breaks up into capillary vessels. As a result, some harmful substances are ?ltered from the bloodstream and destroyed, while various constituents of the food are stored in the liver for use in the body’s metabolic processes. The liver also receives the large hepatic artery from the coeliac axis. After circulating through capillaries, the blood from both sources is collected into the hepatic veins, which pass directly from the back surface of the liver into the inferior vena cava.
Minute structure The liver is enveloped in a capsule of ?brous tissue – Glisson’s capsule – from which strands run along the vessels and penetrate deep into the organ, binding it together. Subdivisions of the hepatic artery, portal vein, and bile duct lie alongside each other, ?nally forming the interlobular vessels,
which lie between the lobules of which the whole gland is built up. Each is about the size of a pin’s head and forms a complete secreting unit; the liver is built up of hundreds of thousands of such lobules. These contain small vessels, capillaries, or sinusoids, lined with stellate KUPFFER CELLS, which run into the centre of the lobule, where they empty into a small central vein. These lobular veins ultimately empty into the hepatic veins. Between these capillaries lie rows of large liver cells in which metabolic activity occurs. Fine bile capillaries collect the bile from the cells and discharge it into the bile ducts lying along the margins of the lobules. Liver cells are among the largest in the body, each containing one or two large round nuclei. The cells frequently contain droplets of fat or granules of GLYCOGEN – that is, animal starch.
Functions The liver is, in e?ect, a large chemical factory and the heat this produces contributes to the general warming of the body. The liver secretes bile, the chief constituents of which are the bile salts (sodium glycocholate and taurocholate), the bile pigments (BILIRUBIN and biliverdin), CHOLESTEROL, and LECITHIN. These bile salts are collected and formed in the liver and are eventually converted into the bile acids. The bile pigments are the iron-free and globin-free remnant of HAEMOGLOBIN, formed in the Kup?er cells of the liver. (They can also be formed in the spleen, lymph glands, bone marrow and connective tissues.) Bile therefore serves several purposes: it excretes pigment, the breakdown products of old red blood cells; the bile salts increase fat absorption and activate pancreatic lipase, thus aiding the digestion of fat; and bile is also necessary for the absorption of vitamins D and E.
The other important functions of the liver are as follows:
In the EMBRYO it forms red blood cells, while the adult liver stores vitamin B12, necessary for the proper functioning of the bone marrow in the manufacture of red cells.
It manufactures FIBRINOGEN, ALBUMINS and GLOBULIN from the blood.
It stores IRON and copper, necessary for the manufacture of red cells.
It produces HEPARIN, and – with the aid of vitamin K – PROTHROMBIN.
Its Kup?er cells form an important part of the RETICULO-ENDOTHELIAL SYSTEM, which breaks down red cells and probably manufactures ANTIBODIES.
Noxious products made in the intestine and absorbed into the blood are detoxicated in the liver.
It stores carbohydrate in the form of glycogen, maintaining a two-way process: glucose
glycogen.
CAROTENE, a plant pigment, is converted to vitamin A, and B vitamins are stored.
It splits up AMINO ACIDS and manufactures UREA and uric acids.
It plays an essential role in the storage and metabolism of FAT.... liver
Before applying a truss the wearer must make certain that the hernia has been reduced; this may mean lying down beforehand. A truss will rarely control a hernia satisfactorily, and it should be considered as a temporary measure only until surgical correction is possible. In the past, trusses have been supplied to patients considered too frail for surgery, but modern anaes-thetic techniques mean that most people can have their hernias surgically repaired.... truss
Form and position Each lung is a sponge-like cone, pink in children and grey in adults. Its apex projects into the neck, with the base resting on the DIAPHRAGM. Each lung is enveloped by a closed cavity, the pleural cavity, consisting of two layers of pleural membrane separated by a thin layer of ?uid. In healthy states this allows expansion and retraction as breathing occurs.
Heart/lung connections The HEART lies in contact with the two lungs, so that changes in lung volume inevitably affect the pumping action of the heart. Furthermore, both lungs are connected by blood vessels to the heart. The pulmonary artery passes from the right ventricle and divides into two branches, one of which runs straight outwards to each lung, entering its substance along with the bronchial tube at the hilum or root of the lung. From this point also emerge the pulmonary veins, which carry the blood oxygenated in the lungs back to the left atrium.
Fine structure of lungs Each main bronchial tube, entering the lung at the root, divides into branches. These subdivide again and again, to be distributed all through the substance of the lung until the ?nest tubes, known as respiratory bronchioles, have a width of only 0·25 mm (1/100 inch). All these tubes consist of a mucous membrane surrounded by a ?brous sheath. The surface of the mucous membrane comprises columnar cells provided with cilia (hair-like structures) which sweep mucus and unwanted matter such as bacteria to the exterior.
The smallest divisions of the bronchial tubes, or bronchioles, divide into a number of tortuous tubes known as alveolar ducts terminating eventually in minute sacs, known as alveoli, of which there are around 300 million.
The branches of the pulmonary artery accompany the bronchial tubes to the furthest recesses of the lung, dividing like the latter into ?ner and ?ner branches, and ending in a dense network of capillaries. The air in the air-vesicles is separated therefore from the blood only by two delicate membranes: the wall of the air-vesicle, and the capillary wall, through which exchange of gases (oxygen and carbon dioxide) readily takes place. The essential oxygenated blood from the capillaries is collected by the pulmonary veins, which also accompany the bronchi to the root of the lung.
The lungs also contain an important system of lymph vessels, which start in spaces situated between the air-vesicles and eventually leave the lung along with the blood vessels, and are connected with a chain of bronchial glands lying near the end of the TRACHEA.... lungs
Habitat: Low-lying meadows, sides of ditches.
Features ? Stem strong, woody, reddish hue, three or four feet high. Leaves in large and small pairs, alternate, serrate ; end leaf has three leaflets with longer one in middle ; dark green on top surface, white and downy underneath. Flowers small, creamy white, clustered in large, dense cymes.Part used ? Herb.Action: Astringent, diuretic, aromatic, tonic.
The 1 ounce to 1 pint infusion is taken in wineglassful doses for stranguryand dropsy. It is especially useful in infantile diarrhea.Meadowsweet is included in recipes for many herb beers, its pleasantly aromatic, tonic and diuretic qualities making it particularly suitable for this purpose.... meadowsweetTwo types of sperm cells are produced: one contains 22 autosomes and a Y sex chromosome (see SEX CHROMOSOMES); the other, 22 autosomes and an X sex chromosome. All the ova, however, produced by normal meiosis have 22 autosomes and an X sex chromosome.
Two divisions of the NUCLEUS occur (see also CELLS) and only one division of the chromosomes, so that the number of chromosomes in the ova and sperms is half that of the somatic cells. Each chromosome pair divides so that the gametes receive only one member of each pair. The number of chromosomes is restored to full complement at fertilisation so that the zygote has a complete set, each chromosome from the nucleus of the sperm pairing up with its corresponding partner from the ovum.
The ?rst stage of meiosis involves the pairing of homologous chromosomes which join together and synapse lengthwise. The chromosomes then become doubled by splitting along their length and the chromatids so formed are held together by centromeres. As the homologous chromosomes – one of which has come from the mother, and the other from the father – are lying together, genetic interchange can take place between the chromatids and in this way new combinations of GENES arise. All four chromatids are closely interwoven and recombination may take place between any maternal or any paternal chromatids. This process is known as crossing over or recombination. After this period of interchange, homologous chromosomes move apart, one to each pole of the nucleus. The cell then divides and the nucleus of each new cell now contains 23 and not 46 chromosomes. The second meiotic division then occurs, the centromeres divide and the chromatids move apart to opposite poles of the nucleus so there are still 23 chromosomes in each of the daughter nuclei so formed. The cell divides again so that there are four gametes, each containing a half number (haploid) set of chromosomes. However, owing to the recombination or crossing over, the genetic material is not identical with either parent or with other spermatozoa.... meiosis
Causes Mumps is due to infection with a virus and is highly infectious from person to person. It is predominantly a disease of childhood and early adult life, but it can occur at any age. Epidemics usually occur in the winter and spring. It is infectious for two or three days before the swelling of the glands appears. A vaccine is now available that gives a high degree of protection against the disease, the incidence of which is falling sharply. The vaccine is combined with those for MEASLES and RUBELLA – see MMR VACCINE; IMMUNISATION.
Symptoms There is an incubation period of 2–3 weeks after infection before the glands begin to swell. The gland ?rst affected is generally the parotid, situated in front of and below the ear. The swelling usually spreads to the submaxillary and sublingual glands lying beneath the jaw. The patient is feverish and the gland is tender. The swelling disappears after about ?ve days. In 15–30 per cent of males, in?ammation of the testicles (orchitis) develops. This usually occurs during the second week of the illness, but may not occur until 2–3 weeks later; it may result in partial ATROPHY of the testicles, but practically never in INFERTILITY. In a much smaller proportion of females with mumps, in?ammation of the OVARIES or BREASTS may occur. In?ammation of the PANCREAS, accompanied by tenderness in the upper part of the abdomen and digestive disturbances, sometimes results, and MENINGITIS is also an occasional complication. The various complications are found much more often when the disease affects adults than when it occurs in childhood.
Treatment There is no speci?c treatment but ANALGESICS and plenty of ?uid should be available. The child may need to be in bed for a few days and should not return to school until the symptoms have settled. Adults with orchitis may need strong painkillers, and CORTICOSTEROIDS may be required to reduce the painful swelling.... mumps
A variation of the syndrome – Munchausen’s syndrome by proxy, better termed ‘fabricated and induced illness’ – has been identi?ed, in which the persons affected in?ict damage upon others, usually children (or even animals) in their care. Factitious illness refers to simulating symptoms, such as stating that the child has blood in its urine when it is actually the parent’s blood. Induced illness includes such events as injecting dirty water into a baby’s muscles, dropping mild caustic into their eyes, adding salt to a baby’s milk or diluting it 50–50 with water, and so on. Much debate has ensued about the suggestion that some sudden infant deaths are due to smothering rather than natural causes, as a type of induced illness. As a consequence of two successful appeals against conviction for murder in 2004, the UK attorney general ordered a review of all criminal and family court cases in which disputed medical evidence had formed the basis of the decision. Paediatricians are concerned that one result is likely to be an increase in undetected child abuse.... munchausen’s syndrome
conductive deafness Deafness caused by faulty conduction of sound from the outer to the inner ear.... conduct disorders
baby’s head is large in relation to the size of the mother’s pelvis, a forceps delivery or vacuum extraction may be required.
If a vaginal delivery is impossible or dangerous to the mother or the baby, a caesarean section is necessary.... delivery
Each gland is made up of branching tubes closely packed together, and supported by strong connective tissue. These tubes are lined by large cells that secrete the saliva, and ducts transfer the saliva to openings in the mouth. The parotid gland secretes a clear ?uid containing the ENZYME, PTYALIN; in the sublingual gland they mainly produce mucus, whilst the submandibular gland contains cells of both types.... salivary glands
Treatment therefore consists of the removal of any of these causes of mouth-breathing that may be present. Should this not succeed in preventing snoring, then measures should be taken to prevent the sufferer from sleeping lying on his or her back, as this is a habit strongly conducive to snoring. Simple measures include sleeping with several pillows, so that the head is raised quite considerably when asleep; alternatively, a small pillow may be put under the nape of the neck. If all these measures fail it may be worth trying the traditional method of sewing a hairbrush, or some other hard object such as a stone, into the back of the snorer’s pyjamas. Thus, if they turn on their back, they are quickly awakened. (See also STERTOR.)... snoring
Function As well as the stomach’s prime role in physically and physiologically breaking down the food delivered via the oesophagus, it also acts as a storage organ – a function that enables people to eat three or four times a day instead of every 30 minutes or so as their metabolic needs would otherwise demand. Gastric secretion is stimulated by the sight and smell of food and its subsequent arrival in the stomach. The secretions, which contain mucus and hydrochloric acid (the latter produced by parietal cells), sterilise the food; pepsin, a digestive ENZYME in the gastric juices, breaks down the protein in food. The juices also contain intrinsic factor, vital for the absorption of vitamin B12 when the chyle – as the stomach contents are called – reaches the intestine. This chyle is of creamy consistency and is the end product of enzymic action and rhythmic contractions of the stomach’s muscles every 30 seconds or so. Food remains in the stomach for varying lengths of time depending upon its quantity and nature. At regular intervals a bolus of chyle is forced into the duodenum by contractions of the stomach muscles coordinated with relaxation of the pyloric sphincter.... stomach
entrance to the larynx (voice-box). The epiglottis is usually upright to allow air to pass through the larynx and into the rest of the respiratory system. During swallowing, it tilts downward to cover the entrance to the larynx, preventing food and drink from being inhaled.... epiglottis
The human backbone is about 70 cm (28
inches) in length, and varies little in full-grown people; di?erences in height depend mainly upon the length of the lower limbs. The number of vertebrae is 33 in children, although in adult life ?ve of these fuse together to form the sacrum, and the lowest four unite in the coccyx, so that the number of separate bones is reduced to 26. Of these there are seven in the neck, known as cervical vertebrae; 12 with ribs attached, in the region of the thorax known as thoracic or dorsal vertebrae; ?ve in the loins, called lumbar vertebrae; ?ve fused to form the sacrum; and four joined in the coccyx. These numbers are expressed in a formula thus: C7, D12, L5, S5, Coc4=33.
Although the vertebrae in each of these regions have distinguishing features, all the vertebrae are constructed on the same general plan. Each has a thick, rounded, bony part in front, known as the body, and these bodies form the main thickness of the column. Behind the body of each is a ring of bone, the neural ring, these rings placed one above another forming the bony canal which lodges the spinal cord. From each side of the ring a short process of bone known as the transverse process stands out, and from the back of the ring a larger process, the spinous process, projects. These processes give attachment to the strong ligaments and muscles which unite, support, and bend the column. The spines can be seen or felt beneath the skin of the back lying in the centre of a groove between the muscular masses of the two sides, and they give to the column its name of the spinal column. One of these spines, that of the seventh cervical vertebra, is especially large and forms a distinct bony prominence, where the neck joins the back. Between the bodies of the vertebrae lies a series of thick discs of ?brocartilage known as intervertebral discs. Each disc consists of an outer portion, known as the annulus ?brosus, and an inner core, known as the nucleus pulposus. These 23 discs provide the upper part of the spine with pliability and resilience.
The ?rst and second cervical vertebrae are specially modi?ed. The ?rst vertebra, known as the atlas, is devoid of a body, but has a specially large and strong ring with two hollows upon which the skull rests, thus allowing forward and backward movements (nodding). The second vertebra, known as the axis, has a pivot on its body which ?ts into the ?rst vertebra and thus allows free rotation of the head from side to side. The spinal column has four natural curves (see diagram) which help to cushion the shocks of walking and running.
The neural rings of the vertebrae form a canal, which is wide in the neck, smaller and almost round in the dorsal region, and wide again in the lumbar vertebrae. Down the canal runs the spinal cord, and the nerves leaving the cord do so through openings between the vertebrae which are produced by notches on the upper and lower margins of each ring. The intervertebral foramina formed by these notches are so large in comparison with the nerves passing through them that there is no chance of pressure upon the latter, except in very serious injuries which dislocate and fracture the spine.... spinal column
Syncope can also result when the venous return to the heart is impaired as a result of a rise in intrathoracic pressure. This may happen after prolonged vigorous coughing – the so-called COUGH SYNCOPE – or when elderly men with prostatic hypertrophy strain to empty their bladder. This is known as micturition syncope. Syncope is particularly likely to occur when the arterial blood pressure is unusually low. This may result from overtreatment of HYPERTENSION with drugs or it may be the result of diseases, such as ADDISON’S DISEASE, which are associated with low blood pressures. It is important that syncope be distinguished from EPILEPSY.... syncope
Malpresentation includes breech presentation (in which the baby’s bottom appears first), face presentation, and shoulder presentation (in which the baby is lying across the uterus).
Breech presentations are the most common.
A breech baby may be born by breech delivery or caesarean section.
A shoulder presentation baby usually requires a caesarean section.... malpresentation
A diagnosis is made by a physical examination and by a chest X-ray. Treatment may include morphine, diuretic drugs, aminophylline, and oxygen therapy; artificial ventilation may also be given.... pulmonary oedema
Adult kidneys have a smooth exterior, enveloped by a tough ?brous coat that is bound to the kidney only by loose ?brous tissue and by a few blood vessels that pass between it and the kidney. The outer margin of the kidney is convex; the inner is concave with a deep depression, known as the hilum, where the vessels enter. The URETER, which conveys URINE to the URINARY BLADDER, is also joined at this point. The ureter is spread out into an expanded, funnel-like end, known as the pelvis, which further divides up into little funnels known as the calyces. A vertical section through a kidney (see diagram) shows two distinct layers: an outer one, about 4 mm thick, known as the cortex; and an inner one, the medulla, lying closer to the hilum. The medulla consists of around a dozen pyramids arranged side by side, with their base on the cortex and their apex projecting into the calyces of the ureter. The apex of each pyramid is studded with tiny holes, which are the openings of the microscopic uriniferous tubes.
In e?ect, each pyramid, taken together with the portion of cortex lying along its base, is an independent mini-kidney. About 20 small tubes are on the surface of each pyramid; these, if traced up into its substance, repeatedly subdivide so as to form bundles of convoluted tubules, known as medullary rays, passing up towards the cortex. One of these may be traced further back, ending, after a tortuous course, in a small rounded body: the Malpighian corpuscle or glomerulus (see diagram). Each glomerulus and its convoluted tubule is known as a nephron, which constitutes the functional unit of the kidney. Each kidney contains around a million nephrons.
After entering the kidney, the renal artery divides into branches, forming arches where the cortex and medulla join. Small vessels come o? these arches and run up through the cortex, giving o? small branches in each direction. These end in a tuft of capillaries, enclosed in Bowman’s capsule, which forms the end of the uriniferous tubules just described; capillaries with capsule constitute a glomerulus.
After circulating in the glomerulus, the blood leaves by a small vein, which again divides into capillaries on the walls of the uriniferous tubules. From these it is ?nally collected into the renal veins and then leaves the kidney. This double circulation (?rst through the glomerulus and then around the tubule) allows a large volume of ?uid to be removed from the blood in the glomerulus, the concentrated blood passing on to the uriniferous tubule for removal of parts of its solid contents. Other arteries come straight from the arches and supply the medulla direct; the blood from these passes through another set of capillaries and ?nally into the renal veins. This circulation is con?ned purely to the kidney, although small connections by both arteries and veins exist which pass through the capsule and, joining the lumbar vessels, communicate directly with the aorta.
Function The kidneys work to separate ?uid and certain solids from the blood. The glomeruli ?lter from the blood the non-protein portion of the plasma – around 150–200 litres in 24 hours, 99 per cent of which is reabsorbed on passing through the convoluted tubules.
Three main groups of substances are classi?ed according to their extent of uptake by the tubules:
(1) SUBSTANCES ACTIVELY REABSORBED These include amino acids, glucose, sodium, potassium, calcium, magnesium and chlorine (for more information, see under separate entries).
(2) SUBSTANCES DIFFUSING THROUGH THE TUBULAR EPITHELIUM when their concentration in the ?ltrate exceeds that in the PLASMA, such as UREA, URIC ACID and phosphates.
(3) SUBSTANCES NOT RETURNED TO THE BLOOD from the tubular ?uid, such as CREATINE, accumulate in kidney failure, resulting in general ‘poisoning’ known as URAEMIA.... structure each kidney is about 10 cm long,
The opposite of supination is pronation.... supination
The opposite is dorsal.... ventral
Deep wounds on the inner side of the thigh are dangerous by reason of the risk of damage to the large vessels. Pain in the back of the thigh is often due to in?ammation of the sciatic nerve (see SCIATICA). The veins on the inner side of the thigh are specially liable to become dilated.... thigh
– and the embolism lodges in the pulmonary (lung) circulation. PULMONARY EMBOLISM is a potentially fatal condition and requires urgent anticoagulant treatment (see ANTICOAGULANTS) and sometimes surgery. Extended periods lying in bed or prolonged sitting in a con?ned position such as a car or aeroplane can cause DVT; venous thromboses in the legs may occur after surgery and preventive anticoagulant treatment with HEPARIN and warfarin is often used. Similar treatment is needed if a thrombus develops. STREPTOKINASE is also used to treat thromboembolism.... thromboembolism
Habitat: Found in many damp places such as low-lying meadows and woods, about the banks of rivers and lakes, and in marshy, swampy ground generally.
Features ? A handsome plant, growing from two to four feet and more high, whose stalks are round, thick, furrowed, and of a pale greenish colour. The leaves are pinnate with lance-shaped leaflets, growing opposite each other from the stem. The pink-white flowers (June to August) blossom in large tufts at the stalk head. A sweetish, disagreeable taste and unpleasant characteristic odour are given from the short, thick, greyish, many-fibred rootstock, which is the part used medicinally.Action: Nervine and antispasmodic.
Valerian promotes sleep and is much valued in hysteria, neuralgia and nervous debility, especially when combined with Scullcap, Mistletoe and Vervain. An infusion of 1 ounce to 1 pint of boiling water is taken in wineglass doses three or four times daily. Larger doses should not be taken.... valerianUse of herbs in combination enhances activity of the mild ones and modifies effects of the strong. Volatile properties of one may be kept in balance by opposing alkaloids, glycosides, etc.
Present practice views with disfavour the combination of several remedies, approval being given to a maximum of no more than four plant substances.
Herbs may be combined in equal parts or in specific proportions; i.e. Elder 4, Ladies’ Mantle 3 and Pulsatilla 1: represent Elder 4 parts, Ladies’ Mantle 3 parts and Pulsatilla 1 part.
The object of combining medicines is (a) to augment, correct or modify the action of a remedy, (b) to obtain a joint operation of two or more remedies, (c) to obtain a new medicine and (d) to afford a suitable form for administration.
“A combination of similar remedies will produce a more certain, speedy and considerable effect than an equivalent dose of any single one.” (Fordyce) Some herbs used singly may be of little use, their true value lying in a correct combination. Referred to as polypharmacy where a number of remedies are used in one prescription. ... combinations, formulae
Symptoms. Attack may be sudden, with acute low right abdominal pain. Lost appetite. Vomiting occurs usually only once. Nausea. Temperature slightly raised (102°). Muscles rigid and boardlike. The sufferer tries to find relief by lying on his back with right leg drawn up. Rapid heartbeat.
May lapse into abscess, perforation or peritonitis. If neglected, gangrene is a possibility, therefore a modern hospital is the safest place. In any case surgical excision may be necessary to prevent a burst when pus would discharge into the surrounding cavity causing peritonitis.
Differential diagnosis. Inflammation of the right ovary, gall bladder or kidney, ileitis, diverticulitis, perforated peptic ulcer.
Skin temperature aids diagnosis. Application of Feverscan thermometer detects local skin temperature over the right iliac fossa and records at least 1°C warmer than that on the left.
An added aid to diagnosis is the facial expression which predominantly conveys an aura of malaise with an obvious upward curving of the upper lip. This is not a wince or grimace but a slower reaction, and occurs on gentle pressure over the appendix. Rectal tenderness may indicate peritonitis.
A practitioner’s prescription would be raised according to the individual requirements of each case; some calling for support of nervous system (Skullcap, Lady’s Slipper) or for the heart (Hawthorn, Motherwort), etc.
To be treated by or in liaison with a qualified medical practitioner.
Treatment. Acute stage – immediate hospitalisation.
Tea. Formula. For non-acute stage: equal parts – German Chamomile, Yarrow, Black Horehound. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.
Tea: children. Agrimony.
Tablets/capsules. (non-acute stage), Goldenseal, Blue Flag root, Calamus, Cranesbill, Wild Yam. Juice: Aloe Vera.
Chinese medicine. Fenugreek seeds: 2 teaspoons to each cup water simmer 5 minutes. 1 cup thrice daily, consuming the seeds.
Powders. Formula. Echinacea 2; Myrrh half; Wild Yam half; trace of Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily. Every 2 hours for acute cases.
Tinctures. Formula. Echinacea 2; Wild Yam half; Elderflowers 1; few drops Tincture Capsicum (cayenne). Dose: 1-2 teaspoons in water or herb tea thrice daily or every 2 hours for acute cases.
Finlay Ellingwood MD. Equal parts, Liquid Extract Bryonia and Echinacea. Dose: 20 drops in water, hourly. For prevention of sepsis and pus formation.
Eric F.W. Powell, MNIMH. 1 teaspoon Tincture Echinacea; 10 drops Tincture Myrrh; 2 drops Tincture
Capsicum; in wineglassful hot water. Each wineglass taken in sips; dose repeated hourly until pain eases; then less frequently.
Frank Roberts, MNIMH. Liquid extracts: Equal parts, Wild Yam, Echinacea, Lobelia. Mix. 30-60 drops in wineglassful water, sipped 4 times daily.
John Cooper MD, Waldron, Arkansas, USA. 20 grains Epsom’s salts in hot water every 2 hours until pain ceases, then continue half that quantity. To control pain: Tincture Belladonna, 8 drops in water, when necessary.
Enema. Large enemas are not indicated. Warm strong infusion of German Chamomile proves helpful (50 flowers to 1 pint boiling water). Inject with 1 tablespoon warm olive oil.
Topical. Castor oil packs. Chamomile, Catnep, or Linseed poultices. In France, cases of acute appendicitis are treated with Tea Tree oil by abdominal massage as an alternative to surgery; good results reported.
Diet. No solid food taken as long as raised temperature persists. Herb tea and fruit-juice fast.
Remission of fever or after surgery: Slippery Elm gruel. Convalescent stage requires extra protein to make good muscle wastage and loss of weight. Low fibre.
Supplements. Daily. Beta-carotene 300,000iu. Vitamin C 2-3g. Vitamin E 400-800iu. Child: quarter of adult dose.
Acute stage: until the doctor comes. Do not eat or drink, take laxatives or painkillers. Go to bed. Hot water bottle to ease pain. ... appendicitis
Constituents: flavonoids, oil, tannins.
Berries contain Vitamin C and iron. Elderblossom works well with Peppermint or Yarrow, as a tea. Action: anti-inflammatory, laxative (especially berries and bark), anticatarrhal, relaxing diaphoretic, hydragogue (inner bark), cathartic (inner bark). Elderblossom is an emollient skin care product. Emetic (inner bark). Diuretic (urinary antiseptic). An ancient household remedy for promoting flow of urine (cold infusion). Expectorant (hot infusion).
Uses: the common cold, influenza, winter’s chills, early stages of fevers with dry skin and raised body temperature. Nasal catarrh, sinusitis. Tonsillitis, inflammation of mouth, throat and trachea (mouth wash and gargle). Night sweats (cold infusion). Chilblains (local).
“The inner bark of Elder has been used with success in epilepsy by taking suckers or branches 1-2 years old. The grey outer bark is scraped off and 2oz of it steeped in 5oz boiling water for 48 hours. Strain. Give a wineglassful every 15 minutes when a fit is threatening. Have the patient fast. Resume every 6 to 8 days.” (Dr F. Brown (1875))
Croup (combined with Coltsfoot – equal parts). Eyestrain, conjunctivitis, twitching: cotton wool pads soaked in cold Elder tea applied to the closed lids, patient lying down.
Preparations: Tea (flowers) 2 teaspoons (2-4g) in each cup boiling water; infuse 5 minutes. Half-1 cup two-hourly for acute conditions. Cold tea is laxative and sedative. Hot tea excites and stimulates. Cold tea soothes and heals chapped hands and useful for sunbathing.
Distilled Elderflower water: for inflamed eyes.
Liquid Extract. 1 teaspoon in water, thrice daily.
Home tincture (traditional). Chippings of inner green bark macerated in white wine for 8 days, strain; for dropsy and constipation.
Ointment. 3 parts fresh Elder leaves. Heat with 6 parts Vaseline until leaves are crisp; strain and store. (David Hoffmann)
Elderberry wine: traditional.
Powder: dose, 3-5g.
Veterinary. “If sheep or farm animals with foot-rot have access to the bark and young leaves, they soon cure themselves.” (Dr John Clarke, Dictionary of Materia Medica) ... elder
Three forms: major (grand mal); temporal lobe; and minor (petit mal). In petit mal the period of unconsciousness consists of brief absences lasting less than 15 seconds.
Treatment. Orthodox medical: Carbamazepine, phenytoin and many other drugs.
Alternatives. BHP (1983) recommends: Grand mal: Passion flower, Skullcap, Verbena. Petit mal: Hyssop. Standard central nervous system relaxants are Hops, Lobelia, Passion flower, Vervain, Valerian, Skullcap. Wm Boericke used Mugwort. Peony leaf tea had a long traditional use. In nearly all epileptics there is functional heart disturbance (Hawthorn, Lily of the Valley, Motherwort). Mistletoe can help in the struggle to control seizures and improve the quality of life.
Two important remedies are Skullcap and Passion flower. Both work quickly without risk of respiratory arrest. If dose by mouth is not possible insert gelatin capsules containing powders, per rectum, child or adult lying prone. This method is particularly suitable for feverish convulsions or Grand mal.
Repeat after 5 minutes if patient continues in convulsion. Where neither of these powders are available, Chamomile, Valerian or Mistletoe may be used.
“The remedy I have relied on most,” writes C.I. Reid, MD (Ellingwood’s Journal) “is Passion flower. Use this alone or in combination with Gelsemium – more often alone. I cannot say I obtain an absolutely curative effect, but the spasms disappear and do not return while the remedy is continued. It has none of the unpleasant effects of other medicines. I give the liquid extract in doses from 25-30 drops, 3-4 times daily, for continued use. It may be given more frequently for convulsions.”
Alfred Dawes, MNIMH. Green tincture of Mistletoe, 3-5 drops. Or, combine equal parts: Liquid Extract Skullcap, Valerian and Black Horehound.
Finlay Ellingwood MD combines White Bryony, Prickly Ash, Skullcap and St John’s Wort.
Samuel Thomson MD. Lobelia 2; Cayenne 1; (antispasmodic drops) given at the premonitary stage. 1-2 teaspoons.
Edgar Cayce. Passion flower tea. Hot Castor oil packs.
Excess acidity and intestinal toxaemia. There is considerable opinion that these trigger an attack. Combination: Liquid Extracts – Skullcap 15ml; Mistletoe 10ml; Meadowsweet 10ml; Elderflowers 10ml. Two 5ml teaspoons in water thrice daily.
West African Black Pepper. (Piper guineense) is used by traditional Nigerian healers to good effect. Associated with imperfect menstruation. Liquid Extracts, single or in combination: Black Cohosh, Life root, Lobelia. Dose: 5-15 drops thrice daily.
Associated with mental weakness. Liquid Extract Oats (avena sativa). 2-3 teaspoons in water thrice daily.
Aromatherapy. (Complex partial seizures) Massage with essential oils found to be beneficial. (The Lancet, 1990, 336 (8723) 1120)
Diet. Salt-free lacto-vegetarian. Oatmeal porridge. A cleansing 8-day grape juice fast has its advocates. Vitamin E. In 24 epileptic children refractory to anti-epileptic drugs (AEDs) with generalised tonic- clonic and other types of seizures, addition of Vitamin E 400iu daily to existing AEDs was accompanied by a significant reduction in 10 of 12 cases. (Epilepsy 1989; 30(1): 84-89)
Supportives: osteopathic or chiropractic adjustments.
Note: A number of Italian physicians linked a salt-rich diet with epileptic fits. Number and violence diminished when discontinued and did not recur for weeks. Dr W.P. Best found that, in children, circumcism made a valuable contribution.
Drug-dependency. Herbal medication may offer a supportive role to primary medical treatment. Under no circumstances should sufferers discontinue basic orthodox treatments except upon the advice of a physician.
Information. British Epilepsy Association, 40 Hanover Square, Leeds LS3 1BE, UK. Send SAE.
To be treated by or in liaison with a qualified medical practitioner. ... epilepsy
Symptoms: blinking, watering, acute discomfort. Sensation of grit in the eye does not always imply foreign body, but symptoms of conjunctivitis or keratitis. Automatic blinking is sometimes enough to clear offending object.
Treatment. External. Evert lid and remove. Swab out with dilute Witch Hazel on cotton wool. Inject one drop Castor oil, (also good for scratched cornea), Aloe Vera gel or juice. Fenugreek seed puree. Juice of Houseleek and dairy cream.
Difficult case. Removal of particles of iron or dust, apply mucilage of Slippery Elm powder to eye – patient lying on his back, a second person injecting it into corner of eye, the patient moving eye in opposite direction. Safe and healing. Clean eye and bathe with warm milk.
Referral to consultant ophthalmologist. ... eyes – foreign body
Failure of the left ventricle may occur in cases of pericarditis, disease of the aortic valve, nephritis or high blood pressure.
Left ventricular failure is often of sudden onset, urgent, and may manifest as “cardiac asthma”.
Causes: blood clot, anaemia, thyroid disorder, coronary disease, congenital effects, drug therapy (beta blockers, etc), and to fevers that make heavy demands on the left ventricle.
Symptoms: breathlessness, wheezing, sweating, unproductive cough, faintness, bleeding from the lungs, palpitation. Cardiac asthma at night: feels he needs air; better upright than lying flat. Exertion soon tires. Sensation as if heart would stop. Blueness of lips and ears from hold-up in circulation of the blood through the lungs. Frequent chest colds. Awakes gasping for breath. Always tired. Cold hands and feet. Symptoms abate as compensation takes place. ‘Cream and roses’ complexion. The failure of left ventricle soon drags into failure of the right ventricle.
Right ventricular failure leads to congestive heart failure, with raised venous pressure in neck veins and body generally, causing oedema, ascites and liver engorgement.
Treatment. Agents to strengthen, support, and eliminate excess fluids from the body. BHP (1983) advises four main remedies: Hawthorn, Motherwort, Broom and Lily of the Valley. The latter works in a digitaloid manner, strengthening the heart, contracting the vessels, and lessening congestion in the lungs. Tinctures. Hawthorn 2; Stone root 1. Lily of the Valley 1. Dose: 15-45 drops thrice daily.
Broom tea. 2 teaspoons flowers, or 2-3 teaspoons tops and flowers, in cup water brought to boil and simmered one minute. 1 cup freely.
To remove fluid retention in the lungs, diuretics are indicated; chief among which is Dandelion root because of its high potassium content to prevent hypokalaemia. Dandelion coffee. As urinary excretion increases, patient improves.
Vitamin E. Not to be taken in left ventricular disorders.
Diet. See entry: DIET – HEART AND CIRCULATION.
UK Research. Researchers found that left ventricular failure was reduced by a quarter when patients were given magnesium intravenously for the first 24 hours after admission to the coronary care unit. They conclude that it should be given before any other heart therapy is commenced, and that patients should receive regular infusions if no other drug treatment is used. (The Lancet, 2.4.1994). This supports the use of magnesium sulphate (Epsom’s salts) by a past generation of herbal practitioners for the condition. ... heart – left ventricular failure (lvf)
Treatment. Most abdominal hernias can be pushed back manually. Where this is not possible it is known as irreducible. Umbilical hernias in children usually disappear by the fourth year.
Alternatives. Teas. Fenugreek, Aloe Vera, Rupturewort. 1 teaspoon fresh or dried herb to each cup boiling water. Strain when cold. 1 cup thrice daily.
Lobelia. (Priest) Liquid Extract. 2-10 drops in water thrice daily. Thuja (infants). Liquid Extract. 1-2 drops in water thrice daily. Yarrow. (Wm Boericke MD)
Marshmallow root decoction. Traditional European.
Topical. Massage affected area with hot Castor oil (rotary motion), first to left, then to right. 2-3 tablespoons being absorbed by the body. Improvement may lead to athletic support in place of truss. (Wm A. McGarey MD)
Compress Comfrey root: pulp of fresh root. (Fletcher Hyde).
Witch Hazel packs, left in position day and night. Strangulated hernia. Put patient to bed, lying on his back, with head low, feet raised above level of body. Rub affected part with No 6 Thomson’s Compound, followed by Chickweed ointment. Give Thomson’s 3rd Preparation (Antispasmodic tincture); teaspoon doses in a cup of hot water every 20 minutes. After massage with the ointment for half an hour tissues relax and with gentle manual pressure the protrusion may be restored. (Sarah A. Webb MD) ... hernia
Symptoms: distension, regurgitation, belching, pain, heart-burn worse lying down or when stooping, food may ‘stick in the gullet’, worse when straining at stool.
Alternatives. Teas. Wood Betony. (Dr John Clarke) To prevent reflux: Hops, Black Horehound, Meadowsweet. Day-starter: Chamomile tea.
Tablets. Slippery Elm. Chew 3-5 tablets when necessary. Vegetable Charcoal; Papaya: 2 before meals. Fennel. Quarter of a teaspoon crushed seeds in cup boiling water.
Goldenseal, Liquid Extract. 5 drops in water, thrice daily.
Slippery Elm gruel.
Externally. Cold water packs to upper abdomen.
Diet. Cup fresh Carrot juice before each meal. Potato water. Avoid rich fatty foods. No solid foods at bedtime.
Supplementation. Vitamin B-complex (high formula). 1 Dolomite tablet at meals. Vitamin E 400iu daily to oxygenate the blood.
Reduction of weight favourably affects a sliding hiatus hernia. Relief from sleeping on left side is supported. Practice yawning. Relaxation techniques. ... hiatus hernia
May be caused by anxiety, exercise, smoking, alcohol, caffeine, anaemia, thyroid disorder, a specific fever or presence of a ‘coronary’. Extra-systoles may be felt as a thumping in the chest. May also be caused by excessive digitalis therapy.
Treatment. Where due to shock (Passion flower), overstrain (Ginseng), flatulence (Chamomile), sense of oppression in the chest (Hawthorn), suffocation (Aconite), worse lying on the left side (Cactus), highly sensitive women (Pulsatilla), mental depression (Cactus), congestion of the lungs (Lobelia).
Tea. Combine equal parts – Motherwort and Passion flower. 1-2 teaspoons to each cup boiling water; infuse 15 minutes; 1 cup as necessary.
Tablets/capsules. Chamomile, Hawthorn, Lobelia, Mistletoe, Motherwort, Pulsatilla, Passion flower (Passiflora), Valerian.
Formula. Equal parts: Lily of the Valley, Passion flower. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey. Practitioner. Tincture Aconite, BPC 1949. Dose: 0.12 to 0.3ml (2 to 5 drops). OR:– Spartiol (Broom) 20 drops thrice daily. (Klein).
Diet. See: DIET – HEART AND CIRCULATION.
Vitamin E. One 400iu capsule (or tablet) daily.
Minerals. Magnesium 300mg daily. ... palpitation
Recurrent, sudden pain in a muscle that is not associated with hardness of the muscle may be caused by peripheral vascular disease. In this case, the condition should be investigated and treated by a doctor.... cramp
Most attacks are harmless and are caused by a fall in the pressure of blood to the brain. This can occur when getting up quickly from a sitting or lying position (called postural hypotension). Similar symptoms may result from a transient ischaemic attack, in which there is temporary, partial blockage in the arteries that supply the brain. Other causes include tiredness, stress, fever, anaemia, heart block, hypoglycaemia, and subdural haemorrhage.
Dizziness as part of vertigo is usually due to a disorder of the inner ear, the acoustic nerve, or the brainstem. The principal disorders of the inner ear that can cause dizziness and vertigo are labyrinthitis and Ménière’s disease. Disorders of the acoustic nerve, such as acoustic neuroma, are rare causes of dizziness and vertigo. Brainstem disorders which can cause dizziness and vertigo include a type of migraine, brain tumours, and vertebrobasilar insufficiency. Brief episodes of mild dizziness usually
clear up after taking a few deep breaths or after resting for a short time. Severe, prolonged, or recurrent dizziness should be investigated by a doctor. Treatment depends on the underlying cause.... dizziness
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