Morphine Health Dictionary

Also known as diacetyl morphine or diamorphine, this Class A controlled drug is an opiate

– a group which includes morphine, codeine, pethidine and methadone. It is a powerful analgesic and cough suppressant, but its capacity to produce euphoria rapidly induces DEPENDENCE. Popular with addicts, its mostly pleasant effects soon produce TOLERANCE; the need to inject the drug, with associated risks of HIV infection, has affected its use by addicts. Withdrawal symptoms include restlessness, insomnia, muscle cramps, vomiting and diarrhoea; signs include dilated pupils, raised pulse rate, and disturbed temperature control. Although rarely life-threatening, the effects of withdrawal may cause great distress, and for this reason methadone, which has a slower and less severe withdrawal syndrome, is commonly used when weaning addicts o? heroin. Legally still available to doctors in the UK, heroin is normally only used in patients with severe pain, or to comfort the dying.... heroin

One of a varied family of alkaline, nitrogen-containing substances, usually plant-derived, reacting with acids to form salts. Normally intensely bitter, alkaloids form a body of substances widely used in drug and herbal therapy. They are usually biologically active and have a toxic potential. The term is more pharmaceutical and medical than chemical since alkaloids come from a variety of otherwise unrelated organic compounds. (Examples: caffeine, morphine, berberine).... alkaloid

Substances found commonly in various plants. They are natural nitrogenous organic bases and combine with acids to form crystalline salts. Among alkaloids, morphine was discovered in 1805, strychnine in 1818, quinine and ca?eine in 1820, nicotine in 1829, and atropine in 1833. Only a few alkaloids occur in the animal kingdom, the outstanding example being ADRENALINE, which is formed in the medulla of the suprarenal, or adrenal, gland. Alkaloids are often used for medicinal purposes. The name of an alkaloid ends in ‘ine’ (in Latin, ‘ina’).

Neutral principals are crystalline substances with actions similar to those of alkaloids but having a neutral reaction. The name of a neutral principal ends in ‘in’, e.g. digitalin, aloin.

The following are the more important alkaloids, with their source plants:

Aconite, from Monkshood.

Atropine, from Belladonna (juice of Deadly

Nightshade).

Cocaine, from Coca leaves.

Hyoscine, from Henbane.

Morphine, Codeine, from Opium (juice of

Poppy). Thebaine, Nicotine, from Tobacco. Physostigmine, from Calabar beans. Pilocarpine, from Jaborandi leaves. Quinidine, from Cinchona or Peruvian bark. Strychnine, from Nux Vomica seeds.... alkaloids

Physical or psychological reliance on a substance or an individual. A baby is naturally dependent on its parents, but as the child develops, this dependence lessens. Some adults, however, remain partly dependent, making abnormal demands for admiration, love and help from parents, relatives and others.

The dependence that most concerns modern society is one in which individuals become dependent on or addicted to certain substances such as alcohol, drugs, tobacco (nicotine), caffeine and solvents. This is often called substance abuse. Some people become addicted to certain foods or activities: examples of the latter include gambling, computer games and use of the Internet.

The 28th report of the World Health Organisation Expert Committee on Drug Dependence in 1993 de?ned drug dependence as: ‘A cluster of physiological, behavioural and cognitive phenomena of variable intensity, in which the use of a psychoactive drug (or drugs) takes on a high priority. The necessary descriptive characteristics are preoccupation with a desire to obtain and take the drug and persistent drug-seeking behaviour. Psychological dependence occurs when the substance abuser craves the drug’s desirable effects. Physical dependence occurs when the user has to continue taking the drug to avoid distressing withdrawal or abstinence symptoms. Thus, determinants and the problematic consequences of drug dependence may be biological, psychological or social and usually interact.’

Di?erent drugs cause di?erent rates of dependence: TOBACCO is the most common substance of addiction; HEROIN and COCAINE cause high rates of addiction; whereas ALCOHOL is much lower, and CANNABIS lower again. Smoking in the western world reached a peak after World War II with almost 80 per cent of the male population smoking. The reports on the link between smoking and cancer in the early 1960s resulted in a decline that has continued so that only around a quarter of the adult populations of the UK and USA smokes. Globally, tobacco consumption continues to grow, particularly in the developing world with multinational tobacco companies marketing their products aggressively.

Accurate ?gures for illegal drug-taking are hard to obtain, but probably approximately 4 per cent of the population is dependent on alcohol and 2 per cent on other drugs, both legal and illegal, at any one time in western countries.

How does dependence occur? More than 40 distinct theories or models of drug misuse have been put forward. One is that the individual consumes drugs to cope with personal problems or diffculties in relations with others. The other main model emphasises environmental in?uences such as drug availability, environmental pressures to consume drugs, and sociocultural in?uences such as peer pressure.

By contrast to these models of why people misuse drugs, models of compulsive drug use – where individuals have a compulsive addiction

– have been amenable to testing in the laboratory. Studies at cellular and nerve-receptor levels are attempting to identify mechanisms of tolerance and dependence for several substances. Classical behaviour theory is a key model for understanding drug dependence. This and current laboratory studies are being used to explain the reinforcing nature of dependent substances and are helping to provide an explanatory framework for dependence. Drug consumption is a learned form of behaviour. Numerous investigators have used conditioning theories to study why people misuse drugs. Laboratory studies are now locating the ‘reward pathways’ in the brain for opiates and stimulants where positive reinforcing mechanisms involve particular sectors of the brain. There is a consensus among experts in addiction that addictive behaviour is amenable to e?ective treatment, and that the extent to which an addict complies with treatment makes it possible to predict a positive outcome. But there is a long way to go before the mechanisms of drug addiction are properly understood or ways of treating it generally agreed.

Effects of drugs Cannabis, derived from the plant Cannabis sativa, is a widely used recreational drug. Its two main forms are marijuana, which comes from the dried leaves, and hashish which comes from the resin. Cannabis may be used in food and drink but is usually smoked in cigarettes to induce relaxation and a feeling of well-being. Heavy use can cause apathy and vagueness and may even cause psychosis. Whether or not cannabis leads people to using harder drugs is arguable, and a national debate is underway on whether its use should be legalised for medicinal use. Cannabis may alleviate the symptoms of some disorders – for example, MULTIPLE SCLEROSIS (MS) – and there are calls to allow the substance to be classi?ed as a prescribable drug.

About one in ten of Britain’s teenagers misuses volatile substances such as toluene at some time, but only about one in 40 does so regularly. These substances are given o? by certain glues, solvents, varnishes, and liquid fuels, all of which can be bought cheaply in shops, although their sale to children under 16 is illegal. They are often inhaled from plastic bags held over the nose and mouth. Central-nervous-system excitation, with euphoria and disinhibition, is followed by depression and lethargy. Unpleasant effects include facial rash, nausea and vomiting, tremor, dizziness, and clumsiness. Death from COMA and acute cardiac toxicity is a serious risk. Chronic heavy use can cause peripheral neuropathy and irreversible cerebellar damage. (See SOLVENT ABUSE (MISUSE).)

The hallucinogenic or psychedelic drugs include LYSERGIC ACID DIETHYLAMIDE (LSD) or acid, magic mushrooms, ecstasy (MDMA), and phencyclidine (PCP or ‘angel’ dust, mainly used in the USA). These drugs have no medicinal uses. Taken by mouth, they produce vivid ‘trips’, with heightened emotions and perceptions and sometimes with hallucinations. They are not physically addictive but can cause nightmarish bad trips during use and ?ashbacks (vivid reruns of trips) after use, and can probably trigger psychosis and even death, especially if drugs are mixed or taken with alcohol.

Stimulant drugs such as amphetamine and cocaine act like adrenaline and speed up the central nervous system, making the user feel con?dent, energetic, and powerful for several hours. They can also cause severe insomnia, anxiety, paranoia, psychosis, and even sudden death due to convulsions or tachycardia. Depression may occur on withdrawal of these drugs, and in some users this is su?ciently deterrent to cause psychological dependence. Amphetamine (‘speed’) is mainly synthesised illegally and may be eaten, sni?ed, or injected. Related drugs, such as dexamphetamine sulphate (Dexedrine), are prescribed pills that enter the black market. ECSTASY is another amphetamine derivative that has become a popular recreational drug; it may have fatal allergic effects. Cocaine and related drugs are used in medicine as local anaesthetics. Illegal supplies of cocaine (‘snow’ or ‘ice’) and its derivative, ‘crack’, come mainly from South America, where they are made from the plant Erythroxylon coca. Cocaine is usually sni?ed (‘snorted’) or rubbed into the gums; crack is burnt and inhaled.

Opiate drugs are derived from the opium poppy, Papaver somniferum. They are described as narcotic because they induce sleep. Their main medical use is as potent oral or injectable analgesics such as MORPHINE, DIAMORPHINE, PETHIDINE HYDROCHLORIDE, and CODEINE. The commonest illegal opiate is heroin, a powdered form of diamorphine that may be smoked, sni?ed, or injected to induce euphoria and drowsiness. Regular opiate misuse leads to tolerance (the need to take ever larger doses to achieve the same e?ect) and marked dependence. A less addictive oral opiate, METHADONE HYDROCHLORIDE, can be prescribed as a substitute that is easier to withdraw.

Some 75,000–150,000 Britons now misuse opiates and other drugs intravenously, and pose a huge public-health problem because injections with shared dirty needles can carry the blood-borne viruses that cause AIDS/HIV and HEPATITIS B. Many clinics now operate schemes to exchange old needles for clean ones, free of charge. Many addicts are often socially disruptive.

For help and advice see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP – National Dugs Helpline.

(See ALCOHOL and TOBACCO for detailed entries on those subjects.)... dependence

A naturally occurring brain PEPTIDE, the effects of which resemble those of MORPHINE or other opiates (see ENDORPHINS; ENKEPHALINS).... encephalin

Peptides (see PEPTIDE) produced in the brain which have a pain-relieving action; hence their alternative name of opiate peptides. Their name is derived from endogenous MORPHINE. They have been de?ned as endogenous opiates or any naturally occurring substances in the brain with pharmacological actions resembling opiate alkaloids such as morphine. There is some evidence that the pain-relieving action of ACUPUNCTURE may be due to the release of these opiate peptides. It has also been suggested that they may have an antipsychotic action and therefore be of value in the treatment of major psychotic illnesses such as SCHIZOPHRENIA.... endorphins

The dried juice of the unripe seed-capsules of the white Indian poppy, Papaver somniferum.The action of opium depends upon the 20– 25 ALKALOIDS it contains. Of these, the chief is MORPHINE, the amount of which varies from around 9–17 per cent. Other alkaloids include codeine, narcotine, thebaine, papaverine, and naceine.

The importation into Britain of opium is strictly regulated under the Dangerous Drugs Acts. Similar regulations govern the sale and distribution of any preparation of morphine or diamorphine (heroin) stronger than 1 part in

500. (See DEPENDENCE.)

Action The action of opium varies considerably, according to the source of the drug and the preparation used.

In small doses, opium produces a state of gentle excitement, the person ?nding their imagination more vivid, their thoughts more brilliant, and their power of expression greater than usual. This stage lasts for some hours, and is succeeded by languor. In medicinal doses this stage of excitement is short and is followed by deep sleep. When potentially poisonous doses are taken, sleep comes on quickly, and passes into coma and death (see OPIOID POISONING). The habitual use of opium produces great TOLERANCE, so that opium users require to take large quantities daily before experiencing its pleasurable effects. The need for opium also confers tolerance, so that people suffering great pain may take, with apparently little e?ect beyond dulling the pain, quantities which at another time would be dangerous.... opium

Drugs which relieve or abolish PAIN. Unlike local anaesthetics, they are usually given systemically – affecting the whole body – and produce no SENSORY or MOTOR blockade stopping the activity in the sensory or motor nerves respectively that supply a part of the body. The many di?erent types of analgesics have varying modes of action. The choice of drug and method of administration will depend upon the type and severity of pain being treated.

Non-opioid analgesics include ASPIRIN, PARACETAMOL and NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS), which are used to treat mild or moderate pain such as headache (see also MIGRAINE), DYSMENORRHOEA, and transient musculoskeletal pain. Some analgesics – for example, aspirin and paracetamol – also reduce PYREXIA. A strong non-opioid analgesic is NEFOPAM HYDROCHLORIDE, which can be used for persistent pain or pain that fails to respond to other non-opioid analgesics, but does have troublesome side-effects. These non-opioid analgesics can be obtained without a doctor’s prescription – over the counter (OTC) – but the sale of some has to be supervised by a quali?ed pharmacist. A wide range of compound analgesic preparations is available, combining, say, aspirin or paracetamol and CODEINE, while the weak stimulant CAFFEINE is sometimes included in the preparations. Most of these are OTC drugs. NSAIDs are especially e?ective in treating patients with chronic diseases accompanied by pain and in?ammation. They, too, are sometimes combined with other analgesics.

Paracetamol acts within the central nervous system by inhibition of PROSTAGLANDINS. It is often combined with other analgesics – for example, aspirin or codeine; in proprietary compounds and in therapeutic doses it has few side-effects. Overdosage, however, can cause damage to the liver or kidneys (20–30 tablets are su?cient to do this). Paracetamol is often used by individuals attempting suicide. Even if there are no immediate symptoms, individuals suspected of having taken an overdose should be sent to hospital urgently for treatment.

The NSAIDs (including aspirin) inhibit prostaglandin synthesis. Prostaglandins are released by tissues that are in?amed, and may cause pain at peripheral pain sensors or sensitise nerve endings to painful stimuli: by inhibiting their production, pain and in?ammation are reduced. NSAIDs are particularly e?ective for pain produced by in?ammation – for example, ARTHRITIS. Side-effects include gastrointestinal bleeding (caused by mucosal erosions particularly in the stomach), inhibition of platelet aggregation (see PLATELETS), and potential for renal (kidney) damage.

Severe pain is often treated with opioid drugs. The original drugs were naturally occurring plant ALKALOIDS (e.g. MORPHINE), whilst newer drugs are man-made. They mimic the action of naturally occurring compounds (ENDORPHINS and ENCEPHALIN) which are found within the brain and spinal cord, and act on receptors to reduce the transmission of painful stimuli within the central nervous system (and possibly peripherally). They tend to produce side-effects of euphoria, respiratory depression, vomiting, constipation and itching. Chronic use or abuse of these drugs may give rise to addiction.... analgesics

Datura metel

Solanaceae

San: Dhustura Hin.: Kaladhatura

Ben: Dhatura Mal: Ummam Kan; Dattura

Tam: Vellummattai

Tel: Tellavummetta

Importance: Downy datura or thorn apple is an erect branched under shrub whose intoxicating and narcotic properties have been made use of by man from ancient time. The plant and fruit are spasmolytic, anticancerous and anthelmintic. Leaves and seeds are inhaled in whooping cough, asthma and other respiratory diseases. Root, leaf and seed are febrifuge, antidiarrhoeal, anticatarrhal and are used in insanity, cerebral complications and skin diseases. Leaf is antitumour, antirheumatic and vermicide. Flower is antiasthamatic, anaesthetic and is employed in swellings and eruptions on face. Fruit juice is used in earache and seed decoction in ophthalmia. For the rheumatic swellings of joints, lumbago, sciatica and neuralgia, warm leaf smeared with an oil is used as a bandage or sometimes the leaf is made into a poultice and applied. The root boiled with milk is used in insanity. It is also an ingredient in the ayurvedic preparation Kanakasva used in bronchial troubles, and the Unani formulations “Roghan dhatura” used as a massage oil for the paralysed part. The alkaloids of pharmaceutical interest present in the plant are hyoscyamine, hyoscine and meteloidine. Datura is the chief commercial source of hyoscine available from natural source. Hyoscine, in the form of hyoscine hydrobromide, is used as a pre-anaesthetic in surgery, child birth, ophthalmology and prevention of motion sickness. It is also employed in the relief of withdrawal symptoms in morphine and alcoholic addiction, paralysis agitans, post- encephaletic parkinsonianism and to allay sexual excitement. Hyoscyamine and its salt hyoscyamine sulphate and hyoscyamine hydrobromide are used in delerium, tremour, menia and parkinsonianism (Kaul and Singh, (1995).

Distribution: Datura is distributed throughout the world, particularly the warmer regions. Datura stramonium is indigenous to India. Out of 15 species reported from different parts of the world, only 10 are known to occur in India. They are found commonly in wastelands, gardens and roadsides. They are distributed in rich localities under semi -arid and arid regions of Punjab, Haryana, Rajastan, and Gujarat; the Central Plateau of Andhra Pradesh and Maharastra and the southern peninsular region of Tamil Nadu. Datura innoxia is indigenous to Mexico and is distributed in Latin American countries. A wealth of genetic stock on genotypes and varieties are maintained in several research institutes in Germany, Bulgaria, USSR and Poland.

Botany: The genus Datura, belonging to the family solanaceae, consists of annual and perennial herbs, shrubs and trees. Three species,viz, Datura metel Linn., D. stramonium Linn. and D. innoxia Mill. are medicinally important. D. innoxia mill. and D. metel Linn. (var. alba, and var, fastuosa) are the choice drug plants, rich in hyoscine. D. metel Linn. is the most common in India. The names, D. metel Linn., D. fastuosa Linn., D. alba Nees., D. fastuosa Linn. var. alba (Nees) C.B. Clarke and D. metel Linn. var. fastuosa (Linn.) Safford are synonymously used by many workers. Two varieties are often noted in D. metel Linn., namely the white flowered var. alba and purple flowered var. fastuosa. D. metel Linn. is an erect succulent branched undershrub divaricate often purplish branches and ovate pubescent leaves which are oblique at the base of lamina. Flowers are large, solitary, short pedicelled, purplish outside and white inside. Fruits are sub-globose capsules covered all over with numerous, fleshy prickles, irregularly breaking when mature. Seeds are numerous, smooth, yellowish brown. (warrier et al, 1994).

Agrotechnology: Datura grows well in a wide range of climate from tropical to temperate conditions.

The plant thrives best in areas of low rainfall where winter and monsoon rains are followed by long dry periods. Areas with annual rainfall below 1000mm with mean temperature of 10-15oC in winter and 27 - 28oC in May-June are ideal. The crop cannot stand frost, high rainfall or high temperature in the plains in May-June. It grows on majority of soils, however, alkaline or neutral clay loam soil or those tending to saline-alkaline reaction rich in organic matter are ideal for vigorous growth. The clayey, acidic, water-logged or moisture deficient soils do not suit this crop.

The plant is propagated by seeds but it is characterised by poor and often erratic seed germination which can be improved either by leaching out the inhibitor from the seeds or by alternate freezing and thawing of seeds. The optimum season for raising the crop is Rabi in tropical and subtropical areas while Kharif in temperate areas. The seeds can be broadcast - sown or seedlings can be raised in nursery and then transplanted. Seed rate is 7-8 kg/ha for broadcasting and 2-3 kg/ha. for transplanting. The field is ploughed and disced adequately to produce fine seed bed. In the case of direct seeding, seeds are drilled in rows taken 45-60 cm apart. The plants are thinned to keep a spacing of 30-45 cm at the time of first weeding. In the case of transplanting 4-6 weeks old seedlings are planted at 45-60 x 30-45 cm spacing. The field should be irrigated immediately after sowing or planting if soil moisture is inadequate. Thereafter 3-4 irrigations may be given if sufficient rainfall is not received. Application of organic manure at 10-15 t/ha and fertilisers at 60:40:40 kg N, P2O5 and K2O/ha is recommended for the crop for better growth and yield N may be applied in 3-4 equal split doses at planting and after each weeding which is required 2-3 times during the growing season. Application of micronutrients is reported to improve the alkaloid contents. No major insect pest is known to attack this crop. However, leaf spot, wilt and mosaic diseases cause damage to this crop. Leaf spot is caused by Alternaria tennuissima (Nees) Wiltshire and characterised by brown round to oval spots, becoming necrotic at later stage which leads to withering and dropping of leaves. Wilt is caused by Sclerotium rolfsii Sace; it starts with dropping of leaves and finally wilting of the entire plant. Root and foot wilt, caused by Corticium solani, appears as damping off of seedlings and mature plants. Datura distortion mosaic is characterised by yellowing of the veins followed by inward rolling and distortion of leaves with a reduction in plant size. For reducing the impact of these diseases, field sanitation, use of resistant varieties, crop rotation for 3-4 years and fungicide application should be resorted to. For the purpose of leaf and top, harvesting is done as soon as flowering starts. Entire top containing leaves and twigs is cut, dried in shade and stored in gunny bags. For seed and fruit, fully grown fruits, still green are picked 2-3 times before final harvest when the entire plant is cut from the base and dried in the open. The dried fruits are then thrashed with a stick to separate the seeds. The seed yield is 1-1.5 t/ha. (Husain, 1993; Kaul and Singh, 1995)

Properties and activity: The alkaloids hyoscyamine and hyoscine (scopolamine) and meteloidine are found in all parts of the plant. The total alkaloid content is 0.26 - 0.42 % Fruits contain daturaolone and daturadiol while roots contain additionally ditigloyloxy tropane derivatives, tigloidine, apohyoscine, norhyoscine, norhyocyamine, cusiohygrine and tropine. Other alkaloids isolated from the plant are apohyoscyamine, DL-scopolamine, normeteloidine, tigloylputrescine, scopine, nortigloidine, tropine, psuedo valeroidine, fastudine, fastunine, fastusinine, 7-hydroxy-3, 6-ditigloyloxytropane (2) datura nolone and fastusic acid. The physiological effects of hyoscyamine are qualitatively the same as those of its recemic derivative atropine. This is relatively more active in its paralysing affect on nerve endings and less active in its stimulant action on the central nervous system. The sedative and hypnotic action of hyoscyamine is weaker than that of hyoscine. Atropine has a stimulant action on the central nervous system and depresses the nerve endings to the secretary glands and plain muscles. The plant or the different alkaloids have narcotic, anthelmintic, spasmolytic anaesthetic, sedative, ophthalmic, anticancerous, antitumour, antirheumatic, antiasthmatic, antidiarrhoeal and anticatarrhal activities. (Thakur et al, 1989).... datura

An antidote to MORPHINE. It is usually given intravenously.... levallorphan tartrate

A synthetic derivative of MORPHINE. It is an e?ective analgesic but, like morphine, is a drug of addiction.... levorphanol

Nalorphine reduces or abolishes most of the actions of MORPHINE and similarly acting NARCOTICS, such as PETHIDINE HYDROCHLORIDE. It was used as an antidote in the treatment of overdosage with these drugs but has now been superseded by NALOXONE.... nalorphine

The hydrochlorides of ALKALOIDS of OPIUM. Papaveretum relaxes smooth MUSCLE and has the pain-relieving and narcotic effects of MORPHINE, but fewer side-effects. It is largely used to prepare patients for ANAESTHESIA.... papaveretum

Burns are injuries caused by dry heat, scalds by moist heat, but the two are similar in symptoms and treatment. Severe burns are also caused by contact with electric wires, and by the action of acids and other chemicals. The burn caused by chemicals di?ers from a burn by ?re only in the fact that the outcome is more favourable, because the chemical destroys the bacteria on the affected part(s) so that less suppuration follows.

Severe and extensive burns are most frequently produced by the clothes – for example, of a child – catching ?re. This applies especially to cotton garments, which blaze up quickly. It should be remembered that such a ?ame can immediately be extinguished by making the individual lie on the ?oor so that the ?ames are uppermost, and wrapping him or her in a rug, mat or blanket. As prevention is always better than cure, particular care should always be exercised with electric ?res and kettles or pots of boiling water in houses where there are young children or old people. Children’s clothes, and especially night-clothes, should be made of non-in?ammable material: pyjamas are also much safer than nightdresses.

Severe scalds are usually produced by escape of steam in boiler explosions. Cigarettes are a common cause of ?res and therefore of burns; people who have fallen asleep in bed or in a chair while smoking may set ?re to the bed or chair. Discarded, unextinguished cigarettes are another cause.

Degrees of burns Burns are referred to as either super?cial (or partial-thickness) burns, when there is su?cient skin tissue left to ensure regrowth of skin over the burned site; and deep (or full-thickness) burns, when the skin is totally destroyed and grafting will be necessary.

Symptoms Whilst many domestic burns are minor and insigni?cant, more severe burns and scalds can prove to be very dangerous to life. The main danger is due to SHOCK, which arises as a result of loss of ?uid from the circulating blood at the site of a serious burn. This loss of ?uid leads to a fall in the volume of the circulating blood. As the maintenance of an adequate blood volume is essential to life, the body attempts to compensate for this loss by withdrawing ?uid from the uninjured areas of the body into the circulation. If carried too far, however, this in turn begins to affect the viability of the body cells. As a sequel, essential body cells, such as those of the liver and kidneys, begin to suffer, and the liver and kidneys cease to function properly. This will show itself by the development of JAUNDICE and the appearance of albumin in the urine (see PROTEINURIA). In addition, the circulation begins to fail with a resultant lack of oxygen (see ANOXIA) in the tissues, and the victim becomes cyanosed (see CYANOSIS), restless and collapsed: in some cases, death ensues. In addition, there is a strong risk of infection occurring. This is the case with severe burns in particular, which leave a large raw surface exposed and very vulnerable to any micro-organisms. The combination of shock and infection can all too often be life-threatening unless expert treatment is immediately available.

The immediate outcome of a burn is largely determined by its extent. This is of more signi?cance than the depth of the burn. To assess the extent of a burn in relation to the surface of the body, what is known as the Rule of Nine has been evolved. The head and each arm cover 9 per cent of the body surface, whilst the front of the body, the back of the body, and each leg each cover 18 per cent, with the perineum (or crutch) accounting for the remaining 1 per cent. The greater the extent of the burn, the more seriously ill will the victim become from loss of ?uid from his or her circulation, and therefore the more prompt should be his or her removal to hospital for expert treatment. The depth of the burn, unless this is very great, is mainly of import when the question arises as to how much surgical treatment, including skin grafting, will be required.

Treatment This depends upon the severity of the burn. In the case of quite minor burns or scalds, all that may be necessary if they are seen immediately is to hold the part under cold running water until the pain is relieved. Cooling is one of the most e?ective ways of relieving the pain of a burn. If the burn involves the distal part of a limb – for example, the hand and forearm – one of the most e?ective ways of relieving pain is to immerse the burned part in lukewarm water and add cold water until the pain disappears. As the water warms and pain returns, more cold water is added. After some three to four hours, pain will not reappear on warming, and the burn may be dressed in the usual way. Thereafter a simple dressing (e.g. a piece of sterile gauze covered by cotton-wool, and on top of this a bandage or adhesive dressing) should be applied. The part should be kept at rest and the dressing kept quite dry until healing takes place. Blisters should be pierced with a sterile needle, but the skin should not be cut away. No ointment or oil should be applied, and an antiseptic is not usually necessary.

In slightly more severe burns or scalds, it is probably advisable to use some antiseptic dressing. These are the cases which should be taken to a doctor – whether a general practitioner, a factory doctor, or to a hospital Accident & Emergency department. There is still no general consensus of expert opinion as to the best ‘antiseptic’ to use. Among those recommended are CHLORHEXIDINE, and antibiotics such as BACITRACIN, NEOMYCIN and polymixin. An alternative is to use a Tulle Gras dressing which has been impregnated with a suitable antibiotic.

In the case of severe burns and scalds, the only sound rule is immediate removal to hospital. Unless there is any need for immediate resuscitation, such as arti?cial respiration, or attention to other injuries there may be, such as fractures or haemorrhage, nothing should be done on the spot to the patient except to make sure that s/he is as comfortable as possible and to keep them warm, and to cover the burn with a sterile (or clean) cloth such as a sheet, pillowcases, or towels wrung out in cold water. If pain is severe, morphine should be given – usually intravenously. Once the victim is in hospital, the primary decision is as to the extent of the burn, and whether or not a transfusion is necessary. If the burn is more than 9 per cent of the body surface in extent, a transfusion is called for. The precise treatment of the burn varies, but the essential is to prevent infection if this has not already occurred, or, if it has, to bring it under control as quickly as possible. The treatment of severe burns has made great advances, with quick transport to specialised burns units, modern resuscitative measures, the use of skin grafting and other arti?cial covering techniques and active rehabilitation programmes, o?ering victims a good chance of returning to normal life.

CHEMICAL BURNS Phenol or lysol can be washed o? promptly before they do much damage. Acid or alkali burns should be neutralised by washing them repeatedly with sodium bicarbonate or 1 per cent acetic acid, respectively. Alternatively, the following bu?er solution may be used for either acid or alkali burns: monobasic potassium phosphate (70 grams), dibasic sodium phosphate (70 grams) in 850 millilitres of water. (See also PHOSPHORUS BURNS.)... burns and scalds

Mexican prickly poppy (Argemone mexicana).

Plant Part Used: Leaf, flower, root and stem.Dominican Medicinal Uses: Leaf/whole herb: prepared as a tea for blood-cleansing, cancer, stomach ulcers, delayed menstruation, vaginal infection, menopause symptoms; prepared as a douche for vaginal infection and inflammation; as a multi-herb mixture for ovarian cysts, uterine fibroids and tumors; root: boiled tea for stomach pain.Safety: Entire plant shown to be hepatotoxic due to sanguinarine and alkaloid content, especially concentrated in the seeds; internal use strongly cautioned against.Contraindications: Pregnancy, lactation, children.Laboratory & Preclinical Data: In vitro: antifungal, anti-HIV, anti-tumor, morphine-withdrawal alleviation, uterine stimulant (organic plant extracts).* See entry for Cardo santo in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.

... cardo santo

In the United Kingdom, controlled drugs are those preparations referred to under the Misuse of Drugs Act 1971. The Act prohibits activities related to the manufacture, supply and possession of these drugs, and they are classi?ed into three groups which determine the penalties for o?ences involving their misuse. For example, class A includes COCAINE, DIAMORPHINE, MORPHINE, LSD (see LYSERGIC ACID DIETHYLAMIDE and PETHIDINE HYDROCHLORIDE. Class B includes AMPHETAMINES, BARBITURATES and CODEINE. Class C includes drugs related to amphetamines such as diethylpropion and chlorphentermine, meprobamate and most BENZODIAZEPINES and CANNABIS.

The Misuse of Drugs Regulations 1985 de?ne the classes of person authorised to supply and possess controlled drugs, and lay down the conditions under which these activities may be carried out. In the Regulations, drugs are divided into ?ve schedules specifying the requirements for supply, possession, prescribing and record-keeping. Schedule I contains drugs which are not used as medicines. Schedules II and III contain drugs which are subject to the prescription requirements of the Act (see below). They are distinguished in the British National Formulary (BNF) by the symbol CD and they include morphine, diamorphine (heroin), other opioid analgesics, barbiturates, amphetamines, cocaine and diethylpropion. Schedules IV and V contain drugs such as the benzodiazepines which are subject to minimal control. A full list of the drugs in each schedule can be found in the BNF.

Prescriptions for drugs in schedules II and III must be signed and dated by the prescriber, who must give his or her address. The prescription must be in the prescriber’s own handwriting and provide the name and address of the patient and the total quantity of the preparation in both words and ?gures. The pharmacist is not allowed to dispense a controlled drug unless all the information required by law is given on the prescription.

Until 1997 the Misuse of Drugs (Noti?cation and Supply of Addicts) Regulations 1973 governed the noti?cation of addicts. This was required in respect of the following commonly used drugs: cocaine, dextromoramide, diamorphine, dipipanone, hydrocodeine, hydromorphone, levorphanol, methadone, morphine, opium, oxycodone, pethidine, phenazocine and piritranide.

In 1997 the Misuse of Drugs (Supply to Addicts) Regulations 1997 revoked the 1973 requirement for noti?cation. Doctors are now expected to report (on a standard form) cases of drug misuse to their local Drug Misuse Database (DMD). Noti?cation by the doctor should be made when a patient ?rst presents with a drug problem or when he or she visits again after a gap of six months or more. All types of misuse should be reported: this includes opioids, benzodiazepines and central nervous system stimulants. The data in the DMD are anonymised, which means that doctors cannot check on possible multiple prescribing for drug addicts.

The 1997 Regulations restrict the prescribing of diamorphine (heroin), Diconal® (a morphine-based drug) or cocaine to medical practitioners holding a special licence issued by the Home Secretary.

Fuller details about the prescription of controlled drugs are in the British National Formulary, updated twice a year, and available on the Internet (see www.bnf.org).... controlled drugs

Wall.

Family: Papaveraceae.

Habitat: The West Himalayas, from Kashmir to Kumaon.

Ayurvedic: Bhootakeshi (a doubtful substitute for Bhootajataa, Nardostachys jatamansi DC.) Species of Selinum are also used as Bhootakeshi.

Action: Sedative, spasmolytic, hypotensive, nervine, antiseptic. Used in cutaneous and scrofulous affections, chronic fever and liver complaints.

The roots contain phthalide iso- quinoline alkaloids. In addition, stems and leaves contain tetrahydroproto- berberines.

A related species, C. solida, indigenous to Siberia, northern China and Japan, contains alkaloids including corydalmine, tetrahydropalmatine, protoberberine-type alkaloid lenticin. The alkaloids are analgesic and sedative and have been shown to work, at least in part, by blocking the dopamine receptors in the central nervous system.

The powdered rhizome of Corydalis possesses one-hundredth of the analgesic potency of morphine.... corydalis govaniana

A synthetic analgesic and antispasmodic drug, which is used in the treatment of painful and spasmodic conditions in place of morphine and atropine. A prompt but short-lasting analgesic, it has less of a constipating e?ect than morphine but is less potent. Useful for analgesia during childbirth because it produces less respiratory depression in the baby than other opioids. Pethidine is one of the CONTROLLED DRUGS.... pethidine hydrochloride

A drug preparation in solid, bullet-like form, which is inserted into the RECTUM (or the VAGINA, when it is called a pessary). This method of using drugs may be chosen for various reasons. For example, the suppository, as in the case of glycerin suppositories, may be used to produce an aperient action. Other suppositories, such as those of MORPHINE, are used to reduce pain and check the action of the bowels. Suppositories are useful when the patient is unable to take oral medication and when no suitable preparation is available for injection.... suppository

This occurs when the response to a particular amount of a drug or physiological messenger decreases, so that a larger dose must be given to produce the same response as before. It is particularly common with certain drug dependencies (see DEPENDENCE): for example, with MORPHINE or HEROIN.... tolerance

(in the UK) an Act of Parliament restricting the use of dangerous drugs. These controlled drugs are divided into three classes: class A drugs (e.g. heroin, morphine and other potent opioid analgesics, cocaine, LSD) cause the most harm when misused; class B drugs include amphetamines, barbiturates, and cannabis, and class C drugs include most benzodiazepines and anabolic steroids. The Act specifies certain requirements for writing prescriptions for these drugs. The Misuse of Drugs (Supply to Addicts) Regulations 1997 and the Misuse of Drugs Regulations 2001 lay down who may supply controlled drugs and the rules governing their supply, prescription, etc.... misuse of drugs act 1971

n. strictly, one of a group of drugs derived from opium, including *morphine, *codeine, and *heroin (diacetylmorphine). The term may be used more loosely to include, in addition, synthetic drugs with similar effects, such as *methadone and *buprenorphine; in this case the term opioid is usually preferred. Opiates depress the central nervous system: they relieve pain, induce feelings of euphoria, suppress coughing, and stimulate vomiting. Because prolonged use can lead to *tolerance and *dependence, opioid *analgesics are reserved for the relief of moderate or severe pain; other side-effects include drowsiness, nausea and vomiting, constipation, and depression of breathing.... opiate

Many factors in?uence the activity with which drugs operate. Among the factors which affect the necessary quantity are age, weight, sex, idiosyncrasy, genetic disorders, habitual use, disease, fasting, combination with other drugs, the form in which the drug is given, and the route by which it is given.

Normally, a young child requires a smaller dose than an adult. There are, however, other factors than age to be taken into consideration. Thus, children are more susceptible than adults to some drugs such as MORPHINE, whilst they are less sensitive to others such as ATROPINE. The only correct way to calculate a child’s dose is by reference to texts supplying a recommended dose in milligrams per kilogram. However, many reference texts simply quote doses for certain age-ranges.

Old people, too, often show an increased susceptibility to drugs. This is probably due to a variety of factors, such as decreased weight; diminished activity of the tissues and therefore diminished rate at which a drug is utilised; and diminished activity of the KIDNEYS resulting in decreased rate of excretion of the drug.

Weight and sex have both to be taken into consideration. Women require slightly smaller doses than men, probably because they tend to be lighter in weight. The e?ect of weight on dosage is partly dependent on the fact that much of the extra weight of a heavy individual is made up of fatty tissue which is not as active as other tissues of the body. In practice, the question of weight seldom makes much di?erence unless the individual is grossly over- or underweight.

Idiosyncrasy occasionally causes drugs administered in the ordinary dose to produce unexpected effects. Thus, some people are but little affected by some drugs, whilst in others, certain drugs – for example, psychoactive preparations such as sedatives – produce excessive symptoms in normal or even small doses. In some cases this may be due to hypersensitivity, or an allergic reaction, to the drug, which is a possibility that must always be borne in mind

(e.g. with PENICILLIN). An individual who is known to be allergic to a certain medication is strongly advised to carry a card to this e?ect, and always to inform medical and dental practitioners and/or a pharmacist before accepting a new prescription or buying an over-the-counter preparation.

Habitual use of a drug is perhaps the in?uence that causes the greatest increase in the dose necessary to produce the requisite e?ect. The classical example of this is with OPIUM and its derivatives.

Disease may modify the dose of medicines. This can occur in several ways. Thus, in serious illnesses the patient may be more susceptible to drugs, such as narcotics, that depress tissue activity, and therefore smaller doses must be given. Again, absorption of the drug from the gut may be slowed up by disease of the gut, or its e?ect may be enhanced if there is disease of the kidneys, interfering with the excretion of the drug.

Fasting aids the rapidity of absorption of drugs, and also makes the body more susceptible to their action. Partly for this reason, as well as to avoid irritation of the stomach, it is usual to prescribe drugs to be taken after meals, and diluted with water.

Combination of drugs is to be avoided if possible as it is often di?cult to assess what their combined e?ect may be. In some cases they may have a mutually antagonistic e?ect, which means that the patient will not obtain full bene?t. Sometimes a combination may have a deleterious e?ect.

Form, route and frequency of administration Drugs are now produced in many forms, though tablets are the most common and, usually, convenient. In Britain, medicines are given by mouth whenever possible, unless there is some degree of urgency, or because the drug is either destroyed in, or is not absorbed from, the gut. In these circumstances, it is given intravenously, intra-muscularly or subcutaneously. In some cases, as in cases of ASTHMA or BRONCHITIS, the drug may be given in the form of an inhalant (see INHALANTS), in order to get the maximum concentration at the point where it is wanted: that is, in the lungs. If a local e?ect is wanted, as in cases of diseases of the skin, the drug is applied topically to the skin. In some countries there is a tendency to give medicines in the form of a suppository which is inserted in the rectum.

Recent years have seen developments whereby the assimilation of drugs into the body can be more carefully controlled. These include, for example, what are known as transdermals, in which drugs are built into a plaster that is stuck on the skin, and the drug is then absorbed into the body at a controlled rate. This method is now being used for the administration of GLYCERYL TRINITRATE in the treatment of ANGINA PECTORIS, and of hyoscine hydrobromide in the treatment of MOTION (TRAVEL) SICKNESS. Another is a new class of implantable devices. These are tiny polymers infused with a drug and implanted just under the skin by injection. They can be tailored so as to deliver drugs at virtually any rate – from minutes to years. A modi?cation of these polymers now being investigated is the incorporation of magnetic particles which allow an extra burst of the incorporated drug to be released in response to an oscillating magnetic ?eld which is induced by a magnetic ‘watch’ worn by the patient. In this way the patient can switch on an extra dose of drug when this is needed: insulin, for instance, in the case of diabetics. In yet another new development, a core of drug is enclosed in a semi-permeable membrane and is released in the stomach at a given rate. (See also LIPOSOMES.)... dosage

Unpleasant physical and mental symptoms that occur when a person stops using a drug or substance on which he or she is dependent (see DEPENDENCE). The symptoms include tremors, sweating, and vomiting which are reversed if further doses are given. Alcohol and hard drugs, such as morphine, heroin, and cocaine, are among the substances that induce dependence, and therefore withdrawal symptoms, when stopped. Amphetamines and nicotine are other examples.... withdrawal symptoms

Drugs used to reduce or stop diarrhoea and to help regulate bowel action in people with a colostomy or ileostomy.

In most acute cases of diarrhoea, the only treatment recommended is oral rehydration therapy.

Antidiarrhoeal drugs include adsorbents, bulk-forming agents such as kaolin, and antimotility drugs (including the opioid drugs, morphine and codeine, and loperamide), which slow movement through the intestine.

None of these drugs are suitable for children.... antidiarrhoeal drugs

A synthetic, opioid analgesic drug similar to morphine; it is another name for heroin. Diamorphine is used to relieve severe pain and also to relieve distress in acute heart failure. It carries the risk of dependence so is prescribed with caution. The drug may also cause nausea, vomiting, and constipation. (See also heroin abuse.)... diamorphine

The gall-bladder rests on the underside of the LIVER and joins the common hepatic duct via the cystic duct to form the common BILE DUCT. The gall-bladder acts as a reservoir and concentrator of BILE, alterations in the composition of which may result in the formation of gallstones, the most common disease of the gallbladder.

Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.

Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.

Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of

An unpleasant sensation, as if ants were crawling over the skin.

This may occur following abuse of certain drugs, such as alcohol or morphine.... formication

A synthetic opioid analgesic drug that resembles morphine.

Methadone is used under supervision to relieve withdrawal symptoms in people undergoing a heroin or morphine detoxification programme.

Side effects may include nausea, vomiting, constipation, dizziness, and dry mouth.... methadone

A type of analgesic drug (painkiller) used to treat moderate to severe pain.

Opioids, also knows as narcotic drugs, may be abused for their euphoric effects; abuse may cause tolerance (the need for greater amounts of a drug to get the same effect), and physical and psychological drug dependence.

Commonly used opioids include codeine, diamorphine, morphine, and pethidine.... opioid

The treatment of pain, usually with analgesic drugs. Paracetamol, aspirin and codeine are the most widely used drugs in this group. Pain accompanied by inflammation is often alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs). Severe pain may require treatment with opioids, such as morphine.

Other methods of pain relief include massage, ice-packs, poultices, TENS, acupuncture, or hypnosis. Surgery to destroy pain-transmitting nerves (as in a cordotomy) is occasionally performed when other treatments fail.... pain relief

Red or purple, flat, pinhead spots that occur in the skin or mucousmembranes. Petechiae are caused by a localized haemorrhage from small blood vessels. They occur in purpura and, sometimes, bacterial endocarditis. pethidine A synthetic opioid analgesic drug similar to, but less powerful than, morphine. Pethidine is used as a premedication and to relieve severe pain after operations, during childbirth, or in terminal illness. As it may cause nausea and vomiting, it is usually given with an antiemetic drug.... petechiae

Miers.

Synonym: J. calumba Miers.

Family: Menispermaceae.

Habitat: Indigenous to south-east tropical Africa. Imported into India.

English: Calumba, Colombo.

Ayurvedic: Kalambaka. (Coscinium fenestratum Colebr., known as False calumba, is used as a substitute for J. palmata.)

Siddha/Tamil: Kolumbu.

Action: Root—bitter tonic without astringency, carminative, gastric tonic, antiflatulent, hyptotensive, orexigenic, uterine stimulant, sedative. Used in anorexia, poor digestion, hypochlorhydria, amoebic dysentery and menstrual disorders. Antifungal.

Key application: As appetite stimulant. (The British Herbal Pharmacopoeia.)

The root gave isoquinoline alkaloids 2-3%; palmatine, jaterorrhizine and its dimer bis-jateorrhizine, columbamine; bitters (including chasmanthin and palmanin). Volatile oil contains thymol.

The alkaloid jateorrhizine is sedative, hypotensive. Palmatine is a uterine stimulant.

As calumba contains very little volatile oil and no tannins, it is free from as- tringency which is common with other bitter herbs.

The root alkaloids exhibit narcotic properties and side effects similar to morphine. It is no longer used (in Western herbal) as a digestive aid, and is rarely used as an antidiarrhoeal agent. (Natural Medicines Comprehensive Database, 2007.)... jateorhiza palmata

Linn.

Family: Compositae; Asteraceae.

Habitat: Native to Europe. Imported into India.

English: Bitter Lettuce, Wild Lettuce.

Unani: Kaahuu Sahrai (var.), Kaahuu Barri (var.).

Action: Mild sedative, hypnotic, (once used as a substitute for opium), anodyne, expectorant.

Key application: As sedative. (The British Herbal Pharmacopoeia.)

Used in insomnia, nervous excitability, anxiety, restlessness, hyperactivity in children, nymphomania, smoker's cough, irritable cough and bronchitis.

Aerial parts contain sesquiterpene glycosides.

The leaves and dried juice contain lacticin, lactucopicrin (sesquiterpene lactones); flavonoids (mainly based on quercetin); coumarins (cichoriin and aesculin); N-methyl-beta-phenethy- lamine; triterpenes include taraxas- terol and beta-amyrin. The sesquiterpene lactones have a sedative effect.

The Wild Lettuce also contains hyos- cyamine, while the dried sap is devoid of it. Morphine content has been found in low concentrations, too low to have pharmacological effect. (Natural Medicines Comprehensive Database, 2007.)

The oil of seeds is used for arteriosclerosis.

Synonym: L. vulgaris Ser. L. leucanth Rusby. Cucurbita siceraria Mol.

Family: Cucurbitaceae.

Habitat: Throughout India.

English: Bitter Bottle-Gourd.

Ayurvedic: Katu-tumbi, Tumbini, Ikshavaaku. Tiktaalaavu, Pindapha- laa.

Unani: Kaddu-e-talkh (bitter var.).

Siddha/Tamil: Suraikai.

Action: Pulp—purgative, emetic. Leaf—used in jaundice.

Cucurbita lagenaria Linn. is equated with Lauki or Sweet Bottle-Guard, used all over India as a vegetable.

Cucurbita siceraria Mol. is equated with Titalauki or the Bitter Bottle- Gourd. Bitter fruits yield 0.013% of a solid foam containing cucurbitacin B,D,G and H, mainly cucurbitacin B. These bitter principles are present in the fruit as aglycones. Leaves contain cucurbitacin B, and roots cucurbitacins B, D and traces of E. The fruit juice contains beta-glycosidase (elaterase).

Plants which yield non-bitter fruits contain no bitter principles or elat- erase; their roots are not bitter.... lactuca virosa

Accumulation of fluid in the lungs, usually due to leftsided heart failure. It may also be due to chest infection, inhalation of irritant gases, or to any of the causes of generalized oedema. The main symptom is breathlessness, which is usually worse when lying flat and may disturb sleep. There may be a cough, producing frothy, sometimes pink, sputum. Breathing may sound bubbly or wheezy.

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

A life-threatening condition in which the amount of carbon dioxide in the blood rises, and the amount of oxygen falls, due to disruption of the normal exchange of gases between the air in the lungs and the blood. Ventilatory failure may be due to brain damage or to depression of the respiratory centres by excessive doses of drugs such as morphine. Treatment may involve artificial ventilation or, in some cases, the use of respiratory stimulant drugs. (See also respiratory failure.)... ventilatory failure

1. n. a drug that relieves pain. Nonopioid analgesics, such as *aspirin and *paracetamol, are used for the relief of headache, toothache, and mild rheumatic pain. More potent opioid analgesics, such as *morphine, *pethidine, *alfentanil, and *buprenorphine, are used to relieve moderate or severe pain; these drugs may produce *dependence and *tolerance (see opiate). Some analgesics, including aspirin and *indometacin, also reduce fever and inflammation and are used in rheumatic and other inflammatory conditions (see NSAID). 2. adj. relieving pain.... analgesic

a mixture of alcohol, morphine, and cocaine sometimes given to control severe pain in terminally ill people, especially those dying of cancer. The mixture was first tried at the Brompton Hospital, London.... brompton cocktail

Medicines are drugs made stable, palatable and acceptable for administration. In Britain, the Medicines Act 1968 controls the making, advertising and selling of substances used for ‘medicinal purposes’, which means diagnosing, preventing or treating disease, or altering a function of the body. Permission to market a medicine has to be obtained from the government through the MEDICINES CONTROL AGENCY, or from the European Commission through the European Medicines Evaluation Agency. It takes the form of a Marketing Authorisation (formerly called a Product Licence), and the uses to which the medicine can be put are laid out in the Summary of Product Characteristics (which used to be called the Product Data Sheet).

There are three main categories of licensed medicinal product. Drugs in small quantities can, if they are perceived to be safe, be licensed for general sale (GSL – general sales list), and may then be sold in any retail shop. P (pharmacy-only) medicines can be sold from a registered pharmacy by or under the supervision of a pharmacist (see PHARMACISTS); no prescription is needed. P and GSL medicines are together known as OTCs – that is, ‘over-thecounter medicines’. POM (prescription-only medicines) can only be obtained from a registered pharmacy on the prescription of a doctor or dentist. As more information is gathered on the safety of drugs, and more emphasis put on individual responsibility for health, there is a trend towards allowing drugs that were once POM to be more widely available as P medicines. Examples include HYDROCORTISONE 1 per cent cream for skin rashes, CIMETIDINE for indigestion, and ACICLOVIR for cold sores. Care is needed to avoid taking a P medicine that might alter the actions of another medicine taken with it, or that might be unsuitable for other reasons. Patients should read the patient-information lea?et, and seek the pharmacist’s advice if they have any doubt about the information. They should tell their pharmacist or doctor if the medicine results in any unexpected effects.

Potentially dangerous drugs are preparations referred to under the Misuse of Drugs Act 1971 and subsequent regulations approved in 1985. Described as CONTROLLED DRUGS, these include such preparations as COCAINE, MORPHINE, DIAMORPHINE, LSD (see LYSERGIC ACID

DIETHYLAMIDE (LSD)), PETHIDINE HYDROCHLORIDE, AMPHETAMINES, BARBITURATES and most BENZODIAZEPINES.

Naming of drugs A European Community Directive (92/27/EEC) requires the use of the Recommended International Non-proprietary Name (rINN) for medicinal substances. For most of these the British Approved Name (BAN) and rINN were identical; where the two were di?erent, the BAN has been modi?ed in line with the rINN. Doctors and other authorised subscribers are advised to write titles of drugs and preparations in full because uno?cial abbreviations may be misinterpreted. Where a drug or preparation has a non-proprietary (generic) title, this should be used in prescribing unless there is a genuine problem over the bioavailability properties of a proprietary drug and its generic equivalent.

Where proprietary – commercially registered

– names exist, they may in general be used only for products supplied by the trademark owners. Countries outside the European Union have their own regulations for the naming of medicines.

Methods of administration The ways in which drugs are given are increasingly ingenious. Most are still given by mouth; some oral preparations (‘slow release’ or ‘controlled release’ preparations) are designed to release their contents slowly into the gut, to maintain the action of the drug.

Buccal preparations are allowed to dissolve in the mouth, and sublingual ones are dissolved under the tongue. The other end of the gastrointestinal tract can also absorb drugs: suppositories inserted in the rectum can be used for their local actions – for example, as laxatives – or to allow absorption when taking the drug by mouth is di?cult or impossible – for example, during a convulsion, or when vomiting.

Small amounts of drug can be absorbed through the intact skin, and for very potent drugs like OESTROGENS (female sex hormones) or the anti-anginal drug GLYCERYL TRINITRATE, a drug-releasing ‘patch’ can be used. Drugs can be inhaled into the lungs as a ?ne powder to treat or prevent ASTHMA attacks. They can also be dispersed (‘nebulised’) as a ?ne mist which can be administered with compressed air or oxygen. Spraying a drug into the nostril, so that it can be absorbed through the lining of the nose into the bloodstream, can avoid destruction of the drug in the stomach. This route is used for a small number of drugs like antidiuretic hormone (see VASOPRESSIN).

Injection remains an important route of administering drugs both locally (for example, into joints or into the eyeball), and into the bloodstream. For this latter purpose, drugs can be given under the skin – that is, subcutaneously (s.c. – also called hypodermic injection); into muscle – intramuscularly (i.m.); or into a vein – intravenously (i.v.). Oily or crystalline preparations of drugs injected subcutaneously form a ‘depot’ from which they are absorbed only slowly into the blood. The action of drugs such as TESTOSTERONE and INSULIN can be prolonged by using such preparations, which also allow contraceptive ‘implants’ that work for some months (see CONTRACEPTION).... medicines

n. an opioid analgesic derived from *morphine but less potent as a pain killer and sedative and less toxic. It is also used to suppress dry coughs and treat diarrhoea. Common side-effects include constipation, nausea, vomiting, dizziness, and drowsiness, but *dependence is uncommon. Codeine may also be administered orally in combination with paracetamol (as co-codamol) or aspirin (as co-codaprin) for pain relief.... codeine

n. an opioid *analgesic used to relieve moderate to severe pain (see opiate). It sometimes causes nausea, dizziness, and constipation. Dependence of the *morphine type can also occur, but this is rare. Dihydrocodeine may be administered in combination with *paracetamol (as co-dydramol).... dihydrocodeine

n. a hydroalcoholic solution containing 1% morphine, prepared from macerated raw opium. It was formerly widely used as an opioid analgesic.... laudanum

n. poisoning from the effects of eating or smoking *opium or the products derived from it, especially *morphine.... meconism

morphine, oxygen, nitrates, aspirin: the standard treatments for *acute coronary syndromes.... mona

Also known as Physeptone®, this is a synthetic drug structurally similar to MORPHINE, one of many opioid drugs used to treat severe pain. Methadone is, however, less sedating and has a longer half-life. Furthermore, it is more reliable when taken orally. Although vomiting is common, this is generally less severe than with morphine.

Methadone is valuable as a suppressant for non-productive cough, acting on the medullary ‘cough centre’ in the central nervous system. It is also helpful in weaning addicts o? morphine and heroin, having a slower onset of DEPENDENCE and a less severe withdrawal syndrome. When used for prolonged periods, methadone should not be given more often than twice daily, to avoid the risks of accumulation and opioid overdosage.... methadone hydrochloride

See also MEDICINES. Government legislation covers the manufacture, sale and prescription of drugs in the UK. As well as stating which drugs may be sold over the counter (OTC) without a doctor’s or dentist’s prescription, and those which can be obtained only with such a prescription, government regulations determine the extent of availability of many substances which are liable to be abused – see Misuse of Drugs Act 1971 (below). The Misuse of Drugs Regulations 1985 de?ne those individuals who in their professional capacity are authorised to supply and possess controlled drugs: see the schedules of drugs listed below under the 1985 regulations.

Misuse of Drugs Act 1971 This legislation forbids activities relating to the manufacture, sale and possession of particular (controlled) drugs. These are classi?ed into three grades according to their dangers if misused. Any o?ences concerning class A drugs, potentially the most damaging when abused, carry the toughest penalties, while classes B and C attract lesser penalties if abused.

Class A includes: cocaine, dextromoramide, diamorphine (heroin), lysergic acid (LSD), methadone, morphine, opium, pethidine, phencyclidine acid and injectable preparations of class B drugs.

Class B includes: oral amphetamines, barbiturates, codeine, glutethimide, marijuana (cannabis), pentazocine and pholcodine.

Class C includes: drugs related to the amphetamines, anabolic and androgenic steroids, many benzodiazepines, buprenorphine, diethyl propion, human chorionic gonadotrophin (HCG), mazindol, meprobamate, pemoline, phenbuterol, and somatropin.

Misuse of Drugs Regulations 1985 These regulations de?ne those people who are authorised in their professional capacity to supply and possess controlled drugs. They also describe the requirements for legally undertaking these activities, such as storage of the drugs and limits on their prescription.

Drugs are divided into ?ve schedules and some examples follow.

I: Almost all are prohibited except in accordance with Home O?ce authority: marijuana (cannabis), LSD.

II: High potential for abuse but have

accepted medical uses: amphetamines, cocaine.

III: Lower potential for abuse: barbiturates, meprobamate, temazepam.

IV: Lower potential for abuse than I to III. Minimal control: benzodiazepines.

V: Low potential for abuse: generally compound preparations containing small amounts of opioids: kaolin and morphine (antidiarrhoeal medicine), codeine linctus (cough suppressant).

(See also CONTROLLED DRUGS.)... misuse of drugs

MORPHINE and CODEINE are natural opium ALKALOIDS found in the opium poppy (Papaver somniferum). The other opioids are either synthetic or semi-synthetic analogues of these. Their main use is in the treatment of moderate to severe PAIN, but they are also used as antidiarrhoeal and antitussive agents. As a result of induced tolerance (see DEPENDENCE) and great individual variability, the amount of opioid substances required to cause serious consequences varies enormously.

The most common effects of opioid overdose are vomiting, drowsiness, pinpoint pupils, BRADYCARDIA, CONVULSIONS and COMA. Respiratory depression is common and may lead to CYANOSIS and respiratory arrest. HYPOTENSION occurs occasionally and in severe cases non-cardiogenic pulmonary oedema and cardiovascular collapse may occur. Cardiac ARRHYTHMIA may occur with some opioids. Some opioids have a HISTAMINE-releasing e?ect which may result in an urticarial rash (see URTICARIA), PRURITUS, ?ushing and hypotension. Activated CHARCOAL should be given following overdose and NALOXONE administered to reverse respiratory depression and deep coma.... opioid poisoning

n. a drug that is a specific antidote to morphine and other opioids. It is used in the emergency treatment of opioid overdosage and to reverse the respiratory depression induced by opioid analgesics used during surgery. As it is short-acting, repeated doses may be necessary.... naloxone

n. a drug that induces stupor and insensibility and relieves pain. Now largely obsolete in medical contexts, the term was used particularly for morphine and other derivatives of opium (see opiate) but also referred to other drugs that depress brain function (e.g. general anaesthetics and hypnotics). In legal terms a narcotic is any addictive drug subject to illegal use.... narcotic

The management of MALIGNANT disease – a major health problem since successful management requires close liaison between the patient, surgeons, physicians, oncologists, haematologists, paediatricians and other specialists. Diagnosis may involve various investigations and often requires a BIOPSY. Once a diagnosis has been established, treatment may involve surgery, radiotherapy or chemotherapy (or various combinations as required) – see below, and main dictionary entries.

Surgery may be most common, and is often the only treatment, for some gastrointestinal tumours, soft-tissue tumours, gynaecological tumours and advanced cancers of the head and neck.

Radiotherapy uses ionising radiation to kill tumour cells. Radiation is by naturally occurring isotopes (see ISOTOPE) or arti?cially produced X-RAYS. Germ-cell tumours (see SEMINOMA; TERATOMA) and malignant lymphomas (see LYMPHOMA) appear to be particularly sensitive to irradiation, and many head and neck tumours, gynaecological cancers, and localised cancers of the PROSTATE GLAND and URINARY BLADDER are curable with radiotherapy. It is also a valuable means of reducing pain from bone metastases (see METASTASIS). Unpleasant side-effects are common: chie?y lethargy, loss of appetite and dry, itchy skin symptoms.

Chemotherapy is also an important treatment in germ-cell tumours (see above); in some forms of LEUKAEMIA and lymphoma; in ovarian cancer (following surgery – see OVARIES, DISEASES OF); and in small-cell lung cancer (although most patients die within 18 months – see LUNGS, DISEASES OF). It is also used in some breast cancers (see BREASTS, DISEASES OF); advanced myeloma (see MYELOMATOSIS); sarcomas (see under CANCER); and some childhood cancers (such as WILMS’ TUMOUR).

More than 20 substances are in common use, the major classes being ALKYLATING AGENTS (e.g. cyclophosphamide, chlorambucil, busul fan); ANTIMETABOLITES (e.g. methotrexate); VINCA ALKALOIDS (e.g. vincristine, vinblastine); and antitumour ANTIBIOTICS (e.g. actinomycin D). Choice of agent and the appropriate regimen requires expert guidance. Common side-effects include nausea and vomiting, bone-marrow suppression and ALOPECIA, with each substance having its own spectrum of unwanted effects.

Good doctor-patient communication, with the sharing of information and bringing the patient into the decision-making process, is vital even if time-consuming and exhausting.

Equally imortant treatment is PALLIATIVE, for example to ensure e?ective pain or nausea control. Common sources of pain in cancer may involve bone, nerve compression, soft tissue, visceral, myofascial, constipation, muscle spasm, low-back pain, joint pain (e.g. capsulitis) and chronic post-operative pain. Patients may be suffering from more than one pain, all of which should be identi?ed. The aim should be to eliminate pain.

There are three rungs of the analgesic ladder; if one rung fails, the next one should be tried:

(1) non-opioid drugs – for example, aspirin, PARACETAMOL, NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS); (2) weak opioids – for example, CODEINE, DIHYDROCODEINE, dextropropoxyphene; (3) strong opioids

– for example, MORPHINE, DIAMORPHINE, buprenorphine. Oral treatment is always preferable, unless prevented by severe vomiting. (See also CANCER; ONCOLOGIST; PAIN; PALLIATIVE CARE.)... oncology

Linn.

Family: Poaceae.

Habitat: Cultivated mainly in Uttar Pradesh, Madhya Pradesh, Andhra Pradesh, Karnataka and Tamil Nadu.

English: Common Millet, Proso Millet, Hog Millet.

Ayurvedic: Chinaaka, Cheenaa.

Unani: Chinaa Ghaas, Faaluudaa.

Siddha/Tamil: Panivaragu.

Folk: Chenaa, Chi-Tibet.

Action: Seeds (grains)—demul- cent; used in diarrhoea. Plant— antigonorrhoeal.

The seedlings contain an alkaloid hordenine (beta-p-hydroxyphenethyl dimethylamine). Saponins afforded diosgenin and yamogenin isolated from the leaves.

The grains contain 10-18% of proteins which include prolamin, glutelin and smaller amounts of albumin and globulin. The protein has a biological value of 56% and a digestibility coefficient of 91% at 10% level of protein intake.

In Indian medicine, Chinaaka and Kangu (Setaria italica L. Beauv.) are synonyms.

(0.015%). The capsules contain morphine, thebine and narcotine and me- conic acid.

Other species, commonly grown in Indian gardens, are P. nudicaule Linn. (Iceland Poppy) and P. orientale (Oriental Poppy). P. nudicaule plants with yellow flowers are more cyanogenetic than those with red or white flowers. P. orientate contains 0.16% alkaloids, which include the- baine, isothebaine, protopine, glauci- dine and oripavine. Isothebaine stimulates and later depresses the central nervous system.... panicum miliaceum

n. an alkaloid, derived from opium, that relaxes smooth muscle. In combination with *morphine and *codeine, it is administered for relief of postoperative pain and severe chronic pain, but is now rarely used. It may cause abnormal heart rate. Papaverine may also be given by injection into the corpora cavernosa of the penis to treat erectile dysfunction.... papaverine

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (International Association for the Study of Pain, 1979). Pain is perceived in the cerebral cortex (see BRAIN) and is always subjective. Sometimes sensations that would usually be benign can be perceived as painful – for example, allodynia (extreme tenderness of the skin) or dysaesthesia (unpleasant skin sensations resulting from partial damage to sensory nerve ?bres, as in herpes zoster, or shingles).

Acute pain is caused by internal or external injury or disease. It warns the individual that harm or damage is occurring and stimulates them to take avoiding or protective action. With e?ective treatment of disease or injury and/or the natural healing process, the pain resolves – although some acute pain syndromes may develop into chronic pain (see below). Stimuli which are su?ciently intense potentially to damage tissue will cause the stimulation of speci?c receptors known as NOCICEPTORS. Damage to tissues releases substances which stimulate the nociceptors. On the surface of the body there is a high density of nociceptors, and each area of the body is supplied by nerves from a particular spinal segment or level: this allows the brain to localise the source of the pain accurately. Pain from internal structures and organs is more di?cult to localise and is often felt in some more super?cial structure. For example, irritation of the DIAPHRAGM is often felt as pain in the shoulder, as the nerves from both structures enter the SPINAL CORD at the same level (often the structures have developed from the same parts of the embryo). This is known as referred pain.

The impulses from nociceptors travel along nerves to the spinal cord. Within this there is modulation of the pain ‘messages’ by other incoming sensory modalities, as well as descending input from the brain (Melzack and Walls’ gate-control theory). This involves morphine-like molecules (the ENDORPHINS and ENKEPHALINS) amongst many other pain-transmitting and pain-modulating substances. The modi?ed input then passes up the spinal cord through the thalamus to the cerebral cortex. Thus the amount of pain ‘felt’ may be altered by the emotional state of the individual and by other incoming sensations. Once pain is perceived, then ‘action’ is taken; this involves withdrawal of the area being damaged, vocalisation, AUTONOMIC NERVOUS SYSTEM response and examination of the painful area. Analysis of the event using memory will occur and appropriate action be taken to reduce pain and treat the damage.

Chronic pain may be de?ned in several ways: for example, pain resistant to one month’s treatment, or pain persisting one month beyond the usual course of an acute illness or injury. Some doctors may also arbitrarily choose the ?gure of six months. Chronic pain di?ers from acute pain: the physiological response is di?erent and pain may either be caused by stimuli which do not usually cause the perception of pain, or may arise within nerves or the central nervous system with no apparent external stimulation. It seldom has a physiological protective function in the way acute pain has. Also, chronic pain may be self-perpetuating: if individuals gain a psychological advantage from having pain, they may continue to do so (e.g. gaining attention from family or health professionals, etc.). The nervous system itself alters when pain is long-standing in such a way that it becomes more sensitive to painful inputs and tends to perpetuate the pain.

Treatment The treatment of pain depends upon its nature and cause. Acute pain is generally treated by curing the underlying complaint and prescribing ANALGESICS or using local anaesthetic techniques (see ANAESTHESIA – Local anaesthetics). Many hospitals now have acute pain teams for the management of postoperative and other types of acute pain; chronic pain is often treated in pain clinics. Those involved may include doctors (in Britain, usually anaesthetists), nurses, psychologists and psychiatrists, physiotherapists and complementary therapists. Patients are usually referred from other hospital specialists (although some may be referred by GPs). They will usually have been given a diagnosis and exhausted the medical and surgical treatment of their underlying condition.

All the usual analgesics may be employed, and opioids are often used in the terminal treatment of cancer pain.

ANTICONVULSANTS and ANTIDEPRESSANT DRUGS are also used because they alter the transmission of pain within the central nervous system and may actually treat the chronic pain syndrome.

Many local anaesthetic techniques are used. Myofascial pain – pain affecting muscles and connective tissues – is treated by the injection of local anaesthetic into tender spots, and nerves may be blocked either as a diagnostic procedure or by way of treatment. Epidural anaesthetic injections are also used in the same way, and all these treatments may be repeated at intervals over many months in an attempt to cure or at least reduce the pain. For intractable pain, nerves are sometimes destroyed using injections of alcohol or PHENOL or by applying CRYOTHERAPY or radiofrequency waves. Intractable or terminal pain may be treated by destroying nerves surgically, and, rarely, the pain pathways within the spinal cord are severed by cordotomy (though this is generally only used in terminal care).

ACUPUNCTURE and TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) are used for a variety of pain syndromes, particularly myofascial or musculoskeletal pain. It is thought that they work by increasing the release of endorphins and enkephalins (see above). It is possible to implant electrodes within the epidural space to stimulate directly the nerves as they traverse this space before passing into the spinal cord.

Physiotherapy is often used, particularly in the treatment of chronic backache, where pain may be reduced by improving posture and strengthening muscles with careful exercises. Relaxation techniques and psychotherapy are also used both to treat chronic pain and to help patients cope better with their disability.

Some types of chronic pain are caused by injury to sympathetic nerves or may be relieved by interrupting conduction in sympathetic nerves. This may be done in several ways. The nerves may be blocked using local anaesthetic or permanently destroyed using alcohol, phenol or by surgery.

Many of these techniques may be used in the management of cancer pain. Opioid drugs are often used by a variety of routes and methods, and management of these patients concentrates on the control of symptoms and on providing a good quality of life.... pain

Linn.

Family: Papaveraceae.

Habitat: Kashmir and throughout the plains of North India; cultivated in gardens.

English: Corn Poppy, Red Poppy.

Ayurvedic: Rakta Posta.

Siddha/Tamil: Sivappu, Kasakasa.

Folk: Laal Posta, Laal Kaskas.

Action: Latex from capsules— narcotic. Petal—expectorant, antitussive, sudorific. Used for diseases of the respiratory tract, for disturbed sleep and as a sedative for the relief of pain. (Included among unapproved herbs by German Commission E.)

The petals contain cyanidine derivatives. An alkaloid rhoeadine is present in leaves and flowers (0.031%), unripe capsules (0.035%) and in roots

Family: Papaveraceae.

Habitat: Native to Asia; now grown in Uttar Pradesh, Punjab, Rajasthan and Madhya Pradesh.

English: Opium Poppy.

Ayurvedic: Ahiphena, Aaphuuka. Post-daanaa (seed).

Unani: Afyum. Tukhm-e- khashkhaash (seed).

Siddha/Tamil: Kasakasa (seeds).

Action: Opium is obsolete as a drug. Narcotic, sedative, hypnotic, analgesic, sudorific, anodyne, antispasmodic. Crushed poppyheads were in use as a topical poultice for crippling pain in terminal diseases. Poppy seed—nutritive, demulcent, emollient, spasmolytic, devoid of narcotic properties. Specific against obstinate constipation, also used in catarrh of the bladder. Poppy seed oil is also free from narcotic properties. Used against diarrhoea, dysentery and scalds.

Opium contains isoquinoline alkaloids; the major one is morphine with narcotine, codeine, papaverine and thebaine. Poppy seeds, used in Indian medicine, do not contain alkaloids. The seeds contain thiamine 420, riboflavin 49, folic acid 30, pantothenic acid 2667 and niacin 1877 mcg/100 g. The seed oil (from Turkey) contains gamma-tocopherol 220, alpha-toco- pherol 40 and beta-tocopherol 20 mcg/ 100 g. Some low-molecular proteins (15% of total protein) have been isolated, along with cysteine, glutamic acid and arginine. The seeds yield a fatty oil (45%) containing palmitic, stearic, oleic, linoleic and linolenic acids.

The extract of seeds showed highly significant antisecretory (antidiarr- hoeal activity) against E. coli entero- toxin-induced secretory responses in experimental animals.

The triglycerides isolated from seeds showed anti-tumour activity against Ehrlichs ascites in mice.

The aqueous extract of seeds showed marked hypoglycaemic activity when administered to glucose-loaded and al- loxan diabetic rats.

The seeds were found to increase the activity of carcinogen detoxifying enzyme, glutathione-S-transferase by more than 78% in the stomach, liver and oesophagus in mice.

Following Papaver sp. are found in India:

P. argemone Linn. (indigenous to the Mediterranean region; commonly grown in gardens in India) contains 0.15% of alkaloids including rhoeadine, protopine, and anthocyanins. Petals are sudorific.

P dubium Linn. (North-western Himalaya form Kashmir to Garhwal; as a winter weed in North Indian plains) contains rhoeagenine as the principal alkaloid, besides rhoeadine, protopine. Petals contain cyanidin B and pelargonidin C. Petals are sudorific.

P. hybridum Linn. (gardens of Punjab and Uttar Pradesh) is diaphoretic (petals). Plant latex contains alkaloids including berberine, coptisine, pahybrine, papaverrubines A, B, D and E and sanguinarine. Plant also gave glaucine and glucamine.

P. nudicaule Linn. (Gulmarg, Kashmir, at altitudes of 3,300-3,600 m), known as Iceland Poppy, gave alkaloids including papaverrubines B and D; leave gave cyanogenic glycosides including dhurrin and triglochinin. The flower and fruit are mild diaphoretic.

P. orientale Linn. (indigenous to Mediterranean region; grown in Indian gardens), known as Oriental Poppy, contains 0.16% of alkaloids including thebaine, isothebane, protopine, glaucidine and oripavine. Latex from poppy capsule is narcotic.... papaver somniferum

The rash produced by the sudden release of HISTAMINE in the skin. It is characterised by acute itching, redness and wealing which subsides within a few minutes or may persist for a day or more. Depending upon the cause, it may be localised or widespread and transient or constantly recurrent over years. It has many causes.

External injuries to the skin such as the sting of a nettle (‘nettle-rash’) or an insect bite cause histamine release from MAST CELLS in the skin directly. Certain drugs, especially MORPHINE, CODEINE and ASPIRIN, can have the same e?ect. In other cases, histamine release is caused by an allergic mechanism, mediated by ANTIBODIES of the immunoglobulin E (IgE) class – see IMMUNOGLOBULINS. Thus many foods, food additives and drugs (such as PENICILLIN) can cause urticaria. Massive release of histamine may affect mucous membranes – namely the tongue or throat – and can cause HYPOTENSION and anaphylactic shock (see ANAPHYLAXIS) which can occasionally be fatal.

Physical factors can cause urticaria. Heat, exercise and emotional stress may induce a singular pattern with small pinhead weals, but widespread ?ares of ERYTHEMA, activated via the AUTONOMIC NERVOUS SYSTEM (CHOLINERGIC urticaria) may also occur.

Rarely, exposure to cold may have a smiilar e?ect (‘cold urticaria’) and anaphylactic shock following a dive into cold water in winter is occasionally fatal. The diagnosis of cold urticaria can be con?rmed by applying a block of ice to the arm which quickly induces a local weal.

Transient urticaria due to rubbing or even stroking the skin is common in young adults (DERMOGRAPHISM or factitious urticaria). More prolonged deep pressure induces delayed urticaria in other subjects. IgE-mediated urticaria is part of the atopic spectrum (see ATOPY, and SKIN, DISEASES OF – Dermatitis and eczema). Allergy to peanuts is particularly dangerous in young atopic subjects. Notwithstanding the many known causes, chronic urticaria of unknown cause is common and may have an autoimmune basis (see AUTOIMMUNE DISORDERS).

Treatment Causative factors must be removed. Topical therapy is ine?ective except for the use of calamine lotion, which reduces itching by cooling the skin. Oral ANTIHISTAMINES are the mainstay of treatment and are remarkably safe. Rarely, injection of ADRENALINE is needed as emergency treatment of massive urticaria, especially if the tongue and throat are involved, following by a short course of the oral steroid, prednisolone.

Angio-oedema is a variant of urticaria where massive OEDEMA involves subcutaneous tissues rather than the skin. It may have many causes but bee and wasp stings in sensitised subjects are particularly dangerous. There is also a rare hereditary form of angio-oedema. Acute airway obstruction due to submucosal oedema of the tongue or larynx is best treated with immediate intramuscular adrenaline and antihistamine. Rarely, TRACHEOSTOMY may be life-saving. Patients who have had two or more episodes can be taught self-injection with a preloaded adrenaline syringe.... urticaria

The ?eld of medicine concerned with physical ?tness and the diagnosis and treatment of both acute and chronic sports injuries sustained during training and competition. Acute injuries are extremely common in contact sports, and their initial treatment is similar to that of those sustained in other ways, such as falls and road traf?c incidents. Tears of the muscles (see MUSCLES, DISORDERS OF), CONNECTIVE TISSUE and LIGAMENTS which are partial (sprains) are initially treated with rest, ice, compression, and elevation (RICE) of the affected part. Complete tears (rupture) of ligaments (see diagrams) or muscles, or fractures (see BONE, DISORDERS OF – Bone fractures) require more prolonged immobilisation, often in plaster, or surgical intervention may be considered. The rehabilitation of injured athletes requires special expertise

– an early graded return to activity gives the best long-term results, but doing too much too soon runs the risk of exacerbating the original injury.

Chronic (overuse) injuries affecting the bones (see BONE), tendons (see TENDON) or BURSAE of the JOINTS are common in many sports. Examples include chronic INFLAMMATION of the common extensor tendon where it

attaches to the later EPICONDYLE of the humerus – common in throwers and racquet sportspeople – and stress fractures of the TIBIA or METATARSAL BONES of the foot in runners. After an initial period of rest, management often involves coaching that enables the athlete to perform the repetitive movement in a less injury-susceptible manner.

Exercise physiology is the science of measuring athletic performance and physical ?tness for exercise. This knowledge is applied to devising and supervising training regimens based on scienti?c principles. Physical ?tness depends upon the rate at which the body can deliver oxygen to the muscles, known as the VO2max, which is technically di?cult to measure. The PULSE rate during and after a bout of exercise serves as a good proxy of this measurement.

Regulation of sport Sports medicine’s role is to minimise hazards for participants by, for example, framing rule-changes which forbid collapsing the scrum, which has reduced the risk of neck injury in rugby; and in the detection of the use of drugs taken to enhance athletic performance. Such attempts to gain an edge in competition undermine the sporting ideal and are banned by leading sports regulatory bodies. The Olympic Movement Anti-Doping Code lists prohibited substances and methods that could be used to enhance performance. These include some prohibited in certain circumstances as well as those completely banned. The latter include:

stimulants such as AMPHETAMINES, bromantan, ca?eine, carphedon, COCAINE, EPHEDRINE and certain beta-2 agonists.

NARCOTICS such as DIAMORPHINE (heroin), MORPHINE, METHADONE HYDROCHLORIDE and PETHIDINE HYDROCHLORIDE.

ANABOLIC STEROIDS such as methandione, NANDROLONE, stanazol, TESTOSTERONE, clenbuterol, androstenedone and certain beta-2 agonists.

peptide HORMONES, mimetics and analogues such as GROWTH HORMONE, CORTICOTROPHIN, CHORIONIC GONADOTROPHIC HORMONE, pituitary and synthetic GONADOTROPHINS, ERYTHROPOIETIN and INSULIN. (The list produced above is not comprehen

sive: full details are available from the governing bodies of relevant sports.) Among banned methods are blood doping (pre-competition administration of an athlete’s own previously provided and stored blood), administration of arti?cial oxygen carriers or plasma expanders. Also forbidden is any pharmacological, chemical or physical manipulation to affect the results of authorised testing.

Drug use can be detected by analysis of the URINE, but testing only at the time of competition is unlikely to detect drug use designed to enhance early-season training; hence random testing of competitive athletes is also used.

The increasing professionalism and competitiveness (among amateurs and juveniles as well as professionals) in sports sometimes results in pressures on participants to get ?t quickly after injury or illness. This can lead to

players returning to their activity before they are properly ?t – sometimes by using physical or pharmaceutical aids. This practice can adversely affect their long-term physical capabilities and perhaps their general health.... sports medicine

Disruptive termination of pregnancy before twenty-eighth week. Too premature expulsion of contents of the pregnant womb may be spontaneous, habitual, or by intentional therapy. Untimely onset of uterine contractions with dilation of cervical os (mouth of the womb) dispose to abortion. Essential that services of a suitably qualified doctor or obstetrician be engaged. It would be his responsibility to ensure that the embryo (unborn baby) and the placenta (after birth) are completely expelled.

Alternatives. Tea: equal parts – Agnus Castus, Ladysmantle, Motherwort, Raspberry leaves, 1-2 teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup 2-3 times daily.

Tablets/capsules. Cramp bark, Helonias.

Powders. Formula. Combine Blue Cohosh 1; Helonias 2; Black Haw 3. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Practitioner. Tincture Viburnum prunifolium BHP (1983), 20ml; Tincture Chamaelirium luteum BHP (1983) 20ml; Tincture Viburnum opulus BHP (1983), 20ml; Tincture Capsicum, fort, BPC 1934, 0.05ml. Distilled water to 100ml. Sig: 5ml tds pc c Aq cal.

Black Cohosh. Liquid Extract Cimicifuja BP 1898, 1:1 in 90 per cent alcohol. Dosage: 0.3-2ml. OR: Tincture Cimicifuja, BPC 1934, 1:10 in 60 per cent alcohol. Dosage: 2-4ml.

Squaw Vine (mother’s cordial) is specific for habitual abortion, beginning soon after becoming pregnant and continuing until the seventh month. Also the best remedy when abortion threatens. If attended by a physician for abortion, a hypodermic of morphine greatly assists; followed by Liquid Extract 1:1 Squaw Vine. Dosage: 2-4ml, 3 times daily.

Liquid extracts. Squaw Vine, 4 . . . Helonias, 1 . . . Black Haw bark, 1 . . . Blue Cohosh, 1. Mix. Dose: One teaspoon every 2 hours for 10 days. Thereafter: 2 teaspoons before meals, 3 times daily. Honey to sweeten, if necessary. (Dr Finlay Ellingwood)

Abortion, to prevent: Cramp bark, (Dr John Christopher)

Evening Primrose. Two 500mg capsules, at meals thrice daily.

Diet: High protein.

Vitamins. C. B6. Multivitamins. E (400iu daily).

Minerals. Calcium. Iodine. Iron. Selenium, Zinc. Magnesium deficiency is related to history of spontaneous abortion; magnesium to commence as soon as pregnant.

Enforced bed rest. ... abortion – to prevent

Strychnos nux-vomica

Loganiaceae

San: Karaskara;

Hin: Kajra, Kuchila;

Mal: Kanjiram; ;

Tam: Itti, Kagodi, Kanjirai Mar:Jharkhatchura;

Kan: Hemmushti, Ittangi;

Tel: Mushti, Mushidi; Ori: Kora, Kachila

Importance: It is a large deciduous tree, with simple leaves and white fragrant flowers.

Strychnos is highly toxic to man and animals producing stiffness of muscles and convulsions, ultimately leading to death. However, in small doses it can also serve as efficacious cure forms of paralysis and other nervous disorders. The seeds are used as a remedy in intermittent fever, dyspepsia, chronic dysentery, paralytic and neuralgic affections, worms, epilepsy, chronic rheumatism, insomnia and colic. It is also useful in impotence, neuralgia of face, heart disease, spermatorrhoea, skin diseases, toxins, wounds, emaciation, cough and cholera. Leaves are applied as poultice in the treatment of chronic wounds and ulcers and the leaf decoction is useful in paralytic complaints. Root and root bark used in fever and dysentery (Nadkarni, 1982; Kurup et al, 1979).

Distribution: The plant is distributed throughout India in deciduous forests up to 1200m. It is also found in Sri Lanka, Siam, Indochina and Malaysia.

Botany: Strychnos nux-vomica Linn. is a large tree belonging to the family Loganiaceae. Leaves are simple, opposite, orbicular to ovate, 6-11.5x6-9.5cm, coriaceous, glabrous, 5 nerved, apex obtuse, acute or apiculate, transverse nerves irregular and inconspicuous. Inflorescence is many flowered terminal cymes, 2.5-5cm across. Bracts (5mm) and bracteoles (1.5mm) small. Flowers are white or greenish white and fragrant. Calyx 5 lobed, pubescent and small (2mm). Corolla salver shaped, tube cylindrical slightly hairy near the base within and greenish white, tube much elongate than the lobes. Tube 7mm and lobes 2.5mm long. Lobes 5 and valvate. Stamens 5, filaments short, 0.1mm long. Anthers 1.5mm subexerted, linear oblong. Ovary 1.5 mm, pubescent, 2 celled, ovules one to many. Style 9mm, stigma capitate. Fruit is a berry, 5-6cm diameter, globose, indehiscent, thick shelled, orange red when ripe with fleshy pulp enclosing the seeds. Seeds 1-many, discoid, compressed, coin like, concave on one side and convex on the other, covered with fine grey silky hairs.

The leaf fall is during December (do not shed all the leaves at a time) and new foliage appears in February. Flowering is during March - April and fruiting during May - December. Fruits take about 8-9 months to mature.

Properties and activity: Strychnine and brucine are the most important and toxic alkaloids present in the plant. They occur not only in the seeds but also in roots, wood, bark, fruit pulp and hard fruit shells. The minor alkaloids present in the plant are vomicine, -colubrine, -colubrine, pseudostrychnine and N-methyl-sec-pseudobrucine (novacine). Loganin a glycoside is also present (Warnat, 1932; Martin et al, 1953; Guggisberg et al, 1966; Bisset and Chaudhary, 1974). Chatterji and Basa (1967) reported vomicine as the major constituent alkaloid along with unidentified alkaloid in leaves and identified another alkaloid kajine (N-methyl pseudostrychnine) from the leaves of very young plants.

Root bark of S. nux-vomica yeilded 4-hydroxy-3-methoxy strychnine, 4 hydroxy strychine, nor-macusine, a new alkaloid 12 , 13 dihydro-12 -hydroxy isostrychnine named protostrychnine (Baser et al, 1979) methoxy strychnine, and mavacurine (Guggisberg et al, 1966). Leaves and root bark also yeilded 11 new alkaloids. 10-hydroxy strychnine, 3-12-dihydroxystrychnine, 12-hydroxy–11- methoxy strychnine, 3-12-dihydroxy- 11-methoxy strychnine,12-hydroxy strychnine-N- oxide 12-hydroxy-11-methoxy strychnine- N-oxide-19,20–dihydro isostrychnine, 16 , 17 dihydro-17 -hydroxy isostrychnine, O- methyl-macusine B, 16-epi-o-methyl–macusine B and normelinone B (Baser and Bisset, 1982).

De and Datta (1988) isolated 5 tertiary indole alkaloids viz. strychnine, brucine, vomicine, icajine and novacine from S.nux-vomica flowers. Bisset et al (1989) isolated and identified two phenolic glycosides salidroside and cuchiloside – a compound consisting of salidroside and an attached xylose unit, from the fruit of S.nux-vomica.

Rodriguez et al (1979) isolated an indole alkaloid from the seeds of S. nux- vomica and identified as a 3-methoxy icajine. A new alkaloid 15-hydroxy strychnine has been isolated from the seeds and the structure of the alkaloid established by spectroscopic data (Galeffi et al, 1979). Cai et al (1990a) isolated 4 new alkaloids isobrucine, isobrucine N-oxide, isostrychnine N-oxide and 2 hydroxy–3-methoxy strychnine from the heat treated seeds of S. nuxvomica and the structure of the alkaloids were determined by 13 CNMR (Cai et al, 1994). Cai et al (1990 b) studied the changes in the alkaloid composition of the seeds during drug processing. Saily et al (1994) determined the mineral elements in Strychnos nux-vomica. Corsaro et al (1995) reported polysaccharides from the seeds of Strychnos species.

Seeger and Neumann (1986) reviewed the physico-chemical characteristics, occurrence, identification, utilisation, poisoning, toxicity, kinetics, differential diagnosis and therapeutic uses of strychnine and brucine. Aspergillus niger, A. flavus and Pencillium citrinum showed regular association with Strychnos seeds and effectively deteriorated the alkaloid content of the seeds (Dutta, 1988; Dutta and Roy, 1992). Nicholson (1993) described the history, structure and synthesis of strychnine which occur in the seeds of S. nux-vomica. Rawal and Michoud (1991) developed a general solution for the synthesis of 2- azabicyclo (3.3.1) nonane substructure of Strychnos alkaloids.

Villar et al (1984) and Hayakawa et al (1984) developed HPLC method for the analysis of strychnine and brucine. Graf and Wittliner (1985), Kostennikova (1986) and Gaitonde and Joshi (1986) suggested different methods for the assay of strychnine and brucine. Biala et al, (1996) developed new method for the assay of alkaloids in S. nux- vomica.

The seeds are bitter, acrid, alexeteric, aphrodisiac, appetiser, antiperiodic, anthelmintic, digestive, febrifuge, emmenagogue, purgative, spinal, respiratory and cardiac stimulant and stomachic. The bark is bitter, and tonic and febrifuge (Nadkarni, 1954; Kurup et al, 1979; Warrier et al, 1996).

The quarternery alkaloid from the root bark of the Sri Lankan plant exhibited muscle-relaxant activity (Baser and Bisset, 1982). Antimicrobial activity of indole alkaloid isolated from the Strychnos nux-vomica was studied by Verpoorte et al, 1983. Shukla et al (1985) evaluated the efficacy of Rasnadigugglu compound consisting of S. nux-vomica, on rheumatoid arthritis and found to be effective in reducing inflammatory oedoma and rheumatoid arthritis. It also exhibited analgesic activity. A compound Unani formulation containing S. nux-vomica significantly attenuated withdrawal intensity in morphine dependent rats (Zatar et al, 1991). Shahana et al (1994) studied the effect of Unani drug combination (UDC) having Strychnos nux-vomica on the abstinence syndrome in moderately and severely morphine dependent rats. The UDC strikingly suppressed the abstinence syndrome was seen to possess central depressant and analgesic action.

Melone et al (1992) reported brucine-lethality in mice. Panda and Panda (1993) and Satyanarayanan et al (1994) reported antigastric ulcer activity of nux vomica in Shay rats. Banerjee and Pal (1994) reported the medicinal plants used by the tribals of plain land in India for hair and scalp preparation and S. nux-vomica being used to cure alopecia (baldness) by the tribals. Tripathi and Chaurasia (1996) studied the effect of S. nux-vomica alcohol extract on lipid peroxidation in rat liver.... strychnine tree

Waste substances resulting from the body’s metabolic processes, selected by the KIDNEYS from the blood, dissolved in water, and excreted. Urine is around 96 per cent water, the chief waste substances being UREA (approximately 25 g/1), common salt (approximately 9 g/l), and phosphates and sulphates of potassium, sodium, calcium, and magnesium. There are also small amounts of URIC ACID, ammonia, creatinine, and various pigments. Poisons, such as MORPHINE, may be excreted in the urine; and in many infections, such as typhoid fever (see ENTERIC FEVER), the causative organism may be excreted.

The daily urine output varies, but averages around 1,500 ml in adults, less in children. The ?uid intake and ?uid output (urine and PERSPIRATION) are interdependent, so as to maintain a relatively constant ?uid balance. Urine output is increased in certain diseases, notably DIABETES MELLITUS; it is diminished (or even temporarily stopped) in acute glomerulonephritis (see under KIDNEYS, DISEASES OF), heart failure, and fevers generally. Failure of the kidneys to secrete any urine is known as anuria, while stoppage due to obstruction of the ureters (see URETER) by stones, or of the URETHRA by a stricture, despite normal urinary secretion, is known as urinary retention.

Normal urine is described as straw- to amber-coloured, but may be changed by various diseases or drugs. Chronic glomerulonephritis or poorly controlled diabetes may lead to a watery appearance, as may drinking large amounts of water. Consumption of beetroot or rhubarb may lead to an orange or red colour, while passage of blood in the urine (haematuria) results in a pink or bright red appearance, or a smoky tint if just small amounts are passed. A greenish urine is usually due to BILE, or may be produced by taking QUININE.

Healthy urine has a faint aroma, but gives o? an unpleasant ammoniacal smell when it begins to decompose, as may occur in urinary infections. Many foods and additives give urine a distinctive odour; garlic is particularly characteristic. The density or speci?c gravity of urine varies normally from 1,015 to 1,025: a low value suggests chronic glomerulonephritis, while a high value may occur in uncontrolled diabetes or during fevers. Urine is normally acidic, which has an important antiseptic action; it may at times become alkaline, however, and in vegetarians, owing to the large dietary consumption of alkaline salts, it is permanently alkaline.

Chemical or microscopical examination of the urine is necessary to reveal abnormal drugs, poisons, or micro-organisms. There are six substances which must be easily detectable for diagnostic purposes: these are ALBUMINS, blood, GLUCOSE, bile, ACETONE, and PUS and tube-casts (casts from the lining of the tubules in the kidneys). Easily used strip tests are available for all of these, except the last.

Excess of urine It is important to distinguish urinary frequency from increase in the total amount of urine passed. Frequency may be due to reduced bladder capacity, such as may be caused by an enlarged PROSTATE GLAND, or due to any irritation or infection of the kidneys or bladder, such as CYSTITIS or the formation of a stone. Increased total urinary output, on the other hand, is often a diagnostic feature of diabetes mellitus. Involuntary passage of urine at night may result, leading to bed wetting, or NOCTURNAL ENURESIS in children. Diagnosis of either condition, therefore, means that the urine should be tested for glucose, albumin, gravel (fragments of urinary calculi), and pus, with appropriate treatment.... urine

Papaver somniferum L. Prescription by a medical practitioner only. Contains morphine alkaloids and codeine. Analgesic, narcotic.

Although medication with opiates is addictive and its abuse ranges from dependence to death, use of crushed poppyheads as a topical poultice for crippling pain, as in terminal disease of chest or abdomen, is worthy of consideration. In an age before modern drugs and anaesthetics this was one of the few solaces available. Even today, there are a few situations for which this deep-acting pain-killer is indicated as, for instance, wounds healed but not without pain.

In spite of the plethora of modern drugs to combat the pain of terminal illness, few are as effective as the greatest anodyne of all time which led the eminent Sydenham to say “. . . if it were expunged from the pharmacopoeia, I would give up the practise of medicine”. ... opium poppy

Drugs used to relieve pain. The 2 main types are nonopioid and opioid. Nonopioid analgesics, which include aspirin, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), are useful in the treatment of mild to moderate pain (for example, headache or toothache). Combinationsof a weak opioid analgesic, such as codeine, with a nonopioid analgesic relieve more severe pain. Potent opioids such as morphine are used only when other preparations would be ineffective because they can produce tolerance and drug dependence.

Adverse effects are uncommon with paracetamol. Aspirin and NSAIDs may irritate the stomach lining and cause nausea, abdominal pain, and, rarely, a peptic ulcer. Nausea, drowsiness, constipation, and breathing difficulties may occur with opioid analgesics.... analgesic drugs

An invasive growth which gradually emerges into life and, undisciplined, eats its way into neighbouring tissues. Malignancy is the growth of abnormal cells with the ability to form a primary lesion from which cells may be bloodborne to other parts of the body (metastasis). Growth usually follows the line of the lymph vessels (Violet leaves have an affinity for lymph vessels).

Course of the disease is unpredictable, cases surviving for many years on primary or supportive herbal treatment. Suspected malignancy should be referred to modern hospital treatment immediately. Early detection is vital.

Common signs calling attention are: (1) Unusual bleeding or discharge. (2) Tired feeling all the time. (3) Thickening or lump in breast or elsewhere. (4) Sudden change in hair texture and colour. (5) Irritable cough or hoarseness. (6) Extreme mental depression. (7) Obvious change in a mole or wart. (8) Muscle weakness and cramps. (9) A sore that does not heal. (10) Change in bowel or bladder habit. (11) Sudden weakness of the eyes. (12) Difficulties in swallowing; indigestion. (13) Excess wind in stomach or bowel.

Tumour-killing effect of chemotherapy may be intensified and side-effects minimised (loss of weight, and of white blood cells) when certain neoplastic herbs are prescribed. Cytotoxic drugs inhibit the ability of Vitamin C to stimulate the body’s defences. Herbs enhance the body’s self-healing ability to eliminate. An inoperable cancer would appear to be good grounds for herbal medication which often relieves pain and preserves a man’s dignity in his hour of extremity.

A series of medical trials in Finland revealed that terminal cases had 12 per cent lower mean serum selenium concentration than controls. Other similar trials point to the need for selenium supplements. Those with both low selenium and low Vitamin E levels are especially at risk.

See: GERSON CANCER THERAPY.

Exercise. High levels of fitness are associated with lower death rates. (American study)

Plants with a special reference to cancer include: Blue Flag, Burdock, Clivers, Condurango, Echinacea, Guaiacum, Houseleek, Poke root. There are many more referred to in medical literature.

Poke Root. John Bartram reported in the late 18th century that from his experience among the Mohawk Indians, Poke root (Phytolacca decandra) was a “cure” for cancer. (American Indian Medicine, Virgil J. Vogel)

Blood Root. For internal or external bleeding of cancer.

Calendula (Marigold). For the same purpose.

Mistletoe. Dr Alfred Vogel advises an extract of the plant (Loranthus europaeus) as grown on the Oak tree: dose: 10-15 drops.

Almonds. Edgar Cayce, Virginia Beach, USA, with some successes to his credit, advised eating three almonds a day to counter any tendency towards the disease.

Laetrile. From Apricot kernels that contain cyanogenic glucosides. Though competent physicians have reported positive results in some terminal cases without prior surgery or radiation, the remedy has been withdrawn from general practice because of possible toxicity.

Much needless suffering may be incurred because of out-moded resistance of doctors and governments against prescribing morphine early in cancer patients. It is estimated that 50-80 per cent of patients do not receive satisfactory pain-relief because doctors fear tolerance of the drug would increase, necessitating a higher dosage. From the beginning of time the Opium Poppy has been the most effective analgesic for the terminal condition. Morphine is a respiratory depressant and some authorities believe it should be given before the final stages in continuous doses for adequate pain control. Risks must be balanced with benefits. Dangerous in asthmatics.

Way of Life. Herbal medication of malignant disease involves the patient with his treatment. Here is something he or she can do to regain some control over their life. It can give them the satisfaction of knowing that in some way they are ‘fighting back’ thus influencing the quality of life and a sense of well- being.

If improvement in cancer is not possible maybe the condition can be stabilised and the patient helped to cope with the very unpleasant side-effects of chemotherapy and radiation. Thus, may be restored the body’s natural balance and a possible extension of lifespan.

For this, patients and practitioners may need information and support. That is why suggestions for malignant disease are included in this book. Moreover, well-meaning friends and relatives may exert pressure on the patient ‘to leave no stone unturned’ in search of a cure. Thus every possible secondary treatment should be considered since any one may prove to contribute towards recovery. It is hoped that this book will invite a therapeutic alliance with members of the medical profession as well as with other practitioners.

Macmillan nurses help alleviate physical pain and the psychological distress that can accompany this illness. They are trained to help people with cancer and their families fight cancer with more than medicine.

All forms of cancer should be treated by or in liaison with a qualified medical practitioner or an oncologist. ... cancer

One of a number of drugs subject to restricted use because of their potential for abuse. They include

opiates such as cocaine and morphine, amfetamine drugs, and barbiturate drugs. controlled trial A method of testing the effectiveness of new treatments or comparing different treatments. In a typical controlled drug trial, 2 comparable groups of patients suffering from the same illness are given courses of apparently identical treatment. However, only one group receives the new treatment; the second control group is given a placebo. Alternatively, the control group may be given an established drug that is already known to be effective. After a predetermined period, the 2 groups are assessed medically. Controlled trials must be conducted “blind’’ (the patients do not know which treatment they are receiving). In a “double-blind’’ trial, neither the patients nor the doctors who assess them know who is receiving which treatment. contusion Bruising to the skin and underlying tissues from an injury. convalescence The recovery period following an illness or surgery during which the patient regains strength before returning to normal activities.... controlled drug

A group of illegally produced chemicals that mimic the effects of specific drugs of abuse. They can cause drug dependence and drug poisoning. Made in illicit laboratories, they are cheap to produce and undercut the street prices of drugs.

There are 3 major groups: drugs derived from opioid analgesic drugs such as fentanyl; drugs similar to amfetamines, such as ecstasy; and variants of phencyclidine (PCP), a hallucinogenic drug. These highly potent drugs are not tested for adverse effects or for the strength of the tablets or capsules, making their use hazardous. For example, some derivatives of fentanyl are 20–2,000 times more powerful than morphine. Amfetamine derivatives can cause brain damage at doses only slightly higher than those required for a stimulant effect. Many designer drugs contain impurities that can cause permanent damage.... designer drugs

The harmful effects on the body as a result of an excessive dose of a drug. Accidental poisoning is most common in young children. In adults, it usually occurs in elderly or confused people who are unsure about their treatment and dosage requirements. Accidental poisoning may also occur during drug abuse. Deliberate self-poisoning is usually a cry for help (see suicide; suicide, attempted). The drugs that are most commonly taken in overdose include benzodiazepine drugs and antidepressant drugs. Anyone who has taken a drug overdose and any child who has swallowed tablets that belong to someone else should seek immediate medical advice. It is important to identify the drugs that have been taken. Treatment in hospital may involve washing out the stomach (see lavage, gastric). Charcoal may be given by mouth to reduce the absorption of the drug from the intestine into the bloodstream. To eliminate the drug, urine production may be increased by an intravenous infusion. Antidotes are available only for specific drugs. Such antidotes include naloxone (for morphine) and methionine (for paracetamol).

Drug poisoning may cause drowsiness and breathing difficulty, irregular heartbeat, and, rarely, cardiac arrest, fits, and kidney and liver damage.

Antiarrhythmic drugs are given to treat heartbeat irregularity.

Fits are treated with anticonvulsants.

Blood tests to monitor liver function and careful monitoring of urine output are carried out if the drug is known to damage the liver or kidneys.... drug poisoning

Physical and psychological care with the aim of making the final period of a dying person’s life as free from pain, discomfort, and emotional distress as possible. Carers may include doctors, nurses, other medical professionals, counsellors, social workers, clergy, family, and friends.

Pain can be relieved by regular low doses of analgesic drugs. Opioid analgesics, such as morphine, may be given if pain is severe. Other methods of pain relief include nerve blocks, cordotomy, and TENS. Nausea and vomiting may be controlled by drugs. Constipation can be treated with laxatives. Breathlessness is another common problem in the dying and may be relieved by morphine.

Towards the end, the dying person may be restless and may suffer from breathing difficulty due to heart failure or pneumonia. These symptoms can be relieved by drugs and by placing the patient in a more comfortable position.

Emotional care is as important as the relief of physical symptoms.

Many dying people feel angry or depressed and feelings of guilt or regret are common responses.

Loving, caring support from family, friends, and others is important.

Many terminally ill people prefer to die at home.

Few terminally ill patients require complicated nursing for a prolonged period.

Care in a hospice may be offered.

Hospices are small units that have been established specifically to care for the dying and their families.... dying, care of the

Inability of the heart to cope with its workload of pumping blood to the lungs and to the rest of the body. Heart failure can primarily affect the right or the left side of the heart, although it most commonly affects both sides, in which case it is known as congestive, or chronic, heart failure.

Left-sided heart failure may be caused by hypertension, anaemia, hyperthyroidism, a heart valve defect (such as aortic stenosis, aortic incompetence, or mitral incompetence), or a congenital heart defect (see heart disease, congenital). Other causes of left-sided heart failure include coronary artery disease, myocardial infarction, cardiac arrhythmias, and cardiomyopathy.

The left side of the heart fails to empty completely with each contraction, or has difficulty in accepting blood that has been returned from the lungs. The retained blood creates a back pressure that causes the lungs to become congested with blood. This condition leads to pulmonary oedema.

Right-sided heart failure most often results from pulmonary hypertension, which is itself caused by left-sided failure or by lung disease (such as chronic obstructive pulmonary disease (see pulmonary disease, chronic obstructive). Right-sided failure can also be due to a valve defect, such as tricuspid incompetence, or a congenital heart defect.

There is back pressure in the circulation from the heart into the venous system, causing swollen neck veins, enlargement of the liver, and oedema, especially of the legs and ankles. The intestines may become congested, causing discomfort.

Immediate treatment consists of bed rest, with the patient sitting up. Diuretic drugs are given, and digitalis drugs and vasodilators, especially ACE inhibitors, may also be administered. Morphine and oxygen may be given as emergency treatment in acute left-sided failure.... heart failure

A gross distension (enlargement) of the colon, usually accompanied by severe, chronic constipation.

In children, the main causes of megacolon are anal fissures, Hirschsprung’s disease, and psychological factors that may have arisen during toilet-training. In elderly people, causes include the long-term use of strong laxative drugs. People suffering from chronic depression or schizophrenia often have megacolon. Other, rarer causes include hypothyroidism, spinal injury, and drugs such as morphine and codeine.

Megacolon causes constipation and abdominal bloating. Associated loss of appetite may lead to weight loss. Diarrhoea may result if semi-liquid faeces leak around the obstructing hard faeces.

Diagnosis is made by proctoscopy, barium X-ray examination, and tests of bowel muscle function. If Hirschsprung’s disease is suspected, biopsy of the large intestine may be performed. Impacted faeces are often removed using enemas. In severe cases, the faeces must be removed manually.... megacolon

A dangerous reduction of blood flow throughout the body tissues, which may occur with severe injury or illness. Shock in this sense is physiological shock, as distinct from the mental distress that may follow a traumatic experience.

In most cases, reduced blood pressure is a major factor in causing shock and is one of its main features. Shock may develop in any situation in which blood volume is reduced, blood vessels are abnormally widened, the heart’s action is weak, blood flow is obstructed, or there is a combination of these factors. Causes include severe bleeding or burns, persistent vomiting or diarrhoea, myocardial infarction, pulmonary embolism, peritonitis, and some types of poisoning.

Symptoms of shock include rapid, shallow breathing; cold, clammy skin; rapid, weak pulse; dizziness; weakness; and fainting. Untreated, shock can lead to collapse, coma, and death.

Emergency treatment is required. This involves an intravenous infusion of fluid, a blood transfusion, oxygen therapy, and, if necessary, morphine or similar powerful analgesics. Further treatment depends on the underlying cause. (See also anaphylactic shock; septic shock; shock, electric; toxic shock syndrome.)... shock

n. the sequence of actions by which a baby and the afterbirth (placenta) are expelled from the uterus at childbirth. The process usually starts spontaneously about 280 days after conception, but it may be started by artificial means (see induction). In the first stage the muscular wall of the uterus begins contracting while the muscle fibres of the cervix relax so that the cervix expands. A portion of the membranous sac (amnion) surrounding the baby is pushed into the opening and ruptures under the pressure, releasing *amniotic fluid to the exterior. In the second stage the baby’s head appears at the cervix and the contractions of the uterus strengthen. The passage of the infant through the vagina is assisted by contractions of the abdominal muscles and conscious pushing by the mother. When the top of the baby’s head appears at the vaginal opening the whole infant is eased clear of the vagina, and the umbilical cord is cut. If the emergence of the head is impeded an incision may be made in the surrounding tissue (see episiotomy). In the final stage the placenta and membranes are pushed out by the continuing contraction of the uterus, which eventually returns to its unexpanded state. The average duration of labour is about 12 hours in first pregnancies and about 8 hours in subsequent pregnancies. The pain of labour may be reduced with effective birth preparation, continuous midwifery support in labour, and by the use of drugs (e.g. morphine, epidural anaesthesia). See also Caesarean section.... labour