See APPENDIX 1: BASIC FIRST AID.
has no connection with foot and mouth disease in cattle, deer, pigs and sheep.... hand, foot and mouth disease
Mechanism of respiration For the structure of the respiratory apparatus, see AIR PASSAGES; CHEST; LUNGS. The air passes rhythmically into and out of the air passages, and mixes with the air already in the lungs, these two movements being known as inspiration and expiration. INSPIRATION is due to a muscular e?ort which enlarges the chest, so that the lungs have to expand in order to ?ll up the vacuum that would otherwise be left, the air entering these organs by the air passages. The increase of the chest in size from above downwards is mainly due to the diaphragm, the muscular ?bres of which contract and reduce its domed shape and cause it to descend, pushing down the abdominal organs beneath it. EXPIRATION is an elastic recoil, the diaphragm rising and the ribs sinking into the position that they naturally occupy, when muscular contraction is ?nished. Occasionally, forced expiration may occur, involving powerful muscles of the abdomen and thorax; this is typically seen in forcible coughing.
Nervous control Respiration is usually either an automatic or a REFLEX ACTION, each expiration sending up sensory impulses to the CENTRAL NERVOUS SYSTEM, from which impulses are sent down various other nerves to the muscles that produce inspiration. Several centres govern the rate and force of the breathing, although all are presided over by a chief respiratory centre in the medulla oblongata (see under BRAIN – Divisions). This in turn is controlled by the higher centres in the cerebral hemispheres, so that breathing can be voluntarily stopped or quickened.
Quantity of air The lungs do not completely empty themselves at each expiration and re?ll at each inspiration. With each breath, less than one-tenth of the total air in the lungs passes out and is replaced by the same quantity of fresh air, which mixes with the stale air in the lungs. This renewal, which in quiet breathing amounts to about 500 millilitres, is known as the tidal air. By a special inspiratory e?ort, an individual can draw in about 3,000 millilitres, this amount being known as complemental air. By a special expiratory e?ort, too, after an ordinary breath one can expel much more than the tidal air from the lungs – this extra amount being known as the supplemental or reserve air, and amounting to about 1,300 millilitres. If an individual takes as deep an inspiration as possible and then makes a forced expiration, the amount expired is known as the vital capacity, and amounts to around 4,000 millilitres in a healthy adult male of average size. Figures for women are about 25 per cent lower. The vital capacity varies with size, sex, age and ethnic origin.
Over and above the vital capacity, the lungs contain air which cannot be expelled; this is known as residual air, and amounts to another 1,500 millilitres.
Tests of respiratory e?ciency are used to assess lung function in health and disease. Pulmonary-function tests, as they are known, include spirometry (see SPIROMETER), PEAK FLOW METER (which measures the rate at which a person can expel air from the lungs, thus testing vital capacity and the extent of BRONCHOSPASM), and measurements of the concentration of oxygen and carbon dioxide in the blood. (See also LUNG VOLUMES.)
Abnormal forms of respiration Apart from mere changes in rate and force, respiration is modi?ed in several ways, either involuntarily or voluntarily. SNORING, or stertorous breathing, is due to a ?accid state of the soft palate causing it to vibrate as the air passes into the throat, or simply to sleeping with the mouth open, which has a similar e?ect. COUGH is a series of violent expirations, at each of which the larynx is suddenly opened after the pressure of air in the lungs has risen considerably; its object is to expel some irritating substance from the air passages. SNEEZING is a single sudden expiration, which di?ers from coughing in that the sudden rush of air is directed by the soft palate up into the nose in order to expel some source of irritation from this narrow passage. CHEYNE-STOKES BREATHING is a type of breathing found in persons suffering from stroke, heart disease, and some other conditions, in which death is impending; it consists in an alternate dying away and gradual strengthening of the inspirations. Other disorders of breathing are found in CROUP and in ASTHMA.... respiration
Thrush is characterised by the presence of white patches on the mucous membrane which bleeds if the patch is gently removed. It is caused by the growth of a parasitic mould known as Candida albicans. Antifungal agents usually suppress the growth of candida. Candidal in?ltration of the mucosa is often found in cancerous lesions.
Leukoplakia literally means a white patch. In the mouth it is often due to an area of thickened cells from the horny layer of the epithelium. It appears as a white patch of varying density and is often grooved by dense ?ssures. There are many causes, most of them of minor importance. It may be associated with smoking, SYPHILIS, chronic SEPSIS or trauma from a sharp tooth. Cancer must be excluded.
Stomatitis (in?ammation of the mouth) arises from the same causes as in?ammation elsewhere, but among the main causes are the cutting of teeth in children, sharp or broken teeth, excess alcohol, tobacco smoking and general ill-health. The mucous membrane becomes red, swollen and tender and ulcers may appear. Treatment consists mainly of preventing secondary infection supervening before the stomatitis has resolved. Antiseptic mouthwashes are usually su?cient.
Gingivitis (see TEETH, DISEASES OF) is in?ammation of the gum where it touches the tooth. It is caused by poor oral hygiene and is often associated with the production of calculus or tartar on the teeth. If it is neglected it will proceed to periodontal disease.
Ulcers of the mouth These are usually small and arise from a variety of causes. Aphthous ulcers are the most common; they last about ten days and usually heal without scarring. They may be associated with STRESS or DYSPEPSIA. There is no ideal treatment.
Herpetic ulcers (see HERPES SIMPLEX) are similar but usually there are many ulcers and the patient appears feverish and unwell. This condition is more common in children.
Calculus (a) Salivary: a calculus (stone) may develop in one of the major salivary-gland ducts. This may result in a blockage which will cause the gland to swell and be painful. It usually swells before a meal and then slowly subsides. The stone may be passed but often has to be removed in a minor operation. If the gland behind the calculus becomes infected, then an ABSCESS forms and, if this persists, the removal of the gland may be indicated. (b) Dental, also called TARTAR: this is a calci?ed material which adheres to the teeth; it often starts as the soft debris found on teeth which have not been well cleaned and is called plaque. If not removed, it will gradually destroy the periodontal membrane and result in the loss of the tooth. (See TEETH, DISORDERS OF.)
Ranula This is a cyst-like swelling found in the ?oor of the mouth. It is often caused by mild trauma to the salivary glands with the result that saliva collects in the cyst instead of discharging into the mouth. Surgery may be required.
Mumps is an acute infective disorder of the major salivary glands. It causes painful enlargement of the glands which lasts for about two weeks. (See also main entry for MUMPS.)
Tumours may occur in all parts of the mouth, and may be BENIGN or MALIGNANT. Benign tumours are common and may follow mild trauma or be an exaggerated response to irritation. Polyps are found in the cheeks and on the tongue and become a nuisance as they may be bitten frequently. They are easily excised.
A MUCOCOELE is found mainly in the lower lip.
An exostosis or bone outgrowth is often found in the mid line of the palate and on the inside of the mandible (bone of the lower jaw). This only requires removal if it becomes unduly large or pointed and easily ulcerated.
Malignant tumours within the mouth are often large before they are noticed, whereas those on the lips are usually seen early and are more easily treated. The cancer may arise from any of the tissues found in the mouth including epithelium, bone, salivary tissue and tooth-forming tissue remnants. Oral cancers represent about 5 per cent of all reported malignancies, and in England and Wales around 3,300 people are diagnosed annually as having cancer of the mouth and PHARYNX.
Cancer of the mouth is less common below the age of 40 years and is more common in men. It is often associated with chronic irritation from a broken tooth or ill-?tting denture. It is also more common in those who smoke and those who chew betel leaves. Leukoplakia (see above) may be a precursor of cancer. Spread of the cancer is by way of the lymph nodes in the neck. Early treatment by surgery, radiotherapy or chemotherapy will often be e?ective, except for the posterior of the tongue where the prognosis is very poor. Although surgery may be extensive and potentially mutilating, recent advances in repairing defects and grafting tissues from elsewhere have made treatment more acceptable to the patient.... mouth, diseases of
may be due to malfunction of the part of the brain that controls breathing (as occurs in some cases of stroke and head injury).
It may also occur as a result of heart failure or in healthy people at high altitudes, especially during sleep.... cheyne–stokes respiration
Causes: occupational hazards, contact with toxic metals and minerals.
A Health Department’s committee found an increased risk of developing mouth cancer from “snuff- dipping”, the practice of sucking tobacco from a small sachet, “tobacco teabags”.
Of possible value:– Fresh plant juices, Houseleek, Aloe Vera.
Teas: Chickweed, Mullein, Comfrey. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes; dose – 1 cup thrice daily, increasing to as much as well tolerated.
Condurango Liquid extract. 10-30 drops in water before meals.
Goldenseal Liquid extract. 3-5 drops in water before meals.
George Burford MD. Condurango and Goldenseal.
E.H. Ruddock MD 1925. “Several cases of cancer of the lips have been cured by Goldenseal.”
Topical. Wipe area with Liquid Extract Condurango, Goldenseal, Thuja, Poke root or fresh plant juices of above. Slippery Elm paste: powdered Slippery Elm in few drops milk or water.
Mouthwash. Equal parts: Liquid Extract Goldenseal, Liquid Extract Bayberry, Tincture Myrrh and Glycerine. Some may be swallowed as internal medicine. Comfrey, Mullein or Chickweed cream.
Diet. See: DIET – CANCER.
Treatment by a general medical practitioner or hospital oncologist. ... cancer – mouth and lips
Rarely, permanent dry mouth may occur as part of Sjögren’s syndrome or from radiotherapy to treat mouth cancer.
Dryness usually causes difficulty in swallowing and speaking, interference with taste, and tooth decay (see caries, dental).
It may be relieved by spraying the inside of the mouth with artificial saliva.... mouth, dry
Predisposing causes of mouth cancer are poor oral hygiene, drinking alcoholic spirits, tobacco-smoking, chewing tobacco, and inhaling snuff. Irritation from ill-fitting dentures or jagged teeth are other factors. Men are affected twice as often as women; most cases occur in men over the age of 40.
Mouth cancer usually begins with a whitish patch, called leukoplakia, or a small lump. These may cause a burning sensation, but are usually painless. As the tumour grows, it may develop into an ulcer or a deep fissure, which may bleed and erode surrounding tissue.
Diagnosis is based on a biopsy. Treatment consists of surgery, radiotherapy, or both. Extensive surgery may cause facial disfigurement and problems with eating and speaking, which may require reconstructive surgery. Radiotherapy sometimes damages the salivary glands (see mouth, dry).
When mouth cancer is detected and treated early, the outlook is good.... mouth cancer
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