History Child health services were originally designed, before the NHS came into being, to ?nd or prevent physical illness by regular inspections. In the UK these were carried out by clinical medical o?cers (CMOs) working in infant welfare clinics (later, child health clinics) set up to ?ll the gap between general practice and hospital care. The services expanded greatly from the mid 1970s; ‘inspections’ have evolved into a regular screening and surveillance system by general practitioners and health visitors, while CMOs have mostly been replaced by consultant paediatricians in community child health (CPCCH).
Screening Screening begins at birth, when every baby is examined for congenital conditions such as dislocated hips, heart malformations, cataract and undescended testicles. Blood is taken to ?nd those babies with potentially brain-damaging conditions such as HYPOTHYROIDISM and PHENYLKETONURIA. Some NHS trusts screen for the life-threatening disease CYSTIC FIBROSIS, although in future it is more likely that ?nding this disease will be part of prenatal screening, along with DOWN’S (DOWN) SYNDROME and SPINA BIFIDA. A programme to detect hearing impairment in newborn babies has been piloted from 2001 in selected districts to ?nd out whether it would be a useful addition to the national screening programme. Children from ethnic groups at risk of inherited abnormalities of HAEMOGLOBIN (sickle cell disease; thalassaemia – see under ANAEMIA) have blood tested at some time between birth and six months of age.
Illness prevention At two months, GPs screen babies again for these abnormalities and start the process of primary IMMUNISATION. The routine immunisation programme has been dramatically successful in preventing illness, handicap and deaths: as such it is the cornerstone of the public health aspect of child health, with more potential vaccines being made available every year. Currently, infants are immunised against pertussis (see WHOOPING COUGH), DIPHTHERIA, TETANUS, POLIOMYELITIS, haemophilus (a cause of MENINGITIS, SEPTICAEMIA, ARTHRITIS and epiglottitis) and meningococcus C (SEPTICAEMIA and meningitis – see NEISSERIACEAE) at two, three and four months. Selected children from high-risk groups are o?ered BCG VACCINE against tuberculosis and hepatitis vaccine. At about 13 months all are o?ered MMR VACCINE (measles, mumps and rubella) and there are pre-school entry ‘boosters’ of diphtheria, tetanus, polio, meningococcus C and MMR. Pneumococcal vaccine is available for particular cases but is not yet part of the routine schedule.
Health promotion and education Throughout the UK, parents are given their child’s personal health record to keep with them. It contains advice on health promotion, including immunisation, developmental milestones (when did he or she ?rst smile, sit up, walk and so on), and graphs – called centile charts – on which to record height, weight and head circumference. There is space for midwives, doctors, practice nurses, health visitors and parents to make notes about the child.
Throughout at least the ?rst year of life, both parents and health-care providers set great store by regular weighing, designed to pick up children who are ‘failing to thrive’. Measuring length is not quite so easy, but height measurements are recommended from about two or three years of age in order to detect children with disorders such as growth-hormone de?ciency, malabsorption (e.g. COELIAC DISEASE) and psychosocial dwar?sm (see below).
All babies have their head circumference measured at birth, and again at the eight-week check. A too rapidly growing head implies that the infant might have HYDROCEPHALUS – excess ?uid in the hollow spaces within the brain. A too slowly growing head may mean failure of brain growth, which may go hand in hand with physically or intellectually delayed development.
At about eight months, babies receive a surveillance examination, usually by a health visitor. Parents are asked if they have any concerns about their child’s hearing, vision or physical ability. The examiner conducts a screening test for hearing impairment – the so-called distraction test; he or she stands behind the infant, who is on the mother’s lap, and activates a standardised sound at a set distance from each ear, noting whether or not the child turns his or her head or eyes towards the sound. If the child shows no reaction, the test is repeated a few weeks later; if still negative then referral is made to an audiologist for more formal testing.
The doctor or health visitor will also go through the child’s developmental progress (see above) noting any signi?cant deviation from normal which merits more detailed examination. Doctors are also recommended to examine infants developmentally at some time between 18 and 24 months. At this time they will be looking particularly for late walking or failure to develop appropriate language skills.... child health
Nutritional Profile Energy value (calories per serving): Moderate Protein: Low (cocoa powder) High (chocolate) Fat: Moderate Saturated fat: High Cholesterol: None Carbohydrates: Low (chocolate) High (cocoa powder) Fiber: Moderate (chocolate) High (cocoa powder) Sodium: Moderate Major vitamin contribution: B vitamins Major mineral contribution: Calcium, iron, copper
About the Nutrients in This Food Cocoa beans are high-carbohydrate, high-protein food, with less dietary fiber and more fat than all other beans, excepting soy beans. The cocoa bean’s dietary fiber includes pectins and gums. Its proteins are limited in the essential amino acids lysine and isoleucine. Cocoa butter, the fat in cocoa beans, is the second most highly saturated vegetable fat (coconut oil is number one), but it has two redeeming nutritional qualities. First, it rarely turns rancid. Second, it melts at 95°F, the temperature of the human tongue. Cocoa butter has no cholesterol; neither does plain cocoa powder or plain dark chocolate. Cocoa beans have B vitamins (thiamine, riboflavin, niacin) plus min- erals (iron, magnesium, potassium, phosphorus, and copper). All chocolate candy is made from chocolate liquor, a thick paste pro- duce by roasting and grinding cocoa beans. Dark (sweet) chocolate is made of chocolate liquor, cocoa butter, and sugar. Milk chocolate is made of choc- olate liquor, cocoa butter, sugar, milk or milk powder, and vanilla. White * These values apply to plain cocoa powder and plain unsweetened chocolate. Add- ing other foods, such as milk or sugar, changes these values. For example, there is no cholesterol in plain bitter chocolate, but there is cholesterol in milk chocolate. chocolate is made of cocoa butter, sugar, and milk powder. Baking chocolate is unsweetened dark chocolate. The most prominent nutrient in chocolate is its fat. Fat Content in One Ounce of Chocolate
| Saturated fat (g) | Monounsaturated fat (g) | Polyunsaturated fat (g) | Cholesterol (mg) | |
| Dark (sweet) | ||||
| chocolate | 5.6 | 3.2 | 0.3 | 0 |
| Milk chocolate | 5.9 | 4.5 | 0.4 | 6.6 |
| Baking chocolate | 9 | 5.6 | 0.3 | 0 |
| White chocolate | 5.5 | 2.6 | 0.3 | 0 |
The Most Nutritious Way to Serve This Food With low-fat milk to complete the proteins without adding saturated fat and cholesterol. NOTE : Both cocoa and chocolate contain oxalic acid, which binds with calcium to form cal- cium oxalate, an insoluble compound, but milk has so much calcium that the small amount bound to cocoa and chocolate hardly matters. Chocolate skim milk is a source of calcium.
Diets That May Restrict or Exclude This Food Antiflatulence diet Low-calcium and low-oxalate diet (to prevent the formation of calcium oxalate kidney stones) Low-calorie diet Low-carbohydrate diet Low-fat diet Low-fat, controlled-cholesterol diet (milk chocolates) Low-fiber diet Potassium-regulated (low-potassium) diet
Buying This Food Look for: Tightly sealed boxes or bars. When you open a box of chocolates or unwrap a candy bar, the chocolate should be glossy and shiny. Chocolate that looks dull may be stale, or it may be inexpensively made candy without enough cocoa butter to make it gleam and give it the rich creamy mouthfeel we associate with the best chocolate. (Fine chocolate melts evenly on the tongue.) Chocolate should also smell fresh, not dry and powdery, and when you break a bar or piece of chocolate it should break cleanly, not crumble. One exception: If you have stored a bar of chocolate in the refrigerator, it may splinter if you break it without bringing it to room temperature first.
Storing This Food Store chocolate at a constant temperature, preferably below 78°F. At higher temperatures, the fat in the chocolate will rise to the surface and, when the chocolate is cooled, the fat will solidif y into a whitish powdery bloom. Bloom is unsightly but doesn’t change the chocolate’s taste or nutritional value. To get rid of bloom, melt the chocolate. The chocolate will turn dark, rich brown again when its fat recombines with the other ingredients. Chocolate with bloom makes a perfectly satisfactory chocolate sauce. Dark chocolate (bitter chocolate, semisweet chocolate) ages for at least six months after it is made, as its flavor becomes deeper and more intense. Wrapped tightly and stored in a cool, dry cabinet, it can stay fresh for a year or more. Milk chocolate ages only for about a month after it is made and holds its peak flavor for about three to six months, depending on how carefully it is stored. Plain cocoa, with no added milk powder or sugar, will stay fresh for up to a year if you keep it tightly sealed and cool.
What Happens When You Cook This Food Chocolate burns easily. To melt it without mishap, stir the chocolate in a bowl over a pot of hot water or in the top of a double boiler or put the chocolate in a covered dish and melt it in the microwave (which does not get as hot as a pot on the store). Simple chemistry dictates that chocolate cakes be leavened with baking soda rather than baking powder. Chocolate is so acidic that it will upset the delicate balance of acid (cream of tartar) and base (alkali = sodium bicarbonate = baking soda) in baking powder. But it is not acidic enough to balance plain sodium bicarbonate. That’s why we add an acidic sour-milk product such as buttermilk or sour cream or yogurt to a chocolate cake. Without the sour milk, the batter would be so basic that the chocolate would look red, not brown, and taste very bitter.
How Other Kinds of Processing Affect This Food Freezing. Chocolate freezes and thaws well. Pack it in a moistureproof container and defrost it in the same package to let it reabsorb moisture it gave off while frozen.
Medical Uses and/or Benefits Mood elevator. Chocolate’s reputation for making people feel good is based not only on its caffeine content—19 mg caffeine per ounce of dark (sweet) chocolate, which is one-third the amount of caffeine in a five-ounce cup of brewed coffee—but also on its naturally occurring mood altering chemicals phenylethylalanine and anandamide. Phenylethylalanine is found in the blood of people in love. Anandamide stimulates areas of your brain also affected by the active ingredients in marijuana. (NOTE : As noted by the researchers at the Neurosci- ences Institute in San Diego who identified anandamide in chocolate in 1996, to get even the faintest hint of marijuana-like effects from chocolate you would have to eat more than 25 pounds of the candy all at once.) Possible heart health benefits. Chocolate is rich in catechins, the antioxidant chemicals that give tea its reputation as a heart-protective anticancer beverage (see tea). In addition, a series of studies beginning with those at the USDA Agricultural Research Center in Peoria, Illinois, suggest that consuming foods rich in stearic acid like chocolate may reduce rather than raise the risk of a blood clot leading to a heart attack. Possible slowing of the aging process. Chocolate is a relatively good source of copper, a mineral that may play a role in slowing the aging process by decreasing the incidence of “protein glycation,” a reaction in which sugar molecules ( gly = sugar) hook up with protein molecules in the bloodstream, twisting the protein molecules out of shape and rendering them unusable. This can lead to bone loss, rising cholesterol, cardiac abnormalities, and a slew of other unpleasantries. In people with diabetes, excess protein glycation may be one factor involved in complications such as loss of vision. Ordinarily, increased protein glyca- tion is age-related. But at the USDA Grand Forks Human Nutrition Research Center in North Dakota, agricultural research scientist Jack T. Saari has found that rats on copper-deficient diets experience more protein glycation at any age than other rats. A recent USDA survey of American eating patterns says that most of us get about 1.2 mg copper a day, considerably less than the Estimated Safe and Adequate Daily Dietary Intake (ESADDI) or 1.5 mg to 3 mg a day. Vegetarians are less likely to be copper deficient because, as Saari notes, the foods highest in copper are whole grains, nuts, seeds, and beans, including the cocoa bean. One ounce of dark chocolate has .25 mg copper (8 –17 percent of the ESADDI).
Adverse Effects Associated with This Food Possible loss of bone density. In 2008, a team of Australian researchers at Royal Perth Hos- pital, and Sir Charles Gairdner Hospital published a report in the American Journal of Clinical Nutrition suggesting that women who consume chocolate daily had 3.1 percent lower bone density than women who consume chocolate no more than once a week. No explanation for the reaction was proposed; the finding remains to be confirmed. Possible increase in the risk of heart disease. Cocoa beans, cocoa powder, and plain dark chocolate are high in saturated fats. Milk chocolate is high in saturated fats and cholesterol. Eating foods high in saturated fats and cholesterol increases the amount of cholesterol in your blood and raises your risk of heart disease. NOTE : Plain cocoa powder and plain dark chocolate may be exceptions to this rule. In studies at the USDA Agricultural Research Center in Peoria, Illinois, volunteers who consumed foods high in stearic acid, the saturated fat in cocoa beans, cocoa powder, and chocolate, had a lower risk of blood clots. In addition, chocolate is high in flavonoids, the antioxidant chemicals that give red wine its heart-healthy reputation. Mild jitters. There is less caffeine in chocolate than in an equal size serving of coffee: A five- ounce cup of drip-brewed coffee has 110 to 150 mg caffeine; a five-ounce cup of cocoa made with a tablespoon of plain cocoa powder ( 1/3 oz.) has about 18 mg caffeine. Nonetheless, people who are very sensitive to caffeine may find even these small amounts problematic. Allergic reaction. According to the Merck Manual, chocolate is one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach.* The others are berries (blackberries, blueberries, raspberries, strawberries), corn, eggs, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).
Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated food, such as cocoa or chocolate, while you are taking an M AO inhibitor, the result may be a hypertensive crisis. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal gland, secretes adrenalin, which the body converts to VM A (vanillylmandelic acid). VM A is excreted in urine, and, until recently, the test for this tumor measured the level of VM A in the urine. In the past, chocolate and cocoa, both of which contain VM A, were eliminated from the patient’s diet prior to the test lest they elevate the level of VM A in the urine and produce a false-positive result. Today, more finely drawn tests usually make this unnecessary. * The evidence link ing chocolate to allergic or migraine headaches is inconsistent. In some people, phenylet hylamine (PEA) seems to cause headaches similar to t hose induced by t yramine, anot her pressor amine. The PEA-induced headache is unusual in t hat it is a delayed react ion t hat usually occurs 12 or more hours after t he chocolate is eaten.... chocolate
Psychiatrists like to categorise mental illnesses because mental signs and symptoms do occur together in clusters or syndromes, each tending to respond to certain treatments. The idea that illnesses can be diagnosed simply by recognising their symptom patterns may not seem very scienti?c in these days of high technology. For most common mental illnesses, however, this is the only method of diagnosis; whatever is going wrong in the brain is usually too poorly understood and too subtle to show up in laboratory tests or computed tomography scans of the brain. And symptom-based definitions of mental illnesses are, generally, a lot more meaningful than the vague lay term ‘nervous breakdown’, which is used to cover an attack of anything from AGORAPHOBIA to total inability to function.
There is still a lot to learn about the workings of the brain, but psychiatry has developed plenty of practical knowledge about the probable causes of mental illness, ways of relieving symptoms, and ways of aiding recovery. Most experts now believe that mental illnesses generally arise from di?erent combinations of inherited risk and psychological STRESS, sometimes with additional environmental exposure – for example, viruses, drugs or ALCOHOL.
The range of common mental illnesses includes anxiety states, PHOBIA, DEPRESSION, alcohol and drug problems, the EATING DISORDERS anorexia and bulimia nervosa, MANIC DEPRESSION, SCHIZOPHRENIA, DEMENTIA, and a group of problems related to coping with life that psychiatrists call personality disorders.
Of these mental illnesses, dementia is the best understood. It is an irreversible and fatal form of mental deterioration (starting with forgetfulness and eventually leading to severe failure of all the brain’s functions), caused by rapid death of brain cells and consequent brain shrinkage. Schizophrenia is another serious mental illness which disrupts thought-processes, speech, emotions and perception (how the brain handles signals from the ?ve senses). Manic depression, in which prolonged ‘highs’ of extremely elevated mood and overexcitement alternate with abject misery, has similar effects on the mental processes. In both schizophrenia and manic depression the sufferer loses touch with reality, develops unshakeable but completely unrealistic ideas (delusions), and hallucinates (vividly experiences sensations that are not real, e.g. hears voices when there is nobody there). This triad of symptoms is called psychosis and it is what lay people, through fear and lack of understanding, sometimes call lunacy, madness or insanity.
The other mental illnesses mentioned above are sometimes called neuroses. But the term has become derogatory in ordinary lay language; indeed, many people assume that neuroses are mild disorders that only affect weak people who cannot ‘pull themselves together’, while psychoses are always severe. In reality, psychoses can be brief and reversible and neuroses can cause lifelong disability.
However de?ned and categorised, mental illness is a big public-health problem. In the UK, up to one in ?ve women and around one in seven men have had mental illness. About half a million people in Britain suffer from schizophrenia: it is three times commoner than cancer. And at any one time, up to a tenth of the adult population is ill with depression.
Treatment settings Most people with mental-health problems get the help they need from their own family doctor(s), without ever seeing a psychiatrist. General practictitioners in Britain treat nine out of ten recognised mental-health problems and see around 12 million adults with mental illness each year. Even for the one in ten of these patients referred to psychiatrists, general practitioners usually handle those problems that continue or recur.
Psychiatrists, psychiatric nurses, social workers, psychologists, counsellors and therapists often see patients at local doctors’ surgeries and will do home visits if necessary. Community mental-health centres – like general-practice health centres but catering solely for mental-health problems – o?er another short-cut to psychiatric help. The more traditional, and still more common, route to a psychiatrist for many people, however, is from the general practititioner to a hospital outpatient department.
Specialist psychiatric help In many ways, a visit to a psychiatrist is much like any trip to a hospital doctor – and, indeed, psychiatric clinics are often based in the outpatient departments of general hospitals. First appointments with psychiatrists can last an hour or more because the psychiatrist – and sometimes other members of the team such as nurses, doctors in training, and social workers – need to ask lots of questions and record the whole consultation in a set of con?dential case notes.
Psychiatric assessment usually includes an interview and an examination, and is sometimes backed up by a range of tests. The interview begins with the patient’s history – the personal story that explains how and, to some extent, why help is needed now. Mental-health problems almost invariably develop from a mixture of causes – emotional, social, physical and familial – and it helps psychiatrists to know what the people they see are normally like and what kind of lives they have led. These questions may seem unnecessarily intrusive, but they allow psychiatrists to understand patients’ problems and decide on the best way to help them.
The next stage in assessment is the mental-state examination. This is how psychiatrists examine minds, or at least their current state. Mental-state examination entails asking more questions and using careful observation to assess feelings, thoughts and mental symptoms, as well as the way the mind is working (for example, in terms of memory and concentration). During ?rst consultations psychiatrists usually make diagnoses and explain them. The boundary between a life problem that will clear up spontaneously and a mental illness that needs treatment is sometimes quite blurred; one consultation may be enough to put the problem in perspective and help to solve it.
Further assessment in the clinic may be needed, or some additional tests. Simple blood tests can be done in outpatient clinics but other investigations will mean referral to another department, usually on another day.
Further assessment and tests
PSYCHOLOGICAL TESTS Psychologists work in or alongside the psychiatric team, helping in both assessment and treatment. The range of psychological tests studies memory, intelligence, personality, perception and capability for abstract thinking. PHYSICAL TESTS Blood tests and brain scans may be useful to rule out a physical illness causing psychological symptoms. SOCIAL ASSESSMENT Many patients have social diffculties that can be teased out and helped by a psychiatric social worker. ‘Approved social workers’ have special training in the use of the Mental Health Act, the law that authorises compulsory admissions to psychiatric hospitals and compulsory psychiatric treatments. These social workers also know about all the mental-health services o?ered by local councils and voluntary organisations, and can refer clients to them. The role of some social workers has been widened greatly in recent years by the expansion of community care. OCCUPATIONAL THERAPY ASSESSMENT Mental-health problems causing practical disabilities – for instance, inability to work, cook or look after oneself – can be assessed and helped by occupational therapists.
Treatment The aims of psychiatric treatment are to help sufferers shake o?, or at least cope with, symptoms and to gain or regain an acceptable quality of life. A range of psychological and physical treatments is available.
COUNSELLING This is a widely used ‘talking cure’, particularly in general practice. Counsellors listen to their clients, help them to explore feelings, and help them to ?nd personal and practical solutions to their problems. Counsellors do not probe into clients’ pasts or analyse them. PSYCHOTHERAPY This is the best known ‘talking cure’. The term psychotherapy is a generalisation covering many di?erent concepts. They all started, however, with Sigmund Freud (see FREUDIAN THEORY), the father of modern psychotherapy. Freud was a doctor who discovered that, as well as the conscious thoughts that guide our feelings and actions, there are powerful psychological forces of which we are not usually aware. Applying his theories to his patients’ freely expressed thoughts, Freud was able to cure many illnesses, some of which had been presumed completely physical. This was the beginning of individual analytical psychotherapy, or PSYCHOANALYSIS. Although Freud’s principles underpin all subsequent theories about the psyche, many di?erent schools of thought have emerged and in?uenced psychotherapists (see ADLER; JUNGIAN ANALYSIS; PSYCHOTHERAPY). BEHAVIOUR THERAPY This springs from theories of human behaviour, many of which are based on studies of animals. The therapists, mostly psychologists, help people to look at problematic patterns of behaviour and thought, and to change them. Cognitive therapy is very e?ective, particularly in depression and eating disorders. PHYSICAL TREATMENTS The most widely used physical treatments in psychiatry are drugs. Tranquillising and anxiety-reducing BENZODIAZEPINES like diazepam, well known by its trade name of Valium, were prescribed widely in the 1960s and 70s because they seemed an e?ective and safe substitute for barbiturates. Benzodiazepines are, however, addictive and are now recommended only for short-term relief of anxiety that is severe, disabling, or unacceptably distressing. They are also used for short-term treatment of patients drying out from alcohol.
ANTIDEPRESSANT DRUGS like amitriptyline and ?uoxetine are given to lift depressed mood and to relieve the physical symptoms that sometimes occur in depression, such as insomnia and poor appetite. The side-effects of antidepressants are mostly relatively mild, when recommended doses are not exceeded – although one group, the monoamine oxidase inhibitors, can lead to sudden and dangerous high blood pressure if taken with certain foods.
Manic depression virtually always has to be treated with mood-stabilising drugs. Lithium carbonate is used in acute mania to lower mood and stop psychotic symptoms; it can also be used in severe depression. However lithium’s main use is to prevent relapse in manic depression. Long-term unwanted effects may include kidney and thyroid problems, and short-term problems in the nervous system and kidney may occur if the blood concentration of lithium is too high – therefore it must be monitored by regular blood tests. Carbamazepine, a treatment for EPILEPSY, has also been found to stabilise mood, and also necessitates blood tests.
Antipsychotic drugs, also called neuroleptics, and major tranquillisers are the only e?ective treatments for relieving serious mental illnesses with hallucinations and delusions. They are used mainly in schizophrenia and include the short-acting drugs chlorpromazine and clozapine as well as the long-lasting injections given once every few weeks like ?uphenazine decanoate. In the long term, however, some of the older antipsychotic drugs can cause a brain problem called TARDIVE DYSKINESIA that affects control of movement and is not always reversible. And the antipsychotic drugs’ short-term side-effects such as shaking and sti?ness sometimes have to be counteracted by other drugs called anticholinergic drugs such as procyclidine and benzhexol. Newer antipsychotic drugs such as clozapine do not cause tardive dyskinesia, but clozapine cannot be given as a long-lasting injection and its concentration in the body has to be monitored by regular blood tests to avoid toxicity. OTHER PHYSICAL TREATMENTS The other two physical treatments used in psychiatry are particularly controversial: electroconvulsive therapy (ECT) and psychosurgery. In ECT, which can be life-saving for patients who have severe life-threatening depression, a small electric current is passed through the brain to induce a ?t or seizure. Before the treatment the patient is anaesthetised and given a muscle-relaxing injection that reduces the magnitude of the ?t to a slight twitching or shaking. Scientists do not really understand how ECT works, but it does, for carefully selected patients. Psychosurgery – operating on the brain to alleviate psychiatric illness or di?cult personality traits – is extremely uncommon these days. Stereo-tactic surgery, in which small cuts are made in speci?c brain ?bres under X-ray guidance, has super-seded the more generalised lobotomies of old. The Mental Health Act 1983 ensures that psychosurgery is performed only when the patient has given fully informed consent and a second medical opinion has agreed that it is necessary. For all other psychiatric treatments (except another rare treatment, hormone implantation for reducing the sex drive of sex o?enders), either consent or a second opinion is needed – not both. TREATMENT IN HOSPITAL Psychiatric wards do not look like medical or surgical wards and sta? may not wear uniforms. Patients do not need to be in their beds during the day, so the beds are in separate dormitories. The main part of most wards is a living space with a day room, an activity and television room, quiet rooms, a dining room, and a kitchen. Ward life usually has a certain routine. The day often starts with a community meeting at which patients and nurses discuss issues that affect the whole ward. Patients may go to the occupational therapy department during the day, but there may also be some therapy groups on the ward, such as relaxation training. Patients’ symptoms and problems are assessed continuously during a stay in hospital. When patients seem well enough they are allowed home for trial periods; then discharge can be arranged. Patients are usually followed up in the outpatient clinic at least once.
TREATING PATIENTS WITH ACUTE PSYCHIATRIC ILLNESS Psychiatric emergencies – patients with acute psychiatric illness – may develop from psychological, physical, or practical crises. Any of these crises may need quick professional intervention. Relatives and friends often have to get this urgent help because the sufferer is not ?t enough to do it or, if psychotic, does not recognise the need. First, they should ring the person’s general practitioner. If the general practitioner is not available and help is needed very urgently, relatives or friends should phone the local social-services department and ask for the duty social worker (on 24-hour call). In a dire emergency, the police will know what to do.
Any disturbed adult who threatens his or her own or others’ health and safety and refuses psychiatric help may be moved and detained by law. The Mental Health Act of 1983 authorises emergency assessment and treatment of any person with apparent psychiatric problems that ful?l these criteria.
Although admission to hospital may be the best solution, there are other ways that psychiatric services can respond to emergencies. In some districts there are ‘crisis intervention’ teams of psychiatrists, nurses, and social workers who can visit patients urgently at home (at a GP’s request) and, sometimes, avert unnecessary admission. And research has shown that home treatment for a range of acute psychiatric problems can be e?ective.
LONG-TERM TREATMENT AND COMMUNITY CARE Long-term treatment is often provided by GPs with support and guidance from psychiatric teams. That is ?ne for people whose problems allow them to look after themselves, and for those with plenty of support from family and friends. But some people need much more intensive long-term treatment and many need help with running their daily lives.
Since the 1950s, successive governments have closed the old psychiatric hospitals and have tried to provide as much care as possible outside hospital – in ‘the community’. Community care is e?ective as long as everyone who needs inpatient care, or residential care, can have it. But demand exceeds supply. Research has shown that some homeless people have long-term mental illnesses and have somehow lost touch with psychiatric services. Many more have developed more general long-term health problems, particularly related to alcohol, without ever getting help.
The NHS and Community Care Act 1990, in force since 1993, established a new breed of professionals called care managers to assess people whose long-term illnesses and disabilities make them unable to cope completely independently with life. Care managers are given budgets by local councils to assess people’s needs and to arrange for them tailor-made packages of care, including services like home helps and day centres. But co-ordination between health and social services has sometimes failed – and resources are limited – and the government decided in 1997 to tighten up arrangements and pool community-care budgets.
Since 1992 psychiatrists have had to ensure that people with severe mental illnesses have full programmes of care set up before discharge from hospital, to be overseen by named key workers. And since 1996 psychiatrists have used a new power called Supervised Discharge to ensure that the most vulnerable patients cannot lose touch with mental-health services. There is not, however, any law that allows compulsory treatment in the community.
There is ample evidence that community care can work and that it need not cost more than hospital care. Critics argue, however, that even one tragedy resulting from inadequate care, perhaps a suicide or even a homicide, should reverse the march to community care. And, according to the National Schizophrenia Fellowship, many of the 10–15 homicides a year carried out by people with severe mental illnesses result from inadequate community care.
Further information can be obtained from the Mental Health Act Commission, and from MIND, the National Association for Mental Health. MIND also acts as a campaigning and advice organisation on all aspects of mental health.... mental illness
As there is no statute de?ning the scope and limits of advance statements in the UK, their legal status depends principally on case precedents. As well as written documents, competent patients can make equally valid advance oral refusals which should be recorded in the medical notes. Some health professionals or health facilities may have a conscientious objection (see ETHICS) to the concept of withdrawing life-prolonging treatment from incompetent patients, even at the patient’s advance request. Such objections need to be made known to patients well in advance of a living will becoming eligible for implementation, so that the patient can make other arrangements. The British Medical Association has issued a code of practice on the subject; this provides widely approved guidance on various facets of drafting, storing, witnessing and implementing advance statements. It is also dealt with in the GMC document on withdrawing treatment.... living will
Voice This has three varying characteristics: loudness, pitch, and quality or timbre. Loudness depends on the volume of air available and therefore on the size of the chest and the strength of its muscles. Pitch is determined by larynx size, the degree of tenseness at which the vocal cords are maintained, and whether the cords vibrate as a whole or merely at their edges.
In any given voice, the range of pitch seldom exceeds two and a half octaves. Typically, the small larynx of childhood produces a shrill or treble voice; the rapid growth of the larynx around PUBERTY causes the voice to ‘break’ in boys. Changes in the voice also occur at other ages as a result of the secondary action of the SEX HORMONES. Generally speaking, the adult voice is bass and tenor in men, contralto or soprano in women. Timbre is due to di?erences in the larynx, as well as to voluntary changes in the shape of the mouth.
Speech Rapid modi?cations of the voice, produced by movements of the PALATE, tongue and lips. Infants hear the sounds made by others and mimic them; hence the speech centres in the BRAIN are closely connected with those of hearing.
Defects of speech See below, and also SPEECH DISORDERS. MUTISM, or absence of the power to speak, may be due to various causes. LEARNING DISABILITY that prevents the child from mimicking the actions of others is most common; in other cases the child has normal intelligence but some neurological disorder, or disorder of the speech organs, is responsible. Alternatively, complete DEAFNESS or early childhood ear disease may be the cause. STAMMERING is a highly individual condition, but is basically a lack of coordination between the di?erent parts of the speech mechanism. (See also main entry on STAMMERING.) DYSPHASIA is the inability to speak or understand speech, most commonly following brain disease, such as STROKE. APHONIA or loss of voice may be caused by LARYNGITIS or, rarely, a symptom of conversion and dissociative mental disorders – traditionally referred to as HYSTERIA. It is generally of short duration.... voice and speech
National Screening Committee website: contains detailed notes on all screening programmes the committee has considered and the rationale for the decisions the committee has made... uk national screening committee
Constituents: allantoin, pyrrolizidine alkaloids (fresh young leaves and roots), mucilage, phenolic acids, steroidal saponins (root).
Action: astringent-demulcent, haemostatic, vulnerary. Rapid healer of flesh and bones by its property to accelerate mitosis (cell-division). Useful wherever a mucilaginous tissue restorative is required (repairing broken bones and lacerated flesh), especially in combination with Slippery Elm powder which prevents excess fluidity.
Uses: Ulceration anywhere along the gastrointestinal tract; colitis, hiatus hernia.
Bleeding from stomach, throat, bowel, bladder and lungs (haemoptysis) in which it reduces blood clotting time. Once used extensively for tuberculosis (pulmonary and elsewhere). Irritating cough, ‘dry’ lung complaints; pleurisy. Increases expectoration. Should not be given for oedematous conditions of the lungs.
Bones – fractures: to promote formation of a callus; rickets, wasting disease. Skin – varicose ulcers and indolent irritating sores that refuse to heal. Promotes suppuration of boils and gangrene as in diabetes. Bruises. STD skin lesions, internally and externally. Blood sugar control: assists function of the pancreas. Urine: scalding. Rheumatoid arthritis: improvement reported. Malignancy: cases of complete regression of sarcoma and carcinoma recorded. Rodent ulcer, (as a paste).
Preparations: thrice daily.
Tea: dried herb, one heaped teaspoon to each cup; or, 1oz to 1 pint boiling water; infuse 15 minutes, half- 1 cup for no more than 8 weeks.
Tincture (leaf). 1 part to 5 parts alcohol: dose 2.5-5ml. Maximum weekly dosage – 100ml for no more than 8 weeks.
Tincture (root). 1 part to 5 parts alcohol. Maximum weekly dosage – 80ml, for 8 weeks.
(National Institute of Medical Herbalists)
Poultice. A mucilage is prepared from fresh root in a liquidiser or by use of a rolling pin. For sprains, bruises, severe cuts, cleaning-out old ulcers and wounds.
Compress. 3 tablespoons crushed root or powder in 1 pint (500ml) water. Bring to boil; simmer gently 10 minutes. Saturate linen or suitable material and apply. Renew 2-3 times daily as moisture dries off. Ointment. 1 part powder, or liquid extract, to 10 parts base (cooking fat, Vaseline, etc).
Oil (external use). Ingredients: powdered Comfrey root in peanut oil and natural chlorophyll. (Henry Doubleday Research Association)
Notes. Contains trace element germanium, often given for cancer and arthritis. (Dr Uta Sandra Goodman) Helps eliminate toxic minerals. Neutralises free radicals that are created by toxic substances entering the body. Restores the body’s pH balance disturbed by highly acid foods such as meat, dairy products, refined foods and alcohol.
Dr H.E. Kirschner, well-known American physician, reported being called to the bedside of a patient with a huge advanced cancer of the breast. The odour was over-powering and the condition hopeless, but he advised poultices of fresh crushed Comfrey leaves several times daily to the discharging mass. Much to the surprise of all, the vile odour disappeared. The huge sore scaled over and the swelling subsided. Within three weeks the once-malignant sore was covered with a healthy scale and the pain disappeared. Unfortunately, treatment came too late; metastases had appeared in the liver which could not be reached by the poultices.
Claims that Comfrey is a toxic plant are unsubstantiated by a mass of clinical evidence to the contrary. Attempts to equate the effects of its isolated compounds apart from the whole plant yield conflicting results. For thousands of years the plant has been used by ancient and modern civilisations for healing purposes. Risks must be balanced with benefits.
There is a growing body of opinion to support the belief that a herb which has, without ill-effects been used for centuries and capable of producing convincing results is to be recognised as safe and effective.
Experiments reveal that in sufficient doses Comfrey can cause liver disease in laboratory animals. Its risk to humans has been a matter of serious debate since the 1960s, and is still unresolved. Although the overall risk is very low, a restriction has been placed on the plant as a precautionary measure. Fresh Comfrey leaves should not be used as a vegetable which is believed to be a health risk. It is believed that no toxicity has been found in common Comfrey (Symphytum officinale L). No restriction has been placed on use of dried Comfrey leaves as a tea. The debate continues.
It would appear that use of the root of Symphytum officinale may be justified in the treatment of severe bone diseases for which it has achieved a measure of success in the past, such as rickets, Paget’s disease, fractured bones, tuberculosis, etc, its benefits outweighing risks. Few other medicinal plants replenish wasted bone cells with the speed of Comfrey. (external use only) ... comfrey
Symptoms: malaise, bloody alternating diarrhoea and constipation; right side colicky abdominal pain worse after meals; flatulence, loss of weight and appetite. Intestinal obstruction can usually be palpated. Blood count. A blood count high in whites indicates an abscess – a serious condition which may require surgical repair during which segments of the gut may have to be removed. Malignant change rare. Differential diagnosis. Ulcerative colitis, appendicitis, appendix abscess, irritable bowel syndrome.
Cracks or ulcers at corners of the mouth may be a good marker of Crohn’s Disease.
Treatment. Select one of the following. Herbal treatment offers a safe alternative to steroids by inducing remission in acute exacerbation. Good responses have been observed from the anti-bacterials Wild Yam and Goldenseal. Fenugreek seeds are of special value. Comfrey (tissue regeneration). Irish Moss.
Teas: Chamomile, Comfrey leaves, Hops, Marshmallow leaves, Meadowsweet, Shepherd’s Purse (Dr A. Vogel), Lobelia. Silverweed and Cranesbill are excellent for internal bleeding; Poke root for intestinal ulceration.
Decoction. Fenugreek seeds: 2 teaspoons to large cup water simmered gently 10 minutes. 1 cup freely. The seeds also should be consumed.
Tablets/capsules. Wild Yam, Fenugreek, Ginger, Goldenseal, Lobelia, Slippery Elm.
Powders. Formula. Wild Yam 2; Meadowsweet 2; Goldenseal 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Liquid Extracts. (1) Formula. Wild Yam 1, Echinacea 2. 30-60 drops in water thrice daily. Or, (2) Formula: Turkey Rhubarb 2, Goldenseal 1, Caraway half. 20-30 drops in water thrice daily.
Tinctures. Formula. Bayberry 2, Goldenseal 1, Cardamoms 1. Dose: One to two 5ml teaspoons thrice daily.
Ispaghula seeds. 2-4 teaspoons thrice daily.
Tea Tree oil Suppositories. Insertion at night.
Diet. Bland, little fibre, Slippery Elm gruel. Irish Moss preparations. Increase fluid intake. Reject: broccoli, tomatoes, lima, Soya, Brussels sprouts, pinto beans, cocoa, chocolate, cow’s milk, peas, onions, turnips, radishes. Accept fish oils.
Addenbrookes Hospital, Cambridge. Reject foods containing wheat and all dairy produce.
Supplements. Vitamins A, B12, C, Calcium, Iron, Magnesium, Potassium, Zinc.
Study. In a study carried out by UK researchers (1993) food allergies were found to be the most common cause of the disease. Results suggested that dietary changes may be as effective as corticosteroids in easing symptoms. The most common allergens were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats, chocolate. An elemental diet with a formula of nutrients (E028, produced by Hospital Supplies, Liverpool) was used in trials. (The Lancet, 6.11.1993)
Notes. Crohn’s Disease is associated with Erythema nodosum, more frequently recognised in childhood. A frequent cause is cow’s milk intolerance. Smoking adds to the risk of Crohn’s disease.
In susceptible people, the food additives titanium dioxide and aluminosilicates may evoke a latent inflammatory response resulting in Crohn’s disease, ulcerative colitis or bowel cancer. These chemicals may be found in the intestinal lymphoid aggregations in gut mucosa. (Jonathan Powell, Gastro-intestinal Laboratory, St Thomas’s Hospital, London) (Titanium dioxide rarely occurs naturally but is added to confectionery, drinking water and anti-caking agents.) ... crohn’s disease
Symptoms. Tremors, restlessness, nausea and sleep disturbance. The greater potency of the drug, the higher the rebound anxiety. Many drugs create stress, weaken resistance to disease, tax the heart and raise blood sugar levels.
Drugs like Cortisone cause bone loss by imperfect absorption of calcium. Taken in the form of milk and dairy products, calcium is not always absorbed. Herbs to make good calcium loss are: Horsetail, Chickweed, Slippery Elm, Spinach, Alfalfa.
Agents to calm nerves and promote withdrawal may augment a doctor’s prescription for reduction of drug dosage, until the latter may be discontinued. Skullcap and Valerian offer a good base for a prescription adjusted to meet individual requirements.
Alternatives. Teas: German Chamomile, Gotu Kola, Hops, Lime flowers, Hyssop, Alfalfa, Passion flower, Valerian, Mistletoe, Oats, Lavender, Vervain, Motherwort. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; half-1 cup thrice daily.
Decoctions: Valerian, Devil’s Claw, Siberian Ginseng, Lady’s Slipper. Jamaica Dogwood, Black Cohosh.
Tablets/capsules. Motherwort, Dogwood, Valerian, Skullcap, Passion flower, Mistletoe, Liquorice. Powders. Formulae. Alternatives. (1) Combine equal parts Valerian, Skullcap, Mistletoe. Or, (2) Combine Valerian 1; Skullcap 2; Asafoetida quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily. Formula No 2 is very effective but offensive to taste and smell.
Practitioner. Tincture Nucis vom. once or twice daily, as advised.
Aloe Vera gel (or juice). Russians tested this plant on rabbits given heavy drug doses and expected to die. Their survival revealed the protective property of this plant: dose, 1 tablespoon morning and evening. Aromatherapy. Sniff Ylang Ylang oil. Lavender oil massage for its relaxing and stress-reducing properties.
Diet. Avoid high blood sugar levels by rejecting alcohol, white flour products, chocolate, sugar, sweets and high cholesterol foods.
Supplements. Daily. Multivitamins, Vitamin B-complex, B6, Vitamin C 2g, Minerals: Magnesium, Manganese, Iron, Zinc. Change of lifestyle. Stop smoking. Yoga.
Notes. “Do not withdraw: insulin, anticoagulants, epileptic drugs, steroids, thyroxin and hormone replacement therapy (the endocrine glands may no longer be active). Long-term tranquillisers e.g., Largactil or any medicament which has been used for a long period. Patients on these drugs are on a finely-tuned medication the balance of which may be easily disturbed.” (Simon Mills, FNIMH)
Counselling and relaxation therapy.
The Committee on Safety of Medicines specifically warns against the abrupt cessation of the Benzodiazepines and similar tranquillisers because of the considerable risk of convulsions. ... drug dependence
Action: antibiotic, bacteriostatic, anti-parasitic, anti-viral, anti-carcinogen, antispasmodic, antiseptic, fungicide, anti-thrombic, cholagogue, diaphoretic, hypoglycaemia, hypotensor, expectorant, anthelmintic. A wide range of anti-infection activity reported. Hypolipidaemic. Non-sedating antihistamine. Anticoagulant – reduces blood platelet clumping, raises HDL. Lowers total cholesterol after a fatty meal in normal subjects. As a vasodilator tends to reduce blood pressure. Bacteria do not become resistant to it. (Dr Stephen Fulder) Detoxifier.
Uses: Prevents build-up of cholesterol in the blood. Lowers a too high blood pressure and raises one too low. Beneficial in thrombosis and arteriosclerosis.
“Helps clear fat accumulating in blood vessels, reducing the tendency to heart disease: also can drastically reduce the level of sugar in the blood, which could help diabetics.” (Lancet i 607, 1979)
Bronchitis (loosening phlegm), asthma, cough, whooping cough and as a preventative of influenza and colds. Sinusitis; catarrh of the stomach, throat and nose. Catarrhal discharge from the eyes returning every night; catarrhal deafness. Intestinal worms. To stimulate bile for digestion of fats. Mucous colitis, allergies including hay fever, ear infections, paroxysmal sneezing, candida and some other fungus infections, vaginal trichomoniasis.
“Anti-tumour activity reported.” (Y. Kimura and K. Yamamoto, Gann, 55, 325 (1964); Chem. Abstra, 63, 1089d 919650)
The therapeutically active ingredients of Garlic are the smelly ones. Deodorised Garlic has not the efficacy of the odoriferous. (Dr Stephen Fulder, JAM Feb. 1986) Chewed Parsley may mask the odour of Garlic on the breath.
Preparations: Fresh clove: eaten at meals.
Fresh juice: half-1 teaspoon in honey or water.
Capsules: one before meals or three at night to prevent infection.
Powder: 300mg capsules; 5-10 capsules twice daily during meals.
Tincture BHP (1983): 1:5 in 45 per cent alcohol. Dose, 2-4ml in water.
Compress: mashed clove or oil on suitable material.
Ear or nasal drops: pierce Garlic capsule and squeeze oil into ear or nose for infection. Notes. Source of the important trace element, Germanium. Combines well with Echinacea. ... garlic
Constituents: berberine, hydrastine, canadine, resin.
Action: alterative, choleretic, antiseptic, anti-inflammatory, anti-microbial, bacteriostatic against staphyococcus. (Complementary Medical Research Vol 2, No 2, p.139) Bitter, diuretic, haemostatic, laxative, oxytocic, powerful stomach and liver tonic, detoxifier. Increases blood supply to the spleen. Uses. Mucous membranes generally. Ulceration of mouth, throat, intestines. Heartburn, chronic dyspepsia, gastric and duodenal ulcer, diverticulosis, ulcerative colitis, liver damage. To assist function of old age. Drying to mucous surfaces and therefore indicated in all forms of catarrh (respiratory, vaginal etc). Proteinuria. Painful, excessive menstruation and bleeding from the womb for which the addition of Beth root (equal parts) enhances action. Itching of anus and genitals. Ear infections: internal and topical medication. Prostatitis. Bleeding gums. Tinnitus. Has a long history for use in sexually transmitted diseases. Once used to stimulate contractions of the womb to hasten delivery.
Preparations: Standard dose: half-1 gram. Thrice daily.
Decoction. Quarter to half a teaspoon dried rhizome to each cup water simmered gently in a covered vessel 20 minutes. Dose: half a cup.
Liquid Extract, BHC Vol 1. 1:1 in 60 per cent ethanol; 0.3-1ml, (5-15 drops).
Tincture, BHC Vol 1. 1:10, 60 per cent ethanol; 2-4ml, (15-60 drops).
Formula. Popular. All BHP (1983) standard powders:– Marshmallow root 100mg; Goldenseal 10mg; Cranesbill 30mg; Dandelion root 60mg. Traditional for the relief of indigestion, heartburn, flatulence, nausea and gastric irritation.
Powder. Dose: half-1g.
Lotion. Equal parts, Tincture Goldenseal and glycerine. For painting mouth, throat and lesions elsewhere. Goldenseal solution. 250mg powder shaken in 3oz Rosewater or Witch Hazel: filter. 5-10 drops in eyebath half-filled with water; douche 3 or more times daily.
Goldenseal ointment. 1 teaspoon (5ml) tincture in 1oz Vaseline; dissolve in gentle heat.
Mouth Wash. 5-10 drops tincture in glass water.
Vaginal douche or enema. 10 drops tincture to 2 pints boiled water; inject warm.
Notes. Liquid extract may be used instead of tincture, in which case half quantity is used. Not given in pregnancy, lactation or high blood pressure Not given with Eucalyptus to which it is antagonistic.
GSL, schedule 1
“GONE ALL TO PIECES” SYNDROME. Nervous disarray and weakness from severe emotional or physical shock.
Tablet: 45mg each, Skullcap, Lupulin, Hydrocotyle; and the aqueous extractive from: 90mg Gentian, 75mg Jamaica Dogwood. ... goldenseal
Acute. Eye is brick red and brick hard. Agonisingly painful, vision much reduced, pupil dilated and oval, the cornea steamy and the iris greenish, sees rainbow rings around lights, misty vision, pain in head and eyes, colours appear dull, can read for only short periods, unable to walk confidently downstairs, damage to retina and optic nerve from build-up of fluid.
Etiology: Damage from past inflammations, high blood pressure, steroids, stress, diet deficiencies, injury. Develops more in far-sighted people.
Ocular emergency requiring immediate hospital specialist treatment. If admission to hospital is delayed Pilocarpine may save the day: 1 drop of 1 per cent solution to each eye to constrict the pupil and open the drainage angle. This lasts 4-5 hours. Apply 1 drop 4 times every 24 hours. In the absence of Pilocarpine, a practitioner may prescribe Tincture Gelsemium BPC 1963, 5 drops in water not more than thrice daily.
A history of eyelids that are stuck down in the mornings reveals blockage from inflammatory exudate, tension rises and may precipitate glaucoma.
Chronic (gradual and long-continued). Usually in the elderly. Sometimes genetic. Chronic rise in painless intra-ocular pressure arrests blood supply to the optic discs thus disrupting bundles of retinal nerve fibres. ‘Deeply cupped discs’. Condition usually unsuspected. A sight destroyer.
Symptoms: bumping into objects and people. As above.
Treatment. Surgical drainage incision through the iris relieves tension. The object is to contract the pupil and focussing (ciliary) muscle which promotes the escape of watery fluid from the eye. Agents which contract the pupil are Pilocarpine, Adrenalin. Promotion of the body’s own supply of Adrenalin is mildly assisted by Ginseng. All cases should receive Echinacea to enhance resistance. Herbal medicine often stabilises the condition, with remedies such as Pulsatilla.
Alternatives:– Maintenance anti-inflammatory. Tea: fresh or dried herbs. Equal parts: Nettles, Marigold petals, Horsetail. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose: half-1 cup thrice daily.
Traditional. It was common practice in the South of France to douche the eye with dilute lemon juice, doubtless because Vitamin C has an osmotic effect, drawing away fluid.
Rutin (Buckwheat). 20mg thrice daily. Tablets, powder, etc.
Canasol. A non-hallucinogenic alkaloid of the marijuana plant (cannabis) has been used with success. Blood Tonics. See entry. Healthy blood contributes to healthy eyes and common blood tonics have been responsible for some cures in the early stages.
Bilberries. Mr Eric Wright suffered from glaucoma for many years. At 74 he was nearly blind, walked with a white stick, and couldn’t read or write. Improvement was impressive after taking Bilberry extract. His specialist agreed that his sight was at its best in three years since surgery to reduce intra-ocular pressure.
Diet. Begin 3-day fast, followed by 3 days on fruit and vegetable juices. Wholefoods thereafter. Increase protein intake. Repeat fast every 3 months. Fresh Bilberries as desired. Dr Rolf Ulrich links coffee with glaucoma. (Clinical Physiology)
Supplements. Daily. Vitamin A 7500iu, Vitamin B1 15mg, Vitamin B2 10mg, Vitamin B6 10mg, Vitamin C 3g, Vitamin E 500mg, Zinc.
Notes. Stress automatically raises intra-ocular pressure for which relaxation techniques are indicated. Tobacco worsens by causing constriction of blood vessels supplying the optic nerve. Abstain alcohol. Glaucoma becomes more prevalent in an ageing population. Patients with a strong history and with high blood pressure and diabetes should be screened.
To be treated by a general medical practitioner or hospital specialist. ... glaucoma
Causes: these are many and varied, including low blood glucose levels, excessive tea, coffee, Cola or other stimulants, cold, heat, cough, anxiety, depression. Sleep tends to decline with age, and is a cause of restless leg syndrome.
Alternatives. Transient insomnia: Roman Chamomile, Betony, Cowslip flowers, Hops, Balm, Passion flower, Skullcap, Vervain, Valerian. Ginseng. Lime flowers.
Chronic insomnia: Jamaica Dogwood, Ladyslipper, Valerian. Wild Lettuce, Mistletoe, Californian Poppy.
Tea. Any one of the above. Teas, medicines, etc may be sweetened with honey.
Maria Treben tea. Combine parts: Cowslip flowers 10; Lavender 5; St John’s Wort 2; Hops 3; Valerian 1. 1 heaped teaspoon to cup boiling water; infuse 3 minutes. Sip, warm, before sleep.
Dr A. Vogel. (Dormeason) sleeping drops; parts: Balm 40; Oats 38; Passion flower 10; Hops 9; Valerian 2; Hop grains (lupulin) 1. Dose: 10-15 drops.
Insomnia from wind. Tea: Equal parts, Lime flowers, Passion flower, Spearmint. 1 heaped teaspoon to each cup boiling water: infuse 15 minutes. Half-1 cup freely.
Tablets. Motherwort formula. Pulverised Passiflora BHP (1983) 90mg, Pulverised Extract Motherwort 4:1 50mg, Pulverised Extract Lime flowers 3:1 67mg. (Gerard House)
Lobelia: 2 tablets at bedtime.
Tinctures. Formula. Equal parts: Passion flower, Valerian, Jamaica Dogwood. 1 teaspoon in warm water at bedtime, and again for restlessness during the night. OR:– Skullcap. 1:1 in 25 per cent alcohol. 15-60 drops in water at bedtime.
Tincture. 1oz Passion flower herb steeped in 1 pint white wine 14 days. Shake daily. Filter. Dose: 1 wineglassful when necessary. On failure to sleep, repeat after half hour of dose.
Aromatherapy. Hot bath to which 10 drops oil of Lavender is added.
Insomnia from pain: Jamaica Dogwood.
Insomnia from nervous excitability: Chamomile, Vervain, Valerian.
Practitioner: desperate cases: equal parts Tinctures Gelsemium and Valerian. 10 drops hour before retiring.
Diet. Breakfast porridge oats. Avoid caffeine-containing drinks: tea, coffee, cola, cocoa and heavy meals in the evening. Honey drink at bedtime: 2 teaspoons honey in hot milk.
Supplementation: Vitamins, B-complex, B6, B12, Niacin, C, D. Calcium.
Complementary: Hot bath.
Notes. No caffeine drinks at bedtime. Deep-breathing exercises. Ensure bedroom is not too hot or cold. Keep regular hours for sleeping periods. A quiet room and a warm bed. If after one week sleep is still absent, a practitioner should be consulted. ... insomnia
To establish efficacy of treatment for a named specific disease by herbs, the DHSS requires scientific data presented to the Regulatory authorities for consideration and approval.
A product is not considered a herbal remedy if its active principle(s) have been isolated and concentrated, as in the case of digitalis from the Foxglove. (MAL 2. Guidance notes)
A herbal product is one in which all active ingredients are of herbal origin. Products that contain both herbal and non-vegetable substances are not considered herbal remedies: i.e. Yellow Dock combined with Potassium Iodide.
The British Government supports freedom of the individual to make an informed choice of the type of therapy he or she wishes to use and has affirmed its policy not to restrict the general availability of herbal remedies. Provided products are safe and are not promoted by exaggerated claims, the future of herbal products is not at risk. A doctor with knowledge and experience of herbal medicine may prescribe them if he considers that they are a necessary part of treatment for his patient.
Herbalism is aimed at gently activating the body’s defence mechanisms so as to enable it to heal itself. There is a strong emphasis on preventative treatment. In the main, herbal remedies are used to relieve symptoms of self-limiting conditions. They are usually regarded as safe, effective, well-tolerated and with no toxicity from normal use. Some herbal medicines are not advised for children under 12 years except as advised by a manufacturer on a label or under the supervision of a qualified practitioner.
World Health Organisation Guidelines
The assessment of Herbal Medicines are regarded as:–
Finished, labelled medicinal products that contain as active ingredients aerial or underground parts of plants, or other plant material, or combinations thereof, whether in the crude state or as plant preparations. Plant material includes juices, gums, fatty oils, essential oils, and any other substances of this nature. Herbal medicines may contain excipients in addition to the active ingredients. Medicines containing plant material combined with chemically defined active substances, including chemically defined, isolated constituents of plants, are not considered to be herbal medicines.
Exceptionally, in some countries herbal medicines may also contain, by tradition, natural organic or inorganic active ingredients which are not of plant origin.
The past decade has seen a significant increase in the use of herbal medicines. As a result of WHO’s promotion of traditional medicine, countries have been seeking the assistance of WHO in identifying safe and effective herbal medicines for use in national health care systems. In 1989, one of the many resolutions adopted by the World Health Assembly in support of national traditional medicine programmes drew attention to herbal medicines as being of great importance to the health of individuals and communities (WHA 42.43). There was also an earlier resolution (WHA 22.54) on pharmaceutical production in developing countries; this called on the Director-General to provide assistance to the health authorities of Member States to ensure that the drugs used are those most appropriate to local circumstances, that they are rationally used, and that the requirements for their use are assessed as accurately as possible. Moreover, the Declaration of Alma-Ata in 1978 provided for inter alia, the accommodation of proven traditional remedies in national drug policies and regulatory measures. In developed countries, the resurgence of interest in herbal medicines has been due to the preference of many consumers for products of natural origin. In addition, manufactured herbal medicines from their countries of origin often follow in the wake of migrants from countries where traditional medicines play an important role.
In both developed and developing countries, consumers and health care providers need to be supplied with up-to-date and authoritative information on the beneficial properties, and possible harmful effects, of all herbal medicines.
The Fourth International Conference of Drug Regulatory Authorities, held in Tokyo in 1986, organised a workshop on the regulation of herbal medicines moving in international commerce. Another workshop on the same subject was held as part of the Fifth International Conference of Drug Regulatory Authorities, held in Paris in 1989. Both workshops confined their considerations to the commercial exploitation of traditional medicines through over-the-counter labelled products. The Paris meeting concluded that the World Health Organisation should consider preparing model guidelines containing basic elements of legislation designed to assist those countries who might wish to develop appropriate legislation and registration.
The objective of these guidelines, therefore, is to define basic criteria for the evaluation of quality, safety, and efficacy of herbal medicines and thereby to assist national regulatory authorities, scientific organisations, and manufacturers to undertake an assessment of the documentation/submission/dossiers in respect of such products. As a general rule in this assessment, traditional experience means that long-term use as well as the medical, historical and ethnological background of those products shall be taken into account. Depending on the history of the country the definition of long-term use may vary but would be at least several decades. Therefore the assessment shall take into account a description in the medical/pharmaceutical literature or similar sources, or a documentation of knowledge on the application of a herbal medicine without a clearly defined time limitation. Marketing authorisations for similar products should be taken into account. (Report of Consultation; draft Guidelines for the Assessment of Herbal Medicines. World Health Organisation (WHO) Munich, Germany, June 1991) ... herbal medicine
From food we eat, sugar (glucose) is converted into glycogen which is stored in the liver and muscles. To ensure its removal from the bloodstream to storage areas a balancing mechanism causes the pancreas to produce insulin for this purpose. Exhaustion of the pancreas may follow too frequent release of insulin for reducing high levels of sugar. All symptoms are temporarily relieved by eating sweet foods, chocolate, etc, or by drinking stimulating beverages: tea, coffee, cola, alcohol, etc.
Convincing evidence shows how large amounts of refined and concentrated sugars overwork the pancreas, causing wide swings in blood sugar levels. This is the reverse of diabetes which occurs from a lack of insulin.
Another factor is over-stimulation of the adrenal glands that produce adrenalin which has the power to release stored sugars. When adrenalin is discharged too frequently into the bloodstream the conversion of glycogen to glucose is impaired. This leads to a craving for sweet foods and stimulating beverages.
Symptoms are numerous and often confuse the doctor: constant hunger, tightness in the chest, dizziness, headaches, twitching of limbs, digestive disorders, fatigue, weakness in legs, irritability, migraine, nervous tension, nervous mannerisms, insomnia, memory lapses, phobia – sense of panic, cold sweats. Cold hands and feet, visual disturbances, vague aches and pains and depression.
Life becomes a succession of erratic rises and falls of the blood sugar. Symptoms are worse when the person is passing through a ‘low’ period. All this is reflected upon the sympathetic nervous system and affects the emotional life. A special blood test is carried out to assess the situation; the Glucose Tolerance Test.
Alternatives. To raise low blood sugar levels: Avens, Balmony, Bayberry, Calamus, Centuary, Chamomile (German), Dandelion root, Echinacea, Feverfew, Gentian (Yellow), Ginger, Ginseng, Goldenseal, Holy Thistle, Hops, Horehound (White), Liquorice, Quassia, Southernwood, Betony.
Teas. Chamomile (German), Ginseng, Avens, Centuary, Hops, Betony.
Decoctions. Yellow Gentian (cold infusion), Calamus (cold infusion), Dandelion root (hot infusion), Angustura bark (hot infusion).
Tablets/capsules. Calamus, Dandelion, Ginseng, Goldenseal, Echinacea, Liquorice, Kelp.
Powders. Formula. Balmony 2; Bayberry 2; White Poplar 1; Ginger 1. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily, before meals.
Liquid Extracts. Formula. Goldenseal 10ml; Dandelion root 20ml; Holy Thistle 20ml; Cayenne 1ml. 30- 60 drops thrice daily in water before meals.
Tinctures. Same formula, double dose.
Angostura wine. Wineglassful daily.
Diet: Herb teas, juices and mineral water instead of tea, coffee and other drinks containing caffeine. Honey. Wholefoods. Adequate protein intake. Small meals throughout the day. Avoid: alcohol, sugary snacks, white flour and white sugar products.
Supplementation. Daily. B-complex, B6 50mg, E 200iu, C 1g, Chromium 125mcg, Calcium Pantothenate 500mg, Kelp, Lecithin, Zinc.
Notes: Brewer’s yeast tablets contain chromium which assists sugar metabolism. Smoking causes both glucagon and insulin to be released thus aggravating the condition. Diabetics should carry in their pocket some form of sugar against emergency. ... hypoglycaemia
Symptoms. Effusion of fluid into the middle ear with increasing deafness, discharge, tinnitus. Infant shakes head. Perforation in chronic cases. Inspection with the aid of an auriscope reveals bulging of the ear-drum. Feverishness.
Treatment. Antibiotics (herbal or others) do not remove pain therefore a relaxing nervine should be included in a prescription – German Chamomile, Vervain, etc.
Before the doctor comes. Any of the following teas: Boneset, Feverfew, Holy Thistle, Thyme. One heaped teaspoon to each cup boiling water; infuse 15 minutes; one cup thrice daily.
Formula. Practitioner. Echinacea 2; Thyme 1; Hops half; Liquorice quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Acute: every 2 hours. Chronic: thrice daily.
Topical. Dry-mop purulent discharge before applying external agents. Inject warm 2-3 drops any one oil: Mullein, St John’s Wort, Garlic, Lavender or Evening Primrose.
Once every 8-10 days syringe with equal parts warm water and Cider Vinegar. Repeat cycle until condition is relieved.
Diet. Salt-free. Low-starch. Milk-free. Abundance of fruits and raw green salad vegetables. Freshly squeezed fruit juices. Bottled water. No caffeine drinks: coffee, tea or cola.
Supplements. Vitamins A, B-complex, B2, B12, C, E, K, Iron, Zinc. Evening Primrose capsules.
Notes. Where pressure builds up against the drum, incision by a general medical practitioner may be necessary to facilitate discharge of pus. Grossly enlarged tonsils and adenoids may have to be surgically removed in chronic cases where treatment over a reasonable period proves ineffective. A bathing cap is sometimes more acceptable than earplugs.
Breast-feeding. Significantly protects babies from episodes of otitis media. Commenting on a study published in the Obstetrical and Gynaecological Survey, Dr Mark Reynolds, author of a breast-feeding policy by the Mid-Kent Care Trust said: “Breast milk is known to reduce respiratory infection – a precursor of otitis media.”
Hopi ear candles. ... otitis media
Causes (female). Absence of menses, dry vaginal entrance, tension, stress, tiredness, deformed or retroverted womb, cervical polyps, inflammation of the cervix or ovaries, fibroids, cystic ovaries, diabetes, drugs, steroids, psychogenic factors. Women who use intra-uterine devices may become infertile from tubal infection. The Pill affects fertility. Vitamin E deficiency. Professor Richard Morisset (World Health Organisation) asserts STD’s account for more than 50 per cent infertility in women. Alcohol is a factor.
Causes (male). Inadequate seman, testicular or prostate infection, orchitis (from past mumps), kidney failure, chronic lung disease from smoking, thyroid deficiency, liver and other infections, calcium or Vitamin E deficiency. Low sperm count is found in regular drinkers of alcohol. 30 per cent cases of infertility are found to be due to the male.
“Women who drink more than one cup of coffee a day may find it harder to become pregnant.” (American study reported in The Guardian, 28.12.88)
“Vegetarian women have lower levels of oestrogen. The amount of fibre women eat is believed to affect oestrogen levels in their blood.” (Dr Elwyn Hughes, University of Wales Institute of Science and Technology)
“Drinking more than four cups of coffee a day and smoking more than 20 cigarettes could be a dangerous combination for male fertility.” (Research study, North Carolina, USA)
Women whose mothers smoked when they were pregnant are only 50 per cent as fertile as women who were not exposed (when in the uterus) to a mother’s tobacco smoke. (C. Weinberg, “Reduced Fecundity in Women with Prenatal exposure to cigarette smoking.” American Journal of Epidemiology 1989; 129 p1072)
Margarine has been implicated in low sperm counts.
Alternatives. Endocrine balancers.
Female. Tea. Equal parts: herbs – Motherwort, Agnus Castus and Oats. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose, 1 cup 2-3 times daily.
Tablets: Agnus Castus, dosage as on bottle.
Liquid Extracts: equal parts Agnus Castus and Helonias: 1 teaspoon in water 2-3 times daily.
Maria Treben: 25 drops fresh Mistletoe juice in water, on empty stomach, night and morning.
External: Castor oil abdominal packs twice weekly.
Male. Ginseng, Gotu Kola, or the traditional combination of Damiana, Saw Palmetto and Kola. Tablets, liquid extracts, powders or tinctures. Tinctures (practitioner): Capsicum Fort BPC 5ml; Saw Palmetto (1:5) 10ml; Damiana (1:5) 50ml; Prickly Ash (1:5) 10ml. Aqua to 100ml. 1 teaspoon in water, thrice daily. (Arthur Hyde FNIMH)
An orange a day helps keep sperm OK. (Important role of Vitamin C – New Scientist 1992 NO.1812 p20)
Fasting. Mrs A. Rylin, Sweden, had been trying to conceive for 2 years. Conventional medicine proved ineffective until both she and her husband decided to fast for ten days. Within a month she conceived. Other successes reported.
Diet. (For both partners) Vitamin A foods. Wholefoods, oatmeal products (breakfast oats, etc). Regular raw food days. No alcohol. The key mineral for infertility is zinc, a deficiency of which may be made up with bran which is not only high in zinc but in soluble fibre. Not to eat any green peas, which are mildly contraceptive.
Supplements. Daily. Vitamin C (1 gram). Vitamin E (500iu). One B-complex tablet, including B6. The calcium ion is the key regulator of human sperm function – Calcium Lactate 300mg (2 tablets thrice daily at meals). Zinc – 2 tablets or capsules at night. Folic acid, 400mcg. Dolomite. Iron.
Notes. Consider Vitamin B12 and Iron deficiency when evaluating anaemia in infertile couples.
20 percent of men suffer infertility and produce high levels of superoxide radicals in their semen. Vitamin E, an antioxidant, is believed to mop up their superoxide radicals.
Observe sign of zinc deficiency: white flecks on nails. ... infertility
Causes: mumps, tuberculosis, gonorrhoea or, if following childbirth or abortion, sepsis. Inflammatory adhesions may cause ovary and tube to mat together and ulcerate.
Symptoms: feverishness, pelvic pain, abdominal swelling.
Treatment. Decoction, powders, liquid extracts or tinctures.
Formula. Echinacea 2; Helonias 1; Cramp bark 1; Liquorice quarter. Dosage. Decoction: half-1 cup. Powders: one-third teaspoon. Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water/honey.
External. Castor oil pack to abdomen.
2. Cysts. Single or multiple hollow growths containing fluids may grow large, obstruct abdominal circulation, interfere with digestion and cause shortness of breath. They are caused by excessive stimulus from the pituitary gland. A fluid-filled sac on the ovary grows in preparation for egg release but fails to rupture. The follicle continues to grow, accumulating fluid and a cyst results.
Liquid Extract Thuja: 5-10 drops, thrice daily. Of value.
Notes. Bulimia Nervosa (eating disorder) has been linked with polycystic ovary disease. (St George’s Hospital Medical School, London)
The presence of acne is a valuable clue to ovarian disorder: a treatment for acne reacts favourably on ovaries.
3. Tumour (non-malignant). May avoid detection. Usually revealed by laparoscopy or X-ray. When a tumour or cyst twists on an ovary’s ligament severe abdominal pain is followed by vomiting and shock.
Treatment. Secondary to surgery. Decoction, powders, liquid extracts, or tinctures. Combination. Cramp bark 2; Poke root 1; Thuja half. Dosage. Decoction: half-1 cup. Powders: 500mg (one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons in water/honey thrice daily.
Following surgical removal of ovaries: Pulsatilla. Pre- and post-operative pain: Cramp bark BHP (1983). Black Willow. (Dr J. Christopher)
Supplements: calcium, magnesium.
Note: Increased bone loss is associated with ovarian disturbances in premenopausal women. (Canadian Study in “New England Journal of Medicine”) See: OSTEOPOROSIS.
Polycystic ovaries have an important association with heart attacks in elderly women. (Professor Howard Jacobs, Middlesex School of Medicine) ... ovaries
FAMILY: Lamiaceae (Labiatae)
SYNOYNMS Common basil, joy-of-the-mountain, ‘true’ sweet basil, European basil.
GENERAL DESCRIPTION: A tender annual herb, with very dark green, ovate leaves, greyish-green beneath, an erect square stem up to 60 cms high, bearing whorls of two-lipped greenish or pinky-white flowers. The whole plant has a powerful aromatic scent.
DISTRIBUTION: Native to tropical Asia and Africa, it is now widely cultivated throughout Europe, the Mediterranean region, the Pacific Islands, North and South America. The European, French or ‘true’ sweet basil oil is produced in France, Italy, Egypt, Bulgaria, Hungary and the USA.
OTHER SPECIES: There are many varieties of basil occurring all over the world, used both for their culinary and medicinal applications, such as bush basil (O. minimum), holy basil (O. sanctum), both from India, camphor basil (O. kilimanjaricum) from East Africa (also grown in India), and the fever plant (O. viride) from West Africa. However, there are two principal chemotypes most commonly used for the extraction of essential oil: the so-called ‘French basil’ and the ‘exotic basil’ – see separate entry.
HERBAL/FOLK TRADITION: Widely used in Far Eastern medicine especially in the Ayurvedic tradition, where it is called tulsi. It is used for respiratory problems such as bronchitis, coughs, colds, asthma, ’flu and emphysema but is also used as an antidote to poisonous insect or snake bites. It has also been used against epidemics and fever, such as malaria. It improves blood circulation and the digestive system and in China it is used for stomach and kidney ailments.
In the West it is considered a ‘cooling’ herb, and is used for rheumatic pain, irritable skin conditions and for those of a nervous disposition. It is a popular culinary herb, especially in Italy and France.
ACTIONS: Antidepressant, antiseptic, antispasmodic, carminative, cephalic, digestive, emmenagogue, expectorant, febrifuge, galactagogue, nervine, prophylactic, restorative, stimulant of adrenal cortex, stomachic, tonic.
EXTRACTION: Essential oil by steam distillation from the flowering herb.
CHARACTERISTICS: ‘True’ sweet basil oil is a colourless or pale yellow liquid with a light, fresh sweet-spicy scent and balsamic undertone. It blends well with bergamot, clary sage, lime, opopanax, oakmoss, citronella, geranium, hyssop and other ‘green’ notes.
PRINCIPAL CONSTITUENTS: Linalol (40–45 per cent), methyl chavicol (23.8 per cent) and small amounts of eugenol, limonene and citronellol, among others.
SAFETY DATA: Relatively non-toxic, non-irritant, possible sensitization in some individuals. Avoid during pregnancy.
AROMATHERAPY/HOME: USE
Skin Care: Insect bites (mosquito, wasp), insect repellent.
Circulation, Muscles and Joints: Gout, muscular aches and pains, rheumatism.
Respiratory Syste: Bronchitis, coughs, earache, sinusitis.
Digestive System: Dyspepsia, flatulence, nausea.
Genito-Urinary System: Cramps, scanty periods.
Immune System: Colds, fever, ’flu, infectious disease.
Nervous System: Anxiety, depression, fatigue, insomnia, migraine, nervous tension: ‘Oil of Basil is an excellent, indeed perhaps the best, aromatic nerve tonic. It clears the head, relieves intellectual fatigue, and gives the mind strength and clarity.’8
OTHER USES: The oil is used in soaps, cosmetics and perfumery; it is also used extensively in major food categories, especially savouries.... basil, french
FAMILY: Burseraceae
SYNONYMS: C. erythraea var. glabrascens, bisabol myrrh, sweet myrrh.
GENERAL DESCRIPTION: A tall tropical tree, similar to myrrh (to which it is closely related), which contains a natural oleogum resin in tubular vessels between the bark and wood of the trunk. The natives make incisions in the trunk of the tree to increase the yield. The crude gum dries to form dark reddish-brown tear-shaped lumps with a sweet-woody, rootlike odour.
DISTRIBUTION: Native to East Africa (Somalia) and eastern Ethiopia (Harrar Province) where it grows wild. The essential oil production is generally carried out in the USA and Europe from the crude oleogum resin.
OTHER SPECIES: The original or ‘true’ opopanax used in perfumery was derived from a large plant Opopanax chironium or Pastinaca opopanax, a plant similar to the parsnip of the Umbelliferae family and native to the Levant region, Sudan and Arabia. The oleogum resin was obtained by cutting into the stem at the base, which then produces reddish-yellow tears of a strong rootlike, parsnip or celery-type smell. This type of opopanax is now unavailable, and has been replaced by a similar type of oil known as ‘bisabol myrrh’.
Not to be confused with cassie (Acacia farnesiana), which is also known as ‘opopanax’.
HERBAL/FOLK TRADITION: Opopanax derived from O. chironium is described as having antispasmodic, expectorant, emmenagogue and antiseptic properties, which used to be employed in asthma, hysteria and visceral afflictions. In the Far East the bisabol myrrh is used extensively as an ingredient in incense.
ACTIONS: Antiseptic, antispasmodic, balsamic, expectorant.
EXTRACTION: 1. Essential oil by steam (or water) distillation from the crude oleogum resin. 2. A resinoid by solvent extraction from the crude oleogum resin.
CHARACTERISTICS: 1. An orange, yellow or olive liquid with a sweet-balsamic, spicy, warm, animal-like odour (it does not contain a medicinal note like myrrh). It resinifies on exposure to air. 2. A solid dark mass with a warm, powdery, sweet-balsamic, rooty odour. It blends well with clary sage, coriander, labdanum, bergamot, myrrh, frankincense, vetiver, sandalwood, patchouli, mimosa, fir needle and neroli.
PRINCIPAL CONSTITUENTS: The crude contains resins, gums (50–80 per cent) and essential oils (10–20 per cent), notably the sesquiterpene ‘bisabolene’ and sesquiterpene alcohols.
SAFETY DATA: Frequently adulterated – it is more expensive than the ‘hirabol myrrh’. The commercial resinoid is also usually mixed with a solvent such as myristate, because it is otherwise unpourable at room temperatures.
AROMATHERAPY/HOME: USE Possibly similar uses to myrrh.
OTHER USES: Used as a fixative and fragrance component in high-class perfumery. Used in liqueurs to lend body and add winelike notes.... opopanax
FAMILY: Magnoliaceae
SYNONYMS: M. aurantiaca, Magnolia champaca, joy perfume tree, champak, champac, champa, golden champaca.
GENERAL DESCRIPTION: Champaca is a large, sub-tropical tree up to 6 metres high with a smooth grey bark and long, oval-shaped, glossy evergreen leaves. The flowers have 10–20 yellow, orange or cream-coloured narrow petals and an extremely heady fragrance. They bloom both in spring and autumn – on a warm, humid night, the scent can be enjoyed several hundred feet away! Champaca fruit are brown, containing bright red seeds.
DISTRIBUTION: Michelia champaca is native to India, where it occurs in humid, tropical evergreen forests. It is also found throughout Indo-China, Malaysia, Sumatra, Java and south-western China, as well as occurring naturally in the eastern Himalayan region. It is often grown as a boulevard tree in the tropics and in India is frequently planted in Hindu temple grounds and ornamental gardens. Champaca, especially its white-flowered hybrid, is now commonly cultivated in warm climates worldwide, for example, in California.
OTHER SPECIES: The genus Michelia contains about 40 species with a distribution including India, Malaysia, Indonesia, southern Japan, Taiwan and China. The leaves and flowers of the Michelia species resemble Magnolia, but the blossoms of Michelia generally form clusters among the leaves, rather than singly at the branch ends like Magnolia. There are several related species of M. champaca, such as the red champaca and the white champaca, grown specifically for their scented flowers, which are also used to produce essential oils. M. x alba, a white-flowered hybrid of M. champaca and M. montana, is prized throughout Asia for its fragrant, pure-white flowers, which are commonly floated in water bowls as Buddhist temple offerings and used a household decoration.
NB: Occasionally champaca is confused with champaca wood oil or guaiacwood oil (Bulnesia sarmienti), also known as palo santo (meaning ‘holy wood’), which is derived from an entirely different species native to South America.
HERBAL/FOLK TRADITION: Champaca is regarded as one of the most sacred trees of India and tropical Asia and has been revered by the people of India for thousands of years. M. champaca is sacred to Hindus and Buddhists alike and the flower is especially sacred to the Hindi god Vishnu, the god of love, and his consort Lakshmi. In India, the flowers are also used for adornment and their alluring scent is employed as a natural aphrodisiac, and as a fragrant decoration for bridal beds and for garlands.
All parts of the tree are considered medicinal and are utilized in various traditional remedies. In India, the scented oil infused from the champaca blossom is used for relief of vertigo and headaches. As a herbal remedy, the flowers have been used to treat urinary tract infections and as an emollient, febrifuge and to soothe anxiety. It is also considered a valuable aid for the treatment of all skin types, particularly mature, dry or sensitive skin. The derivation of the word ‘shampoo’ is the Hindi word champo, meaning ‘to massage’, which comes from champa, the Sanskrit name for champaca. This is because the oil from the tree was traditionally used to make fragrant hair and massage oils!
ACTIONS: Antidepressant, aphrodisiac, antispasmodic, antiseptic, antiviral, astringent, emollient, euphoric, emollient, febrifuge, stimulant and tonic.
EXTRACTION: The absolute is produced by solvent extraction from the fresh flowers. (An oil is also produced by steam distillation of the petals). The absolute requires thousands of fresh flowers to produce a tiny amount: thus its high cost.
CHARACTERISTICS: An intense, fresh, green-floral scent with an underlying warmth and subtle leafy notes. It blends well with jasmine, lemon, coriander, tuberose, grapefruit, bergamot, rose, ylang ylang, neroli, sandalwood and other floral scents
PRINCIPAL CONSTITUENTS: Champaca absolute contains mainly linalool, benzyl acetate, beeta lonone, phenyl ethyl alcohol, gamma-selinene, benzyl benzoate, phenylethyl benzoate and eugenol.
SAFETY DATA: Non-toxic, non-irritant, possible sensitization. Avoid during pregnancy.
AROMATHERAPY/HOME: USE:
Skin Care: Dry, mature skin and sensitive skin, wrinkles and general skin care.
Nervous System: Anxiety, depression, fear, grief, insomnia, nervous debility, tension headaches, mood swings, stress.
OTHER USES: Champaca flowers are used (in part) to make the world’s most expensive perfume, Jean Patou’s famous scent, ‘Joy’, the second best selling perfume in the world after Chanel No. 5. The tree is also a source of timber and fuel and for the production of a yellow dye. The tree’s wood is used for making boats, drums, and religious engravings. In India, however, where the tree is revered, it is rarely cut down. ... champaca
FAMILY: Lauraceae
SYNOYNMS Ho oil, ho-wood il, shiu oil, ho-leaf oil.
GENERAL DESCRIPTION: A tall, tropical evergreen tree, quite dense with small white flowers and black berries, which grows up to 30 metres in height. This is the same tree that produces camphor comes from the wood of the tree.
DISTRIBUTION: Native to China, Japan, Taiwan and south-east Asia. It is now cultivated in many tropical and sub-tropical countries including India, Australia, Madagascar and parts of the USA where it has naturalized.
OTHER SPECIES: Cinnamomum camphora is a large genus with many subspecies which yield a volatile oil on distillation, including ho oil (wood and leaf), camphor, apopin, sassafras and ravintsara. All these essential oils, although derived from the same principal botanical species, differ in their chemical profile enormously depending on their country of origin as well as the part of the plant used to extract the oil. There are thus many different subvarieties of the camphor tree found throughout Asia, for example the Yu-sho in China and the Sho-guy variety found in Taiwan. Ho (wood and leaf) oil is derived both from the Hon-sho and Ho-sho varieties growing mainly in Japan and Taiwan. This variety has linalool as its major constituent.
Rosewood (Aniba rosaedora), a native tree of the Amazon, also yields an oil very rich in linalool. However, rosewood became endangered due to over-harvesting and although plantations have since been planted, it will take time for the trees to mature. Rosewood oil and ho wood oil are very similar in nature, and since ho wood is more renewable, it is increasingly used as a replacement for the former. However, ho leaf oil, distilled from the leaves of C. camphora, is gradually beginning to replace ho wood oil in aromatherapy usage, because its scent is smoother, containing hardly any camphor-like notes.
HERBAL/FOLK TRADITION: Ho wood has traditionally been used for making the handles of Japanese swords and knives because it is soft and will not scratch the blades. It is also used nowadays for ornamental parts of houses, carpentry and cabinet making, as it is of a very similar beauty to rosewood. Ho wood oil became very popular in Taiwan during the 1900s as a linalool-rich product, locally referred to as shiu oil. C. camphora was also heavily exploited as a source of camphor in Japan and Taiwan until World War II.
The high ‘linalool’ content makes Ho oil a potent immune system stimulant (good for infections such as cold or ’flu) as well as a powerful relaxant or sedative … soothing yet uplifting in effect. Recent studies also suggest that the oil may play a role as a cellular stimulant and tissue regenerator, being beneficial for complaints associated with the skin.
ACTIONS: Analgesic, anti-fungal, anti-infectious, anti-inflammatory, anti-oxidant, antiseptic, antispasmodic, bactericidal, immune support, sedative, tonic. It is also believed to be a mild aphrodisiac.
EXTRACTION: Steam distilled from the leaves (ho leaf oil) and wood (ho wood oil)
CHARACTERISTICS: Ho wood oil is a pale yellow liquid with a soft, warm, floral, spicy-woody scent with a slightly camphor-like undertone. The leaf oil has a sweet-fresh, green-floral and woody scent. It blends well with basil, bergamot, cedarwood, chamomile, lavender, lime, geranium, juniper, neroli, petitgrain, myrtle, sandalwood, ylang ylang and spice oils.
PRINCIPAL CONSTITUENTS: Ho (wood and leaf) oil contains up to 99 per cent linalool, with traces of limonene, myrcene, gamma-terpinene and other components. Ho wood oil generally contains higher levels of cineol. Japanese ho oil ‘A’ quality has a linalool content of 94 per cent or more; a ‘B’ grade has 85–90 per cent linalool.
SAFETY DATA: It is non-toxic and non-irritant but with possible sensitization in some individuals.
AROMATHERAPY/HOME: USE
Skin Care: Acne, cuts, dermatitis, stretch marks, scars, wounds & general skin care: dry, oily, mature and sensitive skin.
Circulation Muscles And Joints: Aches and pains caused by inflammation.
Respiratory System: Chills, coughs and colds, ’flu.
Immune System: Low libido and frigidity: boosts vitality.
Nervous System: Anxiety, depression, insomnia, nervous tension, stress.
OTHER USES: The use of C. camphora as a source of ho leaf and wood oil has expanded in recent years and it is now an important source of natural linalool (which is still preferred over the synthetic form) for some fragrance applications in the perfumery industry. Indeed, ho leaf and wood oil has largely displaced the use of rosewood as a source of natural linalool. It is also an effective insect repellent.... ho wood
FAMILY: Oleaceae
SYNONYMS: Jasmin, jessamine, common jasmine, poet’s jessamine.
GENERAL DESCRIPTION: An evergreen shrub or vine up to 10 metres high with delicate, bright green leaves and star-shaped very fragrant white flowers.
DISTRIBUTION: Native to China, northern India and west Asia; cultivated in the Mediterranean region, China and India (depending on the exact species). The concrete is produced in Italy, France, Morocco, Egypt, China, Japan, Algeria and Turkey; the absolute is mainly produced in France.
OTHER SPECIES: There are many species of jasmine used for medicine and perfumery work. Apart from the common jasmine, the most widespead varieties are the royal or Italian jasmine (J. grandiflorum) which is grown in the Mediterranean region, and its Eastern counterpart J. officinale var. grandiflorum or J. auriculatum. See the Botanical Classification section for a more comprehensive list.
HERBAL/FOLK TRADITION: In China the flowers of J. officinale var. grandiflorum are used to treat hepatitis, liver cirrhosis and dysentery; the flowers of J. sambac are used for conjunctivitis, dysentery, skin ulcers and tumours. The root is used to treat headaches, insomnia, pain due to dislocated joints and rheumatism.
In the West, the common jasmine was said to ‘warm the womb ... and facilitate the birth; it is useful for cough, difficulty of breathing, etc. It disperses crude humours, and is good for cold and catarrhous constitutions, but not for the hot.’ It was also used for hard, contracted limbs and problems with the nervous and reproductive systems.
ACTIONS: Analgesic (mild), antidepressant, anti-inflammatory, antiseptic, antispasmodic, aphrodisiac, carminative, cicatrisant, expectorant, galactagogue, parturient, sedative, tonic (uterine).
EXTRACTION: A concrete is produced by solvent extraction; the absolute is obtained from the concrete by separation with alcohol. An essential oil is produced by steam distillation of the absolute.
CHARACTERISTICS: The absolute is a dark orange-brown, viscous liquid with an intensely rich, warm, floral scent and a tealike undertone. It blends well with rose, sandalwood, clary sage, and all citrus oils. It has the ability to round off any rough notes and blend with virtually everything.
PRINCIPAL CONSTITUENTS: There are over 100 constituents in the oil including benzyl acetate, linalol, phenylacetic acid, benzyl alcohol, farnesol, methyl anthranilate, cis jasmone, methyl jasmonate, among others.
SAFETY DATA: Non-toxic, non-irritant, generally non-sensitizing. (An allergic reaction has been known to occur in some individuals.)
AROMATHERAPY/HOME: USE
Skin care: Dry, greasy, irritated, sensitive skin.
Circulation muscles and joints: Muscular spasm, sprains.
Respiratory system: Catarrh, coughs, hoarseness, laryngitis.
Genito-urinary system: Dysmenorrhoea, frigidity, labour pains, uterine disorders.
Nervous system: Depression, nervous exhaustion and stress-related conditions. ‘It ... produces a feeling of optimism, confidence and euphoria. It is most useful in cases where there is apathy, indifference or listlessness.’.
OTHER USES: Extensively used in soaps, toiletries, cosmetics and perfumes, especially high-class floral and oriental fragrances. The oil and absolute are employed in a wide range of food products, alcoholic and soft drinks. The dried flowers of J. sambac are used in jasmine tea.... jasmine
FAMILY: Lamiaceae (Labiatae)
SYNONYMS: Satureia hortensis, Calamintha hortensis, garden savory.
GENERAL DESCRIPTION: An annual herb up to 45 cms high with slender, erect, slightly hairy stems, linear leaves and small, pale lilac flowers.
DISTRIBUTION: Native to Europe, naturalized in North America. Extensively cultivated, especially in Spain, France, Yugoslavia and the USA for its essential oil.
OTHER SPECIES: Closely related to the thyme family, with which it shares many characteristics. There are several different types ‘of savory’ which include S. thymbra, found in Spain, which contains mainly thymol, and the winter savory (S. montana) – see separate entry.
HERBAL/FOLK TRADITION: A popular culinary herb, with a peppery flavour. It has been used therapeutically mainly as a tea for various ailments including digestive complaints (cramp, nausea, indigestion, intestinal parasites), menstrual disorders and respiratory conditions (asthma, catarrh, sore throat). Applied externally, the fresh leaves bring instant relief from insect bites, bee and wasp stings.
‘This kind is both hotter and drier than the winter kind ... it expels tough phlegm from the chest and lungs, quickens the dull spirits in the lethargy.’.
ACTIONS: Anticatarrhal, antiputrescent, antispasmodic, aphrodisiac, astringent, bactericidal, carminative, cicatrisant, emmenagogue, expectorant, fungicidal, stimulant, vermifuge.
EXTRACTION: Essential oil by steam distillation from the whole dried herb. (An oleoresin is also produced by solvent extraction.)
CHARACTERISTICS: A colourless or pale yellow oil with a fresh, herbaceous, spicy odour. It blends well with lavender, lavandin, pine needle, oakmoss, rosemary and citrus oils.
PRINCIPAL CONSTITUENTS: Carvacrol, pinene, cymene, camphene, limonene, phellandrene and borneol, among others.
SAFETY DATA: Dermal toxin, dermal irritant, mucous membrane irritant. Avoid during pregnancy.
AROMATHERAPY/HOME: USE None. ‘Should not be used on the skin at all.’.
OTHER USES: Occasionally used in perfumery work for its fresh herbaceous notes. The oil and oleoresin are used in most major food categories, especially meat products and canned food.... savory, summer
FAMILY: Oleaceae
SYNONYMS: Sweet osmanthus, sweet olive, tea olive, fragrant olive, silang, holly osmanthus, holly olive, kwai hwa.
GENERAL DESCRIPTION: An evergreen shrub or small tree growing up to 12 metres tall, with broad leaves and bearing purple-black fruits containing a single hard-shelled seed. The small flowers, which appear in clusters late in the season, can be white, pale yellow, gold, orange or reddish in colour, with a strong sweet fragrance much like fresh apricots or peaches.
DISTRIBUTION: This plant is native to Asia from the Himalayas through southern China to Taiwan and southern Japan. It is the ‘city flower’ of the cities of Hangzhou, Suzhou and Guilin in China. Today it is cultivated as an ornamental plant in gardens in Asia, Europe, North America, and elsewhere in the world, mainly for its deliciously fragrant flowers.
OTHER SPECIES: Osmanthus is a genus of about 30 species belonging to the olive family, which are mainly found growing in warm climates. While the flowers of O. fragrans range in colour from silver-white (O. fragrans Lour. var. latifolius) to gold-orange (O. fragrans Lour. var. thunbergii) to reddish (O. fragrans Lour. var. aurantiacus), the absolute is usually prepared from the gold-orange flowered species. A number of cultivars of this species have also been selected for garden use, with specific names: for example, in Japan, the white and orange-blossoming subspecies are distinguished as silver osmanthus and gold osmanthus respectively.
HERBAL/FOLK TRADITION: The exotic flowers from this plant have traditionally been cherished in the East for a range of purposes. Due to the time of its blossoming, sweet osmanthus is closely associated with the Chinese mid-autumn festival when osmanthus-flavoured wine and tea are traditionally served. The flowers are also used to produce a special osmanthus-scented jam, called guì huà jiàng. The tree is known as tea olive because in ancient times the Chinese used it to make a natural ‘de-tox’ herbal tea to flush out excessive nitric oxide from the system; the tisane was also recommended for menstrual irregularities. In some regions of North India, especially in the state of Uttarakhand, the flowers of sweet osmanthus are still used to protect clothes from insects.
Traditional Chinese medical literature describes the usefulness of the flowers of Osmanthus fragrans in the treatment of phlegm reduction, dysentery with blood in the bowel, indigestion and diarrhoea. The Chinese also used the flowers as a natural medicine to improve the complexion of the skin and today the absolute is still employed in cosmetic preparations. However, modern evidence regarding the therapeutic efficacy of the flowers has shown them to be somewhat limited, although studies have indicated they do have anti-oxidant properties, valuable for skincare. Findings also confirmed the ability of the O. fragrans flowers to reduce phlegm and suggest that they may be useful as an anti-allergic agent. Although little used in aromatherapy, since the aroma is relaxing and soothing, helping bring relief from mental stress and depression, it can make a valuable addition to floral-based blends.
ACTIONS: Anti-oxidant, anti-allergic, expectorant, depurative, insecticide, nervine, regulating, sedative.
EXTRACTION: A concrete and absolute by solvent extraction from the fresh flowers. Since the yield of absolute from concrete is only about one kilo per 3,000 kilos of flowers, the enfleurage method or the infusion process have also been applied to these flowers.
CHARACTERISTICS: A green to brown viscous liquid with a very strong sweet-honey, floral, fruity perfume with notes of peach and apricot. It blends well with lime, orange, sandalwood, rose, benzoin, violet, jasmine, mimosa and ylang ylang.
PRINCIPAL CONSTITUENTS: Main constituents include beta ionone, gamma-decanolid, palmitic acid, linoleic acid, linalool oxide, dihydro-beta-Ionone, trans-beta-Ionone and cis-jasmone.
SAFETY DATA: No recorded contraindications for external application: best avoided during pregnancy.
AROMATHERAPY/HOME: USE
Skin care: Dry or mature skin and general skin care.
Nervous system: Anxiety, depression, nervous debility and tension, mood swings, stress.
OTHER USES: Osmanthus absolute (although often adulterated) is used in high-class perfumes for its exquisite aroma, which is very pleasing to the senses. It is also used as a cosmetic ingredient.... osmanthus
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