Pacinian corpuscles, or lamellated corpuscles, are minute bulbs at the ends of the nerves scattered through the SKIN and subcutaneous tissue, and forming one of the end-organs for sensation.
Uses The main use of iron is in the treatment of iron-de?ciency anaemias (See ANAEMIA.) Iron preparations sometimes cause irritation of the gastrointestinal tract, and should therefore always be taken after meals. They sometimes produce a tendency towards constipation. Whenever possible, iron preparations should be given by mouth; if PARENTERAL administration is clinically necessary because of malabsorption, a suitable preparation is iron sorbitol injection given intramuscularly. Most patients respond successfully to oral iron preparations.... iron
Touch sense proper, by which we perceive a touch or stroke and estimate the size and shape of bodies with which we come into contact, but which we do not see.
Pressure sense, by which we judge the heaviness of weights laid upon the skin, or appreciate the hardness of objects by pressing against them.
Heat sense, by which we perceive that an object is warmer than the skin.
Cold sense, by which we perceive that an object touching the skin is cold.
Pain sense, by which we appreciate pricks, pinches and other painful impressions.
Muscular sensitiveness, by which the painfulness of a squeeze is perceived. It is produced probably by direct pressure upon the nerve-?bres in the muscles.
Muscular sense, by which we test the weight of an object held in the hand, or gauge the amount of energy expended on an e?ort.
Sense of locality, by which we can, without looking, tell the position and attitude of any part of the body.
Common sensation, which is a vague term used to mean composite sensations produced by several of the foregoing, like tickling, or creeping, and the vague sense of well-being or the reverse that the mind receives from internal organs. (See the entry on PAIN.)
The structure of the end-organs situated in the skin, which receive impressions from the outer world, and of the nerve-?bres which conduct these impressions to the central nervous system, have been described under NERVOUS SYSTEM. (See also SKIN.)
Touch affects the Meissner’s or touch corpuscles placed beneath the epidermis; as these di?er in closeness in di?erent parts of the skin, the delicacy of the sense of touch varies greatly. Thus the points of a pair of compasses can be felt as two on the tip of the tongue when separated by only 1 mm; on the tips of the ?ngers they must be separated to twice that distance, whilst on the arm or leg they cannot be felt as two points unless separated by over 25 mm, and on the back they must be separated by more than 50 mm. On the parts covered by hair, the nerves ending around the roots of the hairs also take up impressions of touch.
Pressure is estimated probably through the same nerve-endings and nerves that have to do with touch, but it depends upon a di?erence in the sensations of parts pressed on and those of surrounding parts. Heat-sense, cold-sense and pain-sense all depend upon di?erent nerve-endings in the skin; by using various tests, the skin may be mapped out into a mosaic of little areas where the di?erent kinds of impressions are registered. Whilst the tongue and ?nger-tips are the parts most sensitive to touch, they are comparatively insensitive to heat, and can easily bear temperatures which the cheek or elbow could not tolerate. The muscular sense depends upon the sensory organs known as muscle-spindles, which are scattered through the substance of the muscles, and the sense of locality is dependent partly upon these and partly upon the nerves which end in tendons, ligaments and joints.
Disorders of the sense of touch occur in various diseases. HYPERAESTHESIA is a condition in which there is excessive sensitiveness to any stimulus, such as touch. When this reaches the stage when a mere touch or gentle handling causes acute pain, it is known as hyperalgesia. It is found in various diseases of the SPINAL CORD immediately above the level of the disease, combined often with loss of sensation below the diseased part. It is also present in NEURALGIA, the skin of the neuralgic area becoming excessively tender to touch, heat or cold. Heightened sensibility to temperature is a common symptom of NEURITIS. ANAESTHESIA, or diminution of the sense of touch, causing often a feeling of numbness, is present in many diseases affecting the nerves of sensation or their continuations up the posterior part of the spinal cord. The condition of dissociated analgesia, in which a touch is quite well felt, although there is complete insensibility to pain, is present in the disease of the spinal cord known as SYRINGOMYELIA, and a?ords a proof that the nerve-?bres for pain and those for touch are quite separate. In tabes dorsalis (see SYPHILIS) there is sometimes loss of the sense of touch on feet or arms; but in other cases of this disease there is no loss of the sense of touch, although there is a complete loss of the sense of locality in the lower limbs, thus proving that these two senses are quite distinct. PARAESTHESIAE are abnormal sensations such as creeping, tingling, pricking or hot ?ushes.... touch
Causes The direct cause is various BACTERIA. Sometimes the presence of foreign bodies, such as bullets or splinters, may produce an abscess, but these foreign bodies may remain buried in the tissues without causing any trouble provided that they are not contaminated by bacteria or other micro-organisms.
The micro-organisms most frequently found are staphylococci (see STAPHYLOCOCCUS), and, next to these, streptococci (see STREPTOCOCCUS) – though the latter cause more virulent abscesses. Other abscess-forming organisms are Pseudomonas pyocyanea and Escherichia coli, which live always in the bowels and under certain conditions wander into the surrounding tissues, producing abscesses.
The presence of micro-organisms is not suf?cient in itself to produce suppuration (see IMMUNITY; INFECTION); streptococci can often be found on the skin and in the skin glands of perfectly healthy individuals. Whether they will produce abscesses or not depends upon the virulence of the organism and the individual’s natural resistance.
When bacteria have gained access – for example, to a wound – they rapidly multiply, produce toxins, and cause local dilatation of the blood vessels, slowing of the bloodstream, and exudation of blood corpuscles and ?uid. The LEUCOCYTES, or white corpuscles of the blood, collect around the invaded area and destroy the bacteria either by consuming them (see PHAGOCYTOSIS) or by forming a toxin that kills them. If the body’s local defence mechanisms fail to do this, the abscess will spread and may in severe cases cause generalised infection or SEPTICAEMIA.
Symptoms The classic symptoms of in?ammation are redness, warmth, swelling, pain and fever. The neighbouring lymph nodes may be swollen and tender in an attempt to stop the bacteria spreading to other parts of the body. Infection also causes an increase in the number of leucocytes in the blood (see LEUCOCYTOSIS). Immediately the abscess is opened, or bursts, the pain disappears, the temperature falls rapidly to normal, and healing proceeds. If, however, the abscess discharges into an internal cavity such as the bowel or bladder, it may heal slowly or become chronic, resulting in the patient’s ill-health.
Treatment Most local infections of the skin respond to ANTIBIOTICS. If pus forms, the abscess should be surgically opened and drained.
Abscesses can occur in any tissue in the body, but the principles of treatment are broadly the same: use of an antibiotic and, where appropriate, surgery.... abscess
The blood serum of the animal, known now as anti-typhoid serum, is issued to laboratories for use when bacilli are found in the excretions of a patient who is possibly suffering from typhoid fever. The bacilli are exposed to the action of a drop of the serum; if the serum shows the power of agglutinating these bacteria, this forms evidence that the bacteria in question are typhoid bacilli. The reaction may also be carried out in the contrary manner: that is to say, the serum from the blood of a patient who may be suffering from typhoid fever, but in whom the diagnosis is still doubtful, is added to a drop of ?uid containing typhoid bacilli; if these are agglutinated into clumps by the patient’s serum, the patient is then known to be suffering from typhoid fever. If they do not agglutinate, the symptoms are due to some other condition. This reaction for typhoid fever is known as the Widal reaction. Comparable agglutination reactions, using an appropriate serum, are used in the diagnosis of a number of diseases, including glandular fever (when it is known as the Paul-Bunnell reaction), typhus fever (when it is known as the Weil-Felix reaction), undulant fever, and Weil’s disease. (For more information about these diseases, see under separate entries.)... agglutination
Composition The cellular components are red cells or corpuscles (ERYTHROCYTES), white cells (LEUCOCYTES and lymphocytes – see LYMPHOCYTE), and platelets.
The red cells are biconcave discs with a diameter of 7.5µm. They contain haemoglobin
– an iron-containing porphyrin compound, which takes up oxygen in the lungs and releases it to the tissue.
The white cells are of various types, named according to their appearance. They can leave the circulation to wander through the tissues. They are involved in combating infection, wound healing, and rejection of foreign bodies. Pus consists of the bodies of dead white cells.
Platelets are the smallest cellular components and play an important role in blood clotting (see COAGULATION).
Erythrocytes are produced by the bone marrow in adults and have a life span of about 120 days. White cells are produced by the bone
marrow and lymphoid tissue. Plasma consists of water, ELECTROLYTES and plasma proteins; it comprises 48–58 per cent of blood volume. Plasma proteins are produced mainly by the liver and by certain types of white cells. Blood volume and electrolyte composition are closely regulated by complex mechanisms involving the KIDNEYS, ADRENAL GLANDS and HYPOTHALAMUS.... blood
In blood transfusion, the person giving and the person receiving the blood must belong to the same blood group, or a dangerous reaction will take place from the agglutination that occurs when blood of a di?erent group is present. One exception is that group O Rhesus-negative blood can be used in an emergency for anybody.
| Agglutinogens | Agglutinins | Frequency | |
| in the | in the | in Great | |
| Group | erythrocytes | plasma | Britain |
| AB | A and B | None | 2 per cent |
| A | A | Anti-B | 46 per cent |
| B | B | Anti-A | 8 per cent |
| O | Neither | Anti-A and | 44 per cent |
| A nor B | Anti-B | ||
Rhesus factor In addition to the A and B agglutinogens (or antigens), there is another one known as the Rhesus (or Rh) factor – so named because there is a similar antigen in the red blood corpuscles of the Rhesus monkey. About 84 per cent of the population have this Rh factor in their blood and are therefore known as ‘Rh-positive’. The remaining 16 per cent who do not possess the factor are known as ‘Rh-negative’.
The practical importance of the Rh factor is that, unlike the A and B agglutinogens, there are no naturally occurring Rh antibodies. However, such antibodies may develop in a Rh-negative person if the Rh antigen is introduced into his or her circulation. This can occur (a) if a Rh-negative person is given a transfusion of Rh-positive blood, and (b) if a Rh-negative mother married to a Rh-positive husband becomes pregnant and the fetus is Rh-positive. If the latter happens, the mother develops Rh antibodies which can pass into the fetal circulation, where they react with the baby’s Rh antigen and cause HAEMOLYTIC DISEASE of the fetus and newborn. This means that, untreated, the child may be stillborn or become jaundiced shortly after birth.
As about one in six expectant mothers is Rh-negative, a blood-group examination is now considered an essential part of the antenatal examination of a pregnant woman. All such Rh-negative expectant mothers are now given a ‘Rhesus card’ showing that they belong to the rhesus-negative blood group. This card should always be carried with them. Rh-positive blood should never be transfused to a Rh-negative girl or woman.... blood groups
Structure of bone Bone is composed partly of ?brous tissue, partly of bone matrix comprising phosphate and carbonate of lime, intimately mixed together. The bones of a child are about two-thirds ?brous tissue, whilst those of the aged contain one-third; the toughness of the former and the brittleness of the latter are therefore evident.
The shafts of the limb bones are composed of dense bone, the bone being a hard tube surrounded by a membrane (the periosteum) and enclosing a fatty substance (the BONE MARROW); and of cancellous bone, which forms the short bones and the ends of long bones, in which a ?ne lace-work of bone ?lls up the whole interior, enclosing marrow in its meshes. The marrow of the smaller bones is of great importance. It is red in colour, and in it red blood corpuscles are formed. Even the densest bone is tunnelled by ?ne canals (Haversian canals) in which run small blood vessels, nerves and lymphatics, for the maintenance and repair of the bone. Around these Haversian canals the bone is arranged in circular plates called lamellae, the lamellae being separated from one another by clefts, known as lacunae, in which single bone-cells are contained. Even the lamellae are pierced by ?ne tubes known as canaliculi lodging processes of these cells. Each lamella is composed of very ?ne interlacing ?bres.
GROWTH OF BONES Bones grow in thickness from the ?brous tissue and lime salts laid down by cells in their substance. The long bones grow in length from a plate of cartilage (epiphyseal cartilage) which runs across the bone about 1·5 cm or more from its ends, and which on one surface is also constantly forming bone until the bone ceases to lengthen at about the age of 16 or 18. Epiphyseal injury in children may lead to diminished growth of the limb.
REPAIR OF BONE is e?ected by cells of microscopic size, some called osteoblasts, elaborating the materials brought by the blood and laying down strands of ?brous tissue, between which bone earth is later deposited; while other cells, known as osteoclasts, dissolve and break up dead or damaged bone. When a fracture has occurred, and the broken ends have been brought into contact, these are surrounded by a mass of blood at ?rst; this is partly absorbed and partly organised by these cells, ?rst into ?brous tissue and later into bone. The mass surrounding the fractured ends is called the callus, and for some months it forms a distinct thickening which is gradually smoothed away, leaving the bone as before the fracture. If the ends have not been brought accurately into contact, a permanent thickening results.
VARIETIES OF BONES Apart from the structural varieties, bones fall into four classes: (a) long bones like those of the limbs; (b) short bones composed of cancellous tissue, like those of the wrist and the ankle; (c) ?at bones like those of the skull; (d) irregular bones like those of the face or the vertebrae of the spinal column (backbone).
The skeleton consists of more than 200 bones. It is divided into an axial part, comprising the skull, the vertebral column, the ribs with their cartilages, and the breastbone; and an appendicular portion comprising the four limbs. The hyoid bone in the neck, together with the cartilages protecting the larynx and windpipe, may be described as the visceral skeleton.
AXIAL SKELETON The skull consists of the cranium, which has eight bones, viz. occipital, two parietal, two temporal, one frontal, ethmoid, and sphenoid; and of the face, which has 14 bones, viz. two maxillae or upper jaw-bones, one mandible or lower jaw-bone, two malar or cheek bones, two nasal, two lacrimal, two turbinal, two palate bones, and one vomer bone. (For further details, see SKULL.) The vertebral column consists of seven vertebrae in the cervical or neck region, 12 dorsal vertebrae, ?ve vertebrae in the lumbar or loin region, the sacrum or sacral bone (a mass formed of ?ve vertebrae fused together and forming the back part of the pelvis, which is closed at the sides by the haunch-bones), and ?nally the coccyx (four small vertebrae representing the tail of lower animals). The vertebral column has four curves: the ?rst forwards in the neck, the second backwards in the dorsal region, the third forwards in the loins, and the lowest, involving the sacrum and coccyx, backwards. These are associated with the erect attitude, develop after a child learns to walk, and have the e?ect of diminishing jars and shocks before these reach internal organs. This is aided still further by discs of cartilage placed between each pair of vertebrae. Each vertebra has a solid part, the body in front, and behind this a ring of bone, the series of rings one above another forming a bony canal up which runs the spinal cord to pass through an opening in the skull at the upper end of the canal and there join the brain. (For further details, see SPINAL COLUMN.) The ribs – 12 in number, on each side – are attached behind to the 12 dorsal vertebrae, while in front they end a few inches away from the breastbone, but are continued forwards by cartilages. Of these the upper seven reach the breastbone, these ribs being called true ribs; the next three are joined each to the cartilage above it, while the last two have their ends free and are called ?oating ribs. The breastbone, or sternum, is shaped something like a short sword, about 15 cm (6 inches) long, and rather over 2·5 cm (1 inch) wide.
APPENDICULAR SKELETON The upper limb consists of the shoulder region and three segments – the upper arm, the forearm, and the wrist with the hand, separated from each other by joints. In the shoulder lie the clavicle or collar-bone (which is immediately beneath the skin, and forms a prominent object on the front of the neck), and the scapula or shoulder-blade behind the chest. In the upper arm is a single bone, the humerus. In the forearm are two bones, the radius and ulna; the radius, in the movements of alternately turning the hand palm up and back up (called supination and pronation respectively), rotating around the ulna, which remains ?xed. In the carpus or wrist are eight small bones: the scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate and hamate. In the hand proper are ?ve bones called metacarpals, upon which are set the four ?ngers, each containing the three bones known as phalanges, and the thumb with two phalanges.
The lower limb consists similarly of the region of the hip-bone and three segments – the thigh, the leg and the foot. The hip-bone is a large ?at bone made up of three – the ilium, the ischium and the pubis – fused together, and forms the side of the pelvis or basin which encloses some of the abdominal organs. The thigh contains the femur, and the leg contains two bones – the tibia and ?bula. In the tarsus are seven bones: the talus (which forms part of the ankle joint); the calcaneus or heel-bone; the navicular; the lateral, intermediate and medial cuneiforms; and the cuboid. These bones are so shaped as to form a distinct arch in the foot both from before back and from side to side. Finally, as in the hand, there are ?ve metatarsals and 14 phalanges, of which the great toe has two, the other toes three each.
Besides these named bones there are others sometimes found in sinews, called sesamoid bones, while the numbers of the regular bones may be increased by extra ribs or diminished by the fusion together of two or more bones.... bone
Every cell consists essentially of a cell-body of soft albuminous material called cytoplasm, in which lies a kernel or nucleus which seems to direct all the activities of the cell. Within the nucleus may be seen a minute body, the nucleolus; and there may or may not be a cell-envelope around all. (See also MITOCHONDRIA.) Each cell nucleus carries a set of identical CHROMOSOMES, the body’s genetic instructions.
Cells vary much in size, ranging in the human body from 0·0025 mm to about 0·025 mm.
All animals and plants consist at ?rst of a single cell (the egg-cell, or ovum), which begins to develop when fertilised by the sperm-cell derived from the opposite sex. Development begins by a division into two new cells, then into four, and so on till a large mass is formed. These cells – among them stem cells (see STEM CELL) which have the potential to develop into a variety of specialised cells – then arrange themselves into layers, and form various tubes, rods, and masses which represent in the embryo the organs of the fully developed animal. (See FETUS.)
When the individual organs have been laid down on a sca?olding of cells, these gradually change in shape and in chemical composition. The cells in the nervous system send out long processes to form the nerves; those in the muscles become long and striped in appearance; and those which form fat become ?lled with fat droplets which distend the cells. Further, they begin to produce, between one another, the substances which give the various tissues their special character. Thus, in the future bones, some cells deposit lime salts and others form cartilage, while in tendons they produce long white ?bres of a gelatinous substance. In some organs the cells change little: thus the liver consists of columns of large cells packed together, while many cells, like the white blood corpuscles, retain their primitive characters almost entire.
Thus cells are the active agents in forming the body, and they have a similar function in repairing its wear and tear. Tumours, and especially malignant tumours, have a highly cellular structure, the cells being of an embryonic type, or, at best, forming poor imitations of the tissues in which they grow (see TUMOUR).... cells
The three-stage process of coagulation is complex, involving many di?erent substances. There are two cascading pathways of biochemical reactions for activating coagulation of blood. The extrinsic pathway is the main physiological mechanism, which is triggered when blood vessels are damaged, usually by trauma or surgery. The intrinsic pathway is activated by internal disruption of the wall of a blood vessel. The basic pattern is broadly the same for both and is summarised simply as follows:
prothrombin + calcium + thromboplastin
thrombin + ?brinogen
?brin
Prothrombin and calcium are normally present in the blood. Thromboplastin is an enzyme which is normally found in the blood platelets and in tissue cells. When bleeding occurs from a blood vessel, there is always some damage to tissue cells and to the blood platelets. As a result of this damage, thromboplastin is released and comes into contact with the prothrombin and calcium in the blood. In the presence of thromboplastin and calcium, prothrombin is converted into thrombin, which in turn interacts with ?brinogen – a protein always present in the blood – to form ?brin. Fibrin consists of needle-shaped crystals which, with the assistance of the blood platelets, form a ?ne network in which the blood corpuscles become enmeshed. This meshwork, or CLOT as it is known, gradually retracts until it forms a tight mass which, unless the tissue injury is very severe or a major artery has been damaged, prevents any further bleeding. It will thus be seen that clotting, or coagulation, does not occur in the healthy blood vessel because there is no thromboplastin present. There is now evidence suggesting that there is an anti-thrombin substance present in the blood in small amounts, and that this substance antagonises any small amounts of thrombin that may be formed as a result of small amounts of thromboplastin being released.
The clotting or coagulation time is the time taken for blood to clot and can be measured under controlled conditions to ensure that it is normal (3–8 minutes). In certain diseases – HAEMOPHILIA, for example – clotting time is greatly extended and the danger of serious haemorrhage enhanced.... coagulation
Haemoglobin exists in two forms: simple haemoglobin, found in venous blood; and oxy-haemoglobin, which is a loose compound with oxygen, found in arterial blood after the blood has come into contact with the air in the lungs. This oxyhaemoglobin is again broken down as the blood passes through the tissues, which take up the oxygen for their own use. This is the main function of haemoglobin: to act as a carrier of oxygen from the lungs to all the tissues of the body. When the haemoglobin leaves the lungs, it is 97 per cent saturated with oxygen; when it comes back to the lungs in the venous blood, it is 70 per cent saturated. The oxygen content of 100 millilitres of blood leaving the lungs is 19·5 millilitres, and that of venous blood returning to the lungs, 14·5 millilitres. Thus, each 100 millilitres of blood delivers 5 millilitres of oxygen to the tissues of the body. Human male blood contains 13–18 grams of haemoglobin per 100 millilitres; in women, there are 12–16 grams per 100 millilitres. A man weighing 70 kilograms (154 pounds) has around 770 grams of haemoglobin circulating in his red blood corpuscles.... haemoglobin
Habitat: Cultivated chiefly in Andhra Pradesh, Maharashtra, Karnataka, and Orissa.
English: Castor seed.Ayurvedic: Eranda, Chitra- bija, Triputi; Tribija, Vaataari, Chanchu, Manda, Uruvaka, Gandharva-hastaa, Panchaan- gula, Vardhamaana, Uttaanpatraka, Vyaaghrapuchha, Chitraa.Unani: Bedanjeer, Arand.Siddha/Tamil: Ammanakku.Action: Oil from seeds and young leaf—purgative. Oil is used in dermatosis and eczema. Leaves— used as poultice to extract the worm.
Root—a decoction is administered for lumbago and allied complaints.Bark—purgative.The Ayurvedic Pharmacopoeia ofIn- dia recommends the decoction of the dried, mature root in rheumatism, pain in the urinary bladder, lumbago, diseases of the abdomen and inflammations; fresh leaf in helminthiasis, dysu- ria, arthritis, pain in the urinary bladder, dysuria, abscesses; dried seed powder in constipation, rheumatism, diseases of the liver and spleen, piles, lumbago, sciatica.The root extract exhibited significant anti-inflammatory activity against carrageenan-, bradykinin-, 5-HT-and dextran-induced rat hind paw oedema. N-Demethylricinine showed dose-dependent anticholestatic and hepato- protective activities in rats.Castor oil, derived from the seeds, is a well-known purgative (dose 520 ml).Castor seed contains toxic components (2.8-3.0% on whole seed; about 10% in the flour) which are highly poisonous to human beings and animals. The principal toxic substance is the albumin, ricin. Allergens and a feebly toxic alkaloid ricinine is also present. An ulcerative factor in the seed is reported. Like other toxalbumins, ricin agglutinizes the mammalian red bleed corpuscles. (Ricin loses its toxicity and antigenic action on treatment with potassium permanganate.)Castor oil consists principally of ri- cinoleic acid. Stearic, oleic, linoleic and dihydroxystearic acids are present in small amounts. The strong laxative property of castor oil is reported due to the local irritant action caused in the intestines by ricinoleic acid formed by hydrolysis under the influence of lipolytic enzymes. (The oil should not be used with fat-soluble vermifuge, it may increase its absorption and toxic- ity.)Dosage: Root—20-30 g for decoction. (API, Vol. I.) Leaf—10- 20 ml juice; 2-5 g powder; seed— 0.5-3 g powder. (API, Vol. III.)... ricinus communisSymptoms These depend upon whether the anaemia is sudden in onset, as in severe haemorrhage, or gradual. In all cases, however, the striking sign is pallor, the depth of which depends upon the severity of the anaemia. The colour of the skin may be misleading, except in cases due to severe haemorrhage, as the skin of many Caucasian people is normally pale. The best guide is the colour of the internal lining of the eyelid. When the onset of the anaemia is sudden, the patient complains of weakness and giddiness, and loses consciousness if he or she tries to stand or sit up. The breathing is rapid and distressed, the pulse is rapid and the blood pressure is low. In chronic cases the tongue is often sore (GLOSSITIS), and the nails of the ?ngers may be brittle and concave instead of convex (koilonychia). In some cases, particularly in women, the Plummer-Vinson syndrome is present: this consists of di?culty in swallowing and may be accompanied by huskiness; in these cases glossitis is also present. There may be slight enlargement of the SPLEEN, and there is usually some diminution in gastric acidity.
CHANGES IN THE BLOOD The characteristic change is a diminution in both the haemoglobin and the red cell content of the blood. There is a relatively greater fall in the haemoglobin than in the red cell count. If the blood is examined under a microscope, the red cells are seen to be paler and smaller than normal. These small red cells are known as microcytes.
Treatment consists primarily of giving suf?cient iron by mouth to restore, and then maintain, a normal blood picture. The main iron preparation now used is ferrous sulphate, 200 mg, thrice daily after meals. When the blood picture has become normal, the dosage is gradually reduced. A preparation of iron is available which can be given intravenously, but this is only used in cases which do not respond to iron given by mouth, or in cases in which it is essential to obtain a quick response.
If, of course, there is haemorrhage, this must be arrested, and if the loss of blood has been severe it may be necessary to give a blood transfusion (see TRANSFUSION – Transfusion of blood). Care must be taken to ensure that the patient is having an adequate diet. If there is any underlying metabolic, oncological, toxic or infective condition, this, of course, must be adequately treated after appropriate investigations.
Megaloblastic hyperchromic anaemia There are various forms of anaemia of this type, such as those due to nutritional de?ciencies, but the most important is that known as pernicious anaemia.
PERNICIOUS ANAEMIA An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the PARIETAL cells of the stomach. These cells normally produce INTRINSIC FACTOR, the carrier protein for vitamin B12 (see APPENDIX 5: VITAMINS) that permits its absorption in the terminal part of the ILEUM. Lack of the factor prevents vitamin B12 absorption and this causes macrocytic (or megaloblastic) anaemia. The disorder can affect men and women, usually those over the age of 40; onset is insidious so it may be well advanced before medical advice is sought. The skin and MUCOSA become pale, the tongue is smooth and atrophic and is accompanied by CHEILOSIS. Peripheral NEUROPATHY is often present, resulting in PARAESTHESIA and numbness and sometimes ATAXIA. A rare complication is subacute combined degeneration of the SPINAL CORD.
In 1926 two Americans, G R Minot and W P Murphy, discovered that pernicious anaemia, a previously fatal condition, responded to treatment with liver which provides the absent intrinsic factor. Normal development requires a substance known as extrinsic factor, and this depends on the presence of intrinsic factor for its absorption from the gut. The disease is characterised in the blood by abnormally large red cells (macrocytes) which vary in shape and size, while the number of white cells (LEUCOCYTES) diminishes. A key diagnostic ?nd is the presence of cells in the BONE MARROW.
Treatment consists of injections of vitamin B12 in the form of hydroxocobalamin which must be continued for life.
Aplastic anaemia is a disease in which the red blood corpuscles are very greatly reduced, and in which no attempt appears to be made in the bone marrow towards their regeneration. It is more accurately called hypoplastic anaemia as the degree of impairment of bone-marrow function is rarely complete. The cause in many cases is not known, but in rather less than half the cases the condition is due to some toxic substance, such as benzol or certain drugs, or ionising radiations. The patient becomes very pale, with a tendency to haemorrhages under the skin and mucous membranes, and the temperature may at times be raised. The red blood corpuscles diminish steadily in numbers. Treatment consists primarily of regular blood transfusions. Although the disease is often fatal, the outlook has improved in recent years: around 25 per cent of patients recover when adequately treated, and others survive for several years. In severe cases promising results are being reported from the use of bone-marrow transplantation.
Haemolytic anaemia results from the excessive destruction, or HAEMOLYSIS, of the red blood cells. This may be the result of undue fragility of the red blood cells, when the condition is known as congenital haemolytic anaemia, or of acholuric JAUNDICE.
Sickle-cell anaemia A form of anaemia characteristically found in people of African descent, so-called because of the sickle shape of the red blood cells. It is caused by the presence of the abnormal HAEMOGLOBIN, haemoglobin S, due to AMINO ACID substitutions in their polypeptide chains, re?ecting a genetic mutation. Deoxygenation of haemoglobin S leads to sickling, which increases the blood viscosity and tends to obstruct ?ow, thereby increasing the sickling of other cells. THROMBOSIS and areas of tissue INFARCTION may follow, causing severe pain, swelling and tenderness. The resulting sickle cells are more fragile than normal red blood cells, and have a shorter life span, hence the anaemia. Advice is obtainable from the Sickle Cell Society.... inadequate intake of iron
Epithelial tissues, including the cells covering the skin, those lining the alimentary canal, those forming the secretions of internal organs. (See EPITHELIUM.)
Connective tissues, including ?brous tissue, fat, bone, cartilage. (See under these headings.)
Muscular tissues (see MUSCLE).
Nervous tissues (see NERVE).
Wandering corpuscles of the BLOOD and LYMPH. Many of the organs are formed of a single
one of these tissues, or of one with a very slight admixture of another, such as cartilage, or white ?brous tissue. Other parts of the body that are widely distributed are very simple in structure and consist of two or more simple tissues in varying proportion. Such are blood vessels (see ARTERIES; VEINS), lymphatic vessels (see LYMPHATICS), lymphatic glands (see GLAND), SEROUS MEMBRANES, synovial membranes (see JOINTS), mucous membranes (see MUCOUS MEMBRANE), secreting glands (see GLAND; SALIVARY GLANDS; THYROID GLAND) and SKIN.
The structure of the more complex organs of the body is dealt with under the heading of each organ.... tissues of the body
Excessive consumption of meat, combined with sedentary habits.
GOUT.
Diseases in which the white corpuscles of the blood are increased: for example, LEUKAEMIA.
The bi-urate of sodium and urate of ammonium occur in considerable amounts in the URINE during a feverish state or after great exertion, and produce, as the urine cools, a dense pink or yellow sediment. Owing to their insolubility, uric acid and the various urates often produce deposits in the urinary passages, which are known as urinary sand, gravel, or stones according to their size.... uric acid
Bitters increase the appetite, assist assimilation, and are indicated for perverted or loss of the sense of taste (zinc). They reduce fermentation in the intestines and are of value in hypoglycaemia and diabetes mellitus. Bitters are not carminatives. Some, such as Gentian, Calumba and Chamomile are also sialogogues (increasing the flow of saliva). Another effect, little understood, is an increase in white corpuscles in the peripheral circulation.
Aletris, Angostura, Avens, Balmony, Barberry, Betony, Bogbean, Boneset, Calumba, Centuary, Chicory, Condurango, Feverfew, Gentian, Goldenseal, Holy Thistle, Hops, Quassia Chips, Rue, Southernwood, White Horehound, Wormwood.
Not used in presence of gastric ulcer. ... bitters
Care should be taken to trace any underlying cause which should receive primary treatment: diabetes, kidney inflammation, anaemia, etc. The ‘core’ or centre of the boil should be extracted, although pustular matter may disperse and eruption aborted. Echinacea counters infection and hastens ripening. Goldenseal is shown to be effective for staph. aureus.
Alternatives. Teas. Chickweed, Clivers, Comfrey leaves, Figwort, Linseed, Marshmallow leaves, Plantain, Nettles.
Combination tea. Equal parts: Dandelion root, Nettles, Senna leaf, Burdock leaves. 1-2 teaspoons to each cup boiling water, thrice daily.
Decoctions from any of the following: one teaspoon to two cups water; gently simmer 20 minutes; strain when cold. Half-1 cup thrice daily. Blue Flag root, Burdock root, Echinacea root, Marshmallow root, Yellow Dock, Wild Indigo.
Tablets/capsules. Echinacea, Blue Flag, Queen’s Delight, Poke root.
Powders. Formula: Echinacea 1; Poke root half; Goldenseal quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.
Tinctures. Formula. Echinacea 1; Burdock 1; Yellow Dock 1; Few drops Tincture Myrrh. Mix. Dose: 1 teaspoon in water thrice daily.
Tincture Myrrh, BPC (1973). 10-20 drops in water, 3 times daily.
BHP (1983) recommends, internal – combination: Burdock, Poke root, Violet and Wild Indigo.
Topical. Self-cleansing process is promoted by hot poultices of equal parts: Marshmallow root and Slippery Elm bark (preferably in powder form). An ointment with this combination is available. In the absence of herbs, use honey on clean lint, cover with cotton wool and fix in position. Alternatives: poultices of Carrot, Cabbage, White Pond Lily, Chickweed, Comfrey, Plantain, Linseed, Fenugreek. Cover with clean linen or gauze.
Dr A. Vogel. Tincture Marigold; pulped Cabbage leaves.
Tea Tree oil. After cleansing site, use lotion: 5 drops oil in eggcup boiled water, 3-4 times daily. Supplements. Vitamins A, C, D, E. Zinc.
Preventative: 2 Garlic capsules at night. ... boils
Red blood cells (also known as RBCs, red blood corpuscles, or erythrocytes) transport oxygen from the lungs to the tissues (see respiration). Each is packed with haemoglobin, enzymes, minerals, and sugars. Abnormalities can occur in the rate at which RBCs are either produced or destroyed, in their numbers, and in their shape, size, and haemoglobin content, causing forms of
anaemia and polycythaemia (see blood, disorders of).
White blood cells (also called WBCs, white blood corpuscles, or leukocytes) protect the body against infection and fight infection when it occurs. The 3 main types of are granulocytes (also called polymorphonuclear leukocytes), monocytes, and lymphocytes. Granulocytes are further classified as neutrophils, eosinophils, or basophils, and each type of granulocyte has a role in either fighting infection or in inflammatory or allergic reactions. Monocytes and lymphocytes also play an important part in the immune system. Lymphocytes are usually formed in the lymph nodes. One type, a T-lymphocyte, is responsible for the delayed hypersensitivity reactions
White (see allergy) and Red blood blood cell is also involved in cell (neutrophil) protection against cancer. T-lymphocytes manufacture chemicals, known as lymphokines, which affect the function of other cells. In addition, the T-cells moderate the activity of B-lymphocytes, which form the antibodies that can prevent a second attack of certain infectious diseases. Platelets (also known as thrombocytes), are the smallest blood cells and are important in blood clotting.
The numbers, shapes, and appearance of the various types of blood cell are of great value in the diagnosis of disease (see blood count; blood film).... blood cells
FAMILY: Rutaceae
SYNONYMS: C. limonum, cedro oil.
GENERAL DESCRIPTION: A small evergreen tree up to 6 metres high with serrated oval leaves, stiff thorns and very fragrant flowers. The fruit turns from green to yellow on ripening.
DISTRIBUTION: Native to Asia, probably east India; it now grows wild in the Mediterranean region especially in Spain and Portugal. It is cultivated extensively worldwide in Italy, Sicily, Cyprus, Guinea, Israel, South and North America (California and Florida).
OTHER SPECIES: There are about forty-seven varieties which are said to have been developed in cultivation, such as the Java lemon (C. javanica). The lemon is also closely related to the lime, cedrat (or citron) and bergamot.
HERBAL/FOLK TRADITION: The juice and peel are widely used as a domestic seasoning. It is very nutritious, being high in vitamins A, B and C. In Spain and other European countries, lemon is something of a ‘cure-all’, especially with regard to infectious illness. It was used for fever, such as malaria and typhoid, and employed specifically for scurvy on English ships at sea.
Taken internally, the juice is considered invaluable for acidic disorders, such as arthritis and rheumatism, and of great benefit in dysentery and liver congestion.
ACTIONS: Anti-anaemic, antimicrobial, antirheumatic, antisclerotic, antiscorbutic, antiseptic, antispasmodic, antitoxic, astringent, bactericidal, carminative, cicatrisant, depurative, diaphoretic, diuretic, febrifuge, haemostatic, hypotensive, insecticidal, rubefacient, stimulates white corpuscles, tonic, vermifuge.
EXTRACTION: Essential oil by cold expression from the outer part of the fresh peel. A terpeneless oil is also produced on a large scale (cedro oil).
CHARACTERISTICS: A pale greeny-yellow liquid (turning brown with age), with a light, fresh, citrus scent. It blends well with lavender, neroli, ylang ylang, rose, sandalwood, olibanum, chamomile, benzoin, fennel, geranium, eucalyptus, juniper, oakmoss, lavandin, elemi, labdanum and other citrus oils.
PRINCIPAL CONSTITUENTS: Limonene (approx. 70 per cent), terpinene, pinenes, sabinene, myrcene, citral, linalol, geraniol, octanol, nonanol, citronellal, bergamotene, among others.
SAFETY DATA: Non-toxic; may cause dermal irritation or sensitization reactions in some individuals – apply in moderation. Phototoxic do not use on skin exposed to direct sunlight.
AROMATHERAPY/HOME: USE
Skin care: Acne, anaemia, brittle nails, boils, chilblains, corns, cuts, greasy skin, herpes, insect bites, mouth ulcers, spots, varicose veins, warts.
Circulation muscles and joints: Arthritis, cellulitis, high blood pressure, nosebleeds, obesity (congestion), poor circulation, rheumatism.
Respiratory system: Asthma, throat infections, bronchitis, catarrh.
Digestive system: Dyspepsia.
Immune system: Colds, ’flu, fever and infections.
OTHER USES: Used as a flavouring agent in pharmaceuticals. Extensively used as a fragrance component in soaps, detergents, cosmetics, toilet waters and perfumes. Extensively employed by the food industry in most types of product, including alcoholic and soft drinks.... lemon
FAMILY: Poaceae (Gramineae)
SYNONYMS: Andropogon muricatus, vetivert, khus khus.
GENERAL DESCRIPTION: A tall, tufted, perennial, scented grass, with a straight stem, long narrow leaves and an abundant complex lacework of undergound white rootlets.
DISTRIBUTION: Native to south India, Indonesia and Sri Lanka. Also cultivated in Reunion, the Philippines, the Comoro Islands, Japan, West Africa and South America. The oil is mainly produced in Java, Haiti and Reunion; some is distilled in Europe and the USA.
OTHER SPECIES: Botanically related to lemongrass, citronella, litsea cubeba and flouve oil (also from the roots of a tropical grass).
HERBAL/FOLK TRADITION: The rootlets have been used in the East for their fine fragrance since antiquity. They are used by the locals to protect domestic animals from vermin, and the fibres of the grass are woven into aromatic matting. It is grown in India to protect against soil erosion during the tropical rainy season.
In India and Sri Lanka the essence is known as ‘the oil of tranquillity’.
ACTIONS: Antiseptic, antispasmodic, depurative, rubefacient, sedative (nervous system), stimulant (circulatory, production of red corpuscles), tonic, vermifuge.
EXTRACTION: Essential oil by steam distillation from the roots and rootlets washed, chopped, dried and soaked. (A resinoid is also produced by solvent extraction for perfumery work.)
CHARACTERISTICS: A dark brown, olive or amber viscous oil with a deep smoky, earthy woody odour with a sweet persistent undertone. The colour and scent can vary according to the source – Angola produces a very pale oil with a dry-woody odour. It blends well with sandalwood, rose, violet, jasmine, opopanax, patchouli, oakmoss, lavender, clary sage, mimosa, cassie and ylang ylang.
PRINCIPAL CONSTITUENTS: Vetiverol, vitivone, terpenes, e.g. vetivenes, among others.
SAFETY DATA: Non-toxic, non-irritant, non-sensitizing.
AROMATHERAPY/HOME: USE
Skin care: Acne, cuts, oily skin, wounds.
Circulation muscles and joints: Arthritis, muscular aches and pains, rheumatism, sprains, stiffness.
Nervous system: Debility, depression, insomnia, nervous tension – ‘Vetiver is deeply relaxing, so valuable in massage and baths for anybody experiencing stress.’.
OTHER USES: Employed as a fixative and fragrance ingredient in soaps, cosmetics and perfumes, especially oriental types. The oil is used in food preservatives, especially for asparagus.... vetiver
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