The practice of seeking the judgement of another medical practitioner or specialist regarding a health condition.
Alceena, Alcyna, Alsina, Alsyna, Alzina, Alcine, Alcinia, Alcyne, Alsine, Alsyn, Alzine, Alcinah, Alcee, Alceenah, Alcynah, Alcienah, Alciena, Alceina, Alceinah, Alceana, Alceanah... alcina
Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its effects within the home, but most cases are unrecognised, unreported and untreated, even though victims may suffer from long-term effects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments suffering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.
Clinical effects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are affected to a great extent. Common effects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may suffer neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.
First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical effects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to
0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... carbon monoxide (co)
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
Severe and extensive burns are most frequently produced by the clothes – for example, of a child – catching ?re. This applies especially to cotton garments, which blaze up quickly. It should be remembered that such a ?ame can immediately be extinguished by making the individual lie on the ?oor so that the ?ames are uppermost, and wrapping him or her in a rug, mat or blanket. As prevention is always better than cure, particular care should always be exercised with electric ?res and kettles or pots of boiling water in houses where there are young children or old people. Children’s clothes, and especially night-clothes, should be made of non-in?ammable material: pyjamas are also much safer than nightdresses.
Severe scalds are usually produced by escape of steam in boiler explosions. Cigarettes are a common cause of ?res and therefore of burns; people who have fallen asleep in bed or in a chair while smoking may set ?re to the bed or chair. Discarded, unextinguished cigarettes are another cause.
Degrees of burns Burns are referred to as either super?cial (or partial-thickness) burns, when there is su?cient skin tissue left to ensure regrowth of skin over the burned site; and deep (or full-thickness) burns, when the skin is totally destroyed and grafting will be necessary.
Symptoms Whilst many domestic burns are minor and insigni?cant, more severe burns and scalds can prove to be very dangerous to life. The main danger is due to SHOCK, which arises as a result of loss of ?uid from the circulating blood at the site of a serious burn. This loss of ?uid leads to a fall in the volume of the circulating blood. As the maintenance of an adequate blood volume is essential to life, the body attempts to compensate for this loss by withdrawing ?uid from the uninjured areas of the body into the circulation. If carried too far, however, this in turn begins to affect the viability of the body cells. As a sequel, essential body cells, such as those of the liver and kidneys, begin to suffer, and the liver and kidneys cease to function properly. This will show itself by the development of JAUNDICE and the appearance of albumin in the urine (see PROTEINURIA). In addition, the circulation begins to fail with a resultant lack of oxygen (see ANOXIA) in the tissues, and the victim becomes cyanosed (see CYANOSIS), restless and collapsed: in some cases, death ensues. In addition, there is a strong risk of infection occurring. This is the case with severe burns in particular, which leave a large raw surface exposed and very vulnerable to any micro-organisms. The combination of shock and infection can all too often be life-threatening unless expert treatment is immediately available.
The immediate outcome of a burn is largely determined by its extent. This is of more signi?cance than the depth of the burn. To assess the extent of a burn in relation to the surface of the body, what is known as the Rule of Nine has been evolved. The head and each arm cover 9 per cent of the body surface, whilst the front of the body, the back of the body, and each leg each cover 18 per cent, with the perineum (or crutch) accounting for the remaining 1 per cent. The greater the extent of the burn, the more seriously ill will the victim become from loss of ?uid from his or her circulation, and therefore the more prompt should be his or her removal to hospital for expert treatment. The depth of the burn, unless this is very great, is mainly of import when the question arises as to how much surgical treatment, including skin grafting, will be required.
Treatment This depends upon the severity of the burn. In the case of quite minor burns or scalds, all that may be necessary if they are seen immediately is to hold the part under cold running water until the pain is relieved. Cooling is one of the most e?ective ways of relieving the pain of a burn. If the burn involves the distal part of a limb – for example, the hand and forearm – one of the most e?ective ways of relieving pain is to immerse the burned part in lukewarm water and add cold water until the pain disappears. As the water warms and pain returns, more cold water is added. After some three to four hours, pain will not reappear on warming, and the burn may be dressed in the usual way. Thereafter a simple dressing (e.g. a piece of sterile gauze covered by cotton-wool, and on top of this a bandage or adhesive dressing) should be applied. The part should be kept at rest and the dressing kept quite dry until healing takes place. Blisters should be pierced with a sterile needle, but the skin should not be cut away. No ointment or oil should be applied, and an antiseptic is not usually necessary.
In slightly more severe burns or scalds, it is probably advisable to use some antiseptic dressing. These are the cases which should be taken to a doctor – whether a general practitioner, a factory doctor, or to a hospital Accident & Emergency department. There is still no general consensus of expert opinion as to the best ‘antiseptic’ to use. Among those recommended are CHLORHEXIDINE, and antibiotics such as BACITRACIN, NEOMYCIN and polymixin. An alternative is to use a Tulle Gras dressing which has been impregnated with a suitable antibiotic.
In the case of severe burns and scalds, the only sound rule is immediate removal to hospital. Unless there is any need for immediate resuscitation, such as arti?cial respiration, or attention to other injuries there may be, such as fractures or haemorrhage, nothing should be done on the spot to the patient except to make sure that s/he is as comfortable as possible and to keep them warm, and to cover the burn with a sterile (or clean) cloth such as a sheet, pillowcases, or towels wrung out in cold water. If pain is severe, morphine should be given – usually intravenously. Once the victim is in hospital, the primary decision is as to the extent of the burn, and whether or not a transfusion is necessary. If the burn is more than 9 per cent of the body surface in extent, a transfusion is called for. The precise treatment of the burn varies, but the essential is to prevent infection if this has not already occurred, or, if it has, to bring it under control as quickly as possible. The treatment of severe burns has made great advances, with quick transport to specialised burns units, modern resuscitative measures, the use of skin grafting and other arti?cial covering techniques and active rehabilitation programmes, o?ering victims a good chance of returning to normal life.
CHEMICAL BURNS Phenol or lysol can be washed o? promptly before they do much damage. Acid or alkali burns should be neutralised by washing them repeatedly with sodium bicarbonate or 1 per cent acetic acid, respectively. Alternatively, the following bu?er solution may be used for either acid or alkali burns: monobasic potassium phosphate (70 grams), dibasic sodium phosphate (70 grams) in 850 millilitres of water. (See also PHOSPHORUS BURNS.)... burns and scalds
Habitat: Mild climatic regions of south and central Europe, north Africa and West Asia. C. scoparius is fairly common in and around Oatacmund (Nilgiris) and is found wild as a garden escape. It grows also in Simla and neighbouring places. An allied species, C. monspessulanus Linn., White Broom, also occurs in the Nilgiri hills.
English: Broom, Scotch Broom, Yellow Broom.Folk: Broom.Action: Green twigs of the plant, collected before flowering, either fresh or after drying, are used as diuretic and cathartic. Emetic in large doses. The seeds are also used similarly. The herb is used chiefly in the form of sulphate in tachycardia and functional palpitation. (The action of the whole plant is stated to be different from that of isolated alkaloids.) The whole herb has been used to treat tumours.
Key application: For functional heart and circulatory disorders. Aqueous-ethanolic extracts are used internally. Simultaneous administration of MAO-inhibitors contraindicated due to the tyramine content. (German Commission E.) The British Herbal Pharmacopoeia reported antiarrhythmic and diuretic action of the herb.The herb contains quinolizidine alkaloids; main alkaloids are (-)-spar- teine, lupanine, ammodendrine and various derivatives; biogenic amines, including tryramine, epinine, dopa- mine; isoflavone glycosides including genistein, scoparin; flavonoids; essential oil; caffeic acid and p-coumaric acids; tannins. Seeds contain lectins (phytohaemagglutinins).The herb contains over 2% tyramine. Tyramine acts as an indirect sympa- thomimetic, vasoconstrictive and hy- potensive.The herb is contraindicated in high blood pressure, A-V block and pregnancy.Scoparin's action on renal mucous membrane is similar to that of Buchu and Uva-ursi. (A decoction or infusion of broom is used in dropsical complaints of cardiac origin.)Sparteine produces a transient rise in arterial pressure followed by a longer period of decreased vascular tension (contradictory observations have been recorded). Some researchers are of the opinion that sparteine is a regulator in chronic vulvar disease. It showed no cumulative action like digitalis. In large doses, it is highly toxic and impairs the activity of respiratory organs.C. monopessulanus (a related species) contains. 9% alkaloids.Sparteine is toxic at more than 300 mg dose. (Francis Brinker.)... cytisus scopariusMost of the detailed information available about the practice of euthanasia comes from the Netherlands, where court rulings in the 1970s and 1980s began to permit voluntary euthanasia under certain circumstances (although both euthanasia and assisted suicide remain technically illegal). The di?culty of maintaining limits was highlighted in 1994–5 when it became clear that a small percentage of Dutch patients undergoing euthanasia had previously expressed an interest but not speci?cally requested it (involuntary euthanasia) or had no known desire for it and may have been opposed to it (non-voluntary euthanasia). The relevance of terminal illness and physical suffering was tested in Holland in 1994 when a patient received euthanasia who was not physically ill and subject to mental rather than physical suffering. Nevertheless, Dutch doctors risk prosecution if they fail to follow rules of careful conduct when carrying out euthanasia or assisted suicide. (See also ETHICS; SUICIDE.)... euthanasia
Cause The disease is caused by a VIRUS of the in?uenza group. There are at least three types of in?uenza virus, known respectively as A, B and
C. One of their most characteristic features is that infection with one type provides no protection against another. Equally important is the ease with which the in?uenza virus can change its character. It is these two characteristics which explain why one attack of in?uenza provides little, if any, protection against a subsequent attack, and why it is so di?cult to prepare an e?ective vaccine against the disease.
Epidemics of in?uenza due to virus A occur in Britain at two- to four-year intervals, and outbreaks of virus B in?uenza in less frequent cycles. Virus A in?uenza, for instance, was the prevalent infection in 1949, 1951, 1955 and 1956, whilst virus B in?uenza was epidemic in 1946, 1950, 1954 and, along with virus A, in 1958–59. The pandemic of 1957, which swept most of the world, although fortunately not in a severe form, was due to a new variant of virus A
– the so-called Asian virus – and it has been suggested that it was this variant that was responsible for the pandemics of 1889 and 1918. Since 1957, variants of virus A have been the predominating causes of in?uenza, accompanied on occasions by virus B.
In 1997 and 2004, outbreaks of Chinese avian in?uenza caused alarm. The in?uenza virus had apparently jumped species from birds
– probably chickens – to infect some people. Because no vaccine is available, there was a risk that this might start an epidemic.
Symptoms The incubation period of in?uenza A and B is 2–3 three days, and the disease is characterised by a sudden onset. In most cases this is followed by a short, sharp febrile illness of 2–4 days’ duration, associated with headache, prostration, generalised aching, and respiratory symptoms. In many cases the respiratory symptoms are restricted to the upper respiratory tract, and consist of signs of irritation of the nose, pharynx and larynx. There may be nosebleeds, and a dry, hacking cough is often a prominent and troublesome symptom. The fever is usually remittent and the temperature seldom exceeds 39·4 °C (103 °F), tending to ?uctuate between 38·3 and 39·4 °C (101 and 103 °F).
The most serious complication is infection of the lungs. This infection is usually due to organisms other than the in?uenza virus, and is a complication which can have serious results in elderly people.
The very severe form of ’?u which tends to occur during pandemics – and which was so common during the 1918–19 pandemic – is characterised by the rapid onset of bronchopneumonia and severe prostration. Because of the toxic e?ect on the heart, there is a particularly marked form of CYANOSIS, known as heliotrope cyanosis.
Convalescence following in?uenza tends to be prolonged. Even after an attack of average severity there tends to be a period of weakness and depression.
Treatment Expert opinion is still divided as to the real value of in?uenza vaccine in preventing the disease. Part of the trouble is that there is little value in giving any vaccine until it is known which particular virus is causing the infection. As this varies from winter to winter, and as the protection given by vaccine does not exceed one year, it is obviously not worthwhile attempting to vaccinate the whole community. The general rule therefore is that, unless there is any evidence that a particularly virulent type of virus is responsible, only the most vulnerable should be immunised – such as children in boarding schools, elderly people, and people who suffer from chronic bronchitis or asthma, chronic heart disease, renal failure, diabetes mellitus or immunosuppression (see under separate entries). In the face of an epidemic, people in key positions, such as doctors, nurses and those concerned with public safety, transport and other public utilities, should be vaccinated.
For an uncomplicated attack of in?uenza, treatment is symptomatic: that is, rest in bed, ANALGESICS to relieve the pain, sedatives, and a light diet. A linctus is useful to sooth a troublesome cough. The best analgesics are ASPIRIN or PARACETAMOL. None of the sulphonamides or the known antibiotics has any e?ect on the in?uenza virus; on the other hand, should the lungs become infected, antibiotics should be given immediately, because such an infection is usually due to other organisms. If possible, a sample of sputum should be examined to determine which organisms are responsible for the lung infection. The choice of antibiotic then depends upon which antibiotic the organism is most sensitive to.... influenza
Structure Each tooth is composed of enamel, dentine, cement, pulp and periodontal membrane. ENAMEL is the almost translucent material which covers the crown of a tooth. It is the most highly calci?ed material in the body, 96–97 per cent being composed of calci?ed salts. It is arranged from millions of long, six-sided prisms set on end on the dentine (see below), and is thickest over the biting surface of the tooth. With increasing age or the ingestion of abrasive foods the teeth may be worn away on the surface, so that the dentine becomes visible. The outer sides of some teeth may be worn away by bad tooth-brushing technique. DENTINE is a dense yellowish-white material from which the bulk and the basic shape of a tooth are formed. It is like ivory and is harder than bone but softer than enamel. The crown of the tooth is covered by the hard protective enamel and the root is covered by a bone-like substance called cement. Decay can erode dentine faster than enamel (see TEETH, DISORDERS OF – Caries of the teeth). CEMENT or cementum is a thin bone-like material which covers the roots of teeth and helps hold them in the bone. Fibres of the periodontal membrane (see below) are embedded in the cement and the bone. When the gums recede, part of the cement may be exposed and the cells die. Once this has happened, the periodontal membrane can no longer be attached to the tooth and, if su?cient cement is destroyed, the tooth-support will be so weakened that the tooth will become loose. PULP This is the inner core of the tooth and is
composed of a highly vascular, delicate ?brous tissue with many ?ne nerve-?bres. The pulp is very sensitive to temperature variation and to touch. If the pulp becomes exposed it will become infected and usually cannot overcome this. Root-canal treatment or extraction of the tooth may be necessary. PERIODONTAL MEMBRANE This is a layer of ?brous tissue arranged in groups of ?bres which surround and support the root of a tooth in a bone socket. The ?bres are interspersed with blood vessels and nerves. Loss of the membrane leads to loss of the tooth. The membrane can release and re-attach the ?bres to allow the tooth to move when it erupts, or (to correct dental deformities) is being moved by orthodontic springs.
Arrangement and form Teeth are present in most mammals and nearly all have two sets: a temporary or milk set, followed by a permanent or adult set. In some animals, like the toothed whale, all the teeth are similar; but in humans there are four di?erent shapes: incisors, canines (eye-teeth), premolars (bicuspids), and molars. The incisors are chisel-shaped and the canine is pointed. Premolars have two cusps on the crown (one medial to the other) and molars have at least four cusps. They are arranged together in an arch in each jaw and the
cusps of opposing teeth interdigitate. Some herbivores have no upper anterior teeth but use a pad of gum instead. As each arch is symmetrical, the teeth in an upper and lower quadrant can be used to identify the animal. In humans, the quadrants are the same: in other words, in the child there are two incisors, one canine and two molars (total teeth 20); in the adult there are two incisors, one canine, two premolars and three molars (total 32). This mixture of tooth-form suggests that humans are omnivorous. Anatomically the crown of the tooth has mesial and distal surfaces which touch the tooth next to it. The mesial surface is the one nearer to the centre line and the distal is the further away. The biting surface is called the incisal edge for the anterior teeth and the occlusal surface for the posteriors.
Development The ?rst stage in the formation of the teeth is the appearance of a down-growth of EPITHELIUM into the underlying mesoderm. This is the dental lamina, and from it ten smaller swellings in each jaw appear. These become bell-shaped and enclose a part of the mesoderm, the cells of which become specialised and are called the dental papillae. The epithelial cells produce enamel and the dental papilla forms the dentine, cement and pulp. At a ?xed time the teeth start to erupt and a root is formed. Before the deciduous teeth erupt, the permanent teeth form, medial to them. In due course the deciduous roots resorb and the permanent teeth are then able to push the crowns out and erupt themselves. If this process is disturbed, the permanent teeth may be displaced and appear in an abnormal position or be impacted.
Eruption of teeth is in a de?nite order and at a ?xed time, although there may be a few months’ leeway in either direction which is of no signi?cance. Excessive delay is found in some congenital disorders such as CRETINISM. It may also be associated with local abnormalities of the jaws such as cysts, malformed teeth and supernumerary teeth.
The usual order of eruption of deciduous teeth is:
Middle incisors 6–8 months Lateral incisors 8–10 months First molars 12–16 months Canines (eye-teeth) 16–20 months Second molars 20–30 months
The usual order of eruption of permanent teeth is:
First molars 6–7 years Middle incisors 6–8 years Lateral incisors 7–9 years Canines 9–12 years First and second premolars 10–12 years Second molars 11–13 years Third molars (wisdom teeth) 17–21 years
The permanent teeth of the upper (top) and lower (bottom) jaws.
Teeth, Disorders of
Teething, or the process of eruption of the teeth in infants, may be accompanied by irritability, salivation and loss of sleep. The child will tend to rub or touch the painful area. Relief may be obtained in the child by allowing it to chew on a hard object such as a toy or rusk. Mild ANALGESICS may be given if the child is restless and wakens in the night. A serious pitfall is to assume that an infant’s symptoms of ill-health are due to teething, as the cause may be more serious. Fever and ?ts (see SEIZURE) are not due to teething.
Toothache is the pain felt when there is in?ammation of the pulp or periodontal membrane of a tooth (see TEETH – Structure). It can vary in intensity and may be recurring. The commonest cause is caries (see below) when the cavity is close to the pulp. Once the pulp has become infected, this is likely to spread from the apex of the tooth into the bone to form an abscess (gumboil – see below). A lesser but more long-lasting pain is felt when the dentine is unprotected. This can occur when the enamel is lost due to decay or trauma or because the gums have receded. This pain is often associated with temperature-change or sweet foods. Expert dental advice should be sought early, before the decay is extensive. If a large cavity is accessible, temporary relief may be obtained by inserting a small piece of cotton wool soaked, for example, in oil of cloves.
Alveolar abscess, dental abscess or gumboil This is an ABSCESS caused by an infected tooth. It may be present as a large swelling or cause trismus (inability to open the mouth). Treatment is drainage of the PUS, extraction of the tooth and/or ANTIBIOTICS.
Caries of the teeth or dental decay is very common in the more a?uent countries and is most common in children and young adults. Increasing awareness of the causes has resulted in a considerable improvement in dental health, particularly in recent years; this has coincided with a rise in general health. Now more than half of ?ve-year-old children are caries-free and of the others, 10 per cent have half of the remaining carious cavities. Since the start of the National Health Service, the emphasis has been on preventive dentistry, and now edentulous patients are mainly found among the elderly who had their teeth removed before 1948.
The cause of caries is probably acid produced by oral bacteria from dietary carbohydrates, particularly re?ned sugar, and this dissolves part of the enamel; the dentine is eroded more quickly as it is softer (see TEETH – Structure). The exposed smooth surfaces are usually protected as they are easily cleaned during normal eating and by brushing. Irregular and overcrowded teeth are more at risk from decay as they are di?cult to clean. Primitive people who chew coarse foods rarely get caries. Fluoride in the drinking water at about one part per million is associated with a reduction in the caries rate.
Prolonged severe disease in infancy is associated with poor calci?cation of the teeth, making them more vulnerable to decay. As the teeth are formed and partly calci?ed by the time of birth, the diet and health of the mother are also important to the teeth of the child. Pregnant mothers and children should have a good balanced diet with su?cient calcium and vitamin
D. A ?brous diet will also aid cleansing of the teeth and stimulate the circulation in the teeth and jaws. The caries rate can be reduced by regular brushing with a ?uoride toothpaste two or three times per day and certainly before going to sleep. The provision of sweet or sugary juices in an infant’s bottle should be avoided.
Irregularity of the permanent teeth may be due to an abnormality in the growth of the jaws or to the early or late loss of the deciduous set (see TEETH – Development). Most frequently it is due to an imbalance in the size of the teeth and the length of the jaws. Some improvement may take place with age, but many will require the help of an orthodontist (specialist dentist) who can correct many malocclusions by removing a few teeth to allow the others to be moved into a good position by means of springs and elastics on various appliances which are worn in the mouth.
Loosening of the teeth may be due to an accident or in?ammation of the GUM. Teeth loosened by trauma may be replaced and splinted in the socket, even if knocked right out. If the loosening is due to periodontal disease, the prognosis is less favourable.
Discoloration of the teeth may be intrinsic or extrinsic: in other words, the stain may be in the calci?ed structure or stuck on to it. Intrinsic staining may be due to JAUNDICE or the antibiotic tetracycline. Extrinsic stain may be due to tea, co?ee, tobacco, pan (a mixture of chuna and betel nuts wrapped in a leaf), iron-containing medicines or excess ?uoride.
Gingivitis or in?ammation of the gum may occur as an acute or chronic condition. In the acute form it is often part of a general infection of the mouth, and principally occurs in children or young adults – resolving after 10–14 days. The chronic form occurs later in life and tends to be progressive. Various microorganisms may be found on the lesions, including anaerobes. Antiseptic mouthwashes may help, and once the painful stage is past, the gums should be thoroughly cleaned and any calculus removed. In severe conditions an antibiotic may be required.
Periodontal disease is the spread of gingivitis (see above) to involve the periodontal membrane of the tooth; in its ?orid form it used to be called pyorrhoea. In this, the membrane becomes damaged by the in?ammatory process and a space or pocket is formed into which a probe can be easily passed. As the pocket becomes more extensive, the tooth loosens. The loss of the periodontal membrane also leads to the loss of supporting bone. Chronic in?ammation soon occurs and is di?cult to eradicate. Pain is not a feature of the disease but there is often an unpleasant odour (halitosis). The gums bleed easily and there may be DYSPEPSIA. Treatment is largely aimed at stabilising the condition rather than curing it.
Dental abscess is an infection that arises in or around a tooth and spreads to involve the bone. It may occur many years after a blow has killed the pulp of the tooth, or more quickly after caries has reached the pulp. At ?rst the pain may be mild and intermittent but eventually it will become severe and a swelling will develop in the gum over the apex of the tooth. A radiograph of the tooth will show a round clear area at the apex of the tooth. Treatment may be by painting the gum with a mild counter-irritant such as a tincture of aconite and iodine in the early stages, but later root-canal therapy or apicectomy may be required. If a swelling is present, it may need to be drained or the o?ending teeth extracted and antibiotics given.
Injuries to teeth are common. The more minor injuries include crazing and the loss of small chips of enamel, and the major ones include a broken root and avulsion of the entire tooth. A specialist dental opinion should be sought as soon as possible. A tooth that has been knocked out can be re-implanted if it is clean and replaced within a few hours. It will then require splinting in place for 4–6 weeks.
Prevention of dental disease As with other disorders, prevention is better than cure. Children should be taught at an early age to keep their teeth and gums clean and to avoid re?ned sugars between meals. It is better to ?nish a meal with a drink of water rather than a sweetened drink. Fluoride in some of its forms is useful in the reduction of dental caries; in some parts of the UK natural water contains ?uoride, and in some areas where ?uoride content is low, arti?cial ?uoridation of the water supply is carried out. Overcrowding of the teeth, obvious maldevelopment of the jaw and persistent thumbsucking into the teens are all indications for seeking the advice of an orthodontist. Generally, adults have less trouble with decay but more with periodontal disease and, as its onset is insidious, regular dental inspections are desirable.... teeth
Laryngitis In?ammation of the mucous membrane of the larynx and vocal chords may be acute or chronic. The cause is usually an infection, most commonly viral, although it may be the result of secondary bacterial infection, voice abuse or irritation by gases or chemicals. ACUTE LARYNGITIS may accompany any form of upper-respiratory-tract infection. The main symptom is hoarseness and often pain in the throat. The voice becomes husky or it may be lost. Cough, breathing diffculties and sometimes stridor may occur. Acute airway obstruction is unusual following laryngitis but may occasionally occur in infants (see laryngotracheo-bronchitis, below).
Treatment Vapour inhalations may be soothing and reduce swelling. Usually all that is needed is rest and analgesics such as paracetamol. Rarely, airway intervention – either ENDOTRACHEAL INTUBATION or TRACHEOSTOMY – may be necessary if severe airway obstruction develops (see APPENDIX 1: BASIC FIRST AID). A?ected patients should rest their voice and avoid smoking.
Chronic laryngitis can result from repeated attacks of acute laryngitis; excessive use of the voice – loud and prolonged, singing or shouting; tumours, which may be benign or malignant; or secondary to diseases such as TUBERCULOSIS and SYPHILIS.
Benign tumours or small nodules, such as singer’s nodules, may be surgically removed by direct laryngoscopy under general anaesthetic; while cancer of the larynx may be treated either by RADIOTHERAPY or by SURGERY, depending on the extent of the disease. Hoarseness may be the only symptom of vocal-chord disturbance or of laryngeal cancer: any case which has lasted for six weeks should be referred for a specialist opinion.
Laryngectomy clubs are being established
A laryngoscopic view of the interior of the larynx.
throughout the country to support patients following laryngectomy. Speech therapists provide speech rehabilitation.... larynx, disorders of
Rare causes include a tumour in the spine or spinal column, tuberculosis of the spine, ankylosing spondylitis (see SPINE AND SPINAL CORD, DISEASES AND INJURIES OF) or a tumour in one of the organs in the pelvis such as the UTERUS.
Treatment consists essentially of rest in bed in the early stages until the acute phase is over. ANALGESICS, such as aspirin and codeine, are given to relieve the pain. Expert opinion varies as to the desirability of wearing a PLASTER OF PARIS jacket or a specially made corset; also, as to the desirability of manipulation of the spine and operation. Surgeons are selective about which patients might bene?t from a LAMINECTOMY (removal of the protruding disc).... sciatica
Habitat: Wastes, pastures and field borders.
Features ? The branched stems of one to three feet high are tough and bristly. The whole plant is hairy, and the leaves are oblong and bipinnate, with acute segments. Blossoming in June and July, the umbel of white flowers usually contains one crimson flower in the centre. The root tapers, is yellowish-white, sweetish, and faintly aromatic. Wren tells us that "in taste and odour it resembles the garden carrot, but the root is small and white, not large." Ferrier, however, says of this root, "no resemblance in taste or colour to the cultivated carrot." Our own opinion is that Wild Carrot tastes like a rather distant relative of the household carrot—which it probably is.Part used ? The whole plant.Action: Pronouncedly diuretic in action, as well as de-obstruent and stimulant.
Wild Carrot naturally, therefore, takes a prominent place in many formulae for the treatment of dropsy, gravel, retention of urine, and bladder trouble generally. Either an infusion or decoction may be prepared in the usual proportions, and doses of 2 fl. ounces taken three or four times daily.Culpeper comments ? "Wild Carrots belong to Mercury, and therefore breaketh wind, and removeth stitches in the sides, provoketh urine and women's courses, and helpeth to break and expel the stone."... wild carrotTeething. Teas: Spearmint, Roman Chamomile, Peppermint. 1 heaped teaspoon to cup boiling water; infuse 15 minutes; frequent teaspoon doses. Alternative: place one Chamomile flower in feeding bottle. Essential oils: rub gums with diluted oils: Spearmint, German Chamomile, Peppermint or Mullein. Urinary Tract Infection, Cystitis or urethritis.
Teas: Horsetail, Couch Grass, Golden Rod, Rosehip. Dandelion coffee. For pus in the urine: 1-5 drops Tincture Myrrh in cup of warm water: Dose: 1-2 teaspoons thrice daily. Fullness under the eyes may indicate Bright’s Disease for which specialist opinion should be obtained without delay.
Diet. Wholegrain cereals, wholemeal bread, pasta, two servings fresh fruit and vegetables daily. Little lean meat, poultry, fish. Dairy products: yoghurt, cheese, milk in moderation. Fresh orange juice, raw fresh vegetable salads. Oatmeal (porridge oats) is sustaining to the nervous system.
Avoid: crisps, fizzy drinks, hamburgers, biscuits, chocolate, sugar-filled snacks, alcohol, strong tea and coffee.
Supplement. Most children may benefit from one zinc tablet weekly.
Medicine doses. See: DOSAGE.
Fish oils. As well as to help children guard against winter illnesses, Cod Liver oil supplements may help them later in life against arthritis, heart disease, psoriasis, eczema and other inflammatory disorders.
Aspirin. It is clear that a link exists between Reye’s syndrome and aspirin. Aspirin is not advised for minor viral illness in children. ... roseola
Substances that cause allergic reactions are known as allergens. Their number are limitless. Against these, the body produces antibodies to fight off invaders. If we are allergic, such defence mechanisms over-react. The reaction has the effect of releasing various chemicals such as histamine which causes irritation and swelling of mucous membranes. Removal of dental amalgam fillings sometimes relieves.
Perhaps the most common allergy is hay fever. It is now known that most sufferers have a family
history of the complaint. Asthma is a serious form, but with the aid of certain herbs (Lobelia, etc) sufferers may lead normal lives.
Premature babies fed on cow’s milk are at risk of cow’s milk allergy with increased histamine release. (Dunn Nutrition Unit, Cambridge)
Food allergies from shell fish and cereal grain fungi are difficult to detect. A large body of opinion favours Garlic (corm, tablets or capsules), being observed that Garlic eaters seldom suffer allergies. Agrimony tea.
Skin reactions may be severe. Hives, dermatitis and blisters can be the result of allergies triggered off by insect stings or animal bites, drugs, food additives, colourings, monosodium glutamate, chocolate, wines, aspirin, penicillin and other drugs. Cytotoxic tests are made to discover foods to which a person may be allergic.
Heredity predisposes, but forms vary. A ‘nettle rash’ father may have a ‘hay fever’ son. Stress is an important factor. While allergy is not a psychosomatic disturbance, there is general agreement that emotional distress – fright, fury or fatigue – can be related. An allergy can also be due to a flaw in the immune system, the body over-reacting to an allergen. Some allergies are treated with the antihistamines of orthodox pharmacy but which may induce drowsiness.
Treatment. The phytotherapist’s primary agent is Ephedra.
Teas. Chamomile, Centuary, Elderflowers, Ground Ivy, Lime flowers, Nettles, Plantain, Red Sage. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes. 1 cup 1 to 3 times daily.
Liquid Extract. Ephedra sinica BHP (1983): Dose – 1-3ml. Thrice daily.
Tincture. Ephedra sinica BHP (1983) 1:4 in 45 per cent alcohol. Dose: 6-8ml thrice daily.
A Vogel. Devil’s Claw, thrice daily.
J. Christopher. Burdock, Marshmallow root, Parsley root.
Valerian. Add to prescription in cases of nervous hyperactivity.
Diet. Low salt, low fat, high fibre. Eggs and dairy products are known to cause allergies. Raw salad once daily. Add more protein, cooked and raw vegetables. Rice is not known to cause any allergic reactions. Supplements. Daily. Vitamin A, B-complex, Vitamin C. Bromelain, Selenium, Zinc.
Note: No animals or birds in the house. ... allergy
Constituents: allantoin, saponins, Vitamin C and K.
Keynote: kidneys and bladder.
Action: antilithic, mild stimulant, soothing urinary demulcent, diuretic.
Uses: Kidney and bladder disorders. Cystitis, uncontrollable bladder, retention, pus in the urine, bed- wetting, prostate gland enlargement, irritation of the urinary tract by phosphatic and uric acids, urethritis, expulsion of gravel. Gonorrhoea, in combination with powerful alteratives: Yellow Dock, Burdock, Queen’s Delight.
Heart failure with oedema and scanty urine; used with success. (William Boericke MD) Chronic malaria – in strong infusion the shucks have been used with success. (Dr E.C. Lowe) Nephritis (with equal parts Marshmallow) for temporary relief. Its value is increased by adding to it (equal parts) Dandelion root and Shepherd’s Purse herb. (J.H. Greer MD) Of special value for bed-wetting: with Agrimony herb (equal parts). Diabetes. (Chinese medicine)
Preparations: It is a consensus of professional opinion that the infusion (tea) is the best form. 3-4 teaspoons to each cup boiling water; infuse 15 minutes; drink freely.
Liquid Extract: 1-2 teaspoons, in water.
Tincture: 1-3 teaspoons, in water. ... corn silk
Symptoms. Morning stiffness and pain wearing off later. Easy fatigue and decline in health. Nodules on surface of bones (elbows, wrists, fingers). Joint fluids (synovia) appear to be the object of attack for which abundant Vitamin C is preventative. Anaemia and muscle wasting call attention to inadequate nutrition, possibly from faulty food habits for which liver and intestine herbs are indicated.
Treatment. Varies in accord with individual needs. May have to be changed many times before progress is made. Whatever treatment is prescribed, agents should have a beneficial effect upon the stomach and intestines to ensure proper absorption of active ingredients. (Meadowsweet)
It is a widely held opinion that the first cause of this condition is a bacterial pathogen. An anti- inflammatory herb should be included in each combination of agents at the onset of the disease. See: ANTI-INFLAMMATORY HERBS. Guaiacum (Lignum vitae) and Turmeric (Curcuma longa) have a powerful anti-inflammatory action and have no adverse effects upon bone marrow cells or suppress the body’s immune system. Breast feeding cuts RA death rate.
Of therapeutic value according to the case. Agrimony, Angelica root, Balmony, Black Cohosh (particularly in presence of low back pain and sciatica), Bogbean, Boldo, Burdock, Celery, Cramp bark, Devil’s Claw, Echinacea (to cleanse and stimulate lymphatic system), Ginseng (Korean), Ginseng (Siberian), Liquorice, Meadowsweet, Poke root, Prickly Ash bark, White Poplar bark, White Willow bark, Wild Yam.
Tea. Formula. Equal parts. Alfalfa, Bogbean, Nettles. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes, 1 cup thrice daily.
Decoction. Prickly Ash bark 1; Cramp bark 1; White Willow bark 2. Mix. 1oz to 1 pint water gently simmered 20 minutes. Dose: Half-1 cup thrice daily.
Tablets/capsules. Black Cohosh, Celery, Cramp bark, Devil’s Claw, Feverfew, Poke root, Prickly Ash, Wild Yam, Ligvites.
Alternative formulae:– Powders. White Willow bark 2; Devil’s Claw 1; Black Cohosh half; Ginger quarter. Mix. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.
Liquid extracts. White Willow bark 2; Wild Yam half; Liquorice half; Guaiacum quarter. Mix. Dose: 1-2 teaspoons thrice daily.
Tinctures. Cramp bark 1; Bogbean 1; Prickly Ash half; Meadowsweet 1; Fennel half. Mix. Dose: 1-3 teaspoons thrice daily.
Ligvites. (Gerard House)
Cod Liver oil. Contains organic iodine, an important factor in softening-up fibrous tissue, to assist metabolism of uric-acid, help formation of haemoglobin, dilate blood vessels; all related to arthritics. The oil, taken internally, can reach and nourish cartilage by the process of osmosis; its constituents filter into cartilage and impart increased elasticity.
Topical. Evening Primrose oil, Wintergreen lotion, Comfrey poultice. Hydrotherapy: hot fomentations of Hops, Chamomile or Ragwort. Cold water packs: crushed ice or packet of frozen peas in a damp towel applied daily for 10 minutes for stiffness and pain. See: MASSAGE OIL.
Aromatherapy. Massage oils, any one: Cajeput, Juniper, Pine or Rosemary. 6 drops to 2 teaspoons Almond oil.
Supportives: under-water massage, brush baths, sweat packs, Rosemary baths, exposure of joints to sunlight.
Diet. Low salt, low fat, oily fish, Mate tea, Dandelion coffee. On exacerbation of the disease cut out all dairy products.
Supplements. Daily. Evening Primrose capsules: four 500mg; Vitamin C (1-3g); Bromelain 250mg between meals; Zinc 25mg.
General. Residence in a warm climate. Yoga. Disability and deformity may be avoided by a conscientious approach to the subject. ... arthritis – rheumatoid
Dosage may vary from herb to herb but today’s standard doses are as follows unless stated otherwise. Dried herbs may be swallowed with water (Psyllium seeds) or drunk as a tea or decoction. Dosage is usually thrice daily for chronic conditions and every 2 hours for acute cases.
Refer to appropriate entries for dosage of teas (infusions), decoctions, powders, liquid extracts, tinctures.
Children. 5 to 12 years. One quarter to half adult dose except where otherwise stated. Medical opinion is that after 12 years a child is regarded as an adult. For babies and children, teas and decoctions have much to commend them. Alcohol-based preparations should be avoided where possible.
Babies. 1 to 5 years. 1 to 5 teaspoons tea or decoction. Should a baby fail to take extract internally, a strong tea or decoction may be prepared and used as a footbath or poured into the bath water. This would need to be ten times as strong as for an internal dose. In this way medicaments may indirectly enter the circulation by absorption through a baby’s soft receptive tissue. Other liquid medicines: one drop for each year of age to 5 years; two drops thereafter to 12 years.
Measurement. 1 millilitre = 15 drops. 1 teaspoon = 5ml (5 millilitres or 75 drops liquid medicine). For liquid medicines always use a medicine glass graduated in millilitres, or a standard dropper. Take liquid extracts or tinctures in water (25ml) or honey. ... dosage
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
Before the practitioner comes: instil into the ear: few drops Onion or Garlic juice, Houseleek, Aloe Vera or Plantain juice; oils of Mullein, St John’s Wort or Almond. Moistened Chamomile flower sachet; apply to ear to ease pain.
Feverfew. A traditional way to relieve was to hold the ear over hot steaming Feverfew tea.
Supportive: A number of strong yawns while pinching the nostrils and blowing the nose vigorously may free obstruction and normalise pressure on both sides of the drum. Hot foot baths divert blood from the head and reduce pain. ... earache
Three forms: major (grand mal); temporal lobe; and minor (petit mal). In petit mal the period of unconsciousness consists of brief absences lasting less than 15 seconds.
Treatment. Orthodox medical: Carbamazepine, phenytoin and many other drugs.
Alternatives. BHP (1983) recommends: Grand mal: Passion flower, Skullcap, Verbena. Petit mal: Hyssop. Standard central nervous system relaxants are Hops, Lobelia, Passion flower, Vervain, Valerian, Skullcap. Wm Boericke used Mugwort. Peony leaf tea had a long traditional use. In nearly all epileptics there is functional heart disturbance (Hawthorn, Lily of the Valley, Motherwort). Mistletoe can help in the struggle to control seizures and improve the quality of life.
Two important remedies are Skullcap and Passion flower. Both work quickly without risk of respiratory arrest. If dose by mouth is not possible insert gelatin capsules containing powders, per rectum, child or adult lying prone. This method is particularly suitable for feverish convulsions or Grand mal.
Repeat after 5 minutes if patient continues in convulsion. Where neither of these powders are available, Chamomile, Valerian or Mistletoe may be used.
“The remedy I have relied on most,” writes C.I. Reid, MD (Ellingwood’s Journal) “is Passion flower. Use this alone or in combination with Gelsemium – more often alone. I cannot say I obtain an absolutely curative effect, but the spasms disappear and do not return while the remedy is continued. It has none of the unpleasant effects of other medicines. I give the liquid extract in doses from 25-30 drops, 3-4 times daily, for continued use. It may be given more frequently for convulsions.”
Alfred Dawes, MNIMH. Green tincture of Mistletoe, 3-5 drops. Or, combine equal parts: Liquid Extract Skullcap, Valerian and Black Horehound.
Finlay Ellingwood MD combines White Bryony, Prickly Ash, Skullcap and St John’s Wort.
Samuel Thomson MD. Lobelia 2; Cayenne 1; (antispasmodic drops) given at the premonitary stage. 1-2 teaspoons.
Edgar Cayce. Passion flower tea. Hot Castor oil packs.
Excess acidity and intestinal toxaemia. There is considerable opinion that these trigger an attack. Combination: Liquid Extracts – Skullcap 15ml; Mistletoe 10ml; Meadowsweet 10ml; Elderflowers 10ml. Two 5ml teaspoons in water thrice daily.
West African Black Pepper. (Piper guineense) is used by traditional Nigerian healers to good effect. Associated with imperfect menstruation. Liquid Extracts, single or in combination: Black Cohosh, Life root, Lobelia. Dose: 5-15 drops thrice daily.
Associated with mental weakness. Liquid Extract Oats (avena sativa). 2-3 teaspoons in water thrice daily.
Aromatherapy. (Complex partial seizures) Massage with essential oils found to be beneficial. (The Lancet, 1990, 336 (8723) 1120)
Diet. Salt-free lacto-vegetarian. Oatmeal porridge. A cleansing 8-day grape juice fast has its advocates. Vitamin E. In 24 epileptic children refractory to anti-epileptic drugs (AEDs) with generalised tonic- clonic and other types of seizures, addition of Vitamin E 400iu daily to existing AEDs was accompanied by a significant reduction in 10 of 12 cases. (Epilepsy 1989; 30(1): 84-89)
Supportives: osteopathic or chiropractic adjustments.
Note: A number of Italian physicians linked a salt-rich diet with epileptic fits. Number and violence diminished when discontinued and did not recur for weeks. Dr W.P. Best found that, in children, circumcism made a valuable contribution.
Drug-dependency. Herbal medication may offer a supportive role to primary medical treatment. Under no circumstances should sufferers discontinue basic orthodox treatments except upon the advice of a physician.
Information. British Epilepsy Association, 40 Hanover Square, Leeds LS3 1BE, UK. Send SAE.
To be treated by or in liaison with a qualified medical practitioner. ... epilepsy
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
Hippocrates was aware of the universal law similia similibus curentur (like cures like). He taught that some diseases were cured by similars, and others by contraries. Stahl (1738) was also aware of this law of healing: “diseases will yield to and be cured by remedies that produce a similar affection”. But it was Samuel Hahnemann (1755-1843) who proved to the world this doctrine held the key to the selection of specifically acting medicines. His early experiments with nux vomica, arnica, ignatia and veratrum showed how the medicine which cured produced a similar condition in healthy people.
While no one has yet discovered the ‘modus operandi’ of the science, it has grown up largely through empiric experience, especially during certain historical epidemics in different parts of the world. For example, in 1836 cholera raged through most of the cities of Austria. Orthodox medicine could do little.
Out of desperation, the Government commissioned the aid of homoeopathy. A crude hospital was hastily prepared and patients admitted. Results convinced the most hardened sceptics. Physician-in-charge, Dr Fleischman, lost only 33 per cent, whereas other treatments showed a death rate of over 70 per cent.
It is said that reduction of inflammatory fevers by homoeopathic Aconite, Gelsemium, Baptisia and Belladonna played no small part in reducing the practice of blood-letting in the early 19th century.
Since Hahneman, homoeopathy has been the object of intense professional bitterness by its opponents but since the 1968 Medicines Act (UK) provision has been made for homoeopathic treatment on the “National Health Service”. Conversion of medical opinion has been gradual and today many registered medical practitioners also use the therapy.
“It is the general theory that the process of dilution and succussion (a vigorous shaking by the hand or by a machine) “potentises” a remedy.
“To prepare. A remedy is first prepared in solution as a “mother tincture”. In the decimal system of dilution a small quantity is then diluted ten times by the addition of nine parts by volume of diluent – either alcohol or water and then shaken vigorously by hand or machine (succussion). A small quantity of this is then diluted to one tenth and succussed a second time; this process is repeated again and again, producing solutions identified as 3x, 6x, 30x according to the number of times diluted. It may even be continued a thousand times (1 M). The resulting solutions are adsorbed on to an inert tablet or granules, usually of lactose, and in this form it is claimed that they remain therapeutically active indefinitely.
“For higher dilutions the centesimal system is used, when each dilution is by 1 in 100. The resulting solutions or tablets are referred to as 3C, 6C, 12C etc according to the number of times diluted.
“When dealing with a remedy which is insoluble, e.g. Carbo Veg, the first three dilutions and succussions are done in powder form, i.e. to “3x” beyond which the remedy is sufficiently soluble for further dilutions to proceed in liquid form.
“In homoeopathy a remedy may in some cases be given in a dilution so great that no single molecule of the original substance remains. The concept of “memory laden” water implies that the effect lies in a pattern impressed on the water molecules and that this is carried over from one dilution to the next.” (John Cosh MD., FRCP)
Homoeopathic medicines can stand most tests for safety, since it is widely held that they are completely safe and non-addictive, with no side-effects. ... homoeopathy
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