A wad of absorbent material used to apply antiseptics or soak up body fluids during surgery, or to obtain a sample of bacteria from an infected patient.
Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.
Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.
In young women the most common benign tumour is a dermoid cyst, while in older women, ?broma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.
Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.
Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.... ovaries, diseases of
Acute tonsillitis The infection is never entirely con?ned to the tonsils; there is always some involvement of the surrounding throat or pharynx. The converse is true that in many cases of ‘sore throat’, the tonsils are involved in the generalised in?ammation of the throat.
Causes Most commonly caused by the ?haemolytic STREPTOCOCCUS, its incidence is highest in the winter months. In the developing world it may be the presenting feature of DIPHTHERIA, a disease now virtually non-existant in the West since the introduction of IMMUNISATION.
Symptoms The onset is usually fairly sudden with pain on swallowing, fever and malaise. On examination, the tonsils are engorged and covered with a whitish discharge (PUS). This may occur at scattered areas over the tonsillar crypts (follicular tonsillitis), or it may be more extensive. The glands under the jaw are enlarged and tender, and there may be pain in the ear on the affected side: although usually referred pain, this may indicate spread of the infection up the Eustachian tube to the ear, particularly in children. Occasionally an ABSCESS, or quinsy, develops around the affected tonsil. Due to a collection of pus, it usually comes on four to ?ve days after the onset of the disease, and requires specialist surgical treatment.
Treatment Most cases need no treatment. Therefore, it is advisable to take a throat swab to assess the nature of any bacterial treatment before starting treatment. Penicillin or erythromycin are the drugs of choice where betahaemolytic streptococci are isolated, together with paracetamol or aspirin, and plenty of ?uids. Removal of tonsils is indicated: when the tonsils and adenoids are permanently so enlarged as to interfere with breathing (in such cases the adenoids are removed as well as the tonsils); when the individual is subject to recurrent attacks of acute tonsillitis which are causing signi?cant debility, absence from school or work on a regular basis (more than four times a year); when there is evidence of a tumour of the tonsil. Recurrent sore throat is not an indication for removing tonsils.... tonsillitis
Treatment: Quarter of a teaspoon powdered or tincture Myrrh in water; spray or pour into throat. Massage back with Capsicum ointment or Lotion. Warm blankets. ... drowning
Bacteriology includes techniques used to isolate and identify bacteria from specimens such as a throat swab or urine.
Bacteria are identified by their appearance under a microscope, including their response to stains (see staining) and the use of culture.
Testing for sensitivity to antibiotics may be performed.... bacteriology
As well as a sore throat, there may be discomfort when swallowing, slight fever, earache, and swollen lymph nodes in the neck.
Gargling with warm salt water and taking analgesic drugs is usually the only treatment needed.
If the sore throat is severe or prolonged a doctor may take a throat swab and prescribe antibiotic drugs.... pharyngitis
Urethritis is in?ammation of the urethra from infection.
Causes The sexually transmitted disease GONORRHOEA affects the urethra, mainly in men, and causes severe in?ammation and urethritis. Non-speci?c urethritis (NSU) is an in?ammation of the urethra caused by one of many di?erent micro-organisms including BACTERIA, YEAST and CHLAMYDIA.
Symptoms The classic signs and symptoms are a urethral discharge associated with urethral pain, particularly on micturition (passing urine), and DYSURIA.
Treatment This involves taking urethral swabs, culturing the causative organism and treating it with the appropriate antibiotic. The complications of urethritis include stricture formation.
Stricture This is an abrupt narrowing of the urethra at one or more places. Strictures can be a result of trauma or infection or a congenital abnormality from birth. Rarely, tumours can cause strictures.
Symptoms The usual presenting complaint is one of a slow urinary stream. Other symptoms include hesitancy of micturition, variable stream and terminal dribbling. Measurement of the urine ?ow rate may help in the diagnosis, but often strictures are detected during cystoscopy (see CYSTOSCOPE).
Treatment The traditional treatment was the periodic dilation of the strictures with ‘sounds’
– solid metal rods passed into the urethra. However, a more permanent solution is achieved by cutting the stricture with an endoscopic knife (optical urethrotomy). For more complicated long or multiple strictures, an open operation (urethroplasty) is required.... urethra, diseases of and injury to
Symptoms The ?rst, or catarrhal, stage is characterised by mild, but non-speci?c, symptoms of sneezing, conjunctivitis (see under EYE, DISORDERS OF), sore throat, mild fever and cough. Lasting 10–14 days, this stage is the most infectious; unfortunately it is almost impossible to make a de?nite clinical diagnosis, although analysis of a nasal swab may con?rm a suspected case. This is followed by the second, or paroxysmal, stage with irregular bouts of coughing, often prolonged, and typically more severe at night. Each paroxysm consists of a succession of short sharp coughs, increasing in speed and duration, and ending in a deep, crowing inspiration, often with a characteristic ‘whoop’. Vomiting is common after the last paroxysm of a series. Lasting 2–4 weeks, this stage is the most dangerous, with the greatest risk of complications. These may include PNEUMONIA and partial collapse of the lungs, and ?ts may be induced by cerebral ANOXIA. Less severe complications caused by the stress of coughing include minor bleeding around the eyes, ulceration under the tongue, HERNIA and PROLAPSE of the rectum. Mortality is greatest in the ?rst year of life, particularly among neonates – infants up to four weeks old. Nearly all patients with whooping-cough recover after a few weeks, with a lasting IMMUNITY. Very severe cases may leave structural changes in the lungs, such as EMPHYSEMA, with a permanent shortness of breath or liability to ASTHMA.
Treatment Antibiotics, such as ERYTHROMYCIN or TETRACYCLINES, may be helpful if given during the catarrhal stage – largely in preventing spread to brothers and sisters – but are of no use during the paroxysmal stage. Cough suppressants are not always helpful unless given in high (and therefore potentially narcotic) doses, and skilled nursing may be required to maintain nutrition, particularly if the disease is prolonged, with frequent vomiting.... whooping-cough
Symptoms: mucopurulent vaginal discharge, sometimes blood-stained. Backache. Urinary problems. Diagnosis confirmed by smear test, biopsy or swab culture.
Alternatives (also for cervicitis).
Teas, decoctions, powders or tinctures:– Agnus Castus, Black Cohosh, Echinacea. Myrrh. Pulsatilla. Practitioner: Tinctures. Mix, parts: Black Cohosh 3; Gelsemium 1. Dose: 10-20 drops in water, morning and evening.
Lapacho tea (Pau d’arco tea). Soak gauze tampons with extract, insert, renew after 24 hours.
Douche: German Chamomile tea, or Lapacho tea.
Tampons: saturate with paste of equal parts Slippery Elm powder and milk. Or: saturate tampons with Aloe Vera gel or fresh juice. In event of unavailability refer to entry: SUPPOSITORY.
Diet. Lacto-vegetarian.
Vitamins. A. B-complex. C (1g daily). E (400iu daily).
Minerals. Iron, Zinc.
Note: Women who have an abnormal cervical smear should be tested for chlamydia. ... cervix
Symptoms: low grade fever, malaise, sore throat, massive swelling of cervical lymph glands, thick white exudate from tonsils, false membrane forms from soft palate to larynx with brassy cough and difficult breathing leading to cyanosis and coma. Toxaemia, prostration, thin rapid pulse. Throat swabs taken for laboratory examination. See: NOTIFIABLE DISEASES.
Treatment. Bedrest. Encourage sweating.
Recommendations are for those parts of the world where medical help is not readily available and may save lives. Alternatives:–
1. Combine: Tincture Echinacea 3; Tincture Goldenseal 2; Tincture Myrrh 1. Dose: 30-60 drops in water, two-hourly.
2. Combine equal parts: Tincture Lobelia; Tincture Echinacea. Dose: 30-60 drops in water, two-hourly.
3. Combine Tincture Poke root 2; Tincture Echinacea 3. Dose: 30-60 drops in water, two hourly.
4. G.L.B. Rounseville, MD, Ill., USA. I have treated diphtheria since 1883. I have treated diphtheria until I am sure the number of cases treated run into four digits. I have never given a hypodermic of antitoxin on my own initiative, nor have I ever lost a case early enough to inhibit conditions. I have depended upon Echinacea not only prophylactic but also as an antiseptic . . . In the line of medication the remedies are: Aconite, Belladonna, Poke root and Cactus grand, according to indications. But remember, if you are to have success, Echinacea must be given internally, externally and eternally! Do not fear any case of diphtheria with properly selected remedies as the symptoms occur. Echinacea will also be your stimulant, diaphoretic, diuretic, sialogogue, cathartic and antipyretic. (Ellingwood’s Physiomedicalist, Vol 13, No 6, June, 1919, 202)
5. Alexander M. Stern MD, Palatka, Florida, USA. Combine: tinctures Echinacea 1oz, Belladonna 10 drops, Aconite 10 drops. Water to 4oz. 1 teaspoon 2-hourly.
6. F.H. Williams, MD, Bristol, Conn., USA. I took a case which had been given up to die with tracheal diphtheritic croup. I gave him old-fashioned Lobelia (2) seed and Capsicum (1) internally and externally and secured expulsion of a perfect cast of the trachea without a tracheotomy.
7. Gargle, and frequent drink. To loosen false membrane. Raw lemon juice 1, water 2. Pineapple juice. Teas: Red Sage, fresh Poke root. Cold packs – saturated with Echinacea (Tincture, Liquid Extract or decoction) to throat.
Note: Capsicum and Lobelia open up the surface blood flow of the body thus releasing congestion on the inner mucous membranes.
Diet. Complete lemon-juice and herb tea fast with no solid foods as long as crisis lasts.
To be treated by a general medical practitioner or hospital specialist. ... diphtheria
Symptoms: blinking, watering, acute discomfort. Sensation of grit in the eye does not always imply foreign body, but symptoms of conjunctivitis or keratitis. Automatic blinking is sometimes enough to clear offending object.
Treatment. External. Evert lid and remove. Swab out with dilute Witch Hazel on cotton wool. Inject one drop Castor oil, (also good for scratched cornea), Aloe Vera gel or juice. Fenugreek seed puree. Juice of Houseleek and dairy cream.
Difficult case. Removal of particles of iron or dust, apply mucilage of Slippery Elm powder to eye – patient lying on his back, a second person injecting it into corner of eye, the patient moving eye in opposite direction. Safe and healing. Clean eye and bathe with warm milk.
Referral to consultant ophthalmologist. ... eyes – foreign body
Avoid overstocking; some herbs lose their potency on the shelf in time, especially if exposed. Do not keep on a high shelf out of the way. Experts suggest a large box with a lid to protect its contents, kept in a cool dry place away from foods and other household items. Store mixtures containing Camphor separately elsewhere. Camphor is well-known as a strong antidote to medicinal substances. Keep all home-made ointments in a refrigerator. However harmless, keep all remedies out of reach of children. Be sure that all tablet containers have child-resistant tops.
Keep a separate box, with duplicates, permanently in the car. Check periodically. Replace all tablets when crumbled, medicines with changed colour or consistency. Always carry a large plastic bottle of water in the car for cleansing dirty wounds and to form a vehicle to Witch Hazel and other remedies. Label all containers clearly.
Health care items: Adhesive bandages of all sizes, sterile gauze, absorbant cotton wool, adhesive tape, elastic bandage, stitch scissors, forceps (boiled before use), clinical thermometer, assorted safety pins, eye-bath for use as a douche for eye troubles, medicine glass for correct dosage.
Herbal and other items: Comfrey or Chickweed ointment (or cream) for sprains and bruises. Marshmallow and Slippery Elm (drawing) ointment for boils, abscesses, etc. Calendula (Marigold) ointment or lotion for bleeding wounds where the skin is broken. An alternative is Calendula tincture (30 drops) to cupful of boiled water allowed to cool; use externally, as a mouth rinse after dental extractions, and sipped for shock. Arnica tincture: for bathing bruises and swellings where the skin is unbroken (30 drops in a cup of boiled water allowed to cool). Honey for burns and scalds. Lobelia tablets for irritating cough and respiratory distress. Powdered Ginger for adding to hot water for indigestion, vomiting, etc. Tincture Myrrh, 5-10 drops in a glass of water for sore throats, tonsillitis, mouth ulcers and externally, for cleansing infected or dirty wounds. Tincture Capsicum (3-10 drops) in a cup of tea for shock, or in eggcup Olive oil for use as a liniment for pains of rheumatism. Cider vinegar (or bicarbonate of Soda) for insect bites. Oil Citronella, insect repellent. Vitamin E capsules for burns; pierce capsule and wipe contents over burnt area. Friar’s balsam to inhale for congestion of nose and throat. Oil of Cloves for toothache. Olbas oil for general purposes. Castor oil to assist removal of foreign bodies from the eye. Slippery Elm powder as a gruel for looseness of bowels. Potter’s Composition Essence for weakness or collapse. Antispasmodic drops for pain.
Distilled extract of Witch Hazel deserves special mention for bleeding wounds, sunburn, animal bites, stings, or swabbed over the forehead to freshen and revive during an exhausting journey. See: WITCH HAZEL.
Stings of nettles or other plants are usually rendered painless by a dock leaf. Oils of Tea Tree, Jojoba and Evening Primrose are also excellent for first aid to allay infection. For punctured wounds, as a shoemaker piercing his thumb with an awl or injury from brass tacks, or for shooting pains radiating from the seat of injury, tincture or oil of St John’s Wort (Hypericum) is the remedy. ... first aid and medicine chest
To determine the cause of earache, the ear is inspected (see ear, examination of). Analgesic drugs may relieve the pain, and antibiotic drugs may be given for infection. Pus in the outer ear may be removed by suction. Pus in the middle ear may be drained by myringotomy. ear, cauliflower See cauliflower ear. ear, discharge from An emission of fluid from the ear, also called otorrhoea. It may be due to outer-ear infection (see otitis externa). It may also follow perforation of the eardrum (see eardrum, perforated), usually due to middle-ear infection (see otitis media). Rarely, after a skull fracture, cerebrospinal fluid or blood may be discharged.
A swab may be taken of the discharge and analysed to identify any infection. Hearing tests may be performed. X-rays of the skull are taken if there has been a head injury or serious middle-ear infection is suspected. Treatment usually includes antibiotic drugs.... earache
Untreated gonorrhoea may spread to other parts of the body. In men, it may cause prostatitis or epididymo-orchitis, affecting fertility. In women, untreated gonorrhoea results in pelvic inflammatory disease, causing damage to the fallopian tubes. This increases the risk of ectopic pregnancy and may lead to infertility. Gonococcal bacteria in the bloodstream may result in septicaemia or septic arthritis.
Tests are performed on a sample of discharge or on swabs taken from the urethra, cervix, or rectum in order to confirm the diagnosis. Gonorrhoea is treated with antibiotic drugs.... gonorrhoea
Genital herpes cannot be cured, but treatment can reduce the severity of symptoms. Antiviral drugs such as aciclovir make the ulcers less painful and also encourage healing. Other measures include taking analgesic drugs and bathing with a salt solution.
Once the virus enters the body, it stays there for the rest of the person’s life. Recurrent attacks may occur, usually during periods when the person is feeling run down, anxious, or depressed, before menstruation, or after sexual intercourse. The virus can be spread to others through sexual intercourse even when symptoms are absent. Recurrent attacks tend to become less frequent and less severe over time.Genital herpes may be passed from a pregnant woman to her baby during delivery.
If the virus can be detected in vaginal swabs, delivery by caesarean section is usually recommended.... herpes, genital
Common symptoms include abdominal pain and tenderness, fever, and irregular menstrual periods. Pain often occurs after menstruation and may be worse during intercourse. There may also be malaise, vomiting, or backache. A diagnosis is usually made by an internal pelvic examination, examination of swabs to look for infection, and a laparoscopy. Antibiotic drugs and sometimes analgesic drugs are prescribed. An may need to be removed.... pelvic inflammatory disease
Most infected children have no symptoms. In others, there is a slight fever, sore throat, headache, and vomiting after a 3–5-day incubation period. Most children recover completely, but inflammation of the meninges may develop. Symptoms are fever, severe headache, stiff neck and back, and aching muscles, sometimes with widespread twitching. Often, extensive paralysis, usually of the legs and lower trunk, occurs in a few hours. If infection spreads to the brainstem, problems with, or total loss of, swallowing and breathing may result.
Diagnosis is made by lumbar puncture, throat swab, or a faeces sample. Characteristic paralysis with an acute feverish illness allows an immediate diagnosis. There is no effective drug treatment for polio. Nonparalytic patients usually need bed rest and analgesic drugs. In paralysis, physiotherapy and, in some cases, catheterization, tracheostomy, and artificial ventilation are needed.
Recovery from nonparalytic polio is complete. More than half of those with paralysis make a full recovery, fewer than a quarter are left with severe disability, and fewer than 1 in 10 dies.
In the , vaccination against polio is given at about age 2, 3, and 4 months, with a booster dose at about 5 years (see immunization). Parents and carers should also be immunized because the active vaccine can cause polio.... poliomyelitis
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