See PULSATION.
“Half of all migraine patients suffer from anxiety, and one in five experiences depression,” according to a study carried out at Manchester University. (Dr Jennifer Devlen)
Causes: many and varied. Alcohol, excess coffee and caffeine stimulants, gluten food allergies, dairy products, chocolate, citrus fruits. Related to carbohydrate metabolism. May be associated with menstruation or emotional disturbance, nervous or physical fatigue; liver, stomach or kidney disturbance, or The Pill.
Symptoms: temporary blindness, or sight may be only half the visual field. Flashing lights, throbbing headache, loud noises worsen, nausea, vomiting, depression.
Treatment. In the initial (constrictive) stage any of the following simple teas may resolve: German Chamomile, Betony, Skullcap, Wild Thyme, Valerian.
Where the condition has progressed to vasodilation (engorgement of cerebral blood vessels) give any of the following alternatives. Whilst the requirements of each individual case is observed, inclusion of a remedy for stomach and liver may enhance efficacy. Sometimes a timely diuretic to reduce volume of the blood aborts an attack.
Associated with menstrual disorders: Agnus Castus, Evening Primrose oil.
Tea: Formula. (1) Equal parts: Betony, Valerian, Dandelion root. (2) Alfalfa 1; Valerian half; Hops quarter. One heaped teaspoon to each cup boiling water; infuse 15 minutes. Half-1 cup 2-3 times daily. Formula. Skullcap 2; Mistletoe 1; Hops half. Dose: Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) 2-3 times daily.
Valerian. German traditional.
Feverfew. 2-3 fresh leaves on bread. Tincture (or essence) 5-10 drops.
Practitioner: Tincture Gelsemium, BPC (1963) 5 drops.
Diet: Fruit juice fast. Oily fish. Hay diet. Salt-free.
Vitamins. A. B-complex, B6, B12, C (up to 1000mg). E, Niacin.
Minerals. Manganese, Calcium, Magnesium, Zinc.
Rose-tinted glasses. Ophthalmology Department, Birmingham University.
Information. British Migraine Association, 178A High Road, West Byfleet, Surrey KT14 7ED. Send SAE. ... migraine
Symptoms In most cases, death from asphyxia is due to insu?ciency of oxygen supplied to the blood. The ?rst signs are rapid pulse and gasping for breath. Next comes a rise in the blood pressure, causing throbbing in the head, with lividity or blueness of the skin, due to failure of aeration of the blood, followed by still greater struggles for breath and by general CONVULSIONS. The heart becomes overdistended and gradually weaker, a paralytic stage sets in, and all struggling and breathing slowly cease. When asphyxia is due to charcoal fumes, coal-gas, and other narcotic in?uences, there is no convulsive stage, and death ensues gently and may occur in the course of sleep.
Treatment So long as the heart continues to beat, recovery may be looked for with prompt treatment. The one essential of treatment is to get the impure blood aerated by arti?cial respiration. Besides this, the feeble circulation can be helped by various methods. (See APPENDIX 1: BASIC FIRST AID – Choking; Cardiac/respiratory arrest.)... asphyxia
Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.
SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.
The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.
HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper
limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.
Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.
Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.
The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.
Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.
with plaster of Paris. If closed traction does not work, then open reduction of the fracture may
be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.
External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.
Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.
Complications of fractures are fairly common. In non-union, the fracture does not unite
– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.
Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.
Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:
subcapital where the neck joins the head of the femur.
intertrochanteric through the trochanter.
subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur
need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.
In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.
Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.
Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.
The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.
Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).
Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.
Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.
Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.
By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.
Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.
Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.
Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.
Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.
With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.
Further information is available from the National Osteoporosis Society.
Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.
If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.
For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.
Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.
EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.
MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.
OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.
OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of
Examination of the ear includes inspection of the external ear. An auriscope is used to examine the external ear canal and the ear drum. If a more detailed inspection is required, a microscope may be used to improve illumination and magni?cation.
Tuning-fork or Rinne tests are performed to identify the presence of DEAFNESS. The examiner tests whether the vibrating fork is audible at the meatus, and then the foot of the fork is placed on the mastoid bone of the ear to discover at which of the two sites the patient can hear the vibrations for the longest time. This can help to di?erentiate between conductive and nerve deafness.
Hearing tests are carried out to determine the level of hearing. An audiometer is used to deliver a series of short tones of varying frequency to the ear, either through a pair of headphones or via a sound transducer applied directly to the skull. The intensity of the sound is gradually reduced until it is no longer heard and this represents the threshold of hearing, at that frequency, through air and bone respectively. It may be necessary to play a masking noise into the opposite ear to prevent that ear from hearing the tones, enabling each ear to be tested independently.
General symptoms The following are some of the chief symptoms of ear disease: DEAFNESS (see DEAFNESS). EARACHE is most commonly due to acute in?ammation of the middle ear. Perceived pain in this region may be referred from other areas, such as the earache commonly experienced after tonsillectomy (removal of the TONSILS) or that caused by carious teeth (see TEETH, DISORDERS OF). The treatment will depend on the underlying cause. TINNITUS or ringing in the ear often accompanies deafness, but is sometimes the only symptom of ear disease. Even normal people sometimes experience tinnitus, particularly if put in soundproofed surroundings. It may be described as hissing, buzzing, the sound of the sea, or of bells. The intensity of the tinnitis usually ?uctuates, sometimes disappearing altogether. It may occur in almost any form of ear disease, but is particularly troublesome in nerve deafness due to ageing and in noise-induced deafness. The symptom seems to originate in the brain’s subcortical regions, high in the central nervous system. It may be a symptom of general diseases such as ANAEMIA, high blood pressure and arterial disease, in which cases it is often synchronous with the pulse, and may also be caused by drugs such as QUININE, salicylates (SALICYLIC ACID and its salts, for example, ASPIRIN) and certain ANTIBIOTICS. Treatment of any underlying ear disorder or systemic disease, including DEPRESSION, may reduce or even cure the tinnitis, but unfortunately in many cases the noises persist. Management involves psychological techniques and initially an explanation of the mechanism and reassurance that tinnitus does not signify brain disease, or an impending STROKE, may help the person. Tinnitus maskers – which look like hearing aids – have long been used with a suitably pitched sound helping to ‘mask’ the condition.
Diseases of the external ear
WAX (cerumen) is produced by specialised glands in the outer part of the ear canal only. Impacted wax within the ear canal can cause deafness, tinnitis and sometimes disturbance of balance. Wax can sometimes be softened with olive oil, 5-per-cent bicarbonate of soda or commercially prepared drops, and it will gradually liquefy and ‘remove itself’. If this is ineffective, syringing by a doctor or nurse will usually remove the wax but sometimes it is necessary for a specialist (otologist) to remove it manually with instruments. Syringing should not be done if perforation of the tympanic membrane (eardrum) is suspected. FOREIGN BODIES such as peas, beads or buttons may be found in the external ear canal, especially in children who have usually introduced them themselves. Live insects may also be trapped in the external canal causing intense irritation and noise, and in such cases spirit drops are ?rst instilled into the ear to kill the insect. Except in foreign bodies of vegetable origin, where swelling and pain may occur, syringing may be used to remove some foreign bodies, but often removal by a specialist using suitable instrumentation and an operating microscope is required. In children, a general anaesthetic may be needed. ACUTE OTITIS EXTERNA may be a di?use in?ammation or a boil (furuncle) occurring in the outer ear canal. The pinna is usually tender on movement (unlike acute otitis media – see below) and a discharge may be present. Initially treatment should be local, using magnesium sulphate paste or glycerine and 10-per-cent ichthaminol. Topical antibiotic drops can be used and sometimes antibiotics by mouth are necessary, especially if infection is acute. Clotrimazole drops are a useful antifungal treatment. Analgesics and locally applied warmth should relieve the pain.
CHRONIC OTITIS EXTERNA producing pain and discharge, can be caused by eczema, seborrhoeic DERMATITIS or PSORIASIS. Hair lotions and cosmetic preparations may trigger local allergic reactions in the external ear, and the chronic disorder may be the result of swimming or use of dirty towels. Careful cleaning of the ear by an ENT (Ear, Nose & Throat) surgeon and topical antibiotic or antifungal agents – along with removal of any precipitating cause – are the usual treatments. TUMOURS of the ear can arise in the skin of the auricle, often as a result of exposure to sunlight, and can be benign or malignant. Within the ear canal itself, the commonest tumours are benign outgrowths from the surrounding bone, said to occur in swimmers as a result of repeated exposure to cold water. Polyps may result from chronic infection of the ear canal and drum, particularly in the presence of a perforation. These polyps are soft and may be large enough to ?ll the ear canal, but may shrink considerably after treatment of the associated infection.
Diseases of the middle ear
OTITIS MEDIA or infection of the middle ear, usually occurs as a result of infection spreading up the Eustachian tubes from the nose, throat or sinuses. It may follow a cold, tonsillitis or sinusitis, and may also be caused by swimming and diving where water and infected secretions are forced up the Eustachian tube into the middle ear. Primarily it is a disease of children, with as many as 1.5 million cases occurring in Britain every year. Pain may be intense and throbbing or sharp in character. The condition is accompanied by deafness, fever and often TINNITUS.
In infants, crying may be the only sign that something is wrong – though this is usually accompanied by some localising manifestation such as rubbing or pulling at the ear. Examination of the ear usually reveals redness, and sometimes bulging, of the ear drum. In the early stages there is no discharge, but in the later stages there may be a discharge from perforation of the ear drum as a result of the pressure created in the middle ear by the accumulated pus. This is usually accompanied by an immediate reduction in pain.
Treatment consists of the immediate administration of an antibiotic, usually one of the penicillins (e.g. amoxicillin). In the majority of cases no further treatment is required, but if this does not quickly bring relief then it may be necessary to perform a myringotomy, or incision of the ear drum, to drain pus from the middle ear. When otitis media is treated immediately with su?cient dosage of the appropriate antibiotic, the chances of any permanent damage to the ear or to hearing are reduced to a negligible degree, as is the risk of any complications such as mastoiditis (discussed later in this section). CHRONIC OTITIS MEDIA WITH EFFUSION or glue ear, is the most common in?ammatory condition of the middle ear in children, to the extent that one in four children in the UK entering school has had an episode of ‘glue ear’. It is characterised by a persistent sticky ?uid in the middle ear (hence the name); this causes a conductive-type deafness. It may be associated with enlarged adenoids (see NOSE, DISORDERS OF) which impair the function of the Eustachian tube. If the hearing impairment is persistent and causes problems, drainage of the ?uid, along with antibiotic treatment, may be needed – possibly in conjunction with removal of the adenoids. The insertion of grommets (ventilation tubes) was for a time standard treatment, but while hearing is often restored, there may be no long-term gain and even a risk of damage to the tympanic membrane, so the operation is less popular than it was a decade or so ago. MASTOIDITIS is a serious complication of in?ammation of the middle ear, the incidence of which has been dramatically reduced by the introduction of antibiotics. In?ammation in this cavity usually arises by direct spread of acute or chronic in?ammation from the middle ear. The signs of this condition include swelling and tenderness of the skin behind the ear, redness and swelling inside the ear, pain in the side of the head, high fever, and a discharge from the ear. The management of this condition in the ?rst instance is with antibiotics, usually given intravenously; however, if the condition fails to improve, surgical treatment is necessary. This involves draining any pus from the middle ear and mastoid, and removing diseased lining and bone from the mastoid.
Diseases of the inner ear
MENIÈRE’S DISEASE is a common idiopathic disorder of ENDOLYMPH control in the semicircular canals (see EAR), characterised by the triad of episodic VERTIGO with deafness and tinnitus. The cause is unknown and usually one ear only is affected at ?rst, but eventually the opposite ear is affected in approximately 50 per cent of cases. The onset of dizziness is often sudden and lasts for up to 24 hours. The hearing loss is temporary in the early stages, but with each attack there may be a progressive nerve deafness. Nausea and vomiting often occur. Treatment during the attacks includes rest and drugs to control sickness. Vasodilator drugs such as betahistine hydrochloride may be helpful. Surgical treatment is sometimes required if crippling attacks of dizziness persist despite these measures. OTOSCLEROSIS A disorder of the middle ear that results in progressive deafness. Often running in families, otosclerosis affects about one person in 200; it customarily occurs early in adult life. An overgrowth of bone ?xes the stapes (the innermost bone of the middle ear) and stops sound vibrations from being transmitted to the inner ear. The result is conductive deafness. The disorder usually affects both ears. Those affected tend to talk quietly and deafness increases over a 10–15 year period. Tinnitus often occurs, and occasionally vertigo.
Abnormal hearing tests point to the diagnosis; the deafness may be partially overcome with a hearing aid but surgery is eventually needed. This involves replacing the stapes bone with a synthetic substitute (stapedectomy). (See also OTIC BAROTRAUMA.)... ear, diseases of
– supply, leading to NECROSIS of the skin and, in severe cases, of the underlying tissues. Chie?y affecting exposed parts of the body, such as the face and the limbs, frostbite occurs especially in people exercising at high altitudes, or in those at risk of peripheral vascular disease, such as diabetics (see DIABETES MELLITUS), who should take particular care of their ?ngers and toes when in cold environments.
In mild cases – the condition sometimes known as frostnip – the skin on exposed parts of the body, such as the cheeks or nose, becomes white and numb with a sudden and complete cessation of cold and discomfort. In more severe cases, blisters develop on the frozen part, and the skin then gradually hardens and turns black until the frozen part, such as a ?nger, is covered with a black shell of dead tissue. Swelling of the underlying tissue occurs and this is accompanied by throbbing and aching. If, as is often the case, only the skin and the tissues immediately under it are frozen, then in a matter of months the dead tissue peels o?. In the most severe cases of all, muscles, bone and tendon are also frozen, and the affected part becomes cold, swollen, mottled and blue or grey. There may be no blistering in these severe cases. At ?rst there is no pain, but in time shooting and throbbing pains usually develop.
Prevention This consists of wearing the right clothing and never venturing on even quite short expeditions in cold weather, particularly on mountains, without taking expert advice as to what should be worn.
Treatment Frostnip is the only form of frostbite that should be treated on the spot. As it usually occurs on exposed parts, such as the face, each member of the party should be on the lookout for it in another. The moment that whitening of the skin is seen, the individual should seek shelter and warm the affected part by covering it with his or her warm hand or a glove until the normal colour and consistency of the affected part are restored. In more severe cases, treatment should only be given in hospital or in a well-equipped camp. In essence this consists of warming the affected part, preferably in warm water, against a warm part of the body or warm air. Rewarming should be done for spells of 20 minutes at a time. The affected part should never be placed near an open ?re. Generalised warming of the whole body may also be necessary, using hot drinks, and putting the victim in a sleeping bag.... frostbite
Causes As a rule, a person is not conscious of the beating of the heart except when the nervous system is unduly excited. A disorder of the rhythm of the heart (ARRHYTHMIA) may cause palpitations. Sudden emotions, such as fright, or overuse of tobacco, tea, co?ee or alcohol may bring it on. Sometimes it may appear in people with organic heart disease.
Symptoms There may simply be a ?uttering of the heart and a feeling of faintness, or the heart may be felt pounding and the arteries throbbing, causing great distress. The subject may be conscious of the heart missing beats.
Treatment Although these symptoms can be unpleasant, they do not necessarily signify serious disease. Moderate exercise is a good thing. If the person is a smoker, he or she should stop. Tea, co?ee, alcohol or other stimulants should be taken sparingly. If symptoms persist or are severe, the individual should see a doctor and any underlying disorder should be investigated – including by exercise ECG – and treated. The BETA-ADRENOCEPTOR-BLOCKING DRUGS are the most useful drugs in controlling the palpitations of anxiety and those due to some cardiac arrhythmias.... palpitation
Abscess of the rectum (anorectal, ischiorectal, perianal) can be exceedingly painful. Chiefly from E. Coli infection, it may be associated with piles, colitis, fissures or small tears in the mucosa from hard faeces. There may be throbbing pain on sitting or defecation. In all cases Echinacea should be given to sustain the immune system.
Alternatives: Abundant herb teas. Burdock leaves, Clivers, Comfrey leaves, Figwort, Gotu Kola, Ground Ivy, Horsetail, Marigold petals, Marshmallow leaves, Mullein, Plantain, Red Clover tops. 1 heaped teaspoon to each cup boiling water: drink half-1 cup thrice daily.
Mixture: Tinctures. Echinacea 30ml; Blue Flag 15ml; Bayberry 5ml; Hydrastis can 1ml; Liquorice 1ml. Dose: One 5ml teaspoon in water, honey or fruit juice thrice daily.
Tablets/capsules. Blue Flag, Echinacea, Poke root, Red Clover, Seaweed and Sarsaparilla, Garlic (or capsules): dosage as on bottle.
Powders. Formula. Echinacea 1; Marshmallow root 1; Goldenseal quarter. Dose: 500mg (one-third teaspoon, or two 00 capsules), thrice daily.
Ointments or poultices: Aloe Vera, Comfrey, Marshmallow and Slippery Elm.
Abscess of the breast. Internal mixture as above.
Abscess of the kidney. Mixture: tinctures. Equal parts: Echinacea, Bearberry, Valerian. Dose: 1-2 5ml teaspoons, thrice daily.
Topical. Ointments or poultices: Aloe Vera, Comfrey, Marshmallow and Slippery Elm.
Diet: Regular raw food days. Vitamin C (oranges, lemons, etc.). Fish oils, oily fish or other vitamin A- rich foods.
Supplements. Vitamins A, B and E. ... abscess
Symptoms: bursting and throbbing pain, worse sitting down. Hot bath relieves.
Alternatives. Teas: Holy Thistle, Marigold petals, dried flowering tops. Clivers, Nettles. Wormwood. Oat husk. Thyme. 1 heaped teaspoon to each cup boiling water infused for 10-15 minutes. 1 cup 2-3 times daily.
Decoctions: Echinacea. Goldenseal. Juniper berries. Wild Indigo. 1 teaspoon to each cup water simmered gently 20 minutes. Half a cup 2-3 times daily.
Powders. Formula. Echinacea 1; Stone root half; Wild Yam half. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.
Liquid extracts. Echinacea 1; Goldenseal quarter; Stone root quarter; Marshmallow 1 and a half. Mix. Dose: 15-30 drops, in water, 2-3 times daily before meals.
Tincture. Tincture Myrrh BPC (1973). 15-40 drops, in water or honey, 3 times daily before meals. Topical. Aloe Vera juice, fresh leaf or gel. Comfrey, Chickweed or Marshmallow and Slippery Elm ointment. ... abscess anal
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
See separate entry for migraine.
As indicated: relaxants, antispasmodics, hepatics (liver agents), laxatives. BHP (1983) recommends: Betony, Hops, St John’s Wort, Yerba Mate, Catmint, Passion flower, Jamaican Dogwood, Pulsatilla, Rosemary. A diuretic may release excess body fluid and surprisingly relieve headache as in pre-menstrual tension.
Frontal headache: Agnus Castus.
From eyestrain: Rue, Witch Hazel.
After heavy physical work: Ginseng.
Neuralgia of the skull: Gelsemium.
Low blood pressure: Gentian.
High blood pressure: Lime flowers.
Depressive conditions: Cola.
Pain, back of the head: Oats, Ladyslipper.
Pre-menstrual: Cramp bark, Agnus Castus.
Excess mental exertion: Rosemary.
Following anger: Sumbul.
In children: see CHILDREN’S COMPLAINTS.
Pain, top of head: Pulsatilla, Cactus.
Throbbing headache: Chamomile.
Sick headache: Blue Flag.
Tension headache: Skullcap, Betony, Passion flower.
Cluster headache, associated with shingles: Vervain, Skullcap.
Menstrual headache: see entry: MENSTRUAL HEADACHE.
Alternatives. Tea. Combine equal parts: Skullcap, Betony, Chamomile. 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup when necessary.
Decoction. Combine equal parts: Valerian, Blue Flag, Barberry bark. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup whens necessary.
Tablets/capsules. Blue Flag, Valerian, Chamomile, Passion flower.
Powders. Formula. Equal parts: Skullcap, Rosemary, Valerian. 500mg (two 00 capsules or one-third teaspoon) when necessary.
Tinctures. Combine equal parts: Mistletoe, Valerian, Skullcap. One to two teaspoons in water every 3 hours as necessary.
Tincture Rosemary. 15-30 drops in water as necessary.
Practitioner. Tincture Gelsemium 5 drops to 100ml water (half cup) – 1 teaspoon hourly.
Traditional combination: Skullcap, Valerian, Mistletoe.
Topical. Hot footbaths. Cold compress to head.
Aromatherapy. Anoint forehead with few drops: Lavender, Chamomile, Rosemary, Mint, Balm, or Tiger Balm essential oils.
Diet. Low fat. Low salt. Avoid meats preserved in sodium nitrite (bacon, ham, red meats, etc). Supplementation. Vitamins A, B-complex, B6 (50mg), B12, C (up to 1 gram), E (up to 1000iu). Magnesium, Zinc. ... headache, common
Symptoms: Mastoid bone behind the ear is tender to touch. Feverishness, red flush over mastoid area, deafness with throbbing earache, malaise, heavy discharge from the ear through perforated eardrum. Diagnostic sign: pinna (external ear) is displaced.
Treatment. Indicated: anti-microbials, anti-bacterials, alteratives with nervines as supportives. Yarrow tea.
Decoction. Combine: Echinacea 3; Wild Indigo 2; Poke root 1. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup every 2 hours with pinch of Cayenne.
Formula. Echinacea 2; Wild Indigo 1; Pulsatilla 1; few grains of Cayenne or Tincture Capsicum drops. Dose: Liquid Extracts: 30-60 drops (2-4ml). Tinctures: 4-8ml. Powders: 500mg (two 00 capsules or one- third teaspoon). Every 2 hours according to age. Children under 5 years – one-quarter dosage; under 12 years – half dosage.
Vitamin C. Copious fluids: fruit juices. Yarrow tea.
Topical. Goldenseal Ear Drops. Oil of Mullein, Sage or Lavender. Gentle massage with Tea Tree oil or Rosemary oil around the mastoid bone and in front of the ear 3/4 times daily.
Treatment by or in liaison with a general medical practitioner. ... mastoiditis
Action: prostaglandin inhibitor, anti-diarrhoeal, anti-inflammatory, antispasmodic, sedative, diaphoretic, brain stimulant, carminative, aromatic (oil), digestive stimulant.
Uses: children’s diarrhoea, dysentery, colic, nausea, vomiting, to promote acid content of gastric juice. Claimed to dissolve gall-stones. Nervous stomach, throbbing headache caused by stress, palpitation.
Relief of muscle tension back of neck.
“To comfort head and nerves.” (Dr Joseph Mill)
Preparations: Average dose, 0.3-1 gram or equivalent. Thrice daily, after meals. Grains obtained by rubbing a Nutmeg over a metal kitchen grater; may be taken in a beverage, honey, mashed banana, etc. Powder: Fill No 3 gelatin capsules; 1 capsule or 50mg.
Oil: an alternative for internal conditions. 1-2 drops daily.
Massage oil for rheumatic pains and to stimulate circulation: Nutmeg oil (1), Olive oil or Almond oil (10).
Home tincture: one freshly grated Nutmeg to macerate in half pint 60 per cent alcohol (Vodka, gin, etc) 7 days. Decant. Dose: 5-10 drops.
Avoid large doses. ... nutmeg
Infection is usually blood-born from dental abscess, tonsils, boil, or old wounds. Prompt modern hospital treatment is necessary to avoid thrombosis or necrosis of bone. Herbal medication can play a substantial supportive role. Differential diagnosis should exclude Infective Arthritis, Cellulitis, Rheumatic Fever, Leukaemia.
Symptoms. Affected bone painful and hot. Throbbing. Fever. Dehydration. Raised E.S.R. Severe general illness.
Treatment. Should enhance resistance as well as combat infection. Comfrey and Echinacea are principle remedies. Infected bone areas are not well supplied with blood, so oral antibiotics may not reach them; this is where topical herbal treatments can assist. Anti-bacterial drinks are available in the absence of conventional antibiotics.
To promote cell proliferation and callous formation: Comfrey root, Marigold, St John’s Wort, Arnica. (Madaus)
To stimulate connective tissue: Thuja.
Comfrey root. Potential benefit outweighs possible risk.
Teas. Nettles. Plantain. Silverweed, Yarrow. Boneset. Marigold petals. St John’s Wort. Comfrey leaves. Singly or in combination. Abundant drinks during the day.
Formula. Echinacea 2; Comfrey 1; Myrrh half; Thuja quarter. Dose – Liquid extracts: 2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Three or more times daily in water or honey.
Madaus: Tardolyt. Birthwort: a sodium salt of aristolochic acid.
Maria Treben: Yarrow and Fenugreek tea. Half cup Yarrow tea 4 times daily. To two of such cups, add half a teaspoon ground Fenugreek seeds.
Dr Finlay Ellingwood: Liquid Extract Echinacea 20-30 drops in water four times daily. And: Liquid Extract Lobelia 20-30 drops in water twice daily. Calcium Lactate tablets.
Topical. Comfrey root poultices to facilitate removal of pus, and to heal.
Diet. No solids. Fruit and milk diet for 5 days, followed by lacto-vegetarian diet. Herb teas as above. Plenty of water to combat dehydration.
Supplements. Daily. Vitamin B12 (50mcg), C (3g), D (500iu), E (1000iu). Calcium (1000-1500mg) taken as calcium lactate, Zinc.
General. Regulate bowels. Surgical treatment in a modern hospital necessary for removal of dead bone (sequestrum) and for adequate nursing facilities.
Treatment by a general medical practitioner or hospital specialist. ... osteomyelitis
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