Wasting Health Dictionary

Wasting of a tissue or organ... atrophy

Wasting of body tissues. Thin (same as cachexia).... emaciation

A rare disease affecting the SPINAL CORD, in which irregular cavities form, surrounded by an excessive amount of the connective tissue of the central nervous system. These cavities encroach upon the nerve-tracts in the cord, producing especially loss of the sense of pain or of that for heat and cold in parts of the limbs, although the sensation of touch is retained. Another occasional symptom is wasting of certain muscles in the limbs. Changes affecting outlying parts like the ?ngers are also found. Because of their insensitiveness to pain, these are often burnt or injured; troublesome ulcers, or loss of parts of the ?ngers, may result. The condition of the spinal cord is probably present at birth, although the symptoms do not usually appear until adulthood. The disease is slowly progressive, although sudden exacerbations may occur after a cough, a sneeze, or sudden straining. Treatment is supportive for this progressive disorder.... syringomyelia

Slow progressive muscle wasting and weakness in childhood, developing usually before the fifth year. Peroneal muscular atrophy. Few survive after adolescence. “Waddling” gait, frequent falls, deformity. Another type: facio-scapular-humeral develops in early adult life. No cure possible.

Associated with a deficiency of taurine, (an amino acid) and Vitamin E.

Treatment. No specific therapy. Surgery sometimes able to correct. Herbs to support the constitution. Herbs contain vital complexes of minerals which may arrest progress of the disease.

Teas: Plantain, Alfalfa, Fenugreek seeds.

Tablets/capsules. Alfalfa, Kelp, Irish Moss, Saw Palmetto, Damiana.

For pain. See: ANTISPASMODIC DROPS. Wild Lettuce.

Evening Primrose. 4 × 500mg capsules, daily.

Diet. Bananas for potassium. Oats: oatmeal porridge.

Vitamins. A. B6. B12. C. E. Pantothenic acid.

Minerals. Dolomite, Potassium. Zinc.

Aromatherapy. Massage spine. Three drops each – Rosemary and Lavender in 2 teaspoons Almond oil. Treatment by or in liaison with a general medical practitioner. ... muscular dystrophy

Wasting of body tissues. Extremely thin (cachectic).... cachexia

A type of muscular dystrophy (see MUSCLES, DISORDERS OF) in which the affected person has weakness and wasting of the muscles, particularly those in the face and neck. Other effects are CATARACT, ptosis (see EYE, DISORDERS OF), baldness and malfunctioning of the endocrine system (see ENDOCRINE GLANDS). Both sexes may be affected by this inherited disorder.... dystrophia myotonica

Progressive wasting, especially in young children, when there is no ascertainable cause. It is generally associated with defective feeding. (See also ATROPHY; INFANT FEEDING.)... marasmus

A historical term means wasting, and was applied to that progressive enfeeblement and loss of weight that arose from tuberculous disease of all kinds, but especially from the disease as it affected the lungs (see TUBERCULOSIS).... phthisis

A group of disorders of unknown origin. Certain cells in the neurological system’s MOTOR nerves degenerate and die. Upper and lower motor neurones may be affected but sensory cells retain their normal functions. Three types of MND are identi?ed: amyotrophic lateral sclerosis (AML – 50 per cent of patients); progressive muscular atrophy (25 per cent), in which the prognosis is better than for AML; and bulbar palsy (25 per cent). Men are affected more than women, and the disorder affects about seven people in every 100,000. Those affected develop progressive weakness and wasting of their muscles. The diagnosis is con?rmed with various tests including the measurement of electrical activity in muscles, electromyography, muscle BIOPSY, blood tests and X-ray examination of the spine. There is no medical treatment: patients need physical and psychological support with aids to help them overcome disabilities. The Motor Neurone Disease Association provides excellent advice and help for sufferers and their relatives. (See APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP.)... motor neurone disease (mnd)

Radiculopathy is damage to the roots of nerves where they enter or leave the SPINAL CORD. Causes include ARTHRITIS of the spine, thickening of the MENINGES, and DIABETES MELLITUS. Symptoms include pain, PARAESTHESIA, numbness and wasting of muscles supplied by the nerves. Treatment is of the underlying cause.... radiculopathy

Tuberculosis results form infection with Mycobacterium tuberculosis. The lungs are the site most often affected, but most organs in the body can be involved in tuberculosis. The other common sites are LYMPH NODES, bones, gastrointestinal tract, kidneys, skin and MENINGES.

The weight loss and wasting associated with tuberculosis before treatment was available led to the disease’s popular name of consumption. Enlargement of the glands in the neck, formerly called scrofula, was known also as the ‘king’s evil’ from the supersition that a touch of the royal hand could cure the condition. Lupus vulgaris (see under LUPUS) is another of the skin manifestations of the disease.

The typical pathological change in tuberculosis involves the formation of clusters of cells called granulomas (see GRANULOMA) with death of the cells in the centre producing CASEATION.

It is estimated that there are 7–8 million new cases of tuberculosis worldwide each year, with 2–3 million deaths. The incidence of tuberculosis in developed countries has shown a steady decline throughout the 20th century, mainly as a result of improved nutrition and social conditions and accelerated by the development of antituberculous chemotherapy in the 1940s. Since the mid-1980s the decline has stopped, and incidence has even started to rise again in inner-city areas. In 2002, 7,239 cases of tuberculosis were noti?ed in the UK compared with 6,442 a decade earlier; more than 390 deaths in 2003 were attributed to the disease. Factors involved in this rise are immigration from higher-prevalence areas, poorer social conditions and homelessness in some urban centres and the association with HIV infection and drug abuse. The incidence of tuberculosis is also rising in many developing countries because of the emergence of resistant strains of the tubercle bacillus (see below). In the UK recently there have been serious outbreaks in a handful of urban-based schools.... tuberculosis

Shrinkage or wasting away of a muscle, leading to weakness.

Amyotrophy is usually due to poor nutrition, reduced use of the muscle (as when a limb is immobilized for a long period), or disruption of the blood or nerve supply to the muscle (as can occur in diabetes mellitus or poliomyelitis).... amyotrophy

Paralysis of the lower arm, with wasting of the small muscles in the hand, and numbness of the fingers (excluding the thumb) and of the inside of the forearm.

Klumpke’s paralysis is caused by injury to the 1st thoracic nerve (one of the spinal nerves) in the brachial plexus, which is usually the result of dislocation of the shoulder.... klumpke’s paralysis

A group of disorders in which there is degeneration of the nerves in the central nervous system that control muscular activity. This causes weakness and wasting of the muscles. The cause is unknown.

The most common type of motor neuron disease is amyotrophic lateral sclerosis ( or Lou Gehrig’s disease). It usually affects people over the age of 50 and is more common in men. Some cases run in families. Usually, symptoms start with weakness in the hands and arms or legs, and muscle wasting. There may be irregular muscle contractions, and muscle cramps or stiffness. All four extremities are soon affected.

Progressive muscular atrophy and progressive bulbar palsy both start with patterns of muscle weakness different from but usually develop into.There are 2 types of motor neuron disease that first appear in childhood or adolescence. In most cases, these conditions are inherited. Werdnig–Hoffman disease affects infants at birth or soon afterwards. In almost all cases, progressive muscle weakness leads to death within several years. Chronic spinal muscular atrophy begins in childhood or adolescence, causing progressive weakness but not always serious disability.

There are no specific tests for motor neuron disease. Diagnosis is based on careful clinical examination by a neurologist. Tests including EMG, muscle biopsy, blood tests, myelography, CT scanning, or MRI may be performed.

The disease typically goes on to affect the muscles involved in breathing and swallowing, leading to death within 2–4 years. However, about 10 per cent of sufferers survive for 10 years.

Nerve degeneration cannot be slowed down, but physiotherapy and the use of various aids may help to reduce disability. The drug riluzole is used to extend life (or the time until mechanical ventilation is required).... motor neuron disease

Acquired Immune De?ciency Syndrome (AIDS) is the clinical manifestation of infection with Human Immunode?ciency Virus (HIV). HIV belongs to the retroviruses, which in turn belong to the lentiviruses (characterised by slow onset of disease). There are two main HIV strains: HIV-1, by far the commonest; and HIV-2, which is prevalent in Western Africa (including Ivory Coast, Gambia, Mali, Nigeria and Sierra Leone). HIV attacks the human immune system (see IMMUNITY) so that the infected person becomes susceptible to opportunistic infections, such as TUBERCULOSIS, PNEUMONIA, DIARRHOEA, MENINGITIS and tumours such as KAPOSI’S SARCOMA. AIDS is thus the disease syndrome associated with advanced HIV infection.

Both HIV-1 and HIV-2 are predominantly sexually transmitted and both are associated with secondary opportunistic infections. However, HIV-2 seems to result in slower damage to the immune system. HIV-1 is known to mutate rapidly and has given rise to other subtypes.

HIV is thought to have occurred in humans in the 1950s, but whether or not it infected humans from another primate species is uncertain. It became widespread in the 1970s but its latency in causing symptoms meant that the epidemic was not noticed until the following decade. Although it is a sexually transmitted disease, it can also be transmitted by intravenous drug use (through sharing an infected needle), blood transfusions with infected blood (hence the importance of e?ective national blood-screening programmes), organ donation, and occupationally (see health-care workers, below). Babies born of HIV-positive mothers can be infected before or during birth, or through breast feeding.

Although HIV is most likely to occur in blood, semen or vaginal ?uid, it has been found in saliva and tears (but not sweat); however, there is no evidence that the virus can be transmitted from these two body ?uids. There is also no evidence that HIV can be transmitted by biting insects (such as mosquitoes). HIV does not survive well in the environment and is rapidly destroyed through drying.

Prevalence At the end of 2003 an estimated 42 million people globally were infected with HIV – up from 40 million two years earlier. About one-third of those with HIV/AIDS are aged 15–24 and most are unaware that they are carrying the virus. During 2003 it is estimated that 5 million adults and children worldwide were newly infected with HIV, and that 3 million adults and children died. In Africa in 2003,

3.4 million people were newly infected and 2.3 million died, with more than 28 million carrying the virus. HIV/AIDS was the leading cause of death in sub-Saharan Africa where over half of the infections were in women and 90 per cent of cases resulted from heterosexual sex. In some southern African countries, one in three pregnant women had HIV.

In Asia and the Paci?c there were 1.2 million new infections and 435,000 deaths. The area with the fastest-growing epidemic is Eastern Europe, especially the Russian Federation where in 2002 around a million people had HIV and there were an estimated 250,000 new infections, with intravenous drug use a key contributor to this ?gure. Seventy-?ve per cent of cases occurred in men, with male-to-male sexual transmission an important cause of infection, though heterosexual activity is a rising cause of infection.

At the end of 2002 the UK had an estimated 55,900 HIV-infected adults aged between 15 and 59. More than 3,600 individuals were newly diagnosed with the infection in 2000, the highest annual ?gure since the epidemic started

– in 1998 the ?gure was 2,817 and in 1999 just over 3,000 (Department of Health and Communicable Disease Surveillance Centre). The incidence of AIDS in the UK has declined sharply since the introduction of highly active antiretroviral therapy (HAART) and HIV-related deaths have also fallen: in 2002 there were 777 reported new AIDS cases and 395 deaths, compared with 1,769 and 1,719 respectively in 1995. (Sources: UNAIDS and WHO, AIDS Epidemic Update, December 2001; Public Health Laboratory Services AIDS and STD Centre Communicable Disease Surveillance and Scottish Centre for Infection and Environmental Health, Quarterly Surveillance Tables.)

Poverty is strongly linked to the spread of AIDS, for various reasons including lack of health education; lack of e?ective public-health awareness; women having little control over sexual behaviour and contraception; and, by comparison with the developed world, little or no access to antiretroviral drugs.

Pathogenesis The cellular target of HIV infection is a subset of white blood cells called T-lymphocytes (see LYMPHOCYTE) which carry the CD4 surface receptor. These so-called ‘helper T-cells’ are vital to the function of cell-mediated immunity. Infection of these cells leads to their destruction (HIV replicates at an enormous rate – 109) and over the course of several years the body is unable to generate suf?cient new cells to keep pace. This leads to progressive destruction of the body’s immune capabilities, evidenced clinically by the development of opportunistic infection and unusual tumours.

Monitoring of clinical progression It is possible to measure the number of viral particles present in the plasma. This gives an accurate guide to the likely progression rate, which will be slow in those individuals with fewer than 10,000 particles per ml of plasma but progressively more rapid above this ?gure. The main clinical monitoring of the immune system is through the numbers of CD4 lymphocytes in the blood. The normal count is around 850 cells per ml and, without treatment, eventual progression to AIDS is likely in those individuals whose CD4 count falls below 500 per ml. Opportunistic infections occur most frequently when the count falls below 200 per ml: most such infections are treatable, and death is only likely when the CD4 count falls below 50 cells per ml when infection is developed with organisms that are di?cult to treat because of their low intrinsic virulence.

Simple, cheap and highly accurate tests are available to detect HIV antibodies in the serum. These normally occur within three months of infection and remain the cornerstone of the diagnosis.

Clinical features Most infected individuals have a viral illness some three weeks after contact with HIV. The clinical features are often non-speci?c and remain undiagnosed but include a ?ne red rash, large lymph nodes, an in?uenza-like illness, cerebral involvement and sometimes the development of opportunistic infections. The antibody test may be negative at this stage but there are usually high levels of virus particles in the blood. The antibody test is virtually always positive within three months of infection. HIV infection is often subsequently asymptomatic for a period of ten years or more, although in most patients progressive immune destruction is occurring during this time and a variety of minor opportunistic infections such as HERPES ZOSTER or oral thrush (see CANDIDA) do occur. In addition, generalised LYMPHADENOPATHY is present in a third of patients and some suffer from severe malaise, weight loss, night sweats, mild fever, ANAEMIA or easy bruising due to THROMBOCYTOPENIA.

The presentation of opportunistic infection is highly variable but usually involves either the CENTRAL NERVOUS SYSTEM, the gastrointestinal tract or the LUNGS. Patients may present with a sudden onset of a neurological de?cit or EPILEPSY due to a sudden onset of a STROKE-like syndrome, or epilepsy due to a space-occupying lesion in the brain – most commonly TOXOPLASMOSIS. In late disease, HIV infection of the central nervous system itself may produce progressive memory loss, impaired concentration and mental slowness called AIDS DEMENTIA. A wide variety of opportunistic PROTOZOA or viruses produces DYSPHAGIA, DIARRHOEA and wasting. In the respiratory system the commonest opportunistic infection associated with AIDS, pneumonia, produces severe shortness of breath and sometimes CYANOSIS, usually with a striking lack of clinical signs in the chest.

In very late HIV infection, when the CD4 count has fallen below 50 cells per ml, infection with CYTOMEGALOVIRUS may produce progressive retinal necrosis (see EYE, DISORDERS OF) which will lead to blindness if untreated, as well as a variety of gastrointestinal symptoms. At this stage, infection with atypical mycobacteria is also common, producing severe anaemia, wasting and fevers. The commonest tumour associated with HIV is Kaposi’s sarcoma which produces purplish skin lesions. This and nonHodgkin’s lymphoma (see LYMPHOMA), which is a hundred times more frequent among HIV-positive individuals than in the general population, are likely to be associated with or caused by opportunistic viral infections.

Prevention There is, as yet, no vaccine to prevent HIV infection. Vaccine development has been hampered

by the large number of new HIV strains generated through frequent mutation and recombination.

because HIV can be transmitted as free virus and in infected cells.

because HIV infects helper T-cells – the very cells involved in the immune response. There are, however, numerous research pro

grammes underway to develop vaccines that are either prophylactic or therapeutic. Vaccine-development strategies have included: recombinant-vector vaccines, in which a live bacterium or virus is genetically modi?ed to carry one or more of the HIV genes; subunit vaccines, consisting of small regions of the HIV genome designed to induce an immune response without infection; modi?ed live HIV, which has had its disease-promoting genes removed; and DNA vaccines – small loops of DNA (plasmids) containing viral genes – that make the host cells produce non-infectious viral proteins which, in turn, trigger an immune response and prime the immune system against future infection with real virus.

In the absence of an e?ective vaccine, preventing exposure remains the chief strategy in reducing the spread of HIV. Used properly, condoms are an extremely e?ective method of preventing exposure to HIV during sexual intercourse and remain the most important public-health approach to countering the further acceleration of the AIDS epidemic. The spermicide nonoxynol-9, which is often included with condoms, is known to kill HIV in vitro; however, its e?ectiveness in preventing HIV infection during intercourse is not known.

Public-health strategies must be focused on avoiding high-risk behaviour and, particularly in developing countries, empowering women to have more control over their lives, both economically and socially. In many of the poorer regions of the world, women are economically dependent on men and refusing sex, or insisting on condom use, even when they know their partners are HIV positive, is not a straightforward option. Poverty also forces many women into the sex industry where they are at greater risk of infection.

Cultural problems in gaining acceptance for universal condom-use by men in some developing countries suggests that other preventive strategies should also be considered. Microbicides used as vaginal sprays or ‘chemical condoms’ have the potential to give women more direct control over their exposure risk, and research is underway to develop suitable products.

Epidemiological studies suggest that male circumcision may o?er some protection against HIV infection, although more research is needed before this can be an established public-health strategy. Globally, about 70 per cent of infected men have acquired the virus through unprotected vaginal sex; in these men, infection is likely to have occurred through the penis with the mucosal epithelia of the inner surface of the foreskin and the frenulum considered the most likely sites for infection. It is suggested that in circumcised men, the glans may become keratinised and thus less likely to facilitate infection. Circumcision may also reduce the risk of lesions caused by other sexually transmitted disease.

Treatment AIDS/HIV treatment can be categorised as speci?c therapies for the individual opportunistic infections – which ultimately cause death – and highly active antiretroviral therapy (HAART) designed to reduce viral load and replication. HAART is also the most e?ective way of preventing opportunistic infections, and has had a signi?cant impact in delaying the onset of AIDS in HIV-positive individuals in developed countries.

Four classes of drugs are currently in use. Nucleoside analogues, including ZIDOVUDINE and DIDANOSINE, interfere with the activity of the unique enzyme of the retrovirus reverse transcriptase which is essential for replication. Nucleotide analogues, such as tenofovir, act in the same way but require no intracellular activation. Non-nucleoside reverse transcriptase inhibitors, such as nevirapine and EFAVIRENZ, act by a di?erent mechanism on the same enzyme. The most potent single agents against HIV are the protease inhibitors, such as lopinavir, which render a unique viral enzyme ineffective. These drugs are used in a variety of combinations in an attempt to reduce the plasma HIV viral load to below detectable limits, which is achieved in approximately 90 per cent of patients who have not previously received therapy. This usually also produces a profound rise in CD4 count. It is likely, however, that such treatments need to be lifelong – and since they are associated with toxicities, long-term adherence is di?cult. Thus the optimum time for treatment intervention remains controversial, with some clinicians believing that this should be governed by the viral load rising above 10,000 copies, and others that it should primarily be designed to prevent the development of opportunistic infections – thus, that initiation of therapy should be guided more by the CD4 count.

It should be noted that the drug regimens have been devised for infection with HIV-1; it is not known how e?ective they are at treating infection with HIV-2.

HIV and pregnancy An HIV-positive woman can transmit the virus to her fetus, with the risk of infection being particularly high during parturition; however, the risk of perinatal HIV transmission can be reduced by antiviral drug therapy. In the UK, HIV testing is available to all women as part of antenatal care. The bene?ts of antenatal HIV testing in countries where antiviral drugs are not available are questionable. An HIV-positive woman might be advised not to breast feed because of the risks of transmitting HIV via breastmilk, but there may be a greater risk associated with not breast feeding at all. Babies in many poor communities are thought to be at high risk of infectious diseases and malnutrition if they are not breast fed and may thus be at greater overall risk of death during infancy.

Counselling Con?dential counselling is an essential part of AIDS management, both in terms of supporting the psychological wellbeing of the individual and in dealing with issues such as family relations, sexual partners and implications for employment (e.g. for health-care workers). Counsellors must be particularly sensitive to culture and lifestyle issues. Counselling is essential both before an HIV test is taken and when the results are revealed.

Health-care workers Health-care workers may be at risk of occupational exposure to HIV, either through undertaking invasive procedures or through accidental exposure to infected blood from a contaminated needle (needlestick injury). Needlestick injuries are frequent in health care – as many as 600,000 to 800,000 are thought to occur annually in the United States. Transmission is much more likely where the worker has been exposed to HIV through a needlestick injury or deep cut with a contaminated instrument than through exposure of mucous membranes to contaminated blood or body ?uids. However, even where exposure occurs through a needlestick injury, the risk of seroconversion is much lower than with a similar exposure to hepatitis C or hepatitis B. A percutaneous exposure to HIV-infected blood in a health-care setting is thought to carry a risk of about one infection per 300 injuries (one in 1,000 for mucous-membrane exposure), compared with one in 30 for hepatitis C, and one in three for hepatitis B (when the source patient is e-antigen positive).

In the event of an injury, health-care workers are advised to report the incident immediately where, depending on a risk assessment, they may be o?ered post-exposure prophylaxis (PEP). They should also wash the contaminated area with soap and water (but without scrubbing) and, if appropriate, encourage bleeding at the site of injury. PEP, using a combination of antiretroviral drugs (in a similar regimen to HAART – see above), is thought to greatly reduce the chances of seroconversion; it should be commenced as soon as possible, preferably within one or two hours of the injury. Although PEP is available, safe systems of work are considered to o?er the greatest protection. Double-gloving (latex gloves remove much of the blood from the surface of the needle during a needlestick), correct use of sharps containers (for used needles and instruments), avoiding the resheathing of used needles, reduction in the number of blood samples taken from a patient, safer-needle devices (such as needles that self-blunt after use) and needleless drug administration are all thought to reduce the risk of exposure to HIV and other blood-borne viruses. Although there have been numerous cases of health-care workers developing HIV through occupational exposure, there is little evidence of health-care workers passing HIV to their patients through normal medical procedures.... aids/hiv

There are some minor signs, such as: relaxation of the facial muscles (which produces the staring eye and gaping mouth of the ‘Hippocratic countenance’), as well as a loss of the curves of the back, which becomes ?at by contact with the bed or table; discoloration of the skin, which takes on a wax-yellow hue and loses its pink transparency at the ?nger-webs; absence of blistering and redness if the skin is burned (Christison’s sign); and failure of a ligature tied round the ?nger to produce, after its removal, the usual change of a white ring, which, after a few seconds, becomes redder than the surrounding skin in a living person.

The only certain sign of death, however, is that the heart has stopped beating. To ensure that this is permanent, it is necessary to listen over the heart with a stethoscope, or directly with the ear, for at least ?ve minutes. Permanent stoppage of breathing should also be con?rmed by observing that a mirror held before the mouth shows no haze, or that a feather placed on the upper lip does not ?utter.

In the vast majority of cases there is no dif?culty in ensuring that death has occurred. The introduction of organ transplantation, however, and of more e?ective mechanical means of resuscitation, such as ventilators, whereby an individual’s heart can be kept beating almost inde?nitely, has raised diffculties in a minority of cases. To solve the problem in these cases the concept of ‘brain death’ has been introduced. In this context it has to be borne in mind that there is no legal de?nition of death. Death has traditionally been diagnosed by the irreversible cessation of respiration and heartbeat. In the Code of Practice drawn up in 1983 by a Working Party of the Health Departments of Great Britain and Northern Ireland, however, it is stated that ‘death can also be diagnosed by the irreversible cessation of brain-stem function’. This is described as ‘brain death’. The brain stem consists of the mid-brain, pons and medulla oblongata which contain the centres controlling the vital processes of the body such as consciousness, breathing and the beating of the heart (see BRAIN). This new concept of death, which has been widely accepted in medical and legal circles throughout the world, means that it is now legitimate to equate brain death with death; that the essential component of brain death is death of the brain stem; and that a dead brain stem can be reliably diagnosed at the bedside. (See GLASGOW COMA SCALE.)

Four points are important in determining the time that has elapsed since death. HYPOSTASIS, or congestion, begins to appear as livid spots on the back, often mistaken for bruises, three hours or more after death. This is due to the blood running into the vessels in the lowest parts. Loss of heat begins at once after death, and the body has become as cold as the surrounding air after 12 hours – although this is delayed by hot weather, death from ASPHYXIA, and some other causes. Rigidity, or rigor mortis, begins in six hours, takes another six to become fully established, remains for 12 hours and passes o? during the succeeding 12 hours. It comes on quickly when extreme exertion has been indulged in immediately before death; conversely it is slow in onset and slight in death from wasting diseases, and slight or absent in children. It begins in the small muscles of the eyelid and jaw and then spreads over the body. PUTREFACTION is variable in time of onset, but usually begins in 2–3 days, as a greenish tint over the abdomen.... death, signs of

Diabetes mellitus is a condition characterised by a raised concentration of glucose in the blood due to a de?ciency in the production and/or action of INSULIN, a pancreatic hormone made in special cells called the islet cells of Langerhans.

Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.

Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.

Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.

A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.

Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production

– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).

Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.

Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.

Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.

Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).

Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;

(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.

Complications The risks of complications increase with duration of disease.

Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.

Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.

Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.

Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).

Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.

Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.

Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.

Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.

Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;

(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.

Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.

Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.

However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.

Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.

Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.

Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.

A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.

Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus

The wasting of muscles after prolonged immobility. This can be seen after lengthy immobilisation in a plaster cast, and is particularly severe following paralysis of a limb through nerve injury. (See ATROPHY.)... disuse atrophy

An X-linked recessive disorder (that is, the abnormal gene is carried on the X chromosome). This means that the disease occurs almost exclusively in males, as its presence in a female is counteracted by the normal gene likely to be in her other X chromosome. The disorder is characterised by progressive muscular weakness and wasting. It is the most common form of muscular dystrophy, ocurring in 30 per 100,000 live male births, often – but not always – in families with other members having the disorder.

The disease usually appears within the ?rst three years of life, beginning in the pelvic girdle and lower limbs and later spreading to the shoulder girdle. The calf muscles become bulky (pseudohypertrophy). The weakness gives rise to a characteristic waddling gait and, when rising from the supine position, the child rolls on to his face and then uses his arms to push himself up. Death usually occurs by the middle of the second decade from respiratory infections. Prenatal screening of female carriers using gene probes is increasingly available. (See DYSTROPHY; MUSCLES, DISORDERS OF – Myopathy.)... duchenne muscular dystrophy

Compression syndrome The tense, painful state of muscles induced by excessive accumulation of INTERSTITIAL ?uid in them, following unusual exercise. This condition is more liable to occur in the muscles at the front of the shin, because they lie within a tight fascial membrane: here the syndrome is known as the anterior tibial syndrome (‘shin splints’). Prevention consists of always keeping ?t and in training for the amount of exercise to be undertaken. Equally important is what is known in sporting circles as ‘warming down’: i.e., at the end of training or a game, exercise should be gradually tailed o?. Treatment consists of elevation of the affected limb, compression of it by compression bandages, with ample exercise of the limb within the bandage, and massage. In more severe cases DIURETICS may be given. Occasionally surgical decompression may be necessary.

Cramp Painful spasm of a muscle usually caused by excessive and prolonged contraction of the muscle ?bres. Cramps are common, especially among sportsmen and women, normally lasting a short time. The condition usually occurs during or immediately following exercise as a result of a build-up of LACTIC ACID and other chemical by-products in the muscles

– caused by the muscular e?orts. Cramps may occur more frequently, especially at night, in people with poor circulation, when the blood is unable to remove the lactic acid from the muscles quickly enough.

Repetitive movements such as writing (writer’s cramp) or operating a keyboard can cause cramp. Resting muscles may suffer cramp if a person sits or lies in an awkward position which limits local blood supply to them. Profuse sweating as a result of fever or hot weather can also cause cramp in resting muscle, because the victim has lost sodium salts in the sweat; this disturbs the biochemical balance in muscle tissue.

Treatment is to massage and stretch the affected muscle – for example, cramp in the calf muscle may be relieved by pulling the toes on the affected leg towards the knee. Persistent night cramps sometimes respond to treatment with a drug containing CALCIUM or QUININE. If cramp persists for an hour or more, the person should seek medical advice, as there may be a serious cause such as a blood clot impeding the blood supply to the area affected.

Dystrophy See myopathy below.

In?ammation (myositis) of various types may occur. As the result of injury, an ABSCESS may develop, although wounds affecting muscle generally heal well. A growth due to SYPHILIS, known as a gumma, sometimes forms a hard, almost painless swelling in a muscle. Rheumatism is a vague term traditionally used to de?ne intermittent and often migratory discomfort, sti?ness or pain in muscles and joints with no obvious cause. The most common form of myositis is the result of immunological damage as a result of autoimmune disease. Because it affects many muscles it is called POLYMYOSITIS.

Myasthenia (see MYASTHENIA GRAVIS) is muscle weakness due to a defect of neuromuscular conduction.

Myopathy is a term applied to an acquired or developmental defect in certain muscles. It is not a neurological disease, and should be distinguished from neuropathic conditions (see NEUROPATHY) such as MOTOR NEURONE DISEASE (MND), which tend to affect the distal limb muscles. The main subdivisions are genetically determined, congenital, metabolic, drug-induced, and myopathy (often in?ammatory) secondary to a distant carcinoma. Progressive muscular dystrophy is characterised by symmetrical wasting and weakness, the muscle ?bres being largely replaced by fatty and ?brous tissue, with no sensory loss. Inheritance may take several forms, thus affecting the sex and age of victims.

The commonest type is DUCHENNE MUSCULAR DYSTROPHY, which is inherited as a sex-linked disorder. It nearly always occurs in boys.

Symptoms There are three chief types of myopathy. The commonest, known as pseudohypertrophic muscular dystrophy, affects particularly the upper part of the lower limbs of children. The muscles of the buttocks, thighs and calves seem excessively well developed, but nevertheless the child is clumsy, weak on his legs, and has di?culty in picking himself up when he falls. In another form of the disease, which begins a little later, as a rule at about the age of 14, the muscles of the upper arm are ?rst affected, and those of the spine and lower limbs become weak later on. In a third type, which begins at about this age, the muscles of the face, along with certain of the shoulder and upper arm muscles, show the ?rst signs of wasting. All the forms have this in common: that the affected muscles grow weaker until their power to contract is quite lost. In the ?rst form, the patients seldom reach the age of 20, falling victims to some disease which, to ordinary people, would not be serious. In the other forms the wasting, after progressing to a certain extent, often remains stationary for the rest of life. Myopathy may also be acquired when it is the result of disease such as thyrotoxicosis (see under THYROID GLAND, DISEASES OF), osteomalacia (see under BONE, DISORDERS OF) and CUSHING’S DISEASE, and the myopathy resolves when the primary disease is treated.

Treatment Some myopathies may be the result of in?ammation or arise from an endocrine or metabolic abnormality. Treatment of these is the treatment of the cause, with supportive physiotherapy and any necessary physical aids while the patient is recovering. Treatment for the hereditary myopathies is supportive since, at present, there is no cure – although developments in gene research raise the possibility of future treatment. Physiotherapy, physical aids, counselling and support groups may all be helpful in caring for these patients.

The education and management of these children raise many diffculties. Much help in dealing with these problems can be obtained from Muscular Dystrophy Campaign.

Myositis ossi?cans, or deposition of bone in muscles, may be congenital or acquired. The congenital form, which is rare, ?rst manifests itself as painful swellings in the muscles. These gradually harden and extend until the child is encased in a rigid sheet. There is no e?ective treatment and the outcome is fatal.

The acquired form is a result of a direct blow on muscle, most commonly on the front of the thigh. The condition should be suspected whenever there is severe pain and swelling following a direct blow over muscle. The diagnosis is con?rmed by hardening of the swelling. Treatment consists of short-wave DIATHERMY with gentle active movements. Recovery is usually complete.

Pain, quite apart from any in?ammation or injury, may be experienced on exertion. This type of pain, known as MYALGIA, tends to occur in un?t individuals and is relieved by rest and physiotherapy.

Parasites sometimes lodge in the muscles, the most common being Trichinella spiralis, producing the disease known as TRICHINOSIS (trichiniasis).

Rupture of a muscle may occur, without any external wound, as the result of a spasmodic e?ort. It may tear the muscle right across – as sometimes happens to the feeble plantaris muscle in running and leaping – or part of the muscle may be driven through its ?brous envelope, forming a HERNIA of the muscle. The severe pain experienced in many cases of LUMBAGO is due to tearing of one of the muscles in the back. These conditions are usually relieved by rest and massage. Partial muscle tears, such as occur in sport, require more energetic treatment: in the early stages this consists of the application of an ice or cold-water pack, ?rm compression, elevation of the affected limb, rest for a day or so and then gradual mobilisation (see SPORTS MEDICINE).

Tumours occur occasionally, the most common being ?broid, fatty, and sarcomatous growths.

Wasting of muscles sometimes occurs as a symptom of disease in other organs: for example, damage to the nervous system, as in poliomyelitis or in the disease known as progressive muscular atrophy. (See PARALYSIS.)... muscles, disorders of

Any wasting disease in which the whole body or part of the body is involved... phythisis

Dystrophy means defective or faulty nutrition, and is a term applied to a group of developmental changes occurring in the muscles, independently of the nervous system (see MUSCLES, DISORDERS OF). The best-known form is progressive muscular dystrophy, a group of hereditary disorders characterised by symmetrical wasting and weakness, with no sensory loss. There are three types: Duchenne (usually occurring in boys within the ?rst three years of life); limb girdle (occurring in either sex in the second or third decade); and facio-scapulohumeral (either sex, any age). The three types have di?erent prognoses, but may lead to severe disability and premature death, often from respiratory failure. The third type progresses very slowly, however, and is compatible with a long life.

Diagnosis may be con?rmed by ELECTROMYOGRAPHY (EMG) or muscle biopsy. Although genetic research is pointing to possible treatment or prevention, at present no e?ective treatment is known, and deterioration may occur with excessive con?nement to bed. Physio-therapeutic and orthopaedic measures may be necessary to counteract deformities and contractures, and may help in coping with some disabilities.... dystrophy

Once known as infantile paralysis, this disease is caused by a viral infection involving the BRAIN and SPINAL CORD. Since the development of e?ective vaccines in the 1950s (see IMMUNISATION), polio has been practically eliminated in most developed countries. People who have not been fully vaccinated, however, may get the disease: it remains a serious risk for unvaccinated travellers to Africa, Asia or southern Europe. Most reported cases are now from sub-Saharan Africa.

Pathology There are three types of virus, infection spreading by the stools-contaminated hands-mouth route. Children are most susceptible.

One attack usually produces permanent immunity, and second attacks are rare. The virus typically affects the anterior horn cells of the spinal cord, especially those in the lumbar region; the grey matter of the brain stem and cortex may also be damaged.

Vaccination is given to infants at two, three and four months: a booster dose is given at around the age of ?ve. The vaccine contains all three types of polio virus. Two types of vaccine are available: inactivated polio virus (IPV) contains dead virus and is administered by injections; oral polio vaccine (OPV) contains live, harmless strains. The latter is used in the United Kingdom.

Symptoms The incubation period is around 7–14 days, the onset being marked by a mild fever and headache which improves after a few days. In around 85 per cent of infected children there is no further progression, but in some – after approximately one week – the symptoms recur, together with neck sti?ness and signs of meningeal irritation (see MENINGES). Weakness of individual muscle groups is common, and may progress – to a variable extent, depending on the distribution of the virus – to widespread PARALYSIS. Involvement of the diaphragm and intercostal muscles may lead to respiratory failure and rapid death unless arti?cial respiration is provided. Involvement of the cranial nerves and brain may lead to nystagmus (see under EYE, DISORDERS OF), hoarseness and di?culty in swallowing, and CONVULSIONS may occur in young children. The CEREBROSPINAL FLUID shows an early increase in lymphocytes, followed by a rise in protein concentration.

Treatment There is no e?ective drug treatment for the infection. Treatment involves early bed rest, followed by PHYSIOTHERAPY and orthopaedic measures as required. At the onset of respiratory diffculties a TRACHEOSTOMY and arti?cial ventilation should be started. (In the 1950s, when polio epidemics were occurring, respiratory diffculties were treated by placing patients in an ‘iron lung’ – a large, airtight, cylindrical container in which the air pressure was raised and lowered to simulate normal breathing.) In cases of severe paralysis with persistent wasting of the limbs, surgery may be necessary to minimise the resulting disability.... poliomyelitis

A rare condition in which wasting of the skin and the bones, IMPOTENCE, and loss of hair (ALOPECIA) occur as a result of destruction of the PITUITARY GLAND.... simmonds’ disease

This means, literally, a wasting disease, and is a traditional name applied to various diseases such as tabes dorsalis (tertiary SYPHILIS) and TUBERCULOSIS accompanied by enlargement of glands (see GLAND).... tabes

A concretion that forms on the TEETH near the margin of the gum, consisting chie?y of phosphate of lime deposited from the saliva. Mixed with this are food particles, and this is an ideal medium for bacteria to ?ourish in. Regular brushing of the teeth is a preventive measure. Dentists or dental hygienists routinely remove tartar, because it gives rise to wasting of the gums and loosening of the teeth.... tartar

Trace element. Imparts ‘tone’ to walls of blood vessels and muscles.

Deficiency. A diet deficient in Fluorine induces relaxed conditions: varicose veins, weak ligaments. Bone-wasting diseases – osteoporosis, dental decay.

Body effects. Maintains vascular, bone and dental health.

Sources. Meat, fish (where bones are consumed) sardines, salmon. Plants: Garlic, Watercress.

Note: Excess causes: fluorosis – mottling of teeth, arthritic joints and increased density of the bones. Controversial government policy promotes addition of Sodium flouride to water to achieve a minimum of one part per million. ... fluorine

Fries

Family: Polyporaceae.

Habitat: On the old trunks of various coniferous trees.

English: White Agaric.

Unani: Ghaariqoon.

Action: Used in the treatment of sweats in wasting diseases such as phthisis (it checks profuse sweats); also as an expectorant and diuretic.

The drug contains agaric acid (agari- cin). The resinous extract, when burnt, yields not more than 2% of a white ash, rich in phosphates. The drug gives 46% soft resin.

Agaric acid acts as a counter-irritant when applied to abraded surfaces or mucous membrane.... polyporus officinalis

The formation of a BLOOD CLOT within the vessels or heart during life. The process of clotting within the body depends upon the same factors as that of clotting of blood outside the body, involving the ?brinogen and calcium salts circulating in the blood, as well as blood PLATELETS. The indirect cause of thrombosis is usually some damage to the smooth lining of the blood vessels brought about by in?ammation, or the result of ATHEROMA, a chronic disease of the vessel walls. The blood is also specially prone to clot in certain general conditions such as ANAEMIA, the ill-health of wasting diseases like cancer, and in consequence of the poor circulation of old age.

Thrombosis may occur in the vessels of the brain and thus causes STROKE in people whose arteries are much diseased.

Thrombosis of a coronary artery of the heart is a very serious condition which affects, as a rule, middle-aged or elderly people.

(See also ARTERIES, DISEASES OF; COAGULATION; HEART, DISEASES OF – Coronary thrombosis; VEINS, DISEASES OF.)... thrombosis

A ?ne involuntary movement. Tremors may be seen in projecting parts like the hands, head and tongue, or they may involve muscles. Coarse tremors, which prevent a person from drinking a glass of water without spilling it, are found in MULTIPLE SCLEROSIS (MS) and in CHOREA; somewhat ?ner tremors, which produce trembling of the hands or tongue when they are stretched out, are caused by alcoholism (see ALCOHOL) and other forms of poisoning, by PARKINSONISM, and by the weakness which follows some acute disease or characterises old age. A ?ne tremor of the outstretched ?ngers is a characteristic of thyrotoxicosis (see under THYROID GLAND, DISEASES OF); very ?ne tremors, visible in the muscles of face or limbs and known as ?brillary tremors, are present in general paralysis of the insane (see SYPHILIS), and in progressive muscular atrophy or wasting palsy. Tremors may occur at rest and disappear on movement as in Parkinsonism, or they may occur only on movement (intention tremors) as in cerebellar disease.... tremor

The disease (caseous lymphadenitis) attacks the lymphatic system and may spread to sheep and humans. Breaks out sporadically in goats imported from abroad. Those in close contact with infected animals are at risk.

Symptoms: loss of weight, wasting illness, skin abscesses.

Treatment. Tea: Aniseed 1; Senna leaf 1; Nettles 2. 2 teaspoons to each cup boiling water; infuse 10-15 minutes in covered vessel. 1 cup thrice daily. Add to each dose: 30 drops Tincture Echinacea. ... goat disease

A general term for a number of conditions arising from an abnormal breakdown of fats with rapid consumption of carbohydrates. Diabetic, oxybutyric acids and other allied bodies appear in the urine. Diagnosis may be confirmed by a smell of acetone on the breath.

Causes. Diet too rich in fats, inability to digest fats. May be associated with diabetes, starvation wasting diseases and liverish attacks; when followed by coma, situation is serious.

Symptoms. Physical weakness, pallor, lethargy, acid stools, constant yawning, constipation, diarrhoea – in severe cases, jaundice. A liver tonic would be an ingredient of a prescription (Barberry, Balmony, Dandelion, Mulberry, Wahoo).

A reduced alkalinity of the blood allows acidosis to take over. Symptoms of diabetic coma when due to salt deficiency profoundly affects the chemistry of the blood.

Alternatives. Teas: Agrimony, Balm (lemon), Bogbean, Boldo, Centuary, Chamomile, Cleavers, Dandelion, Fumitory, Hyssop, Meadowsweet, Motherwort, Wormwood.

Tea. Formula: equal parts, Balm, Chamomile and Dandelion. 1 heaped teaspoon to each cup boiling water, infuse 10 minutes; dose – 1 cup thrice daily.

Tablets/capsules. Seaweed and Sarsaparilla, Blue Flag, Goldenseal, Wild Yam, Yellow Dock.

Potter’s Acidosis tablets: Anise oil, Caraway oil, Cinnamon, Meadowsweet, Rhubarb, Medicinal Charcoal.

Formula. Equal parts: Dandelion, Blue Flag, Meadowsweet. Mix. Dose: Powders: 500mg; Liquid extracts: 30-60 drops; Tinctures: 1-2 teaspoons thrice daily.

Goldenseal tincture: 1-2ml thrice daily.

Diet. Vigorous cutback in food-fats, especially dairy products. Readily assimilable form of carbohydrate (honey), replenishing stores in the liver without working that organ too hard. Restore body chemistry. Kelp instead of salt. Powdered skimmed milk, yoghurt, plantmilk made from Soya bean. Pectin foods: raw apples help solidify the stool. Bananas, carrots, carob flour products. Vitamin B complex, B6, Folic ac., Niacin, Pantothenic acid. See: CAROB BEAN. ... acidosis

Pink disease. The term was once confined to children of teething age who were believed to be allergic to mercury in teething, worm and dusting powders, and ointments containing mercury. The term is now increasingly used for mercury poisoning in all ages, in one of its many forms: atmospheric pollution, cereal grains, fish living in polluted waters, escape of vaporised mercury from teeth fillings, cassettes, camera mechanism, etc.

Symptoms: sweat rash, photophobia (intolerance of bright light on the iris of the eye), wasting, rapid heart beat, weakness, swollen ankles, diminished reflexes.

Alternatives. Assist the liver in its task to eliminate poisons, and to cleanse the lymph system.

Adults: Gotu Kola, Sarsaparilla, German Chamomile: teas.

Young children: German Chamomile tea: sips, freely – as much as well tolerated. ... acrodynia

Compression of the median nerve between the transverse carpal ligament and the carpal bone. May cause damage to the sensory and motor nerves and manifest as teno-synovitis or ganglion. Affects chiefly middle-aged women.

Symptoms. Numbness or tingling in first three fingers which feel ‘clumsy’. Worse at night. Muscle wasting of palm of the hand.

Diagnostic sign: the ‘flick’ sign – shaking or ‘flicking’ of the wrist when pain is worse and which is believed to mechanically untether the nerve and promote return of venous blood. (J. Neural Neurosurgery and Psychiatry, 1984, 47, 873)

Differential diagnosis: compression of seventh cervical spinal nerve root (osteopathic lesion) has tingling of the hands when standing or from exaggerated neck movements.

Treatment. Reduction of spasm with peripheral relaxants (antispasmodics). Also: local injection of corticosteroid or surgical division of the transverse carpal ligament.

Alternatives:– Tea. Equal parts. Chamomile, Hops, Valerian. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 2-3 times daily.

Tablets/capsules. Cramp bark. St John’s Wort. Wild Yam. Lobelia. Prickly Ash. Passion flower. Black Cohosh. Hawthorn.

Powders. Formula. Cramp bark 1; Guaiacum half; Black Cohosh half; Pinch Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Bromelain, quarter to half a teaspoon between meals.

Turmeric. Quarter to half a teaspoon between meals.

Tinctures. Formula: Cramp bark 1; Lobelia half; Black Cohosh half. Few drops Tincture Capsicum. Mix. 1 teaspoon in water when necessary. To reduce blood pressure, add half part Mistletoe.

Practitioner. For pain. Tincture Gelsemium BPC 1963 5-15 drops when necessary.

Topical. Rhus tox ointment. Camphorated oil.

Lotion: Tincture Lobelia 20; Tincture Capsicum 1.

Supplements. Condition responsive to Vitamin B6 and B-complex. Some authorities conclude that CTS is a primary deficiency of Vitamin B6, dose: 50-200mg daily.

General. Yoga, to control pain. Attention to kidneys. Diuretics may be required. Cold packs or packet of peas from the refrigerator to site of pain for 15 minutes daily. ... carpal tunnel syndrome (cts)

A term used to describe periods spent in bed. Bed rest may be a part of treatment in certain illnesses, such as rheumatic fever, and for some types of injury, such as a fractured vertebra. Prolonged bed rest carries risks such as muscle wasting, weakness, and increased risk of blood clots developing in the legs. Bed rest was once considered an essential part of the treatment of many common conditions but is now avoided whenever possible. Patients are now encouraged to be mobile as soon as possible after surgery.... bed rest

An inherited muscle-wasting disease of the legs (see peroneal muscular atrophy).... charcot–marie–tooth disease

A skin disorder characterized by inflammation, redness, and scaling of the skin over most of the body. Exfoliative dermatitis may be the result of an allergic response to a drug or may be due to worsening of a skin condition such as psoriasis or eczema. The condition sometimes occurs in lymphoma and leukaemia.

There is a widespread rash with severe flaking of the skin, which results in increased loss of water and protein from the surface of the body.

Protein loss may cause oedema and muscle wasting.

Further possible complications include heart failure and infection.

The treatment and outlook depend on the cause.... exfoliative dermatitis

Reduced physical activity, for example, through disease, injury, or following major surgery. Immobility is particularly harmful in the elderly because it causes muscle wasting and progressive loss of function.

Total immobility can produce complications including bedsores, pneumonia, or contractures. A common complication of partial immobility is oedema (fluid retention), which causes swelling of the legs. Rarely, sluggish blood flow encourages formation of a thrombus (abnormal blood clot) in a leg vein. Regular physiotherapy and adequate nursing care are important for any person who is totally immobile.... immobility

A systemic inflammatory disease of several joints together where erosive changes occur symmetrically, and which may arise from inflammation and thickening of the synovial membrane. Cartilage becomes eroded and fibrous or even bony fusion leads to permanent fixation of a joint, or joints. Polyarthritis. An auto-immune disease.

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

Chirata. Swertia chirata, Buch. German: Driesenenzian. French: Swertie. Italian: Swertia. Indian: Chirata. Entire plant.

Constituents: xanthone derivatives, iridoids, alkaloids, flavones.

Action: bitter tonic, digestive, liver stimulant, febrifuge, antimalarial, anthelmintic.

Uses: Feeble digestion, lack of appetite. Wasting and cachetic conditions. Used for malaria before discovery of Peruvian bark. Liver damage and complaints. “Ascites due to liver involvement.” (Baiter, 1871, Ghani, 1913)

Preparations: Thrice daily.

Tea: half-1 teaspoon to each cup boiling water; infuse 15 minutes; dose: Half-1 cup. Liquid Extract BHP (1983) 1:1 in 25 per cent alcohol. Dose: 2 to 4ml.

Powder: half-2 grams. ... chiretta

A shrinkage or wasting of the optic nerve fibres due to disease or injury to the optic nerve, resulting in partial or complete loss of vision.

Optic atrophy may occur without prior signs of nerve disease, such as inflammation.... optic atrophy

A rare, inherited disorder characterized by muscle wasting in the feet and calves and then in the hands and forearms.

The condition, also known as Charcot–Marie– Tooth disease, is caused by degeneration of some peripheral nerves.

It is more common in boys, and usually appears in late childhood or adolescence.

Muscle wasting stops halfway up the arms and legs, making them look like inverted bottles; sensation may be lost.

There is no treatment, but the sufferer rarely becomes totally incapacitated because the disease usually progresses very slowly.

Life expectancy is normal.... peroneal muscular atrophy

A term used to describe a lack of vigour or strength. This is a common symptom of a wide range of conditions, including anaemia, emotional problems, and various disorders affecting the heart, nervous system, bones, joints, and muscles. When associated with emotional disorders, weakness may represent a lack of desire or ambition, rather than loss of muscle strength.More specifically, the term describes loss of power in particular muscle groups, which may be accompanied by muscle wasting and loss of sensation. (See also paralysis.)... weakness

Cinnamomum zeylanicum Blume. German: Zimtbaum. French: Cannelle. Spanish: Canela. Italian: Cannella. Malayan: Kayu manis. Dried inner bark, and oil distilled from bark and leaves.

Constituents: tannins, essential oil, coumarin.

Action: stimulant astringent to the stomach. Aromatic, antimicrobial, carminative, antispasmodic, anti- diarrhoea, anti-worm; a warming remedy for cold conditions. Haemostatic, anti-putrescent, antiseptic, vermifuge. “A stimulating effect on bone healing” (Hamdard, Oct/Dec 1988, Vol XXXI No 4) Anti- diabetic.

Uses: Weak digestion, feeble appetite, flatulence, vomiting, hyperacidity, to promote secretion of gastric juices. Irritable bowel, summer diarrhoea. Influenza and colds. Wasting and cachexia (5 drops oil in honey). Infestation: body lice (rub with oil). Chest complaints: massage chest with 3 drops oil to 2 teaspoons Almond oil. The tea is used by the Chinese to boost insulin activity.

Combines well with Chamomile for stomach upsets; with Elderflowers and Peppermint for influenza. Preparations. Thrice daily, or as necessary.

Tea: Quarter of a teaspoon bark in cup of boiling water, hot tea, or other beverage, infuse 15 minutes. Essence of Cinnamon: 10-20 drops in water or beverage.

Langdale’s Cinnamon Essence.

Oil of Cinnamon: BP, 0.05 to 0.2ml.

Powder: half to 1 gram.

Liquid Extract BHP (1983) 1:1 in 70 per cent alcohol, dose 0.5 to 1ml. ... cinnamon bark

Knitbone. Symphytum officinale, L. French: Grande consoude. German: Reinweld. Italian: Consolide maggiore. Part used: root and leaves. Considerable therapeutic versatility.

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

a *sex-linked (X-linked) disorder in which affected males develop an increase in muscle size followed by weakness and wasting. It usually starts between the ages of 5 and 15, and 25 years after onset most patients are wheelchair-bound. Although most men become severely disabled, life expectancy is close to normal. The disorder is similar to Duchenne *muscular dystrophy but less severe. [P. E. Becker (20th century), German geneticist]... becker muscular dystrophy

Taraxacum officinalis Wiggers. Parts used: dried root and herb. French: Pissenlit. German: Kuhblume. Spanish: diente de le?on. Italian: Dente de Lion.

Constituents: carotenoids, sesquiterpene lactones.

Action: powerful diuretic, bitter tonic, pancreatic regulator, galactagogue, cholagogue, anti-rheumatic, pancreatic and bile duct stimulant, stimulant to the portal circulation, laxative (mild), urinary antiseptic, anti-eczema, detoxicant, choleretic. Contains Vitamins A, B and C. Rich in nutrient minerals. Promotes elimination of plasma cholesterol.

Uses: Liver disorders, inflammation of the gall bladder, to counter tendency to form gallstones; mild jaundice, to clear a yellowish complexion and brighten the eyes; to stimulate flow of bile. Not given in presence of blocked bile duct. Indigestion, lack of appetite, sweating in the anal cleft, muscular rheumatism, hypoglycaemia, anorexia nervosa, cachexia and other wasting diseases. Congestive heart failure: should be prescribed for every case of oedema of heart origin. Warts: express milky sap and wipe wart frequently. Has a reputation for splenic and pancreatic disorders as an ingredient of diabetic and anaemia prescriptions. A decoction of the root has been taken with success for infective hepatitis. An older generation of gardeners chewed the root for bladder disorders. Combine: with Alfalfa and Kelp for nutrient minerals; with Yarrow and Lime flowers (equal parts) for high blood pressure. Promotes loss of weight during dieting.

Preparations: Thrice daily.

Tea (leaf). 3-4 teaspoons to each cup or, 2oz to 1 pint boiling water; infuse 15 minutes. Half-1 cup freely. Decoction, root. 1 teaspoon to each cup boiling water gently simmer 15 minutes. Half-1 cup freely. Liquid Extract. Dose: half-2 teaspoons.

Tincture, BHC Vol 1. 1 part to 5 parts 25 per cent ethanol. Dose: 5-10ml (1-2 teaspoons).

Juice of fresh root (by liquidiser or blender) 1-4 teaspoons

Tablets/capsules. Popular combination. Powdered Dandelion BHP (1983) 90mg; powdered Horsetail extract 3:1 10mg; powdered Uva Ursi extract 3:1 75mg. To assist urinary flow and prevent fluid retention. Waterlex tablets. (Gerard House)

Dandelion coffee, roots roasted and ground. Freely.

Diet. Leaves used in salads or cooked as spinach. In all preparations a pinch of Ginger renders it more diffusive.

Note: The elderly need gentle control of blood pressure with a minimum of side-effects, without loss of potassium and magnesium, for which the root (dandelion coffee) is an alternative to synthetic drugs. ... dandelion

Luxations. Displacement of a structure, usually bone, as in an osteopathic lesion. May occur spontaneously as a result of weak ligaments or from injury, posture. Common in the shoulder. Many dislocations of the spine and skeleton are resolved by osteopathy.

Alternatives. To strengthen ligaments: Comfrey (topical). Wild Yam, Irish Moss, Slippery Elm bark, Horsetail, Fenugreek seeds. St John’s Wort, Ginseng.

Supplementation. Calcium and Zinc, Vitamin C (1 gram thrice daily).

DISMUTASE ENZYMES (SOD). A dismutase enzyme is a biologically active enzyme complex present in most human cells and capable of converting tissue-damaging oxygen free radicals (highly reactive cellular toxins) into less harmful chemical substances that can be excreted from the body through the usual eliminatory channels.

Evidence shows that a number of chronic diseases including MS, diabetes, arthritis, even cancer, are the result of free radical damage. SOD is derived from a natural wheat sprout extract from specially cultured wheat that is hypoallergenic. It stimulates and supports the immune system, neutralises toxins, and minimises tissue damage in wasting diseases and organ transplantation. Protecting oxygen levels in body cells, it allays the ageing process and alleviates circulatory disorders. ... dislocations

Failure of the right ventricle to hold its own with the return flow of blood and to re-direct it through the lungs where it is re-oxygenated before entering the left ventricle for completing the circulatory cycle. Usually secondary to failure of the left ventricle. May be caused by valvular disease, especially narrowing of the orifice of the mitral valve.

Mitral disease leads to heart failure either by a narrowing of the orifice (stenosis) or a regurgitation blocks the passage of blood from the left atrium (auricle) to the left ventricle. The left atrium enlarges (hypertrophies) in an effort to counter the impediment. Real compensation – increased thrust of the blood – is provided by the right ventricle. In order to overcome a mitral impediment the right ventricle has to enlarge.

Sooner or later the right ventricle cannot enlarge any further and general heart failure sets in. Though caused primarily by a lesion of the mitral valve, it may be secondary to left ventricular failure (LVF), thyroid disorder (thyrotoxicosis), pericarditis, congenital heart disease, or any disease which weakens ventricular muscle.

Venous congestion and back pressure of RVF leads to congestion and accumulation of fluid in the lungs, cough and spitting of blood, painful swelling of the liver, nausea, loss of appetite and severe wasting.

Where the right ventricle fails to move the blood forward as it arrives from the systemic circulation, generalised dropsy sets in. Congestion of the kidneys leads to reduced urinary excretion and presence of albumin in the urine.

The picture is well known to the cardiac practitioner: blueness of the skin, congestion of the brain circulation with sleeplessness and delirium. Soon the tension of water-logged tissues results in pain and extreme anxiety. Feet are swollen and ankles pit on pressure; chest cavities fill with fluid and the abdomen swells (ascites).

Alternatives. Cardio-tonics would be given to strengthen the ventricle and diuretics to correct fluid retention: Lily of the Valley, Hawthorn, Motherwort, Broom. BHP (1983).

Due to rheumatic fever: Hawthorn.

High Blood Pressure: Mistletoe.

Effort Syndrome: Motherwort.

Tinctures. Combine, Lily of the Valley 2; Hawthorn 2; Motherwort 3. Dose: 1 teaspoon thrice daily after meals.

Diet. Low salt, low fat, high fibre. Restricted fluids, vegetarian protein foods, yoghurt. See also: DIET – HEART AND CIRCULATION.

Supplements. Potassium (bananas), Vitamin B6.

General. Stop smoking. Correction of overweight. Complete bed-rest with legs raised above level of the abdomen and patient propped-up to relieve difficult breathing. ... heart – right ventricular failure (rvf)

(peroneal muscular atrophy) a group of inherited diseases of the peripheral nerves, also known as hereditary sensorimotor neuropathy, causing a gradually progressive weakness and wasting of the muscles of the legs and the lower part of the thighs. The hands and arms are eventually affected. The genetic defect responsible for the most common form, type Ia, is a duplication on chromosome 17. The diagnosis is made by nerve conduction tests followed by genetic blood tests. [J. M. Charcot; P. Marie (1853–1940), French physician; H. H. Tooth (1856–1925), British physician]... charcot–marie–tooth disease

(Lymphadenoma. Lymphogranulomatosis). Chronic enlargement of the lymph nodes often together with that of the liver, spleen and bone marrow. Affects more males than females, 30- 40 years. High white blood cell count. Cancer of the lymph vessels. Follows a typical clinical course with anaemia until necrosis supervenes. The disease is suspected by a combination of enlargement of lymph nodes (especially the neck), severe itching and unexplained fever. Symptoms vary according to part of the body affected.

Symptoms. Hard rubbery glands are general, chiefly detected under the arm and groin. Enlarged nodes may compress nearby structures to produce nerve pains. Weight loss. Accumulation of fluid in lungs and abdomen. Obstruction of bile duct leads to jaundice. Patient may be prone to shingles. High fever heralds approaching fatality. Blood count, bone marrow aspiration and node biopsy confirm. Tubercula glands may simulate Hodgkin’s disease.

Some success reported by the use of the Periwinkle plant. (vinca rosea – Vinchristine) Wm Boericke, M.D. refers to Figwort as a powerful agent in Hodgkin’s disease.

Alternatives. Although there is no known cure, emphasis on the cortex of the adrenal gland may reduce skin irritation and pain in the later stages (Gotu Kola, Liquorice, Sarsaparilla). To arrest wasting and constitutional weakness: Echinacea. Anti-pruritics, alteratives and lymphatics are indicated.

Tea. Formula. Equal parts, Nettles, Gotu Kola, Red Clover. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 or more times daily.

Decoction. Formula. Equal parts – Yellow Dock, Queen’s Delight, Echinacea. 1 teaspoon to each cup water gently simmered 20 minutes. Half-1 cup 3 or more times daily.

Tablets/capsules. Poke root. Blue Flag root. Echinacea. Mistletoe.

Powders. Formula. Echinacea 2; Poke root 1; Bladderwrack 1. Dose: 500mg (two 00 capsules or one- third teaspoon) 3 or more times daily.

Tinctures. Mixture. Parts: Echinacea 2; Goldenseal quarter; Thuja quarter; Poke root half; Periwinkle 1. Dose: 1-2 teaspoons, 3 or more times daily. Where active inflammation is present – add Wild Yam 1. External. Castor oil packs to abdomen.

Treatment by a general medical practitioner or hospital specialist.

HOLISTIC MEDICINE. A school of thought which regards disease as a manifestation of an inner disturbance of the vital force, and not merely abnormality of certain groups of nerves, muscles, veins, or even the mind itself. Article 43 of Dr Samuel Hahnemann’s Organon of the Healing Art describes it:

“No organ, no tissue, no cell, no molecule is independent of the activities of the others but the life of each one of these elements is merged into the life of the whole. The unit of human life cannot be the organ, the tissue, the cell, the molecule, the atom, but the whole organism, the whole man.”

Holistic medicine relates disease to a patient’s personality, posture, diet, emotional life, and lifestyle. Treatment will be related to body, mind and spirit. It encourages a positive psychological response to the disease from which a patient suffers. For instance, its gentle approach to cancer embraces stress control, meditation, forms of visualisation and other life-enhancing skills.

Diet may be vegetarian, even vegan.... hodgkin’s disease

Lower than normal level of calcium in the blood. Due to (a) Vitamin D deficiency, (b) underactivity of parathyroid glands. Muscular spasms may follow from tetany or seizure. Babies fed on cow’s milk may be at risk.

Symptoms: breathlessness, vomiting, spasm, convulsions. The calcium balance is governed by hormones from the parathyroid gland. Absorption of the mineral depends upon dietary calcium and Vitamin D. (See: CALCIUM, VITAMIN D)

Abnormality may be shown by decrease of serum calcium levels in the blood, or by increase in size and density of bones and other tissues.

Causes: tumour, hardened arteries, bone-wasting diseases, chronic kidney disease.

Alternatives. Horsetail tea. Comfrey root powder: 2-4g, 1 to 3 times daily. Comfrey: potential benefit outweighs possible risk.

Diet. Cod Liver oil. Fish oils generally. Fresh Carrot juice.

Supplementation. Vitamins A, C, D (up to 20,000 units daily). Calcium, Magnesium, Beta Carotene, Dolomite, Phosphorus.

See: CALCIUM DISORDERS. RICKETS: OSTEOPOROSIS: OSTEOMALACIA. ... hypocalcaemia

Cetraria islandica, L. German: Torfmoos. French: Sphaigne. Spanish: Hiusgo. Italian: Stagno. Indian: Lahana. Dried lichen. Keynote: cough.

Constituents: cetrarin, lichen acids, terpenes, lichenin.

Action: demulcent, expectorant, antitussive, nutrient, antemetic. Helps arrest permanent respiratory damage in wasting diseases. Highly active in chest infections. Bitter tonic. Mucilage.

Uses: Loss of weight in terminal or wasting diseases with exhaustion and vomiting. To improve digestion. Vomiting – to arrest. Catarrh of nose, throat and chest. To break-up tough mucus in respiratory organs. Chronic bronchitis, cough. Blocked sinuses.

Combinations: with Goldenseal for wasting diseases: with Lobelia for chronic respiratory disorders. Preparations. Average dose: 1-2 grams. Thrice daily.

Decoction. 1 teaspoon to each cup water, gently simmer 20 minutes. Dose: half-1 cup.

Tincture BHP (1983). 1 part to 5 parts 40 per cent alcohol. Dose: 1-1.5ml.

Tablets/capsules. Popular formula: Iceland Moss BHP (1983) 250mg; Liquorice BP 30mg; Lobelia BP 20mg. ... iceland moss

n. any disease causing wasting of tissues, especially (formerly) pulmonary tuberculosis. —consumptive adj.... consumption

an acute mononeuropathy of the femoral nerve, usually of microvascular origin, associated with chronic poor diabetic control. Symptoms are thigh pain and progressive weakness of knee extension. Examination reveals wasting of the quadriceps muscle group and loss of the knee jerk. It may affect both legs and recovery is usually slow. Treatment is with physiotherapy and improved control of the diabetes; the condition never seems to recur in the same leg. The main *differential diagnosis is of compression of the nerve roots in the spinal canal.... diabetic amyotrophy

pain, muscle wasting, and paralysis resulting from pressure on a nerve in conditions in which it is subjected to compression by surrounding structures. See carpal tunnel syndrome.... entrapment neuropathy

Carrageen. Chondrus crispus L. Seaweed. Whole plant (thallus).

Constituents: trace minerals, polysaccharides. Source of minerals, iodine, iron, bromine.

Action. Antitussive, nutrient, demulcent, pectoral, antibacterial. Detoxicant. Anticoagulant, hypotensive. Lowers blood cholesterol levels.

Uses: Bronchitis and respiratory disorders generally. Pulmonary tuberculosis. Dry cough. To cleanse mucous membranes. Thin people desiring to put on weight. Wasting diseases, cachexia. Inflammation of the alimentary canal. Irritable stomach, gastric and duodenal ulcer, recovery from surgical operation. To protect lining of stomach from acidity. Inflammation of kidneys or bladder.

External. A base for ointments, cosmetic creams, etc.

Preparations: Thrice daily, or as necessary.

Decoction. Dried seaweed, 5 to 10 grams to each large cup water gently simmered 20 minutes. Cannot be strained. Half a cup eaten with spoon. Honey enhances action.

Diet. Use of the powder to thicken soups, jellies, aspic and for inclusion in recipes requiring a thickener. A fingerful (powder) in early morning tea for chest protection in winter. ... irish moss

The universal herb. Sweet root. Glycyrrhiza glabra L. Shredded or powdered dried root. Long history for strength and long life in Chinese medicine. Sweet of the Pharoahs of Ancient Egypt. Carried by armies of Alexander to allay thirst and as a medicine.

Constituents: volatile oil, coumarins, chalcones, triterpenes, flavonoids.

Action: demulcent expectorant, glycogenconservor, anti-inflammatory, mild laxative. Adrenal restorative (has glycosides remarkably similar to body steroids). ACTH-like activity on adrenal cortex (Simon Mills). Female hormone properties (Science Digest). Regulates salt and water metabolism (Medicina, Moscow, 1965). Anti-stress. Anti-ulcer. Antiviral. Increases gastric juices up to 25 per cent, without altering pH. Aldosterone-like effect. Liver protective. Anti-depressive.

Use s. Adrenal insufficiency – sodium-retention properties suitable for Addison’s disease. Hypoglycaemia. Peptic ulcer – reduces gastric juice secretion. Inflamed stomach. Mouth ulcer. Duodenal ulcer. Respiratory infections: dry cough, hoarseness, bronchitis, lung troubles, catarrh. Tuberculosis (Chinese traditional). In the absence of more effective remedies of value in food poisoning. To prevent urinary tract infections.

Combinations: with Iceland Moss for wasting and cachexia to nourish and increase weight; with Lobelia for asthma and bronchitis: with Raspberry leaves for the menopause; with Comfrey for dental caries.

“Liquorice is recorded as a cancer remedy in many countries.” (J.L. Hartwell, Lloydia, 33, 97. 1970) Preparations. Average dose: 1-5 grams. Thrice daily before meals.

Decoction: half-1 teaspoon to each cup water, simmer 15 minutes. Half-1 cup.

Liquid Extract: 1:1. Dose: 2-5ml.

Sticks: for chewing.

Powdered root: 750mg (three 00 capsules or half a teaspoon).

Diet: Pontefract cakes – use in kitchen for adrenal failure; because of their sodium-retaining properties may be taken as sweets without added sugar. Low salt when taken.

Contra-indicated: In pregnancy, cirrhosis (liver) and in the presence of digitalis.

Note: If over-consumed may result in low potassium levels, high blood pressure and falls in renin and aldosterone. Where taken for a long period, increase intake of potassium-rich foods. May cause fluid retention of face and ankles which could be tolerated while primary disorder is being healed. ... liquorice root

Arising from poor assimilation of nutrients, minerals, fat soluble vitamins by the intestines. Patient not getting maximum nourishment from food.

Multiple causes: diseases of the gut; strictures, fistulas, Crohn’s disease, obstructions, parasites, infections, drugs, X-rays, endocrine disease, gastric surgery. A common cause is gluten sensitivity due to ingestion of gluten foods (wheat, oats, rye, barley).

Symptoms: Wasting of muscles, weight loss, flatulence, loss of appetite, distension, fat in the faeces, large pale frothy stools, vitamin and mineral deficiencies.

Alternatives. Teas: Alfalfa, Agrimony, Gotu Kola, Meadowsweet, Red Clover, Oats.

Decoctions: Irish Moss, Dandelion root, Fenugreek seeds, Bayberry bark. Calamus or Gentian, in cold infusion.

Formula. Dandelion 1; Echinacea 2; Saw Palmetto 1; few grains Cayenne or drops Tincture Capsicum. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Powders: 500mg (two 00 capsules or one- third teaspoon). Thrice daily.

Irish Moss, strengthening. Echinacea to sustain natural powers of resistance. Diet. Gluten-free. Soya products. Avoid dairy products. Slippery Elm gruel. Vitamins: B-complex, B1, B6, B12, Folic acid, PABA, C, E.

Minerals: Calcium, Iron, Copper, Zinc. ... malabsorption syndrome

n. reddening of the face and/or neck. Hectic flush occurs in such wasting diseases as pulmonary tuberculosis. A hot flush, accompanied by a feeling of heat, occurs in some emotional disorders and during the menopause (see vasomotor symptoms).... flush

a variety of symptoms, mainly neurological (including chronic fatigue, dizziness, amnesia, digestive upsets, and muscle wasting), that have been attributed to exposure of armed forces personnel to chemicals (e.g. insecticides) used during the Gulf War (1991) or possibly to the effects of vaccines and tablets given to protect personnel against the anticipated threat of chemical and biological warfare during the conflict. Medical research into the syndrome is continuing.... gulf war syndrome

a condition in males characterized by absence of penile erection combined with absence of pulses in the femoral arteries and wasting of the buttock muscles. It is caused by occlusion of the abdominal aorta and iliac arteries. [R. Leriche (1879–1956), French surgeon]... leriche’s syndrome

n. a mixture of carbohydrates, predominantly maltose, produced by the breakdown of starch contained in barley or wheat grains. As well as its use in brewing and distilling, malt has been used as a source of nutrients in wasting diseases.... malt

n. any disease of the muscles. The myopathies are usually subdivided into those that are inherited (see muscular dystrophy) and those that are acquired. The acquired myopathies include *polymyositis and muscular diseases complicating endocrine disorders, carcinoma, or drug therapy. All are typified by weakness and wasting of the muscles, which may be associated with pain and tenderness.... myopathy

“Brittle bones”. The Silent Epidemic. Weakness and softness of the bones due to wastage of minerals, chiefly calcium. Crippling, painful, deforming. ‘Bone-thinning’ leads to hundreds of thousands of crush and spontaneous fractures every year. Vertebra of the spine may collapse with loss of height and stooping. Sufferers show body levels of zinc about 25 per cent lower than normal. May run in families.

Affects women more than men by 10:1 especially after menopause, whether this is natural or due to destruction or removal of ovaries in early adult life.

By means of a calcium-rich diet after 35 years it is a preventable disease. Like so many degenerative diseases a common cause is widespread consumptions of refined, processed, chemicalised foods. It is possible that dental caries is in reality osteoporosis.

In men, alcohol is the chief cause. It wreaks its greatest havoc in women 10-15 years after the menopause. Increased calcium will not restore tissue already lost by wasting. Emphasis is therefore on prevention. It is estimated that a quarter of women over 50 in the West suffer bone loss after the menopause when reduced oestrogen speeds loss of calcium with possible bone damage to wrist, spine and especially hip. The chances of such fractures in women reaching seventy are one in two.

Vitamin D deficiency predisposes, as also does over-prescription of thyroxine for hypothyroid cases. Fat-free diets can break bones.

In menopausal women, increased bone loss is associated with disorders of the ovaries, which organs should receive treatment. Specially at risk are anorexic women with absence of periods. Secondary causes: hyperthyroidism, long-term use of steroids, liver disease, drugs (Tamoxifen, Antacids).

Common fractures are those of hips, spine and wrist. Wrist bone mineral content and grip strength are related. Squeezing a tennis ball hard three times each morning and evening reduces risk of fractures of the wrist.

Drinking of Lemon juice contributes to brittle bones. The habit of daily drinking of the juice causes enamel of teeth to crumble and the removal of calcium from the bones.

Cod Liver oil (chief of the iodised oils) reaches and nourishes cartilage, imparting increased elasticity which prevents degeneration.

Coffee. Two or more cups of coffee a day significantly reduces bone mineral density in women, but drinking milk each day can counter it.

Alternatives. Alfalfa, Black Cohosh, Chamomile, Clivers, Fennel, Dong quai, Fenugreek, Liquorice, Meadowsweet, Mullein, Pimpernel, Helonias, Plantain, Rest Harrow, Shepherd’s Purse, Silverweed, Toadflax, Unicorn root. Nettle tea.

Tea. Equal parts. Alfalfa, Comfrey leaves, Nettles. Mix. 2 teaspoons to each cup boiling water; infuse 5- 15 minutes; 1 cup thrice daily.

Decoction. Equal parts: Comfrey root, Irish Moss (for minerals), Horsetail. Mix. 3 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: 1 cup thrice daily.

Tablets/capsules. Bamboo gum, Helonias, Iceland Moss, Irish Moss for minerals, Kelp, Prickly Ash. Formula. Horsetail 2; Alfalfa 2; Helonias 1. Mix. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action is enhanced by taking in a cup of Fenugreek tea.

Comfrey decoction. 1 heaped teaspoon to cup water gently simmered 5 minutes. Strain when cold. Dose: 1 cup, to which is added 10 drops Tincture Helonias, morning and evening. Fenugreek seeds may be used as an alternative to Comfrey root. Comfrey and Fenugreek are osteo-protectives. For this condition the potential benefit of Comfrey outweighs possible risk.

Propolis. Regeneration of bone tissue.

Dr John Christopher. Mix powders: Horsetail 6, de-husked Oats 3; Comfrey root 4; Lobelia 4. Dose: quarter to half a teaspoon 2-3 times daily.

Diet. Fresh raw fruit and green vegetables. Consumption of raw bran (which contains calcium-binding phytic acid) and wholemeal bread should be suspended until recovery is advanced. Natural spring water. Fish and fish oils. Reject high salt intake which aggravates bone loss and places the skeleton at risk by creating increasing loss of calcium and phosphorus through the kidneys. Avoid soft drinks, alcohol. Heavy meat meals inhibit calcium metabolism. Incidence of the disease is lower in vegetarians. High protein. Supplements. Daily. Vitamin A, Vitamin B12 (50mcg); Vitamin C (500mg); Vitamin D, Vitamin E, Folic acid 200mcg; Vitamin B6 (50mg); Calcium citrate 1g; Magnesium citrate 500mg. Boron and Vitamin D. Zinc 15mg.

Calcium helps reduce risk of fracture particularly in menopausal women who may increase their daily intake to 800mg – Calcium citrate malate being more effective than the carbonate. Dried skimmed milk can supply up to 60 per cent of the recommended daily amount of Calcium.

Stop smoking.

Information. National Osteoporosis Society, PO Box 10, Radstock, Bath BA3 3YB, UK. Send SAE. ... osteoporosis

(thoracic outlet syndrome) the group of symptoms caused by compression of the subclavian artery and the lower roots of the brachial plexus against the fibrous and bony structures of the outlet of the upper thoracic vertebrae. Loss of sensation, wasting, and vascular symptoms may be found in the affected arm, which may also be painful.... scalenus syndrome

(Sir James Paget, 1814-99) Osteitis deformans. Chronic inflammation of bone at focal points (Pagetic sites), often widespread. Chronic. Progressive softening followed by thickening with distortion. Renewal of new bone outstrips absorption of old bone. Enlargement of the skull (‘Big head’) and of the long bones. Broadened pelvis, distorted spine (kyphosis) from flattened vertebra. Male predominence. Over 40 years. Spontaneous fractures possible. Paget’s disease and diabetes may be associated in the same family.

Some authorities believe cause is vitamin and mineral deficiency – those which promote bone health being calcium and magnesium (dolomite). Supplementation helps cases but evidence confirms that some pet-owners are at risk – a virus from cats and dogs possibly responsible. The prime candidate is one exposed to canine distemper. Dogs are involved twice as much as cats. The virus is closely related to the measles virus in humans.

Symptoms. Limbs deformed, hot during inflammatory stage. Headaches. Dull aching pain in bones. Deafness from temporal bone involvement. Loss of bone rigidity. Bowing of legs.

Surgical procedures may be necessary. Appears to be a case for immunisation of dogs against distemper.

Alternatives. Black Cohosh, Boneset, Cramp bark, Bladderwrack, German Chamomile, Devil’s Claw, Helonias, Oat husks, Prickly Ash, Sage, Wild Yam.

Tea. Oats (mineral nutrient for wasting diseases) 2; Boneset (anti-inflammatory) 1; Valerian (mild analgesic) 1; Liquorice quarter. Mix. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup thrice daily.

Decoction. Cramp bark 1; White Willow 2. Mix. 4 heaped teaspoons to 1 pint (500ml) water gently simmered 20 minutes. Dose: half-1 cup thrice daily.

Tablets/capsules. Cramp bark, Devil’s Claw, Echinacea, Helonias, Prickly Ash, Wild Yam.

Formula. Devil’s Claw 1; Black Cohosh 1; Valerian 1; Liquorice quarter. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Action enhanced when taken in cup of Fenugreek tea. Thrice daily. Every 2 hours acute cases.

Practitioner’s analgesic. Tincture Gelsemium: 10 drops in 100ml water. Dose: 1 teaspoon every 2 hours (inflammatory stage).

Topical. Comfrey root poultice.

Diet. High protein, low salt, low fat. Oily fish.

Supplements. Daily. Vitamin C (500mg); Vitamin D (1000mg); Calcium citrate (1 gram); Dolomite (1 gram); Beta-Carotene (7500iu). Kelp. ... paget’s disease

Loss of ability to move a limb or the whole body. Flaccid paralysis (with wasting of muscle) is due to lesion of a spinal or peripheral nerve. Spastic paralysis is due to “stroke” in the brain. Diagnosis: wasting follows damage to a surface nerve. In damage of the spinal cord there will be no wasting but loss of use of muscles.

Treatment. Depends upon the cause. Though cure is impossible, some herbs tend to prevent stiffening, and ameliorate symptoms. Others may assist function as in paralysis ileus (paralysis of muscles of the intestinal walls) where Ispaghula seeds provide bulk and promote peristalsis. To strengthen the nervous system: Oats. Circulatory stimulants and nerve restoratives are indicated. Nettle tea is helpful. Limbs have regained temporary sensation on being beaten with the herb; others have lost rheumatism. Virginia Snake root had its reputation among early American Eclectics.

For a mild or temporary condition:– Teas: Nettles. Yerbe Mate.

Other alternatives:– Tablets/capsules. Prickly Ash. Black Cohosh.

Formula. Equal parts: Gentian, Ginger, Ginkgo.

Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon). Thrice daily.

Cystitis: to relieve: Bearberry or Cranesbill tea.

Practitioner. Tincture Nux vomica: 10 drops in 100ml water. Dose: one teaspoon every two hours (temporary).

Thomson School. 1 teaspoon Cayenne pepper mixed with 2 teaspoons Lobelia herb or seeds. Half a teaspoon to each cup boiling water; infuse 15 minutes. Half a cup 2-3 times daily with honey.

Diet. Lacto-vegetarian.

Supplements: B-complex, B6, B12, E. Calcium, Magnesium, Zinc.

For other paralytic conditions see: MOTOR NEURONE DISEASE, MULTIPLE SCLEROSIS, MYASTHENIA GRAVIS, POLYMYELITIS, STROKE, SYRINGOMYELIA.

Treatment of severe nerve conditions should be supervised by neurologists and practitioners whose training prepares them to recognise serious illness and to integrate herbal and supplementary intervention safely into the treatment plan. ... paralysis

Petroselinum crispum, Hill. German: Petersilie. French: Persil. Spanish: Perejil. Italian: Prezzemolo. Indian: Bilati. Dried root, seeds and leaves. Seeds contain apiol. Source of precursor of carotene, Vitamins C, E, bioflavonoids, iron and folic acid.

Also contains apiole and myristicin (volatile oils) coumarins and flavonoids.

Action: anti-microbial, anti-spasmodic, anti-rheumatic, emmenagogue, laxative, mild brain tonic, diuretic, carminative, expectorant, gastric tonic, uterine tonic. A warming remedy for cold conditions, wasting, cachexia; avoided in fevers. Mild activator of adrenals and thyroid gland. Galen, Greek physician, advised it for disorders of womb and bladder.

Uses: Retention of excess fluid in the tissues, dropsy, bladder disorders, painful urination for those who pass water only after long intervals. Absent or painful menses. Windy colic. Inflammation of the prostate gland. PMT and menopausal hot flushes. To dispel fatigue. Mashed and unheated, leaves were once applied to the breasts of nursing mothers to arrest the flow of milk. Rich in minerals, calcium, potassium.... parsley

A nutritional disorder resulting from a lack of thiamine (vitamin B1) in the diet. Without thiamine, the brain, nerves, and muscles (including the heart muscle) are unable to function properly. In developed countries, the illness is seen only in people who are starving or on an extremely restricted diet, such as alcoholics. There are 2 forms of the illness. In dry beriberi, thiamine deficiency mainly affects the nerves and skeletal muscles. Symptoms include numbness, a burning sensation in the legs, and muscle wasting. In severe cases, the patient becomes virtually paralysed, emaciated, and bedridden. In wet beriberi, the main problem is heart failure, which leads to oedema (swelling caused by fluid accumulation) in the legs, and sometimes also in the trunk and face. Other symptoms of wet beriberi include poor appetite, rapid pulse, and breathlessness.

Beriberi is treated with thiamine, given orally or by injection.... beriberi

A hormonal disorder caused by an abnormally high level of corticosteroid hormones in the blood. Cushing’s syndrome is characterized by a red moon-shaped face, wasting of the limbs, thickening of the trunk, and a humped upper back. Other symptoms

include acne, stretch marks, bruising, weakening of the bones by osteoporosis, susceptibility to infection and peptic ulcers, and, in women, increased hairiness. Mental changes frequently occur, causing depression, insomnia, paranoia, or, euphoria. Hypertension, oedema, and diabetes mellitus may develop. In children, growth may be suppressed.

The excess hormones are most commonly due to prolonged treatment with corticosteroid drugs. Such cases of Cushing’s syndrome are usually mild. In other cases, high hormone levels are due to overactivity of the adrenal glands as a result of an adrenal tumour, or of a pituitary tumour affecting production of ACTH (adrenocortocotrophic hormone), which stimulates the adrenal glands.

Cushing’s syndrome caused by corticosteroid drugs usually disappears if the dose is gradually reduced.

A tumour of an adrenal gland is removed surgically.

A pituitary tumour may be removed surgically or shrunk by irradiation and drug treatment.

In both cases, surgery is followed by hormone replacement therapy.... cushing’s syndrome

The overproduction of thyroid hormones by an overactive thyroid gland. The most common form of hyperthyroidism is Graves’ disease, which is an autoimmune disorder. Less commonly, the condition is associated with the development of enlarged nodules within the thyroid gland.

The characteristic signs of hyperthyroidism include weight loss, increased appetite, increased sweating, intolerance to heat, a rapid heart-rate, and protruding eyes. In severe cases, the thyroid gland often becomes enlarged (see goitre) and there is physical and mental hyperactivity and muscle wasting.

The diagnosis of hyperthyroidism is confirmed by measuring the level of thyroid hormones present in the blood. The condition can be treated with drugs that inhibit the production of thyroid hormones or by removal of part of the thyroid gland.... hyperthyroidism

A rare form of arthritis affecting children. Juvenile chronic arthritis occurs more often in girls, and usually develops between 2 and 4 years of age or around puberty. There are 3 main types. Still’s disease (systemic onset juvenile arthritis) starts with fever, rash, enlarged lymph nodes, abdominal pain, and weight loss. These symptoms last for a period of several weeks. Joint pain, swelling, and stiffness may develop after several months. Polyarticular juvenile arthritis causes pain, swelling, and stiffness in many joints. Pauciarticular juvenile arthritis affects 4 joints or fewer.

Possible complications include short stature, anaemia, pleurisy, pericarditis, and enlargement of the liver and spleen. Uveitis may develop, which, if untreated, may damage vision. Rarely, amyloidosis may occur or kidney failure may develop. Diagnosis is based on the symptoms, together with the results of X-rays and blood tests, and is only made if the condition lasts for longer than 3 months.

Treatment may include antirheumatic drugs, corticosteroid drugs, nonsteroidal anti-inflammatory drugs, or aspirin. Splints may be worn to rest inflamed joints and to reduce the risk of deformities. Physiotherapy reduces the risk of muscle wasting and deformities.

The arthritis usually clears up after several years. However, in some children, the condition remains active into adult life.

– kala-azar A form of leishmaniasis that is spread by insects. Kala-azar occurs in parts of Africa, India, the Mediterranean, and South America.... juvenile chronic arthritis

Disease or inflammation of, or damage to, the peripheral nerves, which connect the central nervous system (brain and spinal cord), to the muscles, glands, sense organs, and internal organs. The term neuritis is now used more or less interchangeably with neuropathy. Most nerve cell axons (the conducting fibres that make up nerves) are insulated by a sheath of the fatty substance myelin. Most neuropathies arise from damage to, or irritation of, either the axons or their myelin sheaths, which may cause slowing or a complete block of the passage of electrical signals. Polyneuropathy (or polyneuritis) means damage to several nerves; mononeuropathy (or mononeuritis) indicates damage to a single nerve; neuralgia describes pain caused by irritation or inflammation of a nerve.

Some cases of neuropathy have no obvious cause. Among specific causes are diabetes mellitus, dietary deficiencies, excessive alcohol consumption, and metabolic upsets such as uraemia.

Nerves may become acutely inflamed after a viral infection, and neuropathies may also result from autoimmune disorders, such as rheumatoid arthritis. Neuropathies may occur secondarily to cancerous tumours, or with lymphomas and leukaemias. There is also a group of inherited neuropathies, the most common being peroneal muscular atrophy.

The symptoms of neuropathy depend on whether it affects mainly sensory nerve fibres or mainly motor nerve fibres. Damage to sensory nerve fibres may cause numbness, tingling, sensations of cold, and pain. Damage to motor fibres may cause muscle weakness and muscle wasting. Damage to autonomic nerves may lead to blurred vision, impaired or absent sweating, faintness, and disturbance of gastric, intestinal, bladder, and sexual functioning.

To determine the extent of the damage, nerve conduction studies are carried out together with EMG tests, which record the electrical activity in muscles.

Diagnostic tests such as blood tests, MRI scans, and nerve or muscle biopsy may also be required.

When possible, treatment is aimed at the underlying cause.

If the cell bodies of the damaged nerve cells have not been destroyed, full recovery from neuropathy is possible.... neuropathy

a combination of *paraesthesia (pins and needles), numbness, and pain in the hand, usually affecting the thumb, index, and middle fingers and sometimes extending to the medial aspect of the fourth finger. The symptoms are usually worse at night, and in longstanding cases there may be weakness of grip due to wasting of the *thenar eminence of the thumb. It is caused by pressure on the median nerve as it passes through the wrist (see carpal tunnel), which may result from any continuous repetitive movements of the hand, such as keyboarding, or any condition causing local swelling. It is common in rheumatoid arthritis, myxoedema, pregnancy, and at the menopause, when it is more likely to be bilateral. Treatment is by splinting of the wrist, *NSAIDs, injection of a steroid, or – in severe cases – by surgical release of the nerve under local anaesthesia.... carpal tunnel syndrome

a family of autosomal *recessive genetic disorders causing decreased activity of any of the enzymes involved in the synthesis of *cortisol from *cholesterol. The most commonly affected enzymes are 21-hydroxylase and 11-hydroxylase, and each enzyme deficiency can itself be due to a variety of genetic mutations. The clinical manifestations depend on which enzyme is affected and the resultant deficiencies and build-up products produced. The most serious consequence is adrenal crisis and/or severe salt wasting due to lack of cortisol and/or aldosterone, which may prove fatal if undiagnosed. The condition is often easier to spot at birth in females, who may have indeterminate genitalia due to high levels of *testosterone in utero. Adrenal hyperplasia occurs due to excessive stimulation of the glands by *ACTH (adrenocorticotrophic hormone) in response to the resultant cortisol deficiency of these conditions. Less complete deficiencies of the enzymes concerned may present for the first time in young women after puberty, with signs of androgen excess and menstrual irregularity mimicking *polycystic ovary syndrome.... congenital adrenal hyperplasia