Constipation is a chronic condition and must be distinguished from the potentially serious disorder, acute obstruction, which may have several causes (see under INTESTINE, DISEASES OF). There are several possible causes of constipation; those due to gastrointestinal disorders include:

Dietary: lack of ?bre; low ?uid consumption.

Structural: benign strictures (narrowing of gut); carcinoma of the COLON; DIVERTICULAR DISEASE.

Motility: poor bowel training when young; slow transit due to reduced muscle activity in the colon, occurring usually in women; IRRITABLE BOWEL SYNDROME (IBS); HIRSCHSPRUNG’S DISEASE.

•Defaecation: anorectal disease such as ?ssures, HAEMORRHOIDS and CROHN’S DISEASE; impaction of faeces. Non-gastrointestinal disorders causing constipation include:

Drugs: opiates (preparations of OPIUM), iron supplements, ANTACIDS containing aluminium, ANTICHOLINERGIC drugs.

Metabolic and endocrine: DIABETES MELLITUS, pregnancy (see PREGNANCY AND LABOUR), hypothyroidism (see under THYROID GLAND, DISEASES OF).

Neurological: cerebrovascular accidents (STROKE), MULTIPLE SCLEROSIS (MS), PARKINSONISM, lesions in the SPINAL CORD. Persistent constipation for which there is no

obvious cause merits thorough investigation, and people who experience a change in bowel habits – for example, alternating constipation and diarrhoea – should also seek expert advice.

Treatment Most people with constipation will respond to a dietary supplement of ?bre, coupled, when appropriate, with an increase in ?uid intake. If this fails to work, judicious use of LAXATIVES for, say, a month is justi?ed. Should constipation persist, investigations on the advice of a general practitioner will probably be needed; any further treatment will depend on the outcome of the investigations in which a specialist will usually be involved. Successful treatment of the cause should then return the patient’s bowel habits to normal.... constipation

Nutritional Profile Energy value (calories per serving): Moderate Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: High Sodium: Low Major vitamin contribution: Vitamin A (in yellow corn), B vitamins, vitamin C Major mineral contribution: Potassium

About the Nutrients in This Food Like other grains, corn is a high-carbohydrate, high-fiber food. Eighty-one percent of the solid material in the corn kernel consists of sugars, starch, and dietary fiber, including insoluble cellulose and noncarbohydrate lignin in the seed covering and soluble pectins and gums in the kernel.* Corn has small amounts of vitamin A, the B vitamin folate, and vitamin C. Corn is a moderately good source of plant proteins, but zein (its major protein) is deficient in the essential amino acids lysine, cystine, and tryptophan. Corn is low in fat and its oils are composed primarily of unsaturated fatty acids. Yellow corn, which gets its color from the xanthophyll pigments lutein and zeaxanthin plus the vitamin A-active pigments carotene and cryptoxanthin, contains a little vitamin A; white corn has very little. One fresh ear of yellow corn, 5.5– 6.5 inches long, has three grams dietar y fiber, one gram fat (0.1 g saturated fat, 0.3 g monounsaturated fat, 0.4 mg polyunsaturated fat), 137 IU vitamin A (6 percent of the R DA for a woman, 5 percent of the R DA for a man), 34 mcg folate (9 percent of the R DA), and 5 mg vitamin C (7 percent of the R DA for a woman, 6 percent of the R DA for a man). * The most plent iful sugar in sweet corn is glucose; hydrolysis (chemical splitt ing) of corn starch is t he principal indust rial source of glucose. Since glucose is less sweet t han sucrose, sucrose and fructose are added to commercial corn syrup to make it sweeter.

The Most Nutritious Way to Serve This Food With beans (which are rich in lysine) or milk (which is rich in lysine and tryptophan), to complement the proteins in corn. With meat or a food rich in vitamin C, to make the iron in corn more useful.

Diets That May Restrict or Exclude This Food Low-fiber diet

Buying This Food Look for: Cobs that feel cool or are stored in a refrigerated bin. Keeping corn cool helps retain its vitamin C and slows the natural conversion of the corn’s sugars to starch. Choose fresh corn with medium-sized kernels that yield slightly when you press them with your fingertip. Very small kernels are immature; very large ones are older and will taste starchy rather than sweet. Both yellow and white kernels may be equally tasty, but the husk of the corn should always be moist and green. A dry yellowish husk means that the corn is old enough for the chlorophyll pigments in the husk to have faded, letting the carotenes underneath show through.

Storing This Food Refrigerate fresh corn. At room temperature, fresh-picked sweet corn will convert nearly half its sugar to starch within 24 hours and lose half its vitamin C in four days. In the refrigera- tor, it may keep all its vitamin C for up to a week and may retain its sweet taste for as long as ten days.

Preparing This Food Strip off the husks and silk, and brush with a vegetable brush to get rid of clinging silky threads. R inse the corn briefly under running water, and plunge into boiling water for four to six minutes, depending on the size of the corn.

What Happens When You Cook This Food Heat denatures (breaks apart) the long-chain protein molecules in the liquid inside the corn kernel, allowing them to form a network of protein molecules that will squeeze out moisture and turn rubbery if you cook the corn too long. Heat also allows the starch granules inside the kernel to absorb water so that they swell and eventually rupture, releasing the nutrients inside. When you cook corn, the trick is to cook it just long enough to rupture its starch granules while keeping its protein molecules from turning tough and chewy. Cooking fresh corn for several minutes in boiling water may destroy at least half of its vitamin C. At Cornell University, food scientists found that cooking fresh corn in the microwave oven (two ears/without water if very fresh/4 minutes/600 –700 watts) preserves most of the vitamin C.

How Other Kinds of Processing Affect This Food Canning and freezing. Canned corn and frozen corn both have less vitamin C than fresh- cooked corn. The vitamin is lost when the corn is heated during canning or blanched before freezing to destroy the natural enzymes that would otherwise continue to ripen it. Blanch- ing in a microwave oven rather than in boiling water can preserve the vitamin C in frozen corn (see above). Milling. Milling removes the hull and germ from the corn kernel, leaving what is called hominy. Hominy, which is sometimes soaked in wood ash (lye) to increase its calcium con- tent, can be dried and used as a cereal (grits) or ground into corn flour. Coarsely ground corn flour is called cornmeal. Processed corn cereals. All processed, ready-to-eat corn cereals are much higher in sodium and sugar than fresh corn. Added calcium carbonate. Pellagra is a niacin-deficiency disease that occurs most com- monly among people for whom corn is the staple food in a diet lacking protein foods with the essential amino acid tryptophan, which can be converted to niacin in the human body. Pellagra is not an inevitable result of a diet high in corn, however, since the niacin in corn can be made more useful by soaking the corn in a solution of calcium carbonate (lime) and water. In Mexico, for example, the corn used to make tortillas is boiled in a dilute solution of calcium carbonate (from shells or limestone) and water, then washed, drained, and ground. The alkaline bath appears to release the bound niacin in corn so that it can be absorbed by the body.

Medical Uses and/or Benefits As a wheat substitute in baking. People who are allergic to wheat or cannot tolerate the glu- ten in wheat flour or wheat cereals can often use corn flour or hominy instead. Bath powder. Corn starch, a fine powder refined from the endosperm (inner part) of the corn kernel, can be used as an inexpensive, unperfumed body or face powder. Because it absorbs oils, it is also used as an ingredient in dry shampoos.

Adverse Effects Associated with This Food Allergic reaction. According to the Merck Manual, corn is one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach. The others are berries (blackberries, blueberries, raspberries, strawberries), choco- late, eggs, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).... corn

Calcium is a most important element in diet; the chief sources of it are milk and cheese. Calcium is especially needed by the growing child and the pregnant and nursing mother. The uptake of calcium by the baby is helped by vitamin D (see APPENDIX 5: VITAMINS). A de?ciency of calcium may cause TETANY, and an excess may result in the development of CALCULI (stones) in the KIDNEYS or gallbladder (see LIVER).

The recommended daily intakes of calcium are: 500 mg for children, 700 mg for adolescents, 500–900 mg for adults and 1,200 mg for pregnant or nursing mothers.... calcium

Enteric-coated capsules, which have been largely superseded by enteric-coated tablets, are capsules treated in such a manner that the ingredients do not come in contact with the acid stomach contents but are only released when the capsule disintegrates in the alkaline contents of the intestine.

The term is also applied to the ?brous or membranous envelope of various organs, as of the spleen, liver or kidney. Additionally, it is applied to the ligamentous bag surrounding various joints and attached by its edge to the bones on either side.... capsule

Not all sufferers from coeliac disease present with gastrointestinal symptoms: doctors, using screening techniques, have increasingly identi?ed large numbers of such people. This is important because researchers have recently discovered that untreated overt and silent coeliac disease increases the risk of sufferers developing osteoporosis (brittle bone disease – see BONE, DISORDERS OF) and cancer. The osteoporosis develops because the bowel fails to absorb the CALCIUM essential for normal bone growth. Because those with coeliac disease lack the enzyme LACTASE, which is essential for digesting milk, they avoid milk – a rich source of calcium.

The key treatment is a strict, lifelong diet free of gluten. As well as returning the bowel lining to normal, this diet results in a return to normal bone density. People with coeliac disease, or parents or guardians of affected children, can obtain help and guidance from the Coeliac Society of the United Kingdom. (See also MALABSORPTION SYNDROME; SPRUE.)... coeliac disease

The disorder is characterised by failure to gain weight in spite of a good appetite, by repeated attacks of bronchitis (with BRONCHIECTASIS developing at a young age), and by the passage of loose, foul-smelling and slimy stools (faeces). AMNIOCENTESIS, which yields amniotic ?uid along with cells shed from the fetus’s skin, can be used to diagnose cystic ?brosis prenatally. The levels of various enzymes can be measured in the ?uid and are abnormal when the fetus is affected by cystic ?brosis. Neonatal screening is possible using a test on blood spots – immunoreactive trypsin (IRT).

In children with symptoms or a positive family history, the disease can be tested for by measuring sweat chloride and sodium. This detects the abnormal amount of salt that is excreted via the sweat glands when cystic ?brosis is present. Con?rmation is by genetic testing.

Treatment This consists basically of regular physiotherapy and postural drainage, antibiotics and the taking of pancreatic enzyme tablets and vitamins. Some children need STEROID treatment and all require nutritional support. The earlier treatment is started, the better the results. Whereas two decades ago, only 12 per cent of affected children survived beyond adolescence, today 75 per cent survive into adult life, and an increasing number are surviving into their 40s. Patients with end-stage disease can be treated by heart-lung transplantation (with their own heart going to another recipient). Research is underway on the possible use of GENE THERAPY to control the disorder. Parents of children with cystic ?brosis, seeking help and advice, can obtain this from the Cystic Fibrosis Trust.... cystic fibrosis

Breast. Harmless breast tumours and cysts are common in women over 40. They may form a lump, be with or without pain. Sometimes there is a light blood-stained discharge from the nipple (Poke root). Ovary. See OVARIES.

Dermoid. May be made up of hair and skin (Greater Celandine).

Hydatid. Caused by parasitic infection (Thuja).

Sebaceous. Caused by blockage of a gland of the skin by a plug of fat (Marigold ointment).

A spot, often on the upper back, may irritate and itch and be diagnosed as a lipoma. Before resorting to surgery, external application of any one of the following may prove helpful: Castor oil, Liquid Extract Thuja, Blood root.

Cervical. Chaparral tea douche.

Dr John R. Christopher recommends: Poultice of Walnut leaves or bark. Chaparral, externally. Apple cider vinegar. ... cyst

The operation is usually performed through a low, horizontal ‘bikini line’ incision. A general anaesthetic in a heavily pregnant woman carries increased risks, so the operation is often performed under regional – epidural or spinal – ANAESTHESIA. This also allows the mother to see her baby as soon as it is born, and the baby is not exposed to agents used for general anaesthesia. If a general anaesthetic is needed (usually in an emergency), exposure to these agents may make the baby drowsy for some time afterwards.

Another problem with delivery by Caesarean section is, of course, that the mother must recover from the operation whilst coping with the demands of a small baby. (See PREGNANCY AND LABOUR.)... caesarean section

The large Calorie or kilocalorie, which is used in the study of dietetics and physiological processes, is the amount of heat required to raise one kilogram of water one degree centigrade in temperature. The number of Calories required to carry on the processes necessary for life and body warmth – such as the beating of the heart, the movements of the chest in breathing, and the chemical activities of the secreting glands – is, for an adult person of ordinary weight, somewhere in the neighbourhood of 1,600. For ordinary sedentary occupations an individual requires about 2,500 Calories; for light muscular work slightly over 3,000 Calories; and for hard continuous labour around 4,000 Calories daily.

Under the International System of Units (SI UNITS – see APPENDIX 6: MEASUREMENTS IN MEDICINE) the kilocalorie has been replaced by the joule, the abbreviation for which is J (1 kilocalorie=4,186·8 J). The term Calorie, however, is so well established that it has been retained in this edition. Conversion from Calories (or kilocalories) to joules is made by multiplying by 4·2 .... calorie

In the United Kingdom, the number of cases of food poisoning (by all types of infection) has risen from 102.9 to 162.9 per 100,000 population over the last 15 years. In 2003, more then 70,000 cases of food poisoning were noti?ed. The use of preventive methods throughout the food production process, marketing and consumption of food is most important in controlling infection, as is taking hygienic precautions, such as hand-washing, after handling animals – including domestic pets.

Mild cases can be treated at home with no solid food but plenty of liquids and some salt. Serious cases require hospital care.... campylobacter

The chopped leaves are usually smoked but can be eaten in food or taken as tea. The active ingredient is tetrahydrocannibol. There is much public debate in western countries over the social use of cannabis: it is illegal to possess or supply the substance in the United Kingdom, but nevertheless cannabis is quite widely used. Cannabis is classi?ed as a Schedule 1 drug under the Misuse of Drugs Act 1971 and has not o?cially been used medicinally – despite some claims that it is helpful in ameliorating painful symptoms in certain serious chronic diseases such as multiple sclerosis. A related agent, NABILONE, is a synthetic cannabinoid licenced for use in treating nausea and vomiting caused by CYTOTOXIC drugs.... cannabis

Cardiac Disease

See HEART, DISEASES OF.... cardiac cycle

Habitat: California and British Columbia. Features ? Bark in quills about three-quarter inch wide by one-sixteenth inch thick,

Action: Tonic laxative.

Habitat: There are many varieties of the shrub, which is indigenous to India, Africa and South America.

Action: Cayenne is acknowledged as the finest stimulant in the herbal materia medica, and is, in addition, carminative, tonic, diaphoretic and rubifacient.

Habitat: Uncultivated places, and close to old walls.

Action: Alterative, diuretic and cathartic.

Habitat: Dry pastures.

Action: Stomachic, bitter tonic.

The disease manifests itself in many ways. It may not be ?nally diagnosed and characterised until the infant is two years old, but may be apparent much earlier – even soon after birth. The child may be spastic or ?accid, or the slow, writhing involuntary movements known as athetosis may be the predominant feature. These involuntary movements often disappear during sleep and may be controlled, or even abolished, in some cases by training the child to relax. The paralysis varies tremendously. It may involve the limbs on one side of the body (hemiplegia), both lower limbs (paraplegia), or all four limbs (DIPLEGIA and QUADRIPLEGIA). Learning disability (with an IQ under 70) is present in around 75 per cent of all children but children with diplegia or athetoid symptoms may have normal or even high intelligence. Associated problems may include hearing or visual disability, behavioural problems and epilepsy.

The outlook for life is good, only the more severely affected cases dying in infancy. Although there is no cure, much can be done to help these disabled children, particularly if the condition is detected at an early stage. Assistance is available from NHS developmental and assessment clinics, supervised by community paediatricians and involving a team approach from experts in education, physiotherapy, occupational therapy and speech training. In this way many of these handicapped children reach adulthood able to lead near-normal lives. Much help in dealing with these children can be obtained from SCOPE (formerly the Spastics Society), and Advice Service Capability Scotland (ASCS).... cerebral palsy

The cerebrospinal ?uid (CSF) provides useful information in various conditions and is invaluable in the diagnosis of acute and chronic in?ammatory diseases of the nervous system. Bacterial MENINGITIS results in a large increase in the number of polymorphonuclear LEUCOCYTES, while a marked lymphocytosis is seen in viral meningitis and ENCEPHALITIS, tuberculous meningitis and neurosyphilis. The total protein content is raised in many neurological diseases, being particularly high with neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE) and Guillan-Barré syndrome, while the immunoglobulin G fraction is raised in MULTIPLE SCLEROSIS (MS), neurosyphilis, and connective-tissue disorders. The glucose content is raised in diabetes (see DIABETES MELLITUS), but may be very low in bacterial meningitis, when appropriately stained smears or cultures often de?ne the infecting organism. The CSF can also be used to measure immune proteins produced in response to infection, helping diagnosis in cases where the organism is not grown in the laboratory culture.... cerebrospinal fluid

Contents The trachea divides into right and left main bronchi which go to the two LUNGS. The left lung is slightly smaller than the right. The right has three lobes (upper, middle and lower) and the left lung has two lobes (upper and lower). Each lung is covered by two thin membranes lubricated by a thin layer of ?uid. These are the pleura; similar structures cover the heart (pericardium). The heart lies in the middle, displaced slightly to the left. The oesophagus passes right through the chest to enter the stomach just below the diaphragm. Various nerves, blood vessels and lymph channels run through the thorax. The thoracic duct is the main lymphatic drainage channel emptying into a vein on the left side of the root of the neck. (For diseases affecting the chest and its contents, see HEART, DISEASES OF; LUNGS, DISEASES OF; CHEST, DEFORMITIES OF.)... chest

Causes The disease occurs in epidemics affecting especially children under the age of ten years. It is due to the varicella zoster virus, and the condition is an extremely infectious one from child to child. Although an attack confers life-long immunity, the virus may lie dormant and manifest itself in adult life as HERPES ZOSTER or shingles.

Symptoms There is an incubation period of 14–21 days after infection, and then the child becomes feverish or has a slight shivering, or may feel more severely ill with vomiting and pains in the back and legs. Almost at the same time, an eruption consisting of red pimples which quickly change into vesicles ?lled with clear ?uid appears on the back and chest, sometimes about the forehead, and less frequently on the limbs. These vesicles appear over several days and during the second day may show a change of their contents to turbid, purulent ?uid. Within a day or two they burst, or, at all events, shrivel up and become covered with brownish crusts. The small crusts have all dried up and fallen o? in little more than a week and recovery is almost always complete.

Treatment The fever can be reduced with paracetamol and the itching soothed with CALAMINE lotion. If the child has an immune disorder, is suffering from a major complication such as pneumonia, or is very unwell, an antiviral drug (aciclovir) can be used. It is likely to be e?ective only at an early stage. A vaccine is available in many parts of the world but is not used in the UK; the argument against its use is that it may delay chickenpox until adult life when the disease tends to be much more severe.... chickenpox

Habitat: Waste places, roadsides.

Action: Demulcent, emollient, pectoral.

In recent years persistent child abuse in some children’s homes has come to light, with widespread publicity following o?enders’ appearances in court. Local communities have also protested about convicted paedophiles, released from prison, coming to live in their communities.

In England and Wales, local-government social-services departments are central in the prevention, investigation and management of cases of child abuse. They have four important protection duties laid down in the Children Act 1989. They are charged (1) to prevent children from suffering ill treatment and neglect; (2) to safeguard and promote the welfare of children in need; (3) when requested by a court, to investigate a child’s circumstances; (4) to investigate information – in concert with the NSPCC (National Society for the Prevention of Cruelty to Children) – that a child is suffering or is likely to suffer signi?cant harm, and to decide whether action is necessary to safeguard and promote the child’s welfare. Similar provisions exist in the other parts of the United Kingdom.

When anyone suspects that child abuse is occurring, contact should be made with the relevant social-services department or, in Scotland, with the children’s reporter. (See NONACCIDENTAL INJURY (NAI); PAEDOPHILIA.)... child abuse

Treatment The choking person should take slow, deep inspirations, which do not force the particle further in (as sudden catchings of the breath between the coughs do), and which produce more powerful coughs. If the coughing is weak, one or two strong blows with the palm of the hand over either shoulder blade, timed to coincide with coughs, aid the e?ect of the coughing. If this is ine?ective, the Heimlich manoeuvre may be used. This involves hugging the person from behind with one’s hands just under the diaphragm. A sudden upward compressive movement is made which serves to dislodge any foreign body. In the case of a baby, sit down with left forearm resting on thigh. Place the baby chest-down along the forearm, holding its head and jaw with the ?ngers and thumb. The infant’s head should be lower than its trunk. Gently deliver three or four blows between the shoulder blades with the free hand. The resuscitator should not attempt blind ?nger-sweeps at the back of the mouth; these can impact a foreign body in the larynx.

If normal breathing (in adult or child) cannot be quickly restored, seek urgent medical help. Sometimes an emergency TRACHEOSTOMY is necessary to restore the air supply to the lungs. (See APPENDIX 1: BASIC FIRST AID.)... choking

Circumcision in women is a damaging procedure, involving the removal of all or parts of the CLITORIS, LABIA majora and labia minora, sometimes combined with narowing of the entrance to the VAGINA. Total removal of the external female genitalia, including the clitoris, is called INFIBULATION. The result may be psychological and sexual problems and complications in childbirth, with no known bene?t to the woman’s health, though cultural pressures have resulted in its continuation in some Muslim and African countries, despite widespread condemnation of the practice and campaigns to stop it. It has been estimated that more than 80 million women in 30 countries have been circumcised.... circumcision

Uses Before the serious effects that result from its habitual use were realised, the drug was sometimes used by hunters, travellers and others to relieve exhaustion and breathlessness in climbing mountains and to dull hunger. Derivatives of cocaine are used as locally applied analgesics via sprays or injections in dentistry and for procedures in the ear, nose and throat. Because of its serious side-effects and the risk of addiction, cocaine is a strictly controlled Class A drug which can be prescribed only by a medical practitioner with a Home O?ce licence to do so.... cocaine

Coitus interruptus (see CONTRACEPTION).... coitus

Habitat: It prefers moist, clayey soil, and is usually found growing near streams and ditches.

Action: Expectorant and demulcent.

Habitat: Damp fields and waste places ; ditch and river sides.

Action: The roots, and to some extent the leaves, are demulcent and astringent.

(e.g. in the gut or respiratory tract, or on the skin) without doing any harm to the individual.... commensal

The female condom might be suitable for contraception when a woman misses a day or two of her contraceptive pill; if there is DYSPAREUNIA; when the perineum needs protection, for example, after childbirth; or in cases of latex allergy to traditional condoms. Used properly with spermicide, it provides an e?ective barrier both to infections and to spermatozoa. Failure may result if the penis goes alongside the condom, if it gets pushed up into the vagina, or if it falls out. (See CONTRACEPTION.)... condom

(2) A cone biopsy is a surgical technique in which a conical or cylindrical section of the lower part of the neck of the womb is excised.... cone

Disposable lenses are soft lenses designed to be thrown away after a short period of continuous use; their popularity rests on the fact that they need not be cleaned. The instructions on use should be followed carefully because the risk of complications, such as corneal infection, are higher than with other types of contact lenses.

Contraindications to the use of contact lenses include a history of ATOPY, ‘dry eyes’, previous GLAUCOMA surgery and a person’s inability to cope with the management of lenses. The best way to determine whether contact lenses are suitable, however, may be to try them out. Good hygiene is essential for wearers so as to minimise the risk of infection, which may lead to a corneal abscess – a serious complication. Corneal abrasions are fairly common and, if a contact-lens wearer develops a red eye, the lens should be removed and the eye tested with ?uorescein dye to identify any abrasions. Appropriate treatment should be given and the lens not worn again until the abrasion or infection has cleared up.... contact lenses

Barrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.

Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.

SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.

These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.

INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.

The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.

Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.

HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.

In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... contraception

The Department of Health has drawn up a list of suitable eye-banks to which people can apply to bequeath their eyes, and an o?cial form is now available for the bequest of eyes. (See also DONORS; TRANSPLANTATION.)... corneal graft

The explosive nature of coughing results in a spray of droplets into the surrounding air and, if these are infective, hastens the spread of colds (see COLD, COMMON) and INFLUENZA. Coughing is, however, a useful reaction, helping the body to rid itself of excess phlegm (mucus) and other irritants. The physical e?ort of persistent coughing, however, can itself increase irritation of the air passages and cause distress to the patient. Severe and protracted coughing may, rarely, fracture a rib or cause PNEUMOTHORAX. Coughs can be classi?ed as productive – when phlegm is present – and dry, when little or no mucus is produced.

Most coughs are the result of common-cold infections but a persistent cough with yellow or green sputum is indicative of infection, usually bronchitis, and sufferers should seek medical advice as medication and postural drainage (see PHYSIOTHERAPY) may be needed. PLEURISY, pneumonia and lung CANCER are all likely to cause persistent coughing, sometimes associated with chest pain, so it is clearly important for people with a persistent cough, usually accompanied by malaise or PYREXIA, to seek medical advice.

Treatment Treatment of coughs requires treatment of the underlying cause. In the case of colds, symptomatic treatment with simple remedies such as inhalation of steam is usually as e?ective as any medicines, though ANALGESICS or ANTIPYRETICS may be helpful if pain or a raised temperature are among the symptoms. Many over-the-counter preparations are available and can help people cope with the symptoms. Preparations may contain an analgesic, antipyretic, decongestant or antihistamine in varying combinations. Cough medicines are generally regarded by doctors as ine?ective unless used in doses so large they are likely to cause sedation as they act on the part of the brain that controls the cough re?ex.

Cough suppressants may contain CODEINE, DEXTROMETHORPHAN, PHOLCODINE and sedating ANTIHISTAMINE DRUGS. Expectorant preparations usually contain subemetic doses of substances such as ammonium chloride, IPECACUANHA, and SQUILL (none of which have proven worth), while demulcent preparations contain soothing, harmless agents such as syrup or glycerol.

A list of systemic cough and decongestant preparations on sale to the public, together with their key ingredients, appears in the British National Formulary.... cough

Habitat: Moist pastures and open places.

Action: Antispasmodic, sedative.

Treatment Most important is prevention of the initial tapeworm infection, by ensuring that pork is well cooked before it is eaten. Nurses and others attending to a patient harbouring an adult tapeworm must be careful to avoid ingesting ova from contaminated hands. The tapeworm itself can be destroyed with NICLOSAMIDE. Brain infections are treated with sedatives and anti-convulsants, surgery rarely being necessary. Most patients make a good recovery.... cysticercosis

The options for individuals would include taking no action; modifying their behaviour; or taking some form of direct action. For those at risk of having an affected child, where prenatal diagnosis is available, this would involve either carrying on with reproduction regardless of risk; deciding not to have children; or deciding to go ahead to have children but opting for prenatal diagnosis. For an adult-onset disorder such as a predisposition to ovarian cancer, an individual may choose to take no action; to take preventive measures such as use of the oral contraceptive pill; to have screening of the ovaries with measures such as ultrasound; or to take direct action such as removing the ovaries to prevent ovarian cancer from occurring.

There are now regional genetics centres throughout the United Kingdom, and patients can be referred through their family doctor or specialists.... genetic counselling

Genes carry, in coded form, the detailed speci?cations for the thousands of kinds of protein molecules required by the cell for its existence, for its enzymes, for its repair work and for its reproduction. These proteins are synthesised from the 20 natural AMINO ACIDS, which are uniform throughout nature and which exist in the cell cytoplasm as part of the metabolic pool. The protein molecule consists of amino acids joined end to end to form long polypeptide chains. An average chain contains 100–300 amino acids. The sequence of bases in the nucleic acid chain of the gene corresponds in some fundamental way to the sequence of amino acids in the protein molecule, and hence it determines the structure of the particular protein. This is the genetic code. Deoxyribonucleic acid (see DNA) is the bearer of this genetic information.

DNA has a long backbone made up of repeating groups of phosphate and sugar deoxyribose. To this backbone, four bases are attached as side groups at regular intervals. These four bases are the four letters used to spell out the genetic message: they are adenine, thymine, guanine and cystosine. The molecule of the DNA is made up of two chains coiled round a common axis to form what is called a double helix. The two chains are held together by hydrogen bonds between pairs of bases. Since adenine only pairs with thymine, and guanine only with cystosine, the sequences of bases in one chain ?xes the sequence in the other. Several hundred bases would be contained in the length of DNA of a typical gene. If the message of the DNA-based sequences is a continuous succession of thymine, the RIBOSOME will link together a series of the amino acid, phenylalanine. If the base sequence is a succession of cytosine, the ribosome will link up a series of prolines. Thus, each amino acid has its own particular code of bases. In fact, each amino acid is coded by a word consisting of three adjacent bases. In addition to carrying genetic information, DNA is able to synthesise or replicate itself and so pass its information on to daughter cells.

All DNA is part of the chromosome and so remains con?ned to the nucleus of the cell (except in the mitochondrial DNA). Proteins are synthesised by the ribosomes which are in the cytoplasm. DNA achieves control over pro-tein production in the cytoplasm by directing the synthesis of ribonucleic acid (see RNA). Most of the DNA in a cell is inactive, otherwise the cell would synthesise simultaneously every protein that the individual was capable of forming. When part of the DNA structure becomes ‘active’, it acts as a template for the ribonucleic acid, which itself acts as a template for protein synthesis when it becomes attached to the ribosome.

Ribonucleic acid exists in three forms. First ‘messenger RNA’ carries the necessary ‘message’ for the synthesis of a speci?c protein, from the nucleus to the ribosome. Second, ‘transfer RNA’ collects the individual amino acids which exist in the cytoplasm as part of the metabolic pool and carries them to the ribosome. Third, there is RNA in the ribosome itself. RNA has a similar structure to DNA but the sugar is ribose instead of deoxyribose and uracil replaces the base thymine. Before the ribosome can produce the proteins, the amino acids must be lined up in the correct order on the messenger RNA template. This alignment is carried out by transfer RNA, of which there is a speci?c form for each individual amino acid. Transfer RNA can not only recognise its speci?c amino acid, but also identify the position it is required to occupy on the messenger RNA template. This is because each transfer RNA has its own sequence of bases and recognises its site on the messenger RNA by pairing bases with it. The ribosome then travels along the chain of messenger RNA and links the amino acids, which have thus been arranged in the requisite order, by peptide bonds and protein is released.

Proteins are important for two main reasons. First, all the enzymes of living cells are made of protein. One gene is responsible for one enzyme. Genes thus control all the biochemical processes of the body and are responsible for the inborn di?erence between human beings. Second, proteins also ful?l a structural role in the cell, so that genes controlling the synthesis of structural proteins are responsible for morphological di?erences between human beings.... genetic code

Pes cavus may be present at birth or it can be caused by disruption of or damage to the blood and nerve supplies to the foot muscles. The use of a specially made insole in the shoe may help, but surgery is sometimes needed.... pes cavus

In its course from the base of the skull to the lumbar region, the cord gives o? 31 nerves on each side, each of which arises by an anterior and a posterior root that join before the nerve emerges from the spinal canal. The openings for the nerves formed by notches on the ring of each vertebra have been mentioned under the entry for spinal column. To reach these openings, the upper nerves pass almost directly outwards, whilst lower down their obliquity increases, until below the point where the cord ends there is a sheaf of nerves, known as the cauda equina, running downwards to leave the spinal canal at their appropriate openings.

The cord is a cylinder, about the thickness of the little ?nger. It has two slightly enlarged portions, one in the lower part of the neck, the other at the last dorsal vertebra; and from these thickenings arise the nerves that pass to the upper and lower limbs. The upper four cervical nerves unite to produce the cervical plexus. From this the muscles and skin of the neck are mainly supplied, and the phrenic nerve, which runs down through the lower part of the neck and the chest to innervate the diaphragm, is given o?. The brachial plexus is formed by the union of the lower four cervical and ?rst dorsal nerves. In addition to nerves to some of the muscles in the shoulder region, and others to the skin about the shoulder and inner side of the arm, the plexus gives o? large nerves that proceed down the arm.

The thoracic or dorsal nerves, with the exception of the ?rst, do not form a plexus, but each runs around the chest along the lower margin of the rib to which it corresponds, whilst the lower six extend on to the abdomen.

The lumbar plexus is formed by the upper four lumbar nerves, and its branches are distributed to the lower part of the abdomen, and front and inner side of the thigh.

The sacral plexus is formed by parts of the fourth and ?fth lumbar nerves, and the upper three and part of the fourth sacral nerves. Much of the plexus is collected into the sciatic nerves, the largest in the body, which go to the legs.

The sympathetic system is joined by a pair of small branches given o? from each spinal nerve, close to the spine. This system consists of two parts, ?rst, a pair of cords running down on the side and front of the spine, and containing on each side three ganglia in the neck, and beneath this a ganglion opposite each vertebra. From these two ganglionated cords numerous branches are given o?, and these unite to form the second part – namely, plexuses connected with various internal organs, and provided with numerous large and irregularly placed ganglia. The chief of these plexuses are the cardiac plexus, the solar or epigastric plexus, the diaphragmatic, suprarenal, renal, spermatic, or ovarian, aortic, hypogastric and pelvic plexuses.

The spinal cord, like the brain, is surrounded by three membranes: the dura mater, arachnoid mater, and pia mater, from without inwards. The arrangement of the dura and arachnoid is much looser in the case of the cord than their application to the brain. The dura especially forms a wide tube which is separated from the cord by ?uid and from the vertebral canal by blood vessels and fat, this arrangement protecting the cord from pressure in any ordinary movements of the spine.

In section the spinal cord consists partly of grey, but mainly of white, matter. It di?ers from the upper parts of the brain in that the white matter (largely) in the cord is arranged on the surface, surrounding a mass of grey matter (largely neurons – see NEURON(E)), while in the brain the grey matter is super?cial. The arrangement of grey matter, as seen in a section across the cord, resembles the letter H. Each half of the cord possesses an anterior and a posterior horn, the masses of the two sides being joined by a wide posterior grey commissure. In the middle of this commissure lies the central canal of the cord, a small tube which is the continuation of the ventricles in the brain. The horns of grey matter reach almost to the surface of the cord, and from their ends arise the roots of the nerves that leave the cord. The white matter is divided almost completely into two halves by a posterior septum and anterior ?ssure and is further split into anterior, lateral and posterior columns.

Functions The cord is, in part, a receiver and originator of nerve impulses, and in part a conductor of such impulses along ?bres which pass through it to and from the brain. The cord contains centres able to receive sensory impressions and initiate motor instructions. These control blood-vessel diameters, eye-pupil size, sweating and breathing. The brain exerts an overall controlling in?uence and, before any incoming sensation can affect consciousness, it is usually ‘?ltered’ through the brain.

Many of these centres act autonomously. Other cells of the cord are capable of originating movements in response to impulses brought direct to them through sensory nerves, such activity being known as REFLEX ACTION. (For a fuller description of the activities of the spinal cord, see NEURON(E) – Re?ex action.)

The posterior column of the cord consists of the fasciculus gracilis and the fasciculus cuneatus, both conveying sensory impressions upwards. The lateral column contains the ventral and the dorsal spino-cerebellar tracts passing to the cerebellum, the crossed pyramidal tract of motor ?bres carrying outgoing impulses downwards together with the rubro-spinal, the spino-thalamic, the spino-tectal, and the postero-lateral tracts. And, ?nally, the anterior column contains the direct pyramidal tract of motor ?bres and an anterior mixed zone. The pyramidal tracts have the best-known course. Starting from cells near the central sulcus on the brain, the motor nerve-?bres run down through the internal capsule, pons, and medulla, in the lower part of which many of those coming from the right side of the brain cross to the left side of the spinal cord, and vice versa. Thence the ?bres run down in the crossed pyramidal tract to end beside nerve-cells in the anterior horn of the cord. From these nerve-cells other ?bres pass outwards to form the nerves that go direct to the muscles. Thus the motor nerve path from brain to muscle is divided into two sections of neurons, of which the upper exerts a controlling in?uence upon the lower, while the lower is concerned in maintaining the muscle in a state of health and good nutrition, and in directly calling it into action. (See also NERVE; NERVOUS SYSTEM.)... spinal cord

In a highly signi?cant advance in research, a scienti?c team in the United States obtained stem cells from newly formed human embryos

– donated by women who had become pregnant after successful in vitro fertilisation – and successfully cultivated these cells in the laboratory. This achievement opened the way to replicating in the laboratory, the various specialised cells that develop naturally in the body. UK government legislation constrains the use of human embryos in research (see ETHICS) and the ethical aspects of taking this stem-cell culture technique forwards will have to be resolved. Nevertheless, this discovery points the biological way to the use of genetic engineering in selecting di?erentiated specialised cells from which replacement tissues could be grown for use as transplants to rectify absent or damaged tissues in the human body.

Research into potential use of stem cells has raised expectations that in the long term they may prove to be an e?ective regenerative treatment for a wide range of disorders including PARKINSONISM, ALZHEIMER’S DISEASE, type-2 diabetes (see under DIABETES MELLITUS), myocardial infarction (see HEART, DISEASES OF), severe burns, osteoporosis (see under BONE, DISORDERS OF) and the regeneration of blood to replace the need for BONE MARROW TRANSPLANT. Recent research has shown that adult stem cells may also be stimulated to produce new cell lines. If successful, this would eliminate the need to use embryos and thus resolve existing ethical dilemmas over the use of stem cells.... stem cell

Symptoms The onset may be sudden or insidious. In the acute form there is severe diarrhoea and the patient may pass up to 20 stools a day. The stools, which may be small in quantity, are ?uid and contain blood, pus and mucus. There is always fever, which runs an irregular course. In other cases the patient ?rst notices some irregularity of the movement of the bowels, with the passage of blood. This becomes gradually more marked. There may be pain but usually a varying amount of abdominal discomfort. The constant diarrhoea leads to emaciation, weakness and ANAEMIA. As a rule the acute phase passes into a chronic stage. The chronic form is liable to run a prolonged course, and most patients suffer relapses for many years. SIGMOIDOSCOPY, BIOPSY and abdominal X-RAYS are essential diagnostic procedures.

Treatment Many patients may be undernourished and need expert dietary assessment and appropriate calorie, protein, vitamin and mineral supplements. This is particularly important in children with the disorder. While speci?c nutritional treatment can initiate improvement in CROHN’S DISEASE, this is not the case with ulcerative colitis. CORTICOSTEROIDS, given by mouth or ENEMA, help to control the diarrhoea. Intravenous nutrition may be required. The anaemia is treated with iron supplements, and with blood infusions if necessary. Blood cultures should be taken, repeatedly if the fever persists. If SEPTICAEMIA is suspected, broad-spectrum antibiotics should be given. Surgery to remove part of the affected colon may be necessary and an ILEOSTOMY is sometimes required. After recovery, the patient should remain on a low-residue diet, with regular follow-up by the physician, Mesalazine and SULFASALAZINE are helpful in the prevention of recurrences.

Patients and their relatives can obtain help and advice from the National Association for Colitis and Crohn’s Disease.... ulcerative colitis

Symptoms The ?rst, or catarrhal, stage is characterised by mild, but non-speci?c, symptoms of sneezing, conjunctivitis (see under EYE, DISORDERS OF), sore throat, mild fever and cough. Lasting 10–14 days, this stage is the most infectious; unfortunately it is almost impossible to make a de?nite clinical diagnosis, although analysis of a nasal swab may con?rm a suspected case. This is followed by the second, or paroxysmal, stage with irregular bouts of coughing, often prolonged, and typically more severe at night. Each paroxysm consists of a succession of short sharp coughs, increasing in speed and duration, and ending in a deep, crowing inspiration, often with a characteristic ‘whoop’. Vomiting is common after the last paroxysm of a series. Lasting 2–4 weeks, this stage is the most dangerous, with the greatest risk of complications. These may include PNEUMONIA and partial collapse of the lungs, and ?ts may be induced by cerebral ANOXIA. Less severe complications caused by the stress of coughing include minor bleeding around the eyes, ulceration under the tongue, HERNIA and PROLAPSE of the rectum. Mortality is greatest in the ?rst year of life, particularly among neonates – infants up to four weeks old. Nearly all patients with whooping-cough recover after a few weeks, with a lasting IMMUNITY. Very severe cases may leave structural changes in the lungs, such as EMPHYSEMA, with a permanent shortness of breath or liability to ASTHMA.

Treatment Antibiotics, such as ERYTHROMYCIN or TETRACYCLINES, may be helpful if given during the catarrhal stage – largely in preventing spread to brothers and sisters – but are of no use during the paroxysmal stage. Cough suppressants are not always helpful unless given in high (and therefore potentially narcotic) doses, and skilled nursing may be required to maintain nutrition, particularly if the disease is prolonged, with frequent vomiting.... whooping-cough

RDA – none known. Has a vital relationship with Vitamin B12, a deficiency of which causes pernicious anaemia.

Deficiency. Anaemia, bowel disorders, nervousness, poor muscle tone.

Sources. Meats, liver, kidneys, eggs. ... cobalt

Symptoms: mucopurulent vaginal discharge, sometimes blood-stained. Backache. Urinary problems. Diagnosis confirmed by smear test, biopsy or swab culture.

Alternatives (also for cervicitis).

Teas, decoctions, powders or tinctures:– Agnus Castus, Black Cohosh, Echinacea. Myrrh. Pulsatilla. Practitioner: Tinctures. Mix, parts: Black Cohosh 3; Gelsemium 1. Dose: 10-20 drops in water, morning and evening.

Lapacho tea (Pau d’arco tea). Soak gauze tampons with extract, insert, renew after 24 hours.

Douche: German Chamomile tea, or Lapacho tea.

Tampons: saturate with paste of equal parts Slippery Elm powder and milk. Or: saturate tampons with Aloe Vera gel or fresh juice. In event of unavailability refer to entry: SUPPOSITORY.

Diet. Lacto-vegetarian.

Vitamins. A. B-complex. C (1g daily). E (400iu daily).

Minerals. Iron, Zinc.

Note: Women who have an abnormal cervical smear should be tested for chlamydia. ... cervix

Chiropractors stress the importance of X-raying patients before applying manipulation. “Patients treated by chiropractors,” reported the Medical Research Council in the British Medical Journal, “were not only no worse off than those treated in hospital but almost certainly fared considerably better and maintained their improvement for two years.” ... chiropractic

Deficiency. Rare. Hypoglycaemia, arteriosclerosis, heart disease. Depression, irritability, sudden mood swings. A lack of Chromium may result in diabetes in young adults, and a craving for sweet foods (sugar, chocolate).

Body effects. Metabolism of sugars and fats. Blood sugar regulator. Builds up muscle. Lowers cholesterol levels. Encourages the body’s insulin to perform effectively. Suppresses appetite – especially craving for sugar, chocolate etc. Sportsperson’s mineral to build muscle and reduce fat.

Sources. Red meat, liver, kidney, cheese, mushrooms, wholegrain cereals, brewer’s yeast, fresh fruits, nuts, honey, molasses, corn oil, raisins, grapes, beets, peppers, shellfish. ... chromium

COLI BACILLUS. Infections. Freshly-grated Horseradish root steeped in cup cold water for 2 hours.

Remove root. 1 cupful freely, as tolerated. Papaya fruit.

COLIC. Spasm of the bowels, particularly the colon. Severe pain under the navel with nausea, vomiting.

Patient writhes from side to side. Cause may be wind, acid bile, worms, constipation, food; aluminium, lead or other metal poisoning, strangulated hernia, appendicitis, adhesions.

Differential diagnosis: gallstones, menstrual difficulties, kidney stone.

Alternatives. Teas, any one. Roman Chamomile, Catmint, Fennel, Lovage, Caraway, Betony, Avens, Wormwood, Holy Thistle, Peppermint leaves, Aniseed, Tormentil.

Decoction, any one. Angelica root, Boldo, Calamus, Cardamom, Condurango, Coriander, Cramp bark, Ginger root, Liquorice, Wild Yam.

Tablets/capsules. Dandelion, Capsicum, Valerian, Wild Yam, Cramp bark, Blue Flag root.

Powders. Alternatives. (1) Calamus 2; Marshmallow root 1. Add pinch Cayenne. (2) Turkey Rhubarb plus pinch of Cayenne. (3) Wild Yam plus pinch of Cayenne. Dose: 500mg (one-third teaspoon or two 00 capsules) every 2 hours.

Tinctures. Formulae. Alternatives: (1) Angelica root 1; Wild Yam 1; Ginger half. Mix. (2) Dandelion 2; Wild Yam 1; few drops Tincture Capsicum. Mix. (3) Wild Yam 1; Galangal root half; Ginger half. Mix. Dose: 1 teaspoon in hot water every 2 hours.

Traditional German combination. Ginger, Gentian, Turkey Rhubarb.

Topical. Apply hot bran, oats, hops or Slippery Elm poultice, or Castor oil packs to abdomen. Aromatherapy. Any one oil: Aniseed, Fennel, Mint, Garlic, Bergamot. Adult: 6 drops to 2 teaspoons Almond oil: child, 2 drops in 1 teaspoon Almond oil, for abdominal massage.

Enema. 1oz Catmint, Boneset or Chamomile in 2 pints boiling water. Strain, inject warm.

Diet. 3-day fast, with fruit juices and herb teas.

See: RENAL COLIC, COLIC OF PREGNANCY, CHILDREN. Gripe water. ... cold sore

Symptoms. Sudden drawing-up of knees, nausea, vomiting, pallor, shallow breathing, prostration, weak heart beat, irritability, amnesia.

Treatment. Bed rest. Protection of eyes against light. Admission to hospital in case of deep brain damage. Quietness. Tranquillisers, sedatives and alcohol aggravate symptoms. If patient can swallow, alternatives as follows:–

Teas. St John’s Wort (concussion of the spine). Skullcap (to ease headache). Ginkgo (cerebral damage). Powders. Formula. Combine, St John’s Wort 3; Skullcap 2; Oats 2; Trace of Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) two-hourly.

Tinctures. Formula as above, but with few drops Tincture Capsicum in place of Cayenne powder: 1-2 teaspoons in water hourly.

Tincture Arnica. (European practise) 2-5 drops in hot water usually sufficient to hasten recovery.

Topical. Distilled Extract Witch Hazel saturated pad over eyes and to wipe forehead.

Supplements. Vitamin B-complex. B6, C. ... concussion

Symptoms: malaise, bloody alternating diarrhoea and constipation; right side colicky abdominal pain worse after meals; flatulence, loss of weight and appetite. Intestinal obstruction can usually be palpated. Blood count. A blood count high in whites indicates an abscess – a serious condition which may require surgical repair during which segments of the gut may have to be removed. Malignant change rare. Differential diagnosis. Ulcerative colitis, appendicitis, appendix abscess, irritable bowel syndrome.

Cracks or ulcers at corners of the mouth may be a good marker of Crohn’s Disease.

Treatment. Select one of the following. Herbal treatment offers a safe alternative to steroids by inducing remission in acute exacerbation. Good responses have been observed from the anti-bacterials Wild Yam and Goldenseal. Fenugreek seeds are of special value. Comfrey (tissue regeneration). Irish Moss.

Teas: Chamomile, Comfrey leaves, Hops, Marshmallow leaves, Meadowsweet, Shepherd’s Purse (Dr A. Vogel), Lobelia. Silverweed and Cranesbill are excellent for internal bleeding; Poke root for intestinal ulceration.

Decoction. Fenugreek seeds: 2 teaspoons to large cup water simmered gently 10 minutes. 1 cup freely. The seeds also should be consumed.

Tablets/capsules. Wild Yam, Fenugreek, Ginger, Goldenseal, Lobelia, Slippery Elm.

Powders. Formula. Wild Yam 2; Meadowsweet 2; Goldenseal 1. Dose: 500mg (two 00 capsules or one- third teaspoon) thrice daily.

Liquid Extracts. (1) Formula. Wild Yam 1, Echinacea 2. 30-60 drops in water thrice daily. Or, (2) Formula: Turkey Rhubarb 2, Goldenseal 1, Caraway half. 20-30 drops in water thrice daily.

Tinctures. Formula. Bayberry 2, Goldenseal 1, Cardamoms 1. Dose: One to two 5ml teaspoons thrice daily.

Ispaghula seeds. 2-4 teaspoons thrice daily.

Tea Tree oil Suppositories. Insertion at night.

Diet. Bland, little fibre, Slippery Elm gruel. Irish Moss preparations. Increase fluid intake. Reject: broccoli, tomatoes, lima, Soya, Brussels sprouts, pinto beans, cocoa, chocolate, cow’s milk, peas, onions, turnips, radishes. Accept fish oils.

Addenbrookes Hospital, Cambridge. Reject foods containing wheat and all dairy produce.

Supplements. Vitamins A, B12, C, Calcium, Iron, Magnesium, Potassium, Zinc.

Study. In a study carried out by UK researchers (1993) food allergies were found to be the most common cause of the disease. Results suggested that dietary changes may be as effective as corticosteroids in easing symptoms. The most common allergens were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats, chocolate. An elemental diet with a formula of nutrients (E028, produced by Hospital Supplies, Liverpool) was used in trials. (The Lancet, 6.11.1993)

Notes. Crohn’s Disease is associated with Erythema nodosum, more frequently recognised in childhood. A frequent cause is cow’s milk intolerance. Smoking adds to the risk of Crohn’s disease.

In susceptible people, the food additives titanium dioxide and aluminosilicates may evoke a latent inflammatory response resulting in Crohn’s disease, ulcerative colitis or bowel cancer. These chemicals may be found in the intestinal lymphoid aggregations in gut mucosa. (Jonathan Powell, Gastro-intestinal Laboratory, St Thomas’s Hospital, London) (Titanium dioxide rarely occurs naturally but is added to confectionery, drinking water and anti-caking agents.) ... crohn’s disease

Causes: a tumour on the adrenal glands or excessive medication with large doses of corticosteroid drugs to make up for adrenal insufficiency. There is diminished resistance to infection. (Echinacea)

Symptoms. Fat plethoric ‘moon’ face. Limbs thin, trunk obese. Skin easily bruises (Arnica). Fatigue, weakness, pink streaks on skin. Cessation of menstruation. Loss of sex drive in men. High blood pressure and sugar in the urine are common. Bone softening leads to pain. Acne (Agnus Castus). Excess body hair. Personality change.

Treatment. Adrenal stimulants may obviate surgery or irradiation to the adrenal glands: they include Ginseng, Liquorice, Sarsaparilla, Holy Thistle (Hyde), Samphire (Hyde).

Men. Tinctures. Formula. Ginseng 3; Sarsaparilla 2; Liquorice 1. One to two teaspoons in water thrice daily.

Women. Tinctures. Formula. Agnus Castus 2; Helonias 2; Pulsatilla 1. One to two teaspoons in water thrice daily.

Good responses have been observed from Pulsatilla and Black Cohosh. ... cushing’s syndrome

“It is believed that oxidation of the lipids by free radicals (which are also present in high numbers in patients who have Dupuytren’s contracture) produces toxins which kill fibroblast cells in the palmar fascia. The surrounding tissue overreacts by producing many more fibroblasts, a bit like callous formation after a wound. The rapid increase in fibrous tissue leads to the contracture. This explains why the contracture is so common among patients with diabetes, epilepsy and alcoholism – serum lipid levels are raised in all these groups . . . However, the disorder occurs only if the patient has a genetic predisposition to the disease.” (Mr Paul Sanderson, Orthopaedic Surgeon, Wrightington Hospital, Wigan, in the Journal of Bone and Joint Surgery, Nov. 1992)

Treatment. Directed towards prevention. Same as for HYPERLIPIDAEMIA.

DWARF BEAN. See: FRENCH BEAN.

DWARF ELDER. Danewort. Ground Elder. Sambucus ebulus L. French: Petit sureau. German:

Attichwurzel. Spanish: Sauro enano. Italian: Ebbio. Part used: leaves. Action: expectorant, diaphoretic, diuretic, purgative.

Uses: Dropsy, kidney and bladder torpor, rheumatism.

Combine, equal parts Dwarf Elder, Greater Plantain and Parsley Piert for gravel.

Combine, equal parts Dwarf Elder, Wild Carrot, Broom and Motherwort for oedema of heart origin. Combine, equal parts Dwarf Elder and Celery seeds for polymyalgia and rheumatism. (W.T. Hewitt, FNIMH)

Preparations: Thrice daily.

Tea. 2 teaspoons leaves to each cup boiling water; infuse 10 minutes. Half-1 cup.

Tincture. 1 part in 5 parts 45 per cent alcohol. Macerate 8 days. Decant. 5-10ml (1-2 teaspoons). ... dupuytren’s contracture

Habitat: The alpine zone of the Himalayas from Gilgit to Kumaon.

Action: Nervine tonic.

This technique is used when normal methods of attempted CONCEPTION or ARTIFICIAL INSEMINATION with healthy SEMEN have failed. In the UK, assisted-conception procedures are governed by the Human Fertilisation & Embryology Act 1990, which set up the Human Fertilisation & Embryology Authority (HFEA).

Human Fertilisation & Embryology Act 1990 UK legislation was prompted by the report on in vitro fertilisation produced by a government-appointed committee chaired by Baroness Warnock. This followed the birth, in 1978, of the ?rst ‘test-tube’ baby.

This Act allows regulation monitoring of all treatment centres to ensure that they carry out treatment and research responsibly. It covers any fertilisation that uses donated eggs or sperm (called gametes) – for example, donor insemination or embryos (see EMBRYO) grown outside the human body (known as licensed treatment). The Act also covers research on human embryos with especial emphasis on foolproof labelling and immaculate data collection.

Human Fertilisation & EmbryologyAuthority (HFEA) Set up by the UK government following the Warnock report, the Authority’s 221 members inspect and license centres carrying out fertilisation treatments using donated eggs and sperm. It publishes a code of practice advising centres on how to conduct their activities and maintains a register of information on donors, patients and all treatments. It also reviews routinely progress and research in fertility treatment and the attempted development of human CLONING. Cloning to produce viable embryos (reproductive cloning) is forbidden, but limited licensing of the technique is allowed in specialist centres to enable them to produce cells for medical treatment (therapeutic cloning).

In vitro fertilisation (IVF) In this technique, the female partner receives drugs to enhance OVULATION. Just before the eggs are released from the ovary (see OVARIES), several ripe eggs are collected under ULTRASOUND guidance or through a LAPAROSCOPE. The eggs are incubated with the prepared sperm. About 40 hours later, once the eggs are fertilised, two eggs (three in special circumstances) are transferred into the mother’s UTERUS via the cervix (neck of the womb). Pregnancy should then proceed normally. About one in ?ve IVF pregnancies results in the birth of a child. The success rate is lower in women over 40.

Indications In women with severely damaged FALLOPIAN TUBES, IVF o?ers the only chance of pregnancy. The method is also used in couples with unexplained infertility or with male-factor infertility (where sperms are abnormal or their count low). Women who have had an early or surgically induced MENOPAUSE can become pregnant using donor eggs. A quarter of these pregnancies are multiple – that is, produce twins or more. Twins and triplets are more likely to be premature. The main danger of ovarian stimulation for IVF is hyperstimulation which can cause ovarian cysts. (See OVARIES, DISEASES OF.)... assisted conception

Caid, Caide, Cayd, Cayde, Caed, Caede... cade

A tin-like metal, cadmium accumulates in the body. Long-term exposure can lead to EMPHYSEMA, renal failure (see KIDNEYS, DISEASES OF) and urinary-tract CALCULI. Acute exposure causes GASTROENTERITIS and PNEUMONITIS. Cadmium contamination of food is the most likely source of poisoning. The EU Directive on the Quality of Water for Human Consumption lays down 5 milligrams per litre as the upper safe level.... cadmium poisoning

Verapamil, the longest-available, is used to treat angina and hypertension. It is the only calcium-channel blocker e?ective against cardiac ARRHYTHMIA and it is the drug of choice in terminating supraventricular tachycardia. It may precipitate heart failure, and cause HYPOTENSION at high doses. Nifedipine and diltiazem act more on the vessels and less on the myocardium than verapamil; they have no antiarrhythmic activity. They are used in the prophylaxis and treatment of angina, and in hypertension. Nicardipine and similar drugs act mainly on the vessels, but are valuable in the treatment of hypertension and angina. Important di?erences exist between di?erent calcium-channel blockers so their use must be carefully assessed. They should not be stopped suddenty, as this may precipitate angina. (See also HEART, DISEASES OF.)... calcium-channel blockers

Habitat: Ceylon.

Action: Tonic, febrifuge.

(e.g. cane sugar), polysaccharides (e.g. starch). Many of the cheaper and most important foods are included in this group, which comprises sugars, starches, celluloses and gums. When one of these foods is digested, it is converted into a simple kind of sugar and absorbed in this form. Excess carbohydrates, not immediately needed by the body, are stored as glycogen in the liver and muscles. In DIABETES MELLITUS, the most marked feature consists of an inability on the part of the tissues to assimilate and utilise the carbohydrate material. Each gram of carbohydrate is capable of furnishing slightly over 4 Calories of energy. (See CALORIE; DIET.)... carbohydrate

Nutritional Profile Energy value (calories per serving): Moderate Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: High Sodium: Low Major vitamin contribution: Niacin Major mineral contribution: Calcium

About the Nutrients in This Food Carob flour, which is milled from the dried pod of a Mediterranean ever- green tree, Ceratonia siliqua, looks like cocoa but has a starchy, beanlike flavor. It can be mixed with sweeteners to make a cocoalike powder or combined with fats and sweeteners to produce a candy that looks like and has the same rich mouthfeel as milk chocolate but tastes more like honey. Ounce for ounce, carob, which is also known as locust bean gum, has more fiber and calcium but fewer calories than cocoa. Its carbohydrates include the sugars sucrose, D-mannose, and D-galactose. (D-galactose is a simple sugar that links up with other sugars to form the complex indigest- ible sugars raffinose and stachyose.) Carob also contains gums and pectins, the indigestible food fibers commonly found in seeds.

The Most Nutritious Way to Serve This Food As a substitute for cocoa or chocolate for people who are sensitive to chocolate.

Diets That May Restrict or Exclude This Food Low-carbohydrate diet

Buying This Food Look for: Tightly sealed containers that will protect the flour from moisture and insects.

Storing This Food Store carob flour in a cool, dark place in a container that protects it from air, moisture, and insects. Keep carob candy cool and dry.

Preparing This Food Measure out carob flour by filling a cup or tablespoon and leveling it off with a knife. To substitute carob for regular flour, use ¼ cup carob flour plus ¾ cup regular flour for each cup ordinary flour. To substitute for chocolate, use three tablespoons of carob flour plus two tablespoons of water for each ounce of unsweetened chocolate. Carob flour is sweeter than unsweetened chocolate.

What Happens When You Cook This Food Unlike cocoa powder, carob flour contains virtually no fat. It will burn, not melt, if you heat it in a saucepan. When the flour is heated with water, its starch granules absorb moisture and rupture, releasing a gum that can be used as a stabilizer, thickener, or binder in processed foods and cosmetics. In cake batters, it performs just like other flours (see flour).

Medical uses and/or Benefits Adsorbent and demulcent. Medically, carob flour has been used as a soothing skin powder. As a chocolate substitute. People who are sensitive to chocolate can usually use carob instead. Like cocoa beans, carob is free of cholesterol. Unlike cocoa, which contains the cen- tral-nervous-system stimulant caffeine and the muscle stimulant theobromine, carob does not contain any stimulating methylxanthines. Lower cholesterol levels. In 2001, a team of German nutrition researchers from the Institute for Nutritional Science at the University of Potsdam, the German Institute of Human Nutri- tion, Center for Conventional Medicine and Alternative Therapies (Berlin) Nutrinova Nutri- tion Specialties and Food Ingredients GmbH, and PhytoPharm Consulting, Institute for Phytopharmaceuticals GmbH conducted a study to evaluate carob’s effectiveness in lower- ing cholesterol. For a period of eight weeks, 47 volunteers with moderately high cholesterol levels (232– 302 mg/dL) were fed 15 g of carob per day in breakfast cereal, fruit grain bars, and a drink made from powdered carob pulp as supplements to their normal diet. After four weeks, the volunteers’ total cholesterol levels fell an average of 7 percent and their LDL (low density lipoprotein—“bad” cholesterol) levels fell an average 10.6 percent. At six weeks, the numbers were 7.8 percent and 10.6 percent. There was no effect on HDLs (high density lipoproteins, a.k.a. “good” cholesterol).... carob

Casildah, Cassilda, Casylda, Cassylda... casilda

Cassea, Cassiah, Casseah... cassia

Prevention consists of minimising exposure to detergents and soapy water, and wearing rubber gloves for all routine household duties.... chapped hands

Cherrie, Cherri, Cherrey, Cherree, Cherrea, Cherreah... cherry

Habitat: Northern India.

Action: Bitter tonic.

Habitat: Meadows, pastures, waysides.

Action: Astringent.

Habitat: Among hedges and bushes.

Action: Diuretic, tonic, alterative.

In 1997 the ?rst mammal to be cloned from the tissue of an adult animal was born. A technique that scientists have been trying to perfect for decades, the success of the Roslin Institute, near Edinburgh, in producing ‘Dolly’, a cloned sheep, has profound implications. Already some scientists are talking of cloning humans, although this has great medical, legal and ethical consequences. The key to the scientists’ success in producing Dolly was the ability to coordinate the fusion of a donor cell (from an adult) containing all its DNA with a recipient egg from which DNA had been removed. The di?culty of the technique is shown by the fact that, out of 277 fused pairs of cells where the donor cell was from adult tissue, Dolly was the only survivor and she has developed premature arthritis. Research suggests that cloning may be accompanied by a higher than normal incidence of congenital defects.

Since Dolly was born, other animal clones have been produced and American researchers have cloned the ?rst human embryo – which grew to six cells – with the aim of providing stem cells for therapeutic use. As a result the UK government passed emergency legislation to outlaw human cloning for reproductive purposes.... cloning

Habitat: Indigenous to the Molucca Island, cultivated in Zanzibar, Madagascar, Java, Penang.

Action: Stimulant, aromatic, carminative.

The three-stage process of coagulation is complex, involving many di?erent substances. There are two cascading pathways of biochemical reactions for activating coagulation of blood. The extrinsic pathway is the main physiological mechanism, which is triggered when blood vessels are damaged, usually by trauma or surgery. The intrinsic pathway is activated by internal disruption of the wall of a blood vessel. The basic pattern is broadly the same for both and is summarised simply as follows:

prothrombin + calcium + thromboplastin

thrombin + ?brinogen

?brin

Prothrombin and calcium are normally present in the blood. Thromboplastin is an enzyme which is normally found in the blood platelets and in tissue cells. When bleeding occurs from a blood vessel, there is always some damage to tissue cells and to the blood platelets. As a result of this damage, thromboplastin is released and comes into contact with the prothrombin and calcium in the blood. In the presence of thromboplastin and calcium, prothrombin is converted into thrombin, which in turn interacts with ?brinogen – a protein always present in the blood – to form ?brin. Fibrin consists of needle-shaped crystals which, with the assistance of the blood platelets, form a ?ne network in which the blood corpuscles become enmeshed. This meshwork, or CLOT as it is known, gradually retracts until it forms a tight mass which, unless the tissue injury is very severe or a major artery has been damaged, prevents any further bleeding. It will thus be seen that clotting, or coagulation, does not occur in the healthy blood vessel because there is no thromboplastin present. There is now evidence suggesting that there is an anti-thrombin substance present in the blood in small amounts, and that this substance antagonises any small amounts of thrombin that may be formed as a result of small amounts of thromboplastin being released.

The clotting or coagulation time is the time taken for blood to clot and can be measured under controlled conditions to ensure that it is normal (3–8 minutes). In certain diseases – HAEMOPHILIA, for example – clotting time is greatly extended and the danger of serious haemorrhage enhanced.... coagulation

Habitat: The dried rhizome and roots are imported from the U.S.A., to which country and Canada the plant is indigenous.

Action: Astringent, diuretic, emmenagogue and alterative.

Uses Its main use is in gout, for which colchicine, the active principle of colchicum, in doses of 0·5 mg every one or two hours until the pain is relieved, followed by 0·5 mg thrice daily for about a week, is the form generally employed.... colchicum

Also called acute coryza or upper respiratory infection, the common cold is characterised by in?ammation of any or all of the airways – NOSE, sinuses (see SINUS), THROAT, LARYNX, TRACHEA and bronchi (see BRONCHUS). Most common, however, is the ‘head cold’, which is con?ned to the nose and throat, with initial symptoms presenting as a sore throat, runny nose and sneezing. The nasal discharge may become thick and yellow – a sign of secondary bacterial infection – while the patient often develops watery eyes, aching muscles, a cough, headache, listlessness and the shivers. PYREXIA (raised temperature) is usual. Colds can also result in a ?are-up of pre-existing conditions, such as asthma, bronchitis or ear infections. Most colds are self-limiting, resolving in a week or ten days, but some patients develop secondary bacterial infections of the sinuses, middle ear (see EAR), trachea, or LUNGS.

Treatment Symptomatic treatment with ANTIPYRETICS and ANALGESICS is usually su?cient; ANTIBIOTICS should not be taken unless there is de?nite secondary infection or unless the patient has an existing chest condition which could be worsened by a cold. Cold victims should consult a doctor only if symptoms persist or if they have a pre-existing condition, such as asthma which could be exacerbated by a cold.

Most colds result from breathing-in virus-containing droplets that have been coughed or sneezed into the atmosphere, though the virus can also be picked up from hand-to-hand contact or from articles such as hand towels. Prevention is, therefore, di?cult, given the high infectivity of the viruses. No scienti?cally proven, generally applicable preventive measures have yet been devised, but the incidence of the infection falls from about seven to eight years – schoolchildren may catch as many as eight colds annually – to old age, the elderly having few colds. So far, despite much research, no e?ective vaccines have been produced.... cold, common

Compensation also refers to the ?nancial compensation awarded to an individual who has been injured or made ill as a result of wrongful action or inaction by another individual or organisation. NHS trusts are increasingly being sued for compensation because patients believe that they have had unsatisfactory or damaging treatment. This is costing the NHS over £1 billion a year. (See RISK MANAGEMENT.)

Compensation neurosis Compensation neurosis or ‘traumatic’ neurosis is a psychological reaction to the prospects of compensation. It is a condition about which specialists disagree. Su?erers complain of a range of symptoms that may be a genuine consequence of their condition or an exaggerated response.... compensation

Computed tomography can distinguish soft tissues from cysts or fat, but in general soft-tissue masses have similar appearances, so that distinguishing an in?ammatory mass from a malignant process may be impossible. The technique is particularly useful in patients with suspected malignancy; it can also de?ne the extent of the cancer by detecting enlarged lymph nodes, indicating lymphatic spread. The main indications for computed tomography of the body are: mediastinal masses, suspected pulmonary metastases, adrenal disease, pancreatic masses, retroperitoneal lymph nodes, intra-abdominal abscesses, orbital tumours and the staging of cancer as a guide to e?ective treatment.... computed tomography

The earliest attempt at surgical separation is said to have been made by Dr Farius of Basle in 1689. The ?rst successful separation in Great Britain was in 1912: both twins survived the operation and one survived well into adult life. This is said to be the ?rst occasion on which both twins survived the operation. The success of the operation is largely dependent upon the degree of union between the twins. Thus, if this is only skin, subcutaneous tissue and cartilage, the prospects of survival for both twins are good; but if some vital organ such as the liver is shared, the operation is much more hazardous. (See MULTIPLE BIRTHS.)... conjoined twins

(w.t.e. 78,462).... consultant

(2) The coming together of various nerve ?bres to form a nerve tract that provides a single pathway from di?erent parts of the brain.... convergence

Causes The most common reason for convulsions is EPILEPSY, and the underlying cause of the latter often remains uncertain. In newborns, convulsions may be due to HYPOXIA following a di?cult labour, or to low levels of sugar or calcium in the blood (HYPOGLYCAEMIA; HYPOCALCAEMIA). A sudden rise of body temperature during infective illness may induce convulsions in an infant or young child.

Diseases of the brain, such as meningitis, encephalitis and tumours, or any disturbance of the brain due to bleeding, blockage of a blood vessel, or irritation of the brain by a fracture of the skull, may also be responsible for convulsions (see BRAIN, DISEASES OF).

Asphyxia, for example from choking, may also bring on convulsions.

Treatment Newborns with hypoglycaemia or hypocalcaemia are treated by replacing the missing compound. Infants with febrile convulsions may be sponged with tepid water and fever reduced with paracetamol.

In epilepsy, unless it is particularly severe, the movements seldom need to be restrained. If convulsions persist beyond a few minutes it may be necessary to give BENZODIAZEPINES, either intravenously or rectally. In the UK, paramedics are trained to do this; likewise many parents of epileptic children are capable of administering the necessary treatment. If however this fails to stop the convulsions immediately, hospital admission is needed for further treatment. Once ?ts are under control, the cause of the convulsions must be sought and the necessary long-term treatment given.... convulsions

Cotti, Cottie, Cotty, Cottey, Cottee, Cottea, Cotteah... cotton

Habitat: Cultivated in shrubberies, etc., for decorative purposes.

Action: Antispasmodic, nervine.

Nutritional Profile Energy value (calories per serving): Low Protein: Low Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Low Sodium: Moderate Major vitamin contribution: Vitamin C Major mineral contribution: Iron, potassium

About the Nutrients in This Food Cranberries are nearly 90 percent water. The rest is sugars and dietary fiber, including insoluble cellulose in the skin and soluble gums and pectins in the flesh. Pectin dissolves as the fruit ripens; the older and riper the cran- berries, the less pectin they contain. Cranberries also have a bit of protein and a trace of fat, plus moderate amounts of vitamin C. One-half cup cranberries has 1.6 g dietary fiber and 6.5 mg vitamin C (9 percent of the R DA for a woman, 7 percent of the R DA for a man). One-half cup cranberry sauce has 1.5 g dietary fiber and 3 mg vitamin C (4 percent of the R DA for a woman, 3 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food Relish made of fresh, uncooked berries (to preserve the vitamin C, which is destroyed by heat) plus oranges.

Diets That May Restrict or Exclude This Food Low-fiber diet

Buying This Food Look for: Firm, round, plump, bright red berries that feel cool and dry to the touch. Avoid: Shriveled, damp, or moldy cranberries. Moldy cranberries may be contaminated with fusarium molds, which produce toxins that can irritate skin and damage tissues by inhibiting the synthesis of DNA and protein.

Storing This Food Store packaged cranberries, unwashed, in the refrigerator, or freeze unwashed berries in sealed plastic bags for up to one year.

Preparing This Food Wash the berries under running water, drain them, and pick them over carefully to remove shriveled, damaged, or moldy berries. R inse frozen berries. It is not necessary to thaw before cooking.

What Happens When You Cook This Food First, the heat will make the water inside the cranberry swell, so that if you cook it long enough the berry will burst. Next, the anthocyanin pigments that make cranberries red will dissolve and make the cooking water red. Anthocyanins stay bright red in acid solutions and turn bluish if the liquid is basic (alkaline). Cooking cranberries in lemon juice and sugar preserves the color as well as brightens the taste. Finally, the heat of cooking will destroy some of the vitamin C in cranberries. Cranberry sauce has about one-third the vitamin C of an equal amount of fresh cranberries.

Medical Uses and/or Benefits Urinary antiseptic. Cranberr y juice is a long-honored folk remedy for urinar y infections. In 1985, researchers at Youngstown (Ohio) State University found a “special factor” in cran- berries that appeared to keep disease-causing bacteria from adhering to the surface of cells in the bladder and urinar y tract. In 1999, scientists at study at Rutgers University (in New Jersey) identified specific tannins in cranberries as the effective agents. In 2004, research- ers at Beth Israel Medical Center (New York) published a review of 19 recent studies of cranberries. The report, in the journal American Family Physician, suggested that a regimen of eight ounces of unsweetened cranberr y juice or one 300 – 400 mg cranberr y extract tablet twice a day for up to 12 months safely reduced the risk of urinar y tract infections. In 2008, a similar review by scientists at the University of Stirling (Scotland) of 10 studies showed similar results.

Adverse Effects Associated with This Food Increased risk of kidney stones. Long-term use of cranberry products may increase the risk of stone formation among patients known to form oxalate stones (stones composed of calcium and/or other minerals).

Food/Drug Interactions Anticoagulants Anticoagulants (blood thinners) are drugs used to prevent blood clots. They are most commonly prescribed for patients with atrial fibrillation, an irregular heartbeat that allows blood to pool in the heart and possibly clot before being pumped out into the body. In 2006 researchers at the College of Pharmacy and the Antithrombosis Center at the Univer- sity of Illinois (Chicago) reported that consuming cranberry juice while using the anticoagu- lant warafin (Coumadin) might cause fluctuations in blood levels of the anticoagulant, thus reducing the drug’s ability to prevent blood clots.... cranberries

Cytotoxic drugs are used either singly or in combination, when an enhanced response is the aim. Chemotherapy of cancer is a complex process and should be supervised by an oncologist in co-operation with physicians, surgeons, radiotherapists and radiologists as appropriate.

The cytotoxic drugs include:

(1) The alkylating agents which act by damaging DNA, thus interfering with cell reproduction. Cyclophosphamide, ifosfamide, chlorambucil, kelphalan, busulphan, thiotepa and mustine are examples of alkylating agents.

(2) There are a number of cytotoxic antibiotics used in the treatment of cancer – doxorubicin, bleomycin, dactinomycin, mithramycin and amsacrine are examples. They are used primarily in the treatment of acute leukaemia and lymphomas.

(3) Antimetabolites – these drugs combine irreversibly with vital enzyme systems of the cell and hence prevent normal cell division. Methotrexate, cytarabine, ?uorouracil, mercaptopurine and azathioprine are examples.

(4) Another group of cytotoxic drugs are the vinca alkaloids such as vincristine, vinblastine and vindesima.

(5) Platinum compounds such as carboplatin, cisplatin and oxaliplatin are e?ective. All of them are given intravenously, but the latter two tend to have more unpleasant side-effects. Carboplatin and cisplatin are useful in the treatment of solid tumours. Carboplatin, a derivative of cisplatin, is given intravenously in ovarian cancer and in small-cell lung cancer. Better tolerated than cisplatin, the drug causes less nausea and vomiting, nephrotoxicity, neurotoxicity and ototoxicity. Where platinum-containing therapy has failed, intravenous treatment with paclitaxel may be tried. With only a limited success rate, it is relatively toxic and should be carefully supervised; responses, however, are sometimes prolonged.

Also of increasing importance in treating cancer are interferons. These are naturally occurring proteins with complex effects on immunity and cell function. Although toxic, with numerous adverse effects, they have shown some anti-tumour e?ect against certain lymphomas and solid tumours.... cytotoxic

The cells produce the main constituents of MUCUS.... goblet cell

Ben: Kalmegh

Treatment Topical nasal decongestants include sodium chloride drops and corticosteroid nasal drops (for polyps). For commoncold-induced congestion, vapour inhalants, decongestant sprays and nasal drops, including EPHEDRINE drops, are helpful. Overuse of decongestants, however, can produce a rebound congestion, requiring more treatment and further congestion, a tiresome vicious circle. Allergic RHINITIS (in?ammation of the nasal mucosa) usually responds to ipratropium bromide spray.

Systemic nasal decongestants given by mouth are not always as e?ective as topical administrations but they do not cause rebound congestion. Pseudoephedrine hydrochoride is available over the counter, and most common-cold medicines contain anticongestant substances.... nasal congestion

Sometimes during cell division chromosomes may be lost or duplicated, or abnormalities in the structure of individual chromosomes may occur. The surprising fact is the infrequency of such errors. About one in 200 live-born babies has an abnormality of development caused by a chromosome, and two-thirds of these involve the sex chromosomes. There is little doubt that the frequency of these abnormalities in the early embryo is much higher, but because of the serious nature of the defect, early spontaneous ABORTION occurs.

Chromosome studies on such early abortions show that half have chromosome abnormalities, with errors of autosomes being three times as common as sex chromosome anomalies. Two of the most common abnormalities in such fetuses are triploidy with 69 chromosomes and trisomy of chromosome 16. These two anomalies almost always cause spontaneous abortion. Abnormalities of chromosome structure may arise because of:

Deletion Where a segment of a chromosome is lost.

Inversion Where a segment of a chromosome becomes detached and re-attached the other way around. GENES will then appear in the wrong order and thus will not correspond with their opposite numbers on homologous chromosomes.

Duplication Where a segment of a chromosome is included twice over. One chromosome will have too little nuclear material and one too much. The individual inheriting too little may be non-viable and the one with too much may be abnormal.

Translocation Where chromosomes of different pairs exchange segments.

Errors in division of centromere Sometimes the centromere divides transversely instead of longitudinally. If the centromere is not central, one of the daughter chromosomes will arise from the two short arms of the parent chromosome and the other from the two long arms. These abnormal daughter chromosomes are called isochromosomes.

These changes have important bearings on heredity, as the e?ect of a gene depends not only upon its nature but also upon its position on the chromosome with reference to other genes. Genes do not act in isolation but against the background of other genes. Each gene normally has its own position on the chromosome, and this corresponds precisely with the positon of its allele on the homologous chromosome of the pair. Each member of a pair of chromosomes will normally carry precisely the same number of genes in exactly the same order. Characteristic clinical syndromes, due to abnormalities of chromosome structure, are less constant than those due to loss or gain of a complete chromosome. This is because the degree of deletion, inversion and duplication is inconstant. However, translocation between chromosomes 15 and 21 of the parent is associated with a familial form of mongolism (see DOWN’S (DOWN) SYNDROME) in the o?spring, and deletion of part of an X chromosome may result in TURNER’S SYNDROME.

Non-disjunction Whilst alterations in the structure of chromosomes arise as a result of deletion or translocation, alterations in the number of chromosomes usually arise as a result of non-disjunction occurring during maturation of the parental gametes (germ cells). The two chromosomes of each pair (homologous chromosomes) may fail to come together at the beginning of meiosis and continue to lie free. If one chromosome then passes to each pole of the spindle, normal gametes may result; but if both chromosomes pass to one pole and neither to the other, two kinds of abnormal gametes will be produced. One kind of gamete will contain both chromosomes of the pair, and the other gamete will contain neither. Whilst this results in serious disease when the autosomes are involved, the loss or gain of sex chromosomes seems to be well tolerated. The loss of an autosome is incompatible with life and the malformation produced by a gain of an autosome is proportional to the size of the extra chromosome carried.

Only a few instances of a gain of an autosome are known. An additional chromosome 21 (one of the smallest autosomes) results in mongolism, and trisomy of chromosome 13 and 18 is associated with severe mental, skeletal and congenital cardiac defects. Diseases resulting from a gain of a sex chromosome are not as severe. A normal ovum contains 22 autosomes and an X sex chromosome. A normal sperm contains 22 autosomes and either an X or a Y sex chromosome. Thus, as a result of nondisjunction of the X chromosome at the ?rst meiotic division during the formation of female gametes, the ovum may contain two X chromosomes or none at all, whilst in the male the sperm may contain both X and Y chromosomes (XY) or none at all. (See also CHROMOSOMES; GENES.)... sex chromosomes

The human backbone is about 70 cm (28

inches) in length, and varies little in full-grown people; di?erences in height depend mainly upon the length of the lower limbs. The number of vertebrae is 33 in children, although in adult life ?ve of these fuse together to form the sacrum, and the lowest four unite in the coccyx, so that the number of separate bones is reduced to 26. Of these there are seven in the neck, known as cervical vertebrae; 12 with ribs attached, in the region of the thorax known as thoracic or dorsal vertebrae; ?ve in the loins, called lumbar vertebrae; ?ve fused to form the sacrum; and four joined in the coccyx. These numbers are expressed in a formula thus: C7, D12, L5, S5, Coc4=33.

Although the vertebrae in each of these regions have distinguishing features, all the vertebrae are constructed on the same general plan. Each has a thick, rounded, bony part in front, known as the body, and these bodies form the main thickness of the column. Behind the body of each is a ring of bone, the neural ring, these rings placed one above another forming the bony canal which lodges the spinal cord. From each side of the ring a short process of bone known as the transverse process stands out, and from the back of the ring a larger process, the spinous process, projects. These processes give attachment to the strong ligaments and muscles which unite, support, and bend the column. The spines can be seen or felt beneath the skin of the back lying in the centre of a groove between the muscular masses of the two sides, and they give to the column its name of the spinal column. One of these spines, that of the seventh cervical vertebra, is especially large and forms a distinct bony prominence, where the neck joins the back. Between the bodies of the vertebrae lies a series of thick discs of ?brocartilage known as intervertebral discs. Each disc consists of an outer portion, known as the annulus ?brosus, and an inner core, known as the nucleus pulposus. These 23 discs provide the upper part of the spine with pliability and resilience.

The ?rst and second cervical vertebrae are specially modi?ed. The ?rst vertebra, known as the atlas, is devoid of a body, but has a specially large and strong ring with two hollows upon which the skull rests, thus allowing forward and backward movements (nodding). The second vertebra, known as the axis, has a pivot on its body which ?ts into the ?rst vertebra and thus allows free rotation of the head from side to side. The spinal column has four natural curves (see diagram) which help to cushion the shocks of walking and running.

The neural rings of the vertebrae form a canal, which is wide in the neck, smaller and almost round in the dorsal region, and wide again in the lumbar vertebrae. Down the canal runs the spinal cord, and the nerves leaving the cord do so through openings between the vertebrae which are produced by notches on the upper and lower margins of each ring. The intervertebral foramina formed by these notches are so large in comparison with the nerves passing through them that there is no chance of pressure upon the latter, except in very serious injuries which dislocate and fracture the spine.... spinal column

A target cell is also a cell that is the focus of attack by macrophages (killer cells – see MACROPHAGE) or ANTIBODIES; it may also be the site of action of a speci?c hormone (see HORMONES).... target cell

Symptoms: low blood pressure, reduced urinary output, water in the lungs, etc. See: MYOCARDITIS. ... cardiogenic shock

A steady herbal regime is required including agents which may coax sluggish liver or kidneys into action (Dandelion, Barberry). Sheer physical exhaustion may require Ginseng. For purulent sputum – Boneset, Elecampane, Pleurisy root. To increase resistance – Echinacea. Where due to tuberculosis – Iceland Moss. For blood-streaked mucus – Blood root. For fever – Elderflowers, Yarrow. To conserve cardiac energies – Hawthorn, Motherwort. A profuse sweat affords relief – Elderflowers.

Alternatives. Capsicum, Ephedra, Fenugreek, Garlic, Grindelia, Holy Thistle, Iceland Moss, Lobelia, Mullein, Pleurisy Root, Wild Cherry.

Tea. Formula. Iceland Moss 2; Mullein 1; Wild Cherry bark 1. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily.

Powders. Pleurisy root 2; Echinacea 1; Holy Thistle 1. Pinch Ginger. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Tinctures. Formula. Iceland Moss 2; Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 1-2 teaspoons two or more times daily.

Practitioner. Liquid Extract Ephedra BHP (1983), dose 1-3ml. Or: Tincture Ephedra BHP (1983), dose 6-8ml.

Topical. Same as for acute bronchitis.

Note: In a test at Trafford General Hospital, Manchester, blowing-up balloons proved of benefit to those with chronic bronchitis. Fourteen patients were asked to inflate balloons and 14 refrained from doing so. After 8 weeks, the balloon-blowers showed considerable improvement in walking and a sense of well- being. Breathlessness was reduced. Condition of the others was either unchanged or worse. ... bronchitis, chronic

Action: Antiseptic, antispasmodic, rubefacient, anthelmintic, insect repellent. Antimicrobial. Antiscorbutic. Expectorant.

Uses: Used by natives of the Molucca Islands as a lotion for painful stiff joints. Advised by physicians at the turn of the century to combat the tubercle bacillus. Infections of the bronchi. Worms in children. Toothache. Headache.

Preparation. Topically for toothache, bruises, sprains, neuralgia. Cajuput oil BPC: dose, 0.05-0.2ml.

Today it is confined to external use only as an ingredient of stimulating liniments and ointments for aching joints, fibrositis, etc. An ingredient of Olbas oil. ... cajeput

Action: expectorant, diuretic, hypotensive, digestive, tonic.

Uses: Indigestion, high blood pressure.

Preparations: Tea: Half-1 teaspoon to each cup boiling water; infuse 15 minutes; dose 1 cup, thrice daily. Fresh juice: Half-1 teaspoon, or as a lotion for eczema. ... chervil

Tea. Mix, equal parts: Agrimony, Lemon Balm, Raspberry leaves. 2 teaspoons to each cup boiling water; infuse 15 minutes. 1 cup freely. Honey for sweetening. Or: Burdock leaves, hot tea.

Tinctures. Formula: Black root 1oz (30ml); Echinacea 1oz (30ml); Peruvian bark half an ounce (15ml). 5ml teaspoon in water before meals thrice daily.

Cider Vinegar. 2 teaspoons to glass water, morning and evening.

Floradix Formula Food supplement (Salus). ... chlorosis

Fragrant oil extracted from an Asian perennial grass. Rarely used internally.

Action: antirheumatic, strong insect repellent, febrifuge, diaphoretic, antispasmodic. Uses: Muscular rheumatism.

External: Locally to repel insects and vermin. ... citronella

Symptoms: flushing of face and neck, diarrhoea, low blood pressure, weight loss.

Treatment: relief of symptoms only. Diarrhoea – Fenugreek seed tea. Flushing: Chamomile tea.

Vitamin and Mineral Supplementation: Because of severe drain on these food elements Multivitamins should be taken daily together with additional 1000ius Vitamin E for the disturbed circulatory system. The heart should be sustained with a preparation of the Hawthorn berry.

To be treated by or in liaison with a qualified medical practitioner. ... carcinoid syndrome

Action: powerfully stimulates genito-urinary mucous surfaces and for this purpose was used by the Old School extensively for gonorrhoea and other STDs. As an expectorant was once used for chronic cough and bronchitis (1ozenges).

Preparations: Thrice daily.

Liquid Extract BPC (1934) 1 in 1. Dose: 2-4ml. Tincture Cubebs BPC 1949; dose, 2-4ml. Powder: dose, 2-4g. ... cubebs

Cause: Septicaemia or infected embolism conveyed from elsewhere – veins of the face, sinuses, head. May be a complication of meningitis.

Symptoms: headache, nausea, swelling of eyelids and forehead, pupils distended, veins of temples prominent, fever with severe constitutional disturbance.

Prognosis: usually fatal in the absence of orthodox antibiotics, but anti-staphylococcal herbs are helpful. Tinctures. Formula. Echinacea 3; Goldenseal 2; Myrrh (Tincture) 1. 1 teaspoon in water every 2 hours (acute). Thrice daily (chronic).

Treatment by or in liaison with general medical practitioner. ... cavernous sinus thrombosis

Contains apiol, coumarins. Minerals: iron, phosphorus, potassium, sodium.

Action: alkaline reaction on the blood. Antirheumatic, urinary antiseptic, diuretic, antispasmodic, carminative, tonic digestive, galactagogue, assists elimination of uric acid. Anti-gout, anti-inflammatory, hypotensor, aphrodisiac.

Uses: Rheumatic disorders, stiffness and muscular pain, rheumatoid arthritis. Inflammation of the urinary tract, cystitis. To increase milk flow in nursing mothers. Bad breath.

Preparations: Thrice daily.

Green Drink: fresh raw celery juice prepared in a liquidiser. Blends well with carrot or apple juice. Cooling drink for a sickroom.

Decoction. Quarter to half a teaspoon bruised dry seeds to each cup water, gently simmer 10 minutes in covered vessel. Half-1 cup.

Liquid extract, BHC Vol 1. 1:1, 90 per cent ethanol. Dose: 0.5 to 2ml.

Tincture, BHC Vol 1. 1:5, 90 per cent ethanol. Dose: 2 to 8ml.

Tablets/capsules. Powdered plant 120mg; seed BHP (1983) 5mg.

Home acid tincture. 1 part bruised celery seed to 20 parts Cider vinegar. Macerate 1 month. Filter. Dose: 2-3 teaspoons in water (rheumatic aches and pains).

Essential oil: 1-2 drops in water or honey.

Diet: The vegetable is low in calories: for weight-conscious. Non-fattening.

Not taken in pregnancy.

CELL PROLIFERANTS. Comfrey, Fenugreek, Calendula. ... celery seed

Treatment. To activate capillary function and assist toxic elimination: Bladderwrack, Gotu Kola, Kola, Parsley tea. A diuretic may assist by eliminating excess fluid.

Gotu Kola tea: Quarter to half a teaspoon leaves to each cup boiling water; infuse 5-10 minutes. 1 cup morning and evening.

Formula. Tea. Equal parts: Alfalfa, Clivers, Fennel, Senna leaves. 1 heaped teaspoon to each cup boiling water: infuse 5-10 minutes. Half-1 cup morning and evening.

Seline. Tablets. Ingredients: Each tablet contains Lecithin 100mg; Pulverised Dandelion 100mg; Pulverised Horsetail 100mg; Pulverised extract Fucus 5:1 30mg; Vitamin C 40mg; Vitamin B6 1mg. 1 tablet thrice daily.

Aescin. Compound isolated from Horse-chestnuts to decrease capillary permeability and swelling. Topical. Decoction of Horse-chestnuts as a lotion. Or: infusion of Bladderwrack.

Aromatherapy and Herb essences. Combination for external use. Ingredients: Almond oil 47ml; Fennel oil 1ml; Juniper oil 1ml; Cypress essence 0.5ml; Lemon essence 0.5ml. Apply to affected areas morning and evening; small area 5 drops, large area 10 drops (Gerard). Gentle massage with a string glove, loofah or massage glove.

Diet. Reduce calorie intake. Raw fresh fruits and vegetable salads to account for 50 per cent of the diet. No sweet or dried fruits. Conservatively-cooked vegetables. Seafood. Iodine-rich foods. Wholegrain cereals. Protein: beans, chicken, poached eggs, fish, little lean meat: no pork, bacon or ham. Low-fat yoghurt. Cold-pressed unsaturated oils for salad dressings with lemon juice. Dandelion coffee to stimulate liver. Avoid sugar, alcohol, bananas and white flour products. Spring water.

Supportives. Stop smoking. Adopt an alternative to the contraceptive pill. To avoid fluid retention, 2-3 glasses of water daily. ... cellulite

Alternatives. Teas. Lime flowers, Nettles, Horsetail, Ginkgo, Oats, Mistletoe, Yarrow.

Tea. Mix equal parts: Ginkgo, Hawthorn, Yarrow. One heaped teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup thrice daily.

Tablets/capsules. Ginkgo, Hawthorn, Prickly Ash.

Diet. See: DIET–HEART AND CIRCULATION.

Supplements. Daily: Vitamin E 1000mg; B6 50mg; B12 2mcg. Selenium 200mcg; Zinc 15mg. Strict bedrest; regulate bowels; avoid excessive physical and mental exertion. ... cerebral thrombosis

Alternatives. Internal. Prickly Ash, Hawthorn, Cayenne, Blue Flag, Ginger.

Tinctures. To tone the skin. Mix, equal parts: Yarrow, Blue Flag root, Prickly Ash. Few drops tincture Capsicum (Cayenne). One 5ml teaspoon in water before meals thrice daily.

Topical. Oak bark hand or foot baths: handful bark to each 1 pint (500ml) water simmered 20 minutes. Capsicum or Black Bryony (Tamus): cream or lotion.

Friar’s balsam: soak cotton wool and apply.

Traditional. Rub with raw onion. Bathe with potato water. Infusion of Wild Thyme wash (Dr Alfred Vogel). Cider vinegar.

Prophylactic measures: adequate footwear (socks and shoes) before winter comes.

Supplementation. 2 × 300mg Calcium lactate tablets at meals thrice daily. Vitamin E (400iu daily). Vitamin B-complex (500mg daily). ... chilblains

Since the barefoot doctors (paramedics) have been grafted into the public Health Service, mass preventative campaigns with public participation of barefoot doctors have led to a reduction in the mortality of infectious disease.

Chinese doctors were using Ephedra 5000 years ago for asthma. For an equal length of time they used Quinghaosu effectively for malaria. The Chinese first recorded goose-grease as the perfect base for ointments, its penetrating power endorsed by modern scientific research.

While Western medicine appears to have a limited capacity to cure eczema, a modern Chinese treatment evolved from the ancient past is changing the lives of many who take it. The treatment was brought to London by Dr Ding-Hui Luo and she practised it with crowded surgeries in London’s Chinatown.

Chinese herbalism now has an appeal to general practitioners looking for alternative and traditional therapies for various diseases where conventional treatment has proved to be ineffective.

See entry: BAREFOOT DOCTOR’S MANUAL.

Address. Hu Shilin, Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medicine, Beijing, China. ... chinese medicine

Herbs are composed of alkaloids, saponins, esters, oils etc. In order to trace these in sample plant material, a picture is taken by a process known as Thin-layer-chromatography (TLC) on which a silica- gel coated ‘negative’ makes visible a number of constituents.

To initiate this process, active constituents (alkaloids etc) are extracted and separated. Their separation is possible by dipping into a special solvent solution, after which the ‘negative’ is developed by spraying with a reagent that reveals the constituents in various colours. Each component of the plant has its own distinctive colour. Each herb has its own specific ‘profile’ which can be ‘read’ by the technician and checked against known control samples. Each plant can thus be accurately identified. ... chromatography

Café au lait spots are usually oval in shape and may measure several centimetres across.

Generally, a few spots are not significant; larger numbers may be a sign of neurofibromatosis.... café au lait spots

Calcification also occurs in injured muscles, in arteries affected by atherosclerosis, and when blood calcium levels are raised by disorders of the parathyroid glands.... calcification

When it is compressed and cooled to -75ºC, carbon dioxide becomes solid dry ice, which is used in cryosurgery.... carbon dioxide

Carbon monoxide binds with haemoglobin and prevents the transportation of oxygen to body tissues.

The initial symptoms of acute high-level carbon monoxide poisoning are dizziness, headache, nausea, and faintness.

Continued inhalation of the gas may lead to loss of consciousness, permanent brain damage, and even death.

Low-level exposure to carbon monoxide over a period of time may cause fatigue, nausea, diarrhoea, abdominal pain, and general malaise.... carbon monoxide

the hand, are applied to the lower breastbone until trained help arrives.

Both these measures are used to restore blood circulation to the brain.

Brain damage is likely if the brain is starved of oxygen for more than 3–4 minutes.... cardiopulmonary resuscitation

Coronary thrombosis is more common in the West because of its preference for animal fats; whereas in the East fats usually take the form of vegetable oils – corn, sunflower seed, sesame, etc. Fatty deposits (atheroma) form in the wall of the coronary artery, obstructing blood-flow. Vessels narrowed by atheroma and by contact with calcium and other salts become hard and brittle (arterio-sclerosis) and are easily blocked. Robbed of oxygen and nutrients heart muscle dies and is replaced by inelastic fibrous (scar) tissue which robs the heart of its maximum performance.

Severe pain and collapse follow a blockage. Where only a small branch of the coronary arterial tree is affected recovery is possible. Cause of the pain is lack of oxygen (Vitamin E). Incidence is highest among women over 40 who smoke excessively and who take The Pill.

The first warning sign is breathlessness and anginal pain behind the breastbone which radiates to arms and neck. Sensation as if the chest is held in a vice. First-line agent to improve flow of blood – Cactus.

For cholesterol control target the liver. Coffee is a minor risk factor.

Measuring hair calcium levels is said to predict those at risk of coronary heart disease. Low hair concentrations may be linked with poor calcium metabolism, high aortic calcium build-up and the formation of plagues. (Dr Allan MacPherson, nutritionist, Scottish Agricultural College, Ayr, Scotland)

Evidence has been advanced that a diagonal ear lobe crease may be a predictor for coronary heart disease. (American Journal of Cardiology, Dec. 1992)

Tooth decay is linked to an increased risk of coronary heart disease and mortality, particularly in young men. (Dr Frank De Stefano, Marshfield Medical Research Foundation, Wisconsin, USA) Treatment. Urgency. Send for doctor or suitably qualified practitioner. Absolute bedrest for 3 weeks followed by 3 months convalescence. Thereafter: adapt lifestyle to slower tempo and avoid undue exertion. Stop smoking. Adequate exercise. Watch weight.

Cardiotonics: Motherwort, Hawthorn, Mistletoe, Rosemary. Ephedra, Lily of the Valley, Broom.

Cardiac vasodilators relax tension on the vessels by increasing capacity of the arteries to carry more blood. Others contain complex glycosides that stimulate or relax the heart at its work. Garlic is strongly recommended as a preventative of CHD.

Hawthorn, vasodilator and anti-hypertensive, is reputed to dissolve deposits in thickened and sclerotic arteries BHP (1983). It is believed to regulate the balance of lipids (body fats) one of which is cholesterol.

Serenity tea. Equal parts: Motherwort, Lemon Balm, Hawthorn leaves or flowers. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes; 1 cup freely.

Decoction. Combine equal parts: Broom, Lily of the Valley, Hawthorn. 1-2 teaspoons to each cup water gently simmered 20 minutes. Half-1 cup freely.

Tablets/capsules. Hawthorn, Motherwort, Cactus, Mistletoe, Garlic.

Practitioner. Formula. Hawthorn 20ml; Lily of the Valley 10ml; Pulsatilla 5ml; Stone root 5ml; Barberry 5ml. Tincture Capsicum 1ml. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily in water or honey.

Prevention: Vitamin E – 400iu daily.

Diet. See: DIET – HEART AND CIRCULATION.

Supplements. Daily. Vitamin C, 2g. Vitamin E possesses anti-clotting properties, 400iu. Broad spectrum multivitamin and mineral including chromium, magnesium selenium, zinc, copper.

Acute condition. Strict bed-rest; regulate bowels; avoid excessive physical and mental exertion. Meditation and relaxation techniques dramatically reduce coronary risk. ... coronary heart disease

Most casts are made of bandages, impregnated with plaster of Paris, which are applied wet and harden as they dry.... cast

Catharsis is used to refer to the process of cleaning out the bowels.

Sigmund Freud used the term in psychoanalytic theory to describe the expression of repressed feelings and memories.... catharsis

Caudal means “of the tail”.... caudal

Caustic agents such as silver nitrate are used to destroy warts.... caustic

Plenty of fluids are indicated. Where these are supplied by herb teas a double purpose is served; these advised being of proven value for pregnancy and parturition.

Tea. Equal parts: Raspberry leaves, Cornsilk. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup 3-4 times daily. ... cystinuria

and osteoarthritis.

Side effects include nausea and diarrhoea.

Gastrointestinal discomfort may also occur, but can be minimized by taking the drug with food.... celecoxib

When a fluid such as blood is spun at high speed around a central axis, groups of particles of varying density, for example red and white blood cells, are separated by centrifugal force.... centrifuge

The swelling is not serious and gradually subsides.... cephalhaematoma

The disease may eventually cause a cerebrovascular accident, which commonly leads to a stroke.

Extensive narrowing of blood vessels throughout the brain can be a cause of dementia.... cerebrovascular disease

Alternatives. To sustain.

Teas. Lime flowers, Motherwort, Buckwheat, Hawthorn.

Tablets/capsules. Hawthorn, Mistletoe, Motherwort.

Formula. Hawthorn 2; Lily of the Valley 1; Selenicereus grandiflorus 1. Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. In water morning and evening. ... heart disease – congenital

Treatment is with a suture (stitch) applied like a purse string around the cervix during the 4th month of pregnancy. The suture is left in position until the pregnancy is at or near full term and is then cut to allow the mother to deliver the baby normally.... cervical incompetence

The grading system is used to distinguish levels of change in the surface cells of the cervix in biopsy samples taken during colposcopy, a procedure usually performed following an abnormal cervical smear test.

Grades 1–3 broadly correspond to mild to severe cervical dysplasia in cells obtained from a smear.... cervical intraepithelial neoplasia

The flea penetrates the skin of the feet and lays eggs.

Chigoe fleas should be removed with a sterile needle, and the wounds treated with an antiseptic.... chigoe

When a blood vessel is damaged, it constricts immediately to reduce blood flow to the area. The damage sets off a series of chemical reactions that lead to the formation of a clot to seal the injury. First, platelets around the injury site are activated, becoming sticky and adhering to the blood-vessel wall. Then, the activated platelets release chemicals, which, in turn, activate blood clotting factors. These factors, together with vitamin K, act on fibrinogen and convert it to fibrin. Strands of fibrin form a meshwork, which traps red blood cells to form a clot.

There are several anticlotting mechanisms to prevent the formation of unwanted clots. These include prostacyclin (a prostaglandin), which prevents platelet aggregation, and plasmin, which breaks down fibrin (see fibrinolysis). Blood flow washes away active coagulation factors; and the liver deactivates excess coagulation factors.

Defects in blood clotting may result in bleeding disorders.

Excessive clotting (thrombosis) may be due to an inherited increase or defect in a coagulation factor (see factor V), the use of oral contraceptives, a decrease in the level of enzymes that inhibit coagulation, or sluggish blood flow through a particular area.

Treatment is usually with anticoagulant drugs such as heparin or warfarin.... blood clotting

The first sign of breast cancer may be a painless lump. Other symptoms may include a dark discharge from the nipple, retraction (indentation) of the nipple, and an area of dimpled, creased skin over the lump. In 90 per cent of the cases, only 1 breast is affected. The cancer may be suspected after discovering a lump during breast self-examination or mammography. If a lump is detected, cells will be collected from it by needle aspiration or surgical biopsy. If the lump is cancerous, the treatment given depends on the woman’s age, the size of the tumour, whether or not there are signs of spread to the lymph nodes, and the sensitivity of the tumour cells to hormones, as assessed in the laboratory. A small tumour, with no evidence of having spread outside the breast, is removed surgically. Lymph nodes in the armpit are also commonly removed at the same time. Surgery may be combined with radiotherapy and/or anticancer drugs.

Secondary tumours in other parts of the body are treated with anticancer drugs and hormones. Regular check-ups are required to detect recurrence or the development of a new cancer in the other breast. If the cancer recurs, it can be controlled, in some cases, for years by drugs and/or radiotherapy.... breast cancer

Cholesteatoma usually occurs as a result of long-standing otitis media together with a defect in the eardrum (see eardrum, perforated).

Left untreated, it may damage the small bones in the middle ear and other structures.

Cholesteatoma needs to be removed surgically through the eardrum or by mastoidectomy.... cholesteatoma

A direct blow to the body may rupture the thin capillary walls, causing bleeding under the surface of the skin, which in turn causes swelling and bruising. Increasing age, high doses of corticosteroid drugs, and scurvy (vitamin C deficiency) make capillaries more fragile; a tendency to purpura (small areas of bleeding under the skin) may develop.... capillary

Usually occurring in middle age, the tumour develops slowly from a noncancerous tumour (see chondroma; dyschondroplasia) or from normal bone.

Amputation of the bone above the tumour usually results in a permanent cure.... chondrosarcoma

Chordee mainly occurs in males with hypospadias, a birth defect in which the urethral opening lies on the underside of the penis.

Corrective surgery is usually performed between the ages of 1 and 3 years.... chordee

The left carotid arises from the aorta and runs up the neck on the left side of the trachea (windpipe). The right carotid arises from the subclavian artery (which branches off the aorta) and follows a similar route on the right side of the

neck. Just above the level of the larynx (voice-box), each carotid artery divides to form an external carotid artery and an internal carotid artery. The external arteries have multiple branches that supply most tissues in the face, scalp, mouth, and jaws; the internal arteries enter the skull to supply the brain and eyes. At the base of the brain, branches of the 2 internal carotids and the basilar artery join to form a ring of vessels called the circle of Willis. Narrowing of these vessels may be associated with transient ischaemic attack (TIA); obstruction of them causes a stroke. carpal tunnel syndrome Numbness, tingling, and pain in the thumb, index finger, and middle fingers caused by compression of the median nerve at the wrist. Symptoms may be worse at night. The condition results from pressure on the nerve where it passes into the hand via a gap (the “carpal tunnel’’) under a ligament at the front of the wrist. It is common among keyboard users. It also occurs without obvious cause in middleaged women, and is associated with pregnancy, initial use of oral contraceptives, premenstrual syndrome, rheumatoid arthritis, myxoedema, and acromegaly.

The condition often disappears without treatment.

Persistent symptoms may be treated with a corticosteroid drug injected under the ligament, or the ligament may be cut to relieve pressure on the nerve.... carotid artery

The cerebellum is situated behind the brainstem and has 2 hemispheres.

From the inner side of each hemisphere arise 3 nerve fibre stalks, which link up with different parts of the brainstem and carry signals between the cerebellum and the rest of the brain.

Nerve fibres from these stalks fan out towards the deep folds of the cortex (outer part) of each brain hemisphere, which consists of layers of grey matter.

Information about the body’s posture and the state of contraction or relaxation in its muscles is conveyed from muscle tendons and the labyrinth in the inner ear via the brainstem to the cerebellum.

Working with the basal ganglia (nerve cell clusters deep within the brain), the cerebellum uses this data to fine tune messages sent to muscles from the motor cortex in the cerebrum.... cerebellum

called the corpus callosum carries nerve signals between the 2 hemispheres.

The outer surface layer of each hemisphere is the cerebral cortex – the “grey matter’’, where much of the sensory information from organs such as the eyes and ears is processed. Specific sensory processing takes place in separate regions. For example, visual perception is located in a part of the occipital lobe called the visual cortex.

The cortex also contains “motor’’ areas concerned with the initiation of signals for movement by the skeletal muscles.

Linked to the sensory and motor areas of the cortex are association areas, which integrate information from various senses and also perform functions such as comprehension and recognition, memory storage and recall, thought and decision making.

Some of these cortical functions are localized to one “dominant’’ hemisphere (the left in almost all right-handed and many left-handed people).

Two clearly defined areas in the dominant hemisphere are Wernicke’s area, responsible for the comprehension of words, and Broca’s area, which is concerned with language expression.... cerebrum

Clemastine can cause drowsiness.... clemastine

In the systemic circulation, oxygen-rich blood from the pulmonary circulation is pumped under high pressure from the left ventricle of the heart into the aorta, from where it travels through arteries and smaller arterioles to all parts of the body. Within body tissues, the arterioles branch into networks of fine blood vessels called capillaries. Oxygen and other nutrients pass from the blood through the capillaries’ thin walls into body tissues; carbon dioxide and other wastes pass in the opposite direction. Deoxygenated blood is returned to the heart via venules, veins, and the venae cavae.

Venous blood returns to the right atrium of the heart to enter the pulmonary circulation. It is pumped from the right ventricle through the pulmonary artery

to the lungs, where carbon dioxide is exchanged for oxygen. The reoxygenated blood then returns through the pulmonary veins to the heart and re-enters the systemic circulation.... circulatory system

It is a common ingredient of ointments and medicinal shampoos prescribed for skin and scalp conditions such as psoriasis and some forms of dermatitis and eczema.... coal tar

Colonoscopy is used to investigate symptoms such as bleeding from the anus and to look for disorders such as colitis, polyps, and cancer.

Instruments may be passed through the colonoscope to take biopsy specimens or to remove polyps.... colonoscopy

The phenomenon occurs most commonly in chronic alcoholics suffering from Wernicke–Korsakoff syndrome.

It may also occur with head injuries.... confabulation

In classical conditioning, a stimulus that consistently evokes a particular response is paired repeatedly with a second stimulus that would not normally produce the response.

Eventually, the second stimulus begins to produce the response whether the first stimulus is present or not.

In operant conditioning, attempts to modify behaviour are made through a system of rewards and/or punishments.

The theory that inappropriate behaviour patterns in some psychological disorders are learned through conditioning and can be modified by the same process underlies behavioural psychology (see behaviour therapy).... conditioning

opiates such as cocaine and morphine, amfetamine drugs, and barbiturate drugs. controlled trial A method of testing the effectiveness of new treatments or comparing different treatments. In a typical controlled drug trial, 2 comparable groups of patients suffering from the same illness are given courses of apparently identical treatment. However, only one group receives the new treatment; the second control group is given a placebo. Alternatively, the control group may be given an established drug that is already known to be effective. After a predetermined period, the 2 groups are assessed medically. Controlled trials must be conducted “blind’’ (the patients do not know which treatment they are receiving). In a “double-blind’’ trial, neither the patients nor the doctors who assess them know who is receiving which treatment. contusion Bruising to the skin and underlying tissues from an injury. convalescence The recovery period following an illness or surgery during which the patient regains strength before returning to normal activities.... controlled drug

The first symptom of coronary artery disease is frequently the chest pain of angina. Treatment is with drugs such as glyceryl trinitrate and other nitrate drugs, beta-blockers, calcium channel blockers, potassium channel activators, and vasodilator drugs. If drug treatment fails to relieve the symptoms, or there is extensive narrowing of the coronary

arteries, blood flow may be improved by balloon angioplasty or coronary artery bypass surgery.... coronary artery disease

(See also auscultation.)... crepitation

The inflammatory response produced is believed to help in bronchitis, asthma, and musculoskeletal pains.... cupping

Side effects include lethargy, loss of appetite, leg cramps, dizziness, rash, and impotence.... cyclopenthiazide

Cystocele may be associated with a prolapsed uterus (see uterus, prolapse of).

If the urethra is pulled out of position by a cystocele, it may cause stress incontinence or incomplete emptying of the bladder, leading to infection of the retained urine (see cystitis).

Pelvic floor exercises may relieve symptoms.

Surgery may be used to lift and tighten the tissues at the front of the vagina.... cystocele

Treatment, including removal of bladder tumours or calculi and insertion of stents (narrow tubes) into a ureter to relieve an obstruction, can all be performed via the cystoscope.... cystoscopy

For example, a leukocyte is a white blood cell.... cyte

Emergency treatment consists of turning the person on to the affected side or supporting the flail segment by firm strapping.

In severe cases, artificial ventilation is needed until the chest wall is stable.... flail chest

In an allergic response, mast cells release histamine.... mast cell

The crisis may be associated with muscle spasm of the tongue, mouth, and neck, and is often triggered by stress.

It may also occur following encephalitis and in parkinsonism, or may be induced by drugs, such as phenothiazine derivatives.... oculogyric crisis

Ovarian cysts are often symptomless, but some cause abdominal discomfort, pain during intercourse, or irregularities of menstruation such as amenorrhoea, menorrhagia, or dysmenorrhoea. Severe abdominal pain, nausea, and fever may develop if twisting or rupture of a cyst occurs. This condition requires surgery.An ovarian cyst may be discovered during a routine pelvic examination and its position and size confirmed by ultrasound or laparoscopy. In many cases, simple ovarian cysts – thin-walled or fluid-filled cysts – resolve themselves. However, complex cysts (such as dermoid cysts) usually require surgical removal. If an ovarian cyst is particularly large, the ovary may need to be removed (see oophorectomy).... ovarian cyst

The pulp is removed through a hole drilled in the crown. An antibiotic paste and a temporary filling are packed in. A few days later, the filling is removed and the canals are checked for infection. When no infection is detected the cavity is filled and the roots are sealed with cement. If the cavity is not filled completely, periodontitis may occur.

Treated teeth may turn grey but their appearance can be restored by bonding (see bonding, dental), fitting an artificial crown (see crown, dental), or by bleaching (see bleaching, dental).... root-canal treatment

Side effects include coughing and throat irritation on inhalation.... sodium cromoglicate

Sydenham’s chorea usually clears up after 2–3 months and has no long-term adverse effects.... sydenham’s chorea

Treatment is by manipulation back into position of any displaced bones, followed, if necessary, by surgical restoration of blood flow in the forearm.

If there is permanent deformity, physiotherapy may help to restore function.... volkmann’s contracture

Habitat: Bihar and South India. Ayurvedic: Aadaari (related sp.) Folk: Ari, Araara.

Action: See A. torta.... acacia canescens

Habitat: Drier regions of India, particularly Punjab, Madhya Pradesh, Uttar Pradesh, Bihar, Andhra Pradesh, Orissa and Rajasthan.

Action: Cutch from wood— powerful astringent (in urinary and vaginal discharge), antidiarrhoeal, haemostatic; used for treating excessive mucous discharges, haemorrhages, relaxed conditions of gums, throat and mouth, stomatitis, irritable bowel; also used as an antileprotic drug.

Habitat: Rajasthan, Gujarat, Maharashtra, Tamil Nadu and Andhra Pradesh on dry and rocky soils.

Action: Uses similar to those of A. catechu heartwood extract.

Habitat: Tropical jungles throughout India, especially in the Deccan.

Action: Febrifuge, expectorant, emetic, spasmolytic, diuretic, antidiarrhoeal. Leaves—an infusion is given in malarial fever. Pods and seeds—decoction is used to remove dandruff (known as Shikaakaai), extensively used as a detergent. An ointment is used for skin diseases. Bark—extract is used in leprosy.

Habitat: Common in plains, as a weed in gardens; also in wastelands, especially in Bangalore and Pachmarhi.

Action: See A. indica.

Action: Leaves—stomachic, alterative; prescribed in digestive disorders, dyspepsia, colic, diarrhoea.... acalypha ciliata

Habitat: The western Himalayas from Hazara to Kashmir and Chamba in Himachal Pradesh, between altitudes of 2,100 m and 3,600 m.

Action: Sedative, antirheumatic, analgesic, antitussive, antidiar- rhoeal. Ayurvedic Formulary of India, Part I and Part II, equated A. chasmanthum with Vatsanaabha. (See A.ferox.) It has the same uses as A. ferox. The alkaloid content of the root ranges from 2.98 to 3.11%; includes chasmaconitine and chasmanthinine.

Habitat: All along the Himalayas from Kashmir to Sikkim between altitudes of 1,800 and 2,700 m.

Action: Astringent, demulcent, expectorant, antitussive, stimulant, emmenagogue. Fonds used in chronic catarrh (as an ingredient of cough and bronchial medicines); also in cold imposthumes of uterus, hard swellings and hard tumours of spleen, liver and other viscera.

Habitat: Indigenous in deciduous forests all over India.

Action: Antibacterial, antiseptic, antidysenteric, antibilious (used in biliary colic), febrifuge. Root— astringent.

Habitat: The fungi is distributed in many parts of India, particularly on the hills and plains of northern and eastern India. Grows during the rainy weather on dead organic matter, e.g. rotting leaves and manure.

Action: A protein (2.74%) supplement and an excellent source of vitamins of B complex. Vitamins K, C and D are also present. Though all the amino acids are reported to be present, the concentration of tryptophane is particularly low.

Habitat: Throughout India, up to an altitude of 1,800 m.

Action: Anti-inflammatory, antibacterial, antifungal, styptic.

... ageratum conyzoides

Habitat: Native to Central America and Brazil. Grown in Indian gardens.

Action: Leaves—cathartic (in moderate doses; emetic in large doses). Bark—hydragogue, in ascites.

Habitat: Cultivated as an annual all over the country. The most important onion-growing states are Maharashtra, Tamil Nadu, Andhra Pradesh., Karnataka and Madhya Pradesh.

Action: Antibiotic, antibacterial, antisclerotic, anticoagulant, anti-inflammatory, antiasthmatic, expectorant, carminative, anti- spasmodic, diuretic, hypotensive, antidiabetic.

• place 1 or 2 teaspoons of dried allspice fruit (or powder) in 1 cup of boiling water
• steep them for 10 to 20 minutes
• drink the tea (sugar or honey might be added)

• facilitate and promote good digestion
• help bloating, belching and flatulence
• help in preventing allergies
• help lower blood sugar
• help relieve toothache and muscle/joint pain
• help uplift the mood and relax the body

Habitat: Grown as vegetable in northern India.

Action: Blood-purifier, diuretic; used in piles, strangury, dropsy and anasarca; tea has been used for relieving pulmonary conditions; also given in scrofula and applied to scrofulous sores. Antimicrobial peptides have been isolated from seeds.

Habitat: Coastal forests of West Bengal and Andaman Islands.

Action: Leaf—anti-inflammatory.... amoora cucullata

Habitat: The western Himalayas.

Action: Depurative, bechic, blood purifier (used in skin diseases). Root powder and decoction also used as an adjunct in tuberculosis.

Habitat: Native to tropical Asia; cultivated throughout India.

Action: Corm is prescribed in bronchitis, asthma, abdominal pain, emesis, dysentery, enlargement of spleen, piles, elephantiasis, diseases due to vitiated blood, rheumatic swellings.

Habitat: Native to Asia Minor and Persia; cultivated in India in cooler parts of Punjab and Kashmir.

Action: Sweet almonds—nutrient, nervine tonic, demulcent. Oil— externally for skin. Bitter almonds— not used medicinally.

Habitat: The Khasi Hills, Orissa and peninsular India.

Action: Insecticide, antifungal; highly valued in skin diseases; used externally to kill lice and other parasites.

Habitat: Native to South America; cultivated mostly in Tamil Nadu, coastal Andhra Pradesh, Assam, Kerala, Karnataka, West Bengal, Tripura and Orissa.

Action: Anti-inflammatory (fresh juice used as a gargle for sore throat). A proteolytic enzyme, bromelain, is derived from the stem—anti-inflammatory, smooth muscle relaxant, digester, inhibitor of blood platelet aggregation. (It is used for cellulitis, post-operative oedema, sinusitis and for promoting digestion of proteins.)

Habitat: The western Himalayas, Central and southern India.

Action: Stimulant, expectorant and diaphoretic. Juice of fresh leaves is used in urticaria and other allergic conditions; a domestic remedy for coughs and cold. Alcoholic extract of the whole plant—antibacterial. Essential oil—antitubercular.

Habitat: Native to Malaysia; now grown along the coasts of Karnataka, Kerala, Tamil Nadu, West Bengal, Assam and Maharashtra.

Action: Taeniacide (confined to veterinary medicine), astringent, stimulant.

Habitat: Indigenous to the northern parts of southern Europe, Central and East-Central Europe; cultivated in the United States. A related sp., Asarum himalaicum, synonym A. canadense, is reported from the eastern Himalayas.

Action: Brain and nervine tonic, diuretic, deobstructant and anti- inflammatory; used in bronchial spasm and in preparations of cephalic snuffs.

Habitat: Naturalized in many parts of India as an ornamental.

Action: Spasmogenic, cardiotonic, cytotoxic, antihaemorrhagic, styptic, antibacterial. Various plant parts, as also plant latex, are used against warts and cancer. Root—used as an astringent in piles. Leaves—juice, antidysenteric, also used against haemorrhages. Flowers—juice, styptic. Alcoholic extract of the plant—cardiotonic.

Habitat: Native to Malaysia; cultivated throughout the warmer parts of India, especially in Kerala.

Action: Root—antidote in poisoning. Leaf and shoot—applied externally in ringworm, scabies, chickenpox. Flower—vermicidal. Fruit—laxative, antidysenteric, antiphlogistic, febrifuge, anti- inflammatory, antispasmodic (used in hepatic colic, bleeding piles). Seeds—galactogenic; in large doses act as an emmenagogue and cause abortion.

Habitat: Subtropical Himalaya, Sikkim, Khasi Hills, Central and Southern India at 1,350 m.

Action: Extract of the plant— sasmogenic and hypoglycaemic. Root extract—given in anaemia. The leaves are chewed in toothache. Roots and leaves are applied to swellings. An infusion is given in cough.

• certain forms of cancer
• digestion
• prostate
• sleep disorder