Age Disease and mode of administration

3 days BCG (Bacille Calmette-Guerin) by injection if tuberculosis in family in past 6 months.

2 months Poliomyelitis (oral); adsorbed diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

3 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

4 months Poliomyelitis (oral); diphtheria, whooping-cough (pertussis)1 and tetanus2 (triple vaccine given by injection); HiB injection.3

12–18 months Measles, mumps, and rubella (German measles)4 (given together live by injection).

(SCHOOL ENTRY)

4–5 years Poliomyelitis (oral); adsorbed diphtheria and tetanus (given together by injection); give MMR vaccine if not already given at 12–18 months.

10–14 females Rubella (by injection) if they have missed MMR.

10–14 BCG (Bacille Calmette-Guerin) by injection to tuberculin-negative children to prevent tuberculosis.

15–18 Poliomyelitis single booster dose (oral); tetanus (by injection).

1 Pertussis may be excluded in certain susceptible individuals.

2 Known as DPT or triple vaccine.

3 Haemophilus in?uenzae immunisation (type B) is being introduced to be given at same time, but di?erent limb.

4 Known as MMR vaccine. (Some parents are asking to have their infants immunised with single-constituent vaccines because of controversy over possible side-effects – yet to be con?rmed scienti?cally – of the combined MMR vaccine.)

Recommended immunisation schedules in the United Kingdom... immune system

Checking a hormone pro?le in the woman’s blood will help in the diagnosis of ovulatory disorders like polycystic ovaries, an early menopause, anorexia or other endocrine illnesses. Ovulation itself is best assessed by ultrasound scan at mid-cycle or by a blood hormone progesterone level in the second half of the cycle.

The FALLOPIAN TUBES may be damaged or blocked in 20–30 per cent of infertile women. This is usually caused by previous pelvic infection or ENDOMETRIOSIS, where menstrual blood is thought to ?ow backwards through the fallopian tubes into the pelvis and seed with cells from the lining of the uterus in the pelvis. This process often leads to scarring of the pelvic tissues; 5–10 per cent of infertility is associated with endometriosis.

To assess the Fallopian tubes adequately a procedure called LAPAROSCOPY is performed. An ENDOSCOPE is inserted through the umbilicus and at the same time a dye is pushed through the tubes to assess their patency. The procedure is performed under a general anaesthetic.

In a few cases the mucus around the cervix may be hostile to the partner’s sperm and therefore prevent fertilisation.

Defective production is responsible for up to a quarter of infertility. It may result from the failure of the testes (see TESTICLE) to descend in early life, from infections of the testes or previous surgery for testicular torsion. The semen is analysed to assess the numbers of sperm and their motility and to check for abnormal forms.

In a few cases the genetic make-up of one partner does not allow the couple ever to achieve a pregnancy naturally.

In about 25 per cent of couples no obvious cause can be found for their infertility.

Treatment Ovulation may be induced with drugs.

In some cases damaged Fallopian tubes may be repaired by tubal surgery. If the tubes are destroyed beyond repair a pregnancy may be achieved with in vitro fertilisation (IVF) – see under ASSISTED CONCEPTION.

Endometriosis may be treated either with drugs or laser therapy, and pregnancy rates after both forms of treatment are between 40–50 per cent, depending on the severity of the disease.

Few options exist for treating male-factor infertility. These are arti?cial insemination by husband or donor and more recently in vitro fertilisation. Drug treatment and surgical repair of VARICOCELE have disappointing results.

Following investigations, between 30 and 40 per cent of infertile couples will achieve a pregnancy usually within two years.

Some infertile men cannot repair any errors in the DNA in their sperm, and it has been found that the same DNA repair problem occurs in malignant cells of some patients with cancer. It is possible that these men’s infertility might be nature’s way of stopping the propagation of genetic defects. With the assisted reproduction technique called intracytoplasmic sperm injection, some men with defective sperm can fertilise an ovum. If a man with such DNA defects fathers a child via this technique, that child could be sterile and might be at increased risk of developing cancer. (See ARTIFICIAL INSEMINATION; ASSISTED CONCEPTION.)... infertility

Interventional Radiology

The use of radiology (see X-RAYS) to enable doctors to carry out diagnostic or treatment procedures under direct radiological vision. This X-ray procedure is used in MINIMALLY INVASIVE SURGERY (MIS) – for example, ANGIOPLASTY, the removal of stones from the kidney (see KIDNEYS, DISEASES OF), and the observation of obstructions in the bile ducts (percutaneous CHOLANGIOGRAPHY). (See also magnetic resonance imaging – MRI.)... intertrigo

Externally iodine is used as an antiseptic. Its drawback is that it is ?xed by protein, which reduces its antiseptic e?ciency in open wounds. Its main use in this sphere therefore is for sterilising the unbroken skin, as before an operation. Radioactive iodine is used for diagnosing and treating disease of the thyroid gland.... iodine

Uses The main use of iron is in the treatment of iron-de?ciency anaemias (See ANAEMIA.) Iron preparations sometimes cause irritation of the gastrointestinal tract, and should therefore always be taken after meals. They sometimes produce a tendency towards constipation. Whenever possible, iron preparations should be given by mouth; if PARENTERAL administration is clinically necessary because of malabsorption, a suitable preparation is iron sorbitol injection given intramuscularly. Most patients respond successfully to oral iron preparations.... iron

It is characterised by excessive thirst and the passing of large volumes of urine which have a low speci?c gravity and contain no abnormal constituents. It is either due to a lack of the antidiuretic hormone normally produced by the HYPOTHALAMUS and stored in the posterior PITUITARY GLAND, or to a defect in the renal tubules which prevents them from responding to the antidiuretic hormone VASOPRESSIN. When the disorder is due to vasopressin insu?ciency, a primary or secondary tumour in the area of the pituitary stalk is responsible for one-third of cases. In another one-third of cases there is no apparent cause, and such IDIOPATHIC cases are sometimes familial. A further one-third of cases result from a variety of lesions including trauma, basal MENINGITIS and granulomatous lesions in the pituitary-stalk area. When the renal tubules fail to respond to vasopressin this is usually because of a genetic defect transmitted as a sex-linked recessive characteristic, and the disease is called nephrogenic diabetes insipidus. Metabolic abnormalities such as HYPERCALCAEMIA and potassium depletion render the renal tubule less sensitive to vasopressin, and certain drugs such as lithium and tetracycline may have a similar e?ect.

If the disease is due to a de?ciency of vasopressin, treatment should be with the analogue of vasopressin called desmopressin which is more potent than the natural hormone and has less pressor activity. It also has the advantage in that it is absorbed from the nasal mucosa and so does not need to be injected.

Nephrogenic diabetes insipidus cannot be treated with desmopressin. The urine volume can, however, usually be reduced by half by a thiazide diuretic (see THIAZIDES).... diabetes insipidus

Blunt injuries These may cause haemorrhage inside the eye, cataract, retinal detachment or even rupture of the eye (see also EYE, DISORDERS OF). Injuries from large blunt objects – for example, a squash ball – may also cause a ‘blow-out fracture’ of the orbital ?oor resulting in double vision. Surgical treatment may be required depending on the patient’s speci?c problems.

Chemical burns Most chemical splashes cause conjunctivitis and super?cial keratitis in the victim (see EYE, DISORDERS OF); both conditions are self-limiting. Alkalis are, however, more likely to penetrate deeper into the eye and cause permanent damage, particularly to the cornea. Prompt irrigation is important. Further treatment may involve testing the pH of the tears, topical antibiotics and CORTICOSTEROIDS, and vitamin C (drops or tablets – see APPENDIX 5: VITAMINS), depending on the nature of the injury.

Corneal abrasion Loss of corneal epithelium (outermost layer). Almost any sort of injury to the eye may cause this. The affected eye is usually very painful. In the absence of other problems, the epithelium heals rapidly: small defects may close within 24 hours. Treatment conventionally consists of antibiotic ointment and sometimes a pad over the injured eye.

Foreign bodies Most foreign bodies which hit the eye are small and are found in the conjunctival sac or on the cornea; most are super?cial and can be easily removed. A few foreign bodies penetrate deeper and may cause infection, cataract, retinal detachment or haemorrhage within the eye. The foreign body is usually removed and the damage repaired; nevertheless the victim’s sight may have been permanently damaged. Particularly dangerous activities include hammering or chiselling on metal or stone; people carrying out these activities (and others, such as hedge-cutting and grass-strimming) should wear protective goggles.... eye injuries

For the diagnosis of true food allergy, it is necessary to demonstrate that there is a reproducible intolerance to a speci?c food; also, that there is evidence of an abnormal immunological reaction to it. Occasionally the allergic response may not be to the food itself but to food contaminants such as penicillin, or to food additives such as tartrazine. There may also be reactions to foods which have pharmacological effects, such as ca?eine in strong co?ee or histamine in fermented cheese, or such reactions may be due to the irritant e?ect on the intestinal mucosa (especially if it is already diseased) by, say, highly spiced curries.

Testing blood and skin for food allergy is beloved of some alternative practitioners but, in practice, the results of tests do not necessarily agree with what happens when the food is taken. Therefore, a careful history is as useful as any test in making a diagnosis.... food intolerance

In hospital the possible need for urgent action is monitored by use of the GLASGOW COMA SCALE.

People suffering the results of such injuries and their relatives can obtain help and advice from Headway – the brain injury association.... head injury

Ichthyosis vulgaris Common and inherited as a dominant trait. Beginning in early childhood, it is often associated with atopic eczema (see DERMATITIS). The limb ?exures and face are spared.

X-linked ichthyosis is much less common, more severe and appears earlier than ichthyosis vulgaris. The ?sh-like scales are larger and darker and do not spare the ?exures and face.

Ichthyosiform erythroderma Of two types and very rare: in the recessive form, the appearance at birth is of the so-called ‘collodion baby’; in the dominant form the baby is born with universally red, moist and eroded skin with an unpleasant smell. Gradually, over several months, thick scales replace the ERYTHEMA.

Treatment Minor forms are helped by constant use of EMOLLIENTS and moisturising applications. Cream containing UREA can be valuable. The rare erythrodermic patterns in the neonate require skilled intensive care as thermoregulation is disturbed and massive ?uid loss occurs through the skin. Later in childhood, oral RETINOIDS are useful.... ichthyosis

Insulin is extracted mainly from pork pancreas and puri?ed by crystallisation; it may be made biosynthetically by recombinant DNA technology using Escherichia coli, or semisynthetically by enzymatic modi?cation of porcine insulin to produce human insulin. The latter is the form now generally used, although some patients ?nd it unsuitable and have to return to porcine insulin.

The hormone acts by enabling the muscles and other tissues requiring sugar for their activity to take up this substance from the blood. All insulin preparations are to a greater or lesser extent immunogenic in humans, but immunological resistance to insulin action is uncommon.

Previously available in three strengths, of 20, 40, and 80 units per millilitre (U/ml), these have now largely been replaced by a standard strength of 100 U/ml (U100). Numerous different insulin preparations are listed; these differ in their speed of onset and duration of action, and hence vary in their suitability for individual patients.

Insulin is inactivated by gastrointestinal enzymes and is therefore generally given by subcutaneous injection, usually into the upper arms, thighs, buttocks, or abdomen. Some insulins are also available in cartridge form, which may be administered by injection devices (‘pens’). The absorption may vary from di?erent sites and with strenuous activity. About 25 per cent of diabetics require insulin treatment: most children from the onset, and all patients presenting with ketoacidosis. Insulin is also often needed by those with a rapid onset of symptoms such as weight loss, weakness, and sometimes vomiting, often associated with ketonuria.

The aim of treatment is to maintain good control of blood glucose concentration, while avoiding severe HYPOGLYCAEMIA; this is usually achieved by a regimen of preprandial injections of short-acting insulin (often with a bedtime injection of long-acting insulin). Insulin may also be given by continuous subcutaneous infusion with an infusion pump. This technique has many disadvantages: patients must be well motivated and able to monitor their own blood glucose, with access to expert advice both day and night; it is therefore rarely used.

Hypoglycaemia is a potential hazard for many patients converting from porcine to human insulin, because human insulin may result in them being unaware of classical hypoglycaemic warning symptoms. Drivers must be particularly careful, and individuals may be forbidden to drive if they have frequent or severe hypoglycaemic attacks. For this reason, insurance companies should be warned, and diabetics should – after taking appropriate medical advice – either return to porcine insulin or consider stopping driving.... insulin

Divisions The intestine is divided into small intestine and large intestine. The former extends from the stomach onwards for 6·5 metres (22 feet) or thereabouts. The large intestine is the second part of the tube, and though shorter (about 1·8 metres [6 feet] long) is much wider than the small intestine. The latter is divided rather arbitrarily into three parts: the duodenum, consisting of the ?rst 25–30 cm (10–12 inches), into which the ducts of the liver and pancreas open; the jejunum, comprising the next 2·4–2·7 metres (8–9 feet); and ?nally the ileum, which at its lower end opens into the large intestine.

The large intestine begins in the lower part of the abdomen on the right side. The ?rst part is known as the caecum, and into this opens the appendix vermiformis. The appendix is a small tube, closed at one end and about the thickness of a pencil, anything from 2 to 20 cm (average 9 cm) in length, which has much the same structure as the rest of the intestine. (See APPENDICITIS.) The caecum continues into the colon. This is subdivided into: the ascending colon which ascends through the right ?ank to beneath the liver; the transverse colon which crosses the upper part of the abdomen to the left side; and the descending colon which bends downwards through the left ?ank into the pelvis where it becomes the sigmoid colon. The last part of the large intestine is known as the rectum, which passes straight down through the back part of the pelvis, to open to the exterior through the anus.

Structure The intestine, both small and large, consists of four coats, which vary slightly in structure and arrangement at di?erent points but are broadly the same throughout the entire length of the bowel. On the inner surface there is a mucous membrane; outside this is a loose submucous coat, in which blood vessels run; next comes a muscular coat in two layers; and ?nally a tough, thin peritoneal membrane. MUCOUS COAT The interior of the bowel is completely lined by a single layer of pillar-like cells placed side by side. The surface is increased by countless ridges with deep furrows thickly studded with short hair-like processes called villi. As blood and lymph vessels run up to the end of these villi, the digested food passing slowly down the intestine is brought into close relation with the blood circulation. Between the bases of the villi are little openings, each of which leads into a simple, tubular gland which produces a digestive ?uid. In the small and large intestines, many cells are devoted to the production of mucus for lubricating the passage of the food. A large number of minute masses, called lymph follicles, similar in structure to the tonsils are scattered over the inner surface of the intestine. The large intestine is bare both of ridges and of villi. SUBMUCOUS COAT Loose connective tissue which allows the mucous membrane to play freely over the muscular coat. The blood vessels and lymphatic vessels which absorb the food in the villi pour their contents into a network of large vessels lying in this coat. MUSCULAR COAT The muscle in the small intestine is arranged in two layers, in the outer of which all the ?bres run lengthwise with the bowel, whilst in the inner they pass circularly round it. PERITONEAL COAT This forms the outer covering for almost the whole intestine except parts of the duodenum and of the large intestine. It is a tough, ?brous membrane, covered upon its outer surface with a smooth layer of cells.... intestine

(see EXPECTORANTS) given in the treatment of BRONCHITIS. (See POISONS.)... ipecacuanha

Di?erent tumours seem to be particularly sensitive to radiation; radiotherapy plays an important role in the management of germ-cell tumours (SEMINOMA; TERATOMA) and lymphomas (see LYMPHOMA). Many head and neck tumours, gynaecological cancers, and localised prostate and bladder cancers are curable with radiotherapy. It may be used to reduce the pain

– for example, from bone metastases.

Unwanted effects Generalised: lethargy, loss of appetite. Skin: ERYTHEMA, dry desquamation with itching, moist desquamation. Patients should keep the treated area(s) dry and clean and avoid soap, antiseptic mouthwashes, smoking and spicy food if possible. (See ISOTOPE; RADIATION SICKNESS; RADIOTHERAPY).... irradiation

(e.g. HIV, syphilis, hepatitis, gonorrhoea, and genetic disorders). Insemination is performed at the time of ovulation by introducing the semen into the upper vagina. Semen may be fresh or have been stored frozen in liquid nitrogen. (See ARTIFICIAL INSEMINATION.)... donor insemination

Eggs are obtained and mixed with the partner’s semen, then introduced into the woman’s Fallopian tubes for fertilisation to take place. The fertilised egg travels to the uterus where IMPLANTATION occurs and pregnancy proceeds. A variation of GIFT is zygote intrafallopian transfer (ZIFT) in which early development of the fertilised eggs happens in the laboratory before the young embryo is transferred to the Fallopian tubes. GIFT is best used in couples with unexplained infertility or with minor degrees of male or female cervical factor infertility. The success rate is about 17 per cent. (See also ARTIFICIAL INSEMINATION.)... gamete intrafallopian transfer (gift)

Patients and their relatives can obtain help and guidance from the National Association for Colitis and Crohn’s Disease.... ileitis

Foreignness: molecules recognised as ‘self’ are generally not immunogenic; the body tolerates these self-molecules. To be immunogenic, molecules must be recognised as non-self or foreign.

Molecular size: proteins with high molecular weights (over 100,000) are the most e?ective immunogens; those below 10,000 are weakly immunogenic; and small ones, for example, AMINO ACIDS, are non-immunogenic.

Chemical complexity: the greater the chemical complexity, the more immunogenic the substance.

Dosage, route and timing of antigen administration: all these are important factors.... immunogenicity

There has been a rapid introduction in recent years of monoclonal antibodies which prevent T-cells from proliferating. They can be recognised by the su?x ‘mab’ (standing for monoclonal antibody) and include rituximab and alemtuzumab. In?iximab, used in CROHN’S DISEASE and RHEUMATOID ARTHRITIS, inhibits tumour necrosis factor alpha.... immunosuppression

(2) The surgical replacement of injured or unhealthy tissue or organ with healthy tissue or organ (also known as TRANSPLANTATION).

(3) Attachment of the early EMBRYO to the lining of the UTERUS, which occurs around six days after conception; the site where this happens is where the placenta will develop.... implantation

(2) In the haematological context, an adverse reaction in a patient given a blood TRANSFUSION in which the donor blood is incompatible with that of the recipient.... incompatibility

It must be noted that diseases are not communicated to others by a person who is incubating an illness. Some diseases, however, such as MEASLES, become infectious as soon as the ?rst symptoms set in after the incubation period is over; others, like SCARLET FEVER and SMALLPOX, are not so infectious then as in their later stages. The incubation period for any given disease is remarkably constant, although in the case of a severe attack the incubation is usually slightly shortened, and if the oncoming attack is a mild one, the period may be lengthened. All, however, may take a few days longer than the time stated to show themselves (see INFECTION), and several – especially WHOOPINGCOUGH – may be di?cult to recognise in their early stages.

Incubation periods of the more common infectious diseases:

The fore?nger or second digit of the hand.... incubation

GENES carried in the CHROMOSOMES of the germ cells. (See GERM CELL; GENETIC CODE; GENETIC DISORDERS.)... inheritance

Integritey, Integritee, Integritea, Integriti, Integritie... integrity

infertility units. Safety concerns relate to a higher-than-expected rate of abnormalities in the SEX CHROMOSOMES after ICSI, and also the potential risk of transmitting paternal genetic defects in the Y chromosome to sons born after ICSI.... intracytoplasmic sperm injection

(2) A psychological term to describe what happens when an individual is more interested in his or her ‘inner world’ than in what is happening around in the real world. An INTROVERT tends to have few friends and prefers to persist in activities that they have started. Karl Jung (see JUNGIAN ANALYSIS) described introversion as a person’s tendency to distance him or herself from others; to have philosophical interests;

and to have reactions that are reserved and defensive.... introversion

Common features of IBS include:

abdominal distension.

altered bowel habit.

colicky lower abdominal pain, eased by defaecation.

mucous discharge from rectum.

feelings of incomplete defaecation.

Investigations usually produce normal results. Positive diagnosis in people under 40 is usually straightforward. In older patients, however, barium ENEMA, X-rays and COLONOSCOPY should be done to exclude colorectal cancer.

Reassurance is the initial and often e?ective treatment. If this fails, treatment should be directed at the major symptoms. Several months of the antidepressant amitriptyline (see ANTIDEPRESSANT DRUGS) may bene?t patients with intractable symptoms, given at a dose lower than that used to treat depression. The majority of patients follow a relapsing/remitting course, with episodes provoked by stressful events in their daily lives. (See also INTESTINE, DISEASES OF.)... irritable bowel syndrome (ibs)

Applications of radionuclides to diagnosis The use of radionuclides in diagnosis is based on the fact that it is possible to tag many of the substances normally present in the body with a radioactive label. Certain synthetic radioactive elements, such as technetium, can also be used. Because it is possible to detect minute quantities of radioactive material, only very small doses are needed, making the procedure a safe one. Furthermore the body pool of the material is therefore not appreciably altered, and metabolism is not disturbed. Thus in studies of iodine metabolism the ratio of radioactive atoms administered to stable atoms in the body pool is of the order of 1:1,000 million. By measuring radioactivity in the body, in blood samples, or in the excreta it is possible to gain information about the fate of the labelled substance, and hence of the chemically identical inactive material. Therefore it is theoretically possible to trace the absorption, distribution and excretion of any substance normally present in the body, provided that it can be tagged with a suitable radioactive label.

If the investigation necessitates tracing the path of the material through the body by means of external counting over the body surface, it is obviously essential to use an isotope that emits gamma radiation or positrons. If, however, only measurements on blood sample or excreta are required, it is possible to use pure beta emitters. Whole-body counters measure the total radioactivity in the body, and these are of great value in absorption studies.

Moving images can provide information on body functions such as the movements of the heart, blood ?ow, bile ?ow in the liver, and urine in the kidneys. The development of COMPUTED TOMOGRAPHY or CT scanning has replaced radionuclide scanning for some imaging procedures.

Five main groups of diagnostic uses may be de?ned:

(1) METABOLIC STUDIES The use of radioactive materials in metabolic studies is based on the fundamental property that all isotopes of an element are chemically identical. The radioactive isotope is used as a true isotope tracer – that is, when introduced into the body (in whatever form) it behaves in the same way as the inactive element. For example, isotopes of iodine are used to measure thyroid function (see THYROID GLAND), and isotopes of calcium enable kinetic studies of bone formation and destruction to be performed.... isotope

Action: Emmenagogue, antispasmodic, carminative, expectorant. Leaves and seed— astringent, antispasmodic. Warm infusion of herb—promotes suppressed menstrual flow.

Treatment varies, depending (amongst other things) on the severity of the condition. In the acute phase, rest in bed is advisable, along with ANALGESICS. Later, exercise and physiotherapy are helpful, and in some cases manipulation of the spine brings relief by allowing the herniated, or prolapsed, disc to slip back into position. The injection of a local anaesthetic into the spine (epidural ANAESTHESIA) is yet another measure that often helps the more chronic cases. If those measures fail, surgery to remove the prolapsed disc may be necessary, but the patient’s condition should be carefully reviewed before surgery is considered since success is not certain. An alternative form of treatment is the injection into the disc of chymopapain, an ENZYME obtained from the paw-paw, which dissolves the disc.... prolapsed intervertebral disc

Action: Whole plant—infusion useful in cold and bronchitis, also in the treatment of rheumatism.

Symptoms: distension, dehydration, atony, vomiting, constipation.

Alternatives. Wild Yam. Calamus. Papaya.

Condition may have to be resolved by surgery. Simple obstruction: large doses (4-8 teaspoons) Isphaghula seeds. Lime flower tea. See: COLITIS. ... intestinal obstruction

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 main symptoms are an intense desire to pass a bowel movement; pain in the rectum, anus, and centre of the abdomen; and, in some cases, watery faeces that are passed around the mass. Treatment is with enemas or by manual removal of the faecal mass.... faecal impaction

Alternatives. External.

Tinctures: Arnica, Acid tincture of Lobelia, Echinacea, Marigold, Myrrh, St John’s Wort.

Fresh plants. Crush and apply: Comfrey, Garlic, Houseleek, Marigold, Onion, Plantain. St John’s Wort: specific – horsefly.

Witch Hazel Lotion.

Cider Vinegar: wasp bites.

Bee and ant bites: in absence of any of the above: bicarbonate of soda.

Aromatherapy. Any one oil – Eucalyptus, Clove, Lavender.

For shock: with faintness and pallor: few grains Cayenne pepper in honey or cup of tea. Supplements. Vitamin A and B-complex. ... insect bites

The response consists of the production of cells called lymphocytes, substances called antibodies, or immunoglobulins, and other substances and cells that act to destroy the antigenic material.

(See also immune system.)... immune response

There are 2 types of artificial insemination: , artificial insemination with the semen of the woman’s male partner; and , insemination with a donor’s sperm. is usually used for couples who are unable to have intercourse, or if the man has a low sperm count or a low volume of ejaculate. It is also used when semen has been stored from a man prior to treatment (such as chemotherapy) that has made him sterile. is available to couples if the man is infertile or is a carrier of a genetic disease. It may also be used by a woman who wants children but has no male partner.

Insemination is timed to coincide with natural ovulation or may be combined with treatment to stimulate ovulation.... artificial insemination

A depot injection is useful for patients who may not take their medication correctly.

It also prevents the necessity of giving a series of injections over a short period.

Hormonal contraceptives (see contraception, hormonal methods of), corticosteroid drugs, and antipsychotic drugs may be given by depot injection.

Side effects may arise due to the uneven release of the drug into the bloodstream.... depot injection

Many X-ray imaging techniques have been superseded by newer procedures. These include ultrasound scanning, MRI (magnetic resonance imaging), PET scanning, and radionuclide scanning. However, X-rays are used in CT scanning. Some of these techniques use computers to process the raw imaging data and produce the actual image. Others can produce images without a computer, although one may be used to enhance the image. imipramine A tricyclic antidepressant drug most commonly used as a longterm treatment for depression. Possible adverse effects include excessive sweating, blurred vision, dizziness, dry mouth, constipation, nausea, and, in older men, difficulty passing urine.... illusion

Injections may be intravenous (into a vein), intramuscular (into a muscle), intradermal (into the skin), intra-articular (into a joint), or subcutaneous (under the skin).... injection

Immunoglobulin G (IgG) is the major class of immunoglobulin of the 5 in the blood (IgA, IgD, IgE, IgG, and IgM). Its molecule consists of 2 parts: 1 binds to an antigen; the other binds to other cells, which then engulf the microorganisms bearing the antigen.

Immunoglobulins can be extracted from the blood of people who have recovered from certain infectious diseases and used for passive immunization.... immunoglobulin

The need for warmth, food, love, and sex are all forms of instinct, but the instinct for survival is probably the most powerful.... instinct

Apathy, obeying orders unquestioningly, accepting a standard routine, and loss of interests are the main features.... institutionalization

The ovum is then placed in the uterus.... (icsi)

An intradermal injection is made into the skin; whereas a subcutaneous injection is made under the skin.... intradermal

Side effects include itching, dryness and flaking of the skin, and cracking of the lips. Isotretinoin may damage a developing fetus; pregnancy must be avoided during treatment and for at least 3 months after taking the drug. Regular blood tests are recommended to check for complications.... isotretinoin

Virtually every organ or tissue in the body can suffer inflammation, so “itis” is by far the most common word ending in medicine.

Examples of its use are bronchitis (inflammation of the bronchi) and hepatitis (inflammation of the liver).... itis

Possible risk factors include: laying the baby face-down to sleep; overheating; parental smoking after the birth; prematurity and low birth weight; and poor socioeconomic background.

Preventive measures include: ensuring that the baby sleeps on its back at the foot of the cot; regulating the baby’s temperature (using the same amount of clothing and blankets that an adult would need); and stopping smoking.... sudden infant death syndrome

TIAs may be caused by a blood clot (see embolism) temporarily blocking an artery that supplies the brain, or by narrowing of an artery as a result of atherosclerosis.

After a TIA, tests such as CT scanning, blood tests, ultrasound scanning, or angiography may be needed to determine a cause. In some cases, the heart is studied as a possible source of blood clots. Treatment is aimed at preventing stroke, which occurs within 5 years in up to one third of patients with TIA. Treatments include endarterectomy, anticoagulant drugs, or aspirin.... transient ischaemic attack

Habitat: Throughout the hotter parts of India. Found as a weed in the sub-Himalayan tract and other hills up to 1,200 m.

Action: Dried, whole plant— febrifuge, anthelmintic, demulcent, diuretic, anti-inflammatory (in urinary and uterine discharges, piles, lumbago). Juice of the plant— emollient. Seeds—demulcent (used in cough, chronic cystitis), laxative. Leaves—cooked and eaten for bleeding piles. Flowers— antibacterial, anti-inflammatory. Bark—astringent, diuretic. Root— nervine tonic, given in paralysis; also prescribed in strangury.

Habitat: Occurs throughout the plains of India, ascending the hills in Orissa up to 210 m.

Action: Antibacterial (leaf used in scabies). Plant—emetic, expectorant (used in bronchitis, asthma, pneumonia). Tincture of fresh plant is used in homoeopathy for incipient phthisis with bloody expectorations, emaciation and arterial haemorrhage.

Habitat: Common in tidal forests along the East and West coasts; also distributed in Meghalaya and the Andamans.

Action: Decoction—antacid (used in dyspepsia with acid eructations), also diuretic (used in dropsy and bilious swellings). Aerial parts show effect on nictitating membrane. The root is a cordial attenuant and is used in debility associated with asthma, paralysis, leucorrhoea.

Habitat: The plains and the lower slopes of the hills in Punjab, Rajasthan, West Bengal, Tamil Nadu and Maharashtra.

Action: Used in hemicrania, cough, fever; externally in skin diseases; used as a substitute for A. capillus-veneris.

Habitat: The Himalayas from Kashmir to western Nepal, Kulu and Chamba in Himachal Pradesh, Tehri-Garhwal and Kumaon in Uttar Pradesh at 900-3,600 m.

Action: Antirheumatic, galacto- genic, antileucorrhocic.

• steep the dried blossoms in a 12-gram cup of hot water (5 minutes)
• alternatively, place a teaspoon of dried Albizia herb powder in newly-boiled water and similarly steep for about 5 minutes
• drink the tea slowly

• fighting insomnia
• improving the mood, uplifting the spirit and fighting depression, melancholy and anxiety
• fighting irritability
• strengthening mental health
• relieving stress
• relieving tightness in the chest

Habitat: A genus of topical Asia, Malayasia and the Pacific. Found wild and cultivated all over India.

Action: Rootstock—mild laxative, diuretic (in anasarca); used in inflammations and diseases of abdomen and spleen. Leaf—astringent, styptic, antitumour. Root and leaf—rubefacient. Tubers—used as vegetable after eliminating oxalate content.

Habitat: Eastern Himalayas, Assam, Meghalaya, Orissa and peninsular India.

Action: The extract of aerial parts— hypotensive.... aspidopterys indica

Habitat: Indian gardens, and hills.

Action: Stimulant, tonic, demulcent; used in bilious complaints, fever, cough, asthma; as diuretic in bladder and kidney stones. Oil—a rich source of vitamin E (0.72%), more than that of wheat-germ oil (0.18%). The nutlets show positive tests for alkaloids and tannins. The flowers yield anthocyanins and the leafy stems yield bornesitol.... anchusa italica

Habitat: The Himalayas from Kashmir to Sikkim and Darjeeling at altitudes of 1,800-3,400 m

Action: Astringent. Used in piles, also in rheumatism.

Habitat: Throughout the country, mainly in the plains and lower hilly regions.

Action: Oxytocic, abortifacient, emmenagogue.

Habitat: Cultivated throughout the hotter parts of India.

Action: Latex—bacteriolytic, promotes healing of abscesses. Juice of the plant—applied to glandular swellings and abscesses for promoting suppuration. Root— used for diarrhoea, asthma, skin diseases. Unripe fruit—acrid, astringent. Ripe fruit—cooling, laxative, difficult to digest. Seeds— diuretic. Lactin extraction showed potent and selective stimulation of distinct human T and B cells.

• Place about 1 teaspoon of dried ashwagandha leaves in boiling water.
• Let the mix steep for about 15 minutes and cool.
• Strain and then drink.

• calm the nerves and treat severe stress and nervous exhaustion
• help in the treatment of hypertension
• clear the mind, as well as to improve memory and cognitive abilities
• help in fighting arthritis
• help in restoring sexual vitality, especially in males

Habitat: Native to Burma; found all over India.

Action: Leaf, bark—antimicrobial, antifungal, anthelmintic, insecti- cidal, antiviral, antipyretic, anti- malarial, antiperiodic, mosquito larvicidal, anti-inflammatory, antifertility, spermicidal, hypogly- caemic; used in inflammation of gums, gingivitis, periodonitis, sores, boils, enlargement of spleen, malarial fever, fever during childbirth, measles, smallpox, head scald and cutaneous affections. Oil—used as a contraceptive for intravaginal use, for the treatment of vaginal infections, and as a mosquito repellent.

• bring the water and the basil leaves to boil (in a small tea pan)
• lower the heat and allow it to brew for 3-4 minutes
• add the tea leaves or tea bags and sugar according to taste
• bring to boil
• turn off the heat
• strain it into cups and add milk according to taste

• treat intestinal colics, gastric ulcers and bloating/swelling of the abdomen
• treat anorexia
• fight urinary tract infections
• help against diarrhea
• help fight insomnia
• help treat lesions and inflammations in the mouth
• enhance the body’s ability to resist stress
• help to relieve pain

13.

The ?rst type of damage occurs as an acute episode in which one or more severe blows leads to loss of consciousness and occasionally to death. Death in the acute phase is usually due to intracranial haemorrhage and this carries a mortality of 45 per cent even with the sophisticated surgical techniques currently available. The second type of damage develops over a much longer period and is cumulative, leading to the atrophy of the cerebral cortex and brain stem. The repair processes of the brain are very limited and even after mild concussion it may suffer a small amount of permanent structural damage. Brain-scanning techniques now enable brain damage to be detected during life, and brain damage of the type previously associated with the punch-drunk syndrome is now being detected before obvious clinical signs have developed. Evidence of cerebral atrophy has been found in relatively young boxers including amateurs and those whose careers have been considered successful. The tragedy is that brain damage can only be detected after it has occurred. Many doctors are opposed to boxing, even with the present, more stringent medical precautions taken by those responsible for running the sport. Since the Royal College’s survey in 1969, the British Medical Association and other UK medical organisations have declared their opposition to boxing on medical grounds, as have medical organisations in several other countries.

In 1998, the Dutch Health Council recommended that professional boxing should be banned unless the rules are tightened. It claimed that chronic brain damage is seen in 40–80 per cent of boxers and that one in eight amateur bouts end with a concussed participant.

There is currently no legal basis on which to ban boxing in the UK, although it has been suggested that an injured boxer might one day sue a promoter. One correspondent to the British Medical Journal in 1998 suggested that since medical cover is a legal requirement at boxing promotions, the profession should consider if its members should withdraw participation.... boxing injuries

Severe head injuries cause unconsciousness for hours or many days, followed by loss of memory before and after that period of unconsciousness. The skull may be fractured; there may be ?ts in the ?rst week; and there may develop a blood clot in the brain (intracerebral haematoma) or within the membranes covering the brain (extradural and subdural haematomata). These clots compress the brain, and the pressure inside the skull – intracranial pressure – rises with urgent, life-threatening consequences. They are identi?ed by neurologists and neurosurgeons, con?rmed by brain scans (see COMPUTED TOMOGRAPHY; MRI), and require urgent surgical removal. Recovery may be complete, or in very severe cases can be marred by physical disabilities, EPILEPSY, and by changes in intelligence, rational judgement and behaviour. Symptoms generally improve in the ?rst two years.

A minority of those with minor head injuries have complaints and disabilities which seem disproportionate to the injury sustained. Referred to as the post-traumatic syndrome, this is not a diagnostic entity. The complaints are headaches, forgetfulness, irritability, slowness, poor concentration, fatigue, dizziness (usually not vertigo), intolerance of alcohol, light and noise, loss of interests and initiative, DEPRESSION, anxiety, and impaired LIBIDO. Reassurance and return to light work help these symptoms to disappear, in most cases within three months. Psychological illness and unresolved compensation-claims feature in many with implacable complaints.

People who have had brain injuries, and their relatives, can obtain help and advice from Headwat and from www.neuro.pmr.vcu.edu and www.biausa.org... brain injuries

• add one teaspoonful of dried bugleweed herbs to a cup of boiling water
• allow the mixture to steep for 10-15 minutes

• treat hyperthyroidism
• alleviate cyclic breast pain in women by moderating estrogen levels
• sedate and calm the nerves
• suppress cough and fighting tuberculosis and other disorders of the lungs
• moderate a rapid heart rate
• remove excess fluid in the body and promote better circulation
• accelerate the healing of bruises and other wounds (when applied topically)

• fight insomnia by ushering in restful sleep
• fight anxiety
• fight headaches
• fight toothaches and stomachaches
• fight skin sores and ulcers

Habitat: Coastal regions, particularly Orissa, Karnataka, Maharashtra and the Andamans. Also cultivated as an ornamental tree.

Action: Oil of seeds—specific for scabies and other skin diseases, and for rheumatism. Used in the treatment of genitourinary and venereal diseases. Bark—juice is taken as purgative; pounded with water is applied in orchitis, and for dressing ulcers. Root bark— antibacterial, used for indolent ulcers. Leaf—used in vertigo and migraine, also for chicken pox, skin inflammations, scabies, sunburn. Flowers and stamens—used as a substitute for Naagakesara (Mesua ferrea Linn.)

Habitat: Native to tropical America. Now cultivated in Darjeeling, Assam, in the Nilgiris, and in Sikkim.

Action: Root—Antiprotozal, expectorant (in low doses), diaphoretic, emetic (in high doses); used in amoebic dysentery, stubborn cough, whopping cough (for liquefying bronchial phlegm).

Habitat: Lichen found in the hills from Tehri Garhwal to East Nepal.

Action: A food and tonic in convalescence and exhausting diseases. Used for chronic catarrh and bronchitis.

Habitat: Native to China and Japan. Cultivated as an ornamental.

Action: Flowers—stomachic, aperient, anti-inflammatory. Leaves— prescribed in migraine (as circulatory stimulant). Uses same as those of chamomile.

Habitat: Native to Europe; commonly occurs in North West India, Tamil Nadu and parts of Andhra Pradesh.

Action: Diuretic, laxative, chol- agogue, mild hepatic. Excites peristalsis without affecting the functions of the stomach. Used in liver congestion, jaundice, rheumatic and gouty joints.

Lung trauma or contusion

Inhalation of toxic gases or smoke

ASPIRATION of gastric contents

Near-drowning... direct insult

Habitat: Throughout India; Tripura, West Bengal and Gangetic valley, as a weed.

Action: Seed—carminative, antiseptic, anthelmintic (for round worms). Leaf—sudorific. Bark— externally rubefacient, vesicant. Root—vermifuge.

Habitat: Cultivated as an ornamental throughout India, especially in South and Eastern India.

Action: Root—used for asthma, cough, scrofulous affections. Leaf— vermifuge. Resin—antirheumatic. The plant is also used in fever, atrophy, emaciation of cachexia and consumption.

Habitat: Throughout India in tidal forests, wild all over coastal areas; planted in gardens in Tamil Nadu.

Action: Leaf—febrifuge, alterative. Used as a substitute for Swertia chirayita and quinine in remittent and intermittent fevers. The leaf juice is taken orally to relieve muscular pains and stiffness of legs (in tetanus).

Habitat: Throughout India. Ayurvedic: Bhaandira, Bhaandi, Kaari. Also known as Bhaarangi (C. serratum). Siddha/Tamil: Karukanni, Perugilai.

Action: Leaves—used as a substitute for Chiretta. Leaves and roots— employed externally for skin diseases and alopecia. Leaves are prescribed in headache. Roots are given in cramps and rheumatism.

Habitat: Cultivated in Assam, West Bengal, Bihar, Orissa, Maharashtra, Andhra Pradesh, Tamil Nadu; wild in many parts of India.

Action: Carminative, antipyretic, galactagogue. Powder of root is taken with water to stop vomiting. Juice of leaves—antispasmodic and expectorant. Applied externally in eruptions of the skin. Root— antiprotozoal. Fruit, leaf and root— antidiabetic. Various plant parts are used in slow pulse and convulsions, also against infective hepatitis.

Habitat: Western Himalayas and hilly regions of the western parts of Peninsular India, abundantly in Maharashtra.

Action: The plant is the source of alkaloid scopolamine which is used as a pre-anaesthetic in surgery and childbirth, in ophthalmology and for the prevention of motion sickness.

Habitat: Kashmir at 1,700-3,000 m.

Action: Bulbs—emollient, diuretic, resolvent, spasmolytic, hypotensive, cardiotonic.... fritillaria imperialis

Habitat: The Himalayan region. Found in Ranikhet.

Action: Nervine and cardiac tonic.... habenaria intermedia

Habitat: The Himalayas from Nepal to Bhutan; north Bengal, Bihar, Orissa and Madhya Pradesh.

Action: Fruit—laxative, carminative, bechic, febrifuge, antispasmodic (used for abdominal pains). Bark and leaves—astringent.

The interaction may take place:

(1) Prior to absorption or administration – for example, antacids bind tetracycline in the gut and prevent absorption.

(2) By interfering with protein binding – one drug may displace another from binding sites on plasma proteins. The action of the displaced drug will be increased because more drug is now available; for example, anticoagulants are displaced by analgesics.

(3) During metabolism or excretion of the drug – some drugs increase or decrease the activity of liver enzymes which metabolise drugs, thus affecting their rate of destruction; for example, barbiturates, nicotine, and alcohol all activate hepatic enzymes. Altering the pH of urine will affect the excretion of drugs via the kidney.

(4) At the drug receptor – one drug may displace another at the receptor, affecting its e?cacy or duration of action.... drug interactions

In Britain there are an average of 110 deaths a year from electrocution, half of these occurring in the home.

Treatment No electrical apparatus or switch should be touched by anyone who is in metallic contact with the ground, such as through a metal pipe, especially, for example, from a bath. The ?rst action is to break the current. This can sometimes be done by turning o? a switch. If the victim is grasping or in contact with a live wire, the contact may be severed with safety only by someone wearing rubber gloves or rubber boots; but as these are not likely to be immediately available, the rescuer’s hands may be protected by a thick wrapping of dry cloth, or the live wire may be hooked or pushed out of the way with a long wooden stick such as a broom-handle. If the injured person is unconscious, and especially if breathing has stopped, arti?cial respiration should be applied as described in APPENDIX 1: BASIC FIRST AID – Electrocution. When the patient begins to breathe again, he or she must be treated for shock and professional help obtained urgently.... electrical injuries

Habitat: Australia, North America; throughout the warmer parts of the world. In India, in wet plains and low hills and pasture grounds.

Action: Used for biliary disorders. In Vietnamese traditional medicine, a decoction of the whole plant is used as stomachic, diuretic, febrifuge, and in sprains.

Habitat: Grown as an ornamental.

Action: Leaf—cathartic, diuretic, antiseptic, anti-inflammatory. Applied externally for dispersing venereal buboes. Bark—antibilious, anthelmintic, febrifuge, astringent, expectorant. (E. variegata is an adulterant to the Ayurvedic drug Rohitaka.) Different parts of the plant are used as nervine sedative, antiepileptic, astringent, antiasthmatic and antiseptic. Bark is used in liver ailments, fever and rheumatism.

Habitat: Cultivated in Assam, Maharashtra and Bengal.

Action: Gum—anticholerin. Used as a gargle. Applied to eczema and skin diseases. Bark—antidysenteric, astringent, diuretic. Seed— antirheumatic. Fruit—stomachic. Root—applied externally in skin diseases. Leaves and young shoots— astringent and stomachic.

Diagnosis and treatment Any person with isolated, itching, dry and scaling lesions of the skin with no obvious cause – for example, no history of eczema (see DERMATITIS) – should be suspected of having a fungal infection. Such lesions are usually asymmetrical. Skin scrapings or nail clippings should be sent for laboratory analysis. If the lesions have been treated with topical steroids they may appear untypical. Ultraviolet light ?ltered through glass (Wood’s light) will show up microsporum infections, which produce a green-blue ?uorescence.

Fungal infections used to be treated quite e?ectively with benzoic-acid compound ointment; it has now been superseded by new IMIDAZOLES preparations, such as CLOTRIMAZOLE, MICONAZOLE and terbina?ne creams. The POLYENES, NYSTATIN and AMPHOTERICIN B, are e?ective against yeast infections. If the skin is macerated it can be treated with magenta (Castellani’s) paint or dusting powder to dry it out.

Refractory fungal infection can be treated systematically provided that the diagnosis of the infection has been con?rmed. Terbina?ne, imidazoles and GRISEOFULVIN can all be taken by mouth and are e?ective for yeast infections. (Griseofulvin should not be taken in pregnancy or by people with liver failure or porphyria.) (See also FUNGUS; MICROBIOLOGY.)... fungal and yeast infections

– for example, METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA). This makes hospital-acquired infections potentially dangerous and sometimes life-threatening, and is one of the developments that is prompting calls for greater care in the prescribing of antibiotics as well as higher standards of cleanliness.... hospital-acquired infection

Habitat: Evergreen forests of Western Ghats from Konkan southwards and in Goa. Also cultivated in southern districts of Maharashtra and on lower slopes of Nilgiris.

Action: Fruit—antiscorbutic, cholagogue, cooling, antibilious, emollient and demulcent. A syrup from the fruit juice is given in bilious affections. Bark—astringent, Oil or Kokam Butter—used for dysentery and diarrhoea with mucus. Applied externally to ulcerations, fissures of lips, chapped skin and skin diseases.

Gender is determined by a combination of genetic and environmental factors, in which the in?uence of family upbringing is an important factor. When physical sexual characteristics are ambiguous, the child’s gender identity can usually be established if the child is reared as being clearly male or female. Should, however, the child be confused about its sexual identity, the uncertainty may continue into adult life. Transsexuals generally experience con?icts of identity in childhood, and such problems usually occur by the age of two years. In this type of identity disorder, which occurs in one in 30,000 male births and one in 100,000 female births, the person believes that he or she is the victim of a biological accident, trapped in a body different from what is felt to be his or her true sex.

Treatment is di?cult: psychotherapy and hormone treatment may help, but some affected individuals want surgery to change their body’s sexual organs to match their innately felt sexual gender. The decision to seek a physical sex change raises major social problems for individuals, and ethical problems for their doctors. Surgery, which is not always successful in the long term, requires careful assessment, discussion and planning. It is important to preclude mental illness; results in homosexual men who have undergone surgery are not usually satisfactory. Advice and information may be obtained from Gender Identity Consultancy Services.... gender identity disorders

Iannah, Iana, Ianah, Ionna, Iona... ianna

Iantha, Ianthia, Ianthina, Ianthyna, Ianthea, Ianthiya, Ianthya... ianthe

Habitat: Dry forests throughout the country.

Action: Pods and bark—antidiar- rhoeal, astringent, antibilious. Bark and root—antigalactic, demulcent, expectorant (used in cough and asthma). Leaf—paste used against skin diseases. Pods—anthelmintic. Used in fever due to cold. Seeds— aqueous extract administered in colic and dysentery.

Habitat: Throughout India.

Action: Plant—diuretic, astringent, emollient, vulnerary. Used as a local application for ulcers, wounds, sores, gum boils and skin affections. Decoction of leaves is used in urticaria and fevers; that of root in coughs. Flowers—emmenagogue in small doses, abortifacient in large doses. Masticated seeds— stomachic.

Habitat: Throughout India; common in Bengal, Maharashtra and extending to Travancore.

Action: Blood purifier, antisyphilitic, antileucorrhoeic, galactogenic, antidiarrhoeal, antirheumatic, febrifuge, alterative. Roots used against gonorrhoea, leucoderma, bleeding piles, jaundice and dysentery.

Habitat: Throughout greater parts of India, also grown in gardens.

Action: Bark—internally and externally used in rheumatism. Stem bark paste—in scabies. Seeds—used topically on ringworm.

Habitat: Native to Europe; cultivated in gardens. Reported to occur in Chamba.

Action: Used for gout, rheumatism, also for bronchitis and asthma; as a tonic in enlargement of heart to allay excited action of the heart.

• Helps treating bronchitis.
• Cough remedy.
• Helps combat irritable bowel infections, gastritis and dysentery.
• Prevents congestion.
• Fights infestation of intestinal worms.

• Over consumption can be unsafe, because the dried Iceland moss plant can be contaminated with lead.
• Pregnant and breastfeeding women should avoid drinking Iceland Moss Tea. During pregnancy, it can be harmful to the mother and to the unborn child.
• It can cause ulcers in the stomach or small intestine.
• Iceland Moss Tea may interact with the effects of some medications, so make sure you always consult your doctor before drinking Iceland Moss Tea or any kind of herbal tea.
• It can cause nausea and liver problems.

Habitat: Uttar Pradesh, Madhya Pradesh, Bihar, Assam and the Sunderbans.

Action: Root—demulcent, diuretic, alterative, diaphoretic; used in fevers, dyspepsia and cutaneous affections. The roots of the plant are used as a substitute for Indian sarsaparilla and are often mixed with the roots of Hemidesmus indicus (their therapeutic properties for use as sarsaparilla have bot been established).

Idoney, Idonee, Idonea, Idoni, Idonie... idony

Ieshia, Ieshea, Ieesha, Ieasha, Ieashia, Ieashiah, Ieeshah, Ieeshia... iesha

Ifeomah, Ifyoma, Ifyomah... ifeoma

Igantiah, Ignacia, Ignazia, Iniga... ignatia

Igona, Igoneh, Igonia, Igonea... igone

Igrayne, Igrain, Igerne, Igrayn, Igraen, Igraene... igraine

Ileana, Ileane, Ileanna, Ileanne, Illeanna, Illia, Illiana, Illianna, Illionya, Ilona, Ilonna, Iliona, Ilone, Ilonka, Illonna, Ilon... iliana

Ilithya, Ilithiya, Ilithyiah... ilithyia

Habitat: Native to Europe; grown occasionally in gardens at hill stations.

Action: Leaves—diaphoretic, febrifuge. Used in catarrh, pleurisy, intermittent fever, smallpox and rheumatism. Also in jaundice. Berries—violently emetic and purgative; employed in dropsy. Powdered berries are used as astringent to check bleeding.

Habitat: Native to South America; cultivated in some Indian gardens. In northern India, grows in Lucknow.

Action: Stimulant to brain and nervous system, mild antispasmod- ic, eliminates uric acid. Used for physical exhaustion, rheumatism, gout and nervous headache. (A national drink of Paraguay and Brazil.) Causes purging and even vomiting in large doses.

Habitat: Indigenous to China.

Action: Carminative and pectoral. Used in hard, dry cough where expectoration is difficult. (Oil of Anise is distilled in Europe from the fruits of Pimpinella anisum.)

Habitat: Native to China. Fruits imported from China and IndoChina.

Action: Carminative (used for colic), stimulant, diuretic. Also used in rheumatism.

Illori, Ilorie, Illorie, Ilory, Illory, Ilorey, Illorey, Iloree, Illoree, Ilorea, Illorea... ilori

Iluminata, Ilumynada, Ilumynata, Iluska, Ilu... iluminada

Imalah, Imalla, Imallah, Immala, Immalla... imala

Imeldah, Imalda, Imaldah... imelda

Habitat: Cultivated in plains throughout India.

Action: Cathartic, diuretic, antirheumatic. Flowers—used in burns and scalds.

Habitat: The hotter parts of India, both in plains and hills, ascending up to 2,300 m in the Himalayas.

Action: Diuretic, anti-inflammatory.

Imtithala, Imtithaal, Imtithalia, Imtithalea... imtithal

Inannah, Inana, Inanah, Inann, Inanne, Inane... inanna

Symptoms These depend upon whether the anaemia is sudden in onset, as in severe haemorrhage, or gradual. In all cases, however, the striking sign is pallor, the depth of which depends upon the severity of the anaemia. The colour of the skin may be misleading, except in cases due to severe haemorrhage, as the skin of many Caucasian people is normally pale. The best guide is the colour of the internal lining of the eyelid. When the onset of the anaemia is sudden, the patient complains of weakness and giddiness, and loses consciousness if he or she tries to stand or sit up. The breathing is rapid and distressed, the pulse is rapid and the blood pressure is low. In chronic cases the tongue is often sore (GLOSSITIS), and the nails of the ?ngers may be brittle and concave instead of convex (koilonychia). In some cases, particularly in women, the Plummer-Vinson syndrome is present: this consists of di?culty in swallowing and may be accompanied by huskiness; in these cases glossitis is also present. There may be slight enlargement of the SPLEEN, and there is usually some diminution in gastric acidity.

CHANGES IN THE BLOOD The characteristic change is a diminution in both the haemoglobin and the red cell content of the blood. There is a relatively greater fall in the haemoglobin than in the red cell count. If the blood is examined under a microscope, the red cells are seen to be paler and smaller than normal. These small red cells are known as microcytes.

Treatment consists primarily of giving suf?cient iron by mouth to restore, and then maintain, a normal blood picture. The main iron preparation now used is ferrous sulphate, 200 mg, thrice daily after meals. When the blood picture has become normal, the dosage is gradually reduced. A preparation of iron is available which can be given intravenously, but this is only used in cases which do not respond to iron given by mouth, or in cases in which it is essential to obtain a quick response.

If, of course, there is haemorrhage, this must be arrested, and if the loss of blood has been severe it may be necessary to give a blood transfusion (see TRANSFUSION – Transfusion of blood). Care must be taken to ensure that the patient is having an adequate diet. If there is any underlying metabolic, oncological, toxic or infective condition, this, of course, must be adequately treated after appropriate investigations.

Megaloblastic hyperchromic anaemia There are various forms of anaemia of this type, such as those due to nutritional de?ciencies, but the most important is that known as pernicious anaemia.

PERNICIOUS ANAEMIA An autoimmune disease in which sensitised lymphocytes (see LYMPHOCYTE) destroy the PARIETAL cells of the stomach. These cells normally produce INTRINSIC FACTOR, the carrier protein for vitamin B12 (see APPENDIX 5: VITAMINS) that permits its absorption in the terminal part of the ILEUM. Lack of the factor prevents vitamin B12 absorption and this causes macrocytic (or megaloblastic) anaemia. The disorder can affect men and women, usually those over the age of 40; onset is insidious so it may be well advanced before medical advice is sought. The skin and MUCOSA become pale, the tongue is smooth and atrophic and is accompanied by CHEILOSIS. Peripheral NEUROPATHY is often present, resulting in PARAESTHESIA and numbness and sometimes ATAXIA. A rare complication is subacute combined degeneration of the SPINAL CORD.

In 1926 two Americans, G R Minot and W P Murphy, discovered that pernicious anaemia, a previously fatal condition, responded to treatment with liver which provides the absent intrinsic factor. Normal development requires a substance known as extrinsic factor, and this depends on the presence of intrinsic factor for its absorption from the gut. The disease is characterised in the blood by abnormally large red cells (macrocytes) which vary in shape and size, while the number of white cells (LEUCOCYTES) diminishes. A key diagnostic ?nd is the presence of cells in the BONE MARROW.

Treatment consists of injections of vitamin B12 in the form of hydroxocobalamin which must be continued for life.

Aplastic anaemia is a disease in which the red blood corpuscles are very greatly reduced, and in which no attempt appears to be made in the bone marrow towards their regeneration. It is more accurately called hypoplastic anaemia as the degree of impairment of bone-marrow function is rarely complete. The cause in many cases is not known, but in rather less than half the cases the condition is due to some toxic substance, such as benzol or certain drugs, or ionising radiations. The patient becomes very pale, with a tendency to haemorrhages under the skin and mucous membranes, and the temperature may at times be raised. The red blood corpuscles diminish steadily in numbers. Treatment consists primarily of regular blood transfusions. Although the disease is often fatal, the outlook has improved in recent years: around 25 per cent of patients recover when adequately treated, and others survive for several years. In severe cases promising results are being reported from the use of bone-marrow transplantation.

Haemolytic anaemia results from the excessive destruction, or HAEMOLYSIS, of the red blood cells. This may be the result of undue fragility of the red blood cells, when the condition is known as congenital haemolytic anaemia, or of acholuric JAUNDICE.

Sickle-cell anaemia A form of anaemia characteristically found in people of African descent, so-called because of the sickle shape of the red blood cells. It is caused by the presence of the abnormal HAEMOGLOBIN, haemoglobin S, due to AMINO ACID substitutions in their polypeptide chains, re?ecting a genetic mutation. Deoxygenation of haemoglobin S leads to sickling, which increases the blood viscosity and tends to obstruct ?ow, thereby increasing the sickling of other cells. THROMBOSIS and areas of tissue INFARCTION may follow, causing severe pain, swelling and tenderness. The resulting sickle cells are more fragile than normal red blood cells, and have a shorter life span, hence the anaemia. Advice is obtainable from the Sickle Cell Society.... inadequate intake of iron

Inass, Inasse, Inasa, Inassa... inas

Indea, Indiah, Indeah, Indya, Indiya, Indee, Inda, Indy, Indi... india

Indian Medicinal Plants

[catlist id=3 numberposts=100 pagination=yes instance=2 orderby=title order=asc]

Ben: Amlaki

Habitat: Throughout greater parts of India.

Action: Astringent, antileucor- rhoeic, antirheumatic, alterative, restorative.

Indumatie, Indumaty, Indumatey, Indumatee, Indumatea... indumati

• Strenghtens the immune system.
• Can speed recovery from the common cold.
• Helps heal wounds and cuts.
• Treats respiratory infections such as pharyngitis and tonsilitis.
• Heals sore thorat.
• Helps reduce fever.
• Helps in the treatment of chronic fatigue syndrome when combined with echinacea.

• Taking in large doses, Indigo Root Tea can cause nausea, diarrhea, voming or asphyxiation.
• Pregnant and breastfeeding women should avoid drinking Indigo Root Tea.
• People with auto-immune disorders should not drink Indigo Root Tea.

Habitat: Cultivated in Assam, Bihar and in parts of Uttar Pradesh.

Action: See I. tinctoria.

Habitat: Bihar and Western and Peninsular India.

Action: Root, leaf—bitter tonic. Seed—anthelmintic.... indigofera arrecta

Habitat: Plains of Karnataka, Andhra Pradesh and Tamil Nadu.

Action: Antileprotic, antitumour, anti-inflammatory. Used in psoriasis and erysipelas. Ash of the burnt plant is used for dandruff. Root is used in aphthae.... indigofera aspalathoides

Habitat: The Himalayas up to 1,200 m and in plains of India.

Action: Juice of the plant— antiscorbutic, diuretic, alterative. The plant, boiled with oil, is applied to burns. A decoction is given in epilepsy and insanity.

Habitat: Throughout greater parts of India.English: Wild Indigo, Mysore Panicled Indigo.Ayurvedic: Bana-Nila, Dill, Jhill.Unani: Vasmaa.Siddha/Tamil: Kattukkarchamathi.Folk: Jhil (Gujarat).

Action: Plant—antisyphilitic. All parts of the plant are found useful in enlargement of liver and spleen.The leaves gave apigenin 7-rhamno- glucoside, apigenin 7, 4'-diglucoside, kaempferol-3-neohesperidoside and rhoifolin, along with protocatechuic, p-coumaric, p-hydroxybenzoic, salicylic and vanillic acid.... indigofera oblongifolia

Habitat: The hills in India.

Action: Root—used for cough. Powder of the root applied externally for muscular pain in chest.

Habitat: Cultivated in many parts of India.

Action: Plant—antiseptic, hepato- protective, hypoglycaemic, nervine tonic. Used in enlargement of liver and spleen, skin diseases, leucoder- ma, burns, ulcers, piles, nervous disorders, epilepsy, asthma, lumbago, gout. Leaf—anti-inflammatory. Used in blennorrhagia. Root— diuretic. Used in hepatitis. Root and stem—laxative, expectorant, febrifuge, anticephalalgic, anti- tumour, anthelmintic, promote growth of hair.

METABOLIC DISORDERS such as URAEMIA and pancreatitis (see PANCREAS, DISORDERS OF)

Bowel infarction

Drug ingestion

Massive blood transfusion, transfusion reaction (see TRANSFUSION OF BLOOD), CARDIOPULMONARY BYPASS, disseminated intravascular coagulation

Treatment The principles of management are supportive, with treatment of the underlying condition if that is possible. Oxygenation is improved by increasing the concentration of oxygen breathed in by the patient, usually with mechanical ventilation of the lungs, often using continuous positive airways pressure (CPAP). Attempts are made to reduce the formation of pulmonary oedema by careful management of how much ?uid is given to the patient (?uid balance). Infection is treated if it arises, as are the possible complications of prolonged ventilation with low lung compliance (e.g. PNEUMOTHORAX). There is some evidence that giving surfactant through a nebuliser or aerosol may help to improve lung e?ectiveness and reduce oedema. Some experimental evidence supports the use of free-radical scavengers and ANTIOXIDANTS, but these are not commonly used. Other techniques include the inhalation of NITRIC OXIDE (NO) to moderate vascular tone, and prone positioning to improve breathing. In severe cases, extracorporeal gas exchange has been advocated as a supportive measure until the lungs have healed enough for adequate gas exchange. (See also RESPIRATORY DISTRESS SYNDROME; HYALINE MEMBRANE DISEASE; SARS.)... indirect insult

Breast feeding Unless there is a genuine contraindication, every baby should be breast fed. The nutritional components of human milk are in the ideal proportions to promote the healthy growth of the human newborn. The mother’s milk, especially colostrum (the ?uid secreted before full lactation is established) contains immune cells and antibodies that increase the baby’s resistance to infection. From the mother’s point of view, breast feeding helps the womb to return to its normal size and helps her to lose excess body fat gained during pregnancy. Most importantly, breast feeding promotes intimate contact between mother and baby. A ?nal point to be borne in mind, however, is that drugs taken by a mother can be excreted in her milk. These include antibiotics, sedatives, tranquillisers, alcohol, nicotine and high-dose steroids or vitamins. Fortunately this is rarely a cause of trouble. (See also main entry on BREAST FEEDING.)

Arti?cial feeding Unmodi?ed cows’ milk is not a satisfactory food for the human newborn and may cause dangerous metabolic imbalance. If breast feeding is not feasible, one of the many commerciallly available formula milks should be used. Most of these are made from cows’ milk which has been modi?ed to re?ect the composition of human milk as closely as possible. For the rare infant who develops cows’-milk-protein intolerance, a milk based on soya-bean protein is indicated.

Feeding and weight gain The main guide as to whether an infant is being adequately fed is the weight. During the ?rst days of life a healthy infant loses weight, but should by the end of the second week return to birth weight. From then on, weight gain should be approximately 6oz. (170g) each week.

The timing of feeds reffects social convention rather than natural feeding patterns. Among the most primitive hunter-gatherer tribes of South America, babies are carried next to the breast and allowed to suckle at will. Fortunately for developed society, however, babies can be conditioned to intermittent feedings.

As the timing of breast feeding is ?exible – little or no preparation time being required – mothers can choose to feed their babies on demand. Far from spoiling the baby, demand feeding is likely to lead to a contented infant, the only necessary caution being that a crying baby is not always a hungry baby.

In general, a newborn will require feeding every two to four hours and, if well, is unlikely to sleep for more than six hours. After the ?rst months, a few lucky parents will ?nd their infant sleeping through the night.

Weaning Weaning on to solid foods is again a matter of individuality. Most babies will become dissatis?ed with a milk-only diet at around six months and develop enthusiasm for cereal-based weaning foods. Also at about this time they enjoy holding objects and transferring them to their mouths – the mouth being an important sense organ in infants. It is logical to include food items that they can hold, as this clearly brings the baby pleasure at this time. Introduction of solids before the age of four months is unusual and best avoided. The usual reason given for early weaning is that the baby appears hungry, but this is unlikely to be the case; crying due to COLIC, for example, is more probable. Some mothers take the baby’s desire to suck – say, on their ?nger – as a sign of hunger when this is, in fact, re?ex activity.

Delaying the start of weaning beyond nine months is nutritionally undesirable. As weaning progresses, the infant’s diet requires less milk. Once established on a varied solid diet, breast and formula milks can be safely replaced with cows’ milk. There is, however, no nutritional contraindication to continued breast feeding until the mother wishes to stop.

It is during weaning that infants realise they can arouse extreme maternal anxiety by refusing to eat. This can lead to force-feeding and battles of will which may culminate in a breakdown of the mother-child relationship. To avoid this, parents must resist the temptation to coax the child to eat. If the child refuses solid food, the meal should be taken away with a minimum of fuss. Children’s appetites re?ect their individual genetic structure and a well child will eat enough to grow and maintain satisfactory weight gain. If a child is not eating properly, weight gain will be inadequate over a prolonged period and an underlying illness is the most likely cause. Indeed, failure to thrive is the paediatrician’s best clue to chronic illness.

Advice on feeding Many sources of con?icting advice are available to new parents. It is impossible to satisfy everyone, and ultimately it is the well-being of the mother and infant and the closeness of their relationship that matter. In general, mothers should be wary of rigid advice. An experienced midwife, health visitor or well-baby-clinic nursing sister are among the most reliable sources of information.

Protein Fat per Sugar Calories per cent cent per cent per cent

Human milk 1·1 4·2 7·0 70 Cows’ milk 3·5 3·9 4·6 66

Composition of human and cows’ milk... infant feeding

Infinitey, Infiniti, Infinitie, Infinitee, Infinitye, Infinitea... infinity

The improvement in the infant mortality rate has occurred mainly in the period from the second month of life. There has been much less improvement in the neonatal mortality rate – that is, the number of infants dying during the ?rst four weeks of life, expressed as a proportion of every 1,000 live births. During the ?rst week of life the main causes of death are asphyxia, prematurity, birth injuries and congenital abnormalities. After the ?rst week the main cause of death is infection.

Social conditions also play an important role in infant mortality. In England and Wales the infant mortality rate in 1930–32 was: Social Class I (professional), 32·7; Social Class III (skilled workers), 57·6; Social Class V (unskilled workers), 77·1. Many factors come into play in producing these social variations, but overcrowding is undoubtedly one of the most important.

1838–9 146 1950–52 30 1851–60 154 1960–62 22 1900–02 142 1970–72 18 1910–12 110 1980–82 12 1920–22 82 1990–92 7 1930–32 67 1996 6·2 1940–42 59 1999 5.8 2000 5.6

It is thus evident that for a reduction of the infant mortality rate to the minimum ?gure, the following conditions must be met. Mothers and potential mothers must be housed adequately in healthy surroundings, particularly with regard to safe water supplies and sewage disposal. The pregnant and nursing mother must be ensured an adequate diet. E?ective antenatal supervision must be available to every mother, as well as skilled supervision during labour (see PREGNANCY AND LABOUR). The newborn infant must be adequately nursed and fed and mothers encouraged to breast feed. Environmental and public-health measures must be taken to ensure adequate housing, a clean milk supply and full availability of medical care including such protective measures as IMMUNISATION against diphtheria, measles, poliomyelitis and whooping-cough. (See also PERINATAL MORTALITY.)... infant mortality rate (imr)

– systemic infection.... inflammation

The imaging systems of COMPUTED TOMOGRAPHY (CT) and magnetic resonance imaging (see MRI) have powerful computer techniques underlying them.

Computerised statistical analysis of study data, population databases and disease registries is now routine, leading to enhanced understanding of the interplay between diseases and the population. And the results of research, available on computerised indexes such as MEDLINE, can be obtained in searches that take only seconds, compared with the hours or days necessary to accomplish the same task with its paper incarnation, Index Medicus.

Medical informatics The direct computerisation of those activities which are uniquely medical – history-taking, examination, diagnosis and treatment – has proved an elusive goal, although one hotly pursued by doctors, engineers and scientists working in the discipline of medical informatics. Computer techniques have scored some successes: patients are, for example, more willing to be honest about taboo areas, such as their drug or alcohol consumption, or their sexual proclivities, with a computer than face to face with a clinician; however, the practice of taking a history remains the cornerstone of clinical practice. The examination of the patient is unlikely to be supplanted by technological means in the foreseeable future; visual and tactile recognition systems are still in their infancy. Skilled interpretation of the result by machine rather than the human mind seems equally as remote. Working its way slowly outwards from its starting point in mathematical logic, ARTIFICIAL INTELLIGENCE that in any way mimics its natural counterpart seems a distant prospect. Although there have been successes in computer-supported diagnosis in some specialised areas, such as the diagnosis of abdominal pain, workable systems that could supplant the mind of the generalist are still the dream of the many developers pursuing this goal, rather than a reality available to doctors in their consulting rooms now.

In therapeutics, computerised prescribing systems still require the doctor to make the decision about treatment, but facilitate the process of writing, issuing, and recording the prescription. In so doing, the system can provide automated checks, warning if necessary about allergies, potential drug interactions, or dosing errors. The built-in safety that this process o?ers is enhanced by the superior legibility of the script that ensues, reducing the potential for error when the medicine is dispensed by the nurse or the pharmacist.

Success in these individual applications continues to drive development, although the process has its critics, who are not slow to point to the lengthier consultations that arise when a computer is present in the consulting room and its distracting e?ect on communication with the patient.

Underlying these many software applications lies the ubiquitous personal computer – more powerful today than its mainframe predecessor of only 20 years ago – combined with networking technology that enables interconnection and the sharing of data. As in essence the doctor’s role involves the acquisition, manipulation and application of information – from the individual patient, and from the body of medical knowledge – great excitement surrounds the development of open systems that allow di?erent software and hardware platforms to interact. Many problems remain to be solved, not least the fact that for such systems to work, the whole organisation, and not just a few specialised individuals, must become computer literate. Such systems must be easy to learn to use, which requires an intuitive interface between user(s) and system(s) that is predictable and logical in its ordering and presentation of information.

Many other issues stand in the way of the development towards computerisation: standard systems of nomenclature for medical concepts have proved surprisingly di?cult to develop, but are crucial for successful information-sharing between users. Sharing information between existing legacy systems is a major challenge, often requiring customised software and extensive human intervention to enable the previous investments that an organisation has made in individual systems (e.g. laboratory-result reporting) to be integrated with newer technology. The beginnings of a global solution to this substantial obstacle to networking progress is in sight: the technology that enables the Internet – an international network of telephonically linked personal computers – also enables the establishment of intranets, in which individual servers (computers dedicated to serving information to other computers) act as repositories of ‘published’ data, which other users on the network may ‘browse’ as necessary in a client-server environment.

Systems that support this process are still in early stages of development, but the key conceptualisations are in place. Developments over the next 5–10 years will centre on the electronic patient record available to the clinician on an integrated clinical workstation. The clinical workstation – in essence a personal computer networked to the hospital or practice system – will enable the clinician to record clinical data and diagnoses, automate the ordering of investigations and the collection of the results, and facilitate referral and communication between the many professionals and departments involved in any individual patient’s care.

Once data is digitised – and that includes text, statistical tables, graphs, illustrations and radiological images, etc. – it may be as freely networked globally as locally. Consultations in which live video and sound transmissions are the bonds of the doctor-patient relationship (the techniques of telemedicine) are already reality, and have proved particularly convenient and cost-e?ective in linking the patient and the generalist to specialists in remote areas with low population density.

As with written personal medical records, con?dentiality of personal medical information on computers is essential. Computerised data are covered by the Data Protection Act 1984. This stipulates that data must:

be obtained and processed fairly and lawfully.

be held only for speci?ed lawful purposes.

•not be used in a manner incompatible with those purposes.

•only be recorded where necessary for these purposes.

be accurate and up to date.

not be stored longer than necessary.

be made available to the patient on request.

be protected by appropriate security and backup procedures. As these problems are solved, concerns about

privacy and con?dentiality arise. While paper records were often only con?dential by default, the potential for breaches of security in computerised networks is much graver. External breaches of the system by hackers are one serious concern, but internal breaches by authorised users making unauthorised use of the data are a much greater risk in practice. Governing network security so that clinical users have access on a need-to-know basis is a di?cult business: the software tools to enable this – encryption, and anonymisation (ensuring that clinical information about patients is anonymous to prevent con?dential information about them leaking out) of data collected for management and research processes – exist in the technical domain but remain a complex conundrum for solution in the real world.

The mushroom growth of websites covering myriad subjects has, of course, included health information. This ranges from clinical details on individual diseases to facts about medical organisations and institutes, patient support groups, etc. Some of this information contains comments and advice from orthodox and unorthodox practitioners. This open access to health information has been of great bene?t to patients and health professionals. But web browsers should be aware that not all the medical information, including suggested treatments, has been subject to PEER REVIEW, as is the case with most medical articles in recognised medical journals.... information technology in medicine

Ingaberg, Ingaborg, Inge, Ingegerg, Inngeborg, Ingibjorg, Inga, Ingunn, Ingunna, Injerd... ingeborg

Ingagard, Ingegerd, Ingagerd, Ingigard, Ingigerd... ingegard

Cause The disease is caused by a VIRUS of the in?uenza group. There are at least three types of in?uenza virus, known respectively as A, B and

C. One of their most characteristic features is that infection with one type provides no protection against another. Equally important is the ease with which the in?uenza virus can change its character. It is these two characteristics which explain why one attack of in?uenza provides little, if any, protection against a subsequent attack, and why it is so di?cult to prepare an e?ective vaccine against the disease.

Epidemics of in?uenza due to virus A occur in Britain at two- to four-year intervals, and outbreaks of virus B in?uenza in less frequent cycles. Virus A in?uenza, for instance, was the prevalent infection in 1949, 1951, 1955 and 1956, whilst virus B in?uenza was epidemic in 1946, 1950, 1954 and, along with virus A, in 1958–59. The pandemic of 1957, which swept most of the world, although fortunately not in a severe form, was due to a new variant of virus A

– the so-called Asian virus – and it has been suggested that it was this variant that was responsible for the pandemics of 1889 and 1918. Since 1957, variants of virus A have been the predominating causes of in?uenza, accompanied on occasions by virus B.

In 1997 and 2004, outbreaks of Chinese avian in?uenza caused alarm. The in?uenza virus had apparently jumped species from birds

– probably chickens – to infect some people. Because no vaccine is available, there was a risk that this might start an epidemic.

Symptoms The incubation period of in?uenza A and B is 2–3 three days, and the disease is characterised by a sudden onset. In most cases this is followed by a short, sharp febrile illness of 2–4 days’ duration, associated with headache, prostration, generalised aching, and respiratory symptoms. In many cases the respiratory symptoms are restricted to the upper respiratory tract, and consist of signs of irritation of the nose, pharynx and larynx. There may be nosebleeds, and a dry, hacking cough is often a prominent and troublesome symptom. The fever is usually remittent and the temperature seldom exceeds 39·4 °C (103 °F), tending to ?uctuate between 38·3 and 39·4 °C (101 and 103 °F).

The most serious complication is infection of the lungs. This infection is usually due to organisms other than the in?uenza virus, and is a complication which can have serious results in elderly people.

The very severe form of ’?u which tends to occur during pandemics – and which was so common during the 1918–19 pandemic – is characterised by the rapid onset of bronchopneumonia and severe prostration. Because of the toxic e?ect on the heart, there is a particularly marked form of CYANOSIS, known as heliotrope cyanosis.

Convalescence following in?uenza tends to be prolonged. Even after an attack of average severity there tends to be a period of weakness and depression.

Treatment Expert opinion is still divided as to the real value of in?uenza vaccine in preventing the disease. Part of the trouble is that there is little value in giving any vaccine until it is known which particular virus is causing the infection. As this varies from winter to winter, and as the protection given by vaccine does not exceed one year, it is obviously not worthwhile attempting to vaccinate the whole community. The general rule therefore is that, unless there is any evidence that a particularly virulent type of virus is responsible, only the most vulnerable should be immunised – such as children in boarding schools, elderly people, and people who suffer from chronic bronchitis or asthma, chronic heart disease, renal failure, diabetes mellitus or immunosuppression (see under separate entries). In the face of an epidemic, people in key positions, such as doctors, nurses and those concerned with public safety, transport and other public utilities, should be vaccinated.

For an uncomplicated attack of in?uenza, treatment is symptomatic: that is, rest in bed, ANALGESICS to relieve the pain, sedatives, and a light diet. A linctus is useful to sooth a troublesome cough. The best analgesics are ASPIRIN or PARACETAMOL. None of the sulphonamides or the known antibiotics has any e?ect on the in?uenza virus; on the other hand, should the lungs become infected, antibiotics should be given immediately, because such an infection is usually due to other organisms. If possible, a sample of sputum should be examined to determine which organisms are responsible for the lung infection. The choice of antibiotic then depends upon which antibiotic the organism is most sensitive to.... influenza

Ingelisse, Ingeliss, Ingelyse, Ingelisa, Ingelissa, Ingelysa, Ingelyssa... ingelise

Ingred, Ingrad, Inga, Inge, Inger, Ingmar, Ingrida, Ingria, Ingrit, Inkeri... ingrid

Aerosols Asthmatic patients (see ASTHMA) ?nd aerosol devices to be of value in controlling their attacks. They provide an e?ective and convenient way of applying drugs directly to the bronchi, thus reducing the risks of unwanted effects accompanying SYSTEMIC therapy. BRONCHODILATOR aerosols contain either a beta-sympathomimetic agent or ipratropium bromide, which is an ANTICHOLINERGIC drug.

ISOPRENALINE was the ?rst compound to be widely used as an aerosol. It did however stimulate beta1 receptors in the heart as well as beta2 receptors in the bronchi, and so produced palpitations and even dangerous cardiac arrhythmias. Newer beta-adrenoceptor agonists are speci?c for the beta2 receptors and thus have a greater safety margin. They include SALBUTAMOL, TERBUTALINE, rimiterol, fenoterol and reproterol. Unwanted effects such as palpitations, tremor and restlessness are uncommon with these, more speci?c preparations. In patients who get insu?cient relief from the beta-adrenoreceptor agonist, the drug ipratropium bromide is worth adding. Salmeterol is a longer-acting choice for twice-daily administration: it is not intended for the relief of acute attacks, for which shorter-acting beta2 stimulants such as salbutamol should be used. Salmeterol should be added to existing corticosteroid therapy (see CORTICOSTEROIDS), rather than replacing it.

Patients must be taught carefully and observed while using their inhalers. It is important for them to realise that if the aerosol no longer gives more than slight transient relief, they should not increase the dose but seek medical help.... inhalants

Inicko, Inicco, Inico, Inyko, Inycko, Inycco, Inyco... iniko

Innocencia, Innocenta, Inocenta, Inocentia, Inoceneia, Innoceneia, Innocentia, Innocence... inocencia

Unfortunately, insects are liable to become resistant to insecticides, just as bacteria are liable to become resistant to antibiotics, and it is for this reason that so much research work is being devoted to the discovery of new ones. Researchers are also exploring new methods, such as releasing sexually sterile insects into the natural population.

The useful effects of insecticides must be set against increasing evidence that the indiscriminate use of some of these potent preparations is having an adverse e?ect – not only upon human beings, but also upon the ecosystems. Some, such as DDT – the use of which is now banned in the UK – are very stable compounds that enter the food chain and may ultimately be lethal to many animals, including birds and ?shes.... insecticides

The mental age is established by various tests, the most widely used of which are the Stanford-Binet Scale, the Wechsler Adult Intelligence Scale, and the Mill Hill Vocabulary Test.

Average intelligence is represented by an IQ of 100, with a range of 85 to 115. For practical purposes it is taken that the intellectual level reached by the average 15-year-old is indistinguishable from that of an adult.... intelligence quotient (iq)

The principle of one-to-one, 24-hours-a-day care for seriously ill patients has been widely adopted and developed for the initial treatment of many patients with life-threatening conditions. Thus, severely injured patients – those with serious medical conditions such as coronary thrombosis or who have undergone major surgery, and individuals suffering from potentially lethal toxic affects of poisons – are treated in an INTENSIVE THERAPY UNIT (ITU). Patients whose respiratory or circulatory systems have failed bene?t especially by being intensively treated. Most patients, especially post-operative ones, leave intensive care when their condition has been stabilised, usually after 24 or 48 hours. Some, however, need support for several weeks or even months. Since 1952, intensive medicine has become a valued specialty and a demanding one because of the range of skills needed by the doctors and nurses manning the ITUs.... intensive care medicine

For more prolonged arti?cial ventilation it is usual to use a specially designed machine or ventilator to perform the task. The ventilators used in operating theatres when patients are anaesthetised and paralysed are relatively simple devices.They often consist of bellows which ?ll with fresh gas and which are then mechanically emptied (by means of a weight, piston, or compressed gas) via a circuit or tubes attached to an endotracheal tube into the patient’s lungs. Adjustments can be made to the volume of fresh gas given with each breath and to the length of inspiration and expiration. Expiration is usually passive back to the atmosphere of the room via a scavenging system to avoid pollution.

In intensive-care units, where patients are not usually paralysed, the ventilators are more complex. They have electronic controls which allow the user to programme a variety of pressure waveforms for inspiration and expiration. There are also programmes that allow the patient to breathe between ventilated breaths or to trigger ventilated breaths, or inhibit ventilation when the patient is breathing.

Indications for arti?cial ventilation are when patients are unable to achieve adequate respiratory function even if they can still breathe on their own. This may be due to injury or disease of the central nervous, cardiovascular, or respiratory systems, or to drug overdose. Arti?cial ventilation is performed to allow time for healing and recovery. Sometimes the patient is able to breathe but it is considered advisable to control ventilation – for example, in severe head injury. Some operations require the patient to be paralysed for better or safer surgical access and this may require ventilation. With lung operations or very unwell patients, ventilation is also indicated.

Arti?cial ventilation usually bypasses the physiological mechanisms for humidi?cation of inspired air, so care must be taken to humidify inspired gases. It is important to monitor the e?cacy of ventilation – for example, by using blood gas measurement, pulse oximetry, and tidal carbon dioxide, and airways pressures.

Arti?cial ventilation is not without its hazards. The use of positive pressure raises the mean intrathoracic pressure. This can decrease venous return to the heart and cause a fall in CARDIAC OUTPUT and blood pressure. Positive-pressure ventilation may also cause PNEUMOTHORAX, but this is rare. While patients are ventilated, they are unable to breathe and so accidental disconnection from the ventilator may cause HYPOXIA and death.

Negative-pressure ventilation is seldom used nowadays. The chest or whole body, apart from the head, is placed inside an airtight box. A vacuum lowers the pressure within the box, causing the chest to expand. Air is drawn into the lungs through the mouth and nose. At the end of inspiration the vacuum is stopped, the pressure in the box returns to atmospheric, and the patient exhales passively. This is the principle of the ‘iron lung’ which saved many lives during the polio epidemics of the 1950s. These machines are cumbersome and make access to the patient di?cult. In addition, complex manipulation of ventilation is impossible.

Jet ventilation is a relatively modern form of ventilation which utilises very small tidal volumes (see LUNGS) from a high-pressure source at high frequencies (20–200/min). First developed by physiologists to produce low stable intrathoracic pressures whilst studying CAROTID BODY re?exes, it is sometimes now used in intensive-therapy units for patients who do not achieve adequate gas exchange with conventional ventilation. Its advantages are lower intrathoracic pressures (and therefore less risk of pneumothorax and impaired venous return) and better gas mixing within the lungs.... intermittent positive pressure (ipp)

– usually the result of neurological disorder affecting the bladder (neuropathic bladder). (See URINARY BLADDER, DISEASES OF.)... intermittent self-catheterisation

Intersexuality inevitably leads to considerable psychological disturbance as the child grows up. It is therefore important to reach an early decision as to the child’s sex – or at least, the sex that he or she is to be brought up as. Surgical or hormonal means should then be employed, when appropriate, to develop the attributes of that sex and diminish those of the other, together with psychological counselling.... intersexuality

Several diseases and conditions are treated under separate headings. (See APPENDICITIS; CHOLERA; COLITIS; CONSTIPATION; CROHN’S DISEASE; DIARRHOEA; DYSENTERY; ENTERIC FEVER; HAEMORRHOIDS; HERNIA; INFLAMMATORY BOWEL DISEASE (IBD); ILEITIS; INTUSSUSCEPTION; IRRITABLE BOWEL SYNDROME (IBS); PERITONITIS; RECTUM, DISEASES OF; ULCERATIVE COLITIS.)

In?ammation of the outer surface is called peritonitis, a serious disease. That of the inner surface is known generally as enteritis, in?ammation of special parts receiving the names of colitis, appendicitis, irritable bowel syndrome (IBS) and in?ammatory bowel disease (IBD). Enteritis may form the chief symptom of certain infective diseases: for example in typhoid fever (see ENTERIC FEVER), cholera and dysentery. It may be acute, although not connected with any de?nite organism, when, if severe, it is a very serious condition, particularly in young children. Or it may be chronic, especially as the result of dysentery, and then constitutes a less serious if very troublesome complaint.

Perforation of the bowel may take place as the result either of injury or of disease. Stabs and other wounds which penetrate the abdomen may damage the bowel, and severe blows or crushes may tear it without any external wound. Ulceration, as in typhoid fever, or, more rarely, in TUBERCULOSIS, may cause an opening in the bowel-wall also. Again, when the bowel is greatly distended above an obstruction, faecal material may accumulate and produce ulcers, which rupture with the ordinary movements of the bowels. Whatever the cause, the symptoms are much the same.

Symptoms The contents of the bowel pass out through the perforation into the peritoneal cavity, and set up a general peritonitis. In consequence, the abdomen is painful, and after a few hours becomes extremely tender to the touch. The abdomen swells, particularly in its upper part, owing to gas having passed also into the cavity. Fever and vomiting develop and the person passes into a state of circulatory collapse or SHOCK. Such a condition may be fatal if not properly treated.

Treatment All food should be withheld and the patient given intravenous ?uids to resuscitate them and then to maintain their hydration and electrolyte balance. An operation is urgently necessary, the abdomen being opened in the middle line, the perforated portion of bowel found, the perforation stitched up, and appropriate antibiotics given.

Obstruction means a stoppage to the passage down the intestine of partially digested food. Obstruction may be acute, when it comes on suddenly with intense symptoms; or it may be chronic, when the obstructing cause gradually increases and the bowel becomes slowly more narrow until it closes altogether; or subacute, when obstruction comes and goes until it ends in an acute attack. In chronic cases the symptoms are milder in degree and more prolonged.

Causes Obstruction may be due to causes outside the bowel altogether, for example, the pressure of tumours in neighbouring organs, the twisting around the bowel of bands produced by former peritonitis, or even the twisting of a coil of intestine around itself so as to cause a kink in its wall. Chronic causes of the obstruction may exist in the wall of the bowel itself: for example, a tumour, or the contracting scar of an old ulcer. The condition of INTUSSUSCEPTION, where part of the bowel passes inside of the part beneath it, in the same way as one turns the ?nger of a glove outside in, causes obstruction and other symptoms. Bowel within a hernia may become obstructed when the hernia strangulates. Finally some body, such as a concretion, or the stone of some large fruit, or even a mass of hardened faeces, may become jammed within the bowel and stop up its passage.

Symptoms There are four chief symptoms: pain, vomiting, constipation and swelling of the abdomen.

Treatment As a rule the surgeon opens the abdomen, ?nds the obstruction and relieves it or if possible removes it altogether. It may be necessary to form a COLOSTOMY or ILEOSTOMY as a temporary or permanent measure in severe cases.

Tumours are rare in the small intestine and usually benign. They are relatively common in the large intestine and are usually cancerous. The most common site is the rectum. Cancer of the intestine is a disease of older people; it is the second most common cancer (after breast cancer) in women in the United Kingdom, and the third most common (after lung and prostate) in men. Around 25,000 cases of cancer of the large intestine occur in the UK annually, about 65 per cent of which are in the colon. A history of altered bowel habit, in the form of increasing constipation or diarrhoea, or an alternation of these, or of bleeding from the anus, in a middle-aged person is an indication for taking medical advice. If the condition is cancer, then the sooner it is investigated and treated, the better the result.... intestine, diseases of

Intisara, Intisarah, Intizar, Intizara, Intizarah, Intisarr, Intysarr, Intysar... intisar

About one-third of women have adverse effects as the result of IUCD use: common ones are backache and heavy menstrual bleeding (see MENSTRUATION). The frequency of unwanted pregnancies is about 2 per 100 women-years of use. (See CONTRACEPTION.)... intrauterine contraceptive device (iucd)

Habitat: Temperate and Alpine Himalayas from Chitral to Nepal at 1,500-4,200 m.

Action: Antispasmodic, stomachic, antihistaminic, expectorant, anticatarrhal. Used for asthma, chronic bronchitis and pulmonary disorders.

Habitat: The warmer parts of India from Delhi to Bengal and throughout Deccan Peninsula.

Action: Diuretic, antigonorrhoetic and demulcent. Root—given in urinary infections, for bowel complaints of children.

Iphedeia, Iphedia, Iphedea, Iphidea, Iphidia, Iphideia... iphedeiah

Iphimedea, Iphimedea, Ifimedeia, Ifimedea, Ifimedia... iphimedeia

Habitat: North American species. Not found wild in India. Grown in Indian gardens.

Action: Seed—purgative. Used as a substitute for Jalap (Exogonium purga).

Habitat: Throughout warmer parts of India, except the north-western arid region.

Action: Diuretic. Used in strangury, urethral discharges.... ipomoea vitifolia

Habitat: Throughout the greater part of India.

Action: Emetic and purgative. Used as an antidote to arsenical or opium poisoning. Plant juice is used for liver complaints; buds for ringworm.

Habitat: Native to tropical America; cultivated throughout India for edible tubers.

Action: Root—used in strangury, urinary discharges, burning sensation, thirst. Whole plant—used in low fever and skin diseases.

Habitat: Throughout India.

Action: Root bark—purgative. Leaves—used in filariasis.

Habitat: Tropical India in moist regions.

Action: Cholagogue, galactagogue, alterative, demulcent, purgative. Resin from root—uses similar to Jalap. Flour of raw rhizome is given in enlargement of liver and spleen, also for menorrhagia, debility and fat accumulation.

Habitat: Temperate Himalaya and in Khasi Hills.

Action: Deobstruent (in bilious obstructions), diuretic, cathartic. Used in diseases of the liver.

Habitat: On river banks, by the side of lakes, ponds. Native to Great Britain.

Action: Cathartic and acrid. Used in dysmenorrhoea and leucorrhoea. Juice of the root—used for obstinate coughs and convulsions.

Habitat: Throughout India.

Action: Antirheumatic, anticepha- lalgic, antiepileptic and antileprotic.

Habitat: Throughout India in the plains, especially on the bank of stream and rivers.

Action: Used as a single drug for curing sterility in women, and for promoting fertility and virility.

Habitat: The Himalayas, West Bengal, Bihar, Orissa, Maharashtra and South India.

Action: Purgative, febrifuge. Seeds—cardiac depressant, spasmolytic, hypotensive, antibacterial, antifungal. Plant juice destroys bedbugs.

Habitat: Throughout India; also occurs as a weed.

Action: Purgative and blood- purifier. A substitute for Jalap. Seeds—antifungal.

Habitat: Near sea, especially on the West Coast.

Action: Astringent, stomachic, laxative, antidiarrhoeal, antiemetic, analgesic. Leaf—diuretic, anti- inflammatory. Used in colic, prolapsus ani; externally in rheumatism. Essential oil of leaves— antagonistic to histamine. Leaf extract is used for different types of inflammations including injuries caused by poisonous jelly-fish.

Habitat: Throughout India; ascending to 300 m.

Action: Purgative. Used as a supporting herb for diseases of the nervous system.

Habitat: Cultivated in the Nilgiris and Poona.

Action: Strong cathartic and purgative. Usually used with carminatives.

Habitat: Native of tropical America; found throughout greater part of India, grown in gardens.

Action: Purgative. Seed extract— antibacterial.

Habitat: Native to tropical America; grown as an ornamental.

Action: Powdered root is given as a sternutatory. Pounded leaves are applied to bleeding piles.

Habitat: In damp places in upper Gangetic plains; Bihar, Bengal, Peninsular India.

Action: Deobstruent, diuretic, alterative. Used for rheumatic affections, neuralgia, headache, skin diseases and urinary affections.

Habitat: Throughout greater part of India.

Action: Juice of the plant—de- obstruent, diuretic, hypotensive, uterine tonic, antidote to arsenic poisoning. Seeds—cardiac depressant, hypotensive, spasmolytic.... ipomoea sepiaria

Habitat: Temperate Northwestern Himalaya at 1,500-2,700 m. and from Kashmir to Himachal Pradesh. Often grown in gardens.

Action: Used in diseases of the liver.

Action: Demulcent, antidiarrhoeal, expectorant. Extract of the leaf is used for the treatment of frozen feet.

Habitat: The Himalayas from Garhwal to Arunachal Pradesh at 2,400-3,600 m.

Action: Diuretic, spasmolytic, febrifuge; antidote for opium addiction.

Habitat: In swamps. Native to America and Canada.

Action: Anti-inflammatory, astringent, cholagogue, laxative, diuretic, antiemetic, blood and lymph purifier, alterative for sluggish conditions of liver, gallbladder and glandular system.

Habitat: Native to Afghanistan and Western Tibet. Now cultivated as an ornamental.

Action: Plant—used in the form of an ointment for ulcers, oedematous and malignant tumours. Leaves— antimicrobial, antifungal.