Habitat: Imported from Alexandria, East Indies, and the Near East.

Action: Laxative, cathartic.

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

The nervous system can be likened to a computer. The central processing unit – which receives, processes and stores information and initiates instructions for bodily activities – is called the central nervous system: this is made up of the brain and SPINAL CORD. The peripheral nervous system – synonymous with the cables that transmit information to and from a computer’s processing unit – has two parts: sensory and motor. The former collects information from the body’s many sense organs. These respond to touch, temperature, pain, position, smells, sounds and visual images and the information is signalled to the brain via the sensory nerves. When information has been processed centrally, the brain and spinal cord send instructions for action via motor nerves to the ‘voluntary’ muscles controlling movements and speech, to the ‘involuntary’ muscles that operate the internal organs such as the heart and intestines, and to the various glands, including the sweat glands in the skin. (Details of the 12 pairs of cranial nerves and the 31 pairs of nerves emanating from the spinal cord are given in respective texts on brain and spinal cord.)

Functional divisions of nervous system As well as the nervous system’s anatomical divisions, the system is divided functionally, into autonomic and somatic parts. The autonomic nervous system, which is split into sympathetic and parasympathetic divisions, deals with the automatic or unconscious control of internal bodily activities such as heartbeat, muscular status of blood vessels, digestion and glandular functions. The somatic system is responsible for the skeletal (voluntary) muscles (see MUSCLE) which carry out intended movements initiated by the brain – for example, the activation of limbs, tongue, vocal cords (speech), anal muscles (defaecation), urethral sphincters (urination) or vaginal muscles (childbirth). In addition, many survival responses – the most powerfully instinctive animal drives, which range from avoiding danger and pain to shivering when cold or sweating when hot – are initiated unconsciously and automatically by the nervous system using the appropriate neural pathways to achieve the particular survival reaction required.

The complex functions of the nervous system include the ability to experience emotions, such as excitement and pleasure, anxiety and frustration, and to undertake intellectual activities. For these experiences an individual can utilise many built-in neurological programmes and he or she can enhance performance through learning – a vital human function that depends on MEMORY, a three stage-process in the brain of registration, storage and recall. The various anatomical and functional divisions of the nervous system that have been unravelled as science has strived to explain how it works may seem confusing. In practical terms, the nervous system works mainly by using automatic or relex reactions (see REFLEX ACTION) to various stimuli (described above), supplemented by voluntary actions triggered by the activity of the conscious (higher) areas of the brain. Some higher functions crucial to human activity – for example, visual perception, thought, memory and speech – are complex and subtle, and the mechanisms are not yet fully understood. But all these complex activities rest on the foundation of relatively simple electrochemical transmissions of impulses through the massive network of billions of specialised cells, the neurones.... nervous system

When virilisation is noted at birth, great care must be taken to determine genetic sex by karyotyping: parents should be reassured as to the baby’s sex (never ‘in between’). Blood levels of adrenal hormones are measured to obtain a precise diagnosis. Traditionally, doctors have advised parents to ‘choose’ their child’s gender on the basis of discussing the likely condition of the genitalia after puberty. Thus, where the phallus is likely to be inadequate as a male organ, it may be preferred to rear the child as female. Surgery is usually advised in the ?rst two years to deal with clitoromegaly but parent/ patient pressure groups, especially in the US, have declared it wrong to consider surgery until the children are competent to make their own decision.

Other treatment requires replacement of the missing hormones which, if started early, may lead to normal sexual development. There is still controversy surrounding the ethics of gender reassignment.

See www.baps.org.uk... adrenogenital syndrome

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

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

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

Action: Tonic laxative.

Diseases There are several diseases that result from lesions to the extrapyramidal system, of which the most common is PARKINSONISM. Others include WILSON’S DISEASE, KERNICTERUS, CHOREA and ATHETOSIS.... extrapyramidal system

Symptoms Symptoms vary with the age of infection. In young infants, herpes simplex may cause a generalised infection which is sometimes fatal. In young children the infection is usually in the mouth, and this may be associated with enlargement of the glands in the neck, general irritability and fever. The condition usually settles in 7–10 days. In adults the vesicles may occur anywhere in the skin or mucous membranes: the more common sites are the lips, mouth and face, where they are known as cold sores. The vesicles may also appear on the genitalia (herpes genitalis) or in the conjunctiva or cornea of the EYE, and the brain may be infected, causing ENCEPHALITIS or MENINGITIS. The ?rst sign is the appearance of small painful swellings; these quickly develop into vesicles which contain clear ?uid and are surrounded by a reddened area of skin. Some people are particularly liable to recurrent attacks, and these often tend to be associated with some debilitating condition or infection, such as pneumonia.

Except in the case of herpes of the cornea, the eruption clears completely unless it becomes contaminated with some other organism. In the case of the cornea, there may be residual scarring, which may impair vision.

Treatment Aciclovir is e?ective both topically as cream or eye drops or orally. In severe systemic infections it can be given intravenously.... herpes simplex

A related condition, congenital hypertrophic pyloric stenosis, occurs in babies (commonly boys) about 3–5 weeks old, and surgery produces a complete cure.... pyloric stenosis

Saline is also given orally to severely dehydrated children or adults suffering from diarrhoea and, in particular, CHOLERA.... saline

The principal function of saliva is to aid in the initial processes of digestion, and it is essential for the process of mastication (chewing), whereby food is reduced to an homogeneous mass before being swallowed. In addition, the ptyalin in the saliva initiates the digestion of starch in the food.

An excessive ?ow of saliva known as salivation occurs as the result of taking certain drugs. Salivation also occurs as the result of irritation in the mouth – as for instance, in the teething child – and from DYSPEPSIA. De?ciency of saliva is known as XEROSTOMIA.... saliva

Symptoms The period of incubation (i.e. the time elapsing between the reception of infection and the development of symptoms) varies somewhat. In most cases it lasts only two to three days, but in occasional cases the patient may take a week to develop his or her ?rst symptoms. The occurrence of fever is usually short and sharp, with rapid rise of temperature to 40 °C (104 °F), shivering, vomiting, headache, sore throat and marked increase in the rate of the pulse. In young children, CONVULSIONS or DELIRIUM may precede the fever. The rash usually appears within 24 hours of the onset of fever and lasts about a week.

Complications The most common and serious of these is glomerulonephritis (see under KIDNEYS, DISEASES OF), which may arise during any period in the course of the fever, but particularly when DESQUAMATION occurs. Occasionally the patient develops chronic glomerulonephritis. Another complication is infection of the middle ear (otitis media – see under EAR, DISEASES OF). Other disorders affecting the heart and lungs occasionally arise in connection with scarlet fever, the chief of these being ENDOCARDITIS, which may lay the foundation of valvular disease of the heart later in life. ARTHRITIS may produce swelling and pain in the smaller rather than in the larger joints; this complication usually occurs in the second week of illness. Scarlet fever, which is now a mild disease in most patients, should be treated with PENICILLIN.... scarlet fever

Causes There is an inherited element: parents, children or siblings of schizophrenic sufferers have a one in ten chance of developing the disorder; a twin has a 50 per cent chance if the other twin has schizophrenia. Some BRAIN disorders such as temporal lobe EPILEPSY, tumours and ENCEPHALITIS seem to be linked with schizophrenia. Certain drugs – for example, AMPHETAMINES – can precipitate schizophrenia and DOPAMINE-blocking drugs often relieve schizophrenic symptoms. Stress may worsen schizophrenia and recreational drugs may trigger an attack.

Symptoms These usually develop gradually until the individual’s behaviour becomes so distrubing or debilitating that work, relationships and basic activities such as eating and sleeping are interrupted. The patient may have disturbed perception with auditory HALLUCINATIONS, illogical thought-processes and DELUSIONS; low-key emotions (‘?at affect’); a sense of being invaded or controlled by outside forces; a lack of INSIGHT and inability to acknowledge reality; lethargy and/or agitation; a disrespect for personal appearance and hygiene; and a tendency to act strangely. Violence is rare although some sufferers commit violent acts which they believe their ‘inner voices’ have commanded.

Relatives and friends may try to cope with the affected person at home, but as severe episodes may last several months and require regular administration of powerful drugs – patients are not always good at taking their medication

– hospital admission may be necessary.

Treatment So far there is no cure for schizophrenia. Since the 1950s, however, a group of drugs called antipsychotics – also described as NEUROLEPTICS or major tranquillisers – have relieved ?orid symptoms such as thought disorder, hallucinations and delusions as well as preventing relapses, thus allowing many people to leave psychiatric hospitals and live more independently outside. Only some of these drugs have a tranquillising e?ect, but their sedative properties can calm patients with an acute attack. CHLORPROMAZINE is one such drug and is commonly used when treatment starts or to deal with an emergency. Halperidol, tri?uoperazine and pimozide are other drugs in the group; these have less sedative effects so are useful in treating those whose prominent symptoms are apathy and lethargy.

The antipsychotics’ mode of action is by blocking the activity of DOPAMINE, the chemical messenger in the brain that is faulty in schizophrenia. The drugs quicken the onset and prolong the remission of the disorder, and it is very important that patients take them inde?nitely. This is easier to ensure when a patient is in hospital or in a stable domestic environment.

CLOZAPINE – a newer, atypical antipsychotic drug – is used for treating schizophrenic patients unresponsive to, or intolerant of, conventional antipsychotics. It may cause AGRANULOCYTOSIS and use is con?ned to patients registered with the Clorazil (the drug’s registered name) Patient Monitoring Service. Amisulpride, olanzapine, quetiapine, risperidone, sertindole and zotepine are other antipsychotic drugs described as ‘atypical’ by the British National Formulary; they may be better tolerated than other antipsychotics, and their varying properties mean that they can be targeted at patients with a particular grouping of symptoms. They should, however, be used with caution.

The welcome long-term shift of mentally ill patients from large hospitals to community care (often in small units) has, because of a lack of resources, led to some schizophrenic patients not being properly supervised with the result that they fail to take their medication regularly. This leads to a recurrence of symptoms and there have been occasional episodes of such patients in community care becoming a danger to themselves and to the public.

The antipsychotic drugs are powerful agents and have a range of potentially troubling side-effects. These include blurred vision, constipation, dizziness, dry mouth, limb restlessness, shaking, sti?ness, weight gain, and in the long term, TARDIVE DYSKINESIA (abnormal movements and walking) which affects about 20 per cent of those under treatment. Some drugs can be given by long-term depot injection: these include compounds of ?upenthixol, zuclopenthixol and haloperidol.

Prognosis About 25 per cent of sufferers recover fully from their ?rst attack. Another 25 per cent are disabled by chronic schizophrenia, never recover and are unable to live independently. The remainder are between these extremes. There is a high risk of suicide.... schizophrenia

Habitat: Indigenous to the United States, the plant is also found in England on the banks of streams and in wet ditches.

Individuals with dementia suffer a gradual deterioration of memory and of the ability to grasp what is happening around them. They often cover up their early failings and the condition may ?rst become apparent as a result of emotional outbursts or uncharacteristic behaviour in public. Eventually personal habits and speech deteriorate and they become thoroughly confused and di?cult to look after. Treatment is primarily a matter of ameliorating the symptoms, coupled with a sympathetic handling of the sufferer and the relatives. Admission to hospital or nursing home may be necessary if relatives are unable to look after the patient at home. (See also MEDICINE OF THE AGEING.)... senile dementia

Serum is a clear, yellowish ?uid containing around 7 per cent proteins and globulins, small quantities of salts, fat, sugar, urea, and uric acid, and even smaller quantities of immunoglobulins, essential in the prevention of disease (see IMMUNITY; IMMUNOLOGY). The serum given in the commonly used vaccines is generally derived from horses’ blood, after they have been subjected to a long course of treatment.... serum

Shoulder-blade or scapula. A ?at bone, about as large as the ?at hand and ?ngers, placed on the upper and back part of the With the arm hanging by the side, the scapula extends from the second to the seventh rib, but, as the arm is raised and lowered, it slides freely over the back of the chest. On the rear surface of the bone is a strong process, the spine of the scapula. This arches upwards and forwards into the acromion process. The latter forms the bony prominence on the top of the shoulder, where it unites in a joint with the outer end of the clavicle.... shoulder

The incidence of silicosis is steadily being reduced by various measures which diminish the risk of inhaling silica dust. These include adequate ventilation to draw o? the dust; the suppression of dust by the use of water; the wearing of respirators where the risk is particularly great and it is not possible to reduce the amount of dust – for example, in sand-blasting; and periodic medical examination of work-people exposed to risk. Fewer than 100 new cases a year are diagnosed now in the United Kingdom. (See also OCCUPATIONAL HEALTH, MEDICINE AND DISEASES.)... silicosis

Arrangement of the bones In childhood, the bones are independent, gradually fusing together by sutures, and in old age fusing completely so that the cranium forms a solid bony case. At the time of birth the growth of several bones of the infant’s head has not been quite completed, so that six soft spots, or fontanellas, present; here the brain is covered only by skin and membranes, and the pulsations of its blood vessels may be seen. One of these spots, the anterior fontanelle, does not close completely until the child is 18 months to 2••• years old.

Parts of the skull The cranium, enclosing the brain, consists of eight bones, while the face, which forms a bony framework for the eyes, nose and mouth, consists of 14 bones. These two parts can be detached.

Shape of the skull The development of large central hemispheres of the brain in humans has in?uenced the skull shape. Unlike in other mammals, the cranium extends above as well as behind the face which therefore looks forwards. The skull’s proportions change with age: the cranium in children is larger in comparison with the face – one-eighth of the whole head – than is the case in adults, where sizes are about the same. Old age reduces the size of the face because of the loss of teeth and absorption of their bony sockets. Women’s skulls tend to be lighter and smoother with less obvious protuberances than those in men.... skull

Non-rapid-eye-movement (NREM) sleep This is subdivided into four stages, of which stage 1 is the lightest and stage 4 the deepest. The activity of the cerebral cortex (see BRAIN) is diminished and the body’s functions are mainly regulated by brain-stem activity. The metabolic rate is reduced; in keeping with this the temperature falls, respiration is reduced, cardiac output, heart rate, and blood pressure fall, and activity of the sympathetic nervous system is reduced. NREM sleep normally occurs at the onset of sleep except in neonates. During adult life, the duration – particularly of stages 3 and 4 – of NREM sleep becomes less, and very little of this deep sleep occurs after the age of 60 years.

NREM sleep has been thought to have several functions, such as energy conservation and growth. Growth hormone is produced in bursts during stages 3 and 4, and more cell division occurs during this type of sleep than during wakefulness. A controversial proposal has been that processing of information acquired during wakefulness occurs during NREM sleep.... sleep

Treatment therefore consists of the removal of any of these causes of mouth-breathing that may be present. Should this not succeed in preventing snoring, then measures should be taken to prevent the sufferer from sleeping lying on his or her back, as this is a habit strongly conducive to snoring. Simple measures include sleeping with several pillows, so that the head is raised quite considerably when asleep; alternatively, a small pillow may be put under the nape of the neck. If all these measures fail it may be worth trying the traditional method of sewing a hairbrush, or some other hard object such as a stone, into the back of the snorer’s pyjamas. Thus, if they turn on their back, they are quickly awakened. (See also STERTOR.)... snoring

Sodium carbonate, commonly known as soda or washing soda, has a powerful softening action upon the tissues.

Sodium bicarbonate, or baking soda, is used as an antacid (see ANTACIDS) in relieving indigestion associated with increased acidity of the gastric secretion.

The citrate and the acetate of sodium are used as DIURETICS.... sodium

Sodium valproate has widespread metabolic effects and may have dose-related side-effects. There has been concern over severe hepatic or pancreatic toxicity, but such adverse effects are rare. Other adverse effects include digestive upsets, drowsiness, muscle incoordination and skin rashes. Rare reports have been given of behavioural disturbances, with occasional aggression. Initiation and withdrawal of treatment should always be slow. Patients should reduce their alcohol intake; any other drugs they are taking that are metabolised by the liver should be carefully monitored.... sodium valproate

While mercury sphygmomanometers are simple, accurate and easily serviced, there is concern about possible mercury toxicity for users, those servicing the devices and the environment. Use of them has already been banned in some European hospitals. Although it may be a few years before they are widely replaced, automated blood-pressure-measuring devices will increasingly be in routine use. A wide variety of ambulatory blood-pressuremeasuring devices are already available and may be ?tted in general practice or hospital settings, where the patient is advised on the technique. Blood-pressure readings can be taken half-hourly – or more often, if required – with little disturbance of the patient’s daily activities or sleep. (See also BLOOD PRESSURE; HYPERTENSION.)... sphygmomanometer

Habitat: U.s.a

Action: Alterative, diaphoretic.

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

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

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

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

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

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

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

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

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

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

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

Causes Tropical sprue is thought to be due to an inborn error of metabolism, characterised primarily by an inability to absorb fats from the intestines. Its epidemiological pattern suggests that an infection such as DYSENTERY may be the precipitating factor. Subsequently there is interference with the absorption of carbohydrates, vitamins, and minerals, leading to anaemia and HYPOCALCAEMIA.

Symptoms Of gradual or rapid onset, there is initial weakness, soreness of the tongue, dif?culty swallowing, indigestion, diarrhoea and poor appetite. Anaemia is typically macrocytic, and mild HYPOGLYCAEMIA may occur. Untreated, the patient steadily loses weight and, unless appropriate treatment is started early, death may be expected because of exhaustion and some intercurrent infection.

Treatment This consists of bed rest, a high-protein diet (initially skimmed milk), and treatment of the anaemia and any other de?ciencies present. Minimum fat should be given to sufferers, who should also take folic acid and cyanocobalamin for the anaemia; large vitamin-B-complex supplements (such as Marmite®) are helpful. Vitamins A and D, together with calcium supplements, help to raise the concentration of calcium in the blood. A long convalescence is often required, which may lead to marked depression, and patients should be sent home to a temperate climate.

Non-tropical sprue is the result of GLUTEN hypersensitivty and is treated with a gluten-free diet.... sprue

– an early graded return to activity gives the best long-term results, but doing too much too soon runs the risk of exacerbating the original injury.

Chronic (overuse) injuries affecting the bones (see BONE), tendons (see TENDON) or BURSAE of the JOINTS are common in many sports. Examples include chronic INFLAMMATION of the common extensor tendon where it

attaches to the later EPICONDYLE of the humerus – common in throwers and racquet sportspeople – and stress fractures of the TIBIA or METATARSAL BONES of the foot in runners. After an initial period of rest, management often involves coaching that enables the athlete to perform the repetitive movement in a less injury-susceptible manner.

Exercise physiology is the science of measuring athletic performance and physical ?tness for exercise. This knowledge is applied to devising and supervising training regimens based on scienti?c principles. Physical ?tness depends upon the rate at which the body can deliver oxygen to the muscles, known as the VO2max, which is technically di?cult to measure. The PULSE rate during and after a bout of exercise serves as a good proxy of this measurement.

Regulation of sport Sports medicine’s role is to minimise hazards for participants by, for example, framing rule-changes which forbid collapsing the scrum, which has reduced the risk of neck injury in rugby; and in the detection of the use of drugs taken to enhance athletic performance. Such attempts to gain an edge in competition undermine the sporting ideal and are banned by leading sports regulatory bodies. The Olympic Movement Anti-Doping Code lists prohibited substances and methods that could be used to enhance performance. These include some prohibited in certain circumstances as well as those completely banned. The latter include:

stimulants such as AMPHETAMINES, bromantan, ca?eine, carphedon, COCAINE, EPHEDRINE and certain beta-2 agonists.

NARCOTICS such as DIAMORPHINE (heroin), MORPHINE, METHADONE HYDROCHLORIDE and PETHIDINE HYDROCHLORIDE.

ANABOLIC STEROIDS such as methandione, NANDROLONE, stanazol, TESTOSTERONE, clenbuterol, androstenedone and certain beta-2 agonists.

peptide HORMONES, mimetics and analogues such as GROWTH HORMONE, CORTICOTROPHIN, CHORIONIC GONADOTROPHIC HORMONE, pituitary and synthetic GONADOTROPHINS, ERYTHROPOIETIN and INSULIN. (The list produced above is not comprehen

sive: full details are available from the governing bodies of relevant sports.) Among banned methods are blood doping (pre-competition administration of an athlete’s own previously provided and stored blood), administration of arti?cial oxygen carriers or plasma expanders. Also forbidden is any pharmacological, chemical or physical manipulation to affect the results of authorised testing.

Drug use can be detected by analysis of the URINE, but testing only at the time of competition is unlikely to detect drug use designed to enhance early-season training; hence random testing of competitive athletes is also used.

The increasing professionalism and competitiveness (among amateurs and juveniles as well as professionals) in sports sometimes results in pressures on participants to get ?t quickly after injury or illness. This can lead to

players returning to their activity before they are properly ?t – sometimes by using physical or pharmaceutical aids. This practice can adversely affect their long-term physical capabilities and perhaps their general health.... sports medicine

Habitat: Grown near the sea coast in Sicily and Malta.

Action: Expectorant, emetic.

Squints may be convergent (where one eye ‘turns in’) or divergent (one eye ‘turns out’). Vertical squints can also occur but are less common. All squints should be seen by an eye specialist as soon as possible. Some squints can be corrected by exercises or spectacles; others require surgery.... squint

Idiopathic stammering begins at some time between the onset of speech and puberty, mostly between 2–5 years of age. Acquired stammering at a later age due to brain damage is rare. The prevalence of stammering (the percentage of the population actually stammering at any point in time) is approximately 0·9 per cent. Three times as many boys as girls stammer. About 70 per cent of stammering children recover with little or no therapy. Stammerers have not been shown to demonstrate di?erences in personality from non-stammerers; there are, however, indications that at least some stammerers show minimal di?erences from ?uent speakers in cerebral processing of verbal material.

There is a genetic predisposition towards stammering. The risk of stammering among ?rst-degree relatives of stammerers is more than three times the population risk. In 77 per cent of identical twins, either both stammer or both are ?uent. Only 33 per cent of non-identical twins agree in this way. As there are identical twins who di?er for stammering, environmental factors must be important for some stammerers. There are relatively large numbers of stammerers in highly competitive societies, where status and prestige are important and high standards of speech competence are valued.

Di?erent treatments have been demonstrated to produce considerable bene?t, their basic outline being similar. A long period of time is spent in training stammerers to speak in a di?erent way (?uency-shaping techniques). This may include slowing down the rate of speech, gentle onset of utterance, continuous ?ow with correct juncturing, etc. When the targets have been achieved within the clinic, a series of planned speech assignments outside the clinic is undertaken. In these assignments, and initially in everyday situations, the ?uency-enchancing techniques have to be used conscientiously. Gradually speech is shaped towards normality requiring less and less e?ort. Therapy may also include some work on attitude change (i.e. helping the client to see him or herself as a ?uent speaker) and possibly general communicative skills training.

For information about organisations concerned with stammering, see Appendix 2.... stammering

Starch is converted into sugar when treated with heat in presence of a dilute acid. It is changed largely into dextrin when exposed to a considerable degree of dry heat, as in toasting bread; and a similar change into dextrin and malt-sugar takes place under the action of various enzymes (see ENZYME) such as the PTYALIN of the SALIVA. Starch forms a chief constituent of the carbohydrate foods (see DIET); and in the process of digestion, the above-mentioned change takes place to prepare it for absorption. It is also slowly broken down in the process of cooking.

Starch is used as a constituent of dusting powders for application to chafed or irritable areas of the skin.... starch

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

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

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

Patients with stomas often ?nd explanatory booklets helpful: Living with your Colostomy and Understanding Colostomy are examples. They are published by the British Colostomy Association.... stoma

Function As well as the stomach’s prime role in physically and physiologically breaking down the food delivered via the oesophagus, it also acts as a storage organ – a function that enables people to eat three or four times a day instead of every 30 minutes or so as their metabolic needs would otherwise demand. Gastric secretion is stimulated by the sight and smell of food and its subsequent arrival in the stomach. The secretions, which contain mucus and hydrochloric acid (the latter produced by parietal cells), sterilise the food; pepsin, a digestive ENZYME in the gastric juices, breaks down the protein in food. The juices also contain intrinsic factor, vital for the absorption of vitamin B12 when the chyle – as the stomach contents are called – reaches the intestine. This chyle is of creamy consistency and is the end product of enzymic action and rhythmic contractions of the stomach’s muscles every 30 seconds or so. Food remains in the stomach for varying lengths of time depending upon its quantity and nature. At regular intervals a bolus of chyle is forced into the duodenum by contractions of the stomach muscles coordinated with relaxation of the pyloric sphincter.... stomach

Strangulation of a person’s neck, either with a ligature or with the hands, obstructs the jugular veins in the neck, preventing the normal out?ow of blood from the brain and head. The TRACHEA is also compressed, cutting o? the supply of air to the lungs. The combination of these effects leads to HYPOXIA and damage to the brain. If not quickly relieved, unconsciousness and death follow. Strangulation may be deliberate or accidental – the latter being a particular hazard for children, for example, when playing with a rope. Removal of the constriction, arti?cial respiration, and medical attention are urgently necessary.... strangulation

One of the AMINOGLYCOSIDES, streptomycin has two disadvantages. The most important of these is the tendency of organisms to become resistant to it. This means that the administration of this antibiotic must be carefully supervised to ensure that correct dosage is being used. The other disadvantage is that streptomycin produces toxic effects, especially disturbance of the vestibular and hearing apparatus. This may result in DEAFNESS, VERTIGO, and TINNITUS. Whilst in many cases these toxic manifestations disappear when the antibiotic is withdrawn, they may be permanent. For this reason therefore streptomycin must always be used with special care.... streptomycin

Stress prompts the body to raise its output of HORMONES such as ADRENALINE and CORTISOL, causing changes in blood pressure, heart rate and metabolism. These are physiological responses intended to improve a person’s physical and mental performance – the ‘?ght or ?ight’ reaction to fear. Stress may, however, disrupt the ability to cope. Constant or recurrent exposure to stress may produce symptoms such as anxiety, depression, headaches, indigestion, diarrhoea, palpitations and general malaise (see POST-TRAUMATIC STRESS DISORDER (PTSD)). Treatment can be di?cult and prolonged; counselling can help as can ANXIOLYTICS or ANTIDEPRESSANT DRUGS – but a change in job or lifestyle may be necessary in some circumstances.... stress

Causes Blood supply to the brain may be interrupted by arteries furring up with ATHEROSCLEROSIS (which is accelerated by HYPERTENSION and DIABETES MELLITUS, both of which are associated with a higher incidence of strokes) or being occluded by blood clots arising from distant organs such as infected heart valves or larger clots in the heart (see BLOOD CLOT; THROMBOSIS). Hearts with an irregular rhythm are especially prone to develop clots. Patients with thick or viscous blood, clotting disorders or those with in?amed arteries – for example, in SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) – are particularly in danger of having strokes. Bleeding into the brain arises from areas of weakened blood vessels, many of which may be congenital.

Symptoms Minor episodes due to temporary lack of blood supply and oxygen (called TRANSIENT ISCHAEMIC ATTACKS OR EPISODES (TIA, TIE)) are manifested by short-lived weakness or numbness in an arm or leg and may precede a major stroke. Strokes cause sudden weakness or complete paralysis of the muscles controlled by the part of the brain affected, as well as sensory changes (e.g. numbness or tingling). In the worst cases these symptoms and signs may be accompanied by loss of consciousness. If the stroke affects the area of the brain controlling the larynx and throat, the patient may suffer slurring or loss of speech with di?culty in initiating swallowing. When the face is involved, the mouth may droop and the patient dribble. Strokes caused by haemorrhage may be preceded by headaches. Rarely, CVAs are complicated by epileptic ?ts (see EPILEPSY). If, on the other hand, numerous small clots develop in the brain rather than one major event, this may manifest itself as a gradual deterioration in the patient’s mental function, leading to DEMENTIA.

Investigations Tests on the heart or COMPUTED TOMOGRAPHY or ultrasonic scans (see ULTRASOUND) on arteries in the neck may indicate the original sites of distantly arising clots. Blood tests may show increased thickness or tendency to clotting, and the diagnosis of general medical conditions can explain the presence of in?amed arteries which are prone to block. Special brain X-rays show the position and size of the damaged brain tissue and can usually distinguish between a clot or infarct and a rupture of and haemorrhage from a blood vessel in the brain.

Management It is better to prevent a stroke than try to cure it. The control of a person’s diabetes or high blood pressure will reduce the risk of a stroke. Treatment with ANTICOAGULANTS prevents the formation of clots; regular small doses of aspirin stop platelets clumping together to form plugs in blood vessels. Both treatments reduce the likelihood of minor transient ischaemic episodes proceeding to a major stroke.

Once the latter has occurred, there is no e?ective treatment to reduce the damage to brain tissue. Function will return to the affected part of the body only if and when the brain recovers and messages are again sent down the appropriate nerves. Simple movements are more likely to recover than delicate ones, and sophisticated functions have the worst outlook. Thus, movement of the thigh may improve more easily than ?ne movements of ?ngers, and any speech impairment is more likely to be permanent. A rehabilitation team can help to compensate for any disabilities the subject may have. Physiotherapists maintain muscle tone and joint ?exibility, whilst waiting for power to return; occupational therapists advise about functional problems and supply equipment to help patients overcome their disabilities; and speech therapists help with diffculties in swallowing, improve the clarity of remaining speech or o?er alternative methods of communication. District nurses or home helps can provide support to those caring for victims of stroke at home. Advice about strokes may be obtained from the Stroke Association.... stroke

Whilst an infected patient is frequently asymptomatic, heavy infection can cause jejunal mucosal abnormalities, and an absorptive defect, with weight loss. During the migratory phase an itchy linear rash (larva currens) may be present on the lower abdomen, buttocks, and groins; this gives rise to recurrent transient itching. In an immunosuppressed individual, the ‘hyperinfection syndrome’ may ensue; migratory larvae invade all organs and tissues, including the lungs and brain. Associated with this widespread infection, the patient may develop an Enterobacteriacae spp. SEPTICAEMIA; this, together with S. stercoralis larvae, produces a MENINGOENCEPHALITIS. There is no evidence that this syndrome is more common in patients with HIV infection.

Diagnosis consists of visualisation of S. stercoralis (larvae or adults) in a jejunal biopsy-section or aspirate. Larvae may also be demonstrable in a faecal sample, especially following culture. Eosinophilia may be present in peripheral blood, during the invasive stage of infection. Chemotherapy consists of albendazole. The formerly used benzimidazole compound, thiabendazole, is now rarely prescribed in an uncomplicated infection due to unpleasant side-effects; even so, in the ‘hyperinfection syndrome’ it probably remains the more e?ective of the two compounds.... strongyloidiasis

Societies vary in the degree to which they tolerate individuals acting intentionally to cause their own death. Apart from among some native peoples, particularly the Innuit, suicide is generally viewed pejoratively in modern societies. Major religious movements, including Catholicism, Judaism and Islam, have traditionally regarded suicide as a sin. Nevertheless, it is a growing phenomenon, particularly among the young, and so has become a serious public health problem. It is estimated that suicide among young people has tripled – at least – during the past 45 years. Worldwide, suicide is the second major cause of death (after tuberculosis) for women between the ages of 15 and 44, and the fourth major killer of men in the same age-group (after tra?c accidents, tuberculosis and violence). The risk of suicide rises sharply in old age. Globally, there are estimated to be between ten and 25 suicide attempts for each completed suicide.

In the United Kingdom, suicide accounts for 20 per cent of all deaths of young people. Around 6,000 suicides are reported annually in the UK, of which approximately 75 per cent are by men. In the late 1990s the suicide rate in England, Wales and Northern Ireland fell, but increased in Scotland and the Republic of Ireland. Attempted suicide became signi?cantly more common, particularly among people under the age of 25: among adolescents in the UK, for example, it is estimated that there are about 19,000 suicide attempts annually. Follow-up studies of teenagers who attempt suicide by an overdose show that up to 11 per cent will succeed in killing themselves over the following few years. In young people, factors linked to suicide and attempted suicide include alcohol or drug abuse, unemployment, physical or sexual abuse, and the fact of being in custody. (In the mid-1990s, 20 per cent of all prison suicides were by people under 21.)

Apart from the young, those at highest risk of dying by suicide include health professionals, pharmacists, vets and farmers. Self-poisoning (see POISONS) is the common method used by health professionals for whom high stress levels, together with relatively easy access to means, are important factors. The World Health Organisation has outlined six basic steps for the prevention of suicide, focusing particularly on reducing the availability of common methods. Although suicide is not a criminal o?ence in the UK, assisting suicide is a crime carrying a potential sentence of 14 years’ imprisonment. There are several dilemmas faced by health professionals if they believe that a patient is considering suicide: one is that the provision of information to the patient may make them an accessory (see below). A dilemma after suicide is the common demand from insurers for medical information, although, ethically, the duty of con?dentiality extends beyond the patient’s death (see ETHICS). (Legally, some disclosure is permitted to those with a claim arising from the patient’s death.) Life-insurance contracts generally render invalid any claim by the heirs on the policy of an individual who commits suicide, so that disclosure by a doctor often creates tensions with the relatives. Non-disclosure of relevant medical information, however, may result in a fraudulent insurance claim being made.

Physician-assisted suicide Although controversial, a special legal exemption applies to doctors in a few countries who assist terminally ill patients to kill themselves. Oregon in the United States legalised physician-assisted suicide in 1997, where it still occurs; assisted suicide was brie?y legal in the Australian Northern Territory in 1996 but the legislation was repealed. (It is also practised, but not legally authorised, in the Netherlands and Switzerland.)

In the UK there have been unsuccessful parliamentary attempts to legalise assisted suicide, such as the 1997 Doctor Assisted Dying Bill. In law, a distinction is made between killing people with their consent (classi?ed as murder) and assisting them to commit suicide (a statutory o?ence under the Suicide Act 1961). The distinction is between acting as a perpetrator and as an accessory. Doctors may be judged to have aided and abetted a suicide if they knowingly provide the means – or even if they simply provide advice about the toxicity of medication and tell patients the lethal dosage. Some argue that the distinction between EUTHANASIA and physician-assisted suicide has no moral or practical relevance, particularly if patients are too disabled to act themselves. In theory, patients retain ultimate control in cases of assisted suicide, whereas control rests with the doctor in euthanasia. Surveys of health professionals appear to indicate a feeling by some that less responsibility or culpability attaches to assisting suicide than to euthanasia. In a recent UK court case (2002), a judge declared that a mentally alert woman on a permanent life-support regime in hospital had a right to ask for the support system to be switched o?. (See also MENTAL ILLNESS.)... suicide

It takes up to 15 years to train a surgeon from the time at which he or she enters medical school; after graduating as a doctor a surgeon has to pass a comprehensive two-stage examination to become a fellow of one of the ?ve recognised colleges of surgeons in the UK and Ireland.

Surgery is carried out in specially designed operating theatres. Whereas it used to necessitate days and sometimes weeks of inpatient hospital care, many patients are now treated as day patients, often under local anaesthesia, being admitted in the morning and discharged later in the day.

More complex surgery, such as transplantation and neurosurgery, usually necessitates patients being nursed post-operatively in high-dependency units (see INTENSIVE THERAPY UNIT (ITU)) before being transferred to ordinary recovery wards. Successful surgery requires close co-operation between surgeons, physicians and radiologists as well as anaesthetists (see ANAESTHESIA), whose sophisticated techniques enable surgeons to undertake long and complex operations that were unthinkable 30 or more years ago. Surgical treatment of cancers is usually done in collaboration with oncologists. Successful surgery is also dependent on the skills of supporting sta? comprising nurses and operating-theatre technicians and the availability of up-to-date facilities.... surgery

– include catgut, Vicryl® and Dexon®. Nonabsorbable sutures include silk, nylon and prolene. The type used and time of suture-removal depend upon the site and general state of the patient. Those patients on steroids who have a malignant or infective disorder heal slowly, and their sutures may need to stay in for 14 days or more instead of the usual 5–8 days.... suture

Syncope can also result when the venous return to the heart is impaired as a result of a rise in intrathoracic pressure. This may happen after prolonged vigorous coughing – the so-called COUGH SYNCOPE – or when elderly men with prostatic hypertrophy strain to empty their bladder. This is known as micturition syncope. Syncope is particularly likely to occur when the arterial blood pressure is unusually low. This may result from overtreatment of HYPERTENSION with drugs or it may be the result of diseases, such as ADDISON’S DISEASE, which are associated with low blood pressures. It is important that syncope be distinguished from EPILEPSY.... syncope

Traveller’s diarrhoea is an all-toocommon a?iction of the traveller, which basks in a multiplicity of names: for example, Aden gut, Aztec two-step, Basra belly, Delhi belly, Gippy tummy, Hong Kong dog, Montezuma’s revenge, Tokyo trots, turista. It is caused by a variety of micro-organisms, usually E. coli. Some people seem to be more prone to it than others, although for no good cause. Obvious preventive measures include the avoidance of salads, unpeeled fruit and ice cream, and never drinking unboiled or unbottled water. If diarrhoea occurs, co-phenotrope and loperamide are often used to reduce the frequency of bowel movements in adults. Prophylactic antibacterial drugs are not advisable.... travel sickness

Characteristic white streaks appear on the optic fundi (see EYE). Molecular genetic testing can identify up to 90 per cent of individuals with a tuberin gene. Genetic counselling of families is helpful. Relatives of those with this condition can obtain help and guidance from the Tuberous Sclerosis Association of Great Britain.... tuberous sclerosis

MOTH REPELLENT. Sew into small linen bags any of the following: Cinnamon, Sandalwood chips, Camphor, Cloves. Add: sprinkle of Cedarwood for greater potency. MOTHER SEIGEL’S SYRUP. See: SHAKERS, The. ... morning sickness

Scrapie. Notifiable disease. Fatal disease in the nervous system of cattle, unknown before 1985. Microscopic holes appear in the brain giving a spongiform appearance, but with little inflammation. Can spread from one animal to another: sheep, goats, deer, mules, mink, hamsters, mice, pigs and monkeys. Cause: not a virus. Animals itch and scrape themselves against trees or posts for relief. May spread from animals to humans, with brain infection after the character of polio.

Symptoms. (Human). Speech impairment, short-term-memory-loss, difficulty in controlling body movements. Zinc deficiency.

Treatment. Hospitalisation.

Suggested treatment for human infection, unproven.

Tinctures. Echinacea 5; Black Cohosh 3; Yarrow 2; Senna leaf 1.2-3 teaspoons in water (or cup hot Yarrow tea) 3-4 times daily. For headache: Gelsemium.

Supplement: Zinc.

To be treated by a general medical practitioner or hospital specialist. ... bovine spongiform encephalopathy

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

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

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

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

Differential diagnosis: gallstones, menstrual difficulties, kidney stone.

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

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

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

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

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

Traditional German combination. Ginger, Gentian, Turkey Rhubarb.

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

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

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

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

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

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

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

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

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

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

Cases of Down’s have followed use of nonoxynol-9 (vaginal contraceptive device) such as the polyurethane sponge. The sponge. when left in situ for a long time, may cause Down’s to follow.

Certain physical characteristics are present. The most important feature is impaired mental development. Almost all are coeliacs.

Symptoms. Low IQ, short fingers, small flat head, flattened nose, low-set ears. May be subject to umbilical hernia, and heart disease. No treatment can cure, but certain herb teas rich in minerals (Alfalfa, Red Clover) together with Kelp (either in tablet or powder form) may help children, with possible improvements in IQ. Vitamin supplements – A, D, Thiamine, Riboflavin, B6, B12, C and E improve a child’s physical and mental health – as do also the minerals: Magnesium, Calcium, Zinc, Manganese, Copper, Iron and Iodine.

Children with Down’s syndrome run an increased risk of coeliac disease, due to disturbed immunity. A substantial evidence is held in America that links a low level of Selenium in the mother. Unnecessary X- rays should be avoided. Ensure fitness before conception by gentle exercise and nutrients: Folic Acid, Selenium and Zinc.

Children with the condition are noted for their happy disposition and warmth of feeling towards others. ... down’s syndrome

Diagnosis is difficult to the inexperienced practitioner. Referral to a dermatologist for skin biopsy. Homosexuals are at risk from semen ejaculated into a foreign environment. The blood abnormality extends to the lymph system for which Lymphatics such as Echinacea, Saw Palmetto and Poke root are indicated. See: AIDS.

Treatment by a general medical practitioner or hospital specialist. ... kaposi’s sarcoma

Lymph fluid, loaded with waste, excess protein, etc, is sucked into the lymph tubes to be filtered by the spleen and the lymph nodes. The tubes are filled with countless one-way valves referred to collectively as the lymphatic pump, which propels the flow of lymph forwards. Lymph ultimately is collected in the main thoracic duct rising upwards in front of the spine to enter the bloodstream at the base of the neck.

A number of disorders may arise when the fluid becomes over-burdened by toxaemia, poor drainage and enlarged nodes (glands). Such un-eliminated wastes form cellulite – unwanted tissue formation and swelling. Thus, the soil may be prepared for various chronic illnesses from glandular disorders to arthritis. If the lymph is circulating freely it is almost impossible to become sick.

This system is capable of ingesting foreign particles and building up an immunity against future infection. Some herbal Lymphatics are also antimicrobials, natural alternatives to conventional antibiotics.

Treatment. Clivers is particularly relative to glandular swellings of neck and axillae.

For active inflammation: Echinacea, Goldenseal, Ginseng (Panax).

Alternatives. Teas: Clivers, Red Clover, Agnus Castus herb, Bladderwrack, Violet leaves, Marigold petals.

Decoctions: Blue Flag, Echinacea, Fenugreek seeds, Saw Palmetto.

Tablets/capsules. Agnus Castus, Echinacea, Bladderwrack, Red Clover, Thuja, Poke root, Fenugreek. Formula No 1. Echinacea 2; Clivers 1; Burdock 1; Poke root half. Dose: Liquid Extracts: one 5ml teaspoon. Tinctures: two 5ml teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily.

Formula No 2. Equal parts: Blue Flag root, Poke root, Senna. Dose: as above.

Topical. Poultices: Slippery Elm, Fenugreek seeds, Marshmallow. Horsechestnut (Aesculus) ointment. ... lymphatic system

Features: long fingers and arm span, high palate, kyphosis, etc.

Symptoms. Backache, pain in joints, dislocations.

Alternatives. Alfalfa, Fenugreek, Irish Moss, Kelp, Horsetail, Marshmallow, Bamboo gum.

Teas. Alfalfa, Comfrey leaves, Horsetail, Plantain, Silverweed. Any one: 1 heaped teaspoon to each cup boiling water; infuse 10-15 minutes. 1 cup thrice daily.

Decoction. Fenugreek seeds 2; Horsetail 1; Bladderwrack 1; Liquorice half. Prepare: 3 heaped teaspoons to 1 pint (500ml) water gently simmered 10 to 20 minutes. 1 wineglass thrice daily. Fenugreek seeds decoction.

Diet. High protein, oily fish.

Supplements. Calcium, Dolomite, Zinc. ... marfan’s syndrome

Cup of Chamomile, Balm, or Meadowsweet tea. Liquorice helpful, but most popular is Ginger taken in the form of Ginger wine, or powdered root (quarter to half a teaspoon). Chrystalised Ginger from sweetshop is one of the safest and cheapest: 2-3 pieces sucked or chewed half hour before journey and at intervals thereafter.

Avoid tobacco which reduces oxygen count. Potter’s Ginger root capsules.

Peppermint. Before travelling, glass water with 2 drops.

Aromatherapy. Inhalant. 2-3 drops Peppermint oil on tissue.

Diet. No alcohol or fatty foods. Accept Papaya fruit, Lemons or Lemon juice, Honey, Acidophilus. Supplements. Alternatives to the above. Seven days before journey: B-complex, magnesium 200mg, calcium 400mg. ... motion sickness

Anabolic steroids have been used to stimulate protein anabolism in debilitating illness, and to promote growth in children with pituitary dwar?sm and other disorders associated with interference of growth. Stimulation of protein anabolism may also be of value in acute renal failure, and the retention of nitrogen and calcium is of probable bene?t to patients with OSTEOPOROSIS and to patients receiving corticosteroid therapy. Anabolic steroids may stimulate bone-marrow function in hypoplastic ANAEMIA.

They have been widely abused by athletes and body-builders aiming to improve their strength, stamina, speed or body size. However, there are considerable doubts over their e?cacy, with little experimental evidence that they work. Dangerous adverse effects include precocious myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis), DIABETES MELLITUS, liver disease, precocious carcinoma of the prostate, acne, and severe psychiatric disorders. Anabolic steroids should not be used by athletes, who face bans from o?cial competitions if they take them.

The anabolic steroids in therapeutic use include nandrolone and stanozolol.... anabolic steroids

Sudden death sometimes occurs in infants, usually in the ?rst year of life: this is called SUDDEN INFANT DEATH SYNDROME (SIDS) or, colloquially, cot death, the possible causes of which are an ongoing subject for research and debate.

When a person dies unexpectedly the event must be reported to a CORONER, who has the power to decide whether an AUTOPSY is necessary.... death, sudden

Genetic screening is proving to be a controversial subject. Arguments are developing over whether the results of such screenings should be made available to employers and insurance companies – a move that could have adverse consequences for some individuals with potentially harmful genetic make-ups. (See GENES; GENETIC DISORDERS.)... genetic screening

Habitat: This valuable plant appears, according to Coffin, to have been first discovered and used by the aborigines of North America. It is indigenous to that part of the world.

Action: Tonic, alterative, and laxative.

The death rate is 2–10 per cent and the majority of patients survive without renal failure. The longer the period of OLIGURIA, the greater the risk of chronic renal failure.

Treatment is supportive, with replacement of blood and clotting factors, control of HYPERTENSION, and careful observation of ?uid balance.... haemolytic uraemic syndrome

Heart transplant Replacement of a person’s unhealthy heart with a normal heart from a healthy donor. The donor’s heart needs to be removed immediately after death and kept chilled in saline before rapid transport to the recipient. Heart transplants are technically demanding operations used to treat patients with progressive untreatable heart disease but whose other body systems are in good shape. They usually have advanced coronary artery disease and damaged heart muscle (CARDIOMYOPATHY). Apart from the technical diffculties of the operation, preventing rejection of the transplanted heart by the recipient’s immune system requires complex drug treatment. But once the patient has passed the immediate postoperative phase, the chances of ?ve-year survival is as high as 80 per cent in some cardiac centres. A key di?culty in doing heart transplants is a serious shortage of donor organs.... heart surgery

HLA incompatibility causes the immune response, or rejection reaction, that occurs with unmatched tissue grafts. Strong associations between HLA and susceptibility to certain diseases – notably the AUTOIMMUNE DISORDERS such as rheumatoid arthritis, insulin-dependent diabetes, and thyrotoxicosis – have been described. Certain HLA antigens occur together more frequently than would be expected by chance (linkage disequilibrium), and may have a protective e?ect, conferring resistance to a disease. (See IMMUNITY.)... hla system

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

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)

The condition is caused by an imbalance between LUTEINISING HORMONE (LH) and FOLLICLE-STIMULATING HORMONE (FSH); this imbalance stops OVULATION and varies the TESTOSTERONE output of the ovaries. The treatment may be with CLOMIPHENE; with a PROGESTOGEN drug; with LUTEINISING HORMONE-RELEASING HORMONE (LHRH); or with oral contraceptives (see under CONTRACEPTION – Non-barrier methods). The treatment chosen depends on the severity of the disease and whether the woman wants to conceive. Rarely a section of ovarian tissue is surgically removed.... polycystic ovary syndrome

Fever, an o?ensive-smelling post-partum vaginal discharge (lochia) and pain in the lower abdomen are the main features. Untreated, the women may develop SALPINGITIS, PERITONITIS and septicaemia. Antibiotics are used to treat the infection and any retained placental tissue must be removed.... puerperal sepsis

Respiratory distress syndrome is a complication of SHOCK, systemic SEPSIS and viral respiratory infections. It was ?rst described in 1967, and – despite advances with assisted ventilation

– remains a serious disease with a mortality of more than 50 per cent. The maintenance of adequate circulating blood volume, peripheral PERFUSION, acid-base balance and arterial oxygenation is important, and assisted ventilation should be instituted early.

In newborns the mechanism is diferent, being provoked by an inability of the lungs to manufacture SURFACTANT.... respiratory distress syndrome

Saffrone, Saffronn, Saffronne, Safron, Safronn, Safronne, Saffronah, Safrona, Safronah, Safrone, Safronna, Safronnah, Saffrona... saffron

Symptoms There are headache, feverishness, general sensations like those of INFLUENZA, flushed face and bloodshot eyes, but no signs of CATARRH. The fever passes off in three days, but the patient may take some time to convalesce.

Treatment As there is no specific remedy, PROPHYLAXIS is important. This consists of the spraying of rooms with an insecticide such as GAMMEXANE; the application of insect repellents such as dimethyl phthalate to the exposed parts of the body (e.g. ankles, wrists and face), particularly at sunset; and the use of sandfly nets at night. Once the infection is acquired, treatment consists of rest in bed, light diet and aspirin and codeine.... sandfly fever

(2) The act of cutting in surgery; for example, an abdominal section is done to explore the abdomen.

(3) The issuing of an order under the United Kingdom’s Mental Health Act to admit someone compulsorily to a psychiatric hospital.... section

Sexual dysfunction may be due to physical or psychiatric disease, or it may be the result of the administration of drugs. The main group of drugs likely to cause sexual problems are the ANTICONVULSANTS, the ANTIHYPERTENSIVE DRUGS, and drugs such as metoclopramide that induce HYPERPROLACTINAEMIA. The benzodiazepine TRANQUILLISERS can reduce libido and cause failure of erection. Tricyclic ANTIDEPRESSANT DRUGS may cause failure of erection and clomipramine may delay or abolish ejaculation by blockade of alpha-adrenergic receptors. The MONOAMINE OXIDASE INHIBITORS (MAOIS) often inhibit ejaculation. The PHENOTHIAZINES reduce sexual desire and arousal and may cause di?culty in maintaining an erection. The antihypertensive drug, methyldopa, causes impotence in over 20 per cent of patients on large doses. The beta-adrenoceptorblockers and the DIURETICS can also cause impotence. The main psychiatric causes of sexual dysfunction include stress, depression and guilt.... sexual dysfunction

Habitat: Throughout India, in moist places.

Action: Plant—used as a supporting drug in pulmonary tuberculosis, nervous diseases and rheumatism. Leaves—applied to swelling as paste. Stem-mucilage—demulcent and emollient. Used internally in skin diseases and as a diuretic and febrifuge.

Structure

CORIUM The foundation layer. It overlies the subcutaneous fat and varies in thickness from 0·5–3.0 mm. Many nerves run through the corium: these have key roles in the sensations of touch, pain and temperature (see NEURON(E)). Blood vessels nourish the skin and are primarily responsible for regulating the body temperature. Hairs are bedded in the corium, piercing the epidermis (see below) to cover the skin in varying amounts in di?erent parts of the body. The sweat glands are also in the corium and their ducts lead to the surface. The ?brous tissue of the corium comprises interlocking white ?brous elastic bundles. The corium contains many folds, especially over joints and on the palms of hands and soles of feet with the epidermis following the contours. These are permanent throughout life and provide unique ?ngerprinting identi?cation. HAIR Each one has a root and shaft, and its varying tone originates from pigment scattered throughout it. Bundles of smooth muscle (arrectores pilorum) are attached to the root and on contraction cause the hair to stand vertical. GLANDS These occur in great numbers in the skin. SEBACEOUS GLANDS secrete a fatty substance and sweat glands a clear watery ?uid (see PERSPIRATION). The former are made up of a bunch of small sacs producing fatty material that reaches the surface via the hair follicle. Around three million sweat or sudoriparous glands occur all over the body surface; sited below the sebaceous glands they are unconnected to the hairs. EPIDERMIS This forms the outer layer of skin and is the cellular layer covering the body surface: it has no blood vessels and its thickness varies from 1 mm on the palms and soles to 0·1 mm on the face. Its outer, impervious, horny layer comprises several thicknesses of ?at cells (pierced only by hairs and sweat-gland openings) that are constantly rubbed o? as small white scales; they are replaced by growing cells from below. The next, clear layer forms a type of membrane below which the granular stratum cells are changing from their origins as keratinocytes in the germinative zone, where ?ne sensory nerves also terminate. The basal layer of the germinative zone contains melanocytes which produce the pigment MELANIN, the cause of skin tanning.

Nail A modi?cation of skin, being analagous to the horny layer, but its cells are harder and more adherent. Under the horny nail is the nail bed, comprising the well-vascularised corium (see above) and the germinative zone. Growth occurs at the nail root at a rate of around 0·5 mm a week – a rate that increases in later years of life.

Skin functions By its ability to control sweating and open or close dermal blood vessels, the skin plays a crucial role in maintaining a constant body temperature. Its toughness protects the body from mechanical injury. The epidermis is a two-way barrier: it prevents the entry of noxious chemicals and microbes, and prevents the loss of body contents, especially water, electrolytes and proteins. It restricts electrical conductivity and to a limited extent protects against ultraviolet radiation.

The Langerhans’ cells in the epidermis are the outposts of the immune system (see IMMUNITY), just as the sensory nerves in the skin are the outposts of the nervous system. Skin has a social function in its ability to signal emotions such as fear or anger. Lastly it has a role in the synthesis of vitamin D.... skin

Action: Emollient, demulcent, pectoral.

Sneezing may be caused by the presence of irritating particles in the nose, such as snu?, or the pollen of grasses and ?owers. It is also an early symptom of colds, INFLUENZA, MEASLES, and HAY FEVER, being then accompanied or followed by running at the nose (RHINITIS).... sneezing

Habitat: Rocky woods in high situations.

Action: Astringent, demulcent.

Dumbness is the inability to pronounce the sounds that make up words. DEAFNESS is the most important cause, being due to a congenital brain defect, or acquired brain disease, such as tertiary SYPHILIS. When hearing is normal or only mildly impaired, dumbness may be due to a structural defect such as tongue-tie or enlarged tonsils and adenoids, or to ine?cient voice control, resulting in lisping or lalling. Increased tension is a common cause of STAMMERING; speech disorders may occasionally be of psychological origin.

Normal speech may be lost in adulthood as a result of a STROKE or head injury. Excessive use of the voice may be an occupational hazard; and throat cancer may require a LARYNGECTOMY, with subsequent help in communication. Severe psychiatric disturbance may be accompanied by impaired social and communication skills. (See also VOICE AND SPEECH.)

Treatment The underlying cause of the problem should be diagnosed as early as possible; psychological and other specialist investigations should be carried out as required, and any physical defect should be repaired. People who are deaf and unable to speak should start training in lip-reading as soon as possible, and special educational methods aimed at acquiring a modulated voice should similarly be started in early childhood – provided by the local authority, and continued as required. Various types of speech therapy or PSYCHOTHERAPY may be appropriate, alone or in conjunction with other treatments, and often the ?nal result may be highly satisfying, with a good command of language and speech being obtained.

Help and advice may be obtained from AFASIC (Unlocking Speech and Language).... speech disorders

Once ejaculated during intercourse the spermatozoon travels at a rate of 1·5–3 millimetres a minute and remains mobile for several days after insemination, but quickly loses its potency for fertilisation. As it takes only about 70 minutes to reach the ovarian end of the uterine tube, it is assumed that there must be factors other than its own mobility, such as contraction of the muscle of the womb and uterine tube, that speed it on its way.... spermatozoon

The human backbone is about 70 cm (28

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

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

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

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

Treatment is of the underlying disease or injury. Mild sti?ness can be treated symptomatically with local warmth and ANALGESICS. PHYSIOTHERAPY is helpful in relieving sti?ness as a result of muscle or joint injuries.... stiffness

Treatment The patient should be kept quiet. Arti?cial respiration may be necessary and intravenous BENZODIAZEPINES to prevent convulsions may also be needed. (See POISONS; also APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)... strychnine

(2) A psychological defence mechanism by which an individual intentionally refuses to acknowledge an idea or memory that he or she ?nds distasteful or unpleasant.

(3) A treatment that stops the visible signs of an illness or holds back its usual progress.... suppression

(2) An agent, for example a drug, that acts with another to produce a result that is greater than adding together the separate effects of the two agents. Synergism in drug treatment may be bene?cial, as in the case of combined LEVODOPA and SELEGILINE, a selective monoamine oxidase inhibitor (see MONOAMINE OXIDASE INHIBITORS (MAOIS), in the treatment of PARKINSONISM. It may be potentially dangerous, however, as when MAOIs boost the effects of BARBITURATES.... synergist

Habitat: Grown in, and imported from, California. Features ? Leaves elliptic-lanceolate, serrate, about three inches by one inch, shiny above, white down underneath. Taste and odour, aromatic. Part used ? Leaves.

Action: Expectorant, tonic. In catarrhal affections of the respiratory organs. Often a constituent of asthma prescriptions.... yerba santa

External: Aloe Vera juice or gel. Comfrey paste: Mix a little powder and water. ... age spots

Teas: any one: Aniseed, Balm, Caraway seeds, Cardamom seeds, Cinnamon bark, Fennel seeds, Dill seeds, Parsley. 1 teaspoon to each cup boiling water; infuse 5-15 minutes; dose half-1 cup freely.

Ginger: powder, crystallised or tincture. Horseradish sauce. Few grains Cayenne pepper. Oil Peppermint: 1-2 drops in honey. ... air swallowing

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

Selenium 50mcg and Vitamin E 400iu are recommended by Jonathan Wright MD, for decreasing the pain of disease, decreasing over 3 months. (Health Update USA, June 1990) ... osgood schlatter disease

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

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

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

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

Intelligence is normal or high.

Asperger’s syndrome is considered to be an autistic spectrum disorder and is also known as pervasive developmental disorder.

Special educational support may be needed, often within mainstream education.

The condition is lifelong.... asperger’s syndrome

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

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

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

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

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

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

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

Preparations: Thrice daily.

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

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

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

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

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

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

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

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

Not taken in pregnancy.

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

The area is not sensitive to light because it has no light receptors (nerve endings responsive to light).

The blind spot can also be used to describe the part of the visual field in which objects cannot be detected.... blind spot

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

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

Symptoms. Swelling of glands of armpit, neck and groin.

Alternatives. Tea: combine equal parts: Clivers, Red Clover, Gotu Kola. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose: half-1 cup thrice daily.

Decoction. Formula. Equal parts, Yellow Dock, Plantain, Clivers, Liquorice root, 1oz to 1 pint water gently simmered 20 minutes. Half a cup thrice daily.

Powders. Formula. Bayberry 1; Echinacea 2; Poke root half; a trace of Cayenne. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Combine equal parts: Poke root and Echinacea. One 5ml teaspoon in water thrice daily.

Poke root. A leading remedy for the condition.

Agnus Castus. Swollen glands in young girls.

Dr Finlay Ellingwood: Liquid Extracts: equal parts, Blue Flag root and Poke root. 30-60 drops in water thrice daily.

Diet. See: DIET – GENERAL. See: LYMPHATICS. ... glands – swollen

Causes: emotional tension, hiatus hernia, food allergy and the damaging potential of hot drinks. Alternatives. Acute case: Cramp bark. German Chamomile tea, freely. Phytomedicines for chronic condition or as preventatives: Passion flower, Skullcap, Wild Yam, Lobelia, Mistletoe, Valerian. Formula. Cramp bark 2; Chamomile 1; Peppermint 1. Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) 3 or more times daily.

Milk. Drink whole glass cold milk, with or without 1 drop oil Peppermint, immediately on onset of pain. May relieve spasms in seconds. ... oesophageal spasm

Causes: injury, scarring by chemical medicines, drugs swallowed with insufficient water, antacids for heartburn, piping-hot tea. It is important to exclude oesophageal cancer.

Those with ‘gullet-reflex’ such as the elderly, are at risk. A relationship exists between toothlessness and this condition. Eating of soft fibreless foods does not expand the tube down which food passes. Alternatives. Horsetail, Irish Moss. Echinacea. Marshmallow. Goldenseal. Sarsaparilla. Calendula (Marigold), Chamomile.

Tea. Formula – equal parts, Horsetail, Chamomile, Marshmallow. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 1 cup thrice daily.

Tablets/capsules. Echinacea, Goldenseal, Sarsaparilla, Chamomile.

Formula. Irish Moss 1; Comfrey 1; Calendula half; Goldenseal quarter. Dose – Liquid extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg (three 00 capsules or half a teaspoon) in water before meals.

Diet. High fibre. Raw carrots with prolonged mastication. Hot drinks are potentially damaging. ... oesophageal stricture

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

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

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

Divers with decompression sickness are immediately placed inside a recompression chamber. Pressure within the chamber is raised, causing the bubbles within the tissues to redissolve. Subsequently, the pressure in the chamber is slowly reduced, allowing the excess gas to escape safely via the lungs. If treated promptly, most divers with the “bends” make a full recovery. In serious, untreated cases, there may be long-term problems, such as paralysis.... decompression sickness

The sarcoma is diagnosed by X-rays and a biopsy.

If cancer is found, the whole skeleton is examined by X-rays and radionuclide scanning, and the lungs viewed by CT scanning, to determine if, and how far, the cancer has spread.

Treatment is with radiotherapy and anticancer drugs.

If the cancer has not spread, the outlook is good.... ewing’s sarcoma

The child may resume normal growth if an underlying chemical abnormality can be corrected. Alternatively, a kidney transplant may be possible.... fanconi’s syndrome

The disorder occurs within families according to an X-linked recessive pattern of inheritance (see genetic disorders).

Although mainly males are affected, women can become carriers of the genetic defect.

In addition to having learning difficulties, affected males tend to be tall and physically strong, with large testes, a prominent nose and jaw, increased ear length, and are prone to epileptic seizures.

About a third of female carriers show some intellectual impairment.

The condition cannot be treated.... fragile x syndrome

It starts in childhood with repetitive grimaces and tics.

Involuntary barks, grunts, or other noises may appear as the disease progresses.

In some cases, the sufferer has episodes of issuing foul language.

The syndrome is more common in males.

It is usually of lifelong duration, but antipsychotic drugs can help in some cases.... gilles de la tourette’s syndrome

Abscesses develop beneath the skin, which becomes reddened and painful and may ooze pus.

The condition tends to be recurrent and can eventually cause scarring in the affected areas.

Antibiotic drugs may help to reduce the severity of an outbreak.... hidradenitis suppurativa

Affected children may appear normal at birth but, at 6–12 months of age, they develop cardiac abnormalities, umbilical hernia, skeletal deformities, and enlargement of the tongue, liver, and spleen.

Growth is limited and mental development slows.

If the condition is diagnosed in early infancy, a bone marrow transplant may be curative.... hurler’s syndrome

The usual complaints are abdominal pain, bleeding, neurological symptoms, rashes, and fever. Sufferers typically invent dramatic histories and behave disruptively in hospital. Many have detailed medical knowledge and scars from self-injury or previous treatment. In Munchausen’s syndrome by proxy, parents cause factitious disorders in their children.

Treatment consists of protecting sufferers from unnecessary operations and drug treatments.... munchausen’s syndrome

Nelson’s syndrome is treated by hypophysectomy (removal or destruction of the pituitary gland).... nelson’s syndrome

Common causes include natural disasters, violence, rape, torture, serious physical injury, and military combat.

Symptoms, which may develop many months after the event, include recurring memories or dreams of the event, a sense of personal isolation, and disturbed sleep and concentration.

There may be a deadening of feelings, or irritability and feelings of guilt, sometimes building up to depression.

Most people recover, in time, with emotional support and counselling.... post-traumatic stress disorder

It may be present at birth, in which there are usually no symptoms.

Surgery may be performed to treat a disc prolapse or spondylolisthesis.

(See also spinal fusion.)... sacralization

The syndrome is caused by an immune response and usually develops only in people with a genetic predisposition. Most patients have the -B27 tissue type (see histocompatability antigens). The syndrome’s development is induced by infection: usually nongonococcal urethritis, but sometimes bacillary dysentery. Reiter’s syndrome usually starts with a urethral discharge, which is followed by conjunctivitis and then arthritis. The arthritis usually affects 1 or 2 joints (usually the knee and/or ankle) and is often associated with fever and malaise. Attacks can last for several months. Tendons, ligaments, and tissue in the soles of the feet may also become inflamed. Skin rashes are common.

Diagnosis is made from the symptoms.

Analgesic drugs and nonsteroidal antiinflammatory drugs relieve symptoms but may have to be taken for a long period.

Relapses occur in about 1 in 3 cases.... reiter’s syndrome

The disorder starts as the child recovers from the infection. Symptoms include uncontrollable vomiting, lethargy, memory loss, and disorientation. Swelling of the brain may cause seizures, disturbances in heart rhythm, coma, and cessation of breathing.

Brain swelling may be controlled by corticosteroid drugs and by intravenous infusions of mannitol. Dialysis or blood transfusions may be needed. If breathing stops, a ventilator is used.

The death rate is around 10 per cent, and higher for those who have seizures, lapse into deep coma, and stop breathing.

Permanent brain damage may occur.... reye’s syndrome

Salpingectomy may be performed if the tube is infected (see salpingitis) or to treat ectopic pregnancy.

(See also salpingo-oophorectomy.)... salpingectomy

It is sometimes removed and used to bypass a blockage in blood vessels of the heart (see coronary artery bypass).... saphenous vein

The richest sources are meat, fish, whole grains, and dairy products.... selenium

In separation anxiety disorder, the reaction to separation is greater than that expected for the child’s level of development.

The anxiety may manifest as physical symptoms.

Separation anxiety disorder may be a feature of depression.... separation anxiety

The term is usually used in plural (sequelae) to refer to the complications of a disease.... sequela

Applications of serological techniques include the diagnosis of infectious diseases by the identification of antibodies, the development of antiserum preparations for passive immunization, and the determination of blood groups in paternity testing and forensic investigations.... serology

(See radiation units).... sievert

The nasal cavity, throat, and vagina may also be affected.

The syndrome tends to occur with certain autoimmune disorders, such as rheumatoid arthritis and systemic lupus erythematosus.

Most sufferers are middle-aged women.... sjögren’s syndrome

to heal, or that would leave tethering or unsightly scars. A skin graft is often used in the treatment of burns or sometimes for nonhealing ulcers. A piece of healthy skin is detached from one part of the body and transferred to the affected area. New skin cells grow from the graft and cover the damaged area. In a meshed graft, donor skin is removed and made into a mesh by cutting. The mesh is stretched to fit the recipient site; new skin cells grow to fill the spaces in the mesh. In a pinch graft, multiple small areas of skin are pinched up and removed from the donor site. Placed on the recipient site, they gradually expand to form a new sheet of healthy skin. (See also skin flap.)... skin graft

People with sleep apnoea may not be aware of any problem during the night, but they may be sleepy during the day, with poor memory and concentration. Severe sleep apnoea is potentially serious and may lead to hypertension, heart failure, myocardial infarction, or stroke.

Obstructive sleep apnoea is the most common type and may affect anyone, but more often middle-aged men, especially those who are overweight. The most common cause is over-relaxation of the muscles of the soft palate in the pharynx, which obstructs the passage of air. Obstruction may also be caused by enlarged tonsils or adenoids. The obstruction causes snoring. If complete blockage occurs, breathing stops. This triggers the brain to restart breathing, and the person may gasp and wake briefly.

In central sleep apnoea, breathing stops because the chest and diaphragm muscles temporarily cease to work, probably due to a disturbance in the brain’s control of breathing. Causes include paralysis of the diaphragm and disorders of the brainstem. Snoring is not a main feature.People who are overweight may find losing weight helps.

Alcohol and sleeping drugs aggravate sleep apnoea.

In one treatment, air from a compressor is forced into the airway via a mask worn over the nose.

Night-time artificial ventilation may be needed.

Tonsillectomy, adenoidectomy, or surgery to shorten or stiffen the soft palate may be performed.... sleep apnoea

part of the eye and of the retina at the back. (See also eye, examination of.)... slit-lamp

It often causes belching and abdominal discomfort.

Long-term use may cause swollen ankles, muscle cramps, tiredness, and nausea.... sodium bicarbonate

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

spinal anaesthesia Injection of an anaesthetic into the cerebrospinal fluid in the spinal canal to block pain sensations before they reach the central nervous system. It is used mainly during surgery on the lower abdomen and legs.

(See also epidural anaesthesia.)... spina bifida

Disc prolapse may lead to pressure on a spinal nerve, causing pain. Injury to a nerve may lead to loss of sensation or movement in the area supplied by the nerve. (See also nerve injury; neuropathy.)... spinal nerves

Usually due to trauma, it can also be a sign of infective endocarditis.... splinter haemorrhage

As a result, the arch is weak and prone to damage under stress, which may produce spondylolisthesis.

Otherwise, spondylolysis is usually symptomless.

See cervical spondylosis; cervical osteoarthritis.... spondylolysis

The infection is most often contracted through a skin wound; gardeners are particularly vulnerable.

An ulcer develops at the site of the wound, followed by the formation of nodules in lymph channels around the site.

Potassium iodide solution taken orally usually clears up the infection.

Rarely, in people with reduced immunity, sporotrichosis spreads to other parts of the body and requires treatment with amphotericin, an antifungal drug.... sporotrichosis

Treatment consists of applying an icepack, wrapping the joint in a bandage, resting it in a raised position, and taking analgesic drugs.

In severe cases, surgical repair may be necessary.... sprain

Striae often develop on the hips and thighs during the adolescent growth spurt, especially in athletic girls. They are a common feature of pregnancy, occurring on the breasts, thighs, and lower abdomen. Purple striae are a characteristic feature of Cushing’s syndrome.

Striae are thought to be caused by an excess of corticosteroid hormones.

There is no means of prevention, but in some cases laser treatment may be used.... stria

A radioactive variety, strontium 90, is produced during nuclear reactions and may be present in nuclear fallout.

Strontium 90 accumulates in bone, where the radiation it emits may cause leukaemia and/or bone tumours.

Other forms of radioactive strontium have been used to diagnose and treat bone tumours.... strontium

The cause is narrowing of the arteries that carry blood to the arms, usually due to atherosclerosis.

Treatment is by arterial reconstructive surgery.... subclavian steal syndrome

Possible side effects are constipation and abdominal pain.... sucralfate

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

Side effects include nausea and abdominal pain.... sulfinpyrazone

Popularly termed the “conscience”, the superego arises as a result of a child incorporating the moral views of those in authority (usually parents).... superego

It may be used before injections as an antiseptic.... surgical spirit

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

Investigations of swallowing difficulty may include oesophagoscopy or barium swallow (see barium X-ray examinations).

Treatment depends on the cause.... swallowing

joints. The condition is 3 times as common in women and is most likely to appear between the age of 30 and 50.

The number and severity of symptoms varies. The most common symptom is Raynaud’s phenomenon. Also common are changes in the skin, especially of the face and fingers, which becomes shiny, tight, and thickened, leading to difficulty with movements. Other parts of the body may also be affected, leading to difficulty in swallowing, shortness of breath, palpitations, high blood pressure, joint pain, or muscle weakness. Progression of scleroderma is often rapid in the first few years and then slows down or even stops. In a minority of people, degeneration is rapid, and leads to death from heart failure, respiratory failure, or kidney failure.

There is no cure for scleroderma, but many of the symptoms can be relieved.... systemic sclerosis

The cause is a defective response of the body tissues to testosterone.

The causative genes are carried on the X chromosome, and so females can be carriers. Affected individuals appear to be girls throughout childhood, and most develop female secondary sexual characteristics at puberty; but amenorrhoea occurs, and a diagnosis is usually made during investigations to find its cause. Chromosome analysis shows the presence of male chromosomes and blood tests show male levels of testosterone. Treatment of testicular feminization syndrome involves surgical removal of the testes, to prevent cancerous change in later life, and therapy with oestrogen drugs. An affected person is not fertile but can live a normal life as a woman.... testicular feminization syndrome

Treatment with growth hormone from infancy helps girls with Turner’s syndrome to achieve near normal height. Coarctation of the aorta is treated surgically. Treatment with oestrogen drugs induces menstruation, but it does not make affected girls fertile.... turner’s syndrome

Habitat: Native to Sudan. Cultivated in dry parts of western India.

Action: The tree yields the true Gum arabic of commerce. Mucilaginous, demulcent, emulsifying agent. Used as an ingredient in compounds for treatment of diarrhoea, catarrh.

Habitat: West Bengal, Bihar, western peninsula.

Action: Cutch is prepared from the heartwood. See A. catechu.

Habitat: The alpine zone of the Himalayas of Sikkim and Chumbi. Principal source of Bikh or Bish of Kolkata market. English: Nepal Aconite. Ayurvedic: Vatsanaabha (related sp.).

Action: Antipyretic, analgesic.

Habitat: Native to Europe; grows in temperate Himalayas from Hazara to Bhutan.

Action: Root—antirheumatic, anti-inflammatory, nerve sedative, emetic, purgative; used in the treatment of rheumatic fever, lumbago, scrofula, nervous disorders, chorea.

The exact trigger is unknown, but it is thought that, whatever the stimulus, chemical mediators produced by cells of the immune system or elsewhere in the body spread and sustain an in?ammatory reaction. Cascade mechanisms with multiple interactions are provoked. CYTOTOXIC substances (which damage or kill cells) such as oxygen-free radicals and PROTEASE damage the alveolar capillary membranes (see ALVEOLUS). Once this happens, protein-rich ?uid leaks into the alveoli and interstitial spaces. SURFACTANT is also lost. This impairs the exchange of oxygen and carbon dioxide in the lungs and gives rise to the clinical and pathological picture of acute respiratory failure.

The typical patient with ARDS has rapidly worsening hypoxaemia (lack of oxygen in the blood), often requiring mechanical ventilation. There are all the signs of respiratory failure (see TACHYPNOEA; TACHYCARDIA; CYANOSIS), although the chest may be clear apart from a few crackles. Radiographs show bilateral, patchy, peripheral shadowing. Blood gases will show a low PaO2 (concentration of oxygen in arterial blood) and usually a high PaCO2 (concentration of carbon dioxide in arterial blood). The lungs are ‘sti?’ – they are less e?ective because of the loss of surfactant and the PULMONARY OEDEMA.

Causes The causes of ARDS may be broadly divided into the following:... acute respiratory distress syndrome (ards)

Habitat: Native to Central Asia. Cultivated all over India.

Action: Antibiotic, bacteriostatic, fungicide, anthelmintic, antithrom- bic, hypotensive, hypoglycaemic, hypocholesterolaemic. Also used for upper respiratory tract infections and catarrhal conditions.

Habitat: Native to temperate northern Europe and the U.S.; distributed in the western Himalayas from Kashmir to Kumaon at altitudes of 2,400-3,000 m.

Action: Used in place of young onions.

Habitat: Native to East Indies. Occurs in the eastern Himalayas from West Bengal eastwards.

Action: Rhizomes are used as a substitute for A. galanga and even for ginger; antiulcerative, spasmolytic.

Habitat: Throughout moist regions of India, especially in West Bengal and west-coast forests of southern India.

Action: Bark—febrifuge, antiperi- odic, spasmolytic, antidysenteric, uterine stimulant, hypotensive; used for internal fevers.

Habitat: Throughout the hotter parts of India, especially around tanks and ponds.

Action: Febrifuge, galactagogue, cholagogue.

Habitat: Cultivated fields, waste places and along roadsides.

Action: Galactogenic, laxative, emollient, spasmolytic, diuretic. Pollen extract—used for allergic asthma and allergic rhinitis. Root— used in menorrhoea.

Habitat: Cultivated in swampy places in Bengal, Sikkim, Assam and Tamil Nadu.

Action: Stomachic, antiemetic, an- tibilious, astringent, alexipharmic; used for the treatment of indigestion, biliousness, abdominal pains, vomiting, in congestion of liver. Pericarp—in headache and stomatitis.

Habitat: The western Himalayas at 2,400-3,900 m, and Kashmir.

Action: Gum—an Indian substitute for tragacanth (A. gummifer gum).... astragalus strobiliferus

Habitat: Cultivated all over India.

Action: Carminative, stomachic, antispasmodic.

Habitat: A native to South America and the West Indies; now cultivated throughout India.

Action: Leaves—insecticide (seed powder, mixed with leaf juice is used for removing lice from scalp). Seeds—abortifacient. Root— purgative, used in blood dysentery.

Habitat: Found all over India, ascending to 300 m.

Action: Root—aphrodisiac (considered as a rejuvenator), nervine (used in diseases of nervous system, sexual disorders), diuretic (used in strangury), antirheumatic. Seeds—hypotensive, spasmolytic. Leaves—used externally in skin diseases (ringworm, eczema, boils, swellings); rubefacient, topically stimulant.

Habitat: Throughout India; up to 1,800 m in the western Himalayas.

Action: Antidysenteric, anticholerin, febrifuge; also used in anaemia, anasarca and hemiplegia. Seeds— taeniafuge.

• Infuse 1 teaspoon of dried (or powdered) flower into ½ cup of hot water.
• Allow the mix to steep for about 10 minutes.

• muscle pains
• contusions
• sore feet
• leg ulcers in diabetics
• sprains and bruises
• hair loss
• acne
• scars, eczemas and itching caused by poison ivy

Habitat: The mountainous regions from Asia Minor to Iraq and Iran.

Action: Gum—antirheumatic, aperient, anthelmintic, emollient.

Habitat: A cereal and fodder crop of Europe and America; also cultivated in India.

Action: Nervine tonic (used in spermatorrhoea, palpitation, sleeplessness), cardiac tonic (used in debility), stimulant, antispasmodic, thymoleptic, antidepressant (used in menopausal phase). Also used in diarrhoea, dysentery, colitis. Externally, emollient.

Absent CORNEAL REFLEX

Absent VESTIBULO-OCULAR REFLEX

No cranial motor response to somatic (physical) stimulation

Absent gag and cough re?exes

No respiratory e?ort in response to APNOEA despite adequate concentrations of CARBON DIOXIDE in the arterial blood.... b nosed. the test for brain-stem death are:

Habitat: The Himalayas from Uttar Pradesh to West Bengal, up to an altitude of 1,200 m.

Action: Mild antiseptic, expectorant (given in spasmodic cough); also used as an antianaemic.

Habitat: Madhya Pradesh, Maharashtra, Karnataka.

Action: Anti-inflammatory (used internally and externally for rheumatic affections).... blepharispermum subsessile

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

About the Nutrients in This Food Because beans use stored starches and sugars to produce green shoots called sprouts, sprouted beans have less carbohydrate than the beans from which they grow. But bean sprouts are a good source of dietary fiber, including insoluble cellulose and lignin in leaf parts and soluble pectins and gums in the bean. The sprouts are also high in the B vitamin folate and vitamin C. One-half cup raw mung bean sprouts has 1.2 mg dietary fiber, 31.5 mcg folate (8 percent of the R DA), and 7 mg vitamin C (9 percent of the R DA for a woman, 7 percent of the R DA for a man). Raw beans contain anti-nutrient chemicals that inhibit the enzymes we use to digest proteins and starches; hemagglutinins (substances that make red blood cells clump together); and “factors” that may inactivate vita- min A. These chemicals are usually destroyed when the beans are heated. with the bean must be cooked before serving. Sprouted beans served

The Most Nutritious Way to Serve This Food Cooked (see Adverse effects associated with this food ).

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

Buying This Food Look for: Fresh, crisp sprouts. The tips should be moist and tender. (The shorter the sprout, the more tender it will be.) It is sometimes difficult to judge bean sprouts packed in plastic bags, but you can see through to tell if the tip of the sprout looks fresh. Sprouts sold from water-filled bowls should be refrigerated, protected from dirt and debris, and served with a spoon or tongs, not scooped up by hands. Avoid: Mushy sprouts (they may be decayed) and soft ones (they have lost moisture and vitamin C).

Storing This Food Refrigerate sprouts in a plastic bag to keep them moist and crisp. If you bought them in a plastic bag, take them out and repack them in bags large enough that they do not crush each other. To get the most vitamin C, use the sprouts within a few days.

Preparing This Food R inse the sprouts thoroughly under cold running water to get rid of dirt and sand. Discard any soft or browned sprouts, then cut off the roots and cook the sprouts. Do not tear or cut the sprouts until you are ready to use them. When you slice into the sprouts, you tear cells, releasing enzymes that begin to destroy vitamin C.

What Happens When You Cook This Food Cooking destroys some of the heat-sensitive vitamin C in sprouts. To save it, steam the sprouts quickly, stir-fry them, or add them uncooked just before you serve the dish.

How Other Kinds of Processing Affect This Food Canning. Vitamin C is heat-sensitive, and heating the sprouts during the canning process reduces their vitamin C content.

Medical Uses and/or Benefits Lower risk of some birth defects. As many as t wo of ever y 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their mothers’ not having gotten adequate amounts of folate during pregnancy. The R DA for folate is 400 mcg for healthy adult men and women, 600 mcg for pregnant women, and 500 mcg for women who are nursing. Taking folate supplements before becoming pregnant and continuing through the first t wo months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Woman’s Hospital, in Boston, demonstrated that a diet provid- ing more than 400 mcg folate and 3 mg vitamin B6 daily, from either food or supplements, more than twice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the analysis, the results are assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane University examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease.

Adverse Effects Associated with This Food Food poisoning: Reacting to an outbreak of Salmonella and E. coli O157:H7 food poisoning associated with eating raw alfalfa sprouts, the Food and Drug Administration issued a warn- ing in 1998 and again in summer 1999, cautioning those at high risk of food-borne illness not to eat any raw sprouts. The high-risk group includes children, older adults, and people with a weakened immune system (for example, those who are HIV-positive or undergoing cancer chemotherapy). Tests conducted by the U.S. Department of Agriculture in 1999 sug- gest that irradiating raw sprouts and bathing them in an antiseptic solution at the processing plant may eliminate disease organisms and prolong the vegetable’s shelf life; this remains to be proven.... bean sprouts

Habitat: Native to Mexico; grown in Indian gardens.

Action: Leaf and flower—used to treat asthma; to induce hallucinations. Can cause severe toxicity.

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

About the Nutrients in This Food Brussels sprouts are high in dietary fiber, especially insoluble cellulose and lignan in the leaf ribs. They are also a good source of vitamin A and vitamin C. One-half cup cooked fresh brussels sprouts has three grams of dietary fiber, 1,110 IU vitamin A (48 percent of the R DA for a woman, 37 percent of the R DA for a man), 47 mcg folate (16 percent of the R DA), and 48 mg vitamin C (64 percent of the R DA for a woman, 53 percent of the R DA for a man). Brussels sprouts also contain an antinutrient, a natural chemical that splits the thiamin (vitamin B1) molecule so that it is no longer nutritionally useful. This thiamin inhibitor is inactivated by cooking.

The Most Nutritious Way to Serve This Food Fresh, lightly steamed to preserve the vitamin C and inactivate the antinutrient.

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

Buying This Food Look for: Firm, compact heads with bright, dark-green leaves, sold loose so that you can choose the sprouts one at a time. Brussels sprouts are available all year round. Avoid: Puff y, soft sprouts with yellow or wilted leaves. The yellow carotenes in the leaves show through only when the leaves age and their green chlorophyll pigments fade. Wilting leaves and puff y, soft heads are also signs of aging. Avoid sprouts with tiny holes in the leaves through which insects have burrowed.

Storing This Food Store the brussels sprouts in the refrigerator. While they are most nutritious if used soon after harvesting, sprouts will keep their vitamins (including their heat-sensitive vitamin C) for several weeks in the refrigerator. Store the sprouts in a plastic bag or covered bowl to protect them from moisture loss.

Preparing This Food First, drop the sprouts into salted ice water to flush out any small bugs hiding inside. Next, trim them. Remove yellow leaves and leaves with dark spots or tiny holes, but keep as many of the darker, vitamin A–rich outer leaves as possible. Then, cut an X into the stem end of the sprouts to allow heat and water in so that the sprouts cook faster.

What Happens When You Cook This Food Brussels sprouts contain mustard oils (isothiocyanates), natural chemicals that break down into a variety of smelly sulfur compounds (including hydrogen sulfide and ammonia) when the sprouts are heated, a reaction that is intensified in aluminum pots. The longer you cook the sprouts, the more smelly compounds there will be. Adding a slice of bread to the cook- ing water may lessen the odor; keeping a lid on the pot will stop the smelly molecules from floating off into the air. But keeping the pot covered will also increase the chemical reaction that turns cooked brussels sprouts drab. Chlorophyll, the pigment that makes green vegetables green, is sensi- tive to acids. When you heat brussels sprouts, the chlorophyll in their green leaves reacts chemically with acids in the sprouts or in the cooking water to form pheophytin, which is brown. The pheophytin turns cooked brussels sprouts olive or, since they also contain yel- low carotenes, bronze. To keep cooked brussels sprouts green, you have to reduce the interaction between chlorophyll and acids. One way to do this is to cook the sprouts in a lot of water, so the acids will be diluted, but this increases the loss of vitamin C.* Another alternative is to leave the lid off the pot so that the hydrogen atoms can float off into the air, but this allows the smelly sulfur compounds to escape, too. The best solution is to steam the sprouts quickly in very little water, so they retain their vitamin C and cook before there is time for reaction between chlorophyll and hydrogen atoms to occur.

How Other Kinds of Processing Affect This Food Freezing. Frozen brussels sprouts contain virtually the same amounts of vitamins as fresh boiled sprouts.

Medical Uses and/or Benefits Protection against cancer. Naturally occurring chemicals (indoles, isothiocyanates, gluco- sinolates, dithiolethiones, and phenols) in brussels sprouts, broccoli, cabbage, cauliflower and other cruciferous vegetables appear to reduce the risk of some cancers, perhaps by pre- venting the formation of carcinogens in your body or by blocking cancer-causing substances from reaching or reacting with sensitive body tissues or by inhibiting the transformation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inac- tivate and help eliminate carcinogens. At Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. In 1997, the Johns Hopkins researchers discovered that broccoli seeds and three- day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old broccoli sprouts contain as much sulforaphane as 150 grams of mature broccoli. The sulforaphane levels in other cruciferous vegetables have not yet been calculated. Lower risk of some birth defects. Up to two or every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their mothers’ not having gotten adequate amounts of folate during pregnancy. NOTE : The current R DA for folate is 180 mcg for a woman and 200 mcg for a man, but the FDA now recommends * Brussels sprouts will lose as much as 25 percent of their vitamin C if you cook them in water that is cold when you start. As it boils, water releases oxygen that would otherwise destroy vitamin C. You can cut the vitamin loss dramatically simply by letting the water boil for 60 seconds before adding the sprouts. 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becoming pregnant and continuing through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Possible lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Women’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, either from food or supple- ments, might reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the study, the results were assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sulfora- phane to suggest that it may also protect cells in the eyes from damage due to ultraviolet light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss.

Adverse Effects Associated with This Food Enlarged thyroid gland (goiter). Cruciferous vegetables, including brussels sprouts, contain goitrin, thiocyanate, and isothiocyanate. These chemicals, known collectively as goitrogens, inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to produce more. Goitrogens are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have a thyroid condi- tion or are taking thyroid medication. Intestinal gas. Bacteria that live naturally in the gut degrade the indigestible carbohydrates (food fiber) in brussels sprouts and produce gas that some people find distressing.

Food/Drug Interactions Anticoagulants Brussels sprouts are rich in vitamin K, the blood-clotting vitamin produced naturally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of drained, boiled brussels sprouts contains 219 mcg vitamin K, nearly three times the R DA for a healthy adult.... brussels sprouts

Habitat: Indigenous to New Zealand. Now distributed in Karnataka and Tamil Nadu.

Action: Fruit—used in puerperal sepsis and septic wounds, also for debility and cough.

Habitat: Throughout tropical India.

Action: Plant—used in insomnia, convulsions, cramps, chest-complaints, inflammations, tumours, chronic skin diseases. Ash—in stomachache. Leaves— diuretic, astringent, antiseptic. Paste is applied to burns, contusions and wounds. Decoction is given in strangury, asthma and phthisis. Roots—decoction is given in lithia- sis. Mature leaves are recommended in diabetes; contain an insulin-like principle.

• Place one teaspoonful of the dried bistort rhizome in a 250 ml cup of water and boil the mix.
• Let it steep for about 10 to 15 minutes.
• Strain the liquid.

• treat diarrhea, dysentery and irritable bowel syndrome
• aid in the treatment of diverticulitis
• help treating oral and tongue inflammations
• help fighting pharyngitis and sore throat
• help in the treatment of jaundice
• aid fighting measles and smallpox
• fight hemorrhoids
• ease menstrual bleeding
• help in the healing of wounds, skin ruptures and burstings (when applied topically)

Habitat: The drier parts of Peninsular India.

Action: Gum-resin—antiseptic, anti-inflammatory, antiatheroscle- rotic, emmenagogue, analgesic, sedative, hypotensive. Also used in obesity, diarrhoea, dysentery, piles, urinary disorders, scrofulous affections. Oil—used topically in chronic ulcers, ringworm.

Many snakes are non-venomous (e.g. pythons, garter snakes, king snakes, boa constrictors) but may still in?ict painful bites and cause local swelling. Most venomous snakes belong to the viper and cobra families and are common in Asia, Africa, Australia and South America. Victims of bites may experience various effects including swelling, PARALYSIS of the bitten area, blood-clotting defects, PALPITATION, respiratory di?culty, CONVULSIONS and other neurotoxic and cardiac effects. Victims should be treated as for SHOCK – that is, kept at rest, kept warm, and given oxygen if required but nothing by mouth. The bite site should be immobilised but a TOURNIQUET must not be used. All victims require prompt transfer to a medical facility. When appropriate and available, antivenoms should be administered as soon as possible.

Similar management is appropriate for bites and stings by spiders, scorpions, sea-snakes, venomous ?sh and other marine animals and insects.

Bites and stings in the UK The adder (Vipera berus) is the only venomous snake native to Britain; it is a timid animal that bites only when provoked. Fatal cases are rare, with only 14 deaths recorded in the UK since 1876, the last of these in 1975. Adder bites may result in marked swelling, weakness, collapse, shock, and in severe cases HYPOTENSION, non-speci?c changes in the electrocardiogram and peripheral leucocytosis. Victims of adder bites should be transferred to hospital even if asymptomatic, with the affected limb being immobilised and the bite site left alone. Local incisions, suction, tourniquets, ice packs or permanganate must not be used. Hospital management may include use of a speci?c antivenom, Zagreb®.

The weever ?sh is found in the coastal waters of the British Isles, Europe, the eastern Atlantic, and the Mediterranean Sea. It possesses venomous spines in its dorsal ?n. Stings and envenomation commonly occur when an individual treads on the ?sh. The victim may experience a localised but increasing pain over two hours. As the venom is heat-labile, immersion of the affected area in water at approximately 40 °C or as hot as can be tolerated for 30 minutes should ease the pain. Cold applications will worsen the discomfort. Simple ANALGESICS and ANTIHISTAMINE DRUGS may be given.

Bees, wasps and hornets are insects of the order Hymenoptera and the females possess stinging apparatus at the end of the abdomen. Stings may cause local pain and swelling but rarely cause severe toxicity. Anaphylactic (see ANAPHYLAXIS) reactions can occur in sensitive individuals; these may be fatal. Deaths caused by upper-airway blockage as a result of stings in the mouth or neck regions are reported. In victims of stings, the stinger should be removed as quickly as possible by ?icking, scraping or pulling. The site should be cleaned. Antihistamines and cold applications may bring relief. For anaphylactic reactions ADRENALINE, by intramuscular injection, may be required.... bites and stings

All reversible pharmacological, metabolic, endocrine and physiological causes must be excluded, and there should be no doubt that irreversible brain damage has occurred. Two senior doctors carry out diagnostic tests to con?rm that brain-stem re?exes are absent. These tests must be repeated after a suitable interval before death can be declared. Imaging techniques are not required for death to be diag-... brain-stem death

Action: Taraamiraa (Jirjeer)— used in Unani medicine as a spermatic tonic (powder of seeds is administered with a half-fried egg), also as a blood purifier, diuretic, emmenagogue and deobstruent. Leaf juice—used as a lotion for blotches, spots and blemishes.

Severe and extensive burns are most frequently produced by the clothes – for example, of a child – catching ?re. This applies especially to cotton garments, which blaze up quickly. It should be remembered that such a ?ame can immediately be extinguished by making the individual lie on the ?oor so that the ?ames are uppermost, and wrapping him or her in a rug, mat or blanket. As prevention is always better than cure, particular care should always be exercised with electric ?res and kettles or pots of boiling water in houses where there are young children or old people. Children’s clothes, and especially night-clothes, should be made of non-in?ammable material: pyjamas are also much safer than nightdresses.

Severe scalds are usually produced by escape of steam in boiler explosions. Cigarettes are a common cause of ?res and therefore of burns; people who have fallen asleep in bed or in a chair while smoking may set ?re to the bed or chair. Discarded, unextinguished cigarettes are another cause.

Degrees of burns Burns are referred to as either super?cial (or partial-thickness) burns, when there is su?cient skin tissue left to ensure regrowth of skin over the burned site; and deep (or full-thickness) burns, when the skin is totally destroyed and grafting will be necessary.

Symptoms Whilst many domestic burns are minor and insigni?cant, more severe burns and scalds can prove to be very dangerous to life. The main danger is due to SHOCK, which arises as a result of loss of ?uid from the circulating blood at the site of a serious burn. This loss of ?uid leads to a fall in the volume of the circulating blood. As the maintenance of an adequate blood volume is essential to life, the body attempts to compensate for this loss by withdrawing ?uid from the uninjured areas of the body into the circulation. If carried too far, however, this in turn begins to affect the viability of the body cells. As a sequel, essential body cells, such as those of the liver and kidneys, begin to suffer, and the liver and kidneys cease to function properly. This will show itself by the development of JAUNDICE and the appearance of albumin in the urine (see PROTEINURIA). In addition, the circulation begins to fail with a resultant lack of oxygen (see ANOXIA) in the tissues, and the victim becomes cyanosed (see CYANOSIS), restless and collapsed: in some cases, death ensues. In addition, there is a strong risk of infection occurring. This is the case with severe burns in particular, which leave a large raw surface exposed and very vulnerable to any micro-organisms. The combination of shock and infection can all too often be life-threatening unless expert treatment is immediately available.

The immediate outcome of a burn is largely determined by its extent. This is of more signi?cance than the depth of the burn. To assess the extent of a burn in relation to the surface of the body, what is known as the Rule of Nine has been evolved. The head and each arm cover 9 per cent of the body surface, whilst the front of the body, the back of the body, and each leg each cover 18 per cent, with the perineum (or crutch) accounting for the remaining 1 per cent. The greater the extent of the burn, the more seriously ill will the victim become from loss of ?uid from his or her circulation, and therefore the more prompt should be his or her removal to hospital for expert treatment. The depth of the burn, unless this is very great, is mainly of import when the question arises as to how much surgical treatment, including skin grafting, will be required.

Treatment This depends upon the severity of the burn. In the case of quite minor burns or scalds, all that may be necessary if they are seen immediately is to hold the part under cold running water until the pain is relieved. Cooling is one of the most e?ective ways of relieving the pain of a burn. If the burn involves the distal part of a limb – for example, the hand and forearm – one of the most e?ective ways of relieving pain is to immerse the burned part in lukewarm water and add cold water until the pain disappears. As the water warms and pain returns, more cold water is added. After some three to four hours, pain will not reappear on warming, and the burn may be dressed in the usual way. Thereafter a simple dressing (e.g. a piece of sterile gauze covered by cotton-wool, and on top of this a bandage or adhesive dressing) should be applied. The part should be kept at rest and the dressing kept quite dry until healing takes place. Blisters should be pierced with a sterile needle, but the skin should not be cut away. No ointment or oil should be applied, and an antiseptic is not usually necessary.

In slightly more severe burns or scalds, it is probably advisable to use some antiseptic dressing. These are the cases which should be taken to a doctor – whether a general practitioner, a factory doctor, or to a hospital Accident & Emergency department. There is still no general consensus of expert opinion as to the best ‘antiseptic’ to use. Among those recommended are CHLORHEXIDINE, and antibiotics such as BACITRACIN, NEOMYCIN and polymixin. An alternative is to use a Tulle Gras dressing which has been impregnated with a suitable antibiotic.

In the case of severe burns and scalds, the only sound rule is immediate removal to hospital. Unless there is any need for immediate resuscitation, such as arti?cial respiration, or attention to other injuries there may be, such as fractures or haemorrhage, nothing should be done on the spot to the patient except to make sure that s/he is as comfortable as possible and to keep them warm, and to cover the burn with a sterile (or clean) cloth such as a sheet, pillowcases, or towels wrung out in cold water. If pain is severe, morphine should be given – usually intravenously. Once the victim is in hospital, the primary decision is as to the extent of the burn, and whether or not a transfusion is necessary. If the burn is more than 9 per cent of the body surface in extent, a transfusion is called for. The precise treatment of the burn varies, but the essential is to prevent infection if this has not already occurred, or, if it has, to bring it under control as quickly as possible. The treatment of severe burns has made great advances, with quick transport to specialised burns units, modern resuscitative measures, the use of skin grafting and other arti?cial covering techniques and active rehabilitation programmes, o?ering victims a good chance of returning to normal life.

CHEMICAL BURNS Phenol or lysol can be washed o? promptly before they do much damage. Acid or alkali burns should be neutralised by washing them repeatedly with sodium bicarbonate or 1 per cent acetic acid, respectively. Alternatively, the following bu?er solution may be used for either acid or alkali burns: monobasic potassium phosphate (70 grams), dibasic sodium phosphate (70 grams) in 850 millilitres of water. (See also PHOSPHORUS BURNS.)... burns and scalds

Habitat: Central and Southern India.

Action: Seeds—sedative and anthelmintic; decoction emollient and used topically for piles. Seed oil—anthelmintic and hypotensive. Seeds exhibit haemagglutinating activity against human ABO red cells. Roots—hypotensive. Watery sap from stems is used for drinking purposes. Bark is used in tonics and elixirs.

Habitat: Native to India and Malaysia. Cultivated in Bengal and South India, also grown as a hedge plant.

Action: Wood decoction— emmenagogue, antidiarrhoeal; used in skin diseases.

Habitat: Western temperate Himalayas from 2,500 to 4,000 m.

Habitat: Cultivated in Assam, Darjeeling, Travancore, the Nilgiris, Malabar, Bengal, Dehra Dun and Kumaon.

Action: Stimulant, diuretic, astringent. In China, used for diarrhoea and dysentery (causes gastrointestinal upsets and nervous irritability when consumed in excess). Green tea: anticancer effects have been observed in Chinese green tea, Camellia thea, extract; the extract of Japanese green tea showed antihepatotoxic effects.

Habitat: A large, deciduous tree distributed in West Ghats, Assam and Sikkim.

Action: Resin—used for chronic cutaneous diseases, such as psoriasis, pityriasis; as a linament in rheumatic affections. Dammer Oil—used for rheumatism, asthma, venereal diseases.

Habitat: Cultivated all over the country. Commonly occurs in waste grounds, along road side, often becoming gregarious along the irrigation channels of gardens.

Action: Hallucinogenic, hypnotic, sedative, analgesic, anti- inflammatory, Hemp derivatives are suggested for treating glaucoma and as an antiemetic in cancer chemotherapy. All variants produce initial excitement followed by depression.

Habitat: Dry regions of the country, also planted as a hedge plant.

Habitat: Native to the Mediterranean region. Distributed in North-west India, Rajasthan, and Peninsular India.

Action: Anti-inflammatory, deob- struent to liver and spleen, diuretic, anthelmintic, vasoconstrictive. Bark—given in splenic, renal and hepatic complaints. Juice of leaves and fruits—anticystic, bactericidal and fungicidal. Dried flower buds— used in scurvy.

Mexican prickly poppy (Argemone mexicana).

Plant Part Used: Leaf, flower, root and stem.Dominican Medicinal Uses: Leaf/whole herb: prepared as a tea for blood-cleansing, cancer, stomach ulcers, delayed menstruation, vaginal infection, menopause symptoms; prepared as a douche for vaginal infection and inflammation; as a multi-herb mixture for ovarian cysts, uterine fibroids and tumors; root: boiled tea for stomach pain.Safety: Entire plant shown to be hepatotoxic due to sanguinarine and alkaloid content, especially concentrated in the seeds; internal use strongly cautioned against.Contraindications: Pregnancy, lactation, children.Laboratory & Preclinical Data: In vitro: antifungal, anti-HIV, anti-tumor, morphine-withdrawal alleviation, uterine stimulant (organic plant extracts).* See entry for Cardo santo in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.

Habitat: In gardens as hedge throughout India.

Action: Leaves, seeds, bark— cathartic; considered specific for ringworm and other skin diseases (bark may cause dermatitis); used for bronchitis and asthma.

Synonym: C. vulgaris Lam.

Habitat: Darjeeling, Khasi Hills, Punjab and Himachal Pradesh.

Action: Leaves—astringent, antitussive and febrifuge (used for fevers and diseases of the respiratory tract). An infusion is used as a gargle in pharyngitis, proxysmal coughs, catarrh and whooping cough. Nuts—extract, as platelet inhibitor in thrombosis and atherosclerosis.

Habitat: Cultivated in Punjab. English: Locust Bean; St. John's Bread, Carob tree.

Action: Pod and husk from seed— antidiarrhoeal (stools in gastroenteritis and colitis are known to solidify within 48 h).

Habitat: Dry, deciduous forests, throughout Peninsular India.

Action: Leaves—anti-inflammatory, antiseptic. A paste is applied to wounds; also in rheumatism. Bark—astringent. A decoction is used in contusions and for painful joints. (The wood, its dust, moist dust of freshly cut wood, cause skin irritation and dermatitis.)

In the 19th century CFS was called neurasthenia. In the UK, myalgic encephalomyelitis (ME) is often used, a term originally introduced to describe a speci?c outbreak such as the one at the Royal Free Hospital, London in 1955. The term is inaccurate as there is no evidence of in?ammation of the brain and spinal cord (the meaning of encephalomyelitis). Doctors prefer the term CFS, but many patients see this as derogatory, perceiving it to imply that they are merely ‘tired all the time’ rather than having a disabling illness.

The cause (or causes) are unknown, so the condition is classi?ed alongside other ‘medically unexplained syndromes’ such as IRRITABLE BOWEL SYNDROME (IBS) and multiple chemical sensitivity – all of which overlap with CFS. In many patients the illness seems to start immediately after a documented infection, such as that caused by EPSTEIN BARR VIRUS, or after viral MENINGITIS, Q FEVER and TOXOPLASMOSIS. These infections seem to be a trigger rather than a cause: mild immune activation is found in patients, but it is not known if this is cause or e?ect. The body’s endocrine system is disturbed, particularly the hypothalamopituitary-adrenal axis, and levels of cortisol are often a little lower than normal – the opposite of what is found in severe depression. Psychiatric disorder, usually depression and/or anxiety, is associated with CFS, with rates too high to be explained solely as a reaction to the disability experienced.

Because we do not know the cause, the underlying problem cannot be dealt with e?ectively and treatments are directed at the factors leading to symptoms persisting. For example, a slow increase in physical activity can help many, as can COGNITIVE BEHAVIOUR THERAPY. Too much rest can be harmful, as muscles are rapidly weakened, but aggressive attempts at coercing patients into exercising can be counter-productive as their symptoms may worsen. Outcome is in?uenced by the presence of any pre-existing psychiatric disorder and the sufferer’s beliefs about its causes and treatment. Research continues.... chronic fatigue syndrome (cfs)

In one part of the body there is a further complication. The veins coming from the bowels, charged with food material and other products, split up, and their blood undergoes a second capillary circulation through the liver. Here it is relieved of some food material and puri?ed, and then passes into the inferior vena cava, and so to the right atrium. This is known as the portal circulation.

The circle is maintained always in one direction by four valves, situated one at the outlet from each cavity of the heart.

The blood in the arteries going to the body generally is bright red, that in the veins dull red in colour, owing to the former being charged with oxygen and the latter with carbon dioxide (see RESPIRATION). For the same reason the blood in the pulmonary artery is dark, that in the pulmonary veins is bright. There is no direct communication between the right and left sides of the heart, the blood passing from the right ventricle to the left atrium through the lungs.

In the embryo, before birth, the course of circulation is somewhat di?erent, owing to the fact that no nourishment comes from the bowels nor air into the lungs. Accordingly, two large arteries pass out of the navel, and convey blood to be changed by contact with maternal blood (see PLACENTA), while a large vein brings this blood back again. There are also communications between the right and left atria, and between pulmonary artery and aorta. The latter is known as the ductus arteriosus. At birth all these extra vessels and connections close and rapidly shrivel up.... circulatory system of the blood

Habitat: A shrub distributed throughout the country, especially common in Assam and Bengal.

Action: Root—Antiasthmatic, antihistaminic, antispasmodic, antitussive carminative, febrifuge. Leaf—febrifuge.

One example, called ISABEL, can be accessed by paediatricians to check on their diagnosis and management of many childhood disorders.... computerised decision-support systems

Habitat: A native to the Mediterranean region.

Action: Resin from rhizomes—hy- dragogue, Cathartic, administered in dropsy and anascara.

Habitat: Cultivated chiefly in Madhya Pradesh, Maharashtra, Rajasthan, Andhra Pradesh, Tamil Nadu, Karnataka and Bihar.

Action: Stimulant, stomachic, carminative, antispasmodic, diuretic; also hypoglycaemic and anti-inflammatory. Oil—bactericidal and larvicidal. Used in China as a remedy for measles, diabetes, aerophagy and gastroenteritis.

Habitat: Assam, North Bengal, Khasi and Jaintia Hills, sub Himalayan tracts of Uttar Pradesh and Himachal Pradesh and Western Ghats.

Action: Astringent, purgative, depurative, anti-inflammatory (used in gout, rheumatism; bronchitis, asthma, catarrhal fevers, dysuria), anthelmintic, antivermin, maggoticide, antifungal.

Habitat: Cultivated in Kashmir up to 2,000 m and in Chaubattia in Uttar Pradesh.

Action: Stigma and style—nervine tonic, sedative, antispasmodic expectorant (in dry cough, whooping cough, bronchitis), stomachic, diaphoretic, emmenagogue.

Habitat: Cultivated for its edible fruits which are usually used as salad vegetable.

Action: Seed—used in dysuria, irritation of the urinary tract, cystitis. Reduces specific gravity of urine. Also used for tapeworms.

Habitat: Native to Asia Minor, Syria and North Persia. The tree is a variety only known in the cultivated state in North-West India. (Chopra RN.)

Action: Tincture—vasoconstrictor, antiseptic, sedative, antispasmodic, diuretic. Used for cough, cold, bronchitis, varicose veins, piles, menopausal cramps, leg-cramps. Essential oil—used only externally. Used in aromatherapy for massage (10 drops in 2 teaspoonful of almond oil).