The meaning of the symbols of dream, sources/dictionary tropical, medicine seen in a dream.

What does the symbols of dream, sources/dictionary tropical and medicine mean in a dream?

The keywords of this dream: Dream Sources/dictionary Tropical

Herbal Medicine

The use of herbs as medicines is probably as old as mankind; every culture has its own traditions. Herbalism was formally established in England by an Act of Parliament during Henry VIII’s reign. Di?erent parts of a variety of plants are used to treat symptoms and to restore functions.... herbal medicine


(1) The skills and science used by trained practitioners to prevent, diagnose, treat and research disease and its related factors.

(2) A drug used to treat an individual with an illness or injury (see MEDICINES).

(3) The diagnosis and treatment of those diseases not normally requiring surgical intervention.

Defensive medicine Diagnostic or treatment procedures undertaken by practitioners in which they aim to reduce the likelihood of legal action by patients. This may result in requests for investigations that, arguably, are to provide legal cover for the doctor rather than more certain clinical diagnosis for the patient.... medicine

Preventive Medicine

The branch of medicine dealing with the prevention of disease and the maintenance of good health practices.... preventive medicine

Tropical Ulcer

A cutaneous ulcer seen particularly in malnourished individuals. The cause of these ulcers is often ascribed to a synergistic infection by the spirochaete Treponema vincentii and the anaerobic Gram negative rod, Fusobacterium nucleatum.... tropical ulcer

Alternative Medicine


Forensic Medicine

That branch of medicine concerned with matters of law and the solving of crimes, for example, by determining the cause of a death in suspicious circumstances or identifying a criminal by examining tissue found at the scene of a crime. The use of DNA identi?cation to establish who was present at the ‘scene of the crime’ is now a widely used procedure in forensic medicine.... forensic medicine

Evidence-based Medicine

The process of systematically identifying, appraising and using the best available research ?ndings, integrated with clinical expertise, as the basis for clinical decisions about individual patients. The aim is to encourage clinicians, health-service managers and consumers of health care to make decisions, taking account of the best available evidence, on the likely consequences of alternative decisions and actions. Evidence-based medicine has been developing internationally for the past 25 years, but since around 1990 its development has accelerated. The International COCHRANE COLLABORATION ?nds and reviews relevant research. Several other centres have been set up to look at the clinical application of research results, including the Centre for Evidence-Based Medicine in Oxford.... evidence-based medicine

Nuclear Medicine

The branch of medicine concerned with the use of radioactive material in the diagnosis, investigation and treatment of disease.... nuclear medicine

Sports Medicine

The ?eld of medicine concerned with physical ?tness and the diagnosis and treatment of both acute and chronic sports injuries sustained during training and competition. Acute injuries are extremely common in contact sports, and their initial treatment is similar to that of those sustained in other ways, such as falls and road traf?c incidents. Tears of the muscles (see MUSCLES, DISORDERS OF), CONNECTIVE TISSUE and LIGAMENTS which are partial (sprains) are initially treated with rest, ice, compression, and elevation (RICE) of the affected part. Complete tears (rupture) of ligaments (see diagrams) or muscles, or fractures (see BONE, DISORDERS OF – Bone fractures) require more prolonged immobilisation, often in plaster, or surgical intervention may be considered. The rehabilitation of injured athletes requires special expertise

– 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.


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

Tropical Medicine

In simple terms, tropical medicine is the medicine practised in the tropics. It arose as a discipline in the 19th century when physicians responsible for the health of colonists and soldiers from the dominant, European countries were faced with diseases not encountered in temperate climates. With extensive worldwide travel possible today, tropical diseases are now being widely seen in returning travellers and expatriates.... tropical medicine

Community Medicine

The study of health and disease in the population of a defined community or group and the practice of medicine concerned with groups or populations rather than individual patients.... community medicine

Environmental Medicine

The study of the consequences for people’s health of the natural environment. This includes the effects of climate, geography, sunlight and natural vegetation.... environmental medicine

Fringe Medicine


Genito-urinary Medicine

The branch of medicine that deals with the effects of SEXUALLY TRANSMITTED DISEASES (STDS) on the URINARY TRACT, REPRODUCTIVE SYSTEM and other systems in the body. The specialty overlaps with GYNAECOLOGY (women’s urinary and reproductive systems) and UROLOGY (men’s urinary and reproductive system).... genito-urinary medicine

Geriatric Medicine

The branch of medicine specializing in the health and illnesses of old age and the appropriate care and services.... geriatric medicine

Internal Medicine

Generally, that branch of medicine concerned with diseases that do not require surgery, specifically the study and treatment of internal organs and body systems; it encompasses many subspecialties.... internal medicine

Social Medicine

See PUBLIC HEALTH.... social medicine

Space Medicine

A medical specialty dealing with the physiological, PSYCHOLOGICAL and pathological consequences of space ?ight in which the body has to cope with unusual variations in gravitational forces, including weightlessness, a constricted environment, prolonged close contact with work colleagues in very demanding technical circumstances, and sustained periods of emotional pressure including fear. Enormous progress has been made in providing astronauts with as normal an environment as possible, and they have to undergo prolonged physical and mental training before embarking on space travel.... space medicine

Travel Medicine

That aspect of public health which seeks to prevent illnesses and injuries occurring to travellers, especially those going abroad, and manages problems arising in travellers coming back or from abroad. It is also concerned about the impact of tourism on health and the provision of health and safetyservices for tourists.... travel medicine

Physical Medicine

A medical specialty founded in 1931 and recognised by the Royal College of Physicians of London in 1972. Physical-medicine specialists started by treating rheumatic diseases; subsequently their work developed to include the diagnosis and rehabilitation of people with physical handicaps. The specialty has now been combined with that of RHEUMATOLOGY. (See also PHYSIOTHERAPY.)... physical medicine

Tropical Diseases

Technically, those diseases occurring in the area of the globe situated between the Tropic of Cancer and the Tropic of Capricorn: pertaining to the sun. They include many ‘exotic’ infections – many of them parasitic in origin – which fall under the umbrella of ‘TROPICAL MEDICINE’. However, disease in the tropics is far broader than this and includes numerous other infections, many of them with a viral or bacterial basis: for example, the viral hepatidises, streptococcal and pneumococcal infections, and tuberculosis. The prevalence of other diseases, such as rheumatic cardiac disease, cirrhosis, heptocellular carcinoma (‘hepatoma’), and various nutrition-related problems, is also much increased in most areas of the tropics. With people from developed countries increasingly travelling to worldwide destinations for business and holiday, the ‘importation’ of tropical diseases to temperate climates should be borne in mind when people fall ill.


Tropical Medicinal Plants

Tropical countries are a treasure house of a wide variety of medicinal plants. Some species are found wild, while a number of species have been domesticated by the farmers. Many species have been grown in homesteads and become part of traditional home remedies. A limited number of species are commercially cultivated though a few more have potential for large-scale production. The important tropical and subtropical medicinal plants are discussed here highlighting the importance, medicinal and other uses, distribution, botany, agrotechnology, chemical constituents and activity. For practical convenience of the discussion in this book, they are classified under the following four broad groups.

a) Medicinal herbs

b) Medicinal shrubs

c) Medicinal climbers

d)Medicinal trees... tropical medicinal plants

Complementary Medicine

A group of therapies, often described as “alternative”, which are now increasingly used to complement or to act as an alternative to conventional medicine. They fall into 3 broad categories: touch and movement (as in acupuncture, massage, and reflexology); medicinal (as in naturopathy, homeopathy. and Chinese medicine); and psychological (as in biofeedback, hypnotherapy, and meditation).... complementary medicine

Chinese Medicine

Modern Chinese medicine has rejected entirely the conception of disease due to evil spirits and treated by exorcism. Great advances in scientific knowledge in China have been made since 1949, removing much of the superstitious aspect from herbal medicine and placing it on a sound scientific basis. Advances in the field of Chinese Herbal Medicine are highlighted in an authoritative work: Chinese Clinical Medicine, by C.P. Li MD (Pub: Fogarty International Centre, Bethseda, USA).

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

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

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

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


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

Accident And Emergency Medicine

Accident and Emergency Medicine is the specialty responsible for assessing the immediate needs of acutely ill and injured people. Urgent treatment is provided where necessary; if required, the patient’s admission to an appropriate hospital bed is organised. Every part of the UK has nominated key hospitals with the appropriately trained sta? and necessary facilities to deal with acutely ill or injured patients. It is well-recognised that prompt treatment in the ?rst hour or so after an accident or after the onset of an acute illness – the so-called ‘golden hour’ – can make the di?erence between the patient’s recovery and serious disability or death.

A&E Medicine is a relatively new specialty in the UK and there are still inadequate numbers of consultants and trainees, despite an inexorable rise in the number of patients attending A&E departments. With a similar rise in hospital admissions there is often no bed available immediately for casualties, resulting in backlogs of patients waiting for treatment. A major debate in the specialty is about the likely need to centralise services by downgrading or closing smaller units, in order to make the most e?cient use of sta?.

See accident and emergency medicine

Alternative And Complementary Health Care / Medicine / Therapies

Health care practices that are not currently an integral part of conventional medicine. The list of these practices changes over time as the practices and therapies are proven safe and effective and become accepted as mainstream health care practices. These unorthodox approaches to health care are not based on biomedical explanations for their effectiveness. Examples include homeopathy, herbal formulas, and use of other natural products as preventive and treatment agents.... alternative and complementary health care / medicine / therapies

Approved Names For Medicines

The term used for names devised or selected by the British Pharmacopoeia Commission for new drugs. European Union law (1992) requires the use of a Recommended International Non-proprietary Name (rINN) for medicinal substances. In most cases the British Approved Name (BAN) and rINN were the same when the legislation was introduced; where there were di?erences, the BAN was modi?ed to meet the new requirements.

Pharmaceutical manufacturers usually give proprietary (brand) names to the drugs they develop, though doctors in the NHS are expected to prescribe using approved – nonproprietary or generic – titles. Most nonproprietary titles are those in the European Pharmacopoeia, British Pharmacopoeia Commission or the British Pharmaceutical Codex. The USA has its own legislation and arrangements covering the naming and prescribing of medicines. (See PROPRIETARY NAME; GENERIC DRUG; PATENT.)... approved names for medicines

Committee On Safety Of Medicines (csm)

An independent advisory committee – launched in 1971 in the United Kingdom – composed of doctors, pharmacists and other specialists. It advises the MEDICINES CONTROL AGENCY in the UK on the safety, e?cacy and pharmaceutical quality of MEDICINES for which licences are sought and also reviews reports of ADVERSE REACTIONS TO DRUGS, including spontaneous ‘Yellow Card’ reports from doctors or pharmacists who suspect that a patient has suffered an adverse reaction from a medicine. Its predecessor, the Committee for Safety of Drugs, was set up in 1963 in response to the THALIDOMIDE disaster.... committee on safety of medicines (csm)

Conventional Medicine

Medicine as practised by holders of a medical degree and their allied health professionals, some of whom may also practise complementary and alternative medicine. See “alternative and complementary health care”.... conventional medicine

Information Technology In Medicine

The advent of computing has had widespread effects in all areas of society, with medicine no exception. Computer systems are vital – as they are in any modern enterprise – for the administration of hospitals, general practices and health authorities, supporting payroll, ?nance, stock ordering and billing, resource and bed management, word-processing correspondence, laboratory-result reporting, appointment and record systems, and management audit.

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

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

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

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

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

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

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

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

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

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

be obtained and processed fairly and lawfully.

be held only for speci?ed lawful purposes.

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

•only be recorded where necessary for these purposes.

be accurate and up to date.

not be stored longer than necessary.

be made available to the patient on request.

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

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

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

Lifestyle Medicines

Drugs used for non-health problems or for disorders that are in the grey area between a genuine health need and a desire to change a ‘lifestyle failing’ by the use of medication. Examples are: SILDENAFIL CITRATE, which is prescribed for men unable to achieve penile erection (erectile dysfunction); and ORLISTAT, a drug used to combat OBESITY.... lifestyle medicines

Complementary And Alternative Medicine (cam)

This is the title used for a diverse group of health-related therapies and disciplines which are not considered to be a part of mainstream medical care. Other terms sometimes used to describe them include ‘natural medicine’, ‘nonconventional medicine’ and ‘holistic medicine’. CAM embraces those therapies which may either be provided alongside conventional medicine (complementary) or which may, in the view of their practitioners, act as a substitute for it. Alternative disciplines purport to provide diagnostic information as well as o?ering therapy. However, there is a move now to integrate CAM with orthodox medicine and this view is supported by the Foundation for Integrated Medicine in the UK in its report, A way forward for the next ?ve years? – A discussion paper (1997).

The University of Exeter Centre for Complementary Health Studies report, published in 2000, estimated that there are probably more than 60,000 practitioners of complementary and alternative medicine in the UK. In addition there are about 9,300 therapist members of organisations representing practitioners who have statutory quali?cations, including doctors, nurses (see NURSING), midwives, osteopaths and physiotherapists; chiropractors became fully regulated by statute in June 2001. There are likely to be many thousands more health sta? with an active interest or involvement in the practice of complementary medicine – for example, the 10,000 members of the Royal College of Nursing’s Complementary Therapy Forum. It is possible that up to 20,000 statutory health professionals regularly practise some form of complementary medicine including half of all general practices providing access to CAMs – most commonly manipulation therapies. The report from the Centre at Exeter University estimates that up to 5 million patients consulted a practitioner specialising in complementary and alternative medicine in 1999. Surveys of users of complementary and alternative practitioners show a relatively high satisfaction rating and it is likely that many patients will go on to use such therapists over an extended period. The Exeter Centre estimates that, with the increments of the last two years, up to 15–20 million people, possibly 33 per cent of the population of the country, have now sought such treatment.

The 1998 meeting of the British Medical Association (BMA) agreed to ‘investigate the scienti?c basis and e?cacy of acupuncture and the quality of training and standards of con?dence in its practitioners’. In the resulting report (July 2000) the BMA recommended that guidelines on CAM use for general practitioners, complementary medicine practitioners and patients were urgently needed, and that the Department of Health should select key CAM therapies, including acupuncture, for appraisal by the National Institute for Clinical Medicine (NICE). The BMA also reiterated its earlier recommendation that the main CAM therapies, including acupuncture, should be included in familiarisation courses on CAM provided within medical schools, and that accredited postgraduate education should be provided to inform GPs and other clinicians about the possible bene?ts of CAM for patients.... complementary and alternative medicine (cam)

Intensive Care Medicine

The origin of this important branch of medicine lies in the e?ective use of positive-pressure VENTILATION of the lungs to treat respiratory breathing failure in patients affected by POLIOMYELITIS in an outbreak of this potentially fatal disease in Denmark in 1952. Doctors reduced to 40 per cent, the 90 per cent mortality in patients receiving respiratory support with the traditional cuirass ventilator by using the new technique. They achieved this with a combination of manual positive-pressure ventilation provided through a TRACHEOSTOMY by medical students, and by looking after the patients in a speci?c area of the hospital, allowing the necessary sta?ng and equipment resources to be concentrated in one place.

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

Medical Dictionary

Medical Dictionary

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... medical dictionary

Medicines Commission

A government-appointed expert advisory body on the use of MEDICINES in the UK.... medicines commission

Medicine Of Ageing

Diseases developing during a person’s lifetime may be the result of his or her lifestyle, environment, genetic factors and natural AGEING factors.

Lifestyle While this may change as people grow older – for instance, physical activity is commonly reduced – some lifestyle factors are unchanged: for example, cigarette smoking, commonly started in adolescence, may be continued as an adult, resulting in smoker’s cough and eventually chronic BRONCHITIS and EMPHYSEMA; widespread ATHEROSCLEROSIS causing heart attacks and STROKE; osteoporosis (see BONE, DISORDERS OF) producing bony fractures; and cancer affecting the lungs and bladder.

Genetic factors can cause sickle cell disease (see ANAEMIA), HUNTINGTON’S CHOREA and polycystic disease of the kidney.

Ageing process This is associated with the MENOPAUSE in women and, in both sexes, with a reduction in the body’s tissue elasticity and often a deterioration in mental and physical capabilities. When compared with illnesses described in much younger people, similar illnesses in old age present in an atypical manner

– for example, confusion and changed behaviour due to otherwise asymptomatic heart failure, causing a reduced supply of oxygen to the brain. Social adversity in old age may result from the combined effects of reduced body reserve, atypical presentation of illness, multiple disorders and POLYPHARMACY.

Age-related change in the presentation of illnesses This was ?rst recognised by the specialty of geriatric medicine (also called the medicine of ageing) which is concerned with the medical and social management of advanced age. The aim is to assess, treat and rehabilitate such patients. The number of institutional beds has been steadily cut, while availability of day-treatment centres and respite facilities has been boosted – although still inadequate to cope with the growing number of people over 65.

These developments, along with day social centres, provide relatives and carers with a break from the often demanding task of looking after the frail or ill elderly. As the proportion of elderly people in the population rises, along with the cost of hospital inpatient care, close cooperation between hospitals, COMMUNITY CARE services and primary care trusts (see under GENERAL PRACTITIONER (GP)) becomes increasingly important if senior citizens are not to suffer from the consequences of the tight operating budgets of the various medical and social agencies with responsibilities for the care of the elderly. Private or voluntary nursing and residential homes have expanded in the past 15 years and now care for many elderly people who previously would have been occupying NHS facilities. This trend has been accelerated by a tightening of the bene?t rules for funding such care. Local authorities are now responsible for assessing the needs of elderly people in the community and deciding whether they are eligible for ?nancial support (in full or in part) for nursing-home care.

With a substantial proportion of hospital inpatients in the United Kingdom being over 60, it is sometimes argued that all health professionals should be skilled in the care of the elderly; thus the need for doctors and nurses trained in the specialty of geriatrics is diminishing. Even so, as more people are reaching their 80s, there seems to be a reasonable case for training sta? in the type of care these individuals need and to facilitate research into illness at this stage of life.... medicine of ageing

Safe Disposal Of Unwanted Medicines

Unwanted medicines are a form of ‘controlled waste’ under the Environmental Protection Act 1990 and must be disposed of in an appropriate way. The best thing is to take any extra or unwanted medicines to a registered pharmacy. Syringes and needles (used by diabetic patients, for example) pose problems: devices exist to cut o? and retain the needle, and some local authorities in the United Kingdom arrange for collection and safe disposal. There are also local ‘needle exchange’ schemes for intravenous drug abusers.

Safe use of medicines All medicines can have unwanted effects (‘side-effects’ or, more strictly, adverse effects) that are unpleasant and sometimes harmful. It is best not to take any medicine, prescribed or otherwise, unless there is a clear reason for doing so; the possible adverse effects of treatment, and the risk of their occurring, have to be set against any likely bene?t. Remember too that one treatment can affect another already being taken. Many adverse events depend upon the recommended dose being exceeded. Some people – for example, those with allergies (see ALLERGY) to a particular group of drugs, or those with kidney or liver disease – are more likely to suffer adverse effects than otherwise healthy people.

When an individual begins a course of treatment, he or she should take it as instructed. With ANTIBIOTICS treatments especially, it is important to take the whole course of tablets prescribed, because brief exposure of bacteria to an antibiotic can make them resistant to treatment. Most drugs can be stopped at once, but some treatments can cause unpleasant, and occasionally dangerous, symptoms if stopped abruptly. Sleeping tablets, anti-EPILEPSY treatment, and medicines used to treat ANGINA PECTORIS are among the agents which can cause such ‘withdrawal symptoms’. CORTICOSTEROIDS are a particularly important group of medicines in this respect, because prolonged courses of treatment with high doses can suppress the ability of the body to respond to severe stresses (such as surgical operations) for many months or even years.... safe disposal of unwanted medicines

State Medicine (health Care Systems)

Major government schemes to ensure adequate health services to substantial sectors of the community through direct provision of services.... state medicine (health care systems)

Traditional Medicine

A system of treatment modalities based on indigenous knowledge pertaining to healing. See “alternative medical system”.... traditional medicine


Medicines are drugs made stable, palatable and acceptable for administration. In Britain, the Medicines Act 1968 controls the making, advertising and selling of substances used for ‘medicinal purposes’, which means diagnosing, preventing or treating disease, or altering a function of the body. Permission to market a medicine has to be obtained from the government through the MEDICINES CONTROL AGENCY, or from the European Commission through the European Medicines Evaluation Agency. It takes the form of a Marketing Authorisation (formerly called a Product Licence), and the uses to which the medicine can be put are laid out in the Summary of Product Characteristics (which used to be called the Product Data Sheet).

There are three main categories of licensed medicinal product. Drugs in small quantities can, if they are perceived to be safe, be licensed for general sale (GSL – general sales list), and may then be sold in any retail shop. P (pharmacy-only) medicines can be sold from a registered pharmacy by or under the supervision of a pharmacist (see PHARMACISTS); no prescription is needed. P and GSL medicines are together known as OTCs – that is, ‘over-thecounter medicines’. POM (prescription-only medicines) can only be obtained from a registered pharmacy on the prescription of a doctor or dentist. As more information is gathered on the safety of drugs, and more emphasis put on individual responsibility for health, there is a trend towards allowing drugs that were once POM to be more widely available as P medicines. Examples include HYDROCORTISONE 1 per cent cream for skin rashes, CIMETIDINE for indigestion, and ACICLOVIR for cold sores. Care is needed to avoid taking a P medicine that might alter the actions of another medicine taken with it, or that might be unsuitable for other reasons. Patients should read the patient-information lea?et, and seek the pharmacist’s advice if they have any doubt about the information. They should tell their pharmacist or doctor if the medicine results in any unexpected effects.

Potentially dangerous drugs are preparations referred to under the Misuse of Drugs Act 1971 and subsequent regulations approved in 1985. Described as CONTROLLED DRUGS, these include such preparations as COCAINE, MORPHINE, DIAMORPHINE, LSD (see LYSERGIC ACID


Naming of drugs A European Community Directive (92/27/EEC) requires the use of the Recommended International Non-proprietary Name (rINN) for medicinal substances. For most of these the British Approved Name (BAN) and rINN were identical; where the two were di?erent, the BAN has been modi?ed in line with the rINN. Doctors and other authorised subscribers are advised to write titles of drugs and preparations in full because uno?cial abbreviations may be misinterpreted. Where a drug or preparation has a non-proprietary (generic) title, this should be used in prescribing unless there is a genuine problem over the bioavailability properties of a proprietary drug and its generic equivalent.

Where proprietary – commercially registered

– names exist, they may in general be used only for products supplied by the trademark owners. Countries outside the European Union have their own regulations for the naming of medicines.

Methods of administration The ways in which drugs are given are increasingly ingenious. Most are still given by mouth; some oral preparations (‘slow release’ or ‘controlled release’ preparations) are designed to release their contents slowly into the gut, to maintain the action of the drug.

Buccal preparations are allowed to dissolve in the mouth, and sublingual ones are dissolved under the tongue. The other end of the gastrointestinal tract can also absorb drugs: suppositories inserted in the rectum can be used for their local actions – for example, as laxatives – or to allow absorption when taking the drug by mouth is di?cult or impossible – for example, during a convulsion, or when vomiting.

Small amounts of drug can be absorbed through the intact skin, and for very potent drugs like OESTROGENS (female sex hormones) or the anti-anginal drug GLYCERYL TRINITRATE, a drug-releasing ‘patch’ can be used. Drugs can be inhaled into the lungs as a ?ne powder to treat or prevent ASTHMA attacks. They can also be dispersed (‘nebulised’) as a ?ne mist which can be administered with compressed air or oxygen. Spraying a drug into the nostril, so that it can be absorbed through the lining of the nose into the bloodstream, can avoid destruction of the drug in the stomach. This route is used for a small number of drugs like antidiuretic hormone (see VASOPRESSIN).

Injection remains an important route of administering drugs both locally (for example, into joints or into the eyeball), and into the bloodstream. For this latter purpose, drugs can be given under the skin – that is, subcutaneously (s.c. – also called hypodermic injection); into muscle – intramuscularly (i.m.); or into a vein – intravenously (i.v.). Oily or crystalline preparations of drugs injected subcutaneously form a ‘depot’ from which they are absorbed only slowly into the blood. The action of drugs such as TESTOSTERONE and INSULIN can be prolonged by using such preparations, which also allow contraceptive ‘implants’ that work for some months (see CONTRACEPTION).... medicines

Medicines Control Agency

An executive agency of the Department of Health with the prime function of safeguarding the public health. It ensures that branded and non-branded MEDICINES on the UK market meet appropriate standards of safety, quality and e?cacy. The agency applies the strict standards set by the UK Medicines Act (1968) and relevant European Community legislation.... medicines control agency

Non-conventional Medicine

An umbrella term to describe alternative, complementary, folk and other types of healing practices that are outside the de?nition of conventional western-type medical practice. (See COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM).)... non-conventional medicine

Occupational Health, Medicine And Diseases

Occupational health The e?ect of work on human health, and the impact of workers’ health on their work. Although the term encompasses the identi?cation and treatment of speci?c occupational diseases, occupational health is also an applied and multidisciplinary subject concerned with the prevention of occupational ill-health caused by chemical, biological, physical and psychosocial factors, and the promotion of a healthy and productive workforce.

Occupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.

In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.

The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.

Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.

The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.

Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.

Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.

Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.

Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).

Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.

In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:

the nature of the work.

how the tasks are performed in practice.

the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).

what control measures are in place and the extent to which these are adhered to.

previous occupational and non-occupational exposures.

whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,

for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.

Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that

19.5 million working days were lost as a result. The ten most frequently reported disease categories were:

stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.

back injuries: 508,000.

upper-limb and neck disorders: 375,000.

lower respiratory disease: 202,000.

deafness, TINNITUS or other ear conditions: 170,000.

lower-limb musculoskeletal conditions: 100,000.

skin disease: 66,000.

headache or ‘eyestrain’: 50,000.

traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.

vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu

pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.

While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:

CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.

hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.

LEPTOSPIROSIS – infection with Leptospira (various listed occupations).

viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.

LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.

asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.

mesothelioma from exposure to asbestos.

In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.

There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.

The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.

Inhaled materials

PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.

Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).

The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)

Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.

Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)

Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.

Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.

Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.

Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.

Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).

Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.

Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.

Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.

Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury

(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... occupational health, medicine and diseases

Thomsonian Medicine

That school of medical philosophy and therapy founded by the American messianic nature therapist Samuel Thomson (b. 1769). Thomson’s great axiom was, “Heat is life, and cold is death.” He lived in New England, which explains some of this. He and the later Thomsonians made great use of vomiting, sweating, and purging to achieve these ends...crude by present standards, but saner than standard medicine of the times (mercury, lead, bleeding, etc.). The Thomsonians split vehemently from the early Eclectics before the Civil War; the latter, larger group preferred to train professional physicians as M.D.s. The first group disavowed any overt medical training (“physicking”) although the small medical sect of Physio-Medicalists, with several medical schools and some east-coast physician converts, used Thomsonian precepts within an otherwise orthodox armamentarium.. Their training, however, became less rigorous and more charismatic in time, and, unlike the Eclectic Medical Schools that, with one exception, chose to change to an A.M.A­supported curriculum to stay in business (thereby selling their souls), the Physio-Medicalist schools were too radical and erratic, and faded into history as their graduates were left, finally, with only Michigan allowing them to practice. Many of the practices of Jethro Kloss (Back to Eden) and John Christopher are neo-Thomsonian, and much of what still goes on in the old guard of alternative therapy is what Susun Weed calls the “Heroic Tradition” (no compliment intended). Rule of thumb: If you see Lobelia and Capsicum together in a formula, along with recommendations for colonics, it’s probably something Sam Thomson did first.... thomsonian medicine

Tropical Almond

Terminalia catappa

Description: This tree grows up to 9 meters tall. Its leaves are evergreen, leathery, 45 centimeters long, 15 centimeters wide, and very shiny. It has small, yellowish- green flowers. Its fruit is flat, 10 centimeters long, and not quite as wide. The fruit is green when ripe.

Habitat and Distribution: This tree is usually found growing near the ocean. It is a common and often abundant tree in the Caribbean and Central and South America. It is also found in the tropical rain forests of southeastern Asia, northern Australia, and Polynesia.

Edible Parts: The seed is a good source of food. Remove the fleshy, green covering and eat the seed raw or cooked.... tropical almond

Tropical Eosinophilia

A syndro me found in certain tropical areas in which patients present with hypereosinophilia, pulmonary infiltration, cough, chest pain and asthma-like attacks. Associated with infection by the filarial nematodes Wuchereriabancrofti and Brugia malayi. These infections are usually amicrofilaraemic, , especially in expatriates, i.e. no microfilariae can be detected in peripheral blood.... tropical eosinophilia

Tropical Sprue

A chronic malabsorptive, diarrhoeal, steatorrhoeic condition of unknown aetiology but often associated with secondary bacterial involvement.... tropical sprue

Anecdotal Medicine

A medicament, the efficacy of which has not been proved by convincing clinical investigation and double blind trials. To the scientific mind, the difference between fact and fiction depends upon satisfying the Medicines Control Agency with worthwhile evidence of efficacy before issue of a Product Licence. ... anecdotal medicine

Anthroposophical Medicine

Holistic medicine based on the work of Dr Rudolf Steiner (1861-1925) an Austrian scientist who founded the Anthroposophical Society in 1913. To Steiner disease was more than a group of physical symptoms. It was a malfunction of man on one of four planes. These planes consist of (1) the physical body, which is surrounded by (2) the etheric body. (3) He also declared man to have an astral body (our inner life of emotional reactions) and (4) a consciousness of the personal ego – the “I”.

Steiner equated these planes with the doctrine of the elements earth, fire, air and water as understood by the Ancient World. In health all four work together in one “harmonious integrated whole”. Bad health was a sign that the balance between these states had been disrupted.

The school of thought believes that disease may be a preparation for future life towards which reincarnation is a feature. It is not possible to be an anthroposophical doctor without a fundamental relationship with the plant kingdom. It is believed that to heal the four-fold dimensions of man demands a high level spiritual awareness which is not always acquired through the usual channels of medical education. The movement has its international centre at the Goetheanum, Dornach, Switzerland. See: RUDOLF STEINER. ... anthroposophical medicine

Bastyr College Of Naturopathic Medicine

An institution for training and granting of the qualification, Doctor of Naturopathic Medicine, including study of two years basic medical sciences and two years clinical sciences. The philosophical approach includes personal responsibility for one’s own health, natural treatment of the whole person, prevention of disease, and to awaken the patient’s inherent healing powers. Of university status. Address: 144 N.E. 54th, Seattle, WA 98105, USA. See: NATUROPATHY. ... bastyr college of naturopathic medicine

Committee On Safety Of Medicines

The Committee for safety of medicines was set up in 1963 after the thalidomide disaster. It is an advisory committee which examines drugs before clinical trials, before a product licence is granted, and when passed for marketing. A product cannot be tested in the human body without the company holding a clinical trial certificate. A product licence is renewable after five years. ... committee on safety of medicines

European Journal Of Herbal Medicine

Published three times a year by The National Institute of Medical Herbalists, 9 Palace Gate, Exeter, Devon, England EX1 1JA. Material of high quality on all subjects relevant to the practice of herbal medicine, creating a forum for sharing information and opinion about developments in the field, including scientific, professional and political issues of importance to the medical herbalist. ... european journal of herbal medicine

Ayurveda Medicine

System of sacred medicine originating from Ancient India, dating from 1000 to 3000BC. Most likely it goes back to Babylonian times. It is generally believed that Western medicine has grown out of Greek medicine which, in turn scholars claim to have come from India.

Ayur (“life”) and veda (“science”), the science of life, is part of the Hindu writings – the Artharva- veda. By 500BC many of these writings, including a vast collection of ‘Materia medica’ gravitated to the University of Benares, to be joined 700 years later with another huge volume of medical literature which together formed the basis of the Ayurveda system. In rural India where Western medicine is absent it is still practised by 80 per cent of the population. Like the medical culture of China, that of India is among the oldest in the world. Today, its practitioners are skilled in gynaecology, obstetrics and other specialties.

It is a branch of Holistic medicine whereby body imbalances are restored by a natural regime, baths, fasting, enemas, cleansing diets and herbs. Time is given up to meditation and prayer for which many mantras exist. Those who practise it support the role of preventive medicine, insisting it is not only a system of cure but a metaphysical way of life touching body, mind and spirit. A strict daily discipline embraces yoga and special foods to maintain a sound and wholesome life. Ayurvedic medicine regards the herb Valerian as important for epilepsy.

Important Ayurvedic medicines include Borage, Liquorice, Cinnamon, Garlic, Gotu Kola and Wild Yam, renowned for their versatility. Of special importance to this system of medicine is the hypoglycaemic plant, Gymnema sylvestre, used since the 6th century for a condition known as “honey urine”, which today grows in popularity in the West for the treatment of diabetes. ... ayurveda medicine

British Herbal Medicine Association

Before the Medicine’s Bill proceeded to the Statute book to become the Medicine’s Act 1968, so great was the threat to the practice of herbal medicine and sale of herbal preparations, that the profession and trade were galvanised into mobilising opposition. Thus, the British Herbal Medicine Association was formed in 1964. In the ensuing struggle, important concessions were won that ensured survival.

The BHMA is recognised by the Medicines Control Agency as the official representative of the profession and the trade. Its objects are (a) to defend the right of the public to choose herbal remedies and be able to obtain them; (b) to foster research in herbal medicine and establish standards of safety which are a safeguard to the user; (c) to encourage the dissemination of knowledge about herbal remedies, and (d) do everything possible to advance the science and practice of herbal medicine, and to further recognition at all levels.

Membership is open to all interested in the future of herbal medicine, including herbal practitioners, herbal retailers, health food stores, wholesalers, importers, manufacturers, pharmacists, doctors and research workers.

The BHMA produces the British Herbal Pharmacopoeia. Its Scientific Committee is made up of senior herbal practitioners, university pharmacologists and pharmacognosists. Other publications include: BHMA Advertising Code (1978), Medicines Act Advertising guidelines (1979), the Herbal Practitioner’s Guide to the Medicine’s Act (F. Fletcher Hyde), and miscellaneous leaflets on ‘Herbs and Their Uses’.

The BHMA does not train students for examination but works in close co-operation with the National Institute of Medical Herbalists, and with the European Scientific Co-operative on Phytotherapy.

Chairmen since its inception: Frank Power, 1964-1969; Fred Fletcher-Hyde, 1969-1977; Hugh Mitchell 1977-1986; James Chappelle 1986-1990; Victor Perfitt 1990-.

During the years the association has secured important advantages for its membership, particularly continuity of sale of herbal medicines in health food shops. It continues to maintain vigilance in matterss British and European as they affect manufacturing, wholesaling, retailing, prescribing and dispensing.

See: BRITISH HERBAL PHARMACOPOEIA and BRITISH HERBAL COMPENDIUM. ... british herbal medicine association

British Herbal Medicine Association, Scientific Committee, 1995

Peter R. Bradley MSc CChem FRSC (Chairman). Whitehall Laboratories.

Sheila E. Drew BPharm PhD MRPharms. Deputy Head of Technical Services, William Ransom & Son plc.

Fred Fletcher-Hyde BSc FNIMH. President Emeritus, British Herbal Medicine Association. President Emeritus, National Institute of Medical Herbalists.

Simon Y. Mills MA FNIMH. Director, Centre for Complementary Health Studies, University of Exeter. Hugh W. Mitchell MNIMH (Hon). President, British Herbal Medicine Association. Managing Director, Mitchfield Botanics Ltd.

Edward J. Shellard BPharm PhD DSc(Hon) (Warsaw Medical Academy) FRPharmS CChem FRSC FLS. Emeritus Professor of Pharmacognosy, University of London.

Arnold Webster CChem MRSC. Technical Director, English Grains Ltd.

Peter Wetton BSc LRSC. G.R. Lane Health Products Ltd.

Hein Zeylstra FNIMH. Principal. School of Phytotherapy, Sussex. ... british herbal medicine association, scientific committee, 1995

Aviation Medicine

The medical speciality concerned with the physiological effects of air travel and with the causes and treatment of medical problems that may occur during a flight.... aviation medicine

Diving Medicine

See scuba-diving medicine; decompression sickness.... diving medicine

Folk Medicine

Any form of medical treatment that is based on popular tradition, such as the charming of warts or the use of copper bracelets to treat rheumatism.... folk medicine

Holistic Medicine

A form of therapy that treats the whole person, not just specific disease symptoms. A holistic approach is emphasized by many practitioners of complementary medicine.... holistic medicine

Council For Complementary And Alternative Medicine

A General Medical Council style organisation with a single Register, common ethics and disciplinary procedures for its members. To promote high standards of education, qualification and treatment; to preserve the patient’s freedom of choice.

Founder groups: The National Institute of Medical Herbalists, College of Osteopaths, British Naturopathic and Osteopathic Association, The British Chiropractic Association, The Society of Homoeopaths, The British Acupuncture Association, The Traditional Acupuncture Society and the Register of Traditional Chinese Medicine.

Objects: to provide vital unified representation to contest adverse legislation; to promote the interests of those seeking alternative treatments; to maintain standards of competent primary health care; to protect the practice of alternative medicine if Common Law is encroached upon. The Council prefers to work in harmony with the orthodox profession in which sense it is complementary. Council’s first chairman: Simon Mills, FNIMH. Address: 10 Belgrave Square, London SW1X BPH. ... council for complementary and alternative medicine

Eclectic Medicine

The eclectics were a group of North American physicians who selected from various systems of medicine such principles as they judged to be rational. Their materia medica was based almost entirely on herbal medicine. Part of their knowledge was acquired from the native Indian population and they enjoyed an extraordinary degree of success in the treatment of some of the deeper disturbances of the human race. However, their work was eclipsed by the advance of science and the medical revolution with its brilliant discoveries that have long since been adopted by the orthodox profession. Impressive results were reported in their professional magazine, Ellingwood’s Therapeutist, which continued in publication from the turn of the century until 1920. The recorded experiences of those early pioneers awaken renewed interest today. ... eclectic medicine

Occupational Medicine

A branch of medicine dealing with the effects of various occupations on health, and with an individual’s capacity for particular types of work. It includes prevention of occupational disease and injury and the promotion of health in the working population. Epidemiology is used to analyse patterns of sickness absence, injury, illness, and death. Clinical techniques are used to monitor the health of a particular workforce. Assessment of psychological stress and hazards of new technology are part of the remit. Occupational health risks are reduced by dust control, appropriate waste disposal, use of safe work stations and practices, limiting exposure to harmful substances, and screening for early evidence of occupational disorders.... occupational medicine

Physical Medicine And Rehabilitation

A branch of medicine concerned with caring for patients who have become disabled through injury or illness.... physical medicine and rehabilitation

Prescription-only Medicine

Drugs and medicines that are not available over the counter and can only be obtained by prescription.

Prescription-only medicines are those whose safe use is difficult to ensure without medical supervision.... prescription-only medicine

Scuba-diving Medicine

A medical speciality concerned with the physiological hazards of diving with self-contained underwater breathing apparatus.

Most hazards stem from the pressure increase with depth.

Conditions treated include burst lung and decompression sickness.... scuba-diving medicine

Accident And Emergency Medicine

accident and emergency medicine: an important specialty dealing with the immediate problems of the acutely ill and injured. See also ED.... accident and emergency medicine

Clinical Medicine

the branch of medicine dealing with the study of actual patients and the diagnosis and treatment of disease at the bedside, as opposed to the study of disease by *pathology or other laboratory work.... clinical medicine

Defensive Medicine

health care that becomes distorted by real or exaggerated fear of legal action so that medical decisions are taken with a view to protecting the professional against legal liability. See also negligence.... defensive medicine

Genitourinary Medicine

the medical specialty concerned with the study and treatment of *sexually transmitted diseases.... genitourinary medicine

First Aid And Medicine Chest

Various aspects of first aid are described under the following: ABRASIONS, BLEEDING, CUTS, SHOCK, EYES, FAINTING, FRACTURES, INJURIES, POISONING, WOUNDS, WITCH HAZEL.

Avoid overstocking; some herbs lose their potency on the shelf in time, especially if exposed. Do not keep on a high shelf out of the way. Experts suggest a large box with a lid to protect its contents, kept in a cool dry place away from foods and other household items. Store mixtures containing Camphor separately elsewhere. Camphor is well-known as a strong antidote to medicinal substances. Keep all home-made ointments in a refrigerator. However harmless, keep all remedies out of reach of children. Be sure that all tablet containers have child-resistant tops.

Keep a separate box, with duplicates, permanently in the car. Check periodically. Replace all tablets when crumbled, medicines with changed colour or consistency. Always carry a large plastic bottle of water in the car for cleansing dirty wounds and to form a vehicle to Witch Hazel and other remedies. Label all containers clearly.

Health care items: Adhesive bandages of all sizes, sterile gauze, absorbant cotton wool, adhesive tape, elastic bandage, stitch scissors, forceps (boiled before use), clinical thermometer, assorted safety pins, eye-bath for use as a douche for eye troubles, medicine glass for correct dosage.

Herbal and other items: Comfrey or Chickweed ointment (or cream) for sprains and bruises. Marshmallow and Slippery Elm (drawing) ointment for boils, abscesses, etc. Calendula (Marigold) ointment or lotion for bleeding wounds where the skin is broken. An alternative is Calendula tincture (30 drops) to cupful of boiled water allowed to cool; use externally, as a mouth rinse after dental extractions, and sipped for shock. Arnica tincture: for bathing bruises and swellings where the skin is unbroken (30 drops in a cup of boiled water allowed to cool). Honey for burns and scalds. Lobelia tablets for irritating cough and respiratory distress. Powdered Ginger for adding to hot water for indigestion, vomiting, etc. Tincture Myrrh, 5-10 drops in a glass of water for sore throats, tonsillitis, mouth ulcers and externally, for cleansing infected or dirty wounds. Tincture Capsicum (3-10 drops) in a cup of tea for shock, or in eggcup Olive oil for use as a liniment for pains of rheumatism. Cider vinegar (or bicarbonate of Soda) for insect bites. Oil Citronella, insect repellent. Vitamin E capsules for burns; pierce capsule and wipe contents over burnt area. Friar’s balsam to inhale for congestion of nose and throat. Oil of Cloves for toothache. Olbas oil for general purposes. Castor oil to assist removal of foreign bodies from the eye. Slippery Elm powder as a gruel for looseness of bowels. Potter’s Composition Essence for weakness or collapse. Antispasmodic drops for pain.

Distilled extract of Witch Hazel deserves special mention for bleeding wounds, sunburn, animal bites, stings, or swabbed over the forehead to freshen and revive during an exhausting journey. See: WITCH HAZEL.

Stings of nettles or other plants are usually rendered painless by a dock leaf. Oils of Tea Tree, Jojoba and Evening Primrose are also excellent for first aid to allay infection. For punctured wounds, as a shoemaker piercing his thumb with an awl or injury from brass tacks, or for shooting pains radiating from the seat of injury, tincture or oil of St John’s Wort (Hypericum) is the remedy. ... first aid and medicine chest

Medicines And Healthcare Products Regulatory Agency

(MHRA) a UK government agency that regulates the use of medicinal drugs and medical devices. The agency regulates and issues *licences for the clinical trial, manufacture, and marketing of new products. It also applies the regulations governing the collection, storage, and use of human blood and blood products.

MHRA section of the website... medicines and healthcare products regulatory agency

Neglected Tropical Diseases

(NTDs) as defined by the *World Health Organization (WHO), a diverse group of *communicable diseases found almost entirely among poor populations in tropical and subtropical parts of Africa, Asia, and the Americas. Although they affect more than 1.4 billion people, and countermeasures would in many cases be inexpensive, NTDs have traditionally received far less attention than the major infectious diseases HIV/AIDS, tuberculosis, and malaria. In 2013 the WHO resolved to intensify its efforts to eradicate or control NTDs. The current WHO list identifies 24 such diseases, including *Buruli ulcer, *chikungunya fever, *dengue, *leishmaniasis, and *Madura foot (mycetoma).... neglected tropical diseases

Oral Medicine

see stomatology.... oral medicine

Public Health Medicine

the specialty concerned with preventing disease and improving health in populations as distinct from individuals. Formerly known as community medicine or social medicine, it includes *epidemiology, *health promotion, *health service planning, *health protection, and evaluation. See also public health consultant.... public health medicine

Tropical Abscess

(amoebic abscess) an abscess of the liver caused by infection with *Entamoeba histolytica. See dysentery.... tropical abscess

Medicine’s Act, 1968. 

An enabling Act allowing subsequent definitive statutory instruments to be issued at the discretion of the Medicines Control Agency. The Act controls all aspects of the sale of medicines in the United Kingdom; with no exceptions.

Medicines fall into three categories: POM (Prescription Only Medicines), P (Pharmacy Only), and OTC (Over The Counter). POM and P medicines must be prescribed by a registered medical practitioner and dispensed by a pharmacist. P medicines can be sold only by a registered pharmacist. Health stores are concerned with the OTC products, the sale of which is governed by S.I. Medicines General Sales List, Order 1980, No 1922.

All medicines and substances used as medicine bearing a medicinal claim on label or advertising material must be licenced. Without a licence it is not lawful for any person, in his business, to manufacture, sell, supply, export, or import into the United Kingdom any medicinal products unless some exemption is provided in the Act or subsequent regulations. The prefix ML, followed by the Manufacturer’s number must appear on the label together with the product licence number prefixed by the capitals PL. For example, if any person other than a pharmacist sells a medicinal product which claims to relieve indigestion or headache, but the label of which bears no licence number, that shopkeeper (and the manufacturer) will be breaking the law.

All foods are exempt from licencing provided no claims are made of medicinal benefits.

A special licence (manufacturer’s) is required by any person who manufactures or assembles a medicinal product. (Section 8) He must hold a Product Licence for every product he manufactures unless some special exemption is provided by the Act. He may of course act to the order of the product licence holder. (Section 23)

“Manufacture” means any process carried on in the course of making a product but does not include dissolving or dispersing the product in, or diluting or mixing it with some other substance used as a vehicle for the purpose of administering it. It includes the mixture of two or more medicinal products.

“Assembly” means enclosing a medicinal product in a container which is labelled before the product is sold or supplied, or, where the product is already enclosed in a container in which it is supplied, labelling the container before the product is sold or supplied in it. (Section 132)

From the practitioner’s point of view, herbal medicines are exempt from the Act and no licence is required.

The consulting herbalist in private practice who compounds his own preparations from medicinal substances may apply to the Medicines Control Agency, 1 Nine Elms Lane, London SW8 5NQ for a manufacturer’s licence to authorise mixture and assembly, for administration to their patients after he has been requested in their presence to use his own judgement as to treatment required. Products thus sold, will be without any written recommendation and not advertised in any way.

The “assembly” aspect of his licence refers to his ability to buy in bulk, repackage and label. Where he uses prepackaged products and does not open the packet, or relabel, a licence is not required. He will not be able to use terms, “Stomach mixture”, “Nerve mixture”, etc, implying cure of a specific condition.

It is necessary for the practitioner to have a personal consultation with his patient before making his prescription. Subsequent treatment may be supplied by a third person or by post at the discretion of the practitioner.

A licence is required where one or more non-herbal ingredients (such as potassium iodide, sodium citrate, etc) are included. Dispensing non-herbal remedies constitutes “manufacture” for which a licence is required. (MAL 24 (3))

The main thing the licensing authority looks for before granting a licence is evidence of safety. The manufacturers’ premises must be licenced. A wholesaler or distributor, also, must have a licence.

Where a product is covered by a Product Licence certain medicinal claims may be made. Where claims are made, the Act requires a warning to appear on the label worded: “If you think you have the disease to which this product refers, consult a registered medical practitioner before taking this product. If you are already receiving medical treatment, tell your doctor you are also taking this product.” (SI 41, s.5)

Labels of all medicines, tablets, etc, must carry the words: “Keep out of the reach of children”.

Under the Act it is illegal for medicines to be offered for sale for cancer, diabetes, epilepsy, glaucoma, kidney disease, locomotor ataxy, paralysis, sexually transmitted diseases and tuberculosis; these diseases to be treated by a registered medical practitioner only.

Definition of a herbal remedy. A “herbal remedy” is a medicinal product consisting of a substance produced by subjecting a plant or plants to drying, crushing or any other process, or of a mixture whose sole ingredients are two or more substances so produced, or of a mixture whose sole ingredients are one or more substances so produced and water or some other inert substances. (Section 132)

No licence is required for the sale, supply, manufacture or assembly of any such herbal remedy in the course of a business in which the person carrying on the business sells or supplies the remedy for administration to a particular person after being requested by or on behalf of that person, and in that person’s presence, to use his own judgement as to the treatment required. The person carrying on the business must be the occupier of the premises where the manufacture or assembly takes place and must be able to close them so as to exclude the public. (Section 12 (1))

No licence is required for the sale, supply, manufacture or assembly of those herbal remedies where the process to which the plant or plants are subjected consists only of drying, crushing or comminuting and the remedy is sold or supplied under a designation which only specifies the plant or plants and the process and does not apply any other name to the remedy; and without any written recommendation (whether by means of a labelled container or package or a leaflet or in any other way) as to the use of the remedy. (Section 12 (2)) This exemption does not apply to imported products. Except where a herbal product is supplied for a medicinal use, legally it is not even a medicinal product.

The 1968 Act has been a great step forward in the history of herbal medicine, The British Herbal Medicine Association and the National Institute of Medical Herbalists fought and won many special concessions. In years following the Act standards rose sharply. Practitioners enjoy a measure of recognition, with power to manufacture and dispense their own medicines and issue official certificates for incapacitation for work.


Indian Medicine

Traditional Indian, or Ayurvedic, medicine was originally based largely on herbal treatment, although simple surgical techniques were also used. Indian medicine later developed into a scientifically based system with a wide range of surgical techniques (such as operations for cataracts and kidney stones) along with the herbal tradition.... indian medicine